Journal Of The Indonesian Medical Association

Prognosis of the 6-Minute Walk Test for Cardiovascular Events or Cardiovascular Patient Mortality

Devina Angela — 2023-09-30

Introduction

In performing activities, individuals require submaximal aerobic metabolism which is an integrated effort of the respiratory, cardiovascular and skeletal muscle systems that will determine functional capacity.^1,2 Disorders of the heart and vascular system that supply oxygen can lead to impaired functional capacity. Low functional capacity is associated with an increased risk of mortality, especially cardiovascular disease.³ In Indonesia, cardiovascular disease is the second leading cause of morbidity and mortality, responsible for one third of all deaths in Indonesia.⁴ Functional capacity assessment can provide diagnostic information, pretreatment and posttreatment comparisons, and predictors of morbidity and mortality in patients with cardiovascular disease and various clinical conditions.^2,5

Point-of-Care Diagnosis of Chronic Pulmonary Aspergillosis in Respiratory Disease Patients: Hope in a Resource-Limited Setting

Anna Rozaliyani — 2023-09-30

Introduction: Chronic pulmonary aspergillosis (CPA) is a global health burden, however the diagnosis is still challenging due to non-specific clinical and radiological features. To overcome this problem, the lateral flow assay to detect Aspergillus-specific antibodies has the potential for rapid CPA diagnosis (point-of-care test/POCT). The aim of this study is to describe the profile of POCT Aspergillus-specific antibody detection in various populations as part of CPA diagnosis in Indonesia.
Methods: This study is a part of previous CPA studies conducted in Jakarta between 2018-2021. The tests were carried out at the Laboratory of Parasitology Department, Faculty of Medicine Universitas Indonesia. All sera were tested using Aspergillus-specific immunochromatography lateral flow assay (LDBio, Diagnostics, Lyon, France) according to the manufacturer's instructions.
Results: There were 314 patients' sera derived from four groups: post-TB (n=82), active TB (n=105), uncontrolled-asthma (n=50), and lung cancer (n=77). The positive results of LDBio Aspergillus ICT were 43% in post TB, 11% in active TB, 16% in uncontrolled asthma, and 14% in lung cancer patients. Further analysis revealed that the prevalence of CPA was 6-22% in those populations.
Conclusion: The LDBio Aspergillus ICT has the potential as a POCT for early diagnosis of CPA. The risk of CPA was found highest in the post-TB group compared to others.

Benefit of Adiponectin And Leptin For Monitoring Exercise Effect On Adipose Function In Metabolic Syndrome

Nani Cahyani Sudarsono — 2023-09-30

Introduction: The Prevalence of metabolic syndrome (MetS) in Indonesia is increasing, with the highest age in the 45 – 54 years old, and high mortality and morbidity rates complications and cost. Biomarkers such as adiponectin, leptin, and their ratios may be useful in monitoring and quantifying patient's body fat tissue function improvement after exercise training. This study aims to determine adiponectin, leptin, and their ratios benefits in monitoring physical exercise effects on adipose tissue function in pre-elderly (45-59 years old) and elderly (> 60 years old) patients with MetS.
Methods: Literature review through hand searching and pubmed database related to the benefits of leptin and adiponectin test in monitoring physical exercise effect on adipose function in the pre-elderly and/or elderly population with MetS.
Results: Physical exercise significantly increased adiponectin levels (mean difference (MD): 0.42 µg/mL; 95% CI 0.23, 0.60, p < 0.0001), and reduced leptin levels (MD: -1.89 ng /ml; 95% CI, -2.64, -1.14, p<0.0001). High-intensity aerobic exercise can even reduce serum leptin levels by 6.29 ng/ml (p < 0.001), and increase serum adiponectin levels by 0.74 μg/ml (p = 0.04). This significant change mainly occurs in men with a Body Mass Index (BMI) of 30 kg/m² and 25.0-29. 9 kg/m².
Conclusion: Adiponectin/leptin ratio examination has potential future benefits in MetS management as an evaluation physiological biomarkers related to exercise interventions. There are only a few capable laboratories, and expensive cost, so that its current implementation is mostly devoted to research. Adopting a healthy lifestyle, balanced nutrition, physical activity habits and regular physical exercise are still the best suggestions for preventing MetS.

No Association between Frequency of Blood Transfusions and Incompatibility of Blood Transfusions in Thalassemia Patients

Teuku Ilhami Surya Akbar — 2023-09-30

Introduction: Thalassemia is an inherited disease caused by genetic changes that decrease the rate of synthesis of one or more globin chains of hemoglobin (Hb) tetramer. Patients with thalassemia who have changes in Hb may require frequent blood transfusions as a result of these changes in Hb. As a result of an antigen reaction known as incompatibility, frequent blood transfusions might result in the production of antibodies. Incompatibilities with blood transfusions may result in immediate side effects or delayed reactions. The purpose of this study is to ascertain the association between the frequency of blood transfusions and the incompatibility of blood transfusions with regard to thalassemia patients at Cut Meutia General Hospital in North Aceh.
Method: This research is a descriptive analytic with a cross-sectional approach, a retrospective study. The sample in this study was the medical records of thalassemia patients in the Pediatric Inpatient Room at North Aceh Cut Meutia General Hospital (RSUCM) for the 2021 period. The sampling technique was carried out by total sampling.
Results: Obtained 66 samples, in the age category the majority of thalsemia patients aged 6-11 years with a percentage of 45.5% (30), and male sex with a percentage of 53% (35). The frequency of blood transfusions was obtained by the majority doing ≤12 times per year with a percentage of 86.4% (57) and the results of patient incompatibility were obtained by 27.3% (18) in all respondents who underwent blood transfusions.
Conclusion: The results of this study concluded that there was no relationship between the frequency of blood transfusions (p=0.213) and the incompatibility of blood transfusions in thalassemia patients at RSUCM Hospital. Limitation of this study was small sample size.

Drug Interaction Considerations in Choosing Psychopharmaceutical Drugs in HIV Patients with Mood Disorders: Evidence Based Case Report

Frilya Rachma Putri — 2023-09-30

Introduction: Mood disorders are one of the most common mental disorders in HIV patients. When used for HIV patients with mood disorders, psychiatric drugs might interact with ARVs. The selection of psychiatric drugs for HIV patients needs to be adjusted to avoid side effects due to adverse drug interactions. Objective: To discuss the interactions between psychiatric drugs and HIV ARVs as a consideration for treatment options.
Methods: A literature search was conducted through PubMed and Scopus using keywords with the Boolean operator concept. Selected literature reviews a collection of drug interactions between psychiatric drugs for mood disorders and antiretrovirals used for HIV patients.
Results: Out of 88 literatures works obtained, 3 of which reviewed the interactions of various psychiatric drugs with antiretrovirals in HIV patients. Psychopharmaceutical and antiretroviral interactions are related to their metabolism by the Cytochrome P450 (CYP450) enzyme. Psychopharmaceutical and antiretrovirals that are metabolized by the same isoenzyme will cause changes in blood plasma levels which then leads to risks of causing side effects.
Conclusion: Although there is no ideal drug option for treating mood disorders in HIV patients, SSRIs are still the first choice because of their fewer interactions with antiretrovirals. The antiretrovirals that interacts the most with psychopharmaceutical are those belonging to PI group. It is recommended to avoid drug combinations that cause a lot of interactions and reduce the treatment benefits.

Thoracic Endometriosis in Right Diaphragm with Manifestation of Right Chest Pain and Right Pneumothorax

Tommy Dharmawan — 2023-09-30

Introduction: Thoracic endometriosis is a rare disease but could lead to morbidity and mortality. Early detection with prompt anamnesis and supporting examination may direct the best therapy and also increase the prognosis of patient.
Case report: On this case report, we presented a female patient with right chest pain and shortness of breath on menstruation time.
Discussion: From chest X-ray we found right pneumothorax and it led to chest tube placement on the right chest. The anamnesis supported the diagnosis of thoracic endometriosis and furthermore from CT scan we found lesion on the right diaphragm. So, we proceeded with minimal invasive surgery (video assisted thoracoscopic surgery (VATS)). Pathology anatomy examination revealed a true endometriosis lesion.
Conclusion: The operation went uneventful and then post operative we gave gonadotropin releasing hormone analog.

Potential Drug Interactions in Critically Ill Patients

Mario Abet Nego — 2023-09-30

Abstract

Patients in critical condition are potentially prone to experiencing drug interactions due to receiving polypharmacy accompanied by complex and dynamic clinical conditions. Drug interactions can decrease drug effectiveness, increase therapeutic responses, or even lead to toxic effects. Factors that can enhance the effects of drug interactions include advanced age, obesity, hypoalbuminemia, polymorphism, sepsis, kidney and liver insufficiency. Therefore, monitoring the potential for drug interactions becomes crucial as it can distinguish whether changes in a patient's condition are caused by drug interactions or the disease process itself. This literature review aims to discuss the potential for drug interactions and the monitoring of interaction effects in critically ill patients.