Articles

Found 31 Documents
Search

HUBUNGAN ANTARA OBESITAS SENTRAL DENGAN ADIPONEKTIN PADA PASIEN GERITARI DENGAN PENYAKIT JANTUNG KORONER Gotera, Wira; Suastika, Ketut; Santoso, Anwar; Kuswardhani, Tuty
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Obesity is rapidly becoming a global problem not only in developed countries but also in developing countries such asIndonesia. Visceral obesity (central obesity) is an importance risk for cardiovascular disease and recognition that adipose tissuecan be regarded as a large endocrine organ that secreted inflammatory and anti inflammatory molecules (adiponectin). This studyaims to know the correlation between central obesity and adiponectin in geriatric coronary heart disease (CHD) patients. Thisstudy was cross sectional analytic study of geriatric CHD at out and in patients in Sanglah hospital. Data are presented as groupmean ± SD and analyzed by t-test, chi-square, and Pearson correlation with SPSS 12 software. Forty five patients (35 males and10 females), 23 patient unstable angina pectoris, 14 patient acute myocardial infarction, and 8 patient stable angina pectoris wererecruited and examined. There was high prevalence of central obesity 51.1% (23 patients). Mean of log adiponectin weresignificantly difference between central obese and non central obese (1.80 ± 0.61 vs 1.09 ± 0.41 with p). Central obesity increasedrisk of hypoadiponectinemia 5 times than non central obesity (p=0.011, CI 95% 1.4-17.8). Waist circumference has negativecorrelation with log plasma adiponectin (R=-0.663, p<0.001). There was high prevalence of central obesity in geriatric coronaryheart disease patients. Central obesity increased risk of hypoadiponectinemia 5 times than non central obesity. Waistcircumference has negative correlation with plasma adiponectin. Increased of waist circumference will decrease of adiponectin(cardioprotective protein) and will increase risk of acute coronary syndrome in geriatric patients.
KORELASI ANTARA BRACHIAL-ANKLE PULSE WAVE VELOCITY DAN PROFIL LIPID PADA KARYAWAN RUMAH SAKIT SANGLAH DENPASAR Arsana, Gede Putu; -, Kambayana; Santoso, Anwar; Suastika, Ketut
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Brachial-ankle pulse wave velocity (baPWV) is an indicator of limb arterial stiffness. Dislipidemia is a major risk factorof atherosclerosis and may worsen baPWV by increasing the blood viscosity. This study aims to study the correlations betweenbaPWV and the lipid profile among employees of Sanglah Hospital. Cross sectional analytic study was performed in Sanglahhospital. Pulse wave velocity was measured using an automatic device (Fukuda VS 1000). Lipid profile were taken as well. Datawas expressed in mean + SD, analyzed by t-test compare mean and Pearson correlation by using SPSS 13.0. There were 85patients involved, all subjects were male, age all between 40-56 (mean 47.23 + 5.16) years old. Cholesterol total, LDL-C, HDLC,and triglyceride concentrations varied subject, range (means + SD) as (205.05 + 39.40) mg/dL, (144.26 + 36.85) mg/dL,(45.94 + 8.98) mg/dL, and (151.94 + 64.56) mg/dL, respectively. BaPWV on the right limbs were between (13,31 + 2,14 ) m/sec,on the left limbs were (15,05 + 2,33 ) m/sec. Significant correlations were found between total cholesterol concentration and theleft baPWV (r = 0.222, p = 0.41), while a significant correlation were found on the right side (r = 0.234, p = 0.031). Brachialanklepulse wave velocity is positively correlation with total cholesterol concentration.
PREDIKTOR DISFUNGSI EREKSI PADA PENDERITA DIABETES TIPE 2 DI POLIKLINIK PENYAKIT DALAM RS SANGLAH DENPASAR Ratna Saraswat, Made; Sanjaya, Dwija; Suastika, Ketut
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Erectile dysfunction (ED) is a commonly reported condition among men with diabetes, however little is known aboutthe predictive factors associated with diabetic ED. To examine the predictors related to ED among type 2 diabetes outpatient, aconsecutive cross sectional study at Internal Medicine Outpatient Clinic, Sanglah Hospital was conducted, enrolled 137 type 2diabetes men aged between 35 ? 77 years old. We found 79.5% of type 2 diabetics with ED. Erectile function score was significantlycorrelated with other component of International Index of Erectile Function 15 (IIEF 15) including orgasmic function(r=0.622, p<0.001), sexual desire (r=0.782, p<0.001), intercourse satisfaction (r=0.911, p<0.001), and overall satisfaction (r=0.842,p<0.001). Erectile function was also correlated with age (r=0.315, p<0.001). Chi square analysis among diabetic complication,ED were significantly higher among patient with albuminuria/proteinuria (p=0.025, prevalence ratio 7.43 (95% IC 0.95 ? 58.15).Other factors such as duration of diabetes, central obesity, cigarette smoking, alcoholism, diabetic control (HbA1C and lipidprofile), diabetic complications, and hypertension were not significantly correlated with ED. ED were high among type 2 diabeticsand erectile function were correlated with orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction.ED also correlated with age and albuminuri/proteinuria but not with other predictors.
SEORANG PENDERITA HIPOKALSEMIA BERAT OLEH KARENA HIPOPARATIROIDISME DIDAPAT Dharmawan Harjanto, David; Ratna Saraswati, Made; Suastika, Ketut
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Albeit rare, hypocalcemia might present an acute severe symptom as hypocalcemic seizure, which is documented in ourpatients. Failure in its diagnosis and management will lead to significant morbidity and mortality. Establishing the PTH status,anorganic-phosphate and magnesium level will enable investigation on possible etiology of hypocalcemia. The overall incidenceof post thyroidectomy hypoparathyroidism and hypocalcemia is about 0.5-3 % worldwide. The pathophysiology are multifactorial,it is not simply the glands extirpations, as well as its multiple risk factors although operator technique skill is still theprominent one. We have presented a case of 24 year old female with an acute generalized seizure (hypocalcemic seizure) andprolonged corrected QT interval due to a severe hypocalcemia secondary to hypoparathyroidism from a total thyroidectomy,accompanied by acquired hyperthyroidism and a cerebral cortex calcification. Clinical symptoms and total calcium were improvedafter intravenous calcium gluconate, followed by oral calcium and calcitriol administrations. However, the ideal therapyfor hypoparathyroidism is still the hormone substitution, either by auto/xeno-transplantations or injections, pending further studies.PTH level determinations immediately or several hours after surgery and thus oral calcium supplementations might predictand reduce the incidence of post thyroidectomy hypocalcemia and hypoparathyroidism.
HUBUNGAN KENDALI GLIKEMIK DENGAN ASYMMETRIC DIMETHYLARGININE PENDERITA DIABETES MELITUS TIPE 2 LANJUT USIA Ngurah Hariawa, Kadek; Suastika, Ketut
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Increasing life expectacy is usually in line with increasing prevalence of matabolic diseases, especially diabetes mellitus(DM). Old age and DM are risk factors for cardiovascular disease. Endothelial dysfunction is the early process of atherosclerosis.Asymmetric dimethylarginine (ADMA) is a marker for endothelial dysfunction. Until recently however, there is a lack of studyon the correlation of diabetes control and ADMA in elderly with DM.The objective of this study was to assess the correlation of diabetes control with ADMA in diabetes elderly. The designof the study was cross sectional analytic study. The study subects were diabetic patients aged 60 years or above without smokingand existance of end stage renal disease.The 80 study subjects consisted of 57 males and 43 females, ages ranging from 60 to 80 years. The majority of thesubjects were with other diseases i.e. hipertension 62 (77.5%), dyslipidemia 51 (63.8%), overweight 59 (73.9%), decreased renalfunction with creatinin clearence below 60 ml/mnt 58 (72.5%), hyperhomocysteinemia 35 (43.8%). The subjects with goodglicemic control were 25 (32%), moderate 31 (38.8%), and bad glicemic control 24 (30%). Pearson correlation showed there wasno correlation between glicemic control (fasting blood glucose, 2 hour after meal blood glucose, HbA1c) and ADMA. Analysis onother factors showed a correlation of ADMA with sistolic blood pressure (r=-0.222; p=0.024) and homocystein (r=0.333; p=0.001).Multiple liniar regression analysis constanly showed a correlation between homocystein and ADMA (B=0.473; p=0.003). Thenew construction model of this study was the formula ADMA (µmol/L)= 0.213+0.473 log homocystein µmol/L. Based on thecriteria used diabetes control, we found mean difference of ADMA at systolic blood pressure (p=0.031). There was no meandiffrence of ADMA found based on the treatment regimens given i.e. those given insulin or not (p=0.547) and those givenmetformin or not (p=0.219).In conclusion, blood glucose control has no correlation with ADMA in the elderly with DM, however homocystein haspositve correlation with ADMA in elderly with DM. The elderly with DM have several accompanying of diseases.
HUBUNGAN JUMLAH SEL LIMFOSIT T CD8+ PADA ULKUS KAKI DIABETIK DERAJAT 3, 4, 5 DAN ULKUS NON DIABETIK Putu Sutirta Yasa, I Wayan; Sudewa Djelantik, Anak Agung Gde; Suastika, Ketut; Mantik Astawa, Nyoma; Yuatmadja, Ignatius Ferdi
journal of internal medicine Vol. 10, No. 1 Januari 2009
Publisher : journal of internal medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Diabetes mellitus (DM) is a complex metabolism disorder characterized by a severe chronic hyperglycemia with a largenumber of complications, diabetic foot ulcer (DF) is one of its disastrous progressive complication. It can cause a significantmorbidity if not treated adequately. Diabetic foot ulcer is very difficult to heal as it is generally associated with other co-morbidities,such as vassal complications (peripheral vassal disease) that may cause ischemia sufficient to damage many tissues in thebody. The excess of free radical products induces widespread inflammatory reactions. These conditions may also be exacerbatedby neuropathy and foot injury which directly cause the formation of DF. If the process is followed by infection, the inflammatoryreaction will be more severe. All these events will disrupt the normal immune response to participate in wound healing process.This cross sectional study was performed to determine CD8+ T lymphocyte count in diabetic foot ulcer graded 3, 4, and 5based on Wagner Ulcer Classification System (1989) and to test the hypothesis that CD8+ T cells count in DF grade 3, 4, and 5 islower than non-DM ulcer. As many as 11 patients with DF grade 3, 10 patients with grade 4, 7 patients with grade 5 were includedin this study. Sixteen patients with non-DM ulcer as control group. Red pea-shaped fresh ulcer tissues of lower extremity werecollected from each group for CD8+ T cell lymphocyte count and 2 cc blood were collected from vein for blood glucose examination.The result showed that CD8+ T cell count consistently decreased along with the increase of DF grade. The greatest countwas observed in non-DM ulcer {26/10 field view (10 fv)}, followed respectively by grade 3 (12/10 fv), 4 (8/10 fv), and 5 (6/10fv). Statistical analysis showed the difference in CD8+ T cell count among diabetic foot ulcer groups and foot ulcer non diabeticwas highly significant (p<0.05). The relationship between CD8+ T cell lymphocyte count among groups (Non-DM ulcer, DFgrade 3, 4, 5) based on Spearman Correlation test was 0.84 for CD8+ T cell lymphocyte (r = -0,846, p<0.001).
HUBUNGAN ANTARA KONSENTRASI ASAM URAT SERUM DENGAN RESISTENSI INSULIN PADA PENDUDUK SUKU BALI ASLI DI DUSUN TENGANAN PEGRINGSINGAN KARANGASEM Ngurah Wises, Ida Bagus; Suastika, Ketut
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Elevated serum uric acid concentrations are commonly seen in association with individual cardiovascular risk factorsuch as hypertriglyseridemia, hypertension, obesity, and hyperglycemia, a cluster that, when found together in the same person,characterizes the so-called metabolic syndrome. The original conceptualization of this syndrome was on the basis of resistance tothe actions of insulin. The reduction of endothelial nitric oxide bioavailability and the production of reactive oxygen species byuric acid may be the mechanism for insulin resistance. Otherwise insulin has a physiological action on renal tubules by stimulatingreabsorption of sodium and urate, resulting an increase in serum uric acid levels. In this condition, HOMA-IR was the modelwhich is a convenient means of evaluating insulin resistance.To know the association between serum uric acid concentration and insulin resistance, a cross sectional analytic studywas conducted on Balinese in Tenganan region between Desember 2007 and January 2008. The study involved 80 participantsage of 18-65 years old, agree to participate by informed consent. Serum concentration of insulin was measured by immunoassaymethod, plasma glucosa, serum uric acid, HDL-cholesterol, trigycerides, serum creatinin, were determined by enzymatic procedureafter overnight fast. Descriptive statistic analysis on numeric data presented as mean ± SD, nominal and ordinal data inproportion. Inferential statistic analysis with bivariate KendallÕs tau correlation and simple logistic regression was performed andmultiple logistic regression was used to know the independency of its association.Of 80 eligible samples, 39 (49%) men, and 41 (51%) women, mean age was 41.73 ± 12.41 yo, mean of waist circumferencewas 77.99 ± 10.91 cm, mean of serum uric acid concentration was 5.49 ± 1.38 mg/dL, mean of plasma glucosa was 92.04± 8.79 mg/dL, median of insulin was 2.70 (2.00 Ð 17.90) mIU/mL, median of HOMA-IR was 0.685 (0.38-4.10), mean of HDLcholesterol was 59.19 ± 14.01 mg/dL, and median of triglycerides was 122.50 (48 Ð 369) mg/dL. In univariate analysis, theinsulin resistance were positively correlated with serum uric acid, waist circumference, and triglycerides (r= 0.234; P = 0.003),(r = 0.269; P = 0.001), and (r = 0.153; P = 0.046) respectively and negatively with HDL cholesterol (r = -0.297; P = 0.009). Inmultivariate analysis with multiple logistic regression both the 2nd tertile of uric acid (4,7 Ð 6,6 mg/dL) and waist circumferencewere independently associated with the insulin resistance (PR 3.97; IK 95% : 1.273 Ð 12.386; P = 0.018), and (PR 5.79; IK 95%: 1.417 Ð 23.650; P = 0.014) respectively. Conclusion: There is association between serum uric acid concentration and insulinresistance, and both the 2nd tertile of uric acid and waist circumference are independently and significantly associated with insulinresistance.
HUBUNGAN ANTARA KADAR ADIPONEKTIN PLASMA DAN RESISTENSI INSULIN PADA PENDUDUK ASLI DESA TENGANAN PEGRINGSINGAN - KARANGASEM Putrawan, Ida Bagus Putu; Suastika, Ketut
journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

The association between plasma adiponectin level and insulin resistance (IR), diabetes mellitus (DM)-2, hypertension,and cardiovascular disease have been reported previously. Adiponectin is expressed and produced by adipocyte cells, and playscritical role in the glucose metabolism. IR in the adipose cells increases lipolysis and release free fatty acid (FFA). Furthermore,inactivation of mitochondrial pyruvat dehydrogenase and Þ nally decreases glucose uptake through disturbance of insulin receptorsignaling.To investigate the association between plasma adiponectin level and IR that was calculated by HOMA-IR, a cross sectionalanalytic study was conducted in Tenganan region, Bali from December 2007 to January 2008. As many as 80 participants whoseage was 18 ! 65 years old were involved.The study involved 38 (47.5%) males and 42 (52.5%) females whose mean of waist circumference (WC) was 78.03± 10.88 cm, mean of plasma glucosa was 91.73 ± 8.84 mg/dl, median of insulin was 2.70 (2.00 ! 17.90)  IU/ml, median ofHOMA-IR was 0.67 (0.38 ! 3.71), mean of HDL cholesterol was 58.93 ± 13.73 mg/dl, and mean of triglycerides was 145.64± 67.97 mg/dl, systolic blood pressure (SBP) was 70 ! 180 mmHg, and diastolic blood pressure (DBP) was 50 ! 100 mmHg. Inthis study, we found signiÞ cant correlation between plasma adiponectin level and IR (r = -0.370; p < 0.001). IR also signiÞ cantlycorrelation with central obesity (r = 0.361; p < 0.001), body mass index (BMI) (r = 0.381; p < 0.001), plasma HDL level (r =-0.327; p= 0.002), TG (r = 0.255; p = 0.011), and SBP (r = 0.198; p = 0.039). On multivariate analysis with multiple logisticregression, only central obesity has independent association with IR (B = 1.641; p = 0.023). Central obesity and sex weresigniÞ cantly inß uential to the plasma adiponektin level (ß = -1.542; p = 0.035) dan (ß = 2.865; p < 0.001) respectively in whichmean of the plasma adiponectin level in female (5.610 ± 2.815) was signiÞ cantly higher than that of male (3.365 ± 2.365; MD= -2.245; p < 0.001). Mean difference to plasma adiponectin level was signiÞ cantly inß uential of the plasma HDL level dan TG(MD = -10.500; p < 0.001) and (MD = 35.075; p = 0.020) respectively
KORELASI ANTARA KADAR MAGNESIUM DENGAN RESISTENSI INSULIN PADA PENDUDUK SUKU BALI DI DESA PEDAWA KABUPATEN BULELENG Sri Yenny, Luh Gede; Suastika, Ketut
journal of internal medicine Vol. 12, No. 3 September 2011
Publisher : journal of internal medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Magnesium is one of microminerals playing pivotal role in glucose homeostasis and insulin activities. Magnesium playsa very important role in phosphorylation of insulin receptor. This is an analytical cross-sectional study to determinethe prevalence of hypomagnesium and correlation between magnesium level with insulin resistance, performed inPedawa Village Bali at February 2010. Subjects for this study were comprised of 111 people, 45 males (40.5%) and 66females (59.5%). Prevalence of hypomagnesium is 17.12%. The prevalence of hypomagnesium is higher in geriatricsubjects compare with non geriatric subjects (38.48% vs 10.98%, p = 0.004), is higher in diabetes subjects compare withnon diabetes (60% vs 15.1%, p = 0.035), and higher in subject with metabolic syndrome compare with non metabolicsyndrome (34.78% vs 12.5%, p = 0.025). Because lack on sensitivity of insulin measurement, 87 subjects (78.38%) thathave insulin level < 2  IU/ml can not measured by machine so the level of HOMA-IR of this subjects can not calculated,and just 24 subjects (21.62%) have insulin level > 2  IU/ml which can measured. From this 24 subjects, there is nosigniÞ cant correlation between magnesium level and insulin resistance (HOMA-IR) (r = -0.1, p = 0.642). In this study,we found a high prevalence of hypomagnesium in residents of Pedawa Village. The prevalence of hypomagnesium ishigher in geriatrics, diabetes mellitus, and metabolic syndrome subjects. There is no signiÞ cant correlation betweenmagnesium and insulin resistance (HOMA-IR), may be because lack of subject in this study. Thus further studies withhigher sensitivity of insulin measurement and enough sample of diabetic or metabolic syndrome patients in hospitalsettingare needed to determine correlation between magnesium level and insulin resistance.
HUBUNGAN POSITIF ANTARA ULKUS KAKI DIABETIK DENGAN PERSENTASE SEL BERMARKAH CD4+ PEMBAWA MALONDIALDEHID Putu SutirtaYasa, I Wayan; Suastika, Ketut; Sudewa Djelantik, Anak AgungGede; Mantik Astawa, I Nyoman
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 3, No. 1 Januari 2009
Publisher : Udayana University

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Tingginya angka kejadian ulkus kaki diabetik (UKD) dan luka di kaki yangsulit sembuh memberi petunjuk kemungkinan ada proses kematian sel imun yangsangat banyak dan belum jelas mekanismenya secara molekuler pada jaringan UKD.Telah diteliti hubungan antara derajat UKD dengan persentase sel bermarkahCD4+ pembawa malondialdehid (MDA). Penelitian ini adalah penelitianobservasional dengan rancangan cross sectional analytic study yang dilakukan diRumah Sakit pemerintah dan swasta di Denpasar, Badung, Tabanan, dan Gianyar.Parameter yang diukur dari bahan darah adalah kadar gula darah memakai metodeenzimatik (heksokinase), dan dari bahan jaringan kaki, dihitung sel bermarkah CD4+pembawa MDA memakai metode imunohistokimia (reagen dari Biodesign danAbcam ). Dari 80 sampel UKD didapatkan 49 (61,2%) penderita laki-laki dan 31(38.8%) penderita wanita, berdasarkan tingkat keparahan UKD, sampel dipilah lagimenjadi: 29 (31,9%) derajat 2; 20 (21,9%) derajat 3; 13 (14,3%) derjat 4; dan18(19,8%) derajat 5, rata-rata persentase sel bermarkah CD4+MDA adalah 75,0 ±20,5 %, Didapatkan korelasi positif kuat antara persentase sel bermarkah CD4+pembawa malondialdehid dengan derajat UKD (r = 0,71; p < 0,01). Pada penelitianini membuktikan ada mekanisme kematian sel imun dan sekaligus menjawabpermasalahan bahwa pada penderita UKD mudah terkena infeksi dan sulit untukdisembuhkan, dengan dibuktikan bahwa ada korelasi positif kuat antara derajat UKDdengan persentase pembentukan MDA dari sel bermarkah CD4+, ini menyatakanbahwa semakin berat derajat UKD semakin banyak mengalami kematian sel imun..