Medica Hospitalia : Journal of Clinical Medicine

Full Text Volume 11 Number 1 March 2024

2024-03-28T06:29:34+07:00

Full Text Volume 11 Number 1 March 2024

Correlation of Duration of Antipsychotic Therapy with Hemoglobin Levels in People with Schizophrenia

2023-02-03T04:28:47+07:00

Background: Schizophrenia is a serious mental disorder with various unknown causes accompanied by a collection of positive symptoms, negative symptoms, disorganization in thinking, speaking or movement and cognitive dysfunction. The therapeutic modality used to treat these symptoms is antipsychotic therapy. Over a certain period of time, the use of antipsychotics can cause hematological syndrome which affects the process of red blood cell formation and hemoglobin levels. Low hemoglobin levels can worsen neuronal function in the brain, thereby aggravating symptoms in schizophrenia.

Aim: Analyzing the relationship between duration of antipsychotic therapy <2 years and ≥2 years with hemoglobin levels in schizophrenia patients.

Method: This research is an analytical observational study with a cross-sectional approach in which research subjects were obtained using a consecutive sampling method from medical records of patients with schizophrenia (ODS) at RSJD Dr. Amino Gondohutomo Semarang (n=68) divided into 2 groups consisting of patients with a duration of therapy <2 years and a duration of therapy ≥2 years. The relationship between duration of antipsychotic therapy and hemoglobin levels was analyzed using unpaired t-test.

Result: The mean hemoglobin value for people with schizophrenia in the group with a duration of therapy <2 years is 14.09, while that in the group with a duration of therapy ≥2 years is 14.06 with a p value = 0.928.

Conclusion: There was no relationship between hemoglobin levels in people with schizophrenia and duration of therapy both <2 years and ≥2 years.

Analysis of the Relationship between Neutrophils, Lymphocytes, and Comorbidities with Time to Death in COVID-19 Patients

2023-06-19T08:39:28+07:00

BACKGROUND: COVID-19 caused 5.4 million deaths in 2021. Various parameters such as comorbidities and laboratory findings are known to be predictors of death in COVID-19, but these findings differ in each country, and their relationship to time of death has not been widely studied. This study was conducted to determine the relationship between levels of neutrophils, lymphocytes, neutrophil to lymphocyte ratio (NLR), and comorbidities with time to death in COVID-19.

METHODS: A retrospective cohort study was conducted from April 2020 to September 2021 in the COVID-19 Inpatient Room at RSUD dr. Saiful Anwar Malang with 300 COVID-19 patient subjects aged 18 years and over. Data on comorbidities (hypertension, CAD, HF, obesity, COPD, CKD, cancer), time to death, and laboratory were taken from medical records. The Kolmogorov-Smirnov test, Chi square test and Mann Whitney test were carried out to analyze the data.

RESULTS: There was a significant relationship between neutrophil levels and time to death, as well as a significant difference in neutrophil levels in the group with time to death >48 hours with comorbidities compared to <48 hours with and without comorbidities. There was a significant difference in lymphocyte levels and NLR in patients with comorbidities with time to death <48 hours and >48 hours (p < 0.05).

CONCLUSION: There is a significant relationship between neutrophil levels and time to death, both in subjects with and without comorbidities showing the potential of neutrophil levels as a predictor of time to death in COVID-19.

Differences of Dyspareunia in Primipara with 2nd Degree Perineal Laceration Sutured with Rapide Polyglactin 910 and Chromic Catgut Threads

2023-08-25T06:35:34+07:00

BACKGROUND: Dyspareunia is persistent or recurrent pain during sexual intercourse. Perineal laceration, spontaneous or episiotomy, is one of the most common causes. Perineal lacerations that occur must be treated through suturing. Chromic catgut is a natural thread that is often used in medical practice, but this thread have a higher inflammatory response compared to Rapide Polyglactin 910.

AIMS: To analyze the difference in the incidence of dyspareunia in primipara with 2nd degree perineal lacerations sutured with Rapide Polyglactin 910 and Chromic catgut threads

METHOD: True experimental research with randomized controlled trial-single blinded method. The research was conducted at dr. Kariadi Semarang, RA Kartini Hospital and dr. Soeselo from August 2022 to February 2023. The research subjects were primipara with 2nd degree perineal lacerations which were divided into 2 groups, namely 45 subjects in the Chromic catgut group and 45 subjects in the Rapide Polyglactin 910 group. Evaluation of dyspareunia after 3 months was carried out using the Female Sexual Function Index (FSFI)

RESULT: Subjects sutured using Chromic catgut had a 2.7 times greater risk of experiencing dyspareunia when compared to using Rapide Polyglactin 910 (OR=2.7; 95% CI=1.1-6.6). A significant confounding factor was found, namely the act of episiotomy (p=0.047; OR=9.56; 95% CI=1.86 - 48.97). After controlling for these variables, the subjects who were sewn using Chromic had a significant risk (p=0.002, OR=5.39; 95% CI=1.76-16.50)

CONCLUSION: Subjects with Chromic catgut have a higher risk of experiencing dyspareunia than using Rapide Polyglactin 910 threads after 3 months of suturing.

Pregnancy Associated Plasma Protein-A (PAPP-A) as a Marker to Distinguish Normotensive with Early 2nd Trimester and Late 3rd Trimester Onset of Preeclampsia

2023-10-09T09:44:01+07:00

Introduction: Preeclampsia is a hypertensive condition that occurs after 20 weeks of gestation accompanied by target organ damage. Complications of preeclampsia can cause intrauterine fetal growth retardation, and placental hypoperfusion, even in the most serious situations, namely termination of pregnancy and death of the fetus and/or mother. Pregnancy-associated plasma protein-A (PAPP-A) is a high molecular weight glycoprotein that is produced in the placenta and secreted into the maternal bloodstream. However, based on several studies that have been conducted, there is uncertainty in the results of assessing PAPP-A levels obtained in pregnant women in the second and third trimesters.

Aim: Proving differences in PAPP-A levels in the second and third trimesters in the incidence of early-onset preeclampsia and normotensive pregnancy.

Methods: An analytic observational study with a cross-sectional approach was carried out in the delivery room of RSUP Dr. Kariadi Semarang, Halmahera Health Center, Ngesrep Health Center, Bulu Health Center, and private midwife practice in Semarang City. The subjects of the study were six 2^nd-trimester preeclampsia patients, fourteen 3^rd-trimester preeclampsia patients, and twenty normotensive pregnancy patients who met the inclusion and exclusion criteria. Data were analyzed using Mann Whitney with a significance of p<0.05

Results: There was a significant difference in PAPP-A levels (p<0.001) between the preeclampsia and normotensive pregnancy groups, whereas PAPP-A levels were higher in the preeclampsia group. There were significant differences in PAPP-A levels (p<0.001) between the 2^nd-trimester preeclampsia, 3^rd-trimester preeclampsia, and normotensive pregnancies, where the highest PAPP-A levels were found in the 2^nd-trimester preeclampsia group.

Conclusion: There was a significant difference in PAPP-A levels between the second and third trimesters of early-onset preeclampsia compared to normotensive pregnancies, where PAPP-A levels were higher in the second and third trimesters of early-onset preeclampsia. Elevated PAPP-A levels in the second and third trimesters are associated with an increased risk of early-onset preeclampsia.

Comparison Between Placenta Accreta Index and Tovbin Score as A Predictor of Placenta Accreta Spectrum Disorders (PASD)

2023-11-08T03:02:43+07:00

Background : The incidence of Placenta Accreta Spectrum Disorders (PASD) in developed countries has reportedly increased 10-fold in the last 50 years. The significant increase was followed by an increase in the number of caesarean section from 12.5% to 23.5% in the last 10 years. Maternal morbidity related to PASD events reaches 7% in intraoperative and postoperative actions, while the morbidity reaches 60%. In cases of late diagnosis, maternal mortality with placenta accreta reaches 30%. Efforts to prevent maternal morbidity and mortality can be carried out by early detection at antenatal care visits. The Placenta Accreta Index (PAI) and Tovbin scoring systems based on the results of ultrasound examination can be used to screening for placenta accreta.

Objective: To analyze the comparison of the accuracy of the PAI and Tovbin scoring systems in predicting the incidence of Placenta Accreta Spectrum Disorder (PASD).

Method: The study used an analytic observational with a cross sectional design. Sampling was done by consecutive sampling method. There were 35 subjects who met the inclusion and exclusion criteria. PAI and Tovbin scoring were performed on each selected subject. The accuracy of the PAI and Tovbin scoring systems was confirmed by establishing a diagnosis based on PASD histopathology.

Results: The PAI scoring system in predicting PASD has a sensitivity value of 79.31%, a specificity of 83.33%, a positive predictive value (NDP) of 95.83%, a negative predictive value (NDN) of 45.45%, an accuracy of 80.00%. While the Tovbin scoring system obtained a sensitivity value of 86.21%, specificity of 83.33%, NDP of 96.15%, NDN of 55.56%, accuracy of 85.71 %.

Conclusion: In the comparison of scoring systems, it was found that the Tovbin scoring system has almost the same sensitivity and accuracy and the same specificity in predicting Placenta Accreta Spectrum Disorder (PASD).

Comparison Of The Effectiveness Of High Intensity Laser Therapy (HILT) And Low-Level Laser Therapy (LLLT) On Improving Balance In Knee Osteoarthritis

2023-09-21T11:15:19+07:00

BACKGROUND : Osteoarthritis (OA) of the knee is a joint disease with a high prevalence among the elderly. OA can cause balance disorders, which are one of the main causes of falls in the elderly. Balance can be measured using several scoring systems, one of which is the Berg Balance Scale (BBS). One of the treatment modalities for OA is laser therapy which is non-invasive and easy to apply. Low level laser therapy (LLLT) has been widely used in patients with knee OA, but recently high intensity laser therapy (HILT) has begun to be used in physical therapy with advantages over a wider range and depth.

AIMS : to compare the effect of LLLT and HILT therapy on improving functional balance in the elderly with knee OA.

METHOD : This research is a randomized controlled trial pre-test and post-test-controlled group design. The sampling method used in this study is the simple random sampling method. The sample size was 27 subjects and divided into two groups, the LLLT group (n=14) and the HILT group (n=13). Each subject received laser therapy sessions 2 times a week for 4 weeks. Balance was assessed using the BBS before and after the intervention.

RESULT : There was an increase in BBS scores before and after treatment in the HILT group (p<0.001) and in the LLLT group (p<0.001), with the increase in the HILT group (7.79 ± 2.16) significantly greater than in the LLLT group (3 .08 ± 0.76) (p<0.001).

CONCLUSION : HILT improves balance score better than LLLT.

Relationship Between Serum Malondialdehyde (MDA) Levels With Seizure Frequency In Epilepsy Patients With Combination Of Phenytoin And Valproic Acid

2023-09-21T10:27:41+07:00

Background: Oxidative stress is believed to be one of the factors involved in the pathogenesis of epileptogenic where lipid peroxidation occurs which produces Malondialdehyde (MDA). Epilepsy and some Antiepileptic Drugs (AEDs) can improve or worsen seizure frequency thereby significantly changing blood MDA levels.

Objective: To determine the relationship between serum MDA levels and seizure frequency in epileptic patients treated with AEDs, a combination of phenytoin and valproic acid.

Methods: A cross-sectional study with consecutive sampling of 46 subjects (with epilepsy receiving combination therapy with phenytoin and valproic acid. The research was conducted at the Neurology Policlinic at RSUP Dr. Kariadi in December 2022 – February 2023. MDA levels were measured using the Enzyme Linked Immunosorbent Assay (ELISA) method. The relationship between serum MDA levels and seizure frequency was analyzed using Spearman's test since both of the variables are ordinal scale, the results were significant if p<0.05.

Results: There was no relationship between MDA levels and seizure frequency in epileptic patients with the combination of phenytoin and valproic acid. (p=0.516) There is a significant relationship between the frequency of seizures and the length of treatment (p=0.026) with a weak negative correlation (rho=0.328). There is a significant relationship between the frequency of seizures and the age of onset of epilepsy (p=0.037) with a weak negative correlation (rho=0.309).

Conclusion: There is a significant relationship between the frequency of seizures with the length of treatment and the age of onset of epilepsy.

Characteristics and Risk Factor of Multidrug-Resistant-Organism Infection in the Pediatric Intensive Care Unit of Dr. Kariadi Hospital Semarang

2023-10-17T11:42:51+07:00

BACKGROUND: The Pediatric Intensive Care Unit (PICU) that treats critical patients with various invasive procedures is a potential place for Multidrug Resistant Organism (MDRO) infections. This spesific unit, especially in tertiary care facilities may have higher prevalence of MDRO than non-PICU settings, causes serious disease and mortality. AIMS: To describe the characteristics and risk factor of MDRO infection in the PICU of dr. Kariadi Hospital Semarang, METHOD: Retrospective study in patients aged 1 month - 18 years with growth of germs on culture results during 2021-2022. Demographic data, use of central venous catheters and ventilator, length of stay, duration of antibiotic usage, and history of major surgery were investigated from medical records. The amount of risk expressed by the Odds Ratio (OR).RESULT: From 544 culture examinations, 199 (36.5%) germs grew, consisting of 79 MDRO isolates (39.7%) and 120 non-MDRO isolates (60.3%). Gram-negative bacteria were found in 140 samples (70.4%) with Klebsiella pneumoniae as the most common germ (15.1%) and respiratory tract infection (56.3%) being the most common infection diagnosis. As many as 24 of 30 (80%) isolates that grew Klebsiella pneumoniae were MDRO. Mechanical ventilator use (OR 2.15; 95% CI 1.07 – 4.3; p=0.043) and length of stay in the PICU (OR 2.44; 95% CI 1.21 – 4.96; p=0.018) are risk factors for MDRO infection.CONCLUSION: Klebsiella pneumoniae is the most common germ found from culture isolates and respiratory tract infection is the most common diagnosis. The use of mechanical ventilators and length of stay in the PICU are risk factors for MDRO infection.

Effectiveness of Foot Exercises together with the Hydrotherapy program on Blood Sugar Levels in Elderly People without Diabetes

2023-10-09T10:38:28+07:00

Background: The elderly human population is susceptible to health problems due to decreased organ function. The risk of diabetes in old age also reduces quality of life. Preventing the risk of developing diabetes mellitus requires simple and simple exercise programs such as foot exercises and hydrotherapy. The effect of light leg exercise and hydrotherapy on carbohydrate metabolism is unknown.

Objectives: To find out the impact of hydrotherapy alone or in combination with foot exercise on elderly's blood sugar levels.

Methods: Parallel three-group pre and post-test designs for an experimental investigation. 21 elderly in RW 04 Karangwetan, Ungaran served as research participants, divided into control group (n=7), combination of foot exercises and hydrotherapy intervention group (n=7), and foot exercise intervention group (n=7). The intervention took place three times per week for five weeks. We used POCT to assess blood sugar levels.

Results: There is no significant decrease in blood sugar levels from control group (p>0.05). There is significant decrease in blood sugar levels from foot exercise and hydrotherapy intervention group (p<0.05) and foot exercise intervention group (p<0.05). The difference in blood sugar levels showed significant results between foot exercise and hydrotherapy intervention group and control group (p=0.000) and between foot exercise intervention group and control group (p=0.004). There is no significant differences in blood sugar levels between foot exercise and hydrotherapy intervention group and foot exercise intervention group (p=0.112).

Conclusion: Simple exercise activities such as foot exercises together with hydrotherapy have been proven to reduce blood sugar levels in healthy elderly populations without diabetes

The Relationship between the Duration of Suffering from Diabetes and HbA1c Levels with the Degree of Liver Stiffness in Type 2 Diabetes Mellitus Patients

2023-10-03T08:59:43+07:00

BACKGROUND : Type 2 diabetes mellitus (DM) is one of the major problems faced by the health system. Diabetes is a multifactorial, chronic and progressive metabolic disorder characterized by chronic hyperglycemia. Persistent hyperglycemia is associated with long-term damage to the liver. Ultrasound elastography is one of imaging modality that can assess liver stiffness, thus can assist clinicians in determining therapy, evaluating, and predicting disease progression.

AIMS : Aim of this study was to determine the relationship between liver stiffness degree by using ultrasound elastography with the duration of T2DM and HbA1c levels.

METHOD : This study was an observational analytic research with a cross-sectional approach which carried out from May to September 2022 at the radiology department of Dr. Kariadi Hospital Semarang. Fifty subjects were included in this study and Rank-Spearman correlation test was used to analyze the relationship between liver stiffness degree with T2DM duration and HbA1c levels.

RESULT : Using ultrasonography elastography, the liver stiffness average was 7.92 + 6.72 kPa. The average of HbA1c levels was 8.55 + 2.63%. T2DM duration average was 9.10 + 6.50 years. The rank-spearman test showed a significant correlation between HbA1c levels and the degree of liver stiffness (p = 0.000) with a correlation coefficient (r) of 0.68. There was no significant correlation between the T2DM duration and the degree of liver stiffness (p = 0.052).

CONCLUSION : There was a significant correlation between liver stiffness and HbA1c levels, but there is no correlation between liver stiffness and T2DM duration

The Effect of Mckenzie Exercise to Increase Craniovertebral Angle in Forward Head Posture of Adolescent

2023-10-10T11:24:31+07:00

BACKGROUND : adolescents with low physical activity and smartphone addiction has been indicated to reduced the craniovertebral angle, there by causing a forward head posture and increasing scapular dyskinesis, characterized by a craniovertebral angle (CVA) less than 50^o. McKenzie is one of exercise that can helm correct posture in forward head posture

AIMS : to determine the effect of the McKenzie exercise on increasing the craniovertebral angle in the forward head posture of adolescents.

METHOD : students of MAN 1 Surakarta (Islamic Boarding School) with advanced head posture, aged 14-17 years using a simple random sampling technique divided into group I as the intervention group (n=16) and group II as the control group (n=14). Group I was given treatment of McKenzie exercise 3 times a week for 4 weeks, and the control group was not given any treatment. The Craniovertebral angle were assessed using photo analysis with Image-J application.

RESULT : The results of the study indicate that the characteristics of respondents according to age are mostly 16 years old. The mean NDI score in the intervention group was 23,63 and the mean NDI score in the control group was 24,60. The results of statistical test using independent samples test showed that there was a significant difference during the intervention and the control group (p=0,000)

CONCLUSION : McKenzie's exercise can affect to increasing the craniovertebral angle in the forward head posture of adolescents.

Effectiveness of Kelly Plication Method on Clinical Improvement in Stress Urinary Incontinence Patients

2023-10-09T07:15:18+07:00

BACKGROUND: Patients with pelvic organ prolapse (POP) usually present with POP, but stress urinary incontinence (SUI) is also found during history taking and physical examination. As a result, the complaint of SUI is persistent despite POP surgery. Therefore, SUI found along with POP and undergoing surgery can be performed Kelly plication method.

OBJECTIVES: To examine the effectiveness of Kelly's plication method on clinical changes and quality of life of patients suffering from SUI.

METHODS: A single cohort prospective one-group pretest-posttest design conducted at RSUP Dr. Kariadi Teaching Hospital Semarang involving 31 research subjects. All subjects were measured preoperative IIQ-7 questionnaire and pad test. Then, all subjects will undergo Kelly method surgery. Postoperative evaluation will be conducted 3 months later, including measurement of the IIQ-7 questionnaire and pad test. All data will be analyzed with univariate and bivariate analysis using paired t-test and Wilcoxon test.

RESULTS: The effectiveness rate of Kelly's plication method was 58.06% in this study. Most of the subjects were aged 50-59 (38.7%) years and had experienced menopause (87.1%). Correlation analysis of baseline data on the degree of preoperative SUI showed that the degree of POP correlated SUI. The Pad test and IIQ-7 questionnaire test showed a significant decrease in postoperative measurements in the treatment group (p: <0.001 & p: <0.001).

CONCLUSIONS: Kelly's plication method is effective in treating SUI.

The Correlation between Volatile Organic Compounds (VOC) with Leukotriene B4 and Eosinophil Counts in Chronic Obstructive Pulmonary Disease Patients

2023-11-08T02:59:02+07:00

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by increasing Leukotriene B4 (LTB4) and eosinophil counts. Volatile organic compounds (VOCs) have shown promise as non-invasive biomarkers, reflecting COPD pathophysiology. Identifying specific VOCs associated with increased LTB4 and eosinophil counts could lead to the discovery of potential biomarkers for COPD severity or progression.

AIMS: This study aims to investigate the correlation between VOCs and leukotriene B4 (LTB4) levels, as well as eosinophil counts counts in COPD patients.

METHOD: Using an observational-analytic method with a case-control approach, 20 COPD patients and 20 controls were enrolled from the respiratory outpatient department of Dr. Saiful Anwar General Hospital, Malang. VOC levels were measured using a breath analyzer, while LTB4 levels were determined through enzyme-linked immunosorbent assays. Spearman’s correlation tests examined associations between VOCs, LTB4, eosinophil counts, and comorbidity, with Mann-Whitney tests comparing results against the control group. Data significance was set at p < 0.05.

RESULT: There were 40 COPD patients and 40 controls in this study. There were significant differences between VOCs in the COPD group and the control group (p < 0.05). LTB4 level significantly increased in the COPD group than in the control group (p < 0.001), and there was no difference in the eosinophil level. There was a correlation between LTB4 and VOC level of C₂H₅OH in COPD patients (p = 0.009; r = 0.410). There was no correlation between eosinophil counts and VOCs (p = 0.939). The level of VOCs was significantly different between patients with only COPD and patients with COPD and comorbid lung cancer (p < 0.05).

CONCLUSION: There is a correlation between VOC and LTB4 in COPD patients.

The Effectiveness Of E-Backnshou Exercise To The Improvement Of Neck, Shoulder And Back Pain In Computer Vision Syndrome Patient

2023-12-20T01:33:28+07:00

BACKGROUND : Extra-ocular complaints of Computer Vision Syndrome (CVS) are neck, shoulder, back pain. The 20-20-20 rule and E-BACKNSHOU exercise are expected to improve accommodative mechanisms, ocular surface of the eye and extra ocular symptoms of CVS.

AIMS : Proving the effectiveness of E-BACKNSHOU exercise for the improvement of neck, shoulder and back pain in CVS patient.

METHOD : The research design was Pre-Post Test with Control Design. Subjects were 30 medical students of Faculty of Medicine, Diponegoro University, Semarang, Indonesia who experienced CVS and neck, shoulder and back pain. The treatment group got the 20-20-20 rule and E-BACKNSHOU exercise and the control group got the 20-20-20 rule for 1 month. Pain was measured by Visual Analogue Scale (VAS). Statistical test was conducted using paired t-test, unpaired t-test and chi square. Value of significance p<0.05.

RESULT : There were significant differences in VAS score of neck, shoulder, upper back pain (p=0.00), and low back pain (p=0.022) before and after the intervention in the treatment group and VAS score of neck (p=0,002), shoulder (p=0.020), upper back (p=0.011), and low back pain (p=0.019) in the control group. Delta VAS score of the treatment group was greater than the control group and there was a significant difference in delta VAS score of shoulder pain (p=0,030), but there were no significant differences in delta VAS score of neck (p=0,934), upper back (p=0,356), and low back pain (p=0,150).

CONCLUSION : The effectiveness of 20-20-20 rule and E-BACKNSHOU exercise is better than the 20-20-20 rule alone on treating neck, shoulder and back pain in CVS patient.

Prenatal, Perinatal And Postnatal Risk Factors From Mother And Child To The Incidence Of Epilepsy

2023-11-08T03:09:09+07:00

BACKGROUND: Epilepsy is a health problem that affects sufferers and their families, characterized by at least two seizures without provocation with an interval of more than 24 hours between seizures, one seizure without provocation with the possibility of recurring within 10 years, a diagnosis of epilepsy syndrome has been established. The risk of epilepsy can be influenced by the condition of the mother and child in the prenatal, perinatal and postnatal periods.

AIMS: This study analyzed the risks of several prenatal, perinatal, and postnatal factors of mother and child as risk factors for epilepsy incidence.

METHOD: A case control study was conducted at RSUP Dr. Kariadi Semarang from July 2022 to March 2023. A total of 90 eligible subjects were divided into 45 case with epilepsy and 45 control with a non-epileptic diagnosis. Inclusion criteria were aged over 17 years to 40 years and exclusion criteria were subjects with mothers who had died or could not be interviewed, data were incomplete and had structural brain disorders or other diseases with clinical symptoms of seizures for the control group. The data obtained were analyzed using chi squares test for bivariate association, followed by multivariate analysis with multiple logistic regression.

RESULT: Maternal age during pregnancy (p=0.016), low birth weight (p=0.007), surgical birth (p=0.004), head trauma at the age of less than 6 years (p=0.008) have been shown to influence the occurrence of epilepsy with significance respectively.

CONCLUSION: Prenatal factors of the mother which is maternal age during pregnancy, perinatal and postnatal factors of the child which are low birth weight, surgical birth, and head trauma at the age of less than 6 years are risk factors that influence the occurrence of adulthood epilepsy.

Functional Capacity COVID-19 Survival Among Workers in Koja Public Health Center

2023-08-25T06:11:49+07:00

Introduction: Coronavirus disease 19 (COVID-19) primarily affects the respiratory system and other organ systems which limit respiratory and physical status. The aim of this study is to evaluate functional capacity COVID-19 survivor among workers in Koja Public Health Center

Methods: participant were enrolled on March-April 2022. Demographics, symptoms, functional scale post COVID-19 questionnaire, risk stratification, and 6-min walk test (6mwt) were analysed. Patients unable to walk were excluded from the study.

Results: 79 participants, 38% was a health care worker, had a median age 33 (21-57) years and 43 women (54.4%). Men had higher 6mwt 518.2 (120-625.8) meter while women had 457 (340-600) meter p (<0.001), VO2max 17.47 (9.74-20.67) in men and 16.45 (14.07-19.19) in women p (<0.001), and METs 5.02 (2.78-5.90) in men and 4.69 (4.02-5.48) in women p (<0.001). Most of the participant had good fitness, 10 participant (12.7%) had functional limitation; 2 participants (2.5%) still had symptom.

Conclusion: Despite being COVID-19 survivors, the workers at the Koja Public Health Center have good functional capacity.

Effect Of Triamcinolone Trigger Point Injection On Changes In TNF-α Levels And Oswestry Disability Index (ODI) Scores Non-Specific Low Back Pain (LBP) Patients

2023-12-19T03:57:08+07:00

Background: Low back pain (LBP) is the most common musculoskeletal problem and a major cause of worldwide disability causing increased health costs and indirect costs associated with reduced or lost productivity. One of the therapeutic management of LBP is Triamcinolone trigger point injection. Until now, research on the effect of Triamcinolone trigger point injection on changes in TNF-α levels and Oswestry Disability Index (ODI) scores in Non-Specific LBP patients is still limited.

Objective: To analyze the effect of Triamcinolone trigger point injection on changes in TNF-α levels and ODI scores before and after Triamcinolone trigger point injection in Non-Specific LBP patients.

Methods: This is a quasi-experimental analytic observational study with a pre and post-test group design approach. Subjects were diagnosed with Non-Specific LBP who had met the inclusion criteria (acute pain less than 3 months, patient age 30-55 years, moderate-severe pain intensity, had never received a Triamcinolone trigger point injection) with the exclusion criteria patients experiencing severe pain. not only caused by NPB. The study subjects were checked for TNF-α levels and ODI scores before and after the Triamcinolone trigger point injection. Then a paired T-test was carried out.

Results: During the study period September - November 2022 at the Neurology Outpatient Polyclinic, RSUP Dr. Kariadi Semarang obtained 32 subjects. There was a significant difference between changes in TNF-α levels before and after Triamcinolone trigger point injection (p=0.000). There was a significant difference in ODI scores before and after the Triamcinolone trigger point injection (p=0.000). There was no significant relationship between the risk factors for gender, occupation, BMI, physiotherapy, and changes in TNF-α levels with changes in the ODI score.

Conclusion: There is a significant difference in changes in TNF-α levels and ODI scores before and after Triamcinolone trigger point injection.

Rehabilitation of A Child with Low Endurance in the Recovery Phase of Guillain-Barré Syndrome

2023-09-21T11:12:49+07:00

BACKGROUND: Guillain-Barré Syndrome (GBS) usually has a good prognosis of recovery. However, some patients can have remaining disabilities due to low cardiorespiratory fitness or endurance and needs to be managed.

AIMS: This study reports the rehabilitation assessment and management of a child with low cardiorespiratory endurance in the recovery phase of GBS.

CASE: A 12-year-old girl with a history of hospitalization due to Acute Motor and Sensory Axonal Neuropathy (AMSAN)-type of GBS was referred to the Physical Medicine and Rehabilitation (PMR) outpatient clinic with tiredness that restricted her school participation. She had low cardiorespiratory endurance, which was confirmed by a six-minute walk test (6-MWT). After the rehabilitation program, her endurance level was increased, and she can return to school.

DISCUSSION: A comprehensive assessment showed that the muscle weakness, accompanied by obesity, anemia, and inactivity, led to low cardiorespiratory endurance that restricted the activity and participation. A rehabilitation program that consisted of aerobic and strengthening exercises improved cardiorespiratory endurance, walking ability, and school participation.

CONCLUSION: Rehabilitation management in children with low cardiorespiratory endurance due to the sub-acute phase of GBS could help them regain their activity and participation during the recovery phase.

Follicular Ameloblastoma of Maxillary: A Case Report

2024-02-28T08:06:24+07:00

Introduction: Ameloblastoma is a benign odontogenic tumor that appears in the mandible and maxilla. Ameloblastoma has slow growth that takes several years for symptoms to appear, but ameloblastoma in the maxilla has a more aggressive clinical course compared to the mandible. The lack of initial symptoms leading to diagnosis at an advanced disease when the tumour has already extended beyond maxilla. The cancellous structure of the maxillary bone makes it easier for tumors to spread to the nasal cavity, paranasal sinuses, orbitals, parapharyngeal tissue and skull base. This article reports a case of resection of maxillary ameloblastoma.

Case Report: A 63 year old female patient came with complaints of a lump on her right cheek since 2 years back that gradually increased in size. Since 2 months ago, pus and blood have been coming out of the lump. Extra oral examination revealed a well-defined mass with a solid and hard consistency, there were no ulcers or fistulas. Intraorally, a mass measuring 5x5x3cm was found in the region of teeth 12 to 15 which extended to the buccal-palatal area. History of allergies and weight loss was denied. Supporting examinations including panoramic radiography, PA chest radiography, CT-Scan, FNAB, and biopsy resulted in a diagnosis of ameloblastoma. Treatment was carried out by resection of the right maxillary tumor mass under general anesthesia.

Discussion: In this case, the patient's clinical examination showed a hard and large palpable swelling in the right maxilla area which extended from the region of tooth 12 to tooth 15 which caused facial asymmetry and no tooth mobility was found. This hard and painless swelling takes about 2 years before the patient experiences symptoms of pus and blood discharge. The post-maxillectomy defect in this case was covered with an intraoral prosthesis in the form of a post-surgical obturator made of acrylic resin. The obturator functions to hold the surgical packing, and prevent food or dirt contamination in the defect area which can cause infection and slow healing. The use of a prosthesis also helps restore swallowing and speech function to the patient.

Conlussion: In principle, the treatment for ameloblastoma is resection of the involved bone, as in this case the action taken is a maxillectomy. Maxillectomy can result in facial and oral cavity deformities characterised by facial disfigurement and alterations in oral functionality.Therefore, maxillary reconstruction is needed to treat maxillary defects after surgical procedures involving the loss of part or all of the maxilla.

Case Series : Orbital Complications In Pediatric Rhinosinusitis

2024-02-28T08:11:12+07:00

Introduction: Acute bacterial rhinosinusitis in children can cause orbital complications, either directly through fissures or indirectly through veins. Proper treatment can reduce morbidity due to orbital complications.

Case: Two cases of orbital complications in pediatric acute bacterial rhinosinusitis caused by adenoid hypertrophy and dental infection. The first case of acute bacterial rhinosinusitis with periorbital cellulitis and left premaxillary abscess accompanied by adenoid hypertrophy and multiple pulp gangrene. The second case of acute bacterial rhinosinusitis with subperiosteal abscess accompanied by adenoid hypertrophy and multiple dental caries. Functional endoscopic sinus surgery (FESS), abscess drainage, adenoidectomy and odontectomy were performed. The culture results of the first patient were Streptococcus anginosus, and it was resistant to tetracycline. Meanwhile, the culture results of the second patient, Staphylococcus epidermidis, were resistant to amoxiclav, ampicillin, cefoxitin, oxacillin, penicillin G, and tetracyclin.

Conclusion: Acute rhinosinusitis with orbital complications can caused by adenoid hypertrophy and dental infection. Medical treatment with adequate antibiotic followed by FESS, abscess drainage, adenoidectomy and odontectomy give an optimal result.