Mohammad Hoesin General Hospital Palembang Research Articles

Disease Severity Based on Autologous Serum Skin Test Result in Chronic Spontaneous Urticaria Patients at Dermatology and Venereology Outpatient Clinic of Dr. Mohammad Hoesin General Hospital Palembang

Studies on the severity of chronic spontaneous urticaria based on the results of theAutologous Serum Skin Test (ASST) have been done before, but the results vary so thereare still differences of opinion among some researchers. This study aims to determinethe correlation between disease severity and ASST results in chronic spontaneousurticaria patients at the Dermatology and Venereology (DV) Polyclinic of Dr. MohammadHoesin (RSMH) Palembang. The type of this study is analytic observational with cross-sectional design which used secondary data in the form of medical records. There were110 samples of chronic spontaneous urticaria patients at the DV clinic and it is 76samples that met the inclusion criteria. The highest distribution of chronicspontaneous urticaria patients was in the 17-25 year age group (23.7%) and the femalegroup (64.5%). The majority of chronic spontaneous urticaria patients had negativeASST results (52.6%) and mild disease activity (63.2%). Bivariate analysis showed nosignificant correlation between urticaria activity (UAS7 score) and ASST results with avalue of p = 0.287 or p > 0.05.

Factors Affecting Generalization of Ocular Myasthenia Gravis in Palembang

Introduction. Ocular myasthenia gravis (OMG) is an autoimmune disease which is characterized by weakness of extraocular muscles, levator palpebrae and orbicularis oculi, resulting in ptosis and binocular diplopia. Nearly all patients present with eyelid and extra ocular muscles involvement. Approximately 30% to 80% of patients with OMG experience a conversion to generalized myasthenia gravis (GMG) within 2 years. There are not only have ptosis and diplopia but also limb weakness,bulbar symptoms, or even respiratory failure.
 Objective. To observe the clinical features of OMG to GMG and risk factors and median time to conversion of OMG to GMG of myasthenia gravis patients in Mohammad Hoesin General Hospital Palembang.
 Method. This study is a cohort retrospective study and the data were collected from the medical records of 91 patients who were registered as myasthenia gravis patients during September 2018 to March 2020. Sosiodemographic and clinical characteristics, including onset of OMG to GMG, history of smoking, presence of thymic abnormalities, and medications received were reviewed retrospectively.
 Result. A total of 91 OMG patients were observed in this study with 32 (35,2%) patients converted from ocular myastenia gravis to general myastenia gravis. Median conversion time to GMG was 34 months. Risk factor for convertion cases of OMG to MGG was receiving immunosupressive agents(Risk: 14.7, 95% CI 4.83, 44.7), thymus hyperplasia (Risk: 3.36, CI 95% 0.33, 33.6), Female (Risk: 2.41, 95% CI 0.94, 6.17), Smoking (Risk: 1.56, 95% CI 0.31, 7.81).
 Conclusion. Ptosis was the definitive sign for OMG in this study, with all patients had ptosis, thus it needs the colaboration from neuroophthalmologist and neurologist to diagnose and manage this case. Most of converted case was female and those who receive an immunosupressive agent therapy.

Characteristics and Patterns of Deep Neck Infection in Dr. Mohammad Hoesin General Hospital Palembang 2020

Intoduction: Deep neck infection is the accumulation of pus in the potential space and facial area in the deep neck. The incidence of deep neck space infections is 1/100.000 in adults and 2/100.000 in children. Risk factors such as age, oral hygiene, and comorbidities such as DM are predisposed factors in deep neck infection. Effective pus collection of specimens is essential, to obtain the organisms and determine the effective antibiotics. Purpose: The aim of this study was to describe the characteristics and bacterial patterns of abscess in Dr. Mohammad Hoesin General Hospital Palembang. Methods: This study was conducted retrospectively using medical records of patients who diagnosed deep neck infection in Dr. Mohammad Hoesin General Hospital Palembang during January to December 2020 who took pus collection and been checked in microbiology laboratory. Data recorded include gender, age, site, onset, risk factors, comorbidities, bacteria culture, antibiotic sensitivity, and complications. Results: Of the 36 patients, 23 (63.8%) were males, followed by 13 (36.1%) were female, and the age of 31-45 years old group were found in 13 subjects (36.1%). The onset was mostly found at 0-1 week as many as 19 subjects (52.7%). The highest complaints of dysphagia and odynophagia were found in 22 cases (26,2%), odontogenic factors were found in 35 cases (97,2%). Abscess location in multiple space were found in 17 cases (47,2%), while in single space there were 19 cases (52.7%), where the most location was in submandibular space in 7 cases. Diabetes was the most comorbid factors found in 6 subjects (50%). The most bacterial were Klebsiella pneumoniae in 4 cases (11.1%) and sensitive antibiotics including ciprofloxacin, meropenem, and tigecycline, in 6 cases (20%) respectively. And the most complication was mediastinitis in 6 cases (75%). Conclusion: Klebsiella pneumoniae is the most common found in deep neck infection with sensitive antibiotics including ciprofloxacin, meropenem, and tigecycline.

The Association between Aromatase Gene Polymorphism Cyp19 Val 80 and Endometriosis Risk

Background: Endometriosis implant has been known to express aromatase enzyme, Cytochrome p450 that catalyzes androgen into estrogen. It causes local estrogen production, leading to increased estrogen level, and subsequently triggers endometriosis lesion. CYP19 gene resided at chromosome 15q21.1 is the biggest component of aromatase coding cytochrome p450 enzyme.
 Objective: To identify relationship between aromatase gene polymorphism CYP19 Val 80 and the risk of endometriosis. Methods: This is an observational case-control study using frozen DNA sample from women with endometriosis and/ or adenomyosis who had undergone laparotomy/ laparoscopy at Obstetrics and Gynecology Department Dr. Mohammad Hoesin General Hospital Palembang January-November 2013. Samples were amplified and cut by PCR-FRLP using Rsa1 restriction enzyme. Results were divided into A/A genotype (homozygote mutant), G/A (heterozygote mutant), and G/G (homozygote wild type). Data were analyzed by SPSS 21.0 version.
 Results: PCR-RFLP results for A/A genotype were 20 (21.3%) in endometriosis group and 8 (8.5%) in control group. G/A genotype were 18 (19.1%) in endometriosis group and 22 (23.4%) in control group. G/G genotype were 9 (9.6%) and 17 (18.1%) in endometriosis group and control group, respectively. There was significant increase risk of endometriosis in women carrying genotype A/A to those with genotype G/G with OR 4.722 (p<0.05).
 Conclusion: Polymorphism on aromatase gene CYP19 Val 80 A/A increases risk of endometriosis.

Correlation of Vitamin D Serum Levels with Muscle Mass, Muscle Strength, and Physical Performance in the Elderly Community in Mohammad Hoesin General Hospital Palembang

A B S T R A C TIntroductionOlder people tend to have decreased activity and intake of macronutrients andmicronutrients that are not in accordance with the body's needs. Research in 2017on elderly men and women at the Center for Family Compensation (PUSAKA) inCentral Jakarta showed that 80.2% of elderly people have vitamin D deficiency. Lowserum levels of vitamin D in the body are the initial risk of decreased muscle massand physical performance in old age. where there is a significant correlation betweenlow serum vitamin D levels in the body with sarcopenia and mortality. The purposeof this study was to determine the correlation of vitamin D levels with muscle mass,muscle strength and physical performance in the elderly community at RSMHPalembang. Methods This research is a study analytic observation with a cross-sectional approach that was carried out at the Integrated Geriatric Clinic InternalMedicine RSMH Palembang from November 2019 to November 2020. A sample of 34people aged> 60 years were examined for muscle mass, muscle strength, physicalperformance and serum vitamin D levels. All processing and analysis The data inthis study used SPSS version 25 for Windows. Results From 34 subjects, it wasfound that there were 29 women (85.3%) and 5 men (14.7%). The mean value ofmuscle mass is38.76 ± 4.1 kg / m2, long runs within 6 meters 6.12± 0.9 m / sec,and hand grip strength 24.9 ± 5.2 kg. It was found that 18 (62.1%) female sampleshad vitamin D deficiency while 11 (37.9%) samples had vitamin D insufficiency.There was a significant correlation between muscle mass and hand grip strengthwith vitamin D with weak correlation strength and length of walking with vitamin Dwith moderate correlation strength.Conclusion There is a significant correlationbetween muscle mass and grip strength and walking time of 6 meters with vitaminD.

Comparison of the Effectiveness 3% Tranexamic Acid Cream Versus 4% Hydroquinone Cream for Treatment of Epidermal Type Melasma

Background: Melasma is an acquired hypermelanosis in areas that are exposed to sun. especially in face. Severity of melasma is measured using modified Melasma Area Severity Index (mMASI) and Melanin Index (MI). Hydroquinone (HQ) is an effective drug and also a gold standard in terms of melasma treatment. However. thedrawback of hydroquinone is the treatment duration which is quite long. the occurence of side effects. and also recurrence potential. Several recent studies shows that one of the anti-pigmentation agent options. the tranexamic acid (TA). is able to prevent melanocyte activation. The results of various studies found that the use of TA showed a significant improvement in MASI scores.
 Objective: To compare the effectivity of 3% TA cream with 4% HQ cream as an alternative therapy in epidermal type melasma treatment.
 Methods: A double-blind. matched. randomized clinical trial was conducted during July 2019 until August 2019 at Dr. Mohammad Hoesin General Hospital Palembang. Subjects were divided into two groups. The first group. consists of 30 participants. get 3% TA cream; and the second group. consists of 30 participants. get 4% HQ cream. Subjects who fulfilled the inclusion criteria was included through a simple randomization. Study subjects wer given random cream pot (with label A or B on it) according to the result of simple randomization. Finally. every subjects’ melasma severity was measured using mMASI and mexameter ® .
 Results: There were differences in terms of baseline. 4 th weeks and 8 th weeks after treatment mMASI scores in 3% TA and 4% HQ group. At 8 th week. the mMASI score the 3% TA group was lower than 4% HQ group. There was no differences in baseline. 4 th weeks and 8 th after treatment MI between the two groups. Melanin index for 3% TA group was lower than 4% HQ group.
 Conclusion: Three-percent TA cream and 4% HQ cream is effective in decreasing mMASI score and MI in epidermal type melasma. There were differences in terms of the mMASI score during the 8th week after treatment between 3% TA and 4% HQ group.

Comparison of the Effectiveness 3% Tranexamic Acid Cream Versus 4% Hydroquinone Cream for Treatment of Epidermal Type Melasma

A B S T R A C TBackground: Melasma is an acquired hypermelanosis in areas that are exposed tosun. especially in face. Severity of melasma is measured using modified MelasmaArea Severity Index (mMASI) and Melanin Index (MI). Hydroquinone (HQ) is aneffective drug and also a gold standard in terms of melasma treatment. However. thedrawback of hydroquinone is the treatment duration which is quite long. theoccurence of side effects. and also recurrence potential. Several recent studies showsthat one of the anti-pigmentation agent options. the tranexamic acid (TA). is able toprevent melanocyte activation. The results of various studies found that the use ofTA showed a significant improvement in MASI scores. Objective: To compare theeffectivity of 3% TA cream with 4% HQ cream as an alternative therapy in epidermaltype melasma treatment. Methods: A double-blind. matched. randomized clinicaltrial was conducted during July 2019 until August 2019 at Dr. Mohammad HoesinGeneral Hospital Palembang. Subjects were divided into two groups. The first group.consists of 30 participants. get 3% TA cream; and the second group. consists of 30participants. get 4% HQ cream. Subjects who fulfilled the inclusion criteria wasincluded through a simple randomization. Study subjects wer given random creampot (with label A or B on it) according to the result of simple randomization. Finally.every subjects’ melasma severity was measured using mMASI and mexameter ® .Results: There were differences in terms of baseline. 4 th weeks and 8 th weeks aftertreatment mMASI scores in 3% TA and 4% HQ group. At 8 th week. the mMASI scorethe 3% TA group was lower than 4% HQ group. There was no differences in baseline.4 th weeks and 8 th after treatment MI between the two groups. Melanin index for 3%TA group was lower than 4% HQ group. Conclusion: Three-percent TA cream and4% HQ cream is effective in decreasing mMASI score and MI in epidermal typemelasma. There were differences in terms of the mMASI score during the 8th weekafter treatment between 3% TA and 4% HQ group.

Characteristics Of Patient With Foreign Body Ingestion In Palembang

Abstract
 Introduction. Foreign body ingestion is a common diagnosis that presents in emergency departments—coins as the oesophagal foreign body most commonly found in infants and children. Coins retained in the oesophagus require intervention to prevent complications. This study aimed to determine oesophagal coin foreign body patient's characteristic at Mohammad Hoesin General Hospital Palembang.
 Method. This study design was retrospective descriptive. Samples were all patient diagnosed with oesophagal coin foreign bodies which underwent Extraction with esophagoscopy guidance that was performed at Mohammad Hoesin General Hospital Palembang during January 2013 – August 2017.
 Result. Forty-three patients had diagnosed with oesophageal coin foreign bodies consist of 22 males and 21 females. The most frequent age was 4fouryears old. The most presenting symptoms are Globus sensation on the throat (79%) and odynophagia (51,1%). Radiologist confirmation was done in every patient with foreign coin bodies in oesophagus. All patients underwent oesophagoscopy. 65,1% of cases of foreign coin bodies were found in the second constriction of throat. Duration of stay in hospital was the range from 1- 4 days, with the most frequent, was two days. There was no complication found in all patients.
 Conclusion. Oesophagal coin foreign body is most commonly ingested in children. The most presenting symptom is globus sensation on the throat. There is no complication found in this study.

The Quality Test for Postoperative Pain Management using the American Pain Society Patient Outcome Questionnaire Revisied (APS-POQ-R) version Indonesia at Mohammad Hoesin Hospital in Palembang (A study of the quality level of postoperative pain management

A B S T R A C TPain is an unpleasant sensory and emotional experience associated with actual orpotential tissue damage, or described in terms of such damage. APS-POQ-R (RevisedAmerican Pain Society Patient Outcome Questionnaire) is a measuring tool for assessingthe quality of postoperative pain management by exploring patient experiences andoutcomes. This research aims to assess the quality of postoperative pain managementat Mohammad Hoesin Hospital Palembang and to determine the factors that influenceit. The Cross-sectional observational analytic study was conducted toward 51respondents. Data was collected primarily by using questionnares and interview. Datawas analyzed by using chi-square. The study showed that the quality of postoperativepain management at RSUP Mohammad Hoesin General Hospital Palembang has goodquality with a total of 27 patients (52.9%). From statistical analysis there wassignificant relationship between the quality of post-operative pain management withage (p=0,037), gender (p=0,027), ethnicity (p=0,039), education level (p=0,039), andeconomic level (p=0,005). So it can be concluded that was a significant relationshipbetween the quality of post-operative pain management with age, gender, ethnicity,education level, and economic level.

The Relationship between Inflammatory Cell Infiltration Density and the Clinicopathology of Colorectal Carcinoma in Dr. Mohammad Hoesin General Hospital-Palembang

BackgroundColorectal carcinoma has become one of primary problem that caused mortality and morbidity around the world. This malignancyhas contributed almost more than 9% of all cancer incidence. Lymphocyte infiltration density (TILs) is one of prognostic factors toevaluate colorectal cancer. Although some studies have found that there still have variations in sassociation lymphocyte density withclinicopathology of colorectal carcinoma which related to patient prognosis. This study was aimed to identify and analyze theassociation of lymphocyte density with clinicopathological colorectal carcinoma patients in Dr. Mohammad Hoesin General HospitalPalembang.MethodsA total of 41 HE stained slides which were diagnosed as colorectal carcinoma were observed under the light microscope.Lymphocytes were counted in five different areas that showed the highest lymphocytes density. The mean values of the lymphocytewere received from those five different areas. Determination of cutoff point was counted from the median of all mean value of thelymphocytes and being classified to become two categories, high-density lymphocytes and low-density lymphocytes.ResultsOut of 41 subjects, most patients have tumor size more than/or equal to 5 cm (63.4%), the tumors are often found in the left-sided ofcolon (39.0%), have moderate differentiated degree (65.9%), are included into T3 in tumor staging (48.8%), and no regional lymphnodes metastasis (39.0%). The most histopathological classification is adenocarcinoma (41.5%). Bivariate analysis showed thatlymphocyte density has correlation with tumor differentiation degree (p=0.021) and histopathological classification (p=0.004).ConclusionLymphocyte infiltration density has correlation with degree differentiation and histopathological classification of colorectal carcinomain Dr. Mohammad. Hoesin General Hospital-Palembang

Correlation Between Erythrocyte Glutathione Levels and Severity of Melasma

Background: Melasma is a common acquired disorder of hyperpigmentation, characterized classically by the presence of symmetrical, light-to-dark, muddy-brown macules with borders on the face, especially the forehead, cheeks, upper lip, chin, and nose. Knowledge of an increase in free radicals and decreased antioxidants in patients with melasma led to the belief that oxidative stress is involved in the pathogenesis of melasma. Glutathione (GSH) is an antioxidant that can be used as a parameter to assess the antioxidant-free radical activity in the pathogenesis of melasma. Objectives: The study aimed to determine the correlation between erythrocyte glutathione levels and the severity of melasma. Methods: A case series study was done from May to July 2018 in the Outpatient Clinic of Dermatology and Venereology Department, Dr. Mohammad Hoesin General Hospital Palembang. Thirty female patients met the inclusion criteria. The independent variable was the erythrocyte glutathione level, and the dependent variable was the melasma severity. The diagnosis was established based on clinical examinations, and the severity was determined by the modified Melasma Area Severity Index (mMASI) score. The correlation between variables was analyzed using Spearman Rho’s test (P < 0.05). The data analysis was done with SPSS version 20.0 (SPSS, Inc Chicago, Illinois). Results: Thirty female patients were diagnosed with melasma. The mean mMASI score was 8.72 ± 5.14 (2.0 to 16.9). Most of the participants had mild melasma (46.7%). The mild group had the highest mean erythrocyte glutathione level (4.05 ± 0.63 μmol/g) and the lowest mean erythrocyte glutathione level was in the severe group (1.79 ± 0.16 μmol/g). There was a very strong negative correlation between erythrocyte glutathione levels and melasma severity (r = -0.907; P = 0.000). Conclusions: There was a very strong negative correlation between erythrocyte glutathione levels and melasma severity.

Expression of HPV16 Oncoprotein E7 in Precancerous Lesions and Cervical Squamous Cell Carcinoma

BackgroundCervical cancer is the secondmost common malignancy in women worldwide.The vast majority of cervical cancersare associatedwith high risk HPV16 infection. The persistence of HPV16 and integration of viral DNA into cell genome are necessary for thedevelopment of precancerous lesion and squamous cell carcinoma (SCC) of the cervix. The integration of viral DNA in the host cellgenome resulted in the regulation of oncoprotein E7 leading to detection of HPV16 E7 expression in precancerous lesions and SCCof the cervix.The aim of this study was to evaluate differences of HPV16 E7 expression in precancerous lesions and cervical SCC.MethodsAn observational study with cross-sectional design was performedat Department of Anatomical Pathology Faculty of MedicineUniversity of Sriwijaya/dr. Mohammad Hoesin General Hospital Palembang, from 1st July 2014 to 30st Juni 2017. The selectedsamples consisted of 25 precancerous cases lesions (13 cases of LSIL and 12 samples of HSIL) and SCC (25 cases).Immuhistochemical stained was conducted using HPV16 E7 antibody. Fisher exact’s test was used to analyze differences inexpression of HPV16 E7 among precancerous lesions and cervical SCC.ResultsThe pracancerous lesions occurred mostly between the ages of 30-40 years, while SCC were those between the ages of 51-60years. All SCC cases (100%) and 91.6% of HSIL showed weak to strong HPV16 E7 expression, and 84.6% cases of LSIL showedimmunonegative.ConclusionThe positivity of HPV16 E7 increased in HSIL and KSS lesions.

Efficacy of Adapalene 0.1% Versus Tretinoin 0.025% Cream as Treatment of Mild Acne Vulgaris

Abstract
 
 Introduction: Acne vulgaris (AV) is a chronic inflammatory of the pilosebaceous unit. Topical retinoid is a mainstay of mild AV first-line treatment.
 Aim of study: To assess the efficacy of topical retinoid for the treatment of mild AV.
 Method: The randomized double-blind clinical trial was conducted from June to September 2019 at Dr. Mohammad Hoesin General Hospital Palembang. A total of 70 mild AV patients who fulfilled inclusion criteria were enroled consecutively. Patients randomly treated with adapalene 0.1% cream or tretinoin 0.025% cream and evaluated every 2 weeks for 8 weeks to examine the number of AV lesion (inflammation, non-inflammation and total lesion).
 Result: There are reduction in number of inflammatory and non-inflammatory lesions at both groups but only inflammatory lesion was statistically significant (p <0.05). Total lesions also decrease in adapalene and retinoin group (21.66 vs 5.75, 22.21 vs 7.96, respectively) and statistically significant (p <0.05).
 Conclusion: Adapalen 0.1% cream showed non-inferiority to tretinoin 0.025% cream in efficacy, especially in the reduction of non-inflammatory and total lesions.

Identification of KRAS gene codon 12 polymorphism in colorectal cancer patients at Mohammad Hoesin General Hospital Palembang

Colorectal cancer occurs due to neoplastic transformation of epithelial cells in the colon and rectum resulting from the accumulation of genetic and epigenetic aberrations. One of the genetic factors associated with colorectal cancer is KRAS gene polymorphism, which mostly occurs in codon 12. KRAS gene polymorphism leads to constitutional activation of KRAS protein effectors which will initiate signalling network to nucleus to increase cell proliferation, survival and differentiation. The aim of this study was to identify the KRAS gene codon 12 polymorphism in colorectal cancer patients at Mohammad Hoesin General Hospital Palembang. This study was a descriptive laboratory study with PCR–RFLP technique using BstNI enzyme on thirty patients with colorectal cancer. Wild type genotype (GG) of KRAS gene codon 12 found in 15 patients (50%), heterozygous mutant genotype (Gg) found in 12 patients (40%) and homozygous mutant genotype (gg) only found in 3 patients (10%). The G allele frequency was 70% and the g was 30%. The most common genotype found in colorectal cancer patients was GG genotype and most common alotype was G allele. KRAS gene polymorphism was found in half of the colorectal cancer patients, heterozygous mutant genotype (Gg) was more frequent then homozygous mutant genotype (gg).

The ratio of monocytes to lymphocytes accuracy as tuberculosis predictor

Tuberculosis is one of the top ten death’s causes in the world and even cause more deaths than HIV in 2015. In the same years, there are 10.4 million new TB case incidences with case notification rate is 142/100,000 population globally. Monocytes and lymphocytes play an important role in the body’s defense mechanism against tuberculosis. Tuberculosis can induce increased monocytes and decreased lymphocytes. The ratio of Monocytes to lymphocytes is expected to be used as predictors of tuberculosis. Therefore, this study was conducted to determine the ratio of monocytes to lymphocytes accuracy as tuberculosis predictor. This diagnostic study was done at dr. Mohammad Hoesin General Hospital Palembang. Samples of this study had been taken from medical records which fulfilled the inclusion and exclusion criteria. The study was analyzed using SPSS version 22.0. The sample of the study was 101 tuberculosis subjects. Most of the subjects were men (70,3%) and were 36-45 years old group (25,7%). The cut-off value of 0,476 allowed the discrimination of tuberculosis with positive bacterial culture from negative bacterial culture, with a sensitivity of 95,1% and a specificity of 70%. Therefore, we concluded that the ratio of monocytes to lymphocytes can be considered as an early predictor marker of tuberculosis.

Correlation of serum lipid profile with leptin levels of skin tags patients

Skin tags may be associated with increased adipose deposition. Mechanism of skin tags formation is through the activation of leptin receptor in the dermis and epidermis. Recent study suggested that the presence of skin tags is associated with obesity, abnormal lipid profile and elevated serum leptin levels. Researcher are interested to analyse the correlation betwen serum lipid profile and leptin levels of patients with skin tags. This is a cross sectional study, conducted from October 2017 to February 2018 at Tumor and Dermatosurgery Divison-Dermatology and Venereology Department outpatient clinic in Dr. Mohammad Hoesin General Hospital Palembang. Sample study was obtained with consecutive sampling. There were 40 patients with skin tags that met the inclusion criteria included in the study. Serum lipid profile and serum leptin were measured. Statistic significant correlation between triglycerides and leptin levels was found (p=0.04; r=0.327), however there was no significant correlation between total cholesterol, LDL, HDL cholesterol with leptin levels (p=0.273; r=0.177, p=0.288; r=0.172, p=0.794; r=0.043). Triglyceride levels was found to have significant correlation with leptin levels.

THE CHARACTERISTICS OF ADOLESCENTS NASOPHARYNGEAL CARCINOMA PATIENTS IN MOHAMMAD HOESIN GENERAL HOSPITAL PALEMBANG JANUARY 2013 -DECEMBER 2017

Introduction
 Nasopharyngeal carcinoma is (NPC) mostly found in men of productive age with a ratio of men and women 2,18: 1 and 60% of patients age between 25 and 60 years. NPCs are very rarely found in adolescents, namely age 11 to 21 years.
 Objective
 To determine the characteristics of nasopharyngeal carcinoma in adolescent patients at ORL-HNS Department of Dr. Mohammad Hoesin General Hospital Palembang.
 Method
 This is a descriptive retrospective study. The sample is all patients diagnosed with NPC in adolescence at ORL-HNS Department of Dr. Mohammad Hoesin General Hospital Palembang in January 2013 to December 2017 period.
 Results
 In this study, the number of adolescent NPC patients from January 2013 to December 2017 was 12 patients. The majority of adolescent NPC patients were male (66,6%). The most common histopathological finding was WHO 2B (50%). Based on the T category, largely, the patients were T4 (41,6%). Most patients with Nodules were N3 (58,3%) and came to the ENT clinic were already in stage IV (41,6%).
 Conclusion
 Adolescent nasopharyngeal carcinoma is more common in men than women (2: 1), and shows a response to proper therapy.

Correlation of Glycated Albumin and Glycated Hemoglobin with Glycemic Control in Patients with Diabetic Chronic Kidney Disease on Hemodialysis

Background and aims. Diabetes mellitus (DM) is the most common cause of end-stage renal disease (ESRD) worldwide and is the primary etiology of ESRD in Indonesia. It is estimated that there are 10 million patients with DM in Indonesia and about 25-40% of diabetics develop diabetic nephropathy (DN) within 25 years. Poor glycemic control is associated with increased mortality in a large observational study among diabetics on hemodialysis. Glycated hemoglobin, or known as HbA1c, was the currently recommended biomarker to monitor long-term glycemic control in diabetes mellitus guideline. However, it becomes underestimated in patients with DN on hemodialysis (DN-HD), because of 20- 50% reduction of erythrocyte lifespan, clinical use of iron therapy, and effects of recombinant human erythropoietin. Glycated albumin (GA), ketoamine formed via a non-enzymatic glycation reaction of serum albumin, is free from interference by erythrocyte lifespan or erythropoietin therapy and subsequently can be used as an alternative biomarker to monitor glycemic control in DN-HD. As albumin has a half-life of only 14-21 days* compared to Hb 60-100 days in well ESKD patients, thus GA may provide a better reflection of recent diabetic control than HbA1c. The aim of this study was to analyze the correlation between GA and HbA1c with glycemic control in DN-HD. Methods The study was an analytical observational study with a cross-sectional design. The subjects were consecutive patients with DN-HD who visited Hemodialysis Unit at Mohammad Hoesin General Hospital Palembang during August-November 2014. The glycemic control index was determined by the average value of 2 times a week pre-HD random blood glucose for 4 weeks (aRBG). Results. The subjects were 25 patients with an average age of 56.16±7.49 years old. The average value of GA was 26.94±7.74%. GA was strongly correlated with aRBG with r=0.776; p=0.000. After correcting for age, sex, and BMI, the correlations became significantly very strong (r=0.809, p <0.001). The simple linear regression for the relationship between GA and aRBG was aRBG=4,62×GA+42.74 (R2=0.602, P<0.001), estimating that a 1% increase of GA was associated with 4.62mg/dL increase of aRBG. After correcting for age, sex, & BMI, the correlations between HbA1c and aRBG were significant (r=0.852, p<0.001). Conclusion. GA was strongly correlated with glycemic control in patients with DN-HD and HbA1c was correlated better.

A17266 Intradialytic Hypertension and Its Association with Nitric Oxide Level Changes

Objectives: Intradialytic hypertension is associated with increased morbidity and mortality, yet the mechanism is uncertain. Prior studies investigate imbalances in endothelial-derived vasoregulators nitric oxide, which these studies show conflicting result. The aim of the study was to investigate the association between intradialytic hypertension and the changes of nitric oxide level pre-to-post-dialysis. Methods: We conducted a before-and-after experimental studies in hemodialysis unit of Mohammad Hoesin General Hospital Palembang including 12 hemodialysis subjects without (controls) and 12 with intradialytic hypertension (an increased systolic BP pre-to-post-dialysis ≥10 mmHg in ≥4/6 consecutive HD sessions). The primary outcome was the changes of nitric oxide pre-to-post-dialysis, which was assessed in the 7th HD session, using ELISA. Dependent t-test was used to compare nitric oxide level changes. Results: Baseline characteristics, comorbidities, and anti-hypertensive drug consumption were similar between groups. Compared with controls, nitric oxide level changes was significantly higher among subjects with intradialytic hypertension (14.21 ± 10.24 u/M vs 6.45 ± 5.00 u/M). The changes of nitric oxide level pre-to-post-dialysis between 2 groups showed mean difference of 9.14 ± 2.06 u/M and 95%CI value was 4.87–13.41. Conclusion: Intradialytic hypertension is associated with nitric oxide level changes. We propose that nitric oxide level changes pre-to-post-dialysis may partially explain the higher event rates observed in these patients.

Cost-effectiveness Analysis on Advanced Cervical Carcinoma Patients at Dr Mohammad Hoesin General Hospital Palembang, South Sumatra, Indonesia

Cost-effectiveness Analysis on Advanced Cervical Carcinoma Patients at Dr Mohammad Hoesin General Hospital Palembang, South Sumatra, Indonesia