Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Prediction score for post-stroke cognitive impairment (PSCI) after acute ischemic stroke
No full textIt was estimated that patients with ischemic stroke and post-stroke cognitive impairment (PSCI) have been increasing. In addition, this PSCI is often late diagnosed when it has already developed into post-stroke dementia. Only a few studies have developed a scoring system of predictor factors cognitive impairment (CI) for post-acute ischemic stroke in Indonesia. This study aimed to develop a scoring system of predictor factors of CI for post-stroke ischemic patients. The patients included were >18 years old diagnosed with acute ischemic stroke who underwent mini-mental state examination (MMSE) and clock drawing test (CDT) examination on day-30 at Bethesda Hospital Yogyakarta. It was retrospective cohort study design and samples were obtained from the stroke registry and medical records. Patients who had a history of CI and incomplete medical records were excluded. The results of MSSE and CDT at day-30 were the outcomes of this study. To evaluate the relationship between the independent variable and the dependent variable, chi-squared tests were perforemd followed by multivariate logistic regression analysis with Hosmer-Lemeshow tests with backward likelihood-ratio (LR) method and by assessing the final area under the curve (AUC) model. The final model was transformed into a scoring system to determine the value of probability prediction of PSCI, the optimal cut-off point, the sensitivity value and specificity value of the cognitive impairment scoring system at day-30 after acute ischemic stroke. A total of 140 subjects were included in the study with an average age of 62.8 years, 86 (61.4%) males and 54 (38.6%) females. Ninety-one subjects (65%) experienced post-stroke CI. The multivariate analysis showed age >70 years, education level ≤6 years, modified ranking score (mRS) >3 at diagnosis, Barthel index score ≤4 at diagnosis, the number of multiple lesions and the location of lesion in the cortex were independent predictor factors affecting CI 30 days after acute ischemic stroke. The developed predictor score obtained AUC discrimination value of 82.6% (95%CI:0.757-0.896) and calibration value of p>0.366. The scoring system had a value range of 0-7, and with a cut-off ≥1, it had a sensitivity value of 86.8% and a specificity value of 59.2%. It can be concluded that the predictor score has a good performance in predicting the occurrence of PSCI at day-30 after acute ischemic stroke
Exercise-based cardiac rehabilitation adaptation protocol during Covid-19 pandemic achieved similar results as compared to non-pandemic usual practice: a single center experience
No full textDuring the Covid-19 pandemic, exercise-based cardiac rehabilitation (EBCR) faced challenges. Adaptation protocols were implemented to circumvent these challenges. The study aimed to investigate whether the adaptation protocols of EBCR during Covid-19 period influenced the result of cardiac rehabilitation. This was a retrospective cohort study. The subjects were patients who underwent an EBCR program in Dr. Sardjito General Hospital. Yogyakarta, Indonesia. The registry of cardiac rehabilitation was obtained and divided into two periods: non-Covid-19 period and Covid-19 period. During the non-Covid-19 period, 3 EBCR sessions per wk (10-12 total sessions) were performed. During the Covid-19 period, EBCR was reduced to 2 sessions per wk (10-12 total sessions). The functional capacities were evaluated as metabolic equivalents (METs) and exercise test time (min) by treadmill test. A total of 122 subjects completed the EBCR. There were no significant differences in METs and exercise minute achieved between two time periods. Among subjects with different sessions per wk, namely 2, 3, and 4-5 sessions per wk, there were no significant differences in METs (7.01±1.89; 7.23±1.74; and 7.33±2.13, p=0.813) and minutesachieved (6.72±1.94; 6.96±1.96; and 6.81±1.84, p=0.848) in the end sessions. In conclusion, the adaptation of EBCR protocols during the Covid-19 period by reducing the number of sessions per wk has similar results as compared to the usual regular EBCR practice
Therapeutic options for extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases producing Escherichia coli and Klebsiella sp. isolated from various clinical samples
No full textEscherichia coli and Klebsiella sp. are the predominant species isolated from clinical samples. Recent and proper understanding of the antibiotic susceptibility pattern of extended-spectrum β-lactamases (ESBL) and AmpC β-lactamases (AmpC) producing E. coli and Klebsiella sp. will prevent the distribution and future incidence of ESBL and AmpC. We designed this study to understand antibiotic susceptibility patterns of ESBL and AmpC producing E. coli and Klebsiella sp. isolated from a tertiary care hospital in North India. A cross-sectional study was conducted from March 2021 to February 2022. Guring this period, various clinical samples were collected and further tested for ESBL producing E. coli and Klebsiella sp. by using the Double disc Synergy test, whereas AmpC was detected by the Boronic acid disk potentiation method. Their antibiotic susceptibility patterns were noted. Various clinical specimens were collected, in which 37.95% were shown growth of bacteria. Among them, 46.67% of E. coli and 25.21% of Klebsiella sp. were identified by standard laboratory protocol. ESBL producing isolates were 44.37% and 34.20% in E. coli and Klebsiella sp., respectively. Whereas AmpC production was detected in 18.27% of E. coli and 29.36% of Klebsiella sp. ESBL and AmpC producing E. coli and Klebsiella sp. isolated from pus, blood, and sputum samples showed the highest sensitivity towards colistin, tigecycline, and imipenem while in urine samples imipenem, meropenem showed the highest sensitivity. Susceptibility patterns of ESBL and AmpC producing E. coli and Klebsiella sp. from various clinical specimens enhance hospital infection management and help clinicians to prescribe the appropriate antibiotics. The carbapenem, nitrofurantoin, colistin and tigecycline were showed highest susceptible against ESBL and AmpC producing E. coli and Klebsiella sp
Maternal determinants of average weekly fetal weight gain in Yogyakarta, Indonesia
No full textAverage fetal weight gain (AWG) is one of the important parameters usuallyused as an indicator to identify the fetal risk of poor outcomes of intrauterinegrowth restriction (IUGR) or macrosomia. This study aimed to investigate theassociation between AWG and maternal factors such as body weight (BW), bodymass index (BMI), middle-upper arm circumference (MUAC), and economicstatus in Yogyakarta, Indonesia. This community-based cross-sectional studywas conducted in one district in the Yogyakarta Special Province, Indonesia.The study included 50 mother-infant pairs who delivered at term (37-42 weeksof pregnancy). The mother’s BW, height, BMI, and MUAC were recorded usinga case-report form. Questionnaires were also completed to establish therespondents’ economic status. Maternal factors associated with fetal birthweight were determined using univariate and multivariate analyses. Themothers registered in our study mostly had good nutritional status (74.0% hadan optimal MUAC > 23cm). The mean AWG and birth weights were 172.6 ±24.5g/wk and 3.08 ± 0.34kg, respectively. Univariable analysis models wereused to assess the associations between each variable and AWG (with a cut-offvalue of 153.8 g/wk). Our study found no associations between higher MUACand higher AWG (OR=1.03; 95% CI: 0.83-1.27; p=0.77) and energy intakes perday with AWG (OR=1.0; 95% CI: 1.00-1.001; p=0.21). Socioeconomic factors suchas the mother’s educational background also showed no association with AWG(OR=0.38; 95% CI: 0.92-1.57; p=0.18). In conclusion, this finding shows that thereis no association between variables such as MUAC, mother’s age, energy intake,and educational background with the average fetal weight gain achieved
Challenge in diagnosing tuberculosis on a boy with severely wasted in limited resource area
No full textHunger and malnutrition are still the leading cause of morbidity and mortality among children around the world. Undernutrition increases the risk of tuberculosis (TB) which in turn could worsen undernutrition. Indonesia is currently the second highest newly diagnosed TB in the world after India. TB in children with severely wasted is difficult to diagnose. This is a case report about a 35-month-old boy with severely wasted complicated with hypoglycemia, severe dehydration, and pneumonia. After proper nutritional management without the expected outcome, patient was then worked up for TB resulting negative result of tuberculin skin test (TST). Nevertheless, he was still treated with antituberculosis and had significant improvement, hence continuation to complete 6 mo period of therapy. This case report describes the challenge of diagnosing TB in children with severely wasted in limited resource areas. The reduced immune responses, due to severely wasted, caused subtle clinical signs of TB and decreased sensitivity to tuberculin testing. The unavailability of radiologic examination added further problem in diagnosis. The diagnosis of TB should be considered among children in areas with a high prevalence of TB, presenting with severely wasted refractory to proper nutritional management
Obesity and the role of genetic polymorphism: A review of genes as the risk of obesity
No full textObesity can be caused by environmental factors, which are higher energy input or lower energy expenditure. Environmental factors supported by genetic factors cause a person to have a different risk for developing obesity from to another. Genetics factors cause obesity through several pathways, which are impaired regulation in the hypothalamus and the regulation of energy expenditure. Obesity may be caused by one gene as monogenic-associated obesity, however, commonly caused by several genes together with environmental factors as the main multi-factorial risk of obesity. Obesity causes inflammation which leads to metabolic diseases. Many efforts are performed to prevent or treat obesity through the intervention to environmental and or genetic factors. Many attempts to reduce the prevalence of obesity were performed by influencing the environmental risk factors or the genetic risk factors. In this review, we identified the main genes which influence obesity. The genetic risks of obesity may be different from one to another country or between ethnic groups. Therefore, a better treatment approach should consider the differences role of genes in obesity rather than only changes in lifestyle. Nutrigenetic approach by considering the difference role of gens in responding to nutrients or drugs is recommended in individualized treatment plans
Pathological fracture in fibrous dysplasia: a case report
No full textFibrous dysplasia (FD) is described as a growth disorder characterized by the progressive replacement of normal bone elements by fibrous-osseus tissue. Bones affected by FD is presented with bone weakening and prone to pathological fracture. We reported a case of FD in an 8-years-old boy, who came to the hospital with pain in the upper right thigh after falling with bumps in his head and foot. An X-ray revealed a deformity as a diasteal scalloping with radiolucency lesions on one-third proximal of the right upper femur, greater trochanter, and lesser trochanter, with complete transverse discontinuity in the distal deformity. No similar lesion was found in the other bones. Bone structure and trabeculation in the deformity area has decreased and the cortex was thinning. On magnetic resonance imaging (MRI), bone size was enlarged, hypointense on T1WI and inhomogeneous hyperintense on T2WI. Fibrous dysplasia with a pathological fracture is a rare case. The appearance on the X-ray was diasteal scalloping with a ground-glass radiolucency represented with Shepherd's crook deformity. This lesion was accompanied by a pathological fracture (fragility fracture) on distal lesion. Fibrous dysplasia which characterized by bone developmental anomaly gave an inhomogeneous hypointense on T1W1 and hyperintense on T2WI
Characteristics of patients with Hepatitis B and C at Dr. Moewardi General Hospital in Surakarta, Indonesia
No full textHepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain a significant health burden in the world, which is mainly attributed to patients who develop chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). The epidemiology of hepatitis B and C in Surakarta, Central Java Province, Indonesia has never been reported. This study aimed to investigate the demographic, clinical, and laboratory characteristics of patients with hepatitis B and C who were admitted to Dr. Moewardi General Hospital, Surakarta in 2019. The medical records of patients with hepatitis B (n=94) and hepatitis C (n=75) were examined, and the data were analyzed using the chi-square and Mann-Whitney tests. The patients with hepatitis C were generally older, more likely to develop jaundice and ascites, and had higher levels of serum urea, creatinine, AST, and total bilirubin compared to those with hepatitis B. In conclusion, patients with HCV infection had worse clinical presentation and laboratory profiles than those with HBV infection. However, further research is needed on a wider scale to confirm this result
Potential skin problems of diabetes mellitus patients: a review
No full textDiabetes mellitus (DM) is one of the common metabolic disorders, and a major part of chronic diseases, the prevalence of which tends to increase due to multifactor. Blood vessels, kidneys, lungs, and skin are among the organs that are affected. The first problem that arises, or commonly exists among one-third of diabetics, are problems with their skin, although skin lesions may develop along with the progress of the disease, or can occur during the later phase of DM. The prevalence and symptoms of skin problems in type 1 DM (T1DM) and type 2 DM (T2DM) are often unclear, and at the beginning of the course of the diseases they often go undiagnosed. Several theories regarding the pathophysiology of DM can be used as a logical reference for the early identification and diagnosis of skin problems, aimed at preventing the worsened condition. The use of skin autofluorescence (SAF) and AGEs reader in several cases of skin problems, can also be an important marker as an adjunct to predict the possibility and progressiveness of DM. Skin problems linked to patients with DM can be categorized as strongly related to diabetes, non-specific and related to DM, skin infection in DM, and skin problems due to diabetic medication. With the current COVID-19 pandemic, there are additional demands for more critical investigation of skin problems in patients with DM. The skin problems that occur in DM may need to be examined from the early stage and it is necessary to inhibit the progression of skin problems, as well as to consider the need for multidisciplinary DM therapy
Relationship between high-risk human papilloma virus (HPV) and subclinical condyloma acuminata (CA) in the cervix of high-risk women
No full textCondyloma acuminata (CA) is a sexually transmitted infection (STI) caused by both high- and low risk human papilloma virus (HPV) infection. Subclinical CA looks like a white spot after an acetic acid test. High-risk women are women who have a high risk of STIs, including CA. The aim of this study was to evaluate the relationship between high-risk HPV and subclinical CA in the cervix of high-risk women. This was a cross-sectional analytic study involving 30 high-risk women. The age, the age at first sexual intercourse, the frequency of sexual intercourse, the number of sexual partners and the use of condoms were recorded. Subclinical CA was diagnosed by the 5% acetowhite test. HPV infection was detected by PCR. Kruskal Wallis test was conducted to evaluate the relationship between variables and the results were considered to be significant if p 0.05). No significantly relationship between age at first sexual intercourse and frequency of sexual intercourse with high-risk HPV was also observed (p> 0.05), however, a significantly relationship with subclinical CA was observed (p < 0.05). In conclusion, there is a relationship between high-risk HPV and subclinical CA in the cervix of high-risk women