E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Pengaruh Derajat Keparahan Penyakit (Skor APACHE II) terhadap Utilisasi Sumber Daya (Skor TISS-28) dan Biaya Perawatan Pasien di ICU
Get PDFICU merupakan unit perawatan di rumah sakit yang membutuhkan biaya tinggi. Oleh karena itu, penting untuk mengevaluasi faktor-faktor yang mempengaruhi utilisasi sumber daya biaya perawatan pasien ICU. Salah satu faktor yang dapat mempengaruhi utilisasi sumber daya dan biaya perawatan ICU adalah keparahan penyakit. Penelitian ini menggunakan desain analitik observasional dengan desain kohort prospektif Subjek penelitian ini adalah pasien ICU RSUP Dr. Hasan Sadikin Bandung yang dirawat pada bulan Maret–Mei 2023. Derajat keparahan penyakit dinilai dengan skor APACHE II, sementara utilisasi sumber daya ICU dinilai dengan skor TISS-28. Uji Pearson Product Moment digunakan untuk mendapatkan nilai koefisien korelasi (r) dan koefisien determinasi (r2) skor APACHE II terhadap skor TISS-28 dan biaya perawatan pasien ICU. Sebanyak 113 pasien ICU disertakan sebagai subjek penelitian. Rata-rata skor TISS-28 harian 25,6 dan biaya perawatan harian pasien ICU Rp6.657.925,00. Dari analisis skor APACHE II terhadap skor TISS-28 harian didapatkan nilai r=0,538; r2=0,289; p ≤0,001. Sedangkan dari analisis skor APACHE II dan biaya perawatan harian pasien ICU didapatkan r=0,502;r2=0,253; p≤0,001. Derajat keparahan berdasarkan skor APACHE II berpengaruh terhadap skor TISS-28 dan biaya perawatan pasien di ICU dengan korelasi positif. Hasil studi ini diharapkan dapat membantu meningkatkan efektivitas dan efisiensi perawatan pasien di ICU.ICU merupakan unit perawatan di rumah sakit yang membutuhkan biaya tinggi. Oleh karena itu, penting untuk mengevaluasi faktor-faktor yang mempengaruhi utilisasi sumber daya biaya perawatan pasien ICU. Salah satu faktor yang dapat mempengaruhi utilisasi sumber daya dan biaya perawatan ICU adalah keparahan penyakit. Penelitian ini menggunakan desain analitik observasional dengan desain kohort prospektif Subjek penelitian ini adalah pasien ICU RSUP Dr. Hasan Sadikin Bandung yang dirawat pada bulan Maret-Mei 2023. Derajat keparahan penyakit dinilai menggunakan skor APACHE II. Utilisasi sumber daya ICU dinilai menggunakan skor TISS-28. Uji Pearson Product Moment digunakan untuk mendapatkan nilai koefisien korelasi (r) dan koefisien determinasi (r2) skor APACHE II terhadap skor TISS-28 dan biaya perawatan pasien ICU. Sebanyak 113 pasien ICU disertakan sebagai subjek penelitian. Rata-rata skor TISS-28 harian 25,6 dan biaya perawatan harian pasien ICU Rp 6.657.925,-. Dari analisis skor APACHE II terhadap skor TISS-28 harian didapatkan nilai r = 0,538; r2 = 0,289; p ≤ 0,001. Sedangkan dari analisis skor APACHE II dan biaya perawatan harian pasien ICU didapatkan r = 0,502 ; r2 = 0,253 ; p ≤ 0,001. Derajat keparahan skor APACHE II berpengaruh terhadap skor TISS-28 dan biaya perawatan pasien di ICU dengan arah korelasi positif. Hasil studi ini diharapkan dapat membantu meningkatkan efektivitas dan efisiensi perawatan pasien di ICU
Vitamin D Supplementation and Colorectal Cancer Patients Outcomes
Get PDFColorectal cancer is the third most encountered malignancy worldwide in 2018. Some earlier studies indicate a significant influence of vitamin D supplementation on the 5-year survival rate and the rate of metastasis progression in colorectal cancer patients. Studies investigating the effects of vitamin D supplementation on the outcomes of colorectal cancer patients are limited in Indonesia. Therefore, a double-blinded Randomized Controlled Trial (RCT) of the effect of vitamin D supplementation on the outcome of colorectal cancer patients was conducted from April 2022 to March 2023 at the digestive surgery outpatient clinic of Dr. Hasan Sadikin General Hospital Bandung, Indonesia. In this study, 36 patients received vitamin D and 34 patients received a placebo. Data analysis performed using the multivariate analysis with multiple regression revealed no significant relationship between vitamin D supplementation and colorectal cancer patient outcomes. Furthermore, ANOVA analysis indicated no relationship between the analyzed independent and dependent variables in this study. No relationship was found between vitamin D supplementation and the outcomes of metastasis, mortality, and Karnofsky scores in colorectal cancer patients. Further research with a larger population is still needed to determine the benefits of vitamin D supplementation on the outcomes of colorectal cancer patients
Characteristics and Therapy of Patients with Bartholin's Cysts in An Indonesian Tertiary Hospital
Get PDFA blocked duct of the Bartholin gland causes mucus accumulation and a fluid-filled sac, i.e., a Bartholin cyst, that can develop into an abscess when infected. This study specifically explored the characteristics and treatment Bartholin cysts or abscesses in patients registered at the obstetrics and gynecology clinic of Dr. Cipto Mangunkusumo National General Hospital, a tertiary hospital in Indonesia. This retrospective and descriptive study utilized data from patients registered at the hospital from July 2021 to July 2023. Bartholin cysts were found to be more common in patients aged 40 to 45 (57.1%) with a non-working status (71.4%), and married (90.5%). Cysts were found to be 1 to 3 cm in size (52.4%) and occured unilaterally (95.2%). Four of the fourteen patients complained of recurring Bartholin cysts. On history and clinical examinations, 20 (95.2%) patients reported the presence of lumps. Antibiotics were the most commonly used treatment, with 15 of 21 Bartholin cyst patients (71.4%) receiving them. Obtaining data on the demographic of patient characteristics is essential when providing appropriate health care. Clinical considerations such as cyst size, patient age, symptoms, and history of recurrent Bartholin cysts or abscesses influence the choice of comprehensive medical and surgical management
Survival Analysis of Trabeculectomy and Phacotrabeculectomy in Primary Angle Closure Glaucoma
Get PDFGlaucoma is the global leading cause of irreversible blindness. Primary angle closure glaucoma occurs most frequently in Asian populations, including in Indonesian population. Surgical management of Primary Angle Closure Glaucoma (PACG) includes cataract extraction, trabeculectomy, or combined phacotrabeculectomy. Many patients presented in the advanced stages of the disease with significant cataracts, requiring combined surgery. This study aimed to determine whether trabeculectomy alone was better in reducing intraocular pressure compared to phacotrabeculectomy in primary angle closure glaucoma. This was an analytic retrospective observational study reviewing medical records of PACG patients underwent trabeculectomy or phacotrabeculectomy from January to December 2015, within a 5-year follow-up period of a tertiary eye hospital. The success rates of the two groups were assessed with Kaplan-Meier survival analysis. Success criteria were defined as > 20% reduction of IOP or IOP <21 mmHg with or without medication. Results showed 104 and 41 eyes underwent trabeculectomy and phacotrabeculectomy, respectively. The cumulative 5-year survival rate in trabeculectomy group was 58.6%, and 85.4% in phaco trabeculectomy. There was no statistical difference in the success rate between the trabeculectomy and phaco trabeculectomy groups (p=0.102). Postoperative complications observed in the phacotrabeculectomy group were one choroidal detachment, one malignant glaucoma, and one vitreous prolapse. Thus, the cumulative success rate of phacotrabeculectomy was better than trabeculectomy after 5 years of follow up, albeit not statistically significant
Shallot-Peel Extract Supplementation Increases Glutathione Levels in Gastritis Rat Model
Get PDFBackground: Mefenamic acid can cause gastritis. Glutathione is one of the oxidative stress defense mechanisms and nutrient supplementation containing high antioxidants. Peel of shallot (Allium cepa var. Ascalonicum) contains higher antioxidant compounds and may increase glutathione levels. This study aimed to analyze the effect of shallot peel extract supplementation on gastric glutathione (GSH) levels in gastritis rats model.Methods: This was an experimental study using 24 male Wistar rats which were divided into 4 groups, namely group K0 (given 2 ml of aquadest for 14 days); group K1 (given mefenamic acid 23.25 mg/day for the first 7 days, then Na-CMC 2 ml/day for the next 7 days), group P1 and P2 (given mefenamic acid 23.25 mg/day for the first 7 days, then given shallot peel extract for the next 7 days at dose of 600 mg/kgBW/day or 1200 mg/kgBW/day). Gastric GSH levels were determined by the Ellman method. The data was analyzed by ANOVA and post hoc test.Results: The shallot peel extract supplementation at a dose of 600 mg/kgBW and 1200 mg/kgBW significantly increased gastric GSH levels in gastritis rats (p<0.05), however, GSH levels did not reach normal conditions. Linear regression analysis showed an R coefficient of 0.751.Conclusion: Shallot peel extract supplementation increases gastric GSH levels in gastritis rats model in a dose-dependent manner, suggesting an effective dose of shallot peel extract. Further study to develop shallot peel extract into phytopharmaca is imperative
Characteristics of Extraneural Tuberculosis in Patients with Tuberculous Meningitis Hospitalized at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia in 2017–2021
Get PDFBackground: Tuberculous (TB) meningitis is the most severe manifestation of extrapulmonary TB and contributes to a high mortality rate. The presence of extraneural TB may raise suspicion of TB meningitis (TBM). This study aimed to explore the characteristics of extraneural TB in TBM patients.Methods: This was a cross-sectional descriptive study using secondary data from medical records of TBM patients admitted at Dr. Hasan Sadikin General Hospital Bandung, Indonesia from 2017 to 2021. Demographic and clinical data were collected, including HIV status. TBM cases were classified into grades I, II, and III using Medical Research Counsil (MRC) criteria that were based on Glasgow Coma Scale (GCS) score and the presence of focal neurological deficits. The clinical classification diagnosis of TBM was made based on the Marais diagnostic criteria which included several diagnostic items and corresponding scoring which further divides TBM into three classes. Extraneural TB is defined as the finding of TB outside the nervous system. Disseminated TB was diagnosed based on the finding of ≥2 infected locations.Results: During the study period, 497 medical records were analyzed. Most TBM patients experienced Grade II (76.9%) and extraneural TB site was found in 65.4%, with pulmonary TB as the common site (77%). The highest mortality rate was in disseminated TB (50%). The finding of extraneural TB did not differ between HIV-negative and HIV-positive patients (67.8% vs. 67.9%; p=0.101).Conclusion: The presence of extraneural TB is common in patients with TBM. Therefore, extraneural TB evaluation is important to ensure TBM diagnosis. Further studies are needed to explore factors related to TBM diagnosis to ensure TBM patient’s wellbeing
Characteristics and Risk Factors of Diabetic Retinopathy Patients in West Java, Indonesia
Get PDFDiabetic retinopathy (DR) is the major microvascular complication of diabetes mellitus (DM) and responsible as the leading cause of vision loss among working-age adults. With the estimated DM cases reaching 578 million in 2030, public health systems are faced with challenges of increasing costs of implementation and maintenance of DR screening program in people with DM. This study aimed to describe characteristics and risk factors of DR among patients of a Primary Health Care Center in West Java, Indonesia. This was a cross-sectional study during the period of March 2021 until June 2022 on 1,080 participants. Among these participants with DM, 28.89% (25.16–33.12% [95% CI]) were classified to have DR. A total of 32.69% (28.14–36.71 [95% CI]) participants with DR had vision threatening DR (VTDR). The prevalence of DR in this study was higher in women (77.23%) with a mean age of 57.26 ± 9.17 and duration of DM of ≥5-years (56.01%), blood glucose level <200 mg/dL (63.79%), high systolic blood pressure (52.03%), high diastolic blood pressure (39.07%), normal BMI (55.5%), high waist circumference (43.7%), and high HbA1C (3.42%). A total of 1,041 (96.39%) participants were using antidiabetic drugs, and 9.63% of them were currently smoking. This study showed that diastolic blood pressure, abnormal abdominal circumference, and high HbA1C levels were more prevalent in DR and VTDR groups. The findings of this study represent the current characteristics of DR patients in West Java and can be used as a baseline or comparison data for other regions in Indonesia
Phenotypic and Molecular Detection of Carbapenemase-Producing Acinetobacter baumannii Strains from Clinical Specimens in Dezful Teaching Hospital
No full textNowadays, antibiotic resistance in bacteria has become a global problem. Therefore, the identification of resistant strains of bacteria has attracted special attention in a pursue to choose more effective treatment solutions. One of the most common mechanisms of resistance is the production of carbapenemase enzyme in Acinetobacter baumannii. This present study aimed to detect carbapenemase-producing strains by phenotypic and molecular methods in clinical specimens collected in Ganjavian Hospital of Dezful between June 2021 and May 2022. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion and Etest assay, while the extended-spectrum beta-lactamase production (ESBLs) and Metalobetalactamases (MBLs) were detected by combined disk method using ceftazidime and ceftazidime/clavulanic acid disks and imipenem and imipenem /EDTA disks, respectively. Molecular detection of blaIMP, blaSPM, blaOXA-23, and blaOXA-24, blaOXA-58, blaGES genes was performed. Of a total of 54 strains, the highest resistance rate was for cephalosporins (98.1%), and ciprofloxacin (94.2%), in contrast to minocycline (13%). ESBL and MBL producers were 26% and 80%, respectively. All isolates had intermediate resistance against colistin. The most prevalent gene in the carbapenem-resistant A. baumannii (CRAB) was blaOXA-23, followed by blaOXA-24, blaGES, blaIMP, and blaOXA-58 genes. Present report highlights the existence of CRAB and intermediate resistance to colistin and also the co-existence of several genes from different carbapenemase classes in this region. Therefore, resistant strains should be identified promptly and specific treatment protocols should be devised to control the dissemination of resistance genes in therapeutic settings
Post Cesarean Pain Intensity and Wound Healing in ERACS and Conventional Method
Get PDFCesarean section is a common delivery method in Indonesia, with a prevalence of 17.6%. This method is used when vaginal delivery is not possible or in emergency cases, in an effort to prevent maternal and infant fatalities. Enhanced Recovery After Cesarean Surgery (ERACS) is a new method whose effectiveness has not been widely studied. The aim of this study was to compare post-cesarean pain intensity and wound healing in patients receiving ERACS and cesarean conventional methods at Bandung Kiwari General Hospital. This cross-sectional study used an analytic observational design and accidental sampling with 52 post-cesarean patients as the subjects during the three-months of study. Pain intensity was observed using the NRS instrument and wound healing was observed using the REEDA scale instrument on days one, two, and six post-surgery. The t-test analysis showed that the ERACS method had better pain intensity post-cesarean than the conventional method with a p-value of 0.000. However, there was no difference in wound healing between ERACS and conventional methods with a p-value of 0.136
Suicide among Older Adults in Gunungkidul, Indonesia
Get PDFBackground: Older adults are vulnerable to suicidal crises due to decreased cognitive, health and psychosocial functions. Gunungkidul is a regency in Indonesia that has a demographic structure with an increasing older population and a high prevalence of suicide. This study aimed to determine the characteristics of suicide among older adults in Gunungkidul, Indonesia, from 2012 to 2022.Methods: This was a retrospective analytical descriptive study examining forensic reports of suicide from the Gunungkidul Resort Police, Indonesia, from 2012 to 2022. A total of 388 suicide reports were included, with 186 of them pertaining to older adult suicides. Demographic data and suicide methods were collected using descriptive statistics, and Chi-square analysis was performed to examine any associations or differences in the data.Results: Suicide cases in older adults were more dominant (55.03%) in all suicide cases in Gunungkidul. Hanging was the most prevalent method of suicide (96.2%) among older adults, and there was no difference in suicide methods between males and females (p=0.35). Furthermore, the older adults consisting of males (n=120) were more dominant than females (n=66), however, there was no significant difference across the age group in the youngest-old (60–69 years), the middle-old (70–79 years), and the oldest-old (≥80 years) age group (p>0.01).Conclusions: The prevalence of suicide in older adults in Gunungkidul exceeds other productive age groups, mostly males, and hanging is the most predominant method. Addressing suicide among older adults in Gunungkidul requires a holistic approach by considering individual and societal factors, which necessitates immediate attention to their health, psychological, and socio-economic needs through targeted interventions