Agranulocytosis Induced by Antithyroid Drug (Propiltyourasil): A Rare Case

Antithyroid drugs can cause agranulocytosis in 0.2-0.5% of cases of Graves\u27 disease, which can be life-threatening. Although rare, prompt management is crucial for a good outcome. A 41-year-old woman presented to the emergency department in March 2023 with complaints of fever, odynophagia, cough, nausea, vomiting, and weight loss. She had been diagnosed with hyperthyroidism in 2015 and was prescribed thiamazole 5mg once daily. She was declared cured in 2018. In February 2023, she was hospitalized for heart failure and diagnosed with Graves\u27 disease. She was discharged with PTU 100mg three times daily. After two weeks of PTU treatment, the patient developed symptoms of agranulocytosis. Laboratory tests showed low white blood cell count and abnormal thyroid function. PTU therapy was discontinued, and the patient was treated with SC GCSF 300mg once daily, IV Ceftriaxone 1g twice daily, IV Ciprofloxacin 400mg twice daily, PO Propranolol 40mg three times daily with a target heart rate <90 beats per minute, and PO Thiamazole 5mg once daily initiation again because there is no side efect at previous medication with the same regiment and the alternative treatment such as iodine radioactive and surgery did not perform yet. Although initially the ANC was low, the patient\u27s condition improved, and she was discharged after 13 days of treatment with normal laboratory results. Follow-up outpatient monitoring showed continued improvement. Accurate diagnosis and appropriate management are crucial in handling agranulocytosis induced by antithyroid drugs, which can significantly improve treatment outcomes and the patient\u27s prognosis

Analysis of the Impact of Neoadjuvant Chemotherapy on CD8+ Tumour Infil-trating Lymphocytes in Epithelial Ovarian Cancer

Background: In India, ovarian cancer is one of the most common malignancies, second only to cervical cancer 1. About ninety percent of malignant ovarian cancers are epithelial ovarian carcinomas. Effective treatment modalities for advanced stage disease are still under research. Management of such advanced cancers is becoming more challenging due to therapeutic limitations. All these factors contribute to the current high mortality rate 2. Several immune markers have been postulated to affect the prognosis of the disease. This study has been undertaken to evaluate the effect of neoadjuvant chemotherapy (NACT) on Tumour Infiltrating Lymphocytes (TILs) in epithelial ovarian cancer. Aim: Evaluation of the impact of neoadjuvant chemotherapy on CD8+ TILs in epithelial ovarian cancer. Objectives: To analyze the percentage of CD8+ TILs expression in epithelial ovarian cancer. Also, to assess the effect of neoadjuvant chemotherapy on TILs. Results: 52 cases of epithelial ovarian cancers diagnosed during the period between January 2021 to June 2022 in Government Kilpauk medical college and its annexe Government Royapettah hospital, India were included in the study.. Representative tissue sections were taken from specimens sent for histopathological examination .TILs was evaluated using CD8 Immunohistochemistry. High density of CD8+ TILs (>=20/HPF) was seen in 42.3% of cases. Patients who had received NACT prior to surgery showed high density of CD8 + TILs when compared to patients with no prior NACT. The association between NACT and CD 8+ TILs was statistically significant. Conclusion: The present study indicated that NACT had a positive effect on tumor immune microenvironment

Successful Modified Chemotherapy Regiment in Patient with Hairy Cell Leukemia Variant

Hairy Cell Leukemia variant (HCLv) is distinct from Hairy Cell Leukemia classic (HCLc) and categorized as an unclassified splenic B-cell lymphoma/leukemia. HCLv is a rare disease with a 15% survival rate after 15 years, and accounts for only 0.4% of chronic lymphoid malignancies and the etiology remains unclear. In this context, it responds poorly to standard Hairy Cell Leukemia (HCL) therapy. The primary complaints of a 64-year-old patient on admission were weight loss, early satiety, fatigue, and abdominal enlargement. Physical examination showed massive splenomegaly, and laboratory results showed thrombocytopenia and leukocytosis with a predominance of lymphocytes. Meanwhile, bone marrow puncture (BMP) and flow cytometry results showed hairy cells with morphology and immunophenotyping consistent with HCLv. Due to the unavailable purine analogs, and considering potential outcomes, the patient was treated with a combination of Cytarabine, Daunorubicin, and Rituximab for 5 days. After 3 months, clinical improvement was observed, and BMP evaluation showed no evidence of hairy cells projection, leading to the patient being declared in complete remission. This case presents a new therapy regimen that has not been previously applied to HCLv cases and it may serve as an option for similar cases, subject to clinician judgment and patient preferences. Keywords: HCL variant, modified chemotherapy regimen, total remissio

ChatGPT as The Future of Discharge Reports? A Perspective from Geriatric Medicine

Background: Conventional discharge reports often suffer from inconsistencies, incomplete information, and lack of clarity, impeding effective communication and continuity of care. ChatGPT, a powerful language model based on deep learning techniques, can enhance the quality and efficiency of discharge reports. Aim: This article explores the possibility of using ChatGPT in geriatric medicine specifically, where complex medical conditions and multidimensional care plans are common. ChatGPT can assist in capturing detailed patient histories, comprehensively documenting geriatric syndromes, and incorporating personalized recommendations for geriatric care management. Methods: Using GPT-3, we employed the chatbot to generate a discharge report based on comprehensive patient data. The AI-generated report was compared with the actual discharge report, and the AI\u27s approach was validated by requesting supporting sources. This evaluation aimed to assess the reliability and credibility of the AI-generated discharge report. Discussions: Despite its potential advantages, the integration of ChatGPT into healthcare workflows necessitates addressing various challenges. These include ensuring patient data privacy, validating the accuracy and reliability of generated information, and establishing guidelines for responsible use. Conclusion: ChatGPT holds promise as a transformative technology for improving the quality of discharge reports in geriatric medicine. By leveraging its language processing capabilities, ChatGPT can enhance communication, patient understanding, and care coordination, ultimately leading to better patient outcomes and healthcare efficiency. Future research and collaborative efforts are necessary to fully explore and refine the application of ChatGPT in this context and to ensure its seamless integration into clinical practice

Effect of Combination of Rosmarinic Acid with Valsartan and Irbesartan on NO and ADMA Levels in Diabetic Nephropathy Model Rats

Background: Diabetic nephropathy (DN) is a complication that often occurs in diabetes mellitus, in which the kidneys are damaged. Nitric oxide (NO) and Asymmetric Dimethylarginine (ADMA) are mediators that play a role in the pathophysiology of DN. Rosmarinic acid (AR) is an antioxidant compound that has the potential to be an alternative treatment for diabetic nephropathy. Valsartan and Irbesartan are antihypertensive drugs that have a nephroprotective effect. However, no studies have studied the concomitant use of AR with these two antihypertensive drugs. Aim: To identify the effect of the combination of AR and Valsartan and Irbesartan on NO and ADMA levels in DN rat models.. Methods: True experimental laboratory design and a randomized posttest only controlled group design method. The rats were divided into four groups, namely the negative control group, positive control (diabetic rats without therapy), group 3 (AR) 75 mg/kgBW/day with Irbesartab 1.5 mg/kg BW/day) and group 4 (AR) 75 mg/kgBW /day with Valsartan 1 mg/kg/day). Data were analyzed using One-way ANOVA with a significance level of p<0.05. Results: Administration of Valsartan (79.42±13.95 µmol/L) and Irbesartan (84.62±18.59 µmol/L) significantly increased NO levels compared to the positive control (61.49±8.03 µmol/L) (p< 0.05). Administration of Valsartan (57.87 ± 9.29 ng/mL) and Irbesartan (53.77 ± 9.42 ng/mL) did not decrease NO levels compared to control (50.46 ± 8.52 ng/mL) (p> 0.05 ). Conclusion: Administration of valsartan and irbesartan increased NO levels in DN rats exposed to rosmarinic acid. However, administration of valsartan and irbesartan did not affect ADMA levels in DN rats exposed to rosmarinic acid

Association of Sociodemographic Factors in Affecting the Knowledge, Attitude, and Behaviour of Tuberculosis and HIV in Malang: A Community-Based Study in Rural Area

Background: Tuberculosis is the leading cause of death among people with HIV.  In Indonesia, the Tuberculosis prevalence in 2021 stood at 969,000 cases with an average of 354 cases per 100,000 people. Nevertheless, tuberculosis is often neglected by many people, whereas in fact, it is a preventable and curable disease. This study aims to assess the knowledge, perception, behaviour, and screening for tuberculosis and their association with sociodemographic factors in a rural area of Malang, Indonesia. Method: A cross-sectional community-based study was conducted. The subjects of this study were adults (≥18 years old) who could comprehend the Indonesian language. We included 462 individuals who were chosen randomly by a multistage stratified sampling technique in rural areas of Malang, Indonesia. A validated questionnaire was asked to be filled in by participants, which were selected randomly using a multistage stratified sampling technique. Collected data were analyzed on SPSS for Windows version 25.0 Results: This study found that most (59.77%) of adults from the study area are still unaware of tuberculosis infection, transmission, prevention, and its risk factors. Only 1.2% were aware of the importance of screening if they had contact with positive tuberculosis patients. Participants in the age groups of 61 to 70 and over 70 years old were 5.5 and 4.0 times more likely to exhibit unsatisfactory behaviour compared to those in the 27 to 30 age group. Conclusion: This study shows that knowledge, perceptions, behaviours and tuberculosis screening toward tuberculosis are still lacking in rural communities in Malang and showed that participant on younger age and higher educational subjects has better knowledge, behaviour, perception and screening towards Tuberculosis and HIV

Differences in Nutritional Status and Quality of Life in Hemodialysis Patients Compared to CAPD

Background: Patients with chronic kidney disease who undergo hemodialysis and CAPD (Continous Ambulatory Peritoneal Dialysis) modalities often experience disturbances in nutritional status and quality of life. The condition is affected by the chosen modalities and duration. Aim: This study assesses the differences in nutritional status and quality of life in individuals undergoing hemodialysis therapy with a duration of 4-hour, hemodialysis with a duration of 5-hour, and CAPD in order to determine the best modalities for patients with chronic kidney disease. Methods: Data were collected with cross-sectional from patients with chronic kidney disease at the hemodialysis polyclinic at RSUD dr. Saiful Anwar Malang, Panti Nirmala Hospital Malang, Wava Husada Kepanjen Hospital, and the CAPD polyclinic at RSUD dr. Saiful Anwar Malang. Classified into CAPD group, 4-hour hemodialysis group, and 5-hour hemodialysis group. Assessment with a questionnaire consisting of the patient’s baseline characteristics, subjective global assessment (SGA), and SF-36 are used to assess and analyze differences in nutritional status and quality of life of patients with chronic kidney disease against the selected dialysis modality. Results: The physical health of the 5-hour hemodialysis group showed significant results compared to the 4-hour hemodialysis and CAPD (p <0.05). Mental health in the 5-hour hemodialysis procedure showed significant results compared to the 4-hour hemodialysis and CAPD (p <0.05). The nutritional status of 5-hour of hemodialysis was better than 4-hour of hemodialysis and CAPD (p<0.05). Conclusion: Hemodialysis with a duration of 5-hour has a better nutritional status and quality of life compared to a duration of 4-hour or CAPD

Correlation of serum Uric Acid levels with Blood Pressure and Glycated Hemoglobin in Prediabetes and Diabetes patients: Correlation of serum Uric Acid in prediabetes and diabetes

Background: Increased serum uric acid (SUA) through a series of pathophysiological sequelae like oxidative strain, inflammation and endothelial vascular impairment causes different diseases. Aim: Evaluate association between serum uric acid levels and hypertension, blood sugar and glycated hemoglobin in prediabetes, diabetes and healthy control. Methods: Cross sectional study conducted in 120 subjects, divided equally into three groups: 40 prediabetes, 40 type 2 Diabetes (T2DM) and 40 healthy controls. Data was collected using a proforma, covering particulars related to hypertension, fasting blood sugar (FBG), glycated hemoglobin (HbA1c) and the levels of SUA. SPSS software was used for analysing the data. Results: The age- and sex-matched prediabetic and diabetic groups had significantly higher systolic and diastolic blood pressures compared to control group. Diabetes markers FBG and HbA1c were recorded highest in the T2DM group, which shows a significant difference in mean compared to prediabetes and the control group. SUA levels were highest in diabetes but found an insignificant difference with prediabetes, whereas the control group showed significant differences (4.4±0.5, p<0.05) with prediabetes (7.1±2.4) and diabetes (7.6±1.5). A significant and positive correlation was recorded between SUA and blood pressure, FBG and HbA1c in the diabetes group. In prediabetes, SUA was found to have a positive association with only systolic blood pressure (SBP) and FBG.  Conclusion:  Severity of disease progression in patients with hypertension and diabetes, SUA can probably be used as an early biochemical marker. So, assessment of serum uric acid as a routine investigation may be recommended for evaluating disease progress

Role of Surveillance Colonoscopy With Mortality Event due to Colorectal Cancer and Cancer Stage Findings in Inflammatory Bowel Disease Patients

Background: Patients with Inflammatory bowel disease (IBD), both due to ulcerative colitis (UC) and Crohn’s disease (CD), are at higher risks of having colorectal cancer (CRC). Various guidelines have recommended surveillance using a colonoscopy. However, evidence of its usefulness for prognosis remains a subject of discussion. Aim: To determined the difference in mortality rate due to CRC and cancer stage between patients IBD who undergo routine surveillance and whoes do not. Methods: Studies performed searches on database of Science Direct, PUBMED, EBSCO, and Cochrane for research types of randomized controlled trials (RCTs), cohort, or case-controls that evaluate the role of surveillance on patients with IBD regarding to mortalities due to CRC and cancer stage findings. Data were then analyzed using the fixed/random effect model based on heterogeneity to evaluate the odds ratio (ORs) with a 95% confidence interval, calculated using the Mantel-Haenszel method. Results: Based on five observational studies that evaluated 3,215 patients with Inflammatory Bowel Disease by surveillance, compared with 4,465 control patients, it was found that patients undergoing surveillance have significantly lower mortality due to CRC (15.1%) than the control patients (23.8%) (OR 0.36 (95% CI: 0.24–0.52), p < 0.00001). There are more patients with end-stage colorectal cancer without surveillance (37%) than those with surveillance (20%) (OR 0.28 (95% CI: 0.20–0.41), p < 0.00001). Conclusion:  Patients with inflammatory bowel disease who undergo routine colonoscopy surveillance will have a lower mortality rate and be found with earlier-stage cancer than patients who do not undergo routine colonoscopy examination