Hasan Sadikin General Hospital Bandung Research Articles

Diastolic Blood Pressure as a Predictor of Mortality in Intracerebral Hemorrhage Stroke Patients with Hypertension

Background: Intracerebral hemorrhage (ICH) stroke contributes to a considerable number of deaths, ranging between 30% and 40% of the overall stroke mortality. The incidence of stroke increases with higher blood pressure. High blood pressure at the onset of ICH stroke is a strong predictor for mortality and morbidity. This study aimed to explore the role of diastolic blood pressure as a predictor of death in ICH stroke patients.Methods: Data on 113 ICH stroke patients with chronic hypertension were collected from the medical records of patients treated in the Neurology ward of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, in 2019. Data collected were patient characteristics, hypertension status, systolic and diastolic blood pressures, and patient outcome. Analysis was then performed using the Mann-Whitney test.Results: This study revealed a positive correlation (p=0.031) between diastolic blood pressure and death in ICH stroke patients with chronic hypertension.Conclusion: High diastolic blood pressure is associated with mortality in ICH stroke patients with chronic hypertension.

IP-10 as a Non Sputum Biomarker in TB Treatment Monitoring

There are currently still limitations in the diagnosis of tuberculosis (TB). Sputum collection as specimen for diagnosis is not only difficult but also has low sensitivity.In blood, IP-10/CXCL-10 chemokine plays a role in inducing the movements of chemotactic inflammatory cells towards the sites of inflammation. A high level of IP-10 is found in active pulmonary TB patients and significantly decline after the patients have completed the TB treatments. The aim of this study was to analyze the decline of the IP-10 level before and after 2 months of TB treatment. This study was conducted from March­ toJuni 2020. This was a comparative observational cohort study on active pulmonary TB patients who were >18 years old at the DOTS Clinic of Dr. Hasan Sadikin General Hospital Bandung. Thirty patients who met the inclusion criteria were followed up until 2 months of TB treatment. Serum of these patients were collected and examined for the IP-10 level before and after 2 months of TB treatment. It was demonstrated that the median IP-10 level in new active pulmonary TB patients was 384.1 pg/mL (136.70–779.80) and dropped to 251.85 pg/mL (91.10–698.30) (p<0l001) two months of TB treatment. Thus, the IP-10 level in the active pulmonary TB patients is significantly declined (p<0.001) after 2 months of TB treatment and that serum IP-10 level could be considered as a non-sputum-based marker to monitor TB treatment.

Comparison of Diagnostic Accuracy of Tuberculosis Spondylitis between Genexpert and Histopathological Examination

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Spinal TB is associated with poor functional outcomes. Histopathological examination requires a long waiting times to obtain the results thus impractical for screening and may delay diagnosis. GeneXpert offers rapid tests for prompt screening and diagnosis. This study aimed to assess the diagnostic accuracy of GeneXpert in patients with spinal TB when compared to the histopathology test as the gold standard. This study was performed on patients in the Spine Clinic of the Department of Orthopedic and Traumatology, Dr. Hasan Sadikin General Hospital Bandung who were diagnosed with spinal TB during the period of May 2019–May 2020. Blood samples were collected from the patients and tested using GeneXpert and histopathological assessment. Results demonstrated 34 patients with a positive result and 6 patients with negative results on both diagnostic methods. Twenty nine out of 40 patients (72.5%) had rifampin-sensitive TB. Diagnostic accuracy of GeneXpert, when compared to histopathological examination, is represented by the sensitivity of 88.2%, specificity of 33.3%, positive predictive value of 88.2%, and negative predictive value of 33.3%. High sensitivity results forpatients with spinal TB on GeneXpert suggests that the test is appropriate to be used as a screening method and as a high-yield rapid diagnostic test for patients suspected for spinal TB.

Left to right shunt congenital heart disease as a risk factor of recurrent pneumonia in under five-year-old children: a single centre experience in Bandung Indonesia.

Aim Children with congenital heart diseases are at the greater risk of respiratory tract infection such as pneumonia. Recurrent pneumonia is one of the most major challenge for paediatric physicians. The aim of this study is to investigate risk factors of congenital heart diseases to recurrent pneumonia children. Methods This was a retrospective study of under five-year-old children hospitalized in Hasan Sadikin General Hospital Bandung Indonesia from 2015 to 2018. Congenital heart diseases and pneumonia, as well as recurrent pneumonia, were identified. Congenital heart diseases diagnosis with and without pneumonia were reviewed. Results Of 6997 hospitalized children, in 1258 (18.0%) congenital heart diseases were found, of which 232 (18.4%) had recurrent pneumonia. Most of those had left to right (L to R) shunt, 213 (91.8%). Congenital heart diseases in children aged under 1 year, 144 (62%) were more preponderant than in those aged 1-5 years. More than a half, 119 (51.3%) were males. Left to right shunt was documented as having recurrent pneumonia, of which patent ductus arteriosus and ventricular septal defect were the most common type in congenital heart diseases. Ventricular septal defect had a possibility for recurrent pneumonia by 1.551 times, and malnutrition 2.591 times. Conclusion Ventricular septal defect and malnutrition were identified as risk factors for recurrent pneumonia. Those patients require multidisciplinary approach to prevent respiratory complications.

Correlation between Serum Interleukin-6 Level and Modified Rodnan Skin Score in Systemic Sclerosis Patients

Objective: To determine the correlation between serum levels of IL-6 and MRSS in systemic sclerosis patients. Methods: This was a crossectional observational study on patients with SSc visiting the Rheumatology Clinic of Dr. Hasan Sadikin General Hospital Bandung, Indonesia from January 2019 to December 2020. Registered SSc patients, with validated MMRS by a rheumatologist, and available biological materials for IL-6 measurement were included. Patients with other autoimmune diseases, acute infection, diabetes mellitus, and obesity were excluded from this study Results: Of the 51 SSc patients, 42 patients met the inclusion criteria. Women comprised the majority of these patients (95.2%), while patients’ mean age was 43±12 years. The mean duration of disease was 20 months, with diffuse SSc (78.6%) as the most frequent type. Bivariate analysis showed that IL-6 was positively correlated with MRSS (100-scale) with r=0.397 and p=0.005. Conclusion: There is a medium positive correlation between MRSS and interleukin-6 serum among systemic sclerosis patients visiting Dr. Hasan Sadikin General Hospital Bandung, Indonesia.

Clinical Profile of Adverse Cutaenous Drug Reactions in Patients with Human Immunodeficiency Virus

Background: Adverse cutaneous drug reactions (ACDRs) are common problems in patients during the treatment of various diseases. The clinical feature varies from mild manifestation such as morbilliform, urticaria, and contact dermatitis, to severe manifestation such as Stevens - Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Patients infected with the human immunodeficiency virus (HIV) have an increased risk of developing ACDRs due to immune system disruption. This study aimed to describe the clinical features of ACDRs in HIV patients and the drugs that cause ACDRs. Method: This study was a retrospective study using secondary data from medical records of HIV patients with ACDRs who visited Teratai Clinic of Dr. Hasan Sadikin General Hospital Bandung from 2014 to 2018. Total sampling was applied and results were presented in percentage. Results: There were 94 HIV patients with ACDRs out of 557 HIV patients. Adverse cutaneous drug reactions are commonly found in males aged 20-39 years old. The clinical features found were morbilliform (85.6%), SJS (8.9%), urticaria (4.4%), and erythroderma (1.1%). The most common drugs causing ACDRs were Cotrimoxazole (30%), Efavirenz (28.9%), and Nevirapine (16.7%). Conclusion: The prevalence of ACDRs in HIV patients in this study is 16.9%. The most common clinical features are morbilli form and SJS with Cotrimoxazole, Efavirenz, and Nevirapine causing most of the ACDRs.

Correlation Between Tumor Cell Differentiation and CEA Levels in Patients with Adenocarcinoma of the Rectum

Adenocarcinoma of the rectum is the most common colorectal cancer in Indonesia. This cancer has the highest recurrence after curative surgical therapy with or without adjuvant therapy. With the advancing modern histopathology and molecular biology, the prognosis after therapy can be predicted through surveillance using tumor cell differentiation and carcinoembryonic antigen (CEA). The aim of this study was to analyze the correlation between tumor cell differentiation and serum CEA level in patients with adenocarcinoma of the rectum in Dr. Hasan Sadikin General Hospital Bandung, Indonesia. This was a retrospective observational analytic study conducted from January 2018- January 2019. There were 36 patients involved in this study consisting of 3 patients (8.3%) diagnosed with Stage II, 10 patients (27.7%) with Stage IIIA, 20 patients (55.5%) with stage IIIB, and 3 patients (8.3%) with stage IIIC. On histopathological examination, it was demonstrated that19 patients (52.8%) were well-differentiated, 15 patients (41.7%) were moderately differentiated, and 2 patients (5.6%) were poorly differentiated. The mean CEA level (CI 95%) for well-differentiated patients before surgery was 138.18 (15.99-260.38) ng/ml while the same level for the moderately differentiated patients was 64.34 (34.34-163.02) ng/ml. The mean CEA level for poorly differentiated patients was 1.55 (6.71-9.81) ng / ml. The result of the Kruskal Wallis test showed a p-value of 0.004. There is a strong correlation between the level of tumor cell differentiation and CEA level.

Association Between Polymorphonuclear Leukocyte Cell Percentage in Cerebrospinal Fluid and Outcome of Tuberculous Meningitis Patients in a Tertiary Hospital in Indonesia

Tuberculous (TB) meningitis is the most severe type of extrapulmonary TB with high morbidity and mortality rates. Many factors affect patient outcome, including the intracranial inflammation process. In acute inflammation, recruitment of a high number of polymorphonuclear (PMN) cells can cause edema which may eventually increase the intracranial pressure. This increase in intracranial pressure may lead to functional decline, disability, and even death. This study aimed to explore the association between the PMN percentage in cerebrospinal fluid (CSF) and TB meningitis patient outcome as measured by the Glasgow Outcome Scale at Dr. Hasan Sadikin General Hospital Bandung, which is a tertiary hospital in Indonesia. This was a retrospective cohort study using patient medical record data from 2017. All TB meningitis patients over 18 years old were included. Patients with missing PMN results in medical record were excluded, which led to a total 88 subjects participating in this study. Variables analyzed were PMN percentage in CSF and patient outcome that were categorized as poor, moderate, and good. Analysis were performed using theKruskal-wallis test. An increase in PMN median as the patient outcome declined were observed, but the association between the PMN percentage in CSF and patient outcome was insignificant (p=0.186). Hence, no association between PMN percentage in CSF and TB meningitis patient outcome was identified in this study.

Effect of Iron Supplementation in Anti-Tuberculosis Drug Treatment on Interferon-γ Level in Tuberculosis Spondylitis Patients

Tuberculosis (TB) is still one of the major health problems in the community. Micronutrients, including iron, are crucial in the body's defense mechanism. Iron modulates the activation of IFN-γ, which in turn will activate the macrophages. This study explores the effect of iron supplementation given with anti-tuberculosis drug therapy on the IFN-γ level in tuberculosis spondylitis patients. This was a single-blind randomized control trial study at Dr. Hasan Sadikin General Hospital Bandung, from December 2018 to March 2019, using the consecutive sampling approach. Thirty-four respondents with category 1 TB spondylitis and an sTfR level of> 21.7 pg /µL were recruited and randomized into control and experimental groups. The control group (n=17) was treated with 2 RHZE for 2 months while the experimental group (n=17) received 2 RHZE and iron tablet for 2 months. An increase in the IFN-γ level of the experimental group was observed from an average of 21.7 pg/ml before therapy to an average of 72.39 pg/mL after therapy. Meanwhile, the IFN-γ level in the control group increases from an average of 22.5 pg/mL to an average of 35.35 pg/mL. This difference was statistically significant based on the analysis using the independent t-test (p-value <0.05). Therefore, the administration of anti-tuberculosis drugs with the addition of iron can increase the body's immune response, which is indicated by the increasing level of IFN-γ.

Characteristic of Intratemporal Complication in Chronic Suppurative Otitis Media Patient with and without Cholesteatoma at Hasan Sadikin General Hospital Bandung

Otitis media supuratif kronis (OMSK) merupakan penyakit telinga umum di negara-negara berkembang. Kasus OMSK dengan kolesteatoma sering disebut sebagai tipe bahaya. Tujuan penelitian ini untuk mengetahui karakteristik komplikasi intratemporal pada pasien OMSK dengan dan tanpa kolesteatoma di Poliklinik Telinga Hidung Tenggorok Bedah Kepala Leher (THT-KL) Rumah Sakit Hasan Sadikin (RSHS) Bandung. Penelitian ini merupakan penelitian deskriptif retrospektif dari pasien yang datang ke poliklinik THT-KL RSHS Bandung periode 2014-2017. Diagnosis ditegakkan berdasarkan anamnesis, pemeriksaan fisik, dan penunjang radiologi. Didapatkan 791 kasus baru OMSK; pria (51,20%), sebanyak 30,59% kasus berada di rentang usia 21-30. Gejala dan tanda klinis yang paling sering terjadi adalah telinga berair (70,92) %, tipe gangguan dengar yang paling sering terjadi adalah tuli konduktif (83,94%). Pada proyeksi foto Schuller, 64,72 % menunjukkan gambaran mastoiditis kronis dengan kolesteatoma. Dari hasil kultur dijumpai 19,97 % kasus disebabkan oleh Pseudomonas aeroginosa. Komplikasi mastoiditis didapatkan pada 86,34%. Pada operasi Canal Wall Down ditemukan kolesteatoma pada 60, 42% kasus. Komplikasi terbanyak intratemporal pasien OMSK dengan dan tanpa kolesteatoma adalah mastoiditis kronis. Simpulan, komplikasi terbanyak intratemporal pasien OMSK dengan dan tanpa kolesteatoma adalah mastoiditis kronis. Profil penderita OMSK tipe bahaya dengan komplikasi intratemporal di RSUP Dr. Hasan Sadikin masih tinggi.
 
 Kata kunci: karakteristik; kolesteatoma; mastoiditis kronis; otitis media supuratif kronik

Time to Hospital Admission of Stroke Patients in Department of Neurology Hasan Sadikin General Hospital Bandung

Stroke merupakan penyebab kematian terbesar di dunia dalam 15 tahun terakhir. Tujuan penelitian ini adalah untuk mengetahui gambaran waktu kedatangan pasien stroke ke rumah sakit yang dirawat di Departemen Neurologi Rumah Sakit Dr. Hasan Sadikin Bandung. Penelitian ini menggunakan studi desain deskriptif analitik yang dilakukan dari Juli-Agustus 2018. Sampel didapat dari seluruh rekam medis pasien stroke iskemik dan hemoragik di Departemen Neurologi RSUP Dr. Hasan Sadikin Bandung dari Mei 2017-Desember 2017. Dari penelitian didapatkan median waktu kedatangan pasien stroke adalah 16,50 jam (0,5-336 jam). Sebanyak 65,93% pasien stroke datang ke rumah sakit di atas delapan jam setelah mengalami gejala. 9,26% pasien stroke datang ke rumah sakit dalam jangka waktu 6-8 jam, 11,48% pasien stroke datang ke rumah sakit dalam jangka waktu 4,5 -6 jam, 9,63% pasien datang ke rumah sakit dalam jangka waktu 3- 4,5 jam dan hanya 3,70% pasien stroke yang datang ke rumah sakit dibawah 3 jam setelah mengalami gejala. Dari penelitian dapat disimpulkan terdapat perbedaan signifikan waktu kedatangan pasien berdasarkan jenis stroke, cara kedatangan dan hasil terapi pasien.
 
 Kata kunci: stroke iskemik; stroke hemoragik; waktu kedatangan

4-7CORONARY ARTERY DISEASE ALTER ON NOVEL CLASSIFICATION LEFT VENTRICULAR GEMOMETRY IN HYPERTENSIVE PATIENTS IN HASAN SADIKIN GENERAL HOSPITAL BANDUNG

Background: Coronary artery disease (CAD) was known to cause an increase in left ventricular mass and changes in cardiac dimensions in hypertensive patients. There is a novel classification of left ventricular (LV) geometry. Objective: To evaluate the impact of CAD on LV geometry (LV dilatation, hypertrophy, and concetricity) in hypertensive patients at the Hasan Sadikin General Hospital Bandung. Method: Between September and December 2019, 115 consecutive patients underwent trans-thoracal echocardiography examination in Hasan Sadikin General Hospital Bandung, who had suffered from hypertension. Hypertension was defined as resting systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥90mmHg or on antihypertensive therapy routinely. CAD was defined as the patients have a known history of CAD in the medical record. Patients were divided based on LV dilation (end-diastolic volume[EDV]/body surface area[BSA]>75 ml/m2), LV hypertrophy (LVM/BSA>115 and >95 g/m2 on men and women respectively), and concentricity (RWT>0.42;0.32–0.42;or<0.32). Results: One-hundred-ten patients were included after excluding patients with incomplete data. Sixty patients (54.55%) were females, mean age was 56.95±11.54 years old. Forty patients was diagnosed CAD (36.36%), 70 patients non-CAD (63.63%). Dilation LV was found in 23 patients (20.9%); CAD vs non-CAD (15/40 (37,5%) vs 8/70 (11,8%)); p = 0,001. Hypertrophic LV was found in 70 patients (63.6%); CAD vs non-CAD (32/40 (80%) vs 38/70 (54.3%)); p = 0,008. Concentricity RWT > 0,42 (60%), RWT 0,32–0,42 (31.8%), RWT < 0,32 (8.2%). In CAD vs non-CAD (26/7/7 vs 40/28/2); p = 0,04. Conclusion: In hypertensive patients, CAD group has significant difference in LV dilatation, hypertrophy, and concentricity compared to it counterparts. Based on this novel classification, CAD in hypertensive patients might have an impact on its prognosis.

Spirometric Values of Patients with Chronic Obstructive Pulmonary Disease in Dr. Hasan Sadikin General Hospital Bandung

Background : Chronic obstructive pulmonary disease (COPD) is a frequently underdiagnosed disease. Definitive COPD has been diagnosed using spirometry to evaluate pulmonary function. This study aimed to explore the spirometric values of COPD patients to aid in the diagnosis of COPD. Methods : A descriptive study was conducted in Dr. Hasan Sadikin General Hospital Bandung from October to November 2015. Data on patients diagnosed with COPD, aged 40 to 60 years old, were collected during the year 2014 prior to ethical clearance. Spirometry values consisted of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were taken from the medical records. Results : Sixty-eight COPD patients, consisting of 48 males and 20 females, were included of with most were classified as moderate COPD. The FEV1 was 49.72±17.79, whereas the FVC was 55.90 (range 22.80–96.03), and the FEV1/FVC ratio was 0.70±0.12. Most patients were classified into moderate COPD who had FEV1 between 50 and 80% of normal as GOLD 2 standard. Conclusions : Even though patients seem to have no symptoms, spirometric values may show a silent insufficient lung function affecting patients’ daily life.

Cerebral Palsy Parents’ Knowledge, Attitude, and Behavior at Dr. Hasan Sadikin General Hospital Bandung 2014

Background : Cerebral palsy (CP) as a non-progressive syndrome of motor function and posture disturbance is caused by the abnormality or damage on the brain during its development. Children with CP usually have motor, sensory, communication, and intellectual disturbances. Medical rehabilitation is important; however, the environmental aspect is also crucial for their development. Parents as their caregivers may have good knowledge to assist their children during rehabilitation. This study aimed to explore the knowledge, attitude, and behavior among parents with CP children. Methods : This study was descriptive quantitative study and conducted at the Physical Medicine and Rehabilitation Clinic of Dr. Hasan Sadikin General Hospital Bandung during September to October 2014. Parents of CP children were asked to complete a questionnaire that was specifically designed for this study after their consent was obtained. Results : From a total of 31 parents, 51.6% had good knowledge about CP; 58.1% had good attitude toward CP children, and 51.6% had good behavior while taking care of their children. Conclusions : The majority of parents with CP children have good knowledge, attitude, and behavior towards CP children. The knowledge of risk factors of cerebral palsy are poor, therefore, it is necessary for doctors and therapists to provide more education sessions on the risk factors and other related topics about cerebral palsy.

Relationship between Calcification on Mammography and Human Epidermal Growth Factor Receptor 2 (HER-2) Expression in Breast Carcinoma

Background : Breast carcinoma shows over-expression of Human Epidermal Growth Factor Receptor 2 (HER-2) in 18 to 20% of the cases. This type of cancer is very progressive and has a poor prognosis. This study aimed to determine the association between the calcification on mammography with HER-2 expression in breast carcinoma as a marker of breast carcinoma aggressiveness. Methods : This was an analytic observational study with a case-control design. Patients with breast carcinoma at the Department of Radiology and Department of Anatomical Pathology of Dr. Hasan Sadikin General Hospital Bandung from July–September 2019 were enrolled in this study. Samples were consecutively collected. The association of calcification on mammography and HER2 expression was analyzed using the Chi-square test. Result : In total, 40 patients were included, consisting of 20 individuals with HER-2 positive and 20 individuals with HER-2 negative. The youngest was 40 years old and the oldest was 73 years old. Statistical test results showed that there was a significant association between calcifications in mammography and HER-2 expression (p-value = 0.0001, OR 13.22; 95% CI 2.7–62.6). Conclusions : There is a significant association between calcification on mammography and HER-2 expression in breast carcinoma, suggesting that positive calcification mammography was 13.22 times higher in patients with HER-2 positive compared to patients with negative calcifications.

PREVALENCE OF NASOPHARYNGEAL CARCINOMA PATIENTS IN DEPARTEMENT OF ORL-HNS HASAN SADIKIN GENERAL HOSPITAL 2010 -2017

Introduction:
 Nasopharingeal Carcinoma starting from Rosenmuller fossa and intracranial or local spread as a mass in the head area. Nasopharyngeal carcinoma is also associated with hearing problems, serous otitis media, tinnitus, nasal congestion, anosmia, nose bleeding, difficulty swallowing, and dysphonia. Nasopharyngeal carcinoma is a disease that spreads globally and divides races around the world. The purpose of this study is to determine the prevalence of nasopharyngeal disease in Otorhinolaringology-Head and Neck Department, Dr. Hasan Sadikin General Hospital Bandung in 2010-2017.
 Methods:
 Medical record method description of Nasopharyngeal Carcinoma at Departement of Otorhinolaringology- Head and Neck Surgery, Dr. Hasan Sadikin General Hospital Bandung in 2010-2017 that used sampling method.
 Results:
 There were 1378 patients nasopharyngeal carcinoma, 976 people that included, 657 were men and 319 were women. Obtain most elementary school education (54.9 %) the majority of male patients (67.3 %) with various job background, whereas female patients were housewives (28.1%), and those aged 41-50 years (34%). Most histopathology are undifferentiated carcinoma (58.3 %).
 Conclusion:
 Nasopharyngeal Carcinoma patients at the Otorhinolaringology-Head and Neck Surgery Departement. Dr. Hasan Sadikin General Hospital Bandung are 1378 cases. There was higher instance in middle age, and older men and elementary school educated with major histopathology finding was undifferentiated carcinoma

Outcomes of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis at Hasan Sadikin General Hospital Bandung

Peripheral joints involvement in Ankylosing spondylitis (AS) has been reported in 73% of these cases, with the hip being the most commonly affected diarthrodial joint. The reported prevalence of hip involvement in AS varies from 19 to 36%. Total Hip Arthroplasty (THA) is often required to manage pain and restore function and mobility. The aim of this study was to retrospectively analyze outcomes related to performing THA on patients with AS.Methods:We evaluated the oncologic, functional outcome and complications of a patient 27 years old with Ewing sarcoma Data of 19 AS patients who underwent 29 THAs between 2014 and 2018 were retrospectively analyzed. Clinical and imaging data were collected preoperatively, postoperatively, and during the follow-up period for surgical outcomes.Results:There were 14 males and 5 females with 29 affected hips (53% bilateral, 47% unilateral). The average patient at surgery was 31.7 years old (range, 17-47 years). After surgeries, overall inclinations and anteversions of acetabular cups were 44.9°±0.3° (range, 30°–50°) and 18.42°±0.30° (range, 0°–25°) respectively. Mean Visual Analogue Scale (VAS) score decreased from 7.4±0.14 (range, 4–10) preoperatively to 3.21±0.09 (range, 0–4) at final follow-up. Mean Harris Hip Score (HHS) improved from 24.36±2.6 (range, 15–45) to 92±1.66 (range, 80–95) at final follow-up. Postoperative Range of Motion (ROM) was improved from 10.26°±2.61° (range, 0°–50°) preoperatively to 84.26°±0.76° (range, 70°–100°) at final follow-up. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, which shows the activity of disease, was 7.6±0.17, and it decreased to 3.5±0.15 at last follow-up. There were post-operative complications in 8 hips (27.6%). Superficial wound infection was documented in 3 hips (10.3%), sciatic nerve injury in 1 hip (3.4%), implant loosening in 2 hip (6.9%), and heterotopic ossification was documented in 2 hips (6.9%) at final follow-up.Conclusion:Surgical outcomes of THA for AS patients with hip involvement are satisfactory.

Resistive Index Value of Superior Mesenteric Artery In Preterm Infants With Necrotizing Enterocolitis

Aims: to find out the comparison of RI values of superior mesenteric artery inpremature infants with NEC and without NEC.Material and methods: This study was an observational analytic study, with acase-control study design, where the sampling method was using consecutive samplingin the NICU Room, Anturium and Radiology Department Dr. Hasan Sadikin GeneralHospital Bandung from September to October 2019. Data processing uses unpairedT-test.Results: The total sample was 22 subjects, consisting of 11 with positive NEC and11 negative NEC, with an average gestational age of 31.36 weeks and an average birthweight of 1490.45 grams. In the positive NEC group, the average RI value was 0.90and in the negative NEC group, the average RI value was 0.70. Statistical test resultswith unpaired T-test showed that there was a statistically significant increase in thevalue of superior mesenteric artery RI in premature infants with NEC compared topremature infants without NEC with a p-value = 0.0001 (p-value < 0.05).Conclusion: There was an increase in the value of superior mesenteric artery RIin premature infants with NEC compared to premature infants without NEC with avalue of p = 0.0001 (p-value <0.05).Key words: Necrotizing Enterocolitis–Superior Mesenteric Artery–Ultrasonography

Difference in Correlation Coefficient between Heart Rate Variability and Mechanical Dispersion in Breast Cancer Patients with and without Cardiovascular Risk Factors Post Anthracycline Chemotherapy

Background: Sympathetic hyperactivity is one of the several factors that influence left ventricular dyssynchrony post anthracycline. Cardiovascular risk factors affect the acceleration of left ventricular dyssynchrony. The purpose of this study is to assess the difference in correlation coefficient between HRV and mechanical dispersion in breast cancer patients with and without cardiovascular risk factors after anthracycline administration.Method: This was a cross sectional study with linear regression analysis conducted at Hasan Sadikin General Hospital Bandung between July-October 2018. Subjects were breast cancer patients who had received 6 cycles of FAS and were divided into 2 groups. Group I was patients with breast cancer who have cardiovascular risk factors and group II was without cardiovascular risk factors. Sympathetic hyperactivity was assessed using HRV baseline frequency with minimum duration of recording and left ventricular dyssynchrony was assessed using MD method by echocardiography.Result: This study involved 66 patients. Group I (n=34, age 50.3±6.3 years) and group II (n=32, age 48.5±9 years). The median of LF/HF ratio was 2.7 ms2 (group I) and 1.9 ms2 (group II). MD value in group I and group II was 52.2±13.6 ms and 45.7±8.8 ms, respectively. The result of linear regression analysis showed positive correlation between the LF/HF ratio and MD in group I (r=0.546, p=0.001) and group II (r=0.423, p=0.016) after adjusting three confounding factors (systolic blood pressure, cumulative dose of Doxorubicin, and age).Conclusion: Correlation coefficient of HRV with mechanical dispersion in post anthracycline breast cancer patients in those with cardiovascular risk factorswas worse compared to those without cardiovascular risk factors but was not statistically significant.

Management of Juvenile Nasopharyngeal Angiofibroma in a Referral Hospital in West Java, Indonesia

Background : Juvenile nasopharyngeal angiofibroma (JNA) is a fibrovascular tumor originating from the supero-posterior area of the sphenopalatine foramen. This tumor is histologically benign, but is clinically malignant because JNA has potentially destructive spread extending to the skull base and the cranium. The aim of the study was to evaluate the management of JNA in Dr. Hasan Sadikin General Hospital Bandung, a referral hospital in West Java. Methods : This was a descriptive retrospective study using medical record data of JNA patients during the period of 2011-2018. The stage of JNA was designated, based on the FISCH classification. Results : There were112 JNA cases, consisting of 99% male and 1% female. Most of them (97%) were aged 10-20 years old (median16 years old). The chief complaints were nasal obstruction (46%) and recurrent epistaxis (36%). Most of the JNA stage was stage II (43%). Major feeding vessel of JNA was from an internal maxillary artery (IMAX) and ascending pharyngeal artery (28%). Preoperative management was equal for ligation and embolization. The complication of embolization was local pain (75%). The most surgical technique performed was the transpalatal approach (41.36%). Blood loss in a different stage in JNA surgery with embolization was less than surgery with ligation. There were patients (10%)with residual disease after 6 months follow-up. Conclusions : JNA is essentially a disease of the adolescent males. The management of JNA patients is surgery, mostly using transpalatal technique. Preoperative embolization of JNA is a safe procedure, minimizes intraoperative blood loss, decrease the incidence of residual or recurrence, and shortening the duration of the surgery.