Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Three Years Survival of Elderly Cancer Patients in Indonesia: Do We Need a Different Approach?
Get PDFBackground: the number of elderly people in Indonesia is increasing. Additionally, cancer prevalence among older patients is also increasing. However, studies assessing clinical factors associated with the survival of elderly patients with cancer are still lacking. This study aimed to investigate the survival of geriatric patients with cancer and associated factors. Methods: this was a retrospective cohort study. Subjects were geriatric patients with cancer aged >60 years, enrolled between 2013 and 2015 in Dharmais Cancer Hospital. Data were retrieved from medical records and consisted of gender, age, cancer type, stage, Eastern Cooperative Oncology Group (ECOG) performance status (PS), body mass index (BMI), Charlson Comorbidity Index, and type of treatment. Cox regression analysis was used to identify independent prognostic factors for survival. Results: a total of 249 patients were enrolled, with a median age of 66 (60–85) years. The most common cancer was of the lung, followed by breast, colorectal, and uterine cervical cancers. The median survival time was 24 months. Cox multivariate analysis was performed by gender stratification. Advanced stage cancer (III-IV) was identified as the risk factor for mortality in female patients (hazard ratio [HR] 2.72; 95% confidence interval [CI] 1.53–4.80; p = 0.001), while poor performance status (ECOG 2 – 4) was the risk factor in male group (HR 1.82; 95% CI 1.01–3.24; p = 0.04). Conclusion: the survival of elderly patients with cancer is affected by traditional prognostic factors. Advanced cancer stage was significant independent prognostic factor in female patients, while poor performance status was significant in male patients
Priapismus as Leukostasis Manifestation in Chronic Myeloid Leukemia
Get PDFChronic Myeloid Leukemia (CML) is a myeloproliferative disease characterized by the presence of Philadelphia chromosome or BCR-ABL oncogene fusion. Patients with CML commonly present in the chronic phase with chief complaint of abdominal pain or early satiety. Priapism as the first manifestation of CML is a rare phenomenon. Priapism as a consequence of leukostasis is a urological emergency that requires immediate intracavernosus therapy followed by systemic therapy. We report a 44-year-old male patient presenting with priapism as the first manifestation of CML
COVID-19 in Indonesia: Challenges and Multidisciplinary Perspectives for a Safe and Productive New Normal
Get PDFThe COVID-19 pandemic has caused disruption in all aspects of life, and countries around the world have been combating this pandemic using multiple approaches. Success in one country does not guarantee a transferable approach to other countries with different contexts. This review describes the challenges of COVID-19 management in Indonesia as a populous, socially and culturally diverse, and archipelagic country. It aims to provide multidisciplinary perspectives for a safe, evidence-based, and productive new normal as well as a comprehensive and integrated actionable policy for COVID-19 control
Misleading Diagnosis of Radiological Imaging of COVID-19 Pneumonia During Pandemic Era: Risk on the Existence of CMV Infection
Get PDFCoronavirus disease 2019 (COVID-19) is an acute respiratory disease which rapidly disseminated due to Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) virus. Clinical presentations of COVID-19 are fever, non-productive cough, and dyspnea. Although the diagnosis establishment is done by detecting the viral ribonucleic acid (RNA) through reverse transcription-polymerase chain reaction (RT-PCR) method, CT scan has an important role in detection and treatment of COVID-19 especially in high prevalence regions. Chest CT scan has high sensitivity yet low specificity because there are a lot of other pathological spectrums that also present features of COVID-19 such as ground glass opacities (GGO) and consolidation, one of them is CMV infection. The objective of this case report is to raise vigilance towards other diseases that have radiological image similarities with COVID-19, especially in the immunocompromised patients who are susceptible to viral infections like CMV infection so that the delay in the disease treatment can be prevented
The Influence of New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting on Three-Year Survival
Get PDFBackground: new-onset atrial fibrillation after coronary artery bypass grafting (CABG) is a common postoperative complication. This arrhytmia considered as temporary phenomenon which the majority are converted back to sinus rhytm when the patients discharged from the hospital. Despite its transience, those arrhytmia can recur and increasing the long term mortality. This study aims to determine the role of new-onset atrial fibrillation after CABG in three year survival. Methods: retrospective cohort study using survival analysis of patients who underwent coronary artery bypass grafting since January 2012 to December 2015 at Cipto Mangunkusumo Hospital. Patients with atrial fibrillation before surgery, who had surgery without cardiopulmonary bypass machine, and who died in 30 days after surgery are excluded. Subjects are divided into two category based of the presence of new-onset atrial fibrillation after CABG and the mortality status is followed up until 3 years post-surgery. The Kaplan-Meier curve is used to determine the three-year survival of the patients who had new-onset atrial fibrillation after CABG and Cox regression test used as multivariate analysis with confounding variables in order to get adjusted hazard ratio (HR). Results: new-onset atrial fibrillation after-CABG occurred in 29,59% patients. Patients with new-onset atrial fibrillation after CABG have higher three-year mortality (15,52% vs 3,62%) and significantly decreases three-year survival (p=0,008; HR 4,42; 95% CI 1,49-13,2). In multivariate analysis, new-onset atrial fibrillation after CABG is an independent factor of the three-year survival decline (adjusted HR 4,04; 95% CI; 1,34-12,14). Conclusion: new-onset atrial fibrillation after CABG independently decreases three-year survival
The Role of Chest Radiograph, Procalcitonin and Moxifloxacin in Diagnosis and Management of Breast Cancer Patients with COVID-19
Get PDFGlobal widespread of current coronavirus disease 2019 (COVID-19) pandemic has emerged huge predicament to healthcare systems globally. This disease caused by a new beta-type coronavirus, known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), may lead to systemic multiorgan dysfunction syndrome and subsequently cause death due to abundant angiotensin converting enzyme 2 as its functional receptors throughout body. Oncology patients even have a worse prognosis with greater infection susceptibility because they are in a state of suppression of the systemic immune system due to malignancy and anticancer therapy. This problem makes adequate and appropriate treatment urgently needed. Through randomized clinical trials, various drugs were known to have good responses in COVID-19 patients. Here, we reported a-49-year-old-woman that was confirmed for COVID-19 by clinical manifestation, radiology profile, high procalcitonin concentration, and positive polymerase chain reaction (PCR) test. The patient also had breast and thyroid cancers history and had undergone various therapeutic modalities such as chemotherapy, thyroid surgery, and breast surgery. She was undergoing hormone therapy but experiencing disease progression after achieving complete remission based on PET-CT scan 4 months before. The patient was treated with various antibiotics but showed a significant clinical improvement by administering moxifloxacin
Factors Associated with Mortality of Intensive Care Unit Patients with Acute Kidney Injury at Cipto Mangunkusumo National Central General Hospital
Get PDFBackground: the incidence of acute kidney injury (AKI) in intensive care units is associated with increased mortality, post AKI morbidity and high treatment costs. Research on factors related to mortality of AKI patients in intensive care units in Indonesia, especially Cipto Mangungkusumo General Hospital has never been done. This study aims to determine the prevalence of AKI, mortality rate of AKI patients, and the factors associated with increased mortality of AKI patients in intensive care units in ICU Cipto Mangunkusumo General Hospital. Methods: this is a retrospective cohort study of all patients diagnosed with AKI in the intensive care unit at Cipto Mangunkusumo General Hospital, January 2015 - December 2016. An analysis of bivariate relationships with multvariate with STATA Statistics 15.0 between age > 60 years, sepsis, use of ventilator, ventilator duration, dialysis, oligoanuria, and APACHE II scores at admission with mortality. Results: the prevalence of AKI patients in the intensive care unit was 12.25% (675 of 5511 subjects) and 220 subjects (32.59%) of the 675 analyzed subjects died in the intensive care unit. Factors related to increased mortality in multivariate analysis were sepsis (OR 6,174; IK95% 3,116-12,233), oligoanuria (OR 4,173; IK95% 2,104-8,274), use of ventilator (OR 3,085; IK95% 1,348-7,057), (scores APACHE II at admission) 1/2 [OR 1,597; IK95% 1.154-2.209], and the duration of the ventilator (OR 1.062; IK95% 1.012-1.114). Conclusion: the prevalence of AKI patients and their mortality rate in the intensive care unit of Cipto Mangunkusumo General Hospital obtained 12.25% and 32.59%. Sepsis, oligoanuria, ventilators (APACHE II score at admission) 1/2, and ventilator duration are factors that are significantly associated with increased mortality of AKI patients in intensive care units
Plasma Concentrations of Adiponectin in Patients with Coronary Artery Disease and Coronary Slow Flow
Get PDFBackground: Adiponectin, an adipocyte-secreted hormone involved in energy homeostasis, has broad anti-inflammatory, antioxidant, and endothelium- and myocardial-protective effects, together with a potentially positive regulatory function in coronary microcirculation. Although the physiological role of adiponectin has not yet been fully elucidated, it may well be involved in the regulation of many of the inflammatory processes or lipid metabolisms that contribute to atherosclerosis. In this study we investigate the plasma concentration of adiponectin in patients with coronary artery disease (CAD), those with coronary slow flow (CSF) and in healthy subjects. Methods: this study was conducted according to a cross-sectional design involving 30 CAD, 30 CSF, and 30 healthy subjects. These subjects were sourced from the Dr. Zainoel Abidin Center Hospital, Banda Aceh, Indonesia, between December 2017 and February 2018. The plasma concentration of adiponectin was measured using enzyme-linked immunosorbent assay (ELISA) according to the manufacturer’s specifications. Results: there were statistically significant differences at p<0.001 between the CAD, CSF, and healthy-subject groups in terms of age, sex, systolic blood pressure, total cholesterol, triglycerides, and creatinine. Mean plasma concentrations of adiponectin in patients with CAD were significantly lower than in patients with CSF and in healthy subjects (CAD: 3.40 (0.87) μg/ml; CSF: 4.58 (2.32) μg/ml; healthy subjects: 5.65 (4.87) μg/ml; P<0.001). Conclusion: the findings suggest that low plasma adiponectin concentration is associated with atherosclerosis. Plasma concentrations of adiponectin may be related to the pathophysiology role of cardiovascular disease in both CAD and CSF patients
Practical Guidelines Management of Graves Ophthalmopathy
Get PDFGraves’ ophthalmopathy is the most common extra-thyroid manifestation in patients with Graves’ disease, based on inflammatory and autoimmune conditions in orbital tissue. This practical guideline was formed by a multidiciplinary team, and is intended to provide guidance for diagnosis and management of Graves’ ophthalmopathy in daily clinical practice to improve quality of care and treatment outcome
Intact Glycocalyx of Intestinal Mucosa in Intraabdominal Infection: an Investigation Using Blood Group Antigen
Get PDFBackground: intestinal glycocalyx plays a role in bacterial translocation as the pathogenesis sepsis derived from intra-abdominal infections that vulnerable in certain blood types. However, the link between intestinal glycocalyx in specific types of blood groups and abdominal infections remains unknown. This study aims to find out the condition of intestinal glycocalyx in certain blood types with intraabdominal sepsis. Methods: descriptive study involved subjects with intraabdominal infections who underwent laparotomy. Samples are in the form of intestinal specimens. The measurement of intestinal glycocalyx proceeded by the ELISA method using blood group antigens (A and B). Expression data on the secretors were analyzed using the Kolmogorov – Smirnov test followed by parametric comparisons using ANOVA and t-tests. Results: there were 32 subjects with intra-abdominal infections studied in this study. All of them are secretors and express A and B antigens strongly. We found no difference between intraabdominal infections in those with complications or without complications. Blood type O is a predominant blood type found (43.8%). Escherichia coli is the most commonly found microbe in the culture (61.3%). Conclusion: this study shows there is no disrupted intestinal glycocalyx of sepsis patients caused by intraabdominal infection