Acta medica Indonesiana最新文献

Background: By 2019, the human immunodeficiency virus (HIV) had infected approximately 3.8 million people in Southeast Asia and caused 120,000 deaths. In Indonesia, despite periodic fluctuations, the incidence of HIV/AIDS continues to rise annually. Although antiretroviral therapy (ART) has substantially extended the lives of people living with HIV/AIDS (PLWHA), various risk factors continue to influence treatment outcomes. This study aimed to identify the risk factors significantly associated with mortality among PLWHA undergoing ART therapy at RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia.

Methods: In a retrospective cohort design, we reviewed sociodemographic and clinical data of all adult PLWHA (aged ≥18 years) who initiated ARV therapy at RSUP Dr. Sardjito Hospital between January 2008 and December 2021. Patients with incomplete baseline data or those referred from other facilities were excluded. The final cohort was categorized into surviving and deceased groups. Univariate and multivariate logistic regression analyses were conducted to determine the factors linked to mortality, and survival probabilities were estimated using Kaplan-Meier curves.

Results: Out of 1,591 patients included in the study, 199 died during the follow-up period. Univariate analysis revealed that age over 45 years, tuberculosis status, low CD4+ count, occupation, and advanced clinical stage of HIV/AIDS were significantly associated with mortality. Multivariate analysis further demonstrated that low CD4+ count, employment status, and, most notably, advanced clinical stage (stages 3 and 4) were independent predictors of death. The survival probabilities at 1 and 5 years were 89% and 87%, respectively.

Conclusion: Occupation, CD4+ count, and clinical stage critically influence mortality in PLWHA on ART therapy, with advanced clinical stage being the most significant. Early diagnosis and prompt ART initiation are essential to enhance survival.

Atrioventricular block (AVB) is a rare complication of rheumatoid arthritis (RA). Complete AVB in people with RA significantly increases cardiovascular morbidity and doubles the mortality risk. We report on a 48-year-old woman presenting with dyspnea and peripheral edema, with symptoms of polyarthritis for 3 years. Physical findings included bradycardia, bilateral rales, and finger deformities consistent with RA. Electrocardiography featured complete AVB, and a thoracic computed tomography scan showed a mosaic appearance with fibrosis, bronchiectasis, and partial atelectasis of the lungs. Further tests showed elevated levels of C-reactive protein, rheumatoid factor, and several inflammatory cytokines. Transient followed by permanent pacemaker placement was performed along with pharmacological treatments, including intravenous (IV) methylprednisolone pulse therapy and IV tocilizumab. Cardiac involvement in RA usually takes the form of pericardial effusion, heart failure, myocarditis, and coronary artery disease. Complete AVB is a rare but important extra-articular involvement in RA that warrants early recognition and treatment with a pacemaker, anti-inflammatory drugs, and disease-modifying antirheumatic drugs.

Atherogenic dyslipidemia is a lipid disorder characterized by high triglyceride (triglyceride-rich lipoprotein) levels, reduced HDL-C levels, and an abundance of small dense LDL (sdLDL) particles. This condition is frequently associated with diseases or states that involve insulin resistance and inflammation, such as obesity, metabolic syndrome, and type 2 diabetes. Atherogenic dyslipidemia/lipoprotein is linked to a heightened risk of cardiovascular disease. The presence of numerous sdLDL particles and remnant lipoproteins are critical in the development and buildup of plaque in atherosclerosis. Elevated triglyceride levels can also promote inflammation and thrombosis within the arterial walls. In addition to lifestyle modifications, cholesterol-lowering drugs-whether used alone or in combination-are often prescribed for the prevention or management of atherosclerotic cardiovascular disease (ASCVD), including statins, ezetimibe, bempedoic acid, and PCSK9 inhibitors.

Jaundice, characterized by yellow discoloration of the skin, mucous membranes, and sclera, results from hyperbilirubinemia and is uncommon in adults. Its occurrence often signals serious underlying conditions. Hyperbilirubinemia may also present with cutaneous manifestations, including xerosis, hyperpigmented plaques, and erythematous rashes. A 47-year-old woman presented with hyperbilirubinemia, transaminitis, and cutaneous manifestations, including hyperpigmented plaques on the face, erythematous rashes on the hands and feet, and yellowish discoloration of the skin. Despite extensive evaluation, including viral hepatitis screening, autoimmune markers, and imaging, a definitive diagnosis remained elusive. The clinical features and laboratory findings suggested Primary Biliary Cholangitis (PBC) as the most likely diagnosis, although further confirmation through advanced serological testing and liver biopsy was needed. Treatment with ursodeoxycholic acid (UDCA) and high-dose oral methylprednisolone showed clinical improvement but persisted in transaminitis with a normal ultrasonographic appearance. This case emphasizes the importance of recognizing cutaneous signs in systemic diseases and the need for a comprehensive diagnostic approach in resource-limited settings.

Acute-on-chronic liver failure (ACLF) is a severe condition with an incidence rate of 5.7 cases per 1,000 person-years. A primary trigger for ACLF is hepatitis B reactivation, which is responsible for 40-60% of cases. Co-infection with hepatitis A can also contribute to its occurrence. This study presents the case of a 58-year-old male patient with a history of hepatitis B virus (HBV)-related cirrhosis, presenting with symptoms including confusion, disorientation, worsening jaundice, abdominal discomfort, nausea, vomiting, loss of appetite, malaise, muscle pain, and fever. Despite regular treatment for HBV, the patient's condition deteriorated over 14 days. He had no history of hypertension, diabetes, autoimmune diseases, alcohol consumption, or smoking. On examination, the patient exhibited grade 2 hepatic encephalopathy, severe jaundice, ascites, and lower limb edema. Laboratory results revealed elevated liver enzymes, increased bilirubin levels, and decreased albumin. Subsequent testing confirmed acute hepatitis A infection and a significant hepatitis B viral load. The report highlights that reactivation of Chronic Hepatitis B, accompanied by co-infection with hepatitis A, played a critical role in inducing inflammation and worsening the ACLF condition.

Background: First-degree relatives (FDR) of individuals with type 2 diabetes mellitus (T2DM) are at higher risk of developing early metabolic disturbances, particularly insulin resistance and lipid metabolism abnormalities. These issues contribute to a greater predisposition to cardiovascular disease compared to the general population. Despite the significant contribution, there is limited information on the relationship between atherogenic lipoproteins and normotensive, normoglycemic young FDR in Indonesia. Therefore, this study aimed to evaluate the correlation between small dense low-density lipoprotein (sdLDL) levels and HOMA-IR in FDR with T2DM, as well as assess variation in sdLDL levels within FDR and non-FDR groups.

Methods: This cross-sectional study analyzed secondary data from the Metabolic Endocrine and Diabetes Division of the Internal Medicine Department, Faculty of Medicine, Universitas Indonesia, and Cipto Mangunkusumo Hospital. The primary study, titled "Early Cardio-Metabolic Disorders in the First-Degree Relative Population of Type 2 Diabetes Mellitus," was expanded to include sdLDL measurements. Bivariate analysis and correlation tests were used to explore the relationship between sdLDL and HOMA-IR.

Results: The experiment included 125 subjects, consisting of 62 FDR and 63 non-FDR. Based on the results, sdLDL levels were significantly higher in the FDR group compared to the non-FDR group (31.42 (IQR 20.1-41.39) vs 21.05 (IQR 12.18-26.13) mg/dL, p<0.0001). However, no significant correlation was observed between sdLDL levels and HOMA-IR in the FDR group (r=0.059, p=0.649).

Conclusion: This study showed a significant difference in sdLDL levels between FDR and non-FDR of T2DM patients. However, no correlation was found between sdLDL and HOMA-IR in the FDR group.

Background: Tension pneumothorax(TP) is defined as a pneumothorax in which the pressure of intrapleural air exceeds atmospheric pressure, producing adverse effects, including contralateral mediastinal shift associated with cardiovascular collapse, due to reduced venous return (because of compression of the SVC and IVC) and hypoxia. Usually, patients with TP present to the Emergency Department with vague pleuritic chest pain and shortness of breath, but being considered a red flag it should be diagnosed during the primary assessment and managed promptly with large bore needle decompression followed by chest tube insertion. Presence of extensive subcutaneous emphysema(SCE) can further aggravate the respiratory distress and make the airway management even more challenging in the ER. Situation can become even worse when such a patient needs cardiopulmonary resuscitation on arrival.

Case report: We report an unusual case of a 55 years old man, who presented in the ER with history of sudden onset respiratory distress while taking bath. Patient was brought to the ER in a state of gasping, hypoxia and shock. Needle decompression of the pneumothoraces was not sufficient as he also had extensive subcutaneous emphysema which resulted in cardiac arrest. The CPR and the airway management extremely were practically difficult. He was finally tracheostomised in the ER and accompanied by bilateral chest-tube thoracotomy. He was discharged for home after pleurodesis without any neurological deficit.

Conclusion: Primary spontaneous pneumothorax is an uncommon condition but can rarely end up in tension pneumothorax and accompanying subcutaneous emphysema can make the management further challenging. Airway skills of the ER team are important in saving such patients ives.

Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality worldwide. Recent advancements in regenerative medicine have unveiled the promising roles of secretome and exosomes in the treatment of CVDs. In this article, we aim to understand the roles of secretome and exosomes in the cardiovascular system, both in physiological and pathological conditions, and explore the broad applications of secretome and exosomes in mitigating CVD progression. Secretome and exosomes, which play crucial roles in intercellular communication, tissue repair, and immunomodulation, have shown potential in reducing cardiovascular disease progression by inhibiting inflammation, promoting blood vessel growth, and regulating biological mechanisms. Further research is needed to maximize their use in advanced cardiovascular therapy.

Background: Cardiovascular diseases increase the mortality risk in Graves' disease (GD) patients. Atrial fibrillation (AF) is one of the most prevalent cardiovascular diseases in GD. Hyperthyroidism that occurs in GD may increase uric acid levels, while uric acid levels can also increase the risk of AF in the general population. This study is designed to observe the correlation between free T4 (FT4) and uric acid, and compare the levels of uric acid in subjects with and without AF in GD.

Methods: A cross-sectional study was conducted, including GD patients who met research criteria in Dr. Cipto Mangunkusumo Hospital during 2024. We performed history taking, physical examination, laboratory examination, and electrocardiogram for each subject. Data was analyzed using Pearson or Spearman correlation, and bivariate analysis to evaluate the comparison of uric acid in subjects with and without AF.

Results: We included 74 subjects, with an average age of 41 years, mostly female (86.5%), and 62.2% had normal FT4 levels. AF occurred only in 4.1% subjects. Mean of uric acid is 4.71 ± 1.2 mg/dl, which is within the normal range. No correlation was found between FT4 and uric acid (r = 0.076; p = 0.520), including after adjustment with subgroup analysis based on thyroid status, gender, and diabetes mellitus. Mean of uric acid is not statistically different between subjects with and without AF (4.9 ± 1.01 mg/dl vs 4.7 ± 1.2 mg/dl; p = 0.785).

Conclusion: No significant correlation was found between FT4 and uric acid. Mean of uric acid is not statistically different between subjects with and without AF.

Background: Tuberculosis is a high-burden infectious disease requiring long-term treatment. Compliance is the key to cure; however, directly observed therapy (DOTS) is not always feasible. Telemedicine use in DOTS offers improved accessibility; however, its effectiveness has not been established. We aimed to investigate the effectiveness of telemedicine-based DOTS on treatment compliance in patients with tuberculosis.

Methods: Databases including MEDLINE, Scopus, EMBASE, PubMed, and Cochrane were searched for studies implementing telemedicine-based DOTS until November 2nd, 2023. Studies were appraised for validity, importance, and applicability using the Oxford Centre of Evidence-Based Medicine tool, and the outcomes were graded based on their levels of evidence (LOE).

Results: Our search yielded six systematic reviews. Telemedicine-based DOTS yielded favourable effects in improving adherence (LOE: I), treatment completion (LOE: II-III), and cure rates (LOE: II-III). Other outcomes, in terms of bacteriological resolution (LOE: II) and mortality (LOE: IV), were estimated to be non-inferior to those of DOTS. In terms of the telemedicine mode, the VDOTS yielded the highest LOE in improving adherence (LOE: I), followed by short messaging services (LOE: III) and medication monitors (LOE: III), which yielded similar effects. Results for phone reminders were contradictory, with the highest evidence suggesting that it might be ineffective for treatment completion (LOE: I-III) but may increase the cure rate (LOE: III).

Conclusion: Telemedicine-based DOTS may improve adherence, treatment completion, and cure rate, and is non-inferior in terms of bacteriological resolution and mortality. Telemedicine-based DOTS can be considered for implementation; however, further high-quality studies in limited-resource settings are needed to strengthen the evidence.