Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Prognostic factors affecting the mortality of 2nd and 3rd degree burn injuries at a tertiary care center in Indonesia
No full textAbout two million people suffer from burn injuries in the United States eachyear, with 100,000 hospitalized in the burn unit. Around 1000 patients sufferfrom severe burn injuries, with each year average of 300 deaths. Improvementsin the understanding of the prognostic factors affecting burn injuries over thepast decades have led to advances in medical and surgical treatment. However,comprehensive data on the factors affecting burn injuries in Indonesia havenot been available, yet. The aim of the study was to investigate the prognosticfactors affecting the mortality of 2nd and 3rd burn injuries patients in Dr. SardjitoGeneral Hospital, Yogyakarta. This was a cross-sectional study conducted withinthe period of 2007-2011 using secondary data from the Department of MedicalRecords. Chi-square and logistic regression analysis were used to evaluate thecorrelation between the prognostic factors and the mortality. A p value 0.05).Furthermore, patients with albumin level 50%, inhalation trauma and hospitalized in 24 hours after the incident were at22.98, 7.65, 3.0 and 4.59 times higher risk of mortality, respectively (p<0.05).In conclusion, albumin level, burn injury percentage, inhalation trauma and time ofarrival are prognostic factors affecting the mortality of the burn injuries patients
Correlation between CD4 cell counts with mucocutaneous manifestations: study of HIV patients in Dr. Sardjito General Hospital, Yogyakarta
No full textMucocutaneous disorders often seen in HIV patients with varying morbidity. The HIVprogression is characterized by the declining of CD4 cell counts and emergence ofmucocutaneous manifestations. The aim of the study was to evaluate the relationshipbetween CD4 cell counts with mucocutaneous manifestations in HIV patients. This wasa cross-sectional study based on medical records at Dr. Sardjito General Hospital duringthe period January 2011-December 2015. Data of patient’s age, sex, risk factors oftransmission, most mucocutaneous manifestations and CD4 cell count were gathered. Thecorrelation between CD4 cell counts with muscocutaneous manifestations were analyzedusing chi-square test. A total 928 patients were involved in the study. More than half ofthe patients were male (65.4%) and mostly, the patients aged 20-29 years (38.69%).The main risk factors for HIV transmission were unsafe sex (75%). The highest CD4 cellcounts was 1094 cells/mm3 and the lowest was 1 cell/mm3. We found 306 cases ofmucocutaneous manifestations. The most mucocutaneous manifestations was a fungalinfection (40.4%) with the highest infection type was oral candidiasis(33.8%); then noninfection(28%) with the highest type was drug eruption(35.9%); and tumors(0.5%) thatwas only Kaposi sarcoma cases. We also found sexually transmitted infections (STIs)(18.85%) with the highest cases was condyloma acuminata (49.3%). Statistical analysisshowed a significantly relationship between CD4 cell counts with a fungal infection(p 200 cells/mm3) increases therisk of viral infection by about 2.5 times and parasitic infections as much as 5 times
Comparison of Bcl-xL protein expression in placental trophoblast cells between pregnancy complicated by severe preeclampsia and normotensive pregnancy
No full textPreeclampsia is one of the main causes of maternal and perinatal mortality and morbidity.The pathogenesis of preeclampsia remains unclear until now. It is believed thatregulation of apoptosis in trophoblast cells plays an important role in the pathophysiologyof preeclampsia. Failure of spiral arteries remodeling will eventually lead to placentalhypoxia lead to excessive trophoblast apoptosis. The molecular mechanism of apoptosisis very complicated involving many signaling molecules included Bcl-2 proteins. The Bcl-2 protein group consists of proapoptosis proteins (Bax) and apoptosis inhibitor proteins(Bcl-2 and Bcl-xL). The aimed of this stuty was to compare the expression of Bcl-xLprotein in placental trophoblast cells of pregnancy complicated by severe preeclampsiawith that normotensive pregnancy. This study was an observational study with crosssectional design involving 43 pregnancy patients with severe preeclampsia and 38normotensive pregnancy who treated in Dr. Sardjito General Hospital, Yogyakarta fromOctober 2011 until March 2012. Placenta samples were obtained from all subjects forBcl-xL protein expression analysis using immunohistochemistry technique. Data wereanalyzed using independent t-test, chi-square test, and logistic regression. A p value<0.05 was considered significant. Significant difference in Bcl-xL protein expressionin trophoblast cells of pregnancy complicated by severe preeclampsia (1.29 ± 0.12)compared to that normotensive pregnancy (1.71 ± 0.14) was reported (p = 0.00). Inaddition, logistic regression test showed that diagnosis of severe preeclampsia had astatistically significant role in Bcl-xL protein expression (p= 0.000). In conclusion, theexpression of Bcl-xL protein is lower in pregnancy complicated by severe preeclampsiacompared to normotensive pregnancy
S. epidermidis : how to turn from commensal to be a pathogen lifestyle
No full textStaphylococcus epidermidis normally is a commensal inhabitant of healthy human skin and mucosa, but also a common nosocomial pathogen in immunocompromised patients, neonates, and patients with indwelling medical devices. To distinguish the pathogen and commensal strain is a big challenge when identifying this agent with its related infection. This mini-review aims to summarize recent research in this area with a special emphasis on the virulence factor of generating genotypic and phenotypic diversity in S. epidermidis.By living between a commensal and pathogen, S. epidermidis needed to establish many strategies to face different clinical environments, including the new ecological niche of biomaterials. In addition, the growing number of immunocompromised patients increased the risk for a very sensitive host. However, further exploration of the relationship between virulence factor and in vivo pathogenesis is still needed. According to the virulence factor of these bacteria, which are considered as a real pathogen, strict control measures should be taken for S. epidermidis infection
LDL/HDL ratio association with out-patient NIHSS score and Dyslipidemic Drug intake status as Metabolic Syndrome Criteria of ischemic stroke patients at RSUP Dr. Sardjito, Yogyakarta
No full textLDL-C/HDL-C ratio (numeric) is a more significant predictor of the progression of IMT than LDL-C or HDL-C alone (2). The Objective is to check whether being dyslipidemic or metabolic syndrome shown by the ratio, affects the data of NIHSS results obtained to measure functional outcome. the data was analyzed using Pearson Chi-square with contingency table post-hoc analysis and Spearmann’s Correlation with additional simple-linear regression.Out of 189 subjects, only 156 data are complete and valid. 70 patients were dyslipidemic, 65 were non-dyslipidemic and the rest were unknown. There is a significant association of LDL/HDL ratio cut off point above 2,3 with dyslipidemic drug intake likely to produce a mild NIHSS outcome category (z score 2,1) (calculator is P value = 0,035729), but not with other NIHSS categories. There is significant association of patients that do not take dyslipidemic drug with whatever LDL/HDL cut off point to the predictor outcome of Mild NIHSS category, but not with other NIHSS categories. The correlations are also insignificant between the LDL/HDL ratio and NIHSS score in one tailed (p<0,36) and at two tailed (p<0,72).Moreover, simple linear regression reveal that LDL/HDL ratio predicts 16% of NIHSS score, while taking anti dyslipidemic drugs which mean the person is dyslipidemic, and LDL/HDL ratio predict 31% of NIHSS outcome. Therefore LDL/HDL ratio have weak predictor value to NIHSS outcome, should not be an independent predictor
Coronary Artery Calcium Score Improved Cardiovascular Disease Risk Prediction in Asymptomatic Patients
No full textThis study examined whether coronary artery calcium score (CACS) has a betteraccuracy than the cardiovascular risk prediction chart (CRPC), and evaluate thereclassification improvement of CACS if it isused as a screening tool compared withthe CRPC. CACS has a better accuracy than the CRPC and reclassified a considerableproportion (39%) of a symptomatic patient into correct cardiovascular risk categories.CACS should be assessed in asymptomatic people with5-year CVD risk score of5-10% and 10-15%
Trends of Rotavirus Diarrhea in Hospitalized Children in Yogyakarta Year 2013 –2015
No full textDiarrhea, together with pneumonia, is accountable for 25% death of children under five globally (IVAC, 2017). In Indonesia, diarrhea is also among the top ten diseases of cause of death in children under five (WHO, 2015). Rotavirus diarrhea is responsible for 60% in 2006 (Soenarto et al, 2009) of children diarrhea in Indonesia. Rotavirus vaccine in Indonesia was introduced commercially in 2011, nonetheless its use was reportedly low. Despite the declining rate of rotavirus incidence, surveillance is important to show the burden of rotavirus diarrhea in children. Thus, this study aims to describe the incidence of rotavirus diarrhea in hospitalized children under five in Yogyakarta province. This was a prospective study, conducted in two participating hospitals in Yogyakarta: RSUP Sardjito Yogyakarta and RSUD Wates from January 2013 – December 2015. This study is a part of the Indonesia surveilance entitled “Hospital-based surveillance of rotavirus diarrhea in children in Indonesia”, enrolling children under five hospitalized due to acute watery diarrhea. The questionare was modified from the WHO generic protocol of rotavirus surveillance (WHO, 2002). Data collection was perfomed after informed consent was signed by parent or guardian. The stool samples were tested for rotavirus with the EIA test and tested for genotyping with RT-PCR. The data were analysed and presented using descriptive analytic method. Of 684 eligible patients hospitalized with acute watery diarrhea, 557 subjects were enrolled with 518 feces were tested for rotavirus. The percentage of rotavirus incidence in year 2013, 2014, and 2015 were 37%, 41% and 61 % respectively. The predominant rotavirus genotyping was G3P [8]. Rotavirus mostly found in children age 6 – 23 months (55 %), and was identified more in male than female (62 % vs 38%). During the 3 years study period, rotavirus occurred all year round, and showed to reach its peak on January 2015. Rotavirus positive diarrhea commonly presented with dehydration (79%) compare to negative rotavirus diarrhea (55%). It indicated that the incidence rate of rotavirus diarrhea in Yogyakarta is quite high and rotavirus diarrhea remains as significant contributor to hospitalized children with diarrhea. The trend of rotavirus diarrhea in children under 5 years increased over the years’ period. The rotavirus diarrhea mostly presented with dehydration, thus rotavirus diarrhea remains as significant contributor to hospitalized children with diarrhea. This shows an evidence that the burden of rotavirus diarrhea in children under 5 years remains prominent
AAssociation between migraine and ischaemic stroke in Prof. Dr. Margono Soekarjo Hospital, Purwokerto, Indonesia
No full textHeadache especially the migraine type has been correlated with various disease, such as stroke. There are some controversies in studies that reported association between migraine and ischaemic stroke. Thus, study that investigate the association between migrain – stroke andalso identify stroke risk factor are needed. Study showed there is no statistically significant relationship between migraine and ischaemic stroke in RSUD Prof. Dr. Margono Soekarjo Purwokerto (p=0,235). Analysis of confounding variables such as hypertension, smoking, diabetes, obesity, alcohol consumption, and oral contraceptive shows that hypertension is a predictor for stroke
Village based information display of health facility data and public awareness of Dengue Hemorrhagic Fever: a lesson from Mlati Primary Health Care Center of Yogyakarta Province
No full textPublic health agencies concern about the disease contraction processes at the population level. Early detection and prompt treatment can be made to prevent transmission in the earliest stage. Understanding that their areas are endemic to DHF and the fact that cases continue to occur from year to year, community and public health stakeholders have a reduced motivation to take actions to have precaution to dengue. The village community will not be aware of the problems until patients from their areas visit health facility. The goal of this paper is to illustrate health center initiative to raise DHF precaution through village based spatial data display of dengue for the villagers attention in raising agenda in the management of dengue hemorrhagic fever at the level where they live. The paper points out the success story of the team of health facility manager, active public health program managers, an information technology literate administrators, and participation of local and private health workers asking DHF suspects to have their blood test in the health center. Supporting staff with health informatics training background has been able to work together with laboratory workers. The laboratory workers input the computer application that translate patient thrombocyte count data into village based geographic-spatial display. These data provide quick evidence about what is happening in the population. Puskesmas manager has the MPH training with population health perspective and the moral of public health problem solving. By having this data, she could make the health promotion actions at the population level. This paper shows the ability of health center manager to link health facility data and the population level evidence for public health action. The data can be used to trigger community be aware of DHF and to raise agenda in the prevention of local diseases. This is an easy and feasible things to do. Primary care and public health are under the common responsibility of the puskesmas managers. It is clear that data of health facility serve as the warning system of disease contracting process at the population level and the promotion of simple evidence to push community to get involved in prevention activities
Profile of traumatic brain injury (TBI) in relation with maxillofacial and thoracic injury Dr. Hasan Sadikin General Hospital, Bandung
No full textTraumatic brain injury (TBI) has a relation with concomitant injuries, which are mostlymaxillofacial and thoracic injury. This study aimed to know which injury was common inTBI patients and the difference in the severity of TBI when patients were associated withone or both types of injuries. This was a descriptive retrospective study. The data used wasmedical records from Department of Neurosurgery, Dr. Hasan Sadikin General Hospital,Bandung, Indonesia from the period of August 2015 to July 2016. Total sampling methodwas used in this study. The variables were patients with TBI, maxillofacial injury, thoracicinjury, accident related mechanism and non-accident related mechanism and the GlasgowComa Score (GCS). The total cases for this study were 47 patients. The highest case wasmales with 37 cases and 10 for females. Accident related trauma had 23 cases whereasnon accident related trauma had 24 cases. The total cases of maxillofacial injury were 32,thoracic were 6 cases whereby for both injuries were 9 cases. Patients with mild TBI were28 cases, moderate TBI were 13 cases, and severe TBI had 6 cases in total. The rate ofTBI was higher in single injury which was the maxillofacial injury. However, the thoracicand both injuries combined had higher severity of TBI compared to maxillofacial injury