E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Cognitive Function and Nutritional Status in Pre-Elderly Individuals with Human Immunodeficiency Virus
No full textBackground: Human immunodeficiency virus (HIV) infection remains a global health issue, particularly in Africa and Asia. Cognitive impairment may early develop in individuals living with HIV and can therefore potentially impact nutritional status. This study aimed to assess the correlation between cognitive function and nutritional status in pre-elderly individuals with HIV.Methods: A cross-sectional study was conducted from March 2023 to October 2024 among individuals living with HIV aged 45–59 years in Jakarta, Indonesia. Cognitive function was measured using the Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina) and nutritional status was evaluated using body mass index (BMI). Data were analyzed using the Chi-square test with Jeffrey’s Amazing Statistics Program (JASP).Results: Of the 157 respondents, most were male (75.2%) with a mean age of 49±4.17 years. The majority were unmarried (44.6%), employed (70.1%), had incomes below the Jakarta minimum wage (74.5%), and had completed senior high school education (56.0%). Mild cognitive impairment was found in 70.7% of participants, whereas normal nutritional status was the most common (45.9%). However, no significant relationship was found between cognitive function and nutritional status (p=0.161). Conclusion: Mild cognitive impairment is prevalent among pre-elderly individuals with HIV, most of whom have normal nutritional status. Although no significant relationship is observed between cognitive function and nutritional status, these findings highlight the importance of incorporating early cognitive screening into routine HIV care to support healthy aging and timely identification and management of cognitive decline
Blokade Peribulbar dengan Adjuvan Fentanil: Efek Hemodinamik dan Analgetik pada Vitrektomi
No full textOperasi vitrektomi membutuhkan analgesia adekuat dan stabilitas hemodinamik, terutama pada pasien usia lanjut dengan komorbiditas. Ropivakain adalah anestesi lokal yang umum digunakan untuk blokade peribulbar, namun kualitas bloknya dapat ditingkatkan dengan penambahan opioid seperti fentanil. Studi ini merupakan penelitian pertama yang membandingkan efektivitas ropivakain 0,75% dengan kombinasi ropivakain 0,75% dan fentanil 3 μg/mL pada tekanan darah dan kualitas analgesia pada operasi vitrektomi. Desain penelitian ini adalah single blind randomized controlled trial yang melibatkan 54 pasien yang menjalani vitrektomi. Penelitian dibagi menjadi dua kelompok yang masing-masing terdiri 27 pasien: kelompok R yang menerima ropivakain 0,75% dan kelompok RF yang menerima ropivakain 0,75% dan fentanil 3 μg/ml. Tekanan darah sistolik, diastolik, MAP, serta kualitas analgesia (NRS) diukur pada tiga waktu yaitu sebelum, selama dan setelah operasi. Analisis statistik menggunakan uji t tidak berpasangan, Mann Whitney dan Chi-Square. Hasil penelitian menunjukkan bahwa tidak terdapat perbedaan bermakna dalam perubahan tekanan darah sistolik, diastolik, dan MAP antara kedua kelompok (p>0,05). Kualitas analgesia yang dinilai menggunakan NRS juga tidak menunjukkan perbedaan signifikan (p>0,05). Kesimpulan penelitian ini adalah kombinasi ropivakain 0,75 % dan fentanil 3 mcg/ml memberikan hasil yang sebanding dengan ropivakain 0,75 % saja dalam hal stabilitas hemodinamik dan kualitas analgesia pada operasi vitrektomi.Operasi vitrektomi membutuhkan analgesia adekuat dan stabilitas hemodinamik, terutama pada pasien usia lanjut dengan komorbiditas. Ropivakain adalah anestesi lokal yang umum digunakan untuk blokade peribulbar, namun kualitas bloknya dapat ditingkatkan dengan penambahan opioid seperti fentanil. Penelitian ini bertujuan membandingkan efektivitas ropivakain 0,75% dengan kombinasi ropivakain 0,75% dan fentanil 3 μg/mL pada tekanan darah dan kualitas analgesia pada operasi vitrektomi. Penelitian dilaksanakan di Netra Klinik Spesialis Mata 2 Bandung sejak Juni–Agustus 2024 yang menggunakan single blind randomized controlled trial dengan melibatkan 54 pasien yang menjalani vitrektomi. Penelitian dibagi menjadi dua kelompok yang terdiri atas 27 pasien: kelompok R yang menerima ropivakain 0,75% dan kelompok RF yang menerima ropivakain 0,75% dan fentanil 3 μg/mL. Tekanan darah sistolik, diastolik, MAP, serta kualitas analgesia (NRS) diukur pada tiga waktu yaitu sebelum, selama dan setelah operasi. Analisis statistik menggunakan uji-t tidak berpasangan, Mann Whitney dan chi-square. Hasil penelitian menunjukkan bahwa tidak terdapat perbedaan bermakna dalam perubahan tekanan darah sistolik, diastol, dan MAP antara kedua kelompok (p>0,05). Kualitas analgesia yang dinilai menggunakan NRS juga tidak menunjukkan perbedaan signifikan (p>0,05). Simpulan, kombinasi ropivakain 0,75 % dan fentanil 3 mcg/mL memberikan hasil yang sebanding dengan ropivakain 0,75 % saja dalam hal stabilitas hemodinamik dan kualitas analgesia pada operasi vitrektomi
Maternal Anemia in Patients with Preterm Delivery in Indonesia
No full textPreterm delivery remains one of the leading causes of fetomaternal morbidity and mortality worldwide. Anemia during pregnancy is also a significant concern, and may contribute to adverse pregnancy outcomes including preterm birth, intrauterine growth restriction (IUGR), and postpartum hemorrhage (PPH). This study aimed to assess the prevalence of maternal anemia in women with preterm delivery and to evaluate its association with preterm-related complications. A retrospective cross-sectional study was conducted at the Obstetrics and Gynecology Department of Arifin Achmad Hospital, Pekanbaru, Indonesia. Anemia was defined according to the CDC criteria as hemoglobin levels below 11 g/dL in the first and third trimesters or below 10.5 g/dL in the second trimester. Data were collected from medical records of 654 preterm deliveries, of which 359 met the inclusion criteria. Among these, 204 women (56.82%) had anemia, while 155 women (43.18%) had normal hemoglobin levels. A significant association was found between anemia and preterm delivery (p=0.010). Maternal anemia was associated with preterm premature rupture of membranes (PPROM) (p=0.035, contingency coefficient=0.110, 95% CI). These findings suggest that maternal anemia is significantly correlated with preterm birth and its complications, particularly PPROM. Screening and early management of anemia in pregnancy may help reduce the risk of preterm delivery and improve maternal and neonatal outcomes
Correlation Between ERCP Implementation Time and Outcomes of Patients with Acute Cholangitis Due to Choledocholithiasis
No full textAcute cholangitis is a serious condition, and timely ERCP is essential for effective management. This prospective cohort study was conducted at Dr. Hasan Sadikin Hospital in Bandung, Indonesia, from June 2023 to April 2024, to evaluate the feasibility of performing ERCP beyond 48 hours in the presence of various limitations. The study included patients with acute cholangitis caused by common bile duct stones. The ERCP timing was categorized into three groups: less than 48 hours, 48-72 hours, and more than 72 hours. Outcomes measured were hospital stay duration, ICU admission, and 30-day mortality. Of these patients, 52.8% underwent ERCP at 48-72 hours, 27.8% after 72 hours, and 19.4% before 48 hours. The median hospital stay was 7.5 days (IQR 3-15). ICU admissions occurred only in patients receiving ERCP after 72 hours (30.0%), a significantly higher rate compared to the other groups (p=0.014). A strong correlation was found between delayed ERCP and longer hospital stays (r=0.711, p<0.01), as well as ICU admission (r=0.405, p=0.014), though no significant correlation with mortality was observed (r=-0.021, p=0.905)
Comparison of ABO Blood Group Antibody Titers in Elderly and Young Adult Patients
No full textImmunosenescence in the elderly decreases their antibodies, which may lead to weaker degree of agglutination formation that potentially causes ABO discrepancies. This may lead to misinterpretation of blood group in this group. This study aimed to determine whether there are differences in antibody titer levels and degree of agglutination formed when examining ABO blood groups in the elderly as compared to young adults. This was a cross-sectional study employing analytical observational methods. Data were collected prospectively from the Blood Services Unit of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, between May 2022 and July 2022. The subjects included were 42 elderly participants and 42 young adults, grouped accordingly. The ABO blood typing was performed using the slide method, while anti-A and anti-B titers were measured by serial two-fold dilution using the tube method. A significant difference in ABO blood group antibody titer levels was observed between elderly and young adult groups (median: 6 vs 64, p<0.001). Antibody titers were lower in the elderly across blood groups A (median: 8 vs 64, p<0.001), B (median: 8 vs 64, p<0.001), and O (median: 4 vs 64, p<0.001). The degree of agglutination was lower in the elderly (2+) compared to young adults (4+). On average, antibody titers in elderly individuals were approximately tenfold lower than those in young adults across all three blood groups. The reduced degree of agglutination further supports the diminished antibody response in the elderly group
Diagnostic Utility of Claudin-4 Immunohistochemistry in Distinguishing Adenocarcinoma Cells from Reactive Mesothelial Cells in Effusion Cytology
No full textBackground: Differentiating adenocarcinoma cells from reactive mesothelial cells in cases of effusion remains a diagnostic challenge due to overlapping morphological features. Claudin-4, a tight junction protein expressed in epithelial but absent in mesothelial cells, has emerged as a potential immunohistochemical (IHC) marker for this distinguishing between these cell types.Objective: to evaluate the diagnostic utility of Claudin-4 immunohistochemistry in differentiating adenocarcinoma cells from reactive mesothelial cells in effusion cytology.Methods: This prospective study was conducted at the Department of Pathology, Nizam’s Institute of Medical Sciences, Hyderabad, India, between June 2023 and December 2024. A total of 77 formalin-fixed paraffin-embedded cell block samples from effusion fluids (pleural, ascitic, and peritoneal) were analyzed. Inclusion criteria comprised cases diagnosed as malignant or reactive on cytology. Claudin-4 immunostaining was performed by using EP417 clone. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of Claudine for differentiating malignant versus non-malignant effusion was calculated.Results: Out of the 77 studied cases, 57 were malignant and 20 were non-malignant. Claudin-4 showed positive membranous staining in 50/57 malignant cases (87.72%) and in none of the non-malignant cases (100% specificity). The PPV was 100%, and NPV was 74.10%. Pulmonary adenocarcinoma was the most common malignancy showing Claudin-4 positivity. Claudin demonstrated excellent specificity for diagnosis of malignant effusions. Conclusion: Claudin-4 immunohistochemistry is highly specific as a reliable marker for differentiating malignant cells from reactive mesothelial cells. Its high specificity and positive predictive value make it a valuable diagnostic tool. However, a negative Claudin-4 immunohistochemistry results should be interpreted cautiously, particularly in clinically suspicious cases
Clinical Outcomes of Hypertonic Dextrose Prolotherapy Injection in Obese Patients with Knee Osteoarthritis: A Quasi-Experimental Study
No full textBackground: Obesity is a major risk factor for knee osteoarthritis (KOA), contributing to pain, reduced joint function, and decreased quality of life. Hypertonic dextrose prolotherapy (HDP) has emerged as a potential treatment to lessen pain and improve function in KOA. This study aimed to observe the clinical outcomes of HDP injections in obese patients with KOA.Methods: A quasi-experimental study was conducted in 2023, involved obese patients diagnosed with KOA. Participants were divided into two groups: an intervention group receiving HDP injections and a control group receiving normal saline (NS) injections. Clinical outcomes were assessed using the Numeric Rating Scale (NRS) for pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) before intervention, and at two and six weeks after intervention. Intergroup and intragroup mean differences were analyzed, with a significance value of p<0.05.Results: A total of 38 participants were included, with 20 assigned to the HDP group and 18 to the control group. Intragroup analysis showed a significant reduction in NRS scores in both groups (p<0.001), whereas no significant intragroup change was observed in WOMAC scores. Intergroup analysis showed significantly greater improvement in both NRS and WOMAC scores in the HDP group compared with the control group at two and six weeks after intervention (p<0.001).Conclusions: HDP injections improve clinical outcomes in obese patients with KOA, particularly in reducing pain intensity and improving functional status. Pain reduction may support participation in exercise and weight management programs, although persistent obesity may increase the risk of KOA recurrence
Red Cell Distribution Width to Albumin Ratio versus Red Cell Distribution Width to Platelet Ratio as Predictors of 28-Day Mortality in Sepsis Patients Admitted to the Intensive Care Unit
No full textBackground: Sepsis is a leading cause of mortality in the Intensive Care Unit (ICU). Early identification of high-risk patients requires simple and accessible prognostic biomarkers. The Red Cell Distribution Width to Albumin Ratio (RAR) and Red Cell Distribution Width to Platelet Ratio (RPR) have been proposed as potential biomarkers.Methods: This prospective cohort study was conducted in the ICU of Dr. Hasan Sadikin General Hospital, Bandung, from July to September 2025, involving 71 subjects who met the Sepsis-3 criteria. RAR and RPR values were calculated from blood tests within the first 24 hours of ICU admission. The primary outcome was 28-day mortality. Statistical analysis used the Receiver Operating Characteristic (ROC) curve to determine the cut-off value, sensitivity, specificity, and Area Under the Curve (AUC). The AUC comparison between RAR and RPR was analyzed using the DeLong test.Results: A total of 41 patients (57.7%) experienced 28-day mortality. The optimal cut-off value for RAR was 5.7404 (Sensitivity 85.4%; Specificity 73.3%) with an AUC of 89.3% (95% CI: 79.8–95.4%). The optimal cut-off value for RPR was 0.0627 (Sensitivity 75.6%; Specificity 76.7%) with an AUC of 74.7% (95% CI: 63.0–84.3%). RAR had a significantly better discriminatory value than RPR (p=0.026).Discussion: The RAR value is a better predictor of 28-day mortality than the RPR value in septic patients treated in the ICU.Conclusion: RAR can be considered a simple and effective prognostic tool for the early risk stratification of septic patients.Background: Sepsis is a leading cause of mortality in the Intensive Care Unit (ICU). Early identification of high-risk patients requires simple and accessible prognostic biomarkers. The Red Cell Distribution Width to Albumin Ratio (RAR) and Red Cell Distribution Width to Platelet Ratio (RPR) have been proposed as potential biomarkers.Methods: This prospective cohort study was conducted in the ICU of Dr. Hasan Sadikin General Hospital, Bandung, from July to August 2025 involving 71 subjects who met the Sepsis-3 criteria. RAR and RPR values were calculated from blood tests within the first 24 hours of ICU admission. The primary outcome was 28-day mortality. Statistical analysis used the Receiver Operating Characteristic (ROC) curve to determine the cut-off value, sensitivity, specificity, and Area Under the Curve (AUC). The comparison of AUC between RAR and RPR was analyzed using the DeLong test.Results: A total of 41 patients (57.7%) experienced 28-day mortality. The optimal cut-off value for RAR was 5.7404 (Sensitivity 85.4%; Specificity 73.3%) with an AUC of 89.3% (95% CI: 79.8–95.4%). The optimal cut-off value for RPR was 0.0627 (Sensitivity 75.6%; Specificity 76.7%) with an AUC of 74.7% (95% CI: 63.0–84.3%). RAR had a significantly better discriminatory value than RPR (p=0.026).Discussion: The RAR value is a better predictor of 28-day mortality than the RPR value in septic patients treated in the ICU.Conclusion: RAR can be considered a simple and effective prognostic tool for the early risk stratification of septic patients
Severe Hypokalemia in the Intensive Care Unit: Case Series on Potassium Correction Strategies and Clinical Outcomes
No full textHypokalemia is one of the electrolyte disorders that often occurs in intensive care units (ICUs), defined as a serum potassium concentration below 3.5 mmol/L. Its severity is classified as mild (3.0–3.4 mmol/L), moderate (2.5–3.0 mmol/L), and severe (<2.5 mmol/L). Hypokalemia occurs when the body loses too much potassium due to several factors such as vomiting, excessive diarrhea, kidney disease, hormonal disorders, or taking diuretic drugs. Symptoms of hypokalemia generally appear when serum potassium is less than 3.0 mmol/L, ranging from mild weakness to life-threatening cardiac arrhythmias. In critically ill patients, untreated severe hypokalemia can lead to cardiac arrhythmias, respiratory arrest, and renal dysfunction, with a higher risk of complications and mortality in patients with hypotension, diabetes, or chronic kidney disease. This case series involved six ICU patients with severe hypokalemia (K⁺ ≤1.8 mmol/L) who underwent rapid potassium correction at a rate of 10–40 mEq/hour adjusted to the patient's clinical severity. In patients with ventricular arrhythmias, initial correction of 2 mEq/minute was followed by 10 mEq over 5–10 minutes. Most patients showed clinical improvement, while worse outcomes were observed in patients with hyperthyroidism and after return of spontaneous circulation (ROSC). This case series highlights the importance of individualized potassium replacement strategies, immediate intervention, and careful monitoring to prevent life-threatening complications and improve outcomes in patients with severe hypokalemia in the ICU
GAMBARAN POLA KUMAN, RESISTENSI, FAKTOR RISIKO, DAN TINGKAT MORTALITAS PADA PASIEN VENTILATOR ASSOCIATED PNEUMONIA DI GENERAL INTENSIF CARE RSUP HASAN SADIKIN BANDUNG PERIODE JANUARI 2022 - DESEMBER 2022
No full textVentilator Associated Pneumonia (VAP) merupakan infeksi paru yang terjadi 48–72 jam setelah tindakan intubasi endotrakeal dan menjadi salah satu infeksi nosokomial paling sering di Intensive Care Unit (ICU), dengan prevalensi mencapai 70-80% dari seluruh kasus pneumonia di rumah sakit. Di Indonesia, insiden VAP tergolong tinggi, terutama disebabkan oleh Acinetobacter baumannii yang bersifat resisten terhadap berbagai antibiotik dan berkontribusi terhadap peningkatan angka mortalitas. Penelitian ini menggunakan metode observasional deskriptif dengan pendekatan retrospektif berdasarkan data rekam medis pasien VAP di ICU RSUP Dr. Hasan Sadikin Bandung periode Januari–Desember 2022. Dari 33 pasien yang diteliti, ditemukan 70 hasil kultur kuman, dengan 55 di antaranya tergolong Multidrug Resistant (MDR). Kuman yang paling dominan adalah Acinetobacter baumannii (85,7% MDR), diikuti Klebsiella pneumoniae (94,4% MDR) dan Pseudomonas aeruginosa (87,5% MDR). Angka mortalitas mencapai 60,6%, dengan tingkat kematian lebih tinggi pada pasien dengan kultur MDR. Faktor risiko yang sering ditemukan ialah hipertensi, penyakit serebrovaskular, dan gagal ginjal kronik. Pola resistensi tinggi teridentifikasi pada Acinetobacter baumannii terhadap cefazolin (95,7%) dan ampicillin-sulbactam (91,3%), Klebsiella pneumoniae terhadap cefazolin (97,0%) dan ceftriaxone (96,8%), serta Pseudomonas aeruginosa terhadap imipenem (94,7%) dan cefazolin (91,7%). Hasil ini menunjukkan perlunya peningkatan program penanganan VAP di RSUP Dr. Hasan Sadikin.Ventilator Associated Pneumonia (VAP) merupakan infeksi paru yang terjadi pada 48-72 jam setelah intubasi endotrakeal, menempati sebagian besar infeksi nosokomial di ruang Intensive Care Unit (ICU). Prevalensi VAP di ICU mencapai 70-80% dari seluruh kasus pneumonia di rumah sakit. Di Indonesia, insiden VAP lebih tinggi dibandingkan negara maju, dengan Acinetobacter baumannii sebagai penyebab utama yang meningkatkan mortalitas karena resistensi antibiotik.Penelitian ini merupakan studi observasional deskriptif retrospektif dengan sumber data dari rekam medis seluruh pasien yang didiagnosis VAP di ruang perawatan General intensive care unit RSUP Dr. Hasan Sadikin Bandung periode Januari – Desember 2022.Total terdapat 33 pasien dengan 70 temuan kultur kuman, di mana 55 di antaranya merupakan kuman Multidrug Resistant (MDR). Acinetobacter baumannii merupakan kuman dominan pada pasien VAP dengan proporsi 21 kuman dan 18 (85,7%) di antaranya merupakan MDR. Diikuti oleh Klebsiella pneumoniae 18 kuman dengan 17 kuman (94,4%) MDR dan Pseudomonas aeruginosa 16 kuman dengan 14 kuman (87,5%) MDR. Tingkat mortalitas pasien VAP mencapai 60,6%, dengan mortalitas yang lebih tinggi terjadi pada pasien dengan kultur kuman yang menunjukkan MDR. Faktor risiko komorbiditas tersering yang berkontribusi terhadap mortalitas terdiri dari hipertensi, penyakit serebrovaskular, dan gagal ginjal kronis. Resistensi antibiotik menunjukkan Acinetobacter baumannii dengan resistensi tinggi terhadap cefazolin (95,7%) dan ampicillin-sulbactam (91,3%), Klebsiella pneumoniae terhadap cefazolin (97,0%) dan ceftriaxone (96,8%) serta Pseudomonas aeruginosa terhadap imipenem (94,7%) dan cefazolin (91,7%).Pola VAP di General intensive care unit RSUP Dr. Hasan Sadikin Bandung periode Januari – Desember 2022 masih diperlukan perbaikan program penanganan terhadap infeksi ini untuk mencapai pelayanan yang baik