Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Hyperbilirubinemia with Unusual Dermatologic Signs: A Diagnostic Puzzle
Full text linkJaundice, characterized by yellow discoloration of the skin, mucous membranes, and sclera, results from hyperbilirubinemia and is uncommon in adults. Its occurrence often signals serious underlying conditions. Hyperbilirubinemia may also present with cutaneous manifestations, including xerosis, hyperpigmented plaques, and erythematous rashes. A 47-year-old woman presented with hyperbilirubinemia, transaminitis, and cutaneous manifestations, including hyperpigmented plaques on the face, erythematous rashes on the hands and feet, and yellowish discoloration of the skin. Despite extensive evaluation, including viral hepatitis screening, autoimmune markers, and imaging, a definitive diagnosis remained elusive. The clinical features and laboratory findings suggested Primary Biliary Cholangitis (PBC) as the most likely diagnosis, although further confirmation through advanced serological testing and liver biopsy was needed. Treatment with ursodeoxycholic acid (UDCA) and high-dose oral methylprednisolone showed clinical improvement but persisted in transaminitis with a normal ultrasonographic appearance. This case emphasizes the importance of recognizing cutaneous signs in systemic diseases and the need for a comprehensive diagnostic approach in resource-limited settings
Subphenotypic Classification of Immune Response in Sepsis: Predicting Mortality and Guiding Future Personalized Immunotherapy
Full text linkThe most recent definition of sepsis highlights the dysregulation of the host’s immune response to infection, which varies between individual hosts, with patients predominantly presenting with either hyperinflammation, immunoparalysis, or a combination of both states. Therefore, management strategies must be tailored to accommodate the heterogeneity of patients with sepsis, as these conditions are associated with distinct prognoses and therapeutic approaches. Identification of the immune response in patients with sepsis can be achieved through advanced techniques, such as gene expression profiling or, more simply, through a subphenotypic approach. This article introduces a subphenotypic classification of the sepsis immune response into macrophage activation-like syndrome (MALS), where pathological macrophage activation leads to excessive hyperinflammation, immunoparalysis, or neither. Patients are classified using serum ferritin levels and monocyte HLA-DR expression, which is assessed using peripheral blood. This classification demonstrates significant differences in survival across groups, which is attributed to their distinct underlying biological processes. Immunotherapeutic options also differ for these three groups. In the future, such immune response classifications will be valuable in sepsis management algorithms for personalized prognostication and therapy
Bridging Palliative Care and HIV/AIDS: A Call for Integrated Approaches
Full text linkHuman Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS) remain significant global health challenges. Beyond the physical manifestations, individuals living with HIV/AIDS often grapple with psychological burdens, notably anxiety, which can adversely affect their quality of life (QoL) and physiological stress markers, such as cortisol levels. Palliative care, traditionally associated with end-of-life support, has evolved to address the multifaceted needs of chronic illness patients, including those with HIV/AIDS. In the world, 1.89 million individuals require palliative care due to pain, and around 2.7 million people have HIV. This editorial explores the role of palliative care in enhancing QoL and modulating cortisol levels among HIV/AIDS patients experiencing anxiety.
Palliative care is holistic, addressing physical, emotional, social, and spiritual needs. In the context of HIV/AIDS, palliative interventions have demonstrated efficacy in alleviating symptoms, reducing psychological distress, and improving overall well-being. A systematic review highlighted that home-based palliative care and inpatient hospice services significantly improved patient outcomes in pain management, symptom control, anxiety reduction, and spiritual well-being. Palliative care emerges as a vital component in the comprehensive management of HIV/AIDS, particularly for patients grappling with anxiety. By enhancing quality of life and potentially modulating stress-induced hormonal imbalances, palliative interventions offer a holistic approach that addresses both psychological and physiological aspects of the disease. Future research should focus on elucidating the mechanisms by which palliative care influences cortisol levels and exploring its long-term benefits on disease progression and patient well-being
Role of Antidepressants in Acute Coronary Syndrome: An Evidence-Based Case Report
Full text linkBackground: Acute coronary syndrome (ACS) and depression are related to each other. Detection and proper treatment of these conditions can improve functional ability and quality of life. However, there is still controversy in this population regarding the use, safety, and efficacy of antidepressant pharmacotherapy. This evidence-based case report (EBCR) aims to determine the role of antidepressants in acute coronary syndrome patients. Methods: Literature searching was performed using online databases such as EBSCO, Embase, PubMed, ClinicalKey, and ScienceDirect according to clinical questions. The studies were selected based on the suitability of the inclusion and exclusion criteria followed by critical appraisal. Results: In patients with ACS, antidepressants do not affect mortality but may reduce rehospitalization. In patients with ACS and depression who received antidepressants, there is a reduced risk of myocardial infarction (MI) recurrence. In post-ACS patients, the use of antidepressants is associated with a reduced risk of recurrent MI. Conclusion: In ACS patients, antidepressants do not affect mortality, but can reduce the incidence of myocardial reinfarction
Isolated Pulmonary Arterial Thrombosis in Patient with Eisenmenger Syndrome Treated with Catheter-directed Thrombolysis: A Case Report and Literature Review
Full text linkThe concept of venous thromboembolism (VTE) has recently been revisited because of evidence of a new spectrum of the disease called in situ pulmonary arterial thrombosis (ISPAT). We present the case of a 40-year-old female with shortness of breath, who was referred from a regional hospital because of a secundum atrial septal defect. Using echocardiography and computed tomography pulmonary angiogram, she was diagnosed with ISPAT. She received catheter-directed thrombolysis with good results. Knowing the difference in diagnostic clues between classical VTE and ISPAT is crucial, especially for managing the patient correctly
Quality of Life Study in Chronic Diseases: More Needed Than Ever
Full text linkNumerous thyroid diseases can impact patients’ lives, one of which is Graves’ ophthalmopathy (GO). Graves’ ophthalmopathy is a progressive thyroid-related disease that causes eye symptoms due to an autoimmune reaction targeting thyrotropin/thyroid stimulating hormone (TSH) receptors in the orbital space. This condition can be easily recognized by the patient, including exophthalmos, pain, swelling, double vision, and impaired vision. Globally, the estimated incidence of GO is 3.3–8 per 100,000 in women and 0.9–1.6 per 100,000 in men with the peak incidence between 30-60 years old. The prevalence of GO is 9 per 100,000, with the prevalence of GO among patients with Graves’ disease reaching 30%.Anggraini and Nusanti’s study is one of only a few studies in Indonesia that aim to adapt a quality of life questionnaire into Bahasa Indonesia and find out patients’ quality of life afterward, specifically in the thyroid field. The steps for translation, validation, and adaptation of the questionnaire and thus exploring patients' quality of life can be a model for similar studies. Today, our patients not only need assessment for clinical symptoms, signs, laboratory, or radiology results but also need assessment for their well-being and unmet needs which are summarized in the quality of life questionnaires. In the end, optimal quality of care will be the ultimate goal for all chronic disease patients.
Outcome of Patients with Metabolic-Associated Fatty Liver Disease Who Are Infected with SARS-CoV-2: A Meta-Analysis
Full text linkBackground: Metabolic-associated fatty liver disease (MAFLD) is excess fat accumulation in the liver due to metabolic syndrome. Coronavirus disease 2019 (COVID-19) is an infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 not only attacks the respiratory system but also involves systemic and extra-pulmonary organ disorders, including liver disorders. This review evaluates the severity of COVID-19, mortality, and length of hospital stays of patients with MAFLD who were infected with SARS-CoV-2. Methods: Literature searches were conducted through various online databases. The risk of bias assessment was conducted by two researchers using the Newcastle Ottawa Scale tool for NRSI studies, and any discrepancies were resolved by another team member. The meta-analysis was performed using Revman 5.4.1 and results were presented in forest plot by calculating the pooled odds ratio or mean difference between the MAFLD and non-MAFLD groups from the evaluated studies with a 95% CI. Results: The results of the meta-analysis using a fixed-effect model from seven studies showed that COVID-19 patients with MAFLD were associated with a higher mortality compared to those without MAFLD (OR 1.41, 95% CI 1.19-1.69, p=0.01, I2 48). However, there were no differences in COVID-19 severity (OR 3.12, IK95% 0.89–11.03, p=0.08, I2 92) and length of hospital stay (MD 1.27, CI95% 0.03–2.52, p=0.04, I2 80) between the two groups. Conclusion: MAFLD patients infected with SARS-CoV-2 were associated with higher mortality than non-MAFLD patients, but they were not associated with greater severity of COVID-19 nor a longer duration of hospitalization
Validation of Indonesian Graves’ Ophthalmopathy Quality of Life Questionnaire and Its Association with Clinical Activity and Severity of Graves’ Ophthalmopathy
Full text linkBackground: Graves’ ophthalmopathy (GO) ocular abnormalities can persist even after treatment, negatively impacting patients’ psychological and social health. The Indonesian Graves’ Ophthalmopathy Quality of Life (GO-QoL) Questionnaire has not been validated, hence it cannot measure patient quality of life, which is crucial to GO treatment. We aimed to provide a reliable Indonesian GO-QoL Questionnaire and identify an association between patient quality of life and clinical activity and the severity of GO. Methods: The process of questionnaire validation involves transcultural adaptation and a cross-sectional design. The content validity index (CVI) and Cronbach’s alpha assessed validity and reliability, respectively. Results: The CVI was 1.00 for the Indonesian GO-QoL questionnaire. The Cronbach’s alpha for the visual function subscale value was 0.971, the appearance subscale value was 0.993, and the total score was 0.986. The appearance subscale and total score of GO patients’ quality of life had a significant association with clinical activity score (p<0.05) and disease severity (p<0.001). Conclusion: The Indonesian version of the GO-QoL has good validity and reliability. Both the active clinical activity of GO and the severity of the disease decreased patients’ appearance and general quality of life
The Effect of Music Therapy for Improving Quality of Life in Patients with Cancer Pain: An Evidence Based Case Report
Full text linkBackground: Music therapy is a frequently used complementary and creative arts treatment in psychosocial cancer care. Particularly in advanced cancer populations and palliative care, music therapy has recently received high attention in both research and clinical care. This evidence-based case report is aimed to assesed the effect of music therapy for improving quality of life in patients with cancer pain. Methods: the search was conducted on Pubmed, Cochrane Library, and EMBASE according to clinical question. The studies were selected based on inclusion and exclusion criteria. The selected study was critically appraised. Results: All selected studies significantly showed effectiveness of music therapy towards quality of life in cancer patient. Conclusion: Music therapy might be beneficial adjuvant for cancer patients
Hypertonic Dextrose Prolotherapy Injection in Grade IV Knee Osteoarthritis with Obesity: A Case Report
Full text linkThe main complaint in knee osteoarthritis (KOA) is knee pain and limited range of motion (ROM) which affects the patient's quality of life. Dextrose prolotherapy successfully reduced pain and enhanced functional status and quality of life in chronic knee pain, which is classified as KOA grade II or III by the Kellgren-Lawrence classification. We present a case of grade IV KOA with co-morbid obesity who refused surgical management but got dextrose prolotherapy instead. She received prolotherapy for the right knee 5 times with a gap of 4 weeks between treatments. Western Ontario and McMaster Universities Osteoarthritis (WOMAC score), Numerical Rating Scale (NRS), knee ROM, Barthel index, count test, and Timed Up and Go Test (TUG) were evaluated 1 day after each treatment and compared to each post-injection score. This patient is also comorbid of grade II obesity which is associated with mechanical loads on the knee joint causing inflammation and progression of KOA. After 5 months of prolotherapy treatment, strengthened quadricep muscle exercising and static cycle endurance exercising, she improved her pain, WOMAC score, and cardiorespiratory function. Hypertonic dextrose prolotherapy (HDP) is one of the choices for interventional therapy of its advantages, inexpensive, easily conducted, safe with minimal or even no recorded complications, and long-term efficacy even for grade IV of KOA like this patient