Proportion of Hypogonadism in Transfusion-Dependent Thalassemia Patients and Its Contributing Factors.

BACKGROUND: Beta thalassemia is a lifelong disease involving malformed red blood cells (RBC). One of the disease's complications is hypogonadism, in which adults tend to exhibit regression in sexual characteristics, experience sexual dysfunction, and therefore have a lower quality of life. Around 3-10% of the Indonesian population carries the beta-thalassemia gene. This study aimed to see the proportions of hypogonadism in transfusion-dependent thalassemia patients and its contributing factors. METHODS: This is a cross-sectional study involving 60 male patients admitted to three Indonesian general hospitals from July 2022 to July 2023. All patients were diagnosed with beta-thalassemia via chromatography hemoglobin analysis. We performed a single-time physical examination and laboratory examinations to determine FSH, LH, and free testosterone levels. The correlation between Hb and sexual hormone levels was analyzed using Spearman's rank correlation coefficient. ROC curve analysis was conducted afterward. All statistical analysis was done in SPSS version 29. RESULTS: 31 out of 60 thalassemia patients had hypogonadism. Pre-transfusion Hb count was found to be linearly correlated with FSH (r = 0.388, p = 0.049), LH (r = 0.338, p = 0.008), and free testosterone (r = 0.255, p = 0.049). ROC analysis indicated that pre-transfusion Hb was viable as a predictor for hypogonadism (AUC = 0.655, 65.5% sensitivity, 67.7% specificity). CONCLUSION: We confirmed the role of pre-transfusion Hb count as a potential predictor for hypogonadism due to the tissue hypoxia mechanism and transfusion-related iron overload in TDT patients. Decreased Hb is linearly correlated with FSH, LH, and testosterone levels. Decreased Hb also downregulates these factors.

Effectiveness of an online mental health strengthening module to build resilience and overcome stress for transitional aged medical students.

Introduction: Transitional-aged youths (17-to-24-years-old) are prone to mental-health problems. Students in higher education, especially medical students, are more exposed to stressors and thus need training to increase resilience. However, there have been limited mental-health strengthening modules specifically developed for medical students of transitional age, and none in Indonesia. This study intends to test the effectiveness of an online mental-health strengthening module in altering resilience. Methods: A pragmatic randomized trial with repeated measurements was employed to evaluate biopsychosocial outcomes of resilience. The intervention module was delivered in 4 weeks to 105 eligible students. Participants were divided into intervention group (n = 52) and control group (n = 53). Outcomes were measured in the 4th, 8th, and 12th weeks. Primary outcome was resilience level as measured by Connor-Davidson Resilience Scale (CD-RISC). Perceived Stress Scale (PSS), Depression Anxiety Stress Scale (DASS) were utilized to measure stress, depression and anxiety. Knowledge and attitude toward mental-health were also measured through validated questionnaires. Stress levels of participants were measured biologically by measuring salivary cortisol and alpha-amylase levels at the baseline and 12th-week. Results: Compared to the control group, there were no significant difference in resilience score of the intervention group compared to control group [F(1, 103) = 2.243, P = .137]; however, there was a significant main effect of time [F(3, 309) = 18.191, P < .001] and interaction effect between intervention and time in resilience score [F(3, 309) = 5.056, P = .002]. Additionally, compared to the control group, there were significant increases in knowledge [F(1, 103) = 66.805, P < .001], attitudes and behavior towards mental-health [F(1, 103) = 5.191, P = .025], and a significant decrease in stress perception score [F(1, 103) = 27.567, P < .001]. The mean salivary delta cortisol during pre-test and post-test at week 12 in the intervention group showed significant difference (P < .001). However, there was no significant difference in the mean delta salivary alpha-amylase between pre-test and post-test at week 12, both in the intervention and control groups. Conclusion: The mental-health strengthening module was accepted and applicable to first-year medical students and was found to be effective in increasing resilience from various biopsychosocial aspects. It is also advisable to have similar modules throughout the medical school to maintain sustainability.

The association of apolipoprotein in the risk of ST-elevation myocardial infarction in patients with documented coronary artery disease.

Introduction: Cardiovascular disease (CVD) is the number one cause of death worldwide, in this case, acute coronary syndrome (ACS) or acute myocardial infarction (AMI) that developed from coronary artery disease (CAD). Several risk factors contribute to AMI. Non-modifiable risk factors are age, sex, race, and family history. Modifiable risk factors include dyslipidemia, hypertension, smoking, diabetes mellitus, as well as recent factors that are considered more specific such as homocysteine, lipoprotein a [Lp(a)], high sensitivity C- reactive protein (hs-CRP), and apolipoprotein. This study aimed to determine the role of apolipoprotein as a risk factor for STEMI. Methods: This study combines three epidemiological designs: a descriptive and cross-sectional correlative study with 62 STEMI patients at the National Cardiovascular Center Harapan Kita and a comparative study of 62 STEMI patients and 20 non-ACS CAD patients at the Universitas Indonesia Hospital. Results and conclusion: The descriptive study showed the level of apoB 80.71 ± 28.3, apoA1 104.93 ± 27.8, apoB/apoA1 ratio 0.78 ± 0.22, and Lp(a) 6.85 (1.0-48.1). ApoB moderately correlates with LDLc (p < 0.001; r = 0.571). ApoA1 weakly correlates with HDLc (p = 0.005; r = 0.379). In comparative study, there were significant differences between the STEMI and non-ACS CAD groups on apoA1 (104.93 ± 27.8 vs. 137.48 ± 26.46), apoB/apoA1 ratio (0.78 ± 0.22 vs. 0.59 ± 0.15), and hs-CRP (2.88 [0.4-215] vs. 0.73 [0.15-8.9]). Multivariate analysis showed that the most significant risk factors for STEMI in this study were hypertension for modifiable factors and apoA1 for apolipoprotein. The apoA1 and apoB/apoA1 ratio examination can be suggested for people who have experienced plaque formation and are at risk for myocardial infarction.

Diagnostic role of stool TB-PCR in suspected tuberculous colitis patient at Dr Cipto Mangunkusumo National Central General Hospital: a cross-sectional study.

Introduction: the signs and symptoms of tuberculous (TB) colitis were similar with other diseases, such as inflammatory bowel disease. Therefore, finding the diagnostic modality to help differentiate TB colitis with other diseases was a challenge. In this study we aimed to find the proportion of positive stool TB-PCR in suspected TB colitis subjects and also the diagnostic value of the stool TB-PCR if compared to colonoscopy, histopathology and clinical evaluation. Methods: a cross-sectional study was done on subjects suspected to have TB colitis who undergone colonoscopy and histopathology examination between February-April 2019. Stool samples from those subjects were collected and extracted with the QIAamp® Fast Stool DNA Mini Kit. The TB-PCR was done using artus® M. tuberculosis RG PCR kit, which targeted on 16s rRNA gene. The results of stool TB-PCR then were compared with the combination of colonoscopy, histopathology and clinical evaluation as the gold standard. Results: from sixty subjects who were recruited, there were 26/60 (43.3%) subjects with positive stool TB-PC. It was consisted of 7/8 TB colitis subjects and 19/52 non-TB colitis subjects. The diagnostic value of the stool TB-PCR was: sensitivity 87.5%, specificity 63.5%, positive predictive value 26.9% and negative predictive value 97.1%. Conclusion: stool TB-PCR has good sensitivity but low specificity for diagnosing TB colitis. Therefore, stool TB-PCR could be utilized as a screening test for TB colitis.

Cutoff Value of Qualitative HBsAg for Confirmatory HBsAg Using the Chemiluminescence Microparticle Immunoassay Method.

BACKGROUND: Confirmatory hepatitis B surface antigen (HBsAg) is an assay used to distinguish weakly reactive from false-positive HBsAg results. OBJECTIVE: To determine the signal to cutoff (S/CO) value of chemiluminescence microparticle immunoassay (CMIA) HBsAg assay that should trigger follow-up confirmatory HBsAg testing. METHODS: All specimens with an initial S/CO value of 0.90-100.00 were subjected to repeat HBsAg testing after high-speed centrifugation. The specimens with an initial S/CO value in that range remained in the same range and were then followed up with confirmatory HBsAg testing. RESULT: In total, 132 specimens had an S/CO value between 0.90 and 100.00 after high-speed centrifugation, followed by confirmatory HBsAg retesting. The S/CO value of HBsAg specimens for which the results required verification with confirmatory HBsAg was 0.98 (100% sensitivity, 3.3% specificity) through 9.32 (47.1% sensitivity, 100% specificity). CONCLUSION: The HBsAg S/CO values (as determined by the chemiluminescent microparticle immunoassay [CMIA] method) that should trigger confirmatory HBsAg testing are 0.98-9.32.

Whole-Genome Sequencing of SARS-CoV-2 Infection in a Cluster of Immunocompromised Children in Indonesia.

Background: Thus far, Indonesia has recorded over 4,000,000 confirmed COVID-19 cases and 144,000 fatalities; 12.8% of cases have been in children under 18 years. Whole-genome viral sequencing (WGS) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been demonstrated to help differentiate hospital-acquired infection from community-acquired coronavirus disease 2019 (COVID-19) infection. Our study highlighted the use of WGS to investigate the origin of infection among pediatric oncology patients in Jakarta. The aim of our study was to evaluate clinical and laboratory characteristics and also the efficacy of using WGS to confirm hospital-acquired COVID-19 infection in a cluster of immunocompromised children within a single ward of a tertiary hospital in metropolitan Jakarta based on quasispecies, viral load, and admission dates. Method: Real-time reverse-transcription polymerase chain reaction (RT-PCR) from nasopharyngeal (NP) swabs was used to diagnose the patients and also guardians and healthcare workers (HCWs) in the ward, followed by WGS of RT-PCR positive cases to establish their phylogenetic relationships. Result: Using WGS, we showed that SARS-CoV-2 transmission in a cluster of children with underlying malignancy was characterized by high similarity of whole virus genome, which suggests nosocomial transmission.