Djamil General Hospital Research Articles

The Relationship between Neutrophil-Lymphocyte Ratio to Intestinal Viability in Invagination Patients at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Invagination is an acute condition in the pediatric abdomen that results in obstruction and constriction of blood vessels (strangulation) in the proximal intestinal mesenterium trapped in the distal intestine, allowing necrosis of surrounding tissue. Intestinal necrosis and perforation in children are causes of abdominal emergencies that require immediate surgery. In supporting examinations, neutrophil, lymphocyte, and biomarker combination ratios have been used for early detection of systemic inflammatory markers. The threshold value of several biomarkers should be investigated to assess the occurrence of strangulation in the pre-operative period in invaginated patients. This study aimed to determine the relationship between neutrophil-lymphocyte ratio and intestinal viability in pediatric patients with invagination.
 Methods: This study used retrospective analytic data collection from medical records of invagination patients at Dr. M. Djamil General Hospital Padang for the period January 1, 2020, to December 31, 2022.
 Results: The majority of subjects were male (53.8%) at the age of ≤ 1 year, with as many as 87.2% having a diagnosis of operative invagination (76.9%) and 56.4% having intestinal viability. The mean neutrophil, lymphocyte, and NLR values were 62.15±17.68, 19.03±8.97, and 3.74±1.55, respectively. The pathological NLR status was found to be 59%. The p-value for the association of diagnosis with intestinal viability was 0.002. The p-value for the relationship between NLR and intestinal viability was 0.001, and the r-calculated was -0.528.
 Conclusion: There is a significant relationship between NLR value and disease diagnosis on intestinal viability.

The Relationship between Plasma Glutamate Levels and Sleep Quality in HIV Patients

Background: Disturbance sleep quality is often found in sufferers of human immunodeficiency virus (HIV). Disturbed sleep quality can affect immunity, which ultimately can increase patient morbidity and mortality. Impaired sleep quality in HIV sufferers is related to neurotoxicity due to the HIV virus, which damages sleep architecture. HIV infection can cause an increase in brain extracellular glutamate. Elevated glutamate plays a role in neuronal and glial damage and death. This study aimed to assess the relationship between plasma glutamate levels and sleep quality in HIV sufferers.
 Methods: The research uses a cross-sectional design. The samples were HIV sufferers in a polyclinic voluntary counseling test (VCT) internal medicine of Dr. M. Djamil General Hospital Padang, who met the inclusion and exclusion criteria. Samples are selected by consecutive methods. Sleep quality was assessed using a questionnaire called the Pittsburgh sleep quality index (PSQI). Plasma glutamate levels were measured using the ELISA method. Statistical analysis using SPSS with a p-value <0.05 was considered statistically significant.
 Results: The research sample consisted of 82 people. The median plasma glutamate level was 16.39 µg/mL. Impaired sleep quality was found in 45 (54.9%) HIV sufferers. There was no significant relationship between plasma glutamate levels (p= 0.506), age (p=0.795), gender (p=0.547), education (p=0.358), occupation (p=0.255), disease duration (p=0.348), stage (p=0.309) and type of ARV therapy (p=0.791) with sleep quality in HIV sufferers. From this research, a significant relationship was found between sleep quality, body mass index (BMI) (p= 0.015), and marital status (p= 0.039).
 Conclusion: There is no relationship between plasma glutamate levels and sleep quality in HIV sufferers. There are other factors that influence sleep quality, namely BMI and marital status.

The Difference of Survival Rate COVID-19 in Patients with Initiated Hemodialysis and Regularly Hemodialysis

Background: Since December 2019, a novel coronavirus called SARSCoV-2 (severe acute respiratory syndrome coronavirus) has caused an international outbreak of respiratory illness described as COVID-19. This study aimed to describe the difference in the survival rate of COVID-19 induced AKI with hemodialysis and COVID-19 in patients with CKD on hemodialysis in Dr. M Djamil General Hospitals. Also, in this review, we provide a comprehensive overview of data on the factors that may be affected by COVID-19 survival rates in patients with COVID-19 induced AKI with hemodialysis and COVID-19 in patients with CKD on hemodialysis. This study was conducted to analyze the survival of COVID-19 with initiated or regular HD patients in Dr. M. Djamil General Hospital, Padang, Indonesia.
 Methods: This study was conducted from January 2021 to July 2021 in Dr. M. Djamil General Hospital, Padang, West Sumatera, Indonesia. Data for this study was collected through medical records of patients admitted for COVID-19 with CKD in hemodialysis and acute renal failure induced by COVID-19 to show the demographics, comorbidities, and survival rates of the patients who underwent hemodialysis.
 Results: Factors associated with survival in COVID-19 with hemodialysis were COVID-19 severity and abnormal potassium serum level (Table 3). Moderate COVID-19 patients tend to survive than severe COVID-19 patients (OR 60; 95% CI 16.034 – 224.525). There was no significant difference in survival between initiated and regular HD (p = 0.829).
 Conclusion: There is no difference in clinical outcome from patients with COVID-19 who initiated hemodialysis or regularly HD to the survival rates.

The Role of Vitamin D Binding Protein and Vitamin D Level in Mortality of Sepsis Patients.

Vitamin D plays crucial roles in immune cell function, including macrophage activation, immune response modulation, and antimicrobial peptide production. Low vitamin D levels can result in reduced immune response, heightened inflammation, and impaired organ function, thereby exacerbating sepsis severity and impacting patient prognosis. This study investigates the influence of vitamin D binding protein expression and vitamin D levels on the mortality of septic patients. This analytical observational study employs a case-control approach and involves patients at the Critical Care Unit of Dr. M. Djamil General Hospital in Padang, Indonesia. The study comprises 40 patients in the case group and 40 patients in the control group. Vitamin D and vitamin D binding protein levels are assessed using the enzyme-linked immunosorbent assay method. Vitamin D and vitamin D binding protein levels were observed to be lower in the case group compared to the control group. In the case group, the majority of patients had vitamin D binding protein levels below 200 µg/mL. A significant association was found between vitamin D levels and mortality in sepsis patients (P< 0.05). Patients with vitamin D levels below 20 µg/mL faced a 2.54 times higher risk of mortality than those with levels exceeding 20 µg/mL. Diminished levels of vitamin D binding protein and vitamin D contribute to an increased risk of mortality in septic patients.

EP16.14: Placenta accreta spectrum disorder, an obstetrical challenge: a case series at a tertiary hospital (M Djamil General Hospital Padang) in Indonesia

EP16.14: Placenta accreta spectrum disorder, an obstetrical challenge: a case series at a tertiary hospital (M Djamil General Hospital Padang) in Indonesia

EP16.28: Descriptive study of placenta accreta cases in M Djamil General Hospital Padang (a tertiary hospital) in Indonesia in 2022

EP16.28: Descriptive study of placenta accreta cases in M Djamil General Hospital Padang (a tertiary hospital) in Indonesia in 2022

Comparison of Outcomes in Patients with Malignant Pleural Efusion et Causa Breast Cancer Metastase Thought of Pleurodesis with Talc Poudrage and Talc Slurry at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Breast cancer accounts for about 50-65% of malignant pleural effusions. Talc pleurodesis is one of the definitive procedures for pleural effusions in which the route of administration is divided into poudrage and slurry. This study aimed to compare the differences of outcomes in malignant pleural effusion patients et causa breast cancer metastase who receive pleurodesis therapy with talc poudrage and talc slurry.&#x0D; Methods: This study has a cross-sectional design, which was conducted at Dr. M. Djamil General Hospital in May – July 2023. This study used medical records of patients diagnosed with malignant pleural effusion due to metastases of breast cancer at Dr. M. Djamil General Hospital Padang from January 2019 – July 2023. The outcomes assessed included drain production in 24 hours, drain release time, and in-hospital mortality.&#x0D; Results: In this study, 12 respondents who have talc poudrage and talc slurry pleurodesis were included. In the talc poudrage group, the mean of 24-hour drain production was 259.17 ± 46.79 ml, the mean of drain release time was 4.08 ± 0.66 days, and there was one respondent who died during hospitality. In the talc slurry group, the mean of 24-hour drain production was found to be more (420.83 ± 78.21 ml), drain release time was found to be much longer (5.67 ± 0.98 days), and 3 respondents died in hospital. The bivariate analysis found a significant difference between the 24-hour drain production and drain release time of patients who underwent talc slurry and talc poudrage meanwhile there was no difference in hospital mortality.&#x0D; Conclusion: Talc poudrage has a better outcome than talc slurry regarding drain production and drain release time in patients with malignant pleural effusion due to metastases of breast cancer.

Indoxyl Sulphate Levels and Its Relation with Executive Function in Routine Hemodialysis Patients

Executive function is a crucial cognitive domain that can be adversely affected by various toxic substances, including the uremic toxin indoxyl sulfate. Although it's known that indoxyl sulfate has harmful effects on intra or extra-kidney organs, its impact on executive function remains unclear. This study aimed to evaluate indoxyl sulfate levels in patients with chronic kidney disease (CKD) undergoing hemodialysis and to understand its correlation with executive function impairments. This observational cross-sectional study was conducted at the Dr. M. Djamil General Hospital Padang Hemodialysis Unit from March to July 2022; 60 patients undergoing hemodialysis and 20 healthy controls participated. Executive function was assessed using the Trail Making Test B (TMT-B). Indoxyl sulfate levels were quantified using an ELISA assay with the Assay Genie kit. The Mann-Whitney test set statistical significance at a p&lt;0.05. The average age of the subjects was 51.4±11.4 years, with 53.3% being male. The mean indoxyl sulfate levels were considerably higher in the CKD group (118.79 ng/mL, range: 11–1,709 ng/mL) compared to the control group (6.028±1.829 ng/mL), with a significant difference (p&lt;0.001). Impaired executive function was observed in 75% of the CKD patients. The average indoxyl sulfate level was 165.12 ng/mL (range: 29–1709 ng/mL) in the impaired executive function group and 71.22 ng/mL (range: 11–333 ng/mL) in the group with normal executive function, indicating a significant difference (p=0.013). Patients with CKD undergoing hemodialysis exhibit elevated serum indoxyl sulfate levels compared to healthy individuals. Moreover, CKD patients with impaired executive function have notably higher indoxyl sulfate levels than those with normal executive function. Further research is needed to elucidate the mechanistic links between indoxyl sulfate and cognitive impairments.

Comparing the Optical Coherence Tomography Outcomes of Intravitreal Injection Anti Vascular Endothelial Growth Factor in Branch Retinal Vein Occlusion (BRVO)

Background: BRVO is a blockage of the branches of the retinal vein due to a thrombus. The prevalence of 10-year BRVO is 1.6 per 100 subjects. The effect of anti-VEGF injection on BRVO management is effective in improving visual acuity and reducing macular oedema.&#x0D; Case presentation: A man, 32 years old, presented to the ophthalmology clinic at the Dr. M. Djamil General Hospital with a chief complaint of blurred vision in his left eye 1 week before admission. The blurred vision began suddenly. Visual acuity in LE was 20/50 and did not advance with a pinhole. Funduscopic examination of LE showed clear media, rounded papillae with well-defined borders, blood vessels aa:vv = 1:3, venous tortuosity (+) increased in the inferotemporal quadrant; retina: Bleeding (+) with dot blot and flame-shaped inferiorly, exudate (+) cotton wool spots at the inferotemporal region; foveal reflex (+)↓ on the macula. OCT LE examination showed macular intraretinal hypo-reflection and macular thickening with a central macular thickness of 617 μm. The physical examination showed a body weight of 114.9 kg, a height of 173 cm, and a body mass index of 38.4. Within 5 months after 3 times administrations of intravitreal injections of anti-VEGF bevacizumab and ranibizumab, visual acuity of LE: 20/25 was obtained, and increased appearance of the retinal fundus and OCT LE.&#x0D; Conclusion: Intravitreal injection therapy of anti-VEGF bevacizumab and ranibizumab is effective in reducing macular oedema and restoring visual acuity in BRVO.

Tracheostomy as an Effort to Help Weaning Ventilated Obese Patient: A Case Report

Background: The prevalence of tracheostomy in the ICU was performed in 10%-15% of patients. Tracheostomy is performed in patients with prolonged intubation. The most compelling indications for tracheostomy are acute respiratory failure with prolonged or expected prolonged duration of mechanical ventilation and failure to wean from a mechanical ventilator. &#x0D; Case presentation: A 60-year-old female patient came to the emergency room of Dr. M. Djamil General Hospital with decreased consciousness 2 days before admission. Vital signs showed Sopor consciousness, RR: 30 x/min, and BMI: 39 kg/m2. Thorax examination of bronchovesicular breath sounds, rhonchi +/+, wheezing +/+. The patient was intubated and put on a ventilator, and admitted to the ICU. A tracheostomy on day 5 was performed on the patient. The patient was able to be weaned from the ventilator and then admitted to the neurology ward on day 18.&#x0D; Conclusion: Tracheostomy can help weaning patients from mechanical ventilation. In this case, a severely obese patient can be weaned from the ventilator with a tracheostomy.

Bartter Syndrome: A Case Report

Background: Bartter's syndrome refers to a group of genetic disorders that affect the renal tubular system, which is responsible for reabsorbing various substances such as sodium, potassium, and chloride from the urine into the blood. This study aimed to present a clinical case related to Bartter syndrome.&#x0D; Case presentation: A 52-year-old male patient in the internal medicine department of Dr. M. Djamil General Hospital Padang with the main complaint of weakness in both legs increasing since 1 day ago. On laboratory examination, the patient found potassium 1.7 mmol/L, indicating hypokalemia. Renal function examination showed normal kidney function. Examination of blood gas analysis showed results of metabolic alkalosis. Examination of urine potassium obtained potassium levels of 22 mmol/day, urine osmolarity of 140 mOsm/kgH2O at serum osmolarity of 274 mOsm/kgH2O, with TTKG (transtubular potassium gradient) = 28. The patient was diagnosed with Bartter syndrome. Treatment is carried out by administering KSR tablets 3x600 mg orally while monitoring electrolytes regularly.&#x0D; Conclusion: This patient has hypokalemia, metabolic alkalosis, normal magnesium and calcium, and hypercalciuria. This patient is diagnosed with Bartter syndrome.

Intensive Strategy Resuscitation of Hemorrhagic Shock Patients with Ectopic Pregnancy in the Intensive Care Unit: A Case Report

Background: Ectopic pregnancy is a health problem in women of reproductive age whose products of conception implant outside the endometrium. Fluid resuscitation and maintenance and adequate treatment in intensive care unit can reduce mortality and morbidity in patients.&#x0D; Case presentation: A 19-year-old woman came to the emergency department of Dr. M. Djamil General Hospital Padang with complaints of pain in the lower abdomen for 8 hours before entering the hospital. Physical examination results and obtained anemic conjunctiva (+)/(+). Check-up result in deep vaginal touch (VT) was obtained portion rocking pain (+). Then inspection culdosynthesis with results (+). The patient was diagnosed with acute abdominal ec suspected ruptured ectopic pregnancy at G2P1A0H1 gravid 8-9 weeks with severe anemia. After undergoing laparotomy, the patient was admitted to the ICU for 2 days.&#x0D; Conclusion: Adequate resuscitation of fluids and blood products and overcoming shock causes are crucial in managing hemorrhagic shock in the intensive care unit.

Relationship between Breast Cancer Subtypes and Serum CA 15-3 Levels with the Incidence of Pleural Effusion in Breast Cancer Patients at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Breast cancer is a disease that has a high incidence rate worldwide. Serum CA 15-3 levels have been used extensively as a tumor marker in breast cancer and can assist in early detection, monitoring of response to therapy, and monitoring of recurrence. This study aimed to evaluate whether there is a relationship between breast cancer subtypes and serum CA 15-3 levels with the incidence of pleural effusion in breast cancer patients at this hospital.&#x0D; Methods: This study was a cross-sectional observational study. A total of 176 research subjects participated in this study. Analysis of the relationship between breast cancer and CA 15-3 levels with pleural effusion was carried out univariate and bivariate using SPSS version 25.&#x0D; Results: The results showed that there was a significant relationship between CA 15-3 serum levels and the incidence of pleural effusion in breast cancer patients (p-value = 0.0001). There was no statistically significant relationship between breast cancer subtypes and the incidence of pleural effusion (p-value = 0.105). There was no relationship between serum CA 15-3 levels and the incidence of pleural effusion in breast cancer patients based on breast cancer subtype (p-value&gt; 0.005).&#x0D; Conclusion: There is a significant relationship between serum levels CA 15-3 serum with the incidence of pleural effusion in breast cancer patients at Dr. M. Djamil General Hospital, Padang, Indonesia.

Intensive Management of Diffuse Peritonitis Caused by Spontaneously Healed Gastric Perforation: A Case Report

Background: Gastric perforation will cause acute peritonitis. Proper diagnosis and management, especially in ICU, are needed to prevent complications and even death from this event. This study aimed to describe the intensive management of diffuse peritonitis caused by gastric perforation.&#x0D; Case presentation: A 61 years old male patient presented with pain in the whole abdomen for 6 days before admission. The pain began at the epigastrium and suddenly spread to the whole abdomen. The pain was felt continuously and increased by movement. Routine blood examination revealed anemia, lekousitosis, and radiology examination found homogeneous confluence was found in the abdominal, dilated small intestine, psoas line was not visible, in the left lateral decubitus position, an air-fluid level and free air were found. The patient underwent diagnostic laparoscopic surgery + peritoneal lavage on emergency surgery for 2 hours, obtained a resolution of gastric perforation, and the patient was treated postoperatively in the ICU of Dr. M. Djamil General Hospital.&#x0D; Conclusion: Cases of spontaneous resolution of gastric perforation are not only in terms of surgical management but in terms of postoperative care. It also plays an important role in the success and good results in cases of gastric perforation.

Risk Factors of Contrast-Induced Nephropathy in Patients Undergoing Coronary Intervention Procedures

Introduction: Coronary intervention (coronary angiography and percutaneous coronary intervention) is a medical procedure that uses significant amounts of contrast, which can lead to an increased incidence of contrast-induced nephropathy (CIN). This study aimed to determine the risk factors for contrast-induced nephropathy in patients undergoing coronary intervention procedures at Dr. M Djamil General Hospital, Padang, Indonesia.&#x0D; Methods: This study is a cross-sectional analytic observational study. A total of 100 research subjects participated in this study. Univariate analysis of the frequency distribution was performed on the variable test. Bivariate analysis was performed to determine the risk factors associated with CIN in patients undergoing coronary intervention procedures, p&lt;0.05.&#x0D; Results: The results of the study showed that contrast volume ≥ 100 ml was associated with the incidence of CIN, p&lt;0.05. In addition, serum creatinine level &gt; 1.5 mg/dL was associated with the incidence of CIN, p&lt;0.05.&#x0D; Conclusion: Contrast volume ≥ 100 ml and serum creatinine level &gt; 1.5 mg/dl increase the risk of contrast-induced nephropathy in patients undergoing coronary intervention procedures at Dr. M Djamil General Hospital, Padang, Indonesia.

The Relationship between Clinical Appearance and Albumin Levels in Pulmonary Tuberculosis (TB) Patients at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Pulmonary TB is strongly associated with malnutrition. Malnutrition is often found in pulmonary TB patients, especially hospitalized patients, and can worsen the treatment and recovery outcomes of pulmonary TB patients. Pulmonary TB patients can experience a significant decrease in albumin levels, and albumin is the largest protein in blood plasma. This study aimed to determine the relationship between the patient's clinical appearance and albumin levels in pulmonary tuberculosis patients at Dr. M. Djamil General Hospital, Padang, Indonesia.&#x0D; Methods: This study was an analytic observational study with a retrospective cohort approach. A total of 177 research subjects participate in this study. Observations on sociodemographic data, clinical data, and laboratory data were carried out in this study. Data analysis was carried out using SPSS version 25 univariate and bivariate.&#x0D; Results: Clinical appearance of pulmonary TB patients treated in the pulmonary ward isolation room at Dr. M. Djamil General Hospital, Padang, Indonesia, which is significantly related to albumin levels is BMI (underweight and normal) and complications pneumothorax (p&lt;0.05); while other clinical appearances such as onset and complications of coughing up blood, pleural effusion, hydropneumothorax, and without complications not related to albumin levels (p&gt;0.05).&#x0D; Conclusion: BMI (underweight and normal) and complications pneumothorax is a clinical picture related to albumin levels in pulmonary tuberculosis patients at Dr. M. Djamil General Hospital, Padang, Indonesia.

The Outcome of Concurrent Intracameral Fluconazole Injection with Amniotic Membrane Transplantation for Fungal Keratitis in Dr. M. Djamil General Hospital: A Case Series

Background: Fungal keratitis is often difficult to eradicate and requires long treatment. Antifungal agents have lower efficacy because of low tissue penetration and the indolent nature of the infection. Fluconazole has effective ocular penetration ability, reaching aqueous concentration as same as plasm concentration. Multilayer amniotic membrane transplantation (MLAMT) has been shown to be a promising surgical procedure to reconstruct the ocular surface by supporting the epithelialization of the cornea and having protective antimicrobial properties. This study aims to report the outcome of concurrent intracameral fluconazole injection with amniotic membrane transplantation for fungal keratitis in Dr. M. Djamil General Hospital.&#x0D; Case presentation: Four inpatients in the ophthalmology ward of Dr. M. Djamil General Hospital with moderate to severe fungal keratitis. All patients were first treated with medications. Because the patients did not show clinical improvement after getting maximum therapy, they underwent intracameral fluconazole injection concurrent with MLAMT. MLAMT was performed with multilayered amniotic membranes to fill and cover the defect. The bandage contact lens was placed to protect and keep the MLAMT in place and for patients’ comfort. Patients were then observed for signs of inflammatory reaction and epithelialization. All patients showed reduced inflammation and improved epithelization after surgery.&#x0D; Conclusion: Concurrent intracameral fluconazole injection with MLAMT can be considered an alternative treatment for refractory fungal keratitis as it decreases the rate of inflammation and improves epithelization.

Clinical Grading of Corneal Ulcer and Its Management in Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Infectious corneal ulcer (CU) occurs due to an agent, which may be a bacterial, fungal, or viral microorganism. A detailed examination of the ulcer was needed to determine the severity grading of the ulcer. Based on the size, depth of ulcer, density of infiltrate, and scleral involvement, it's divided into mild, moderate, and severe grades and may be used to objectively monitor the progress of the ulcer and as a parameter for management. Medical management includes topical, systemic antibiotic, and periocular injection, while amniotic membrane transplantation (AMT), conjunctiva flap, fascia lata, and evisceration as surgical. This study aimed to assess the clinical grading associated with the management of CU in Dr. M. Djamil General Hospital, Padang, Indonesia.&#x0D; Methods: Observational analytics based on the medical record of corneal ulcer patients in Dr. M. Djamil General Hospital, Padang, Indonesia, in 2016-2017. A total of 191 research subjects participated in this study. Data analysis was carried out using SPSS univariately.&#x0D; Results: The fungal, bacterial, and viral CU was diagnosed clinically. The severity grading that we found is moderate (60,73%), mild (25,14%), and severe (14,13%). All of the cases used medical treatment. Surgical was performed in moderate (36,59%) and all severe cases. AMT was performed in severe cases with perforation ≤ 4 mm and perforation &gt; 4 mm conjunctival flap (3.7%), fascia lata (3,7%), and evisceration (61,53%), preferably.&#x0D; Conclusion: The clinical grading of corneal ulcers in our hospital is moderate, and it may be associated with our hospital as a referral hospital. Surgery was performed in all severe and moderate cases that don't respond well to medicine.

Characteristics of Adult Sepsis Patients Admitted to Department of Internal Medicine, Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to infection. Septic shock is the most dangerous complication of sepsis, characterized by abnormalities in the circulatory and metabolic systems. This study aimed to determine the characteristics of adult sepsis patients admitted to the department of internal medicine of Dr. M. Djamil General Hospital, Padang, Indonesia.&#x0D; Methods: This research was a descriptive study and used secondary data from medical records. Samples in this study were medical record data from the medical record installation of Dr. M. Djamil General Hospital, Padang, Indonesia. The inclusion criteria were adult patients aged more than 18 years old, diagnosed with sepsis, and hospitalized in the department of internal medicine for the period of January 2020 to December 2021.&#x0D; Results: Most of the sepsis patients were mostly aged more than 60 years old (51.7%), female (57.2%), and had normal BMI scores (59.3%). The infections mainly originated from the lungs (80%), the most common comorbid disease was chronic kidney disease (26.4%), the most frequent causing microorganism was Escherichia coli (15.9%), the frequent degree of severity was a septic shock (60%), and cefepime was used as the initial empirical antibiotic (44.8%).&#x0D; Conclusion: Most sepsis patients were adults aged more than 60 years old and females, with the focus on infection originating from the lungs, degree of severity in the form of septic shock, and the most used initial empirical antibiotic, namely cefepime.&#x0D;

The Relationship between Cholesteatoma Stage and Hearing Bone Erosion Degree in Chronic Suppurative Otitis Media Patients with Cholesteatoma at Dr. M. Djamil General Hospital, Padang, Indonesia

Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear mucosa and mastoid space. Cholesteatoma is an ectopic keratinized epithelial tissue that develops through the mucosa of the middle ear cavity and desquamates, resulting in the accumulation of keratin and epithelial debris. This study aimed to determine the relationship between the stage of cholesteatoma and the degree of erosion of the ossicles in patients CSOM with cholesteatoma at Dr. M. Djamil General Hospital, Padang, Indonesia.&#x0D; Methods: This study was an observational case series study. A total of 70 research subjects were included in this study, and the research subjects met the inclusion criteria. The inclusion criteria in this study were patients with a diagnosis of CSOM with cholesteatoma at Dr. M. Djamil General Hospital, Padang, Indonesia and have complete medical record data. Data analysis was carried out using SPSS software version 25. Correlation analysis between cholesteatoma stage and degree of osseous erosion was performed using the Spearman correlation test, p&lt;0.05.&#x0D; Results: The majority of research subjects were aged 21-30 years (28.6%) and were male (51.4%). Based on clinical symptoms, the majority of patients experience otorrhoea for 5 to 10 years (47.1%), perforated type membrane total tympani (54.3%), degree of erosion of the ossicles type D (48.6%), stage 4 cholesteatoma (61.4%) and granulation tissue (81.4%).&#x0D; Conclusion: There is a relationship between the stage of cholesteatoma and the degree of erosion of the ossicles in patients with CSOM (chronic suppurative otitis media) with cholesteatoma at Dr. M. Djamil General Hospital, Padang, Indonesia.