Majalah Kedokteran Bandung
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Diagnostic Challenge of Adult-onset Type 1 Diabetes Mellitus in a Remote Hospital
Full text linkType 1 Diabetes Mellitus (T1DM) is a chronic endocrinological disease due to an autoimmune process. The prevalence of T1DM is 9.5% worldwide, with the incidence of 15 out of 100,000 people, ranging from childhood to 40 years of age. Autoimmunity-related late-onset Diabetes Mellitus (DM) patients could be diagnosed as classic T1DM or latent autoimmune diabetes in adults (LADA). A 30-year-old male patient with unremarkable previous medical history was admitted to the emergency room with dyspnea for the last three days that was worsened six-hour before admission. Physical examinations showed a body Mass Index (BMI) of 18.75 kg/m2, irregular pulse, and Kussmaul breathing. The patient was diagnosed with diabetic ketoacidosis (DKA) on May 23, 2019. He was discharged with subcutaneous insulin pen injections. Two years later, he was readmitted with DKA due to discontinuing his treatment. He stated that the reason for stopping the insulin was because he was tired of injecting it. The patient was hospitalized and was discharged with oral antidiabetic agents to cope with his injection tiredness issue. One week later, the patient complained of dyspnea and was diagnosed with recurrent DKA. He was hospitalized and prescribed subcutaneous insulin. In this kind of situation, a diagnosis of LADA for patients presenting with DKA without prior history of DM in early adulthood needs to be considered. In contrast to the classic T1DM, the need for insulin occurs late in LADA. Affordable and widely available ancillary examinations are needed, including in remote hospitals. Finally, motivational support for patients is as important as the pharmacological treatment since lifelong insulin injections are needed
Age, Gender, and Preoperative LVEF Influence on ICU Length of Stay After CABG
Full text linkCoronary artery bypass graft (CABG) surgery is a surgical therapy for coronary artery disease (CAD) patients who cannot be solely treated using pharmacological therapy. Patients undergoing CABG surgery require careful postoperative monitoring in the intensive care unit (ICU). This leads to the need for careful selection of patients due to the limited number of ICU beds available. A prolonged stay in ICU could delay surgery for other patients. This retrospective study analyzed how preoperative factors such as age, gender, and preoperative left ventricular ejection fraction (LVEF) may influence patient's length of stay (LOS) in the ICU. For this study, subjects were patients undergoing isolated CABG in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, during the period of January 2019- December 2020 who were selected using the simple random sampling method. The subjects were categorized into 96 hours) and non-prolonged ICU LOS (65 years old) is at a higher risk of having prolonged ICU LOS after CABG; thus, a careful scheduling of patients for CABG surgery by age is important to prevent prolonged ICU LOS after CABG
Validity Test For C-Reactive Protein and Ferritin Level in Moderate and Severe Covid-19 Patients
Full text linkMild, moderate, severe, and critical COVID-19 are associated with hyperinflammation. The CRP and ferritin are acute phase proteins that marks incidence of inflammation and used as the paramaters of hyperinflammation. This study aimed to determine the validity of CRP and ferritin level examination in moderate and severe COVID-19 since the time of admission. This was a cross-sectional analytical retrospective study with on moderate and severe COVID-19 patients admitted to Dr. Hasan Sadikin General Hospital Bandung, Indonesia, during the period of March 2020 to December 2020. The CRP and ferritin levels were obtained since the beginning of admission to the fourth day since admission on patients without any history of anemia. Subjects in this study were divided into moderate and severe COVID-19 groups based on the 3rd edition of COVID-19 Prevention and Control Guideline issued by the Ministry of Health Republic of Indonesia. Each group consisted of 30 subjects. The cut-off value was 7.65 mg/dL (AUC 0.698) for CRP and 963.1 mcg/L (AUC 0.938) for ferritin. The validity of ferritin vs CRP were reflected respectively as follows: 93.3% vs 76.7% sensitivity; 80.0% vs 63.3% specificity; 82.4% vs 67.6% PPV; and 92.3% vs 73.1% NPV. The validity of ferritin was proven to be superior as it significantly increases since day one, persisted longer and reaches its peak on the16th day. Meanwhile, CRP increases within 6-8 hours and reaches its peak within 48 hours after inflammation, then declines soon afterwards
Hospital Management Information System Implementation Assessment Using HOT-FIT Model in Langsa General Hospital Aceh, Indonesia
Full text linkIn providing the best health care to the community, hospitals as health care facilities utilize technologies that are influenced by developments and advances in medical sciences and technologies. One of such technologies is the information management technology. Since the quality of information processing is an essential factor for succesful medical care of patients, Regulation of the Minister of Health of the Republic of Indonesia Number 82 of 2013 requires all hospitals to implement a hospital information management system (HIMS). To assess the successful implementation of HIMS, various models and frameworks have been developed, including the HOT-FIT model. This study aimed to analyze the implementation of the hospital management information system at Langsa General Hospital, Aceh, Indonesia, using the HOT-FIT model which applied the SEM-PLS method. This quantitative study was performed in approximately three months using the HOT-FIT (company, technology-FIT human,) framework that includes nine variables of system quality, information quality, service quality, organization structure, facility situations, support from leadership, system usage, user satisfaction, and net benefits. Data analysis was performed using the SEM-PLS analysis in SmartPLS application (V.3.2.9). Results showed that human, organization, and technology supports were factors that influence the successful implementation of HIMS. To conclude, the HOT-FIT model can be used to identify the factors that influence the successful implementation of HIMS to inform the HIMS improvement in the hospital that will eventually improve the hospital’s quality system, information, service quality, and user satisfaction
Comparison of Several Indonesian Medicinal Plants Effects on LDL-C and IL-6 Levels in Wistar Rats After High Fat Feeding
Full text linkHigh-fat diet habits lead to an increase in LDL-C levels that eventually influence the atherosclerotic plaque formation and progression, causing coronary heart disease. Atherosclerosis is a chronic inflammatory process that releases various pro-inflammatory cytokines, including IL-6. Indonesians often use medicinal plants to decrease cholesterol levels. This study aimed to compare the LDL-C and IL-6 levels after treatments of ethanol extracts from Java ginger (EEJG), turmeric (EET), garlic (EEG), and pomegranate flowers (EEPF) in a hypercholesterolemia animal model. This study was conducted at the Maranatha Biomedical Research Laboratory from June–December 2020. Male Wistar rats were divided into six groups (n=5 per group) and received high-fat feeding and 0.01% propylthiouracil. The following treatments were given for 28 days: oral carboxymethylcellulose 1% for negative control; 35 mg/200g of oral EEJG, EET, EEG, EEPF for respective treatment groups (n=5 groups); and 0.36 mg/200 g of oral Rosuvastatin for positive control. It was demonstrated that the mean LDL-C levels were 65.75 mg/dL, 55.25 mg/dL, 56.75 mg/dL, and 59.60 mg/dL for EEJG, EET, EEG, EEPF groups, respectively, which were significantly different from that of the negative control (81.73 mg/dL). The IL-6 levels of the EEJG (27.55 pg./mL) and EEG (27.54 pg./mL) group were significantly different from the EEPF group (24.5 pg./mL) but not significantly different from the negative control (25.58 pg./mL), EET (25.60 pg./mL), and rosuvastatin (26.09 pg./mL) groups. The administration of ethanol extracts of Java ginger, turmeric, garlic, and pomegranate flower decreases the C-LDL levels; however, only the ethanol extract of pomegranate flowers administered for 28 days decreases the IL-6 levels of Wistar rat hypercholesterolemia model, albeit insignificantly
Correlation Analysis of Lactic Acid Level as A Predictor of Severity of Patients with Acute Appendicitis
Full text linkPerforated appendicitis is a leading cause of morbidity and mortality in all appendicitis cases, both for adults and children. Delay in preoperative diagnosis is the main reason for perforation. In previous studies, it was revealed that diagnostic modalities such as radiological examination and the current scoring system have not been able to predict the onset of perforated appendicitis. Serological biomarkers of lactic acid are associated with intestinal obstruction and ischemia. The increase in the serological value of lactic acid in perforated appendicitis compared to acute one was shown to increase significantly by 0.25 mmol/L (p<0.05) according to a previous study. This study aimed to determine the correlation between lactic acid level and the severity of appendicitis in patients visiting Dr. Hasan Sadikin General Hospital. This was a cross-sectional prospective analytic observational study on adult patients diagnosed with appendicitis who were admitted to the emergency room of Dr. Hasan Sadikin General Hospital from January 1, 2021 to June 1, 2021. Data analysis was performed using bivariate analysis and correlation tests of difference. This study involved 54 subjects with a mean lactic acid level of 2,5093 mmol/L (0.9 mmol/L - 11.8 mmol/L). In the complicated appendicitis group, 20 subjects (37%) was found to experience an increase in lactic acid (OR 1.07; 95% CI: -0.03-0.22; p=0.14). The correlation analysis showed the direction of negative correlation. Thus, it is concluded that there is no significant correlation between lactic acid level and the severity of appendicitis in patients with appendicitis
Ajwa Date (Phoenix dactylifera L.) Extract to Prevent Alzheimer’s Disease in Rat Model
Full text linkAlzheimer's disease (AD) is the most common disease of aging characterized by increased extracellular deposits of amyloid-β (Aβ) in the brain. Globally, the number of people affected by AD has increased from 35.6 million in 2010 to 46.8 million in 2015. Ajwa dates contain phenolic compounds that can protect against inflammation and oxidative stress in the brain. This study aimed to analyze the effect of the dose and duration of Ajwa date extract administration on IL-6 levels and SOD activity in rats induced with 400 mg/day homocysteine to trigger Alzheimer's Disease. This was a laboratory experimental study with a pretest-posttest group design conducted at the Laboratory of the Center for Food and Nutrition Studies (PSPG), Universitas Gadjah Mada, Yogyakarta, Indonesia from December 2020 - January 2021. A total of 48 rats were divided into one control group, one untreated group, and 4 treatment groups that received different doses of Ajwa Date Extract (ADE) for 21 and 28 days in rats. The results showed that the administration of ADE (Ajwa date extract) for 21 and 28 days could reduce IL-6 levels but did not have the same effectiveness as donepezil. The administration of 800 mg/kg BW ADE for 28 days can increase SOD activities with the same effectiveness as donepezil. Ajwa date extract can be proven to have beneficial effects to prevent Alzheimer's disease and can be used to prevent decreased antioxidant and increased inflammation. Thus, further studies to explore the potential clinical use of the extract to manage Alzheimer's Disease may be beneficial
Effect of High Fat and Cholesterol Diet on Total Blood Cholesterol Levels in Pregnant Wistar Rats
Full text linkHypercholesterolemia during pregnancy is a physiological condition resulting from increased insulin resistance, lipoprotein synthesis, and lipolysis in adipose tissue, which mobilizes lipids as an energetic substrate for fetal growth. Consumption of foods high in fat and cholesterol may lead to an increase in total blood cholesterol levels during pregnancy due to saturated fat and cholesterol contents that will increases the synthesis of lipoproteins in the blood. The objectives of this study were to determine the effects of high fat and cholesterol diet on the total blood cholesterol levels in pregnant Wistar rats. This study was a true experimental research using a randomized post-test-only control group design conducted from November 2020 to October 2021on fourteen female Wistar rats that were divided into control and intervention groups. Cow brain was provided as the high fat and cholesterol diet and after the rats gave birth, blood was drawn from the heart. The total blood serum cholesterol levels were assessed using Micro Lab 300 with the CHOD-PAP method and the data were analyzed using an independent t-test. This study showed that the mean total blood cholesterol levels for the control and treatment groups were 80.43±18.512 mg/dL and 142.57±24.786 mg/dL, respectively, which reflected a significant differences in the mean total blood cholesterol level between the control and treatment groups (p-value <0.01). In conclusion, a high fat and cholesterol diet affects the total blood cholesterol level in pregnant Wistar rats