Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Comorbidities of COVID-19 patients associated with mortality at the Baubau Regional Public Hospital, South East Sulawesi
No full textSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that cause coronavirus disease 2019 (COVID-19) has become a global pandemic. Until November 30th, 2020, World Health Organization (WHO) confirmed 61,869,330 positive cases with 1,448,896 deaths (CFR 2.3%). Some comorbidities are associated with the COVID-19 mortality. This study aimed to investigate risk factors of the COVID-19 mortality at the Baubau Regional Public Hospital, Sout East Sulawesi. It was a cross-sectional study with a retrospective analysis involving 81 COVID-19 patients. Purposive sampling was applied in this study. Chi-square analysis was conducted to calculate odd ratio (OR). The result showed that in the period from January to September 2021, 30 COVID-19 patients died consisting of 20 male and 10 female. Most of the patients died were >45 yo and only 4 patients died were <45 yo. Among the patients died, 11 patients had hypertension, 12 patients had type 2 diabetes mellitus (DM), 4 patients had pulmonary TB and 3 patients had dyspepsia. Further analysis showed that hypertension (OR=6.803; 95%CI: 1.925-24.038; p=0.002) and dyspepsia (OR=0.222; 95%CI: 0.059-0.838; p=0.016) were significantly associated with the COVID-19 mortality, whereas type 2 DM (OR=1.123; 95%CI: 0.445-2.832; p=0.495) and pulmonary TB (OR=0.559; 95%CI: 0.059-0.838; p=0.270) were not. In conclusion, hypertension is risk factor, whereas dyspepsia is protective factor of COVID-19 mortality
Atrial septostomy to prevent pulmonary hypertension crisis in children with ventricular septal defect (VSD) and pulmonary hypertension (PH) underwent cardiac surgery: a case series
No full textSevere pulmonary hypertension (PH) was reported in 22.4% of ventricular septal defect (VSD) and it was mainly seen on a large VSD. Atrial septostomy (AS) could improve the hemodynamic condition and long-term survival of PH patients. Here, three VSD and PH cases in children who underwent AS surgery as their early treatment, concomitant with PH-specific pharmacological treatment were reported. Patient’s hemodynamic and general condition improved with no further complications during the follow-up period. Atrial septostomy was usually conducted after all PH-specific pharmacological interventions failed. However, a study found that the survival benefit of AS was significantly increased if it was conducted before PH-specific pharmacotherapies. Most of the patients in this case received immediate hemodynamic and functional improvement. In this case series, it was reported that the AS procedure could lower the pulmonary arterial pressure and be safely conducted without further complications or death >24 hr post-surgery. Considering the clinical benefit, safety procedure, and improved pulmonary arterial pressure, performing AS procedure concomitant with PH-specific pharmacotherapy as an early treatment for PH patients is recommended
Health measurement profile of older adults in Sleman District, Yogyakarta: its correlation with low-grade chronic inflammation in hypertension
No full textThe older adult often experiences a low-grade chronic inflammation that commonly manifests in various conditions without infection, including hypertension. The serum neutrophil-to-lymphocyte ratio (NLR) and hyperuricemia are important markers for various diseases including hypertension. Older adult accounts for 17.33% of the total population of Yogyakarta Special Province, which is the highest compared to other provinces. The study aimed to evaluate the relationship between NLR and hyperuricemia with hypertension among adult patients in Sleman District, Yogyakarta, Indonesia. It was a community-based cross-sectional nested study involving 90 older adults aged ≥70 y.o. living around of the Sleman Health and Demographic Surveillance System (HDSS). Data of demographic and health characteristics of the subjects were collected. Independent t test, and Mann Whitney test were used to analyze mean differences between normotensive and hypertensive groups. Multivariate analysis with logistic regression was used to analyze correlation between all variables. The results showed 59 respondents (65%) suffered from hypertension and 31 (35%) respondents had normal and pre-hypertension. No significantly different in almost of the subject characteristics between the normotensive and the hypertensive groups was observed (p>0.05). However, significantly different between the normotensive group and the hypertensive group was observed in the history of hypertension, blood pressure/BP, mean arterial pressure/MAP, abdominal circumstance/AC, fasting blood glucose/FBG, triglyceride, and hemoglobin (p0.05). However, the uric acid level of the hypertensive group [5.6 (2.9-9.4 mg/dL)] was significantly higher than that the normotensive group [4.7 (2.9-8.0 mg/dL)] (p=0.042), although it was no significantly relationship with hypertension (p>0.05). In conclusion, there is no relationship between NLR, HsCRP and uric acid with hypertension among middle old and oldest old in Sleman District
Reconsidering the limited role of right heart catheterization on severe pulmonary hypertension-due to progressive interstitial lung disease in young male patient : a case report
No full textPulmonary hypertension (PH)-associated with interstitial lung disease (ILD) develops as a consequence of progressive underlying lung disease or disproportionately to the underlying disease. The PH investigation by right heart catheterization (RHC) for defining PH severity is recommended in patients with ILD who show more severe symptoms than expected from lung disease, appearance of right heart failure, and clinical deterioration not matched by the declining lung function. In patient with progressive ILD, RHC is only considered if it affects the future treatment such as lung transplantation or enrollment in clinical trial/registry. The decision to undertake the RHC in progressive ILD was still fraught with doubts. Here we reported a young adult male patient with ILD whom developed progressive signs and symptoms. By RHC, he had severe precapillary PH with hemodynamic parameters indicated the presence of pulmonary vascular disease. A PH-specific treatment, sildenafil citrate, was administered, and patient responded well and was clinically stable during the addition of sildenafil citrate. This case highlights the clinical implication of performing RHC in progressive ILD, which can change the treatment decision by PH-specific drugs. Therefore, the RHC decision making in patient with progressive ILD need reconsideration
The difference in biofilms formations on duration less than 90 d and more than 90 d of tracheotomy cannula usage
No full textCurrently, prevention of local and systemic infections caused by implantable devices is increasingly improved. Tracheostomy is a surgical action followed by an implantable device called tracheotomy cannula into a trachea to maintain upper airway patenting. The incidence of biofilm-related complications and infections is associated with the length of duration of the attached tracheostomy. The formation and spread of biofilms from distal cannula increase the infection incidence in stoma, tracheitis, and even peripheral pneumonia. However, until now there has been no consensus on when the tracheostomy replacement supposedly conducted. Some manufacturers recommend that cannula replacement supposedly conducted within 30 d, but the data are not yet in agreement and need further study. This study aimed to determine the difference in biofilms formations in a duration of less than 90 d and more than 90 d of tracheotomy cannula usage. It was a cross-sectional study involving patients who underwent a tracheostomy at the Department of Otorhinolaryngology of Dr. Sardjito General Hospital, Yogyakarta. Fisher exact test was applied to analyze the biofilms formations of the two different duration of tracheostomy cannula usage. A total of 20 patients were involved in this study. Durations of more than 90 d had more biofilms formations compared to less than 90 d, although it was not significantly different (p>0.05). However, the PR value of 6 indicated that subjects who have attached cannula more than 90 d clinically have 6 times higher risk for developing biofilms formations than those less than 90. In conclusion, there is no significant differences in biofilms formations between the less than 90 d and more than 90 d of tracheostomy cannula usage. However, clinically subjects with longer duration of tracheostomy cannula usage have higher risk for developing biofilms formations
Pulmonary vascular resistance/systemic vascular resistance (PVR/SVR) ratio changes after sildenafil therapy in uncorrected congenital heart disease-associated pulmonary arterial hypertension
No full textPulmonary vascular resistance (PVR) to systemic vascular resistance (SVR) ratio is a prognostic predictor in congenital heart disease (CHD)-associated pulmonary arterial hypertension (PAH) after defect correction. Sildenafil, widely used as a PAH drug, can decrease PVR with minimal or without changes in SVR, resulting in decreased PVR/SVR ratio after treatment. However, there is limited evidence that PVR/SVR ratio reduced after sildenafil therapy in uncorrected CHD-associated PAH patients. This study aimed to investigate the decreasing of the PVR/SVR ratio after ≥ 1-year oral sildenafil therapy in adult uncorrected CHD-associated PAH. A total of 30 uncorrectable CHD-associated PAH subjects derived from the COHARD-PH registry were included in this study. Right heart catheterization (RHC) was performed during the first visit and further evaluations were conducted after ≥1-year oral sildenafil therapy. The PVR/SVR ratio at the baseline and after the evaluation was collected. The primary outcome of this study was the changes in PVR/SVR ratio from baseline to evaluated RHC. Characteristic analysis of subjects with decreased PVR or PVR/SVR ratio was perforemd as the secondary outcome. The mean PVR and SVR were not different from baseline and evaluated RHC (15.98± 10.67 vs. 18.38±13.93 WU, p=0.206 and 36.65±13.99 vs. 39.34±15.46 WU, p=0.262). There was no significant difference in the baseline PVR/SVR ratio and the evaluated PVR/SVR ratio after ≥1-year sildenafil therapy (0.48 ±0.32 vs. 0.49±0.36; p=0.882). As much as 15 subjects (50%) experienced decreased PVR/SVR ratio. However, there was no significant difference in the characteristics, including age, Eisenmenger syndrome, type of shunts, baseline PVR, PAH-specific treatment, and baseline NT-proBNP level (p>0.05). In conclusion, sildenafil therapy does not change PVR/SVR ratio in adults with uncorrected CHD-associated PAH
Health-related quality of life of the elderly after natural disasters: a scoping review
No full textEvery nation on earth is experiencing an increase in the number and proportion of elderly people. This vulnerable population may experience a decline in health-related quality of life (HRQOL) following a natural disaster. This scoping review aimed to have a better understanding on the elderly’s HRQOL following natural disasters, its influencing factors, and the state of the research on this topic. A literature search was conducted using four databases (PubMed/MEDLINE, Cochrane Library, Science Direct, and ProQuest) for the last 10 years (2013–2022). The summary of the selected relevant articles and analysis data were used to present the findings. There were seven articles included in our review. One article was about floodsand the rest was about earthquake.Two out of the six earthquake articles involved tsunamis. All of the studies were conducted during the recovery phase and revealed that the elderly had poor HRQOL after natural disasters. Several aspects, including demographics, physical, psychological, social, and environmental factors, were identified as having impacts on the elderly‘s HRQOL following a disaster. The relocation had a significant negative impact on the mental health of the elderly, with a mean difference of -3.69 (-5.60, -1.77). In conclusion, the HRQOL of the elderly after a natural disaster is low and affected by several factors. To improve it, a stronger research agenda and disaster management programs that take these factors into account are required
Corrigendum: Effects of 7-hydroxy-2-(4-hydroxy-3-methoxyphenyl)-chroman-4-one on serum levels of antioxidant enzymes in hyperlipidemic rats
No full textGut dysbiosis and the role of probiotics in chronic kidney disease
No full textChronic inflammatory condition in chronic kidney disease (CKD) patients is associated with increased risk of cardiovascular morbidity and mortality. Gut dysbiosis is assumed as one of leading factors to the chronic inflammatory condition. The relationship between the kidney and the gastrointestinal, knowns as the gut-kidney axis, has a role in production and accumulation of uremic toxins derived from gut microbial fermentation of protein, and translocation of endotoxins and microbial from gut lumen into bloodstream due to alterations of intestinal epithelial barrier in CKD patients. Probiotics supplementation is one of the optional theraphy to restore the gut dysbiosis in CKD patients. Recent studies found that probiotics supplementation in CKD patients decreased uremic toxins and pro-inflammatory cytokines production, and delayed CKD progression. The improvement of this chronic inflammatory condition is expected to decrease cardiovascular disease risk in CKD patients. This review aims to describe the importance of gut-kidney axis in CKD patients, particularly in gut dysbiosis, and the role of probiotics in progression of CKD
Diagnosis approach, treatment, evaluation and fertility preservation in patient with Herlyn-Werner-Wunderlich syndrome: a case report
No full textHerlyn-Werner-Wunderlich (HWW) syndrome is a very rare female congenital anomaly of urogenital tract. The definite etiology of HWW syndrome is still unknown. It may be caused by the abnormal development of Mullerian and Wolffian ducts. The characteristic triad of this syndrome includes didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis, recently known as Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome. A 17 y.o. presented with intermittent lower abdominal pain. Physical examination revealed in normal limit. From the ultrasonography examination, it was found uterus didelphys with left hemiuterus hematomethra, hematocolpos, with normal anatomy and function of the right kidney, but there was no left kidney. From pelvic magnetic resonance imaging (MRI) and laparoscopy showing a complete duplication of the uterus from the horn to the cervix with no connection between the two uterine cavities. Both ovaries were normal. The right fallopian tube was normal. The left tube was enlarged, attached to the uterus and the left ovary. No left kidney was found. From the previous surgery, there was a misdiagnosed with brown cyst. Physical examination such as rectal toucher often missed, regardless it can be used to determine some differential diagnosis. MRI is most accurate for providing details regarding the altered anatomy and for identifying associated hematocolpos, hematosalping or hematometra for HWW syndrome cases. The laparoscopy guiding diagnostic and operative management of the vaginal septectomy procedure was performed. In conclusion, misdiagnosis of HWW syndrome can be occurred on ultrasound examination. MRI is an examination that is considered appropriate to help confirm the diagnosis. Laparoscopy can be used with the aim of establishing a diagnosis or in surgical management, in this case, a septectomy is performed