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Neutrophil-Lymphocyte Ratio as a Novel Biomarker for Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study Pradesta, Rahnowi; Novadian; Yulianto Kusnadi; Nova Kurniati; Syarif Husin
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i3.1235

Background: Early detection of diabetic nephropathy (DN) is crucial to prevent progression to end-stage renal disease. The gold standard for diagnosing DN involves urine microalbumin testing and renal biopsy. However, the availability of these diagnostic tools is limited in many healthcare facilities across Indonesia. Consequently, there is a pressing need for an alternative examination that is readily accessible and can effectively monitor the progression of DN. Methods: This cross-sectional study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, from February 2024 to May 2024. The study aimed to investigate the correlation between neutrophil-lymphocyte ratio (NLR) and urinary albumin levels in type 2 diabetes mellitus (DM) patients. NLR, calculated from complete blood counts, has emerged as a potential inflammatory marker for various conditions. A total of 65 participants diagnosed with type 2 DM were enrolled in the study. Data analysis involved Spearman's correlation test to assess the relationship between NLR and urinary albumin levels. Results: The majority of the 65 subjects were female (58.5%). The study found that 44 subjects had normoalbuminuria, 18 had microalbuminuria, and 3 had macroalbuminuria. A significant positive correlation was observed between NLR and albuminuria levels in type 2 DM patients (r = 0.795; p < 0.01). Conclusion: The study's findings suggest that NLR is a potential cost-effective biomarker for the early detection of DN in type 2 DM patients, especially in resource-limited settings. Further large-scale studies are recommended to validate these findings and establish specific NLR thresholds for predicting DN progression.

Multigravida at 31 Weeks with Imminent Preterm Labor, Type 2 Diabetes Mellitus, Maxillary Abscess, and Bad Obstetric History : A Case Report Sentani, Ray Suga Aulia; Bernolian, Nuswil; Muzakkie, Mufida; Kusnadi, Yulianto
Sriwijaya Journal of Medicine Vol. 8 No. 3 (2025): Vol 8, No 3, 2025
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/sjm.v8i3.351

Imminent preterm labor (IPL) is defined by irregular uterine contractions, back pain, and vaginal discharge, with approximately 25-30% of cases progressing to preterm delivery. Preterm birth remains a major global issue, contributing to 35% of neonatal deaths, and often results in long-term health complications for the infant. This case report discusses a 35-year-old woman (G4P2A1) at 30 weeks of gestation, with a history of type 2 diabetes mellitus (T2DM), bad obstetric history (BOH), and a right maxillary abscess. She presented with swelling and pus discharge from the maxillary region, along with abdominal cramps, but no signs of imminent labor. The patient’s diabetes was managed with insulin, and her clinical condition was complicated by high blood glucose and an ongoing infection. The cervical length was measured via ultrasound, which indicated a risk for preterm delivery, and the patient was diagnosed with IPL. Initial management included fluid resuscitation, tocolytics to prevent labor, and antibiotics for the maxillary abscess. The patient was closely monitored, and insulin therapy was adjusted to stabilize glucose levels. Despite the complexity of managing IPL in diabetic patients, the patient's condition improved after debridement of the abscess and management of blood glucose levels. This case emphasizes the importance of multidisciplinary care in managing complicated pregnancies with comorbidities like T2DM.

Correlation Between Serum Testosterone Levels and CD4 T Lymphocyte Counts in Naive HIV-Infected Men at dr. Mohammad Hoesin General Hospital Palembang Fahrenheit, Fahrenheit; Kusnadi, Yulianto; Hudari, Harun; Bahar, Erial; Shahab, Alwi; Anggraini, Ratna Maila Dewi; Permata, Mega; Salim, Nelda Aprilia; Yuniza; Bakrie, Muhammad
Clinical and Research Journal in Internal Medicine Vol. 6 No. 2 (2025): Volume 6 No 2, November 2025
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2025.006.02.07

Background: HIV infection often leads to endocrine complications, including hypogonadism which characterized by low serum testosterone, potentially affects quality of life and contributes to metabolic issues, such as muscle weakness, depression, osteoporosis, and cardiovascular disease. Some studies have indicated a connection between testosterone levels and CD4 T lymphocyte counts. Aim: To evaluate the correlation between total serum testosterone levels and CD4 T lymphocyte counts in naive HIV-infected men. Methods: A cross-sectional analitycal study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, from April to October 2024. Involving 64 naive HIV-infected men. Total serum testosterone and CD4 T cell counts were measured and analyzed. Results: Participants mean age is 36.52 ± 11.03 years with BMI of 19.52 ± 3.71 kg/m². Most subject (62.5%) are reported men who had sex with other men. Poor sleep quality was found in 81%, mild depressive symptoms in 38.1%, and mild erectile dysfunction in 28.6%. Hypogonadism occurred in 32.8% of subjects (28.1% secondary and 4.7% primary). Mean number of testosterone level was 446.75 ± 260.95 ng/dL, with a median CD4 count of 23.5 cells/µL. A significant positive correlation was observed between testosterone levels and CD4 counts (r = 0.313; p = 0.012) although testosterone levels did not significantly differ across HIV clinical stages (p = 0.464). Conclusion: There is a significant positive correlation between serum testosterone levels and CD4 T lymphocyte counts in naive HIV-infected men. Hormonal disturbances may arise in early infection. Hence, testosterone assessment is recommended during the initial evaluation on HIV patients.

Effect of Vitamin D Supplementation on Recurrence Risk in Graves’ Disease Measured By The GREAT Score at Dr. Mohammad Hoesin General Hospital Palembang Ali Rabbani, Muhammad Iqbal; Anggraini, Ratna Maila Dewi; Kusnadi, Yulianto; Maritska, Ziske
Sriwijaya Journal of Medicine Vol. 8 No. 3 (2025): Vol 8, No 3, 2025
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/sjm.v8i3.370

Graves’ disease is the most common cause of primary hyperthyroidism with a prevalence of approximately 0.5%, predominantly affecting women (female-to- male ratio 6–7:1) aged 35–40 years. Predictors of treatment outcomes and recurrence risk have been studied, among them the GREAT Score, which combines age, goiter size, FT4, and TRAb levels. The aim of this study was to analyze changes in the GREAT Score after the addition of vitamin D supplementation in Graves' disease patients at Dr. Mohammad Hoesin General Hospital, Palembang, within 3 months. This was a double-blind randomized clinical trial involving 30 patients with Graves’ disease, both inpatients and outpatients, who met the inclusion criteria. Patients were randomly assigned into two groups: the intervention group received10,000 IU of vitamin D, while the control group received placebo. Recurrence risk was assessed using the GREAT Score at the first and third months, and data were analyzed with SPSS v.25. Analysis using the Wilcoxon test showed no significant change in the GREAT Score for the vitamin D group (p=0.102). At the first month, the distribution was 53.3% class I, 40.0% class II, and 5.7% class III, while at the third month it was 40.0% class I, 40.0% class II, and 20.0% class III. In the placebo group, results were also not significant (p=0.480), with the first-month distribution of 33.3% class I, 40.0% class II, and 26.7% class III, and the third month 40.0% class I, 33.3% class II, and 13.3% class III. In summary, Vitamin D supplementation has no significant effect in reducing the recurrence of Graves' disease compared to placebo.

Adult Onset Nesidioblastosis (Non Insulinoma Pancreatogenous Hypoglycemia Syndrome): A Rare Case Rita Sriwulandari; Yulianto Kusnadi; Ratna Maila Dewi; Alwi Shahab; Anne Rivaida
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
Publisher : PP PERKENI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v1i2.18

Finding the etiology of hypoglycemia in adult patients can be challenging because of the wide variety of etiologies. Ninety percent of endogenous hyperinsulinemic hypoglycemia is caused by insulinoma, the rest are caused by insulin antibodies and pancreatic β cell dysfunction (nesidioblastosis) which indicates neoformation of nesidioblasts (stem cells that form the islets of Langerhans). A 28-year-old female complained of neuroglycopenia and adrenergic symptoms that improved with drinking sugar, so she had weight gain. The 72 hours of prolonged fasting test results are C-peptide ≥0.2 mmol/L, insulin ≥21 pmol/L, insulin to C-peptide molar ratio ≤1, and negative insulin antibody. Imaging tests were normal and there is no evidence of malignancies. When blood glucose falls, the first defense mechanism to prevent hypoglycemia is decreased in insulin secretion. When this mechanism fails, insulin and C-peptide levels remain high in circulation. Confirmation of Whipple's triad is required, followed by insulin tests in hypoglycemic conditions. Imaging tests, biomarkers, and hormonal malignancies were done to rule out differential diagnoses. Nuclear diagnostics, SACST, biopsy, and histopathology are currently in capable of being carried out. The diagnosis of adult-onset Nesidioblastosis/NIPHS in this patient was made through the diagnosis of exclusion, namely by eliminating all diagnostic appeals because several examination modalities cannot be carried out. The gold standard for diagnosing Nesidioblastosis/NIPHS is SACST and histopathological examination of pancreatic tissue. The patient is well-controlled with Amlodipine 2.5 mg.

Adjuvant Resveratrol Reduces Albuminuria and Serum Transforming Growth Factor-β Without Improving Glomerular Filtration Rate in Diabetic Kidney Disease: A 12-Week Randomized Controlled Trial Eva Julita; Zulkhair Ali; Yulianto Kusnadi; Legiran
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 7 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i7.1627

Background: Diabetic kidney disease (DKD) progresses through inflammation and fibrosis, with transforming growth factor-β (TGF-β) as the principal profibrotic mediator and albuminuria as a clinical surrogate of glomerular injury. Methods: We conducted a 12-week, double-blind, placebo-controlled randomized trial at Dr. Mohammad Hoesin General Hospital, Palembang, between October 2025 and January 2026 to evaluate adjuvant resveratrol on serum TGF-β, urinary albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR). Results: Of 61 randomized adults with DKD on standard care, 54 were analyzed (resveratrol n=27 received 25 mg twice daily, derived from Polygonum cuspidatum in 95% lecithin; placebo n=27). Within the resveratrol group, serum TGF-β fell from 123.7 to 77.1 pg/mL (p=0.008) and UACR from 94.1 to 89.8 mg/g (p=0.017); within placebo, UACR rose from 81.9 to 112 mg/g (p=0.029) while TGF-β change was non-significant (p=0.428). Between-group ΔUACR was significant (p<0.001), whereas ΔTGF-β (p=0.303) and ΔeGFR (p=0.567) were not. Multivariable linear regression identified resveratrol as an independent predictor of UACR reduction (B=−394.12 mg/g; 95% CI −659.53 to −128.71; p=0.004; adjusted R²=0.129). Baseline TGF-β was the dominant predictor of ΔTGF-β (B=−0.81; p<0.001; adjusted R²=0.701), and baseline LFG stage predicted ΔeGFR (B=−4.76; p=0.021). Mild bloating was reported in 14.8% of resveratrol versus 11.1% of placebo recipients; no serious adverse events occurred. Conclusion: Adjuvant low-dose resveratrol reduces albuminuria and serum TGF-β over 12 weeks in DKD without short-term improvement in eGFR, supporting an antifibrotic biomarker signal that warrants longer trials.

Adjuvant Resveratrol Reduces Albuminuria and Serum Transforming Growth Factor-β Without Improving Glomerular Filtration Rate in Diabetic Kidney Disease: A 12-Week Randomized Controlled Trial Eva Julita; Zulkhair Ali; Yulianto Kusnadi; Legiran
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 7 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i7.1627

Background: Diabetic kidney disease (DKD) progresses through inflammation and fibrosis, with transforming growth factor-β (TGF-β) as the principal profibrotic mediator and albuminuria as a clinical surrogate of glomerular injury. Methods: We conducted a 12-week, double-blind, placebo-controlled randomized trial at Dr. Mohammad Hoesin General Hospital, Palembang, between October 2025 and January 2026 to evaluate adjuvant resveratrol on serum TGF-β, urinary albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR). Results: Of 61 randomized adults with DKD on standard care, 54 were analyzed (resveratrol n=27 received 25 mg twice daily, derived from Polygonum cuspidatum in 95% lecithin; placebo n=27). Within the resveratrol group, serum TGF-β fell from 123.7 to 77.1 pg/mL (p=0.008) and UACR from 94.1 to 89.8 mg/g (p=0.017); within placebo, UACR rose from 81.9 to 112 mg/g (p=0.029) while TGF-β change was non-significant (p=0.428). Between-group ΔUACR was significant (p<0.001), whereas ΔTGF-β (p=0.303) and ΔeGFR (p=0.567) were not. Multivariable linear regression identified resveratrol as an independent predictor of UACR reduction (B=−394.12 mg/g; 95% CI −659.53 to −128.71; p=0.004; adjusted R²=0.129). Baseline TGF-β was the dominant predictor of ΔTGF-β (B=−0.81; p<0.001; adjusted R²=0.701), and baseline LFG stage predicted ΔeGFR (B=−4.76; p=0.021). Mild bloating was reported in 14.8% of resveratrol versus 11.1% of placebo recipients; no serious adverse events occurred. Conclusion: Adjuvant low-dose resveratrol reduces albuminuria and serum TGF-β over 12 weeks in DKD without short-term improvement in eGFR, supporting an antifibrotic biomarker signal that warrants longer trials.

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