Acta medica Indonesiana最新文献

Background: Individuals with HIV/AIDS often experience significant physical and mental burdens. Palliative care has emerged as a means to improve the quality of life for people living with HIV/AIDS (PLWHA). This study aims to determine the effect of palliative care on the quality of life and psychoneuroimmunoendocrine aspects in PLWHA, particularly those suffering from anxiety, as indicated by cortisol hormone levels.

Methods: A total of 30 PLWHA with anxiety were selected based on inclusion and exclusion criteria. This study employed a quantitative design with a quasi-experimental one-group pre-test and post-test approach. The data were analyzed using descriptive statistics and a paired t-test to assess the impact of the intervention on quality of life and cortisol hormone levels.

Results: The findings indicated a significant improvement in quality of life following palliative care (p = 0.000, p < 0.05). The cortisol levels in PLWHA with anxiety decreased following palliative care; however, the reduction was not statistically significant, suggesting that palliative care had no measurable impact on cortisol levels post-intervention (p = 0.845, p > 0.05).

Conclusion: Palliative care significantly enhances the quality of life in PLWHA. However, it does not lead to a statistically significant reduction in cortisol hormone levels before and after the intervention. Factors such as patient compliance with the palliative care plan and the influence of efavirenz on cortisol levels in PLWHA are likely contributing to these results.

Background: A family history of hypertension increases the risk of renin-angiotensin-aldosterone system activation, insulin resistance, and vascular inflammation, contributing to cardiovascular disease. Early vascular disturbances, marked by angiotensin II and insulin resistance assessed through the homeostatic model assessment of insulin resistance (HOMA-IR), play crucial roles in hypertension development. This study aims to determine the comparison and correlation between Ang II levels and HOMA-IR in normotensive young adults with or without offspring hypertension.

Methods: We conducted this cross-sectional study by recruiting fifty normotensive participants, who were categorized into two groups: normotensive young adults who are offspring of parents with essential hypertension (case) and those who are not (control). The serum Ang II and HOMA-IR were measured. The comparative analysis was conducted using the Mann-Whitney test, and correlations were evaluated using Spearman's test.

Results: Among the 50 subjects (25 cases and 25 controls), a significant difference was observed in Ang II levels (p = 0.010), whereas HOMA-IR (p = 0.206) showed no notable difference between case and control. Notably, a positive correlation between Ang II and HOMA-IR (r = 0.554; p = 0.004) was observed in the case group, while the control group exhibited an insignificant correlation (r = -0.089; p = 0.671).

Conclusion: There are marked differences in Ang II levels between normotensive young adults with a family history of essential hypertension and those without such history. Additionally, a significant correlation was found between Ang II and HOMA-IR in normotensive young adults who have a family history of essential hypertension.

Background: Geriatric patients are often subject to polypharmacy, increasing their risk of adverse drug reactions (ADRs). This study evaluated polypharmacy practices, ADR incidence, predictive factors, and the applicability of the GerontoNet Score at a tertiary referral teaching hospital in Indonesia.

Methods: This retrospective study included 340 geriatric inpatients at Dr. Cipto Mangunkusumo Hospital, Jakarta, in 2023. The relationship between demographic data, comorbidities, number of drugs used, and ADR events was analyzed using the Chi-square test. The association between GerontoNet ADR scores and ADR events was also assessed.

Results: The study included 182 (53.5%) male and 158 (46.5%) female patients, with a mean age of 71.9±6.1 years. Of these, 70.9% were aged 65 to 74. A total of 78.8% of patients had ≥ 4 comorbidities. The number of drugs ranged from 3 to 28, with a mean of 10.7 drugs and a median of 10 drugs. ADRs were detected in 26 patients (7.6%), with 17 cases in females and 9 in males (p=0.044). Insulin- and diuretic-induced hypokalemia were the most frequent ADR (13 patients), followed by heparin-induced thrombocytopenia (3 patients). No significant correlation was found between ADRs and age (p=0.505), number of comorbidities (p=0.425), number of drugs (p=0.576), or GerontoNet ADR Score (p=0.530).

Conclusion: Polypharmacy is prevalent at Dr. Cipto Mangunkusumo Hospital, yet the incidence of ADRs is relatively low. Most ADRs were related to high-alert drugs, while no significant correlations were found between age, polypharmacy, comorbidities, or GerontoNet Score with ADR events.

Background: Heart disease is one of the non-communicable diseases that cause the highest mortality. Its symptoms affect the patient's functional capacity and activities. The six-minute walking test can be done to assess a person's functional ability, response to therapy, and prognosis of chronic heart-lung conditions. The study aims to determine the safety of the six-minute walking test in inpatients after percutaneous coronary intervention by assessing the response of vital signs, Borg scale, and angina scale.

Methods: This study was a one-group pre-and post-test design study with subjects of inpatients after percutaneous coronary intervention at the Integrated Cardiac Service in Cipto Mangunkusumo General Hospital Jakarta. Research subjects conducted a six-minute walking test twice with a five-minute break in between. Examination of vital signs, Borg scale, and angina scale before and after walking test. The number of subjects was 30 (27 male and 3 female) with the majority classified as a low-risk stratification.

Results: The six-minute walking test was performed over two days or more in 56.7% of the subjects. The mean covered distance was 294.68 ± 57.02 meters. Vital signs of systolic and diastolic blood pressure, pulse rate, respiratory rate, and Borg rating of perceived exertion (RPE) scale increased during the test. They decreased to baseline after resting for five minutes with p-value <0.05 in the Wilcoxon Signed Rank test. Changes in saturation, dyspnea, and leg fatigue of the Borg scale, and angina scale were not statistically significant. All study subjects did not have major adverse events.

Conclusion: The six-minute walking test is safe to do in inpatients after percutaneous coronary intervention with vital signs, Borg scale, and angina scale change accordingly to physiological response.

Hirschsprung disease (HSCR) is a rare congenital intestinal disease characterized by the absence of ganglion cells in the myenteric and submucosal plexuses of the intestine. Individuals with HSCR demonstrate a higher risk for inflammatory bowel disease (IBD), with Chron's disease (CD) commonly observed. Renal and urinary involvement is reported by between 4 and 23% of IBD patients, which manifests as urinary calculi, fistulas, and ureteral obstruction, which causes hydronephrosis. Those conditions can lead to a predisposition to recurrent urinary tract infections (UTIs) and should be suspected in male patients with IBD. A 26-year-old male with a history of HSCR and multiple surgeries presented with recurrent UTIs over 3 months. Upon further evaluation, he was found to have hydronephrosis in both kidneys. An MRI of the abdomen with contrast showed thickening and fibrosis in contact with the posterior wall of the rectum, causing a narrowing of the bilateral ureter. This clinical case has been reported to raise awareness of urological complications in CD patients with a history of HSCR, with recurrent UTIs as the presenting symptom.

Background: Olfactory dysfunction is a common symptom of Coronavirus disease 2019 (COVID-19). In this study, we aimed to evaluate the recovery rate and duration of these symptoms in COVID-19patients.

Methods: This systematic review was conducted by searching PubMed and Google Scholar from April 1st, 2020, until October 1st, 2022, using the terms ''COVID-19'' OR ''COV-2,'' OR ''Coronavirus 2'' OR coronavirus AND ''loss of smell'' OR Anosmia OR Hyposmia OR olfaction OR ''olfactory loss'' AND ageusia OR Hypogeusia OR dysgeusia OR ''gustatory loss'' OR gustation OR ''loss of taste''. The references of included studies were also manually screened. Random-effects meta-analysis was performed.

Results: One hundred and twenty-five studies with test-confirmed COVID-19 infection from 31 countries were included. 62 publications which reported data on loss of taste were used to estimate patients' recovery rate in 13700 COVID-19 patients. Accordingly, the time to recovery of loss of taste among COVID-19 patients ranged from 2±0.352 to 43.6 ± 28.5 days. The estimated overall pooled recovery rate of loss of taste among COVID-19 patients was 74%. The estimated overall pooled time to recover loss of taste among COVID-19 patients was 11.44 days [95% CI 8.11, 14.77(]. 90 publications which reported data on loss of smell were used to estimate patients' recovery rate in 20027 COVID-19 patients. Accordingly, the time to recover the loss of smell among COVID-19 patients ranged from 2.44±0.352 to 31.9 ± 30.7 days The estimated overall pooled recovery rate of loss of smell among COVID-19 patients was 72%. The estimated overall pooled time to recover loss of smell among COVID-19 patients was 12.87 days [95% CI)1011, 15.64(].

Conclusion: The recovery rate of loss of smell and taste among COVID-19 patients was high globally, and time to recovery of loss of smell and taste among COVID-19 patients usually was less than 2 weeks; regional differences supported the relevance of these symptoms as important markers. Health workers must consider smell and taste symptoms as suspicion indices for the empirical diagnosis of COVID-19 infection and reassure patients with their high recovery rate in a short period of time.

Background: Inflammation plays a role in ST-segment elevation myocardial infarction (STEMI), especially in reperfusion injury (RI). Colchicine, an anti-inflammatory drug, can suppress inflammation during RI. We assessed the effectiveness of administering colchicine to STEMI patients undergoing primary percutaneous coronary intervention (PPCI) in suppressing RI events.

Methods: This study was a randomized, double-blind, placebo-controlled clinical trial conducted in a multicenter manner at two hospitals in Jakarta with IKPP facilities from December 2022 to April 2023. STEMI patients that underwent PPCI received 2 mg of colchicine as a loading dose and a maintenance dose of 0.5 mg every 12 hours for two days or amylum at a similar dose. Patients were observed for RI events (low-flow thrombolysis in myocardial infarction (0-2) during angiography procedure, reperfusion arrhythmia, cardiogenic shock, or persistent chest pain).

Results: Seventy-seven STEMI patients with a mean age of 55.2 ± 9.9 years underwent PPCI. Of these patients, 37 received colchicine, and 40 received a placebo. Most subjects were male (77.5%), suffered three-vessel disease (44.15%), and occlusion in left anterior descending coronary artery (53.24%). Colchicine was found to fail to reduce the incidence of ischemia-RI (51.5% vs. 42.4%; p = 0.437). Analysis of comorbidities (hypertension, chronic kidney disease, diabetes mellitus, and obesity) and angiography results (vessel disease, lesion diameter, and culprit artery) failed to demonstrate a statistical difference in RI. Side effects were similar in the colchicine and placebo groups (21.6% vs. 15%).

Conclusion: Colchicine administration in STEMI patients undergoing PPCI failed to reduce RI.

Tuberculosis (TB) is a major worldwide health concern, with 10.4 million new cases reported each year. Extrapulmonary tuberculosis (EPTB) accounts for 20% of all occurrences, with cutaneous tuberculosis (CTS) accounting for just 1-2%. Scrofuloderma is the most prevalent kind of secondary CTS, and it commonly starts in the underlying lymph nodes, bones, or joints.Here, we describe the case of a 35 years old man presenting with a solitary nodule necrotic ulcer that happens 4 days before going to the hospital. The skin biopsy from the lesion was suggestive of TB scrofuloderma. Scrofuloderma typically presents as subcutaneous nodules that ulcerate and form sinus tracts. Diagnosis is challenging, often requiring histopathological confirmation due to potential negative microbiological results. In this case, the atypical penile appearance and the patient's history of an invasive operation aided in the diagnosis. Diabetes mellitus-related immune weakness increased the patient's susceptibility to cutaneous tuberculosis. This case demonstrates the wide range of cutaneous tuberculosis presentations and the significance of extensive diagnostic techniques, particularly in unusual patients. It also emphasizes the increased risk of tuberculosis in immunocompromised people, such as those with diabetes mellitus.

Sticky platelet syndrome (SPS) is a hereditary disorder. SPS can cause pregnancy complications, such as recurrent miscarriages. However, proper management can prevent the incidence of recurrent miscarriages. Here, we describe a case of a woman who lost her fifth first-trimester pregnancy, and upon assessment, we discovered SPS. The 33-year-old woman underwent consultation with an obstetrician because of her history of five first-semester miscarriages. Gynecology ultrasound, infection parameters, hormonal and metabolic panels, and autoimmune workup were all found to be normal; however, vitamin D deficiency was identified as was SPS from a platelet aggregation test. The patient was then treated with clopidogrel and vitamin D3 supplementation. She became pregnant after five months of treatment. Her pregnancy was normal and she went into delivery at 40 weeks gestation with no maternal or fetal complications.

Background: Reperfusion serves as a mainstay therapy in almost all ischemic vascular diseases (IVD), but reperfusion may enhance cell damage after an ischemic period time. Increased ROS and inflammatory markers, decreasing organ function parameters, along with systemic inflammatory response and multi-organ damage may occur in ischemic reperfusion injury (IRI). Unfortunately, this series of events is unpredictable and sudden, causing high mortality in patients with IRI. Due to the significant role of inflammation in IRI, how is the effectiveness of anti-inflammatory agents administered before reperfusion therapy to prevent IRI? To know the efficacy of anti-inflammatory agents administered before reperfusion therapy to prevent IRI.

Methods: A systematic search was conducted in databases (Pubmed, EMBASE, Scopus) and was later selected according to predetermined inclusion and exclusion criteria. Studies included later critically appraised using the CEBM Oxford questionnaire for randomized control trials and systematic review.

Results: Seven studies were included among 1072 studies found in early searching. Six of the studies are randomized control trials, and one is a meta-analysis of randomized control trials. Methylprednisolone, pexelizumab, tirilazad mesylate, and N-acetylcysteine are known anti-inflammatory agents applicable in humans. The highest effectiveness of anti-inflammatory agents is methylprednisolone, with a relative risk reduction (RRR) of 75-85%. Besides that, pexelizumab also had an RRR of 27%, and tirilazad-mesylate had an RRR of 18%. N-acetylcysteine is not effective in preventing IRI. IL-6 levels postoperatively also decreased significantly in patients given anti-inflammatory agents before reperfusion therapy. There are no side effects of the intervention reported.

Conclusion: Anti-inflammatory agent administration before reperfusion therapy effectively prevents IRI. The choices of anti-inflammatory agents recommended are methylprednisolone, pexelizumab, and tirilazad-mesylate. Anti-inflammatory agent administration before reperfusion therapy is recommended.