Acta medica Indonesiana最新文献

Transfusion-dependent thalassemia (TDT) is often accompanied by complications related to iron overload and the development of malignant solid tumors or hematological malignancies. The occurrence of Neuroendocrine carcinoma, specifically in the respiratory tract, is very rare, with a prevalence of approximately 25%. Therefore, this study presented a case of a 42-year-old male with a beta-thalassemia major at 28 years, complaining of shortness of breath. This case was reported due to its rarity in providing information about solid tumors in thalassemia patients. The physical examination revealed several symptoms, including tachycardia, tachypnea, anemia, icteric sclera, elevated jugular venous pressure, coarse wet Ronchi in the medial to basal areas of both lungs, hepatomegaly, and splenomegaly (Schuffner 4). The patient regularly received blood transfusions and iron chelation therapy. A thoracic CT scan showed a lung mass and a biopsy of the mass revealed Pulmonary Neuroendocrine Carcinoma with high-grade proliferation and, large cell type. The patient also passed through cisplatin-etoposide chemotherapy for 6 cycles every 21 days. There is almost no data on pulmonary neuroendocrine carcinoma in thalassemia patients, so it is hoped that this case report can provide information about malignant solid tumors that can occur in thalassemia patients.

Background: Hepatocellular carcinoma (HCC) is a cancer with poor prognosis. Indonesia is a country with high prevalence of chronic hepatitis B infection. The performance of alpha fetoprotein (AFP) as a tumor marker in HCC surveillance is primarily influenced by the etiology of the underlying liver disease. We aimed to determine the best cut-off value of AFP biomarker examination for HCC surveillance in patients with chronic hepatitis B infection.

Methods: The study collected medical record data of the Hepatobiliary Division of Dr. Cipto Mangunkusumo Hospital from the period of 2017 to 2023. A total of 506 subjects with chronic hepatitis B of all spectrums (hepatitis B without cirrhosis, liver cirrhosis, and early-stage HCC, BCLC 0 and A) were included by total sampling that was performed from 26 July 2023 to 31 August 2023. Determination of the AFP cut-off value was carried out using the receiver operating characteristics (ROC) method.  Results: For HCC surveillance caused by hepatitis B virus, ROC curve analysis resulted in an area under the curve (AUC) of 0.792 (95% CI, 0.719-0.866), and the cut-off value with the highest Youden index was 8.7 ng/ml, with 58% sensitivity, 94% specificity, positive predictive value (PPV)  56.14%, negative predictive value (NPV) 94.43%, positive likelihood ratio (LR+) 10.08, and negative likelihood ratio (LR-) 0.46.

Conclusion: The cut-off value of AFP in HCC surveillance on hepatitis B specific etiology is lower than the cut-off value of AFP in previous HCC surveillance which was not etiologically specific. The cut-off value of 8.7 ng/ml produces the best sensitivity and specificity for the cut-off value for HCC surveillance with hepatitis B etiology.

Adrenal insufficiency can increase the risk of infection. Respiratory infections play a role in the greater number of mortalities in patients with primary adrenal insufficiency. Severe acute illness elevates the risk of adrenal crisis which can give lethal outcome.A 52-year-old woman came to the emergency unit due to worsening gastrointestinal symptoms for the past 3 days. She had chronic epigastric pain, general weakness, weight loss, and skin hyperpigmentation. She was suspected of primary adrenal insufficiency one year ago, but she had poor compliance. In this current admission, she was suspected to have adrenal crisis and was diagnosed with COVID-19. On the 5th day of inpatient care, her condition was worsening, and she was diagnosed with adrenal crisis, septic shock, and severe COVID-19. Her ACTH level was 78.6 pg/mL (normal range 7.4-64.3 pg/mL) and her morning cortisol level was 1.1 ug/dL (normal range 3.7-19.4). Imaging showed unilateral hypertrophy of the adrenal gland, a positive result of IGRA, and fibrotic of the lung that led to tuberculosis of the adrenal as suspected etiology.Making a diagnosis of adrenal insufficiency is challenging because of its non-specific signs and symptoms. The need for education, equipment (adequate steroid supplies), and empowerment (development of specific guidelines for PAI and COVID-19) were taught to help prevent the adrenal crisis. Further examination is needed to obtain the definitive etiology of adrenal insufficiency in this patient.

Monkeypox (Mpox) is a virus that originally infected only animals. Caused by the monkeypox virus, this infection presents with symptoms similar to smallpox. Although two years have passed since the 2022 outbreak, new cases continue to emerge monthly. Initially, human cases of mpox were confined to outbreaks in central and western Africa. However, the virus has recently spread globally, possibly due to a decline in vaccination rates. In this context, evidence for effective therapies, such as antivirals, is urgently needed. Three antivirals-tecovirimat, brincidofovir, and cidofovir-are known to have activity against the mpox virus. Their use is currently limited to expanded access for treating non-variola orthopoxvirus infections, with ongoing phase 3 trials. This review will discuss the mechanisms of action, clinical use, and efficacy of these antivirals.

Gastrointestinal toxicities of radiation might develop after exposure, thus leading to conditions such as abdominal pain, rectal bleeding, diarrhea, anemia, and weight loss. The development of drugs to reduce mucosal damage progression has been a focus on managing radiation proctitis. Radiation proctitis resulting from exposure to pelvic radiotherapies is effectively managed with topical administration on the anal mucosa. The clinical use of hyaluronic acid offers an innovative approach to managing radiation injury. Hyaluronic acid has multiple beneficial properties, such as regulating immune process to reduce inflammation and oxidative stress, supporting natural protective mechanism, promoting mucosa healing, and improving tissue hydration. Therefore, this case series introduces the idea that application of hyaluronic acid could potentially improve patients' clinical conditions.

The main complaint in knee osteoarthritis (KOA) is knee pain and limited range of motion (ROM) which affects the patient's quality of life. Dextrose prolotherapy successfully reduced pain and enhanced functional status and quality of life in chronic knee pain, which is classified as KOA grade II or III by the Kellgren-Lawrence classification. We present a case of grade IV KOA with co-morbid obesity who refused surgical management but got dextrose prolotherapy instead. She received prolotherapy for the right knee 5 times with a gap of 4 weeks between treatments. Western Ontario and McMaster Universities Osteoarthritis (WOMAC score), Numerical Rating Scale (NRS), knee ROM, Barthel index, count test, and Timed Up and Go Test (TUG) were evaluated 1 day after each treatment and compared to each post-injection score. This patient is also comorbid of grade II obesity which is associated with mechanical loads on the knee joint causing inflammation and progression of KOA. After 5 months of prolotherapy treatment, strengthened quadricep muscle exercising and static cycle endurance exercising, she improved her pain, WOMAC score, and cardiorespiratory function. Hypertonic dextrose prolotherapy (HDP) is one of the choices for interventional therapy of its advantages, inexpensive, easily conducted, safe with minimal or even no recorded complications, and long-term efficacy even for grade IV of KOA like this patient.

Background:  The COVID-19 pandemic has affected physical and mental health. SLE patients are prone to psychosomatic disorders which can decrease their quality of life. This study aimed to determine the factors associated with psychosomatic disorders among SLE patients during the COVID-19 pandemic. Methods: This was a cross-sectional study of adult female SLE patients from the outpatient clinic of Cipto Mangunkusumo Hospital, Jakarta. Data regarding psychosomatic disorders were collected using SCL-90 questionnaires, and data on demographic factors, perception of COVID-19 conditions, perception of stress, psychosocial stressors, disease activity (MEX-SLEDAI), and treatment were also collected. Bivariate analysis for categorical data was conducted using the Chi-square test. Variables with a p-value <0.25 were further analyzed with logistic regression, and p-values <0.05 were considered significant. Meanwhile, data per domain were analyzed using the Mann-Whitney test with p-values < 0.05 being considered significant. Results: There were 200 female SLE patients recruited. More than half of the subjects (54%) experienced psychosomatic disorders. From multivariate analysis, high educational levels, moderate and high psychosocial stressors, and very severe disease activity levels were found to be significantly associated with the occurrence of psychosomatic disorders in SLE patients during the COVID-19 pandemic.

Conclusion: Education level, psychosocial stressors, and disease activity level were found to be significantly associated with the occurrence of psychosomatic disorders in SLE patients during the COVID-19 pandemic.

Background: Febrile neutropenia (FN) is an oncologic emergency which commonly occurrs in patients who undergo chemotherapy, with a mortality rate of 12.5%. Risk stratification in FN plays an important role in increasing the accuracy of therapy. This study aims to compare the performance between CISNE score and MASCC score in predicting complications on post-chemotherapy FN in solid and hematologic malignancy.  Methods: This is a retrospective cohort study on FN patients undergoing inpatient treatment at Cipto Mangunkusumo Hospital between July 2015 and December 2019. Basic demographic and clinical data were collected from medical records. Subjects were grouped based on the CISNE and MASCC score, and complications during hospitalization were recorded. Predictive performance of each score was analyzed and compared using area of under curve.  Results: CISNE score showed a better performance both in solid malignancy with AUC of CISNE score (0.80 CI 95% 0.73-0.88, p = 0.00) compared to AUC of MASCC score (0.68; 95% CI 0.59 - 0,78, p = 0.00) and in hematologic malignancy with AUC of CISNE score (0.85; 95% CI 0.77 - 0.93, p = 0.00) and AUC MASCC score (0.65 ; 95% CI 0.54 - 0.76, p = 0.007).

Conclusion: CISNE score showed a better performance compared to MASCC score in predicting in-hospital complication in both solid and hematologic malignancy with cut-off point of 2.

A 62-year-old active career woman came to the clinic with a chief complaint of left heel pain for 7 months without numbness. She had previously sought consultation at several clinics and was prescribed oral nonsteroidal anti-inflammatory and opioid analgesic drugs with no improvement in symptoms. She was offered plantar corticosteroid injection therapy but refused due to fear of corticosteroid's possible side effects. She had a medical history of dyslipidemia and no other comorbid diseases. She was obese with a body mass index of 27.3 kg/m2. There was tenderness at the plantar medial calcaneal tuberosity, rated as 7/10 on the pain scale. Tinel tests were negative on both feet. Musculoskeletal ultrasound examination demonstrated a 7.7 mm thickness of left plantar fascia. In comparison, her right plantar fascia thickness was 2.8 mm. Three milliliters of dextrose 5% were injected perineural to the tibial nerve, posteriorly to the left medial malleolus. The patient reported a significant reduction of pain to 3. The second session of perineural dextrose injection was performed after one week, resulting in a pain severity reduction to 1. The patient was also advised to consult a dietician for weight loss management and avoid barefoot walking. No study yet compares the efficacy between conventional corticosteroid injection and perineural dextrose injection in treating plantar fasciitis.

Background: DLBS3233, recognized as an agent enhancing insulin sensitivity, has exhibited promise as a therapeutic option for addressing type 2 diabetes mellitus (T2DM). This study aimed to evaluate the effectiveness and safety of DLBS3233, a natural compound, in individuals newly diagnosed with T2DM.

Methods: A 12-week double-blind, randomized, placebo-controlled clinical trial was conducted with 104 eligible participants. They were assigned to receive DLBS3233 or a placebo along with lifestyle modifications. Various metabolic parameters, including fasting and post-meal plasma glucose levels at two hours, fasting insulin level, HOMA-IR, adiponectin level, lipid profile, superoxide dismutase (SOD) activity, GLUT-4 concentrations, and body weight measurements, were assessed at baseline, Week 6, and Week 12. Safety parameters assessment will include vital signs, liver function, renal function and adverse event.

Results: Participants exhibited similar demographic characteristics in both groups. While no significant changes were noted in fasting plasma glucose and most other parameters, the DLBS3233 group significantly reduced 2-hour postprandial glucose at Week 12 (p = 0.026). There were no substantial differences in A1c levels, fasting insulin, insulin resistance, adiponectin levels, or lipid profiles between the two groups at any point in time. Safety parameters, including blood pressure, liver enzymes, heart rate, gamma GT, and serum creatinine, remained comparable between the groups.

Conclusion: DLBS3233 showed potential for improving postprandial glucose control in newly diagnosed T2DM individuals. Although significant changes were limited, the study suggests that DLBS3233 could enhance glycemic regulation. The safety evaluation indicated no adverse effects on vital parameters. Further research with larger samples and more prolonged duration is warranted to comprehensively explore DLBS3233's potential in T2DM management.