Severe COVID-19 infection management for a recipient of kidney transplant has debatable prognosis and treatment. We described the case of a COVID-19 infected 70 year old female, previously had renal transplantation in 2017. The patient took immunosuppressive agents as routine drugs for transplant recipient status and received lopinavir/ritonavir, hydroxychloroquine, and dexamethasone daily at the hospitalization. Specific question arises about renal transplant recipients being infected by COVID-19 – whether the infection will get worse compared to those without immunosuppresive agent. In this case, author decided to stop the immunosuppressive agent followed administration of combination lopinavir/ritonavir, hydroxychloroquine, and dexamethasone that gives a good clinical impact change to patient’s condition after once getting worsened and mechanically ventilated. Nevertheless, the assessment of risk and benefit in continuing immunosuppressive drugs is concurrently essential due to the prevention of transplant rejection.
Latar Belakang. Diet ketogenik merupakan diet populer untuk menurunkan berat badan dengan efek terhadap profil lipid masih inkonsisten. Tujuan Penelitian. Menganalisis perbedaan profil lipid tikus Rattus norvegicus pada pemberian pakan ketogenik dengan komposisi lemak 80% (jenuh dan tidak jenuh), protein 15% dan karbohidrat 5% selama 4 minggu. Metodologi. Desain penelitian true experimental dengan posttest only control group design. Tikus jantan dengan berat badan 125-150 g dibagi secara random dalam 3 kelompok (P0, P1 dan P2) menerima diet 25-30 kkal/hari sesuai dengan kebutuhan energi harian tikus. P0 kelompok kontrol menerima pakan tikus biasa. P1 menerima diet ketogenik lemak jenuh dari margarin. P2 menerima diet ketogenik lemak tak jenuh dari minyak zaitun ekstra virgin. Kolesterol total, LDL, HDL dan trigliserida diperiksa pada minggu ke 2 dan 4. Data dianalisis dengan Uji t Independen dan Mann Whitney (p<0,05). Hasil. Pada P1 terdapat perbedaan kadar HDL yang signifikan (38 menjadi 22,40 mg/dL, p=0,005) namun perbedaan kadar kolesterol total, LDL dan kadar trigliserida tidak signifikan. Pada P2 didapatkan perbedaan yang signifikan pada kadar kolesterol total (93,20 menjadi 67,80 mg/dL, p=0,042), HDL (29,40 menjadi 22,20 mg/dL, p=0,004), LDL (25,60 menjadi 13,80 mg/dL, p=0,009), dan trigliserida (100,80 menjadi 51,40 mg/dL, p=0,016). Pada P0 tidak ada perbedaan yang signifikan. Kesimpulan. Diet ketogenik dengan lemak tidak jenuh selama 4 minggu menunjukkan efek yang menguntungkan dalam menurunkan kadar kolesterol total, LDL dan trigliserida pada tikus Rattus norvegicus. kata kunci: diet ketogenik, lemak jenuh, lemak tidak jenuh, kolesterol total, HDL, LDL, trigliserida
Introduction. The 2018 Riskesdas data shows that the prevalence of diabetes mellitus is increasing each year. Strobilanthes crispus leaves are known for lowering blood glucose levels. This study aimed to determine the difference in the effectiveness of S. crispus leaves ethanolic extract on fasting blood glucose (FBG) and post-oral glucose tolerance test (OGTT). Methods. True experimental study using post-test only control group design and Rattus norvegicus as experimental animals. Rattus norvegicus were selected by random sampling which were then divided into 4 groups (K, P1, P2, P3), each group consisted of 5 animals. The animals were subsequently induced with diabetes mellitus via a single injection of 160 mg/kgBW/IP alloxan. Group K was given 0.5% NaCMC solution at a dose of 1 ml/200 g BW/day/oral/day. Group P1, P2, and P3 received extract at a dose of 100, 400, 600 mg/kg BW/oral/day for 21 days using oral gavage. Statistical analysis was performed using ANOVA, Tukey, Brown-Forsythe, and Kruskal-Wallis tests. Results. Mean FBG level in group K, P1, P2, P3 were 338.40 mg/dL, 270.80 mg/dL, 200.00 mg/dL, and 138.60 mg/dL, respectively. Mean value of 60 minutes OGTT blood glucose level in group K, P1, P2, P3 were 355.60 mg/dL, 289.00 mg/dL, 188.00 mg/dL, and 164.40 mg/dL, respectively. Meanwhile, mean value of 120 minutes OGTT blood glucose level in group K, P1, P2, P3 were 346.60 mg/dL, 236.20 mg/dL, 175.40 mg/dL, and 117.20 mg/dL, respectively. The hypothesis test results showed a significant difference in 120 minutes OGTT blood glucose level (p= 0.031). Conclusion. The use of ethanol extract from S. crispus leaves is more beneficial in reducing blood glucose levels in 120 minutes OGTT compared to FBG level and 60 minutes OGTT level, with the highest reduction observed in the group given a dose of 600 mg/kgBW/oral/day compared to control.
Background: Leukemia is a hematologic malignancy that can affect all ages. In 2018, the death rate of leukemia in Indonesia reached 11,314 people. Imatinib is the first-line treatment for chronic myelocytic leukemia, which works by inhibiting the tyrosine kinase in the oncoprotein BCR-ABL. In Indonesia, the drug is the preferred therapy provided in hospitals and covered by the Social Security Administrator (BPJS). The side effects of these drugs are different from person to person, such as nausea, vomiting, headaches, indigestion, and joint pain. Compliance with taking medication is a determinant in the success of therapy, but several factors that influence compliance include age, gender, education level, and total income each month Purpose: To compare the demographic factors that affect patients with chronic myelocytic leukemia in taking drugs in the Gist and Leukemia Community Surabaya. Method: This study used a Cross-Sectional Analytic research design. This research was conducted in September-November 2020 at the Gist and Leukemia Community Surabaya. The Gist and Leukemia Community in Surabaya is a community formed for sufferers of Chronic Myelocytic Leukemia and Gist (Tumors in the Stomach). The sample size required in the study, according to the Slovin formula, is 67 respondents. The sampling technique in this study is non-probability sampling so that this figure is met. Retrieval of patient demographic data and filling out the MMAS-8 questionnaire was done by filling in the form provided by the researcher in the form of a link on the google form. After that, short structured interviews were conducted with several respondents by telephone. Result: Based on the research that has been conducted, the results obtained are 67 respondents with high levels of compliance as many as 28 respondents, 22 respondents with moderate compliance, and 17 respondents with low compliance. With the number of male sex more than female, namely 40 men and 27 women. In addition, 20 respondents were aged 50-60 years, 22 respondents were aged 40-49 years old, 17 respondents were aged 30-39 years old, and eight respondents were aged 20-29 years old. In this study, the results obtained were 28 respondents with education levels of D3 / S1 / S2 / S3, 25 respondents with education levels of high school students, and 14 respondents with education levels of junior high school students. Also obtained the results of respondents with a monthly income of less than Rp 4,200,000 more, namely as many as 44 people compared to respondents with a monthly income, more than Rp 4,200,000 as many as 23 people. After obtaining the research data, the results of hypothesis testing using the Chi-Square test with sig. p <0.05. Results sig. p <0.05 means that the variable affects medication compliance in the respondent during sig. p> 0.05 means that the variable does not affect medication compliance among respondents. The results show that the factor influencing medication compliance in patients with chronic myelocytic leukemia is the monthly income with a sig. 0.025. Meanwhile, other factors such as gender, age, and education level do not affect medication compliance in patients with chronic myelocytic leukemia with sig. > 0.05. Conclusion: In the research that has been conducted with a total of 67 respondents, it can be concluded that Chronic Myelocytic Leukemia patients who are members of the Surabaya Gist and Leukemia Community for the period September-November 2020 are still in the category of obedience in consuming Imatinib drugs. The demographic factor that affects respondents' compliance with medication is the amount of income per month.
BACKGROUND Tuberculosis (TB) remains one of the highest Asia’s health problems. Spondylitis TB in diabetes mellitus (DM) and hypothyroidism patients is a rare case of extrapulmonary tuberculosis. However, there is a lack of therapeutic guidelines to treat spondylitis TB, particularly with type 2 DM (T2DM) and hypothyroidism as comorbidities. Here we present a case of spondylitis TB with T2DM and hypothyroidism in a relatively young patient and its therapeutic procedure. CASE SUMMARY We report the case of a 35-year-old male patient from Surabaya, Indonesia. Based on anamnesis, physical examination, and magnetic resonance imaging, the patient has been categorized in stage II of spondylitis TB with grade 1 paraplegia. Surprisingly, the patient also had a high HbA1c level, high thyroid stimulating hormone, and low free T 4 (FT 4 ), which indicated T2DM and hypothyroidism. A granulomatous process was observed in the histopathological section. The antituberculosis drugs isoniazid and rifampicin were given. In addition, insulin, empagliflozin, and linagliptin were given to control hyperglycemia conditions, and also levothyroxine to control hypothyroidism. CONCLUSION The outcome was satisfactory. The patient was able to do daily activities without pain and maintained normal glycemic and thyroid levels. For such cases, we recommend the treatment of spondylitis TB by spinal surgery, together with T2DM and hypothyroidism therapies, to improve the patients’ condition. Prompt early and non-invasive diagnoses and therapy are necessary.
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