Indonesian Journal of Biomedicine and Clinical Sciences

Current topics in human varicella infection: Pearls and challenges

Luthvia Annisa — 2024-10-14

Varicella zoster virus (VZV), an alphaherpesvirus, is a highly contagious and neurotropic virus infecting the majority of the adult and pediatric population worldwide. Varicella zoster virus is the only human herpesvirus for which a licensed live attenuated vaccine has been developed. It can be considered that additional study on VZV is superfluous given the significant success of the VZV vaccines. This has been the case for other viruses including rubella and measles, for which effective vaccinations are widely available. Contrarily, much regarding VZV, a complex and chronic human disease due to its latency, still needs to be uncovered. Over the past two decades, our understanding of the molecular biology of VZV and its pathogenicity has expanded. In this review, we discussed our recent understanding of VZV biology, pathogenesis as well as its clinical aspect, including diagnosis, clinical management, and vaccine development.

Neuro-ophthalmologic manifestations of COVID-19: a review

Indra Tri Mahayana — 2024-10-14

Several mechanisms for the pathogenesis of COVID-19 have been proposed. These are direct viral toxicity, endothelial cell damage and thromboinflammation, dysregulated immune response, and renin-angiotensin-aldosterone system (RAAS) dysregulation. The ophthalmic manifestations of COVID-19 vary, affecting the anterior, posterior, and neuro-ophthalmic components. However, the relationship between COVID-19 and neuro-ophthalmologic presentations is limited. This literature review focuses on discussing these manifestations. A manual search was performed using the following keywords “neuro-ophthalmology”, “ocular”, “manifestations”, COVID-19, and coronavirus. The searches were conducted in PubMed and Google Scholar, where any study type and online publications were included. The most common ocular manifestation found in COVID-19 patients is conjunctival involvement. Some reported neuro-ophthalmic manifestations of COVID-19 are papillophlebitis, optic neuritis, cranial nerve palsies, Miller Fisher syndrome, Tolosa-Hunt syndrome, Adie’s tonic pupil, and internuclear ophthalmoplegia. A physician should examine the presence of diplopia, pain during eye movement, declining vision, or any other neurological symptoms. Therefore, it is essential to perform a comprehensive eye examination which includes visual acuity, pupillary response, ocular motility, ptosis, and optic disc examination. Additional tests such as neuroimaging or angiography might be performed to detect cerebral infarction or any other abnormalities when necessary. It is vital to be vigilant and consider COVID-19 as one of the possible causes of disease during this pandemic.

Toxoplasma encephalitis in HIV/AIDS patients in Prof. Dr. I.G.N.G. Ngoerah General Hospital, Bali, Indonesia

Anak Agung Ayu Suryapraba — 2024-10-15

Toxoplasma gondii, an opportunistic infection in HIV/AIDS patients, is an obligate intracellular parasite that causes toxoplasma encephalitis (TE). The symptoms of TE range from subacute focal or global neurologic impairments to neuropsychiatric disorder, and infectious mass lesions. In clinical practice, presumptive diagnosis, including clinical syndrome, finding single or multiple brain lesions on neuroimaging evaluation are preferred. This study aimed to identify neurologic and radiologic characteristics of HIV/AIDS patients with TE in Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali. It was a retrospective study using medical records of patients with TE from January 2018 to December 2021. Of 122 subjects, 66.4% were male and 33.6% were female, age ranged from 19-59 y.o. with a median of age 33 y.o., and the CD4 count median was 29.5 cell/mm3. Decreased consciousness was the most prevalent clinical symptom in 40.2% of subjects followed by headache in 18.9% of subjects. A structural lesion in neuroimaging was primarily found in the basal ganglia area of the brain (44.3%). The fatality rate (30.3%) was significantly associated with decreased consciousness, higher leukocyte levels, and a higher neutrophil-to-lymphocyte ratio (p<0.05). Diagnosis of TE should be considered in immunocompromised young adults with subacute onset of focal and/or global neurological deficit and neuroimaging results showing hypodense lesion, particularly with ring-like enhancement, in the
basal ganglia and corticomedullary junction area of the brain. An altered state of consciousness and NLR can indicate poor outcomes in HIV/AIDS patients with TE.

The role of toxoplasma, rubella, cytomegalo virus, herpes virus infection as a risk factor for sensory hearing loss in children

Bambang Udji Djoko Rianto — 2024-12-03

Toxoplasma, rubella, cytomegalovirus and herpes virus infection (TORCH) are syndromes that are considered risk factors for deafness.. This study aims to prove the risk factors which play the most significant role in the incidence of Sensory Hearing Loss in children. This used a case-control design, conducted at JIH Yogyakarta Hospital started from December 2023 to June 2024. All participants aged less than 5 years underwent oto-acoustic emission (OAE) examination, then determined presence or absence toxoplasma, rubella, cytomegalovirus and herpes virus using the electrochemiluminescence immunoassay (ECLIA) method. The inclusion criteria for the case group were: 1) patients diagnosed with sensory hearing loss (SHL), while the control group was normal. The exclusion criteria for the case and control groups there were non-infectious risk factors. Based on a type I error of 5% and type II error of 20%. The recommended sample size is 18 samples per group. Statistical analysis used stratified statistical analysis. The results of this study show that the combination of rubella + CMV had the greatest odds ratio (OR: 8) of sensory hearing loss, CMV OR: 0.62, herpes simplex virus OR: 0.28, combination of rubella + herpes simplex virus OR: 0.28, toxoplasma + CMV OR: 0.28, rubella obtained OR: 1 .5, and the combination of rubella + CMV + herpes simplex virus OR: 0.1. Based on these results the combination of rubella + CMV had the greatest OR compared to the combination of other risk factors and single risk factor.

Outcome of intravesical doxorubicin installation in T1 non muscle invasive bladder cancer: experience from a tertiary hospital in Indonesia

Adhika Restanto Purnomo — 2024-12-11

In Indonesia, the proportion of non-muscle bladder cancer is low compared to other countries. Doxorubicin is currently one of options for adjuvant therapy for nonmuscle invasive bladder (NMIBC) that underwent transurethral resection of bladder tumor (TURBT). This study is aimed to evaluate the oncological outcome of doxorubicin intravesical. Eight consecutive T1 bladder patients who underwent TURBT with complete tumor resection, and received intravesical chemotherapy were enrolled in this study. All the clinical data were gathered retrospectively. One of eight patients did not respond to intravesical doxorubicin instillation. Patients were recorded with univocal, low grade and female patients. In conclusion, doxorubicin intravesical may be one of options. Despite a small number of samples were enrolled. This preliminary data showed promising results on intravesical doxorubicin instillation.

Association between chemotherapy-related cardiac dysfunction (CTRCD) and 6-minute walking distance (6MWD) in breast cancer patient receiving anthracycline-based chemotherapy

Putri Ayudhia Trisnasari — 2024-12-12

Anthracycline chemotherapy is one of the most commonly given therapies to breast cancer patients. Anthracycline has a cardiotoxicity effect causing cardiac myocyte death. This chemotherapy-related cardiac dysfunction (CTRCD) will decrease oxygen delivery to tissues characterized by reduced cardiorespiratory fitness. The 6-min walking distance (6MWD) could be a predictor of cardiorespiratory fitness. This study aimed to investigate the association between CTRCD and the reduction in 6MWD after receiving anthracycline-based chemotherapy. It was an analytical observational study with a retrospective cohort design that conducted on breast cancer patients underwent anthracycline-based chemotherapy. Subjects were patients from the Cardio-oncocare registry who met the inclusion and exclusion criteria. The CTRCD was assessed using left ventricle ejection fraction (LVEF) and global longitudinal strain (LVGLS) by transthoracic echocardiography examination based on criteria from the European Society of Cardiology guidelines. The 6MWD was assessed by performing 6-min walking tests. The LVEF, LVGLS and 6MWD data were retrieved from the Cardio-oncocare registry database, which were performed before and after chemotherapy. The changes and association of LVEF, LVGLS and 6MWD from before to end of chemotherapy were analyzed. Of 250 Cardio-oncocare registered patients, 58 patients met the criteria. Among them, 17 patients (29%) had CTRCD, and 41 patients (71%) had no CTRCD after chemotherapy. A significant decrease in LVEF and LVGLS in patients with CTRCD was observed. The 6MWD before chemotherapy did not statistically differ between CTRCD and no CTRCD patients. After chemotherapy, the proportion of patients experienced reduction of 6MWD was not significantly different between CTRCD patients and no CTRCD patients [7 patients (41%) vs. 21 patients (51%); p=0.342]. In conclusion, there is no significant association between CTRCD and reduction of 6MWD in breast cancer patients receiving antracycline-based chemotherapy.

Triple valve replacement on rheumatic heart disease patient: a case report

Haryo Aribowo — 2024-12-19

Triple valve replacement surgery is a complex, open-heart surgery to permanently replace all three heart valves (mitral, aorta, and tricuspid) in situations such as valvular diseases as complications of rheumatic heart disease. The expected outcome of the surgery is the proper functioning of the heart valves and the improvement of intracardiac blood flow. Triple valve replacement surgery is still considered a challenging procedure to be performed in developing countries including Indonesia due to its complexity and difficulties. The procedure needs a capable surgeon followed by the prolonged use of cardiopulmonary bypass machines and aortic cross-clamping procedures. This study presented the result of a successful triple valve replacement surgery on a 45 y.o. female with rheumatic heart disease who has manifested into cardiac valve complications. Follow-up examinations conducted directly after surgery, on the 1^st, 8^th postoperative day, and six months after discharge showed the desired outcome of well-functioning mechanical valves and normal global systolic function of the left ventricle, without significant postoperative cardiac events and complications. The result indicated that triple valve replacement surgery is a safe and effective procedure for rheumatic heart disease patients requiring surgical replacement of all three heart valves, encouraging more implementation of this procedure.

The effect of fluid restriction monitoring guidelines using the Heart Failure Self-Care Application (Aplikasi Perawatan Mandiri Heart Failure/ATRIA) on reducing risk of fluid retention in heart failure patients at Dr. Saiful Anwar Hospital Malang

Ghazyarda Aqilah Setya — 2024-12-20

Heart failure patients are often at risk of rehospitalization due to recurrent symptoms such as dyspnea, edema, pulmonary congestion, and rapid weight gain resulting from fluid retention. This study aimed to analyze the impact of guided fluid restriction using the ATRIA application on risk of fluid retention in heart failure patients. The quasi-experimental method was used with a posttestonly control group design. Simple random sampling was carried out to select respondents, with the intervention group given the ATRIA application and the control group receiving a booklet intervention. The study duration was four weeks, with 16 respondents in the intervention group and 15 respondents in the control from Dr. Saiful Anwar Hospital, Malang. Data analysis used an independent sample t-test to assess differences in body and weekly weight changes. The results
showed no significant difference in body weight between the intervention and control groups each week (p > 0.05). Similarly, there was no significant difference change in body weight between the two groups (p > 0.05). In conclusion, there is no distinction observed between the ATRIA application and booklet concerning fluid restriction guidelines for reducing risk of fluid retention in heart failure patients. The results suggested that nurses could provide educational services and monitor the condition of heart failure patients using either application or booklet. Future studies are recommended to analyze factors that might impact fluid retention in heart failure patient.