Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Role of Gastric Acid Suppression Therapy in Erosive Esophagitis: From H2 Receptor Antagonists, Proton Pump Inhibitors, to Potassium-Competitive Acid Blockers
Full text linkErosive esophagitis (EE) is an inflammation of the esophageal mucosa resulting from gastric and duodenal acid reflux, affecting approximately 55% of gastroesophageal reflux disease (GERD) patients in Indonesia. Effective acid suppression is essential for mucosal healing and symptomatic relief. Histamine-2 receptor antagonist (H2RA) was initially used for standard treatment for GERD, including EE, reducing gastric acid secretion by blocking H2 receptors. However, their efficacy is limited by inadequate acid suppression. Proton pump inhibitors (PPIs) became the mainstay therapy due to their stronger and longer-lasting acid suppression. Although PPIs have been proven to be quite effective, they have several limitations, including slow onset and inability to provide sustained acid suppression over a full 24-hour period. In recent years, Potassium-competitive acid blockers (PCAB) have become known as a category of drugs that effectively suppress gastric acid production, through a slightly different mechanism, and have advantages over PPIs, including faster onset and longer time of action. Both PPIs and PCABs can be used as therapy for patients with EE. PCABs are more recommended, especially in patients with severe grades of EE. H2RAs may still be considered in patients who have already received PPI therapy but continue to experience unresolved nocturnal acid symptoms
Investigating Elevated E-Selectin and P-Selectin Levels in Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) Patients: The Stepping Stone to a Future Clinical Approach
Full text linkBackground: Studies regarding hypercoagulation in Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) patients have produced conflicting results. With a presumption that the early coagulation phase may affect the occurrence of NAION, this study aims to investigate the early coagulation markers, E-selectin and P-selectin, to determine whether these biomolecular changes play a significant role in NAION, thus potentially leading to a better clinical approach. Methods: A cross-sectional study involving two groups of NAION subjects, a hypercoagulation group and a non-hypercoagulation group, was conducted in the Neuro-Ophthalmology Division, Department of Ophthalmology, FKUI-RSCM Kirana from October 2020 to April 2022. All patients were evaluated for E-selectin and P-selectin levels measured using flow cytometry. Results: A total of 42 subjects comprising 14 hypercoagulation and 28 non-hypercoagulation subjects were included. In all subjects, E-selectin was strongly correlated with P-selectin (r = 0.862, p < 0.001). There was no significant difference in E-selectin and P-selectin values between the groups (p = 0.317 for E-selectin, and p = 0.575 for P-selectin). Prothrombin time and international normalized ratio (INR) were inversely correlated with both E-selectin and P-selectin in the hypercoagulation group (p = 0.032, p = 0.030 for E-selectin and p = 0.044, p = 0.036 for P-selectin). There was no significant correlation between E-selectin and P-selectin for NAION-associated metabolic risk factors. However, higher E-selectin and P-selectin values were found in the presence of risk factors except for P-selectin in the hypertension group. Conclusion: This interesting finding opens up the potential for considering the involvement of E-selectin and P-selectin in the diagnostic strategy for NAION. It prompts consideration of whether assessing E-selectin and P-selectin levels should be recommended for all NAION patients. Furthermore, considering the role of E-selectin and P-selectin in the early coagulation process, future studies are also needed to further evaluate whether anticoagulants could play a role in the choice of treatment for NAION despite a clinically hypercoagulable state
Olfactory and Gustatory Recovery Time Evaluation of COVID-19: A Systematic Review and Meta-Analysis
Full text linkBackground: Olfactory dysfunction is a common symptom of Coronavirus disease 2019 (COVID-19). In this study, we aimed to evaluate the recovery rate and duration of these symptoms in COVID-19patients. Methods: This systematic review was conducted by searching PubMed and Google Scholar from April 1st, 2020, until October 1st, 2022, using the terms ‘‘COVID-19’’ OR ‘‘COV-2,’’ OR ‘‘Coronavirus 2’’ OR coronavirus AND ‘‘loss of smell’’ OR Anosmia OR Hyposmia OR olfaction OR ‘‘olfactory loss’’ AND ageusia OR Hypogeusia OR dysgeusia OR ‘‘gustatory loss’’ OR gustation OR ‘‘loss of taste’’. The references of included studies were also manually screened. Random-effects meta-analysis was performed. Results: One hundred and twenty-five studies with test-confirmed COVID-19 infection from 31 countries were included. 62 publications which reported data on loss of taste were used to estimate patients' recovery rate in 13700 COVID-19 patients. Accordingly, the time to recovery of loss of taste among COVID-19 patients ranged from 2±0.352 to 43.6 ± 28.5 days. The estimated overall pooled recovery rate of loss of taste among COVID-19 patients was 74%. The estimated overall pooled time to recover loss of taste among COVID-19 patients was 11.44 days [95% CI 8.11, 14.77(]. 90 publications which reported data on loss of smell were used to estimate patients' recovery rate in 20027 COVID-19 patients. Accordingly, the time to recover the loss of smell among COVID-19 patients ranged from 2.44±0.352 to 31.9 ± 30.7 days The estimated overall pooled recovery rate of loss of smell among COVID-19 patients was 72%. The estimated overall pooled time to recover loss of smell among COVID-19 patients was 12.87 days [95% CI)1011, 15.64(]. Conclusion: The recovery rate of loss of smell and taste among COVID-19 patients was high globally, and time to recovery of loss of smell and taste among COVID-19 patients usually was less than 2 weeks; regional differences supported the relevance of these symptoms as important markers. Health workers must consider smell and taste symptoms as suspicion indices for the empirical diagnosis of COVID-19 infection and reassure patients with their high recovery rate in a short period of time
The Aging Population and Dementia: The Need for Comprehensive Palliative Care
Full text linkDementia is a progressive condition that gradually impairs cognitive function, memory, and daily living skills. This disease not only impacts the individual but also has significant consequences for their families and caregivers. The global prevalence of dementia is on the rise, including in Indonesia. It's estimated that approximately 1.2 million people in Indonesia are currently living with dementia, a number projected to quadruple by 2050. Patients with dementia often experience a range of symptoms and complications, including pain, difficulty eating, shortness of breath, and susceptibility to infections. For those in advanced stages of the disease, family and caregivers play a crucial role in their well-being. However, this role can be emotionally taxing, making support essential. Palliative care offers a promising approach to enhancing the quality of life for both dementia patients and their families. By prioritizing symptom management, psychological support, and respecting patient autonomy, palliative care can help alleviate suffering and promote well-being throughout the disease's progression
Prevalence and Impact of Central Post-Stroke Pain on Quality of Life Among Stroke Survivors: A Cross-Sectional Study
Full text linkBackground: Stroke continues to be a significant public health challenge. Central post-stroke pain (CPSP) is a notable aspect of post-stroke pain that not only causes physical discomfort but also affects psychological well-being, leading to a reduced quality of life. The objective of this was to assess the prevalence of CPSP and its relationship with quality of life. Methods: This hospital-based cross-sectional study was conducted between August and December 2023 in Manado, Indonesia, the study involved the consecutive recruitment of stroke patients. CPSP diagnosis adhered to the 2017 criteria set forth by the American Pain Society, while quality of life was evaluated using the Indonesian version of the Stroke Specific Quality of Life (SS-QoL) scale. Results: The study comprised 166 stroke patients, revealing that 30.1% experienced CPSP. Notably, there was a significant difference in mean SS-QoL scores based on both the severity of the stroke and the presence of depression. Within the CPSP group, a significant variation in SS-QoL summary scores was observed between male and female patients. Those with CPSP reported significantly lower mean scores in the Thinking and Energy categories. However, there was no significant difference in the overall SS-QoL scores between CPSP and non-CPSP patients. Conclusion: In summary, stroke patients suffering from depression, greater severity of stroke, and those experiencing burning or pressure-like sensations are at an increased risk of having a lower quality of life
Anti-Inflamatory Drug for Myocardial Injury in Acute Coronary Syndrome
Full text linkAcute coronary syndrome (ACS) as the acute setting of coronary chronic syndrome has been widely known to have high mortality rates. ST segment elevation of myocardial infarction (STEMI) is one category of ACS which occurs when major coronary arteries are fully blocked acutely and diminish coronary flow leading to myocardial injury and necrosis. Epidemiology data showed that global prevalence varied from 3.8% in patients whose age to 9.5%. The national heart survey of Indonesia also revealed the rising trends of STEMI from 0.63% in 2013 to 1.5% in 2018. STEMI is associated with high mortality despite advanced system and management such as primary percutaneous coronary intervention (PCI). Colchisine is derived from Colchicum autumnale plant and known for remedies for a long time since 1500 BC. The remedy effect is due to combination anti-inflammatory actions. Key actions include decrease neutrophile L-selectin expression on endothelial cell and interfere the interaction of neutrophile-platelet which is leading to atherothrombosis. The idea to use colchisine in STEMI patients to reduce mortality rate is presumed through this mechanism. To date, colchisine already known to reduce anti-inflammatory markers in ACS. Colchisine is widely known to be safe and effective as anti-inflammatory drug. Numerous studies had investigated the effect of colchisine in various setting of coronary artery disease. Unfortunately, various results had made it unclear. Meanwhile, the mechanism of colchisine in acute and chronic coronary syndrome need to be explored comprehensively. The evidence of clinical studies for the beneficial use of colchisine in ACS especially in STEMI is still insufficient. The ongoing studies worth to be waited for the supporting clinical evidence for the use of colchisine in acute coronary syndrome
Perspective of Muslims on Kidney Transplantation in Indonesia: A Narrative Review
Full text linkThe prevalence of end-stage renal disease patients in Indonesia is predicted to increase by the end of 2025. Kidney transplantation is the preferred treatment for end-stage renal disease, and the demand for kidney transplants is steadily increasing globally, including in Indonesia. However, organ transplantation and donation are debatable issues in the medical field, particularly when considered in conjunction with religious views. The Qur'an and Hadith do not directly discuss transplantation in Islam, prompting several interpretations and fatwas. Diverse ideologies, cultures, and beliefs also result in prospective differences. To address these differences, fatwas regarding the permissible conditions for transplantation have been issued by the Indonesian Ulema Council. This study aimed to explore the perspectives of Muslims and Islamic law on kidney transplantation in Indonesia. The study also includes comparative studies of Muslim perspectives from different countries. The findings provide an overview of Islamic law, the perspectives of religious scholars, and the perspectives of Muslims residing in Indonesia, as well as in other countries
Temporal Changes in Inflammation, Oxidative Stress, Apoptosis, and Endothelial Glycocalyx Degradation in Correlation to Organ Function Assessment Following On-Pump Coronary Artery Bypass Graft Surgery
Full text linkBackground: A coronary artery bypass graft is a complex procedure that can cause various physiological responses, including inflammation, oxidative stress, apoptosis, and endothelial dysfunction. Nevertheless, the correlation between these responses and organ function after CABG has not yet been established. This study aims to investigate the correlation between inflammation, oxidative stress, apoptosis, endothelial dysfunction markers, and postoperative organ function assessment as evaluated by the Cardiac Surgery Score (CASUS). Methods: A prospective cohort study was conducted on patients undergoing coronary artery bypass graft from two hospitals in Jakarta. IL-6, MDA, caspase-3, and syndecan-1 levels were measured at three points in time: before surgery, on ICU Day-1, and ICU Day-2. Postoperative organ function was assessed on ICU Day 2 by Cardiac Surgery Score (CASUS). Results: Fifty-one patients were included in the study. There was a positive correlation between IL-6 measured before surgery (r = 0.325, p = 0.020) and at the time of admission to the ICU (r = 0.374, p = 0.007). Positive correlation was also found between syndecan-1 levels on ICU day 1 (r = 0.304, p = 0.030) with CASUS. MDA correlated with CASUS on ICU day 2 (r = 0.392, p = 0.004); meanwhile, no significant association was found between caspase-3 and postoperative organ function assessment. Conclusion: Interleukin-6 levels pre-surgery and on ICU day 1, syndecan-1 levels on ICU day 1, and MDA levels on ICU day 2 were correlated with CASUS
Role of Colchicine in Reducing Reperfusion Injury in STEMI Patients Who Undergo Primary Percutaneous Coronary Intervention: A Randomized Clinical Trial
Full text linkBackground: Inflammation plays a role in ST-segment elevation myocardial infarction (STEMI), especially in reperfusion injury (RI). Colchicine, an anti-inflammatory drug, can suppress inflammation during RI. We assessed the effectiveness of administering colchicine to STEMI patients undergoing primary percutaneous coronary intervention (PPCI) in suppressing RI events. Methods: This study was a randomized, double-blind, placebo-controlled clinical trial conducted in a multicenter manner at two hospitals in Jakarta with IKPP facilities from December 2022 to April 2023. STEMI patients that underwent PPCI received 2 mg of colchicine as a loading dose and a maintenance dose of 0.5 mg every 12 hours for two days or amylum at a similar dose. Patients were observed for RI events (low-flow thrombolysis in myocardial infarction (0–2) during angiography procedure, reperfusion arrhythmia, cardiogenic shock, or persistent chest pain). Results: Seventy-seven STEMI patients with a mean age of 55.2 ± 9.9 years underwent PPCI. Of these patients, 37 received colchicine, and 40 received a placebo. Most subjects were male (77.5%), suffered three-vessel disease (44.15%), and occlusion in left anterior descending coronary artery (53.24%). Colchicine was found to fail to reduce the incidence of ischemia-RI (51.5% vs. 42.4%; p = 0.437). Analysis of comorbidities (hypertension, chronic kidney disease, diabetes mellitus, and obesity) and angiography results (vessel disease, lesion diameter, and culprit artery) failed to demonstrate a statistical difference in RI. Side effects were similar in the colchicine and placebo groups (21.6% vs. 15%). Conclusion: Colchicine administration in STEMI patients undergoing PPCI failed to reduce RI
Correlation of Serum FT4 with Serum Uric Acid and Comparison of Uric Acid in Subjects with and without Atrial Fibrillation in Graves’ Disease: A Cross-Sectional Study
Full text linkBackground: Cardiovascular diseases increase the mortality risk in Graves’ disease (GD) patients. Atrial fibrillation (AF) is one of the most prevalent cardiovascular diseases in GD. Hyperthyroidism that occurs in GD may increase uric acid levels, while uric acid levels can also increase the risk of AF in the general population. This study is designed to observe the correlation between free T4 (FT4) and uric acid, and compare the levels of uric acid in subjects with and without AF in GD. Methods: A cross-sectional study was conducted, including GD patients who met research criteria in Dr. Cipto Mangunkusumo Hospital during 2024. We performed history taking, physical examination, laboratory examination, and electrocardiogram for each subject. Data was analyzed using Pearson or Spearman correlation, and bivariate analysis to evaluate the comparison of uric acid in subjects with and without AF. Results: We included 74 subjects, with an average age of 41 years, mostly female (86.5%), and 62.2% had normal FT4 levels. AF occurred only in 4.1% subjects. Mean of uric acid is 4.71 ± 1.2 mg/dl, which is within the normal range. No correlation was found between FT4 and uric acid (r = 0.076; p = 0.520), including after adjustment with subgroup analysis based on thyroid status, gender, and diabetes mellitus. Mean of uric acid is not statistically different between subjects with and without AF (4.9 ± 1.01 mg/dl vs 4.7 ± 1.2 mg/dl; p = 0.785). Conclusion: No significant correlation was found between FT4 and uric acid. Mean of uric acid is not statistically different between subjects with and without AF