Authors:Febriyani Hamzah, Andi Makbul Aman, Harun Iskandar Abstract: Thyroid crisis is an emergency due to impaired thyroid function caused by various conditions, particularly infections such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that result in the dysfunction of various vital organs. We report a case of a 31-year-old Indonesian female with a 2-year history of hyperthyroidism with elevated thyroid-stimulating hormone (TSH) receptor antibodies. (TRAb) who developed thyroid crisis possibly in association with SARS-CoV-2 pneumonia, sepsis, and disseminated intravascular coagulation (DIC). Prior to admission, she was treated for her hyperthyroidism with propylthiouracil and had been in stable remission for a year. She was admitted to the Emergency Room with complaints of watery stools, icteric sclerae, jaundice, coughing, and shortness of breath. The physical examination showed a World Health Organization (WHO) performance score of 4, delirium, blood pressure within normal limits, tachycardia, tachypnea, axillary temperature of 36.7°C, icteric sclerae, jaundice, and exophthalmos. There was a 3 cm palpable nodule on the right side of the neck. Auscultation of the lungs revealed bilateral pulmonary rales. Abdominal examination noted a palpable liver and enlarged spleen. Laboratory tests showed thrombocytopenia, electrolyte imbalance, hypoalbuminemia and elevated transaminases. The thyroid function tests showed a suppressed TSH level with an elevated free thyroxine (FT4) level. The SARS-CoV-2 polymerase chain reaction (PCR) swab test was positive. Initial patient management was with supportive therapy that included favipiravir and anti-hyperthyroidism medication; however, despite these interventions, her condition continued to deteriorate and she died after a few hours. This case demonstrates no difference in therapy between patients with thyroid crises and COVID-19 or other infections. Proper and timely treatment is important for reducing mortality rates. PubDate: 2022-11-09 Issue No:Vol. 37, No. 2 (2022)
Authors:Yotsapon Thewjitcharoen, Natthakan Saiwaew, Soontaree Nakasatien, Thep Himathongkam Abstract: Since May 2022, monkeypox outbreaks have been reported in several countries outside Africa. The typical skin lesions of monkeypox begin as papules that appear in possible areas of inoculation, such as the skin or mucous membranes, followed by generalized pustules. Systemic symptoms appear simultaneously or a few days earlier than the lesions. PubDate: 2022-10-28 Issue No:Vol. 37, No. 2 (2022)
Authors:Bayani Pocholo Maglinte, Alex Junia, Jeremyjones Robles Abstract: Objectives. This cross-sectional study evaluates the degree of agreement between the 2018 American College of Cardiology/American Heart Association (ACC/AHA2018) and 2020 Philippine guideline (PG2020) treatment algorithms for the primary prevention of dyslipidemia among Filipinos. Methodology. This review included 159 charts of tatin-naive Filipinos who are 45-79 years old. Using risk profile and lipid measurements, statin treatment recommendation was determined through the PG2020 algorithm and ACC/AHA-ASCVD Risk Estimator Plus web application. The degree of agreement was measured by Cohen’s kappa statistic with the two algorithms as independent raters. Results. A total of 159 patients were included in the final analysis. There was a slight agreement with a kappa coefficient of 0.209 or 4.4% (95% CI 0.078-0.340, p=0.003). Statin treatment was recommended in 69 out of 159 patients (43.4%) by the PG2020 overlapping with ACC/AHA2018 in 56 cases (81.2%). On the other hand, 109 cases (68.6%) were recommended for statin treatment by ACC/AHA2018 overlapping with PG2020 in only 51.4%. Conclusions. The low degree of agreement between the two treatment algorithms highlights the key demographic and ethnic variations in dyslipidemia management necessitating outcome-based studies to translate these differences. Overestimation of ASCVD risk calculation in the ACC/AHA2018 and consideration of important, unique risk factors among Filipinos favors the applicability of the Philippine guideline. PubDate: 2022-09-15 Issue No:Vol. 37, No. 2 (2022)
Authors:Sze Teik Teoh, Suhaimi Hussain, Janet Yeow Hua Hong Abstract: Objectives . This study described and compared glycaemic changes with the use of the following Continuous Glucose Monitoring (CGM) metrics: time in range, time in hyperglycaemia and time in hypoglycaemia from retrospective CGM data among children and adolescents with Type 1 Diabetes Mellitus (T1DM), before and during Ramadan to better understand the impact of fasting during this season. Methodology. This study was conducted in 2 tertiary centres: Hospital Putrajaya (HPJ) and Hospital Universiti Sains Malaysia (HUSM) from February to May 2020. Muslim T1DM patients between ages 8 to18 who intended to fast during Ramadan were given Ramadan-focused education. CGM iPro2® (Medtronic) was used before and during Ramadan, complemented by finger-prick glucose monitoring or self-monitoring of blood glucose (SMBG). Results. Of the 32 patients, only 24 (12 female) were analysed. Mean age was 13.6 ± 3.1 years old, mean HbAlc was 9.6 ± 1.9% and mean duration of illness was 5.4 ± 3.4 years. Majority (91.7%) were on multiple dose injections (MDI) while only 8.3% were on continuous subcutaneous insulin infusion (CSII). All fasted in Ramadan without acute complications. Retrospective CGM analysis revealed similar results in time in range (TIR), time in hyperglycaemia and time in hypoglycaemia before and during Ramadan, indicating no increased hypoglycaemic or hyperglycaemic events related to fasting. Glycaemic variability before Ramadan as measured by the LBGI, HBGI and MAG, were similar to values during Ramadan. Conclusion. Ramadan fasting among T1DM children and adolescents, by itself, is not associated with short-term glycaemic deterioration. T1DM youths can fast safely in Ramadan with the provision of focused education and regular SMBG. PubDate: 2022-09-09 Issue No:Vol. 37, No. 2 (2022)
Authors:Jielin Yew, Shui Boon Soh Abstract: Primary hyperparathyroidism (PHPT) is a common endocrine condition, increasingly presenting asymptomatically and detected on routine laboratory examination in developed countries. Multiple spontaneous tendon ruptures as the initial presentation of PHPT is extremely rare. We present the case of a 28-year-old male diagnosed with severe hypercalcemia secondary to PHPT after presenting with complications of multiple spontaneous tendon ruptures,and discuss the management issues in PHPT for this patient. PubDate: 2022-09-08 Issue No:Vol. 37, No. 2 (2022)
Authors:Poh Shean Wong, Sue Wen Lim, Chin Voon Tong, Masni Mohamad, Zanariah Hussein Abstract: Thyroid hormone plays an important role in cardiovascular function. Pericardial effusions are commonly seen in cases of severe hypothyroidism. However, large to massive pericardial effusions with cardiac tamponade are exceptionally rare. Herein, we present two cases of severe hypothyroidism with massive pericardial effusion. Our first case demonstrates that a patient with large pericardial effusion can be managed conservatively with aggressive thyroid hormone replacement therapy. In our second case, pericardiocentesis was performed in addition to thyroid hormone replacement therapy as the underlying aetiology of effusion could not be reasonably limited to hypothyroidism. These two cases served to highlight and demonstrate rapid normalisation of thyroid function test by using aggressive oral thyroid hormone replacement therapy using liothyronine, in combination with levothyroxine, which led to resolution of pericardial effusion and prevent its re-accumulation. PubDate: 2022-09-05 Issue No:Vol. 37, No. 2 (2022)
Authors:Kriselle Rae Dy, Christy Yao Abstract: Objectives. This study determined the prevalence, clinical characteristics and pregnancy outcomes of high-risk women diagnosed with gestational diabetes mellitus (GDM) before and after 24 weeks of gestation. Methodology. This retrospective study included all singleton deliveries with GDM at the Pasig City General Hospital from January 2018 to December 2019. Subjects were grouped into those who were diagnosed with GDM before 24 weeks of gestation (<24 weeks, n=61) and thereafter (≥24 weeks, n=219). Outcomes examined were preeclampsia, cesarean delivery, preterm birth, macrosomia, large-for-gestational age, small-for-gestational age, neonatal hypoglycemia, neonatal ICU admission, congenital malformations and perinatal mortality. Results. The group diagnosed with GDM before 24 weeks was significantly older (33.0 ± 5.7 years versus 29.4 ± 5.9 years, p<0.001), had higher 2-hour 75 g oral glucose tolerance test (OGTT) results (158.2 ± 20.0 mg/dL versus 150.0 ± 23.7 mg/dL, p=0.014), and had more pregnancies with preeclampsia (23.0% versus 9.6%, p=0.005). Conclusion. High-risk women diagnosed with GDM before 24 weeks of gestation had a higher incidence of preeclampsia compared with high-risk women diagnosed with GDM after 24 weeks of gestation. PubDate: 2022-08-27 Issue No:Vol. 37, No. 2 (2022)
Authors:Chici Pratiwi, Martin Rumende, Ida Ayu Made Kshanti , Pradana Soewondo Abstract: Introduction. Hypoglycemia is an important and harmful complication that often occurs in inpatient and outpatient settings. This study aims to assess the incidence of inpatient hypoglycemia and its related factors. We also assessed mortality and length of hospital stay. Methodology. We performed a retrospective cohort study among patients with type 2 diabetes mellitus admitted to a tertiary hospital in Indonesia. Using multivariate regression, we analyzed age, sex, body mass index, comorbidities, history of hypoglycemia, hyperglycemia treatment administered, nutritional intake, and medical instruction as the related risk factors for inpatient hypoglycemia. Results. From 475 subjects, 80 (16.8%) had inpatient hypoglycemia, of which, 7.4% experienced severe hypoglycemia. We found that patients with a history of hypoglycemia (RR: 4.6; 95% CI: 2.8-7.6), insulin and/or sulfonylurea treatment (RR 6.4; 95% CI: 1.6-26.5), and inadequate nutritional intake (RR 2.6; 95% CI: 1.5-4.3) were more likely to have hypoglycemic events compared to those who did not. The length of hospital stay for patients in the hypoglycemic group is significantly longer than those in the non-hypoglycemic group (13 vs 7 days, p<0.001), but their mortality rates did not differ (16% vs 10.9%, p=0.18). Conclusion. Inpatient hypoglycemia may be affected by a history of hypoglycemia and inadequate nutritional intake. Patients who had inpatient hypoglycemia tend to have a longer median length of hospital stay. PubDate: 2022-08-25 Issue No:Vol. 37, No. 2 (2022)
Authors:Maria Stella Giron, Shelley Ann de la Vega Abstract: Objective. To estimate the prevalence of diabetes among Filipino older persons living in the community. Methodology. A cross-sectional analysis was done on a random sample of persons ages 60 years and older from the Focused Interventions for Frail Older Adults Research and Development Program (2018-2019). A diagnosis of diabetes was established by self-reported physician’s diagnosis or if the person was on any antihyperglycemic drugs. Results. The prevalence of self-reported diabetes was 20.5%, with no difference in age, sex, education, or body mass index between older persons with and without diabetes. The presence of 2 or more comorbidities was significantly more common among older persons with diabetes (p<0.001). Visual impairment (p<0.01), hypertension (p<0.001) and hyperlipidemia (p <0.001) were more frequent among those with diabetes. Conclusion. Diabetes is prevalent among community-living older Filipinos. Therefore, effective public health measures for diabetes prevention and management are needed for the ever-growing older population, who are at the highest risk for morbidity and mortality. PubDate: 2022-08-23 Issue No:Vol. 37, No. 2 (2022)
Authors:Hanna Clementine Tan, Oliver Allan Dampil, Maricar Mae Marquez Abstract: Background. The weight loss benefit of semaglutide in patients with diabetes is well-documented, but its clinical utility in treating obesity among patients without diabetes is less described. We therefore assessed the efficacy and safety of subcutaneous semaglutide as treatment for obesity in patients without diabetes. Methodology. A comprehensive search of PubMed/MEDLINE, Cochrane and Google scholar was performed to identify trials on the efficacy and safety of subcutaneous semaglutide on patients with obesity without diabetes. Primary outcome was expressed as percent mean weight difference. Secondary outcomes including risk for gastrointestinal adverse events, discontinuation of treatment and serious adverse events were expressed as risk ratios. These were calculated using the random effects model. Results. The study included 4 randomized controlled trials having a total of 3,613 individuals with obesity without diabetes. The mean difference for weight reduction was -11.85%, favoring semaglutide [95% confidence interval (CI) (-12.81,-10.90), p<0.00001]. Secondary outcomes showed that the risk of developing gastrointestinal adverse events was 1.59 times more likely with semaglutide (RR 1.59, 95%CI [1.34, 1.88], p<0.00001). Risk for discontinuation due to adverse events was twice as likely in the semaglutide group (RR 2.19, 95%CI [1.36,3.55], p=0.001) and the risk for serious adverse events was 1.6 times more likely for semaglutide (RR1.60, 95% CI [1.24, 2.07], p=0.0003). Serious events were mostly of gastrointestinal and hepatobiliary disorders such as acute pancreatitis and cholelithiasis. Conclusion. Among individuals with obesity without type 2 diabetes, subcutaneous semaglutide is effective for weight loss with an 11.85% reduction from baseline compared to placebo. This supports the use of semaglutide for weight management in obesity. However, risk of gastrointestinal adverse events, discontinuation of treatment and serious adverse events were higher in the semaglutide group versus placebo. PubDate: 2022-08-23 Issue No:Vol. 37, No. 2 (2022)
Authors:Sylvernon Israel, Katherine Ann Tan, Ma. Felisse Carmen Gomez, Florence Rochelle Gan, Jean Uy-Ho Abstract: The presence of autoantibodies is a common link between autoimmune hypothyroidism (AH) and Systemic Lupus Erythematosus (SLE). The coexistence of AH (Hashimoto’s Thyroiditis) and SLE is common; however, massive pericardial effusion (PEEF) with signs of tamponade is extremely rare and only a few cases have been reported in literature. We present a case of a 54-year-old female who came in with progressive dyspnea who was found out to have massive PEEF from overt AH and concurrent SLE, which was successfully managed medically. This gave us valuable insight that massive pericardial effusion occurring in overt hypothyroidism may be secondarily caused by other co-existing disease entities such as SLE. The importance of the correct diagnosis cannot be overemphasized, as this largely contributed to the successful management of this case. PubDate: 2022-08-18 Issue No:Vol. 37, No. 2 (2022)
Authors:Putu Moda Arsana, Novi Khila Firani, Siti Fatonah, Affa Kiysa Waafi, Adinda Dian Novitasari Abstract: Introduction. Type 2 DM (T2DM) is associated with inflammation and vascular dysfunction which impact hemostasis. Thromboelastography (TEG) as a hemostasis assessment method, is not routinely applied in T2DM. Methodology. A cross-sectional study was conducted among T2DM patients attending the Endocrinology Clinic of Saiful Anwar Hospital, Indonesia. Glycemic profiles were determined using fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2hPPG), and glycosylated hemoglobin (HbA1c). Therapy for T2DM was classified into insulin and non-insulin regimens. The primary and secondary hemostasis profile were examined using TEG and was classified as hypo- hyper- and normo- Result. A total of 57 T2DM patients were included. Kruskal-Wallis test did not reveal a significant association between glycemic profiles and groups of hemostasis. However, the median HbA1c was higher in the hypercoagulable group of primary hemostasis and fibrinolysis. The median FPG and 2hPPG were higher in the normo-coagulable group of secondary hemostasis. Logistic regression did not indicate a significant association between type of therapy for diabetes and hemostasis profile. Conclusion. This study did not find significant associations between glycemic levels and type of DM therapy with hemostasis profiles using the TEG method in patients with T2DM. PubDate: 2022-08-13 Issue No:Vol. 37, No. 2 (2022)
Authors:Kristine Abas, Maria Honolina Gomez, Jennifer Mapanao-Gonong, Rosella Arellano Abstract: Adrenocortical carcinoma (ACC) is a rare and aggressive neoplasm with poor prognosis. We report a case of a 30-year-old female who presented with profound classic features of an adrenocorticotrophic hormone (ACTH)-independent Cushing’s syndrome (CS) and a large adrenal mass with massive venous tumor thrombosis of the entire inferior vena cava (IVC), left renal and adrenal veins confirmed by imaging. Adrenal biopsy histopathology and immunohistochemistry confirmed ACC. Systemic palliative chemotherapy was administered. This rare case presents a unique and atypical presentation of an extensive tumor thrombosis of IVC. With the advanced stage at diagnosis, aggressive nature and poor prognosis of the disease, there is still a need to determine viable therapeutic options for metastatic ACC associated with venous invasion. PubDate: 2022-08-07 Issue No:Vol. 37, No. 2 (2022)
Authors:Adlina Awanis Mamat , Noraida Ramli, Najib Majdi Yaacob, Suhaimi Hussain Abstract: Objective. This study aimed to determine the proportion, clinical characteristics, hormonal status, median time for normalization of serum thyroxine (FT4) and thyroid-stimulating hormone (TSH) and factors affecting time to thyroid function test (TFT) normalization of neonates born to mothers with maternal hyperthyroidism admitted in our institution. Methodology. This was a retrospective cohort study that included 170 newborns admitted to the Neonatal Intensive Care Unit (NICU) of Hospital Universiti Sains Malaysia (HUSM) with a history of maternal hyperthyroidism from January 2013 until December 2018. We analyzed their baseline demographic and clinical characteristics, maternal thyroid status and antibody levels. Finally, we analyzed newborn thyroid function and thyroid antibodies. Results. The proportion of neonates born to mothers with maternal hyperthyroidism was 0.8% (170 of 20198 neonates within the study period). Seven (4.1%) developed overt hyperthyroidism, while four (2.4%) had thyroid storm. The median time for thyroid function test normalization was 30 days (95% CI: 27.1 to 32.8). The median time for TFT normalization was longer among neonates of mothers with positive thyroid antibodies [46.6 days ( 39.4)] and of mothers who received anti-thyroid treatment [31.7 days (95% CI, 23.5 to 39.9)]. Conclusion. Neonates born to mothers with hyperthyroidism is uncommon. These babies were observed to have a longer time for normalization of thyroid function tests if their mothers had thyroid antibodies or received anti-thyroid treatment. PubDate: 2022-08-06 Issue No:Vol. 37, No. 2 (2022)
Authors:Pankaj Ferwani, Aasim Maldar, Nishitkumar Shah, Phulrenu Chauhan, Manoj Chadha Abstract: Background. Genitourinary tract infections, mycotic as well as bacterial, as defined by clinical symptoms, are one of the common adverse effects associated with the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in type 2 diabetes mellitus (T2DM) patients in clinical trials. However, Indian data in terms of the prevalence of culture-proven bacterial type of urinary tract infection (UTI), and the causative organism is limited. Objective. This study aimed to determine the prevalence and causative agents of bacterial UTI among patients with T2DM on SGLT2i. Methodology. This was a prospective longitudinal study involving all patients with T2DM who were prescribed with SGLT2i, uncontrolled on other oral anti-diabetic medications, from June 2019 to February 2020. Prevalence of bacterial UTI was evaluated at baseline and 12 weeks after initiation of SGLT2i. Results. A total of 80 patients were started on SGLT2i. One female patient on canagliflozin had significant asymptomatic bacteriuria and the causative agent was Acinetobacter baumannii. One male patient on dapagliflozin had symptomatic urinary tract infection with negative urine culture study. Four patients developed genital mycotic infection. Conclusion. In this real-world study, SGLT2i as a class, was well tolerated with favorable safety profile, and risk of developing significant bacteriuria and/or symptomatic UTI was minimal. PubDate: 2022-07-25 Issue No:Vol. 37, No. 2 (2022)
Authors:Marisa Khatijah Borhan, Florence Hui Sieng Tan, Nur Shazwaniza Awang Basry Abstract: Acollision tumor involving metastasis to a pituitary adenoma is rare. We describe a case of a 68-year-old Bidayuh woman with underlying treatment-responsive lung adenocarcinoma, who presented with mass effect, panhypopituitarism and polyuria. Her initial imaging study reported pituitary macroadenoma, and she was treated with hormone replacement therapy. She then underwent transsphenoidal tumor debulking surgery with subsequent histopathological findings of a collision tumor of an adenocarcinoma with metastasis to a non-functioning pituitary adenoma. PubDate: 2022-06-16 Issue No:Vol. 37, No. 2 (2022)
Authors:Anggraini Dwi Kurnia, Nur Lailatul Masruroh, Nur Melizza, Yoyok Bekti Prasetyo, Herdianti Nur Hidayani Abstract: Background. Type 2 Diabetes Mellitus (T2DM) is one of the fastest-growing diseases and most serious major health problems worldwide. Few studies have focused on the association of social support with diabetes-related dietary behaviour. Objective. To examine the relationship between social support and dietary behaviour among patients with diabetes in a rural area of Indonesia. Methodology. This was a descriptive cross-sectional study that included 120 physically healthy patients above 18 years old with type 2 diabetes mellitus for at least 6 months. Data analysis was done using a stepwise regression model. Results. The mean age was 61.97 years (SD = 7.85, range = 52-74); 86.7% of the participants were females. Social support (β = 0.272, p = <0.001), diabetes medications (β = 0.169, p = 0.003), duration of diabetes (β = 0.118, p = 0.0047), and presence of diabetes complications (β = 0.197, p = 0.008) were significant predictors of dietary behaviour and accounted for 34.2% of the variance. Conclusion. Social support, diabetes medications, presence of diabetes complications, and duration of diabetes were associated with improved dietary behaviour. Therefore, social support should be considered when designing dietary interventions for patients with type 2 diabetes mellitus. PubDate: 2022-06-16 Issue No:Vol. 37, No. 2 (2022)
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