The impact of social connections and discrimination to HIV risk among Asian gay and bisexual men in Australia.

BACKGROUND: Asian gay, bisexual, and other men who have sex with men (GBMSM) are overrepresented in new HIV diagnoses in Australia. Social engagement with other GBMSM has been associated with HIV testing and pre-exposure prophylaxis (PrEP) uptake. Asian GBMSM may be socially disconnected from LGBTQ+ people, which may increase their HIV risk. This analysis assessed the contribution of social connection on HIV risk among Asian GBMSM. METHODS: Using an online cross-sectional survey of Asian GBMSM in Australia, we measured condomless anal intercourse (CLAI) in the last 6months without PrEP or an undetectable viral load (UVL), i.e. CLAI with a risk of HIV transmission. Bivariable and multivariable logistic regression models were performed to compare demographic characteristics and social engagement of participants who had CLAI without PrEP or UVL to those who had not. Analyses were restricted to participants who reported sex with casual partners in the last 6months. RESULTS: Among 509 participants who had casual partners in the last 6months, 151 (29.7%) reported CLAI without PrEP or UVL. CLAI without PrEP or UVL was negatively associated with full-time employment, and recently being tested for HIV and was positively associated with experiencing discrimination based on sexual orientation. Social engagement with LGBTQ+ people was not associated with CLAI without PrEP or UVL. CONCLUSIONS: CLAI without PrEP or UVL was not related to social connections with LGBTQ+ people but was more likely among Asian men who had experienced sexuality-related discrimination, suggesting that mitigating homophobia and biphobia may assist in improving HIV prevention among Asian GBMSM who live in Australia.

Plasmodium falciparum Isolates Carrying pfk13 Polymorphisms Harbor the SVMNT Allele of pfcrt in Northwestern Indonesia.

Artemisinin-based combination therapy (ACT) is the first-line antimalarial regimen in Indonesia. Susceptibility of Plasmodium falciparum to artemisinin is falling in the Greater Mekong subregion, but it is not known whether the efficacy of current combinations is also threatened in nearby Sumatera. We evaluated the genetic loci pfcrt, pfmdr1, and pfk13, considered to be under selection by artemisinin combination therapy, among 404 P. falciparum infections identified by PCR detection in a cross-sectional survey of 3,731 residents of three regencies. The pfcrt haplotype SVMNT (codons 72 to 76) was the most prevalent and displayed significant linkage disequilibrium with the pfmdr1 haplotype YY (codons 86 and 184) (odds ratio [OR] 26.7; 95% confidence interval [CI], 5.96 to 239.4; P < 0.001). This contrasts with Mekong countries, where the CVIET haplotype of pfcrt predominates. Among 231 evaluable isolates, only 9 (3.9%) showed any evidence of nonsynonymous gene variants in the propeller domain of pfk13 The Thr474Ala variant was seen in six individuals, and Cys580Tyr was identified with low confidence in only a single isolate from an asymptomatic individual. Among a subset of 117 symptomatic P. falciparum-infected individuals randomized to receive either dihydroartemisinin-piperaquine or artemether-lumefantrine, the treatment outcome was not associated with pretreatment genotype. However, submicroscopic persistent parasites at day 28 or day 42 of follow-up were significantly more likely to harbor the pfmdr1 haplotype NF (codons 86 and 184) than were pretreatment isolates (P < 0.001 for both treatment groups). Current ACT regimens appear to be effective in Sumatera, but evidence of persistent submicroscopic infection in some patients suggests further detailed studies of drug susceptibility should be undertaken.

Contribution of Plasmodium knowlesi to Multispecies Human Malaria Infections in North Sumatera, Indonesia.

Background: As Indonesia works toward the goal of malaria elimination, information is lacking on malaria epidemiology from some western provinces. As a basis for studies of antimalarial efficacy, we set out to survey parasite carriage in 3 communities in North Sumatera Province. Methods: A combination of active and passive detection of infection was carried out among communities in Batubara, Langkat, and South Nias regencies. Finger-prick blood samples from consenting individuals of all ages provided blood films for microscopic examination and blood spots on filter paper. Plasmodium species were identified using nested polymerase chain reaction (PCR) of ribosomal RNA genes and a novel assay that amplifies a conserved sequence specific for the sicavar gene family of Plasmodium knowlesi. Results: Of 3731 participants, 614 (16.5%) were positive for malaria parasites by microscopy. PCR detected parasite DNA in samples from 1169 individuals (31.3%). In total, 377 participants (11.8%) harbored P. knowlesi. Also present were Plasmodium vivax (14.3%), Plasmodium falciparum (10.5%) and Plasmodium malariae (3.4%). Conclusions: Amplification of sicavar is a specific and sensitive test for the presence of P. knowlesi DNA in humans. Subpatent and asymptomatic multispecies parasitemia is relatively common in North Sumatera, so PCR-based surveillance is required to support control and elimination activities.

Early Detection of Diabetic Peripheral Neuropathy in Diabetic Patients: A Cross-Sectional Study.

BACKGROUND: Diabetic Peripheral Neuropathy (DPN) is a chronic complication in Type 2 Diabetes Mellitus (T2DM) patients and is characterized by paresthesia, pain, and hypoesthesia of the extremities. The Diabetic Neuropathy Symptom-Score (DNS) is a quick, inexpensive, and easy-to-perform tool to detect DPN in clinical practice. Biochemical markers like Nitric Oxide (NO) and Vascular Endothelial Growth Factor (VEGF) play a role in the early detection of DPN. This study aims to investigate the relationship between risk factors and these biomarkers. So, it is expected to improve the prevention and treatment of diabetic neuropathy more effectively. METHOD: A cross-sectional method was used for this study. The sample size was 85 patients with T2DM who visited several primary healthcare in Medan, selected by consecutive sampling method based on eligibility criteria. Data collected included DNS, assessment of NO, VEGF, Glycated Hemoglobin (HbA1C), plasma blood glucose (PBG), and lipid profile. The collected data were analyzed using an independent T-test. RESULT: The results showed that most T2DM patients, namely 73 people (85.9%), experienced DPN. From the bivariate analysis results, the risk factors associated with the prevalence of DPN in T2DM patients were found to be increased levels of total cholesterol, HbA1c, NO, and VEGF (p < 0.05). Meanwhile, blood pressure, fasting BGL, HDL-C, LDL-C, and triglycerides were not related to the occurrence of DPN in this study (p> 0.05). CONCLUSION: DNS can be used as a quick and easy initial screening tool implemented in clinical practice for screening DPN. Diabetic patients with DPN tend to have lower NO and increased VEGF; besides, NO levels are also associated with the progression of DPN. Furthermore, education, blood sugar control, and physical exercise, especially leg exercises, can prevent progressive DPN.

Norwegian scabies in human immunodeficiency virus and tuberculosis-infected child: A case report.

Norwegian scabies is a rare scabies with the manifestation of thick crusts of the extremities of the skin that contain eggs and mites. Several conditions in which scabies infection is easily transmitted include immunocompromised, home nursing, and severe neurological disorder. The aim of this case report was to present a thorough analysis of a comprehensive resource for the management of Norwegian scabies patients, with a specific focus on individuals who also have HIV or other immunocompromising diseases. A 1-year-and-7-month-old boy was presented to the hospital with a chief complaint of a thick crust that he had experienced for four months. It began as a red papule in the lower extremity, then crusted and spread to the whole body. The patient kept scratching due to itching, had a recurrent fever and diarrhea for three months, and cough for one month. The patient was diagnosed with human immunodeficiency virus (HIV) and pulmonary tuberculosis at three months, suspected to get the infection from the parents. Sarcoptes scabiei was found from microscopy examination of skin scraping. The patient received holistic treatment, including antiretroviral drugs, antituberculosis medication, scabies treatment, and malnutrition treatment. Appropriate scabies treatment aimed at peeling crusted skin, relieving itching, and increasing the patient ability to use the extremities. Comorbidity conditions caused by HIV and pulmonary tuberculosis should also be treated to optimize the outcome. The patient was discharged in good condition with sanitation education and regular follow-up at the outpatient clinic. This case highlights that Sarcoptes scabiei infestation may be a clue to an immunocompromised condition. Holistic therapy aiming to cure underlying infection, infestation and underlying nutrition and psychosocial problems must be addressed to fully cure this high-burden case.

Atherosclerotic Cardiovascular Disease in Diabetes Patients.

BACKGROUND: Diabetes mellitus (DM) is a metabolic disorder characterized by abnormally elevated levels of blood glucose. The hyperglycemic condition is caused by abnormalities in either insulin secretion, insulin action, or both. Two-thirds of diabetes-related deaths are caused by atherosclerotic cardiovascular disease (ASCVD). OBJECTIVE: The purpose of this study was to determine the risk of ASCVD and related factors in type 2 DM patients in Medan, North Sumatra. METHODS: We conducted a cross-sectional observational study. A total of 252 DM patients visiting primary health centers in Medan were recruited after fulfilling the inclusion and exclusion criteria. The level of risk of atherosclerotic cardiovascular disease (ASCVD) was determined by using ASCVD Risk Calculator. Data required to use this calculator are age, sex, race, total cholesterol, HDL-C, systolic blood pressure, diastolic blood pressure, history of diabetes, history of hypertension treatment, smoking history, and use of statins for anti-hyperlipidemia. The data were then analyzed with Chi-square Test (p < 0.0%) and processed with SPSS. RESULTS: There were 59 (23.41%), 140 (55.56%), and 53 (21.03%) participants who had high, moderate, and low risks of ASCVD, respectively. Bivariate analysis showed significant association between risk of ASCVD with age, SBP, total cholesterol level, HDL-C levels, and duration of diabetes (p < 0.05). Meanwhile, gender and familial history not related to ASCVD risks among DM patients (p > 0.05). CONCLUSION: The risks for atherosclerotic complications of cardiovascular disease in type 2 DM patients in Medan were predominantly high. The variables related to ASCVD risks included age, gender, HbA1C, systolic blood pressure (SBP), total cholesterol levels, HDL-C, and LDL-C levels.

Citizens' perception of and willingness to receive COVID-19 vaccination in Medan. Indonesia.

One of the efforts to control the COVID-19 pandemic is through vaccination, which is targeted to build immunity and prevent severe disease and finally to control transmission. This study aimed to analyze the perception of and the willingness to receive the COVID-19 vaccine among citizens of Medan. This research is an analytic study with a cross-sectional research design. Data collection was carried out from 16 April 2021 to 18 April 2021 by having participants fill out a Google Forms questionnaire. The population in this study was adults and elderly citizens in Medan who had not yet been vaccinated against COVID-19, and the sample was taken by consecutive sampling technique, which was the group of people who met the inclusion and exclusion criteria. The measurements of perceptions of and willingness to receive the COVID-19 vaccine used a previously validated questionnaire. The data was processed using SPSS. Data analysis used the Chi-square test (p<0.05). This study indicates that 31.8% of respondents positively perceive the COVID-19 vaccine. In comparison, 68.2% of respondents have a negative perception. On willingness to receive the vaccine, 80.2% accepted being vaccinated, 5.2% did not, and 4.6% had not decided whether to be vaccinated. There is a relationship between perception and willingness to undergo COVID-19 vaccination.

Educational Model and Prevention on Prediabetes: A Systematic Review.

BACKGROUND: Prediabetes is a reversible condition before the onset of Type 2 Diabetes Mellitus. Untreated condition of prediabetes will develop into diabetes and its complications. The prevalence of prediabetes has been emerging worldwide and has a considerable socioeconomic impact. The current study reviews the roles of early detection, educational models, life modification, and prophylaxis of individuals with prediabetes in preventing the progression of prediabetes into Type 2 Diabetes Mellitus and complications in the future. METHODS: This study included published articles from several electronic databases. The obtained articles were limited to March 2023. Articles that were not open access and not in Indonesian or English were excluded. The protocol for this study used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020. RESULTS: Of 39627 articles, 39601 were excluded due to duplication and did not meet the eligibility criteria. At the final, there were 26 articles that were eligible for systematic review. CONCLUSION: Prevention of the development of prediabetes into diabetes is essential. A comprehensive understanding and training on intensive lifestyle modification protocols from local and national experts in diabetes prevention through digital-based education models and linguistically and culturally approach can be considered. Intensive lifestyle modification and pharmacological approaches may improve the outcome. Regular monitoring of glycemic control is also important for early diagnosis of diabetes, especially in patients with special conditions.

A pediatric case and literature review of mucormycosis: Diagnostic and treatment challenges in a resource poor setting.

Mucormycosis is an emerging disease that primarily affects immunocompromised patients; however, it has also been reported in immunocompetent individuals. Studies in the pediatric population are limited and reported mostly in case studies or series. The aim of this case report is to present a pediatric mucormycosis originated from Sumatra Island, Indonesia. A 13-year-old boy was referred to a tertiary hospital with facial necrosis involving the nasal, oral, and left maxillary areas, as well as left periorbital edema. No known underlying conditions were documented. The diagnosis was confirmed by histopathological findings of broad, pauci-septate, ribbon-like hyphae branching at 90°. The patient was managed by a multidisciplinary team consisting of the ear, nose, and throat, infectious diseases, dermatology, surgery, microbiology, and pathology departments. Management of the patient included debridement of the necrotic lesion and antibiotics and anti-fungal (fluconazole). Due to unavailability, the patient was not treated with amphotericin B. The patient died after 30 days of admission. This case highlights the importance of maintaining a high suspicion of invasive mucormycosis, even in immunocompetent children, when symptoms and signs are present, especially in resource-limited settings.

Risk of Cardiovascular Complication Among Type 2 Diabetes Mellitus Patients in Medan, Indonesia. A Cross-sectional Study.

Background: Cardiovascular disease (CVD) is a disease associated with impaired heart and blood vessel function. The occurrence of Diabetes Mellitus (DM) is due to an imbalance in blood glucose that could cause damage to large and small blood vessels and increase platelet aggregation, contributing to atherosclerosis and cardiovascular disease. It could be attributed to high blood pressure, smoking, diabetes, lack of movement, obesity, high cholesterol, unbalanced diet. CVD can be prevented, especially in at-risk groups, with risk assessment utilizing the Framingham Risk Score (FRS). Objective: The study aimed to to analyze the risk of CVD according to the Framingham Risk Score (FRS) in type 2 DM patients in Medan. Methods: The data were collected with the Framingham Risk Score, which consisted of sub-variables of age, total cholesterol, HDL cholesterol, systolic blood pressure (SBM), history of DM, and history of smoking, which were assessed by gender. It was a cross-sectional analytic study with consecutive sampling on 252 respondents, namely DM patients who came for treatment or control to the health centers in Medan and fulfilled the inclusion and exclusion criteria. The data were then analyzed with SPSS. Results: The respondents consisted of 197 women (78.2%) and 55 men (21.8%). The results were predominated with high risk patients (139, 55.2%), followed by those with medium risks (80, 31.7%), and low risks (33, 13.1%). Chi-square test yielded a significant association between each sub-variable of CVD risk factors and the risks based on FRS in type 2 DM patients. Conclusion: Each sub-variable of CVD risk factors and the risks on FRS among type 2 DM patients. In future studies, it is recommended to include that a larger number of samples in the community with a balanced proportion of men and women.

Early detection of macrovascular complications in type 2 diabetes mellitus in Medan, North Sumatera, Indonesia: A cross-sectional study.

Background: Macrovascular complications occur very frequently in patients with type 2 diabetes mellitus (T2DM) with a high mortality rate, due to the development of cardiovascular disease (CVD), such as stroke, atherosclerosis acceleration, and atrial fibrillation. T2DM is a significant risk factor for CVD and has become the leading cause of death. The purpose of this study was to detect the early risk of macrovascular complications by using the ankle brachial index (ABI) as a marker. Methods: This study was an analytic study with a cross-sectional approach. The study population was patients with T2DM from several primary health care centers in Medan. In total, 89 subjects who met the inclusion and exclusion criteria were recruited with consecutive sampling. ABI was determined as the ratio of systolic blood pressure in the brachial artery to the posterior tibial artery after the subjects had been relaxed and felt comfortable in a supine position. Examination of vitamin D and lipid profile was derived from examination of venous blood.  Data were processed using SPSS and analyzed with one-way ANOVA. Results: The study found that there was a relationship between LDL-C, triglyceride, and vitamin D (25OH-D) based on the ABI (p > 0.05). Conclusions: ABI can be used for an early detection of macrovascular complications. Apart from being easy to perform, ABI was non-invasive. Some other risk factors that can also be used to assess complications and have relationships with ABI were LDL-C, triglyceride, and vitamin D (25OH-D). Complications in T2DM patients can be prevented with reasonable blood sugar control and lifestyle changes. Education and motivation need to be given to patients so that they become more independent in controlling their disease and improving their quality of life.

Recurrence of Plasmodium malariae and P. falciparum Following Treatment of Uncomplicated Malaria in North Sumatera With Dihydroartemisinin-Piperaquine or Artemether-Lumefantrine.

BACKGROUND: We assessed the efficacy of artemisinin-based combination therapies for treatment of uncomplicated falciparum malaria, with or without co-infecting Plasmodium spp., in Sumatera, Indonesia. METHODS: Febrile patients aged >6 months with uncomplicated P. falciparum were randomized to receive dihydroartemisinin-piperaquine or artemether-lumefantrine, plus single-dose primaquine, and were followed for 42 days. Mixed Plasmodium infections were included; P. vivax infections received 14 days of primaquine. We retrospectively restricted the analysis to cases with polymerase chain reaction (PCR)-confirmed parasitemia. Recurrent parasitemia in follow-up was identified by species-specific nested PCR. RESULTS: Of the 3731 participants screened, 302 were enrolled and randomized. In the dihydroartemisinin-piperaquine arm, P. falciparum infections were confirmed by PCR in 59 participants, with mixed infections in 23 (39.0%). In the artemether-lumefantrine arm, P. falciparum infections were confirmed by PCR in 55 participants, with mixed infections in 16 (29.0%). Both regimens were well tolerated, and symptoms improved rapidly in all treated participants. In the dihydroartemisinin-piperaquine arm, 1 P. falciparum recurrence (on day 7) and 6 P. malariae recurrences (1 had a mixed infection with P. falciparum) were identified during days 3-42 of follow-up. In the artemether-lumefantrine arm, 1 P. falciparum/P. malariae/P. vivax recurrence occurred on day 35. Submicroscopic persistence occurred during follow-up in 21 (37%) of 57 receiving dihydroartemisinin-piperaquine and 20 (39%) of 51 receiving artemether-lumefantrine. CONCLUSIONS: In Sumatera, both regimens effectively cleared initial parasitemia, but P. falciparum and P. malariae persisted in some individuals. Molecular species detection should be deployed in antimalarial efficacy trials in Indonesia. TRIAL REGISTRATION: NCT02325180.