Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Pulmonary Fibrosis Caused by Severe COVID-19 Infection: Discharge May Not Be The End of Treatment
Get PDFSince December 2019, COVID-19 caused by SARS-CoV-2 infection has been spread rapidly in the world. Beside acute respiratory distress syndrome found in acute phase of infection, there is also pulmonary fibrosis as a chronic complication due to COVID-19. With the global pandemic of COVID-19, more and more autopsy and puncture histopathological results have been published.Until now there is no specific therapy to handle post-inflammatory pulmonary fibrosis due to COVID-19 infection. Several studies are ongoing to determine an effective treatment for this chronic complication. While ARDS appears to be the main cause of pulmonary fibrosis in COVID-19, the pathogenesis of ARDS caused by SARS-CoV-2 is different from the typical ARDS. Some therapies may be considered for reducing the fibrosis process in lung after COVI-19 infection namely pirfenidone, nintedanib and mesenchymal stem cells. Many patients are still recovering spontaneously in the first six weeks after acute COVID-19 infection and do not generally require fast-track entry into a pulmonary rehabilitation programme. However, those who have significantly persistent respiratory illness may need to be supported by pulmonary rehabilitation. Multidisciplinary intervention based on personalized evaluation and treatment which includes exercise training, education and behavioral modification can be given to improve the physical and psychological condition of patients with post-COVID pulmonary fibrosis
Frequency of Acute Kidney Injury in Patient Receiving Piperacillin - Tazobactam: A Hospital-based Study from Qatar
Get PDFBackground: several studies have been reported piperacillin-tazobactam (TAZ / PIPC)-associated AKI with various frequencies. The aim of this study was to determine the frequency of TAZ/PIPC- associated AKI among our patients and to identify the risk factors for this clinical entity. Methods: this retrospective cross-sectional study was conducted at Hamad General Hospital; it involved adult patients who were admitted from January 2017 to December 2017. Results: we involved 917 patients, of whom 635 (69.25%) were males and 282 (30.75%) were females. The mean age of the patients was 52 (SD 19) years, and 98 (10.7%) patients were diagnosed with AKI. The patients with AKI were significantly older than without AKI [59.71 (SD 19.79) versus 51.06 (SD 18.67); P <0.001]. After TAZ/PIPC initiation, the mean creatinine level in the AKI group was higher than the mean creatinine level in the non-AKI group, [158.91 (SD 81.93) versus 66.78 (SD 21.42); P<001]. The mean time of onset of AKI after PIPC/TAZ initiation was 4.46 (SD 3.20) (1-12 days). AKI was significantly associated with low mean serum albumin (P<0.001), high mean fasting blood glucose (P<0.001), coronary artery diseases (P<0.001), heart failure (P<0.001), liver diseases (P=0.047), diabetes mellitus (P=0.021) and hypertension (P<0.001). The in-hospital mortality was significantly higher in the AKI group [38.78% versus 5.13% in the non-AKI group; P<0.001], and only advanced age and heart failure were found as independent risk factors for TAZ/PIPC-associated AKI. Conclusion: TAZ/PIPC was significantly associated with AKI. Advanced age and heart failure were identified as independent risk factors for TAZ/PIPC-associated AKI
The Management of Pulmonary Fibrosis in COVID-19
Get PDFPulmonary fibrosis due to COVID-19 is recognized as sequel of ARDS characterized by failed alveolar re-epithelization, fibroblast activation, excessive collagen deposition and other extracellular matrix components that disrupt the normal lung architecture. There are risk factor for pulmonary fibrosis namely advanced age, severe ARDS infection, mechanical ventilation due to ventilator-induced lung injury, smoking and chronic alcoholism. Diagnosis of post-COVID pulmonary fibrosis can be made by clinical symptoms and characteristic finding from lung CT scan. To date, there is no definitive treatment for post-inflammatory pulmonary fibrosis after COVID-19 infection, however some of antifibrotic therapies may be considered. Beside medical treatment, pulmonary rehabilitation program and long-term oxygen treatment should be included as part of comprehensive treatment for pulmonary fibrosis due to COVID-19
Clinical Evaluation of HIV/AIDS Patients on Antiretroviral Therapy using HIV Symptoms Index: A reliability and Applicability Evaluation using Indonesian Language
Get PDFBackground: HIV/AIDS is a chronic, lifelong disease with a wide clinical spectrum which could decrease the quality of life. Objective symptoms measurement is important because it is correlated to treatment adherence and progressivity of the disease. Currently, there is no clinical tool available to evaluate symptoms of HIV infection and the treatment’s side effect for the outpatient setting. This study aimed is to assess the reliability of the Indonesian version of HIV Symptom Index for measuring symptoms of HIV/AIDS patients, and use it for assessment of their symptom profile. Methods: this is a cross sectional study in outpatient HIV/AIDS subjects (n=87) recruited in Cipto Mangunkusumo Hospital’s HIV clinic from September-November 2018. The HIV Symptom Index consisted of 20 items evaluating somatic, psychologic, and the combination of both symptoms, and its’ language adaptation to Indonesian was done with Beaton and Guillemin method. Reliability of the Indonesian version of HIV Symptom Index was tested by alpha cronbach’s a coefficient analysis, and the internal validity was tested with multitrait scaling analysis before being used to profile the symptom pattern of HIV/AIDS patients. Results: Indonesian version of HIV Symptom Index is reliable (cronbach alpha 0.76) and valid (multitrait correlation >0.4) for measuring symptoms of HIV/AIDS patients. The most common symptom is fatigue (55.7%), followed by insomnia (43.3%), dizziness and lightheadedness (42.3%), skin problems (42.3%), and pain, numbness, or tingling in the hands or feet (39.2%). Conclusion: Indonesian version of HIV symptom Index is reliable and valid to measure symptoms of HIV/AIDS patiens objectively
The Relationship between Folic Acid and Vitamin B12 Serum Levels with High Sensitivity C-reactive Protein and Homocysteine in Chronic Hemodialysis Patients: A Cross-sectional Study
Get PDFBackground: Folic acid (FA) and vitamin B12 treatment have been routinely prescribed to lower serum homocysteine levels and to reduce inflammation. However, no study has been conducted to determine serum folic acid (SFA) and vitamin B12 (B12) levels in patients who have twice-weekly hemodialysis. The aim of our study was to assess serum folate and B12 levels in chronic hemodialysis patients and their relationship with hsCRP and homocysteine levels. Methods: Our study was a cross-sectional study involcing patients who had twice-weekly hemodialysis in Dr Cipto Mangunkusumo National Hospital Jakarta, Indonesia. Predialysis blood samples were taken to measure SFA, B12, homocysteine and hsCRP levels. Patients with medical conditions affecting the assays were excluded. Spearman correlation was used to compare variables. Results: Eighty subjects enrolled in this study. Among those of non-given folic acid and vitamin B-12 supplementation, only 3.85% of subjects had low folic acid levels, and none had low vitamin B12 levels. A moderate negative correlation between serum folic acid and homocysteine level (p≤0.001; r=-0.42) and a weak correlation between serum vitamin B12 and homocysteine level (p=0.009; r=-0.29) was found. Among the high-risk cardiovascular group (CRP>3, n=49), there is a moderate negative correlation between serum folic acid and homocysteine level (p≤0.001; r=-0.561) and a weak negative correlation between vitamin B12 and homocysteine level (p=0.018; r=-0.338). Conclusion: There is a significant negative correlation between serum vitamin B12 and folic acid with homocysteine levels, especially in high-risk cardiovascular group
The Validity and Reliability of the MacNew Heart Disease Health Related Quality of Life Questionnaire: The Indonesian Version
Get PDFBackground: The MacNew heart disease health related quality of life tool is used widely in the cardiac populations to evaluate the impact of disease and intervention including rehabilitation. In addition to the English version, it is also available for several other languages except the Indonesian language. Therefore, the purpose of this study were 1) to translate the MacNew questionnaire from the English version to the Indonesian language and 2) to estimate the preliminary validity and reliability of the Indonesian MacNew for patients with coronary artery disease. Methods: Forward and backward translation procedure was used to develop the Indonesian MacNew. The Indonesian MacNew was administered to 24 patients after one week of revascularization surgery. Reliability was assessed by internal consistency and test-retest reliability. To evaluate concurrent validity, the correlation of the compatible domain of the Indonesian MacNew and SF-36 was assessed. Results: Internal consistency reliability of the Indonesian MacNew was confirmed with Cronbach’s α of the global scale and all three subscales exceeding 0.95. Test- retest reliability was acceptable with intraclass correlation coefficient of 0.66 for the global score. Furthermore, an acceptable concurrent validity was established with statistically significant correlation between Indonesian MacNew and SF-36 (pearson correlation ranging from 0.47 to 0.71). Conclusion: The first results of the Indonesian MacNew indicate acceptable validity and reliability as a measurement tool to assess health related quality of life of Indonesian patients with coronary artery disease
Atypical Exanthem as Cutaneous Manifestation Related to COVID-19 at a Primary Healthcare Facility
Get PDFCoronavirus disease (COVID-19) infection attacks the mucosal structures of the respiratory tract, especially the bronchial mucosa and immune cells. The skin changes and manifestations related to COVID-19 infection remain not clearly understood. Cutaneous manifestations related to COVID-19 had been reported. Our patient manifested atypical cutaneous exanthem on her legs, with no other abnormalities found. We used oral azithromycin 500 mg, dexamethasone 0.5 mg, vitamin C 100 mg, and paracetamol 500 mg, which are available at Badak Baru Primary Health Care. The exanthem has improved after 10 days of treatment
Correlation of Serum Ferritin and Cardiac Iron Toxicity with Cardiac Function in Transfusion Dependent Beta-Thalassemia Major Patients
Get PDFBackground: Cardiac iron toxicity is a major cause of mortality in transfusion-dependent beta-thalassemia major patients. The main modality for detecting cardiac iron toxicity is MRI T2* with limited availability. This study aims to obtain iron toxicity profiles in transfusion-dependent beta-thalassemia patients; to see a correlation between iron toxicity and cardiac function. Methods: We conducted a cross-sectional study at the Adult Thalassemia Polyclinic of Cipto Mangunkusumo Hospital, Indonesia from December 2017 to March 2018. We performed the statistical analysis using Pearson/Spearman Test comparing MRI T2* values with ejection fraction and E/A ratio. Results: The median of 4-months mean of ferritin levels was 5130 ng/mL. The mean for cardiac T2* was 24.96 ms. Severe cardiac hemosiderosis (mean cardiac MRI T2* < 10 ms) occurred in 11.3% of the subjects. There was weak correlation between serum ferritin with cardiac iron toxicity (r=-0.272, p=0.032) and ejection fraction (r=-0.281, p=0.013). But, there was no correlation between cardiac iron toxicity with ejection fraction and E/A ratio. Conclusion: Serum ferritin correlated weakly with cardiac iron toxicity and cardiac systolic function. Meanwhile, there was no correlation between cardiac iron toxicity with cardiac systolic and diastolic function
Diagnostic Value of PCR compared to Urine Culture for Urinary Tuberculosis in Adult Women: An Evidence-Based Case Report
Get PDFBackground: genitourinary tuberculosis (GUTB) refers to a Mycobacterium tuberculosis infection of the urinary tract with clinical manifestation masquerading as various urological diagnostic entities. With an incidence rate of 192-232 per 100,000 individuals, current diagnoses have fallen short in comparison to the total incidence. Combined with an atypical and non-specific manifestation, a high false negative rate of acid-fast bacilli (AFB) staining, and long AFB culture duration has made diagnosis difficult. We aim to gather current available evidence regarding the diagnostic performance of polymerase chain reaction (PCR) in the diagnosis of GUTB. Methods: a literature search was conducted in four different, well-known databases using a predetermined PICO, keywords, and Boolean operators. All included articles will be subjected to rigorous appraisal according the University of Oxford’s Centre for Evidence-Based Medicine (CEBM) Diagnostic Variability Criteria. Review and meta-analysis will be subjected to the QFAITH appraisal checklist to assess its quality. Results: out of a total of 243 initial search results, 11 relevant studies were determined after title and abstract screening. Additionally, nine articles were excluded based on the predetermined criteria. Two fully appraised articles were included in the study: one systematic review article, revealing a heterogenous (I2 = unstated; p = unstated) result of sensitivity mean above 85% and specificity above 75%; and one cross-sectional diagnostic study that reported the use of two different PCR primers: IS6110-PCR and 16SrRNA-PCR primer with a sensitivity of 95.99% and 87.05% and specificity of 98.11% and 98.9%, respectively. Conclusion: current limited evidence showed that PCR could not be solely used for the diagnosis of GUTB, but its use is recommended to guide patient treatment and monitoring.
Giant Recurrence Pituitary Adenoma After Three Times Transphenoidal Removal Surgery, One Craniotomy Procedure, and 30 Doses of External Radiotherapy
Get PDFThis is a case of 42nd year-old woman with history of sight loss in her both eyes. She experienced headache and visual field decrease gradually since 2014. After several laboratory and imaging examinations, from her dynamic pituitary magnetic resonance imaging (MRI), it is concluded that she had a giant adenoma of the pituitary gland which compressed to her optic chiasm. From her pituitary laboratory hormone panel, it is revealed that the tumor is a non-functioning pituitary adenoma. From the neuro-ophthalmology (campimetry) examinations, she had papillae atrophy in her both eyes and also bilateral temporal hemianopia