International Journal of Integrated Health Sciences
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Association between Malnutrition Inflammation Score and Latent Tuberculosis among Chronic Hemodialysis Patients
Get PDFObjective: To investigate the association of malnutrition with latent tuberculosis (TB) among chronic kidney disease (CKD) patients on hemodialysis (HD).Methods: This was a cross-sectional study conducted at the Hemodiaylisis Unit of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Subjects were patients aged >18 years who had undergone HD twice a week for at least three months. Patients suspected of active tuberculosis (TB), malignancy, or immunocompromised were excluded. Latent TB was diagnosed using the interferon-gamma release assays (IGRA). Malnutrition was defined by a malnutrition inflammation score (MIS) of less than 5. All data including age, sex, CKD etiologies, and laboratory findings were obtained and recorded in a case report form.Results: A total of 120 subjects were involved in this study. Subjects with positive, negative, and indeterminate IGRA results were 39.2%, 56.7%, and 4.2%, respectively. There was no significant differences in subjects characteristics between positive and negative IGRA subjects. The MIS>5 was shown to have no statistically significant association with positive IGRA subjects (OR=3.47, 95%CI 0.93–12.93).Conclusion: Malnutrition based on an MIS score of less than 5 is not statically associated, but clinically associated, with latent TB. Further causal inference study to investigate these associations is needed
Pulmonary Embolism in High-Risk Patients: How to Select Standard Imaging and Management Strategy?
Get PDFObjective: To describe the use of computed tomography pulmonary angiography (CTPA) for diagnostic purposes and percutaneous catheter-directed thrombolysis (PCDT) as a treatment choice for high-risk pulmonary embolism (PE) patients.Methods: This case report describes a case of an elderly female presented with dyspnea, cough, fever, and chest pain. No significant medical history was identified.Results: CTPA was conducted and showed multiple thrombus with significant stenosis in several branches of pulmonary artery. Initial anticoagulation was administered without delay. Patient then underwent PCDT to remove the thrombus. No post intervention symptom and systemic complications were noted.Conclusions: Computed tomography pulmonary angiography is useful as the standard imaging modality to help evaluating suspected pulmonary embolism. Percutaneous catheter-directed thrombolysis is indicated to treat high-risk patients with high risk of bleeding
Erythropoiesis Differences in Various Clinical Phases of Dengue Fever using Immature Reticulocyte Fraction Parameter
Get PDFObjective: To determine the mechanism of erythropoiesis that led to anemia using the Immature Reticulocyte Fraction (IRF) parameter in various clinical phases of dengue fever.Methods: This study was a comparative analytical research using secondary data derived from the Dengue-associated Endothelial Cell Dysfunction and Thrombocyte Activation (DECENT) research. The study was performed at Dr. Hasan Sadikin Hospital Bandung, Indonesia from March 2011 to March 2012. Patients were grouped into fever, critical, recovery, and convalescent phases and a healthy control was established. Data collected were analyzed using the Kolmogorov-Smirnov normality test, followed by Friedman test and Mann-Whitney post hoc test.Results: There were 244 subjects participating in this study. The median IRF for all subjects was 4.8% with an IQR of 2.4-8.1%. The values of Immature Reticulocyte Fraction in fever-phase, critical-phase, recovery-phase, convalescent-phase and healthy-control were 1.8% (IQR of 0.5-2.85%), 3.6% (IQR of 1.8-5.0%), 7.05% (IQR of 4.08-11.85%, 7.3 % (IQR of 3.95-9.3%) and 4.1% (IQR of 2.2-6.6%), respectively. There was a significant difference in IRF between groups (p<0.05). The immature Reticulocyte Fraction in fever phase was significantly different from the IRF in other phases and healthy controls (p<0.05).Conclusions:There are changes in erythropoiesis activities detected through the IRF in various clinical phases of dengue infection. Erythropoiesis suppression occurs mainly during the fever phase and starts to be restored in the critical phase. In the recovery and convalescent phases, the erythropoiesis activities increase. This is the first study describing IRF in multiple phases of dengue disease.
Length of Stay Children Hospitalized with Chronic Kidney Disease Based on Etiology and Stage in Dr. Hasan Sadikin Hospital Bandung
Get PDFObjectives: This study aims to describe the LOS children hospitalized with CKD based on the etiology and stage at Dr. Hasan Sadikin General Hospital, Bandung in 2016–2018.Methods: This was a retrospective study with a cross-sectional design from June–October 2019. The inclusion were all medical records of pediatric inpatient diagnosed with CKD and exclusion criteria were incomplete medical record data and hospital readmission patients. The variables studied were CKD etiology, CKD stage, and length of stayResults: From 103 patients, the etiologies found were steroid-resistant nephrotic syndrome (SRNS) (58.25%), congenital anomalies of kidney and urinary tract (9.71%), urinary tract infection (5.83%), and chronic glomerulonephritis (21.36%). The mean LOS was 19 days. The longest LOS found in CKD stage 5 patients caused by SRNS (141 days). Meanwhile, the shortest LOS was found in CKD stage 2 patients caused by chronic glomerulonephritis and CKD stage 5 patients were caused by SRNS who died (1 day). Conclusion: Pediatric patients with CKD stage 5 with SRNS has the potential to have a longer LOS than other etiologies
Relationship between the Quality of Informed Consent at Surgical Procedure in Terms of Ethics and Medicolegal with Satisfaction of Patient Health Service in dr. Zainoel Abidin Hospital
Get PDFObjective: To determine the relationship between the quality of informed consent in terms of ethics and medicolegal with patient health service satisfaction at the dr. Zainoel Abidin Hospital (ZAH) Banda Aceh.Method: This study is an observational analytic with a cross-sectional method. Subject selection through a total sampling method. This study involved patients who were treated at dr. Zainoel Abidin Hospital (ZAH) Banda Aceh and a total of patients were 100 (52 men and 48 women) who met the inclusion criteria carried out on 16 December 2019 to 31 December 2019.Results: As many as 90% of respondents rated informed consent made at ZAH as good quality and 85% expressed the satisfaction with health services at ZAH. An ethical and medicolegal review of informed consent emphasizes the basic principles of bioethics. As many as 84% of respondents stated that their autonomy rights had been fulfilled, 92.50% thought that the doctor had done beneficence, nonmaleficence, and justice well in the process of informed consent and 92.33% of respondents rated the three elements of informed consent as being well implemented. Based on the results of the chi-square statistical test showed a significant relationship between the quality of informed consent in terms of ethics and medicolegal with patient health service satisfaction under the value of p = 0.001 (p≤0.05).Conclusion: Good quality of informed consent in terms of ethics and medicolegal has an important role in increasing patient satisfaction with health services at the dr. Zainoel Abidin Hospital of Banda Aceh
Elderly Satisfaction on Chronic Disease Management Program at Public Health Center, Bandung City, West Java, Indonesia
Get PDFObjective: To identify the satisfaction level of the elderly on the health services provided by The Chronic Disease Management Program (prolanis) at the Public Health Center (puskesmas).Methods: A descriptive quantitative study with a cross-sectional approach had been carried out to 112 elderly from 8 puskesmas in Bandung City, West Java, Indonesia. This study was conducted from August until November 2019. The variables in this study were 5 dimensions of the SERVQUAL. The collected data were analyzed using percentages and the Importance-Performance matrix.Results: The satisfaction level of the elderly on the health services provided by the prolanis was 92%. The dimension that has the highest satisfaction level was the assurance dimension (94,6%) and the lowest one was the tangibles dimension (84,8%). The result of the importance-performance matrix showed that assurance, responsiveness, and empathy dimensions needed to be maintained to reach the patient’s satisfaction. Conclusions: The elderly satisfaction on the health services provided by the prolanis is high in every dimension of the SERVQUAL
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
Prevalence of Trichomonas vaginalis Based on Clinical Manifestation and Polymerase Chain Reaction among Reproductive Women
Get PDFObjective: To measure the prevalence of Trichomonas vaginalis (T. vaginalis) based on clinical manifestations and polymerase chain reaction (PCR) among reproductive women.Methods: Subjects of the study were the vaginal swab obtained from reproductive women who attended the gynecology examination at Kandanghaur and Sindang primary health care of Indramayu District, West Java in 2016. This study was a descriptive study with cross-sectional method. Sampling was performed with total sampling method and 76 of vaginal swabs were included in this study. The prevalence of T. vaginalis was measured using PCR. The vaginal specimens were collected and then processed for PCR analysis using TVK3/TVK7.Results: Prevalence of T. vaginalis among reproductive women in Indramayu District, West Java that analyzed using PCR was 0%. This result could be affected by the study setting in community, presence or absence of symptoms, and population studied.Conclusion: There were no positive results of T. vaginalis, suggested by the samples that obtained from community-based of a low-risked population.Keywords: Trichomonas vaginalis, polymerase chain reaction, prevalence, reproductive women
Defined Daily Dose and Cost of Therapy of Empirical Ceftriaxone Pre- and Post-Antimicrobial Stewardship Program Model Implementation in Sepsis Patients in A Tertiary Hospital in Indonesia
No full textObjective: Antibiotic resistance requires substantial responses through two mechanisms: new antibiotic development and smart antibiotic use. Antibiotic Stewardship Program (ASP) is one of the responses that reduce the overall antibiotics use and prevent the overuse of antibiotics to avoid antibiotic resistance. The purpose of this study was to assess the difference in defined daily dose (DDD) and the cost of therapy (COT) for empirical ceftriaxone therapy in sepsis patients pre- and post-ASP model implementation in Dr. Hasan Sadikin General Hospital, Bandung.Methods: A pre- and post-intervention quasi-experimental study on ASP model implementation in empirical ceftriaxone therapy provided to sepsis patients treated in the intensive or semi-intensive care units was performed from December 2015 to July 2016 using the Mann Whitney test and t-test. The DDD was calculated as DDD/100 patient-days, while the COT was calculated as the COT/patient-day. The ASP model intervention implemented in these units applied 2 main strategies: ceftriaxone use restriction and ceftriaxone therapy duration audit.Results: Participants of this study consisted of 112 sepsis subjects (n=112) with 55 subjects in the pre-ASP group and 57 subjects in the post-ASP group. The mean DDD/100 patient-days in the post-ASP subject was lower than that of the pre-ASP (16.3±4.3 and 45.8±16.8; p=0.018). The median COT/patient-days in post-ASP subject was IDR 42,000 (IDR 14.000–42.000), which was lower than that of the pre-ASP group of IDR 84.000 (IDR 28.000–420.000, p=0.001).Conclusion: The differences in the DDD/100 patient-day and COT/patient-day values between the pre-ASP and post-ASP are significant. The ASP model applied in Dr. Hasan Sadikin General Hospital, Bandung leads to a smart use of ceftriaxone and reduces costs for the empiric ceftriaxone therapy in sepsis patients
Prevalence of Hematotoxic Effect of Intravenous Chemotherapy among Retinoblastoma Population in Tertiary Hospital in Bandung, Indonesia
Get PDFObjective: To observe the prevalence of hematotoxic effect in retinoblastoma patients who were given intravenous chemotherapy with vincristine, etoposide, and carboplatin (VEC) regimen. Retinoblastoma is the second most common cancer in children in Indonesia. Standard chemotherapy agents used in retinoblastoma treatment is VEC given in 7 cycles intravenously. The most common side effect of VEC regimen is hematotoxic effect which might lead to chemotherapy failure.Methods: This study used descriptive method with cross sectional study design. Data were collected from medical records of retinoblastoma patients in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from 2014 until 2016 using total sampling technique.Results: Forty-six patients were included in this study. Of those subjects, 36 (78.3%) patients experienced hematotoxic effect. The most common hematotoxic effect occurred were anemia and neutropenia, that occurred in 32 (69.6%) and 18 (39.1%) patients, respectively. The most common hematotoxic effect severity occurred were grade 1 anemia, grade 1 leukopenia, grade 1 neutropenia, and grade 3 thrombocytopenia. Percentage of patients experienced anemia tended to increase until the 7th cycle. Seven (15.2%) patients had anemia prior to chemotherapy administration.Conclusion: The majority (78.3%) of the patients experienced hematotoxic effect on intravenous chemotherapy administration with VEC regimen. Anemia was the most common hematotoxic effect occurred.Keywords: Hematotoxic effect, intravenous chemotherapy, retinoblastoma