Jurnal Klinik dan Riset Kesehatan

Do We Need a Nephro-Cardiology Subspecialty?

2024-11-21T02:38:32+00:00

Correlation Between Nocturia and Quality of Sleep in Clinical Year Students of Medical Faculty Brawijaya University during Covid-19 Pandemic

2024-11-21T02:39:41+00:00

Background: Nocturia defined as an individual's complaint of having an urge to urinate during the night, followed by sleep. It is particularly happened in young adults who have a heavy workload. Clinical year students are among the populations with high levels of physical fatigue and stress, which may lead to sleep disorders that might impair the quality of one's sleep. Particularly recently, the Covid-19 pandemic is affecting many parts of people's life, such as the implementation of a lecture system and limitations on the number of hours that clinical year students in Indonesia can work.

Aim: The purpose of this study is to determine the prevalence of nocturia, the quality of their sleep, and the correlation between those two in clinical year students in the Faculty of Medicine at Universitas Brawijaya during the Covid-19 pandemic.

Methods: This is an analytic observational study with cross sectional design and purposive sampling method. This study was conducted in April and May of 2022. According to inclusion and exclusion criteria, 78 clinical year students were selected as the participants in the study. Data analyzed with the Chi-square test for univariate and bivariate data analysis.

Results: Among the 78 respondents, 39 (50%) reported having nocturia and 47 (60.30%) reported having poor sleep quality. The chi-square probability value for the test of the correlation between nocturia and sleep quality was 0.488 (p>0.05).

Conclusion: Clinical year students frequently have poor sleep quality and nocturia symptoms. However there is no association between nocturia and sleep quality.

Left to Right Shunt Congenital Heart Disease with Pulmonary Hypertension Patients’ Characteristics in RSUD Saiful Anwar Malang

2024-11-21T02:40:13+00:00

Background: The worldwide incidence of congenital heart disease (CHD) is estimated at 1.2 million cases out of 135 million live births each year. Pulmonaryarterial hypertension (PAH) is a frequent complication of congenital heart disease (CHD), especially in patients with left-to-right shunt. Adult CHD (ACHD) and ACHD- PAH patients present to health facilities in late phase conditions, because the early- stage symptoms are very uncommon, as a result the treatmentbecomes more difficult with a poor prognosis. Until now, there’s no national registry of ACHD and ACHD- PAH in Indonesia.

Aim: Describe the demographic characteristics, clinical presentation, supporting examination findings, management, complications, and outcomes of ACHD and ACHD-PAH populations in Malang.

Methods: Left to Right Shunt and Pulmonary Hypertention Registry is an observational study of adult patients (aged ≥ 18 years) diagnosed with left to rightshunt CHD and PAH at Saiful Anwar Hospital Malang. This study evaluated patients from November 2022 - October 2023 consecutively. Patients underwent a series of examinations including clinical examination, ECG, chest X-ray, SMWT, laboratory examination, transthoracic echocardiography and right heart catheterization.

Results: Total sample of this registry is 124 samples. The majority of sample is young adult woman and ASD is the most common ACHD defect. The majority of sample (83.0%) is with symptoms with NT pro BNP median is 548 (152.1 – 2550.5). The majority of sample was WHO functional class II

Conclusion: LET SHINE Registry is the first ACHD and ACHD-PAH in East Java Province which depict demographic, clinical presentation, hemodynamicpresentation pf ACHD and ACHD-PAH patient.

Relationship Between The Compliance of Antiretroviral Therapy and The Occurrence of Underweight Conditions, Calf Circumference, Handgrip Strength, and Triceps Skinfold in HIV/AIDS Patients at RSSA Malang

2024-11-21T02:40:41+00:00

Background: Human Immunodeficiency Virus or commonly known as HIV is a virus that infects CD4 cells thereby impaired the human immune system. The number of new HIV cases in Indonesia in 2019 was reported to have reached 50,282 cases and tends to increase from year to year. What often happens in people with HIV/AIDS (PLWHA) tends to experience weight loss accompanied by opportunistic infections that do not occur in normal people. Adherence to therapy is the main factor that must be emphasized by PLWHA in order to achieve treatment success. However, ARV therapy adherence rates are reported to be <80%. This number can be a predictor of therapy failure. One indicator of the success of therapy is when there is clinical improvement in the patient's condition, such as no opportunistic infections or weight gain.

Aim: The aim of this study was to determine whether there is a relationship between adherence to antiretroviral therapy and underweight conditions in HIV/AIDS patients.

Methods: This study used a cross sectional design with an analytical observational nature and the research subjects were patients at RSSA Malang who visited from June to August 2023.

Results: The results of the study showed that there was a significant relationship between adherence to taking ARVs and being underweight (p=0.018) and there was no significant relationship between adherence to taking ARVs with calf circumference, handgrip strength, and triceps skinfold.

Conclusion: The conclusion of this study is that the more compliant the patient is with ARV therapy, the higher the increase in body mass index and the smaller the possibility of becoming underweight.

Hemangioma in Children: Literature Review

2024-11-21T02:40:56+00:00

Hemangioma is a vascular anomaly that is benign and generally occurs in children. ISVVA 2018 classifies vascular anomalies into two categories, namely vascular malformations and vascular tumors (hemangioma). The prevalence of hemangioma is higher in low birth weight babies, premature babies, and girls. Several theories suggest that hemangiomas are caused by vasculogenesis and angiogenesis or an imbalance between angiogenic and antiangiogenic factors. Hemangiomas grow through a proliferation phase, involution phase, and post-involution phase. Hemangioma classification is based on the depth of the lesion, time of appearance of the lesion, distribution of the lesion, and its relationship to syndrome complication.. Diagnosis of hemangioma is based on anamnesis, physical examination, and supporting examinations which include USG, MRI, and CT-Scan. Hemangiomas that lead to complications should require immediate treatment. Hemangioma treatment can be done with topical therapy, systemic therapy (propranolol, corticosteroids, β-blockers, vincristine, rapamycin), laser therapy (PDL, diode, Nd: YAG, argon, KTP, CO2, IPL), and other treatments consisting of from surgical and non-surgical procedures (bleomycin injection).

In-Depth Review of the Influence of Renal Insuficiency on Major Adverse Cardiovascular Event (MACE) and Mortality in Patients with Acute St-Segment Elevation Myocardial In- farction (STEMI)

2024-11-21T02:41:11+00:00

The widespread implementation of invasive procedures such as coronary angiography and primary percutaneous coronary intervention (PCI) into the routine management of patients with acute ST-segment elevation myocardial infarction (STEMI) in the last 10 years has led to a significant improvement in patient prognosis. At the same time, this also raises new problems and questions, mostly related to the fact that there are many elderly patients and/or patients with comorbidities who need to undergo this invasive procedure. One of the most important comorbidities is renal insufficiency. STEMI patients with renal insufficiency typically present with more extensive atherosclerotic lesions, including diffuse coronary calcification, which poses a challenge to the interventional cardiologist due to a higher risk of periprocedural complications, higher risk of restenosis, major adverse cardiovascular event (MACE) , and patient mortality. This review discusses in depth the influence of renal insufficiency on MACE and mortality in STEMI patients.

Keywords: renal insufficiency, STEMI, MACE, mortality.

The Effect of Exercise Training on Inflammatory Marker Levels in Pulmonary Hypertension Patients

2024-11-21T02:41:31+00:00

Pulmonary hypertension (PH) is characterized by pulmonary vascular dysfunction, which can lead to right heart failure and death, as well as the accumulation of inflammatory cells in the perivascular area. Chronic inflammation plays an important role in the pathophysiology of pulmonary hypertension. Inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) are often elevated in patients with pulmonary hypertension. The accumulation of inflammatory cells accelerates the remodeling process of pulmonary blood vessels and pulmonary hypertension. Despite the current therapeutic approaches for pulmonary hypertension (PH), which aim to improve functional capacity and hemodynamics, pulmonary hypertension remains incurable but remains controllable. Inflammatory processes play a critical role in progressive pulmonary hypertension. Physical exercise can reduce the risk of chronic disease, and recent research has shown that it improves inflammatory marker profiles. This literature review aims to combine evidence on the influence of physical exercise on levels of inflammatory markers in patients with pulmonary hypertension.

L2 Acute Lymphoblastic Leukemia With Tumor Lysis Syndrome

2024-11-21T02:41:45+00:00

Background: Tumor lysis syndrome is metabolic abnormalities due to accumulation of intracellular contents in systemic circulation. Cairo and Bishop criteria is used to diagnosing it. Patient with hematological malignancies such as acute leukemia is more prone to this syndrome, and also infection that comes with it. Evaluating tumor lysis syndrome, especially knowing which laboratory parameters used and probable complication are crucial.

Case Report: Two years old boy undergone maintenance chemotherapy for his ALL L2 that has been diagnosed one year ago. Patient has no complaint at admission, but went to worsened condition as the chemotherapy was given. Electrolyte imbalances and clinical manifestations depicting tumor lysis syndrome was found. Patient also experiencing pneumonia, gastrointestinal tract infection and sepsis (PELOD score 15).

Conclusion and Suggestion: Patient experiencing tumor lysis syndrome when he was going through maintenance chemotherapy. Even though he was admitted without any major complaints, but hyperuricemia and elevated creatinine at the time of admission should be considered before initiating chemotherapy. Sepsis in this patient might be cause by bacterial infection of the gastrointestinal tract due to his severe neutropenia condition.

Acute Limb Ischemia in a Nephrotic Syndrome Patient: A Rare and Unpredictable Complication

2024-11-21T02:41:58+00:00

Background: Acute Limb Ischemia ALI requires urgent intervention to avert irreversible tissue damage, with treatment complexity increasing in patients with nephrotic syndrome.

Case Presentation: A 23-year-old female with nephrotic syndrome presented acute right leg pain. Examination showed erythema and a cold sensation in the affected leg. Ultrasound revealed no blood flow in certain leg arteries. Despite multiple thrombectomies and heparin treatment, only minimal improvement was observed. The patient underwent a below-knee amputation after unsuccessful attempts to restore blood flow. Her condition worsened with new vascular occlusions, requiring Catheter Direct Thrombolysis CDT. Post-CDT, she suffered severe bleeding, hemorrhagic shock, cardiac arrest, and multi-organ complications, leading to her death on treatment day 35.

Discussion: This case illustrates the complexities of managing ALI in patients with nephrotic syndrome, which increases hypercoagulability and vascular complication risks. It highlights the need for an integrated nephrology and vascular approach, considering the high risks of hemorrhagic and thrombotic complications. A comprehensive and multidisciplinary treatment strategy is crucial, especially with vigilant monitoring for severe complications like infection and sepsis, to enhance treatment outcomes in similar cases.

Conclusion: This case of a 23-year-old woman with ALI and nephrotic syndrome presented significant treatment challenges. Despite numerous interventions, including thrombectomies and CDT, severe complications ensued, emphasizing the need for comprehensive management and further research in similar complex conditions.