Hospital Medan Research Articles

Hubungan Pengetahuan dengan Penggunaan Mobile JKN : Studi Kasus RS Santa Elisabeth Medan

Mobile JKN is a form of digital transformation in the form of an application that can be used by JKN participants anywhere and at any time and is expected to reduce queues when registering patients. At the Santa Elisabeth Hospital in Medan, there are still patients who do not understand how to use the JKN mobile application because the level of knowledge about Mobile JKN is still relatively low, especially in patients who have low education and are entering old age so that the available health services are not utilized optimally. The aim of this research is to identify the relationship between knowledge and the use of mobile JKN at Santa Elisabeth Hospital Medan in 2024. The analytical research design uses a cross sectional approach. The sample for this research was 95 respondents with the sampling technique being accidental sampling. The instrument used was a questionnaire. Data analysis using the Chi-square test. The results of this study showed that 80 patients' knowledge was in the good category (84.2%), 51 people's use of mobile JKN was in the good category (53.7%). The results of the Chi-square test obtained a p-value of 0.002 (p<0.05) indicating that there is a significant relationship between knowledge and the use of mobile JKN at Santa Elisabeth Hospital Medan in 2024.

Analysis of the effect of range of motion exercises on the quality of life of post-stroke patients at royal prima hospital Medan in 2024

Stroke is a severe medical condition that occurs due to the interruption of blood supply to the brain, either through blockage (ischemic stroke) or rupture of blood vessels (hemorrhagic stroke). With more than 15 million cases each year worldwide, stroke is a leading cause of disability and death, with a significant impact on patients' quality of life. In Indonesia, the prevalence of stroke is very high, especially among adult patients, which contributes to the high mortality and disability rates. This study aims to evaluate the effect of Range of Motion Exercises on the physical condition and quality of life of post-stroke patients at the Rehabilitation Polyclinic of Royal Prima Hospital Medan. Using a correlational descriptive research design with the One Group Pretest-Posttest approach, this study involved 30 respondents who underwent a range of motion exercises. The results of the analysis showed that before the intervention, the majority of patients were in the poor quality of life category. However, after undergoing a rehabilitation program, there was a significant improvement in the patient's quality of life, where 50% of the respondents reported an excellent quality of life. This study indicates that range of motion exercises are effective in improving the quality of life of stroke patients, which has the potential to make an essential contribution to the development of stroke rehabilitation programs in Indonesia.

Analysis of related factors related to the quality of life of post-stroke patients at Royal Prima Hospital Medan

Stroke is a severe global health problem and is ranked the third leading cause of death after heart disease and cancer. According to WHO data, about 15 million people have a stroke each year, with more than 5 million suffering from permanent disability. In Indonesia, the prevalence of stroke increases with the increase in risk factors such as hypertension and unhealthy lifestyles. This study aims to analyze the factors that affect the quality of life of post-stroke patients at Royal Prima Hospital Medan. The method used is non-experimental quantitative research with a descriptive approach and associative analysis. The study was conducted at the Royal Prima Hospital Medan, a population of patients undergoing post-stroke rehabilitation in the last three months. A sample of 60 patients was taken using the Slovin formula, and data analysis was carried out univariate, bivariate using the Chi-Square test, and multivariate with logistic regression analysis. The results of the study showed a significant relationship between age factors (p-value = 0.002), gender (p-value = 0.001), psychological condition (p-value = 0.002), physical condition (p-value = 0.004), and family support (p-value = 0.000) on the quality of life of patients. Family support was the most significant factor, with an odds ratio (OR) of 11,686, indicating that patients who received family support were likelier to achieve a good quality of life. These findings are expected to provide insights into designing more effective rehabilitation programs and raise awareness about the importance of support for post-stroke patients.

Analysis Head Nurses' Leadership Styles to Staff Inpatient Nurses' Job Performance Royal Prima Hospital

lack of research in knowing the relationship between nurse leadership styles and nurse performance. Data collection by interviews, questionnaires and observations on inpatient nurses at Rotal Prima Hospital Medan. This study tries to examine the influence of the Job Performance Nurse dimension which is influenced by the dimensions of the Transactional Leadership Style and the Transformational Leadership Style of Head Nurses. This research is associative, with a quantitative method approach, using a descriptive correlational research design. The research was validated using SPSS-26 with data analysis techniques using multiple linear regression analysis. The results showed that the Transactional Leadership Style and Transformational Leadership Style had a positive and significant effect on Nurse Job Performance. The results of this study, we found that nurse leaders must have a good transformational leadership style so that leaders can help and encourage their subordinates in providing training and achieving their work goals properly. Nurse leaders are more likely to adopt a transformational leadership style. The results of this study also show that transactional leadership can affect nurse performance, although it is even better if the head nurse performs transformational leadership.

Effect Of Ramadhan Fasting On Apolipoprotein B And Small Dense Ldl In Type 2 Diabetes Mellitus Patients

This study's objective was to ascertain how type 2 Diabetes Mellitus patients' apolipoprotein B and small dense LDL were affected by Ramadan fasting. On 19 patients who had been diagnosed with type 2 DM at H. Adam Malik General Hospital Medan, a longitudinal prospective study from the fasting month of Ramadan until the end of the 2015 Ramadan fast was employed as the research methodology. The information was gathered by obtaining blood samples at the start and end of the Ramadan fast, after which the levels of apolipoprotein B and small dense LDL were determined. The T-Test and Wilcoxon tests were then used to assess the data. According to the study's findings, 13 respondents (68.4%) of the 19 patients with type 2 diabetes were men, and their average age was 57.26 years. Apoliprotein B (p=0.0001), small dense LDL (p=0.022), 2-hour PPG DGD (p=0.039), and mean body weight (p0.001) all indicated statistically significant changes. According to the study's findings, type 2 DM patients' apolipoprotein B and small dense LDL are significantly affected by Ramadan fasting.

Contribution of Product, Price, Place, Promotion, and People (5P) Marketing Mix Strategy on Patients’ Interest To Revisit

In the National Health Insurance (JKN) era, hospitals in Indonesia rapidly grew in number and also developed. In order to stand out amongst the competition, hospitals often rely on marketing strategies through attractive advertisements, offering unique services, and also introducing their services to the public. One method often utilized in the 5P marketing mix consists of product, price, place, promotion, and people. This study aims to identify the impact of 5P marketing mix strategies on the patients’ interest in visiting Bandung Hospital in the city of Medan. Bandung Hospital in Medan conducted this quantitative study using a cross-sectional approach. This study involved 150 patients of Bandung Hospital’s inpatient unit, which is the whole outpatient clinic patient (total sampling) during the May 2023 period. Analysis was carried out using frequency distribution, chi-square, and binomial logistic regression analysis. This study found that the majority of patients visiting Bandung Hospital belong to the 30-39 years age group (62.0%), are female (58.7%), hold a bachelor's degree (48.0%), and are visiting Bandung Hospital for the first time (62.7%). Most of the patients in this study have a good perception toward all aspects of 5P marketing strategies in Bandung Hospital and are interested in visiting the hospital again in the future (p<0.05), with place playing the biggest role in influencing patients’ interest (OR = 4.082). According to all findings in this study, it can be concluded that marketing strategies such as the 5P marketing mix strategy positively influence patients’ interest in visiting Bandung Hospital. It can also be inferred that this strategy would work in similar types of hospitals, not only in Bandung Hospital. Keywords: Marketing mix, Hospital, Product-Price-Place-Promotion-People (5P), Patients

The Influence of Work Stress Compensation and Job Satisfaction on Nurse Turnover Intention at General Hospital Sinar Husni Medan

This study aims to determine Job Stress partially has a significant effect on Nurse Turnover Intention at Sinar Husni Medan Hospital, to determine Compensation partially has a positive and significant effect on Nurse Turnover Intention at Sinar Husni Medan Hospital, Job Satisfaction partially has a positive and significant effect on Nurse Turnover Intention at Sinar Husni Medan Hospital. The method used in this research is quantitative which analyzes and tests with data using numbers with instrument tools, classical assumption tests, multiple linear regression tests, hypothesis tests, and determination tests. Research results: Partially Job Stress is positive and significant to Turnover intention, partially Compensation has an effect on Turnover Intentuon, partially Job Satisfaction has a positive and significant effect on Turnover Intention, simultaneously Job Stress, Compensation and Job Satisfaction have a positive and significant effect on Turnover Intention.

Correlation Between Shoulder Pain Severity, Acromion Morphology, and Acromiohumeral Distance Using MRI: A Study at Haji Adam Malik Hospital Medan in 2022

Background: Studies have shown that rotator cuff tears (RCTs) are the most common cause of shoulder pain and restricted movement. The acromion is a posterior shoulder landmark. Specific acromion morphologies may predispose individuals to rotator cuff tears. Furthermore, studies have found a correlation between supraspinatus tendon tears and acromiohumeral distance. This study examines how shoulder pain assessed with American Shoulder and Elbow Surgeons (ASES) score relates to acromion morphology and acromiohumeral distance on MRI at Haji Adam Malik Hospital in 2022.Methods: This descriptive analytical study employed a cross-sectional approach. A total of 38 patients with a confirmed diagnosis of shoulder pain underwent shoulder MRI examinations and were assessed using the ASES score. Statistical analysis included assessing data normality and performing Spearman correlation analysis. Data were processed and analyzed using SPSS version 25.0.Results: In this study of 38 patients, most participants were women with an average age of 54.66 years. The most common acromion type was type 1 (flat), and the most frequent acromiohumeral distance category was normal. There was no correlation between acromion type and ASES scores, but a moderate correlation was found between the scores and acromiohumeral distance (p=0.016). A positive correlation was observed between type III acromion and ASES score. Conclusion: Shoulder pain based on ASES score has a moderate correlation with acromiohumeral distance and acromion type III variation has a positive correlation although there is no significant correlation was found between shoulder pain and acromion type.

Effectiveness of Propioceptive Neuromuscular Facilitation in Improving Walking Quality in Post-Stroke Patients at Haji General Hospital Medan

Nationally, the prevalence of stroke in Indonesia in 2018 was 10.9 per mile, an increase compared to 2013 which was 7 per mile. Stroke is the second leading cause of death and the third leading cause of disability in the world. Two-thirds of stroke events occur in developing countries. Weakness and decreased muscle strength in stroke sufferers occur on one side of the limb, however, in the trunk muscles, weakness occurs on both sides, resulting in limited trunk rotation and difficulty in maintaining balance and gait). Propioceptive Neuromuscular Facilitation (PNF) is a physiotherapy intervention method that can be used to improve the quality of walking in stroke patients. This method can improve proprioceptor function by stimulating it in muscles and tendons. PNF also improves muscle strength, flexibility, and balance). Description of respondent data was carried out using univariate analysis to determine the frequency of age, weight, height, gender, paralyzed side and Wisconsin values ??before and after the intervention for both groups. Bivariate test to compare the average WGS value after treatment with before treatment in both the PNF group and the conventional group and compare the average difference between the PNF group and the conventional group. The average value of the difference before and after the intervention in the PNF group was 1.75 with a standard deviation of ± 0.463, while in the conventional group the average value of the difference before and after the intervention was 0.63 with a standard deviation of ± 0.518. Statistical tests using the Wilcoxon rink test between the two groups obtained a p-value of 0.024, which is smaller than 0.05, which means there is a significant difference between the PNF intervention group and the Conventional intervention group.

031. Urine Neutrophil Gelatinase-Associated Lipocalin (NGAL) Levels as a Predictor of Early Acute Kidney Injury in Post Coronary Artery Bypass Graft (CABG) Patients in H. Adam Malik Hospital Medan

Background: One of the main complications after open heart surgery is acute kidney injury. Coronary Artery Bypass Graft surgery is one of the main factors in this complication. Currently, the use of serum creatinine as one of the diagnostic criteria for AKI is not sensitive for diagnosing AKI at an early stage. Elevated urine NGAL levels are more indicative of a renal damage process than an increase in circulation. An increase in NGAL levels in urine can occur 100 times faster than circulating NGAL. Thus our research aimed to view NGAL ability to predict AKI in CABG patient. Methods: This research is an observational study with cross-sectional data collection methods to find out whether NGAL can be a predictor of AKI in patients who have undergone CABG surgery. Results: The collection of research subjects was stopped when the number of samples had been reached so that this study was a cohort study with consecutive sampling techniques. In the results of this study, we obtained 31 research samples. In 31 research samples, it was found that the average age was 61.46 years with a standard deviation of 8.2 years. This study was dominated by male gender with a total of 20 people or 64% of the total sample. After CABG surgery, it was found that 4 patients had postoperative acute renal failure or 13.3% of the total sample. The sensitivity of the instrument is 100% with a specificity of 96%. The accuracy of the NGAL is 97.5%. Conclusion: NGAL is a useful parameter to predict AKI and would have significant advantage however further study with multi-center design would be necessary to validate these result.

Comparison of Changes in Cortisol Values Before and After Administration of a Combination of Continuous Fentanyl and Paracetamol Drip in Post-Craniotomy Patients in ICU of Haji Adam Malik General Hospital Medan

Introduction: Post-craniotomy surgical pain can trigger an inflammatory response and release various stress response mediators. Prolonged stress response to pain can increase cortisol secretion which will eventually be resulted in cortisol dysfunction and widespread inflammation. Opioids have been shown to provide pain management after craniotomy. Fentanyl is a commonly used opioid analgesic to manage postoperative pain. The addition of paracetamol is often used as multimodal analgesia which aims to reduce postoperative pain and to minimize the stress response that occurs. The aim of the study was to obtain a comparison of changes in cortisol values before and after the administration of a combination of continuous fentanyl and paracetamol in post-craniotomy patients in the ICU of Haji Adam Malik General Hospital Medan. Subject and Methods: This research design used a cross sectional test with pretest and posttest design, with primary data sources obtained directly from examinations on patients in the ICU. This study involved 15 post-craniotomy patients in the ICU with mechanical ventilation. The cortisol levels in the patient’s blood were checked before and after administration continuous fentanyl and paracetamol drip. Results: There was a decrease in cortisol levels after being given a combination of continuous fentanyl and paracetamol drip in post-craniotomy patients by 18% with a p-value of 0.001 (p <0.05). Conclusion: Combination of continuous fentanyl and paracetamol drip can provide analgesia effects that can reduce the stress response, namely cortisol.

The Effect of Complementary Acupressure Therapy on Nausea and Vomiting After Regional Block Anesthesia (Spinal Anesthesia) in the Recovery Room Imelda Indonesian Workers General Hospital, Medan

Postoperative nausea and vomiting is one of the side effects that often occurs in spinal anesthesia. Nausea and vomiting affect patient morbidity such as stress, discomfort, dehydration, prolonging treatment time and increasing treatment costs. This study aims to determine the effect of acupressure therapy on the incidence of nausea and vomiting after spinal anesthesia in the recovery room at the Imelda Workers Indonesia General Hospital, Medan. This type of research is quantitative research with quasi-experimental research methods. Data reports in the province of North Sumatra showed that there were 25,602 patients who underwent surgery. Meanwhile, at the Indonesian Umim Workers Hospital in Medan, data on surgical patients for January-March 2024 totaled 666 patients, and 250 patients had spinal anesthesia. This research was carried out in February - June 2024 at the Imelda Indonesian Workers General Hospital, Medan. The research sample was taken as many as 20 respondents. incidence of nausea and vomiting after spinal anesthesia at the Imelda Workers Indonesia General Hospital, Medan. Based on the characteristics of respondents based on age, they were in the age range of 36-40 years, namely 55%, based on gender, the majority of respondents were women, namely 60%, respondents based on smoking history were the majority 65%, the distribution of respondents with a history of nausea and vomiting was the majority 55% and the majority of respondents with nausea and vomiting were 60%. The recommendation for this research is that acupressure therapy can be applied in nursing practice so that patients are able to perform it independently. For the Imelda Workers Indonesia General Hospital, Medan, it is necessary to score the risk of nausea and vomiting in patients before surgery to minimize the incidence of post-operative nausea and vomiting.

The Effect of Occupational Safety and Health Counseling on the Use of Personal Protective Equipment at the Special UPTD of the Medan Hajj Hospital

The development of occupational safety and health science in the work environment can be seen with the development of advanced science and technology as well as the emergence of new innovations in the work environment and encouraging companies to improve the knowledge and skills of their human resources. The purpose of this study is to determine the Influence of Occupational Safety and Health Education (K3) on the Behavior of Using Personal Protective Equipment at the Special UPTD of Haji Medan Hospital. This research includes quasi-experimental research. This study uses a one group pretest and pottest design. The population in this study is emergency room nurses at the Special UPTD of Haji Medan Hospital which totals 50 nurses in June-August 2024. The sampling technique in this study is total sampling. The measuring tool in this study uses a univariate and bivariate distribution of non-parametric data with the Wilcoxon test. The results of the Wilcoxon statistical test of both knowledge and attitude obtained a P-value of 0.000. This means that at alpha 5% there is a significant difference in median score between before and after counseling. Meanwhile, in the aspect of action, there was an increase in the number of PPE users between before and after counseling. Because the results of Asymp.Sig of knowledge, attitudes and actions are less than 0.05, H0 is rejected so that there is an influence of occupational health and safety counseling (K3) on the behavior of using PPE. In conclusion, there is an influence of Occupational Safety and Health Counseling (K3) on the behavior of using personal protective equipment at the Special UPTD of Haji Medan Hospital. The suggestions are expected to increase the frequency of counseling and provide information on the importance of using personal protective equipment in the workplace, provide strict sanctions against nurses who do not use personal protective equipment at work, increase the frequency.

Analysis of Demographics Characteristics on Depression in Perimenopausal Staff at a Central General Hospital in Medan, Indonesia

Introduction/Objective Perimenopause is a period where the ovary gradually starts to produce less estrogen. One of the impacts that could happen during perimenopause is the onset of depression arising from hormonal and metabolic disorders due to the significant decrease of ovarium function and secretion of endogenous estrogen. This study was conducted to assess the factors related to depression in perimenopausal women. Methods A multivariate linear regression analysis with a cross-sectional design was conducted at a Central General Hospital in Medan, Indonesia, from October 2023 to January 2024. Subjects were perimenopausal female staff at the hospital who met the inclusion and exclusion criteria. Symptoms of depression were assessed using the Beck Depression Inventory-II (BDI-II) score. Data analysis was conducted using bivariate and multivariate tests with linear regression. Results A total of 111 subjects were included in this study. The median age was 48 years, and the median Body Mass Index (BMI) was 25. The mean depression score based on BDI-II was 12.96±7.084. Bivariate analysis showed significance on age, years of education, total monthly income, BMI, and number of pregnancies. Multivariate analysis showed that total monthly income had the highest correlation amongst other variables, followed by age, while the number of pregnancies had the lowest correlation. Conclusion In conclusion, there was a significance between depression and age, income, and number of pregnancies in perimenopausal staff. On the other hand, there was no significance between depression and years of education, BMI, marital status, and chronic disease.

Postpartum Care Practices of Nurses and Midwives: A Study from Islamic Malahayati Hospital Medan

Background: The postpartum period, lasting approximately six weeks after childbirth, is a critical phase for maternal and neonatal health. Effective care during this time requires skilled health workers to address physical, emotional, and social needs while promoting maternal autonomy and recovery. This study investigated the practices of nurses and midwives in delivering postpartum care at Islamic Malahayati Hospital Medan. Methods: A descriptive research design was used, involving 61 nurses and midwives selected through total sampling. Data were collected using a structured questionnaire focusing on postpartum care practices, responsibilities, and standards adherence. Quantitative analysis of the data was conducted, with results presented as frequency distributions and percentages. Results: The majority of participants were aged 26–35 years, with less than five years of work experience, and held a Diploma Degree. Of the respondents, 82% actively provided postpartum care, reflecting strong professional commitment and competency. These health workers demonstrated responsibility in fulfilling their roles, ensuring quality care for postpartum mothers and their newborns. Conclusion: Health workers at Islamic Malahayati Hospital Medan showed commendable engagement in postpartum care, translating academic training into practical application. Future research should focus on improving systemic support and exploring additional factors influencing sustained high-quality postpartum care to enhance maternal and neonatal outcomes.

Korelasi Skor Get with The Guidelines-Heart Failure dan Rasio Platelet Limfosit pada Pasien Rawat Inap dengan Gagal Jantung

Introduction. The Get with the Guidelines-Heart Failure (GWTG-HF) risk score is a widely utilized and validated tool for assessing prognosis in patients with heart failure. Inflammation significantly contributes to the pathophysiology of heart failure, evidenced by platelet activation and a reduction in lymphocyte counts. Consequently, the platelet-to-lymphocyte ratio (PLR) may function as a prognostic biomarker in this population. This study aims to investigate the correlation between the GWTG-HF risk score and PLR as an inflammatory marker in patients hospitalized with heart failure. Methods. This cross-sectional study utilized medical records of heart failure patients admitted to Adam Malik Hospital in Medan from January 2022 to July 2023. Total GWTG-HF scores and PLR values were recorded at the time of patient admission. Correlation analyses were conducted to assess the relationship between the two variables. Results. The study evaluated 106 patient records, with male patients comprising 72.64% and a mean age of 55.84 (SD 14.09) years. The median GWTG-HF score was 37.5, while the median PLR was 137.14. Correlation analysis yielded a coefficient of r = 0.249 (p < 0.05), indicating a statistically significant association. Conclusion. A weak positive correlation exists between the GWTG-HF score and PLR in patients with heart failure, suggesting that PLR may serve as a supplementary inflammatory marker in prognostic assessments.

Relationship of Stromal Tumor Infiltrating Lymphocytes (STILs) with Grading Histopathology in Penis Squamous Cell Carcinoma

ABSTRACT Background:Penile squamous cell carcinoma is the most common penile malignance found in the world. Assessment of stromal tumor infiltrating lymphocytes (STILs) associated with grading against penile squamous cell carcinoma can provide a potential prognostic picture and help determine the action. Method:Cross-sectional analytical study with 32 samples of histopathological preparations diagnosed as penile squamous cell carcinoma at H. Adam Malik Hospital Medan. The assessment of stromal TILs was carried out by assessing the number of lymphocyte inflammatory cells in the peritumoral stroma and then determined the assessment score, zero score no lymphocytes (minimum), score one found 0-10% lymphocytes (moderately), score two found 20-40% lymphocytes (massive) , score three found 50-90% lymphocytes. Grading assessments are categorized into grade I (well differentiated), grade II (moderately differentiated), and grade III (poorly differentiated). Result:The most grading found was grade II (43.8%) and the most STILs found were score three (50.0%). There is a significant relationship between grading and STILs in penile squamous cell carcinoma (p value=0.0001) i.e. the higher the STILs score , the lower the tumor grade. Conclusion:There is a relationship between STILs and histopathological grading in Penile Squamous Cell Carcinoma so that it can be used as an indikasi prognosis in patients with penile squamous cell carcinoma.

Frequency Distribution of Oncology Patients Who Come to Emergency Department at H. Adam Malik Hospital, Medan

A multidisciplinary approach is needed to comprehensively evaluate cancer patient’s condition and understanding patient demographic characteristics can improve health care by adapting to each patient's needs. This research is a descriptive observational study with a cross-sectional study design conducted at the Haji Adam Malik General Hospital in Medan on oncology patients who met the inclusion criteria. Data with a numerical measuring scale will be presented in mean+standard deviation (SD) and data with a categorical measuring scale will be presented in frequencies and percentages. The results showed that majority of patients were in 46–59 year age group as much as 32 patients (37.2%) and 58 patients (67.4%) were female. The highest level of education was found in 26 patients (30.2%) as bachelor, and 45 patients (52.3%) lived in Medan City. Most patients came to be treated at the surgical installation as many as 50 patients (25.6%). The research results found that majority of patients are in the age group 46-59 years, female, bachelor, domicile in Medan and are treated in surgical installation.

Mortality of Guillain Barre Syndrome and Myasthenic Crisis in Haji Adam Malik Central General Hospital Medan January 2021- December 2022

Introduction: Neuromuscular disorders are disorders of the neuro system that impact the muscular system. Among them are Guillain-Barré Syndrome and Myasthenic Crisis. Guillain-Barré syndrome is an autoimmune disorder of the nervous system that is polyradiculoneuropathic, characterized by weakness that radiates from the legs to the arms, torso, and face. Myasthenic crisis is a state of acute respiratory failure due to the exacerbation of Myasthenia Gravis. These two diseases are the most common types of neurodiseases found in hospital ICU patients. Objective: Determining the mortality rate of Guillain-Barré Syndrome and Myasthenic Crisis at Haji Adam Malik Central General Hospital Medan January 2021-December 2022. Methods : This study was a descriptive study with data obtained from medical records. The subjects were inpatients and outpatients with Guillain Barré Syndrome and Myasthenia Crisis, with as many as 129 patients. The subjects were selected by purposive sampling and met the inclusion and exclusion criteria. Results: A total of 40 Guillain-Barré Syndrome patients were studied, and 6 of them died. The majority were patients aged 36-50 years, and the male and female sexes were equally significant. A total of 89 patients with Myasthenic Crisis were studied, and 1 of them died, namely patients with the age category of 36-50 years and female. Conclusion: Guillain-Barré Syndrome mortality was 15%, and Myasthenic Crisis was 1.12% at Haji Adam Malik Center General Hospital Medan January 2021-December 2022. Keyword : Guillain-Barré Syndrome, Mortality, Myasthenic Crisis

Cesarean Scar Defect (Niche) Risk Factors: A Prospective Study on Indonesian Women

Introduction: Niche or cesarean scar defect is a complication of a cesarean section that has long-term implications for both obstetrics and gynecology. The rate of niche is believed to be increasing with the high number of cesarean sections. This study assesses the risk factors for niche development after cesarean section. Methods: A prospective cohort study was conducted on women who underwent cesarean section at the Haji Adam Malik General Hospital Medan between August 2020 and August 2022. Niche was assessed six weeks after cesarean section using transvaginal ultrasonography. The primary outcome was the presence of a niche. The antepartum, intrapartum and postpartum risk factors were analyzed for niche development. A logistic regression model was used to assess independent risk factors from the bivariate analysis. Results: There were 280 patients enrolled in this study. The prevalence of niche was 44.3% by using transvaginal ultrasound. There was no significant relationship between maternal age, gestational age, parity, nutritional status based on upper arm circumference, hypertension in pregnancy, anemia status, surgical indications, duration of surgery, volume blood loss, and puerperal infection to niche development (P > 0.05). The independent risk factors for niche development were Cervical dilatation > 4 cm (P = 0.035; RR = 1.75), locking suture technique (P = 0.015; RR = 13.81), non-closure vesicouterine folds (P = 0.04; RR = 0.14) and a retroflexed uterus (P = 0.001; RR = 0.039). Conclusion: Cervical dilatation > 4 cm, locking suture technique, non-closure vesicouterine folds, and a retroflexed uterus are risk factors for niche development after CS.