Acta medica Indonesiana最新文献

Cancer is still the leading cause of death worldwide. Despite advances in diagnosis, management with the rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R-CHOP) chemotherapy regimen, and careful clinical and radiologic evaluation, diffuse large B-cell lymphoma (DLBCL) still carries high recurrence in clinical practice. This case series aims to assess the potential of circulating free RNA as a biomarker for evaluating therapeutic responses in DLBCL. This case series was conducted at Dharmais National Cancer Center Hospital in Jakarta in 2020. The subjects were 13 DLBCL patients who came for treatment to our hospital in 2020. Sampling was carried out by taking peripheral blood, which was taken 7-14 days after the patient underwent the 3rd and 6th cycles of chemotherapy or before and 7-14 days following the 3rd cycle of chemotherapy. Circulating free RNA (cfRNA) was extracted and assessed. The quantity of cfRNA was subsequently examined twice as matching samples from each patient, with the following results - (1) no mutations detected; (2) mutation detected solely in the second examination; (3) mutation only detected in the first examination; and (4) changes in gene mutations and mutation types. Statistic tabulation neither showed an association between recurrency and clinical variables nor detected cfRNA from the matching samples. This case series underscores the challenges in utilizing cfRNA as a biomarker for therapeutic evaluation in DLBCL due to heterogeneity and increased mutations in post chemotherapy conditions. Further research with larger sample sizes is needed to emphasize the role of cfRNA in DLBCL disease monitoring.

Numerous thyroid diseases can impact patients' lives, one of which is Graves' ophthalmopathy (GO). Graves' ophthalmopathy is a progressive thyroid-related disease that causes eye symptoms due to an autoimmune reaction targeting thyrotropin/thyroid stimulating hormone (TSH) receptors in the orbital space. This condition can be easily recognized by the patient, including exophthalmos, pain, swelling, double vision, and impaired vision. Globally, the estimated incidence of GO is 3.3-8 per 100,000 in women and 0.9-1.6 per 100,000 in men with the peak incidence between 30-60 years old. The prevalence of GO is 9 per 100,000, with the prevalence of GO among patients with Graves' disease reaching 30%.Anggraini and Nusanti's study is one of only a few studies in Indonesia that aim to adapt a quality of life questionnaire into Bahasa Indonesia and find out patients' quality of life afterward, specifically in the thyroid field. The steps for translation, validation, and adaptation of the questionnaire and thus exploring patients' quality of life can be a model for similar studies. Today, our patients not only need assessment for clinical symptoms, signs, laboratory, or radiology results but also need assessment for their well-being and unmet needs which are summarized in the quality of life questionnaires. In the end, optimal quality of care will be the ultimate goal for all chronic disease patients.

The burden of undiagnosed diabetes mellitus (DM) is substantial, with approximately 240 million individuals globally unaware of their condition, disproportionately affecting low- and middle-income countries (LMICs), including Indonesia. Without screening, DM and its complications will impose significant pressure on healthcare systems. Current clinical practices for screening and diagnosing DM primarily involve blood or laboratory-based testing which possess limitations on access and cost. To address these challenges, researchers have developed risk-scoring tools to identify high-risk populations. However, considering generalizability, artificial intelligence (AI) technologies offer a promising approach, leveraging diverse data sources for improved accuracy. AI models (i.e., machine learning and deep learning) have yielded prediction performances of up to 98% in various diseases. This article underscores the potential of AI-driven approaches in reducing the burden of DM through accurate prediction of undiagnosed diabetes while highlighting the need for continued innovation and collaboration in healthcare delivery.

Background: Malaria infection has caused a significant morbidity and mortality, notably in high-risk groups. Some evidence showed that ABO blood types might associate with malaria severity. This study aimed to determine the relationship between blood types and malaria severity in Papua, as Papua is a malaria-endemic area.

Methods: A cross-sectional study was conducted in a regional referral hospital in Jayapura, Indonesia. Diagnosis of malaria was determined using World Health Organization criteria and classified into severe and uncomplicated malaria. Blood types were classified into O and non-O groups.

Results: Out of 210 patients, 84 (40%) and 126 (60%) patients had non-O and O blood types, respectively. Severe malaria was more prevalent in non-O compared to O blood type (16.7% vs. 9.5%; the prevalence ratio (PR) was 2.4; 95% CI 1.06-6.42; p value 0.032). Amongst non-O groups, group B blood type demonstrated the highest incidence of severe malaria (p value 0.038; 95% CI: 1.06-6.42).

Conclusion: There is an association between ABO blood group and the severity of malaria in Papua. Severe malaria was found more in non-O blood types, especially type B blood group.

Background: Monocytes are evolutionarily preserved innate immune cells that play essential roles in immune response regulation. Three activated monocyte subsets-classical (CD14++CD16-), intermediate (CD14++CD16+), and nonclassical (CD14+CD16++)-are associated with systemic lupus erythematosus (SLE) progression. This study aims to determine the association of monocyte subsets with SLE disease activity.

Methods: A cross-sectional study involving 25 patients with SLE was conducted. Blood samples were collected, and monocyte subsets were identified using flow cytometry. Patients were grouped by disease activity using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) into inactive (SLEDAI-2K ≤ 4) and active (SLEDAI-2K > 4). The cutoff for monocyte subsets was determined using Receiver Operating Characteristic (ROC) analysis.

Results: Nine active and 16 inactive subjects were identified. Compared with individuals without active disease, individuals with active disease had significantly lower mean classical monocyte subsets (71.9% vs 88%, p = 0.008), and higher median intermediate monocytes (29.1% vs 11.1%, p = 0.019). The median nonclassical monocyte subsets were not significantly different between the two groups. The cutoff for classical monocytes in active disease was ≤72.2%, AUC = 0.788, p = 0.021, with 66.7% sensitivity and 87.5% specificity; for intermediate monocytes, it was >22.3%, AUC = 0.788, p = 0.014, with 66.7% sensitivity and 100% specificity.

Conclusion: Classical and intermediate monocytes could be considered as immune cellular markers for identifying active SLE.

This report describes a rare case of anuric acute kidney injury related to suspected urate nephropathy in a 23-year-old male with chronic phase of Chronic Myeloid Leukemia (CML). The patient presented with anuria and limb edema, with a history of imatinib-treated CML. Investigations revealed probable urate crystals causing bilateral hydronephrosis and hydroureters. Management included fluid restriction to maintain euvolemic status, hypouricemic agents, urinary alkalinization, urgent hemodialysis for acute kidney injury, and blood product transfusions to address haematological imbalances. The continued use of imatinib and aforementioned treatments resulted in the restoration of renal function depicted through normalization of serum urea, creatinine and uric acid levels. This case highlights the importance of meticulous assessment and management of anuric acute kidney injury in CML patients to ensure a positive outcome.

A 36-year-old woman with a history of neck swelling was diagnosed with papillary thyroid carcinoma, a common but typically slow-growing thyroid cancer with a good prognosis. Despite frequent lymph node metastasis, mortality rates are low. This cancer can rarely spread to unusual areas like the axillary region. The patient had multiple nodules in her thyroid and metastasis to cervical lymph nodes. After a total thyroidectomy and neck dissection, 14 metastatic lymph nodes were found. Post-surgery, radioactive iodine treatment and a whole-body scan revealed axillary lymph node involvement, confirmed as metastasis from the thyroid cancer.Papillary thyroid carcinomas usually have an excellent survival rate, but some can be aggressive. Risk factors for poor outcomes include larger tumors, extracapsular spread, older age, specific variants, and distant metastasis. Surgical removal is the primary treatment, aiming to eliminate local and regional spread. However, metastasis to atypical regions like the axilla is rare and not well understood due to limited data. It's thought to spread retrograde from the neck or due to abnormal lymphatic flow caused by surgery.Axillary metastasis is often found during or after surgery and may indicate systemic disease. Imaging techniques are used for detection. While it's usually a sign of poor prognosis, isolated cases without distant metastasis exist. Aggressive thyroid cancer treatment should consider the potential for distant metastases.

Background: Central obesity increases the risk of developing poor outcomes of COVID-19. The pro-inflammatory state and antibody dysfunction are thought to contribute to poor outcomes; however, the evidence is unclear.

Methods: This is a cohort study among COVID-19 patients with central obesity in Dr. Cipto Mangunkusumo National General Hospital Jakarta, Indonesia, during the early phase of the COVID-19 pandemic. Our study is a part of the COVID-19, Aging, and Cardiometabolic Risk Factors (CARAMEL) study. From the CARAMEL study, we selected adult non-ICU/HCU inpatient subjects with central obesity that met inclusion/exclusion criteria, collected clinical and anthropometric data, and measured inflammatory cytokines and IgG S-RBD SARS-CoV-2 antibody titers from a stored sample taken at day 2 of hospitalization. The poor clinical outcome of hospitalization was observed. We used the Mann-Whitney test to analyse non-normally distributed data, and T-test for normally-distributed data. The adjusted-relative risk of negative seroconversion antibody for poor outcomes was analysed using logistic regression.

Results: 23 of 178 (12.9%) subjects developed poor clinical outcomes during hospitalization. Subjects with poor outcomes had a higher visceral fat area (14.5 vs. 11, p < 0.05), waist circumference and BMI. The level of CRP, pro-inflammatory cytokines (IL-6 and MCP-1) and anti-inflammatory cytokines (IL-1Ra, IL-4, and IL-10) were significantly higher in subjects with poor outcomes, alongside with the lower antibody titer in subjects with poor outcomes. Antibody seroconversion failure increased the risk of developing poor outcomes (aRR 2.696, 95% CI 1.024-7.101), after adjusting for age and sex.

Conclusion: In COVID-19 patients with central obesity, we confirmed the association between higher pro- and anti-inflammatory parameters, and lower SARS-CoV-2 antibody with poor outcomes of COVID-19.

Background: Hepatitis B virus infection is the most common cause of chronic hepatitis. Vertical transmission is the main transmission route of this virus. Current prevention involves giving newborns immune prophylaxis within 12 hours of birth. However, there is still a failure of immunoprophylaxis, especially in cases of mothers who have a high viral load or are HBeAg positive. Tenofovir disoproxil fumarate (TDF) is the first-line treatment for chronic hepatitis B and is known to reduce perinatal HBV transmission. This study aims to determine the efficacy of TDF in preventing vertical transmission in pregnant women with chronic hepatitis B.

Methods: A literature search was performed on the online databases of PubMed/MEDLINE, Embase, Scopus, Cochrane, and ScienceDirect. The inclusion criteria used were pregnant women with chronic hepatitis B and using TDF antiviral as a transmission prevention therapy with the study design used in the form of a meta-analysis, systematic review, randomized or nonrandomized controlled trial. The outcome of interest was the vertical transmission rate of hepatitis B.

Results: There are two studies used with a meta-analysis study design and a nonrandomized controlled trial with a good critical review result of Validity, Importance, and Applicability. TDF significantly prevented vertical transmission of hepatitis B compared to placebo. In addition, TDF was not associated with the incidence of maternal and fetal complications.

Conclusion: TDF has high effectiveness in preventing vertical transmission of hepatitis B and is safe to give to pregnant women.

Background: Hepatocellular carcinoma (HCC) is a cancer with poor prognosis. Indonesia is a country with high prevalence of chronic hepatitis B infection. The performance of alpha fetoprotein (AFP) as a tumor marker in HCC surveillance is primarily influenced by the etiology of the underlying liver disease. We aimed to determine the best cut-off value of AFP biomarker examination for HCC surveillance in patients with chronic hepatitis B infection.

Methods: The study collected medical record data of the Hepatobiliary Division of Dr. Cipto Mangunkusumo Hospital from the period of 2017 to 2023. A total of 506 subjects with chronic hepatitis B of all spectrums (hepatitis B without cirrhosis, liver cirrhosis, and early-stage HCC, BCLC 0 and A) were included by total sampling that was performed from 26 July 2023 to 31 August 2023. Determination of the AFP cut-off value was carried out using the receiver operating characteristics (ROC) method.  Results: For HCC surveillance caused by hepatitis B virus, ROC curve analysis resulted in an area under the curve (AUC) of 0.792 (95% CI, 0.719-0.866), and the cut-off value with the highest Youden index was 8.7 ng/ml, with 58% sensitivity, 94% specificity, positive predictive value (PPV)  56.14%, negative predictive value (NPV) 94.43%, positive likelihood ratio (LR+) 10.08, and negative likelihood ratio (LR-) 0.46.

Conclusion: The cut-off value of AFP in HCC surveillance on hepatitis B specific etiology is lower than the cut-off value of AFP in previous HCC surveillance which was not etiologically specific. The cut-off value of 8.7 ng/ml produces the best sensitivity and specificity for the cut-off value for HCC surveillance with hepatitis B etiology.