Dendritic Cells in Graves’ Disease

Dendritic cells are major antigen-presenting cells (APC) that stimulate naïve T cells, which induce adaptive immune responses. Graves’ disease (GD) is an autoimmune disease characterized by the presence of autoantibodies against Thyroid Stimulating Hormone Receptor (TSHR). The autoantibodies bind with TSHR and stimulate thyroid hormone production. Dendritic cells are still the major APC in GD immune response although thyrocytes in GD can also express Major Histocompatibility Class (MHC) class II molecule. Studies about DC in GD have been conducted by isolating intra-thyroid DC or DC in peripheral circulation. Results of DC studies in GD are still controversial. Changes in number and profile of DC are found, which indicate altered immune response activity and defects of regulator T cell (Treg) in GD.Key words: dendritic cells, Graves’ diseas

Pengaruh Sistem Pengingat Melalui Pengiriman Pesan Singkat (Text-Messaging Reminder System) untuk Meningkatkan Kepatuhan Pasien dalam Pengobatan Tuberkulosis: Tinjauan Kasus Berbasis Bukti

Abstrak Indonesia merupakan negara kedua di dunia dengan insidensi Tuberkulosis (TB) terbanyak setelah India, sehingga Indonesia termasuk high-burden country dalam penyakit TB. Angka keberhasilan pengobatan TB di Indonesia baru mencapai 84% pada tahun 2016 sehingga perlu ditingkatkan. Inovasi yang banyak dikembangkan untuk meningkatkan kepatuhan pasien dalam pengobatan TB adalah metode pengingat dengan menggunakan media elektronik, salah satunya melalui SMS mengingat pengguna aktif telepon genggam di Indonesia cukup banyak, yaitu mencapai 70,2 juta untuk smartphone pada tahun 2017 dan terus meningkat. Tujuannya untuk mengetahui pengaruh sistem pengingat melalui pesan singkat (text-messaging reminder system) dalam kepatuhan pasien terhadap pengobatan TB. Pencarian literatur dilakukan pada beberapa pangkalan data jurnal ilmiah kedokteran besar seperti Pubmed, Cochrane, EBSCOhost, dan Science Direct. Artikel disaring sesuai desain yang dibutuhkan untuk tinjauan intervensi, kriteria inklusi, dan kriteria eksklusi. Telaah kritis menggunakan metode intervensi sesuai Oxford Center for Evidence Based Medicine 2011. Telaah kritis dilakukan pada dua artikel terpilih dengan metode RCT dan telaah sistematis. Pada studi RCT terhadap 2207 pasien di Pakistan, diperoleh penggunaan sistem pengingat SMS tidak berpengaruh terhadap kepatuhan pengobatan TB. Pada telaah sistematis yang meninjau empat artikel, diperoleh kesimpulan bahwa sistem SMS mampu meningkatkan kepatuhan pengobatan TB. Namun, signifikansinya masih diragukan karena studi yang diinklusi merupakan studi dengan tingkatan bukti rendah berdasarkan kategori GRADE. Pengaruh metode pengingat berupa SMS terhadap kepatuhan pengobatan TB masih inkonklusif. Diperlukan penelitian lebih lanjut dengan populasi besar serta desain penelitian yang sesuai (RCT). Kata kunci: Tuberkulosis, SMS, Sistem Pengingat, Kepatuhan, Pengobatan Abstract Indonesia ranked second in the world for its Tuberculosis (TB) incidence. Therefore, Indonesia is included in the list of high burden countries for TB. TB treatment success rate in Indonesia for 2016 is 84%, but this number still needs to be increased. Many innovations using electronic devices such as handphones are developed to increase patient’s adherence to TB treatment. One of the easiest applicable methods is through SMS. Indonesia is also a developing country with developing technology usage, with 70.2 million active smartphone users in 2017. To determine whether a text messaging reminder system can increase adherence in patients with Tuberculosis treatment. Literature searching was conducted in large medical journal databases such as Pubmed, Cochrane, EBSCOhost, and Science Direct. The articles are selected by considering the study designs that correlate with the intervention appraisal method, inclusions, and exclusions criteria. Intervention type appraisal was conducted using the guideline of the Oxford Center for Evidence-Based Medicine 2011. Appraisals were made for two chosen articles: one with the RCT method, and the other with a systematic review method. RCT study conducted in Pakistan showed that text messaging reminder system does not affect adherence in patients with TB treatment. The other study that reviews four articles concludes that a text messaging reminder system may increase adherence in TB patients undergoing treatment. But, the significance is still doubted as the studies included in this review are of low evidence level based on the GRADE category. The impact of the text messaging reminder system in increasing treatment adherence of TB patients is still inconclusive. Further research with a large population, better design and methodology are still needed. Keywords: Tuberculosis, SMS, Text Messaging, Reminder System, Adherence, Treatmen

Treatment Adherence and Incidence of Coronary Heart Disease in Type 2 Diabetes Mellitus Patients

Previous studies showed that uncontrolled blood sugar and long-term use of several types of antidiabetic could increase the risk of coronary heart disease (CHD). This study aimed to compare the incidence of CHD in type 2 diabetes mellitus (T2DM) patients showing treatment adherence and non-adherence behavior over four years. This was a retrospective cohort study with data sets obtained from the Bogor Cohort Study of Non-Communicable Disease Risk Factors. All study subjects were not diagnosed with CHD at the beginning of the study. The sample was divided into two groups; one had adhered to treatment from health centers and followed the treatment instructions (adherent group), while the other had not followed the treatment instructions (non-adherent group). Of 5,690 subjects, 276 were eligible for this study (84 in the adherent and 192 in the non-adherent group). The incidence of CHD in the non-adherent group was 2.3% higher than in the adherent group (p-value = 0.564) and had a 1.7 times greater risk of developing CHD, but not statistically significant (adjusted HR = 1.739; 95% CI = 0.673-4.490). The non-adherent T2DM patients had a greater risk of developing CHD than adherent T2DM patients

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

Personal Resilience in Patients with Type 2 Diabetes Mellitus: A Concept Analysis

Introduction: The most common kind of diabetes is type 2 diabetes mellitus (T2DM), which accounts for 95% of all DM cases. Microvascular and macrovascular complications burden patients physically, psychologically, socially, and economically. Patients must be resilient to live more affluent lives. Personal resilience in T2DM patients is essential in nursing practice and the development of nursing science. Understanding the concept of personal resilience is important to minimize bias and distortion in using the concept of resilience, especially in T2DM patients. Objectives: This study aimed to clarify the concept of personal resilience in T2DM patients. Methods: Walker and Avant\u27s concept analysis approach was applied. A literature search was performed using Google Scholar, ProQuest, ScienceDirect, and PubMed databases. The articles used from the databases were published between 2013 and 2022. Results: The attributes determining the level of personal resilience of T2DM patients are survival, adaptation, and recoverability. The antecedents include self-esteem, spirituality, culture, self-efficacy, optimism, hope, and age. The consequences include adherence, quality of life, effective coping, equilibrium, and illness perception. Conclusions: The three attributes, antecedents, and consequences of good personal resilience identified from the concept analysis could improve the researchers\u27 understanding of personal resilience and its implementation in the care of T2DM patients along with the complexity of the problems experienced by patients. The clarity of this concept lies in the reference for treatment that focuses on empowering the personal abilities of T2DM patients to carry out self-management to achieve prosperous quality of life

The Correlation Between Body Fat Distribution and Medial Tibiofemoral Joint Space Width in Obese Knee Osteoarthritis Patients

Background: Obesity is a major risk factor for knee osteoarthritis. The relationship between obesity and OA may not be simply due to a mechanical factor. Evidences suggest that metabolic factors related to body fat play important roles, but the specific type of fat that contributes to OA is unclear. The objective of this study was to examine the possible correlation between body fat distribution with knee OA.Methods: This study was a cross sectional study of OA patients with obesity visiting the Rheumatology and Geriatric-Internal Medicine clinics at Cipto Mangunkusumo Hospital between January-March 2016. Data was collected by consecutive sampling. Knee OA was diagnosed from clinical and radiologic evaluation based on American College of Rheumatology 1986 criteria. Body fat distribution was measured by bioelectrical impedance analysis (BIA). Conventional radiography of the knee was used to evaluate jointspace narrowing (JSN). The correlation between body fat distribution and joint space width was analyzed by bivariate analysisResult: A total of 56 subjects were recruited, majority were women (73.2%). Median visceral fat was 12% (7.5-16.5), median subcutaneous fat was 30.2% (16.5-37.9), and median visceral to subcutaneous fat ratio was 0,40 (0,26-0,80). The mean medial tibiofemoral joint space width was 2.34 mm (SD 0.78). Bivariate analysis revealed a correlation between visceral fat and medial tibiofemoral joint space width (r: -0,474 p: < 0,001). There is no correlation between subcutaneous fat and medial tibiofemoral joint space width (r: -0,187 p:0,169); and visceral to subcutaneous fat ratio and medialtibiofemoral joint space width (r: -0,225 p: 0,09).Conclusion: Visceral fat is correlated with medial tibiofemoral joint space width (r: -0.474 p: < 0.001). There is no correlation between subcutaneous fat, and visceral to subcutaneous fat ratio, with medial tibiofemoral joint space width

Effect of Metformin on Handgrip Strength, Gait Speed, Myostatin Serum Level, and Health-related Quality of Life: A Double Blind Randomized Controlled Trial among Non-diabetic Pre-frail Elderly Patients

Background: sarcopenia contributes to the development of frailty syndrome. Frailty syndrome is potentially improved by modifying insulin resistance, inflammation, and myostatin level. This study is aimed to investigate the effect of metformin on handgrip strength, gait speed, myostatin serum level, and health-related quality of life (HR-QoL) among non-diabetic pre-frail elderly patients. Methods: a double blind randomized controlled trial study was conducted on non-diabetic elderly outpatients aged ≥ 60 years with pre-frail status based on phenotype and/ or index criteria (Cardiovascular Health Study and/ or Frailty Index 40 items) consecutively recruited from March 2015 to June 2016 at Cipto Mangunkusumo Hospital. One-hundred-twenty subjects who met the research criteria were randomized and equally assigned into 3 x 500 mg metformin or placebo group. The study outcomes were measured at baseline and after 16 weeks of intervention. Results: out of 120 subjects, 43 subjects in metformin group and 48 subjects in placebo group who completed the intervention. There was a significant improvement on the mean gait speed of metformin group by 0.39 (0.77) second or 0.13 (0.24) meter/second that remained significant after adjusting for important prognostic factors (p = 0.024). There was no significant difference on handgrip strength, myostatin serum level, and HR-QoL between both groups. Conclusion: 3 x 500 mg metformin for 16 weeks was statistically significant and clinically important in improving usual gait speed as one of the HR-QoL dimensions, but did not significantly improve the EQ-5D index score, handgrip strength, nor myostatin serum level

EFFECTS OF ORAL ALFACALCIDOL ON MATURATION OF DENDRITIC CELLS IN GRAVES' DISEASE PATIENTS: A DOUBLE-BLINDED RANDOMIZED CLINICAL TRIAL

Maturity level of dendritic cells (DC) plays a pivotal role in initiating and regulating autoimmunity. In graves' disease (GD), DCs have more active immune responses than those in healthy subjects. Our previous study demonstrated immunoregulatory effects of in vitro 1,25-D3 on maturation of DC in GD patients. This study aims to evaluate the effect of oral 1α-D3 on DC maturation in GD patients. Methods: Twenty five GD patients with thyrotoxicosis were divided into two groups: 12 GD patients receiving oral 1α-D3 and 13 GD patients receiving placebo, in addition to treatment of propylthiouracil. Comparison of DC maturation were performed before and after the oral 1α-D3. DC maturation was assessed based on the expression of DC markers (HLA-DR, CD80, CD40, CD83, CD14 and CD206) and the ratio of cytokines interleukin-12/IL-10.Results: After 8 weeks, 8 out of 12 GD patients in treatment group and 6 out of 13 GD patients in placebo group still had high fT4 level. The expression of CD80 decreased (p=0.48) and CD206 increased (p=0.47) insignificantly among treatment group. The IL-12/IL-10 ratio decreased along with the improvement of fT4 level in both groups. No difference of the IL-12/IL10 ratio between treatment and placebo group. Conclusion: The effects of oral 1α-D3 on DC maturation of GD patients have not been clearly demonstrated in this study yet. Â

Prediction of Wound Healing in Diabetic Foot Ulcers: an Observational Study in Tertiary Hospital in Indonesia

Aim: to evaluate the role of clinical characteristics, functional markers of vasodilation, inflammatory response, and atherosclerosis in predicting wound healing in diabetic foot ulcer. Methods: a cohort study (February – October 2010) was conducted from 40 subjects with acute diabetic foot ulcer at clinical ward of Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia. Each subject underwent at least two variable measurements, i.e. during inflammatory phase and proliferation phase. The studied variables were clinical characteristics, complete peripheral blood count (CBC) and differential count, levels of HbA1c, ureum, creatinine, lipid profile, fasting blood glucose (FBG), marker of endothelial dysfunction (asymmetric dimethylarginine/ADMA, endothelin-1/ET-1, and flow-mediated dilation/FMD of brachial artery), and marker of vascular calcification (osteoprotegerin/OPG). Results: median of time achieving 50% granulation tissue in our study was 21 days. There were nine factors that contribute in the development of 50% granulation tissue, i.e. family history of diabetes mellitus (DM), previous history of wound, wound area, duration of existing wound, captopril and simvastatin medications, levels of ADMA, ET-1, and OPG. There were three out of the nine factors that significantly correlated with wound healing, i.e. wound area, OPG levels, and simvastatin medications. Conclusion: in acute diabetic foot ulcers, wound area and OPG levels had positive correlation with wound healing, whereas simvastatin medications had negative correlation with wound healing

The Correlation between Body Fat Distribution and Medial Tibiofemoral Joint Space Width in Obese Knee Osteoarthritis Patients

Background: Obesity is a major risk factor for knee osteoarthritis. The relationship between obesity and OA may not be simply due to a mechanical factor. Evidences suggest that metabolic factors related to body fat play important roles, but the specific type of fat that contributes to OA is unclear. The objective of this study was to examine the possible correlation between body fat distribution with knee OA.Methods: This study was a cross sectional study of OA patients with obesity visiting the Rheumatology and Geriatric-Internal Medicine clinics at Cipto Mangunkusumo Hospital between January-March 2016. Data was collected by consecutive sampling. Knee OA was diagnosed from clinical and radiologic evaluation based on American College of Rheumatology 1986 criteria. Body fat distribution was measured by bioelectrical impedance analysis (BIA). Conventional radiography of the knee was used to evaluate jointspace narrowing (JSN). The correlation between body fat distribution and joint space width was analyzed by bivariate analysisResult: A total of 56 subjects were recruited, majority were women (73.2%). Median visceral fat was 12% (7.5-16.5), median subcutaneous fat was 30.2% (16.5-37.9), and median visceral to subcutaneous fat ratio was 0,40 (0,26-0,80). The mean medial tibiofemoral joint space width was 2.34 mm (SD 0.78). Bivariate analysis revealed a correlation between visceral fat and medial tibiofemoral joint space width (r: -0,474 p: &lt; 0,001). There is no correlation between subcutaneous fat and medial tibiofemoral joint space width (r: -0,187 p:0,169); and visceral to subcutaneous fat ratio and medialtibiofemoral joint space width (r: -0,225 p: 0,09).Conclusion: Visceral fat is correlated with medial tibiofemoral joint space width (r: -0.474 p: &lt; 0.001). There is no correlation between subcutaneous fat, and visceral to subcutaneous fat ratio, with medial tibiofemoral joint space width.Keywords: Osteoarthritis, obesity, visceral fat, subcutaneous fat, visceral to subcutaneous fat ratio, medial tibiofemoral joint space widt