E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Vitamin D Levels and Incidence of Preterm Labor
Get PDFOne pathophysiology of preterm delivery is maternal or fetal hypothalamus-pituitary-adrenal (HPA) axis activation. The HPA axis can be affected by vitamin D, which increases uterine contractions and affects the body’s immune mechanism against bacterial infections. A lower level of vitamin D in pregnant women is suspected to contribute to the incidence of premature conditions. This study aimed to compare the 25-hydroxy-vitamin D3 concentration in preterm parturient with non-preterm parturient, and the correlation between vitamin D level and the incidence of preterm labor. This comparative analytic study used a cross-sectional approach and involved 46 subjects who were divided into case and control groups. This study was conducted in August–September 2017 at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. The Electro-chemiluminescence Immunoassay (ECLIA) method was used to examine the serum 25-hydroxy-vitamin D3 concentration in case and control groups, demonstrating that 25-hydroxy-vitamin D3 concentration in case group (17.26 ng/mL) was significantly (p<0.0001) lower than in control group (24.30 ng/mL). The correlation coefficient between the 25-hydroxy-vitamin D3 and the incidence of preterm labor was -0.837 (p<0.001). Thus, there was a correlation between the 25-hydroxy-Vitamin D3 level and the incidence of preterm labor that vitamin D supplementation in pregnant women must be considered
Anxiety Levels of Medical Students in Online Learning During COVID-19 Pandemic
Get PDFBackground: The COVID-19 pandemic has affected the education sector and caused major changes. This situation provides challenges for students, resulting in increased anxiety, especially for medical students who tend to have higher level of anxiety. This study aimed to determine the proportion of anxiety levels among undergraduate medical students in online learning during the COVID pandemic.Methods: This cross-sectional descriptive study was conducted in September–November 2022, involving 156 undergraduate medical students at Universitas Padjadjaran, Indonesia batch 2019–2021 who had no history of somatic or psychiatric disease. The stratified simple random sampling method was used. Anxiety levels was assessed using the Hamilton Anxiety Rating Scale (HAM-A) questionnaire. Data was analyzed using Pearson’s Correlation.Results: Participants were dominated by females (71.1%), average age 19.9 years with a grade point average (GPA) of 3.51-4.00 (88.5%). The anxiety level of most participants was mild (67.9%) and 19.2% were at the severe level. Interestingly, severe levels of anxiety seemed to occur more commonly in females, group batch 2020, GPA 2.51-3.00, living alone and in a place other than in the family home or rented house. Furthermore, respiratory manifestations tended to be the mildest, whereas intellectual manifestations were more often severely impacted.Conclusions: The anxiety level of undergraduate medical students in Universitas Padjadjaran is mostly mild. Female more often experience anxiety at a more severe level. Further research is needed to identify and analyze more comprehensively other possible anxiety factors in medical students
Terapi Substitusi Ginjal pada Sindrom HELLP ( Hemolysis, Elevated Liver Enzymes and Low Platelets) dan Cedera Ginjal Akut
Get PDFRenal replacement therapy (RRT)/terapi substitusi ginjal untuk pasien cedera ginjal akut di unit perawatan intensif menghadirkan masalah unik dalam menyediakan pembuangan biokimia dan cairan pada pasien dengan instabilitas sirkulasi, inotropik, dan peningkatan permeabilitas kapiler. Pasien pre-eklamsia dengan insufisiensi ginjal dapat ditegakkan diagnosisnya jika kadar kreatinin serum lebih atau sama dengan 1,1 mg/dL. Pasien hamil dengan pre-eklamsia berat (PEB) dan sindrom hemolysis, elevated liver enzymes levels and low platelet levels (HELLP) merupakan salah satu faktor risiko cedera ginjal akut pada kehamilan. Peningkatan kreatinin juga dilaporkan meningkatkan progresivitas terjadi strok iskemik Seorang perempuan berusia 21 tahun dengan pascaoperasi sectio caesaria dengan indikasi gawat janin pada pre-eklamsia berat disertai cerebrovascular disease infarct, acute kidney injury dd/acute on chronic kidney disease, asidosis metabolik, elektrolit imbalans, masuk di rawat di ruang rawat intensif RSUP Dr. Hasan Sadikin, Bandung. Pascaoperasi pasien masih dalam keadaan tersedasi dan terintubasi, untuk kemudian dikontrol pernapasannya. Karena terjadi peningkatan kadar kreatinin dan terjadi hiperkalemia refrakter maka pada pasien dilakukan continuous renal replacement therapy. (CRRT). Tujuan CRRT pada pasien ini adalah menekan progresivitas cedera ginjal akut serta hiperkalemia, menghindari fluktuasi hemodinamika, serta menghindari progresivitas cerebrovascular disease (CVD) iskemik.Terapi substitusi ginjal (RRT) untuk pasien cedera ginjal akut (AKI) di unit perawatan intensif (ICU) menghadirkan masalah unik dalam menyediakan pembuangan biokimia dan cairan pada pasien dengan instabilitas sirkulasi, inotropik, dan peningkatan permeabilitas kapiler. Pasien pre eklampsia dengan insufisiensi ginjal dapat ditegakkan diagnosisnya jika kadar kreatinin serum lebih atau sama dengan 1,1 mg/dl. Pasien hamil dengan preeklampsia dan sindroma HELLP merupakan salah satu faktor resiko untuk terjadinya cedera ginjal akut pada kehamilan. Peningkatan kreatinin juga dilaporkan meningkatkan progresifitas terjadinya stroke iskemik 1,2,3Seorang perempuan berusia 21 tahun dengan post operasi SC dengan indikasi gawat janin pada pre eclampsia berat disertai CVD infarct, AKI dd/ acute on CKD, asidosis metabolic, elektrolit imbalans, masuk di rawat di ruang rawat intensif RSU. Dr. Hasan Sadikin, Bandung. Paska operasi pasien masih dalam keadaan tersedasi dan terintubasi, untuk kemudian dikontrol pernapasannya. Karena terjadi peningkatan nilai creatinine dan terjadinya hiperkalemia refrakter, maka pada pasien dilakukan CRRT. Tujuan dilakukan CRRT pada pasien ini adalah untuk menekan progresifitas cedera ginjal akut serta hiperkalemia, menghindari fluktuasi hemodinamika serta menghindari progresifitas CVD iskemik.Penggunaan modalitas terapi substitusi ginjal pada pasien preeklampsia dengan cedera ginjal akut, pneumonia dan CVD iskemik berguna untuk menekan progresifitas penurunan fungsi ginjal dan evolusi CVD iskemik
Effectiveness of Short-Term Use Denosumab and Risedronate Using β-Crosslaps and Histopathology as a Parameter in Osteoporotic Rat Model
Get PDFOsteoporosis is a condition of decreased bone mass density. Pharmacological management uses drugs that decrease bone resorption or increase bone formation. The most commonly used drugs are bisphosphonates. Risedronate is one of these bisphosphonates. It inhibits osteoclasts, resulting in osteoclast apoptosis. Denosumab is a human monoclonal antibody that inhibits receptor activator kappa-B ligand, inhibiting osteoclast activation. Both drugs are widely used. Research on the efficacy of these two mechanisms has yet to obtain conclusive results. β-cross-laps is a parameter that can be used to evaluate the effectiveness of therapy through monitoring the bone resorption process. This experimental study used female rats >9 weeks old and was conducted at the Pharmacology and Therapeutic Laboratory, Universitas Padjadjaran Bandung, Indonesia, from June to September 2021. This study utilized a simple random sampling to allocate 24 experimental animals into three groups: control, risedronate, and denosumab. β-Crosslaps expression values before ovariectomy, post ovariectomy before receiving medication, and post ovariectomy and receiving medication was recorded and statistically analyzed using the SPSS version 24.0. The analysis of 24 samples revealed a statistically significant decrease in the median value of β-Crosslaps after ovariectomy in the denosumab group (p=0.036) when compared to the control group, whereas the decrease in the risedronate group was not significant (p=0.687). Administration of denosumab in rat models is more effective in reducing bone resorption compared to risedronate
Outcome of Minimally Invasive Percutaneous Plate Osteosynthesis Using Locking Compression Plate for Distal Tibial Fractures
Get PDFObjectives: To assess the functional and radiological outcomes of the distal tibia fractures managed surgically with a locking compression plate by MIPPO technique.Methods: This prospective observational study included 34 patients with distal tibial fractures treated at Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, India. After ethics committee approval and informed consent, eligible adults with complex or unfavorable simple, closed fractures were enrolled. Exclusions were patients under 18 with pathological fractures or comorbidities affecting functional outcomes. Standard preoperative protocols and imaging were conducted. All patients were surgically managed with a locking compression plate by MIPPO technique. Postoperatively, exercises and staged weight-bearing were implemented. Follow-up assessments at 45, 90, 135, and 180 days evaluated pain, movement, and radiological union using Olerud and Molander score. Statistical analysis utilized paired t-test and Chi-Square test.Results: Out of 34 patients with distal tibial fractures, 24 (70.6%) were males and 10 (29.4%) were females with a mean age of 41.88 years. Most fractures were 42A1 (35.3%) and 43A2 (32.4%). Post-operative superficial wound infection occurred in 3 (8.8%) and deep infection in 2 (5.9%). Mean union time was 16.62 weeks. Functional outcomes were excellent in 3 (8.8%), good in 22 (64.7%), and fair in 9 (26.5%). At six months, complications included ankle stiffness (29.4%), non-union (20.6%), and malunion (8.8%). No cases had plate or screw breakage.Conclusion: MIPPO technique allows for good functional outcomes while reducing complications, especially in fractures with poor soft tissue conditions
Effects of Yacon Leaf Extract on MCP-1 and IL-10 Expressions and Macrophage Phenotypes in CKD Mouse Model
Get PDFMacrophages are essential in tissue homeostasis and immunity, but also contribute to disease development and progression. Chronic kidney disease (CKD) is characterized by interstitial infiltration of macrophages, the density of which correlates inversely with kidney survival. Studies have shown that yacon (Smallanthus sonchifolius) has beneficial effects on CKD. Therefore, this study aimed to investigate the effects of yacon leaf extract on mice with subtotal nephrectomy by evaluating the M1 and M2 macrophage counts and mRNA expressions of monocyte chemoattractant protein-1 (MCP-1 and IL-10. The mice were randomly divided into five groups: SO (negative control: underwent sham operation), SN (positive control: underwent subtotal nephrectomy), and yacon-treated groups: YK1, YK2, and YK3 (underwent subtotal nephrectomy, given peroral yacon leaf extract for 14 days with doses of 24,5 mg/kgBW/day, 49 mg/kgBW/day, and 98 mg/kgBW/day, respectively). The macrophage subtypes were assessed using immunohistochemistry anti-CD68 for M1 and anti-Arginase I for M2. MCP-1 and IL-10 mRNA expressions were analyzed using semi-quantitative PCR. Results showed that yacon leaf extract could significantly lower the M2 macrophage count (p<0.001) and the mRNA expressions of MCP-1 and IL-10 in all yacon-treated groups when compared to the SN group. However, the M1 macrophage count was only lower in the YK2 group (p=0.009). In conclusion, the administration of yacon leaf extract could attenuate kidney injury by lowering the macrophage count and the expression of MCP-1 and IL-10
Comparison of Phaco-Chop versus Stop-and-Chop Nucletomy Techniques in Patients with Soft to Moderate Nucleus Cataracts
No full textVarious phacoemulsification techniques are commonly used, with phaco-chop and stop-and-chop techniques as the most popular ones. Phacoemulsification inevitably leads to endothelial cell destruction, which, in severe cases, might result in vision impairment. This study aimed to compare endothelial cell characteristics between two phacoemulsification procedures, phaco-chop, and stop-and-chop, in patients with soft to moderate nucleus cataracts. This study was conducted on 142 patients at the National Eye Center of Cicendo Hospital between April and August 2018. Of those, 66 patients underwent the phaco-chop technique, while 76 patients underwent the stop-and-chop technique. Intraoperative parameters such as effective phaco time (EPT), phaco time, average power, and duration were recorded. Endothelial density, hexagonality, coefficient of variation (CV), and central cornea thickness (CCT) were also recorded before surgery, as well as one week and four weeks after surgery. Mean power, EPT, phaco time, and duration in the phaco-chop group were significantly lower than in the stop-and-chop group. Mean (SD) endothelial density at one-week and four-week evaluation in the phaco-chop group were considerably lower than in the stop-and-chop group (p-value=0.024 and p-value=0.000, respectively). Mean (SD) CV at one-week evaluation in the phaco-chop group was significantly higher compared to a stop-and-chop group, 43.3 (8.0) versus 40.0 (6.7) % (p-value=0.009). Mean (SD) hexagonality at four-week evaluation in the phaco-chop group was significantly higher compared to a stop-and-chop group (43.1 (17.6) versus 48.7 (13.2) respectively, p-value=0.045). Phaco-chop technique have significantly lower EPT, average power, phaco time, and surgery duration than stop-and-chop techniques at one-week and four-week evaluation after phacoemulsification
Study of Clinical and Demographic Profile of Scrub Typhus Patients Admitted to a Tertiary Care Hospital in Central India
Get PDFObjectives: To study epidemiological characteristics, clinical features, laboratory findings, and clinical outcomes in cases of scrub typhus. Additionally, the study aims to identify the predictors of disease severity.Methods: This cross-sectional study was conducted in the Department of General Medicine at Dr PDM Medical College in Amaravati, India. The study duration was 6 months, from July 2023 to December 2023. All clinically confirmed patients with scrub typhus were evaluated through history, clinical examination, and appropriate laboratory investigations. The clinical and laboratory profiles, hospital course, and outcomes were analyzed. Organ dysfunction upon admission was assessed using the sequential organ failure assessment (SOFA) score.Results: A total of 200 cases were included in the study. The majority of the cases were in the age range of 31-40 years, and most of them were males. The highest number of scrub typhus cases occurred in September. The most common presenting symptoms were fever (81%), followed by nausea (37.5%), generalized weakness (34%), abdominal pain, eschar (21.5%), breathlessness, and cough (21% each), headache (19%), vomiting (15%), and altered sensorium (4.5%). The majority of patients (72.5%) did not experience any complications, while 55 patients (27.5%) developed multi-organ dysfunction syndrome (MODS) as a complication. The mortality rate was 1%.Conclusion: Scrub typhus is a significant cause of acute febrile illness in the Vidarbha region of Maharashtra. It can present with various clinical manifestations, with or without an eschar. Early diagnosis and appropriate treatment of these cases can lead to minimal complications
Second-Line Anti-Tuberculosis Drugs Susceptibility Pattern in Multidrug-resistant Tuberculosis Patients at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
Get PDFBackground: Indonesia has the second-highest tuberculosis prevalence in the world. Moreover, Indonesia is among the 30 countries with the highest burden of multidrug-resistant tuberculosis (MDR-TB). This study aimed to determine the pattern of second-line anti-tuberculosis drug resistance in MDR-TB patients.Method: This study was a descriptive cross-sectional using data from MDR-TB patients aged 18 years and older, diagnosed with drug-resistant TB at Dr. Hasan Sadikin General Hospital from December 2021 to June 2022. Total sampling was used. Data on age, gender, history of previous antituberculosis drug treatment and second-line antituberculosis drug susceptibility test results were collected. Resistance distribution patterns were identified using the Line Probe Assay (LPA) and the Mycobacteria Growth Indicator Tube (MGIT) test.Results: Of 134 data retrieved, only 82 data were complete. The median age of the patients was 42 years (range 27-51 years), predominantly female (53.7%), without a history of antituberculosis drug treatment (52.4%). The highest number of resistances was resistant to high dose isoniazid (43.9%), followed by low dose fluoroquinolone (14.6%). Among patients who were resistant to low dose moxifloxacin, 16.67% of patients were still sensitive to high dose moxifloxacin. There was no resistance to bedaquiline.Conclusions: Almost half of the patients are resistant to high dose isoniazid, followed by resistance to low dose fluoroquinolone. These finding are expected to be taken into consideration by clinicians in making decisions on the diagnosis or management of MDR-TB patients and can further serve as input for the government in implementing MDR-TB control programs in Indonesia
Factors Affecting Breast Milk Substitute in Pidie Jaya, Aceh, Indonesia
Get PDFBackground: Breast milk is the first, main, and best natural food for babies. Breast milk contains various nutrients needed in the process of growth and development of babies. Breastfeeding is a health behavior carried out by mothers. This study aimed to analyze the factors that influence the provision of breast milk substitutes.Methods: This was a quantitative study, using a cross-sectional design. Data collection was carried out from July to August 2022 on 71 mothers who had babies aged up to 6 months at the Bandar Baru Public Health Center, Pidie Jaya, Aceh, Indonesia. Consecutive sampling technique was used. The variables studied included behavior intentions, social support, accessibility of information, personal autonomy, and situational action. Chi-square was used to assess the relationship between independent variables and the dependent variables.Results: Most mothers were aged 20–35 years (70.4%), had junior high school education (78.9%), were unemployed (76.1%), and most did not provide breast milk substitutes (70.4%). Mothers who provided breast milk substitutes was significantly associated with the mother’s intention to give breast milk (p=0.002) and environmental conditions/situations for action (p=0.001). Mothers with low intentions tended to substitute breastmilk (53.8%). Furthermore, the situation of action influenced mothers to provide breast milk substitutes (48.6%).Conclusion: Factors that influence mothers to provide breast milk substitutes are low intention and environmental conditions/situations to act. Therefore, education for mothers to give exclusive breast milk is encouraged.