Incidence and first trimester risk factors of stillbirth in Indonesia

OBJECTIVES

To determine the incidence and the risk factors of stillbirth from maternal biophysical, ultrasound, and biochemical markers at 11-13 weeks of gestation in the Indonesian population.

METHODS

This was a retrospective cohort study of pregnant women for first-trimester preeclampsia screening at 11-13 weeks of gestation in some clinics and hospital in Jakarta. Maternal characteristics and history, mean arterial pressure (MAP) measurement, uterine artery pulsatility index (UtA-PI) ultrasound, maternal ophthalmic peak ratio (Oph-PR) Doppler, and placental growth factor (PlGF) serum were collected during the visit. Stillbirth was classified into placental dysfunction-related when it occurred with preeclampsia or birth weight <10th percentile and non-placental dysfunction-related. Bivariate and multivariate logistic regression analyses were employed to determine the risk factors associated with stillbirth.

RESULTS

Of 1,643 eligible participants, 13 (0.79 %) stillbirth cases were reported. More than half of the stillbirths (7) were placental dysfunction-related. After adjusted with maternal age, body mass index (BMI), and parity status, chronic hypertension (aOR (adjusted odds ratio)) 24.41, 95 % CI {confidence interval} 5.93-100.43), previous pregnancy with preeclampsia (aOR 15.79, 95 % CI 4.42-56.41), MAP >101.85 (aOR 26.67, 95 % CI 8.26-86.06), UtA-PI >1.90 (aOR 10.68, 95 % CI 2.34-48.58, and PlGF <28.77 pg/mL (aOR 18.60, 95 % CI 5.59-61.92) were associated with stillbirth.

CONCLUSIONS

The incidence of stillbirth in the population is comparable to studies conducted in developed countries. Most routine variables assessed at the 11-13 weeks combined screening for preeclampsia are associated with the risk of stillbirth.

The Etiology of Advanced Chronic Kidney Disease in Southeast Asia: A Meta-analysis

INTRODUCTION

Chronic kidney disease (CKD) etiology varies greatly between developed and developing countries. In addition, differences in underlying pathogenesis and therapeutic options affect the progression towards advanced-CKD. This meta-analysis aims to identify the etiology of advanced-CKD in Southeast Asia.

METHODS

A systematic search in four electronic-databases and complementary search on national kidney registries and repository libraries was conducted until July 20, 2023. The risk of bias was assessed using Newcastle-Ottawa Scale for observational studies and Version-2 of Cochrane for intervention studies. A random-effects model was used to estimate pooled prevalence. The protocol is registered in the International Prospective Register of Systematic Reviews PROSPERO; Registration ID:CRD42022300786.

RESULTS

We analyzed 81 studies involving 32,834 subjects. The pooled prevalence of advanced-CKD etiologies are diabetic kidney disease (DKD) 29.2% (95%CI 23.88-34.78), glomerulonephritis 20.0% (95%CI 16.84-23.38), hypertension 16.8% (95%CI 14.05-19.70), other 8.6% (95%CI 6.97-10.47), unknown 7.5% (95%CI 4.32-11.50), and polycystic kidney disease 0.7% (95%CI 0.40-1.16). We found a significant increase in DKD prevalence from 21% (9.2%, 95%CI 0.00-33.01) to 30% (95%CI 24.59-35.97) before and after the year 2000. Among upper-middle-income and high-income countries, DKD is the most prevalent (26.8%, 95%CI 21.42-32.60 and 38.9%, 95%CI 29.33-48.79, respectively), while glomerulonephritis is common in lower-middle-income countries (33.8%, 95%CI 15.62-54.81).

CONCLUSION

The leading cause of advanced-CKD in Southeast Asia is DKD, with a substantial proportion of glomerulonephritis. An efficient screening program targeting high-risk populations (diabetes mellitus and glomerulonephritis) is needed, with the aim to delay CKD progression.

Chronic kidney disease in Hepatitis C and its association with liver cirrhosis and viral load: Revealing the importance of hematuria

Hepatitis C virus (HCV) contributed as a risk factor for chronic kidney disease (CKD). Many studies only showed it associated with estimated glomerular filtration rate (eGFR) reduction and albuminuria, but none revealed hematuria data. Besides, liver cirrhosis and viral load as risks for CKD are still yet to be established. This study aimed to assess the prevalence of CKD and its component in hepatitis C and to associate it with liver cirrhosis and viral load. A cross-sectional study using consecutive recruitment on the basis of anti-HCV positivity was done from August 2018 until January 2019. The participants with any renal abnormality on the first meeting were followed prospectively for at least three months. The study was done in Hepatology Clinic Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Liver cirrhosis was defined using transient elastography (>11 kPa). A baseline viral load >100,000 IU/mL was considered as high. CKD was defined as persistence of decreased eGFR and/or albuminuria and/or hematuria for three months. Logistic regression models were used to evaluate adjusted odds ratio (aOR) with adjustment for age, sex, diabetes mellitus, and hypertension. Of the 185 participants, prevalence of CKD was 23.2% [confidence interval (CI) 95% 17.1%-29.3%]. Decreased eGFR was present in 22 (11.9%), albuminuria in 29 (15.7%), and hematuria in 13 (7%). Liver cirrhosis was associated with CKD (aOR 2.948, CI 95%: 1.218-7.136) but not viral load (aOR: 0.93, CI 95%: 0.396-2.185). Renal examination is recommended in all patients with hepatitis C, particularly in patient with liver cirrhosis.

The challenges of a small medical journal to have international recognition in Indonesia: editors' perspectives

[No abstract available]

Visit to Singapore Medical Journal during COVID-19 outbreak: learning “beyond” the expectation

[No abstract available]

Moving forward without leaving the ethical standard of publication

[no abstract available]

Radiofrequency Ablation versus Resection in Large Single Nodule of Hepatocellular Carcinoma: an Evidence-based Case Report

BACKGROUND

nowadays, radiofrequency ablation (RFA) is applied widely as an alternative therapy of resection in patient with hepatocellular carcinoma (HCC). Moreover, in single nodule with size of less than 2 cm, RFA can be the primary treatment. Although resection is the main treatment and one of the curative treatments in nodule meeting Milan criteria, it needs consideritation of the surgery risk stratification. This report was aimed to search evidence of RFA compared with RFA in term of survival in patient with HCC single nodule size of more than 5 cm.

METHODS

the searching was done using PubMed, Scopus, Web of Science, dan CINAHL from EBSCO with keyword of "hepatocellular carcinoma", "single nodule", "radiofrequency ablation", "resection", and "survival". The limitation of the article was English with clinical question of "In patient with HCC single nodule size of more than 5cm, was RFA more superior in resection in term of survival?".

RESULTS

there were three articles with retrospective study. One of the article combined RFA and percutaneous ethanol injection in the analysis, meanwhile another article combined RFA and transarterial chemoembolization. These articles showed conflicting data that showed absolute risk reduction of 33% till absolute risk increment of 60.6%.

CONCLUSION

all studies used RFA as the alternative of resection when the the tumor was irresectable which means the severity is higher in RFA group. Hence, we can not solely conclude that RFA resulted in worse survival.

Anemia among children and adolescents in a rural area

Background Anemia in children and adolescents affects growthand development. It is a preventable disease, but unfortunately isoften ignored until the symptoms occur. There have been limitedreports on the prevalence of anemia in children and adolescentsin Indonesia, especially from rural areas.Objective To describe the prevalence of anemia in children andadolescents in district ofMalinau, a rural area in East KalimantanProvince.Methods This cross-sectional study was done in June 20 10 usinglaboratory records between July 2009 to January 20 10. Laboratoryrecords of patients aged between 6 months and 18 years whichinvestigated were complete blood count (CBC) from ambulatory,inpatient, and emergency care ofMalinau Public Hospital in EastKalimantan. Mentzer and England & Fraser indices were used todifferentiate iron deficiency anemia (IDA) and thalassemia amongmicrocytic hypochromic anemic patients.Results This study involved 709 laboratory records. Prevalenceof anemia was 53 .9% (95% CI 50.2% to 57 .5%) . The prevalenceof IDA among age groups were as follows: 29.4% (95% CI 24.3to 34.5%) in 6- 59 months group, 16% (95% CI 11 to 21 %) in5- 11.9 years, and 15.2% (95% CI 10.2 to 20.2%) in 12- 18 years.Children aged 6- 59 months tended to have more anemia th anthose aged 5- 11.9 years (OR 2. 184, 95% CI 1.398 to 3.413) oraged 12- 18 years (OR 2.3 19, 95% CI 1.464 to 3.674).Conclusion T he prevalence of an emia in children andadolescents of the Malinau Regency is 53 .9% (95% CI 50.2 to57.5%), quite similar to that of other developing countries . Agovernment program to overcome anemia is recommended, n otonly for pregnant women, but also for children and adolescents.