Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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The Profile of Multidrug Tuberculosis Regimen and Treatment Outcomes in Pulmonary MDR-TB Patients at the Tertiary Referral Hospital Dr. Soetomo, East Java, Indonesia: A Seven-Year Retrospective Study on Bedaquiline
Full text linkBackground: The use of bedaquiline has been reported to minimize the number of lost to follow-up and fewer rejections from the patients. This study is the first to depict the use of bedaquiline. It aims to provide information related to the profile of the MDR-TB drug regimen in the last 7 years with the treatment outcomes of pulmonary MDR-TB patients at a tertiary referral hospital in East Java. Methods: This study was a retrospective, descriptive, and data analysis on 1053 pulmonary MDR-TB patients in tertiary referral hospital Dr Soetomo, East Java, Indonesia, with the SPSS software version 25 and Microsoft Excel 2021. Results: The study analyzed the MDR-TB treatment regimen following the latest guidelines from WHO (2020) at a tertiary referral hospital in East Java. This study shows that a bedaquiline-containing regimen started in January 2015 to July 2022 with the percentage of distribution (1, 3, 11, 4, 18, 13, 29, 21)% consecutively in the regimen. The treatment outcome profile of MDR-TB patients shows the average percentage of cured (15%), died (12%), lost-to-follow-up cases (27%), moved to an individualized regimen or a different health facility (42%), and currently in the evaluation stage (4%). Overall from January 2017 to July 2022, the number of LTFU cases decreased (42, 46, 29, 19, 8, 4)%. However, the cured case fluctuated between 2017-2022 (16, 28, 26, 32)% respectively after Bdq started to be included in the regimen regularly for treating RR/MDR-TB. Conclusion: After seven years of study, we revealed an association between adding bedaquiline to the regimen and the treatment success and decreasing lost-to-follow-up cases
Success Treatment of Severe and Active Graves’ Orbitopathy with Tocilizumab After Thyroidectomy and Maximum Dose of Intravenous Methylprednisolone
Full text linkWe report a woman, 45th year old with Graves’ disease treated with anti-thyroid drug (thiamazole). She came to our clinic with severe and active Graves’ orbitopathy. We treated her with high dose intravenous methylprednisolone weekly (0.5 g weekly/ 6 weeks) and mycophenolate sodium 0.72 g daily/ 6 weeks. Because of her longterm consumption but not successful to achieve remission of anti-thyroid drugs and the size of her goiter, we decided to do total thyroidectomy. Only one week after thyroidectomy, her eye inflammation grade was reduced, but still bulging. We continue with the intravenous methylprednisolone weekly. Because of the partial response, we continue with another dose of methylprednisolone (0.25 g weekly for another 6 weeks).After 12 weeks of intravenous methylprednisolone (maximum dose for 1st course 4.5 g), there is a partial response make it to moderate to severe grade but still active inflammation. Our team decided to give her second-line treatment and we give her intravenous tocilizumab monthly for 4 weeks. After three tocilizumab infusion, the inflammation is reduced remarkably. Her overall appearance is getting better. But, because of her sight was not improved much as the inflammation reduced, we done orbital MRI and we decided to do another intravenous methylprednisolone 1 g for three days followed by orbital decompresion surgery. Shortly after the orbital decompresion, her sight was improved very well. She can now doing activities she can do previously. After recovery, we plan to give her the fourth (last) tocilizumab infusion. Overall, tocilizumab improves clinical outcome in patient with active corticosteroid-resistant moderate to severe Graves’ orbitopathy. Patient’s quality of life also improved
Risk Factors for Declined Functional Status within 30 days After Elective Surgeries in Elderly Patients: A Prospective Cohort Study
Full text linkBackground: Older adults are at risk of decreasing functional status due to their condition and many factors. Although many studies have been conducted about declining in functional status, based on the author’s knowledge, only this study that has conducted about functional status changes in the elderly involving the frailty status which undergoing surgery in Indonesia. There are many factor was postulated, some of that was checked routine and applicable in clinical practice. Furthermore, identification of these risk factors can be used a basis for decision making to perform surgeries in older adults because poor functional status causes declining quality of life in the elderly patients. The aim of this research was to determine the risk factors for declined functional status within 30 days after elective surgeries in elderly patients. Methods: We conducted a prospective cohort study from July 2021 to December 2021 at Dr. Kariadi Hospital, Semarang, Indonesia. We included patients aged 60 or older who underwent elective surgery under general anesthesia. We excluded those who underwent emergency surgery, day care surgery, or were unwillingness to participate. The functional status were assessed using the ADL (Activity of Daily Living) Barthel index. To identify risk factors of declined ADL scores, a logistic regression analysis was performed on the age variable, gender, body mass index, frailty status, postoperative complications, as well as haemoglobin, and albumin levels. Results: This study included 191 participants, with 97 women (50.79%) and 94 men (42.21%). Declined in functional status within 30-days after surgery occurred in 54 participants (28.2%). There was a significant changed of functional status before and after surgery. Multivariate analysis showed that independently significant variables for declined functional status were male sex (OR 4.48, p value < 0.001), hypoalbuminemia (OR 2.59, p value 0.02), preoperative functional status (OR 2.37; p value 0.05), and postoperative complications (OR 24.885; p value < 0.001). Conclusion: Risk factors for declined functional status within 30 days after elective surgery in older patients are postoperative complications, preoperative functional status, hypoalbuminemia, and male gender
Unusual Presentation of Unilateral Choroidal Melanoma with Bilateral Vasculitis in Young Individual: A Case Report and Review of Literature
Full text linkOcular melanoma stands as the predominant primary intraocular malignancy, albeit infrequently exhibiting ipsilateral inflammatory manifestations. In this article, we present an exceptional case involving a middle-aged male who presented with unilateral ocular choroidal melanoma alongside bilateral retinal vasculitis. The patient initially received temporary steroid treatment, followed by brachytherapy, which contributed to the resolution of vasculitis symptoms. The study aims to document the atypical occurrence of bilateral retinal vasculitis, which could potentially masquerade as melanoma, emphasizing the need for heightened vigilance and further investigations when encountering choroidal masses in its presence. Future research endeavors are warranted to better understand the incidence of such occurrences in this context
A Mixed Gonadal Dysgenesis in an 19 Year Old Girl with Ambigous Genitalia: A Case Report
Full text linkA 19-year-old girl was referred with delayed puberty and ambiguous genitalia. She had short stature with high blood pressure and Turner’s stigmata with external genitalia Prader Score 4. Ultrasound revealed hypoplastic uterus with no gonad. Follicle stimulating hormone, luteinizing hormone and testosterone level were increased (51.29 mIU/mL, 23.66 mIU/mL and 742 ng/dl). Karyotyping revealed 46 XY with Fluorescence in situ hybridization cytogenetic study based on 300 cells showed mosaic chromosome, monosomy X (17%) and XY (83%). Laparascopic gonadectomy was done and showed that testes were only in the right inguinal canal. Then patient had external genitalia reconstruction and received estrogen replacement therapy
Assessment of Circulating Tumor Cells in Colorectal Cancer as an Adjunctive Non-invasive Diagnostic Method
Full text linkBackground: Colorectal cancer (CRC) is a significant contributor to cancer-related morbidity and mortality. Biopsy remains the gold standard for CRC diagnosis, but invasive testing may not be preferred as an initial diagnostic procedure. Therefore, alternative non-invasive approaches are needed. Circulating tumor cells (CTC) present in the bloodstream have great potential as a non-invasive diagnostic marker for CRC patients. This study aimed to assess the diagnostic potential of CTC in CRC as an adjunctive diagnostic method using a subjective manual identification method and laser capture microdissection at 40x magnification. Methods: A cross-sectional study was conducted on adult patients suspected to have CRC at Dr. Cipto Mangunkusumo National General Hospital, Jakarta, between November 2020 and March 2021. CTC analysis was performed using the negative selection immunomagnetic method with Easysep™ and the CD44 mesenchymal tumor marker. The identification and quantification of CTC were conducted manually and subjectively, with three repetitions of cell counting per field of view at 40x magnification. Results: Of 80 subjects, 77.5% were diagnosed with CRC, while 7.5% and 15% exhibited adenomatous polyps and inflammatory/hyperplastic polyps, respectively. The diagnostic analysis of CTC for detecting CRC (compared to polyps) using a CTC cutoff point of >1.5 cells/mL suggested sensitivity, specificity, and positive predictive value (PPV) of 50%, 88.89%, and 93.94%. Additionally, the negative predictive value (NPV), as well as the positive and negative likelihood ratio (PLR and NLR) were 34.04%, 4.5, and 0.56, respectively. The subjective manual identification and quantification of CTC were performed at 40x magnification using laser capture microdissection. Conclusion: This study assessed the diagnostic potential of CTC examination in CRC as an adjunctive diagnostic method using the subjective manual identification method and laser capture microdissection at 40x magnification. Despite the limitations associated with subjective cell counting, the results showed 50% sensitivity and 88.89% specificity in diagnosing CRC. Further studies are needed to optimize the manual identification process and validate the clinical utility of CTC analysis in CRC patients
Validation of Spleen Stiffness Measurement for Screening of High-risk Esophageal Varices Among Cirrhotic Patients in Indonesia: A Single-Center Cross-sectional Study
Full text linkBackground: Spleen stiffness measurement (SSM) is a recently developed non-invasive method for predicting clinically significant portal hypertension and esophageal varices in compensated advanced liver disease or cirrhosis. This study aims to validate the accuracy of SSM for screening high-risk esophageal varices among cirrhotic patients in Indonesia. Methods: This is a single-center, cross-sectional study. Patients with liver cirrhosis who underwent endoscopy at Cipto Mangunkusumo Hospital, Jakarta were included. Clinical data and data from laboratory tests, endoscopy, liver, and spleen stiffness measurement by transient elastography (TE) were collected. A 100 Hz spleen-dedicated TE probe was used for SSM. Results: Of 86 patients, 52 had high-risk esophageal varices. The median (IQR) value of SSM were significantly higher in patients with high-risk varices [36.1 kPa (IQR 21.5-59.1) vs. 70.3 kPa (IQR (52.2-86.0); p<0.001). SSM with a low cutoff value of 20 kPa had sensitivity and negative predictive value of 98.1% and 87.5%, respectively. The high cutoff value of 70 kPa had specificity and positive predictive value of 82.4% and 81.3%, respectively. Conclusion: SSM is useful for screening high-risk esophageal varices. Furthermore, the new dual cutoff value can help rule-in and rule-out high-risk esophageal varices among cirrhotic patients in Indonesia
The Nutritional Management of Patients with Continuous Ambulatory Peritoneal Dialysis
Full text linkEnd-stage kidney disease (ESKD) is a severe final phase of chronic kidney disease (CKD). Currently, it is related to high morbidity and mortality rates, making it an important health issue and a catastrophic disease. There is an increase in the death rate, especially when the underlying metabolic disorders are not treated with renal replacement therapy. Continuous ambulatory peritoneal dialysis (CAPD), or continuous dialysis in the peritoneal cavity, is one of the treatment options available in Indonesia as CKD becomes more prevalent each year, in addition to hemodialysis and kidney transplants. Patients with CKD who are on either hemodialysis or CAPD are frequently malnourished. The primary cause of these nutritional and metabolic disorders in uremic patients has decreased appetite, a major disease symptom. It is also observed that the protein levels in the serum and tissues are typically low, although protein and energy intake have been adjusted to meet standard nutritional guidelines. Also, there is reverse epidemiology in CKD patients, where a higher weight gain could result in a lower risk of mortality than non-CKD patients, where a higher weight gain causes an increased risk of death. Assessment and monitoring of nutritional status are necessary to determine mortality and morbidity due to cardiovascular abnormalities and for prevention and management of other complications in CKD patients undergoing CAPD. Lastly, there is currently a scarcity of research on the nutritional status of CAPD patients. Therefore, risk assessment and nutritional management monitoring can help reduce CKD incidence in patients undergoing CAPD
Effectiveness of Internet-Based Group Supportive Psychotherapy on Psychic and Somatic Symptoms, Neutrophil-Lymphocyte Ratio, and Heart Rate Variability in Post COVID-19 Syndrome Patients
Full text linkBackground: COVID-19 can have serious long term health consequences, which is called Post-COVID-19 Syndrome (PCS). Currently, the available evidence and understanding of PCS management is limited. Because one of the symptoms of PCS is associated to psychological symptoms, psychotherapy is believed to have a role in the management of PCS. This study aimed to identify the effectiveness of supportive psychotherapy in PCS patients at Cipto Mangunkusumo National General Hospital. Methods: This study was a single blind randomized clinical trial using a pre-and post-test with control group study design. Participants were randomly divided into two groups: a psychotherapy group with 40 participants and an education group with 37 participants. Each group was given internet-based psychotherapy or education three times a week in a form of group consisting of 6-8 participants. Symptom Checklist-90 questionnaire was used to evaluate somatic and psychological symptoms. Heart rate variability and neutrophil lymphocyte ratio were also investigated. Data analysis was performed using the independent T test. Results: An improvement in the SCL-90 score was found to be 17.51 (SD 30.52) in the psychotherapy group and 19.79 (SD 35.10) in the education group, although there was no significant difference between the two groups (p = 0.771). There was no significant difference between the two groups in decreasing NLR (p = 0.178) and improving HRV (p = 0.560). Conclusion: Both internet-based group supportive psychotherapy and education improved psychological and somatic symptoms in PCS patients, although there was no significant difference between the two groups. There was no significant difference between the two groups in decreasing NLR and improving HRV. Suggestions for further research regarding adding frequency of internet-based group psychotherapy in PCS patients and held in the morning to achieve more optimal results
Advancing The Cardiovascular Care in Cancer Patients on Chemotherapy
Full text linkCardiotoxicity associated with chemotherapy, also known as Cancer Therapy-Related Cardiac Dysfunction (CTRCD), affects 10% of patients undergoing chemotherapy and is the most undesirable side effect of chemotherapy. Over time, it is anticipated that there would be an increase in the number of cancer patients receiving treatments that could harm their cardiovascular systems. Physicians should choose whether to continue, halt, delay, or reduce the dose of chemotherapeutic drugs to reduce the impact of cardiotoxicity. Cardiotoxicity screening and diagnosis need a variety of methods, primarily echocardiography to evaluate Left Ventricular Ejection Fraction (LVEF) and Global Longitudinal Strain (GLS). Depending on the clinical state, these procedures may be carried out prior to, during, or following chemotherapy. It’s critical to reduce cardiovascular risk factors and offer advice on leading a healthy lifestyle before giving cancer patients medicines. There are a lot of cancer treatment facilities all around the world that don’t have evidence-based perspective cardiotoxicity scores to stratify the risk of cardiovascular problems caused by cancer therapy. Additionally, comorbid conditions like diabetes and hypertension are frequently present in cancer patients, which can have a significant impact on clinical outcomes and cancer treatment. Therefore, this article aims to discuss assessment methods, clinical practice guidance, and prevention of CTRCD