Current Internal Medicine Research and Practice Surabaya Journal

Diagnosis and Management of Autoimmune Hemolytic Anemia in Systemic Lupus Erythematosus

Mega Kahdina — 2024-08-27

Autoimmune hemolytic anemia (AIHA) may indicate the first manifestation of systemic lupus erythematosus (SLE). It is estimated that the incidence of AIHA is around 10% in patients with SLE. The first-line therapy for AIHA is corticosteroids. Nevertheless, a second-line therapy may be considered if an adequate response is not obtained. Transfusion indication in AIHA patients do not differ from other types of anemia. These indications include the degree of hemolysis, the progression of anemia, and clinical symptoms. However, blood transfusion for AIHA patients is challenging due to the limited availability of serologically compatible blood. In addition, AIHA patients who receive transfusions have an increased risk of experiencing hemolytic transfusion reactions. In this paper, we aimed to present a case report on the diagnosis of AIHA in an SLE patient treated with second-line therapy and red blood cell transfusions. The patient was a 49-year-old woman who presented with the main complaint of swelling in both legs. According to the medical history, the patient experienced petechia, abdominal distension, body weakness, and weight gain. No reports of joint pain, diarrhea, constipation, fever, shortness of breath, or yellowish skin were made. Before being referred to Dr. Soetomo General Academic Hospital in Surabaya, Indonesia, the patient experienced high blood pressure and body swelling that were unresponsive to treatment. Once the diagnosis of AIHA was confirmed, the patient was set to receive second-line therapy and red blood cell transfusions. At the conclusion of the therapy, the patient exhibited favorable outcomes.

Highlights:

This paper presents the management of autoimmune hemolytic anemia in systemic lupus erythematosus, which has been understudied in Indonesia.
This paper provides additional evidence regarding the indications and outcomes of red blood cell transfusion in a case of autoimmune hemolytic anemia.

Hepatocellular Carcinoma with Chronic Hepatitis B and Non-Islet Cell Tumor Hypoglycemia: A Case Report

Angela Kimberly Tjahjadi — 2024-08-27

Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome manifestation associated with hepatocellular carcinoma (HCC). This report details a case of a 20-year-old woman with HCC linked to untreated chronic hepatitis B. The patient presented with refractory hypoglycemia that was suspected to be NICTH. She also exhibited decreased consciousness with an initial blood glucose reading of 31 mg/dL. After the administration of intravenous dextrose solution, the patient's consciousness improved, yet intermittent hypoglycemic episodes persisted due to insufficient oral intake. The laboratory findings revealed low levels of insulin and C-peptide. The management of the patient included a continuous infusion of 5% dextrose solution, administration of corticosteroids, and adherence to a high-calorie complex carbohydrate diet. Despite presenting with significant right upper abdominal discomfort and weight loss, the patient was diagnosed with HCC at stage B, according to the Barcelona Clinic Liver Cancer (BCLC) Staging System. The stage was determined based on the presence of extensive multifocal lesions, which rendered surgical resection and transarterial chemoembolization (TACE) non-viable. Consequently, palliative treatment using lenvatinib and antiviral therapy with tenofovir were initiated. NICTH involves an increased insulin-like growth factor 2 (IGF-2) precursor processing by tumor cells, leading to heightened peripheral glucose utilization and persistent hypoglycemia. Although tumor resection is the most effective treatment for NICTH, it was not feasible in this case. This report emphasizes the importance of considering NICTH in the differential diagnosis of refractory hypoglycemia for non-diabetic patients. It also underscores the need for parenteral nutrition and corticosteroid therapy to maintain euglycemia.

Highlights:

This case report details a rare clinical presentation of non-islet cell tumor hypoglycemia (NICTH) associated with hepatocellular carcinoma (HCC) and chronic hepatitis B in a young patient, adding to the limited documented cases of this paraneoplastic syndrome.
The report provides a thorough clinical description, extensive diagnostic workup, and comprehensive management strategies, offering valuable insights into the complexities and challenges in diagnosing and treating NICTH in HCC patients.
This case emphasizes the critical need for early detection and intervention in HCC, particularly in non-cirrhotic patients with chronic hepatitis B, and highlights the importance of considering paraneoplastic syndromes in the differential diagnosis of refractory hypoglycemia in non-diabetic patients.

Comorbid Diseases and Outcomes of Critically Ill COVID-19 Patients Admitted to an Indonesian Intensive Care Unit from May to October 2021

Katrin Wilentina Siahaan — 2024-08-27

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). The spread of COVID-19 has become a worldwide health threat, with 583,038,110 cases and a death toll of 6,416,023. This study attempted to determine the relationship of age, sex, and comorbid diseases with the outcomes of critically ill COVID-19 patients at Prof. Dr. IGNG Ngoerah Central General Hospital, Denpasar, Indonesia.

Methods: This analytic study employed a retrospective approach, analyzing secondary data from medical records using a purposive sampling method. The research included univariate analysis, bivariate analysis using the chi-square test, and multivariate analysis using a general linear model performed with the assistance of IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, N.Y., USA). A statistical analysis result with a p-value of less than 0.05 was deemed significant.

Results: A total of 264 critically ill COVID-19 patients were hospitalized in the Intensive Care Unit of Prof. Dr. IGNG Ngoerah Central General Hospital from May to October 2021. Comorbid diseases were present in 215 patients. The comorbid diseases that had the greatest impact on increasing mortality were diabetes mellitus, hypertension, kidney disease, and cardiovascular disease (p=0.000–0.006, 95% CI).

Conclusion: Age and sex do not have any significant relationship with the outcomes of critically ill COVID-19 patients. Meanwhile, comorbid diseases, such as diabetes mellitus, hypertension, and renal and cardiovascular diseases, pose a significant impact on the mortality rate of critically ill COVID-19 patients.

Highlights:

This study investigated patients who were critically ill with COVID-19 to determine the relationship between age, sex, comorbidities, and patient outcomes.
The findings of this study may provide additional data on the impact of comorbidities on the severity of COVID-19, which can be valuable to prevent mortality due to the infection.

The Effect of Ajwa Date (Phoenix dactylifera) Extract on the Histopathology of Pancreatic Islets in Mice with Diabetes Mellitus

Nadhifa Arna — 2024-08-27

Introduction: It is necessary to develop alternative antidiabetic therapies that are safer and more affordable to overcome the high prevalence of diabetes mellitus in Indonesia. Ajwa dates (Phoenix dactylifera) have a high flavonoid content; hence, this study aimed to investigate their effect on streptozotocin-induced diabetes mellitus mice by examining the number of beta cells and the islets of Langerhans.

Methods: Twenty-five mice were divided into five groups: a negative control group (K1), a positive control group (K2), and three treatment groups (P1, P2, and P3). The K2, P1, P2, and P3 groups were induced by 100 mg/kg bw of streptozotocin. Additionally, the P1, P2, and P3 groups received oral treatment using ajwa date methanol extract at different doses of 3, 5, and 7 g/kg bw, respectively. The treatment was administered daily for four weeks. The initial analysis included the homogeneity test and the Shapiro-Wilk test. As the data were non-normally distributed, the analysis proceeded with the Kruskal-Wallis test (p<0.05).

Results: The comparative analysis revealed significant differences in the number of beta cells among the groups, with a notable decrease observed in the K2 group and an increase in each treatment group. The measurement of the islets of Langerhans exhibited significant differences among the groups, with p=0.001.

Conclusion: The administration of ajwa date methanol extract can affect the number of beta cells and the islets of Langerhans in mice with diabetes mellitus.

Highlights:

This original study examined the antioxidant compounds derived from naturally sourced ajwa date (Phoenix dactylifera) extract.
Ajwa date extract has the potential to protect against histological damage, specifically to beta cells and pancreatic islets, in mice induced by streptozotocin.

Smoking Behaviors, Dietary Patterns, and Dyspepsia among Indonesian Adults in 2022

Dwi Aprilawati — 2024-08-27

Background: The global prevalence of dyspeptic syndrome among adults was estimated to be 1.8–57% in 2014, with an average of 20.8%. In a pilot survey involving 30 respondents, we found 21 acute respiratory infections, 16 dyspeptic syndromes, and 6 hypertension cases. Smoking was observed in 70% of the total respondents. This was the basis for conducting additional research in 2022 to examine the relationship between dyspepsia, smoking behaviors, and dietary patterns among adults in Krajan Hamlet, Malang, Indonesia.

Methods: This quantitative study used an analytical observational design with a cross-sectional approach. The sample consisted of 70 adults aged 18–65, selected by random sampling. The collected data were analyzed using the Chi-squared test (p<0.05).

Results: The prevalence rate for dyspepsia was 44.3%. Among them, 67.1% were smokers (both frequent and non-frequent), and 32.9% were non-smokers (including former and passive). The active smokers had a smoking duration of >2 years and smoked >10 cigarettes daily. A total of 11.4% of subjects exhibited eating habits of consuming trigger foods that put them at a high risk for dyspepsia. Specifically, 42.0% of subjects had an eating interval of >6 hours, while 87.1% had a meal frequency that led to a high risk of developing dyspepsia. There was a significant relationship between a high-risk diet and dyspeptic syndrome (p=0.037).

Conclusion: High-risk diets exhibited a relationship with the prevalence of dyspeptic syndrome. Early detection is crucial in an effort to prevent and reduce the incidence and complications of dyspeptic syndrome.

Highlights:

This study investigated the relationship between dyspepsia, smoking behaviors, and dietary patterns, which are often overlooked, particularly among those living in rural areas.
The findings of this study are anticipated to raise awareness regarding the detrimental impacts of smoking and unhealthy diets on dyspepsia.

Knee Pain and Quality of Life among the Elderly

Akilla Nathania Melati — 2024-08-27

Background: The aging process can lead to knee pain in the elderly, which negatively impacts their quality of life by decreasing their physical functioning and potentially affecting their psychological well-being over time. This study aimed to determine the association between knee pain and the quality of life of the elderly.

Methods: This analytical study involved elderly patients aged 60 years and over who presented with complaints of knee pain at the Geriatric Outpatient Clinic of Universitas Airlangga Hospital, Surabaya, Indonesia, from September 2022 to March 2023. The participants were selected by consecutive sampling until a total of 50 samples were collected using the interview method. The independent variable was knee pain, while the dependent variable was quality of life. The instruments used were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to measure knee pain and the Barthel Index for Activities of Daily Living (ADL) to assess the quality of life. The data were analyzed using Spearman's rho, with p<0.01 indicating a significant correlation.

Results: The majority of the elderly were female (54%) and fell within the age group of 66–70 years. The most prevalent complaint was mild knee pain (52%). A total of 50% of the elderly had an independent quality of life. A strong correlation was found between the degree of knee pain and quality of life in the elderly (p=0.000). The correlation coefficient indicated an inverse relationship between the degree of knee pain and quality of life in the elderly.

Conclusion: The findings suggest that the higher the pain degree suffered by the elderly, the lower their quality of life.

Highlights:

This study evaluated the factors that influence the quality of life of elderly individuals with knee pain, an issue that has been relatively overlooked in Indonesia.
The results of this study will hopefully assist scholars and stakeholders, enabling them to optimize the quality of life for elderly individuals experiencing knee discomfort.

Serum Serotonin Levels and the Severity Scores and Types of Delirium among Geriatric Patients in Denpasar, Indonesia

I Made Dedy Kusnawan — 2024-08-27

Background: Delirium is an acute attention disorder that often occurs in elderly patients. The serotoninergic pathway is the main neurotransmitter pathway involved in the development of delirium. Serotonin, known as 5-hydroxythyramine (5-HT), affects mood, aggressiveness, cognition, depression, pressure, and stress in the brain environment. This may lead to the formation of hypoactive, hyperactive, or mixed delirium processes. This study utilized laboratory data with the aim of investigating whether serotonin levels have a correlation with severity score and delirium type in elderly individuals who experience delirium during hospitalization.

Methods: This study was conducted in the field of geriatrics at Prof. Dr. IGNG Ngoerah Central General Hospital, Denpasar, Indonesia, from April 2022 to October 2023. The sample was gathered consecutively, consisting of 62 hospitalized geriatric patients who suffered from delirium and were willing to participate by signing an informed consent. We excluded post-surgical patients and psychoactive drug users. The data were collected using the Memorial Delirium Assessment Scale (MDAS), the Confusion Assessment Method (CAM), and a serum serotonin test. This study used bivariate analysis, the Kruskal-Wallis test, and Spearman’s correlation (p<0.05).

Results: A total sample of 62 individuals was required. There was a significant difference in the mean serotonin levels among different types of delirium (p<0.05). Out of all the documented cases, hypoactive delirium was the most frequently observed (64.5%). Most of the elderly patients experienced severe delirium (54.8%). Serotonin levels had a significantly negative correlation with the MDAS scores (r=-0.95; p<0.001).

Conclusion: The research findings indicate a correlation between lower serotonin levels and higher MDAS scores, and vice versa.

Highlights:

This study attempted to determine the relationship between serum serotonin levels and delirium severity scores among geriatric patients in Indonesia.
There was a significant difference in the mean serotonin levels among elderly individuals with hypoactive, hyperactive, and mixed types of delirium.

COVID-19 Vaccination in Autoimmune Patients: A Literature Review

Atiqah Nurul Wardhany — 2024-08-27

Patients with autoimmune diseases, especially rheumatic diseases, have their own concerns regarding the coronavirus disease 2019 (COVID-19) vaccination. Their concerns are specifically related to the physicological response, side effects, and effectiveness of the COVID-19 vaccination. COVID-19 and autoimmune diseases share some similarities in their clinical manifestations, immune responses, and pathogenic mechanisms. The correlation between COVID-19 vaccination and autoimmune diseases can be attributed to epitope mimicry, where the antigen contained in the vaccine has a structural similarity to self-antigen. The purpose of this literature review was to discuss the various types of vaccines, the side effects of the COVID-19 vaccination, and the effect of autoimmune patients' medication on the administration of the COVID-19 vaccination. According to several articles obtained in this study, most autoimmune patients typically experienced mild to moderate side effects. It was not advised for these patients to stop treatment before receiving the COVID-19 vaccination, as doing so was unlikely to affect the vaccine's effectiveness or the patients' immune response. The condition of the autoimmune patients was what influenced the immune response mediated by antibodies. Therefore, the COVID-19 vaccination must be administered when the patients are in a stable condition. In conclusion, it was determined that there is no restriction preventing autoimmune patients from receiving the COVID-19 vaccination. However, it should be noted that autoimmune patients are not recommended to receive live vaccines.

Highlights:

This study reviewed the concerns of autoimmune patients over the side effects of the COVID-19 vaccination on their prescribed medication.
It is advisable for autoimmune patients to refrain from obtaining live-attenuated vaccines because of their potential effect on the immune response.

Shift Work and Associated Health Consequences: A Review

Ahmed Burooj — 2024-08-27

This literature review aims to examine the complex relationship between engaging in shift work and its subsequent health sequelae, while also shedding light on fields of research that require further investigation. Indexing services (i.e., Scopus and PubMed) were used to identify pertinent studies, prioritizing original research, review articles, and meta-analyses from 2018 to 2023. Papers not published in English or where full-text translation was not available, research conducted solely on non-human populations, as well as proposal and opinion papers, were excluded. Papers published before 2018 and those with a sample size of 50 participants or fewer were also omitted. The author conducted a thorough evaluation of each study to ensure its relevance and significance. After deduplication of the search results and implementation of the exclusion criteria, 51 papers were shortlisted for this review. The keywords used for the literature search were “shift work”, “health”, “night shift”, “cardiovascular”, “circadian, cancer”, “disease”, “dose-response relationship”, and “long working hours”. The results showed that shift work significantly impacts various aspects of health, presenting risks in the areas of cardiovascular health, cancer susceptibility, circadian rhythm, immunity, metabolism, reproductive health, and mental well-being. Shift workers have increased risks for diabetes, hypertension, adverse cardiac events, circadian dysrhythmia, metabolic syndrome, mental health disorders, and even certain types of cancer. Shift work exhibits significant associations with sexual and reproductive dysfunction in both sexes, including elevated risks for miscarriages and preterm birth. In conclusion, the findings underscore the need for comprehensive health interventions and further research to understand the intricate relationships between shift work and long-term health consequences.

Highlights:

Disruption of circadian rhythm due to shift work contributes to various health issues, including altered melatonin levels, immune dysfunction, and metabolic disturbances.
There is a critical need for longitudinal studies to explore interventions and workplace policies that can mitigate the adverse health effects of shift work.
Addressing the multifaceted impact of shift work on health requires a holistic approach that considers factors like circadian rhythm optimization, workplace support, and tailored interventions.