Medica Hospitalia : Journal of Clinical Medicine

Radiologic Features Of Anencephaly : A Serial Case Report

2025-03-12T15:32:26+08:00

Background : Anencephaly is a lethal central nervous system anomaly characterized by absence of cerebral structures and cranial vault. It is the most common open neural tube defect that occurs in 0.5 – 2 per 1,000 live births. This anomaly can be detected as early as 11 weeks of pregnancy by transvaginal ultrasonography. Micronutrient deficiency, such as anemia and folic acid deficiency, was known to be the potential risk factor for anencephaly.

Case Report : We reported 4 cases of anencephaly diagnosed using ultrasonography during pregnancy. All patients were referred to Dr. Kariadi General Hospital from private hospitals in Central Java. 3 out of 4 cases were diagnosed in the first trimester and 1 case was diagnosed in the third trimester. Ultrasonography features showed typical signs of anencephaly including ‘frog eyes sign’, ‘Mickey mouse sign’ and acrania. All of the patients underwent termination of pregnancy with variable route of delivery according to each patients’ condition and gestational age.

Discussion : Routine antenatal ultrasonography is recommended for early detection of fetal viability and other congenital anomalies including anencephaly. Ultrasonography is able to detect typical findings of anencephaly and therefore is able to accurately establish the diagnosis. Advanced imaging technique such as MRI is unnecessary unless diagnosis using ultrasonography is indeterminate. Establishing the diagnosis of anencephaly is very important due to determining its definitive treatment, in which termination of pregnancy.

Conclusion : In this serial case series, we present various radiologic features of anencephaly using ultrasonography so that clinicians will be able to diagnose this anomaly in earlier age of pregnancy. Hence, definitive treatment can be done and complications during pregnancy can be prevented.

The Association Vitamin D and Left Ventricular Hypertrophy in Metabolic Syndrome Patients

2024-12-05T07:28:13+08:00

Background: Vitamin D deficiency is common, especially in people with metabolic syndrome. This condition increases the risk of cardiovascular problems, including left ventricular hypertrophy (LVH). While the connection between metabolic syndrome and LVH is well-documented, it is still unclear whether vitamin D deficiency alone contributes to the development of LVH in these patients.

Aim: To study the association between vitamin D levels and LVH in patients with metabolic syndrome.

Methods: A cross-sectional study was conducted with 38 patients diagnosed with metabolic syndrome in Kariadi Hospital, Semarang. Serum vitamin D levels were measured using the ELISA method, and LVH was diagnosed via echocardiography. Patients were categorized into normal and LVH groups. Vitamin D levels were classified as sufficient, insufficient, or deficient. The relationship between vitamin D levels, metabolic syndrome components, and LVH was analyzed.

Results: Our findings revealed no significant difference in vitamin D levels between patients with LVH and those without it (mean 19.98 ± 5.59 ng/mL for the LVH group vs. 20.91 ± 6.56 ng/mL for the normal group, p=0.65). However, patients with LVH had a significantly higher number of metabolic syndrome components compared to those without LVH (p=0.044).

Conclusion: While no direct association was found between vitamin D levels and LVH, the cumulative burden of metabolic syndrome components plays a significant role in the development of LVH. Future research should explore larger populations to investigate the therapeutic potential of vitamin D in cardiovascular outcomes.

Serum Protein D Surfactant Level Based on Length of Exposure in Workers at the Supit Urang Waste Disposal Site, Malang

2024-12-06T05:18:21+08:00

BACKGROUND: Waste collectors are at risk of developing lung disease due to exposure to bioaerosols from organic and inorganic materials. The function of surfactant protein D (SP-D) is as innate immunity that protects the lungs. Exposure to bioaerosols in landfills causes inflammatory reactions which can increase the permeability of the blood-lung barrier. As a result, SP-D will leak into the plasma.

AIMS: This study aims to analyze serum SP-D levels in relation to length of exposure in waste collectors.

METHOD: This analytical, cross-sectional study was done in a Supit Urang waste disposal site, Malang, Indonesia. Samples for serum SP-D analysis were taken from peripheral blood samples and analyzed with ELISA technique.

RESULT: There were 68 subjects, consisting of 24 subjects with exposure duration of 5 years, 14 subjects of 5-10 years, and 30 subjects with exposure of 10 years. The number of smokers and non-smokers were 36 and 32 subjects respectively. Significant differences in SP-D serum levels were found between different exposure durations, particularly with exposure of more than 5years. A significant positive correlation was obtained between serum SP-D levels and exposure duration (r = 0,585; p = 0,000). Meanwhile, there was no significant difference in serum Sp-D levels based on smoking status (p=0.112).

CONCLUSION: Length of exposure significantly affected SP-D serum levels in waste workers, especially with exposure of more than 5 years.

The Correlation Between Folic Acid Supplementation And Change In Cognitive Function In Elderly (A Study of The Effect of Folic Acid Supplementation on Homocysteine Levels)

2023-10-03T08:53:39+08:00

Background: A good cognitive function is one of the things that affect the quality of life of the elderly. Decreased cognitive function in elderly can be caused by physiological or pathological processes. Increased homocysteine is one of risk factors associated with decreased cognitive function. Folic acid supplementation has been shown to reduce homocysteine levels.

The aim: To know the relationship between folic acid supplementation and change in cognitive function in elderly.

Methods: This research is a quasi-experimental study at Pucang Gading Nursing Home, Semarang. A total of 30 subjects were divided into 2 groups, namely 15 treatment subjects (given folic acid supplementation 1 mg/24 hours) and 15 control group subjects (given placebo), 1 subject dropped out due to death. The study was conducted for 12 weeks, assessment of homocysteine level and cognitive function (with MoCA Ina) was carried out before and after the study.

Results: There was no relationship between folic acid supplementation and changes in homocysteine level (p 0.322). There is a relationship between folic acid supplementation with change in cognitive function in elderly (p 0.000). There is a relationship between changes in homocysteine level and global change in cognitive function in elederly (p 0.018),

Conclusion: There is a significant relationship between folic acid supplementation and change in cognitive function in elderly.

Analysis of Risk Factors for The Severity of Hyaline Membrane Disease in Preterm Infants Based on Modality Chest X-Ray

2024-12-11T04:54:29+08:00

BACKGROUND : Hyaline membrane disease is one of the leading causes of morbidity and mortality in premature infants. Chest X-ray examination can significantly improve the diagnosis of hyaline membrane disease.

AIMS : This study aims to examine the relationship between risk factors and the severity of hyaline membrane disease using chest X-ray modalities.

METHOD : An analytic observational study with a cross sectional and retrospective approach was conducted. Consecutive sampling of 30 preterm infants’s medical records and thoracic X-ray at Dr. Kariadi Hospital Semarang was used. Data collection was carried out from April to July 2023. Statistical tests included the Contingency Coefficient Correlation Test and Intraclass Correlation Coefficient (ICC).

RESULT : Findings indicate that HMD severity is associated with lower birth weights (p = 0.020; r = 0.392); gestational ages (p = 0.011; r = 0.420) and maternal hypertension (p = 0.013; r = 0.414). Preeclampsia, delivery method, and gender not significantly related to the HMD severity (p>0.05).

CONCLUSION : Infant birth weight, gestational age, and maternal hypertension are significantly associated with the severity of hyalin membrane disease.

Evaluation of Definitive Antibiotic Therapy Effectiveness in Sepsis Patients at Tabanan Hospital, Indonesia

2024-11-14T10:02:20+08:00

BACKGROUND : The study evaluated the use of definitive antibiotics and examined the association between the causative bacteria, resistance patterns, and antibiotic regimens with clinical outcomes in sepsis.

AIMS : To assess the suitability of definitive antibiotics in sepsis patients at Tabanan Hospital, focusing on the correlation between bacterial type, antibiotics, and resistance profiles with clinical outcomes, aiming to improve sepsis management and reduce antibiotic resistance.

METHOD : The observational cross-sectional study analyzed data descriptively to evaluate antibiotic-pathogen compatibility retrospectively. Chi-square tests were used for bivariate analysis of mortality-related variables. Survival analysis employed the Kaplan-Meier method.

RESULT : Among 112 sepsis patient records (Jan 2020 - Dec 2022), 62% received antibiotics based on bacterial sensitivity test contradiction to another 38% who were given inappropriately antibiotic. Empiric antibiotic treatment was associated with increased mortality (OR=4.379; CI 95% 1.274-15.052; P=0.022). Bacterial type and resistance status showed no significant association with mortality (OR=0.417; CI 95% 0.030-5.708; P=1.000 and OR=1.500; CI 95% 0.156-14.420; P=1.000, respectively).

CONCLUSION : Definitive antibiotic use for sepsis patients at Tabanan Hospital was mostly appropriate, and the empiric antibiotics treatment was associated with mortality, while the causal bacteria and resistance status were not significantly associated with mortality. Findings highlight the importance of transitioning from empiric to targeted therapy to potentially reduce mortality in sepsis management.

Comparative Effectiveness of Betahistine vs Dimenhydrinate in Reducing Dizziness Handicap Scores in Patients with Peripheral Vestibular Disorders

2025-03-11T14:31:11+08:00

BACKGROUND: Peripheral vestibular disorder is a disorder of the peripheral vestibular system. Its symptoms affect the quality of life from moderate to severe. An objective assessment is quite difficult therefore a questionnaire method has been developed such as Dizziness Handicap Inventory (DHI). Aim of the treatment is to achieved optimal quality of life by using symptomatic treatment like dimenhydrinate and betahistine.

AIMS : To prove the effectiveness of betahistine and dimenhydrinate and to compare the effectiveness in reducing DHI score

METHOD : : This was an intervention study with pretest and posttest control group designs, randomized control trial, double blind study at ENT-HNS Clinic, CDC Dr. Kariadi Hospital and Dr.Soetrasno Hospital Rembang. Data was collected from September 2015 to June 2016. Subject filled out the DHI pre-test questionnaire, stratified randomly divided into 2 group. One group received betahistine 12 mg / 8 hours and the other received dimenhydrinate 50 mg / 8 hours in a double-blind selection process. After 2 weeks of drug administration, subject filled out a post test questionnaire of DHI.

RESULT : Subjects were 44 people; dimenhydrinate, 20 people (45.5%) and betahistine, 24 people (54.4%). Result showed that DHI score of post test is lower than pre test in both group with significance value of p < 0.05. There is no significant difference in DHI score of dimenhydrinate compared with betahistine group (p = 0.137).

CONCLUSION : Betahistine and dimenhydrinate are shown to be effective in lowering the DHI score.and betahistine not proven to be more effective