Hasan Sadikin General Hospital Bandung Research Articles

Overview of Characteristics of Parathyroid Tumor Patients at Dr. Hasan Sadikin General Hospital Bandung, Indonesia: A 5-Year Study

Background: Parathyroid tumors are the most common endocrine neoplasms, with hyperparathyroidism as the main clinical manifestation. Parathyroid adenoma is the most common benign neoplasm, while parathyroid carcinoma is relatively rare but difficult to differentiate from benign disorders. This study aims to describe the characteristics of parathyroid tumor patients at Dr. Hasan Sadikin General Hospital (RSHS) Bandung over the last 5 years. Methods: This descriptive observational research was carried out by collecting medical record data from parathyroid tumor patients at RSHS Bandung for the 2019-2023 period. Parameters identified included age, gender, and histopathological type. Data analysis was carried out using SPSS univariately. Results: There were 12 patients with parathyroid tumors with an increasing trend in cases over the last 5 years. The average age of patients was 37.33 years, with the majority (9 cases) being women. Parathyroid adenoma was the most common histopathological type (8 cases), followed by parathyroid carcinoma (2 cases), osteitis fibrocystica (1 case), and bone deformity (1 case). One patient with parathyroid adenoma was also diagnosed with fibrous dysplasia. Conclusion: The majority of cases of parathyroid tumors at RSHS Bandung occur in women, with the incidence of parathyroid carcinoma being the same in men and women. Parathyroid adenoma is the most common histopathological type, and bone abnormalities complications can occur in patients with parathyroid disorders (3 patients).

Characteristics Of Pleomorphic Adenoma at Oral and Maxillofacial Surgery Department Dr. Hasan Sadikin General Hospital Bandung Period 2017-2022

Introduction: Pleomorphic adenoma (benign mixed tumors) is the most common neoplasm affecting both major and minor salivary glands, slow growing, asymptomatic, and unilateral. The most affected location of the tumor is major salivary glands namely parotid glands and in minor salivary glands, it manifests in the intraoral, namely the palate region. This study aims to obtain information about the characteristics of patients with pleomorphic adenoma at the Oral and Maxillofacial Surgery Department of Hasan Sadikin General Hospital Bandung. Methods: This study is a retrospective descriptive analysis method based on the medical data record of a patient who was diagnosed with pleomorphic adenoma and undergoing treatment at Oral and Maxillofacial Surgery Department of Hasan Sadikin General Hospital Bandung period 2017 to 2022. The data obtained include age, gender, patient domicile, tumor predilection location, supporting examination, and definitive treatment. Results: The total participants in this study were 27 patients, with women 8 (70%), range at the age of 31-50 years old (30%). The majority of patients were from Bandung City (56%). Most of the lesion were found in major salivary glands was at parotid gland with 3 patient (10%) and in minor salivary was at the palate region with 18 patients (77%). Most common supporting examination used in this study were fine needle aspiration biopsy (FNAB), panoramic x-ray, and CT scan, with definitive treatment received by the respondent were surgical excision. Conclusion: Pleomorphic adenomas are often occurred in women during third decade of life. The majority of the lesion occurred in minor salivary gland at the palate region. Surgical excision is most definitive treatment were performed. Keywords: Patient characteristics, pleomorphic Adenoma, salivary gland

Rationality of antibiotic use in COVID-19 patients in the ICU of Dr. Hasan Sadikin General Hospital, Bandung; a cohort study

Background and Objectives: Nearly three-quarters of the patients with COVID-19 received antibiotic therapy despite the bacterial coinfection being only less than 10% in many studies and ranging from 8-22% in ICU patients. The use of broad-spectrum antibiotics in COVID-19 patients has not been proven effective. Overuse of antibiotics may be associated with side effects and antibiotic resistance. The purpose of this study was to determine the antibiotic rationality in COVID-19 patients in the ICU of Dr. Hasan Sadikin Hospital, Bandung, Indonesia.
 Methodology: This descriptive, retrospective cohort study was carried out by analyzing medical records of COVID-19 patients admitted in the ICU of Dr. Hasan Sadikin Hospital from January-June 2021.
 Results: There were 138 patients who met the inclusion criteria. A total of 126 (91.3%) patients received antibiotics. A total of 12 (8.7%) severe/critical patients did not receive antibiotics and 79 (62.70%) received inappropriate antibiotic duration. Inappropriate regimen was found in 59 patients (74.68%) with COVID-19 without HAP/VAP and 15 patients (31.92%) with HAP/VAP. The primary issue identified was the inappropriate regimen of antibiotics, Gyssens category 4a.
 Conclusion: This study concludes that 23.02% patients used rational empirical antibiotics and 45.98% used rational definitive antibiotics in COVID-19 patients in the ICU at RSUP Dr. Hasan Sadikin Bandung during January-June 2021.
 Abbreviations: ACE- Angiotensin Converting Enzyme; ICU- Intensive Care Unit; HAI- Hospital-Associated Infections; HAP- Hospital-Acquired Pneumonia; IDSA- Infectious Diseases Society of America VAP- Ventilator-Associated Pneumonia
 Key words: Antibiotics; Antimicrobial Resistance; COVID-19; Intensive Care Units; Prescribing Pattern
 Citation: Indriasari, Oktaliansah E, Munazat RI. Rationality of antibiotic use in COVID-19 patients in the ICU of Dr. Hasan Sadikin General Hospital Bandung; a cohort study. Anaesth. pain intensive care 2024;28(1):115−125.
 DOI: 10.35975/apic.v28i1.2384
 Received: November 20, 2023; Reviewed: December 03, 2023; Accepted: December 26, 2023

Steiner Analysis of Cephalometric in Orthognathic Surgery Patients of Department Oral and Maxillofacial Surgery Hasan Sadikin General Hospital Bandung of Period April 2017 – April 2022

Objective: Orthognathic surgery is surgery on abnormalities of dentofacial that occur in the maxilla, mandible, or both. Determine measurement of the type of dentoskeletal abnormality in malocclusion using cephalometric analysis. Steiner analysis is used because it is considered that the Sela tursica-nasion-point A (SNA) angle, Sela tursica-nasion-point B (SNB) used to describe the relationship between the maxilla and the mandible Material and Methods: The study involved 30 patients who underwent orthognathic surgery between April 2017 and April 2022 at Hasan Sadikin Hospital Bandung. Attention was carried out using cephalometric radiography and analyzed using the stainer method by observing angles also observing patient characteristics such as gender and age, average angle of SNA, SNB, ANB, diagnosis, number of corrected jaws and type of orthognathic surgery. Results: The results of this study showed that orthognathic surgery patients were more male (63.3%), most aged between 19 - 20 years (40%), diagnosis of grade III malocclusion (96.7%), double jaw correction action (90%), bilateral sagittal split osteotomy (93%), osteotomy le fort I (96.7%), chinplasty (16.7%), mean angle SNA (83.8), angle SNB (90.6), angle ANB (-6.8). Conclusion: The results showed that more patients underwent orthognathic surgery with class III malocclusion and underwent orthognathic surgery on the maxilla and mandible simultaneously Keywords: Orthognathic surgery, cephalometry, Steiner analysis, malocclusion

Association of Nuclear VDR Immunoexpression with Breslow’s Thickness in Acral Melanoma

Background: Acral melanoma (AM) is a subtype of malignant melanoma (MM) that has a predilection for glabrous skin and is the most common type of melanoma among Asians. Depth of invasion is one of the prognostic factors in AM. VDR may have an association with depth of invasion in AM. However, reports from Asian patients are still lacking. The aim of this study was to explore the association between VDR immunoexpression and depth of invasion in AM patients in Bandung, Indonesia.Methods: This study was a retrospective cross-sectional study that analyzed the nuclear and cytoplasm VDR expression of melanoma cells and its association with Breslow’s thickness in patients with AM in Dr. Hasan Sadikin General Hospital Bandung. VDR immunostaining was performed on paraffin blocks. The Breslow thickness was measured using dot slide software. Chi square statistical analysis was done to determine the results.Results: Of the 30 patients, 73% had a Breslow thickness of >4 mm. There was a significant inverse association between nuclear VDR immunoexpression and Breslow thickness of AM (p<0.001), but not for cytoplasmic VDR immunoexpression (p=0.914). Conclusion: Low nuclear VDR immunoexpression is associated with the depth of invasion in AM. Nuclear VDR immunoexpression possibly affect progression and should be considered before administration of vitamin D therapy in AM.

Validity Test For C-Reactive Protein and Ferritin Level in Moderate and Severe Covid-19 Patients

Mild, moderate, severe, and critical COVID-19 are associated with hyperinflammation. The CRP and ferritin are acute phase proteins that marks incidence of inflammation and used as the paramaters of hyperinflammation. This study aimed to determine the validity of CRP and ferritin level examination in moderate and severe COVID-19 since the time of admission. This was a cross-sectional analytical retrospective study with on moderate and severe COVID-19 patients admitted to Dr. Hasan Sadikin General Hospital Bandung, Indonesia, during the period of March 2020 to December 2020. The CRP and ferritin levels were obtained since the beginning of admission to the fourth day since admission on patients without any history of anemia. Subjects in this study were divided into moderate and severe COVID-19 groups based on the 3rd edition of COVID-19 Prevention and Control Guideline issued by the Ministry of Health Republic of Indonesia. Each group consisted of 30 subjects. The cut-off value was 7.65 mg/dL (AUC 0.698) for CRP and 963.1 mcg/L (AUC 0.938) for ferritin. The validity of ferritin vs CRP were reflected respectively as follows: 93.3% vs 76.7% sensitivity; 80.0% vs 63.3% specificity; 82.4% vs 67.6% PPV; and 92.3% vs 73.1% NPV. The validity of ferritin was proven to be superior as it significantly increases since day one, persisted longer and reaches its peak on the16th day. Meanwhile, CRP increases within 6-8 hours and reaches its peak within 48 hours after inflammation, then declines soon afterwards.

Difference between Nutrition Status in First and Recurrent Ischemic Stroke Patients: a Retrospective Cross-Sectional Study

Malnutrition in stroke patients can be caused by neurological deficits such as decreased consciousness, dysphagia, cranial nerve paresis, and hemiparesis/hemiplegia. The condition of malnutrition seriously impacts healing and can exacerbate the underlying disease, in this case, stroke, so malnutrition in stroke patients extends the length of stay and increases morbidity and mortality. This study compares nutritional status between first and recurrent ischemic stroke patients based on body mass index (BMI) and subjective global assessment (SGA). This study is a comparative analysis of the medical records of ischemic stroke patients in Dr. Hasan Sadikin General Hospital Bandung from January 2018 until December 2020. The chi-square and Fisher's exact tests were used for statistical analysis. The significance criteria are the p-value if p≤0.05 means statistically significant. A total of 236 subjects in both groups of first and recurrent ischemic stroke patients consisting of 130 men and 106 women with an average age of 56.64 and 61.75 years, and the majority had risk factors for hypertension. The first ischemic stroke group has a good nutrition status compared with the recurrent stroke group (p<0.05). Thirteen patients (11.02%) of first ischemic stroke and 11 patients of recurrent ischemic stroke (9.32%) were underweight, 67 patients (56.78%) of first ischemic stroke and 74 patients of recurrent ischemic stroke (62.71%) had average weight, 31 patients (26.27%) first ischemic stroke and 33 patients (27.97%) recurrent ischemic stroke were overweight, five patients (4.24%) first ischemic stroke and seven patients (5.93%) recurrent ischemic stroke were obese (p<0.05). In conclusion, there was a significant difference in the nutritional status of first and repeated ischemic stroke patients. The nutritional status of recurrent ischemic stroke patients is worse than that of first ischemic stroke patients.

Use of Methotrexate for More Than 4 Years Is Not Associated with Liver Fibrosis in Rheumatoid Arthritis Patients

Background. Methotrexate is an anchor drug in the management of rheumatoid arthritis (RA). However, the association between methotrexate and development of liver fibrosis remains a subject of controversy. Non-invasive methods to assess liver fibrosis, such as the FIB-4 score, have been developed. RA patients on methotrexate therapy should be monitored for any signs of liver fibrosis. This study aims to investigate the correlation between methotrexate cumulative dose and the FIB-4 score in rheumatoid arthritis patients who received methotrexate therapy to assess the hepatotoxic effects of methotrexate.
 Methods. This cross-sectional study involved rheumatoid arthritis patients who received methotrexate therapy at Dr. Hasan Sadikin General Hospital Bandung from September 2022 to November 2022. Clinical data, laboratory tests (including platelet values and liver function test), and cumulative methotrexate doses were extracted from medical records. Data were analyzed using the Spearman correlation test.
 Results. This study involved 100 subjects aged between 22-82 years, comprising 93% women and 7% men. The median FIB-4 score was 0.73 (0.24-6.80), while the median methotrexate cumulative dose was 2477.5 mg, with a range of 1005-10400 mg. The results showed that correlation coefficient between the FIB-4 score and methotrexate cumulative dose in rheumatoid arthritis patients was -0.089 (p=0.378).
 Conclusion. There is no significant correlation between FIB-4 score and cumulative dose of methotrexate in rheumatoid arthritis patients. The use of methotrexate in RA patients over 4 years is relatively safe as it does not increase the risk of liver fibrosis.

Depression as comorbidity in Sundanese epilepsy patients

Background: Depressive disorder is a common psychiatric comorbidity in patients with epilepsy (PWE). This health condition is prevalent among the Sundanese who have a calm and polite character, with a tendency to hide their feelings, which is associated with an increased risk of depression. Methods: This cross-sectional study aimed to determine the prevalence of major depressive disorder (MDD) and the associated factors among Sundanese PWE. The study was carried out in the neurology outpatient clinic at Hasan Sadikin General Hospital Bandung, consisting of the Sunda ethnic group as the majority of patients. Self-stigma degree was measured using the Indonesian version of Internalized Stigma of Epilepsy (ISEP) questionnaire, while depression symptom was screened through the Indonesian version of Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Subsequently, patients who had depression symptoms were referred to a psychiatrist to confirm whether their conditions matched the criteria of MDD according to the Diagnostic and Statistical Manual of Mental Disorder-5. Results: The prevalence of depressive symptoms in Sundanese epilepsy patients was found to be 18.4%, and MDD was 6.8% among 103 patients included in this study. Many PWE with MDD were not married, had uncontrolled seizures, used polytherapy anti-seizure medication, and exhibited a higher degree of self-stigma. Conclusion: In this study, the prevalence of MDD was found to be 6.8% among a cohort of Sundanese PWE. A significant relationship was also observed between MDD and several factors, including single status, uncontrolled seizure, polytherapy, and a higher degree of self-stigma.

Emergency Management of Symphysis and Right Angle of Mandible Fracture with Laceration Wound at Buccal and Submental Region: A Case Report

Introduction: Fracture of the mandible is a case that is quite commonly found in the ER of The Oral and Maxillofacial Surgery Department at Dr. Hasan Sadikin General Hospital Bandung, fractures of the mandible rank second to fractures of the facial area because it is a prominent bone that is located at the edge and position in the lower third of the face. Emergency management aims to take any appropriate action, prevent complications, and consult other departments involved. Objective: To explain the emergency management of symphysis and right angle of mandible fracture with laceration wound at buccal and submental region. Case report: A manage 21 year came with bleeding from the mouth due to a motorcycle accident approximately 24 hours before admission to the hospital. Physical examination showed asymmetrical face, edema at right cheek region, laceration wound at right cheek and chin region, and multiple abrasive wound at facial region. There were steps, crepitus on symphysis, and right angle of mandible region. Intraoral examination showed laceration wounds on the gingiva. Case management: The laceration area is then sutured both intraoral and extraoral followed by the application of closed reduction in the mandible with interdental wiring at the lower jaw aiming to prevent infection and malunion. The management of soft tissue and hard tissue injury is by reduction, fixation, and immobilization of fractures, management of pain, and administration of antibiotics. Conclusion: The emergency management of symphysis and right angle of mandible fracture with laceration wound at the buccal and submental region is promptly and rapidly carried out with minimal intervention by using closed reduction method gave good results in stability and function before definitive treatment.

Correlation between Acute Phase Symptoms with Neurological Long Covid Symptoms on COVID-19 Survivors

Objective: To investigate prolonged neurological impacts of COVID-19 and establish a connection between initial COVID-19 symptom severity and chronic fatigue syndrome (CFS) development, poor sleep quality (PSQ), and cognitive impairment (CI) in individuals recovered from COVID-19.Methods: This cross-sectional study recruited COVID-19 survivors at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, between June and December 2021. All participants gave informed consent and underwent interviews on demography, clinical features, long-COVID questionnaire, and neurological examination. Participants underwent cognitive examination (MOCA-INA), Chalder Fatigue Scale and Pittsburgh Sleep Quality Index (PSQI) to assess CI, CFS, and PSQ variables. Chi-Square analysis was performed to determine the probability of neurological long COVID-19 syndrome manifestations using SPSS 24.0.Results: Of the 127 participants recruited, 67.7% were women, median (IQR) age of 33 (21-65) years, and time from hospitalization to examination of nine months (1-13). The most common neurological Long COVID symptoms were PSQ (59.8. %), CFS (51.2%), and CI (33.9%). Participants with more than five acute phase COVID-19 symptoms had a higher probability of CFS and CI (OR 2.38 (1, 16-4.9, CI 95%); OR 2.20 (1.01-4.79, CI 95%)) than those with less than five symptoms. The study did not find a significant correlation between sleep quality and number of acute-phase COVID-19 symptoms (OR 1.56 (0.76-3.20, CI 95%)).Conclusion: Almost two-thirds of the COVID-19 survivors experienced PSQ, more than half had CFS, and almost one-third had CI. The study revealed an increasing likelihood of CFS and CI in COVID-19 survivors as the number of acute COVID-19 symptoms increases.

Comparison of Preemptive Post-Intubation 15 Mg/KgBW Paracetamol to 0.35 Mg/KgBW Meperidine in Incidence of Post-Anesthetic Shivering

Post anesthesia shivering (PAS) is a repetitive involuntary movement of one or more muscle groups as a result of a decrease in core body temperature. Pharmacological therapy in preventing PAS may include meperidine and paracetamol. This study compared the effectiveness of paracetamol to meperidine in reducing the incidence of post-anesthesia shivering. This study used an experimental randomized double-blind comparative analytic design on patients underwent exploratory laparotomy surgery under general anesthesia at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from September 2021 to August 2022. Patients with 50 ASA 1-2 physical status were included and divided into two groups. One group received 15 mg/kg group paracetamol and the other received 0.35 mg/kg meperidine. Data on tympanic membrane temperature and hemodynamics before and after induction and after extubating were collected. Furthermore, data on the results of the assessment of the incidence and grade of shivering in each treatment group were also collected. The results of this study showed that there was a decrease in the frequency of PAS in patients receiving intravenous 15 mg/kg paracetamol (p<0.05), as well as less side effects in the form of nausea and vomiting (p < 0.05). The incidence and degree of shivering after general anesthesia using intravenous 15 mg/kg paracetamol was lower compared to the use of 0.35 mg/kg meperidine. In the meperidine group, the decrease in body temperature was lower than in the paracetamol group, while the incidence of nausea and vomiting in the paracetamol group was lower than in the meperidine group. In conclusion, paracetamol reduces the incidence of post-anesthesia shivering better than meperidine.

Thawing Time Difference between Fresh Frozen Plasma Using Ziplock Plastic and non-Ziplock Plastic in Blood Transfusion Unit Dr. Hasan Sadikin General Hospital Bandung, Indonesia

Background: The quality of fresh frozen plasma (FFP) in a clinical setting depends on thawing time. Thawing using a water bath is often used in blood transfusion units because it is easy to perform, affordable, and easy to look for. Protective plastics (Ziplock and non-Ziplock) are used to reduce the risk of contamination,. This study aimed to determine whether there is a difference in thawing time between FFP using Ziplock plastic and non-Ziplock plastic.Method: This experimental design was conducted in the Blood Bank Unit of Hasan Sadikin Hospital from June-August 2021. Samples were divided into two groups, namely thawing using Ziplock and non-Ziplock. Each group consisted of volume 160-200 ml and 201-240 ml.Results: The total samples were 24 FFP bags. In the group of the bag 160-200 ml, the median thawing time using Ziplock plastic was 8 minutes (8-16 minutes), non-Ziplock was 15 minutes (8-16 minutes) (p value 0,111), whereas in a group of bags with volume 201-240 ml, the median thawing time using Ziplock was 15 minutes (8-28 minutes), non-Ziplock was 20 minutes (14-30 minutes) (p- value 0,332). Although there was a time difference in both groups, the difference was non-significant.Conclusion: The thawing time between the small bag with a volume of 160-200 ml and the larger volume of 201-240 ml shows no difference. Ziplock plastic can be used to reduce the risk of contamination.

Characteristics of Referral Patients with Gestational Trophoblastic Neoplasia in Dr. Hasan Sadikin General Hospital Bandung

Background: : Gestational trophoblastic disease (GTD) is a heterogeneous group of lesions caused by abnormal trophoblast proliferation and the malignant form is called gestational trophoblastic neoplasia (GTN). Dr. Hasan Sadikin General Hospital, located in Bandung, West Java, is one of the main cancer referral hospitals in Indonesia. Consequently, the characteristics of GTN patients in this hospital can represent the general population in the province. This study aimed to elaborate on the characteristics of referral patients with GTN in Dr. Hasan Sadikin General Hospital.Methods: : Medical records of post-molar GTN patients in Dr. Hasan Sadikin General Hospital from between January 2019 to December 2020 were collected and analyzed. GTN was diagnosed according to the International Federation in Gynecology and Obstetrics (FIGO) criteria. Additionally, both the sociodemographic and clinical characteristics of patients were evaluated.Results: The results showed that among the 160 participants in this study, the overall mean age was 33±8.7 years, with a mean βhCG level of 241,461.81±630,557.90 mIU/mL. Moreover, approximately 16.3% had gestosis and 5% were diagnosed with hyperthyroidism. The majority of post-molar observations at the hospital were not carried out according to standards, with only 8.1% of patients receiving optimal surveillance. About 56.8% visited the hospital due to vaginal bleeding, while most histopathological results showed complete hydatidiform moles (44.4%), and choriocarcinomas (16.3%). Most of the patients were diagnosed as stage I (81.9%), had lowrisk FIGO scores (80.6%), and were treated with methotrexate (80.6%).Conclusions: GTN patients in Dr. Hasan Sadikin General Hospital showed clinical characteristics consistent with previous studies. The low percentage of patients receiving optimal post-molar surveillance could cause delayed referral. This suboptimal surveillance might be due to the high cost of βhCG testing, lack of facilities, and low patient compliance in West Java

Head and Neck Sarcomas Characteristics at Dr. Hasan Sadikin General Hospital for 5 Years (2017-2021)

Background: Sarcoma is a malignant neoplasm originating from mesodermal tissue with an incidence rate of 1% of neoplasms throughout the body. Head and neck sarcoma requires more complex management and until now, reviews of this disease are still very rare. This study aimed to report the incidence and characteristics of head and neck sarcoma during 2017-2021 at Dr. Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung.
 Methods: Research data was taken from patient medical records through SIRS at Dr. Hasan Sadikin General Hospital during the 2017-2021 period according to the ICD10 of head and neck malignancies and histopathological data.
 Results: During 2017-2021, 15 cases of head and neck sarcoma were found, consisting of 9 cases (60%) rhabdomyosarcoma, 2 cases (13.3%) fibrosarcoma, and 1 case each (6.7%) synovial sarcoma, undifferentiated pleomorphic sarcoma, angiosarcoma and dermatofibrosarcoma protuberans. The neck and shoulder area are the most frequently affected site (40%), followed by the scalp (26.7%), maxilla (20%), and oral cavity (13.3%). The highest incidence rates were in female (60%) and children aged <17 years (46.7%).
 Conclusion: The incidence of head and neck sarcoma at Dr. Hasan Sadikin General Hospital Bandung is rare. The most frequent cases are rhabdomyosarcoma the most commonly affected areas are the neck and shoulders.

The characteristics of mandibular fracture in Dr. Hasan Sadikin General Hospital Bandung, Indonesia

ABSTRACT 
 INTRODUCTION Mandibular fracture poses a fatal complication because the mandible plays an essential role in occlusion and aesthetics. The mandible is one of the bones most affected by facial fractures commonly resulting from trauma to the face and may be associated with severe morbidity and serious consequences METHODS The records of 282 patients referred to RSUP Dr. Hasan Sadikin General Hospital Bandung, Indonesia between January 2017 and January 2021 were analysed retrospectively. Data including age, sex, etiology of mandibular fracture, type of mandibular fracture, and treatment. Incompleted data from the medical record were excluded. 
 RESULTS Men aged 17-30 years were the most common victims of mandibular fracture. Road traffic accidents (RTAs) were responsible in 84% of cases. The most common anatomic site for mandibular fracture was parasymphysis region 28.7 with simple fractures 79%, and 82% of the total fractures were treated with open reduction 
 CONCLUSION The characteristics of mandibular fracture patients describe trauma patterns in the community. This finding is similar with some readily available literature with RTAs was the most common etiology and parasymphysis was the most common fracture site. Reasons for this high frequency may include the large number of poorly maintained, overloaded vehicles on unsuitable roads, violation of traffic regulations particularly by inexperienced young drivers.

PATTERN OF ANTICOAGULANT THERAPY IN CARDIOEMBOLIC STROKE

Background: Cardioembolic stroke is a category of ischemic stroke that manifests more severe, is prone to recurrence, and is related to a higher mortality rate than the other categories of ischemic stroke. Anticoagulant therapy is recommended in cardioembolic stroke, both for primary and secondary prevention. Objective: The objective of this study is to understand the pattern of anticoagulant therapy in cardioembolic stroke patients admitted at Hasan Sadikin General Hospital Bandung. Methods: The methodology of this study uses retrospective descriptive cross-sectional and use data from medical records collected during January 2015 to December 2020 at Neurology Department of Hasan Sadikin General Hospital with total sampling method. The inclusion criteria were cardioembolic stroke patients that received anticoagulant therapy. Anticoagulant therapy was stratified into Warfarin and New Oral Anticoagulants (NOACs) which consist of dabigatran, rivaroxaban, and edoxaban. To assess stroke severity outcome between warfarin and NOACs we use the National Institutes of Health Stroke Scale (NIHSS) Score. Results: From the 162 cardioembolic stroke patients, the most common oral anticoagulant used was warfarin (90.12%), followed by dabigatran (4.94%), rivaroxaban (3.70%), and edoxaban (1.23%). Only 1 (0.62%) patient who experienced complications from anticoagulant therapy, the complication was non-major bleeding and occurred in warfarin users. Both warfarin and NOACs mainly had NIHSS on discharge in a moderate category with the mean of NIHSS 7.615 and 7.276 for warfarin and NOACs respectively. Conclusion: Warfarin is the most common oral anticoagulant used for cardioembolic stroke based on this study. Both warfarin and NOACs groups have similar stroke severity outcomes measured by NIHSS on discharge and NOACs have lower incidence of bleeding compared to warfarin group.

Predictors of Urethral Stricture After Transurethral Resection of the Prostate Procedure

Transurethral resection of the prostate (TURP) is the most frequently used urology surgical method to manage benign prostate hyperplasia (BPH). Despite the relatively efficacious treatment, urethral stricture (US) may form after TURP. The prevalence of the urethral strictures (US) following TURP ranges from 2.2% to 9.8%. The study aimed to identify the predictors of urethral strictures in patients receiving TURP. This study was a retrospective cohort study on patients underwent TURP in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, between 2015 and 2019. Data were obtained from medical records and urology registry of a minimum 12-month follow-up period. Data on patient demographics, estimated volume of the prostate, total resected prostate, and operating time were extracted. Multiple logistic regression was utilized to determine the odds ratio difference between groups. A total of 451 TURP cases were performed between 2015 and 2019, with 22 (4.87%) cases of post TURP US identified. The mean estimated prostate weight was 45.6 g and resected prostate weight was 20.4 g, with a 0.37 gr/min resection rate. Prostate weight, operating time, and duration of catheterization after surgery were not significantly different statistically. Slower resection rate and smaller resected volume are the statistically significant predictors of increased occurrence of urethral stricture (p<0.05). Lower resection rate is also a predictor for urethral stricture after TURP procedure.

Clinicopathological Characteristics of Cervical Carcinoma with Pelvic Lymph Node Metastases in Dr. Hasan Sadikin General Hospital, Bandung 2013-2021

Background: Carcinoma of the cervix is the most common gynecological malignancy, which ranks first among carcinomas in Indonesia. Lymph node metastasis is a risk of recurrence, affecting survival and therapy. The purpose of this study was to determine the clinicopathological characteristics of cervical carcinoma with pelvic lymph node metastasis that had undergone radical hysterectomy and lymphadenectomy at Dr. Hasan Sadikin General Hospital, Bandung.Methods: This study used a cross-sectional retrospective descriptive study. Data on the clinical stage I-II cervical cancer patients with pelvic lymph node metastasis were collected from the archives of the pathological anatomy laboratory during period from 2013 to 2021. Data were presented in percentage.Results: There were 64 data patients, and the most common age of cervical carcinoma ranged from 40 to 50 years old (51.6%), the most common stage was stage II (62.5%), and the most frequent histopathological type was squamous cell carcinoma (70.3%). The highest degree of differentiation was moderate differentiation (35.9%). The most frequently found tumor size was ≥4 cm (54.7%).Conclusion: The cases of cervical carcinoma at Dr. Hasan Sadikin General Hospital Bandung were treated with radical hysterectomy and lymphadenectomy. The patients generally aged between 41-50 years old, stage II, squamous cell carcinoma with a moderate degree of differentiation and tumor diameter around ≥ 4 cm.

Therapeutic Outcome of High Flow Nasal Cannula (HFNC) for Severe COVID-19 Patients in Isolation Intensive Care Unit

This retrospective descriptive study aimed to understand the outcomes of HFNC therapy in severe COVID-19 patients admitted to isolation ICU during the period of January to June 2021 in Dr. Hasan Sadikin General Hospital Bandung, Indonesia. A total of 134 patients with severe COVID-19 were admitted to the isolation ICU and received HFNC. Among them, 44 patients (32.8%, N:134) were successfully weaned from HFNC and 90 patients (67.2%, N:134) failing HFNC with 10 patients (7.5%, N:134) died on HFNC use, 72 patients (53.9%, N:134) died on ventilator use, 4 patients (2.9%, N:134) moved rooms under HFNC use, and 4 patients (2.9%, N:134) moved to non-ICU isolation with ventilator use as the outcome. Patients’ median age was 60 years, most were male (52.3 %, N:134), median BMI was 25.4 kg/m2, with hypertension and diabetes mellitus as the main comorbidities. There was an improvement in the SpO2 on the first day after the use of HFNC. The ROX index had a median value of 3.6 on the first day, with the lowest ROX index of 3.2 and the highest of 4.4 during the treatment time. There was an improvement in the P/F Ratio in successful patients with a median initial P/F Ratio of 86.7 to 200.1 at the end of treatment. Overall, HFNC improves the hypoxemic conditions in early admission but does not correlate with general patient outcomes.