Background and aims: Millions of people in Indonesia have diabetes. The cluster of metabolic abnormalities has long been identified as the risk factors for type 2 diabetes and is now commonly described as metabolic syndrome/MetS. Insulin resistance takes a key role in the process of the MetS and has even been hypothesized as its underlying cause. Clinical and epidemiologic studies also indicate that inflammatory factors might be correlated with IR. Prospective studies have proved that metabolic syndrome grows during childhood/adolescence and progresses to adulthood T2DM. The purpose of this study was to investigate relationships between metabolic syndrome components and low-grade systemic inflammation with insulin resistance in non-diabetic Indonesian adolescent male. Methods: This was a cross-sectional analysis of non-diabetic adolescent male in Indonesian population (n ¼ 128) aged between 18 and 22 years old. MetS components are based on NCEP ATP III (2004) modification for Asia Pacific population. Marker for low-grade systemic inflammation is hsCRP and insulin resistance was determined by HOMA-IR formula. Relevant measures were anthropometry, blood pressure, fasting insulin, serum glucose, lipid profiles and hsCRP. Results: Of the 128 adolescent male, we found that 16 subjects (12.5%) have central obesity; 3 subjects (2.3%) have hyperglycemia; 26 subjects (20.3%) have low HDL-c; 19 subjects (14.8%) have high triacylglycerol; 45 subjects (35.2%) have hsCRP 1.0 mg/dL; 4 subjects (3.1%) have high blood pressure and 39 subjects (30.5%) have insulin resistance. The association of MetS components with the risk of insulin resistance is central obesity and high triacylglycerol with OR of 24.4 (95%CI: 5.19e114.42) and 9.4 (95%CI: 3.09e28.68) consecutively. We also found that low-grade systemic inflammation (hsCRP 1.0 mg/dL) was strongly associated with incident of insulin resistance with OR 5.2 (95%CI: 2.31e11.64). Meanwhile, we found that high triacylglycerol level is the solely one of five MetS components which has contribution to the incident of systemic low-grade inflammation with OR 3.9 (95%CI: 1.43e10.92). Conclusion: Central obesity and high triacylglycerol level are the important MetS components associated with IR. Systemic low-grade inflammation has been associated with insulin resistance. Identification of obesity, high triacylglycerol and high hsCRP should be focused for prevention of type 2 diabetes in nondiabetic Indonesian adolescent male.

A case of male, 34 years old with a diagnosis of immunodeficiency syndrome resulting from HIV infection with suspected pneumonia in the differential diagnosis of pulmonary tuberculosis relapse, in the course of the disease, patients experienced hypersensitivity reactions to some antibiotics and antituberculosis drugs. Hypersensitivity reactions were exaggerated by immune response to an allergen in a normal immune system. In this case, we found the drug hypersensitivity reactions in patients with immunodeficiency. Until now, the exact underlying mechanism is not fully known but may be due to multifactorial and the dysregulation of the immune system due to HIV infection.

No abstract

Background: Obesity is strongly associated with atherogenic dyslipidemia phenotype and is an independent risk factor of cardiovascular disease (CVD). Besides body mass index (BMI), there are various obesity indices, namely waist circumference (WC) to detect central obesity, and percentage of body fat (%BF) using bioimpedance analysis (BIA) to detect peripheral-central obesity. The aim of this study is to determine which obesity index is better in predicting dyslipidemia. Methods:This cross-sectional study involved 99 professionally active doctors working at tertiary hospital, from January to March 2021. Obesity was measured by obesity indices such as BMI, WC, and %BF using BIA. After that, the serum lipid profile was then measured. Dyslipidemia is a disorder of lipoprotein metabolism, including lipoprotein overproduction or deficiency that may be manifested by high total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and low high-density lipoprotein cholesterol (HDL) cholesterol. Results:Of the total 99 subjects, 49.5% were male, while 50.5% were female. The prevalence of obesity based on BMI, WC, and %BF using BIA was 57.6%, 74.8%, and 72.7%, respectively. Obesity based on BMI has 9.8 times the risk of having low HDL cholesterol levels (odds ratio (OR) = 9.814, 95% confidence interval (CI): 1.213 -79.379) and 4.6 times of having high triglycerides levels (OR = 4.618,). Meanwhile, central obesity based on WC has 3.1 times the risk of having high LDL cholesterol levels (OR = 3.100, 95% CI: 1.170 -8.218). On the contrary, the results of the analysis on obesity based on %BF on lipid profile were not significant.Conclusions: Obesity based on BMI and WC measurements are better than %BF in predicting dyslipidemia.

Background: The calcium in the artery was thought to be the result of the imbalance or dysregulation of the promoter and inhibitor cytokines influenced by various subclinical and clinical conditions. This study aimed to investigate the interaction between central obesity, as an early subclinical condition, also known as a chronic low grade inflammation condition and coronary artery calcium (CAC) in non-diabetic population including the underlying pathomechanisms of a CAC in the early stage of atherosclerosis.Materials and Methods: This was a cross-sectional pathway analysis study enrolling 60 central obesity non-diabetic men that underwent coronary calcium score scan, anthropometrics and biomarker assays.Results: There was a positive correlation between increasing free leptin index/adiponectin (FLI/A) ratio and CAC (r=0.297; p<0.05). There was a positive correlation between increasing FLI/A ratio and plasma high sensitive C-reactive protein (hs-CRP) (r=0.318; p<0.05). Plasma hs-CRP and bone morphogenetic protein-2 (BMP-2)-matrix gla protein (MGP) dysregulation were positively correlated (r=0.221; p<0.05) after adjusted to risk factors including insulin resistance, hypertension, age, and dyslipidemia.Conclusion: The study found that one of the pathways involved in CAC in the centrally obese non-diabetic male is might be due to an increase of free leptin and decrease of adiponectin. The free leptin and adiponection ratio also increased hs-CRP, which partially correlated to the dysregulation of BMP-2 and MGP.Keywords: coronary artery calcification, central obesity, adipokines, bone regulator protein, pathomechanism