Acta medica Indonesiana最新文献

{"title":"Hepatitis B Virus Reactivation Superimposed Hepatitis A Co-Infection Leading to Acute on Chronic Liver Failure: A Case Report and Literature Review.","authors":"Satria Agung Maulana Fahmi, Tamara Audrey Kadarusman, Rusdiyana Ekawati","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Acute-on-chronic liver failure (ACLF) is a severe condition with an incidence rate of 5.7 cases per 1,000 person-years. A primary trigger for ACLF is hepatitis B reactivation, which is responsible for 40-60% of cases. Co-infection with hepatitis A can also contribute to its occurrence. This study presents the case of a 58-year-old male patient with a history of hepatitis B virus (HBV)-related cirrhosis, presenting with symptoms including confusion, disorientation, worsening jaundice, abdominal discomfort, nausea, vomiting, loss of appetite, malaise, muscle pain, and fever. Despite regular treatment for HBV, the patient's condition deteriorated over 14 days. He had no history of hypertension, diabetes, autoimmune diseases, alcohol consumption, or smoking. On examination, the patient exhibited grade 2 hepatic encephalopathy, severe jaundice, ascites, and lower limb edema. Laboratory results revealed elevated liver enzymes, increased bilirubin levels, and decreased albumin. Subsequent testing confirmed acute hepatitis A infection and a significant hepatitis B viral load. The report highlights that reactivation of Chronic Hepatitis B, accompanied by co-infection with hepatitis A, played a critical role in inducing inflammation and worsening the ACLF condition.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"361-367"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atherogenic Lipoprotein Profile in First-Degree Relatives of Individuals with Type 2 Diabetes Mellitus.","authors":"Dyah Purnamasari, Laila Miftakhul Jannah, Irsan Hasan, Muhadi Muhadi, Sally Aman Nasution, Kaka Renaldi, Andri Sanityoso, Adityo Susilo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>First-degree relatives (FDR) of individuals with type 2 diabetes mellitus (T2DM) are at higher risk of developing early metabolic disturbances, particularly insulin resistance and lipid metabolism abnormalities. These issues contribute to a greater predisposition to cardiovascular disease compared to the general population. Despite the significant contribution, there is limited information on the relationship between atherogenic lipoproteins and normotensive, normoglycemic young FDR in Indonesia. Therefore, this study aimed to evaluate the correlation between small dense low-density lipoprotein (sdLDL) levels and HOMA-IR in FDR with T2DM, as well as assess variation in sdLDL levels within FDR and non-FDR groups.</p><p><strong>Methods: </strong>This cross-sectional study analyzed secondary data from the Metabolic Endocrine and Diabetes Division of the Internal Medicine Department, Faculty of Medicine, Universitas Indonesia, and Cipto Mangunkusumo Hospital. The primary study, titled \"Early Cardio-Metabolic Disorders in the First-Degree Relative Population of Type 2 Diabetes Mellitus,\" was expanded to include sdLDL measurements. Bivariate analysis and correlation tests were used to explore the relationship between sdLDL and HOMA-IR.</p><p><strong>Results: </strong>The experiment included 125 subjects, consisting of 62 FDR and 63 non-FDR. Based on the results, sdLDL levels were significantly higher in the FDR group compared to the non-FDR group (31.42 (IQR 20.1-41.39) vs 21.05 (IQR 12.18-26.13) mg/dL, p<0.0001). However, no significant correlation was observed between sdLDL levels and HOMA-IR in the FDR group (r=0.059, p=0.649).</p><p><strong>Conclusion: </strong>This study showed a significant difference in sdLDL levels between FDR and non-FDR of T2DM patients. However, no correlation was found between sdLDL and HOMA-IR in the FDR group.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"314-320"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buried in Trapped Air: Tension Pneumothorax, Massive Subcutaneous Emphysema and the Battle for Airway Control.","authors":"Parul Issar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Tension pneumothorax(TP) is defined as a pneumothorax in which the pressure of intrapleural air exceeds atmospheric pressure, producing adverse effects, including contralateral mediastinal shift associated with cardiovascular collapse, due to reduced venous return (because of compression of the SVC and IVC) and hypoxia. Usually, patients with TP present to the Emergency Department with vague pleuritic chest pain and shortness of breath, but being considered a red flag it should be diagnosed during the primary assessment and managed promptly with large bore needle decompression followed by chest tube insertion. Presence of extensive subcutaneous emphysema(SCE) can further aggravate the respiratory distress and make the airway management even more challenging in the ER. Situation can become even worse when such a patient needs cardiopulmonary resuscitation on arrival.</p><p><strong>Case report: </strong>We report an unusual case of a 55 years old man, who presented in the ER with history of sudden onset respiratory distress while taking bath. Patient was brought to the ER in a state of gasping, hypoxia and shock. Needle decompression of the pneumothoraces was not sufficient as he also had extensive subcutaneous emphysema which resulted in cardiac arrest. The CPR and the airway management extremely were practically difficult. He was finally tracheostomised in the ER and accompanied by bilateral chest-tube thoracotomy. He was discharged for home after pleurodesis without any neurological deficit.</p><p><strong>Conclusion: </strong>Primary spontaneous pneumothorax is an uncommon condition but can rarely end up in tension pneumothorax and accompanying subcutaneous emphysema can make the management further challenging. Airway skills of the ER team are important in saving such patients ives.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"374-379"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Secretome and Exosomes in Cardiovascular Diseases.","authors":"Eka Ginanjar, Zahra Nuril Anwar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality worldwide. Recent advancements in regenerative medicine have unveiled the promising roles of secretome and exosomes in the treatment of CVDs. In this article, we aim to understand the roles of secretome and exosomes in the cardiovascular system, both in physiological and pathological conditions, and explore the broad applications of secretome and exosomes in mitigating CVD progression. Secretome and exosomes, which play crucial roles in intercellular communication, tissue repair, and immunomodulation, have shown potential in reducing cardiovascular disease progression by inhibiting inflammation, promoting blood vessel growth, and regulating biological mechanisms. Further research is needed to maximize their use in advanced cardiovascular therapy.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"396-402"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of Serum FT4 with Serum Uric Acid and Comparison of Uric Acid in Subjects with and without Atrial Fibrillation in Graves' Disease: A Cross-Sectional Study.","authors":"Bella Yunita, Imam Subekti, Birry Karim, Murdani Abdullah, Cleopas Martin Rumende, Dyah Purnamasari, Juferdy Kurniawan, Adityo Susilo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular diseases increase the mortality risk in Graves' disease (GD) patients. Atrial fibrillation (AF) is one of the most prevalent cardiovascular diseases in GD. Hyperthyroidism that occurs in GD may increase uric acid levels, while uric acid levels can also increase the risk of AF in the general population. This study is designed to observe the correlation between free T4 (FT4) and uric acid, and compare the levels of uric acid in subjects with and without AF in GD.</p><p><strong>Methods: </strong>A cross-sectional study was conducted, including GD patients who met research criteria in Dr. Cipto Mangunkusumo Hospital during 2024. We performed history taking, physical examination, laboratory examination, and electrocardiogram for each subject. Data was analyzed using Pearson or Spearman correlation, and bivariate analysis to evaluate the comparison of uric acid in subjects with and without AF.</p><p><strong>Results: </strong>We included 74 subjects, with an average age of 41 years, mostly female (86.5%), and 62.2% had normal FT4 levels. AF occurred only in 4.1% subjects. Mean of uric acid is 4.71 ± 1.2 mg/dl, which is within the normal range. No correlation was found between FT4 and uric acid (r = 0.076; p = 0.520), including after adjustment with subgroup analysis based on thyroid status, gender, and diabetes mellitus. Mean of uric acid is not statistically different between subjects with and without AF (4.9 ± 1.01 mg/dl vs 4.7 ± 1.2 mg/dl; p = 0.785).</p><p><strong>Conclusion: </strong>No significant correlation was found between FT4 and uric acid. Mean of uric acid is not statistically different between subjects with and without AF.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"346-352"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine-assisted Directly Observed Therapy (DOTS) for Tuberculosis: An Evidence-based Case Report.","authors":"Valerie Josephine Dirjayanto, Kieran Pasha Ivan Sini, Aureilia Calista Zahra, Pandya Praharsa, Muhammad Afif Vargas Pramono, Diantha Soemantri","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis is a high-burden infectious disease requiring long-term treatment. Compliance is the key to cure; however, directly observed therapy (DOTS) is not always feasible. Telemedicine use in DOTS offers improved accessibility; however, its effectiveness has not been established. We aimed to investigate the effectiveness of telemedicine-based DOTS on treatment compliance in patients with tuberculosis.</p><p><strong>Methods: </strong>Databases including MEDLINE, Scopus, EMBASE, PubMed, and Cochrane were searched for studies implementing telemedicine-based DOTS until November 2nd, 2023. Studies were appraised for validity, importance, and applicability using the Oxford Centre of Evidence-Based Medicine tool, and the outcomes were graded based on their levels of evidence (LOE).</p><p><strong>Results: </strong>Our search yielded six systematic reviews. Telemedicine-based DOTS yielded favourable effects in improving adherence (LOE: I), treatment completion (LOE: II-III), and cure rates (LOE: II-III). Other outcomes, in terms of bacteriological resolution (LOE: II) and mortality (LOE: IV), were estimated to be non-inferior to those of DOTS. In terms of the telemedicine mode, the VDOTS yielded the highest LOE in improving adherence (LOE: I), followed by short messaging services (LOE: III) and medication monitors (LOE: III), which yielded similar effects. Results for phone reminders were contradictory, with the highest evidence suggesting that it might be ineffective for treatment completion (LOE: I-III) but may increase the cure rate (LOE: III).</p><p><strong>Conclusion: </strong>Telemedicine-based DOTS may improve adherence, treatment completion, and cure rate, and is non-inferior in terms of bacteriological resolution and mortality. Telemedicine-based DOTS can be considered for implementation; however, further high-quality studies in limited-resource settings are needed to strengthen the evidence.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"405-420"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Leptin and Adiponectin Levels and Sarcopenia in Non-Geriatric Type 2 Diabetes Mellitus Patients.","authors":"Khoirul Husam, Purwita Wijaya Laksmi, Robert Sinto, Andhika Rachman, Rudy Hidayat, Sukamto Koesnoe, Noto Dwimartutie, Dyah Purnamasari","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>Leptin levels and LAR were associated with sarcopenia in a non-geriatric T2DM population.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"353-360"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Psychotherapy in the Management of Inflammatory Bowel Disease.","authors":"Hamzah Shatri, Rudi Putranto, Edward Faisal, Vinandia Irvianita, Dika Sinulingga, Yanuar Ardani, Dadang Makmun, Muhammad Faisal Prananda, Ayu Suciah Khaerani","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"421-431"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"p.Gly693Arg Homozygote Mutation in Dubin-Johnson Syndrome with Atypical Liver Biopsy due to Reactivation of Hepatitis B Concomitant with Persistent Loss of Kidney Function.","authors":"Juferdy Kurniawan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"387-395"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Care Quality of Patients with Type 2 Diabetes in Indonesia: A Study of DISCOVER CaReMe Registry Program.","authors":"Rulli Rosandi, Herman Bagus Trianto, Aywar Zamri, Harli Amir, Roy Panusunan Sibarani, Samuel Sulaiman, Achmad Rudijanto Cholil","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"321-331"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}