Acta medica Indonesiana最新文献

Diabetic kidney disease (DKD) is one of the common and serious complications of diabetes mellitus, with a complex pathogenesis and a lack of ideal treatment options in clinical practice. In recent years, the protective role of vitamin D and its receptor signaling pathway in DKD has garnered widespread attention. Vitamin D plays an important role in the onset and progression of DKD by participating in the regulation of insulin secretion, inhibiting inflammatory responses, attenuating podocyte injury, modulating the renin-angiotensin system (RAS), and inhibiting renal interstitial fibrosis through its receptor (VDR). Studies on the use of vitamin D and its receptors in DKD have increased gradually in recent years, with a focus on the development of vitamin D analogs and the clinical application of VDR activators. This study reviewed the mechanisms of vitamin D and its receptor in diabetic nephropathy, as well as the potential for therapeutic applications and associated adverse effects. It also analyzed current research hotspots and development trends based on bibliometrics. Future research should focus on further optimizing vitamin D-based therapeutic strategies to achieve better clinical efficacy and safety.

Background: Metabolic-associated fatty liver disease (MAFLD) is excess fat accumulation in the liver due to metabolic syndrome. Coronavirus disease 2019 (COVID-19) is an infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 not only attacks the respiratory system but also involves systemic and extra-pulmonary organ disorders, including liver disorders. This review evaluates the severity of COVID-19, mortality, and length of hospital stays of patients with MAFLD who were infected with SARS-CoV-2.

Methods: Literature searches were conducted through various online databases. The risk of bias assessment was conducted by two researchers using the Newcastle Ottawa Scale tool for NRSI studies, and any discrepancies were resolved by another team member. The meta-analysis was performed using Revman 5.4.1 and results were presented in forest plot by calculating the pooled odds ratio or mean difference between the MAFLD and non-MAFLD groups from the evaluated studies with a 95% CI.

Results: The results of the meta-analysis using a fixed-effect model from seven studies showed that COVID-19 patients with MAFLD were associated with a higher mortality compared to those without MAFLD (OR 1.41, 95% CI 1.19-1.69, p=0.01, I2 48). However, there were no differences in COVID-19 severity (OR 3.12, IK95% 0.89-11.03, p=0.08, I2 92) and length of hospital stay (MD 1.27, CI95% 0.03-2.52, p=0.04, I2 80) between the two groups.

Conclusion: MAFLD patients infected with SARS-CoV-2 were associated with higher mortality than non-MAFLD patients, but they were not associated with greater severity of COVID-19 nor a longer duration of hospitalization.

Dementia is a progressive condition that gradually impairs cognitive function, memory, and daily living skills. This disease not only impacts the individual but also has significant consequences for their families and caregivers. The global prevalence of dementia is on the rise, including in Indonesia. It's estimated that approximately 1.2 million people in Indonesia are currently living with dementia, a number projected to quadruple by 2050. Patients with dementia often experience a range of symptoms and complications, including pain, difficulty eating, shortness of breath, and susceptibility to infections. For those in advanced stages of the disease, family and caregivers play a crucial role in their well-being. However, this role can be emotionally taxing, making support essential. Palliative care offers a promising approach to enhancing the quality of life for both dementia patients and their families. By prioritizing symptom management, psychological support, and respecting patient autonomy, palliative care can help alleviate suffering and promote well-being throughout the disease's progression.

Background: Stroke continues to be a significant public health challenge. Central post-stroke pain (CPSP) is a notable aspect of post-stroke pain that not only causes physical discomfort but also affects psychological well-being, leading to a reduced quality of life. The objective of this was to assess the prevalence of CPSP and its relationship with quality of life.

Methods: This hospital-based cross-sectional study was conducted between August and December 2023 in Manado, Indonesia, the study involved the consecutive recruitment of stroke patients. CPSP diagnosis adhered to the 2017 criteria set forth by the American Pain Society, while quality of life was evaluated using the Indonesian version of the Stroke Specific Quality of Life (SS-QoL) scale.

Results: The study comprised 166 stroke patients, revealing that 30.1% experienced CPSP. Notably, there was a significant difference in mean SS-QoL scores based on both the severity of the stroke and the presence of depression. Within the CPSP group, a significant variation in SS-QoL summary scores was observed between male and female patients. Those with CPSP reported significantly lower mean scores in the Thinking and Energy categories. However, there was no significant difference in the overall SS-QoL scores between CPSP and non-CPSP patients.

Conclusion: In summary, stroke patients suffering from depression, greater severity of stroke, and those experiencing burning or pressure-like sensations are at an increased risk of having a lower quality of life.

Acute coronary syndrome (ACS) as the acute setting of coronary chronic syndrome has been widely known to have high mortality rates. ST segment elevation of myocardial infarction (STEMI) is one category of ACS which occurs when major coronary arteries are fully blocked acutely and diminish coronary flow leading to myocardial injury and necrosis. Epidemiology data showed that global prevalence varied from 3.8% in patients whose age to 9.5%. The national heart survey of Indonesia also revealed the rising trends of STEMI from 0.63% in 2013 to 1.5% in 2018. STEMI is associated with high mortality despite advanced system and management such as primary percutaneous coronary intervention (PCI). Colchisine is derived from Colchicum autumnale plant and known for remedies for a long time since 1500 BC. The remedy effect is due to combination anti-inflammatory actions. Key actions include decrease neutrophile L-selectin expression on endothelial cell and interfere the interaction of neutrophile-platelet which is leading to atherothrombosis. The idea to use colchisine in STEMI patients to reduce mortality rate is presumed through this mechanism. To date, colchisine already known to reduce anti-inflammatory markers in ACS. Colchisine is widely known to be safe and effective as anti-inflammatory drug. Numerous studies had investigated the effect of colchisine in various setting of coronary artery disease. Unfortunately, various results had made it unclear. Meanwhile, the mechanism of colchisine in acute and chronic coronary syndrome need to be explored comprehensively. The evidence of clinical studies for the beneficial use of colchisine in ACS  especially in STEMI is still insufficient. The ongoing studies worth to be waited for the supporting clinical evidence for the use of colchisine in acute coronary syndrome.

Background: Aside from the factors more commonly known as predictors in colorectal cancer, there are 3 additional less well-known factors, i.e., tumor budding (TB), T cell densities and loss of MMR protein expression, the aforementioned three factors are known to be independent predictive factors in CRC survival. In this study association of TB, T cell densities and loss of MMR protein were examined to see the association with differentiation, tumor location, invasiveness and lymph node invasiveness.

Methods: A retrospective cohort study was conducted using 68 CRC Formalin Fixed Paraffin Embedded samples from patients who underwent removal surgeries with the diagnosis of adenocarcinoma not otherwise specified. TB counts were identified by immunohistochemical staining using Pan-Cytokeratin AE1/AE3 and were categorized into low and high. MMR protein loss was analyzed using antibodies MLH1 and MSH6 categorized as positive and negative, then classified into Microsatellite Stable (MSS) and Microsatellite Instability (MSI). CD3 and CD8 T cell densities were identified using CD3 Biocare Medical and CD8 Biocare, was categorized into low and high. Secondary data from medical records were collected and analyzed using SPSS 25.

Results: A significant relationship was found between tumor budding with the depth of invasion and lymph node involvement (p=0.021 and 0.020).

Conclusion: Tumor budding (TB) plays a role in the depth of invasion and lymph node involvement in CRC but has no significant relationship with CD3/CD8 densities, differentiation, location, and MMR status. There was also no significant relationship between MMR status with differentiation, location, depth of invasion, lymph node involvement, and TB.

Long QT Syndrome (LQTS) is a rare cardiac condition whose etiology is acquired or congenital. It has a wide range of clinical manifestations ranging from asymptomatic to sudden cardiac death due to malignant arrhythmia such as ventricular tachycardia. Congenital LQTS usually occurs at an early age in the form of prolonged QT interval in ECG examination, but such a condition may occur in later life. Therefore, QT interval should be assessed thoroughly to minimize the risk of iatrogenic ventricular tachycardia. A 72-year-old Javanese female with recurrent syncope episodes for 8 months was referred to the emergency department for temporary pacemaker implantation due to a complete heart block and NSTEMI. Family history revealed a first-degree family history of sudden cardiac death. She had a history of recurrent cardiac arrest due to ventricular arrhythmia and was treated with amiodarone continuous intravenous infusion in the previous hospital. During examination in the emergency department, she experienced another episode of cardiac arrest due to ventricular arrhythmia. Electrocardiogram examination pre-cardiac arrest revealed a complete heart block, atrial rate 60 bpm, ventricle rate 60 bpm, T Inversion in I, aVL, V2-V6, with prolonged QT interval (QT 616 ms, QTc 578 ms). Thus, amiodarone was subsequently stopped, and defibrillation was administered under ACLS guidelines. After the return of spontaneous circulation, revascularization was conducted due to ongoing typical chest pain and increased troponin level (117 ng/mL) to the LAD. Despite optimal revascularization and normal electrolyte level (Sodium 137 mEq/L, Potassium 3.8 mEq/L, Chloride 104.5 mEq/L), prolonged QT interval was observed in the patient until the 9th day post-revascularization and the double-chamber pacemaker implantation was conducted on patient. Thus, the prolonged QT interval subsided after double-chamber pacemaker implantation. Long QT Syndrome may occur at any period of life and may be asymptomatic. A thorough ECG examination before commencing treatment on a patient was pivotal to preventing malignant arrhythmia.

The concept of venous thromboembolism (VTE) has recently been revisited because of evidence of a new spectrum of the disease called in situ pulmonary arterial thrombosis (ISPAT). We present the case of a 40-year-old female with shortness of breath, who was referred from a regional hospital because of a secundum atrial septal defect. Using echocardiography and computed tomography pulmonary angiogram, she was diagnosed with ISPAT. She received catheter-directed thrombolysis with good results. Knowing the difference in diagnostic clues between classical VTE and ISPAT is crucial, especially for managing the patient correctly.

Tricuspid Regurgitation (TR) surgical treatment is associated to high operative mortality, suboptimal long-term survival, and frequent TR recurrence after repair, especially in the elderly. This case report highlights our early experience of TricValve implantation in Indonesia, conducted on a 72-year-old male patient with severe tricuspid regurgitation and advanced right ventricular dysfunction. In this context, the TricValve system offers a promising, less invasive alternative. Despite previous pharmacological management, our patient had been readmitted multiple times due to refractory right heart failure. One month post-TricValve implantation, he showed significant symptomatic relief and stable cardiac function as evidenced by echocardiographic measurements. This case underscores the potential utility of the TricValve system in providing an effective, lower-risk treatment option for patients not suited for traditional surgical intervention.

Background: Studies regarding hypercoagulation in Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) patients have produced conflicting results. With a presumption that the early coagulation phase may affect the occurrence of NAION, this study aims to investigate the early coagulation markers, E-selectin and P-selectin, to determine whether these biomolecular changes play a significant role in NAION, thus potentially leading to a better clinical approach.

Methods: A cross-sectional study involving two groups of NAION subjects, a hypercoagulation group and a non-hypercoagulation group, was conducted in the Neuro-Ophthalmology Division, Department of Ophthalmology, FKUI-RSCM Kirana from October 2020 to April 2022. All patients were evaluated for E-selectin and P-selectin levels measured using flow cytometry.  Results: A total of 42 subjects comprising 14 hypercoagulation and 28 non-hypercoagulation subjects were included. In all subjects, E-selectin was strongly correlated with P-selectin (r = 0.862, p < 0.001). There was no significant difference in E-selectin and P-selectin values between the groups (p = 0.317 for E-selectin, and p = 0.575 for P-selectin). Prothrombin time and international normalized ratio (INR) were inversely correlated with both E-selectin and P-selectin in the hypercoagulation group (p = 0.032, p = 0.030 for E-selectin and p = 0.044, p = 0.036 for P-selectin). There was no significant correlation between E-selectin and P-selectin for NAION-associated metabolic risk factors. However, higher E-selectin and P-selectin values were found in the presence of risk factors except for P-selectin in the hypertension group.

Conclusion: This interesting finding opens up the potential for considering the involvement of E-selectin and P-selectin in the diagnostic strategy for NAION. It prompts consideration of whether assessing E-selectin and P-selectin levels should be recommended for all NAION patients. Furthermore, considering the role of E-selectin and P-selectin in the early coagulation process, future studies are also needed to further evaluate whether anticoagulants could play a role in the choice of treatment for NAION despite a clinically hypercoagulable state.