Soetomo General Academic Hospital Research Articles

Clinical and Demographic Profiling of Patients with Spondyloarthritis and Its Association with Disease Activity in a Tertiary Hospital in Surabaya, Indonesia

Introduction: The assessment of disease activity is crucial for effectively managing chronic diseases like spondyloarthritis (SpA). Establishing the relationship between disease activity, demographic, and clinical factors is essential for better disease management. This study aimed to delve into the demographic and clinical characteristics of patients at Dr. Soetomo General Academic Hospital, a tertiary hospital in Surabaya, Indonesia, contributing to a comprehensive understanding of SpA occurrences in Surabaya.Methods: Data were obtained from 38 SpA patients’ data classified using ASAS 2009 criteria at Dr. Soetomo General Academic Hospital, excluding individuals with SLE, gout, RA, and septic arthritis. Disease activity was measured using ASDAS-CRP. Association analysis between disease activity, clinical parameters, and demographics was conducted using Mann-Withney U test and Spearman correlation test.Results: Results indicated a male-to-female ratio of 8:30, with patients having a median age of 48 (95% CI: 41-53) and most of the patients had a senior high school education (42.11%). The patients exhibited a mean BMI of 25.19 ± 3.77, a median disease duration of 8.5 (95% CI: 5-10) years, and a median CRP value of 0.2 (95% CI: 0.1-0.5) mg/dL. The majority displayed moderate disease activity, with a median ASDAS-CRP score of 2 (95% CI: 1.5-2.7). Interestingly, no significant correlation was found between disease activity using ASDAS-CRP and the demographic or clinical parameters studied.Conclusion: Disease activities were found not to have correlations with the demography and clinical parameters of patients with SpA from Dr. Soetomo General Academic Hospital in Surabaya, Indonesia. This emphasizes the necessity for further research to comprehend the intricate relationship between disease activity and diverse influencing factors.

Correlation of TED Laterality with Thyroid Status among Thyroid Eye Disease (TED) Patients in a Tertiary Hospital in Indonesia

Introduction: Thyroid eye disease (TED), an autoimmune thyroid disorder, is prevalent in Asian countries and exhibits a variety of manifestations. Orbital involvement in TED is usually bilateral but may occur unilaterally in some cases. While it is commonly associated with hyperthyroidism, it also manifests in individuals with hypothyroidism or euthyroidism. The purpose of this study was to investigate the relationship between TED laterality and thyroid status in TED patients treated at the Eye Oncology Clinic of Dr. Soetomo General Academic Hospital in Surabaya, Indonesia.Methods: The study was retrospective, analytical and observational. Patients diagnosed with TED who were treated at Dr. Soetomo General Academic Hospital between January 2019 and December 2021 were the focus of this study. SPSS analyses of medical records that satisfied the sample criteria were used to compile the data for this study.Results: There were 88 samples that were dominated by females (57.95%) and aged 41 – 50 (32.96%). Proptosis was the most common clinical manifestation (94.32%), with compressive optic neuropathy was the least common (3,41%). Eyelid retraction occurred in only 22.7% of the patients. TED was categorized into unilateral (44.32%) and bilateral (50%). The majority had hyperthyroidism (70.45%), followed by euthyroidism (25%), and hypothyroidism (4.55%). It was found that there was a significant correlation between thyroid status and TED laterality. Compared to euthyroidism, abnormal thyroid conditions such as hyperthyroidism and hypothyroidism develop bilateral TED more frequently than normal thyroid conditions.Conclusion: There was a correlation between TED laterality and thyroid status among patient TED.

Association between the Duration of Steroid Therapy with Hyperglycemia in Patients with Systemic Lupus Erythematosus (SLE)

Introduction: Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease which primary treatment consists of steroid drugs administration. Prolonged steroid administration is often associated with an increase in blood glucose, a condition known as hyperglycemia. Hence, this study aimed to evaluate the association between the duration of steroid therapy with hyperglycemia in patients with SLE treated at a tertiary healthcare center in Surabaya, Indonesia.Methods: A cross-sectional study was conducted under a purposive sampling frame from January to December of 2022 by utilizing secondary data from electronic medical health records in Dr. Soetomo General Academic Hospital, a tertiary healthcare center in Surabaya, Indonesia. The association between variables were analyzed using Fisher’s exact test, chi square test, independent T-test, one-way ANOVA, Mann-Whitney, and Spearman's rank correlation.Results: Out of 150 included patients, 2.67% experienced hyperglycemia following steroid therapy for SLE. There were no significant associations between clinical variables and hyperglycemia occurence in SLE patients (p>0.05). Patients that received higher doses of steroid did not experience any significant difference in hyperglycemia (p=0.727 for <6 months; p=0.865 for ≥6 months). Daily steroid dose was also not significantly associated with the severity of SLE manifestations based on the SLEDAI score (p=0.081). Overall, no significant association was identified between the duration of steroid therapy with hyperglycemia among SLE patients in the hospital (p=0.365). Conclusion: The study found no significant correlation between clinical variables, hyperglycemia incidence, daily steroids dosage, methylprednisolone dosage, SLE severity, or steroid use duration in patients with Systemic Lupus Erythematosus.

Hypertensive and Non-hypertensive Hospital Admission Blood Pressure Association with Cognitive Function in Stroke Patients

Highlight: A comparative study of hypertension and non-hypertension on cognitive function. Hospital admission blood pressure and cognitive function in acute-phase stroke patients. Blood pressure is not associated with cognitive function. ABSTRACT Introduction: Cognitive impairment is one of the many stroke effects. White matter damage, microinfarcts, microbleeding, atrophy, and amyloid buildup in the brain due to stroke are all potential causes of this condition. Cognitive impairment studies have yet to provide a definitive explanation for how this condition develops following a stroke. Blood pressure is one of several risk factors for stroke. Meanwhile, few studies have been conducted on the association between blood pressure and cognitive function in stroke patients, and no definitive results have been established. Objective: This research was designed to examine and evaluate the difference in the measured cognitive function category between hypertensive and non-hypertensive hospital admission blood pressure stroke patients. Methods: This research used a cross-sectional design with a consecutive sampling method on acute stroke patients at Dr. Soetomo General Academic Hospital. The MMSE (Mini Mental State Examination) was carried out to assess the degree of cognitive function. The blood pressure measured is the hospital admission blood pressure. Results: There were 40 patients included in this study. A total of 36 patients (90%) were in the hypertension group (blood pressure ≥ 130/80 mmHg), and 4 patients (10%) were in the non-hypertension group (blood pressure < 130/80 mmHg). The MMSE results showed that 10 patients performed with no cognitive impairment, 12 patients performed with mild cognitive impairment, and 18 patients performed with severe cognitive impairment. Statistical analysis of the Mann-Whitney U test showed that p = 0.561. Conclusion: There was no difference in the measured cognitive function category between hypertensive and non-hypertensive hospital admission blood pressure stroke patients.

Comparison of Recurrent Stroke in Patients with First Stroke Ischemic and Hemorrhagic in Soetomo General Academic Hospital Surabaya

Highlight: The incidence of recurrent stroke in patients with the first stroke of ischemic type was 2.5-fold higher than that of hemorrhagic type, with the majority of recurrent strokes being the same type as the first stroke. Hypertension is the most common modifiable stroke risk factor in both stroke types, and in 5% of cases, secondary prevention is still not optimal. The average length of hospital stay for patients with the first stroke of hemorrhagic type was 3 days longer, along with a higher average NIHSS score on presentation than patients with ischemic stroke. ABSTRACT Introduction: Stroke is the leading cause of mortality and disability in Indonesia, as well as being the major cause of death and disability-adjusted life years (DALY) lost worldwide. Recurrent stroke is one of the most common complications of stroke after discharge, despite being highly preventable. Objective: This study aimed to compare the differences in recurrent stroke profiles between patients with first stroke ischemic and hemorrhagic strokes. Methods: The study was done by collecting secondary data from medical records and the stroke registry at Dr. Seotomo General Academic Hospital over a period of six months (January–July 2020). Result: This study examined 36 samples that met the inclusion criteria. The results revealed that patients who experienced their first stroke of the ischemic type had a 2.5-fold higher incidence of recurrent stroke than those who suffered a hemorrhagic type. Except for one case, the majority of patients had the same type of stroke as the first. The most frequent modifiable risk factors seen in these two types of strokes are hypertension and physical inactivity. It was found that there were still 5% of the risk factors for which secondary prevention had not been carried out optimally with antidyslipidemic, antidiabetic, or antihypertensive drugs. The most common acute treatment for ischemic stroke is antiplatelet therapy, either single or dual therapy. Up to 90% of hemorrhagic strokes were treated conservatively, and in one patient, extraventricular drainage was performed. Conclusion: There were more stroke patients with a first stroke of hemorrhagic type that presented with NIHSS scores in the severe to very severe range, and the average length of hospitalization in this group was longer.

Clinical Outcome of COVID-19 Infection on Chronic Diabetic Complications Patients

Introduction: COVID-19 is an infectious disease resulting from the SARS-CoV-2 virus. The virus targets the respiratory system and leads to a significant number of fatalities worldwide. Consequently, it was officially classified as a pandemic in 2020. The Covid varians is now being monitored by the World Health Organization. Diabetes mellitus is one of the disorders that might deteriorate following an infection. Diabetes mellitus and its associated comorbidities continue to pose a significant health challenge in Indonesia, while it is also a focus of concern of the Sustainable Development Goals (SDGs). The study was aimed to assess the risks and outcomes associated with COVID-19 infection and the long-term consequences of diabetes mellitus.Methods: This was a descriptive study using a retrospective design. Research data were taken from the medical records of patients confirmed positive for COVID-19 infection and also had chronic complications of diabetes mellitus who were treated at Dr Soetomo General Academic Hospital, Surabaya, Indonesia in 2021. There were 156 patients who met the criteria of this research.Results: There were 156 patients (97 males, 59 females). The average age of the patients was 58, while most of the patients (84%) died and the rest of the patients (16%) survived. Most of the patients with fatality (55.8%) were those with critical severity level and complications of microangiopathy, while the patients who survived (10.3%) were those with moderate severity level and complications of microangiopathy. Conclusion: COVID-19 patients with diabetes and comorbidities had a higher mortality rate than those who recovered, while most of the patients with fatality were those with significant COVID-19 and diabetic microangiopathy complications.

Nutrition Status And Neuropsychiatric Disorders In Indonesian Childhood Lupus: Experience At A Single Tertiary Referral Center

NPSLE diagnosis is still challenging because of many SLE-related and non-SLE-related processes that can be presented in patient. The report of NPSLE in Indonesia is still limited. This study aim to describe the clinical features, nutrition status, and laboratory characteristics of Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) and compared to non NPSLE case in Indonesian children. The study is a retrospective cohort study. Data were collected from the complete medical record of Juvenile Systemic lupus Erythematosus (jSLE) patients 2016 - 2020 at the Allergy Immunology Outpatient clinic at Dr. Soetomo General Academic Hospital. We include all patients with ages ranging from age 0-18 years old with a diagnosis of Systemic lupus Erythematosus (SLE). The diagnosis fo SLE based on American College of Rheumatology (ACR) criteria 1997 and Neuropsychiatric (NP) manifestations were classified using the standardized nomenclature and case definitions for the 19 NP manifestations linked to SLE developed in 1999 by the ACR ad hoc Committee. Disease activity SLE was defined according to the American Mexican-Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) criteria. Statistical analysis conducted in this study was descriptive analysis, paired T-test (NPSLE vs. non-NPSLE as the dependent variable), Fischer exact test, and Pearson Chi-square test using SPSS ver. 21. A total of 90 patients with juvenile SLE were enrolled, but only 71 patients were eligible as participants with complete medical records obtained. Mex-SLEDAI score was significantly higher on NPSLE compared to non-NPSLE (p=0.001).

Correlation between PD-L1 and Ki-67 Expression at various T-stage Clear Cell Renal Cell Carcinomas

Renal cell carcinoma (RCC) is a malignant neoplasm originating from renal epithelium, with the clear cell renal cell carcinoma (ccRCC)being the most common type (80%) and the most common cause of death among other types of kidney cancer. Pathological stage is an important parameter that affects ccRCC survival, followed by nuclear grade. Pathological staging of RCC according to the AJCC (American Joint Committee on Cancer) TNM system 8th edition is based on local extension of the main tumor (T), involvement of lymph node (N), and metastasis (M). Ki-67 is a marker of proliferation used to assess tumor grade. High Ki-67 correlates with poor prognosis, advanced clinical and pathological features, thus Ki-67 can be used as a biomarker in the management of RCC.Ki-67 is routinely used to see the proliferation index in various cases of malignancy, but not in kidney malignancy. Programmed death ligand 1 (PD-L1) acts as a negative regulator of T cell-mediated anti-tumor immune responses. PD-L1 is expressed on T cells, B cells, macrophages, dendritic cells, endothelial cells and in various tumor cells including ccRCC. This study aims to determine the correlation between the expression of PD-L1 and Ki-67 in various T-stage clear cell renal cell carcinomas. Material and Method: This was an observational analytical study with cross-sectional approach toward 52 cases of ccRCC whose diagnosis was made histopathologically at the Anatomical Pathology Installation of Dr. Soetomo General Academic Hospital Surabaya from January 2014 to December 2020. Immunohistochemical stainingwas carried out using Ki-67 and PD-L1 antibodies, followed by an assessment using a scoring system. T-stage data were obtained from the patients’ medical recordswhich were then analyzed statistically with the Spearman test. Result: The study included 52 cases of ccRCC obtained from nephrectomy specimens at RSUD dr. Soetomo between 2014–2020. The age distribution of the subjects was 29–69 years and the mean and median age was 53 years. The ratio of male patients compared to female patients was 2.5:1. The majority was stage T2 (50%). Statistical test results showed no correlation between the expression of PD-L1 and Ki-67 in various T-stage clear cell renal cell carcinomas (p=0.965 and p=0.680). Conclusion: This study showed no correlation between the expression of PD-L1 and Ki-67 in various T-stage clear cell renal cell carcinomas. Nonetheless PD-L1 can be considered as an important biomarker with a poorer prognosis and aggressive clinicopathological findings in patients with RCC.

Success Rate of Coronary Artery Bypass Grafting on Elderly Patients in Dr. Soetomo General Academic Hospital, Surabaya

Highlights: CABG is the most performed cardiac surgery in Indonesia, and most patients undergoing this surgery are above 60 years old. CABG success rate is not significantly influenced solely by the patient’s age but also by several perioperative characteristics such as gender, comorbidities, and other variables included in the calculation of EuroSCORE II. Abstract Introduction: Coronary artery disease (CAD) causes more than a quarter of deaths in Indonesia and is found to be more prevalent in the elderly (≥60 years old). Treatment includes coronary artery bypass grafting (CABG), the most-performed cardiac surgery in Indonesia. This study aimed to determine the short-term and one-year postoperative success, morbidity, and mortality rates with their causes in Dr. Soetomo General Academic Hospital, Surabaya. Methods: This was a cross-sectional retrospective study using secondary data obtained from 85 medical records of CABG patients aged ≥60 years old in the Department of Thoracic, Cardiac, and Vascular Surgery, Dr. Soetomo General Academic Hospital, Surabaya, from January 2018 to December 2020. Aside from descriptive statistics, logistic regression was conducted to assess the relationship between EuroSCORE II and the success of CABG in elderly patients. Results: Patients were mostly male in their sixties with a mean of 65.5 ± 4.9 years old, had three-vessel disease, and had a predicted mortality rate of 1.6%. The average number of grafts used was 3.3 ± 0.7, and the average length of hospital stay was 7.4 ± 2.4 days. The morbidity rate was 71.8%, with bleeding as the most common complication, a 17.6% mortality rate with septic shock as the most frequent cause, and a success rate of 82.4% (short-term) and 80% (one-year postoperative). Higher EuroSCORE II was found to significantly decrease the probability of both short-term and one-year postoperative success. Conclusion: The success rates of CABG in Dr. Soetomo General Academic Hospital, Surabaya, were 82.4% (short-term) and 80% (one-year postoperative), negatively correlated with EuroSCORE II.

Primary Open-Angle Glaucoma Patients in the Ophthalmology Outpatient Clinic Dr. Soetomo General Academic Hospital, Surabaya, in 2013–2015

Highlights: POAG is a common type of glaucoma. POAG patients were predominantly >60 years old, with males being more dominant than females. Abstract Introduction: Primary open-angle glaucoma (POAG) is a progressive, chronic optic neuropathy characterized by distinct optic nerve atrophy and impairment of the visual field. The purpose of this study was to describe the characteristics of primary open-angle glaucoma patients in the ophthalmology outpatient clinic of Dr. Soetomo General Academic Hospital, Surabaya, in 2013–2015. Methods: This was a descriptive-retrospective study. Samples were patients with a primary open-angle glaucoma (POAG) diagnosis in the ophthalmology outpatient clinic at Dr. Soetomo General Academic Hospital, Surabaya, in 2013–2015. Results: There were 88 samples of POAG patients in the ophthalmology outpatient clinic at Dr. Soetomo General Academic Hospital, Surabaya, in 2013–2015. POAG was dominated in the age group 60–69 years old, with a percentage of 37.50%. Males were more dominant than females, with a percentage of 55.70%. Many POAG patients were unemployed, with a percentage of 56.82%. Most patients with POAG did not have a history of hypertension or diabetes mellitus, with a percentage of 73.86%. Patients who had a history of hypertension were 11.36%, those with diabetes mellitus were 9.09%, and those who had a history of both hypertension and diabetes mellitus were 5.68%. Conclusion: POAG was a higher risk in older adults, with males being more dominant than females. Most patients did not have a history of either hypertension or diabetes mellitus.

Trauma Profile of Homicide Victims at Dr. Soetomo General Academic Hospital, Surabaya, during the COVID-19 Pandemic

Highlights: Most homicide victims were predominantly in the productive age range of 21-40 years old. Males were more likely to be homicide victims than females. Abstract Introduction: The injuries of homicide victims are clues in forensic medicine to uncover a possible crime. In Indonesia, there are not many studies on trauma profiles, specifically in homicide cases. This study aimed to provide an overview of the trauma profile of homicide victims at Dr. Soetomo General Academic Hospital, Surabaya. Methods: This was a descriptive study. Secondary data was collected from 34 forensic examination reports at Dr. Soetomo General Academic Hospital, Surabaya. Data such as age, sex, type of injury, sites of injury, number of injuries, cause of death, and mechanism of death were analyzed statistically. Results: Most victims were between 21 and 30 years old and 31 and 40 years old (26.47%). Sex was dominated by men (76.47%). The most common type of injury was abrasion (25.71%). The most common injury sites were head-neck (34.34%) and chest-upper back (34.34%). The most common number of injuries was ≥10 (44.12%). The most common cause of death was sharp-force trauma (54.54%), and the most common mechanism of death was exsanguination (54.54%). Conclusion: Males predominated in the age ranges of 21 to 30 years old and 31 to 40 years old. The most common type of injury was abrasion. The most common sites of injury were the head, neck, and chest upper back. The most common number of injuries was ≥10. Most victims died of sharp-force trauma. Exsanguination was the most common mechanism of death.

Risk Factor Profile of Amputation in Diabetic Foot Patients in Dr. Soetomo General Academic Hospital, Surabaya, from 2019 to 2020

Highlights: Certain variables are known to be risk factors associated with the outcome of lower extremity amputation among diabetic foot patients. The patient population was observed to be slightly female-biased, with a high prevalence of older age, abnormally high blood sugar and HbA1c, and a history of nephropathy, dyslipidemia, and hypertension. Prior history of vascular diseases, prior amputation history, and heavy smoking were observed but not as prevalent. Abstract Introduction: This study aimed to find the general distribution of certain variables as risk factors for lower extremity amputation among diabetic foot patients at the Inpatient Ward of the Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, from 2019 to 2020. Methods: This was a descriptive-retrospective study using data from medical records. The Statistical Package for the Social Sciences (SPSS) was used to calculate the distribution through the Kolmogorov-Smirnov test. Results: The mean ± SD of age was 55.38 ± 7.503 years old and was slightly female-biased. The median (min-max) blood sugar level was 212.00 (85–446) mg/dL. Fifteen out of 16 patients had an HbA1c beyond 7.0%. The body mass index (BMI) of most patients was between normal and overweight, with a mean ± SD of 24.018 ± 4.1827. 15% of patients were smokers. Strokes were present in 3.9% of patients, cardiovascular diseases were present in 13.73% of patients, prior lower extremity amputation (LEA) history was present in 15.7% of patients, hypertension was present in 49% of patients, and dyslipidemia was present in 13 of 15 patients. The mean estimated glomerular filtration rate (eGFR) was 70.15 ± 34.498 mL/min/1.732. Conclusion: Older age, high blood sugar, high HbA1c levels, nephropathy, dyslipidemia, and hypertension had a high prevalence. Smoking, cardiovascular diseases, strokes, and prior amputation had a low prevalence. Gram-negative bacterial infection was observed in almost all reported patients. ABI results were either mostly not assessable or abnormally high. Most of the patients’ Wagner gradings were in the worst category.

HEMATOLOGY PROFILES AND DISEASE SEVERITY OF PEDIATRIC DENGUE VIRUS INFECTION AT A TERTIARY HOSPITAL IN SURABAYA, INDONESIA

Highlights Dengue virus infections exhibit a spectrum of clinical manifestations, ranging from asymptomatic cases to severe disease, with the potential for fatalities if not managed effectively. Hematology factors significantly contribute to the severity of dengue virus infection. Abstract Background: The escalating incidence of dengue cases in Surabaya, Indonesia, underscores the imperative to comprehend the hematology profiles and disease severity in pediatric patients affected by dengue virus infections (DVI). As the prevalence of DVI continues to surge, understanding the nuanced clinical manifestations becomes paramount for effective management and mitigation of the disease burden. Objective: This study aimed to characterize the hematology profiles and the disease severity of dengue virus infections (DVI) among pediatric patients hospitalized at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia throughout 2019. Material and Method: A retrospective descriptive cross-sectional study was conducted using secondary data from medical records. Pediatric patients aged six months to 18 years were enrolled. A total sampling method comprised 67 patients meeting the inclusion criteria. Result: Severe thrombocytopenia was most commonly observed in dengue hemorrhagic fever (DHF) III cases (36.4%), while leukopenia was predominant in DF cases (42.2%). High hematocrit levels were more prevalent in DHF III cases (27.3%), and high hemoglobin levels were most frequently identified in DHF II and DHF III cases (33% in each case). Significant differences in DVI severity were observed in platelets and hemoglobin levels (p=0.0002 and p=0.0066, respectively) but not in leukocyte and hematocrit levels. Conclusion: Mild thrombocytopenia was prevalent in Dengue Fever (DF), while severe thrombocytopenia was most prevalent in Dengue Hemorrhagic Fever (DHF) grade III. Leukopenia was prominent in DF patients, and platelets and hemoglobin levels varied across severity of DVI. These findings provide insights for improved clinical management and diagnostic criteria refinement.

AUTOIMMUNE OPTIC NEUROPATHY (AON) PROFILE AT OPHTHALMOLOGY OUTPATIENT CLINIC OF A TERTIARY HOSPITAL IN SURABAYA, INDONESIA

Highlights Autoimmune optic neuropathy (AON) is one of the diseases that involve the central nervous system (CNS) and can result in disability if not treated quickly and appropriately. The autoimmune optic neuropathy (AON) patient’s profile, including disease etiology and therapy, is essential to minimize the incidence of AON. Abstract Background: Autoimmune optic neuropathy (AON) is a kind of optic neuritis that causes progressive and severe vision loss. The presence of an autoimmune disease usually characterizes the diagnosis of this disease. Several autoimmune processes that can cause AON are Multiple Sclerosis (MS), Neuromyelitis Optica Spectrum Disorder (NMOSD), Myelin Oligodendrocyte Glycoprotein Immunoglobulin (MOG-IgG), and other disorders, specifically systemic autoimmune disease, such as Systemic Lupus Erythematous (SLE), Sjogren’s Syndrome, and Sarcoidosis. Risk factors for AON involve young adults and women. Most of the patients received therapy according to the ONTT protocol and underwent outpatient treatment with oral methylprednisolone or prednisone. Objective: The study aimed to obtain the autoimmune optic neuropathy (AON) profile in patients at the Ophthalmology Outpatient Installation of Dr. Soetomo General Academic Hospital Surabaya, Indonesia, in the 2017-2022 Period. Material and Method: This retrospective descriptive study used medical records; 70 subjects were included. Result: Most subjects suffered from SLE (55.7%) as the cause of AON and received therapy according to the ONTT protocol, namely oral methylprednisolone or prednisone (67.1%) with outpatient therapy. Some patients were given other therapies (25.7%), such as mecobalamin and other B complex vitamins. Conclusion: AON is an uncommon condition. However, if not treated promptly and effectively, it can result in handicaps. This study may serve as a reference for future relevant research and as an attempt to prevent the disease.

Seminal Plasma Examination Test Result Agreements Using the WHO Manual Recommendation: With Semi-Automatic and Automatic Methods

Objective: To analyze the suitability of the measurement results of neutral alpha-glucosidase and fructose in seminal plasma, between the manual method recommended by the World Health Organization (WHO) Sixth Edition and the semi-automatic method, using Biosystems BTS 350 and the automatic method using Biosystems A15.Material and Methods: This study involved 47 subjects at the Andrology Outpatient Department of Dr. Soetomo General Academic Hospital; from October 2022 and February 2023. The measurement of neutral alpha-glucosidase and fructose levels in seminal plasma was conducted, via three different approaches: the manual method, as recommended by the WHO Sixth Edition, the semi-automatic Biosystems BTS 350, and the automatic Biosystems A15. The manual method recommended by the WHO Sixth Edition was employed as the reference system.Results: The average disparity in neutral alpha-glucosidase levels among the manual method, as recommended by the WHO Sixth Edition, compared to the semi-automatic and automatic methods were recorded as: -1.0215 IU/l and -2.3428 IU/l, respectively. Similarly, the fructose levels exhibited differences of -2.1234 mmol/l and 2.2834 mmol/l. Notably, within the method comparisons, 44 values of neutral alpha-glucosidase levels fell within the limit of agreement, while fructose levels showed 44 and 45 values within the agreement limit.Conclusion: The results obtained from the manual method, as recommended by the WHO Sixth Edition, demonstrated agreement with the measurements of neutral alpha-glucosidase and fructose obtained when using both the semi-automatic and automatic methods.

Seminal Plasma Examination Test Result Agreements Using the WHO Manual Recommendation: With Semi-Automatic and Automatic Methods

Objective: To analyze the suitability of the measurement results of neutral alpha-glucosidase and fructose in seminal plasma, between the manual method recommended by the World Health Organization (WHO) Sixth Edition and the semi-automatic method, using Biosystems BTS 350 and the automatic method using Biosystems A15.Material and Methods: This study involved 47 subjects at the Andrology Outpatient Department of Dr. Soetomo General Academic Hospital; from October 2022 and February 2023. The measurement of neutral alpha-glucosidase and fructose levels in seminal plasma was conducted, via three different approaches: the manual method, as recommended by the WHO Sixth Edition, the semi-automatic Biosystems BTS 350, and the automatic Biosystems A15. The manual method recommended by the WHO Sixth Edition was employed as the reference system.Results: The average disparity in neutral alpha-glucosidase levels among the manual method, as recommended by the WHO Sixth Edition, compared to the semi-automatic and automatic methods were recorded as: -1.0215 IU/l and -2.3428 IU/l, respectively. Similarly, the fructose levels exhibited differences of -2.1234 mmol/l and 2.2834 mmol/l. Notably, within the method comparisons, 44 values of neutral alpha-glucosidase levels fell within the limit of agreement, while fructose levels showed 44 and 45 values within the agreement limit.Conclusion: The results obtained from the manual method, as recommended by the WHO Sixth Edition, demonstrated agreement with the measurements of neutral alpha-glucosidase and fructose obtained when using both the semi-automatic and automatic methods.

Immunohistochemistry Assay for Differentiating Liposarcoma and Its Mimickers

Introduction: Soft tissue tumors account for 1 – 1.5% of all cancer, which is the tenth most common cancer in referral oncology hospitals in Indonesia. Liposarcomas are a group of histologically diverse lesions, accounting for 12.8% – 20% of all soft tissue malignancies. Some soft tissue tumors may show similar histological appearance, making differentiating mesenchymal neoplasms a difficult challenge. Immunohistochemical examination is an advanced examination to refine and determine the diagnosis that cannot be established based on histopathological examination only. Methods: This study was an observational descriptive study with a retrospective approach. The data of patients with liposarcoma was obtained from immunohistochemistry examination results in Dr. Soetomo General Academic Hospital during 2020 – 2022 period, which includes the histopathology result. All cases were classified based on WHO. We considered only patients with immunohistochemistry examination proven diagnosis who underwent surgery or biopsy in the same institution. Results: The total number of liposarcoma cases was 20, with most patients were male (90%) and age group 40 – 49 years old (30%). The most common location was the abdominal region (55%), including intra-abdominal, mesentery, and retroperitoneal. The most common subtype was dedifferentiated liposarcoma with 10 cases (50%). Conclusions: Immunohistochemistry examination in malignant adipocytic tumors aims to confirm the diagnosis, with the most common subtype being dedifferentiated liposarcoma. It is necessary to consider the morphology in H&E staining together with the immunohistochemistry profile as well as all clinical and radiology information to establish the most relevant diagnosis.

Immunohistochemistry Assay for Differentiating Liposarcoma and Its Mimickers

Introduction: Soft tissue tumors account for 1 – 1.5% of all cancer, which is the tenth most common cancer in referral oncology hospitals in Indonesia. Liposarcomas are a group of histologically diverse lesions, accounting for 12.8% – 20% of all soft tissue malignancies. Some soft tissue tumors may show similar histological appearance, making differentiating mesenchymal neoplasms a difficult challenge. Immunohistochemical examination is an advanced examination to refine and determine the diagnosis that cannot be established based on histopathological examination only. Methods: This study was an observational descriptive study with a retrospective approach. The data of patients with liposarcoma was obtained from immunohistochemistry examination results in Dr. Soetomo General Academic Hospital during 2020 – 2022 period, which includes the histopathology result. All cases were classified based on WHO. We considered only patients with immunohistochemistry examination proven diagnosis who underwent surgery or biopsy in the same institution. Results: The total number of liposarcoma cases was 20, with most patients were male (90%) and age group 40 – 49 years old (30%). The most common location was the abdominal region (55%), including intra-abdominal, mesentery, and retroperitoneal. The most common subtype was dedifferentiated liposarcoma with 10 cases (50%). Conclusions: Immunohistochemistry examination in malignant adipocytic tumors aims to confirm the diagnosis, with the most common subtype being dedifferentiated liposarcoma. It is necessary to consider the morphology in H&E staining together with the immunohistochemistry profile as well as all clinical and radiology information to establish the most relevant diagnosis.

Factors associated with biliary atresia in children with cholestasis in Surabaya

Introduction. Biliary atresia (BA) represents a progressive and obstructive fibrotic cholangiopathy, serving as a leading cause of liver failure and pediatric liver transplantation worldwide. Identifying risk factors associated with BA incidence is crucial for expediting diagnosis; however, limited research has been conducted in Indonesia. This study aims to investigate the characteristics and analyze the factors associated with the occurrence of BA. Methods. A retrospective observational analysis of medical records encompassing 523 cholestatic patients at the Pediatric Hepatology Outpatient Department and Pediatric Ward of Dr. Soetomo General Academic Hospital, Surabaya, from 2011 to 2022 was conducted. The data was segregated into BA and non-BA groups, and diagnostic chi-square tests were employed to determine interrelationships among variables. Subsequently, logistic regression analysis was performed to identify the most impactful variable. Results. Notably, age at first time visiting specialist (p = 0.003), gestational age (p <0.001), birth weight (p = 0.039), and domicile (p = 0.028) exhibited substantial associations with BA. Moreover, gestational age emerged as the most influential factor (p = 0.004). Infants with normal birth weight (≥2,500 grams) exhibited strongest factor associated factor of BA cholestasis. Conclusion. Initial specialist consultations were predominantly observed within the 0-6 months age range, while term infant and normal birth weight were linked to a higher likelihood of BA cholestasis. Residence in rural areas exhibited a significant correlation with BA incidence.

Co-morbid potentiality of Acquired TB MDR patients in RSUD DR. Soetomo

Tuberculosis or TB is a global problem because of it high number globally. The 2021 WHO report shows that in 2020 there were around 9.9 million TB cases of which 1.2 million died. Of the total cases, 465,000 were MDR/RR-TB case. In Indonesia, TB RO is estimated to reach 2.4% of the total new TB patients and 13% of TB patients who have been treated previously. In the Global Tuberculosis Report issued by WHO in 2023, there were 28,000 cases of MDR-TB in Indonesia. TB patients with Diabetes Mellitus (DM) also have a 6.8x risk of being infected with secondary MDR-TB. This research is an observational study conducted retrospectively using medical records obtained from the MDR-TB polyclinic in Dr Soetomo General Academic Hospital during the period January 2019 to January 2023. The result of the highest co-morbid was DM with 29.3% MDR-TB Patients are found with DM with 47.7% cause of infection are treatment failure.