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Coronary artery disease (CAD) is one of the main global causes of death. Early diagnosis by physical examination may play important role to identify population at risk and reduce morbidity and mortality. Diagonal Ear Lobe Crease (DELC), also known as Frank’s sign, was observed to be associated with coronary artery disease. We report a case of patient who presented with inferoposterior STEMI and findings of bilateral DELC. A systematic literature search was conducted to identify the latest evidence and its implications for clinical practice.

Anemia sering dijumpai pada pasien dengan penyakit kronis dan meningkatkan morbiditas dan mortalitas dari pasien. Prevalensi anemia penyakit kronis terdapat pada urutan kedua tersering setelah anemia defisiensi besi. Anemia penyakit kronis sering terjadi bersamaan dengan anemia defisiensi besi dan keduanya memberikan gambaran penurunan besi dalam serum. Namun, kedua jenis anemia ini perlu dibedakan karena terdapat perbedaan patogenesis dan tata laksana keduanya. Beberapa parameter besi lain perlu diperiksa untuk membedakannya. Terapi utama pada anemia penyakit kronis adalah dengan mengatasi penyakit yang mendasari.

Pendahuluan: Tuberkulosis (TB) merupakan masalah kesehatan yang penting di negara berkembang. Infeksi bakteri ini akan mengakibatkan neutrofilia dan limfopenia. Rasio neutrofil terhadap limfosit/ neutrophil to lymphocyte ratio (NLR) merupakan pemeriksaan yang mudah, biaya terjangkau, dan cukup sensitif. Nilai NLR pengidap TB lebih tinggi dibandingkan orang normal, dengan nilai cut off >2,16. Penelitian ini bertujuan untuk mengetahui perbedaan nilai NLR pada pasien TB dewasa sebelum dan setelah terapi fase intensif.Metode: Subjek penelitian adalah pasien TB dewasa kasus baru yang datang ke poli klinik Penyakit Dalam RS Atma Jaya, tanpa adanya HIV, gagal ginjal kronik, diabetes melitus, penyakit paru obstruktif kronik, dan pneumonia bakterial. Jumlah leukosit, neutrofil dan limfosit, serta perhitungan NLR sebelum dan setelah terapi fase intensif dicatat. Analisis data menggunakan SPSS. Hasil: Dari 44 pasien TB, 23 (52,3%) diantaranya berjenis kelamin laki-laki, dengan usia median 37 tahun. Delapan puluh delapan persen sampel menderita TB paru. Nilai NLR sebelum terapi (2,77) lebih tinggi daripada setelah terapi (2) fase intensif (p

Pendahuluan: Abses hati ameba merupakan manifestasi amebiasis ekstra-intestinal yang disebabkan oleh infeksi protozoa Entamoeba histolytica. Pasien abses hati ameba dapat disertai dengan peningkatan fungsi hati, yang akhirnya mempengaruhi lama perawatan pasien. Tujuan penelitian ini untuk mengetahuikorelasi gangguan fungsi hati dengan lama perawatan pada pasien dengan abses hati ameba. Metode: Penelitian ini menggunakan rancangan studi potong lintang analitik korelatif. Peserta dalam penelitian ini adalah pasien yang telah didiagnosis abses hati ameba di Rumah Sakit Atma Jaya antara Januari 2014 sampai Desember 2017. Lama perawatan pasien di rumah sakit dan fungsi hati dihitung, lalu dikorelasikan dengan menggunakan uji korelasi Spearman. Hasil: Terdapat 16 pasien abses hati ameba dengan 15 pasien laki-laki, rerata usia 44,56 tahun dan rerata lama perawatan 10 hari. Hepatomegali ditemukan pada 87,5% pasien. Rerata AST 34 U/L, ALT 60,63U/L, Alkali fosfatase 184,82U/L, dan gamma-GT 176,17U/L. Data fungsi hati dan lama perawatan tidak berdistribusi normal dan dilakukan uji korelasi Spearman dengan hasil tidak ada korelasi signifikan (p>0,05) antara gangguan fungsi hati dengan lama perawatan. Kesimpulan: Tidak didapatkan korelasi signifikan antara gangguan fungsi hati dengan lama rawat pada pasien yang menderita abses hati ameba.

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe complication in adults infected with SARS-CoV-2. However, the pathophysiology remains elusive, as the limited number of reports preclude a broader understanding of this syndrome. We conducted this systematic review to explore the clinical spectrum of MIS-A, in particular its rheumatological manifestations. Meta-analyses of case-series were also performed. We identified 28 patients from 14 case reports and two case series of MIS-A. This disease occurred equally in both genders, with a mean age of 33+10 years old, and predominantly in those of African descent (40%). Rheumatological manifestations consisted of Kawasaki Disease (KD)-like symptoms. Ninety percent of patients had positive COVID-19 serology tests, while 48% of patients were negative for COVID-19 RT-PCR test. Twelve patients were admitted to ICU and unfortunately two died. Although the signs and symptoms of MIS mimicked KD, the gastro-intestinal findings were more prominent in the former group. The demographic make-up was also different, with MIS-A occurring mostly in those of African descent. Importantly, unlike their paediatric counterparts, the adult group did not have coronary artery abnormalities. Long-term monitoring is needed as safety data is scarce. Of note, although the prognosis of MIS-A is excellent, the life-threatening nature of this syndrome demands intensive care unit level of care and mechanical support. During the COVID-19 pandemic, a constellation of KD symptoms in an adult patient should alert the clinician to the possibility of MIS-A. Resumen El espectro clinico del sindrome inflamatorio multisistemico en adultos (MIS-A) es una complicacion rara pero grave en adultos infectados con SARS- CoV-2. Realizamos una busqueda bibliografica en varias bases de datos, tambien se hicieron metanalisis. Identificamos 28 pacientes de 14 informes de casos y dos series de casos de MIS-A. Esta enfermedad se presento por igual en ambos sexos, con una edad media de 33 + 10 anos, y se presento predominantemente en afrodescendientes (40%). Las manifestaciones reumatologicas consistieron en sintomas similares a la enfermedad de Kawasaki (KD). El 90% de los pacientes tuvo pruebas positivas de serologia de COVID-19, mientras que el 48% dio negativo para la prueba de RT-PCR de COVID-19. Doce pacientes ingresaron en UCI y, lamentablemente, dos fallecieron. Encontramos que, si bien, los signos y los sintomas de MIS imitaban a KD, los hallazgos gastrointestinales eran mas prominentes en el primer grupo. Ademas, la composicion demografica fue asimismo diferente, con MIS-A que se presento principalmente en afrodescendientes. Es importante destacar que, a diferencia de sus homologos pediatricos, el grupo de los adultos no experimento anomalias en las arterias coronarias. Se necesita un seguimiento a largo plazo, ya que los datos de seguridad son escasos. Es de destacar que, aun cuando el pronostico de MIS-A es excelente, la naturaleza potencialmente mortal de este sindrome exige el nivel de atencion y el soporte mecanico de la unidad de cuidados intensivos. Durante la pandemia de COVID-19, una constelacion de sintomas de EK en un paciente adulto debe alertar al medico sobre la posibilidad de MIS-A.

Mucormycosis is one type of fungal disease, associated with a poor prognosis if not promptly diagnosed and managed because its highly aggressive tendency. Although it is a rare disease, a rapid increase in cases of mucormycosis associated with COVID-19 is being reported. Mostly, risk factors for this disease are uncontrolled diabetes mellitus, other immunosuppressive conditions and corticosteroid therapy. Immune dysfunction, lung pathology and corticosteroid therapy in COVID-19 patients making it more susceptible to develop fungal infection including mucormycosis. The combination of steroid therapy and underlying diabetes mellitus in COVID-19 also can augment immunosuppression and hyperglycemia. Control of hyperglycemia, early treatment with liposomal amphotericin B, and surgery are three important factors in mucormycosis therapy that essential for successful management. However, in this COVID-19 pandemic situation, that management strategies are compromised. First, hyperglicemia can be aggravated by glucocorticoid, therapy that used widely for COVID-19 especially in severe case. Second, patients with ARDS and multiorgan dysfunction can prevent timely diagnostic for imaging and other testing, so appropriate therapy that should be given will be delayed. Last, the essential service in hospital such surgery in this pandemic era reduced signifi cantly to prevent the spread of COVID-19. This review was created with the aim mucormycosis co-infection can be considered in patients with COVID-19, especially with known risk factor. Prompt and rapid diagnosis are important for eff ective therapy and decreasing case fatality rate. The use of steroid in mild cases, utilization of higher doses of steroid and drugs that targeting immune pathway should be avoided.

CrossFit, a high-intensity interval training, keeps growing in trend and is one of the most favorable types of fitness, after wearable technology. However, an excessive workout is detrimental to the human body, particularly the muscle tissue. CrossFit is known to cause exercise-induced rhabdomyolysis, a concerning disease with potentially devastating consequences. Nevertheless, only a few case reports have described this disease, and this is the first case report of such disease in Indonesia to the best of our knowledge. A 27-year-old, previously healthy and active Indonesian male presented with dark urine and myalgia in lower extremities after 720 repetitions of squats three days before admission. His urinalysis showed +1 blood, 2-7 red blood cells/high power field (HPF), but negative protein. Laboratory results showed an increase in creatine phosphokinase (CPK) (54,250 U/L) and LDH (1,670 U/L) levels, consistent with exercise-induced rhabdomyolysis, and serum calcium of 1.87 mmol/L, with normal serum creatinine and BUN level. He was hospitalized for two days and was treated with intravenous hydration therapy. CrossFit-induced rhabdomyolysis is a potentially devastating disease. Apart from prompt diagnosis and treatment, further research regarding the safe number of repetitions for CrossFit training, particularly for lower extremities are needed. Predictors of CrossFit-induced rhabdomyolysis must be sought throughout, and participants' awareness should be increased.

In tropical countries, endemic diseases such as malaria can be challenging to distinguish from COVID-19 because of the similarities in presenting symptoms. Here we reported a case of a young soldier with fever and myalgia six days before admission, with non-productive cough, chills, nausea and vomiting, dizziness, and headache for two days. Previously, he had experienced four times of malaria infection. He had a history of positive non-falciparum malaria rapid diagnostic test (RDT) two days before admission. Significant findings were epigastric tenderness, splenomegaly, and severe thrombocytopenia of 36×103 cells / µL. A naso-oropharyngeal swab examination revealed a positive SARS-CoV-2 infection. Consequently, he was hospitalized for 12 days, successfully treated, and discharged without sequelae. Thus, in light of a pandemic, physicians need to raise the suspicion of concurrent COVID-19 infection with other tropical diseases, especially at-risk patients, because malaria and COVID-19 may share similar manifestations. Moreover, further ancillary testing, such as RDT, may be warranted.

At the beginning of 2020, the national health system and medical communities are faced with unprecedented public health challenges. A novel strain of coronavirus, later identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread globally, marking another pandemic of coronaviruses. This viral disease is responsible for devastating pneumonia, named coronavirus disease of 2019 (COVID-19), and projected to persist until the end of the year. In tropical countries, however, concerns arise regarding the similarities of COVID-19 with other infectious diseases due to the same chief complaint, which is fever. One of the infectious disease of a primary concern is dengue infection, which its peak season is approaching. Others report that there are cases of serological cross-reaction of COVID-19 and dengue infection. In this comprehensive review, we underscore the importance of knowing similar clinical presentations of both diseases and emphasize why excluding COVID-19 in the differentials in the setting of a pandemic is imprudent.

ObjectiveTo investigate the clinical characteristics and outcomes of Coronavirus Disease of 2019 (COVID-19) patients complicated with venous thromboembolism (VTE)MethodWe performed a comprehensive literature search of several databases to find studies that assessed VTE in hospitalized COVID-19 patients with a primary outcome of all-cause mortality and secondary outcomes of intensive care unit (ICU) admission and mechanical ventilation. We also evaluated the clinical characteristics of VTE sufferers.ResultsEight studies have been included with a total of 1237 pooled subjects. Venous thromboembolism was associated with higher mortality (RR 2.48 (1.35, 4.55),p=0.003;I25%,p=0.35) after we performed sensitivity analysis, ICU admission (RR 2.32 (1.53, 3.52),pI280%,pp=0.0004;I277%,p=0.001). Furthermore, it was also associated to male gender (RR 1.21 (1.08, 1.35),p=0.0007;I212%,p=0.34), higher white blood cells count (MD 1.24 (0.08, 2.41), 0.04;I20%; 0.26), D-dimer (MD 4.49 (2.74, 6.25),pI267%,p=0.009) and LDH levels (MD 70.93 (19.33, 122.54),p<0.007;I221%, p=0.28). In addition, after sensitivity analysis was conducted, VTE also associated with older age (MD 2.79 (0.06, 5.53),p=0.05;I225%,p=0.24) and higher CRP levels (MD 2.57 (0.88, 4.26);p=0.003;I20%,p=0.96).ConclusionVenous thromboembolism in COVID-19 patients was associated with increased mortality, ICU admission, and mechanical ventilation requirement. Male gender, older age, higher levels of biomarkers, including WBC count, D-Dimer, and LDH were also being considerably risks for developing VTE in COVID-19 patients during hospitalization.

Pada dasarnya leptospirosis merupakan penyakit infeksi pada hewan (zoonotik) yang disebabkan oleh spesies patogenik Leptospira.1,2 Tetapi tidak jarang pula infeksi akut ini terjadi pada manusia, paling banyak disebabkan oleh Leptospira interogans.1-3 Penyakit ini dapat ditemukan baik pada daerah tropis maupun subtropis, terutama pada daerah dengan kondisi higienis yang buruk sehingga bakteri ini dapat bertahan hidup dan mnyebar ke penderita lain. Di banyak negara, termasuk di Indonesia, leptospirosis merupakan masalah yang kurang mendapat perhatian. Apakah di Indonesia sudah bebas dari penyakit ini? Tentunya belum. Berdasarkan data yang tercatat di kementrian kesehatan, pada tahun 2014 terdapat kejadian luar biasa leptospirosis di Kabupaten Kota Baru, Kalimantan Selatan. Data pada Kemenkes mencatat hingga November 2014 terdapat 435 kasus dengan 62 kematian akibat leptospirosis.

Negara Kesatuan Republik Indonesia merupakan negara kepulauan dengan luas wilayah mencapai 1,7 juta km2 yang tersebar dari Sabang sampai Merauke dan memiliki populasi sebesar 260 juta jiwa.1Beberapa penyakit infeksi masih menjadi masalah endemik di Indonesia, termasuk tuberkulosis. Tuberkulosis tidak hanya menjadi masalah kesehatan di Indonesia tetapi masih menjadi masalah kesehatan utama di dunia. Bahkan dalam 5 tahun terakhir menjadi penyebab utama kematian yang disebabkan oleh infeksi tunggal. Diagnosis dan tata laksana yang tepat dapat menyembuhkan sebagian besar penderita tuberkulosis.2

Seorang wanita usia 22 tahun datang dengan keluhan utama timbul bercak kemerahan dan rasa gatal pada wajah sejak 5 hari sebelum masuk rumah sakit. Keluhan lainnya adalah timbul bengkak pada kedua tungkai, nyeri tenggorokan, dan batuk. Pasien sedang dalam pengobatan untuk lupus eritematosus sistemik dan tuberkulosis paru (sejak 12 hari yang lalu). Pada pemeriksaan fisik, pasien kompos mentis, hemodinamik stabil, dengan edema anasarka, lesi multipel makulo purpura yang tersebar pada tubuhnya, konjungtivis pada kedua mata, lesi multipel ulserasi di rongga mulut, dan tampak eritema pada mukosa genitalia. Hasil laboratorium menunjukkan anemia, lekopenia, hipoalbuminemia, proteinuria. Kami mencurigai pasien ini menderita sindrom Stevens Johnson akibat obat antituberkulosis. Selama perawatan, kami menghentikan pemberian obat antituberkulosis, dan memberikan metilprednisolon parenteral, serta terapi suportif lainnya. Pasien diizinkan untuk rawat jalan setelah terjadi perbaikan klinis dan dapat mobilisasi sendiri. (Med J Indones. 2012;21:235-9)