Acta medica Indonesiana最新文献

Background: Type 2 Diabetes Mellitus (T2DM) in young adults is associated with an increased risk of early sarcopenia due to insulin resistance and inflammation. This insulin resistance and inflammation can be influenced by leptin and adiponectin, which are key adipocytokines produced by adipose cells. However, no studies have examined the relationship between leptin, adiponectin levels, and sarcopenia in T2DM patients under 60 years old. This study aimed to investigate the relationship between leptin, adiponectin levels, and Leptin-to-Adiponectin ratio (LAR) with sarcopenia in non-geriatric T2DM patients.

Methods: This cross-sectional study was conducted from January 2021 to April 2022. The subjects consisted of T2DM patients aged 18-59 years at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Baseline data were sourced from a primary study, while stored serum samples were analyzed for leptin and adiponectin using ELISA. Leptin and adiponectin differences were assessed statistically using the Mann-Whitney U test, and the Kruskal-Wallis test was used for additional analysis.

Results: Among 97 subjects, 4 (4.1%) had sarcopenia, while 34 out of 93 non-sarcopenic subjects belonged to the possible sarcopenia category. Bivariate analysis results showed significant differences between leptin levels (p=0.005) and the Leptin-to-Adiponectin Ratio (LAR) (p=0.003) with sarcopenia in non-geriatric T2DM patients. Meanwhile, adiponectin levels (p=0.799) did not show statistical differences. Further analysis was conducted among three groups, namely sarcopenia, possible sarcopenia, and non-sarcopenia. The result showed statistically significant differences in leptin and LAR levels between sarcopenia and possible sarcopenia (leptin p=0.004; LAR p=0.007) as well as sarcopenia and non-sarcopenia (leptin p=0.038; LAR p=0.011).

Conclusion: Leptin levels and LAR were associated with sarcopenia in a non-geriatric T2DM population.

Inflammatory bowel disease (IBD), consisting of ulcerative colitis (UC) and Crohn's disease (CD), represents one of the debilitating chronic gastrointestinal diseases that affects the physical and psychological aspects of patients, leading to increased morbidity and mortality and affecting patients' quality of life. There is an increased prevalence of depressive disorders and anxiety among IBD patients, with the gut-brain axis as the proposed underlying mechanism. Treatment of psychological issues among patients with IBD enhances long-term management outcomes. Therefore, we provide a comprehensive review of epidemiology, pathomechanism, diagnosis, and treatment modality of psychological issues frequently found among IBD patients.

Dubin-Johnson syndrome is a rare genetic disease that causes impaired transport of bilirubin. In most cases, there will be no symptoms. However, some people might develop jaundice due to certain conditions. In this case, we would like to present a 54-year-old male patient with Dubin-Johnson syndrome confirmed through genetic analysis showing homozygote mutation of p.Gly693Arg, with no apparent bile deposition in liver biopsy and reactivation of hepatitis B. The Patient had no symptoms since birth and was recently found to have an increased level of direct bilirubin. Further inspection showed a familial pattern of the disease. This is a unique case of homozygote mutation with p.Gly693Arg with atypical presentation of liver biopsy and reactivation of hepatitis B with no clinical manifestation.

Background: Type 2 diabetes mellitus (T2DM) is considered one of the top 3 causes of death in Indonesia. However, the current scenario regarding the management of T2DM in Indonesia remains unclear. Thus, the present study aimed to describe the baseline characteristics, treatment types, and quality of care indicators in T2DM patients under the DISCOVER CaReMe Registry program.

Methods: DISCOVER CaReMe Registry program is a multi-centre, prospective, and observational study conducted over 3 years from 2018 to 2021. The data were collected from five different sites across Indonesia.

Results: A total of 539 patients with a mean age of 58.98 ± 9.76 were enrolled in the study. Among them, 62% (334/539) of patients were females. Further, the mean glycated haemoglobin (HbA1c) levels were 8.54 ± 2.88%, which was much higher than the American Diabetes Association (ADA) recommended target of 7%. Overall, 69% of the patients had HbA1c levels of >7%. First-line treatment in patients was mostly metformin (26%). As per the quality-of-care indicators, 72.2% of patients use glucose monitoring equipment and receive education about diabetes treatment and management. Furthermore, the knowledge of T2DM among patients was assessed in over 85% of cases, and misconceptions about the condition were clarified by healthcare professionals (HCPs). HCP advised a "diabetic diet" to 69.4% of patients.

Conclusion: Despite a good knowledge and quality of care indices in patients with T2DM, the proportion of patients with HbA1c levels of >7% is still higher. There is an urgent need for diabetic management programs to prevent such complications in the Indonesian population.

Zenker's diverticulum (ZD) arises from impaired cricopharyngeal (CP) muscle distensibility during deglutition (swallowing), leading to a clinical presentation characterised by dysphagia, regurgitation, aspiration, cough, and potential weight loss. The definitive treatment for ZD is a CP myotomy. Traditionally, open surgical approaches (transcervical diverticulectomy, diverticulopexy, or diverticular inversion) with or without concomitant CP myotomy and rigid endoscopic techniques utilizing stapling or CO2 laser therapy have been employed. However, these interventions are often associated with significant morbidity and mortality, particularly in the elderly and comorbid ZD patient population. The advent of flexible endoscopic ZD treatment has revolutionized the therapeutic landscape, rapidly becoming the preferred first-line modality for the management of small to moderate-sized diverticula. The past decade has witnessed the emergence of a multitude of novel techniques within the realm of flexible endoscopic ZD treatment. In this medical illustration, we report a woman, 64-years-old with Zenker's diverticulum treated with Z-POEM. She came to our clinic with dysphagia and regurgitation for 6 months prior.  Diagnostic gastroscopy showed ZD of 3 cm, located 18 cm from incisors with a thick septal muscle. A triangle-shaped knife created a 2-cm mucosal incision, and submucosal tunneling was made by spray coagulation. The gastroscope was advanced through the submucosal space of the esophageal lumen and the diverticulum site until the bottom of the diverticulum. The septal muscle was completely cut, immediately allowing the gastroscope to pass through easily, and the mucosal defect was closed with hemoclips. Six months after the treatment, the patient no longer experiences dysphagia and regurgitation. Z-POEM offers a precise approach to treating Zenker's diverticulum by providing a complete visualization of the entire septal muscle. This comprehensive view minimizes the risk of incomplete myotomy, ensuring a more effective treatment.

Background: Patients with heart failure are often diagnosed based on clinical signs and serological markers. Finding biomarkers with greater sensitivity and specificity for heart failure patients who also have episodic dyspnea is a challenge for researchers. Thus, we conducted a systematic review and meta-analysis of previous research to determine the diagnostic value of B-type natriuretic peptide as a potential biomarker in heart failure patients experiencing acute dyspnea.

Methods: By searching PubMed/Medline, Scopus, and Google Scholar up to March 2023, all cross-sectional and cohort studies were selected according to the PRISMA guidelines and assessed by the Deeks' funnel plot asymmetry test for bias.

Results: A total of thirty-five qualifying studies had their data extracted. In 26 investigations (n=16002), the precision of B-type natriuretic peptide was evaluated. There were significant differences in the reported sensitivity and specificity between trials. One research study yielded the lowest sensitivity of 0.76 (0.68, 0.82), with a prevalence of 46% for heart failure and a BNP level of ≥500 pg/ml. Specificity grew but stayed variable as the threshold rose, whereas sensitivity declined. A diagnostic meta-analysis was carried out on 14 trials (n=6313) to determine the accuracy of N-terminal probrain natriuretic peptide. When the threshold is raised, the pattern in NTproBNP is similar to that of B-type natriuretic peptides, with sensitivity falling and specificity increasing. Following the final analysis, the confidence areas surrounding the pooled sensitivity and specificity for BNP vs NTproBNP showed a distinct overlap. The overlap indicated that there was no statistically significant difference between the tests at the <100 pg/ml and ≤300 pg/ml rule-out levels, respectively (P>0.05).

Conclusion: The meta-analysis reveals a substantial degree of congruity in the sensitivity and specificity between the levels of BNP and NTproBNP as biomarkers. Nevertheless, it's worth noting that, in the end, there exists a potential for overlooking heart failure diagnoses. Larger future studies, overcoming past limitations, could likely establish a consensus.

Liver dysfunction frequently accompanies heart diseases, especially in hemodynamically unstable acute heart failure or cardiogenic shock. This condition is marked by significant elevation of liver transaminases and brings high morbidity and mortality for > 50 % of cases. Despite the high mortality rate, early recognition with prompt management results in the recovery of liver function. A 53-year-old man presented with late-onset non-reperfused inferior STEMI. The patient presented with persistent chest pain and shortness of breath. The electrocardiogram showed atrioventricular (AV) block grade III and ST-segment elevation evolution in the inferior lead. The patient was diagnosed with a late-onset inferior STEMI with cardiogenic shock and total AV block complication, acute shock liver, lactic acidosis, and acute renal failure. We administered inotropic and chronotropic support drugs as well as post-MI anti-remodelling therapy to treat heart failure (HF) and left ventricular (LV) systolic dysfunction, such as angiotensin-converting enzyme inhibitor and aldosterone antagonist, after systemic perfusion improved. Anti-ischemic therapy, such as antithrombotics, was also administered. Renal and liver function test evaluation after a week of patient discharge showed normalization of these parameters. There is no definite treatment strategy for shock liver. The management strategy is directed at the treatment of underlying causes. Hemodynamic insult is the mainstay therapeutic target. Recovery of liver transaminases was demonstrated after the underlying insult had been eliminated.

Human Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS) remain significant global health challenges. Beyond the physical manifestations, individuals living with HIV/AIDS often grapple with psychological burdens, notably anxiety, which can adversely affect their quality of life (QoL) and physiological stress markers, such as cortisol levels. Palliative care, traditionally associated with end-of-life support, has evolved to address the multifaceted needs of chronic illness patients, including those with HIV/AIDS.  In the world, 1.89 million individuals require palliative care due to pain, and around 2.7 million people have HIV. This editorial explores the role of palliative care in enhancing QoL and modulating cortisol levels among HIV/AIDS patients experiencing anxiety. Palliative care is holistic, addressing physical, emotional, social, and spiritual needs. In the context of HIV/AIDS, palliative interventions have demonstrated efficacy in alleviating symptoms, reducing psychological distress, and improving overall well-being. A systematic review highlighted that home-based palliative care and inpatient hospice services significantly improved patient outcomes in pain management, symptom control, anxiety reduction, and spiritual well-being. Palliative care emerges as a vital component in the comprehensive management of HIV/AIDS, particularly for patients grappling with anxiety. By enhancing quality of life and potentially modulating stress-induced hormonal imbalances, palliative interventions offer a holistic approach that addresses both psychological and physiological aspects of the disease. Future research should focus on elucidating the mechanisms by which palliative care influences cortisol levels and exploring its long-term benefits on disease progression and patient well-being.

Background: Acute pancreatitis is a self-limiting inflammatory disease that in some cases may lead to severe acute pancreatitis. To prevent this development, multimodal management, including nutritional management, is used in treating acute pancreatitis patients. The controversy between parenteral and enteral feeding has led to major debate. This case report aims to assess which method has better outcomes based on multiple cases of organ failure, inflammatory response, and length of hospital stay.

Methods: A 46-year-old male presented to the Emergency Department of our hospital with acute abdominal pain, nausea, and vomiting, 12 h before admission. Based on physical and further examination, the patient was diagnosed with severe acute pancreatitis and underwent a necrotomy procedure. Articles from multiple databases were obtained and assessed using the Cochrane Collaboration Risk of Bias tool. The articles were analyzed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a forest plot model. Effect size quantification for continuous and categorical variables was analyzed using continuous and binary random effect models, respectively.

Results: Seven articles were obtained after exclusion and review. A total of 491 patients with acute/severe acute pancreatitis were assessed. These seven articles conclude that enteral nutrition has advantages over parenteral nutrition.

Conclusion: Our study concluded that early enteral feeding provides better clinical improvement, reduced lipase enzyme levels, and shortened length of hospital stay.

Background: Chronic kidney disease (CKD) is a global health problem with increasing prevalence. This study aims to analyze the effect of Ramadan fasting on important biomarkers in CKD patients.

Methods: A prospective cohort study was conducted on 30 CKD patients with stages 1, 2, and 3A who underwent Ramadan fasting. Measurements of MDA, PARP, SIRT1, NR1D1, and TGF-β levels were carried out before fasting, 2 weeks during fasting, and after fasting using the Enzyme-linked immunosorbent assay (ELISA) method.

Results: There were significant decreases in urea, fasting blood glucose, HbA1C, and uric acid levels (p<0.05). MDA and SIRT1 decreased significantly (p<0.001), while PARP and NR1D1 increased significantly (p<0.001). TGF-β also showed a decrease. There were no significant changes in lipid profiles, creatinine, and albumin.

Conclusion: Ramadan fasting has significant effects on several biochemical parameters and biological markers in early-stage CKD patients. These changes indicate potential improvements in oxidative stress, cell autophagy, inflammation regulation, and circadian rhythm. Further studies are needed to evaluate the long-term effects and clinical implications of these findings in CKD management.