Acute adrenal insufficiency (AI) is a life-threatening condition. While Addison's disease (AD) is rare, in developing countries, tuberculosis (TB) still remains as the primary cause in 7 to 20% of cases. Urinary TB is also the third most common form of extrapulmonary disease. We report a case of 37-year-old male who presented with weakness, anorexia, weight loss, dysuria, flank pain and low grade fever. Examination revealed hypotension, hyperpigmentation, hyponatremia, hypoglycemia and low serum cortisol. He was diagnosed to have adrenal crisis due to Addison's disease and extrapulmonary TB manifesting as urinary tract infection (UTI). He was treated with corticosteroids and anti-TB medications. Urologic reconstructive surgery was subsequently planned..

Background: The utilization of technology in diabetes management, especially self-monitoring blood glucose (SMBG), is growing rapidly. However, the effectiveness of SMBG applications on the smartphone is not yet known. This study aims to assess the effectiveness of using a smartphone-based SMBG application in type 2 diabetes mellitus (T2DM) patients in the Indonesian population.Methods: This is a quasi-experimental (before and after) study conducted at three tertiary hospitals in Jakarta and Malang, Indonesia. Inclusion criteria were T2DM patients aged 18 years and above who have been familiar with performing SMBG  and manually record the results. All subjects were asked to use a smartphone-based SMBG application named Teman Diabetes application for six months, and patients' SMBG performance was assessed at the end of the study Bivariate analysis using T-test or with the Mann Whitney U test performed. Chi-square test is used to analyze the categorical with Risk Ratio (RR) and 95% Confidence Interval (CI). The p-value <0.05 (two-tailed) is considered statically meaningful.Results: From 100 patients enrolled in the study, 78 patients completed the follow-up. We found that the use of the SMBG application helped the subject overcome the difficulty in remembering to perform SMBG (p=0.004), helped change the subject's perception of the benefits of SMBG (p=0.049), improved the subject's diet pattern (p=0.006), and decreased the number of subjects who stopped performing SMBG due to self-perception of lack of benefit SMBG activity (p=0.049).Conclusions: The study found that using the SMBG application helps manage diabetes in T2DM patients.

Background. Indonesia is amongst the top 10 countries with the highest prevalence of Type 2 Diabetes Mellitus (T2DM) at 10.8%. However, the distinguishable features of T2DM in Indonesia remain obscure. Therefore, the DISCOVER study aimed to describe the characteristics of T2DM patients, associated vascular complications and treatment in Indonesia.Methodology. DISCOVER study is a multi-country, multicenter, prospective, cohort study over 3 years. In the present study, the data were collected from 13 sites from clinical practice, hospitals and public health facilities in Indonesia.Results. A total of 221 subjects were recruited with a mean age of 55.6 ± 9.8 years and body mass index (BMI) of 26.4 ± 4.4 kg/m 2 . Over 40% of patients had hypertension and/or hyperlipidemia. The mean duration of T2DM was 58.3 ± 62.0 months while the mean HbA1c levels was 9.2 ± 2%. In total, 82.4% completed the study within a 36-month followup period. BMI remained elevated i.e., >25kg/m 2 . A significant reduction was observed in HbA1c levels as compared to baseline (9.2 ± 2% to 8.1 ± 1.8%). T2DM-associated microvascular complications such as peripheral neuropathy, albuminuria and chronic kidney disease were observed in 17.2%. Macrovascular complications including coronary artery disease and heart failure were seen in 26.2% of patients. We also found that more than 70% of patients were on metformin and/or sulfonylurea.Conclusion.The features of patients with T2DM in Indonesia were high BMI, with hypertension and hyperlipidemia as co-morbidities. Metformin and sulfonylureas were the most common treatment. HbA1c reduction during follow-up did not reach recommended target. Thus, early detection and intervention using available glucose-lowering medications and aggressive management of risk factors and complications are essential to improve outcomes of diabetes management in Indonesia.

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Background: Arthritis rheumatoid (AR) is a chronic inflammatory disease that mainly affects the joints. Decreased bone mass and osteoporosis are its complications. Several factors such as dietary calcium, disease activity, physical activity, vitamin D levels, steroids can affect bone mineral density values. Aim: The purpose of this study was to determine the relationship between disease activity, calcium levels and bone mineral densitometry in patients with arthritis rheumatoid. Methods: 23 AR patients based on the 2010 ACR criteria including the inclusion criteria with a cross sectional study approach that had bone mineral densitometry (BMD) data for the last 1 year. Blood samples were also taken to check the total calcium level, the characteristics of the baseline data were collected, and the disease activity was examined using the DAS 28 LED. The relationship between these factors and the bone mass density was analyzed using the Spearman test. The analysis result was considered significant if p <0.05. Results: The results showed that the basic characteristics of the subjects were 45,87 years old, body mass index 24,51 kg / m2, duration of illness 3,96 years, steroid dose 3,48 mg, disease activity 4.35 (moderate disease activity), anti CCP 333,87 U / ml, rheumatoid factor (RF) 10,18 IU / ml, methotrexate 12,17 mg, leflunomide 20 mg. There was no significant relationship between serum calcium levels and disease activity with BMD. However, there was a significant relationship between age and BMI with BMD in the femur neck (p = 0,043), lumbar 3 (p = 0,017) and lumbar 4 (p = 0,048). Conclusion: There is no relationship between disease activity and calcium levels with bone mass density values in AR patients except for age and BMI.