Acta medica Indonesiana最新文献

Background: Studies regarding hypercoagulation in Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) patients have produced conflicting results. With a presumption that the early coagulation phase may affect the occurrence of NAION, this study aims to investigate the early coagulation markers, E-selectin and P-selectin, to determine whether these biomolecular changes play a significant role in NAION, thus potentially leading to a better clinical approach.

Methods: A cross-sectional study involving two groups of NAION subjects, a hypercoagulation group and a non-hypercoagulation group, was conducted in the Neuro-Ophthalmology Division, Department of Ophthalmology, FKUI-RSCM Kirana from October 2020 to April 2022. All patients were evaluated for E-selectin and P-selectin levels measured using flow cytometry.  Results: A total of 42 subjects comprising 14 hypercoagulation and 28 non-hypercoagulation subjects were included. In all subjects, E-selectin was strongly correlated with P-selectin (r = 0.862, p < 0.001). There was no significant difference in E-selectin and P-selectin values between the groups (p = 0.317 for E-selectin, and p = 0.575 for P-selectin). Prothrombin time and international normalized ratio (INR) were inversely correlated with both E-selectin and P-selectin in the hypercoagulation group (p = 0.032, p = 0.030 for E-selectin and p = 0.044, p = 0.036 for P-selectin). There was no significant correlation between E-selectin and P-selectin for NAION-associated metabolic risk factors. However, higher E-selectin and P-selectin values were found in the presence of risk factors except for P-selectin in the hypertension group.

Conclusion: This interesting finding opens up the potential for considering the involvement of E-selectin and P-selectin in the diagnostic strategy for NAION. It prompts consideration of whether assessing E-selectin and P-selectin levels should be recommended for all NAION patients. Furthermore, considering the role of E-selectin and P-selectin in the early coagulation process, future studies are also needed to further evaluate whether anticoagulants could play a role in the choice of treatment for NAION despite a clinically hypercoagulable state.

In 2023, Indonesia's Ministry of Health reported that nearly 75% of districts and cities in the country were free from malaria transmission, meaning 90% of the population lived in malaria-free zones. However, Papua Province, which accounts for only 1.5% of Indonesia's population, continues to contribute over 90% of the national malaria cases, with more than 16,000 reported cases in 2023.Indonesia has recently completed a malaria vaccine trial, the IDSPZV1, which included the PfSPZ Vaccine and PfSPZ-CVac (CQ), conducted among soldiers deployed to Papua Province, New Guinea, for 10 months. These soldiers were from a battalion located in a malaria-free area in Bangkinang, Riau Province. The results of this clinical trial will be reported separately, but this significant development could offer a potential solution to reduce the risk of malaria infection, particularly among travelers, such as domestic tourists or soldiers visiting Papua.This edition highlights the recent findings from a malaria study conducted in Iwaka District, Mimika, Papua, which revealed that nearly half of the patients presenting with fever at the district hospital were diagnosed with malaria (N=863 patients). The authors explored various factors, including the prevalence of malaria, patient characteristics, history of malaria exposure, housing and environmental conditions, as well as malaria prevention measures among the study participants.In addition to uncomplicated malaria infections, severe malaria cases remain a significant issue, contributing to high mortality rates. Nainggolan et al. investigated the role of host factors, particularly ABO blood groups, in the likelihood of developing severe malaria.Understanding the dynamics of disease prevalence, and risk factors related to both the host and the environment, along with the potential availability of vaccines, chemoprevention, and other preventive measures, are crucial to achieving zero malaria in the island of New Guinea, Papua Province.

Background: Papua is a high-endemic region for malaria in Indonesia. Malaria transmission is heavily influenced by environmental factors, particularly those related to vector breeding habitats and the homes of infected individuals. Communities in high-endemic areas also exhibit risk behaviors that can increase the likelihood of malaria transmission.

Methods: This cross-sectional study was conducted in Iwaka District, Mimika, Papua, and included residents aged 18 years and older who had lived in the district for at least six months and exhibited symptoms of malaria. Subjects with a history of malaria or those under antimalarial treatment in the last two weeks were excluded. We collected demographic characteristics, malaria history, environmental factors, and behavioral components using a structured questionnaire. Each subject underwent a malaria examination using a rapid diagnostic test (RDT). Data were analyzed using STATA software.

Results: A total of 863 subjects met the inclusion and exclusion criteria. Of these, 429 (49.7%) were diagnosed with malaria. Malaria cases were predominantly found among males, individuals aged 21- 40 years, those with secondary education, and those working as farmers. Malaria incidence was associated with having family members who had malaria, living near stagnant water, and residing within 100 meters of forests or fields (p < 0.05). The use of bed nets, mosquito repellents, and long-sleeved clothing was low, and most houses had wooden walls without wire mesh protection.

Conclusion: Malaria prevalence in Iwaka District is extremely high, with risk factors including age, gender, proximity to stagnant water and forests/fields, and family history of malaria.

Increased thrombotic events that occur in up to one-third of patients with COVID-19 are predominantly pulmonary emboli (PE), which are associated with higher severity and increased mortality. Acute PE should therefore be one of the main differential diagnoses among patients with hemodynamic instability. Early treatment of such a condition with systemic thrombolysis remains the first line of treatment especially in patients with COVID-19, which hinders further invasive intervention. The aim of this report is to describe a typical case of hemodynamically unstable acute PE with COVID-19 management in our center to emphasize the role of early detection and prompt treatment of such a condition. A 66-year-old male suspected of having COVID-19 initially presented with shortness of breath and desaturation with normal physical examination, and turned out to be COVID-19 positive. In the isolation ward, he had a cardiac arrest, and bedside echocardiography showed a fresh thrombus had developed in the right atria with signs of acute right ventricular dysfunction. The diagnosis of acute PE with hemodynamic instability was established, and systemic thrombolysis was immediately initiated. The patient recovered well with improvement in his symptoms and was eventually safely discharged. Our case demonstrates how early recognition and prompt treatment of acute PE especially in COVID-19 patients with hemodynamic instability is a life-saving intervention. Identifying the subtle clues of acute PE in emergency situations remains the main challenge.

Functional mitral regurgitation is characterized by normal structures of the mitral valve and chordae tendinea, but the regurgitation occurs due to geometric changes in the left atrium and left ventricle. This condition can contribute to heart failure progression and lead to a poor prognosis. Functional mitral regurgitation is found in approximately one-third of patients with heart failure with a decreased ejection fraction. Echocardiography is the primary work-up for assessing the anatomy and function of the left ventricle, mitral valve, and severity of functional mitral regurgitation. Additionally, for the latter, an integrated qualitative and quantitative assessment is essential to determine the optimal therapeutic strategy. According to the current guidelines, medical therapy remains the main treatment for functional mitral regurgitation. Yet, transcatheter intervention is a safe and effective treatment option in selected patients. While the effect of surgery on improving mortality in patients with functional mitral regurgitation is not established yet, recent guidelines recommend considering surgery for patients who have undergone coronary artery bypass surgery or other cardiac procedures.

Sepsis is a critical, life-threatening condition that demands precise prediction to mitigate adverse outcomes. The heterogeneity of sepsis leads to variable prognoses, making early and accurate identification increasingly difficult. Despite ongoing advancements, no single gold standard has emerged for sepsis prediction. Current research explores a range of prognostic tools, from traditional scoring systems and biomarkers to cutting-edge omics technologies and artificial intelligence. These tools can differ significantly across patient populations and clinical settings, such as the emergency department (ED) and intensive care unit (ICU). This review aims to critically evaluate the development and application of outcome prediction modalities in sepsis and other infectious diseases, highlighting the progress made and identifying areas for further research.

Cardiac tamponade is a rare but fatal complication of catheter ablation. We are reporting a case of a 73-year-old male with ventricular tachycardia (VT) storm undergoing urgent VT ablation, who was later found to have right ventricle (RV) perforation-an unusual site for catheter ablation complication. The patient underwent isochronal late activation mapping (ILAM)-based ablation and elimination of local abnormal ventricular activities (LAVA). After procedure, his blood pressure rapidly decreased, and he was found to have cardiac tamponade. The tamponade was recurring despite of pericardial pigtail placement; thus, the patient was prepared for open-heart surgery. To preserve blood, auto transfusion was used as a bridging therapy.

A 71-year-old man complained of a blackish wound under his left eye, which began with fever and reddish spots after helping to slaughter a cow and cut its meat. The fever occured especially in the afternoon to evening, and is not accompanied by chills and sweating. On day 4 of fever onset, the fever diminished and the spots progressively widened with swelling. On day 7, the lesions on the skin became open wounds that were not purulent and did not bleed. On day 9, a blackish, painless layer appeared over the wounds and widened, further covering their surface. Upon presentation, the patient's general condition was good, with normal vital signs and temperature. He presented with a solitary ulcer accompanied by edema, sized 1 cm x 3 cm, not hyperemic, firm border, flat edge, and covered with blackish eschar. Blood tests revealed normal levels of hemoglobin, leukocyte, platelets, kidney and liver function. The anti-anthrax protective antigen (anti-PA) IgG level is found to be seropositive with a level of 85 U/ml. Gram staining of the tissue underneath the eschar found Gram-positive rod bacteria in reddish-purple color. The patient was clinically diagnosed with probable cutaneous anthrax, and was treated with amoxicillin 500 mg orally t.i.d. for three days and paracetamol 500 mg if fever developed. The tissue sample was sent to a laboratory with Bio Safety level 3 facilities for microbiological culture, with the results of Bacillus anthracis growth. On day three after antibiotic administration, the wound was smaller (0.5 cm x 1.5 cm), firm border, flat edge, with a bit of edema above it. The eschar was thickened, painless, not purulent nor bleeding. Antibiotic administration is continued for another three days with amoxicillin 500 mg orally t.i.d. On day 6 of antibiotic administration, the eschar began to peel off, and antibiotics were stopped. On the 10th day, the eschar peeled off entirely without leaving a mark. Early diagnosis is crucial in preventing the spread that may lead to more cases. Clinical and serological examinations are the spearheads of early detection of anthrax cases. Prompt and appropriate management largely determines the success of therapy.

Background: 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.

Background: Direct acting antivirals (DAAs) have demonstrated remarkable efficacy, in achieving hepatitis C viral (HCV) elimination rates higher than 90%. One particular concern associated with treatment failure is the emergence of resistance associated substitutions (RASs) in the genome. The occurrence of RASs highlights the adaptability and resilience of the HCV. This highlights the importance of RASs mutation, enabling the development of new therapeutic strategies to combat these resistant strains. This study aims to determine the presence of early HCV mutations in chronic hepatitis C in Indonesia and the association between this mutation to the efficacy of sofosbuvir-daclatasvir.

Methods: We conducted a prospective longitudinal study in naïve hepatitis C patient population. The virus was examined for RAS by RNA sequencing before starting treatment. RAS mutations were determined through the cut-off value of RAS mutations that contributed in the successful therapy. All patients were followed up until 12 weeks after completion of treatment to determine the sustained virological response 12 (SVR12).

Results: Out of the 58 patients, 9 patients (15.51%) did not achieve SVR.  Only 14 patients was further analyzed to provide the association between the mutation and SVR-12 failure after sofosbuvir-daclatasvir therapy. Specifically, 2 patients with L31 mutation and one patient with L31/Y93 mutation achieved SVR. Only one patient with failure to achieve SVR and the mutation was found in Y93H region.

Conclusion: The mutation of Y93H may contribute to treatment failure while L31A may increase the susceptibility to DAAs treatment.