Medica Hospitalia : Journal of Clinical Medicine

Full Text Volume 11 Number 3 November 2024

Kariadi General Hospital (Author) — Fri, 29 Nov 2024 00:00:00 +0100

Full Text Volume 11 Number 3 November 2024

The Effect of Feeding Process Stimulation on Oral Preparedness Readiness in Premature Infants

Fri, 29 Nov 2024 00:00:00 +0100

BACKGROUND: Most preterm infants do not have proper sucking, swallowing, and breathing coordination which caused delay in oral feeding readiness.

OBJECTIVE: The objective of this study was to analyze the influence of feeding stimulation on the readiness of premature infant’s oral feeding.

METHOD: This study was a true experimental study that involved 44 preterm infants born between 32-34 weeks of gestational age, devided in two groups. Twenty two infants in the intervention group received positioning (mid-line control symmetric) and oral feeding stimulation, while the control group received only positioning intervention. Oral stimulation was given 8 times a day for 7 days, before starting the oral feeding program. Oral feeding readiness was measured by using a modified early feeding scale (EFS) instrument on the first and the seventh days. Data analysis using t-test dependent, independent t-test, and Mc Nemar test.

RESULT: The results showed that there was a significant effect of the intervention on EFS score (p <0.001) and also on preterm infant’s oral feeding readiness (p = 0.002). The results also showed that there was an effect of intervention on the length of stay (p=0.001).

CONCLUSION: Early oral feeding stimulation improves the infant’s oral feeding readiness and shortens the infant’s length of stay. Researchers recommend stimulation of the feeding process as an independent nursing intervention in caring for premature infants.

The Effect of Core Stability Exercise on Decreasing Angle of Trunk Rotation Degree in Idiophatic Scoliosis in Junior High School Student

Windy Lathifa , Sukadarwanto, Afif Ghufroni (Author) — Fri, 29 Nov 2024 00:00:00 +0100

Background : Scoliosis is a group of conditions consisting of changes in the shape and position of the spine on the lateral side that may be accompanied by rotation caused by various etiologies. Core stability exercise is a form of exercise that can be used to reduce the degree of scoliosis curve

Objective : This study aims to determine the effect of core stability exercise on junior high school student (JHS).

Methods : This study used a one group pre and post test with control design involving 32 students of SMP 2 Wonosari Klaten who were divided into 2 groups, using the blind randomized control trial method. into 2 groups, namely a treatment group and a control group with a treatment group of 16 subjects as intervention group given treatment of core stability exercise and a control group of 16 subjects as control group without any treatment. The intervention was carried out for 5 weeks with a frequency of 3 times a week. Measuring the degree of the scoliosis curve using a scoliometer. The pre-test trunk rotation angle (ATR) value for the treatment group was found to be an average of 5.06º and a post-test ATR value of 4.75º. Meanwhile, in the control group, there was no change in the ATR value during the pre-test or post-test, which was 5.43º.

Result : Statistical test of differences in pre-post test of treatment groups using the Wilcoxon test obtained a value of p = 0.025 (p < 0.05).

Conculsion : From this study it was concluded that There is an effect of core stability exercise on reducing the scoliosis curve in junior high school student.

The Relationship between Family Support And Quality of Life in Elderly with Dementia

Juventus Sandy D.U. Deta, Teguh Santoso (Author) — Fri, 29 Nov 2024 00:00:00 +0100

BACKGROUND : The growing number of elderly individuals can result in a decline in physical and mental functioning, which in turn affects the quality of life of the elderly. The family serves as the primary support system for the elderly in maintaining their health. Effective family support can enhance the quality of life of the elderly, enabling them to enjoy a fulfilling life in their later years.

OBJECTIVE: to determine the relationship between family support and quality of life in elderly people with dementia.

METHOD : This is a quantitative-correlative study design with a cross-sectional design. The analysis test used is chi-square. A total of 73 respondents were sampled for the purposes of data collection. This was achieved by administering two questionnaires: one pertaining to family support and the other to quality of life (Short Form 12).

RESULT : The results of this study indicate that the majority of elderly individuals aged 60–74 (69.9%), females (53.4%), reside in the same household as their children (53.4%), work as farm laborers (69.9%), have basic education (72.6%), and have moderate levels of dementia. (50.7%). Having family support shows the moderate category (91.8%), while the quality of life is mostly good (58.9%), with a significance p-value of 0.033.

CONCLUSION : There is a significant relationship between family support and quality of life in elderly people with dementia.

Effects of α-Mangostin-Loaded Self-Nanoemulsion (MG-SNE) and Physical Exercise on The Reduction of Waist Circumference in Wistar Rats

Fri, 29 Nov 2024 00:00:00 +0100

BACKGROUND : Waist circumference (WC) is a marker of intra-abdominal adipose tissue and a risk factor for cardiometabolic disease. A higher risk of coronary heart disease was associated with an increased WC. Garcinia mangostana Linn's anti-inflammatory activity would reduce abdominal fat deposition and WC. Additionally, Garcinia mangostana Linn's potential would increase in nanotechnology.

AIMS : To demonstrate that WC in Wistar rats induced by an atherogenic diet can be decreased by α-Mangostin-loaded self-nanoemulsion (MG-SNE) treatment combined with physical activity.

METHOD : Experimental research with Randomized Control Trial design using a total sample of 15 male white rats (Rattus novergicus strain Wistar) weighing 300 grams and aged between 6 and 8 weeks, split into 3 groups given physical exercise for 8 weeks along with 3 different doses of medication (group K received Atorvastatin 1.44 mg once; group P1 received Garcinia mangostana Linn pericarp extract, at a dose of 800 mg/kg, divided into 3 administrations; and group P2 received MG-SNE 50 mg/kg once). Waist circumference was measured using a metline, before and after treatment.

RESULT : WC decreased in Groups K, P1, and P2, with deltas of -5.00±21.21 mm, -12.50±24.75 mm, and -17.50±12.58 mm. The greatest decrease in WC was P2. There was no significant difference, according to the paired test between the pre-test and posttest in all groups. The p value >0.05 was determined to indicate that there were no significant differences between the groups.

CONCLUSION : WC in Wistar rats induced by an atherogenic diet can be decreased by MG-SNE treatment combined with physical exercise.

Comparison Between Robotic Finger Therapy Exercise and Conventional Exercise on the Range of Motion of the Metacarpophalangeal Joints: Study of Post-stroke Patients at Diponegoro National Hospital

Fri, 29 Nov 2024 00:00:00 +0100

BACKGROUND : Metacarpophalangeal (MCP) joints range of motion (RoM) exercise can be done using either conventional exercise or robotic finger therapy. This study aimed to compare MCP joints RoM improvement between conventional exercise and robotic finger therapy exercise in post-stroke patients.

METHOD : This study was a randomized controlled trial pre and post test controlled group design. The data were taken from individuals aged 45-65 years with a history of stroke undergoing medical rehabilitation at the Diponegoro National Hospital before and after intervention (robotic finger therapy exercise vs conventional exercise) for 6 weeks. MCP joints RoM was measured using goniometer before and after the intervention. Datas were analysed using SPSS ver 20.0. Normality of data distribution would be assessed using the Shapiro-Wilk test. Differences in the RoM of MCP joints before and after treatment in each group were tested using paired t-test. Group differences were tested using unpaired t-test.

RESULT : There was significant RoM improvement in each MCP joint in each group before and after the treatment (p<0.05). There was no significant difference in RoM improvement between groups (p>0.05).

CONCLUSION : Both robotic and conventional therapy significantly improve MCP joints RoM in post-stroke patients. There was no significant difference in MCP joints RoM improvements between robotic finger therapy and conventional exercise.

Perineal Laceration in primipara in Association with Perineal length, Fetal Head Circumference, and Fetal Weight

Fri, 29 Nov 2024 00:00:00 +0100

BACKGROUND : Perineal laceration is one of the risk and complication of spontaneous labour resulting intervention in short-term and long-term quality of life. Lack of research in Indonesia on perineal length Lack of research on perineal length in Indonesia, fetal birth weight and fetal head circumference and its impact on spontaneous labour and perineal laceration gave rise to the idea of research in order to minimize the occurrence of complications from perineal laceration in spontaneous labour.
OBJECTIVES : To know find out the association between perineal length, fetal head circumference, and fetal weight with degree of perineal laceration in primiparous women.
METHODS : Observational cross sectional multi-center study conducted between August 2023 until October 2023 in which all subject that delivered vaginally within inclusion criteria was measured. All data will be further analized to determine the significant predictor of perineal tear.
RESULTS : Based on this study The result of this study has indicated that there is no significant association of perineal length with the degree of spontaneous primiparous perineal laceration. While there is an association of fetal head circumference and fetal weight with the degree of spontaneous primiparous perineal laceration in aterm pregnancy. Based on further analysis, fetal head circumference greater than 325 mm increases the risk of severe perineal laceration 4.4 times (PR=4,4; 95% CI=1,4-13,9) and Fetal weight greater than 3097.5 grams increases the risk of 2.7 times (PR=2,7; 95% CI=1,1-6,4) the occurrence of severe perineal laceration.
CONCLUSION : There is an association of fetal head circumference and fetal weight with the degree of spontaneous primiparous perineal laceration.

Anthropometric Study of the Relationship Between Tibia Length and Height Ethnic Papuans

Frollivia Adolina Meiselin Iwanggin, Indra Harianto Rante (Author) — Fri, 29 Nov 2024 00:00:00 +0100

BACKGROUND : Height is an important main characteristic in the forensic anthropological identification process to determine the identity of a person. Estimating height based on the length of long bones such as the tibia, fibula, ulna, and humerus is one method that is widely used because it has a good correlation. This study was conducted to determine the relationship between tibia bone length and height in students of the Medical Education Study Program, Faculty of Medicine, Cenderawasih University who are indigenous Papuan.

METHOD : This study applied correlative analytic method with a cross sectional approach. The research sample was students of the Medical Education Study Program at Cenderawasih University in 2020-2023. The tibia bone length was measured using a metline and height was measured using a microtoise directly on the research subject. Data were analysed with Pearson test.

RESULT : Fifty-five subjects (25 males, 30 females), and found male height of 161.060 cm, a female height of 153.000 male tibia bone length of 26.620 cm, and a female of 34.170 cm.

CONCLUSION : There was a relationship between tibia length and height with the results of the Pearson test obtained P value = <0.001

Gait Analysis of Ankle Joints of Indonesians at Low, Medium and High Speeds

Fri, 29 Nov 2024 00:00:00 +0100

Background : Amputation is a loss of body part, and most amputations are lower extremity amputations. The most common is transtibial amputation. After an amputation a person will need a prosthesis. However, up to now there has been no functional prosthesis specifically made for Indonesians who undergo transtibial amputation because the ankle joint gait data that are currently used are European gait data. So it is necessary to measure the normal gait data of Indonesians' ankle joint. The aims of this study was to measure the normal gait data of the ankle joint of Indonesian population

Methods : The Research sample is Indonesians aged 18–26 years with normal gait measured by the 2DMA (two-dimensional motion analyzers) at low, medium and high speeds. The resulting data is searched for the mean and standard deviations and then an independent t-test is performed between normal gait data of Indonesians and Europeans Results : Indonesians have a range of maximum dorsiflexion values for low, medium, and high speeds of : 7.9°, 8.3°, 8.9° and maximum plantar flexion for low, medium, and high speeds of 13.4°, 20.6°, 26°. In the comparison test there was a significant difference between the maximum plantar flexion angle of Indonesians and Europeans.

Conclusion : Indonesians have a range of maximum dorsiflexion values for low, medium, and high speeds of 7.9°, 8.3°, 8.9° and maximum plantar flexion for low, medium, and high speeds of: 13.4°, 20.6°, 26°. There is a difference between the normal gait of the ankle joint of Indonesians and Europeans.

Differences in the Degree of Spasticity in Post-Haemorrhagic and Non-Haemorrhagic Stroke Patients Based on the Modified Ashworth Scale

Fri, 29 Nov 2024 00:00:00 +0100

Background : Stroke is a brain function disorder caused by vascular disturbances with manifestations ranging from paralysis to death. Stroke is a health issue with high incidence and mortality rates. Furthermore, post-stroke patients can experience various residual symptoms such as spasticity, which can lead to decreased productivity and socio- economic impacts. Spasticity is a common symptom in stroke survivors, with a prevalence ranging from 30% to 80%. This symptom typically appears several weeks after a stroke and can persist for up to 12 months, causing reduced productivity and socio-economic challenges. Hemorrhagic strokes result from blood vessel rupture, while non- hemorrhagic strokes are caused by ischemia. Both types can damage motor pathways, leading to spasticity. Understanding the differences in spasticity severity between stroke types may guide targeted rehabilitation strategies. The aimsof ths study was to determine the difference in the degree of spasticity in post-stroke patients between hemorrhagic and non-hemorrhagic strokes based on the Modified Ashworth Scale.

Methods : An analytical observational study with a cross-sectional design was conducted. The study included 33 post-hemorrhagic stroke patients and 33 post-non- hemorrhagic stroke patients. The degree of spasticity was measured using the Modified Ashworth Scale. Statistical analysis was performed using the Chi-Square test.

Results : The Chi-Square test for the variable "stroke type" and "degree of spasticity" yielded a p-value of 0.428 (p > 0.05). The Chi-Square test is considered significant when the p-value is < 0.05.

Conclusion : There is no difference in the degree of spasticity

Correlation between Urine Albumin Creatinin Ratio (UACR) Value to Urine Osmolality Value and Estimate Glomerular Filtration Rate (EGFR) Value on Patient with Kidney Failure

Lisa Anis Fadilatin, Andika Aliviameita (Author) — Fri, 29 Nov 2024 00:00:00 +0100

Background : Kidney failure is one of the causes of death in the world. Laboratory tests related to kidney function are very important in the management of patients with kidney failure because they are useful in identifying any decline in kidney function, monitoring treatment and progression of kidney disease. The urine albumin creatinine ratio (UACR): is related to assess the protein filtration function in the glomerulus. The urine osmolality is to assess pre-renal, renal and post-renal hemodynamic status. The estimated glomerular filtration rate (EGFR) is to assess overall glomerular function. EGFR is the gold standard. The aim of this research is to determine 1). The correlation between UACR value to urine osmolality value, 2). The correlation between UACR value to EGFR value. Patient with kidney failure is the independent variable, meanwhile UACR value, urine osmolality value and EGFR value are dependent variables.

Methods : This study is a quantitative study with analytical observations through a cross sectional design using 30 sample patients with kidney failure either acute kidney injury (AKI) or chronic kidney disease (CKD). This study was conducted from May to June 2024 at the Central Laboratory Installation of Dr. Saiful Anwar Hospital, East Java Province. UACR and EGFR examination used the principle of photometric test while urine osmolality examination used the principle of electrical conductivity. The data were analyzed using the Shapiro-Wilk normality test and the Spearman non-parametric correlation test through SPSS 27.

Results : In the normality test results, it was found that UACR and EGFR values were not normally distributed (p = <0.001) while urine osmolality values were normally distributed (p = 0.523). Spearman's non-parametric correlation test showed that there was no correlation between UACR to urine osmolality (p = 0.342) and EGFR value (p = 0.481).

Conclusion : The results of this study showed no correlation between UACR value to urine osmolality value and EGFR value in patients with kidney failure.

Platelet to Lymphocyte Ratio (PLR) Value in Normotency, Preeclampsia and Severe Preeclampsia

Rony Falty Sibagariang, Bambang Wibowo (Author) — Fri, 29 Nov 2024 00:00:00 +0100

BACKGROUND : Hyperactivation of the inflammatory response in preeclampsia causes a significant increase in the number of leukocytes. Platelet to Lymphocyte Ratio (PLR) has been known as a marker of systemic inflammatory response. In preeclampsia, the role of PLR markers is still uncertain regarding the ability of clinical evaluation, differential diagnosis and evaluation of patient prognosis.

AIMS : To analyze differences in platelet to lymphocyte ratio (PLR) values in normotensive, preeclampsia, and severe preeclampsia pregnancies

METHOD : Analytical observational study with cross sectional design with 90 samples consisting of 30 normotensive pregnancies, 30 preeclampsia and 30 severe preeclampsia. Evaluation is carried out on the platelet to lymphocyte ratio (PLR) value. Analysis was carried out using the SPSS 32 edition application. Results are significant if p<0.05.

RESULT : Comparison between the normotensive group versus preeclampsia versus severe preeclampsia showed that platelet levels decreased but not significantly (p=0.081), lymphocyte levels increased significantly (p<0.001) and PLR values decreased significantly (p<0.001) as the degree of severity increased preeclampsia. In the severe preeclampsia group, the lowest platelet levels, the highest lymphocyte levels and the lowest PLR values were obtained. Patients with a PLR value < 104.62 have an 8.43x (OR 8.43; CI95% 3.12-22.78) higher risk of experiencing severe preeclampsia compared to subjects with a PLR value > 104.62.

CONCLUSION : The PLR value was significantly lowest in the severe preeclampsia group.

Effect Of Vitamin D Administration On Interleukin 6 (IL-6) Levels In Peritoneal Fluid In Endometrioma Patients

Fri, 29 Nov 2024 00:00:00 +0100

BACKGROUND: An endometrioma is a cyst that occurs when endometrial tissue grows on the epithelium of the ovary. Vitamin D is a steroid hormone that can be extracted from commonly available foods and can be synthesized by humans when exposed to sunlight. Vitamin D deficiency has been reported to be associated with various pathologies, including endometrioma. Vitamin D has been reported to have anti-angiogenic effects that may inhibit the growth of endometriotic implants.

AIM: Proving the effect of vitamin D administration on interleukin 6 (IL-6) levels in peritoneal fluid in patients with endometrioma.

METHOD: Experimental research with two group, post-test only design with single blind that carried out at Central General Hospital (RSUP) Dr. Kariadi Semarang. The research subject was 50 patients with endometrioma on ovary. The definite diagnosis of endometrioma is made based on histopathological examination of tissue samples after the patient undergoes surgery. Patients will be divided into 2 groups, namely the vitamin D3 supplementation group and placebo. The intervention was carried out by providing vitamin D3 50,000 IU/week for a month. Evaluation of serum vitamin D levels were obtained using venous blood samples immediately when the patient was undergoing surgery. Interlukin-6 levels were obtained using peritoneal fluid samples obtained when the patient underwent surgery. Statistical analysis was carried out using the Independent T Test, Mann-Whitney U, Dependent T Test and Wilcoxon. Results are significant if p <0.05. Statistical analysis was carried out using SPSS edition 26.

RESULT: Peritoneal fluid interleukin-6 (IL-6) levels between the vitamin D supplementation group and the placebo group did not show a significant difference (p=0.554).

CONCLUSION: Vitamin D supplementation in endometrioma patients is not associated with peritoneal fluid interleukin-6 (IL-6) levels.

Effectiveness of Cognitive Behavior Therapy in Enhancing Self-Esteem Among Schizophrenia Patients at Dr. Soeharto Heerdjan Psychiatric Hospital, Jakarta in 2024

Diah Sukaesti Hendraswantoro, Lilis Komalasari , Anita Sukarno (Author) — Fri, 29 Nov 2024 00:00:00 +0100

BACKGROUND :

Schizophrenia patients often experience low self- esteem which requires modality therapy, one of modality therapy for the patients with mental disorders is cognitive behavioral therapy (CBT).

AIMS : The aim of this research is to determine the effectiveness of cognitive behavior therapy in increasing self-esteem. and abilities in Schizophrenia patients.

METHOD : This research method is quasi-experimental with one group pre-post design with control. The data was analyzed by Paired t test. The research was conducted in one hospital on 50 control patients and 50 intervention patients.

RESULT : The research results showed that cognitive behavior therapy significantly reduced signs and symptoms in clients with low self-esteem (P-value ≤ 0.05 ). The comparison of self-esteem scores in the intervention group was significantly higher compared to the control group (P-value ≤ 0.05 ).

CONCLUSION : Conclusions and suggestions: Cognitive behavior therapy is effective for patients with low self-esteem because it can increase self-esteem and abilities in patients with schizophrenia. Future researchers should conduct research using cognitive behavior therapy without providing psychotherapy.

The Association between Waist-Hip Ratio and Body Fat Composition, and Metabolic Syndrome: A Study at RSUP dr. Kariadi

Fri, 29 Nov 2024 00:00:00 +0100

Background: Metabolic syndrome, which is a collection of symptoms which are usually include of hypertension, hyperglycemia, dyslipidemia, and central obesity, has various fatal complications. Fat composition is known to have a close relationship with complications of metabolic syndrome. However, measurement of fat usually requires expensive tools and methods. Meanwhile, anthropometric indicators such as waist-to-hip ratio (WHR) have links with metabolic syndrome and central obesity. This study examines whether there is a significant relationship between WHR and body fat composition in patients with metabolic syndrome.

Objectives: This study examined relationship between WHR and body fat composition as described in fat percentage, fat mass, visceral fat rating, and degree of obesity in patients with metabolic syndrome.

Methods: Cross-sectional observational analytic study was conducted on 51 metabolic syndrome patients at Endocrine Polyclinic, RS dr. Kariadi. Respondents filled out informed consent and questionnaires and measured WHR and body fat composition using Tanita scales. Data analysis was performed by univariate test and bivariate test (Pearson test, Spearman test, or Mann-Whitney test).

Results: There is a weak significant negative correlation between WHR and body fat percentage (p = 0.023; r = -.0.318). There is no correlation between WHR and fat mass (p=0.312). There is a weak positive significant correlation between WHR and visceral fat rating (p=0.001; r=0.441). And there is no correlation between WHR and the degree of obesity (p=0.785).

Conclusion: WHR has a weak significant correlation with body fat percentage and visceral fat rating in NCEP ATP III metabolic syndrome patients.

The Effect of Standardized Mangosteen Skin Extraction, Nano-emulsion, Nano-chitosan and Treadmill Exercise on Atherogenic Rat Model

Fri, 29 Nov 2024 00:00:00 +0100

Background: Atherosclerosis, the most common cause of CVD, is associated with oxidative stress and cholesterol. Antioxidant and regular physical exercise have been considered as the probable interventions to dampen the process. The pericarp of mangosteen (Garcinia mangostana Linn) is known for containing a high amount of xanthones including α-mangostin with antioxidant effects. The current study investigates the anti-atherogenic potential of mangosteen skin extract in nano-emulsion and nano-chitosan formulations, singly and in combination with treadmill exercise, versus the statin, Atorvastatin.

Methods: A randomized controlled trial was conducted on 30 male Wistar rats, divided into six groups: normal diet control (C1), atherogenic diet control (C2), and four treatment groups receiving an atherogenic diet plus treadmill exercise combined with Atorvastatin (T1), standardized mangosteen extract (T2), mangosteen nano-emulsion (T3), or mangosteen nano-chitosan (T4). The aortic tunica intima and tunica intima-media thickness were measured histologically after 56 days.

Results: The aortic intimal thickness was noticeably higher in the atherogenic diet group (C2: 12.13±1.87 mm) compared to the normal diet group (C1: 4.27±0.75 mm). In the treatment groups, the intimal thickness ranged from 2.97±0.45 mm to 4.17±1.70 mm and showed no significant differences from the normal diet group. A similar pattern was seen in the intima-media thickness, with 145.63±17.12 mm recorded for the normal diet group and values ranging from 106.90±10.41 mm to 135.90±12.63 mm in the treatment groups, again without significant differences. Survival analysis using Kaplan-Meier curves showed clear differences between the groups (p < 0.001). The untreated atherogenic diet group (C2) had the poorest survival, with no rats surviving until the study's conclusion. In contrast, survival improved in all treatment groups, with the Mangosteen Nano-chitosan (T4) group and the normal diet group (C1) achieving the best outcomes, as all rats in these groups survived.

Conclusion: Mangosteen skin extracts, whether in nano-emulsion or nano-chitosan forms, combined with treadmill exercise, showed significant differences in maintaining the survivability of rat with atherogenic-induced diet despite no significant differences in preventing atherogenesis compared to Atorvastatin or a normal diet. Further research is needed to confirm these potential therapeutic effects.

A Clinical Dilemma Of Bilateral Hematosalpinx In Ectopic Pregnancy: Case Report

Fri, 29 Nov 2024 00:00:00 +0100

Background: Blastocyst implantation outside the uterine cavity leads to ectopic pregnancy. About 96% of ectopic pregnancies occur in the fallopian tubes, where it most frequently occurs; the fimbrial end accounts for 11% of all ectopic pregnancies. There was an uncommon type of ectopic pregnancy called bilateral tubal ectopic pregnancy. Bilateral tubal ectopic pregnancy is estimated to affect 1 out of 725 - 1580 ectopic pregnancies or 1 out of 200,000 live births. However, the villi quickly penetrate the endosalpinx once the implantation of the ectopic pregnancy has occurred before reaching the tubal wall and peritoneum. Vascular growth and a peritubal hematoma or hematosalpinx, which frequently involves the contralateral tubal section, are also present with this penetration. The purpose of this article is to report on the dilemmas that often occur in the case of bilateral hematosalpinx in ectopic pregnancy.

Case Description: In this report, we discuss a 33-year-old woman with a positive pregnancy test and transvaginal ultrasound result that was suggestive of ectopic pregnancy in a stable hemodynamic state. The patient underwent an exploratory laparotomy, which showed bilateral hematosalpinx with right ectopic pregnancy with damaged fimbria. The left fallopian tube had a blue-purple bulge that suggested hematosalpinx secondary to ectopic pregnancy rather than bilateral ectopic pregnancy condition. The decision for deﬁnitive management was made, right salpingectomy puncture and drainage of the hematosalpinx were performed without complication. The ﬁnal diagnosis was conﬁrmed on pathology examination that showing chorionic villi within the right damaged fimbria, focal decidua, a few trophoblast-like cells that indicated ectopic pregnancy in the left tubal cavity.

Conclusion: This approach encourages both shared decision-making and preparedness, both of which are required to provide patient-centered and comprehensive caremanagement such as bilateral hematosalpinx in ectopic pregnancy case, that must always be individualized, and patient's desire for future conception must be taken into account.

Oropharyngeal Dysphagia as The Presenting Symptom of Myasthenia Gravis with Diabetes Mellitus

Fri, 29 Nov 2024 00:00:00 +0100

Background: Oropharyngeal dysphagia may caused by a variety of causes. Myasthenia gravis is a common autoimmune disease affecting the neuromuscular junction. While ocular symptoms are common in myasthenia gravis, bulbar symptoms such as dysarthria and dysphagia are less common.

Aim: To present the importance of recognizing atypical presentations of myasthenia gravis and utilizing electromyography in diagnosis when AChR antibody testing is unavailable.

Case Presentation: A 57-year-old woman was referred because of progressive dysphagia for both solid and liquid food. She also experienced weight loss, heaviness of the right eyelid, drooling, and chewing difficulty. Medical history revealed diabetes. Vital signs were stable. Physical examination revealed right ptosis without any other neurological deficits. Wartenberg test and dysarthria counting test were positive. Laboratory examination revealed a blood glucose level of 270 mg/dL and an HbA1c level of 9.4%. The barium swallow study revealedno abnormalities. Esophagogastroduodenoscopy revealed esophageal candidiasis. Electromyography showed more than 20% decremental response of the orbicularis oculi muscle. This result is suggestive of neuromuscular junction disorder. Improvement of the condition was achieved after the administration of intravenous steroids and oral pyridostigmine combined with therapeutic plasma exchange.

Discussion: Oropharyngeal dysphagia accompanied by ptosis and positive Wartenberg & dysarthria counting test is suggestive of myasthenia gravis. Although an AChR antibody test cannot be performed, significant electromyography alongside relevant clinical presentation is sufficient to diagnose myasthenia gravis.

Conclusion: It is crucial to recognize the accompanying signs and symptoms of oropharyngeal dysphagia. EMG may be used to diagnose MG in the appropriate clinical context.

A Case Report of Female Systemic Lupus Erythematosus and Cerebral Lupus as The Complication : Diagnosis and Treatment

Fri, 29 Nov 2024 00:00:00 +0100

BACKGROUND : Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that affects multiple systems in the body. Because clinical manifestations can appear in different organs, the complications are diverse and can be quite severe, one of which is cerebral lupus or neuropsychiatric systemic lupus erythematosus (NPSLE). It includes neurological and psychiatric syndromes in SLE patients where other causes have been ruled out. We reported a case of SLE manifestation with cerebral complication involvement.

AIMS : This case report aims to provide insights and expect to offer an understanding into the clinical presentation, diagnosis, and management of a patient with cerebral lupus.

CASE PRESENTATION : 18-year-old Indonesian woman with complaint of sudden seizure was referred to the Emergency Unit of Dr. Ramelan Naval Central Hospital Surabaya. She had previously been diagnosed with SLE back in 2022 and consistently does a monthly checkup in the internal medicine clinic at Dr. Ramelan Naval Central Hospital Surabaya. Initial examinations revealed signs of infection, slight electrolyte imbalances, and a flare phase of SLE, but no abnormalities in imaging tests. She received initial treatments of loading phenytoin along with mecobalamin injection, vitamin B6, methamizole, and cefobactam. Over the course of her hospital stay, with no further seizures, she was discharged with medication for continued treatment and a scheduled follow-up.

CONCLUSION : This case of cerebral lupus is rare. SLE can damage the blood brain barrier (BBB), causing neuropsychiatric complications.

Case Report : Rehabilitation Intervention in Improving Infant’s Oromotor Skill and Body Weight

Merliana Sari Situmeang, Ida Ayu Diana J.S (Author) — Fri, 29 Nov 2024 00:00:00 +0100

Introduction

Preterm birth rates are still very high. Global data found that preterm babies occurred in 11% of all live births. A recent study showed that more than 25% of neonates baby born between 28 and 32 weeks of gestation, developed disorders condition at the age of two, and this ratio reached 40% at the age of ten. Preterm infants had higher risk of poor motoric skills, such as subtle deficits in eye-hand coordination, sensory-motor integration, manual dexterity, and gross motor skills that lead to poor feeding skills and neuromotor development delay. Therefore, interventions need to be done to optimize growth and development.

Case

A 10-day-old male infant consulted by the Medical Rehabilitation department due to feeding difficulty and low birth weight. At 10 days old, the patient weighs 1550 grams, length 44 cm, head circumference 31 cm, and the non-nutritive scoring (NNS) was 45. The patient was given proper positioning, oral motor stimulation (OMS) with the Fucile method for 1 week in the hospital and the treatment continue at home. After 2 weeks of intervention, the infant’s body weight increased to 2010 grams, body length 45 cm, head circumference 32 cm, and the non-nutritive scoring (NNS) became 86.

Conclusion

Oral motor stimulation improves oral motor skills such as sucking and swallowing reflexes in infants without organ abnormalities thus optimized good oral feeding ability and weight gain acceleration.