Journal Of The Indonesian Medical Association

Step Up Approach in The Management of Pediatric Allergic Rhinitis

2024-06-27T13:20:02+07:00

Allergic rhinitis (AR) is clinically characterized by two or more symptoms including itching, sneezing, nasal obstruction and rhinorrhoea. It is known to be caused by IgE-mediated hypersensitivity reaction in response to inhaled allergens. It has been shown to have high burden of disease, as patients with AR show significant reductions in the number of healthy days, interruption of daily activities due to symptoms, and overall reduction in quality of life. The International Study of Asthma and Allergies in Childhood (ISAAC) estimates the prevalence of AR across children and adults to be about 10-30% in the United States (US) and other developed countries. Allergic rhinitis negatively impacts quality of life directly through, or from the consequences of, its symptoms such as sleep disturbances, fatigue, impaired learning and cognitive functions, leading to reduction in productivity, worsened school performances and may also lead to embarrassment.

Guidelines for the Diagnosis and Management of Common Bile Duct Stones: Indonesian Society of Digestive Surgeons (IKABDI) consensus

2024-06-27T13:19:45+07:00

Introduction: Choledocholithiasis, the presence of stones in the common bile duct (CBD), is a challenge in the field of digestive surgery due to the wide range of cases with varying levels of difficulty. Until now, the options for diagnostic and therapeutic modalities have been increasingly evolving, ranging from non-invasive to invasive procedures. Therefore, the Indonesian Society of Digestive Surgeons provides recommendations for the management of CBD stone cases in Indonesia.
Method: The consensus was developed using the Delphi survey method involving digestive surgery experts from various cities in Indonesia. Several issues related to the diagnosis and management of CBD stones were formulated and answered based on current research, while also considering the opinions of the experts.
Result: This consensus consists of two parts: 15 recommendations related to the selection of diagnostic modalities and 10 recommendations related to management options. Recommendations regarding diagnosis include the use of ultrasonography, abdominal CT-scan, and magnetic resonance cholangiopancreatography (MRCP). In addition to standard therapeutic procedures, this consensus also provides recommendations regarding contemporary procedures such as endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic common bile duct exploration (LCBDE), and open common bile duct exploration (OCBDE).
Conclusion: These recommendations are aimed to assist digestive surgery experts in providing the best management for CBD stone cases.

Prevalence and Survival Rate of Advanced Stage Cervical Cancer Patients with Obstructive Uropathy in a Tertiary Hospital

2024-06-27T13:19:29+07:00

Introduction: This study aims to determine the prevalence and survival rate of advanced cervical cancer patients with obstructive uropathy based on grade of hydronephrosis, type of hydronephrosis, deobstruction action, type of deobstruction, clinical stage, and cancer cell type.
Method: This research is a descriptive analytical study with a cross-sectional retrospective approach. Samples were obtained from medical records of patients with stage IIIB, IVA and IVB cervical cancer who were treated at RSUD Dr. Saiful Anwar Malang in 2016–2023. Sampling was carried out using the total sampling method.
Result: Of the 171 patients, the majority of patients had stage IIIB cervical cancer (71.9%), moderate (72.5%) and bilateral (90.1%) hydronephrosis were found in the majority of patients. SCC dominated the sample (82.5%) and was followed by ADC (14.6%). Most patients underwent deobstruction (64.3%) with DJ stent insertion being the most common type of deobstruction (84.5%). Patients with stage IVB have a lower survival rate than IIIB and IVA (p greater than 0.05). Patients with SCC had lower survival (3%) than ADC (5%). The average survival rate for the three grades of hydronephrosis was not significantly different (p greater than 0.05). Patients undergoing deobstruction showed a higher survival rate (5%) (p greater than 0.05). DJ stent, PCN, and UCS insertion showed similar survival rates in patients (p greater than 0.05).
Conclusion: Stage IIIB cervical cancer, moderate hydronephrosis, bilateral hydronephrosis, and SCC dominated the patients in the study. Patients with stage IVB cervical cancer, SCC, unilateral or severe hydronephrosis have a worse prognosis. The presence of deobstruction indicates a better prognosis and can be performed with PCN, DJ stent insertion, or UCS.

Knowledge On Anemia Among Young Adults in Jakarta and West Java: National Survey on Demographic and Health 2017

2024-06-27T13:19:13+07:00

Introduction: Iron deficiency anemia in developing countries is common. However, knowledge on the etiology of anemia among young adults needs to be further explored, including hemoglobinopathy, since Indonesia is located in the thalassemia belt, harboring 6-10% thalassemia carriers. The study aimed to explore the knowledge about anemia among young adults in Jakarta and the province of West Java.
Methods: A descriptive analytical study design using secondary data from the National Demographic and Health Survey 2017 was employed. A questionnaire was distributed to unmarried young adults (n=5389) aged 15-24, including questions about anemia. Knowledge was further compared between places, genders, and age groups.
Result: Only 70% of young adults have heard about anemia. However, the knowledge was poor. The definition of anemia was lack of blood (48%), and only 5% stated it was due to iron deficiency. The etiology of anemia was lack of vegetables (21%) and meat (18%) consumption. As a treatment, only 9% mentioned the iron tablets. None mentioned thalassemia carrier as an alternative cause of anemia.
Conclusion: Young adults in Jakarta and West Java are poorly informed about anemia. Socialization to increase knowledge about anemia is imperative. Thalassemia carriers need to be introduced among unmarried young adults for better family planning in the future.

The Impact of COVID-19 Severity on TNF-α and IFN-γ in T2DM Patients' PBMC Monocytes

2024-06-27T13:18:57+07:00

Introduction: Monocytes are very sensitive to changes in the metabolic environment, including hyperglycemia, such as type 2 diabetes mellitus (T2DM). T2DM is characterized by chronic low-grade inflammation and becomes one COVID-19 comorbid. TNF-α and IFN-γ are cytokines often linked to inflammation, the severity of COVID-19, and long COVID-19. This study aims to analyze the relationship between COVID-19 severity and TNF-α and IFN-γ in T2DM one month post-infection.
Methods: This research is an experimental study at the Integrated Laboratory Faculty of Medicine, Universitas Indonesia, for four months. The total samples are 44 cryotubes of PBMC (18 T2DM and 26 Non-T2DM) from the CARAMEL study (COVID-19, Aging, and Cardiometabolic Risk Factors). PBMCs were stimulated with inactivated whole virions SARS-CoV-2 and incubated for 24 hours. Monocyte subsets and intracellular cytokines are detected by flow cytometry.
Results: Research showed that IFN-γ in the T2DM group was higher in all subsets. There was no significant difference between the T2DM and non-T2DM groups. Based on the history of the severity of COVID-19, MedFI IFN-γ classic and intermediate monocytes differed significantly between the COVID-19 severity groups (p = 0.049 and p = 0.022). Further research is needed to analyze the risk factors involved.
Conclusion: MedFI of classic and intermediate monocyte IFN-γ differed significantly between the severity of COVID-19. There were no significant differences between the T2DM and non-T2DM groups. The history of the severity of COVID-19 is significantly related to long COVID-19.

Distinguishing Breavement from Depression in Stable Decline Paranoid Schizophrenia: a Case Report

2024-06-27T13:18:40+07:00

Introduction: Schizophrenic patients with a bereaved history of close family members can develop depressive affect which is often misinterpreted as depressive episodes or even schizoaffective.
Case: A 45-year-old woman was diagnosed as a paranoid schizophrenic (F20.02). During the last month, the patient also often felt tired and unenthusiastic. He thought it was only a matter of time before he could catch up with his parents who had died. The patient had no suicidal intentions and had never attempted suicide. There were two differential diagnoses in this patient, such as schizoaffective depressive type (F25.1) and major depressive episode with psychotic symptoms (F32.3).
Discussion: The topic of conversation in this patient’s affective disorder was always related to the mood of mourning: the death of both parents. The response to a significant loss, such as bereavement, might very well resemble a depressive episode.
Conclusion: Bereavement can be distinguished from depressive episodes by looking at some of the characteristic symptoms. The correct diagnosis aims to provide appropriate management so that it can help patients reach their best state.

The Irrational Use of Antibiotics in Critically Ill Pediatric Patients in the Pediatric Intensive Care Unit

2024-06-27T13:18:24+07:00

Besides their underlying diseases, patients in the Pediatric Intensive Care Unit (PICU), also have a high risk of developing secondary infections infections due to various procedures and the long length of stay. It has become a culture to give antibiotics to almost all patients who come to the PICU. The aim of this study is to assess the pattern and impact of the irrational use of antibiotics (both as empiric therapy, prophylaxis and definitive therapy), as well as to determine the role of biomarkers as a consideration for administering antibiotics to pediatric patients in the PICU. Irrational use of antibiotics in PICU still occurs all over the world, both as empiric therapy, prophylaxis and definitive therapy. This can have an impact on increasing the incidence of antibiotic resistance, extending the length of stay, increasing the economic burden on society, and worst of all, increasing the death rate due to infection. PCT and CRP, can help to differentiate the etiology, so they are useful guides for the initiation, de-escalation, or discontinuation of antibiotics. It is important to provide regular education to medical personnel regarding the protocol for administering antibiotics, including indications, types, doses and duration of administration. A written form can also be provided to assess the need for therapy using the Gyssens flowchart. In addition, cooperation from various parties is needed to carry out a comprehensive, sustainable management strategy to resolve this problem.