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Background: Hepatitis C is an inflammatory disease of the liver caused by infection with the hepatitis C virus (HCV). Inflammatory markers are significant in assessing the course of an infectious or inflammatory disease. One of them is the neutrophil-lymphocyte ratio (NLR) and the amount of HCV RNA viral load, which combines neutrophils as an active inflammatory component and lymphocytes as a regulatory and protective component in a single parameter. Research on the relationship between NLR and HCV RNA in HIV patients coinfected with HCV is still limited. This study aimed to determine the relationship between NLR and HCV RNA in HIV-HCV coinfected patients who received DAA therapy and went to the outpatient polyclinic at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Methods: Analytic observational study. A total of 38 research subjects participated in this study. Observation of NLR was carried out using hematology analyzer, and observation of HCV RNA levels was carried out using the PCR technique. Data analysis was carried out using SPSS univariate and bivariate. Results: There was a difference between pre-post therapy NLR and pre-post therapy HCV RNA viral load, p

The pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The clinical manifestation of COVID-19 is broad, ranging from an asymptomatic carrier state to severe disease leading to the death penalty. There is also emerging evidence that kidneys are affected early in COVID-19. Proteinuria and haematuria have been reported in 44% and 26.7% on admission, respectively. This literature review shows clinical manifestations of acute kidney injury (AKI) in a patient with COVID-19 infection. Literature reviews are carried out on various sources found on Google Scholar and Pubmed to search for articles, journal research, case reports, systematic reviews, meta-analyses, and textbooks. Various studies demonstrate the possibility of coronavirus infecting the kidney with several mechanisms such as cytokine storm syndrome (CSS), direct viral infection, and imbalance of renin-angiotensin-aldosterone (RAAS). Haematuria and proteinuria are associated with higher mortality and may signify aggressive disease early. Thus all patients should have a baseline urinalysis. There is a number of different causes of AKI in COVID-19, and some mechanisms by which COVID-19 affects kidneys remain unclear.

Background. COVID-19 infection, both moderate and severe symptoms can cause pneumonia that can be detected on a chest X-ray. Along with the increasing severity of the clinical picture of COVID 19, it can also trigger a cytokine storm, one of which is an increase in Interleukin-6 levels. This study was conducted to see the correlation between IL-6 levels with clinical features and chest radiographs in patients with COVID-19 Methods. This research is a cross-sectional study using an observational analytic. The samples in this study were confirmed COVID-19 patients who were being treated at Dr. Mohammad Hoesin General Hospital, Palembang. A history and physical examination were performed to determine the clinical picture as well as a chest X-ray and IL-6 levels. Results. There were 31 samples of COVID 19 patients. High levels of IL-6 were found in 26 (83.9%) samples. The clinical picture of the patient was dominated by dyspnea as much as 19 (61.3%), fever 16 (5.6%), low O2 saturation 12 (38.4%) and a chest X-ray of pneumonia 26 (83.9%). There was a significant relationship (P

Human immunodeficiency virus (HIV) is a retrovirus type virus that infects cells of the human immune system (especially CD4 positive T-cells and major components of the cellular immune system) and interferes with their function. This viral infection results in a continuous decline in the immune system, which will result in immune deficiency. People who are immune deficient/immunodeficiency become more susceptible to various types of infections. A 23 year male, a cafe employee, was admitted to hospital with complaints of weakness since 2 weeks before. He has productive cough for 3 weeks. He had decrease of food appetite, nauseas and vomiting. He had weight loss about 10 kg in the last 4 months. Patient had history of free sex, LGBT, since 2016 and history of hearing loss for 3 months. Laboratory finding showed rhonchi were found at the apex of the right and left lungs, Anti-HIV reactive and Absolute CD-4 count was 53 cell/uL, Gene Xpert MTB was detected, and Acid fast bacilli in stool is positive. Audiometry showed bilateral sensorineural deafness. Patient was diagnosed with HIV stage 4 with pulmonary tuberculosis, tuberculosis collitis, oral candidiasis, wasting syndrome, and sensorineural deafness.

HIV-AIDS mengakibatkan penurunan sistem imun tubuh dan terjadinya inflamasi yang berpengaruh pada kualitas hidup pasien. Kadar IL-10 dapat dikaitkan juga sebagai respon terhadap adanya inflamasi yang akan mempengaruhi kualitas hidup pasien HIV-AIDS. Penelitian ini bertujuan mengukur kadar IL-10 serum pasien, menentukan kualitas hidup pasien berdasarkan skor WHOQOL dan menganalisis korelasi kadar IL-10 serum dengan kualitas hidup pasien HIV-AIDS. Desain penelitian ini adalah potong lintang dengan rancangan uji korelasi, dilakukan pada Juni-Oktober 2020 di RSMH Palembang dengan subjek penelitian pasien yang didiagnosis HIV-AIDS dalam pengobatan rutin di Poliklinik Tropik dan Infeksi Penyakit Dalam RSMH Palembang. Sampel diperoleh dengan metode consecutive sampling pasien yang mengkonsumsi obat anti retroviral (ARV) dan berusia ≥ 18 tahun. Seluruh pengolahan dan analisis data dalam penelitian ini dengan menggunakan Program SPSS versi 22 for Windows.Dari sampel sebanyak 32 pasien didapatkan Kadar IL-10 serum pasien HIV-AIDS dengan median 0,41 pg/ml, nilai minimum 0,14 pg/ml; dan nilai maksimum 5,41 pg/ml. Sebanyak 20 orang (62.5%) memiliki kualitas hidup baik, sedangkan 12 orang (37.5%) memiliki kualitas hidup buruk. Berdasarkan hasil analisis multivariat didapatkan interpretasi bahwa semakin lama mengkonsumsi ARV dan semakin rendah kadar IL-10 secara simultan, maka kualitas hidup akan semakin baik dengan kekuatan korelasi kuat (r= 0.673). Kadar IL-10 serum berkorelasi negatif dengan kualitas hidup pasien HIV-AIDS dengan kekuatan korelasi kuat (r= -0,641).Dengan demikian kadar IL-10 serum dapat dijadikan prediktor kualitas hidup pasien HIV-AIDS

Objective: To determine NAC oral administration’s effect on changes in IL-10 levels and total lymphocyte count (TLC) in patients with HIV/AIDS in Dr Mohammad Hoesin Hospital, Palembang. Material and Methods: This study was a double-blind, randomized clinical trial. A total of 32 HIV/AIDS patients undergoing ARV treatment were randomly divided into two groups: the placebo and NAC groups. In the placebo group, patients were given capsules containing lactose at a dose of 3x1 capsules/ day, while the NAC group, were given NAC at a dose of 3x200 mg/day. Each group was treated for 12 weeks. Results: NAC administration significantly reduced IL-10 levels P= 0.038 but could not significantly increase TLC after treatment P= 0.376. However, TLC on the NAC group remained higher when compared with TLC on the placebo group. Conclusion: NAC administration significantly reduced levels of IL-10 and increased TLC; therefore, NAC has potential effects of increasing the effectiveness of antiretroviral therapy in HIV/AIDS patients, although it still needs to be studied further. J MEDICINE 2021; 22: 114-118

The COVID-19 pandemic that attacks the world has made the attention of all medical personnel focused on this disease. The clinical picture is similar to other infectious diseases such as malaria, dengue, influenza, etc., which often leads to misdiagnosis. We report the case of a man, 31 years old, with a history of travel and complaints of high fever persisting for more than 7 days. On physical examination, the temperature was 39-40 C, others were within normal limits. Initial platelet count was 69 x 103/µL, leukocytes was 15.52 x 109/L, CRP was 96 mg/L. The blood smear found Plasmodium falciparum, and PCR SARS-CoV-2 was positive. Chest X-ray showed pneumonia. Dihydroartemisinin-piperaquine and primaquine therapies were administered for malaria, as well as favipiravir, azithromycin, and other symptomatic therapy for COVID-19. Platelets decreased to 38 x 103/µL while D-dimer level increased (> 20 mg/L). Anticoagulant was delayed. On monitoring after therapy, the platelets returned to normal, the D-dimer level decreased, and there was no bleeding. The co-infectious conditions of malaria and COVID-19 should be suspected in patients with suggestive symptoms and travel history from endemic areas, therefore both examinations should be performed. This co-infection has the potential to cause hyper inflammation and hypercoagulation and this is associated with a poor prognosis. Appropriate treatment is needed.

Introduction. Human Immunodeficiency Virus (HIV) infection has been a concerning health problem worldwide. It causes reduction in body immune system and inflammation that can affect its clinical profile. Undergoing ARV therapy patients causes intestine microbiota dysbiosis and translocation that lead to imperfect absorbtion of fatty acid. One way to control microbiota dysbiosis is by controlling the nutritional factor, especially with omega-3. However, different regions upstands different custom in fish consumption especially those of which are rich in omega-3. The purpose of this research is to compare omega-3 serum level between HIV-AIDS patients and healthy population, as well as analyzing the correlation of omega-3 serum level with of HIV-AIDS patient clinical profile.Methods. The research will be applying observational analytic study using comparative study approach which will be performed in Tropical Infection Internal Medicine polyclinic and Medical Check-Up Polyclinic in RSMH Palembang starting from April 2020 until January 2021. Sample consisted of 32 HIV-AIDS patients from 20-58 years of age and 16 healthy population from 27-35 years of age on whom will be performed physical examination as well as clinical profile and omega-3 serum level examination. All data processing and analysis will be performed using SPSS v.25 for windows.Results. Out of 32 HIV-AIDS patients, we obtained low omega-3 serum level with median value at 3 (2-4) Umol/L, while in healthy population was 4 (3-6) Umol/L. Multivariate analysis inferred that the lower omega-3 serum level correlated with HIV-AIDS stage, duration of ARV therapy, blood pressure, and sex.Conclusion. Omega-3 serum levels in HIV-AIDS patients were lower than the healthy population. There was a correlation between omega-3 serum levels and their clinical profile of HIV-AIDS patients in Mohammad Hoesin General Hospital Palembang.

Penyakit HIV/AIDS merupakan suatu penyakit infeksi yang masih terus menjadi masalah besar bagi masyarakat global. Hasil estimasi dan proyeksi jumlah orang dengan HIV/AIDS di Indonesia pada tahun 2018 sebanyak 640.000 orang dan prevalensi secara nasional pada orang dewasa sebesar 0,4%. Berbagai macam bentuk infeksi yang disebabkan oleh HIV, salah satunya ditandai dengan turunnya jumlah sel limfosit T CD4+ dan juga penurunan kadar IFN-γ yang dapat menyebabkan percepatan replikasi virus hingga terjadi kegagalan sistem imun. N-asetilsistein (NAC) merupakan varian dari asam amino L-sistein yang merupakan sumber dari golongan sulfhydryl (SH) dan diubah dalam tubuh menjadi metabolit yang mampu menstimulasi sintesis gluthatione (GSH), menginduksi detoksifikasi dan bertindak secara langsung sebagai pemakan radikal bebas juga merupakan antioksidan diharapkan dapat memperbaiki kondisi tersebut. Penelitian ini bertujuan untuk mengetahui efek pemberian NAC terhadap perubahan kadar IFN-γ pada penderita HIV/AIDS di RSUP dr. Mohammad Hoesin Palembang. Penelitian ini merupakan uji klinik acak tersamar ganda. Sampel yang digunakan dalam penelitian ini sebanyak 32 pasien HIV/AIDS yang menjalani pengobatan ARV di RSUP dr. Mohammad Hoesin Palembang dibagi secara acak ke dalam 2 kelompok, yaitu kelompok Plasebo dan NAC. Pada kelompok Plasebo, pasien diberi kapsul yang berisi laktosa dengan dosis 3x1 kapsul/hari, sedangkan kelompok NAC, diberi NAC dengan dosis 3x 200 mg/hari. Setiap kelompok diberi perlakuan sama selama 12 minggu. Darah pasien diambil sebelum dan setelah perlakuan untuk diperiksa kadar IFN-γ. Hasil penelitian menunjukkan bahwa kelompok uji yang diberikan NAC maupun placebo tidak menunjukkan perubahan kadar IFN-γ yang bermakna setelah 12 minggu perlakuan(p>0,05). Kesimpulan penelitian, pemberian NAC tidak mempengaruhi kadar IFN-γ pada penderita HIV/AIDS yang menjalani pengobatan ARV.

Introduction. Vitamin D plays a role in health overall, but hypovitaminosis D still occurs throughout the world. HIV/AIDS patients are prone to suffer from hypovitaminosis D because of the infection itself and the side effects of antiretroviral therapy. Various effort have been tried to improve the immune status of HIV/AIDS patients, one of them is by adding vitamin D. Vitamin D acts as an antiinflammatory so that it can prevent apoptosis of CD4 T cells and increase CD4 cell count. Methods. This is a randomized control trial add on a study that aims to determine the effect of vitamin D to increase in CD4 counts of HIV / AIDS patients who have received antiretroviral drugs. Subjects were HIV / AIDS patients who had received antiretroviral drugs. A total of 20 subjects were divided randomly into two groups; one group received vitamin D (calcitriol 0.5 mcg per day) for eight weeks, and the other group that received a placebo. Each group was measured of CD4 cell count before and after treatment. Results. There was a significant increase in the CD4 cell count of the vitamin D group (p = 0.046), but not in the CD4 cell count of both groups (p = 0.985). The comparison of mean CD4 cell counts between groups before treatment was not significantly different (p = 0.057), but after treatment, it became significantly different (p = 0.040). Conclusion. Vitamin D has been successful in increasing CD4 cell count in the vitamin D group, and it is recommended to give HIV / AIDS patients to increase CD4 cell count.

Aims: to determine the effect of NAC administration on hematological abnormalities in HIV/AIDS patients who are undergoing ARV treatment. Method: This was a pilot study using a double blind randomized clinical trial. A total of 32 subjects who met the inclusion and exclusion criteria were divided into 2 groups, namely placebo and NAC. Subjects in the NAC group were given NAC at a dose of 3x200 mg/day, while the placebo group was given lactose at a dose of 3x200 mg/day. Each group was given treatment for 12 weeks. Before and after treatment, subjects were examined for hematologic parameters. Results: Most of subjects had normal hematological features. NAC administration did not have a significant effect on the mean levels of Hb, Ht, number of erythrocytes, leukocytes and platelets (p> 0.05). However, NAC administration can reduce the degree of anemia and improve the condition of thrombocytopenia, leukopenia and lymphopenia. Conclusion: NAC administration can reduce hematological abnormalities HIV/AIDS patients undergoing ARV treatment. Keywords: ARV, Hematological abnormalities, HIV/AIDS, NAC.

World Health Organization (WHO) has declared the novel corona virus (COVID-19) as a pandemic due to its high transmission and the rapid spread of the COVID-19. Along these lines, there is a need for more research about risk factors that can affect the spread of COVID-19 and its fatality. Therefore, this study aims to analyze risk factors in patients who died from COVID-19 at the Mohammad Hoesin Hospital in Palembang, South Sumatra, Indonesia. This study used a cross-sectional approach. The data were collected from all patients who died with suspected, probable, and confirmed status until September 2020 Data on death due to COVID-19 were collected with suspect, probable, and confirmed status. The results showed that comorbidity became the most dominant factor (62.1%) with (OR Adj) 3.780 (1.000 – 3.168) after controlling for contact history with confirmed cases and sex. There were differences in the mean age and length of stay in patients with confirmed COVID-19 and not. Prevention of death in COVID-19 patients can be done by controlling comorbidities and contact history with positive cases of COVID-19.

Histoplasma capsulatum is a dimorphic fungus which can cause infection usually in immunocompromised patients. An immunocompetent patient can be affected if he got chronic exposure to soil contaminated with birds or bats guano. We are reporting a case of a 54 years old man, working as trashman at open-air landfill, presented to hospital, with persistent fever and abdominal pain. The patient also complained of enlargement of submandibular lymph nodes. The abdominal ultrasound and CT-scan showed bilateral adrenal masses. Biopsy per laparoscopy of adrenal mass, and aspiration cytology of lymphadenopathy were performed and the results of cyto and histopathology examinations were Histoplasma capsulatum infection. The patient was planned for itraconazole 200 mg bid for 12-24 months. After 6 months of therapy, the patient had no more complains and the lymph nodes have shrinked significantly.