E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Cardiorespiratory Endurance among End Year Student of Faculty of Pharmacy in Jatinangor, Bandung
Get PDFBackground: Physical fitness indicates the ability of an individual to perform daily physical activities with ease. The major component of physical fitness is the cardiorespiratory endurance, which is assessed through maximal oxygen consumption (VO2 max). A decrease in cardiorespiratory endurance can be associated with a sedentary lifestyle. This study was conducted to determine the cardiorespiratory endurance among young adults in Jatinangor, Bandung.Methods: This cross-sectional study had used total sampling method, conducted among end year student of Faculty of Pharmacy, Universitas Padjadjaran from October–November 2013. The inclusion criteria wasall end year students who had no health-related problems and the students had to agree to participate in the study. After obtaining written informed consent from the participants, Astrand-Rhyming Step Test was performed to measure the level of VO2max.Results: In total, 32 students were included of whom 14 students (43.7%) had an average level of VO2 max and 9 (28.2%) had just below average level. Chi-square test results showed that there was no significant relationship (p>0.05) between VO2 max level and gender, BMI level, and smoking habit, but showed a significant relationship (p< 0.05) with exercising habit.Conclusions: The majority of the participants had an average level of VO2 max. A significant relationship between the level of VO2 max and exercising habit, suggesting a regular exercise for a better lifestyle
Perbandingan Angka Keberhasilan Intubasi dan Waktu Intubasi antara Menggunakan Bougie dan Purwarupa Camera–Bougie pada Maneken Simulasi Kesulitan Intubasi
Get PDFPenatalaksanaan jalan napas merupakan hal fundamental bagi ahli anestesi. Kegagalan penatalaksanaan jalan napas mengakibatkan kematian. Berbagai modalitas tersedia untuk penatalaksanaan jalan napas sulit, mulai dari alat sederhana seperti stylet dan bougie hingga alat canggih seperti video laryngsocope dan fiberoptic. Fiberoptik masih menjadi standar baku kesulitan intubasi, namun penggunaannya masih terbatas karena harganya mahal dan penggunaannya sulit. Purwarupa camera–bougie merupakan modalitas baru yang diharapkan dapat mengatasi keterbatasan tersebut dan menjembatani antara bougie yang sederhana dan fiberoptik yang sangat canggih. Tujuan penelitian adalah membandingkan angka keberhasilan intubasi dan waktu intubasi antara bougie dan purwarupa camera–bougie pada maneken simulasi kesulitan intubasi di RSUP Dr. Hasan Sadikin Bandung. Penelitian analitik eksperimental ini dilakukan pada 41 peserta didik Program Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadaran/RSUP Dr. Hasan Sadikin Bandung semester 5 sampai dengan 11 yang melakukan intubasi dengan bougie dan purwarupa camera–bougie secara bergantian dengan metode randomisasi permutasi blok pada maneken simulasi kesulitan intubasi. Penelitian dilakukan dari tanggal 16–24 Oktober 2018. Keberhasilan dan waktu intubasi dicatat dan dianalisis secara statistik dengan Uji Mc. Nemar dan Wilcoxon. Keberhasilan intubasi dengan bougie sebesar 39% dan purwarupa camera-bougie 100% (p<0,001). Waktu intubasi dengan bougie dan purwarupa camera-bougie sebesar 18,81 (12,19) detik dan 7,0 (1,47) detik (p<0,001). Simpulan, purwarupa camera–bougie meningkatkan keberhasilan intubasi dan memperpendek waktu intubasi pada maneken simulasi kesulitan intubasi.Comparison of Success Rate and Duration of Intubation between Bougie and Bougie–Camera Prototype in Simulated Difficult Airway ManikinAirway management is fundamental for anesthesiologist. Fiberoptic is still the gold standard for difficult intubation but its expensive price and complicated handling limit its use. Bougie–camera prototype is one of the new modalities that is expected to overcome these limitations and bridge the gap between simple bougie and very sophisticated fiberoptic. The aim of this study was to compare the success rate and duration of intubation between bougie and bougie–camera prototype in simulated difficult airway manikin at Dr. Hasan Sadikin General Hospital Bandung. This experimental analytic study was conducted on 41 fifth semester anesthesiology residents of the Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital who performed intubation with bougie and bougie–camera prototype alternately on simulated difficult airway mannequin using permutation block randomization method. This study was held during the period of 16–24th of October 2018. The success rate and duration of intubation were recorded and analyzed statistically by Mc. Nemar and Wilcoxon tests. The rate of successful intubation with bougie was 39% and 100% with bougie–camera prototype (p<0.001). Duration of intubation with bougie and bougie–camera prototype was 18.81 (12.19) seconds and 7.0 (1.47) seconds (p<0.001). The conclusion of this study is bougie–camera prototype increases the success rate of intubation and shortens the duration of intubation on simulated difficult airway on mannequin.Penatalaksanaan jalan napas merupakan hal fundamental bagi ahli anestesi. Kegagalan penatalaksanaan jalan napas mengakibatkan kematian. Berbagai modalitas tersedia untuk penatalaksanaan jalan napas sulit, mulai dari alat sederhana seperti stylet dan bougie hingga alat canggih seperti video laryngsocope dan fiberoptic. Fiberoptik masih menjadi standar baku kesulitan intubasi, namun penggunaannya masih terbatas karena harganya mahal dan penggunaannya sulit. Purwarupa camera–bougie merupakan modalitas baru yang diharapkan dapat mengatasi keterbatasan tersebut dan menjembatani antara bougie yang sederhana dan fiberoptik yang sangat canggih. Tujuan penelitian adalah membandingkan angka keberhasilan intubasi dan waktu intubasi antara bougie dan purwarupa camera–bougie pada maneken simulasi kesulitan intubasi di RSUP Dr. Hasan Sadikin Bandung. Penelitian analitik eksperimental ini dilakukan pada 41 peserta didik Program Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadaran/RSUP Dr. Hasan Sadikin Bandung semester 5 sampai dengan 11 yang melakukan intubasi dengan bougie dan purwarupa camera–bougie secara bergantian dengan metode randomisasi permutasi blok pada maneken simulasi kesulitan intubasi. Penelitian dilakukan dari tanggal 16–24 Oktober 2018. Keberhasilan dan waktu intubasi dicatat dan dianalisis secara statistik dengan Uji Mc. Nemar dan Wilcoxon. Keberhasilan intubasi dengan bougie sebesar 39% dan purwarupa camera-bougie 100% (p<0,001). Waktu intubasi dengan bougie dan purwarupa camera-bougie sebesar 18,81 (12,19) detik dan 7,0 (1,47) detik (p<0,001). Simpulan, purwarupa camera–bougie meningkatkan keberhasilan intubasi dan memperpendek waktu intubasi pada maneken simulasi kesulitan intubasi.Kata kunci: Bougie, intubasi, jalan napas sulit, maneken, purwarupa camera–bougi
Antibiotic Utilization Pattern in the Intensive Care Unit of Tertiary Hospital in West Java, Indonesia
No full textObjective: To find out the pattern of antibiotic utilization in intensive care unit (ICU). The high use of antibiotics in intensive care may increase antibiotic resistance.Methods: This was a retrospective study with total sampling method from patients who were treated in ICU in the period of January to June 2016. Selected data is processed using the Anatomical Therapeutic Chemical (ATC) Classification/Defined Daily Dose (DDD) system as an international measurement standard for analyzing and comparing usage applied by the WHO.Results: The results showed that of the 57 medical records collected, the total antibiotic use was 295.72 DDD/100 bed-days. Levofloxacin, meropenem, ceftriaxone, ceftazidime, and metronidazole were the five maximally utilized antibiotics with 143.18, 49.88, 30.62, 19.74, dan 16.99 DDD/100 bed-days respectively.Conclusion: The most frequently used of antibiotics is ceftriaxone, used in 54.39% of patients. Whereas in number, the most widely used antibiotic is levofloxacin with a total of 143.18 DDD/100 bed-days
Use of Propranolol in Infantile Hemangioma Resulting in Scarless Healing
Get PDFInfantile hemangiomas (IHs) are the most common childhood tumors. Some can ulcerate causing pain, bleeding, and scarring, leading to cosmetical disfigurement. The use of propranolol has beaten the traditional high-dose systemic corticosteroids therapy, which falls short on its infamous adverse effects. In these case series, regimen of propranolol was highlighted when surgery is not an option. Two cases were presented. Case 1 involveda three-month-old baby girl was presented with a 0.6x0.6 cm disfiguring purple tumor on her nasal tip and columella and Case 2 involveda three-month-old baby girl with a 2x0.5 cm sharply bordered and bulging red tumor on her left labium major.Both lesions became visible at the age of 3 months and grew rapidly since then. Propranolol was initiated at 2 mg/kgBW per day with careful administration. Adverse effects and drug tolerance were closely monitored under pediatrician and plastic surgery care with none reported. Dramatic results was seen after 2 weeks of treatment and no scar was found at the end of the therapy. This confirmed that propranolol is an effective and well tolerated treatment when commenced early and continued with the minimum protocol of 2 mg/kgBW/day through the proliferative phase of infantile hemangioma. It is concluded that propranolol is beneficial for managing infantile hemagioma cases with a scarless outcome that cannot be achieved through surgery. The use of propanolol is extremely beneficial when the case involves a tumor in a site that makes it impossible for reconstruction. Penggunaan Propranolol pada Hemangioma Infantil yang Menghasilkan Penyembuhan Tanpa Bekas LukaHemangioma infantil adalah tumor yang paling sering pada anak. Tumor ini dapat mengalami ulserasi, nyeri, perdarahan, parut buruk, sampai menyebabkan penampilan cacat. Terapi propranolol telah mengalahkan kortikosteroid, yang dikenal mempunyai banyak efek samping yang buruk. Pada serial kasus ini, kami akan menyoroti regimen penggunaan propranolol, ketika pembedahan tidak mungkin dilakukan. Kasus 1: Bayi perempuan, 3 bulan, datang dengan tumor keunguan yang menyebabkan disfigurasi pada nasal tip dan kolumela. Kasus 2: Bayi perempuan, 3 bulan, datang dengan tumor kemerahan, berbatas tegas dan benjol, pada labium mayor sinistra. Kedua lesi timbul pada usia 3 bulan dan membesar dalam hitungan hari. Propranolol dimulai dengan dosis 2 mg/kg/BB per hari, dengan pengawasan ketat oleh spesialis anak dan bedah plastik. Kedua kasus tidak terdapat efek samping dan toleransi obat baik. Hasil drastis terlihat dalam dua minggu dan pada akhir terapi didapatkan parut yang kasat mata. Kasus kami mengonfirmasi bahwa terapi propranolol adalah efektif dan dapat ditoleransi dengan baik, diberikan dini dan stabil pada dosis 2 mg/kg/BB per hari pada fase proliferasi, dengan hasil tanpa bekas yang tidak dapat dicapai dengan pembedahan. Kami ingin meningkatkan kesadaran pada dokter dalam penggunaan propranolol yang telah dibuktikan bermanfaat, terutama pada tumor yang berada di tempat yang tidak dapat dioperasi dan sulit direkonstruksi
Pattern of Bacteria, Antibiotic Uses and Sensitivity among Ear, Nose, and Throat Infectious Disease in Otolaryngology Ward in Tertiary Hospital
Get PDFObjective: To provide an overview of antibiotic use, bacterial patterns and sensitivity to antibiotics in the otolaryngology ward.Methods: This was a cross-sectional study, with total sampling method from medical record data of otolaryngology inpatients that use antibiotics for the period of January 1, 2016–June 30, 2016. Exclusion criteria are incomplete patient medical records and chemotherapy or radiotherapy patients. The variables studied were antibiotic use, bacterial pattern and susceptibility.Results: Among 276 subjects included in the inclusion criteria, the most widely used are single antibiotics (98.9%), generally used for 2–3 days (73.9%), via intravenous lines (92%), and with indications as empirical+prophylaxis (77.5%). Commonly used antibiotics are cefazolin (42.51%), ceftriaxone (29.54%), and cefotaxime (20.76%). The most common bacteria were E. coli (36.36%) and the most sensitive types of antibiotics were meropenem, amikacin, and tigecyclin, while the most resistant antibiotics were ampicillin, ciprofloxacin, and ceftriaxone.Conclusions: The majority of antibiotics used in the otolaryngology treatment room are cefazolin as prophylaxis. E. coli were the most found culture results and the most sensitive types of antibiotics, namely meropenem, amikacin, and tigecyclin, while the most resistant antibiotics were ampicillin, ciprofloxacin, and ceftriaxone.Keywords: Antibiotics, antibiotic sensitivity, bacterial pattern, ears, nose, throa
Triple Negative Breast Cancer Characteristics Based on Basal-like and Non-Basal-like Subtypes
Get PDFObjective: To observe triple negative breast cancer (TNBC) characteristics in three hospitals located in Bandung based on basal-like (BL) and non-basal-like (NBL) subtypes.Methods: This was a cross-sectional study which used descriptive categorical data from medical records and paraffin blocks of TNBC patients treated in Dr. Hasan Sadikin General Hospital, Bandung; Borromeus Hospital; and Santosa Hospital Bandung Central in the period of January 1, 2012–December 31, 2016. The subjects of the study were 57 TNBC patients. The data collected in the study based on medical records were age, tumor size, histopathological images, severity, and immunohistochemical data. The paraffin blocks of the patients based on the completed medicals records were investigated through examinations of immunohistochemichal cytokeratin (CK) 5/6 expressions and epidermal growth factor receptor (EGFR).Results: Prevalence of TNBC were 82.5% of basal-like subjects and 17.5% of non-basal-like subjects. Among the TNBC subjects, median age of each subtype was 50 years of basal-like subtype and 45 years of non-basal-like subtype. Both subtypes were mostly found in the subjects who aged >40 years. Higher histopathological grade was discovered in both subtypes. The therapy mostly carried out to the subjects was adjuvant chemotherapy. Majority of basal-like subtype subjects were still alive and had longer survival rate and lower incidences of deaths when compared to the non-basal-like subtype.Conclusion: In TNBC, the basal-like subjects showed greater median age, lower severity stage, and longer survival rate than the non-basal-like subjects. There was no histopathology grade between both subtypes. Keywords: Basal-like and non-basal-like subtypes, breast cancer, characteristics, triple negative
Social Determinant Factors of Elderly as an Input in Enhancing Primary Health Care in Indonesia
Get PDFObjective: To analyze the differences of social determinant factors among elderly according to gender, in urban and rural areas in Indonesia. Indonesia is one of the most populated countries in the world, faces an increased number of elderly. This situation leads to the increase of degenerative diseases and demands of caregivers as well. The identification of social determinant factors of elderly has an important role in enhancing primary health care.Methods: A comparative study was carried out in 33 provinces in Indonesia using secondary data from Statistics Indonesia 2013. The variables included in this study were percentage of elderly according to education, marital status, occupation, income and living arrangements, divided in gender, urban and rural areas. The normally distributed data were analyzed using unpaired T test and not normally distributed data were analyzed using Mann-Whitney test. Results: This study showed that there were differences in education, occupation and income between urban and rural areas. In urban area, most of the elderly worked in industry and trade and in rural area they worked in agricultural, indicated huge risks of occupational haxards. Most of them were poor, still married, lived with spouses and family of three generations.Conclusions: It can be concluded that there were differences of social determinant factors (education, occupation and income) in elderly who live in urban and rural areas that can contribute to the risks of disease in elderly and these situations must be considered as an input to enhance the primary health care.Keywords: Elderly, gender, rural, social determinants, urba
Etiology of Symptomatic Focal Epilepsy based on Neuroimaging Result in Neurology Outpatient Clinic of Dr. Hasan Sadikin General Hospital
Get PDFBackground: Focal epilepsy is the most common type of epilepsy that can be caused by structural lesions. Images from neuroimaging can show those structural lesions that may point to the etiology of epilepsy and would affect the management of epilepsy. The aim of the study was to explore the possible etiology of symptomatic focal epilepsy from neuroimaging result at the Neurology Outpatient Clinic in Dr. Hasan Sadikin General Hospital.Methods: This study was a cross-sectional descriptive study. The medical records that fulfilled the inclusion criteria were collected at the Neurology Outpatient Clinic of Dr. Hasan Sadikin General Hospital from the year 2017. The inclusion criteria were symptomatic focal epilepsy patients that had abnormal neuroimaging result.Results: In total, there were 71 medical records collected of which eight etiologies of symptomatic focal epilepsy were found, that were vascular disorder caused by strokes (33%), tumors (21%), hippocampal sclerosis (20%), infections (11%), head trauma (6%), malformations of cortical development (4%), vascular malformations (3%), and phakomatosis (1%). Vascular disorder was the most abundant etiology found in all brain lobes, except in temporal and frontal lobes, which also most often caused by hippocampal sclerosis and tumors, respectively.Conclusions: Vascular disorders due to stroke, is the most abundant etiology found in symptomatic focal epilepsy, therefore, stroke patients need to be informed about the possibility of having epilepsy later on
Acute and Sub-chronic Toxicity Studies of Combination of Physalis angulata L. (Cecendet) Extract and Methylprednisolone on Animals
Get PDFObjective: To evaluate the safety of combination of Physalis angulata L. (Cecendet) extract and methylprednisolone through a single dose in mice (acute toxicity) and repeated doses within 90 days in rats (subchronic toxicity).Methods: Acute toxicity test was conducted to 2 groups of female mice by monitoring their behavior and death at 4 hours and 24 hours after cecendet adminstration. While subchronic toxicity test was conducted to 6 groups of rats as normal group, control group, and receive varoius cecendet dose. Each group was combined with methylprednisolone 5 mg/kg b.w. at first month and gradually taperred to 3.2 mg/kg b.w. at third month. Subchronic toxicity was evaluated by monitoring rats’ behavior, mortality, blood biochemistry, blood cell count, urinalysis, and organ macroscopic and histologic.Results: The study showed cecendet extracts did not affect mice behavior in single dose therapy up to 5 g/kg b.w. and had LD50 of more than 5 g/kg b.w., which was categorized as practically non-toxic. The sub-chronic toxicity study showed that up to 1 g/kg b.w. of cecendet extracts that was administered for 90 days did not cause death, was not organ toxic, did not affect blood biochemistries, blood cell count, and urinalysis.Conclusions: Cecendet extract and methylprednisolone combination was safe based on acute and sub-chronic toxicity data.Keywords: Acute toxicity, LD50, Lupus, Physalis angulata L, subchronic toxicity
Implementasi Early Warning Score pada Kejadian Henti Jantung di Ruang Perawatan Rumah Sakit Dr. Hasan Sadikin Bandung yang Ditangani Tim Code Blue Selama Tahun 2017
No full textAngka kejadian henti jantung di rumah sakit sangat bervariasi. Sebagian besar kasus henti jantung didahului oleh penurunan kondisi pasien yang digambarkan dengan gangguan parameter tanda vital. Keberhasilan Early warning score (EWS) dalam menurunkan angka kejadian henti jantung dipengaruhi oleh implementasi yang baik dari instrumen EWS sesuai dengan pedoman yang ditetapkan. Penelitian ini bertujuan melihat implementasi EWS di RSUP Dr. Hasan Sadikin Bandung. Penelitian bersifat deskriptif dengan desain potong lintang menggunakan data rekam medis pasien henti jantung di ruang perawatan yang ditangani oleh tim Code Blue selama tahun 2017, dan dilakukan pada bulan November 2018. Data EWS 6 jam sebelum dan saat henti jantung, serta tindak lanjut yang dilakukan setelah penilaian EWS dicatat. Didapatkan 87 data rekam medis henti jantung yang memenuhi kriteria inklusi dan tidak termasuk eksklusi. Di antaranya, 72% memiliki catatan EWS lengkap, 9% memiliki catatan EWS tidak lengkap, dan 18% tidak memiliki data EWS. Dari 63 data rekam medis yang memiliki data EWS lengkap hanya 21% yang mendapat tindak lanjut yang sesuai dengan standar prosedur operasional EWS. Simpulan penelitian ini adalah implementasi EWS di ruang rawat inap RSUP Dr. Hasan Sadikin belum cukup memuaskan. Tindak lanjut yang dilakukan setelah penilaian EWS belum sesuai dengan standar prosedur operasional EWS yang berlaku.Implementation of Early Warning Score to Patients with In-Hospital Cardiac Arrest in Dr. Hasan Sadikin General Hospital Managed by Code Blue Team Incidence of in-hospital cardiac arrest varies greatly around the world. Most in-hospital cardiac arrests are preceded with physiological deteriorations that manifest as alterations in vital signs. The success of early warning score (EWS) in reducing the incidence of cardiac arrest is influenced by the good implementation of EWS instruments by ward staff in accordance with the guidelines The aim of this study was to assess to what degree EWS was implemented at Dr. Hasan Sadikin General Hospital Bandung. This was a cross sectional descriptive study on patients with in-hospital cardiac arrest managed by the code blue team during 2017 that was conducted in November 2018. EWS 6 hour prior to cardiac arrest event, EWS at the event, and action taken upon finding an abnormal value were obtained from medical records. Eighty seven medical records were included. Of these, 72% medical records had complete EWS data, 9 medical records had incomplete EWS data, and 18% medical records had no EWS recorded. From those 63 medical records with complete EWS recorded, only 21% had been managed correctly according to the EWS guideline. This study concludes that the implementation of EWS in the wards of Dr. Hasan Sadikin General Hospital Bandung has not been completely satisfactorily. Actions taken after EWS assessment are still not accordance with the EWS guideline.Angka kejadian henti jantung di rumah sakit sangat bervariasi. Sebagian besar kasus henti jantung didahului oleh penurunan kondisi pasien yang digambarkan dengan gangguan parameter tanda vital. Keberhasilan Early warning score (EWS) dalam menurunkan angka kejadian henti jantung dipengaruhi oleh implementasi yang baik dari instrumen EWS sesuai dengan pedoman yang ditetapkan. Penelitian ini bertujuan melihat implementasi EWS di RSUP Dr. Hasan Sadikin Bandung. Penelitian bersifat deskriptif dengan desain potong lintang menggunakan data rekam medis pasien henti jantung di ruang perawatan yang ditangani oleh tim Code Blue selama tahun 2017, dan dilakukan pada bulan November 2018. Data EWS 6 jam sebelum dan saat henti jantung, serta tindak lanjut yang dilakukan setelah penilaian EWS dicatat. Didapatkan 87 data rekam medis henti jantung yang memenuhi kriteria inklusi dan tidak termasuk eksklusi. Di antaranya, 72% memiliki catatan EWS lengkap, 9% memiliki catatan EWS tidak lengkap, dan 18% tidak memiliki data EWS. Dari 63 data rekam medis yang memiliki data EWS lengkap hanya 21% yang mendapat tindak lanjut yang sesuai dengan standar prosedur operasional EWS. Simpulan penelitian ini adalah implementasi EWS di ruang rawat inap RSUP Dr. Hasan Sadikin belum cukup memuaskan. Tindak lanjut yang dilakukan setelah penilaian EWS belum sesuai dengan standar prosedur operasional EWS yang berlaku.Kata kunci: Early warning score, henti jantung di rumah sakit, implementas