Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Neuraxial Anesthesia for Cesarean Section in Pregnant Women with Ruptured Arteriovenous Malformation
Get PDFBackground: Maternal stroke as a result of ruptured arteriovenous malformation (AVM) in pregnancy is rare. However, AVM rupture can result in high morbidity during pregnancy and the puerperium. In its management, several special considerations are needed to ensure the welfare of the mother and fetus. This article will discuss anesthesia in pregnant patients after hemorrhagic stroke due to AVM rupture under neuraxial anesthesia.
Case presentation: A 25-year-old patient with a second pregnancy with twins at 33 weeks came with complaints of water coming out of the birth canal 1.5 hours before admission to the hospital. The patient was diagnosed with G2P0010 33 Weeks 3 days Gemelli H/H head presentation, buttocks presentation, intracerebral hemorrhage (ICH) et cause suspected AVM rupture, premature rupture of membranes, and first-day febrile observation and planned to undergo cito cesarean section.
Conclusion: Neuraxial anesthesia is one of the safe options for pregnant patients after a hemorrhagic stroke with controlled intracranial pressure
Clinical Insights into Internuclear Ophthalmoplegia: A Case Report
Get PDFBackground: Internuclear ophthalmoplegia (INO) is a rare neuro-ophthalmological disorder characterized by impaired horizontal eye movement coordination due to lesion in the medial longitudinal fasciculus. INO commonly results from demyelinating diseases, vascular lesions, or structural brain abnormalities.
Case presentation: A 60-year-old male patient presented with diplopia for the past 4 days. He had history of hypertension and diabetes mellitus and “mild” stroke for past years. Clinical examination revealed normal primary gaze, limited medial movement of the left eye, and diplopia in all gaze positions. Hess screen examination demonstrated underaction of the left medial rectus muscle and overaction of the right lateral rectus muscle. The laboratory results an elevated blood sugar level. Brain CT scan revealed multiple infarcts in the right parietal and cerebellar lobes and left parieto-occipital lobe, with evidence of brain atrophy. The patient was diagnosed with INO. Management involved addressing the underlying systemic diseases, namely diabetes and hypertension, in collaboration with internist and neurologist. The patient also received citicoline therapy and underwent regular follow-up. In the third-month follow-up, the patient demonstrated significant improvement, with reduction in diplopia and enhancement in left eye medial movement.
Conclusion: This case report highlights the importance of considering INO in patients presenting with diplopia and a history of vascular risk factors. Timely diagnosis and comprehensive management with regular follow-up is crucial to monitor the progress and enhance the patient's quality of life
Comparison of Post Vaccination Antibody Levels for Coronavirus Disease 2019 (COVID-19) between Survivors and Non-Survivors of COVID-19
Get PDFBackground: The COVID-19 vaccine is useful for protecting the body by causing or stimulating specific immunity in the body. COVID-19 survivors are a group of individuals who have been exposed to COVID-19 and have successfully recovered from COVID-19 infection. Exposure to COVID-19 causes the activation of memory cells and anti-SARS-CoV-2 IgG antibodies. In contrast to individuals who have never been exposed to COVID-19, the bodies of individuals who are not COVID-19 survivors have not had the experience of exposure to COVID-19, which causes the absence of memory cells and anti-SARS-CoV-2 IgG antibodies. This study is one of the first studies to explore differences in anti-SARS-CoV-2 IgG antibody levels in survivors and non-survivors of COVID-19 at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.
Methods: This was an analytic observational study with a cohort approach. A total of 136 research subjects participated in this study. Observation of anti-SARS-CoV-2 IgG levels was carried out before vaccination, weeks 2, 12, and 24. Data analysis was carried out using SPSS univariate and bivariate.
Results: The COVID-19 survivors group consistently from the time they were vaccinated, weeks 2, 12, and 24 showed a relatively higher average anti-SARS-CoV-2 IgG level than the non-COVID-19 survivors' group. The group of survivors of COVID-19 shows a trend of decreasing average anti-SARS-CoV-2 IgG levels over time. In contrast to the non-survivor group of COVID-19, which showed a trend of increasing anti-SARS-CoV-2 IgG levels.
Conclusion: There were differences in anti-SARS-CoV-2 IgG levels between the COVID-19 survivor group and non-survivor COVID-19 group at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
Alcohol-Induced Hyperosmolar Hyperglycemic State in Type 1 Diabetes Mellitus: A Case Report
Get PDFBackground: Adolescents with diabetes mellitus who consume alcohol increase the risk of developing diabetic ketoacidosis (DKA) and HHS. In addition, alcohol consumption has long-term adverse effects on the glycemic control of type 1 diabetes mellitus. This study aimed to describe cases of alcohol-induced hyperosmolar hyperglycemic state in adolescents with type 1 diabetes mellitus.
Case presentation: A teenage boy, aged 15 years, came with his family to the ER with complaints of weakness. The patient also complained of persistent tingling in the legs for the last two weeks. Three days before entering the hospital, the patient also felt blurred vision that disturbed him while studying at school. The results of the physical examination stated that the general condition was weak, compos mentis, pulse 80x/minute, blood pressure 110/70 mmHg, respiratory rate 20x/minute, axillary temperature 36ºC, weight 65 kg, and height 165 cm. Examination of the extremities showed a slow return of skin turgor. Laboratory evaluation showed an increased leukocyte count (10.45x103/μL), and blood gas analysis showed mild acidosis (HCO3 24.3 mmol/L, PCO2 38.6 mmHg, PO2 82 mmHg, tCO2 26 mmol/L, pH 7.4, and SaO2 96%), HbA1c 14.2%, glucose at 621 mg/dL (hyperglycemia), C-peptide 0.87 ηg/dL. The patient was diagnosed with hyperglycemia, hyperosmolar state, type 1 diabetes mellitus, and mild dehydration.
Conclusion: The main management of alcohol-induced hyperosmolar hyperglycemic state in type 1 diabetes mellitus is fluid resuscitation to achieve hemodynamic stability, correction of electrolyte abnormalities, gradual reduction of blood sugar levels, and hyperosmolality. Insulin administration to lower blood sugar levels is done after stable hemodynamics
Diagnosis and Management of Choledochal Cyst in One Year-Old Baby: A Case Report
Get PDFBackground: Choledochal cysts (CC) are rare congenital anomalies of the biliary tract. The classic triad of jaundice, abdominal pain, and right upper quadrant mass are rare symptoms, mainly in children and adolescents. This study aimed to present the diagnosis and management of choledochal cyst cases in a baby girl.
Case presentation: A 1-year-old girl, domiciled outside the city of Padang, was brought to the hospital by her parents with complaints of repeated vomiting for 1 day before being admitted to the hospital. This complaint has been accompanied by yellowish eyes and body, pale bowel movements, and dark brown urine since 3 months ago. The patient was never brought to the doctor for treatment. Since 1 month ago, the patient often feels pain in the abdomen and has a lump in the upper right abdomen. On the abdomen area, there was no distention, hepar was ¼-1/4 sharp edge, tenderness at the epicondrium area, no rebound tenderness, turgor was decreased, and no palpable mass. Abdominal ultrasonography presented a choledochal duct cyst with biliary obstruction. Abdominal CT scan with contrast revealed intrahepatic and extrahepatic biliaryectasis et causa suggestive of the choledochal cyst (Todani IVA) and hepatomegaly. The patient was consulted by the pediatric surgery division for further management and was advised to undergo surgery with the Roux En-y procedure. Follow-up after the patient underwent surgery showed clinical improvement. Symptoms of jaundice in the eyes and skin begin to decrease, as brownish stools and light brown urine.
Conclusion: Surgical treatment with the Roux-en-Y procedure is the definitive treatment for choledochal cysts in this patient
The Outcome of Concurrent Intracameral Fluconazole Injection with Amniotic Membrane Transplantation for Fungal Keratitis in Dr. M. Djamil General Hospital: A Case Series
Get PDFBackground: Fungal keratitis is often difficult to eradicate and requires long treatment. Antifungal agents have lower efficacy because of low tissue penetration and the indolent nature of the infection. Fluconazole has effective ocular penetration ability, reaching aqueous concentration as same as plasm concentration. Multilayer amniotic membrane transplantation (MLAMT) has been shown to be a promising surgical procedure to reconstruct the ocular surface by supporting the epithelialization of the cornea and having protective antimicrobial properties. This study aims to report the outcome of concurrent intracameral fluconazole injection with amniotic membrane transplantation for fungal keratitis in Dr. M. Djamil General Hospital.
Case presentation: Four inpatients in the ophthalmology ward of Dr. M. Djamil General Hospital with moderate to severe fungal keratitis. All patients were first treated with medications. Because the patients did not show clinical improvement after getting maximum therapy, they underwent intracameral fluconazole injection concurrent with MLAMT. MLAMT was performed with multilayered amniotic membranes to fill and cover the defect. The bandage contact lens was placed to protect and keep the MLAMT in place and for patients’ comfort. Patients were then observed for signs of inflammatory reaction and epithelialization. All patients showed reduced inflammation and improved epithelization after surgery.
Conclusion: Concurrent intracameral fluconazole injection with MLAMT can be considered an alternative treatment for refractory fungal keratitis as it decreases the rate of inflammation and improves epithelization
The Effect of Giving Dark Chocolate on Reducing Menstrual Pain in Primary Dysmenorrhoea in Employees of Cabangbungin General Hospital, Bekasi Regency in 2023
Get PDFBackground. Dark chocolate can be used as an alternative to overcome pain during menstruation time because it contains many benefits in the health sector. This study aimed to determine the effect of giving dark chocolate on reducing dysmenorrhea menstrual pain in female employees of the Cabangbungin General Hospital, Bekasi Regency, in 2023.
Methods. This study was an experimental study of 32 research subjects. Data analysis was carried out univariate and bivariate using SPSS version 25.
Results. Statistical test results used test paired sample t-test obtained ρ value = 0.000, with a value of α = 0.05 (ρ <α), indicating that there is an effect of giving dark chocolate to reducing dysmenorrhea menstrual pain.
Conclusion. There was an effect of giving dark chocolate to reducing dysmenorrhea menstrual pain in female employees of the Cabangbungin General Hospital, Bekasi Regency, in 2023
Anesthesia Management in A Newborn Baby with Tracheoesophageal Fistula: A Case Report
Get PDFBackground: In infants with esophageal atresia/tracheoesophageal fistula, excessive salivation, coughing, choking, cyanosis, and regurgitation associated with attempts to eat may be seen, as well as aspiration of gastric contents. Thus difficulties encountered during anesthetic management include ineffective ventilation due to an endotracheal tube placed in the fistula, massive gastric dilatation, preexisting severe lung disease from aspiration of gastric contents and/or respiratory distress syndrome of prematurity, and associated anomalies, especially cardiac. This study aimed to discuss the anesthetic management of neonates with tracheoesophageal fistula.
Case presentation: The patient was a 12-day-old baby girl with type C tracheoesophageal fistula. Anesthesia was performed using general anesthesia. The procedure lasts 3 hours 15 minutes. The patient underwent closure of the esophageal fistula, repair of the trachea in the distal part of the tracheoesophageal fistula, and performed end-to-end anastomosis proximal and distal esophagus. Postoperatively the patient was treated at the neonatal intensive care unit on a ventilator and given a combination of opioid and non-opioid analgesics.
Conclusion: The key to successful anesthetic management in the operation of a patient with a tracheoesophageal fistula is airway management, where the ETT must be properly placed on the trachea and try not to get the ETT into the fistula
Comparison of Outcomes in Patients with Malignant Pleural Efusion et Causa Breast Cancer Metastase Thought of Pleurodesis with Talc Poudrage and Talc Slurry at Dr. M. Djamil General Hospital, Padang, Indonesia
Get PDFBackground: Breast cancer accounts for about 50-65% of malignant pleural effusions. Talc pleurodesis is one of the definitive procedures for pleural effusions in which the route of administration is divided into poudrage and slurry. This study aimed to compare the differences of outcomes in malignant pleural effusion patients et causa breast cancer metastase who receive pleurodesis therapy with talc poudrage and talc slurry.
Methods: This study has a cross-sectional design, which was conducted at Dr. M. Djamil General Hospital in May – July 2023. This study used medical records of patients diagnosed with malignant pleural effusion due to metastases of breast cancer at Dr. M. Djamil General Hospital Padang from January 2019 – July 2023. The outcomes assessed included drain production in 24 hours, drain release time, and in-hospital mortality.
Results: In this study, 12 respondents who have talc poudrage and talc slurry pleurodesis were included. In the talc poudrage group, the mean of 24-hour drain production was 259.17 ± 46.79 ml, the mean of drain release time was 4.08 ± 0.66 days, and there was one respondent who died during hospitality. In the talc slurry group, the mean of 24-hour drain production was found to be more (420.83 ± 78.21 ml), drain release time was found to be much longer (5.67 ± 0.98 days), and 3 respondents died in hospital. The bivariate analysis found a significant difference between the 24-hour drain production and drain release time of patients who underwent talc slurry and talc poudrage meanwhile there was no difference in hospital mortality.
Conclusion: Talc poudrage has a better outcome than talc slurry regarding drain production and drain release time in patients with malignant pleural effusion due to metastases of breast cancer
Diagnosis and Management of Osteosarcopenia
Get PDFOsteosarcopenia is a syndrome defined as a combination of low bone density and muscle mass as well as decreased strength and/or functional capacity. Osteoporosis and sarcopenia often coexist in the elderly, leading to a significantly worse prognosis. The epidemiology of osteosarcopenia is quite limited because the term is still new. Osteosarcopenia is more common in women than men and in malnutrition. Age-related immunological changes such as hormonal imbalance, chronic inflammation, increased oxidative stress, imbalance in protein metabolism, increased fat deposition, decreased physical activity, and poor nutritional status contribute to sarcopenia. Decreased bone density in osteoporosis can occur due to an imbalance between osteoblasts and osteoclasts. The diagnosis of osteosarcopenia is made based on the presence of osteoporosis and sarcopenia. Instrument strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC–F) are recommended for assessing sarcopenia and the fracture risk assessment tool (FRAX) for the risk of osteoporotic fracture. Management of osteosarcopenia is carried out holistically, including management of osteoporosis and sarcopenia both non-pharmacologically and pharmacologically