Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Family-centered rehabilitation in high risk infant; A case report
No full textPreterm infants are categorized as a high-risk group in neonatology. Theyare physiologically less mature and have limited compensatory responsesto the extrauterine environment compared with term infants. Preterminfants need long-term evaluation, monitoring, and follow-up to optimizeneonatal care and development through an extensive rehabilitationperiod. However, the COVID-19 pandemic restricted patient care andfollow-up in the outpatient hospital setting. This case report discusses ahigh-risk infant treated with family-centered rehabilitation (FCR). Thepatient's rehabilitation issues included delays in gross motor, fine motor,and language development and preventing complications that may arisein a high-risk premature infant. Considering recent occurrences, ourapproach to rehabilitation programs for high-risk infants needs to bereevaluated and revised, focusing on home programs through familycentered treatment. These techniques may aid in delivering rehabilitationtreatments to children with developmental delays during COVID-19
Evaluation of clinical pathway implementation and clinical practice guidelines in the management of deep neck abscess (DNA) at Dr. Sardjito, General Hospital Yogyakarta, Indonesia
No full textDeep neck abscess (DNA) is an infectious condition categorized as anemergency case with high mortality and morbidity. The incidence decreasesover time due to extensive use of antibiotics, operative intervention, andimproved awareness of dental hygiene. Management of DNA must be carriedout appropriately and efficiently to prevent complications that may occur,such as jugular vein thrombosis, pericarditis, and pneumonia. Patients withDNA are often categorized as high-cost patients, because of the long durationof hospitalization, the need for special examinations, and complicatedmanagement. Clinical practice guidelines (CPG) and clinical pathways (CP)are a standard created for management, quality, and cost control. The studyaimed to evaluate the implementation of the CPG and CP in DNA patients atDr. Sardjito General Hospital, Yogyakarta. The study used medical recordsdata of DNA patients from January 2018 to December 2020 who met theinclusion and exclusion criteria. A total of 55 subjects were obtained, withcompliance to complete CPG filling of 98.3% and CP filling of 96.2%. There was100% completion in CPG filling categorized as good compliance, whilst thenumber of good compliances for CP was 92.7%. In conclusion, the diagnosisand management of DNA patients at Dr. Sardjito General Hospital has goodcompliance with CPG and CP available
Comparison of neutrophil lymphocyte ratio (NLR), mean platelet volume (MPV) and platelet lymphocyte ratio (PLR) in preeclampsia and normotensive pregnancies
No full textThe study aimed to compare the NLR (neutrophil lymphocyte ratio), MPV (meanplatelet volume), and PLR (platelet lymphocyte ratio) values in preeclampsiaand normotensive pregnancies. This was a retrospective case-control studyusing medical records of pregnancies between January 1, – December 31, 2019.A total 31 pregnancies with preeclampsia who met the inclusion and exclusioncriteria were involved in the study. As control, 31 normotensive pregnanciesrecruited by simple random sampling were used. The data were presented asmean ± standard deviation (SD) and analyzed by using SPSS program. Receiveroperating characteristic (ROC) curve were used to determine the optimal cutoff point for predicting preeclampsia. The NLR and MPV values of patients withpreeclampsia were significantly higher compare to normotensive pregnancy(p0.245). The result of AUC analysis showed that the NLR and MPVhave AUC values of 0.758 (95%CI:0.637-0.878; p=0.000) and 0.903 (95%CI:0.816-0.989; p=0.000), respectively. Further analysis showed that the optimal cut-offpoint for NLR was 4.0 (sensitivity of 64.5% and a specificity of 71.0%) and forMPV was 7.55 (sensitivity of 87.1% and specificity of 80.0%). In conclusion, theNLR and MPV values are significantly higher in preeclampsia. However, theMPV value has a better predictive value than NLR for preeclampsia
A comparison study of GeneXpert and In-House N1N2 CDC Real-Time RT-PCR for detection of SARS-CoV-2 infection
No full textCOVID-19 is a disease caused by SARS-CoV-2, a new virus from genus β-coronaviruses. This disease has been declared a pandemic by WHO on 11 March 2020 until now. The nucleic acid tests are the most frequently used assays because of their high sensitivity and specificity. One of the tests is the GeneXpert, a real-time reverse transcription polymerase chain reaction (rRT-PCR)-based assay platform. The use of the GeneXpert shows great public health interest because of the rapid (50 min), the minimum number of trained staff, and less infrastructure and equipment. However, there are limited data on the application of the GeneXpert for the detection of SARS-CoV-2. Therefore, we conducted a comparative study between the GeneXpert and in-house N1N2 CDC rRT-PCR assay. Of 86 samples, 17 were rRT-PCR positive while 13 were GeneXpert positive. Of rRT-PCR positive 17 samples, 7 were GeneXpert negative [58.82% (10/17] sensitivity]. We also found that 3 GeneXpert positive samples showed rRT-PCR negative (95.65% [66/69] specificity). It is concluded that negative results by the GeneXpert can not rule out the possibility of SARS-CoV-2 infection, particularly in close-contact individuals and the interpretation of the positive result should be analyzed carefully, particularly amplification with Ct>40
Pruritus in diabetes mellitus (DM) and its pathophysiology-based treatment
No full textPruritus is a common complaint of diabetic patients with a substantial impact on financial and health status, but the pathophysiology is unclear and treatment with antihistamines has mostly been unsuccessful. To date, we still do not have guidelines to help us treat pruritus in diabetes mellitus, so we felt the need to review the existing literature to explore possible ways to treat these patients. We collected 85 pieces of literature from various sources such as PubMed and Google Scholar, and independently extracted these data to make this review. While the pathophysiology behind pruritus in diabetes mellitus remains largely unknown, some trials have found a few pharmacological treatments to be effective in alleviating itch in these patients
Otoacoustic emission (OAE) features in newborns at Dr. Kariadi Central Genetal Hospital, Semarang, Indonesia
No full textThe joint committee on infant hearing (JCIH) recommends the detection and intervention of hearing impairment in newborns. Dr Kariadi Central General Hospital, Semarang, Indonesia is a referral hospital in Central Java province that has implemented an early detection program for hearing lossin newborns. Screening or early detection using otoacoustic emissions (OAE). This study aimed to find out the description of OAE in newborns at Dr. Kariadi Central General Hospital, Semarang. This research was a descriptive analytic using secondary data the OAE results on newborns with or without risk factors (FR) who are treated at Dr. Kariadi Central General Hospital, Semarang in 2020. The result of OAE pass meant that the outer hair cell (OHC) was functioning properly in both ears while refer was if the OHC in one ear or both was not functioning properly. Total 1338 newborns with and without FR whose OAE pass resulted as much as 1297 (97%) and refer 41 (3%). Most risk factors were low birth weight 331 (42%) with the results of OAE pass 312 (94.3%), and refer 19 (5.7%). In conclusion, this study shows that OAE passed in 97% of newborns
The influence of tympanic membrane perforation site on the hearing level of conductive hearing loss in chronic suppurative otitis media
No full textChronic suppurative otitis media (CSOM) is an infection of the middle ear cavity both partially and totally. It is characterized by ear discharge through a tympanic membrane perforation for over a period of 2 to 6 weeks. Hearing loss is the most common complication of CSOM. One of the degrees of hearing loss in tympanic membrane perforation is depending on the site of perforation, but this premise is still debatable because of pros and contras by some researchers. This study aimed to assess the degree of hearing loss in relation to the site of tympanic membrane perforation. A cross-sectional prospective study design was performed involving 43 patients of safe type CSOM who came to the Department of Otolaryngology Head and Neck Surgery from the period January 2016 to November 2018. All subjects were divided into 4 groups based on the site of perforation. There was a perforation in the posteroinferior, the posterosuperior, the anteroinferior, and the anterosuperior. A statistical analysis using Anova along with multivariate analysis was conducted. Our result showed that the most common site of tympanic membrane perforation was at the anteroinferior (30 samples, 59.8%). The highest hearing threshold was seen at posteroinferior with a mean hearing level of 37.7±2.0 dB, anteroinferior with a mean hearing level of 31.7±0.7 dB, anterosuperior with a mean hearing level 30.7±1.4 dB, and posterosuperior mean hearing level 28.9±1.5 dB. The difference was found significant with p=0.004. Posteroinferior tympanic membrane perforation had a higher number of hearing loss compared to the other sites. In conclusion, the tympanic membrane perforation site has an important role in the hearing level of conductive hearing loss in CSOM
Antibiotic effectiveness on biofilm-producing Escherichia coli isolated from catheterized patients
No full textBiofilm is one of the factors that facilitate the occurrence of catheter-associated urinary tract infection (CAUTI). Escherichia coli is reported as one of the most dominant bacteria that have virulence factors including biofilm formation. Uropathogenic E. coli (UPEC) shows increasing resistance to several antibiotics. Examination of the antibiotic sensitivity on the biofilm-producing E. coli and its activity on biofilm formation are important for selecting high effectiveness antibiotics which is beneficial for the management of CAUTI patients. A total of 35 E. coli isolates were recultured in the medium of LB agar and blood agar. The isolates were evaluated the sensitivity based on their MIC value to several antibiotics. In addition, the antibiofilm activity of the antibiotics based on their MBIC value was also evaluated. The data obtained were analyzed both descriptively and analytically. Almost the E. coli isolates have good sensitivity to meropenem antibiotics, amoxicillin-clavulanic acid, and Fosfomycin. However, among the evaluated antibiotics, only fosfomycin that showed antibiofilm activity. The different in terms of the resistance phenotype between the urinary isolates and the catheter isolates was observed. However, there were no significantly differences in the MIC value (pMIC=0.522) and the MBIC value (pMBIC = 0.523). In conclusion, the alternatives of antibiotic therapy for the planktonic bacteria are amoxicillin-clavulanic acid and fosfomycin, while for the biofilm bacteria is fosfomycin. A biofilm screening examination on the catheter to improve the effectiveness of therapy management for CAUTI patients is recommended
The role of clinical reminder system to drug prescribing on patients of the National Health Insurance with ischemic stroke
No full textSince 2014 Indonesia has entered the era of universal health coverage (UHC) and public health financing system managed by the Social Security Organizing Agency Law/SSOAL (Badan Penyelenggara Jaminan Sosial/BPJS) . In this system, a national formulary was used as the basis for prescribing drugs by clinicians. One effort for quality and cost control in UHC was to develop a clinical reminder system (CRS) to help prescriber set treatment options in accordance with the national formulary. The aim of this study was to measure the role of CRS to the compatibility of drug prescribing in patients with ischemic stroke in Bethesda Hospital Yogyakarta, Indonesia. This study was carried out using quasi-experimental with pre-test and post-test design. The subjects of this study were outpatient ischemic stroke and the National Health Insurance (NHI) participant, age >18 years and had complete medication data. Prescribing data were compared between stroke patients treated at the hospital before and after implementation of CRS. The study was performed in 200 National Health Insurance (NHI) scheme outpatients with ischemic stroke. The groups consisted of 100 patients without CRS and 100 patients with CRS. The basic characteristics of both groups were similar. The results showed that after implementation of CRS, a significant improvement in the compliance of the neurologist prescribing medicine used to be available only in national formulary (RR: 1.02; 95% CI=1.00-1.04; p=0.015). Among others the most significant improvement was the prescription of antidyslipidemic using HMG-CoA medicine available in formulary. In conclusion, CRS can improve the compliance of prescribing with national formulary in stroke ischemic patients
Association between the level of high-sensitivity troponin I (Hs-Trop I) and major adverse cardiovascular events in patients with acute myocardial infarction of segment elevation (STEMI) with primary percutaneous coronary intervention (PCI)
No full textST-segment elevation myocardial infarction (STEMI) is a condition which increases the risk of developing major adverse cardiovascular events (MACEs). For patients with STEMI, an efficient method of risk stratification is necessary in order to evaluate the clinical outcome. Troponin has been commonly used in the diagnosis of both STEMI and NSTEMI. The use of high sensitivity assays of troponin has been extensively studied in order to measure the size of myocardial damage caused by STEMI. This study aimed to investigate the association between the level of high sensitivity troponin I (Hs-Trop I) and the incidence of MACEs in patients with primary percutaneous coronary intervention (PCI) in Dr. Sardjito General Hospital, Yogyakarta, Indonesia. It was a cross-sectional observational analytic study involving a total of 195 patients. Data were obtained from both the SCIENCE (Sardjito Cardiovascular Intensive Care) registry and the medical record of Dr. Sardjito General Hospital. Pearson’s Chi square test to evaluate the association between variables was applied. To determine the effect of confounding variables, a multivariate analysis was used. A significant difference in the baseline characteristics between the supramedian and inframedian Hs-Trop I groups (cutoff value of 2063.8 ng/mL) in age, onset, total ischemic time, wire crossing time and the smoking history of both groups was observed. Bivariate analysis showed a significant associations between Hs-Trop I and MACEs (p = 0.033), acute heart failure (p = 0.009) as well as mortality (p = 0.024). Meanwhile, no significant association between Hs-Trop I and cardiogenic shock (p = 0.977) and malignant arrythmia (p = 0.551) was reported. Furthermore, multivariate analysis showed Hs-Trop I, age and wire crossing time were significantly associated with the incidence of MACEs (p = 0.045). In conclusion, there is a significant association between the Hs-Trop I levels and the MACEs events in STEMI patients with primary PCI in Dr. Sardjito General Hospital, Yogyakarta, Indonesia