E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Preventing the Incidence of Severe Preeclampsia by Maintaining an Ideal Body Weight During Pregnancy
Full text linkPreeclampsia is a pregnancy-specific disease potentially leading to complications, morbidity, and mortality. In general, obesity may cause preeclampsia through several common mechanisms. This study aimed to examine the association between obesity and the incidence of severe preeclampsia (SP) at Dr. Dradjat Prawiranegara General Hospital, Serang, Indonesia. A retrospective cohort design was used and the sample comprised of 168 parturients (84 SP and 84 non-SP subjects). Sample selection was consecutively conducted from June to November 2023, while data were analyzed using the Chi-Square test and multivariable analysis with multiple logistic regression. There was a statistically significant relationship between nutritional status and obesity in participants with SP history (p<0.05). Obese women had a 2.96 times higher risk of developing SP compared to non-obese. Additionally, the study found that multigravidas (≥G2) had a 2.19 times higher risk of suffering from SP compared to primigravidas (G1) (p=0.019). Furthermore, women who only completed ≤ junior high school education had a 2.14 times higher risk of suffering from SP compared to those who completed ≥ high school (p=0.060). In conclusion, women in delivery who suffered from obesity have a 2.68 times greater risk of suffering SP than non-obese, as evident from both bivariable and multivariable analyses
Correlation between Hemoglobin Concentration and Oxygen Saturation Post-Exercise with Cardiorespiratory Fitness: Early Indicators for Cardiovascular Health in Young Adults
Full text linkBackground: Cardiorespiratory fitness (CRF) is an important indicator of cardiorespiratory health and a strong predictor of mortality. Several factors affect CRF, including arterial oxygen content (CaO2), which is influenced by hemoglobin (Hb) concentration and oxygen saturation. However, the correlation between CRF and Hb remains inconclusive. This study aimed to explore the correlation between Hb concentration and oxygen saturation post-exercise with CRF, especially in young adults.Methods: A cross-sectional study was conducted in October 2024, involving 68 medical students from a university in Jakarta, Indonesia. Consecutive stratified sampling was applied based on gender. The Global Physical Activity Questionnaire (GPAQ) and the Physical Activity Readiness Questionnaire (PAR-Q+) were used as screening tools. Hb concentration and oxygens saturation were measured using a digital hemoglobinometer and pulse oximetry, while CRF was evaluated using a 20-meter multistage test. Additional measurements included body mass index (BMI), blood pressure, and heart rate. Data were analyzed with correlation and multiple linear regression tests.Results: The most participants were female (57.4%). Normal Hb concentration was found in 80.9% with mean Hb levels of 14.15±1.54 g/dL in males and 12.9±1.37 g/dL in females. CRF correlated positively with Hb concentration (p=0.005; r=1.13), and negatively with oxygen saturation post-exercise (p=0.005; r=-0.4). These correlations were significant in males and not in females. Conclusion: Hb concentration and oxygen saturation post-exercise significantly correlate with CRF in males, whereas BMI and physical activity play stronger roles in females. Maintaining optimal Hb levels, preventing anemia, and promoting active lifestyles are essential strategies to support CRF, cardiovascular health, and long-term wellness
Heat Stress Exposure and Chronic Kidney Disease in Indonesian Rayon Factory Workers
No full textChronic kidney disease (CKD) has become an emerging occupational health concern, particularly among workers exposed to high temperatures. This study aimed to determine the prevalence of CKD among workers in a rayon factory in West Java, Indonesia, and evaluate its association with occupational heat exposure. A retrospective cohort study was conducted using secondary data from the company’s annual medical check-up records (2022–2023) and workplace heat stress measurements obtained in 2017 using the Quest Temp Wet-Bulb Globe Temperature monitor. Workers who completed medical examinations in both years and gave written informed consent to participate in the study were included. CKD was defined as a serum creatinine level >1.2 mg/dL and an estimated glomerular filtration rate <60 mL/min/1.73 m² in two consecutive years. Chi-square tests were used for bivariate analysis, and multivariate logistic regression was performed to obtain adjusted odds ratios (ORs). Of 675 eligible workers, male constituted the majority (99.7%) and 49% were older than 40 years. Most workers (96.1%) were exposed to workplace temperatures above 28°C, and obesity (47%), hypertension (16.7%), and diabetes mellitus (5.5%) were common comorbidities. The prevalence of reduced kidney function was 5.5%, with heat exposure of 28.2–30°C associated with an OR of 4.5 (95% CI: 1.372–14.792). The prevalence of CKD was 0.9%, and heat exposure in the same temperature range demonstrated an OR of 8.958 (95% CI: 1.207–66.515). However, the association was not statistically significant after adjusting for age, obesity, and hypertension. These findings suggest that occupational heat exposure may contribute to early kidney impairment, highlighting the need for heat mitigation strategies and routine worker health monitoring in industries where workers are at risk of heat exposure
Left Ventricular Function in Steroid-Resistant Nephrotic Syndrome At Dr. Hasan Sadikin Hospital
No full textSteroid-resistant nephrotic syndrome (SRNS) is a nephrotic syndrome (NS) which does not respond to high-dose corticosteroid therapy after 4 to 8 weeks. SRNS occurs in approximately 10–20% of childhood idiopathic nephrotic syndrome. SRNS patients are at risk of developing cardiovascular complications due to the long duration of the disease. This retrospective descriptive study investigated left ventricular function in pediatric patients with steroid-resistant nephrotic syndrome (SRNS) at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from 2018 to 2022. A total of 42 patients aged 1 month to 18 years who underwent transthoracic echocardiography (TTE) were included. Left ventricular function was assessed using ejection fraction (EF) and fractional shortening (FS). Most patients (61.9%) had normal EF and FS values, while 38.1% showed decreased systolic function. The mean EF and FS were 55.8% and 30.2%, respectively, with median values of 59.3% and 31.2%. An important finding in this study is that some children with SRNS exhibited decreased EF and FS values despite having no other identifiable risk factors for ventricular dysfunction, such as congenital heart disease (CHD), rheumatic heart disease (RHD), chronic kidney disease (CKD), or hypertension. This finding sugest that ventricular dysfunction may still occur independently in some cases of SRNS
Faktor Risiko Komorbid pada Mortalitas Sepsis
No full textSepsis merupakan disfungsi organ yang disebabkan oleh respons berlebihan tubuh terhadap infeksi dan dapat mengancam jiwa. Secara global, insiden sepsis di rumah sakit mencapai 189 kasus per 100.000 orang per tahun dengan tingkat moralitas 26,7%. Salah satu faktor yang dapat memengaruhi luaran pasien adalah komorbiditas. Penelitian observasional analitik dengan desain potong lintang dilakukan untuk menilai faktor risiko komorbid yang berhubungan dengan kematian pasien sepsis di Rumah Sakit PKU Muhammadiyah Gamping pada tahun 2022–2023. Berdasarkan data rekam medik diperoleh 55 subjek dengan sepsis, baik yang meninggal maupun hidup, dengan komorbid meliputi gangguan paru, gangguan jantung, gangguan ginjal, gangguan saraf, dan diabetes mellitus. Analisis menggunakan uji chi-square menunjukkan bahwa dari lima faktor komorbid yang dianalisis, dua faktor berhubungan signifikan dengan mortalitas, yaitu gangguan paru dan gangguan ginjal (p<0,05).Sepsis adalah kondisi disfungsi organ yang disebabkan oleh reaksi berlebihan tubuh terhadap infeksi dan mengancam jiwa. Secara global, insiden sepsis di rumah sakit mencapai 189 kasus per 100.000 orang per tahun, dengan tingkat kematian 26,7%. Salah satu faktor yang dapat mempengaruhi kondisi akhir pasien sepsis adalah komorbiditas. Studi observasional analitik dengan desain cross-sectional dilakukan untuk mengetahui faktor risiko komorbid terkait kematian pasien sepsis di RS PKU Muhammadiyah Gamping. Dari data rekam medik diperoleh 55 subjek sepsis meninggal maupun hidup dengan beberapa komorbid yaitu: gangguan paru, gangguan jantung, gangguan ginjal, gangguan saraf, dan diabetes mellitus. Hasil analisis data menggunakan regresi bivariat chi square menunjukkan bahwa dari lima faktor komorbid yang dianalisis, terdapat dua faktor yang secara signifikan terkait dengan mortalitas pasien sepsis, yaitu gangguan paru, dan gangguan ginjal (p< 0,05)
Prognostic Nutritional Index (PNI) at Admission Predicts In-Hospital Mortality of COVID-19-Infected Patients
No full textCorona Virus Disease-2019 (COVID-19) was declared a pandemic in March 2020 and caused considerable deaths in all parts of the world. Mortality is influenced by the immune system status and increased vulnerability to infection, both related to nutritional status. The Prognostic Nutritional Index (PNI), calculated using lymphocyte count and albumin levels, may have the ability to more accurately characterize the nutritional and inflammatory conditions of COVID-19 patients. This retrospective study analyzed 967 COVID-19 patients at Ulin Hospital Banjarmasin, Indonesia, by examining demographic data, laboratory results, and PNI in relation to survival outcomes. The study revealed that factors such as age, sex, comorbidities (including hypertension, diabetes mellitus/DM, obesity, etc.), number of comorbidities, and disease severity correlated with mortality. Leucocyte count, lymphocyte count, albumin levels, and PNI all showed significant correlations with survival (p<0.001), suggesting that these factors may serve as useful prognostic indicators for COVID-19 patient’s survival. The PNI was associated with an increased risk of mortality, with a univariate odds ratio (OR) of 0.923. Receiver operating characteristic (ROC) analysis demonstrated that a PNI cut-off value of p<41.9 had a sensitivity of 44.9% and a specificity of 82.4%, with an area under the curve (AUC) of 0.666 (p<0.001). Hence, PNI at admission, which reflects patients' immune system and nutritional status upon hospital admission, can be used as a simple, cost-effective, and reliable predictor of mortality in COVID-19 patients
AI-powered Somatic Cancer Cell Analysis for Early Detection of Metastasis: The 62 principal Cancer Types
Full text linkBackground: Early detection of metastasis is critical in improving survival outcomes in cancer patients, with artificial intelligence offering advanced tools for predictive analytics.Objective: To emphasize the importance of early metastasis detection in improving cancer patient outcomes, and to highlight that recent advancements in AI-powered somatic cancer cell analysis may enhance early detection and personalize treatment strategies.Methods: This study leveraged a comprehensive survival and artificial intelligence (AI) powered analysis to identify key genomic and clinical factors influencing cancer prognosis, with a focus on early metastatic detection. The AI algorithms explored the possibility of detecting tumors with a high spread risk. The study underscored the critical role of AI-powered analysis in the early detection of metastasis and the personalization of treatment strategies in cancer care.Results: By leveraging advanced AI algorithms, key predictors of cancer prognosis such as fraction genome alteration, primary tumor site, and smoking history, all of which significantly influence metastasis outcomes, were identified. Furthermore, the models demonstrated exceptional predictive accuracy, with XGBoost and Support Vector Machines achieving an accuracy of 0.95.Conclusion: Integrating AI capabilities into clinical workflows holds the promise of significantly enhancing early detection and treatment of metastatic cancer, thereby improving patient outcomes and optimizing therapeutic interventions
Stigma and Quality of Life Among Pre-elderly with HIV in Jakarta, Indonesia
No full textBackground: The quality of life (QoL) of people living with HIV (PLWHIV) is affected by physical, psychological, social, and spiritual aspects. During the pre-elderly period (ages 45–59 years), these aspects become major challenges. Stigma is one of the social aspects that may be related to QoL among PLWHIV. This study aimed to examine the correlation between stigma and QoL among pre-elderly with HIV.Method: This was an analytical observational study with a cross-sectional design, conducted from July 2022 to August 2023 in health services and online-based HIV communities in Jakarta, Indonesia. Sampling was performed using convenience sampling, including 120 pre-elderly living with HIV. Data were collected online using Google Forms. Stigma was assessed using the Berger HIV Stigma Scale, while QoL was measured using the WHOQOL-HIV BREF questionnaire. Data were analyzed using Spearman’s rank correlation test in SPSS.Results: Most participants were male (62.5%). The highest median scores in stigma domains were public attitudes (41) and personalized stigma (36). For QoL, the highest median scores were in the physical and spiritual domains (both 15). Personalized stigma and disclosure concerns were negatively correlated with the physical, psychological, independence, and spiritual QoL domains (p<0.05). Negative self-image demonstrated negative correlations with all QoL domains (p<0.05).Conclusions: Stigma is negatively correlated with the quality of life among pre-elderly with HIV in Jakarta. The greater the stigma experienced, the lower their quality of life. Further research using qualitative methods such as in-depth interviews, is recommended to explore the correlation of each stigma domain with the quality of life.
Functional Outcome of Biportal Endoscopy Spine Surgery for Lumbar Disc Herniation Diseases
Full text linkBiportal endoscopic spine surgery (BESS) is an innovative, minimally invasive technique to treat lumbar disc herniation (LDH). BESS provides superior surgical visualization with minimal tissue dissection. However, its application requires a thorough understanding of endoscopic anatomy and adaptation of endoscopy equipment, which are key factors in achieving optimal functional outcomes post-surgery. This study aimed to evaluate the functional outcomes and complications of BESS performed on 49 patients between 2020 and 2022 at Dr. Kariadi Hospital, Semarang, Indonesia. The majority of patients (53%) had herniation at the L4-5 level, followed by L5-S1. Pain assessment using the Visual Analog Scale (VAS) demonstrated a significant reduction in pain, from 4.26 to 1.5, post-surgery. Functional outcomes, as evaluated using MacNab’s Criteria, revealed that 93.8% of patients achieved a satisfactory condition, with 36.7% reporting no pain and 57.1% experiencing occasional pain that did not affect their daily activities. Complications were minimal, with two cases of dural tears and intraoperative bleeding. The study concludes that BESS is a safe and effective procedure for LDH, resulting in significant pain relief and functional improvement, although certain technical challenges persist
Effect of Vitamin D Supplementation on Irisin, Telomerase, Klotho, and Tumor Necrosis Factor-alpha (TNF-α) in Elderly: A Quasi-Experimental Study
Full text linkBackground: Vitamin D plays a crucial role in aging by regulating mitochondrial function, inflammation, oxidative stress, and telomere stability. Vitamin D deficiency is common among the elderly and is linked to accelerated aging. Biomarkers such as irisin, telomerase, klotho, and tumor necrosis factor-alpha (TNF-α) are associated with aging processes. This study aimed to evaluate the effect of vitamin D supplementation on these biomarkers in elderly individuals.Methods: This quasi-experimental pretest-posttest study was conducted in Kadugadung Village, Banten, Indonesia from Maret to September 2024. A total of 47 healthy elderly individuals (≥60 years) were recruited using purposive sampling. The treatment group (n=25) received 800 IU/day of vitamin D for 20 days, whereas the control group (n=22) received none. Blood samples were collected before and after the intervention to measure serum irisin, telomerase activity, klotho, and TNF-α. Baseline variables included body mass index (BMI), blood pressure, hemoglobin, hematocrit, blood glucose, cholesterol, and uric acid. Data were analyzed using paired and independent statistical tests.Results: Vitamin D supplementation significantly increased serum irisin levels (p=0.016), meanwhile no significant changes were observed in telomerase activity (p=0.128), klotho (p=0.819), or TNF-α (p=0.098). In the treatment group, blood glucose was correlated positively with TNF-α (r=0.423, α<0.05), whereas cholesterol was correlated negatively with TNF-α (r=-0.51, α<0.01). Furthermore, telomerase activity was correlated positively with irisin (r=0.348, α<0.05).Conclusion: Vitamin D supplementation at 800 IU/day significantly enhances serum irisin, but does not affect telomerase, klotho, or TNF-α. These findings suggest a potential role of vitamin D in modulating aging-related biomarkers