Majalah Kedokteran Bandung
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HbA1c Level in Type 2 Diabetes Mellitus Patients With and Without Obesity in An Indonesian Regional Hospital
Full text linkDiabetes Mellitus (DM) is a disease characterized by hyperglycemia due to insulin deficiency or impaired insulin function. The International Diabetes Federation (IDF) estimated that approximately 463 million people aged 20 to 79 years old were affected by DM worldwide in 2019. Indonesia is the third highest with a prevalence of 11.3%. More than 90% of diabetic patients are obese which reduced insulin sensitivity. This study aimed to determine the difference in HbA1c levels between obese and non-obese patients with Type 2 Diabetes Mellitus (T2DM) at Tarakan Regional Hospital, Indonesia. Data from medical records of T2DM patients from January to December 2023 were collected based on inclusion and exclusion criteria using consecutive sampling method, resulting in 128 samples. The results of the study, as determined using the Mann Whitney test, indicated a significant difference in the HbA1c levels between T2DM patients with and without obesity (p=0.031), with non-obese T2DM patients tend to have better HbA1c control compared to their obese counterparts. Thus, it can be inferred that obesity affects the blood glucose control in diabetic patients. However, this result needs to be further researched as there are a few limitations inherent to this study, particularly the partial availability of certain medical record information, such as duration of diagnosis and medication adherence
Comparison of Sensitivity and Specificity between B.I.L.E. Criteria and Tokyo Guidelines 2018 (TG18) for Diagnosing Acute Cholangitis
Full text linkAcute cholangitis is an inflammatory condition of the biliary system due to bacterial infection associated with biliary stasis or obstruction. Diagnosis is made using the Tokyo Guidelines 2018 (TG18) criteria. The biliary imaging abnormality, inflammatory test abnormality, liver test abnormality, and exclusion of cholecystitis/pancreatitis (B.I.L.E.) criteria are relatively new, with limited studies evaluating their sensitivity, specificity, and validation. This study aimed to compare the sensitivity and specificity of B.I.L.E. and TG18 criteria for the diagnosis of acute cholangitis. This is an observational analytic study with prospective cohort design during May 2023–May 2024. Data were obtained from patients who came to the Emergency Department of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, with clinical symptoms of fever and jaundice, suspected of acute cholangitis. There were 95 subjects in this study. Based on B.I.L.E. criteria, 57 (60%) patients were categorized as high probability and 38 (40%) patients were categorized as unlikely acute cholangitis, while the TG18 criteria resulted in 61 (64.2%) patients classified as definite and 34 (35.8%) patients classified as suspected acute cholangitis. The sensitivity of the B.I.L.E. criteria was 92.1%, with a specificity of 94.73%. Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of B.I.L.E. criteria were 92.1% and 94.73%, respectively. In contrast, the sensitivity and specificity of TG18 criteria in this study were 82.35% and 83.6%, respectively. The PPV of TG18 reached 73.68% while the NPV of TG18 reached 89.47%. In conclusion, B.I.L.E. criteria have higher sensitivity and specificity than TG18 criteria in diagnosing acute cholangitis patients
Skinfold Thickness and Mid-upper Arm Circumference in Pediatric Patients with Chronic Kidney Disease
Full text linkChronic kidney disease (CKD) can impair the kidneys' capacity to manage nutrition, and any nutritional imbalances in CKD may affect the disease's progression. This study evaluated triceps skinfold (TSF) thickness and mid-upper arm circumference (MUAC) as indicators of nutritional status in children with early- and late-stage CKD at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. A descriptive cross-sectional design was used with secondary data from the nephrology division registry collected between August 2021 and August 2022. Data analysis was conducted with Microsoft Excel. The study involved 65 participants, with 32 in the early stage and 33 in the late stage. For early-stage patients, the average TSF was 13.75 mm and the MUAC was 12 cm, while, the average TSF an MUAC in the late stage were 11.39 mm and 11.70 cm, respectively. Based on TSF percentiles, most patients fell within the normal range, whereas MUAC measurements indicated that the majority were below normal. In terms of %TSF, most early-stage patients had above-average values, whereas late-stage patients were below average. All MUAC measurements indicated below-average values for both stages. Overall, TSF percentiles suggested that most patients had adequate nutritional status; however, %TSF revealed excess adiposity in early-stage patients and deficits in late-stage patients. MUAC consistently indicated deficits across both groups
Effect of Isocenter Placement at Nasion and Symphysis Menti on the Quality of MRI Images in Cases of Nasopharyngeal Cancer
Full text linkMagnetic Resonance Imaging (MRI) examinations require precise placement of the isocenter as it directly influences the quality of MRI images. In the context of nasopharyngeal MRI examinations, different opinions regarding the optimal placement of the isocenter exist. Currently, two methods of isocenter placement are commonly applied, i.e., nasion and symphysis menti isocenter placement. This study aimed to analyze how these different isocenter placements affect the quality of MRI images in T2 Turbo Spin Echo sequences of the nasopharynx in the coronal plane. This study was conducted in June 2023 at the Radiology Installation of Dharmais Cancer Hospital, Jakarta, Indonesia. This study used the quantitative experimental approach. Six samples were purposively selected from nasopharyngeal cancer patients, and two treatments were conducted: isocenter placement at the nasion and isocenter placement at the symphysis menti. Data processing was performed using a statistical software. The results of the Wilcoxon test for image quality from the perspective of the signal-to-noise ratio (SNR) yielded a p-value of 0.173, which was greater than 0.05, indicating that there was no significant difference in image quality as measured by the SNR between the two isocenter placements. Similarly, the paired sample t-test for image quality in terms of the contrast-to-noise ratio (CNR) resulted in a p-value of 0.610, which was also greater than 0.05. This demonstrated no significant difference in the image quality between the two isocenter placements from the perspective of the CNR measures. Thus, both isocenter placements resulted in comparable image quality
Comparison of CONUT Score, SGA Score, and GLIM Score as Gold Standard for Colorectal Cancer Patients
Full text linkMalnutrition in colorectal cancer increases toxicity, worsens quality of life, and reduces body functions. Early identification of malnutrition is crucial to determine treatments. This study compared the Global Leadership Initiative on Malnutrition (GLIM) score as the standard nutritional status screening tool to the Controlling Nutritional Status (CONUT) and Subjective Global Assessment (SGA) scores. This study expected to identify a new nutritional status screening tool for colorectal cancer patients. This was a cross-sectional diagnostic study on 60 colorectal cancer patients treated at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia from August 16, 2022 to July 16, 2023. Results revealed that the CONUT score had a sensitivity, specificity, accuracy, and effectiveness values of 80.4%, 0.0%, 85%, and 85%, respectively, in detecting malnutrition. The SGA score had a sensitivity value of 100%, a specificity value of 21.95%, an accuracy value of 85%, and an effectiveness of 85% in detecting malnutrition. When compared with the GLIM score as the gold standard, which is assumed to have a sensitivity and specificity values of 100%, the SGA score was better than the CONUT score for detecting malnutrition in colorectal cancer patients. The SGA score is closest to the GLIM score as the gold standard for assessing malnutrition in colorectal cancer patients
Family Support and Medication Adherence in Patients in Prolanis Program
Full text linkThe Chronic Disease Management Program, or Program Pengelolaan Penyakit Kronis (Prolanis), is a disease management program designed for individuals with chronic illnesses. It aims to maintain health and improve quality of life. The success of Prolanis depends not only on patient adherence to medication but also on family involvement as the primary source of support. This study aimed to examine the relationship between family support and medication adherence among Prolanis patients at Batoh Public Health Center, Banda Aceh, Indonesia. An observational analytic study with a cross-sectional design was conducted using consecutive sampling of 74 Prolanis participants. Data were collected through guided interviews. Among the participants, 33 individuals (44.5%) exhibited low medication adherence, while 41 individuals (55.5%) demonstrated high adherence. Additionally, 8 participants (10.8%) reported poor family support, whereas 66 participants (89.2%) received good family support. Data analysis using the chi-square test revealed a significant relationship (p=0.009) between family support and medication adherence. Therefore, it can be concluded that family support is significantly associated with medication adherence in Prolanis patients. Families are the main supporters in maintaining the health of their family members, with an important role in encouraging, supporting, and supervising patients' treatment. Good support and constant encouragement and attention can increase patients' confidence, which in turn will affect their adherence to treatment
Preventing the Incidence of Severe Preeclampsia by Maintaining an Ideal Body Weight During Pregnancy
Full text linkPreeclampsia is a pregnancy-specific disease potentially leading to complications, morbidity, and mortality. In general, obesity may cause preeclampsia through several common mechanisms. This study aimed to examine the association between obesity and the incidence of severe preeclampsia (SP) at Dr. Dradjat Prawiranegara General Hospital, Serang, Indonesia. A retrospective cohort design was used and the sample comprised of 168 parturients (84 SP and 84 non-SP subjects). Sample selection was consecutively conducted from June to November 2023, while data were analyzed using the Chi-Square test and multivariable analysis with multiple logistic regression. There was a statistically significant relationship between nutritional status and obesity in participants with SP history (p<0.05). Obese women had a 2.96 times higher risk of developing SP compared to non-obese. Additionally, the study found that multigravidas (≥G2) had a 2.19 times higher risk of suffering from SP compared to primigravidas (G1) (p=0.019). Furthermore, women who only completed ≤ junior high school education had a 2.14 times higher risk of suffering from SP compared to those who completed ≥ high school (p=0.060). In conclusion, women in delivery who suffered from obesity have a 2.68 times greater risk of suffering SP than non-obese, as evident from both bivariable and multivariable analyses
Closure Techniques and Postoperative Outcomes of Major Lower Limb Amputation in Acute Limb Ischemia
Full text linkAmputation, derived from the Latin "amputare," refers to the removal of a body part covered by skin, often necessitated by acute limb ischemia (ALI). Effective wound closure is critical for minimizing complications, length of stay, costs, and the risk of re-amputation. This study compared postoperative outcomes of major lower limb amputation in ALI patients with primary versus delayed wound closure. A descriptive analytic study was conducted at Dr. Hasan Sadikin Hospital, Bandung, Indonesia, from January 2020 to December 2023, analyzing medical records of 46 patients aged 19–85 years, with a predominance of female patients. Thrombosis was the leading cause of ALI (76.1%), and hypertension was the most frequent comorbidity. Significant differences were observed in stump complications and revision surgery rates between primary and delayed wound closure groups (p<0.05), while length of stay and mortality did not show statistically significant differencesy. In conclusion, the study highlights a significant relationship between different wound closure methods and complications, suggesting that choice of closure technique may influence the postoperative outcomes in ALI patients
Antibacterial Activity of Mangrove Leaves Extract (Rhizopora Apiculata) Against Salmonella typhi Growth
Full text linkMangrove leaves (Rhizopora apiculata) contain antibacterial chemical compounds with antibacterial properties against various pathogens. Salmonella typhi, the causative agent of thyphoid fever, triggers a systemic infectious disease that can lead to complications and deaths if not treated properly. This study aimed to screen the phytochemical content of R. apiculata leaf extract, evaluate its antibacterial activity against S. typhi, and determine the optimal inhibitory concentration. Leaves were collected from the Sicanang mangrove forest in Belawan, North Sumatra, Indonesia, and extracted using the maceration method with 96% ethanol. Antibacterial effectiveness was assessed using disc diffusion method by measuring the zone of inhibition after exposure to mangrove leaf extract at concentrations of 40%, 60%, 80%, and 100%, with chloramphenicol as a positive control, to determine the most effective concentration for inhibiting the growth of Salmonella typhi. The results of the study showed that there were differences in inhibition zones in each group. Mangrove leaves extract at a concentration of 100% is the most effective in inhibiting the growth of Salmonella typhi compared to 80%, 60%, and 40% concentrations
Home Environmental Hazard as Extrinsic Factors For Falls Among Community-Dwelling Elderly
Full text linkFalls among the elderly are a major concern in both clinical practice and public health. Studies have shown that falls occur more frequently at home than outside home.This study aimed to identify the areas and types of home environmental hazards present in the residences elderly individuals. A quantitative descriptive study was conducted from April to May 2024 accross six primary healthcare centers in Bandung, West Java, Indonesia, selected from having the highest number of elderly patients. A total of 100 elderly respondents were recruited using a multistage purposive convenience sampling method. Data collection was carried out using an instrument consisting of two parts: the first part focused on respondent characteristics and the second part on home environmental hazards.The study variables were respondent characteristics and environmental hazards in the terrace, living room, stairs, bedroom, bathroom, kitchen, and garage. Data were analyzed using Microsoft Excel software and presented in tabular form. Results showed that all areas of the home posed potential hazards, with the presence of scattered items on the floor as the commonly identified risk. In specific areas such as the kitchen, high shelves were found, and in the bathroom, there were slippery floors, squat toilets, absence of handrails, and inward-opening bathroom door. Home can be a source of environmental hazards that increase the fall risk among the elderly. It is essential to provide the elderly with adequate information on these risk to encourage preventive actions and, where necessary, home modifications that improve safety and reduce the risk of falls