Moewardi General Hospital Research Articles

Clinical Characteristics and Mortality Risk Factors of Hospitalized COVID-19 in Children: An Experience of Two Years Pandemic in Regional Referral Hospital

Coronavirus disease 2019 (COVID-19) has spread worldwide rapidly. COVID-19 in children is relatively mild compared to adults. However, several studies showed high mortality rates in children with underlying diseases. This study aimed to describe the clinical characteristics and outcomes of pediatric COVID-19 cases in regional referral hospital. This study was retrospective observational study using data from Medical Record Dr. Moewardi General Hospital between October 1st, 2020 and October 30th, 2022. The epidemiological and clinical data were extracted from the database and were compared with outcomes of patients. All statistical analyses were performed by SPSS software version 27. This study enrolled 371 (19,9%) children with confirmed RT-PCR SARS CoV-2 from 1856 hospitalized suspected children whereas 55% were males, and 63% aged under 5 years old. Moderate-severe patients accounted for 18% of the cases. Cough (74,4%), fever (66,6%) and shortness of breath (22,6) are the most common symptoms while 99 (26,7%) patients who had chronic diseases with the most common diseases being congenital heart disease, hematological malignancy and neurological disorders. Patient outcomes were significantly related to age, degree of severity and chronic disease with p=0.004, p< 0.001, and p< 0.001 respectively. After performing multivariate regression analysis, degree of severity [p<0.001; adjusted OR = 28.03, 95% CI (10.73–73.21)] was found to be significant predictors for mortality. The clinical and epidemiological data revealed that the majority symptom were cough, fever and shortness of breath. Mortality rate during hospitalization was higher in children with moderate-to-severe COVID-19.

Profile of Generalized Pustular Psoriasis Inpatient Installation at Dr. Moewardi General Hospital Surakarta from January 2018-December 2022

Profile of Generalized Pustular Psoriasis Inpatient Installation at Dr. Moewardi General Hospital Surakarta from January 2018-December 2022

Multivariate Analysis and Scoring Prediction Model of Risk Factors for Atrial Fibrillation after Stroke: A Retrospective Study in Indonesia

Background: Several studies have shown that atrial fibrillation (AF) detected after stroke (AFDAS) occurs in approximately 23.7% of patients with ischemic stroke. Aim: This study aimed to determine the relationship between the type, location, volume, and therapy of stroke as risk factors for AF. Methods: This retrospective study was composed of adult patients diagnosed with stroke in the High Care Unit (HCU) of Dr. Moewardi General Hospital. The type and location of stroke, hemorrhage volume, history of medication administration, and serum low density lipoprotein-cholesterol (LDL-c) level were studied. Multivariate regression was used to determine the risk factor scoring for AF likelihood after diagnosis. Results: From 549 included patients, 262 (47.7%) had AF. The elderly (55.9%) and women (52.1%) constituted the majority of the study population. Seven variables that significantly contributed to AF incidence were ischemic stroke (AOR 4.12, CI 2.40–7.07, P < 0.001), cerebral cortex location (AOR 2.34, CI 1.35–4.06, P = 0.003), administration of the neuroprotective agent (AOR 0.24, CI 0.15–0.41, P < 0.001), history of hypertension (AOR 2.46, CI 1.09–5.56, P = 0.031), coronary heart disease (AOR 7.61, CI 3.82–15.15, P < 0.001), heart failure (AOR 2.80, CI 1.37–5.73, P = 0.005), and serum LDL-c with a cutoff level of 112 mg/dL (AOR 5.10, CI 3.04–8.57, P < 0.001). A scoring system from logistic regression analysis showed that a score of >1.7 may be interpreted as a risk factor AF. Conclusion: A scoring system from the risk factors can be used to predict the probability of AFDAS.

Factors Associated with the Outcomes of Patients with Hospital-Acquired Pneumonia (HAP) at Dr. Moewardi General Hospital, Surakarta

Introduction: Hospital-acquired pneumonia (HAP) is a common infection with a poor prognosis. Previous studies on factors influencing HAP outcomes have yielded inconsistent findings. Therefore, further research is needed to determine risk factors that affect HAP outcomes. This study evaluated the factors associated with HAP outcomes to enable timely interventions to reduce mortality, costs, and length of stay (LOS). Methods: This cross-sectional study was conducted at Dr. Moewardi General Hospital, Surakarta, using medical record data from January to December 2022. The data included age, gender, malnutrition, anemia, level of consciousness, comorbidities, bacterial culture, and multidrug-resistant organisms (MDROs). The analyses were performed using the Chi-squared and Mann-Whitney U tests, followed by multiple logistic and linear regression tests to determine the correlation between risk factors and outcomes (recovery, death, and LOS). Results: This study included 102 patients with HAP, the majority being males (64.7%) aged 60 years old and above. Additionally, most patients did not exhibit malnutrition (87.3%) or anemia (96.1%), had normal levels of consciousness (67.6%) and mild comorbidities (60.8%), were not infected with MDROs (66.7%), and were predominantly infected by Klebsiella pneumoniae (21.6%). The multiple logistic regression test revealed that decreased consciousness was significantly associated with increased mortality (p < 0.001). Meanwhile, age 60 years old and above was significantly associated with a shorter LOS (p = 0.05). Conclusion: The majority of HAP cases occurred in men aged 60 years and above. Furthermore, there was a significant relationship between decreased consciousness and increased mortality, as well as between the age of 60 years and above and a shorter LOS.

Correlation of electrolytes with falling risk, cognitive function, and functional outcome in acute ischemic stroke patient

Stroke outcome is determined on multiple factors. However, there are limited studies discussing the impact of electrolyte imbalance on stroke outcome. In this study, we analyzed sodium, calcium, and potassium level in acute ischemic stroke, and compare their risk of falling, cognitive function, and functional outcome. This was a cross-sectional study in Dr. Moewardi General Hospital, Indonesia between January and June 2023. Patient with acute ischemic stroke were enrolled in this study. Cognitive function was assessed with mini mental state examination (MMSE) and the Indonesian version of montreal cognitive assessment (MoCA-Ina). National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Scale (MRS) and Morse Fall Score (MFS) were used to assessed stroke severity, disability, and risk of falling, respectively. Pearson correlation was then performed to evaluate the correlation of electrolytes level with MMSE, MoCA-Ina, NIHSS, MRS, and MFS. Furthermore, we also analyzed the odds ratio of increasing risk of falling, cognitive function deterioration, and worse functional outcome. A p-value of <0.05 is considered statistically significant. On univariate analysis, natrium is correlated with MMSE (r=0.174; p=0.042), NIHSS (r=-0.412; p=0.011), MRS (r=-0.174; p=0.042), and MFS (r=-0.304; p=0.042). Potassium is correlated with MMSE (r=0.344; p=0.044), MoCA-INA (r=0.341; p=0.048), NIHSS (r=-0.572; p=0.019), (MRS r=-0.376; p=0.017), and MFS (r=-0.612; p=0.031). Calcium is correlated with NIHSS r=-0.348 (p=0.018), MRS r=-0.256 (p=0.036). On odds ratio analysis, low natrium level increased the risk of deteriorating cognitive function, and low level of potassium increased the risk of falling. Electrolyte imbalances correlates with risk of falling and deteriorating cognitive function.

The Effectiveness of Mindfulness-Based Cognitive Therapy to Improve Anxiety Symptoms and Quality of Life in Breast Cancer Patients.

Breast cancer patients often experience anxiety, impacting their Quality of Life (QOL) . Mindfulness-Based Cognitive Therapy (MBCT) is a 3rd generation psychotherapy from CBT combined with MBSR where mindfulness methods are carried out in a structured and scheduled manner, able to provide a pause between the stressor and the automatic response it causes. This study aimed to assess MBCT's effectiveness in alleviating anxiety and enhancing QOL in Stage III breast cancer patients undergoing chemotherapy, with mild-moderate anxiety disorders. The experimental research, conducted at Moewardi General Hospital Surakarta from March to June 2023, employed a quasi-experimental pretest-posttest control group design. Thirty subjects were divided into intervention (MBCT) and control (psychoeducation) groups. Participants completed demographic forms, disease history, and assessments using the Hospital Anxiety & Depression Scale (HADS-A) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). There was a significant improvement in HADS-A scores in both groups (P <0.001) where the difference in the median HADS score in intervention group was higher compared to the control group. The effect of MBCT to the score improvement of HADS-A showed statistically significant results P=0.003 with HR 1.288. In the EORTC QLQ C30 Global score, the intervention group experienced a significant increase P<0.001, and in the control group, it did not significantly increase p=0.087 although multivariate analysis showed that MBCT was not significant in improving the global EORTC score. From the continued multivariate analysis of the EORTC QLQ C30 function, score improvement was significantly influenced by MBCT with P=0.035 and HR 3.086. Meanwhile, for the EORTC symptoms, score improvement was influenced by MBCT with P=0.005 and HR3.401. There is a score improvement in HADS-A and EORTC with the provision of MBCT psychotherapy and with the provision of psychotherapy. However, the HADS and EORTC improvement scores were significantly higher with MBCT compared to psychotherapy alone.

Impact of Obesity on Dysmenorrhea and Lower Urinary Tract Symptoms in Adenomyosis Patients

Obesity poses a substantial health challenge globally, affecting various aspects of reproductive health, including adenomyosis. Adenomyosis, characterized by the presence of endometrial tissue within the myometrium, commonly affects women during their reproductive years, leading to symptoms such as dysmenorrhea and lower urinary tract symptoms (LUTS). This study aimed to investigate the influence of obesity on dysmenorrhea and LUTS severity in adenomyosis patients, considering demographic factors such as age and educational levels as potential moderators. Forty-four adenomyosis patients participated in a cross-sectional study at Dr. Moewardi General Hospital in Surakarta City of Indonesia, between April and September 2023. Diagnosis was confirmed using 2D Transvaginal Ultrasound (2D-TVUS). Obesity was defined using Body Mass Index (BMI) categories, and dysmenorrhea and LUTS were assessed using the Numerical Rating Scale (NRS) and modified International Prostate Symptom Score (IPSS) questionnaire, respectively. Statistical analyses included Pearson correlation. Results indicated a significant positive correlation between obesity and dysmenorrhea (rho = 0.256, P = 0.049) and LUTS (rho = 0.292, P = 0.029). Age and educational level did not significantly moderate these relationships, emphasizing the independent influence of obesity on symptom severity. In conclusion, obesity significantly impacts the severity of dysmenorrhea and LUTS in adenomyosis patients, highlighting the need for tailored management strategies that address both hormonal and inflammatory pathways.

Comparison of Severity in Diabetic Ulcer Patients with and Without Sepsis

Diabetes mellitus patients in Central Java grow yearly. According to data provided by the Central Java Health Department in 2019, Diabetes mellitus ranks second as the largest non-communicable disease (NCD), covering 13,4% of the total NCD patients. The prevalence of diabetic ulcers is 15-25% of all diabetes mellitus patients in Indonesia, which concerns the author regarding the possible increase of the diabetic ulcer population in Central Java. The severity of diabetic ulcers depends on various factors, including infection and complications. The most common complication is sepsis, a systemic infection often arising from local infections that are not appropriately treated, causing progressive damage and increasing mortality rates. This study aims to examine the comparison of ulcer severity in diabetic ulcer patients with sepsis and non-sepsis complications using Meggitt Wagner's criteria. This study utilizes an analytic observational study using a cross-sectional approach. The author sampled 126 patients diagnosed with Diabetic Ulcers in 2022 at Dr. Moewardi General Hospital for this study, using a purposive sampling method. The research was conducted by looking at the patient's medical record data, and data analysis using SPSS software. The test used in this research includes a Parametric T-independent test and a Pearson bivariate relationship test. This study shows that the comparison of ulcer severity in diabetic ulcer patients with sepsis and without sepsis was statistically significant (p-value = 0.000002). The mean of the group with sepsis (3.4127) was greater than the group without sepsis (2.5238). In conclusion, the comparison of ulcer severity in diabetic ulcer patients with sepsis and without sepsis is significant. We recommend future researchers include patients’ comorbidities, total hospitalization time, and detailed information on drug use and patient adherence to treatment in their research for more nuanced findings.

Analysis of the Role of Vitamin C Hypovitaminosis in Scurvy on Bone Health: A Single Center Observational Study at Dr. Moewardi General Hospital, Surakarta, Indonesia

Background: Scurvy, vitamin C deficiency, is a rare condition but remains relevant in Indonesia. This study aims to analyze the role of vitamin C hypovitaminosis in the development of scurvy and its impact on bone health through an observational study at Dr. Moewardi General Hospital. Surakarta. Methods: A cross-sectional observational study was conducted on 30 patients diagnosed with scurvy at Dr. Moewardi General Hospital Surakarta during the 2020-2023 period. Demographic data, medical history, nutritional status, and severity of scurvy were collected. A radiological examination of the bone is performed to assess scurvy-related changes. Descriptive, comparative, and Spearman correlation statistical analyzes were used. Results: The majority of patients were men (66.7%) with a mean age of 45 years. A history of an unbalanced diet with low fruit and vegetable intake was found in the majority of patients (86.7%). Common symptoms include fatigue (86.7%), joint pain (73.3%), bleeding gums (60%), and skin bleeding (53.3%). The severity of scurvy varied, with 10 patients (33.3%) experiencing severe scurvy. Radiological examination shows significant changes in long bones, especially osteoporosis and thinning of the cortex, which is more obvious in patients with severe scurvy. Spearman correlation analysis showed a positive correlation between the severity of scurvy and the incidence of osteoporosis (rho = 0.495, p = 0.005) and cortical thinning (rho = 0.394, p = 0.031). Conclusion: Vitamin C hypovitaminosis plays a significant role in the development of scurvy and has a negative impact on bone health. Early screening and diagnosis of scurvy are important to prevent musculoskeletal complications. Nutritional education and dietary interventions to increase vitamin C intake need to be intensified, especially in high-risk groups.

Influence of Age, Obesity, Smoking, Sleep duration, and Sleep Quality on Concentration, Morphology, and Sperm Motility: A Cross-Sectional Study.

Age, smoking, sleep duration, sleep quality, and obesity are risk factors that can affect the amount of sperm concentration, morphology, and motility. The aim of this study is to assess the lifestyle effects: of age, smoking, sleep duration, sleep quality, and obesity on the amount of concentration, morphology, and motility of sperm. The study utilized an analytical observational approach with a cross-sectional design. The study subjects comprised 70 male partners of infertile couples admitted to the Sekar Fertility Clinic at the Dr. Moewardi General Hospital between March and August 2022. The study assessed variables including age, body mass index (BMI), smoking status, sleep duration, sleep quality, sperm concentration, sperm morphology, and sperm motility. Furthermore, the data were analyzed using univariate, bivariate, and multivariate methods with SPSS 25 software. The research findings demonstrate that obesity is significantly associated with abnormal sperm concentration [odds ratio (OR)=40.07, confidence interval (CI)=3.90-411.67, P=0.002]. Furthermore, moderate or heavy smoking is significantly associated with abnormal sperm concentration (OR=17.45, CI=1.83-166.15, P=0.013) and sleep quality with severe disorders (OR=5.73, CI=1.12-29.21, P=0.036). Moreover, obesity is significantly associated with abnormal sperm motility (OR=12.97, CI=2.66-63.15, P=0.002), while moderate or heavy smoking (OR=5.89, CI=1.23- 28.20, P=0.026) and poor sleep duration (OR=6.21, CI=1.43-26.92, P=0.015) also exhibit significant associations with abnormal sperm motility. However, no significant findings were observed regarding sperm morphology. The findings of this study indicate that obesity, moderate or heavy smoking, and sleep quality have statistically significant effects on sperm concentration, while obesity, moderate or heavy smoking, and sleep duration have statistically significant effects on sperm motility. However, no statistically significant influence was observed on sperm morphology. Further research with larger sample sizes and more diverse populations is needed to validate these findings and explore other potential factors that may impact male fertility.

PROFILE OF PROSTATE CANCER PATIENTS AT DR. MOEWARDI HOSPITAL PERIOD JANUARY 2017 – JANUARY 2022: RETROSPECTIVE STUDY

Objective: This study aims to know the profile of prostate cancer patients treated at Moewardi General Hospital from January 2017 to January 2022. Material &amp; Methods: A retrospective study was conducted in prostate cancer patients who have or are undergoing therapy at Moewardi General Hospital from January 2017 to January 2022 using purposive sampling techniques. Results: From January 2017 to January 2022, 441 male patients were diagnosed with prostate cancer which is dominated able to go home alive, around 92.97%. The age of study subjects was overlooked of 70-80 years with a total of 182 people, dominated by self-employed as many as 420 people. The breakdown of PSA scores of 1-20 in as many as 247 people, Adeno Ca Prostate as many as 374 people with the majority of prostate Ca cases in subjects in non-metastatic status (359 people). The results of variable Rectal Toucher examination described results dominated by palpable prostate and hard as many as 437 people. Conclusion: The most important prognostic indicators in prostate cancer are the patient's age and general health at the time of diagnosis, the cancer stage, the level of pre-therapeutic PSA, and the Gleason score. A worse prognosis is associated with high levels of the disease, more advanced stages, younger age, and elevated levels of PSA. Keywords: Prostate cancer, patient’s age, PSA, male.

Correlation of CD4+ levels and caspase-3 in condyloma acuminata with HIV reactive patients

Background: Human papillomavirus is an infection that causes malignancy because of persistency and modulation of apoptotic pathways, especially caspase-3. Factors that can increase persistency, recurrency, and malignancy of HPV infection include HIV infection with low CD4 levels. There is disagreement or deep molecular understanding of the induction and modulation of apoptosis in HIV-mediated CD4+ T cell depletion, especially in CA. However, it is necessary to see how CD4+ levels can influence caspase-3, so it may open up new avenues for supporting investigation to consider the presence of malignancy or therapeutic strategies regarding CD4+ can induce apoptosis.Purpose: This study aimed to determine whether there is a correlation between CD4+ levels and caspase-3 expression in condyloma acuminata with HIV reactive patients.Methods: This is an analytic observational study with a cross-sectional design. The research was conducted at Dr. Moewardi General Hospital from August to December 2023. Nineteen patients with condyloma acuminata and HIV reactive were included in this study with a consecutive sampling technique. The expression of caspase-3 was assessed using immunohistochemical staining, looking at the percentage of stained cell nuclei and cytoplasm and CD4+ levels with flow cytometry examination—data analysis using Pearson correlation.Results: Respondents in this study were primarily men, self-employed with heterosexual orientation and genito-genital-oral sexual intercourse. The statistical analysis showed no significant relationship (p: 0.300, r: -0.251) between CD4+ levels and caspase-3 expression.Conclusions: While not statistically significant, CD4+ level is reduced in correlation with increased caspase-3 expressions.

Profile And Risk Factors of Stevens Johnson Syndrome–Toxic Epidermal Necrolysis on Adult Patients in Dr. Moewardi General Hospital Surakarta from January 2019 – December 2022

Background: Steven Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute and life-threatening skin diseases, commonly induced by medications. Study on SJS/TEN in Indonesia was still limited, hence knowledge about the profile and risk factors of SJS/TEN patients is still required to provide appropriate management and reduce patient mortality rate. This study aimed to determine the profile and risk factors of adult SJS/TEN patients in the inpatient installation of RSDM Surakarta. Methods: We conducted a cross sectional study using secondary data from medical records of SJS/TEN patients at the inpatient installation of Dr. Moewardi hospital, Surakarta from 2019 – 2022. Correlation tests on characteristics, comorbidity with length of stay (LoS) and discharge status were analyzed. Results: Of the total 147,531 inpatients, 35 (0.02%) of them were diagnosed with SJS/TEN, dominated by females (57.14%) with the mean of 45.74 years old. Most subjects were diagnosed with SJS (48.57%), followed by SJS/TEN (40.0%) and TEN (11.43%). The mean LoS was ± 8 days. Most subjects were discharged alive (85.71%). Paracetamol was the most common causative drug (25.71%), followed by cefadroxil (11.43%). Acute kidney injury (AKI) was the most common comorbidity (14.29%, p = 0.040). Spearman Rank test obtained no correlation between comorbidities and LoS (r = 0.028 ; p = 0.842) as well as discharge status (r = 0.063 ; p = 0.651). Conclusion: SJS/TEN is rare case with high mortality rate. Patients’ comorbidities have a very weak correlation with LoS and discharge status. Initial knowledge of the patient’s profile and risk factors including comorbidity and causative drugs can optimise comprehensive therapy for SJS/TEN patients.

Comparison of Long-term Outcomes between Hirschsprung's Disease Patients after Soave Procedure and Duhamel Procedure Based on the Paediatric Incontinence and Constipation Scoring System: A Retrospective Cohort Study

Introduction: Hirschprung's disease is a congenital disease that causes intestinal motility disorders. Hirschprung's disease is still the most common condition that causes intestinal obstruction in children. The incidence of Hirschprung's disease is 1:5000 live births. The incidence ratio of this disease is around 4:1 between men and women, with a higher percentage of men 1,3,4. Approximately 75% of cases of Hirschprung's disease occur in the rectosigmoid colon area, 17% in the splenic flexure or transverse colon and 8% along the colon and terminal ileum. The Duhamel technique still remains a popular procedure most surgeons especially for long segment treatment and redo procedures.28, 30 The advantage of the Duhamel Procedure is that it is easy to perform, reduces the risk of damage to surrounding structures such as genitourinary innervation, but has the possibility of complications of anastomotic leakage which causes fistulas and abscesses.&#x0D; Materials and Methods: Total subjects of this study was 441 patients with Hirschprung's disease who were treated with the Soave procedure and the Duhamel procedure at Dr. Moewardi General Hospital in Surakarta, Central Java, Indonesia for the period January 2017 - January 2022. This type of research is descriptive analytics with a retrospective cohort.&#x0D; Results: The results of the study can be concluded that patients with HAEC increases the risk of constipation. Congenital abnormalities predispose to fecal incontinence. Differences in surgical techniques do not significantly influence or increase the risk of constipation and fecal incontinence based on statistical tests. However, the increased risk of constipation and fecal incontinence is higher in patients undergoing the Duhamel surgical procedure.&#x0D; Conclusion: Conclusions that can be drawn from research regarding the comparison of long-term outcomes of Hirschsprung disease patients after Soave and Duhamel operations based on the Pediatric Incontinence and Constipation Scoring System at Dr. Moewardi General Hospital in Surakarta, Indonesia for period January 2017 – January 2022, it can be concluded that there is no significant difference in the outcome of patients who underwent the Soave or Duhamel procedures. The Duhamel procedure has a higher prevalence of complications of constipation and fecal incontinence compared to the Soave procedure. The presence of HAEC before the surgical procedure increases the risk of constipation, significantly in the Soave and Duhamel procedures.

Delta Neutrophil Index and C-Reactive Protein as Predictors of Mortality in Early Onset Neonatal Sepsis at Dr. Moewardi Hospital

Background: Neonatal sepsis is an infection disease in newborns that still be a major problem in developing countries such as Indonesia. Early onset sepsis has higher mortality and morbidity. A simple and applicable biomarkers are needed to predict mortality in early onset neonatal sepsis. This study aimed to investigate whether Delta Neutrophil Index (DNI) and C-Reactive Protein (CRP) can be used as predictors of mortality in early onset neonatal sepsis. Subjects and Method: A cohort study that was conducted at neonatal HCU and NICU at Dr. Moewardi Hospital from March to June 2023. Total of 30 neonates aged 0-72 hours which met the inclusion criteria and became research subjects. The dependent variable was the mortality of neonatal sepsis. The independent variable were levels of DNI and CRP values. The instruments were flowcytometry to measure levels of DNI and Enzyme Linked Immunoassay (ELISA) for determining CRP values. Data were analyzed using SPSS 25.0. Bivariate analysis was using Chi square and Fisher exact followed by multivariate analysis using logistic regression with p&lt;0.05. Results: Thirty early onset septic neonates were included in study, of whom 17 children died and 13 children survived. Both DNI and CRP had significant correlation with mortality of neonatal sepsis (p&lt;0.001). The DNI cut-off value of ≥ 5.4% (OR = 10.83; 95% CI 1.96 to 59.63; p = 0.004) can predict mortality in early onset neonatal sepsis. The CRP cut-off values of ≥5.75 mg/L (OR = 15.56; 95%CI 2.59 to 93.57; p = 0.001) could predict early onset neonatal sepsis mortality. Other factors such as gender, gestational age, birth weight and blood culture couldn’t be used as predictors of mortality in neonatal sepsis, with p value &gt;0.05. Conclusion: DNI and CRP could be used as predictors of mortality in early onset neonatal sepsis. Keywords: clean and healthy living behavior, diarrhea, toddlers. Correspondence: Almira Muthia Deaneva. Department of Pediatrics, Sebelas Maret University/Dr. Moewardi General Hospital, Surakarta, Central Java, Indonesia. Kolonel Sutarto Street No. 132, Surakarta, Indonesia. email: almiradea@gmail.com Phone: 081215822020.

Effectiveness of Online Learning to Improve Knowledge About Metabolic Syndrome in Pregnancy

Background: Metabolic syndrome is a persistent global health problem and a risk factor for diabetes and heart disease. A metabolic syndrome that occurs during pregnancy will pose a threat to maternal and fetal health. The incidence of metabolic syndrome during pregnancy, especially in developing countries, will become a serious public health problem in the future. This study aims to assess the effectiveness of online learning in improving the knowledge of online learning participants on metabolic syndrome cases in pregnancy. Subjects and Method: This was a cross-sectional study conducted in July through Zoom online learning on Metabolic Syndrome in Pregnancy attended by 125 participants. The dependent variable was knowledge about metabolic syndrome in pregnancy. The independent variable was online learning. The data obtained from this study were in the form of pretest and post-test scores. The data were analyzed by t-test. Results: The mean score of knowledge about metabolic syndrome in pregnancy after online learning was higher (Mean= 90.8; SD= 14.05) than before (Mean= 60.08; SD= 6.94), and this was statistically significant (p= &lt;0.001). Conclusion: Online learning is effective to improve knowledge about metabolic syndrome in pregnancy among Indonesian Obstetrics and Gynecology Association (POGI) members and young POGI members. Keywords: metabolic syndrome, pregnancy, online learning. Correspondence: Nutria Widya Purna Anggraini. Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi General Hospital, Surakarta, Central Java, Indonesia. Mobile: +62 812-2651-819. E-mail: nutria_dr@staff.uns.ac.id

Profile of Urticaria and Angioedema Patients at Dr. Moewardi General Hospital Surakarta, Indonesia

Background: Urticaria is a heterogeneous inflammatory skin disease that results from the activation and degranulation of cutaneous mast cells, followed by the release of histamine and other mediators that cause sensory nerve activation, vasodilation, plasma extravasation, and recruitment of immune cells. The prevalence and incidence of urticaria and angioedema have been extensively studied worldwide, but there is still limited data in Indonesia, especially regarding the profile of urticaria and angioedema patients. The purpose of this study was to determine the profile of urticaria and angioedema patients at Dr. Moewardi General Hospital for the period January 1st, 2020 - December 31st, 2022.&#x0D; Methods: This study is a cross-sectional retrospective study with secondary data derived from medical records of urticaria and angioedema patients.&#x0D; Results: There were 152 patients with urticaria, most of whom were in the age group &gt;60 years (20.39%), female with a male to female ratio of 1:1.92, and worked as housewives (17.76%) and students (16.45%). Most cases were diagnosed with urticaria (86.84%) with some patients having angioedema (13.16%). The most common comorbidities rhinoconjunctivitis (2.63%), atopic dermatitis (1.97%) and asthma (1.32%). The dominant symptoms were itching and bumps (100%). The main treatment received by patients was single AH1 (71.71%) followed by combination therapy of AH1 and systemic corticosteroids (14.47%), combination therapy of AH1 and topical corticosteroids (10.53%), and the rest received combination therapy of AH1, topical corticosteroids, and systemic corticosteroids (3.29%). The skin prick test was positive in 16 patients (35.56%), with the most common allergens found being peanut (37.5%), egg yolk (37.5%), and tomato (37.5%).&#x0D; Conclusion: The characteristics of urticaria patients were dominated by elderly patients, female gender, and working as housewives or not working. Patients were predominantly diagnosed with urticaria with the most common comorbidities being diabetes mellitus. The main treatment received was AH1 class drugs. The most common types of allergens identified were peanuts, egg yolks, and tomatoes.

Humoral and Cellular Immune Response on COVID-19 Patients and Sinovac Vaccine Participants

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 is a new SARS-CoV virus. A person who is infected with this virus will induce both humoral and cellular immune responses. Herd immunity can be achieved through vaccination. The purpose of vaccination is the formation of antibodies capable of neutralizing coronavirus against the receptor binding domain. This study aimed to determine the differences between humoral and cellular immune responses between confirmed COVID-19 patients and Sinovac vaccine participants. This observational analytic study with a prospective cohort approach was conducted between March to October 2021. Fifty subjects (25 officers who had received vaccinations for COVID-19 patients and 25 COVID-19 patients treated at the Dr. Moewardi General Hospital) and met the inclusion and exclusion criteria were enrolled. Different tests were carried out to see the difference between the levels of CD8+ T cells and anti-SARS-CoV-2 antibodies in the vaccine group and the COVID-19 patient group. There was no significant difference in humoral immune response (anti-SARS-CoV-2) between the vaccine group and COVID-19 patient group [33.93 (0.4–196.6) U/L vs. 101.28±158.59 U/L; p=0.409], but there was a significant difference in cellular immune response (CD8+) between the vaccine group and COVID-19 patient group [878.52±47368 cells/µL vs. 270.16±213.64 cells/µL; p=0.001]. CD8 assay can be used as a parameter to differentiate the cellular immune response between COVID-19 patients and COVID-19 vaccine recipients.

Thymoma Profile at Dr. Moewardi General Hospital: Does Thymoma Size Really Affect Distant Metastasis?

Introduction: Size is a predictor factor of a patient’s prognosis and metastasis in solid tumors. This study determined the relationship between thymoma size and distant metastasis. Methods: A cohort retrospective study using medical record data was conducted at Dr. Moewardi General Hospital, Surakarta, from January 2019 to August 2021. Of 1,430 thoracic oncology patients, 150 (10%) had mediastinal mass with thymoma as the majority (48.6%). About 73 thymoma patients were included. The size of the thymoma was the dependent variable, and the metastasis (distant and non-distant) was the independent variable. The cut-off point of thymoma size was determined with receiver operating characteristic (ROC) analysis. The correlation of thymoma size with distant metastasis was analyzed with the Chi-Square test, and p &lt; 0.05 was considered significant. Results: Thymoma was predominated by males (53.4%), the mean age was 43 ± 16 years old, and dyspnea was the most common symptom. Metastatic lesions were found in 87.7% of the patients, and the most common metastatic sites were intrathoracic (79.5%), followed by axillary lymph nodes (49.3%), bone (21.9%), liver (20.5%), and brain (1.4%). The cut-off value of thymoma size was 8.25 cm, indicating that &gt;8.25 cm was categorized as large thymoma. Distant metastasis was found in 86.0% of large thymoma patients. The large tumors tend to spread into various sites (OR = 5.39; 95% CI 2.8-32.6; p = 0.002). Conclusion: Thymoma must be taken into account when there are male patients in their forties presented with dyspnea and mediastinal mass. The cut-off point of 8.25 cm for the thymoma size can predict distant metastasis.

Correlation Between Acute Phase Delta NIHSS and Quality of Life Score in Post Thrombotic Infarct Stroke Patient in Dr. Moewardi General Hospital via Tele-Stroke Specific Quality of Life-12 Questionnaire (SSQOL-12)

Correlation Between Acute Phase Delta NIHSS and Quality of Life Score in Post Thrombotic Infarct Stroke Patient in Dr. Moewardi General Hospital via Tele-Stroke Specific Quality of Life-12 Questionnaire (SSQOL-12)