Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Myocarditis Presenting as Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) in a Young Man: A Case Report
Full text linkMyocardial infarction with non-obstructive coronary arteries (MINOCA) is a unique disorder that manifests as an acute myocardial infarction clinically without overt coronary arteries obstruction on angiography. Herein, we report a 17-year-old male presented with a chest pain occurring 3 hours before admission and fever lasting for 2 days. Electrocardiogram examination showed ST elevation in lead II, III, aVF and V3-V6. Laboratory tests results showed a normal leukocyte level of 9850/µL, an elevated troponin of 3.55 ng/mL and an elevated quantitative CRP of 46 mg/L. Coronary angiography performed, indicating 20-30% stenosis of the left anterior descending artery, left circumflex artery and right coronary artery, whereas in typical acute myocardial injury, angiography shows >50% coronary stenosis. Additional cardiac MRI examination showed a fulfillment of Lake Louis Criteria for myocarditis, with further findings of acute myocardial edema in the lateral wall of left ventricle, with left ventricle ejection fraction of 59.73%. As researchers are still working on the definition of MINOCA, present knowledge of the causes, pathophysiology, clinical features, or specific phenotypes of MINOCA is also limited. A stepwise diagnostic approach is needed to diagnose MINOCA, with subsequent differential diagnosis exclusion
The Impact on Working Conditions and Income Amongst Internists in Indonesia: Lesson Learned from the COVID-19 Pandemic
Full text linkInternists are at the forefront of providing care for COVID-19 patients. This situation adds more strain on already overburdened internists, particularly in Indonesia, where resources are scarce and unevenly distributed. The pandemic altered working conditions due to restrictions and regulatory changes. Multiple evidence exists for the effect of the COVID-19 pandemic on physicians’ well-being, but less is known about its impact on their work dynamics and livelihoods. This study provides some lessons learned during the COVID-19 pandemic regarding the changes in working conditions and earnings experienced by Indonesian internists. There were 3,115 and 1,772 participants in the first and second survey, respectively. After one year, the proportion of internists handling COVID-19 cases, including critical COVID-19 cases, increased; with fewer internists over 60 years old involved. Working hours, number of patients, and monthly earnings decreased for the majority of internists. The increased workload was experienced by most participants one year of the pandemic, predominantly reported by female internists. The COVID-19 pandemic caused a considerable impact on working conditions and income amongst internists in Indonesia. These findings may provide information to institutions in formulating strategies and tools to improve the working conditions and livelihoods of internists in Indonesia amidst the pandemic and potential public health emergencies in the future
A Case Report of Hereditary Angioedema: Challenges in Diagnosis and Management
Full text linkHereditary angioedema (HAE) is a rare autosomal dominant genetic disorder which causes bradykinin mediated angioedema. Although it can be life threatening, HAE may be underdiagnosed due to a lack of awareness of the disease and limited access to laboratory testing. Here, we report a case of HAE which was diagnosed only after the patient was referred for COVID-19 vaccination even though he had been experiencing recurrent angioedema for the past 30 years.
Five-Year Survival Rate of Patients with End-Stage Renal Disease on Continuous Ambulatory Peritoneal Dialysis (CAPD) at Malang CAPD Center, Indonesia
Full text linkBackground: Continuous Ambulatory Peritoneal Dialysis (CAPD) is an alternative therapy for renal replacement in patients with kidney failure in developing countries such as Indonesia. The CAPD program in Malang Indonesia has been running since 2010. Until now, there has been little research on the mortality of CAPD therapy in Indonesia. We aimed to provide report on the characteristics and 5-year survival of CAPD therapy in patients with end-stage renal disease (ESRD) in developing countries like Indonesia. Methods: We conducted a retrospective cohort study involving 674 patients with end-stage renal disease receiving CAPD therapy from the medical records of the CAPD Center RSUD Dr. Saiful Anwar from August 2014 to July 2020. The 5-year survival rate was analyzed using Kaplan-Meier, and the hazard ratio was analyzed using Cox regression. Results: Of 674 patients with end-stage renal disease who underwent CAPD, 63.2% survived up to 5 years, with general survival rates at 1, 3, and 5 years of 80%, 60%, and 52%, respectively. The 3-year survival rate for patients with end-stage renal disease and comorbid hypertension was 80%, while it was 10% for patients with comorbid hypertension and type II diabetes mellitus. The hazard ratio for patients with end-stage renal disease who had comorbid hypertension and type II diabetes mellitus was 8.4 (95% CI = 6.36-11.21). Conclusion: Patients with end-stage renal disease who receive CAPD therapy have a favorable 5 years survival rate. Patients with end-stage renal disease on CAPD therapy who have comorbid hypertension and type II diabetes mellitus have a lower survival rate than patients with comorbid hypertension alone
Global Longitudinal Strain and Myocardial Work Index in Post-COVID-19 Syndrome with Mild Symptoms: A Case Series
Full text linkThe involvement of the cardiovascular system in COVID-19 is prevalent. The effect of SARS-COV-2 infection in both acute and recovery phases is called a post-COVID-19 syndrome. Considering the high prevalence of cardiac abnormalities after COVID-19, clinicians should continue to monitor cardiac function in COVID-19 patients after hospital discharge. Echocardiography is an accurate and accessible tool to assess cardiac function after COVID-19. Left-ventricle (LV) and right ventricle (RV) longitudinal strains are more sensitive to detecting subtle abnormalities than standard parameters, such as left-ventricle ejection fraction and tricuspid annular plane systolic excursion (TAPSE). Myocardial work index is a novel parameter including afterload to evaluate cardiac function. These parameters can give further information on cardiac function in COVID-19 patients. We presented two cases of COVID-19 with serial cardiac assessment using echocardiography
Ulcerative Colitis as the Rarer Phenotype of Inflammatory Bowel Disease to Coexist with Psoriatic Arthritis: A Case Report
Full text linkPsoriatic arthritis (PsA) has been linked to various diseases associated with immune dysregulation, such as Inflammatory Bowel Disease (IBD). Numerous studies have shown strong correlation between PsA and one of the phenotypes of IBD, Crohn’s disease. On the other hand, the studies regarding the association of PsA with ulcerative colitis (UC) are less robust and have conflicting findings. We herein report a case of 56-year-old woman with a history of psoriatic arthritis, who developed chronic diarrhea and significant weight loss. The colonoscopy and histopathologic findings were suggestive of pancolitis with backwash ileitis, from which the working diagnosis of ulcerative colitis was carried out. The patient fit the typical epidemiological profile of a PsA patient with concomitant UC, but some aspects of the clinical features observed in this case, such as the development of anterior uveitis was rarely documented in similar studies. A conducted bidirectional meta-analysis also showed that there were more cases where UC preceded the diagnosis of psoriasis, which makes the late development of UC in this case atypical. Due to the uncommon nature of the concurrent development of these two disease entities in this case, this study could provide additional insights to the association of PsA and UC
Long-Term Use of Omeprazole: Effect on Haematological and Biochemical Parameters
Full text linkBackground: Long-term use of proton pump inhibitors (PPIs) is believed to have various potential adverse events. Omeprazole is a part of PPIs most commonly prescribed worldwide; it irreversibly binds to H+-K+ ATPase enzyme system in the gastric parietal cells to reduce secretion of H+ ions into the lumen of stomach. The main objective of the current work is to assess the adverse effects of omeprazole medication on certain haematological and biochemical parameters in patients who were on treatment for one year and more. Methods: We conducted a comparative cross-sectional study between October 2021 and March 2022. A total of 90 participants of both sexes were enrolled in this study, aged between 25-58 years. The participants were categorized into two groups: 40 patients on long-term omeprazole medication (40 mg) as a patients group and 50 healthy subjects as a healthy group who did not use omeprazole. Complete blood count and biochemical parameters were measured for both groups. Results: Patients of a group 1 had remarkable significant reductions in the number of red blood cells (RBCs) (p<0.001) and the indices. Omeprazole elevated the cholesterol level (p<0.001) and triglyceride (p<0.001) as well as low-density lipoprotein (p<0.01). However, no impact was found with high-density lipoprotein (HDL) (p>0.05). Alkaline phosphatase (ALKP) (p<0.001) and aspartate aminotransferase (ASAT) (p<0.01) levels were elevated in long-term patients treated with omeprazole. In contrast, no significant change was found in the level of alanine aminotransferase (ALAT) (p>0.05). Creatinine level (p<0.001) and nitrogen blood urea (p<0.0001) were significantly increased in patients group treated with omeprazole medication. The results also showed that group 1 had a high significant decline in serum ferritin (p<0.0001), vitamin D3 (p<0.01) and calcium levels (p<0.001) than that of healthy group. Conclusion: Prolonged use of omeprazole might result in adverse effect on hematological profile, particularly RBCs and their indices leading to develop anemia in patients on this medication. Furthermore, it might result in disturbances in biochemical profile, levels of minerals and vitamins as consequences of affected absorption
Polymorphisms of SLCO1B1 Gene in Sundanese Ethnic Population of Tuberculosis Patients in Indonesia
Full text linkBackground: The blood level of rifampicin, one of the tuberculosis (TB) drugs, depends on the organic anion transporting polypeptide 1B1 (OATP1B1) in hepatocytes. This protein is encoded by the solute carrier organic anion 1B1 (SLCO1B1) gene. Its genetic variation has been reported to have an impact on clinical outcomes and drug efficacy. However, the polymorphism in the SLCO1B1 gene has not been examined in Indonesia yet. We aimed to identify the frequency of polymorphism in SLCO1B1 gene among pulmonary TB patients in Bandung, Indonesia. Methods: Cross-sectional study was conducted in West Java. 145 pulmonary TB patients who were treated with first-line drugs treatment (including rifampicin 450 mg daily) were analyzed for polymorphism in SLCO1B1 gene. Patients aged between 18–64 years old and mainly came from Sundanese ethnic group (92.4%). Genetic variants were detected using Polymerase Chain Reaction (PCR) and Sanger sequencing. Results: Polymorphism of c.463C>A(rs11045819) was not identified, while heterozygous and homozygous polymorphism of c.85-7793C>T(rs4149032) were identified in 74 (51.0%) and 56 (38.6%) patients, respectively. The minor allele frequency (MAF) of T (mutant) allele of c.85-7793C>T(rs4149032) was 64.13% (186/209), higher than in the general population, which the MAF of rs4149032 is 53.6% based on 1000 genome database. Conclusion: This study highlights the presence of different allele frequencies of polymorphisms within the population, which might affect treatment outcomes
Persistent ST Segment Elevation After Repeated Percutaneous Coronary Intervention: A Dressler Syndrome?
Full text linkIn the era of percutaneous coronary intervention (PCI), Dressler syndrome has become an extremely rare phenomenon. Originally known as post-myocardial infarction syndrome, it is characterized by fever, pleuritic chest pain, and pericardial or pleural effusion after myocardial infarction. It is one of the sub-entities of post-myocardial infarction pericarditis (PMIP). A 62-year-old man presented with persistent chest pain and diffuse ST segment elevation even after repeated PCIs. This condition was accompanied by fever and bilateral pleural effusion upon chest X-ray. The patient showed improvement in ST segment elevation and clinical condition after 2 weeks of steroid administration. The findings in this case suggest the possibility of PMIP. Although uncommon, physicians should be aware of the potentials of this condition in the differential diagnosis of chest pain after myocardial infarction and PCI so that immediate effective treatment can be given
Current Diagnostic and Treatment Approach of Clostridioides difficile Infection
Full text linkC. difficile infection is related to wide spectrum of disease, from self-limiting diarrhea to fulminant disease that can cause toxic megacolon or pseudo-membrane colitis. Difficult approach to diagnose this disease is also problem. C. difficile infection is diagnosed when diarrhea occurred in high risk patient with positive result of GDH or NAAT test that was confirmed by positive result of toxin test. Nevertheless, there is limited choice of treatment in Indonesia. Thus, the main priority of C. difficile infection in Indonesia is associated with its prevention, by implementing standard precaution and use of rational antimicrobial