Vol. 26 No. 4, Page 160-215

October 2, 2007

Case study : ischemic stroke with diffuse infarct in young male patient with mitral stenosis

By Sendjaja Muljadi, Alfred Sutrisno, & Linda Lison

Background

Although there is a steady rise in the incidence of stroke in young adults with increasing age, stroke are encountered less frequently than in the middle aged and elderly. The cause of ischemic stroke is more heterogenous among young adults than among older patients.

Case Description

We report a case of 39 years old man, who suffered from seizures about 30 minutes, one hour before admitted to the hospital and at that time he was somnolent, the brain CT scan didn’t show any infarction. But 12 hours later, the second brain CT scan showed the extensive infarction on the right hemi-cerebral. Also the echocardiography showed a large left atrium, mitral stenosis in mitral valves, with area use 0.94 cm2 and mitral score 14. Electro cardiogram (EKG) showed sinus rhythm.

Conclusion

Heart disease is a potent cause of stroke in all ages. This patient had a big problem with his heart and caused the occlusion (the second brain CT scan showed the extensive infarction). This patient passed away after 6 days hospitalization. The prognosis of ischaemic stroke in young adult with mitral stenosis not so good.

Language : Indonesia

Clinical manifestations of upper respiratory tract infection in children at Kalideres Community Health Center, West Jakarta

By Widagdo, Harmon Mawardi, Ellen P. Gandaputra, Firda Fairuza, Rudy Pou, & Paul Bukitwetan

Introduction

The National Household Health Survey showed that the incidence of upper respiratory tract infection (URI) in Indonesia was high. The objectives of the study were to investigate the clinical manifestations of URI, its bacterial spectrum and sensitivity.

Methods

A cross sectional study was carried out involving one hundred children with symptoms of URI i.e. fever, cough and or runny nose. The data of demography, physical sign, hematology, bacterial spectrum and sensitivity were collected.

Results

The prevalence of URI was higher in male, younger age, smoker family, low educated, low income family, and polluted environment. The manifestations of URI were rhinopharyngitis (52%), pharyngitis (18%), rhinitis (12%), tonsilopharyngitis (10%), and tonsillitis (8%). The isolated bacteria were S. aureus, S. b hemolyticus, K. pneumoniae, C. diphtheriae, S. albus and S. anhemolyticus. S. aureus was higher in male than in female (p<0.01), while S. aureus, S. â hemolyticus, and C. bacterium diphtheriae were higher in preschool age children (p<0.01), and K. pneumoniae were higher in infants (p<0.01). S. aureus, and S. â hemolyticus were higher in children with under-nutrition, while in normal nutrition were of K. pneumonia and C diphtheriae (p<0.01). Most bacteria were intermediate and resistant to fourteen tested antibiotics.

Conclusion

The manifestations of URI were rhinopharyngitis (52%), pharyngitis (18%), rhinitis (12%), tonsilopharyngitis (10%), and tonsillitis (8%), each of which could be associated with the complication and accompanying disease. The pathogenic bacterial spectrum of the throat consisted of S. aureus, S. â hemolyticus, K. pneumonia, and C. diphtheriae.

Language : English

Dietary zinc intake and zinc status differences between male and female elderly of South Jakarta community

By Rina K. Kusumaratna, Oktavianus Ch.Salim, & Novia I. Sudharma

Introduction

The elderly have a greater risk of zinc deficiency compared to younger adults. This condition may be reflected by a lowered zinc intake and reduced zinc absorption in the elderly. The aim of the study was to explore the dietary zinc intake and zinc status differences between male and female elderly.

Methods

A cross-sectional study was conducted included eighty-nine free-living subjects, aged above 60 years, apparently healthy and ambulatory. A two day and non consecutive diet record was used to assess energy and nutrient intake of the elderly. It was combined with a semi-quantitative food frequency questionnaire (SQ-FFQ), with food model that was also used to quantify the food pattern on each food frequency item. Serum zinc concentrations were measured by using atomic absorption spectrum photometry.

Results

The total energy intake and normal serum zinc concentration in both genders of free-living elderly were mostly below the recommended dietary allowance. The mean serum zinc concentration did not differ significantly between female (13.7 µmo/l) and male elderly (13.9 µmo/l). Mostly the intake of zinc was below two thirds of the RDA it presented on intake of zinc in males was much less compared to female. Overall, the prevalence of zinc deficiency appeared low among the free-living elderly in South Jakarta.

Conclusions

The prevalence of zinc deficiency was relatively low in healthy elderly. Prevalence of zinc deficiency and zinc intake were lower in female compared to male elderly.

Language : English

The corelation between oral health status and the quality of life in the elderly

By Kartika Wangsarahardja, Olly V. Dharmawan, & Eddy Kasim

BACKGROUND

The proportion of older people is growing rapidly, faster than other age groups especially in developing countries, and life expectancy has increased. Poor oral health has a negative impact on quality of life of older people, and needs intensive oral health programme implementation.

METHODS

A cross-sectional design was conducted in Cideng, Tomang, and Jati Pulo villages. Three hundred and sixty eight elderly (age > 60), mobile, with good communication and agreed to participate, included in this study. Information on age, gender, marriage status, education, occupation, and socio-economic status (income), and quality of life were collected by six trained interviewers. Oral health status information were collected by three dentists.

RESULT

The average DMFT of the older age >70 was 15.57 + 10.36, higher than those of <70 of age (12.31 + 9.72). There were a weak significant correlation between DMFT with the intimacy domain (r=0.15; p<0.05) and quality of life (r=0.135; p<0.05).

CONCLUTION

Due to the high index of the DMFT in the elderly which effected negatively the quality of life, an intervention aimed at improving the oral health is needed.

Language : Indonesia

Central obesity, metabolic syndrome and type 2 diabetes mellitus

By Pusparini

It is well recognized that persons with generalized obesity suffer from a high risk of insulin resistance and its metabolic complications, such as type 2 diabetes mellitus (T2DM), hypertriglyceridemia, low levels of high density lipoprotein cholesterol, hypertension and cardiovascular disease. Accumulation of adipose tissue in a particular anatomical compartment as in abdominal cavity caused an excess risk of insulin resistance until caused metabolic syndrome. Metabolic syndrome, which is defined by a metabolic abnormalities involve a cluster of risk factors of cardiovascular disease is an important risk factor among modern population. Production control of adipocytokine is an important factor of homeostatis glucose and lipid metabolism. Disregulation of adipocytokine production in central obesity has direct pathogenicity of metabolic syndrome. Weight loss or prevention of increased body weight is a good intervention for preventing the obesity, especially central obesity and T2DM. Education about complication of obesity and conscientious involvement by family members is necessary for T2DM treatment.
Language : Indonesia

Non alcoholic fatty liver disease

By A. Nurman & Margareta A. Huang

The cilinicopathologic spectrum of non alcoholic fatty liver disease (NAFLD) ranges from simple steatosis to non alcoholoic steatohepatitis (NASH) .Simple steatosis has a relatively benign cilinical course,but NASH can progress to cirrhosis and hepatocellular carcinoma. NAFLD is often asymptomatic and its presence must always be considered in patients with abdominal obesity and type 2 diabetes mellitus. Elevation of serum alanin aminotransferase (ALT) level and/or fatty liver appearance on ultrasound are often the 1st clues toward the diagnostic of NAFLD. The diagnostic of NAFLD is established after excluding other causes of chronic liver diseases, such as viral hepatitis, alcoholic liver disease, drug-induced liver disease, etc. However, only liver biopsy establishes the definitive diagnosis. ALT elevation usually does not exceed five times upper normal limit. Should ALT elevation exceed five times upper normal limit, other diagnosis must be considered. Management of NAFLD is not solely directed at NAFLD itself, but should focus on improving insulin resistance and related metabolic dearangements as well, which start with life-style modification. Body weight should be reduced gradually by diet and exercise, as exercise increase glucose uptake in skeletal muscle cells. Vitamine E and ursodeoxylate acid are often administrated due to their economical cost and capable of reducing ALT level, eventhough histological improvement may not always take place. Metformin and/or rosiglitazone can be given to patients without overt diabetes as these drugs do not cause hypoglycemia but improve insulin sensitivity. Avoiding hepatotoxic agents is necessary to prevent further deterioration of liver function.
Language : Indonesia