The Risk of Developing Non-Alcoholic Fatty Liver Disease in Adult Patients with Subclinical Hypothyroidism Compared to Euthyroid: An Evidence-based Case Report

Background: hypothyroidism is a common concomitant disease of non-alcoholic fatty liver disease (NAFLD). Previous studies regarding the relationship between subclinical hypothyroidism and NAFLD showed conflicting results, ranging from a strong association to not significant one. This case report aimed to investigate the risk of developing NAFLD in subclinical hypothyroidism patients. Methods: literature searching used ScienceDirect, PubMed, ProQuest, and Scopus. Filtering process of titles and abstracts by using inclusion and exclusion criteria yielded 4 eligible articles (1 systematic review, 1 prospective cohort, 1 retrospective cohort, and 1 case-control study) for answering the clinical question. Critical appraisal was conducted by using worksheets from Centre for Evidence-Based Medicine, University of Oxford. Results: the systematic review was considered invalid due to its less comprehensive search for relevant studies, inappropriate article selection to find a causal relationship between diseases, and statistical heterogeneity. The retrospective cohort was decided unimportant because it possessed a relative risk of 0.85 (95% confidence interval [CI], 0.72--1.00) which the upper limit of its CI included 1.00. The rest were valid and had important risk relative and odds ratio (1.27 [95% CI, 1.09--1.47], 3.41 [95% CI, 1.16--9.98]; respectively). The number needed to harm (5—17) indicated the clinically meaningful harm of the exposure since only a few patients with subclinical hypothyroidism is needed to obtain one additional NAFLD incidence. Those two articles were also suitable to be applied in our case. Conclusion: patients with subclinical hypothyroidism, compared to euthyroid patients, are at higher risk of developing NAFLD

Association between Thyroid Status and Glucose Intolerance in Hyperthyroid Patients

Introduction. The most common endocrinopathy in adults are diabetes mellitus (DM) and thyroid disease. Hyperthyroidism decreases blood glucose control and increased the need of insulin. However, the mechanism of abnormal glucose metabolism in hyperthyroidism is not fully understood. This study aims to determine the relationship of thyroid status with incidence of glucose intolerance in hyperthyroid patients compared to hyperthyroid patients who have achieved clinical status of eutyroid and normal population. Methods. This study was cross sectional design in outpatients with hyperthyroidism in hyperthyroid and euthyroid/subclinical hyperthyroid status, and healthy volunteers who had matching age and sex. An oral glucose test and Homeostatic Model Assesment Insulin Resistance was performed after the diagnosis of hyperthyroidism by FT4 and TSH measurement. Data analysis was performed using SPSS for Windows version 20.0. Results. There were 114 eligible patients (40 case hyperthyroid, 40 case euthyroidism/subclinical hyperthyroidism and 34 healthy subjects). Proportion of glucose intolerance in hyperthyroidism is 52,5% (10% DM, 32,5% impaired glucose tolerance (IGT), and 10% impaired fasting glucose (IFG)), in euthyroidism/subclinical hyperthyroidism was 20% (5% DM, 15% IGT, and 0% IFG), and in healthy subjects was 11,8% (0% DM, 8,8% IGT, and 2,9% IFG). Glucose intolerance in hyperthyroidism was significantly different than euthyroidism/subclinical hyperthyroidism (p=0.002). We also found that the association between thyroid status and glucose intolerance in the group without insulin resistance was significantly different (p=0.004). Conclusions. Our study conclude that there is association between hyperthyroidism and glucose intolerance. Hyperthyroid patients in euthyroidism/subclinical hyperthyroidism status have the same risk as the healthy subject to became glucose intolerance

Prevalence and Profile of Fibrosis in Diabetic Patients with Non-alcoholic Fatty Liver Disease and the Associated Factors

Background: the risk of Non-Alcoholic Fatty Liver Disease (NAFLD) is increasing in patients with type-2 diabetes. Prevalence and factors related to the increased risk of NAFLD in diabetic patients in Indonesia has never been studied before. Data regarding the profile of fibrosis in the population has also been unknown. This study aimed to identify the difference on the profile of diabetic patients with and without NAFLD as well as the degree of fibrosis. Methods: the study was conducted using a cross-sectional method in type-2 diabetic patients who were treated at the outpatient clinic of endocrinology and metabolic division in Cipto Mangunkusumo Hospital. Sampling was done consecutively. Collected data comprised of age, duration of diabetes, body mass index (BMI), waist circumference, HDL, triglyceride, and HbA1C levels. Abdominal ultrasonography was conducted for all patients to determine the presence of NAFLD. Patients with NAFLD were subsequently underwent transient elastography in order to assess their degree of liver fibrosis. Chi-square or Fisher’s-Exact tests were used for bivariate analysis and logistic regression was used for multivariate analysis. Results: as many as 186 patients were analyzed in the study and 84 patients (45.2%) were demonstrated to have NAFLD. Transient elastography examinations were carried out in 68 patients and 17 patients (25.0%) were found with severe fibrosis. Univariate analysis showed significant differences on BMI (PR=1.878; 95%CI= 1.296-2.721; p<0.001) and waist circumference (PR=2.368; 95%CI= 1.117-5.017; p=0.018) between patients with and without NAFLD. However, the multivariate test showed that BMI was the only factor that had a significance difference between both groups (OR=2.989; 95%CI=1.625-5.499; p<0.001). Conclusion: prevalence of NAFLD among type-2 diabetic patients in Cipto Mangunkusumo Hospital has reached 45.2% and 25.0% among them had severe fibrosis. BMI is the only factor found to be associated with the occurrence of NAFLD

EFFECTIVENESS OF ZINC SUPPLEMENTATION FOR TYPE II DIABETES PREVENTION: A SYSTEMATIC REVIEW

Background: The incidence of prediabetes is predicted to continue to increase. Approximately 25% of prediabetes patients develop type 2 diabetes mellitus (T2DM) within 3–5 years. Zinc is known to have a role in the synthesis, storage, secretion, and action of the insulin hormone. Purpose: The aim of the study is to know about the impact of zinc supplementation in type 2 diabetes mellitus (DM) prevention. Methods: A systematic literature search was performed using the PubMed, Cochrane, and EBSCOHost search engines. The inclusion study includes systematic review and metaanalysis of randomized clinical trials study and randomized clinical study, and we only include the research of the last 10 years. Results: Three RCTs were selected from 175 articles to undergo a critical review with a total of 353 patients with a duration of 6-12 months (level of evidence II-III). The incidence of T2DM in the intervention group decreased significantly (OR: 0.37 [95% CI 0.7-0.8]; RR: 0.44; ARR: 14% [95% CI 3.5-24.5%]; NNT: 7.14 [4-29]) in one study. Zinc supplementation significantly reduced Fasting Blood Sugar (FBS) in two studies (mean difference -17.3 and -5.76) and oral glucose tolerance test (OGTT) in one study (MD -22.6). Conclusion: Administration of zinc in prediabetes patients to prevent the development of T2DM still requires further study with a larger sample, longer duration, and control variables by design and statistics

Practical Guidelines Management of Graves Ophthalmopathy

Graves’ ophthalmopathy is the most common extra-thyroid manifestation in patients with Graves’ disease, based on inflammatory and autoimmune conditions in orbital tissue. This practical guideline was formed by a multidiciplinary team, and is intended to provide guidance for diagnosis and management of Graves’ ophthalmopathy in daily clinical practice to improve quality of care and treatment outcome

The Effect of Statin Therapy on Mortality in Adult Patients with Liver Cirrhosis: An Evidence-Based Case Report

Background: Liver cirrhosis causes over one million deaths annually worldwide, but its prognosis varies depending on the presence of complications and decompensating events. Reduction of portal pressure is associated with a reduced risk of mortality in cirrhotic patients. Statin therapy has successfully reduced portal pressure in previous studies, but its effects on overall mortality are unclear. This report aims to determine whether statin therapy significantly affects mortality in patients with liver cirrhosis. Methods: A comprehensive literature search was conducted using five electronic databases: PubMed, Scopus, Embase, Ovid MEDLINE, and Web of Science. Meta-analyses, randomized controlled trials (RCTs), and cohort studies were selected based on pre-set inclusion and exclusion criteria. The quality of selected studies was evaluated using critical appraisal tools developed by the Center for Evidence-Based Medicine. Results: One meta-analysis, one RCT, and one retrospective cohort study were included in this report. The meta-analysis and cohort study were of good quality and reported significantly reduced mortality with statin therapy in cirrhosis patients. However, the RCT had poor validity and did not report a statistically significant difference in mortality between the intervention and control groups. The survival benefits of statins may be limited to Child–Pugh A and B patients only, but this requires confirmation in a larger population of Child–Pugh C patients. Conclusion: Statins potentially reduce mortality in patients with liver cirrhosis, but more evidence is required before they can be widely recommended in clinical practice for this indication

DiabCare Asia 2012: diabetes management, control, and complications in patients with type 2 diabetes in Indonesia

BACKGROUND Indonesia was a part of the most recent edition of DiabCare Asia held in 2008. DiabCare Asia 2012 is modeled after a similar project to provide the latest information to facilitate healthcare policymaking in this area. METHODS This was an observational, non-interventional, cross-sectional study of patients with type 2 diabetes mellitus from primary, secondary, and tertiary care centers in Indonesia. Patient data collected included demography, medical history complications, eye and foot examinations, diabetes management, and most recent laboratory investigations. Blood samples were collected from all patients for the analysis of glycated hemoglobin (HbA1c). RESULTS A total of 1,967 patients participated in the study, with a mean (SD) age of 58.4 (9.5) years and a median (range) duration of diabetes 6.0 (0.1−47.0) years. The percentage of patients with HbA1c <7.0% was 30.8% and the mean (SD) HbA1c level was 8.3 (2.2%). The proportion of patients using insulin was 34.7% with a mean (SD) total daily dose of 37.9 (24.1) IU. The most common diabetes-related complications were peripheral neuropathy (59.1%), erectile dysfunction (32.4%), and eye complications (29.1%). CONCLUSIONS Glycemic and metabolic control remain unsatisfactory in type 2 diabetes patients in Indonesia. Efforts are needed to optimize control and prevent complications in these patients

A COVID-19 self-isolation monitoring module for FMUI undergraduate medical students: Linking learning and service needs during the pandemic surge in Indonesia.

To ensure that students continued receiving adequate yet safe clinical exposure during the COVID-19 pandemic, the Faculty of Medicine at Universitas Indonesia (FMUI) created the Module of COVID-19 Self-Isolation Monitoring which aims to equip students with the knowledge and skill to monitor confirmed and close contact cases of COVID-19. Module development, divided into four phases: preparation, orientation, implementation, and evaluation phase, started as soon as the delta wave of COVID-19 cases forced medical students to halt their offline clinical rotations. A quantitative secondary data were obtained from student and patient satisfaction questionnaires and on students' performance and reflection. We analyzed the distribution of module evaluation, the student's discussion score during the module, the students' interest in participating as Covid-19 volunteers before and after the module's deployment, and the correlation between learning outcomes and satisfaction. A total of 372 patients were monitored by 208 students during the 4-week module. The response rates were above 80%, with the majority agreeing that students found this module well-organized and fulfilled their expectations. There was a significant increase in discussion scores from weeks 1 to 4, a significant difference in the proportion of students interested in COVID-19 volunteering before and after the module completion as well as a significant low correlation between the patient's monitoring score sheet and the reflection essay towards the patient's satisfaction. We should still improve tutors' time management, tutors' provision of triggering questions for critical thinking skills, and tutors' feedback for students. The module met patient expectations and is expected to assist tutors in providing feedback and examples of doctor-patient communication, thus accelerating students' competence in patient interaction. Further evaluation is needed regarding knowledge transfer, the impact on community health, and the faculty development program, especially regarding how tutors fulfill their roles as medical educators

Differential effect of ramadan fasting on intercellular adhesion molecule-1 (ICAM-1) in diabetes mellitus and non-diabetes mellitus patients

Background: The month of Ramadan is a holy month for Muslims. During this month, Muslims do not eat, drink, or smoke from sunrise to sunset. Patients with type 2 diabetes mellitus (T2DM) will also fast from dawn to dusk, creating a unique opportunity to study the effects of dietary changes during fasting period. One of the interesting results of Ramadan fasting is its effect on endothelial dysfunction, measured using Intercellular Adhesion Molecule-1 (ICAM-1) as a biological marker of endothelial function. Aim: To determine the changes ICAM-1 levels in T2DM and non-DM patients during Ramadan fasting. Methods: A retrospective cohort study was performed on 26 T2DM patients and 21 non-DM, age-matched patients (aged 19–60 years). Measurement of metabolic parameters (systolic and diastolic blood pressure, total calorie intake, and intensity of physical activity), anthropometry (body weight, body mass index (BMI) and abdominal circumference), total dietary intake, and laboratory analysis (blood glucose fasting, HbA1c, lipid profile, ICAM-1) were done at 4 weeks before (T0) and 14 days after Ramadan fasting (T1). Result: The median ICAM-1 level in T2DM patients at T0 was 340.9 (193–505) ng/mL and at T1 was 312.3 (158–581) ng/mL, while the ICAM-1 level in non-DM patients at T0 was 482 (305–653) and at T1 was 398.4 (202–526) ng/mL. There was no significant difference of ICAM-1 level between study groups at both T0 and T1 (p > 0.05). Both T2DM and non-DM patients had lower ICAM-1 level following Ramadan fasting. However, only non-DM patients had significantly lower post Ramadan ICAM-1 (p = 0.008) Conclusion: There was a significant decrease in ICAM-1 level in both T2DM and non-DM patients after Ramadan fasting