Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Management of Critically Ill Patients with Severe Diabetic Ketoacidosis and Acute Renal Failure: A Case Report
Get PDFBackground: Diabetic ketoacidosis (DKA) is one of the hyperglycemic crises related to diabetes. The main problem in DKA is ketogenesis, a metabolic process that increases the production and decreases the utilization of ketones. DKA is characterized by a biochemical triad such as hyperglycemia, ketonemia, and high anion gap metabolic acidosis. Management of DKA needs to be carried out appropriately and immediately because it may lead to diabetic coma and death.
Case presentation: A 38-year-old woman had decreased consciousness due to metabolic encephalopathy as a complication of severe DKA. The metabolic derangement shows an overlapping high anion gap metabolic acidosis and non-anion gap metabolic acidosis. This case is complicated by acute renal failure. The patient also had been in a hypovolemic state, causing pre-renal acute kidney injury. We treat the patient using a balanced solution to correct hypovolemia. Sonography of the vena cava and blood lactate levels are used to guide fluid resuscitation. We intubate and control the patient's breathing to reduce the metabolic demand. We titrate the insulin infusion until the ketogenesis process is abolished. Antibiotics are given based on sputum culture.
Conclusion: Acute renal failure (ARF) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA). Early recognition and aggressive treatment of ARF during DKA may improve the prognosis of these patients
Intraoperative Fluid Management Correlates with Intraoperative Complications in Cesarean Section: A Prospective Clinical Trial
Get PDFBackground: This study focused on perioperative fluid administration in pregnant women undergoing a caesarean section (CS) by comparing liberal and non-liberal fluid administration in a multicentre setting across various Hospitals in the Bali province and its surrounding areas.
Methods: Sampling was conducted using a total sampling method. All patients meeting the inclusion criteria were included in this study. A total of 310 samples of pregnant patients undergoing CS surgery in various operating rooms across hospitals in the Bali province and surrounding areas were obtained during the period of January to December 2022. The fluid administration strategy was divided into two types: liberal and non-liberal. Data analysis was performed using the Chi-square test with the correlation test of the contingency coefficient.
Results: The results showed that liberal fluid administration significantly increased complications in the operating room for pregnant patients undergoing cesarean section (p<0.001; r=0.305; OR 6.22) but not in the recovery room or postoperative hospital ward.
Conclusion: Liberal fluid administration could significantly increase complications in the operating room for pregnant patients undergoing cesarean section but not in the postoperative period
Epidural Anesthesia in Management of Pregnant Eissenmenger’s Syndrome Patient Undergoing Caesarean Section
Get PDFBackground: Eisenmenger syndrome is very rare in pregnant women. Debates remain concerning the management of Eisenmenger syndrome in this patient population, and the prognosis is unclear in terms of maternal and fetoneonatal outcomes. Managing anesthesia in maternal patients with a cardiac abnormality might be particularly difficult because these individuals have inadequate circulatory reserves and altered maternal cardiovascular physiology.
Case presentation: We present a 26-year-old 34 weeks pregnant woman with Eisenmenger’s syndrome (ES) scheduled for an elective caesarean section. The clinical findings reveal slight tachypnea with peripheral oxygen saturation of 82% with oxygen supplementation using a cannula at 3 lpm. The patient's baseline hemodynamics are stable, but a third-degree murmur is heard in the 3rd and 4th left intercostal space. The patient was managed with epidural anesthesia using bupivacaine 0.5% 20 ml without adjuvant. The epidural catheter was inserted in an interspinous process between L3-L4. The surgery was done in 90 minutes with stable hemodynamics, and postoperatively, the patient was monitored in the intensive cardiac care unit (ICCU).
Conclusion: Epidural anesthesia has been shown to provide favorable outcomes due to its slow onset and reducing the likelihood of abrupt hemodynamic changes
Surgical Outcome of Amniotic Membrane Transplantation (AMT) in Patients with Corneal Ulcer in Dr. M. Djamil General Hospital, Padang, Indonesia
Get PDFBackground: Amniotic Membrane Transplantation or AMT Graft has been known to successfully manage ocular surface diseases, especially corneal ulcers. The amniotic membrane promotes epithelialization and inhibits proteinase activity that is required for wound healing. A corneal ulcer is a potentially sight-threatening condition resulting in permanent corneal opacity.
Methods: This is a retrospective descriptive study. Subjects were patients diagnosed with corneal ulcers and have been treated with AMT grafts. The data were grouped according to age, gender, severity, cause, visual acuity before and after AMT, and time required for complete epithelialization.
Results: Fifty-two patients were included in this study, aged 41-50, with a mean age of 43,17. Men were more common than women by 88,5% vs 11,5%. AMT graft was performed for moderate and severe corneal ulcers in this study, and most of them were caused by infection. The visual acuity before AMT was mostly in the second WHO category of blindness and visual impairment. Four weeks after surgery, 34.6% of patients had improved visual acuity. Complete epithelialization was most frequently (59,6%) achieved in 15-28 days. AMT graft was repeated in 3 patients, and other surgical interventions were required for 2 patients.
Conclusion: The AMT graft has successfully managed corneal ulcer patients, especially in moderate to severe cases, in Dr. M. Djamil General Hospital, Padang, Indonesia
Pilomatrixoma Pathology Description of Squamous Cell Carcinoma: A Case Report
Get PDFBackground: Pilomatrixoma is a benign neoplasm derived from hair follicles, and it rarely happens. Some cases were misdiagnostic with another skin lesion. One of them was squamous cell carcinoma (SCC). This study aimed to describe the pilomatrixoma pathology description of squamous cell carcinoma.
Case presentation: A man, 72 years old admitted to the hospital with a chief complaint lump on his chin that penetrated into his mouth near the mandible gum. A lump had an irregular surface, hyperemic ulcer, bled easily, and penetrated into the mouth near the mandible gum. The size was 5x8x5cm, tenderness (+), and fixed with the mandible. There was no enlargement of neck nodes. The pathology description from the incision biopsy was pilomatrixoma. Wide excision, segmental mandibulectomy, and frozen section were performed on the patient, and the result was keratinizing SCC well differentiated.
Conclusion: A man 72 years old with a lump on his chin was diagnosed with pilomatrixoma, a benign neoplasm that occurs in hair follicles and is a rare case
Intensive Care Management of Preeclampsia: A Case Report
Get PDFBackground: The prevalence of preeclampsia is around 5% - 15% of all pregnant women. It can cause severe complications and even death in the mother and fetus if not adequately managed.
Case presentation: A 36-year-old housewife was admitted to the emergency department with a chief complaint of shortness of breath before hospital arrival. The patient also complained of headaches. From the physical examination, consciousness was compos mentis, blood pressure 162/100 mmHg, HR 90 x/min, RR 24x/min, SpO 96%. From abdominal ultrasound gravid 36-37 weeks according to biometry, fetal alive, gemelli, intrauterine, transverse lie right head dorsoinferior- breech presentation, the Laboratory in emergency room result, haemoglobin: 10,4, leukocyte, 13.020, thrombocyte 359.000, hematocrit 31, ureum: 11, creatinin: 0.5, glucose: 72, protein urine: +2.
Conclusion: In patients with preeclampsia, proper diagnosis and appropriate treatment in the intensive care unit and management by a multidisciplinary team can prevent preeclampsia complications and improve preeclamptic patients' outcomes
The Relationship between Skeletal Muscle Strength and Cardiac Senescence Performance in the Elderly at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
Get PDFBackground: The aging process is physiological, but the onset, rate, and extent of the progression of aging at the cell, tissue, organ, and system level are very heterogeneous because they are influenced by genetic and environmental factors. The aging process is known to involve the entire body, including musculoskeletal and cardiovascular components. Several theories explain this association, including reduced muscle mass associated with chronic heart failure, decreased serum myostatin, and cross-talk between skeletal and cardiac muscle mediated by inflammatory cytokines. This study aimed to determine the relationship between skeletal muscle strength and cardiac performance in elderly patients at Dr. Mohammad Hoesin General Hospital, Palembang.
Methods: This research is an analytical observational study with a cross-sectional design. The total sample size was 65 individuals who met the inclusion and exclusion criteria. Data analysis was carried out using the SPSS 25 for Windows program.
Results: Handgrip strength has a significant relationship with diastolic dysfunction on a numerical scale (p=0.009). Low handgrip strength has a 3 times greater risk of experiencing diastolic dysfunction than patients with Normal Handgrip Strength.
Conclusion: Skeletal muscle strength has a relationship with cardiac senescence performance in elderly patients at Dr. Mohammad Hoesin General Hospital, Palembang
Target Therapy in Systemic Lupus Erythematosus: A Narrative Literature Review
Get PDFSystemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by the presence of autoantibodies against cells and involves many organ systems in the body. The Lupus Foundation of America estimates that around 1.5 million cases occur in America and at least 5 million cases occur worldwide. Every year it is estimated that there are around 16 thousand new cases of SLE. Various pro- and anti-inflammatory cytokines such as transforming growth factor (TGF), interleukin-10, B cell activating factor (BAFF), interferon-α, interleukin-17, and interleukin-23 play an important pathogenic role. Disruption of apoptotic cells and immune complexes is an important contributor to the development of this disease. Loss of immune tolerance increases antigenic load, excessive role of T cells, impaired B cell suppression and impaired transition of the immune response from T helper 1 (Th1) to Th2 which causes hyperactivity of B cells and produces pathogenic autoantibodies. The management of cases of severe or refractory SLE to conventional therapy has attracted a lot of attention in recent years, so that many researchers have developed several targeted therapies that have been tested on SLE, such as anti-CD 20 and CD 22 antibodies and BAFF inhibitors found in B lymphocyte cells. The Rituximab anti-CD 20 antibody target has been clinically proven to be able to improve the severity of SLE, while the effectiveness of other targeted therapies is still under research
Expression of Estrogen Receptor and Progesterone Receptor in Meningioma Patients
Get PDFBackground: Meningioma is a primary intracranial benign tumor that is affected by the balance of the estrogen and progesterone hormones. This study aimed to assess the relationship between estrogen receptor (ER) expression and progesterone receptor (PR) expression in meningioma conditions.
Methods: Analytical observational research with a cross-sectional study design. The number of samples is 25 meningioma patients who performed ER and PR examinations. The research was performed at Dr. Kariadi General Hospital Semarang. Statistical test using Spearman test.
Results: Relationship of ER and PR to degree of meningioma is p = 0.181 (r = -0,276) and p = 0,056 (-0,387).
Conclusion: There is no correlation between estrogen receptor (ER) and progesterone (PR) receptor to the degree of meningiom
Management of Clavicle Midshaft Fractures: A Comparative Prospective Study in Jammu
Get PDFBackground: Clavicle fracture, which is also commonly known as a broken collarbone, occurs mostly due to direct high impact energy over the bone due to a fall onto the lateral shoulder or on the outstretched hand. It has been seen that such types of fractures are prevalent among active and sports persons due to sporting activities. This study aimed to assess the pros and cons associated with conservative and surgical management of clavicle fractures.
Methods: The present prospective comparative study was conducted at Government Medical College Kathua between February 2021 to January 2022. There was a total of 52 patients, with 26 patients in each group. Group A patients were given conservative management, while Group B patients were operated on for plate fixation.
Results: The average fracture union time in group A was slightly higher compared to group B (15.9 vs. 13) weeks. And the difference was statistically significant with a p-value of 0.0483. We observed that there exists a significant difference between the two groups with respect to the total score at 24 weeks (6 months). Evidently, the average CMS score for the conservative group is smaller compared to the operated group (89.95 vs. 94.2) weeks. However, the majority of patients in group A had malaunion complications (65.4%) compared to (3.8%) in group B, and the difference was statistically significant.
Conclusion: Evidently, post six months of displaced midshaft clavicle fracture, the rate of complications was more prevalent in group A compared to group B