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Acta Interna : The Journal of Internal Medicine
Published by Universitas Gadjah Mada
ISSN : 2303131X     EISSN : 25415441     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology
The Journal considers any original research that advocates change in, or illuminates, clinical practice. The journal also publishes interesting and informative reviews and opinions pieces on any topics connected with clinical practice. Manuscripts must be solely the work of the author(s) stated, not have been published previously elsewhere, and not be under consideration by another journal. all papers should be written to be clearly understandable to the journal`s readers in a wide range of specialities and countries. Diagrams, figures, and photographs should be used to supplement and enhance the text.
Arjuna Subject : -
Articles 129 Documents
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Impact of irrational antibiotic therapy to hospital cost of care of pneumonia in patients in Dr. Sardjito Hospital Sutrisno, Edi
Acta Interna The JOurnal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Acta Interna The JOurnal of Internal Medicine

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ABSTRACTBackground: The mortality rate from pneumonia remains very high, reaching 15% in the United States while inIndonesia pneumonia is the second leading cause of death. Antibiotics improve outcomes in those with bacterialpneumonia. Irrational antibiotic therapy impacts to bacteria resistance, potentially increasing side effects of drugs,prolonged patient’s length of stay and higher total hospital costs.Aim: This study aimed to improve the service quality by calculating the percentage of irrational antibiotic therapybased on Gyssens workfl ow and the additional total of consumables antibiotics costs.Methods: The study design was retrospective, including 57 pneumonia inpatients in internal medicine departmentwards in Dr. Sardjito Hospital, from November 2011 to January 2012. Statistical analyses were conducted byusing Mann-Whitney U test.Results: From 57 pneumonia inpatients, irrational antibiotic therapy reached 68,4% (39 of 57 patients).Azithromycin was misused and overused antibiotic. Total excess cost of daily antibiotic were Rp 294,000.00and consumables antibiotics were Rp 215,000.00Conclusion: Irrational antibiotic therapy in pneumonia is associated with and an overall impacts on healthcarecosts.Keywords: irrational antibiotic therapy, health-care cost, and customer satisfaction.
JAK2 mutation and treatment of JAK2 inhibitors in Philadelphia chromosome-negative myeloproliferative neoplasms Hutajulu, Susanna Hilda; Kurnianda, Johan
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

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ABSTRACTThe Philadelphia chromosome-negative (Ph-negative) myeloproliferative neoplasms (MPNs) polycythaemia vera (PV), essential thombocythaemia (ET) and primary myelofi brosis (PMF) are clonal disorders of multipotent haematopoietic progenitors. The genetic cause of these disorders was not fully defi ned until a somatic activating mutation in the JAK2 non-receptor tyrosine kinase, JAK2V617F, was identifi ed in most patients with PV and a considerable proportion of patients with ET and PMF. The discovery of JAK2 mutation has changed the molecular reclassification of MPNs and served as a genomic target for therapeutic implication. A number of JAK2 inhibitors have been developed and tested for MPNs. Several JAK2 inhibitors have reached the phases of clinical trial and included patients with intermediate-risk or high-risk MF. This population of MF is the best candidate for trials because currently it has no effective therapy besides patients’ poor survival. Considering all clinical data on Ph negative MPNs, JAK2 inhibitors have shown a clinical benefi t and reduced symptoms in the vast majority of MF cases. The most developed among JAK2 inhibitors is Ruxolitinib, which has demonstrated clinical improvement with well tolerated toxicities. However, JAK2 inhibitor was equally active in patients with and without JAK2 mutation. Other JAK2 inhibitors are less developed, but showed a similar clinical benefi t. Furthermore, its effect on the natural course of MPNs in treating patients needs to be investigated.Keywords: myeloproliferative neoplasms – JAK2 mutation – JAK2 inhibitors.
Reactivation and Flare of Chronic Hepatitis B: Natural History, Diagnosis, Therapy and Prevention Cahyono, Suharjo Broto; Neneng Rasari, Neneng Rasari; Bayupurnama, Putut; Maduseno, Sutanto; Nurdjanah, Siti
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
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Abstract

ABSTRACTAlmost 30% of the world population has been exposed to hepatitis B virus (HBV) and 400 millionof these are chronically infected. 20–30% of HBsAg carriers may develop reactivation or fl are (acuteexacerbation) of chronic hepatitis B with elevation of biochemical levels, high serum HBV DNA level with orwithout sero-coversion to HBeAg. In countries with intermediate or high endemicity for HBV, compoundedin use cytotoxic or immunosuppressive therapy for the treatment of a wide variety of clinical disease,reactivation or fl are may be the fi rst presentation of HBV infection. Sometime it is diffi cult to differentiatebetween acute hepatitis B and reactivation (fl are). Accurate diagnosis in these cases is very important fordeciding whether to start treatment or not, because acute hepatitis B does not require treatment, whilereactivation or fl are may take benefi t from it. Effort to early detect, to treat and to prevent the reactivationor fl are of chronic hepatitis B is very crucial to reduce morbidity and mortality.Keywords: Reactivation, fl are (acute exacerbation) of chronic hepatitis B, acute hepatitis B, nucleos(t)ideanalogues
Correlation between Depressive Symptom Score and Geriatric Handgrip Strength at Nursing Home Province of Yogyakarta Syahri, Ahmad; Siswanto, Agus; Pramantara, I Dewa Putu
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
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ABSTRACTBackground: By the year of 2020, Indonesia’s elderly population will be expected to the fourth highest number in the world after China, India and USA. Special Region of Yogyakarta has the highest percentage that is equal to 13.72%. Depression may increase the risk of mortality, disability and motivation of physical Low grip strength would increase mortality and morbidity in the elderly.Objective: This study aimed to assess the correlation between depressive symptoms and handgrip strength in the elderly population in nursing homes at province of Yogyakarta.Methods: This study was a cross-sectional study that conducted in October 2010 at the nursing home residents. Depression was assessed by the Geriatric Depression Scale Cronbach’s alpha 0.88. Handgrip strength was measured by a handgrip dynamometer. Data of age, education and gender was collected by questionnaire. The study performed statistical tests to assess the correlation of symptoms depression and grip strength.Results: The mean age of subjects was 73.84 ± 8.36 years with 36 subjects (35.3%) were between 60-69 years and 66 subjects (64.7%) were over 70 years. There were 33 men (32.4%) and 69 women (67.6%). MeanGDS score was 12.76 ± 3.22. Handgrip strength in the depression group 16.94 ± 6.96 kg was higher than the non-depressed group 15.23 ± 6.79. There was correlation between severity of depression symptom byhandgrip strength with r = 0.235 (weak correlation) and statistically signifi cant with p = 0.017.Conclusion: The severity of depressive symptom scores was correlated significantly to the handgrip strength in elderly nursing homes in the province of Yogyakarta.Keywords: elderly, nursing homes, depression, handgrip strength.confi dent interval.
The Effect of Telmisartan and Metformin on Insulin Resistance in Metabolic Syndrome Patients with Insulin Therapy oktariani, Siswi; Pramono, Raden Bowo; Sinorita, Hemi
Acta Interna The JOurnal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
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ABSTRACTBackground: Recommendations for therapy insulin resistance are metformin and thiazolidindion. Sideeffects of thiazolidindion due to peripheral edema occurs to 2-5% and increased 5-15% when combinedwith insulin therapy. Telmisartan, an angiotensin receptor blocker, has anti-hypertensive effects and improveinsulin resistance. Telmisartan effect on peroxisome proliferator activated receptor γ agonist and has the samestructure of the group thiazolidindion, pioglitazone. The research objective was to determine the effectsof telmisartan and metformin on insulin resistance in metabolic syndrome patients with insulin therapy.Methods: This study used a before-after design. The study was conducted in the internal medicine clinic of theendocrinology department of Dr. Sardjito Hospital Yogyakarta. Subjects were patients who met the diagnosis of metabolic syndrome based on the IDF 2005, hypertension and received insulin therapy. Subjects given metforminand telmisartan therapy for 12 weeks. Subjects examined HOMA IR before and after treatment. The averagedecrease in HOMA IR was tested by paired t-test or Wilcoxon test. P value <0.05 was considered signifi cant.Result: The total sample were 27 subjects. Data analysis was performed on 11 subjects. Fasting bloodglucose before and after treatment was signifi cantly decreased (p<0.001) whereas the fasting insulin levelsincreased. HOMA IR was signifi cantly decreased after treatment {p = 0.004 (5.79 – 20.26), CI 95%}.Conclusion: this study found insulin resistance decreased signifi cantly in patients with the metabolicsyndrome of insulin therapy who received metformin and telmisartan.Keywords : metabolic syndrome, insulin therapy, metformin, telmisartan, HOMA IR
Relationship Between Systemic Lupus Activity Measurement (SLAM) Score and Mortality in Systemic Lupus Erytemathosus (SLE) Inpatients Paramaiswari, Ayu; Kertia, Nyoman; Achadiyono, Deddy Wachid
Acta Interna The JOurnal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
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ABSTRACTBackground: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder that can be severeand life threatening. Mortality in SLE may due to lupus activity or long-term sequel. Systemic Lupus ActivityMeasurement (SLAM) score is a tool that can count lupus disease activity inpatients.Aims: To analyze the relationship between SLAM score and mortality in lupus inpatients.Methods: Retrospective cohort study used for reaching objective of the study. Lupus inpatients was usedas research population. Medical record was used as study data collection over periods of 2006 until 2011.Independent variable was a SLAM score. The cut point of SLAM score was made based on the mean ofSLAM score (16.7 point score). Dependent variable was mortality.Results: There were differences between number of ACR criteria fi ndings, pneumonia, heart rate withSLAM score (p value 0.001; 0.001; 0.002 respectively).There was a difference of median survival between less and more than 16.7 point score, 45 and 28 respectively (p 0.034). There was a relationship betweenSLAM score (more than 16.7 point score) and mortality HR 2.78 (96% CI 1.01-7.53).There was a differenceof mortality incidence between more and less than 16.7 point score, 0.35 and 0.10 respectively. There wasa relationship between SLAM score (more than 16.7 point score) and mortality RR 3.5 (95% CI). Mortalityin lupus inpatients was 23%.Conclusion: There was a relationship between SLAM score and mortality on lupus inpatients.Keywords: SLE, SLAM, Mortality
Acute Coronary Syndrome in Young Patients at Dr. Sardjito General Hospital Setianto, Budi Yuli; Sari, Julia; Hartopo, Anggoro Budi; Gharini, Putrika Prastuti Ra
Acta Interna The JOurnal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
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ABSTRACTBackground: The incidence of acute coronary syndrome in the young patients is increased recently.Several studies reported that young patients have distinct clinical characteristics as compare with olderpatients.Objective: To assess the prevalence, risk factors and clinical presentation of acute coronarysyndrome(ACS) in young patients at Dr. Sardjito Hospital, Yogyakarta.Methods: We conducted a cross sectional study between September 2008-May 2009 at intensivecardiovascular care unit (ICCU) of Dr. Sardjito Hospital. We enrolled consecutive patients admittedwith acute coronary syndrome. We divided the patients as young ACS (age ≤ 45 years) and older ACS(age >45 years). We compared cardiovascular risk factors, clinical presentation and clinical spectrumsfrom both groups. Statistics analysis was performing using chi-square test, p value < 0.05 was consideredsignifi cantly different.Results: In our study there were 20 (13.5%) young ACS and 128 (86.5%) older ACS patients. Mostyoung ACS patients are male (90%). Proportion of diabetes mellitus in young ACS was not differentfrom that in older ACS patients (20% vs. 18.8%; p=0.55). Hypertension was not different either (50%vs. 53.1%; p=0.49). Sixty percent of young ACS patients were smoker, however its proportion did notdiffer from older ACS patients (p=0.84). There were no signifi cant differences of dyslipidemia. Theyoung ACS patients mostly experienced STEMI than NSTEMI and unstable angina (55% vs. 15%vs. 30%), but there were no signifi cant differences when compared to older ACS patients (p=0.65).Thirty percent of young ACS patients presented with Killip class II or higher, however there were nosignifi cant differences between groups (p=0.40).Conclusion: In this study we found that there were no signifi cant differences in risk factors, clinicalpresentation and spectrums between young ACS and older ACS patients. The need for preventionprogram in both groups should not be difference.Keywords: ACS– young– older– clinical presentation.
The Accuracy of Wells Clinical Model for Predicting Pretest Probability in Deep Vein Thrombosis (DVT) at Dr. Sardjito Hospital Wulansih, Dwi; Kurnianda, Johan; Widayati, Kartika
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
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ABSTRACTBackground: The diagnosis of deep vein thrombosis (DVT) is an important issue in the medical field because a large number of cases are undiagnosed. The accurate diagnosis of the DVT is essential to prevent complications of acute pulmonary embolism and long-term complications. The complication such as pulmonary hypertension and post phlebitis syndrome. It also to avoid improper anticoagulant therapy associated with a high risk of bleeding. There are several models of clinical suspicion of DVT include Hamilton’s score and Wells’ score. The Wells clinical model for predicting pretest probability for DVT has been widely used and tested its validity in several countries in Europe. The accuracy of a Wells clinical model of pretest probability for DVT has not been done for the races of Asia especially in Indonesia.Objective: This study aimed to test the accuracy and precision (sensitivity, specificity and predictive value) of Wells clinical model for predicting pretest probability for diagnose DVT for patients in the Dr. Sardjito Hospital.Methods: This study was a diagnostic study with cross-sectional design. The subjects were patients with DVT symptoms who visited Tulip clinic, outpatient and inpatient in the department of Dr. Sardjito General Hospital during January 2011-May 2012. In this study, a total of 100 patients were participated the Wells clinical model of pretest probability for DVT examination, Doppler ultrasound and D-dimer examination. The negative results on the fi rst ultrasound examination will be examined again 1 week later.Results: DVT was confi rmed in 56 patients (56%) from 100 patients. The baseline characteristics showed the number of women more than men and the mean age was 52.98 ±1.335 years. The 57% of subjects were women and the median age was ≥60 years. The most frequent risk factors of DVT were cancer 49 patients (49%), bed ridden 42 patients (42%) and elderly 33 patients (33%). The accuracy of the Wells clinical model of pretest probability for DVT was 81%, precision was 77.6%, sensitivity was 92.8%, specifi city was 65.9%, and negative predictive value was 87.9%.Conclusion: The Wells clinical model for predicting pretest probability in DVT has a high accuracy, moderate precision, high sensitivity and poor specifi city to diagnose DVT at Dr. Sardjito Hospital.Keywords: deep vein thrombosis/DVT, the Wells clinical model of pretest probability for DVT, accuracy test, precision
Acute Coronary Syndrome in Young Patients at Dr. Sardjito General Hospital Setianto, Budi Yuli; Sari, Julia; Hartopo, Anggoro Budi; Ra Gharini, Putrika Prastuti
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
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Abstract

ABSTRACTBackground: The incidence of acute coronary syndrome in the young patients is increased recently. Several studies reported that young patients have distinct clinical characteristics as compare with older patients.Objective: To assess the prevalence, risk factors and clinical presentation of acute coronary syndrome(ACS) in young patients at Dr. Sardjito Hospital, Yogyakarta.Methods: We conducted a cross sectional study between September 2008-May 2009 at intensive cardiovascular care unit (ICCU) of Dr. Sardjito Hospital. We enrolled consecutive patients admitted with acute coronary syndrome. We divided the patients as young ACS (age ≤ 45 years) and older ACS (age >45 years). We compared cardiovascular risk factors, clinical presentation and clinical spectrums from both groups. Statistics analysis was performing using chi-square test, p value < 0.05 was considered significantly different.Results: In our study there were 20 (13.5%) young ACS and 128 (86.5%) older ACS patients. Most young ACS patients are male (90%). Proportion of diabetes mellitus in young ACS was not different from that in older ACS patients (20% vs. 18.8%; p=0.55). Hypertension was not different either (50% vs. 53.1%; p=0.49). Sixty percent of young ACS patients were smoker, however its proportion did not differ from older ACS patients (p=0.84). There were no signifi cant differences of dyslipidemia. The young ACS patients mostly experienced STEMI than NSTEMI and unstable angina (55% vs. 15% vs. 30%), but there were no signifi cant differences when compared to older ACS patients (p=0.65). Thirty percent of young ACS patients presented with Killip class II or higher, however there were no significant differences between groups (p=0.40).Conclusion: In this study we found that there were no signifi cant differences in risk factors, clinical presentation and spectrums between young ACS and older ACS patients. The need for prevention program in both groups should not be difference.Keywords: ACS– young– older– clinical presentation.
Relationship Between Systemic Lupus Activity Measurement (SLAM) Score and Mortality in Systemic Lupus Erytemathosus (SLE) Inpatients Paramaiswari, Ayu; Kertia, Nyoman; Achadiyono, Deddy Wachid
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

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Abstract

ABSTRACTBackground: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder that can be severe and life threatening. Mortality in SLE may due to lupus activity or long-term sequel. Systemic Lupus Activity Measurement (SLAM) score is a tool that can count lupus disease activity inpatients.Aims: To analyze the relationship between SLAM score and mortality in lupus inpatients.Methods: Retrospective cohort study used for reaching objective of the study. Lupus inpatients was used as research population. Medical record was used as study data collection over periods of 2006 until 2011. Independent variable was a SLAM score. The cut point of SLAM score was made based on the mean of SLAM score (16.7 point score). Dependent variable was mortality.Results: There were differences between number of ACR criteria fi ndings, pneumonia, heart rate with SLAM score (p value 0.001; 0.001; 0.002 respectively).There was a difference of median survival between less and more than 16.7 point score, 45 and 28 respectively (p 0.034). There was a relationship between SLAM score (more than 16.7 point score) and mortality HR 2.78 (96% CI 1.01-7.53). There was a difference of mortality incidence between more and less than 16.7 point score, 0.35 and 0.10 respectively. There was a relationship between SLAM score (more than 16.7 point score) and mortality RR 3.5 (95% CI). Mortality in lupus inpatients was 23%.Conclusion: There was a relationship between SLAM score and mortality on lupus inpatients.Keywords: SLE, SLAM, Mortality

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