Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Microsatellite Status, Tumor Budding, CD3 and CD8 T Cell Densities in Relation to Invasiveness, Lymph Node Involvement in Colorectal Adenocarcinoma
Full text linkBackground: Aside from the factors more commonly known as predictors in colorectal cancer, there are 3 additional less well-known factors, i.e., tumor budding (TB), T cell densities and loss of MMR protein expression, the aforementioned three factors are known to be independent predictive factors in CRC survival. In this study association of TB, T cell densities and loss of MMR protein were examined to see the association with differentiation, tumor location, invasiveness and lymph node invasiveness. Methods: A retrospective cohort study was conducted using 68 CRC Formalin Fixed Paraffin Embedded samples from patients who underwent removal surgeries with the diagnosis of adenocarcinoma not otherwise specified. TB counts were identified by immunohistochemical staining using Pan-Cytokeratin AE1/AE3 and were categorized into low and high. MMR protein loss was analyzed using antibodies MLH1 and MSH6 categorized as positive and negative, then classified into Microsatellite Stable (MSS) and Microsatellite Instability (MSI). CD3 and CD8 T cell densities were identified using CD3 Biocare Medical and CD8 Biocare, was categorized into low and high. Secondary data from medical records were collected and analyzed using SPSS 25. Results: A significant relationship was found between tumor budding with the depth of invasion and lymph node involvement (p=0.021 and 0.020). Conclusion: Tumor budding (TB) plays a role in the depth of invasion and lymph node involvement in CRC but has no significant relationship with CD3/CD8 densities, differentiation, location, and MMR status. There was also no significant relationship between MMR status with differentiation, location, depth of invasion, lymph node involvement, and TB
Scrofuloderma of the Penis: Unveiling a Rare Case of Cutaneous Tuberculosis
Full text linkTuberculosis (TB) is a major worldwide health concern, with 10.4 million new cases reported each year. Extrapulmonary tuberculosis (EPTB) accounts for 20% of all occurrences, with cutaneous tuberculosis (CTS) accounting for just 1-2%. Scrofuloderma is the most prevalent kind of secondary CTS, and it commonly starts in the underlying lymph nodes, bones, or joints.Here, we describe the case of a 35 years old man presenting with a solitary nodule necrotic ulcer that happens 4 days before going to the hospital. The skin biopsy from the lesion was suggestive of TB scrofuloderma. Scrofuloderma typically presents as subcutaneous nodules that ulcerate and form sinus tracts. Diagnosis is challenging, often requiring histopathological confirmation due to potential negative microbiological results. In this case, the atypical penile appearance and the patient's history of an invasive operation aided in the diagnosis. Diabetes mellitus-related immune weakness increased the patient's susceptibility to cutaneous tuberculosis. This case demonstrates the wide range of cutaneous tuberculosis presentations and the significance of extensive diagnostic techniques, particularly in unusual patients. It also emphasizes the increased risk of tuberculosis in immunocompromised people, such as those with diabetes mellitus
A 28-Year-Old Woman with Impending Thyroid Storm, Hyperbilirubinemia, and Total Atrioventricular Block
No full textThyrotoxicosis, a state of excess thyroid hormone, often presents with diverse clinical manifestations, including thyroid storm, a rare but critical condition. Here, we present a case of a 28-year-old woman with thyrotoxicosis, hyperbilirubinemia, and total atrioventricular (AV) block. The patient exhibited jaundice, chest discomfort, and a history of chronic diarrhea, weight loss, tremors, and exertional dyspnea. She was on propylthiouracil and propranolol for two weeks.Physical examination revealed jaundice, proptosis, a large goiter, and tremors. Laboratory tests on admission indicated elevated liver enzymes, hypokalemia, and markedly elevated thyroid hormones. ECG revealed total AV block. Treatment involved hydrocortisone, thiamazole, discontinuation of propranolol, and gradual correction of electrolyte imbalances. The patient improved clinically, and propranolol’s discontinuation improved the rhythm disturbance. The Patient was discharged for outpatient Graves’ disease management.Future assessments may include an electrophysiology study if needed. Total AV block in thyrotoxicosis is rare. This case highlights the complexity of managing thyrotoxicosis with concurrent hepatic and cardiac complications, emphasizing the importance of tailored treatment strategies and close monitoring
Acute Shock Liver in Inferior ST-Segment Elevation Myocardial infarct with Total Atrioventricular block: A Case Report
Full text linkLiver dysfunction frequently accompanies heart diseases, especially in hemodynamically unstable acute heart failure or cardiogenic shock. This condition is marked by significant elevation of liver transaminases and brings high morbidity and mortality for > 50 % of cases. Despite the high mortality rate, early recognition with prompt management results in the recovery of liver function. A 53-year-old man presented with late-onset non-reperfused inferior STEMI. The patient presented with persistent chest pain and shortness of breath. The electrocardiogram showed atrioventricular (AV) block grade III and ST-segment elevation evolution in the inferior lead. The patient was diagnosed with a late-onset inferior STEMI with cardiogenic shock and total AV block complication, acute shock liver, lactic acidosis, and acute renal failure. We administered inotropic and chronotropic support drugs as well as post-MI anti-remodelling therapy to treat heart failure (HF) and left ventricular (LV) systolic dysfunction, such as angiotensin-converting enzyme inhibitor and aldosterone antagonist, after systemic perfusion improved. Anti-ischemic therapy, such as antithrombotics, was also administered. Renal and liver function test evaluation after a week of patient discharge showed normalization of these parameters. There is no definite treatment strategy for shock liver. The management strategy is directed at the treatment of underlying causes. Hemodynamic insult is the mainstay therapeutic target. Recovery of liver transaminases was demonstrated after the underlying insult had been eliminated
Role of Desmoglein Autoantibody in the Diagnosis of Pemphigus Vulgaris: A Case Report
Full text linkPemphigus vulgaris (PV) is a group of autoimmune diseases that cause abnormalities in the form of lesions or blisters on the skin and mucous membranes. It often presents diagnostic challenges due to its varied clinical manifestations. Accurate diagnosis and treatment are essential to reduce mortality in patients with PV. Traditional diagnostic methods, such as histopathology and direct immunofluorescence, may not always provide conclusive results, especially if the patient does not have an intact bulla. Our report emphasizes the role of desmoglein autoantibody testing using enzyme-linked immunosorbent assay to confirm the diagnosis, allowing for prompt and targeted therapeutic interventions
The Use of Secretome and Exosomes in Cardiovascular Diseases
Full text linkCardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality worldwide. Recent advancements in regenerative medicine have unveiled the promising roles of secretome and exosomes in the treatment of CVDs. In this article, we aim to understand the roles of secretome and exosomes in the cardiovascular system, both in physiological and pathological conditions, and explore the broad applications of secretome and exosomes in mitigating CVD progression. Secretome and exosomes, which play crucial roles in intercellular communication, tissue repair, and immunomodulation, have shown potential in reducing cardiovascular disease progression by inhibiting inflammation, promoting blood vessel growth, and regulating biological mechanisms. Further research is needed to maximize their use in advanced cardiovascular therapy
Dual Anti-HER2 Combination with Chemotherapy as First-line Treatment for HER2-positive Metastatic Breast Cancer
Full text linkHER2-positive metastatic breast cancer is an aggressive subtype of breast cancer associated with poor prognosis due to high recurrence and mortality rates. The introduction of dual anti-HER2 therapy combined with chemotherapy has significantly improved treatment outcomes.
A 50-year-old woman with a history of left mastectomy in 2019 who initially declined adjuvant chemotherapy and radiotherapy. Three years later, she presented to the clinic with erythematous skin changes, a nodule at the mastectomy site, and left-arm lymphedema. A biopsy confirmed recurrent HER2-positive breast cancer with metastases to lymph nodes, liver, and bones (cT4cN3cM1 ER−, PR−, HER2+). She received initial treatment with dual anti-HER2 (Pertuzumab, Trastuzumab) and Docetaxel every 3 weeks for six cycles, followed by maintenance therapy with Pertuzumab and Trastuzumab. PET scan evaluations showed an excellent response, with complete resolution of the primary lesion and substantial regression of metastases. The CLEOPATRA trial supports the efficacy of a combination of dual anti-HER2 and Docetaxel, showing prolonged progression-free and overall survival. The combination of dual anti-HER2 enhanced antitumor efficacy by providing dual inhibition of HER2. This case highlights the pivotal role of dual anti-HER2 therapy combined with chemotherapy in improving survival outcomes of patients with metastatic HER2-positive breast cancer
Efficacy of Exercise in the Sitting Position Compared with Exercise in the Standing Position in Obese Patients with Knee Osteoarthritis
Full text linkBackground: Knee osteoarthritis (OA) is a degenerative condition that causes pain, swelling, and stiffness, affecting a person’s ability to move freely. Non-weight-bearing therapeutic exercise programs provide better pain reduction and improve joint function compared with conventional exercise programs. This study compared the effectiveness of therapeutic exercises in sitting versus standing positions in reducing pain, improving knee function, and enhancing quality of life in obese patients with OA. Methods: Fifty-four obese women aged 50–80 years were randomly assigned to one of two exercise program groups, either sitting or standing. Members of each group participated in a 12-week intervention consisting of aerobics, hip stretching and strengthening, and balance exercises. Sessions lasted 45 minutes, three times per week, increasing by 30 minutes every four weeks. Pain was assessed using the Numerical Rating Scale, knee function was measured with the Knee Injury and Osteoarthritis Outcome Score, and quality of life was assessed with the 12-Item Short Form Survey. Measurements were taken at baseline and every four weeks during the intervention. Results: When compared with the standing position group, the sitting position group showed significantly less pain and better knee function as determined by NRS and KOOS, as well as better physical quality of life (p<0.05). In contrast, the standing position group had a better mental quality of life. Conclusion: Therapeutic exercises in a sitting position are more effective in reducing pain, improving knee function, and enhancing physical quality of life in OA. However, standing exercises contribute more to mental well-being
Peripheral Classic and Intermediate Monocyte Subsets as Immune Biomarkers of Systemic Lupus Erythematosus Disease Activity
Full text linkBackground: Monocytes are evolutionarily preserved innate immune cells that play essential roles in immune response regulation. Three activated monocyte subsets—classical (CD14++CD16–), intermediate (CD14++CD16+), and nonclassical (CD14+CD16++)—are associated with systemic lupus erythematosus (SLE) progression. This study aims to determine the association of monocyte subsets with SLE disease activity. Methods: A cross-sectional study involving 25 patients with SLE was conducted. Blood samples were collected, and monocyte subsets were identified using flow cytometry. Patients were grouped by disease activity using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) into inactive (SLEDAI-2K ≤ 4) and active (SLEDAI-2K > 4). The cutoff for monocyte subsets was determined using Receiver Operating Characteristic (ROC) analysis. Results: Nine active and 16 inactive subjects were identified. Compared with individuals without active disease, individuals with active disease had significantly lower mean classical monocyte subsets (71.9% vs 88%, p = 0.008), and higher median intermediate monocytes (29.1% vs 11.1%, p = 0.019). The median nonclassical monocyte subsets were not significantly different between the two groups. The cutoff for classical monocytes in active disease was ≤72.2%, AUC = 0.788, p = 0.021, with 66.7% sensitivity and 87.5% specificity; for intermediate monocytes, it was >22.3%, AUC = 0.788, p = 0.014, with 66.7% sensitivity and 100% specificity. Conclusion: Classical and intermediate monocytes could be considered as immune cellular markers for identifying active SLE
Hepatitis B Virus Reactivation Superimposed Hepatitis A Co-Infection Leading to Acute on Chronic Liver Failure: A Case Report and Literature Review
Full text linkAcute-on-chronic liver failure (ACLF) is a severe condition with an incidence rate of 5.7 cases per 1,000 person-years. A primary trigger for ACLF is hepatitis B reactivation, which is responsible for 40-60% of cases. Co-infection with hepatitis A can also contribute to its occurrence.This study presents the case of a 58-year-old male patient with a history of hepatitis B virus (HBV)-related cirrhosis, presenting with symptoms including confusion, disorientation, worsening jaundice, abdominal discomfort, nausea, vomiting, loss of appetite, malaise, muscle pain, and fever. Despite regular treatment for HBV, the patient’s condition deteriorated over 14 days. He had no history of hypertension, diabetes, autoimmune diseases, alcohol consumption, or smoking. On examination, the patient exhibited grade 2 hepatic encephalopathy, severe jaundice, ascites, and lower limb edema. Laboratory results revealed elevated liver enzymes, increased bilirubin levels, and decreased albumin. Subsequent testing confirmed acute hepatitis A infection and a significant hepatitis B viral load.The report highlights that reactivation of Chronic Hepatitis B, accompanied by co-infection with hepatitis A, played a critical role in inducing inflammation and worsening the ACLF condition