E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Systemic Immune-Inflammation Index as a Potential Indicator of COVID-19 Severity in a Tertiary Hospital in Indonesia
Full text linkBackground: The progression of coronavirus disease 2019 (COVID-19) to severe stages is strongly influenced by host immunity and inflammatory. The Systemic Immune-Inflammation Index (SII) is a novel biomarker reflecting both immunity and inflammation. This study aimed to analyze differences in SII according to COVID-19 severity.Methods: A cross-sectional study was conducted using medical records of COVID-19 patients hospitalized at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, between March 2020 and August 2021. SII was calculated as the absolute neutrophil count and platelet count divided by the absolute lymphocyte count obtained from peripheral blood samples. COVID-19 severity was classified based on oxygen saturation (SpO₂). Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the discriminatory ability of SII. Results: Of the 1,192 patients included, 410 (34.3%) had severe symptoms and 782 (65.7%) had mild to moderate symptoms. The median SII at admission was significantly higher in severe symptoms [1779 x 109 /L (IQR 46-40416)] compared with mild to moderate symptoms [880 x 109 /L (IQR 14.5-23280)]; p<0.001. ROC analysis showed an SII cut-off of 1244 with an AUC of 0.695 (95% CI 0.668–0.721), sensitivity 65.9%, and specificity 66.2%.Conclusions: SII may serve as a potential biomarker for predicting COVID 19 severity. Its simplicity and availability from routine blood counts make it particularly valuable for early risk stratification, especially in resource-limited settings. Moreover, early recognition of elevated SII could support timely interventions, prevent disease progression, and improve clinical outcomes
Determinants of Cardiovascular Disease Risk in the Chronic Disease Management Program at Pasirkaliki Public Health Center, Bandung, Indonesia
Full text linkBackground: Cardiovascular diseases (CVDs) are the leading causes of death worldwide and are influenced by multiple risk factors. Stratifying CVD risk using the World Health Organization (WHO) CVD risk charts for Southeast Asia can support routine management, especially for patients with chronic diseases. This study aimed to assess determinants of CVD risk among patients enrolled in the Chronic Disease Management Program at a Public Health Center.Methods: This cross-sectional study was conducted in June 2024 at Pasirkaliki Public Health Center, Bandung, Indonesia. Purposive sampling was applied to select medical records and data was extracted, including age, gender, smoking status, history of diabetes mellitus (DM), systolic blood pressure (SBP), and total cholesterol (TC). CVD risk was stratified using WHO CVD risk classification charts for Southeast Asia. Descriptive and correlation analyses were performed.Results: A total of 124 data patients were collected, with the majority were female adults, non-smokers, had a history of DM with grade 1 hypertension and TC levels between 5.0–5.99 mmol/L. CVD risk stratification showed 43.5% high risk, 25% moderate risk and 16.9% low risk. Interestingly, very high risk was detected in 13.7% and 0.8% was an extremely high risk. Age was strongly correlated with CVD risk (r=0.708, p<0.01), and SBP showed a moderate correlation (r=0.646, p<0.01), whereas TC levels were not significantly correlated (p=0.064).Conclusion: Patient-related factors increase the CVD risk, particularly age and SBP. Routine risk stratification and strengthened chronic disease management program are essential to reduce CVD-related morbidity and mortality
Implementation of Healthcare Failure Mode and Effect Analysis (HFMEA) as an Effort to Improve Patient Safety in Hemodialysis Services in Indonesia
No full textHemodialysis patients are at risk of preventable adverse outcomes as a result of the ongoing medical treatments required throughout their life. Minimizing risk is crucial for ensuring patient safety in healthcare environments. Healthcare Failure Mode and Effect Analysis (HFMEA) is a proactive risk assessment method designed to identify potential failures in healthcare processes and improve the quality and safety of patient care. This qualitative descriptive study aimed to identify potential failure modes in hemodialysis services in Nitipuran Hemodialysis Clinic by implementing HFMEA. A multidisciplinary team was involved as the unit of analysis to identify processes and subprocesses for in-center hemodialysis treatment. The study employed purposive sampling, selecting 10 team members who were directly involved in providing hemodialysis services. Data collected were analyzed using the HFMEA worksheet. Over five weeks, the team convened six times to identify Failure Modes (FMs) and Failure Mode Causes (FMCs), conduct a Hazard Analysis, and determine necessary actions to address the FMCs. Five processes, 23 subprocesses, 74 Failure Modes (FMs), 39 Failure Mode Causes (FMCs) were identified. Based on the Hazard Analysis results, 27 FMCs required corrective actions and thirteen actions were proposed to address the FMCs and improve patient safety based on the findings of this study. Further research is needed to evaluate the effectiveness of the implementation of these corrective actions in improving patient safety
Risk Factors for Stroke in Lacunar Ischemic Stroke Patients
No full textThe shift in global epidemiology has significantly increased the prevalence of non-communicable diseases, positioning stroke as one of the primary contributors to both disability and vascular-related mortality worldwide, with a notable impact observed in Asia. This research endeavours to explore the correlation between various stroke risk factors and the occurrence of lacunar stroke at Dr Soebandi Regional Hospital, Jember, Indonesia. Employing a cross-sectional correlational design, the study drew upon data extracted from medical records of 41 patients who had experienced a first-time ischemic stroke between 2022 and 2023. The primary variables under investigation were gender, age, hypertension, diabetes mellitus, dyslipidaemia, and heart disease. Statistical analysis conducted with Chi-square test indicated a significant association between hypertension and diabetes mellitus, with both conditions linked to an 11-fold increased risk of lacunar stroke compared to having only one condition. In contrast, factors such as age, gender, dyslipidaemia, and heart disease did not exhibit significant associations. These results emphasize the imperative for rigorous management of hypertension and diabetes to reduce the risk of lacunar stroke
In-Hospital Outcomes Comparison Between Off-Pump and On-Pump CABG: Indonesian Tertiary Center Experience
No full textBackground: Coronary artery disease (CAD) often requires revascularization. Coronary artery bypass grafting (CABG) is a cornerstone intervention that improves patients’ survival. Both on-pump and off-pump CABG have their own advantages and limitations, with reported outcomes vary across studies.Objective: to investigate the differences in the outcomes of patients undergoing off-pump and on-pump CABG.Methods: A retrospective cohort study was performed on 186 patients aged ≥18 years undergoing on-pump or off-pump CABG between June 2020 and December 2023. Outcomes included were all-cause mortality, postoperative acute renal failure, length of postoperative stay, and complete revascularization rate. Comparative analysis was conducted using Chi-Square test and independent T-test. Multivariate analysis, including logistic regression tests, was carried out to identify independent predictors associated with each outcome.Results: The on-pump group presented more diabetes (42.9% vs. 28.4%; P=0.040) and lower left ventricular ejection fraction (LVEF) values (43 [IQR 16–79] vs. 53 [23–75]; P=0.001). Patients in this group also had higher rates of postoperative renal failure (61.5% vs. 24.2%; P<0.001), longer stays (64.8% vs. 41.1%; P=0.001), and better complete revascularization (98.9% vs. 92.6%; P=0.035), but no significant difference in mortality (16.5% vs. 13.7%; P =0.594). Multivariate analysis identified diabetes, LVEF ≤40%, and postoperative renal failure as predictors of mortality.Conclusions: On-pump CABG is associated with higher rates of complete revascularization. However, the adoption of this technique is linked to a higher risk of postoperative acute kidney failure and prolonged hospital stays. No difference in mortality is observed between those with off-pump and on-pump
Effect of Spinal Anesthesia on Blood Pressure During Cesarean Section in Private Indonesian Hospital
No full textThe 2018 Indonesian Basic Health Research Data presented an increase in the number of cesarean sections from the previous years, with an increase of 17.6%. In Anugerah Bunda Khatulistiwa Hospital, a private hospital in Pontianak, Indonesia, cesarean section was performed in 689 and 641 cases in 2021 and 2022, respectively. This trend highlights the importance of understanding the anesthesia methods used during this procedure, including spinal anesthesia. Despite the common use of this type of anesthesia, spinal anesthesia an cause changes in the maternal blood pressure. This study aimed to determine the effect of spinal anesthesia on patients’ blood pressure during cesarean section. This retrospective observational analytical study was conducted at the Anugerah Bunda Khatulistiwa Hospital Pontianak, Indonesia, from May 2023 to January 2024. Medical records were selected from 246 patients using consecutive sampling method. Most patients aged between 27 and 29 years, with 207 were in the productive age group (20-35 years). The mean weight was 72.77 kg (±10.43) and the mean height was 156.70 cm (±5.85). The majority were overweight based on the BMI score (n=111), and the spinal anesthesia dose used was 15 mg bupivacaine. The Friendman test on the systolic and diastolic blood pressures before and after anesthesia to determine the effect of spinal anesthesia on blood pressure. The results showed a p-value of 0.000 (p<0.05) for both systolic and diastolic observations. This indicates that spinal anesthesia influences the blood pressure of patients undergoing cesarean sections under spinal anesthesia
Potential of Binahong Leaf Extract (Anredera cordifolia) for Anemia Treatment in Anemic Rat Model
No full textAnemia, characterized by low hemoglobin (Hb) and erythrocyte counts, can be induced by reactive oxygen species (ROS) or known as hemolytic anemia. Binahong (Anredera cordifolia) has been explored for its potential in managing anemia; yet, its efficacy against ROS-induced anemia remains under investigated. This study, conducted from January to May 2023, aimed to evaluate the potential of Binahong leaf extract (BLE) in treating anemia caused by oxidative stress. Anemia was induced by administering NaNO2 to 24 rats (Rattus norvegicus), followed by the administration of BLE at doses of 50,100, and 200 mg/kgBW for seven days. Hemoglobin levels were measured using Sahli method and erythrocytes count were determined using a Hemocytometer at three stages: pre anemia (HA), before-treatment (H0), and after-treatment (H7). Results showed that BLE significantly increased the Hb level by 1.3g/dL (p=0.000), 3.87g/dL (p=0.034), and 4.53g/dL (p=0.016) at 50 mg/kgBW, 100mg/kgBW, and 200 mg/kgBW, respectively, after treatment. Additionally, a dose of 200 mg/kgBW significally increased the erythrocyte count by 3.84 x 106 L/mm3 (p=0.033). These findings suggested that BLE has the potential to improve Hb levels and erythrocyte counts in ROS-induced anemia, indicating a promising natural approach to managing anemia
Local Tumor Control Affects Survival of Patients with Osteosarcoma and Ewing Sarcoma
No full textOsteosarcoma and Ewing sarcoma are the most common primary malignant bone tumors in children. This study aimed to analyze the characteristics of osteosarcoma and Ewing sarcoma patients at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from 2020 to 2023 and compare the one-year survival rates between patients who underwent complete treatment (surgery for local tumor control and chemotherapy) and those who received chemotherapy alone. This study used a descriptive-analytical observational design with a retrospective approach by reviewing electronic medical records from the Indonesian Pediatric Cancer Registry (IPCAR). A total of 44 osteosarcoma patients and 14 Ewing sarcoma patients who met the inclusion criteria were included. The majority of patients were boys (osteosarcoma=61.36%; Ewing sarcoma=64.29%), with a mean age of 13.5 years for osteosarcoma and 9.1 years for Ewing sarcoma. Osteosarcoma was most commonly found in the femur and tibia (90.92%), whereas Ewing sarcoma was primarily located in the axial region (71.43%). Most patients underwent chemotherapy without local tumor control (osteosarcoma=61.36%; Ewing sarcoma=57.14%). The analysis revealed a significant difference in one-year survival between patients who received local tumor control combined with chemotherapy and those who underwent chemotherapy alone (osteosarcoma p=0.000; Ewing sarcoma p=0.010). In conclusion, local tumor control significantly improves one-year survival in both tumor types
Anemia and Aggression Among Patients with Schizophrenia in Amino Gondohutomo Psychiatric Hospital
Full text linkBackground: Anemia has been identified as a potential modifiable factor influencing aggression levels in individuals with schizophrenia.Objective: To investigate the association between anemia and incidence of aggression in patients with schizophrenia in Amino Gondohutomo Psychiatric Hospital, Semarang, Indonesia.Methods: A cross-sectional study was conducted between January 2022 and December 2023 on patients with schizophrenia in Amino Gondohutomo Psychiatric Hospital, Semarang, Indonesia. Subjects were selected using consecutive sampling technique, and individuals with affective mood disorder and lost to follow-up were excluded from the study. Data were obtained through patients’ medical records, PANSS-EC scores, and hemoglobin measuring devices. Chi-square test and logistic regression were applied for statistical analyses.Results: Of 100 participants, patients with schizophrenia presented with aggression were predominantly above 40 years old (26 patients, 81.3%), women (17 patients, 51.1%), and non-anemic (17 patients, 57.1%). Gender and anemia were significantly associated with aggression in patients with schizophrenia (p <0.05). Schizophrenic patients with anemia had a 7.68-fold greater risk (95% CI: 2.70 – 21.8) of aggression. Men with schizophrenia was associated with a 2.37-fold greater risk (95% CI: 1.00 – 5.60) of aggression.Conclusion: Anemia and men seems to be risk factors of aggression in patients with schizophrenia. Further multicenter studies with larger sample size is needed to support this finding
Overnutrition Status Is Associated with Elevated Blood Pressure among Adolescents in Central Jakarta, Indonesia
Full text linkBackground: Overweight and obesity are rising among Indonesian adolescents and are known risk factors for hypertension. This study aimed to examine the relationship between overnutrition status and blood pressure among adolescents.Method: A cross-sectional study was conducted from May to September 2024, among overweight and obese adolescents aged 12–16 years in Central Jakarta, Indonesia. Nutritional status was determined by body mass index (BMI) Z-scores based on CDC growth charts, adjusted for sex and age. Blood pressure was measured using a digital sphygmomanometer and classified according to the 2017 AAP guidelines. Data were analyzed using chi-square tests. Results: A total of 98 adolescents participated (67.3% male; mean age 13 years). Overweight (49%) and obesity (51%) were almost equally distributed, with the highest BMI recorded at 46.7 kg/m². More than half (58.2%) had elevated blood pressure, with one case reaching grade 2 hypertension (143/84 mmHg). Overnutrition status was significantly associated with elevated blood pressure (p=0.044). Stratified analysis showed a strong association among males (p=0.005), where 42.4% of obese males exhibited elevated blood pressure, but no significant association was observed among females (p=0.58).Conclusion: Overnutrition is significantly associated with elevated blood pressure among adolescents, particularly in males. Early interventions promoting balanced nutrition, physical activity, and healthy lifestyle habits are critical to reducing the long-term cardiovascular risk in this age group