Background: Peritoneal tuberculosis (PTB) could mimic advanced ovarian cancer cases, making its diagnosis challenging. Comprehensive and conscientious examinations for diagnosis are needed to differentiate such cases to avoid inappropriate treatment. We report a problematic diagnosis of PTB that mimic ovarian malignancy. Case Presentation: A 20-year-old female patient with history of multiple rehospitalizations, presented with complaints of abdominal pain, nausea/vomiting, low-grade fever, and weight loss in the last five months. In the first admission, patient was suspected with malignant ovarian cyst due to clinical features of malignancy with normal chest X-ray, abdominal USG suggested ovarian cyst in both ovaries, high levels of Ca125. However abdominal CT-scan showed thickening in peritoneum which suggested PTB. The patient was planned for urgent laparotomy while waiting for GenExpert result. On the second admission, patient presented with recurrent abdominal pain, GenExpert sputum and stool showed negative result, and planned for surgery but the patient refused. On the last admission, patient diagnosed with impending bowel obstruction and underwent abdominal CT-scan with contrast showed diffuse multiloculated cystic lesion in cavum pelvic and multiple prominent mesenteric lymph nodes that suggested abdominal TB with abscess in cavum pelvic. Exploratory laparotomy revealed conglomeration, pus and tubercles in the peritoneum. A TB was confirmed based on pathology and microbiology examination from tissue biopsy and pus. Conclusion: We reported patients with PTB with unspecific clinical symptoms which suspected as ovarian malignancy. This study highlights the challenges in diagnosing PTB and therefore PTB could be considered a differential diagnosis in patients suspected of ovarian malignancy in the TB endemic countries.
{"title":"Diagnosis challenges of a patient with peritoneal tuberculosis masquerading as ovarian malignancy: a case report","authors":"Anggoro Satrio Bimantoro, U. Maimunah","doi":"10.15562/bmj.v11i3.3892","DOIUrl":"https://doi.org/10.15562/bmj.v11i3.3892","url":null,"abstract":"Background: Peritoneal tuberculosis (PTB) could mimic advanced ovarian cancer cases, making its diagnosis challenging. Comprehensive and conscientious examinations for diagnosis are needed to differentiate such cases to avoid inappropriate treatment. We report a problematic diagnosis of PTB that mimic ovarian malignancy.\u0000Case Presentation: A 20-year-old female patient with history of multiple rehospitalizations, presented with complaints of abdominal pain, nausea/vomiting, low-grade fever, and weight loss in the last five months. In the first admission, patient was suspected with malignant ovarian cyst due to clinical features of malignancy with normal chest X-ray, abdominal USG suggested ovarian cyst in both ovaries, high levels of Ca125. However abdominal CT-scan showed thickening in peritoneum which suggested PTB. The patient was planned for urgent laparotomy while waiting for GenExpert result. On the second admission, patient presented with recurrent abdominal pain, GenExpert sputum and stool showed negative result, and planned for surgery but the patient refused. On the last admission, patient diagnosed with impending bowel obstruction and underwent abdominal CT-scan with contrast showed diffuse multiloculated cystic lesion in cavum pelvic and multiple prominent mesenteric lymph nodes that suggested abdominal TB with abscess in cavum pelvic. Exploratory laparotomy revealed conglomeration, pus and tubercles in the peritoneum. A TB was confirmed based on pathology and microbiology examination from tissue biopsy and pus.\u0000Conclusion: We reported patients with PTB with unspecific clinical symptoms which suspected as ovarian malignancy. This study highlights the challenges in diagnosing PTB and therefore PTB could be considered a differential diagnosis in patients suspected of ovarian malignancy in the TB endemic countries.","PeriodicalId":44369,"journal":{"name":"Bali Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45390399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Boby Abdul Rahman, P. Airlangga, Andy Nauman Saputra, Prihatma Kriswidyatomo, Agustina Salinding, Hamzah, Maulidya, Muhtarum Yusuf
Introduction: Controlled hypotension is one of the techniques applied to several microscopic ear, nose, and throat (ENT) surgeries. However, this technique has risks and complications, which result in impaired perfusion and oxygenation of organs including the brain that could trigger the postoperative cognitive dysfunction (POCD). Damage that occurs in brain cells can trigger the secretion of biomarker proteins in the blood, one of which is S100B which can indicate nerve damage in the intra and postoperative period. This study aimed to analyze the correlation between S100B protein level and the incidence of POCD in patients who received ENT surgeries with controlled hypotension. Methods: A cross-sectional study was conducted among patients that underwent elective ENT surgeries at Dr. Soetomo General Academic Hospital, Surabaya, from July to August 2022. Cognitive function was assessed using Mini-mental State Examination (MMSE) at 12 hours before and 2 and 24 hours after surgery. The level of S100B was measured using enzyme-linked immunosorbent assay (ELISA) 12 hours prior surgery and 30 minutes post-surgery. Results: A total of 31 patients were recruited in the study, including a mean age of 31.7 years. The mean S100B levels in POCD patients pre- and postoperative were 311.97 ng/L, and 415.34 ng/L, respectively. In non-POCD patients, the mean levels of S100B pre and postoperative were 436.90 ng/L, and 444.29 ng/L, respectively. There were 3 (9.7%) patients experienced POCD. Our data suggested there was a significant difference between preoperative and postoperative S100B levels in the groups of patients with POCD (103.37ng/L) and non-POCD (7.38 ng/L) (p<0.001). Patients that experienced POCD had significantly increased S100B compared to those who did not. Conclusion: There is a correlation between changes of S100B levels and the incidence of POCD in patients undergoing ENT surgeries with controlled hypotension.
{"title":"Correlation of S100B level and postoperative cognitive dysfunction (POCD) events among patients with ear, nose and throat (ENT) surgeries with controlled hypotension","authors":"Boby Abdul Rahman, P. Airlangga, Andy Nauman Saputra, Prihatma Kriswidyatomo, Agustina Salinding, Hamzah, Maulidya, Muhtarum Yusuf","doi":"10.15562/bmj.v11i3.3847","DOIUrl":"https://doi.org/10.15562/bmj.v11i3.3847","url":null,"abstract":"Introduction: Controlled hypotension is one of the techniques applied to several microscopic ear, nose, and throat (ENT) surgeries. However, this technique has risks and complications, which result in impaired perfusion and oxygenation of organs including the brain that could trigger the postoperative cognitive dysfunction (POCD). Damage that occurs in brain cells can trigger the secretion of biomarker proteins in the blood, one of which is S100B which can indicate nerve damage in the intra and postoperative period. This study aimed to analyze the correlation between S100B protein level and the incidence of POCD in patients who received ENT surgeries with controlled hypotension.\u0000Methods: A cross-sectional study was conducted among patients that underwent elective ENT surgeries at Dr. Soetomo General Academic Hospital, Surabaya, from July to August 2022. Cognitive function was assessed using Mini-mental State Examination (MMSE) at 12 hours before and 2 and 24 hours after surgery. The level of S100B was measured using enzyme-linked immunosorbent assay (ELISA) 12 hours prior surgery and 30 minutes post-surgery.\u0000Results: A total of 31 patients were recruited in the study, including a mean age of 31.7 years. The mean S100B levels in POCD patients pre- and postoperative were 311.97 ng/L, and 415.34 ng/L, respectively. In non-POCD patients, the mean levels of S100B pre and postoperative were 436.90 ng/L, and 444.29 ng/L, respectively. There were 3 (9.7%) patients experienced POCD. Our data suggested there was a significant difference between preoperative and postoperative S100B levels in the groups of patients with POCD (103.37ng/L) and non-POCD (7.38 ng/L) (p<0.001). Patients that experienced POCD had significantly increased S100B compared to those who did not.\u0000Conclusion: There is a correlation between changes of S100B levels and the incidence of POCD in patients undergoing ENT surgeries with controlled hypotension.","PeriodicalId":44369,"journal":{"name":"Bali Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45446282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Charles Limantoro, Fandy Santoso, C. Suharti, Trilaksana Nugroho
Introduction: Coronary artery disease (CAD) is the accumulation of atherosclerotic plaques in the coronary arteries. CAD is the most common cause of death worldwide, and its prevalence continues to increase, especially in the elderly population. Atherosclerosis is a chronic inflammatory condition that involves various inflammatory markers, including tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). In the inflammatory process, vitamin D plays an essential role in developing atherosclerotic plaques affecting the severity of CAD. The elderly are susceptible to vitamin D deficiency and an increase in the inflammatory process related to the severity of CAD. Therefore, this study aims to prove the relationship between inflammatory markers and vitamin D levels with the severity of CAD in elderly patients. Methods: This study used a cross-sectional design in stable CAD patients aged 60 - 75 years who had passed through coronary arteriography. The severity was assessed from the angiography results using the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, which 3 cardiovascular consultants evaluated and the average outcome was calculated. TNF-α, IL-6, and vitamin D were taken during angiography and examined using high sensitivity enzyme-linked immunoabsorbent assay (ELISA). The correlation test was analyzed using Spearman's Rank correlation test. Results: A total of 38 subjects were included in this study, where 30 (78.9%) patients were male. The mean age of the patients was 64.79 years, and the prevalence of vitamin D deficiency was 57.9%. There was a moderately significant positive correlation between markers of inflammation TNF-α (r=0.499, p=0.001) and IL-6 (r=0.518, p=0.001) and the SYNTAX score. A weak negative correlation was also discovered between vitamin D and the SYNTAX score (r=-0.335, p=0.040). Conclusion: The levels of inflammatory markers (TNF-α and IL-6) and vitamin D correlated with the severity of CAD in elderly patients.
{"title":"The relationship between inflammatory markers and vitamin D levels with the severity of coronary artery disease in elderly patients","authors":"Charles Limantoro, Fandy Santoso, C. Suharti, Trilaksana Nugroho","doi":"10.15562/bmj.v11i3.3631","DOIUrl":"https://doi.org/10.15562/bmj.v11i3.3631","url":null,"abstract":"Introduction: Coronary artery disease (CAD) is the accumulation of atherosclerotic plaques in the coronary arteries. CAD is the most common cause of death worldwide, and its prevalence continues to increase, especially in the elderly population. Atherosclerosis is a chronic inflammatory condition that involves various inflammatory markers, including tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). In the inflammatory process, vitamin D plays an essential role in developing atherosclerotic plaques affecting the severity of CAD. The elderly are susceptible to vitamin D deficiency and an increase in the inflammatory process related to the severity of CAD. Therefore, this study aims to prove the relationship between inflammatory markers and vitamin D levels with the severity of CAD in elderly patients.\u0000Methods: This study used a cross-sectional design in stable CAD patients aged 60 - 75 years who had passed through coronary arteriography. The severity was assessed from the angiography results using the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, which 3 cardiovascular consultants evaluated and the average outcome was calculated. TNF-α, IL-6, and vitamin D were taken during angiography and examined using high sensitivity enzyme-linked immunoabsorbent assay (ELISA). The correlation test was analyzed using Spearman's Rank correlation test.\u0000Results: A total of 38 subjects were included in this study, where 30 (78.9%) patients were male. The mean age of the patients was 64.79 years, and the prevalence of vitamin D deficiency was 57.9%. There was a moderately significant positive correlation between markers of inflammation TNF-α (r=0.499, p=0.001) and IL-6 (r=0.518, p=0.001) and the SYNTAX score. A weak negative correlation was also discovered between vitamin D and the SYNTAX score (r=-0.335, p=0.040).\u0000Conclusion: The levels of inflammatory markers (TNF-α and IL-6) and vitamin D correlated with the severity of CAD in elderly patients.","PeriodicalId":44369,"journal":{"name":"Bali Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48185813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Adhiatma, C. Waloejo, Belindo Wirabuana, E. Rahardjo
Introduction: Recognition of conus medullaris position, contains lumbosacral plexuses which supply motor and sensory innervation to the whole lower limb, pelvic and perineal areas, is critical to avoid injury due to lumbar procedures, such as spinal anesthesia and lumbar punctures. This study aimed to investigate the position of conus medullaris among Indonesians through magnetic resonance imaging (MRI) of the lumbar spine at Dr. Soetomo General Academic Hospital in order to minimize the risk of conus medullaris trauma. Methods: A retrospective study was conducted to investigate the conus medullaris level and its correlation to gender and age Indonesian patients. The data were collected from lumbar MRI at Dr Soetomo General Academic Hospital during January 2020 and December 2021. The level variations of conus medullaris were recorded and determined as the highest, lowest and most common location descriptively. Results: A total of 257 patients (126 male and 131 female) were included. The highest level of conus medullaris was in T11-T12 vertebrae (five patients). There were 12 patients in T12 vertebrae, T12–L1 in 86 patients, L1 in 62 patients, L1–L2 in 76 patients, and L2 in 12 patients. The lowest level was in between L2 and L3 vertebrae in 4 patients. Gender and age had no association with conus medullaris level. Conclusion: The lowest level of conus medullaris was in between L2 and L3 vertebrae. The lumbar procedure such as punctures should be done below the L3 to avoid conus medullaris puncture trauma.
{"title":"Variation of conus medullaris location based on magnetic resonance imaging of the lumbar spine in Indonesia: A study at Dr Soetomo General Academic Hospital, Surabaya, Indonesia","authors":"A. Adhiatma, C. Waloejo, Belindo Wirabuana, E. Rahardjo","doi":"10.15562/bmj.v11i3.3867","DOIUrl":"https://doi.org/10.15562/bmj.v11i3.3867","url":null,"abstract":"Introduction: Recognition of conus medullaris position, contains lumbosacral plexuses which supply motor and sensory innervation to the whole lower limb, pelvic and perineal areas, is critical to avoid injury due to lumbar procedures, such as spinal anesthesia and lumbar punctures. This study aimed to investigate the position of conus medullaris among Indonesians through magnetic resonance imaging (MRI) of the lumbar spine at Dr. Soetomo General Academic Hospital in order to minimize the risk of conus medullaris trauma.\u0000Methods: A retrospective study was conducted to investigate the conus medullaris level and its correlation to gender and age Indonesian patients. The data were collected from lumbar MRI at Dr Soetomo General Academic Hospital during January 2020 and December 2021. The level variations of conus medullaris were recorded and determined as the highest, lowest and most common location descriptively.\u0000Results: A total of 257 patients (126 male and 131 female) were included. The highest level of conus medullaris was in T11-T12 vertebrae (five patients). There were 12 patients in T12 vertebrae, T12–L1 in 86 patients, L1 in 62 patients, L1–L2 in 76 patients, and L2 in 12 patients. The lowest level was in between L2 and L3 vertebrae in 4 patients. Gender and age had no association with conus medullaris level.\u0000Conclusion: The lowest level of conus medullaris was in between L2 and L3 vertebrae. The lumbar procedure such as punctures should be done below the L3 to avoid conus medullaris puncture trauma.","PeriodicalId":44369,"journal":{"name":"Bali Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47795503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Alvin, P. Airlangga, Edward Kusuma, Prihatma Kriswidyatomo, Pudji Lestari, Yunias Setiawati
Introduction: Postoperative cognitive dysfunction (POCD) following general anesthesia is frequent among geriatric patients worldwide. Neuroinflammation and neuronal injury have been associated with the incidence of POCD. Some biomarkers of brain damage including neuron-specific enolase (NSE) and S100B protein have been widely studied; however, their association with the incidence of POCD is still controversial. This study aimed to assess the correlation of serum NSE and S100B levels with the incidence of POCD among geriatric patients receiving general anesthesia. Methods: A prospective cohort study was conducted among geriatric patients receiving general anesthesia at Dr. Soetomo Hospital, Surabaya from July to October 2022. The Montreal Cognitive Assessment (MoCA) INA instrument was used to assess POCD, and enzyme-linked immunosorbent assay (ELISA) was used to quantify the levels of serum NSE and S100B. Spearman’s rank correlation was implemented to identify the correlation of MoCA INA scores with the levels of NSE and S100B. Mann-Whitney analysis was used to determine the association between NSE and S100B levels with the incidence of POCD. A p-value of ≤0.05 was considered statistically significant. Results: A total of 48 patients were enrolled in the study and 16.7% of them had POCD. Spearman’s correlation test suggested no significant correlation between MoCA INA score with serum NSE level (rs:-0.095; p=0.522) and S100B level (rs:-0.213; p=0.146). Mann-Whitney analysis indicated no significant difference in the NSE and S100B levels of patients with and without POCD (p=0.3470 and p=0.097, respectively). Conclusion: There was no significant association between NSE and S100B levels with the incidence of POCD among geriatric patients receiving general anesthesia during elective surgeries at Dr. Soetomo Hospital, Surabaya.
{"title":"The role of neuron-specific enolase (NSE) and S100B protein in the incidence of acute postoperative cognitive dysfunction (POCD) in geriatric patients receiving general anesthesia","authors":"Muhammad Alvin, P. Airlangga, Edward Kusuma, Prihatma Kriswidyatomo, Pudji Lestari, Yunias Setiawati","doi":"10.15562/bmj.v11i3.3846","DOIUrl":"https://doi.org/10.15562/bmj.v11i3.3846","url":null,"abstract":"Introduction: Postoperative cognitive dysfunction (POCD) following general anesthesia is frequent among geriatric patients worldwide. Neuroinflammation and neuronal injury have been associated with the incidence of POCD. Some biomarkers of brain damage including neuron-specific enolase (NSE) and S100B protein have been widely studied; however, their association with the incidence of POCD is still controversial. This study aimed to assess the correlation of serum NSE and S100B levels with the incidence of POCD among geriatric patients receiving general anesthesia.\u0000Methods: A prospective cohort study was conducted among geriatric patients receiving general anesthesia at Dr. Soetomo Hospital, Surabaya from July to October 2022. The Montreal Cognitive Assessment (MoCA) INA instrument was used to assess POCD, and enzyme-linked immunosorbent assay (ELISA) was used to quantify the levels of serum NSE and S100B. Spearman’s rank correlation was implemented to identify the correlation of MoCA INA scores with the levels of NSE and S100B. Mann-Whitney analysis was used to determine the association between NSE and S100B levels with the incidence of POCD. A p-value of ≤0.05 was considered statistically significant.\u0000Results: A total of 48 patients were enrolled in the study and 16.7% of them had POCD. Spearman’s correlation test suggested no significant correlation between MoCA INA score with serum NSE level (rs:-0.095; p=0.522) and S100B level (rs:-0.213; p=0.146). Mann-Whitney analysis indicated no significant difference in the NSE and S100B levels of patients with and without POCD (p=0.3470 and p=0.097, respectively).\u0000Conclusion: There was no significant association between NSE and S100B levels with the incidence of POCD among geriatric patients receiving general anesthesia during elective surgeries at Dr. Soetomo Hospital, Surabaya.","PeriodicalId":44369,"journal":{"name":"Bali Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46528583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Acute limb ischemia is a sudden decrease in limb blood perfusion with an onset of less than 14 days, most commonly occurs in lower extremities. Diabetes mellitus, one of diseases underlying peripheral artery disease, complicates the pathophysiology of acute limb ischemia. In this case report we present a patient with type 2 diabetes mellitus and acute limb ischemia in the left upper extremity that had successful thrombectomy treatment. Case presentation: A 58-year-old female patient came to the Emergency Care Unit of Dr. Soetomo General Hospital with the continuous pain in the five fingers to the palm of the left hand for the past two days. The numbness spread from the elbow to the left fingers, making them weak and difficult to grip. Those five fingers were pale and cold as well. The left hand had no pulsated radialis and ulnar artery, weak brachial pulse and undetected pulse oximetry result. The patient was diagnosed with type 2 diabetes mellitus since 2005 and has a controlled treatment. On the first day of hospitalization, the patient was scheduled for emergency thrombectomy at Dr. Soetomo General Hospital. Follow-up on the seventh-day post-surgery, the patient had no complaints of pain and pale in the left hand and the brachial, ulnar and radial arteries were palpable. Conclusion: Acute limb ischemia is uncommon in the upper extremities but we found that it has an excellent prognosis with early revascularization, even in a patient with diabetes mellitus. The treatment must be in conjunction with aggressive diabetes mellitus treatment to avoid acute limb ischemia worsening
{"title":"Emergency thrombectomy in acute upper limb ischemia patient with diabetes mellitus","authors":"Yunita Arif, H. Novida","doi":"10.15562/bmj.v11i3.3822","DOIUrl":"https://doi.org/10.15562/bmj.v11i3.3822","url":null,"abstract":"Background: Acute limb ischemia is a sudden decrease in limb blood perfusion with an onset of less than 14 days, most commonly occurs in lower extremities. Diabetes mellitus, one of diseases underlying peripheral artery disease, complicates the pathophysiology of acute limb ischemia. In this case report we present a patient with type 2 diabetes mellitus and acute limb ischemia in the left upper extremity that had successful thrombectomy treatment.\u0000Case presentation: A 58-year-old female patient came to the Emergency Care Unit of Dr. Soetomo General Hospital with the continuous pain in the five fingers to the palm of the left hand for the past two days. The numbness spread from the elbow to the left fingers, making them weak and difficult to grip. Those five fingers were pale and cold as well. The left hand had no pulsated radialis and ulnar artery, weak brachial pulse and undetected pulse oximetry result. The patient was diagnosed with type 2 diabetes mellitus since 2005 and has a controlled treatment. On the first day of hospitalization, the patient was scheduled for emergency thrombectomy at Dr. Soetomo General Hospital. Follow-up on the seventh-day post-surgery, the patient had no complaints of pain and pale in the left hand and the brachial, ulnar and radial arteries were palpable.\u0000Conclusion: Acute limb ischemia is uncommon in the upper extremities but we found that it has an excellent prognosis with early revascularization, even in a patient with diabetes mellitus. The treatment must be in conjunction with aggressive diabetes mellitus treatment to avoid acute limb ischemia worsening","PeriodicalId":44369,"journal":{"name":"Bali Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44839740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Micropenis is a condition where the penis size is smaller than 2.5 standard deviation on average without any anatomical malformations. Hypogonadotropic hypogonadism is one of the causes of micropenis and one of the structural disorders that could lead to hypogonadotropic hypogonadism is a pituitary microadenoma that alters the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone. In this case-report we present a patient with micropenis caused by pituitary adenoma. Case presentation: A 40-year-old male patient, presented to Dr Soetomo Hospital with a chief complaint of having a small penis that did not match the proportions of the body but could still erect and ejaculate. The patient experienced fatigue for about two months before the admission and struggled to concentrate while walking for the last six months. The laboratory results were hyperprolactinemia, hypo albumin, and dyslipidemia. From the MRI examination with contrast, a mass was found in the left pituitary. The patient was diagnosed with pituitary microadenoma, hypogonadotropic hypogonadism, micropenis, hypotestosterone, hypocortisolism, and hypothyroidism. The patient was assigned for monthly monitoring. Consultation with a neurosurgeon suggested there were no indications for surgery. The patient was treated with testosterone intramuscular injection 250 mg every month, methylprednisolone 4 mg every 8 h, simvastatin 20 mg every 24 h, and levothyroxine sodium 50 mg every 24 h. One month follow up, fatigue was disappeared and nine months follow up found improvements in hormone levels and balance during walking. Conclusion: Pituitary microadenoma can manifest as micropenis, hypocortisolism, and shift hormone levels. The main therapy for pituitary microadenoma is hormone therapy as presented this present case report.
{"title":"Diagnostic challenges and management a patient with micropenis and pituitary microadenoma","authors":"I. Putu, Surya Pridanta, Deasy Ardiany","doi":"10.15562/bmj.v11i3.3828","DOIUrl":"https://doi.org/10.15562/bmj.v11i3.3828","url":null,"abstract":"Background: Micropenis is a condition where the penis size is smaller than 2.5 standard deviation on average without any anatomical malformations. Hypogonadotropic hypogonadism is one of the causes of micropenis and one of the structural disorders that could lead to hypogonadotropic hypogonadism is a pituitary microadenoma that alters the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone. In this case-report we present a patient with micropenis caused by pituitary adenoma.\u0000Case presentation: A 40-year-old male patient, presented to Dr Soetomo Hospital with a chief complaint of having a small penis that did not match the proportions of the body but could still erect and ejaculate. The patient experienced fatigue for about two months before the admission and struggled to concentrate while walking for the last six months. The laboratory results were hyperprolactinemia, hypo albumin, and dyslipidemia. From the MRI examination with contrast, a mass was found in the left pituitary. The patient was diagnosed with pituitary microadenoma, hypogonadotropic hypogonadism, micropenis, hypotestosterone, hypocortisolism, and hypothyroidism. The patient was assigned for monthly monitoring. Consultation with a neurosurgeon suggested there were no indications for surgery. The patient was treated with testosterone intramuscular injection 250 mg every month, methylprednisolone 4 mg every 8 h, simvastatin 20 mg every 24 h, and levothyroxine sodium 50 mg every 24 h. One month follow up, fatigue was disappeared and nine months follow up found improvements in hormone levels and balance during walking.\u0000Conclusion: Pituitary microadenoma can manifest as micropenis, hypocortisolism, and shift hormone levels. The main therapy for pituitary microadenoma is hormone therapy as presented this present case report.","PeriodicalId":44369,"journal":{"name":"Bali Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42274224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The disease progression of coronavirus disease 2019 (COVID-19) in individuals with comorbidities, such as type 2 diabetes mellitus (T2DM) in particular, has been associated with the occurrence of the cytokine storm. Ferritin, an acute-phase protein indicating inflammation, has been linked to T2DM and the severity of COVID-19. Our study aimed to investigate the association between the level of ferritin and the severity of COVID-19 in T2DM patients. Methods: A cross-sectional study was conducted among COVID-19 patients admitted at Dr. Soetomo General Hospital, Surabaya, from April to September 2020. The patients who met the inclusion criteria were enrolled in the study. The data used in this study was secondary data obtained from the medical records at Dr. Soetomo General Hospital, which consisted of serum ferritin levels, the severity of COVID-19, the results of blood analysis, and other demographic and clinical characteristics (age, gender, hypertension, the number of complaints, and vital signs). Data analysis was performed using SPSS software and presented in percentage (%), mean ± standard deviation (SD), or median (min-max). A chi-square test was carried out to identify the association between serum ferritin level and the severity of COVID-19 in T2DM patients at α=0.05. Results: Of the total 159 patients were included and 80.8% of them had moderate severity of COVID-19, whereas the rest (19.5%) had severe COVID-19. Out of total patients, 78.6% had ferritin levels of ≥400 mg/dL, suggesting hyperferritinemia syndrome (mean ± SD: 1177.21 ± 1275.90 mg/dL). The Chi-squared analysis revealed a significant association between serum ferritin levels with the severity of COVID-19 in T2DM patients (p=0.024). Conclusion: There was a significant relationship between serum ferritin levels and the severity of COVID-19 in T2DM patients and further study with a bigger sample size is needed to confirm this finding.
{"title":"The role of serum ferritin level and disease severity in COVID-19 with type 2 diabetes mellitus patients","authors":"F. Liani, S. W. Mudjanarko, H. Novida","doi":"10.15562/bmj.v11i3.3818","DOIUrl":"https://doi.org/10.15562/bmj.v11i3.3818","url":null,"abstract":"Introduction: The disease progression of coronavirus disease 2019 (COVID-19) in individuals with comorbidities, such as type 2 diabetes mellitus (T2DM) in particular, has been associated with the occurrence of the cytokine storm. Ferritin, an acute-phase protein indicating inflammation, has been linked to T2DM and the severity of COVID-19. Our study aimed to investigate the association between the level of ferritin and the severity of COVID-19 in T2DM patients.\u0000Methods: A cross-sectional study was conducted among COVID-19 patients admitted at Dr. Soetomo General Hospital, Surabaya, from April to September 2020. The patients who met the inclusion criteria were enrolled in the study. The data used in this study was secondary data obtained from the medical records at Dr. Soetomo General Hospital, which consisted of serum ferritin levels, the severity of COVID-19, the results of blood analysis, and other demographic and clinical characteristics (age, gender, hypertension, the number of complaints, and vital signs). Data analysis was performed using SPSS software and presented in percentage (%), mean ± standard deviation (SD), or median (min-max). A chi-square test was carried out to identify the association between serum ferritin level and the severity of COVID-19 in T2DM patients at α=0.05.\u0000Results: Of the total 159 patients were included and 80.8% of them had moderate severity of COVID-19, whereas the rest (19.5%) had severe COVID-19. Out of total patients, 78.6% had ferritin levels of ≥400 mg/dL, suggesting hyperferritinemia syndrome (mean ± SD: 1177.21 ± 1275.90 mg/dL). The Chi-squared analysis revealed a significant association between serum ferritin levels with the severity of COVID-19 in T2DM patients (p=0.024).\u0000Conclusion: There was a significant relationship between serum ferritin levels and the severity of COVID-19 in T2DM patients and further study with a bigger sample size is needed to confirm this finding.","PeriodicalId":44369,"journal":{"name":"Bali Medical Journal","volume":"207 ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41275197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Non-cirrhotic portal hypertension refers to elevated portal vein pressure in the absence of liver cirrhosis. Surgery could be an effective procedure for patients with recurrent variceal bleeding who fail to respond to pharmacotherapy or endoscopic therapy. We report a success story of modified Sugiura technique in managing a patient with non-cirrhotic portal hypertension. Case presentation: A male, 24-year-old, complained of recurrent vomiting of dark red blood color for six months. Anemic conjunctiva and splenomegaly were discovered during a physical examination. Pancytopenia and normal hepatobiliary function were revealed in the laboratory examination. Ultrasonography of the abdomen demonstrates nonspecific splenomegaly. An abdominal computerized tomography scan revealed hepatosplenomegaly and pelvic fluid accumulations. Grade IV esophageal varices and mild portal hypertensive gastropathy were observed during endoscopic examination. Active bleeding still presented despite initiation of medical treatment and endoscopic ligation. Finally, a surgical procedure using the Sugiura technique was performed. The patient was recovered, no recurrent symptom of hematemesis was reported after one year of follow-up. Conclusion: Modified Sugiura technique is a useful treatment of choice in non-cirrhotic portal hypertension patients who failed to respond other medical treatments. However, comprehensive assessment is critical prior to choose this procedure.
{"title":"A success story of modified Sugiura technique surgery in a non-cirrhotic portal hypertension (NCPH)","authors":"Aditya Satrio Faredisto, Budi Widodo","doi":"10.15562/bmj.v11i3.3848","DOIUrl":"https://doi.org/10.15562/bmj.v11i3.3848","url":null,"abstract":"Background: Non-cirrhotic portal hypertension refers to elevated portal vein pressure in the absence of liver cirrhosis. Surgery could be an effective procedure for patients with recurrent variceal bleeding who fail to respond to pharmacotherapy or endoscopic therapy. We report a success story of modified Sugiura technique in managing a patient with non-cirrhotic portal hypertension.\u0000Case presentation: A male, 24-year-old, complained of recurrent vomiting of dark red blood color for six months. Anemic conjunctiva and splenomegaly were discovered during a physical examination. Pancytopenia and normal hepatobiliary function were revealed in the laboratory examination. Ultrasonography of the abdomen demonstrates nonspecific splenomegaly. An abdominal computerized tomography scan revealed hepatosplenomegaly and pelvic fluid accumulations. Grade IV esophageal varices and mild portal hypertensive gastropathy were observed during endoscopic examination. Active bleeding still presented despite initiation of medical treatment and endoscopic ligation. Finally, a surgical procedure using the Sugiura technique was performed. The patient was recovered, no recurrent symptom of hematemesis was reported after one year of follow-up.\u0000Conclusion: Modified Sugiura technique is a useful treatment of choice in non-cirrhotic portal hypertension patients who failed to respond other medical treatments. However, comprehensive assessment is critical prior to choose this procedure.","PeriodicalId":44369,"journal":{"name":"Bali Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43062498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Islamiyah, Nasronudin, A. Machin, Iin Ernawati, Paulus Sugianto
Introduction: Epilepsy is an unprovoked seizure caused by an abnormal paroxysmal neuronal release in the brain. One of epilepsy treatments is anti-epileptic drug divalproex sodium. It is often prescribed to control seizures but it increases body weight. Weight gain may decrease the effectiveness of epilepsy treatment and cause endocrine disorders. CYP2C19 polymorphism may help physicians map patients vulnerable to weight gain due to divalproex sodium. This study aimed to determine the relationship between CYP2C19 polymorphisms and the incidence of weight gain based on gender in epilepsy patients treated with divalproex sodium. Methods: This cross-sectional study consisted of 17 male and 23 female patients. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to identify CYP2C19 polymorphism which was grouped into: extensive metabolizer, intermediate metabolizer and poor metabolizer. The results were analyzed using Chi-squared test to determine the relationship between CYP2C19 and each variable (gender, age, epilepsy types, valproic acid types, family history of obesity and presence of weight gain) based on of gender. Results: The results showed that there was no statistically significant association between CYP2C19 polymorphisms and gender-based epilepsy patients groups (p>0.05). We found that most of the subjects in this study were women with an increase in body weight by 57.5%. There was no association of CYP2C19 polymorphism with type of divalproex sodium, dose of divalproex sodium, length of treatment, type of epilepsy and family history of obesity. Conclusion: There is no significant association between CYP2C19 polymorphism and weight gain between genders in epilepsy patients.
{"title":"Relationship between CYP2C19 polymorphisms and weight gain in epilepsy patients treated with divalproex sodium: does gender matter?","authors":"W. Islamiyah, Nasronudin, A. Machin, Iin Ernawati, Paulus Sugianto","doi":"10.15562/bmj.v11i3.3748","DOIUrl":"https://doi.org/10.15562/bmj.v11i3.3748","url":null,"abstract":"Introduction: Epilepsy is an unprovoked seizure caused by an abnormal paroxysmal neuronal release in the brain. One of epilepsy treatments is anti-epileptic drug divalproex sodium. It is often prescribed to control seizures but it increases body weight. Weight gain may decrease the effectiveness of epilepsy treatment and cause endocrine disorders. CYP2C19 polymorphism may help physicians map patients vulnerable to weight gain due to divalproex sodium. This study aimed to determine the relationship between CYP2C19 polymorphisms and the incidence of weight gain based on gender in epilepsy patients treated with divalproex sodium. \u0000Methods: This cross-sectional study consisted of 17 male and 23 female patients. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to identify CYP2C19 polymorphism which was grouped into: extensive metabolizer, intermediate metabolizer and poor metabolizer. The results were analyzed using Chi-squared test to determine the relationship between CYP2C19 and each variable (gender, age, epilepsy types, valproic acid types, family history of obesity and presence of weight gain) based on of gender.\u0000Results: The results showed that there was no statistically significant association between CYP2C19 polymorphisms and gender-based epilepsy patients groups (p>0.05). We found that most of the subjects in this study were women with an increase in body weight by 57.5%. There was no association of CYP2C19 polymorphism with type of divalproex sodium, dose of divalproex sodium, length of treatment, type of epilepsy and family history of obesity.\u0000Conclusion: There is no significant association between CYP2C19 polymorphism and weight gain between genders in epilepsy patients. ","PeriodicalId":44369,"journal":{"name":"Bali Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45449139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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