Cermin Dunia Kedokteran

Analysis of Bacterial Patterns and Risk Factors Associated with Bacteremia in Adult Intensive Care Unit at Soeradji Tirtonegoro General Hospital Klaten, Indonesia

2025-05-08T16:17:20+07:00

Introduction: Bloodstream infections (BSI) are life-threatening and pose an increased risk of mortality, particularly in intensive care patients. This study aims to delineate the bacterial patterns and analyze the risk factors associated with bacteremia among patients in the adult
intensive care unit at Soeradji Tirtonegoro Hospital. Methods: This study used a descriptive-analytical design with a cross-sectional approach. The study population consisted of all adult ICU patients at Soeradji Tirtonegoro Hospital with positive blood cultures during the treatment period from October 1, 2019, to August 31, 2022. Analysis of risk factors associated with bacteremia was performed using Fisher's exact test. Results: Analysis shows a significant association between the accumulation of 3 or more risk factors and the bacterial patterns found in patients with bacteremia. Data from 52 patients were selected for analysis, comprising 21 females and 31 males. The risk factors associated with bacteremia included installation of hemodialysis catheters, water-sealed drainage (WSD), ventilator use, a history of diabetes, and previous surgery. Several patients had more than one risk factor associated with bacteremia. Blood culture results revealed that 30 out of 52 cases (57.7%) were caused by Gram-negative bacteria, while 22 out of 52 cases (42.3%) were caused by Gram-positive bacteria. The analysis identified two cases of methicillin-resistant coagulase-negative staphylococci (MR CoNS), but no methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamases (ESBLs) or carbapenemase-producing bacteria were found. Conclusion: This study identified bacterial patterns and analyzed risk factors associated with bacteremia in adult intensive care units. There was a significant association between the number of accumulated risk factors and specific bacterial pathogens in patients with bacteremia.

The Relationship between Menopause Symptoms and Insomnia in Pre-elderly

2026-01-23T16:13:52+07:00

Introduction: Menopause causes somatic, psychological, and urogenital symptoms as risk factors for insomnia. This study aims to determine the relationship between menopause symptoms and insomnia in the pre-elderly. Methods: Descriptive analytical study using a cross-sectional method. The variables in this study were menopause symptoms and the severity of insomnia as measured by the MRS and ISI questionnaire. The sample consisted of 107 pre-elderly menopausal women at a church in South Tangerang, using the convenience sampling method. Data analysis included univariate analysis (descriptive statistics) to examine sample characteristics and bivariate analysis with the Kruskal-Wallis test to examine the relationship between menopausal symptoms and the severity of insomnia. Results: A significant relationship between menopause symptoms and the severity of insomnia (p < 0.05). Based on each insomnia severity, the highest mean rank of respondents who experienced moderate clinical insomnia had somatic symptoms (90.44), the highest mean rank of respondents who experienced subthreshold insomnia had psychological symptoms (75.59), and the highest mean rank of respondents who did not experience insomnia had urogenital symptoms (42.91). Conclusion: Menopause symptoms are significantly related to the severity of insomnia in pre-elderly individuals.

Iron Status Improvement by Green Tea Supplementation in Transfusion-Dependent Thalassemia: Systematic Review and Meta-Analysis

2026-02-06T11:50:12+07:00

Introduction: Iron overload significantly contributes to organ dysfunction in transfusion-dependent thalassemia (TDT) patients. Green tea extract (GTE), rich in polyphenols with iron-chelating properties, has shown promise in reducing iron levels in these patients, although its effectiveness remains unclear. This study aims to evaluate the impact of GTE on iron status in TDT patients. Methods: A systematic search of the PubMed, Embase, and Cochrane Library databases was conducted up to July 2024, identifying randomized clinical trials (RCTs) based on predefined criteria. Iron status was assessed through serum ferritin, total iron binding capacity (TIBC), serum iron, and transferrin saturation. Five RCTs involving 217 participants were included. Results: There has been a significant reduction in serum ferritin in the GTE group compared to controls (mean difference MD -0.55, 95% CI: -0.81, -0.29) and a similar reduction in serum iron (MD -63.73, 95% CI: -106.46, -21.00). Significantly higher TIBC and lower transferrin saturation were also observed in the GTE group. Conclusion: These findings suggest that GTE supplementation lowers serum ferritin and serum iron in TDT patients. Further research with larger cohorts is needed to better understand the effects on diverse populations.

Effect of Vitamin D Supplementation on Hemoglobin Level in Hemodialysis Patients: Evidence-Based Case Report

2026-02-18T10:11:57+07:00

Introduction: Anemia is a common complication of end-stage chronic kidney disease (CKD), particularly in patients undergoing hemodialysis. Vitamin D, a micronutrient with receptors in various cell types, plays a role in enhancing erythropoiesis by promoting the proliferation of erythroid progenitor cells, reducing proinflammatory cytokines and hepcidin, thereby increasing iron bioavailability for hemoglobin (Hb) synthesis. This study aims to investigate the effect of vitamin D supplementation on Hb levels in chronic hemodialysis patients. Methods: A systematic literature search was conducted across 4 databases: PubMed, ProQuest, Cochrane, and Scopus. Inclusion criteria were studies on adult patients undergoing chronic hemodialysis with anemia and with any vitamin D status, published within the last 5 years, and consisting of systematic reviews and meta-analyses (SR-MA) of randomized controlled trials (RCTs) or RCTs. Critical appraisal was performed using the validity, importance, and applicability (VIA) framework from the Oxford Centre for Evidence-Based Medicine (OCEBM). Results: Two RCTs and one SR-MA were critically appraised. Vitamin D supplementation was found to improve Hb levels in chronic hemodialysis patients, with statistically significant effects observed in longer supplementation durations. Conclusion: Vitamin D supplementation in chronic hemodialysis patients has shown promising results in improving Hb levels. Further research is required to determine the optimal type, dosage,
and duration of vitamin D supplementation.

Aural Myiasis in the Elderly – A Case Report

2025-04-02T09:34:58+07:00

Introduction: Aural myiasis is a rare parasitic infestation in the external ear canal caused by fly larvae. It is commonly observed in tropical and subtropical regions, with risk factors including poor hygiene, chronic illnesses, and occupational exposure to environments infested with flies. Case: A 72-year-old male from a rural village presented with complaints of severe pain in his right ear, accompanied by bloody discharge, and a sensation of movement in the ear canal. Multiple removal procedures were finally succeeded in extracting all infesting larvae. The patient was treated with antibiotics, analgesics, and antiseptic irrigation. Discussion: Aural myiasis poses a health risk, especially in geriatric and rural populations. Delayed treatment can lead to extensive tissue damage and secondary infections. Conclusion: Diagnosis is made by identifying dipteran larvae in infested body parts. Comprehensive management involves mechanical removal, pharmacological treatment,and preventive education. Increased awareness among healthcare providers is essential to reduce morbidity associated with aural myiasis.

A Young Adult Woman with Heart Failure, Pneumonia, and Hypoxemia: Complications of Morbid Obesity – A Case Report

2024-12-19T18:21:11+07:00

Introduction: Heart failure is a clinical syndrome resulting from structural or functional abnormalities of the heart that cause cardinal symptoms and signs of heart failure. One of the contributing factors to increased incidence of heart failure among young people is obesity. Obesity also increases the risk of impaired lung function and other organs. Case: A 25-year-old female with shortness of breath since 1 day. Peripheral oxygen saturation (SpO2) was 80% in room air. Her body mass index was 52 kg/m2. Chest radiology showed cardiomegaly with pulmonary infiltrates and edema. Echocardiography revealed a left ventricular ejection fraction of 79.8% and mild left ventricular diastolic dysfunction. Discussion: Diagnosis was heart failure with preserved ejection fraction (HFpEF) 79.8% and pneumonia. Treatment with furosemide and antibiotics relieved the shortness of breath, congestion, and pulmonary infiltrates, yet the patient continued to experience hypoxemia in room air. Chest physiotherapy and breathing exercises were applied to improve the impaired lung function due to obesity. Conclusion: Obesity is a risk factor for heart failure in young adult population. Maintaining ideal body weight is important to prevent obesity and its complications.

Short-Term High Fiber, Diabetes-Specific Enteral Nutrition in an Elderly Patient with Type 2 Diabetes Mellitus: A Case Report

2025-07-28T13:39:10+07:00

Introduction: High-fiber diabetes-specific formulas (DSFs) are designed to support glycemic control in patients with type 2 diabetes mellitus (T2DM), particularly those requiring nutritional support. Despite their potential benefits, evidence regarding their short-term effects on blood glucose levels and insulin requirements remains limited. This case report explores the impact of an oral DSF on glycemic control in an elderly patient with T2DM over a four-day inpatient period. Case: A 70-year-old overweight woman (BMI 24.6 kg/m²) was hospitalized due to
uncontrolled hyperglycemia (HbA1c 10.6%, fasting glucose 469 mg/dL) with poor oral intake (< 50% of needs) secondary to nausea and vomiting. A standardized DSF was administered orally alongside a diabetic soft diet for 4 days. DSF was introduced at 150 mL three times daily and titrated to 200 mL twice daily, contributing to a total intake of approximately 1,500 kcal/day. Insulin doses (10 IU regular insulin three times a day) remained unchanged. Monitoring included daily fasting glucose and clinical tolerance. Fasting blood glucose decreased from 469 mg/dL on day 1 to 260 mg/dL by day 4. The patient showed improved oral intake (up to 75% of caloric needs) and better appetite without gastrointestinal complaints. No hypoglycemia episodes or insulin dose adjustments were necessary. Discussion: During the four-day observation period, fasting blood glucose decreased progressively from 469 mg/dL to 260 mg/dL without modification of insulin dosage. Oral intake improved to approximately 75% of estimated needs, and no hypoglycemic episodes or gastrointestinal intolerance were observed. The improvement in glycemic trends occurred alongside structured nutritional support and consistent insulin therapy. Conclusion: Short-term administration of a high-fiber DSF improved glycemic trends and nutritional intake in an elderly T2DM patient without adverse effects. DSF can be an effective adjunct in individualized medical nutrition therapy to support glycemic stabilization during hospitalization.

Anaphylactic Shock Due to Radiological Contrast Media - A Case Report

2026-01-23T16:39:22+07:00

Introduction: Anaphylaxis is an acute, life-threatening hypersensitivity reaction characterized by rapid onset and multisystem involvement, including the respiratory, cardiovascular, and mucocutaneous systems. Iodinated radiologic contrast media is recognized as one of the triggers of anaphylactic reactions, although the incidence is relatively low. Case: A 51 year-old male who developed anaphylactic shock after undergoing a contrast-enhanced CT scan using iohexol. One hour after the procedure, the patient experienced weakness, dyspnea, generalized rash, decreased consciousness, hypotension, oxygen desaturation, palpebral and facial edema, and cold extremities. The diagnosis was established based on clinical findings and standard diagnostic criteria for anaphylaxis. The patient’s condition improved after administration of intramuscular epinephrine (1:1000) at a dose of 0.5 mg as first-line therapy, followed by intravenous fluids, oxygen,diphenhydramine, nebulized bronchodilators, and dexamethasone. The patient was subsequently admitted to the intensive care unit for monitoring. Discussion: Anaphylaxis is a severe, acute, and potentially fatal allergic reaction resulting from the massive release of mediators from mast cells, leading to multisystem involvement. The diagnosis was established according to established criteria. Prompt management was initiated, and clinical improvement was observed following standard guideline-based therapy. Conclusion: Early recognition and rapid administration of epinephrine are key to the successful management of contrast media-induced anaphylactic shock.

Necrotizing Pneumonia: A Rare Complication of Pneumonia in Child Who Used Vape Cigarette – A Case Report

2026-02-18T09:31:23+07:00

Introduction: Necrotizing pneumonia (NP) is a severe complication of pneumonia characterized by lung parenchymal destruction, cavitation, and significant morbidity in children. It is commonly associated with virulent bacterial infections and inadequate response to initial antibiotic therapy. Certain risk factors, including exposure to cigarette smoke and electronic cigarettes (vaping), may influence immune defense mechanisms and contribute to disease severity. Case: A 15-year-old boy presented to the emergency room with shortness of breath, persistent fever, productive cough, and bloody sputum for 2 weeks. He had no history of TB contact but had used vape and smoke cigarettes regularly during the past year. Physical examination revealed tachypnea and rhonchi on auscultation. Chest radiography demonstrated
extensive consolidation, and thoracic CT scan showed cavitary lesions consistent with necrotizing pneumonia. GeneXpert sputum testing was negative for Mycobacterium tuberculosis. The diagnosis was necrotizing pneumonia (NP). Broad-spectrum antibiotics and supportive management were administered. Discussion: Early recognition of NP in children is essential to prevent complications and prolonged hospitalization. Inhalational exposures such as vaping may compromise pulmonary defense and potentially exacerbate infectious processes.
Conclusion: Necrotizing pneumonia should be suspected in children with severe pneumonia unresponsive to initial therapy. Timely diagnosis and appropriate management are critical to improving clinical outcomes. Vaping is likely to play a role in this rare complication because its chemicals can damage the pulmonary defense, making it susceptible to and potentially worsening infection. Future research and awareness towards vape health effects should be enhanced to suppress the use, especially in children.

Primary Congenital Glaucoma

2024-09-04T17:18:25+07:00

Primary congenital glaucoma is a form of glaucoma caused by abnormal development of the anterior chamber angle, particularly the trabecular meshwork, which obstructs aqueous humor outflow and leads to increased intraocular pressure. This condition is one of the leading causes of blindness in children and has long-term consequences on visual development and overall quality of life. More than 75% of primary congenital glaucoma cases are diagnosed within the first 12 months after birth; in more severe cases, the disease may already be detected at birth. Persistent elevation of intraocular pressure that is not promptly treated can result in permanent optic nerve damage, globe enlargement (buphthalmos), corneal edema and opacity, and progressive visual field defects. Diagnosis is generally established based on characteristic clinical features such as epiphora, photophobia, and blepharospasm, supported by comprehensive ophthalmologic examination. Surgical intervention remains the primary treatment approach, aiming to reduce intraocular pressure and prevent further complications. Early detection and timely management are essential to preserve visual function and prevent permanent visual impairment in affected children.

Management of Cutaneous Vasculitis

2024-09-13T14:08:46+07:00

Cutaneous vasculitis represents a heterogeneous group of inflammatory disorders characterized by inflammation of the cutaneous blood vessel walls and surrounding perivascular tissue, with highly variable clinical manifestations depending on the size and anatomical location of the affected vessels. This condition may present as a disease limited to the skin or as part of a systemic disorder. Epidemiologically, cutaneous vasculitis can occur at all ages but is more frequently observed in adults, whereas in children it is generally self-limiting, with IgA vasculitis being the most common subtype. The etiology of cutaneous vasculitis is predominantly idiopathic; however, infections, medications, autoimmune diseases, and malignancies may also contribute. The pathogenesis involves immune complex deposition and mechanisms mediated by anti-neutrophil cytoplasmic antibodies (ANCA), leading to endothelial injury and vascular inflammation. The main clinical manifestation is palpable purpura, typically distributed symmetrically on the lower extremities, accompanied by various additional skin lesions such as papules, nodules, vesicles, and ulcers. Diagnosis is established through skin biopsy, which remains the gold standard, including histopathological examination and direct immunofluorescence. Most cases are mild and resolve spontaneously; however, systemic therapy is required in severe, chronic, or recurrent conditions. Overall, the prognosis of cutaneous vasculitis is favorable, with a low risk of progression to systemic vasculitis when appropriate diagnosis and management are implemented.

The Role of AREDS2 Supplementation in Reducing the Progression of Age-Related Macular Degeneration

2025-09-03T19:26:59+07:00

Age-related macular degeneration (AMD) is a degenerative macular disease that is the leading cause of irreversible vision loss in the elderly in developed countries. The prevalence of AMD in Asian populations is 6.8% for early-stage AMD and 0.56% for late-stage AMD. Increased production of reactive oxygen species (ROS) that cannot be balanced by the retinal antioxidant system causes structural damage to the retinal pigment epithelium (RPE) layer. This damage results in RPE cell dysfunction, drusen accumulation, and disease progression to advanced stages. Antioxidant supplementation such as the AREDS2 formulation is a therapeutic option that can reduce AMD progression from intermediate to late stages. The AREDS2 formulation consists of lutein, zeaxanthin, vitamin C, vitamin E, zinc, and copper, which work through various mechanisms to protect the retina from oxidative stress, inhibit inflammation, and restore cellular function. This literature review discusses the role of AREDS2 supplementation in AMD along with the mechanism of action of each component in reducing disease progression and maintaining visual function in elderly patients.