Acta medica Indonesiana最新文献

Stroke is ranked as the second-leading cause of death worldwide. As a result, the long-term sequelae of motor and cognitive abnormalities, such as hemiparesis, paralysis, psychomotor, chronic pain, and behavioral symptoms, can delay the patient's full recovery and function in society. In this context, stem cell-based treatment for stroke has been proven effective due to the potential to provide neurorestorative benefits. This study presented a case of a 50-year-old patient admitted to Cipto Mangunkusumo National General Hospital, Jakarta, in 2022 with intracerebral hemorrhage in the left thalamus, surrounding perifocal edema, and left lateral intraventricular hemorrhage. The patient was given mesenchymal stem cells (MSCs) treatment three times through Digital Subtraction Angiography (DSA). The patient achieved good outcomes in terms of body mobility, balance, and voluntary movement of the upper and lower right limbs.

Background: Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder frequently accompanied by psychological disturbances such as depression and reduced quality of life. Probiotic intervention has been studied as a potential adjunct therapy to address psychological symptoms and improve the quality of life in IBS patients. This study aims to evaluate the effect of probiotic supplementation on depressive symptoms and quality of life in IBS patients at Dr. Cipto Mangunkusumo National General Hospital using the Beck Depression Inventory-II (BDI-II) and SF-36 instruments.

Methods: This study was a double-blind randomized controlled trial with a pre-post intervention design. A total of 70 participants were randomly assigned into two groups: the intervention group (n=35), which received probiotics, and the control group (n=35), which received a placebo. Depressive symptoms were assessed using the BDI-II, while quality of life was measured using the SF-36 questionnaire, both before and after the intervention. Statistical analysis was performed using the Mann-Whitney test and independent t-test, with a significance level of p<0.05.

Results: After the intervention, the probiotic group showed a significant reduction in BDI-II scores compared to the placebo group (p<0.0001). In addition, the probiotic group demonstrated significant improvements in almost all domains of the SF-36 compared to the placebo group, including physical functioning, role physical, bodily pain, general health, vitality, social functioning, emotional well-being, and mental health (p<0.0001).

Conclusion: Probiotic supplementation significantly reduces depressive symptoms and improves quality of life in IBS patients. These findings support the potential of probiotics as an adjunct therapy in the comprehensive management of IBS.

Background: Knee osteoarthritis (OA) is a degenerative condition that causes pain, swelling, and stiffness, affecting a person's ability to move freely. Non-weight-bearing therapeutic exercise programs provide better pain reduction and improve joint function compared with conventional exercise programs. This study compared the effectiveness of therapeutic exercises in sitting versus standing positions in reducing pain, improving knee function, and enhancing quality of life in obese patients with OA.

Methods: Fifty-four obese women aged 50-80 years were randomly assigned to one of two exercise program groups, either sitting or standing. Members of each group participated in a 12-week intervention consisting of aerobics, hip stretching and strengthening, and balance exercises. Sessions lasted 45 minutes, three times per week, increasing by 30 minutes every four weeks. Pain was assessed using the Numerical Rating Scale, knee function was measured with the Knee Injury and Osteoarthritis Outcome Score, and quality of life was assessed with the 12-Item Short Form Survey. Measurements were taken at baseline and every four weeks during the intervention.

Results: When compared with the standing position group, the sitting position group showed significantly less pain and better knee function as determined by NRS and KOOS, as well as better physical quality of life (p<0.05). In contrast, the standing position group had a better mental quality of life.

Conclusion: Therapeutic exercises in a sitting position are more effective in reducing pain, improving knee function, and enhancing physical quality of life in OA. However, standing exercises contribute more to mental well-being.

Conn syndrome is an adrenal gland adenoma that causes primary hyperaldosteronism, with a prevalence of <1% in the world population. Therefore, this case report presents a patient with Conn syndrome co-existing with hyperthyroidism. A 26-year-old female was admitted with muscle spasms in the left arm and muscle weakness in both legs for a day, palpitations, excessive sweating, nocturia, polyuria, and polydipsia. The patient had a history of hyperthyroidism for 10 years and routinely took anti-hypertension (Nifedipine), anti-thyroid, and potassium supplements. Physical examination showed the presence of hypertension. In addition, laboratory examinations revealed hypokalemia, slightly elevated FT4. The patient showed a high level of ARR (Aldosterone-Renin ratio; >30 ng/dL), consistent with primary hyperaldosteronism. Since abdominal USG revealed no abnormality, abdominal MRI with contrast was performed and showed an adenoma in the left adrenal gland. During admission, the patient had refractory hypokalemia despite various efforts to correct the defect. An anti-hypertension drug was then administered, particularly a mineralocorticoid antagonist receptor (Spironolactone). After the treatment, the patient had manageable hypertension and a normal potassium serum level, with no symptoms. Subsequently, discharge was then granted after 9 days of treatment, with a surgery schedule. Conn syndrome with hyperthyroidism can cause refractory hypokalemia, which transforms into a challenge in patient management. With early detection and management, the outcome of this case is manageable.

The prevalence of end-stage renal disease patients in Indonesia is predicted to increase by the end of 2025. Kidney transplantation is the preferred treatment for end-stage renal disease, and the demand for kidney transplants is steadily increasing globally, including in Indonesia. However, organ transplantation and donation are debatable issues in the medical field, particularly when considered in conjunction with religious views. The Qur'an and Hadith do not directly discuss transplantation in Islam, prompting several interpretations and fatwas. Diverse ideologies, cultures, and beliefs also result in prospective differences. To address these differences, fatwas regarding the permissible conditions for transplantation have been issued by the Indonesian Ulema Council. This study aimed to explore the perspectives of Muslims and Islamic law on kidney transplantation in Indonesia. The study also includes comparative studies of Muslim perspectives from different countries. The findings provide an overview of Islamic law, the perspectives of religious scholars, and the perspectives of Muslims residing in Indonesia, as well as in other countries.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a primary therapeutic modality for managing malignant and benign biliary obstruction. Technical success (TS) and clinical success (CS) of modality are essential indicators of procedural efficacy, which is influenced by various patient- and procedure-related factors. Therefore, this study aims to evaluate the TS and CS rates of ERCP and identify their predictors in patients with biliary obstruction at a tertiary referral center in Indonesia.

Methods: A retrospective analysis was conducted on patients with biliary obstruction who underwent therapeutic ERCP at Cipto Mangunkusumo Hospital between January 2022 and December 2024. Patients with diagnostic ERCP or prehepatic/parenchymal jaundice were excluded.

Results: A total of 259 patients were included (49.4% female, mean age 50.6 years) in this study. The results show that the TS rate is 96.5%, with multivariate analysis identifying ulcerative fragile papillary mass (AOR 0.075; P=0.001) as an independent negative predictor. Meanwhile, the CS rate is 88%, with pre-ERCP bilirubin >3 mg/dL (AOR 8.545; P<0.001) and previous ERCP stenting/pre-cutting (AOR 0.330; P=0.037) being independent predictors. Distal malignant obstruction causes a higher pre-ERCP bilirubin level (P=0.025) of >3 mg/dL (OR 6.116; P=0.011).

Conclusion: ERCP showed high technical and clinical success rates in managing biliary obstructions. TS was negatively predicted by ulcerative fragile papillary mass. CS was positively predicted by pre-ERCP bilirubin >3 mg/dL and negatively by prior stenting or pre-cutting. These findings should be taken into consideration when planning and delivering ERCP to achieve better outcomes.

We report a case of thoracic empyema in a 61-year-old male patient, a heavy smoker with malignancy undergoing chemotherapy. The patient's clinical symptoms included shortness of breath, productive cough, fever, and chest pain. This patient had never received antibiotics before. Streptococcus pneumoniae was isolated from a bedside culture of empyema fluid collected through thoracentesis. The empyema fluid was cultured on chocolate agar plates and in aerobic and anaerobic culture bottles. The isolate was identified as serotype 23F, a vaccine strain with sequence type 17532. The isolate was resistant to chloramphenicol, tetracycline, and cotrimoxazole. The patient clinically improved with the administration of combined intravenous ceftriaxone and levofloxacin antibiotics, along with chest tube drainage via thoracostomy. This is the first report of thoracic empyema caused by S. pneumoniae in an adult in Indonesia. Serotype 23F is multi-resistant with low invasiveness, typically causing infections in patients with underlying health conditions. The pneumococcal conjugate vaccine covers it; thus, it usually occurs in areas with low vaccine coverage. Our findings support the importance of improving adult pneumococcal vaccination coverage in Indonesia.

Typhoid fever remains a major public health issue in Indonesia, with its true burden likely underreported due to diagnostic challenges. The clinical manifestations of typhoid fever are often nonspecific and overlap with other endemic febrile illnesses such as dengue, leptospirosis, and rickettsial infections, leading to frequent misdiagnosis. Although blood culture and PCR are the gold standards, their limited accessibility in Indonesia has resulted in reliance on suboptimal diagnostic tools such as the Widal test and TUBEX TF. Recent advances, including the Nelwan Score and CRP-based differentiation, have shown promise in improving early clinical screening. Furthermore, antibody-based proteomic diagnostics offer enhanced accuracy but remain largely confined to research settings. A combined approach utilizing validated clinical scores, affordable biomarkers, and selective use of serological tests is essential to improve diagnostic accuracy and patient care. Misdiagnosis not only endangers patient outcomes but also contributes to inappropriate antibiotic use, accelerating the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Salmonella Typhi. Resistance to first-line antibiotics and fluoroquinolones has been increasingly reported in Indonesia, although some regions still demonstrate preserved susceptibility. Cautious and evidence-based antibiotic prescribing is therefore critical to mitigating resistance. This article underscores the urgent need to strengthen diagnostic strategies and antimicrobial stewardship to address the persistent challenge of typhoid fever in Indonesia.

Background: Depression and anxiety are prevalent among patients with systemic lupus erythematosus (SLE), and gut microbiota may be a contributing factor. This study aimed to investigate the clinical characteristics, food intake, and gut microbiota profiles of SLE patients with anxiety or depression.

Methods: An analysis of secondary data was conducted. The primary study was conducted at Cipto Mangunkusumo Hospital, Jakarta, Indonesia, in 2017-2018. The inclusion criteria were: a diagnosis of SLE, age 18‒60 years, and gastrointestinal symptoms. The data collected included clinical data, food intake, anxiety and depression scores, SLE disease activity, and stool samples. Sequencing of the 16S rRNA gene was performed to profile the gut microbiota using DNA was extracted from the stool samples.

Results: After excluding those with incomplete data, 41 patients were analyzed. Among the subjects, 53.66% and 14.63% had anxiety and depression, respectively. SLE patients with anxiety were significantly more likely to harbor Bacteroides compared to those without anxiety (33.45% vs. 9.78%; p=0.02) and had lower levels of complement C3 (78.72 vs. 100.85 mg/dL; p=0.03). SLE patients with anxiety or depression had significantly lower fat intake compared to those without these conditions (38.78 vs. 48.43 g/day; p=0.04, and 31.48 vs. 45.27 g/day; p=0.04). A significant correlation was observed between the proportion of Bacteroides and SLE disease activity (p=0.02).

Conclusion: SLE patients with anxiety showed a significantly higher proportion of Bacteroides and a lower C3 level compared to those without anxiety. Fat intake was significantly lower among SLE patients with anxiety or depression compared to those without either condition.

Background: Identifying liver fibrosis is crucial for initiating antiviral therapy for hepatitis B infection. Liver biopsy is the gold standard for assessing the degree of fibrosis. However, a liver biopsy is an invasive procedure that carries some risks. This study aimed to evaluate the diagnostic capabilities of the red cell distribution width-to-platelet ratio (RPR) and compare its efficacy for determining the degree of fibrosis in patients with chronic hepatitis B infection with that of the aspartate aminotransferase-to-platelet ratio index (APRI) and the Fibrosis-4 index (FIB-4).

Methods: This was a retrospective study conducted on patients with chronic hepatitis B infection who had transient elastography results at the Gastroenterology Hepatology Clinic, Dr. Hasan Sadikin General Hospital, Bandung, between January and December 2024. Statistical analysis was performed using receiver operating characteristic curves to determine the diagnostic values and cutoff points of the RPR, APRI, and FIB-4 to detect liver fibrosis based on Transient Elastography in patients with Chronic Hepatitis B infection.

Results: A total of 114 patients with chronic hepatitis B infection were included in this study (42 with significant fibrosis and 72 with nonsignificant fibrosis). The area under the curve (AUC) of the RPR was 0.873 (p < 0.001) with a cutoff point of >0.0538, whereas the AUCs of the APRI and FIB-4 were 0.833 (p < 0.001) and 0.746 (p < 0.001), respectively.

Conclusion: The RPR has a higher diagnostic performance than the APRI and is superior to the FIB-4 in assessing the degree of fibrosis in patients with chronic hepatitis B infection. The RPR is a simple and cost-effective test and has the potential to be a screening tool for patients with hepatitis B infection.