The Iodine Status of Women of Childbearing Age in an Iodine-repleted Area: An Epidemiological Study in Sengi Village on Merapi Mountain Area.

BACKGROUND: The low iodine content of daily water sources and repeated volcanic eruptions are expected to affect the iodine status and thyroid hormone profile of women of childbearing age in the Magelang regency. This study aimed to determine the iodine and thyroid profile among women of childbearing age. METHODS: We used a cross-sectional descriptive study to learn about 140 women of reproductive age living in Sengi village from October 2017 to January 2018. We assessed the iodine level, dietary intake, and goitrogenic food consumption using food frequency questionnaire (FFQ), urinary iodine concentration (UIC), thyroid stimulating hormone (TSH) and free thyroxine (fT4), and total goiter rate (TGR). RESULTS: The median UIC was 199.5 (126.0 - 264.0)µg/L. The TGR was 10.7% on palpation and 7.8% on ultrasound. The proportion of UIC levels below 100µg/L was 18.5%. The mean water iodine content was 2.03 ± 4.74 µg/L. The mean salt iodine level was 28.6±13.7ppm. There were only 35% who consumed salt with adequate iodine contents, and only 19.29% consumed >150µg iodine from daily dietary intake based on FFQ. The median TSH and FT4 levels were 1.72 and 1.51mIU/L. CONCLUSION: Women of childbearing age in Sengi Village generally had adequate iodine profiles and normal thyroid hormone levels but a considerable proportion of TGR and low UIC. The iodine contents within the freshwater source, table salt, and daily dietary intake were low. There are no significant association between Iodine status, daily goitrogen intake, daily iodine intake and salt iodine concentration.

The Effects of Colocasia esculenta Leaf Extract in Inhibition of Erythrocyte Aldose Reductase Activity and Increase of Haemoglobin in Experimental Rats.

Diabetes Mellitus (DM) has reached a number of 382 million in 2013 and expected to rise to 592 million by 2035. Chronic diabetes can lead to impaired formation of erythropoietin in haemoglobin production and may cause anemia. Inhibition of aldose reductase is a key point of diabetes treatment and prevention of complications in diabetes. Colocasia esculenta (CE) leaf is one of Indonesian vegetables which has inhibition effect on aldose reductase activity. This research was a true experimental study with post-test only group design. 21 male Sprague dawley rats were divided into: K (control group), P1 (extract CE 200 mg/KgBW) and P2 (extract CE 400 mg/KgBW). Rats were induced to become obese with High Fat Sucrose Diet (HFSD) for 4 wk then extract CE were given for 3 wk. The data were analyzed with independent t-test. CE have a significant effect to increase haemoglobin but have no significant inhibition effect to erythrocyte aldose reductase activity. The results of this research found that the mean haemoglobin of control group was 13.14±1.55, treatment group 1 (P1) was 15.22±0.59, and treatment group 2 (P2) was 15.77±0.71. There was significant increase in haemoglobin (p<0.05). The mean of aldose reductase activity of treatment group was lower than control group. However, there was no significant difference found (p>0.05) between the groups. 200 mg/kgBW and 400 mg/kgBW dose of CE could increase haemoglobin and decrease the mean of aldose reductase activity.

The Role of Cytotoxic T-lymphocyte-associated Protein 4 (CTLA-4) Gene, Thyroid Stimulating Hormone Receptor (TSHR) Gene and Regulatory T-cells as Risk Factors for Relapse in Patients with Graves Disease.

BACKGROUND: graves' disease (GD) is the most common condition of thyrotoxicosis. The management of GD is initiated with the administration of antithyroid drugs; however, it requires a long time to achieve remission. In reality more than 50% of patients who had remission may be at risk for relapse after the drug is stopped. This study aimed to evaluate the role of clinical factors such as smoking habit, degree of ophtalmopathy, degree of thyroid enlargement; genetic factors such as CTLA-4 gene on nucleotide 49 at codon 17 of exon 1, CTLA-4 gene of promotor -318, TSHR gene polymorphism rs2268458 of intron 1; and immunological factors such as regulatory T cells (Treg) and thyroid receptor antibody (TRAb); that affecting the relapse of patients with Graves' disease in Indonesia. METHODS: this was a case-control study, that compared 72 subjects who had relapse and 72 subjects without relapse at 12 months after cessation of antithyroid treatment, who met the inclusion criteria. Genetic polymorphism examination was performed using PCR-RFLP. The number of regulatory T cells was counted using flow cytometry analysis and ELISA was used to measure TRAb. The logistic regression was used since the dependent variables were categorical variables. RESULTS: the analysis of this study demonstrated that there was a correlation between relapse of disease and family factors (p=0.008), age at diagnosis (p=0.021), 2nd degree of Graves' ophthalmopathy (p=0.001), enlarged thyroid gland, which exceeded the lateral edge of the sternocleidomastoid muscles (p=0.040), duration of remission period (p=0.029), GG genotype of CTLA-4 gene on the nucleotide 49 at codon 17 of exon 1 (p=0.016), CC genotype of TSHR gene on the rs2268458 of intron 1 (p=0.003), the number of regulatory T cells (p=0.001) and TRAb levels (p=0.002). CONCLUSION: genetic polymorphisms of CTLA-4 gene on the nucleotide 49 at codon 17 of exon 1, TSHR gene SNP rs2268458 of intron 1, number of regulatory T cells and TRAb levels play a role as risk factors for relapse in patients with Graves' disease.

Primary Hyperaldosteronism Due to Adrenocortical Adenoma: a Case Report.

Primary hyperaldosteronism is an adrenal abnormality in which there is some degree of autonomy of aldosterone secretion. We report a case of thirty three years old Javanese female presented with uncontrolled hypertension, muscular weakness, cramps  and progressing shortness of breath during working for 6 years. She had history of hypertension since age 20. Her serum potassium level was always low that associated with inappropriate kaliuresis. Blood gas analysis revealed metabolic alkalosis. Sonography of the adrenal gland showed right hipoechoic architecture; CT scan of the abdomen confirmed an right adrenal tumor measured 4 cm in its greatest dimension. Endocrine evaluation revealed high plasma aldosterone concentration, suppressed plasma renin activity, aldosterone/renin ratio of 112 and confirmed the diagnosis of primary aldosteronism. She underwent unilateral adrenalectomy. Histopathological report from excised adrenal tumor were compatible to benign adrenocortical adenoma. The patient discharge home with well controlled blood pressure and normokalemia. No clinical symptoms was reported in follow-up.

Biventricular Cardiac Hypertrophy in a Patient with Primary Aldosteronism and Atrial Septal Defect.

BACKGROUND Primary aldosteronism can be caused by adrenocortical adenoma and is usually associated with left ventricular hypertrophy. Biventricular cardiac hypertrophy and heart failure in the presence of a pre-existing atrial septal defect (ASD) are a rare association of primary aldosteronism. CASE REPORT A 33-year-old woman with resistant hypertension and refractory hypokalemia presented with signs and symptoms of heart failure. She had previously been diagnosed having a right adrenal tumor and ostium secundum type ASD. Transthoracic echocardiography confirmed the location of the ASD, with a left-to-right cardiac shunt, moderate to severe tricuspid insufficiency, moderate pulmonary hypertension (60 mm Hg), four chamber dilatation and biventricular hypertrophy. The left ventricular ejection fraction was 17%. Endocrine function tests showed a raised plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio, which supported a diagnosis of primary aldosteronism. A captopril suppression test failed to suppress the patient's PAC, which confirmed the diagnosis. The patient underwent a right adrenalectomy with subsequent normalization of hypokalemia, PAC, and PAC to PRA ratio and her hypertension was managed successfully with monotherapy. Surgical pathology examination of the tumor revealed an adrenocortical adenoma. At follow-up at 18 months, the patient had a normal potassium level, and her cardiac function and ventricular geometries were improved. CONCLUSIONS Reversible cardiac hypertrophy is rarely associated with primary aldosteronism, however, it should be recognized. Present findings suggest that aldosteronism contributes to cardiac remodelling and biventricular hypertrophic changes. Administering appropriate treatment in a timely manner, can reverse cardiac changes along with the other symptoms of primary aldosteronism.

Clinical profile and outcome of diabetic foot ulcer, a view from tertiary care hospital in Semarang, Indonesia.

Background: This study attempted to determine the disease burden in terms of clinical profile and outcome of diabetic foot ulcer (DFU) admissions at a tertiary care hospital in a developing country. Methods: In this descriptive study, the data were collected from the medical record of diabetic patients with foot ulcer who were treated in Dr. Kariadi General Hospital during a 3-year period. The demographic characteristic, type of foot lesion, etiology, isolated microorganism, treatment, and outcome were reviewed. Results: Foot problems accounted for 16.2% of total diabetic admission (n = 1429). All patients had type 2 diabetes with no gender predominance. The mean age was 54.3 ± 8.6 years and diabetes control was very poor. Before admission, the ulcers had already developed for 4.7 ± 2.9 weeks; however, the majority of patients were unaware of the preceding causes. Ulcers were neuropathic in 42.2% of cases, neuroischemic in 29.9%, and pure ischemic at lesser percentage. More than 70% of ulcers were in Wagner grade ≥3 with infection event in nearly all patients. The most common isolates from culture were Gram-negative bacteria. A total of 98 (36.3%) lower extremity amputations (LEAs) at various level of the foot were carried out, including major LEA in 24 patients and multiple amputations in seven patients. Mortality rate due to DFU reached 10.7%. Conclusions: Diabetic foot problems constitute a source of morbidity, a reason for LEA surgery as well as being a cause of death among patients with diabetes mellitus.

Current Diagnosis and Management of Thyroid Nodules.

Thyroid nodules are frequently found. Although they are often palpable, many are found incidentally during unrelated radiographic studies. Ten to 15% of thyroid nodules represents thyroid malignancy. Clinician suc as an internist/endocrinologist have to  classify the nodule, stratify the risk of thyroid cancer, performed a diagnostic work-up, provide medical / non-surgical therapy, select candidates for surgery and provide appropriate follow-up that should last a lifetime. This article provide an up-date review of diagnostic approach and management of thyroid nodules, focusing on current algorithm in lights of the most recent published American Thyroid Association thyroid nodule and differentiated thyroid cancer management guidelines.

Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study.

BACKGROUND: Diabetic foot ulcers (DFU) may cause significant morbidity and lower extremity amputation (LEA) due to diabetic foot problems can occur more often compared to the general population. The purpose of the present study was to use an epidemiological design to determine and to quantify the risk factors of subsequent amputation in hospitalized DFU patients. METHODS: We performed a hospital-based, case-control study of 47 DFU patients with LEA and 47 control DFU patients without LEA. The control subjects were matched to cases in respect to age (±5 years), sex, and nutritional status, with ratio of 1:1. This study was conducted in Dr. Kariadi General Hospital Semarang between January 2012 and December 2014. Patients' demographical data and all risk factors-related information were collected from clinical records using a short structural chart. Using LEA as the outcome variable, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Univariate and stepwise logistic regression analyses were used to assess the independent effect of selected risk factors associated with LEA. The data were analyzed in SPSS version 21. RESULTS: There were 47 case-control pairs, all of which were diagnosed with type 2 diabetes mellitus. Seven potential independent variables show a promise of influence, the latter being defined as p≤0.15 upon univariate analysis. Multivariable logistic regression identified levels of HbA1c ≥8% (OR 20.47, 95% CI 3.12-134.31; p=0.002), presence of peripheral arterial disease (PAD) (OR 12.97, 95% CI 3.44-48.88; p<0.001), hypertriglyceridemia (OR 5.58, 95% CI 1.74-17.91; p=0.004), and hypertension (OR 3.67, 95% CI 1.14-11.79; p=0.028) as the independent risk factors associated with subsequent LEA in DFU. CONCLUSIONS: Several risk factors for LEA were identified. We found that HbA1c ≥8%, PAD, hypertriglyceridemia, and hypertension have been recognized as the predictors of LEA in this study. Good glycemic control, active investigation against PAD, and management of comorbidities such as hypertriglyceridemia and hypertension are considered important to reduce amputation risk.