COVID-19 Vaccination Intention in Patients with Autoimmune Diseases in Indonesia: An Application of the Integrated Behavioural Model.

Vaccine hesitancy can be a challenge for those with autoimmune diseases. This study investigated the acceptance of COVID-19 vaccination by patients with autoimmune diseases in Indonesia using the integrated behavioral model (IBM). This cross-sectional study was conducted from December 2021 to February 2022. A total of 404 patients with autoimmune diseases completed the survey. The majority of respondents (57.9%) said they intended to get vaccinated against COVID-19. The IBM model with added demographic variables explained 54.1% of the variance of vaccination intention (R2 = 0.541). Self-efficacy, perceived norms, experiential attitude, and instrumental attitude are significantly correlated with vaccination intention in components of health behavior theories. Self-efficacy is the most critical factor influencing vaccination intention in patients with autoimmune diseases (F(2, 401) = 96.9, p < 0.001, R2 = 0.326). In the multivariate analysis, vaccine intention was found to be positively associated with patients' occupation as health-care workers (ß = 0.105). Meanwhile, having a personal history of contracting COVID-19 and having co-morbidities other than autoimmune diseases were negatively correlated to the willingness to be vaccinated against COVID-19. This study confirms the viability of the IBM model for predicting the COVID-19 vaccination intention of patients with autoimmune diseases. It is essential to provide patients with autoimmune diseases with information that is clear and supported by evidence-based medicine.

RETINAL VASCULITIS ASSOCIATED WITH EPSTEIN-BARR VIRUS INFECTION, A CASE REPORT.

PURPOSE: To report a case of retinal vasculitis associated with Epstein-Barr virus infection. METHODS: Case report. RESULTS: A 26-year-old woman came with blurry vision. Funduscopy illustrated vasculitis with frosted branch-like appearance. The patient was treated with systemic acyclovir and topical steroid. Circulating polymerase chain reaction was positive for Epstein-Barr virus antibodies. Two months of treatment resolved the clinical manifestations. CONCLUSION: Epstein-Barr infection should be considered as the etiology of retinal vasculitis with similar clinical manifestations.

Antibody and markers of T-cell activation illuminate the pathogenesis of HCV immune restoration disease in HIV/HCV co-infected patients commencing ART.

Some HIV/hepatitis C virus co-infected patients beginning ART experience Immune Restoration Disease (IRD) manifested as a rise in serum alanine transaminase. This was investigated in HIV/HCV co-infected individuals (n=50) commencing ART in Jakarta (Indonesia). Samples were collected at weeks 0, 4, 8, 12, 24 and at HCV IRD. Nine patients experienced HCV IRD (incidence=9.2 per 1000 person-weeks). These resolved without changing treatment. Markers of T-cell activation (sCD26, sCD30) and immune recruitment (CXCL10) increased in many HCV IRD cases, so T-cells may mediate HCV IRD. Total anti-HCV antibody (core, NS3, NS4) remained lower in HCV IRD cases, but levels of antibody to core were not lower in HCV IRD cases. Rises in HCV RNA on ART were independent of HCV IRD, but there was a negative correlation between baseline HCV RNA and total anti-HCV antibody. High levels of antibody may protect against HCV IRD, via lower HCV antigen loads.

Reduced bone mineral density and serum C-telopeptide concentration in HIV-infected patients in Cipto Mangunkusumo Hospital.

AIM: To evaluate BMD and bone resorption marker in HIV-infected patients in Cipto Mangunkusumo Hospital, Jakarta. METHODS: A cross-sectional study was performed between February and May 2008 in adult HIV-infected patients who had not been treated with antiretrovirals. BMD was measured at the lumbar spine by dual energy X-ray absorptiometry (DEXA) bone densitometer (Lunar Prodigy, GE Medical System, USA), whereas CTX (C-terminal telopeptide) was measured by an automated analyzer (Elecsys 2010, Roche Diagnostics GmbH, Mannheim, Germany) using the b-Crosslaps serum reagents. RESULTS: Fourty-two patients were included, comprising 31 (73.8%) men and 11 (26.2%) women. Patients' median age was 28 years, ranging from 22 to 39 years old. The peak age group was 26-30 years old. Low BMD (osteopenia) was found in 11 (26.2%) of patients. Mean serum CTX level was significantly correlated with BMD (r=0.446; p=0.003). CONCLUSION: Patients with low CD4 count and low BMI tended to have higher serum CTX. HIV-infected, treatment-naive patients possess a significant risk for reduced BMD due to increase bone resorption activity. Further studies are needed to evaluate the association of disease severity and bone resorption markers.

Drug provocation test in patient with antituberculosis drug allergy.

Hypersensitivity reaction is an unexpected drug adverse effect which sometimes can lead to fatal condition. Confirmation of the suspected drugs that cause hypersensitivity reaction is sometimes difficult. Drug provocation test is still a gold standard to establish the diagnosis of hypersensitivity to certain drugs or agents. Drug provocation test is a controlled drug treatment which aims at making diagnosis of hypersensitivity reaction to drugs. We reported a demonstration case of a 47 year-old female patient with hypersensitivity to anti tuberculosis drugs (isoniazid, rifampicin, pyrazinamid and ethambutol). Drug provocation test is important in this case to confirm which drug had caused hypersensitivity reaction because anti tuberculosis drugs were the treatment of choice for her illness.

The proportion of dyslipidemia in systemic lupus erythematosus patient and distribution of correlated factors.

AIM: To understand the proportion of dyslipidemia in systemic lupus erythematosus (SLE) patients and the influencing factors of dyslipidemia. METHODS: AN observational, cross-sectional study was conducted on new and longstanding SLE patients who had been diagnosed based on ARA criteria 1982 with 1997 revision. They had been hospitalized and treated at Department of Internal Medicine, Cipto Mangunkusumo National Central General Hospital and the other private Hospitals in Jakarta, i.e. Kramat Hospital in July - November 2003. The sample was selected by non probability sampling method with consecutive sampling technique. Every participant underwent history taking, physical and laboratory examination. RESULTS: There were 77 patients satisfying the inclusion criteria. The proportion of dyslipidemia in this study was 75.3%. By confidence interval of 95%, the dyslipidemia in SLE patient was 65.3% - 84.6%. The distribution of lipid profile in sample population were 43% with total cholesterol > or = 200 mg/dL, 26% with HDL cholesterol level < 40 mg/dL, 26.4% with LDL cholesterol level > or = 130 mg/dl and 44.2% with triglycerides serum level > or = 150 mg/dL. The characteristics of influencing factors in dyslipidemia prevalence for sample population consisted of 24.7% with renal involvement, 53.2% with > or = 3 years illness periods, 26% had received > or = 30 mg/day prednisone, 94.8% had not received chloroquines, and 58.4% had illness activity of Mex-SLEDAI > or = 2. By bivariate analysis, we found that illness period < 3 years tends to affect dyslipidemia with OR value of 12.04 (CI 95%, 2.54-57.05, p = 0.001). After conducting multivariate analysis by backward methods, it appears that only one significant influencing factor of dyslipidemia prevalence in SLE patient i.e. Illness period od < 3 years with OR value 12.04 (CI 95% 2.54 - 57.05, p = 0.001). CONCLUSION: Illness period of 3 years is represent a significant correlative factor for dyslipedemia prevalence. Prednisone > or = 30 mg/dL is the correlative factor for total cholesterol > or = 200 mg.dL and triglycerides > or = 150 mg/dL. Mex-SLEDAI > or = 2 is the corrective factor for HDL cholesterol < 40 mg/dL.

Diagnosis of disseminated intravascular coagulation in sepsis scoring system of a thrombosis-hemostasis center.

BACKGROUND: Disseminated intravascular coagulation (DIC) is a septic complication that is not easily diagnosed. The purpose of the study is to obtain a scoring system to diagnose DIC in sepsis. SUBJECT AND METHODS: An observational study with a cross-sectional design was performed at the Department of Internal Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital from February to August 2002. Subjects were septic patients in the emergency unit or inpatient ward of the Department of Internal Medicine, and were taken consecutively. The criteria of sepsis, severe sepsis and septic shock were based on ACCP/SCCM Consensus 1991. The evaluation conformed to the Thrombosis Hemostasis Center (THC) scoring system, compared with modified Bick scoring system as a gold standard. RESULTS: There were 34 subjects ranging from 19 to 78 years old, 32.4% were septic patients, 41.2% with severe sepsis and 26.5% with septic shock. The most common source of infection was pneumonia, where bacterial pathogens were found in 35.2% of blood aerobic culture and 17.7% in pus or urine culture. Gram negative bacteria was the most common pathogen found. According to a modified Bick and THC scoring system, DIC was found in all subjects, consisting of mild and moderate DIC. No severe DIC was found. There was no difference between both scoring systems, with a p value of 0.125 based on the Mc Nemar test. There was no difference found in mild and moderate DIC in sepsis, severe sepsis and septic shock of modified Bick scoring systems (p value of 0.987) and THC scoring system (p value of 1.000). CONCLUSION: No difference was found between THC and modified Bick scoring system in diagnosing DIC in septic patients. In sepsis, severe sepsis and septic shock, mild and moderate DIC complications can be diagnosed with THC scoring system, which are of the same potency with the modified Bick, with the assumption that the modified Bick scoring system was the same as the Bick scoring system.