Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Anti-inflammatory Therapy Before Reperfusion Therapy in Patients with Ischemic Vascular Disease on the Incidence of Ischemic Reperfusion Injury: An Evidence-Based Case Report
Full text linkBackground: Reperfusion serves as a mainstay therapy in almost all ischemic vascular diseases (IVD), but reperfusion may enhance cell damage after an ischemic period time. Increased ROS and inflammatory markers, decreasing organ function parameters, along with systemic inflammatory response and multi-organ damage may occur in ischemic reperfusion injury (IRI). Unfortunately, this series of events is unpredictable and sudden, causing high mortality in patients with IRI. Due to the significant role of inflammation in IRI, how is the effectiveness of anti-inflammatory agents administered before reperfusion therapy to prevent IRI? To know the efficacy of anti-inflammatory agents administered before reperfusion therapy to prevent IRI. Methods: A systematic search was conducted in databases (Pubmed, EMBASE, Scopus) and was later selected according to predetermined inclusion and exclusion criteria. Studies included later critically appraised using the CEBM Oxford questionnaire for randomized control trials and systematic review. Results: Seven studies were included among 1072 studies found in early searching. Six of the studies are randomized control trials, and one is a meta-analysis of randomized control trials. Methylprednisolone, pexelizumab, tirilazad mesylate, and N-acetylcysteine are known anti-inflammatory agents applicable in humans. The highest effectiveness of anti-inflammatory agents is methylprednisolone, with a relative risk reduction (RRR) of 75-85%. Besides that, pexelizumab also had an RRR of 27%, and tirilazad-mesylate had an RRR of 18%. N-acetylcysteine is not effective in preventing IRI. IL-6 levels postoperatively also decreased significantly in patients given anti-inflammatory agents before reperfusion therapy. There are no side effects of the intervention reported. Conclusion: Anti-inflammatory agent administration before reperfusion therapy effectively prevents IRI. The choices of anti-inflammatory agents recommended are methylprednisolone, pexelizumab, and tirilazad-mesylate. Anti-inflammatory agent administration before reperfusion therapy is recommended
Sticky Platelet Syndrome as a Cause of Recurrent Miscarriages: A Rare Case Report
Full text linkSticky platelet syndrome (SPS) is a hereditary disorder. SPS can cause pregnancy complications, such as recurrent miscarriages. However, proper management can prevent the incidence of recurrent miscarriages. Here, we describe a case of a woman who lost her fifth first-trimester pregnancy, and upon assessment, we discovered SPS. The 33-year-old woman underwent consultation with an obstetrician because of her history of five first-semester miscarriages. Gynecology ultrasound, infection parameters, hormonal and metabolic panels, and autoimmune workup were all found to be normal; however, vitamin D deficiency was identified as was SPS from a platelet aggregation test. The patient was then treated with clopidogrel and vitamin D3 supplementation. She became pregnant after five months of treatment. Her pregnancy was normal and she went into delivery at 40 weeks gestation with no maternal or fetal complications
Unusual Co-existence of Drug-Susceptible Lung Tuberculosis and Drug-Resistant Pleural Tuberculosis: A Rare Case Presentation of Dual Infection
Full text linkTuberculosis (TB) has become one of the global burdens of disease, with increasing morbidity and mortality every year. Tuberculosis can affect not only the lungs but also the extrapulmonary organs. The prevalence of drug-resistant tuberculosis (DR-TB) is rising and has caused a higher mortality rate than drug-susceptible tuberculosis (DS-TB). This article presents a patient with a rare co-infection of pulmonary DS-TB and pleural DR-TB. Pulmonary and pleural TB (pTB) was diagnosed using the Xpert MTB/RIF assay. The patient was treated with an individualized DR-TB regimen and recovered
Complete Atrioventricular (AV) Block as a Cardiac Complication of Rheumatoid Arthritis: A Rare Case Report
Full text linkAtrioventricular block (AVB) is a rare complication of rheumatoid arthritis (RA). Complete AVB in people with RA significantly increases cardiovascular morbidity and doubles the mortality risk. We report on a 48-year-old woman presenting with dyspnea and peripheral edema, with symptoms of polyarthritis for 3 years. Physical findings included bradycardia, bilateral rales, and finger deformities consistent with RA. Electrocardiography featured complete AVB, and a thoracic computed tomography scan showed a mosaic appearance with fibrosis, bronchiectasis, and partial atelectasis of the lungs. Further tests showed elevated levels of C-reactive protein, rheumatoid factor, and several inflammatory cytokines. Transient followed by permanent pacemaker placement was performed along with pharmacological treatments, including intravenous (IV) methylprednisolone pulse therapy and IV tocilizumab. Cardiac involvement in RA usually takes the form of pericardial effusion, heart failure, myocarditis, and coronary artery disease. Complete AVB is a rare but important extra-articular involvement in RA that warrants early recognition and treatment with a pacemaker, anti-inflammatory drugs, and disease-modifying antirheumatic drugs
Successful Ultrasound-Guided Dry Needling for Treatment of Piriformis Syndrome
Full text linkPiriformis syndrome is an often overlooked cause of chronic buttock or low back pain, sometimes radiating to the posterior thigh. Despite various treatment options, a definitive standard therapy has not been established. Dry needling has recently gained attention as a non-pharmacological intervention, especially when guided by ultrasound to enhance accuracy and safety.
A 69-year-old woman presented with a 9-month history of fluctuating right gluteal pain, aggravated by prolonged sitting and movements. Physical examination revealed tenderness in the piriformis area and positive provocative tests, with no neurological deficits. After failure of previous pharmacological and physiotherapeutic interventions, the patient underwent ultrasound-guided dry needling of the piriformis muscle. The procedure was performed using an in-plane technique with a 0.3 x 75 mm needle and elicited a twitch response. After two sessions, the patient reported a significant reduction in pain intensity from 7/10 to 2/10.
Ultrasound-guided dry needling offers several benefits, including precise targeting of the piriformis muscle, avoidance of chemical agents, and reduced risk of adverse effects. The analgesic effect is attributed to inactivation of myofascial trigger points and neuromodulation involving reduced levels of substance P and calcitonin gene-related peptide. We conclude that ultrasound-guided dry needling appears to be a safe, effective, and minimally invasive option in the management of piriformis syndrome, particularly when conventional therapies fail
Factors Associated with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) Related Mortality at Dr. Sardjito Hospital in Indonesia
Full text linkBackground: By 2019, the human immunodeficiency virus (HIV) had infected approximately 3.8 million people in Southeast Asia and caused 120,000 deaths. In Indonesia, despite periodic fluctuations, the incidence of HIV/AIDS continues to rise annually. Although antiretroviral therapy (ART) has substantially extended the lives of people living with HIV/AIDS (PLWHA), various risk factors continue to influence treatment outcomes. This study aimed to identify the risk factors significantly associated with mortality among PLWHA undergoing ART therapy at RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia. Methods: In a retrospective cohort design, we reviewed sociodemographic and clinical data of all adult PLWHA (aged ≥18 years) who initiated ARV therapy at RSUP Dr. Sardjito Hospital between January 2008 and December 2021. Patients with incomplete baseline data or those referred from other facilities were excluded. The final cohort was categorized into surviving and deceased groups. Univariate and multivariate logistic regression analyses were conducted to determine the factors linked to mortality, and survival probabilities were estimated using Kaplan–Meier curves. Results: Out of 1,591 patients included in the study, 199 died during the follow-up period. Univariate analysis revealed that age over 45 years, tuberculosis status, low CD4+ count, occupation, and advanced clinical stage of HIV/AIDS were significantly associated with mortality. Multivariate analysis further demonstrated that low CD4+ count, employment status, and, most notably, advanced clinical stage (stages 3 and 4) were independent predictors of death. The survival probabilities at 1 and 5 years were 89% and 87%, respectively. Conclusion: Occupation, CD4+ count, and clinical stage critically influence mortality in PLWHA on ART therapy, with advanced clinical stage being the most significant. Early diagnosis and prompt ART initiation are essential to enhance survival
Association Between ABO Blood Groups and Malaria Severity in a Regional Referral Hospital in Jayapura Papua, Indonesia
Full text linkBackground: Malaria infection has caused a significant morbidity and mortality, notably in high-risk groups. Some evidence showed that ABO blood types might associate with malaria severity. This study aimed to determine the relationship between blood types and malaria severity in Papua, as Papua is a malaria-endemic area. Methods: A cross-sectional study was conducted in a regional referral hospital in Jayapura, Indonesia. Diagnosis of malaria was determined using World Health Organization criteria and classified into severe and uncomplicated malaria. Blood types were classified into O and non-O groups. Results: Out of 210 patients, 84 (40%) and 126 (60%) patients had non-O and O blood types, respectively. Severe malaria was more prevalent in non-O compared to O blood type (16.7% vs. 9.5%; the prevalence ratio (PR) was 2.4; 95% CI 1.06-6.42; p value 0.032). Amongst non-O groups, group B blood type demonstrated the highest incidence of severe malaria (p value 0.038; 95% CI: 1.06-6.42). Conclusion: There is an association between ABO blood group and the severity of malaria in Papua. Severe malaria was found more in non-O blood types, especially type B blood group
The Role of Vitamin D and Its Receptor Signaling in Diabetic Nephropathy and the Current Status of Research: A Literature Review
Full text linkDiabetic kidney disease (DKD) is one of the common and serious complications of diabetes mellitus, with a complex pathogenesis and a lack of ideal treatment options in clinical practice. In recent years, the protective role of vitamin D and its receptor signaling pathway in DKD has garnered widespread attention. Vitamin D plays an important role in the onset and progression of DKD by participating in the regulation of insulin secretion, inhibiting inflammatory responses, attenuating podocyte injury, modulating the renin-angiotensin system (RAS), and inhibiting renal interstitial fibrosis through its receptor (VDR). Studies on the use of vitamin D and its receptors in DKD have increased gradually in recent years, with a focus on the development of vitamin D analogs and the clinical application of VDR activators. This study reviewed the mechanisms of vitamin D and its receptor in diabetic nephropathy, as well as the potential for therapeutic applications and associated adverse effects. It also analyzed current research hotspots and development trends based on bibliometrics. Future research should focus on further optimizing vitamin D-based therapeutic strategies to achieve better clinical efficacy and safety
Polypharmacy and the Risk of Adverse Drug Reactions in the Elderly at a Tertiary Referral Hospital in Indonesia: Assessing the Applicability of the GerontoNet Score
Full text linkBackground: Geriatric patients are often subject to polypharmacy, increasing their risk of adverse drug reactions (ADRs). This study evaluated polypharmacy practices, ADR incidence, predictive factors, and the applicability of the GerontoNet Score at a tertiary referral teaching hospital in Indonesia. Methods: This retrospective study included 340 geriatric inpatients at Dr. Cipto Mangunkusumo Hospital, Jakarta, in 2023. The relationship between demographic data, comorbidities, number of drugs used, and ADR events was analyzed using the Chi-square test. The association between GerontoNet ADR scores and ADR events was also assessed. Results: The study included 182 (53.5%) male and 158 (46.5%) female patients, with a mean age of 71.9±6.1 years. Of these, 70.9% were aged 65 to 74. A total of 78.8% of patients had ≥ 4 comorbidities. The number of drugs ranged from 3 to 28, with a mean of 10.7 drugs and a median of 10 drugs. ADRs were detected in 26 patients (7.6%), with 17 cases in females and 9 in males (p=0.044). Insulin- and diuretic-induced hypokalemia were the most frequent ADR (13 patients), followed by heparin-induced thrombocytopenia (3 patients). No significant correlation was found between ADRs and age (p=0.505), number of comorbidities (p=0.425), number of drugs (p=0.576), or GerontoNet ADR Score (p=0.530). Conclusion: Polypharmacy is prevalent at Dr. Cipto Mangunkusumo Hospital, yet the incidence of ADRs is relatively low. Most ADRs were related to high-alert drugs, while no significant correlations were found between age, polypharmacy, comorbidities, or GerontoNet Score with ADR events
Cardiac Tamponade Due to Right Ventricle Perforation: A Rare Complication of Catheter Ablation for Ventricular Tachycardia Storm
Full text linkCardiac tamponade is a rare but fatal complication of catheter ablation. We are reporting a case of a 73-year-old male with ventricular tachycardia (VT) storm undergoing urgent VT ablation, who was later found to have right ventricle (RV) perforation—an unusual site for catheter ablation complication. The patient underwent isochronal late activation mapping (ILAM)-based ablation and elimination of local abnormal ventricular activities (LAVA). After procedure, his blood pressure rapidly decreased, and he was found to have cardiac tamponade. The tamponade was recurring despite of pericardial pigtail placement; thus, the patient was prepared for open-heart surgery. To preserve blood, auto transfusion was used as a bridging therapy