Projection of diabetes morbidity and mortality till 2045 in Indonesia based on risk factors and NCD prevention and control programs

Diabetes Mellitus is one of the biggest health problems in Indonesia but the research on the disease's projection is still limited. This study aimed to make a projection model of prevalence and mortality of diabetes in Indonesia based on risk factors and NCD programs. The study was a quantitative non-experimental study through multiple linear regression models and system dynamics. The baseline projection was created by 2018 data and projections until 2045 involved the dynamization of risk factors and programs, population, and case fatality rate. The model was created from 205 districts data. This study used secondary data from Basic Health Research, BPJS Kesehatan, NCD programs, and Ministry of Health. The prevalence of diabetes in Indonesia is estimated to increase from 9.19% in 2020 (18.69 million cases) to 16.09% in 2045 (40.7 million cases). The prevalence will be lower to 15.68% (39.6 million) if interventions of programs were carried out, and to 9.22% (23.2 million) if the programs were added with prevention of risk factors. The projected number of deaths due to diabetes increases from 433,752 in 2020 to 944,468 in 2045. Deaths due to stroke among diabetes increases from 52,397 to 114,092 in the same period. Deaths from IHD among diabetes increase from 35,351 to 76,974, and deaths from chronic kidney disease among diabetes increase from 29,061 to 63,279. Diabetes prevalence and mortality in Indonesia rise significantly in Indonesia and can be reduced by intervention of several programs and risk factors. This study findings could be source of planning and evaluation of Diabetes prevention and control program at national and provincial level in the future related to risk factors control and program development.

Multi-strain probiotic improves subjective sleep quality with no impact on body composition, hemodynamics, and physical activity

The objective of the study was to examine the impact of a multi-strain probiotic (MSP) on sleep, physical activity, and body composition changes. We used a randomised, double-blind, placebo-controlled approach with 70 healthy men and women (31.0 ± 9.5 years, 173.0 ± 10.4 cm, 73.9 ± 13.8 kg, 24.6 ± 3.5 kg/m2) supplemented daily with MSP (4 × 109 live cells Limosilactobacillus fermentum LF16, Lacticaseibacillus rhamnosus LR06, Lactiplantibacillus plantarum LP01, and Bifidobacterium longum 04; Probiotical S.p.A., Novara, Italy) or placebo (PLA). In response to supplementation (after 0, 2, 4, and 6 weeks of supplementation) and 3 weeks after stopping supplementation, participants had subjective (Pittsburgh Sleep Quality Index, PSQI) and objective sleep indicators, body composition, daily physical activity and resting hemodynamics assessed. Subjective sleep quality indicators using the PSQI (sleep latency, sleep disturbance, and global PSQI score) improved ( P < 0.05) at various time points with MSP supplementation. Systolic blood pressure in PLA increased ( P < 0.05) after 6 weeks of supplementation with no change in MSP. No changes ( P > 0.05) in sleep (hours asleep, minutes awake, number of times awake) or physical activity (step count, minutes of sedentary activity, total active minutes) metrics assessed by the wearable device were observed. Additionally, no changes in resting heart rate, diastolic blood pressure, and body composition were discerned. In conclusion, MSP supplementation improved the subjective ability to fall asleep faster and disturbances experienced during sleep, which resulted in improved overall sleep quality as assessed by the PSQI. No differences in other sleep indicators, physical activity, hemodynamics, and body composition were observed during or following MSP supplementation. Registered at clinicaltrials.gov: NCT05343533.

Successful COVID-19 Contact Tracing of Crew from Two Cargo Ships at the Morowali Seaport, Indonesia

OBJECTIVES

This study aims to report a successful systematic quarantine of coronavirus disease (COVID-19) to detect Omicron, a new variant of concern, among 2 cargo ships in the Morowali seaport, Indonesia.

METHODS

An international standard entry point protocol had been followed in this study for all crew. Rapid diagnostic tests and whole-genome sequencing (WGS) tests have been conducted to identify Omicron, the variant of concern. Individual characteristics, laboratory result, and vaccine status were collected in this study.

RESULTS

On December 9 and 18, 2021, there was an increase of 21 and 22 new cases, respectively, from 2 ships in the seaport. Both ships came from abroad, 43 new cases with a positivity rate increase from 0 to 13.4% and 13.7% within 2 weeks. A polymerase chain reaction (PCR) examination was carried out on all crews and obtained results 21 of the 22 positive COVID-19 crew (95.5%). The monitoring results showed that there was no fever in the entire crew, no symptoms of cough, runny nose, shortness of breath, and other symptoms pointing to COVID-19.

CONCLUSION

Systematic quarantine has successfully contained the large clusters of COVID-19 in the crews of 2 ships and prevented further outbreaks in the local community.

Triglyceride/Glucose Index (TyG Index) as a marker of glucose status conversion among reproductive-aged women in Jakarta, Indonesia: The Bogor cohort study (2011-2016)

BACKGROUND AND AIMS

Reproductive-aged women are prone to type 2 diabetes mellitus. This study aims to evaluate the optimal cut off point of Triglyceride/Glucose Index for predicting glucose status conversion among women of reproductive age.

METHODS

This study involved normoglycemic and prediabetes women aged 20-49 years from the Bogor Non-Communicable Diseases Cohort Study (West Java, Indonesia) conducted from 2011 to 2016. Statistical analysis was performed using Receiver Operating Characteristics curve analysis with STATA version 15.

RESULTS

Among prediabetes subjects (n = 371), the cut-off point of TyG index for regression from prediabetes to normoglycemic subjects was <4.51 [sensitivity, specificity, AUC (95%CI) 83.9%, 80.1%, 0.913 (0.875-0.943), respectively] and the cut-off point for progression from prediabetes to diabetes was >4.54 [80.0%, 73.1%, 0.858 (0.807-0.900)]. Among normoglycemic subjects (n = 1300), the cut-off point of TyG index for progression to prediabetes and diabetes were >4.44 [80.1%, 71.1%, 0.834 (0.812-0.854)] and >4.47 [80.6%, 80.8%, 0.909 (0.890-0.926)] respectively.

CONCLUSION

Based on sample of subjects evaluated between 2011 and 2016, TyG index appears to be a promising marker for glucose status conversion among reproductive-aged women in Jakarta, Indonesia.

Metabarcoding analysis of gut microbiota of healthy individuals reveals impact of probiotic and maltodextrin consumption

In a previously published double-blind, placebo-controlled study, we showed that probiotics intake exerted a positive effect on sleep quality and a general improvement across time in different aspects of the profile of mood state, like sadness, anger, and fatigue in 33 healthy individuals. The present work investigates the impact of the probiotic product, constituted of Limosilactobacillus fermentum LF16, Lacticaseibacillus rhamnosus LR06, Lactiplantibacillus plantarum LP01 (all former members of Lactobacillus genus), and Bifidobacterium longum 04, on the gut microbiota composition of the same cohort through a metabarcoding analysis. Both the placebo and probiotic treatments had a significant impact on the microbiota composition. Statistical analysis showed that the microbiota of the individuals could be clustered into three groups, or bacteriotypes, at the baseline, and, inherently, bacterial compositions were linked to different responses to probiotic and placebo intakes. Interestingly, L. rhamnosus and L. fermentum were retrieved in the probiotic-treated cohort, while a bifidogenic effect of maltodextrin, used as placebo, was observed. The present study shed light on the importance of defining bacteriotypes to assess the impact of interventions on the gut microbiota and allowed to reveal microbial components which could be related to positive effects (i.e. sleep quality improvement) to be verified in further studies.

Knowledge, empathy, and willingness to counsel patients with HIV among Indonesian pharmacists: a national survey of stigma

This study aimed to assess the level of HIV treatment knowledge, empathy, and HIV stigma of pharmacy students and pharmacists working with patients as well as potential factors associated with stigma. This survey included 250 hospital pharmacists within 33 provinces and 1013 final-year pharmacy students from Java, the most populated island in Indonesia. The data were collected via Qualtrics® and distributed by WhatsApp. The mean age of the participants was (Mean ± SD) 24.68 ± 5.30 years, and 80.0% were female. The mean knowledge score of students and pharmacists were 14.14 ± 2.01 and 15.39 ± 1.87, respectively, out of the maximum score of 21. The mean empathy score of students and pharmacists was 72.06 ± 5.39 and 77.40 ± 1.35, respectively out of the maximum score of 105. The mean stigma score of students and pharmacists was 21.02 ± 4.65 and 20.66 ± 4.41, respectively, out of a maximum score of 48. Regression analysis showed that knowledge, empathy, and willingness to counsel patients were negatively associated with stigma. Working with patients was positively associated with stigma. A multi-level intervention including education may reduce stigma and strengthen the role of pharmacists in caring for patients.

Longitudinal data of neuropsychological profile in a cohort of Duchenne muscular dystrophy boys without cognitive impairment

The aim of the study was to re-assess neuropsychological profile in a group of boys with Duchenne muscular dystrophy without intellectual disability and neuropsychiatric disorder three years apart from a previous evaluation, to establish possible changes over time. We were also interested in defining more in detail correlation between genotype and neuropsychological phenotype. Thirty-three of the previous 40 subjects (mean age at follow up: 10 years and 7 months) agreed to participate in the follow up study and to perform the new assessment. The results confirm a typical neuropsychological profile, with difficulty in the manipulation of stored information, poor abstract reasoning and planning capacity and impulsiveness, supporting the involvement of a cerebellar striatal cortical network for these children. The more detailed description of subgroups of subjects, according to the real expression of Dp140, let to reveal possible genotype-neuropsychological phenotype correlations, and a more general neuropsychological impairment emerged in boys without Dp140 expression.

Sometimes they come back: New and old spinal muscular atrophy adults in the era of nusinersen

BACKGROUND AND PURPOSE

Following the commercial availability of nusinersen, there have been a number of new referrals of adults with spinal muscular atrophy (SMA) not regularly followed in tertiary-care centers or enrolled in any disease registry.

METHODS

We compared demographics and disease characteristics, including assessment of motor and respiratory function, in regularly followed patients and newcomers subdivided according to the SMA type.

RESULTS

The cohort included 166 adult patients (mean age: 37.09 years): one type I, 65 type II, 99 type III, and one type IV. Of these 166, there were 67 newcomers. There was no significant difference between newcomers and regularly followed patients in relation to age and disease duration. The Hammersmith Functional Motor Scale Expanded and Revised Upper Limb Module scores were higher in the regularly followed patients compared to newcomers in the whole cohort and in both SMA II and II. A difference was also found on ventilatory status (p = 0.013) and Cobb's angle >50° (p = 0.039) between the two subgroups. No difference was found in scoliosis surgery prevalence (p > 0.05).

CONCLUSIONS

Our results showed differences between the two subgroups, even if less marked in the type III patients. In the type II patients, there was a higher proportion of newcomers who were in the severe end of the spectrum. Of the newcomers, only approximately a third initiated treatment, as opposed to the 51% in the regularly followed patients. The identification of patients who were not part of the registries will help to redefine the overall prevalence of SMA and the occurrence of different phenotypes.

Duchenne muscular dystrophy: preliminary experience with sacubitril-valsartan in patients with asymptomatic left ventricular dysfunction

OBJECTIVE

Duchenne muscular dystrophy (DMD) is an inherited X-linked recessive neuromuscular disease caused by mutations of the dystrophin gene, leading to early and progressive muscle deterioration and dilated cardiomyopathy. The aim of this investigation was to assess whether treatment with sacubitril/valsartan (S/V) is well tolerated and may have beneficial effects in DMD patients with left ventricle (LV) dysfunction.

PATIENTS AND METHODS

We administered S/V to 3 DMD patients (19-29 yeard old) with LV ejection fraction <35% at echocardiography but no symptoms of heart failure. All patients were on optimal medical therapy. S/V was initiated at a very low dose of 12/13 mg/die, after withdrawal of angiotensin-converting enzyme inhibitor therapy, and slowly titrated to the dose of 49/51 mg twice daily or the maximally tolerated dose. Clinical and echocardiographic follow-up was performed after 3, 6 and 12 months.

RESULTS

At baseline, the LV ejection fraction was 32±1%. A significant improvement of LV ejection fraction was observed at 3 months (44.0±6.0%; p<0.05), which was maintained at 6 (45.7±5.0%) and 12 (43.3±3.2%) months (p<0.05 for both). No relevant side effects were reported throughout the period of the study.

CONCLUSIONS

Our preliminary data suggest that, in DMD patients with reduced LV ejection fraction, S/V is safe and may improve LV function.

Indonesian Hajj Cohorts and Mortality in Saudi Arabia from 2004 to 2011

The Hajj is an annual pilgrimage that 1-2 million Muslims undertake in the Kingdom of Saudi Arabia (KSA), which is the largest mass gathering event in the world, as the world's most populous Muslim nation, Indonesia holds the largest visa quota for the Hajj. All Hajj pilgrims under the quota system are registered in the Indonesian government's Hajj surveillance database to ensure adherence to the KSA authorities' health requirements. Performance of the Hajj and its rites are physically demanding, which may present health risks. This report provides a descriptive overview of mortality in Indonesian pilgrims from 2004 to 2011. The mortality rate from 2004 to 2011 ranged from 149 to 337 per 100,000 Hajj pilgrims, equivalent to the actual number of deaths ranging between 501 and 531 cases. The top two mortality causes were attributable to diseases of the circulatory and respiratory systems. Older pilgrims or pilgrims with comorbidities should be encouraged to take a less physically demanding route in the Hajj. All pilgrims should be educated on health risks and seek early health advice from the mobile medical teams provided.

Penanggulangan Krisis Kesehatan di Indonesia Tahun 2016

AbstractHealth crisis is an event/series of events that threaten the health of individuals or communities caused by disasters and / or potentially disasters. Researchs on health crisis as scientific source in disaster policy making in Indonesia is still very limited. The description of health crises events of including victims, displacement and damage to health facilities and support for health crisis response in the form of emergency response along with the initial recovery by the Ministry of Health in 2016 were the aims of this study. This study is a qualitative study, using literature review method, reference / electronic information tracking such as through Health Crisis Management Information System, National Disaster Management Agency (BNPB) website, Regional Disaster Management Agency (BPBD), Social Service, Regional Government Police and other related agencies. Secondary data from related units/agencies and the main Ministry of Health units are obtained through focus group discussions (FGDs). The frequency of health crisis events due to the disaster in 2016 was 661 incidents dominated by natural disasters as many as 400 events (60%), while the frequency of non-natural disasters was 237 events (36%) and social disasters 24 events (4%). Most of the health crisis incidents due to the 2016 disaster (97%) were the remaining hydrometeorological disasters, 3% of the most non-natural disasters were outbreaks of food poisoning, transportation accidents, fire, technology failure, industrial accidents and outbreaks of disease. The ratio of refugees due to natural disaster is 693 per event, while social disasters are 225 per incident The ratio of deaths from non-natural disasters is 1.5 times higher than natural disaster. Poisoning has the highest victim ratio of 20 per incident of poisoning. Health facility damage caused by disaster 174 units. The greatest health impacts arising from the health crisis in 2016 was. dominated by natural disasters in the forms of floods, landslides and earthquake disasters. Effective emergency response efforts must involve as many sub-clusters as possible that have special expertise to overcome the impact on disasters.  AbstrakKrisis kesehatan merupakan peristiwa/rangkaian peristiwa yang mengancam kesehatan individu atau masyarakat yang disebabkan oleh bencana dan/atau berpotensi bencana. Penelitian tentang krisis kesehatan sebagai sumber ilmiah dalam pengambilan kebijakan kebencanaan di Indonesia masih sangat terbatas. Deskripsi kejadian krisis kesehatan meliputi korban, pengungsian dan kerusakan fasilitas kesehatan serta penanggulangan krisis kesehatan dalam bentuk tanggap darurat beserta pemulihan awal yang dilakukan Kementerian Kesehatan pada tahun 2016 menjadi tujuan dari kajian ini. Kajian ini merupakan kajian kualitatif, menggunakan metode literature review, penelusuran referensi/informasi elektronik seperti melalui Sistem Informasi Penanggulangan Krisis Kesehatan, website Badan Nasional Penanggulangan Bencana (BNPB), Badan Penanggungalan Bencana Daerah (BPBD), Dinas Sosial, Kepolisian Pemerintah Daerah dan instansi terkait lainnya. Data primer dari unit/instansi terkait dan unit utama kementerian kesehatan didapatkan melalui focus group discussion (FGD). Frekuensi kejadian krisis kesehatan akibat bencana pada tahun 2016 sejumlah 661 kejadian, juga didominasi oleh bencana alam sebanyak 400 kejadian (60%), sementara frekuensi bencana non alam 237 kejadian (36%) dan bencana sosial 24 kejadian (4%). Sebagian besar kejadian krisis kesehatan akibat bencana tahun 2016 (97%) merupakan kejadian bencana hidrometeorologi sisanya 3% bencana non alam terbanyak adalah KLB Keracunan makanan, kecelakaan transportasi, kebakaran, gagal teknologi, kecelakaan industri dan KLB Penyakit. Rasio pengungsi akibat bencana alam sebesar 693 per kejadian, sedangkan bencana sosial 225 per kejadian. Rasio kematian akibat bencana non alam 1.5 kali lebih tinggi daripada bencana alam. Keracunan mempunya rasio korban tertinggi sebesar 20 per kejadian keracunan. Kerusakan fasilitas kesehatan akibat bencana 174 unit. Dampak kesehatan terbesar yang timbul akibat kejadian krisis kesehatan di tahun 2016, didominasi oleh bencana alam berupa bencana banjir, banjir bandang dan tanah longsor serta bencana gempa bumi.

Factors influencing HIV group counseling participation at a referral hospital in Jakarta, Indonesia

Abstrak Latar Belakang: Beberapa penelitian sebelumnya memperlihatkan bahwa dukungan sosial termasuk Konseling HIV dan dukungan kelompok memiliki efek langsung terhadap kepatuhan pada pengobatan HIV. Faktor yang berpengaruh terhadap partisipasi pada konseling kelompok pasien HIV di Indonesia belum diketahui. Penelitian ini dilakukan untuk mengetahui partisipasi pasien HIV pada konseling kelompok di Rumah Sakit Penyakit Infeksi-Sulianti Saroso, Jakarta Utara. Faktor demografi dan klinis pada pasien HIV diduga berhubungan dengan partisipasi dalam konseling kelompok. Metode: Penelitian ini dilakukan pada bulan Juli – Oktober 2013 menggunakan metode kuantitatif dengan desain studi potong lintang. Pasien HIV yang menggunakan anti retroviral sebanyak 1440 orang diminta kesediannya untuk berpartisipasi pada penelitian ini. Analisis dilakukan menggunakan analisis regresi logistik. Hasil: 709 dari 880 pasien yang mengikuti konseling kelompok telah melengkapi kuesioner dan bersedia menjadi sampel penelitian. Sebagian besar responden adalah laki-laki (71.1%), lulus SMP (84.3%), dan bekerja penuh waktu (51.5%). Stadium klinis mayoritas responden (87.3%) stadium 3 dan 4. Sebagian kecil responden (9.7%) memiliki ko-infeksi hepatitis B atau C, dan 12.7 % memiliki anggota keluarga HIV positif. Sebanyak 272 (38,4%) responden mengikuti konseling kelompok. Umur, waktu kerja, kepuasan terhadap penghasilan, memiliki anggota keluarga dengan HIV positif dan responden yang pernah menggunakan narkoba suntik (IDU) merupakan faktor-faktor yang mempengaruhi partisipasi responden pada konseling kelompok. Kesimpulan: Konseling kelompok harus dikenalkan pada penderita HIV yang sulit dijangkau, termasuk pasien yang lebih tua dan pasien dengan riwayat IDU. Selain itu, penyedia layanan kesehatan harus mempertimbangkan jadwal alternatif untuk pasien yang bekerja penuh waktu dan tidak dapat menghadiri konseling kelompok selama jam kerja. Keywords: HIV, konseling, partisipasi, dukungan, sosial   Abstract: Background: Previous studies indicate that social support, including HIV counseling and support groups, have a direct effect on adherence to HIV therapy. Currently, factors of non-participation in HIV counseling in the Indonesian population are unknown. Based on this condition, we performed this study to explore HIV patient in group counseling participation at Prof. Sulianto Saroso Infectious Disease Hospital (RSPI-SS), a national referral hospital in Northern Jakarta in Indonesia. We assessed demographic and clinical factors that are associated with participation in HIV group counseling. Methods: A cross-sectional study was conducted between July and October 2013. 1,440 HIV patients in Jakarta obtaining ART from RSPI-SS were approached to participate in a quantitative survey. Factors associated with group counseling participation were assessed using logistic regression analyses. Results: A total of 709 (80.6%) out of 880 patients in group counseling completed the survey. The most of respondents were male (71.1%), had completed at least secondary school (84.3%), and worked full-time (51.5%). The majority (87.3%) of respondents had advanced disease (clinical stage 3 and 4). A small proportion (9.7%) of patients had hepatitis B or C co-infection, and 12.7 % reported having a family member (partner or child) who was also HIV positive. Only 272 (38,4%) of surveyed patients reported attending HIV group counseling. Five variables were found to be independently associated as factors influencing with participation in HIV group counseling including age, hours worked, income satisfaction, Family member with HIV, and history of Injection Drug User’s (IDU’s).   Conclusion: Based on findings, outreach activities promoting HIV group counseling should target patients who are unable or less likely to attend group counseling, including older patients and patients with history of IDU’s. Additionally, health care providers should consider alternative schedules for patients who work full-time and are unable to attend group counseling during work hours. Keywords: HIV, counseling, participation, social, support

Factors associated with regular counselling attendance of HIV outpatients of a national referral hospital in Jakarta, Indonesia: a cross sectional study

Background

Counselling has been shown to improve adherence to medication in people living with HIV (PLHIV). The aim of this study was to investigate factors associated with regular counselling attendance of patients taking antiretroviral therapy (ART).

Methods

We conducted a cross-sectional, paper-based survey among 880 PLHIV patients on ART attending outpatient clinics of a referral hospital in Jakarta. Patients on ART, above 18 years old, providing written consent were included. The primary outcome was regular counselling attendance (i.e., having attended at least 3 sessions in the previous 3 months) using records from counsellors. Factors associated with regular counselling attendance were assessed using logistic regression analysis.

Results

The majority of patients were male (71.1%) and had regular counselling (78.4%). Being 31 to 40 years old (odds ratio (OR) = 0.55, 95% confidence interval (CI) = 0.32–0.93, > 40 years (OR = 0.30, 95% CI = 0.16–0.55) vs < 30 years, hepatitis B/C co-infection (OR = 0.42, 95% CI = 0.24–0.75), living > 20 km from the hospital (OR = 0.55, 95% CI = 0.33–0.93), transmission male-to-male (OR = 0.13, 95% CI = 0.04–0.44), unemployment (OR = 1.88, 95% CI = 1.02–3.44), part-time employment (OR = 10.71, 95% CI = 4.09–28.02), household member with HIV (OR = 3.31, 95% CI = 1.70–6.44), and Christianity (OR = 1.82, 95% CI = 1.12–2.94) were associated with regular counselling attendance.

Conclusion

This study suggests that counselling services should be reviewed to ensure that they are near home and fit the needs of older patients or patients with co-morbidities and minorities. Tailoring counselling may improve attendance.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5924-5) contains supplementary material, which is available to authorized users.

Cognitive profile in Duchenne muscular dystrophy boys without intellectual disability: The role of executive functions

The aim of our prospective observational study was to assess profiles of cognitive function and a possible impairment of executive functions in a cohort of boys with Duchenne muscular dystrophy without intellectual and behavior disability. Forty Duchenne boys (range of age: 6 years to 11 years and 6 months) were assessed by Wechsler Intelligence scale and battery of tests including tasks assessing working memory and executive functions (inhibition and switching, problem solving and planning). In our cohort some aspects of cognitive function were often impaired. These included multitasking, problem solving, inhibition and working memory necessary to plan and direct goal oriented behavior. Our results support the suggestion that aspects of cognitive function could be impaired even in boys without intellectual disability and support the hypothesis that executive functions may play an important role in specific aspects of cognitive impairment in Duchenne muscular dystrophy.

MYH7-related myopathies: clinical, histopathological and imaging findings in a cohort of Italian patients

BACKGROUND

Myosin heavy chain 7 (MYH7)-related myopathies are emerging as an important group of muscle diseases of childhood and adulthood, with variable clinical and histopathological expression depending on the type and location of the mutation. Mutations in the head and neck domains are a well-established cause of hypertrophic cardiomyopathy whereas mutation in the distal regions have been associated with a range of skeletal myopathies with or without cardiac involvement, including Laing distal myopathy and Myosin storage myopathy. Recently the spectrum of clinical phenotypes associated with mutations in MYH7 has increased, blurring this scheme and adding further phenotypes to the list. A broader disease spectrum could lead to misdiagnosis of different congenital myopathies, neurogenic atrophy and other neuromuscular conditions.

RESULTS

As a result of a multicenter Italian study we collected clinical, histopathological and imaging data from a population of 21 cases from 15 families, carrying reported or novel mutations in MYH7. Patients displayed a variable phenotype including atypical pictures, as dropped head and bent spine, which cannot be classified in previously described groups. Half of the patients showed congenital or early infantile weakness with predominant distal weakness. Conversely, patients with later onset present prevalent proximal weakness. Seven patients were also affected by cardiomyopathy mostly in the form of non-compacted left ventricle. Muscle biopsy was consistent with minicores myopathy in numerous cases. Muscle MRI was meaningful in delineating a shared pattern of selective involvement of tibialis anterior muscles, with relative sparing of quadriceps.

CONCLUSION

This work adds to the genotype-phenotype correlation of MYH7-relatedmyopathies confirming the complexity of the disorder.

Factors that influence adherence to antiretroviral treatment in an urban population, Jakarta, Indonesia

INTRODUCTION

Although the number of people receiving antiretroviral therapy (ART) in Indonesia has increased in recent years, little is known about the specific characteristics affecting adherence in this population. Indonesia is different from most of its neighbors given that it is a geographically and culturally diverse country, with a large Muslim population. We aimed to identify the current rate of adherence and explore factors that influence ART adherence.

METHODS

Data were collected from ART-prescribed outpatients on an HIV registry at a North Jakarta hospital in 2012. Socio-demographic and behavioral characteristics were explored as factors associated with adherence using logistics regression analyses. Chi squared test was used to compare the difference between proportions. Reasons for missing medication were analyzed descriptively.

RESULTS

Two hundred and sixty-one patients participated, of whom 77% reported ART adherence in the last 3 months. The level of social support experienced was independently associated with adherence where some social support (p = 0.018) and good social support (p = 0.039) improved adherence compared to poor social support. Frequently cited reasons for not taking ART medication included forgetting to take medication (67%), busy with something else (63%) and asleep at medication time (60%).

DISCUSSION

This study identified that an increase in the level of social support experienced by ART-prescribed patients was positively associated with adherence. Social support may minimize the impact of stigma among ART prescribed patients. Based on these findings, if social support is not available, alternative support through community-based organizations is recommended to maximize treatment success.

Hammersmith Functional Motor Scale and Motor Function Measure-20 in non ambulant SMA patients

The aim of this prospective longitudinal multi centric study was to evaluate the correlation between the Hammersmith Functional Motor Scale and the 20 item version of the Motor Function Measure in non ambulant SMA children and adults at baseline and over a 12 month period. Seventy-four non-ambulant patients performed both measures at baseline and 49 also had an assessment 12 month later. At baseline the scores ranged between 0 and 40 on the Hammersmith Motor function Scale and between 3 and 45 on the Motor Function Measure 20. The correlation between the two scales was 0.733. The 12 month changes ranged between -11 and 4 for the Hammersmith and between -11 and 7 for the Motor Function Measure 20. The correlation between changes was 0.48. Our results suggest that both scales provide useful information although they appeared to work differently at the two extremes of the spectrum of abilities. The Hammersmith Motor Function Scale appeared to be more suitable in strong non ambulant patients, while the Motor Function Measures appeared to be more sensitive to capture activities and possible changes in the very weak patients, including more items capturing axial and upper limb activities. The choice of these measures in clinical trials should therefore depend on inclusion criteria and magnitude of expected changes.

Six minute walk test in type III spinal muscular atrophy: a 12month longitudinal study

The aim of our longitudinal multicentric study was to establish the changes on the 6min walk test (6MWT) in ambulant SMA type III children and adults over a 12month period. Thirty-eight ambulant type III patients performed the 6MWT at baseline and 12months after baseline. The distance covered in 6min ranged between 75 and 510m (mean 294.91, SD 127) at baseline and between 50 and 611m (mean 293.41m, SD 141) at 12months. The mean change in distance between baseline and 12months was -1.46 (SD 50.1; range: -183 to 131.8m). The changes were not correlated with age or baseline values (p>.05) even though younger patients reaching puberty, had a relatively higher risk of showing deterioration of more than 30m compared to older patients. Our findings provide the first longitudinal data using the 6MWT in ambulant SMA patients.

Respiratory and cardiac function in congenital muscular dystrophies with alpha dystroglycan deficiency

The aim of this retrospective study was to assess respiratory and cardiac function in a large cohort of patients with congenital muscular dystrophies (CMD) with reduced glycosylation of alphadystroglycan (α-DG). Thirteen of the 115 patients included in the study died between the age of 1 month and 20 years. The age at last follow up of the surviving 102 ranged between 1 year and 68 years (median: 9.3 years). Cardiac involvement was found in 7 of the 115 (6%), 5 with dilated cardiomyopathy, 1 cardiac conductions defects and 1 mitral regurgitation. Respiratory function was impaired in 14 (12%). Ten of the 14 required non invasive nocturnal respiratory support, while the other four required invasive ventilation. Cardiac or respiratory involvement was found in patients with mutations in FKRP, POMT1, POMT2. All of the patients in whom mutation in POMGnT1 were identified had normal cardiac and respiratory function.

SEPN1-related myopathies: clinical course in a large cohort of patients

OBJECTIVE

To assess the clinical course and genotype-phenotype correlations in patients with selenoprotein-related myopathy (SEPN1-RM) due to selenoprotein N1 gene (SEPN1) mutations for a retrospective cross-sectional study.

METHODS

Forty-one patients aged 1-60 years were included. Clinical data including scoliosis, respiratory function, and growth measurements were collected by case note review.

RESULTS

Mean age at onset was 2.7 years, ranging from birth to the second decade of life. All but 2 remained independently ambulant: one lost ambulation at age 5 years and another in his late 50s. The mean age of starting nocturnal noninvasive ventilation (NIV) was 13.9 years. One child required full-time NIV at the age of 1 year while in 2 cases NIV was started at 33 years. Two patients died from respiratory failure at the age of 10 and 22 years, respectively. The mean age at scoliosis onset was 10 years, in most cases preceded by rigidity of the spine. Fourteen patients had successful spinal surgery (mean age 13.9 years). Twenty-one were underweight; however, overt feeding difficulties were not a feature.

CONCLUSIONS

This study describes the largest population affected by SEPN1-RM reported so far. Our findings show that the spectrum of severity is wider than previously reported. Respiratory insufficiency generally develops by 14 years but may occur as early as in infancy or not until the fourth decade. Motor abilities remain essentially static over time even in patients with early presentation. Most adult patients remain ambulant and fully employed.

Congenital muscular dystrophies with cognitive impairment. A population study

BACKGROUND

Cognitive impairment has been reported in a significant proportion of patients with congenital muscular dystrophies (CMD), generally associated with brain changes.

OBJECTIVES

The aim of this study was to establish 1) the overall prevalence of CMD and cognitive impairment in the Italian population; 2) the frequency of individual genetically defined forms; and 3) the presence of distinct phenotypes not associated with mutations in the known genes.

METHODS

We included all patients with CMD and cognitive impairment followed in all the Italian tertiary neuromuscular centers. Clinical, brain MRI, and morphologic data were collected. Genetic screening of the known genes was performed according to clinical and muscle biopsy findings.

RESULTS

Ninety-two of the 160 (58%) patients with CMD followed in our centers had cognitive impairment. alpha-Dystroglycan (alpha-DG) reduction on muscle biopsy was found in 73/92 (79%), with 42/73 carrying mutations in the known genes. Another 6/92 (7%) showed a laminin alpha2 deficiency on muscle biopsy and 5 of the 6 carried mutations in LAMA2. The remaining 13/92 (14%) patients had normal alpha-DG and laminin alpha2 expression on muscle.

CONCLUSIONS

This is the first population study establishing the prevalence of CMD and cognitive impairment and providing a classification on the basis of clinical, MRI, and genetic findings. We also showed that cognitive impairment was not always associated with alpha-DG or laminin alpha2 reduction or with structural brain changes.

The Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND): test development and reliability

The motor skills of patients with spinal muscular atrophy, type I (SMA-I) are very limited. It is difficult to quantify the motor abilities of these patients and as a result there is currently no validated measure of motor function that can be utilized as an outcome measure in clinical trials of SMA-I. We have developed the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders ("CHOP INTEND") to evaluate the motor skills of patients with SMA-I. The test was developed following the evaluation of 26 infants with SMA-I mean age 11.5 months (1.4-37.9 months) with the Test of Infant Motor Performance and The Children's Hospital of Philadelphia Test of Strength in SMA, a newly devised motor assessment for SMA. Items for the CHOP INTEND were selected by an expert panel based on item mean and standard deviation, item frequency distribution, and Chronbach's alpha. Intra-rater reliability of the resulting test was established by test-retest of 9 infants with SMA-I over a 2 month period; Intraclass correlation coefficient (ICC) (3,1)=0.96. Interrater reliability was by video analysis of a mixed group of infants with neuromuscular disease by 4 evaluators; ICC (3,4)=0.98 and in a group of 8 typically developing infants by 5 evaluators ICC (3,5)=0.93. The face validity of the CHOP INTEND is supported by the use of an expert panel in item selection; however, further validation is needed. The CHOP INTEND is a reliable measure of motor skills in patients with SMA-I and neuromuscular disorders presenting in infancy.