Cermin Dunia Kedokteran

The Relationship Between Obesity and Mortality in Heart Failure Patients

2025-10-09T12:24:08+07:00

Introduction: Obesity is a condition of excessive accumulation of body fat. Obesity has a greater risk of death from cardiovascular diseases. Heart failure is a clinical syndrome caused by structural and functional defects of the myocardium that result in impaired ventricular filling or blood ejection. This study was conducted to determine the relationship between obesity and mortality in heart failure patients at a teaching hospital in Yogyakarta. Methods: A cross-sectional quantitative study with an observational analytical research design from the secondary data from medical records of heart failure patients in January 2018–March 2024. Data was analyzed using Fisher’s exact test. Results: A total of 108 patients met the inclusion and exclusion criteria. Data analysis showed a p-value = 0.216 (>0.05). In this study, 61.1% of heart failure patients were male. The results showed that the mortality rate was higher in obese patients (11.1%) compared to non-obese patients (5.55%). Conclusion: There was no relationship between obesity and mortality among heart failure patients.

Several Factors Contributing to Nutritional Disorders in Children at the Maubesi Community Health Center, East Nusa Tenggara: A Retrospective Cohort Study

2025-10-09T12:28:22+07:00

Introduction: In Indonesia, the incidence of nutritional disorders (malnutrition) in children aged 0–59 months in 2023 reached 8.5%. Methods: A retrospective cohort study was conducted on 48 children in the Maubesi Health Center working area, East Nusa Tenggara, in January–June 2024 to assess the relationship between gender, birth weight and length, number of siblings, place of birth, exclusive breastfeeding, immunization status, medical history, food variation, mother’s age and education, mother’s
occupation, mother’s weight before pregnancy, mother’s Hb levels during pregnancy, mother’s history of hypertension and diabetes, and antenatal care (ANC) visits with the incidence of malnutrition and severe malnutrition. Data were obtained from the Integrated SIGIZI application, and children’s nutritional status was measured using the WHO (2006) weight-for-height chart. Results: The
analysis used Fisher’s exact test and Spearman’s rank correlation test. A significant relationship was found between the number of ANC visits and the incidence of both malnutrition and severe malnutrition (p = 0.001), which showed a weak negative correlation: r(44) = -0.139, p = 0.357. Conclusion: In this study, a negative correlation was obtained between the number of ANC visits and
the incidence of undernutrition and severe malnutrition.

Autoimmune Bullous Diseases in the Elderly

2024-09-01T19:16:12+07:00

The increase in cases of bullous diseases in the elderly is related to various factors. Aging causes a decline in skin structure and integrity, making it more susceptible to bullous diseases. This disease occurs because the aging process causes immune system dysregulation, which increases the risk of autoimmune conditions. Bullous diseases that commonly occur in the elderly are usually bullous pemphigoid (an autoimmune bullous condition) and pemphigus vulgaris (a skin disease that causes blisters), which are associated with significant morbidity and mortality. Bullous pemphigoid is characterized by tense subepidermal blisters, while pemphigus vulgaris is characterized by loose suprabasal blisters that rupture easily. Histopathological examination and direct immunofluorescence are the gold standard for diagnosis. The management of autoimmune bullous diseases in the elderly is generally the same as for bullous diseases in general, such as corticosteroids and immunosuppressive agents. However, appropriate and effective management is necessary, along with increased attention to the risks of polypharmacy and drug side effects that may cause new problems in elderly patients, including an increased risk of infection, osteoporosis, and metabolic complications.

Hyperbaric Oxygen Therapy as a Treatment for Sudden Deafness

2024-05-09T15:05:16+07:00

Sudden deafness or sudden sensorineural hearing loss is sensorineural deafness which is an ENT emergency because it can become permanent if not treated immediately. Sudden deafness is characterized by a sensorineural hearing loss of at least 30 dB within less than 72 hours. Most causes of sudden deafness are unknown (idiopathic) so treatment is empirical. The principles of managing sudden deafness are early detection, early diagnosis, and early treatment. The main treatment for sudden deafness is oral steroids, intratympanic, or a combination of both. Hyperbaric oxygen therapy (HBOT) has become a promising adjuvant therapy, working by increasing oxygenation in the perilymph and ischemic cochlear tissue. Several studies have shown that combining HBOT with steroids provides superior results compared to steroid monotherapy, especially in cases of severe deafness and if started within two weeks of symptom onset. Further research is still needed to confirm the effectiveness of hyperbaric oxygen therapy as a treatment for sudden deafness.

A Case Report of Congenital Corneal Opacity: Challenges of Keratoplasty Surgery in Children

2024-11-12T19:59:21+07:00

Introduction: Congenital corneal opacity (CCO) is a group of anterior segment dysgenesis of the eye manifested by corneal transparency loss at birth or during the first 4 weeks of life. CCO is one of the most prominent disease entities in anterior segment dysgenesis. CCO resulted from disruptions in mesodermal development, particularly affecting the anterior segment of the eye. Case:
A 2-week-old boy with bilateral CCO. One week post-keratoplasty surgery, the parents reported no complaints but had difficulty administering eye drops. Physical examination showed a clearer corneal graft. One month later, a cloudy graft and broken sutures were noted, indicating graft rejection. The family was educated on the importance of consistent medication for any future graft surgery. Discussion: The surgical option for CCO is corneal graft or keratoplasty. Keratoplasty is a corneal transplant where a clear donor graft replaces the central opaque cornea. Conclusion: A comprehensive workup is essential for diagnosing CCO. Keratoplasty can restore corneal clarity and vision, but pediatric cases require careful patient education and comprehensive follow-up.

Chronic Bilateral Earlobes Thickening: A Case Report of Irritant Contact Dermatitis Mimicking Leprosy

2024-10-08T12:04:12+07:00

Introduction: Irritant contact dermatitis (ICD) is an inflammatory cutaneous disorder induced by the breakdown of the barrier and activation of innate immune responses. In the chronic stage, plaques thicken and cause scaling, hyperkeratosis, fissures, rhagades,and/or lichenification. Case: A 34-year-old male presented with both earlobe thickening and minor numbness, particularly while
sweating or being exposed to direct sunlight. Physical examination revealed erythematous patches, as well as edema and thickness of both earlobes. Patch test and slit skin smears yielded negative findings, ruling out allergic contact dermatitis (ACD) and leprosy. The diagnosis of irritant contact dermatitis was caused by sweat and sun exposure. The treatment consisted of twice daily of
desoximethasone and mupirocin cream, and 10 mg loratadine once daily. Discussion: ICD is an inflammatory cutaneous disorder induced by the breakdown of the skin barrier and the activation of the innate immune response. Thickening and numbness of both earlobes are caused by repetitive irritation from sweat and sunlight exposure over time. Conclusion: Irritant contact dermatitis in both earlobes should be differentiated from other skin diseases, particularly leprosy.

A Case Report of Autoimmune Hemolytic Anemia with Deep Vein Thrombosis in a 16-year-old Girl - Is It Systemic Lupus Erythematosus?

2024-06-20T23:55:12+07:00

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease with various clinical manifestations. Multiorgan involvement is associated with a worse prognosis. SLE in pediatrics is rare, with an estimated incidence of 0.3–0.9 per 100,000 children. Case: A 16-year-old Asian girl was admitted with pain, swelling, and a bluish discoloration with blisters on the right leg for 6 days. She had a history of facial rash, hair loss, and oral ulcer. Doppler ultrasound showed deep vein thrombosis in the right lower extremity with acute thrombosis, with visible soft-material intraluminal thrombus. Coombs test was 4+ positive. Elevated total bilirubin 2.2 mg/dL, indirect bilirubin 0.9 mg/dL, and elevated reticulocyte 5.2%. ANA test result is borderline 0.8, and anti-DS DNA negative. CT angiography showed proximal total occlusion of the right dorsalis pedis artery, DVT along the external iliac vein, femoral vein, and popliteal vein to the proximal 1/3 of the right posterior tibial vein. Diagnosis of an autoimmune disease leading to autoimmune hemolytic anemia and deep vein thrombosis was suspected. Her condition improved after corticosteroids and anticoagulant treatment. Conclusion: A 16-year-old girl was diagnosed with autoimmune hemolytic anemia, deep vein thrombosis, and suspected systemic lupus erythematosus. Early recognition of unusual manifestations of SLE is important.

The Effect of Amino Acid Administration in Preventing Acute Kidney Injury (AKI) Following Cardiac Surgery

2024-11-25T20:23:37+07:00

Introduction: The administration of amino acids can be a safe and effective approach to reducing the risk of acute kidney injury (AKI) following cardiac surgery. Methods: In this systematic review, data were obtained from scientific databases PubMed, ProQuest, ScienceDirect, and Google Scholar, covering publications from January 1 to November 1, 2024. This systematic review analyzed 3 randomized controlled trials involving a total of 3,647 patients. Results: AKI was observed in 26.6% patients in the amino acid group compared to 31.9% in the control group (RR = 0.67; 95% CI [0.43–1.06]; I² = 52.5%; p = 0.0854). Additionally, the risk of stage 1 AKI (21.1% vs 24.5%; RR 0.86; 95% CI [0.77–0.96]; I² = 0%) and stage 3 AKI (0.15% vs 0.3%; RR 0.52; 95% CI [0.34–0.81]; I² = 0%) was significantly lower in the amino acid group. No serious adverse events were reported in the included studies. Risk of bias was assessed using the Cochrane Risk of Bias-2 (RoB2) tool, and data analysis was performed using R software. Conclusion: Findings suggest that amino acids offer clinical benefits in AKI prevention, particularly in stages 1 and 3, without increasing the risk of severe adverse effects

Vaccination as a Preventive Measure Against Foodborne Diseases in Children

2024-09-20T14:17:08+07:00

Foodborne disease is one of the disease burdens because it can lead to disability and mortality, particularly in children. Hepatitis A and typhoid are the primary causes of foodborne diseases in developing countries. Although the majority will recover, children with hepatitis A can be a source of transmission. Meanwhile, in addition to endemicity in Indonesia, antibiotic resistance to typhoid infections is rising. Vaccination is considered an economic measure to suppress the incidence and transmission of disease, as well as prevent outbreaks. To achieve the effectiveness and efficiency of vaccination, it is essential for the general practitioner to have a comprehensive understanding of the preparations, methods of use, storage, precautions, contraindications, and potential adverse effects of the vaccine. In addition, increased public awareness of the importance of vaccination and the implementation of good food hygiene are factors that support the success of foodborne disease prevention. Public education efforts through health facilities and schools need to be strengthened to expand childhood immunization coverage. Thus, it is hoped that the incidence of hepatitis A and typhoid can be significantly reduced, in line with national and global health program targets to reduce morbidity and mortality rates from vaccine-preventable diseases.

The Development of Teledermoscopy in Indonesia: A Review from a Health Law Perspective

2024-10-28T22:18:45+07:00

Teledermoscopy, as a component of telemedicine, represents an important innovation in dermatological healthcare that enhances accessibility, effectiveness, and the overall quality of medical services in Indonesia. This technology provides significant benefits, particularly for communities in regions with limited access to dermatology specialists. Law Number 17 of 2023 concerning Health and Government Regulation Number 28 of 2024 serve as the primary legal foundations supporting the implementation of teledermoscopy in Indonesia. These regulations address the legality of practice, patient data protection, information security standards, and the responsibilities of healthcare professionals and electronic system providers in delivering digital health services. Teledermoscopy
enables remote examination, diagnosis, and monitoring of skin lesions through digital dermoscopy devices connected to the national health information system. The technology accelerates diagnosis, facilitates referrals, and broadens access to dermatological care. With a robust legal framework, continuous professional training, and reliable digital infrastructure, teledermoscopy has the potential to become a strategic component in the transformation of Indonesia’s national healthcare system.

Phlebotomy in Cyanotic Adult Congenital Heart Disease

2024-01-29T11:42:18+07:00

Adult congenital heart disease is a cardiovascular condition that necessitates a comprehensive approach to medical and surgical intervention. In this condition, cyanosis results from a right-to-left shunt, which subsequently causes secondary erythrocytosis and hyperviscosity. Dehydration and iron deficiency can exacerbate the symptoms of hyperviscosity. One proposed strategy for reducing
viscosity is phlebotomy. Phlebotomy procedures should be conducted with adequate fluid replacement to prevent acute stroke. While phlebotomy can reduce red blood cell mass and serum viscosity, it should be performed judiciously and not repeatedly to avoid stroke complications. Repeated phlebotomy without appropriate indications may lead to chronic iron deficiency and microcytic erythrocytes, which paradoxically increase the risk of cerebrovascular complications. Indications for therapeutic phlebotomy include moderate to severe hyperviscosity symptoms with hematocrit levels of at least 65% in the absence of dehydration or iron deficiency.
The benefits of phlebotomy should only be considered when appropriate indications are met to achieve improved patient outcomes.

Radiological Features of Inflammatory Arthritis

2024-09-27T12:11:33+07:00

Arthritis is a common disease that often causes activity limitations. The diagnosis of inflammatory arthritis requires conventional radiography as the primary modality. Assessment of alignment (A), bone (B), cartilage loss (C), demineralization (D), erosion (E), and soft tissue swelling (S) on radiographs is necessary to differentiate the three most common inflammatory arthritides: rheumatoid
arthritis, gouty arthritis, and psoriatic arthritis (PsA). Each type of arthritis has characteristic radiological features that are important for diagnosis. Rheumatoid arthritis is characterized by marginal erosion in bare areas, periarticular osteopenia, and uniform joint space narrowing with bilateral symmetrical distribution. Gouty arthritis shows punched-out erosion with overhanging edges, tophi deposits, and normal bone mineralization. Psoriatic arthritis has characteristic marginal erosions accompanied by new bone formation, pencilin- cup deformities, and dactylitis. Understanding the differences in the radiological features of these three diseases is important for establishing an accurate diagnosis and determining appropriate therapy. The combination of radiographic examination with clinical and laboratory data is expected to improve diagnostic accuracy and reduce disease progression.