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Introduction: Type 2 Diabetes Mellitus is a group of metabolic disorders characterized by clinical hyperglycemia due to defects in insulin secretion, insulin action or both. This study was to determine the correlation between serum fasting Glucagon Like Peptide-1 (fGLP-1) levels and serum 1 hour post prandial Glucagon Like Peptide-1 (1hGLP-1) levels with IMT of carotid artery in patients with Type 2 DM. Method: This study used a correlative analytic with a cross-sectional approach in population of Type 2 DM patients who were treated at the Interna Polyclinic at Dr. Mohammad Hoesin Palembang the IMT of carotid artery was measured with a high-resolution carotid doppler ultrasound B-mode ultrasound machine. The GLP-1 level was measured by the ELISA method. There were 40 subjects with a median age of 52 (40-59) years. Result: A strong negative correlation was found between fGLP-1 serum levels and IMT of carotid artery with r= -0.748; p = 0.000; n=40. This study also found a strong negative correlation between serum levels of 1hGLP-1 and carotid IMT with r = -0.600; p = 0.000; n=40. There is a strong correlation between serum fGLP-1 levels and serum 1hGLP-1 levels with IMT of carotid artery in Type 2 DM patients. Conclusion: measurement of serum levels of fGLP-1 and 1hGLP-1 may be an important indicator in evaluating cardiovascular risk in Type 2 DM patients. It may also provide guidance in the development of therapies for Type 2 DM patients to reduce the risk of cardiovascular disease.

Background: Acute kidney injury (AKI) is a clinical condition characterized by a rapid decline in kidney function that causes homeostatic failure in regulating fluid, electrolyte, and acid-base balance within hours to days. Nutritional supplementation is effective in replacing lost protein and as an energy reserve. This study aimed to determine the effect of intravenous essential amino acid supplementation on the recovery of kidney function in acute kidney injury patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Methods: This study is an open clinical trial of experimental research. A total of 34 research subjects participated in this study, where the subjects were grouped into treatment (IV amino acid supplementation) and placebo groups. Data analysis was carried out using STATA in univariate and bivariate. Results: Administration of amino acid supplements can reduce creatinine by 1.36. Meanwhile, the placebo was unable to reduce creatinine levels and even caused an increase in creatinine by 0.26. Conclusion: Intravenous administration of essential amino acid supplements has an effect on the recovery of kidney function in acute kidney injury patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

BACKGROUND: Vitamin D has a role in downregulating the proinflammatory cytokines as well as promoting the antiinflammatory pathway in rheumatoid arthritis (RA). Seluang fish (Rasbora sp.) has potency as a new source of vitamin D. Previous study had proven Seluang fish oil efficacy in systemic lupus erythematosus. However, there are no trials that prove its efficacy in RA yet. Hence, this study was conducted to find out the ability of Seluang fish oil to improve proinflammatory cytokines, vitamin D levels, and disease activity in RA.METHODS: A clinical trial with a randomized and double-blind method was done in two groups, each one consisting of 17 RA subjects. One group was given 500 mL of a Seluang fish oil capsule (contains 665 IU cholecalciferol), while the other group was given a placebo daily, for 12 consecutive weeks. Measurements of the RA disease activity score 28 erythrocyte sedimentation rate (DAS28-ESR) and DAS28 C-reactive protein (DAS28-CRP), as well as measurement of interleukin (IL)-6, IL-17, and vitamin D levels by using immunoassay method were performed before and after the supplementation.RESULTS: Significant alterations in the lower levels of IL-17 were observed in the Seluang fish oil group (p=0.031), but not in the placebo group (p=0.320). Reduction of DAS28-ESR (p=0.000) and DAS28-CRP (p=0.000) score demonstrated that the Seluang fish oil supplementation was useful in reducing RA disease activity. No significant shift was observed in either vitamin D (p=0.967) or IL-6 levels (p=0.076) after Seluang Fish Oil supplementation.CONCLUSION: Seluang fish oil is effective in lowering IL-17 levels, DAS28-ESR, and DAS28-CRP, but not in improving vitamin D level or lowering IL-6 level in RA patients.KEYWORDS: rheumatoid arthritis, seluang fish oil, interleukin-6, interleukin-17, vitamin D, DAS28

Rheumatic Arthritis (RA) is an autoimmune-rheumatic disease that requires evaluation and monitoring of disease activity. RA management aims to achieve low disease activity based on DAS28. This study was conducted to know the characteristics of RA patients at RSUP Dr. Mohammad Hoesin Palembang and associated factors. A cross-sectional study was performed on RA patients at the Rheumatology Outpatient Clinic, Department of Internal Medicine, Dr. Moh Hoesin General Hospital Palembang, that meets criteria inclusion by consecutive in October 2021. RA disease activity was assessed with Disease Activity Score (DAS 28). Analysis statistic was conducted with SPSS version 24.0. A total of 35 subjects participated in this study; 94.3% of subjects were female. The mean age of subjects is 46.54± 9.86 years old. The proportion of subjects that has low, moderate, and high disease activity based on DAS28 were 1 (2.9%), 21 (60%), and 13 (37.1%). Analysis with unpaired t-test showed that subjects with high disease activity disease have higher Erythrocyte Sedimentation Rate (76.38±30.7 vs 47.5±26.97 mm/hour, p= 0.006) and pain score based on Visual Analog Scale (VAS) (7.54 ± 1.05 vs 6.18±2.10, p=0.016) compared to subject with low and moderate disease activity. Factors associated with disease activity in RA patients are Erythrocyte Sedimentation Rate and pain scale based on VAS. Keywords: Rheumatoid Arthritis, DAS28, Disease Activity ABSTRAK Artritis Reumatoid (AR) merupakan penyakit autoimun-rematik yang membutuhkan evaluasi dan pemantauan aktivitas penyakti sebagai bagian dalam penatalaksanaannya. Aktivitas penyakit rendah berdasarkan DAS28 menjadi tujuan dalam pengobatan AR. Penelitian ini dilakukan untuk mengetahui karakteristik pasien AR di RSUP Dr. Mohammad Hoesin Palembang dan faktor-faktor yang mempengaruhinya. Studi potong lintang yang dilakukan dengan memeriksa pasien AR di Poliklinik Reumatologi Departemen Ilmu Penyakit Dalam RSUP Dr. Moh Hoesin Palembang yang memenuhi kriteria inklusi secara konsekutif pada bulan Oktober 2021. Derajat aktivitas penyakit AR dinilai dengan menggunakan Disease Activity Score (DAS 28). Analisis statistik dilakukan dengan menggunakan program SPSS versi 24.0. Sebanyak 35 subyek yang ikut dalam penelitian, 94.3% di antaranya berjenis kelamin wanita. Rerata usia subyek adalah 46.54± 9.86 tahun. Proporsi subyek yang memiliki aktivitas penyakit rendah, sedang, dan tinggi berdasarkan DAS 28 berturut-turut adalah 1 (2.9%), 21 (60%), dan 13 (37.1%). Analisis dengan uji t tidak berpasangan didapatkan subyek dengan aktivitas penyakit tinggi memiliki nilai Laju Endap Darah lebih tinggi (76.38±30.7 vs 47.5±26.97 mm/jam, p= 0.006) dan skala nyeri berdasarkan Visual Analog Scale (VAS) lebih tinggi (7.54 ± 1.05 vs 6.18±2.10, p=0.016) dibanding subyek dengan aktivitas penyakit rendah-sedang. Faktor yang mempengaruhi derajat aktivitas penyakit pada pasien AR antara nilai Laju Endap Darah dan skala nyeri berdasarkan VAS. Kata Kunci: Artritis Reumatoid, DAS 28, Derajat Aktivitas Penyakit

Type 2 Diabetes Mellitus (T2DM) is the leading cause of chronic kidney disease (CKD), accounting for almost half of all cases of kidney failure that necessitate replacement therapy. Cardiovascular disease (CVD) is the leading cause of death in patients with T2DM and CKD. To lower blood glucose levels by inhibiting glucose reabsorption in the proximal tubule, sodium/glucose cotransporter 2 inhibitors (SGLT2-i) were developed. Consistent reductions in risks for secondary kidney disease end points (albuminuria and a composite of serum creatinine doubling or 40% estimated glomerular filtration rate decline, kidney failure, or death) were recognized in clinical trials designed to demonstrate the CVD safety of SGLT2i in type 2 diabetes mellitus (T2DM), as well as reductions in CVD events. The DECLARE-TIMI58 (Dapagliflozin Effect on Cardiovascular Events-Thrombolysis in Myocardial Infarction 58, or DECLARE) trial in patients with T2DM, urinary albumin-creatinine ratio >300 mg/g, and estimated glomerular filtration rate of 30 to 90 mL/min/1.73 m2 established the kidney and CVD benefits of dapagliflozin in patients with CKD. SGLT2i boost glomerular hemodynamic function and are figured to augment other local and systemic processes that contribute to the development of CKD and CVD. According to latest Indonesian Society of Endocrinologist’s guideline, patients with T2DM was recommended to use SGLT2i to reduce their risk of CKD and CVD, in accordance with the clinical trial entry criteria. To achieve widespread use of these life-saving medications, effective implementation strategies are required.

Rheumatoid arthritis (RA) is an autoimmune disease that requires careful management and regular evaluation of the degree of disease activity. AR is known for its pathophysiology and is strongly influenced by the increase of proinflammatory cytokines, especially IL-6. This study was conducted to determine the correlation of IL-6 levels with the degree of disease activity in AR patients at Dr. Mohammad Hoesin Palembang. A cross-sectional study was conducted on RA patients at the Rheumatology Polyclinic, Department of Internal Medicine, Dr. Moh Hoesin Palembang, who met the inclusion criteria consecutively in October 2021. The degree of RA disease activity was assessed using the Disease Activity Score (DAS 28). Statistical analysis was performed using SPSS version 24.0. A total of 34 subjects participated in the study, with most being women and a median age of 49.5 years. The majority of subjects had a moderate-high degree of RA activity. There is no significant correlation between IL-6 levels with DAS 28 CRP (r=0.256, p=0.072) and DAS 28 LED (r= 0.056, p=0.376). There was no significant correlation between serum IL-6 levels and disease activity in Rheumatoid Arthritis patients at Dr. Mohammad Hoesin Palembang.

Lupus Eritematosus Sistemik (LES) merupakan penyakit kronik inflamatif autoimun. Perjalanan penyakitnya ditandai dengan episode remisi dan eksaserbasi sering menyebabkan gejala depresi yang signifikan. Penyakit LES dan depresi memiliki kesamaan dalam proses dan penyebabnya yakni Interleukin-10 (IL-10). Sitokin antiinflamasi (IL-10) pada LES ini selain mempengaruhi tingkat keparahan aktivitas LES, juga berkontribusi terhadap patofisiologi depresi yang menurunkan kualitas hidup pasien LES. Tujuan penelitian ini untuk menentukan hubungan kadar IL-10 dengan tingkat depresi melalui penilaian skor BDI (Beck’s Depression Inventory) pada penderita LES. Penelitian ini adalah studi observasional analitik dengan rancangan cross sectional dan menggunakan uji hubungan untuk melihat hubungan IL-10 dengan tingkat depresi pada pasien LES yang dilakukan di ruang poliklinik dan perawatan penyakit dalam RSUP dr. Mohammad Hoesin Palembang dari November 2019 hingga Maret 2020. Jumlah subjek penelitian sebanyak 40 sampel yang merupakan pasien LES dengan depresi yang telah dilakukan perhitungan tingkat depresi menggunakan skor BDI. Terdapat 40 subjek penelitian dengan median umur 30,50 tahun dan rentang umur 18-56 tahun. Subjek dengan tingkat depresi ringan 17 orang (42,5%), sedang 14 orang (35%) dan berat 9 orang (22,5%). Pada aktifitas LES, terdapat 5 orang (12,5%) dengan aktifitas LES ringan, 20 orang (50%) dengan aktifitas LES sedang, dan 15 orang (37,5%) dengan aktifitas LES berat. Pada penelitian ini terdapat hubungan yang bermakna antara tingkat depresi dengan tingkat keparahan aktifitas LES (MEX SLEDAI) (r= 0,444 p=0,004). Namun, tidak terdapat hubungan bermakna antara kadar IL-10 serum dengan tingkat keparahan aktifitas LES (p= 0,170, r = 0,221) dan kadar IL-10 serum dengan tingkat depresi (p = 0,437, r= 0,126). Pada penelitian ini tidak terdapat hubungan antara IL-10 serum dan tingkat depresi pada pasien LES di RSUP Dr. Mohammad Hoesin Palembang.

Introduction: The extraordinary thrombotic manifestations of Corona virus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome CoV-2 (SARS-CoV-2) virus, presenting as venous and arterial thrombosis have been reported in several literatures, but in this report, we presented a special case of acute limb ischemia in a patient that has been vaccinated by COVID-19 vaccine. Acute limb ischemia (ALI) is defined as decreasing in arterial perfusion of a limb with a threat to viability of the limb and mortality. COVID-19 has been declared as a global pandemic by the WHO. Patients with COVID-19 have abnormalities in blood coagulation parameters and are prone to thromboembolic events. This hypercoagulable state caused by COVID-19 mainly manifests as venous thromboembolism while peripheral arterial involvement is less frequent. Case: A 54-year diabetic and smoker male has already got one dose COVID-19 vaccination came to our emergency unit with severe acute respiratory syndrome and pain, pale and paresthesia of his left leg. There was pneumonia pattern according to chest X-ray and a ground glass opacity in chest CT-scan, he was confirmed infected by COVID-19 according to RT-PCR test. From CT-Angiography we found multiple thrombosis in the distal aorta, superficial femoral artery (SFA), anterior tibial artery (ATA), and posterior tibial artery (PTA) of left lower extremity. Initial treatment we started with unfractionated heparin, oxygenation, intravenous fluid and analgesia. We managed the patient in isolation ward special for COVID-19. We did thrombectomy to save the limb, nevertheless in few days after we performed amputation at the level of talonavicular joint to the distal part of left foot caused by gangrene. Conclusion: Vaccination can protect from COVID-19 if we vaccinated with full dose and our immune system able to create antibody. The condition will be different in immunocompromised condition and we get not full dose vaccination. Covid-19 Patient with Diabetes and smoker could have higher risk to develop acute limb ischemia because of hypercoagulable state. Management of a COVID-19 patient with cute limb ischemia is more complicated and challenging. Although we have already vaccinated life style modification like wearing a mask, social distancing and using hand sanitizer can give us more protection from Covid 19. Keywords: acute limb ischemia, COVID-19 vaccination, heparinization, thrombectomy

A B S T R A C T Introduction. Old age is related to geriatric syndrome where there are several health problems that often occur related to a decrease in body function and an increase in the inflammatory process. Decrease in muscle mass, muscle strength and physical performance will lead to a condition of sarcopenia and frailty syndrome in the elderly. The importance of prevention so that sarcopenia does not occur in the elderly by evaluating the factors that can cause it, one of which is controlling nutritional factors (macro and micro nutrients), such as in research, namely omega-3 macronutrients. The purpose of this study was to determine the correlation between serum omega-3 levels with muscle mass, muscle strength, and physical performance in the elderly community at Moehammad Hoesin Hospital Palembang. Methods. This research is an observational analytic study with a cross-sectional approach which was conducted at the Integrated Geriatric Clinic Internal Medicine RSMH Palembang from November 2019 to November 2020. A sample of 21 people aged> 60 years was examined for muscle mass, muscle strength, physical performance and omega- levels. 3 serums. All data processing and analysis in this study used SPSS version 25 for Windows. Results. Of the 21 subjects, it was found that women were 19 people (90.5%) and 2 men (9.5%). The mean value of muscle mass was 37.65 ± 5.7, hand grip strength was 24.04 ± 5 kg, and walking speed was 6.72 ± 1.8 seconds per 6 meters. There were 11 subjects with low serum omega-3 levels of 485.25 ± 110.19 mg. There was a significant relationship between serum omega-3 levels and muscle mass (p = 0.041) with moderate correlation strength (r = 0.448). Conclusion: Muscle mass has a significant relationship with serum omega-3 levels in the elderly with moderate strength. Meanwhile, muscle strength and physical performance did not have a significant relationship.