Sriwijaya Journal of Internal Medicine

The Dynamics of NS1 Antigen and Platelet Levels in the Acute Phase of Dengue Hemorrhagic Fever

Emma Ismawatie — 2024-08-05

Introduction: Dengue hemorrhagic fever (DHF) is a significant global health concern, particularly in tropical and subtropical regions. The early diagnosis and effective management of DHF are crucial to reduce morbidity and mortality. The NS1 antigen and platelet count are two key laboratory parameters used in the diagnosis and monitoring of DHF. This study aimed to investigate the dynamics of NS1 antigen and platelet levels during the acute phase of DHF and their correlation with disease severity.

Methods: A prospective cohort study was conducted at a tertiary care hospital in Central Java, Indonesia. Patients presenting with suspected DHF were enrolled and followed up during their hospitalization. Blood samples were collected at admission and at regular intervals to measure NS1 antigen levels and platelet counts. Clinical and laboratory data were collected to assess disease severity.

Results: A total of 150 patients were included in the study. The majority of patients were adults (median age, 32 years) with a female predominance (58%). The median duration of fever at presentation was 4 days. NS1 antigen levels were significantly higher in patients with DHF compared to those with dengue fever (DF) (p < 0.001). Platelet counts were significantly lower in patients with DHF compared to those with DF (p < 0.001). NS1 antigen levels showed a negative correlation with platelet counts (r = -0.62, p < 0.001). The levels of NS1 antigen and platelet count were also significantly associated with disease severity.

Conclusion: The dynamics of NS1 antigen and platelet levels during the acute phase of DHF provide valuable insights into disease pathogenesis and can aid in the early diagnosis and prediction of disease severity. The negative correlation between NS1 antigen and platelet levels suggests a potential role of NS1 in the development of thrombocytopenia in DHF. Further studies are needed to elucidate the exact mechanisms underlying these observations.

Activated Growth Factor (AGF): An Advanced Modality of Platelet-Rich Plasma as a New Biological Agent for the Treatment of Degenerative and Traumatic Conditions

Rachmat Hidayat — 2024-11-13

Platelet-rich plasma (PRP) has emerged as a promising therapeutic modality for various medical applications, particularly in regenerative medicine and wound healing. This is largely attributed to its rich concentration of growth factors (GFs) that play pivotal roles in tissue repair and regeneration. However, the inherent limitations of PRP, such as the variable GF concentrations and short-lived release kinetics, have spurred the development of advanced modalities to enhance its therapeutic efficacy. Activated growth factor (AGF) represents one such advancement, aiming to optimize the release and bioavailability of GFs from platelets. This comprehensive review delves into the biological mechanisms underlying AGF, its preparation methodologies, preclinical and clinical evidence supporting its use, and its potential applications in treating degenerative and traumatic conditions. Furthermore, it explores the advantages of AGF over conventional PRP and discusses future directions for research and clinical translation.

The Impact of Uncontrolled Type 2 Diabetes Mellitus on Chronic Rhinosinusitis Severity and Treatment Outcomes: A Prospective Cohort Study in Bandung, Indonesia

Zainal Abidin Hasan — 2024-11-29

Introduction: Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition, and type 2 diabetes mellitus (T2DM) is a known comorbidity that can exacerbate inflammatory processes. This study aimed to investigate the impact of uncontrolled T2DM on CRS severity and treatment outcomes in a cohort of patients in Bandung, Indonesia.

Methods: A prospective cohort study was conducted at a private hospital in Bandung, Indonesia, from January 2020 to December 2022. Adult patients diagnosed with CRS (with or without nasal polyps) were enrolled and categorized into two groups: controlled T2DM (HbA1c ≤ 7%) and uncontrolled T2DM (HbA1c > 7%). CRS severity was assessed using the Sino-Nasal Outcome Test-22 (SNOT-22) and Lund-Mackay CT scoring. Treatment outcomes were evaluated at 3, 6, and 12 months post-initial treatment (medical and/or surgical) based on SNOT-22 scores, endoscopic findings, and the need for revision surgery.

Results: A total of 240 patients were included (120 with controlled T2DM, 120 with uncontrolled T2DM). At baseline, the uncontrolled T2DM group had significantly higher mean SNOT-22 scores (58.5 ± 12.3 vs. 45.2 ± 10.1, p < 0.001) and Lund-Mackay CT scores (11.8 ± 3.5 vs. 8.2 ± 2.8, p < 0.001) compared to the controlled T2DM group. At 12 months, the uncontrolled T2DM group showed significantly less improvement in SNOT-22 scores (mean change: -15.4 ± 8.7 vs. -28.3 ± 9.2, p < 0.001) and a higher rate of revision surgery (18.3% vs. 5.8%, p = 0.002). Multivariate analysis revealed that uncontrolled T2DM (HbA1c > 7%) was an independent predictor of poorer treatment outcomes (OR: 3.45, 95% CI: 1.98-6.01, p < 0.001).

Conclusion: Uncontrolled T2DM is associated with increased CRS severity and significantly poorer treatment outcomes in patients in Bandung, Indonesia. Effective glycemic control should be a crucial component of CRS management in patients with T2DM.

Cardiovascular Risk Stratification in Pregnant Women with Gestational Diabetes: A Comparative Analysis of Predictive Models in Padang, Indonesia

Cinthya Callathea — 2025-02-25

Introduction: Gestational diabetes mellitus (GDM) significantly increases the risk of both short-term and long-term cardiovascular disease (CVD) in women. Effective risk stratification during pregnancy is crucial for targeted interventions. This study aimed to compare the performance of established cardiovascular risk prediction models in a cohort of pregnant women with GDM in Padang, Indonesia.

Methods: A prospective cohort study was conducted involving 350 pregnant women diagnosed with GDM at two major hospitals in Padang, Indonesia, between January 2022 and June 2023. Baseline demographic, clinical, and laboratory data were collected. Three established CVD risk prediction models – the Framingham Risk Score (FRS), the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equations (PCE), and a modified version of the PCE adapted for GDM (PCE-GDM) – were applied to calculate individual 10-year CVD risk scores. The primary outcome was the development of any major adverse cardiovascular event (MACE), defined as myocardial infarction, stroke, or cardiovascular death, or new-onset hypertension requiring medication, within one year postpartum. Model performance was assessed using discrimination (c-statistic) and calibration (Hosmer-Lemeshow goodness-of-fit test).

Results: The mean age of participants was 32.4 ± 5.1 years. The prevalence of pre-existing hypertension was 8.6%, and the mean pre-pregnancy BMI was 28.5 ± 4.7 kg/m². During the one-year follow-up, 25 (7.1%) women experienced a MACE. The PCE-GDM model demonstrated the best discrimination (c-statistic = 0.82, 95% CI 0.76-0.88), followed by the PCE (c-statistic = 0.75, 95% CI 0.68-0.82), and the FRS (c-statistic = 0.68, 95% CI 0.60-0.76). The PCE-GDM also showed good calibration (χ² = 8.3, p = 0.41), while the FRS and PCE tended to underestimate risk (χ² = 18.5, p = 0.02 and χ² = 15.2, p = 0.06, respectively).

Conclusion: The PCE-GDM model, specifically adapted for GDM, showed superior performance in predicting short-term cardiovascular risk compared to traditional models in this Indonesian cohort. These findings highlight the need for GDM-specific risk stratification tools to improve cardiovascular risk management in this vulnerable population.

Glycated Hemoglobin (HbA1c) as a Predictor of Periodontal Disease Progression in Patients with Type 2 Diabetes: A Longitudinal Study in Surabaya, Indonesia

Alexander Mulya — 2025-02-25

Introduction: Periodontal disease is a prevalent complication of type 2 diabetes mellitus (T2DM), and poor glycemic control is a known risk factor. This longitudinal study aimed to investigate the predictive value of glycated hemoglobin (HbA1c) for periodontal disease progression in a cohort of T2DM patients in Surabaya, Indonesia.

Methods: A prospective cohort study was conducted at private hospital, Surabaya, Indonesia, from January 2021 to January 2023. 180 patients with T2DM and pre-existing chronic periodontitis were enrolled. Periodontal parameters, including probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and plaque index (PI), were assessed at baseline, 12 months, and 24 months. HbA1c was measured at each visit. Multivariate linear regression and mixed-effects models were used to analyze the association between HbA1c and changes in periodontal parameters over time, adjusting for potential confounders.

Results: The mean age of participants was 58.5 ± 8.2 years, and 55% were female. Baseline mean HbA1c was 8.2 ± 1.5%. After adjusting for age, gender, smoking status, diabetes duration, and baseline periodontal parameters, higher baseline HbA1c was significantly associated with greater increases in PPD (β = 0.15 mm per 1% HbA1c increase, 95% CI: 0.08-0.22, p < 0.001) and CAL (β = 0.18 mm per 1% HbA1c increase, 95% CI: 0.10-0.26, p < 0.001) over 24 months. Furthermore, sustained elevation of HbA1c (average HbA1c over 24 months) was a stronger predictor of periodontal disease progression than baseline HbA1c alone. A significant interaction between HbA1c and time was observed (p < 0.001), indicating that the effect of HbA1c on periodontal parameters increased over time.

Conclusion: HbA1c is a significant independent predictor of periodontal disease progression in patients with T2DM. Sustained glycemic control is crucial for preventing and managing periodontal complications in this population. These findings highlight the importance of interdisciplinary collaboration between internists and dentists in the comprehensive care of T2DM patients.