Sriwijaya Journal of Internal Medicine

Dissociated Glycemic Status in Diabetes Mellitus: A Meta-Analysis of the Interaction between Acute Stress Hyperglycemia and Chronic Glycemic Control on Sepsis Outcomes

Novia Wira Tungadi — Tue, 03 Mar 2026 02:31:26 +0000

Introduction: Sepsis profoundly complicates diabetes mellitus, yielding disproportionately high mortality. Clinicians traditionally utilize absolute admission blood glucose for risk stratification. However, this metric is fundamentally flawed in pre-existing diabetes because chronic hyperglycemia alters the physiological baseline. The concept of dissociated glycemic status—quantified as the stress hyperglycemia ratio or glycemic gap—captures the discordance between acute stress hyperglycemia and chronic Hemoglobin A1c. This study investigated whether dissociated status serves as a superior predictor of sepsis mortality compared to absolute hyperglycemia, with a specific subgroup focus on the distinct pathophysiology of Type 1 Diabetes.

Methods: A systematic review and meta-analysis of eight manuscripts, including registry data, clinical cohorts, and pre-clinical models was conducted. The human incidence cohort encompassed over 300,000 subjects; the mortality analysis included approximately 3,500 patients. The primary exposure was dissociated glycemic status. The primary outcome was sepsis-related mortality. Animal model data and glycemic variability metrics were strictly segregated from the primary quantitative synthesis. Data were synthesized using a random-effects model, assessing heterogeneity via the I-squared statistic, alongside a comprehensive risk of bias assessment.

Results: Absolute hyperglycemia failed to independently predict mortality when adjusted for chronic control. A high dissociated glycemic status is strongly associated with mortality (Pooled Odds Ratio 2.14; 95 % Confidence Interval 1.65 to 2.78; I2 42 percent). Separate analysis demonstrated that glycemic variability independently increased mortality risk. Type 1 Diabetes patients exhibited a 3.7-fold increase in sepsis hospitalization compared to controls. Review of pre-clinical models suggested this vulnerability in Type 1 Diabetes is driven by an immunoparalysis phenotype rather than a classic cytokine storm.

Conclusion: The interaction between acute and chronic glycemia dictates survival in diabetic sepsis. Dissociated glycemic status represents a critical vital sign indicating a failure of metabolic and immune homeostasis.

The Impact of Peer-Led Community Testing Models on Early HIV Diagnosis Among Key Populations: A Systematic Review and Meta-Analysis

Wahyuni Maria Prasetyo Hutomo, Agnesia Hetriany Sorsery, Maria Wati Manseni — Wed, 15 Apr 2026 01:53:40 +0000

Introduction: HIV testing remains a critical entry point to the care cascade. Peer-led community testing models have emerged as promising approaches to improve early diagnosis among key populations, yet evidence synthesis regarding their effectiveness remains limited. This study aimed to systematically review and meta-analyse the effectiveness of peer-led community testing interventions on HIV testing uptake among key populations.

Methods: Systematic search of PubMed, Embase, Global Health, CINAHL, and Web of Science (2014-2024) for randomized controlled trials and quasi-experimental studies. Screening, quality assessment (Cochrane Risk of Bias tool), and meta-analysis using Hedges' g as the pooled effect measure. GRADE methodology applied to assess certainty of evidence. Sensitivity analysis excluding systematic reviews conducted.

Results: Seven studies (52,698 participants; 31,381 intervention, 21,317 control) met inclusion criteria. Pooled standardized mean difference was 0.4834 (95% CI: 0.3671 to 0.5997; p < 0.001), indicating a moderate effect of peer-led testing on uptake. Heterogeneity was moderate (I² = 55.23%, τ² = 0.0111). GRADE analysis indicated moderate certainty of evidence, downgraded for study design heterogeneity but upgraded for large absolute effect and consistency. The 95% prediction interval ranged from −0.05 to 1.02, suggesting that while most future settings would benefit, some may show minimal effects. Sensitivity analysis excluding two systematic reviews (5 primary studies: g = 0.58) remained statistically significant. Subgroup analysis demonstrated differential effectiveness by setting and intervention modality.

Conclusion: Peer-led community testing models yield moderate improvements in HIV testing uptake among key populations. Translation to policy implies approximately 9,600 additional individuals tested per 100,000 reached, potentially yielding 288-480 additional diagnoses at 3-5% prevalence. However, sustainability, linkage to care, and integration within health systems remain critical implementation challenges. Further research addressing long-term retention, cost-effectiveness, and contextualization to specific key population and geographic settings is warranted.

Cold Agglutinin Disease Presenting with Acute Encephalopathy in an Elderly Patient with Multiple Comorbidities: A Case Report and Laboratory Diagnostic Perspective

Tue, 28 Apr 2026 05:51:52 +0000

Introduction: Cold agglutinin disease (CAD) is a rare form of autoimmune hemolytic anemia caused by monoclonal immunoglobulin M autoantibodies that bind to red blood cells at temperatures below 37 degrees Celsius. CAD typically manifests with chronic hemolytic anemia in elderly patients, but presentations with acute, severe complications remain infrequent.

Case presentation: We report a 70-year-old male patient who presented with acute decreased consciousness lasting 2 hours, preceded by one week of cough and fever. Initial clinical evaluation suggested sepsis-associated encephalopathy. However, a comprehensive laboratory investigation, including peripheral blood smear and direct Coombs test, revealed CAD as the underlying diagnosis. Critical laboratory finding was marked mean corpuscular hemoglobin concentration elevation to 43 g/dL, exceeding physiologic maximum and indicating erythrocyte agglutination interference. Positive Coombs test with immunoglobulin G sensitization and positive cold agglutinin titer confirmed the diagnosis. The patient had significant comorbidities, including chronic kidney disease Stage V, type 2 diabetes mellitus, and heart failure with coronary artery disease. The patient subsequently underwent supportive care with cooling precautions, and clinical improvement was noted.

Conclusion: This case exemplifies how careful attention to laboratory pattern recognition, particularly supraphysiologic mean corpuscular hemoglobin concentration values, can facilitate the diagnosis of CAD in elderly patients presenting with acute multisystem complications. The role of clinical pathology in the diagnostic identification of rare hematologic disorders deserves emphasis in medical education and clinical practice.

Kimura Lymphadenitis of the Retroauricular Region in a 48-Year-Old Indonesian Male: A Rare Case Report with Long-Standing Disease Duration

Kadek Susi Setyawati, Ketut Suardamana, Dekta Filantropi Esa — Tue, 28 Apr 2026 08:10:00 +0000

Introduction: Kimura disease is a rare chronic inflammatory disorder of unknown etiology predominantly affecting young Asian males, characterized by painless subcutaneous masses in the head and neck region, peripheral eosinophilia, and elevated serum immunoglobulin E levels. This condition remains underreported in Southeast Asian countries, particularly Indonesia, leading to significant diagnostic delays.

Case presentation: We present the case of a 48-year-old Indonesian male from Bali who presented with a retroauricular mass persisting for 10 years prior to definitive diagnosis. The patient had undergone surgical excision one month prior and was subsequently referred for further evaluation. Laboratory investigations demonstrated leukocytosis with a white blood cell count of 13.82 × 10³/µL, peripheral eosinophilia of 8.60%, absolute eosinophil count of 1.19 × 10³/µL, and elevated total serum immunoglobulin E of 168.16 KUI/L. Renal function was preserved without proteinuria despite prolonged disease duration. Histopathological examination confirmed Kimura lymphadenitis with reactive follicular hyperplasia, dense eosinophilic microabscesses, vascular hyalinization, and multinucleated Warthin-Finkeldey giant cells. The patient was managed with surgical excision followed by oral methylprednisolone 8 mg daily with planned tapering.

Conclusion: This case highlights diagnostic challenges of Kimura disease in Indonesian clinical settings and the importance of histopathological confirmation.