E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Success Rate and Complications of Percutaneous Nephrolithotomy (PCNL) in Nephrolithiasis Patients
Full text linkPercutaneous Nephrolithotomy (PCNL) is the standard management method for kidney stones due to its high success rates. This process is associated with risks, including complications such as infection and bleeding. This study aimed to evaluate the complications and success rates of PCNL in nephrolithiasis patients and provide important insights for clinical decision-making. Data were collected from patients undergoing PCNL for nephrolithiasis at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, in the form of demographic data, stone parameters, and postoperative complications. Data were then analyzed statistically to identify the associated factors. This study was conducted at the Urology Department of the hospital from January to December 2023, involving 80 nephrolithiasis cases. Predominantly, 67.5% of patients were males, with 63.7% in the age group of above 50 years. Multiple stones were the most common (55%), with stone sizes of ≥1.5 cm prevalent in 95% of cases. Left-sided stones (43.75%) were most frequent, followed by right-sided (36.25%) and bilateral stones (20%). Hydronephrosis complications were present in 36.25% of cases, with 100% stone clearance found in Guy Stone Score (GSS) grade 1 cases, while GSS grade 4 cases exhibited the lowest stone clearance rate at 45.45%. This study provided insights into nephrolithiasis demographics, stone characteristics, and postoperative outcomes. Male predominance, multiple stones, high rates of stone clearance, and postoperative complications, particularly in the Guy's score system, underscore the need for proper management strategies and further research in this field
Acute Toxicity (LD50 value) of Peppermint (Mentha piperita) Suspension in Female Mice
No full textPeppermint has several benefits, such as antibacterial, anti-inflammatory, and antifungal properties, that leads to its use in various products, especially in herbal medicine. This study aimed to evaluate the LD50 value of peppermint suspension through an acute toxicity test. This study was conducted at the Animal Laboratory Management Unit of the School of Veterinary Medicine and Biomedical Sciences, IPB University, from October 9 to 30, 2024. A total of 25 female mice were divided into 5 groups, and given different doses of peppermint suspension of 0, 0.5, 1, 1.5, and 2.0 g/kgBW. Observations were then carried out for 14 days on the parameters of body weight, physiological responses, clinical symptoms, absolute and relative organ weight, body weight, and number of mortalities per day. Results showed that the highest mortality was found in the groups administered with a 1.5 and 2.0 g/kgBW of peppermint suspension. Clinical symptoms, such as hair standing, lethargies, and decreased locomotor activity were also observed in these groups. In addition, the administration of peppermint suspension in mice had no significant effect on body weight, as well as on absolute and relative organ weight, It was also demonstrated that organs collected did not present any significant lesion. Thus, the acute toxicity test of peppermint suspension showed no macroscopic lesion or changes in organs and body weight. The LD50 value suggested that the is in the moderate toxicity category, with an LD50 value of 1.92 g/kgBW
General Anesthesia Management of Super Refractory Status Epilepticus in Anti-N-Methyl-D-Aspartate-Receptor (NMDAR) Meningitis
Full text linkBackground: Super Refractory Status Epilepticus poses significant management challenges, requiring intensive therapeutic approaches including general anesthesia.Objective: To discuss the management of Super Refractory Status Epilepticus (SRSE) with general anesthesia to control seizures.Case Illustration: A 17-year-old female with tonic-clonic seizures, headache, unclear speech, and a change in behavior, who also appeared to be restless, was presented. She was admitted to the intensive care unit and administered anticonvulsant medication. A brain MRI with contrast showed the impression of meningitis, and cerebrospinal fluid examination showed a positive anti-NMDAR result. First-line therapy involved high-dose steroids and intravenous immunoglobulin for 5 days, followed by second-line therapy with rituximab. Patient received general anesthesia using sevoflurane volatile, dexmedetomidine, continuous rocuronium, propofol, ketamine, and fentanyl due to persistent seizures despite receiving anticonvulsant therapy. Monitoring was conducted for vital signs, seizure activity, and depth of anesthesia using the bispectral index (BIS). Tonic-clonic seizures in patients were successfully managed with general anesthesia. However, facial dyskinesia was still present despite the administration of general anesthesia. Facial dyskinesia worsened upon discontinuation of continuous rocuronium.Conclusion: General anesthesia could be used in the management of SRSE with the aim of controlling seizures and preventing complications arising from continuous seizures
Infanticide Cases at a Top Referral Hospital in West Java, Indonesia: Prevalence and Causes from 2019 to 2023
No full textBackground: Infanticide refers to the intentional killing of a newborn by the biological mother shortly after birth, which can be proven through internal and external forensic examinations. This study aimed to determine the prevalence and causes of suspected infanticide cases at a top referral hospital in West Java, Indonesia.Methods: A descriptive study was conducted using total sampling of all Visum et Repertum reports from 2019 to 2023 at the Department of Forensic and Legal Medicine, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. A total of 1,531 forensic cases were reviewed. Data on characteristics and findings from internal and external examinations were collected and analyzed.Results: Of 1,531 cases, the most common classification was death on arrival (n=480), whereas suspected infanticide ranked fourth (n=50). However, only 16 cases met the established forensic criteria for infanticide. The leading cause of deaths was head injury due to blunt force trauma (37.5%), followed by undetermined causes (25%), hypothermia (12.5%), asphyxia (12.5%), drowning (6.25%), and neglect (6.25%).Conclusions: The prevalence of confirmed infanticide is 1.05%, with blunt head trauma being the most common cause of death. These findings highlight the urgent need for government intervention to evaluate population and family development programs, including reproductive health education, readiness for marriage, and parenting responsibilities in school curricula. Promoting comprehensive education and responsible parenting may reduce the incidence of infanticide and support healthier family environments for future generations
Perbandingan Bupivacain 0,25 % + Epinefrin 1:10.000 dengan Epinefrin 1:10.000 dalam Mencegah Perdarahan Intranasal Setelah Intubasi Nasotrakeal
No full textEpistaksis dan rasa tidak nyaman pada hidung merupakan komplikasi paling umum dari intubasi nasotrakeal, dengan angka kejadian yang dilaporkan antara 22–77%. Pencegahan komplikasi ini penting untuk meningkatkan kenyamanan pasien serta kelancaran prosedur anestesi dan pembedahan. Penelitian ini bertujuan mengevaluasi efektivitas kombinasi bupivakain dan epinefrin dibanding dengan epinefrin tunggal dalam mengurangi epistaksis dan nyeri intranasal pascaoperasi. Penelitian dilakukan dengan desain uji klinis acak tersamar tunggal di RSUD Dr. Agoesdjam, Ketapang, Kalimantan Barat, pada Juni–Juli 2023. Sebanyak 72 pasien yang menjalani pembedahan elektif dengan intubasi nasotrakeal diacak ke dalam dua kelompok. Kelompok kombinasi (BE, n=36) menerima 2 mL larutan bupivakain 0,25%+epinefrin 1:10.000 intranasal, sedangkan kelompok epinefrin (E, n=36) menerima 2 mL epinefrin 1:10.000. Parameter yang dievaluasi meliputi status hemodinamik, kejadian epistaksis, dan nyeri intranasal pascaoperasi. Hasil menunjukkan bahwa angka kejadian epistaksis serupa pada kedua kelompok, namun skor nyeri intranasal pascaoperasi secara signifikan lebih rendah pada kelompok BE. Simpulan, kombinasi bupivakain dan epinefrin memberikan efektivitas setara dalam mencegah epistaksis dan memberikan manfaat tambahan berupa penurunan nyeri intranasal pascaoperasi.Intubasi nasotrakeal dapat menyebabkan epistaksis, bakteremia, kerusakan mukosa, dan rasa tidak nyaman pada hidung. Epistaksis adalah komplikasi intubasi nasotrakeal yang paling umum dan kejadiannya telah dilaporkan berkisar antara 22% sampai 77%. Tujuan dari penelitian ini adalah untuk mengevaluasi efikasi praterapi bupivakain dan epinefrin untuk mengurangi epistaksis dan nyeri hidung dibandingkan dengan praterapi epinefrin. Penelitian ini adalah penelitian eksperimental dengan pendekatan single blind randomized control trial. Penelitian dilakukan di RSUD Dr. Agoesdjam Ketapang Kalimantan Barat bulan Juni-Juli 2023. Total 72 pasien yang dijadwalkan operasi elektif dibagi secara acak menjadi 2 kelompok. Kelompok bupivacaine+epinefrin (n=36) diberikan 2 ml intranasal. Kelompok epinefrin (n=36) diberikan 2 ml intranasal. Pada penelitian ini,hemodinamik, epistaksis dan nyeri intranasal di pantau.Angka kejadian epistaksis sama pada kedua kelompok tapi nyeri hidung paska operasi lebih rendah pada kelompok bupivacaine+epinefrin. Bupivacain 0,25 % + Epinefrin 1:10.000 sama efektifnya dengan Epinefrin 1:10.00 dalam pencegahan epistaksis tetapi lebih baik dalam pencegahan nyeri hidung paska operasi. Kata kunci : Intubasi Nasotrakeal, Epistaksis,Bupivacaine+Epinefri
Occurrence of Gastritis Is Related to Stress among Health Science Students
Full text linkBackground: Gastritis is among the top 10 health issues in Indonesia, with stress as the primary factor. Stress can put students at risk, leading to stress management neglect. This study aimed to find the relationship between stress and the occurrence of gastritis among students, especially those majoring in Health Sciences.Methods: This was a retrospective cohort study conducted in October 2022–March 2023 on 273 Health Science students at the University of Jember, Indonesia, using a simple random sampling method. Data on suspected gastritis occurrence with stress was analysed, using the Spearman's rank correlation test.Results: The majority of respondents were female (84.2%) aged 22 years (50.2%) and were at the post-proposal seminar stage (55.7%). Stress level was moderate (41.8–46.9%). There was a relationship between the type of stress and the suspected gastritis occurrence (p<0.05). The type of stress that was strongly associated with suspected occurrence of gastritis was social-related stressor (r= 0.316).Conclusions: The study highlights the impact of stress on physical health and encourages the use of mental health services on campus to prevent and address related issues. Further studies are needed to explore other contributing factors. A better healthy lifestyle among students with health sciences background is recommende
Perbedaan Frekuensi PVA (Patient Ventilator Asynchrony) Pada Beberapa Level Sedasi Pasien Kritis
No full textBackground: Patient–ventilator asynchrony (PVA) is a frequent but often underrecognized phenomenon in mechanically ventilated patients, associated with adverse outcomes. Sedation depth is a modifiable factor affecting PVA, yet data from resource-limited ICUs remain scarce. This study aimed to evaluate PVA prevalence and its association with sedation depth and mechanical ventilation duration.Methods: A cross-sectional observational study included 60 adult ICU patients on mechanical ventilation. Ventilator waveform recordings were analyzed over 30-minute periods, totaling 41,372 breaths. PVA events were identified, classified, and quantified. Sedation depth was categorized as fully awake, light sedation, or deep sedation. Associations between sedation depth, PVA frequency, and mechanical ventilation duration were assessed using statistical tests.Results: A total of 2,539 PVA events were detected, yielding an overall asynchrony rate of 6.1%. Ineffective effort was most common (58%), followed by double triggering (17.2%) and flow asynchrony (15.3%). Mean PVA values increased significantly with deeper sedation (p<0.05). A weak but statistically significant positive correlation existed between average PVA and duration of mechanical ventilation (r=0.306, p<0.05).Discussion: PVA is prevalent in mechanically ventilated ICU patients, with ineffective effort predominating. Deeper sedation levels are associated with higher PVA frequency, which correlates with prolonged ventilation. These findings emphasize the need for careful sedation management and routine ventilator waveform monitoring to improve patient–ventilator interaction.Conclusion: Patient–ventilator asynchrony is common and significantly associated with sedation depth and ventilation duration. Optimized sedation and vigilant waveform monitoring may enhance synchrony and reduce ventilation timePatient-ventilator asynchrony (PVA) dapat didefinisikan sebagai ketidaksesuaian antara pasien dan ventilator dalam hal waktu, flow, volume, atau tuntutan tekanan dari sistem pernapasan, yang memasok kebutuhan tersebut selama ventilasi mekanis. Faktor yang mempengaruhi terjadinya PVA bisa berhubungan dengan pasien, ventilator, atau keduanya. Faktor pasien meliputi tingkat keparahan penyakit, diagnosis yang mendasari, indikasi penggunaan ventilasi mekanis, dan respons pasien terhadap perawatan medis. Tujuan dari penelitian ini adalah mengidentifikasi perbandingan frekuensi terjadinya PVA pada tiga level sedasi pasien kritis. Metode yang digunakan pada penelitian ini adalah studi cross-sectional dengan menganalisis rekaman ventilator 60 pasien di ICU RSUP Dr. Hasan Sadikin sesuai dengan kriteria inklusi dan eksklusi, yang dibagi menjadi 3 kelompok level sedasi masing-masing 20 orang. Hasil analisis rekaman ventilator pada 60 pasien selama 30 menit, didapatkan 5 jenis asinkroni yaitu IT(ineffective trigger) sebanyak 58%, DT (Double Trigger) 17,2%, FA (Flow Asynchrony) 15,3%, dan SC (Short Cycling) PC (Prolong Cycling) masing-masing 6,5% dan 3 %. Dilakukan uji perbandingan pada masing-masing kelompok sedasi. Simpulan didapatkan bahwa rerata PVA pada kelompok level sadar-penuh < sedasi ringan < sedasi dalam secara berurutan. Diperlukan penelitian lebih lanjut tentang efek adanya PVA yang berat terhadap mortalitas dan lama rawatan di ICU.
Effects of Propofol and Thiopental on Brain Relaxation and Hemodynamic Response to Craniotomy Supratentorial Tumors Removal
No full textSurgical procedures for brain tumors, particularly supratentorial tumor removal via craniotomy, present challenges related to brain relaxation and maintaining hemodynamic stability. The choice of intravenous anesthetics, such as Propofol and Thiopental, is crucial due to their distinct effects on intracranial pressure (ICP), cerebral blood flow (CBF), and hemodynamic parameters. This study aimed to compare the effects of Propofol and Thiopental on brain relaxation and hemodynamic responses during supratentorial tumor removal. A randomized experimental study was conducted at Arifin Achmad General Hospital, Riau, Indonesia, from May to September 2024 involving patients undergoing elective craniotomy for supratentorial tumors. Patients were divided into two groups: the Propofol group (1-3 mg/kg body weight, with maintenance of 50-100 µg/kg/min) and the Thiopental group (4-6 mg/kg body weight, with maintenance of 100-200 µg/kg/min), both receiving continuous infusion until a bispectral index of 40-60 was achieved. Hemodynamic parameters, including systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), and heart rate, were measured at various stages: before induction, during surgery, and at multiple intervals. Brain relaxation was subjectively assessed by a neurosurgeon using a four-point scale. Results showed that 90% of subjects receiving Thiopental experienced good brain relaxation during duramater opening, compared to 70% in the Propofol group, though this difference was not statistically significant (p=0.118). Hemodynamically, the Thiopental group exhibited higher diastolic blood pressure and MAP at induction (p<0.05). In conclusion, Thiopental demonstrated superior hemodynamic stability, albeit both agents provided equally effective brain relaxation
Arterial Blood Gas Analysis and Dyselectrolytemia in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)
No full textBackground: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is one of the important causes of morbidity, mortality, and healthcare burden. Electrolyte disturbances and acid–base imbalances are frequent but under-recognized complications that may worsen outcomes in cases of AECOPD.Objective: To understand the prevalence of serum electrolyte abnormalities and arterial blood gas (ABG) parameters in patients admitted with AECOPD.Methods: This prospective observational study enrolled 200 patients with confirmed AECOPD admitted to a tertiary care hospital in Kalaburagi, India, over an 18 month period. The ABG analysis and serum electrolytes (sodium, potassium, magnesium, chloride) measurement were performed at admission. Demographic, clinical, and radiological data were also collected. Data were then analyzed using SSPS 23.0, with a P value of 45 mmHg was found in 43%. Acid–base imbalance was seen in 35% cases, with 4.5% showing severe acidosis (pH ≤7.1). Cough (72.5%) and breathlessness (60.5%) were most common symptoms. The majority were elderly males (65%) whereas 57% were smokers. Diabetes was the most common comorbidity (30.5%).Conclusion: Electrolyte abnormalities and ABG derangements are nearly universal in AECOPD and have important prognostic implications. Routine metabolic profiling should be integrated into the acute management of COPD to improve outcomes, particularly in resource-constrained settings
Prevalence, Severity, and Self-Medication for Dysmenorrhea among Female Adolescents in Indonesia
No full textDysmenorrhea, commonly referred to as menstrual pain, is a prevalent condition affecting many reproductive-aged women, particularly female adolescents, with varying degrees of intensity. Dysmenorrhea affects 64.5% of female adolescents in Indonesia, with the highest prevalence rates found in West Java (98.8%) and Jakarta (87.5%). Over the years, various therapy modalities have been developed for treating this condition based on its pathophysiology. However, in Indonesia, a country renowned for its rich natural resources and medicinal herbs, there is a prevailing belief in the efficacy of traditional medicine. Female adolescents in Indonesia are often engaged in self-medication practices, combining traditional medicine with nonsteroidal anti-inflammatory drugs (NSAIDs). This study aimed to analyze the prevalence, severity, and self- medication practices for dysmenorrhea among female adolescents in Indonesia. The study was conducted from January to December 2020 using an online survey that included questions about menstrual pain, family history, and the use of traditional medicine and NSAIDs. This study comprised 362 participants recruited through convenience sampling. Results showed that 92.5% of participants experienced dysmenorrhea with varying degrees of pain. A total of 216 (59.9%) female adolescents experienced frequent dysmenorrhea, while 118 (32.6%) reported experiencing this condition every menstrual cycle. Of all participants, 33.1% used traditional medicine as a treatment option, and 16.9% used NSAIDs. According to the self-reported visual analog scale (VAS), the use of natural remedies, such as traditional medicine, was associated with lower pain levels, suggesting their potential benefits in healthcare services for dysmenorrhea