Current Internal Medicine Research and Practice Surabaya Journal

Efficacy of Ozoralizumab vs. Golimumab for Rheumatoid Arthritis: A Systematic Review

Nathania Elma Fithriyah — 2025-07-31

Introduction: Rheumatoid arthritis, a systemic autoimmune disease, affects 13% of the world population. As a well-established therapy, golimumab provides a key benchmark for assessing novel biological treatments. In contrast, ozoralizumab represents an innovative therapeutic approach. This study aimed to comprehensively elucidate the efficacy of golimumab and ozoralizumab in reducing rheumatoid arthritis disease activity.

Methods: Literature searches were conducted throughout PubMed, Cochrane, and Web of Science using Boolean operators, covering available records from database inception until October 2024. The literature search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The included studies were randomized controlled trials (RCT) evaluating the efficacy of ozoralizumab or golimumab for rheumatoid arthritis. Five studies from 2015 to 2022 were obtained and assessed using the Cochrane Risk of Bias 2 (ROB2) tool.

Results: The five studies consisted of two ozoralizumab trials and three golimumab trials conducted in Japan and the United States, involving 2,305 participants. All included studies exhibited a low risk of bias based on assessments undertaken using the ROB2 tool. The differences in Disease Activity Score-28 (DAS28) remission rates between ozoralizumab and placebo were 42.6% in one study and 6.3% in the other, whereas golimumab mainly showed smaller differences versus placebo across three studies (4.6%, 5.9%, and 10.4%).

Conclusion: This study demonstrates DAS28 remission in rheumatoid arthritis patients receiving either ozoralizumab or golimumab therapy. Nonetheless, further direct statistical studies are essential to determine which therapy is superior and under what circumstances it should be administered.

Highlights:

1. This study provides robust evidence that establishes ozoralizumab as a novel tumor necrosis factor-alpha (TNF-α) inhibitor for rheumatoid arthritis.

2. According to the findings, ozoralizumab may be a clinician's choice due to its comparable efficacy and potential advantages over golimumab.

Effectiveness of Radioiodine Therapy for Graves' Hyperthyroidism: A Quality-of-Life Assessment

Machfud Fauzi — 2025-07-31

Introduction: Graves' disease, an autoimmune disorder characterized by hyperthyroidism, is commonly managed through radioactive iodine therapy, antithyroid drugs, and thyroidectomy. Previous reports suggest that individuals undergoing radioactive iodine therapy exhibit superior overall quality of life and satisfaction compared to those opting for alternative therapeutic modalities. This study systematically reviewed evidence on the effectiveness of radioiodine therapy for Graves' hyperthyroidism, specifically emphasizing its impact on patients' quality of life.

Methods: A systematic review was conducted on studies evaluating the quality of life of adult patients with Graves’ hyperthyroidism following radioiodine therapy. A literature search was carried out utilizing the PubMed, ScienceDirect, and Sage Journals online databases. The search results were screened according to the eligibility criteria for inclusion in a narrative synthesis.

Results: The search yielded 203 items, of which four articles fulfilled the eligibility criteria and were included in the review. radioiodine therapy demonstrated improvements in the quality of life of patients with Graves' disease compared to other therapeutic modalities or no treatment at all. Enhancement in quality of life was observed across various scales, encompassing physical symptoms (goiter, hyperthyroidism, eye symptoms, and hypothyroidism), psychological symptoms (depression and anxiety), functioning and well-being (fatigue, cognitive impairment, and emotional vulnerability), and participation (social life disruptions, daily life interference, and cosmetic complaints).

Conclusion: Findings concerning quality of life underscore the long-term effectiveness of radioiodine therapy as a preferred intervention for Graves' disease, contributing valuable insights for clinical decision-making.

Highlights:

1. This systematic review comprehensively synthesizes research findings regarding the impact of radioiodine therapy on the long-term quality of life of patients with Graves’ hyperthyroidism compared to surgery or antithyroid medication.

2. The findings suggest that radioiodine therapy offers improvement in the quality of life, which may be indicated by physical and psychological symptoms, functioning, well-being, and participation.

Emerging Resistance to Albendazole in Soil-Transmitted Helminths

Antonio Ayrton Widiastara — 2025-07-31

Soil-transmitted helminths (STHs) are significant pathogens affecting approximately 1.5 billion people globally, with the highest prevalence in sub-Saharan Africa, South America, and Asia. This study examined the effectiveness of albendazole, a widely used anthelminthic drug, in treating STH infections, particularly focusing on its potential resistance. Despite its effectiveness in many cases, recent studies have indicated a concerning trend of reduced efficacy, particularly against species such as Trichuris trichiura. This study reviewed literature from the past decade, identifying key studies that demonstrate a decline in albendazole’s effectiveness across various populations, including school-aged children in multiple regions. The findings proposed that while albendazole remains the primary treatment option, its effectiveness varies significantly based on geographic and demographic factors, raising concerns about the emergence of drug resistance. This study emphasizes the need for ongoing monitoring and potential pharmacological combinations to enhance treatment efficacy and address the threat of resistance. Ultimately, the research highlights the complexity of managing STH infections and the necessity for tailored intervention strategies.

Highlights:

1. Although albendazole is a commonly used medication for soil-transmitted helminths (STHs), its efficacy seems to be waning, thereby requiring additional research to analyze potential resistance.

2. Many studies have pointed out a decreased efficacy of albendazole, despite none having verified resistance, indicating that the medication remains efficacious in specific groups, geographical areas, and dosage regimens where STH infections are prevalent.

Liver Injury Associated with Antituberculosis Medications

Syifa Mustika — 2025-07-31

Tuberculosis remains a major global health concern, with a sharp increase in new cases in 2022, exceeding the prevalence before the coronavirus disease 2019 (COVID-19) pandemic. Conventional antituberculosis therapy, comprising a combination of first-line medications, is essential for controlling tuberculosis. However, more than 7% of patients undergoing treatment may develop drug-induced liver injury (DILI), mainly from isoniazid and rifampicin. This literature review aimed to evaluate DILI in tuberculosis, focusing on its causes, diagnosis, and management. Several factors, including age, sex, genetic predisposition, and pre-existing liver conditions, affect the occurrence of antituberculosis DILI. Advanced age and being female are significant risk factors for severe liver injury. Diagnosing DILI requires careful differentiation from other hepatic disorders, as its clinical presentation may include symptoms such as jaundice, abdominal pain, and elevated liver enzyme levels. Early detection relies heavily on liver function tests and clinical assessments. Managing DILI involves promptly discontinuing the offending drug, closely monitoring the patient, and gradually reintroducing medications, prioritizing less hepatotoxic options, such as rifampicin. Hepatoprotective agents and alternative drug regimens, particularly those excluding pyrazinamide, may be used to mitigate the risk of liver injury. The rise in tuberculosis cases in 2022 underscores the ongoing global burden of this disease and the critical need for effective treatment strategies. Tailored therapeutic approaches, comprehensive liver function monitoring, and early identification of DILI are vital for minimizing hepatotoxicity while ensuring successful tuberculosis management. Although hepatoprotective drugs and alternative regimens show promise, further research is necessary to optimize their application across diverse patient populations.

Highlights:

1. This article presents a thorough evaluation of antituberculosis drug-induced liver injury, particularly concerning its causes, diagnosis, and management, highlighting the importance of a meticulous differentiation from other liver disorders through a comprehensive assessment of clinical indicators.

2. The literature review included studies utilizing advanced diagnostic tools for precise causality determination as well as innovative approaches, such as the selective omission of pyrazinamide or the integration of non-standard treatment protocols, which offer promising avenues to mitigate hepatotoxicity risk.

3. This literature review suggests that hepatoprotective agents, such as N-acetylcysteine, may have advantages due to their notable efficacy in preserving liver function, offering a proactive strategy for patient safety.

Retrospective Analysis of Numerical Pain Rating Scale (NPRS) Scores in Diabetic Neuropathy Patients Receiving Gabapentin and Non-Gabapentin Therapies at an Indonesian Tertiary Hospital

Rifky Alif Novianto — 2025-07-31

Introduction: Diabetic neuropathy is a common complication of diabetes, affecting over half of patients and frequently leading to diabetic neuropathic pain (DNP), which can be difficult to treat. Gabapentin is commonly used as a first-line therapy for DNP and works by modifying calcium channels to reduce pain. This study aimed to evaluate and compare Numerical Pain Rating Scale (NPRS) profiles in DNP patients receiving gabapentin and non-gabapentin therapies at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Methods: This retrospective study analyzed the medical records of 24 DNP patients at Dr. Soetomo General Academic Hospital from January to December 2023. The inclusion criteria comprised patients diagnosed with diabetic neuropathy, according to the International Statistical Classification of Diseases, Tenth Revision (ICD-10) code E11.4, and treated for pain using gabapentin and/or other therapies. Patients with incomplete records or unrelated neuropathic conditions were excluded. The data encompassed NPRS scores, demographics, diabetes mellitus duration, pain characteristics, drug types, doses, and therapy durations.

Results: Among 24 patients, the majority were female (54.1%) and over 60 years old (58.3%), with a diabetes duration of 6–10 years (54.1%). Tingling was the most frequently observed symptom (75%). Gabapentin administered as monotherapy (1×300 mg) was the predominant treatment (56.5%) and provided the greatest reduction in NPRS scores (7 points) after 4–12 weeks. Combination therapies showed smaller reductions.

Conclusion: Gabapentin used as monotherapy is effective for managing DNP, especially over 4–12 weeks. Patients with long-standing diabetes, particularly older adults, are the most affected and benefit from targeted therapy.

Highlights:

1. This study evaluates the demographic, clinical, and therapeutic profiles of patients with diabetic neuropathic pain, focusing on gabapentin and non-gabapentin therapies.
2. Novel insights into the distribution of therapies and numerical pain rating scale (NPRS) scores among patients offer a foundation for optimizing pain management strategies.
3. This research contributes to identifying patterns in drug efficacy and therapy duration, particularly with the administration of gabapentin for managing diabetic neuropathic pain.

Analysis of Risk Factors for Antimicrobial Resistance in Bacterial Infections among Diabetic Foot Ulcer Patients

Andrew William — 2025-07-31

Introduction: Diabetic foot ulcer (DFU) is a chronic and progressive complication of diabetes mellitus resulting from macroangiopathy and microangiopathy disorders. Acknowledging the relationship between the Wagner diabetic foot ulcer classification system and infection severity may offer a promising instrument for guiding empirical antibiotic selections in clinical settings. This study aimed to assess the relationship between Wagner grades and the pathogen profiles of patients with DFU, along with their susceptibility to antibiotic therapy.
Methods: A cross-sectional study was conducted from January 2021 to August 2023, utilizing 33 secondary datasets obtained from electronic medical records. The data contained the patients' Wagner grades alongside the results of their complete microbiological analysis and antibiotic susceptibility test. The association between determinant factors and patients' pathogen profiles and antibiotic susceptibility patterns was examined using the Chi-square bivariate analysis (p<0.05).
Results: Positive culture results were observed in 32 patients (97%), with 59% exhibiting resistance to first-line antibiotics. The most commonly isolated pathogen was Staphylococcus aureus. The antibiotic susceptibility patterns indicated that gentamicin-syn demonstrated the highest activity against Gram-positive bacteria (GPB) isolates, while erythromycin was the most effective against Gram-negative bacteria (GNB) isolates. With escalating Wagner grades, there was an increased proportion of mixed infections, GNB infections (n=8, X²=23.28, p=0.003), and antibiotic resistance (n=8, X²=39.97, p=0.000). GNB isolates showed higher resistance compared to GPB isolates (n=18, X²=42.15, p=0.001).
Conclusion: Our findings suggest that DFU patients with varying Wagner grades exhibit different bacterial profiles, infection patterns, and antibiotic sensitivities.

Highlights:
1. This is the first study conducted in Indonesia to analyze the relationship between the Wagner diabetic foot ulcer classification system and patients' pathogen profiles and antimicrobial susceptibility.
2. This study incorporated an in-depth analysis of several infection patterns and the occurrence of antimicrobial resistance, hence offering valuable information on the application of the Wagner classification system not only as a tool for grading infection severity but also for guiding clinicians in selecting the appropriate antibiotics for patients with diabetic foot ulcers.

The CD4 Count and Viral Load Differences in HIV Patients with and without Infectious Posterior Uveitis at a Tertiary Hospital in Indonesia

Shofa Annesa Hidayat — 2025-07-31

Introduction: The human immunodeficiency virus (HIV) compromises the immune system, making the monitoring of cluster of differentiation (CD4) counts and viral loads critical for assessing disease progression and opportunistic infection risks. Eye-related manifestations, such as uveitis, are common among HIV patients. The purpose of this study was to investigate the differences in CD4 count and viral load between HIV patients with infectious posterior uveitis and those without at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Methods: A retrospective study with an analytical observational design was conducted using the medical records of 75 HIV patients. The examined variables included CD4 count and viral load as independent variables, alongside the incidence and absence of infectious posterior uveitis as dependent variables. The inclusion criteria were HIV patients with regular follow-ups, thereby excluding those with irregular follow-ups. The analysis used the Mann-Whitney test, with p<0.05 indicating a statistically significant difference.

Results: All 75 samples met the inclusion criteria for analysis. The majority of the patients were male (64%) and within the age range of 31 to 40 years (44%). Patients with infectious posterior uveitis had significantly lower CD4 counts (p<0.05) compared to those without the disease. However, no significant differences in viral loads (p>0.05) were observed between patients with posterior uveitis and those without.

Conclusion: CD4 counts differ significantly between patients with infectious posterior uveitis and those without, while viral loads show no considerable differences.

Highlights:

1. This study highlights the differences in cluster of differentiation (CD4) lymphocyte count and viral load between HIV patients with infectious posterior uveitis and those without.

2. The findings may provide new insights into the immunological mechanisms underlying infectious posterior uveitis in persons living with HIV.

3. This work contributes to determining the factors that affect the development of infectious posterior uveitis and explores the potential use of CD4 lymphocyte count and viral load as biomarkers for the diagnosis and management of the disease.

Bloodstream Infections Leading to Sepsis: Clinical and Microbiological Profiling of Bacteremia among Hospitalized Patients in Surabaya, Indonesia

Nuritsna Marwasyifa — 2025-07-31

Introduction: Bacteremia poses a significant health risk due to its frequently atypical presentation and potential progression to sepsis. Understanding its clinical profiles and causative pathogens is essential for timely diagnosis and effective management. This study examined the characteristics of bacteremia cases in 2022 at Universitas Airlangga Hospital, Surabaya, Indonesia.

Methods: A retrospective, descriptive observational study was conducted utilizing hospitalized bacteremia patients' medical records. A total of 107 patients met the inclusion criteria, which required positive blood cultures along with complete data on age (≥19 years), sex, comorbidities, clinical manifestations, bacterial infection diagnosis, outcomes, and pathogen characteristics. Medical records failing to meet these criteria were excluded. The data were categorized and analyzed by variables.

Results: Bacteremia predominantly affected patients aged >65 years (36.4%), males (50.5%), and those with diabetes (54.2%) and with pneumonia (79.4%). Key symptoms included tachycardia (55.1%), tachypnea (55.1%), anemia (65.4%), and leukocytosis (71.0%), despite normal vitals observed in numerous cases. Gram-positive bacteria were most prevalent (69.7%), mainly Staphylococcus hominis (18.7%). Escherichia coli (9.3%) was the leading Gram-negative isolate, while extended-spectrum beta-lactamase (ESBL) strains (4.2%) were the primary multidrug-resistant organisms (MDRO). Sepsis and septic shock were equally prevalent (35.5%). Mortality (64.5%) occurred primarily due to septic shock (49.3%).

Conclusion: Sepsis and septic shock frequently occur in older males with diabetes and pneumonia. Key symptoms include frequent tachycardia, tachypnea, anemia, and leukocytosis. Septic shock, the leading cause of death in bacteremia patients, frequently occurs alongside infections by Staphylococcus hominis and ESBL-producing Escherichia coli.

Highlights:

1. This study offers fresh perspectives on the clinical profiles of hospitalized bacteremia patients and the characteristics of causative bacteria at Universitas Airlangga Hospital, a topic that has been minimally explored in the Indonesian medical community.

2. It highlights the prevalence of bacteremia, its clinical manifestations, and outcomes to determine the mortality rate of hospitalized bacteremia patients.

3. This study provides valuable data that can help inform future infection control strategies to manage and prevent bloodstream infections, hence enhancing healthcare outcomes by emphasizing the importance of improving clinical data collection and monitoring.

Profiles of Deceased Patients with Coronavirus Disease 2019 (COVID-19) and Multidrug-Resistant Bacterial Coinfections at an Indonesian Tertiary Hospital

Joedhistira Bayu Firmansyah — 2025-07-31

Introduction: Antibiotic use in coronavirus disease 2019 (COVID-19) patients reached 70% during the pandemic, potentially inducing the invasion of multidrug-resistant organisms (MDROs). This study analyzed patients who died from COVID-19 with MDRO coinfections at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Methods: We conducted a retrospective descriptive study of 120 deceased COVID-19 inpatients from January to December 2021. The inclusion criteria required: (1) positive MDRO cultures from ≥2 specimens, and (2) resistance to ≥1 agent across ≥3 antimicrobial categories. Patients with incomplete records or no antibiotic therapy were excluded. The data were presented using descriptive statistics to characterize patient demographics, microbiological profiles, and antimicrobial resistance patterns.

Results: The patients were predominantly male (60%), aged 41–80 years (78.33%), and hospitalized for 8–30 days (53.44%). The microbiological examinations revealed blood cultures as the main specimen source (43.10%), followed by sputum (27.59%), urine (19.40%), pus (7.33%), and cerebrospinal fluid (2.59%). The prevalent isolates varied by specimen type: coagulase-negative staphylococci (51%) in blood, Pseudomonas spp. in pus (17.65%), Klebsiella spp. in sputum (26.69%), and Escherichia coli in urine (37.78%). The cerebrospinal fluid cultures showed an equal distribution of Gram-negative bacilli, Gram-positive bacilli, and Gram-positive cocci (33.33% each).

Conclusion: This study characterizes the profiles of fatal COVID-19 cases with MDRO coinfections, demonstrating a predominance of older male patients with prolonged hospitalization. The identified resistance patterns and pathogen distribution, notably coagulase-negative staphylococci in blood, highlight the importance of improved infection surveillance and antibiotic stewardship to minimize the risk of coinfection in the future.

Highlights:

1. While existing studies have examined multidrug-resistant organism (MDRO) coinfections in COVID-19 globally, this work offers a valuable standalone characterization of a high-risk subgroup in Indonesia, where resistance patterns arising from antimicrobial use during the pandemic created unique clinical challenges.

2. This study provides comprehensive data on the mortality of COVID-19 patients with MDRO coinfections at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, enhancing medical personnel's awareness of MDRO bacterial transmission and informing improvements in antibiotic stewardship programs within hospitals.

Clinical and Laboratory Characterization of Hemodialysis Patients in Relation to Survival Outcomes at a Tertiary Referral Hospital in Indonesia

Elisabeth Sipayung — 2025-07-31

Introduction: Despite advancements in hemodialysis care, disease progression and outcomes in adults with various comorbidities, particularly in Indonesia’s overburdened tertiary hospitals, remain poorly characterized, limiting tailored care strategies. This study analyzed clinical characteristics and laboratory parameters among hemodialysis patients at Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia, with stratification by survival outcomes.

Methods: We conducted a retrospective cohort study of adults (>18 years) undergoing hemodialysis at Sulianti Saroso Infectious Disease Hospital between March and July 2024. Using purposive sampling, we analyzed 27 cases with documented laboratory parameters (i.e., blood urea nitrogen (BUN), serum creatinine, and estimated glomerular filtration rate (eGFR)) and clinical outcomes. Associations between outcomes and laboratory/clinical variables were assessed using Fisher’s exact test and logistic regression (p<0.05).

Results: Mortality was reported in 25.9% of patients, including one who passed away due to complications related to coronavirus disease 2019 (COVID-19) shortly after being discharged. The leading indication for hemodialysis was hyperuricemia (85.2%), followed by chronic kidney disease. Nearly half of the patients (48.1%) had comorbid diabetes mellitus. Diabetic nephropathy was a key contributor to elevated urea levels. Prevalent complications reported among the patients included sepsis (70.4%) and glomerular disease (40.7%).

Conclusion: This study found an association between diabetes mellitus and mortality in chronic kidney disease patients who underwent hemodialysis. Severe uremia, marked by elevated BUN levels, and symptomatic complications such as shortness of breath were observed, indicative of advanced disease progression. Earlier detection and optimized management are necessary to mitigate preventable morbidity in high-risk populations.

Highlights:

1. This study examined undercharacterized hemodialysis patients at an Indonesian tertiary hospital, focusing on high comorbidity burdens and outcomes.

2. Severe kidney disease and high mortality were observed, driven by comorbidities such as diabetes mellitus, hypertension, coronavirus disease 2019 (COVID-19), and infectious diseases (drug-resistant tuberculosis and hepatitis B/C).

3. The findings underscore the importance of optimized risk stratification and early intervention for end-stage renal failure in patients with both communicable and non-communicable disease comorbidities.