Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Efficacy of Hyaluronic Acid in Radiation Proctitis: A Case Series
Full text linkGastrointestinal toxicities of radiation might develop after exposure, thus leading to conditions such as abdominal pain, rectal bleeding, diarrhea, anemia, and weight loss. The development of drugs to reduce mucosal damage progression has been a focus on managing radiation proctitis. Radiation proctitis resulting from exposure to pelvic radiotherapies is effectively managed with topical administration on the anal mucosa. The clinical use of hyaluronic acid offers an innovative approach to managing radiation injury. Hyaluronic acid has multiple beneficial properties, such as regulating immune process to reduce inflammation and oxidative stress, supporting natural protective mechanism, promoting mucosa healing, and improving tissue hydration. Therefore, this case series introduces the idea that application of hyaluronic acid could potentially improve patients’ clinical conditions
Chlorpromazine-Induced Severe Hyponatremia in 66 Years Old Patient
Full text linkHyponatremia is a common clinical problem in older people. The aging process is usually accompanied by various maladaptations to stress in different organs and physiologic functions. Medications are often the cause of hyponatremia such as thiazide diuretics, antidepressants, antiepileptic and antipsychotics. Antipsychotics can lead to severe hyponatremia by the mechanism of the development of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). We report a patient who presented with severe hyponatremia due to Chlorpromazine and improved after receiving corrective hyponatremia
Cirrhosis Management: Utilization and Optimizing Non-Invasive Tests in Portal Hypertension
Full text linkEarly identification of clinically significant portal hypertension (CSPH) is crucial in cirrhosis, as it is the primary underlying mechanism of cirrhosis complications. One such complication is esophageal varices, which are associated with high morbidity and mortality. Hepatic venous pressure gradient (HVPG) measurements and endoscopy, considered the gold standard for these conditions, are invasive methods that are limited, costly, and inconvenient. To address this challenge, a combination of non-invasive tests can be employed to predict CSPH and esophageal varices. A validated approach involves combining liver stiffness measurement (LSM) by transient elastography (TE) with platelet count. Additionally, spleen stiffness measurement (SSM) has emerged as a promising method for evaluating high-risk varices, as reported by Nababan et al. Therefore, non-invasive methods can be utilized to identify patients who need invasive procedures or potentially replace invasive procedures altogether.
The Association between Anemia and Mortality of Severe Pneumonia COVID-19 Patients in the High Care Unit of a Tertiary Hospital in Jakarta
Full text linkBackground: Numerous studies explored the association between anemia and mortality in patients with severe pneumonia due to COVID-19. However, the findings were inconsistent. Therefore, this study was conducted to investigate the association between anemia at HCU admission and in-hospital mortality in severe pneumonia COVID-19 patients. Methods: This retrospective cohort study obtained data on 110 COVID-19 patients with severe pneumonia who were admitted to the HCU between January, 1st 2021, and May 31st, 2021. Patients were categorized as anemic and non-anemic based on the World Health Organization (WHO) guidelines. The demographic and clinical characteristics of the subjects were described. The Chi-squared test was carried out followed by a logistic regression test to determine the association of anemia and mortality. Results: Anemia was observed in 31% of 110 patients with severe pneumonia COVID-19. The source population consisted of 60.9% men and 39.1% women with a median age of 58 years. The most prevalent comorbidity was hypertension (38.2%), followed by diabetes mellitus (27.2%), renal diseases (19.1%) and heart diseases (10%). TAnemia on HCU admission was associated with in-hospital mortality in patients with severe pneumonia COVID-19 (RR: 2.794, 95% CI 1.470-5.312). After adjusting comorbidities as confounding factors, anemia was independently associated with mortality (RR: 2.204, 95% CI: 1.124-4.323, P < 0.021). The result also showed anemic patients had longer lengths of stay and higher levels of D-dimer than non-anemic patients. The median duration length of stay among the anemic and non-anemic was 16 (11-22) and 13 (9-17) days, respectively. The median D-dimer among the anemic and non-anemic was 2220 μg/ml and 1010 μg/ml, respectively. Conclusion: There is a significant association between anemia at HCU admission and mortality in patients with severe pneumonia COVID-19 during hospitalization
Circulating Tumour Cells and FOXP3 in Regulatory T-Cells as New Modalities in Cancer Diagnosis and Metastasis Location Prediction
Full text linkCancer is a complex group of diseases which arises from uncontrolled growth and spread of abnormal cells in the body. The pathophysiology of cancer involves a sequence of events at the cellular and molecular levels, often initiated by genetic mutations or alterations. These mutations can be acquired due to various factors like environmental exposures such as from carcinogens, lifestyle choices, or inherited genetic conditions. When a cell’s DNA is damaged or mutated, it can disrupt the normal regulatory mechanisms that control cell division and apoptosis, leading to uncontrolled proliferation and cancer.the intricate interplay between genetic mutations, angiogenesis, hematogenic spread, CTCs, immune cells, and systemic cancer therapy defines the complex landscape of cancer progression and treatment. Understanding the role of immune cells, particularly Tregs marked by FOXP3, as prognostic markers in various cancers, alongside advancements in cancer diagnosis involving CTCs, holds promise in understanding cancer prognosis and improving cancer management. Moreover, ongoing research into alleviating chemotherapy-induced side effects, like HFS offer avenues for improving patient care and treatment outcomes in cancer management
Periendoscopic Care Continuum in Acute Cholangitis Caused By Common Bile Duct Stone
Full text linkAcute cholangitis (AC) is a biliary tract infection with in-hospital mortality rates reaching up to 14.7%. The underlying condition is biliary obstruction caused by benign and malignant etiologies, as well as bacteriobilia, with commom bile duct (CBD) stone being one of the most common causes. Currently, the diagnosis is validated using Tokyo Guidelines 2018 criteria. Acute cholangitis due to CBD stone should be managed in a comprehensive manner, i.e., periendoscopic care continuum, consisting of pre-endoscopic care, endoscopic management, and post-endoscopic care. Pre-endoscopic care is primarily comprised of supportive therapy, antibiotic administration, optimal timing of endoscopic retrograde cholangiopancreatography (ERCP), pre-ERCP preparation, and informed consent. Endoscopic management is biliary decompression with stone extraction facilitated via ERCP procedure. Selective biliary cannulation should be performed meticulously. Bile aspiration and minimal bile duct contrast injection should be done to minimize the worsening of biliary infection. Endoscopic biliary sphincterotomy, endoscopic papillary balloon dilatation, and/or endoscopic papillary large balloon dilatation are all safe procedures that can be used in AC. Special precautions must be undertaken in critical and severe acute cholangitis patients who may not tolerate bleeding, in whom endoscopic biliary sphincterotomy may be postponed to decrease the risk of bleeding, and biliary decompression may be only attempted without CBD stone extraction. Nasobiliary tubes and plastic biliary stents are equally effective and safe for patients who have only undergone biliary decompression. In post-endoscopic care, management of adverse events and observation of therapy response are mandatory
Challenges and Strategies for Controlling Indonesia's Emerging and Re-Emerging Infection Diseases (EID-REIDs)
Full text linkThis review aims to highlight the occurrences of several emerging and re-emerging infectious diseases, particularly 13 types under surveillance of Indonesia’s emerging contagious disease task force. These diseases are considered potentially epidemic, due to the nature of tropical climate and high humidity of Indonesia’s area. Several factors contribute to the emergence of these diseases: in conjunction with human behavior. Most of these diseases are zoonotic, specifically spread by viruses. The latest emerging infectious disease in Indonesia is monkeypox. Controlling the management of EID-REIDs presents a major obstacle for international health initiatives, particularly in Indonesia because of its extensive population, varied geographical landscape, and constrained resources. Overcoming these obstacles demands tactics like prioritizing Indonesian policies, bolstering disease monitoring systems, upgrading diagnostic capacities, fortifying public health facilities, fostering community involvement and education, and executing efficient prevention and management protocols. These strategies should be implemented in collaboration with international partners and organizations to effectively control and prevent the spread of emerging and re-emerging infectious diseases in Indonesia
Successfull Treatment of Plantar Fasciitis with Perineural Dextrose Injection
Full text linkA 62-year-old active career woman came to the clinic with a chief complaint of left heel pain for 7 months without numbness. She had previously sought consultation at several clinics and was prescribed oral nonsteroidal anti-inflammatory and opioid analgesic drugs with no improvement in symptoms. She was offered plantar corticosteroid injection therapy but refused due to fear of corticosteroid’s possible side effects. She had a medical history of dyslipidemia and no other comorbid diseases. She was obese with a body mass index of 27.3 kg/m2. There was tenderness at the plantar medial calcaneal tuberosity, rated as 7/10 on the pain scale. Tinel tests were negative on both feet. Musculoskeletal ultrasound examination demonstrated a 7.7 mm thickness of left plantar fascia. In comparison, her right plantar fascia thickness was 2.8 mm. Three milliliters of dextrose 5% were injected perineural to the tibial nerve, posteriorly to the left medial malleolus. The patient reported a significant reduction of pain to 3. The second session of perineural dextrose injection was performed after one week, resulting in a pain severity reduction to 1. The patient was also advised to consult a dietician for weight loss management and avoid barefoot walking. No study yet compares the efficacy between conventional corticosteroid injection and perineural dextrose injection in treating plantar fasciitis
Risk Factors Associated with the Colonization of Multidrug-Resistant Gram-Negative Bacteria Upon Admission to the Intensive Care Unit: A Cross-sectional Study
Full text linkBackground: Multidrug-resistant Gram-negative bacteria (MDR-GNB) are prevalent in intensive care units (ICUs), leading to increased morbidity and mortality. Limited data on MDR-GNB in Indonesia prompted this study to determine the prevalence and risk factors associated with MDR-GNB colonization, enhancing screening strategies, and acquiring phenotypic and genotypic data on these bacteria. Methods: This analytical cross-sectional observational study included participants who met the criteria and were admitted to the ICU at Dr. Cipto Mangunkusumo Hospital from January to December 2022. We used multivariate analysis on the findings from rectal swab screening, sociodemographic, clinical, and microbiological examinations. Results: Out of 108 participants, 172 cultures comprised 165 Gram-negative isolates, four yeasts, and three with no growth. The prevalence of patients colonized with MDR-GNB was 51.85% (56/108), and the prevalence of MDR-GNB isolates was 39.53% (68/172), with the most common MDR-GNB being Escherichia coli (29.65%) and Klebsiella pneumoniae (19.44%). The most resistant gene found in ESBL was CTX-M (75%), and the carbapenemase producer gene was NDM (5.88%). Risk factors associated with MDR-GNB colonization were the length of stay before admission to the ICU (p = 0.003) and a history of previous antibiotic therapy (p = 0.036). Conclusion: In this study, two risk factors were associated with the occurrence of MDR-GNB colonization, with the prevalence of MDR-GNB colonization in patients initially admitted to the ICU still quite high. Therefore, selecting screening patients based on risk factors at the time of initial admission to the ICU is crucial for infection control programs
Identifying Predictors of Mortality in Sepsis Patients with Malignancy: A Retrospective Cohort Study
Full text linkBackground: Sepsis is a major problem that contributes to a high mortality rate. Its mortality is especially high in patients with malignancy. One study reported that sepsis patients with malignancy have a 2.32 times higher risk of mortality compared to patients without malignancy. For this reason, factors that influence mortality in sepsis patients with malignancy become especially important to provide effective and efficient therapy. This study aims to identify factors that influence mortality in sepsis patients with malignancy. Methods: This study is a retrospective cohort study using medical records of sepsis patients with malignancy who were treated at Cipto Mangunkusumo Hospital from 2020 to 2022. A bivariate analysis was carried out and followed by a logistic regression analysis on variables with p-value<0.25 on the bivariate analysis. Results: Among the 350 eligible sepsis subjects with malignancy, there was an 82% mortality rate (287 subjects). Bivariate and multivariate analyses revealed significant associations between mortality and both SOFA score (adjusted Odds Ratio of 5.833, 95%CI 3.214–10.587) and ECOG performance status (adjusted Odds Ratio of 3.490, 95%CI 1.690–7.208). Conclusion: SOFA score and ECOG performance status are significantly associated with sepsis patient mortality in malignancy cases