E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Bacterial and Antibiotic Sensitivity Patterns in Patient Urine after Percutaneous Nephrostomy
Get PDFPercutaneous nephrostomy (PN) is a urine diversion procedure using a tube, stent, or catheter. Knowledge of bacterial sensitivity to antibiotics can guide the establishment of an appropriate and safe treatment to reduce the incidence of percutaneous nephrostomy-related infection (PNCI). The purpose of this study was to determine the suitability of antibiotics medication based on the results of bacterial culture and bacterial sensitivity test. This study was a retrospective descriptive observational study on medical records of patient diagnosed with obstructive uropathy who underwent PN in the period January 2017 to December 2019. A total of 20 bacterial isolates were classified as gram-positive bacteria isolates (16.53%) and 101 isolates presented gram-negative bacteria (83.47%). The most frequent gram-negative bacteria identified in these isolates were E. coli (n=42), Pseudomonas aeruginosa (n=22), and Klebsiella pneumonia (n=20). Meanwhile, Staphylococcus aureus was seen in ten isolates with gram-positive bacteria. Vancomycin antibiotics had the best sensitivity to gram-positive bacteria based on the antibiotic sensitivity tests. On the other hand, meropenem and amikacin had the best sensitivity to gram-negative bacteria (83.2%). This study showed that the most common bacteria identified from nephrostomy patients is E. coli with meropenem and amikacin as the most sensitive antibiotic for these patients. Thus, antibiotic therapy before and after PN procedure should be considered wisely to prevent resistant PNCI
Correlation between Estrogen Receptorβ (ERβ), Neurofilament Protein (NF), and Protein Gene Product 9.5 (PGP9.5) Expressions as a Marker of Pain on Adenomyosis Etiopathogenesis
Get PDFAdenomyosis is a pathological condition characterized by the presence of endometrial glands and stroma within the myometrium. Endometrial like cells development was influenced by local inflammatory reactions, increases local estradiol due to asynchromatized estrogen synthesis (ERβ) and then stimulated to proliferation and fibrosis, are also irritation on small nerve fibers in women with painful characterized symptoms on adenomyosis. There are expressions of neurofilament protein (NF) and protein gene product 9.5 (PGP 9.5) is a highly specific pan-neuronal marker for microfilament nerve fibers and is related to presenting pain with adenomyosis symptoms. A retrospective immunohistochemical study of thirty samples histopathological of adenomyosis as study groups and 30 with control groups between 25–49 ages which were established at Dr. Hasan Sadikin General Hospital and the satellites in April 2014–May 2015. This case-control analyzed ERβ, NF, and PGP 9.5 expressions compared and correlation between study groups and controls. The results showed there were significant differences in expression of ERβ, NF, and PGP 9.5 on adenomyosis higher than the control study (p6(sensitivity 66.7%; specificity 70%), NF>3 (sensitivity 93%; specificity 46%), PGP 9.5>4 (sensitivity 90%; specificity 67%). Odds Ratio (CI 95%) ERβ>6= 4.67; NF >3=12.25; PGP 9.5 >4=24.75 (p<0.001). The value of histoscore of ERβ and PGP9.5 have correlates to adenomyosis, the differences were statistically significant (p<0.05). The conclusion were that the adenomyosis had higher ERβ, NF, and PGP 9.5 expressions. There are simultant correlates and positive values between ERβ, NF, and PGP9.5 based on etiophatogenesis of pain on adenomyosis
Pulmonary Embolism in High-Risk Patients: How to Select Standard Imaging and Management Strategy?
Get PDFObjective: To describe the use of computed tomography pulmonary angiography (CTPA) for diagnostic purposes and percutaneous catheter-directed thrombolysis (PCDT) as a treatment choice for high-risk pulmonary embolism (PE) patients.Methods: This case report describes a case of an elderly female presented with dyspnea, cough, fever, and chest pain. No significant medical history was identified.Results: CTPA was conducted and showed multiple thrombus with significant stenosis in several branches of pulmonary artery. Initial anticoagulation was administered without delay. Patient then underwent PCDT to remove the thrombus. No post intervention symptom and systemic complications were noted.Conclusions: Computed tomography pulmonary angiography is useful as the standard imaging modality to help evaluating suspected pulmonary embolism. Percutaneous catheter-directed thrombolysis is indicated to treat high-risk patients with high risk of bleeding
Effectiveness of Multimedia and Education using Lecturing Method on Role of Vitamin D for Health Cadres
Get PDFObjective: To investigate the differences in the effectiveness of learning methods between multimedia and lecture methods on benefits of vitamin D for health from the perspective of health cadres' knowledge,. Methods: This study was an experimental study with a pre-and post-test design. The knowledge of health cadres was assessed using a questionnaire. The questionnaire was distributed before and after the health cadres received vitamin D education by two different methods. Data analysis was conducted using paired and independent t-test with a significance level of p <0.05. Results: A total of 59 health cadres participated in this study. Prior to education, the median test score for the multimedia group was 9.45, while the median test score for the lecture group was 82.70. After the education, the multimedia group and the lecture group got a median test score of 10.84. The multimedia method and lecture method significantly increased health cadres' knowledge with p-values of <0.02 and 0.003, respectively. There was no difference in the multimedia method's effectiveness compared to the lecture method in increasing the knowledge of health workers about vitamin D's role in health (p=0.62). Conclusion: The multimedia education method is as effective as the lecture method in increasing health cadres' knowledge about the role of vitamin D in health.
Culprit-Only Versus Complete Revascularization in STEMI Multi-Vessel Disease: A Case Report
Get PDFObjective: To revisit data and highlight management of STEMI multi-vessel disease and explore culprit-only versus multi-vessel PCI and optimal timing to achieve complete revascularization.Methods: A 67 years old male with chest pain at rest 2 hours before admission with a history of smoking one pack of cigarette every day, was presented to the hospital. Physical examination was within normal limit with normal hemodynamically; however, elevated cardiac troponin was identified. Electrocardiogram showed STEMI anteroseptal wall with ischemic inferior wall, leading toSTEMI anteroseptal wall, Killip I diagnosis. Primary PCI was performed and multi-vessel disease was found. A complete revascularization single-staged procedure was performed due to his persistent chest pain. PCI of these coronary stenoses is beneficial to reduce risk of cardiac death and recurrent infarction. However, some issues related to PCI of non-culprit coronary arteries lesion and optimal timing to do complete revascularization is still a dilemma. Results: Related to data from some trials, e.g PRAMI, CvLPRIT, DANAM-3-PRIMULTI, COMPARE-ACUTE, COMPLETE, and some meta-analyses, showed benefit and safety of routine PCI of non-culprit lesions as a preventive strategy to reduce morbidity and mortality. Data showed reduce future morbidity and mortality in this setting. Meanwhile, the optimal timing of complete revascularization is still a matter of debate, although some data showed benefit of index procedural PCI.Conclusion: PCI of non-culprit lesions of myocardial infarction is consistently beneficial over culprit-only revascularization in patients with STEMI multi-vessel disease, despite the debate on the optimum timing for complete revascularization in this setting
Perbedaan Kebutuhan Morfin PCA Pasca Laparatomi antara Infiltrasi Ketamin Dan Infiltrasi Levobupivakain
Get PDFPenanganan nyeri akut yang tidak adekuat merupakan faktor risiko terjadin nyeri kronik dan komplikasi lainnya. Metode yang efektif dan efisien mengontrol nyeri akut yang berat adalah infiltrasi tepi luka operasi. Penelitian ini bertujuan untuk mengetahui efektivitas infiltrasi ketamin dan levobupivakain dalam mengurangi kebutuhan morfin patient controlled analgesia (PCA) pascalaparatomi. Penelitian ini merupakan uji klinik acak tersamar tunggal yang dilakukan di RSUD Dr. Moewardi Surakarta pada bulan Agustus 2018. Sampel terdiri atas 30 subjek yang dilakukan operasi laparatomi dengan anestesi umum yang dibagi menjadi 3 kelompok, yaitu kelompok infiltrasi levobupivakain, infiltrasi ketamin, dan infiltrasi saline. Semua pasien mendapatkan morfin PCA pascaoperasi. Setelah itu dinilai jumlah penggunaan morfin dan efek mual-muntah pascaoperasi, dan efek samping tindakan infiltrasi. Penggunaan morfin PCA pada kelompok ketamin rerata 2,20+1,32 mg, pada kelompok levobupivakain penggunaan morfin rerata 5,80+1,03 mg, dan pada kelompok NaCl penggunaan morfin rerata 10,00+1,76 mg. Uji statistik Kruskal Wallis didapatkan perbedaan yang signifikan penggunaan morfin PCA antara pasien kelompok ketamin, levobupivakain dan NaCl (p<0,05). Simpulan penelitian ini bahwa infiltrasi ketamin mengurangi nyeri pascalaparatomi lebih baik dibanding dengan infiltrasi levobupivakain dan saline.Differences in Post-laparotomy PCA Morphine Needs between Ketamine Infiltration and Levobupivacaine Infiltration Inadequate acute pain management is a risk factor for chronic pain and other complications. Laparotomy is a painful procedure with severe acute pain. Patient controlled analgesia (PCA) morphine use in acute pain control is promoted for efficiency and effectiveness. Wound infiltration is also effective in reducing acute pain. This study aimed to determine the effectiveness of ketamine and levobupivacaine wound infiltration in reducing the need for post-laparotomy PCA morphine. This study used a single-blind randomized clinical trial at RSUD Dr. Moewardi Surakarta on 30 subjects who underwent laparotomy and met the inclusion criteria. The samples were divided into three groups: wound infiltration with levobupivacaine, wound infiltration with ketamine, and wound infiltration with saline. All patients received standard general anesthetic treatment and were then evaluated for the total use of PCA morphine. It also assessed the effects of postoperative nausea-vomiting and the side effects of wound infiltration. The average PCA morphine use in the ketamine group was 2.20+1.32 mg. In the Levobupivacaine group was 5.80+1.03 mg, and in the NaCl group was 10.00+1.76 mg. Kruskal Wallis statistical test obtained p-value=0.000 (p<0.05), which means that there was a significant difference in PCA morphine use after 24 hours between the three groups. No complication occurred with the three-group wound infiltration. Thus, there is a significant difference in the use of PCA morphine between wound infiltration with ketamine and wound infiltration with levobupivacaine and with saline infiltration. Ketamine wound infiltration can be used effectively to reduce post-laparotomy pain.Penanganan nyeri akut yang tidak adekuat merupakan faktor risiko terjadinya nyeri kronik dan komplikasi lainnya. Laparatomi merupakan operasi dengan nyeri operasi berat. Patient Controlled Analgesia (PCA) adalah suatu metode yang efektif dan efisien untuk mengontrol nyeri akut yang berat. Infiltrasi tepi luka efektif untuk mengurangi nyeri dan penggunaan PCA. Penelitian ini bertujuan untuk mengetahui efektivitas infiltrasi ketamin dan Levobupivakain dalam mengurangi kebutuhan Morfin PCA pasca laparatomi. Penelitian ini menggunakan uji klinik acak tersamar tunggal di RSUD Dr. Moewardi Surakarta pada 30 subyek yang dilakukan operasi laparatomi dan memenuhi kriteria inklusi dimulai pada bulan Agustus 2018. Sampel dibagi menjadi 3 kelompok yaitu kelompok infiltrasi dengan Levobupivakain, infiltrasi dengan ketamin dan infiltrasi dengan saline. Semua pasien mendapatkan perlakuan anestesi umum sesuai standar dan kemudian diberikan Morfin PCA pasca operasi. Setelah itu dinilai jumlah penggunaan morfin dan efek mual-muntah pasca operasi, dan efek samping tindakan infiltrasi. Ketiga kelompok memiliki karakteristik dasar yang homogen. Penggunaan morfin PCA pada kelompok ketamin rata-rata 2,20 +1,32 mg, pada kelompok Levobupivakain penggunaan morfin rata-rata 5,80 +1,03 mg, dan pada kelompok NaCl penggunaan morfin rata-rata 10,00 +1,76 mg. Uji statistik kruskal wallis didapatkan nilai p=0,000 (p<0,05) yang berarti bahwa terdapat perbedaan yang signifikan penggunaan morfin PCA antara pasien kelompok Ketamin, Levobupivakain dan NaCl. Dengan demikian, terdapat perbedaan penggunaan morfin PCA yang bermakna antara infiltrasi ketamin dan infiltrasi Levobupivakain serta infiltrasi saline. Infiltrasi ketamin dapat digunakan secara efektif untuk mengurangi nyeri pasca laparatomi
Perbandingan Numeric Rating Scale Nyeri Pascaoperasi Kolesistektomi Laparoskopik Antara Blokade Erector Spinae Plane Dan Pethidine Intravena
Get PDFNyeri pascaoperasi harus diatasi dengan baik. Berbagai metode analgetik dilakukan untuk mengatasi nyeri pascaoperasi kolesistektomi laparoskopik, namun tidak ada yang ideal dalam menangani nyeri pascaoperasi. Blokade erector spinae plane adalah teknik baru untuk penanganan nyeri pascaoperasi kolesistektomi laparoskopik. Penelitian ini bertujuan mengetahui perbedaan nyeri pascaoperasi kolesistektomi laparoskopik yang dinilai dengan NRS nyeri antara pasien yang menggunakan blokade erector spinae plane dan petidin intravena. Penelitian dilakukan pada periode Juni–Oktober 2020 di RSUP Dr. Hasan Sadikin Bandung. Penelitian ini menggunakan metode uji klinis acak terkontrol buta tunggal terhadap 30 pasien. Pasien dibagi menjadi dua kelompok, kelompok petidine intravena (kelompok A, n=15) dan kelompok blokade erector spinae plane (kelompok B, n=15). Nyeri pascaoperasi dinilai dengan NRS pada 0–1 jam, 1–6 jam, 6–12 jam, dan 12–24 jam. Analisis data numerik dengan uji T tidak berpasangan dan Mann Whitney. Data kategorik dengan uji chi square. Skor NRS pada kelompok blokade erector spinae plane lebih rendah dibanding dengan kelompok petidin intravena pada 6–12 jam pascaoperasi (p=0,002) dan kebutuhan rescue analgetik pada 6–12 jam lebih rendah pada kelompok blokade. Metode analgetik blokade erector spinae plane pada pasien pascaoperasi kolesistektomi laparoskopik lebih baik daripada petidin intravena. Comparison of Pain Numeric Rating Scale between Erector Spinae Plane Block and Intravenous Pethidine Post-Laparoscopic Cholecystectomy Postoperative pain is a complaint that must be properly managed. Various analgesic methods are implemented to alleviate laparoscopic cholecystectomy postoperative pain, but none are ideal in managing postoperative pain. Erector spinae plane block is a new technique in laparoscopic cholecystectomy postoperative pain. This study aims to discover the difference in post laparoscopic cholecystectomy pain measured using the NRS pain scale in patients with erector spinae plane block and intravenous pethidine. The study was conducted between June–October 2020 in Dr. Hasan Sadikin General Hospital Bandung. This was a single blind control trial in 30 patients. Patients were divided into two groups, an intravenous pethidine group (group A, n=15) and an erector spinae plane block group (group B, n=15). Postoperative pain was measured using the NRS pain scale on hour 0–1, 1–6, 6–12, and 12–24. Numerical data was analyzed using the unpaired T test and the Mann Whitney test. Categorical data using the chi square test. NRS measurements in the erector spinae plane block group were lower compared to the intravenous pethidine group in hour 6–12 postoperation (p=0.002) and the need for a rescue analgesic in hour 6–12 lower in the blokade group. The analgesic method erector spinae plane block in patients post laparoscopic cholecystectomy is better than intravenous pethidine. Nyeri pascaoperasi harus diatasi dengan baik. Berbagai metode analgetik dilakukan untuk mengatasi nyeri pascaoperasi kolesistektomi laparoskopik, namun tidak ada yang ideal dalam menangani nyeri pascaoperasi. Blokade Erector Spinae Plane adalah teknik baru untuk penanganan nyeri pascaoperasi kolesistektomi laparoskopik. Penelitian ini bertujuan untuk mengetahui perbedaan nyeri pascaoperasi kolesistektomi laparoskopik yang dinilai dengan NRS nyeri antara pasien yang menggunakan Blokade Erector Spinae Plane dan pethidine intravena. Penelitian dilakukan pada periode Juni-Oktober 2020 di RSUP dr. Hasan Sadikin Bandung. Penelitian ini menggunakan metode uji klinis acak terkontrol buta tunggal terhadap 30 pasien. Pasien dibagi menjadi dua kelompok, kelompok pethidine intravena (kelompok A, n=15) dan kelompok Blokade Erector Spinae Plane (kelompok B, n=15). Nyeri pascaoperasi dinilai dengan NRS pada 0-1 jam, 1-6 jam,6-12 jam, dan 12-24 jam. Analisis data numerik dengan uji T tidak berpasangan dan Mann Whitney. Data kategorik dengan uji Chi Square. Skor NRS pada kelompok Blokade Erector Spinae Plane lebih rendah dibanding dengan kelompok pethidine intravena pada 6-12 jam pascaoperasi (p=0,002) dan kebutuhan rescue analgetik pada 6-12 jam lebih rendah pada kelompok blokade. Metode analgetik Blokade Erector Spinae Plane pada pasien pascaoperasi kolesistektomi laparoskopik lebih baik daripada pethidine intravena
Relationship between Nutrition Intake and Hemoglobin Levels in Toddlers Aged 12-24 Months
Get PDFBackground: The toddler period is a crucial life period and needs special attention. Toddlers need to have a proper amount and good quality of nutrition from daily food to prevent anemia. This study aimed to explore the relationship between nutritional intake and Hb level in toddlers aged 12-24 months in Sumedang District, West Java, IndonesiaMethods: This was a cross-sectional quantitative conducted in August-November 2019 on 96 toddlers aged 12-24 months. Toddlers were recruited using proportioned simple random sampling method. The mothers of these toddlers were asked to complete a food record for three consecutive days for their toddlers. Data were then processed using the Nutrisurvey application while the hemoglobin (Hb) level was measured using a Digital Hb tool. All data were analyzed using a Pearson Correlation Test.Results: Most mothers of these toddlers graduated from senior high school (45.8%) and were housewives (78.1%). The iron requirement was met 61 toddlers (63.5%). Most toddlers were not anemic (56.3%) with a mean Hb of 10.99 gr/dl. A relationship was established between iron intake and Hb level (p=0.000).Conclusion: Low iron intake is associated with Hb level in toddlers aged 12-24 months in Sumedang District, West Java Province, Indonesia. A nutrition program needs to be well set-up for toddlers in this area
Cut-off Score of Indonesian Version of Sensorimotor History Questionnaire for Preschooler and Soft Sign Cambridge Neurological Inventory against Intelligent Quotient
Get PDFEarly detection of Sensory Processing Disorder (SPD) is important for deciding on appropriate interventions for children at risk. However, there is no valid screening tool available at this moment. The purpose of this study was to validate the deGangi, Sensorimotor History Questionnaire for Preschooler (SHQP), and neurological soft sign of Cambridge Neurological Inventory (NSS CNI) against intelligent quotient (IQ) to establish a reliable cut-off for SPD screening tools for children aged 4–6 years. Sixty-four parent-child were recruited randomly from 3 kindergartens in Bandung, Indonesia. Eligible parents were asked to fill out the SHQP, while their child was assessed using theWechsler Preschool and Primary Scale of Intelligent (WPPSI) and NSS CNI. The deGangi SHQP score and NSS CNI showed a weak and moderate correlation with Full-scale IQ (FIQ). The total score of deGangi SHQP’s sensitivity was 50% with a specificity of 53.4% and a negative predictive value (NPV) of 91.2% agaisnt the FIQ score. The total sensitivity for the NSS CNI was 66.7%, while the total specificity was 58.6% and the NPV was 94.4%. Meanwhile, the sensitivity for the sensory integration subscale score of the NSS CNI was 83.3%, with a specificity of 60.3% and an NPV of 97.2%. The deGangi SHQP can be considered to be an SPD screening tool with the cut-off scores for each subscale of self-regulation, sensory processing of touch, sensory processing of movement, emotional maturity, and motor maturity of 3, 3, 3, and 2, respectively, while the NSS CNI can be used for identifying SPD in children aged 4–6 years with a cut-off scores for the motor coordination, sensory integration, and disinhibition subscales of 7, 10, and 3, respectively
Three-Month Iron Supplementation as Treatment for Microcytic Hypochromic Anemia in Pregnancy
Get PDFIn pregnant women there is a twofold increase in iron requirements due to increased blood volume without the expansion of plasma volume. Pregnant women are very prone to suffering from iron deficiency anemia. Iron deficiency anemia generally has an erythrocyte index which represents hypochromic microcytic. This study aimed to determine the effect of three-month iron tablet supplementation as a therapy against microcytic hypochromic anemia in pregnancy. This was a quantitative quasi-experimental study using pre-test and post-test design. The study was conducted in May-September 2020 at the Arifin Achmad Regional General Hospital, Riau Province, Indonesia. Subjects were 30 pregnant women with microcytic hypochromic anemia. Primary data were analyzed using statistical paired sample t-tests. Results showed that there was an increase in hemoglobin levels after the supplementation of iron tablet from an average of 9.1 ± 1.2 gr/dl to 11.8 ± 1.0 g/dl. This change was significant based on the results of the T-test (p-0.003) Thus, iron supplementation for three month significantly increases hemoglobin levels in pregnant women