Kuntjoro Harimurti

Background: Ischemic and reperfusion injuries occur during cardiac arrest and after successful resuscitation, potentially triggering apoptosis and autophagy, which can cause irreversible cell damage or death. Beclin-1 and Caspase-3 are proteins that play roles in autophagy and apoptosis pathways. However, it remains unclear whether the insertion of an IABP influences the serum levels of these proteins in patients with cardiac arrest and acute coronary syndrome (ACS). Objective: To investigate the Caspace-3 and Beclin-1 serum levels after Intra-Aortic Balloon Pumps (IABP) in cardiac arrest survivors with ACS. Methods: This is a single-center prospective randomized control trial (RCT) study using an unpaired t-test and a Mann-Whitney U-test to analyze the data (p-value<0.05). Result: This study included sixty subjects: 48 males and 12 females, with a mean age of 60.3 ± 9.85 years. The result showed there’s no significant difference in Beclin-1 and Caspase-3 serum levels before and after the insertion of IABP in both survival and non-survival groups (p=0.676). Caspace-3 serum level was higher in non-survival group. ROC curve analysis showed the caspase-3 level has a predictive value for mortality in cardiac arrest survivors with ACS (p=0.012). Conclusion: IABP insertion in cardiac arrest patients with ACS doesn’t significantly affect Beclin-1 and Caspase-3 levels. Caspase-3 serum levels may predict mortality in these patients, with a sensitivity of 64% and a specificity of 66.7%. Keyword : Beclin-1; Cardiac Arrest Survivor; Caspase-3; Critical Care; IABP.

A high anticholinergic burden (ACB) scale score (≥3) and polypharmacy have been viewed negatively due to possible adverse events. As Indonesian multicentre data in this field are lacking, this study aimed to provide regional data related to ACB, polypharmacy, and falls, and to analyse factors potentially linked to falls. Data from community-dwelling older adults aged ≥60 years were collected in 12 geriatric care centres through history taking and medical records. Bivariate and multivariate analyses were conducted to evaluate the association between covariates and falls. Polypharmacy and high ACB (score ≥3) were observed in 43.9% and 1.8% of 626 older adults, respectively. The five most prescribed drug classes were calcium-channel blockers, angiotensin receptor blockers, statins, beta blockers, and proton pump inhibitors. The three most prescribed drugs with possible anticholinergic activity were furosemide, isosorbide dinitrate, and cetirizine. The prevalence of past-year falls was 16.8%. Falls were associated with age ≥80 years (odds ratio [OR] 2.44, 95% confidence interval [CI] 1.31-4.53), female sex (OR 2.08, 95% CI 1.30-3.31), transient ischaemic attack and cerebrovascular accident (OR 1.97, 95% CI 0.94-4.10), multimorbidity (≥3 co-morbidities) (OR 1.80, 95% CI 1.07-3.03), depression (OR 1.79, 95% CI 1.00-3.23), and polypharmacy (OR 0.65, 95% CI 0.40-1.05). The prevalence of a high ACB score and falls were 1.8% and 16.8%, respectively. Approximately one in two older adults had polypharmacy. We observed a non-significant inverse relationship between polypharmacy and falls. This may possibly suggest appropriate polypharmacy and closer monitoring applied in geriatric settings, which requires further investigation.

Peripheral Artery Disease (PAD), a manifestation of systemic atherosclerosis, has been linked to cognitive impairment. However, evidence within the Indones

Diabetic kidney disease (DKD) is marked by inflammation, fibrosis and oxidative stress. Calcitriol may offer renoprotective effects by modulating these processes. This double-blind, randomized controlled trial investigated the effects of calcitriol supplementation on kidney injury biomarkers in patients with early DKD. This study randomized 120 patients with controlled type 2 diabetes, albuminuria, and estimated glomerular filtration rate above 45 mL/min/1.73 m² to receive either 0.25 mcg/d calcitriol or a placebo for six months. The primary outcomes were changes in urinary nephrin, podocin, kidney injury molecule-1 (KIM-1), interleukin-6 (IL-6), and urinary albumin-to-creatinine ratio (UACR). After 6 months, the calcitriol group showed lower increases in IL-6 levels (baseline 0.72 pg/mL to 0.87 pg/mL) compared to placebo (1.03 pg/mL to 2.94 pg/mL, p = 0.006), and lower KIM-1 levels (0.36 to 0.51 ng/mL vs. 0.55 to 0.99 ng/mL, p = 0.020). Full baseline and post-treatment values are provided in Tables 2. Urinary nephrin levels decreased in the calcitriol group, while change in the placebo group varied. Although UACR decreased more in the calcitriol group, the difference was not statistically significant (p = 0.099). Positive correlations were observed between KIM-1 and IL-6 in both groups, and a moderate correlation between IL-6 and urinary nephrin was observed in in the calcitriol group. No significant adverse events or changes in serum calcium or phosphate levels were reported. These findings suggest that Calcitriol supplementation may provide renoprotection in patients with early DKD by reducing inflammation and tubular injury, with potential effects on podocyte injury. Further research is required to validate these effects and determine the optimal dosing regimens. ClinicalTrials.gov (NCT05298163).

Introduction Respiratory syncytial virus (RSV) is a public health concern, particularly among neonates/young infants, in individuals with chronic medical conditions, and for older adults. In contrast to children, limits in surveillance and substantial underreporting obscure the full impact of RSV infections on adults. A structured process for adult RSV disease decision-making can guide public health epidemiology and planning. Methods Twelve experts from six Asian countries (Indonesia, Malaysia, Philippines, Singapore, Taiwan, and Thailand) participated in a modified Delphi consensus study to guide surveillance, diagnosis, and impact of RSV in adults in Asia. The expert recommendations could be organized into four themes: epidemiology and surveillance, diagnosis, high-risk groups, and healthcare utilization. Results The expert panel recommended strengthening RSV disease monitoring through integration within current influenza and COVID-19 surveillance systems. Furthermore, to standardize RSV case definitions, it was recommended that the RSV respiratory infection clinical criteria exclude fever. Although rapid antigen tests are employed as standard of care, polymerase chain reaction (PCR) testing should be utilized whenever feasible. Along with year-round testing in Asia to establish incidence, an adjustment factor of at least 2.2-fold was recommended to address the underestimation of RSV-related hospitalization rates based on single-specimen PCR testing. For all adults aged ≥ 75 as well as for those adults aged ≥ 60 with comorbid or immunocompromising conditions, or those residing in long-term care facilities, the experts recommended universal RSV vaccination (contingent upon vaccine licensure), and cost-effectiveness analyses should be used to inform region-specific policy decisions. Conclusions Priority actions proposed for adult RSV infection and disease include streamlining diagnostic testing processes, launching disease awareness campaigns, and engaging public health authorities to advance prevention programs in coordinated efforts with policymakers and payers.

A coronary artery bypass graft is a complex procedure that can cause various physiological responses, including inflammation, oxidative stress, apoptosis, and endothelial dysfunction. Nevertheless, the correlation between these responses and organ function after CABG has not yet been established. This study aims to investigate the correlation between inflammation, oxidative stress, apoptosis, endothelial dysfunction markers, and postoperative organ function assessment as evaluated by the Cardiac Surgery Score (CASUS). A prospective cohort study was conducted on patients undergoing coronary artery bypass graft from two hospitals in Jakarta. IL-6, MDA, caspase-3, and syndecan-1 levels were measured at three points in time: before surgery, on ICU Day-1, and ICU Day-2. Postoperative organ function was assessed on ICU Day 2 by Cardiac Surgery Score (CASUS). Fifty-one patients were included in the study. There was a positive correlation between IL-6 measured before surgery (r = 0.325, p = 0.020) and at the time of admission to the ICU (r = 0.374, p = 0.007). Positive correlation was also found between syndecan-1 levels on ICU day 1 (r = 0.304, p = 0.030) with CASUS. MDA correlated with CASUS on ICU day 2 (r = 0.392, p = 0.004); meanwhile, no significant association was found between caspase-3 and postoperative organ function assessment. Interleukin-6 levels pre-surgery and on ICU day 1, syndecan-1 levels on ICU day 1, and MDA levels on ICU day 2 were correlated with CASUS.

Background: Breast cancer treatment-related lymphedema (BCRL) is a chronic progressive morbidity for which a definitive cure has not yet been achieved. Since axillary lymph node dissection (ALND) is the main risk factor, we have studied the pattern of lymphatic drainage and subclinical lymphedema progression with ICG lymphography (ICG-L) after ALND as a part of our strategy to prevent BCRL. Methods: This study was a prospective cohort of breast cancer patients who underwent ALND between October 2022 and August 2024. We prospectively evaluated postoperative lymphatic drainage with ICG-L. Subclinical lymphedema progression to lymphedema was analyzed using the Kaplan–Meier method. Results: Sixty-three patients were analyzed. Five classifications of lymphatic pathways were identified. The most prevalent pattern was arm and chest wall dermal backflow (DB), draining to internal mammary nodes or type III in 54% of cases, followed by arm DB and collateral drainage to clavicular nodes (type II) in 19.1%, and arm DB only (type I) in 14.3% cases. The cumulative incidence of subclinical lymphedema progression to BCRL was 71.7% [95% confidence interval (CI), 47.0–96.4] with a median BCRL incidence of 13.8 months (95% CI, 10.0–17.5). The hazard rate of BCRL reached its peak at 3 and 12 months. Conclusion: The lymphatic drainage pattern of the arm will mainly drain into the internal mammary and clavicular nodes after ALND. A substantial number of subclinical cases progressing to early-stage BCRL can be detected by ICG-L within the first year. This finding could be used to develop strategies for BCRL prevention.

Background: The needs for surgery in older adult populations is increasing every year. Postoperative delirium is one the most common complications and will impact many adverse outcomes. Comprehensive Geriatric Assessment (CGA) and perioperative risk stratification of older adults are needed as an initial prevention strategy as well as an efficient and applicable prognosis predictor model.Objectives: This study aims to determine the incidence of post-operative delirium and develop a prediction model for delirium in older adults after major non-cardiac elective surgery based on predictor factors.Methods: This research is a retrospective cohort study using secondary data from medical records of older adult inpatients who underwent major elective non-cardiac surgery at Cipto Mangunkusumo Hospital between January 2020 and March 2023. Data analysis using SPSS 20.0 and STATA 10. Development of a prediction model for post-operative delirium complications using the Hosmer- Lemeshow test and Area Under the Curve of the Receiver Operating Characteristic (AUC ROC).Results: Total of 370 subjects that met the criteria were analyzed. The incidence of post-operative delirium was 6.8%. The predictor factors analyzed were age (HR = 3.43; 95% CI 1.544–7.635), cognitive status (HR = 2.74; 95% CI 1.156–6.492), and nutritional status (HR = 3.35; 95% CI 1.459–7,679). The postoperative delirium complication prediction model had good calibration (p > 0.05) and moderate score performance for predicting the incidence of delirium in older adults [AUC 0.750 (p < 0.001; 95% CI 0.640–0.860)].Conclusion: Age, cognitive status, and nutritional status are strong predictors of postoperative delirium in older adults undergoing major non-cardiac elective surgery. The postoperative delirium prediction model has good calibration and moderate score performance.

The current hypothesis regarding the mechanism of Non-Alcoholic Fatty Liver Disease (NAFLD) is the multiple hit theory, where one of the factors involved is gut microbiota. Short-chain fatty acid (SCFA) is the main metabolite of gut microbiota and is suspected to play a role in the development of NAFLD. This study aims to determine the correlation between SCFA levels (acetate, propionate, butyrate) and the degree of fibrosis and steatosis in patients with NAFLD assessed by controlled attenuation parameter (CAP) and transient elastography (TE). A cross-sectional study that included 33 consecutively selected patients at Cipto Mangunkusumo Hospital was conducted from January to August 2023. Fecal sample collection was performed for SCFA examination using GC-MS (Gas Chromatography-Mass Spectrometry). Absolute fecal SCFAs were analyzed for correlation with steatosis and fibrosis based on controlled attenuation parameter (CAP) and transient elastography (TE) values. Subjects were predominantly female (51.5%), with an average age of 49 years, an average CAP value of 296 dB/m, and a median transient elastography value of 6.1 kPa. The ratio of acetate, propionate, and butyrate values in the subjects was 59:24:17. A moderate negative correlation was observed between the absolute butyrate and CAP values (r=-0.522; p=0.002). There is no correlation was identified between short-chain fatty acid levels and transient elastography values.

Background/Objectives: Breast cancer-related lymphedema (BCRL) is one of the major morbidity in breast cancer. Since lymphedema treatment is difficult, especially once it progresses, screening and early detection should be prioritized to prevent the progression. This study used indocyanine green lymphography (ICG-L) as a sensitive diagnostic tool for BCRL screening after axillary lymph node dissection (ALND). Methods: This prospective cohort study included breast cancer patients who underwent ALND from October 2022 to October 2024 at Dharmais National Cancer Hospital. ICG-L was performed to diagnose BCRL. Our study outcome was a 2-year BCRL cumulative incidence and ICG-L stage distribution. Results: This study included 69 patients with a mean body mass index of 26.3±5.1 kg/m2. The median (IQR) of dissected lymph nodes was 18 (14-21), with the number of lymph node metastases 2 (0-10). Forty-six patients (66.7%) were in the locally advanced stage and 42 (60.9%) received radiotherapy. Based on ICG-L, our 2-year BCRL cumulative incidence was 58.0% (45.2-71.4). A total of 25 patients (71.4%) who had BCRL experienced symptoms, with heaviness (60%) and swelling (48%) being the most common signs. The upper extremity lymphedema index increase of > 10 % was only found in 11 (31.4%) patients. Most patients were in ICG-L stage II, as shown in 18 (51.4%) subjects. Conclusions: ICG-L was able to detect early BCRL more frequently. This finding showed its sensitivity as a screening method and that it should be used in preventive BCRL management.