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INDONESIA
Journal of the Indonesian Medical Association
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Core Subject : Health,
Journal of the Indonesian Medical Association - Majalah Kedokteran Indonesia
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Articles 508 Documents
Eosinophilic Lung Disease Saraswati, Meilania
Journal of the Indonesian Medical Association Vol. 61 No. 1 January 2011
Publisher : Journal of the Indonesian Medical Association

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Abstract

Lung is one of the organs that support life. One role of the lung is to fascilitated O2-CO2 exchange between the free air and blood, this role makes lung particularly vulnerable to outside intruders either from organic or inorganic compound.1 But, of course, lung is protected by the harmonious work of immune system and mucous cells along the respiratory track. The balance of the bodys defense system is very influential in this harmony.1,2 There are many diseases  that attacks or involve lung. The general symptoms are almost the same namely chronic cough;-sometimes accompanied by blood, shortness of breath and / or chest pain.1 Epidemiologycaly in Indonesia, the pulmonary symptoms refers to infections, particularly Tuberculosis. In fact there are many diseases other infections and non-infection, with similar clinical and radiology appearance. Besides infection, other things that caused chronic lung disease is the environment, in the form of air pollution, especially cigarette smoke.1-3 Despite various government efforts to reduce opportunity for someone to smoke, there are still many smokers who do not care that they pollute the air and interfere with the comfort and health of others, because materials contained in cigarette smoke is irritating to the airway. It is anamnesis and good physical examination at the first meeting in a general physician/ family doctors office, that should be able to distinguish which further examination is required. One of the instruments that play a role in the immune system lung defense is the eosinophil. Eosinophil plays a major role in releasing pro-inflammatory cytokines to eliminate pathogens, that are recognized as antigens foreigners, such as parasites,  fungi, and even in viral infections.1,4 Eosinophil, as the main cells that produce IgE, is one instruments in natural immune system (innate) that reacts instantly in recognizing antigens, which is considered as foreign particles in the body.Eosinophil levels that are higher than normal or hypereosinophilia, can be found in people with immune system defect, or due to outside stimulation.1,2 The manifestation of hypereosinophilia can be in the form of various organs disturbance, including the lung. In the lung the excessive cytokine release, especially if the number of eosinophil is high, can cause respiratory track epithelial damage and interstitial cells damage. This process can lead to granulomatous inflammation.5 Manifestations of this condition in the lung called eosinophilic lung disease. Eosinophilic lung disease is broad spectrum of disease, covering the process of immunologic (Asthma), infections, neoplasia, and also idiopathic (churgstrauss syndrome). 4-6 Some literature even divide it into group of known cause, no known cause, and vaskulitis.6 History of the Disease can be acute, sub-acute, or chronic. Recognizing the eosinophilic lung disease, especially the etiology, it is very important because etiology determines the therapy. Several entities within the spectrum of eosinophilic lung diseases are sensitive to kortikosteroid.5 Incorrect diagnosis will  lead to inappropriate therapy and detrimental to the patients.The diagnosis of eosinophilic lung disease is made from synthesis of clinical symptoms, radiological images, laboratory data and histopathology confirmation. It is only histopathology examination that can state that there is eosinophil infiltration in the alveolar lumen or lung interstitial.6 However, histopathology examination as gold standard is not always easy to perform because of various reasons, such as the difficulty in obtaining the specimen, the high risk procedures, and it is required at least 2 days (in Indonesian standards) to make the diagnosis. Therefore, clinical and laboratory data must be very detailed and complete before arriving at a decision to perform lung biopsy.Eosinophilic lung disease will be discussed at the Continuing Professional Development (CPD) section in this edition. This discussion was purposed to make the reader familiar with the disease entities, so that help medical professionals in his or her practice when seeing patients with pneumonia. As usual, feedback can be done by sending the answer sheet of our CPD questions or send reader letters, which will be very valuable to the Editorial Team.Enjoy reading this edition.
Muscle Strength and Mobility in Elderly After Home-based Quadriceps femoris Isotonic Strengthening Exercise Wardhani, Indah Retno; Nuhoni, Siti Annisa; Tamin, Tirza Z; Wahyudi, Edy Rizal; Kekalih, Aria
Journal of the Indonesian Medical Association Vol. 61 No. 1 January 2011
Publisher : Journal of the Indonesian Medical Association

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Abstract

Muscle strength and mobility decrease with age. Strengthening exercise can prevent decreased muscle strength and mobility. The purpose of this study is to evaluate the effects of home-based Quadriceps femoris strengthening exercise in elderly subjects and its correlation with functional mobility, measured using Timed Up and Go (TUG) test. Thirty-three subjects aged 60 years and above were analyzed in this study. Quadriceps femoris strength was determined using ankle weights that give a perception of “somewhat hard” in Borg Scale after 10 repetitions. Exercise was done at home three times a week, in 3x10 repetitions. TUG test and ankle weights was re-examined on 4th and 8th week. Initial quadriceps strength was 1,4 (0,4) kg. After 4 weeksof exercise, there was 46,61% increment to 2,0 (0) kg and after 8 weeks 95,91% increment was recorded with ankle weight of 2,6 (0,6) kg. TUG test at initial was 11,3 (1,4) seconds. After 4 weeks, TUG improved to 10,0 (1,3) seconds and after 8 weeks to 9,33 (1,40) seconds. Modest correlation (r=-0,354) was recorded between Quadriceps femoris strength improvement and TUG improvement. Quadriceps femoris strengthening exercise can improve muscle strength and mobility in elderly.Keywords: elderly, TUG, muscle strength, quadriceps femoris, home based strengthening exercise.
The Correlation Between Adiponectin and Tumor Necrosis Factor Alpha (TNF-a) in Indonesia Obese non Diabetic Males Lina, Yani; Patellongi, Ilhamjaya; Lawrence, Gatot Susilo; Wijaya, Andi
Journal of the Indonesian Medical Association Vol. 61 No. 1 January 2011
Publisher : Journal of the Indonesian Medical Association

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Abstract

Adiponectin is an adipocytokine, abundant in the peripheral circulation, which has been shown to have anti-inflammatory and anti-atherogenic properties. Plasma concentration of adiponectin is decreased in obesity and negatively correlates with body mass index (BMI) and with insulin resistance. The aim of this study is to know adiponectin profile and its association with TNF-a in Indonesian obese non diabetic males. This is a cross sectional study with 137 Indonesian obese non diabetic males volunteers (age between 30-60 years, waist circumference >90 cm and fasting blood glucose <126 mg/dL) which was done in Jakarta, Indonesia. There is a significant negative correlation between adiponectin and TNF (r=-0.232; p=0.006) and nonsignificant negative correlations between adiponectin and fasting plasma glucose, adiponectin and HOMAIR, and adiponectin and waist circumference. This study confirm that central obesity will reduce adiponectin concentration so that increase insulin resistance and inflammation risk in Indonesian obese non diabetic men.Key words: Obesity, Adiponectin, TNF-a, Insulin Resistance, Inflammation
Work Stress and Related Risk Factors in Call Center Workers at "X" Company Ismar, Rinda; Amri, Zarni; Sostrosumihardjo, Danardi
Journal of the Indonesian Medical Association Vol. 61 No. 1 January 2011
Publisher : Journal of the Indonesian Medical Association

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Abstract

Call center workers respond to the telephone calls while simultaneously using display screen equipment that may lead to various health conditions, including work stress. This study was conducted to know the prevalence of work stress among call center workers and to identify the related risk factors. A cross sectional study was conducted and data was collected from questionaires and assessment of the physical environment. The respondents were 73 call center workers whom had worked for minimum of six months. Work stress was categorized as medium to high stress, based on the self rating survey diagnostic stress questionaire. The highest prevalence of medium to high work stress among call center workers was 87.7% for the career development stressor. Work factor that was associated with work stress was years of work for the quantity work load stressor (adjusted OR 0.22, CI 0.05-0.90; p=0.03). Habitual factors were not associated with work stress. Physical environment factor that was associated with work stress was the subjective perception of noise for the responsiblity to other people stressor (adjusted OR 5.39, CI 1.43-20.24; p=0.01)
Stigma Towards Leprosy Among Medical Students Caroline, Caroline; Puspita, Caroline Gladys; Widjaja, Felix Firyanto; Sopandi, Sandy Sofian; Menaldi, Sri Linuwih
Journal of the Indonesian Medical Association Vol. 61 No. 1 January 2011
Publisher : Journal of the Indonesian Medical Association

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Abstract

Stigma towards leprosy is usually generated not only from the unpleasant appearance of the patients, but also people’s false perceptions and insufficient knowledge concerning leprosy. The purpose of this study was to analyze the relationship between knowledge and stigmarelated attitudes, affect and behavioral intentions towards leprosy patients among medical students. A cross-sectional study was performed by distributing questionnaires consecutively to 77 medical students in a Competency-Based Curriculum (CBC) 2005 of Faculty of Medicine University of Indonesia in April 2009. We assigned their gender, age, knowledge, along with sources and score of their knowledge. Then, we analyzed the relationship between knowledge and attitudes, affect and behavioral intentions towards leprosy patients. The questionnaire assessing knowledge was made by authors and experts after validity assessment (minimum alpha reliability = 0.514 and reliability coefficient = 0.845), while the questionnaire for stigmarelated attitudes, affect and behavioral intentions was adapted and translated to Bahasa from Attribution Questionnaire-Short Form (AQ-SF) after validity checking with Cronbach’s alpha; the minimum was 0.514 and the reliability coefficient 0.897. The subject consisted of 36 male and 41 female students whose age was varied from 18 to 23 years old with the most common source of knowledge concerning leprosy was school. Correlation analysis showed weak negative correlation (r = -0.267 and p = 0.019) between knowledge and AQ-SF score. The higher the knowledge, the lower the AQ-SF score, meant that stigma-related attitudes, affect, and behavioral intentions were better.Keywords: knowledge, leprosy, medical student, stigma
The Accordance of Tuberculin Skin Test Reading by Health Workers in Primary Health Care Kaswandani, Nastiti; Rahajoe, Nastiti N; Kamso, Sudijanto
Journal of the Indonesian Medical Association Vol. 61 No. 1 January 2011
Publisher : Journal of the Indonesian Medical Association

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Abstract

The main problem in managing tuberculosis (TB) in children is the difficulty of establish-ing the diagnosis. Those problems are due to unspecific TB symptoms in children and the difficultyin obtaining representative and good quality specimens. Tuberculin skin test (TST) is an impor-tant diagnostic tool to identify TB infection in children. This study was aimed to evaluate whetherthe health nurses in primary health care (puskesmas) could perform TST and to evaluate whetherthey also could measure as accurate as medical doctors and pediatricians. Two hundred and fortychildren suspected TB in puskesmas were injected with tuberculin using Mantoux method. Thesensitivity and specificity of measurement by general practitioners compared to pediatricianswere 94% and 96% respectively, while the sensitivity and specificity of measurement by nursescompared to general practitioners were 94% and 100% respectively. The positive likelihoodratios of both comparison groups were 26.44 and undefined. This study concluded that themedical nurses could perform and measure the results as accurate as the general practitioners socould the general practitioners compared to pediatricians.Key words: accordance, tuberculin skin test, nurse, general practitioner , pediatrician
Asymptomatic Situs Inversus with Dextrocardia Tiong, Diana; Santosa, Yudistira Panji
Journal of the Indonesian Medical Association Vol. 61 No. 1 January 2011
Publisher : Journal of the Indonesian Medical Association

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Abstract

Situs inversus is a rare situs anomaly that is seen in 0,01% of population. Situs inversuswith dextrocardia is characterized by mirror image position of the visceroatrial organs and theposition of cardiac apex on the right side of midline (dextrocardia). This form of anomaly isextremely important for identification to avoid mishaps before surgery or other therapeutic intervention.We reported female patient, 45 years old that came to our hospital for surgery. After preoperation examination, we found that the patient has asymptomatic situs inversus. No seriousproblem or complications were reported during and after the surgery. The patient was dischargedthree days post operation with no difficulty in doing her daily activity.Keywords: Situs inversus, dextrocardia, visceroatrial, asymptomatic
Eosinophilic Lung Diseases Surjanto, Eddy; Prasetyo, Yudi
Journal of the Indonesian Medical Association Vol. 61 No. 1 January 2011
Publisher : Journal of the Indonesian Medical Association

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Abstract

Eosinophilic lung diseases are a diverse group of pulmonary disorders characterized by pulmonary opacities associated with tissue or peripheral eosinophilia. The pathogenesis of eosinophilic disorders is the release of eosinophils by toxic substances stored in intracellular granules. The diagnosis of eosinophilic lung diseases can be made if any of following findings is present: pulmonary opacities with peripheral eosinophilia, tissue eosinophilia confirmed at either open or transbronchial lung biopsy, increased eosinophils in bronchoalveolar lavage fluid. The differential diagnosis from lung disease with eosinophil syndrome are acute eosinophilic pneumonias (idiophatic, or caused by drugs, parsites, other), tropical pulmonary eosinophilia, chronic eosinophilic pneumonia, allergic bronchopulmonary mycosis, Churg-Strauss syndrome, idiophatic hypereosinophilic syndrome. The management of eosinophilic lung diseases is directed to the underlying disease, and use of corticosteroid or symptomatic treatment.Keywords: eosinophilic lung diseases, eosinophil, opacity, corticosteroid
Nitrite Test for Optimizing Diagnosis of Asymptomatic Urinary Tract Infection in Pregnant Women: An Evidence-based report Widjaja, Felix Firyanto; Nanda, Adly; Widyowati, Dyah; Budiningsih, Retnani; Faiz, Nirk; Purnamasari, Dyah
Journal of the Indonesian Medical Association Vol. 61 No. 2 February 2011
Publisher : Journal of the Indonesian Medical Association

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Abstract

Asymptomatic urinary tract infections (UTIs) in pregnant women who are not treated appear more likely to develop serious complications on occassional life threatening and risk to deliver more low birth weight neonates. Thus, it is necessary to test whether the infection is really present or not. Urine culture as the gold standard examination still has limitations. This report was made to examine nitrite as a component of urinalysis to be an alternative test for asymptomatic UTIs. A search was conducted on PubMed,® Proquest,® Cochcrane® and Embase.® After screening titles and abstracts by inclusion and exclusion criteria, 16 original articles were found, but only 4 articles were used by author. All four articles showed high negative predictive value (0.82-0.96) and three of them showed good post-test probability (<0.09) when the test result was negative for asymptomatic UTIs. On the other hand, the positive predictive value (0.5-0.69) was poor. Based on the results, nitrite is not strong enough as a sole test for diagnosing asymptomatic UTIs. But, we found that nitrite is good enough to confidently rule out the asymptomatic UTIs in pregnant woman.Keywords: asymptomatic UTI, nitrite, diagnosis, pregnant woman.
Expression of P53 Mutant and Ki-67 in Variants of Diffuse Large B-Cell Lymphoma Handayani, Supri Irianti; Nasar, I Made; Ramelan, Wahyuning
Journal of the Indonesian Medical Association Vol. 61 No. 2 February 2011
Publisher : Journal of the Indonesian Medical Association

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Abstract

Malignant lymphoma (ML) is a primary malignancy of lymphoid tissue. In Indonesia ML is the third most common malignancy found in male. Traditionally there are two types of ML, which is Hodgkin lymphoma and Non-Hodgkin Lymphoma. Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma, which is regarded as high grade malignancy. According to Kiel classification DLBCL is divided into 3 variant, named centroblastic, immunoblastic and anaplastic variant. In DLBCL, mutation of p53 was reported to be detected in 17 to 25 % of cases, meanwhile Ki-67 proliferation index may reach 80 %. The aim of this study is to examine the expression of p53 and Ki-67 on three different variants of DLBCL. In this study, 28 cases of DLBCL were collected from the archives of Anatomical Pathology Department Faculty of Medicine University of Indonesia/Cipto Mangunkusumo Hospital. Ten cases were centroblastic, 5 were immunoblastic, and the rest were anaplastic variant. Immunohistochemistry examination were performed by using p53 and Ki-67 monoclonal antibody. The results showed that p53 expression is significantly different on these three variants of DLBCL. Expression of p53 was found to be highest in anaplastic variant of DLBCL, meanwhile the lowest expression was found in centroblastic variant. However, there is no significant difference of Ki-67 expression on three variants of DLBCL. In conclusion, p53 expression by immunohistochemistry is more important in distinguishing these three variants of DLBCL.Keywords: Diffuse Large B Cell Lymphoma, p53, Ki-67

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