Clinical and Research Journal in Internal Medicine

Case Report: CMML in Young Age which Transformed to AML

Wilujeng Anggraini — 2023-11-25

CMML (Chronic Myelomonocytic Leukemia) is a rare type of blood cancer that characterized with the presents of monocytes in the blood. ^1,2According to WHO it is categorized as overlapped manifestation of MDS (Myelodysplastic Syndrome) and MPD (Myeloproliferative Disease) or MPN (Myeloproliferative Neoplasm). ^2,3The origin cause of CMML is gene mutation on TET2 (60 %), SRSF2 (50 %), ASLX1 (40 %), and RAS (30 %). ^1,3,4 Men are predominantly affected with incidence peak between 71 and 74 years of age, and the prevalence on young adult are very rare and considered to be closely related to the presence of gene mutations in ASLX1. ^1,3,5 From several case reports, there were 63 % of CMML patients changed into secondary AML within 1-5 years due to somatic gene mutations in the ASLX1. ^2,3,4,6 In this case, we report a 21-year-old male who is diagnosed with CMML and eventually transformed to AML.

Clinical Clue and Predictive Blood Count of Hemodialysis Cathether-Related Infection: Case Series

Nadya Vanessa — 2023-11-25

Most patients with chronic kidney disease (CKD) require renal replacement therapy. Majority of hemodialysis initiation is done through a dialysis catheter access. The use of catheters double lumen (CDL) for hemodialysis has several potential complications, including infection. Catheter related bloodstream infection (CRBSI) is associated with increased morbidity and mortality in CKD patients. CRBSI therapy should not be delayed, including delays due to waiting for culture results to confirm the diagnosis. Several studies have reported the use of clinical findings and routine blood count parameters to predict CRBSI. This case series reported three cases with suspected CRBSI consisting of one woman and two men with mean age of 44.67 ± 8.21 years, mean catheter days 13 ± 6.97, and mean hemodialysis duration of 10.5 ± 13.79 month. Diagnosis CRBSI was suspected from clinical clue, i.e symptoms such as fever and chills, pain at the CDL site, and physical examination i.e body temperature and local CDL site signs. Laboratory parameters in this case series reported elevations for PLR, NLR and SIRI supporting the suspicion of bloodstream infection. All patients in this case series improved after CDL removal and antibiotics therapy. Investigation of clinical findings and routine blood count parameters can be an alternative diagnosis of CRBSI that enables prompt treatment in areas with limited facilities.

Keywords: chronic kidney disease, catheter related bloodstream infection, diagnosis

Identify The Type of Pleural Effusion with Lung Ultrasound: A Case Report and State-of-Art

Simone Ielo — 2023-11-25

Pleural effusion is the most common pleural pathology and is seen in a large group
of patients admitted to internal medicine wards.
The purpose of this state of art literature review is to describe the various ultrasound findings that can be observed, to highlight the ability of lung ultrasound to facilitate differential diagnosis by pointing to a specific type of effusion and its cause.
To this end, the clinical case description aims to demonstrate the above and promote the use of bedside lung ultrasound by considering this technique as the fifth physical examination technique after inspection, palpation, percussion and auscultation.

Tailored CML Treatment in Indonesia, Let’s See More

Shinta Oktya Wardhani — 2023-11-25

Lung Abnormalities in Liver Cirrhosis

Muli Yaman — 2023-11-25

Regardless of preexisting lung illness, patients suffering from liver cirrhosis, especially decompensated liver cirrhosis can develop distinct pulmonary complications. Liver cirrhosis patients should be assessed for hepatopulmonary syndrome (HPS), portopulmonary hypertension (PoPH), hepatic hydrothorax (HH) and spontaneous bacterial empyema (SBEM) which are the most clinically significant pulmonary consequences, in particular when dyspnea develops in conjunction with hepatic cirrhosis. These entities differ in terms of pathophysiology, clinical characteristics, diagnosis and suitable treatment options. This emphasize the need of specific diagnostic algorithm in liver cirrhosis patients presenting with dyspnea or other pulmonary symptoms. These pulmonary complications might be rare in patients with liver cirrhosis and portal hypertension but these complications might carry significant morbidity and mortality risks and, therefore, strong clinical suspicion is required to make an early accurate diagnosis. There are several medical therapies available for each condition in the multiple studies but most of the treatments and proceures doesn’t have significant benefit or have short lived benefit. The only treatment that changes the clinical prognosis of decompensated cirrhosis effectively in long term is liver transplantation. However liver transplantation also needs careful considerations as on some cases it might increase the risk of morbidity and mortality.

Keywords: Cirrhosis Hepatis, Hepatopulmonary Syndrome, Portopulmonary Hypertension, Hepatic Hydrothorax, Spontaneous Bacterial Empyema

Best Recommended Exercise for patients with Hypertension

Cholid Tri Tjahjono — 2023-11-25

Hypertension is known as a fatal yet preventable risk factor for cardiovascular disease and is responsible for majority of cardiovascular mortality. Hypertension is closely associated with sedentary lifestyle. Physical activity and/or exercise are shown to retard development of hypertension.

Exercise, combined with other measures of lifestyle behaviour and pharmacologic treatments, is recommended as an effective lifestyle behaviour for adults to prevent and treat hypertension.

The current exercise prescription for the treatment of hypertension is: cardiovascular mode, for 20-60 minutes, 3-5 days per week, at 40-70% of maximum oxygen uptake (VO2(max))..

Both aerobic and resistance exercise, should be performed simultaneously by hypertensive patients. Aerobic activity could include walking, jogging, cycling, rowing swimming. While dynamic resistance training could include free weights, resistance machines, and resistance bands. Functional exercises should be comprised of step-ups, bodyweight exercises, and balance training.

After an exercise session, BP decreases, and this decline continues for up to 24 h; which is called post-exercise hypotension. Overall 5 mmHg decrease in BP with regular exercise may be encouraged. With a decrease of 5 mmHg in systolic BP, mortality due to coronary artery disease decreases by 9%, mortality due to cerebrovascular accident decreases by 14% and all-cause mortality decreases by 7%. Regular exercise should therefore be recommended for all individuals including normotensives, pre-hypertensives, and hypertensives.

The Difference in Obesity Between Adults and Elderly with Knee Osteoarthritis

Raynald Pradigo — 2023-11-25

Background: Knee osteoarthritis (KOA) is one of the most common diseases of arthritis. The increase in KOA prevalence is also affected by the increase in obesity prevalence as one of the KOA risk factors.

Aim: To see the difference in obesity association with KOA between adults and the elderly.

Methods: The study design is analytic cross-sectional. 102 cases and controls data each are collected from Tarempa public health center (Phc) medical records by simple random sampling using a random number generator. Data taken is the latest patient visit record in the form of name, age, gender, weight, and height. Data are then analyzed using SPSS. This study's ethical clearance is accepted by the ethic committee faculty of medicine University of Sumatera Utara.

Results: 59 (28.9%) men and 83 (71.1%) women participated in this study. The mean age of KOA subjects is 57.5 ± 11,4 with the most age range being 50-59 years old (38.2%). 71 (69.6%) KOA subjects are obese. The results of data analysis show that people ≥ 50 y.o with obesity were at 2.7 times more risk of suffering KOA than the normoweight or overweight people. There is no association between obesity and KOA in people under 50 years old.

Conclusion: The risk of obesity developing into knee OA increased with age

The Effectiveness of Depression Intervention and Risk Factor in Geriatrics: a Systematic Review

Sri Sunarti — 2023-11-25

Background: Increasing age is a new challenge in today's health services. With increasing age, the physiological function will decrease. Not only infectious diseases and systemic diseases, but the elderly are also prone to social problems and mental health problems, including depression. Depression is the most common mental illness in the elderly. Depression can significantly reduce the quality of life of the elderly.
Aim: To obtain a deeper understanding of interventions and risk factors for depression in geriatrics.
Methods: Literature searches were taken from Science Direct, Pubmed, and Google Scholar from 2020 - 2022, in which 8 eligible articles were found. The keywords used in the search were "depression", "elderly", "elder", and "geriatric". Article quality was evaluated using the CASP checklist.
Results: The results of the articles were obtained from several countries. The interventions carried out can be grouped into several categories, namely interventions in the form of physical activity therapy, music therapy, psychoeducation, cognitive change, and problem-solving. This review helps inform several interventions that can be performed on the elderly and factors that support the success of interventions.
Conclusion: There are several risk factors for depression in the elderly, by performing several intervention methods in the elderly, depression can reduce the risk of depression.

Clinical Characteristics of Rheumatoid Arthritis Patients in Malang: Where Are We Now According to the Treat-to-Target Strategy?

Mirza Zaka Pratama — 2023-11-25

Background: Rheumatoid arthritis (RA) is the most frequent type of systemic inflammatory arthritis.

Aim: to observe RA patients' clinical characteristics in Malang and assess the adherence of the clinical data to the existing guideline for the treat-to-target (T2T) strategy.

Methods: This survey included 111 RA patients who visited the Rheumatology Clinic at Saiful Anwar Hospital in Malang. Patient's demographic information, medical and drug history, body mass index (BMI), tender joint count (TJC), swollen joint count (SJC), visual analogue scale (VAS) for pain, erythrocyte sedimentation rate (ESR), anti-cyclic citrullinated protein (CCP), and rheumatoid factor (RF) were all collected. The disease activity score for 28 joints - ESR (DAS28-ESR) was used to assess disease activity and remission.

Results: The mean duration of the disease was 2.9±1.6 years. Among those patients, four patients (3.6%) got disease remission, and two patients (1.8%) had low activity. Methotrexate (MTX) was given to all subjects for an average of 78.4±11.7 months at a dose of 9.5±2.8 mg/week. Six patients (5.4%) received the DMARD combination of MTX+LEF (4.5%) and MTX+SSZ (0.9%). Most subjects had delayed MTX initiation (mean duration 6.0±2.2 months after the first onset); 77 patients (69.3%) initiated their MTX after >6 months since the first onset. Most subjects got 7.5 mg/weeks (45.0%), while only 11.7% of patients had ≥15 mg/weeks of MTX.

Conclusion: The remission rate of RA patients in Malang is still low, which can be caused by inadequate adherence to the relevant guidelines and T2T strategy in clinical practices.

Seroprevalence of Chikungunya virus infection in a Tertiary Care Hospital, Warangal, Telangana, South India

Gudikandula Krishna — 2023-11-25

Introduction:

The Chikungunya virus, an Alpha virus belongs to the Togaviridae family which infects via the vector Aedes spp. mosquitoes, is the cause of the Chikungunya sickness. The most prevalent symptoms are an abruptly rising temperature, rash, and acute arthralgia. Similar to other arboviral diseases such as Dengue and Japanese B encephalitis infections, it is a serious public health issue.

Methods: A total of 3027 blood samples were received from suspected cases of Chikungunya in the Tertiary Care Hospital, Warangal, Telangana. Over a period of 17 months, this study was conducted. Nearly 5-10ml of blood was collected from the patients after 5 days of fever, and the serum was separated. Using an IgM antibody capture ELISA kit manufactured by NIV (NIV, Pune, India).

Results: In our study population of 3027 during 12 months, 313 Chikungunya cases (10.34%) were found to be seropositive for Chikungunya by IgM ELISA. Most cases were from 0-10 Years (24.60%), followed by 11-20 years (17.25%). Regarding the sex ratio of the total affected cases, 53.35% were males, and 46.64% were females. A maximum number of positives were seen in September, November, and October, which were found to be 35.46%, 18.84%, and 17.57%.

Conclusion: The study found a seroprevalence rate of 23.06% for Chikungunya, with a notable increase in frequency during the monsoon season. Additionally, the virus was found to disproportionately affect individuals in the productive age range of the population.