Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Persistent lymphopenia in septic patients at Dr. Sardjito General Hospital, Yogyakarta
No full textSepsis triggers immune responseboth pro-inflammatory and anti-inflammatory. Lymphocytes play an important role in the regulation of the inflammatory response. The decrease in lymphocyte numbers due to continuous apoptosis by sepsiscan suppress the immune system and failure to resolve inflammation. Persistent lymphopenia is also associated with a poor prognosis of sepsis. Currently, there are limited studies about persistent lymphopenia in sepsis patients in low- and middle-income countries, including Indonesia. This study aimed to describe the sociodemographic, clinical, and laboratory patterns of sepsis patients with persistent lymphopenia. This was a descriptive study that analyzed patients’ medical records who were treated at the Department of Internal Medicine, Dr. Sardjito General Hospital, Yogyakarta from January 1st, 2016, to December 31th, 2017. Patients diagnosed with clinical sepsis and persistent lymphopenia were included in the study. The status of persistent lymphopenia was described as lymphocyte counts that remained low or lower (<1.62x103/L) on day 4± 24 h compared to the initial value at the time of sepsis diagnosis (day one). Information of patients’ individual and clinical characteristics, complete blood cell count profiles and culture results were included. The outcomes of interest were the survival status and length of stay of the patients. A total of 101 patients with sepsis and persistent lymphopenia were involved in this study. The average increase in lymphocyte numbers was 73.63 ± 426.86/µL. The main source of infection was pulmonary infection, with a mortality rate of 43.6% and a median survival of 19 days. The average length of stay was 13.1±6.8. Persistent lymphopenia in patients with sepsis has a high mortality. Further research is needed to determine the clinical ramifications of persistent lymphopenia
Controversy of angiotensin receptor blockers (ARBs) and angiotensin converting enzymeinhibitors (ACEIs) prescription for hypertension patients in coronavirus disease 2019 (COVID-19) pandemic
No full textCoronavirus disease 2019 (COVID-19) pandemic has made all the world in a mess. Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 infects human cells through angiotensin-converting enzyme 2 receptors (ACE receptors). Angiotensin-converting enzyme 2 (ACE) is upregulated in diabetes and cardiovascular diseases including hypertension. Hypertension patients commonly consume angiotensin receptor blockers (ARBs) and/or angiotensin-converting enzyme inhibitors (ACEIs) which could increase ACE receptors. It was suspected that the ARBs or ACEIs administration may worsen the clinical outcome for the hypertension patients with COVID-19. However, no clinical trial had significantly revealed how appropriate management and prescription of ARBs and ACEIs for the hypertension patients with COVID-19. The use of ARBs and ACEIs for these patients is still controversy. Studies concerning the side effect of single or combination use of ARBs and ACEIs in the hypertension patients with COVID-19 as well as specific morbidity and mortality are needed. This review was aimed to provide understanding concerning the appropriate management and prescription of ARBs and ACEIs for hypertension patients with COVID-19
Angiotensin converting enzyme 2 (ACE2), COVID-19 and cardiac injury: what cardiologist should know
No full textCoronavirus disease 2019 (COVID-19) has already stated as a pandemic by the World Health Organization (WHO). Until now, Indonesia has also infected with this severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. All medical staffs join hand by hand to overcome this pandemic, not only pulmonologist but also cardiologist. Early reports from China showed that cardiovascular comorbidities add more mortality than without comorbid. Cardiac implication of this infection is cardiac injury. Viral pathology and pathophysiology that induced cardiac injury is still debatable and not well understood. Angiotensin-converting enzyme 2 (ACE2) has emerged as a key regulator of renin-angiotensin system in cardiovascular disease. ACE2 has been postulated as one of the pathophysiology of COVID-19 and cardiac injury
Human security, social stigma, and global health: the COVID-19 pandemic in Indonesia
No full textCoronavirus disease 2019 (COVID-19) is now a global public health threat with many medical, ethical, economic, and socialimpacts. COVID-19 has spread worldwide, to many Asian and Middle Eastern countries, the United Statesof America, and European countries. The current COVID-19 pandemic that has devastated Indonesia, has infected and killed more healthcare workers, in particular doctors and nurses, than any other outbreak in the history of this virus. People have basic needs that must be met for them to feel safe and secure. A history of the outbreak of the COVID-19 is brifley showed, before exploring the impact the virus had in Indonesia. During this exploration, some of the key issues arising from the experiences in Indonesia, in addressing the threat of COVID-19 will be reviewed. Drawing on the COVID-19 as the case study, we consider the ways in which the concept of human security expands understanding of its relationship to health. Further, weshow how major public health issues can evolve into security threats.The final section of the article will be an analysis of the lessons learned from COVID-19 and policy implications in addressing health and human security threats
Pulmonary artery hypertension patients and the coronavirus disease of 2019 (COVID-19): are they protected from severe disease?
No full textThe coronavirus disease of 2019 (COVID-19) is a current pandemic of viral infection which mainly involves respiratory system and may progress into severe multiple organ dysfunction and mortality. Pulmonary artery hypertension (PAH) is a disease marked by increased mean pulmonary artery pressure and pulmonary vascular resistance due to pulmonary panvascular remodeling. Although rare, the prevalence of PAH is currently escalating in Indonesia due to increased diagnostic capacity and referral, treatment availability and improved survival. Despite chronic cardiac and pulmonary diseases are at increased risk to develop severe COVID-19, patients with PAH are considered to be not in higher risk to develop severe COVID-19. However, whether this population is protected from severe COVID-19 is unclear. There are protective and offensive factors need to be considered in PAH patients in respect to COVID-19
The correlation of HbA1c levels on the healing process of postoperative fractures in diabetes mellitus patients
No full textFracture is defined by the loss of bone or cartilage continuity, either total or partial. Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both. HbA1c could be used as a diagnostic tool and determines the glycaemic control of DM patients. This study aimed to investigate the correlation between serum HbA1c levels and the healing process of postoperative fractures in DM patients. This was an observational study with a retrospective cohort design. The study population was DM patients who were admitted to the Department of Emergency, Dr. Wahidin Sudirohusodo General Hospital, Makassar due to long bone fracture within the period of September 2019-February 2020. The bone fractures healing was evaluated based on the radiographic union scale in tibial fractures (RUST) scores. The results are analysed using the Chi-square test. A total of 70DM patients who underwent fracture reduction surgery were involved in this study. Out of 35 patients with controlled DM (HbA1c 7%), and there were 13 (37.1%) patients and 22 (62.9%) patients with good and delayed union, respectively. The Chi-square test showed a significant relationship (p= 0.008). It can be concluded that the increase in HbA1c levels was related to the obstacles in bone fractures healing. Moreover, an infection contributes to the healing status of bone fractures
Insulin resistance and non-alcoholic fatty liver disease: a review of the pathophysiology and the potential targets for drug actions
No full textInsulin resistance refers to the reduced physiological effects of insulin on various tissues. Insulin resistance has been implicated in the pathophysiology of non-alcoholic fatty liver disease (NAFLD), which is a spectrum of diseases ranging from hepatic steatosis on one end to steatohepatitis, liver cirrhosis and hepatocellular carcinoma on the other end. In most parts of the developed world, it is now the most commoncause of chronic liver disease and the most commonindication for liver transplantation. A similar findingis emerging in the developing world due to the rising prevalence of obesity and widespread adoption of Western lifestyles. Despite these epidemiological data, there are no universally approved medications for the treatment of NAFLD. The pathophysiological mechanisms of NAFLD essentially include adipose tissue insulin resistance, hepatic insulin resistance, inflammation and fibrosis. At the subcellular level, mitochondrial dysfunction, oxidative changes and endoplasmic reticulum dysfunction have been documented. Several drugs have been tested in vitro and in animal studies to target these pathophysiological mechanisms. Some are presently going through clinical trials, while others have already gone through clinical trials with variable results. Other potential target sites of drug development for the treatment of NAFLD are based on the complex pathophysiology of the disease. Insulin resistance plays an important role in the development of NAFLD. There are potential targets in the pathophysiology of NAFLD that can be explored in the development of medications for the disease
Association between monocyte-high density lipoprotein ratio (MHR) and severity level of lower extremity artery disease (LEAD)
No full textThe incidence of lower extremity artery disease (LEAD) has increased worldwide in the last decade. Its severity has been associated with increased morbidity and mortality. Atherosclerosis is believed as the main cause of LEAD. Monocytes and low-density lipoprotein (LDL) are the hallmarks of atherosclerosis. High-density lipoprotein (HDL) plays a role in suppressing the activation of monocytes. The monocyte to HDL ratio (MHR) has been reported as a marker of coronary artery disease complexity. However, this marker has not been investigated to assessthe LEAD severity. The study aimed to investigate the association between MHR and LEAD severity. This was an analytic observational study using a cross-sectional design. Patients were selected from the Vascular Disease Registry in Dr.Sardjito General Hospital, Yogyakarta from January 2016 – January 2019. The blood sample was drawn at one day prior, on the day, or one day after duplex ultrasound performed. The duplex ultrasound was then interpreted based on the duplex ultrasound score. Patients were classified into two groups according to the score i.e. severe (score ≥ 8) and nonsevere (score< 8). Where as, the MHR was classified into two groups according to the cut-off point i.e. high (≥ 14.51) and low (< 14.51). The Chi-square test was used for statistical analysis and pvalue <0.05 was considered as statistically significant. A total of 50 patients were involved in this study. There were 21 (42%) patients in the severe group and 29 (58%) in the nonsevere group. The proportion of the high MHR group and the low MHR group with severe levels of LEAD were 12 (57.1%) and 9 (42.9%), respectively. However, it was not statistically significant [p = 0.145; CI95% PR 1.57 (0.81 – 3.03)]. In conclusion, there is no association between MHR and LEAD severity.
Association between serum soluble ST2 level and right ventricle systolic function on pulmonary hypertension due to atrial septal defect
No full textPulmonary hypertension (PH) due to atrial septal defect (ASD) may cause a decline in right ventricle (RV) function. Soluble ST2 isa prognostic biomarker for left ventricle dysfunction. However, its role in RV function has not been investigated. This study aimed to investigate the association between serumsoluble ST2 with RV systolic function in patients withASD–associatedPH. This was a cross sectional study. Subjects were patients participated in the COHARD-PH registry performed in Dr. Sardjito General Hospital, Yogyakarta Indonesia. The patients with ASD and PH confirmed by right heart catheterization (RHC) were enrolled in this study. The soluble ST2 level was measured in the serum collected from pulmonary artery during RHC. Right ventricle systolic function was determined by transthoracic echocardiography using peak systolic velocity of tricuspid annulus (S’) parameter. This study was performed in 32 adults with uncorrected ASD. They predominantly females [n=29 (90.6%)] with median age of 31(22.5-44.0) years old. Mean ASD diameter was 2.69±0.53 cm. Median mean pulmonary artery pressure (mPAP) 45.0 (36.25-70.0) mmHg. Median soluble ST2 level was 23.28 ng/mL. There were no significant correlations between soluble ST2 level with S’value (r=0.071; p=0.35), with mPAP (r=0.043; p=0.815), with pulmonary vasculer resistance (PVR) (r=0.025; p=0.893) and with right ventricle (RV) diameter (r=0.200; p=0.273). Soluble ST2 level was found higher in subject with RV dysfunctionbut not statistically significant. In conclusion, serum soluble ST2 level did not associate withRV systolic function, measured by S’, in adult ASD-associated PH
Correlation between CD44 expression on histopathological grading, metastasis, survival overall (SO) and disease free survival (DFS) on women breast cancer
No full textBreast cancer is one of the health problems in the world. In Indonesia, it washighest prevalence of cancerin 2018. CD44, a non-kinase transmembrane glycoprotein, plays an important role in cancer development and progression.It isresponsible for mediating of the adhesion between adjacent cells andalsobetween cells and the extracellular matrix. The aim of study was to investigatethe relationship between the CD44 expressionand histopathological grading, metastasis, overall survival (OS) as well as disease free survival (DFS)in breast cancer patients.Thiswas a retrospective cross sectional studyusing data on medical records of breast cancer cases at Dr. Wahidin Sudirohusodo General Hospital, Makasarfrom 2016 to 2018. Examination of CD44 expression were performed from paraffin block samples.Data of the CD44 expression and medical records obtained were then presented in tables and statistically analyzed using chi-squared and Kaplan–Meier survival analysis.No significantly relationship between the CD44 expression and histopathological grading was reported (p>0.05). However, significantly relationship between the CD44 expression and metastasis war reported (p0.05). In conclusion, there isrelationship between CD44 expression and metastasis in the breast cancer patients. However, there is norelationship between CD44 expression and histopathological grading, OS as well as DFS.