Althea Medical Journal
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Patients’ Satisfaction in Public and Private Primary Health Care: A Study in Karawang Regency, West Java, Indonesia
Get PDFBackground: Primary health care is the foundation of the Sustainable Development Goals (SDGs) to achieve Universal Health Coverage (UHC). Patient satisfaction with the health services acquired is one of the factors to achieve the UHC target. This study aimed to determine patients’ satisfaction in public and private primary health care centers.Methods: This quantitative analytic study with a cross-sectional method was conducted in five sub-districts of Karawang Regency based on community satisfaction surveys. The instrument used was a standard questionnaire with nine dimensions and filled with a survey approach by the respondents. Data was transformed from ordinal to numeric using Rach modelling. Then, numerical data were analysed with Chi Square Test in IBM SPSS Statistic 23 Version to determine differential between public and private groups. Results: In total, 193 respondents were included of whom 123 patients were from public health centers (Pusat Kesehatan Masyarakat, Puskesmas) and 70 from private primary care (clinic). Three dimensions had differences in satisfaction, including the requirements (p=0.001); systems, mechanisms, and procedures (p=0.001); and service time (p=0.001). The other six dimensions such as cost (p=0.534); product specification type of service (p=0.213); implementer competence (p=0.163); implementer behavior (p=0.000); handling of complaints, suggestions, and advances (p=0.448); and facilities infrastructure (p=0.063) were not proven to have differences in satisfaction. Overall, patients’ satisfaction level at Puskesmas (67.5%) was lower than at clinics (88.6%) (p=0.001).Conclusion: Patients’ satisfaction with the Puskesmas is lower than the clinic. Further study with a larger sample size and more complete dimension is needed
Correlation of Serum Potassium Status and HEART Score in Acute Coronary Syndrome Patients
Get PDFBackground: Patients with acute coronary syndrome (ACS) often experience hypokalemia which increase the risk of ventricular arrhythmia. The HEART Score can identify the prognosis of ACS. This study aimed to examine the correlation between serum potassium and HEART Score on ACS.Methods: This was a cross-sectional observational, correlative analytic study. The data were taken retrospectively using secondary data. Inclusion criteria were all ACS patients who had been examined for serum potassium parameters at the Emergency Room of Dr. Hasan Sadikin General Hospital Bandung in 2019. The HEART Score was calculated based on history (H), electrocardiogram (E), Age (A), risk factors (R), and troponin (T). Subjects were divided into low risk, intermediate risk, and high risk groups based on the HEART Score value.Results: Fifty-two ACS subjects were mostly male with a mean±SD age of 59±9 years. All subjects had moderate and high HEART scores, with 79% subjects having normokalemia. There was no correlation between HEART Score and serum potassium levels (r = -0.083, p=0.279).Conclusion: There is no relationship between serum potassium and the HEART Score that may need to determine the prognosis in ACS patients. Further study is imperative to explore serum potassium levels which might begin to decline 24 hours after the acute attack.
Positive Postoperative Blood Cultures in Major Abdominal Surgery Patients Attending a Tertiary Hospital in Durban, South Africa
Get PDFBackground: Evidence from high-income countries suggests that bloodstream infection is an essential complication following major surgery. However, studies of bloodstream infections following major surgery in lower-income settings, particularly in Africa, are rare. This study aimed to determine the incidence of postoperative bloodstream infection and to explore any association with mortality in high-risk laparotomy patients in South Africa. Methods: This study was a retrospective study, reviewing 435 consecutive adults who underwent laparotomy at a South African tertiary hospital over a five-year period. Incident postoperative bloodstream infection, defined as a positive blood culture following surgery, was determined from laboratory reports in the patient’s medical chart. Source infections and the causative microorganisms were established from laboratory reports. Inpatient mortality was determined from the patient’s hospital discharge summary. Data were summarized using descriptive statistics. Potential associations between bloodstream infection and mortality were tested using the chi-square test.Results: The incidence of postoperative bloodstream infection was 7.4%. Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus were isolated from 21.9%, 18.7%, and 15.6% of blood cultures. Mortality in patients with bloodstream infection was 46.9% vs. 16.1% in patients without bloodstream infection (p<0.001).Conclusions: Postoperative bloodstream infection is an essential complication following major abdominal surgery with K. pneumoniae, E. coli, and S. aureus being the most common causative agents. Bloodstream infection is associated with a higher risk of postoperative mortality. Further studies are recommended to confirm the findings and improve patient management
Effect of Annona muricata L. Leaf Ethanol Extract in CCl4 Hepatitis Rat Model
Get PDFBackground: Liver can be damaged by various factors, including the oxidative stress mechanism. This damage can be inhibited by the application of anti-oxidant. The Annona muricata L. leaf is known to have antioxidant properties. This study aimed to explore the effect of Annona muricata L. leaf extract against hepatitis in rats.Methods: An experimental study was performed on 25 male Wistar rats that were given Annona muricata L. leaf ethanol extract at 200 mg/kgBW, 400 mg/kgBW, and 600 mg/kgBW for eight days. The CCl4 was administrated on the eighth day and the rats were laparotomized on the next day. The average number of normal hepatocytes was counted in one field of view. This study was conducted at the laboratory of Pharmacology and Therapy of the Faculty of Medicine, Universitas Padjadjaran in September–October 2012.Results: The negative control group showed an intact cell membrane, homogenous cytoplasm, and round nucleus, whereas the positive control group showed necrosis marked by a ruptured cell membrane, vacuolated cytoplasm, and degenerated nucleus. The average number of normal hepatocytes counted in the negative control and the positive group was 404.91±34.09 cells and 23.16±7.84 cells, respectively. In the treatment group, the normal hepatocytes were 95.91±20.96 cells (200 mg/kgBW), 74.53±13.59 cells (400 mg/kgBW) and 46.84±8.46 cells (600 mg/kgBW). Statistically significant inhibition was observed (p<0.05).Conclusions: The Annona muricata L. leaf ethanol extract can inhibit liver tissue damages in hepatitis model rats, possibly due to the presence of acetogenins as an anti-oxidant agent
Characteristics of Neonates with Hyperbilirubinemia in Cileunyi, West Java
Get PDFBackground: Neonates are prone to hyperbilirubinemia or jaundice due to the immaturity of various organ systems and complications at birth. Immature organ systems occur primarily in preterm babies and babies with low birth weight (LBW). The incidence of hyperbilirubinemia is about 60% among term neonates and is higher in preterm neonates. This study aimed to determine the characteristics of neonates with hyperbilirubinemia.Methods: This study used a cross sectional research design. Samples were obtained from medical records of neonates with hyperbilirubinemia throughout 2019 at Annisa Medical Center Hospital, Bandung Regency. Data on neonates that met the inclusion criteria were selected, including gender, gestational age, birth weight, mode of delivery, bilirubin levels (before and after phototherapy), and duration of treatment. Data analysis was performed using univariate statistical calculations.Results: From 786 data obtained, the prevalence rate of hyperbilirubinemia was 21.2%. Male neonates with hyperbilirubinemia were predominantly prevalent (n=103; 61.7%); whereas preterm neonates accounted for 51.5% (n=86), normal weight (85.6%), and born through vaginal delivery (n=116; 69.5%). After treatment, total bilirubin levels decreased, with the percentage of the >10 mg/dL group decreasing from 97.0% to 10.2%. The average duration of treatment for neonates with hyperbilirubinemia was 4.4 days, however, the neonates who were treated less than the average were 71.3%.Conclusion: Preterm male is predominantly prevalent among neonates with hyperbilirubinemia, although they have conformed birth weight and vaginal delivery mode. The duration of treatment for neonates with hyperbilirubinemia mostly does not exceed 4 days, as long as the treatment reduces the total bilirubin level. Good therapeutic management in the first week of hyperbilirubinemia neonates is required
Outcomes of Tuberculous Meningitis Patients with Hydrocephalus with or without Cerebrospinal Fluid Diversion
Get PDFBackground: Hydrocephalus is a common complication in tuberculous meningitis patients and is a poor predictor with high mortality and morbidity rates. Therefore, early diagnosis, detection, and treatment of hydrocephalus are important. Cerebrospinal fluid diversion is the process used to drain accumulated fluid in the brain and spinal cord. This study aimed to explore the outcome of tuberculous meningitis patients with hydrocephalus who underwent cerebrospinal fluid diversion and who did not.Methods: This was a retrospective cross-sectional descriptive study, including tuberculosis meningitis patients with hydrocephalus, admitted at the Department of Neurology Dr. Hasan Sadikin Bandung General Hospital during the period 2018. Functional outcomes were grouped based on the Glasgow Outcome Scale.Results: Of the 55 patients, only 14 (25.5%) underwent cerebrospinal fluid diversion. The outcome of patients with cerebrospinal fluid diversion was 8 of 14 good, 1 of 14 poor, and 5 of 14 died. The outcome of patients without cerebrospinal fluid diversion was 13 of 41 good, 2 of 41 poor, and 26 of 41 died. Most tuberculous meningitis patients with hydrocephalus, with or without the cerebrospinal fluid diversion procedure were at an advanced stage with a high mortality rate. Conclusion: The proportion of good functional outcomes in patients with cerebrospinal fluid diversion is higher than in patients without the cerebrospinal fluid diversion.
Coping Stress of the COVID-19 Pandemic among Medical and Non-Medical Undergraduate Students at Universitas Padjadjaran, Bandung, Indonesia
Get PDFBackground: Coping stress is an act of dealing with stress by adapting to the problems of the thought process. The ‘Distance Learning’ policy is a stress factor during the COVID-19 pandemic which may have an impact on psychological conditions and coping stress. This study aimed to determine differences in stress levels and coping stress among medical and non-medical undergraduate students against the global COVID-19 pandemic.Methods: Cross-sectional analytical methods were used. Stratified random sampling recruiting undergraduate students, including from medical students (n=80) and non-medical students (n=84) at Universitas Padjadjaran class 2017–2019. The distributed questionnaire contained 25 questions adapted from the Depression Anxiety Stress Scale (DASS 42) and the Cope Inventory. Validity and reliability tests were carried out previously, and statistical analysis was performed using SPSS v.26.Results: The median age of both groups was 21 years and most of the respondents were female. There was no significant difference in stress and coping stress. At the time of coping, the medical students focused more on emotions and the non-medical students focused more on the problems.Conclusion: There is no difference in the levels of stress and coping stress with emotional and problems focus in the medical and non-medical students
Correlation between Cognitive Function and Physical Performance in Community-Dwelling Older Adults
Get PDFBackground: One of the health problems often found among older adults in Indonesia is cognitive impairment, resulting in difficulties daily life and a significant decrease in functional status. This study aimed to determine the correlation between cognitive function and physical performance in community-dwelling older adults.Methods: This was a cross-sectional study conducted from October–November 2019. Samples were collected from North Jakarta through consecutive sampling (n=38). Cognitive function was measured using the Mini-Mental State Examination (MMSE) and the physical performance was measured using the Timed Up and Go Test (TUG) method. The statistical test applied in this study was Spearman’s rank correlation (p<0.05). Results: The majority of the subjects in this study were mostly female young older adults with the most received ≥12 years of education. The results for both MMSE and TUG were normal. There was a negative correlation between MMSE and TUG scores (r= -0.357, p=0.028).Conclusions: There is a weak but significant correlation between cognitive function and physical performance in community-dwelling older adults. A further study exploring cognitive dysfunction and physical performance in older adults is needed
Comparison of Cognitive Function of Ischemic Stroke Patients with and without Pneumonia
Get PDFBackground: Pneumonia is a common complication of ischemic stroke that may worsens brain injury, leading to cognitive impairment as well as patient outcome. The aim of this study was to compare cognitive function in ischemic stroke patients with and without pneumonia.Methods: This study was a comparative numerical analytic retrospective cross-sectional study that was conducted from September 2020 to February 2021. This study used data from ischemic stroke patients treated at Dr. Hasan Sadikin General Hospital in 2019 with the total sampling method. Data were stratified into patients with pneumonia and without pneumonia. The mini mental state examination (MMSE) was used to measure cognitive function in both groups and scores were compared using the Mann-Whitney Test.Result: Of the 164 data, 25 were patients with pneumonia and 139 without pneumonia. Male patients were predominantly prevalent in the pneumonia and non-pneumonia groups. Hemiparesis was the most common neurological deficit. The MMSE score was significantly lower in the pneumonia group (22.6 ± 5.4 vs. 24.7 ± 4.8, respectively; p-value=0.032). Conclusion: Cognitive function is more prevalent in ischemic stroke patient with pneumonia compared to non-pneumonia. However, other factors such as recurrent stroke and possible vascular risk factors should be considered for future studies to better identify the relationship between ischemic stroke and pneumonia
IgG levels in Human Papillomavirus Infection Associated with Clinical Stage of Head and Neck Squamous Cell Carcinoma
Get PDFBackground: Head and neck squamous cell carcinoma (HNSCC) is an invasive neoplasm of epithelial tissue in the head and neck and one of the etiologies of HNSCC is human papillomavirus (HPV) which maybe associated with the clinical stage of HNSCC. HPV infection in squamous cell epithelium produces specific IgG antibodies against HPV. IgG titer of HPV can help identify patients who are at risk for HPV-related cancers. This study aimed to explore the association between IgG titer of HPV with the clinical stages of HNSCC.Methods: The design of this study was analytic cross sectional, conducted at the Outpatient Clinic of Otorhinolaryngology-Head and Neck Surgery, Division of Oncology, Dr. Hasan Sadikin General Hospital Bandung period September-December 2017. Patients with HNSCC were recruited, and history was taken. Furthermore, histopathologic examination and HPV IgG serology examination was performed using the ELISA method. The HPV IgG levels were compared by stage and data were analyzed using the Shapiro Wilks test and Unpaired T test.Result: The HPV IgG was high in 75% (n=21) of HNSCC patients in the advanced stage and low in 25% (n=7) of patients in the early stage. There was a significant relationship between HPV IgG titer and early and advanced stage of HNSCC (p=0.001).Conclusion: The HPV IgG titer is related to the clinical stage of HNSCC indicating that the higher the HPV IgG level, the more advanced the clinical stage. Further study is needed to explore HPV IgG levels as a prognostic marker in HNSCC