Mohammad Hoesin Hospital Palembang Research Articles

Effectiveness and Efficiency of Using LINAC Precise and Cobalt-60 Medical Devices at Dr. Mohammad Hoesin Hospital Palembang

Hospitals are social institutions that provide quality health services to every customer. To meet expected service standards, hospitals should have effective procurement of medical equipment. This study aims to evaluate the effectiveness and efficiency of utilities in the use of medical devices in supporting services at RSUP Dr. Mohammad Hoesin Palembang, with descriptive analytical research using quantitative methods with a cross sectional research design. The research results show that there is a significant difference between the Break Event Point (BEP) value before and after purchasing the Cobalt 60 aircraft from the target of 90 patients per day to 87 patients per day, and there is a significant difference between the BEP value before and after purchasing the Precise LINAC aircraft from the target of 70 patients per day to 55 patients per day. Based on the calculation of the effectiveness and efficiency of the utility of using the Cobalt 60 and Linac Precise aircraft, it can be concluded that the utility of using the Cobalt 60 aircraft at RSUP Dr. Mohammad Hoesin Hospital Palembang is considered ineffective (50%) but efficient (70.88%) with a BEP value of 5.5 years; while the utility of using the Linac Precise aircraft at RSUP Dr. Mohammad Hoesin Hospital Palembang is considered effective (113%) and efficient (51.77%) with a BEP value of 4.1 years. The data above shows that hospitals experienced slight losses due to the Covid-19 pandemic because the number of patients using medical equipment did not reach the target, but hospitals were able to manage expenditure well so that there was a decrease in the efficiency ratio every year in the procurement of medical equipment.

Quality of Life in Pelvic Organ Prolapse Patients with Operative Therapy at RSUP Dr. Mohammad Hoesin

Introduction. Pelvic organ prolapse is a condition where the pelvic organs descend from their original position and protrude into the vagina. This condition causes several complaints in the patients that can interfere with their daily activities and have an impact on their quality of life. One of the treatments that can be given to patients with POP is operative therapy, which one of the goals is to improve patient's quality of life. This study aims to determine the quality of life of pelvic organ prolapse patients with operative therapy at Dr. Mohammad Hoesin Hospital Palembang. Methods. This study used an observational analytical method with a cross-sectional study design. This study consisted of 17 respondents. This study used primary data from interviews using the P-QOL questionnaire guidelines and secondary data from medical records. Results. This study showed an improvement in the quality of life of pelvic organ prolapse patients in all P-QOL quality of life domains (p<0.05) after receiving operative therapy compared to before receiving operative therapy. Analysis of the effect of confounding factors on the total quality of life score showed that age (p=0.138), BMI (p=0.999), parity (p=0.468), degree of POP (p=0.439), and type of surgery (p=0.814) did not have a significant influence on the quality of life of postoperative POP patients. Conclusion. There was a significant improvement in the quality of life in pelvic organ prolapse patients after receiving operative therapy, and there is no significant relationship between age, BMI, parity, degree of POP, also type of surgery on the quality of life in postoperative POP patients.

THE EFFECTIVENESS OF LEVOFLOXACIN 0.5% WITH POVIDONE IODINE 2.5% IN REDUCING CONJUNCTIVA BACTERIAL FLORA IN PRE INTRA OCULAR OPERATIVE

Abstract
 Introduction & Objectives : This study aims to compare the effectiveness of Levofloxacin ED 0.5% with Povidone iodine 2.5% in reducing normal bacterial flora of the conjunctiva in preoperative procedures.
 Methods : Clinical trials will be conducted in the inpatient ward on patients who will undergo intravitreal surgery at Mohammad Hoesin Hospital Palembang from May 2022-July 2022. Subjects were divided into two groups, which is Levofloxacin ED 0.5% and Povidone iodine 2.5% group. Before and after the fornices preparation, the number of bacterial colonies that grow will be counted and evaluated using bivariate analysis.
 Results : There were 32 samples that fulfilled the inclusion criteria. A significant decrease of conjunctival flora was observed in both groups (p value = 0.000). Comparison of the two groups’ decrease in conjunctival flora was not significant. There was a reduction of up to 100% in 11 samples (68.75%) of both intervention groups.
 Conclusion : The use of Levofloxacin 0.5% and Povidone iodine 2.5% was equally good in reducing the number of bacterial colonies in the conjunctiva.

Survival Analysis Of Dry Eye Disease Related To The Bleb Morphology In Primary Glaucoma Patient Post Trabeculectomy

Abstract
 Introduction & Objectives : Dry eye disease (DED) has a prevalence of approximately 40-59% of all glaucoma patients. Changes in cellular structure after trabeculectomy underlie the instability of the tear film. This study aims to determine the relationship between DED and post-trabeculectomy bleb morphology.
 Methods : An observational study with survival analysis design to evaluate the time to DED in primary glaucoma patients with post- trabeculectomy blebs was undertaken at the Eye Health Polyclinic of Mohammad Hoesin Hospital Palembang from January to March 2022. There were 30 primary glaucoma patients who met the inclusion criteria. Bivariate analysis to determine the relationship between bleb morphology and DED was analyzed using the Fisher Exact test. DED survival analysis was conducted using Kaplan Meier analysis.
 Results : Three months after trabeculectomy, 11 of 30 (36.7%) patients suffered from DED. There was a significant relationship between bleb height and DED three months after trabeculectomy [PR = 14.222 (Cl 95% 2.324- 87.028; p = 0.004)]. In addition, the results showed that there was a significant difference in the survival time of DED in glaucoma patients based on bleb height (p = 0.001).
 Conclusion : Bleb height is a predictor of DED in glaucoma patients after trabeculectomy.

Comparing Voice Related Quality of Life scores between fenestrated and speaking valve cannula users

Background: Tracheostomy is a procedure that aims to maintain the airway so that air can enter the lungs and bypass the upper airway. Tracheostomy causes physiological changes, especially in terms of communication, which leads to reduced voice-related quality of life. Fenestrated tracheal cannula and speaking valve can assist patients in generating voice.
 Objective: To compare the V-RQOL scores of the fenestrated tracheal cannula and speaking valve users.
 Methods: Analytic observational study using a cross-sectional design. Data collection was done through interviews with the V-RQOL questionnaire guide. The study was conducted in September-December 2022 at the THTBKL Polyclinic of Dr. Mohammad Hoesin Hospital Palembang. Data were analyzed with IBM SPSS 26.
 Results: 42 patients were using tracheal cannula, with 21 patients each with a fenestrated and speaking valve tracheal cannula. Patients with fenestrated tracheal cannula had lower quality of life in the physical, social, and total domains than those in the speaking valve group (poor QoL in the physical domain: 66.67% vs. 9.52%; social domain: 85.71% vs. 57.14%; total domain: 76.19% vs. 4.76%; p<0.001). From the multivariate analysis, the tracheal cannula type influenced the patient's quality of life was (p<0.001). The probability of someone with a fenestrated tracheal cannula will experience a poor QoL is 76.2%, while speaking valve is 4.7%.
 Conclusion: The quality of life of patients with a fenestrated type of tracheal cannula is significantly lower than that of speaking valve tracheal cannula users in both the physical, social, and total domains as measured by the V-RQOL.

The Relationship Between Platelet-to-Lymphocyte Ratio (PLR) and HCV RNA Levels in HCV-HIV Coinfected Patients Before and After Receiving Direct-Acting Antiviral (DAA) Therapy at Dr. Mohammad Hoesin Hospital Palembang

The background described in the introduction section highlights the importance of studying the correlation between the platelet-to-lymphocyte ratio (PLR) and HCV RNA levels in these patients. This research follows an analytical correlational observational design with a cross-sectional approach. The study was conducted at the Internal Medicine Polyclinic of Dr. Mohammad Hoesin Hospital, Palembang. It involved 38 subjects who met the inclusion and exclusion criteria. The primary objective was to determine the correlation between PLR and HCV RNA levels in HIV-HCV coinfected patients receiving DAA therapy. The research findings concluded that there was a decrease in PLR and HCV RNA Viral Load levels in HIV-HCV coinfected patients after receiving DAA therapy compared to before receiving DAA therapy. The Platelet-to-Lymphocyte Ratio (PLR) was directly proportional to the quantitative HCV RNA Viral Load levels in HIV-HCV coinfected patients with a strong correlation value both before and after DAA therapy.

A Randomized Trial of Total Drain Volume in Post-Modified Radical Mastectomy (MRM) Breast Cancer Patient Using Songket Incision Compare to Stewart Incision plus Axillary Anchor at Dr. Mohammad Hoesin Hospital Palembang

Background: Breast cancer is the most common malignancy in women globally. In Indonesia, a total of 65,858 new cases with a 22,530 mortality rate were reported in 2020. To overcome this health condition, surgery serves as the primary treatment, with post-mastectomy complications frequently involving seroma formation, exacerbating post-operative problems. Therefore, this study aimed to assess the total drain volume in post-MRM breast cancer patients using Songket incision compared to Stewart incision plus axillary anchor. This experiment was conducted to determine the optimal surgical option for breast cancer patients.Methods: A two-arm randomized controlled trial was conducted in female patients with breast cancer treated at the Surgical Oncology Division of Mohammad Hoesin Hospital Palembang between April to May 2022. Patients were blindly assigned to one of the two arms, namely the Songket incision and Stewart incision plus an axillary anchor. The eligible sample consisted of patients diagnosed with breast cancer who were slated for Modified Radical Mastectomy (MRM) surgery, willing to participate, and signed informed consent. The primary outcome of this study was total drain volume, while the secondary objective encompassed the length of treatment selected.Results: A total of 26 patients participated in this study (n=13 in each arm). The total drain volume using the Stewart incision was 378.07 ± 219.57, compared to 174.23 ± 97.44 ml for the Songket design (p< 0.001). The mean length of treatment was 4.46 ± 0.77 days in the Stewart incision plus axillary anchor group and 3.23 ± 0.43 days in the Songket incision design (p < 0.001). Conclusions: Songket incision was the best surgical option for breast cancer patients.

OVERVIEW OF PERIPHERAL NEUROPATHY IN CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING HEMODIALYSIS AT DR. MOHAMMAD HOESIN HOSPITAL PALEMBANG

Neurological complications occur in almost 60% of patients with advanced CKD and affect the nervous system at all levels, both central and peripheral. Peripheral neuropathy in CKD is usually asymptomatic until renal function is below 15%, and glomerular filtration is less than 10-12 ml/min. This study seeks to identify and characterize peripheral neuropathy in patients with chronic kidney disease undergoing hemodialysis at Dr. Mohammad Hoesin Hospital Palembang. This is a descriptive cross-sectional study with the research sample comprising chronic kidney disease patients undergoing hemodialysis at Dr. Mohommad Hoesin Palembang Hospital. The distribution of research subjects based on the Neuropathy Symptom Score (NSS) revealed that 65.7% fell into the mild neuropathy category, based on an NSS of 3-4. According to the electrophysiology results, 82.9% of patients exhibited peripheral neuropathy, while 17.1% showed normal NCS results. Sensory motor neuropathy accounted for 51.4%, including 71.5% with axonal neuropathy, 11.4% with axonal-demyelinating lesions, and no demyelinating lesions. The high prevalence of peripheral neuropathy in CKD patients identified through electrophysiological examination (ENMG) emphasizes the importance of nerve conduction examination as a diagnostic tool for peripheral neuropathy in CKD patients. This can aid in determining the progression of peripheral neuropathy in CKD patients, allowing for appropriate management and prevention of disability complications to enhance the quality of life for these individuals.

Characteristic Of Catheter Double Lumen Infection In Chronic Kidney Disease Patients At Dr. Mohammad Hoesin Hospital Palembang

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>The majority of chronic kidney failure patients (40-60%) require hemodialysis (HD) twice a week and often face problems with inadequate venous access. Hemodialysis patients with CKD often use an alternative to central venous access in the form of a well-tunneled double lumen (CDL) catheter or non-tunneled. However, the use of CDL causes many risks of infection This study aims to analyzed risk factors for CDL infection in patients with chronic kidney failure undergoing hemodialysis at dr. Mohammad Hoesin Hospital period January to December 2021.Descriptive study with retrospective study design was undertaken in the hemodialysis unit at dr. Mohammad Hoesin Hospital Palembang from January to December 2022. There were 100 samples who met the inclusion criteria. The relationship between independent and dependent variables was analyzed using the Chi Square test or Fisher's Exact. The most important risk factors were analyzed using the Logistic Regression test. All data were analyzed by SPPS version 22.0. In this study, there was no significant relationship between gender, age, ureum, creatinine, leucocyte and length of use with the incidence of CDL infection (p > 0,05), however there is a significant relationship between nutritional status with the incidence of CDL infection (OR = 31.418 (CI5% 10.028 – 98.438); p = 0.000); there was a significant relationship between catheter location with the incidence of CDL infection (p = 0.000); and there was a significant relationship between the type of catheter with the incidence of CDL infection (OR = 32.276 (CI5% 4.096 – 254.319); p = 0.000).In this study, it was found that the factors influencing CDL infection were nutritional status and type of catheter</em><em>.</em></p><p> </p></td></tr></tbody></table></div><strong><em>Keyword: Catheter, CDL, Chronic Kidney Failure, Haemodialysis, Infection</em></strong>

Comparison of MMP-9 Density Between Triple Negative and HER2 Enriched Breast Carcinoma Subtypes

Background
 Matrix metalloproteinase-9 (MMP-9) is a protease that plays an important role in various biological processes of breast cancer. This marker may be useful in determining the prognosis and become a promising therapy, especially in breast carcinoma with an aggressive subtype including HER2 enriched and triple negative. Both subtypes have high MMP-9 expression, but it is necessary to differentiate them because they have different biological and molecular aspects. This study aims to compare the density of MMP-9 between triple negative and HER2 enriched breast carcinoma subtypes and their relationship with clinicopathological characteristics.
 
 Methods
 This is a cross sectional study using 32 samples of paraffin blocks and slides of breast carcinoma patients with triple negative and HER2 Enriched subtypes at the Department of Anatomical Pathology Faculty of Medicine Sriwijaya University/Dr. Mohammad Hoesin Hospital Palembang for the period January 1, 2016 to December 31, 2019. Each sample was stained with MMP-9 antibodies immunohistochemistry (polyclonal, Abcam). Comparative analysis of MMP-9 density between the two subtypes was carried out using the median value based on the Mann-Whitney analysis. MMP-9 density was categorized as high and low based on the ROC curve and analyzed by using chi-square test to assess its association with clinicopathological characteristics.
 
 Results
 Mann-Whitney test showed that the MMP-9 density was higher in the HER2 enriched subtype (median 12.0) than triple negative (median 8.8) with a p value of 0.632. The relationship distribution of high MMP-9 density was found in the category of age group >40 years old (60.0%), positive lymphovascular invasion (86.7%) and histological grade III (80.0%) with p values of 0.798, 0.402 and 0.691.
 
 Conclusion
 MMP-9 density in HER2 enriched subtype was higher than triple negative subtype, but statistically not significant.

KNOWLEDGE, ATTITUDE, AND PERCEPTION OF ANTICIPATING 2022 GLOBAL HUMAN MONKEYPOX INFECTION AMONG INTERNAL MEDICINE RESIDENTS AT PALEMBANG INDONESIA: AN ONLINE SURVEY

Rapid increasing cases of Monkeypox infections in countries around the world, forcing medical professionals to be prepared to prevent it becoming the next global pandemic. We conducted the study to determine knowledge, attitude, and perception of doctors regarding preparedness for 2022 human monkeypox infection. This cross-sectional design research was conducted on 2-5 of August 2022, by circulating an online survey link to all internal medicine residents at the medical faculty of Universitas Sriwijaya, Dr. Mohammad Hoesin hospital Palembang Indonesia. The survey contained questions about the respondent's characteristics, knowledge, attitudes and perceptions about Monkeypox infection. A total of 75 residents agreed and completed the survey and were analyzed, with a mean age of 31 years, and 49 men (65.3%). Respondents’ knowledge of monkeypox is not very good. Almost all respondents knew that monkeypox was transmitted by direct contact, but only 53.4% knew that monkeypox was not transmitted airborne, 34.7% not sexually, and only 18.7% answered correctly that there was no specific therapy. The percentage who answered in doubt ranged from 20-30%. Respondents' attitudes and perceptions were quite good. Almost all equipped themselves with personal protective equipment and try to find information about monkeypox by attending seminars, downloading guidelines and reading online articles. A total of 58 people (77.3%) were willing to be vaccinated against monkeypox. Residents must increase the correct knowledge about this disease in order to be able to manage appropriately if they encounter cases of monkeypox infection.

Relationship between the Number of CD4+ and CD8+ Cells in Patients with COVID-19 (Coronavirus Disease 2019) at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: The pathogenesis of COVID-19 involves complex immunological processes that can predispose to disease severity. In COVID-19 patients, there will be changes in the number of CD4 + and CD8 + cells which are part of lymphocyte cells in the specific immune system. This study aims to see the relationship between CD4+ and CD8+ cell counts in COVID- 19 patients at Dr. Mohammad Hoesin Hospital Palembang, Indonesia.
 Methods: This research is an observational study with a case series approach. A total of 30 study subjects who were COVID-19 patients participated in this study. The number of CD4+ and CD8+ cells was assessed, then correlation analysis was performed with the Spearman test, p<0.05.
 Results: The correlation between CD4+ and CD8+ has a value of R = 0.875 and p<0.01. This shows that CD4+ and CD8+ have a strong positive correlation and are statistically significant.
 Conclusion: The increase in the number of CD4+ cells will be followed by an increase in the number of CD8+ cells in COVID-19 patients at Dr. Mohammad Hoesin General Hospital Palembang, Indonesia.

Clinical Characteristics of Post-surgical Ptosis Patients at Dr. Mohammad Hoesin General Hospital Palembang

Introduction: Blepharoptosis is drooping of the upper eyelid in a primary position, causing the narrowing of the palpebral fissure. This condition can partially or completely cover the visual axis. Establishing the diagnosis of ptosis requires a comprehensive eye examination, including history taking, physical examination, and examination of the eyelids in ptosis patients. The majority of patients with ptosis require surgery, and clinical characteristics play an important role in classifying the type of ptosis and then formulating a detailed treatment plan strategy so that a better outcome is obtained.
 Methods: A descriptive retrospective study was conducted from medical records of post-surgical ptosis patients at Dr. Mohammad Hoesin Hospital Palembang from January 2016 to December 2021. The data taken included age, gender, the onset of occurrence, laterality, type of ptosis based on the onset, vertical palpebral fissure (FPV), horizontal palpebral fissure (FPH), margin-reflex distance (MRD), margin limbal distance (MLD), lid lag, bell's phenomenon levator muscle function, type of ptosis surgery and postoperative condition. This study aims to determine the clinical characteristics of patients with ptosis at Dr. Mohammad Hoesin Hospital Palembang.
 Results: Of the 57 ptosis patients in this study, the majority of patients were male, as many as 32 patients (56.1%) with the age category >40 years, as many as 24 patients (42.1%) with unilateral lateral ptosis as many as 50 patients (87.7%) with the more frequent comparison was the left eye in 29 patients (58%). Acquired ptosis was the most common cause in this study in as many as 46 patients (80.7%), and the most common mechanism of acquired ptosis was neurogenic (33.3%). The majority of patients had no previous surgical history of 41 patients (71.9%), moderate levator function of as many as 42 (73.7%), and frontal suspension surgery technique with synthetic materials as many as 17 (34%) patients. the mean FPV was 5.08±2.627 with a median of 5.00 (0-11), FPH 25.94±1.726 with a median of 26.00 (20-29), MRD 0.246±1.78 with a median of 0.00 (-4 -5), MLD 4.789±2.801 with a median of 5.00 (-4-11) and LA 7.16±4.083 with a median of 7.00 (0-14). Ptosis patients had negative lid lag in 47 patients (82.5%) and positive bell's phenomenon in 49 patients (86%). The postoperative condition of ptosis patients was satisfactory where there was no recurrence and reoperation of ptosis, postoperative complications as many as 1 (1.8%) patients experienced overcorrection, 6 (10.5%) patients experienced lagophthalmos, and 2 (3.5%) patients had an outcome. asymmetric.
 Conclusion: Clinical characteristics of ptosis patients can determine the diagnosis and treatment that will be given to the patient.

THE THREE-YEAR SURVIVAL RATE OF CERVICAL CANCER PATIENTS AT REFERRAL HOSPITAL IN SOUTHERN SUMATRA, INDONESIA

Background: Cervical cancer is the second most common cancer and the third leading cause of death in Indonesia. Purpose: This study aims to identify the 3-year survival rate of cervical cancer patients and its prognostic factors in a referral hospital in Southern Sumatra, Indonesia. Methods: Cohort retrospective study using secondary data from medical records of cervical cancer patients from January 2014 until December 2016. Data of each patient was evaluated for 36 months since the patients were firstly diagnosed with cervical cancer. Kaplan Meier curve was used to determine the survival rate and identify the proportional hazard assumption. The Cox regression model was utilized to determine the survival rate and Hazard Ratio (HR). Results: There were 274 of 799 cervical cancer patients who met the inclusion criteria. The 3-year survival rate for cervical cancer patients at survival rate was around 65%, and prognostic factors related to the survival of cervical cancer patients with p-value <0.05, i.e. age (HR=0.51; 95%CI=0.29-0.90), metastasis (HR=2.43; 95%CI=1.28-4.61), and completeness of therapy (HR=7.23; 95%CI=3.82-13.71. The complication was a confounding factor with metastasis and survival rate. Conclusion: The 3-year survival rate for cervical cancer patients at Mohammad Hoesin Hospital Palembang (RSMH) was 65%. The prognostic factors for the survival rate were age, metastasis, and completeness therapy. It was essential for cervical cancer patients to adhere to the therapy program recommended by doctors to increase the survival rate.

Identification of the Risks of Giving the Covid 19 Vaccine on Other Health Workers at Dr Mohammad Hoesin Hospital Palembang

Corona Virus Disease 2019 (COVID-19) is a disease caused by the SARS-CoV-2 virus, this disease spreads faster and in a short time becomes a worldwide pandemic. In the context of controlling and preventing the spread of the COVID-19 virus, the COVID-19 vaccination is carried out. The main priority in administering the COVID 19 vaccination is health workers because they are at high risk of being exposed to the COVID 19 virus. Other Health Workers who are included in the Committee for other Health Workers at Dr Mohammad Hoesin Hospital Palembang also receive the COVID-19 vaccination which is carried out in 2 doses or 2 injections. The COVID-19 vaccination may pose a risk of local or systemic side effects. This study aims to identify the risks that arise after administering the COVID-19 vaccine to other health workers at Dr Mohammad Hoesin Hospital Palembang. The design of this study was quantitative using an analytical survey method through a retrospective approach. The population is 534 people consisting of 20 other health professions. Based on the data analysis, it can be concluded that the risks that arise after the administration of the COVID -19 I Vaccination are in the form of systemic side effects, namely drowsiness (67%) and local side effects are pain (58.5%), while after the second Covid 19 vaccination, the most common side effects are pain. Common side effects are local side effects, namely pain (77.3%) and systemic side effects are drowsiness (62.1%). occurred after the administration of the first Covid 19 vaccination (86.2%). After giving the COVID 19 vaccination, there were still 5 other Health Workers who were exposed to the Covid 19 virus (4.6%).

Correlation of Cholesteatoma Stadium with Degree of Erosion Ossicular in CSOM (Chronic Suppurative Otitis Media) Patients with Cholesteatoma in Dr. Mohammad Hoesin General Hospital Palembang

Background: Chronic suppurative otitis media (CSOM) is inflammation of the middle ear mucosa and mastoid space more than 2 months characterized by perforation of the tympanic membrane and continuous or intermittent discharge from the ear canal. CSOM with cholesteatoma is characterized by perforation that is located marginally or attic with cause destruction ossicle and often causes dangerous complications. This study was aimed to determine the correlation between cholesteatoma stadium among CSOM patients with cholesteatoma in RSUP Dr. Mohammad Hoesin Palembang.
 Methods: Observational research using a cross sectional design. The data were collected using medical record on 70 subjects with a diagnosis of CSOM with cholesteatoma who underwent mastoidectomy surgery at RSUP Dr. Mohammad Hoesin Hospital Palembang for the period of January 2018 to June 2021.
 Results: From 70 samples conducted in the study, degree of erosion ossicular in CSOM with cholesteatoma with highest group type D with MERI index score 4 in 34 patients (48,6%). There was a strong positive correlation between degree of erosion ossicular based on MERI index score and cholesteatoma stadium based on Bluestone (p<0.005, R=0.655) From the linear regression test, the most influential in causing degree of erosion ossicular in CSOM with cholesteatoma were tympanic perforation type, granulation and cholesteatoma stadium.
 Conclusions: There is a significant relationship between degree of erosion ossicular based on MERI index score and cholesteatoma stadium based on Bluestone.

Relationship between Primary Tumors of Nasopharyngeal Carcinoma with the Degree of Conductive Hearing Loss in Dr. Mohammad Hoesin Hospital Palembang

Background. Nasopharyngeal carcinoma is a malignant tumor that grows in the nasopharyngeal area with predilection in the fossa Rossenmuller and the nasopharyngeal roof adjacent to the Eustachian tube, so one of NPC’s early symptoms is ear symptoms. Hearing loss is a common symptom found in people with NPC due to dysfunction of the Eustachian tube, a continuing middle ear disorder that can result in conductive hearing loss.This study aims to find out the relationship between primary tumor of NPC and the degree of conductive hearing loss at dr. Mohammad Hoesin Hospital Palembang.
 Methods. This is a cross sectional study that obtained 42 samples from the medical records at Dr. Mohammad Hoesin Hospital Palembang that met the inclusion and exclusion criteria. The study subjects collected in total sampling have been conducted audiometry examinations at the ORLHNS clinic of Dr. Mohammad Hoesin Hospital Palembang during the period January 2019 - April 2021.
 Results. The proportion of hearing loss in NPC patients in this study was 30 subjects (71.4%) with the highest proportion of hearing loss complaints being 33.3%. The proportion of conductive hearing loss of nasopharyngeal carcinoma patients in the study was 33 subjects (78.5%) right ear and 28 subjects (66.7%) left ear. There was a significant association between the degree of the NPC primary tumor and the incidence of conductive deafness of the left ear, but there was no significant association in the right ear. There is a significant correlation between NPC primary tumors and left ear hearing thresholds at frequencies of 500 Hz and 4000 Hz, but there is no significant association between the degree of NPC primary tumor and right ear hearing loss.
 Conclusions. There is significant correlation between the primary tumor of NPC and the hearing threshold of the left ear but there was no significant association in the right ear.

Relationship between CD-8 Expression to Treatment Response in Nasopharyngeal Carcinoma Patient After Neoadjuvant Chemotherapy in Dr. Mohammad Hoesin Hospital Palembang

Background. Nasopharyngeal carcinoma (NPC) is the most common malignancy in head and neck in Indonesia with 19,943 new cases in 2020 resulting 13,399 deaths. Lymphocytes are cells that play a role in the anti-cancer immune response, especially CD-8 T-cells. Neoadjuvant chemotherapy is chemotherapy given before radiotherapy that aims to kill primary tumors and micrometastasis tumors. This study aims to find out the relationship of CD-8 expression to treatment response in NPC undergoing neoadjuvant chemotherapy at Dr. Mohammad Hoesin Hospital Palembang.
 Methods. This study is an analytical observational research study on a retrospective cohort basis. Data collection from medical records using total sampling in 15 patients pilot study of NPC patients undergoing neoadjuvant chemotherapy and conducted CD-8 examination at ORLHNS polyclinic Dr. Mohammad Hoesin Hospital Palembang from December 2018 to December 2019 that met the criteria of inclusion and exclusion.
 Results. From 15 samples, the average CD-8 test result before neoadjuvant chemotherapy was 24.54 ng/μL and after neoadjuvant chemotherapy was 193.56 ng/μL. There was a tendency to increase the average CD-8 from before to after completion of neoadjuvan chemotherapy with a statistically significant difference of p =0.001. ROC analysis found CD-8 cut off points is 23.76 ng/μL with an area below the curve is 0.667. There were no significant relationships between CD-8 to performance status and treatment response with p values of 0.289 and 0.219, respectively. 
 Conclusions. There was a significant change between CD-8 before neoadjuvant chemotherapy and after neoadjuvant chemotherapy with increased CD-8 tendencies and trends from before to after 6 series neoadjuvant chemotherapy with CD-8 cut off points is 23.76 ng/μL. In this study there has not been a significant relationships between CD-8 to performance status and treatment response in NPC patients undergoing neoadjuvant chemotherapy.

Clinicopathological Characteristics and the Relationship between Histological Grade with Luminal B Breast Cancer in RSUP Mohammad Hoesin within 2014-2016

BackgroundBreast carcinoma is the second highest malignant disease that causes death in Indonesia with 58,256 new cases in 2018. LuminalB has more aggressive clinical behavior and is considered as having unfavorable prognosis. This study aimed to determine theclinicopathological characteristics and the relationship histological grade with breast carcinoma subtype molecular luminal B.MethodsThis is a descriptive analytic study with cross sectional design using secondary data of breast carcinoma patients registered atRSUP Mohammad Hoesin Palembang during the period of January 1st, 2014 to December 31st, 2016.ResultsFrom 903 breast carcinoma patients in Mohammad Hoesin Hospital Palembang during 2014 to 2016, 43.63% had luminal Bmolecular subtype. The highest incidence and prevalence washappened in year 2016, whichwere 4.7 and 4.4 per 10 breastcarcinoma patients, respectively. The majority of breast carcinoma of luminal B molecular subtype occurs in the group of patientsaged ≥40 years (81.7%), female (98.7%), Malay race (100%), marital status (98.8%), housewives (68.3%), histopathologicalcarcinoma of invasive non-specific type (75.9%), high grade/ grade III (63.7%), localized (60.6%), no metastases (60.0%), rightsided tumor laterality (50.8%) and with negative HER2 (65.2%). There was a significant relationship between the histopathologicalgrade and breast carcinoma luminal B molecular subtype (p=0.009).ConclusionThe incident of breast carcinoma molecular subtype luminal B at Mohammad Hoesin Hospital Palembang has increased in the lastthree years with the poor clinicopathological characteristics.

Analysis of Family Planning Services in Mohammad Hoesin Hospital Palembang on 2016

Background. Family planning services in hospitals have been held since 1970 by the functional implementing unit led by obstetric and gynecologist specialists. Situational changes following decentralization in the 1990s caused policymakers and family planning practitioners' lack of attention to family planning services at province, district, and city levels. Data from 2002-2007 showed a decrease in family planning services from 6.2% to 4.9% in government hospitals and from 3.4% to 2.2% in private hospitals. The decrease in contraception use was affected by family planning users and providers. This study aims to analyze the factors contributing to family planning services in Mohammad Hoesin Hospital.
 Methods. This was a descriptive-analytic study with a cross-sectional design. The author used primary and secondary data with quantitative and qualitative approaches through the study of documents, observation, questionnaire, in-depth interview, and focused group discussion.
 Results. We identified various factors that play a role in the implementation of family planning services in almost all aspects, such as policy system, incomplete infrastructures; competence and the number of health workers; standard service procedure; sources and mechanism of the contraceptive tools; financial problems; recording and reporting system; quality control services; monitoring and evaluation; development services; also knowledge and behavior of the health workers.
 Conclusion. Family planning services need support and more serious attention from the directors to improve and overcome the problems and obstacles. In addition, the board of directors requires better coordination effort and cooperation on the internal level (between divisions or departments within the hospital) and with the relevant instance.