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.

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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

Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease and disturbed bacterial clearance. Vitamin D deficiency is sometimes observed in COPD patients and as significant roles in increasing inflammation of airway obstruction and systemic obstruction, increasing proinflammatory cytokine including TNF-α, reduction of bacterial clearance and increase exacerbation risk due to infection. Also, vitamin D plays significant roles in the metabolism of calcium and mineralization of bones and regulation system of immune. TNF-α also has essential roles in pathogenesis and inflammation of COPD.  Several studies that investigate the relationship between vitamin D level and serum TNF-α concentration in COPD patients are relatively uncommon, including in Indonesia. For that reason, this study aimed to assess the relationship between vitamin D level and TNF-α concentration in patients on the severity of the chronic obstructive pulmonary disease. Methods This study was a hospital-based descriptive cross-sectional study. Total samples were 50 COPD patients with the average age of older than 60 years during their enrollments at the Department of Pulmonology and Respiratory Medicine of the Dr.Wahidin Sudirohusodo General hospital  Makassar in September 2018-January 2019. All procedures of the present study were reviewed and approved by the Research Ethics Committee of Medicine Faculty of Hasanuddin University. The severity of COPD was assessed according to the combination of COPD assessment stages that referred to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guideline 2015 that consisted of the combination of scoring COPD Assessment Test (CAT), the modified Medical Research Council (mMRC) questionnaire and results of the spirometric measurement. Assessment of airway obstruction levels referred to the GOLD spirometric criteria. Determination of thoracic photographs was conducted to verify the COPD diagnosis of the severity of COPD. Determination of serum TNF-α concentration and vitamin D3 [1,25(OH)2D3] level used the ELISA method. Results  The majority of COPD patients were observed in the category of older than 60 years old accounted for 34 COPD patients (68%), and the majority of COPD patients were males accounted for 47 males with COPD (94%). The majority of COPD patients were observed in the group of D (38%). All the study subjects observed in this study were smokers, and 82% of them were in the category of heavy smokers. 21 study subjects had higher concentration of serum TNF-α  (tertile 3 = 0.21-1.83 pg/dl), 20 study subjects  and lower level of vitamin D (tertile 1 = 182.1-364.5 pg/dl). The majority of the study subjects (38%) were in the category of severe COPD (category D of the severity of COPD at the tertile 3) according to the GOLD Combine Assessment. In view of the relationship between vitamin D level and serum TNF-α concentration on the airway obstruction, there were significant positive correlations between the increase of vitamin D levels and the increase of serum TNF-α concentrations on airway obstruction. In view of the relationship between vitamin D level and serum TNF-α concentration on the severity of COPD, there were significant positive correlations between the increase of vitamin D levels (tertiles 1, 2 and 3) and the increase of serum TNF-α concentrations on the severity of COPD at p-value<0.05. Overall, there were non-linear relationships between vitamin D level and serum TNF-α concentration on the severity of COPD. Conclusions: Serum TNF-α concentration was positively associated with airway obstruction level and severity of COPD. Low level of vitamin D was negatively associated with airway obstruction level and severity of COPD. Vitamin D3 level (1,25(OH)2D) was negatively associated with serum TNF-α concentration and airway obstruction level and severity of COPD.

In patients with stable coronary artery disease (CAD), secretory phospholipase A2 (sPLA2) is commonly increased and acts as a good prognosticator for the future cardiovascular events.1,2 Even a single test of plasma sPLA2 activity in those with acute coronary syndromes (ACS) would indicate an important scientific information regarding prediction for the next cardiovascular events.3 Phospholipase A2 enzymes hydrolyze phospholipids at the sn-2 position to produce lysophospholipids and fatty acids. 4 This enzyme produces isoprostanes, a prostaglandin-like compound formed in vivo from the free radical-catalyzed peroxidation of essential fatty acids, which has strong mitogenic activity. It induces thrombocyte aggregation and vasoconstriction 5 and possibly stimulates acute inflammatory response. In the future, a promising inhibitor of this enzyme activity would be an evolving new therapy in atherosclerosis. Serum amyloid-A (SAA) is a family of proteins that form a major component of the acute-phase inflammatory Keywords ► acute coronary syndromes ► secretory phospholipase A2 ► myeloperoxidase ► serum amyloid-A ► coronary heart disease ► case-control study ► odds ratio AbstractIn coronary heart disease (CHD), levels of secretory phospholipase A2 (sPLA2) are commonly increased. Serum amyloid-A (SAA) is increased in acute coronary syndromes (ACS) as well. It is needed to verify the hypotheses that sPLA2 is associated with the odds of ACS through elevation of SAA. We conducted a case-control study with 57 male patients with ACS and 30 controls matched by gender category. Levels of sPLA2, SAA, and myeloperoxidase (MPO) were measured by immunoreactive assay on the basis of a double-antibody sandwich technique. Levels of sPLA2, MPO, and SAA were significantly higher in patients than those in controls (11,359.0 AE 10,372.4 pg/mL vs. 1,320.5 AE 654.5 pg/mL, p ¼ 0.00; 438.6 AE 310.7 ng/mL vs. 271.1 AE 176.8 ng/mL, p ¼ 0.01; 10,995.2 AE 2,842.6 ng/mL vs. 3,861.7 AE 3,173.5 ng/mL, p ¼ 0.00). There were significant correlations between age, visceral obesity, MPO, sPLA2, and SAA (r ¼ 0.43; p ¼ 0.00; r ¼ 0.30; p ¼ 0.00; r ¼ 0.28; p ¼ 0.00 and r ¼ 0.53; p ¼ 0.00). On multivariate logistic regression analyses, there were significant and independent associations between sPLA2 and SAA with odds of ACS [OR (95% CI) ¼ 14.2 (2.1 to 98.6), p ¼ 0.00; OR (95% CI) ¼ 44.9 (6.9 to 328.4), p ¼ 0.00]. Our findings suggest that sPLA2 may be associated with the odds of ACS compared with controls through increased inflammation, represented by elevated SAA.

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