Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Measurement of Health-Related Quality of Life in Patients with Functional Dyspepsia
Get PDFIn up to 80% of dyspepsia patients who consult a physician in the hospital, dyspepsia is considered to be functional dyspepsia. Although not associated with increased mortality, functional dyspepsia is a burden at both the community and national levels because it can cause physical, mental, and social distress that can affect a patient’s quality of life. Health-related quality of life (HRQOL) is a multidimensional construct comprising at least three broad domains—physical, psychological, and social functioning—which can all be affected by a disease and its treatment. It is important to assess HRQOL in patients with functional dyspepsia to identify the effects of the disease and its treatment on patients. Both disease-specific and generic instruments can be used to assess HRQOL in patients with functional dyspepsia. Each instrument has its own advantages and limitations. The selection of instrument to assess HRQOL is determined by the study population, research questions, disease entities, and researcher preferences. The purpose of this article is to explain the concept of HRQOL and the use of HRQOL assessment in patients with functional dyspepsia
The Role of Reed-Sternberg CD30 Receptor and Lymphocytes in Pathogenesis of Disease and Its Implication for Treatment
Get PDFHodgkin lymphoma is a cancer that can be cured using standard chemotherapy with or without radiation. Although it accounts for only 0.6% of all malignancy worldwide, but it usually affects young adults with median age of 38 years. About 60 to 90% cases can be cured depending on its stage and 5 to 10% cases are refractory to the first-line chemotherapy; while 20 to 30% patients experiencing relapse after receiving the first-line chemotherapy. The relapse causes new problem in treatment. A monoclonal antibody-chemotherapy conjugate, Brentuximab vedotin, was approved by Food Drug Association and European Medicine since 2011 dan was approved by European Medicine Agency since 2012 to treat relapsed classical Hodgkin lymphoma and anaplastic large cell lymphoma (ALCL). Brentuximab vedotin has also been known as anti-CD30.CD30 or Ki-1 or TNFRSF8 is a 120-kD glycoprotein, which is a trans-membrane receptor of Hodgkin lymphoma cells. The glycoprotein was first identified in 1982 using monoclonal antibody against Hodgkin lymphoma-derived cell lines. The glycoprotein was then cloned and recognized as a member of tumor necrosis factor receptor (TNFR) superfamily, which has intracellular, transcellular and extracellular domains. The monoclonal antibody obviously does cause a reaction not only with the Reed-Sternberg (RS) cells of Hodgkin lymphoma, but also with a small number of normal lymphocytes subset, which are located at perifollicular zone as well as lymphoid tumor such as anaplastic large cell lymphoma (ALCL) and other non-lymphoid tumor such as embryonic and pancreas carcinoma, undifferentiated nasopharyngeal carcinoma and malignant melanoma. Therefore, CD30 monoclonal antibody alone to confirm the diagnosis of Hodgkin lymphoma is ineffective as it must be used together with other panel of immunohistochemistry antibodies such as cytokeratins, carcinoma embryonic antigen, melanoma-associated antigen and placental alkaline phosphatide.The expression of CD30 molecules in Reed-Sternberg cells of Hodgkin lymphoma has been demonstrated in over 98% of classical Hodgkin lymphoma cases; however, there is a difference in staining intensity among various cases or even in one case
Adaptation of the Tool to Estimate Patient Costs Questionnaire into Indonesian Context for Tuberculosis-affected Households
Get PDFBackground: Indonesia is the second-highest country for tuberculosis (TB) incidence worldwide. Hence, it urgently requires improvements and innovations beyond the strategies that are currently being implemented throughout the country. One fundamental step in monitoring its progress is by preparing a validated tool to measure total patient costs and catastrophic total costs. The World Health Organization (WHO) recommends using a version of the generic questionnaire that has been adapted to the local cultural context in order to interpret findings correctly. This study is aimed to adapt the Tool to Estimate Patient Costs questionnaire into the Indonesian context, which measures total costs and catastrophic total costs for tuberculosis-affected households. Methods: the tool was adapted using best-practice guidelines. On the basis of a pre-test performed in a previous study (referred to as Phase 1 Study), we refined the adaptation process by comparing it with the generic tool introduced by the WHO. We also held an expert committee review and performed pre-testing by interviewing 30 TB patients. After pre-testing, the tool was provided with complete explanation sheets for finalization. Results: seventy-two major changes were made during the adaptation process including changing the answer choices to match the Indonesian context, refining the flow of questions, deleting questions, changing some words and restoring original questions that had been changed in Phase 1 Study. Participants indicated that most questions were clear and easy to understand. To address recall difficulties by the participants, we made some adaptations to obtain data that might be missing, such as tracking data to medical records, developing a proxy of costs and guiding interviewers to ask for a specific value when participants were uncertain about the estimated market value of property they had sold. Conclusion: the adapted Tool to Estimate Patient Costs in Bahasa Indonesia is comprehensive and ready for use in future studies on TB-related catastrophic costs and is suitable for monitoring progress to achieve the target of the End TB Strategy
Chromobacterium violaceum: The Deadly Sepsis
Get PDFChromobacterium violaceum is a Gram-negative facultatively anaerobic, oxidase-positive bacterium producing a dark violet antioxidant pigment called violacein. It is an opportunistic pathogen and has an ubiquitous distribution, mainly resides in water and soil of tropical and subtropical regions.An-18-year-old man referred to the emergency room with a 5-day history of progressively worsening swelling of the right cheek. He sought consult and hospitalized at another institution for three days prior this admission; however, his condition deteriorated. He had a history of having abscesses several time. Four month before this visit, he was also admitted in our hospital due to an abscess in the right thigh. Pus and blood culture were positive for Staphylococcus haemolyticus, with a total serum IgE of 2493.0 IU/ml. He recovered completely after being treated with vancomycin in this event. He had neither diabetes mellitus nor human immunodeficiency virus infection history. In this presentation, he was in a critically ill state with septic shock. Physical examination revealed diffuse, indurated, partly fluctuant, and some deep purple area of right hemifacial swelling. It was extended anteriorly from angle of mouth to retroauricular, superiorly from superior palpebra to lower border of mandible. Laboratory studies were notable for a white-cell count of 12,970/mm3 (total lymphocyte count 778.2), platelet count 96,000/mm3. The patient got norepinephrine drip and broad-spectrum antibiotic intravenously. He also underwent superficial drainage of the abscess. Unfortunately, the patient eventually succumbed. Sample from right submandibular abscess showed no growth, but blood sample was confirmed to grow C. violaceum. It showed sensitivity to ciprofloxacin, amikacin, cotrimoxazole, chloramphenicol, tetracycline.Since it was firstly described in 1927, only a few cases of human infection with C. violaceum have been reported. As shown in our case, the classical clinical manifestation was localized soft tissue infection which rapidly progressed to fulminant sepsis with a high mortality rate. A defect in host defense system might be the predisposing factor for this kind of infection in our case. As this is such a rare infection, there is no guideline on the choice of antibiotics or duration of treatment at present. Successful treatment is most likely due to early recognition, prompt surgical drainage and appropriate antibiotic. To the best of our knowledge, this is the first reported case from Indonesia that could be identified in the literature
Diagnostic Determinants of Proliferative Lupus Nephritis Based on Clinical and Laboratory Parameters: A Diagnostic Study
Get PDFBackground: proliferative lupus nephritis (LN) has higher prevalence and worse prognosis than non-proliferative LN. Renal biopsy plays an important role in diagnosis and therapy of LN, but there are some obstacles in its implementation. A diagnostic scoring system for proliferative LN is necessary, especially for cases in which renal biopsy cannot be performed. This study aimed to develop a diagnostic scoring system of proliferative LN based on its diagnostic determinants including hypertension, proteinuria, hematuria, eGFR, anti-dsDNA antibody, and C3 levels. Methods: a cross-sectional study with total sampling method was conducted. Our subjects were adult LN patients who underwent renal biopsy in Cipto Mangunkusumo Hospital between January 2007 and June 2017. Results: from a total of 191 subjects with biopsy-proven LN in this study, we found a proportion of proliferative LN of 74.8%. There were 113 subjects included for analysis of proliferative LN determinants. The multivariate analysis demonstrated that determinants for proliferative LN were hypertension (OR 3.39; 95% CI 1.30-8.84), eGFR <60ml/min/1.73m2 (OR 9.095; 95% CI 1.11-74.68), and low C3 levels (OR 3.97; 95% CI 1.41-11.17). After further analysis, we found that hypertension, eGFR <60ml/min/1.73m2, low C3 levels, and hematuria were essential components of the diagnostic scoring system on proliferative LN. The scoring system was tested with ROC curve and an AUC of 80.4% was obtained (95% CI 71.9-89). Conclusion: the proportion of proliferative LN in biopsy-proven LN patients of Cipto Mangunkusumo Hospital is 74.8%. Components of scoring system for proliferative LN consist of hypertension, eGFR <60ml/min/1.73m2, low C3 levels, and hematuria
Effect of Alfacalcidol on Inflammatory markers and T Cell Subsets in Elderly with Frailty Syndrome: a Double Blind Randomized Controlled Trial
Get PDFThyroid Dysfunction in Type 2 Diabetes Mellitus Patients
Get PDFBackground: thyroid dysfunction is more likely to occur in diabetes mellitus patients than general population. Until now, no study has been done to find prevalence of hypothyroidism and hyperthyroidism in Indonesian diabetics. This study aimed to find the proportion and characteristics of thyroid dysfunction in Indonesian type 2 diabetes mellitus patients.Methods: a cross-sectional study was conducted in Endocrine and Diabetes Polyclinic, Department of Internal Medicine, Cipto Mangunkusumo Hospital from July to September 2015. This study include type 2 diabetes mellitus patients, age ≥ 18 year-old, willing to undergo thyroid laboratory testing. In this study, hypothyroidism defined as TSH more than 4.0 mIU/L, while hyperthyroidism is defined as TSH less than 0.4 mIU/L with eCLIA.Results: from 364 subjects who were recruited from Endocrine and Diabetes Polyclinic, Cipto Mangunkusumo Hospital, 303 subjects underwent this study until analysis. Two hundred and three (273) subjects (90.1%) were euthyroid, 7 subjects (2.31%) were hyperthyroid, and 23 subjects (7.59%) were hypothyroid. Majority of the patients had subclinical hypothyroidism (56.5% based on Zulewski and Billewicz Score and 65.2% based on fT4 laboratory result), while 42.9% and 71.4% subjects had clinical hyperthyroidism based on clinical appearance and fT4 laboratory result respectively.Conclusion: proportion of hypothyroidism was 7.59% and hyperthyroidism was 2.31%, while the proportion of total thyroid dysfunction was 9.9% among diabetics. It is suggested that screening for thyroid dyscfunction can be done in high risk condition as a part of comprehensive management in type 2 diabetes mellitus patients
ST Elevation in Lead aVR and Its Association with Clinical Outcomes
Get PDFThe purpose of this case repots are to evaluate the role of ST elevation in aVR lead and to make analysis between both cases. There are some atypical electrocardiogram (ECG) presentations which need prompt management in patient with ischemic clinical manifestation such as ST elevation in aVR lead. In this case study, we report a 68-year old woman with chief symptoms of shortness of breath and chest discomfort. She was diagnosed with cardiogenic shock, with Killip class IV, and TIMI score of 8. The second case is a 57-year-old man with typical chest pain at rest which could not be relieved with nitrate treatment. He was diagnosed with ST elevation in inferior and aVR lead, and occlusion in left circumflex artery (LCX). Both patients underwent primary percutaneous coronary intervention (PPCI). Subsequently, both cases presented remarkable clinical improvements and improved ST elevation myocardial infarction (STEMI) in aVR lead
Ectopic Infra Orbital Nerves: Case Series of a Dangerous Normal Variant
Get PDFNormal variations in the paranasal sinus region are well documented in literature. We present five cases of a little known normal variant, which can have serious implications for the patient as well as the operating surgeon. An ectopic infra orbital nerve canal coursing through the maxillary sinus has rarely been described in imaging literature. This may sometimes be mistaken for a simple septum in the maxillary sinus and may cause serious complications during Functional Endoscopic sinus surgery (FESS) surgeries. We describe the imaging findings and present a brief review of the previous publications on the same subject
Current Diagnosis and Management of Graves’ Disease
Get PDFGraves’ disease is an autoimmune disorder which affect thyroid gland. Graves’ disease is the most common cause of hyperthyroidism and thyrotoxicosis. Understanding of disease pathophysiology, diagnostic and treatment strategies, and prevention of disease relapse are important for all clinicians especially internal medicine specialist to give optimal and comprehensive management for Graves’ disease patients. This article highlights clinical points to treat Grave’s disease patients from reviews and latest guidelines from American Thyroid Association (ATA), European Thyroid Association (ETA), and Japan Thyroid Association/ Japan Endocrine Society