Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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HIV Drug Resistance after Failure of 6 Month First-line Therapy in a Hospital: A Case Series
Get PDFThis is the first report of HIV drug resistance in RSUPN Dr. Cipto Mangunkusumo. We tested We reviewed eleven new cases of HIV patients who had virologic failure after 6 months first-line antiretroviral therapy. With the sequencing method, analysis of gene mutations encoded HIV drug resistance. Genotypic resistance results and HIV-1 subtype were interpreted by Stanford DR database. Of ten plasma samples that were successfully amplified and sequenced, all samples were resistant to at least one antiretroviral drug. Genotypic resistance towards the antiretroviral drugs being used was observed in lamivudine (90%), tenofovir (83%), nevirapine (100%) dan efavirenz (100%). It is interesting that no zidovudine resistance were found, including in four patients receiving zidovudine in their HAART. The common NRTI mutations were M184VI and K65R, while NNRTI mutations were Y181CFGVY, K103N, A98AG, E138GQ and G190AGS. No mayor PI mutations were found. Based on these findings, we supports the need for appropriate virology monitoring and HIV drug resistance survey in clinical practice and access to drug options in case of virology failure
Adult-onset Still’s Disease as a Differential Diagnosis in Prolonged Fever: Diagnosis and Treatment Experience
Get PDFAdult onset Still’s disease is a rare systemic disease that may involve many organs and may mimick many disease such as infection, autoimmune disease, and also malignancy. The diagnostic approach and treatment strategies have not been well established due to its rarity; however, there are some diagnostic criteria that may help. We present a case of 36-year old man who experienced high prolonged fever which firstly thought as infection. He also had unilateral wrist and knee joint pain and maculopapular rash. Laboratory examination showed high leukocytes count with elevated polymorphonuclear neutrophil count, high platelet count, high ferritin level, and negative results of many infection markers (typhoid antibody, procalcitonin, malaria test, blood culture, urine culture, IgM pneumonia, ASTO, syphilis test, antiHIV, HBsAg, antiHCV, etc). Chest X-ray, joint X-ray, ultrasonography, and echocardiography showed normal result. The patient was then diagnosed with Adult-onset Still’s disease and received intravenous methylprednisolone and the fever was disappeared in 3 days. Six months later the arthralgia appeared again, methotrexate was administered and the pain was then relieved
Aspirin vs. P2Y12 Inhibitor Rivalry: Which One Can be Continued During Gastrointestinal Bleeding
No full textDual antiplatelet therapy (DAPT) is the mainstay of secondary prevention treatment for acute coronary syndrome (ACS) and ischemic stroke, especially after coronary intervention. DAPT consists of aspirin and P2Y12 receptor inhibitor (e.g. clopidogrel), and the use of DAPT has been increased over time. The most serious and common adverse effect is gastrointestinal bleeding. Guidelines in managing such condition are available among Gastroenterologist Societies and Cardiologist Societies. Most guidelines are consistent with each other to continue the use of aspirin while withholding P2Y12. However, European Society of Cardiologist (ESC) guideline in 2017 recommends P2Y12 receptor inhibitor as the preferred antiplatelet for patient with upper gastrointestinal bleeding. This review will look on the guidelines and other supporting evidence for the justification on the antiplatelet of choice
The Effect of Vitamin E Supplementation on Lipid Profiles and Adiponectin Levels in Obese Adolescents: A Randomized Controlled Trial
Get PDFBackground: low-grade chronic inflammation in obese individuals contributes to the development of lipid abnormality and insulin resistance. Vitamin E has antioxidant and insulin-sensitizing properties, mediated by adiponectin. In this study, we aimed to evaluate the effect of vitamin E supplementation on lipid profiles and adiponectin levels in obese adolescents. Methods: this was a randomized, double-blind, controlled study. Obese adolescents aged 14-18 years, with no history of taking anti-obesity or antioxidant drugs, were recruited and randomized into two groups: vitamin E and placebo. The dose of vitamin E was 400 IU/day. Intervention was administered for two months. Lipid profiles and adiponectin levels were measured at baseline and after intervention. Primary outcomes were analyzed using the per-protocol analysis principle. Statistical analysis was performed using the independent t-test or the Mann-Whitney U test. Results: a total of 66 subjects completed the intervention study, 34 in the vitamin E group and 32 in the placebo group. Lipid profiles and adiponectin levels at 2 months after intervention did not differ significantly between the two groups. Changes from the baseline level were also not significantly different between the two groups and were inconsistent from one subject to another. Conclusion: in obese adolescents, vitamin E supplementation of 400 IU/day for 2 months does not significantly affect lipid profiles and adiponectin levels
The Emergence of Non-communicable Disease in Indonesia
Get PDFBased on data from the Indonesian Ministry of Health Information Center, the estimated population of Indonesia in 2016 was approximately 258,704,986 people, consisted of 129,988,690 men and 128,716,296 women. This number of Indonesian population represents young population since the proportion of population aged 0-14 years is more than that aged >14 years. Meanwhile, the proportion of population aged 50 years and above is significantly reduced, which is thought to be due to high mortality rate in the middle-aged population. The mortality rate in Indonesia is dominated by non-communicable diseases (NCD). Alteration in environment, technology and lifestyle have changed the pattern of disease in Indonesia to be dominated by NCD such as DM, heart disease, dyslipidemia, obesity, kidney disease, lung disease, and malignancy.According to the 2014 Indonesian Sample Registration System, the 10 most common diseases were stroke (21.1%), heart disease (12.9%), diabetes mellitus (6.7%), tuberculosis (5.7%), complications of high blood pressure (5.3%), chronic lung disease (4.9%), liver disease (2.7%), traffic accidents (2.6%), pneumonia (2.1%), and combined diarrhea and gastroenteritis due to infection (1.9%). Furthermore, according to Indonesia Basic Health Research 2018, most of NCD such as cancer, stroke, kidney disease, joint disease, DM, heart disease, hypertension, and overweight/ obesity, showed an increasing trend compared to the previous report in 2013.Non-communicable diseases are chronic, often asymptomatic and progressive, thus patients usually did not realize having the disease until the sign and symptoms of its complications occur. This problem drives the need of early screening for high-risk population, early treatment and periodic monitoring. Furthermore, ongoing epidemiological studies are also done to evaluate both established and unknown risk factors, pattern of non-communicable disease development in certain area and the treatment response
The Association Between Parents History of Type 2 Diabetes with Metabolic Syndrome Component and Insulin Resistance in Non-Diabetic Young Adult Male
Get PDFBackground: the familial nature of type 2 diabetes is manifested by the presence of insulin resistance in non-diabetic first degree relatives. Most of these studies have been performed in middle-aged and there is only few published studies in young age individuals and adolescents. This study aimed to determine the relationship between parents history of type-2 diabetes with metabolic syndrome component and insulin resistance in adolescent non-diabetic subjects. Methods: this was a cross sectional study comparing the metabolic profile, risk of metabolic syndrome and insulin resistance in non-diabetic male adolescents (17-24 years old) whose one or both parents were with type-2 diabetes. We performed anamnesis, physical examination, fasting plasma glucose, lipid profile, fasting insulin level and insulin resistance based on HOMA-IR. Results: metabolic abnormalities were more prevalent in subjects whose parents were with history of type-2 diabetes, especially their waist circumference, fasting plasma glucose, triglyceride, fasting insulin and HOMA-IR (p=0.000). There was increased risk of developing central obesity in adolescents with parental history of 19.3 fold (95%CI 2.46-151.07) and insulin resistance of 10.3 fold (95%CI 3.89-27.23). Parental history of type-2 diabetes together with metabolic syndrome component ie. waist circumference >90 cm and triglyceride ≥150 mg/dl were strong determinat factors for insulin resistance (R2=50.7%). Conclusion: the early multiple metabolic defect can be detected in non-diabetes adolescents with parental history of type-2 diabetes. Cluster of metabolic syndrome component in these subject become a powerful determinat factor for insulin resistance
Profile of Kawasaki Disease in Adolescents: Is It Different?
Get PDFBackground: there is clearly growing population of young adults with potentially important coronary artery disease after Kawasaki disease (KD) during childhood, and cardiologist must be prepared to take care for them. As Kawasaki disease in adolescent and adult is rare and under-recognized, it is important to study data on patient presentations which may permit development of diagnostic criteria and treatment guidelines for this age group.This study aimed to compare the clinical profile of KD between adolescents (>10 years of age) and children ≤10 years. Methods: This is a cross sectional study. A total of 1150 KD cases (age 1-192 months) during the period of January 2003-December 2016 were analyzed. The clinical profile of subjects aged >10 years (adolescents) and ≤10 years (children) at acute phase of KD were compared. Results: we found 17 cases of KD in adolescents among 1150 total cases (1.5%). Incomplete KD was more often seen in adolescents compared to children ≤ 10 years of age (59% vs. 29%). Some clinical features were more frequently seen in children than in adolescents, e.g. conjunctivitis (85% in ≤ 10 years of age vs. 65% in > 10 years), mucosal changes (94% vs. 77%), rash (86% vs. 59%), and hand/foot changes (68% vs. 41%). While other clinical features were more often seen in adolescents, e.g., cervical lymphadenopathy (82% vs. 39%) and coronary dilatation (47% vs. 29%). Laboratory results (hemoglobin, leukocytes, erythrocyte sedimentation rate and C-reactive protein) did not differ much between the two groups. Conclusion: Kawasaki disease in adolescents has some different clinical profile from that of younger age. Majority of adolescent patients have incomplete presentation. Some clinical features such as conjunctivitis, mucosal changes, rash, and hand/foot changes are more often seen in children ≤ 10 years compared to in adolescents, while cervical lymphadenopathy and coronary dilatation are more frequently seen in adolescents. The ratio of male to female is much higher in adolescents
The Role of Epigenetic Changes in The Development of Diabetes Mellitus
Get PDFDiabetes mellitus (DM) is one of the most abundant diseases in the 21st century and believed as result of interaction between genes and environment exposure. There is a hypotesis of epigenetic mechanisms, using molecular basis to explain about the mechanism of DM. Because of the enviromental exposure including nutrition status and hyperglycemia state, the risk of DM has started since pre-conception, last until adulthood and will be inhireted trans-generational . Mainly, there are 3 epigenetic mechanisms that have role in DM. Epigenetic mechanisms are also have role in the metabolic memory that the DM complications may still developed although the blood glucose level is already normal. The restriction of calory intake may help delaying the development and onset of degerative diseases including DM by stabilizing genome through epigenetic mechanisms
Acute Appendicitis in a Patient with Systemic Lupus Erythematosus
Get PDFSystemic lupus erythematosus (SLE) is a chronic excacerbative autoimmune disease with wide clinical spectrum. Gastrointestinal manifestasion is a frequent clinical manifestasion seen in SLE. Management with glucocorticoid and non-steroid anti-inflammatory drugs (NSAID) can mask the gastrointestinal symptoms in patient with SLE. One of the etiologies of gastrointestinal manifestations in SLE is acute appendicitis. Patients with acute appendicitis usually have abdominal pain as its chief complaint. The pathophysiology of acute appendicitis can occur primarily from SLE and secondary from other causes eg: infection, inflammation, etc. When a SLE patient has acute appendicitis as its initial assessment, determining its etiology is pivotal to give comprehensive management and preventing life-threatening complications
Cushing’s Syndrome: A Large Adenoma of Adrenal Gland
Get PDFA 20-year old man was admitted for evaluation of Cushing’s syndrome. He presented with a history of headache, fatique, mood disorder, hypertension (Blood Pressure 170/120 mmHg), moon face, buffalo hump, striae rubrae. Cortisol serum laboratory increased 33.53 µgr/dl (Normal range: 3.09 – 16.6µgr/dl). Abdominal CT Scan showed a right adrenal mass diameter 10.53 x 6.83 cm, with calcified and necrotized area.Levels of ACTH < 5 pg/ml (Normal range : 6 – 50 pg/ml), absence hypothalamus pituitary defect in brain MRI angiography lead the primary site on adrenal.Patient was given ketoconazole 600 mg daily to treat hypercortisolemia. The patient underwent laparoscopic right adrenalectomy. Preparation of hydrocortisone 100 mg during anesthesia-surgery to prevent occurrence of adrenal crisis.Patient position was LLD, 11mm trocar port with 0, 30 degree optic, 2 port 5mm was used for working element. Harmonic ultrasoundshear was used for dissection, hemoLock clip to control vascular. Right subcostal incision make to remove adrenal gland. EBL 1000 cc, close monitoring in ICU ward.Hydrocortison was continued 5 days after surgery. Ventilatory support removed in 2 day after surgery. On the fifth day condition stable without signs of adrenal crisis, and the patient sent to elective ward. The pathology report revealed a cushing adenoma of adrenal gland.On the fifth day after surgical intervention, postoperative cortisol levels at 12 µgr/dl. On seventh day, surgical wound healing was well with minimum dose NSAID orally. Striae thining, ginecomastia, buffalo neck, moon face was reduced.The patient was regularly followed up at Endocrine division, Department of Internal medicine. Moon face have been eliminated, no striae and good mood condition. Blood pressure was 130/ 70 mmHg (without antihypertensive drugs) and cortisol serum was 4.52 µgr/dL and independent from steroid medication.Multidisciplinary approach including endocrine treatment, prevention adrenal crisis and laparoscopic adrenalectomy procedure have good result for Cushing’s syndrome due to adenoma of adrenal gland