Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Sarcopenia in a Multiethnic State: A Cross-Sectional Data Analysis of Multicentre Indonesia Longitudinal Aging Study
Full text linkBackground: Previous regional studies related to sarcopenia in multiethnic Indonesia suggested inconsistent findings. We aimed to find the prevalence of sarcopenia and its associated factors among Indonesian older adults. Methods: In this cross-sectional analysis, we utilised the data of Indonesia Longitudinal Aging Study (INALAS) from community-dwelling outpatients in eight centres. Statistical analyses included descriptive, bivariate, and multivariate analyses. We categorised older adults into sarcopenia group based on the criteria of the SARC-F questionnaire, namely strength, assistance with walking, rising from a chair, climbing stairs, and falls questionnaire. Results: Among 386 older adults, 17.6% were in sarcopenia group. The prevalence of sarcopenia was found to be the lowest in Sundanese group (8.2%). Following appropriate statistical adjustment, sarcopenia was associated with female sex (OR 3.01, 95% CI 1.34-6.73), dependent functional capacity (OR 7.38, 95% CI 3.26-16.70), frailty (OR 11.82, 95% CI 5.41-25.80), and history of fall (OR 5.17 (95% CI 2.36-11.32). Sarcopenia was not significantly associated with age 70 years and older (OR 1.67, 95% CI 0.81-3.45), Sundanese group (OR 0.44, 95% CI 0.15-1.29), and being at high risk for malnutrition or malnourished (OR 2.98, 95% CI 0.68-13.15). All centenarians had no sarcopenia nor frailty, and 80% of them were Sundanese older adults. Conclusion: One in five Indonesian community-dwelling older adults had sarcopenia, associated with female sex, dependent functional capacity, frailty, and history of fall. Albeit statistically nonsignificant, there may still be link between Sundanese, age 70 years and older, as well as being at high risk for malnutrition, and sarcopenia
Mental Health Status and Its Associated Factors Related to Pulmonary Tuberculosis Patients in Primary Health Care Centre in Surabaya, Indonesia
Full text linkBackground: Mental disorders in TB patients are due to long-term treatment, drug side effects, and relapse. This study aimed to analyse the mental health status among TB patients and its associated factors. Methods: The study was carried out on 107 Pulmonary TB patients from 5 Primary Healthcare centres in Surabaya, Indonesia. Furthermore, Mental Health Inventory (MHI-18) was used to measure the mental health status. The MHI-18 has four subscales including, anxiety, depression, behaviour control, and positive affection. In addition, the score range of MHI and its subscales is 0-100, where the higher score showed a better mental health status. Results: The results showed no difference in the score of mental health status, anxiety, depression, and positive affect in all factors. However, behaviour control depicted a significant difference between sex and marital status. In conclusion, mental health problems can occur in all TB patients irrespective of their characteristics. Conclusion: Screening is required for the prevention of severe disease in the early treatment phase and various factors related to mental health should be considered during the implementation of TB management to optimize treatment outcomes
Vitamin D Levels in Pre-frail Older Adults and Its Correlation with Hand Grip Strength
Full text linkBackground: Vitamin D deficiency is frequent in older adults and associated with poor musculoskeletal function. The prevalence of pre-frailty is also high in older persons, who may proceed to a frail state. This study aimed to determine the vitamin D levels in pre-frail older adults and its correlation with hand grip strength. Methods: A cross-sectional study was conducted on older adults (age > 60 years) with a pre-frail condition who were visiting the outpatient geriatric clinic at Cipto Mangunkusumo Hospital in Jakarta, Indonesia. Serum levels of vitamin D, measured as 25(OH)D, were determined by enzyme-linked immunosorbent assay (ELISA), and hand grip strength was measured using a Jamar hydraulic dynamometer. Correlations between vitamin D levels and hand grip strength were evaluated by Spearman’s rank correlation coefficient. Multiple linear regression analysis was carried out to assess contribution of variables that influence hand grip strength. Results: Of 95 pre-frail older adults (mean age 70.08 ± 5.35 years), 67.4% were female, and the median vitamin D level was 17.91 (interquartile range/IQR 13.68–26.36) ng/mL. Overall, 11.6% of the participants had normal vitamin D levels, whereas 34.7% and 53.7% had insufficient and deficient levels, respectively. Females were more likely to have inadequacy of vitamin D than males. Those with vitamin D deficiency tended to have a higher body mass index (BMI) and lower vitamin D intake than normal levels. A significant correlation between serum vitamin D levels and hand grip strength was observed (r = 0.283; P = 0.006). After adjusting for age, comorbidities, nutritional status, functional status, BMI, protein intake, and sun exposure score, regression analysis between hand grip strength and vitamin D levels gave standard coefficient beta = 0.255 (P = 0.013). Conclusion: In this study, pre-frail older adults had a high proportion of deficient and insufficient vitamin D levels, and a significant correlation was found between serum vitamin D levels and hand grip strength
A Case Report of Profuse Bleeding in the Lower Gastrointestinal Tract due to Dieulafoy Lesion in the Rectum
Full text linkDieulafoy lesion is a rare condition that usually occurs in cases of gastric bleeding in the upper gastrointestinal tract. However, this condition can also occur in the lower gastrointestinal tract but less frequently. The lesion is an arteriolar malformation that extends to the submucosa, causing erosion and bleeding. Meanwhile, this is a case of a 67-year-old woman presenting with a bright red bloody stool prior to admission, as well as a history of constipation which was relieved by digital stool evacuation two weeks earlier. The medical history of the patient reveals episodes of repeated ischaemic stroke for over seven years and three months, which has led to other conditions such as right-sided paralysis, transcortical motor aphasia, and neurogenic dysphagia. The patient was routinely on antithrombotic medications, which was stopped during hospitalisation where repeated packed cell transfusion was done in order to avoid hematochezia. The patient needed the support of her caregiver most of the time since she was bedridden. Furthermore, the haemostasis and platelet function of the patient were normal. On colonoscopy, there was the discovery of a small lesion of about 3mm in her rectum, protruding into the lumen and pulsated, which was discovered to be Dieulafoy’s lesion. Subsequently, this lesion was closed using rubber band ligation, and after a month, there was no recurrence of the lower gastrointestinal bleeding
Sleep Problem in Post COVID-19 Patient, Its Impact on Quality of Life and Current Management: An Evidence-based of Case Report
Full text linkBackground: COVID-19 is a global health problem that affects both physical and psychological aspect of patients. Sleep problems were experienced by many patients during the acute phase of after COVID-19 recovery. It affects patient’s quality of life and required comprehensive management. This evidence-based case report aims to study the effect of sleep disturbance on quality of life and what is the appropriate management in post COVID-19 patients. Methods: searching were conducted in Pubmed, Cohcrane, EBSCO according to clinical questions. Study was selected based on inclusion and exclusion criteria, then it was critically appraised. Results: high score on the insomnia severity index and the Pittsburgh sleep quality index were found to be associated with quality of life. Cognitive Behavioural Therapy is currently the best evidence-based treatment in patient during and after COVID-19. Conclusion: sleep disturbance is a problem that many post COVID-19 patient face and CBT can improve their quality of life
HIV-Associated Progressive Multifocal Leukoencephalopathy: A Case Study
Full text linkProgressive multifocal leukoencephalopathy (PML) is a rare, life-threatening, infectious, lytic, demyelinating disease that results from reactivation of the virulent JC polyomavirus (JCV) “major opportunistic infection” in immunosuppressed individuals. We reported a case of a young girl who presented with new onset focal neurological defect, evaluated, and laboratory and radiological findings in the context of a clinical setting confirmed HIV-related-PML infection. However, remyelination does not occur, the patients may develop complications in the long term including cognitive impairment, sensory deficits, motor deficits, and disturbances in balance. We must increase our knowledge about HIV- related PML in any patient with reduced immunity and who presented with new onset neurological defect.
Genetic Polymorphisms Associated with Cyclophosphamide Outcome and Risk of Toxicity in Patients with Lupus Nephritis
Full text linkA 6-month cyclophosphamide induction therapy followed by maintenance therapy every three months is the first-line treatment for Class III, IV, and V lupus nephritis. Among the 139 single nucleotide polymorphisms (SNPs) associated with cyclophosphamide, four SNPs, namely rs4244285, rs4802101, rs7254579 and rs3957356, are related to the response and risk of toxicity in patients with lupus nephritis. Although pharmacogenetic studies in patients with lupus nephritis (LN) have not been conducted previously in Indonesia, data on rs4244285 are available for several ethnic groups, including Papuans, Bataks, Balinese, Dayaks, Javanese, Bugis, Chinese, Timorese and Malays, even though direct evidence in LN patients is less detectable. However, this can be followed up prior to cyclophosphamide therapy based on the identification of genetic markers. Therefore, clinical studies in patients with lupus nephritis are deemed necessary to evaluate the potential of these markers
Evaluation of Potential Drug-Drug Interactions and Association with Adverse Drug Reactions in Predialysis Chronic Kidney Disease Patients at Indonesian National Referral Hospital
Full text linkBackground: Chronic kidney disease (CKD) is often accompanied by a variety of comorbidities that require several medications thus, polypharmacy is unavoidable. One of the consequences of polypharmacy is the occurrence of potential drug-drug interactions (DDI). The aim of this study is to evaluate the profile of DDI in pre-dialysis CKD patients and to identify the possible adverse drug reactions (ADR) due to DDI. Methods: This cross-sectional study includes stage 3-5 pre-dialysis CKD patients at a referral hospital in Indonesia in 2019 – 2020. Data were collected from the electronic health record and the hospital’s medical record. The prescriptions were analysed for potential DDI using Micromedex software and ADRs assessment through clinical symptoms and laboratory data abnormalities. Results: A total of 106 patients were included in the study, around 60 (56.6%) patients received more than six medications. There were 111 types of medications prescribed with the most frequently prescribed drug was bisoprolol (36.5%). The proportion of patients who received treatment with a potential DDI was 76% (81 patients), while the proportion of patients who experienced ADR was 28% (23 patients). The most prevalent ADRs were hyperglycaemia, hypertension, hyperkalaemia, and hypotension. Cardiovascular disease had a statistically significant relationship with ADR suspected due to DDI (p = 0.03). Conclusion: A significant number of potential DDI were seen in the prescriptions of stage 3-5 pre-dialysis CKD patients at a referral hospital in Indonesia between 2019 – 2020. Cardiovascular disease was identified as the most common risk factor for ADR suspected caused by DDI.
Rare Case: Unilateral Acute Primary Angle-closure Glaucoma After Colonoscopy in Malang, East Java, Indonesia
Full text linkGlaucoma is a heterogeneous group of optic neuropathies characterized by a progressive loss of retinal ganglion cells (RGCs) with corresponding visual field defects, and one of the main risk factors is elevated intraocular pressure (IOP). Furthermore, colonoscopy procedures require insufflation of the colon lumen with gases which can increase intraabdominal pressure (IAP) and ends with an elevation of IOP. Glaucoma is an infrequent complication due to colonoscopy; in this case, a 63 years-old woman was diagnosed with glaucoma after a colonoscopy procedure. A few hours after the colonoscopy, the patient suffered blurred vision in the left eye, and the physical examination revealed mixed conjunctival and ciliary injection with visual acuity of 1/300. There was an increase in IOP with a value of 40,2 mmHg on Schiotz tonometry. This case presented the pitfalls of the procedure and the importance of taking glaucoma awareness before a colonoscopy.
The Characteristic of Recurrent Malaria Episode: An Observational Study in Timika Papua
Full text linkBackground: People living in malaria endemic areas are at risk of suffering from the recurrent malaria episodes. The recurrent episode of malaria can be determined by various factors and will bring some serious impacts on all life aspects. This study aims to identify malaria demographics and factors associated with the recurrent episodes of malaria in Timika, Papua. Methods: This observational study used medical record data from the Naena Muktipura Sub-District Health Center, Timika Papua in 2020. Plasmodium infection was identified based upon microscopic examination. Subjects were then categorized into positive and negative malaria followed by the determination of the positivity rate. Each case of malaria was traced regarding frequency, time, and type of Plasmodium. The recurrent episodes of malaria were defined as Plasmodium infections occurred more than once in a year. Demographic data including age, sex, and ethnicity were then analyzed using Chi square. Results: The incidence of recurrent malaria in Timika Papua was 16% with the highest positivity rate occurred in June. The most recurrent episodes of malaria were 2 episodes (77.2%) in which men were more at risk (OR 2.512). Meanwhile, ethnicity and age were not associated with recurrent episodes. Most of recurrent episodes of malaria are caused by the similar plasmodium species, particularly Plasmodium falciparum (82.25%) with the shortest interval between episodes of 14 days. Conclusion: Malaria is mostly experienced by men, of productive age and Javanese ethnicity. Men were found more at risk of experiencing recurrent episodes of malaria. The identification of these demographic factors is important to issue the policies on malaria elimination and malaria transmission termination in Timika, Papua