Current Internal Medicine Research and Practice Surabaya Journal

Weight Gain in Type 2 Diabetes Mellitus Patients Receiving Sulfonylurea Medications at a Tertiary Hospital in Surabaya, Indonesia

2024-06-07T09:50:19+07:00

Introduction: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. The prevalence of diabetes in Indonesia is 1.5%, although East Java recorded a 2.1% rate in 2013. T2DM medications, such as sulfonylureas, may lead to hypoglycemia and weight gain. This study aimed to investigate the weight gain effects of sulfonylureas in T2DM patients at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Methods: This retrospective cross-sectional study used retrograde anamnesis on 41 T2DM patients receiving sulfonylurea medications for the preceding six months. The data were collected from medical records and interviews with the T2DM patients who received treatment at the Internal Medicine Clinic of Dr. Soetomo General Academic Hospital from January to June 2022.

Results: Most patients were 46–65 years old (73.2%), female (51.2%), and had been diabetic for over 15 years (48.8%). The predominant medications administered to the patients were glimepiride (41.4%) and a combination of glibenclamide 5 mg, metformin 500 mg, and acarbose 100 mg (19.5%). Almost all patients took their medications in the morning before meals (92.6%). The average weight gain was 4.6 kg, with the glibenclamide and metformin combination resulting in a 17% incidence.

Conclusion: T2DM patients who use sulfonylureas generally gain weight and exhibit specific traits, including being middle-aged, female, and diabetic for multiple years. The most commonly used sulfonylureas are glimepiride for monotherapy and glibenclamide for combination therapy with metformin and acarbose. Future research is required to understand weight gain in T2DM patients treated with sulfonylureas more comprehensively.

Highlights:

This study investigated weight changes in type 2 diabetes mellitus (T2DM) patients receiving sulfonylureas, with a special focus on the emergence of weight gain as a new problem in T2DM management.
The importance of this study pertains to its findings regarding weight gain in T2DM patients treated with sulfonylureas, offering additional data that aids in preventing adverse effects of the medications.

Bacterial and Fungal Coinfections in COVID-19 Inpatients at a Tertiary Hospital in Surabaya, Indonesia, from November 2020 to February 2022

2025-02-25T16:07:35+07:00

Introduction: After the first discovery of coronavirus disease 2019 (COVID-19) in 2020, the rapid increase of cases beyond China prompted the declaration of a pandemic. Elevated rates of bacterial-fungal coinfection were observed in hospitalized COVID-19 patients. This study aimed to determine the profiles of bacterial and fungal coinfections in COVID-19 patients diagnosed between November 2020 and February 2022 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Methods: This retrospective descriptive study obtained data from medical records and used total sampling to assemble 278 COVID-19 patients who met the inclusion criteria. The evaluated variables were subject characteristics, including age, sex, comorbidities, length of stay, ventilator use, bacterial coinfections, fungal coinfections, and bacterial-fungal coinfections.

Results: The age group of 55–64 years (26.9%) was predominant among the patients, with males (55.4%) outnumbering females. Hypertension was the most prevalent comorbidity (15.8%). The patients were mostly hospitalized for over ten days (66.2%). Eleven patients (4%) were admitted to the intensive care unit, and five patients (1.8%) required mechanical ventilation. The bacterial coinfections were primarily caused by Streptococcus viridans (56.6%), found in 145 sputum specimens, followed by Klebsiella pneumoniae (23.4%). The predominant isolates in the bacterial-fungal coinfections were Streptococcus viridans and Candida albicans (24.8%), identified in 125 sputum specimens, followed by Klebsiella pneumoniae and Candida albicans (18.4%).

Conclusion: COVID-19 patients with bacterial-fungal coinfections present certain characteristics, including being male, middle-aged, hypertensive, and hospitalized beyond ten days. Streptococcus viridans, Klebsiella pneumoniae, and Candida albicans are common etiologies in bacterial-fungal coinfections.

Highlights:

This study overviews the distribution of patients and causative pathogens associated with bacterial, fungal, and bacterial-fungal coinfections, which have escalated with the rapid rise of coronavirus disease 2019 (COVID-19) hospitalization.
Data on the causative pathogens of bacterial-fungal coinfection in COVID-19 patients can be considered in the development of guidelines for empirical therapy in clinical practice.

Coronavirus Disease 2019 (COVID-19) Leads to Risen Hypertension Prevalence among Type 2 Diabetes Mellitus Patients

2024-11-22T14:26:16+07:00

Introduction: Diabetes is the second most prevalent comorbidity of coronavirus disease 2019 (COVID-19) cases in Indonesia. Type 2 diabetes mellitus (T2DM) patients experience increased blood vessel remodeling, resulting in elevated peripheral arterial resistance. In addition to exacerbating the severity of T2DM, COVID-19 also increases hypertension risk. This study aimed to elucidate the effect of COVID-19 on hypertension prevalence among T2DM patients.

Methods: This research employed an analytical observational design, specifically the case-control study design. A total of 200 datasets were extracted from medical records covering the period from May 2020 to April 2022 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. The inclusion criteria for the study samples were T2DM patients diagnosed by a doctor, as documented in their medical records, with no previous history of hypertension. The data were analyzed using the Chi-square test at a significance level of p<0.05 to determine the effect of COVID-19 on hypertension prevalence in T2DM patients.

Results: There were 100 T2DM patients without COVID-19 (30 with hypertension and 70 without hypertension) and 100 T2DM patients with COVID-19 (45 with hypertension and 55 without hypertension). The Chi-square test indicated an effect associated with COVID-19 on hypertension prevalence in T2DM patients, with p=0.028 and an odds ratio (OR) of 1.909.

Conclusion: The study suggests that COVID-19 infection increases the risk of hypertension in T2DM patients. Raising awareness of the complications of hypertension is important, particularly for high-risk individuals, such as T2DM patients who have a history of COVID-19.

Highlights:

There has been no research examining the relationship between coronavirus disease 2019 (COVID-19) and the prevalence of hypertension complications, especially in type 2 diabetes mellitus (T2DM) patients.
This study highlights the importance of raising awareness regarding the finding that the incidence of COVID-19 increases the prevalence of hypertension in T2DM patients.

Dyslipidemia is Associated with Coronary Heart Disease in Patients with Type 2 Diabetes Mellitus at a Tertiary Hospital in Surabaya, Indonesia

2025-02-25T16:05:53+07:00

Introduction: Diabetes mellitus ranks as the third leading cause of mortality in Indonesia. The commonly found comorbidity of diabetes mellitus is cardiovascular disease, which contributes to elevated mortality rates. Diabetes mellitus sufferers face a heightened risk of cardiovascular disease, in part, due to dyslipidemia. This study aimed to establish the association between dyslipidemia and coronary heart disease (CHD) in type 2 diabetes mellitus (T2DM) patients receiving treatment at the diabetes subdivision of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Methods: This retrospective cross-sectional investigation examined 100 eligible individuals with T2DM and dyslipidemia at the diabetes subdivision of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, to assess the prevalence of CHD. Statistical analysis was performed using Pearson's chi-squared test to determine whether there was an association between dyslipidemia and CHD in the T2DM sufferers. If the p-value was below 0.05, the findings of the analysis were considered significant. The statistical test was conducted through IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, N.Y., USA).

Results: Dyslipidemia was present in 74% of the T2DM patients. Patients who had dyslipidemia and T2DM were primarily female and aged between 51 and 60 years. Meanwhile, CHD affected 40 T2DM patients (40%). These patients were predominantly male and between the ages of 51 and 60. T2DM patients who also suffered from CHD typically presented with dyslipidemia (85%).

Conclusion: This study demonstrates that the presence of dyslipidemia in T2DM sufferers is associated with CHD.

Highlights:

This study examined type 2 diabetes mellitus patients receiving treatment in a tertiary hospital to determine the association between dyslipidemia and coronary heart disease, an important concern given the rising prevalence of the disease in Indonesia.
The analysis revealed that type 2 diabetes mellitus patients who also have dyslipidemia face an elevated risk of developing coronary heart disease.
This study offers additional information, particularly related to the presence of dyslipidemia and coronary heart disease, which may enhance the management of type 2 diabetes mellitus throughout primary, secondary, and tertiary health facilities.

Comparative Analysis of Erythrocyte, Leukocyte, and Platelet Indices through Examinations using Sysmex XN-3000 and Yumizen H2500 in Clinical Practice

2025-02-25T16:05:20+07:00

Introduction: Examining erythrocyte, leukocyte, and platelet indices is critical for diagnosis, disease management, therapy selection, and monitoring. It is imperative to evaluate the hematology analyzer used for a complete blood examination, as each device possesses distinct specifications, methods, and technologies. This study aimed to compare complete blood count parameters, specifically the erythrocyte, leukocyte, and platelet indices, using Sysmex XN-3000 and Yumizen H2500.

Methods: This cross-sectional study used blood samples from adult outpatients aged >18 years at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Samples were collected using purposive sampling, resulting in 100 blood specimens for complete blood count analysis. The examined variables included erythrocyte, leukocyte, and platelet indices, which were compared across two different instruments, i.e., Sysmex XN-3000 and Yumizen H2500. The data were analyzed using either the Spearman or Pearson correlation test (p<0.05). The Bland-Altman plotting was employed to assess the differences between variables, with a minimum of five agreed-upon outliers.

Results: Significant correlations were observed across all parameters, except for the mean corpuscular hemoglobin concentration (MCHC), which showed limited agreement in the Bland-Altman analysis. The Pearson and Spearman analyses revealed a significant correlation in the parameters of erythrocytes (0.00), leukocytes (0.00), and platelets (0.00). The Bland-Altman plot indicated seven outliers in the average MCHC values from the two analyzers, demonstrating insufficient agreement.

Conclusion: There is significant agreement and correlation in the erythrocyte, leukocyte, and platelet indices from both analyzers. This finding affirms the compatibility of both instruments for clinical use, with caution advised when interpreting MCHC values.

Highlights:

This study evaluated the validity of different hematology analyzers for complete blood count examinations in medical laboratories, a topic that has rarely been discussed in detail.
The results of this study are expected to contribute to the quality improvement of medical laboratory technologies in Indonesia.

Causes and Profiles Pertaining to the Emergency Room Admission of Stage V Chronic Kidney Disease Patients Undergoing Regular Hemodialysis at a Tertiary Hospital in Surabaya, Indonesia

2025-02-25T16:03:40+07:00

Introduction: Chronic kidney disease (CKD) is characterized by decreased kidney function, with a glomerular filtration rate below 60 mL/min/1.73 m² persisting for at least three months. Hemodialysis is a common therapy for stage V CKD, yet complications may arise requiring emergency treatment. This study aimed to elucidate the causes and profiles of stage V CKD patients on regular hemodialysis who were admitted to the Emergency Department of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Methods: A retrospective cross-sectional design and purposive sampling were used in this descriptive observational study. A univariate analysis was conducted on data collected from 72 stage V CKD patients who underwent regular hemodialysis and were admitted to the emergency room between January and March 2023. The inclusion criteria comprised stage V CKD patients undergoing regular hemodialysis in the emergency room. Patients with incomplete medical records were excluded. The collected data encompassed patients' age, sex, hemodialysis duration, interdialytic weight gain (IDWG), comorbidities, and complications.

Results: Among the 72 patients, the predominant demographic was male (51.4%), primarily aged 56–65 years (30.6%), with a hemodialysis duration of ≤12 months (65.3%), an IDWG of 1–2 kg (16.7%), and hypertension (54.2%). The complications leading to patient admission in the emergency room mostly included anemia (77.8%), metabolic acidosis (54.2%), urinary tract infection (23.6%), hyperkalemia (19.4%), pulmonary edema (18.1%), and pneumonia (18.1%).

Conclusion: Stage V CKD patients on regular hemodialysis are primarily admitted to the emergency room due to complications, including anemia, metabolic acidosis, urinary tract infections, hyperkalemia, pulmonary edema, and pneumonia.

Highlights:

Since almost all patients with stage V chronic kidney disease (CKD) undergo routine hemodialysis, it is important to assess its associated complications to help improve patient outcomes.
This study reports the prevalence of comorbid diseases and the diagnostic outcomes of patients experiencing complications in the Emergency Department of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
The findings of this study provide valuable insights to patients, researchers, and future medical personnel regarding the characteristics of stage V CKD patients who regularly undergo hemodialysis and present to the emergency room.

Changes in the Lipid Profiles of Pre- and Post-Cholecystectomy Patients: A Systematic Review and Meta-Analysis

2024-11-05T10:53:04+07:00

Background: Patients with gallstones often exhibit irregular lipid profiles, such as hyperlipidemia, which may cause various morbidities. Gallstone treatment by cholecystectomy can alter bile acids, subsequently impacting the lipid profile. This study aimed to analyze the effects of cholecystectomy on lipid profiles.

Methods: This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, ProQuest, and Google Scholar were utilized to discover prospective or retrospective cohort studies, cross-sectional studies, and non-randomized trials. The inclusion criteria were studies comparing lipid profiles pre- and post-cholecystectomy in the same patients, conducted on humans, and published in English with full text available. Abstracts from conferences, case studies/series, review articles, letters, editorials, and research published in languages other than English were excluded. A meta-analysis was conducted on patient outcomes using random- or fixed-effect models to generate pooled odds ratios (OR) with 95% confidence intervals (CI). A significant change in lipid profiles was indicated by p<0.05.

Results: There were 17 selected studies involving 1,691 participants. Within less than a week, cholecystectomy significantly decreased total cholesterol and low-density lipoprotein (LDL). During one-month follow-ups, cholecystectomy significantly increased high-density lipoprotein (HDL) while reducing other lipid profile markers, including total cholesterol, LDL, and triglycerides. During follow-ups beyond one month, there were no significant changes in lipid profiles.

Conclusion: Cholecystectomy decreases total cholesterol and LDL within days and improves all lipid profile markers a month post-surgery. Beyond one month, it does not exhibit significant changes in lipid profiles.

Highlights:

This is the first systematic review and meta-analysis that provides valuable insights into the effects of cholecystectomy on lipid profile.
This study offers a foundation for more effective postoperative management strategies to mitigate cardiovascular disease risks.
This study may also be the foundation of theories regarding the advantage of cholecystectomy for improving lipid profile.

Systematic Review and Meta-Analysis of the Efficacy and Safety Profile of Belimumab in Combination with Standard Therapy for Adults with Systemic Lupus Erythematosus

2025-02-25T16:04:10+07:00

Introduction: Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder marked by pathogenic autoantibodies, resulting in considerable morbidity and mortality. Despite existing diverse treatment regimens, the need for more effective therapies persists. Recent advancements include monoclonal antibodies, such as belimumab, which can inhibit receptors tied to SLE’s pathogenesis. This meta-analysis aimed to evaluate the efficacy and safety of combining belimumab and standard therapy compared to placebo in SLE patients, utilizing as many indicators as possible to comprehensively assess the former's potential.

Methods: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Handbook for Systematic Reviews of Interventions. A thorough literature search was performed across various databases, including PubMed, ScienceDirect, ProQuest, and grey literature sources such as MedRxiv and BioRxiv. The data underwent statistical analysis, with I²<50% indicating low heterogeneity and p<0.05 denoting statistical significance.

Results: The literature search yielded seven records for analysis in this study. All the selected studies were multicenter, phase III/IV, randomized clinical trials published between 2011 and 2019. The selected studies' risk of bias was assessed using Cochrane’s Risk of Bias (RoB) 2 tool. The results indicated that belimumab and standard therapy significantly improved disease activity, reduced flare occurrences—particularly severe flares, lowered corticosteroid dosage, and enhanced key biomarkers compared to placebo. The safety profile was favorable, with significantly minimal side effects, infections, and mortality risks.

Conclusion: Belimumab combined with standard therapy demonstrates promising efficacy and safety for SLE treatment, suggesting its potential for broader adoption in clinical practice.

Highlights:

This systematic review and meta-analysis provide a thorough and complete analysis of multiple indicators regarding the efficacy and safety of belimumab in the treatment of systemic lupus erythematosus (SLE), which have never been reviewed before.
The findings of this study may lead to broader acceptance and adoption of belimumab as the standard treatment for SLE.

Tolvaptan Improves Refractory Ascites and Overall Survival in Cirrhosis: A Meta-Analysis

2024-12-13T16:31:20+07:00

Introduction: Refractory ascites is a frequent complication associated with liver cirrhosis. Tolvaptan, a V₂-receptor antagonist, has shown effectiveness in improving refractory ascites. This meta-analysis sought to assess the effectiveness of tolvaptan in patients suffering from cirrhosis and refractory ascites.

Methods: Databases including Google Scholar, Cochrane, ClinicalTrials.gov, PubMed, and PubMed Central were systematically queried to search for papers from January 1, 2020, to August 10, 2023. Eligible publications for this study included all research evaluating body weight reduction and overall survival rates in patients with refractory ascites according to their response to tolvaptan. The meta-analysis included five studies, encompassing 530 patients with cirrhosis and refractory ascites who were treated with tolvaptan. Research characteristics were documented for all included studies, and outcomes were recorded for tolvaptan responders compared to non-responders.

Results: The statistical analysis revealed a significant weight reduction in tolvaptan responders in comparison to non-responders, with a risk ratio (RR) of 1.92 and a confidence interval (CI) of 1.12 to 3.31. The results of the heterogeneity analysis performed on the two outcomes, weight reduction and overall survival in tolvaptan responders, were I²=84%, τ²=0.1328, p<0.01, and I²=86%, τ²=0.6006, respectively.

Conclusion: The clinical application of tolvaptan improves symptoms in cirrhotic patients with refractory ascites, resulting in increased survival rates. Nonetheless, additional randomized controlled trials of a larger scale are necessary to validate the findings of this study, accurately predict the benefits of tolvaptan, and identify the patients who would derive the most benefit from its use.

Highlights:

Our meta-analysis covers the most recent studies and confirms that tolvaptan improves survival rates in cirrhotic patients with refractory ascites, hence reducing morbidity and mortality.
Notable weight reduction is seen in patients with refractory ascites who respond to tolvaptan.

Challenges in Managing Portal Hypertension and Fibrosis in a Case of Biliary Atresia Post-Kasai Procedure—Implications for Early Detection and Long-Term Care

2024-10-21T09:41:04+07:00

Biliary atresia frequently causes portal hypertension, resulting in significant morbidity and mortality. Elevated portal pressure can be detected as early as during a Kasai procedure. Pediatric portal hypertension is the primary cause of various complications, including variceal hemorrhage, ascites, and extra-hepatic processes. This paper aims to draw attention to the complications and limitations of the Kasai procedure by presenting a case of portal hypertension and fibrosis in an 8-month-old male infant with biliary atresia who underwent the procedure at 3 months. The patient was never completely free of jaundice post-surgery. The jaundice worsened, and the pale-colored stool reappeared two months later. The abdomen was distended, accompanied by ascites, hepatomegaly, splenomegaly, and dilated veins. Edema was present on the lower extremities and the scrotum. The patient was diagnosed with biliary atresia and portal hypertension. Supportive therapy was recommended as a preparatory measure before a liver transplant. However, the parents declined the procedure due to financial constraints. This case suggests that the Kasai procedure may not always be effective. Despite the timely execution of the procedure, liver fibrosis may persist and be associated with portal hypertension. Most patients develop significant fibrosis that progresses to cirrhosis, requiring a liver transplant. To date, biliary atresia remains the primary indication for liver transplant in children, with no alternative medical treatment recognized. This case report highlights the progression of portal hypertension and liver fibrosis following the Kasai procedure for biliary atresia, emphasizing the challenges in early detection, complications management, and the exploration of alternative therapeutic strategies.

Highlights:

This study critically reviews the limitations and complications of the Kasai procedure in treating biliary atresia, with particular focus on portal hypertension issues, for which case reports are limited.
This study highlights the important need for accessible and effective long-term treatment alternatives by presenting a pediatric case where financial constraints prevented a liver transplant.
The data from this study are anticipated to contribute to the advancement of healthcare equity and pediatric liver disease management.