Pregnancy and Delivery with Cardiac Disease in Dr. Soetomo Hospital 2018

Background: Cardiac disease is one of the non obstetric problems causing mortality both in pregnancy and labor due to the complications. Preventions for the complications have not been implemented, thus the number of patients which have cardiac disease with complications and perinatal outcome with low birth weight is still high. Objective : To identify maternal and neonatal outcome of pregnant women with cardiac disease in dr. Soetomo Surabaya hospital in 2018. Method: Descriptive retrospective study using medical records in dr. Soetomo Surabaya hospital 2018. Result: We found 1433 pregnancy cases with 51 (3,6 %) patients were having cardiac disease and included in this research. The most common maternal complication was pulmonary hypertension 16 cases. A dead case was found 1 case (1,9 %) with eissenmenger syndrome. We found the perinatal outcome of 30 babies (58.8%) born with a weight of 2500 gram and under. There are 7 patients with cardiac disease that have been corrected (13,7%). Among those 7 patients, 6 had a perinatal outcome with a birth weight of more than 2500 gram. Conclusion : Most pregnant patients with cardiac disease in dr. Soetomo Surabaya hospital 2018 are already having some complications with perinatal outcomes of low birth weight. Therefore, management of cardiac disease in pregnancy to prevent complications by means of preconception counseling, good antenatal care, and appropriate referrels are still needed to improve the quality of maternal and neonatal outcomes.

The Effects of Turmeric Infusion and Turmeric Juice (Curcuma Domestica) on The Staphylococcus Aureus Growth in Vitro

Background: Turmeric is a plant that grows in tropical areas and functions as medicine. The chemical compounds contained in turmeric have a role as antioxidants, antimicrobials, anti-cancer, indigestion, smallpox, insect bites. The curcumin content in turmeric has antibacterial activity against various types of Gram negative, Gram positive, antiviral and anti-tumor bacteria. Essential oils can be used as antibacterial because they contain hydroxyl and carbonyl functional groups which are phenol derivatives. Flavonoids can interfere with cell wall formation with peptidoglycan transpeptidase activity which will break down cell walls and damage cell membranes so that important components such as proteins, nucleic acids, nucleotides will be lysis. Staphylococcus bacteria are normal flora on the skin, respiratory tract, and digestive tract of food in humans. These bacteria can cause disease when they reach 1,000,000 or 106 per gram, an amount sufficient to produce the toxin. S. aureus bacteria can cause various types of infections ranging from minor skin infections, food poisoning to systemic infections. The aim of our study was to analyze the effects of infusion and turmeric juice (Curcuma domestica val) on the growth of bacteria Staphylococcus aureus through invitro. Method: This study is a laboratory experimental study with the aim of analyzing turmeric infusion (Curcuma domestica val) and turmeric juice effect on the growth of staphylococcus aureus by invitro. This research was conducted in an integrated laboratory, FK UNUSA. The samples in this study were 4 replications per treatment. The independent variables in this study were turmeric infusion and turmeric juice (with a concentration of 10%, 30%, 50% while the dependent variable in this study was the growth of Staphylococcus aureus bacteria. Data analysis used was the one way ANOVA test and Pearson correlation to determine the effect of giving turmeric infusion and turmeric juice on the growth of bacteria staphylococcus aureus through invitro. Result: The average growth of bacteria in the turmeric infusion in group I (control), 10%, 30% and 50% of turmeric infusion was 4.89 ± 0.4425 log CFU / ml, 3.07 ± 0.61330 log CFU / ml, 2.99 ± 0.63986 log CFU. / ml and 3.02 ± 0.22650 log CFU / ml. The average growth of this bacteria in giving turmeric juice in group I (control), giving 10%, 30% and 50% turmeric infusion was 4.89 ± 0.04425 log CFU / ml, 4.40 ± 0.18355log CFU / ml, 3.10 ± 0.58926 log CFU / ml and 3.02 ± 0.38206 log CFU / ml. Conclusion: In this study, found that there was an effect of giving turmeric infusion and turmeric juice (Curcuma domestica val) on Staphylococcus aureus growth and there was an effect of giving multilevel doses of turmeric infusion and turmeric juice (Curcuma domestica val) on Staphylococcus aureus growth through invitro.

Clinical Characteristic of Congenital Fetal Anomaly In Tertiary Referral Hospital in East Java, Indonesia

Background: Congenital fetal anomalies were defined as any structural defect present at birth. Congenital fetal anomalies are an important causes of neonatal morbidity and mortality in developed and developing countries that affect health care system. Reliable data on these congenital anomalies are still lacking, especially in Indonesia. Objective: This study aims to determine the characteristic profile of congenital fetal anomaly in single tertiary hospital in East Java, Indonesia. Methods: Retrospective cross-sectional by using medical record data of dr. Soetomo General Hospital on January – December 2017. Results: There were 58 cases (4,3%) with fetal congenital anomaly from 1360 deliveries in 2017. The majority of cases were referral cases (51 cases; 88%) and only seven cases were booked cases in obstetric outpatient dr. Soetomo General Hospital. Most of these congenital fetal anomaly cases ( 25 cases / 43,1%) were born from mother with ages 20 – 30 years old. Most cases (34 cases; 58,64%) were diagnosed first at third trimester (gestational age > 28 weeks). There were 36 cases (62%) had active termination of pregnancy. Thirty eight percent (22 cases) were born at 37-42 weeks and majority were born section caesaria. The three highest proportion of organ systems involved in fetal congenital anomalies were those of abdomen (22 cases; 37,9%); head (20 cases; 34,5%); thorax and muskuloskeletal (each 12 cases; 20,7%). Conclusion: The incidence of congenital fetal anomaly in dr. Soetomo Hospital at 2017 was 4,3%. Omphalocele and CTEV were two most common types of congenital fetal anomaly found. Most cases of congenital fetal anomalies have a poor prognosis, 67% cases born died. Further research about risk factors and comprehensive database are needed on cases of congenital anomaly to establish appropriate prevention and management.

Exploring Past, Present and Future of Orthotics and Prosthetics in Pakistan

This is a qualitative study to explore the perception of Orthotists and Prosthetists regarding past, present and future of their profession. The Qualitative research approach using individual interviews. Data was collected from professionals of some private and some government sector in Rawalpindi, Peshawar and Lahore during April 2019 to July 2019. The sample size was 12. A demographic questionnaire and standarized instrument from Nvivo was filled satisfying the inclusion criteria. A comprehensive audio-videography have been developed, recorded, transcripted and documented. Data was transcribed and thematic analysis along with characteristics was drawn manually. Data verification was done with the help of coders. After the extraction of data followings results are emerged. General category themes are trainings and seminars, opportunities, government setup, lack of coherence among professionals, uniform curriculum, and establishment of council, effects of earthquake, German contribution and techniques/technology. Barriers are identified at the level are lack of awareness/ acknowledgement, low job opportunities, no proper workshops, poor referral system, limited resources and old technologies. It is concluded that the field of orthotics and prosthetics in Pakistan need attention in the following categories i.e. trainings and seminars, job opportunities, uniform curriculum, unity among professionals, establishment of council, acknowledgment at government level and awareness among other health professionals.

Host Immune Response to Malaria

Malaria is still a health threat, especially for children and pregnant women in endemic areas. The World Health Organization (WHO) reports 228 million cases of malaria occur worldwide and an estimated 405,000 deaths from malaria globally in 2018. A series of malaria control efforts according to WHO recommendations have been carried out widely. However, these programs face obstacles. Therefore, the existence of an effective malaria vaccine is absolutely necessary in a series of malaria control strategies. Development of a malaria vaccine requires a basic concept regarding the host's immune response to malaria. Unfortunately, only a few in Indonesia have reviewed how the immune response is. This article will present an understanding of how the human immune system responds to Plasmodium falciparum.

Characteristics of PPROM in General Hospital Dr. Soetomo Surabaya Period September 2017 to September 2019

Background: Preterm Prelabour Rupture of Membranes (PPROM) is one of the causes of perinatal morbidity and mortality. Objective: To find out the characteristic of PPROM in Dr. Soetomo Hospital in September 2018 to September 2019. Method: A Retrospective Descriptive Study. The data came from the medical records of patients with PPROM who were included in the inclusion criteria. The exclusion criteria is all PPROM cases at Gestational age > 34 weeks. Result: The incidence of PPROM during September 2017 to September 2019 was 6.8% (175 patients), of which 152 patients included NBC cases and 23 patients with BC cases. Primipara 76 patients and Multipara 99 patients. For gestational age <26 weeks it was 17.1%, 26-30 weeks 29.7% and 31-34 weeks 53.1%. In this study, PPROM was amused 23.6%, underweight 3.1%, HBsAg 7.5%, HIV 7%, anemia 10.3%, Obesity 5.2%, Pragestational Diabetes 7.4%, Gestational Diabetes. 2,6%, preeclampsia 7,9% and severe preeclampsia 2,2%. The distribution of PPROM patients who received lung maturation was 72%, while the remaining 28% did not get lung maturation. Type of delivery for PPROM cases was vaginal delivery as much as 60% while 40% for cesarean section. Indications for vaginal delivery include fetal distress 25%, abnormal NST 18%, gemeli 17%, BSC 12%, febris 10%, pulmonary edema 5% and breech presentation 5%. The outcome distribution of PPROM infants born with asphyxia at birth was 87%. Weight of babies born with PPROM> 2500 g 4%, 1000-2500 g 73% and <1000 g 23%. The condition of the babies at birth with spontaneous breathing was 36 babies, nasal O2 was 13 babies and CPAP was 70 babies. The causes of death for preterm KPP babies included RDS 9 babies, Sepsis 4 babies and severe asphyxia 19 babies. The length of NICU care for infants who died with KPP Preterm mothers was <24 hours for 15 babies, 1-3 days 13 babies, 4-7 days 3 babies,> 7 days 3 babies and 5 fetuses were IUFD. 12 patients with PPROM received amnioinfusion while 5 patients with amniopatch, Outcome of infants from conservative PPROM who were treated with amniopatch or amnioinfusion obtained 6 babies died at birth, 8 babies with CPAP breath support, 1 baby with PCV breath support, 1 baby with ventilator and 1 infant spontaneously breathed. A total of 3 babies were outpatient after treatment for a maximum of ± 25 days. Conclusion: Perinatal care is currently experiencing some rapid progress, but the case of PPROM is still one of the biggest contributors to perinatal morbidity and mortality.

The Effect of Mercury Exposure to Escherichia Coli Bacteria Resistant to Mercury and Escerichia Coli Esbl in Vitro

Background: The level of pollution in Indonesia is still very high, consist of water pollution, air pollution and soil pollution. Mercury is one of the heavy metals that pollutes the waters of the sea, while Escherichia coli is exposed to mercury will try to defend itself by doing mercury detoxification so that it can live in an environment that contains mercury. Escherichia coli that tries to defend itself from mercury exposure in the environment will experience a change in its genes into mercury resistant Escherichia coli. In plasmids or transposons, it might also stimulate the formation of resistance genes for some antibiotics, include producing the ESBL enzyme, so that it can convert non ESBL Escherichia coli into ESBL Escherichia coli. Objective: This study aims to prove that the repeated exposure of mercury will change non ESBL-mercury sensitive Escherichia coli into ESBL- mercury resistant Escherichia coli. Method: This was an experimental study with 27 non-ESBL Escherichia coli isolates as identified from Phoenix. Non-ESBL Escherichia coli clinical isolates were tested by giving exposure to HgCl2 with concentrations of 0.02 ppm, 0.10 ppm, 0.20 ppm for 1-14 days until mercury resistant Escherichia coli was formed, and then ESBL screening was tested by giving Cefotaxime exposure to them. Results: On the first day of mercury exposure, there were 9 isolates of 0.02 ppm HgCl2 resistant Escherichia coli, 9 isolates of 0.10 ppm HgCl2 resistant Escherichia coli, 9 isolates of 0.20 ppm HgCl2 resistant Escherichia coli. Furthermore, this Escherichia coli isolate was exposed to Cefotaxim as ESBL screening. The final results of post-exposure HgCl2 0.02 ppm was obtained 3 (33.3%) isolates were still sensitive to Cefotaxime and 6 (66.7%) isolates that were resistant to Cefotaxime. The final results of post-exposure HgCl2 0.10 ppm was obtained all 9 (100%) isolates that were resistant to Cefotaxime. The final results of post-exposure HgCl2 0.20 ppm obtained 2 (22.2%) isolates were still sensitive to Cefotaxime and 7 (77.8%) isolate were resistant to Cefotaxime. Conclusion: Escherichia coli in urine had the phenotive change into mercury resistant Escherichia coli. Mercury exposure of 0.02 ppm, 0.10 ppm, 0.20 ppm for 1 day in vitro on isolates of non ESBL-mercury resistant Escherichia coli caused changes in 22 isolates of Escherichia coli in urine

The Use of Prophylactic Antibiotics on Orthopaedic Procedures in an Academic Hospital in Indonesia

Background: Surgical site infections (SSIs) are common surgical complications that will increase cost of treatment. The incidence of SSI can be prevented with antibiotic prophylactic. Uncompliance using of prophylactic antibiotics is one of the factors leading to the occurrence a microbes resistance. The data on the using of prophylactic antibiotics in Indonesia is still limited. Objective: This study aims to analyze the using of prophylactic antibiotic guideline on orthopaedic surgery. Methods: The study was conducted retrospectively using data from medical records on patients who had clean and clean-contaminated orthopedic procedures from 2013 to 2016 in the standard operating room of Dr. Soetomo hospital Surabaya. We analyzed the use of prophylactic antibiotics in terms of antibiotic selection, timing of administration, and the compliance to the prophylactic antibiotic local guidelines on orthopaedic surgery. Results: Overall, patient data from 2013 to 2016 was 5246 patients. The compliance rate of prophylactic antibiotics from 2013 to 2016 was 48.3%. This level of compliance uses a selection of antibiotics, dose of administration, delivery mode, delivery time, and route of administration. Conclusion: The results of this study have shown that the prophylactic antibiotic compliance rate on orthophaedic procedures in Soetomo Hospital from 2013 to 2016 was 48,3%. Antibiotic resistance control program quite effective at increasing compliance with the use of the prophylaxis antibiotics.

Characteristic of Pregnancy in Woman with Rheumatic Mitral Stenosis in Dr. Soetomo Hospital Surabaya from 2015 – 2017

Background: Cardiac disease is 1 of the major causes of maternal mortality. Mitral Stenosis (MS) is a particularly high-risk condition for a pregnant woman in emerging countries, the main cause of MS is a complication from rheumatic heart disease. Objective: To study the maternal and perinatal outcome of pregnancies complicated by mitral stenosis from rheumatic heart disease. Methods: We conduct a cross-sectional retrospective study using electronic medical data records in dr. Soetomo General Hospital over the period of 3 years from 2015 – 2017 involving 36 cases of pregnant women complicated by rheumatic mitral stenosis. The maternal and perinatal outcome was reviewed. Result: Most of the pregnant women with rheumatic mitral stenosis were at 29 - 34 weeks of gestational age. Majority of the patient (61,1 %) was in NYHA II classification for heart failure degree. The Degree of MS was moderate (75 %) and severe (25 %), with a maternal mortality rate was 4/36 patients (11,1 %), and all of the patients were with severe MS had class III/IV heart failure. The main reason for hospital admission was heart failure (50 %). 38 % of women with NYHA Class III/IV had severe MS. Most accompanying valve diseases occur at the patient with severe MS, with Tricuspid Regurgitation as the most accompanying valve disease (66,67 %) followed by Mitral Regurgitation (36,11 %) and Aortic Regurgitation (25 %). Percutaneous Transmitral Valve Commissurotomy (PTMC) was the chosen surgical intervention for valve correction. For a patient with Moderate MS, 6/8 (75 %) of the pregnancy terminated at ³ 34 weeks of gestational age, compared with 18/28 (64,28 %) patient with Severe MS the pregnancy terminated at < 34 weeks of gestational age. Cesarean section was the most chosen method of delivery for most of the cases. Fetal weight (4/7 cases) at delivery for Moderate MS was > 2500 g, compared with (7/18 cases) was < 2000 g for Severe MS. APGAR Score for Moderate MS cases was 8-10 for 5/7 cases, compared with Severe MS, 16/24 cases were < 8. Conclusions: Cardiac and obstetric complications from rheumatic mitral disease remain a major challenge in this disease. Early diagnosis and management with good adherent to pre-conceptional and prenatal care remain a key factor for preventing maternal and fetal morbidity and mortality.

Effects of Breathing Exercises on Lung Volumes and Capacities Among Smokers

Objective: To determine the effect of deep breathing exercises on lung volumes and capacities among smokers. Methodology: The participants were divided into a control group and an experimental group. The control group was not given any treatment, while the experimental group performed deep breathing exercise techniques. The experimental group performed exercises for six weeks. After six weeks lung function tests were performed to evaluate the effects. Data were compared at baseline and after the intervention. To check within the group's changes paired sample t-test was used. To check between groups changes independent sample t-test was used for normally distributed data. Results: In the experimental group, significant changes (p ≤ 0.05) were observed after the intervention. While comparing groups, significant differences (p ≤ 0.05) were observed in some variables between experimental and control groups.Conclusion: It was concluded that deep breathing exercises are useful among smokers. As deep breathing helps in improving lung volumes and capacities.