Universitas Sumatera Utara Hospital Research Articles

Analysis of the Storage of Solid Medical Hazardous and Toxic Waste (B3) in Enhancing the Performance of Type C Hospitals: A Case Study at Universitas Sumatera Utara Hospital

The Universitas Sumatera Utara Hospital’s waste management system, based on Regulation 56 of 2015, has been criticized for unsanitary conditions and lack of proper waste labeling. A study focusing on three locations revealed that the majority of B3 waste originates from infectious properties and sharp objects. The hospital's waste management involves segregating waste based on its characteristics, using appropriate containers, and transporting it to the B3 waste Temporary Storage for storage. The hospital is implementing a multi-stage approach to manage B3 waste, including sorting, containerization, internal transportation, and storage. The waste is segregated and contained within designated containers, transported daily using trolleys or wheeled containers, stored in facilities shielded from direct sunlight, and designed to prevent access by animals, insects, and birds. Regular cleaning is also essential. The hospital aims to improve waste management efficiency by implementing proper waste disposal, packaging, and transportation.

Role of digital education through smartphones in improving knowledge among asthma patients: A preliminary study.

Asthma is a chronic inflammatory airway disorder and is among the top ten causes of morbidity and mortality in Indonesia, highlighting the need for effective management strategies. This study aimed to evaluate changes in asthma knowledge levels before and after using the "Paru Sehat" smartphone application for digital education. A quasi-experimental study using a pre- and post-test design was conducted over three months at the outpatient clinic of Universitas Sumatera Utara Hospital, Medan, Indonesia, among asthma patients aged over 18 years. The patients completed the Patient Asthma Knowledge Questionnaire (PAKQ) before installing the "Paru Sehat" application to establish baseline knowledge. Once a week, patients received reminders to access materials covering an asthma overview, peak flow meter use, medication differences, and management techniques. After four weeks of intervention, the participants' knowledge was reassessed using the PAKQ. Data were analyzed using either paired Student's t-test or Wilcoxon test to assess the improvement in knowledge. The results showed increases in knowledge about asthma in general, asthma triggers, and asthma diagnosis domains, with the median score in each domain rising by one point (p=0.003, p=0.001, and p=0.002, respectively). The asthma management domain exhibited the largest change, with a median increase of two points (p<0.001). The total scores increased by an average of five points (p<0.001), indicating an overall improvement in patient knowledge about asthma. The "Paru Sehat" application demonstrated significant potential in enhancing asthma knowledge across multiple domains. Further research is warranted to explore the long-term effectiveness of the application in diverse populations and settings, ultimately contributing to improved asthma management and patient outcomes.

Characteristics and management of iatrogenic urinary tract injuries in teaching hospital: A single-centered study.

Despite its rarity, iatrogenic urinary tract injury can cause severe morbidity and mortality. The purpose of this study was to determine the frequency of urinary tract injuries caused by medical treatment in a hospital in Medan, Indonesia. This retrospective descriptive study was conducted at H. Adam Malik General Hospital and Universitas Sumatera Utara Hospital in Medan from March to August 2022. Medical data of individuals who had iatrogenic urinary tract injuries in a Medan teaching hospital from 2018 to 2022 were obtained using total sampling. SPSS version 25 was utilized to analyze patient characteristics, the type of surgery, urinary tract injuries, and urologic procedures. There were 11 ureteral injuries and 23 bladder injuries in 32 iatrogenic urinary tract injuries. The average age of the patients was 40.5 ± 13.3. Patients who received obstetrical care had the highest rate of iatrogenic urinary tract injury (56.3%), followed by patients who received gynecological care (21.9%) and surgical care (21.9%). The procedure most likely to cause iatrogenic urinary tract injury was hysterectomy (40.6%). Bladder rupture (65.5%) and ureteral transection (28.1%) were common types of iatrogenic bladder and ureteral injuries. Majority of iatrogenic urinary tract injuries were treated with bladder repair (68.8%). Obstetrical and gynecologic procedures, especially hysterectomy, were the most common causes of iatrogenic urinary tract injury; bladder repair was the most common treatment. Iatrogenic urinary tract injury is best managed by knowing the anatomical position of the urinary tract inside the operative field.

Analysis Of Direct Medical Costs On Type 2 Diabetes Mellitus Outpatient With Cardiovascular Disease

T2DM is a chronic disease characterized by high blood glucose levels due to insulin resistance or insufficient insulin production. Aim of this study was to analyze the direct medical costs of outpatient T2DM management with cardiovascular disease complications. 58 T2DM patients at the Universitas Sumatera Utara Hospital, in Sumatera Utara, Indonesia were recruited in this study in April-May 2023. This study analyze based on payer prespective named as Badan Penyelenggara Jaminan Sosial (BPJS). This quantitative research was carried out by collecting data retrospectively. Result of this study show that phycian service IDR 8,715,000, drug acquisition cost IDR 13,081,242, laboratory examination IDR 2,531,000, medical execution IDR 410,000, and administration IDR 1,425,000. Conclusion of this study, that drug acquisition cost was the highest cost IDR 13,081,242.

Exploring the moderating effects of SIRT1 and gene polymorphisms rs7895833 on the relationship between hemoglobin levels and physical frailty in elderly adults with comorbid chronic diseases: A moderated mediation analysis

Background Relationship age, hemoglobin, and physical frailty have all been investigated in older people with more than one chronic disease. There has been little analysis of the relationship between hemoglobin, age, physical frailty, plasma levels of Sirtuin1 (SIRT1), and the gene polymorphism (SNP) rs7895833 A&gt;G. The goal of this study was to find out how SIRT1 level, SNP rs7895833, hemoglobin, age, and physical frailty (frail score) are related in older Indonesian adults with comorbid chronic diseases. Methods This was an observational study. Demographic and clinical data were retrieved from the electronic health records of Universitas Sumatera Utara Hospital, Medan, Indonesia. Physical frailty, SIRT1 level, and SNP rs7895833 were measured using an appropriate and valid method. Purposive sampling was used to determine the eligibility of 132 elderly adults from November 2022 to February 2023. Results The indirect effect of hemoglobin on the frail score (FS) through age was negative and significant, according to a conditional mediation analysis (β=-0.0731; p=0.023). Meanwhile, the direct effect of hemoglobin on the FS was negative and not significant (β=0.1632; p=0.052). According to the conditional moderated mediation analysis, the size of the direct effect of age on FS was increased by genotype AG-GG and SIRT1 level (βlow=0.2647; p=0.002, βmiddle=0.2956; p&lt;0.001, and βhigh=0.319; p&lt;0.001). The size of the conditional indirect effect of Hemoglobin on FS through age was negative and significantly increased by SNP genotype AG-GG and SIRT1 level (βlow=-0.0647; p=0.032, βmiddle=-0.0723; p=0.024, and βhigh=-0.078; p=0.02). Conclusions Higher plasma levels of SIRT1 and the SNP genotype AG-GG may both contribute to physical frailty in the elderly population. Hemoglobin levels in the blood fall with age, which can negatively impact older persons who already have chronic diseases. However, the interactions between these factors are intricate, requiring more study to completely understand the processes underlying development.

Comparative analysis between PUMA and CAPTURE questionnaires for chronic obstructive pulmonary disease (COPD) screening in smokers.

Chronic obstructive pulmonary disease (COPD) presents a significant global challenge, impacting health systems, economies, and societies. Its prevalence is anticipated to rise owing to an aging demographic. Although the PUMA and CAPTURE questionnaires are available for COPD screening, their comparative effectiveness has not been studied in Indonesia. The aim of this study was to evaluate the effectiveness of the PUMA and CAPTURE questionnaires as screening tools for COPD among smokers. A cross-sectional study was conducted at Universitas Sumatera Utara Hospital and H. Adam Malik General Hospital, Medan, Indonesia, from December 2022 to February 2023. Smokers aged over 40 or above with a history of smoking more than 100 cigarettes in their lifetime and no previous COPD diagnosis were included in the study. To collect the responses to PUMA and CAPTURE questionnaire, face-to-face interviews were conducted, followed by a spirometry test. A total of 76 smokers were included in the study; the predominant age group was 51-60 years (36.8%), with the majority being male (81.6%). Most participants began smoking at ages 15-20 years (65.8%) and had been smoking for 20-30 years (36.8%) at a moderate intensity (44.8%). Spirometry tests indicated obstructive patterns in 50 participants, with 17 classified as severe obstruction. At a cut-off score of ≥6, the PUMA questionnaire yielded a sensitivity of 72.55% and a specificity of 84%. In contrast, the CAPTURE questionnaire, with a cut-off score of ≥4, exhibited a sensitivity of 70.83% and a specificity of 64.29%. These results imply that the PUMA questionnaire could be more efficient in COPD screening compared to the CAPTURE questionnaire.

Exploring the moderating effects of SIRT1 and gene polymorphisms rs7895833 on the relationship between hemoglobin levels and physical frailty in elderly adults with comorbid chronic diseases: A moderated mediation analysis.

Relationship age, hemoglobin, and physical frailty have all been investigated in older people with more than one chronic disease. There has been little analysis of the relationship between hemoglobin, age, physical frailty, plasma levels of Sirtuin1 (SIRT1), and the gene polymorphism (SNP) rs7895833 A>G. The goal of this study was to find out how SIRT1 level, SNP rs7895833, hemoglobin, age, and physical frailty (frail score) are related in older Indonesian adults with comorbid chronic diseases. This was an observational study. Demographic and clinical data were retrieved from the electronic health records of Universitas Sumatera Utara Hospital, Medan, Indonesia. Physical frailty, SIRT1 level, and SNP rs7895833 were measured using an appropriate and valid method. Purposive sampling was used to determine the eligibility of 132 elderly adults from November 2022 to February 2023. The indirect effect of hemoglobin on the frail score (FS) through age was negative and significant, according to a conditional mediation analysis (β=-0.0731; p=0.023). Meanwhile, the direct effect of hemoglobin on the FS was negative and not significant (β=0.1632; p=0.052). According to the conditional moderated mediation analysis, the size of the direct effect of age on FS was increased by genotype AG-GG and SIRT1 level (β low=0.2647; p=0.002, β middle=0.2956; p<0.001, and β high=0.319; p<0.001). The size of the conditional indirect effect of Hemoglobin on FS through age was negative and significantly increased by SNP genotype AG-GG and SIRT1 level (β low=-0.0647; p=0.032, β middle=-0.0723; p=0.024, and β high=-0.078; p=0.02). Higher plasma levels of SIRT1 and the SNP genotype AG-GG may both contribute to physical frailty in the elderly population. Hemoglobin levels in the blood fall with age, which can negatively impact older persons who already have chronic diseases. However, the interactions between these factors are intricate, requiring more study to completely understand the processes underlying development.

Factors Affecting the Quality of Life Among Pulmonary Tuberculosis Patients at the TB-DOTS Outpatient Clinic of Public Hospital

Background: Indonesia is the second country in the world with the highest burden of tuberculosis. Pulmonary tuberculosis is one of the global health issues that can substantially affect quality of life.&#x0D; Objective: To analyze the quality of life and associated factors among pulmonary tuberculosis patients.&#x0D; Methods: A cross-sectional study was conducted at the TB-DOTS outpatient clinic of Prof. Chairuddin Panusunan Lubis Universitas Sumatera Utara Hospital, Medan, Indonesia. The study subject was 100 pulmonary tuberculosis patients aged ≥18 years, newly diagnosed, and undergoing treatment from August to October 2023, selected using consecutive sampling. Primary data were collected through face-to-face interviews using the WHOQOL-BREF questionnaire. Descriptive statistics, the chi-square test, and the logistic regression test were used for data analyses.&#x0D; Results: The chi-square test showed there was a significant relationship between age (p = 0.022), family income (p = 0.005), treatment phase (p &lt; 0.001), and adverse drug reactions (p = 0.040) with overall quality of life. The logistic regression test showed there was a significant relationship between family income (p = 0.007, OR = 3.685, 95% CI = 1.432–9.479) and treatment phase (p &lt; 0.001, OR = 5.643, 95% CI = 2.139–14.888) with the deterioration of overall quality of life.&#x0D; Conclusion: The treatment phase lasting less than 2 months was the factor that most influenced the deterioration of the overall quality of life. Hence, families, healthcare workers, and the government should consider the treatment phase as a focus of interventions to enhance the quality of life of pulmonary tuberculosis patients

Factors associated with cognitive impairment and the quality-of-life among COVID-19 survivors working as healthcare workers.

Prolonged physical and mental health changes, known as post-COVID conditions (PCC), could impair the quality-of-life (QoL) of healthcare workers. The aim of this study was to identify factors that contribute to cognitive impairments and QoL among COVID-19 survivors working as healthcare workers. This cross-sectional study involved healthcare workers at Prof. Dr. Chairuddin P. Lubis Universitas Sumatera Utara Hospital, Medan, Indonesia. The Montreal Cognitive Assessment (MoCA) was used to assess the cognitive function, while the World Health Organization Quality-of-Life Brief Version (WHOQOL-BREF) questionnaire was used to evaluate the QoL. Factors associated with cognitive and QoL status were examined using Mann-Whitney and Chi-squared tests. A total of 100 COVID-19 survivors were included in the study, most of whom were female (74%), aged ≤35 years (95%), and were doctors (62%). Only 22% of the participants had a normal BMI, 93% had a history of mild COVID-19, and 54% had one comorbidity. The Overall MoCA score averaged 24.18±2.86, indicating mild cognitive impairment among the groups. The distribution of MoCA scores had similar patterns with no significant differences based on age, gender, comorbidities, BMI, COVID-19 severity, and frequency of COVID-19 infection. Interestingly, the number of vaccine doses received by the participants had a statistically significant associated with MoCA scores of which those receiving more than two doses had higher cognitive scores than those with only two doses (p=0.008). Based on categorized MoCA scores (normal vs cognitive impairment), none assessed factors were not significantly associated with cognitive outcomes. The WHOQOL-BREF scores ranged from 62.5 to 95.5, with a mean±SD of 83.67±7.03. None of the assessed factors were associated with WHOQOL-BREF scores among COVID-19 survivors. These findings highlight the need for further study to explore the protective role of vaccination frequency in cognitive impairment and the factors underlying the resilience in QoL among survivors.

Post Stroke, Is Perimetry Necessary? A Case Report

Abstract&#x0D; Introduction : Stroke are generally associated with peripheral visual field loss. Three out of four stroke patients report some form of disability, one of which is visual impairment. Approximately 16% of these patients have a homonymous visual field defect poststroke. These vision problems can lead to difficulty carrying out a lot of daily tasks and activities, such as driving. This report tries to define the diagnostic flow to determine the exact type and lesion.&#x0D; Case Illustration : Male, 61 years old, came to Universitas Sumatera Utara Hospital with visual field loss in both eyes. Two months ago, he was diagnosed with ischemic stroke and treated with Aspirin 80 mg, with no limbs disability right now. He also had hypertension and treated with Amlodipine 10 mg. VOD: 6/60 with BCVA S-2.00 6/7,5, VOS: 6/60 with BCVA S-2.00 6/7.5. With confrontation test and perimetry, defect was found in medial visual field OD and lateral visual field OS. Hess screen and Amsler Grid was normal. Head CT-Scan was performed with multiple infarcts, mainly in right occipital lobe. The patient was diagnosed with Incomplete Hemianopia, Left Congruous Homonymous Hemianopia with Macular Sparing, and treated with Citicholine 1000 mg once daily.&#x0D; Discussion&#x0D; Conclusion : In stroke patients with homonymous visual field loss, visual field testing with detailed evaluation of visual field defect can determine the lesion location, and neuro-radiological imaging was necessary to assess visual pathway. It’s important for educate the patients, diagnostic and prevent the stroke recurrent.

Lived experiences of type 2 diabetes patients in North Sumatra Province, Indonesia: A phenomenology study

Objective: To explore lived experiences of type 2 diabetes patients in North Sumatra Province, Indonesia. Methodology: This descriptive phenomenology study recruited seven participants at Universitas Sumatera Utara Hospital through purposive sampling. Data were collected from April to June 2021 by in-depth interviews using a voice recorder and analyzed according to Colaizzi method. Results: There were four main themes and nine theme clusters, including having complications (in the eyes, heart, as well as brain and nerves), emotional responses (psychological stress, and unstable emotions), changes in dietary patterns (setting a healthy diet, and feeling sad about changing diet pattern), and changes in activity patterns (start exercising, and reduce energy expenditure). Conclusion: Participants experienced difficulties in adapting to a new lifestyle that targeted type 2 diabetes treatment. Therefore, healthcare providers should provide support for effective lifestyle changes.

Comparison of vascular cell adhesion molecule 1 (VCAM-1) during pregnancy, after placental detachment and during puerperium between normal and pregnancy with COVID-19.

Pregnant women have a number of physiological changes that lower the immune responses to avoid embryonic rejection, which increases the risk of problems after contracting coronavirus disease 2019 (COVID-19). Multiple inflammatory cytokines are dysregulated in this process and expressed inappropriately during systemic inflammatory responses associated with COVID-19. The aim of the study was to compare the levels of vascular cell adhesion molecule 1 (VCAM-1), a marker of endothelial damage in pregnancies with and without COVID-19. A cohort prospective study was conducted at H. Adam Malik General Hospital and the Universitas Sumatera Utara Hospital, Indonesia. Pregnant women without COVID-19 and pregnant women with moderate and severe degrees of COVID-19 were recruited. The level of VCAM-1 was measured at three different time points (during pregnancy, within an hour of placental detachment, and 24 hours postpartum). The ANOVA and Student t-test were used to compare the VCAM-1 levels among different time points and between groups, respectively. The mean VCAM-1 levels at the hospital admission, one hour of placental detachment and 24 hours postpartum in non-COVID-19 and COVID-19 pregnancies were 591.29 vs 1176.27 pg/mL; 558.2 vs 1136.2 pg/mL; and 508.59 vs 985.2 pg/mL, respectively. There was a significant different in VCAM-1 levels in normal pregnancy at the time of hospital admission, one hour after detachment of the placenta and 24 hours postpartum (p=0.04). The mean VCAM-1 levels in pregnant women with COVID-19 also had significant differences between three time points (p=0.033). The levels of VCAM-1 were statically higher among pregnancy in the COVID-19 group compared to the non-COVID-19 group during hospital admission (p=0.023), one hour after placenta detachment (p=0.040) and 24 hours postpartum (p=0.043). The results suggested the usefulness of identifying the VCAM-1 level as a marker of endothelial dysfunction in pregnancy with COVID-19.

Evaluation of antibiotics using ATC/DDD and DU 90% methods on ICU patients at Universitas Sumatera Utara Hospital

Background: Evaluation of the use of antibiotics is the control of antimicrobial resistance. The ATC/DDD method was recommended to evaluate drug use quantitatively which can be used to compare the quantity of antibiotic use between hospitals and between countries. This research was a descriptive study with retrospective data collection cross-sectional. This research was conducted at the ICU of Universitas Sumatera Utara hospital in August-November 2022 from medical record data for the period January-December 2021 which included patient demographics, patient diagnoses, antibiotic dosage forms, routes of administration, types of antibiotics, dosage, duration of antibiotics use, and duration of treatment. Methods: Evaluation of antibiotic doses using the ATC/DDD method. The results of the study from 57 medical records that met the inclusion criteria showed that the ICU patients who used the most antibiotics were male (59.7%), the age group was &amp;gt;56 years (56.14%), patient diagnoses with COVID-19 (33.33%), and the dosage form was injection with the intravenous route of administration. The most frequently used antibiotics were levofloxacin (48.54%) 45.61 DDD/100 patient-days and ceftriaxone (30.06%) 28.25 DDD/100 patient-days, and the average value of Length of Stay (LOS) is 5.4 ±3.98 days with a total DDD/100 patient-days value of 93.96 (reference value of 51–67 DDD/100 patient-days). DU 90% segment namely levofloxacin (48.69%), ceftriaxone (30.16%) and meropenem (12.82%). The results of the study concluded that the use of antibiotics in ICU patients at Universitas Sumatera Utara Hospital showed a high DDD/100 patient-days rate. Therefore, it is necessary for hospital to continuously monitor and evaluated the rational use of antibiotics to prevent resistance of antibiotics.

Tumor Markers as Predictors of Acute Kidney Injury Incidence and Staging of the Muscle-Invasive Bladder Cancer Receiving Chemoradiation Therapy.

Bladder cancer, as one of types of cancers within the urinary tract, is associated with a greater risk of acute kidney injury (AKI), resulting in a poorer prognosis, discontinuation of effective oncological treatments, longer hospitalization, and higher expenses. There is no discussion yet on tumor markers in bladder cancer. With the revolutionary advances in bladder cancer molecular subtyping over the past decade, the presence of tumor markers to assess the staging of bladder cancer has yet to be discussed. In this study, we intended to assess the relationship between tumor markers and incidence of AKI, also between tumor markers and the cancer staging. This retrospective cross-sectional study utilized secondary data from 26 medical records of patients diagnosed with bladder cancer at the Adam Malik and Universitas Sumatera Utara Hospital between 2021and 2022. This study included all patients with bladder cancer who met the inclusion criteria. Continuous variables were reported as mean (standard deviation (SD)) and examined using an independent t-test. Categorical variables were reported as proportions, examined using Chi-square or Fisher's exact test. Pre- and post-tumor marker data were evaluated with dependent sample t-test for normal variance data, and Wilcoxon test for data with atypical distribution. P values were set at 0.05. CD44 (P = 0.003) and programmed cell death 1 (PD-1) (P = 0.030) were the only significant markers in their pre- and post-chemoradiation states among the four investigated tumor markers in this study. Meanwhile, PD-1 tumor marker levels were only found to be significant between AKI and pre-chemoradiation (P = 0.011). Even though the multivariate study of tumor staging did not show any statistical significance, both tumor markers CD44 and PD-1 showed a significant effect on the incidence of acute renal damage (P = 0.034). Pre-chemoradiation PD-1 tumor markers showed promise as good predictive indicators for staging and AKI incidence in muscle-invasive bladder cancer patients undergoing chemoradiation therapy.

Early Postoperative Serum Sodium Level and Urine Output Volume Profile after Endoscopic Endonasal Transsphenoidal Surgery in Macroadenoma Pituitary Tumor

Introduction: Surgery is still the initial treatment of choice to for the majority of date with pituitary tumors. One of the most commonly performed minimally invasive neurosurgical procedures is transsphenoidal endoscopic endonasal surgery (ETS) and microscopic transsphenoidal surgery (MTS), used commonly for the resection of pituitary tumors. Neurosurgical operations for pituitary and suprasellar tumors may result in postoperative complications due to the crucial anatomical location of these tumors. The resulting postoperative complications can manifest as anterior or posterior pituitary dysfunction, particularly sodium disturbances, due to the changes in antidiuretic hormone (ADH) secretion, which remains one of the most frequent postoperative reasons for hospital readmission. Method: The aim of this study is to describe and determine the frequency distribution of patient characteristics who underwent endoscopic endonasal transsphenoidal resection of pituitary adenoma at Universitas Sumatera Utara Hospital between 2021 and 2022. Result: The findings of this study showed the frequency distribution of patient characteristics who underwent endoscopic endonasal transsphenoidal resection and postoperative sodium serum level profile as well as postoperative urine output profile. Discussion: The discussion section briefly discusses the findings and their implications. It mentions the high prevalence of headache and visual deficits among the patients, which aligns with previous studies. It also provides an overview of normal water balance and the pathophysiology of water balance disorders after pituitary surgery.

Demography and Clinical Characteristic COVID-19 with Diabetes Mellitus at the Universitas Sumatera Utara Hospital

Background: COVID-19 is a disease caused by a virus called SARS-CoV-2. COVID-19 can infect almost all age groups, however, the elderly and those with co-morbidities such as diabetes mellitus can get worse complications from COVID-19. The study aims to find out the demographics and clinical characteristics of COVID-19 patients with diabetes mellitus treated at the Universitas Sumatera Utara Hospital. Method. This research is a descriptive study using retrospective data. The data used is secondary data taken from medical records. The number of samples that met the inclusion criteria was 37 people. Results. The majority of patients were dominated by the age group of 46-65 years (56.8%) and males (54.1%). The predominating clinical characteristics of COVID-19 with diabetes mellitus are cough (70.3%), shortness of breath (59.5%), and fever 51.4%. There was an increase in the laboratory results of COVID-19 patients with diabetes mellitus on blood sugar levels at admission, HbA1c, urea, creatinine, SGOT, SGPT, and d-dimer levels. The most treatment results were recovered by as many as 24 people (64.9%). Conclusion. The majority of patients are in the age group of 46-65 years and are male. The most common clinical characteristic is cough and there is an increase in laboratory results in patients

Doctor’s perception of clinical pharmacy services at Universitas Sumatera Utara Hospital

Clinical Pharmacy Services (CPS) play important roles in the clinical setting. This study aims to evaluate CPS based on Doctors’ perception at the Universitas Sumatera Utara Hospital, Medan, Indonesia. It was a mixed methods descriptive study that used the Importance–Performance Analysis (IPA). The quantitative and qualitative data were accessed simultaneously in a semi-structured interview using questionnaires as the guideline. The forty-three doctors as respondents were interviewed from October to December 2021. According to the findings, doctors have used the CPS in collaboration with clinical pharmacists in percentages ranging from 16% to 98%. Furthermore, information on drug regulatory aspects, reconciliation, and drug information services are in Quadrant II, which showed the CPS has performed well. Meanwhile, the information on pharmaceutical and clinical aspects, patient drug history, as well as recommendations and clinical pharmacy intervention, are in Quadrant III. This indicated the respondents did not consider this service to be important. Based on the interview note, increasing the capacity of CPS is important to be done.

Exploring the moderating effects of SIRT1 protein expression and gene polymorphisms rs7895833 on the relationship between hemoglobin levels and physical frailty in elderly adults with comorbid chronic diseases: A moderated mediation analysis

Background: Relationship age, hemoglobin, and physical frailty have all been investigated in older people with more than one chronic disease. There has been little analysis of the relationship between hemoglobin, age, physical frailty, Sirtuin1 (SIRT1) protein expression, and the gene polymorphism (SNP) rs7895833 A&gt;G. The goal of this study was to find out how SIRT1 level, SNP rs7895833, hemoglobin, age, and physical frailty (frail score) are related in older Indonesian adults with comorbid chronic diseases. Methods: This was an observational study. Demographic and clinical data were retrieved from the electronic health records of Universitas Sumatera Utara Hospital, Medan, Indonesia. Physical frailty, SIRT1 level, and SNP rs7895833 were measured using an appropriate and valid method. Purposive sampling was used to determine the eligibility of 132 elderly adults from November 2022 to February 2023. Results: The indirect effect of hemoglobin on the frail score (FS) through age was negative and significant, according to a conditional mediation analysis (β=-0.0731; p=0.023). Meanwhile, the direct effect of hemoglobin on the FS was negative and not significant (β=0.1632; p=0.052). According to the conditional moderated mediation analysis, the size of the direct effect of age on FS was increased by genotype AG-GG and SIRT1 level (βlow=0.2647; p=0.002, βmiddle=0.2956; p&lt;0.001, and βhigh=0.319; p&lt;0.001). The size of the conditional indirect effect of Hemoglobin on FS through age was negative and significantly increased by SNP genotype AG-GG and SIRT1 level (βlow=-0.0647; p=0.032, βmiddle=-0.0723; p=0.024, and βhigh=-0.078; p=0.02). Conclusions: Hemoglobin levels in the blood decrease with age, which might affect elderly people who also have chronic diseases. Higher levels of SIRT1 and the SNP genotype AG-GG can both contribute to this. However, the interactions between these variables are complex, necessitating more research to fully comprehend the mechanisms underlying the development of physical frailty in the aging population.

Profile of patients visiting the emergency departments at Haji Adam Malik and Universitas Sumatera Utara hospitals in Medan, Indonesia

ObjectivesData on the patient profiles and characteristics of emergency department (ED) visits are crucial for enhancing hospital emergency care resources and developing a more effective emergency healthcare unit. The aim of this study was to report the characteristics and trends of pediatric ED visits at Haji Adam Malik (HAM) and Universitas Sumatera Utara (USU) hospitals in Medan, Indonesia, during the year 2020. MethodsThis was a retrospective descriptive study conducted in HAM Hospital and USU Hospital, using patient medical records data extracted from the hospital information systems for the period January to December 2020. ResultsThis study included 3462 pediatric patients as participants. The majority of the patients in this study were male (57.8%), and the most represented age group was 11–18 years (35.8%). Trauma/injury was the most common ED diagnosis at HAM Hospital, whereas unspecified fever was the most common reason for visits to the ED at USU Hospital. The majority of patients attending the ED at HAM Hospital were hospitalized, while the majority at USU Hospital were treated as outpatients. ConclusionsThis study found that the most frequent diagnosis in the ED was trauma/injury at HAM Hospital and unspecified fever at USU Hospital.

COVID-19 survivors: the link between C-reactive protein and psychopathologies

To investigate several psychiatric implications in survivors of coronavirus disease 2019 (COVID-19), while also exploring its correlation with C-reactive protein (CRP), an important non-specific acute phase reactant in infection and in the presence of psychopathologies. This study was conducted in February-June 2021 at Universitas Sumatera Utara Hospital and Haji General Hospital, Medan, Indonesia. In total, 182 patients with COVID-19 admitted for hospital treatment were screened for psychiatric symptoms. Sociodemographic and clinical data, including CRP level, were screened. Anxiety and depression scores were measured using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II), respectively. The same screening was repeated 4 weeks after hospital discharge. Unpaired t-test was used to assess gender differences in clinical data and psychiatric symptoms, and Pearson's correlation test was used to investigate the link between CRP level and the symptoms of anxiety and depression. In terms of psychopathological symptoms, patient-reported rates of insomnia, anxiety and depression were 94%, 78% and 34%, respectively. Females had significantly higher baseline scores for both anxiety (mean ± standard deviation: 23.79 ± 5.44 vs 20.56 ± 4.90 in males) and depression (20.04 ± 5.29 vs 18.56 ± 3.90 in males) (P=0.000). Interestingly, 4 weeks after hospital discharge, female COVID-19 survivors still had higher anxiety scores than male COVID-19 survivors (8.02 ± 4.72 vs 5.20 ± 2.98, respectively) (P=0.0001). During the interview, patients reported that they were worried about experiencing COVID-19 symptoms again (89%), re-infection (56%), and not having proper first aid at home (64%). A higher CRP level was significantly correlated with higher anxiety and depression scores (baseline CRP-BAI: r=0.623; baseline CRP-BDI-II: r=0.680; follow-up CRP-BAI: r=0.632; follow-up CRP-BDI-II: r=0.621; P=0.001). This study found that worse inflammation fostered worse psychiatric symptoms. Therefore, psychiatric liaison is important not only for patients with COVID-19 but also for COVID-19 survivors. Early assessment of COVID-19-related psychopathology is recommended so that treatment can be tailored as early as possible.