E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Association Between Smoking and Central Obesity in Individuals Aged ≥40 Years Based on the Indonesian Family Life Survey-5
Full text linkBackground: Obesity and smoking are major public health concerns and leading causes of preventable morbidity and mortality. Smoking may contribute to central obesity through multiple mechanisms, and individuals aged ≥40 years are at higher risk. This study aimed to examine the association between smoking and central obesity, considering sociodemographic factors, using data from the Indonesian Family Life Survey-5 (IFLS-5).Methods: A cross-sectional study was conducted using secondary data from IFLS-5. Participants included Indonesians aged ≥40 years with complete data on smoking and waist circumference. Smoking status was assessed using the Brinkman Index (BI) and classified as light (0–199), moderate (200–599), or heavy (>600). Central obesity was defined as waist circumference ≥90 cm for male and ≥80 cm for female. Associations were analyzed using Chi-square tests at 95% confidence interval.Results: Of 3,391 participants, the majority were male (95.4%) with a mean age of 52.76±9.78 years (range 40–101). The prevalence of central obesity was 22.3% (n=790), and the largest group of participants were moderate smokers (54.9%). Central obesity was significantly associated with smoking status (p=0.003), age (p<0.001), gender (p<0.001), and education level (p<0.001). No significant associations were found with marital status (p=0.826), occupation (p=0.374), or residence (p=0.750).Conclusions: Smoking, age, gender, and education level are significantly associated with central obesity among Indonesians aged ≥40 years. Preventive measures, including smoking cessation and lifestyle interventions, are essential to reduce central obesity and the risk of cardiovascular disease
Microbial and Antimicrobial Susceptibility Profile of Pediatric Hematological Malignancy Patients at a Tertiary Hospital
No full textNeutropenia is a major predisposing factor for infection in pediatric patients with hematological malignancies. In Indonesia, data on microbial patterns and antibiotic resistance in this group remain limited, highlighting the need for local data to guide empirical therapy. This study aimed to determine the microbial and antibiotic susceptibility profile of pediatric patients with hematological malignancies. A cross-sectional descriptive study was conducted in the pediatric ward of Dr. Hasan Sadikin General Hospital, Bandung, from April to June 2024. Data were collected retrospectively using total sampling from medical records and registers of patients diagnosed with hematological malignancies (subgroups I and II) between January 2021 and December 2022. Microbial identification and antibiotic susceptibility profiles were performed using an automated colorimetry method. A total of 33 bacterial isolates were identified, with Gram-negative bacteria being the most frequent (75.8%). The predominant isolates were Escherichia coli (39.4%), Klebsiella pneumoniae (15.15%), and Staphylococcus hominis (12.1%). From all isolates, 69.7% were multidrug-resistant organisms (MDROs). About 62.5% of Gram-positive bacteria were methicillin-resistant coagulase-negative Staphylococci (MRCoNS), while 48% and 24% of Gram-negative bacteria were extended-spectrum β-lactamase (ESBL) and carbapenem-resistant, respectively. Gram-positive bacteria showed 100% sensitivity to Linezolid, Tigecycline, and Vancomycin, while Gram-negative bacteria showed the highest sensitivity to Amikacin. Escherichia coli, as the most frequent isolate, showed 100% sensitivity to Tigecycline. In conclusion, Gram-negative bacteria were the predominant organisms, with Escherichia coli being the most common isolate. The antibiotic susceptibility test showed a high proportion of MDROs and decreased susceptibility levels in 2022 compared to 2021
Rare Eccrine Porocarcinoma of The Eyelid in A Non-Caucasian Patient
No full textEccrine porocarcinoma of the eyelid is a rare and locally aggressive tumor with a significant risk of metastasis and recurrence after surgical excision. There are only eight cases of eyelid porocarcinoma reported in the literature, most involve Caucasian patients. A 58-year-old non-Caucasian male had a recurrent mass of the left upper eyelid for a year. He underwent two prior mass removal procedures in the same location of the upper eyelid. At the time of this study, the patient underwent full-thickness excision, and a lateral canthal defect with superior palpebral involvement was sacrificed. The periosteal flap from the lateral orbital rim was attached to the edge of the intact tarsal plate of the upper eyelid as a part of the defect reconstruction. Good outcomes in terms of tumor recurrences, cosmesis, and upper eyelid functionality were observed one month following surgery. According to the histopathology, the tumor was identified as eccrine porocarcinoma, and the patient was recommended for chemotherapy. The 4-month follow-up showed no recurrence or metastasis. Eccrine porocarcinoma is a rare condition that should be taken into account when making a differential diagnosis for patient with malignant eyelid tumors. Wide excision is still a treatment of choice.
A Pediatric Case of Kawasaki Disease with Gastrointestinal Involvement Mimicking Acute Abdomen
No full textBackground: Kawasaki Disease (KD) is a childhood acute vasculitis that predominantly affects medium-sized arteries, particularly the coronaries. While classical KD is diagnosed on the basis of defined clinical criteria, atypical presentations, such as with gastrointestinal (GI) involvement, can obscure timely recognition of this disease. GI symptoms, observed in subset of cases, may mimic acute surgical abdomen.Objective: To highlight the diagnostic challenge of Kawasaki Disease with predominant gastrointestinal symptoms mimicking acute abdomen in a pediatric case, and to emphasize the importance of early recognition and timely initiation of intravenous immunoglobulin (IVIG) therapy to prevent potential cardiac complications.Case: This is the case report of a 7-year-old male who was admitted with high-grade fever, severe abdominal pain, and signs suggestive of an acute abdomen. Initial clinical assessment and abdominal ultrasound indicated mesenteric lymphadenitis. Laboratory findings revealed marked leukocytosis, anemia, thrombocytosis, and elevated inflammatory markers (ESR, CRP) along with increased NT-proBNP suggestive of systemic inflammation. Further imaging ruled out surgical pathology. The persistence of fever, along with emerging mucocutaneous signs, led to the diagnosis of KD. The patient was treated with intravenous immunoglobulin (IVIG) and supportive therapy. Fever resolved within 24 hours, and abdominal symptoms improved markedly. Patient was then discharged afebrile with no evidence of coronary artery abnormalities on echocardiography.Conclusion: This case illustrates that persistent fever and elevated inflammatory markers in the presence of GI symptoms should prompt consideration of KD, even in the absence of full diagnostic criteria. Early diagnosis and IVIG therapy are important as delayed diagnosis may lead to significant cardiac sequelae
Association of Cognitive Function, Depression, and Social Engagement with Quality of Life among Community-Dwelling Elderly in West Jakarta, Indonesia
No full textBackground: As Indonesia’s elderly population grows, quality of life (QoL) has become a critical indicator of healthy aging. Evidence regarding the influence of cognitive function, depression, and social engagement on QoL remains inconsistent and is often limited to institutionalized elderly. This study examined these associations among community-dwelling elderly in an urban setting.Methods: A cross-sectional study was conducted at PUSAKA Kebon Jeruk, West Jakarta, from March to November 2023. Ninety-eight participants aged ≥60 years were selected using simple random sampling. Cognitive function was assessed using the Montreal Cognitive Assessment–Indonesian version (MoCA-INA), depression using the Geriatric Depression Scale (GDS), social engagement using the Social Disengagement Index, and QoL using the WHO Quality of Life–Brief Version (WHOQOL-BREF). Data were analyzed using Chi-square, Fisher’s exact, and multivariate logistic regression.Results: Most respondents were female (71.4%), aged 60–74 years (74.5%). The majority demonstrated normal cognitive function (63.3%), good social engagement (90.8%), and no depression. Overall QoL satisfaction was high, particularly in the social relationship (71.4%) and environmental domains (90.8%). Bivariate analysis showed associations between education, cognitive function, social engagement, gender, depression and specific QoL domains (p<0.05). Multivariate analysis identified gender as the strongest predictor of the environmental QoL (OR=5.63, p=0.025), education for social relationship (OR=2.99, p=0.020), and depression for general health perception (OR=3.16, p=0.041).Conclusions: Cognitive function, depression, education, and social engagement are key determinants of QoL among community-dwelling elderly. Community-based interventions focusing on mental health, cognitive stimulation, and social participation may improve QoL and support healthy aging.
Efek Analgesia Pemberian Lidokain 2,64% Teralkalinisasi dalam Alkohol 70% Secara Topikal Sebelum Flebotomi
No full textBackground: Phlebotomy is an essential procedure in healthcare, but it often causes pain due to its invasive nature. Although lidocaine is effective as a local anesthetic, the injectable formulation and low pH may induce pain before the anesthetic effect begins. Therefore, alkalinized lidocaine administered topically is considered a potential alternative to reduce pain and accelerate anesthetic onset. This study is essential to evaluate the effectiveness of this approach. This research aimed to assess the effect of 2.64% alkalinized lidocaine in 70% alcohol, applied topically, on phlebotomy pain levels, measured using the Numeric Rating Scale (NRS).Methods: This study employed a single-masked randomized controlled trial (RCT) with a posttest-only control group design. Samples were obtained via simple random sampling, yielding 20 paired samples from 135 eligible participants. On the first day, participants underwent phlebotomy after the application of alkalinized lidocaine, and on the tenth day, phlebotomy was repeated using 70% alcohol as the control. Pain was measured using the NRS and analyzed using the Wilcoxon test.Results: NRS scores in the control group were significantly higher than those in the experimental group, with a p-value of 0.001.Discussion: Alkalinized lidocaine effectively reduced phlebotomy pain, likely due to an increased non-ionic fraction that enhances tissue penetration and accelerates anesthetic onset. These findings align with existing literature, although generalization remains limited by the small sample size and single-masked design.Conclusion: Topically applied 2.64% alkalinized lidocaine in 70% alcohol is effective in reducing pain associated with phlebotomy.Flebotomi merupakan tindakan penting dalam dunia kesehatan, tetapi prosedurnya yang invasif selalu menimbulkan nyeri dan memengaruhi kualitas hidup pasien. Lidokain hadir sebagai solusi untuk mengatasi nyeri tersebut, tetapi pemberiannya yang invasif dan pH yang rendah justru menimbulkan nyeri sebelum menimbulkan efek anestesi sehingga diperlukan alkalinisasi dan pemberian secara topikal untuk mengurangi nyeri yang ditimbulkan, serta dapat meningkatkan onset dari lidokain. Penelitian ini bertujuan untuk mengetahui pengaruh pemberian lidokain 2,64% teralkalinisasi dalam alkohol 70% secara topikal sebelum flebotomi terhadap perubahan Numeric Rating Scale (NRS). Penelitian ini menggunakan metode Randomized Control Trial (RCT) dengan pendekatan posttest only control group design dan jenis studi single-blind. Pengambilan sampel menggunakan metode simple random sampling mendapatkan 20 sampel berpasangan yang diacak dari 135 populasi yang telah memenuhi kriteria. Pada hari pertama, sampel diberikan tindakan flebotomi yang sebelumnya diberikan lidokain 2,64% teralkalinisasi dalam alkohol 70% secara topikal sebagai larutan eksperimen dan dilanjutkan tindakan flebotomi pada hari ke-10 yang sebelumnya hanya diberikan alkohol 70% secara topikal sebagai larutan kontrol. Skala nyeri kemudian diukur menggunakan NRS dan dianalisis menggunakan uji Wilcoxon. Hasil penelitian ini menunjukkan NRS flebotomi yang sebelumnya diberikan larutan kontrol ditemukan lebih tinggi dibandingkan larutan eksperimen. Hasil uji Wilcoxon menunjukkan adanya pengaruh pemberian lidokain 2,64% teralkalinisasi dalam alkohol 70% secara topikal sebelum flebotomi yang signifikan (p=0,001). Dengan demikian, dapat disimpulkan bahwa pemberian lidokain 2,64% teralkalinisasi dalam alkohol 70% secara topikal sebelum flebotomi dapat mengurangi nyeri akibat flebotomi
PERBANDINGAN PEMBERIAN PROFILAKSIS ANTARA PHENYLEPHRINE DAN EFEDRIN TERHADAP HEMODINAMIK MATERNAL DAN EFEKNYA PADA AGDA DAN APGAR SKOR BAYI
No full textAnestesi spinal pada ibu hamil sering menyebabkan hipotensi yang dapat memengaruhi kondisi ibu dan bayi. Fenilefrin saat ini menjadi pilihan utama karena dianggap lebih aman terhadap janin dibanding dengan efedrin. Kedua agen vasopresor ini diketahui memengaruhi parameter penting seperti tekanan darah maternal, pH darah umbilikal, skor APGAR, dan analisis gas darah, namun efektivitasnya masih menjadi perdebatan, terutama pada kondisi gawat janin. Penelitian ini bertujuan membandingkan efektivitas fenilefrin dan efedrin sebagai profilaksis dalam mempertahankan hemodinamik maternal serta pengaruhnya terhadap analisis gas darah arteri (AGDA) dan skor APGAR pada seksio sesarea dengan anestesi spinal. Penelitian ini merupakan uji klinis acak tersamar ganda terhadap 38 pasien yang dibagi menjadi dua kelompok. Hasil menunjukkan tidak terdapat perbedaan bermakna pada tekanan darah sistol dan MAP (p>0,05), namun terdapat perbedaan signifikan pada tekanan diastol dan denyut jantung (p0,05). Namun, terdapat perbedaan signifikan pada TD diastolik dan denyut jantung antara kedua kelompok (p0,05).Kesimpulan: Phenylephrine dan efedrin sama baiknya dalam mempertahankan hemodinamik maternal, tetapi lebih baik dalam nilai APGAR dan AGDA bila dibandingkan dengan efedrin. Kata Kunci : AGDA, APGAR, efedrin, hemodinamik maternal, phenylephrin
Prognostic Value of Alactic Base Excess for 28 Day Mortality in Sepsis Patients: A Retrospective Prognostic Accuracy Study in an Intensive Care Unit
No full textIntroduction: Prognostication in sepsis is challenging. Serum lactate is widely used but cannot separate non-lactate contributions to metabolic acidosis. Alactic Base Excess (ABE) provides a more complete assessment of acid–base status. This study assessed ABE’s value in predicting 28-day mortality in sepsis patients.Methods: A retrospective study included 109 adult sepsis patients meeting Sepsis-3 criteria with arterial blood gas analysis within 24 hours of ICU admission. ABE was calculated from base excess and lactate. Prognostic performance was evaluated using ROC analysis, and association with mortality was assessed using odds ratios (OR).Results: Of 109 patients, 59 (54.1%) died within 28 days. Non-survivors had more negative median ABE than survivors (-7.04 vs. -0.15; p<0.001). Optimal ABE cut-off was ≤ -4.1. Patients with ABE ≤-4.1 had a higher risk of mortality (OR 38.6; 95% CI: 13.2–112.9; p<0.001).Discussion: ABE showed strong prognostic performance, reflecting non-lactate metabolic acidosis not captured by lactate alone. As it is derived from routine arterial blood gas analysis, ABE is practical for early risk stratification in critically ill sepsis patients.Conclusion: ABE demonstrates excellent prognostic value for 28-day mortality in ICU sepsis patients. An ABE ≤-4.1 is linked to significantly higher mortality and may serve as a readily available biomarker for early risk assessment and timely clinical decisions
Correlation of Nutritional Status, HbA1c, and Duration of Diabetes Mellitus with Amputation Incidence in Patients with Diabetic Foot Ulcers
No full textDiabetic foot ulcer (DFU) is a severe complication of diabetes that significantly impairs quality of life and may often lead to amputation, particularly when infections become extensive. This study investigated the correlation of nutritional status, HbA1c levels, and duration of diabetes exposure with the incidence of amputation in DFU patients. Using an observational analytic study with a retrospective cohort design, data from 47 DFU patients treated at the Vascular and Endovascular Surgery clinic and Emergency Room of a hospital from 2019-2024 were analyzed. The majority of subjects were men aged 40-60 years (59.57%). Among the amputee group, 55.31% experienced neuropathy, primarily classified as Wagner's degree 4. Patients requiring amputation had significantly higher levels of urea, creatinine, and leukocytes compared to those who did not. A significant correlation was observed between the incidence of amputation and nutritional status—specifically, serum albumin (r=-0.616) and Body Mass Index (BMI) (r=0.823)—as well as HbA1c levels (r=0.806) and duration of diabetes exposure (r=0.445) (p<0.05). However, the Subjective Global Assessment (SGA) did not show a significant relationship with amputation incidence. The findings of this study suggest that nutritional status, HbA1c levels, and duration of diabetes exposure are significantly correlated with the likelihood of amputation in patients with diabetic foot ulcers (DFU)
Workplace Violence Against Doctors and Nurses in Public Healthcare Services in AL- Majmaah City, Saudi Arabia
Full text linkWorkplace violence raises a significant concern in healthcare settings, with healthcare workers being at risk of physical and emotional harms. This phenomenon is, however, rarely investigated in Al-Majmaah city, Saudi Arabia. This study sought to estimate the prevalence of workplace violence against doctors and nurses working in public healthcare facilities in Al-Majmaah city. A cross-sectional study was conducted in public health facilities in Al-Majmaah city, Saudi Arabia, from June to August 2022. Healthcare workers were recruited to participate in a self-administered online questionnaire, which collected data on sociodemographic information, workplace violence exposure, and attitudes towards violence. Of the total participants, 41.9% reported experiencing workplace violence. The majority of incidents occurred in health institutions, with 92.3% involving verbal abuse, 2.6% physical violence, or both. Patients' families were responsible for 48.7% of the violence, followed by the patients themselves (43.6%). In response to violence, healthcare workers reported various coping mechanisms, including pretending the incident never happened (23.1%), attempting to stop the perpetrator (23.1%), and protecting themselves (18%). Regarding system satisfaction, 14% remained indifferent, 16% were dissatisfied, and 2% were satisfied. Furthermore, 15.1% of participants experienced disturbed thoughts or images of the attack, 14% avoided thinking or talking about incidents, and 11.8% were unaffected. Workplace violence is a significant problem affecting healthcare workers in public healthcare facilities in Al-Majmaah city, Saudi Arabia. The high prevalence of verbal abuse and physical violence highlights the need for effective prevention and intervention strategies to ensure a safe working environment for healthcare workers