Indonesian Journal of Biomedicine and Clinical Sciences

Assessing the impact of antimicrobial stewardship programs in tertiary hospitals for UTI: does it work alone?

2024-07-12T10:30:30+07:00

Antibiotic resistance is currently an emergent global challenge. Urinary tract infection (UTI), one of the most commonly reported infections, are is becoming a difficult case to treat considering the increasing prevalence of antimicrobial resistance (AMR). The objective of this study was to assess the impact of a hospital antibiotic stewardship program on AMR in managing UTI at a tertiary referral hospital in Yogyakarta, Indonesia, while considering the absence of the program in lower-tier referral hospitals. A retrospective cross-sectional study was conducted from January 2017 to December 2020, classified into pediatric and adult samples. Urine samples were collected and cultured from all patients with UTI hospitalized in the Dr. Sardjito General Hospital, Yogyakarta. The UTI causative bacteria and antibiotic susceptibilities were investigated in the comparison of the first 2 years (2017-2018, prior to the hospital antibiotic stewardship program) and the last 2 years (2019-2020, following the implementation of the hospital antibiotic stewardship program). The isolates from 717 adult urine samples were cultured. Escherichia coli (39.1%), Acitenobacter baumanii (9.3%), and Pseudomonas aeruginosa (8.5%) were identified as the most common bacteria prior to the hospital antibiotic stewardship program. Extended-spectrum β-lactamase-producing E. coli and Burkholderia cepacia were still increasing in the following the implementation of the hospital antibiotic stewardship program. Our study indicated that the stewardship program does not exhibit a significant change during the first two years considering the absence of the program in lower-tier referral hospitals.

The curative effect of ethanolic extract of Moringa oleifera leaf in an animal model of liver fibrosis

2024-07-12T10:31:48+07:00

Studies about the prevention effect of Moringa oleifera on liver fibrosis has been reported. However, its curative effect has not been reported, yet. This study was conducted to evaluate the curative effect of M. oleifera leaf extract on liver fibrosis. It was a laboratory experimental study with a post-test-only control group design. Rats were divided into 5 groups i.e. normal control which received intraperitoneally injections of 1 mL/kg BW of 0.9% NaCl solution twice a wk for 11 wk. Liver fibrosis control which received intraperitoneally injections of 1 mL/kg BW of 10% CCl₄ solution twice a wk for 11 wk. Three M. oleifera treatment group which received intraperitoneally injections of 1 mL/kg BW of 10% CCl₄ solution twice a wk for 11 wk continued by M. oleifera leaf ethanolic extract at dose of 600 mg/kg BW daily for 3 (MO3), 6 (MO6), and 10 (MO10) wk, respectively. The liver fibrosis level was assessed based on the METAVIR score. Histopathological analysis of liver tissues demonstrated that the 11-week CCl₄ induction successfully resulted in liver fibrosis in rats (F3 and F4). The administration of M. oleifera leaf ethanolic extract decreased METAVIR scores ranged from F3 to F1. The optimal reduction of the METAVIR scores (F1) was observed in MO3 group after 6 wk administration (p<0.05). It was indicated that M. oleifera leaf ethanolic extract ameliorated liver fibrosis. In conclusion, M. oleifera leaf ethanolic extract has a curative effect against liver fibrosis.

The effect of infection on mortality in acute coronary syndrome patients at Dr. Sardjito General Hospital, Yogyakarta

2024-07-12T10:32:23+07:00

Ischemic heart disease is the second most significant health burden in Indonesia and the world. The prevalence of coronary heart disease patients in Yogyakarta is predicted to experience a continuous increase. In Sardjito Hospital, mortality rate of acute coronary syndrome (ACS) patients reaches 15%, with pneumonia infection identified as one of the predictors. Despite this high mortality rate, there is a lack of studies addressing the contribution of infectious comorbidities to mortality incidence among ACS patients. This study aimed to investigate the e ffect of infectious comorbidities on the incidence of mortality among ACS patients and its mortality rate in Sardjito Hospital. This study used a cross-sectional design in 794 patients diagnosed with ACS and registered in the SCIENCE registry from January to December 2022 at Sardjito Hospital. The analysis was conducted using the Chi-square method to determine the effect of infectious comorbidities on mortality among ACS patients and a logistic regression test to evaluate the correlation between variables. Based on bivariate analysis, it was found that infectious comorbidities increased mortality rate among ACS patients (p<0.001, OR=2.22[1.46-3.38]), reaching 5.2%. The bivariate analysis between confounding factors and outcome of patients showed that obesity, dyslipidemia, and revascularization significantly influenced the results of ACS patients. Based on multivariate analysis, it was discovered that infectious comorbidities, obesity, diabetes, dyslipidemia, and revascularization had a significant association with mortality of patients with ACS. Furthermore, infectious comorbidities increased the odds of mortality for ACS patients by 2.04 times. Infectious comorbidities increased the incidence of mortality in ACS patients by 2.04 times with mortality rate of 5.2%.

Laboratory findings of postoperative venous thromboembolism (VTE) in Dr. Sardjito General Hospital, Yogyakarta

2024-07-12T10:32:43+07:00

Venous thromboembolism (VTE) is a significant risk, especially for older individuals. Indonesian studies found 37.1% VTE incidence in bedridden patients over 40 and 2.1% in major surgeries. Surgery, like hip fractures, raises the risk temporarily. Diagnosis relies on tests like ultrasound with Doppler, Wells score, and neutrophil-to-lymphocyte ratio (NLR). This study aimed to evaluate the laboratory findings of postoperative VTE. A retrospective analysis was conducted in Dr. Sardjito General Hospital, Yogyakarta using medical record data of VTE patients who underwent major surgery. The laboratory data, including complete blood count characteristics for every month for three months after postsurgery and DVT presentation when it occurred on the diagnostic day were collected. In total of 27 patients involved in this study, VTE cases were more common in digestive (41.2%) and obstetric gynecology surgeries (29.4%) for females, and nervous (44.4%) and cardiovascular surgeries (22.2%) for males. Females had a higher prevalence of Well Score ≥3 (82.4% vs 40%; p=0.058) and longer VTE therapy durations (65.50 ± 46.51 vs 39.60 ± 41.04 d; p=0.172). Males had more unilateral VTE occurrences (90.9 vs 56.3%; p=0.070) and a higher proportion of total occlusion cases (60 vs 37.5%; p=0.422). NLR exhibited a significant decrease from the 1^st to the 2^nd month (10.52 vs 3.64; p=0.009), followed by an insignificant increase in the 3^rd month (3.64 vs 3.98; p=0.878). Notably, NLR trended downward in the 2^nd month examination. In conclusion, VTE occurs in 0.21% of postoperative patients, with the highest incidence observed in post-gynecological surgery patients. The NLR can serve as a diagnostic tool for VTE in extremities, as an elevated NLR indicates the presence of a more proximal thrombus.

Diagnostic performance of sex hormone binding globulin (SHBG) expression in predicting prostate cancer (PCa)

2024-07-12T10:33:02+07:00

Globally, 1.3 million new cases of prostate cancer (PCa) and 359,000 deaths were reported in 2018. Due to rapid population growth and increasing rates of aging worldwide, the PCa has become the 5^th leading cause of death in men. Sex hormone binding globulin (SHBG) presents in both men and women and its expression is often associated with the development of PCa and breast cancers. This study was conducted to assess the diagnostic performance of SHBG expression in predicting PCa. A total of 31 patients with PCa and 14 patients with BPH as a control were involved in this study. The SHBG expression of formalin-fixed paraffin-embedded (FFPE) prostate tissue was examined by the quantitative reverse transcriptase polymerase chain reaction (RT-PCR). Receiver operator characteristic (ROC) curves were produced and the area under the curve (AUC) was calculated to evaluate the diagnostic performance of the SHBG expression in predicting the PCa. The AUC of SHBG expression was 0.868 (95% CI 0.764-0.971; p<0.001) which indicated good diagnostic performance. The cutoff value was 6.731 which corresponded to 80% accuracy, 71% sensitivity, and 100% specificity. In conclusion, SHBG expression in prostate cancer tissues could be a molecular marker in PCa diagnosis.

ABSTRACT

Secara global terdapat 1,3 juta kasus baru kanker prostat (prostate cancer/PCa) dan 359.000 kematian dilaporkan pada tahun 2018. Karena pertumbuhan populasi yang cepat dan meningkatnya angka usia lanjut di seluruh dunia, PCa telah menjadi penyebab kematian utama ke-5 pada pria. Sex hormone binding globulin (SHBG) terdapat pada pria dan wanita dan ekspresinya sering dikaitkan dengan perkembangan PCa dan kanker payudara. Penelitian ini dilakukan untuk menilai potensi SHBG sebagai penanda molekuler dalam diagnosis PCa. Sebanyak 31 pasien PCa dan 14 pasien BPH sebagai kontrol dilibatkan dalam penelitian ini. Ekspresi SHBG dari jaringan prostat formalin-fixed paraffin-embedded (FFPE) diperiksa dengan the quantitative reverse transcriptase polymerase chain reaction (RT-PCR). Receiver operator characteristic (ROC) dihasilkan dan the area under the curve (AUC) dihitung untuk mengevaluasi kinerja diskriminatif ekspresi SHBG dalam diagnosis PCa. AUC ekspresi SHBG adalah 0,868 (95% CI 0,764-0,971; p<0,001) yang menunjukkan kinerja diskriminatif yang baik. Nilai cutoff adalah 6,731 yang berhubungan dengan akurasi 80%, sensitivitas 71% dan spesifisitas 100%. Kesimpulannya, ekspresi SHBG pada jaringan kanker prostat dapat menjadi penanda molekuler dalam diagnosis PCa

Cytotoxic T lymphocyte associated antigen-4 (CTLA4) expression with renal cell carcinoma subtype and staging

2024-07-12T10:33:23+07:00

In Indonesia, approximately 45% of renal cell carcinoma (RCC) patients are at an advanced stage that requires checkpoint inhibition combination immunotherapy. Cytotoxic T lymphocyte associated antigen-4 (CTLA-4) is associated with poor prognosis of RCC and it is the first checkpoint developed in cancer immunotherapy. This study aimed to investigate CTLA-4 expression among RCC subtypes and staging. Formalin fixed paraffin embedded (FFPE) tissue of RCC patients from 2018-2020 were obtained from the Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta. Expression of CTLA-4 among RCC subtypes and stage was measured using quantitative reverse-transcription polymerase chain reaction (qRT-PCR) and compared. Among the 40 patients involved in this study, the CTLA-4 expression was higher in papillary RCC/pRCC (95.88 + 31.58) compared to clear cell RCC/ccRCC (90.94 + 43.05). However, no significantly different in CTL-4 expression based on histologic subtypes and tumor stage (p>0.05). In conclusion, neither the histologic subtype nor the tumor stage of RCC can be predicted by CTLA-4 expression.

A challenge in diagnosis and treatment in asthma patients with allergic bronchopulmonary aspergillosis: a review

2024-07-12T10:33:41+07:00

Allergic bronchopulmonary aspergillosis (ABPA) is a common form of fungal-related asthma disease mainly caused by Aspergillus fumigatus. The increasing prevalence of asthma globally and the characteristic of Aspergillus are very easily dispersed in the air to inhale, leading to increased cases of ABPA in asthma patients. Inhalation of conidia Aspergillus spp. can trigger asthma exacerbations due to poor mucociliary clearance. However, the exact pathogenesis is still unclear. Clinical features commonly found in ABPA patients are productive cough with dark green or brown mucus or even hemoptysis. Several criteria for establishing the diagnosis of ABPA can be based on clinical features, laboratory examinations, and imaging, but none has become the gold standard. However, the primary laboratory test utilized for ABPA screening is the measurement of serum-specific IgE levels to A. fumigatus, owing to its high sensitivity. Despite the challenges in finding the most fitting universal consensus, most clinicians still follow the criteria proposed by Rosenberg et al. in 1977. The recommended ABPA treatment is prednisone and/or azole antifungal agents such as itraconazole. In addition, the potential of monoclonal antibodies in ABPA therapy is still under further research. Long-term diagnosis and treatment delays can lead to complications such as bronchiectasis and fibrosis. This review aimed to highlight ABPA in asthma patients, from etiopathogenesis to managing the disease

Potential biomarkers of IFN-γ, IL-2 and CXCL9 for diagnosis of Q fever disease

2024-07-12T10:34:18+07:00

The pathogen responsible for Q fever disease, Coxiella burnetii, is a zoonosis classified as a pathogen due to its airborne transmission. The C. burnetii infection could be both acute or chronic in humans. The main and most common entry of the pathogens to the body is through the breathing of polluted aerosols containing a resistant substance similar to C. burnetii spores. This small cell variant (SCV) or spore-like morphotype is extremely stress-resistant, therefore inadequate treatment causes serious effects even death. Due to the diversity of clinical manifestations of Q fever and the presence of less specific and sensitive diagnoses for other diseases, multiple platforms for exploring Q fever biomarkers are required. Apart from serological studies to determine a biomarker for Q fever, it will be prudent to concentrate on the more appropriate cell-mediated immune response. This article discusses C. burnetii causing Q fever disease and how the host develops humoral and cellular immunity, particularly IFN-γ, IL-2 and CXCL9, as potential biomarkers for the diagnosis of Q fever disease.

Serpentine supravenous hyperpigmentation (SSH) in nasopharyngeal carcinoma patient on docetaxel and carboplatin chemotherapy: a case report

2024-07-12T10:34:44+07:00

Serpentine supravenous hyperpigmentation (SSH) is a rare but unique side effect of intravenous anticancer. It manifests as linear hyperpigmentation eruption on the skin that radiates along the superficial vein accompanied by mild pain and/or itch. This SSH does not cause systemic alterations, however, most patients complained about its cosmetic effects. The diagnosis of SSH can be made clinically, although histopathological examinations can aid in excluding differential diagnoses. We reported a case of SSH found in a nasopharyngeal cancer patient during docetaxel and carboplatin chemotherapy. It is a potentially alarming interface dermatitis that is not lot reported in the literature. It was reported, the patient tolerated the second and third cycles well with less severe side effects when premedicated with 250 mL NaCl 0.9% bolus intravenously before and after chemotherapy sessions, 10 mg cetirizine every 24 hr orally, and desoximetasone cream 0.25% every 12 hr topically added.

Management of non-malignant hyperinsulinemic hypoglycaemia in resource limited setting: a case report

2024-07-12T10:35:04+07:00

A 37 y.o. Asian male presented with frequent hypoglycaemia in both fasting and post-prandial state. He had elevated blood insulin levels during the hypoglycaemic episodes with normal pancreatic morphology and no extra-pancreatic tumor. Through systematic symptom assessment and the use of simple laboratory examination, non-insulinoma pancreatogenous hypoglycaemia syndrome presented as the most likely diagnosis. Conclusive aetiological diagnosis could not be reached due to the limited availability of diagnostic modalities. Nevertheless, modest symptom control and frequency reduction of hypoglycaemia were achieved with empirical dietary modification and α-glucosidase inhibitor treatment.