Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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COVID-19 Infection in Adrenal Tuberculosis Patients with Adrenal Insufficiency Who Complicated with Adrenal Crisis
Full text linkAdrenal insufficiency can increase the risk of infection. Respiratory infections play a role in the greater number of mortalities in patients with primary adrenal insufficiency. Severe acute illness elevates the risk of adrenal crisis which can give lethal outcome.A 52-year-old woman came to the emergency unit due to worsening gastrointestinal symptoms for the past 3 days. She had chronic epigastric pain, general weakness, weight loss, and skin hyperpigmentation. She was suspected of primary adrenal insufficiency one year ago, but she had poor compliance. In this current admission, she was suspected to have adrenal crisis and was diagnosed with COVID-19. On the 5th day of inpatient care, her condition was worsening, and she was diagnosed with adrenal crisis, septic shock, and severe COVID-19. Her ACTH level was 78.6 pg/mL (normal range 7.4-64.3 pg/mL) and her morning cortisol level was 1.1 ug/dL (normal range 3.7-19.4). Imaging showed unilateral hypertrophy of the adrenal gland, a positive result of IGRA, and fibrotic of the lung that led to tuberculosis of the adrenal as suspected etiology.Making a diagnosis of adrenal insufficiency is challenging because of its non-specific signs and symptoms. The need for education, equipment (adequate steroid supplies), and empowerment (development of specific guidelines for PAI and COVID-19) were taught to help prevent the adrenal crisis. Further examination is needed to obtain the definitive etiology of adrenal insufficiency in this patient
Prediction Equations for Calculating Maximal Inspiratory Pressure from Spirometry and Thoracic Ultrasound After COVID-19 with Gastroesophageal Reflux Disease in Indonesian Adults: A Cross-sectional Study
Full text linkBackground: This study aimed to determine the prediction equations for calculating maximal inspiratory pressure using spirometry and thoracic ultrasonography (USG) after COVID-19 with gastroesophageal reflux disease (GERD). Methods: This cross-sectional study was conducted from January to December 2022 and included Indonesian adults recruited by consecutive sampling after they developed COVID-19 with GERD symptoms. The following tests were used: spirometry (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1); thoracic USG (left diaphragm excursion (LDE) and right diaphragm excursion (RDE); and respirometry (maximal inspiratory pressure (MIP). The data were analyzed using Pearson correlational analysis and multiple linear regression. Results: Sixty-two participants were recruited: mean age 37.23 ± 9.76 years and average MIP 49.85 ± 18.13 cmH2O. MIP correlated significantly with FVC (r = 0.307; p = 0.015), LDE (r = 0.249; p = 0.051), FEV1(r = 0.186; p = 0.147), and RDE (r = 0.156; p = 0.221). We developed two models based on their applicability. Model 1 provides an MIP prediction equation for health facilities that have only spirometry: 23.841 – (20.455 × FEV1) + (26.190 × FVC). Model 2 provides an MIP prediction equation for health facilities that have both spirometry and thoracic USG: 3.530 – (20.025 × FEV1) + (25.354 × FVC) + (4.819 × LDE). Conclusion: In this study, measures of respiratory function correlated significantly with diaphragm excursion. MIP can be predicted from spirometry and thoracic USG data. Healthcare facilities can choose the prediction equation model that best meets their situation
Health Literacy Among University Students in the COVID-19 Pandemic: A Systematic Review
Full text linkBackground: The purpose of this systematic review was to assess different studies that worked on university students’ health literacy during covid19 pandemic and to make an overview of this issue to recognize possible determinants associated with health literacy. Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Four databases (Google Scholar, Web of Science, Pubmed, and Scopus) were used for searching cross-sectional works that assessed the health literacy of university students. We searched papers from December 1st, 2019 up to June 10th, 2022. English language articles were used. Studies were done in countries including; Iran, Pakistan, the USA, Vietnam, China, Colombia, Germany, and Indonesia. Results: The systematic review contains 12 research studies involving 17773 students. There was a relationship between health literacy and some determinants. Positive determinants included age, female gender, Urban background, cognitive maturity, Higher educational qualification, information source (Health workers), number of semesters, and parental education. Some negative determinants were male gender, Rural background, smoking, drinking, being able to pay for medication, lower conspiracy beliefs, and higher fear of COVID-19. Conclusion: University students around the world should have courses about health literacy according to university disciplines. These courses should be available for students of different fields to enhance their effectiveness, and training should be associated with students’ needs and their subgroup traits
Validation of Drug Resistance in Pneumonia (DRIP) Score as Empirical Antibiotic Failure Predictor in Community-Acquired Pneumonia Patients in Cipto Mangunkusumo Hospital
Full text linkBackground: The incidence of CAP due to Drug-Resistant Pathogen (DRP) requires broad-spectrum antibiotic therapy, Drugs Resistance in Pneumonia (DRIP) score can predict these cases. The use of the DRIP score can prevent antibiotic failure and long hospitalization, but validation is needed so that the DRIP score can be used according to the local community at Cipto Mangunkusumo National Central Public Hospital. Methods: This research is a retrospective cohort study in CAP patients who were hospitalized during the period January 2019 to June 2020. Data were taken from medical records. Failure of empiric antibiotics occurs when one of these criteria is found: patient mortality, ICU transfer, and escalation of antibiotics as well as length of stay. Results: 480 patients met the criteria. There were 331 patients (69%) with a DRIP score of <4 and 149 patients (31%) with a DRIP score of≥4. A total of 283 patients (59%) of antibiotic failures were detailed in 174 patients with a DRIP score <4 and 109 patients DRIP score ≥4. DRIP calibration using the Hosmer-Lemeshow test obtained p-value= 0.667 (p>0.05). AUC observations on the ROC curve obtained 0.651 (95% CI; 0.601-0.700). Conclusion: The DRIP score has low accuracy performance and calibration value in predicting empirical antibiotic failure and poor discriminatory value
The Severity, Quality of Life, and Correlated Factors of Chronic Kidney Disease-associated Pruritus between Hemodialysis and Kidney Transplant Patients: A Cross-sectional Study
Full text linkBackground: Chronic kidney disease-associated pruritus (CKD-aP) mainly occurs in hemodialysis (HD) patients and could persist in kidney transplant (KT) recipients. This study aims to compare the severity, correlation of various biochemical factors, and quality of life (QoL) concerning pruritus in CKD. Methods: A cross-sectional study was conducted on HD and KT recipients with chronic pruritus, where the 5-Dimensional (5-D) Itch Scale and Dermatology Life Quality Index (DLQI) were used to evaluate pruritus severity and QoL. Results: Among the 60 subjects, 76.7% of HD patients had moderate-to-severe pruritus, whereas in the KT group, 83.3% experienced mild pruritus (p < 0.001). The median DLQI score was 5 (3–6) and 3 (2–4), respectively (p < 0.001). There was a correlation between hs-CRP and the 5-D itch score in the HD group (r = 0.443; p < 0.05), whereas e-GFR was correlated with the 5-D itch score in the KT group (r = −0.424; p < 0.05). Conclusion: Moderate-to-severe pruritus was more common in HD patients. While pruritus in KT recipients had a mild effect on QoL, pruritus in the HD group had a mild-moderate impact on QoL. There was a correlation between hs-CRP and e-GFR and the severity of pruritus in HD and KT recipients, respectively
The Relationship Between Appropriateness of Antibiotic Use Based on the Gyssens Algorithm and Mortality: A Retrospective Cohort Study in Indonesian Tertiary Hospital
Full text linkBackground: Some studies have reported that antibiotic use as therapy and prophylaxis in hospitals is inappropriate in approximately 9% to 64% of cases. The Gyssens algorithm is used for qualitative evaluation by assessing the appropriate antibiotic use. This study aimed to determine and evaluate the quality of antibiotic use in inpatients at Dr. M. Djamil Central General Hospital by using the Gyssens algorithm. Methods: This was a retrospective cohort study at Dr. M. Djamil Central General Hospital from January to December 2021. We collected data from the medical records of inpatients who received antibiotics using a random sampling technique, and the number of patients from each department was calculated through a preliminary survey. Results: There were three hundred and sixty samples from the population that met the inclusion and, adults (59.4%), patients treated for >14 days (38.9%), patients discharged with improvement (66.9%), and patients diagnosed with pneumonia (49.5%). Most antibiotics were appropriate (56.5%), with ceftriaxone being the most commonly used antibiotic (199 cases ). Appropriate antibiotic use (Gyssens 0) is mostly found in the Internal Medicine Department Meanwhile, antibiotic use without indications (Gyssens V) is mostly found in the Surgery Department. A significant correlation was found betweenthe appropriateness of antibiotic administration patient outcomes after discharge from the hospital (p < 0.05). There was an increase in the risk of death in inappropriate antibiotic use (Gyssens I-IV) and antibiotic use without indications (Gyssens V) by 1.96 and 4.05 times, respectively. Conclusion: There are many cases of inappropriate antibiotic use in Dr. M. Djamil Central General Hospital; therefore, education regarding appropriate antibiotic use is necessary
Re-Emerging Trend of Mpox Infection: The Indonesia’s Experience and Review
Full text linkBackground: Since Monkeypox (mpox) had an outbreak on 6th May 2022 in 75 countries, it has been declared by the World Health Organization (WHO) that mpox is a public health of international emergency concern (PHEIC). WHO declared mpox as PHEIC again in August 204. Indonesia was also affected by the mpox outbreak with most of the cases coming from vulnerable populations. This study aimed to give an overview of mpox as well as the recent outbreak situation and management in Indonesia. Methods: In this narrative review (using PubMed, Scopus, and Cochrane databases combined with countries’ national official reports and grey literatures), we discussed an overview of mpox including epidemiology, morphology, transmission, symptoms, treatment, and prevention. The management of mpox in Indonesia was specifically reviewed. Results: Mpox is an infectious disease caused by the mpox virus which has infected 79,231 individuals globally. In Indonesia, the first mpox case was detected in August 2022 with 0 deaths and 88 confirmed cases as of August 2024. The virus is transmitted via respiratory droplets or direct contact with contaminated objects, surfaces, or mucocutaneous lesions of an infected individual which could lead to symptoms such as epidermal papules-pustules and clinical characteristics of classical smallpox. Although antivirals such as tecovirimat, cidofovir, and brincidofovir have been raised as potential treatments for mpox, these agents were only considered in severe cases in Indonesia. Conclusion: Mpox is a contagious disease that could cause major health problems if left uncontrolled, especially in specific vulnerable populations due to its high morbidity and mortality. Therefore, particular measures must be performed, especially in Indonesia
Effect of Extra-Virgin Olive Oil on Hand Foot Syndrome and hs-CRP in Patients Receiving Capecitabine: A Randomized Trial
Full text linkBackground: Hand Foot Syndrome (HFS) is a frequent adverse effect observed in patients undergoing capecitabine chemotherapy, often leading to treatment disruptions and dose adjustments. Elevated C-Reactive Protein (hs-CRP) levels have been associated with the development of HFS. This study aimed to assess the potential of unrefined Extra Virgin Olive Oil (EVOO) supplementation in mitigating HFS and hs-CRP elevation among individuals receiving capecitabine chemotherapy. Methods: Between November 2022 and May 2023, forty-five eligible participants were enrolled in this randomized trial. Patients with advanced colorectal or breast cancer were randomly allocated into three groups: an intervention group receiving unrefined EVOO supplementation (30 mL per day) alongside capecitabine, a placebo group receiving refined extra light olive oil (ELOO) supplementation (30 mL per day) alongside capecitabine, and a control group receiving capecitabine alone. The masking of both placebo and intervention groups was ensured through identical packaging and instructions, maintaining participant and physician blindness to the assigned treatments. Randomization, achieved via computer-generated sequences, ensured even distribution among the three groups. Results: HFS incidences were notably lower in the EVOO group (13.3%) compared to the placebo (66.7%) and control (80%) groups. Instances of Grade 2 or more severe HFS were observed in 20% of placebo and 40% of control group patients. No cases of severe HFS were reported in the EVOO group. Moreover, EVOO supplementation led to a significant reduction in hs-CRP levels when contrasted with the placebo and control groups. These findings suggest that EVOO may serve as a preventive measure against HFS and exhibit anti-inflammatory effects in patients undergoing capecitabine chemotherapy. Conclusion: This study demonstrates the potential benefits of incorporating unrefined EVOO into the regimen of patients undergoing capecitabine chemotherapy. EVOO supplementation was associated with lower incidences of HFS and a reduction in hs-CRP levels, indicating its possible role in preventing HFS development and mitigating inflammation
Antimicrobial Resistance Issue: A Matter of Practice and Capacity to Conduct an Audit
Full text linkThe World Health Organization released the practical toolkit for antimicrobial stewardship in health-care facilities in low- and middle-income countries in 2019 due to increasing rates of antimicrobial resistance (AMR) causing the diminishing of treatment options and that the available antibiotics seem to no longer work. The introduction of this toolkit indicates the need to be more down-to-earth in combating the problems of antimicrobial resistance. This situation happened because we have taken antibiotics for granted for too long with less awareness, which results in the potential loss of its use and benefits. On the other hand, even though medicine is available, a major issue on the limited access to antibiotics are still reported in many parts of the world.The problem of antimicrobial resistance extended to the community; the population that is difficult to evaluate. In a hospital setting, patients are expected to be monitored which allows data to be gained easily. The commitment to combat resistance is demonstrated by the Indonesian government through the establishment of the National Committee of Antibiotics mentioned in Permenkes no. 8 (2015) that is located in each hospital and the upscaling of the issues of Antimicrobial Resistance to become one of the national priorities and program.In this issue, Fadrian, et al.7 conducted a study to measure the quality of antibiotics use at the western part of Indonesia. Every year between 18 to 24 November, we are celebrating the World AMR Awareness Week, with a strong hope to reduce the number of deaths which is at an estimate of 1.27 million people in 2019 who have been presumed to have died as a result to drug resistance.The hope must be followed by a strong commitment and understanding of the risk of overprescribing antibiotics, and if we ignore this, there will be a chance of a 9 times increase in mortality rates which translates to up to an estimate of 10 million deaths per year after 2050
Challenges in Diagnosis and Treatment of Male Hypogonadism
Full text linkHypogonadism is a condition characterized by diminished or absent production of sex hormones by the testicles in men and the ovaries in women. Hypogonadism is classified into primary and secondary hypogonadism. Each type of hypogonadism can be caused by congenital and acquired factors. There are many factors that contribute to the occurrence of hypogonadism, including genetic and developmental disorders, infection, kidney disease, liver disease, autoimmune disorders, chemotherapy, radiation, surgery, and trauma. This represents the considerable challenge in diagnosing hypogonadism.The goals of treatment include restore sexual functionality and well-being, initiating and sustaining virilization, osteoporosis prevention, normalize growth hormone levels in elderly men if possible, and restoring fertility in instances of hypogonadotropic hypogonadism. The main approach to treating hypogonadism is hormone replacement therapy. Male with prostate cancer, breast cancer, and untreated prolactinoma are contraindicated for hormone replacement therapy. When selecting a type of testosterone therapy for male with hypogonadism, several factors need to be considered, such as the diversity of treatment response and the type of testosterone formulation. The duration of therapy depends on individual response, therapeutic goals, signs and symptoms, and hormonal levels. The response to testosterone therapy is evaluated based on symptoms and signs as well as improvements in hormone profiles in the blood. Endocrine Society Clinical Practice Guideline recommend therapeutic goals based on the alleviation of symptoms and signs, as well as reaching testosterone levels between 400 – 700 ng/dL (one week after administering testosterone enanthate or cypionate) and maintaining baseline hematocrit.Hormone therapy is the primary modality in the management of hypogonadism. The variety of signs and symptoms makes early diagnosis of this condition challenging. Moreover, administering hypogonadism therapy involves numerous considerations influenced by various patient factors and the potential for adverse effects. This poses a challenge for physicians to provide targeted hypogonadism therapy with minimal complications