A Review of Patient's Knowledge and Practice of Diabetic Foot Self-Care.

Since diabetic foot ulcers (DFUs) are common among diabetes patients, it is essential to increase patients' knowledge and self-care practices to ensure early recognition and management and reduce amputation risk. Therefore, the goal of this review was to identify the range and level of knowledge of people with DFUs and the type of self-care they undertake. A literature review was conducted using the electronic databases PubMed and Google scholar with 'diabetic foot', 'self-care', 'practice' and 'behaviour' as searching keywords. The identification and selection process were conducted to sort the eligible papers through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The criteria are the original papers describing knowledge and practice in DFU; reporting knowledge and practice in their non-intervention studies; writing in English language; and publishing between years 2016 and 2022. The eligible papers were assessed using the strength of reporting observational studies in epidemiology (STROBE) checklist for appraising their quality. Twenty-two papers of 2,073 titles met the inclusion criteria and included in the review. The lowest and the highest quality score of included papers based on STROBE checklist are 11 and 26, respectively. The included papers showed various levels of knowledge from good to poor, which prominent the highest percentage are 88% (good knowledge) and 84.8% (poor knowledge). The majority of the foot-care activities found in the reviewed papers involved the following steps: washing, drying, applying moisturiser and trimming nails routinely. Those activity should be followed by checking the feet with a mirror for ulcers, looking for ingrown nails, choosing appropriate footwear, not walking barefoot and routinely consulting a healthcare provider. The knowledge levels were found variable and acceptable. Daily foot care, choosing the right footwear, foot activity and regular health checks should all be used to manage diabetes.

Assessment of 28-day survival of patients with sepsis based on vitamin D status: a hospital-based prospective cohort study in Indonesia.

Introduction: sepsis is a potentially life-threatening condition caused by the body´s response to an infection. Recent studies have demonstrated a correlation between low vitamin D status and high mortality in septic patients. This study aims to evaluate the vitamin D status of septic patients at Dr. Sardjito Hospital and describe 28-day survival with very low vitamin D levels (< 8.1 ng/mL). Methods: this prospective cohort study was conducted in the intensive care unit and internal medicine ward at Dr. Sardjito Hospital in septic patients admitted between December 2018 and October 2019. Vitamin D [25(OH)D] was prospectively measured within 24 hours of admission. Data collection used SPSS software for statistical analysis. In addition, the sample size was calculated using the sample size formula used in a comparative survival study intended to find the incidence rate in septic patients. The minimum sample for each group is 23 samples. Results: sepsis-related mortality was higher in patients with low vitamin D. The analysis included 88 septic patients during the study period. The mean age was 56.09 ± 16.82 years and the proportion of males was 46.6%. 26 of 28 patients with vitamin D levels < 8.1 ng/mL died (92.6%), whereas 39 of 60 patients with vitamin D levels ≥ 8.1 ng/mL (65%) died. Multivariate Cox regression analysis showed that vitamin D concentrations < 8.1 ng/mL at admission (p=0.01) and sepsis shock (p=0.02) were associated with increased sepsis mortality. The hazard ratio of 28-day mortality was 1.95 (95% CI 1.15-3.29, p=0.01) for vitamin D levels < 8.1 ng/mL. The average survival was 9 days for patients with vitamin D levels < 8.1 ng/mL (median: 6 days) compared with 14 days for those with vitamin D levels ≥ 8.1 ng/mL (median: 10 days). Conclusion: low serum vitamin D levels (< 8.1ng/mL) at admission were associated with increased 28-day mortality in septic patients.

Two Cases of Hemophagocytic Lymphohistiocytosis Associated with Disseminated Histoplasmosis Presented with Transient Pancytopenia.

Transient pancytopenia due to reactive bone marrow suppression often occurs in hemophagocytic lymphohistiocytosis (HLH), a syndrome resulting from excessive immune activation following a severe infection. We reported two cases with pancytopenia and disseminated histoplasmosis accompanied by HLH, initially suspected to be blood malignancies. Our first case documented the relevance between the improvement of pancytopenia and the clearance of Histoplasma capsulatum in serial bone marrow aspirations. The second case showed immense Histoplasma engulfment by the macrophage in relation to a severe clinical condition, followed by improvement of clinical symptoms in accordance with the recovery of pancytopenia. These two cases highlighted the importance of comprehensive and critical analysis for cases with concurrent pancytopenia and severe infection, since it may be that the pancytopenia underlies the severe infection or vice versa.

Etiologies of severe acute respiratory infection (SARI) and misdiagnosis of influenza in Indonesia, 2013-2016.

BACKGROUND: Severe acute respiratory infection (SARI) accounts for a large burden of illness in Indonesia. However, epidemiology of SARI in tertiary hospitals in Indonesia is unknown. This study sought to assess the burden, clinical characteristics, and etiologies of SARI and concordance of clinical diagnosis with confirmed etiology. METHODS: Data and samples were collected from subjects presenting with SARI as part of the acute febrile Illness requiring hospitalization study (AFIRE). In tertiary hospitals, clinical diagnosis was ascertained from chart review. Samples were analyzed to determine the "true" etiology of SARI at hospitals and Indonesia Research Partnership on Infectious Diseases (INA-RESPOND) laboratory. Distribution and characteristics of SARI by true etiology and accuracy of clinical diagnosis were assessed. RESULTS: Four hundred and twenty of 1464 AFIRE subjects presented with SARI; etiology was identified in 242 (57.6%), including 121 (28.8%) viruses and bacteria associated with systemic infections, 70 (16.7%) respiratory bacteria and viruses other than influenza virus, and 51 (12.1%) influenza virus cases. None of these influenza patients were accurately diagnosed as having influenza during hospitalization. CONCLUSIONS: Influenza was misdiagnosed among all patients presenting with SARI to Indonesian tertiary hospitals in the AFIRE study. Diagnostic approaches and empiric management should be guided by known epidemiology. Public health strategies to address the high burden of influenza should include broad implementation of SARI screening, vaccination programs, clinician education and awareness campaigns, improved diagnostic capacity, and support for effective point-of-care tests.

Pan-drug-resistant and biofilm-producing strain of Burkholderia pseudomallei: first report of melioidosis from a diabetic patient in Yogyakarta, Indonesia.

Melioidosis, an infectious disease caused by Burkholderia pseudomallei, has recently gained importance as an emerging infectious disease in Indonesia. Reports of this infection in Indonesia are limited, although cases have been reported in Makassar, South Sulawesi. We report a case of cutaneous melioidosis caused by pan-drug-resistant, moderate biofilm-producer strain of B. pseudomallei in a diabetic patient. To the best of our knowledge, this is the first case of melioidosis caused by multidrug resistant and biofilm-former strain of B. pseudomallei being reported from Yogyakarta Province, Indonesia. The patient was successfully treated with abscess drainage and debridement, including total contact casting and no antibiotic treatment.

Does insulin resistance correlate with routine blood examination? A review on erythrocytes of obese patients.

AIM: To identify whether hyperinsulinemia/insulin resistance affects the hematologic parameter of routine blood, especially the erythrocytes. METHODS: Cross sectional study was conducted on seventy one non-smoking obese patients who were not pregnant, not having lactating period, aged >22 years of age and visited the outpatient clinic of Endocrinology and outpatient clinic of Kidney and Hypertension division at the department of Internal Medicine Dr. Sardjito Hospital, Yogyakarta. Patients with cerebrovascular and blood disease; taking drugs affecting blood e.g.: cytostatics, and erythropoietin; and patients taking insulin, beta blocker, or steroids were excluded. Data on age, gender, body weight, and body height were recorded. Examinations on fasting blood glucose, fasting insulin, total cholesterol, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), and routine blood were performed in the condition of ten hours of fasting. All laboratory examination was conducted at Prodia Laboratory, Yogyakarta. RESULTS: Of seventy one obese patients, 51.5% were male, and 9.1% were diagnosed with diabetes mellitus (DM) during the study and the mean age was 47.09+5.74 years, the mean body mass index was 28.07+4.07 kg/m(2), the mean of hemoglobin level was 13.75+1.57 g%; the mean of leukocyte count was 7.86+1.19 103/mm(3); erythrocytes count was 4.93+0.44 106/mm(3); platelet count 300.28+80.57 103/mm(3); and hematocrite count 41.23+4.28. There were very weak and statistically insignificant negative correlation between Log HOMA IR and erythrocytes (r= -0.048; p=0.693) CONCLUSION: This study demonstrates that insulin resistance has a very weak correlation with erythrocytes counts and it is statistically insignificant.

Correlation between lower-extremity functional status and obesity in type-II diabetic patients with and without peripheral arterial disease at Dr. Sardjito Central General Hospital, Yogyakarta.

AIM: To recognize the correlation between lower-extremity functional status and obesity in patients with type-2 DM with PAD complication (with and without peripheral arterial disease). METHODS: the study was a cross-sectional study conducted at Outpatients Clinic of Internal Medicine, Dr. Sardjito Central General Hospital in August-December 2006. Fifty-five subjects who were patients with type-2 DM aged more than 50 years agreed to participate and were eligible for the study; while the exclusion criteria included smoking, diabetic ulcer or gangrene, history of amputation due to diabetic ulcer or gangrene. The diagnosis of PAD was based on Ankle Brachial Index < 0.90. RESULTS: mean age was 62.53 +/- 6.82 years old and mean value of BMI was 24.26 +/- 3.57 kg/m2, 18 subjects (32.7%) were obese. The proportion of obese subjects with PAD was higher compared to the non-obese subjects (41% vs. 27%, p = 0.372). Lower-extremity functional status of type-2 diabetic patients either with or without PAD in obese subjects needs longer period of time (7.17 +/- 1.74 minute and 6.94 +/- 1.48 minute vs. 5.13 +/- 1.47 minute and 4.58 +/- 1.17 minute, p < 0.05 and p < 0.001). CONCLUSION: the functional status of lower extremities in obese patients with DM is poorer than the non-obese subjects.

Hypoadiponectinemia: a risk factor for metabolic syndrome.

AIM: To find out correlation between plasma adiponectin levels, insulin resistance and IDF criteria of Mets Patients. METHODS: A case-control study was conducted on Native Javanese people from June 2006 to January 2007 in Outpatients Clinic of Dr Sardjito Hospital. The case group involved patients aged between 20 to 55 years old. The diagnosis of metabolic syndrome was confirmed according to IDF criteria. Patients without metabolic syndrome with matching age and sex,were taken as control group. RESULTS: there were significant differences between case and control group for BMI (body mass index) (30.2 +/- 4.1 vs 26.9 +/- 4.7 kg/m2), waist circumference (93.5 +/- 7.9 vs 84.4 +/- 11.5 cm), triglyceride (207.4 +/- 101.8 vs. 119.3 +/- 71.5 mg/dL) , HDL cholesterol (48.6 +/- 9.4 vs. 59.9 +/- 11.8m g/dL), systolic blood pressure (132.8 +/- 17.9 mmHg vs 120.6 +/- 13.5 mmHg) and diastolic blood pressure (83.8 +/- 8.5 mmHg vs. 79.4 +/- 10.7), fasting blood glucose (128.3 +/- 40.8 mg/dL vs. 100.7 +/- 29.4 mg/dL), HOMA index (6.7 +/- 17.4 vs. 2.0 +/- 2.0) and adiponectin levels (3.8 +/- 1.4 vs. 5.9 +/- 2.5), respectively. For metabolic syndrome, hypoadiponectinemia showed the OR value of 6.0 (95% CI 2.13 to 16.98); insulin resistance showed the OR value of 5.7 (95% CI 1.3 to 25.02), after adjustment for waist circumference, TG, HLD, blood pressure, fasting blood glucose. CONCLUSION: Hypoadiponectinemia and insulin resistance represent independent risk factors for metabolic syndrome development.