E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Differences in Neutrophil Lymphocyte Ratio (NLR) between Sepsis and Septic Shock Patients in a Tertiary Hospital in Indonesia
Get PDFSepsis is a severe medical condition characterized by organ dysfunctions resulting from the body's response to an infection. Septic shock is a complication of sepsis that involves circulatory, cellular, and metabolic disturbances. The body's response to infection is typically marked by an increase in neutrophils and a decrease in lymphocytes, leading to increased Neutrophil Lymphocyte Ratio (NLR). This study aimed to investigate the differences in NLR between sepsis and septic shock patients treated at Dr. H. Abdul Moeloek Provincial Hospital, Lampung, Indonesia. This study utilized a comparative analytic study approach with a cross sectional design. A total of 96 sepsis patients who met the inclusion and exclusion criteria treated during the period January 2018 - December 2020 at Dr. H. Abdul Moeloek Provincial Hospital, Lampung, Indonesia, were included in this study. The study found that most of sepsis patients showed an increase in neutrophils (89.58%), a decrease in lymphocytes (94.79%), and elevated NLR values (87.5%). The mean NLR value of septic shock patients (20.10±5.89) was significantly higher than that of sepsis patients (18.01±1.35) (p=0.025). It indicates that the NLR value increases significantly in patients who develop septic shock compared to those with sepsis alone. The findings suggest that NLR could be a potential biomarker for septic shock diagnosis. However, the effectiveness of NLR in predicting the severity of sepsis and determining the risk of mortality in these patients still needs to be examined by conducting studies that involve a larger sample size
Relationship between Knowledge, Attitude and Practice of the Use of Face Mask with Acne among Health Workers at General Hospitals in Mataram City, West Nusa Tenggara, Indonesia
Get PDFBackground: The World Health Organization (WHO) has declared the coronavirus a global emergency transmitted by droplets. Personal protective equipment (PPE) such as masks can help lower the viral infection risk. However, prolonged use of PPE can cause skin lesions and aggravate acne. Acne that develops because of the usage of masks is called mask acne (maskne). Knowledge, attitudes, and practices of health workers regarding the use of face masks can help minimize the occurrence of maskne. This study aimed to assess the relationship between knowledge, attitude ,and practices of the use of face masks with mask acne among health workers in general hospitals in Mataram City, Indonesia.Methods: This study was a cross-sectional analytic observational study involving health workers from type b and c general hospitals in the city of Mataram, specifically the West Nusa Tenggara Provincial Hospital and the Mataram University Hospital. Primary data were collected using a questionnaire consisting of demographic characteristics, knowledge, attitude, and practice of using masks, then analyzed using Lambda test.Results: In total, 104 respondents were included, of whom 39.4% (n=41) had good knowledge, 35.6% (n=37) had a good attitude towards the use of masks, and 25.0% (n=26) had good practice. Interestingly, 42.3% (n=44) had experienced maskne. Lambda test showed that a relationship between knowledge, attitude, and practices towards the usage of masks and the incidence of maskne (p = 0.014; p = 0.000; p = 0.006).Conclusion: There is a relationship between knowledge, attitudes, and practice of health workers regarding the usage of masks with the prevalence of mask acne at the general hospitals type b and c in the Mataram City. This study implies is that health workers can prevent the occurrence of mask acne, which can make the work of health workers more difficult
Prognostic Nutritional Index and Systemic Immune-inflammation Index: Possible New Parameters for COVID-19 Severity
Get PDFBackground: The prognostic nutritional index (PNI) parameter has been widely used in estimating the severity of COVID-19. In contrast, investigating the role of the systemic immune-inflammation index (SII) in determining the COVID-19 severity is prospective. This study aimed to investigate the potential of PNI and SII parameters to distinguish the severity of symptoms of COVID-19.Methods: A retrospective observational study was conducted among 209 hospitalized patients with COVID-19. Data were collected from August 2021 to February 2022 in Indonesia’s general COVID-19 referral hospital. Demographic and laboratory data, including PNI and SII, were analyzed and compared between the severe and non-severe symptoms of COVID-19 patients. The statistical analysis of the receiver operating characteristic curve (ROC) and area under curve (AUC) was conducted to predict the potential of these parameters in distinguishing the COVID-19 severity. Results: More than half of this study’s patients (54.55%) were non-severe COVID-19. The SII values in patients with severe symptoms were significantly higher than in those with non-severe symptoms (2,445.24 vs. 1,423.28, p=0.005). In contrast, the PNI value in patients with severe COVID-19 symptoms was significantly lower than those with non-severe symptoms (38.04 vs. 33.93, p2,212.787. PNI and SII were the potential new diagnostic parameters for COVID-19 severity.Conclusion: PNI and SII parameters can potentially distinguish the severity of symptoms of COVID-19
Comparison of Preemptive Post-Intubation 15 Mg/KgBW Paracetamol to 0.35 Mg/KgBW Meperidine in Incidence of Post-Anesthetic Shivering
Get PDFPost anesthesia shivering (PAS) is a repetitive involuntary movement of one or more muscle groups as a result of a decrease in core body temperature. Pharmacological therapy in preventing PAS may include meperidine and paracetamol. This study compared the effectiveness of paracetamol to meperidine in reducing the incidence of post-anesthesia shivering. This study used an experimental randomized double-blind comparative analytic design on patients underwent exploratory laparotomy surgery under general anesthesia at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from September 2021 to August 2022. Patients with 50 ASA 1-2 physical status were included and divided into two groups. One group received 15 mg/kg group paracetamol and the other received 0.35 mg/kg meperidine. Data on tympanic membrane temperature and hemodynamics before and after induction and after extubating were collected. Furthermore, data on the results of the assessment of the incidence and grade of shivering in each treatment group were also collected. The results of this study showed that there was a decrease in the frequency of PAS in patients receiving intravenous 15 mg/kg paracetamol (p<0.05), as well as less side effects in the form of nausea and vomiting (p < 0.05). The incidence and degree of shivering after general anesthesia using intravenous 15 mg/kg paracetamol was lower compared to the use of 0.35 mg/kg meperidine. In the meperidine group, the decrease in body temperature was lower than in the paracetamol group, while the incidence of nausea and vomiting in the paracetamol group was lower than in the meperidine group. In conclusion, paracetamol reduces the incidence of post-anesthesia shivering better than meperidine
Perbandingan Morfin Dosis 0,05 Mg dengan 0,1 Mg Sebagai Adjuvan Bupivakain 0,5% 10 Mg Intratekal Terhadap Skala Nyeri dan Durasi Analgesia Pascaseksio Sesarea
No full textMasalah pascaoperasi yang paling dikeluhkan oleh pasien yang menjalani seksio sesarea adalah nyeri akut pascaoperasi. Salah satu metode yang direkomendasikan dalam protokol Enhanced Recovery After Cesarean Section (ERACS) untuk mencegah nyeri akut pascaoperasi adalah penggunaan opioid long-acting intratekal dengan morfin intratekal sebagai baku standar. Penelitian dilakukan di RSUP Dr. Hasan Sadikin selama bulan Juli–Oktober 2022 Penelitian ini bertujuan menilai perbandingan intensitas nyeri dan durasi analgesia antara pemberian morfin 0,05 mg dan 0,1 mg sebagai adjuvan bupivakain 0,5% 10 mg intratekal pada pasien yang menjalani prosedur seksio sesarea. Penelitian ini merupakan penelitian eksperimental dengan rancangan double blind randomized controlled trial. Penilaian intensitas nyeri dan durasi analgesia pada pasien dihitung setiap 1 jam sejak operasi selesai (T0) hingga jam ke-24 (T24) pascaoperasi. Analisis statistik data numerik menggunakan uji t tidak berpasangan pada data berdistribusi normal serta uji Mann Whitney pada data tidak berdistribusi normal. Analisis statistik data kategorik menggunakan uji chi-square dan alternatif uji Eksak Fisher. Intensitas nyeri NRS jam ke-2, -3, -4, -5, - 6, dan -7 pada kelompok morfin 0,1 mg lebih rendah dibanding dengan kelompok morfin 0,05 mg dengan perbedaan yang bermakna secara statistik (p<0,05). Simpulan. durasi analgesia pascaseksio sesarea pada pemberian morfin secara intratekal dosis 0,1 mg lebih lama dibanding dengan dosis 0,05 mg. Masalah pascaoperasi yang paling dikeluhkan dan ditakuti oleh pasien yang menjalani seksio sesarea adalah nyeri akut pascaoperasi. Salah satu metode yang direkomendasikan dalam protokol Enhanced Recovery After Cesarean Section (ERACS) untuk mencegah nyeri akut pascaoperasi adalah penggunaan opioid long-acting intratekal, dengan morfin intratekal sebagai baku standar. Penelitian ini bertujuan untuk menilai perbandingan skala nyeri dan durasi analgesia antara pemberian morfin dosis 0,05 mg dengan 0,1 mg sebagai adjuvan bupivakain 0,5% 10 mg intratekal pada pasien yang menjalani prosedur seksio sesarea. Penelitian ini merupakan penelitian eksperimental dengan rancangan double blind randomized controlled trial terhadap kedua kelompok penelitian. Penilaian skala nyeri dan durasi analgesia pada pasien dihitung setiap 1 jam sejak operasi selesai (T0) hingga jam ke-24 (T24) pascaoperasi. Analisis statistik data numerik menggunakan uji t tidak berpasangan pada data berdistribusi normal serta uji Mann Whitney pada data tidak berdistribusi normal. Analisis statistik data kategorik menggunakan Uji Chi-Square dan alternatif Uji Exact Fisher. Terdapat perbedaan skala nyeri NRS jam ke-2, 3, 4, 5, 6, dan 7 yang bermakna secara statistik (p<0,05), dan perbedaan durasi analgesia yang bermakna (p<0,05) pada kedua kelompok. Skala nyeri pascaseksio sesarea pada pemberian morfin secara intratekal dosis 0,1 mg lebih rendah dibandingkan dengan dosis 0,05 mg. Durasi analgesia pascaseksio sesarea pada pemberian morfin secara intratekal dosis 0,1 mg lebih lama dibandingkan dengan dosis 0,05 mg
Correlation Between Physical Activity and Fitness Level Among Anesthesiology and Intensive Care Residents
Get PDFAnesthesiologists have a highly varied scope of work. Previous studies demonstrated that the physical activity of anesthesiologists and their residency program in the work environment does not meet the recommended standards. This study aimed to determine the relationship between physical activity and level of physical fitness among anesthesiology residents. This study was an analytical observational study with a cross-sectional design conducted on residents of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Padjadjaran, Indonesia, between January and April 2022. All anesthesiology residents were asked to fill out the International Physical Activity Questionnaire (IPAQ) and had their number of steps measured using a pedometer while the physical fitness level was assessed using the Harvard Step Test. Physical activity was assessed based on the IPAQ and pedometer. The results of IPAQ measurement showed that more subjects had low physical activity (n=44) compared to good physical activity (n=31). When measured using a pedometer, 38 subjects were classified as having low physical activity while 36 had good physical activity. Low fitness level (n=43) was associated with less physical activity on IPAQ (41 and 2)and pedometer (30 and 13). No residents had moderate or better fitness levels. Correlation analysis between physical activity and physical fitness showed a significantpositive correlation with a p-value <0.05 (Spearman Rho: 0.618). Thus,physical activity and fitness level are well-correlated among of Anesthesiology and Intensive Care residents
Drug Interactions in Diabetic Ulcer Patients in an Indonesian Private Hospital
Get PDFDiabetic ulcers can progress into tissue death, or gangrene, which create a risk for amputation. Measures for preventing other complications and accelerating wound healing in diabetic ulcers include blood sugar level control, diet adjustment, wound care, antidiabetic drug administration, and comorbid therapy. This leads to the use of various drugs that can potentially trigger drug interactions. This study aimed to identify possible drug interactions in the therapeutic management of diabetic ulcer patients treated in Husada Utama Hospital Surabaya, Indonesia, from January 2020–June 2022. This was a descriptive observational study using retrospective data from medical records. Results showed that 103 types of drugs were administered to 48 research samples with 41 of them experienced drug interactions (n=263 cases). Based on the severity of drug interactions, 31 cases were categorized as major cases (11.79%), with drug-class antibiotic-antiemetic interactions as the most frequent interactions. This study proves that it is essential for doctors and pharmacists
Cellular Inflammatory Markers and Castelli Risk Indices in Women with Gestational Diabetes Mellitus
Get PDFBackground: The clinical importance of early identification of potential predictors of cardiovascular events in women with gestational diabetes mellitus (GDM) cannot be overemphasized. This study aimed to determine the plasma levels of Castelli risk indices (CRI) and selected cellular inflammatory markers in women with GDM.Methods: A total of 40 pregnant women, consisting of 11 women with GDM and 29 women without GDM, were randomly enrolled into this case-control study using the convenient sampling method. Venous blood samples were taken. The plasma lipid profiles were determined using the spectrophotometric methods. White blood cell differential was counted using a microscope. Plasma levels of CRI-I, CRI-II, low-density lipoprotein cholesterol (LDL-C), neutrophil-lymphocyte ratio (NLR), and monocyte lymphocyte ratio (MLR) were calculated using the appropriate formula. Student’s t-test, Mann Whitney U, Chi-square, and Spearman’s rho correlations were used for statistical analysis. P<0.05 was considered statistically significant. Results: The CRI-I [6.58(6.06–7.60) vs 3.42(2.83–3.89)], CRI-II [4.59(4.17–5.28 vs 1.82(1.36–2.16)) and NLR (3.72±0.52 vs 2.63±0.61) were significantly higher in women with GDM. Likewise, the mean age (34.18±3.49), gestational weight (92.82±11.23), fasting plasma glucose (FPG) (98.45±6.24), total cholesterol (TC) (310.92(290.81–360.78)), triglyceride (TG) (232.86(221.28–256.00), LDL-C (214.85(206.24–239.80), and neutrophil count (76.36±2.58) were significantly higher in women with GDM (p<0.05). In contrast, HDL-C (45.56(44.90–51.34), lymphocytes (20.82±2.14), and monocytes counts (2.73±1.10) were significantly lower in women with GDM. However, there was no difference in the MLR between the two groups.Conclusion: The CRI-I, CRI-II, and NLR are significantly elevated in women with GDM. Dyslipidemia and systemic inflammation are associated with GDM, which are forerunners of cardiovascular diseases
Clinical Profile of Mucormycosis during the Second Wave of COVID-19 in a Tertiary Care Center in India
Get PDFObjective: To study the clinical profile and treatment outcome of mucormycosis associated with the second wave of COVID-19 pandemic.Methods: An observational study was conducted in a tertiary care center over a period of 12 months, including a 6-month post treatment follow up. Study included all COVID positive patients with a clinical and radiological evidence of rhino-orbito-cerebral mucormycosis during the second wave of COVID-19. All patients underwent further diagnostic workup and confirmed cases underwent surgical debridement and Amphotericin B was started.Results: A total of 59 patients presented with mucormycosis with the mean age being 52.7 years and unilateral facial and orbital edema as the most common symptoms (28.8%). All were diabetic with HbA1c >7 in 54.2%. The mean duration of presentation was 20.7±7.9 days from the onset of COVID-19 infection. Unilateral involvement of the paranasal sinuses was the most common finding in MRI. Early administration of Amphotericin B with prompt surgical debridement was performed in all cases. Orbital exenteration was conducted in nine patients for better fungal load clearance. Patients showed a good response to surgical debridement and prompt medical treatment, with a mortality rate of 27%.Conclusion: COVID-19 associated mucormycosis is difficult to treat and often presents in late stage. Uncontrolled diabetes, immunocompromised state, and steroid-induced immunosuppression were important risk factors. A close surveillance for early identification and initiation of treatment is mandatory. Repeated surgical debridement to clear the dead tissue is effective to control fungal load.
Correlation between Vertebral Slippage in Spondylolisthesis with Ligamentum Flavum Thickening in Dr. Soebandi Hospital, Jember, East Java, Indonesia
Get PDFBackground: Spondylolisthesis is a vertebral slip condition that compromises the body’s axial alignment and structures such as ligamentum flavum. The ligamentum flavum thickening may play a role in spondylolisthesis. The purpose of this study was to investigate the correlation between the slippage of vertebral body (spondylolisthesis) with ligamentum flavum thickening as a tissue response regarding increased mechanical stress.Methods: An analytical retrospective radiological observational was used a cross-sectional study from the results of MRI examination in Dr. Soebandi Hospital, Jember, Indonesia, collected from 2018-2021 using the simple random sampling method. Ligamentum flavum thickness and the degree of vertebral slip were measured using T2-weighted MR imaging and the correlation was analyzed using Fisher’s exact test. Results: Of 102 spondylolisthesis data records, 34 were taken, being female was the most prevalent cases in the age group above 60 years, with the most vertebral segment shift occurring at the L4–L5 level. There was a significant correlation. (p = 0.02; RR = 4.8) between ligamentum flavum thickening and vertebral slip in spondylolisthesis. Conclusion: The significant correlation between ligamentum flavum thickening and vertebral slip in spondylolisthesis suggest that mechanical stress has caused spondylolisthesis, by inducing chronic inflammation that results in hypertrophy of ligamentum flavum. Lumbar segmental instability due to spondylolisthesis is a factor contributing to the development of ligamentum flavum hypertrophy