Pattern of Indirect Immunofluorescence Assay Antinuclear Antibody in Pediatric Lupus Nephritis

Objective: To determine the association between Anti-Nuclear Antibody (ANA) pattern in pediatric Systemic Lupus Erythematosus (SLE) patients and proteinuria as a sign of renal involvement in SLE. Methods: This was a cross-sectional study, using data from medical records involving 89 newly diagnosed with SLE (aged ≤ 18 years) in Department of Child Health Dr. Hasan Sadikin General Hospital, Bandung, from January 1st 2018 to June 30th 2019. Data of ANA pattern and proteinuria were collected from medical record. ANA pattern was examined by Immunofluorescence Assay (IFA) method. Chi-square was used to analyze the association between ANA pattern and proteinuria as a sign of renal involvement in pediatric SLE patients. Results: There were 89 patients, consisting of 7 male (7.9%) and 82 female (92.%) with median age of 14 (IQR=12-16). There were only 44 pattern of ANA as follow: homogenous 56.8%, speckled 36.4%, and nucleolar 6.8%. However, there is no significant association between homogenous pattern with proteinuria events (p=0.831). Conclusions: Homogenous pattern was the most frequent ANA pattern in children with SLE, and the pattern has no association with proteinuria events.

Elderly Satisfaction on Chronic Disease Management Program at Public Health Center, Bandung City, West Java, Indonesia

Objective: To identify the satisfaction level of the elderly on the health services provided by The Chronic Disease Management Program (prolanis) at the Public Health Center (puskesmas). Methods: A descriptive quantitative study with a cross-sectional approach had been carried out to 112 elderly from 8 puskesmas in Bandung City, West Java, Indonesia. This study was conducted from August until November 2019. The variables in this study were 5 dimensions of the SERVQUAL. The collected data were analyzed using percentages and the Importance-Performance matrix. Results: The satisfaction level of the elderly on the health services provided by the prolanis was 92%. The dimension that has the highest satisfaction level was the assurance dimension (94,6%) and the lowest one was the tangibles dimension (84,8%). The result of the importance-performance matrix showed that assurance, responsiveness, and empathy dimensions needed to be maintained to reach the patient’s satisfaction. Conclusions: The elderly satisfaction on the health services provided by the prolanis is high in every dimension of the SERVQUAL.

Relationship between the Quality of Informed Consent at Surgical Procedure in Terms of Ethics and Medicolegal with Satisfaction of Patient Health Service in dr. Zainoel Abidin Hospital

Objective: To determine the relationship between the quality of informed consent in terms of ethics and medicolegal with patient health service satisfaction at the dr. Zainoel Abidin Hospital (ZAH) Banda Aceh. Method: This study is an observational analytic with a cross-sectional method. Subject selection through a total sampling method. This study involved patients who were treated at dr. Zainoel Abidin Hospital (ZAH) Banda Aceh and a total of patients were 100 (52 men and 48 women) who met the inclusion criteria carried out on 16 December 2019 to 31 December 2019. Results: As many as 90% of respondents rated informed consent made at ZAH as good quality and 85% expressed the satisfaction with health services at ZAH. An ethical and medicolegal review of informed consent emphasizes the basic principles of bioethics. As many as 84% of respondents stated that their autonomy rights had been fulfilled, 92.50% thought that the doctor had done beneficence, nonmaleficence, and justice well in the process of informed consent and 92.33% of respondents rated the three elements of informed consent as being well implemented. Based on the results of the chi-square statistical test showed a significant relationship between the quality of informed consent in terms of ethics and medicolegal with patient health service satisfaction under the value of p = 0.001 (p≤0.05). Conclusion: Good quality of informed consent in terms of ethics and medicolegal has an important role in increasing patient satisfaction with health services at the dr. Zainoel Abidin Hospital of Banda Aceh.

Comparison of Cognitive Functions between Paroxysmal and Persistent Atrial Fibrillation Patients without Clinical Stroke

Objective: To compare cognitive functions between paroxysmal and persistent atrial fibrillation patients without clinical stroke, in terms of MoCA-Ina total score and MoCA-Ina cognitive subdomains scores. Methods: A comparative study that compared MoCA-Ina scores between paroxysmal and persistent AF patients without clinical stroke, who came for treatment at the Cardiology Clinic Dr. Hasan Sadikin General Hospital, Bandung and Dustira Hospital, Cimahi from September 2018–January 2019. Results: Sixty four subjects were recruited, consisted of 24 paroxysmal and 40 persistent AF patients. There were no difference in clinical characteristics between two groups, except that there were more subjects in the persistent AF group using anticoagulants therapy: 97.5% vs 62.5% (p=0.005) and more prevalence of type 2 Diabetes Mellitus in the paroxysmal AF group: 25% vs 2.5% (p=0.009). Cognitive impairment (MoCA-Ina score <25) were seen in 70.8% of paroxysmal AF group and 82.5% of persistent AF group (p=0.274). The mean MoCA-Ina total score in the paroxysmal and persistent AF groups were 21.04±4.75 vs 20.70±4.21 (p=0.989), respectively. The median MoCA-Ina cognitive subdomains scores were similar for the two groups (p>0.05). Conclusion: There were no differences in cognitive functions between paroxysmal and persistent AF patients, both in terms of MoCA-Ina total score and MoCA-Ina cognitive subdomains scores, although in both groups had cognitive decline.

Serum Albumin Levels of Oral Candidiasis Immunosuppressed Rats Treated With Hyperbaric Oxygen

Objective: To investigate serum albumin levels in oral candidiasis immunosuppressed rats treated with hyperbaric oxygen. One of the predisposing factors for oral candidiasis was the use of immunosuppressive drugs continuously. It can also affect the work of the liver because it’s one of the organs responsible for drug metabolism. Hyperbaric oxygen therapy was used not only to suppressing fungal infections, but also to improve liver function by evaluating the serum albumin levels. Methods: This study used a post-test only control group design. Fifteen Wistar rats were divided into 3 groups(n=5/3): G1 (healthy group), G2 (oral candidiasis immunosuppressed rats group without hyperbaric oxygen therapy), and G3 (oral candidiasis immunosuppressed rats group with hyperbaric oxygen therapy). G2 and G3 groups were immunosuppressed by giving dexamethasone 0,5mg/day/rat orally for 14 days, added with tetracycline 1 mg/day/rat. Hyperbaric oxygen therapy was given to the G3 group in 5 days. Blood serum of rats in all groups was taken to calculate albumin levels. Results: The average value of albumin levels in G2 group showed a decrease compared to the G1 group, while G3 showed the highest level. One way Anova test showed a significant difference among groups (p<0,05). To compare the difference between each group we used LSD test and showed a significant difference (p<0,05) between G1 compared to G2, G1 compared to G3, and G2 compared to G3. Conclusion: Liver albumin levels of oral candidiasis immunosuppressed rats treated with hyperbaric oxygen therapy showed higher levels than those without therapy.

Venous Thromboembolism Prophylaxis and The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) Score in Medical Illness Patients

Objective: To describe applicability of The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score to implement venous thromboembolism prophylaxis in patients with medical illness in Hasan Sadikin General Hospital Bandung. Methods: This study was descriptive, cross-sectional research from database was performed on December 2018. Inclusion criteria in this study were all patients hospitalized in Department of Internal Medicine, Hasan Sadikin General Hospital in November 2018 with medical illness, which is patients with medical condition involves a more systemic, pharmaceutical approach to treatment. Exclusion criteria were surgical disease, which is requires some form of intervention such as surgery, also patients with incomplete medical record were excluded. Results: There were 162 patients (56% male and 44% female). Median age were higher in males compared to females (53 [18-76] vs. 49 [18-85]) years. Low-risk (score <2), medium-risk (score 2 – 3), and high-risk (score >4) for IMPROVE venous thromboembolism score were 77.2%, 17.3%, and 5.6% respectively. ). Low-risk (score <7) and high-risk (score >7) for IMPROVE bleeding score were 75.9% and 24.1% respectively. Medical thromboprophylaxis were given to 14.8% patients, with 91.7% and 8.3% of the patients received unfractionated heparin (UFH) and low-molecular weight heparin (LMWH) respectively. Thromboprophylaxis was given in 88.9% of high-risk patients for venous thromboembolism. There were 18.7% patients with low-risk and 2.6% with high-risk for bleeding that received prophylaxis. Conclusion: The majority of inpatients treated with thromboprophylaxis had low-risk for both thromboembolism and bleeding. The rate of thromboprophylaxis usage was still low; with the most frequently used thromboprophylaxis agent was UFH. Most of high-risk patients for venous thromboembolism received thromboprophylaxis.

Length of Stay Children Hospitalized with Chronic Kidney Disease Based on Etiology and Stage in Dr. Hasan Sadikin Hospital Bandung

Objectives: This study aims to describe the LOS children hospitalized with CKD based on the etiology and stage at Dr. Hasan Sadikin General Hospital, Bandung in 2016–2018. Methods: This was a retrospective study with a cross-sectional design from June–October 2019. The inclusion were all medical records of pediatric inpatient diagnosed with CKD and exclusion criteria were incomplete medical record data and hospital readmission patients. The variables studied were CKD etiology, CKD stage, and length of stay Results: From 103 patients, the etiologies found were steroid-resistant nephrotic syndrome (SRNS) (58.25%), congenital anomalies of kidney and urinary tract (9.71%), urinary tract infection (5.83%), and chronic glomerulonephritis (21.36%). The mean LOS was 19 days. The longest LOS found in CKD stage 5 patients caused by SRNS (141 days). Meanwhile, the shortest LOS was found in CKD stage 2 patients caused by chronic glomerulonephritis and CKD stage 5 patients were caused by SRNS who died (1 day). Conclusion: Pediatric patients with CKD stage 5 with SRNS has the potential to have a longer LOS than other etiologies.

Intracranial Metastasis as the Initial Presentation of a Young Woman with Luminal B Her-2 Positive Stage 4 Breast Cancer

Objective: Breast cancer is the second most common cause of brain metastasis (BM) among all of the solid cancers, with metastases occurring in 10%–16% of patients and in as many as 30% of autopsy studies. Breast cancer-related BM usually has a poor prognosis and survival rate in the absence of any treatment within 2 months. Survival after BM is related to the subtype of the primary tumor. Human epidermal growth factor-2 (HER-2)-positive patients have a significantly better prognosis compared with other subtypes. The prognosis for the majority of patients with BM remains poor, despite local and systemic therapies, with a median survival of around 10 months. Methods: This case is interesting because our patient is very young, diagnosed with BM before breast cancer was identified, bit still surviving 12 months after her BM diagnosis. A 19-year old woman presented with seizures, vomit and headaches. Results: A cranial CT-scan showed an intracranial mass. The intracranial tumor was removed, and yielded a histopathological result of metastatic adenocarcinoma. Further examination found a lump in her right breast. She was diagnosed with intracranial metastatic stage 4 luminal B Her 2(+) breast cancer. She was referred for WBRT, a mastectomy, chemotherapy with docetaxel cyclophosphamide 4 cycles, followed by 12 cycles of trastuzumab, and continued treatment with tamoxifen and goserelin. The last PET-Scan showed no residual disease. Conclusion: Breast cancer as the primary tumor should be considered in women with a metastatic brain tumor. With appropriate treatment, even stage IV luminal B breast cancer with BM can still have a long life with good quality.

High Tissue Factor Microparticle Level in Major Thalassemic Patients with Pulmonary Hypertension

Objective: To analyze the correlation between tissue factor microparticles (TF-MP) levels and pulmonary hypertension (PH) in adult thalassemic patients. Methods: This study was conducted from September to October 2018, using secondary and primary data. The secondary data consisted of the PH parameter, which was retrieved from a 2017 previous study entitled ‘Clinical Characteristic and Complication due to Iron Overload in Thalassaemic Patients‘in 2017 while the primary data were the TF-MP, which were obtained from the analysis of frozen serum of the same population using ELISA method. The mean pulmonary arterial pressure (mPAP) values were obtained from echocardiography results and PH was defined as mPAP >25 mmHg. Results: Seven (16.7%) major thalassemic patients experienced PH. The median values of TF-MP levels were higher among major thalassemic patients with PH when compared to the non-PH patients (1569 vs 11.5 pg/dL; p=0.023). No significant difference was observed in the median TF-MP levels between subjects with splenectomy and subjects without splenectomy (11.6 vs 12.3 pg/dL; p=0.44). There was also no difference in mPAP values between subjects with splenectomy and subjects without splenectomy (18.0 vs 17.0 mmHg; p=0.663). When the median TF-MP levels among major thalassemic patients were analyzed in terms of correlation with transfusion level, no statistically significant difference was seen between subjects who received sufficient transfusions (≥180 mL/kgbb/year) and those who received insufficient transfusions (<180 mL/kgbb/year) (r= 0.138; p=0.390). Conclusions: There is a positive correlation between the TF-MP levels and PH in adult major thalassemic subjects.

Clinical Manifestations and Hematological Profiles of Pediatric Acute Myeloblastic Leukemia Patients: 3 Years Observational Study in A West Java Tertiary Hospital, Indonesia

Objective: To determine and describe the clinical manifestations and hematological profiles of pediatric Acute Myeloblastic Leukemia (AML) in Dr. Hasan Sadikin General Hospital (RSHS), Bandung as a tertiary hospital in West Java, Indonesia. Methods: A retrospective cross-sectional study using the total sampling method was performed on the medical records of pediatric patients (0-18 years old)who were diagnosed as AML for the first time through bone marrow examination during the period of January 1, 2015 – December 31, 2017. Results: Of the 54 subjects who met the inclusion criteria, 42.6% were AML patients in the age group 6-12 years with male patients comprised 59.3% of the total number of subjects. Patients generally experienced pallor (83.3%), fever (75.9%), and decreased appetite (70.4%). The hematological profiles showed that 35.2% of patients had Hb <6.5 g/dL and 44.4% had a leukocyte count of of >50,000 cells/mm3. The majority of the subjects had a platelet count of <50,000 cells/mm3 (83.3%) and almost half of them had a peripheral blasts count of >50% (46.3%). Conclusion: Clinical manifestations and hematological profiles are important to diagnose AML, especially in pediatric patients. By assessing the manifestations and profiles, it is feasible to access and detect suspected cases of AML.