Margaret Merlyn Tjiang

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.

Diabetic foot gangrene patient with multi-drug resistant Pseudomonas putida infection in Karawaci District, Indonesia

Pseudomonas putida is a rod-shaped, non fermenting Gram-negative organism frequently found in the environment that utilizes aerobic metabolism, previously thought to be of low pathogenicity. It had been reported as cause of skin and soft tissue infection, especially in immunocompromised patients. A female green grocer, 51 year-old came to internal medicine out-patient clinic with gangrene and osteomyelitis on her 1st, 2nd and 3rd digit and wound on the sole of the right foot since 1 month prior. The patient had history of uncontrolled diabetes since a year ago. She was given ceftriaxone 2 grams b.i.d, metronidazole 500 mg t.i.d empirically and then amikacin 250 mg b.i.d, followed by amputation of the digits and wound debridement. The microorganisms culture from pus revealed multi drug resistant Pseudomonas putida. She recovered well after antibiotics and surgery.

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.

2 Hypertension in Systemic Lupus Erythematosus Patients at Karawaci, Tangerang, Banten, Indonesia

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease, usually affects women during their reproductive times. Risk for the development of cardiovascular disease is dramatically increased in SLE patients. Hypertension is a major risk factor for cardiovascular disease and the prevalent in women with SLE is still unknown especially in Asian patients. The aim of this study is to know the prevalence of hypertension in SLE patients and potential factors related. Method: This cross-sectional study evaluated SLE patients came to our Karawaci General hospital in period from 2013–2016. The diagnosis criteria of SLE was based on American Rheumatic Association (ARA) criteria. Hypertension diagnosed if blood pressure >140/90 in three measurements in the one-week period. Kidney ultrasound was done to know if the patients had chronic kidney disease (CKD) and CKD patients were excluded. Status of inflammation were evaluated using high-sensitive C-reactive protein (Hs-CRP). Result: One hundred twenty-two SLE patients were included to this study, 94.3% patients were female, and median of age was 31.5 (12–77) years old. Hypertension were found in 18(14.8%) patients. Nephritic syndrome was diagnosed in 67(54.9%) patients. Sixth nephritic patients had hypertension. Anti-Nuclear Antibody (ANA) was negative in 6(4.9%) patients. Fifteen (12.3%) patients had high Hs-CRP. High value of Hs-CRP did not correlate (p < 0.286) with occurrence of hypertension but the odds ratio (OR) was 2.495 (0.349–17.81). Conclusion: Prevalence of hypertension in SLE patients was 14.8%. High Hs-CRP did not correlate to the occurrence of hypertension in SLE patients.

Defining Cut-off of Intradialytic Hypertension in Indonesian Population

Background: Increasing BP during maintenance hemodialysis or intradialytic hypertension (IDH) is associated with increased morbidity and mortality. Some studies have tried to define IDH, but there is limited study published reporting the definition of IDH in Indonesian population. Objective: To define the criteria of IDH in Indonesian population. Method: We performed a cross-sectional study in adult hemodialysis (HD) patients in our hospital. We recorded those variables for 2 consecutive weeks (6 HD sessions): pre-, intra-, and post-HD systolic blood pressure (SBP). Average SBP of pre-HD (method 1), ID (method 2), post-HD (method 3), pre-post-HD (method 4), and pre-intra-post-HD (method 5) were tested using ROC curved to gain the best sensitivity and specificity. Result: Among the 46 participants, mean age was 52 ± 11.7 years, 58.7% were men, average length of HD was 2.3 ± 1.6 year, body mass index was 21.5 ± 3 kg/m2, with body weight pre-HD 56.9 ± 9.3 kg, and post-HD 54.5 ± 9.1 kg, serum albumin 3.3 ± 0.4 g/dL and serum hemoglobin 10.6 ± 1.2 g/dL. The most common etiology of chronic kidney disease was hypertension in 50% subject. Eighty nine percent of which were on antihypertensive drugs, average number of antihypertensive used was 1.4 ± 1.1. From ROC curve of at least 4 of 6 HD sessions, the highest sensitivity and specificity gained by post-HD SBP (method 3) with 94% sensitivity and 82% specificity, with cut-off points SBP of 148 mmHg. Conclusion: Consideration using post-HD SBP as preferable method in diagnosing IDH in Indonesian population should be done with cut-off point SBP of 148 mmHg.

Clinical Characteristics and Microbiological Profiles of Community-Acquired Intra-Abdominal Infections

Background : Intra-abdominal infections (IAIs) have different aspects to consider. One important aspectis the microbiological analyses, especially in the era of broad spread of resistant microorganisms. The studywas designed to describe the clinical characteristics and microbiological profiles of community acquired IAIs. Method: An observational study was performed on medical records of 12 months period (January toDecember 2013) in a General Hospital, Karawaci, Tangerang. Adult patients undergoing surgery for IAIs with positive microbiological culture and identification of microorganisms were included. Data collected were clinical characteristics and microbiological profiles and wereanalyzed statisticallyusing the SPSS version 17. Results: In 12 months period of study, 17 patients of IAIs with a total of 17 intra peritoneal specimens were collected. A total of six microorganisms were cultured. All the IAIs were monomicrobial, with aerobicmicroorganism dominantly Gram-negative bacilli. The dominant microorganism was Escherichia coli (E.coli), found in 58.8% of IAIs. The most common site was appendix (41.2%), and none from small intestine. Thesusceptibility test found that piperacillin tazobactam, tigecycline, meropenem and amikacin were the most activeantimicrobial against E. coli. Multi-drug resistant (MDR) E. coli in this study was 40%. The MDR E. coli had66.6% resistance to levofloxacin and ciprofloxacin, 66.6% susceptibility to ceftriaxone and ceftazidime, and100.0% susceptibility to amikacin. Conclusion: The most common site of community-acquired IAIs was appendix (41.2%). E. coli is still adominant microorganism with the MDR E. coli proportion of 40%. Keywords: intra-abdominal infections, clinical characteristics, microbiological profiles