Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Evans Syndrome in a Forty-Four Years Old Male Patient: A Case Report
Get PDFBackground: Evans syndrome (ES) is an autoimmune disease characterized by the presence of autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenic purpura (ITP), together with unknown causes. ES disease is the least common, diagnosed in only 0.8% - 3.7% of all patients with AIHA or ITP. This study aimed to describe Evans syndrome in a 44-year-old male patient.
Case presentation: A 44-year-old male patient was reported with complaints of weakness and fatigue, red spots, a history of bleeding gums, a history of bleeding from the nose, and a history of red urination. A routine blood examination revealed mild anemia, reticulocytosis, and thrombocytopenia, and the peripheral blood showed polychromatic erythrocytes. Other laboratory examinations revealed an increase in LDH. The results of a positive Comb’s test and antibody screening examination showed the impression of warm-type AIHA. The diagnosis of Evans syndrome in this patient was confirmed by the presence of AIHA and ITP, which co-occur and are primarily due to unknown causes.
Conclusion: ES is a rare disorder and a diagnosis of exclusion. The diagnosis of ES was established by the presence of signs and symptoms of AIHA and ITP accompanied by a positive direct antiglobulin test with no other etiology found
Clinical Overview and Treatment of Hypokalemia in Pediatric Patients: A Narrative Literature Review
Get PDFHypokalemia is a condition in which the blood potassium levels are below the normal range, which is typically between 3.5 and 5.0 mEq/L. Potassium is an essential electrolyte that plays a critical role in many physiological processes in the body, including nerve and muscle function, heart rhythm, and acid-base balance. This literature review aimed to describe the clinical and current management aspects of hypokalemia in pediatric patients. The pathophysiology of hypokalemia involves a disturbance in the balance of potassium in the body, which can occur due to several mechanisms, including reduced intake of potassium-rich foods, increased loss of potassium, and redistribution of potassium. In children, clinical symptoms of hypokalemia may include weakness and fatigue, abdominal discomfort, cardiac symptoms, respiratory symptoms, neurological symptoms, polyuria, and renal symptoms. There are several diseases and conditions that can cause hypokalemia in children, including renal tubular acidosis, prolonged diarrhea, cystic fibrosis, hyperaldosteronism, malnutrition, medication, type 1 Bartter syndrome, type 2 Bartter syndrome, and Liddle syndrome. Some options for hypokalemia treatment are potassium supplements, a potassium-rich diet, intravenous potassium, and treating underlying conditions. In conclusion, hypokalemia is an overview of the underlying disease and requires immediate management. Understanding the pathophysiology of hypokalemia will increase the accuracy of diagnosis and accelerate hypokalemia intervention in children, as well as prevent complications due to hypokalemia
The Relationship between Basic Sanitation of Healthy Homes and Personal Household Hygiene with the Incidence of Stunting in Toddlers in Residential Area around TPA Cipeucang in 2023
Get PDFBackground: Stunting is one of the problems of malnutrition in toddlers in Indonesia. Environmental sanitation has an important role in stunting. Waste management that has not been maximized at the TPA can cause environmental sanitation pollution and a lack of clean living behavior. Cipeucang TPA is the only TPA for the South Tangerang area, with 2 Sub-Districts that are close to the TPA experiencing an increase in stunting cases in 2021-2022. This study aimed to determine the relationship between basic sanitation in a healthy home and personal hygiene households with the incidence of stunting in toddlers in the residential area around TPA Cipeucang.
Methods: This type of research is observational analytic through a cross-sectional approach. The study population was all toddlers in settlements around the TPA covering 2 Sub-Districts with 4 RT and 2 RW. The research sample was 86 using a purposive sampling technique. The research was conducted from April to June 2023. Data analysis used univariate, bivariate (Chi-square test), and multivariate (logistic regression test).
Results: The results showed that there was a relationship between drinking water facilities and stunting (p=0.05, POR=1.89), and became the dominant factor causing stunting (p=0.054). While clean water facilities (p=0.374, POR=1.44), latrines (p=0.613, POR=1.22), wastewater disposal facilities (p=1.000, POR=1.54), skin hygiene (p =1.000, POR=1.24) and hand and nail hygiene (p=0.625, POR=1.22) were not related to stunting but were risk factors for stunting. Waste management facilities (p=0.310) have no relationship with stunting and are not a risk factor.
Conclusion: There is a relationship between drinking water facilities and the incidence of stunting in toddlers in the residential area around TPA Cipeucang
The Relationship between Serum Cystatin-C Levels and Impaired Cognitive Function in Patients with Chronic Kidney Disease
Get PDFBackground: Cystatin-C acts as a neuroprotector in the central nervous system at normal levels, but high serum cystatin-C levels are associated with impaired cognitive function. Serum cystatin-C levels increase in impaired renal function, and cognitive impairment are comorbidities that can increase the morbidity and mortality of chronic kidney disease patients. This study aimed to assess the relationship between serum cystatin-C levels and cognitive function in chronic kidney disease patients.
Methods: This study used a cross-sectional design with 73 samples of non-hemodialysis chronic kidney disease patients. Cognitive function was assessed using the MoCa-Ina. Serum cystatin-C levels of all samples were measured by the ELISA method. Data analysis was carried out using SPSS.
Results: Impaired cognitive function in CKD patients was found to be 76.7%. The median serum cystatin-C level of CKD patients with impaired cognitive function (n=56) was 1.015 mg/dL, and without cognitive impairment (n=17) was 0.929 mg/dL. There was no significant relationship between serum cystatin-C levels (cut-off point 0.98 mg/dL) and impaired cognitive function (OR : 2.05, 95% CI : 0.680-6.175, p= 0.198).
Conclusion: There is no relationship between serum cystatin-C levels and cognitive function impairment in non-hemodialysis chronic kidney disease patients
The Effect of Giving Cucumber Masks against Melasma in Acceptors of Combination Injection Contraception Users at the Independent Midwife Practice in Bungursari, Purwakarta, Indonesia
Get PDFBackground. Cucumber is one of the natural ingredients that has been widely used traditionally to maintain facial skin health. Cucumber is rich in antioxidants which have the potential to suppress the inflammatory process that arises due to hormonal imbalances in melasma sufferers due to the use of injectable contraception. This study aimed to determine the effect of using a cucumber mask on the incidence of melasma in acceptors injection contraception users at the independent midwife practice in Bungursari, Purwakarta, Indonesia.
Methods. This study was an experimental study in which a total of 30 research subjects participated in this study. Data analysis was carried out using SPSS 25 software in a bivariate manner to determine the effect of using cucumber masks on melasma.
Results. After using the cucumber mask on the first day, there was an improvement in melasma in the intervention group compared to before using the cucumber mask, p=0.02 (p<0.05). Likewise, after using the cucumber mask on the second to the seventh day, there was an improvement in melasma in the intervention group compared to before using the cucumber mask, p <0.05.
Conclusion. There is an effect of using a cucumber mask on melasma in acceptors of injection contraception users at the independent midwife practice in Bungursari, Purwakarta, Indonesia
Comparison of SARS-CoV2 IgG Antibody Levels in Health Workers with and without a History of COVID-19 Infection after Heterologous Vaccination at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
Get PDFBackground: The COVID-19 pandemic, which has spread very quickly, has created crises in all aspects of life around the world. The administration of the COVID-19 heterologous vaccine in Indonesia is prioritized for high-risk groups, one of which is health workers. This study aimed to determine the comparison of quantitative IgG antibody levels for SARS CoV2 between health workers with and without a history of being infected with COVID-19 after heterology vaccination at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.
Methods: This study was a cross-sectional analytic observational study. A total of 64 subjects participated in this study. Data analysis was carried out with the help of SPSS software in univariate and bivariate.
Results: SARS-CoV2 IgG antibody levels with and without a history of being infected with COVID-19 after heterologous vaccination did not find a significant difference in IgG levels between the two groups. However, the quantitative IgG levels of SARS-CoV2 in the infected history group were greater, namely 4834.25 AU/mL, compared to no history of COVID-19 infection of 3833.35 AU/mL
Conclusion: There is a difference in the average SARS-CoV 2 IgG between subjects with a history of being infected with COVID-19 and without a history of COVID-19 at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia, although statistically, it is not significantly different
The Effectiveness of Garlic Extract (Allium sativum) against Decreased Serum Levels Tumor Necrosis Factor-α (TNF-α) in Chronic Hemodialysis Patients at Dr. Mohammad Hoesin General Hospital
Get PDFBackground: Chronic kidney disease (CKD) is a pathophysiological process with various etiologies resulting in a progressive decline in kidney function and generally ends in kidney failure. During hemodialysis, inflammation and activation of TNF-α and other proinflammatory cytokines occur. This inflammatory condition causes a decrease in the effectiveness of HD in reducing the mortality of patients with CKD. Garlic has the potential as an anti-inflammatory agent due to its high antioxidant content in garlic. This study aimed to determine the effectiveness of garlic extract (Allium sativum) on decreasing serum levels of tumor necrosis factor-α (TNF-α) in chronic hemodialysis patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.
Methods: This study is an experimental study with a randomized, controlled, double-blind trial crossover design. A total of 40 research subjects participated in this study which was grouped into treatment (garlic extract) and placebo groups. TNF-α levels were measured using the ELISA method. Data analysis was carried out using SPSS univariate and bivariate.
Results: The results of the study showed that the administration of garlic extract was able to reduce TNF-α levels by 12.5 pg/mL, p<0.05. In contrast, in the placebo group, there was an increase in TNF-α levels of 8.3 pg/mL, p<0.05.
Conclusion: Garlic extract (Allium sativum) is effective in reducing tumor necrosis factor-α (TNF-α) serum levels in chronic hemodialysis patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
En Coup De Sabre in 16-Year-Old Girls: A Case Report
Get PDFBackground: En coup de sabre (ECDS) is one of the clinical variations of morphea. ECDS refers to a variant of linear morphea that usually involves the forehead and frontal scalp that may be associated with alopecia. This study aimed to describe a case of en coup de sabre with its diagnosis and management.
Case presentation: A girl, aged 16 years, came to the dermatology polyclinic with the main complaint of a sunken brown spot on the left forehead and corner of the left eye, which has been expanding since 2 months ago. This complaint does not feel itchy or painful, but because it is getting more widespread, patients feel embarrassed and often cover it up. On dermatological examination, depressed hyperpigmented macules, plaque size, firm boundaries, and location on the left medial superior lid and left medial glabella were found. On dermoscopy examination, a reticular pigment network obliterating the follicular opening was found. The results of the histopathological examination showed the impression of a linear morphea type with en coup de sabre. This patient was diagnosed with linear morphea type with en coup de sabre
Conclusion: En coup de sabre is a rare autoimmune disorder and is a subtype of morphea. Early detection and appropriate intervention will reduce disease progression
Combined General Anesthesia with Epidural Analgesia as a Modality for Adrenal Teratoma Resection in Patients with Coronary Arterial Disease
Get PDFBackground: Adrenalectomy in patients with coronary arterial disease poses a significant challenge requiring good preoperative evaluation, perioperative hemodynamic control, and a detailed and careful anesthetic strategy. Teratomas are benign tumors that develop from pluripotent cells with two or more germ cell layers. Teratomas can develop in the ovaries and testes. Retroperitoneal teratoma, particularly adrenal teratoma, is rare. Indications for adrenal gland surgery include hormonal secretory tumors and non-hormonal secretory tumors.
Case presentation: A 66-year-old man complained of discomfort in the right upper abdomen. From the results of the CT scan, an adrenal teratoma was obtained, and an adrenalectomy operation was planned. The patient underwent adrenalectomy with general anesthesia. Induction was carried out with propofol titrating doses of 100-150 mg until the patient was hypnotized and intubated with Atracurium 30 mg IV. The patient underwent an arterial line and CVC with ultrasound guiding during surgery.
Conclusion: Anesthetic techniques should aim to maintain a myocardial oxygen supply that is greater than required to avoid ischemia. It is necessary to control perioperative hypertension, hyperglycemia, hypokalemia, and blood cortisol levels and maintain the balance of myocardial oxygen supply
Pain Management in Blast Crisis Phase of Chronic Myeloid Leukemia: A Case Report
Get PDFBackground: Chronic myeloid leukemia (CML) is a slow-growing type of cancer that begins in the bone marrow's blood-forming cells and is caused by a chromosomal mutation that is assumed to develop spontaneously. As CML advances into the rapid or blast phase, it can cause significant pain. This study aimed to describe pain management in the blast crisis (BC) phase of CML.
Case presentation: A 48-year-old female diagnosed with CML in the BC phase complained of severe pain in the head, shoulders, back, and tailbone area with a numeric rating scale (NRS) of 9/10. The patient received multimodal analgesic therapy with continuous IV fentanyl at a rate of 0.25 mcg/kg/hour and ketamine at 1.3 mcg/kg/minute for 24 hours. The dosage was gradually increased through titration with a target NRS of 4/10. On the fifth day, we replaced fentanyl with morphine at 0.04 mg/kg/hour and ketamine at 1.3 mcg/kg/minute, and we reduced the titration dose according to the patient’s NRS, and her pain was controlled with NRS 3-4/10 after 7 days of treatment. On the 9th day, she was discharged with oral therapy.
Conclusion: Multimodal analgesia has been shown to effectively reduce the intensity of the pain in blast crisis phase