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Medica Hospitalia
Published by RSUP Dr. Kariadi Semarang
ISSN : 23014369     EISSN : 26857898     DOI : https://doi.org/10.36408/mhjcm
Core Subject : Health,
Dentistry Health Professions Medicine & Pharmacology Nursing Public Health
Medica Hospitalia: Journal of Clinical Medicine adalah jurnal ilmiah yang diterbitkan RSUP Dr. Kariadi dan menerima artikel ilmiah dalam bahasa Indonesia dan bahasa Inggris yang diharapkan dapat menjadi media untuk menyampaikan temuan dan inovasi ilmiah dibidang kedokteran atau kesehatan kepada para praktisi dan akedemisi di bidang kesehatan dan kedokteran.
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Search results for , issue "Vol. 6 No. 2 (2019): Med Hosp" : 13 Documents clear
Status Kesehatan Rongga Mulut Wanita Suku Osing Agustin Wulan Suci Dharmayanti; Suhartini Suhartini; Banun Kusumawardani
Medica Hospitalia : Journal of Clinical Medicine Vol. 6 No. 2 (2019): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (333.692 KB) | DOI: 10.36408/mhjcm.v6i2.386

Abstract

Latar belakang Kualitas hidup manusia ditentukan oleh tingkat sosiodemografi, status kesehatan umum dan rongga mulut yang saling berkaitan. Ras dan suku menentukan genetika dalam merespon keradangan, kerentanan jaringan rongga mulut terhadap bakteri atau injuri, meregulasi hormon reproduksi, dan sindrom menopause. Akan tetapi hubungan faktor tersebut masih belum banyak terungkap, khususnya pada Suku Osing. Suku Osing merupakan salah satu suku yang masih memegang kuat adat istiadat.Tujuan penelitian ini adalah untuk mengetahui status kesehatan rongga mulut wanita suku Osing. Metode Penelitian observasional dengan desain cross sectional.Subyek penelitian dikelompokan menjadi kelompok usia produktif dan menopause. Pada subyek penelitian dilakukan pemeriksaan status kesehatan rongga mulut meliputi jumlah gigi yang tersisa di rongga mulut, indeks periodontal, karies dan kebersihan rongga mulut. Semua data dikategorikan kemudian akan dilakukan uji korelasi non parametric (p?0,05). Hasil Kelompok wanita usia menopause pada penelitian ini sudah mengalami menopause dalam kurun waktu 5-10 tahun.Jumlah gigi wanita usia menopause lebih sedikit dibanding wanita usia produksif (p?0,05). Wanita usia menopause lebih banyak menderita penyakit periodontal yang bersifat irreversible (2,65 ± 0,35) daripada wanita usia produktif (1,16 ± 0,27). Indeks karies kelompok wanita usia menopause (D=166, M=570) lebih tinggi dibanding wanita usia produktif (D=247, M=162). Akan tetapi, kedua kelompok ini mempunyai tingkat kebersihan mulut yang sama. Selain itu terdapat hubungan antara tingkat kebersihan mulut, penyakit periodontal, karies dan lamanya menopause (R>0,3). Simpulan Status kesehatan rongga mulut wanita usia menopause suku Osing di Desa Kemiren, Kecamatan Glagah, Banyuwangi lebih buruk dibanding wanita usia produktif. Akan tetapi, perlu penelitian lebih lanjut mengenai faktor-faktor yang mempengaruhi status kesehatan rongga mulut tersebut. Background Social-demography, health status, and oral health specify a quality life, which all of them are correlated. Races and ethnic assign genetic aspect, especially in inflammation respond, oral tissue susceptibility to bacterial infection and injuries, hormone regulation, and menopause syndrome. However, the relationships are unexplored yet, especially in osingese. Osingese is one of ethnic which hold the customs strongly. The objective of this study was to know the oral health status of Osingese Women. Method This study was observational with a cross-sectional design. The subjects were classified into productive and menopause age. All of the subjects were examined their oral health, including remain teeth, periodontal index, caries index, and oral hygiene index. All of the data were categorized and analyzed by non-parametric correlation analysis (p?0.05). Result Menopause aged group experienced menopause period about 5-10 years. The number of teeth of the menopause group was less than productive group (p?0.05). The menopause group more sustained irreversible periodontal diseases (2.65 ± 0.35) than the productive group (1.16 ± 0.27). Caries index in the menopause group (D=166, M=570) was higher than the productive group (D=247, M=162). However, their oral hygiene index was the same. Moreover, there presented the relationship between oral hygiene, caries index, periodontal index, and menopause status (R>0.3). Conclusion Oral health status menopause aged osingese women was poorer than the productive group. However, it needed further study to investigate the other factor influencing oral health status. Keywords: caries, periodontal disease, oral hygiene, menopause, Osingese
Penentuan Intravitalitas Gantung berdasarkan Gambaran Histopatologis Otak Besar Mencit Balb/c Raja Al Fath Widya Iswara; Sigid Kirana Lintang Bhima; Intarniati Nur Rohmah
Medica Hospitalia : Journal of Clinical Medicine Vol. 6 No. 2 (2019): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (462.077 KB) | DOI: 10.36408/mhjcm.v6i2.387

Abstract

Latar Belakang : Asfiksia merupakan salah satu mekanisme kematian yang dapat terjadi akibat gantung. Otak merupakan salah satu organ penting yang dinilai dalam otopsi kasus gantung. Secara makroskopis tidaklah mudah membedakan temuan asfiksia pada otak yang terjadi antemortem dan perimortem. Adanya temuan asfiksia pada pemeriksaan mikrokopis dapat menentukan intravitalitas gantung. Penelitian ini bertujuan untuk mengetahui penentuan intravitalitas gantung berdasarkan gambaran histopatologis otakbesar mencit Balb/c. Metode : Penelitian eksperimental ini menggunakan post test only with control group design yang telah memenuhi kelayakan etik dengan sampel berjumlah 18 mencit Balb/c jantan yang dibagi menjadi tiga kelompok yaitu kelompok kontrol yang tidak diberi perlakuan, kelompok antemortem yang digantung saat masih hidup, kelompok perimortem yang digantung 15 menit setelah mati. Pada kelompok pelakuan mencit digantung selama 1 jam dengan tali yang ditambahkan beban 50 gram. Penilaian gambaran histopatologi otak besar berdasarkan reaksi inflamasi dan perdarahan. Hasil : Pada kelompok kontrol hampir tidak terdapat inflamasi dan perdarahan, pada kelompok antemortem terdapat inflamasi sedang hingga berat dan perdarahan berat, pada kelompok perimortem terdapat inflamasi dan perdarahan ringan hingga sedang. Pada uji Kruskal Wallis didapatkan perbedaan bermakna pada semua kelompok (p<0,05). Pada Uji Man Whitney didapatkan perbedaan yang bermakna pada parameter inflamasi dan perdarahan antara kelompok kontrol dengan kelompok antemortem dan perimortem, antara kelompok antemortem dan perimortem (p<0,05). Simpulan : Intravitalitas Gantung dapat ditentukan berdasarkan gambaran histopatologis otak besar mencit Balb/c dimana reaksi inflamasi dan perdarahan berat didapatkan pada kelompok antemortem. Kata Kunci: gantung, histopatologis, intravital, otak besar Hanging Intravitality Determination based on Cerebrum Histopathological Features in Balb/c Mice Abstract Background: Asphyxia is one of the death mechanisms that can occur due to hanging. The brain is one of the important organs autopsied in a hanging-related death case. Macroscopically, it is challenging to distinguish between asphyxiated brains occuring antemortem and those occurring perimortem. The presence of asphyxia on micro-examination can help determining the hanging intravitality. This study aims to determine hanging intravitality based on cereberum histopathological features in mice Balb/c mice. Method: This is a post test only experimental study with control group examining 18 male Balb/c mice in three groups involving untreated control group, antemortem group hanged during alive, perimortem group hanged 15 minutes after death. In the treatment groups, mice were hanged with 50 grams load for 1 hour. Determination of histopathological features is based on inflammatory and bleeding reactions. Results: Nearly no inflammation and bleeding was found in the control group, moderate to severe inflammation and heavy bleeding was found in the antemortem group, mild to moderate inflammation and bleeding was found in the perimortem group. The Kruskal Wallis test showed significant differences in all groups (p <0.05). The Man Whitney test found significant differences in the inflammatory and bleeding parameters between the control group and the antemortem and perimortem groups; between the antemortem and perimortem groups (p <0.05). Conclusion: The cerebrum histopathological features of the Balb/c mice can indicate hanging intravitality in which the antemortem group shows inflammatory reactions and heavy bleeding. Keywords: hanging, histopathological, intravital, cerebrum
Hubungan Kadar HbA1c Dan Rasio TG/HDL Dengan Cystatin-C Serum Pada Pasien Diabetes Melitus Tipe 2 Hadian Widyatmojo; Indranila Kustarini Samsuria; Ria Triwardhani
Medica Hospitalia : Journal of Clinical Medicine Vol. 6 No. 2 (2019): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (294.075 KB) | DOI: 10.36408/mhjcm.v6i2.388

Abstract

Latar belakang: Diabetes melitus (DM) tipe 2 dapat menyebabkan komplikasi salah satunya nefropati. Kontrol glikemik yang dinilai dengan HbA1c dan dislipidemia yang dinilai dengan rasio trigliserida/high density lipoprotein (TG/HDL) diduga berhubungan dengan komplikasi nefropati. Cystatin C merupakan petanda yang dapat menilai kerusakan fungsi ginjal dini. Hubungan kadar HbA1c dan rasio TG/HDL dengan Cystatin C pada pasien DM tipe 2 belum diketahui dengan jelas. Tujuan: Mengetahui hubungan antara kadar HbA1c dan rasio TG/HDL dengan Cystatin C pada pasien diabetes melitus tipe 2. Metode: Penelitian observasional analitik dengan pendekatan belah lintang dilakukan pada bulan April - Juni 2019 melibatkan 34 pasien DM tipe 2 di Puskesmas Karang Ayu yang memenuhi kriteria inklusi dan ekslusi. Pemeriksaan kadar HbA1c menggunakan metode HPLC, rasio TG/HDL dihitung dengan perbandingan TG dengan HDL yang diperiksa menggunakan alat kimia klinik otomatis, kadar Cystatin C menggunakan metode ELISA. Uji statistik menggunakan korelasi Spearman. p < 0,05 dianggap signifikan. Hasil: Rerata±SD kadar HbA1c adalah 8,21±1,65. Median (minimum-maksimum) rasio TG/HDL dan Cystatin C berturut-turut adalah 3,65(1,3–9,7), 0,72(0,46 – 1,22) mg/L. Korelasi HbA1c dengan Cystatin C dan rasio TG/HDL dengan Cystatin C berturut-turut adalah (r = 0,505; p = 0,002) dan (r = 0,471; p = 0,005). Simpulan: Terdapat hubungan positif sedang bermakna antara kadar HbA1c dengan Cystatin C dan rasio TG/HDL dengan Cystatin C pada pasien diabetes melitus tipe 2. Kata kunci: HbA1c, rasio TG/HDL, Cystatin C, DM. The correlation of HbA1c and TG/HDL ratio with serum cystatin C in type 2 diabetes patients Background: Type 2 diabetes mellitus (DM) can cause chronic complications such as nephropathy. Glycemic control assessed with HbA1c and dyslipidemia assessed by the tryglyceride/high density lipoprotein (TG / HDL) ratio is thought to be associated with complications of nephropathy. Cystatin C is a marker that can assess early kidney function damage. Relationship between HbA1c levels and TG / HDL ratio with Cystatin C in type 2 DM patients is not clearly known. Objective: to investigate the correlation of HbA1c and TG/HDL ratio with Cystatin C in acute type 2 diabetes mellitus patients. Methods: Analytic observational study with cross sectional approach was conducted in April-June 2019 involving 34 type 2 diabetes mellitus patients at the Karang Ayu Puskesmas who were screened according to the inclusion and exclusion criteria. The level of HbA1c were measured by the HPLC method, TG/HDL ratio was measured by automatic chemistry analyzer and Cystatin C was measured by ELISA method. Statistical analysis used Spearman Correlation Test. p <0.05 was considered significant. Results: The mean ± SD HbA1c level was 8.21 ± 1.65. The median (minimum-maximum) ratio of TG / HDL and Cystatin C were 3.65 (1.3–9.7), 0.72 (0.46 - 1.22) mg / L, respectively. Correlation of HbA1c with Cystatin C and the ratio of TG / HDL with Cystatin C respectively (r = 0.505; p = 0.002) and (r = 0.471; p = 0.005). Conclusions: There are significant moderate positive correlation between HbA1c with Cystatin C and TG/HDL ratio with Cystatin C in type 2 diabetes mellitus patients. Keywords : HbA1c, TG/HDL ratio, Cystatin C, Type 2 Diabetes mellitus.
Terapi Kombinasi Diabetic Self Management Education (DSME) Dengan Senam Kaki Diabetik Terhadap Ankle Brachial Index (ABI) Pada Penderita Diabetes Tipe II Diyah Fatmasari; Rastia Ningsih; Tri Johan Agus Yuswanto
Medica Hospitalia : Journal of Clinical Medicine Vol. 6 No. 2 (2019): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (306.353 KB) | DOI: 10.36408/mhjcm.v6i2.389

Abstract

Latar belakang: Diabetes melitus tipe II merupakan salah satu penyakit tidak menular yang dapat menyebabkan kematian dan memiliki risiko tinggi terjadi komplikasi. Penatalaksanaan empat pilar diabetes tipe II meliputi edukasi, terapi gizi medis, latihan jasmani dan intervensi non farmakologi. Salah satu penanganan non-farmakologi yang sering dilakukan adalah Diabetic Self Management Education (DSME) dan senam kaki diabetik, tetapi kombinasi keduanya belum pernah di teliti. Gabungan beberapa terapi disebut terapi kombinasi. Penelitian ini bertujuan untuk mengetahui pengaruh terapi kombinasi DSME dan senam kaki terhadap Ankle Brachial Index (ABI) pada penderita diabetes tipe II. Metode: Desain penelitian adalah penelitian Experimental dengan rancangan pretest-posttest control group design. Kelompok intervensi di beri terapi kombinasi DSME dengan senam kaki dan kelompok kontrol dengan pemberian Range of Motion (ROM). Teknik sampling non-probability dengan metode consecutive sampling dengan 48 responden yang terbagi dalam 2 kelompok. Hasil Rerata ABI kelompok Intervensi dan Kontrol sebelum perlakuan adalah 0,84 mmHg dan 0,82 mmHg, sedangkan setelah perlakuan adalah 1,09 mmHg dan 0,89 mmHg. Uji independent t test menunjukkan nilai p value 0,000 berarti ada perbedaan rerata selisih ABI kedua kelompok. Kesimpulan kombinasi Diabetic Self Management Education (DSME) dengan senam kaki efektif dalam peningkatan Ankle Brachial Index (ABI) pada penderita diabetes tipe II. Kata kunci : Diabetes Melitus, Diabetic Self Management Education (DSME), senam kaki diabetik, Ankle Brachial Index. COMBINATION THERAPY OF DIABETIC SELF MANAGEMENT EDUCATION (DSME) WITH DIABETIC FOOT EXERCISE TOWARDS ANKLE BRACHIAL INDEX (ABI) ON PATIENTS DIABETIC TYPE II Background: Type II diabetes mellitus is a non-infectious disease which cause death and have a high risk complications. Management of 4 pillars of type II diabetes includes education, medical nutrition therapy, physical exercise and non pharmacological interventions. One of the non-pharmacological treatments is the combination of Diabetic Self Management Education (DSME) and diabetic foot exercises. Study aims is to determine effect of a combination of Diabetic Self Management Education (DSME) with diabetic foot exercises on Ankle Brachial Index (ABI) in type II diabetics patients. Method: Research design was Quasy Experimental with pretest-posttest control group design. Intervention group was 24 patients type II diabetic with therapy combination of DSME and foot exercises, the control group was given Range of Motion (ROM) as therapy. Results: Mean of ABI intervention and control group before treatment are 0.84 mmHg and 0.82 mmHg, while after treatment are 1.09 mmHg and 0,89 mmHg Independent t test shows p value 0.000, that there is a differences of mean of ABI both group. It can be concluded that combination of DSME with foot exercises is effective to increase Ankle Brachial Index (ABI) at patients type II diabetics. Keywords: Diabetes Melitus, Diabetic Self Management Education (DSME), diabetic foot exercises, Ankle Brachial Index.
Manifestasi Klinik Gangguan Neurologis Terkait HIV Rahmayanti Rahmayanti; Retnaningsih Retnaningsih; Muchlis AU Achsan Udji Sofro
Medica Hospitalia : Journal of Clinical Medicine Vol. 6 No. 2 (2019): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (268.748 KB) | DOI: 10.36408/mhjcm.v6i2.390

Abstract

Latar Belakang: Komplikasi neurologis terjadi pada lebih dari 40% pasien dengan infeksi HIV. Kelainan neurologis yang terkait dengan infeksi HIV meliputi infeksi sistem saraf pusat, neoplasma, komplikasi vaskular, neuropati perifer, dan miopati.Penelitian ini bertujuan untuk mengetahui manifestasi klinis gangguan neurologis terkait HIV pada pasien terdiagnosis HIV yang dirawat di RSUP Dr. Kariadi Semarang tanggal 1 Januari 2014- 31 Desember 2016. Metode: Penelitian ini adalah studi deskriptif retrospektif observasional yang dilakukan di Rumah Sakit Umum Dr. Kariadi, Semarang, Jawa Tengah. Data diambil dari Rekam medis, dianalisis manifestasi neurologis terkait HIV. Hasil: Subyek adalah 115 pasien dengan HIV-AIDS, 64 laki-laki (56%) dan 51 perempuan (44%). Usia rata-rata 32,06 tahun (4 sampai 68 tahun). Dari 115 kasus, 40 subyek (34,78%) memiliki manifestasi neurologis terkait HIV. Manifestasi neurologis terkait HIV meliputi toksoplasmosis otak (60%), meningoencephalitis(20%), st non hemoragik (5%),abses serebral (5%) dan vertigo (5%). Kesimpulan. Infeksi HIV dan kaitannya dengan tingkat keparahan imunodefisiensi bertanggung jawab atas sejumlah besar gangguan neurologis. Analisis faktor risiko serta status imunitas harus dilakukan pada semua pasien dengan gangguan neurologis untuk tujuan penyaringan hiv. Kata kunci: HIV, AIDS, Kelainan neurologis Background: Neurologic complications occur in more than 40% of patients with HIV infection. Neurologic disorders associated with HIV infection include central nervous system infections, neoplasms, vascular complications, peripheral neuropathies, and myopathies. This study was aimed to identify clinical manifestation of HIV-associated neurologic disorders in Patients with AIDS treated in Dr. Kariadi General Hospital from 1 January 2014 to 31 December 2016. Methods: This is a descriptive retrospective observational study conducted in neurology clinic,Dr. Kariadi General Hospital, Semarang,between 1 January 2014 and 31 December 2016.Each patient”s medical record was studied in detail and then analyzed specifically in regard to the clinical manifestation of HIV-associated neurologic disorders. Results: One hundred fifteen patients were included, 64 males (56%) and 51 females (44%). The average age was 32,06 years (4 to 68 years). Of the 115 cases, 40 (34,78 %) had neurologic manifestation.The manifestation include brain toxoplasmosis (60%), meningoencephalitis (20%), non hemorragic stroke (5%),cerebral abces (5%) and vertigo (5%). Conclusions. HIV infection and their association with the severity of immunodeficiency is responsible for a large number of neurologic disorders. Analysis of risk factors as well as imunnological status should be made in all patients with neurologic disorders for the purpose of hiv screening. Keywords: HIV, AIDS, neurologic disorders
Hubungan Kebisingan Dengan Gangguan Pendengaran Dan Kejiwaan Para Pekerja Terpapar Bising Rohmatullah Subekti; Muyassaroh Muyassaroh; Zulfikar Naftali
Medica Hospitalia : Journal of Clinical Medicine Vol. 6 No. 2 (2019): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (262.313 KB) | DOI: 10.36408/mhjcm.v6i2.391

Abstract

Latar belakang: Kebisingan di tempat kerja seringkali menjadi problem bagi tenaga kerja. Paparan bising dapat menyebabkan gangguan auditori yaitu noise-induced hearing loss (NIHL) dan gangguan non auditori berupa gangguan kejiwaan seperti depresi, kecemasan serta stress. Tujuan: Untuk mengetahui hubungan antara kebisingan terhadap kejadian gangguan pendengaran dan kejiwaan pada pekerja terpapar bising. Metode: Penelitian ini bersifat deskriptif analitik dengan design belah lintang. Tingkat kebisingan diukur dengan menggunakan alat sound level meter (SLM), gangguan pendengaran dinilai dari hasil audiometri, gangguan kejiwaan dinilai dari jawaban kuesioner Depression Anxiety Stress Scale 42 (DASS 42) dari WHO. Analisis data dengan uji chi square. Hasil : Data yang didapatkan dari 326 sampel menunjukkan bahwa 179 (54.9%) subjek mempunyai masa kerja lebih dari 10 tahun dan 147 (45.1%) subjek mempunyai masa kerja kurang dari 10 tahun. Sebanyak 51 (15.6%) pekerja mengalami NIHL dan 154 (47.2%) pekerja mengalami gangguan jiwa. Terdapat hubungan antara lama paparan bising (P= 0.000) dan intensitas kebisingan (P= 0.022) terhadap kejadian NIHL, dan intensitas kebisingan terhadap derajat keparahan depresi (P= 0.007) Kesimpulan: Lama paparan dan intensitas bising berhubungan dengan gangguan pendengaran sedangkan intensitas bising berhubungan dengan derajat keparahan depresi. Dibandingkan dengan intensitas bising, lama paparan bising mempunyai hubungan yang lebih besar terhadap kejadian NIHL. Kata kunci : Kebisingan, NIHL, depresi, ansietas, stres Background: Noise can raise significant issues in the workplaces. It can affect either auditory disturbance called Noise Induce Hearing Loss (NIHL) or non-auditory disturbance involving psychiatric disorders such as depression, anxiety and stress. Objective: To examine the relationship between noise in the workplace and the incidence of hearing impairment and psychiatric disorders. Method: The study design is analitic desciptive with cross-sectional approach. The noise level was measured with sound-level-metre (SLM), hearing disorders was assessed with audiometric and psychiatric disorder was assessed with Depression Anxiety Stress Scale 42 (DASS 42). The data were analized with chi square. Results : A total of 326 workers were sampled during this study showing that 179 (54.9%) workers have worked over 10 years and 179 (54.9%) workers have worked less than 10 years. It was found that 51 (15.6%) workers suffered from NHIL and 154 (47.2%) workers suffered from mental disorders. A significant relationship was found between the incidence of NIHL and years of noise exposure (P= 0.000) and noise intensity (P= 0.022). A significant relationship was found between noise intensity and depression severity (P= 0.007) Conclusion: The years of noise exposure and noise intensity were related to haring disorders. The noise intensity were related to the depression severity. In comparison with noise intensity, a stronger relationship was found between years of noise exposure and the incidence of NIHL. Keywords : Noise, NIHL, depression, anxiety, stress
Perbandingan Efektivitas Patient-Controlled Analgesia (PCA) Fentanil, PCA Morfin dan Tramadol Intravena sebagai Analgetik Pasca Operasi Modified Radical Mastectomy Widya Istanto Nurcahyo; Arie Faishal Madjan; Ibnu Siena Samdani
Medica Hospitalia : Journal of Clinical Medicine Vol. 6 No. 2 (2019): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (349.683 KB) | DOI: 10.36408/mhjcm.v6i2.392

Abstract

Background : Modified Radical Mastectomy often accompanied by moderate to severe post-operative pain. Some patients who received intermitten analgesic combination of tramadol and ketorolac still complaining of pain. PCA is a new method of analgesic administration. The use of PCA fentanyl and PCA morphine is expected to be more effective in the management of MRM post-operative pain. The aim of study : This study aims to determine the effectivity, side effects and patient satisfaction level between intravenous PCA fentanyl, PCA morphine and tramadol as an analgesic for post-operative MRM. Methods : Double-blind clinical trial of 36 patients who were scheduled to undergo MRMfulfilled this study criteria. After general anesthesia, the patients were divided into 3 groups of post-operative analgesic treatment: 1) PCA fentanyl group with fentanyl loading dose 50 mcg, demand dose 20 mcg, 10 min interval lockout, 70 mcg/hour dose limit, infusion background 30 mcg/hour; 2) PCA group morphine with morphine loading dose 4 mg, demand dose 1 mg, 10 minute interval lockout, 6 mg/hour limit dose, no background infusion; 3) tramadol group who received intravenous tramadol 100 mg/8 hours. Periodic assessment of NRS score, RASS score, vital signs, side effects and patient satisfaction levels during first 24 hours post-operative. Data analyzed with Shapiro-Wilk followed by Kruskal-Wallis or One Way ANOVA, were considered significant if p<0.05. Result : PCA fentanyl is the most effective, followed by PCA morphine then tramadol. PCA fentanyl and PCA morphineRASS score are lower than tramadol(p=0,000). Drugs side effects are nausea,vomiting and dizziness which not statistically significant. PCA fentanyl provides the highest patient satisfaction level, while there is no significant differences between PCA morphine and tramadol(p=0,009). Blood pressure, respiratory rate and pulse rate PCA fentanyl and PCA morphine is significantly lower than tramadol group. Conclusion :PCA fentanyl and PCA morphine are more effective than tramadol. PCA fentanyl providesthe highest patient satisfaction level. Drugs side effects are nausea, vomiting and dizziness which not statistically significant. Keyword : MRM,PCA fentanil, PCA morfin, tramadol, effectivity, side effects, patient satisfaction level Latar Belakang : Operasi Modified Radical Mastectomy menimbulkan nyeri derajat sedang hingga berat pasca operasi. Sebagian pasien yang mendapat kombinasi anagetik tramadol dan ketorolak secara berkala, masih mengeluh nyeri. PCA merupakan metode baru pemberian analgetik. Penggunaan PCA fentanil dan PCA morfin diharapkan dapat lebih efektif dalam mengatasi nyeri pasca operasi MRM. Tujuan : Penelitian ini bertujuan untuk mengetahui perbandingan efektivitas, efek samping dan tingkat kepuasan pasien antara penggunaan PCA fentanil, PCA morfin dan tramadol intravena sebagai analgetik pasca operasi MRM. Metode :Dilakukan uji klinis tersamar ganda terhadap 36 pasien rencana operasi MRM yang memenuhi kriteria penelitian. Setelah dilakukan anestesi umum, pasien dibagi dalam 3 kelompok perlakuan pemberian analgetik pasca operasi: 1) kelompok PCA fentanil dengan fentanilloading dose 50 mcg, demand dose 20 mcg, lockout interval 10 menit, limit dose70 mcg/jam, background infusion 30 mcg/jam; 2) kelompok PCA morfin denganmorfin loading dose 4 mg, demand dose 1 mg, lockout interval 10 menit, limit dose6 mg/jam, tanpa background infusion; 3)kelompok tramadol yang mendapat tramadol intravena 100 mg/8jam. Dilakukan penilaian berkala skor NRS, RASS, tanda vital, efek samping dan tingkat kepuasan pasien selama 24 jam pasca operasi. Data dianalisa dengan Shapiro-Wilk dilanjutkan Kruskal-Wallis atau One wayANOVA, dianggap bermakna bila p< 0,05. Hasil :Efektivitas terbaik pada PCA fentanil, diikuti PCA morfin lalu tramadol. Skor RASS PCA fentanil dan PCA morfin lebih rendah dari tramadol (p=0,000). Terdapat efek samping mual, muntah dan dizziness yang secara statistik tidak berbeda bermakna. Tingkat kepuasan pasien tertinggi pada kelompok PCA fentanil, sedangkan antara kelompok PCA morfin dan tramadol tidak berbeda bermakna(p=0,009). Tekanan darah, laju napas dan laju nadi kelompok PCA fentanil dan PCA morfin lebih rendah daripada tramadol. Simpulan:PCA fentanil dan PCA morfin lebih efektif dibandingkan tramadol. PCA fentanil memberikan tingkat kepuasan pasien yang lebih tinggi dibanding PCA morfin dan tramadol. Terdapat efek samping mual, muntah dan dizziness namun secara statistik tidak berbeda bermakna Kata Kunci : MRM, PCA fentanil, PCA morfin, tramadol, efektivitas, efek samping, tingkat kepuasan pasien
Pengaruh Perawatan Paliatif Terhadap Peningkatan Kualitas Hidup Penderita Karsinoma Nasofaring Stadium Lanjut di RSUP Dr. Kariadi Semarang Muyassaroh Muyassaroh; Tri Lestari
Medica Hospitalia : Journal of Clinical Medicine Vol. 6 No. 2 (2019): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (272.62 KB) | DOI: 10.36408/mhjcm.v6i2.393

Abstract

Background: Palliative care can improve the quality of life for patients with end stage nasopharyngeal carcinoma (NPC). Palliative care includes handling nutrition, relieving pain and reducing the severity of symptoms from the disease, side effects of therapy or other complaints. It also improve psychological, social and spiritual aspects. The purpose of this study was to analyze the effect of palliative care on improving the quality of life for end stage NPC patients. Methods: Observational cohort study in 15-70 years old NPC patients included in the screening criteria for palliative care (total score 4). The sample was divided into 2 groups, 20 sampels per group. Quality of life was assessed with modified Gill scale questionnaire. Data was analyzed with t test. Results: The quality of life of NPC patients increased after palliative care (score 31,8 to 35,6). Decreased in groups without palliative care (score 33,0 to 30,9). Statistical analysis found significant differences between before and after palliative care (p = 0.055). Conclusion: Palliative care improves the quality of life for end stage NPC patients. Key word: Quality of life, Palliative care, Nasopharyngeal carcinoma Latar belakang : Perawatan paliatif dapat meningkatkan kualitas hidup penderita karsinoma nasofaring (KNF) stadium lanjut. Perawatan paliatif meliputi penanganan nutrisi, menghilangkan nyeri dan mengurangi keparahan gejala yang timbul akibat penyakit tersebut ataupun akibat efek samping terapi atau keluhan lain yang tidak lagi responsif terhadap terapi kuratif, serta mengupayakan perbaikan dalam aspek psikologis, sosial dan spiritual. Tujuan penelitian ini adalah menganalisis pengaruh perawatan paliatif terhadap peningkatan kualitas hidup penderita KNF stadium lanjut. Metode : Penelitian kohort observasional pada penderita KNF stadium lanjut usia 15 – 70 tahun yang masuk dalam kriteria penapisan perawatan paliatif (total skor 4). Sampel dibagi menjadi 2 kelompok yaitu kelompok perlakuan dan kelompok kontrol. Besar sampel ditentukan sebanyak 20 tiap kelompok. Kualitas hidup dinilai dengan kuesioner modifikasi skala mc Gill. Analisis data dengan Uji t test. Hasil : Kualitas hidup penderita KNF meningkat setelah dilakukan perawatan paliatif (skor 31,8 menjadi 35,6). Menurun pada kelompok tanpa perawatan paliatif (skor 33,0 menjadi 30,9). Analisis statistik didapatkan perbedaan bermakna antara sebelum dan sesudah dilakukan perawatan paliatif p=0,055. Simpulan : Perawatan paliatif meningkatkan kualitas hidup penderita KNF stadium lanjut. Key word : Kualitas hidup, Perawatan paliatif, Karsinoma Nasofaring
Late Presentation of Arrhythmogenic Right Ventricular Cardiomyopathy : Role of Non Invasive Modalities for The Diagnosis Safir Sungkar; Mochamad Arif Nugroho
Medica Hospitalia : Journal of Clinical Medicine Vol. 6 No. 2 (2019): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (663.321 KB) | DOI: 10.36408/mhjcm.v6i2.394

Abstract

Background : Arrhythmogenic right ventricular cardiomyopathy(ARVC) is an inherited myocardial disease affecting predominantly young people and manifests as sustained ventricular tachycardia, sudden cardiac death (SCD) or heart failure. However, its first manifestation in older patients is infrequent. Diagnosis of ARVC remains a clinical challenge and need further investigation. Our case report investigated role of non invasive modalities for diagnosis of ARVC patient. Case Presentation : A 65 year old man was admitted to the hospital with symptoms of palpitationand near syncope. An Electrocardiogram (ECG) showed a sustained VT with LBBB morphology and inferior axis. The patient was cardioverted to sinus rhytm with a single 100J shock. Postcardioversion ECG showed an epsilon wave in right precordial leads. Echocardiography revealed extensive RV enlargement and reduce function. Our patient had three major (RV aneurysm, epsilon wave and T wave inversion) and one minor criteria (sustained LBBB type-VT with inferior axis)making the diagnosis of ARVC definite according to the revised Task Forced Criteria. Conclusion: ARVC may have a very late presentation and this diagnosis should be considered as a potential cause of sustained VT of RV origin among the elderly. ECG and echocardiography as non invasive modalities have an important role for the diagnosis of patients with suspected ARVC. Keywords :Arrhythmogenic right ventricular cardiomyopathy,ventricular tachycardia, sudden cardiac death, diagnosis.
Ketogenic Diet for Treatment 2-Year 9 Month Old Boy With Intractable Epilepsy I Made Ananta Wijaya; Alifiani Hikmah Putranti; Maria Mexitalia
Medica Hospitalia : Journal of Clinical Medicine Vol. 6 No. 2 (2019): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (372.874 KB) | DOI: 10.36408/mhjcm.v6i2.395

Abstract

Background:The ketogenic diet (KD) is a high-fat, low-carbohydrate, and normal-protein diet that has been used for the treatment of medically refractory childhood epilepsy since the 1920s.The KD includes 80% fat, 15% protein, and 5% carbohydrate; the ratio of fat to carbohydrate plus protein ranges from 2:1 to 4:1.The purpose of the case report was to learn benefits and factors that influence the administration of the ketogenic diet in intractable epilepsy. Case:A 2-years 9 months old boy since 3 month of age the child begins seizure. Five month the child was diagnosed with epilepsy received one type of anti epileptic drug (AED). Seven months of age the child began control in outpatient clinic Neurology Department of Dr. Kariadi Hospital with a diagnosis of general epilepsy, were given 2 type of AEDs. Since10 month of age the child was given 3 type of AEDs. The child still often seizure, at 15 months was diagnosed intractable epilepsyand at 29monthof age, was programed to have long term EEG and KD during hospitalization. Conclusion:The administration of KD in 2-years9 months old boy with intractable epilepsyshowed benefits in reducing the frequency of seizures. Key word : Ketogenic Diet, Intractable Epilepsy, Child

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