Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Diagnostic Performance of INA-FRAIL and Study of Osteoporotic Fractures (SOF) Index Compared to Cardiovascular Health Study (CHS) in Diagnosing Frailty Syndrome in Older Adults with Heart Failure
No full textBackground: There is currently no gold standard for assessing frailty syndrome in older adults with heart failure. The Cardiovascular Health Study (CHS) is a reference standard for evaluating frailty in older adults with heart failure. Still, it requires a dynamometer and a spacious space, rendering it impractical in daily practice. The INA-FRAIL and Study of Osteoporotic Fractures (SOF) Index can often be easy to use; however, it has not been evaluated for diagnostic performance on older adults with heart failure in Indonesia. This study aimed to assess the diagnostic performance of INA-FRAIL and SOF-Index in diagnosing frailty in older adults with heart failure. Methods: This cross-sectional study evaluated the diagnostic performances of INA-FRAIL and SOF-Index compared to CHS as the gold standard in this study. The population was heart failure patients aged > 60 at Cipto Mangunkusumo Hospital. Results: Analysis from 81 samples shows the prevalence of frailty based on CHS (35.5%), INA-FRAIL (23.5%), and SOF-Index (8,6%). Diagnostic performance analysis of INA-FRAIL showed a sensitivity of 55,17% (95% CI 35.69–73.55), specificity 94.23% (95% CI 84.05– 98.79), and AUC 0.805 (95% CI 0.698–0.912). Diagnostic performance analysis of SOF showed 20,69% sensitivity (95% CI 7.99 – 39.72), 98.08% specificity (95% CI 89.74 – 99.95), and AUC 0.719 (95% CI 0.595 – 0.843). Conclusion: INA-FRAIL and SOF-Index had a significant association with CHS. The cut-off point of INA-FRAIL ≥1 showed the highest sensitivity, while INA-FRAIL ≥2 showed the highest Youden index. The cut-off point of SOF ≥1 showed the highest sensitivity and the highest Youden index
Atherogenic Lipoprotein Profile in First-Degree Relatives of Individuals with Type 2 Diabetes Mellitus
Full text linkBackground: First-degree relatives (FDR) of individuals with type 2 diabetes mellitus (T2DM) are at higher risk of developing early metabolic disturbances, particularly insulin resistance and lipid metabolism abnormalities. These issues contribute to a greater predisposition to cardiovascular disease compared to the general population. Despite the significant contribution, there is limited information on the relationship between atherogenic lipoproteins and normotensive, normoglycemic young FDR in Indonesia. Therefore, this study aimed to evaluate the correlation between small dense low-density lipoprotein (sdLDL) levels and HOMA-IR in FDR with T2DM, as well as assess variation in sdLDL levels within FDR and non-FDR groups. Methods: This cross-sectional study analyzed secondary data from the Metabolic Endocrine and Diabetes Division of the Internal Medicine Department, Faculty of Medicine, Universitas Indonesia, and Cipto Mangunkusumo Hospital. The primary study, titled “Early Cardio-Metabolic Disorders in the First-Degree Relative Population of Type 2 Diabetes Mellitus,” was expanded to include sdLDL measurements. Bivariate analysis and correlation tests were used to explore the relationship between sdLDL and HOMA-IR. Results: The experiment included 125 subjects, consisting of 62 FDR and 63 non-FDR. Based on the results, sdLDL levels were significantly higher in the FDR group compared to the non-FDR group (31.42 (IQR 20.1-41.39) vs 21.05 (IQR 12.18-26.13) mg/dL, p<0.0001). However, no significant correlation was observed between sdLDL levels and HOMA-IR in the FDR group (r=0.059, p=0.649). Conclusion: This study showed a significant difference in sdLDL levels between FDR and non-FDR of T2DM patients. However, no correlation was found between sdLDL and HOMA-IR in the FDR group
Atherogenic Dyslipidaemia in Diabetes: Burden and Challenges
Full text linkAtherogenic dyslipidemia is a lipid disorder characterized by high triglyceride (triglyceride-rich lipoprotein) levels, reduced HDL-C levels, and an abundance of small dense LDL (sdLDL) particles. This condition is frequently associated with diseases or states that involve insulin resistance and inflammation, such as obesity, metabolic syndrome, and type 2 diabetes. Atherogenic dyslipidemia/lipoprotein is linked to a heightened risk of cardiovascular disease. The presence of numerous sdLDL particles and remnant lipoproteins are critical in the development and buildup of plaque in atherosclerosis. Elevated triglyceride levels can also promote inflammation and thrombosis within the arterial walls. In addition to lifestyle modifications, cholesterol-lowering drugs—whether used alone or in combination—are often prescribed for the prevention or management of atherosclerotic cardiovascular disease (ASCVD), including statins, ezetimibe, bempedoic acid, and PCSK9 inhibitors
Complicated Thoracic Empyema of Serotype 23F Streptococcus pneumoniae in an Adult Patient
Full text linkWe report a case of thoracic empyema in a 61-year-old male patient, a heavy smoker with malignancy undergoing chemotherapy. The patient’s clinical symptoms included shortness of breath, productive cough, fever, and chest pain. This patient had never received antibiotics before. Streptococcus pneumoniae was isolated from a bedside culture of empyema fluid collected through thoracentesis. The empyema fluid was cultured on chocolate agar plates and in aerobic and anaerobic culture bottles. The isolate was identified as serotype 23F, a vaccine strain with sequence type 17532. The isolate was resistant to chloramphenicol, tetracycline, and cotrimoxazole. The patient clinically improved with the administration of combined intravenous ceftriaxone and levofloxacin antibiotics, along with chest tube drainage via thoracostomy. This is the first report of thoracic empyema caused by S. pneumoniae in an adult in Indonesia. Serotype 23F is multi-resistant with low invasiveness, typically causing infections in patients with underlying health conditions. The pneumococcal conjugate vaccine covers it; thus, it usually occurs in areas with low vaccine coverage. Our findings support the importance of improving adult pneumococcal vaccination coverage in Indonesia
Early Enteral Feeding Versus Total Parenteral Feeding After Surgery in Severe Acute Pancreatitis: An Evidence-Based Case Report
Full text linkBackground: Acute pancreatitis is a self-limiting inflammatory disease that in some cases may lead to severe acute pancreatitis. To prevent this development, multimodal management, including nutritional management, is used in treating acute pancreatitis patients. The controversy between parenteral and enteral feeding has led to major debate. This case report aims to assess which method has better outcomes based on multiple cases of organ failure, inflammatory response, and length of hospital stay. Methods: A 46-year-old male presented to the Emergency Department of our hospital with acute abdominal pain, nausea, and vomiting, 12 h before admission. Based on physical and further examination, the patient was diagnosed with severe acute pancreatitis and underwent a necrotomy procedure. Articles from multiple databases were obtained and assessed using the Cochrane Collaboration Risk of Bias tool. The articles were analyzed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a forest plot model. Effect size quantification for continuous and categorical variables was analyzed using continuous and binary random effect models, respectively. Results: Seven articles were obtained after exclusion and review. A total of 491 patients with acute/severe acute pancreatitis were assessed. These seven articles conclude that enteral nutrition has advantages over parenteral nutrition. Conclusion: Our study concluded that early enteral feeding provides better clinical improvement, reduced lipase enzyme levels, and shortened length of hospital stay
The Correlation Between Angiotensin II Levels and Homeostatic Model Assessment of Insulin Resistance in Normotensive Young Adults with a Family History of Essential Hypertension
Full text linkBackground: A family history of hypertension increases the risk of renin–angiotensin–aldosterone system activation, insulin resistance, and vascular inflammation, contributing to cardiovascular disease. Early vascular disturbances, marked by angiotensin II and insulin resistance assessed through the homeostatic model assessment of insulin resistance (HOMA-IR), play crucial roles in hypertension development. This study aims to determine the comparison and correlation between Ang II levels and HOMA-IR in normotensive young adults with or without offspring hypertension. Methods: We conducted this cross-sectional study by recruiting fifty normotensive participants, who were categorized into two groups: normotensive young adults who are offspring of parents with essential hypertension (case) and those who are not (control). The serum Ang II and HOMA-IR were measured. The comparative analysis was conducted using the Mann-Whitney test, and correlations were evaluated using Spearman’s test. Results: Among the 50 subjects (25 cases and 25 controls), a significant difference was observed in Ang II levels (p = 0.010), whereas HOMA-IR (p = 0.206) showed no notable difference between case and control. Notably, a positive correlation between Ang II and HOMA-IR (r = 0.554; p = 0.004) was observed in the case group, while the control group exhibited an insignificant correlation (r = –0.089; p = 0.671). Conclusion: There are marked differences in Ang II levels between normotensive young adults with a family history of essential hypertension and those without such history. Additionally, a significant correlation was found between Ang II and HOMA-IR in normotensive young adults who have a family history of essential hypertension
Correlation of Short Chain Fatty Acid (SCFA) Levels with Transient Elastography Values and Controlled Attenuation Parameters in Patients with Non-Alcoholic Fatty Liver Disease (NAFLD)
Full text linkBackground: The current hypothesis regarding the mechanism of Non-Alcoholic Fatty Liver Disease (NAFLD) is the multiple hit theory, where one of the factors involved is gut microbiota. Short-chain fatty acid (SCFA) is the main metabolite of gut microbiota and is suspected to play a role in the development of NAFLD. This study aims to determine the correlation between SCFA levels (acetate, propionate, butyrate) and the degree of fibrosis and steatosis in patients with NAFLD assessed by controlled attenuation parameter (CAP) and transient elastography (TE). Methods: A cross-sectional study that included 33 consecutively selected patients at Cipto Mangunkusumo Hospital was conducted from January to August 2023. Fecal sample collection was performed for SCFA examination using GC-MS (Gas Chromatography-Mass Spectrometry). Absolute fecal SCFAs were analyzed for correlation with steatosis and fibrosis based on controlled attenuation parameter (CAP) and transient elastography (TE) values. Results: Subjects were predominantly female (51.5%), with an average age of 49 years, an average CAP value of 296 dB/m, and a median transient elastography value of 6.1 kPa. The ratio of acetate, propionate, and butyrate values in the subjects was 59:24:17. A moderate negative correlation was observed between the absolute butyrate and CAP values (r=-0.522; p=0.002). Conclusion: There is no correlation was identified between short-chain fatty acid levels and transient elastography values
Association Between Leptin and Adiponectin Levels and Sarcopenia in Non-Geriatric Type 2 Diabetes Mellitus Patients
Full text linkBackground: Type 2 Diabetes Mellitus (T2DM) in young adults is associated with an increased risk of early sarcopenia due to insulin resistance and inflammation. This insulin resistance and inflammation can be influenced by leptin and adiponectin, which are key adipocytokines produced by adipose cells. However, no studies have examined the relationship between leptin, adiponectin levels, and sarcopenia in T2DM patients under 60 years old. This study aimed to investigate the relationship between leptin, adiponectin levels, and Leptin-to-Adiponectin ratio (LAR) with sarcopenia in non-geriatric T2DM patients. Methods: This cross-sectional study was conducted from January 2021 to April 2022. The subjects consisted of T2DM patients aged 18-59 years at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Baseline data were sourced from a primary study, while stored serum samples were analyzed for leptin and adiponectin using ELISA. Leptin and adiponectin differences were assessed statistically using the Mann-Whitney U test, and the Kruskal-Wallis test was used for additional analysis. Results: Among 97 subjects, 4 (4.1%) had sarcopenia, while 34 out of 93 non-sarcopenic subjects belonged to the possible sarcopenia category. Bivariate analysis results showed significant differences between leptin levels (p=0.005) and the Leptin-to-Adiponectin Ratio (LAR) (p=0.003) with sarcopenia in non-geriatric T2DM patients. Meanwhile, adiponectin levels (p=0.799) did not show statistical differences. Further analysis was conducted among three groups, namely sarcopenia, possible sarcopenia, and non-sarcopenia. The result showed statistically significant differences in leptin and LAR levels between sarcopenia and possible sarcopenia (leptin p=0.004; LAR p=0.007) as well as sarcopenia and non-sarcopenia (leptin p=0.038; LAR p=0.011). Conclusion: Leptin levels and LAR were associated with sarcopenia in a non-geriatric T2DM population
Performance of Red Cell Distribution Width-to-Platelet Ratio as a Screening Tool of Liver Fibrosis Based on Transient Elastography in Chronic Hepatitis B Infection
Full text linkBackground: Identifying liver fibrosis is crucial for initiating antiviral therapy for hepatitis B infection. Liver biopsy is the gold standard for assessing the degree of fibrosis. However, a liver biopsy is an invasive procedure that carries some risks. This study aimed to evaluate the diagnostic capabilities of the red cell distribution width-to-platelet ratio (RPR) and compare its efficacy for determining the degree of fibrosis in patients with chronic hepatitis B infection with that of the aspartate aminotransferase-to-platelet ratio index (APRI) and the Fibrosis-4 index (FIB-4). Methods: This was a retrospective study conducted on patients with chronic hepatitis B infection who had transient elastography results at the Gastroenterology Hepatology Clinic, Dr. Hasan Sadikin General Hospital, Bandung, between January and December 2024. Statistical analysis was performed using receiver operating characteristic curves to determine the diagnostic values and cutoff points of the RPR, APRI, and FIB-4 to detect liver fibrosis based on Transient Elastography in patients with Chronic Hepatitis B infection. Results: A total of 114 patients with chronic hepatitis B infection were included in this study (42 with significant fibrosis and 72 with nonsignificant fibrosis). The area under the curve (AUC) of the RPR was 0.873 (p < 0.001) with a cutoff point of >0.0538, whereas the AUCs of the APRI and FIB-4 were 0.833 (p < 0.001) and 0.746 (p < 0.001), respectively. Conclusion: The RPR has a higher diagnostic performance than the APRI and is superior to the FIB-4 in assessing the degree of fibrosis in patients with chronic hepatitis B infection. The RPR is a simple and cost-effective test and has the potential to be a screening tool for patients with hepatitis B infection
The Emergence of Drug Resistance in Extrapulmonary Tuberculosis: A Case Series
Full text linkDrug-resistant extrapulmonary tuberculosis (DR-EPTB) represents an escalating global health challenge, complicated by rising rates of rifampicin-resistant (RR-TB) and multidrug-resistant tuberculosis (MDR-TB). Despite growing awareness, DR-EPTB remains underdiagnosed and underreported, often due to presumptive assumptions of drug sensitivity. This case series describes three distinct cases of DR-EPTB: a 34-year-old woman diagnosed with primary MDR-TB involving the lungs and colon; a 41-year-old man with RR-TB-associated arthritis of the elbow joint, following a previous history of pulmonary TB; and a 63-year-old immunosuppressed woman presenting with primary laryngeal and pulmonary RR-TB. These cases highlight the diagnostic complexities and emphasize the necessity of prompt and precise diagnosis facilitated by molecular diagnostics, particularly GeneXpert MTB/RIF. Increased awareness and vigilance for DR-EPTB among clinicians are critical for early detection, effective management, and curbing the spread of drug-resistant strains