High Fetuin-A Level as a Protective Factor to Abdominal Aortic Calcification in Indonesian Regular Hemodialysis Patients.

BACKGROUND: Although the prevalence of cardiovascular disease decreases in the general population, this pattern is not followed in hemodialysis patients. Hence cardiovascular events still occur in 50% of cases resulting in hemodialysis patients. One of the risk factors is vascular calcification. The pathogenesis is not yet fully understood, but recent years studies have shown that vascular calcification in chronic kidney disease (CKD) occurs as a result of the interaction of stimulatory and inhibitory factors. One of the inhibitory factors is Fetuin-A. Until now there has been no data on levels of Fetuin-A as a risk factor for abdominal aortic calcification in Indonesia. AIM: To determine the effect of Fetuin-A levels on abdominal aortic calcification in regular hemodialysis patients. METHODS: This study was a cross-sectional study on 76 regular hemodialysis patients at Rasyida Renal Hospital Medan. Fetuin-A level was examined by enzyme-linked immunosorbent assay (ELISA). Assessment of abdominal aortic calcification was done by lateral lumbar X-ray. RESULTS: Most patients (68.4%) had abdominal aortic calcification, in both layers; intima and media (44.7%). Abdominal aortic calcification was associated with Fetuin-A level and age. Multivariate analysis showed that high Fetuin-A levels were significantly associated with abdominal aortic calcification. CONCLUSION: High Fetuin-A level appeared to be a protective factor against abdominal aortic calcification in regular hemodialysis patients in Indonesia.

Emergence of Melioidosis in Indonesia and Today's Challenges.

A recent modeling study estimated that there could be as many as 20,000 human melioidosis cases per year in Indonesia, with around 10,000 potential deaths annually. Nonetheless, the true burden of melioidosis in Indonesia is still unknown. The Indonesia Melioidosis Network was formed during the first melioidosis workshop in 2017. Here, we reviewed 101 melioidosis cases (99 human and two animal cases) previously reported and described an additional 45 human melioidosis cases. All 146 culture-confirmed cases were found in Sumatra (n = 15), Java (n = 104), Kalimantan (n = 15), Sulawesi (n = 11) and Nusa Tenggara (n = 1). Misidentification of Burkholderia pseudomallei was not uncommon, and most cases were only recently identified. We also evaluated clinical manifestations and outcome of recent culture-confirmed cases between 2012 and 2017 (n = 42). Overall, 15 (36%) cases were children (age <15 years) and 27 (64%) were adults (age ≥15 years). The overall mortality was 43% (18/42). We conducted a survey and found that 57% (327/548) of healthcare workers had never heard of melioidosis. In conclusion, melioidosis is endemic throughout Indonesia and associated with high mortality. We propose that top priorities are increasing awareness of melioidosis amongst all healthcare workers, increasing the use of bacterial culture, and ensuring accurate identification of B. pseudomalleiand diagnosis of melioidosis.