Introduction. Diabetic kidney disease (DKD) is a major microvascular complication of diabetes mellitus, characterized by persistent albuminuria and a progressive decline in glomerular filtration rate (GFR), making it a leading cause of chronic kidney disease (CKD) and end-stage renal disease. Vascular endothelial growth factor-A (VEGF-A) is implicated in the pathogenesis of DKD, being overexpressed in the kidneys and contributing to increased vascular permeability, inflammation, and fibrosis. Albuminuria, an early indicator of renal damage in DKD, is a strong predictor of CKD progression and cardiovascular events. The urine albumin-to-creatinine ratio (UACR) is the recommended test for detecting and monitoring albuminuria. This study aimed to investigate the correlation between serum VEGF-A levels and UACR in patients with DKD. Methods. This cross-sectional analytical observational study involving DKD patients at the Outpatient Clinic of Dr. M. Djamil General Hospital Padang from May to October 2024. Demographic and clinical data were collected. Blood samples were taken for serum VEGF-A measurement using ELISA, and morning spot urine samples were collected for UACR measurement using immunoturbidimetry. Correlation analysis was performed using the Spearman test. Ethical approval was obtained from the Health Research Ethics Committee of Dr. M. Djamil General Hospital Padang. Results. A total of 30 PGD patients were included in the study. The mean age was 61.9 years (SD 9.75), and 53.3% of the participants were male.The mean serum VEGF-A level in DKD patients was 131.34 (SD 83.9) pg/ml, and the mean UACR was 403.90 (SD 53.1) mg/g creatinine. There was a very strong positive correlation between serum VEGF-A levels and UACR (r = 0.993, p < 0.05). Conclusions. Serum VEGF-A levels are very strongly and positively correlated with UACR in DKD patients. Serum VEGF-A may serve as a potential marker for assessing DKD progression and risk of complications, as well as a potential therapeutic target.
Introduction. Fatigue is often found in patients with CKD-HD. Fatigue serves as an indicator of mortality and may be a viable target in a treatment strategy. Current research has not established the determinants of moderate PDF in individuals with CKD who are undergoing HD. Therefore, this study was conducted to prove the predictor factors of moderate PDF. Methods. A retrospective cohort study in CKD-HD patients at Fatmawati Central General Hospital during the period of November-December 2024. The independent variables of this study are comorbidities, MIS, depression, intradialytic SBPV, dialysis vintage, UFG, IDWG, and anemia status. Primary data from the PDF Scale, MIS, and BDI II questionnaire were collected through patient interviews during the eighth hemodialysis session. Demographic and clinical information of the patients was obtained from medical records. Intradialytic SBPV was determined by the ARV. All variables were examined using the chi-square test, except for the depression variable, which failed to fulfil the requirements and was assessed using the Fisher exact test. A logistic regression analysis was performed to identify the most significant association among the predictor variables of moderate PDF. Results. A total of 135 research subjects were included in the study. Based on the results of the bivariate analysis, MIS, depression, and the type of dialysis were significantly linked to moderate post dialysis fatigue (p < 0.05). From the results of the multivariate analysis, inflammatory malnutrition (RR 1.580; 95% CI 1.017–2.455; p = 0.042), dialysis vintage (RR 1.850; 95% CI 1.208–2.834; p = 0.005), and depression (RR 2.165; 95% CI 1.542–3.039; p < 0.001) were obtained. The logistic regression model shows a significant relationship between moderate PDF and severe malnutrition inflammation score, mild to moderate depression, and dialysis vintage exceeding 12 months. Conclusion. Our findings underscore a significant association between depression, dialysis vintage, and malnutrition inflammation score (MIS) with moderate PDF in CKD-HD patients.
Introduction. Heart failure is one of the major challenges in global health due to its significant contribution to morbidity and mortality. One of the pathophysiological aspects is autonomic nervous system dysfunction which can be monitored through heart rate variability (HRV) parameters. Ivabradine is a pharmacological agent that potentially improves the balance of sympathetic and parasympathetic tone. This study was designed to evaluate the impact of ivabradine administration on HRV parameters in heart failure with reduced ejection fraction (≤40%) due to coronary heart disease in Indonesian population. Methods. This study used a quasi-experimental research type with a pretest and posttest method without control which was conducted at Dr. Kariadi Hospital from October 2024 to February 2025. Sixteen patients diagnosed with heart failure with reduced ejection fraction due to coronary heart disease underwent intervention in the form of ivabradine administration at a fixed dose of 5 mg twice a day for 30 days. Evaluation of HRV was carried out through 24 hours holter recording before and after therapy. The HRV parameters analyzed included SDNN, SDANN, RMSSD, pNN50, and LF/HF ratio. Data processing was carried out using a paired t-test for normal distribution and the Wilcoxon Signed-Rank test for non-normal data. P value <0.05 was considered statistically significant. Results. A total of 16 subjects participated in this study, consisting of 14 men (87.5%) and 2 women (12.5%), with a mean age of 57 years. There was a significant increase in SDNN of 14.71 (SD 24.15) milliseconds (p = 0.028), SDANN of 56.99 (SD 26.94) milliseconds (p < 0.001), RMSSD of 18.39 (SD 27.05) milliseconds (p = 0.007), and pNN50 of 6.96% (SD 7.87) (p < 0.001), as well as a decrease in the LF/HF ratio of 1.42 (SD 0.85) (p < 0.001) after 30 days of ivabradine therapy. Conclusions. The administration of ivabradine had a significant effect on improving heart rate variability parameters in both the time and frequency domains in patients with heart failure with reduced ejection fraction due to coronary heart disease. These findings indicate enhanced parasympathetic dominance and reduced sympathetic nervous system activity.
Introduction. The decline in quality of life among geriatric patients undergoing hemodialysis has a negative impact on treatment adherence, physical functioning, dietary patterns, and mortality. This study was conducted to assess the quality of life of geriatric hemodialysis patients and its association with comorbidities, functional status, frailty, sarcopenia, nutritional status, depression, hemoglobin levels, hemodialysis vintage, vascular access, and hemodialysis adequacy. Methods. This study employed a cross-sectional design with primary data collection. Consecutive sampling was used to recruit participants. The study was conducted at the hemodialysis units of Cipto Mangunkusumo National General Hospital (RSCM), Persahabatan National General Hospital (RSP), and Fatmawati National General Hospital (RSF) from June 2024 to August 2024. The inclusion criteria were patients aged ≥60 years undergoing maintenance hemodialysis. Exclusion criteria were unstable clinical condition, cognitive or mental impairment, and refusal to participate. Quality of life was assessed using the EQ-5D-5L instrument. Data on medical history and laboratory findings were obtained from hospital medical records. Bivariate analysis was performed using the Mann–Whitney U test for comorbidities, sarcopenia, depression, hemoglobin level, vascular access, and dialysis adequacy; the Kruskal–Wallis test for frailty, functional status, and nutritional status; and Spearman’s correlation for hemodialysis vintage. Multivariate analysis was conducted using linear regression to identify factors associated with reduced quality of life. Results. A total of 124 subjects (mean age 67 years) were included in this study. The mean EQ-5D-5L index score was 0.76 (IQR 0.63–1.00), while the mean VAS score was 70. The majority of subjects (75%) reported no difficulties in self-care or daily activities. Functional status (p < 0.0001) and depression (p < 0.002) were significantly associated with the quality of life in geriatric patients undergoing hemodialysis, with an adjusted R² value of 0.642. Conclusions. Geriatric patients undergoing HD at RSCM, RSP, and RSF had an average EQ-5D-5L index score of 0.76 (out of 1.000), and 75% of the patients reported no issues with self-care and daily activities. Functional status and depression have been proven to play a significant role in determining their quality of life.
Hepatocellular carcinoma (HCC) is the most common type of liver cancer and the second leading cause of cancer-related mortality worldwide. Liver transplantation is considered the definitive treatment for HCC; however, in Indonesia, adult liver transplantation is still rarely performed due to donor limitations and high costs. Radiofrequency ablation (RFA) has therefore become a preferred therapeutic option in the management of HCC. This report discuss about the survival and recurrence rates of HCC in patients treated with RFA compared with those undergoing liver transplantation. A literature search was conducted using the PubMed, Cochrane, Embase, and Scopus databases. Selected articles were screened according to the predefined clinical question as well as inclusion and exclusion criteria. Critical appraisal was performed based on the 2011 Oxford Centre for Evidence-Based Medicine framework, assessing validity, importance, and applicability. Critical appraisal was conducted on two selected articles. One study reported comparable survival rates between the two groups. However, overall, both articles demonstrated that liver transplantation was associated with higher survival rates and lower recurrence rates compared with RFA. In conclusion, survival outcomes are superior with liver transplantation compared with RFA. Nevertheless, RFA may be considered in the management of hepatocellular carcinoma as a bridging therapy to liver transplantation or in situations where liver transplantation is not available.
Introduction. Sarcopenia is a geriatric syndrome marked by an age-related decline in muscle mass, which is affected by protein intake. Transthyretin is a visceral protein used to evaluate nutritional status and acts as a positive regulator of muscle mass. This study aimed to assess the difference in plasma transthyretin levels between elderly groups with and without sarcopenia. Methods. This was an analytical observational study with a cross-sectional approach. Subjects were elderly patients who visited the Internal Medicine Polyclinic of Dr. M. Djamil Hospital Padang and met the inclusion and exclusion criteria from August to September 2024. Subjects were classified into sarcopenic and non-sarcopenic groups, followed by an examination of plasma transthyretin levels. Sarcopenia was diagnosed using bio-impedance analysis (BIA) measurement, handgrip strength with a Jamar hydraulic hand dynamometer, and physical performance with a walking speed test. Plasma transthyretin levels were measured using the enzyme-linked immunosorbent assay (ELISA) method. Comparative analysis was performed using the unpaired T-test using SPSS 29.0. Results. Among total of 46 subjects who participated in this study, the majority of elderly individuals with sarcopenia were predominantly female. The mean plasma transthyretin level in the sarcopenic elderly group was 10.9 (3.3) mg/dL, while in the non-sarcopenic elderly group was 20.3 (2.5) mg/dL. Comparative analysis demonstrated a significant difference in plasma transthyretin levels between sarcopenic and non-sarcopenic elderly individuals (p < 0.001). Plasma transthyretin levels in the sarcopenic elderly group were lower compared to the non-sarcopenic elderly group. Conclusion. There is a significant difference in plasma transthyretin levels between sarcopenic and non-sarcopenic elderly individuals.
Polycythemia is a condition characterized by an abnormal increase in the total red blood cell mass and is classified into primary and secondary polycythemia. Secondary polycythemia occurs as a physiological response to tissue hypoxia or increased erythropoietin production, without intrinsic abnormalities in erythroid progenitor cells. This condition is rare, particularly when associated with nephrotic syndrome. This report aims to describe a case of secondary polycythemia associated with focal segmental glomerulosclerosis (FSGS). A 20-year-old man presented with generalized edema for five months prior to admission, accompanied by foamy urine. Physical examination revealed peripheral edema and minimal ascites. Laboratory investigations demonstrated massive proteinuria and elevated hemoglobin levels. Renal biopsy confirmed the diagnosis of FSGS, while bone marrow biopsy showed normocellular findings without evidence of malignancy or fibrosis. The patient was treated with methylprednisolone, ramipril, and simvastatin, and underwent four sessions of phlebotomy along with antiplatelet therapy. Following treatment, there was improvement in hemoglobin levels, proteinuria, and blood pressure control. Secondary polycythemia has been reported to be associated with various parenchymal kidney diseases, including FSGS. The proposed mechanisms include increased erythropoietin production due to renal ischemia or dysregulation of erythropoiesis feedback mechanisms. Phlebotomy is an important therapeutic intervention to prevent complications related to hyperviscosity and thromboembolism and has been shown to result in clinical improvement. This case illustrates a rare occurrence of secondary polycythemia in a patient with nephrotic syndrome due to FSGS. Accurate diagnosis and comprehensive management, including phlebotomy, can lead to meaningful clinical improvement. This report is expected to contribute to the literature on the diagnosis and management of secondary polycythemia in kidney disease.
Electronic medical records (EMRs) are essential to modern healthcare systems, yet their implementation continues to face challenges such as disruption of doctor–patient communication, administrative burden, and documentation structures misaligned with clinicians’ clinical reasoning processes. This narrative review aims to assess the limitations of conventional EMRs and examine the potential of artificial intelligence (AI) to improve documentation efficiency, accuracy, and overall clinical performance. The literature indicates that AI technologies, including machine learning, deep learning, and natural language processing, can automate documentation, streamline workflows, enhance decision support, and reduce physician burnout, thereby allowing clinicians to devote more attention to patient care. Nevertheless, the integration of AI into EMRs must address ethical concerns such as algorithmic bias, data privacy, and accountability for AI-assisted decisions. In conclusion, AI-driven EMR optimization has the potential to create a more human-centered, efficient, and data-driven documentation ecosystem when supported by strong regulatory and ethical frameworks.
Introduction. Dolutegravir (DTG) is one of the effective antiretroviral therapies (ART) for suppressing HIV replication and has a favorable safety profile. However, reports regarding neuropsychiatric side effects, especially in patients transitioning from a nevirapine (NVP) regimen to dolutegravir, have started to emerge. This study aimed to describe the changes in neuropsychiatric symptoms before and after the transition from a NVP-based ARV regimen to DTG in HIV patients at Cipto Mangunkusumo Hospital (RSCM), Jakarta. Methods. This study employed a prospective cohort design involving 292 HIV patients at Cipto Mangunkusumo Hospital who were transitioning from NVP to DTG regimen. Participants were monitored for six months, and neuropsychiatric symptoms were assessed using a modified HIV symptom index (mHSI). Data collection was conducted at the beginning of the transition (baseline) and during follow-up through interviews regarding HIV-related symptoms and ART. Results. At the start of the study, 70.2% of participants reported at least one neuropsychiatric symptom, which increased to 80.1% after 6 months of transitioning to TLD. The most commonly reported symptoms were insomnia, headaches, and anxiety, with women reporting more symptoms than men. Statistical analysis showed a significant increase in symptoms of sadness, headaches, and irritability (p < 0.01) after the transition to dtg. Conclusions. Although DTG shows good viral suppression capabilities, significant neuropsychiatric side effects still arose, especially in patients with a history of mental disorders. Close monitoring of neuropsychiatric symptoms and adjustments to the ART regimen need to be carried out to improve the quality of life for HIV patients undergoing DTG therapy.
Type 2 diabetes mellitus (T2DM) is a chronic disease with a high risk of complications, requiring optimal glycemic control. This case report aims to describe the use of continuous glucose monitoring (CGM) in the evaluation of a patient with T2DM and obesity whose glycemic levels remained uncontrolled despite high-dose insulin therapy. A 58-year-old woman with an 18-year history of T2DM presented to the Endocrinology Clinic of Cipto Mangunkusumo Hospital with uncontrolled blood glucose accompanied by classic diabetic symptoms. CGM revealed that the majority of glucose levels were within the time above range (TAR) at 83% without hypoglycemia, while the time in range (TIR) was only 17%. Contributing factors included a high-carbohydrate diet, limited physical activity, and technical difficulties with insulin injection. Interventions consisted of dietary re-education, gradual physical activity, optimization of injection technique, and insulin dose adjustment. CGM provided a comprehensive glycemic profile and helped identify non-pharmacological factors hindering glycemic control. This case highlights the role of CGM as an essential tool for individualized therapy in patients with T2DM requiring high-dose insulin.
Introduction. One consequence of DM is the emergence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN). Diabetic peripheral neuropathy is a complication of diabetes that presents signs and symptoms of motor and sensory disturbances, while PAD is an atherosclerosis condition that gradually develops in the arterial vessels. This study aimed to determine correlation of arterial obstruction assessed using arteriography and the nerve impairment assessed using nerve conduction velocity (NCV) in DM patients with PAD and DPN. Methods. This is a cross-sectional study that takes secondary data from previous research conducted from July 2018 to June 2021 in Cipto Mangunkusumo hospital. Subjects were people with DM type 2 who had NPD and PAP who met the inclusion criteria and did not meet the exclusion criteria. Subjects underwent an arteriography examination to assess the stenosis in the peroneal artery, anterior tibial artery, and posterior tibial artery. Subjects also underwent nerve conduction velocity (NCV) examinations in the peroneal N. communis, N. peroneal superficialis, N. tibialis, and N. suralis. The correlation between the two variables was then tested using the Spearman correlation test. Results. The peroneal artery stenosis had a moderate negative correlation (r = - 0.420) with the sensory NCV of the superficial peroneal nerve which was statistically significant (p = 0.023). Meanwhile, the correlation of stenosis and NCV disorders in the peroneal nerve with the common peroneal nerve, anterior tibial nerve with tibialis nerve and posterior tibial nerve with sural nerve was not statistically significant. This can be explained by the possibility of collaterals appearing in people with PAD, the structure of vasculature on the nerves, and the small number of samples. Conclusions. There is a moderate negative correlation between the stenosis of the peroneal nerve and the sensory NCV of the peroneal superficialis. However, insignificant results were found in the correlation between peroneal artery with common peroneal nerve, anterior tibialis artery with tibial nerve, and posterior tibial artery with sural nerve.
Introduction. Although mortality among adult chronic kidney disease (CKD) patients on regular hemodialysis remains infrequent within the first three months, it is still a potential outcome. Given that hemodialysis is required for life, identifying risk factors for mortality is critical. This study aims to examine risk factors associated with mortality in adult CKD patients undergoing regular hemodialysis. Methods. A case-control study, without matching, was conducted using medical record data from adult CKD patients (≥18 years) receiving regular hemodialysis between 2022 and 2024 at three hospitals (types A, B, and C) in Lampung Province. The case group consisted of patients who experienced mortality, while the control group consisted of similar patients who survived. Patients with autoimmune-related CKD were excluded. Subjects were selected using convenience sampling with a 1:2 case-to-control ratio. Risk factors assessed included sociodemographics, dialysis duration, comorbidities, and nutritional status. Logistic regression analysis was performed. Results. A total of 114 cases and 228 controls were included, with the longest dialysis duration in both groups being 72 months. The oldest patient starting dialysis was 77 years in the case group and 75 years in the control group. Logistic regression analysis revealed that the following factors were associated with increased mortality: history of heart failure (OR = 2.3; 95% CI = 1.2–4.4; p = 0.009), history of post-renal obstruction (OR = 3.5; 95% CI = 1.6–7.6; p = 0.002), random blood glucose ≥140 mg/dL (OR = 2.1; 95% CI = 1.2–3.6; p = 0.011), acute kidney injury (OR = 6.5; 95% CI = 3.8–11.1; p < 0.001), and BMI Conclusion. History of heart failure, post-renal obstruction, elevated blood glucose, acute kidney injury, and low BMI are significant predictors of mortality in adult CKD patients undergoing regular hemodialysis in Lampung Province.
Introduction. Despite its high prevalence and significant impact on health, comprehensive studies are still needed to explore the factors affecting sarcopenia parameters, such as muscle mass, muscle strength, and physical performance. This study aimed to identify the factors influencing sarcopenia parameters in the elderly, including muscle mass, muscle strength, and physical performance. Methods. A cross-sectional study was conducted from July to December 2022 on elderly individuals (>60 years old) at the Geriatric Polyclinic, Moh. Hoesin General Hospital, Palembang, selected through consecutive sampling. Muscle mass was measured using bioimpedance analysis, expressed in ASMI values; muscle strength was measured using a handheld dynamometer; and physical performance was assessed using the five-time sit-to-stand test. The SARC-F score was classified as normal (<4) and abnormal (≥4). Data on age, gender, serum albumin levels, comorbidities, and Mini Nutritional Assessment Short Form (MNA-SF) scores were collected for correlation analysis and comparison with muscle mass, muscle strength, and physical performance. Results. Of the 41 subjects, the average age was 70.75 (SD 7) years, with 56.1% being female. All subjects had low muscle mass, with an average ASMI of 3.31 (SD 0.59) kg/m² in females and 4.89 (SD 1.06) kg/m² in males. The average muscle strength for females was 16.9 (SD 6.1) kg and for males 27.5 (SD 8.3) kg. The five-time sit-to-stand test result for females was 24.2 (SD 14.2) seconds and for males, 21.8 (SD 11.1) seconds. Based on SARC-F, 8 subjects (19.5%) were categorized as at risk for sarcopenia. Serum albumin levels for all subjects were within the normal range [4.3 (SD 0.3) g/dl]. Malnutrition was found in 14 subjects (34.1%) according to the MNA-SF results. Comorbidities were present in 35 patients. Statistical analysis showed a significant correlation between serum albumin levels and muscle strength (r=0.35; p=0.005) and physical performance (r=-0.5; p<0.001). Nutritional status had no significant effect on the three parameters, but it did significantly affect muscle mass in elderly males (p=0.002). Comorbidities, including cardiovascular disease, non-insulin-dependent diabetes mellitus, and musculoskeletal disorders, were not significantly related to any of the sarcopenia parameters. Conclusions. Serum albumin is significantly associated with muscle strength and physical performance, while nutritional status is significantly associated with muscle mass in elderly males. Comorbidities were not significantly related to muscle mass, muscle strength, or physical performance in the elderly.
Introduction. Hemodialysis (HD) is one of the renal replacement therapies commonly used in patients with end-stage renal disease. Patients undergoing hemodialysis typically exhibit lower levels of physical activity compared to inactive yet healthy individuals. A decline in physical function and muscular strength may impair the ability to perform daily activities, ultimately affecting patients’ quality of life (QoL). This study aimed to examine the relationship between physical activity and quality of life among hemodialysis patients at Rumah Sakit Khusus Ginjal Rasyida Medan. Methods. This was an analytical observational study with a cross-sectional design involving 50 respondents undergoing hemodialysis therapy at Rumah Sakit Khusus Ginjal Rasyida Medan between July and November 2022. Participants were selected based on predetermined inclusion and exclusion criteria. The association between variables was analyzed using the Chi-square test. Results. Among the respondents, 72.0% were categorized as having a good quality of life, while 28.0% had a poor quality of life. Regarding physical activity levels, 48.0% of patients had moderate activity, 26.0% had high activity, and 26.0% had low activity. Bivariate analysis revealed significant associations between quality of life and physical activity (p = 0.007), as well as between quality of life and comorbidities (p = 0.024). Multivariate analysis indicated that physical activity was a significant predictor of quality of life, with a prevalence ratio (PR) of 4.429 (95% CI: 1.383–14.191). Conclusion. There is a significant association between physical activity and quality of life among hemodialysis patients at Rumah Sakit Khusus Ginjal Rasyida Medan.
Insulinoma is a rare neuroendocrine tumor of the pancreas arising from β-cells, leading to excessive insulin secretion and resultant hypoglycaemia. Surgical resection is the first-line treatment for insulinoma, but when surgery is not feasible, medical therapy is an important option. Calcium channel blockers (CCBs) such as verapamil can inhibit insulin release from β-cells and have been proposed as an adjunct therapy to help control blood glucose levels in insulinoma. We report a 43-year-old man who presented to the emergency department with decreased consciousness due to hypoglycaemia. His capillary blood glucose at home was 35 mg/dL, about 8 hours after his last meal. He had a history of recurring hypoglycaemic episodes in the past month, with recorded blood glucose ranging from 26–100 mg/dL during a prior hospitalization. On examination, he was hemodynamically stable but had mild epigastric tenderness. Laboratory tests confirmed hyperinsulinemic hypoglycaemia (plasma glucose 58 mg/dL with concurrent serum insulin 47 µIU/mL and C-peptide 13.1 ng/mL), consistent with insulinoma. Abdominal imaging revealed a heterogeneous pancreatic mass suspected as an insulinoma. Initial management included a continuous infusion of 10% dextrose (500 mL/24h) with IV boluses of 40% dextrose as needed for blood glucose <70 mg/dL. Despite this, the patient experienced recurrent hypoglycaemia, so octreotide 50 µg three times daily was added. Octreotide alone did not fully stabilize his blood glucose levels. On the 6th day of hospitalization, oral verapamil 80 mg once daily was initiated – chosen both to treat the patient’s concurrent hypertension and for its potential to suppress insulin release. Following the addition of verapamil, the patient’s blood glucose levels improved and remained above 100 mg/dL with markedly reduced hypoglycemic episodes. The patient subsequently underwent a debulking surgery of the pancreatic tumor. This case highlights the importance of controlling blood glucose in insulinoma patients and demonstrates that the addition of verapamil can stabilize blood glucose when used alongside standard medical therapy (such as octreotide). Verapamil may serve as a useful adjunct in the management of insulinoma-related hypoglycemia, especially in patients awaiting surgery or those who are not surgical candidates.
Introduction. Type 2 diabetes mellitus (T2DM) is the leading metabolic disease in Indonesia. Diabetic peripheral neuropathy (DPN), a major complication of T2DM, was associated with insulin resistance and adipose dysfunction. Visceral adiposity index (VAI) is a tool to measure visceral fat as the indicator of adipose dysfunction and insulin sensitivity. The association between VAI and DPN has not been widely researched, especially in Indonesia. This study aims to assess the association between them. Methods. This was a cross-sectional study conducted on adult patients (aged ≥18 years) with T2DM at H. Adam Malik General Hospital, Medan, from December 2024 to March 2025. DPN was assessed using the Michigan Neuropathy Screening Instrument (MNSI), consisting of a questionnaire (MNSI A) and physical examination (MNSI B). VAI was calculated using waist circumference, body mass index (BMI), triglyceride level, and high-density lipoprotein (HDL) cholesterol level. A bivariate analysis was conducted to compare mean VAI values between patients with and without DPN and to assess correlations between VAI and MNSI scores. Results. From a total of 80 subjects, the average age was 56 years (SD 9), and the majority were female (56.3%). The median VAI value in the DPN group was 2.863 (0.401–11.665), slightly higher than in the non-DPN group, which was 2.549 (0.781–17.414), but the difference was not statistically significant (p=0.34). No statistically significant correlation was found between VAI and MNSI A score (r=0.092; p=0.42) or MNSI B score (r=0.12; p=0.31). Conclusion. There was no significant association between VAI and DPN in patients with T2DM.
Introduction. The available data currently is not adequate to show the differences in vitamin D levels across various clinical stages of COVID-19 in Indonesia. Therefore, this study was conducted to determine the profile of vitamin D levels and its relationship with the clinical severity and inflammatory parameters in confirmed COVID-19 patients. Methods. The study was conducted at Cipto Mangunkusumo Hospital and Wisma Atlet COVID-19 Emergency Hospital from January to December 2021. Subjects who were 18 years old and above and had confirmed COVID-19 status through COVID-19 Polymerase Chain Reaction (PCR) from oropharyngeal swab were included. Those who refused to participate in the study were excluded. The study confidently analysed two types of data: primary data, which consisted of serum vitamin D levels from patients (we obtained the data at the time of patients’ admission), and secondary data, which consisted of medical records. Results. It is worth noting that of the 96 subjects, 77.08% had a vitamin D deficiency. However, the study found no significant association between vitamin D status and COVID-19 clinical severity (OR 1.16 (0.61 – 2.23); p = 0.641). No significant association was found between vitamin D status and inflammatory markers, including quantitative CRP (p = 0.691), D-dimer (p = 0.956), and neutrophil-lymphocyte ratio (p = 0.883). Conclusions. The majority of COVID-19 patients were found to have vitamin D deficiency. Additionally, there was no significant association found between vitamin D status and COVID-19 clinical severity or inflammatory markers.
Refeeding syndrome is a different clinical symptom and metabolic disorder that occur during the reintroduction of nutrition in chronically malnourished patients. Calorie restriction can increase survival and reduce mortality rates. This evidence-based case report was developed to examine the influence of caloric restriction on mortality, morbidity, and duration of critical illness. A literature search was performed using PubMed, EBSCOHost, ScienceDirect, and Cochrane with the keywords: “critically ill,” “restricted caloric intake,” “standard caloric intake,” “mortality,” “morbidity,” and “duration”. Articles were appraised using the University of Oxford Centre for Evidence-Based Medicine (CEBM) tools. Two studies met the inclusion criteria. The first was a randomized controlled trial, which demonstrated that protocolized caloric restriction significantly improved 60-day survival in ICU patients with refeeding syndrome (91% vs. 78%, p = 0.002), although no significant difference was observed in days alive following ICU discharge (44.8 vs. 39.9 days, p = 0.19). The second was a meta-analysis, which suggested a trend toward reduced hospital mortality with hypocaloric feeding; however, risk ratios varied widely (0.23–5.54), and 30-day mortality differences were not statistically significant (RR: 0.79–3.00). In conclusion, while caloric restriction may not significantly impact overall mortality in chronically ill patients, it appears to improve 60- to 90-day survival in critically ill ICU patients with refeeding syndrome. One study noted a reduced risk of respiratory infection, though evidence on other complications remains inconclusive. A regimen of 20 kcal/hour for at least two days may be suitable for managing refeeding syndrome. Overall, caloric restriction may offer modest clinical benefits in this specific population.
Acute delirium syndrome is often found in hospitalized older patients, requiring longer hospital stay and higher hospital cost. Studies showed that 40% of these delirium cases in older patients may be prevented with multicomponent intervention based on National Institute for Health and Clinical Excellence (NICE) and Hospital Elder Life Program (HELP) guidelines. This article explained multicomponent intervention, which includes protocols for disorientation, dehydration, hypoxia, constipation, malnutrition, pain control, infection control, infection prevention, drugs evaluation, early mobilization, and education for patients’ family / caregiver. Prevention of acute delirium syndrome in hospitalized older patients will reduce the medical cost and distress among patients’ family.
Introduction. Frailty is characterized by a multisystem physiological decline that increases the risk of morbidity and mortality, especially in patients with advanced-stage solid malignancies. The association between frailty and one-year survival in older adults with solid malignancies in Indonesia has not yet been established. This study aimed to assess the association between frailty status and one-year survival in elderly patients with advanced-stage solid tumors. Methods. This was a retrospective cohort study conducted at Dr. Cipto Mangunkusumo National General Hospital, Jakarta utilizing patient data from a previous study conducted between November 2020 and 2021. Subjects were cancer patients aged >60 years with advanced-stage solid tumors. Frailty was assessed using the FRAIL scale, and one-year survival was determined through medical records and direct follow-up confirmation. Data analysis included bivariate tests, Kaplan-Meier survival analysis, log-rank test, and multivariate Cox regression. Results. A total of 106 elderly patients with advanced solid tumors were analyzed, with a frailty prevalence of 41.5%. A total of 44.3% of patients died within one year. Multivariate analysis showed that frailty was a significant independent predictor of survival. Frail patients had a 2.131 times higher risk of death. Other factors such as nutritional status, polypharmacy, and comorbidities were not significant. Conclusion. Frailty was identified as a significant independent predictor of reduced one-year survival in elderly patients with advanced-stage cancer.
