Diabetic retinopathy (DR) is the major cause of visual impairment in the working-age population with type 2 diabetes mellitus (T2DM). Magnesium (Mg) is involved in various metabolic processes and in experimental animal studies; Mg has shown essential roles in physiological eye function. Magnesium deficiency is common in T2DM; therefore we analyzed the association between serum Mg status and the presence of DR in T2DM patients. Systematic literature searching in several databases, from 1988 to September 2020, was performed using search terms: “serum magnesium” or “hypomagnesemia” and “diabetic retinopathy” or “retinopathy”. A total of 3,227 patients from 17 studies were included in this meta-analysis. Hypomagnesemia was associated with increased risk of developing DR (OR 4.52 [2.08, 9.81], p=0.0001) in T2DM patients. Serum Mg levels also lower in patients with DR than those without DR (MD –0.30 mg/dL [–0.44, –0.15], p<0.0001). Additionally, serum Mg levels were lower in patients with proliferative DR (PDR) than those with non-proliferative DR (NPDR) (MD-0.21 mg/dL [–0.34, –0.09], p=0.0009). Leave-one-out sensitivity analysis did not change the overall effect. Hypomagnesemia or low serum Mg levels in T2DM patients increased the risk of developing DR.

<p>Rational empirical antimicrobial therapy is an important component of sepsis patient management. This study aimed to assess the rationality of empirical antimicrobial therapy in patients diagnosed with sepsis admitted in intermediate care ward of internal medicine department (RPI) of Dr. Soetomo General Hospital from January 2016 to July 2017. Medical records of 91 patients diagnosed with sepsis were collected and studied retrospectively in period from July 2017 to November 2017. 91 (85.05%) medical records from 107 sepsis patients were evaluated. Cultures and antimicrobial sensitivity tests were carried out in 21 (23.07%) patients. 14 patients yielded positive culture results, 9 of which were MDRO positive with ESBL as resistant marker. Empirical antibiotic therapies for these patients were reviewed according to Gyssens method.</p><p>73 (80.2%) of 91 patients were deemed receiving appropriate empirical antibiotic therapies. Ceftriaxone IV injection as monotherapy or combination therapy were the most common empirical antibiotic therapies (82 in 91 patients, 90.1%), despite local microbiologic flora and antibiogram show most pathogens were resistant to ceftriaxone. Mortality rate in this study was high, 92.3% (84 patients died) despite rational empirical antibiotic therapies were high.<strong> </strong>This study concluded that empirical antibiotic therapies in sepsis patients according to guidelines adopted in Soetomo General Hospital, albeit deemed rational, was no longer appropriate according to local antibiogram issued by microbiological department of Soetomo General Hospital.</p><p> </p><strong>Keywords: <em>Empirical Antibiotics Therapy, Gyssens criteria, Intermediate Care Ward, Sepsis, Septic Shock</em></strong>

Aims SGLT-2 Inhibitor is an anti-diabetic drug. SGLT-2 Inhibitor has favourably effect in cardiovascular outcomes. However, the three-year cardiovascular outcomes of SGLT-2 Inhibitor in Type-2 Diabetes Mellitus remains unclear. We performed meta-analysis to evaluate cardiovascular outcomes in three-years of SGLT-2 Inhibitor therapy. Methods We performed a systematic literature search from various electronic databases. We used keywords “SGLT-2 Inhibitor”, “Type-2 Diabetes Mellitus”, and “Cardiovascular outcome”. Inclusion criteria for research is Randomized Control Trial and 3-year follow-up. Primary endpoint is Major Adverse Cardiovascular Event (MACE). Secondary endpoints are all-cause mortality, cardiovascular mortality and hospitalization of heart failure. Risk ratio (RR) with 95% confidence interval were used to report all outcomes. Results Total of two Randomized Control Trial was selected (EMPA-REG [Jardiance®] and VERTIS-CV [Steglatro®] trial) with 15.266 patients pooled in our analysis. Results of three-year primary outcome compared SGLT-2 Inhibitor with Placebo had no significant reduction in MACE (RR = 0.93 [95% CI, 0.81–1.07], p = 0.32; I2=56%). Result of secondary outcome showed no significant reduction in all-cause mortality (RR = 0.80 [95% CI, 0.60-1.08], p = 0.15; I2=85%) and cardiovascular mortality (RR = 0.77 [95% CI, 0.52–1.12], p = 0.17; I2=87%). However, there are significant reduction in hospitalization of heart failure (RR = 0.68 [95% CI, 0.57–0.82], p &lt; 0.00001; I2=0%). Conclusion SGLT-2 Inhibitor in Type-2 Diabetes Mellitus has significant reduction in hospitalization of heart failure. However, no significant results were found in MACE, all-cause mortality, and cardiovascular mortality after 3-year follow-up.

Sebanyak 650 kasus probabel hepatitis akut dengan etiologi yang tidak diketahui pada anak-anak telah dilaporkan ke Badan Kesehatan Dunia dari 33 negara antara tanggal 5 April hingga 26 Mei 2022. Hepatitis A adalah penyebab paling umum dari hepatitis menular pada pasien anak. Tinjauan sistematis ini disusun untuk memberikan gambaran yang komprehensif tentang epidemiologi hepatitis A pada anak di Indonesia. Metode penelitian adalah tinjauan sistematis literatur dari database Google Scholar, ProQuest, Pubmed, ScienceDirect dan Cochrane. Literatur yang ditemukan sebanyak 390 artikel dan hanya 16 artikel yang dapat ditelaah secara sistematis yang lolos algoritma PRISMA (Preferred Reporting Items for Syatematic Reviews and Meta-Analyses) yang digunakan dalam kajian sistematik ini. Dari tinjauan sistematis ini dapat disimpulkan bahwa hepatitis A pada anak Indonesia terbanyak pada anak laki-laki berusia 11-17 tahun dengan kebiasaan cuci tangan tanpa sabun di Provinsi Jawa Timur.

Aims SGLT-2 Inhibitor is an anti-hyperglycaemic drug. SGLT-2 Inhibitor has favourably affect in Cardiovascular outcome. Nevertheless, the cardiovascular outcome of recent clinical trial of SGLT-2 Inhibitor in Type-2 Diabetes Mellitus remains unclear. We performed meta-analysis to evaluate SGLT-2 Inhibitor in type-2 Diabetes Mellitus. Methods We performed a systematic literature search from various electronic databases. We used keywords “SGLT-2 inhibitor”, “Cardiovascular outcome”, and “Type-2 Diabetes Mellitus”. Inclusion criteria is Randomized Control Trial and 2 to 4-year follow-up. Primary endpoint is Major Adverse Cardiovascular Event (MACE). Secondary endpoints are all-cause mortality, cardiovascular mortality and hospitalization of heart failure. Outcomes is reported using Risk Ratio (RR) with 95% Confidence Interval. Results Total of four Randomized Control Trial was selected (EMPA-REG [Jardiance®], CANVAS [Invokana®], DECLARE-TIMI 58 [Forxiga®] and VERTIS-CV [Steglatro®] trial) with 42.568 patients pooled within our analysis. The results of primary outcome compared SGLT-2 Inhibitor with Placebo had significant reduction in MACE (RR = 0.93 [95% CI, 0.87–0.99], p = 0.03; I2=0%). Result of secondary outcomes showed significant reduction in all-cause mortality (RR = 0.86 [95% CI, 0.75–0.99], p = 0.03; I2=65%) and hospitalization of heart failure (RR = 0.71 [95% CI, 0.63–0.80], p &lt; 0.00001; I2=0%), however, no significant reduction in cardiovascular mortality (RR = 0.85 [95% CI, 0.69–1.05], p = 0.13; I2=73%). Conclusion SGLT-2 Inhibitor in Type-2 Diabetes Mellitus has significant reduction in MACE, all-cause mortality, and hospitalization of heart failure. However, no significant reduction was found in cardiovascular mortality within 2 to 4-year follow-up.