Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Relationship between Metformin and Frailty Syndrome in Elderly People with Type 2 Diabetes
Get PDFAim: to explore the possibility of metformin protective effect on frailty syndrome. Methods: this was a case control study conducted in subjects’ ≥60 years old who visited the Geriatrics and Diabetes outpatient clinic of Cipto Mangunkusumo National Referral Hospital between March and June 2013. Diagnosis of frailty was established using the FI-40 item criteria. Statistical analysis was done with chi-square method for bivariate and logistic regression method in multivariate analysis, all data was accompanied with 95% confidence interval. Results: frailty syndrome was found in 25% of subjects (n=59), with median age of 72 years old (SD 6.27) and median of FI-40 item score was 0.18 (SD 0.085). Metformin was found to have a significant relationship with frailty syndrome in the elderly diabetics, which retained significant value after multivariate analysis (adjusted OR 0.043; 95% CI 0.019-0.099; p<0.001). Conclusion: metformin was shown to have protective effect against frailty syndrome in elderly diabetics. Key words: frailty, diabetes mellitus, metformin, elderly
Aspirin Resistance and Its Importance
Get PDFThe use of salicylates (popularly known as aspirin or ASA) is well established for the secondary prevention of cardiovascular disease. However, there are reportedly a numer of patients who suffered repeat cardiovascular events despite being given aspirin “prophylaxis”, and uncertainty prevails on whether or not this is due to an inherent inability of aspirin to sufficiently modify platelet activity or are there other mechanisms involved. Coined as “aspirinresistance”, the condition warrants attention as an ineffective prophylaxis may lead to unexpected morbidity and subsequent disappointmen
The Proportion of Orthostatic Hypotension and Its Relationship with HbA1c Levels in Elderly Patients with Diabetes
Get PDFAim: to obtain information on the proportion of orthostatic hypotension in elderly patients with diabetes and its relationship with HbA1c levels. Methods: this is a cross-sectional study on 350 patients with diabetes mellitus (DM) aged ≥60 years old who sought treatment at outpatient clinic of Geriatry and Diabetes Division at Cipto Mangunkusumo Hospital between January and March 2016. Orthostatic hypotension was defined as a decrease in systolic blood pressure ≥20 mmHg and/or diastolic pressure ≥10 mmHg within 3 minutes after changing position from lying to standing. HbA1c levels was measured using Nycocard from Axis Shield. Chi square test was used for bivariate analysis and logistic regression was used for multivariate analysis against confounding variables. Results: the proportion of orthostatic hypotension in elderly subjects with DM was 27.4%. Median of HbA1c levels was higher in subjects with than without orthostatic hypotension (7.6% vs. 7.1%; p<0.05). There was an association between HbA1c levels of ≥7.35% and the incidence of orthostatic hypotension (OR 1.987, 95% CI 1.2-3.2). The duration of having DM was a confounding variable. Conclusion: orthostatic hypotension is more common in elderly subjects with DM. There is an association between the incidence of orthostatic hypotension and increased HbA1c levels in elderly patients with diabetes mellitus
Pulmonary Papillomatosis: a Rare Case of Recurrent Respiratory Papillomatosis Presenting with Multiple Nodular and Cavitary Lesions
Get PDFPulmonary papillomatosis is an extremely rare variant of recurrent respiratory papillomatosis which is hard to treat, causes prolonged morbidity, and may transform into malignant disorder in several cases. Since the symptoms and radiologic findings are not specific, pulmonary papillomatosis is often being misdiagnosed. Although considered benign, pulmonary papillomatosis carries the most significant mortality. This is a case report of a 26 year old man who complained recurrent chronic cough, slight hemoptoe, occasional pleuritic pain, and several episodes of fever. He also had laryngeal papillomatosis and undergone serial endoscopic resection since his childhood. Multiple nodular and cavitary lesions, some with air fluid level, were found in both lung fields at chest radiography and scintigraphy. Diagnosis of pulmonary papillomatosis complicated with secondary infection was made after endoscopic and histologic study. Key words: pulmonary papillomatosis, recurrent respiratory papillomatosis, nodular lesion, cavitary lesio
Comparison of Asymmetric Dimethylarginine Levels Between Stages Three, Four, and Five Non-dialysis of Chronic Kidney Disease
Get PDFAim: to determine the differences of ADMA level between stages 3, 4, and 5 non-dialysis of chronic kidney disease (CKD) patients at Outpatient Nephrology Clinic, Dr. Soetomo Hospital. Methods: a cross-sectional study was conducted on stage 3, 4, and 5 non-dialysis CKD patients at Outpatient Nephrology Clinic, Dr. Soetomo Hospital, Surabaya from January to February 2015. Stages of CKD were determined based on GFR estimation according to 4-variable MDRD formula. Statistical analysis of differences in the levels of ADMA in three subject groups use one-way ANOVA test. Results:seventy-five patients were included in the study. Each group consisted of 25 patients stage 3, 4, and, 5 non-dialysis patients. Mean age of stage 3, stage 4, and stage 5 non-dialysis CKD patients were respectively 57.12 years, 54.80 years and 53.68 years. The mean levels of ADMA in stage 3, stage 4, and 5 were 0.62 (0.11) IU/mL, 0.72 (0.16) IU/mL, and 0.73 (0.18) IU/mL respectively. Analysis of the differences between the groups showed significant differences in ADMA levels (p=0.04), with the highest difference between stage 3 and stage 5. Conclusion:comparison of ADMA levels showed significant differences between CKD stages and the level tends to be higher along with increase severity of CKD stages
Challenges in Screening and Diagnosing Frailty Syndrome: Which Tool to be used?
Get PDFFrailty syndrome has become one of the geriatric syndromes with an increasing risk of debilitating clinical outcome. Accordingly, thecurrent treatment guidelines have been focusing in viewing frailty syndrome as an important aspect to be considered. The International Diabetes Federation (IDF) classifies the guideline for managing the elderly with type 2 diabetes mellitus based on their functional status, whether it is functionally independent or dependent. Functionally dependent group is further classified as subgroup of frail and/or demented people. Special consideration on older people has also been discussed as a topic on the treatment algorithm for hypertension and dyslipidemia
New Paradigm in Treating Cancer: Right on Target
Get PDFCancer prevalence is increasing every year and now cancer is the third highest cause of death in developing countries. Effective anticancer treatment can prolong life and improve the patient’s quality of life. Targeted therapy is a new therapeutic modality which targets specific molecules in the cancer cell and disrupts dysregulated signaling pathways involved in carcinogenesis. Since targeted therapy does not attack normal cells, its side effects are considered low compared to chemotherapy. More than 15 drugs have been approved for treatment in various human cancers. These drugs can largely be grouped into tyrosine kinase inhibitors and monoclonal antibodies. This review will focus on the most common agents within both groups
Antifungal Susceptibility Testing in HIV/AIDS Patients: a Comparison Between Automated Machine and Manual Method
Get PDFAim: to evaluate the performance of Vitek2 compact machine (Biomerieux Inc. ver 04.02, France) in reference to manual methods for susceptibility test for Candida resistance among HIV/AIDS patients. Methods: a comparison study to evaluate Vitek2 compact machine (Biomerieux Inc. ver 04.02, France) in reference to manual methods for susceptibility test for Candida resistance among HIV/AIDS patient was done. Categorical agreement between manual disc diffusion and Vitek2 machine was calculated using predefined criteria. Time to susceptibility result for automated and manual methods were measured. Results: there were 137 Candida isolates comprising eight Candida species with C.albicans and C. glabrata as the first (56.2%) and second (15.3%) most common species, respectively. For fluconazole drug, among the C. albicans, 2.6% was found resistant on manual disc diffusion methods and no resistant was determined by Vitek2 machine; whereas 100% C. krusei was identified as resistant on both methods. Resistant patterns for C. glabrata to fluconazole, voriconazole and amphotericin B were 52.4%, 23.8%, 23.8% vs. 9.5%, 9.5%, 4.8% respectively between manual diffusion disc methods and Vitek2 machine. Time to susceptibility result for automated methods compared to Vitex2 machine was shorter for all Candida species. Conclusion: there is a good categorical agreement between manual disc diffusion and Vitek2 machine, except for C. glabrata for measuring the antifungal resistant. Time to susceptibility result for automated methods is shorter for all Candida species
Acta Medica Indonesiana - The Indonesian Journal of Internal Medicine 153 Malignant Pleural Effusion in Acute Myeloid Leukemia with Hepatitis B Virus Infection
Get PDFPleural effusions can be the first presentation of a hematologic malignancy. The most common disorders with pleural effusion are Hodgkin and non-Hodgkin lymphoma with a frequency of 20 to 30%, especially if mediastinal involvement. Acute and chronic leukemia are rarely accompanied by pleural involvement. We describe a 46-year-old female with history of progressive dyspnoea. Physical examination was revealed massive left pleural effusion. Complete blood count revealed anemia, trombositopenia and normal leucocyte count. Viral serology test shown positive of HBsAg and total antiHBc. Chest X-ray revealed left pleural effusion. Pleural fluid cytology was myeloblast consistent with acute myeloid leukemia (AML). Bone marrow aspiration smear, bone marrow biopsy smear, and flow cytometry analysis were consistent with acute myeloid leukemia without maturation (AML M0-FAB classification). Key words: Acute myeloid leukemia, pleural effusion, infection
Use of Pleural Fluid Interferon-gamma Enzyme-linked Immunospot Assay in the Diagnosis of Pleural Tuberculosis
Get PDFAim: to evaluate the diagnostic value of an interferon-gamma release assay (IGRA) with enzyme-linked immunospot (ELISPOT) method, T-SPOT.TB, in the diagnosis of pleural TB using pleural fluid mononuclear cells (PFMC). Methods: forty-eight subjects, presumed to have pleural TB with exudative pleural effusion by Light’s criteria, dominated by mononuclear cells, had their pleural fluid specimen tested with T-SPOT.TB, Mycobacterial Growth Indicator Tube (MGIT) culture, and adenosine deaminase (ADA) activity. Other causes of pleural effusion such as heart failure, renal failure, hepatic cirrhosis, and malignancy were excluded. Results: the sensitivity, specificity, positive predictive value, and negative predictive value of the IGRA ELISPOT assay using PFMC for the diagnosis of pleural TB were 100%, 88.89%, 97.5%, and 100%, respectively. Conclusion: IGRA with ELISPOT method performed on PFMC is useful for a rapid and reliable diagnosis of pleural TB in clinical practice, especially in area with high TB burden