Majalah Kedokteran Bandung
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Case Report on Painful Patellar Crepitation Following a Knee Replacement with Preserved Patella
Full text linkPatellar clunk crepitation is a well-known complication following knee replacement surgery and is associated with posterior stabilized knee replacement surgery and surgical technique. Currently, patellar clunk or crepitation management following knee replacement surgery with preserved patella remains unclear. The purpose of this case report is to discuss whether patellar clunk or crepitation management should include debridement with patellar resurfacing or debridement alone. This case describes a patellar crepitation after knee replacement surgery with the preserved patella. The surgery went uneventfully using the standard medial parapatellar approach. However, the patient was still unsatisfied with the chronic left knee pain (>3 months) and crepitation that developed following the surgery, and the patient was diagnosed with patellar clunk and crepitation (PCC). A patellar resurfacing procedure was performed with a satisfactory clinical outcome. Replicating the original joint line level and placing the tibial component posteriorly play a pivotal role in preventing PCC. Debridement and patellar resurfacing procedures are recommended in this type of case to overcome the valgus knee alignment and the placement of the tibial component
Anxiety (DASS21) and the Quality of Life (FertiQol) of Infertile Women Underwent In Vitro Fertilization
Full text linkInfertility affects physical and mental health and has various consequences. In vitro fertilization (IVF) is one of the Assisted Reproductive Technology (ART) programs that include several phases, requiring longer time, more patience, and is expensive. This may make women who undergo the ART program to have higher stress level, especially anxiety. This study aimed to determine the relationship between anxiety and quality of life in infertile patients undergoing assisted reproductive technology programs. This was a cross-sectional observational analytic study performed at Aster Fertility Clinic, Dr. Hasan Sadikin General Hospital and Bandung Fertility Center, Limijati Hospital Bandung, Indonesia, from February until April 2020. The analysis was performed using the DASS21 scale and FertiQol count on 27 subjects undergoing the IVF program and 30 control subjects who were pregnant without IVF program. The statistical analyses used to determine the condition of anxiety and the condition of quality of life were the Chi-square and the Mann-Whitney tests, while the relationship between anxiety and quality of life as the main subject was measured using the Spearman correlation test. The anxiety level as measured with the DASS21 instrument in the subject and control groups was 6.2 vs 0.7 with p<0.001. From the analysis of the FertiQol instrument in the subject and control groups, the scores were 79.6 vs. 98.9 for the mind-body domain (p<0.001); 68.8 vs 98.5 for the emotional domain (p < 0.001); 83.2 vs 95.7 for the relational domain (p<0.001); and 77.6 vs 97.6 for the social domain (p<0.001). For the overall FertiQol core domains, the score was 77.3 vs 97.7 (p<0.001). The correlation between anxiety and the FertiQol total core domains were evident from the results of the Spearman correlation test, with an r-value of -0.479 (p<0.001). Therefore, there is a significant negative correlation between anxiety and quality of life
In-silico study of the Effectiveness of Allium sativum L. extract as an Angiotensin-Converting Enzyme (ACE) Inhibitor in Hypertension
Full text linkOver the last decade, the global prevalence of hypertension rate has increased by 5.2% and, in Indonesia, the prevalence rate has increased significantly from 25.8% in 2013 to 34.1% in 2018. Hypertension treatments using blood pressure-lowering drugs, such as angiotensin-converting enzyme (ACE) inhibitors, often cause unpleasant side effects. These side effects increase the interest in using potentially effective natural remedies, such as garlic. This study aimed to determine which organosulfur compounds in garlic can act as an ACE inhibitor to reduce blood pressure in hypertension using a cheminformatics approach. Eighteen organosulfur compounds of Allium sativum L. were screened based on Lipinski’s rules and ADMET evaluation. Seven compounds passed the screening and were subjected to QSAR analysis, molecular docking analysis, and molecular dynamics simulations to assess the stability of the protein. The seven compounds then underwent molecular docking and QSAR analysis. Ajoene (4,5,9-trithiadodeca-1,6,11-triene-9-oxide) and S-allylmercaptocysteine (SAMC) were two compounds with better docking values compared to the positive control compound. The QSAR analysis also showed that SAMC had an activity as an ACE inhibitor. The ADMET evaluation showed that Ajoene and SAMC had good absorption and could not penetrate the blood-brain barrier. Molecular dynamics simulation of ACE complexes Ajoene, SAMC, and Captopril ranged from 0.05 to 5.61 Å but exhibited a pattern of synonymous fluctuations for most residues. Based on the simulation data, the organosulfur compounds from garlic, Ajoene, and SAMC are proven to have a mechanism of action as ACE inhibitors to reduce blood pressure in hypertension
Non-Metallic and Metallic Toxicant Exposures from Personal Care Products in Indonesian Male and Female Medical Students
Full text linkStudents can gain various benefits from their daily personal care products. However, the chemicals contained in these products may have adverse health effects. Regardless the inspection performed by regulatory agencies on these products, the products circulating in the market may still contain toxicants thus may jeopardize their safety for use. This study evaluated toxicant ingredients contained in personal care products used by male and female college students. This study was conducted from September to December 2022 on 23 male and 46 female college students of the Faculty of Medicine, Universitas Andalas, Indonesia. Data were collected using a 69-items validated questionnaire. Results were then presented as a distribution of products used categorized by body areas and potentially toxic metallic and non-metallic ingredients identified from their labels. Female college students used at least 10 personal care products, with a median of 19 products. Male students used at least four products and a median of eight products. Investigation on the label of skin, hair, eye, dental and oral, lips, and nail personal care products demonstrated the presence of metallic and non-metallic toxicants. Five metallic toxicants (aluminum, titanium, zinc, copper, and chromium) and 15 non-metallic toxicants (triclosan, talc, fragrance, parabens, butylated hydroxyanisole, butylated hydroxytoluene, diethanolamine, triethanolamine, butylene glycol, propylene glycol, polyethylene glycol, phthalates, benzophenone-3, acetone, and fluoride) were identified. Thus, numerous toxicants are present in marketed personal care products, and females are exposed more than males to these toxicants. Consumers need to be more critical in their choice of personal care products
Comparison of Preemptive Post-Intubation 15 Mg/KgBW Paracetamol to 0.35 Mg/KgBW Meperidine in Incidence of Post-Anesthetic Shivering
Full text linkPost anesthesia shivering (PAS) is a repetitive involuntary movement of one or more muscle groups as a result of a decrease in core body temperature. Pharmacological therapy in preventing PAS may include meperidine and paracetamol. This study compared the effectiveness of paracetamol to meperidine in reducing the incidence of post-anesthesia shivering. This study used an experimental randomized double-blind comparative analytic design on patients underwent exploratory laparotomy surgery under general anesthesia at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from September 2021 to August 2022. Patients with 50 ASA 1-2 physical status were included and divided into two groups. One group received 15 mg/kg group paracetamol and the other received 0.35 mg/kg meperidine. Data on tympanic membrane temperature and hemodynamics before and after induction and after extubating were collected. Furthermore, data on the results of the assessment of the incidence and grade of shivering in each treatment group were also collected. The results of this study showed that there was a decrease in the frequency of PAS in patients receiving intravenous 15 mg/kg paracetamol (p<0.05), as well as less side effects in the form of nausea and vomiting (p < 0.05). The incidence and degree of shivering after general anesthesia using intravenous 15 mg/kg paracetamol was lower compared to the use of 0.35 mg/kg meperidine. In the meperidine group, the decrease in body temperature was lower than in the paracetamol group, while the incidence of nausea and vomiting in the paracetamol group was lower than in the meperidine group. In conclusion, paracetamol reduces the incidence of post-anesthesia shivering better than meperidine
Effect of Hypervirulent Strains, Antibiotic Resistance, and Host Characteristics on Mortality of Klebsiella pneumoniae Bacteremia Patients at a Tertiary Referral Hospital in Denpasar, Indonesia
Full text linkKlebsiella pneumoniae bacteremia is one of the leading causes of sepsis that has a high mortality rate. The effect of multidrug resistance and different virulence of Klebsiella pneumoniae on mortality is still controversial. This study aimed to determine the impact of hypervirulent K. pneumoniae (hvKp), MDR, and clinical characteristics on mortality of K. pneumoniae bacteremia patients. A retrospective cross-sectional study was conducted on K. pneumoniae bacteremia cases of patients hospitalized at Professor dr. I.G.N.G Ngoerah General Hospital from December 1, 2020, to May 31, 2021. A positive PCR of rmpA, iucA genes, and/or a positive string test was identified as hvKp. The mortality rate of 51 K. pneumoniae bacteremia patients samples (aged 0-74 years) was 72.5%, in which 9.8% (5/51) of them were hvKp and 51% of the isolates (26/51) produced the Extended Spectrum Beta Lactamase (ESBL). Furthermore, 9.8% (5/51) of the cases were carbapenem-resistant. Thus, hvKp, MDR, gender characteristics, and comorbidities do not significantly affect the mortality of K. pneumoniae bacteremia patients. Multivariate logistic regression analysis showed that sepsis (odds ratio (OR) 4.29; p=0.038) and adult age group (mean 50 years) (OR 3.75; p=0.039) are independent predictors with a significant effect on mortality of K. pneumoniae bacteremia patients. Careful and integrated management of K. pneumoniae bacteremia patients is essential for better outcomes, especially in sepsis and elderly patients. Although hvKp prevalence is low, emerging MDR-hvKp in health facilities is a severe concern for further actions and research
Pneumonia Clinical Features in Under-Five Children Treated in Atma Jaya Hospital in 2017-2020
Full text linkPneumonia is the leading cause of infection-related death among children and still remains a global health problem, especially for children under five. This study aimed to identify the clinical features of pneumonia in under-five chilren treated at Atma Jaya Hospital during the period of 2017-2020. This was a cross-sectional retrospective descriptive study on all under-five patients diagnosed with pneumonia treated in Atma Jaya Hospital. Data were collected from November 2021-January 2022 from the medical records of these children (n=148) and analyzed using the univariate analysis. Results showed that most subjects of this study were boys (60.8%), in the age group of 1-4 years old (62.2%), with fever as the most common pnemonia clinical symptom (93.9%). Physical examinations revealed that the average pulse of the subjects were 131.2 beats/minute and the average temperature was 37.1°C. Other signs and symptoms identified during physical examinations were tachypnea (20,3%), retractions (56.1%), crackles (82.4%), and wheezing (22,3%). The laboratory findings presented a mean hemoglobin of 11.0 g/dL, a mean hematocrit of 32.5%, and a mean CRP of 13.2 mg/dL, while most subjects had normal leukocyte (58.1%) and platelet counts (52.0%). The most common chest X-ray finding of pneumonia in these children was infiltrate (92.6%) and the average length of stay was 4 days. Most under-five children experiencing pneumonia recovered after treatment (97.3%)
Differences in Neutrophil Lymphocyte Ratio (NLR) between Sepsis and Septic Shock Patients in a Tertiary Hospital in Indonesia
Full text linkSepsis is a severe medical condition characterized by organ dysfunctions resulting from the body's response to an infection. Septic shock is a complication of sepsis that involves circulatory, cellular, and metabolic disturbances. The body's response to infection is typically marked by an increase in neutrophils and a decrease in lymphocytes, leading to increased Neutrophil Lymphocyte Ratio (NLR). This study aimed to investigate the differences in NLR between sepsis and septic shock patients treated at Dr. H. Abdul Moeloek Provincial Hospital, Lampung, Indonesia. This study utilized a comparative analytic study approach with a cross sectional design. A total of 96 sepsis patients who met the inclusion and exclusion criteria treated during the period January 2018 - December 2020 at Dr. H. Abdul Moeloek Provincial Hospital, Lampung, Indonesia, were included in this study. The study found that most of sepsis patients showed an increase in neutrophils (89.58%), a decrease in lymphocytes (94.79%), and elevated NLR values (87.5%). The mean NLR value of septic shock patients (20.10±5.89) was significantly higher than that of sepsis patients (18.01±1.35) (p=0.025). It indicates that the NLR value increases significantly in patients who develop septic shock compared to those with sepsis alone. The findings suggest that NLR could be a potential biomarker for septic shock diagnosis. However, the effectiveness of NLR in predicting the severity of sepsis and determining the risk of mortality in these patients still needs to be examined by conducting studies that involve a larger sample size
Use of sEMG for Swallowing Muscles Activity Quantification in Acute Phase of Stroke
Full text linkEarly diagnosis of dysphagia and aspiration risk is very important in minimizing the risk of various medical consequences. This study aimed to establish a scientific database for future sEMG-based dysphagia screening investigations by examining the electrical activity of swallowing muscles in acute stroke cases. A quantitative cross-sectional study was conducted on 61 stroke inpatients admitted to Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from July to November 2019. The objective of this study was to quantify electrical activities of the suprahyoid (SH) and infrahyoid (IH) muscles during swallowing. Patients participated in both dry swallowing and a 3 mL water swallowing task, with the sEMG used to measure electrical activity parameters (duration, swallowing initiation, time-to-peak, and amplitude) on both paretic and normal sides. The Wilcoxon test was used to compare the electrical activity parameters between the patients paretic and normal sides. Only amplitude showed a significant difference between the paretic and normal side (p=0.023) when performing the 3 mL water swallowing test. Other parameters did not exhibit significant differences in activity between muscle groups during both swallowing tests (p>0.05), although varying water volumes led to distinct activities in both muscles. Despite the absence of a clear pattern in SH and IH contractions during swallowing, the result showed that the sEMG quantification method might become a promising method for screening dysphagia, complementary to FEES and VFSS. The non-invasive and cost-effective sEMG method can serve as an early screening tool for dysphagia in stroke patients. This study underscores the importance of further investigation on sEMG use, incorporating a larger sample size and diverse cohort results with various swallowing exercises (varying in volume and viscosity) to validate the use of sEMG in dysphagia screening
Accuracy of Kampala Trauma Score as a Predictor in Assessing the Prognostic Value of Multiple Trauma
Full text linkDetermining a trauma scoring system appropriate for certain conditions will help in predicting mortality and morbidity, and can determine the need for treatment in patients. Kampala Trauma Score (KTS) is a trauma scoring system that uses a decent number of assessment variables and can be used in all general groups. This study was a retrospective prognostic test conducted in Dr. Hasan Sadikin Hospital Bandung, Indonesia, from December 2021 to July 2022. Data obtained was processed using Microsoft Excel and SPSS spreadsheets. The respondents were 66 people with multiple trauma. Results showed that this study was dominated by patients with blunt trauma (n=63, 95.45%). The mean KTS score in this study was 13.08±1.03. In 49 (74.24%) patients who survived, the mean KTS score was 13.41±0.89 and in 17 (25.76%) patients who died, the mean KTS score was 12.12±0.79. The greatest mortality accuracy was at the cutoff point of the KTS score >12 (81.82% accuracy; 70.59% sensitivity; 85.71% specificity). The accuracy value of the KTS score is in line with the ROC where the optimal KTS score is >12 (85.77%). In conclusion, the Kampala trauma score can be used as a predictor in assessing the prognostic value of multiple trauma patients with the obtained cut-point value as it has high accuracy, sensitivity, and specificity values