Current Internal Medicine Research and Practice Surabaya Journal

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EISSN : 2721-544X
Published by: Universitas Airlangga (10.20473)
Total articles ≅ 10
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Nina Oktafianti Marfu'Ah
Current Internal Medicine Research and Practice Surabaya Journal, Volume 2, pp 11-13; doi:10.20473/cimrj.v2i1.23972

Abstract:
Mixed connective tissue disease (MCTD) is an overlap disease, has been recognized as an entity disease with a mixture of clinical manifestations from systemic lupus erythematosus (SLE), systemic sclerosis (SSc), polymyositis/dermatomyositis, and rheumatoid arthritis, accompanied by the presence of high titers antibodies to U1 ribonucleoprotein (anti-U1RNP). We had reported case of a male patient who has chronic dysphagia, progressive dyspnea, and the presence of skin lesions. Based on the examination, it was found chronic dysphagia, progressive dyspnea caused by pneumonia and suspected interstitial lung disease, autoimmune hemolytic anemia, discoid lesions, and skin biopsy revealed scleroderma. This patient did not meet the diagnostic criteria of MCTD because anti-U1RNP examination had not been performed as one of the requirements in the diagnostic criteria. However, because he has strong signs and symptoms toward MCTD where there were overlapping symptoms of SLE as well as symptoms of SSc, so we diagnosed him as MCTD.
Mamluatul Karimah
Current Internal Medicine Research and Practice Surabaya Journal, Volume 2, pp 14-18; doi:10.20473/cimrj.v2i1.23969

Abstract:
Endogenous Cushing’s syndrome is a rare case, and about 8% is due to adrenocortical carcinoma. We report a case of a 31-year-old womanwith complaints of weight gain, round face, brown lines, menstrual disorders, and limb weakness. On physical examination, there werehypertension, moon face, central obesity, and stroke. On laboratory examination, there were morning serum cortisol levels were 46.87 andACTH levels 5. On CT scan. It was found that the right adrenal gland solid mass enhancement was +/- 6.6x4.9x7.3 cm, with suspicion ofadrenal carcinoma. On histopathological examination, adrenocortical carcinoma was obtained, and capsule invasion was obtained. Patients underwent surgery to remove the tumor, radiotherapy and chemotherapy. The patient was alive and had no residual mass at the surgical bed.
Nadhya Allia, Lita Diah Rahmawati
Current Internal Medicine Research and Practice Surabaya Journal, Volume 2, pp 19-24; doi:10.20473/cimrj.v2i1.23887

Abstract:
Ankylosing spondylitis (AS) is one of the most common types of spondylarthritis (SpA) and Disease-Modifying Antirheumatic Drug (DMARD) is one of the modalities for treating the disease. An increased risk of latent tuberculosis infection (LTBI) reactivation in rheumatic patients receiving DMARD has been reported. Management of patients with rheumatic diseases who are also infected with LTBI needs to be understood in order not tobecome active TB. We reported a case of a 57-year-old man with AS. Patient was planned to be treated with DMARD so that hepatitis and TB screening performed. It was discovered that this patient had LTBI. The prophylactic therapy for TB was given. DMARD therapy started 1 month after TB prophylactic therapy was given. For monitoring the disease progression,anamnesis, physical, laboratory, and radiology examination performed regularly.
Istiana Hairiah Abas, Betty Agustina Tambunan, Awalia Awalia
Current Internal Medicine Research and Practice Surabaya Journal, Volume 2, pp 1-5; doi:10.20473/cimrj.v2i1.23837

Abstract:
Introduction: The Systemic lupus erythematosus (SLE) is autoimmune disease that results in inflammation, and tissue damage. SLE often creates difficulties in the diagnosis and assessment of disease activity. Disease activity is important as basis for selecting the appropriate therapy. In addition to clinical SLE, supporting investigations are needed to determine disease activity, one of which is complement examination. Complement plays an important role in autoimmune disease and thought to mediate tissue damage. This study aimed to analyze correlation between serum complement C3 and C4 levels with disease activity of SLE patients in Dr. Soetomo Hospital Surabaya.Methods: This study used an observational analytic method with a cross-sectional design. The sampling technique was consecutive sampling. The samples of this study were SLE patients who were treated in the inpatient room and poly rheumatology in January-December 2018 periods. The data were analyzed statistically using the Pearson test.Results: There were 150 SLE patients, most of whom were women (90.0%) with mean age of 29.01±9.8 years. Most levels of complement were low levels (C3 = 48.0% and C4 = 50.7%). Most disease activities were severe flares (44.7%). Results of the Pearson test complement C3 with disease activity were p =0.001, and level of correlation was r =-0.287. However, results of the Pearson test complement C4 with disease activity were p =0.026, and level of correlation was r =-0.182.Conclusion: There is negative correlation between C3 and C4 complement levels with disease activity of SLE patients in Dr. Soetomo Hospital, Surabaya which is significant, weak and opposite.
Kholidatul Husna, Hermina Novida
Current Internal Medicine Research and Practice Surabaya Journal, Volume 2, pp 6-10; doi:10.20473/cimrj.v2i1.23806

Abstract:
Diabetes mellitus increases the risk of infection, including Fournier’s gangrene. Fournier’s gangrene (FG) is a rare case, with an average incidence of 1.6 cases per 100,000 population per year. We report a case of a 60 year old male, presented with the history of wounds of the buttocks, penis and scrotum. The patient had a history of uncontrolled diabetes mellitus for 3 years. There were perianal abscesses and necrotic tissue on the penis and scrotum. Radiological evaluation in the patient showed the present of gas forming in scrotal area. Therefore, incision and drainage procedure with necrotomy and debridement were performed, together with antibiotics and blood glucose regulation, then followed by closure of the defect with skin graft and use of flap. The patient was discharge with an improved clinical condition.
Kholidatul Husna, Hermina Novida
Current Internal Medicine Research and Practice Surabaya Journal, Volume 1, pp 31-37; doi:10.20473/cimrj.v1i2.21557

Abstract:
Adrenal incidentaloma (AI) is a rare case, with a prevalence of 3-7% in the general population. We report a case of a 66 year old female, presented with the history of bilateral flank pain. The patient was performed urologic evaluation due to suspicion of right perirenal abscess and left kidney tumor, and from abdominal CT scan it was found suprarenal mass. There were no signs and symptoms of hormonal hyperfunction. Radiological evaluation in the patient showed the present of malignant lesion. Therefore, adrenalectomy was planned. Before undergoing adrenalectomy, the patient had passed away 6 days after first surgery (right pyelolitotomy and unroofing cyst), with septic shock suspected as cause of death due to hospital-acquired pneumonia.
Rusdi Zakki Aminy, Nunuk Mardiana
Current Internal Medicine Research and Practice Surabaya Journal, Volume 1, pp 44-51; doi:10.20473/cimrj.v1i2.21555

Abstract:
Bartter syndrome is inherited tubulopathy caused by mutations in several genes causing hypokalemia, hypomagnesemia, hypocalcemia with hypercalciuria, and metabolic alkalosis. Beside from inherited disorder, Bartter syndrome can be caused by the use of aminoglycosides, so it is called Bartter-like syndrome. Hypokalemia has been reported as a side effect of aminoglycosides in many studies, but Bartter-like syndrome due to aminoglycosides has only been reported in a few case reports. We report a 43 years old female patient who developed muscle weakness due to hypokalemia. We found the patient’s laboratory results was consistent with Bartter syndrome. The patient had MDR-TB and received combination therapy with capreomycin for two months. We diagnosed a patient with Bartter-like syndrome due to capreomycin. Following diagnosis, we discontinued capreomycin and started potassium, magnesium and calcium therapy. After electrolyte imbalances improved, capreomycin was given three times per week and the patient was no longer experiencing the same condition.
Caesar Lagaliggo Givani, Hermina Novida
Current Internal Medicine Research and Practice Surabaya Journal, Volume 1, pp 25-30; doi:10.20473/cimrj.v1i2.21472

Abstract:
Critical Limb Ischemia (CLI) is a clinical syndrome in the form of ischemic pain, especially at rest or a tissue loss condition, such as an ulcer or gangrene that does not heal, associated with Peripheral Arterial Disease (PAD). Diabetes mellitus (DM) accelerates atherosclerosis and becomes one of the risks of PAD. It is also known to accelerate the worsening of PAD with a 4x greater risk of developing CLI compared to patients without DM. At the other side, 60-95% of patients who are operated on as a result of limb ischemia are diagnosed with atrial fibrillation (AF). This paper is a case report regarding a patient with CLI as a complication of DM and AF.
Nenci Siagian, Bramantono Bramantono, Usman Hadi
Current Internal Medicine Research and Practice Surabaya Journal, Volume 1, pp 52-56; doi:10.20473/cimrj.v1i2.21458

Abstract:
Tuberculous Lymphadenitis (TBLN) is most common extrapulmonary tuberculosis. The common symptom of TBLN is cervical lymphadenopathy which is known to mimic numerous pathological conditions like NHL. Coexistency TBLN and lymphoma is a rare. A woman, 56 years old, had chief complaint of cervical masses since 2 months ago. She had history of weight loss, fever and night sweats but no history of chronic cough. From physical examination and supporting examination, the patient was diagnosed with TBLN coexists with NHL. She got antituberculosis drug (ATD) for 2 weeks before chemotherapy. The patient died of septic shock 9 days later after chemotherapy. From HPE examination, TBLN and NHL may show simillar feature so Zhiel-Neelsen staining and Immunohistochemical are important to confirm each disease. ATD was given to supress the mycobacterium activity before chemotherapy. However the patient had febrile neutropenia after chemotherapy and died of septic shock. Both TBLN and NHL may occur with simillar sign and symptom and HPE. Further examinations have to be done to confirm the diagnosis of both disesases. Although ATD had given to prevent Tb infection progresivity. On 7 days after chemotherapy she had febrile neutropenia and lead to death due to septic shock.
Caesar Ayudi, Nunuk Mardiana
Current Internal Medicine Research and Practice Surabaya Journal, Volume 1, pp 38-43; doi:10.20473/cimrj.v1i2.21459

Abstract:
Bartter syndrome is inherited tubulopathy caused by mutations in several genes causing hypokalemia, hypomagnesemia, hypocalcemia with hypercalciuria, and metabolic alkalosis. Beside from inherited disorder, Bartter syndrome can be caused by the use of aminoglycosides, so it is called Bartter-like syndrome. Hypokalemia has been reported as a side effect of aminoglycosides in many studies, but Bartter-like syndrome due to aminoglycosides has only been reported in a few case reports. We report a 43 years old female patient who developed muscle weakness due to hypokalemia. We found the patient’s laboratory results was consistent with Bartter syndrome. The patient had MDR-TB and received combination therapy with capreomycin for two months. We diagnosed a patient with Bartter-like syndrome due to capreomycin. Following diagnosis, we discontinued capreomycin and started potassium, magnesium and calcium therapy. After electrolyte imbalances improved, capreomycin was given three times per week and the patient was no longer experiencing the same condition.
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