Zuljasri Albar
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Gout: Diagnosis and management

Medical Journal of Indonesia Vol 16, No 1 (2007): January-March
Publisher : Faculty of Medicine Universitas Indonesia

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Abstract

Gout is a heterogeneous group of diseases resulting from monosodium urate (MSU) crystal deposition in tissues or from supersaturation of uric acid in extracellular fluids. Clinical manifestations include 1) Recurrent attacks of articular and periarticular inflammation, also called gouty arthritis; 2) Accumulation of articular, osseous, soft tissue, and cartilaginous crystalline deposits, called tophi; 3) Uric acid calculi in the urinary tract; and 4) Interstitial nephropathy with renal function impairment, called gouty nephropathy. Gout predominantly is a disease of adult men, with a peak incidence in the fifth decade. In women usually found after menopause. The metabolic disorder underlying gout is hyperuricaemia. The duration and magnitude of hyperuricemia directly correlate with the likelihood of developing gouty arthritis and uric acid urolithiasis, and with age at onset of initial clinical gouty manifestations. The urate crystals induce phagocytes and synovial cells to generate and release such mediators as cyclooxygenase and lipoxygenase metabolites of arachidonic acid, phospholipase A2-activating protein, lysosomal proteases, tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, and IL-8. Definitive diagnosis of gout needs the demonstration of MSU crystals in synovial fluid or tophus. Gout is frequently associated with comorbidity such as obesity, hypertension, renal disease and dyslipidaemia. Therapeutic goals include terminating acute attacks; providing rapid, safe relief of pain and inflammation; averting future attacks; and preventing such complications as formation of tophi, kidney stones, and destructive arthropathy. Colchicine, nonsteroidal anti-inflammatory drugs and corticosteroid are drugs used for treating acute gouty arthritis. Colchicine is also used for prophylaxis. Urate lowering drugs also play a role in prophylactic management of gout. With early intervention, careful monitoring, and patient education, the prognosis is excellent. (Med J Indones 2007; 16:47-54)Keywords: Hyperuricemia, tophus, arthritis, inflammatory mediators, dietary and lifestyle, urate lowering drugs

Prevalence and Distribution of Anemia Risk Factor in Patient with Chronic Hepatitis C who Has Combination therapy of Interferon Alpha and Ribavirin

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: Interferon alfa and ribavirin combination therapy is one of effective standard therapy for chronic hepatitis C (CHC.) However, anemia is a common side effect of this therapy that patients have to reduce or discontinue ribavirin therapy. But ribavirin dose reduction or discontinuation can reduce the effectivity of the therapy. Hence, it is important to know the prevalence of anemia and to determine the factors associated with anemia. Objective: To know the prevalence of anemia and some risk factors associated with anemia caused by the combination therapy in chronic hepatitis C. Method: Sixty one of CHC patients who received combination therapy were included in this study. The study used cross sectional design and data were obtained by measured complete blood count on 8th week of therapy. Result: Subjects 47 (77%) were males, 14 (23%) were females with mean age 38.9 years. Subjects had genotype 1 and 4 were 23 (71.9%) and 44 (72.1%) subjects received 1,000 mg ribavirin. Prevalence of anemia was found to be 52.5%. On multivariate analysis, only pretreatment hemoglobin concentration < 14 g/dl was found to be the risk factor of anemia. Conclusion: Prevalence of anemia was 52.5%. Pretreatment hemoglobin concentration < 14 g/dl was only found to be the risk factors of anemia. Although age > 50 years or female were not found to be the risk factor of anemia but patient with these risk factors should be carefully monitored. Intervention to prevent anemia should be considered to these patients. Eight subjects from 32 anemia patients had ribavirin dose reduction, and no patient had discontinuation treatment on 8th week of therapy.   Keywords: chronic hepatitis C, IFN-alfa- RIB combination therapy, risk factors of anemia

Effect of range of motion and isometric strengthening exercises on grip strength and hand function in rheumatoid arthritis patients

Universa Medicina Vol 27, No 4 (2008)
Publisher : Faculty of Medicine, Trisakti University

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Abstract

In previous studies, duration of hand exercises in patients with rheumatoid arthritis (RA) had widely varying ranges, from 3 weeks to 4 months. An experimental study was conducted to evaluate the effect of range of motion (ROM) and muscle strengthening exercises for 6 weeks on grip strength and hand function in RA patients. Seventeen patients with chronic RA were randomly assigned to a treatment group and a control group. The treatment group (n=8) was given muscle strengthening exercises and heat therapy using paraffin baths 3 times a week at the hospital and ROM exercises once a day at home for 6 weeks. The control group (n=9) was given only paraffin baths 3 times a week. After 6 weeks, there were significant differences in hand function (p=0.003), right and left grip strength (p=0.000 and p=0.001) and ROM in the interventional group only. ROM and isometric strengthening exercises significantly improved grip strength and hand function in patients with RA, while no impact was found when the patients were given paraffin baths only. In view of the small size of the study population, there is a need for further studies with larger populations.

Diabetes insipidus in neuropsychiatric-systemic lupus erythematosus patient

Indonesian Journal of Rheumatology Vol 2, No 1 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Systemic lupus erythematosus (SLE) is an idiopathic autoimmune chronic inflammatorydisease that is unique in its diversity of clinical manifestations, variability of disease’s progression, and prognosis. The disease is characterized by the remission and multiple flare-ups in between the chronic phase that may affect many organ systems.The prevalence of SLE in the US population is 1:1000 with a woman to man ratio of about 9-14:1. At Cipto Mangunkusumo Hospital, Jakarta in 2002, there was 1.4% cases of SLE of the total number of patients at the Rheumatology Clinic. Neuropsychiatric manifestations of SLE (NP-SLE) have a high mortality and morbidity rates. The incidence of NP-SLE ranges 18-61%. Diagnosis of NP-SLE is difficult because there is no specific laboratory examination. Accordingly, in all SLE patients with central nervous system (CNS) dysfunction, additional tests will be necessary to confirm an NP-SLE diagnosis and exclude other causes. Similar to diabetes insipidus, SLE is a systemic disease which affects many organ systems, one being the endocrine system. No data has specified the occurrence rate of diabetes insipidus in SLE patients. This disease arises from a number of factors able to interfere with the mechanism of neurohypophyseal renal reflex resulting in the body’s failure to convert water.3 There are three general forms of the disease, a polydipsicpolyuric syndrome caused by partial/complete vasopressin deficiency (central-diabetes-insipidus/CDI), vasopressin resistance of the kidney tubules (nephrogenic-diabetes-insipidus/NDI), and primary polydipsia. CDI occurs in about 1 in 25,000 persons

Correlation Of Clinical Disease Activity Index And Disease Activity Score-28 in Indonesian Rheumatoid Arthritis Patients

Indonesian Journal of Rheumatology Vol 9, No 1 (2017)
Publisher : Indonesian Rheumatology Association

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Abstract

Background:Clinical Disease Activity Index (CDAI) stands out amongst other methods in measuring disease activity of rheumatoid arthritis (RA) patient. CDAI is considered to be more practical and cost-effective in daily practice because it requires no laboratoryexamination. Previous studies conducted overseas revealed that CDAI has good correlation compared to other scoring index in measuring RA disease activity. However, those studies only included pure RA patients without any comorbidity diseases. Indonesian RA patients have distinct clinical profile, in terms of comorbidity conditions, and genetic predisposition which affect the fenotype of the disease.Objectives: Analyze correlation between CDAI compared to Disease Activity Score 28 CRP (DAS28- CRP) in measuring RA disease activity of RA patients in Indonesia.Methods: We conducted a cross sectional study to RA patients who visited rheumatology clinic at Cipto Mangunkusumo general hospital from April to May 2016. Data collected included history of illness, physical examination, and recent laboratory results. All data were documented in reseach’s form. Both CDAI and DAS28- CRP were measured in each patient by two observers. Correlation analysis between two numeric datas fromCDAI and DAS28-CRP were measured with Spearman’s Rho. Overall performance was analyzed as additional results using R2 index.Result: A total of 119 subjects were included in this study. All subjects were RA patients with comorbidities and were representing quite numbers of Indonesian races characteristic profile. Spearman’s Rho = 0,918 and R2 index =0,831 (83,1%).Conclusion: There is positive correlation result between outcome of CDAI and outcome of DAS28-CRP in assesing disease activity of Indonesian RA patients.Key Word: rheumatoid arthritis, Indonesia, correlation,Clinical Disease Activity Index.

Vitamin D and inflammation

Indonesian Journal of Rheumatology Vol 2, No 1 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

The discovery that most body cells and tissues have vitamin D receptors and that some of them have the enzymatic machinery to convert the circulating form of vitamin D (25-hydroxyvitamin D) into the active form (1,25- dihydroxyvitamin D/1,25(OH)2D3 ) gave a new insight about the function of this vitamin. In the course of time, more and more evidences showed that a low vitamin D level leads to the occurrence or recurrenceof cardiovascular diseases, type II diabetes mellitus (DM), cell dedifferentiation (oncogenesis), and immune derangement (autoimmune diseases such as lupus, typeI DM, rheumatoid arthritis, and multiple sclerosis). Most researchers have agreed that a minimum 25(OH)D3 serum level of about 30 ng/ml or more is necessary for favorable calcium absorption and good health. Until proven otherwise, the balance of the research clearly indicates that oral supplementation in the range of 1,000 IU/day for infants, 2,000 IU/day for children, and 4,000 IU/day for adults is safe and reasonable to meetphysiologic requirements, to promote optimal health, and to reduce the risk of several serious diseases.

Vitamin D and inflammation

Indonesian Journal of Rheumatology Vol 2 No 1 (2010)
Publisher : Indonesian Rheumatology Association

Show Abstract | Original Source | Check in Google Scholar | Full PDF (325.133 KB)

Abstract

The discovery that most body cells and tissues have vitamin D receptors and that some of them have the enzymatic machinery to convert the circulating form of vitamin D (25-hydroxyvitamin D) into the active form (1,25- dihydroxyvitamin D/1,25(OH)2D3 ) gave a new insight about the function of this vitamin. In the course of time, more and more evidences showed that a low vitamin D level leads to the occurrence or recurrenceof cardiovascular diseases, type II diabetes mellitus (DM), cell dedifferentiation (oncogenesis), and immune derangement (autoimmune diseases such as lupus, typeI DM, rheumatoid arthritis, and multiple sclerosis). Most researchers have agreed that a minimum 25(OH)D3 serum level of about 30 ng/ml or more is necessary for favorable calcium absorption and good health. Until proven otherwise, the balance of the research clearly indicates that oral supplementation in the range of 1,000 IU/day for infants, 2,000 IU/day for children, and 4,000 IU/day for adults is safe and reasonable to meetphysiologic requirements, to promote optimal health, and to reduce the risk of several serious diseases.

Diabetes insipidus in neuropsychiatric-systemic lupus erythematosus patient

Indonesian Journal of Rheumatology Vol 2 No 1 (2010)
Publisher : Indonesian Rheumatology Association

Show Abstract | Original Source | Check in Google Scholar | Full PDF (174.519 KB)

Abstract

Systemic lupus erythematosus (SLE) is an idiopathic autoimmune chronic inflammatorydisease that is unique in its diversity of clinical manifestations, variability of disease’s progression, and prognosis. The disease is characterized by the remission and multiple flare-ups in between the chronic phase that may affect many organ systems.The prevalence of SLE in the US population is 1:1000 with a woman to man ratio of about 9-14:1. At Cipto Mangunkusumo Hospital, Jakarta in 2002, there was 1.4% cases of SLE of the total number of patients at the Rheumatology Clinic. Neuropsychiatric manifestations of SLE (NP-SLE) have a high mortality and morbidity rates. The incidence of NP-SLE ranges 18-61%. Diagnosis of NP-SLE is difficult because there is no specific laboratory examination. Accordingly, in all SLE patients with central nervous system (CNS) dysfunction, additional tests will be necessary to confirm an NP-SLE diagnosis and exclude other causes. Similar to diabetes insipidus, SLE is a systemic disease which affects many organ systems, one being the endocrine system. No data has specified the occurrence rate of diabetes insipidus in SLE patients. This disease arises from a number of factors able to interfere with the mechanism of neurohypophyseal renal reflex resulting in the body’s failure to convert water.3 There are three general forms of the disease, a polydipsicpolyuric syndrome caused by partial/complete vasopressin deficiency (central-diabetes-insipidus/CDI), vasopressin resistance of the kidney tubules (nephrogenic-diabetes-insipidus/NDI), and primary polydipsia. CDI occurs in about 1 in 25,000 persons

Correlation Of Clinical Disease Activity Index And Disease Activity Score-28 in Indonesian Rheumatoid Arthritis Patients

Indonesian Journal of Rheumatology Vol 9 No 1 (2017)
Publisher : Indonesian Rheumatology Association

Show Abstract | Original Source | Check in Google Scholar | Full PDF (355.339 KB)

Abstract

Background:Clinical Disease Activity Index (CDAI) stands out amongst other methods in measuring disease activity of rheumatoid arthritis (RA) patient. CDAI is considered to be more practical and cost-effective in daily practice because it requires no laboratoryexamination. Previous studies conducted overseas revealed that CDAI has good correlation compared to other scoring index in measuring RA disease activity. However, those studies only included pure RA patients without any comorbidity diseases. Indonesian RA patients have distinct clinical profile, in terms of comorbidity conditions, and genetic predisposition which affect the fenotype of the disease.Objectives: Analyze correlation between CDAI compared to Disease Activity Score 28 CRP (DAS28- CRP) in measuring RA disease activity of RA patients in Indonesia.Methods: We conducted a cross sectional study to RA patients who visited rheumatology clinic at Cipto Mangunkusumo general hospital from April to May 2016. Data collected included history of illness, physical examination, and recent laboratory results. All data were documented in reseach’s form. Both CDAI and DAS28- CRP were measured in each patient by two observers. Correlation analysis between two numeric datas fromCDAI and DAS28-CRP were measured with Spearman’s Rho. Overall performance was analyzed as additional results using R2 index.Result: A total of 119 subjects were included in this study. All subjects were RA patients with comorbidities and were representing quite numbers of Indonesian races characteristic profile. Spearman’s Rho = 0,918 and R2 index =0,831 (83,1%).Conclusion: There is positive correlation result between outcome of CDAI and outcome of DAS28-CRP in assesing disease activity of Indonesian RA patients.Key Word: rheumatoid arthritis, Indonesia, correlation,Clinical Disease Activity Index.

Prevalence and Distribution of Anemia Risk Factor in Patient with Chronic Hepatitis C who Has Combination therapy of Interferon Alpha and Ribavirin

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Original Source | Check in Google Scholar

Abstract

Background: Interferon alfa and ribavirin combination therapy is one of effective standard therapy for chronic hepatitis C (CHC.) However, anemia is a common side effect of this therapy that patients have to reduce or discontinue ribavirin therapy. But ribavirin dose reduction or discontinuation can reduce the effectivity of the therapy. Hence, it is important to know the prevalence of anemia and to determine the factors associated with anemia. Objective: To know the prevalence of anemia and some risk factors associated with anemia caused by the combination therapy in chronic hepatitis C. Method: Sixty one of CHC patients who received combination therapy were included in this study. The study used cross sectional design and data were obtained by measured complete blood count on 8th week of therapy. Result: Subjects 47 (77%) were males, 14 (23%) were females with mean age 38.9 years. Subjects had genotype 1 and 4 were 23 (71.9%) and 44 (72.1%) subjects received 1,000 mg ribavirin. Prevalence of anemia was found to be 52.5%. On multivariate analysis, only pretreatment hemoglobin concentration < 14 g/dl was found to be the risk factor of anemia. Conclusion: Prevalence of anemia was 52.5%. Pretreatment hemoglobin concentration < 14 g/dl was only found to be the risk factors of anemia. Although age > 50 years or female were not found to be the risk factor of anemia but patient with these risk factors should be carefully monitored. Intervention to prevent anemia should be considered to these patients. Eight subjects from 32 anemia patients had ribavirin dose reduction, and no patient had discontinuation treatment on 8th week of therapy.   Keywords: chronic hepatitis C, IFN-alfa- RIB combination therapy, risk factors of anemia