Acta medica Indonesiana最新文献

Although acute upper limb ischemia (AULI) is less prevalent than lower acute limb ischemia, AULI may lead to severe morbidity if not well-treated. To manage AULI appropriately, evaluation of the etiologies, risk factors, and revascularization is of importance. Here we present a case of recurrent AULI and its appropriate diagnostic and management approaches. A 27-year-old male with a chief complaint of pain and numbness in his left arm for one week. He had a history of AULI seven months before and was treated by percutaneous intra-arterial thrombolysis at left brachial and radial arteries with residual non-occlusive thrombus. Duplex ultrasound (DUS) and CT angiography revealed a new soft thrombus with occlusion at the left subclavian artery. Evaluation of comorbid risk factors and source of thrombus was performed. The patient underwent pharmacomechanical thrombectomy and angioplasty procedure. The diagnosis of AULI was established based on pain and numbness in the left arm, and the finding of soft thrombus and occlusion of the left subclavian artery on DUS and CT angiography evaluation. Although various workups have been carried out to determine the etiology of AULI in this patient, the definite cause remains unknown. In addition, pharamcomecanical thrombectomy and angioplasty were performed as the appropriate revascularization methods in this condition. Recurrent AULI is a rare vascular phenomenon leading to disabling morbidities and fatal consequences if not treated properly. Further evaluation of etiology and risk factors for recurrent AULI is mandatory for appropriate management besides revascularization.

Background: This study aimed to determine the prediction equations for calculating maximal inspiratory pressure using spirometry and thoracic ultrasonography (USG) after COVID-19 with gastroesophageal reflux disease (GERD).  Methods: This cross-sectional study was conducted from January to December 2022 and included Indonesian adults recruited by consecutive sampling after they developed COVID-19 with GERD symptoms. The following tests were used: spirometry (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1); thoracic USG (left diaphragm excursion (LDE) and right diaphragm excursion (RDE); and respirometry (maximal inspiratory pressure (MIP). The data were analyzed using Pearson correlational analysis and multiple linear regression.

Results: Sixty-two participants were recruited: mean age 37.23 ± 9.76 years and average MIP 49.85 ± 18.13 cmH2O. MIP correlated significantly with FVC (r = 0.307; p = 0.015), LDE (r = 0.249; p = 0.051), FEV1(r = 0.186; p = 0.147), and RDE (r = 0.156; p = 0.221). We developed two models based on their applicability. Model 1 provides an MIP prediction equation for health facilities that have only spirometry: 23.841 - (20.455 × FEV1) + (26.190 × FVC). Model 2 provides an MIP prediction equation for health facilities that have both spirometry and thoracic USG: 3.530 - (20.025 × FEV1) + (25.354 × FVC) + (4.819 × LDE).

Conclusion: In this study, measures of respiratory function correlated significantly with diaphragm excursion. MIP can be predicted from spirometry and thoracic USG data. Healthcare facilities can choose the prediction equation model that best meets their situation.

Early identification of clinically significant portal hypertension (CSPH) is crucial in cirrhosis, as it is the primary underlying mechanism of cirrhosis complications. One such complication is esophageal varices, which are associated with high morbidity and mortality. Hepatic venous pressure gradient (HVPG) measurements and endoscopy, considered the gold standard for these conditions, are invasive methods that are limited, costly, and inconvenient. To address this challenge, a combination of non-invasive tests can be employed to predict CSPH and esophageal varices. A validated approach involves combining liver stiffness measurement (LSM) by transient elastography (TE) with platelet count. Additionally, spleen stiffness measurement (SSM) has emerged as a promising method for evaluating high-risk varices, as reported by Nababan et al. Therefore, non-invasive methods can be utilized to identify patients who need invasive procedures or potentially replace invasive procedures altogether.

This review aims to highlight the occurrences of several emerging and re-emerging infectious diseases, particularly 13 types under surveillance of Indonesia's emerging contagious disease task force. These diseases are considered potentially epidemic, due to the nature of tropical climate and high humidity of Indonesia's area. Several factors contribute to the emergence of these diseases: in conjunction with human behavior. Most of these diseases are zoonotic, specifically spread by viruses. The latest emerging infectious disease in Indonesia is monkeypox. Controlling the management of EID-REIDs presents a major obstacle for international health initiatives, particularly in Indonesia because of its extensive population, varied geographical landscape, and constrained resources. Overcoming these obstacles demands tactics like prioritizing Indonesian policies, bolstering disease monitoring systems, upgrading diagnostic capacities, fortifying public health facilities, fostering community involvement and education, and executing efficient prevention and management protocols. These strategies should be implemented in collaboration with international partners and organizations to effectively control and prevent the spread of emerging and re-emerging infectious diseases in Indonesia.

Background: Since Monkeypox (mpox) had an outbreak on 6th May 2022 in 75 countries, it has been declared by the World Health Organization (WHO) that mpox is a public health of international emergency concern (PHEIC). WHO declared mpox as PHEIC again in August 204. Indonesia was also affected by the mpox outbreak with most of the cases coming from vulnerable populations. This study aimed to give an overview of mpox as well as the recent outbreak situation and management in Indonesia.

Methods: In this narrative review (using PubMed, Scopus, and Cochrane databases combined with countries' national official reports and grey literatures), we discussed an overview of mpox including epidemiology, morphology, transmission, symptoms, treatment, and prevention. The management of mpox in Indonesia was specifically reviewed.

Results: Mpox is an infectious disease caused by the mpox virus which has infected 79,231 individuals globally. In Indonesia, the first mpox case was detected in August 2022 with 0 deaths and 88 confirmed cases as of August 2024. The virus is transmitted via respiratory droplets or direct contact with contaminated objects, surfaces, or mucocutaneous lesions of an infected individual which could lead to symptoms such as epidermal papules-pustules and clinical characteristics of classical smallpox. Although antivirals such as tecovirimat, cidofovir, and brincidofovir have been raised as potential treatments for mpox, these agents were only considered in severe cases in Indonesia.

Conclusion: Mpox is a contagious disease that could cause major health problems if left uncontrolled, especially in specific vulnerable populations due to its high morbidity and mortality. Therefore, particular measures must be performed, especially in Indonesia.

End-stage kidney disease (ESKD) is a severe final phase of chronic kidney disease (CKD). Currently, it is related to high morbidity and mortality rates, making it an important health issue and a catastrophic disease. There is an increase in the death rate, especially when the underlying metabolic disorders are not treated with renal replacement therapy. Continuous ambulatory peritoneal dialysis (CAPD), or continuous dialysis in the peritoneal cavity, is one of the treatment options available in Indonesia as CKD becomes more prevalent each year, in addition to hemodialysis and kidney transplants. Patients with CKD who are on either hemodialysis or CAPD are frequently malnourished. The primary cause of these nutritional and metabolic disorders in uremic patients has decreased appetite, a major disease symptom. It is also observed that the protein levels in the serum and tissues are typically low, although protein and energy intake have been adjusted to meet standard nutritional guidelines. Also, there is reverse epidemiology in CKD patients, where a higher weight gain could result in a lower risk of mortality than non-CKD patients, where a higher weight gain causes an increased risk of death. Assessment and monitoring of nutritional status are necessary to determine mortality and morbidity due to cardiovascular abnormalities and for prevention and management of other complications in CKD patients undergoing CAPD. Lastly, there is currently a scarcity of research on the nutritional status of CAPD patients. Therefore, risk assessment and nutritional management monitoring can help reduce CKD incidence in patients undergoing CAPD.

Background: Spleen stiffness measurement (SSM) is a recently developed non-invasive method for predicting clinically significant portal hypertension and esophageal varices in compensated advanced liver disease or cirrhosis. This study aims to validate the accuracy of SSM for screening high-risk esophageal varices among cirrhotic patients in Indonesia.

Methods: This is a single-center, cross-sectional study. Patients with liver cirrhosis who underwent endoscopy at Cipto Mangunkusumo Hospital, Jakarta were included. Clinical data and data from laboratory tests, endoscopy, liver, and spleen stiffness measurement by transient elastography (TE) were collected. A 100 Hz spleen-dedicated TE probe was used for SSM.

Results: Of 86 patients, 52 had high-risk esophageal varices. The median (IQR) value of SSM were significantly higher in patients with high-risk varices [36.1 kPa (IQR 21.5-59.1) vs. 70.3 kPa (IQR (52.2-86.0); p<0.001). SSM with a low cutoff value of 20 kPa had sensitivity and negative predictive value of 98.1% and 87.5%, respectively. The high cutoff value of 70 kPa had specificity and positive predictive value of 82.4% and 81.3%, respectively.

Conclusion: SSM is useful for screening high-risk esophageal varices. Furthermore, the new dual cutoff value can help rule-in and rule-out high-risk esophageal varices among cirrhotic patients in Indonesia.

Background: Multidrug-resistant Gram-negative bacteria (MDR-GNB) are prevalent in intensive care units (ICUs), leading to increased morbidity and mortality. Limited data on MDR-GNB in Indonesia prompted this study to determine the prevalence and risk factors associated with MDR-GNB colonization, enhancing screening strategies, and acquiring phenotypic and genotypic data on these bacteria.

Methods: This analytical cross-sectional observational study included participants who met the criteria and were admitted to the ICU at Dr. Cipto Mangunkusumo Hospital from January to December 2022. We used multivariate analysis on the findings from rectal swab screening, sociodemographic, clinical, and microbiological examinations.

Results: Out of 108 participants, 172 cultures comprised 165 Gram-negative isolates, four yeasts, and three with no growth. The prevalence of patients colonized with MDR-GNB was 51.85% (56/108), and the prevalence of MDR-GNB isolates was 39.53% (68/172), with the most common MDR-GNB being Escherichia coli (29.65%) and Klebsiella pneumoniae (19.44%). The most resistant gene found in ESBL was CTX-M (75%), and the carbapenemase producer gene was NDM (5.88%). Risk factors associated with MDR-GNB colonization were the length of stay before admission to the ICU (p = 0.003) and a history of previous antibiotic therapy (p = 0.036).

Conclusion: In this study, two risk factors were associated with the occurrence of MDR-GNB colonization, with the prevalence of MDR-GNB colonization in patients initially admitted to the ICU still quite high. Therefore, selecting screening patients based on risk factors at the time of initial admission to the ICU is crucial for infection control programs.

Introduction: COVID-19 is a global health issue that can affect the cardiovascular system at various levels and cause damage to the endothelium, leading to decreased arterial elasticity and vascular dysfunction. This study investigates the relationship between COVID-19 history and arterial vascular elasticity in medical students.

Methods: This study used a case-control design and a purposive random sampling technique. Data on COVID-19 history and characteristics of the subjects were collected using questionnaires, while arterial vascular elasticity was measured using the accelerated photoplethysmograph (APG) analyzer, SA-3000P. The sample consisted of 24 COVID-19 survivors (case) and 24 subjects without COVID-19 history (control).

Results: This study found that three subjects (6.25%) had optimal arterial vascular elasticity, 28 subjects (58.3%) had normal elasticity, and 17 subjects (35.45%) had sub-optimal elasticity. No significant differences were found in age, gender, physical activity, dietary habits, body mass index, and family history of hypertension, diabetes mellitus, heart disease, and obesity between the case and control groups (p > 0.05). The Chi-square test results showed a significant relationship between COVID-19 history and arterial vascular elasticity (p = 0.003; OR = 9.8; CI = 2.2-42.0).

Conclusion: COVID-19 survivors are nine times more likely to have sub-optimal arterial vascular elasticity compared to those who have not been infected with the virus. COVID-19 survivors are advised to adopt healthy lifestyles and undergo regular check-ups to mitigate the risk of developing vascular diseases.

Pseudoaneurysms are false aneurysms that mostly occur at the site of arterial injury. Pseudoaneurysm is the most frequent complication after catheter-associated interventions and occurs because of an insufficient closure of the puncture site. However, there are several reported cases of patients with pseudoaneurysm without a prior history of vascular intervention. We described a case of ruptured giant abdominal aortic pseudoaneurysm in a patient with no prior history of vascular intervention, with an initial complaint of abdominal pain. The patient successfully received EVAR therapy using a kissing graft.