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Pathophysiology
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Hot Topics in Internal Medicine: Moving Forward from the Pandemic...
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Hot Topics in Internal Medicine: Moving Forward from the Pandemic Era

A special issue of Pathophysiology (ISSN 1873-149X).

Deadline for manuscript submissions: closed (31 October 2023) | Viewed by 22171

Special Issue Editor

Prof. Dr. Muhammad Miftahussurur

E-Mail Website1 Website2
Guest Editor
Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
Interests: internal medicine; gastroenterology; microbiology

Special Issue Information

Dear Colleagues,

The development of medical science runs very fast, especially during this pandemic. Coronavirus disease 2019 (COVID-19) has attracted quite a bit of attention over the past two years therefore many other diseases are often overlooked. The devastating effects of COVID-19 have affected the health system globally. Healthcare professionals are struggling to maintain the quality of healthcare provision and overcome limitations arising from this challenging time. In this era of immunization, with the hope of controlling the spread and reducing the severity of COVID-19, a doctor is required to keep abreast of developments in science regarding diseases other than COVID-19. All healthcare professionals must suit their skills and knowledge to work in this progressing healthcare situation in various facilities.

This Special Issue will highlight the hot topics in internal medicine, moving forwards from the pandemic era. The hot topic includes subjects that new trends in internal medicine treatment with some adjustments of the COVID-19 pandemic and also new perspective for diagnostic tools to increase the quality of healthcare. It is the objective of this issue to update and improve professional knowledge on how to overcome boundaries in a such healthcare setting for the best management. We also aim to stimulate healthcare professionals on launching research with our scientific program. All scientists working in these fields are cordially invited to submit their manuscripts.

We are looking forward to your contributions to this Special Issue.

Prof. Dr. Muhammad Miftahussurur
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pathophysiology is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • allergy and immunology 
  • cardiology 
  • endocrinology, metabolic, and diabetes 
  • gastroenterology 
  • geriatric 
  • hematology-oncology medic 
  • hepatology 
  • nephrology 
  • pulmonology and respiratory diseases 
  • rheumatology 
  • tropic and infectious diseases 
  • molecular medicine

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (6 papers)

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Research

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11 pages, 254 KiB  
Article
Clinical Characteristics of 6102 Asymptomatic and Mild Cases for Patients with COVID-19 in Indonesia
by Erwin Astha Triyono, Joni Wahyuhadi, Christijogo Soemartono Waloejo, Dimas Aji Perdana, Nabilah, Sisilia Dewanti, Amal Arifi Hidayat, Michael Austin Pradipta Lusida, Fani Sarasati, Ngurah Arie Kapindra Dharma, Muhammad Ikhtiar Zaki Al Razzak, Tanri Hadinata Wiranegara and Nurarifah Destianizar Ali
Pathophysiology 2023, 30(3), 366-376; https://doi.org/10.3390/pathophysiology30030028 - 4 Aug 2023
Cited by 1 | Viewed by 1841
Abstract
Background: The COVID-19 pandemic has led to a rise in confirmed cases, making epidemiological studies crucial for identifying the source of transmission and developing effective treatment methods. We conducted a study on the clinical characteristics of patients with asymptomatic and mild symptoms of [...] Read more.
Background: The COVID-19 pandemic has led to a rise in confirmed cases, making epidemiological studies crucial for identifying the source of transmission and developing effective treatment methods. We conducted a study on the clinical characteristics of patients with asymptomatic and mild symptoms of COVID-19 at a rescue hospital in Indonesia. Methods: This is an epidemiological study involving 6102 patients who were admitted to the Indrapura forefront hospital in Surabaya from May 2020 to February 2021. We described demographic data, clinical signs and symptoms, laboratory data, therapy, and clinical outcomes. Results: A total of 6102 patients were involved in this study, with 3664 (60.04%) being male and 2438 (39.95%) being female. The age range of 21–30 years was the most prevalent, accounting for 31.1% (1898 patients). The population had 1476 patients (24.2%) with comorbid conditions. The most prevalent comorbidity observed among these patients was hypertension, affecting 1015 individuals (16.6%). Out of the total 6006 patients observed, 40.7% (n = 2486) were asymptomatic, 54.6% (n = 3329) had mild symptoms, and 3.1% (n = 191) had moderate symptoms. All patients were administered supportive therapy without the use of antiviral medication. Out of the 6102 patients included in the study, 5923 patients (97.1%) achieved a cure, 36 patients (0.6%) are currently undergoing treatment, 142 patients (2.3%) were referred for desaturation indications (SpO2 < 94%), and one patient died due to a suspected cardiovascular event. Out of the total number of patients, 74.5% (4529 patients) had an average length of stay (LOS) of less than 10 days, while 25.6% (1563 patients) had an average length of stay of more than 10 days. Conclusion: The clinical presentation of asymptomatic and mild COVID-19 patients at a rescue hospital varies significantly based on the age and sex of patients. Cough and hyposmia are commonly observed symptoms. Supportive therapy is effective, and strict implementation of social distancing is crucial in preventing the spread of this disease from individuals who are asymptomatic or have mild symptoms. Full article
(This article belongs to the Special Issue Hot Topics in Internal Medicine: Moving Forward from the Pandemic Era)
13 pages, 1871 KiB  
Article
Hemodynamic, Oxygenation and Lymphocyte Parameters Predict COVID-19 Mortality
by Choirina Windradi, Tri Pudy Asmarawati, Alfian Nur Rosyid, Erika Marfiani, Bagus Aulia Mahdi, Okla Sekar Martani, Giarena Giarena, Esthiningrum Dewi Agustin and Milanitalia Gadys Rosandy
Pathophysiology 2023, 30(3), 314-326; https://doi.org/10.3390/pathophysiology30030025 - 2 Aug 2023
Cited by 1 | Viewed by 2548
Abstract
The mortality of COVID-19 patients has left the world devastated. Many scoring systems have been developed to predict the mortality of COVID-19 patients, but several scoring components cannot be carried out in limited health facilities. Herein, the authors attempted to create a new [...] Read more.
The mortality of COVID-19 patients has left the world devastated. Many scoring systems have been developed to predict the mortality of COVID-19 patients, but several scoring components cannot be carried out in limited health facilities. Herein, the authors attempted to create a new and easy scoring system involving mean arterial pressure (MAP), PF Ratio, or SF ratio-respiration rate (SF Ratio-R), and lymphocyte absolute, which were abbreviated as MPL or MSLR functioning, as a predictive scoring system for mortality within 30 days for COVID-19 patients. Of 132 patients with COVID-19 hospitalized between March and November 2021, we followed up on 96 patients. We present bivariate and multivariate analyses as well as the area under the curve (AUC) and Kaplan–Meier charts. From 96 patients, we obtained an MPL score of 3 points: MAP < 75 mmHg, PF Ratio < 200, and lymphocyte absolute < 1500/µL, whereas the MSLR score was 6 points: MAP < 75 mmHg, SF Ratio < 200, lymphocyte absolute < 1500/µL, and respiration rate 24/min. The MPL cut-off point is 2, while the MSLR is 4. MPL and MSLR have the same sensitivity (79.1%) and specificity (75.5%). The AUC value of MPL vs. MSLR was 0.802 vs. 0.807. The MPL ≥ 2 and MSLR ≥ 4 revealed similar predictions for survival within 30 days (p < 0.05). Conclusion: MPL and MSLR scores are potential predictors of mortality in COVID-19 patients within 30 days in a resource-limited country. Full article
(This article belongs to the Special Issue Hot Topics in Internal Medicine: Moving Forward from the Pandemic Era)
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13 pages, 1173 KiB  
Article
Duration of SARS-CoV-2 RNA Shedding Is Significantly Influenced by Disease Severity, Bilateral Pulmonary Infiltrates, Antibiotic Treatment, and Diabetic Status: Consideration for Isolation Period
by Muhammad Vitanata Arfijanto, Tri Pudy Asmarawati, Bramantono Bramantono, Musofa Rusli, Brian Eka Rachman, Bagus Aulia Mahdi, Nasronudin Nasronudin and Usman Hadi
Pathophysiology 2023, 30(2), 186-198; https://doi.org/10.3390/pathophysiology30020016 - 4 May 2023
Cited by 4 | Viewed by 2393
Abstract
Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) ribonucleic acid (RNA) shedding is an important parameter for determining the optimal length of isolation period required for coronavirus disease 2019 (COVID-19) patients. However, the clinical (i.e., patient and disease) characteristics that could influence this [...] Read more.
Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) ribonucleic acid (RNA) shedding is an important parameter for determining the optimal length of isolation period required for coronavirus disease 2019 (COVID-19) patients. However, the clinical (i.e., patient and disease) characteristics that could influence this parameter have yet to be determined. In this study, we aim to explore the potential associations between several clinical features and the duration of SARS-CoV-2 RNA shedding in patients hospitalized with COVID-19. A retrospective cohort study involving 162 patients hospitalized for COVID-19 in a tertiary referral teaching hospital in Indonesia was performed from June to December 2021. Patients were grouped based on the mean duration of viral shedding and were compared based on several clinical characteristics (e.g., age, sex, comorbidities, COVID-19 symptoms, severity, and therapies). Subsequently, clinical factors potentially associated with the duration of SARS-CoV-2 RNA shedding were further assessed using multivariate logistic regression analysis. As a result, the mean duration of SARS-CoV-2 RNA shedding was found to be 13 ± 8.44 days. In patients with diabetes mellitus (without chronic complications) or hypertension, the duration of viral shedding was significantly prolonged (≥13 days; p = 0.001 and p = 0.029, respectively). Furthermore, patients with dyspnea displayed viral shedding for longer durations (p = 0.011). The multivariate logistic regression analysis reveals that independent risk factors associated with the duration of SARS-CoV-2 RNA shedding include disease severity (adjusted odds ratio [aOR] = 2.94; 95% CI = 1.36–6.44), bilateral lung infiltrates (aOR = 2.79; 95% CI = 1.14–6.84), diabetes mellitus (aOR = 2.17; 95% CI = 1.02–4.63), and antibiotic treatment (aOR = 3.66; 95% CI = 1.74–7.71). In summary, several clinical factors are linked with the duration of SARS-CoV-2 RNA shedding. Disease severity is positively associated with the duration of viral shedding, while bilateral lung infiltrates, diabetes mellitus, and antibiotic treatment are negatively linked with the duration of viral shedding. Overall, our findings suggest the need to consider different isolation period estimations for specific clinical characteristics of patients with COVID-19 that affect the duration of SARS-CoV-2 RNA shedding. Full article
(This article belongs to the Special Issue Hot Topics in Internal Medicine: Moving Forward from the Pandemic Era)
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Review

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19 pages, 1641 KiB  
Review
Challenges in the Vaccination of the Elderly and Strategies for Improvement
by Gatot Soegiarto and Dewajani Purnomosari
Pathophysiology 2023, 30(2), 155-173; https://doi.org/10.3390/pathophysiology30020014 - 22 Apr 2023
Cited by 19 | Viewed by 8666
Abstract
In recent years, the elderly has become a rapidly growing proportion of the world’s population as life expectancy is extending. Immunosenescence and inflammaging contribute to the increased risk of chronic non-communicable and acute infectious diseases. Frailty is highly prevalent in the elderly and [...] Read more.
In recent years, the elderly has become a rapidly growing proportion of the world’s population as life expectancy is extending. Immunosenescence and inflammaging contribute to the increased risk of chronic non-communicable and acute infectious diseases. Frailty is highly prevalent in the elderly and is associated with an impaired immune response, a higher propensity to infection, and a lower response to vaccines. Additionally, the presence of uncontrolled comorbid diseases in the elderly also contributes to sarcopenia and frailty. Vaccine-preventable diseases that threaten the elderly include influenza, pneumococcal infection, herpes zoster, and COVID-19, which contribute to significant disability-adjusted life years lost. Previous studies had shown that conventional vaccines only yielded suboptimal protection that wanes rapidly in a shorter time. This article reviews published papers on several vaccination strategies that were developed for the elderly to solve these problems: more immunogenic vaccine formulations using larger doses of antigen, stronger vaccine adjuvants, recombinant subunit or protein conjugated vaccines, newly developed mRNA vaccines, giving booster shots, and exploring alternative routes of administration. Included also are several publications on senolytic medications under investigation to boost the immune system and vaccine response in the elderly. With all those in regard, the currently recommended vaccines for the elderly are presented. Full article
(This article belongs to the Special Issue Hot Topics in Internal Medicine: Moving Forward from the Pandemic Era)
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Other

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15 pages, 2038 KiB  
Systematic Review
Risk Factors and Clinical Characteristics of Acute Kidney Injury in Patients with COVID-19: A Systematic Review and Meta-Analysis
by Amal Arifi Hidayat, Vania Azalia Gunawan, Firda Rachmawati Iragama, Rizky Alfiansyah, Decsa Medika Hertanto, Artaria Tjempakasari and Mochammad Thaha
Pathophysiology 2023, 30(2), 233-247; https://doi.org/10.3390/pathophysiology30020020 - 15 May 2023
Cited by 6 | Viewed by 3468
Abstract
Acute kidney injury (AKI) is associated with a worse prognosis in coronavirus disease 2019 (COVID-19) patients. Identification of AKI, particularly in COVID-19 patients, is important for improving patients’ management. The study aims to assess risk factors and comorbidities of AKI in COVID-19 patients. [...] Read more.
Acute kidney injury (AKI) is associated with a worse prognosis in coronavirus disease 2019 (COVID-19) patients. Identification of AKI, particularly in COVID-19 patients, is important for improving patients’ management. The study aims to assess risk factors and comorbidities of AKI in COVID-19 patients. We systematically searched PubMed and DOAJ databases for relevant studies involving confirmed COVID-19 patients with data on risk factors and comorbidities of AKI. The risk factors and comorbidities were compared between AKI and non-AKI patients. A total of 30 studies involving 22385 confirmed COVID-19 patients were included. Male (OR: 1.74 (1.47, 2.05)), diabetes (OR: 1.65 (1.54, 1.76)), hypertension (OR: 1.82 (1.12, 2.95)), ischemic cardiac disease (OR: 1.70 (1.48, 1.95)), heart failure (OR: 2.29 (2.01, 2.59)), chronic kidney disease (CKD) (OR: 3.24 (2.20, 4.79)), chronic obstructive pulmonary disease (COPD) (OR: 1.86 (1.35, 2.57)), peripheral vascular disease (OR: 2.34 (1.20, 4.56)), and history of nonsteroidal anti-inflammatory drugs (NSAID) (OR: 1.59 (1.29, 1.98)) were independent risk factors associated with COVID-19 patients with AKI. Patients with AKI presented with proteinuria (OR: 3.31 (2.59, 4.23)), hematuria (OR: 3.25 (2.59, 4.08)), and invasive mechanical ventilation (OR: 13.88 (8.23, 23.40)). For COVID-19 patients, male gender, diabetes, hypertension, ischemic cardiac disease, heart failure, CKD, COPD, peripheral vascular disease, and history of use of NSAIDs are associated with a higher risk of AKI. Full article
(This article belongs to the Special Issue Hot Topics in Internal Medicine: Moving Forward from the Pandemic Era)
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8 pages, 261 KiB  
Brief Report
Random Blood Glucose, but Not HbA1c, Was Associated with Mortality in COVID-19 Patients with Type 2 Diabetes Mellitus—A Retrospective Study
by Stefanus Gunawan Kandinata, Soebagijo Adi Soelistijo, Agung Pranoto and Erwin Astha Triyono
Pathophysiology 2023, 30(2), 136-143; https://doi.org/10.3390/pathophysiology30020012 - 6 Apr 2023
Viewed by 1701
Abstract
Previous studies have yielded inconsistent results on whether glycated hemoglobin (HbA1c) and random blood glucose (RBG) are associated with mortality of coronavirus disease 2019 (COVID-19) patients with type 2 diabetes mellitus (T2DM). This study aimed to assess the association of HbA1c and RBG [...] Read more.
Previous studies have yielded inconsistent results on whether glycated hemoglobin (HbA1c) and random blood glucose (RBG) are associated with mortality of coronavirus disease 2019 (COVID-19) patients with type 2 diabetes mellitus (T2DM). This study aimed to assess the association of HbA1c and RBG with mortality among COVID-19 patients with T2DM. A retrospective study was conducted on 237 patients with COVID-19 and T2DM (survival (n = 169) and non-survival groups (n = 68)). Data on socio-demography, comorbidities, clinical symptoms, laboratory examination, and mortality were collected. Patients in the non-survival group had an older age range as compared with those in the survival group (60 (52.3–65.0) vs. 56.0 (48.5–61.5) years, p = 0.009). There was no statistical gender difference between the two groups. After matching was done, chronic kidney disease, NLR, d-dimer, procalcitonin, and random blood glucose were higher in the non-survival group compared to the survival group (p < 0.05). HbA1c levels were similar in survivors and non-survivors (8.7% vs. 8.9%, p=0.549). The level of RBG was independently associated with mortality of COVID-19 patients with T2DM (p = 0.003, adjusted OR per 1-SD increment 2.55, 95% CI: 1.36–4.76). In conclusion, RBG was associated with the mortality of COVID-19 patients with T2DM, but HbA1c was not. Full article
(This article belongs to the Special Issue Hot Topics in Internal Medicine: Moving Forward from the Pandemic Era)
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