Indra Wijaya

Pulmonary Arterial Hypertension in Graves’ Disease

Background: Cardiovascular manifestations in Graves’ disease (GD) occur frequently with various phenotypes. A link between GD and pulmonary hypertension has been reported. There is limited data about prevalence PAH and related factors in GD in Indonesia. Objective: To identify the prevalence and related factors of PAH in GD. Method: This retrospective study is using secondary data from transthoracic echocardiographic database of General Hospital since last year. PAH was measured by continuous-wave Doppler echocardiography (pulmonary artery systolic pressure >35 mmHg). Sixty five patients who were diagnosed as GD were enrolled to study participant. Results: Of 65 eligible participants consist of 52 female and 13 male and median ages 42 year old (18–66 year old). Cardiac abnormalities were encountered in 79% participant of which consist of PAH in 15.4%. The patients with pulmonary hypertension had significantly higher pulmonary vascular resistance (PVR), cardiac output compared to those without (p < 0.001 and p < 0.021 respectively). The possible explanations in addition to the effect of thyroid hormone on the cardiovascular system, autoimmune-mediated pulmonary vascular remodeling may play a role in Graves’ disease-linked elevated pulmonary artery systolic pressure. Conclusion: The prevalence of PAH in GD was 15.4%. There is still needed future research to know the factors related to PAH especially related to clinical and laboratory abnormalities in GD.

Poor Sleep Quality of Hospitalized Geriatric Patients in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia

Background: In Indonesia, geriatric population in the year 2005 was 15.8 million (7.2 % population), and expected to reach 11.34% in the year 2020. There was growing evidence for poor sleep as an independent risk factor for poor physical and mental health. Geriatric population may be particularly vulnerable to effects of sleep disturbance due to significant age-related changes in both sleep and inflammatory regulation Objective: To study the epidemiological (gender, age group) and health status (co-morbidities), sleep quality according to Pittsburgh Sleep Quality Index (PSQI) and its associations in geriatric population hospitalized in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia. Materials and Methods: A hospital based cross sectional study was conducted from January to June 2014. A total of 92 subjects aged 60 years and above were selected consecutively from hospitalized geriatric patients for this study. The data was analyzed by means and proportions. Results: The male and female subjects were 51.1% and 48.9%. Mean age was 66.79 + 5.448 years. The age group of 60 – 75 years and above 75 years was 92.4% and 7.6% consecutively. Subjects with diabetes, hypertension, allergy, asthma, cardiac failure and chronic kidney disease were 30.4%, 62.0%, 18.5%, 21.7%, 21.7%, 20.7% consecutively and 63.0% with more than 2 co-morbidities. According to PSQI 72.8% subjects have poor sleep quality. Associations between poor sleep quality to epidemiological and health status were not significant except for diabetes (RR= 3.208 [95% CI: 1.045 – 9.848], p = 0.022) and chronic kidney disease (RR= 6.247 [95% CI: 0.902 – 43.279], p = 0.017) Conclusions: Seventy two percents of subjects have poor sleep quality, and associations between poor sleep quality to epidemiological and health status were not significant except for diabetes.

P3-260Factors Asssociated with Hypopituitarism Reversibility After Neurosurgical Treatment of Pituitary Adenomas in Indonesia

Case 1: A 76-year-old woman who had no smoking history presented with left eyelid ptosis and grade 4 creatine phosphokinase elevation after the 2nd cycle of nivolumab monotherapy. She was diagnosed with lung adenocarcinoma which had EGFR mutation. Dyspnea and muscle weakness developed rapidly with an acute exacerbation. We diagnosed her with myasthenia gravis based on the symptoms and the detection of anti-acetylcholine receptor antibody. She was received plasmapheresis and intravenous immune globulin followed by low dose prednisolone. Her symptoms gradually improved.