Internal Medicine Commons^™

Air Displacement Plethysmography And Resistance Exercise, Joan Cebrick Grossman, Ronald W. Deitrick

Internet Journal of Allied Health Sciences and Practice

Purpose: The purpose of this study was to examine the effect of resistance exercise (RE) on body composition using air-displacement plethysmography (ADP) within 2 hours of completing RE. Methods: Thirteen university students (9 males and 4 females; 18.8±0.5 yrs; mean ± SD) volunteered for this study. The RE program (55.4±8.7 min) consisted of a combination of upper- and lower-body extremity exercises and abdominal exercises for a total of nine different exercises. Relative body fat (BF) was assessed (1.76+0.4 hr) using ADP before and after the RE along with skinfold (SF) measures, body mass (BM) and respiratory quotient. Results …

Kolaborasi Tata Laksana Dan Pengendalian Tuberkulosis Dan Diabetes Melitus, Anna Ujainah

Jurnal Penyakit Dalam Indonesia

Pada akhir tahun 2014, diabetes mellitus (DM) diperkirakan menjadi kontributor 15% kasus tuberkulosis (TB) di dunia. Ancaman kesehatan akibat TB potensial meningkat seiring dengan peningkatan angka penyandang DM.

Faktor-Faktor Yang Berkorelasi Dengan Status Nutrisi Pada Pasien Continuous Ambulatory Peritoneal Dialysis (Capd), Mira Yulianti, Suhardjono Suhardjono, Triyani Kresnawan, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

Pendahuluan: Perubahan status nutrisi dikaitkan dengan tingginya mortalitas pada kelompok pasien penyakit ginjal tahap akhir (PGTA). Berbagai penelitian menunjukkan tingginya prevalensi malnutrisi pada pasien dialisis kronik, namun hingga saat ini, penelitian lebih banyak dilakukan pada pasien yang menjalani hemodialisis. Dengan latar belakang berkembangnya CAPD di Indonesia, perlu diteliti faktor-faktor yang berkaitan dengan kesintasan pasien CAPD untuk menekan tingginya morbiditas dan mortalitas pada kelompok pasien tersebut, salah satunya adalah faktor nutrisi.

Metode: Penelitian ini merupakan studi potong lintang pada kelompok pasien PGTA yang menjalani CAPD yang kontrol ke RSCM dan RS Satelit. Dilakukan pengumpulan data denga wawancara, pemeriksaan fisik, …

Profil Pasien Kaki Diabetes Yang Menjalani Reamputasi Di Rumah Sakit Cipto Mangunkusumo Tahun 2008 -2012, Yohana Sitompul, Budiman Budiman, Suharko Soebardi, Murdani Abdullah

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Prevalensi diabetes global diprediksi akan meningkat sebesar dua kali lipat pada tahun 2030 dari 2,8% menjadi 4,4% (berkisar 366 juta) dengan angka komplikasi kaki diabetes berkisar 10%. Ulkus diabetes dan amputasi ekstremitas bawah merupakan komplikasi diabetes yang akan meningkatkan mortalitas dan morbiditas Setelah lima tahun amputasi pertama, 28-51% pasien akan menjalani amputasi kedua. Penelitian ini dilakukan untuk mengetahui proporsi dan profil pasien yang mengalami reamputasi di Rumah Sakit Cipto Mangunkusumo tahun 2008-2012.

Metode. Disain studi ini adalah potong lintang dengan 80 subjek pasien kaki diabetes yang dirawat di RSCM tahun 2008 sampai 2012. Dilakukan pencatatan data yang …

Serokonversi Hepatitis C Pada Pasien Hemodialisis Di Rumah Sakit Cipto Mangunkusumo, Alvina Widhani, Aida Lydia, Rino A. Gani, Siti Setiati

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Pasien hemodialisis (HD) tergolong kelompok risiko tinggi terinfeksi virus hepatitis C. Penelitian mengenai serokonversi hepatitis C di RS Cipto Mangunkusumo belum pernah dilakukan. Agar transmisi hepatitis C dapat diturunkan, faktor risiko serokonversi hepatitis C penting diketahui. Penelitian ini bertujuan mengetahui proporsi dan faktor risiko serokonversi hepatitis C pada pasien yang menjalani HD di RS Cipto Mangunkusumo.

Metode. Penelitian potong lintang terhadap pasien yang menjalani HD di RS Cipto Mangunkusumo pada bulan Juni-Juli 2011. Pemeriksaan anti-HCV menggunakan Roche Elecsys ECLIA, Analisis multivariat menggunakan regresi logistik.

Hasil. Pada bulan Juni-Juli 2011 terdapat 135 pasien HD yang memenuhi kriteria …

Perubahan Status Fungsi Hati, Status Nutrisi, Kadar 3-Β-Hidroksi Butiran Darah, Dan Keseimbangan Nitrogen Pada Pasien Sirosis Hari Yang Menjalankan Puasa Ramadhan, Azzaki Abubakar, Irsan Hasan, Murdani Abdullah, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Pendahuluan: Prevalensi sirosis cukup tinggi di Indonesia yang mayoritas populasinya adalah muslim. Pada saat menjalani puasa Ramadhan yang merupakan kewajiban umat muslim terjadi berbagai proses metabolik seperti penurunan glikokogenesis, peningkatan glukoneogenesis dan ketogenesis, dapat mempengaruhi keadaan klinis, nutrisi dan bokimiawi pasien sirosis hati yang juga mengalami proses hiperkatabolik. Penelitian tentang pengaruh puasa Ramadhan pada pasien sirosis hati di Indonesia belum pernah dilakukan. Berdasarkan kenyataan diatas perlu diteliti bagaimana perubahan terhadap status nutrisi, status fungsi hati, pembentukan badan keton dan keseimbangan nitrogen pada pasien sirosis hati yang menjalankan puasa Ramadhan.

Metode: Penelitian ini merupakan studi pre dan post, yang …

Hubungan Albumin Serum Awal Perawatan Dengan Perbaikan Klinis Infeksi Ulkus Kaki Diabetik Di Rumah Sakit Di Jakarta, Hendra Dwi Kurniawan, Em Yunir, Pringgodigdo Nugroho

Jurnal Penyakit Dalam Indonesia

Latar Belakang: Ulkus kaki diabetik terinfeksi merupakan kasus DM yang paling banyak dirawat di RS, berhubungan dengan morbiditas, mortalitas, biaya yang tinggi dan bersifat multifaktorial. Salah satu faktor yang berpengaruh adalah albumin. Belum ada penelitian yang secara langsung menghubungkan konsentrasi albumin serum awal perawatan dengan perbaikan klinis infeksi ulkus kaki diabetik. Belum ada batasan mengenai konsentrasi albumin yang dapat mempengaruhi perbaikan klinis infeksi ulkus kaki diabetik. Penelitian ini bertujuan Mendapatkan data mengenai konsentrasi albumin serum awal perawatan dan hubungannya dengan perbaikan klinis infeksi ulkus kaki diabetik. Metode: Penelitian dengan desain kohort prospektif terhadap 71 pasien diabetes dengan ulkus kaki terinfeksi …

Hipoglikemia: Sindrom Paraneoplastik Pada Karsinoma Hepatoselular, Hari Sutanto, Andra Aswar, N Soebijanto

Jurnal Penyakit Dalam Indonesia

Karsinoma hepatoselular (KHS) merupakan tumor ganas hati primer yang menempati urutan ketiga penyebab mortalitas akibat keganasan di seluruh dunia, karena acapkali terdiagnosis pada stadium lanjut. Tidak jarang manifestasi ekstrahepatik mucul pada KHS di antaranya hipoglikemia yang dapat muncul di akhir perjalanan penyakit ketika terjadi kegagalan fungsi hati; namun juga dapat muncul sebagai gejala awal sebelum ditemukan nodul pada hepar. Hipoglikemia dapat meningkatkan morbiditas, menurunkan kualitas hidup, dan menurunkan kesintasan. Pemahaman mengenai patogenesis, kewaspadaan serta diagnosis dini, dan penanganan yang tepat merupakan kunci tatalaksana utama.

Determinan Diagnostik Klinis Defisiensi Vitamin D Pada Wanita Berusia Lebih Dari 50 Tahun, Vera Vera, Siti Setiati, Arya Govinda

Jurnal Penyakit Dalam Indonesia

Pendahuluan: Prevalensi deifisiensi vitamin D pada wanita 50 tahun ke atas di Indonesia cukup tinggi namun pemeriksaan kadar vitamin D serum sangat mahal. Oleh karena itu, diperlukan alat penyaring defisiensi vitamin D yang cukup ekonomis dan sederhana untuk dikerjakan di layanan kesehatan primer. Metode: Penelitian ini merupakan penelitian diagnostik, menggunakan desain potong lintang (cross-sectional) sehubungan dengan pengambilan data hanya dilakukan sewaktu saja. Penelitian ini dilakukan di Kotamadia Bandung selama Agustus–Oktober 2012. Pada 240 subjek, dilakukan pengumpulan data berupa karakteristik responden, diabetes mellitus, penyakit ginjal kronik, riwayat jatuh, riwayat fraktur setelah menopause, nyeri tulang, skor paparan sinar matahari, skor proteksi sinar …

Tatalaksana Terkini Perlemakan Hati Non Alkoholik, Randy Adiwinata, Andi Kristanto, Finna Christianty, Timoteus Richard, Daniel Edbert

Jurnal Penyakit Dalam Indonesia

Perlemakan Hati Non Alkoholik (Non Alcoholic Fatty Liver Disease/NAFLD) merupakan salah satu penyebab utama dari penyakit hati kronis di negara berkembang. NAFLD dapat berkembang menjadi menjadi penyakit hati yang lebih berat seperti Non Alcoholic Steatohepatis (NASH), sirosis hepatis, dan karsinoma hati. Tatalaksana NAFLD terus berkembang, dan saat ini klinisi dihadapkan dengan berbagai pilihan alternatif baik dari segi nonfarmakoterapi maupun farmakoterapi. Tulisan ini akan membahas berbagai pilihan terapi NAFLD terkini tersebut berdasarkan bukti terbaru.

Abuse Among School Going Adolescents In Three Major Cities Of Pakistan: Is It Associated With School Performances And Mood Disorders?, Saleem Khawaja, Adeel Khoja, Komal Motwani

Department of Medicine

Objective: To assess the proportion of various types of abuses and their association with school performances and psychological stress among adolescents from three major cities of Pakistan.

Methods: The cross-sectional school survey was conducted from March to September 2009, comprising adolescent students at six schools in Karachi, Lahore and Quetta. Data was collected using a self-administered and pre-tested questionnaire by trained medical students. SPSS 16 was used for statistical analysis..

Results: Of the 414 subjects in the study, there were 223(54%) boys and 191(46%) girls with an overall mean age of 14.36 ±1.08 years. In all, 140(33.7%) participants were physically …

The Role Of Factor Xa Inhibitors In Venous Thromboembolism Treatment, K. P. Cabral, J. E. Ansell

Journal Articles

Three factor Xa inhibitors have been studied in the treatment of venous thromboembolism, both for acute therapy and as extended therapy to prevent recurrent events. Rivaroxaban, apixaban, and edoxaban have all proven to be effective in Phase III clinical trials for this indication when compared to current standard of therapy with similar or less bleeding. Nevertheless, the agents all offer different pharmacological profiles, which have an impact on patient selection and potential advantages in clinical practice.

Multicenter Randomized Controlled Trial On Duration Of Therapy For Thrombosis In Children And Young Adults (The Kids-Dott Trial): Pilot/Feasibility Phase Findings, N. A. Goldenberg, T. Abshire, P. J. Blatchford, L. Z. Fenton, J. L. Halperin, W. R. Hiatt, C. M. Kessler, J. M. Kittelson, A. C. Spyropoulos, S. Schulman, +4 Additional Authors

Journal Articles

BACKGROUND: Randomized controlled trials (RCTs) on pediatric venous thromboembolism (VTE) treatment have been challenged by unsubstantiated design assumptions and/or poor accrual. Pilot/feasibility (P/F) studies are critical to future RCT success. METHODS: The Kids-DOTT trial is a multicenter RCT investigating non-inferiority of a 6-week (shortened) versus 3-month (conventional) duration of anticoagulation in patients aged < 21 years with provoked venous thrombosis. Primary efficacy and safety endpoints are symptomatic recurrent VTE at 1 year and anticoagulant-related, clinically relevant bleeding. In the P/F phase, 100 participants were enrolled in an open, blinded-endpoint, parallel-cohort RCT design. RESULTS: No eligibility violations or randomization errors occurred. Of the enrolled patients, 69% were randomized, 3% missed the randomization window, and 28% were followed in prespecified observational cohorts for completely occlusive thrombosis or persistent antiphospholipid antibodies. Retention at 1 year was 82%. Interobserver agreement between local and blinded central determination of venous occlusion by imaging at 6 weeks after diagnosis was strong (k-statistic = 0.75; 95% confidence interval [CI] 0.48-1.0). The primary efficacy and safety event rates were 3.3% (95% CI 0.3-11.5%) and 1.4% (95% CI 0.03-7.4%). CONCLUSIONS: The P/F phase of the Kids-DOTT trial has demonstrated the validity of vascular imaging findings of occlusion as a randomization criterion, and defined randomization, retention and endpoint rates to inform the fully powered RCT.

The Orbit Bleeding Score: A Simple Bedside Score To Assess Bleeding Risk In Atrial Fibrillation, E. C. O'Brien, D. N. Simon, L. E. Thomas, E. M. Hylek, B. J. Gersh, J. E. Ansell, P. R. Kowey, K. W. Mahaffey, P. Chang, E. D. Peterson, +3 Additional Authors

Journal Articles

BACKGROUND: Therapeutic decisions in atrial fibrillation (AF) are often influenced by assessment of bleeding risk. However, existing bleeding risk scores have limitations. OBJECTIVES: We sought to develop and validate a novel bleeding risk score using routinely available clinical information to predict major bleeding in a large, community-based AF population. METHODS: We analysed data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), a prospective registry that enrolled incident and prevalent AF patients at 176 US sites. Using Cox proportional hazards regression, we identified factors independently associated with major bleeding among patients taking oral anticoagulation (OAC) over a median …

Investigation Of Body Image As A Mediator Of The Effects Of Bowel And Gi Symptoms On Psychological Distress In Female Survivors Of Rectal And Anal Cancer, C. Benedict, V. M. Rodriguez, J. Carter, L. Temple, C. Nelson, K. Duhamel

Journal Articles

PURPOSE: Treatment for rectal and anal cancer (RACa) can result in persistent bowel and gastrointestinal (GI) dysfunction. Body image problems may develop over time and exacerbate symptom-related distress. RACa survivors are an understudied group, however, and factors contributing to post-treatment well-being are not well understood. This study examined whether poorer body image explained the relation between symptom severity and psychological distress. METHODS: Participants (N = 70) completed the baseline assessment of a sexual health intervention study. Bootstrap methods tested body image as a mediator between bowel and GI symptom severity and two indicators of psychological distress (depressive and anxiety symptoms), …

Cds, Ux, And System Redesign - Promising Techniques And Tools To Bridge The Evidence Gap, T. Mcginn

Journal Articles

INTRODUCTION: In this special issue of eGEMs, we explore the struggles related to bringing evidence into day-to-day practice, what I define as the "evidence gap." We are all aware of high quality evidence in the form of guidelines, randomized clinical trials for treatments and diagnostic tests, and clinical prediction rules, which are all readily available online. We also know that electronic health records (EHRs) are now ubiquitous in health care and in most practices across the country. How we marry this high quality evidence and the practice of medicine through effective decision support is a major challenge. ABOUT THE ISSUE: …

Use And Outcomes Associated With Bridging During Anticoagulation Interruptions In Patients With Atrial Fibrillation: Findings From The Outcomes Registry For Better Informed Treatment Of Atrial Fibrillation (Orbit-Af), B. A. Steinberg, E. D. Peterson, S. Kim, L. Thomas, B. J. Gersh, G. C. Fonarow, P. R. Kowey, K. W. Mahaffey, M. W. Sherwood, J. Ansell, +2 Additional Authors

Journal Articles

BACKGROUND: Temporary interruption of oral anticoagulation for procedures is often required, and some propose using bridging anticoagulation. However, the use and outcomes of bridging during oral anticoagulation interruptions in clinical practice are unknown. METHODS AND RESULTS: The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry is a prospective, observational registry study of US outpatients with atrial fibrillation. We recorded incident temporary interruptions of oral anticoagulation for a procedure, including the use and type of bridging therapy. Outcomes included multivariable-adjusted rates of myocardial infarction, stroke or systemic embolism, major bleeding, cause-specific hospitalization, and death within 30 days. Of …

Malignancies, Particularly B-Cell Lymphomas, Are A Frequent Cause Of Mortality In Human Immunodeficiency Virus-1 Patients Despite Highly Active Antiretroviral Therapy, D. O. Griffin, M. Metzger, K. Poeth, K. Deng, A. Dharsee, J. C. Rico, J. Mcgowan

Journal Articles

Human immunodeficiency virus (HIV)-1-infected individuals are affected by diseases at rates above those of their HIV-negative peers despite the increased life expectancy of the highly active antiretroviral therapy era. We followed a cohort of approximately 2000 HIV-1-infected patients for 5 years. The most frequent cause of death in this HIV-1-infected cohort was malignancy, with 39% of all classified deaths due to cancer. Among the cancer deaths, B-cell lymphomas were the most commonly seen malignancy, representing 34% of all cancer deaths. These lymphomas were very aggressive with a median survival ofdiagnosis.

Perioperative Bridging Anticoagulation In Patients With Atrial Fibrillation, J. D. Douketis, A. C. Spyropoulos, S. Kaatz, R. C. Becker, J. A. Caprini, A. S. Dunn, D. A. Garcia, A. Jacobson, A. K. Jaffer, T. L. Ortel, +4 Additional Authors

Journal Articles

BACKGROUND: It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding. METHODS: We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or …

A Randomized, Phase 2 Trial Of Docetaxel With Or Without Px-866, An Irreversible Oral Phosphatidylinositol 3-Kinase Inhibitor, In Patients With Relapsed Or Metastatic Head And Neck Squamous Cell Cancer, A. Jimeno, J. E. Bauman, C. Weissman, D. Adkins, I. Schnadig, P. Beauregard, D. W. Bowles, A. Spira, B. Levy, N. Seetharamu, D. Hausman, L. Walker, C. M. Rudin, K. Shirai

Journal Articles

INTRODUCTION: The phosphotidylinositol-3 kinase (PI3K)/serine-threonine kinase (AKT)/mammalian target of rapamycin (mTOR) signaling pathway is frequently altered in head and neck squamous cell cancer (HNSCC). PX-866 is an oral, irreversible, pan-isoform inhibitor of PI3K. Preclinical models revealed synergy with docetaxel and a phase 1 trial demonstrated tolerability of this combination. This randomized phase 2 study evaluated PX-866 combined with docetaxel in patients with advanced, refractory HNSCC. METHODS: Patients with locally advanced, recurrent or metastatic HNSCC who had received at least one and no more than two prior systemic treatment regimens were randomized (1:1) to a combination of docetaxel (75mg/m(2) IV every …