Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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The Vascular Access Related Infections: Have We Anticipated Them Adequately?
Get PDFThe number of patients in need of haemodialysis (HD) is increasing from time to time. In 2018, the Indonesian Renal Registry documented more than 130,000 active patients from 651 registered HD centres. Twenty percent are diabetic patients with end-stage renal disease (ESDR) equal to 8,633 patients. Diabetes Mellitus accounts for 2% of all diabetes cases in the age of 15 year-old and above. Hence, the increasing need for HD is inevitable and is parallel with the need for vascular access procedures.One of the major problems that occurs with vascular access is the risk of infection. Among HD patients, mortality and morbidity are predominantly associated with infection; about one-fifth as a cause of hospital admissions, one-fourth of the infection-related admissions are due to infection of vascular access. Susilo et.al, reported around 40% of patients with temporary vascular access had an infection. Data is limited and might be also underestimated.Unfortunately, the available studies examining risk factors for vascular access-associated infection are scarce and mostly collected with substandard methodology. It is to be highlighted that the study of Susilo et al. may represent the population of a referral hospital for HD, yet as a reader it is worth noting that heterogeneity among centres and populations should be acknowledged. A comprehensive in-depth review and further research of these studies are crucial for a greater level of understanding for the cause of infection and therefore inform effective early detection and prevention strategies to reduce morbidity and mortality among haemodialysis patients, especially at-risk patients
Molecular Mechanism of Acute Sarcopenia in Elderly Patient with COVID - 19
Get PDFCoronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Case fatality rate has been on the rise among older adults. Muscle loss is a consequence of several chronic diseases (chronic sarcopenia) and recent theory also suggested that acute sarcopenia may caused by acute significant stressor such as an acute illness, surgery, infections, trauma or burns including COVID-19 infection leading to further muscle loss in elderly. Cytokine storm, the hallmark of COVID-19 pathogenesis will induce various pro-inflammatory cytokine such as IL-1 and IL-6 causing acute sarcopenia by activating negative regulators like NF-κB, atrogin-1, MURF-1. Long standing chronic inflammation also known as inflammaging along with acute inflammation during COVID-19 in elderly will cause reticulum endoplasmic and mitochondria stress activating caspase and finally increase both cytosolic and nuclear levels of AIF and EndoG to induce acute sarcopenia. Several precipitating factors shared same molecular pathway like physical inactivity and hormonal dysregulation which act through IGF-1-AKT-mTOR pathway. Physical inactivity during COVID-19 infection also induced myostatin and Atrogin-1/ MaFbx/ MuRF pathway. This review provides recent research advances dealing with molecular pathway modulating muscle mass in acute sarcopenia during COVID-19 infection
The Validity and Reliability of the Indonesian Version of the Chronic Liver Disease Questionnaire (CLDQ) in Measuring Quality of Life in Patients with Liver Cirrhosis
Get PDFBackground: Liver cirrhosis remains the major cause of liver-related morbidity and mortality around the world. Cirrhosis also negatively affects health-related quality of life. Quality of life evaluation in cirrhosis treatment is often overlooked, despite its importance compared to traditional outcome. One of the specific tools to measure quality of life in cirrhosis patient is the Chronic Liver Disease Questionnaire (CLDQ). Although this tool has been widely used in many countries, no studies have been conducted on its validity and reliability in the Indonesian language. This study aimed to assess the validity and reliability of the Indonesian version of CLDQ using appropriate methods. Methods: This is a cross-sectional study conducted at Hepatobiliary outpatient clinic in Dr. Cipto Mangunkusumo National General Hospital (RSCM), from April-May 2021. The CLDQ was first translated into the Indonesian language and subsequent pretest was performed on 10 people, resulting in the final Indonesian version of the CLDQ. The final version was later tested in the main study with larger number of subjects (52 people). Validity was assessed using construct and external validity tests, while reliability was tested using internal consistency and test-retest methods. Results: The Indonesian version of CLDQ had a good construct validity (r 0.613-0.917), moderate external validity (54.1%), strong correlations between CLDQ and SF-36, good internal consistency (Cronbach-Alpha ≥ 0.7), and good test-retest reliability (ICC > 0.7). Conclusion: The Indonesian version of CLDQ is valid and reliable in measuring the quality of life of liver cirrhosis patients in Indonesia
One Year Survival of Extrahepatic Cholangiocarcinoma Patients Who Did Not Undergo Curative Resection and Paliative Chemotherapy and Its Associated Factors
Get PDFBackground: Extrahepatic cholangiocarcinoma is rare but fatal. Patients who come are usually already in the advanced stage that can not undergo curative resection and chemotherapy also seems to be very rarely done. The survival rate and its associated factors in Indonesia are unknown. This study aimed to identify 1-year survival of patients with extrahepatic cholangiocarcinoma without curative resection and palliative chemotherapy and its associated factors. Methods: This is a cross-sectional study using medical records of extrahepatic cholangiocarcinoma (perihilar and distal) inpatient and outpatient patients at Cipto Mangunkusumo Hospital, Jakarta from January 2015 to March 2020, reviewed retrospectively. The following factors were analyzed in terms of mortality: metastasis, sepsis, hypoalbuminemia, serum bilirubin level, serum CA 19-9 level, billiary drainage, neutrophyl lympocyte ratio (NLR) and comorbid factors. Results: 115 out of 144 patients were enrolled in this study with male proportion of 50.4%, and proportion of patients aged 65 years or above was 71.3%. 1 year survival rate was 10 % and median survival was 3 months (CI 95% 2.388-3.612)Multivariate analysis showed that only sepsis, unsuccessful or no prior biliary drainage and total bilirubin >19.8 mg/dl were independent predictors of mortality. Conclusion: 1 year survival of extrahepatic cholangiocarcinoma without curative resection and paliative chemotherapy was 10 %.Sepsis, unsuccessful or no prior bilirary drainage, and total biirubin >19.8 mg/dl are factors significantly associated with shortened survival in malignant obstructive jaundice patients
COVID-19 Associated Pulmonary Aspergillosis: A Case Series
Get PDFCoronavirus disease 2019 (COVID-19) has been a worldwide pandemic with several problems, one of which is the lack of definitive treatment. COVID-19-associated pulmonary aspergillosis (CAPA), the presence of invasive pulmonary aspergillosis (IPA) in COVID-19 patients, is one of the concerning secondary infections associated with higher mortality and worse clinical outcomes. Diagnosing CAPA may be challenging due to the possible absence of classic host factors and clinical symptoms or obscured radiological findings. We described two CAPA cases, which were suspected due to persistent respiratory failure despite standard treatment of COVID-19 with additional therapies and antimicrobial agents for secondary infections, eventually diagnosed with serum galactomannan testing. Clinical conditions of both patients improved significantly after the administration of voriconazole. This case series emphasizes the importance of being aware of clinical suspicions indicating CAPA followed by galactomannan testing as a relatively fast, noninvasive test for its diagnosis, which leads to appropriate antifungal treatment
Urease Levels and Gastritis Stage in Dyspeptic Patients
Get PDFBackground: Dyspepsia is a frequent main symptom of inpatients and outpatients scenario in Indonesia. However, the number of endoscopy facilities are still low, thus the use of non-invasive method to detect gastritis is necessary. We measured the relationship between urease levels and the stage of gastritis in dyspeptic adult patients. Methods: A cross-sectional study included outpatient dyspepsia patient from November 2018 to February 2019. We examined 14C-Urea Breath Test (UBT) and determined the stage of gastritis based on the Updated Sydney System classification. Results: The urease level of acute and chronic gastritis positive patients were higher than negative patients (p = 0.001, r = 0.353; p <0.0001, r = 0.433, respectively). The AUC value of 14C-UBT to detect acute, chronic, and atrophic gastritis are 0.889, 0.632 and 0.544, respectively. The best cut-off points of 14C-UBT to predict acute gastritis was ≥26.50δ‰ with sensitivity and specificity being 88.89% and 63.95%, respectively. Whereas the best cut-off points for chronic gastritis was ≥34.50δ‰ with 82.89% sensitivity, 63.16% specificity. As for atrophic gastritis, it showed very low AUC value, hence it is not a sufficient test modality to predict atrophic gastritis cases. Conclusion: 14C-UBT is sufficient for predicting acute or chronic gastritis but not for atrophic gastritis
Prioritizing Health Care Workers Safety: The International Year of Health and Care Workers 2021
Get PDFHealthcare workers pose a substantial risk of acquiring COVID-19 infection during their daily works. We have seen various conditions during the pandemic, such as limited adequate personal protective equipment (PPE), accurate diagnostic tests, lack of information regarding disease management, unsupportive work environment, and excessive workload, increased the number of HCWs-infected COVID-19. Compared to the general population, the risk of COVID-19 infection was several-fold higher in HCWs.Employers and health care workers both should share the responsibility to prevent occupationally acquired infections and avoid causing harm to patients by taking reasonable precautions to prevent vaccine-preventable disease transmission.This year, WHO has launched a year-long campaign under the theme -protect, invest, together’. It highlights the urgent need to invest in health care workers, not only during COVID-19. We need to ensure that all health care workers are supported, protected, motivated, and equipped to deliver safe health care at all times, to provide a high-quality standard of care to the patients
Accuracy of Bedside Lung Ultrasound in Emergency (BLUE) Protocol to Diagnose the Cause of Acute Respiratory Distress Syndrome (ARDS): A Meta-Analysis
Get PDFBackground: There is a stigma that ultrasound cannot be used to see abnormalities in the air-filled organs makes ultrasound rarely used to identify lung abnormalities. This study purpose comparing diagnostic accuracy of BLUE protocol with gold standard for each diagnosis causing acute respiratory failure. Methods: Systematic search was done in 6 databases (Pubmed/MEDLINE, Embase, Cochrane Central, Scopus, Ebscohost/CINAHL dan Proquest) and multiple grey-literature sources for cross-sectional studies. We manually extracted the data from eligible studies and calculated pooled sensitivity, pooled specificity, likelihood ratio (LR) and diagnostic odds ratio (DOR). We follow PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline throughout these processes. Results: Four studies has been picked from total 509 studies involved. The results yield parameters indicating BLUE protocol as a reliable modality to diagnose pneumonia with pooled sensitivity 84% (95% CI, 76-89%), pooled specificity 98% (95% CI, 93-99%), LR+ 42 (95% CI, 12-147), LR- 0.12 (95% CI, 0.07-0.2) and DOR 252 (95% CI, 81-788), respectively. It also considerably applicable to diagnose pulmonary oedema with pooled sensitivity 89% (95% CI, 81-93%), pooled specificity 94% (95% CI, 89-96%), LR+ 14 (95% CI, 8-25), LR- 0.165 (95% CI, 0.11-0.24), and DOR 116 (95% CI, 42-320), respectively. Conclusion: BLUE protocol has good diagnostic accuracy to diagnose pneumonia and pulmonary oedema. We recommend implementing BLUE protocol as a tool in evaluating cause of ARF
Factors Associated with SARS-CoV-2 Antibody Titer After Sinovac Vaccination Among Health Care Workers
Get PDFBackground: One of the methods to record immunogenicity after vaccination is to measure antibody titer. This study aimed to get the value of antibody titer post Sinovac vaccination and to analyze factors that associate with it. The trend of titer changes within 3 months period and the incidence of COVID-19 were also observed. Methods: A prospective cohort study was conducted in March until May 2021 involving 250 health care workers of Siloam Hospitals Lippo-Cikarang who have completed two doses of Sinovac vaccination. We collected 3 titer data from each participant to observe the trend of changes. The incidence of COVID-19 among post-vaccinated subjects was also calculated. Results: From total of 250 participants, 88 (35.2%) were males and 162 (64.8%) were females. Fourteen days after vaccination, 248 subjects (99.2%) had seroconversion. The median antibody titer amounted to 63.58 U/ml (0.4->250 U/ml). The titer was higher in age group 26-39 years (85.1 U/ml, p=0.003) and in women (78.7 U/ml, p=0.007). Within 3 months period, 162 from 200 participants (81%) who completed 3 titer tests, had antibody titer reduction (p=0.231). In observation, 94 from 245 (38.3%) participants tested positive COVID-19, with only 5 out of 94 (5.3%) participants being hospitalized. Conclusion: The highest median titer was achieved 14 days after Sinovac vaccination (63.58 U/ml). Younger age group and women are associated with higher value. The reduction trend in titer within 3 months is insignificant. Among post-vaccinated infection subjects, the hospitalization rate is low, which shows that Sinovac vaccination still has a protective effect
Factors Associated with Absolute Neutrophil Count Dynamics and Docetaxel-Adryamicin-Cyclophosphamide (TAC) Chemotherapy Induced Neutropenia During Extended Filgrastim Administration in Breast Cancer Patients
Get PDFBackground: Myelosuppressive effects of chemotherapy for breast cancer treatment may trigger chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN). Filgrastim has been widely used as prophylaxis against CIN and FN. However despite filgrastim administration, some study showed FN still occur and cause patient vulnerability to infection. This study aims to evaluate factors associated with Absolute Neutrophil Count (ANC) dynamics and Docetaxel-Adryamicin-Cyclophosphamide (TAC) CIN during extended filgrastim administration in breast cancer patients. Methods: Patients were selected among breast cancer in-patients who fulfilled the eligibility criteria. Patient characteristics data and ANC were collected. The entire patients received 5μg/kg/day filgrastim by subcutaneous injection 24 hours post-chemotherapy. ANC was monitored daily and filgrastim administration was stopped when ANC reached >10000/mm3 or 14 days of administration. Kruskall-Wallis test and Spearman Correlation test was performed to analyze ANC dynamics and CIN-related factors. Results: This study included 42 breast cancer patients. Patient age median was 52 (31-70) years old. ANC nadir could be observed around 5-7 days after chemotherapy and FN occurred in two out of 38 grade 4 neutropenia patients (4.8%). Critical ANC lasted for 1 day, 2 days, and 3 days respectively in 9 (23.7%), 25 (65.8%) and 4 (10.5%) patients. There was no correlation between neutropenia and age. ANC slope and recovery duration did not show a significant difference. However, depth of nadir is inversely correlated with the duration of ANC recovery (>10000/mm3) and the duration during the peak on the 2nd day until reaching nadir both with fair strength, r = −0.489 and r = −0.438 (p <0.05), respectively. No sepsis incidence had manifested. Conclusion: CIN still occured in breast cancer patient receiving filgrastim primary prophylaxis regardless of age and neutropenia severity. Nadir as the lowest point of ANC should be noted as a pivotal milestone for ANC slope and recovery evaluation