Clinical and Research Journal in Internal Medicine (CRJIM)
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Semen Analysis in Type 2 Diabetes Mellitus Patients with Infertility: Semen Analysis in Type 2 Diabetes Mellitus Patients with Infertility
Full text linkBackground: According to World Health Organization (WHO), the condition of infertility is related with inability to get conceived even after regular unprotected active sexual intercourse for one year. Nowadays, the prevalence of infertility is increasing day by day. Among couples who are desperate for pregnancy, about to 15% have complaints related to infertility.
Aim: The present study is aimed to analyze and compare different semen parameters among diabetic infertile males and non-diabetic fertile males.
Methods: This cross-section study done at Dr.Patnam Mahender Reddy Institute of Medical Sciences, Chevella and included 100 diabetic infertile and 100 fertile males. Subjects are selected as per inclusion and exclusion criteria. After 2 to 7 days of sexual abstinence, the semen samples were obtained by masturbation. Semen samples were then observed for microscopic and macroscopic examination as per WHO instructions. Blood sample was collected from a cubital vein, and serum was obtained. The results obtained were entered in tabular form with relevant heading of each parameter. The obtained data is analyzed IBM SPSS Statistics version 20.
Results: It has been observed that there was a significant decrease of sperm concentration, sperm motility, sperm count, semen volume and sperm morphology in diabetic infertile group when compared to non-diabetic fertile group with significant increase in semen liquefaction time and appearance of abnormal sperms.
Conclusion: Levels of Liquefaction time, abnormal appearance, viscosity and abnormal morphology were found to increased and sperm motility, concentration, count were observed to be decreased in the study group on comparison control group
Performance of Soluble CD28 and CTLA4 as a Potential Marker of Immunosenescence
Full text linkBackground: Immunosenescence is a condition of decreased function of the immune system that is generally found in elderly individuals. Several costimulatory molecules, such as CD28 and CTLA-4 have been investigated for their essential role in the immune aging process.
Aim: This study aimed to determine the role of the soluble costimulatory molecules in immunosenescence.
Methods: This study was observational research with cross-sectional approach. Samples were tested using ELISA and flow cytometry examination. Statistical analysis was conducted using independent T-test or Kruskal-Wallis comparison test. Correlation between each biomarker was determined with Pearson or Spearman correlation test. Diagnostic performances of each biomarked were assessed using ROC curve.
Results: This study involved 52 subjects, of which 20 were young individuals aged between 20 to 28 years and 32 were elderly individuals aged between 60 to 85 years. In this study we found that CD4CD28+ and CD8CD28+ T cells were lower in elderly group (p<0.001), while CD4CD57+ and CD8CD57+ T cells were higher in elderly group (p<0.001). sCD28 and sCTLA-4 were significantly higher (p 0.039 and p 0.025 respectively) in old individuals than in young individuals. CD8CD28+ and sCD28 exhibit a significant negative moderate correlation (p=0.007, r= -0.368) meanwhile sctla4 has no correlation with surface immunosenescence markers. Based on the results of roc analysis, sCTLA-4 was the best predictor to determine immunosenescence with area under curve of 0.7. The cut-off value for sCTLA-4 to determine immunosenescence is 26.5 ng/ml with sensitivity and specificity 58.6% and 63.2% respectively.
Conclusion: sCTLA-4 as a soluble costimulatory molecule can be developed as promising predictive biomarkers of immunosenescence, which could be detected more quickly and efficiently using elisa as an alternative to flowcytometry
Effect of Combination of Rosmarinic Acid with Valsartan and Irbesartan on NO and ADMA Levels in Diabetic Nephropathy Model Rats
Full text linkBackground: Diabetic nephropathy (DN) is a complication that often occurs in diabetes mellitus, in which the kidneys are damaged. Nitric oxide (NO) and Asymmetric Dimethylarginine (ADMA) are mediators that play a role in the pathophysiology of DN. Rosmarinic acid (AR) is an antioxidant compound that has the potential to be an alternative treatment for diabetic nephropathy. Valsartan and Irbesartan are antihypertensive drugs that have a nephroprotective effect. However, no studies have studied the concomitant use of AR with these two antihypertensive drugs.
Aim: To identify the effect of the combination of AR and Valsartan and Irbesartan on NO and ADMA levels in DN rat models..
Methods: True experimental laboratory design and a randomized posttest only controlled group design method. The rats were divided into four groups, namely the negative control group, positive control (diabetic rats without therapy), group 3 (AR) 75 mg/kgBW/day with Irbesartab 1.5 mg/kg BW/day) and group 4 (AR) 75 mg/kgBW /day with Valsartan 1 mg/kg/day). Data were analyzed using One-way ANOVA with a significance level of p<0.05.
Results: Administration of Valsartan (79.42±13.95 µmol/L) and Irbesartan (84.62±18.59 µmol/L) significantly increased NO levels compared to the positive control (61.49±8.03 µmol/L) (p< 0.05). Administration of Valsartan (57.87 ± 9.29 ng/mL) and Irbesartan (53.77 ± 9.42 ng/mL) did not decrease NO levels compared to control (50.46 ± 8.52 ng/mL) (p> 0.05 ).
Conclusion: Administration of valsartan and irbesartan increased NO levels in DN rats exposed to rosmarinic acid. However, administration of valsartan and irbesartan did not affect ADMA levels in DN rats exposed to rosmarinic acid
The Outcome of Primary Hyperaldosteronism in Resistant Hypertension with Efficiency Cost in Clinical Practices A Case Report
Full text linkAldosterone as a major mineralocorticoid has an important role in regulating circulating volume and potassium homeostasis, especially in the kidney. Manifestation of hypertension and hypokalemia in the young age population must be considered about the role of Aldosterone. This case report will discuss a patient with uncontrolled hypertension with severe hypokalemia who was treated with 3 kinds of antihypertensive drugs but the blood pressure is still high. After performing several diagnostic tests, the Aldosterone level was significantly high and left an adrenal tumor from an abdominal MRI. The patient treated with mineralocorticoid receptor antagonists or Spironolactone 25mg daily and show controlled blood pressure
Cardiovascular Health and Risk Factors Among Adult Study Participants: Insights from Sociodemographic Characteristics and Health Behaviors
Full text linkBackground: Cardiovascular diseasesconstitute a significant global health challenge, necessitating a comprehensive understanding of their risk factors. This study explores the interplay between sociodemographic characteristics, health behaviors, and cardiovascular health among adult participants.
Aim: The study aims to assess the cardiovascular health status and risk factors in adults, considering sociodemographic characteristics and health behaviors.
Methods: In the Inter-University Consortium for Political and Social Research Study (ICPSR146521), data that had been gathered prospectively were used to assess the prevalence of metabolic syndrome, its risk factors, and the linked lifestyle in adult Myanmar inhabitants.
Results: The study found that age was significantly associated with cardiovascular health, with an increase in age correlating with elevated risk. While gender was not a significant predictor, marital status and occupation played roles in shaping cardiovascular health outcomes. Smoking and sedentary lifestyles were identified as substantial risk factors, while physical exercise and healthier dietary habits demonstrated protective effects. Regression analysis further underscored the influence of BMI, age, and total cholesterol on cardiovascular health.
Conclusion: This study provides critical insights into the complex interplay between sociodemographic characteristics, health behaviors, and cardiovascular health among adults. The findings emphasize the significance of age, smoking, physical activity, and dietary choices in shaping cardiovascular risk. Tailored interventions and public health strategies that consider these factors can enhance cardiovascular diseases prevention and management efforts, ultimately contributing to a reduction in the global burden of cardiovascular diseases
Bee Sting Rhabdomyolysis: A Clinical Case Study Investigating Elevated Procalcitonin Levels Amidst Biochemical Muscle Injury
No full textBee stings, although a nuisance, seem easy to deal with, causing only mild symptoms in the majority of people, but severe systemic reactions, like anaphylaxis or rhabdomyolysis, can rarely happen. Here is an unusual case report of a 75-year-old man with over a hundred bee stings, which resulted in elevated creatinine phosphokinase (CPK) levels, acute kidney injury (AKI), and increased markers of inflammation like C-reactive protein (CRP), white cell count and procalcitonin levels (PCT). Here, we highlight particular attention to procalcitonin, a marker sensitively used to differentiate between bacterial infections and other causes of inflammation. It was significantly elevated to 350 times above its normal upper range despite the patient not exhibiting any signs or symptoms of the disease. The patient made a complete recovery with supportive care, and all his biochemical markers of muscle injury and inflammation and AKI improved to baseline. Here, the authors highlight that clinicians should be aware that PCT can be spuriously elevated in rhabdomyolysis and does not automatically equate to a bacterial infection, re-iterating the need for reasonable antimicrobial use in this situation
Determinants of Health Associated with Dengue Incidence in Patients from the Lodana Health Center
Full text linkVector-borne diseases constitute a significant public health challenge globally, causing over 700,000 deaths annually. Among them, dengue, transmitted by Aedes mosquitoes, has emerged as a formidable threat, particularly in tropical and subtropical regions. Understanding the biology of the virus, the ecology of mosquito vectors, and the socio-economic factors influencing disease spread is imperative for effective prevention and control strategies. This multidisciplinary challenge necessitates collaboration among scientists, healthcare professionals, governments, and communities. Ecuador, experiencing a surge in dengue cases, particularly in provinces like Manabí, underscores the urgency for tailored interventions. This study aims to analyze the influence of health determinants on dengue incidence at Lodana Health Center, proposing targeted promotional strategies within the healthcare setting. The theoretical framework integrates perspectives from Health Promotion, Critical Epidemiology, and Popular Education, emphasizing community empowerment and participatory approaches to address the complexity of dengue control effectively
Validity and Reliability of MoCA-Ina for Assessing Cognitive Function in Dialysis Patients with Chronic Kidney Disease
Full text linkBACKGROUND: Montreal Cognitive Assessment (MoCA) is widely used for assessing cognitive function in chronic kidney disease (CKD) patients, but its effectiveness in Indonesian CKD populations remains unclear compared to studies in other regions.
OBJECTIVES: To evaluate the reliability and validity of the translated MoCA in assessing cognitive impairment among dialysis patients.
METHODS: This cross-sectional study was conducted at the hemodialysis and Continuous Ambulatory Peritoneal Dialysis (CAPD) unit of RSUD Dr. Saiful Anwar in Indonesia from January to February 2024. The study utilized the Indonesian Version of MoCA for cognitive assessment. Reliability and validity of the questionnaire were evaluated using Cronbach\u27s Alpha and Pearson validity test methods.
RESULTS: In this study, 43 participants were enrolled, including 21 undergoing hemodialysis and 22 receiving CAPD. MoCA\u27s reliability was confirmed with Cronbach\u27s Alpha values of 0.648 for hemodialysis and 0.737 for CAPD, indicating strong internal consistency. The questionnaire exhibited favorable discriminatory power, with corrected item-total correlation scores exceeding 0.3 for all items in both groups. Validity demonstrated strong construct validity, with critical values surpassing standard references. All statistical significance levels were below 0.05, affirming MoCA\u27s reliability in assessing cognitive function in dialysis patients.
CONCLUSION: In conclusion, our study has demonstrated that the translated MoCA is valid and reliable for assessing cognitive function in CKD patients undergoing dialysis
Agranulocytosis Induced by Antithyroid Drug (Propiltyourasil): A Rare Case
No full textAntithyroid drugs can cause agranulocytosis in 0.2-0.5% of cases of Graves\u27 disease, which can be life-threatening. Although rare, prompt management is crucial for a good outcome.
A 41-year-old woman presented to the emergency department in March 2023 with complaints of fever, odynophagia, cough, nausea, vomiting, and weight loss. She had been diagnosed with hyperthyroidism in 2015 and was prescribed thiamazole 5mg once daily. She was declared cured in 2018. In February 2023, she was hospitalized for heart failure and diagnosed with Graves\u27 disease. She was discharged with PTU 100mg three times daily. After two weeks of PTU treatment, the patient developed symptoms of agranulocytosis. Laboratory tests showed low white blood cell count and abnormal thyroid function. PTU therapy was discontinued, and the patient was treated with SC GCSF 300mg once daily, IV Ceftriaxone 1g twice daily, IV Ciprofloxacin 400mg twice daily, PO Propranolol 40mg three times daily with a target heart rate <90 beats per minute, and PO Thiamazole 5mg once daily initiation again because there is no side efect at previous medication with the same regiment and the alternative treatment such as iodine radioactive and surgery did not perform yet. Although initially the ANC was low, the patient\u27s condition improved, and she was discharged after 13 days of treatment with normal laboratory results. Follow-up outpatient monitoring showed continued improvement.
Accurate diagnosis and appropriate management are crucial in handling agranulocytosis induced by antithyroid drugs, which can significantly improve treatment outcomes and the patient\u27s prognosis