Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Efficacy of Additional Solifenacin Succinate Therapy for Storage Symptoms in Females with Uncomplicated Lower Urinary Tract Infection: The SOLUTION Randomized Controlled Trial
Get PDFBackground: urinary tract infection (UTI) is often treated in daily practice as overactive bladder (OAB) by giving anticholinergic, the recommended treatment options of OAB. However, anticholinergic application for UTI symptoms relief has never been investigated. To our knowledge, this study was the first randomized trial which investigate anticholinergic use for UTI treatment. This study aimed to evaluate whether additional anticholinergic is beneficial alongside an empiric antibiotic therapy in reducing symptoms and tolerable for females with uncomplicated UTI. Methods: this was a randomized double-blind controlled trial that included female aged >18 y.o with uncomplicated lower UTI. Patients were randomly assigned to either solifenacin succinate 5 mg (group 1) or placebo (group 2) in addition to empiric levofloxacin 500 mg treatment for 3 days. Those with structural and/or functional abnormalities of the urinary tract and allergic reaction history were excluded. We observed changes in overactive bladder symptom score (OABSS), patient perception of bladder condition (PPBC) score, patient-reported symptoms and adverse events. Results: a total of 126 patients, 63 for each group, initiated the trial with median age of 44 (19-67) y.o. There were no differences of age, OABSS, and PPBC score between the 2 groups at baseline. We found significant (p<0.05) reduction of OABSS and PPBC score in both groups at the end of therapy; however the amount of reduction were not different between groups. In group 1 we found 22.2% of patients complained of dry mouth and 25.4%, 4.7%, 3.2% of patients complained of nausea, somnolence and constipation respectively. In group 2 we found 20.0%, 21.7% and 3.3% patients who complained of dry mouth, nausea, and somnolence respectively. One patient in group 2 experienced allergic reaction and was dropped out. Conclusion: we found no significant difference in OABSS and PPBC score reduction by adding anticholinergic to antibiotic therapy for females with uncomplicated UTI. There was no serious adverse event recorded
Influence of Diabetes Mellitus on the Development of Multi Drug Resistant-Tuberculosis in Yogyakarta
Get PDFBackground: the correlation between diabetes mellitus (DM) and Multi-Drug-Resistant Tuberculosis (MDR-TB) has never been studied among patients with tuberculosis (TB) in Indonesia, while DM has been identified to alter immune response and pharmacokinetics of TB medications that may lead to a failure of TB treatment and develop MDR-TB. Our study aimed to analyze the influence of diabetes mellitus on the development of MDR-TB. Methods: a retrospective cohort study was carried out on 356 TB patients at the Provincial Lung Clinics and Sardjito Hospital, Yogyakarta, Indonesia between 2010 and 2014. Diagnosis of MDR-TB was established based on GeneXpert or drug sensitivity testing, while DM was determined based on the criteria in the National Guidelines. Demographic, epidemiological and outcome variables were collected. Odds ratios and 95% confidence intervals (95% CI) were analyzed using simple logistic regression. Results: among 356 TB patients, 23 patients were with binomial TB-DM, while 333 patients did not suffered from DM. Patients with TB-DM presented a 6.8-fold (95% CI:2.0-23.7, p=0.003) higher risk of developing MDR-TB. Individuals with TB-DM had a 4.4-fold (95% CI:1.5-12.9, p=0.008) greater chance to have positive sputum smear by the second month of treatment indicating a delay in the resolution of the tuberculosis infection. Conclusion: there was a significant correlation between diabetes mellitus and MDR-TB development. Therefore, it is suggested that clinicians at all levels of health care service should conduct any kind of screening test for MDR-TB in such group of patients. Further prospective cohort study is needed to confirm the findings of this preliminary study
The Differences in Serum Quantitative Specific IgE Levels Induced by Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis Sensitization in Intermittent and Persistent Allergic Asthma
Get PDFBackground: house dust mites (HDM) are an important inhalant allergen in allergic asthma. However, molecular diagnostic study of specific IgE to HDM allergens has not been done in Indonesia. In addition, the association of quantitative specific IgE measurement with asthma severity has not been investigatedd. This study aimed to investigate the difference of serum quantitative specific IgE levels induced by Dermatophagoides (D.) pteronyssinus, D. farinae and Blomia tropicalis sensitization in intermittent and persistent allergic asthma.Methods: this was a cross-sectional study on adult allergic asthma patients who were invited for serum specific IgE testing. This study was a part of a larger study within the Division of Allergy and Immunology, Cipto Mangunkusumo Hospital. Asthma severity was defined based on Global Initiative on Asthma (GINA) 2015 criteria and were grouped as intermittent or persistent. Quantitative specific IgE testing was done on blood serum using a multiple allergosorbent test (Polycheck Allergy, Biocheck GmbH, Munster, Germany). The HDM allergens tested were D. pteronyssinus, D. farinae, and Blomia tropicalis. Difference between two groups were analyze using Mann-Whitney test.Results: a total of 87 subjects were enrolled in this study; 69 (79.3%) were women. Mean patients’ age was 40, 2 years. Sixty-three (72.4%) subjects had asthma and allergic rhinitis. Fifty-eight (66.7%) subjects were classified as persistent asthma. The prevalence of sensitization was 62.1% for D. farinae, 51.7% for D. pteronyssinus, and 48.3% for Blomia tropicalis. The median of specific IgE levels were significantly higher in persistent asthma compares to intermittent asthma induced by D. farinae (median 1.30 vs. 0.0 kU/L; p=0.024) and B. tropicalis (median 0.57 vs. 0.0 kU/L; p=0.015) sensitization. Level of Specific IgE D. pteronyssinus was also to be higher in persistent asthma than the level measured in intermittent asthma (0.67 vs. 0.00 kU/L; p=0.066).Conclusion: Sensitization of HDM allergens was shown to be highest for D. farinae 62.1%, followed by D. pteronyssinus 51.7% and Blomia tropicalis 48.3%. Specific IgE level induced by D. farinae and Blomia tropicalis sensitization were significantly higher in patients with persistent asthma compared to intermittent asthma, whereas specific IgE level induced by D. pteronyssinus sensitization was higher in persistent asthma although not statistically significant
Cancer Stem Cells and Molecular Biology Test in Colorectal Cancer: Therapeutic Implications
Get PDFColorectal cancer (CRC) is the third most frequent cancer in males, the second in females, and is the second leading cause of cancer related death worldwide. Within Indonesia’s 250 million population, the incidence rates for CRC per 100,000 population were 15.2 for males and 10.2 for females, and estimated 63,500 cases per year. More than 50% of colorectal cancer patients will develop metastasis. CRC is still the main cause of tumor-related death, and although most CRC patients are treated with surgery to remove the tumor tissue, some of the CRC patients recurred. Chemotherapy used as adjuvant or neoadjuvant therapy also has several problems, in which these treatments are useless in tumor cells with chemo-resistance. Molecular testing of CRC from tumor tissues has important implications for the selection of treatment. Biomarkers can be used as prognostic value, molecular predictive factors, and targeted therapy. Recent research reported that, cancer stem cells (CSCs) are considered as the origin of tumorigenesis, development, metastasis and recurrence. At present, it has been shown that CSCs existed in many tumors including CRC. This review aims to summarize the issue on CSCs, and the future development of drugs that target colorectal cancer stem cells
Risk Factors for Multidrug-resistant Tuberculosis
Get PDFIn 2015, 10.4 million people developed tuberculosis (TB) and 580,000 amongst them suffered from multidrug-resistant TB (MDR-TB). From those 580,000 cases of MDR-TB, only 125,000 were detected and reported. A total of 111,000 people began to receive MDR-TB treatment in 2014 while 190,000 MDR-TB patients were estimated to have died, largely due to lack of access to effective treatment. The mechanism of drug resistance can be caused by genetic factors, factors related to previous treatment and other factors such as comorbidity with diabetes mellitus. Although there is some evidence which postulate host genetic predisposition is the basis for the development of MDR-TB, changes in the genomic content is the major underlying event in the emergence of variants strains in the M. tuberculosis complex. Spontaneous chromosomally-borne mutation occurring in M. tuberculosis at predictable rates are thought to confer resistance to anti-TB drugs. Factors related to previous anti-tuberculosis treatments consists of incomplete or inadequate treatment and also poor treatment adherence. A review of the published literature strongly suggest that the most powerful predictor for the presence of MDR-TB is a history of TB treatment. Many new cases of MDR-TB are created by physician’s errors related to drugs regimen, dosing interval and duration of treatment. Multidrug-resistance TB developed due to error in TB management in the past such as initiation of an inadequat regimen using first line anti-TB drugs, the addition of single drug to a failing regimen, the failure to identify pre-existing resistance and variations in bioavailability of anti-TB drugs that predispose the patient to the development of MDR-TB. Non-adherence to prescribed treatment is often underestimated by physicians and difficult to predict. Certain factors such as psychiatric illness, alcoholism, drug additiction and homelessness can predict non-adherence to treatment. Poor compliance with the treatment is also an important factor in the development of acquired drug resistance.Diabetes mellitus has been a well-known risk factor for TB in the past. The global convergence of the accelerating type 2 DM pandemic, high TB prevalence and drug-resistant TB during the past couple of decades has become a serious challenge to clinicians worldwide. Over the past few years, some studies have shown that the treatment failure rate is higher in TB patients with DM as comorbidity. Moreover, there is significant association between DM an MDR-TB. There is higher chance of TB bacilli persistence to be present in sputum of pulmonary TB patient with DM than TB-only patient after 5 months treatment, and this persistence made it necessary for more longer treatment. Presence of DM in TB patients cause a longer period for sputum conversion, therefore it may become a major cause of poor treatment outcome in TB patients. Previous studies showed that a major mechanism for the emergence of drugs resistance in TB bacilli is random mutation in the bacterial genome and the pressure of selection by anti-TB drugs. Pulmonary TB in diabetic patients usually show higher mycobacterial loads at the initiation of treatment, hence they may have higher chance of bacillary mutation and the emergence of MDR-TB with the presenting of higher bacterial loads, longer treatment is needed to clear the bacteria. Therefore, it is not suprising that a higher chance of MDR-TB patients could be find in those patients. A pharmacokinetic study noted that plasma levels of rifampicin were 53% lower in TB patients with diabetes, which might affect treatment outcomes. Inadequate immune respons of the host may also be important in this negative effect of diabetes. Depressed production of IFN-γ in diabetic patients is related to decreasing immune response to TB infection. Reduction of IL-12 response to mycobacterial stimulation in leukocytes from TB with diabetic patients suggest a compromise of innate immune response
7 Years Experience of Living Donor Kidney Transplantation in Indonesia: A Retrospective Cohort Study
Get PDFBackground: kidney transplantation has been developing rapidly in Indonesia in recent years, yet data on transplants’ characteristics and survival is still unavailable. In Indonesia, only living donors are permitted. Living donor are advantageous, but challenging to recruit. This study aimed to establish the graft and patient survival rates and to describe the characteristics of recipient and donor as well as the process of donor recruitment and evaluation of kidney transplantation in Indonesia. Methods: the study was a retrospective cohort on all donors and kidney transplant recipients at Cipto Mangunkusumo General Hospital (CMGH) from January 2011 to May 2017. Only recipients from January 2011 to May 2014 were included to establish the 1-year and 3-year graft and patient survival; which were described using Kaplan-Meier method. Results: data from 492 kidney transplant procedures were obtained (donor median age, 30 (17 – 66) years; 25.1% were family-related. Recipients mean age, 47 (SD 13.18 years). Data from total of 138 kidney transplant recipients were further analyzed. The 1-year death- censored graft survival, all-cause graft survival and patient survival were 92 %, 82.6 % and 87%. The 3-year death-censored graft survival, all-cause graft survival and patient survival were 90.6%, 76.1% and 79.7%. Kaplan-Meier’s curve showed the highest mortality rates occured in the early months. Conclusion: the 1-year graft and patient survival rate were 92% and 87%. The 3-year graft and patient survival rate were 90.6% and 79.7%. Only small percentage of donor were family-related. Living donor recruitment and evaluation are still a big challenge in Indonesia
The Coexistence of Systemic Lupus Erythematosus and Psoriasis: Is It Possible?
Get PDFSystemic lupus erythematosus (SLE) is a chronic autoimmune disease with various clinical disorders and frequent exacerbations. Psoriasis vulgaris is a common skin disorder which affect 1-3% of general populations. The pathophysiology regarding the coexistence of these diseases is not fully understood. Therapeutic challenges arise since the treatment one of these diseases may aggravate the other. We reported two cases of SLE with psoriasis vulgaris with clinical manifestations as recurrent erythroderma with photosensitivity. Improvement in clinical condition was observed after treating the patients with methylprednisolone combined with methotrexate. The coexistence SLE and psoriasis are considered very rare. The presence of this overlap syndrome may precede one another or occur simultaneously and is closely related with the presence of anti-Ro/SSA. Thus, it raises new challenge regarding its relationships, diagnosis, therapeutic, and management
A Chronic Lymphocytic Leukemia Patient with Progressive Multifocal Leukoencephalopathy Caused by John Cunningham Virus
Get PDFProgressive multifocal leukoencephalopathy (PML) is a rare but fatal disease leading to severe neurological impairments. PML is a clinical manifestation, which is usually associated with John Cunningham virus (JCV) infection. It is also correlated to malignancies that mainly include hematologic malignancies such as chronic lymphocytic leukemia (CLL). Until now, no specific treatment has been established for JCV-induced PML; therefore, the prognosis of this disease is poor.We present a case of a 67-year-old woman who suffered from CLL with a chief complaint of seizure. Her clinical symptoms, results of brain MRI and biopsy were suggestive for the JCV-induced PML. The patient had received treatment using mefloquine at dose of 250 mg/day with no clinical improvement
