Bethesda Hospital Yogyakarta Research Articles

Analysis of the Relationship between Symptoms, Clinical Diagnosis, and Findings of CT-Scan Images to Pictures of Vertebrobasilar Artery Insufficiency

Vertebrobasilar artery insufficiency (VBI) occurs when the blood flow to the posterior circulation of the brain, supplied by the vertebral arteries, becomes inadequate. Frequently, VBI is detected accidentally through CT-Scan in patients who do not show symptoms directly related to this condition. This study highlights the importance of comprehensive evaluation and early screening to improve VBI management. The main objective of this research is to analyze the relationship between clinical symptoms, clinical diagnosis, and CT-Scan findings to enhance diagnostic accuracy and develop more effective treatment strategies. A cross-sectional design was used in this study, with samples obtained from the medical records of patients diagnosed with Vertebrobasilar Artery Insufficiency at Bethesda Hospital Yogyakarta between January and April 2023. The data were analyzed using the chi-square test and processed with SPSS software. The patient population was dominated by elderly individuals (73%) and males (60.5%), although these differences were not statistically significant.The findings suggest that VBI symptoms vary based on age, with older patients more likely to exhibit stroke and hemiparesis, while younger patients typically experience headaches and vertigo. Screening for risk factors like cholesterol and blood sugar levels is crucial for patients over 45, whereas younger patients may require additional tests to assess cardiometabolic or hypercoagulation risks. Early detection through age-appropriate screening is vital for preventing serious complications and improving patient outcomes. These findings imply that systematic screening can help identify undiagnosed VBI cases, allowing for timely and more effective medical intervention.

Characteristics and reasons for delayed presentation in acute ischemic stroke: single-centered study in Indonesia

BackgroundEffective therapy for acute ischemic stroke relies on timely intervention. We aimed to evaluate the factors associated with the onset-to-arrival time and delayed hospital presentation in acute ischemic stroke patients. Subjects with acute ischemic stroke in Bethesda Hospital Yogyakarta, Indonesia from March to June, 2023 were prospectively recruited. A questionnaire was used to collect the information by direct interviews. Prespecified variables were included in univariate and multivariable analyses to identify the predictors of delayed hospital presentation of more than 4.5 h.ResultsAmong a total of 175 patients, 64.6% of the patients arrived at the hospital more than 4.5 h after the stroke onset. Only 3 (1.7%) patients were eligible and received intravenous thrombolysis. In multivariable analysis, monthly income of more than IDR 550,000 (OR, 4.22; 95% CI 1.47–12.17; p = 0.007), wake-up stroke or unknown stroke onset (OR vs. known onset, 0.17; 95% CI 0.05–0.56; p = 0.004), distance from location of stroke onset more than 9.45 km (OR, 3.13; 95% CI 1.41–6.92; p = 0.005) and no history of coronary artery disease or heart failure (OR vs. present history, 0.12; 95% CI 0.04–0.37; p = 0.000) were related to delayed hospital presentation. The most frequently mentioned reasons for the delay were waiting for spontaneous improvement at home and unawareness of the stroke symptoms.ConclusionsThere is an enormous disparity in stroke services between developed and developing countries. This study highlighted the need to increase public stroke symptoms awareness.

THE CORRELATION OF ABO BLOOD TYPES AND COVID-19 SEVERITY IN BETHESDA HOSPITAL YOGYAKARTA

Background COVID-19 is caused by the SARS-CoV-2 virus. The most recent study showed that there was a possible correlation between ABO blood types and COVID-19 risk. However, some studies disproved the correlation. The contradiction indicated that the correlation between the two variables has not been established. Objective To find the correlation between ABO blood types and the severity of COVID-19. Methods It applied an observational-analytic method with a retrospective cohort approach. It used secondary data from 2020-2021 in Bethesda Hospital Yogyakarta. Samples were taken using a consecutive sampling technique. The collected data were analyzed using SPSS 26. Univariate analysis was made using descriptive statistics. Sequentially, bivariate and multivariate analyses were made using chi-square, odds-ratio, relative-risk, and ordinal logistic regression analysis. Results There were 212 data. Blood type O got the biggest percentage (38.2%) with a sample of 81 individuals. There were 88 patients with severe symptoms (41.5%), 86 patients with moderate symptoms (40.6%), and 38 patients with mild symptoms (17.9%). The Chi-square analysis of ABO blood types and the severity of COVID-19 was 0.05 (?0.05). The blood type B had a 2.8 times higher probability of severe incidence (95% CI 0.618–12.16) than the non-B blood type. Meanwhile, blood type O had a 0.33 times lower probability of severe incidence (95% CI 0.618–12.16) than non-O blood type. Conclusion The ABO blood types correlated with COVID-19 severity. Blood type O became a protective factor, and blood type B is the risk factor for severe COVID-19. TRANSLATE with x English Arabic Hebrew Polish Bulgarian Hindi Portuguese Catalan Hmong Daw Romanian Chinese Simplified Hungarian Russian Chinese Traditional Indonesian Slovak Czech Italian Slovenian Danish Japanese Spanish Dutch Klingon Swedish English Korean Thai Estonian Latvian Turkish Finnish Lithuanian Ukrainian French Malay Urdu German Maltese Vietnamese Greek Norwegian Welsh Haitian Creole Persian   TRANSLATE with COPY THE URL BELOW Back EMBED THE SNIPPET BELOW IN YOUR SITE Enable collaborative features and customize widget: Bing Webmaster Portal Back

PROFILE OF ACNE VULGARIS PATIENTS AT BETHESDA HOSPITAL YOGYAKARTA FROM JULY 2019 – DECEMBER 2020

<p><strong>Background </strong>Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles. This disease is usually found in more than 85% of young adults worldwide. Acne vulgaris can cause psychological morbidity and also greatly affects socio-economic and the quality of life. Patients often have already tried several treatments, but still do not get good results. Therefore, it is important to identify the type of lesion and then choose the right treatment for acne vulgaris.</p><p><strong>Objective </strong>To know the profile of acne vulgaris patients at the Dermatology and Venereology Clinics of Bethesda Hospital Yogyakarta, from July 2019 to December 2020.</p><p><strong>Methods </strong>This study was a descriptive-retrospective study, using secondary data from the medical records of acne vulgaris patients. Data will be collected in the percentage frequency distribution table.</p><p><strong>Results </strong>This research was done in the medical records department of Bethesda Hospital Yogyakarta from February – April 2022. The number of samples taken by total sampling technique that matched the inclusion and exclusion criteria was 151 records. The highest percentage of acne vulgaris patients were female 72.2% (109 people), aged 20-24 years 57.0% (86), had inflammatory skin lesions 54.3% (82), received combination of topical and systemic treatment 80.8% (122), the most topical treatment prescribed was niacinamide 80.8% (122), the most systemic treatment was antibiotics 41.7% (63), the most systemic antibiotic was minocycline 73.0% (46), the highest visiting frequency was once (without control) 57.6% (87), and irregular follow-up visits 60.9% (92).</p><p><strong>Conclusion </strong>Based on the study conducted, patients with acne vulgaris were dominated by females, aged 20-24 years. One of the most prominent symptoms was inflammatory skin lesions. The patients have received combinations of topical and systemic treatment. The most used topical treatment was niacinamide; the most used systemic treatment was antibiotics; and the most used systemic antibiotic was minocycline. The highest trend for visiting frequency were irregular controls followed by one-time doctor visit without control.<strong></strong></p><p> </p>

Risk factors of cognitive impairment post-ischemic stroke

BackgroundStroke is still remarked as one of the major ailments in Indonesia. Cognitive impairment occurs frequently after stroke events and its predictors are needed to identify patients with a high risk of cognitive impairment. However, the researches done in Indonesia still vary in results. This retrospective cohort study evaluated 236 ischemic stroke patients in Bethesda Hospital Yogyakarta from January–November 2020 through medical records. Cognitive impairment was measured by MMSE and CDT, defined as MMSE score le 20 for patients with the educational attainment of 1–6 years; le 24 for the educational attainment of > 6 years and/ or CDT < 4. All data were analyzed with univariate test and Chi-square test, followed by logistic regression.ResultsOf 236 subjects, the frequency of cognitive impairment was 67.4% and the risk factors are age > 80 years old (RR: 1,545; CI 0.136–17.542; p: 0.026), educational attainment ≤ 6 years (RR: 20.016; CI 1.951–222.120; p: 0.012), temporal (RR: 4.238; CI 2.266–7.926; p: 0.007) or multiple site lesion location (RR: 7.522; CI: 3.522–17.532; p: 0.047) and multiple (> 1) lesions (RR: 1,819; CI 0.822–4.022; p: 0.040).ConclusionsThe prevalence of post-stroke cognitive impairment is high, affecting up to 2 out of 3 people in this study. The risk factors of post-stroke cognitive impairment are age > 80 years, educational attainment le 6 years, temporal or multiple site lesion, and > 1 lesion. Strict stroke prevention strategies are needed to halt the development of post-stroke cognitive impairment.

Characteristics of the platelet profile as a predictor of 30-day clinical outcome in ischemic stroke patients

Objective. Investigate the relationship between platelet profiles, in this case PDW and MPV at hospital admission, which can be predictors of clinical outcome 30 days after ischemic stroke. Methods. This research is an analytic study with a retrospective cohort method. Secondary data in the form of medical records at the neuro polyclinic of Bethesda Hospital Yogyakarta in 2019 - 2020. The number of subjects was 74, grouped as good outcome (mRS 0-2) and poor outcome (mRS 3-6). Data analysis used was t-test, Pearson’s test, Fisher’s test, ROC, and multivariable logistic regression model. Results. In this study, both PDW (p = 0.982) and MPV (p = 0.174) were not significantly associated (p &gt; 0.05) with poor outcomes on the chi-square test. ROC curve analysis showed that the PDW cutoff value was &gt;11.1 fl [(Area Under Curve (AUC) ROC was 0.638, with 95% CI = 0.518-0.746, and p-value 0.835)] and the MPV cutoff value was ≤9,8 fl [(Area Under Curve (AUC) ROC was 0.521, with 95% CI = 0.402-0.639, and p-value 0.137)] which was also not statistically significant (p &gt; 0.05). From these results, multivariable logistic regression analysis was performed which found that MPV ≤9,8 fl was associated with a small 30-day clinical outcome [(Odds Ratio (OR) = 0.110, 95% CI = 0.013-0.953, p = 0.007)]. While PDW &gt;11.1 fl did not have a significant relationship after regression analysis was carried out where p &gt; 0.05 was obtained. Conclusion. Increased PDW and MPV values at hospital admission did not increase the risk of 30-day disability in ischemic stroke patients.

Relationship of Age With Right or Left Position and Colorectal Cancer Stadium

Colorectal adenocarcinoma can be divided into three types according to etiology and genetics, namely sporadic, familial, and hereditary. Risk factors such as old age, inflammatory bowel disease, family history, genetic syndromes and lifestyle factors may increase the incidence of colorectal adenocarcinoma. Knowing the relationship between the age factor and the position or location of the adenocarcinoma with the stage of colorectal adenocarcinoma is very important, especially at Bethesda Hospital, Yogyakarta. To improve the understanding of relation and characteristics each stage in an effort to determine treatment options including effective therapy for patients at Bethesda Hospital Yogyakarta. Research with cross sectional analysis method. The source of data used is secondary data in the form of Medical Records (MR) with 67 samples divided into 17 groups of young age and 50 groups of old age. In all case groups, the samples were divided into 6 samples with right position adenocarcinoma and 61 samples with left position adenocarcinoma, as well as 35 early stage samples (grade I, II, III) and 32 advanced stage samples (grade IV). Calculation of the value of the relationship is done quantitatively. Statistical data analysis with Chi-Square test with significance test p &lt;0.05. Bivariate analysis was carried out using SPSS (Statistical Package for Social Sciences) Statistic 26. In the bivariate analysis test, it was found that there was no relation between age and the right or left position of colorectal adenocarcinoma (p value = 0.608) and between age and colorectal adenocarcinoma stage (p value = 0.946). There was no significant relationship between age and the right or left position of colorectal adenocarcinoma, nor was there a relationship between age and the stage of colorectal adenocarcinoma at Bethesda Hospital, Yogyakarta.

Medical comorbidities as predictors of COVID-19 short-term mortality: A historical cohort study in Indonesia.

In this study, we aimed to evaluate the relation of comorbidities to coronavirus disease 2019 (COVID-19) short-term mortality. This was a single-center observational study with a historical cohort method at Bethesda Hospital Yogyakarta, Indonesia. COVID-19 diagnosis was made using reverse transcriptase-polymerase chain reaction on nasopharyngeal swabs. Patient data were obtained from digital medical records and used for Charlson Comorbidity Index assessments. Inhospital mortality was monitored throughout their hospital stay. This study enrolled 333 patients. According to the total number of comorbidities in Charlson, 11.7% (n = 39) of patients had no comorbidities; 30.9% (n = 103) of patients had one comorbidity; 20.1% (n = 67) of patients had two comorbidities; and 37.2% (n = 124) of patients had more than three comorbidities. In multivariate analysis, these variables were significantly related to short-term mortality in COVID-19 patients: older age (odds ratio [OR] per year: 1.64; 95% confidence interval [CI]: 1.23-2.19; P 0.001), myocardial infarction (OR: 3.57; 95% CI: 1.49-8.56; P: 0.004), diabetes mellitus (OR: 2.41; 95 CI: 1.17-4.97; P: 0.017), renal disease (OR: 5.18; 95% CI: 2.07-12.97; P < 0.001), and longer duration of stay (OR: 1.20; 95% CI: 1.08-1.32; P < 0.001). This study revealed multiple short-term mortality predictors in COVID-19 patients. The coexistence of cardiovascular disease, diabetes, and renal problem is a significant predictor of short-term mortality in COVID-19 patients.

Association of prostate-specific antigen and prostate volume in benign prostatic hyperplasia patients with urinary tract infection

Introduction: One of the most common diseases in men is benign prostatic hyperplasia (BPH). In this condition, the prostate gland becomes larger, thus it can clamp the urinary tract area and cause obstruction. Obstruction in the lower urinary tract increases the high risk of urinary tract infections (UTI). When the prostate volume becomes larger, the levels of prostate-specific antigen increase. This research aims to determine the correlation between PSA levels and prostate volume in BPH patients with urinary tract infections (UTI). Methods: This study used an analytic observational method with a cross-sectional design. Data were taken from the medical records of BPH patients suffering from UTIs at Bethesda Hospital Yogyakarta from January 2018 to December 2020. Data collection was carried out from January 17 2022 to March 17 2022. The data used in this study were selected using inclusion and exclusion criteria so that the obtained 33 medical record data were analyzed. The data used in this study were analyzed using SPSS software. The univariate analysis describes the distribution of data. Bivariate analysis used the chi-square test so that it could show the relationship between the independent variable (prostate volume) and the dependent variable (PSA level). Result: The data show moderate prostate volume (30-80cc) in 17 (51.5%), high prostate volume (&gt;80ml) in as many as 9 patients (27.3%) and normal prostate volume (&lt;30 ml) in as many as 7 patients (21.2%). High PSA levels are 26 (78.8%) and normal PSA levels are 7 patients (21.2%) that noted. Bivariate analysis data with a chi-square test shows that the significant score is 0.019 (p&lt;0.05). Conclusion: The research shows an association of PSA levels and prostate volume in BPH patients with UTI.

The Effect of Body Mass Index on Five Years Progression Free Survival in Breast Cancer

Backgroud Breast cancer is the type of cancer that has the highest prevalence. Breast cancer growth is related to nutritional status. Nutritional status is assessed based on measurements of BMI Body Mass Index (BMI) and obesity is a factor that plays a role in the growth of cancer cells.Objective To investigate the effect of BMI on the five-year progression-free survival (PFS) of breast cancer patientsMethods A retrospective cohort study using observational methods on 82 female patients with breast cancer at Bethesda Hospital, Yogyakarta.Results A total of 82 medical records of breast cancer patients were collected at Bethesda Hospital Yogyakarta. A total of 71 patients (86.6%) were still alive, while 11 have died. This study found an average progression-free survival of BMI category &lt;25 kg/m2 78,5 months while the BMI ≥ 25.0 kg/m² 80,9 months (HR 2,057, 95% CI: .457–2.491). In addition, BMI and other prognostic variables did not have a significant relationship with progression-free survival in breast cancer patients (p = 0.114).Conclusion In this study, Body Mass Index was not associated with the 5-year progression-free survival of breast cancer patients.Â

Prediction score for post-stroke cognitive impairment (PSCI) after acute ischemic stroke

It was estimated that patients with ischemic stroke and post-stroke cognitive impairment (PSCI) have been increasing. In addition, this PSCI is often late diagnosed when it has already developed into post-stroke dementia. Only a few studies have developed a scoring system of predictor factors cognitive impairment (CI) for post-acute ischemic stroke in Indonesia. This study aimed to develop a scoring system of predictor factors of CI for post-stroke ischemic patients. The patients included were &gt;18 years old diagnosed with acute ischemic stroke who underwent mini-mental state examination (MMSE) and clock drawing test (CDT) examination on day-30 at Bethesda Hospital Yogyakarta. It was retrospective cohort study design and samples were obtained from the stroke registry and medical records. Patients who had a history of CI and incomplete medical records were excluded. The results of MSSE and CDT at day-30 were the outcomes of this study. To evaluate the relationship between the independent variable and the dependent variable, chi-squared tests were perforemd followed by multivariate logistic regression analysis with Hosmer-Lemeshow tests with backward likelihood-ratio (LR) method and by assessing the final area under the curve (AUC) model. The final model was transformed into a scoring system to determine the value of probability prediction of PSCI, the optimal cut-off point, the sensitivity value and specificity value of the cognitive impairment scoring system at day-30 after acute ischemic stroke. A total of 140 subjects were included in the study with an average age of 62.8 years, 86 (61.4%) males and 54 (38.6%) females. Ninety-one subjects (65%) experienced post-stroke CI. The multivariate analysis showed age &gt;70 years, education level ≤6 years, modified ranking score (mRS) &gt;3 at diagnosis, Barthel index score ≤4 at diagnosis, the number of multiple lesions and the location of lesion in the cortex were independent predictor factors affecting CI 30 days after acute ischemic stroke. The developed predictor score obtained AUC discrimination value of 82.6% (95%CI:0.757-0.896) and calibration value of p&gt;0.366. The scoring system had a value range of 0-7, and with a cut-off ≥1, it had a sensitivity value of 86.8% and a specificity value of 59.2%. It can be concluded that the predictor score has a good performance in predicting the occurrence of PSCI at day-30 after acute ischemic stroke.

Correlation between vitamin D levels and cognitive impairment on 90 days post ischemic stroke patients

The prevalence of ischemic stroke based on the American Heart Association (AHA) data in 2019 reached 77.2 million people. As much as 72% of post ischemic stroke patients got cognitive impairment. Vitamin D deficiency is often found in post-stroke patients and causes functional decline. This study aims to assess the relationship between vitamin D levels and cognitive impairment in 90 days post ischemic stroke patients. This study is a cross-sectional study using secondary data from medical records at Bethesda Hospital Yogyakarta taken from January to March 2021. Cognitive impairment in 90 days post ischemic stroke patients were assessed using MMSE (Mini-Mental State Examination) and CDT (Clock Drawing Test). This study was analyzed through univariate tests and bivariate tests using Spearman correlation. This proves a correlation between vitamin D levels and cognitive impairment which is formulated by the value of MMSE (p=0.000) and CDT (p=0.031). The mean of vitamin D levels was 13.53±3.625. The proportion of hypovitaminosis D was divided into 5.7% of insufficiency patients and 94.3% patients stated as deficiency. The lower the vitamin D levels, the lower the MMSE and CDT values accordingly. In conclusion, there is a relationship between vitamin D levels and cognitive impairment in 90 days post ischemic stroke patients. Low levels of vitamin D result in more frequent and more severe cognitive impairments.

The Association between The Patient’s Age Groups with Stage, Grading, and Molecular Subtype of Breast Cancer

In 2020, Global Cancer Observatory reported breast cancer incidence was 11.7% and mortality was 6.9%, most presenting a late-stage and delaying diagnosis. The study aimed to assess the breast cancer clinicopathologic characteristics according to the age groups. The research was conducted on 98 Medical Records from Bethesda Hospital Yogyakarta. The variable data were analyzed by univariate and the association between variables were analyzed with binary logistic regression with odds ratio and 95% confidence interval. The presentation of age groups ≤ 30 years (1,02%), 31-40 years (12,24%), 41-50 years (25,51%), 51-60 years (46,94%), and ≥ 61 years (15,31%); right breast (48,98%) and left breast (51,02%); stage I (3,06%), II (28,57%), III (55,10%), dan IV (13,27%); ductal type of breast cancer (89,80%) and others (10,20%); molecular subtype luminal A (43,88%), luminal B (14,29%), HER-2 neu enriched (29,59%), and basal-like/triple-negative (12,24%). There wasn’t any association between age groups and stages (p=0.368). There was an association between age groups and molecular subtype (p=0.013, OR 2.993 CI95% 1.239-7.230). Conclusions: The commonest clinicopathologic characteristic of breast cancer patients were in the age group 51-60 years, left breast, high stage, ductal type, and luminal A. Hormone receptors in breast cancer expressed more common in patients ≤50 years.

An Overview of Patients of Appendicitis and Surgical Site Infection Postappendectomy at Bethesda Hospital Yogyakarta Period 2019-2020

Appendicitis is inflammation of the appendix and is the case most often encountered by surgeons. This study aims to study the description of appendicitis and surgical site infection post appendectomy patients based on age, gender, type of appendicitis, chief complaint, temperature, leukocytes, preoperative antibiotics, type of appendectomy, duration of surgery, and surgical wound infection. The design of this study was descriptive observation using retrospective data from the medical records of appendicitis patients treated at Bethesda Hospital, Yogyakarta City in 2019-2020 with the whole sampling method. The highest distribution of age is the young adult age group at 43.58%. Appendicitis patients were more male (58.46%). The highest distribution of types of appendicitis was appendicitis simplex (39.48%). The chief complaint of right lower abdominal pain was found in all patients (100%). The highest distribution of body temperature was under 38ºC (94.36%) and the highest distribution of leukocyte count was under 16.000/mm3 (67.18%). Preoperative antibiotics were given to 89.74% of patients. The most common type of appendectomy performed was open appendectomy (60.51%) with the highest distribution of operation duration being 60–90 minutes (57.95%). The incidence of surgical wound infection was found in 4 people (2.05%). In conclusion, the results of this study are in accordance with the theory that has been included in the background.

Factors Associated with Retained Placenta: A Case-Control at Bethesda Hospital Yogyakarta

Background The retained placenta is a common cause of postpartum bleeding. Many conditions commonly can be found in pregnant women cause retained placenta.Objective This study aims to identify factors associated with retained placenta.Method This study was performed as an observational analytic study with a case-control method. The data used is secondary data, using normal postpartum mothers (n=74) and postpartum women diagnosed with the retained placenta (n=37) medical records, at Bethesda Hospital from 2013 until 2018. Variables were analyzed using simple logistic regression to measure crude odds ratio and using multiple logistic regression to calculate adjusted odds ratio.Results The factor associated with retained placenta was preterm labor (OR 37.16; CI 95% 6.98-197.84). Age (OR 1.32; CI 95% 0.34-5.19), anemia in pregnancy (OR 2.43; CI 95% 0.83-7.14), history of previous cesarean section (OR 9.63; CI 95% 0.79-117.36), history of curettage (OR 3.65; CI 95% 0.93-14.37) and parity (OR 2.07; CI 95% 0.72-5.98) increasing risk to develop retained placenta, but not statistically significant.Conclusion A history of previous cesarean section and preterm labor statistically increases the risk of retained placenta in Bethesda Hospital Yogyakarta. Age, anemia in pregnancy, and history of curettage were clinically associated with retained placenta, but not statistically significant.

CLINICAL SKILLS TEACHING USING PATIENT EXAMINATION VIDEO DURING THE COVID-19 PANDEMIC

Background: The current situation of the COVID-19 pandemic has changed the clinical learning system, which was originally fully face-to-face or blended, to be fully online. Skills lab, as one of the most routine medical skills education methods in the undergraduate medical education phase, must also adapt its implementation by optimizing the full-online approach. The purpose of this review was to investigate how patient examination videos can be used as clinical skills educational tool during the COVID-19 pandemic.Learning Media Review: The selected patient video is an unedited, soundless recording of a neurologist doing a pathological reflex test at Bethesda Hospital Yogyakarta. During clinical skills laboratory sessions, videos are displayed concurrently with introductory lectures to examine abnormal reflexes.Conclusion: This study demonstrates that using actual patient videos in clinical skills sessions is acceptable and well-implemented. This is an excellent alternative method of acquiring clinical competencies during the COVID-19 pandemic era.

Characteristic of Red Blood Cell Profile as a Predictor of 30-Day Clinical Outcome in Ischemic Stroke Patients

Ischemic stroke is the most common type of stroke in Indonesia. Measuring inflammatory biomarkers (IL-6) is a way to predict clinical outcomes in ischemic stroke patients. However, the laboratory test is very expensive, so it requires another test that can represent the inflammation, for instance, by measuring RDW and MCV value when hospitalized. Hence, this study aims to measure RDW and MCV value of ischemic stroke patients at admission with a 30-day clinical outcome (disability). This study is a retrospective cohort that used secondary data from medical records of ischemic stroke patients in Bethesda Hospital Yogyakarta and was conducted on 105 subjects. They are divided into two groups by their mRS score in 30-day after onset, (1) the independent group (mRS score of 0- 2), (2) the dependent group (mRS score of 3-6). After that, these two groups are analyzed by an independent t-test. High RDW and low MCV value at admission increased 30-day disability risk. There was a statistically significant RDW value and 30-day clinical outcome (p=0,008), but there was no statistically significant MCV value and 30-day clinical outcome (p=0,277). 30-day clinical outcome in ischemic stroke patients can be predicted by their characteristic of red blood cell profile at admission.

HUBUNGAN KOMORBIDITAS TERHADAP DERAJAT KEPARAHAN ADMISI DAN OUTCOME PASIEN COVID-19

COVID-19 is a disease cause by SARS-CoV-2. One of the concerning clinical consideration is the presence of comorbid in patients. The purpose of this research is to identify the association between the comorbidities toward severity of admission and the outcome of COVID-19 patients at Bethesda Hospital Yogyakarta. The research was done observationally with a cross sectional design on 206 COVID-19 patients that was confirmed through RT-PCR at Bethesda Hospital Yogyakarta of June 2020 – June 2021 period. The comorbid data from COVID-19 patients will be analyzed in association to the severity of admission which is divided into mild, moderate, severe and critical degrees as well toward the outcome of COVID-19 patients. The data obtained were analyzed using the chi-square test with a significance level of 0.05. COVID-19 patients with comorbid were found 125 patients (60,68%). The most common comorbidities were cardiovascular disease (38,8%), followed by diabetes (31,6%), and kidney disease (12,1%). COVID-19 patients with two or more comorbidities as 59 (28.64%) and significantly have an association to the severity of admission and the outcome of the patient (p&lt;0,001). The severity of severe (69%) and critical (89,4%) admissions was significantly higher in comorbid COVID-19 patients (p&lt;0,001) and the mortality rate (88,6%) was significantly higher in case of comorbid COVID-19 patients (p&lt;0,001), and COVID-19 patients who do not have comorbidities are 5,073 times more likely to be cured compared to patients who have comorbidities. There is an association between comorbidity toward severity of admission and outcome of COVID-19 patients.

The role of clinical reminder system to drug prescribing on patients of the National Health Insurance with ischemic stroke

Since 2014 Indonesia has entered the era of universal health coverage (UHC) and public health financing system managed by the Social Security Organizing Agency Law/SSOAL (Badan Penyelenggara Jaminan Sosial/BPJS) . In this system, a national formulary was used as the basis for prescribing drugs by clinicians. One effort for quality and cost control in UHC was to develop a clinical reminder system (CRS) to help prescriber set treatment options in accordance with the national formulary. The aim of this study was to measure the role of CRS to the compatibility of drug prescribing in patients with ischemic stroke in Bethesda Hospital Yogyakarta, Indonesia. This study was carried out using quasi-experimental with pre-test and post-test design. The subjects of this study were outpatient ischemic stroke and the National Health Insurance (NHI) participant, age &gt;18 years and had complete medication data. Prescribing data were compared between stroke patients treated at the hospital before and after implementation of CRS. The study was performed in 200 National Health Insurance (NHI) scheme outpatients with ischemic stroke. The groups consisted of 100 patients without CRS and 100 patients with CRS. The basic characteristics of both groups were similar. The results showed that after implementation of CRS, a significant improvement in the compliance of the neurologist prescribing medicine used to be available only in national formulary (RR: 1.02; 95% CI=1.00-1.04; p=0.015). Among others the most significant improvement was the prescription of antidyslipidemic using HMG-CoA medicine available in formulary. In conclusion, CRS can improve the compliance of prescribing with national formulary in stroke ischemic patients.

Case Report Chest Non-contrast ct-scan findings and follow up a patient suspected covid-19 infection

Background Covid-19 is an infection caused by SARS-CoV-2. Chest X-Ray (CXR) examination doesn’t show the radiographiccharacteristic of Covid-19 infection. Thorax CT-Scan is the gold standard imaging for pneumonia Covid-19 infection.Aim The purpose of this report is to describe a case of bronchopneumonia in a male patient aged 48 years old at Bethesda Hospital Yogyakarta during the Covid-19 pandemic.Case Description A 48 years old male patient came to the Bethesda Hospital in Yogyakarta with a complaint of fever 1 week before being hospitalized. The patient also complained of cough, sore throat, rhinorrhea, shortness of breath, malaise, and decreased appetite. The rapid test result shows SARS-CoV2 IgM and IgG (+), PCR swab Covid-19 results (+). Bronchopneumonia was concluded by CXR examination and chest non-contrast CT-Scan showed Covid-19 infection imaging characteristics. Later on, the patient showed clinical and radiological improvement.Conclusion Covid-19 is an infection caused by the SARS-CoV-2. Common symptoms are fever, cough, sore throat, shortness of breath, and malaise. CXR examinations on patients with Covid-19 infection show images of pneumonia, in this case, bronchopneumonia was concluded. CT-scan shows characteristic imaging of Covid-19 infection can support the decision on regular ward admission versus ICU and for follow-up in regular ward admission.