International Journal of Integrated Health Sciences

Journal Information
ISSN / EISSN : 2302-1381 / 2338-4506
Total articles ≅ 120
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Latest articles in this journal

Kevin Fachri Muhammad, Ferdy Ferdian, Andri Reza Rahmadi
International Journal of Integrated Health Sciences, Volume 10, pp 39-45;

Objective: To describe an unusual case of drug reaction with eosinophilia and systemic symptoms presenting as fever of unknown origin (FUO) and the diagnostic hurdles that come with the presence of differential diagnosis of FUO, which is tuberculous lymphadenitis. Methods: A 34-year-old female with a chief complaint of fever that has lasted for 3 weeks accompanied with jaundice and skin rashes for 2 weeks was admitted with an indication of FUO. She had a history of carbamazepine consumption for trigerminal neuralgia 2 months prior. Cervical lymphadenopathy was palpable bilaterally and hepatomegaly, elevated liver enzyme, as well as hyperbilirubinemia were observed. After excluding differentials for many causes of prolonged fever, patient was treated for Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) and was given intravenous steroid injections. Fine needle aspiration biopsy was performed for her cervical lymphadenopathy. Results: Biopsy presenteda mix of sialadenitis and tuberculous lymphadenopathy. Clinical improvement was observed on the second day after steroid administration. Patient was discharged on the seventh day after steroid administration. Conclusion: FUO is one of the possible manifestations of DRESS; however, thorough investigation still needed to be done considering the possibility of more than one entity of disease that can cause FUO in patients, such as tuberculous lymphadenopathy seen in this case.
Sudeep Kumar, Jyoti Batra, Sumesh Prasad Sah, Dinesh Kumar, Shahid Iqbal, Manisha Arora, Shivani Sharma
International Journal of Integrated Health Sciences, Volume 10, pp 7-11;

Objective: To determine lipid profile, antioxidant vitamin (E and C), and malondialdehyde (MDA) levels, as well as superoxide dismutase (SOD) levels and paraoxonase 1 (PON 1) activities in alcoholic hypertensive patients. Methods: Five hundred subjects were selected for this study consisting of 250 normal healthy individuals and 250 alcoholic hypertensive subjects. Total cholesterol, triglyceride, and HDL levels were measured using the enzymatic method while the LDL and VLDL levels were calculated by Friedwald equation. The MDA level were measured using thiobarbiturate (TBA) and the Vitamin E and C were measured using the enzymatic method. The SOD and PON 1 activities were measured using phenyl acetate as the substrate. Results: Total cholesterol, triglycerides, LDL, VLDL, and MDA levels were found to be significantly high while the HDL and Vitamin E and C levels decreased among the alcoholic hypertensive subjects when compared to the control. Furthermore, significant decreases in SOD and PON 1 activities were also found among the alcoholic hypertensive subjects as compared to control. Conclusion: Alterations in lipid parameters, antioxidant vitamin levels, MDA level, SOD activities, and PON 1 activities are associated with hypertension that may be enhanced by alcohol intake, which may lead to the development cardiovascular disease.
Dinesh Kumar, Preeti Sharma, Sudeep Kumar, Sumesh Prasad Sah, Manisha Arora, Shahid Iqbal, Pradeep Kumar
International Journal of Integrated Health Sciences, Volume 10, pp 1-6;

Objective: To explore the link between cigarette smoking and kidney function through renal parameter assessment. Methods: The present study was performed at the Department of Biochemistry Santosh Medical College, Ghaziabad, India, from September 2019 to April 2021. In this study, 140 subjects were included, out of which 35 were non-smokers, 35 smoked <5 cigarette per day, 35 smoked 5-10 cigarette per day, and the remaining 35 smoked more than 10 cigarettes per day. Results: Blood urea, serum creatinine, urinary albumin, and uACR levels were found to increase significantly (p<0.001) in smokers as compared to non-smokers. These increases were higher among chronic cigarette smokers (p<0.001) as opposed to mild and moderate smokers. In contrast, serum uric acid, e-GFR, and urinary creatinine levels decreased significantly (p<0.001) in smokers when compared to non-smokers, with a higher decrease observed in chronic cigarette smokers (p<0.001) as opposed to the mild and moderate cigarette smokers.Conclusion: Alterations in urinary albumin, serum urea, serum creatinine, urinary creatinine, and e-GFR are associated with the risk of renal dysfunction.
Shadrina Affifa Azzahra, Raden Andri Primadhi, Titing Nurhayati, Muhammad Naseh Sajadi, Achadiyani Achadiyani
International Journal of Integrated Health Sciences, Volume 10, pp 26-31;

Objective: To acquire clinical data regarding indications of implant removal and complications in orthopedic metal implant removal. Methods: This was a cross-sectional observational descriptive study using patient medical records. The inclusion criterion was all patients who underwent orthopedic metal implant removal during 2018-2020 while the exclusion criterion was unintentional implant removal due to subsequent injury or loosening. Data regarding anatomic regions, indications, and complications were collected and presented in tables. Results: In 112 patients participated in this study consisting of 75 (67%) men and 37 (33%) women, the implants were mainly located in thigh, lower leg, and ankle (53% combined). The most common indication for metal implant removal was conversion (31%), followed by infection (25%) and patient's request (20%). The only complication observed in orthopedic metal implant removal in this study was disturbed wound healing in a small percentage of the patients (16%). Most patients (84%) did not experience any complication due to metal implant removal. Conclusions: Indications for metal implant removal may vary, with or without symptoms. Disturbed wound healing is a complication observed in metal implant removal. Despite the advantages of removal, further analysis and guidelines are needed to avoid unnecessary hardware removal considering the risk of complications.
Putri Vidyaniati, Fransisca Fransisca, Kiki Akhmad Rizki, Amaylia Oehadian
International Journal of Integrated Health Sciences, Volume 10, pp 46-50;

Objective: To present a case of rare secondary chronic immune thrombocytopenia in diffuse large B-cell lymphoma. Methods: A case of secondary ITP associated with diffuse large B-cell lymphoma (DLBCL) in a 58-year-old woman suffering from hemorrhagic tendencies that was refractory to conventional treatments of ITP was reported. This case is a rarity because there are not many cases of secondary chronic ITP due to DLBCL have been reported to date. Results: A 58-year-old woman was diagnosed with ITP around 11 months before she was admitted to the Emergency Room with bleeding. Previous treatment with steroid and azathioprine was only temporarily effective. During the course of treatment, splenomegaly and lymphadenopathy were identified, but lymph node biopsy was delayed by the thrombocytopenia. The drug was then replaced to the eltrombopag, which showed good response. However, the patient had to undergo splenectomy because of the mechanical effect of splenomegaly, with the biopsy result showed DLBCL. Immune thrombocytopenia then went into a complete remission after splenectomy. Conclusion: In cases of ITP that are refractory to conventional treatments, a thorough search for secondary ITP might be helpful, even if no underlying disorder is detected at the initial presentation.
Emmy Pranggono, Alvy Syukrie, Valentine Natasya Moenadri, Sumartini Dewi
International Journal of Integrated Health Sciences, Volume 10, pp 20-25;

Objective: To understand the correlation between serum KL-6 level and severity of SARD-related ILD in Indonesia. Method: This was a cross-sectional study to evaluate the correlation between serum KL-6 level and Interstitial Lung Disease (ILD) severity based on Chest High-Resolution Computed Tomography (Chest HCRT) among patients with Systemic Autoimmune Rheumatic Disorders (SARD) who visited the Rheumatology Clinic of Dr. Hasan Sadikin General Hospital during the period of January 2019 to February 2020. Secondary data were retrieved from a study on the Effects of Ciplukan Herbs on Organ Fibrosis. KL-6 serum concentration was measured from stored biological material and the correlation between the serum KL-6 level and ILD severity was analyzed by Rank Spearman's test. Results: Thirty-four patients participated in this study with a median age of 37 years-old. Most of the participants were female (94.1%), Sundanese (64.7%), and had systemic sclerosis as an underlying disease (48.5). The median serum KL-6 level was 57.1 U/ml (21.6-444.1). Most participants belonged to severe ILD group (58.8%) with a mean serum KL-6 level of 65.1±48.9 U/ml. The highest mean serum KL-6 level (111.6±121.8) was observed in the moderate ILD group comprising of 32.4% of the participants. The remaining 11.8% participants belonged to mild ILD group with a mean serum KL-6 level of 61.1±24.9 U/ml. Serum KL-6 level was demonstrated to have a weak correlation with ILD severity (r=-0.229, p=0.193). Conclusion.There is an insignificant weak correlation between serum KL-6 level and ILD severity based on chest HRCT in SARD patients.
Charlotte Johanna Cool, Rachmi Serulina, Aninka Saboe
International Journal of Integrated Health Sciences, Volume 10, pp 32-38;

Objective: To describe patients with corrected Congenital Heart Disease (CHD) who experienced Infective Endocarditis (IE). Methods: Two cases of IE were observed in 2019. The first case involved a 36-year-old woman with previous percutaneous transcatheter perimembranous ventricular septal defect (VSD) closure four months before admission. Echocardiography showed vegetation at noncoronary cusps of the aortic valve. Patient received antibiotics for six weeks and underwent surgery for evacuation of vegetation and device, along with VSD closure with a cardiovascular patch (Gore-tex). The second case involved a 43-year-old woman with a history of surgical closure in secundum atrial septal defect (ASD) by pericardial patch two months before admission. Echocardiography showed vegetation at the tricuspid valve. Patient received antibiotics for four weeks and planned for surgery to evacuate vegetation. Results: IE is one of the major complications in CHD, whether uncorrected, treated, or corrected. The risk of IE increased with an invasive procedure. Post closure IE is rare. Poor dental hygiene and immunocompromised also increased patient's risk to be exposed to IE as shown in the first patient who had dental caries and the second patient who was on methylprednisolone for post-surgical pericardial effusion treatment. Conclusion: The risk of IE increases with invasive procedures in CHD patients. Although the incidence of IE is quite rare, its possibility should become of a serious concern among physicians.
Made Violin Weda Yani, Made Sindy Astri Pratiwi, Agus Indra Yudhistira Diva Putra, Ni Ketut Sri Diniari
International Journal of Integrated Health Sciences, Volume 10, pp 12-19;

Objective: To determine the relationship between depression, anxiety, and stress with the employment status of people in Bali during Covid-19 pandemic. Methods:This study was a cross-sectional analytical study conducted in Bali, Indonesia, in 2021. The instrument used was DASS-21 questionnaire, which was distributed to a total sample size of 96 people. The relationship between variables were analyzed with a p-value of <0.05 as the cut-off for a significant relationship. Results:Depression symptoms had a significant relationship with gender (p=0.024) while anxiety symptoms had a significant association with the employment status during the pandemic (p=0.027). Similarly, stress symptoms also had a significant relationship with gender (p=0.007) and employment status during COVID-19 pandemic (p=0.007). Conclusion: There is a relationship between depression, anxiety, and stress due to changes in employment status during the COVID-19 pandemic in Badung Districts, Bali.
Kevin Kevin, Zulham Yamamoto, Bayu Dewanto
International Journal of Integrated Health Sciences, Volume 9, pp 36-41;

Objective: To report a glioblastoma (GBM) case preceded by a hemorrhagic stroke. Methods: This case reported a 53-year-old male presenting at at Murni Teguh Memorial Hospital, Medan, Indonesia, with a chief complaint of an altered mental state. The condition had been worsened for two weeks. On anamnesis, he was identified to have experienced intracerebral hemorrhage in January 2020. A follow-up head computed tomography scan was conducted in September 2020, showing a normal condition of the brain. Other oncogenic risk factors were not found. Due to convulsion in October 2020, the patient underwent a magnetic resonance imaging examination showing a cystic right temporoparietooccipital lesion and cerebral edema. Craniotomy tumor removal surgery was performed while the tumor was further examined for histopathological findings. The tumor was diagnosed as glioblastoma with microvascular proliferation and palisading necrosis. Results: There was some associations between hemorrhagic stroke and glioblastoma development. Conclusion: GBM preceded by hemorrhagic stroke is a rare case that can be diagnosed thoroughly by complete clinical and adjunct examinations.
Triwedya Indra Dewi, Giky Karwiky, Rekha Nova Iyos, Mega Febrianora
International Journal of Integrated Health Sciences, Volume 9, pp 42-48;

Objectives: To present a rare case of Congenital Complete Heart Block (CCHB) in the setting of post-cesarean delivery of an asymptomatic young patient. Methods: A 30-year-old female patient complained of sudden weakness after C-section delivery with spinal anesthesia. She presented a slow heart rate and Complete Heart Block (CHB) on electrocardiogram (ECG). After one week of observation, the ECG still presented a CHB condition. A permanent pacemaker (PPM) with DDDR mode was then installed for this patient. Result: The etiology of CHB, especially at a young age, is unclear, hence challenging. A patient with a CCHB is difficult to diagnose, especially without any previously related symptoms. This abnormality is usually detected during routine screening not related to cardiovascular disease. The patient in this case study presented an ECG of persistent CHB from the time this patient was admitted until one week after observation. The echocardiography showed normal results. Other modalities to confirm diagnosis and evaluate the prognosis of a CCHB should be done. Conclusion: Establishing the etiology of CHB in young patients is challenging. The implantation of PPM is needed because the condition is permanent, regardless the etiology. However, implanting a permanent pacemaker is not always an easy decision, especially in young patients.
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