E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Gambaran Mortalitas Pasien Sepsis Berdsarkan Fluid Accumulation di ICU RSUP DR. Hasan Sadikin Bandung Tahun 2021–2022
No full textManajemen cairan pasien sakit kritis memiliki risiko terjadinya akumulasi cairan. Resusitasi cairan merupakan bagian penting dalam menstabilkan status hemodinamik dan meningkatkan oksigenasi jaringan. Beberapa penelitian telah menunjukkan bahwa balans cairan kumulatif positif merupakan faktor prognostik yang kuat untuk mortalitas pasien sepsis. Tujuan penelitian ini adalah mengetahui gambaran mortalitas pada pasien sepsis yang mengalami akumulasi cairan selama dirawat di ICU RSUP Dr. Hasan Sadikin Bandung Tahun 2021–2022. Metode pengambilan sampel dilakukan dengan teknik consecutive sampling secara retrospektif melalui rekam medis pasien sepsis yang mengalami akumulasi cairan di ICU RSUP Dr. Hasan Sadikin Bandung selama periode 1 Januari 2021–31 Desember 2022 dengan jumlah sampel adalah 107 orang subjek penelitian. Analisis menunjukkan bahwa karakteristik pasien relatif sama antara kelompok yang mengalami mortalitas dan yang bertahan hidup. Pada kategori akumulasi cairan >10%, semua pasien (100%) mengalami mortalitas, sedangkan pada kategori akumulasi cairan 10% terdapat 55 pasien dimana semua pasien (100%) mengalami mortalitas. Tidak ada pasien (0%) dalam kategori ini yang bertahan hidup. Sedangkan kategori Fluid Accumulation 10% memiliki peluang mengalami mortalitas 1.93 kali lebih tinggi daripada pasien dengan Fluid Accumulation <10%. Interval Kepercayaan (Confidence Interval, CI) 95% untuk PR adalah antara 1.48 dan 2.50
Expression Levels of Intestinal Toll-Like Receptors 2 and 4 in Acute Inflammation Caused by Intestinal Candidiasis: An Experimental Study in Wistar Rats
Get PDFBackground: Candida albicans grows in the gastrointestinal tract as a normal microflora that may cause intestinal candidiasis, characterized by formation of biofilm and inflammation. Candida is recognized by toll-like receptors (TLRs). This study aimed to explore the relationship between intestinal TLR 2 and TLR 4 expression levels in candidiasis at each phase of inflammation.Methods: An experimental study was performed using a simple randomized sampling on 30 male Wistar rats divided into a control and a treatment group. Each group was inoculated with Candida albicans. Dysbiosis conditions were designed in the treatment group using multiple antibiotics and on day 5 the rats were injected with subcutaneous cortisone acetate. The groups were terminated in five different times (days 7, 14, 21, 28 and 35). On the termination day, intestinal tissue was isolated and the TLR 2 and TLR 4 expression were analyzed by immunohistochemistry. The data were analyzed by parametric test with SPSS (p<0.05) and completed by post-hoc test Least Significance Difference (LSD) to compare pairs of groups.Results: The expression of TLR 2 and TLR 4 between control and treatment groups showed significant differences (p=0.005). In the treatment group, there was a gradual increase in the TLR2 and TLR 4 expressions. Positive expression of TLR appeared more in the submucosal or basal area than apical surface. The treatment group showed the highest expression of both TLR2 (82.37%) and TLR4 (87.40%) on termination day 35.Conclusions: Inflammation caused by intestinal candidiasis can result in increased expression of intestinal TLR2 and 4 contributing to an increased risk of biofilm formation
Microbial Diversity and Antimicrobial Susceptibility from Wound Dehiscence Isolates in an Indonesian Tertiary Referral Hospital
Get PDFHealthcare-associated infections (HAIs) remain a critical issue for public health in Indonesia, with wound dehiscence associated with surgical site infections (SSIs) being one of them. Globally, SSIs are known as the most common postoperative complications with a heightened prevalence, particularly in low to middle-income countries. With its retrospective and descriptive design, this study aimed to illustrate the microbial patterns identified in Prof. Dr. I.G.N.G. Ngoerah General Hospital from 12 January 2020 to 12 December 2022. The study includes all patients who underwent surgery and were subsequently diagnosed with wound dehiscence and SSIs. Specimens were collected from patients and submitted to the Microbiology Laboratory at the hospital above. Bacterial identification and susceptibility testing to antimicrobials were performed using the Vitek 2 Compact System (bioMerieux, Marcy l'Etoile, France). Patient information was sourced from medical records. Out of 172 samples, 151 (87.8%) yielded positive cultures. Among these, 151 (87.8%) were found to be positive. Gram-negative bacteria were found to be most prevalent, with Escherichia coli (20.2%) and Pseudomonas aeruginosa (19.6%) being the most frequently isolated bacteria. The bacteria isolated were mostly susceptible to amikacin (72.1%), followed closely by meropenem (71.4%). This information could contribute to the development of an empirical antibiotic therapy protocol for wound dehiscence or SSI cases in this local context
Smoking Parameters in Coronary Heart Disease Patients Treated at Dr. Hasan Sadikin General Hospital Bandung, Indonesia
Get PDFThe association between smoking and coronary heart disease (CHD) has been studied extensively, though smoking parameters that contribute to the development of CHD may still need to be studied further. This cross-sectional study aimed to describe the characteristics of smoking parameters, including the number of cigarettes smoked, age when started smoking, duration of smoking, and cessation of smoking, in CHD patients treated at Dr. Hasan Sadikin General Hospital, Indonesia. CHD patients aged ≥18 years were included from the cardiology outpatient clinic and hospital wards. Smokers (current smokers/quit smoking <6 months) and ex-smokers (quit smoking ≥6 months) were considered patients who had a history of smoking. The Brinkman index, i.e., duration of smoking x number of cigarettes/day, was used to measure the degree of smoking that were categorized into mild, moderate, and severe smokers. Eighty-seven subjects diagnosed with CHD were recruited in this study. Seventy-seven percent of the subjects were male, and the mean age of subjects studied was 58.5±10.4 years. Among all subjects, a history of smoking was found in 66.7% (37.9% smokers and 28.7% ex-smokers), with all composed of male subjects. The age of subjects who had a history of smoking was 20 (15-35) years. Most were moderate smokers (74.1%) from Brinkman Index measurement. Smoking history has a significant association with male sex, lower total cholesterol, and lower LDL levels (p-value <0.05)
Interleukin-6 Level and Neutrophil-Lymphocytes Ratio and Severity of Coronavirus Disease 19
Get PDFInterleukin-6 (IL-6) is a proinflammatory cytokine that plays an important role in hyperinflammation and cytokine storm in Coronavirus Disease 19 (COVID-19) patients. The neutrophil-lymphocyte ratio (NRL) describes the innate and adaptive immune responses. Elevated IL-6 and NLR levels usually indicate a severe clinical condition in COVID-19 patients. Aim of this study was to determine the correlation of IL-6 and NLR with the severity of illness in COVID-19 hospitalized patients. This was a descriptive correlative observational study with a cross-sectional design using secondary data from COVID-19 patients treated in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from November 2020 to October 2021. There were 225 subjects who were classified by the severity and analyzed for IL-6 levels and NLR. Median levels of IL-6 at moderate, severe, and critical levels were 4.1 pg/mL, 20.4 pg/mL, and 38.8 pg/mL, respectively. The median NLR at moderate, severe, and critical grades were respectively 4.41, 9.65, and 17.79. The correlation between IL-6, NLR, and severity was 0.441 (p<0.001) and 0.408 (p<0.001). Meanwhile, the correlation between IL-6 levels and NLR in COVID-19 was 0.230 (p<0.001). Thus, IL-6 and NRL levels have a moderate positive correlation with the severity of COVID-19, while IL-6 and NRL have a weak correlation because IL-6 is not the only factor that affects the NRL
Effectiveness of Pandang Dengar Orang Dengan HIV Campaign in Reducing HIV Stigma among Youth in Pati Regency, Indonesia
Get PDFBackground: Recently, there has been a significant increase in new HIV infections in several regions in Indonesia, one of which is Pati Regency, Central Java. The considerable barrier in preventing HIV/AIDS is the widespread stigma against people living with HIV (PLHIV). Innovative interventions are required to eliminate HIV stigma, particularly among young people. This study evaluated the effectiveness of the Pandang Dengar Orang Dengan HIV (ODHIV) campaign in reducing HIV stigma among youth in Pati Regency, Indonesia.Methods: This was an experimental study with a pretest-posttest control group design with randomization. The residents of Pati Regency aged 15 to 29 years who were active users of Instagram and WhatsApp were involved. The Pandang Dengar ODHIV campaign was conducted using Instagram Reels four times a week for three weeks in the intervention group. The instruments used were the Global Stigma and Discrimination Indicator Working Group (GSDIWG) and the Strive research consortium. The T-test was used to analyze the data with a significance level of 95%.Results: The results revealed a decrease in HIV stigma in both the intervention and control groups (p=0.001). After the intervention, the mean stigma score in the intervention group was lower than the mean in the control group (mean difference of 0.044), however, was not statistically significant (p-value=0.961).Conclusions: The Pandang Dengar ODHIV campaign is effective in reducing HIV stigma among youth in Pati Regency, Indonesia. Further research is needed to demonstrate the effectiveness of campaign in wider audiences and other areas
Perbandingan Blokade Pektoralis dan Blokade Erektor Spinae Menggunakan Bupivakain 0,25% terhadap Durasi Analgesia dan Kebutuhan Morfin Pada Operasi Simple Mastectomy
Get PDFSekitar 60% pasien mastektomi mengalami nyeri akut. Beberapa metode yang dilakukan untuk mengurangi nyeri pascaoperasi mastektomi adalah blokade PECS dan ESP. Tujuan dari penelitian ini untuk mengetahui perbandingan durasi analgesia dan total kebutuhan morfin dalam 24 jam pascaoperasi pada pasien yang dilakukan blokade PECS dengan ESP. Penelitian ini merupakan penelitian eksperimental dengan rancangan single blind randomized controlled trial. Penilaian yang dilakukan yaitu durasi blokade, yang dinilai dari pemberian blokade sampai pasien menekan PCA/patient controlled analgesia pertama kali, selain itu dinilai juga total kebutuhan morfin yang diperlukan setelah operasi dengan menggunakan PCA. Penelitian dilakukan terhadap 32 subjek di RSUP Dr. Hasan Sadikin Bandung pada bulan Juni–September 2023 yang menjalani operasi mastektomi sederhana satu sisi yang memenuhi kriteria inklusi dan tidak termasuk dalam kriteria ekslusi. Hasil penelitian menunjukkan bahwa durasi kelompok PECS memiliki rerata sebesar 6,06±0,69 jam dan ESP sebesar 5,17±0,40 jam sehingga kelompok PECS lebih lama 0,89±0,29 jam dibanding dengan ESP, sementara total konsumsi morfin dalam 24 jam pada kelompok PECS sebesar 2,06±0,772 mg dan ESP sebesar 2,88±0,62 mg sehingga total kebutuhan morfin antara kelompok PECS lebih rendah 0,21±0,41 mg dibanding dengan ESP (p<0,05). Simpulan dari penelitian ini blokade PECS mempunyai durasi analgesia yang lebih lama dan mengurangi kebutuhan morfin pascaoperasi dibanding dengan ESP.Sekitar 60% pasien mastektomi mengalami nyeri akut. Beberapa metode yang dilakukan untuk mengurangi nyeri pascaoperasi mastektomi termasuk blokade PECS dan ESP. Tujuan dari penelitian ini untuk mengetahui perbandingan durasi analgesia dan total kebutuhan morfin dalam 24 jam pascaoperasi pada pasien yang dilakukan blokade PECS dengan ESP. Penelitian ini merupakan penelitian eksperimental dengan rancangan double blind randomized controlled trial. Penilaian yang dilakukan yaitu durasi blokade, yang dinilai dari pemberian blokade sampai pasien menekan patient controlled analgesia (PCA) pertama kali, selain itu dinilai juga total kebutuhan morfin yang diperlukan setelah operasi dengan menggunakan PCA. Sebanyak 32 subjek di RSUP Dr. Hasan Sadikin Bandung pada bulan Juni sampai September 2023 yang menjalani operasi unilateral simple mastectomy yang memenuhi kriteria inklusi dan tidak termasuk dalam kriteria ekslusi. Hasil penelitian menunjukkan bahwa durasi kelompok PECS memiliki rerata sebesar 6,06±0,69 jam dan ESP sebesar 5,17±0,40 jam sehingga kelompok PECS lebih lama 0,89±0,29 jam dibandingkan ESP, sementara total konsumsi morfin dalam 24 jam pada kelompok PECS sebesar 2,06±0,772 mg dan ESP sebesar 2,88±0,62 mg sehingga total kebutuhan morfin antara kelompok PECS lebih rendah 0,21±0,41 mg dibanding dengan ESP (p<0,05). Simpulan blokade PECS mempunyai durasi analgesia yang lebih lama dan mengurangi kebutuhan morfin pascaoperasi disbanding dengan ESP
Hubungan Platelet Lymphocyte Ratio (PLR) dengan Status Mortalitas H-28 pada Pasien Sepsis Associated Acute Kidney Injury
Get PDFInflamasi merupakan proses yang berperan penting dalam perkembangan Sepsis-associated acute kidney injury (S-AKI). Rasio platelet-limfosit (PLR) merupakan penanda inflamasi baru yang mulai sering digunakan untuk memperkirakan mortalitas. Pada fase inflamasi terjadi peningkatan produksi platelet akibat cedera endotel disertai dengan peningkatan rekrutmen limfosit ke ginjal sehingga dapat tergambar pada nilai PLR. Penelitian ini dilakukan untuk melihat hubungan PLR dengan mortalitas pada pasien S-AKI di ICU RSUP Dr. Hasan Sadikin. Metode yang digunakan pada penelitian ini adalah case-control secara retrospektif dengan menggunakan rekam medis 136 pasien S-AKI di ICU RSUP Dr. Hasan Sadikin pada tahun 2021–2022 yang sesuai dengan kriteria inklusi dan eksklusi dan dibagi menjadi kelompok bertahan hidup 68 orang dan kelompok mortal 68 orang. Penelitian dilakukan mulai dari Maret 2022 sampai Februari 2023. Pengambilan sampel dilakukan secara vkonsekutif, kemudian dilakukan analisis statistik chi-square untuk melihat hubungan nilai PLR dengan status mortalitas h-28. Didapatkan rasio odd pada PLR sebesar 165 dan nilai cut-off PLR penelitian ini adalah 120. Terdapat hubungan antara nilai PLR dan mortalitas h-28 pada pasien S-AKI. Pasien dengan nilai PLR≥120 memiliki risiko mortalitas h-28 lebih tinggi. Peningkatan nilai rasio platelet dan limfosit pada pasien cedera ginjal akut akibat sepsis yang mortal terjadi karena peningkatan penggunaan leukosit ke ginjal dan peningkatan produksi platelet akibat inflamasi yang berat
Correlation between Kupffer Cell Infiltration and Liver Parenchymal Cell Damages in Immunosuppressed Drugs-Induced Rats
Get PDFThe liver is the largest organ in the body, composed of both parenchymal and non-parenchymal cells. Chemical substances and various drugs can induce liver injury and involve Kupffer cells which are non-parenchymal cells that release biologically active substances, promoting pathological processes. This study aimed to evaluate the correlation between the number of Kupffer cells and liver parenchymal cell damages in immunosuppressed, drug-induced rats. The study was conducted from July to December 2019 at the Oral Biology Laboratory of the Faculty of Dentistry and the Biochemical Laboratory of the Faculty of Medicine at Universitas Hang Tuah Surabaya. Twelve healthy male Wistar rats were divided into two groups: Healthy (H) and Immunosuppressed Drug-Induced (ID) groups. Immunosuppression was induced using dexamethasone (0.5 mg/day/rat), administered orally for 14 days, combined with tetracycline (1%/day/rat). Liver samples from all rats were examined for Kupffer cell count and parenchymal cell damages were assessed using a light microscope with 400x magnification. Results revealed a significant difference in the number of Kupffer cells and liver parenchymal cell damages between the H and ID groups (p<0.05). Pearson correlation analysis indicated a significant correlation between Kupffer cell number and parenchymal cell damages (p=0.000). Continuous administration of immunosuppressive drugs may activate Kupffer cells, leading to damage of liver parenchymal cells. In conclusion, the infiltration of Kupffer cells is associated with liver parenchymal cell damages, mediated by various factors in the immunosuppressed drug-induced rat model
Malaria Infection and Socioeconomics in Malaria Endemic Areas of East Nusa Tenggara, Indonesia
Get PDFMore than 1.1 million people, or 20.90% of the population in East Nusa Tenggara (NTT), Indonesia, live below the poverty line, making NTT the third province with the highest number of poor people in Indonesia. The region of NTT, which is well known as one of the endemic areas for malaria in Indonesia, also has the highest number of adults with low nutritional status. This study aimed to assess the influence of socioeconomic factors on malaria-endemic areas in eastern Indonesia. A cross-sectional study was conducted in East Nusa Tenggara from January to March 2020. Bivariate and multivariate analyses were then performed on 317 population data of adults with low socioeconomic status. It was found that one of the socioeconomic factors, i.e., the age, is significantly associated with malaria (p-value = 0.031; OR = 1.684) with 40 being the age with the highest association. Thus, age is associated with malaria incidence in endemic areas