E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Medical Student Performance in Diagnosing Common Findings of CT Scan
Get PDFDiagnostic radiology is a key diagnostic tool in many different conditions and ccrucial for monitoring, treating, and predicting outcomes. Accurately interpreting basic radiological images is a paramount skill for medical professionals. Therefore, this study aimed to assess clinical-phase medical students and interns' knowledge on evident findings on CT scans. This observational cross-sectional study was conducted in a single region in Saudi Arabia from May 2022 to December 2022. An electronic questionnaire were used to collect data. Twenty-one radiograph-based questions were used, for which students were asked to provide the best diagnosis and report their confidence for each question. Ethical approval was obtained. A convenience sampling technique was used to recruit the participants and SPSS were used for data analysis. Two hundred fifty-two medical students were included, with a mean age of 23.02 (SD=1.52) year. Of those, females comprised 65.1% and 86.1% of the total participants were in the clinical year. Most students with above-average knowledge were internship students (37.1%) compared to 9.7% among clinical year students (p=0.001). In addition, students with average knowledge had a higher level of confidence (7.62/10) compared with students with average knowledge (5.24) and students with below-average knowledge (5.24 and 5.057, respectively; p=0.001). In conclusion, the high percentage of incorrect responses reported by the current study reflects a strong deficit in the baseline CT knowledge among medical students. Further interventions are necessary to ensure better radiographic education for future physicians
Subchronic Oral Exposure to Chlorpyrifos Decreases Butyrylcholinesterase in Wistar Rat
Get PDFBackground: Indonesia as an agricultural country has more than 33 million workers in the agriculture. Pesticides have an important role in agriculture because they function as powerful plant pest exterminators. However, its use is considered to cause various toxic effects, one of which is on the nervous system. This study aimed to evaluate the impact of pesticide exposure on cognitive impairment by assessing the butyrylcholinesterase biomarker in the blood of rats as experimental animals.Methods: This was a true experimental study conducted during September–November 2022 at the Pharmacology and Biochemistry Laboratory, Faculty of Medicine, University of Jember with a post-test only approach using Wistar rats which were divided into 1 control group and 4 treatment groups treated with chlorpyrifos 5 mg/kg orally. Serum butyrylcholinesterase enzyme levels were measured using the kinetic photometric method and then analyzed with a regression test in IBM SPSS® Statistics software.Results: The average value of butyrylcholinesterase was 920.23±145.27 (Control group); 904.48±91.6 (7 days after chlorpyrifos administration); 889.81±95.2 (14 days after chlorpyrifos administration); 457.84±69.5 (28 days after chlorpyrifos administration); 575.82±194.25 (56 days after chlorpyrifos administration). The results of the One-Way ANOVA test showed significant differences between groups as indicated by a significance test of 0.024 (p <0.05).Conclusions: There is a relationship between the duration of exposure to chlorpyrifos and butyrylcholinesterase levels in Wistar rats. This fact shows that the longer an organism is exposed to low doses of chlorpyrifos pesticides, the higher the level of neurological system toxicity that occurs in that organism
Differential White Blood Cell Count and COVID-19 Hospital Length of Stay: A Post-hoc Analysis
Get PDFObjective: To explore the association between differential white blood cell count and hospital length of stay (LOS) in COVID-19 patients.Methods: This study is a post-hoc analysis of two prospective cohort studies involving hospitalized COVID-19 patients who received standard therapy, including antiviral and supportive treatments at Persahabatan Hospital, Jakarta, Indonesia, during the Delta and Omicron dominant pandemic periods. Baseline differential white blood cell count before initiation of therapy were documented. LOS was categorized as ≤10 days and >10 days.Result: Data from 463 subjects were included with most subjects were males (62.2%) with a median age of 54 (14–93) years. The average LOS for subjects was 12.7 (12.1–13.4) days. Bivariate tests showed that lymphocytes, neutrophils, monocytes, neutrophil-lymphocyte ratio (NLR), and neutrophil-monocyte ratio (NMR) had significant association (p 8.35 × 10^3/µL) at admission may predict shorter hospitalization (<10 days).Conclusion: Monocyte count may serve as a potential marker for length of stay in COVID-19 patients, offering key insights for optimizing patient management and resource allocation
Rationality of Empirical Antibiotic Usage among Digestive Surgery Inpatients at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia: Gyssens Criteria Analysis
Get PDFBackground: Many empirical antibiotics are prescribed unnecessarily, contributing to the rise in the incidence of antibiotic resistance. Preventing infection of surgical sites is one of the most frequent purposes of empirical antibiotic usage. Therefore, this study aimed to analyze the rationality of empirical antibiotic usage among digestive surgery inpatients based on the Gyssens criteria and clinical features outcomes.Methods: A descriptive method was used with a cross-sectional design. Data was collected from medical records of patients underwent digestive surgery and had received empirical antibiotic therapy post-surgery from July to September 2021 at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Subsequently, the data was analyzed using the Gyssens method to qualitatively assess the rationality of antibiotic use based on specific criteria, classified from rational (category 0) to various levels of irrational use (categories I-VI). Clinical outcomes were evaluated by assessing leukocyte count, clinical symptoms of fever, and the appearance of surgical site infection before and after administration of empirical antibiotics.Results: In total, 70 empirical antibiotic prescriptions were obtained from 42 patients, with only 40% of patients using rational antibiotics, whereas 60% of antibiotics were used inappropriately (category I-VI). Clinical evaluation showed no fever, edema, or erythema and reduced leukocytosis and exudate/pus post-therapy.Conclusions: Inappropriate empirical antibiotic prescription for digestive surgery inpatients at Dr. Hasan Sadikin General Hospital based on the Gyssens criteria is high. Nonetheless, clinical outcomes showed improvements in infection-related parameters. These results emphasize the importance of stricter adherence to antibiotic stewardship and regular evaluation of empirical antibiotic practices to optimize usage and patient outcomes
Distribution of Hypertension Cases Based on Primary Health Care 2017–2021 in Malang, Indonesia: Spatial Analysis
Get PDFBackground: Malang Regency is one of the cities in East Java, Indonesia that has a high trend of hypertension cases. The study aimed to describe the distribution of hypertension cases at the primary health care level in Malang Regency, Indonesia using spatial analysis.Methods: This was a descriptive analysis study using secondary data obtained from the Health Profile of Malang Regency from 2017 to 2021. The total sampling method was used. Data on hypertension cases from 16 primary health cares was collected. Quantum geographic information system (QGIS) was used to visualize the distribution of cases. Data was presented in the tables and a map with different coloring based on the high-low categories of hypertension cases in a region.Results: There was a tendency for an increase in hypertension cases every year in 3 of 16 primary health care. Primary Health Cares with an increased prevalence of cases during 2017–2021 were Arjowinangun (7.65% to 24.24%), Mojolangu (17.20% to 31.57%), and Kendalsari (8.84% to 27.29%). However, cases decreased from 2017 to 2018, and experienced a very high increase from 2018 to 2019.Conclusion: The distribution of hypertension cases in Malang Regency from 2017 to 2021 tends to fluctuate from year to year. An education program for the community about a healthy lifestyle and the importance of conducting regular health checks is needed to decrease hypertension cases
Laporan Kasus: Manajemen Anestesi Operasi Caesar pada Wanita Usia 30 Tahun dengan Preeklampsia Berat dengan Hipertensi Pulmonal Probabilitas Tinggi
No full textIbu hamil dengan hipertensi pulmonal (HP) memiliki peningkatan risiko yang signifikan untuk dapat mengalami ketidakstabilan hemodinamik, gagal jantung, sepsis pascaoperasi, dan gagal napas. Kehamilan pada ibu dengan hipertensi pulmonal merupakan kehamilan risiko tinggi sehingga diperlukan perencanaan yang baik dan pendekatan tim multidisiplin. Kehamilan dengan hipertensi pulmonal memerlukan manajemen anestesi yang tepat untuk mencapai hasil klinis ibu dan janin yang optimal. Laporan kasus ini menggambarkan manajemen anestesi yang telah dilakukan pada wanita multigravida berusia 30 tahun dengan preeklampsia berat dan kemungkinan besar menderita HP. Teknik yang digunakan dengan anestesi epidural total. Operasi berlangsung selama 2 jam dan pendarahan sebanyak 250 m. Setelah operasi, pasien dirawat di ICU. Di ICU, keadaan pasien memburuk sehingga dilakukan intubasi dan ventilasi terkontrol. Pasien mengalami serangan jantung dan diresusitasi. Pasien meninggal 3 jam setelah masuk ICU. Hal yang perlu diwaspadai dalam penanganan pasien hipertensi pulmonal adalah pemantauan intensif pascaoperasi untuk memantau dan mengantisipasi terjadinya krisis hipertensi pulmonal yang dapat menyebabkan kematian. Ibu hamil dengan hipertensi pulmonal memiliki peningkatan risikoyang signifikan untuk dapat mengalami ketidakstabilanhemodinamik, gagal jantung, sepsis pasca operasi, dan gagal napas. Kehamilan pada ibu dengan hipertensi pulmonal merupakankehamilan risiko tinggi sehingga diperlukan perencanaan yang baikdan pendekatan tim multidisiplin. Kehamilan dengan hipertensipulmonal memerlukan manajemen anestesi yang tepat untukmencapai hasil klinis ibu dan janin yang optimal. Laporan kasus inimenggambarkan manajemen anestesi yang telah dilakukan pada wanita multigravida berusia 30 tahun dengan preeklampsia beratdan kemungkinan besar menderita PH. Teknik yang digunakandengan anestesi epidural total. Operasi berlangsung selama 2 jam dan pendarahan sebanyak 250 cc. Setelah operasi, pasien dirawat di ICU. Di ICU, keadaan pasien memburuk sehingga dilakukanintubasi dan ventilasi terkontrol. Pasien mengalami seranganjantung dan diresusitasi. Pasien meninggal 3 jam setelah masukICU. Hal yang perlu diwaspadai dalam penanganan pasienhipertensi pulmonal adalah pemantauan intensif pasca operasi untukmemantau dan mengantisipasi terjadinya krisis hipertensi pulmonal yang dapat menyebabkan kematian.
Bilateral Optic Nerve Atrophy Case Report
Get PDFWolfram syndrome, also known as DIDMOAD or juvenile onset diabetes mellitus, optic nerve atrophy, diabetes insipidus, and deafness, is a genetic neurological condition. This case report provides a description on the first instance of Wolfram syndrome in a Saudi family, which manifested as proliferative diabetic retinopathy and a powder-like cataract, among the other unusual ophthalmological findings. This case involved a 27-year-old Saudi woman with bilateral optic nerve atrophy who was first diagnosed with diabetes mellitus at the age of 8 years. At the age of 18, bilateral optic nerve atrophy was identified. At the age of 27, diabetes insipidus and hearing loss were verified. There were no signs of renal, neurological, or psychiatric issues. Atypical ophthalmological traits were examined and addressed in this study. Any individual with bilateral optic nerve atrophy and insulin-dependent diabetes mellitus within the first 30 years of life should be evaluated for the possibility of Wolfram syndrome. Microvascular diabetes is an incredibly rare complication of Wolfram syndrome. Early diagnosis, treatment, and prevention of severe consequences can result in improved survival rates and quality of life
Neurodegenerative and Neurobehavioral Symptoms in Jember Agricultural Workers Caused by Oxidative Stress and Neurotransmitter Disturbance
Get PDFIncreased use of pesticides can have detrimental health consequences, one of which is chronic neurotoxicity. The symptoms include degenerative and neurobehavioral issues. Chronic neurotoxicity occurs through oxidative stress, inflammation, and neurotransmitter disturbances. This study aimed to determine chronic neurotoxicity and test malondialdehyde and cholinesterase levels as neurotoxicity biomarkers among agricultural workers in Wuluhan, Jember, Indonesia. The 60-person research sample was divided into two groups: agricultural and non-agricultural workers. The interview utilized a mini-mental score examination, Chan's questionnaire, and the Patient Health Questionnaire to analyze the cognitive impairment, Parkinsonism, and depressive symptoms. The examination of serum malondialdehyde levels was performed using the TBARS method and cholinesterase levels by photometric kinetic method at a biochemistry laboratory from October to November 2022. Results showed cognitive impairment and depressive symptoms in agricultural workers, as well as high levels of malondialdehyde and low cholinesterase levels. This study concludes the presence of chronic pesticide neurotoxicity among agricultural workers in Jember, Indonesia, and that malondialdehyde and cholinesterase levels might serve as biomarkers of pesticide-induced neurotoxicity
Correlation of Intestinal Protozoa Infection with the Nutritional Status of Toddlers Aged 12–59 Months in Jember Regency, East Java, Indonesia
Get PDFBackground: Intestinal protozoan infection is a problem faced by the global community at all ages. In toddlers, it can cause problems in the form of decreased nutritional status, which is often found in developing countries such as Indonesia. The purpose of this study was to determine the correlation between intestinal protozoa infection and the nutritional status of toddlers.Methods: An observational study with a cross-sectional approach was conducted in October–December 2022 on 45 children aged 12–59 months in Sucopangepok Village, Jelbuk District, Jember Regency, East Java, Indonesia using, consecutive sampling techniques and a total sample size. Nutritional Status was measured based on body weight to body length using the WHO Anthropometric Calculator. Stool examination used the direct smear method and modified Ziehl-Neelsen staining. Data was analyzed using the Cramer's V test. The p-value less than 0.05 was considered statistically significant.. Results: The incidence of wasted children was 15.6% and severely wasted was 2.2%. Intestinal protozoan infection had an incidence of 15.6%. The species detected were Giardia lamblia (6.7%), Cryptosporidium parvum (6.7%), and Blastocystis hominis (2.2%). Statistical analysis showed there was no correlation between intestinal protozoan infection and nutritional status (p= 0.441; r = 0.191).Conclusions: There is no correlation between intestinal protozoan infection and the nutritional status of toddlers. However, comprehensive collaboration between the government and the community needs to be improved, as well as healthy lifestyles for toddlers which also need to be encouraged to overcome nutritional problems in children under five old and prevent intestinal protozoa infections
Perbandingan Vasopressin dan Norephinephrine sebagai Vasopressor pada Pasien Syok Sepsis
Get PDFSepsis menyebabkan kematian terbesar, tingkat mortalitas sepsis tinggi dan dapat mencapai 50% pada syok sepsis. Tatalaksana resusitasi pada syok sepsis menggunakan vasopresor. norepinephrine saat ini adalah rekomendasi utama pada syok sepsis, vasopressin digunakan sebagai obat lini kedua untuk mengurangi efek samping yang disebabkan oleh obat seperti norephinephrine, dan juga membantu pada keadaan syok resisten-katekolamin. Penelitian ini merupakan penelitian uji klinis dengan metode acak tersamar ganda. Penelitian ini bertujuan untuk mengetahui perbandingan penggunaan vasopressin dan norephinephrine sebagai vasopresor pada pasien syok sepsis di ICU RSUP H. Adam Malik Medan. Pencatatan hasil dilakukan setelah diberikan intervensi (T0), 6 jam (T1), dan 24 jam (T2). Sampel yang diperoleh pada penelitian ini berjumlah 36 pasien dengan 13 pasien dalam kelompok vasopressin dan 13 pasien dalam kelompok norepinephrine. Rerata TDS, TDD dan Mean Arterial Pressure (MAP) T0, T1, dan T2 kelompok norepinephrine lebih tinggi bila dibanding dengan dengan kelompok vasopressin. pH pada kelompok norepinephrine lebih rendah bila dibanding dengan dengan kelompok vasopressin. Simpulan, terdapat perbedaan yang signifikan antara norepinephrine dengan vasopressin sebagai vasopressor, dimana MAP dan kadar laktat, pada kelompok Norepinephrine lebih tinggi bila dibanding dengan dengan vasopressin. Sedangkan pH didapatkan lebih rendah pada kelompok norepinpehrine pada jam ke-24 dibanding dengan kelompok vasopressin