Sardjito Hospital Research Articles

P.241: Monocyte to lymphocyte ratio and tacrolimus levels at 2 weeks after kidney transplantation as predictors of mortality among kidney transplant recipients at Dr Sardjito hospital, Indonesia.

P.241: Monocyte to lymphocyte ratio and tacrolimus levels at 2 weeks after kidney transplantation as predictors of mortality among kidney transplant recipients at Dr Sardjito hospital, Indonesia.

Systemic Immune-Inflammation Index as A Predictor of Mortality and Rehospitalization in Heart Failure Patients

ABSTRACT Systemic Immune-Inflammation Index as A Predictor of Mortality and Rehospitalization in Heart Failure Patients Background Heart failure (HF) is a disease closely associated with inflammation and the Systemic Immune inflammation Index (SII) is a novel inflammatory marker. SII is a combined inflammatory indicator that incorporates three significant immune cells namely neutrophils, lymphocytes and platelets. SII is considered an excellent indicator of local immune response and systemic inflammation. SII is an inexpensive and easily accessible laboratory test in peripheral health facilities. Research Objective This study aims to determine whether SII can be used as a predictor of clinical outcomes, which are mortality and rehospitalization in patients with chronic heart failure. Research Methods This study is a retrospective cohort study using data of chronic heart failure patients who underwent hospitalization from the HF (Heart Failure) registry of Dr. Sardjito Hospital for the period January 2022 - February 2023. SII was calculated as platelet count × absolute neutrophil count / absolute lymphocyte count. Results There were 188 patients who met the inclusion criteria as research subjects from 282 chronic heart failure patients who underwent hospitalization. Subjects had a mean age of 58.80 ± 11.48 years. A total of 67,6% (n=127) of the subjects were male. SII value for mortality based on receiver operating characteristic (ROC) cut-off was 1459,59 (area under curve (AUC) 0.600, sensitivity (Sn) 55,6%, specificity (Sp) 68,8%) and the ROC cut-off for rehospitalization was 0,474. Kaplan-Meier analysis of SII with mortality, subjects with high SII values (>1459.59) had a 50,5% survival rate with a mean survival of 8,5 months and low SII (<1459.59) had a 74% survival rate with a mean survival of 9,9 months. Multivariate regression analysis found SII as an independent predictor of mortality odds ratio (OR 3,08, 95% confidence interval (CI) 1,59 – 5,95, p=<0.001) but not significant for rehospitalization. Conclusion Systemic Immune-inflammation Index (SII) is an independent predictor of mortality, but not a predictor of rehospitalization in chronic heart failure patients undergoing hospitalization. Keywords: Systemic Immune-inflammation Index (SII), heart failure (HF), mortality and rehospitalization

Implementation of Islamic Spiritual Charge for Hospital Patients Dr. Sardjito Yogyakarta: Review of Islamic Law

In order to cause a sense of calm and comfort in the hearts of patients, spiritual compensation activities are held. The spiritual field of Dr. Sardjito Hospital coordinates this activity. Spirituality is a religious institution at Dr. Sardjito Hospital, which handles spiritual compensation activities for patients and care for corpses. However, in the implementation, especially the care of the corpse, there has been an error or violation of shari'a or Islamic law in carrying out the care of the corpse, namely, the body of the daughter bathed by a man who is not her mahram without the cause of shari'a / Islamic law that allows. The purpose of the research is to find out what mistakes and factors cause violations of Islamic law, to find out what solutions to avoid violations of shari'a or Islamic law, and to find out the implementation of spiritual compensation at Dr. Sardjito Hospital: Review of Islamic Law. The author uses field and library research methods to complete the abovementioned research objectives. Sampling techniques are Observation, Interview, and Questionnaire. The samples are the Director of RSUP, Dr. Sardjito Yogyakarta, the Clergy Coach, the Head of the Nursing Division, the Head of Forensic Medicine Installation, the Clergy Coordinator, the Clergy Officer, the Forensic Medicine Installation Officer and Patients treated, and the data analysis method is quantitative analysis. The results are a form of mistakes: officers and families do not know Islamic law, forced / emergency, motivation to make money, and factors: No cooperation between mortuary office workers and spirituality, No training in corpse care, No supervision from superiors. The solutions are Coaching and care for corpses, increased cooperation, and good supervision. Clear pro tabs and sanctions. The conclusion is the implementation of spiritual compensation to patients in the hospital. Dr. Sardjito: Review of Islamic Law is in accordance with the Shari'a.

Effect of intradialytic aerobic exercise intervention on dialysis adequacy and quality of life in patients with end-stage kidney disease undergoing hemodialysis at Dr. Sardjito General Hospital, Indonesia.

End-stage kidney disease (ESKD) carries a significant financial burden due to the need for hemodialysis (HD). Many HD patients do not achieve optimal dialysis, particularly in developing countries like Indonesia where HD is performed twice a week. To answer this issue, a study was conducted at Dr. Sardjito hospital, Indonesia to investigate the effectiveness of intradialysis aerobic exercise in improving dialysis adequacy and quality of life in conventional HD patients. This study is an experimental design with a pre-test-post-test control group. ESKD with HD patient was divided into treatment and control groups. The intervention group was subjected to 30min of intradialysis aerobic exercise using an ergocycle within the first 2h of the HD sessions, while the control group received regular care. Both groups were followed for 12weeks. Dialysis adequacy is measured using Kt/V and Urea Reduction Ratio (URR). Quality of life is assessed using KDQOL-36 questionnaire. There was a significant increase in Kt/V and URR (%) in the intervention group compared to the control group, (0.122 ± 0.151 vs - 0.135 ± 0.176, p < 0.001) and (2.627 ± 4.634 vs - 2.620 ± 3.949, p < 0.001), respectively. In addition, quality of life also improved significantly with KDQOL-36 summary score was significantly higher 73.47 (39.44-89.31) to 80.97 (43.06-92.36); p = 0.007) in the intervention group. Multivariate analysis showed that intradialysis exercise (p = 0.001), female gender (p = 0.044), and intradialysis diastolic pressure (p = 0.018) can significantly affect Kt/V changes. Intradialytic aerobic exercise for 12weeks effectively improves dialysis adequacy and quality of life in routine HD patients. This suggests an opportunity for routine deployment, especially when HD resources are limited. However, further studies are needed to investigate additional efficacy aspects and improve exercise protocols for specific ESKD patients. TCTR202403270002 (retrospectively registered on March 27, 2024).

The effect of infection on mortality in acute coronary syndrome patients at Dr. Sardjito General Hospital, Yogyakarta

Ischemic heart disease is the second most significant health burden in Indonesia and the world. The prevalence of coronary heart disease patients in Yogyakarta is predicted to experience a continuous increase. In Sardjito Hospital, mortality rate of acute coronary syndrome (ACS) patients reaches 15%, with pneumonia infection identified as one of the predictors. Despite this high mortality rate, there is a lack of studies addressing the contribution of infectious comorbidities to mortality incidence among ACS patients. This study aimed to investigate the e ffect of infectious comorbidities on the incidence of mortality among ACS patients and its mortality rate in Sardjito Hospital. This study used a cross-sectional design in 794 patients diagnosed with ACS and registered in the SCIENCE registry from January to December 2022 at Sardjito Hospital. The analysis was conducted using the Chi-square method to determine the effect of infectious comorbidities on mortality among ACS patients and a logistic regression test to evaluate the correlation between variables. Based on bivariate analysis, it was found that infectious comorbidities increased mortality rate among ACS patients (p&lt;0.001, OR=2.22[1.46-3.38]), reaching 5.2%. The bivariate analysis between confounding factors and outcome of patients showed that obesity, dyslipidemia, and revascularization significantly influenced the results of ACS patients. Based on multivariate analysis, it was discovered that infectious comorbidities, obesity, diabetes, dyslipidemia, and revascularization had a significant association with mortality of patients with ACS. Furthermore, infectious comorbidities increased the odds of mortality for ACS patients by 2.04 times. Infectious comorbidities increased the incidence of mortality in ACS patients by 2.04 times with mortality rate of 5.2%.

Evaluation of performance of Indonesian Sepsis National Guidelines (PNPK) 2021 in diagnosing pediatric bacterial sepsis

Background Sepsis remains one of the causes of child morbidity and mortality worldwide. The reference standard diagnosis of sepsis is blood culture, but its false negative is relatively high. Therefore, a validated triage tool is needed for rapid diagnosis. In Indonesia, diagnosis and management of pediatric sepsis are based on Indonesian Sepsis National Guidelines 2021. Objective To evaluate the performance of Indonesian Sepsis National Guidelines 2021 in diagnosing pediatric bacterial sepsis in PICU. Methods This cross-sectional study was conducted in the PICU unit of Dr. Sardjito Hospital, Yogyakarta, using subject’s the medical records. All patients with suspected bacterial infection who were admitted to the PICU, had complete evaluation of PELOD-2 score, and the blood culture results were included in this study. Sepsis was assessed with Indonesian Sepsis National Guidelines 2021. Performance analysis of the guidelines was conducted with SPSS version 25, by assessing sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and likelihood ratio. Results Two hundred subjects were enrolled in this study, of whom 52.5% were males. Most subjects aged under one year (40.5%), and the most common infection was respiratory system (49%). A total of 63.5% were referral cases, with the length of stay in the previous hospital more than 48 hours (69.7%). There were 77% of subjects had antibiotics treatment at the previous hospital. As for outcomes, 63.5% survived and 36.5% died. The positivity rate of blood culture in this study was 19%. Performance evaluation of Sepsis Indonesian Sepsis National Guidelines 2021 revealed sensitivity 28.95%, specificity 87.65%, accuracy 76.5%, positive predictive value 35.48%, negative predictive value 84.02%, positive likelihood ratio 2.34 (95%CI 1.28 to 4.32) and negative likelihood ratio 0.81 (95%CI 0.7 to 0.94). Conclusion Indonesian Sepsis National Guidelines 2021 (PNPK Sepsis 2021) has low sensitivity and high specificity in diagnosing bacterial sepsis.

Factor related to preterm premature rupture of membrane among pregnant women

The incidence rate of premature rupture of membranes in Yogyakarta, Indonesia was 10.1%, the highest rate in Indonesia. This study's goal was to determine factors related to premature rupture of membranes among pregnant women in Sardjito Hospital. There were 220 pregnant women, 110 in the premature rupture of membranes or case group and 110 no premature rupture of membranes as control group. Urinary tract infection, anemia, and preterm premature rupture of membrane and the characteristics were the research factors. The Chi-square test and logistic regression were used to examine the data. Secondary data from medical records for the period January 2021 December 2022 was taken. Result of this study showed that 49.1% of the pregnant women in the case group had anemia, and 47.3% had urinary tract infections. In the control group had anemia 30.9% of pregnant women, while urinary tract infections infected 61.8% of them. Urinary tract infections and anemia were associated with a greater incidence of preterm premature rupture of membranes, according to a bivariate analysis with p-values of 0.042 and 0.009 (p-value=0.05). Anemia was the most significant factor associated with the incidence of preterm premature rupture of membranes (OR=2.26).

Tumor Infiltrating Lymphocytes as an Independent Prognostic Factor in Undifferentiated Nasopharyngeal Carcinoma.

Nasopharyngeal carcinoma (NPC) is a common type of cancer in Southeast Asia. This cancer usually spreads locally and to nearby lymph nodes. One unique feature of NPC is its many immune cells called tumor-infiltrating lymphocytes (TILs). Recent studies have suggested that TILs in many types of cancer can indicate a better prognosis. However, the role of TILs in NPC is still a matter of debate. Further research is necessary to determine whether TILs can be used as a prognostic factor of NPC's outcome. A retrospective cohort study was conducted at Sardjito Hospital to examine the records and pathological sections of patients treated for the undifferentiated subtype of NPC. Two pathologists analyzed the presence of TILs using HE-stained slides. TILs were evaluated in stromal compartments, and their association with clinicopathological variables was analyzed using the Chi-square and Fisher exact tests. The study compared overall survival in tumor patients with varying TIL levels using Kaplan-Meier survival curves and the log-rank test. A Cox regression model was used for univariate and multivariate analyses to test the significance of different factors. Out of the total 61 subjects, 16 (26.2%) had high stromal TILs (≥ 70%), and 45 (73.8%) had low stromal TILs (<70%). The subjects' sex, age, and tumor stage did not affect the OS. However, high stromal TILs (≥ 70%) showed a significant association with a longer OS (log-rank test p = 0.006, HR 0.37, 95% CI 0.17-0.79, log-rank p = 0.006). Moreover, multivariate analysis confirmed that TILs were an independent prognostic indicator for OS (aHR 0.015). TILs correlate positively with overall survival in the undifferentiated NPC subtype and are an independent prognostic indicator.

Effect of reperfusion time on right ventricular remodeling in inferior ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Background: Right ventricle (RV) remodeling and dysfunction are frequent in inferior ST-elevation myocardial infarction (STEMI) patients and possibly implicated to poor outcomes. Objective: The purpose of this study is to investigate the influence of reperfusion time on RV remodeling in patients with inferior STEMI who had primary percutaneous coronary intervention (PPCI).Methods: The subjects were patients with inferior STEMI who had undergone PPCI and met the inclusion and exclusion criteria. From September 2021 to April 2022, samples were taken in the order in which they arrived at the Dr. Sardjito Hospital in Yogyakarta, Indonesia. To investigate the occurrence of RV remodeling, 2D-transthoracic echocardiography was performed before PPCI as baseline and 3-months after PPCI. Confounding factors were investigated using bivariate and multivariate analysis.Results: The RV remodeling was observed in 12 (28.6%) of 42 inferior STEMI patients undergoing PPCI. The RV remodeling group had a longer median reperfusion time (798.5 vs 710 minutes, p=0.568). The baseline RV end-systolic area (RVESA) and RV end-diastolic area (RVEDA) had significant correlations with the occurrence of RV remodeling (p=0.046; p=0.008, respectively). The tricuspid annular plane systolic excursion (TAPSE) rose considerably in both groups during the 3-month follow up. There were significant variations in RVEDA and RV basal diameter in the RV remodeling group, but there was a substantial rise in fractional area change (FAC) and RVESA in the non-RV remodeling group.Conclusion: In patients with inferior STEMI undergoing PPCI, reperfusion time showed no significant effect on RV remodeling.

Infection-related mortality and infection control practices in childhood acute myeloid leukemia in a limited resource setting: Experience with the Indonesian national protocol.

In resource-limited settings, addressing infections remains a substantial challenge in the management of children with Acute Myeloid Leukemia (AML). In Indonesia, infection-related mortality (IRM) is thought to be high compared to high-income countries. However, there has been no previous study of infection profile and IRM in Indonesian patients with AML. This study aimed to describe infections and IRM in children with AML treated according to the Indonesian National AML protocol and to describe the implementation of infection control practices in resource-limited settings. This retrospective observational study used secondary data from the medical records of pediatric patients with AML treated with the National Protocol at Dr. Sardjito Hospital, Yogyakarta, Indonesia, from April 2012 to September 2018. Essential patient characteristics, time of IRM, and cause of death were recorded, and infection control practices were observed. Data were analyzed using descriptive statistics. 113 patients with AML were treated with the National protocol, and 83 met the inclusion criteria. Infections occurred in 69 (83%) patients with a total of 123 episodes (mean 1.8/patient). Death was seen in 48 (58%) patients, with 19 (23%) IRM. The majority of infections were in the gastrointestinal tract (n = 51, 30.5%), sepsis (n = 29, 17%), and respiratory tract (n = 28, 17%). Infections mostly occurred during the first induction (41%). There were 90 (73%) episodes of clinically documented infection and 33 (27%) episodes of microbiologically documented infection. The positivity rate of blood cultures was only 27%. The majority of bacteria detected were gram-negative (n = 25, 69%), and among them were Klebsiella pneumonia (19%) and Escherichia coli (19%). Candida albicans was detected in 1 (2%) culture. Suboptimal infection prevention and control were found in the clinical practice. Infections and infection-related mortality in children with AML treated using the National protocol were frequent, mainly occurring during the first induction phase. Compliance with infection prevention and control measures needs improvement. Urgent attention is required for better supportive care, including isolation rooms, antibiotics, and antifungals. The predominance of Gram-negative bacterial infections highlights the necessity for further research into effective prophylaxis. Enhanced healthcare and nursing professional vigilance and tailored antibiotic strategies are vital. Improving compliance and ensuring adequate supportive care resources are essential, emphasizing nursing's pivotal role. Further research is crucial to drive advancements in infection control strategies.

Differentiation of Serous and Non-serous Epithelial Ovarian Cancer by Radiological Imaging

Background: Ovarian cancer has a high incidence and fatality rate, with the most prevalent type is epithelial origin. The serous subtype of epithelial cancer predominates. For therapy selection, it is important to differentiate this subtype by histopathological examination as a gold standard method. Since some patients are not eligible for a biopsy, radiological modalities such as Magnetic Resonance Imaging (MRI) are superior in discriminating tissue compared to computed tomography (CT) or ultrasound. The use of the T1 weighted imaging (T1WI) and T2WI sequences can best differentiate between a cystic and a solid lesion. The goal of this study was to use radiological examination to assist in the identification of ovarian cancer.Methods: This cross-sectional study used secondary data from histopathology and MRI results from patients with ovarian cancer. Data was gathered utilizing electronic medical records in Dr. Sardjito Hospital between January 2017 and May 2022. The following MRI characteristics are evaluated including ascites, papillary projection, solid nodule, signal intensity of solid and cystic components, size, configuration, enhancement of contrast, and bilateral of the lesion.Results: Thirty-eight subjects made up the study’s sample, and 63% of them had serous subtypes. Bilateral lesion suggested a three times greater likelihood that it was serous ovarian cancer (p 0.02; binary logistic regression). Age 50 years old and strong enhancement on contrast was also relevant for separating the serous subtype from other subtypes (enhancement p 0.02; age p 0.044). Conclusions: A bilateral lesion with a significantly enhanced pattern can be seen on the MRI of a serous subtype of epithelial ovarian cancer. The elderly are also more likely to develop this cancer.

Neutrophil to Hemoglobin Lymphocyte Ratio (NHLR) as a Novel Biomarker is Superior to Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) as Predictors of Advanced Colorectal Cancer

Background: Neutrophils, Hemoglobin, and Lymphocytes are biological markers that may be related to the colorectal cancer stage. Neutrophils to Hemoglobin-Lymphocytes Ratio (NHLR) is a new biomarker that will be tested with Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) as common biomarkers that have been shown to have predictive value with colorectal cancer stage. This study aims to prove NHLR as a new biomarker that can predict advanced colorectal cancer in terms of staging and site of cancer compared to NLR and PLR. Methods: This is a retrospective cross-sectional study. Data obtained from the medical records of colorectal cancer patients undergoing surgery at Dr Sardjito Hospital from 2020 until 2022. Results: 386 patients enrolled in the study, and 62 patients met the inclusion criteria. Twentyeight patients (45.16 %) were male, and 34 (54.84 %) were female. The mean age is 58.82 years. Bivariate analysis showed a significant relationship between NHLR, NLR, and PLR with colorectal cancer stage and significant differences between NHLR and NLR with early and advanced colorectal cancer, but not with PLR. There are also significant differences between NHLR, NLR, and PLR with colorectal cancer sites in the colon and rectum. Still, in locally advanced stages of colorectal cancer, there is no significant association between NLR and cancer sites. On the contrary, there are significant differences between colon and rectal cancer sites with NHLR and PLR. Conclusions: NHLR is superior to NLR and PLR in predicting the stage and site of advanced colorectal cancer.

Changes in CA 125 Level Pre and Post Ovarian Cancer Surgery

Background: Ovarian cancer is one of the gynecological cancers that has a fairly high mortality rate and has a poor prognosis. Ovarian cancer management includes optimal operation followed by chemotherapy, which at follow up will have an effect on decreasing CA 125 levels. But in fact there are several studies showing increased CA 125. Given these differences in findings, this study attempted to evaluate the pre and post operation changes in CA 125 levels in ovarian cancer patients.Objective: This study aims to determine the changes in pre and post operation CA 125 levels in ovarian cancer patients. And to find out the optimal relationship between CA 125 level post operation and post operation.Methods: The type of research is an analytic study with a prospective cohort design. The source comes from secondary data taken from Simetris dr. Sardjito Hospital within 6 months.Results: The distribution of the age &lt; 40 years was 11 and 19 were 40 years old. There was a significant change in pre operation log CA 125 levels (mean = 2,53 or 902,03U/ml) and post operation log CA 125 levels (mean = 1,92 or 406,23 U/ml). With a difference or delta mean of 0,61 or 495,80 U/ml and p value = 0.001. There was a significant difference in post operation log CA 125 levels between optimal and non optimal operation. Based on risk factors, there was a significant change or decrease in log CA 125 levels pre and post operation, but there was no significant difference in log CA 125 levels pre and post operation.Conclusion: There was a significant decrease in log CA 125 levels pre and post operation in patients with ovarian cancer who underwent operation. The post operation log CA 125 level in optimal operation is lower than in non-optimal operation.Keywords: CA 125, Ovarian Cancer, Operation, Optimal

FAKTOR RISIKO YANG MEMPENGARUHI TERJADINYA KOMPLIKASI KARDIOVASKULAR PASCA PEMBIUSAN/SEDASI PROSEDURAL PADA PASIEN PEDIATRI

Background: The morphology and physiology of neonates and children differ from those of adults. The most common complications encountered involve respiratory issues followed by cardiovascular problems. The predominant cardiovascular complications in the field of pediatric anesthesia are hemodynamic instability followed by cardiac arrest. Perioperative cardiovascular complications are closely related to a history of prematurity under the age of 1 year, ASA physical status ≥3, concomitant cardiovascular or metabolic diseases, emergency surgeries, and surgical procedures. To date, few risk factors related to the cardiovascular system have been identified in pediatric anesthesia.&#x0D; &#x0D; Objective: To identify risk factors influencing the occurrence of post-anesthesia/sedation cardiovascular complications in pediatric patients at Dr. Sardjito Hospital, Yogyakarta.&#x0D; &#x0D; Method: The research design employed in this study was a prospective cohort observation of pediatric patients undergoing anesthesia or procedural sedation at Dr. Sardjito Hospital. Research subject data included demographic characteristics, ASA status, history of concomitant diseases, type of surgery, urgency level, and post-anesthesia complication occurrences. Data normality was tested using the Kolmogorov-Smirnov test, bivariate analysis was conducted using the Fisher test, variables with p-value &lt;0.25 underwent multivariate analysis using logistic regression for categorical data. The results were processed using SPSS version 23.00.&#x0D; &#x0D; Results: A total of 181 subjects were predominantly male patients aged &gt;5 years. Factors influencing post-anesthetic cardiovascular complications included ASA physical status ≥3 (p=0.033) OR 8.96 (95% CI 2.07 – 38.89), emergency procedures (p=0.043) OR 12.63 (95% CI 1.08 – 147.15), age &gt;5 years (p=0.033) OR 5.67 (95% CI 1.15 – 28.1), female gender (p=0.001) OR 7.85 (95% CI 2.23 – 27.71), and type of surgical procedure (p=0.017) OR 16.64 (95% CI 1.63 – 169.05).&#x0D; &#x0D; Conclusion: Age &gt;5 years, female gender, ASA physical status ≥3, emergency procedures, and surgical procedures are risk factors associated with the occurrence of post-anesthetic/sedation cardiovascular complications in pediatric patients.&#x0D; &#x0D;

SUTURELESS SCLERAL FIXATION OF INTRAOCULAR LENS IN APHAKIA: CHARACTERISTICS AND VISUAL OUTCOMES

Introduction &amp; Objective: Sutureless Scleral fixation surgery is one of the secondary intraocular lens (IOL) implantation procedures for aphakic patients with absent or deficient capsular bag support that has gained more attention these days. This study aimed to describe the characteristics, indications for and visual outcomes of the patient who had undergone scleral fixation of intraocular lens at Sardjito Hospital. Methods: A retrospective cross-sectional study of 43 eyes that undergone sutureless scleral fixation intraocular lens at Sardjito Hospital, Yogyakarta. The data were collected from electronic medical records of the patient from October 2020 to December 2022. The data was analysed descriptively by presenting number and percentage for categorical variables and mean ± standard deviation (SD) for numerical variables. Outcome include pre- and postoperative uncorrected visual acuity (UCVA). Results: There were 43 eyes obtained from 40 patients who underwent scleral-fixation intraocular lens in this study, consisting of 35 males (79,55%) and 9 females (20,45%). The mean age of the subjects was 50.04 ± 19.2 years. Lens subluxation was the most of indication for surgery (32,56%), followed by intraocular lens luxation (20,93%), dropped nucleus (16,28%), lens luxation (16,28%), intraocular lens decentration (9,30%), and endophthalmitis (4,65%). Before surgery, most of the patients had visual acuity of less than 3/60 (81,4%) and after surgery, 32,56% had ?6/18, 34,88% had &lt;6/18-6/60 and 18,60% had &lt;6/60-3/60. Conclusion: The characteristics of patient who underwent scleral fixation intraocular lens in Sardjito Hospital was predominantly male and diagnosed with lens subluxation. There were enhancement in visual outcomes.

Sutureless Scleral Fixation of Intraocular Lens in Aphakia: Characteristics and Visual Outcomes

Introduction &amp; ObjectivesSutureless scleral fixation (SSF) surgery is one of the secondary intraocular lens (IOL) implantationprocedures for aphakic patients with absent or deficient capsular bag support that is beingincreasingly performed these days. This study aimed to describe the characteristics, indications for,and visual outcomes of patients who had undergone sutureless scleral fixation of intraocular lensesat Sardjito Hospital.&#x0D; MethodsA retrospective cross-sectional study of 43 eyes that SSF intraocular lens at Sardjito Hospital,Yogyakarta. The data were collected from electronic medical records of patients from October 2020to December 2022. The data were analyzed descriptively by presenting numbers and percentages forcategorical variables and mean ± standard deviation (SD) for numerical variables. Outcomesincluded pre- and postoperative uncorrected visual acuity (UCVA).&#x0D; ResultsThere were 43 eyes obtained from 40 patients who underwent SSF intraocular lens in this study,consisting of 35 males (79.55%) and 9 females (20.45%). The mean age of the subjects was 50.04 ±19.2 years. Lens subluxation was the most common indication for surgery (32.5%), followed bydropped nucleus (20.45%), intraocular lens luxation (18.18%), lens luxation (15.91%), intraocularlens decentration (9.09%), and endophthalmitis (4.55%). Before surgery, most of the patients hadvisual acuity of less than 3/60 (81.4%) and after surgery, 32.56% had ?6/18, 34.88% had &lt;6/18-6/60,and 18.60% had &lt;6/60-3/60.&#x0D; ConclusionMales predominantly underwent SSF intraocular lens surgery at Sardjito Hospital. Lens subluxationwas the most common indication for the surgery. There was an improvement in visual outcome.

A tertiary care center-based study of a novel ‘ICU Mortality and Prolonged Stay Risk Scoring System’

Background &amp; objective: Intensive care has been associated with high cost and resource-intensive medical care. Therefore, a risk prediction model is required to plan time allocation, human resources, and the required equipment. Various risk predictions for ICU mortality and ‘Prolonged Length of Stay’ (PLOS) scores are already available. Still, the established model, such as the APACHE IV score or SAPS II, sometimes became impractical since they required many laboratory parameters. A model based on co-morbidities and demographic factors may be more useful in limited resources setting. Hence, we developed a simple ICU mortality and PLOS risk prediction model based on co-morbidities and demographic data. Methodology: This retrospective cohort study was performed to develop a risk scoring for mortality and PLOS, using data from Dr. Sardjito Hospital Yogyakarta database between January 01-December 31, 2019. Logistic regression and bootstrap methods were used to create a risk score for estimating the risk. The discrimination performance of the model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC). The Hosmer-Lemeshow test was employed to assess the model’s calibration. Results: A total of 415 patients were included in this study. The risk factors for mortality were perioperative support medication, kidney failure, neurologic disorder, respiratory failure, and intraoperative blood transfusion. The mortality score of 6 was associated with a 100% probability of mortality. Medical cases, GCS &lt; 8, vasoactive/inotropic medication, sepsis, respiratory failure, and kidney failure were the risk factors for PLOS. PLOS score of 3 was associated with a 100% probability of PLOS. The discrimination for either mortality or PLOS was considered excellent with the AUC (± 95% CI) for mortality 0.896 (0.853-0.94), while for PLOS 0.878 (0.80-0.90). The calibration test found that both models had good calibration with P values of 0.53 and 0.55 for mortality and PLOS, respectively. Conclusion: The ‘Mortality and Prolonged Length of Stay Prediction Score’ based on co-morbidities and demographic data upon admission to ICU had good accuracy and can be applied as a potential new scoring system in healthcare institutions. Abbreviations: APACHE- Acute Physiologic Assessment and Chronic Health Evaluation; AUC; Area Under the Curve GCS- Glasgow Coma Scale; ICU- Intensive Care Unit; PLOS- ‘Prolonged Length of Stay’; PRC- Packed Red Cells; SAPS- Simplified Acute Physiology Score Keywords: Risk Scoring; Mortality; Prolonged Length of Stay; ICU Citation: Widyastuti Y, Jufan AY, Widodo U, Wisudarti CFR, Sudadi, Fauzi RA, Ardiansyah F. A tertiary care center-based study of a novel ‘ICU Mortality and Prolonged Stay Risk Scoring System’. Anaesth. pain intensive care 2024;28(1):100−107; DOI: 10.35975/apic.v28i1.2382 Received: October 02, 2023; Reviewed: November 27, 2023; Accepted: December 17, 2023

Development and validation of LC-MS/MS method for the determination of amikacin in human plasma and its application in adult hospitalized patients in Yogyakarta Indonesia

Therapeutic drug monitoring (TDM) is critical to ensure the safe and effective administration of amikacin (AMK), which has a narrow therapeutic index. This study aimed to develop and validate an efficient and simple liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for determining AMK in human plasma and applying it to hospitalized patients. Before LC-MS/MS measurements, plasma samples were treated with an optimized protein precipitation method using methanol (MeOH). Optimum chromatographic conditions for determining AMK in human plasma include using a C8 column (5 μm, 100 × 4.6 mm) and gradient elution using ammonium formate-formic acid-H2O and formic acid-MeOH mixture as the mobile phase at a 0.5 ml/minute flow rate. The method has been validated following the European Medicines Agency guidelines and has met all validation requirements with excellent selectivity, an lowest limit of quantification value of 0.2 μg/ml, good accuracy and precision in the linear range of 0.2–25 μg/ml, good dilution integrity up to 20 dilution times, and stable under various conditions. The method has also successfully been applied for measuring AMK peak levels (Cmax) and trough levels (Cmin) in the plasma of adult inpatients at Dr. Sardjito Hospital Yogyakarta, Indonesia. The LC-MS/MS measurement can be completed in 7.5 minutes, and the method can be applied in the TDM of AMK.

Symptom-based scoring technique by machine learning to predict COVID-19: a validation study

BackgroundCoronavirus disease 2019 (COVID-19) surges, such as that which occurred when omicron variants emerged, may overwhelm healthcare systems. To function properly, such systems should balance detection and workloads by improving referrals using simple yet precise and sensitive diagnostic predictions. A symptom-based scoring system was developed using machine learning for the general population, but no validation has occurred in healthcare settings. We aimed to validate a COVID-19 scoring system using self-reported symptoms, including loss of smell and taste as major indicators.MethodsA cross-sectional study was conducted to evaluate medical records of patients admitted to Dr. Sardjito Hospital, Yogyakarta, Indonesia, from March 2020 to December 2021. Outcomes were defined by a reverse-transcription polymerase chain reaction (RT-PCR). We compared the symptom-based scoring system, as the index test, with antigen tests, antibody tests, and clinical judgements by primary care physicians. To validate use of the index test to improve referral, we evaluated positive predictive value (PPV) and sensitivity.ResultsAfter clinical judgement with a PPV of 61% (n = 327/530, 95% confidence interval [CI]: 60% to 62%), confirmation with the index test resulted in the highest PPV of 85% (n = 30/35, 95% CI: 83% to 87%) but the lowest sensitivity (n = 30/180, 17%, 95% CI: 15% to 19%). If this confirmation was defined by either positive predictive scoring or antigen tests, the PPV was 92% (n = 55/60, 95% CI: 90% to 94%). Meanwhile, the sensitivity was 88% (n = 55/62, 95% CI: 87% to 89%), which was higher than that when using only antigen tests (n = 29/41, 71%, 95% CI: 69% to 73%).ConclusionsThe symptom-based COVID-19 predictive score was validated in healthcare settings for its precision and sensitivity. However, an impact study is needed to confirm if this can balance detection and workload for the next COVID-19 surge.

Exploring knowledge, perception, and expectation about hospital food among pediatric cancer patients at Dr. Sardjito Hospital, Indonesia

Exploring knowledge, perception, and expectation about hospital food among pediatric cancer patients at Dr. Sardjito Hospital, Indonesia