Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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TIMP2 and IGFBP-7 as Biomarkers For The Diagnosis of Acute Kidney Injury (AKI) in Post-operative Patients: An Evidence-Based Case Report
Full text linkBackground: Acute kidney injury (AKI) is defined as a sudden reduction in kidney function which commonly occurs as a complication of major surgeries. It is traditionally diagnosed using serum creatinine elevation. AKI has relatively slow kinetics that makes it unable to diagnose at an earlier more reversible stage. Furthermore, previous research has shown that TIMP-2 and IGFBP7 were urinary biomarkers to use as a diagnostic tool for AKI. We aimed to compare the accuracy of TIMP2 and IGFBP-7 to the gold standard (serum creatinine) in diagnosing AKI in postoperative patients. Methods: A thorough search was performed using a search strategy on EMBASE, PubMed, and Medline (Ovid) using keywords according to the objective. The collected articles were critically appraised using CEEBM critical appraisal tool. Results: 5 studies that fulfilled the inclusion criteria were selected and evaluated. They all stated that the use of TIMP2 and IGFBP7 could not detect AKI better than the gold standard as shown in the sensitivity and specificity of the biomarkers. Furthermore, the examination of AKI using both biomarkers showed a sensitivity of 60-100% and specificity of 58-91%. Conclusion: TIMP2 and IGFBP7 are promising diagnostic tools for AKI. However, due to the wide variation in results amongst the different studies, further research is required to ensure the credibility of this result
The Iodine Status of Women of Childbearing Age in an Iodine-repleted Area: An Epidemiological Study in Sengi Village on Merapi Mountain Area
Full text linkBackground: The low iodine content of daily water sources and repeated volcanic eruptions are expected to affect the iodine status and thyroid hormone profile of women of childbearing age in the Magelang regency. This study aimed to determine the iodine and thyroid profile among women of childbearing age. Methods: We used a cross-sectional descriptive study to learn about 140 women of reproductive age living in Sengi village from October 2017 to January 2018. We assessed the iodine level, dietary intake, and goitrogenic food consumption using food frequency questionnaire (FFQ), urinary iodine concentration (UIC), thyroid stimulating hormone (TSH) and free thyroxine (fT4), and total goiter rate (TGR). Results: The median UIC was 199.5 (126.0 – 264.0)µg/L. The TGR was 10.7% on palpation and 7.8% on ultrasound. The proportion of UIC levels below 100µg/L was 18.5%. The mean water iodine content was 2.03 ± 4.74 μg/L. The mean salt iodine level was 28.6±13.7ppm. There were only 35% who consumed salt with adequate iodine contents, and only 19.29% consumed >150µg iodine from daily dietary intake based on FFQ. The median TSH and FT4 levels were 1.72 and 1.51mIU/L. Conclusion: Women of childbearing age in Sengi Village generally had adequate iodine profiles and normal thyroid hormone levels but a considerable proportion of TGR and low UIC. The iodine contents within the freshwater source, table salt, and daily dietary intake were low. There are no significant association between Iodine status, daily goitrogen intake, daily iodine intake and salt iodine concentratio
Prevalence and Factors Related to Hypovitaminosis D in Type 2 Diabetes Mellitus Patients with Depression
Full text linkBackground: The prevalence of hypovitaminosis D (hypoD) in patients with type 2 diabetes mellitus (T2DM) and depression has not been documented. In addition, the risk factors are unknown. This study aimed to identify the prevalence of and risk factors for hypoD in patients with T2DM who also have depression. Methods: 118 patients with T2DM who visited the outpatient endocrinology clinics at Cipto Mangunkusumo National Hospital between December 2019-September 2022 provided the clinical and demographic data for this cross- sectional study, including body mass index, blood pressure, glycosylated haemoglobin (HbA1c), lipid profiles, therapy, gender, age, marital status, and educational background. We used The Beck Depression Inventory II (BDI II) to evaluate depression. We used enzyme-linked immunosorbent assay kit to assess the dependent variable: serum vitamin D. We characterized serum vitamin D levels into three groups (normal, 30 ng/mL; insufficient, 20-29 ng/mL; deficient, 20 ng/mL). We also used analyses of variance to examine the anthropometric, clinical, and biochemical factors between the three groups. Results: 118 subjects with T2DM. Their median age was 56 years old (48, 75-60 years old), with a BDI II score of 17 (15-19), and a serum concentration of vitamin D. The D level was 18.3 ng/mL (9.17–29.46 ng/mL). Only 21.8% of patients with T2DM and depression had sufficient levels of vitamin D. We used multivariable analysis of variance model to examine the associations between age, BDI II score, HbA1c, and systolic and diastolic blood pressure with vitamin D level. Age and BDI II score both had a statistically significant effect on vitamin D levels. Conclusion: This cross-sectional study discovered that patients with T2DM and depression had a high prevalence (77.7%) of hypoD. Age and BDI II score both affected differences in vitamin D levels with statistical significance
Risk of Non-melanoma Skin Cancer in Kidney Transplantation Recipient: An Evidence-based Case Report
Full text linkBackground: Renal transplantation is the most common organ transplantation procedure in Indonesia. Renal transplant recipients (RTRs) were found to carry 3-to-5-time higher risk of cancer compared to the normal population. Around 40% of cancers in RTR patients were non-melanoma skin cancer (NMSC). It was found to be correlated with several risk factors. The study aimed to determine the prognostic factors for NMSC in RTRs with Indonesian skin colors. Methods: The article search was conducted on three different journal databases, which were Cochrane, PubMed, and Embase. Relevant articles were appraised using critical appraisal guidelines from The Centre for Evidence-Based Medicine (CEBM), University of Oxford. Results: Four articles were selected for appraisal. Incidence of NMSC on RTRs in these studies were 25,2% (CI 24,67%-32,47%), 6,67% (CI 2,87%-10,47%), 23,67% (CI 19,38%-27,96%) and 28,57% (CI 24,67%-32,47%). Prognostic factors correlated with the incidence of NMSC on RTRs were age, sun exposure, history of sunburn, existing chronic actinic lesion, lentigo solaris, precancerous lesion including actinic keratoses, and consumption of cyclosporine and tacrolimus during maintenance therapy. Conclusion: Combination of age, environmental factors, sun exposure-related skin lesion, and immunosuppressant therapy are the main prognostic factors of NMSC on RTRs
The Effect of Anemia and Hypoalbuminemia on Six-Months Hospitalization Risk in End Stage Chronic Kidney Disease Patients Undergoing Hemodialysis: A Retrospective Cohort Study
Full text linkBackground: Chronic kidney disease (CKD) patients, particularly those who require renal replacement therapy, have a higher risk of hospitalization and mortality compared than the general population. The patients can suffer hypoalbuminemia and anemia due to chronic inflammations, that might affect the risk of hospitalization risk. The aim of this study is to investigate the effect of albumin dan hemoglobin levels on the hospitalization incidence of patients with stage 5 chronic kidney disease who undergo chronic hemodialysis. Methods: This retrospective cohort study enrolled patients aged 18 years and older with end stage kidney disease who underwent regular hemodialysis at the Prof. dr. R. D Kandou Hospital, Manado, Indonesia. Patients with malignancy were excluded. We measured the hemoglobin and albumin baseline level and observed the hospitalization incidence over the next 6 months. We used the Chi Square test with significance level of p-value 0.05, to analyze the association between both anemia and hypoalbuminemia with risk of hospitalization over 6 months of follow up period. Results: We enrolled 202 patients as our participants, most of whom were men (61.8%), with a mean age of 60.21±9.32 years. There were 120 participants (59.4%) being hospitalized during 6-months-follow-up period. The mean level of albumin was 3.29±0.63 g/dl, while the mean hemoglobin level was 9.43±1.75 g/dl. This study found that most of the participants had hypoalbuminemia (62.9%) while 45% had anemia. We found significant associations between hypoalbuminemia and anemia with the risk of hospitalization within 6 months, with p values 0.001 and 0.007, respectively. The relative risk for being hospitalized over 6 months follow up period in patients having anemia was 2.32 (95% CI 1.29-4.17), and for hypoalbuminemia was 2.77 (95% CI 1.54-4.99). Conclusion: Hypoalbuminemia and anemia are associated with increased risk of all causes hospitalization within 6 months in stage 5 chronic kidney disease patients undergoing hemodialysis
Generalized Reddish Skin Nodules
Full text linkDiagnosis of nodular red lesions is challenging. The differential diagnosis includes dermal nevus, angioma, pyogenic granuloma, amelanotic melanoma, eccrine poroma, Kaposi’s sarcoma, skin malignancy or metastasis. Erythema nodosum is one of the common consideration of the red skin nodules, however fully work up should be done to find the right diagnosis.A 60 years old female admitted to our hospital due to pain dark reddish skin nodules since one month. She had continuously high grade fever of 39 Celsius accompanied by arthralgia and fatigue since two months prior to admission and she lost 6 kg of weight in 2 months. On admission, physical examination revealed slight fever, pale conjunctiva, mild hepatosplenomegaly, tender dark red nodules 0.3 to 2 cm, firm edge, at her cheek, abdominal area and both lower extremities. No lymph nodes enlargement was noticed. Her laboratory test showed haemoglobin 9,1 g/dl, WBC 3,040/mL, PLT 149,000/mL, SGOT 48 U/L, SGPT 43 U/L, urea 12.5 mg/dL, creatinine 0.67 mg/dL. She was found to be non-reactive for HBsAg, HCV, and HIV antigens. Urine routine and microscopic examination was unremarkable.Her histopathology of left foot nodule biopsy revealed cutaneous lymphoma. The immunohistochemical (IHC) stain of CD45, CD20, and CD10 were positive, Ki67 were also positive with >70% tumor cells, while CD3,CD56, CD30, and Granzyme were negative. Her final diagnosed was Cutaneous Diffuse large B cell lymphoma.Primary cutaneous lymphomas of B-cells occur less frequently than primary cutaneous T-cells lymphomas. Primary extra-nodal diffuse large B-Cell lymphoma (DLBCL) can be seen in up to 40% of cases. However skin involvement is less common and in a large cohort of DLBCL cases, skin involvement at presentation was seen only in 3.3% of cases.It characterized by few lesions, in general showing nodules or infiltrations of relatively fast growth and have no itching. The diagnosis is made by the immunohistochemical findings, clinicopathological correlation, and molecular pathology. The lymphomas have different clinical behaviours despite being identical in morphological appearance. The primary lymphomas presents with local recurrence in up to 68% of the cases and with rare extra-cutaneous dissemination, with an average rate of 5-year survival varying from 89 to 96%. Cutaneous lymphoma should be always become one of considered diagnosed of skin red nodules even it is rare
Pulmonary Artery Wedge Pressure Formula Using Echocardiography Finding
Full text linkThis study aims to introduce a new formula for pulmonary artery wedge pressure (PAWP) derived from the pathophysiology of Velocity A (VA) waves. The current formula is the the Nagueh formula. Left ventricular (LV) filling is described as a velocity A (VA) wave. The VA wave represents the filling rate of the end-diastolic blood phase from the left atrium (LA) to the LV which can be determined on echocardiography. Left ventricular end diastolic pressure (LVEDP) is equivalent to LA pressure and is also equivalent to PAWP. The gold standard method for obtaining PAWP values is right heart catheterization. By measuring the VA waves in the bloodstream, a new PAWP formula is obtained, and the PAWP examination can be validated in research and can be compared with several other PAWP formulas that are currently the world’s standard formula for calculating pulmonary artery wedge pressure (PAWP).The new PAWP formula is obtained from the conversion of the VA wave. This formula could be validated further in research and used in clinical practice
Effects of Modified Diaphragmatic Training on Gastroesophageal Reflux Disease Questionnaire Score, Diaphragmatic Excursion, and Maximum Inspiratory Pressure in Adults with Gastroesophageal Reflux Disease After COVID-19: A Single-Blinded Randomized Control
Full text linkBackground: Although diaphragmatic training has been shown to improve gastroesophageal reflux disease (GERD) symptoms, its effectiveness in adults with GERD after COVID-19 has not been evaluated. This study examined the effectiveness of modified diaphragmatic training (MDT) on GERD questionnaire (GERDQ) score, diaphragmatic excursion, and maximum inspiratory pressure (MIP) in adults with GERD after COVID-19. Methods: This single-blinded randomized control trial was conducted at Persahabatan Hospital from February to April 2023. The medical records of 364 patients with persistent gastrointestinal symptoms were evaluated; among these potential participants, 302 had symptoms before, and 62 after, COVID-19 infection. Fifty of these patients fulfilled the study inclusion and exclusion criteria and were randomly assigned to the intervention (n = 25) or control (n = 25) groups. Four weeks of diaphragmatic training were followed by MDT or standard diaphragmatic training. A follow-up assessment was conducted 30 days after the beginning of the training. Results: The GERDQ score was significantly decreased in the pre–post-intervention group (10.44 ± 2.00 vs 1.84 ± 2.17) and the control group (8.64 ± 0.57 vs 3.32 ± 1.49), with p < 0.001. The intervention group showed significant improvements in the right diaphragmatic excursion (RDE) (44% vs 11.87%), left diaphragmatic excursion (LDE) (46.61% vs 13.62%), and MIP (75.26% vs 23.97%) compared with the control group. Conclusion: MDT in adults after COVID-19 with GERD enhanced diaphragmatic excursion and MIP and decreased symptoms of gastroesophageal reflux by 8.60 points of GERDQ. Respiratory symptoms and other side effects were comparable between the groups
Relationship Between Disease Activity, Levels of IFN-a, IL-4, IL-6, and Anti-NMDA to Cognitive Dysfunction (MoCA-INA Score) in Systemic Lupus Erythematosus (SLE) Patients with Cognitive Dysfunction
Full text linkBackground: Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) is a condition that impacts the patients’ brain with SLE, and cognitive dysfunction (CD) is the most common manifestation. Subsequently, the CD hurts the life quality of SLE patients and creates impaired social function. Furthermore, the Montreal Cognitive Assessment (MoCA-INA) is a screening instrument to evaluate cognitive function. In the context of lupus, cytokines, and autoantibodies act as biomarkers in SLE disease control activities. Purpose: The aim of this study was to analyze the correlation between disease activity, IFN-a, IL-4, IL-6 and Anti-NMDA on CD (MoCA-INA Score) in SLE patients with CD. Methods: This analytical observational study was performed with a cross-sectional design and included a sample of 56 SLE patients. The independent variables were the degree of the disease activity, and levels of IFN-a, IL-4, IL-6, and anti-NMDA. The dependent variable consisted of the degree of CD (MoCA-INA score), while the confounding variables were age, DM, gender, hypertension, obesity, and dyslipidemia. Subsequently, the CD was described as a MoCA-INA score <26, and disease activity was estimated based on the SLEDAI score. Results: Increased IL-6 levels were correlated with decreased MoCA-INA scores (p=0.003; r= -0.387). Younger age was found to be associated with more severe CD (p=0.006) Conclusion:In conclusion, IL-6 levels can be used as a predictor severity of CD in SLE patients.
Skin Mottling as Clinical Manifestation of Cardiogenic Shock
Full text linkA 59 years old male came to the emergency department with chief complain of dyspnea. Dyspnea has worsened since 3 days before admission accompanied with dyspnea on effort, orthopnea and paroxysmal nocturnal dyspnea. In the emergency department, patient experienced cardiac arrest after defecating, leading to cardiopulmonary resuscitation for 45 minutes. Administration of vasoactive drugs were done and the patient was intubated.Post resucitaiton physical examination showed that the patient was sedated, with blood pressure of 72/40 (on dobutamine support). Peripheral circulation examination showed cold and clammy extremities, skin mottling of the lower extremity with mottling score of 2. CRT is more than 2 seconds. Blood gas analysis showed severe metabolic acidosis with blood lactate of 8.1.Angiographic examination were previously done on the patient during the previous admission with the results of three vessels disease with a chronic total occlusion in the left anterior descending artery. However, patient had refused further intervention regarding the coronary problems. Patient also has longtsanding atrial fibrillation.Patient was admitted into the intensive care unit for further management. Patient was stabilized during admisison in the intensive care with inotropes, however despite the hemodynamic stablilization the skin remain mottled-regardless. Patient had complicating factors in the form of pneumonia and sepsis. Patient had difficulty in weaning the ventilator and died because of arrythmia complication