Hyperglycemia can be experienced by corona virus disease (COVID-19) patients due to the invasion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) into pancreatic cells or other mechanisms such as insulin resistance, counter-regulatory, stress induction, and glucocorticoid therapy. Hyperglycemia can stimulate the production of reactive oxygen species (ROS) and pro-inflammatory cytokines leading to an increase in the disease severity. Based on the clinical and laboratory criteria, the severity of COVID-19 patients is classified into asymptomatic, mild, moderate, severe, and critical. This study aimed to investigate the association between blood glucose levels at admission and the severity of COVID-19 patients with and without diabetes mellitus (DM). It was a cross-sectional study using secondary data from COVID-19 patients in Pondok Kopi Jakarta Islamic Hospital from April to June 2021. This study involved 340 patients with comorbid DM (n=78) and without comorbid DM (n=262). The Mann-Whitney and Spearman correlation test were used. A significant difference between random blood glucose levels in comorbid DM patients and patients without comorbid DM (p<0.05). However, there is a weak correlation between random blood glucose levels and severity with comorbid DM (r=0.112) and without comorbid DM (r=0.129). In conclusion, a positive and weak correlation between blood glucose levels at admission and the severity of COVID-19. The severity increases as the blood sugar level increases. Further study needs to be performed considering other comorbid conditions.
Skin aging can be divided into intrinsic and extrinsic aging. Even though it is inevitable, symptoms of skin aging are a common concern for patients. As a result, there is a surge in the making of anti-aging cosmeceuticals. However, there is a lack of evidence-based data to support the usage of topical preparations as anti-aging treatments. Therefore, further studies are needed to explore topical treatment options for skin aging. This literature review discusses the mechanism of commonly used topical anti-aging agents and their adverse reactions.
Percutaneous coronary intervention (PCI) through transradial pathway is associated with lower risk of severe vascular problems comparing to transfemoral. It is reported that the acute compartment syndrome (ACS) in forearm is significant lower comparing to leg. A 47 y.o. male with ACS following a transradial approach of PCI due to inferior myocardial infarction was reported. The patient experienced pain and swelling in his right forearm for 7 hr after the procedure and was later brought to hospital and treated with emergency of fasciotomy. The patient showed good post-fasciotomy recovery on the first 2 wk and showed good DASH score after 4 wk. Quick diagnosis with prompt treatment makes a better outcome for the patient. Consequently, a high level of awareness to make the diagnosis as quickly and accurately management as possible could prevent morbidity caused by late and unrecognized management compartment syndrome eventually could make a better clinical outcome.
Leukoaraiosis is a neurological imaging in the periventricular area and the centrum semiovale. This condition occurs due to abnormalities in the small blood vessels in the brain that lead to hypoxia. It is often observed in patients with ischemic stroke and accompanied by risk factors for hyperlipidemia. This study aimed to evaluate the correlation between the degree of leukoaraiosis and hyperlipidemia in post-ischemic stroke patients. A cross-sectional study retrospectively was conducted on post-ischemic stroke patients who underwent brain MRI (magnetic resonance imaging) on T2 and FLAIR (fluid-attenuated inversion recovery) sequence at the Department of Radiology, Dr. Sardjito General Hospital, Yogyakarta, from January 2021 to March 2022. A total of 36 patients were involved in this study. The leukoaraiosis of patient was examined by brain MRI. Degree of the leukoaraiosis was determined based on Fazekas classification. Serum cholesterol, HDL (high-density lipoprotein), LDL (low-density lipoprotein), and triglyceride levels of patients were then examined. The data obtained were then analyzed using Spearman correlation test. A positive correlation was observed between the degree of leukoaraiosis and triglyceride level (p = 0.042; r = 0.292) and age (p= 0.004; r = 0.464). However, no correlation was observed between the degree of leukoaraiosis and cholesterol, HDL, and LDL (p>0.05). In conclusion, the leukoaraiosis degree is correlated with serum triglyceride levels and age in post-ischemic stroke patients.
Globally, lung cancer is one of the cancers leading to dead, dominated by non-small cell lung cancer (NSCLC). In a previous study has shown those serial miRNA expressions (miR-148, miR-34, miR-222, and miR-155) had prognostic value in advanced-stage NSCLC patients. Meanwhile, CEA and Cyfra 21-1, pulmonary tumor markers, are sometimes considered in the Department of Pulmonology, Dharmais Cancer Hospital, Jakarta, although they are not used in routine clinics for prognostication. Both miRNA and CEA-Cyfra 21-1 are valuable biomarkers in NSCLC. This study aimed to evaluate their correlation between CEA and/or Cyfra 21-1 with miRNA expressions in NSCLC patients. It was a cohort retrospective study using data from the previous study. The correlation between variables was analyzed by Spearman-rho. A positive correlation was observed between CEA and Cyfra 21-1 with miR-148, miR-222, and miR-155 [(CEA: p=0.00369, r=0.522; p=0.00242, r=0.542; p 0.00106, r=0.576) (Cyfra: 21-1= p 0.01252, r=0.378; p=0.00035, r=0.519; p=0.01532, r=0.368)]. In conclusion, CEA and Cyfra 21-1 correlate with miR-148, miR-222, and miR-155 expressions in advanced-stage NSCLC.
Primary demodicosis is an infestation of Demodex colonization >5 mites/cm2 without pre-existing or concomitant inflammatory skin disease. Primary demodicosis is divided into 3 variants i.e. spinulata, papulopustular and nodulocystic. Several topical and systemic agents are used in the Demodex facial treatment. A 22 y.o. man complained of acne on his face three months ago. On physical examination, there were pustules, multiple erythematous papules, ice pick atrophic scars, and box and rolling scars. KOH examination found the Demodex number > 5 mites/cm2. No spores were found. The patient received oral and topical metronidazole therapy. Papulopustular demodicosis is a follicular inflammation caused by Demodex mites. The inflammatory stage shows a predilection for the perioral, periorbital, and periauricular regions. According to the pattern of morphology and localization of the centrofacial area, some cases of demodicosis are often referred to as Rosacea-like (rosaceiform) demodicosis. The treatment goals are to reduce the overall number of mites and treat the underlying condition. This paper reports a case of papulopustular demodicosis of the face. The diagnosis was made by history taking and physical examination using the diagnostic criteria for demodicosis. Clinical improvement was obtained after oral and topical metronidazole therapy for two weeks.
Women of reproductive age are more likely to have systemic lupus erythematosus (SLE), which frequently results in health issues, particularly during pregnancy. A normal pregnancy's first trimester shows a marked increase in the percentage of Th17 cells, which then steadily declined in the second and third trimesters. Meanwhile, IL-17 level increases in SLE-affected pregnant women. This study aimed to analyze the correlation between serum IL-17 and pregnancy outcome (fetus weight, blood pressure, urinary albumin) in SLE pregnant animal models. Twenty mice were randomly divided into two groups, including the normal pregnant group and SLE-pregnant group. The SLE pregnant mice was made by intraperitoneally induction of 0.5 mL pristane. Serum IL-17 was assayed by enzyme-linked immunosorbent assay (ELISA) method. The serum IL-17 level, the blood pressure and urinary albumin were significantly higher in the SLE pregnant mice group than those of the normal pregnant group (p< 0.05). The weight of fetus was significantly smaller in the group of SLE pregnant mice group than the normal pregnant group (p< 0.05). There was a significantly positive correlation between the serum IL-17 level and urinary albumin (p = 0.042; r = 0.459). In conclusion, serum IL-17 levels correlate with urine albumin in SLE pregnant models, but do not correlate with fetus weight and blood pressure.
Ultraviolet B (UVB) rays exposure causes skin inflammation and pigmentation lead to decrease skin lightness. Corncobs (Zea mays) contain flavonoids which can act as antioxidant to prevent free radicals and protect the skin pigmentation. This study aimed to evaluate the protective effect of corncob extract cream on skin pigmentation exposed to UVB rays. This pre-posttest control group study was applied to 25 guinea pigs (Cavia porcellus sp) randomly divided into five groups. Corncob extract cream was given every day 20 min before and 4 h after UVB exposure. The UVB exposure total dose was 780 mJ/cm2. Mexameter examination was carried out on the 1st day and 28th day after treatment. There were significantly differences in the lightness level and the mean melanin index (MI) difference of guinea pigs before and after intervention on various groups (p<0.05). No significantly different of the MI between pre- and post-treatment was observed on normal control group (0.22) and negative control group (-1.06) (p>0.05). However, significantly different of the MI was observed on positive control group (-4.01), corncob 40% group (-2.72), and corncob 30% group (-2.03) (p<0.05). In conclusion, corncob extract cream can inhibit the skin pigmentation due UVB rays exposure.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that cause coronavirus disease 2019 (COVID-19) has become a global pandemic. Until November 30th, 2020, World Health Organization (WHO) confirmed 61,869,330 positive cases with 1,448,896 deaths (CFR 2.3%). Some comorbidities are associated with the COVID-19 mortality. This study aimed to investigate risk factors of the COVID-19 mortality at the Baubau Regional Public Hospital, Sout East Sulawesi. It was a cross-sectional study with a retrospective analysis involving 81 COVID-19 patients. Purposive sampling was applied in this study. Chi-square analysis was conducted to calculate odd ratio (OR). The result showed that in the period from January to September 2021, 30 COVID-19 patients died consisting of 20 male and 10 female. Most of the patients died were >45 yo and only 4 patients died were <45 yo. Among the patients died, 11 patients had hypertension, 12 patients had type 2 diabetes mellitus (DM), 4 patients had pulmonary TB and 3 patients had dyspepsia. Further analysis showed that hypertension (OR=6.803; 95%CI: 1.925-24.038; p=0.002) and dyspepsia (OR=0.222; 95%CI: 0.059-0.838; p=0.016) were significantly associated with the COVID-19 mortality, whereas type 2 DM (OR=1.123; 95%CI: 0.445-2.832; p=0.495) and pulmonary TB (OR=0.559; 95%CI: 0.059-0.838; p=0.270) were not. In conclusion, hypertension is risk factor, whereas dyspepsia is protective factor of COVID-19 mortality.
The older adult often experiences a low-grade chronic inflammation that commonly manifests in various conditions without infection, including hypertension. The serum neutrophil-to-lymphocyte ratio (NLR) and hyperuricemia are important markers for various diseases including hypertension. Older adult accounts for 17.33% of the total population of Yogyakarta Special Province, which is the highest compared to other provinces. The study aimed to evaluate the relationship between NLR and hyperuricemia with hypertension among adult patients in Sleman District, Yogyakarta, Indonesia. It was a community-based cross-sectional nested study involving 90 older adults aged ≥70 y.o. living around of the Sleman Health and Demographic Surveillance System (HDSS). Data of demographic and health characteristics of the subjects were collected. Independent t test, and Mann Whitney test were used to analyze mean differences between normotensive and hypertensive groups. Multivariate analysis with logistic regression was used to analyze correlation between all variables. The results showed 59 respondents (65%) suffered from hypertension and 31 (35%) respondents had normal and pre-hypertension. No significantly different in almost of the subject characteristics between the normotensive and the hypertensive groups was observed (p>0.05). However, significantly different between the normotensive group and the hypertensive group was observed in the history of hypertension, blood pressure/BP, mean arterial pressure/MAP, abdominal circumstance/AC, fasting blood glucose/FBG, triglyceride, and hemoglobin (p<0.05). No significantly different in the NLR and HsCRP levels of the normotensive group compared to the hypertensive groups were observed (p>0.05). However, the uric acid level of the hypertensive group [5.6 (2.9-9.4 mg/dL)] was significantly higher than that the normotensive group [4.7 (2.9-8.0 mg/dL)] (p=0.042), although it was no significantly relationship with hypertension (p>0.05). In conclusion, there is no relationship between NLR, HsCRP and uric acid with hypertension among middle old and oldest old in Sleman District.
An injury to the skin that disrupts the soft tissue may form a wound. The healing process in response to injury is a dynamic and well-regulated process of cellular, humoral, and molecular mechanisms that consists of four partly overlapping phases: hemostasis, inflammation, proliferation, and remodeling. An impaired wound-healing process may cause a formation of an abnormal scar and chronic wounds, leading to a reduced life quality. Therefore, it needs an optimal prevention strategy. Many modalities have been claimed to accelerate wound healing. The trend of using natural products is increasing in most Southeast Asian countries due to their biodiversity. Nowadays, studies on natural compounds are increasing to accelerate wound healing. Moringa oleifera Lam. is a high-value plant that each part of it has a high nutritional value as well as a great range of medicinal uses, including anti-inflammatory, antimicrobial, antioxidant, and wound healing properties. In this review, we have explored the M. oleifera that are very rich in vitamins, minerals, fatty acids, and phytochemical compounds like quercetin, kaempferol, and vicenin-2, that play a role in the wound healing process. Moreover, these compounds may enhance the healing of wounds with pathological conditions such as diabetes, immunocompromised and persistent infection.
Septic arthritis is considered as a medical emergency which can lead to significant morbidity and cause substantial mortality, especially if the diagnosis is delayed. Prolonged use of immunosuppressive and cytotoxic medications as therapy for systemic lupus erythematosus (SLE) causing patient susceptible to secondary infection. However, septic arthritis due to Salmonella sp. is very rare, makes this is an important extraintestinal manifestation especially in immunosuppressed patients. We presented a case of 25 y.o. female diagnosed with SLE 3 m.o. earlier presented with fever and arthritis on her left genu for 1 wk duration. Genu ultrasonography showed synovitis genu sinistra with fluid volume of 1-2 cc on recessus lateral genu sinistra. The patient was further analysis on her synovial fluid was conducted, the gram stained smear of the fluid showed >25 leucocytes, low power field, and Salmonella sp. was isolated from her synovial fluid analysis. The patient was given intravenous ciprofloxacin and discharged home well. Septic arthritis should always be considered in any patients on long-term immunosuppression state who present with acutely swollen joints. It considered as an important medical emergency with high mortality and morbidity. Hence, prompt recognition, joint aspiration with administration of systemic antibiotics and appropriate surgical intervention plays a pivotal role to minimize morbidity and mortality.
Central nervous system (CNS) infections such as encephalitis, meningitis, or myelitis have high morbidity and mortality in Indonesia. High sensitivity C-reactive protein (hs-CRP) is a sensitive marker of acute inflammation, while albumin is the most abundant protein component in plasma and cerebrospinal fluid (CSS). Infection triggers an inflammatory response so that an increase in the hs-CRP/albumin ratio (CAR) can be a predictor of worsening clinical outcome in patients with CNS infections. However, studies examining the predictor value of serum and CSF CAR on worsening clinical outcomes of patients are limited, particularly in CNS infections. The purpose of this study was to prove the CAR as a predictor of worsening clinical outcome in patients with CNS infections. It was an observational study using a prospective cohort design. Fifty subjects recruited until October 2021 at Dr. Sardjito General Hospital were involved. The multivariate regression analysis showed that serum CAR (OR=3.604; 95%CI=1.487-8.736; p =0.005) could be a single predictor. However, by combining three variables, namely serum CAR, CSF CAR, and decreased consciousness at admission, could be a stronger predictor of worsening clinical outcome in patients with CNS infection (AUC = 97.1%; 95%CI = 0.929-1.00; p <0.001). The optimal cut-off value for serum CAR was 1.35 (Youden index = 0.88, sensitivity = 96%, specificity = 92%) while for CSF CAR was 0.14 (Youden index = 0.60, sensitivity = 76%, specificity = 84%). In conclusion, a combination predictive model of three variables, namely serum CAR, CSF CAR, and awareness at admission can be a stronger predictor of clinical outcome in patients with CNS infection than serum CAR alone.
There is strong evidence indicating that excess adiposity in obesity impacts immune function and host defence. However, almost no known mechanism of how the immune and host defence are affected by the low-grade inflammatory response of the obese has been established. The significance of altered immune response in obesity was presumed to be an independent risk factor for increased morbidity and mortality following the influenza pandemic back in 2009. Similarly, obesity is linked with a higher risk of severity and a worse clinical outcome of severe acute respiratory coronavirus 2 (SARS-COV-2) infection.This case reports a complete recovery of a severe coronavirus disease 2019 (COVID-19) infection despite having morbid obesity aggravated by metabolic syndrome.
Chronic inflammatory condition in chronic kidney disease (CKD) patients is associated with increased risk of cardiovascular morbidity and mortality. Gut dysbiosis is assumed as one of leading factors to the chronic inflammatory condition. The relationship between the kidney and the gastrointestinal, knowns as the gut-kidney axis, has a role in production and accumulation of uremic toxins derived from gut microbial fermentation of protein, and translocation of endotoxins and microbial from gut lumen into bloodstream due to alterations of intestinal epithelial barrier in CKD patients. Probiotics supplementation is one of the optional theraphy to restore the gut dysbiosis in CKD patients. Recent studies found that probiotics supplementation in CKD patients decreased uremic toxins and pro-inflammatory cytokines production, and delayed CKD progression. The improvement of this chronic inflammatory condition is expected to decrease cardiovascular disease risk in CKD patients. This review aims to describe the importance of gut-kidney axis in CKD patients, particularly in gut dysbiosis, and the role of probiotics in progression of CKD.
Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia that induces excessive reactive oxygen species (ROS) production and causes oxidative stress. Diabetic cardiomyopathy is a diabetic complication characterized by structural and functional changes of the myocardium. Fibrosis is one of the pathological features of diabetic cardiomyopathy. Moringa oleifera leaves have been reported to possess antidiabetic and antioxidant activities which could prevent diabetic complications such as cardiomyopathy. A previous study reported that M. oleifera leaves extract have protective effects to the kidneys and liver of rats exposed to oxidative stress. This study aimed to investigate the protective effect of the M. oleifera leaves extract on cardiac fibrosis of rats induced by streptozotocin (STZ). This was an experimental study using a posttest-only control group design. Thirty-three male Wistar rats were randomly divided into three groups i.e. normal control group (Group 1) were administered normal saline, diabetic control group (Group 2) were administered normal saline, and diabetic treatment group (Group 3) were administered M. oleifera leaves extract. Diabetes induction of rats was conducted by intraperitoneally injection of STZ at dose of 45 mg/kg BW. The M. oleifera leaves extract at a dose of 1000 mg/kg BW was administered orally one time a day for 28 days. Statistical analysis was performed using the Kruskal-Wallis test followed by Mann Whitney. A significant difference in cardiac fibrosis occurrence between three groups was observed (p < 0.05). No cardiac fibrosis was observed in normal control group, meanwhile cardiac fibrosis was observed in all rats (9 rats) of the diabetic control group (G2). Only 2 rats in the treatment group (G3) had cardiac fibrosis. In conclusion, M. oleifera leaves extract can inhibit cardiac fibrosis in STZ-induced diabetic rats.
Coronavirus disease 2019 (COVID-19) can cause systemic and respiratory symptoms. Acute respiratory distress syndrome (ARDS), anemia, acute heart injury, secondary infection, and stroke are the complications of COVID-19. Age, oxidative stress, endothelial dysfunction, inflammatory status, vascular risk factors, and hypoxemia are risk factors for stroke associated with COVID-19. In this case report, two cases of COVID-19 complicated by stroke and other thromboembolic diseases were discussed. Case 1: a 46-year-old man presented with right extremities weakness, dysarthria, cough, colds, chest pain radiating to left upper extremity. He was diagnosed with moderate COVID-19, with complication of embolic stroke and myocardial infarction. After administration of IV furosemid and recombinant tissue plasminogen activator (rTPA), his condition improved, and he was discharged from our facility. Case 2: a 54-year-old woman presented with a decreased level of consciousness, skin discoloration, tenderness on her left calf, cough, fever, and shortness of breath. She was diagnosed with moderate COVID-19 with a complication of thrombotic stoke and deep vein thrombosis (DVT). She was treated with rTPA, IV citicoline, and fondaparinux for 5 days. In conclusion, COVID-19 carries a risk of thromboembolic complication. COVID-19 patients have a higher risk of bleeding, therefore, medications, particularly anticoagulant, should be administered with more caution.
Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare female congenital anomaly of urogenital tract. The definite etiology of HWW syndrome is still unknown. It may be caused by the abnormal development of Mullerian and Wolffian ducts. The characteristic triad of this syndrome includes didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis, recently known as Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome. A 17 y.o. presented with intermittent lower abdominal pain. Physical examination revealed in normal limit. From the ultrasonography examination, it was found uterus didelphys with left hemiuterus hematomethra, hematocolpos, with normal anatomy and function of the right kidney, but there was no left kidney. From pelvic magnetic resonance imaging (MRI) and laparoscopy showing a complete duplication of the uterus from the horn to the cervix with no connection between the two uterine cavities. Both ovaries were normal. The right fallopian tube was normal. The left tube was enlarged, attached to the uterus and the left ovary. No left kidney was found. From the previous surgery, there was a misdiagnosed with brown cyst. Physical examination such as rectal toucher often missed, regardless it can be used to determine some differential diagnosis. MRI is most accurate for providing details regarding the altered anatomy and for identifying associated hematocolpos, hematosalping or hematometra for HWW syndrome cases. The laparoscopy guiding diagnostic and operative management of the vaginal septectomy procedure was performed. In conclusion, misdiagnosis of HWW syndrome can be occurred on ultrasound examination. MRI is an examination that is considered appropriate to help confirm the diagnosis. Laparoscopy can be used with the aim of establishing a diagnosis or in surgical management, in this case, a septectomy is performed.
Turnaround time (TAT) is defined as the time it takes since request/sample is received at the blood bank until blood is cross-matched/reserved and available for transfusion. Turnround time prolongation affects patient care and satisfaction. This study aimed to evaluate TAT for the provision of packed red cells (PRC) at the Blood Transfusion Unit of Dr. Sardjito General Hospital, Yogyakarta, analyze factors affected in TAT prolongation, and provide solution the prolongation. It was an analytical descriptive study with a qualitative design, by calculating the time since receipt of the PRC request at the Blood Transfusion Unit or since blood collection from donors until data input of the crossmatch results in Dr. Sardjito General Hospital management information system (SIMETRIS) completed. Moreover, the delay in the provision of PRC at the Blood Transfusion Unit was also analyzed. There were 3 (1.5%) of 200 ER samples that met TAT for the provision of the PRC, which was 30 min after receipt of the request at the Blood Transfusion Unit in cito conditions. There were 20 (10%) of 200 samples from the wards that met TAT for the provision of the PRC, which was 2 h after receipt of the request at the Blood Transfusion Unit if the blood stock was available. There were 55 (27.5%) of 200 samples from the wards that met TAT for the provision of the PRC, which was 4 h after the blood was collected from the donor. TAT for the provision of the PRC at the Blood Transfusion for the available blood stock group was 179.08 (67.2 – 396.27) min, replacement blood donor group was 485.38 (126.43 – 910.68) min, and cito group was 121.29 (27.68 – 421.38) min. In conclusion, there is TAT prolongation of PRC provision at the Blood Transfusion Unit of Dr. Sardjito General Hospital.
