Mohammad Hoesin General Hospital Research Articles

Prevalence and risk factors of depression in juvenile systemic lupus erythematosus

Background Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organ systems, including the central nervous system. Depression is one of the neuropsychiatric manifestations of juvenile SLE . Objective To estimate the prevalence of depressive disorders in juvenile SLE and identify its potential risk factors. Methods This cross-sectional study was conducted in juvenile SLE patients at Dr. Mohammad Hoesin General Hospital, Palembang. Sociodemographic data and medications were recorded. Disease activity of SLE was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Physical activity was measured using the Physical Activity Questionnaire for Children (PAQ-C) and the Physical Activity Questionnaire for Adolescents (PAQ-A). All subjects were screened for depression using the Childhood Depression Inventory (CDI) questionnaire. Multiple linear regression analyses were used to determine risk factors for depressive disorders. Results We included 72 patients, of whom 67 (93.1%) were female. Mean age of the patients was 12 years 4 months (SD 2 years 6 months); most (67; 93.1%) were 10-18 years of age. Depression was found in 24 patients (33.3%). SLEDAI scores of ?3 (flare) were found in 54 patients (75%) and low physical activity was found in 62 (86.1%) patients. The prevalence of depression based on the Children's Depression Inventory was 33.3%. A SLEDAI score of ?3 and low physical activity were significantly associated with depression (P=0.009 and P=0.025, respectively). On multiple linear regression analysis, only SLEDAI score of ?3 remained significantly associated with depression (P= 0.017; OR 12.6; 95%CI 1.6–101.7). Gender, age, family economic status, father's education, mother's education, family history of depression, and duration of illness were not associated with depression. Conclusion A SLEDAI score indicating flare (?3) and low physical activity are significantly associated with an increased risk of depression. A SLEDAI score is an independent risk factor for depression when all other significant risk factors are considered.

Efficiency of 7-dehydrocholesterol vitamin-D3 complex cream for xerosis and pruritus in elderly women

Background: Xerosis and pruritus (XP) are the most common skin conditions in the elderly, manifesting clinically as roughness, scales, fissures, and mild-to-severe itching. Vitamin D improves skin hydration, transepidermal water loss (TEWL), and regulates the immune system. We aimed to determine the efficiency of topical 7-dehydrocholesterol (DHC)-vitamin D3 complex cream in elderly patients with XP. Methods: An experimental phase III study was performed on elderly women with XP from December 2021 to March 2022 at the Geriatric Dermatology Clinic of Dr. Mohammad Hoesin General Hospital, Palembang. Inclusion criteria were age older than 55 years, healthy or with comorbidity. The exclusion criteria include the use of moisturizer within two weeks before the study. DHC-vitamin D3 cream was applied on subject’s volar arms once a day. Overall dry skin score (ODSS), visual analog scale (VAS) for pruritus and adverse effects, skin hydration, TEWL, sebum level, serum vitamin D level, and dermatology life quality index (DLQI) were assessed at baseline and after 4 weeks. Statistical analysis was done with Wilcoxon and paired T-test. Results:Eighteen elderly women were included. Most subjects were 60 to 74 years old (83,3%). Half the subjects (50%) had comorbidity. There was a significant difference in skin hydration (p Conclusion: Topical 7-DHC vitamin D3 complex cream is proven to improve skin barriers, increase serum vitamin D levels, well-tolerated, and provided satisfaction and comfort in elderly women with XP.

Analysis of Risk Factors for Continence Post Posterior Sagittal Anorectoplasty (PSARP) in Anorectal Malformation Patients: A Single Center Observational Study at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Analysis of Risk Factors for Continence Post Posterior Sagittal Anorectoplasty (PSARP) in Anorectal Malformation Patients: A Single Center Observational Study at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Accuracy of the Chest Trauma Score (CTS) as a Predictor of Acute Respiratory Distress Syndrome (ARDS) in Blunt Chest Trauma Patients: Single Center Study at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Accuracy of the Chest Trauma Score (CTS) as a Predictor of Acute Respiratory Distress Syndrome (ARDS) in Blunt Chest Trauma Patients: Single Center Study at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Analysis of the Role of Age Factors on Hemoglobin, Leukocyte and Platelet Levels in Breast Cancer Patients Post Chemotherapy 3 Cycles at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Introduction: Breast cancer is one of the most common cancers in women. Chemotherapy is one of the main modalities in the treatment of breast cancer, but it can cause hematological side effects such as anemia, leukopenia, and thrombocytopenia. Age is one factor that is thought to influence these side effects.
 Methods: This study used an analytical observational design with data collected from medical records of breast cancer patients who had undergone 3 cycles of chemotherapy at Dr. Mohammad Hoesin General Hospital Palembang. Data on hemoglobin, leukocyte, and platelet levels before and after chemotherapy were analyzed using the t-test and ANOVA.
 Results: A significant decrease in hemoglobin levels was observed in patients aged > 60 years after chemotherapy (p < 0.05). Leukocyte levels showed fluctuations, especially in patients aged <40 years, while platelet levels fluctuated more in patients aged <40 years and decreased in the age group 40-60 years after chemotherapy.
 Conclusion: Age does not significantly influence the decrease in hemoglobin, leukocyte, and platelet levels in breast cancer patients after chemotherapy.

Perineural Injection of Mecobalamin Versus Dextrose 5% Against Clinical Changes and Electrophysiological Features of Carpal Tunnel Syndrome Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Carpal tunnel syndrome (CTS) is a common compression neuropathy with symptoms of pain, tingling, and numbness in the hands. Perineural injections of steroids and mecobalamin have been shown to be effective in relieving CTS symptoms. This study aims to compare the effectiveness of the perineural injection of mecobalamin and 5% dextrose on clinical changes and electrophysiological features in CTS sufferers.
 Methods: This research is a pilot study open-label randomized controlled trial conducted at Dr. Mohammad Hoesin General Hospital Palembang. A total of 24 CTS patients were randomly divided into two groups: the mecobalamin group (n=12) and the 5% dextrose group (n=12). Patients in both groups received a single perineural injection.
 Results: In the mecobalamin group, there were significant improvements in pain scores (NPRS), Boston carpal tunnel questionnaire (BCTQ) - symptom severity scale (SSS) and functional status scale (FSS), as well as median nerve motor and sensory conduction after 2 weeks. In the 5% dextrose group, there were significant improvements in pain scores and BCTQ-SSS but not in BCTQ-FSS and nerve conduction. Comparison between groups showed significant differences in BCTQ-SSS and sensory conduction amplitude.
 Conclusion: Perineural injection of mecobalamin and 5% dextrose is effective in improving clinical symptoms of CTS. Mecobalamin showed better effects on BCTQ-SSS and sensory conduction amplitude than 5% dextrose.

Factors Playing a Role in Sleep Disorders in Post-COVID-19 (Coronavirus Disease) Patients at the Neurology Polyclinic of Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Sleep disorders are one of the symptoms frequently reported in post-COVID-19 patients. This study aims to identify factors that play a role in sleep disorders in post-COVID-19 patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.
 Methods: This research was conducted in an analytical observational manner with a cross-sectional design. Data was collected from 100 post-COVID-19 patients treated at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Data were analyzed using the logistic regression test.
 Results: Factors that play a role in sleep disorders in post-COVID-19 patients are depressive symptoms (OR=2.5; 95%CI: 1.3-4.8); Anxiety symptoms (OR=3.1; 95%CI: 1.6-5.9); Stress level (OR=2.2; 95%CI: 1.1-4.3); Sleep quality before COVID-19 (OR=2.0; 95%CI: 1.0-3.9).
 Conclusion: Symptoms of depression, anxiety, stress, and sleep quality before COVID-19 are factors that play a role in sleep disorders in post-COVID-19 patients.

Correlation of Soluble Programmed Death Ligand-1 (sPD-L1) with Alpha-Fetoprotein Levels as a Predictor of Prognosis in Hepatocellular Carcinoma Patients

Background: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and one of the leading causes of cancer death worldwide. Chronic hepatitis B virus infection is the most common etiology of HCC. Programmed death ligand-1 (PD-L1) is a protein that is overexpressed on the surface of tumor cells, which can be detected in serum (sPD-L1). Elevated sPD-L1 concentrations in the plasma of cancer patients are associated with poor prognosis in HCC patients, as indicated by increased AFP levels. There have been no previous studies examining the correlation of sPD-L1 levels with AFP in HCC patients. The aim of the study was to determine the correlation of sPD-L1 and AFP as predictors of prognosis in HCC patients.
 Methods: The research is an observational study with a cross-sectional design to see the correlation of sPD-L 1 with serum alpha-fetoprotein levels in HCC patients at Dr. Mohammad Hoesin General Hospital Palembang starts from April to July 2023. Measurement of sPD-L1 levels and serum AFP levels is carried out using ELISA examination.
 Results: Of the 28 subjects studied, HCC patients were more commonly found in men (89.29%) aged 18-60 years (75%). sPD-L1 and AFP values were found to be increased in the advanced stages of HCC. The sPD-L1 value is directly proportional to the serum AFP value.
 Conclusion: There is a strong positive correlation between sPD-L1 levels and serum AFP levels caused by hepatitis B in HCC patients, so the higher the sPD-L1, the higher the serum AFP levels.

Sensitivity and Specificity of Pleural Fluid Cytology to Histopathology Examination in Lung Tumor Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Introduction. Lung tumors are pathological growths in the lung that are strongly associated with lung cancer. In 2018, lung cancer, a form of lung tumor, had the greatest occurrence among all types of cancer. It accounted for 2,093,876 new cases, which represented 11.6% of all cancer cases. The objective of this study was to assess the sensitivity and specificity of pleural effusion cytology testing compared to histopathological examination in patients with lung malignancies at Dr. Mohammad Hoesin General Hospital in Palembang, Indonesia.
 Methods. This study was a retrospective analytical-observational study. This study encompassed a cohort of 35 patients who fulfilled the specified inclusion criteria. We used the SPSS version 22.0 for Windows application to perform bivariate analysis in data processing and analysis.
 Results. The study yielded a sensitivity score of 13.63%, indicating the pleural fluid cytology method's accuracy in detecting lung cancer in individuals with low values. This study demonstrates a specificity value of 100%, indicating the frequency at which the pleural fluid cytology approach accurately identifies cancer.
 Conclusion. The use of cytology as a screening tool for identifying lung tumor illnesses is limited, although it demonstrates a high level of specificity in ruling out healthy individuals.

Analysis of Morphometric Variations in the Thickness of the Mandibular Symphysis in Patients at Dr. Mohammad Hoesin General Hospital Palembang, Indonesia

Introduction. Accurate knowledge of mandibular thickness is necessary for performing surgical treatments on the mandible. The Champy procedure has become the predominant approach for treating fractures of the mandible. Placing plates along these lines is believed to offer the best possible fixing and stability. The objective of this study is to analyze and compare the thickness of the mandible in patients, specifically depending on their gender. The purpose is to gain a more comprehensive understanding of the differences in mandibular architecture across various populations in South Sumatra, Indonesia.
 Methods. This study is a cross-sectional analytical-observational study. The Department of Radiology of Dr. Mohammad Hoesin Central General Hospital, located in Palembang, conducted the study. We included a total of 103 research participants in this study, all of whom met the specified inclusion criteria.
 Results. There is a notable difference in the thickness of the lower jawbone in the front part (A and B) that runs parallel to Champy's line, depending on the person's gender. Males have a greater morphometric thickness of the mandibular symphysis in comparison to females. The thickness of the mandibular symphysis closely links to gender disparities.
 Conclusion. The thickness of symphysis A in men was substantially greater than in females, while the thickness of symphysis B in males was also significantly greater than in females, with a P value less than 0.001.

Vitamin D Levels in Epilepsy Patients at the Neurology Polyclinic, Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: In epilepsy patients, treatment is often lifelong and anti-epileptic drugs (AEDs) can be divided into two general groups, namely drugs that affect cytochrome P-450 (CYP-450) such as carbamazepine, phenytoin, primidone, or valproic acid, and those that affect minimal cytochrome P-450 such as gabapentin, vigabatrin, levetiracetam, oxcarbazepine, or topiramate. AEDs include various drugs that can cause a decrease in vitamin D levels. Therefore, this study was aimed at examining vitamin D levels in epilepsy patients who took AEDs at the neurology polyclinic at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.
 Methods: This research is a descriptive study with a cross-sectional design using primary data obtained from the results of patient examinations using laboratory tests and secondary data from medical records.
 Results: As many as 78% (14 subjects) who received monotherapy had vitamin D levels below normal, and 16 subjects, or 76%, who received polytherapy had vitamin D levels below normal (p = 0.907). A total of 13 (72%) subjects who received phenytoin had vitamin D levels below normal, as well as 5 (63%) subjects who received carbamazepine and 12 (92%) subjects who received other therapies (p = 0.235). A total of 12 (67%) subjects who received therapy for 1-3 years and 18 (86%) subjects who received therapy > 3 years had vitamin D levels below normal (p = 0,406).
 Conclusion: Vitamin D deficiency is a crucial problem in epilepsy patients receiving AED therapy, where more than 75% of patients have vitamin D deficiency. In this study, vitamin D deficiency did not have a significant relationship with the type of therapy (monotherapy or polytherapy) or the type of drug used. used, duration of therapy, and frequency of sun exposure.

Correlation Between the Severity of Dry Eye Disease and Fluorescein Break-Up Patterns (FBUP)

Dry eye disease is a disorder of the eye surface characterized by instability of the tear film. The FBUP examination is one of the examinations used to determine the stability of the tear film. The various symptoms that occur in each type of dry eye indicate differences in break-up patterns (BUP). This study aims to determine the correlation between the severity of dry eye disease and the appearance of FBUP at RSUP dr. Mohammad Hoesin Palembang. A correlative analytical cross-sectional study was undertaken at the Eye Polyclinic, Infection- Immunology Subdivision, Dr. Mohammad Hoesin General Hospital Palembang from January to June 2022. There were 32 patient samples with 60 dry eye samples that met the inclusion criteria. The correlation between the Schirmer Test, TBUT and the severity of dry eye disease with the appearance FBUP was analyzed using the Spearman Rho's test. All data were analyzed with SPPS version 23.0. In this study, the results showed that there was a moderate and significant positive correlation between the degree of the Schirmer test and the appearance FBUP (r = 0.482; p = 0.000) and a moderate and significant positive correlation between the TBUT degree and the appearance FBUP (r = 0.435; p = 0.001) . In addition, the results showed that there was a moderate and significant positive correlation between the severity of dry eye disease and the appearance of FBUP (r = 0.478; p = 0.000). Using the multivariate test, it was concluded that the degree of dry eye was statistically significantly related to age (p = 0.001) and gender (p = 0.001). There is a correlation between the severity of the disease and the appearance FBUP of patients with dry eye disease.

Effectiveness of Nigella sativa Addition against TNF-Alpha in Stage III and IV Breast Cancer Undergoing Doxorubicin and Cyclophosphamide Chemotherapy at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Breast cancer is a malignancy caused by the continuous uncontrolled growth of the component cells of the ducts or lobules of the breast gland. Globally, breast cancer is the second leading cause of death in women. Nigella sativa contains substances thymoquinone. Thymoquinone can inhibit the progression of cancer through anti-inflammatory, anti-oxidant mechanisms, inhibit proliferation, trigger apoptosis, and prevent angiogenesis. Chronic inflammation in breast cancer is mediated by one of them is TNF-alpha tumors. Elevated levels of TNF-α have a significant association with poor prognosis and progression of breast cancer. This study aims to determine the effectiveness of the additional Nigella sativa in declining TNF-α levels in breast cancer patients at Dr. Mohammad Hoesin General Hospital Palembang.
 Methods: This research used a randomized, open clinical trial design, which was carried out at the internal medicine hematology-oncology medical polyclinic and the surgical oncology polyclinic of Dr. Mohammad Hoesin General Hospital Palembang from January 2023 to October 2023. Data processing for data analysis used SPSS version 26 for Windows.
 Results: There were 36 research subjects followed during the study period and received Doxorubicin chemotherapy and cyclophosphamide (AC), which were divided into treatment groups of 18 people (chemotherapy with the addition of Nigella sativa @600 mg 2x2 capsule/ day and a control group of 18 people. A TNF-alpha examination was carried out before and after to assess the comparison before and after. From the results, it was found that TNF-alpha levels in the treatment group showed a decrease in TNF-alpha with a p-value <0.001.
 Conclusion: The addition of Nigella sativa has the effect of reducing TNF-alpha in breast cancer patients receiving AC chemotherapy at Dr. Mohammad Hoesin General Hospital, Palembang.

Diagnostic Test of Transforming Growth Factor-Beta 1 (TGF-β1) in Menstrual Blood with Endometriosis.

Endometriosis is a benign disorder that is generally defined as the presence of endometrial glands and stroma outside their normal location. TGF-β1 is found in stromal cells and its expression is increased in epithelial cells of endometriotic cysts. Endometriosis diagnostics take a long time, so new markers are needed to diagnose endometriosis. This study aims to determine the diagnostic value of TGF-β1 in menstrual blood in diagnosing endometriosis. Diagnostic tests to compare eutopic endometrial TGF-β1 levels from menstrual blood of patients with suspected endometriosis were undertaken in the Obstetrics and Gynecology Department of Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Sriwijaya University, Palembang, from July 2019 to November 2020. 50 patients who were suspected with endometriosis met the inclusion criteria. Comparison of TGF-β1 levels between endometriosis and nonendometriosis patients was analyzed using the Mann-Whitney test. The cutoff point of the TGF-β1 level towards the histopathological outcome was obtained using the ROC curve. Data analysis was performed by using SPSS version 22.0. In this study, endometriosis patients were 31.6 ± 6.55 years of age with a range of 20 to 46 years. In statistical analysis, there was no difference in BMI (p = 0.181) and BMI classification (p = 0.207), the history of contraception (p = 0.097), infertility (p = 1.000), and dysmenorrhoea (p = 1.000) between endometriosis and nonendometriosis patients. In the study, there were differences in TGF-β1 between endometriosis and nonendometriosis patients (p ≤ 0.001). By using the ROC curve, the cutoff point for TGF-β1 levels has the best sensitivity and specificity, which is 515 ng/ml. The TGF-β1 level has a sensitivity of 80%, a specificity of 90%, a positive predictive value (PPV) of 0.969, a negative predictive value (NPV) of 0.529, a positive likelihood ratio of 8, a negative likelihood ratio of 0.222, and an accuracy of 0.820 to the endometriosis outcome. It can be concluded that the TGF-β1 level has a very good diagnostic value in establishing endometriosis diagnostics. This trial is registered with ISRCTN72218532.

Spinal Anesthesia Ambulation Time of Cervical Cancer Brachytherapy Outpatient Clinic: Comparison of 5 mg Hyperbaric Bupivacaine Fentanyl with 2,5 mg Hyperbaric Bupivacaine and 25 mcg Fentanyl

Introduction: Regional anesthetic techniques and local anesthesia have proven to be more effective than general anesthesia in the practice of ambulatory anesthesia. Spinal anesthesia is the technique of choice for ambulatory anesthesia in cervical cancer brachytherapy patients. Low-dose local anesthetics can speed up the ambulation time. This study aims to compare the ambulation time of low-dose spinal anesthesia with conventional doses. Fast ambulation time can speed up recovery time for patients, thereby reducing the patient's length of stay.
 Methods: This study was a double-blind, randomized controlled trial conducted in August – September 2022 at the Radiotherapy Installation of Dr. Mohammad Hoesin General Hospital (RSMH) Palembang. All cervical cancer patients undergoing brachytherapy in adults with ASA I-II physical status were included in the study sample. Samples will be randomized into two groups, namely a combination of hyperbaric bupivacaine 5 mg and fentanyl 25 mcg and a group of bupivacaine 2.5 mg and fentanyl 25 mcg. Patients with allergies, impaired motor function, spinal failure, block level not achieved, shock, apnea, respiratory depression, and experiencing pain during the procedure were excluded from the study.
 Results: Ambulation time in the hyperbaric bupivacaine 5 mg and 25 mcg fentanyl group was longer than the hyperbaric bupivacaine 2.5 mg and 25 mcg fentanyl (155.22 + 10.68 minutes versus 98.69 + 7.13 minutes) with a significance level of p<0.001. Spinal anesthetic drugs work in a dose-dependent manner. Increasing the dose will increase the duration of action of the spinal anesthetic. The only side effects found were hypotension and pruritus.
 Conclusion: Spinal anesthesia with hyperbaric bupivacaine 2.5 mg and fentanyl 25 mcg can accelerate the ambulation time of cervical cancer patients undergoing brachytherapy.

Correlation of Platelet-Derived Growth Factor-BB Levels as a Biomarker of Liver Fibrosis with the Degree of Fibrosis Based on Fibroscan in Chronic Hepatitis B Patients

Background: Liver fibrosis is scar tissue that forms due to excessive accumulation of ECM proteins due to chronic liver injury, mediated by cytokines involving complex cellular interactions, such as platelet-derived growth factor-BB (PDGF-BB). In Indonesia, no research has been conducted to determine the correlation between PDGF-BB levels and the degree of liver fibrosis based on fibroscan. The aim of this study is to assess the correlation between PGDF-BB levels and the degree of liver fibrosis based on fibroscan in chronic hepatitis B.
 Methods: A cross-sectional study was conducted on the chronic hepatitis B population at the internal medicine clinic of Dr. Mohammad Hoesin General Hospital Palembang from January to Agustus 2023. The assessment uses fibroscan to determine the degree of liver fibrosis, measured in kilopascals (kPa). PDGF-BB levels measured by ELISA.
 Results: From 40 subjects, the majority of chronic hepatitis B patients were women (57,5%). The lowest PDGF-BB level was found in chronic hepatitis B patients with fibroscan F0, and the highest PDGF-BB level in fibroscan F4. Fibroscan results are directly proportional to PDGF-BB level.
 Conclusion: PDGF-BB has a strong positive correlation with the degree of fibroscan in chronic hepatitis B patients in Dr. Mohammad Hoesin General Hospital. The higher the range of PDGF-BB levels, the higher the degree of fibroscan in chronic hepatitis B patients.

The Effect of Oral N-Acetyl Cysteine Administration on Acute Kidney Injury Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Acute kidney injury (AKI) is a clinical condition characterized by a rapid decline in kidney function that includes structural damage (injury) or malfunction (impairment). AKI is a common complication that occurs in 5-10% of patients due to various underlying etiologies. One of the underlying pathophysiology of AKI is the role of discharge reactive oxygen species (ROS), which causes injury to kidney cells. From various studies, it has been reported that N-acetylcysteine (NAC) has anti-inflammatory and antioxidant effects and has an effect on reducing serum creatinine values.
 Methods: This research is an open randomized clinical trial without control involving 30 patients at Dr. Mohammad Hoesin General Hospital, Palembang, who were all given intervention in the form of NAC 1200 mg/day, starting in September – October 2023. This study aimed to determine the role of NAC in reducing serum creatinine values in patients with acute kidney injury at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Data analysis was carried out using SPSS 21 univariate and bivariate.
 Results: From the research results, it was found that the average age of patients was 53.9 years, involving 21 males (70%, N=30) and 9 females (30%, N=30). The most common causes were prerenal and then renal (53.3% and 46.7%). The initial serum creatinine level was found to be 2.12± 0.79 mg/dL (n = 30 samples), and after administration of the intervention, the mean serum creatinine level was 1.28± 0.63 mg/dL (n = 30 samples). By using a paired t-test, there was a decrease in serum creatinine levels significant (p=0,012).
 Conclusion: NAC administration to patients with acute kidney injury of pre-renal or post-renal causes has a statistical effect on reducing serum creatinine values in patients with acute kidney injury at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

Double Limberg Flap for Stage IV Sacral Decubitus Ulcers with Compression Fracture of the First Vertebra of Lumbar Spine: A Case Report

Background: Decubitus ulcers are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. There are numbers of surgical methods have been devised over a year for treatment of decubitus ulcers. Double Limberg flap is our procedure of choice, which we present here as our experience. Case presentation: The study describe a 29 years old male with chief complaint is unable to move both limbs. One month before admission the patient admitted that he had been hit by the roof of the chicken coop while cleaning it. After the incident, the patient wan unable to move his legs. The patient also admitted that he was unable to control his urination and bowel movements. The patient also complained that there were ulcers in the buttocks that were caused by being in bed for a long time. At Dr. Mohammad Hoesin General Hospital, the patient is planned to undergo posterior stabilization. After the posterior stabilization is carried out, this patient was planned to have the ulcer closure using a Limberg flap. The double limber flap survived completely. Flap necrosis was not seen in this case. The largest defect covered by this flap. There was no recurrence of pressure sores in this patient in the 6 month follow-up period. Conclusion: The Limberg flap is a fast, accurate and reliable alternative surgical technique utilizing local tissue in treating sacral decubitus ulcer. Limberg flap repair is an effective technique with short learning curve, patient comfort, early healing, and least complications and recurrence rates are the advantages of this procedure.

Accuracy of D-dimer as a Predictive Biomarker for Outcome in Head Injured Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Introduction: D-dimer reflects the upregulation of the overall hemostatic system upon admission. If D-dimer levels increase, coagulation disorders appear. This is considered a poor prognostic factor. High D-dimer levels reflect the severity of brain injury. Activation of systemic coagulation causes extensive intravascular fibrin deposition and a decrease in platelets and coagulation factors. This study aimed to assess the accuracy of D-dimer as a predictive biomarker for outcomes in head injury patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.
 Methods: This study is a prospective prognostic test study to test the sensitivity and specificity of D-dimer for prediction mortality in patients with severe head injuries at Dr. Mohammad Hoesin General Hospital (RSMH) Palembang in the period June 2023 to August 2023. A total of 47 research subjects participated in this study.
 Results: Post 24-hour D-dimer levels have a cut-off point of 11.78 mg/L, which has high accuracy in poor outcomes. D-dimer levels after 5 days have a cut-off point value of 2.3 mg/L and have high sensitivity in predicting poor outcomes, and the value of the difference in changes in D-dimer based on poor outcome patients have a cut-off point of 3.33 mg/L, which has a high sensitivity in predicting a poor prognosis.
 Conclusion: D-dimer levels are quite accurate as a predictive biomarker for outcomes in head injury patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

The Relationship Between High-Sensitivity C-Reactive Protein (hs-CRP) and Diastolic Dysfunction in Geriatrics Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Systemic inflammation associated with high hs-CRP levels constitutes one pathway through which diastolic dysfunction develops in older adults. This study aims to determine the relationship between high-sensitivity c-reactive protein (hs-CRP) and diastolic dysfunction in older adults at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.
 Methods: This research is an observational analytical study using a cross sectional design. The research was conducted at the geriatrics polyclinic at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia from June to August 2023. A total of 65 people took part in this study. The relationship between hs-CRP and diastolic dysfunction was analyzed using SPSS version 25, univariate and bivariate.
 Results: Hs-CRP had a significant relationship with diastolic dysfunction on a numerical scale (p=0.012), with a median value of 1.6 mg/dL in subjects with diastolic dysfunction and 0.9 mg/dL in subjects without diastolic dysfunction. On the categorical scale, the hsCRP less than 1 mg/dL group found nine subjects (23.7%) with diastolic dysfunction and 14 subjects (51.9%) without diastolic dysfunction, the hsCRP 1-3 mg/dL group found 21 subjects (55.3%) with diastolic dysfunction and 12 subjects (44.9%) without diastolic dysfunction, in the hsCRP more than 3 mg/dL group (p=0.026) there were eight subjects (21.1%) with diastolic dysfunction and one subject (3.7%) without dysfunction diastolic.
 Conclusion: There is a significant relationship between hsCRP and left ventricular diastolic dysfunction in geriatrics patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.