Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Possible Cases of SARS-CoV-2 Reinfection In Pekanbaru, Indonesia
Get PDFConfirmed and possible reinfection cases of SARS-CoV-2 have been reported from various countries. Here we present two cases of possible SARS-CoV-2 reinfection in Pekanbaru, Indonesia. A 26 years old female and a 27 years old male healthcare workers were first confirmed by PCR with high Ct-value (>35) while presenting no or mild symptoms, respectively. In more than one month since the last negative test results, both patients developed typical COVID-19 symptoms; fever and anosmia. RT-PCR results for SARS-CoV-2 were positive with Ct-value less than 30. The timeframe between 1st and 2nd episode, negative test result between episodes, and epidemiological risk factor strengthened the possibility of reinfection. However, we did not have whole genome sequence (WGS) or viral viability data to further confirm reinfection with different viable virus. The requirement of viral WGS data to confirm true reinfection cases calls for investment in whole genome sequencing platform in public health laboratories. We encourage standardized definition of SARS-CoV-2 reinfection case in order to be able to investigate and observe such cases
Indonesia DIA-RAMADAN Study: A Real-life, Prospective and Observational of Gliclazide MR in Type-2 Diabetes Patients During Ramadan Fasting
Get PDFBackground: Sulfonylureas (SUs) have been widely used in many countries for T2DM treatment. Gliclazide is one of the SUs with the lowest risk of hypoglycemia; however, the safety and effectiveness of gliclazide MR during Ramadan has not yet been reported in Indonesia. This study aimed to assess safety, efficacy, and tolerability of gliclazide modified release (MR) during Ramadan fasting. Methods: The study was a part of DIA-RAMADAN study, a prospective observational study with subjects of T2DM patients aged >18 years, who had either controlled or sub-optimally controlled blood glucose level, performed Ramadan fasting. Subjects had been treated with gliclazide MR for at least 90 days prior the study, and were examined for their body mass index (BMI), fasting plasma glucose (FPG) and HbA1c levels 6 to 8 weeks before Ramadan (V0) and 4 to 6 weeks after the end of Ramadan (V1). Results: Out of 198 subjects participating in the study, there were only two subjects (1.0%) who reported symptomatic HEs (either confirmed or not confirmed) and no severe HEs had been reported. There were no significant changes in HbA1c and FPG levels (p>0.05). Interestingly, there was a reduction of bodyweight (-0.4kg) from pre- to post-Ramadan (p < 0.001). Almost no subjects reported discontinuation of gliclazide MR throughout the entire study; however, there was one subject who reported a change of diabetic treatment into diet only. Conclusion: gliclazide MR is safe, well tolerated and can maintain glycemic control effectively for Indonesian patients with T2DM who perform Ramadan fasting
Clinical Outcome Following Prolonged Neoadjuvant Chemotherapy and Delayed Surgery in Osteosarcoma Patients: An Evidence-based Clinical Review
Get PDFBackground: The incidence of osteosarcoma reached 16.8 cases annually at dr. Cipto Mangunkusumo Hospital in 1995-2008. Previous studies suggested that prolonged neoadjuvant chemotherapy followed by delayed surgery improves the clinical outcome. Prolonged neoadjuvant chemotherapy followed by delayed surgery commonly occurs in Indonesia, as diagnostic imaging and surgery waiting list will delay the surgery. The aim of this study is to observe the survival rate and the event-free survival rate of osteosarcoma patients with prolonged neoadjuvant chemotherapy and delayed surgery. Methods: This review included randomized controlled trials (RCTs), cohort studies, retrospective cohort studies, clinical trials, and reviews. Literature search was conducted through MEDLINE (PubMed search engine), Cochrane Central Register of Controlled Trial, and Scopus. The studies were screened and selected according to inclusion criteria by author and contributors independently. Results: Six studies were included in the qualitative synthesis of this study. Overall survival rate, event-free survival rate, histological response and recurrence as well as neoadjuvant chemotherapy duration, cycle and regiment were assessed in this study. Conclusion: Prolonged neoadjuvant chemotherapy and delayed surgery results in 5-years survival rate of 43.2% to 96.6% and 5-years event-free survival rate of 35.7% to 86.4%
Positive Deviance: Frequent Blood Pressure Monitoring Among Non-hypertensive Middle-aged Women in Rural Indonesia
Get PDFBackground: In Indonesia, as in many low and middle-income countries, hypertension is a significant health issue. Community health nurses need to identify those with early onset of hypertension by promoting frequent blood pressure (BP) checks, even among those with normal BP. Positive deviance approaches focus on identifying people who undertake uncommon preventive actions. Among middle-aged women in rural West Java, Indonesia, we aimed to identify covariates of the positive deviant practice of having one’s BP checked at least once every three months even when having normal BP. Methods: We conducted a cross-sectional survey recruiting participants at health centers. Our structured questionnaire measured socio-demographic characteristics, frequency of BP checks, BMI, beliefs and practices. We used binomial logistic regression to identify covariates. Results: Among 520 participants, 265 had normal BP, and of those 156 had obtained frequent BP checks, making them positive deviants. For women with normal BP, significant covariates of obtaining frequent BP checks were: 1) having BMI ≥25.0 (adjusted odds ratio (AOR) =2.57, 95% confidence interval (CI)=1.39–4.78), 2) greater tendency to seek health information (AOR=1.13, 95% CI=1.03–1.24), 3) receiving less support from family members (AOR=0.87, 95% CI=0.77–0.97), and 4) receiving greater support from health volunteers (AOR=1.12, 95% CI=1.01–1.23). Conclusion: Positive deviants were more likely to be proactive because of the convergence of their own individual-level tendencies to learn about their health, family-level conditions that allowed for greater autonomy, and community-level capacity of health volunteers to provide them with support. Community health nurses should focus simultaneously on activating individual-level, family-level, and community-level capacity to prevent hypertension
Major Depressive Disorder in a Patient with Systemic Lupus Erythematous, Pulmonary Hypertension, and Hypercoagulation: A Case Report
Get PDFMajor depressive disorder is characterized by the presence of single or repeated major depressive episodes, which are considered periods of 2 weeks of depressive moods featuring impaired neurovegetative functioning, psychomotor activity, and cognition, as well as suicidal thoughts. Major depressive disorder is commonly associated with other medical conditions, especially chronic and systemic medical illnesses. Cardiovascular diseases are among the most related, especially pulmonary hypertension, a cardiovascular disorder that results in increased pulmonary circulation pressure––with an average resting pulmonary artery pressure of at least 25 mmHg––and which the WHO has associated with several other conditions, including connective tissue diseases such as scleroderma and systemic lupus erythematosus (SLE). The patient in this case is a 39-year-old woman diagnosed with major depressive disorder and SLE-associated pulmonary artery hypertension, which has been associated with hypercoagulable states, as observed in this instance. The complicated associations between these problems require collaboration between disciplines to establish optimal treatment integrity, with palliative care necessary to improve this patient’s quality of life
Parenteral and Oral Anticoagulant Treatment for Hospitalized and Post-Discharge COVID-19 Patients: A Systematic Review and Meta-Analysis
Get PDFBackground: The use of anticoagulants has been endorsed by different hematological societies as coagulation abnormalities are key features of COVID-19 patients. This systematic review and meta-analysis aims to provide the most recent update on available evidence on the clinical benefits and risk of oral and parenteral anticoagulants, as well agents with anticoagulant properties, in hospitalized and post-discharge COVID-19 patients. Methods: This systematic review synthesizes data on the outcome of anticoagulation in hospitalized and post-discharge COVID-19 patients. Dichotomous variables from individual studies were pooled by risk ratio (RR) and their 95% confidence interval (95% CI) using the random-effects model. Meta-analyses were performed when feasible. Results: We included 32 studies from 2.815 unique citations, including 7 randomized clinical trials. A total of 33.494 patients were included. Outcomes measured include mortality and survival rates, the requirement for ICU care and mechanical ventilation. A pooled meta-analysis favors anticoagulant compared to no anticoagulant with reduced mortality in hospitalized patients (RR 0,55; 95%CI 0,43-0,66; p<0,001). Higher dose of anticoagulant also showed treatment benefit compared to standard prophylactic dose in selected populations (RR 0,68; 95%CI 0,40-0,96; p<0,001). Regular, pre-hospital anticoagulation prior to hospitalization yielded mixed result. There are currently no data on the benefit of anticoagulation on post-discharge COVID-19 patients. Conclusion: Determination of the presence of thrombosis in COVID-19 is important, as therapeutic dosage of anticoagulants, rather than prophylatic dose, would be indicated in such clinical situation. Anticoagulants were found to decrease the mortality of hospitalized COVID-19. The results from this study are important in the tailored treatment of COVID-19 patients. Further studies on the need for oral anticoagulation for outpatients or post-discharge is warranted. This study has been registered in PROSPERO database (CRD42020201418)
Palliative Screening Tools to Identify Palliative Care Consultation at Tertiary Hospital
Get PDFBackground: The need of palliative care is increasing, but it is not all achievable. It is necessary to identify palliative patients in order to provide the proper care according to the needs of the patients. Cipto Mangunkusumo Hospital has been making the identification using a palliative-patient screening questionnaire, but no performance assessment has been carried out on the screening tool. This study aimed to evaluate the performance of the screening-tool questionnaire used on palliative-care patients at Cipto Mangunkusumo Hospital in order to assess the need of palliative-care consultation and to find out the optimal cut-off point of palliative care screening tools. Methods: The design of this study is cross-sectional and was conducted at Cipto Mangunkusumo National Central Public Hospital in July – October 2019. The sampling was collected by consecutive sampling. The reliability test was performed by the intraclass correlation coefficient (ICC). The internal consistency was measured by the Cronbach’s-Alpha coefficient. The criterion-validity test was run by an evaluation using the Pearson test. Results: There were 64 subjects collected, the largest age group was 51-70 years (50%). Cancer was the main disease found in most of the subjects (56 people / 87.5%). The most common comorbidity was kidney disease (11 people). The most common palliative score distribution was 6 (15 people). The average score was 7.51. The mortality rate at the hospital was 51.6%, 33 patients from a total of 64 patients. From the palliative score distribution curve, the AUC value was 0.687 with a 95% CI (0.557-0.818). The optimal cut-off point was 8. All patients were palliative according to expert opinion based on WHO criteria. Conclusion: The performance of this tool is sufficient to screen palliative patients in a terminal and complex condition, but requires improvements to screen for patients who need early palliative care. The optimal cut-off point to determine the limit of consultation on palliative patients is found at score 8
Major Ocular Abnormalities Among Hemodialysis Patients in Indonesia
Get PDFBackground: This study aimed to identify the major ocular abnormality findings (i.e., cataract and conjunctival and corneal calcification (CCC)) among hemodialysis (HD) patients and their risk factors. Methods: A single institute-based cross-sectional study in Indonesia. Demographic data, medical histories, and complete ocular examinations were collected. For two major ocular abnormalities found, a generalized estimating equation was incorporated in a logistic regression model to assess the relationship with their risk factors. Results: We analyzed 318 eyes (159 individuals), of which 54.7% male and 45.3% female. The mean age was 51.6±11.3 years. The mean HD period was 3.5±3.2 years. Hypertension and diabetes mellitus (DM) was found in 81.1% and 34.6%, respectively. The major ocular abnormalities found were cataract (206 eyes; 64.78% (95% CI 59.53-70.03)), followed by CCC (135 eyes; 42.45% (95 % CI 37.02-47.88)). In a multivariate model, higher education (odds ratio (OR) 0.17; 95% CI 0.04-0.74), hypertension (OR 0.15; 95% CI 0.03-0.79), DM (OR 10.49; 95% CI 1.57-70.06), Systolic Blood Pressure (SBP) 120-129 mmHg (OR 0.05; 95% CI 0.003-0.69), SBP >140 mmHg (OR 0.05; 95% CI 0.004-0.67), Diastolic Blood Pressure (DBP) 80-89 mmHg (OR 7.44; 95% CI 1.13-48.73), and DBP >90 mmHg (OR 48.47; 95% CI 3.4-692.03) showed significant association with cataract. Meanwhile, there was no significant association between CCC and any predictor. Conclusion: Cataract and CCC were found to be the major ocular abnormalities among HD patients in this study, with DM and higher DBP as the risk factors for cataract. This finding supports recommendations for integrated regular eye screening in HD patients
Peripancreatic Tuberculosis Lymphadenopathy: The Role of Endoscopic Ultrasound for Diagnosis
Get PDFPancreatic and peripancreatic tuberculosis is a rare abdominal tuberculosis. Diagnosis for pancreatic tuberculosis can be challenging. Conventional imaging tools may show mass or malignancy in the pancreas. Endoscopic ultrasound (EUS) is an excellent tools for evaluating pancreas and peri pancreas region. It also allows us to obtain tissue sample for cytology and histopathology. Here we present a case of peripancreatic tuberculosis lymphadenopathy that mimic pancreatic mass. His symptoms were also nonspecific (weight loss, epigastric pain, and irregular fever). From EUS evaluation we found that there was no mass but multiple lymphadenopathy around the pancreas and then performed FNA. The result of the cytology was granuloma inflammation and caseous necrosis which is compatible with tuberculosis infection. From this case illustration we conclude that EUS is an important diagnostic tool for pancreatic lesion to avoid unnecessary surgery
Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome in Hasan Sadikin Hospital, Bandung, Indonesia: A Retrospective Cohort Study
Get PDFBackground: Acute coronary syndrome (ACS) is a world health problem with a high mortality rate and is expected to continue to rise in number. The high ACS mortality rate in the hospital is influenced by demographic characteristics, cardiovascular risk factors, clinical presentation, and management. This study aimed to determine the predictors of ACS death at Dr. Hasan Sadikin Hospital Bandung as the highest referral center in West Java. Methods: This study is a retrospective cohort study on all ACS patients undergoing treatment at Dr. Hasan Sadikin Hospital Bandung from January 2018 to December 2019. Multivariate analysis was performed using a logistic regression test with the backward method to assess predictors of patient outcomes. Results: This study involved 919 patients with the in-hospital mortality rate was 10.6%. Multivariate analysis showed that age >65 years was a demographic factor that play a role as a predictor of mortality mortality (AOR 2.143; 95% CI = 1.079-4.256; p = 0.030). Clinical presentation of cardiac arrest arrest (AOR 48.700; 95% CI =14.289-165.980; p<0.001), SBP <90 mmHg (AOR: 4.972; 95% CI =1.730-14.293; p=0.003, heart rate >100 beats per minute (AOR 4.285; 95% CI =2.209-8.310; p<0,001), cardiogenic shock (AOR: 5.433; 95% CI= 2.257-13.074; p<0.001). Cardiovascular management can reduce the risk of in-hospital mortality. Multivariate analysis showed statins (AOR 0.155; 95% CI=0.040-0.594; p=0.007), beta blockers (AOR 0.304; 95% CI=0.162-0.570; p<0,001) and Percutaneous Coronary Intervention (AOR 0.352; 95% CI=0.184-0.673; p=0.002) significantly reduce in-hospital mortality. Interestingly, smoking is associated with a lower mortality rate (OR 0.387; p <0.001). Conclusion: Clinical presentation of cardiac arrest has the highest risk of death, the sequence is cardiogenic shock, heart rate >100 beats per minute, and age >65 years. Administration of statins, beta-blockers, PCI, and smoking are factors that reduce the risk of death