Atma Jaya Hospital Research Articles

Initial clinical and laboratory profiles to predict pediatric dengue infection severity

Background. In dengue infection, it is difficult to differentiate mild and severe dengue prior to its critical phase. Ability to identify risk factors for severe dengue form patients’ initial presentation would help decrease the need of hospitalization, increase physicians’ awareness, and improve outcome.Objective. To predict pediatric dengue infection severity based on initial patient characteristics, routine clinical and laboratory profiles. Methods. This was a cross-sectional study based on medical records of children with dengue infection in Atma Jaya Hospital, Jakarta. Inclusion criteria were children aged 1 – 18 years old with proven dengue infection, hospitalized in Atma Jaya Hospital during January – December 2016. Clinical profiles and laboratory parameters at the time of patient presentation were extracted and analyzed in relationship with dengue severity. Result. Data collected was 110 patients with mean age 9.5 years old. Initial clinical profiles that significantly related to severe dengue were: age ≤5 years old (OR = 0.113, p = 0.001), hepatomegaly (OR = 2.643, p = 0.035), pleural effusion (OR = 9.545, p = 0.000), platelet ≤125,000/uL (OR = 0.201, p = 0.025), hyponatremia (OR = 10.139, p = 0.000) and AST >135 u/L (OR = 5.112, p = 0.014). Gender, duration of fever, additional symptoms, spontaneous bleeding, blood pressure, pulse pressure, hematocrit, leucocyte, random blood glucose, calcium, and ALT were not related significantly to dengue severity.Conclusion. Physician should be cautious in pediatric dengue patients presented in age younger than 5 years old, with hepatomegaly and/or pleural effusion, platelet below 125,000/uL, hyponatremia, and AST more than three times upper normal limit. These patients have higher risk of severe dengue than patients without those findings.

Initial clinical and laboratory profiles to predict pediatric dengue infection severity

Background. In dengue infection, it is difficult to differentiate mild and severe dengue prior to its critical phase. Ability to identify risk factors for severe dengue form patients’ initial presentation would help decrease the need of hospitalization, increase physicians’ awareness, and improve outcome.Objective. To predict pediatric dengue infection severity based on initial patient characteristics, routine clinical and laboratory profiles. Methods. This was a cross-sectional study based on medical records of children with dengue infection in Atma Jaya Hospital, Jakarta. Inclusion criteria were children aged 1 – 18 years old with proven dengue infection, hospitalized in Atma Jaya Hospital during January – December 2016. Clinical profiles and laboratory parameters at the time of patient presentation were extracted and analyzed in relationship with dengue severity. Result. Data collected was 110 patients with mean age 9.5 years old. Initial clinical profiles that significantly related to severe dengue were: age ≤5 years old (OR = 0.113, p = 0.001), hepatomegaly (OR = 2.643, p = 0.035), pleural effusion (OR = 9.545, p = 0.000), platelet ≤125,000/uL (OR = 0.201, p = 0.025), hyponatremia (OR = 10.139, p = 0.000) and AST >135 u/L (OR = 5.112, p = 0.014). Gender, duration of fever, additional symptoms, spontaneous bleeding, blood pressure, pulse pressure, hematocrit, leucocyte, random blood glucose, calcium, and ALT were not related significantly to dengue severity.Conclusion. Physician should be cautious in pediatric dengue patients presented in age younger than 5 years old, with hepatomegaly and/or pleural effusion, platelet below 125,000/uL, hyponatremia, and AST more than three times upper normal limit. These patients have higher risk of severe dengue than patients without those findings.

61 The Association of Hypertension with Depression, Anxiety and Stress Score in Atma Jaya Hospital

Background: Depression in hypertension leads to poorer outcome and quality of life. Studies had shown a relation between hypertension and depression, anxiety, and stress score. Some studies also reported no relation. In Atma Jaya, the interaction between hypertension and depression, anxiety, and stress have not been evaluated. Method: We conducted a cross-sectional study with 58 outpatients in neurology clinic who met the inclusion and exclusion criteria, between the period of October 2016 – November 2016. Data were gathered on patient's demographic characteristics, blood pressure level, history of hypertension treatment, and medical history. Depression, Anxiety, and Stress were evaluated using DASS-42 Questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) based on Chi-Square were used to analyze the correlation of hypertension with depression, anxiety, and stress score. Result: The subjects were 37 women (63.8%) compared to men (36.2%). Most of the education levels were elementary school (31%) and non-educated (25.9%). Duration of hypertension vary from >20 years to less than 1 year. Anxiety levels were reported higher (58.6%) than depression (29.3%) and stress (31%). There were no correlation between hypertension and depression (p>0.05; OR: 0.38; 95% CI 0.12–1.24), hypertension and anxiety (p > 0.05; OR: 1.12; 95% CI 0.395–3.201), hypertension and stress (p > 0.05; OR: 0.9; 95% CI 0.297–2.754), there were also no correlation between the number of anti-hypertensive drugs taken and depression (p > 0.05; OR: 1.588; 95% CI 0.509–4.952), anxiety (p > 0.05; OR: 0.933; 95% CI 0.326–2.667), and stress score (p > 0.05; OR: 0.978; 95% CI 0.319–2.994). Conclusion: Blood pressure levels did not correlate significantly with depression, anxiety, and stress score in well-controlled hypertensive patients.

The Difference of Barthel Index Score Based on Stroke Severity, Weakness Side, and Onset of Physiotherapy in Ischemic Stroke Patients at Atma Jaya Hospital

Background: Stroke is the third cause of disability that can affect the Activity of Daily Living (ADL). Ischemicstroke had higher incidence compared to hemorrhagic strokes. Rehabilitation in the form of physiotherapy canreduce the level of ADL dependencies, that is be measured by Barthel Index Score. Stroke severity, weaknessside, and physiotherapy onset can be factors that influence the success of physiotherapy to reducing the levelof ADL dependencies.Methods:A descriptive analytic study with a cross-sectional design in ischemic stroke patients using secondarydata from the Stroke Registry and medical records at Atma Jaya Hospital for the period of January 2016 toDecember 2017. The data were analyzed using Chi-Square.Results: Study on 110 subjects, consisted of 62 men(56.4%), aged divided by under of 58 years, and above of 58years were 52(47.3%) and 58 (52.7%). While subjects divided by stroke severity, i.e. minor, moderate, moderateto severe, and severe; 44 (40%), 58 (52.7%), 5 (4.5%), and 3 (2.7%) respectively. There were 77 participants(70%) had right side weakness and 33 participants (30%) were left side weakness. The changes of Barthel Indexof ADL score, were 73 (66.4%) improvement, 6 (5.5%) deterioration, and 31 (28.2%) remained. The study hasshown relationship between severity of stroke (p=0.008), weakness side (p=0.000), and physiotherapy onset(p=0.039) with the changes of Barthel Indexscore after treatment.Conclusion: There was a relationship between stroke severity, the weakness side of stroke, and physiotherapyonset with the better result of Barthel Index of ADL score after the physiotherapy.Keywords: Activity of Daily Living (ADL), Barthel Index, ischemic stroke, physiotherapy onset, stroke severity,Weakness side

PSYCHIATRIC DISORDER COMORBIDITY IN CHRONIC NEUROMUSCULOSKELETAL PAIN IN ATMA JAYA HOSPITAL

This study describe comorbid psychiatric disorder especially in depressive disorder, anxiety disorder and sleep disturbance in chronic neuromusculoskeletal pain patients. The aim of this study is to measure the prevalence of psychiatric comorbidity in choric neuromusculoskeletal pain. Cross sectional study with consecutive sampling method is used in this study. The data are collected in the neurology clinic in Atma Jaya Hospital, Jakarta between July – December 2015. Diagnostic and Statistical Manual of Mental Disorder (DSM) V criteria was used to diagnose the psychiatric condition. The data were obtain from 55 study samples, consist of 12 males (21,8%), 43 females (78,2%). Thirty of them are is more than or equal 60 years old (55%) and 25 are is less than 60 years old (45%). The most common is low back pain 30 patients (55%). Non-neuropathic pain 12 patients (22%), and neurophatic pain 43 patients (78%). The most common pain intensity is severe, Visual Analog Scale (VAS) is more than or equal 8 (43%). The most common psychiatric disorder is insomnia (20%), followed by anxiety and insomnia (16,3%), and anxiety (12,7%). Majority of chronic pain has psychiatric disoder comorbidity, coexisting condition should be considered in evaluation, diagnosis, and therapy. Chronic pain usually accompanied by psychiatric disorder, so thorough evaluation, diagnosis and therapy have to be fully addressed to achieve optimum functionality and good quality of life. Next study should collect samples from some hospitals and design the analitic study that can explain association between factors that can influence the comorbidity

MON-P128: A Pilot Study: The Difference of Body Fat Compostion in Chronic Kidney Disease Patienton Hemodialysis with and Without Type 2 Diabetes Mellitus in Atma Jaya Hospital

MON-P128: A Pilot Study: The Difference of Body Fat Compostion in Chronic Kidney Disease Patienton Hemodialysis with and Without Type 2 Diabetes Mellitus in Atma Jaya Hospital

Factors Influencing Maternal Mortality from Severe Preeclampsia and Eclampsia

Objective: To analyze risk factor, both clinical and laboratory findings, associated with maternal mortality from severe preeclampsia and eclampsia in Atma Jaya Hospital. Methods: This was a retrospective case control study. All medical records of maternal death associated with severe preeclampsia and eclampsia between 1st January 2009 and 31st December 2011 were obtained and then information about risk factors were collected and tabulated. Risk factor analyzed were maternal age, gestational age, parity, coexisting medical illness (hypertension), antenatal examination status, maternal complications, systolic and diastolic blood pressure at admission, and admission laboratory data. Results: There were 19 maternal deaths associated with severe preeclampsia and eclampsia during period of study (Consisted of 6 cases of eclampsia and 13 cases of severe preeclampsia). Maternal mortality rate for severe preeclampsia and eclampsia were 16.7% and 33.3% respectively. Multivariate analysis identified the following risk factors associated with maternal death: gestation age <32 week, history of hypertension, thrombocyte count < 100.0000/μl, post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. Conclusion: In this study, we found that gestational age, history of hypertension, and platelet count are the cause of maternal mortality. Maternal complications associated with maternal mortality are post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. [Indones J Obstet Gynecol 2012; 36-2: 90-4] Keywords: eclampsia, maternal mortality, preeclampsia

Blood Pressure Variability and Neurological Improvement on Acute Ischemic Stroke Patients

Background: Several studies have confirmed the relationship between systolic blood pressure variability (BPV) and target organ damage, but only few studies have investigated the relationship between systolic BPV and neurological improvement on acute ischemic stroke patient. Objective: Define the correlation between systolic BPV and neurological improvement on acute ischemic stroke patients Methods: We recruited patients with acute ischemic stroke at Atma Jaya Hospital, North Jakarta, Indonesia. Systolic blood pressure (SBP) for every patient is taken 4 times a day (04.00, 11.00, 16.00, 23.00) on first three days of hospitalization. Variability of SBP is calculated as Standard Deviation (SD) of each patient's blood pressure. Neurological improvement is defined as at least a four score increase on National Institute of Health Stroke Scale (NIHSS) at discharge. We use chi square to determine the relationship between variability of daytime systolic pressure (11.00, 16.00) and nighttime systolic pressure (04.00, 23.00) with neurological improvement. Results: A total of thirty-four patients were included with twelve patients (35,3%) fulfilled the criteria for neurologic improvement. Age, sex, length of stay (LOS), and hypercholesterolemia were not associated with neurological improvement (P > 0.05). There is no significant relationship between systolic BPV and neurological improvement on acute ischemic stroke patients (P > 0.05). There is, however, a tendency of a significant relationship between nighttime systolic BPV and neurological improvement (P = 0.121) Conclusion: There is no significant relationship between systolic BPV and neurological improvement on acute ischemic stroke patients while hospitalized.

FERMENTED SOYBEAN CAKE AND ALBUMIN FORMULA AS NUTRITIONAL SUPPORT PREVENTS PROTEIN ENERGY MALNUTRITION AND AKI IN STROKE PATIENTS

Stroke is the leading cause of death in every hospital in Indonesia. The death rate of newly formed or recurrent stroke is estimated around 750.000 case every year nation wide, 200.000 of which are recurrent stroke. Stroke patients have higher risk to develop another stroke attack. In 5 years time, the recurrence of stroke attack is estimated around 30–43%. In many cases, elderly stroke patients who were admitted to the hospital with recurrent stroke attack also suffer from anorexia which leads to hypoalbuminemia, hyponatremia, hypokalemia and impaired renal function marked by a rise in ureum level with or without elevation in blood creatinin levels. This study uses pre and post nutrition intervention method. Hospital’s fermented soybean cake and albumin blend formula was given through nasogastric tube. The amount of calorie was adjusted according to basal needs x 1,3 and consisted of carbohydrate, protein 1 gram/kg BB (albumin : fermented soybean cake=3:1) and 25% fat. This formula was given to 11 stroke patients who had been admitted to Atma Jaya Hospital for at least 10 days and met the inclusion & exclusion criteria, such as did not receive parenteral blood and albumin transfusion without history of renal failure. All the patients’ intake and fluid balance were monitored. The average albumin level of these patients was ±3,1 mg/dL(pre intervention). After receiving nutrition (NGT) and fluid (parenteral nutrition) intervention, the result is as follows: There was an average of±5 mg increase in Natrium level during day 3–5 of hospital stay. There was an average of±0,3 mg increase in Kalium level during day 2–3 of hospital stay. There was an average of ±15 mg reduction of Ureum level during day 5–7 of hospital stay When there was inadequate calorie intake, protein from muscle might be broken down marked by a rise in blood ureum level with or without an increase in creatinin level. In this condition, electrolyte level, such as Natrium and Kalium, could be corrected with appropriate nutritional support (adequate calorie, protein and mineral) and therefore prevents acute kidney injury and protein energy malnutrition in elderly patients with anorexia.

UJI KLINIK PENGGUNAAN BACTESYN DIBANDING LINCOMYCIN PADA PENDERITA YANG DILAKUKAN ODONTEKTOMI DI RUMAH SAKIT ATMA JAYA

Bactecyn is an antibiotic that contains sultamicillin. This antibiotic is a complex of combination between ampicillin and sulbactam is double ester bond. Whis makes Bactesyn become an antibiotic with broader spectrum. Lincomycin is an antibiotic, which is ideal enough to treat dentoalveolar infections. This antibiotic is well known among the fellow dentist in Atma Jaya Hospital. It is obvious that these two medicines are very effective to deal with infections arising after operations of impacted teeth. The dose of Bactesyn is 375 mg, given twice a day, whereas, Lincomycin is 500 mg, given three times daily.

IDENTIFIKASI GEJALA DI RONGGA MULUT PENDERITA DENGAN INFEKSI HIV-AIDS YANG DIRAWAT DI RUMAH SAKIT ATMA JAYA

The condition of oral cavity in HIV positive patients – AIDS who are treated in the ward of Atma Jaya Hospital, is no different with the result of studies of surveds in several countries. In patients with undetected HIV, candidiasis, gingivitis, and Kaposi's sarcoma is often found in the oral cavity. These opportunistic infections have clinical symptoms that should be recognized by every fellow dentist, so that appropriate steps could be taken along with the anticipation, considering many HIV positive patients are not detected.