E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Perbandingan Efek Durasi Blokade Sensorik dan Motorik, Gejolak Hemodinamik, serta Efek Samping Deksmedetomidin dengan Fentanil sebagai Adjuvan pada Anestesi Spinal
Get PDFFentanil dan deksmedetomidin merupakan agen yang berpotensi baik sebagai adjuvan anestesi spinal. Penelitian ini bertujuan menilai kecepatan mula kerja, pemanjangan lama kerja blokade sensorik dan motorik anestesi spinal, termasuk pengaruhnya terhadap gejolak hemodinamik serta efek samping. Penelitian ini merupakan single blind randomized control trial untuk membandingkan pengaruh penambahan deksmedetomidin 3 mcg dengan fentanil 25 mcg pada lidokain 75 mg hiperbarik yang diberikan sebagai anestesi spinal di kamar instalasi bedah sentral RSUD Dr. Moewardi Surakarta bulan Maret–Mei 2018. Subjek penelitian adalah pasien usia 19–64 tahun yang menjalani pembedahan abdomen bagian bawah dan ekstremitas bawah secara elektif dengan anestesi spinal dengan ASA I dan II. Hasil penelitian menunjukkan bahwa terdapat pengaruh penambahan deksmedetomidin dan fentanil pada lidokain 5% yang diberikan sebagai anestesi spinal, dengan menilai perbedaan kecepatan onset dan pemanjangan durasi blokade sensorik dan motorik, yaitu penambahan deksmedetomidin 3 mcg (diencerkan dalam NaCl 0,9% 0,5 mL) pada 1,5 mL Lidokain 5% lebih efektif dalam pemanjangan durasi blokade sensorik dan motorik dibanding dengan penambahan fentani 25 mcg (0,5 mL) pada 1,5 mL lidokain 5% dan tidak berbeda pengaruhnya pada perubahan tanda vital dan juga tidak meningkatkan efek samping. Comparison of Effects of Sensory and Motor Blockade Duration, Hemodynamic Fluctuations, and Side Effects of Dexmedetomidine with Fentanyl as Adjuvant in Spinal AnesthesiaFentanyl and dexmedetomidine are potentially suitable adjuvants to spinal anesthesia. This study aimed to assess the initial onset of work and prolongation of the duration of sensory and motor blockade of spinal anesthesia, including the effect on hemodynamic turbulence that appears and the occurrence of adverse effects. This study was a single-blind randomized control trial, comparing the impact of adding 3 mcg of dexmedetomidine with 25 mcg fentanyl on hyperbaric lidocaine 75 mg given as spinal anesthesia in the operating room of the central surgical installation of RSUD Dr. Moewardi Surakarta from March–May 2018. The research subjects were patients aged 19–64 who underwent elective abdominal and lower extremity surgery under spinal anesthesia with ASA I and II physical status and obtained informed consent. Based on the results of the study, it found that there was an effect of adding dexmedetomidine and fentanyl to 5% lidocaine given as spinal anesthesia by assessing the difference in the speed of onset and the prolongation of the duration of sensory and motor blockade. The addition of dexmedetomidine 3 mcg (diluted in 0.9% NaCl 0.5 mL) to 1.5 mL lidocaine was 5% more effective in prolonging the duration of sensory and motor blockade compared to 25 mcg fentanyl (0.5 mL) at 1.5 mL 5% lidocaine and no difference in changes in vital signs. Moreover, it also did not increase the occurrence of side effects. Fentanil dan deksmedetomidin merupakan agen yang berpotensi baik sebagai adjuvan anestesi spinal. Penelitian ini bertujuan menilai kecepatan mula kerja, pemanjangan lama kerja blokade sensorik dan motorik anestesi spinal, termasuk pengaruhnya terhadap gejolak hemodinamik serta efek samping. Penelitian ini merupakan single blind randomized control trial untuk membandingkan pengaruh penambahan deksmedetomidin 3 mcg dengan fentanil 25 mcg pada lidokain 75 mg hiperbarik yang diberikan sebagai anestesi spinal di kamar instalasi bedah sentral RSUD Dr. Moewardi Surakarta bulan Maret–Mei 2018. Subjek penelitian adalah pasien usia 19–64 tahun yang menjalani pembedahan abdomen bagian bawah dan ekstremitas bawah secara elektif dengan anestesi spinal dengan ASA I dan II. Hasil penelitian menunjukkan bahwa terdapat pengaruh penambahan deksmedetomidin dan fentanil pada lidokain 5% yang diberikan sebagai anestesi spinal, dengan menilai perbedaan kecepatan onset dan pemanjangan durasi blokade sensorik dan motorik, yaitu penambahan deksmedetomidin 3 mcg (diencerkan dalam NaCl 0,9% 0,5 mL) pada 1,5 mL Lidokain 5% lebih efektif dalam pemanjangan durasi blokade sensorik dan motorik dibanding dengan penambahan fentani 25 mcg (0,5 mL) pada 1,5 mL lidokain 5% dan tidak berbeda pengaruhnya pada perubahan tanda vital dan juga tidak meningkatkan efek samping
Factors Associated with Mortality in COVID-19 Patients Treated at Serui General Hospital, Papua Indonesia
Get PDFCoronavirus Disease 2019 (COVID-19) has a high fatality rate and has caused around 4,771,408 deaths worldwide as of 30 September 2021. COVID-19 infection presents various severity levels, starting from asymptomatic to severe symptoms that lead to death. Mortality in COVID-19 patients is associated with multiple risk factors. This study aimed to analyze the risk factors associated with COVID-19 mortality in Serui General Hospital, Papua, Indonesia. A cross-sectional analytic observational study was performed in Serui General Hospital from September 2020to September 2021. Subjects were COVID-19 positive inpatients who met the inclusion and exclusion criteria. The independent variables were demographic characteristics, clinical manifestations, comorbidities, and lab findings, while the dependent variable was mortality. Statistical analysis was performed using chi-square test and logistic regression. This study included sixty-nine patients with 21 (30.4%) of them were non-survivors. The multivariate analysis showed that an NLR of >3.13 (OR 7.49; p=0.037; 95% CI 1.63–34.35), hypertension (OR 4.71; p=0.019; 95% CI 1.28–17.29), and age (OR 4.26; p=0.028; 95% CI 1.17–15.52) were associated with mortality in COVID-19 patients. Thus, NLR >3.13, hypertension, and age are considered to be the risk factors associated with the mortality caused by COVID-19 among patients in Serui General Hospital
Comparison between the Effectiveness Fecal Immunochemical Test and Colonoscopy As A Tool For Colorectal Cancer Early Detection
Get PDFCancer is a disease that causes a lot of misery and death in humans. According to data from the World Health Organization (WHO) in 2015, there are 8.8 million deaths caused by cancer and colorectal cancer ranked third with 774,000 deaths. One of the prevention effort for colorectal cancer is early detection in the population, especially in high-risk groups and in groups with non-specific symptoms. In general, two types of early detection tests are available: stool-based testing and structural testing. Fecal immunochemical test (FIT) is one type of examination that is categorized as the tool-based test. Meanwhile, the structural test include colonoscopy, CT colonography and flexible sigmoidoscopy. This study aimed to determine difference in the effectiveness of FIT against colonoscopy as an early detection tool for colorectal cancer. This study was a cross-sectional comparative diagnostic analytical observational study to compare FIT to colonoscopy for early detection of colorectal cancer. This study involved patients presented to Dr. Hasan Sadikin General Hospital Bandung, Indonesia. Analysis of diagnostic test data was carried out to obtain the sensitivity, specificity, and the positive and negative predictive values through the use of bivariate analysis in the form of Man Whitney test. Thirty-eight patients were included in this study, consisting of 27 cancer patients and 11 non-cancer patients. Results showed that the sensitivity level of FIT was 81.5%, with 72.7% specificity. There is no significant difference in the effectiveness between FIT and colonoscopy in screening for colorectal cancer
Oral Ulcer Healing Activity of Lemon Pepper Ethanol Extract Gel in Streptozotocin-Induced Diabetic Wistar Rats
Get PDFDiabetes mellitus (DM) is a metabolic condition where the body's ability to produce and utilize insulin is impaired; thus, wound healing process is slower than usual in patients with DM. Lemon pepper has both antioxidant and anti-inflammatory properties. This study aimed to investigate the effect of topical application of lemon pepper fruit ethanol extracts on the healing process of oral traumatic ulcers in diabetic rats. This study was performed at the Pharmacology Laboratory, Faculty of Medicine, Universitas Prima Indonesia from September 2021–October 2021. Thirty males diabetic Wistar rats were thermally injured on the lower labial mucosa and divided into five groups: control, standard, and lemon pepper gel 5%, 7.5%, and 10% groups. The ulcer size was measured after injury and on the 7th and 14th day. On the last day, all rats underwent both routine blood count and histology study for oral ulcer tissue. On the 14th day, all treatment groups showed some significant difference wound contraction, with the highest tendency of wound contraction seen in both lemon pepper gel 10% and standard groups (62.50%. p-value =0.001). The improvement of wound contraction was also supported by reduced white blood cell count (p-value<0.05) in routine blood count and regeneration of epidermis and dermis tissues in the histology study. Hence, it can be concluded that the lemon pepper extract gel in all concentrations has good physical stability and the lemon pepper gel with the highest concentration group presents the best ulcer healing activity compared to other concentrations and has similar ulcer healing activity as the standard group that receives Kenalog® in Orabase
Validity and Reliability of The Indonesian Version of Patient Allergic Rhinitis Questionnaire and Allergic Rhinitis Prevalence in A Class Of 2018-2019 Medical Students of Universitas Padjadjaran, Indonesia
Get PDFObjective: To determine the validity and reliability of the Indonesian version of Patient Allergic Rhinitis Questionnaire as a screening tool for AR and the prevalence of AR in a class of 2018-2019 medical students of Universitas Padjadjaran, Indonesia.Methods: A cross-sectional descriptive study was performed during the period November-December 2021 on a class of 2018-2019 medical students of Padjadjaran University. The Indonesian version of the pre-validated Patient Allergic Rhinitis Questionnaire was distributed online. Allergic rhinitis was determined from history taking by identifying a history of a previous diagnosis of AR and/or 2 or more symptoms (watery runny nose, sneezing, nasal congestion, itching, or conjunctivitis) for more than 1 hour on most days.Results:. The validity of the Indonesian version of the Patient Allergic Rhinitis Questionnaire was good with a 0.895 Cronbach's Alpha coefficient, reflecting a reliable questionnaire. The prevalence of AR was 35.8% with most were female (69.2%). There were 59.9% of respondents who had a history of allergy in their parents. The most common symptom was nasal congestion (85.7%) and the moderate-severe persistent (49.2%) was the most common ARIA-WHO classification. Dusty places (92.1%) were the most common cause of symptoms. The most common comorbidity was rhinosinusitis (35%). The mean symptom severity score was 6.7.Conclusions: The Indonesian version of the Patient Allergic Rhinitis Questionnaire is valid and reliable as a screening tool for AR. The prevalence of AR in this study is quite high, with moderate-severe persistent as the most prominent classification
Depression, Anxiety, and Stress due to Changes in Employment Status during COVID-19 Pandemic: A Study in Badung Districts, Bali, Indonesia
Get PDFObjective: To determine the relationship between depression, anxiety, and stress with the employment status of people in Bali during Covid-19 pandemic.Methods: This study was a cross-sectional analytical study conducted in Bali, Indonesia, in 2021. The instrument used was DASS-21 questionnaire, which was distributed to a total sample size of 96 people. The relationship between variables were analyzed with a p-value of <0.05 as the cut-off for a significant relationship.Results: Depression symptoms had a significant relationship with gender (p=0.024) while anxiety symptoms had a significant association with the employment status during the pandemic (p=0.027). Similarly, stress symptoms also had a significant relationship with gender (p=0.007) and employment status during COVID-19 pandemic (p=0.007).Conclusion: There is a relationship between depression, anxiety, and stress due to changes in employment status during the COVID-19 pandemic in Badung Districts, Bali
Outcomes of Tuberculous Meningitis Patients with or without Hydrocephalus from a Tertiary Hospital in West Java, Indonesia
Get PDFBackground: Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis. One of the most common complications of TBM is hydrocephalus, with a higher risk of mortality. This study aimed to evaluate the outcome among TBM patients with or without hydrocephalus.Methods: This study was a retrospective cross-sectional comparative analytical study. A total sampling was employed based on the number of traceable resumes of TBM patients treated at the Department of Neurology Dr. Hasan Sadikin General Hospital, Bandung, Indonesia in 2018. Results: Of the 127 data of TBM patients, 55 (43.3%) had hydrocephalus, and 72 (56.7%) did not. The median age of TBM patients with and without hydrocephalus was 34 years (IQR 26–45) and 35 years (IQR 24–44), respectively. Decreased consciousness dominated the clinical symptoms for 94.5% in the hydrocephalus group and 84.7% in the non-hydrocephalus group. Hospital-acquired pneumonia occurred mainly in the hydrocephalus group (29.1%), whereas urinary tract infections mainly occurred in without hydrocephalus group (18%). There was a significant difference between the outcome of hydrocephalus and non-hydrocephalus (p=0.005). Mortality was higher in patients with hydrocephalus compared to those without hydrocephalus.Conclusions: The outcome of TBM patients with hydrocephalus is worse than those without hydrocephalus, as reflected by a higher grade of TBM, higher mortality rate, and lower good recovery upon treatment administration. Therefore, prompt diagnosis and treatment are needed to improve the outcome and survival among TBM patients with hydrocephalus
Angka Kejadian dan Karakteristik Mortalitas dan Morbiditas Pada Pengelolaan Anestesi Perioperatif di RSUP Dr. Hasan Sadikin Bandung Tahun 2017-2019
Get PDFPengelolaan anestesi perioperatif merupakan tanggungjawab dokter anestesi yang mencerminkan mutu pelayanan di rumah sakit. Tujuan penelitian ini mengetahui angka kejadian serta karakteristik mortalitas dan morbiditas pada pengelolaan anestesi perioperatif di RSUP Dr. Hasan Sadikin Bandung tahun 2017–2019. Penelitian ini merupakan penelitian deskriptif observasional retrospektif terhadap rekam medis pasien yang mengalami mortalitas dan morbiditas, perioperatif. Hasil penelitian mengungkapkan angka kejadian mortalitas dan morbiditas tahun 2017–2019 sebesar 2 kasus per 1.000 tindakan anestesi. Karakteristik pasien yang mengalami mortalitas dan morbiditas yaitu pasien usia produktif, jenis kelamin wanita, IMT normal, komorbid penyakit jantung, dan status fisik ASA 3. Karakteristik pembedahan, mortalitas ditemukan lebih banyak pada operasi digestif, waktu operasi pukul 07.00–16.00, dan lama operasi ≤3 jam, sedangkan pada morbiditas ditemukan lebih banyak pada operasi obstetri-ginekologi, waktu operasi pukul 07.00–16.00, dan lama operasi ≤3 jam. Karakteristik anestesiologi, mortalitas dan morbiditas lebih banyak terjadi pada anestesi umum, lama anestesi >3 jam, dan kegagalan penanganan jalan napas. Simpulan penelitian ini adalah kejadian mortalitas dan morbiditas pada pengelolaan anestesi perioperatif dipengaruhi oleh berbagai faktor sehingga penilaian, penatalaksanaan, dan koordinasi yang baik dari berbagai bidang dapat memberikan luaran yang baik pada pasien.Incidence Rate and Characteristics of Mortality and Morbidity in Perioperative Anesthesia Management at Dr. Hasan Sadikin Hospital Bandung 2017–2019 The anesthesiologist is responsible for managing perioperative anesthesia, which reflects the quality of care in the hospital. This study aimed to determine the incidence and characteristics of cases of mortality and morbidity in the perioperative anesthesia management at Dr. Hasan Sadikin Bandung Year 2017–2019. This study was a retrospective descriptive observational study on the medical records of perioperative morbidity and mortality patients at Dr. Hasan Sadikin Hospital Bandung Year 2017–2019. The results showed that the mortality and morbidity cases in 2017–2019 were 2 cases per 1,000 anesthetic procedures. Characteristics of patients who experienced mortality and morbidity were productive age, female gender, normal BMI, comorbid heart disease, and ASA physical status 3. The characteristics of surgery in mortality cases were digestive surgery, which was performed between 07.00–16.00 and with a duration of 3 hours. The characteristics of surgery in morbidity cases were obstetric-gynecological surgery performed between 07.00–16.00 and with a duration of 3 hours of surgery. The anesthesiological characteristics in cases of mortality and morbidity were in patients with general anesthesia, duration of anesthesia >3 hours, and failure of airway management. Various factors can influence the incidence of mortality and morbidity in perioperative anesthesia management. Appropriate assessment, management, and coordination of various fields can provide good patient outcomes.Pengelolaan anestesi perioperatif merupakan tanggungjawab dokter anestesi yang mencerminkan mutu pelayanan di rumah sakit. Faktor pasien, pembedahan, dan anestesi mempengaruhi luaran pada saat pengelolaan anestesi perioperatif. Tujuan penelitian ini untuk mengetahui angka kejadian dan karakteristik mortalitas dan morbiditas pada pengelolaan anestesi perioperatif di RSUP Dr. Hasan Sadikin Bandung pada tahun 2017–2019. Penelitian ini merupakan penelitian deskriptif observasional retrospektif terhadap rekam medis pasien yang mengalami mortalitas dan morbiditas perioperatif di RSUP Dr. Hasan Sadikin Bandung pada tahun 2017–2019. Hasil penelitian mengungkapkan angka kejadian mortalitas dan morbiditas pada tahun 2017-2019 sebesar 2 kasus per 1.000 tindakan anestesi. Karakteristik pasien yang mengalami mortalitas dan morbiditas pada usia produktif, jenis kelamin wanita, IMT normal, komorbid penyakit jantung, dan status fisik ASA 3. Karakteristik pembedahan pada mortalitas yaitu pada operasi digestif, waktu operasi pukul 07.00-16.00, dan lama operasi ≤3 jam. Karakteristik pembedahan pada morbiditas yaitu pada operasi obstetri-ginekologi, waktu operasi pukul 07.00-16.00, dan lama operasi ≤ 3 jam. Karakteristik anestesiologi pada mortalitas dan morbiditas yaitu dengan anestesi umum, lama anestesi >3 jam, dan kegagalan penanganan jalan napas. Simpulannya adalah kejadian mortalitas dan morbiditas pada pengelolaan anestesi perioperatif dapat dipengaruhi oleh berbagai faktor sehingga penilaian, penatalaksanaan, dan koordinasi yang baik dari berbagai bidang dapat memberikan luaran yang baik pada pasien