Undetectable high-performance liquid chromatography haemoglobin A1c on variant haemoglobin E phenotype: a case report

The gold standard for long-term monitoring of diabetic patients is glycated haemoglobin (HbA1c), which is routinely tested for glycaemic control. Furthermore, the National glycohemoglobin standardization program (NGSP) has designated high-performance liquid chromatography (HPLC) as the reference method for HbA1c measurement. A woman from the Sumba tribe, Indonesia, aged 52, visited the Internal Medicine Clinic for a routine check-up. She had been taking diabetic and hypertension medicines on a regular basis for over 10 years. The HPLC procedure yielded “no result” for the patient’s HbA1c assessment and there was no peak on the HPLC graphic. However, there was a discrepancy between the data history of HbA1c measured by turbidimetric method (average of 51 mmol/mol, reference range < 48 mmol/mol), fasting blood glucose (average of 7.7 mmol/L, reference range < 7.0 mmol/L) and 2-hour plasma glucose (average of 13 mmol/L, reference range < 11.1 mmol/L). Glycated albumin was 3.1 mmol/L (reference range 1.8-2.4 mmol/L). Haemoglobin electrophoresis identified homozygote haemoglobinopathy E (HbE). Patients with haemoglobin variants are proposed to utilize glycated albumin

Analysis of Adrenocorticotropic Hormone and Cortisol Levels in Acute Respiratory Distress Syndrome COVID-19 Patients

Objective. SARS-CoV-2 infection may cause multiple organ failure. However, scarce information can be found on the impact on the endocrine system. This study was conducted to determine plasma Adrenocorticotropic hormone (ACTH) and plasma cortisol levels in a cohort of COVID-19 patients with Acute Respiratory Distress Syndrome (ARDS). Methods. A prospective cohort study was conducted on COVID-19 patients who manifested ARDS and were admitted to the ICU of Dr. Soetomo Tertiary Hospital, Surabaya, Indonesia. Morning plasma ACTH and plasma total cortisol were measured on 45 recruited patients. The outcome of the patient was justified based on the survivance on days 7th and 30th during the follow-up with groupings of surviving for survived patients and nonsurvive for deceased patients. Results. The ACTH and cortisol median were 1.06 (0.5–64.57) pg/mL and 17.61 (0.78–75) μg/dL, respectively. Both parameters were assembled to allow the allocation of the 45 subjects into the survive and nonsurvive groups. There was a moderate correlation between ACTH and cortisol levels in all groups (, ) and particularly ACTH and cortisol levels in COVID-19 patients who survived on the 7th-day and 30th-day follow-up ( and , respectively, with ). It is important to note that there was no correlation for an individual parameter, either ACTH only or cortisol only, compared to the outcome among patients with various comorbid. Conclusion. ACTH or cortisol alone has no correlation to the outcome of these patients. Therefore, further study of the potential use of corticosteroid treatments guided by ACTH and cortisol levels in reducing the risk of ARDS warrants further investigation

Kajian Narrative terhadap Profil Farmakokinetik Antibiotik pada Pasien Kritis: Implikasi terhadap Ketercapaian Target Farmakokinetik-Farmakodinamik

ABSTRACTThe severity of diseases, the complexity of treatment, and the use of medical devices in the intensive care unit (ICU) may change the pharmacokinetics (PK) profile of antibiotics among critically ill patients.This narrative review aims to explain the PK profile of critically ill patients compared to other group of patients and to describe the pharmacokinetic-pharmacidynamic (PK-PD) target attainment among this group of patients. Only articles published less than 10 years ago were included in this narrative review. Evidences have indicated that critically ill patients have relatively larger volume distribution (Vd) of hydrophilic antibiotics compared to patients with stable conditions. The fluid shifting to interstitial space, hypoalbuminemia, and aggressive fluid treatment may contribute to the increase value of Vd in critically ill patients. The clearance (CL) of hydrophilic antibiotics in critically ill patients is highly determined by dynamic changing of renal function compared to patients in other wards. The phenomenon of augmented renal clearance and the use of high intensity of renal replacement therapy can increase the CL of hydrophilic antibiotics. The different PK profile of antibiotics may lead to the failure of attaining the PK-PD target if the dose of antibiotics is not adjusted according to such differences.ABSTRAKTingkat keparahan penyakit yang relatif tinggi dibandingkan pasien di bangsal rawat lain dan penggunaan terapi serta alat medis yang relatif lebih kompleks di ruang intensive care unit (ICU) dapat berdampak pada perubahan profil farmakokinetik (PK) antibiotik pada pasien kritis. Tujuan utama kajian naratif ini adalah untuk memaparkan profil PK dan ketercapaian target farmakokinetik-farmakodinamik (PK-PD) pasien kritis di ICU. Hanya artikel yang diterbitkan dalam kurun waktu 10 tahun terakhir yang digunakan dalam kajian naratif ini. Bukti penelitian menunjukkan bahwa volume distribusi (Vd) antibiotik hidrofilik pada pasien kritis lebih besar dibandingkan dengan pasien yang relatif lebih stabil atau subyek sehat. Perpindahan cairan intravaskuler ke daerah interstitial, hipoalbuminemia, dan terapi cairan khususnya yang diberikan secara agresif merupakan faktor yang berkontribusi terhadap peningkatan Vd pada pasien kritis. Clearance (CL) antibiotik hidrofilik pada pasien kritis ditentukan oleh perubahan fungsi ginjal yang relatif lebih dinamis dibandingkan dengan pasien di ruang rawat inap lain. Fenomena augmented renal clearance yang umum dijumpai pada pasien kritis dan penggunaan renal replacement therapy dengan intensitas yang tinggi dapat meningkatkan CL antibiotik hidrofilik. Perbedaan profil PK tersebut berpotensi menyebabkan kegagalan untuk mencapai target PK-PD apabila tidak dilakukan penyesuaian dosis antibiotik pada pasien kritis. Identifikasi profil PK perlu diupayakan sebagai langkah awal untuk mengoptimalkan pemberian antibiotik pada kelompok pasien kritis

Narrative Study on Pharmacokinetics of Antibiotics among Critically Ill Patients: the Implication on the Pharmacokinetics-Pharmacodynamics Target Attainment

The severity of diseases, the complexity of treatment, and the use of medical devices in the intensive care unit (ICU) may change the pharmacokinetics (PK) profile of antibiotics among critically ill patients. This narrative review aims to explain the PK profile of critically ill patients compared to other group of patients and to describe the pharmacokinetic-pharmacidynamic (PK-PD) target attainment among this group of patients. Only articles published less than 10 years ago were included in this narrative review. Evidences have indicated that critically ill patients have relatively larger volume distribution (Vd) of hydrophilic antibiotics compared to patients with stable conditions. The fluid shifting to interstitial space, hypoalbuminemia, and aggressive fluid treatment may contribute to the increase value of Vd in critically ill patients. The clearance (CL) of hydrophilic antibiotics in critically ill patients is highly determined by dynamic changing of renal function compared to patients in other wards. The phenomenon of augmented renal clearance and the use of high intensity of renal replacement therapy can increase the CL of hydrophilic antibiotics. The different PK profile of antibiotics may lead to the failure of attaining the PK-PD target if the dose of antibiotics is not adjusted according to such difference

Acute suppurative thyroiditis in a post arteriovenous shunt infection patient

Acute suppurative thyroiditis (AST) is a rare clinical entity that must be treated immediately because of its morbidity, especially swelling in the thyroid area accompanied by fever. AST is often preceded by infection at another site; therefore, it is important to identify the source. A 40-year-old woman came to the Dr. Soetomo General Hospital complaining of pain and swelling in the neck, difficulty swallowing, and fever. The patient suffered from chronic kidney disease. One week before, she had an infected arteriovenous hemodialysis shunt. Laboratory results showed an increased fT4 (3.5 ug/dL) and a decreased TSH (0.015 uIU/mL), leukocytosis, and a raised C reactive protein (CRP). Thyroid ultrasound showed an abscess involving the entire left thyroid. Thyroid fine needle biopsy showed AST. Culture of the pus grew Staphylococcus aureus. The thyroid tests supported the diagnosis of AST with hyperthyroidism; immediate treatment was indicated. Three weeks after treatment, the patient was euthyroid and still had drainage of the wound. The AST was considered to be secondary to the hemodialysis AV shunt infection. Leukocytosis and increased CRP levels supported the presence of inflammation and culture grew Staphylococcus aureus. The patient improved with Clindamycin therapy. To our knowledge, this is the first AST case preceded by hemodialysis AV shunt infection

CORRELATION BETWEEN SERUM VITAMIN D LEVELS AND SEVERITY OF SCHIZOPHRENIA PATIENTS IN THE DR. SOETOMO HOSPITAL

Introduction. Vitamin D deficiency is a common health problem that occurs in various countries. Vitamin D deficiency is linked to various diseases such as kidney failure, liver damage, atherosclerosis, obesity and psychiatric disorders such as depression and schizophrenia. This study aimed to analyze the correlation between serum vitamin D levels and schizophrenia severity. Methods. Schizophrenia patients who visited the Inpatient and Outpatient Clinic Department of Psychiatry of the Dr. Soetomo Hospital Surabaya. This was a cross-sectional observational study, conducted in December 2017 - April 2018 . The subjects consisted of 53 schizophrenia patients, vitamin D levels 30 ng/mL (18 (33.96%). Serum vitamin D levels test by enzyme linked fluorescent assay (ELFA) method using Vidas. The severity of schizophrenia was measured using a positive and negative syndrome scale (PANSS) score. Results. Mean serum vitamin D levels in schizophrenia were 23.45 ± 9.16 ng / mL, serum vitamin D levels in males were 24.36 ± 9.80 ng / ml and females 21.96 ± 7.98 ng / ml. The mean serum vitamin D level and PANSS scores of positive symptoms was 16.42 ± 8.50. The mean serum vitamin D level and PANSS scores of negative symptoms was 15.60 ± 6.12. The mean serum vitamin D level and PANSS scores of general psychopathology symptoms was 29.51 ± 10.29. The statistical results showed no association between vitamin D levels and PANSS scores. Conclusion. The results of this study indicated low serum vitamin D levels in schizophrenia. There was no association between serum vitamin D levels and the severity of schizophrenia using PANSS scores

Determination of serum anti-Mullerian hormone levels in a low-prognosis women treated in-vitro fertilization/intracytoplasmic sperm injection: A cohort study

Abstract Background: Outcome prediction of participants treated with in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) using anti-Mullerian hormone (AMH) concentration has been widely used. According to the patient-oriented strategies encompassing individualized oocyte number (POSEIDON) definition, low prognosis Bologna responders have changed from poor. This definition divides low prognosis into 4 groups. Objective: The purpose of this study was to assess blood AMH levels in the group of women treated with IVF/ICSI who were thought to have a low prognosis. Materials and Methods: A retrospective cohort study among 252 suspected low-prognosis group participants was assessed between January 2016 and December 2019 at Morula IVF, National hospital, Surabaya, Indonesia. Observed AMH serum levels and pregnancy rates were compared among 4 subgroups. Results: The AMH cutoff value was 1.7 ng/mL with a sensitivity of 86.7% and a specificity of 70% for diagnosing low-prognosis women using POSEIDON criteria. There was no difference in the pregnancy rate between those groups (p > 0.05). Conclusion: AMH levels may indicate a poor prognosis for women having IVF/ICSI in accordance with POSEIDON guidelines. To predict the poor prognosis in women, the cutoff value must be identified

Serum Receptor Activator of Nuclear Factor-κβ Ligand and Osteoprotegerin Levels and Ratio in Correlation with Bone Mineral Density

Osteoporosis is a disorder represented by manifestations of low bone mass, decreased bone tissue, and disrupted bone microarchitecture. The diagnosis of osteoporosis so far has been based on fracture manifestations after minimal trauma or by detecting low Bone Mineral Density (BMD). Measurement of Receptor Activator of Nuclear Factor-κβ Ligand (RANKL) and Osteoprotegerin (OPG) levels has opened the discourse of a more specific assessment of osteoblast and osteoclast regulation. The RANKL/OPG ratio can represent resorption and bone formation more significantly when correlated with BMD features. This study aimed to analyze the correlation between serum RANKL and OPG levels and ratio with BMD. A total of 58 post-menopausal females from 13 elderly in Integrated Community Health Care Surabaya and Sidoarjo were enrolled. Data were collected by recording age, onset of menarche, onset of menopause, and Body Mass Index (BMI). Serum RANKL and OPG levels were evaluated using sandwich ELISA from Elabscience®. The RANKL/OPG ratio was obtained from the ratio between measured RANKL and OPG levels in serum. The proximal femur and lumbar spine BMDs were measured using Hologic® Discovery™ QDR™ Dual-Energy X-ray Absorptiometry (DEXA). Pearson's correlation test in this study showed no significant correlation between BMD and RANKL levels (lumbar: p=0.203; hip: p=0.283). The insignificant result was also shown in the correlation between BMD and OPG levels (lumbar: p=0.412; hip: p=0.617). A significant result between lumbar BMD and RANKL/OPG ratio was only found in the osteopenia subjects (p=0.001). The RANKL/OPG ratio had a significant correlation only with osteopenia-BMD in post-menopausal females. Therefore, it could be used as supporting data in osteoporosis screening

Population pharmacokinetics and dose optimization of intravenous levofloxacin in hospitalized adult patients

Although levofloxacin has been used for the last 25 years, there are limited pharmacokinetic data to guide levofloxacin dosing in adult patients. This study aimed to develop a population pharmacokinetic model of levofloxacin for adult hospitalized patients and define dosing regimens that attain pharmacokinetic/pharmacodynamic target associated with maximum effectiveness. Blood samples were drawn from 26 patients during one dosing interval. Population pharmacokinetic modelling and dosign simulations were performed using Pmetrics®. Pathogen minimum inhibition concentration (MIC) distribution data from the European Committee on Antimicrobial Susceptibility Testing database was used to analyse fractional target attainment (FTA). A two-compartment model adequately described the data. The final model included estimated glomerular filtration rate (eGFR) to describe clearance. The population estimate for clearance was 1.12 L/h, while the volume of distribution in the central compartment and peripheral compartments were 27.6 L and 28.2 L, respectively. Our simulation demonstrated that an area under free concentration-time curve to MIC ≥ 80 was hardly achieved for pathogens with MIC ≥ 1 mg/L. Low FTA against Pseudomonas aeruginosa and Streptococcus pneumoniae were observed for patients with higher eGFR (≥ 80 mL/min/1.73m2). A daily levofloxacin dose of 1000 mg is suggested to maximise the likelihood of efficacy for adult patients