Background: Abrupt implementation of lockdowns during the coronavirus disease 2019 (COVID-19) pandemic affected the management of diabetes mellitus in patients worldwide. Limited access to health facilities and lifestyle changes potentially affected metabolic parameters in patients at risk. We conducted a meta-analysis to determine any differences in the control of metabolic parameters in patients with diabetes, before and during lockdown. Methods: We performed searches of five databases. Meta-analyses were carried out using random-or fixed-effect approaches to glycaemic control parameters as the primary outcome: glycosylated hemoglobin (HbA1c), random blood glucose (RBG), fasting blood glucose (FBG), time-in-range (TIR), time-above-range (TAR), time-below-range (TBR). Mean difference (MD), confidence interval (CI), and P value were calculated. Lipid profile was a secondary outcome and is presented as a descriptive analysis. Results: Twenty-one studies enrolling a total of 3,992 patients with type 1 or type 2 diabetes mellitus (T1DM or T2DM) were included in the study. Patients with T1DM showed a significant improvement of TIR and TAR (MD=3.52% [95% CI, 0.29 to 6.74], I 2 =76%, P=0.03; MD=-3.36% [95% CI, -6.48 to -0.25], I 2 =75%, P=0.03), while FBG among patients with T2DM significantly worsened (MD=3.47 mg/dL [95% CI, 1.22 to 5.73], I 2 =0%, P<0.01). No significant difference was found in HbA1c, RBG, and TBR. Use of continuous glucose monitoring in T1DM facilitated good glycaemic control. Significant deterioration of lipid parameters during lockdown, particularly triglyceride, was observed. Conclusion: Implementation of lockdowns during the COVID-19 pandemic did not worsen glycaemic control in patients with diabetes. Other metabolic parameters improved during lockdown, though lipid parameters, particularly triglyceride, worsened.

Critical Limb Ischemia (CLI) is a clinical syndrome in the form of ischemic pain, especially at rest or a tissue loss condition, such as an ulcer or gangrene that does not heal, associated with Peripheral Arterial Disease (PAD). Diabetes mellitus (DM) accelerates atherosclerosis and becomes one of the risks of PAD. It is also known to accelerate the worsening of PAD with a 4x greater risk of developing CLI compared to patients without DM. At the other side, 60-95% of patients who are operated on as a result of limb ischemia are diagnosed with atrial fibrillation (AF). This paper is a case report regarding a patient with CLI as a complication of DM and AF.

Obesity has become an epidemic around the world. High fat diet (HFD) have been implemented as one of intervention to battle obesity. Uncouple protein 1 (UCP1) is one of the key factor on energy expenditure. The aim of this experiment is to see the macronutrients composition on weight loss and UCP1 expression in the visceral fat. Fifty male mice, 2-3 months old, 18-30 grams, were put in five different groups. K1 (20% protein, 62.0% carbohydrate, 12% fat), K2 (60% protein, 0% carbohydrate, 30% fat), K3 (45% protein, 0% carbohydrate, 45% fat), K4 (30% protein, 0% carbohydrate, 60% fat), K5 (15% protein, 0% carbohydrate, 75% fat). The experiment was done in four weeks, mice body weight was measured every week. UCP1 expression seen using immunohistochemistry staining was measured at the end of the fourth week. Significant weight loss was achieved by K4 (-9.60±3.81) gram by the end of week four (p<0.05). K4 had the least amount of visceral fat. The result was that K4 achieved a significant visceral fat mass (0.02±0.06) gram compared to K1 (0.53±0.08) gram. Compared to other groups K5 expressed UCP1 more than the others (3.78±3.72) cphfp. HFD fed groups produced significant weight loss, group that had the greatest weight loss is K4. Meanwhile, each group had a variety of UCP1 expression.

Diabetes mellitus increases the risk of infection, including Fournier’s gangrene. Fournier’s gangrene (FG) is a rare case, with an average incidence of 1.6 cases per 100,000 population per year. We report a case of a 60 year old male, presented with the history of wounds of the buttocks, penis and scrotum. The patient had a history of uncontrolled diabetes mellitus for 3 years. There were perianal abscesses and necrotic tissue on the penis and scrotum. Radiological evaluation in the patient showed the present of gas forming in scrotal area. Therefore, incision and drainage procedure with necrotomy and debridement were performed, together with antibiotics and blood glucose regulation, then followed by closure of the defect with skin graft and use of flap. The patient was discharge with an improved clinical condition.

Weight-bearing Exercise for Better Balance (WEBB) is an exercise method to improve balance and leg muscle strength. It was previously shown that WEBB has a significant effect on balance and lower extremity muscle strength, however, there is no scientific evidence of the WEBB program’s effect on muscle activation. This study examines the effect of the Weight-Bearing Exercise for Better Balance (WEBB) program by telerehabilitation on the activation of the Tibialis anterior (TA) and Gastrocnemius medialis (GM) muscles in obese men. To the best authors’ knowledge, this research is the first study conducted to provide a WEBB program intervention by telerehabilitation. 10 healthy men with grade 2 obesity (BMI≥30 kg/cm2) participated in this study and received a telerehabilitation WEBB program intervention for 8 weeks. GM and TA muscle activation are assessed by looking at the amplitude value and amplitude normalization of the muscle Maximal Voluntary Isometric Contraction (%MVIC) when performing closed eyes One Leg Stance (OLS) test through recording with sEMG examination. This study found that there was a significant effect on the amplitude value of the right GM (p=0,040) and %MVIC of the left TA (p=0,037) muscles after 8 weeks WEBB program by telerehabilitation.

Patients   with   thyroid   dysfunction   are   well   represented   in   the general   population. Hyperthyroidism can develop as a paraneoplastic syndrome in germ cell tumors. Testicular seminoma as a form of germ cell tumors, can express human chorionic gonadotropin (hCG). Beta-hCG strongly resembles TSH. A 26-year-old male with a history of cryptorchidism, came to Dr. Soetomo Hospital with the complaints of palpitation, diarrhea, weight loss, fatigue,  nervousness,  excessive  sweating,  and  heat intolerance.  He  also  complained  of enlarged breast and a palpable mass in lower abdomen for 4 months. From the TSH and FT4 examinations, patient’s symptoms were in accordance with thyrotoxicosis. Anti-TPO and thyroid USG examination were within normal limits. Patient was treated with beta-blocker and thiamazole. Histopathology of abdominal mass showed a testicular seminoma. After surgery and chemoterapy, the clinical symptoms of hyperthyroidism gradually improved. Administration of beta-blocker and thiamazole was stopped in 4 months after surgery. Many of germ cell tumors in male are associated with cryptorchidism, half of them being testicular seminoma. Seminoma expresses hCG.  At  very high levels, hCG can stimulate the TSH receptors,  causing  hyperthyroidism  or  thyrotoxicosis.  TSH  and  FT4  measurement  were needed in patient with suspected hyperthyroidism. Anti-TPO test is performed to exclude autoimmune cause of thyroid disease. Symptomatic management of beta-hCG induced hyperthyroidism is not different from hyperthyroidism in general, namely administration of beta-blocker  and  anti-thyroid  drugs.  However,  the  definitive  treatments  are  surgery and chemotherapy. Hyperthyroidism in germ cell tumors almost all responds well to surgery and chemotherapy.Patients   with   thyroid   dysfunction   are   well   represented   in   the   general   population. Hyperthyroidismcandevelopasaparaneoplasticsyndromeingermcelltumors.Testicularseminomaasaformofgermcelltumors,canexpresshumanchorionicgonadotropin(hCG). Beta-hCGstronglyresemblesTSH.A26-year-oldmalewithahistoryofcryptorchidism,cametoDr.SoetomoHospitalwiththecomplaintsofpalpitation,diarrhea,weightloss, fatigue,  nervousness,  excessive  sweating,  and  heat  intolerance.  He  also  complained  ofenlargedbreastandapalpablemassinlowerabdomenfor4months.FromtheTSHandFT4examinations,patient’ssymptomswereinaccordancewiththyrotoxicosis.Anti-TPOandthyroidUSGexaminationwerewithinnormallimits.Patientwastreatedwithbeta-blocker andthiamazole.Histopathology ofabdominal massshowedatesticularseminoma.After surgery andchemoterapy,theclinicalsymptomsofhyperthyroidismgraduallyimproved. Administration ofbeta-blockerand thiamazolewasstoppedin 4monthsaftersurgery.Many ofgermcelltumorsin maleareassociatedwith cryptorchidism,halfofthembeing testicular seminoma.SeminomaexpresseshCG.  At  veryhighlevels,hCGcanstimulatetheTSH receptors,  causing  hyperthyroidism  or  thyrotoxicosis.  TSH  and  FT4  measurement  were neededin patientwithsuspectedhyperthyroidism.Anti-TPOtestisperformedtoexclude autoimmunecauseof thyroiddisease. Symptomaticmanagementof beta-hCGinduced hyperthyroidismisnotdifferentfromhyperthyroidismingeneral,namely administrationof beta-blocker  and  anti-thyroid  drugs.  However,  the  definitive  treatments  are  surgeryand chemotherapy.Hyperthyroidismingermcell tumorsalmostall respondswelltosurgery and chemotherapy.

Background: A diabetic foot ulcer is a complication that often occurs in patients with diabetes mellitus. The healing process of a chronic wound is more complicated and requires more complex treatment. There is an increase in IL-1, IL6, and TNF-α pro-inflammatory cytokines in a chronic wound. Hyaluronic acid (HA) is a component that has been used for a long time and is known to help the wound healing process. This study was at a time to determine the effectiveness of hyaluronic acid on the reduction of interleukin-6 in accelerating the healing of Wagner II-III diabetic foot ulcers. Methods: This study is an experimental, randomized study of pre and post-test design on diabetic foot ulcer patients with the Wagner II-III classification who were controlled at the thoracic, cardiac, and vascular surgery polyclinic at Dr. Soetomo Hospital Surabaya. Data were analyzed using SPSS version 20 for Windows. Result: About 39 samples are willing to participate in the study, divided into 20 samples in the treatment group and 19 in the control group. The mean concentrations of IL-6 in the treatment group before and after the intervention were 280.70±155.50 ng/ml and 126.60±145.60 ng/ml. There was a significant decrease in IL-6 levels (p<0.05) before and after the intervention. The mean concentrations of IL-6 in the control group pre and post were 315.20±127.40 ng/ml and 136.30±134.60 (p<0.05). The decrease in the control and treatment groups was no statistically significant difference (p>0.05). There was no significant difference in the PUSH Score (p>0.05) in the two groups before intervention/treatment. The decrease of wound area in the control and treatment groups were -4.80 ((-0.40)-(-24.50)) and -4.8 ((-0.70)-(-30.90)) (p>0.05). Conclusion: Topical hyaluronic acid and wound care using 0.9% NaCl reduced interleukin-6 levels, PUSH scores, and wound area in Wagner II-III diabetic foot ulcers.

Introduction: Diabetic ketoacidosis (DKA) is a complication of diabetes mellitus which has a high risk of mortality. Mortality in DKA patients in developed countries is less than 5%, some other sources mention 5-10%, 2-10%, or 9-10%. Mortality events at clinics with simple facilities and elderly patients can reach 25-50%. The mortality rate of DKA patients is generally higher in infection conditions, especially in developing countries and in septic patients. Several factors such as age, sex, and high blood glucose can increase mortality risk of DKA patients. Other risk factors such as history of discontinued insulin therapy, impaired bicarbonate levels, pH, and increased leukocytes of DKA patients due to infection, abnormal albumin levels, electrolyte disturbances, and Serum Creatinine (SK) were thought to affect mortality of DKA patients. The purpose of this study was to determine the risk factors associated with mortality of DKA patients in Dr. Soetomo General Hospital Surabaya. Methods: The method used in this study was observational analytic involving 63 adult patients diagnosed with DKA with analysis using Chi-Square test. Results: From 63 patients included in this study, 37 patients diagnosed with DKA died and 26 patients lived. In a multivariate analysis, DKA severity with p = 0.001 (p < 0.005) was identified as having a relationship with mortality of DKA patients Dr. Soetomo General Hospital Surabaya. Conclusion: Severity is the only risk factor associated with mortality of DKA patients in Dr. Soetomo General Hospital Surabaya.