Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Effectiveness and Safety of DLBS3233 in Newly Diagnosed Type 2 Diabetes Mellitus: A 12-week Clinical Trial
Full text linkBackground: DLBS3233, recognized as an agent enhancing insulin sensitivity, has exhibited promise as a therapeutic option for addressing type 2 diabetes mellitus (T2DM). This study aimed to evaluate the effectiveness and safety of DLBS3233, a natural compound, in individuals newly diagnosed with T2DM. Methods: A 12-week double-blind, randomized, placebo-controlled clinical trial was conducted with 104 eligible participants. They were assigned to receive DLBS3233 or a placebo along with lifestyle modifications. Various metabolic parameters, including fasting and post-meal plasma glucose levels at two hours, fasting insulin level, HOMA-IR, adiponectin level, lipid profile, superoxide dismutase (SOD) activity, GLUT-4 concentrations, and body weight measurements, were assessed at baseline, Week 6, and Week 12. Safety parameters assessment will include vital signs, liver function, renal function and adverse event. Results: Participants exhibited similar demographic characteristics in both groups. While no significant changes were noted in fasting plasma glucose and most other parameters, the DLBS3233 group significantly reduced 2-hour postprandial glucose at Week 12 (p = 0.026). There were no substantial differences in A1c levels, fasting insulin, insulin resistance, adiponectin levels, or lipid profiles between the two groups at any point in time. Safety parameters, including blood pressure, liver enzymes, heart rate, gamma GT, and serum creatinine, remained comparable between the groups. Conclusion: DLBS3233 showed potential for improving postprandial glucose control in newly diagnosed T2DM individuals. Although significant changes were limited, the study suggests that DLBS3233 could enhance glycemic regulation. The safety evaluation indicated no adverse effects on vital parameters. Further research with larger samples and more prolonged duration is warranted to comprehensively explore DLBS3233’s potential in T2DM management
Exploring the Potential Treatment for Mpox
Full text linkMonkeypox (Mpox) is a virus that originally infected only animals. Caused by the monkeypox virus, this infection presents with symptoms similar to smallpox. Although two years have passed since the 2022 outbreak, new cases continue to emerge monthly. Initially, human cases of mpox were confined to outbreaks in central and western Africa. However, the virus has recently spread globally, possibly due to a decline in vaccination rates. In this context, evidence for effective therapies, such as antivirals, is urgently needed. Three antivirals—tecovirimat, brincidofovir, and cidofovir—are known to have activity against the mpox virus. Their use is currently limited to expanded access for treating non-variola orthopoxvirus infections, with ongoing phase 3 trials. This review will discuss the mechanisms of action, clinical use, and efficacy of these antivirals
Diagnostic Accuracy of Serum Procalcitonin to Diagnose Sepsis in Advanced Solid Tumor Patients with Fever
Full text linkBackground: Diagnosis of infection in advanced solid tumor patients can be challenging since signs and symptoms might be overlapping due to paraneoplastic condition. Delay diagnosis of existing infection can lead to more severe conditions and increased mortality. Procalcitonin (PCT) has been used to support the diagnosis of bacterial infection and sepsis. Unfortunately, PCT also increases in malignancy even without an infection. We investigated the diagnostic accuracy of PCT in advanced solid tumor patients with fever to diagnose sepsis. Methods: A cross-sectional study was conducted in solid advanced tumor patients with fever patients who were admitted to Cipto Mangunkusumo Hospitals, Indonesia between June 2016 and April 2018. Sepsis was defined using 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference criteria. The diagnostic accuracy of PCT was determined using the receiver operating characteristic (ROC) curve. Results: A total of 194 subjects were enrolled in this study. 60.3% were female with a mean age of 49.47±12.87 years old. 143 patients (73.7%) with advanced solid tumors. Among this latter group, 39 patients (27%) were sepsis. The ROC curve showed that the levels of PCT for sepsis in advanced solid tumor patients with fever were in the area under the curve (AUC) 0.853 (95%CI 0.785 – 0.921). The Cut-off of PCT in advanced solid tumor patients with fever to classify as sepsis was 2.87 ng/mL, with a sensitivity of 79.5%, and a specificity of 79.8%. Conclusion:PCT has good diagnosis accuracy in advanced solid tumor patients with fever to classify as sepsis, however a higher cut-off compared to non-cancerous patients should be used.
A Life-Threatening Complication During the Fourth Pregnancy Due to Acute Promyelocytic Leukemia: A Case Report
Full text linkIncidents of leukemia in pregnancy are infrequent with only one case found from 75,000 to 100,000 pregnancies. The pathophysiological mechanism of leukemia during pregnancy is still unclear. Leukemia which occurs in pregnancy is usually acute and predominantly the myeloid type.A 35-year-old woman in her fourth pregnancy with a gestational age of 38-39 weeks, came to the emergency department (ED) with complaints of contractions since 4.5 hours before admission. The contraction was not accompanied by discharge, mucus, or blood, and fetal movements was still active. She denied complaints of fever, nausea, vomiting, dizziness, shortness of breath, weakness, fatigue, lethargy, and bleeding. Physical examination results, both palpebral conjunctiva were pale. Laboratory examination results of a complete blood count, white blood cell count were 2,930/uL, hemoglobin 8.3 g/dL, Hct 24.10%, erythrocytes 2.78x106/µL, platelets 62,000/µL. Bone Marrow Aspiration (BMA) revealed Acute Promyelocytic Leukemia (APL).APL is a subtype of Acute Myelogenous Leukemia (AML). Persistent fatigue, recurrent infections, and bleeding are common manifestations of APL. The diagnosis of APL is made by bone marrow aspiration examination, and it is safe for pregnancy. APL therapy in pregnancy uses All-Trans Retinoic Acid (ATRA) and Arsenic Trioxide (ATO). ATRA and ATO are highly teratogenic, but recent studies have reported no fetal abnormalities.Accuracy and speed in diagnosing and initiating APL therapy in pregnancy are essential in preventing serious complications
Sustained Response of Ibrutinib in a Patient with Waldenstrom Macroglobulinemia Presenting with Myasthenic Crisis as a Paraneoplastic Neurological Syndrome: A Case Report and Review of Literature
Full text linkParaneoplastic syndrome is a broad spectrum of signs and symptoms due to neoplasm, attributed to substances produced by tumor cells, or in response to it. Myasthenia gravis (MG) is a well-known paraneoplastic neurological syndrome (PNS), frequently associated with thymic abnormalities, but rarely reported in patients with lymphoplasmacytic lymphoma.This study presents the case of a 52-year-old Indonesian male patient who was diagnosed with Waldenstrom macroglobulinemia (WM), a rare B-cell neoplasm, after developing a new onset of MG with myasthenic crisis. the patient’s MG features improved with Ibrutinib as a treatment targeted toward cancer. This is the first case report presenting the treatment response of Ibrutinib in WM with myasthenic crisis. The literature was reviewed to explain the possibility of MG as a paraneoplastic syndrome of WM and the treatment response of Ibrutinib for this patient, as well as summarizing previous case reports of concomitant MG and WM.MG should be considered a paraneoplastic malignancy syndrome, including WM, during diagnostic workup. Ibrutinib should also be considered when available to patients, due to its adequate response in both previously treated and treatment naïve patients
Genotypic Analysis of Transmitted and Acquired HIV Drug Resistance in People Living with HIV/AIDS in Surabaya, Indonesia, from 2018 to 2019
Full text linkBackground: Despite the availability of various effective antiretroviral (ARV) drugs, human immunodeficiency virus (HIV) infection has come with HIV drug resistance (HIVDR), which compromises its effectiveness in reducing HIV-related morbidity, mortality, and transmission. The emergence of transmitted (TDR) and acquired HIVDR (ADR) among antiretroviral therapy (ART)-naïve and experienced individuals have been reported in several Indonesian regions. Therefore, continuous HIVDR surveillance is needed in Indonesia, especially in Surabaya, which is identified as having the highest prevalence of HIV infection in East Java; thus, this study aimed to identify the emergence of TDR and ADR among people living with HIV/acquired immune deficiency syndrome (AIDS) (PLWHA). Methods: Fifty-eight PLWHA infected with HIV type 1 (HIV-1), comprising 21 and 37 ART-naïve and experienced individuals were enrolled in this study, respectively. Blood samples collected from study participants were subjected to genotypic analysis, mainly towards the pol gene encoding protease (PR gene) and reverse transcriptase (RT gene) of HIV-1. Results: Seventeen PR and 21 RT genes were successfully amplified and sequenced from 29 samples. HIV-1 subtyping revealed CRF01_AE as the most dominant subtype (24/29; 82.76%), followed by subtype B (3/29; 10.34%). Uncommon subtypes, including subtype D and a recombinant containing subtypes B and G genomic fragments, were also identified. TDR for PR inhibitors was not detected; however, TDR and ADR for RT inhibitors were identified in 11.11% and 41.67% of samples, respectively. Two amino acid insertions at position 69 of the RT gene (69ins), a previously never-reported mutation in Indonesia, were identified in this study. Conclusion: Both TDR and ADR have emerged among PLWHA residing in Surabaya, East Java, Indonesia. Uncommon drug-resistance mutations and subtypes were identified in this study. These situations might hamper ART efficacy and treatment success. Continuous surveillance of HIVDR is necessary to monitor both TDR and ADR in Indonesia
Factors Associated with Hepatitis B and Hepatitis C among Infected Patients in Indonesia and Their Knowledge and Attitude: A Multicenter Observational Study
Full text linkBackground: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections are global health problems, including in Indonesia. The purpose of this study was to assess the knowledge and attitudes about HBV and HCV infection among infected patients in Indonesia. Methods: This cross-sectional study used a questionnaire survey. The questionnaire was adapted and translated into Indonesian language, and trialed with 27 HBV and 27 HCV patients. The final validated questionnaire was later used in the target population. Patients diagnosed with Hepatitis B or Hepatitis C were included. The patients were enrolled from November 2019 until February 2020 in sixteen multicenter locations. Multivariate analysis with logistic regression was conducted to determine the factors that are associated with the knowledge and attitude among HBV and HCV patients toward their illness. Results: A total of 931 HBV patients and 254 HCV patients were included in this survey. The proportion of infected patients with adequate knowledge of Hepatitis B and Hepatitis C was 72.1% and 53.9%, respectively. Positive attitudes about Hepatitis B and Hepatitis C were 28.5% and 41.3%, respectively. Multivariate analysis revealed that higher education level, higher income level, diagnosis duration of more than 5 years, and receiving of antiviral therapy were independent factors associated with adequate knowledge about Hepatitis B among HBV patients. Among HCV patients, independent factors associated with adequate knowledge about Hepatitis C were being married, higher education level, higher income level, and receiving antiviral therapy. Moreover, older age and receiving of antiviral therapy were independent factors associated with positive attitudes towards Hepatitis B among HBV patients. However, only higher education level was found to be an independent factor associated with positive attitudes towards Hepatitis C among HCV patients. Conclusion: The knowledge and attitude of patients regarding HBV and HCV were quite low among infected patients in Indonesia
Expert Panel Recommendations on the Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis in Indonesia
Full text linkInvasive candidiasis (IC) ranks among the primary causes of deadly fungal infections. The frequency of IC rises alongside increasing number of patients with altered immune systems, critically ill, chronic diseases, and various medical procedures. The disease causes high morbidity and mortality, as well as prolonged stay and increases hospital costs. The diagnosis and management of IC in Indonesia is still a challenge. Laboratory facilities in identifying pathogenic fungi and susceptibility tests to antifungals are still limited. Clinical awareness and financial support from health policymakers are also insufficient. Early diagnosis is essential for proper treatment to reduce morbidity and mortality rates. Initiated by the Indonesian Pulmonary Mycoses Centre (IPMC), several expert representatives from six medical professional organizations in Indonesia have agreed to set up a meeting series to prepare a joint draft on the diagnosis and management of IC. The expert panel aimed to achieve a consensus on the clinical practice guidelines for diagnosing and treating IC in Indonesia
MPox Skin Lesions
Full text linkMpox is caused by the Monkeypox virus, which belongs to the Orthopoxvirus genus and Poxviridae family. The Monkeypox virus was first identified as a cause of disease in humans in the 1970s in the Democratic Republic of the Congo. Mpox was considered endemic in several African countries. A global outbreak of Mpox was first recognized in Europe in May 2022 and was declared a public health emergency of international concern on July 23, 2022. The first reported Mpox case in Indonesia was in October 2022 which was identified as an imported case, there were no new confirmed Mpox cases until 13 October 2023. Since then there were 72 cases of confirmed Mpox cases in Indonesia by the end of 2023, distributed across 6 provinces, mostly in the Java island.We present two different spectrums of Mpox skin lesions in patients living with HIV, with a positive polymerase chain reaction test for Mpox. The first patient is a 48-year-old male, who developed a maculopapular lesion, that was initially noticed on the face, the lesions were then spread to the back and hand. He identifies as men who have sex with men and living with HIV for the past 18 years. There were no lesions on the genitalia or mucosa. The second patient is a 28-year-old male, the initial symptom was fever, followed by skin lesions after around 1 week of fever. The lesion initially appears as pustules on the face and then spreads throughout the whole body, the lesions also grow larger and become pseudo-pustules and ulcers. There were also mucosal involvements in the mouth, making oral intake difficult. This patient also identified as men who have sex with men with multiple partners, HIV status was not known at the initial presentation. HIV screening was done with positive results
A Mislocation of Double-lumen Catheter Guidewire in Right Atrium Successfully Retrieved with Loop-wire Snaring: A Case Report
Full text linkThe increasing rate of central vascular access use especially for hemodialysis access in Indonesia carries risk of retention of the guidewire to the heart resulting in a condition known as heart foreign bodies. We described a case of mislocation of double-lumen catheter guidewire to the right atrium in a patient planned to perform hemodialysis. The patient complained of dyspnea and swelling of extremities but the symptoms had already appeared before the insertion of the catheter due to the patient’s underlying kidney disease arising conclusion that the foreign bodies itself are asymptomatic. The wire was found on chest x-ray and then confirmed on fluoroscopy during the retrieval procedure. Loop-wire was used to snare the guidewire. The wire was successfully evacuated and the patient was stable. The rare nature of the condition could become a challenge in recognizing the condition. Percutaneous retrieval is the preferred management of the condition