E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Clinical Manifestation and Hematologic Interpretation of Pediatric Systematic Lupus Erythematosus at Initial Presentation: 2-Years Observation
Get PDFBackground: Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by a spectrum of clinical manifestations, immunological abnormalities, and varied laboratories results. In children, SLE manifestation is particularly more severe, involving more organs. Hematological manifestation has been known as the most common manifestation. The purpose of this study was to describe the clinical manifestations and hematologic interpretation of pediatric SLE at initial presentation.Methods: This retrospective data collection study was conducted at the Department of Child Health Dr. Hasan Sadikin General Hospital Bandung on medical records from a two-year period of 2017–2018. The clinical manifestations were categorized into malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, renal disorders, and neurological disorders. The hematologic interpretations were categorized into anemia, leukopenia, neutropenia, lymphopenia, and thrombocytopenia. Clinical manifestations and hematological interpretations were presented as occurrence percentages and stratified into three age-group of pre-pubertal, peri-pubertal, and post-pubertal.Results: Among 79 pediatric SLE patients (median age 14 years old; IQR 11–16), female gender was predominant. Abnormalities hematologic interpretation occurs in more than half of the patients (83.5%). Malar rash and anemia were the commonest findings among all age groups. Increased occurrence of neuropsychiatric and renal disorders were observed in all age-groups.Conclusions: Malar rash and anemia are important findings among pediatric SLE patients. Furthermore, the occurrences of the neuropsychiatric and renal disorders are also important
Visualization of Carotid Doppler in Patients with Ischemic Stroke at Dr. Hasan Sadikin General Hospital Bandung Year 2016-2019
Get PDFBackground: Various pathological changes in both the intra and extracranial arteries that supply the brain can cause disturbance of cerebral blood flow and perfusion leading to cerebral dysfunction. Doppler ultrasound is able to assess these changes. This study was performed to evaluate the anatomical and physiological changes found in the carotid arteries of patients with ischemic stroke using Doppler ultrasound.Methods: The cross-sectional descriptive study design with total sampling method was conducted on the medical records of ischemic stroke patients who had carotid Doppler ultrasound at the Department of Cardiology and Vascular Medicine Dr. Hasan Sadikin General Hospital Bandung from 2016 to 2019. Demographic data, such as stroke diagnoses and plaque characteristics recorded in the Doppler reports were collected.Results: There were 38 data sets collected. The distribution and characteristics of atherosclerotic plaques were similar between the two carotid systems, with the same percentage of plaque being found in the right (31.6%) and left (36.8%) carotid system. The most common type of plaque found was type III and was located in the common carotid artery. Thrombus was absent in all patients. Intimal media thickening was found in 13.2% right system and 15.8% left system. Stenosis was present in 34.2% of patients, and most had 125 cm/s) in 5.3% of the right system and 7.9% of the left system of the internal carotid artery.Conclusions: Most of the atherothrombotic and thromboembolic type of ischemic stroke patients in this study have normal carotid Doppler ultrasound features. Further study on the presence of plaque in ischemic stroke patients in Indonesia is needed
Lethal Dose of Calcium Bentonite in Wistar Rats
Get PDFBackground: Calcium bentonite is a type of clay produced by a devitrification of volcanic ash which is often used as a traditional medicine to absorb toxins and waste products of metabolism. The aim of this study was to determine the lethal dose of calcium bentonite in Wistar rats to explore its toxicity level and safe use.Methods: Fifty male and female Wistar rats were randomly divided into five groups for each sex. The control group was given 5 cc aquadest whereas the other four groups received calcium bentonite solution of 50 mg/kgBW, 300 mg/kgBW, 2,000 mg/kgBW, and 5,000 mg/kgBW, respectively, at a single dose. The weight was observed for up to 7 days and analyzed using the unpaired t-test and Mann-Whitney test. The death rate was calculated using the probit analysis. Median lethal dose results were then classified according to Loomis Criteria. Results: No deaths occurred at the highest dose, suggesting that the median lethal dose value of calcium bentonite was >5,000 mg/kgBW. No weight loss occurred due to the administration of calcium bentonite and a significant increase in the body weight was even observed in the male rat group. Interestingly, a significant decrease was found in the female rats group when compared to the control group.Conclusions: Calcium bentonite is classified as a practically non-toxic material with a median lethal dose of over 5,000 mg/kgBW
Correlation between Cognitive Function and Physical Performance in Community-Dwelling Older Adults
Get PDFBackground: One of the health problems often found among older adults in Indonesia is cognitive impairment, resulting in difficulties daily life and a significant decrease in functional status. This study aimed to determine the correlation between cognitive function and physical performance in community-dwelling older adults.Methods: This was a cross-sectional study conducted from October–November 2019. Samples were collected from North Jakarta through consecutive sampling (n=38). Cognitive function was measured using the Mini-Mental State Examination (MMSE) and the physical performance was measured using the Timed Up and Go Test (TUG) method. The statistical test applied in this study was Spearman’s rank correlation (p<0.05). Results: The majority of the subjects in this study were mostly female young older adults with the most received ≥12 years of education. The results for both MMSE and TUG were normal. There was a negative correlation between MMSE and TUG scores (r= -0.357, p=0.028).Conclusions: There is a weak but significant correlation between cognitive function and physical performance in community-dwelling older adults. A further study exploring cognitive dysfunction and physical performance in older adults is needed
A Case Series of COVID-19 with Severe ARDS and Comorbidities who Survived without Invasive Mechanical Ventilation in ICU at Wisma Atlet Kemayoran COVID-19 Field Hospital, Jakarta
No full textSebagian besar orang yang terinfeksi COVID-19 asimtomatis ataupun bergejala ringan. Namun tidak sedikit juga yang mengalami acute respiratory distress syndrome (ARDS), membutuhkan perawatan ICU bahkan berakhir dengan kematian. Indonesia bahkan telah melampaui angka dunia dengan angka 2,7%. Keadaan ini lebih berisiko dialami oleh pasien dengan komorbid seperti hipertensi (50,1%), diabetes (36,6%), dan obesitas (13,3%). Kebutuhan terapi oksigen dengan ventilasi mekanik hingga tindakan intubasi meningkat pada kebanyakan kasus dengan komorbid. Serial kasus ini melaporkan dua pasien terkonfirmasi COVID-19 dengan komorbid yang memenuhi kriteria intubasi, namun tidak dilakukan. Dalam perjalanannya kedua kasus mengalami perbaikan klinis dan sembuh. Beberapa kemungkinan yang dapat dijelaskan, yaitu terdapat perbedaan antara ARDS pada COVID-19 (CARDS) dan ARDS klasik. Selain itu, prone position yang membantu meningkatkan oksigenasi dan mengatasi hipoksemia melalui beberapa mekanisme. Penggunaan HFNC dini pada pasien COVID-19 dan pemberian regimen kombinasi terapi antibiotik, antivirus, antikoagulan, serta antiinflamasi dinilai dapat menurunkan morbiditas pasien. Tujuan penanganan ARDS ialah menangani hipoksemia dengan meningkatkan oksigenasi. Selain dengan pemberian terapi oksigen untuk meningkatkan FiO2, dapat juga dilakukan dengan prone position. Prone position pada kasus dengan kombinasi HFNC dinilai berhasil karena pasien mampu bertahan tanpa penggunaan ventilasi mekanik dan mengalami perbaikan klinis hingga sembuh. Two Reported Cases of COVID-19 with Severe ARDS and Comorbidities who Survived without Invasive Mechanical Ventilation in ICU at Wisma Atlet Kemayoran COVID-19 Field Hospital, JakartaMost patients with COVID-19 are either asymptomatic or have mild symptoms. However, many also experience acute respiratory distress syndrome (ARDS), requiring ICU, or even lead to death. Indonesia’s case fatality rate of 2.7% has exceeded the global case. Patients with comorbidities such as hypertension (50.1%), diabetes (36.6%), and obesity (13.3%) are at higher risk of experiencing this situation. The need for oxygen therapy with mechanical ventilation or even intubation is increased in most cases with previously mentioned comorbidities. These serial cases reported two confirmed COVID-19 patients with comorbidities that fulfilled intubation criteria; however, the intubation procedures were not performed. Both cases experienced clinical improvement and improved throughout the treatment period. Several possible explanations include that there are differences between ARDS in COVID-19 (CARDS) and classic ARDS. Moreover, the prone position helps in increasing oxygenation and reducing hypoxemia through several mechanisms. Early HFNC in COVID-19 patients and treatment regimen consisting of antibiotics, antivirus, anticoagulant, and anti-inflammatory drugs are considered to reduce morbidity. The goal of ARDS treatment is to treat hypoxemia by increasing oxygenation. In addition, giving oxygen therapy to increase FiO2 can also be done by prone positioning. Combining prone position and HFNC in these cases was considered successful because the patient were able to survive without the use of mechanical ventilation and experienced clinical improvement until they recovered.Most patients with COVID-19 are either asymptomatic or have mild symptoms. However, many also experience acute respiratory distress syndrome (ARDS), requiring ICU, or even lead to death. Indonesia’s case fatality rate of 2,7% has exceeded the global case. Patients with comorbidities such as hypertension (50,1%), diabetes (36,6%), and obesity (13,3%) are at higher risk of experiencing this situation. The need for oxygen therapy with mechanical ventilation or even intubation is increased in most cases with previously mentioned comorbidities. These serial cases reported two confirmed COVID-19 patients with comorbidities that fulfilled intubation criteria, however, the intubation procedures were not performed. Both cases experienced clinical improvement and improved throughout the treatment period. Several possible explanations include that there are differences between ARDS in COVID-19 (CARDS) and classic ARDS. Moreover, the prone position helps in increasing oxygenation and reducing hypoxemia through several mechanisms. Early HFNC in COVID-19 patients and treatment regimen consisting of antibiotics, antivirus, anticoagulant, and anti-inflammatory drugs are considered to reduce morbidity
Difference in Immature Reticulocyte Fraction Percentage between Moderate and Severe Anemia in Transfusion-Dependent Thalassemia
Get PDFThalassemia is an inherited genetic disease caused by the disruption in globin chain synthesis. Inefective erythropoiesis in thalassemia leads to moderate to severe anemia, requiring routine blood transfusions. To evaluate erythropoiesis, immature reticulocyte fractions (IRF) can be measured using the hematology analyzer, avoiding the need of invasive bone marrow examination. The purpose of this study was to analyze the differences in the IRF percentage between moderate and severe anemia in transfusion-dependent thalassemia (TDT) patients. This was a cross-sectional comparative observational analytic study conducted at the Pediatric Thalassemia Clinic of Dr. Hasan Sadikin General Hospital Bandung in August–September 2020. The IRF was examined using the fluorescence flowcytometry method with whole blood sample added by EDTA anticoagulant. The statistical analysis used in this study was unpaired t-test and Mann Whitney’s test. Subjects were 93 TDT pediatric patients, consisting of 48 boys (52%) and 45 girls (48%). The majority (72%) of the patients had been diagnosed with thalassemia for more than 5 years with moderate anemia (40%) and severe anemia (60%). The median IRF percentage in moderate anemia was 6.4% (range 0-22.7) while the range in severe anemia was 11.7% (range 4.1–35.8), suggesting a statistically significant difference (p<0.001) in the IRF percentage between moderate and severe anemia in transfusion-dependent thalassemia patients. To conclude, the more severe the anemia experienced by a thalassemia patient is, the higher the percentage of IRF
Imaging and Minimally Invasive Biopsy for Postmortem Pulmonary Fat Embolism Diagnosis
Get PDFIn recent years, imaging technologies and minimally invasive biopsy have been gaining importance in forensic settings. This study aimed to evaluate the role of imaging and minimally invasive biopsy in postmortem diagnosis of pulmonary fat embolism. This was a systematic literature review by using Pubmed, EBSCO-Host, and ProQuest to search for studies on postmortem diagnosis of pulmonary fat embolism with postmortem imaging and minimally invasive biopsy. Five studies were included in the systematic review. These studies employed the following diagnostic technics: postmortem computed tomography (PMCT), postmortem computed tomography angiography (PMCTA), percutaneous needle biopsy (PNB), postmortem magnetic resonance (PMMR), and traditional autopsy. Imaging and minimally invasive biopsy are potential modalities that might complement or even replace traditional autopsy in diagnosing PFE. Further studies are needed to confirm the sensitivity and specificity of each technique
Neglected Posterior Subtalar Dislocation: A Case Report and Operative Technique
Get PDFPosterior subtalar dislocation is an exceedingly rare entity. Early anatomic reduction, initially by closed means, is crucial. Failure to recognize this condition or any occurrence of neglect will complicate the management and worsen the outcome. There are a handful of case reports on posterior subtalar dislocation and even less for neglected cases. This study reports a neglected subtalar dislocation in a 26-year-old male who worked as a driver and had experienced high-energy trauma due to car collision. This patient was managed by open reduction and pinning, and was followed up 2 months later with a good outcome. This technique was selected to be able to achieve functional motions without pain.
Torsion Testicular Patient Characteristics
Get PDFTesticular torsion is an emergency urological condition that is caused by the torsion of the spermatic cord structures, causing disruption of circulation of the affected testicle. This study aimed to describe the characteristics of patients with testicular torsion treated at Dr. Hasan Sadikin General Hospital Bandung from January 2016 to January 2020. This was a retrospective descriptive study on 34 medical records of patients diagnosed and treated for testicular torsion. Nine patients (29.4%) were 21 years old. The onset was mostly between 6 to 24 hours (38.2%), followed by between 2–7 days (23.5%), less than 6 hours (20.6%), between 1–2 weeks (8.8%), and between 2–4 weeks (8.8%). Left testicular torsion were more frequent than the right torsion (61.8% vs. 38.2%). The etiology of the torsion was mostly idiopathic with no identifiable precedent (88%). Orchidectomy was more frequently performed compared to orchiopexy (78.4% vs. 21.6%). All but one patient (97.1%) presented with testicular pain as the main symptom. Patients presented mostly with a high risk TWIST score (64.7%); however, more presented with low risk compared to the intermediate risk TWIST score (26.5% vs. 8.8%). Orchidectomy is the most frequently performed operation on pre-pubertal and adult patients, possibly due to relatively delayed presentation (>24 hours) to the hospital to receive treatment. Patients were mostly younger; predominantly with high TWIST score and affected left testicle
Perbedaan Pengaruh Balanced dan Unbalanced Crystalloids sebagai Terapi Cairan pada Sepsis dan Syok Sepsis: A Systematic Review
Get PDFMortalitas sepsis dan syok sepsis hampir 20% per tahun dari semua kematian global. Sepsis dan syok sepsis merupakan penyebab 50% pasien dirawat di Intensive Care Unit (ICU). Kristaloid menjadi terapi cairan yang tepat menurut “The Surviving Sepsis Campaign Bundle: 2018 (SSC 2018)”. Kristaloid terbagi menjadi dua jenis, yaitu balanced dan unbalanced crystalloids. Perbedaan kandungan elektrolit keduanya dapat memengaruhi outcome pasien. Penelitian ini bertujuan mengetahui perbedaan pengaruh balanced dan unbalanced crystalloids pada sepsis dan syok sepsis dalam aspek mortalitas, kejadian hiperkloremia, dan lama tinggal di rumah sakit (RS). Metode yang digunakan adalah systematic review. Tempat penelitian berupa pencarian artikel penelitian pada online database dengan waktu penelitian, yaitu artikel dari tahun 2017 hingga 2021. Seleksi studi menggunakan PRISMA, kirteria restriksi dan PICO. Telaah artikel didapatkan 6 dari 249 artikel yang memenuhi syarat. Hasil analisis adalah mortalitas lebih rendah pada grup balanced crystalloids, kejadian hiperkloremia lebih tinggi pada unbalanced crystalloids, namun lama tinggal di RS di kedua grup tidak ada perbedaan signifikan. Simpulan penelitian adalah balanced crystalloids lebih efektif daripada unbalanced crystalloids dalam aspek menurunkan mortalitas dan kejadian hiperkloremia, namun tidak mengenai lama tinggal.Differences in the Effect of Balanced and Unbalanced Crystalloids as Fluid Therapy in Sepsis and Septic Shock: A Systematic ReviewSepsis and septic shock contribute to almost 20% per year to the global total deaths. Sepsis and septic shock are also the the leading causes for patients to be treated in the Intensive Care Unit (ICU), with 50% of the patients treated in this unit due to sepsis and septic shock. Crystalloid is the appropriate thereapy for these conditions according to “The Surviving Sepsis Campaign Bundle: 2018 (SSC 2018)”. Crystalloids are divided into two types: balanced and unbalanced crystalloids. This study aimed to determine the difference between the effects of balanced and unbalanced crystalloids in sepsis and septic shock in terms of mortality, incidence of hyperchloremia, and length of stay in hospital. This was a systematic review on articles from the last five years using PRISMA, restriction criteria, and PICO. The review resulted in 6 out of 249 eligible articles. The results of the analysis demonstrated a lower mortality rate in the balanced crystalloids group while the incidence of hyperchloremia was higher in the unbalanced crystalloids group. No significant difference was found in the length of stay in hospital in both groups. Therefore, balanced crystalloids is more effective than unbalanced crystalloids in the aspect of reducing mortality and the incidence of hiperchloremia, with no significant difference in the length of stay in hospital.Mortalitas sepsis dan syok sepsis hampir 20% per tahun dari semua kematian global sekaligus penyebab 50% pasien masuk Intensive Care Unit (ICU). Kristaloid menjadi terapi cairan yang tepat menurut “The Surviving Sepsis Campaign Bundle: 2018 (SSC 2018)”. Kristaloid terbagi menjadi dua jenis yaitu balanced dan unbalanced crystalloids. Perbedaan kandungan elektrolit keduanya dapat mempengaruhi outcome pasien. Penelitian ini bertujuan untuk mengetahui perbedaan pengaruh balanced dan unbalanced crystalloids pada sepsis dan syok sepsis dalam aspek mortalitas, kejadian hiperkloremia, dan lama tinggal di rumah sakit (RS). Metode yang digunakan adalah systematic review. Pencarian artikel penelitian pada online database dengan seleksi studi menggunakan PRISMA, kirteria restriksi dan PICO. Telaah artikel didapatkan 6 dari 249 artikel yang memenuhi syarat. Hasil analisis adalah mortalitas lebih rendah pada grup balanced crystalloids, kejadian hiperkloremia lebih tinggi pada unbalanced crystalloids, namun lama tinggal di RS di kedua grup tidak ada perbedaan signifikan. Simpulan penelitian adalah balanced crystalloids lebih efektif daripada unbalanced crystalloids dalam aspek menurunkan mortalitas dan kejadian hiperkloremia, namun tidak signifikan dalam lama tinggal di RS