Anggoro Budi Hartopo

Circulating soluble CD40 ligand mediates the interaction between neutrophils and platelets in acute coronary syndrome

Following plaque rupture, activated platelet will induce subsequent inflammatory process including neutrophil recruitment. In vitro study demonstrated an interaction between neutrophils and platelets via a mechanism involving CD40-CD40 ligand. However, whether this mechanism exists in the clinical setting remains unknown. Fifty-four patients with acute myocardial infarction (AMI) and 25 with unstable angina of pain onset of ≤24 h were enrolled consecutively. Acute myocardial infarction was diagnosed from three diagnostic criteria, i.e., anginal pain, electrocardiogram ST-T changes, and cardiac enzyme elevation. Unstable angina was diagnosed in patients without elevated cardiac enzymes. Peripheral venous blood was drawn at admission for routine blood count and soluble CD40 ligand (sCD40L) measurement. Neutrophil count was determined by an automated blood cell counter. Circulating sCD40L was measured using a standard enzyme-linked immunosorbent assay. Neutrophil count was significantly higher in AMI as compared with unstable angina (P < 0.001), whereas circulating sCD40L did not significantly differ. Despite marked elevation, no correlation was observed between neutrophil count and circulating sCD40L in AMI. Interestingly, we observed a strong and positive significant correlation between neutrophil count and circulating sCD40L level (r = 0.607, P = 0.002) in unstable angina. Circulating sCD40L is associated with neutrophil count and may mediate interaction between neutrophils and platelets in acute coronary syndrome, particularly in unstable angina.

Platelet microparticle number is associated with the extent of myocardial damage in acute myocardial infarction

Introduction Activated platelets generate microparticles. Increased platelet microparticles occur in acute myocardial infarction (AMI) and contribute to intracoronary thrombosis and subsequent myocardial injury. This study aimed to investigate the impact of platelet microparticles on intracoronary thrombosis by assessing the relationship between platelet microparticles and the extent of myocardial damage in AMI. Material and methods This was a cross sectional study. The subjects were patients with acute coronary syndrome (ACS). Forty-one consecutive subjects with ACS admitted to intensive cardiovascular care unit were enrolled. The clinical spectrum of ACS comprised AMI (n = 26), both ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI), and unstable angina (n = 15). Platelet microparticles were isolated from peripheral venous blood and detected with anti-CD42b-PE by the flow cytometry method. The extent of myocardial damage was determined by measuring the peak level of serial cardiac enzymes within 24 h of admission. Results Subjects with AMI had a significantly higher number of platelet microparticles than those with unstable angina (4855 ±4509/µl vs. 2181 ±1923/µl respectively; p = 0.036). Subjects with STEMI had the highest number of platelet microparticles, but no significant difference was detected as compared to those with NSTEMI (5775 ±5680/µl vs. 3601 ±1632/µl). The number of platelet microparticles in AMI was positively associated with the extent of myocardial damage (peak CK-MB: r = 0.408, p = 0.019 and peak GOT: r = 0.384, p = 0.026). Conclusions The number of platelet microparticles was increased in AMI as compared to unstable angina and associated with the extent of myocardial damage.

On-admission high endothelin-1 level independently predicts in-hospital adverse cardiac events following ST-elevation acute myocardial infarction

Abstract Introduction Various cardiovascular diseases cause increased level of plasma endothelin-1. In acute myocardial infarction, necrotic cardiomyocites release endothelin-1 in the circulation, thus increasing the level of endothelin-1. Aim The purpose of this study is to investigate whether increased circulating endothelin-1 level predicts subsequent adverse cardiac events in patients hospitalized with ST-elevation acute myocardial infarction (STEMI). Methods We designed a cohort study and enrolled STEMI patients with symptom onset ≤24h. Consecutive subjects were enrolled and followed-up during intensive hospitalization. Endothelin-1 was measured from venous blood on admission before reperfusion procedure. Based on median value, subjects were divided into two groups, those with high endothelin-1 and low endothelin-1. In-hospital adverse cardiac events were death, acute heart failure, cardiogenic shock, reinfarction and rescuscitated VT/VF. Univariate and multivariable analyses were applied to evaluate the prediction value of high endothelin-1. Results We enrolled 125 subjects. The incidence of in hospital adverse cardiac events is 29.6%. The proportion of adverse cardiac events was significantly higher in high endothelin-1 groups as compared with low endothelin-1 group (42.2% versus 16.4%, p=0.02). Univariate analysis indicated that high endothelin-1 predicted in hospital adverse cardiac events. Multivariable analysis determined that high endothelin-1 level was an independent predictor for in hospital adverse cardiac events (adjusted odds ratio: 3.4, 95% CI: 1.2–9.8, p=0.026). Other independent predictors were older age and faster heart rate on admission. Conclusion Higher level of circulating endothelin-1 on admission independently predicts subsequent in hospital major adverse cardiac events in patients presenting with STEMI.

Right-sided infective endocarditis in patients with uncorrected ventricular septal defect and patent ductus arteriosus: Two case reports

Uncorrected left‐to‐right shunt congenital heart defect is a predisposing factor for infective endocarditis (IE), especially right‐sided IE which has different clinical manifestations and complications from left‐sided IE. Prompt diagnosis by means of transthoracic echocardiography and timely antibiotics management for IE are encouraged to prevent multiorgan failure and fatal pulmonary embolism.

The Utility of Point of Care Test for Soluble ST2 in Predicting Adverse Cardiac Events during Acute Care of ST-Segment Elevation Myocardial Infarction

Introduction Soluble ST2 (sST2) is increased during acute myocardial infarction. The point of care test (POCT) for sST2 is currently available. The aim of this study was to investigate the utility of the sST2 POCT measurement for predicting adverse cardiac events during acute care of ST-elevation myocardial infarction (STEMI). Patients and Methods This research used a cohort study design. Consecutive patients with STEMI were enrolled. Soluble ST2 level was measured from peripheral blood taken on admission with POCT. Observation during acute intensive care was conducted to record adverse cardiac events. Two groups were assigned based on median sST2 level, that is, supramedian and inframedian group. The incidence of adverse cardiac events between groups was analyzed. A p value < 0.05 was statistically significant. Results We analyzed 95 subjects with STEMI and 10 patients with stable coronary artery disease as controls. The median sST2 level was significantly higher in subjects with STEMI as compared to controls (152.1 ng/mL versus 28.5 ng/mL, p < 0.01). Among subjects with STEMI, the supramedian group had higher incidence of adverse cardiac events than the inframedian group (38.3% versus 12.5%, p=0.004). Multivariable analysis showed that supramedian sST2 level was independently associated with increased incidence of adverse cardiac events (adjusted OR 6.27; 95% CI: 1.33–29.47, p=0.020). Conclusions The sST2 POCT measurement was useful to independently predict adverse cardiac events during acute intensive care of STEMI.

Large Atrial Septal Defect Closure in a Patient with Severe Pulmonary Arterial Hypertension

Patients with an atrial septal defect (ASD) and severe pulmonary arterial hypertension (PAH) are considered ineligible for defect closure surgery because of the risk of right ventricular decompensation and death after the operation. We report the case of a patient with large ASD and severe PAH who was able to undergo defect closure surgery successfully following long-term use of combined oral sildenafil and beraprost.

Anomalous Origination of Right Coronary Artery from Left Sinus in Asymptomatic Young Male Presenting with Positive Ischemic Response on Treadmill Test

Anomalous origination of coronary artery from the opposite sinus (ACAOS) is a rare coronary artery anomaly. Right ACAOS with interarterial course is a type of ACAOS, which conveys a high risk for myocardial ischemia or sudden death. We reported a case of right ACAOS with interarterial course in otherwise healthy young male. He was asymptomatic, until an obligatory medical check-up with treadmill test showed a sign of positive ischemic response. Further work-up revealed that he had right ACAOS with interarterial course. Watchful observation was applied to him, while strenuous physical activity and competitive sport were absolutely prohibited.

Acute Coronary Syndrome in Young Patients at Dr. Sardjito General Hospital

Background. Diabetes and hypertension are related to each other and have a strong pre-disposition on the incidence of atherosclerosis. The incidence of hypertension 2 times greater in patients with DM than non DM. Endothelial dysfunction underlies these events. Endothelial markers, endothelin-1 is known to affect blood pressure. Aim. The aim of this study is to determine the difference plasma levels of endothelin-1 in type 2 diabetes mellitus in women with and without hypertension. Methods. The cross sectional design was conducted on women with type 2 diabetes mellitus with and without hypertension at metabolic and endocrinology clinic, Dr. Sardjito General Hospital Yogyakarta from July 2010 until the sample met the criterias. Subjects were divided into two groups, type 2 DM woman with hypertension groups and without hypertension. ELISA sandwich’s method was used to measure plasma levels of endothelin-1. Characteristics of the study are presented in the form of mean Kurniaatmaja et al. Results. In this research, the plasma levels of endothelin-1 in in type 2 diabetes mellitus in women with hypertension (n=32) and without hypertension (n=32) respectively 19.17±7.53 ng/ml and 13.75±6.19 ng/dl, and this difference was stastistically signifi cant with p= 0.003 CI 95% -8.87 to -1.97. Conclusion. Plasma levels of endothelin-1 in type 2 diabetes woman with hypertension higher than without hypertension.ABSTRACT Background: 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, MortalityABSTRACT Background . The nutritional problem is a significant role factor in determine of health, mortality and quality of life of people with HIVA with the p value was statistically insignificant. Conclusion . There was no significant correlation between nutritional statuses which is measured by the anthropometric value with the quality of life in people with HIV&AIDS. Keywords: HIV, nutrition, anthropometric, QOLABSTRACT Background : Magnesium Serum in some previous studies had been related to asthma events and severity levels. Correlation between magnesium serum levels and severity of asthma was controversies. It might be influenced by race, genetic pattern, diet and demography factor. Objective : The objective of this study was to know relationship between magnesium serum levels and predictive PEF (Peak Expiratory Flow) in chronic asthma patients in Yogyakarta. Method : This was a cross-sectional study; subjects were asthma patients who visited Pulmonology Outpatient Department in Dr. Sardjito General Hospital Yogyakarta, from September 2004 - March 2005. We performed clinical evaluation, magnesium serum levels (normal 0.65 mmol/L-1.04 mmol/L), predictive PEF and medications. Correlation between magnesium serum levels and PEF were analyzed by Pearson correlation test. This study used analysis of variance (anova) to analyze mean difference among more than 2 groups and multiple regressions to know the variables which influenced serum magnesium levels. Result : There were 62 asthma patients in this study. There was no hypomagnesaemia. The mean of magnesium was 0.89 ± 0.08 mmol/L. Results showed that serum magnesium levels and predictive PEF had weak correlation (r= 0.281; p=0.027). There was no significant correlation between admission rate to Emergency Room due to asthma by magnesium levels ( r =0.029 p = 0.8). Conclusion : Results showed weak relationship serum magnesium levels and PEF in chronic asthma patients. Keywords : bronchial asthma; serum magnesium levels, Peak Expiratory Flow rateBackground. Methods to evaluate pathophysiology of functional dyspepsia (FD) such as barostat are invasive, expensive and not readily available. Nutrient drink test was developed as noninvasive, safe and low cost means to assess impaired gastric accommodation in FD patients. The aim of this study is to evaluate whether this test could be used for diagnostic tool for FD patients. Method. A cross sectional study was conducted from July 2014 to December 2014, at Sardjito General Hospital, Yogyakarta, Indonesia. Twenty FD patients (according Rome III criteria with normal gastroscopy) were matched by age, gender and body mass index with 20 healthy controls. All of FD patient and healthy controls ingested nutrient drink tests (UltraMilk contain 0.6 kcal /mL). Maximum tolerated volume (MTV) of each subject was recorded. Sensitivity, specifi city, positive predictive value (PPV) and negative predictive value (NPV) were analyzed.Results. Using ≤ 950 mL of maximum tolerated volume as cut off point, sensitivity, specificity, PPV and NPV were 95%, 100%, 100% and 95%. Conclusions. A nutrient drinking test can discriminate between FD patients and healthy controls with high sensitivity and specifi city. This test could be used as objective, safe and non-invasive diagnostic tool for FD patients.ABSTRACT Introduction . Hemodialysis patients experience major changes in lifestyle and suffer various physical and emotional symptoms, especially symptoms of depression and sexual dysfunction in more than half of patients. Sexual dysfunction in women is often not identified because of lack of attention, especially by the clinician. Symptoms of depression limit intimacy, and affect sexual arousal and orgasm. Aim : the aim of the study was to determine the correlation between depressive symptoms and female sexual function index (FSFI) in women hemodialysis patients in the Hemodialysis Unit of Dr. Sardjito General Hospital Yogyakarta. Methods . The method of this study was cross-sectional. Research was conducted at the Hemodialysis Unit by Dr. Sardjito General Hospital Yogyakarta from 10 April to 24 April 2012. Result . There were 42 female patients undergone routine hemodialysis who met the criteria. The median age was 49 years old and had undergone hemodialysis for a median duration of 40 months. Conclusion . There was a negative correlation of depression symptoms and female sexual dysfunction with a moderate strength (r = -0.421) and statistical significantly (P <0.05). Age and prolactin had a negative correlation with a moderate strength of FSFI score. HDL levels and menstrual status had a positive correlation with FSFI, with weak and strong correlation respectively. Key Words : Female sexual function index, depression, hemodialysisABSTRACT Background . Depression is more common in persons with chronic illnesses such as diabetes, epilepsy and infection of Human Immunodeficiency Virus (HIV). Depression can make HIV worse. Antidepressant may need, but there can be interaction and side effect when use Antiretroviral (ARV) and antidepressant in combination. Complementary and alternative medicine (CAM) include Latihan Pasrah Diri(LPD) may seem safe to treat depression in HIV patient. Methods. This is a quasi experimental study, participant include outpatient dan inpatient at RSUP Dr. Sardjito, Yogyakarta. They were aged >18 years. After scoring with Zung Self Rating Scale for depression, participants allocated into two groups, with dan without Latihan Pasrah Diri program. Zung Self Rating Scale for depression was evaluated after 1 cycle of program. Result. The means of Zung Self-Rating Depression Scale score before and after LPD were 42,21 ± 9,3 and 35 ± 10,73 (p 0,003). While in control group (without LPD / brief psychotherapy) the means of Zung Self-Rating Depression Scale score before and 3 weeks after brief psychotherapy were 42,93 ± 7.45 and 39,36 ± 7,69 (p 0,019). Statistically there was no significancy in the means of delta Zung Self-Rating Depression Scale in LPD group and control group. Conclusion. It was concluded from this study that there is an influence on the improvement of depressive symptoms post- Latihan Pasrah Diri program to people with HIV / AIDS. Key words: depression, HIV, Latihan Pasrah Diri, Zung Self-Rating ScaleINTRODUCTION The word sepsis is derived from the Greek term for rotten or “to make putrid”. Sepsis, defined as the systemic host response to microorganisms in previously sterile tissues, is a syndrome related to severe infections and is characterized by end-organ dysfunction away from the primary site of infection. To meet the definition of sepsis, patients need to satisfy at least two of the Systemic Inflammatory Response Syndrome (SIRS) criteria in association with having a suspected or confirmed infection. The severity and mortality increase when this condition is complicated by predefined organ dysfunction (severe sepsis) and cardiovascular collapse (septic shock). The normal host response to infection is complex, aiming to both identify and control pathogen invasion and start immediate tissue repair. Both the cellular and humoral immune systems are activated, giving rise to anti-inflammatory and proinflammatory responses. Exacerbating these mechanisms can cause a chain of events that leads to sepsis, promoting massive liberation of mediators and the progression of multiple organ dysfunction 1 . Sepsis remains a critical problem with significant morbidity and mortality even in the modern era of critical care management. Despite intense efforts, sepsis remains a serious clinical problem and still associated with a high mortality rate. Septic shock and sequential multiple organ failure/dysfunction syndrome (MOF/MODS) correlate with poor outcome, and septic shock is the most common cause of death in intensive care units. A recent review by Angus et al estimated the 1995 incidence of sepsis in the United States to be 751,000 cases, resulting in 215,000 deaths. The average cost per case of sepsis was

Plaque, Platelets, and Plug – The Pathogenesis of Acute Coronary Syndrome

22,100 with total costs of

Low Serum Albumin Levels and In-Hospital Adverse Outcomes in Acute Coronary Syndrome

16.7 billion nationally. A more recent analysis of hospital records indicates that the total number of patients who are dying is actually increasing. This study also confirmed the work of Angus et al that the incidence of sepsis is increasing and projected to continue to grow as the population ages. These studies concluded that “severe sepsis is a common, expensive, and frequently fatal condition, with as many deaths annually as those from acute myocardial infarction 2,3 . The immunological cascade resulting in the sepsis response can be initiated by tissue injury, ischemia reperfusion injury, gram-positive organisms, and fungi as well as gram-negative organisms and their constituent endotoxin. The sepsis response may begin with an infectious nidus, which may either invade the bloodstream, leading to dissemination and positive blood cultures, or proliferate locally and release various microbial products into the bloodstream 3 . Multiple derangements exist in sepsis involving several different organs and systems, although controversies exist over their individual contribution to the disease process. Septic patients have substantial, life-threatening alterations in their coagulation system. Previously, it was believed that sepsis merely represented an exaggerated, hyperinflammatory response with patients dying from inflammation-induced organ injury. More recent data indicate that substantial heterogeneity exists in septic patients’ inflammatory response, with some appearing immuno-stimulated, whereas others appear suppressed. Cellular changes continue the theme of heterogeneity. Some cells work too well such as neutrophils that remain activated for an extended time. Other cellular changes become accelerated in a detrimental fashion including lymphocyte apoptosis 2 . The role that apoptosis plays in sepsis syndromes and in the development of CARS and MODS has not been adequately explored, but there is rapidly developing evidence to suggest that increased apoptotic processes may play a determining role in the outcome to sepsis syndromes. In particular, increased apoptosis, particularly in lymphoid tissues and potentially in some parenchymal tissues from solid organs, may contribute to the sepsis-associated MODS 3ABSTRACT Background . Blood transfusion can save lives, patients get the benefit but also the risk of transfusion-related. Febrile non-haemolytic transfusion reaction (FNHTR) most frequently found and have similar symptoms of other transfusion reactions, causing delays in transfusion and decrease the quality of life. Platelet recipients have a higher incidence risk FNHTR than recipients of other blood products. Medications pre-transfusion acetaminophen and diphenhydramine reduce the incidence FNHTR. Methods . The study was conducted from May to November 2010 Internal Medicine Wards, Dr. Sardjito Hospital, Yogyakarta using the method of double-blind randomized controlled trial. Inclusion criteria were first recipient of random donor non leucodepleted platelets in thrombocytopenia malignant patients and willing to participate. Exclusion criteria were fever is when will transfusions or in 2x24 hours, allergies of acetaminophen and diphenhydramine, acetaminophen and diphenhydramine consumption in the last 6 hours, the consumption of continuous corticosteroids, history of transfusion reactions and critical conditions/sepsis. Assessment of the incidence FNHTR 15 minutes before transfusion to 4 hours after transfusion. Medication group will receive a capsule containing 650 mg acetaminophen and 25 mg diphenhydramine dissolved in 5 ml 0.9% NaCl intravenously. The control group received a placebo. Drugs are given 30 minutes before the first transfusion bag. Data were analyzed using Chi-square test and p <0.05 was considered statistically significant. Results . Thirty-two patients met the criteria, 15 patients (46.87%), medication group and 17 (53.13%) patients of control group. Eleven (31.43%) patients had FNHTR, 8 (47.06%) patients of control group and 3 (20%) patients. There are differences in the proportion of incident FNHTR in both groups although not statistically significant (P = 0.04). Every patient has different risk factors on parity, history of transfusion, history of FNHTR and the long of platelet storage. Conclusion . As pre-transfusion medications, Acetaminophen 650 mg and diphenhydramine 25 mg reduced the incidence of FNHTR compared to placebo in the first platelet recipients in malignancy Key words : Acetaminophen, diphenhydramine, medication pretransfusion, FNHTR.ABSTRACT Background: Patients with chronic kidney disease (CKD) suffering from various physical and emotional symptoms show depression and disturbance in quality of life. Patients with chronic kidney disease have a decreased quality of life, and mortality rate about 22% in every year. Depression in patients with CKD must be managed properly because a large effect on HRQOL (Health Related Quality of Life) and the potential side effects on the management of patients with CKD. Latihan pasrah diri (LPD) is a method combining relaxation and remembrance with a focus on breathing exercises and words contained in the dhikr (relaxation and repetitive prayer). The rise of the relaxation response is expected to improve the symptoms of stress or depressive symptoms, which is expected to improve HRQOL. Objective: This study aimed to determine the effect of LPD on quality of life in hemodialysis patients with depressive symptoms that was compared with controls. Methods: The research constituted the study of Randomized Control Trial. The research was measured the KDQOL-SF scores (Kidney Disease Quality of Life-SF) in subjects with LPD treatment during 21 days, compared with controls. The research was conducted at the Hemodialysis Unit of Dr. Sardjito Hospital, Yogyakarta, from May to June 2012. A total of 36 patients who met the inclusion criteria were randomized and divided into LPD group (n = 18) and control group (n = 18). Results: Found a statistically signifi cant decrease in BDI scores in both groups, 23.00 ± 5.34 to 15.00 ± 8.55 (p = 0.001) in the LPD group and 23.00 ± 5.34 to18.33 ± 6, 66 (p = 0.022) in the control group. KDQOL-SF scores after treatment when compared between the LPD and control groups experienced different changes were statistically signifi cant in domains effects of kidney disease 59.65 ±23.52 compared to 39.41 ± 20.03 (p = 0.022), sleep 69 ± 13.17 compared to 46.53. (p = 0.000), overall health 73.89 ± 16.85 compared to 57.22 ± 19.04 (p = 0.009), pain 64.86 ± 20.80 compared to 42.36 ± 24.90 (p = 0.005), general health 53.88 ±16.05 compared to 47.78 ± 20.74 (p = 0.014), and the physical component scale 35.98 ± 6, 83 compared to 29.12 ± 6.46 (p = 0.004). Despite increased KDQOL-SF domain scores, but there were 2 domains that Δ KDQOL-SF score changes were statistically signifi cantly different compared with the control group, which was the domain of sleep and overall health. Conclusion: Latihan pasrah diri twice a day during 21 days (3 weeks) can improved the quality of life of patients with symptoms depression in CKD patients undergoing hemodialysis in domains of sleep and overall health. Keywords: CKD, depression, latihan pasrah diri, KDQOL-SF.ABSTRACT Background. Obesity is one of the risk factor for type 2 diabetes mellitus characterized by insulin resistance, decrease insulin secretion and hyperglycemia. Chronic inflammation has been proposed to have an important role in the pathogenesis of obesity related insulin resistance. A number of studies have indicated that several humoral markers of inflammation are elevated in people with obesity and type 2 diabetes mellitus, because adipose tissue secretes a number of proinflammatory cytokines, including interleukin-6. The level of plasma IL-6 is increase in obese people. Objective. To investigate the mean of difference in the level of IL-6 in obese people with and without insulin resistance. Subjects and Method. The study design was cross-sectional. It was conducted in obese people with BMI ≥ 25 kg/m2. Insulin resistance were measured with HOMA-IR methode, calculated using the following formula: fasting serum glucose X fasting plasma insulin/22,5. Insulin resistance was defined when HOMA-IR > 2,77. Interlukin-6 was measured with Quantikine High Sensitivity human IL-6 ELISA. Difference of mean of IL-6 level was analyzed by student’s t-test for normal distribution and Mann- Whitney U-test if distribution was not normal. Results. There were 56 subjects, 24 (42,9%) subjects with insulin resistance and 32 (57,1%) subjects without insulin resistance. Obese people with insulin resistance had higher mean level of IL-6 than obese people without insulin resistance, although the difference was not significant (20,05±8,59 vs 18,98±8,15 pg/ml; p=0,639; 95% CI -5,58-3,46). Conclusion. There was no difference in the mean of IL-6 level in obese people with and without insulin resistance. Keywords. IL-6, obese, insulin resistanceABSTRACT Introduction. One of the complications which often occur in the liver cirrhosis is bleeding. Closely associated with weighing of bleeding were disturbance haemostatic homeostasis disorders that commonly associated with impaired liver function. Therefore certain biomarkers are needed to objectively measure the severity of liver cirrhosis. Fibrinogen is one of the clotting factors that can be used to determine the severity of liver cirrhosis. The model of end-stage liver disease (MELD) score is most excellent alternative of the Child-Pugh score. It can be used in patients with liver cirrhosis spacious ranges severity of disease and etiology even in patients whose cirrhosis etiology are not clear. Currently, there was not any data showing the correlation between the level of plasmatic fi brinogen and MELD score in patients with liver cirrhosis. Aims. This study aimed to determine the correlation between level of plasmatic fi brinogen and MELD score in patients with liver cirrhosis. Method. This study was cross-sectionally conducted used consecutive sampling. Study population were eligible patients with liver cirrhosis who visited outpatient and inpatient clinic in the Division of Gastroentero-hepatology, Dr. Sardjito general hospital, between November 2011 to October 2012. Correlation between the level of plasmatic fibrinogen and MELD score was statistically assessed using correlation test with fi nal result stated as correlation coefficient (r). Result. There were 40 subjects that met criteria, 28 male and 12 female, with average age of 53 ± 12,51 years. Etiology of cirrhosis was viral hepatitis B in 16 (40,0%) subjects, hepatitis C in 11 (27,5%) subjects and non viral in 13 (32,5%) subjects. Subjects with ascites were 19 (47, 5%) and without ascites were 20 (52.5%). Bleeding was experienced by 30 (80.0%) subjects while 10 (20,0%) subjects did not present with bleeding. Mean of plasma fibrinogen was 198 ± 102, 89 mg/dl, and mean of the MELD score was 17,05 ± 8.79. Spearman correlation coefficients between fi brinogen and MELD score was r = -0,404 (p = 0,010). Conclusion. There was a negative correlation between plasma fi brinogen and the MELD score in liver cirrhosis patients visiting our local setting. Keywords: liver cirrhosis, fi brinogen, MELD scoreABSTRACT Background: Colonoscopy is the gold standard procedure which is widely used in the diagnosis and treatment of colonic mucosal disorder. Inappropriate colonoscopy indications increase rate of complications. Aim: The main aims of our study were to evaluate indications, fi ndings and diagnostic yield at colonoscopy. Methods: A retrospective study of all colonoscopy was conducted from January 2012 through August 2013, at Dr. Sardjito General Hospital, Yogyakarta and there were 688 colonoscopy reports. Seven colonoscopy indications were documented and presented: rectal bleeding or hematochezia, chronic diarrhea, abdominal pain, constipation, screening and surveillance for colonic neoplasia, change in bowel habit and anemia. Diagnostic yield was defi ned as the ratio between signifi cant fi ndings detected on colonoscopy and the total number of procedures performed for the indication. In our study, diagnostic yield was established by colonoscopy, not confirmed by biopsy. Results: Overall diagnostic yield was 72.53%. The leading indication for colonoscopies was rectal bleeding or hematochezia (36.19%), followed by chronic diarrhea (23.11%), abdominal pain (14.09%), constipation (13.37%), screening and surveillance (5.66%), change in bowel habit (5.52%) and anemia (2.02%). Diagnostic yields according colonoscopies examination were normal (37.14%), colorectal cancer (19.33%), proctitis (14.24%), infl ammatory bowel disease (12.50%), polyps (11.19%),hemorrhoid (10.03%), and diverticel(3.78%). Colorectal cancers were found in patients with hematochezia (74 patients, 29.71%), chronic diarrhea (34 patients, 21.38%), constipation (13 patients, 14.13%). Of 249 patients presenting with hematochezia were found colorectal cancer (74 patients), hemorrhoid (50 patients), proctitis (30 patients), normal (30 patients). Our study showed that diagnostic yield was far lower in patients below 50 years (38.48%) compared > 50 years (61.52%), especially for colorectal cancer (p < 0.001), polyps (p = 0.004) and diverticular (p < 0.001). Conclusions: Hematochezia was the leading indication for colonoscopy and the diagnostic yield was 72.53%. The leading of colonoscopy fi ndings were normal colonoscopies, followed by colorectal cancer, proctitis, infl ammatory bowel disease, polyps and diverticel. Colonoscopy indications should be based on the available guidelines to minimize as much as possible the number inappropriate procedures and complications. Keywords: Colonoscopy, diagnostic yield, colonic indications, appropriateness of colonoscopyABSTRACT Background: Estimated nearly 38.6 million people infected by HIV and 2.8 million died in 2005. Evidence suggests the existence of a very important relationship between the output and improved nutritional status in HIV/AIDS patients. Poor nutritional status in HIV/AIDS can be caused by several factors, namely the intake and absorption of inadequate nutrition, metabolic changes, hyper metabolism, or a combination of these, changes in the gastrointestinal tract as well as interactions between drugs and nutrients. Losing weight remains on the HAART (Highly Active Antiretroviral Therapies) era, but the problems are the side effects of HAART and lipodystrophy. Objective: The purpose of this study is to determine the provision of anti- retroviral effect on changes in anthropometric values people with HIV/AIDS. Method: The study is using the one group pre-posttest design (quasi-experimental), by assessing changes in anthropometric values in subjects with HIV before and after the administration of ARVs. Analysis of the data is computerized by a computer program Result: Obtained 30 samples of the study with anthropometric changes pre and post ARVs 6 months. The weight was 51.4 ± 9.12 to 53.6 ± 8.68 with a p-value 0.001. Body Mass Index (BMI) was 19.98 ± 3.47 into 20.84 ± 3.35 with a p-value 0.001 and upper arm circumference 24.13 ± 3.62 into 24.95±3.48 with a p-value 0.003. The provision of antiretroviral drugs for 6 months infl uences the change in nutritional status of HIV patients are assessed by anthropometric measure. Signifi cant changes in the changes body weight, BMI and upper arm circumference. Changes in anthropometric values ARV Efavirenz group and non-Efavirenz meaningful change signifi cant in skinfold thickness obtained at the value of p 0.010. Conclusion: There were no signifi cant changes in anthropometric values compared to patients with early stage HIV and advanced stage after 6 months of antiretroviral therapy. Keywords: HIV, antiretroviral drugs, anthropometric, nutritional statusABSTRACT Background: High titer of rheumatoid factor (RF) in the serum of patients with rheumatoid arthritis (RA) is mostly associated with more severe disease and presence of extra-articular features. To choose the best treatment of RA need the combination of science and art. Objective: the aim of the study was to find the comparison of pharmacological treatment patterns in rheumatoid arthritis patients according to the presence of rheumatoid factor in the serum. Method: This study was a retrospective quantitative observational. The data was collected from medical records of new patients with rheumatoid arthritis who came to the appointment at Rheumatology Clinic Dr. Sardjito Hospital, Yogyakarta in 2010. Results: The total of 39 new patients was eligible in this study. A corticosteroid was the most commonly prescribed (93% of the sero-positive and 84% of the sero-negative patients). Disease modifying anti rheumatic drugs (DMARDs) were used in 92% sero-positive and 84% sero-negative patients (p=0.827; df=6). In choosing the DMARDs, Chloroquine was the most commonly prescribed (29% of sero-positive and 44% of sero-negative patients), followed by methotrexate (21% of sero-positive and 24% of sero-negative) and suphasalazine (21% of sero-positive and 0% of sero-negative). Leflunomide, doxycycline and combined DMARDs were some time prescribed. Non steroidal anti-inflammatory drugs (NSAIDs) were used in 64% sero-positive and 68% sero-negative patients. Conclusion: Corticosteroid was the most commonly prescribed drug. There was no difference between the sero-positive and sero-negative of total patients using DMARDs. Keywords: Rheumatoid arthritis, rheumatoid factor, corticosteroid, diseases modifying anti-rheumatic drugs, non-steroidal anti-inflammatory drugs.ABSTRACT Background: 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%). Mean GDS 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 by handgrip 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.ABSTRACT Background : Cardiac enlargement or cardiomegaly always found in chronic heart failure (CHF). Progressivity of cardiac enlargement relates with pulmonal function changes in CHF. This study examined the influence of increased cardiac enlargement on pulmonal function. Methods : This is a cross sectional study on 63 CHF patient of New York heart Association (NYHA) class I and II that fulfilled inclusion criteria. Definitions of CHF based on Framingham criteria. Cardiac enlargement measured by Danzer’s methods through postero anterior chest radiography. Spirometry used to evaluate FVC and FEV1. Results : Male subjects have an equal proportion (49.21%) with female subjects (50.79%) with mean of CTR 59.47 ± 5.57%. Spirometry test showed mean predicted FVC (%) 61.83 ± 9.62, predicted FEV1 (%) 75.27 ± 12.55, and FEV1/FVC mean ratio 95.53 ± 2.19%. Coefficient correlations between cardiomegaly and FVC (%) and FEV1 (%) predicted are -0.537 ( p <0.001) and -0.460 ( p <0.001). duration of diseased has a negative correlation with FVC (%) and FEV1 (%) predicted (-0.329; p = 0.008 and -0.341; p =0.006). Conclusions: Cardiomegaly on CHF showed a restriction type and has a negative correlation with pulmonal function. Keywords: cardiomegaly, pulmonal dysfunction, chronic heart failureABSTRACT Background . The pathophysiology of acute coronary syndromes (ACS) is now accepted as the rupture or erosion of an atherosclerotic plaque, initially occurs at the shoulder of the plaque and is followed by intra-plaque thrombosis then spread to the vascular lumen and cause total partial vascular occlusion. MMP-9 is an extracellular matrix degrading enzyme that plays a crucial role in the breakdown of the fibrous cap of plaque and subsequent rupture in the pathogenesis of ACS. Cardiac troponins are currently the most sensitive and specific biochemical markers of myocytes necrosis. Objective . To know the correlation between serum level MMP-9 and serum level of Troponin-I in patients with ACS Method . Study design was cross sectional. Data were collected by consecutive sampling from patients in ICCU board of RSUP Dr. Sardjito Yogyakarta, in June 2008-August 2010. A questionnaire was used to collect information from patient. After admission, peripheral venous blood was drawn once and measuring concentration of serum level of MMP-9 and Troponin-I before definitive thrombolysis. Data are expressed as means ± standard deviation (SD). Correlation between serum level of MMP-9 and serum level of Troponin-I were assessed using Spearman’s rank correlations test. A value of p<0.05 was considered statistically significant. Result . There were 139 patients with ACS and comprising 63 patients with STEMI, 27 patients with NSTEMI, and 49 patients with UAP. Means±SD of Troponin-I from all of samples was 9.49±10.47 ng/dL. Mean±SD of MMP-9 from all of samples was 1296.06±729.97 ng/dL. There were significant correlations between MMP-9 and Troponin-I in patients with ACS (r=0.34, p=0.000). Conclusion . There were significant correlations between MMP-9 and Troponin-I in ACS patients in ICCU RSUP Dr. Sardjito Yogyakarta. Keywords : ACS, MMP-9, Troponin-IABSTRACT Almost 30% of the world population has been exposed to hepatitis B virus (HBV) and 400 million of these are chronically infected. 20–30% of HBsAg carriers may develop reactivation or fl are (acute exacerbation) of chronic hepatitis B with elevation of biochemical levels, high serum HBV DNA level with or without sero-coversion to HBeAg. In countries with intermediate or high endemicity for HBV, compounded in 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 differentiate between acute hepatitis B and reactivation (fl are). Accurate diagnosis in these cases is very important for deciding whether to start treatment or not, because acute hepatitis B does not require treatment, while reactivation or fl are may take benefi t from it. Effort to early detect, to treat and to prevent the reactivation or 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)ide analoguesABSTRACT Background. Tumor Necrosis Factor-α (TNF-α), a pro-inflammatory cytokine produced by monocyte is increased in osteoarthritis synovial fluid. Curcuminoid from Curcuma domestica Val. suppresses the secretion of TNF-α. Objective. The purpose of this study was to investigate the suppression effect of curcuminoid from Curcuma domestica Val on synovial fluid monocyte’s TNF-α secretion compared to diclofenac sodium in knee osteoarthritis Methods. A prospective randomized open end blinded evaluation (PROBE) method was applied. Subjects were patients with knee osteoarthritis visiting Rheumatology Clinic Dr. Sardjito Hospital and Wirosaban Hospital Yogyakarta. Curcuminoid 30 mg three times daily or diclofenac sodium 25 mg three times daily were administered for 4 weeks. The level of TNF-α secreted by synovial fluid’s monocytes were measured by ELISA before and after treatment. Results. A total of 80 subjects were enrolled, 39 subjects on curcuminoid treatment groups and 41 subjects on diclofenac sodium group. Seven subjects were dropped out, 5 from the curcuminoid group and 2 from the diclofenac sodium group. There was a significant decrement of TNF-α level during 4 weeks treatment in both groups (p< 0.001 respectively). There was no significant difference on TNF-α levels between groups (p= 0,237), neither in 50% decrement of TNF-α levels (p= 518). Conclusion. The effect of curcuminoid in decreasing TNF- α level on patients with osteoarthritis is similar with sodium diclofenac. Keywords : osteoarthritis-monocyte-TNF-α-curcuminoid-diclofenac sodium