Age is A Critical Factor In Wrist Function After Surgical Therapy of Patients Suffering From A-Type Distal Radius Fracture: A PROM Study

Background: Although distal radius fractures (DRF) are the most common fractures of the human body there is still no consensus concerning the best treatment option, especially for type A fractures. Moreover, studies concerning other anatomic regions could prove that patient age is of high impact on therapy and outcome. Therefore, we have quantified wrist function within a retrospective study design using PROM and we have analysed the influence of age between control and patient collective and young versus old, respectively.Patients and Methods: The retrospective study included all patients with a surgically treated DRF type A and a control group of healthy patients, age and gender matched. The function of the wrist was examined with a self-assessment questionnaire the Munich Wrist Questionnaire (MWQ) according to the patient related outcome measurements (PROM). Results: PROM was answered by 110 patients with DRF type A. The average follow-up was 66 months. 110 healthy wrists were the control group and subgroup matching induced similar age group distribution. Hence, 7 individuals < 30 years, 67 between 31 and 64 years, 29 control individuals between 65 and 79 years and 7 control individuals > 80 years, respectively. Women were significantly older than the men (59±15 vs. 47±17).In overall analysis, there was no significant difference between control and patient group (96±6 vs. 95±7). Function was significantly different between control and patient group < 30 years (100±1 vs. 98±2). In the control group the function was significantly decreasing with advanced aging whereas in the patient group this influence was absent. The difference between age group <30 and 65-79 and >80 and between 30-64 and 65-79 and >80 was significantly different with increasing age. Conclusion: PROM is a suitable tool for a retrospective study design as numerous patients can be analysed. The influence of age is critical for wrist function. Hence, we therefore strongly suggest that this information should be taken into consideration for future study plans.

The Implementation of Modified ERAS Protocol in Laparoscopic Radical Cystectomy: An Outcome at Universitas Gadjah Mada Urological Institute

Background: Enhanced recovery after surgery (ERAS) protocol is multimodal perioperative care designed to achieve enhanced postoperative outcomes. Unfortunately, all these elements are not always fully applied due to each center’s limitations. In this study, the ERAS protocol was modified and implemented in patients with bladder cancer who underwent laparoscopic radical cystectomy (LRC). This study aimed to evaluate the outcomes of the modified ERAS protocol in LRC surgery. Methods: The retrospective study design was used to evaluate 35 patients (27 males and 8 females) who underwent LRC with the application of the perioperative modified ERAS protocol. All information relating to perioperative, intraoperative, and postoperative patient data was obtained from medical records. All complications that occurred were classified according to the Clavien-Dindo classification.Results: The mean age in this study was 58.3 ± 9.2, and the most common pathological finding was urothelial carcinoma. Intraoperative blood loss was 318.5 ± 112.5 cc with those requiring intraoperative blood transfusion of 4.8 ± 2.0 patients. The mean first diet was 2.1 ± 1.2 days. For bowel activities, the first flatulence was 1.6 ± 0.8 days. The mean mobilization with first sitting was 1.8 ± 0.9 days. Seventeen percent of patients experienced intraoperative complications and postoperative complications were encountered in 28.6% of patients. According to the ClavienDindo classification, most complications were grades 1-2 (17.1%). There was no incidence of mortality in this study.Conclusions: These promising results, including the postoperative recovery and complications rates, require validation with multi-center and randomized studies to confirm the benefits of the modified ERAS protocol in minimally invasive procedures, especially LRC surgery

Analisis Korelasi Faktor Resiko Kematian Di Ruang Isolasi Covid-19

Health workers and various other sectors are currently busy with handling world health cases of the Sars Cov-2 virus pandemic. The transmission of COVID-19 is very easy and dangerous, which is the cause of the increasing number of deaths. The large percentage of mortality rates for COVID-19 sufferers can be caused by internal factors and external factors. The purpose of this study was to analyze various factors that caused the death of COVID-19 sufferers. This scientific report uses observational analytics with a retrospective study design. The research target of Covid-19 patients in the isolation room of the Graha Medika hospital in August - December 2020 was 437 respondents. The research sample amounted to 305 respondents who were selected with simple random sampling technique. The instruments that the researchers used in data collection were writing instruments and medical records of patients in the COVID-19 isolation room. Most of the respondents were female, namely 161 respondents (52.8%), Almost half of the respondents aged >60 years, namely 119 respondents (39%), Almost all respondents underwent treatment for 1-5 days, namely 251 respondents (82.3% ), and most of the respondents had comorbidities, namely 228 respondents (74.8%). Factors of age, sex, comorbidities, had a statistical value (p<0.05) while the length of treatment was not related to the value (p>0.05). The most comorbid disease experienced by respondents was diabetes mellitus, and contributed to the death rate of 72 respondents (23.6%). Immediate handling and appropriate intervention for elderly COVID-19 sufferers of various genders and especially those with comorbidities to minimize the mortality rate of COVID-19 sufferers.

Radiation Exposure During Diagnostic and Therapeutic Angiography of Carotid-cavernous Fistula

Purpose The aim of this study was to determine local diagnostic reference levels (DRLs) during endovascular diagnostics and therapy of carotid-cavernous fistulas (CCF). Methods In a retrospective study design, DRLs, achievable dose (AD) and mean values were assessed for all patients with CCF undergoing diagnostic angiography (I) or embolization (II). All procedures were performed with the flat-panel angiography system Allura Xper (Philips Healthcare). Interventional procedures were differentiated according to the type of CCF and the type of procedure. Results In total, 86 neurointerventional procedures of 48 patients with CCF were executed between February 2010 and July 2021. The following DRLs, AD and mean values could be determined: (I) DRL 215 Gy ∙ cm2, AD 169 Gy ∙ cm2, mean 165 Gy ∙ cm2; (II) DRL 350 Gy ∙ cm2, AD 226 Gy ∙ cm2, mean 266 Gy ∙ cm2. Dose levels of embolization were significantly higher compared to diagnostic angiography (p < 0.001). No significant dose difference was observed with respect to the type of fistula or the embolization method. Conclusion This article reports on diagnostic and therapeutic DRLs in the management of CCF that could serve as a benchmark for the national radiation protection authorities. Differentiation by fistula type or embolization method does not seem to be useful.

Zenker Diverticulum: Does Size Correlate With Preoperative Symptoms?

Introduction Zenker diverticulum (ZD) usually affects adults after the 7th decade of life. Treatment for ZD is indicated for all symptomatic patients, but some patients prefer to defer surgical treatment until symptoms get worse and decrease their quality of life. Objective To evaluate the association of the preoperative symptoms in ZD patients with the size of the ZD. Methods A retrospective study design. Electronic medical records were used to identify patients diagnosed with ZD and treated over 11 years. Data collection included the chief complaints and symptoms, medical history, and findings on radiologic swallow evaluations of the patients. The diverticulum size was stratified into 3 groups: small (< 1 cm), moderate (1–3 cm), and large (> 3 cm). Results A total of 165 patients were enrolled and stratified by diverticulum size (48 small, 67 medium, and 50 large). Dysphagia, cough, and regurgitation were the most prevalent symptoms. Dysphonia was more frequent among patients with a small pouch. Logistic regression analysis showed that dysphagia and choking were associated with large and medium diverticulum size (p < 0.05). Additionally, dysphonia was significantly associated with the presence of a small-sized ZD (p < 0.04). Conclusion Upper gastrointestinal symptoms such as dysphagia and choking may be associated with a ZD > 1 cm and should always be evaluated. Additionally, the presence of dysphonia was found to be correlated with a ZD < 1 cm, suggesting that a prompt and appropriate fluoroscopic evaluation must be considered in those patients in whom no other clear cause of dysphonia is evident.

Hubungan Anemia Pada Ibu Hamil Terhadap Kejadian Stunting di RS Marthen Indey Jayapura Tahun 2018-2019

AbstrakPenelitian ini dilakukan untuk mengetahui hubungan antara anemia yang terjadi pada ibu hamil dengan tingkat kejadian stunting di Rumah Sakit Marthen Indey Jayapura dengan Insuline-like Growth Factors (IGF) sebagai salah satu faktor penyebab. Menggunakan metode deskriptif analitik dengan desain studi retrospective dan didapatkan 30 sampel dari total 80 populasi ibu hamil yang mengalami anemia. Didapatkan 15 (50%) sampel yang memiliki panjang badan bayi 36 – 40 cm, 13 (43,3%) sampel yang memiliki panjang badan bayi 41 – 45 cm dan 2 (6,7%) sampel yang memiliki panjang badan bayi > 45 cm dengan nilai p=0,004 (p<0,05) dari hasil uji statistik chi square. Ditemukan hubungan antara anemia pada ibu hamil terhadap tingkat kejadian stunting di Rumah Sakit Marthen Indey Jayapura. Kata Kunci: Anemia pada Ibu Hamil, Insuline-like Growth Factors, StuntingThe Relationship of Anemia in Pregnant Women to Stunting at Marthen Indey Hospital, Jayapura, 2018-2019AbstractThis study was conducted to determine wheter there is a relationship between anemia that occurs in pregnant women and the incidence of stunting at Marthen Indey Hospital, Jayapura with Insuline-like Growth Factors (IGF) as a contributing factor. The study was conducted using a descriptive analytical method with a retrospective study design and obtained 30 samples from a total of 80 population of pregnant women with anemia. The result showed that 15 (50%) sample had a baby body length 36 – 40 cm, 13 (43,3%) sample had a baby length 41 – 45 cm and 2 (6,7%) samplea had a baby body length > 45 cm with p value = 0,004 (p<0,05) from the result of the chi square statistical test. From the analysis, it was found that there was a relationship between anemia in pregnant women and the incidence of stunting at Marhen Indey Hospital, Jayapura.Keywords: Anemia in Pregnant Women, Insuline-like Growth Factors, Stunting

Radiation exposure in the endovascular therapy of cranial and spinal dural arteriovenous fistula in the last decade: a retrospective, single-center observational study

Purpose This study aims to determine local diagnostic reference levels (DRLs) in the endovascular therapy (EVT) of patients with cranial and spinal dural arteriovenous fistula (dAVF). Methods In a retrospective study design, DRLs and achievable dose (AD) were assessed for all patients with cranial and spinal dAVF undergoing EVT (I) or diagnostic angiography (II). All procedures were performed at the flat-panel angiography-system Allura Xper (Philips Healthcare). Interventional procedures were differentiated according to the region of fistula and the type of procedure. Results In total, 264 neurointerventional procedures of 131 patients with dAVF (94 cranial, 37 spinal) were executed between 02/2010 and 12/2020. The following DRLs, AD, and mean values could be determined: for cranial dAVF (I) DRL 507.33 Gy cm2, AD 369.79 Gy cm2, mean 396.51 Gy cm2; (II) DRL 256.65 Gy cm2, AD 214.19 Gy cm2, mean 211.80 Gy cm2; for spinal dAVF (I) DRL 482.72 Gy cm2, AD 275.98 Gy cm2, mean 347.12 Gy cm2; (II) DRL 396.39 Gy cm2, AD 210.57 Gy cm2, mean 299.55 Gy cm2. Dose levels of EVT were significantly higher compared to diagnostic angiographies (p < 0.001). No statistical difference in dose levels regarding the localization of dAVF was found. Conclusion Our results could be used for establishing DRLs in the EVT of cranial and spinal dAVF. Because radiation exposure to comparably complex interventions such as AVM embolization is similar, it may be useful to determine general DRLs for both entities together.

EFFECTS OF FAMILY SUPPORT AND MATERNAL PSYCHOLOGICAL ON EXCLUSIVE BREASTFEEDING

Background: Breastmilk is the best food that a mother can give to her baby from birth until the first 6 months of life to support growth and development during the first 1000 days of life. The success of exclusive breastfeeding is influenced by several factors. The purpose of this study is to analyze the support of family and mother to support exclusive breastfeeding. Method: This research method is cross sectional with a retrospective study design. The number of samples was 48. The independent variables were family and psychological assistance from the mother. The successful variable is exclusive breastfeeding. The research instrument used was a questionnaire. Data analysis using Fisher Exact statistical tests. Results: The results showed that there is no influence between family support and psychological of mother on the success of exclusive breastfeeding. Fisher Exact trial results related to family support for exclusive breastfeeding showed p = 0.339 (p> 0.05), psychological motivation of mothers towards exclusive breastfeeding showed p = 0.167 (p> 0.05). Conclusion: This data shows inappropriate between family support and psychological mother to exclusive breastfeeding.

Risk factors of endometrial cancer in patients with endometrial hyperplasia: implication for clinical treatments

Background Endometrial hyperplasia (EH) is commonly-seen in the patients with endometrial cancer (EC), we aimed to evaluated the risk factors of EC in patients with EH, to provide evidence to the clinical prevention and treatment of EC. Methods This study was a retrospective study design. EH patients confirmed by pathological examinations and treated with hysterectomy in our hospital from June 1, 2018 to February 28, 2021 were included. The clinical characteristics of EC and no-EC patients were compared and analyzed. Logistics regression analyses were conducted to evaluate the risk factors of EC in patients with EH. Results A total of 228 EH patients were included, the incidence of EC in the EH patients was 31.58%. There were significant differences in the age, BMI, diabetes, hypertension and pathology of EH between EC and no EC groups (all P < 0.05), no significant differences in the hyperlipidemia, preoperative CA125, number of deliveries, menopause and endometrial thickness between EC and no EC groups were found (all P > 0.05). Logistic regression analyses indicated that age > 50 y (OR 3.064, 95% CI 1.945–5.931), BMI ≥ 25 kg/m2 (OR 2.705, 95% CI 1.121–3.889), diabetes (OR 3.049, 95% CI 1.781–5.114), hypertension (OR 2.725, 95% CI 1.108–3.431) and severe hyperplasia (OR 3.181, 95% CI 1.496–4.228) were the risk factors of EC in patients with EH (all P < 0.05). Conclusions The risk of EC in EH patients is high, especially for those patients with age > 50 y, BMI ≥ 25 kg/m2, diabetes, hypertension and severe hyperplasia, special attentions should be paid for occurrence of EC and early diagnosis and early treatment are needed for those patients.

Subsidence of a metaphyseal-anchored press-fit stem after 4-year follow-up: an EBRA-FCA analysis

Purpose Uncemented stem migration analysis by EBRA-FCA (Einzel-Bild-Roentgen Analyse, Femoral Component Analyse) has been seen to be a good predictive indicator for early implant failure. In this study, we investigated the migration behavior of a cementless metaphyseal-anchored press-fit stem after 4-year follow-up. Methods Applying a retrospective study design, we reviewed all consecutive patients who between 2012 and 2017 received a cementless Accolade II press-fit stem at our Department. We reviewed medical histories and performed radiological measurements using EBRA-FCA software. EBRA-FCA measurements and statistical investigations were performed by two independent investigators. Results A total of 102 stems in 91 patients (female 60; male 31) fulfilled our inclusion criteria. Mean age at surgery was 66.2 (range 24.3–92.6) years. EBRA migration analysis showed a mean subsidence of 1.4 mm (range 0.0–12.0) at final follow-up. The angle between stem and femur axis was 0.5° (range 0.0°–2.8°) after 48 months. No correlations between gender or Dorr types and subsidence were found (p > 0.05). A body mass index > 30 kg/m2 showed a significant increase in stem subsidence within the first 6 (p = 0.0258) and 12 months (p = 0.0466) postoperative. Conclusions Migration pattern of the metaphyseal-anchored stem and a low subsidence rate at final follow-up may predict a good long-term clinical result. Trial registration Number: 20181024-1875.