Hasan Sadikin General Hospital Research Articles

Comparison of TransPerineal Prostate Biopsy Using Novel Affordable VY Probe (TPPB-VY) and TransRectal Prostate Biopsy (TRPB) in Detection of Prostate Cancer on Hypoechoic Lesions.

Introduction:Prostate cancer is one of the most commonly encountered urologic malignancy. Biopsy samples may be attained using TPPB-VY or TRPB; both of the approaches are relatively comparable in terms of accuracy. Transperineal Access System revolutionizes the methodology for obtaining prostate biopsies. But in Indonesia this device is not available and expensive, we developed VY probe mounted needle guide device. The study was aimed to compare cancer detection rate and rates of cancer detection in Grade Groups (GG) between these two approaches, particularly in prostate cancer patients. Methods:A cross-sectional study with retrospective data from patients diagnosed with prostate cancer in Hasan Sadikin General Hospital in 2019 – 2020 was performed. Ethical approval of this study was sought from the hospital authorities (IRB number: LB.02.01/X.6.5/ 55/2020). The patient was included to the study if PSA ≥ 4 ng/ml, DRE results suggestive of prostate cancer. The diagnostic accuracy of both approaches was compared using histopathological analysis. Results:There were 44 patients included in the study; 22 patients had received TRPB and 22 patients had TPPB-VY. Higher degree of cancer detection rates was found in patients receiving TPPB-VY. Patient with Prostatic adenocarcinoma were all found having hypoechoic lesion in TPPB-VY. On the other hand, half of the patient with Prostatic adenocarcinoma shown having no lesion in TRPB. Prostate cancer with hypoechoic lesion can be detected better by TPPB-VY than TRPB. Cancer detection rates on TPPB-VY were significantly higher than on TRPB for each grade group. Conclusion:Among patient with hypoechoic lesions, TPPB-VY led to more detectionof prostate cancer, it provides detection of all grade groups and high-grade prostate cancer, this showed a non-inferior TPPB-VY compared to TRPB. TPPB-VY should be considered as an option for all men in whom a prostate biopsy is indicated.

SUCCESSFUL NON-OPERATIVE TREATMENT IN MICROCYSTIC LYMPHATIC MALFORMATION OF THE TONGUE: A CASE REPORT

Background: Microcystic lymphatic malformation (MLM) is an abnormal congenital growth of lymphatic vessels. It may occur in any part of the human body, with 75 % cases found in the head and neck, including in oral cavity. This case report aimed to describe a case of MLM in a child who was successfully treated non-operatively with antibiotics and corticosteroid. Case Report: A 4-year-old child came to Oral Medicine Clinic of Dr. Hasan Sadikin General Hospital, Bandung, with a chief complaint lesions of the tongue since a year ago, accompanied by bleeding in the affected areas but not pain. Patient gave history of recurrent episodes of the symptoms since 7 months old. Result : Ultrasonography was performed and diagnosis of microcystic lymphatic malformation was established. Systemic oral corticosteroid, antibiotics, and multivitamins were given and the lesions showed significant improvement after 2-weeks treatment. Conclusion: Therapy of MLM with antibiotics and systemic oral corticosteroid significantly improved patient’s condition, and ultrasonography may be used as a diagnostic modality in MLM diagnosis.

The Profile of Soft Tissue Sarcoma Patients who Undergo Radiotherapy in Dr. Hasan Sadikin General Hospital Bandung

Background: Soft Tissue Sarcoma is one of the rare cancers that increased in number in the last few years, but information about soft tissue sarcoma patients was still limited, especially in West Java, Indonesia. This study aimed to find out the patient profile and the histopathological cell distribution of soft tissue sarcoma patients who undergo radiotherapy. Methods: The study design was retrospective descriptive quantitative with the total sampling method. This study was done by observing all patients’ medical records registered from January 1, 2018, until December 31, 2019, in the Hospital-Based Cancer Registry of Radiology Department of Dr. Hasan Sadikin General Hospital Bandung, with the inclusion criterion of patients diagnosed with soft tissue sarcoma. Results: A total of 5% (n = 75) from 1,388 cases registered were soft tissue sarcoma. The most common patient profile was female (57.3%) and age group 45–54 years (21.3%). The chief complaint was dominated by a painless mass (56.0%) at the lower limb (37.8%) with the most frequent cell of fibrosarcoma (17.3%), the most intention of the radiotherapy of curative adjuvant (78.7%). Conclusions: The number of soft tissue sarcoma is small compared to other malignancies. It is more common in women, the most age group is from 45 to 54 years with the median of 47 years old, ranging from 9 to 90 years, it tends to occur in the lower limb with a chief complaint of a painless mass, and the most frequent cell is fibrosarcoma. The common treatment combination is surgery with radiotherapy

Head and neck cancer in Hasan Sadikin general hospital: A cross-sectional study before and during COVID – 19 pandemics.

The world is fighting against coronavirus disease 2019. Cancer patients are highly immunocompromised by cancer treatment. The conditions potentially increase the mortality and morbidity of head and neck cancer patients. This study aims to identify head and neck cancer prevalence in the Department of Otorhinolaryngology-Head and Neck Surgery Hasan Sadikin General Hospital, Bandung, from the intended year before and during the pandemic. Data were obtained from the hospital database of all head and neck cancer patients from 2018-to 2020. Head and neck cancer patients were compared between 2018-2020 based on outpatients, inpatients, and treatment using the Wilcoxon test to analyze the association between variables. There was a significant decrease in the number of patients and treatment in Hasan Sadikin General Hospital during the pandemic. This study showed a significant decline in patients, treatments, and procedures during the head and neck cancer pandemic. During this crisis and uncertainty, extraordinary measures must ensure the best treatment possible for oncological care. Patients must be transferred to another health facility hospital. The screening of coronavirus disease 2019 must be implemented for every patient to ensure the trust and safety of the patients. Keywords: COVID-19, Cancer, Head and neck, Naso pharyngeal carcinoma.

Correlation of Clinical Presentations and Imaging Findings with Flow Dynamics in Carotid-Cavernous Fistula Patients at Dr. Hasan Sadikin Hospital, Bandung

Background: Carotid cavernous fistulas (CCFs) have variable clinical presentation, imaging, and angiographic findings. The study aims to investigate the association of clinical presentations and radiological findings with flow dynamics from digital subtraction angiography (DSA) of CCFs patients.
 Methods: CCF patients who underwent DSA at Dr. Hasan Sadikin general hospital from January 2017 – December 2019 were included in this study. Patient’s characteristics, clinical presentations, and imaging results were retrieved from the patient’s medical record and radiology database. Fractures, proptosis, extraocular muscle thickening, superior ophthalmic vein dilatation, cavernous hyperdense lesion, and infarct are expected to be identified from imaging results. DSA identified types of flow dynamic based on Barrow classification and venous drainage patterns. Numeric data were analyzed by using Mann Whitney test, while categorical data were analyzed with Fisher’s exact test.
 Results: Twenty-eight patients were included in the study, with patients’ mean age was 30.5-year-old (range: 14- to 61-year-old), consisting of 19 males (67.9%) and 9 females (32.1%). In approximately 75% of the cases, the cause of CCF was a history of trauma. Patients with high flow CCFs were associated with the findings of cavernous sinus hyperdense and proptosis than patients with low flow. Patients who are presented with more than 1-year-long duration of symptoms were more likely to have more than 1 draining vein, compared to patients who are presented with < 1-year-long duration of symptoms.
 Conclusions: History of trauma, longer duration of symptoms, and the presence of a hyperdense cavernous lesion on head CT scan results require further angiographic study prior to endovascular intervention.

Maternal Characteristics and Histopathological Features of Placenta Accreta Spectrum in Dr. Hasan Sadikin General Hospital Bandung, Period 2015–2020

Background: The placenta accreta spectrum (PAS) incidence has inclined today. The PAS is divided into three histopathological classifications, including accreta, increta, and percreta, associated with maternal, fetal morbidity, and mortality. This study aimed to explore the maternal characteristics and histopathological features in PAS at Dr. Hasan Sadikin General Hospital Bandung. Methods: This descriptive observational study involved 135 cases from January 2015–December 2020 at Dr. Hasan Sadikin General Hospital that met the inclusion criteria. The PAS histopathological classification was evaluated based on maternal characteristics such as age, parity, cesarean section (CS), and miscarriage. Results: The incidence of placenta accreta from 2015 to 2020 was 37.0%, whereas increta was 43.4%, followed by percreta at 19.3%. The maternal age of placenta accreta and increta mainly occurred at the age of 30–34 years with the prevalence of 40% and 46%, respectively, whereas percreta was aged 35–39 yo (27%). Most parities in placenta accreta, increta, percreta were three. Interestingly, 93% of cases had a CS history. Furthermore, the miscarriage history for accreta was 18%, increta 29% and percreta 38%. Conclusion: The highest incidence of PAS in Dr. Hasan Sadikin General Hospital is placenta increta, which mainly occurs at the age of 30–34 years. Almost all PAS patients have a history of CS; however, most of the patients do not have a miscarriage history.

Correlation between serum KL-6 level and severity of SARD-related ILD

Objective: To understand the correlation between serum KL-6 level and severity of SARD-related ILD in Indonesia. Method: This was a cross-sectional study to evaluate the correlation between serum KL-6 level and Interstitial Lung Disease (ILD) severity based on Chest High-Resolution Computed Tomography (Chest HCRT) among patients with Systemic Autoimmune Rheumatic Disorders (SARD) who visited the Rheumatology Clinic of Dr. Hasan Sadikin General Hospital during the period of January 2019 to February 2020. Secondary data were retrieved from a study on the Effects of Ciplukan Herbs on Organ Fibrosis. KL-6 serum concentration was measured from stored biological material and the correlation between the serum KL-6 level and ILD severity was analyzed by Rank Spearman's test. Results: Thirty-four patients participated in this study with a median age of 37 years-old. Most of the participants were female (94.1%), Sundanese (64.7%), and had systemic sclerosis as an underlying disease (48.5). The median serum KL-6 level was 57.1 U/ml (21.6-444.1). Most participants belonged to severe ILD group (58.8%) with a mean serum KL-6 level of 65.1±48.9 U/ml. The highest mean serum KL-6 level (111.6±121.8) was observed in the moderate ILD group comprising of 32.4% of the participants. The remaining 11.8% participants belonged to mild ILD group with a mean serum KL-6 level of 61.1±24.9 U/ml. Serum KL-6 level was demonstrated to have a weak correlation with ILD severity (r=-0.229, p=0.193). Conclusion. There is an insignificant weak correlation between serum KL-6 level and ILD severity based on chest HRCT in SARD patients.

Therapeutic Outcomes of Pediatric Acute Myeloblastic Leukemia Patients at a Tertiary Hospital in Bandung, Indonesia

Background: Acute myeloblastic leukemia (AML) is a subtype of leukemia characterized by myeloid infiltration into the bone marrow, blood, and other tissues. AML ranks 5th malignancy in children and the prognosis is poor. After chemotherapy, the outcomes vary. Therefore, this study aimed to provide further insight into the therapeutic outcomes of pediatric AML patients. Methods: This study was conducted with a cross-sectional descriptive method. The data were obtained from the medical records of children diagnosed with AML at the Department of Child Health of Dr. Hasan Sadikin General Hospital in 2017–2019 with the total sampling method. Data including age at determination, gender, laboratory values including hemoglobin, leukocyte, thrombocyte as well as blast cell count on peripheral blood smear were collected. Also, the bone marrow punctures gathered were clustered based on the French-American-British (FAB) classification. Data were presented in tables. Results: In total, 46 data of AML patients were retrieved, with the age category at first diagnosis was >5–12 years (48%) and predominantly males (63%), children with moderate anemia (41%), leukocytosis (35%), severe thrombocytopenia (46%), and blast cell count ≥20% (83%). AML-M2 was the most common subtype (30.4%). The majority of patients (91%) underwent chemotherapy and most (45%) patients died during chemotherapy Conclusion: The outcome of AML therapy among children is mostly poor, and particularly die during chemotherapy. Early detection and follow-up of patients to continue therapy are important aspects to reduce the mortality rate of AML.

Factors Related to Infection in Systemic Lupus Erythematosus Patients Admitted to the Hospital

Background: One of the causes of the increase in hospitalized SLE patients is infection, and it is an important factor in morbidity and mortality, so it is necessary to conduct a research to identify factors related to infection and the type of infection caused in hospitalized SLE patients.
 Methods: This study is a retrospective, categorical descriptive study utilizing medical records of SLE patients diagnosed with and treated for infection both on admission and during their stay in Hasan Sadikin General Hospital between January 2016 to June 2018.
 Results: Seventy- four patients were involved into this study. Female were 70 (94.6%), aged <40 years were 69 (93.2%) patients, and all 74 (100%) were entirely in an active disease condition with a mean Mexican systemic lupus erythematosus disease activity (Mex-SLEDAI) score of 9 ± 5.2. Fifty-three (71.6%) subjects experienced major infections. Mucocutaneous and kidney were the most organs involvement found in SLE patients during infection, 63 (85.1%) and 57 (77.0%) respectively. Sixty-two (83.7%) subjects had received corticosteroids before the onset of infection, while pneumonia was the most common infection found in 33 patients (44.6%). This study also noted 12 (16.2%) patients deceased related to infection with most causes were respiratory failure (66.7%).
 Conclusion: Age less than 40-year-old, mucocutaneous and kidney involvement and previously on corticosteroids were found higher among in hospitalized SLE patients. Most experienced major infections and pneumonia is the most common type of infection.

Glasgow Outcome Scale Assessment in Patients with Cerebral Toxoplasmosis

Background: Cerebral toxoplasmosis is a Toxoplasma gondii infection affecting the brain. Assessment of the functional outcome after treatment is needed as an evaluation for therapeutic management. One of the instruments used is the Glasgow Outcome Scale (GOS). This study aimed to assess the functional outcome of cerebral toxoplasmosis patients using GOS. Methods: A Cross-sectional descriptive study with total sampling method was conducted. Medical records were retrieved from patients with cerebral toxoplasmosis registered at the Department of Neurology, Dr. Hasan Sadikin General Hospital, Bandung during year 2017–2019. Inclusion criteria were patients with cerebral toxoplasmosis aged >18 years and had a positive HIV serological test. The GOS was assessed and presented in frequency, using Microsoft Excel and SPSS software ver. 25.0. Results: Of 87 patients, 68% had somnolent on admission to the hospital, 51% had hemiparesis/hemiplegia, and 76% had GOS 3, indicating severe disability. Almost one third (28%) of patients died during hospitalization with non-neurological complications as the most common cause of death (63%). On discharge from the hospital, 82% of the survivors were fully alert, 40% had hemiparesis/hemiplegia, and 33% had GOS 4 (mild disability). Conclusions: Most of the cerebral toxoplasmosis patients come to the hospital with severe disability. During the treatment, one third of patients died, and those who survived had mild disability. GOS has improved after hospitalization, suggesting that GOS is useful for assessment of therapeutic management.

Reversal Reaction in Leprosy Patients: Study on Prevalence, Sociodemographic Characteristics, and Precipitating Factors at a Tertiary Referral Hospital in West Java, Indonesia

Background: Heretofore, leprosy remains one of the most stigmatizing diseases with serious social consequences. Patients with leprosy might develop inflammatory reactions that interrupt with stable and chronic disease which are called leprosy reactions. Type 1 leprosy reactions, also known as reversal reactions (RR), are caused by immune responses that initially decreases, then “reverses” to become more intense, leading to considerable disability. The aim of this study was to identify the prevalence, sociodemographic characteristics, and precipitating factors of reversal reaction in leprosy patients. Methods: This was a retrospective study with a cross-sectional design, with an approach to collecting data from the medical records of the Leprosy Clinic, Department of Dermatology and Venereology Dr. Hasan Sadikin General Hospital Bandung West Java, during January 2015–December 2019. Results: The results showed that 53 patients (24.7%) of the total 214 leprosy patients experienced a reversal reaction. The most frequent type of leprosy with reversal reaction was borderline lepromatous (BL) (56.5%). Most of the patients were male (68%), aged between 25–44 years (47.2%), unemployed patients (35.8%), and the last education was senior high school (71.7%). Physical stress was suspected as the most precipitating factor in reversal reaction patients (50.9%). Conclusions: The prevalence of leprosy patients with reversal reaction in a Tertiary Referral Hospital West Java, Indonesia is 24.7%, with various characteristics based on sociodemographic. Physical stress is suspected as the most precipitating factor of RR in leprosy patients. Early diagnosis of reversal reaction is important to prevent nerve damage and disability.

Urinary Epithelial Sodium Channel (EnaC) Level as A Diabetic Marker of Nephropathy in Type 2 Diabetes Mellitus with Hypertension

Increased prevalence of diabetes mellitus (DM) leads to the increased of various complications including diabetic nephropathy, which can lead to the end stage renal disease (ESRD). The Epithelial sodium channel (ENaC), which is located in distal convoluted tubules, plays an important role in transepithelial sodium reabsorption for electrolyte homeostasis. Diabetes mellitus can cause changes in ENaC function which will interfere with kidney blood pressure control, worsening hypertension, and kidney injury that eventually may trigger diabetic nephropathy. The aim of this study was to determine the validity of urinary ENaC for screening diabetic nephropathy in type 2 diabetes mellitus (T2DM) with uACR as the gold standard. This was a cross-sectional analytical observational study conducted in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from December 2020 to July 2021. The subjects were 87 patients T2DM with hypertension with the majority of subjects (n=62) had a mean age of 56 years old and were experiencing albuminuria and hyperglycemia with DM for a duration of < 10 years. The poor glycemic control in these patients accelerated the occurrence of kidney damage. Result showed that urine ENaC level had a sensitivity and specificity of 82.3% and 48%, respectively, with 72.4% accuracy. The cut-off point of urine ENaC in this study was 0.98 ng/mL. Hence, urine ENaC level can be used as a test to screen for diabetic nephropathy with 82.3% sensitivity.

Comparison between the Effectiveness Fecal Immunochemical Test and Colonoscopy As A Tool For Colorectal Cancer Early Detection

Cancer is a disease that causes a lot of misery and death in humans. According to data from the World Health Organization (WHO) in 2015, there are 8.8 million deaths caused by cancer and colorectal cancer ranked third with 774,000 deaths. One of the prevention effort for colorectal cancer is early detection in the population, especially in high-risk groups and in groups with non-specific symptoms. In general, two types of early detection tests are available: stool-based testing and structural testing. Fecal immunochemical test (FIT) is one type of examination that is categorized as the tool-based test. Meanwhile, the structural test include colonoscopy, CT colonography and flexible sigmoidoscopy. This study aimed to determine difference in the effectiveness of FIT against colonoscopy as an early detection tool for colorectal cancer. This study was a cross-sectional comparative diagnostic analytical observational study to compare FIT to colonoscopy for early detection of colorectal cancer. This study involved patients presented to Dr. Hasan Sadikin General Hospital Bandung, Indonesia. Analysis of diagnostic test data was carried out to obtain the sensitivity, specificity, and the positive and negative predictive values through the use of bivariate analysis in the form of Man Whitney test. Thirty-eight patients were included in this study, consisting of 27 cancer patients and 11 non-cancer patients. Results showed that the sensitivity level of FIT was 81.5%, with 72.7% specificity. There is no significant difference in the effectiveness between FIT and colonoscopy in screening for colorectal cancer.

Comparison of Cognitive Function between Intracerebral Haemorrhage Stroke Patients with and without Hypertensive Crisis

Background: Intracerebral haemorrhage (ICH) stroke is characterized by neurological dysfunction, caused by focal collection of blood within the brain parenchyma or ventricular system that is not caused by trauma. Hypertension is one of the main risk factors for intracerebral haemorrhage. Hypertensive crisis, which is a more severe type of uncontrolled hypertension may aggravate the cognitive outcomes. The aim of this study was to compare cognitive function between intracerebral haemorrhage stroke patients with and without hypertensive crisis. Methods: This study was a retrospective comparative analytic study, combined with a case-control study from August to November 2020. All medical records of patients with intracerebral haemorrhage, who were admitted to Dr. Hasan Sadikin General Hospital Bandung in 2019, were collected. The total score of mini-mental state examination (MMSE) which was recorded in the medical record was taken and compared between groups using the Mann-Whitney test. The MMSE was conducted on the day of discharge, and the minimum education level of the patients was elementary school. Results: We found a total of 109 medical records with ICH, 67 of which were with hypertensive crisis. The median MMSE score in the hypertensive crisis group was slightly higher than in the non-hypertensive crisis group. Furthermore, there was no statistical difference in MMSE scores between intracerebral haemorrhage patients with and without hypertensive crisis (p-value=0.439). Conclusion: There is no difference in cognitive function between intracerebral haemorrhage patients with and without hypertensive crisis. Further study is of great value to explore the relation between intracerebral haemorrhage patients with and without hypertensive crisis.

Lung Abnormalities in Systemic Sclerosis Patients through Spirometry, Chest X-Ray, and High-Resolution Computed Tomography Scan

Background: Systemic sclerosis (SSc) is a multisystem autoimmune illness with a wide range of clinical symptoms. The pulmonary organ manifestations frequently occur, but the symptoms are non-specific. Radiological examination and pulmonary function tests (spirometry) are needed to detect lung abnormalities in SSc patients. This study aimed to obtain information about the overview of lung abnormalities in SSc patients through spirometry, chest x-ray, and high-resolution computed tomography (HRCT) scan examination. Methods: A descriptive qualitative study was conducted on 75 SSc patients registered in Dr. Hasan Sadikin General Hospital Bandung from January 2019 to December 2020. Data were collected with a total sampling method and presented in proportions and percentages. Results: The majority of subjects were affected by cutaneous 73 (97%), pulmonary 29 (39%), and musculoskeletal 17 (23%) involvement. Spirometry revealed that 43 subjects (57%) had restrictive lung disease, with one false-positive case and two false-negative cases. On a chest x-ray, 45 (60%) of subjects had abnormalities. The majority of subjects were found to have Ground-glass opacities on HRCT scans. Ground-glass opacities were discovered in 46 subjects (82%) and 27 subjects (60%) were identified as having severe fibrosis scores. Conclusion: According to spirometry results and abnormalities on chest x-ray and HRCT scans, the majority of SSc patients have restrictive lung disease.

Snakebites and the Effect of Serum Anti Bisa Ular (SABU) Antivenom at Dr. Hasan Sadikin General Hospital Bandung, Indonesia: an Overview Period 2015–2019

Background: Snakebite is considered a global health issue, especially in the Southeast Asian region. However, data regarding snakebite cases in Indonesia are still very limited. This study aimed to explore the venomous snakebite cases and the serum anti bisa ular (SABU) antivenom effect in treating venomous snakebite caused by other than the snake species indicated in currently available SABU antivenom formulas. Methods: The analytical descriptive method with a cross-sectional study design was conducted in 2021 using a total sampling from the medical records of 63 patients diagnosed with snakebite at Dr. Hasan Sadikin General Hospital Bandung from 2015 to 2019. Characteristics of patients, clinical manifestation, and correlation between snakes species and outcomes after treatment with or without administration of SABU antivenom were collected. Results: Out of 63 patients, males (79%) were predominant with an average age of 39 years. Fifty-six patients arrived at the Emergency Room less than 24 hours after the occurrence (89%). Most cases were categorized as grade 2 (41.%) where the upper extremities were commonly bitten the body area (64%). Edema (83%) was the most common manifestation. There was no correlation between snake antivenom administered to a specific snake species and the stated outcome (p=0.053), meaning that SABU antivenom might be an effective alternative to treat more types of snakebites. Conclusions: Snakebites are most common in males, attack the upper extremities, categorized as grade 2 with edema. Administration of SABU antivenom provides the similar outcome compared to the group caused by the Javan spitting cobra, Banded krait, and Malayan pit viper.

Neutrophil-to-Lymphocyte Ratio Changes in Rheumatoid Arthritis Patients with Oral Focus Infection Treatment


 Rheumatoid Arthritis (RA) is a chronic autoimmune disease that causes inflammation of the joints. RA is known to have associations with oral infection. Oral focus infection treatment has been shown to reduce RA disease activity. The Neutrophil-to-Lymphocyte Ratio (NLR) is a parameter to determine the inflammatory activity in RA patients. This study aims to determine the NLR changes of RA patients after oral focus infection treatment. This study is a descriptive and analytic-comparative study using secondary data obtained from the medical records of oral focus infection treated RA patients at Dr. Hasan Sadikin General Hospital, Bandung, from January to December 2019. Data were processed using the Wilcoxon signed-rank test. The data consisted of 17 samples from 3 focus infection categories. A total of 5 samples had a chronic apical infection, 2 samples had a chronic marginal infection, and 10 samples had a chronic apical-marginal infection. The results showed a decrease in median of the NLR after oral focus infection treatment, without statistical significance. In conclusion, there were no significant NLR changes in RA patients who were given oral focus infection treatment.
 Keywords: neutrophil-to-lymphocyte ratio; rheumatoid arthritis; oral focus infection

Difference Uptake of 99mTc-Pyrophosphate vs 99mTc- Methylenediphosphate in Detecting Cardiac Amyloidosis; First Experience in Hasan Sadikin General Hospital

Cardiac amyloidosis (CA) is a disorder caused by deposits of insoluble fibrils in the myocardium and an underdiagnosed cause of heart failure. Immunoglobulin Light Chain-Associated Amyloid (AL) and Amyloidosis Transthyretin-related (ATTR) are the two protein precursors that most commonly cause cardiac amyloidosis. It is important to distinguish between these two types of amyloidosis because the treatment and prognosis of each types is different. Recent advances in cardiac radionuclide imaging, in particular using bone-seeking agents such as 99mTc-Pyrophosphate (PYP) and 99mTc-Methylenediphosphate (MDP), can differentiate AL from ATTR. This study aimed was to investigate the uptake characteristic of both tracers in CA. Three patients with suspected of having cardiac amyloidosis underwent two cardiac radionuclide imaging examinations using those two different radiopharmaceuticals. The cardiac images were analyzed quantitatively and semi-quantitatively based on ASNC (American Society of Nuclear Medicine) criteria. Cardiac radioactivity uptake of 99mTc-PYP was better from those of 99mTc-MDP based on quantitative as well as semi-quantitative (visual assessment).
 Keywords: cardiac amyloidosis; cardiac imaging; 99mTc-PYP; 99mTc-MDP

Risk factors of latent tuberculosis among chronic kidney disease with routine haemodialysis patients

IntroductionSince immune system alteration occurs, chronic kidney disease (CKD) on routine haemodialysis (HD) patients have a greater risk for latent tuberculosis (LTB). LTB needs special attention so that it does not develop into an active form, because infection in CKD patients increases the mortality. This study aims to determine the risk factors that associated with LTB among CKD on routine HD patients. MethodsThis was a cross-sectional study conducted in Haemodialysis Unit, Hasan Sadikin General Hospital, Bandung. The subjects were recruited from March–May 2020. Subjects aged > 18 years at least have undergoing HD in 3 months and twice a week HD were included in this study. Patients with active tuberculosis (TB) suspected, malignancy, or immunocompromised were excluded. LTB was diagnosed using interferon-γ release assays (IGRA). All data including age, sex, CKD etiologies, smoking status, HD adequacy that assessed using KT/V and urea reduction ratio (URR), and contact status with TB patients were obtained and recorded in case report form. ResultsA total of 120 subjects were involved. LTB based on IGRA was occurred in 39.2% subjects, while 56.7% and 4.1% subjects had negative and indeterminate IGRA, respectively. Adequacy of HD based on KT/V value was not significantly different between positive and negative IGRA subjects. Positive IGRA subjects had lower URR (p = 0.042). Smoking status had significant association with LTB (OR = 2.5[95%CI 1.2–5.4, p = 0.017). Furthermore, URR < 73% also had significant association with LTB (OR = 2.6[1.2–5.6, p = 0.013). ConclusionSmoking status and HD adequacy based on URR < 73% are associated factors that contribute to LTB among CKD on HD patients.

CHARACTERISTICS OF FIRST DAY COMPLICATIONS AFTER ODONTECTOMY OF IMPACTED MANDIBULAR THIRD MOLAR IN GENERAL ANESTHESIA

Introduction: Odontectomy is the most common procedure performed by oral and maxillofacial surgeons. The consideration of odontectomy cases in general anesthesia with certain factors, such as patient anxiety, mental or physical disorders, degree of difficulty in impacted teeth, disoriented patients, number of teeth performed odontectomy, and duration of surgery. Some complications after odontectomy, including swelling, trismus, and paresthesia often occur from the first day after odontectomy. The purpose of this study was to determine the characteristics of the complications on the first day after odontectomy of impacted mandibular third molar in general anesthesia at Dr. Hasan Sadikin General Hospital during January – June 2020. Methods: This study was a cross-sectional retrospective using medical record data of patients diagnosed with class I, II, and III mandibular molar impaction based on clinical and panoramic x-rays and performed odontectomy of mandibular third molar impaction in general anesthesia at Dr. Hasan Sadikin Hospital for the period January - June 2020. Results: The obtained data were 186 cases from 98 patients. Data were obtained from secondary data through medical records of mandibular third molar impaction odontectomy patients in general anesthesia who were treated at the inpatient installation of RSUP Dr. Hasan Sadikin for the period during January to June 2020 to determine the characteristics of complications on the first day after odontectomy of impacted mandibular third molar in general anesthesia based on age, gender, and the classification of mandibular third molar impactions. The percentage of complications on the first day after odontectomy of impacted mandibular M3 in general anesthesia at Dr. Hasan Sadikin General Hospital for the period during January - June 2020 showed that the largest number was found in complications of swelling as many as 41 people (54%), followed by trismus as many as 33 people (43%) and paresthesia were 2 patient (3%). Conclusion: The most common complications were swelling and trismus, where these complications were classified as mild and normal complications from odontectomy of impacted mandibular third molars. Meanwhile, the rarest complication was paresthesia. Keywords: Complications, Post-odontectomy, Impaction of mandibular third molar