E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
Not a member yet
1208 research outputs found
Sort by
Korelasi antara Ketepatan Penempatan Kedalaman Tabung Endotrakeal dan Tinggi Badan pada Pasien Dewasa yang Menjalani Operasi.
No full textIntubasi endotrakea adalah prosedur kritis yang umum dilakukan oleh dokter anestesi dan dokter gawat darurat/perawatan intensif. Salah penempatan tabung endotrakeal (ET) dapat menyebabkan komplikasi seperti desaturasi, hiperinflasi, ateletasis, dan trauma saluran napas. Tinggi badan telah ditemukan berkorelasi dengan kedalaman ET, ini tidak berlaku di Indonesia yang rerata tinggi badan lebih rendah dibanding dengan negara lain. Studi ini bertujuan meneliti akurasi kedalaman ET dan korelasinya dengan tinggi pasien di RSUP Dr. Hasan Sadikin di Bandung, Indonesia periode Oktober 2022 . Penelitian ini adalah studi analitik deskriptif dengan melakukan studi potong lintang dengan mengumpulkan data dari pasien. Subjek penelitian ini adalah pasien dewasa yang menjalani operasi elektif atau darurat di bawah anestesi umum dan memerlukan intubasi endotrakeal di RSUP Dr. Hasan Sadikin Bandung. Penelitian ini menunjukkan korelasi antara kedalaman tabung endotrakeal oral dan tinggi badan pasien di RSUP Dr. Hasan Sadikin Bandung, dengan rerata kedalaman 19,7 cm pada pria dan 18,4 cm pada wanita. Studi ini juga menemukan bahwa pada pria, setiap peningkatan tinggi badan 10 cm maka kedalaman ET meningkat sebesar 0,88 cm, sedangkan pada wanita meningkat sebesar 1,00 cm. Simpulan penelitian ini menunjukkan bahwa terdapat korelasi positif antara kedalaman tabung endotrakeal dan tinggi badan pasien. Intubasi endotrakea adalah prosedur kritis yang umum dilakukan oleh dokter anestesi dan dokter gawat darurat/ perawatan intensif. Salah penempatan tabung endotrakeal (ET) dapat menyebabkan komplikasi seperti desaturasi, hiperinflasi, ateletasis, dan trauma saluran napas. Tinggi badan telah ditemukan berkorelasi dengan kedalaman ET, ini tidak berlaku di Indonesia yang rerata tinggi badan lebih rendah dibanding dengan negara lain. Studi ini bertujuan meneliti akurasi kedalaman ET dan korelasinya dengan tinggi pasien di RSUP Dr. Hasan Sadikin di Bandung, Indonesia. Penelitian ini adalah studi analitik deskriptif dengan melakukan studi potong lintang dengan mengumpulkan data dari pasien. Subjek penelitian ini adalah pasien dewasa yang menjalani operasi elektif atau darurat di bawah anestesi umum dan memerlukan intubasi endotrakeal di RSUP Dr. Hasan Sadikin Bandung. Penelitian ini menunjukkan adanya korelasi antara akurasi kedalaman tabung endotrakeal oral dan tinggi badan pasien di RSUP Dr. Hasan Sadikin Bandung, dengan rerata kedalaman 19,7 cm pada pria dan 18,4 cm pada wanita. Studi ini juga menemukan bahwa pada pria, setiap peningkatan tinggi badan 10 cm, kedalaman ET meningkat sebesar 0,88 cm, dan pada wanita meningkat sebesar 1,00 cm. Hasil dari penelitian ini menunjukkan bahwa terdapat korelasi positif antara akurasi kedalaman tabung endotrakeal dengan tinggi badan pasien
Perbandingan derajat nyeri setelah pemberian Gabapentin dan Amitriptilin sebagai adjuvan analgetik pasien nyeri kanker
Get PDFPenggunaan opioid tunggal pada nyeri kanker kurang efektif sehingga perlu dikombinasikan dengan analgetik non opioid. Tujuan penelitian adalah membandingkan derajat nyeri pada pemberian gabapentin dengan amitriptilin sebagai adjuvan analgetik pasien nyeri kanker. Desain penelitian ini menggunakan uji klinis acak tersamar ganda, subjek penelitian adalah pasien poli nyeri RSUP H. Adam Malik dengan derajat nyeri berat yang dibagi 3, yaitu kelompok gabapentin, amitriptilin, dan plasebo sebagai adjuvan. Penelitian dilakukan selama periode April–Juni 2022. Sampel dievaluasi derajat nyeri, pain DETECT dan efek samping hari 1 (T1), hari 3 (T2), dan hari 7 (T3). Derajat nyeri berat pengukuran T1 pada grup gabapentin didapatkan 1,8%, amitriptilin 10,5% dan plasebo 7%. Pada T2, T3 tidak didapatkan derajat berat pada semua kelompok. Pemeriksaan pain DETECT dijumpai rerata 29,4±5,3. Pada T1 dan T2 tidak terdapat perbedaan bermakna. Pada T3 terdapat perbedaan bermakna dengan nilai p 0,003 antara penggunaan gabapentin dan plasebo. Pada penelitian ini didapatkan penurunan NRS secara klinis pada penggunaan adjuvan analgetik dibanding dengan plasebo, tetapi tidak terdapat perbedaan bermakna secara statistik. Pada pain DETECT ditemukan perbedaan bermakna setelah pemberian adjuvan gabapentin setelah hari ke-7 dibanding dengan plasebo. Simpulan penelitian ini terdapat penurunan derajat nyeri secara klinis penggunaan adjuvan analgetik dibanding dengan plasebo, tetapi tidak terdapat perbedaan bermakna secara statistik. Nyeri merupakan mekanisme pertahanan tubuh yang membantu untuk memberikan tanda bahwa sedang terjadi kerusakan jaringan atau akan terjadi kerusakan jaringan. Pada keganasan nyeri yang ditimbulkan oleh gangguan pada sistem saraf disebut nyeri neuropatik, tatalaksana nyeri kanker bisa dengan analgetik dan adjuvan, salah satunya Gabapentin dan Amitriptilin. Desain penelitian ini menggunakan uji klinis acak tersamar ganda, sampel yang digunakan adalah pasien poli nyeri dengan diagnosis keganasan dengan derajat nyeri NRS berat dengan pemberian MST dan Parasetamol sampel di bagi 3 kelompok yaitu kelompok yang diberikan Gabapentin, Aamitriptilin dan placebo sebagai adjuvan. Kemudian sampel akan di evaluasi derajat nyeri, hari 1 (T1), hari 3 (T2) dan hari 7 (T3). Didapatkan hasil NRS pada grup Gabapentin pada T1 derajat berat menjadi 1 orang (1.8%), grup Amitriptilin 3 orang (10,5%) dan plasebo 4 orang (7%). Pada T2 tidak di dapatkan NRS derajat berat pada semua kelompok. Pada grup Gabapentin pada T2 derajat sedang menjadi 15 orang (26,3%), grup Amitriptilin 15 orang (26,3%) dan plasebo 14 orang (24,6%). Pada T3 tidak di dapatkan NRS derajat berat pada semua kelompok. Pada grup Gabapentin pada T3 derajat sedang menjadi 14 orang (26,3%), grup Amitriptilin 12 orang (21,1%) dan plasebo 15 orang (26,3%).Pada penelitian ini secara klinis didapatkan penurunan NRS secara klinis pada penggunaan adjuvan analgetik dibandingkan Plasebo tetapi tidak terdapat perbedaan bermakna secara statistik. Pada penilaian nyeri neuropatik dengan Pain DETECT ditemukan perbedaan bermakna setelah pemberian adjuvan Gabapentin setelah hari ke-7 dibandingkan dengan Plasebo. Efek samping setelah pemberian obat pada penelitian tidak terdapat perbedaan bermakna
Therapeutic Outcome of High Flow Nasal Cannula (HFNC) for Severe COVID-19 Patients in Isolation Intensive Care Unit
Get PDFThis retrospective descriptive study aimed to understand the outcomes of HFNC therapy in severe COVID-19 patients admitted to isolation ICU during the period of January to June 2021 in Dr. Hasan Sadikin General Hospital Bandung, Indonesia. A total of 134 patients with severe COVID-19 were admitted to the isolation ICU and received HFNC. Among them, 44 patients (32.8%, N:134) were successfully weaned from HFNC and 90 patients (67.2%, N:134) failing HFNC with 10 patients (7.5%, N:134) died on HFNC use, 72 patients (53.9%, N:134) died on ventilator use, 4 patients (2.9%, N:134) moved rooms under HFNC use, and 4 patients (2.9%, N:134) moved to non-ICU isolation with ventilator use as the outcome. Patients’ median age was 60 years, most were male (52.3 %, N:134), median BMI was 25.4 kg/m2, with hypertension and diabetes mellitus as the main comorbidities. There was an improvement in the SpO2 on the first day after the use of HFNC. The ROX index had a median value of 3.6 on the first day, with the lowest ROX index of 3.2 and the highest of 4.4 during the treatment time. There was an improvement in the P/F Ratio in successful patients with a median initial P/F Ratio of 86.7 to 200.1 at the end of treatment. Overall, HFNC improves the hypoxemic conditions in early admission but does not correlate with general patient outcomes
Effect of Hypervirulent Strains, Antibiotic Resistance, and Host Characteristics on Mortality of Klebsiella pneumoniae Bacteremia Patients at a Tertiary Referral Hospital in Denpasar, Indonesia
Get PDFKlebsiella pneumoniae bacteremia is one of the leading causes of sepsis that has a high mortality rate. The effect of multidrug resistance and different virulence of Klebsiella pneumoniae on mortality is still controversial. This study aimed to determine the impact of hypervirulent K. pneumoniae (hvKp), MDR, and clinical characteristics on mortality of K. pneumoniae bacteremia patients. A retrospective cross-sectional study was conducted on K. pneumoniae bacteremia cases of patients hospitalized at Professor dr. I.G.N.G Ngoerah General Hospital from December 1, 2020, to May 31, 2021. A positive PCR of rmpA, iucA genes, and/or a positive string test was identified as hvKp. The mortality rate of 51 K. pneumoniae bacteremia patients samples (aged 0-74 years) was 72.5%, in which 9.8% (5/51) of them were hvKp and 51% of the isolates (26/51) produced the Extended Spectrum Beta Lactamase (ESBL). Furthermore, 9.8% (5/51) of the cases were carbapenem-resistant. Thus, hvKp, MDR, gender characteristics, and comorbidities do not significantly affect the mortality of K. pneumoniae bacteremia patients. Multivariate logistic regression analysis showed that sepsis (odds ratio (OR) 4.29; p=0.038) and adult age group (mean 50 years) (OR 3.75; p=0.039) are independent predictors with a significant effect on mortality of K. pneumoniae bacteremia patients. Careful and integrated management of K. pneumoniae bacteremia patients is essential for better outcomes, especially in sepsis and elderly patients. Although hvKp prevalence is low, emerging MDR-hvKp in health facilities is a severe concern for further actions and research
Validity Test For C-Reactive Protein and Ferritin Level in Moderate and Severe Covid-19 Patients
Get PDFMild, moderate, severe, and critical COVID-19 are associated with hyperinflammation. The CRP and ferritin are acute phase proteins that marks incidence of inflammation and used as the paramaters of hyperinflammation. This study aimed to determine the validity of CRP and ferritin level examination in moderate and severe COVID-19 since the time of admission. This was a cross-sectional analytical retrospective study with on moderate and severe COVID-19 patients admitted to Dr. Hasan Sadikin General Hospital Bandung, Indonesia, during the period of March 2020 to December 2020. The CRP and ferritin levels were obtained since the beginning of admission to the fourth day since admission on patients without any history of anemia. Subjects in this study were divided into moderate and severe COVID-19 groups based on the 3rd edition of COVID-19 Prevention and Control Guideline issued by the Ministry of Health Republic of Indonesia. Each group consisted of 30 subjects. The cut-off value was 7.65 mg/dL (AUC 0.698) for CRP and 963.1 mcg/L (AUC 0.938) for ferritin. The validity of ferritin vs CRP were reflected respectively as follows: 93.3% vs 76.7% sensitivity; 80.0% vs 63.3% specificity; 82.4% vs 67.6% PPV; and 92.3% vs 73.1% NPV. The validity of ferritin was proven to be superior as it significantly increases since day one, persisted longer and reaches its peak on the16th day. Meanwhile, CRP increases within 6-8 hours and reaches its peak within 48 hours after inflammation, then declines soon afterwards
Etiology and Antifungal Sensitivity Test in Otomycosis Caused by Candida Sp
Get PDFOtomycosis is a common fungal infection of the external auditory meatus frequently diagnosed in otolaryngology outpatient clinics. Resistance to antifungals is currently a significant concern, with intrinsic and acquired resistance increasing among isolates that cause fungal infections. The purpose of this research was to identify Candida species causing otomycosis and determine the pattern of antifungal susceptibility among these Candida species. A prospective study was conducted in the Margono Soekarjo General Hospital and Department of Microbiology, Faculty of Medicine, Universitas Jenderal Soedirman Purwokerto, Indonesia, from April – September 2022. Forty-seven (47) clinical samples of otomycosis were collected from 41 patients and then isolated bedside on fungal culture media and was prepared on an object glass for direct microscopic examination of the specimens. Fungal identification was performed using 10% potassium hydroxide (KOH) to observe fungal elements. Samples were cultured on Saboraud dextrose agar (SDA) media with chloramphenicol and Czapek dox agar. The Germ Tube Test was used to identify Candida while yeast-specific identification and antifungal susceptibility assay using a rapid commercial kit was applied for specific identification of the fungus. Antifungal susceptibility patterns were obtained using the Integral System Yeast Plus (ISYP) media pack. Candida parapsilosis was the most prevalent Candida species discovered in this study, accounting for approximately 41.66%, which was followed by Candida tropicalis (25%) and Candida krusei (12.5%), whereas Candida albicans only accounted for 4.1% of the specimens. All Candida species were sensitive to flucitosine and ketoconazole, whereas the voriconazole sensitivity rate reached 96%. This study concludes that Candida parapsilosis is the most prevalent species of Candida in otomycosis, and that all Candida species are sensitive to Flucitosine, ketoconazole, and voriconazole
Anestesi Dosis Rendah pada Pasien Asma dan Suspek Hipertiroid yang Menjalani Seksio Sesarea: Sebuah Laporan Kasus
Get PDFKehamilan dengan penyakit sistemik merupakan kasus yang menjadi perhatian khusus. Asma sebagai penyakit penyerta berisiko tinggi pada jalan napas ibu, sedangkan hipertiroid merupakan salah satu penyakit sistemik pada kehamilan yang dapat menimbulkan kegawatan pada ibu dan janin. Terdapat beberapa laporan kasus terkait manajemen anestesi pada ibu hamil dengan asma maupun hipertiroid, namun masih jarang yang membahas keduanya secara bersamaan. Kami melaporkan wanita 25 tahun dengan G2P1A0 yang menjalani seksio sesarea atas indikasi ketuban pecah dini, hipertiroid, asma intermiten, dan riwayat seksio sesarea. Tekanan darah 143/93 mmHg, laju nadi 111 kali per menit, saturasi 98–100% udara ruang. Pemeriksaan preoperasi didapatkan eksoftalmus, tremor, dan benjolan di leher. Pemeriksaan jantung didapatkan bunyi jantung I–II reguler tanpa murmur, suara paru vesikular dengan mengi minimal di kedua lapang paru. Pemeriksaan leopold didapatkan janin tunggal dengan presentasi kepala, denyut jantung janin 141 kali per menit. Pasien stabil selama operasi dengan anestesi spinal menggunakan bupivakain 7,5 mg adjuvan fentanil 25 mcg. Manajemen anestesi dengan multikomorbid memerlukan tata laksana yang cermat untuk memperoleh luaran yang baik. Kehamilan dengan penyakit sistemik merupakan kasus yang menjadi perhatian khusus. Asma sebagai penyakit penyerta berisiko tinggi pada jalan napas ibu. Sedangkan hipertiroid merupakan salah satu penyakit sistemik pada kehamilan yang dapat menimbulkan kegawatan pada ibu dan janin. Terdapat beberapa laporan kasus terkait manajemen anestesi pada ibu hamil dengan asma maupun hipertiroid, namun masih jarang yang membahas keduanya secara bersamaan. Kami melaporkan wanita 25 tahun dengan G2P1A0 yang menjalani seksio sesarea atas indikasi ketuban pecah dini, hipertiroid, asma intermiten, dan riwayat seksio sesarea. Tekanan darah 143/93 mmHg, laju nadi 111 kali per menit, saturasi 98-100% udara ruang. Pemeriksaan preoperasi didapatkan eksoftalmus, tremor, dan benjolan di leher. Pemeriksaan jantung didapatkan bunyi jantung I-II reguler tanpa murmur, suara paru vesikuler dengan mengi minimal di kedua lapang paru. Pemeriksaan leopold didapatkan janin tunggal dengan presentasi kepala, denyut jantung janin 141 kali per menit. Pasien stabil selama operasi dengan anestesi spinal menggunakan bupivacaine 7,5 mg ajuvan fentanil 25 mcg. Manajemen anestesi dengan multikomorbid memerlukan tatalaksana yang cermat untuk memperoleh luaran yang bai
Effective Visual Media to Increase Knowledge and Comprehension of Multidrug Resistant Tuberculosis Among Patients and Their Caregivers
Get PDFIndonesia ranks thirdamong countries with the largest number of TB cases after India and China. Globally, more than 3-4% of all TB cases are Multidrug-Resistant Tuberculosis (MDR TB). MDR TB is a more complicated TB that needs extra treatments, which extend treatment time and increase adverse effects. Thus, MDR TB patients and their families often feel demotivated about completing treatment, leading to loss to follow up, which contributes to the never-ending transmission and greatly affects the success rate of the national TB control program. Thus, better knowledge and perception on MDR treatment for patients and families plays a crucial role in dealing with this issue. A cross-sectional study was performed from April to June 2019 to evaluate the effectiveness of visual educational media for TB patients and their caregivers. Participants consisted of 144 patients diagnosed with MDR TB and their caregivers or family members (n=22). A pre-test was administered before an education session by a nurse and visual media were used as the educational material. At the end of the session, a post-test was performed. The post-test score was then compared to the pre-test score to evaluate the session’s effectiveness using the paired t-test. Result showed significant increase in the post-test score (t= 3.249, df=3, p=0.04), with the caregivers attained a higher score, showing better improvement in knowledge after the session compared to the patient group. Hence, the MDR TB educational intervention using visual media is considered effective to increase participants ‘understanding of MDR TB. It is expected that with increased knowledge on MDR TB, the treatment success rate will increase and becomes the catalyst for the nationwide TB control strategy
Clinicopathological Characteristics of Cervical Carcinoma with Pelvic Lymph Node Metastases in Dr. Hasan Sadikin General Hospital, Bandung 2013-2021
Get PDFBackground: Carcinoma of the cervix is the most common gynecological malignancy, which ranks first among carcinomas in Indonesia. Lymph node metastasis is a risk of recurrence, affecting survival and therapy. The purpose of this study was to determine the clinicopathological characteristics of cervical carcinoma with pelvic lymph node metastasis that had undergone radical hysterectomy and lymphadenectomy at Dr. Hasan Sadikin General Hospital, Bandung.Methods: This study used a cross-sectional retrospective descriptive study. Data on the clinical stage I-II cervical cancer patients with pelvic lymph node metastasis were collected from the archives of the pathological anatomy laboratory during period from 2013 to 2021. Data were presented in percentage.Results: There were 64 data patients, and the most common age of cervical carcinoma ranged from 40 to 50 years old (52%), the most common stage was stage II (66%), and the most frequent histopathological type was squamous cell carcinoma (70%). The highest degree of differentiation was moderate differentiation (50%). There was no difference in tumor size between sizes <4 cm and ≥4 cm.Conclusion: The cases of cervical carcinoma at Dr. Hasan Sadikin General Hospital Bandung are treated with radical hysterectomy and lymphadenectomy. The patients generally aged between 41–50 years old, stage II, and squamous cell carcinoma with a moderate degree of differentiation
Relationship between Clean, Healthy Living Behaviour, and COVID-19 Infection at the Parigi Public Health Center, West Java, Indonesia
Get PDFBackground: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). One form of prevention is implementing Clean and Healthy Living Behaviour (Perilaku Hidup Bersih dan Sehat, PHBS) at the household level. This study aimed to analyze the association between PHBS at the household level and COVID-19 cases at the Parigi Public Health Center, West Java, Indonesia.Methods: This was an unmatched case control study carried out in September–October 2021 with respondents from Parigi Public Health Center, Pangandaran Regency, involving 63 people for each case and control group. Sampling was conducted by the non-probability method. Data were collected using a checklist to measure the implementation of PHBS at the household level. Data were analyzed by statistical analysis, using the Chi-square or Fisher Exact test and Odds Ratio.Results: There was no statistically significant difference between the implementation of PHBS at the household level and the incidence of COVID-19 (p=0.668).Conclusions: The implementation of PHBS at the household level is not related to the incidence of COVID-19. Further studies are needed with larger population, looking for causal relationship, and controlling for confounding variables