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CORRELATION BETWEEN CHILD PUGH SCORE AND CYSTATIN C IN LIVER CIRRHOSIS PATIENTS Mulya, Deshinta Putri; Nurdjanah, Siti; Ratnasari, Neneng
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

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ABSTRACTBackground. Renal dysfunction is a serious problem and it provides a poor prognosis for patients with advanced liver cirrhosis, where this condition can progress to kidney failure. This condition is known as hepatorenal syndrome. Cystatin C utilization as a marker of decreased kidney function in patients with liver cirrhosis has been widely proven. Data on how far the severity of liver cirrhosis can affect the decline in renal function has not been widely known. Objective. This study aimed is to verify correlation between the severity degree of the liver (Child Pugh/CP score) with levels of Cystatin C serum. Methods. This study was a cross sectional study. Population studied were patients with liver cirrhosis who visited the clinic of Gastroentero-hepatology and treated in the department of Internal Medicine ward Dr. Sardjito Hospital - Yogyakarta during October 2009 - March 2010. Data were analyzed with a computer; the analyzed of the CP score correlation with increased levels of Cystatin C using Spearman correlation for data not normally distributed. Result. We found 48 research subjects during the month of October 2009 - March 2010. The subjects were 35 male (72.9%) and 13 female (27.1%) with average age 53.1 Â± 11.9 years old. Subjects with CP-A were 9 patients (18.8%), CP-B were 14 patients (29.2%) and CP-C were 25 patients (52.1%). The range value of Cystatin C between CP class shows CP-AÂ 0.7 - 0.97 mg/L, CP-B 0.7 - 0.49 mg/L, and CP-C 0.7 â 2.49 mg/L (statistically significant difference with p <0.05). Liver cirrhosis patients who had Cystatin C levels <0.96 mg/L were 22 patients (45.83%) and 26 patients (54.1%), had higher levels of Cystatin C> 0.96 mg/L. Child score was positively correlated to increased levels of Cystatin C (p= 0.000; r= 0.566) linear regression equation with Cystatin was = 0.37 + 0.08 * Child score (r square 0.32). Conclusion. This study concluded that the Child score had a moderate positive correlation with Cystatin C serum level. Â Key words: Liver Cirrhosis â Child Pugh score - Cystatin CÂ

CORRELATION BETWEEN CHILD PUGH SCORE AND CYSTATIN C IN LIVER CIRRHOSIS PATIENTS Deshinta Putri Mulya; Siti Nurdjanah; Neneng Ratnasari
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground. Renal dysfunction is a serious problem and it provides a poor prognosis for patients with advanced liver cirrhosis, where this condition can progress to kidney failure. This condition is known as hepatorenal syndrome. Cystatin C utilization as a marker of decreased kidney function in patients with liver cirrhosis has been widely proven. Data on how far the severity of liver cirrhosis can affect the decline in renal function has not been widely known. Objective. This study aimed is to verify correlation between the severity degree of the liver (Child Pugh/CP score) with levels of Cystatin C serum. Methods. This study was a cross sectional study. Population studied were patients with liver cirrhosis who visited the clinic of Gastroentero-hepatology and treated in the department of Internal Medicine ward Dr. Sardjito Hospital - Yogyakarta during October 2009 - March 2010. Data were analyzed with a computer; the analyzed of the CP score correlation with increased levels of Cystatin C using Spearman correlation for data not normally distributed. Result. We found 48 research subjects during the month of October 2009 - March 2010. The subjects were 35 male (72.9%) and 13 female (27.1%) with average age 53.1 ± 11.9 years old. Subjects with CP-A were 9 patients (18.8%), CP-B were 14 patients (29.2%) and CP-C were 25 patients (52.1%). The range value of Cystatin C between CP class shows CP-A 0.7 - 0.97 mg/L, CP-B 0.7 - 0.49 mg/L, and CP-C 0.7 – 2.49 mg/L (statistically significant difference with p <0.05). Liver cirrhosis patients who had Cystatin C levels <0.96 mg/L were 22 patients (45.83%) and 26 patients (54.1%), had higher levels of Cystatin C> 0.96 mg/L. Child score was positively correlated to increased levels of Cystatin C (p= 0.000; r= 0.566) linear regression equation with Cystatin was = 0.37 + 0.08 * Child score (r square 0.32). Conclusion. This study concluded that the Child score had a moderate positive correlation with Cystatin C serum level. Key words: Liver Cirrhosis – Child Pugh score - Cystatin C

PSIKOSIS PADA AUTOIMUN SEBUAH LAPORAN KASUS SISTEMIK LUPUS ERITEMATOSUS KOINSIDENSI DENGAN MULTIPLE SKLEROSIS Deshinta Putri Mulya; Arief Darmawan
Collaborative Medical Journal Vol 5 No 1 (2022): Januari
Publisher : LPPM Universitas Abdurrab

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36341/cmj.v5i1.1725

Varied symptoms of Systemic lupus erythematosus make its diagnosis challenging. A 40 year old woman was admitted to the Emergency Room for self-talking, rambling and being rowdy. Psychiatric assessment showed an indication of organic hallucination. The patient had been undergoing neurologic treatment for four months due to multiple sclerosis with onset symptoms including of paraperese which was improved after taking steroids. In addition to neurologic symptoms, other conditions including mucous ulcers, malar rash, vasculitis, hair loss, and arthritis were found. The laboratory test indicated the presence of strong positive ANA profile in the RNP/Sm, Sm, SS-A native, Ro-52, SS-B and Ribosomal Protein. Patient’s condition significantly improved after undergoing treatment for Systemic lupus erythematosus flare with a coincidence of multiple sclerosis.

Meningoensefalitis Manifestation in Wegener’s Granulomatosis with Anca Negative: Case Report Sudibyo, Triyanti Kurniasari Ananta Putri; Mulya, Deshinta Putri; Budiono, Eko; Satiti, Sekar; Rosalia, Levina Prima
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
Publisher : UI Scholars Hub

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Wegener’s granulomatosis is a vasculitis that affects small to medium blood vessels, generally occurring at the age of 64- 75 years with an incidence of 8-10 / 1,000,000 people. Meningoencephalitis manifestations are rarely found in Wegener’s granulomatosis with the incidence only in the range of 0-7%. Anti-neutrophil cytoplasmic antibody (ANCA) is often used in diagnosing Wegener’s granulomatosis, but negative ANCA can be found in 10-20% of cases. A 30-year-old man came with a decrease in consciousness. His anamnesis and physical examination showed signs that led to Wegener’s granulomatosis, despite negative ANCA examination results. After getting therapy according to the management of the Wegener’s granulomatosis there is a clinical improvement in the patient. This case is raised because it is a rare case and needs sharpness in establishing a diagnosis. Wegener’s granulomatosis can cause very bad progress, but if handled properly, complete remission can be achieved.

Sensitisasi Alergen Makanan pada Pasien Kolitis Eosinofilik: Laporan Kasus Zagoto, Agnes Dina Irene Dorithy; Mulya, Deshinta Putri; Ratnasari, Neneng
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 1
Publisher : UI Scholars Hub

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Eosinophilic colitis is a very rare disease that can occur in the bimodal population (neonates and young adults) with a prevalence was 2.1/100,000 in overall population and 2.3/100,000 in adults. However, only about 0.1% of cases were diagnosed from biopsy results obtained during colonoscopy. The lack of precise histological criteria for the quantity of eosinophils in the colon mucosa creates a distinct challenge in diagnosing eosinophilic colitis. Eosinophilia in the gastrointestinal tract can be mediated by IgE and non-IgE, but non-IgE tends to be dominant in adults. This report discusses about a case of a 64-year-old male with bloody diarrhea that has been occur for two years. The anamnesis revealed symptoms suggestive of eosinophilic colitis, including complaints of diarrhea with abdominal pain and weight loss. Laboratory tests revealed an increase in peripheral eosinophil count and elevated levels of IgE. A positive skin prick test supported the presence of food allergen sensitization. The endoscopy revealed signs of ulcerative colitis, but the biopsy showed evidence of eosinophilic colitis. Initially, the patient was treated for ulcerative colitis but did not show improvement. Following treatment for eosinophilic colitis, the patient’s clinical status showed improvement. Since eosinophilic colitis can be chronic and recur, an accurate diagnosis and proper management are crucial for achieving complete remission. Keywords: chronic diarrhea, eosinophilic colitis, food allergen sensitization, IgE, peripheral eosinophilia

Anti-DFS70 as Nonsystemic Autoimmune (Primary Billiar Cholangitis) Concomitant Disease Marker in Systemic Lupus Erythematosus Putra, Yasjudan Rastrama; Mulya, Deshinta Putri; Indrarti, Fahmi
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 2
Publisher : UI Scholars Hub

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Anti-dense fine speckled 70 (DFS70) is known as a non-systemic autoimmune marker. It is only found in 1% of systemic autoimmune patients and 2–22% in healthy population. To the best of our knowledge, no anti-DFS70 positive has been reported in systemic lupus erythematosus (SLE) patients with primary billiary cholangitis (PBC) comorbidities. We reported a 40-year-old woman that was diagnosed with SLE 1-month before, came to the hospital due to seven days of fatigue, loss of appetite, icteric, arthralgia, hair loss, and unexplained fever. Total bilirubin was 9.46 mg/dl, direct bilirubin 7.73 mg/dl, gamma-glutamyl transferase (GGT) 503 U/L, alkaline phosphatase (ALP) 520 U/L, ANA-IF 1:1000, ANA-profile measurement borderline on the anti-centromere B, and three positives on the DFS70. Magnetic resonance cholangiopancreatography (MRCP) shown the PBC feature. After ursodeoxycholic acid (UDCA) therapy 250 mg twice daily, ALP and GGT backed to normal limits within two months. This case reminds the doctor that anti-DFS70 finding in SLE needs further evaluation, whether other nonsystemic autoimmune exist or not. Concomitant PBC with SLE well responded with UDCA standard therapy.

Anti-Tuberculosis Therapy after DRESS: Case Report Wahyuni, Dwi; Mulya, Deshinta Putri; Retnowulan, Heni
Acta Interna The Journal of Internal Medicine Vol 11, No 1 (2021): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.94635

Introduction.Anti-tuberculosis-induced DRESS (drug reaction with eosinophilia and systemic symptoms) is uncommon, and usually delayed in diagnosis. The patient has minor complain and the clinical presentation involves the side effect on their heart and skin. Antituberculosis-related DRESS may have been present, but it has been underdiagnosed and underreported for several years. Management including discontinuation of the suspected drugs and changing it with second line treatment become less effective. Identifying the causative drug in DRESS is very difficult, especially in antituberculosis drugs.Case. A 34-year-old woman complains of having itch and redness throughout the body and fever. Two months before hospitalization, the patient was diagnosed with tuberculosis based on GeneXpert examination. Patients were given anti-tuberculosis drug therapy (OAT) which was 4 fixed drug combinations (FDC). Two weeks after taking the drugs, complains appeared. After 3 weeks the drug was stopped and in the next 1 week the patient's condition got worse, with itching and redness of the whole body accompanied by fever. Patients received treatment for 13 days with 125 mg/24-hour methylprednisolone therapy gradually reduced with OAT therapy levofloxacin 500 mg/24 hours and streptomycin 1 gram/24-hour IM (intramuscular).Conclusion. DRESS triggered by OAT was very rare and underreported. The choice of therapy after DRESS needed to be well considered, because it increased the risk for a DRESS to return with more severe manifestations when re-administering the same drug. The management in tuberculosis patients with a history of DRESS was given with second-line OAT with treatment options based on the clinician's experience.

Absolute Eosinophil Counts and Colonic Mucosal Eosinophils Based on Inflammatory Bowel Disease Severity Aulia, Nisma; Mulya, Deshinta Putri; Bayupurnama, Putut
Acta Interna The Journal of Internal Medicine Vol 12, No 1 (2023): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.98159

Background. The inflammatory process in Inflammatory Bowel Disease (IBD) involves various types of inflammatory cells, including eosinophils. Eosinophils are not only associated with the severity of IBD but are also associated with clinical improvement. In contrast to the confirmed role of neutrophils, the role of eosinophils either in the blood or in the colonic mucosa of IBD patients have not been fully understood and confirmed.Objectives. To determine the difference in absolute eosinophil counts in the blood based on the severity of IBD and to determine the differences in the density of colonic mucosal eosinophil based on the severity of IBD.Methods. This is a cross-sectional study with consecutive sampling in the period August 2020 - July 2021. The research subjects were IBD inpatient or outpatient at Dr. Sardjito Hospital who met the inclusion and exclusion criteria. Researcher assessed data on absolute eosinophil counts in peripheral blood and eosinophil density in the colonic mucosa. The number of biopsies and the location of the biopsy were determined based on a colonoscopy performed by a Gastroentero-Hepatology Consultant. The calculation of eosinophils in the colonic mucosal tissue was carried out by an Anatomical Pathologist Specialist. IBD severity was assessed using the Truelove Witts score for Ulcerative Colitis (UC) and Crohn's Disease Activity Index (CDAI) for Crohn's Disease (CD) patients. Analysis using a computer program with a p value <0.05 was considered statistically significant.Results. There were 50 research subjects with a median age of 55 years (24-77 years). There was not a big difference between the number of male and female patients, namely 26 people (52%) vs 24 people (48%). The number of UC patients were dominant, namely 48 people (96%). The severity of IBD were divided into three groups with the number of patients with mild IBD were 22 (44%), moderate were 11 (20%), and severe IBD were 18 (36%). The number of patients with eosinophilia were 7 patients (14%) and colonic mucosal eosinophilia were 5 patients (10%). Kruskal Wallis test found that the mean absolute eosinophil blood in mild IBD was 21.45 cells/µL, moderate IBD was 25.50 cells/µL, and severe IBD was 30.44 cells/µL (p = 0.152). The mean of colonic mucosal eosinophils in mild IBD was 19.48 cells/hpf, in moderate IBD was 27.00 cells/hpf, in severe IBD was 32.03 cells/hpf (p = 0.023) and there was a statistically significant moderate correlation (r = 0.392; p = 0.005).Conclusion. There is no significant difference in absolute eosinophil counts in the blood based on the severity of IBD and there is a significant difference in the density of colonic mucosal eosinophil based on the severity of IBD.

Correlation between the Eosinophil Colonic Mucosa Density and Severity of Ulcerative Colitis Aulia, Nisma; Mulya, Deshinta Putri; Bayupurnama, Putut; Ratnasari, Neneng
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 2 (2023): VOLUME 24, NUMBER 2, August, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2422023132-136

Background: The inflammatory process of ulcerative colitis (UC) involves eosinophils. Eosinophils are not only related to the severity of UC but also to clinical improvement. The role of eosinophils in colonic mucosa has not been fully understood. This study aims to determine the correlation between the density of eosinophils in the colonic mucosa and the severity of ulcerative colitis.Method: This is a prospective cross-sectional study with consecutive sampling between August 2020 and July 2021. The subjects were UC inpatients/outpatients at Dr. Sardjito Hospital who met the inclusion and exclusion criteria. The number and location of the biopsies are determined based on a colonoscopy performed by a Gastroenterology-Hepatology Consultant. An Anatomic Pathology Specialist examined the eosinophil colonic tissue. The severity of UC was classified using the Truelove Witts score. Data analysis using a computer program with a p-value 0.05 was considered statistically significant.Results: There are 3 UC severity categories according to the Truelove Witts score: 22 mild (45.8%), 9 moderate (18.8%), and 17 severe (35.4%). Seven participants (14.6%) had eosinophilia, with a median eosinophilia score of 203.33 cells/microL (0–1470 cells/microL). Five participants (10.4%) with colonic mucosal eosinophilia, with a median value of 14.13 cells/HPF (0–172 cells/HPF). The density of colonic mucosal eosinophils and the severity of UC had a moderate connection (r = 0.396; p = 0.005).Conclusion: There is a significant correlation between the density of eosinophils in the colonic mucosa and the severity of UC.

Positive Anti-Histone Antibodies in Patients with Polymyositis Falah, Khoirul; Mulya, Deshinta Putri
Acta Interna The Journal of Internal Medicine Vol 13, No 1 (2024): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.101290

Background. Polymyositis is an idiopathic inflammatory myopathy characterized by proximal symmetric muscle weakness, increased skeletal muscle enzyme levels, electromyographic abnormalities, and nonspecific muscle biopsy findings. Autoimmune mechanisms are thought to be the pathogenesis of the disease. Some autoantibodies have specificity and a high relationship with myositis.Case. A 23-year-old male presented with progressive quadriparesis, with predominant lower limb weakness, and severe myalgia of one-month duration, significantly impairing ambulation. He has a history of occupational exposure to propylene gas and atmer liquid while working in a plastic factory. Muscle strength in upper extremities were 4 and lower extremities were 3. Laboratory examination showed CK level 11856 U/L, SGOT 773 U/L, SGPT 486 U/L, LDH 1601 U/L, ANA IF 1:1000 with speckled pattern, normal electroneuromyography, anti-Histone antibodies (++). The patient refused a muscle biopsy. The patient met 2 of the 4 criteria so he was diagnosed with possible polymyositis and was treated with methylprednisolone injection 125 mg/ 6 hours for 3 days then tappering down , mycophenolate acid 2x180 mg , mecobalamin 2x500 mcg, and vitamin D 1x400 mg. After 1 month of therapy, muscle weakness improved and he was able to walk again.Discussion. Specific antibodies for myositis include antisynthetase, anti-Jo-1, anti-PL-7, anti-EJ, anti-PL-12, and anti-Mi-2, antibodies associated with myositis include anti-PM-Sci, anti-Ku , anti-KJ, anti-Ro/SSA.Anti-histone antibodies are commonly present in drug-induced lupus, but some studies have shown an association with other autoimmune and rheumatic diseases. Specificity pattern of serum anti-histone antibodies (AHA) on part of polymyositis patient similar with serum pattern of systemic sclerosis. Another study showed positive results in 17% of 46 polymyositis and dermatomyositis patients.Summary. A young man with clinical and laboratory criteria fulfilling the diagnosis of possible polymyositis, positive anti-histone antibodies were obtained, which is an antibody that is rarely found in cases of polymyositis.

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