E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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PERBANDINGAN FLUOKSETIN 20 MG DENGAN AMITRIPTILIN 12,5 MG SEBAGAI ADJUVAN KOMBINASI PARASETAMOL DAN MORFIN DALAM MENGURANGI NYERI PADA PASIEN NYERI KANKER
Get PDFData WHO menunjukkan bahwa 30–40% pasien kanker mengalami nyeri sedang atau berat. Empat kelas obat antidepresan dapat dipakai dalam pengobatan nyeri neuropatik. Penelitian ini bertujuan untuk mengetahui perbandingan fluoksetin 20 mg dengan amitriptilin 12,5 mg sebagai adjuvant kombinasi parasetamol 1000 mg dalam mengurangi gejala nyeri pada pasien nyeri kanker. Penelitian dilaksanakan sejak Juli–September 2023 di klinik nyeri Rumah Sakit Umum Pusat Haji Adam Malik Medan. Penelitian ini adalah uji klinis acak tersamar. Sebanyak 40 subjek dibagi dalam 2 kelompok. Kelompok A (n=20) mendapat fluoksetin, morfin dan parasetamol, sedangkan kelompok B (n=20) mendapat amitriptilin, morfin dan parasetamol. Skor nyeri pada subjek diukur dengan menggunakan PainDETECT. Data dianalisis secara univariat dan bivariat. Data bivariat dianalisis dengan uji Chi-Square, T-Test Independent, T-Test Paired dan Mann-Whitney. Terdapat penurunan skor numeric rating scale dan PainDETECT yang signifikan antara sebelum dan setelah pemberian fluoksetin maupun amitriptilin dengan nilai p<0,05. Kelompok fluoksetin maupun amitriptilin dapat menurunkan skor numeric rating scale dan PainDETECT secara statistik, akan tetapi tidak bermakna secara klinis.Latar Belakang: Nyeri kanker sering ditemukan pada pasien dengan kanker, yaitu 30-50% dan meningkat 70%-90%. Insiden nyeri kanker meningkat seiring dengan progresifitas penyakit. Menurut WHO, kira kira 30%-40 % pasien kanker mengalami nyeri sedang atau berat. Empat kelas obat antidepresan telah dipelajari dapat dipakai dalam pengobatan nyeri neuropatik, yaitu antidepresan trisiklik (TCA), inhibitor reuptake serotonin dan norepinefrin selektif (SNRI), inhibitor reuptake serotonin selektif (SSRI), dan inhibitor monoamine oksidase (MAOI).Tujuan: Penelitian ini bertujuan untuk mengetahui perbandingan fluoksetin 20 mg per 24 jam oral dengan amitriptilin 12,5 mg per 24 jam oral sebagai adjuvant kombinasi parasetamol 1000 mg per 8 jam oral dan morfin 10 mg per 12 jam oral dalam mengurangi gejala nyeri pada pasien nyeri kanker di klinik nyeri RSUP Haji Adam Malik Medan.Metode: Penelitian ini uji klinis acak tersamar. Penelitian ini dilaksanakan pada bulan Juli-September 2023. Sebanyak 40 subjek penelitian yang menjalani endoskopi gastrointestinal dibagi dalam 2 kelompok. Kelompok A (n=20) diberikan fluoksetin, morfin dan parasetamol, sedangkan kelompok B (n=20) diberikan amitriptilin, morfin dan parasetamol. Skor nyeri pada subjek diukur dengan menggunakan PainDETECT. Data dianalisis secara univariat dan bivariat. Data bivariat dianalisis dengan uji Chi-Square, T-Test Independent, T-Test Paired dan Mann-Whitney.Hasil: Terdapat penurunan skor NRS maupun PainDETECT yang signifikan antara sebelum dan setelah pemberian fluoksetin maupun amitriptilin dengan nilai p<0,05.Kesimpulan: Kelompok fluoksetin maupun amitriptilin sama-sama dapat menurunkan skor NRS dan PainDETECT secara statistik, akan tetapi tidak bermakna secara klinis karena target penurunan skor yaitu kurang dari 4 pada skala 0-10 atau penurunan 50% nyeri
Unusual Lifespan of Edwards' Syndrome in COVID-19 Era
Get PDFEdwards' syndrome is caused by an extra chromosome on the 18th chromosome. Patients with this diagnosis have median survival of only 3-14.5 days, with the majority of infants with full trisomy 18 type die before or shortly after they are born. There is only supportive treatment available for Edwards’ syndrome. During the COVID-19 pandemic, providing health services was challenging, leading to less than optimum treatments added by patients’ reluctance to visit healthcare facilities due to the fear of COVID-19 transmission. This case study presented an infant with Edwards’ syndrome with major malformation. The patient had several organ problems, was admitted to the NICU, and continued with home care for monitoring for 6 months. Patient then died at 9 months of age. Maintaining the best quality of life for this patient was very challenging for parents and healthcare providers. Since the management for this type of sydnome is more palliative, good education, information, and psychosocial supports for the parents are needed to prepare them with the worst conditions, which was especially more challenging during the COVID-19 pandemic
Case Series on Imaging Features of Trilateral and Quadrilateral Retinoblastoma: What Radiologists Need to Know
Get PDFObjective: To identify the differences between trilateral and quadrilateral retinoblastoma based on radiologic imaging.Case: We found three cases of retinoblastoma at Sanglah General Hospital. The retinoblastoma patients we found were boys under the age of 5. The first patient presented with swelling, pain, and impaired vision in the right eye. The second and third patients presented with eye protrusion and leukocoria. Computed tomography (CT) imaging revealed a calcified mass in the intraorbital region that extended to the cerebral hemispheres. It may be accompanied by hair-on-end periosteal reaction. In the first patient, the mass extended to the pineal gland. In the second and third patients, the mass extended to the suprasellar and pineal regions. Trilateral retinoblastoma consists of a primordial midline neuroectodermal tumor that originates in the pineal or suprasellar region. It is an uncommon combination of unilateral or bilateral retinoblastomas. Quadrilateral retinoblastoma, on the other hand, presents with bilateral retinoblastoma and tumors in both the suprasellar and pineal regions. The histopathology of trilateral and quadrilateral retinoblastoma shows a different pattern from retinoblastoma.Conclusion: Retinoblastoma poses one of the most challenging problems due to its distinct patterns of growth, extension, and recurrence. Intracranial metastasis of trilateral and quadrilateral retinoblastoma exhibits a different pattern. The prognosis and diagnosis of retinoblastoma are significantly influenced by clinical examination, radiologic imaging, and histopathology
Viability Test of Mycobacterium Tuberculosis Bacteria Stored in Various Cryopreservation Periods
Get PDFBackground: The specimen storage room serves as bioarchive for prospective research purposes. Cryopreservation or preservation at very low temperatures has been used to preserve research isolates for decades. A quality assessment must be conducted to ensure the isolates conditions. This study aimed to assess the quality of isolates by testing the level of viability and contamination from different cryopreservation periods.Methods: This was an experimental study with a total sample of 92 Mycobacterium tuberculosis (Mtb) isolates which were sampled randomly using cryopreservation, aged 8–10 years (in Tryptic Soy Broth media, TSB/) and aged 3–5 years (in Middlebrook 7H9) which was re-cultured in Ogawa Medium at the Tuberculosis Laboratory, Universitas Padjadjaran in May–November 2019. After observing confluent growths, the pure isolate was stained using the Ziehl-Neelsen (ZN) method to confirm the presence of Mtb growth or contamination. A Simple ratio was used to count the recovery rate as a viability parameter and contamination rate of each batch.Results: Test results showed a recovery rate of 66.67–100% of positive cultures stored despite they had been cryopreserved for 10 years. There was no significant difference in the percentage of positive cultures between preservation period groups.Conclusion: Mtb isolates can survive and remain viable after being stored for up to 10 years at -80 ° C in cryopreservation media
Management of Stage-4 HIV with Cerebral Toxoplasmosis Coinfection and SIADH Complication
Get PDFHIV/AIDS stage 4 is the stage where the HIV/AIDS patients have low immunity protection against infections, which can led to coinfections and complications. This case report presented an evaluation of the diagnosis and treatment of an HIV/AIDS stage 4 patient with cerebral toxoplasmosis coinfection and SIADH complications. A man (47 years, 35 kg), married with two children, complaining of weakness, nausea, vomiting, weight loss, and low appetite. Sodium level were measured, showing a 117 mg/dL level that continued to decrease throughout the patient's treatment. Five days later, the patient lost his consciousness with a GCS score of 224, indicating severe brain injury, and was diagnosed with cerebral toxoplasmosis based on the result of head CT-SCAN with contrast. On day 6, the patient was tested positive for HIV and diagnosed with stage 4 with an absolute CD4 count of 4 cells/μl. Therapy was provided by giving pyrimethamine-clindamycin therapy for cerebral toxoplasmosis, followed by Tenofovir, Lamivudine, and Evafirenz as antiretroviral therapy. Treatment for hyponatremia was done by administration of 3% NaCl and tolvaptan. The patient started experiencing an improvement in consciousness after the 10th day of medication, and sodium levels fluctuated throughout the treatments. Patient was discharged after 15 days with clinical improvements
Patient’s Quality of Life After 3-and 6-Months Cataract Surgery
Get PDFCataract surgery is the most common elective procedure and has been shown to increase patients' visual acuity. However, visual acuity alone cannot adequately represent their quality of life. Quality of life can be measured with a standardized questionnaire, such as the National Eye Institute Refractive Error Quality of Life Instrument. Patients with better quality of life pre-operatively will benefit less from cataract surgery. This study aimed to describe patients' quality of life after long-term cataract surgery in the National Eye Center Cicendo Eye Hospital. This cross-sectional descriptive study used primary data collected using a questionnaire from March to May 2022. The subjects were 33 people with cataracts who underwent uncomplicated cataract surgery at Cicendo National Eye Hospital over the past three and six months of the study. Patients who met the inclusion criteria were given the NEI-RQL 42 questionnaire. In visual clarity, patient expectations, near vision, far vision, daily fluctuations, activity limitations, suboptimal correction, and satisfaction with correction variables, an increase in value at three months was observed, yet slightly decreased at 6 months. There was decreased glare complaints, symptoms, and dependence on correction at preoperative, 3 months, and 6 months. An increase in the level of concern and appearance from preoperative, 3 months, and 6 months post-operative was observed. Thus, an improvement in the patient's quality of life is observed three months after surgery, yet decreases slightly in six months after surgery
Effect of Saline Nasal Irrigation in Patients with Sinonasal Symptoms
Get PDFNasal irrigation with saline is frequently used as an alternative therapy for sinonasal diseases since it effectively reduces sinonasal symptoms and improves the quality of life when measured by various subjective instruments. The mechanisms of action of saline irrigation remain unclear, but some hypotheses attribute the direct physical cleansing of thick mucus, allergens, and pollutants. This study aimed to determine the effect of nasal saline irrigation on the nasal mucosa using the modified Lund-Kennedy endoscopic score as the objective evaluation. This pre-post-experimental study was conducted at PKU Muhammadiyah Gamping Hospital Yogyakarta, Indonesia, from May to June 2023. The study included 18 individuals presenting with sinonasal symptoms. Participants meeting the inclusion and exclusion criteria who provided informed consent were trained in nasal saline irrigation. Patients were assessed at baseline and one week after nasal saline irrigation using endoscopy, TNSS, and MCC time. Results revealed that the mean of endoscopic scores before and after saline irrigation were 6.89±1.1 and 5.33±1.4, respectively (p-value 0.006), while the mean of TNSS scores before and after saline irrigation was 6.17±2.3 and 4.28±2.6, respectively (p-value 0.006). Thus, nasal saline irrigation significantly improves the endoscopy and TNSS scores, but not the MCC time
Dysobinol Extracted from Chisocheton Macrophyllus Triggers Proliferation Inhibition, Potential Apoptosis, and Cell Cycle Arrest of He La Cancer Cell Lines
Get PDFDysobinol is a new limonoid from C. macrophyllus seeds reported to have an anticancer activity. This study aimed to determine the cytotoxic activity of Dysobinol against HeLa cancer cell lines and evaluate its mechanism of action by determining the expression level of several carcinogenesis genes related to apoptosis and cell cycle. In this experimental study, the cytotoxic activity was determined using the MTS assay and gene expression by real-time reverse transcriptase PCR. The result shows that Dysobinol has an anticancer activity in a dose and time-dependent manner against HeLa cells and was categorized as toxic with IC50 values of 52.92, 52.70, and 14.96 μg/ml for 24, 48, and 72 hours, respectively. Dysobinol significantly increased the expression of Bax, Cas-8, and Cas-3 and decreased the expression of Cyc D1 at both doses (IC50 and 2x IC50) but only high doses (2x IC50) could affect Cas9 and NF-κB expressions, indicating that Dysobinol can induce apoptosis via the extrinsic pathway and inhibits the cell cycle through the Cyc D1 regulator. Dysobinol has the potential to be developed as a chemotherapy drug or an adjuvant agent for cervical cancer treatment
Association between Lamp Light During Sleep and Sleep Quality in Medical Students
Get PDFBackground: Sleep quality is influenced by numerous factors, including external factors, such as the sleep environment. One aspect of the sleep environment that can influence sleep is lighting. Light exposure emitted by lamps during sleep can impair sleep quality. The aim of this study was to investigate the association between lamp light during sleep and sleep quality in preclinical medical students.Methods: This cross-sectional observational analytic study was carried out on 386 preclinical medical students who were determined using the cluster sampling method. Data was collected in November 2022. Lamp light during sleep and sleep quality among students were measured using the Indonesian version of the Pittsburgh Sleep Quality Index. The association between lamp light and quality of sleep was analyzed by the Chi-Square test.Results: There were 26.68% of students who used lights when sleeping. Poor sleep quality was detected in 46.37% of students. The association between lamp light during sleep and quality of sleep yielded a p-value of 0.002.Conclusion: There is a significant association between lamp light during sleep and sleep quality in preclinical medical students. Thus, improving sleep quality in preclinical medical students may be achieved by modifying the lamp light during sleep
HUBUNGAN ANTARA SKOR APACHE II, SOFA, EWS TERHADAP KEJADIAN PROLONGED MECHANICAL VENTILATOR DI ICU RSUP H. ADAM MALIK MEDAN
No full textPasien yang dirawat di ICU sekitar 30−60% membutuhkan ventilasi mekanik. Penelitian sebelumnya memperkirakan bahwa 3−7% pasien dengan ventilasi mekanis memerlukan prolonged mechanical ventilator (PMV). Prevalensi individu yang membutuhkan ventilator assisted individuals (VAI) berkisar 6,6 hingga 23 per 100.000 pasien. Individu dengan VAI meningkat mengindikasikan peningkatan kebutuhan ventilasi mekanik yang lama/prolonged mechanical ventilation (PMV) dan prognosis yang lebih buruk. Penelitian ini dilakukan untuk menganalisis apakah penilaian skor APACHE II, SOFA, dan NEWS memiliki hubungan dengan penggunaan ventilator mekanik yang memanjang selama Januari–Desember 2022 di ICU RSUP H. Adam Malik Medan. Desain penelitian ini menggunakan uji analitik retrospektif dengan rancangan cohort. Subjek yang memenuhi kriteria inklusi dan tidak termasuk eksklusi dipilih dengan metode total sampling. Jumlah sampel 96 pasien yang dinilai skor APACHE, SOFA, NEWS, dan apakah pasien mengalami PMV. Hasil penelitian ini pasien dengan PMV didapatkan skor APACHE dengan nilai median 18, pada skor SOFA 7 dan pada skor NEWS 12, dengan nilai p=0,001 pada ketiga penilaian ditemukan hubungan yang signifikan. Simpulan penelitian ini didapatkan hubungan skor APACHE II, SOFA, dan NEWS dengan kejadian PMV.Di antara pasien yang dirawat di ICU, 30 - 60% membutuhkan Ventilasi Mekanik. Penelitian sebelumnya memperkirakan bahwa 3-7% pasien dengan ventilasi mekanis memerlukan PMV (Prolonged Mechanical Ventilator). Prevalensi individu yang membutuhkan ventilator (ventilator assisted individuals/ VAI) berkisar antara 6,6 hingga 23 per 100.000 pasien. Meningkatnya individu dengan VAI mengindikasikan peningkatkan kebutuhan ventilasi mekanis yang lama (prolonged mechanical ventilation/ PMV) dan prognosis yang lebih buruk. Desain penelitian ini menggunakan uji analitik retrospektif dengan rancangan cohort. Subjek yang memenuhi kriteria inklusi dan eksklusi dipilih dengan metode total sampling. Dengan total sampel 96, yang dinilai skor APACHE, SOFA, NEWS, dan apakah pasien mengalami PMV. Dari hasil penelitian ini, pasien dengan PMV didapatkan skor APACHE dengan nilai median 18, pada skor SOFA 7, dan pada skor NEWS 12, dengan nilai P pada ketiga penilaian 0,001 yang ditemukan adanya hubungan yang signifikan. Kesimpulan dari penelitian ini didapatkan hubungan yang signifikan pada skor APACHE II, SOFA, dan NEWS dengan kejadian PMV