Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute

Occurrence of Covid-19 in Children Who Have Received Live-Attenuated Dengue Vaccination

Mulya Rahma Karyanti — 2023-12-14

Background: Possible cross-reactions/ false positives were reported in rapid dengue serology tests because antigenic similarities between SARS-CoV-2 and DENV. The study aims to evaluate the occurrence of COVID-19 in children who received chimeric-yellow fever tetravalent dengue vaccine. Methods: A case-control study was conducted in five districts primary healthcares in Jakarta aged 12 years and above through history of COVID-19 questionnaire. Clinical and laboratory confirmation were obtained, and blood draw was performed to measure neutralization RBD IgG SARS-CoV-2 antibody titer. The dengue vaccine group consists of subjects who have received CYD-TDV in 2011-2012 and are willing to participate. The non-dengue vaccine group were matched; all have not received dengue vaccine. Results: This study included 207 cases and 212 controls, with median age in cases 19 years (IQR 5) and control 15 years (IQR 4). Nineteen subjects in the dengue vaccine group have already been infected with COVID-19 before being given COVID-19 vaccine, compared to 11 subjects in the non-dengue vaccine group (P=0.131). The occurrence of COVID-19 in the dengue vaccine group was significantly higher (16 subjects) than the non-dengue vaccine group (4 subjects)(P=0.005) after COVID-19 vaccinations were given. Neutralization RBD IgG SARS-CoV-2 antibody titer was 71.96 U/ml (IQR 39.47) in the dengue vaccine group and 51.92 U/ml (IQR 49.03) in the non-dengue vaccine group(P=0.361). Conclusion: Our study showed that the occurrence of COVID-19 in the dengue vaccine group was higher than in the non-dengue vaccine group, which may suggest no cross reaction from dengue antibodies towards COVID-19, more studies are warranted.

Profile of Anti-Diphtheria Toxoid Immunoglobulin G among Pre-School Children in the Senen District, Jakarta, Indonesia

Theresia Santi — 2023-12-14

Background: Diphtheria is a re-emerging disease in Indonesia that can be prevented by vaccination. This study evaluates the anti-diphtheria toxoid immunoglobulin G levels among healthy children aged 6 – 7 years old who had not received the second booster immunization for Diphtheria, Tetanus, and Pertussis (DTP) commonly administered at 5 – 7 years old. Methods: This cross-sectional study was conducted in the Senen district of Jakarta, Indonesia. All subjects had been vaccinated with three doses of immunization for DTP during the first year of life, and subsequently classified into a group of children who received the first booster immunization of DTP at 18 – 24 months old and who had not received it yet. Antibody against Diphtheria toxoids within the sera samples was assessed by commercial Anti-Diphtheria toxoid IgG Enzyme-Linked Immunosorbent Assay and classified in four groups: no protection (< 0.01 IU/ml), uncertain (0.01 – 0.09 IU/ml), full protection (0.10 – 1 IU/ml) and long-term protection (>1 IU/ml). Results: Eighty-nine children were included in this study; only 71 subjects (79.7%) had received the first DTP booster at 18–24 months old. The specific humoral immunity against diphtheria was observed among 57 children (64%). Notably, among the 89 subjects, only two subjects not receiving the first DTP booster still had antibody protection for diphtheria (p=0.001, OR 27.5, 95% CI: 5.71 – 132.42). Conclusion: The first diphtheria booster vaccination at 18 – 24 months old is crucial to protect pre-school children against diphtheria.

BCG Revaccination to Combat Tuberculosis Infection: an Evidence Based Case Report

Alissa Rifa — 2023-12-14

An elderly man came to the Emergency Room with labored breathing with a history of prior tuberculosis infection and BCG vaccination when he was an infant. He was diagnosed with tuberculosis reinfection with negative microbiology result. This study aims to see whether revaccination of BCG vaccination will positively impact suppressing the rate of tuberculosis infection. A literature search was conducted on three databases: PubMed, Cochrane, and EBSCOhost. Of the searches, three articles were selected for further critical appraisal using the criteria provided by the University of Oxford Centre of Evidence-Based Medicine. The first study shows that BCG Revaccination does not become a protective factor against tuberculosis reinfection with OR 0.92 (0.80 – 1.05) in all populations yet interestingly yielded OR 0.77 (0.59-1.00) in HIV-negative patients, while the second study shows that BCG Revaccination can prevent conversion of QFT with the study showing p <0.05, thus believed to lower tuberculosis infection rates, the third study shows that BCG revaccination yield modest protection against TB infection after 15 years (Hazard Ratio 0.64 95% CI 0.46-0.89). The main difference between the studies is the main population, which the first study also includes HIV-positive patients. In conclusion, BCG Revaccination may be considered to be given and be considered as protective factor against tuberculosis reinfection in HIV-negative patients.

Will-To-Live Scale as a Predictor of Depressive Symptoms in Elderly: an Evidence-Based Case Report

Eugene Alfathan Satryo — 2023-12-14

An elderly man was admitted to inpatient care after a check-up with a gerontologist, stating that he had no will to continue living and showing other depressive symptoms. The gerontologist then ponders whether the will to live is prognostic for depression, specifically in elderly patients. The report aims to determine whether the will to live, measured by the Will-to-Live (WTL) scale, can predict depressive symptoms (DS) emerging in elderly patients. A literature search was conducted on three databases: PubMed, Cochrane, and EBSCOhost. Of the searches, two articles were selected for further critical appraisal using the criteria provided by the University of Oxford Centre of Evidence-Based Medicine. first study, using the WTL Scale to quantify WTL and the Geriatric Depression Scale (GDS) to measure DS, showed that WTL can predict DS but not vice versa with moderate negative correlation (r = -0.49 p<0.001). The second study analyzes the temporal relationship further, showing that WTL still has a negative correlation with DS (measured by modified GDS) (r=-0.4, p<0.05) when assessed in the same time frame but shows little to no correlation when used as a predictor for DS after a 1-year interval from the initial assessment (r= 0.14, p<0.05). The Will-To-Live Scale has the potential to be a more practical tool in predicting depressive symptoms in gerontology settings as compared to usual methods after further validation studies.

The Efficacy of Vitamin D Supplementation to Reduce Urticaria: Systematic Review

Jean Budi Pratista Devi — 2023-12-14

Urticaria is a condition of skin disorders. Based on the duration of symptoms, chronic urticaria occurs > 6 weeks. Chronic urticaria is caused by endogenous factors unrelated to an external physical stimuli. Vitamin D is an immunoregulatory hormone that activates innate and adaptive immune responses. A literature search was conducted in PubMed, ScienceDirect, SpringerLink, and ProQuest with a publication year limit of 2011–2023. The keywords used were "vitamin D deficiency and urticaria" and "vitamin D and urticaria". The present review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. This review included four case reports from 2247 articles. All cases showed a low risk of bias. Two studies found were case-control studies that met the inclusion criteria. The Johanna Briggs Institute checklist was used to assess the risk of bias. The data were presented descriptively. Chronic spontaneous urticaria (CSU) is more common in women than men.. Patients CSU had < 30 ug/ml vitamin D level and experienced reduced urticarial symptoms after receiving vitamin D (p < 0, 001). Vitamin D2 supplement at 20,000 IU for 6 weeks alleviated urticarial symptoms in patients CSU. Alongside vitamin D, antihistamines, and corticosteroid were also recommended as a comination therapy, leading to a better clinical outcome. Vitamin D supplementation reduces symptoms in patients with CSU. A combination therapy with antihistamines and corticosteroid should be considered in clinical practice.

Case Report: Mediastinitis Secondary to Deep Neck Abscess, Should Sternotomy be Done?

Muhammad Farhan Noor — 2023-12-14

A deep neck abscess is a treatable infection in the deep cervical space. The condition may have life-threatening complications. A complication that can happen secondary to the abscess is mediastinitis, and treating a patient with such a complication could be challenging. To emphasize that treatment by exploration of the abscess and insertion of a mediastinal drain could be an alternative therapy compared to sternotomy for mediastinitis secondary to deep neck abscess. A 39-year-old male came to the ER with a chief complaint of swollen and neck tenderness for the past five days, along with difficulty swallowing and chest pain. Radiographic examinations showed a retropharyngeal abscess with a widening mediastinum. The patient underwent surgery to drain the abscess. Cervical and mediastinal drains were inserted, and the patient was transported to the Intensive Care Unit for observation. The patient was extubated after three days, and both drains were removed on the fifth day. Deep neck abscess is still common in Indonesia, and mediastinitis is a complication of deep neck infections. A surgical approach is necessary when mediastinitis occurs as it is considered a medical emergency. Not all ICU units in Indonesia can provide or manage open sternotomy patients. Identifying complications, early detection, and treatment is crucial in determining the patient’s prognosis.

Developing “do it yourself” Phantom for Teaching Seldinger Technique in Vascular Access Placement to General Practitioners

Noor Hafidz — 2023-12-14

Establishing a vascular access is a crucial aspect in managing critically ill patients in the Intensive Care Unit (ICU). The skill in placing vascular access varies among healthcare professionals. Clinical experience and level of training among nurses, general practitioners, and intensivists are the determinants of skill in placing vascular access. Training to establish vascular access using the Seldinger technique needs practice using a vascular phantom or a cadaver. Commercially sold phantoms are difficult to get, and an alternative training phantom is needed. We built a simple “do-it-yourself” model of a vascular phantom using “easy-to-find” material that can be used to practice the Seldinger technique. We used a synthetic polyurethane sponge 16x16 cm in size as a base and a polyvinyl alcohol sheet of the same size. We used 22 F urinary catheters trimmed to 12 to represent blood vessels. The final product is a piece of the urinary catheter embedded in the sponge and then covered by polyvinyl alcohol to simulate the epidermis. The phantom can be used in training programs to improve the skill of general practitioners in placing advanced vascular access. 13 general practitioners were involved in this training, and 100% said that this phantom could simulate the experience. “Do-it-yourself” phantom for vascular access training can be used ro practice the Seldinger technique and can simulate the real experience.

Platelet Rich Plasma Injection for Treatment of Neuropathy After Hernia Repair

Aida Rosita Tantri — 2023-12-14

A young male patient developed persistent severe right-sided groin and scrotal pain following hernia repair. After two months of failed conservative therapy, he was referred to the pain clinic. Genitofemoral Neuralgia was suspected because the area of pain corresponds to the innervation area of the Genitofemoral nerve. For diagnostic and therapeutic purposes, it was injected with local anesthetic and steroid using ultrasound guidance. The initial injection led to pain relief for one month. There are some choices for treating neuralgia after a confirmatory diagnostic block, such as neurolysis, pulsed radiofrequency, or surgical neurectomy. We chose Platelet Rich Plasma (PRP) injection because it has the potential for nerve regeneration and is less invasive. Ultrasound allows for controlled administration and greatly enhances the technical ability to perform precise localization and injection. The patient, in this case, has more than 50% pain reduction after PRP therapy. He no longer needs medication and can return to normal daily activities. This case report illustrates the first presentation of managing post-herniorrhaphy neuropathy using Platelet Rich Plasma.

Effect of Zinc Supplementation on Fasting Blood Glucose Control in Burn Injury Patients with Type 2 Diabetes Mellitus: a Case Report

Chintya Tedjaatmadja — 2023-12-14

Burn injury is the second leading cause of injury in Indonesia. Patients with burn injury may develop zinc deficiency due to loss of exudate and decreased carrier proteins, leading to impaired glucose regulation and inadequate wound healing. Jayawardena et al. showed that zinc supplementation can help regulate blood glucose in patients with diabetes mellitus. This case aims to see the effect of zinc supplementation on fasting blood glucose control in burn injury patients with type 2 diabetes mellitus. A 47-year-old Male with diabetes mellitus and a history of COVID-19 presented with 34% second to third-degree burn injury. The patient was given short-acting insulin 6 IU thrice a day and long-acting insulin 10 IU once a day. Nutrition was increased gradually until it reached 30 kcal/kgBW with protein 1,2 g/kgBW on the 28^th day of hospitalization, referring to a diabetes-specific formula, 6x300 kcal. The patient also received zinc sulfate supplementation, 40 mg per day. The patient’s daily zinc intake was 47 mg/dL, and it was analyzed using Nutrisurvey. Fasting blood glucose in the first 28 days was not well-regulated (92-348 mg/dL). After 28 days of zinc supplementation, the patient's fasting blood glucose was stable. (140-180 mg/dL). Uncontrolled blood glucose leads to bacteremia, decreased skin graft takes, and increased mortality. Zinc deficiency can cause greater insulin resistance that can lead to hyperglycemia. Fasting blood glucose was stable after 28 days of zinc supplementation, similar to the previous study. Supplementation can help to regulate fasting blood glucose in burn patients with diabetes mellitus.

The Role of Eicosapentaenoic Acid Supplementation on Muscle Mass in Malnutrition Patients with Squamous Cell Carcinoma of the Tongue: Case Report

Annisa Nurul Kirana — 2023-12-14

The Indonesian prevalence of lip and oral cavity cancer in 2020 was 14,913, with 5,780 new cases. Head and neck cancer patients are very vulnerable to malnutrition; about 50% are malnourished, and 80% experience unwanted weight loss. Studies showed a significant effect of EPA as an anti-inflammatory substance. A 56-year-old female patient with a diagnosis of tongue squamous cell carcinoma (SCC) presents with the tumor removed along with some teeth. She is experiencing difficulty chewing food and had a weight loss of 8 kg (17%) in the last six months. The patient's muscle mass was 25.5% (low). Patients were given protein intake in the 1.1-1.8 g/kgbw/day range and EPA supplementation of 1.1 g/day. After one month, the BIA measurement showed that her muscle mass had increased to 26.2% and was in the normal category. Omega 3, especially EPA, improved body weight and lean body mass in cancer patients by modulating circulating inflammatory markers, demonstrating an inhibitory effect on inflammatory parameters related to muscle atrophy and lipolysis.Adequate protein intake and supplementation of 1.1 g/day EPA increased muscle mass in malnourished patients and enhanced the effectiveness of cancer therapy.

Fasting and Dietary Restriction Impact on Immune System in Aging Population: A Narrative Review

Luh Gede Laksmi Rahayu Handayani — 2023-12-14

Dietary habits and nutrition metabolism are strongly associated with human physiology. Overnutrition or calorie excess has been shown to have many deleterious effects. At the same time, the impact of fasting as part of dietary restriction (DR) remains elusive, especially on the immune system during the aging process. Here, we describe current updates of fasting and DR impact on the immune system and host responses in the aging population. Generally, fasting causes alteration in immune cell distribution by increasing the homing of peripheral cells to the bone marrow. In the aging population, fasting reduces the inflammatory response and promotes cell regeneration. Additionally, fasting is associated with the B cell clonal expansions important to counter infection. This review offers new perspectives and enhances our understanding of immunosenescence as a key to healthy aging.

Cone Procedure, A New Approach, A New Hope for Ebstein Anomaly Patient: A Case Report

Jefferson Hidayat — 2023-12-14

Ebstein anomaly is a rare congenital disease affecting the cardiac structure involving the tricuspid valve, leading to right ventricular dysfunction. Patients with Ebstein’s anomaly may have other structural abnormalities. Asymptomatic patients can be treated with conservative management, while symptomatic patients presenting with severe tricuspid regurgitation, NYHA class III-IV symptoms, and overwhelming tachyarrhythmias should undergo surgery. A 13-year-old girl presented with EA and ASD underwent a cone procedure with direct ASD closure and PFO creation. Cone procedure is a relatively new surgical approach in EA management and is preferred because it can be applied to various anatomical differences in EA. Managing the hemodynamic effects and anesthetic consideration during EA repair can be complex due to right ventricular dysfunction secondary to tricuspid regurgitation (TR). While opening the pericardium, the monitor showed VT, and the patient was given an internal defibrillation. Transesophageal echocardiography (TEE) was done intraoperatively to help evaluate ventricular function. The sternal closure was delayed due to cardiac edema. The procedure was done, but the patient’s hemodynamic was unstable, so it was decided to delay the sternal closure. Many studies showed that the Cone procedure is a long-lasting repair of TR and creates significant functional improvement, resulting in low in-hospital mortality. TEE during the cone procedure has a vital role in evaluating the tricuspid valve’s function after repair. Our patient's cone procedure was successfully done with reduced TR and good biventricular function, as shown in previous studies.

The Role of Toxicology in Aging Research: An Insight

Rahma Rahma — 2023-12-14

Aging is defined as a time-dependent decline in organ or tissue function. The rate of physiological aging differs among individuals. In addition to genetics, environmental factors contribute to the acceleration of aging. Gerontogen refers to environmental toxicants that can accelerate cellular aging. Toxicology, which is the study of unintended exposures to toxicants, can provide insight into the aging process. Despite the lack of an excellent biomarker to detect aging at the molecular level, several gerontogens, including UV radiation, have been identified. This study will present concise and brief information regarding several biomarkers that can be used to identify gerontogen, as well as a brief explanation of the fundamental mechanism by which gerontogen causes accelerated aging.

Prediction of Arterial Blood Gas from Venous Blood Gas: How Far We’ve Come

Putri Alief Siswanto — 2023-12-14

Venous blood gas has been extensively studied as a replacement for arterial blood gas, which remains the gold standard despite some drawbacks. Many question the validity of venous blood gas for a routine clinical practice application. Arterial and venous pH are clinically interchangeable with a consistently narrow mean difference (bias: 0.03) and limits of agreement (LOA: -0.1 to 0.1). In contrast, arterial and venous pCO₂ demonstrate a wide LOA (-20 to 20), while arterial and venous pO₂ have a more pronounced difference. Many prediction studies showed a high correlation between arterial and venous pCO₂ (r>0.7) yet a poor correlation between arterial and venous pO₂ (r<0.3), suggesting a non-linear relationship. Leveraging the predictive power of artificial intelligence is paramount to modeling complex non-linear relationships between venous and arterial blood gas parameters, which may improve the estimation of arterial blood gas using venous samples.