Acta Medica Indonesiana

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Correlation between cortisol levels and myocardial infarction mortality among intensive coronary care unit patients during first seven days in hospital.
(2004-01-04) Nito, Imran; Waspadji, Sarwono; Harun, S; Markum, H M S
AIM: To measure cortisol level, its relationship with myocardial infarction, and to determine the correlation of elevated cortisol levels with the outcome of myocardial infarction. METHODS: This study was designed as a pre and post study. The diagnosis of myocardial infarction was established based on the WHO criteria. The patients were followed for seven days. Blood specimens were collected on day 1, 3, 5 and 7. RESULTS: Thirty six patients with myocardial infarction were studied. Four patients (11.1%) died and 32 patients (88.9%) survived. Nineteen patients (52.7%) had large infarcts and 23 patients (63.9%) had myocardial complications. The deceased patient's cortisol level differed significantly from those tht survived (65.68 + 29.07 vs 21350 + 15.82 microg/dl, p < 0.05). The groups with large infarcts and myocardial infarct complications had higher cortisol levels, but the difference was not significant compared with the group with small infarcts and patients without complications. Six patients (16.6%) who received thrombolytic therapy had significantly lower cortisol levels as compared to patients without thrombolytic therapy. The duration of elevation cortisol elevation in the deceased patient was longer than that among those who survived. Similar findings were also true for those with large infarcts when compared to those with small infarcts, as well as myocardial infarct patients with complications when compared to those without. However, the duration of cortisol elevation was shorter among patients who received thrombolytic therapy. CONCLUSION: Cortisol level can be used as a prognostic marker for myocardial mortality.
Serum cortisol in acute myocardial infarction.
(2004-01-04) Alwi, Idrus
Relationship between creatinine clearance and plasma homocysteine levels in predialytic chronic renal failure patients.
(2004-01-04) Widiana, I G R; Suwitra, Ketut
In order to determine the relationship between homocysteine levels and renal function, a cross-sectional study was carried out at out-patients clinic division of Nephrology and Hypertension Sanglah General Hospital Denpasar. Patients selected for the study were those with creatinine levels of 1.5-8.0 mg/dl aged 18 to 60 years. All eligible patients were examined for serum creatinine levels. At the same time blood samples were drawn for the examinations of total fasting Homocysteine levels. Creatinine clearance was calculated by Cockcroft-Gault formula, serum creatinine levels were examined by Jaffe method and total fasting Homocysteine levels were examined by fluorescence polarization immunoassay method (FPIA) method. If fasting plasma homocysteine levels were correlated with some related factors including creatinine clearance, reciprocal creatinine levels, age and gender, it was shown that only age (r=0.39, p=0.04) and creatinine clearance (r=0.39, p=0.04) had moderate and significant correlation with homocysteine levels. If both creatinine clearance and age as independent factors were correlated with fasting plasma homocysteine levels using multiple regression analysis, it was shown that both variable had strong (r=0.5) and significant relationship (p=0.03), yielding regression equations: Hcy (mmol/L) = -0.20 Cct (ml/mnt) + 0.21 age (ys) + 12.8. In conclusions, in patients with pre-dialytic chronic renal failure both creatinine clearance and age are strong predictors to plasma homocysteine levels.
Comparison of The World Health Organization (WHO) two-step strategy and OGTT for diabetes mellitus screening.
(2004-01-04) Adam, John M F; Tarigan, Nirmala P
The new diagnostic criteria recommended by the American Diabetes Association (ADA) will only detect diabetic patients with fasting hyperglycemia, and leave patients with isolated post-challenge hyperglycemia (IPCH) and imparied glucose tolerance (IGT) unidentified. The WHO recommends that all those with abnormal fasting glucose should undergo the oral glucose tolerance test (OGTT) to exclude the diagnosis of diabetes (two-step strategy). This two-step strategy will leave out subjects with normal fasting glucose (<109 mg/dl). The aim of this study is to compare the WHO two-step strategy and the gold standard OGTT for all subjects. We re-analyzed the results of 907 high-risk patients who have been screened for diabetes mellitus and impaired glucose tolerance. All subjects were screened with an OGTT containing a 75-gram glucose load after fasting for 12 hours. The results were classified into three categories: the ADA criteria, the two-step strategy, and the OGTT. Using the ADA criteria, these 907 subjects can be classified has having normal fasting glucose (fasting plasma glucose - FPG < 109 mg/dl) in 715 subjects (78.9%), abnormal fasting glucose (FPG 110 - 125 mg/dl) in 107 subjects (11.8%), and diabetes mellitus (FPG > 126 mg/dl) in 85 subjects (9.4%). The WHO two-step strategy performed in 107 IFG subjects identified another 30 diabetic patients (FPG < 109 mg/dl and 2 hour post load > 200 mg/dl = IPCH) or 3.3%, and 49 patients with IGT, or 5.4% from all subjects. If the OGTT was performed on the 715 normal fasting glucose, it could identify another 40 diabetic patients or 4.4%, and another 178 IGT patients, or 19.6% of all subjects. This means that without OGTT to all subjects, 40 diabetic patients or 25.8% of all diabetic patients and 178 patients or 78.4% from all IGT subjects would have remained unidentified. From this study we can conclude that applying the WHO two-step strategy in subjects with IFG would fail to detect 25.8% of diabetic patients and 78.4% of IGT subjects. It is recommended that the old strategy of screening--the gold standard OGTT--should be used instead of the two-step strategy, at least in high-risk groups.
Tips for making a good research proposal.
(2004-01-28) Setiati, Siti
Constrictive pericarditis.
(2004-01-28) Rachmawati, Kamsi; Handayani, Astri; Shatri, Hamzah; Alwi, Idrus; Trisnohadi, Hanafi B
Diagnosis of disseminated intravascular coagulation in sepsis scoring system of a thrombosis-hemostasis center.
(2004-01-28) Sukrisman, Lugyanti; Tambunan, Karmel L; Suhendro,; Sukmana, Nanang
BACKGROUND: Disseminated intravascular coagulation (DIC) is a septic complication that is not easily diagnosed. The purpose of the study is to obtain a scoring system to diagnose DIC in sepsis. SUBJECT AND METHODS: An observational study with a cross-sectional design was performed at the Department of Internal Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital from February to August 2002. Subjects were septic patients in the emergency unit or inpatient ward of the Department of Internal Medicine, and were taken consecutively. The criteria of sepsis, severe sepsis and septic shock were based on ACCP/SCCM Consensus 1991. The evaluation conformed to the Thrombosis Hemostasis Center (THC) scoring system, compared with modified Bick scoring system as a gold standard. RESULTS: There were 34 subjects ranging from 19 to 78 years old, 32.4% were septic patients, 41.2% with severe sepsis and 26.5% with septic shock. The most common source of infection was pneumonia, where bacterial pathogens were found in 35.2% of blood aerobic culture and 17.7% in pus or urine culture. Gram negative bacteria was the most common pathogen found. According to a modified Bick and THC scoring system, DIC was found in all subjects, consisting of mild and moderate DIC. No severe DIC was found. There was no difference between both scoring systems, with a p value of 0.125 based on the Mc Nemar test. There was no difference found in mild and moderate DIC in sepsis, severe sepsis and septic shock of modified Bick scoring systems (p value of 0.987) and THC scoring system (p value of 1.000). CONCLUSION: No difference was found between THC and modified Bick scoring system in diagnosing DIC in septic patients. In sepsis, severe sepsis and septic shock, mild and moderate DIC complications can be diagnosed with THC scoring system, which are of the same potency with the modified Bick, with the assumption that the modified Bick scoring system was the same as the Bick scoring system.
Impaired glucose tolerance, impaired fasting glycaemia and cardiovascular risk.
(2004-01-28) Sanusi, Harsinen
Type 2 Diabetes Mellitus tends to increase year by year and it has a high morbidity and mortality, especially among those who have macro-vascular complication(s) as cardiovascular disease. There are many prevention efforts that have been done, especially primary prevention i.e. prevention of Type 2 Diabetes Mellitus development. Impaired Glucose Tolerance (IGT) and Imparied Fasting Gycaemia (IFG) is regarded as a phase between individual with normal blood glucose and type 2 diabetes mellitus. Individual with Impaired Glucose Tolerance (IGT) has higher possibility to develop Diabetes Mellitus compared to Impaired Fasting Gycaemia (IFG). Likewise, it also has more important role to cause Cardio-Vascular Disease. IGT may develop Cardiovascular Disease similar to Diabetes Mellitus, hence either IGT or Type 2 Diabetes Mellitus is categorized as independent risk factor of Cardio-Vascular Disease development. If compared to IFG then frequency of IGT is more excessive in the population, so that 2 hrs blood glucose after 75 gram glucose load test should be done in blood glucose testing.
Management of high blood pressure in diabetes mellitus: lessons from The ADA Recommendation.
(2004-01-28) Waspadji, Sarwono
The diagnostic approach of massive ascites in constrictive pericarditis.
(2004-01-28) Rachmawati, Kamsi; Handayani, Astri; Shatri, Hamzah; Alwi, Idrus; Trisnohadi, Hanafi B
Cardiogenic shock in acute coronary syndrome: diagnosis and management.
(2004-01-28) Alwi, Idrus
Endotoxin in patients with terminal renal failure undergoing dialysis with re-processing dialyser.
(2004-04-04) Markum, H M S; Suhardjono,; Pohan, Herdiman T; Suhendro,; Lydia, Aida; Inada, Katsuya
AIM: to determine the level of endotoxin in the blood of patients with renal failure prior to and following hemodialysis using re-processing dialyser to know possibility of pyrogenic reactions in hemodialysis patients. METHODS: this study subjects consisted of 10 patients with terminal renal failure undergoing regular hemodialysis. The collected samples were then sent in frozen condition for endotoxin examination in Japan. The normal level of endotoxin in the blood was < 9.8 pg/ml based on standard E.Coli E.0111 endotoxin quantitatively measured using Limulus Amoebocyte lysate test (the endospecy test). Statistical analysis was performed using paired student test. RESULTS: Ten patients with terminal renal failure who were undergoing hemodialysis were obtained, consisting of 1 female and 9 males. The mean age was 55.5 years (SD 6.74), the mean hemoglobin level 7.26 g/dl (SD 2.19), mean white blood cell (WBC) count 8660/mm(3) (SD 3064.2), and mean albumin level 3.59 g/l (SD 247). The etiologies of renal failure were as follows: glomerulonephritis (GN) 30%, Diabetic nephropathy (DN) 20%, hypertension (HT) 10%, interstitial nephritis (IN) 10%, obstruction/infection (01) 10%, unknown (U) 10%. The mean duration of hemodialysis was 97.9 month (SD 54.86). The mean endotoxin level prior to hemodialysis (ET pre-hemodialysis) was 5.4 pg/dl (SD 8). CONCLUSION: we conclude that terminal renal patients who undergoing re-processing hemodialysis did not have endotoxemia both prior to and following hemodialysis unless if they associated with infection, or other complications.
The role of Acinetobacter as a cause of nosocomial bacteremia.
(2004-04-04) Setiawati, Suci; Astrawinata, Dalima A W
The correlation between coagulation test and albumin with antithrombin III in Dengue hemorrhagic fever.
(2004-04-04) Jong, Joko Budiman; Pohan, Heridman T; Zulkarnain, Iskandar; Tambunan, Karmel L; Panggabean, Marulam M; Setiabudy, Rahajuningsih D; Suhendro,; Nelwan, R H H
AIM: To analyse the correlation between coagulation tests (PT APTT fibrinogen, D-dimer) and albumin with AT-II in DHF as well to find the formula to calculate AT-III with the parameter of coagulation tests and albumin. METHODS: A descriptive-correlative cross sectional study was conducted to 49 patients with DHF consisted of DHF I(17), DHF (19), DHF III (6) and DHF IV (7). The diagnosis of DHF is based on WHO criteria 1997. The laboratory examinations were coagulation tests (PT, APT, fibrinogen and D-dimer), antithrombin III and albumin, performed when the fever subside and the platelets reached the lowest count(4(th) - 6(th) day). RESULTS: A significant correlation was found between PT and AT-III (r= -0.631; p=0.000), between D-dimer and AT-III (r= -0.337; p=0.021) and between albumin and AT-III (r= 0.291; p-0.045). In multiple linier regression analysis(backward), AT-III can be calculated with the formula, accuracy 68.3%. CONCLUSIONS: PT and D-dimer were correlated negatively with AT-III, however albumin was correlated positively with AT-III. PT, D-dimer and AT-III were correlated with the grading severity of the DHF. In this study, AT-III can be calculated with the formula, accuracy 68.3%.
Haemostatic disorder in Dengue hemorrhagic fever.
(2004-04-04) Chen, Kie
Gallbladder edema in Dengue hemorrhagic fever and its association with haematocrit levels and type of infections.
(2004-04-04) Zulkarnain, Iskandar
AIM: To determine gallbladder edema with type of Dengue infection and hematocrit level. METHODS: A retrospective study was performed on 225 cases of DHF admitted from January to December 1997 to determine the association between the type of Dengue infection, hemoconcentration and the presence or absence of gallbladder edema. Primary or secondary types of Dengue infection consider to determine the severity and degree of plasma leakage in dengue hemorrhagic fever. The Chi square and Spearman 's tests were performed to establish association between variables. RESULTS: out of 225 cases of DHE 129 cases were found with the following dengue serology test results: 92 IgM positive and 37 negative. Abdominal ultrasound was performed in 57 cases, revealing gallbladder edema in 17 cases and none in 40 cases. The 57 cases were classified as primary dengue cases (positive IgMA), secondary dengue(positive IgM and IgG), or seronegative (negative IgM). Primary dengue was found in 5 cases with gallbladder edema and 15 cases without (25%). In the secondary dengue group,10 cases were found with gallbladder edema and 8 cases without (55.5%), while in the non-Dengue group, there were 2 cases with gallbladder edema and 17 cases without (10.5%).There was association between the development of gallbladder edema and the type of dengue infection(p=0.010). Gallbladder edema was more common in secondary Dengue (55%). There was a tendency for gallbladder edema in patients with higher increases in hematocrit. CONCLUSION: It conclude that gallbladder edema is more common in cases of secondary dengue and that there is a tendency for gallbladder edema with higher increase of hematocrit.
Consensus of malaria management 2003 (part one).
(2004-04-28) ,
Plasmodium malariae.
(2004-04-28) Sutanto, Inge; Pohan, Herdiman T; Suwondo, Pradana
Clinical and laboratory manifestations of typhoid fever at Persahabatan Hospital, Jakarta.
(2004-04-28) Pohan, Herdiman T
AIM: To determine clinical, and therapeutic characteristics, and antibiotic susceptibility test results for typhoid fever. METHODS: A retrospective study using data from medical records of all typhoid fever subjects which is confirmed by blood culture positive for S. typhi or S. paratyphi. This study was performed to determine clinical, laboratory, and therapeutic characteristics. Statistical analysis was performed using unpaired student t-test. RESULTS: Out of 119 subjects, 58.8% were male and 41.2% were female. The average age was 24.98 years (SD 11.11). Predominant symptoms were headache, epigastric pain, nausea, anorexia, together with fever from the afternoon to night. Predominant laboratory abnormalities were decreased or normal leukocyte count, increased of SGOT/SGPT, increased erythrocyte sedimentation rate, thrombocytopenia, and proteinuria. Predominant widal test results for antigen O and H were 1/320. Four time elevations of widal titer were rare in this study. Typhoid hepatitis, typhoid pneumonia, typhoid encephalopathy, intestinal haemorrhage are the most frequent complications in this study. Chloramphenicol is still effective for typhoid fever. CONCLUSION: From this study, it can be concluded that headache, epigastric pain, nausea, decreased appetite together with fever in the evening/at night with normal/decreased leukocyte count and abnormal liver function are the most common clinical symptoms found in typhoid subjects.
Beta-hydroxybutirate levels as a determinant for the success of diabetic ketoacidosis management.
(2004-04-28) Wijaya, Ika Prasetya; Soewondo, Pradana; Widodo, Djoko; Sudoyo, Aru W
AIM: To obtain a greater understanding of the diagnosis and evaluation of success in diabetic ketoacidosis management. METHODS: A prospective observational study was performed on patients with diabetic ketoacidosis at the Emergency Unit of Cipto Mangunkusumo General Hospital. All patients that were admitted were had their blood glucose, beta-hydroxybutirate, acetoacetate, pH, pCO2, HCO3, anion gap and consciousness levels serially monitored on upon admittance (0 hour) and the 2nd, 6th, 12th, 18th and 24(th) hours. The correlation coefficient of each examination was also calculated. The benefit of serial examination of each variable was also determined for each ketoacidosis undergoing the study. RESULTS: Out of the 19 available samples, a strong negative correlation was found between beta-hydroxybutirate and pH with a value of r>0.5 (from -0.524 to -0.833 with p<0.05) for 24 hours, compared to acetoacetate with the lowest r of -0.515 to -0.731 lasting up to 12 hours. Blood glucose and pH is correlated only at 0 hour, the same with the correlation between beta-hydroxybutirate and HCO(3). pCO2 and anion gap is better compared to that of blood glucose and acetoacetate. There is no correlation between the three and the level of consciousness. Significant serial examinations to perform are blood glucose, beta-hydroxybutirate, and HCO(3). CONCLUSION: beta-Hydroxybutirate has a stronger correlation compared to blood glucose and or acetoacetate towards pH, pCO2, HCO(3), and anion gap. Patients with ketoacidosis are recommended to undergo blood beta-hydroxybutirate examination. Serial examination should be performed for blood glucose, beta-hydroxybutirate, and bicarbonate.

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