Medica Hospitalia : Journal of Clinical Medicine

Comparison of the Effectiveness of High Intensity Laser therapy (HILT) and Low-Level Laser Therapy (LLLT) on Functional Improvement in Knee Osteoarthritis Patients

Bernadete Rizky Natalia — 2024-07-31

BACKGROUND : Knee osteoarthritis causes sore, joint stilted, progressive deformity and functional encroachment. The current therapeutic focus on rectifying function and assuaging symptoms, especially pain. There are two types of laser therapy, namely Low-Level Laser Therapy (LLLT) and High Intensity Laser Therapy (HILT). High Intensity Laser Therapy (HILT) is a high-intensity laser radiation with photochemical, photothermal, and photomechanical action possess many therapeutic steads including analgesic, anti-edematous, and biostimulating effects. In this study, we compare the effectiveness of HILT with LLLT on functional enhancement in knee osteoarthritis assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS).

AIMS : To compare the effectiveness of HILT with LLLT on functional enhancement in patients with knee osteoarthritis.

METHOD : This research is a quasi-experimental pre-test and post-test with controlled group design. There were 27 subjects of knee osteoarthritis patients who were divided into 2 treatment groups, the first treatment group admit HILT therapy (14 patients) and the second treatment group admit LLLT therapy (13 patients). Knee Injury and Osteoarthritis Outcome Score (KOOS) was measured before and after 4 weeks of treatment.

RESULT : There was a significant difference in the mean value of functional improvement as measured by KOOS before and after treatment in each group (p < 0.001) and there was a significant difference in the mean value of KOOS in the two groups (p < 0.001).

CONCLUSION : The administration of HILT has shown significant escalation of functional improvement compared to the administration of LLLT in patients with knee osteoarthritis.

Comparison of Protein Energy Wasting Assessment on Quality of Life Regular Hemodialysis Patients

Ni Wayan Sri Wardani — 2024-07-31

Background. Protein energy wasting (PEW) is one of several markers of the quality of hemodialysis (HD) services in Indonesia, however not many studies conducted PEW assessement with quality of life (QoL) domain of regular HD patients.

Aim: To determine comparison of PEW assessment with QoL domains in regular HD patients.

Method: A Cross-sectional study with total sampling of 105 regular HD patients at Sanjiwani Gianyar General Hospital, on June to July 2022, The PEW assessments: body mass index (BMI), serum albumin, subjective global assessment (SGA), malnutrition inflammation score (MIS), and the International Society of Renal Nutrition and Malnutrition (ISRNM) with QoL domains by KDQOL-SF (Kidney Disease Quality of Life Short Form).

Results. Most of the subjects were men (54.2%), the mean age was51.66 years and mean duration of HD was 50.28 months. The mean of BMI, serum creatinine, and serum albumin were 23.46 kg/m2, 9.70 mg/dL, and 3.86 mg/dL respectively, and median MIS 5. This study obtained significant correlation of BMI and QoL domains: work status, physical functioning, role of physics, energy/fatigue, and SF 12 physical composite. The MIS also significantly correlated with emotional well-being, sleep, and burden of disease. And ISRNM significantly correlated with energy/fatigue, and sexual function, On logistic regression analysis, this study obtained that albumin was significantly related to general health, emotional well-being, and energy/fatigue,

Conclusion: Assessment of PEW (BMI, serum albumin, MIS, SGA, and ISRNM ) were related to several domains of QoL.

The Effect of Coenzym Q10 on Doxorubicin-induced Cardiotoxicity in Non Hodgkin's Lymphoma Patients

Julita Melisa Dewi — 2024-07-31

BACKGROUND : Non-Hodgkin's Lymphoma is a primary malignancy in the Lymph Nodes and lymphoid tissue originating from B lymphocytes, T lymphocytes and Natural Killer (NK) cells. Therapy for Non-Hodgkin's Lymphoma chemotherapy can be given alone or combined with radioactive therapy. Doxorubicin is a chemotherapy drug used for lymphoma with side effects, one of which is cardiotoxic effects.

AIMS : To prove that coenzyme Q10 can reduce the cardiotoxic effect of doxorubicin chemotherapy in non-Hodgkin's lymphoma patients

METHOD : Intervention study with a randomized pre and post test double blind control group design with 34 NHL patients undergoing chemotherapy. The treatment group received additional therapy with coenzyme Q10 300mg/day for 12 weeks while the controls received placebo. The cardiotoxic effects examined were assessed based on the results of Electrocardiography and Echocardiography.

RESULT : The treatment group with coenzyme Q10 supplementation after the 4th chemotherapy showed a decrease in echocardiography results in 3 patients (18%) and in the control group 17 patients (100%). There was a significant difference in the echocardiography results of the treatment and control groups (p=0.001). There were no drug side effects in both groups

CONCLUSION : Coenzyme Q10 supplementation provides an improvement in the cardiotoxic effects of doxorubicin in non-Hodgkin's lymphoma patients, on echocardiography, but not on Electrocardiography.

Differences In Effectiveness Between Progressive Muscle Relaxation Therapy And Slow Deep Breathing Therapy On Elderly Sleep Quality

Wajihahni Rodiyah — 2024-07-31

Background

Every individual has a lifetime, starting from the womb, born into the world, to becoming elderly. Aging is a process of gradual loss of tissue's ability to repair itself, maintain its normal structure and function so that it cannot defend the tissue from injury (including infection), and repair the damage that occurs. In the elderly, there are various kinds of health problems such as sleep disorders. Sleep disorder or insomnia is a person's inability to sleep. Poor sleep quality can be improved in various ways such as relaxation techniques.

Aim

To compare the effectiveness of Jacobson's Progressive Muscle Relaxation (JPMR) and Slow Deep Breathing Therapy in improving sleep quality in the elderly.

Method

This type of research was a quantitative quasi-experiment with pretest and post-test methods (one group pre-test and post-test design). Respondents involved 49 people while research data were processed with the Mann-Whitney and Wilcoxon tests. The Sleep Quality Questionnaire used the PSQI questionnaire.

Result

The Wilcoxon test with an alternative to the Mann-Whitney test showed no significant difference in effectiveness between the two therapies with p-value = 0.274.

Conclusion

Both therapies had almost the same level of effectiveness; there was no significant difference between the two, so progressive muscle relaxation therapy and Slow Deep Breathing were equally effective in treating anxiety and improving sleep quality.

Effect of Genistein-rich Edamame Extract on Eosinophil-Lymphocyte Ratio

Reza Dian Pratama — 2024-07-31

BACKGROUND : Atherosclerosis is associated with hypercholesterolemia and inflammation. Edamame, a high-genistein soybean variant, is believed to have protective effects against atherosclerosis.

AIMS : This study aimed to determine the influence of edamame extract rich in genistein on the eosinophil-lymphocyte ratio (ELR) levels in rats induced with atherosclerosis.

METHOD : This research utilized a true experimental design with a post-test only control group. Thirty male rats were divided into five groups: negative control, positive control, treatment 1 with edamame extract supplementation, treatment 2 with edamame extract rich in genistein supplementation, and treatment 3 receiving atorvastatin. After 28 days, the ELR levels were examined from rat blood. Data were analyzed using One-Way ANOVA - Bonferroni, Kruskal-Wallis – Mann-Whitney, and Pearson correlation tests.

RESULT : There were no significant differences in ELR levels (p>0.05) among all treatment groups compared to the negative and positive control groups. T-tests between the negative control and positive control groups, as well as between the positive control and the three treatment groups successively, showed non-significant results (p: 0.376; 0.856; 0.169; 0.066).

CONCLUSION : The administration of edamame extract rich in genistein did not significantly reduce inflammation levels in blood vessels compared to edamame extract alone, as indicated by non-significant results in the ELR difference analysis.

Comparing the Pulmonary-Spirometry In Laboratory Workers Who Wear Acchadana® and KN95® Masks

Fathur Nurkholis — 2024-07-31

BACKGROUND : The upper respiratory tract is susceptible to inflammation caused by exposure to airborne contaminants, particularly chemical irritants. Inhaled irritant gases can lead to various symptoms and adverse reactions in the respiratory tract. Laboratory workers are at a high risk of respiratory tract inflammation due to exposure to volatile chemicals. The use of personal protective equipment (PPE), such as masks, is essential to prevent inflammation and protect the respiratory tract. Lung function tests using spirometry, including Forced Vital Capacity (FVC), Forced Expiratory Volume in One Second (FEV_1.0), and Peak Expiratory Flow (PEF), can help identify abnormalities in lung function.

AIMS : The primary objective of this investigation is to juxtapose the pulmonary conditions of laboratory workers before and after the utilization of KN95® masks and Acchadana® masks.

METHOD : The study design was a Randomized Control Trial, and the subjects were divided into two groups: the control group wearing KN95 masks and the treatment group wearing Acchadana® herbal masks. Spirometry measurements were taken before and after using the masks, and statistical analysis was conducted to compare the results.

RESULT : The results showed that both mask groups experienced improvements in lung function parameters after using the masks. However, the KN95 mask group showed better lung conditions compared to the Acchadana® mask group.

CONCLUSION : Spirometry tests conducted on lab workers revealed improved lung function metrics (including FVC, FEV1.0, and PEF) following the usage of KN95 masks and Acchadana® herbal masks. The KN95 mask users exhibited superior respiratory health compared to the other group in this investigation.

The Relationship Between Cumulative Platinum-Based Chemotherapy Dose And The Occurrence Of Ototoxicity In Head And Neck Malignancies

Hendro Purnomo — 2024-07-31

BACKGROUND: Chemotherapy is a treatment for head and neck malignancies. Hearing impairment is a side effect of chemotherapy, especially caused by platinum-based chemotherapy. Hearing impairment generally occurs at high frequencies after the administration of chemotherapy.

AIMS: To prove assosciation between cumulative doses of platinum-based chemotherapy and ototoxic events in head and neck malignancies.

METHOD: This is a cross-sectional study. The sample is patients with head and neck malignancy receiving platinum-based chemotherapy at Dr. Kariadi Hospital Semarang from March to June 2023. Hearing assessment using pure tone audiometry was performed randomly at all chemotherapy cycles. Data was analyzed with a chi-square test.

RESULT: Eighty-one subjects (52 male, 29 female), consisting of 71 subjects received cisplatin, and 10 subjects received carboplatin. Ototoxicity occurs in 91.7% of subjects receiving cumulative doses of cisplatin >300mg/m² and carboplatin >1500mg/m²compared to cumulative doses of cisplatin <300mg/m² and carboplatin <1500mg/m², which was 46.7% (p = 0.001, CI 1.416-2.725).

CONCLUSION: There was a significant association between cumulative doses of platinum-based chemotherapy and ototoxicity incidence of head and neck malignancy patients.

Risk Factors for Peripheral Vertigo

Yuni Retno Sekarwangi — 2024-07-31

Background: Several risk factors influence the occurrence of peripheral vertigo, including advanced age, gender, and chronic metabolic diseases. This disease is not widely recorded in primary care due to the need for detection with simple examinations. Research on the association of several risk factors has yet to be reported.

Objectives: To examine the relationship between age, gender, type 2 diabetes mellitus (DM2), and hypertension as risk factors for peripheral vertigo.

Methods: This study is a case-control study that used consecutive sampling. The study sample consisted of 39 people: 19 in the case group and 20 in the control group. Data were obtained from 2 health centers and Diponegoro National Hospital, Semarang City. The data were obtained from history taking and physical examinations such as the Gans Sensory Organization Performance Test (SOP), past pointing test, and dysdiadokokinesia test. DM2 disease and hypertension were gathered from medical records. Data analysis used univariate analysis, bivariate analysis with chi-square, and logistic regression multivariate analysis.

Results: Statistical test results concluded that hypertension is a risk factor for peripheral vertigo (p = 0.008; OR = 6.964; 95%CI = 1.657 - 29.263). Whereas age, gender, and DM2 were not risk factors, with p-values of 0.187, 0.378, and 0.417, respectively.

Conclusion: The significant risk factor associated with the occurrence of peripheral vertigo was hypertension by 6.964 times.

The Effect of Cold Temperature on the Severity of Allergic Rhinitis Based on Visual Analog Scale (VAS) Score Among Medical Students of Malikussaleh University

Farianti Zuhra — 2024-07-31

BACKGROUND: Allergic rhinitis is a common condition caused by inflammation of the nasal mucosa after exposure to allergens and is mediated by Immunoglobulin E (IgE). Cold temperatures can aggravate the symptoms of allergic rhinitis. Allergic rhinitis is not fatal, but it can cause a decrease in the patient's quality of life if the symptoms are severe. The severity of allergic rhinitis symptoms is difficult to measure as it should match patient's perception, so VAS is a quantitative measurement tool used. Although VAS is a simple and easy-to-use tool, its use as self-monitoring for AR patients is still infrequent to minimize symptom exacerbations and maintain control of allergic rhinitis.

AIMS: This study aims to examine the effect of cold temperature on the severity of allergic rhinitis based on VAS score.

METHOD: This research is an experimental with a one-group pretest-posttest study. The study samples involved 75 students suffering from allergic rhinitis assessed with the Score for Allergic Rhinitis (SFAR) questionnaire assessment from the class of 2020, 2021, and 2022. Subjects’ pain level was measured before and after the intervention. The intervention was in the form of cold temperature exposure for 15 minutes in a room with a temperature of 18℃. Data were analyzed using the Wilcoxon test.

RESULT: The results showed that the mean VAS score before the intervention was 0 while after the intervention was 38.61 ± 24.07. This shows that the mean VAS score after the intervention is higher than the mean VAS score before the intervention (p-value = 0.00 <0.05).

CONCLUSION: The results of this study indicate that the effect of cold temperature can increase the severity of allergic rhinitis.

Significant Relationship Between Brixia Score And The Degree Of Acute Respiratory Distress Syndrome In Covid 19 Patients

Irni Dwi Aprianty Ibrahim — 2024-07-31

BACKGROUND: Chest X-ray has an important role in detecting early features of COVID-19. To improve risk stratification, a scoring system in chest x-ray called Brixia Score was developed. The Brixia score is designed to measure the severity of lung abnormalities in COVID-19, with an 18-point severity scale.

Deaths in COVID-19 occur mainly due to Acute Respiratory Distress Syndrome (ARDS). ARDS is classified into mild, moderate, and severe degrees. If the degree can be predicted earlier, patients can receive earlier therapy and death rate can be reduced.

AIMS: to analyze relationship between Brixia Score and degree of ARDS in COVID-19 patients.

METHOD: the research used an observational analytic method with a cross-sectional approach to 95 subjects who are positive for COVID-19 and diagnosed with ARDS, in January to December 2021. Brixia Score data was collected based on chest X-ray expertise, ARDS degree was based on medical records and blood gas analysis. Analysis of relationship between Brixia score and degree of ARDS was carried out using the Kruskal-Wallis test.

RESULT: There was a significant difference in Brixia score based on degree of ARDS (p value <0.05). The highest Brixia score was obtained in severe ARDS, while the low Brixia score was obtained in mild ARDS. This proves that there is a relationship between Brixia score and degree of ARDS.

CONCLUSION: Brixia score has a significant relationship to the degree of ARDS in COVID-19 patients.

Correlation Between Brixia Score Imaging and Clinical Laboratory Results In Severe-Critical Covid-19 Patients Receiving Standard Therapy Compared To Tocilizumab

Aulia Fitriani — 2024-07-31

Background. Coronavirus infection disease 19 (COVID-19) is a global health issue. Brixia score and inflammatory markers can assess COVID-19 severity. Severe-critical phase becomes the main concern of clinicians in the management of COVID-19 to reduce mortality. Standard therapy for moderate to severe COVID-19 is convalescent plasma which functions as an antiviral and immunomodulator, while tocilizumab is an IL-6 antagonist which underlies the occurrence of cytokine storms in severe-critical COVID-19.

Aims. To examine the correlation between the Brixia score and clinical laboratory results in patients with severe-critical degree of Covid-19 who received both standard therapy and tocilizumab

Method. A retrospective cohort study of Brixia score, with clinical laboratory results of D-dimer, fibrinogen, ferritin, and CRP (C-reactive protein) COVID-19 patients with severe-critical phase who were administered standard therapy and tocilizumab who were treated at RSUP DR Kariadi Semarang, then a correlation was carried out between the Brixia score and clinical laboratory results using a correlation test Spearman.

Results. The research data consisted of 72 subjects divided into groups that were adiminstered tocilizumab therapy (36 subjects) and standard therapy (36 subjects). There was a significant correlation between the Brixia score and the D-dimer result with p = 0.024 (p <0.05), correlation coefficient = 0.377 in the standard pre-therapy and post therapy. A p-value of less than 0.05 indicates no significant correlation between the Brixia score and clinical laboratory results before or after tocilizumab therapy.

Conclusion. There is a significant correlation between the Brixia score results and the D-dimer results in COVID-19 patients who are adiministered standard therapy, but not significant correlation in tocilizumab

The Effectiveness of Macrophage Hydrolyzed VCO Cream in Healing Second Degree Burns in Wistar Rats

Fahmi Syarif — 2024-07-31

Background: Burns are a global public health issue, with many studies on topical medications that are effective in second-degree burns. Hydrolyzed VCO (hVCO) contains lauric acid, polyferol and alpha tocopherol which are beneficial in wound healing. This study was conducted to determine the effectiveness of hVCO cream macrophage formation for second degree burn wound healing in Wistar rats.

Methods: A parallel group study was conducted on thirty wistar rats randomly divided into six groups induced second degree burns. Basic cream was applied to two control groups on the 6^th and 12^th day, 70% hVCO was applied to two groups on the 6^th and 12^th day, and 100% hVCO was applied to two groups on the 6^th and 12^th day. Histopathological examination of macrophage formation was conducted in each treatment.

Result: The groups with hydrolyzed VCO cream on day 12 (p=0,089) had higher macrophage formation than the same hVCO group on day 6 (p=0,354). The macrophage count of hVCO in each group showed an increase.

Conclusion: 100% hVCO is effective in accelerating second degree burn wound healing in terms of macrophage count.

The Increased Superoxide Dismuatase (SOD) In Mice Infected by Plasmodium Berghei ANKA Treated with Nanoparticle Extract of Beetroot (Beta Vulgaris L)

Fransisca Pramesshinta Hardimarta — 2024-07-31

BACKGROUND: Malaria infection causes increased free radicals which leads to severity and decreases antioxidant activity, thus increasing the risk of severe malaria complications. Beetroot extract has active compounds that function as anti-inflammatory and antioxidants. Nanoparticles are a technology that can be used to improve drug delivery efficiency in smaller doses.

AIMS: to prove the effectiveness of beetroot extract nanoparticles on SOD levels in mice infected with malaria and treated with artemisinin

METHOD: An experimental study using a post-test-only randomized control group design. The research sample used 30 male Balb/c mice divided into 6 groups. Group 1 was the healthy group, group 2 was the infected group without treatment, group 3 was the infected group with artemisinin treatment, group 4 was the infected group with artemisinin treatment and 50 mg/kgBW/day beetroot extract nanoparticles, group 5 was the infected group with artemisinin treatment and 100 mg/kg BW/day beetroot extract nanoparticles, and group 6 was the infected group with artemisinin treatment and 200 mg/kg BW/day beetroot extract nanoparticles. Beetroot extract and artemisinin supplementation were given after parasitemia index > 1% and given for 4 days. On the 5th day after therapy, serum SOD levels were measured using ELISA.

RESULT: The measurement of SOD levels in the artemisinin group supplemented with nanoparticle extracts of beetroot at doses 100-200 mg/KgBW were 21,48-21,59 ng/ml. Kruskal Wallis and Mann Whitney test showed that they are significantly higher serum SOD levels compared to the infected mice group (p<0.05).

CONCLUSION: Supplementation of beetroot extract nanoparticles has an antioxidant effect by increasing SOD levels in mice infected with malaria and receiving artemisinin therapy.

Factors Associated with Survival Rate in Biliary Atresia Patients Following Kasai Surgery

Agung Aji Prasetyo — 2024-07-31

Introduction: Biliary atresia is the most frequent cause of obstructive jaundice leading to liver fibrosis, end-stage liver disease, and death. Kasai surgery offers a bridge to attenuate liver fibrosis progression through reconstruction of the biliary system. The success of the Kasai procedure depends on the presence of jaundice, age at the time of surgery, clay-colored stool, and bilirubin counts.

Aim: This study aimed to investigate and predict the death incidence of Biliary atresia patients following Kasai Surgery in our institution.

Method: We conducted a case-control study from March 2020 to January 2022 at Kariadi General Hospital, Semarang, Indonesia. We collected data related to gender, age at surgery, albumin level pre and post-surgery, total and direct bilirubin before and after surgery, and the presence of ascites. Bivariate analysis using the Chi-Square test with OR (95% CI) was performed to analyze the risk factors in BA patients following the Kasai procedure.

Results: 19 patients with biliary atresia underwent the Kasai procedure with a survival rate of 68.4%. Bilirubin levels ≥10 mg/dL before (p=0.033, OR 11.25) and after (p=0.025, OR 11.00) the Kasai procedure, and the presence of ascites (p=0.005) were significant factors associated with mortality cases. However, a combined multivariate analysis of these factors did not show any significant relationship with outcomes.

Conclusion: Bilirubin exceeding 10 mg/dL before and after the Kasai procedure and the presence of Ascites was a marker for poor outcomes for biliary atresia patients following the Kasai procedure

Correlation Between the Severity Of Chronic Rhinosinusitis and The Degree of Osteitis Based On Computerized Tomography Evaluation

Ardiga Israchmadi — 2024-07-31

BACKGROUND: The incidence of chronic rhinosinusitis (CRS) is increasing every year, characterized by inflammation of the nasal and paranasal sinuses mucoperiosteum for more than 12 weeks. The inflammatory process of CRS sometimes spreads to the surrounding bone tissue resulting in osteitis. Computerized tomography scan (CT scan) can assess the degree of mucosal inflammation using the Lund-Mackay score (LMS) while the degree of bone thickening and remodelling are assessed with Global osteitis score (GOS) and Kennedy osteitis score (KOS).

AIMS: To evaluate the correlation between CRS severity assessment using LMS and osteitis severity assessment using GOS and KOS

METHODS: A retrospective analysis using a cross-sectional design was conducted that included 63 CT scans of the paranasal sinus of CRS patients. The spearman rank test was used to analyze data.

RESULTS: Assessment using LMS showed 44% patients were classified as severe, while 29% and 27% patients were classified as moderate and mild respectively. Global osteitis score showed 2% patients were categorized as severe, while 22% and 46% patients were categorized as moderate and mild respectively, and 30% patients were not significant. Based on KOS assessment, it was found that 3% patients were classified as severe, while 38% and 59% patients were classified as moderate mild respectively. There was a significant correlation between CRS severity using LMS and GOS (p 0.000) with rho= 0.951. There was a significant correlation between CRS severity using LMS and KOS (p 0.000) with rho value= 0.452.

CONCLUSION: This study shows a significant correlation between CRS severity assessment using LMS and bone thickening and remodelling assessment using GOS and KOS. In comparison with KOS, GOS has stronger relationship with LMS.

Risk Factors for Orbital Complication in Odontogenic Rhinosinusitis

Anna Mailasari Kusuma Dewi — 2024-07-31

Background: Orbital involvement is the most common complication in rhinosinusitis presenting about 60-75%. The manifestation of orbital complications such as eyelid edema, proptosis, eye movement disorder and loss of vision. The potential risk factors for developing complications are described in several studies.

Purpose: To examine the risk factors for orbital complication in odontogenic rhinosinusitis.

Methods: A retrospective case control study of 34 patients from July 2022 to July 2023 based on medical records. The subjects were classified into two groups, the case group involving odontogenic rhinosinusitis patients with orbital complication and the control group involving patients without orbital complications. Risk factors were sex, onset of odontogenic sinusitis, sinonasal symptoms, diabetes, histopathological findings, laboratory findings and CT scan images of sinus. The characteristics of orbital complications and the types of pathogenic bacteria cultivated were recorded.

Results: There number of patients in each group were 17, with the female to male ratio of 2,4:1, aged 8 to 81 years were enrolled in this study. The most common orbital complication was sub periosteal abscess (41%). We found 64% positive bacterial growth from tissue culture dominated by Staphylococcus sp. (54.5%). Histopathological examination showed the main inflammatory cell of the sinus mucosal epithelium was neutrophil in both groups. The logistic regression test showed that the risk factors for orbital complication were absolute neutrophil count p 0.008, OR 81.062, mucopurulent discharge p 0.009, OR 0.006 and sinus involvement p 0.027, OR 0.152.

Conclusion: Orbital complications were associated with sinus involvement with main symptom involving mucopurulent discharge and higher absolute neutrophil count.

A 25-year-old Woman with Cholecystolithiasis, Cholecystitis, Choledocholithiasis, and Acute Hepatitis

Naldo Nathanael — 2024-07-31

Introduction: Gallstone disease stands as the foremost gastrointestinal issue leading to hospital admissions, while also emerging as a substantial global public health concern, impacting approximately one-fifth of the population.

Case Report: A 25-year-old woman was admitted with abdominal pain with a history of gallstones. She had risk factors such as obesity with a Body Mass Index (BMI) of 35.3 and dyslipidemia. Further examination showed that she had acute hepatitis and choledocholithiasis. The patient underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) with balloon extraction. The patient recovered from her condition then scheduled for cholecystectomy.

Conclusion: This case showed a relatively young female with cholecystolithiasis, cholecystitis, choledocholithiasis, and acute hepatitis presenting with colicky pain. Comprehensive management of gallstone diseases is essential to avert additional complications and the possibility of relapse, especially considering the young age of the patient.

Catastrophic Event Following Percutaneus Coronary Intervention Developing In-Stent Thrombosis Leading Massive Pericardial Effusion and Free Wall Rupture

Yudhanta Suryadilaga — 2024-07-31

BACKGROUND: One extremely unusual but serious side effect of an acute myocardial infarction is left ventricular free wall rupture. It was reported to happen either during the sub-acute phase with overt cardiac remodeling (type III, 45%) or early after the beginning of Myocardial Infarction (MI) (type I or II, about 55%). Large infarct sizes, female gender, and advanced age have all been linked to an increased risk of free wall rupture. Clinicians continue to face significant challenges in diagnosing and treating this condition because of the diverse clinical manifestations linked to elevated death rates.

AIMS: This case report aims to highlight a rare occurrence of mechanical complication of acute myocardial infarction

CASE: A 69-year-old male patient was referred because of chest pain and dyspneu. He had a primary Percutaneous Coronary Intervention (PCI) and was diagnosed with posterior ST-Evelation Myocardial Infarction (STEMI). The patient had a stent inserted into his ostial-distal Left Circumflex (LCx) artery. Three weeks later, a reangiography revealed a left ventricle (LV) aneurysm and stent thrombosis. Massive pericardial effusion with free wall rupture was seen on the echo. He was breathing heavily while in our emergency room. His blood pressure was 125/74 (94) heart rate was 94 bpm respiratory rate 24 times/minute, SpO2 was 98%, there were no rales, and his ankles had pitting edema. By the bedside, Echo revealed an LV aneurysm, a large, localized pericardial effusion without tamponade, and a possible free wall rupture. Later, he was taken to the intensive care unit and had heart surgery

DISCUSSION: Complications from an acute myocardial infarction may be ischemic, mechanical, arrhythmic, embolic, or inflammatory. Significant short-term clinical improvement and long-term survival are linked to the emergence of mechanical problems following acute myocardial infarction.

CONCLUSION: the fact that primary Percutaneous Coronary Intervention (PCI) has significantly reduced the prevalence of this deadly event. Our results indicate that one of the key predictors and primary causes of this problem is a longer symptom of angiography time.

Sleeve Gastrectomy And Liver Cyst Unroofing In Morbid Obesity With Multiple Liver Cysts: A Case Report

Abdul Mughni — 2024-07-31

Background: Obesity has become a major global health issue which leads to various complications, including hepatic diseases. However, we found a rare case of morbid obesity and symptomatic multiple liver cysts.

Aim: This article aims to represent a rare case of morbid obesity and multiple liver cysts surgically managed by sleeve gastrectomy and liver cyst unroofing which were performed in a single surgery.

Case report: 41-year-old female presented with morbid obesity and blunt intermittent abdominal pain in the right upper quadrant. Stage II hypertension, tenderness on the right upper quadrant of the abdomen and epigastrium were found in clinical assessment. Lipid profiles were shown to be elevated. Abdominal CT revealed fatty liver and multiple cystic lesions in all hepatic segments.

Discussion: Non-parasitic liver cysts affect 2-18% of the global population, with a higher prevalence in females possibly due to hormonal factors. Obesity is associated with hormonal alterations, potentially leading to increased secretion of FSH and LH.

Conclusion: Sleeve gastrectomy and liver cyst unroofing may be considered as a treatment strategy for patients with morbid obesity and multiple liver cysts.

Acute Inferior ST-elevation Myocardial Infarction Arising from Wrap-Around Left Anterior Descending Artery Occlusion

Daniel Nugraha — 2024-07-31

BACKGROUND: Acute myocardial infarction (AMI) remains a leading cause to global morbidity and mortality. Inferior MI predominantly stems from the right coronary artery (RCA) in more than 80% of instances, the left circumflex coronary artery (LCx) in fewer than 20% of cases, and infrequently from the left anterior descending artery (LAD)

AIMS: This case report aims to highlight a rare occurrence of LAD occlusion initially manifested as inferior MI.

CASE: A 56-year-old male presented with typical chest pain lasting for 6 hours. Vital signs were within normal range. Initial electrocardiogram (ECG) revealed ST-segment elevation in inferior leads (II, III, aVF). Laboratory tests indicated elevated troponin levels (>25ng/mL). Coronary angiography identified the culprit lesion as the LAD, which wrapped around the apex.

DISCUSSION: While ECG alterations are valuable in identifying thrombosed vessels during AMI, the presence of simultaneous ST elevation in both inferior and anterior leads can hinder clinicians' ability to determine the specific artery affected by the infarction. Our case, depicting a scenario where both the right and left coronary arteries are co-dominant, showed complete occlusion at the mid-distal wrap-around LAD, resulting in ST-elevation observed in both inferior and anterior leads.

CONCLUSION: The existence of inferior ST-segment elevation alongside alterations in anterior leads could imply occlusion of the wrapped LAD.

Full Text Volume 11 Number 2 July 2024

Kariadi General Hospital — 2024-07-31

Full Text Volume 11 Number 2 July 2024