Response and Side Effects from Rheumatoid Arthritis Therapy at Dr. Soetomo General Hospital Surabaya 2017

Introduction: Rheumatoid arthritis (RA) is an autoimmune disease which mainly attacks synovial membrane and causes systemic manifestation. During treatment, controlling disease activity is needed to prevent further complication. On the other hand, medications used in the treatment of RA may bring various side effects. It is important to evaluate side effects from the given therapy.Methods: This study aimed to evaluate response and side effects of therapy in RA patients. The samples were collected from 59 RA patients at Rheumatology Division of Outpatient Clinic in Department of Internal Medicine Dr. Soetomo General Hospital Surabaya in 2017. This study method was descriptive observational with cross sectional design using medical records.Results: Pain was reduced in 83.1% patients, Erythrocyte Sedimentation Rate (ESR) increased in 61.4% patients, and C-Reactive Protein (CRP) decreased in 50% patients. Based on the statistic analysis, ESR decreased significantly (p = 0.012) while CRP decreased not significantly (p = 0.415). The side effects were observed from clinical and laboratory data. Based on clinical symptoms, there were alopecia in 1.7% patient, dyspepsia in 78% patients, infection in 27.1% patients, and other symptoms including itchy skin, neuropathy, hyperuricemia, hyperkalemia and Acute Kidney Injury (AKI). Meanwhile, abnormalities in laboratory data include increased aspartate transaminase (AST) in 3.8% patients, increased alanine transaminase (ALT) in 26.1% patients, increased Blood Urea Nitrogen (BUN) in 7.9% patients, increased creatinine serum in 7.9% patients, decreased hemoglobin in 15.5% patients, and decreased leukocytes in 3.4% patients.Conclusion: Most patients had a good therapeutic response based on decreased pain, while ESR had a significant decrease and CRP did not have significant decrease. Side effects discovered in patients were various

Difference of Procalcitonin Levels in Gram-Positive and Gram-Negative Bacterial Sepsis Patients of Indonesia Army Central Hospital Gatot Soebroto in 2016

Introduction: Procalcitonin is known as a marker of infection and indicator for severity of infections. In sepsis, elevated procalcitonin levels in blood have a significant value that can be used as a sepsis biomarker. The aim of this study was to determine the mean difference of procalcitonin levels in Gram-positive and Gram-negative bacterial sepsis patients.Methods: This study used quantitative method with cross sectional approach. The sample of this study were bacterial sepsis patients of Indonesia Army Central Hospital Gatot Soebroto in 2016 which were divided into two groups: Gram-positive and Gram-negative bacterial sepsis patients with the number of each group was 30 samples. The data were analyzed by using independent t test.Results: This study showed that mean levels of procalcitonin in Gram-positive bacterial sepsis patients was 6.47 ng/ml and Gram-negative was 66.04 ng/ml. There was a significant difference between mean levels of procalcitonin in Gram-positive and Gram-negative bacterial sepsis patients of Indonesia Army Central Hospital Gatot Soebroto in 2016 with p value = 0.000 (p < 0.05).Conclusion: The mean difference of procalcitonin levels in Gram-negative bacterial sepsis patients were higher than Gram-positive bacterial sepsis patients, because Gram-negative bacteria have lipopolysaccharide which is a strong immunostimulator and increases TNF-α production higher than Gram-positive bacteria.

A 3-Years Pneumonia Incidence in Burn Cases with Inhalation Injury at the Burn Center of Dr. Soetomo General Hospital Surabaya in 2015-2018

Introduction: Inhalation injury is one of burns impact. Airway burns due to inhalation injury is a non-specific term which refer to all respiratory tract injuries occurred due to irritative chemicals, including heat and smoke during inspiration. Inhalation injury increases the risk of death in burns. Pneumonia is one of burns-related inhalation injury complications.Methods: This was a descriptive retrospective study aiming to determine the incidence of pneumonia in burn patients with inhalation injury using secondary data at Burn Center Dr. Soetomo General Hospital Surabaya in the period of January 2015 - December 2018.Results: There were 5 cases of pneumonia in 14 burn cases with inhalation injury (35.71%). Respectively, 2 and 3 cases were found in 2017 and 2018. There were 2 female (40%) and 3 male (60%) patients, with age varied within 28-73 years old. The burn area of burn patients with inhalation injury and pneumonia were found by 15%, 20%, 24%, 32% and 71%, or within the classification of 11-20% burn area, and most complication found was hypoalbuminemia, as much as 3 cases (60%).\Conclusion: Most pneumonia in burn cases with inhalation injury was occurred in 2018, dominated by male patients. The age of the patient were ranging from early adulthood to elderly. Most burns were in the range of 11-20% burn area with the most complication found was hypoalbuminemia.

Profile of Tuberculosis in Children and Adolescent at Dr. Soetomo General Hospital Surabaya

Introduction: Tuberculosis is one of ten leading causes of death worldwide, including Indonesia. Indonesia is one of seven countries that causes 64% deaths due to tuberculosis. Tuberculosis is caused by Mycobacterium tuberculosis through droplet nuclei in the air. It can occur to any group age, including children and adolescent, if there is a contact history of people with tuberculosis infection. In 2016, one million children had tuberculosis and around 250,000 children died because of tuberculosis. This study aimed to know the profile of tuberculosis in children and adolescent at Dr. Soetomo General Hospital Surabaya.Methods: This was a descriptive study using retrospective approach. Sample of this study was collected from electronic medical record provided by Dr. Soetomo General Hospital Surabaya using statistic formula of single sample for estimated population proportions of children and adolescent with tuberculosis from 2013-2017, with total samples of 149 people.Results: There were 149 samples of children and adolescent patients with tuberculosis. Most of the children were mostly 0-4 years old and 57% were female. 84% of the children had been immunized with BCG and classified as moderate, and 35% were under nutritional status. This study showed that 67% of the children in household contacts of adult tuberculosis patients also had tuberculosis. The most frequent symptoms of tuberculosis in children and adolescent were fever (72%) and cough (80%).Conclusion: Tuberculosis in children and adolescent is more likely to occur in children than adolescent, especially children within group age of 0-4 years old. The number of pulmonary tuberculosis in children and adolescent are higher than extrapulmonary tuberculosis.

Understanding Cardiopulmonary Resuscitation Determines the Readiness of Doing Basic Life Support

Introduction: Cardiopulmonary Resuscitation (CPR) is an emergency lifesaving procedure performed when the heart stops beating. Basic Life Support (BLS) is the initial action to save life-saving conditions. BLS is one of the most important components in CPR. BLS greatly determines the fate of the next life-threatening victim. This study aimed to know the relationship of understanding CPR to readiness to do BLS for students of Faculty of Medicine, Universitas Airlangga, Surabaya.Methods: This was non-experimental study using the design of analytic and descriptive statistics. The sample of this study was the students of Faculty of Medicine, class of 2015, Universitas Airlangga, Surabaya and was taken by probability sampling method with a simple random sampling technique. Data retrieval was performed by giving a questionnaire to 100 respondents. This study was conducted in February 2019. The results of this study were then analyzed by SPSS using the Spearman test.Results: The results of this study showed that the most level of understanding CPR was in the good category with 56 people (56%), while the readiness to do BLS was mostly in the moderate category with 55 people (55%). Based on the results of statistical tests using the Spearman test, there was a relationship between the level of understanding CPR and the readiness to do BLS for students of Faculty of Medicine, Universitas Airlangga, Surabaya.Conclusion: There was relationship between the level of understanding CPR and the readiness to do BLS for students of Faculty Medicine, Universitas Airlangga, Surabaya.

Pre- and Post-Operative Intraocular Pressure of Pediatric Cataract Surgery

Introduction: Cataract is an eye lens opacification which prevents clear vision. It is the leading cause of blindness and vision impairment worldwide, including Indonesia. It can also be occurred in children that leads to a major cause of childhood blindness. The prevalence of childhood cataract ranges from 3 to 6 per 10,000 children. The main treatment for cataract is surgery, although pediatric cataract surgery has several complications. One of the most severe complication is glaucoma due to increased intraocular pressure (IOP). This study aimed to determine pre- and post-operative IOP in pediatric cataract surgery.Methods: This was a cross-sectional observational analytic study. Secondary data were collected from medical records of Department of Ophthalmology, Dr. Soetomo General Hospital Surabaya from January 2017 to August 2019. Age, gender, pre- and post-operative IOP, and intraocular lens implantation data were taken. Calculation was performed using the Saphiro-Wilk for data less than 50 samples. The Saphiro-Wilk test results showed that the data were normally distributed (p = 0.628). Data processing were then performed using the parametric t-pair test with a confidence level ofResults: 32 eye samples were obtained from 16 pediatric cataract surgery patients. The mean of pre-operative IOP was 13.05 mmHg and the mean of post-operative IOP was 13.36 mmHg. There was an increase in post-operative IOP with an average increase of 0.31 mmHg. There was no significant difference between pre- and post-operative IOP of pediatric cataract surgery patients (p = 0.711).Conclusion: There was no difference between pre- and post-operative IOP of pediatric cataract surgery patients at Dr. Soetomo General Hospital Surabaya for the period of January 2017 - August 2019.

Antimalarial Activity of Ethanol Extract of Kelakai Leaves (Stenochlaena palustris) to Parasitemia and Splenomegaly in BALB/c Mice Infected with Plasmodium berghei ANKA

Introduction: Malaria is one of global health problems. Splenomegaly is one of malaria symptoms. Antimalarial drug resistance had been reported. Alternative treatment is by using traditional medicinal plants such as kelakai (Stenochlaena palustris). Kelakai contains alkaloid and flavonoid which had been reported to have antimalarial activity. The aim of this study was to discover antimalarial activity of ethanol extract of kelakai leaves to parasitemia and splenomegaly of Plasmodium berghei ANKA in infected BALB/c mice.Methods: This study was based on a modified Peter test using BALB/c mice infected with P. berghei ANKA treated with ethanol extract of kelakai leaves, with chloroquine diphosphate as a positive control. The negative control was P. berghei ANKA infected mice without any additional treatment. Administration of ethanol extract of kelakai leaves was performed for 4 days with a serial doses of 100, 10, and 1 mg/kg body weight. The positive control was given chloroquine diphosphate 20 mg/kg body weight. Parasitemia was observed daily prior to the calculation of the percentage of parasite growth and parasite growth inhibition. At the end of the test, the mice were sacrificed and spleens were isolated to measure their sizes. Probit analysis was performed to obtain ED50 to find the effect of extract in parasite killing by 50%. Spearman test was performed to analyze the correlation of doses of extract and splenomegaly.Results: Parasitemia growth inhibition was directly proportional to the dose. Higher parasitemia inhibition was obtained at higher doses and vice versa. Result of probit analysis showed an ED50 was 77.05 mg/kg body weight. Statistical analysis resulted in insignificant correlation between doses and splenomegaly p = 1.0 (significancy < 0.05).Conclusion: Ethanol extract of kelakai leaves possessed good antimalarial activity and there was no correlation between extract doses and splenomegaly in Plasmodium berghei ANKA-infected mice.

Sleep Duration Determines Excess Body Mass Index among Young Adults in Surabaya

Introduction: Lack of sleep duration is one of the risk factors that cause excess body mass index (BMI). One of the mechanisms are by regulating an increase in appetite and reducing the energy used. This study aimed to identify the relationship between sleep duration and excess BMI in young adults.Methods: This descriptive-analytic observational study with cross-sectional design was conducted on 70 respondents aged 18-25 years old. The primary outcomes measured were sleep duration and BMI. Sleep duration was grouped as <7 hours (short sleepers), and ≥7 hours. BMI was classified as 18.5-22.9 as normal, and ≥23 as excess BMI (including overweight and obesity) according to Asia-Pacific classification. Data were analyzed using SPSS 21 software.Results: The study showed that the prevalence of excess BMI was higher in respondents with sleep deprivation (<7 hours) of 67% compared to respondents with enough sleep of 33%. The average sleep duration was 42 minutes shorter on respondents with excess BMI with an average of 6.1 hours and 6.8 hours on normal-weight respondents. According to the results of the study, there was a significant relationship between sleep duration and excess BMI (p < 0.05).Conclusion: The study revealed that sleep duration was related with excess BMI in young adults.

Early- and Late-Onset Preeclampsia at a Tertiary Hospital in 2016

Introduction: Preeclampsia is still one of the major causes of maternal morbidity and mortality worldwide. Preeclampsia nowadays has another classification, early-onset preeclampsia and late-onset preeclampsia. This study aimed to evaluate the differences between early-onset and late-onset preeclampsia in Dr. Soetomo General Hospital, Surabaya in 2016.Methods: This was an analytic observational study, evaluating the difference between early- and late-onset preeclampsia in terms of maternal data, medical history, and obstetric history. The samples were taken from the medical record of Dr. Soetomo General Hospital, Surabaya from January until December 2016.Results: In maternal data, early- and late-onset preeclampsia mostly happened in productive age, consisted of 34 patients of early-onset preeclampsia (77.3%) and 31 patients of late-onset preeclampsia (73.8%). Early-onset preeclampsia tended to happen in nullipara (42.2%) and primigravida (35.6%) women, and late-onset preeclampsia usually happened in multipara (43.9%) and multigravida (85.4%) women. In medical and obstetric history, early-onset preeclampsia mostly had a history of hypertension (61.7%), rather than late-onset preeclampsia (32.7%). Moreover, there were no significant differences in other variables.Conclusion: Early-onset and late-onset preeclampsia had a significant difference in parity, gravidity, and hypertension disease.

The Maternal Risk Factors for Preterm Birth in Universitas Airlangga Hospital Surabaya in 2017-2018

Introduction: Preterm birth becomes a global problem due to its high rate of morbidity and mortality. In 2010, it is estimated approximately 15 premature birth cases per 100 lives birth in Indonesia. This study aimed to analyze the maternal risk factors towards preterm birth at Universitas Airlangga Hospital Surabaya in 2017-2018.Methods: This was observational analytic study using case-control approach to observe 178 medical records at Universitas Airlangga Hospital Surabaya. The population of this study was women who had preterm and aterm birth. The sample consisted of case group and control group which were convenient to exclusion and inclusion criteria. Univariate analysis was used to observe the relationship between dependent and independent variable. The significance value was p ≤ 0.05. The data were analysed using SPSS.Results: The research samples consisted of 89 case groups and 89 control groups. The case sample characteristic showed that 36% patients had overweight BMI; 62.9% patients had normal/hypotension; 69.7% patients gave birth to male baby; and 82% patients had no history of disease.There was no patient who used drugs and substance abuse (0%). Mothers aged 20 years old and older than 35 years old had OR = 2.13 (95% CI : 1.106-4.11) to become preterm birth. The primiparous women had risk for preterm birth 2.978 folds (95%, CI : 576-5.625) higher.Conclusion: There was a relationship between maternal age and parity to preterm birth. There was no relationship between maternal education, maternal occupation, hemoglobin levels, history of obstetric complications, and multiple pregnancy to preterm birth.