E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Prevalence of Hypertension and Its Relationship with Stress Levels among Medical Students in Jakarta, Indonesia
Full text linkBackground: Stress can occur in all groups, including late adolescents and university students. Repetitive and persistent exposure to stress can induce many other conditions, one of which is hypertension. Aging and the presence of risk factors could increase the prevalence of hypertension. This study aimed to determine the relationship between stress levels and the prevalence of hypertension in pre-clinical medical students.Method: This study used an analytical observational study design with a cross-sectional approach and simple random sampling of 212 pre-clinical medical students at the Atma Jaya Catholic University of Indonesia. The measuring instrument used was the K10 questionnaire, followed by blood pressure screening. The Kruskal-Wallis test using SPSS facilitated the univariate and bivariate data analysis.Results: The majority of the 212 respondents were female (61.8%), aged ranging from 18–21 years. Stress was identified in 49.1% of respondents, with mild stress (20.3%), moderate stress (15.6%), and severe stress (13.2%). Hypertension was detected in 11.8% of respondents, with 9.4% and 2.4% as grade 1 and 2 hypertension, respectively. High-normal blood pressure was detected in 20%. There was no significant relationship between stress levels and prevalence of hypertension among these pre-medical students (p-value for systolic pressure = 0.1318 and p-value for diastolic pressure = 0.8314). Conclusion: Although there is no relationship between stress levels and hypertension in medical students, however, concerns need to be emphasized regarding prevalence of hypertension stress. Further thorough evaluation and intervention are needed to prevent future complications in future medical doctors. Therefore, a healthy lifestyle is encouraged
Characteristics of Patients with Anterior Cruciate Ligament Injury at Ulin Hospital Banjarmasin, Indonesia
Full text linkKnee injuries are one of the common injuries, especially among athletes. Many studies have concluded that the main cause of these injuries were sudden movements while doing sports. The incidence of the knee joint injury in Indonesia was 38 to 78 per 100,000 patients with the prevalence of Anterior Cruciate Ligament (ACL) injuries of 16%. Recently, an increasing number of ACL injury patients was observed to be treated at the Ulin Hospital, Banjarmasin, Indonesia, when compared to the number of the previous years, making it important to understand the characteristics of patients experiencing these injuries. This study aimed to explore the characteristics of patients with ACL injuries in the hospital. Data for this retrospective descriptive study were collected from medical records during the period of March 2022 to June 2023 from Ulin Hospital, Banjarmasin. The inclusion criteria were patients diagnosed with an ACL injury with or without meniscus tear. From a total of 95 patients with ACL injuries, 30 (32%) were below 20 years old, 42 (44%) were 20-30 years old, 18 (19%) were 31-40 years old, 3 (3%) were 41-50 years old, and 2 (2%) were above 50 years old. The ratio between men and women was 11:1. There were 74 patients who had sports-related injuries while the remaining 21 patients experienced the injury due to other activities. Of the total 95 cases, 59 (62%) were treated nonoperatively and 36 (38%) received arthroscopy surgery. The arthroscopy was mostly performed to patients who also experienced a meniscus injury and in the chronic phase, with an average length of stay at the hospital of 2.6 days
Family Support and Medication Adherence in Patients in Prolanis Program
Full text linkThe Chronic Disease Management Program, or Program Pengelolaan Penyakit Kronis (Prolanis), is a disease management program designed for individuals with chronic illnesses. It aims to maintain health and improve quality of life. The success of Prolanis depends not only on patient adherence to medication but also on family involvement as the primary source of support. This study aimed to examine the relationship between family support and medication adherence among Prolanis patients at Batoh Public Health Center, Banda Aceh, Indonesia. An observational analytic study with a cross-sectional design was conducted using consecutive sampling of 74 Prolanis participants. Data were collected through guided interviews. Among the participants, 33 individuals (44.5%) exhibited low medication adherence, while 41 individuals (55.5%) demonstrated high adherence. Additionally, 8 participants (10.8%) reported poor family support, whereas 66 participants (89.2%) received good family support. Data analysis using the chi-square test revealed a significant relationship (p=0.009) between family support and medication adherence. Therefore, it can be concluded that family support is significantly associated with medication adherence in Prolanis patients. Families are the main supporters in maintaining the health of their family members, with an important role in encouraging, supporting, and supervising patients' treatment. Good support and constant encouragement and attention can increase patients' confidence, which in turn will affect their adherence to treatment
Skinfold Thickness and Mid-upper Arm Circumference in Pediatric Patients with Chronic Kidney Disease
Full text linkChronic kidney disease (CKD) can impair the kidneys' capacity to manage nutrition, and any nutritional imbalances in CKD may affect the disease's progression. This study evaluated triceps skinfold (TSF) thickness and mid-upper arm circumference (MUAC) as indicators of nutritional status in children with early- and late-stage CKD at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. A descriptive cross-sectional design was used with secondary data from the nephrology division registry collected between August 2021 and August 2022. Data analysis was conducted with Microsoft Excel. The study involved 65 participants, with 32 in the early stage and 33 in the late stage. For early-stage patients, the average TSF was 13.75 mm and the MUAC was 12 cm, while, the average TSF an MUAC in the late stage were 11.39 mm and 11.70 cm, respectively. Based on TSF percentiles, most patients fell within the normal range, whereas MUAC measurements indicated that the majority were below normal. In terms of %TSF, most early-stage patients had above-average values, whereas late-stage patients were below average. All MUAC measurements indicated below-average values for both stages. Overall, TSF percentiles suggested that most patients had adequate nutritional status; however, %TSF revealed excess adiposity in early-stage patients and deficits in late-stage patients. MUAC consistently indicated deficits across both groups
Korelasi Nilai Transcranial Doppler Pulsatility Index (TCD-PI) dengan Durasi Ventilasi Mekanik pada Pasien Pasca Operasi Bedah Otak
No full textPeningkatan tekanan intrakranial (TIK) merupakan kondisi umum pada pasien pascabedah otak dan berpotensi menyebabkan penurunan kesadaran, gangguan drive napas, serta cedera paru akut, yang dapat menyulitkan proses penyapihan ventilator. Pemantauan TIK secara invasif belum menjadi prosedur rutin, sehingga dibutuhkan alternatif noninvasif, salah satunya Transcranial Doppler Pulsatility Index (TCD-PI). Penelitian ini bertujuan menganalisis korelasi antara nilai TCD-PI dan durasi ventilasi mekanik pada pasien pascabedah otak. Desain penelitian ini adalah observasional prospektif, dilakukan di ICU RSUP Dr. Hasan Sadikin Bandung pada Februari–April 2024. Pemeriksaan TCD-PI dilakukan 12–24 jam setelah pasien masuk ICU. Sebanyak 39 pasien memenuhi kriteria inklusi. Hasil menunjukkan rerata nilai TCD-PI sebesar 1,39 dan rerata durasi ventilasi mekanik selama 6,59 hari. Analisis korelasi Pearson menunjukkan hubungan positif yang signifikan antara nilai TCD-PI dan durasi ventilasi mekanik, dengan koefisien korelasi r=0,671 dan koefisien determinasi r²=0,450 (p<0,001). Simpulan, terdapat korelasi positif dengan kekuatan sedang antara nilai TCD-PI dan durasi ventilasi mekanik, sehingga TCD-PI berpotensi sebagai indikator noninvasif untuk memprediksi lamanya ventilasi mekanik pada pasien pascabedah otak. Peningkatan tekanan intrakranial (TIK) merupakan masalah yang sering terjadi pada pasien pasca operasi bedah otak. Kondisi ini dapat menyebabkan penurunan kesadaran, gangguan drive pernapasan dan cedera paru akut pada pasien neurokritis sehingga sulit untuk lepas dari bantuan ventilasi mekanik. Pemantauan TIK dengan metode invasif tidak rutin dilakukan dan memiliki berbagai risiko dan komplikasi. Pemeriksaan dengan ultrasonografi di otak seperti TCD-PI (Transcranial Doppler Pulsatility Index) dapat menjadi alternatif untuk mengevaluasi TIK. Penelitian ini menggunakan studi prospektif observasional dengan analisis korelasi untuk mendapatkan nilai koefisien korelasi (r), koefisien determinasi (r2) dan arah korelasi dari pemeriksaan TCD-PI dan durasi ventilasi mekanik pasien pasca operasi bedah otak. Subjek penelitian adalah pasien yang dirawat di ICU RSUP Dr. Hasan Sadikin Bandung pada bulan Februari-April 2024 dengan melakukan pemeriksaan TCD-PI pada pasien pasca bedah otak 12-24 jam setelah admisi di ICU. Sebanyak 39 pasien ICU disertakan sebagai subjek penelitian. Hasil penelitian menunjukkan nilai rata-rata TCD-PI pada seluruh subjek penelitian adalah 1,39 dan rata-rata durasi ventilasi mekanik pada seluruh pasien penelitian adalah 6,59 hari. Dari uji Pearson product moment antara TCD-PI dengan durasi ventilasi mekanik didapatkan koefisien korelasi r = 0,671dan koefisien determinasi r2 = 0,450 (p < 0,001). Dari hasil tersebut dapat disimpulkan bahwa nilai TCD-PI dan durasi ventilasi mekanik memiliki arah korelasi positif berkekuatan medium/sedang.
MANAJEMEN HIPERTIROID MOLA HIDATIDOSA PADA KURETASE DENGAN ANESTESI BLOK SUBARACHNOID REGIONAL
No full textMola hidatidosa yang disertai hipertiroidisme merupakan kondisi berisiko tinggi karena potensi terjadinya krisis tiroid yang mengancam jiwa. Hipertiroid dapat menjadi komplikasi penyakit trofoblast gestasional, termasuk pada mola hidatidosa dan koriokarsinoma. Laporan ini memaparkan manajemen anestesi pada pasien perempuan usia 39 tahun dengan diagnosis mola hidatidosa dan hipertiroid. Pasien datang dalam keadaan sadar, dengan tekanan darah 120/80 mmHg, frekuensi nadi 102 kali/menit, laju napas 20 kali/menit, dan saturasi oksigen 98% dalam udara bebas. Skor indeks Wayne adalah 19, dengan peningkatan kadar T4 dan penurunan kadar TSH. Sebelum tindakan kuretase, pasien diberikan propiltiourasil (PTU) 3×100 mg dan propranolol 3×20 mg. Prosedur kuretase dilakukan dengan anestesi spinal menggunakan levobupivakain 15 mg dan adjuvan fentanil 25 µg. Selama dan setelah prosedur, kondisi hemodinamik pasien tetap stabil. Spinal anestesi dipilih karena dianggap lebih aman dan memiliki risiko komplikasi yang lebih rendah dibanding dengan anestesi umum, khususnya pada pasien dengan risiko kardiovaskular tinggi akibat hipertiroidisme. Diagnosis dan tata laksana hipertiroid perlu dilakukan secara cepat dan tepat untuk mencegah komplikasi serius, terutama pada pasien dengan gejala berat seperti perdarahan aktif atau ancaman krisis tiroid. Mola hidatidosa dengan hipertiroid meliputi dua macam penyakit yang dapat membahayakan hidup dengan timbulnya krisis tiroid. Hipertiroid dikenal dapat menjadi penyulit pada penyakit trofoblast gestasional, baik pada khoriokarsinoma maupun pada mola hidatidosa. Kami melaporkan seorang perempuan usia 39 tahun yang merupakan pasien mola hidatidosa dengan hipertiroid. Pemeriksaan fisik didapatkan GCS E4V5M6, tekanan darah 120/80 mmHg, detak jantung 102x/mnt, respirasi 20x/mnt, SpO2 98% dalam posisi supine dengan udara ruang. Indeks Wayne pasien 19 dan terdapat peningkatan T4 dan penurunan TSH yang menunjukan hipertiroid klinis pada pasien. Satu hari sebelum tindakan, pasien diberikan PTU 3x100 mg, dan propranolol 3x20 mg. Pasien selanjutnya dilakukan prosedur kuretase dengan menggunakan anestesi blok subarachnoid regional menggunakan levobupivacain 15 mg ditambahkan adjuvan fentanyl 25 mcg. Kondisi pasien stabil setelah kuretase. Manajemen anestesi pada kasus hipertiroid dan mola hidatidosa dengan tindakan kuretase dapat dilakukan dengan metode RASAB karena lebih aman dan minimal risiko dibandingkan dengan anestesi umum. Diagnosis dan manajemen hipertiroid harus dilakukan secara cepat dan tepat, terutama pada mola hidatidosa yang disertai dengan tanda kegawatan, baik dari perdarahan mola, maupun ancaman krisis tiroid.
Perbandingan Antara Pemberian Infus Kontinu Lidokain dan Morfin Terhadap Skor Visual Analog Scale dan Kadar Neutrophil-Lymphocyte Ratio Pasca Laparotomi
No full textMorfin sebagai analgetik pada laparotomi memiliki efek samping yang merugikan dan potensi menyebabkan kecanduan. Infus lidokain intravena (IVLI) merupakan alternatif analgetik perioperatif yang di nilai lebih aman dan efektif. Penelitian ini bertujuan membandingkan efektivitas pemberian IVLI dan morfin terhadap nyeri serta kadar Neutrophil-Lymphocyte Ratio (NLR) pascalaparotomi. Penelitian ini merupakan uji klinis acak tersamar ganda yang melibatkan 46 pasien laparotomi di RSUD Dr. Moewardi yang memenuhi kriteria inklusi dan eksklusi. Pemberian IVLI bolus 1,5 mg/kg saat induksi dilanjutkan infus 1 mg/kgBB/jam dibanding dengan morfin bolus 15 mcg/kg dilanjutkan infus kontinu 10 mcg/kg/jam. Hasil menunjukkan penurunan skor nyeri VAS pada jam ke-4, 8, dan 24 lebih baik pada kelompok lidokain, meskipun tidak signifikan secara statistik (p=0,128; p=0,097; p=0,100). Penurunan NLR juga lebih baik pada kelompok lidokain namun tidak signifikan (p=0,941). Simpulan, IVLI memberikan efek analgetik yang lebih baik dibanding dengan morfin berdasarkan penurunan skor VAS dan kadar NLR, namun tidak menunjukkan perbedaan yang bermakna secara statistik.Morfin sebagai analgetik pada laparotomi memiliki efek samping yang merugikan dan adanya potensi terjadi kecanduan. Infus lidokain intravena (IVLI) menjadi terobosan analgetik pada tindakan operasi karena diyakini lebih aman dan lebih efektif dalam mengatasi nyeri. Penelitian ini bertujuan untuk mengetahui perbandingan efektivitas pemberian IVLI dan morfin terhadap nyeri dan kadar Neutrophil-Lymphocyte Ratio (NLR) pasca laparotomi. Penelitian ini merupakan uji klinis acak tersamar ganda yang dilakukan pada 46 pasien yang menjalani tindakan laparotomi di RSUD Dr. Moewardi yang memenuhi kriteria inklusi-eksklusi. Pemberian IVLI dosis 1,5 mg/kg bolus pada saat induksi dilanjutkan 1 mg/kgBB/jam memberikan efek anti nyeri lebih baik dibandingkan morfin bolus 15 mcg/kg dilanjutkan infus kontinu 10 mcg/kg/jam dengan penilaian skor VAS jam ke 4,8,24 namun tidak signifikan secara statistik (p = 0.128, p = 0.097, p = 0.100), selain itu juga mampu menurunkan NLR lebih baik tetapi tidak signifikan secara statistik (p = 0.941). Lidokain intravena dosis 1,5 mg/kg bolus saat induksi dilanjutkan 1 mg/kgBB/jam memberikan efek anti nyeri lebih baik dibandingkan morfin bolus 15 mcg/kg dilanjutkan infus kontinus 10 mcg/kg/jam, tetapi tidak signifikan pada keduanya yakni indikator penurunan NLR dan skor VAS jam ke 4, 8, dan 24
Electrolyte Dysregulation in Diabetic with Advanced Chronic Kidney Diseases (CKD): Comparative Analysis of CKD Stages 4 and 5
No full textBackground: Electrolyte imbalance is common in both diabetes mellitus (DM) and chronic kidney disease (CKD). While they may occur independently, their coexistence can exacerbate metabolic disturbances, thereby accelerating disease progression and impairing quality of life. Objective: to investigates the differences in electrolyte profiles between patients with CKD stages 4 and 5 with DM.Methods: A cross-sectional comparative design study was employed. A hundred participants (50 with CKD stage 4 and 50 with CKD stage 5 with DM) were recruited from a clinical laboratory during May to June 2024. Serum natrium, kalium, and chloride levels were measured alongside urea, creatinine, GFR, and glucose. The Mann-Whitney U test was applied to compare the electrolyte levels between these CKD stages.Results: Of 100 participants, more men participating in this study (66% vs. 34%). Pre-elderly (45-59 y.o.) was the most predominant (61%), followed by elderly (>60 years, 20%), and adult (26-45 y.o., 19%). Both groups showed elevated urea, creatinine, and glucose levels with reduced GFR, confirming advanced CKD and DM. There was no significant difference in glucose level between stage 4 and stage 5. A significant difference (p=0.001) was observed in natrium levels, with stage 5 CKD patients exhibiting lower levels compared to those in stage 4. In contrast, kalium and chloride levels showed no significant difference (p=0.71 and p=0.81, respectively) in both groups.Conclusion: This study highlights the specific vulnerability of natrium homeostasis in advanced CKD with diabetes. Natrium dysregulation observed in stage 5 CKD underscores the need for close monitoring and management of sodium levels in this population
Relationship between Neutrophil-Lymphocyte Ratio and Type of Febrile Seizures Event
No full textBackground: Febrile seizure is a common neurological condition affecting children. Complete blood count (CBC) is often used as the initial test to help determine the etiology of fever based on hematology parameters in the emergency ward.Objective: To analyze the relationship between neutrophil-lymphocyte ratio (NLR) and the type of febrile seizure among pediatric patients admitted to Wangaya General Hospital Denpasar, Indonesia.Methods: A cross-sectional design was implemented on a study using medical records of 44 children aged 6 month-5 years old admitted to the Wangaya Hospital between January 1, 2023, and September 8, 2024. Participants were grouped into simple and complex febrile seizures.Results: Among patients who experienced the first febrile seizure, the complex type accounted for most hospitalizations (n=33, 75.0%). The majority of cases occurred in children aged ≤24 months (n=32, 72.7%) with a temperature of >38°C (n=27, 61.4%). Seizure duration was ≤15 minutes in most cases (n=41, 93.9%), with upper Respiratory Infection being the most common etiology (n=20, 45.5%). NLR did not differ significantly between the simple and complex febrile seizures (P value =0.894), with a prevalence ratio (PR) of 1.1. Additionally, leukopenia, lymphocytopenia, and neutrophilia were observed in 28 (63.6%), 23 (52.3%), and 24 (54.5%) patients, respectively.Conclusion: There is no significant relationship between NLR and the type of first febrile seizures. Seizures are more frequently observed in males, particularly those aged 6-24 months with body temperature exceeding 38°C. The mean NLR of 2.78 ± 2.38 and upper respiratory infection are the most frequently associated conditions
Comparison between Keros and Gera Classifications on Paranasal Sinuses Computed Tomography Scan in One Teaching Hospital in Medan, Indonesia
Full text linkBackground: Functional endoscopic sinus surgery (FESS) is a surgical procedure for chronic rhinosinusitis (CRS). Keros and Gera classification can be used to evaluate the height and angle of the lateral lamella (LL) on computed tomography (CT) scan of the paranasal sinuses (PNS) which is the most dangerous area and at risk of injury during FESS. This study aimed to analyze the difference between Keros and Gera classifications on CT scans of PNS.Methods: This study was a cross-sectional study using the results of PNS CT scans from 94 patients at Prof. Dr. Chairuddin Panusunan Lubis Universitas Sumatera Utara Hospital, Medan, Indonesia for the period January–December 2022. The Keros and Gera classification of PNS CT scan were compared based on age and gender and then analyzed using the Chi-Square test. The results were significant if the p-value < 0.05.Results: The most common type of right-sided Keros classification was type 2 (54.3%) and left-sided was type 1 (56%), while the most common type of right-sided and left-sided Gera classification were type 2 (67% and 80.8%). A significant difference was found between the Keros and Gera classification types (p <0.001). The higher the Keros type did not guarantee the higher Gera type, each type of Keros could be paired with each type of Gera.Conclusions: There is a significant difference between Keros and Gera classification on the results of PNS CT scan of patients. Keros classification alone is not enough to identify the high-risk areas at the skull base, therefore, a combination with Gera classification needs to be evaluated by a radiologist to help the clinician in planning a safer FESS