Kariadi Hospital Research Articles

Diagnostic Roles of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Vertebral Fracture due to Tuberculosis and Malignancy

Background: Vertebral fracture is a serious complication that can occur due to various medical conditions, including bone tuberculosis and malignancy (eg, cancer metastasis to the vertebrae). This condition invariably causes an increase in the inflammatory process in the body, which can be identified through the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR). This study aims to investigate the differences in NLR and PLR values in patients with vertebral fractures due to TB or malignancy. Methods: A retrospective observational study was conducted on vertebral fracture patients who underwent surgery in the Orthopedic Surgery Department of Dr. Kariadi Hospital Semarang between January 1st, 2022, and December 31st, 2023. Data on demographics and laboratory test results were extracted from medical records. Statistical analysis was performed using univariate analysis and presented as percentage and frequency. T-test or Mann-Whitney test was used to determine the difference based on their normality distribution. The diagnostic value of NLR and PLR was also analyzed using the receiver operating characteristic (ROC) curve and Youden index. Results: The study included 54 vertebral fracture patients. The mean age of patients was 41.77 ± 16.00 years, and the majority were female patients (68.5%). The Neutrophil to Lymphocyte Ratio (NLR) value was significantly higher in vertebral fracture due to malignancy patients than TB (5.5 (IQR 3.92 – 13.39) vs 4.53 (IQR 2.91 – 6.96), p=0.020). In contrast, the Platelet to Lymphocyte Ratio (PLR) value was not significantly different (p>0.05). The area under the curve for the NLR (0.69, 95% confidence interval [CI], 0.54 – 0.839) was greater than that of PLR (0.408, 95% CI, 0.246 – 0.571). Conclusion: NLR showed significantly different results in determining the cause of vertebral fractures, either tuberculosis or malignancy. NLR can be used as an important diagnostic marker to help differentiate between vertebral fractures caused by malignancy and those caused by infection.

095. A Rare Case Report: A 10-Years-Old Girl with Ectopic Ureter and Ectopic Hypoplasia Kidney

Background: The urinary tract system develops from an embryological structure in the dorsal part of the embryo, the intermediate mesoderm, which develops between the 4th and 10th week of gestation. During the embryogenesis process, disturbed metanephric mesenchyme can cause congenital abnormalities of the kidneys and urinary tract (CAKUT), one of which is ectopic abnormalities. Ectopic ureter and ectopic kidney had an incidence of 1:2000 and 1:3000 worldwide, respectively. Additionally, this rare case will be even more uncommon with the presence of a hypoplasia kidney. These anomalies contribute to impaired urinary drainage. Case: A 10-year-old girl was referred to the surgical department at Dr. Kariadi Hospital due to continuous urinary incontinence. She can urinate regularly via the urethra, but constantly has vaginal leaks. Previously, she had physiotherapy at the regional hospital but there was no improvement. Contrast-enhanced computed tomography revealed an ectopic kidney image accompanied by right kidney hypoplasia and a cyst on the upper pole of the right kidney measuring ± 0.89 x 0.86 cm. Then, urethrocystoscopy and colposcopy also showed the right ureteral orifice on the superior wall of the vagina, ± 2 cm from the vaginal introitus with the left ureteral orifice in a normal position. The patient underwent ureteral reimplantation, and her symptoms successfully resolved, leading to a favourable prognosis. Conclusion: Complete ectopic ureter and ectopic hypoplasia kidney are rare congenital anomalies that require early recognition and careful management in pediatric patients.

Characteristics of Intracerebral Hemorrhage at Dr. Kariadi General Hospital: A Serial Case

Background: Stroke is an acute neurological deficit caused by sudden or rapid disruption of blood circulation to the brain. Intracerebral hemorrhage is the subtype of stroke with the highest mortality and disability rate. Several risk factors may be related to the clinical outcome of intracerebral hemorrhage. Herewith we present a case series regarding the characteristics of intracerebral hemorrhage. Methods: A case series among three intracerebral hemorrhage cases in January - February 2024 at Dr. Kariadi Hospital. Epidemiological, and clinical data were recorded and reported. Case Presentations: Three cases were studied, the main complaint of the patient was decreased consciousness. These patients had different risk factors for stroke. According to the Siriraj score, NIHSS score, and neuroimaging findings, these patients had hemorrhagic strokes with different brain lesions. Two-thirds of the patients had uncontrolled hypertension and one patient was accompanied by uncontrolled diabetes mellitus. Conclusion: Overall, all patients were >45 years old and the risk factors of these patients were modified risk factors that is uncontrolled hypertension and diabetes mellitus over a long period resulting in ganglionic hemorrhage.

015. A Gastrointestinal Infantile Hemangioma: A Rare Case Report and Literature Review

Background: Small intestinal hemangioma in children is a rare case. The most common predilection is jejunum area. History taking, physical examination, and supporting examinations are needed to help establish the diagnosis. Case: 1 year old girl came with complaints of vomiting with blood since the age of 6 months with frequency 10x/day everytime she eats and drinks. The patient has been given treatment according to the diagnosis of pulmonary tuberculosis and digestive problem, then referred to dr. Kariadi hospital because there was no improvement. Based on examinations, the patient was diagnosed with obstructive ileus at the level of jejunum and exploratory laparotomy was performed. Multiple hemangiomas of 14 x 5 cm were found in the jejunum and confirmed by anatomic pathological examination. Six days after the operation, the child was allowed to go home. Conclusion: Although this case is a rare case in children and include benign tumors, it is necessary to perform a quick diagnosis and appropriate management to prevent mortality and morbidity in children due to gastrointestinal bleeding.

Probiotic supplementation for reducing psychological symptoms in cancer patients on chemotherapy: A pilot trial

BackgroundPsychological disorders, including depression, anxiety, and stress, are prevalent among cancer patients undergoing chemotherapy. Probiotics have been investigated as a potential supplement to modulate the gut–brain axis and improve psychological symptoms, possibly through mechanisms such as serotonin regulation. However, studies on the effects of probiotics on psychological symptoms in chemotherapy patients are limited. MethodsThis randomised, double-blinded, placebo-controlled pilot trial was conducted at the outpatient clinic of dr. Kariadi Hospital, Semarang, in 2023. Sixty-one cancer patients undergoing chemotherapy were enrolled and randomised into an intervention (n = 30) and control (n = 31) group. The intervention group received probiotics (Lactobacillus rhamnosus Rosell-11 and Lactobacillus helveticus Rosell-52) twice daily for eight weeks. The primary outcomes were changes in depression, anxiety, and stress levels measured by the Depression, Anxiety, and Stress Scale 42 (DASS-42). The secondary outcome was serum serotonin levels. ResultsThe intervention group showed a significant decrease in total DASS-42 scores (p = 0.001), indicating an overall reduction in psychological distress. However, changes in the scores of the subscales (depression, anxiety, and stress) were not statistically significant (p > 0.05). Serum serotonin levels increased in the intervention group, but this was not statistically significant (p = 0.38). The findings should be interpreted cautiously due to small sample size and potential confounding factors. ConclusionThis pilot study suggests that eight weeks of probiotic supplementation may reduce overall psychological symptoms in cancer patients undergoing chemotherapy. Larger trials with rigorous controls and longer interventions are needed to confirm these preliminary findings.

Diagnostic Value of Osteopontin, Lymphocyte-to-Monocyte Ratio, and CA-125 in Ovarian Carcinoma Suspect

Osteopontin (OPN) is an important protein in cancer development and progressivity. Lymphocyte-to-Monocyte Ratio (LMR) as a systemic immunity and inflammatory indicator could be an ideal predictor biomarker because of its method’s simplicity and availability. Elevated CA-125 and OPN as well as decreased LMR were reported as signs of ovarian malignancy. Limited studies about OPN and LMR as diagnostic biomarkers, as well as various specificity and sensitivity of CA-125 intrigued the researcher to prove OPN, LMR, and CA-125 as diagnostic biomarkers for ovarian carcinoma. This study aimed to measure the diagnostic value of OPN, LMR, and CA-125 levels against histopathology results for ovarian carcinoma diagnosis. Eighty patients involved with suspected ovarian carcinoma who were referred to Dr. Kariadi Hospital, Semarang. Osteopontin and CA-125 levels were measured using ELISA, and LMR was calculated from absolute lymphocyte and monocyte counts using an automated hematology analyzer. The receiver operating characteristics curve was used to determine the cut-off and 2x2 table. The cut-off values for OPN, LMR, and CA-125 were 124 ng/mL, 3.7 and 45.4 U/mL, respectively. The sensitivity for OPN, LMR, and CA-125 was 67.24%, 62.07% and 60.34%. Specificity for OPN, LMR, and CA-125 were 68.18%, 54.55% and 59.09%. Osteopontin is the best parameter for determining the diagnosis of ovarian carcinoma but it is still not sufficient because OPN cut-off was still within the normal reference value.

Correlation vitamin D [25(Oh)D3] with neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) in cervical cancer patient

Vitamin D [25(OH)D3] levels are currently associated with clinical inflammatory markers such as C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR). They are used to monitor the development of cervical cancer. Aim of this study was analyze the correlation of vitamin D [25(OH)D3] levels with NLR values and CRP levels in cervical cancer patients. Vitamin D is expected to be an alternative treatment for cervical cancer. This study was analytical observational with a cross-sectional design conduct at Dr. Kariadi Hospital Semarang in January-March 2024. [25(OH)D3] level was measured using enzyme-linked immunosorbent assay (ELISA) method, CRP levels were checked with the ADVIA centaur device using the principle of chemiluminescence and combined with immunoassay technology and NLR value was calculated manually. Total sample was 40 cervical cancer patients aged 35-60 years old. Mean±SD results of vitamin D [25(OH)D3] levels, NLR values, and CRP levels were 12.0±5.5 ng/ml; 5.0±1.2; 5.5±2.0 mg/dL. Correlation tests between vitamin D [25(OH)D3] levels with NLR values and CRP levels were sequentially obtained (p=0.036; r=-0.333) and CRP (p=0.000; r=-0.588). Result in this study conclude that Vitamin D [25(OH)D3] levels and NLR values showed a weak negative correlation. A moderate negative correlation exists between vitamin D [25(OH)D3] and CRP level.

Unveiling the Disease Patterns and Infection Categories in MDRO-Infected Patients: Insights from a Comprehensive Study at Dr. Kariadi Hospital, Semarang

Background: Multi-drug resistant organisms (MDRO) pose a significant challenge to healthcare systems worldwide, leading to increased morbidity, mortality, and healthcare costs. Understanding the disease patterns and infection categories associated with MDRO infections is crucial for effective management and prevention strategies. This study aims to unveil the prevalent diseases and infection categories among MDRO-infected patients at Dr. Kariadi Hospital, Semarang in Indonesia.Methods: A comprehensive retrospective analysis was conducted on medical records of patients diagnosed with MDRO infections. Clinical characteristics were collected and analyzed. The diseases were classified into broader categories based on their organ system or common medical classification.Result: The study included 100 MDRO-infected patients and they presented with 81 various medical conditions/diseases. The most common diseases associated with MDRO infections were Covid-19, and Bronchopneumonia. Among the infection categories, gastrointestinal disorders, and Neoplastic Diseases were the predominant categories. The study revealed a high prevalence of MDRO infections in patients with these conditions while as the category of Autoimmune and Rheumatic Diseases accounted for the smallest proportion of cases with only one case.Conclusion : This comprehensive study provides valuable insights into the disease patterns and infection categories in MDRO-infected patients at Dr. Kariadi Hospital, Semarang. The findings highlight the need for targeted surveillance, infection control measures, and antimicrobial stewardship programs to effectively manage MDRO infections. Understanding the most prevalent diseases and infection categories associated with MDROs can aid in early detection, appropriate treatment, and the development of preventive strategies.

Analisis Perbedaan Antropometri Vertebra Thorax (T12) antar Kelompok Usia dengan Menggunakan Image CT Scan: Pendekatan Teknik Geometric Morphometric

The role of forensic anthropology is to identify the unknown skeletal remains to assiss in criminal investigation. Age estimation is one of the essential aspects of individual identification. Geometric morphometric is a technique to quantify the morphological of an object using the Cartesian coordinates of anatomical landmarks. There were no studies doing on the T12 vertebra for identification purposes using geometric morphometric techniques. This is an analytic observational study with a retrospective cross sectional study design. Samples were taken from 100 CT scan images at Radiology departemetnt of Dr Kariadi hospital. The age groups as independent variable, while both centroid size which represent the size and Principal component (PCs) which represent the size as the dependent variable. The differences between age group were analyzed using one way ANOVA test. There was a significant difference between age groups in the size of the T12 vertebra with p value = 0.003 (p<0.05). There was no significant difference in size between age groups in size, with p value = 0,149 (p>0,05). Using the Geometric morphometric approach, the vertebra T12 showed significant difference in size.

Effectiveness of epidural dexamethasone vs triamcinolone to relieve neuropathic pain of cervical disc herniation patients; 3-months follow-up

Background & objective: Cervical disc herniation (CDH) is the most common cause of radicular pain; with one-third of the patients suffering for more than six months. Epidural steroid injections (ESI) are widely performed by the pain specialists and the neurosurgeons in this disorder, acute or chronic. We compared triamcinolone and dexamethasone regarding their efficacy to improve neuropathic pain at three months follow-up. Methodology: This randomized blinded control trial was conducted at Dr. Kariadi Hospital in Semarang, Indonesia, on 42 chronic CDH patients. Patients were divided into two equal groups of 21 each, to receive, interlaminar cervical epidural injections of triamcinolone or dexamethasone under fluoroscopic guidance. The study was conducted from January 2022 to July 2023. Follow-up on the PainDETECT score was carried out before and 3 months after the ESI. Data collected was analyzed by using the Mann-Whitney test (P < 0.05). Results: Forty-two CDH subjects were involved in the study grouped as Dexamethasone group (21) and Triamcinolone group (21). Both groups observed significant pain improvement (P < 0.001, and P = 0.020). In the Dexamethasone group 16 out of 21 (76.2%) subjects showed improvement at 3 months of follow-up in the neuropathic pain, while in Triamcinolone group 10 out of 21 (47.6%) showed improvement at 3 months of follow-up. The differences in the two groups were significant (P < 0.001 vs P = 0.007). Conclusion: The results of this study prove that epidural injection of dexamethasone is more effective than triamcinolone for improving neuropathic pain syndrome associated with chronic cervical disc herniation. Keywords: Chronic CDH, Neck pain, Epidural steroid injection, Dexamethasone, Triamcinolone, Pain DETECT Citation: Budisulistyo T, Yudhasyah RA, Kustiowati E, Husni A, Muhartomo H, Suryadi. Effectiveness of epidural dexamethasone vs triamcinolone to relieve neuropathic pain of cervical disc herniation patients; 3-months follow-up. Anaesth. pain intensive care 2024;28(4):732−736; DOI: 10.35975/apic.v28i4.2515 Received: December 28, 2023; Reviewed: February 12, 2024; Accepted: February 17, 2024

Relationship Between Anxiety Level and Sleep Quality in Patients Pre-Cardiac Surgery at Dr. Kariadi Hospital, Semarang, Indonesia

Introduction: Cardiac surgery is a medical procedure that aims to improve the heart's structure and blood vessels. The procedure is performed within 4 to 6 hours. This can cause anxiety in patients and family members. Excessive anxiety can lead to increased blood pressure, tachycardia, depression, and even sleep disturbances before and after cardiac surgery. Poor sleep quality affects quality of life, health status, and activities of daily living. The aim of this study was to determine the relationship between anxiety levels and sleep quality in patients with pre-cardiac surgery. Methods: This research was a descriptive correlation with a cross-sectional approach. The convenience sampling technique was used to select 65 respondents for the sample. The Hamilton Anxiety Rating Scale (HARS) questionnaire was used to gather information on anxiety levels. The Pittsburgh Sleep Quality Index (PSQI) questionnaire assessed the respondents' sleep quality before heart surgery. The obtained data was subjected to analysis using the Spearman-Rho test.Results: There were 36 respondents (55.38%) who had moderate sleep quality and experienced mild anxiety 28 respondents (43.08%). The Spearman rho correlation test of r value was 0.106 in the results. There is no relationship between anxiety level and sleep quality in cardiac pre-surgery patients.Conclusion: The majority of patients with pre-cardiac surgery at Dr. Kariadi Hospital Semarang experience anxiety and sleep disorders. Nurses can consider to manage the anxiety and sleep disorders experienced by patients.

Relationship Between Cumulative Platinum-Based Chemotherapy Dose And The Occurrence Of Ototoxicity In Head And Neck Malignancies

BACKGROUND: Chemotherapy is a treatment for head and neck malignancies. Hearing impairment is a side effect of chemotherapy, especially caused by platinum-based chemotherapy. Hearing impairment generally occurs at high frequencies after the administration of chemotherapy. AIMS: To prove assosciation between cumulative doses of platinum-based chemotherapy and ototoxic events in head and neck malignancies. METHOD: This is a cross-sectional study. The sample is patients with head and neck malignancy receiving platinum-based chemotherapy at Dr. Kariadi Hospital Semarang from March to June 2023. Hearing assessment using pure tone audiometry was performed randomly at all chemotherapy cycles. Data was analyzed with a chi-square test. RESULT: Eighty-one subjects (52 male, 29 female), consisting of 71 subjects received cisplatin, and 10 subjects received carboplatin. Ototoxicity occurs in 91.7% of subjects receiving cumulative doses of cisplatin >300mg/m2 and carboplatin >1500mg/m2 compared to cumulative doses of cisplatin <300mg/m2 and carboplatin <1500mg/m2, which was 46.7% (p = 0.001, CI 1.416-2.725). CONCLUSION: There was a significant association between cumulative doses of platinum-based chemotherapy and ototoxicity incidence of head and neck malignancy patients.

PENGARUH HIDROTERAPI DAN MUSIK ALAM TERHADAP KUALITAS TIDUR PASIEN YANG MENJALANI KEMOTERAPI KANKER PAYUDARA

Breast cancer refers to the cellular malignant growth in breast tissue. Chemotherapy is an applicable treatment for breast cancer but this treatment causes sleeping problems as a side effect. Hydrotherapy and natural music are non-pharmacological methods to manage sleep problems. This quasi-experimental research determines the effects of hydrotherapy and natural music therapy on the quality of sleep of patients receiving breast cancer chemotherapy by applying One Group Pretest and Posttest. The research took 43 sample people using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The survey results revealed that 43 respondents, primarily aged 46 to 55 (23 respondents or 53.5%), 16 respondents with primary education (37.2%), and 32 unemployed respondents (74.4%). Most respondents received chemotherapy at Dr. Kariadi's hospital and had poor sleeping quality before the intervention. After the intervention, 32 respondents had excellent sleeping quality (74.4%). Wilcoxon's statistical results found the influence of hydrotherapy and natural music on the sleeping of patients receiving breast cancer chemotherapy at Dr. Kariadi's Hospital. The P-value value is 0.000 lower than 0.05, accepting Ha and rejecting Ho. The results also recommend the management of the intervention at the same room temperature.

Analysis of Hospital Efficiency and Implications for Financial Performance

Effective financial performance can have a positive impact on hospital efficiency. When hospitals have good financial performance, they are able to optimize resource management, increase revenue, and reduce operating costs. The objective of this study is to analyze Dr. Kariadi Hospital's efficiency from 2018 to 2022 using a financial ratio analysis approach based on PER-24 of 2018 and examine its implications for financial performance. This study employs secondary data in the form of financial statement data from RSUP Dr. Kariadi Semarang, spanning from 2018 to 2022. The data was evaluated by computing eight financial performance metrics. The results suggest that RSUP is efficient based on several indicators, including the current ratio, collection period, fixed asset turnover, and POBO ratio. While inventory turnover is a good indicator, the return on assets (ROA) is only moderate. However, the cash ratio and return on equity (ROE) still need improvement. As a strategic measure, it is recommended to focus on improving the cash ratio and return on equity (ROE) indicators in order to enhance the efficiency and financial performance of Dr. Kariadi Hospital Semarang in the upcoming period.

Epidemiology and diagnostic tools practice of spinal tuberculosis at Kariadi Hospital Semarang, Indonesia

Introduction: Spinal tuberculosis (TB) is one of the most common manifestations of extrapulmonary TB. In contrast to pulmonary TB, currently, there is no consensus for standard management of spinal TB particularly in diagnosis. This study aims to provide an overview of spinal TB from an epidemiological profile and diagnostic practice perspective at Kariadi Hospital, Semarang. Method: We collect spinal TB patient data retrospectively through medical records in Kariadi Hospital Semarang between the 2019 to 2022 period. The data regarding all demographic profile, clinical, imaging, and laboratory data. Result: A total of 40 patients were included in this study, 23 patients were diagnosed through histopathology, 32 patients were diagnosed using gene expert examination, and 17 patients by Acid Fast Bacillus Test. The highest age distribution was 37.5% in the 21-30-year age group, with thoracic level involvement in 70% of cases. The average age was 35.10 ± 14.10 with the main complaint being weakness of the limbs followed by complaints of back pain. The MRI images found were paravertebral abscess (67.5%), followed by vertebral body compression (27.5%), vertebral body destruction (20%), wedging compression and disc narrowing (20%), and kyphosis (12, 5%). Conclusion: Establishing the diagnosis of spinal TB at Kariadi Hospital is very diverse, so management is needed regarding the selection of spinal TB diagnostic tools to provide appropriate management.

Association between Neutrophil to Lymphocyte Ratio and Post Operative Atrial Fibrillation after Coronary Artery Bypass Graft operation.

ABSTRACT Background: Post operative atrial fibrillation (POAF) is associated with cardiovascular outcomes such as stroke, heart failure, and mortality. Neutrophil to lymphocyte ratio (NLR) is one of biomarker of inflammation. The use of cor pulmonary bypass(CPB), surgical trauma and reperfusion injury during cardiac surgery causes inflammation. NLR is suspected to be a biomarker that represents the inflammatory response as a modulator of POAF, but data are still lacking.This study analyzed the association between NLR and POAF after coronary artery bypass graft (CABG) operation.Methods: This was an Observational analytic study, involving patients after the CABG procedure in Kariadi Hospital between June 2022 to September 2023. NLR was assessed in the first three hours after operation. ECG Holter was attained for 96 hours post-CABG procedure.Results: The total subject was 62 patients, consisting of 57 men and 5 women with a mean age of 58,7 ± 6.39 years. Mean postoperative NLR 4.95 ± 2.17 with a median of 4.56 (1.52-11.00). There was a significant association between post-operative NLR with POAF after CABG (p=0.006, OR 4.64, 95%CI 1.50-14.35). High inotropic dose and β blocker initiation time less than 45 hours correlate significantly with POAF after CABG (p<0.001, OR 6.94 dan p=0.001, OR 0.17).Conclusions: Postoperative NLR is associated significantly with POAF after CABG. Keywords: Neutrophil to Lymphocyte Ratio, Post Operative Atrial Fibrillation, coronary artery bypass graft, ECG Holter

Overview of Pelvic Ring Fracture Patients: Observational Study in the Emergency Department at Dr. Kariadi General Hospital, Semarang, Indonesia

Background: Although the incidence of pelvic fractures is only 7% of all trauma, the mortality reaches 21.5%. Management of pelvic fractures remains a challenge because it is often a polytrauma that requires multidisciplinary management and large resources. Knowledge of the characteristics of patients with pelvic fractures is expected to help in management and reduce mortality. Methods: This observational study was conducted retrospectively with a population and sample of all pelvic fracture patients in the emergency room at Dr. Kariadi Hospital Semarang for the period January 2021 to December 2023. The characteristics observed included gender, age, fracture classification, etiology, trauma score, fracture pattern, and management. and output. The data obtained is then presented descriptively. Results: A total of 34 patients with pelvic fractures were recorded in this study. There were 16 male patients and 18 female patients. A total of 3 patients were less than 17 years old, 19 patients were 17-34 years old, 7 patients were 35-52 years old and 3 patients were more than 52 years old. The most common cause of pelvic fractures was traffic accidents (KLL) with 28 patients, followed by work accidents (4 patients) and other trauma (2 patients). Based on the Young-Burgess classification, the most common pelvic fracture pattern was LC1 (11 patients), followed by APC1 (3 patients), APC2 (4 patients), APC3 (3 patients), LC2 (2 patients), LC3 (6 patients), VS (4 patients), and CM (1 patient). A total of 4 patients had an ISS score of 1-8, 8 patients had an ISS score of 9-15, 9 patients had an ISS score of 16-25, and 13 patients had an ISS score of more than 25. The most common accompanying injury was long bone fracture (15 patients), head injury in 10 patients, abdominal trauma in 9 patients, and thorax trauma in 4 patients. Operative treatment was carried out in 21 patients, while 13 other patients were treated non-operatively. Of the 34 patients, 8 patients died and 26 others were discharged in good condition. Conclusion: Most pelvic fractures occur at the age of 17-34 years and the most common cause is KLL. All pelvic fracture patients had concomitant injuries and the majority of patients had unstable fractures that required operative treatment. Mortality due to pelvic fracture and/or accompanying injuries is 23.5%.

VISUAL OUTCOME OF TRAUMATIC OPTIC NEUROPATHYAFTER STEROID TREATMENT IN KARIADI HOSPITAL

Introduction: The occurrence of Traumatic Optic Neuropathy (TON) often occurs in the form of head injuries resulting from traffic accidents. TON is an important cause of impaired visual function which may be improved with steroid therapy. Objective: To determine the visual outcome in patients with TON treated with steroids in Kariadi Hospital, Semarang Methods: This research was a retrospective study. Thirty patients (20 males and 10 females) with TON in ophthalmology clinic, Kariadi Hospital Semarang between Januari 2019 and December 2020. Visual acuity, contrast sensitivity and color blindness test were included data from medical record. Steroid therapy were divided into 3 groups. Intraveous steroid injection alone, intravenous steroid followed with oral steroid, and oral steroid alone. The Wilcoxon and paired-t test as comparison test of pre-post therapy in one group and friedman test as comparison test in 3 groups. Results: There were 5 cases that received intravenous steroid, 18 cases received intravenous steroid with oral steroid, and 7 cases received oral steroid. There were difference visual acuity in intravenous steroid with oral steroid (p = 0.001), visual acuity in oral steroid (p = 0.017), and color blindness test in intravenous steroid with oral steroid in pre-post therapy groups (p = 0.036). There were no difference in visual acuity, color blindness test, and contrast sensitivity between pre-post therapy groups when compared between 3 groups (p= 0.692, p =0.368, p=0.273). Conclusion: Patients with TON had better visual outcome after treated with intravenous steroid followed with oral steroid.

The Impact of Tumor Hypoxia Modulation on sIL-2R Levels in Newly Diagnosed Diffuse Large B Cell Lymphoma (DLBCL) Patients Undergoing Chemotherapy: A Randomized Clinical Trial.

Tumor hypoxia induces the production of Hypoxia-Inducible Factor (HIF)-1 alpha, which interacts with NF-kB, leading to cancer proliferation and metastasis. This study investigated the effect of tumor hypoxia modulation using carbogen (95% O2 and 5% CO2) and nicotinamide on reducing soluble interleukin-2 receptor (sIL-2R) levels in newly diagnosed DLBCL patients with tissue overexpression of HIF-1α ≥10%. A prospective randomized controlled clinical trial was conducted at Dr. Kariadi Hospital in Semarang, Indonesia, from 2021 to 2022. Newly diagnosed DLBCL patients with tissue HIF-1α ≥10% were randomized into an intervention group (nicotinamide 2,000 mg + carbogen 10 liters/min during R-CHOP) and a control group (R-CHOP alone) for one cycle. sIL-2R levels were measured in the blood before and after intervention. The intervention group showed a significant reduction in sIL-2R levels after chemotherapy (p=0.026), with 85% of samples exhibiting a decrease. In contrast, only 45% of samples in the control group demonstrated a decrease in sIL-2R levels (p=0.184). The median sIL-2R level decreased from 139.50 pg/mL to 70.50 pg/mL in the intervention group, while the control group exhibited an increase from 182.50 pg/mL to 250.00 pg/mL following one cycle of chemotherapy. Tumor hypoxia modulation led to a significant decrease in serum sIL-2R levels, potentially through improvements in the crosstalk between hypoxia and inflammation pathways.

Postoperative Analgetic Profile in Pediatric Patients at Dr. Kariadi Hospital

Background: Pain management is pivotal for pediatric patients post-surgery due to its common occurrence and significant impact on well-being. Effective management involves considerations such as surgical type, analgesic selection, and proper pain assessment.Objective: Knowing the profile of postoperative analgesia in pediatric patients at Dr. Kariadi Hospital using pain assessment instruments based on age classification.Method: Employing an observational descriptive approach with a prospective cohort design, the study sampled 172 pediatric patients across varying pain severity levels. Utilizing total sampling, patients were assessed using age-specific pain instruments. Descriptive statistics were utilized to describe patients' characteristics, as well as the attributes of analgesic effectiveness concerning age, surgery type, and drugs administered. Texts and tables were employed to present the results.Results: Sampling on 172 patients with grouping based on the type of surgery that causes mild, moderate, and severe pain. Pain scales and analgesics were recorded at 4 moments: (1) when entering the recovery room; (2) leaving the recovery room; (3) 8 hours and (4) 24 hours postoperative. The results showed that the highest use of analgesics was paracetamol alone (59.9%); analgesic effectiveness in the mild pain surgery 97.2-98.6%; moderate pain 92.2-98.9%, and severe pain 90.9-100%.Conclusion: Postoperative analgesic utilization in pediatric patients at Dr. Kariadi Hospital is generally adequate, predominantly relying on paracetamol. However, enhancements are needed to optimize pain management, particularly for moderate-to- severe pain cases. Strategies to improve analgesic effectiveness should be pursued to ensure comprehensive pain relief for pediatric surgical patients.