Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Multidrug-Resistant Bacteria Colonization in Patients Admitted to Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
Full text linkBackground: Antibiotic resistance is the main problem in infectious disease management. Multidrug-resistant (MDR) bacteria could be carried by admitted patients and become a source of spread in the hospital, causing infections in other patients or the patients themselves. However, the screening of MDR bacteria has not been a standard in developing countries. This study aimed to get the prevalence of MDR bacteria colonization in patients on admission to Dr. Cipto Mangunkusumo Hospital. Methods: Selective liquid media with added antibiotics were used for culturing the MDR bacteria. While admitted to the hospital, subjects were sampled and interviewed to fill out a questionnaire. The screening specimens used for this study were throat, navel, rectal, nasal, and armpit swabs. During hospitalization, hospital-acquired infections (HAIs) were recorded. Results: Of 100 patients included in the study, the prevalence of MDR bacteria colonization on admission was 63% (n=63) with the prevalence of CR-GNB, ESBL-PE, and MRSA were 11%, 54%, and 11%, respectively. Two-thirds of the patients with HAIs (n=8/12) were colonized with MDR bacteria. Factors associated with MDR bacteria colonization were the recent use of invasive medical devices and comorbidity, while a factor associated with CR-GNB colonization was the recent use of antibiotics. Conclusion: The prevalence of MDR bacteria colonization in patients on admission to Dr. Cipto Mangunkusumo Hospital in 2022 was 63% (n=63), of which 12.68% (n=8) experienced HAIs during hospitalization. MDR bacteria colonization was associated with the recent use of invasive medical devices and comorbidity. History of antibiotic use was associated with CR-GNB colonization
Early Experience of Left Bundle Branch Pacing with Lumenless Lead in a Single Center: A Case Series
Full text linkLeft bundle branch pacing (LBBP) has been subject to increasing interest over the last few years due to its capacity for physiological conduction and its advantages compared to His bundle pacing. His bundle pacing has certain limitations, such as a small pacing area for the His bundle, a high threshold that leads to battery depletion, a low R-wave amplitude that may result in atrial or His oversensing, and ventricular signal undersensing. In this case series, four patients (two female and two male) aged 62.2 ± 8.4 years old with symptomatic sick sinus disease and no scar tissue in the interventricular septum underwent LBBP. All LBBPs were done with standard LBBP using a lumenless SelectSecure 3830 lead (Medtronic®, Minneapolis, USA) with a fixed helix. The lead parameters showed a good R-wave amplitudes (13 ± 7.4 mV) and a low threshold (0.77 ± 0.17 V @ 0.4 ms). All patients were discharged on the next day. During follow-up period of 13.3 ± 12.9 months, all patients were well and no complications were noted. In conclusion, LBBP may be as an alternative of novel conduction pacing techniques and can be done relatively easy and safe, even with limited experience center.
Updating AFP Level in Chronic Hepatitis B to Evaluate the Risk of Hepatocellular Carcinoma Occurrence
Full text linkBackground: Hepatocellular carcinoma (HCC) is a cancer with poor prognosis. Indonesia is a country with high prevalence of chronic hepatitis B infection. The performance of alpha fetoprotein (AFP) as a tumor marker in HCC surveillance is primarily influenced by the etiology of the underlying liver disease. We aimed to determine the best cut-off value of AFP biomarker examination for HCC surveillance in patients with chronic hepatitis B infection. Methods: The study collected medical record data of the Hepatobiliary Division of Dr. Cipto Mangunkusumo Hospital from the period of 2017 to 2023. A total of 506 subjects with chronic hepatitis B of all spectrums (hepatitis B without cirrhosis, liver cirrhosis, and early-stage HCC, BCLC 0 and A) were included by total sampling that was performed from 26 July 2023 to 31 August 2023. Determination of the AFP cut-off value was carried out using the receiver operating characteristics (ROC) method. Results: For HCC surveillance caused by hepatitis B virus, ROC curve analysis resulted in an area under the curve (AUC) of 0.792 (95% CI, 0.719-0.866), and the cut-off value with the highest Youden index was 8.7 ng/ml, with 58% sensitivity, 94% specificity, positive predictive value (PPV) 56.14%, negative predictive value (NPV) 94.43%, positive likelihood ratio (LR+) 10.08, and negative likelihood ratio (LR-) 0.46. Conclusion: The cut-off value of AFP in HCC surveillance on hepatitis B specific etiology is lower than the cut-off value of AFP in previous HCC surveillance which was not etiologically specific. The cut-off value of 8.7 ng/ml produces the best sensitivity and specificity for the cut-off value for HCC surveillance with hepatitis B etiology.
Recurrent Acute Upper Limb Ischemia in a Young Male: Case Report
Full text linkAlthough acute upper limb ischemia (AULI) is less prevalent than lower acute limb ischemia, AULI may lead to severe morbidity if not well-treated. To manage AULI appropriately, evaluation of the etiologies, risk factors, and revascularization is of importance. Here we present a case of recurrent AULI and its appropriate diagnostic and management approaches. A 27-year-old male with a chief complaint of pain and numbness in his left arm for one week. He had a history of AULI seven months before and was treated by percutaneous intra-arterial thrombolysis at left brachial and radial arteries with residual non-occlusive thrombus. Duplex ultrasound (DUS) and CT angiography revealed a new soft thrombus with occlusion at the left subclavian artery. Evaluation of comorbid risk factors and source of thrombus was performed. The patient underwent pharmacomechanical thrombectomy and angioplasty procedure. The diagnosis of AULI was established based on pain and numbness in the left arm, and the finding of soft thrombus and occlusion of the left subclavian artery on DUS and CT angiography evaluation. Although various workups have been carried out to determine the etiology of AULI in this patient, the definite cause remains unknown. In addition, pharamcomecanical thrombectomy and angioplasty were performed as the appropriate revascularization methods in this condition. Recurrent AULI is a rare vascular phenomenon leading to disabling morbidities and fatal consequences if not treated properly. Further evaluation of etiology and risk factors for recurrent AULI is mandatory for appropriate management besides revascularization
Spontaneous Rupture of Abdominal Aorta Pseudoaneurysm: a Case Report
Full text linkPseudoaneurysms are false aneurysms that mostly occur at the site of arterial injury. Pseudoaneurysm is the most frequent complication after catheter-associated interventions and occurs because of an insufficient closure of the puncture site. However, there are several reported cases of patients with pseudoaneurysm without a prior history of vascular intervention. We described a case of ruptured giant abdominal aortic pseudoaneurysm in a patient with no prior history of vascular intervention, with an initial complaint of abdominal pain. The patient successfully received EVAR therapy using a kissing graft
Factors Associated with Psychosomatic Disorders Among Systemic Lupus Erythematosus (SLE) Patients During the Coronavirus Disease 2019 (COVID-19) Pandemic
Full text linkBackground: The COVID-19 pandemic has affected physical and mental health. SLE patients are prone to psychosomatic disorders which can decrease their quality of life. This study aimed to determine the factors associated with psychosomatic disorders among SLE patients during the COVID-19 pandemic. Methods: This was a cross-sectional study of adult female SLE patients from the outpatient clinic of Cipto Mangunkusumo Hospital, Jakarta. Data regarding psychosomatic disorders were collected using SCL-90 questionnaires, and data on demographic factors, perception of COVID-19 conditions, perception of stress, psychosocial stressors, disease activity (MEX-SLEDAI), and treatment were also collected. Bivariate analysis for categorical data was conducted using the Chi-square test. Variables with a p-value <0.25 were further analyzed with logistic regression, and p-values <0.05 were considered significant. Meanwhile, data per domain were analyzed using the Mann-Whitney test with p-values < 0.05 being considered significant. Results: There were 200 female SLE patients recruited. More than half of the subjects (54%) experienced psychosomatic disorders. From multivariate analysis, high educational levels, moderate and high psychosocial stressors, and very severe disease activity levels were found to be significantly associated with the occurrence of psychosomatic disorders in SLE patients during the COVID-19 pandemic. Conclusion: Education level, psychosocial stressors, and disease activity level were found to be significantly associated with the occurrence of psychosomatic disorders in SLE patients during the COVID-19 pandemic
Efficacy of Tenofovir Disoproxil Fumarate in Preventing Vertical Transmission of Hepatitis B in Mothers with Chronic Hepatitis B: An Evidence-Based Case Report
Full text linkBackground: Hepatitis B virus infection is the most common cause of chronic hepatitis. Vertical transmission is the main transmission route of this virus. Current prevention involves giving newborns immune prophylaxis within 12 hours of birth. However, there is still a failure of immunoprophylaxis, especially in cases of mothers who have a high viral load or are HBeAg positive. Tenofovir disoproxil fumarate (TDF) is the first-line treatment for chronic hepatitis B and is known to reduce perinatal HBV transmission. This study aims to determine the efficacy of TDF in preventing vertical transmission in pregnant women with chronic hepatitis B. Methods: A literature search was performed on the online databases of PubMed/MEDLINE, Embase, Scopus, Cochrane, and ScienceDirect. The inclusion criteria used were pregnant women with chronic hepatitis B and using TDF antiviral as a transmission prevention therapy with the study design used in the form of a meta-analysis, systematic review, randomized or nonrandomized controlled trial. The outcome of interest was the vertical transmission rate of hepatitis B. Results: There are two studies used with a meta-analysis study design and a nonrandomized controlled trial with a good critical review result of Validity, Importance, and Applicability. TDF significantly prevented vertical transmission of hepatitis B compared to placebo. In addition, TDF was not associated with the incidence of maternal and fetal complications. Conclusion: TDF has high effectiveness in preventing vertical transmission of hepatitis B and is safe to give to pregnant women
Comparison of CISNE and MASCC Score in Predicting Complications on Post Chemotherapy Febrile Neutropenia
Full text linkBackground: Febrile neutropenia (FN) is an oncologic emergency which commonly occurrs in patients who undergo chemotherapy, with a mortality rate of 12.5%. Risk stratification in FN plays an important role in increasing the accuracy of therapy. This study aims to compare the performance between CISNE score and MASCC score in predicting complications on post-chemotherapy FN in solid and hematologic malignancy. Methods: This is a retrospective cohort study on FN patients undergoing inpatient treatment at Cipto Mangunkusumo Hospital between July 2015 and December 2019. Basic demographic and clinical data were collected from medical records. Subjects were grouped based on the CISNE and MASCC score, and complications during hospitalization were recorded. Predictive performance of each score was analyzed and compared using area of under curve. Results: CISNE score showed a better performance both in solid malignancy with AUC of CISNE score (0.80 CI 95% 0.73-0.88, p = 0.00) compared to AUC of MASCC score (0.68; 95% CI 0.59 – 0,78, p = 0.00) and in hematologic malignancy with AUC of CISNE score (0.85; 95% CI 0.77 - 0.93, p = 0.00) and AUC MASCC score (0.65 ; 95% CI 0.54 - 0.76, p = 0.007). Conclusion: CISNE score showed a better performance compared to MASCC score in predicting in-hospital complication in both solid and hematologic malignancy with cut-off point of 2.
Kikuchi-Fujimoto Disease Preceding Overlap Syndrome of Sjögren’s Syndrome and Systemic Lupus Erythematosus: Literature Review Based on a Case Report
Full text linkKikuchi-Fujimoto disease (KFD) is a benign, self-limiting histiocytic necrotizing lymphadenitis systemic disorder with unknown etiology. KFD has been known for half a century, but difficulties in distinguishing it remain. Its diagnostic significance is related to the increasing prevalence of KFD with autoimmune diseases in various timeframes. Systemic lupus erythematosus (SLE) is the most prevalent autoimmune connective tissue disease (AICTD) appearing alongside KFD. An 18-year-old female presented with acute muscle weakness, shortness of breath, fever, and significant weight loss for 5 months before admission. Pain and morning joint stiffness had been felt for 9 months. One year ago, she lumped her right neck and was diagnosed with KFD from the excision biopsy and immunohistochemical staining (CD68). Creatine-kinase enzymes and C-Reactive protein were elevated with a high anti-Ku and anti-Jo-1 negative level. There was a low level of complements, high anti-nuclear antibody titer, with positive anti-SS-A. Sialometry and Schirmer test showed reduced salivary and lacrimal gland production. We diagnosed this patient as having an overlap syndrome preceded by KFD. The AICTD involved was Sjögren’s syndrome and SLE. Although KFD is considered a self-limiting disease, its occurrence should be noticed regarding the possibility of other autoimmune conditions. KFD usually coincides with AICTD, although it could also precede or occur afterward. This case is reported to raise awareness of the overlap syndrome preceded by KFD
Hypokalemia Related to Distal Renal Tubular Acidosis as an Initial Presentation of Primary Sjogren’s Syndrome
Full text linkHypokalemia due to loss of potassium through the kidneys can be caused by distal Renal Tubular Acidosis (dRTA). The etiology of dRTA can be primary due to genetic defects or secondary to autoimmune diseases, especially Sjogren’s syndrome (SS). The occurrence of dRTA in SS patients is low, at only 5% of cases. This case was interesting because dRTA was the initial clinical manifestation that led to the diagnosis of SS in the patient. A 48-year-old woman came with complaints of recurrent weakness. The patient was routinely hospitalized with severe hypokalemia and received potassium supplementation. The diagnosis of dRTA was based on repeated weakness, normal blood pressure, severe and recurrent hypokalemia, high urinary potassium, alkaline urine, low plasma bicarbonate, and standard anion gap metabolic acidosis. The diagnosis of SS in this patient was confirmed based on dry eyes, dry mouth, positive Schirmer’s test, and positive autoantibodies to SS-A and Ro-52. There was a delay in the diagnosis of SS for two years in this patient because the complaints were initially subtle and non-specific. The hypokalemia in this patient was secondary to dRTA associated with primary SS. The possibility of an underlying autoimmune disorder should be considered in a patient presenting with recurrent severe hypokalemia. dRTA, as the etiology of hypokalemia, can be a gateway to the diagnosis of SS. In this patient, complaints related to dRTA appeared before the onset of sicca symptoms, and the diagnosis of SS was established