E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Hidrotoraks Masif Dekstra dengan Penyulit ARDS Akibat Komplikasi Pemasangan Kateter Vena Sentral Jugular Interna
Get PDFHidrotoraks merupakan komplikasi yang jarang terjadi akibat pemasangan kateter vena sentral dengan angka insidensi 0,4–1,0%. Insidensi komplikasi mekanik lebih rendah pada insersi vena jugularis dibanding dengan vena subklavia. Pada kasus ini, kami melaporkan pasien laki-laki berusia 63 tahun dengan berat badan 70 kg. Pasien dengan ASA 4E sepsis dan curiga keganasan. Pasien ini didiagnosis akut abdomen karena total bowel obstruction dan rencana dilakukan tindakan laparotomi dengan anestesi umum. Pasien ini telah dipasang kateter vena sentral saat di IGD. Pasien dilakukan tindakan anestesi umum selama 3 jam dan mendapatkan cairan intraoperatif 1.500 cc melalui kateter vena sentral. Pascaoperasi, pasien tidak dapat dilakukan ekstubasi karena napas tidak adekuat dan hemodinamik tidak stabil sehingga pasien dirawat di ruang ICU. Saat pasien tiba di ruang ICU, pada pemeriksaan fisis ditemukan suara napas paru kanan menurun dan perkusi redup pada paru kanan. Hasil analisis gas darah menunjukkan hipoksemia berat dan asidosis. Pemeriksaan foto rontgen dada ditemukan gambaran efusi pleura masif. Kami melakukan evakuasi kurang lebih 2,2 liter cairan berwarna kemerahan dari kavum pleura dan memasang selang chest tube pada paru kanan. Pasien mengalami acute respiratory distress syndrome (ARDS). Tata laksana pasien dengan sepsis dan ARDS berfokus pada prinsip lung protective strategy dan sepsis bundle sesuai dengan surviving sepsis campaign (SSC) 2018.Right Massive Hydrothorax with ARDS due to Complication of Internal Jugular Central Venous Catheter InsertionHydrothorax is a rare complication seen in approximately 0.4–1.0 % of all catheter placements. The major mechanical complication incidence of internal jugular vein insertion is lower than the one in the subclavia vein. This study presented a case of a 63-year-old, 70 kg man with ASA 4E sepsis and suspected malignancy. Patient was diagnosed with acute abdomen pain due to total bowel obstruction and underwent exploratory laparotomy with general anesthesia. A right jugular central venous catheter (CVC) was inserted in the ER. Patient was under general anesthesia for 3 hours and 1,500 cc intra operative fluid was administered through the CVC. After surgery, the patient experienced extubation failure and was admitted to ICU because of inadequate spontaneous breathing and hemodynamic instability. Patient experienced reduced breath sound and the resonance to percussion was dull in the right hemithorax. The BGA presented severe hypoxemia and acidosis while the chest x-ray showed right sided massive pleural effusion. Almost 2.2 liter of clear reddish fluid was drained from pleural cavity and a chest tube was inserted. Patient was then diagnosed as having acute respiratory distress syndrome (ARDS). Treatment for sepsis and ARDS was then given by focusing on the principle of lung protective strategy and sepsis bundle according to surviving sepsis campaign (SSC) 2018
Elderly Satisfaction on Chronic Disease Management Program at Public Health Center, Bandung City, West Java, Indonesia
Get PDFObjective: To identify the satisfaction level of the elderly on the health services provided by The Chronic Disease Management Program (prolanis) at the Public Health Center (puskesmas).Methods: A descriptive quantitative study with a cross-sectional approach had been carried out to 112 elderly from 8 puskesmas in Bandung City, West Java, Indonesia. This study was conducted from August until November 2019. The variables in this study were 5 dimensions of the SERVQUAL. The collected data were analyzed using percentages and the Importance-Performance matrix.Results: The satisfaction level of the elderly on the health services provided by the prolanis was 92%. The dimension that has the highest satisfaction level was the assurance dimension (94,6%) and the lowest one was the tangibles dimension (84,8%). The result of the importance-performance matrix showed that assurance, responsiveness, and empathy dimensions needed to be maintained to reach the patient’s satisfaction. Conclusions: The elderly satisfaction on the health services provided by the prolanis is high in every dimension of the SERVQUAL
Neutrophil to Lymphocyte Ratio within Clinical Staging of Head and Neck Squamous Cell Carcinoma
Get PDFBackground: Neutrophil to lymphocyte ratio (NLR) is one of the inflammatory markers, associated with malignancies progression and metastasis, including head and neck squamous cell carcinoma (HNSCC). Neutrophil to lymphocyte ratio is presenting the activity index of protumor and antitumor. It is easy to perform in daily clinical practice, obtained from blood examination. The aim of this study was to assess the prognostic value of NLR in HNSCC patients, associated with the clinical staging.Methods: This study was an analytic design to explore the relationship between NLR and clinical staging. The sample was collected from pre-treatment HNSCC patients who came to the Head and Neck Oncology Clinic, Dr.Hasan Sadikin General Hospital. The data consisted of disease history, ENT examination, staging determination, and blood sample examination for NLR count.Results: In total, data on 92 HNSCC patients were collected. There was a statistically significant association between NLR with clinical staging in HNSCC (p<0.001). The higher the NLR, the higher the clinical stage, whereas the lower the NLR, (OR14.1; 95% CI 3.4–59.0).Conclusions: There is a significant association between NLR with clinical staging in HNSCC. Further study is needed to explore NLR as a prognostic marker in HNSCC patient
Attitude and Behavior towards Self-medication using Non-steroidal Anti-inflammatory Drugs and Paracetamol among Housewives in Hegarmanah Village, Jatinangor
Get PDFBackground: The use of drugs by self-medication is widely practiced worldwide. One of the most common drugs used without prescription is analgesic and this is predominantly used among housewives since they are sometimes suffering from minor ailments due to house chores burden. The study aimed to explore the attitude and behavior of Non-steroidal Anti-inflammatory Drugs (NSAIDs) and paracetamol usage among housewives in Jatinangor, West Java-Indonesia.Methods: A cross-sectional study was performed from August–November 2013. After informed consent, housewives living in Hegarmanah village, Jatinangor were included by filling in a validated questionnaire to assess the level of attitude and behavior of NSAIDs and paracetamol usage. The data were presented in percentages. The score was given and categorized as good, moderate and poor for both attitude and behavior.Results: Of a total 110 housewives participated in this study, the attitude of housewife towards the drug use was good (59.1%), moderate (33.6%) and poor (7.3%), whereas the behavior was good (46.4%), moderate (52.7%) and poor (0.9%).Conclusions: The majority of the respondents have moderate to good attitude as well as behavior toward the usage of NSAIDs and paracetamol as self-medication. Public health education and awareness are important to ensure safe and useful self-medication
Forced Expiratory Volume in 1 Second and Forced Vital Capacity in Bronchial Asthma Patients in Relation with Asthma Exercise
Get PDFBackground: Aerobic physical activity is one of the non-pharmacology management approaches of asthma. The Asthma Foundation of Indonesia (Yayasan Asma Indonesia, YAI) has designed an aerobic physical activity for people with asthma, known as Asthma Exercise. Asthma exercise is expected to increase the overall functional capacity of the lungs. One way to measure lung function is by measuring the score of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). The objective of the study was to explore the difference in FEV1 and FVC between bronchial asthma patients with and without asthma exercise. Methods: This study involved asthma patients from the Bandung Asthma Association (Perhimpunan Asma Bandung, PAB) who did asthma exercise (n=28), and as control patients from the Pulmonology Clinic in Dr. Hasan Sadikin General Hospital were selected who did not do asthma exercise. The research data used were primary data from the spirogram examination. Asthma patients were selected based on inclusion and exclusion criteria. This research used unpaired numerical comparative analytical hypothetical tests with a cross-sectional design.Results: The study showed the mean of FEV1 and FVC in the group with asthma exercise (1.6107±0.3780L and 2.0396±0.3465L) was higher than the group without asthma exercise (1.3750±0.4702L and 1.7164±0.4632L). Statistical difference test using independent t-test indicated a score of p=0.044 for FEV1 and p=0.005 for FVC between the two groups.Conclusions: There are significant differences in FEV1 and FVC between bronchial asthma patients with and without asthma exercise. Furthermore, asthma exercise is recommended for asthma patients to improve their lung function.
Cancer Antigen 125 Serum Level in Head and Neck Diffuse Large B-Cell Lymphoma
Get PDFBackground: Diffuse Large B-Cell Lymphoma (DLBCL) is the most common subtype of the Non-Hodgkin Lymphoma (LNH). Until now, lactate dehydrogenase (LDH) is the only tumor marker to assess DLBCL progression; however, increased LDH is a relatively non-specific biomarker. Cancer antigen 125 (CA-125) serum level have been used as a tumor marker in ovarian cancer. The aim of this study was to explore the possible role of CA-125 serum level as a tumor marker in head and neck DLBCL.Methods: This was an observational descriptive study among consecutively sampled DLBCL patients. CA-125 serum level examination was carried out (ADVIA Centaur CA-125II) and described along with the clinical characteristics of DLBCL patients.Results: DLBCL was mostly observed in males (54.05%), most often in the 55-65 year age group (51.3%), with stage 1 DLBCL was the most prevalent (71.9%). The mean CA-125 serum level was 22.9 U/ml and increased in patients with advanced DLBCL.Conclusions: Increased CA-125 serum level in DLBCL, especially at advanced stages, suggests that CA-125 serum level may be of benefit as a tumor marker in the head and neck DLBCL. Further study is in need to explore the role of CA-125.1. Kementerian Kesehatan Republik Indonesia. Data dan kondisi penyakit limfoma di Indonesia. InfoDatin Pusat Data dan Informasi Kementerian Kesehatan RI. 2015 [cited 2020 March 18] Available from: https://www.kemkes.go.id/resources/download/pusdatin/infodatin/infodatin-limfoma.pdf2. Dwianingsih EK, Indrawati, Hardianti MS, Malueka RG , Iswar RR, Sutapa S, et al. Histopathological features of lymphoma in Yogyakarta, Indonesia. Asian Pac J Cancer Prev. 2016;17(9):4213–16.3. Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI. Riset Kesehatan Dasar (RISKESDAS) 2013. Jakarta: Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI; 20134. Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014; 32(27):3059–67.5. Ziepert M, Hasenclever D, Kuhnt E, Glass B, Schmitz N, Pfreundschuh, et al. Standard International prognostic index remains a valid predictor of outcome for patients with aggressive CD20+B-cell lymphoma in the rituximab era. J Clin Oncol. 2010;28(14):2373-2380.6. Gutiérrez A, Martínez-Serra J, Barceló B, Sampol A, Vinas L, Gonzales G, et al. Prognostic value of serum CA125 levels in diffuse large B-cell lymphoma: potential role of a new sex and age adjusted reference value. Int J Lab Hematol. 2010; 32(6 Pt 2): 582–9.7. Dilek I, Ayakta H, Demir C, Meral C, Ozturk M. CA 125 levels in patients with Non-Hodgkin lymphoma and other hematologic malignancies. Clin Lab Haematol. 2005;27(1):51–5.8. Memar B, Aledavood A, Shahidsales S, Ahadi M, Farzadnia, Raziee HR, et al. The prognostic role of tumor marker CA-125 in B-Cell non-Hodgkin’s Lymphoma. Iran J Cancer Prev. 2015;8(1):42–6.9. Garg S, Goyal B. Evaluation of CA-125 as a prognostic marker in patients with Non-Hodgkin’s lymphoma. International Journal of Medical and Health Research. 2017;3(4):13–5.10. Paoli CJ, Bach BA, Quach D, Tsai KT, Wong B, Kallich J. Performance status of real-world oncology patients before and after first course of chemotherapy. The Journal of Community and Supportive Oncology. 2014; 12(5):163–70.11. Yadav C, Ahmad A, D’Souza B, Agarwal A, Nandini M, Prabhu KA, et al. Serum lactate dehydrogenase in Non-Hodgkin’s lymphoma: a prognostic indicator. Indian J Clin Biochem. 2016;31(2):240–2
Clinical Profile of Adverse Cutaneous Drug Reactions in Patients with Human Immunodeficiency Virus
Get PDFBackground: Adverse cutaneous drug reactions (ACDRs) are common problems in patients during the treatment of various diseases. The clinical feature varies from mild manifestation such as morbilliform, urticaria, and contact dermatitis, to severe manifestation such as Stevens - Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Patients infected with the human immunodeficiency virus (HIV) have an increased risk of developing ACDRs due to immune system disruption. This study aimed to describe the clinical features of ACDRs in HIV patients and the drugs that cause ACDRs.Method: This study was a retrospective study using secondary data from medical records of HIV patients with ACDRs who visited Teratai Clinic of Dr. Hasan Sadikin General Hospital Bandung from 2014 to 2018. Total sampling was applied and results were presented in percentage.Results: There were 94 HIV patients with ACDRs out of 557 HIV patients. Adverse cutaneous drug reactions are commonly found in males aged 20-39 years old. The clinical features found were morbilliform (85.6%), SJS (8.9%), urticaria (4.4%), and erythroderma (1.1%). The most common drugs causing ACDRs were Cotrimoxazole (30%), Efavirenz (28.9%), and Nevirapine (16.7%).Conclusion: The prevalence of ACDRs in HIV patients in this study is 16.9%. The most common clinical features are morbilli form and SJS with Cotrimoxazole, Efavirenz, and Nevirapine causing most of the ACDRs
Transfusion Reactions in Pediatric Cancer Patients
Get PDFBackground: Transfusion is an essential component of supportive management for cancer patients with anemia and thrombocytopenia. It is generally safe; however, it has several risks and complications including those caused by transfusion reactions. This study aimed to describe transfusion reactions in pediatric cancer patients in a tertiary hospital in Indonesia. Methods: This was a descriptive cross-sectional study with a total sampling method. A prospective analysis was performed on episodes of blood transfusion in pediatric patients aged younger than 18 years old with cancer and were hospitalized at the Department of Child Health of the hospital from July to August 2019. After the consent of the parents, the patients were interviewed for various transfusion reactions. Data collected were presented using tables and charts.Results: Leukemia was the most frequent cancer in children cancer patients who need transfusion. Out of 42 children included, 155 episodes of transfusion were observed with 22 episodes showed transfusion reactions (14.2%). The most frequent manifestations were pruritus (31.8%), followed by combination of pruritus and erythema (27.4%) and fever (13.6%). These reactions appeared mostly in 1 to 2 hours (27.2%), with most were mild reactions (59.1%).Conclusion: Transfusion reactions mostly occurred among pediatric patients with cancer in the acute phase with clinical manifestation of allergic reactions, predominantly mild. Early identification of these reactions would result in better treatment and prevention for recurrence of transfusion reactions
Studi Komparatif Ukuran Pipa Nafas Tanpa Cuff Pada Pasien Pediatri Berdasar Diameter Subglotis Dengan Metode Konvensional
No full texttersendiri. Pipa endotrakeal (ETT) yang terlalu kecil/besar meningkatkan risiko komplikasi. Prediksi ukuran ETT berdasar atas usia merupakan metode yang paling sering digunakan namun ternyata tidak selalu tepat pada aplikasinya. Parameter lain seperti diameter subglotis atau diameter kelingking tangan dapat menjadi alternatif untuk memprediksi ukuran ETT pediatri. Tujuan penelitian ini menganalisis dan membandingkan akurasi prediksi ukuran ETT tanpa cuff berdasar berbagai variabel pada pasien pediatri di RSUD Dr Soetomo Surabaya mulai Februari hingga April 2020. Subjek penelitian ini pasien usia 2–9 tahun, PS ASA 1–2 yang akan dilakukan operasi elektif. Saat preoperatif, usia, berat, dan panjang badan dicatat. Saat intraoperatif, diameter kelingking tangan dan diameter subglotis menggunakan USG diukur dan dicatat. ETT yang digunakan adalah ETT tanpa cuff berdasar atas diameter subglotis. ETT dianggap tepat apabila memberikan audible air leak pada tekanan 10–25 cmH2O. Bila ETT terlalu kecil/besar maka dilakukan reintubasi. Tiap-tiap parameter dilakukan uji korelasi, agreement test, serta predictive performance menggunakan MAPE, dan RMSE. Dari 48 pasien, didapatkan hasil bahwa prediksi ukuran ETT tanpa cuff berdasar atas diameter subglotis memiliki akurasi yang paling baik hingga 91,67% (r=0,973, koefisien kappa 0,892; p<0,001, MAPE 0,803%, dan RMSE 0,144). Simpulan, prediksi berdasar atas diameter subglotis merupakan metode yang akurat untuk memprediksi ukuran ETT tanpa cuff pediatri. Subglottic Diameter Ultrasonographic Assessment for Estimating Pediatric Uncuffed Endotracheal Tubes Compared to Conventional MethodsAnatomical differences in pediatric airways could be quite a challenge. Choosing endotracheal tube (ETT) optimum size is essential as a larger or smaller tube may cause undesirable complications. ETT size prediction based on age formula is most commonly used, but is not always successful. The little finger diameter and subglottic diameter are alternative parameters to predict pediatric uncuffed ETT optimum size. This study analyzed and compared the multiple variable-based formulas’ accuracy to predict the pediatric uncuffed ETT optimum size. The ETT prediction used subglottic diameter-based formulas. Clinically fit ETT has an audible air leak within the pressure of 10–25 cmH2O. If the ETT predicted was relatively too small/big than clinically fit ETT, it was changed to one size smaller/ bigger. Each variable was then analyzed by correlation test, regressed against clinically fit ETT to test the agreement rates, and predictive performance was assessed using mean absolute percentage error (MAPE), and root mean square error (RMSE). From 48 patients it found that subglottic diameter formulas offered the best result in predicting optimum size uncuffed ETT in pediatrics with an agreement rate up to 44 of 48 patients got the right clinically fit uncuffed ETT (91.67%, r=0.973, kappa 0.892, p-value<0.001, MAPE 0.803%, and RMSE 0.144). In conclusion, the prediction based on subglottic diameter using USG is the best method to predict the optimum size of uncuffed ETT in pediatrics.ABSTRAK. Perbedaan anatomi jalan nafas pada pasien pediatri menyebabkan pemilihan ukuran pipa nafas pediatri menjadi tantangan tersendiri bagi seorang ahli anestesi. Pemilihan ukuran pipa nafas yang terlalu kecil atau terlalu besar dapat meningkatkan resiko komplikasi secara langsung (seperti aspirasi, kebocoran gas anestesi, trauma jalan nafas) maupun tidak langsung akibat resiko yang disebabkan saat reintubasi ( seperti spasme, bradikardia). Prediksi ukuran pipa nafas berdasar usia merupakan salah satu teknik estimasi yang paling lama dikenal dan paling sering digunakan hingga saat ini namun ternyata teknik ini tidak selalu tepat pada aplikasinya. Parameter lain seperti diameter sublotis menggunakan ultrasonografi, atau diameter jari kelingking tangan dapat menjadi modalitas alternatif untuk memprediksi ukuran pipa nafas pasien pediatri. Tujuan : Menganalisis dan membandingkan akurasi prediksi ukuran pipa nafas tanpa cuff berdasar berbagai variabel pada pasien pediatri di RSUD Dr. Soetomo Surabaya. Metode : Subjek penelitian ini adalah pasien pediatri usia 2-9 tahun, PS ASA 1-2, yang akan dilakukan operasi elektif dengan manajemen jalan nafas intubasi. Penelitian ini merupakan penelitian analitik observasional dengan tekhnik pengambilan sampel consecutive sampling. Pada periode preoperatif, usia, berat badan dan panjang badan dicatat sebagai data demografi. Pada periode intraoperatif, diameter jari kelingking tangan dan diameter subglotis menggunakan USG diukur dan dicatat. Pipa nafas yang digunakan adalah pipa nafas tanpa cuff berdasar rumus regresi dari diameter subglotis. Pipa nafas dianggap tepat sesuai klinis apabila memberika audible air leak pada tekanan 10-25 cmH2O. Bila pipa nafas terlalu kecil/besar, maka dilakukan reintubasi sesuai dengan ukuran yang tepat. Masing-masing parameter lalu dilakukan uji korelasi, agreement test, serta predictive performance menggunakan mean absolute percentage error (MAPE), dan root mean square error (RMSE). Hasil : Dari 48 pasien pediatri yang disertakan pada penelitian ini, didapatkan hasil bahwa prediksi ukuran pipa nafas tanpa cuff berdasar diameter subglotis menggunakan USG memiliki akurasi yang paling baik hingga 91,67% (r = 0.973, koefisien kappa 0.892, p < 0.001, MAPE 0.803% dan RMSE 0,144). Kesimpulan : Prediksi berdasar diameter subglotis menggunakan USG merupakan metode yang akurat untuk memprediksi ukuran pipa nafas tanpa cuff pada pasien pediatri di RSUD Dr Soetomo Surabaya
Relationship between Maternal Vitamin D Level and Small for Gestational Age Infant in West Java, Indonesia
Get PDFSmall for gestational age (SGA) infants is one of the unfavorable outcomes of pregnancy that needs to be prevented. There are not many studies available on the association of maternal vitamin D levels during pregnancy and SGA infants. This study aimed to discover the association between maternal vitamin D level and SGA infants in West Java. A cohort study was performed from February 2018 to January 2019 by recruiting 304 pregnant women in Bandung, Cimahi, Waled, and Sukabumi, West Java Province, Indonesia. Of that number, 203 women were followed until the delivery date. Data were collected from the results of serial ultrasonography examinations and maternal vitamin D level measurements. Bivariate analysis and logistic regression were then performed to determine the relationship between variables. This study showed that 30 of 203 (14.78%) infants were born as SGA infants. The mothers of these SGA infants had a lower maternal vitamin D level at the beginning of the second trimester and smaller anthropometric measurements at the beginning of the third trimester. However, no significant difference was found between normal infants and SGA infants when the overall values for all trimesters were compared. It can be inferred that the maternal vitamin D level has a negative relationship with SGA infants in West Java, Indonesia. Further studies are required to prove the relationship between maternal vitamin Dl level and SGA infants.Hubungan Kadar Vitamin D Ibu dan Bayi Kecil Masa Kehamilan di Jawa BaratBayi kecil masa kehamilan (KMK) adalah luaran kehamilan yang perlu dicegah. Informasi tentang hubungan kadar vitamin D ibu dengan kejadian bayi KMK di Indonesia masih terbatas. Kadar vitamin D dan karakteristik ibu diduga berpengaruh dalam kejadian bayi KMK. Tujuan penelitian ini adalah mengetahui hubungan kadar vitamin D ibu dengan kejadian KMK pada bayi. Studi kohort dilakukan dari Februari 2018 hingga Januari 2019 dengan merekrut 304 ibu hamil di Bandung, Cimahi, Waled, dan Sukabumi, Provinsi Jawa Barat, Indonesia. Dari jumlah 203 orang diantaranya berhasil diikuti sejak trimester satu hingga persalinan dan terpilih menjadi subjek penelitian kasus kontrol. Pemeriksaan ultrasonografi, kadar vitamin D dan hemoglobin ibu dilakukan serial tiap trimester. Dilakukan analisis bivariat dan regresi logistik untuk menentukan hubungan antar variabel yang diteliti. Dari penelitian ini didapatkan sebanyak 30 dari 203 (14,78%) persalinan dengan luaran bayi KMK. Bayi KMK cenderung mempunyai riwayat kadar vitamin D yang lebih rendah pada awal trimester kedua dan hasil antropometri yang lebih rendah pada awal trimester tiga, namun secara statistik tidak berbeda signifikan. Simpulan penelitian ini bahwa kadar vitamin D ibu hamil memiliki korelasi negatif dengan bayi KMK. Penelitian lebih lanjut diperlukan untuk membuktikan hubungan antara kadar vitamin D ibu dan bayi KMK.