WIDOWER’S AGE AND NUMBER OF CHILDREN AFFECT PARENTING STYLE AND REMARRIAGE DECISION

Highlight:1. The widow will outsource childcare to other people, such as the widow's mother, stepmother, aunt, or other relatives who believe they know more about childcare after the wife's death.3. There was a significant relationship between widower’s age and the number of children affecting parenting style and remarriage decision.Abstract:Background: The high maternal mortality ratio automatically represents the highest number of widowers in Indonesia. The change of status from a husband to a widower does not rule out the possibility of being able to change his role and function in the family. Objective: To describe that the widower’s age and the number of children have an impact on the parenting style and the desire to remarry. Materials and Methods: This study was an observational study with a cross-sectional design. Husbands who had been left by their wives for two years or more owing to maternal death and had one or more children before the wife's maternal death were the subjects of this study. Widower’s age, as well as kid’s parenting patterns before the death of the mother were recorded. This study was likewise subjected to an ethics review and relied on informed consent. Results: Widowers who had one child before their wife's death and decided to remarry accounted for 7 subjects (87.5%), while those who did not remarry accounted for 5 (31.3%). On the association between a widower’s age and child-rearing practices, there were two respondents (40%) who chose to entrust their children’s care to someone else or not to be cared by themselves. Conclusion: There was a significant relationship between widower’s age and the number of children and the parenting style and remarriage decision. Single parents who decided to remarry were single parents at a relatively younger age.

BACTERIAL AND SENSITIVITY PATTERN OF PATHOGENS CAUSING VENTILATOR-ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT

Highlight:1. Antimicrobial resistance bacteria isolated from VAP patients are often associated with high mortality and length of hospital stay. 2. Mortality in VAP patients was 33.3% and the VAP group had a longer hospital stay compared to the non-VAP group. 3. The three most predominant bacteria that were found were A. baumannii, P. aeruginosa, K. pneumoniae. Cefoperazone-sulbactam, meropenem and amikacin were more than 70% sensitive against these bacteria.Abstract:Background: Ventilator-Associated Pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit (ICU). Antimicrobial resistant bacteria isolated from VAP patients are often associated with high mortality and length of hospital stay. Objective: This study aimed to analyze the pattern and sensitivity among pathogens that caused VAP in ICU. Materials and Methods: The study was conducted retrospectively by extracting the data of bacterial isolates from sputum specimens in the Laboratory of Clinical Microbiology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia and confirming the clinical data on patients suffering from VAP in ICU ward. The study started from January until December 2017. Results: The total 148 pathogens were isolated, 18 of them were diagnosed as VAP, and 130 were not VAP. The most predominant isolates in the VAP group were Acinetobacter baumannii as many as 38 (9%) followed by Pseudomonas aeruginosa 22 (2%), E. coli 16 (7%), and Klebsiella pneumoniae 11 (1%). The pathogens showed a sensitivity rate above 70% to cefoperazone-sulbactam (SCF), meropenem (MEM) and amikacin (AK). Mortality in VAP patients was 33.3% and the VAP group had a longer hospital stay compared to non-VAP group. Conclusion: The three most predominant bacteria that were found were A. baumannii, P. aeruginosa, K. pneumoniae. The pathogens had sensitivity rate above 70% to cefoperazone-sulbactam, meropenem, and amikacin.

PREVALENCE OF DIABETES MELLITUS WITH PULMONARY TUBERCULOSIS IN DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA 2016

Highlight:1. The signs and symptoms of patients with pulmonary tuberculosis and those of diabetes mellitus were similar.2. Male, aged 51-75 years old, and working in private sector are characteristics of most of the diabetic patients with pulmonary tuberculosis.Abstract:Background: Diabetes Mellitus is a type of disorder where the patients’ blood sugar is above average. Diabetes Mellitus can cause an abundance of comorbidities, from viral infection until metabolic abnormalities. The increased risk of infections is mostly because diabetes mellitus changes how the body works. The changes range from changes in mechanical barriers (humoral immunity) and cellular changes (cellular immunity), the changes of the humoral immunity that can increase the chance of protracting pulmonary tuberculosis. Objective: The purpose of this study was to describe the characteristics of diabetes mellitus in pulmonary tuberculosis in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia from January to December 2016. Materials and Methods: The research method used was an observational study using a cross-sectional design conducted in Central Medical Record for hospitalized patients, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. The diabetes mellitus patients’ data collected from the medical records of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia in 2016 were 1,410 and 11 of them were also diagnosed with pulmonary tuberculosis. The final data taken were from 67 out of 115 patients due to the incomplete medical record. Results: According to the data, the most of the diabetic patients with pulmonary tuberculosis were male, age of 51-75 years old, and worked in private sector. Conclusion: There was a significantly higher number of diabetes mellitus with pulmonary tuberculosis patients in older age, males, and private-sector workers. Diabetic patients with pulmonary t

RISK FACTORS OF CORONARY HEART DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Highlight:1. One of the major causes of morbidity and mortality in diabetes mellitus patients is coronary heart disease (CHD).2. The risk factors for coronary heart disease in type 2 diabetes mellitus patients were observed.3. The risk factors of CHD more commonly found in T2DM patients were high-risk age, male sex, hypertension and dyslipidemia.Abstract:Background: Diabetes mellitus is a metabolic syndrome that becomes a concern in almost all countries in the world, particularly developing countries. Changes in lifestyle and genetic factors are causing the incidence of this disease to continue to increase every year. Nowadays, type 2 diabetes mellitus (T2DM) caused by insulin resistance is the most common kind. One of its complications known as a major cause of morbidity and mortality in patients with diabetes is coronary heart disease (CHD). Insulin resistance can lead to the atherosclerosis process that is the basis of coronary heart disease. It is said that conditions of hyperglycemia, hypercoagulable state, and high cholesterol can induce the process of atherosclerosis. Besides diabetes mellitus, the other risk factors that increase the incidence of CHD are sex, age, family history, dyslipidemia, smoking, hypertension, and obesity. Objective: The purpose of this study was to describe the risk factors for coronary heart disease in patients with type 2 diabetes mellitus in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Materials and Methods: A cross-sectional study of diabetes mellitus patients with coronary heart disease was conducted in Dr. Soetomo General Academic Hospital from 1 January 2014 to 31 December 2014. Data were taken from medical records at the Department of Internal Medicine. Incomplete medical records were not included in this study. Risk factors analyzed were age, sex, history of hypertension and dyslipidemia. Results of this study were presented in a frequency distribution table. Results: Based on the data of 70 samples, risk factors of CHD in T2DM patients are found as follows: 44 (62.9%) samples were male, 56 (80%) high-risk aged group, 48 (68.6%) with dyslipidemia, and 50 (71.4%) with hypertension, while 24 (34.3%) samples had three risk factors at once. Conclusion: High-risk aged, male sex, hypertension, and dyslipidemia are more commonly found in T2DM patients with CHD. The more risk factors that one may have will increase the occurrence of cardiovascular disease within 10 years forward.

COMORBIDITIES OF MYASTHENIC CRISIS PATIENTS ACCORDING TO AGE AND GENDER IN DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA IN 2017-2019

Highlight:1. Patients with myasthenia gravis (MG) can have both autoimmune and non-autoimmune comorbidities.2. MG patients were predominantly aged >50 years, females and the commonest comorbidity are hypertension and diabetes mellitus.3. Age and comorbidities were found to have significant correlation among these patients, but not between gender and comorbidities.Abstract:Background: There are limited studies on the comorbidities of myasthenic crisis (MC) associated with age and gender, specifically from Indonesia. These data might be valuable for treatment to improve the outcome of these patients. Objective: To analyze the correlation between age and gender with the comorbidities amongst the MC patients admitted in the ICU of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia in 2017-2019. Materials and methods: A retrospective cross-sectional analytic study was conducted on 25 medical records of MC patients who fulfilled the inclusion and exclusion study criteria. Descriptive statistics and Chi-square tests were done to determine the potential correlation between variables (significant level of p<0.05). Results: The age of MC patients was £50 years (80%) and >50 years (20%) while the gender predominantly found were females (68%) with 32% males. A significant correlation was found between age and comorbidities (p=0.002) whilst not between gender and comorbidities (p=0.115). The most common comorbidities observed were hypertension (30%) and diabetes mellitus (20%). Conclusion: There were 40% of patients found with comorbidities. There was a significant association between age and comorbidities found amongst myasthenic crisis patients, whilst no significant association was found between gender and comorbidities.

SERUM AFP (ALPHA FETO PROTEIN) LEVELS PROFILE OF HEPATOCELLULAR CARCINOMA PATIENTS IN DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA

Higlight:1. The USG results of AFP level can be used for early detection and therapy of hepatocellular carcinoma that can prevent metastasis, progressivity, and recurrence. 2. The most common patients with high AFP levels are those with hepatitis B depending on etiology, younger age, male, gender, high SGOT level and BCLC B patients.Abstract:Background: Hepatocellular carcinoma (HCC) accounts for more than 90% of liver cancer which is the second most common cause of cancer-related death worldwide. The incidence of HCC was 626.000 cases every year worldwide. Early detection and therapy can prevent metastasis, progressivity, and recurrence. AFP level ≥ 400 ng/ml and USG results can be used as a diagnosis parameter of hepatocellular carcinoma. Objective: To analyze the AFP level’s profile in hepatocellular carcinoma. Materials and Methods: Descriptive methods used in this study with data collected from medical records on patients that fulfilled the inclusion criteria in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia during the periods of 1st January 2013- December 31st 2015. This study used various variables such as age, gender, etiology and size of the tumor, number of a nodule, hepatic function with child classification, staging BCLC, and AFP level. Results: This study found that the 98 patients with hepatocellular carcinoma with high AFP level or >400 ng/ml were dominated by younger patients with average age of 49.91 years, the most common etiology was hepatitis B (56.8%), poor results of laboratory tests (SGOT, SGPT), patients with all level of hepatic function based on Child-Pugh classification and staging B of the tumor (70.5%). Patients with normal AFP ≤20 ng/ml were dominated by female patients, with the most common etiology of fatty liver and others, and with BCLC A and C staging. Descriptively, there was no difference in AFP level based on the number of nodules and size of tumor. Conclusion: The most common patients with high AFP level are those who have hepatitis B as etiology, younger age, male gender, high SGOT level and BCLC B staging. Meanwhile, patients with normal AFP level dominated with female and non-hepatitis patients. In this research, we found no differences of AFP level based on number and size of tumor descriptively.

THE DIAGNOSIS AND ASSESSMENT OF THE QUALITY OF LIFE IN TINNITUS PATIENTS. A LITERATURE REVIEW

Highlight:1. Assessment of the patient’s quality of life is used to establish the diagnosis of tinnitus.2. The assessment is performed using several types of questionnaires: Tinnitus Handicap Inventory (THI), Tinnitus and Hearing Survey (THS), Tinnitus Functional Index (TFI) and Tinnitus Primary Function Questionnaire (TPFQ). 3. THI is the questionnaire that has been translated into Indonesian so that it is easier to use in Indonesia.Background: Tinnitus is a symptom with many different causes that can interfere with daily life. The diagnosis of tinnitus can be carried out, starting by examining the history, physical examination, and audiology, and assessing the quality of life of the patient. Assessment of the patient’s quality of life and the severity of tinnitus was carried out using a questionnaire. Objective: This study aimed to explain the frequency of use of several questionnaires to assess the quality of life of patients with tinnitus, including Tinnitus Handicap Inventory (THI), Tinnitus and Hearing Survey (THS), Tinnitus Functional Index (TFI) and Tinnitus Primary Function Questionnaire (TPFQ). Discussion: The use of THI as a research tool has been recommended for assessing the severity of tinnitus functional, emotional, and catastrophic responses. THS is used as a screening instrument to evaluate tinnitus complaints because of a hearing problem and how frequently it happens. TFI was used for identifying the functional impact on tinnitus patients, to evaluate how tinnitus affects a person’s life, while TPFQ was applied as it is a new questionnaire designed specifically for this objective. Conclusion: Many questionnaires can be used as an assessment of the quality of life of patients with tinnitus. Each questionnaire can be used and has its advantages. THI is a questionnaire that has been translated into Indonesian so that it is easier to assess.

CORRELATION BETWEEN THE INITIAL-SURGERY AGE WITH THE HIRSCHSPRUNG’S DISEASE PATIENT STOOLING PATTERNS IN ULIN HOSPITAL BANJARMASIN, SOUTH KALIMANTAN, INDONESIA IN 2012-2015

Background: Hirschsprung's disease may lead to gastrointestinal obstruction if not appropriately treated. The initial-surgery or colostomy is intended to decompress the large bowel, prevent enterocolitis, and the stooling-patterns can be measured after definitive surgery. Objective: To determine the correlation between initial-surgery age with stooling-patterns. Materials and Methods: We performed an analytic observational study in Ulin Hospital in Banjarmasin, South Kalimantan, Indonesia, from November to December 2015 with a total sample of 31 patients. The initial-surgery age was divided into before and after 30 days, while the stooling-patterns were divided into satisfied and not satisfied. Results: There was no significant correlation between initial-surgery age with stooling patterns. Most of the patients, 18/31 (58.1%), underwent initial-surgery after 30 days, and 23/31 (74.2%) had satisfied stooling patterns after surgery. Conclusion: No significant correlation between initial-surgery age and stooling patterns among Hirschsprung's disease patients.

EFFECT OF EMPLOYEE LABOR EXPENSES ON THE RESPONSE TIME IN EMERGENCY DEPARTMENT OF SAMPANG HOSPITAL, INDONESIA

Background: The Emergency Department (ED) has the main purpose of receiving, triageing, stabilizing, and providing acute health services to patients, including those who require resuscitation and emergency patients to some degree. An indicator of the success of medical treatment of emergency patients is the speed of providing adequate assistance both in daily routine situations or during disasters. Factors that influence nurses’ motivation to work, especially implementing triage at the Emergency Department include the characteristics of nurses such as age, sex, education, length of work and training. Objective: To analyze the effect of workload of the medical staff of the Emergency Department on the response time in the Emergency Department of Sampang Hospital, Indonesia. Materials and Methods: Observational analytic research with cross-sectional design. Sampling was performed with total sampling method to 24 people who met the criteria. Data collection was done by questionnaire and observation. Data were analyzed using the Chi-square correlation test and Fisher’s exact test. Results: There was a significant influence between workload and response time of triage P1 of Emergency Department staff at Sampang Hospital, Indonesia (p=0.015), whereas in triage P2 and P3 there was no effect of workload of staff on response time (p>0.05). Conclusion: In Emergency Department of Sampang Hospital, Indonesia, the response time in all categories of emergency (P1/red, P2/yellow, and P3/green) is fast. Workload correlates significantly with response time in P1/red category, while in P2/yellow and P3/green categories the workload has no effect on the response time.

PREVALENCE OF DEPRESSION IN FIRST-YEAR MEDICAL STUDENTS AT UNIVERSITAS AIRLANGGA, SURABAYA, INDONESIA

Background: Depression is a mental disorder with a relatively high prevalence rate in medical students around the world. Medical students are often faced with a variety of pressures ranging from academic to social stress so that the prevalence of depression in medical students tends to be higher than general population. Objective: to find the prevalence of depression in medical students at Universitas Airlangga, Surabaya, Indonesia. Materials and Methods: This research was a descriptive cross-sectional study of first-year medical students at Universitas Airlangga, Surabaya, Indonesia in the academic year of 2017/2018. The data collection was carried out using Beck Depression Inventory II questionnaires as a measurement instrument and was analyzed by SPSS 16.0. Results: From 86 samples obtained from first-year students, 37.20% of them experienced mental conditions that were considered abnormal (mean score of 10.14 ± 7.093), starting from mild mood disturbance (23.26%) to the most severe category, severe depression (1.16%). There was no extreme depression category in this study. Furthermore, mean score of male subjects is 8.57 ± 6.120 while mean score of female subjects is 10.64 ± 7.351. Conclusion: This study revealed that the prevalence of depression in first-year medical students at Universitas Airlangga, Surabaya, Indonesia in the second semester of academic year 2017/2018 was quite high, which was more than one third of the total respondents, while the prevalence in female subjects was higher than in male subjects.