Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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The Association of Kidney Function Monitoring Adherence and Estimated Glomerular Filtration Rate Changes Among Patients At-Risk for Chronic Kidney Disease
Get PDFBackground: Kidney Disease: Improving Global Outcome in 2012 has provided recommendations to prevent CKD progression by monitoring kidney function periodically according to the CKD stage and the clinician’s adherence to these guidelines is important. This is the first study on the relationship between adherence to monitoring renal function and changes in estimated glomerular filtration rate (eGFR) in patients at risk for CKD in Indonesia. Methods: This study was a comparative observational study with a cross-sectional approach. Research subjects were electronic medical record data from the Hasan Sadikin General Hospital information system (SIRS) data collected with the SQL Server Report Builder and “HCLAB” applications on patients at risk for CKD at the Hasan Sadikin General Hospital’s Outpatient Clinic from January 2018 to March 2020. The patients’ data were taken by the total sampling technique and then processed with the Chi-Square test. Results: From 376 subjects, the results showed that poor adherence in renal function monitoring would increase the risk of decreasing eGFR by 1.51 times compared to good monitoring adherence (PR 1.51 95% CI (1.172 - 1.935); p-value 0.007). The eGFR changes were significant (p-value 0.002) with mean 10.84 ml/min/1.73m2 (95% CI: 4.17 – 17.50). Conclusion: The study demonstrated that poor renal function monitoring adherence had an association with a decrease in eGFR in a group of patients at risk for CKD
Evaluation of COVID-19 Patients According to the Survival Time
Get PDFBackground: Coronavirus disease 2019 (COVID-19) was first detected as a form of atypical pneumonia. COVID-19 is a highly contagious virus, and some patients may experience acute respiratory distress syndrome (ARDS) and acute respiratory failure leading to death. We aim to evaluate the clinical, imaging, and laboratory parameters according to survival time to predict mortality in fatal COVID-19 patients. Methods: Fatal 350 and survived 150 COVID-19 patients were included in the study. Fatal patients were divided into three groups according to the median value of the survival days. Demographic characteristics and in-hospital complications were obtained from medical databases. Results: Of the non-survived patients, 30% (104) died within three days, 32% (110) died within 4-10 days, and 39% (136) died within over ten days. Pneumonia on computational tomography (CT), symptom duration before hospital admission (SDBHA), intensive care unit (ICU), hypertension (HT), C-reactive protein (CRP), D-dimer, multi-organ dysfunction syndrome (MODS), cardiac and acute kidney injury, left ventricular ejection fraction (LVEF), right ventricular fractional area change (RV-FAC), and Tocilizumab/Steroid therapy were independent predictors of mortality within three days compared to between 4-10 days and over ten days mortality. A combined diagnosis model was evaluated for the age, CT score, SDBHA, hs-TnI, and D-dimer. The combined model had a higher area under the ROC curve (0.913). Conclusion: This study showed that age, pneumonia on CT, SDBHA, ICU, HT, CRP, d-dimer, cardiac injury, MODS, acute kidney injury, LVEF, and RV-FAC were independently associated with short-term mortality in non-surviving COVID-19 patients in the Turkish population. Moreover, Tocilizumab/Steroid therapy was a protective and independent predictor of mortality within three days
Learning Intelligent for Effective Sonography (LIFES) Model for Rapid Diagnosis of Heart Failure in Echocardiography
Get PDFBackground: The accuracy of an artificial intelligence model based on echocardiography video data in the diagnosis of heart failure (HF) called LIFES (Learning Intelligent for Effective Sonography) was investigated. Methods: A cross-sectional diagnostic test was conducted using consecutive sampling of HF and normal patients’ echocardiography data. The gold-standard comparison was HF diagnosis established by expert cardiologists based on clinical data and echocardiography. After pre-processing, the AI model is built based on Long-Short Term Memory (LSTM) using independent variable estimation and video classification techniques. The model will classify the echocardiography video data into normal and heart failure category. Statistical analysis was carried out to calculate the value of accuracy, area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio (LR). Results: A total of 138 patients with HF admitted to Harapan Kita National Heart Center from January 2020 to October 2021 were selected as research subjects. The first scenario yielded decent diagnostic performance for distinguishing between heart failure and normal patients. In this model, the overall diagnostic accuracy of A2C, A4C, PLAX-view were 92,96%, 90,62% and 88,28%, respectively. The automated ML-derived approach had the best overall performance using the 2AC view, with a misclassification rate of only 7,04%. Conclusion: The LIFES model was feasible, accurate, and quick in distinguishing between heart failure and normal patients through series of echocardiography images
Effectiveness of Bendamustine-Rituximab Compared to R-CHOP/R-CVP as a First-Line Treatment of Indolent Non-Hodgkin’s Lymphoma or Mantle-Cell Lymphoma
Get PDFBackground: R-CHOP/R-CVP is the only recommended first-line treatment for Non-Hodgkin’s Lymphoma (NHL). Limited treatment alternatives often lead to relapse and refractory NHL, which increases disease progressivity and worsens prognosis. Bendamustine-rituximab is being studied for its potential as a superior first-line therapy for indolent NHL and mantle-cell NHL (MCL); however, it is not in the national guidelines. Evidence-based research is needed to demonstrate the effectivity of bendamustine-rituximab compared to R-CHOP/R-CVP for a complete response of indolent NHL and MCL. Methods: A literature search was conducted using PubMed, Scopus, EBSCOHost, and Cochrane. Studies consistent with clinical question and eligibility criteria were included and critically appraised using the Oxford Centre for Evidence-Based Medicine (CEBM) tool. Results: Two randomized controlled trials (RCTs) were included in this study, both concluding that bendamustine-rituximab is superior to R-CHOP/R-CVP with a complete response, with RR values of 0.90 (95% CI 0.80 – 1.01) and 0.86 (95% CI 0.76 – 0.98). Conclusion: Bendamustine-rituximab is more effective than R-CHOP/R-CVP as a first-line treatment of indolent NHL or MCL
Confirmed Delta Variant COVID-19 Infection at A Single Centre Tertiary Hospital: A Case Series
Get PDFSARS-CoV-2 continues to mutate with the emergence of new variants. Variant B.1.617.2 (Delta) is a variant of concern with evidence of increased transmission, more severe disease, decreased effectiveness of treatment or vaccines, or failure of diagnostic detection. In this article, we report on the clinical and biological picture of the first confirmed delta variant COVID-19 infection in Indonesia. From May 31 to June 17, we identified ten cases with confirmed delta variant COVID-19 infection admitted to a tertiary academic hospital in Jakarta. All subjects that have been vaccinated presented with mild-moderate disease. Most patients present with initial respiratory complaints, without radiological abnormalities on chest x-ray examination, and an increase in C-reactive protein. Seven out of ten patients have been vaccinated; the three patients who had not been vaccinated experienced severe COVID-19 symptoms, two of whom died. Due to the increased transmission of this variant, we recommend vaccination, wearing a mask, and social distancing to reduce the impact of infection with delta variant B.1,617.2
Pulmonary Embolism in Hospitalized Patient with Coronavirus Disease 2019 (COVID-19)
Get PDFCoronavirus disease 2019 (COVID-19) has been a global pandemic for over a year. Meanwhile, thrombosis occurs in up to one-third of hospitalized patients with the disease, while pulmonary embolism has been reported to be the most dangerous thrombosis which greatly increases mortality in COVID-19.Hospitalized patients with COVID-19 are at high risk of thromboembolic complications such as deep vein thrombosis and pulmonary embolism. The hypercoagulable state caused by COVID-19 leads to activation of coagulation cascade, meanwhile, CT pulmonary angiography is used to diagnose or exclude pulmonary embolism. Furthermore, ground-glass opacities are also evaluated using this modality. Low molecular weight heparin is the anticoagulant of choice due to simplicity in administration and low risk of drug-drug interactions.Pulmonary embolism occurs in COVID-19 patients without DVT. Based on the results, parenteral anticoagulant followed by DOAC is the mainstay of treatment in COVID-19 coagulopathy
Diagnostic Model of COVID-19 Infection Based on the Combination of Clinical Symptoms, Chest Radiography and Laboratory Test
Get PDFBackground: COVID-19 is an infection caused by SARS-COV 2.For screening the patient, Rapid antigen for COVID-19 is used with a high diagnostic value. However, there are still some cases of false-negative even with clinical symptoms suggesting COVID-19. Undetected COVID-19 patients certainly will increase transmission. A simple and practical diagnostic model, using determining factors, is required to guide physicians through a quicker decision making process, especially when deciding the need for the isolation rooms for patients with COVID-like symptoms. Methods: This study is a cross-sectional study. The study was conducted at CiptoMangunkusumo Hospital, Jakarta.History of contact with COVID-19, clinical symptoms, laboratory examination, and chest radiograph data were taken from medical records. Bivariate and multivariate analyses were conducted to assess the effect sizes of patient factors on the diagnostic results.ROCcurve and Hosmer-Lemeshow calibration was used to make the scoring. Results: There were 187 patients with the majority of subjects in the age group < 60 years old. The selected variables in this scoring systemwere contact history,fever/history of fever, dyspnea with respiratory rate >20 breaths/minute, leucocyte ≤ 10.000 cells/mLand typical chest radiography. The area under the curve for this model was 0,777 (CI95% (0,706-0,847), P<0,001). The probability was 82% with a cut-off point ≥ 4. Conclusion: Determinant models based on the combination of contact history, presence or history of fever, dyspnea, leucocyte count ≤ 10.000 cells/mL and typical chest radiography provides good accuracy to aid physicians in managing isolation room needs for patients with suspected COVID-19
Thyroid Abscess as a Clinical Manifestation of Papillary Thyroid Carcinoma
Get PDFEven in immunocompromised patients, thyroid abscess is a rare occurrence. One factor that predisposes the thyroid gland to infection is pre-existing diseases such as thyroid nodule or thyroid cancer. A mass usually accompanies thyroid cancer. On the other hand, thyroid cancer is uncommon to present with a thyroid cyst or abscess, even as infection symptoms. In this article, we presented a 50-year-old woman who suffered from a thyroid abscess. She had been diagnosed with an untreated thyroid nodule a year prior and presenting with an enlarged, painful, and warm neck mass accompanied with fever, and dysphagia for 7 days. Treatment began with intravenous antibiotic and percutaneous drainage with intracavitary antibiotic injection. The culture contained no organism. Isthmolobectomy was performed due to expanding abscess to the surrounding tissue, and the histopathology examination confirmed thyroid abscess with a follicular variant of papillary thyroid carcinoma.
Management of Cholelithiasis with Concomitant Choledocholithiasis
Get PDFCholelithiasis refers to a condition in which hardened deposits exist within the gall bladder. These deposits are also known as gallstones. Among other gastrointestinal diseases, Cholelithiasis is associated with the highest hospital admissions. Those with cholelithiasis are generally asymptomatic. However, symptoms may start to appear in the case of inflammation or the blockage of the bile duct, which occurs in 10-25% of patients with cholelithiasis. The condition in which gallstones are present in the common bile duct is known as choledocholithiasis. Surgery is a curative therapy for cholelithiasis concomitant with choledocholithiasis. Other available options include laparoscopy, endoscopy, percutaneous technique, and open surgery. These methods can be done gradually or in combination. Considering this, there have been controversies about the best management option for the case. Therefore, this article aims to analyze and compare each methods of management
The Validation of Drug Resistance in Pneumonia (DRIP) Score in Predicting Infections due to Drug-Resistant Pathogens in Community-acquired Pneumonia at Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Get PDFBackground: The emergence of drug-resistant pathogens (DRP) in recent years possibly contributes to the common problems associated with community-acquired pneumonia. However, to predict the risk of the ailment, the DRIP score is mainly applied, although no validation study has been reported in Indonesia. Therefore, the score prediction accuracy in the population, patient characteristics and germ patterns appears indefinite, particularly for Cipto Mangunkusumo Hospital, Jakarta. The purpose of this study is to determine the DRIP performance as an instrument in predicting infections due to drug-resistant pathogens (DRP) in community-acquired pneumonia at Cipto Mangunkusumo Hospital. Methods: This research employed a cross-sectional design, where the subjects were community-acquired pneumonia patients treated between January 2019 and June 2020. In addition, adequate medical records of the participants were obtained. The condition is defined as DRP when the sputum culture results show resistance to non-pseudomonal β-lactam antibiotics, macrolides, and respiratory fluoroquinolones. Furthermore, the score performance was analyzed by determining the calibration and discrimination values, using the Hosmer-Lemeshow test and AUROC, respectively. Results: A total of 254 subjects were known to have satisfied the selection criteria. These participants were categorized into DRP and non-DRP groups, with 103 (40.6%) and 151 (59.4%) patients, correspondingly. The DRIP calibration analysis using the Hosmer-Lemeshow test obtained p-value = 0.001 (p <0.05), while an AUC value of 0.759 (CI 95%, 0.702-0.810) was derived from the ROC curve. However, at a score of ≥ 4, the DRIP showed sensitivity, specificity, positive and negative predictive values of 70.9, 92.7, 86.9, and 82.3%, respectively. Conclusion: The DRIP score demonstrated a significant performance in predicting infections due to DRP in community-acquired pneumonia