Jurnal Klinik dan Riset Kesehatan

Adapting to the Post-COVID Era: Long-Term Impacts, Care Management, & Sustainable Research

Siti Fatma — 2024-02-25

The Differences in INR and D-dimer on Mortality of COVID-19 Patients at RSUD Dr. Saiful Anwar Malang

Claudia Herda Asyari — 2024-02-25

Abstrak

Pendahuluan: Pada Juli 2022, COVID-19 menginfeksi 565 juta orang, dengan 6,3 juta kasus kematian di seluruh dunia. Hubungan parameter laboratorium dengan waktu kematian dan komorbiditas belum banyak diteliti. Studi ini untuk mengetahui perbedaan INR dan D-dimer terhadap mortalitas pasien COVID-19 di RSUD Dr Saiful Anwar Malang.

Metode: Studi kohort retrospektif dilakukan pada April 2020-September 2021, total 229 subjek COVID-19 terdiagnosis swab PCR. Analisis data berupa waktu kematian sejak masuk rumah sakit terbagi menjadi <7 hari dan >7 hari, data laboratorium, data komorbiditas dan tanpa komorbiditas. Uji data dengan Chi Square untuk data kategorik, serta Mann-Whitney, dan Kruskall Wallis untuk data numerik.

Hasil: Pada subjek tanpa komorbiditas, kadar D-Dimer signifikan lebih tinggi pada subjek dengan waktu kematian >7 hari dibanding <7 hari. Pada subjek dengan waktu kematian <7 hari, kadar PT dan INR signifikan lebih tinggi pada subjek dengan komorbiditas dibanding tanpa komorbiditas. Pada subjek dengan waktu kematian >7 hari, kadar D-Dimer dan feritin signifikan lebih rendah pada subjek dengan komorbiditas dibanding tanpa komorbiditas. Secara keseluruhan, kadar INR ditemukan signifikan lebih tinggi pada subjek dengan komorbiditas dibanding subjek tanpa komorbiditas (p<0.05).

Pembahasan: Pada tahap awal COVID-19, dapat terjadi hiperfibrinolisis lokal pada parenkim paru, dan hipofibrinolisis sistemik. Hal ini berujung pada peningkatan D-dimer tanpa diikuti pemanjangan parameter perdarahan, hal ini sesuai dengan subjek waktu kematian <7 hari tanpa komorbiditas. Selain itu, terjadi perubahan kondisi hiperkoagulabel menjadi hiperfibrinolisis akibat konsumsi faktor koagulan yang berlebihan, mengakibatkan meningkatnya PT dan INR pada kondisi COVID-19 yang berat.

Kesimpulan: Secara keseluruhan ditemukan bahwa kadar INR signifikan lebih tinggi pada subjek dengan komorbiditas dibanding tanpa komorbiditas, serta D-dimer pada subjek dengan waktu kematian >7 hari tanpa komorbiditas signifikan lebih tinggi dibanding kelompok subjek lain.

Correlation Between Anxiety Levels and The Incidence of Nocturia among Faculty of Agricultural Technology Students, Brawijaya University during COVID-19 Pandemic

Naura Shafa Pradyaputri — 2024-01-18

Background: Nocturia is the most common and disturbing symptom in lower urinary tract disorders. Younger people, particularly college students, are more affected by nocturia, which can have a negative impact on their academic performance. A study revealed that anxiety often occurs simultaneously with nocturia and has a reciprocal association.

Aim: The purpose of this study is to examine the frequency of nocturia in agricultural technology students during the COVID-19 pandemic and the association between anxiety levels and nocturia incidence.

Methods: Analytic observational study with cross sectional design. The Google form questionnaire contains questions about student characteristics data, the ICIQ-N questionnaire contains the frequency of nocturia and disturbance scores, and the ZSAS questionnaire for anxiety levels. Data analyzed used Chi Square test to analyze the relationship between anxiety level and nocturia.

Results: The results showed that there was an insignificant relationship between anxiety levels (p=0.307). Nocturia is a symptom that is often experienced by students. The disturbing score increases along with the severity of nocturia.

Conclusion: There was a weak association between anxiety level and nocturia.

Unveiling Modern Strategies for Diagnosing and Treating Grave Orbitopathy

Michelle Ujianto — 2024-02-25

Graves' Orbitopathy (GO), also known as thyroid eye disease or thyroid-associated orbitopathy is characterized by inflammation, ocular muscle hypertrophy, adipogenesis, and oedema (due to glycosaminoglycan accumulation). This condition leads to remodeling, tissue expansion, and/or fibrosis within the fibroadipose tissue or extraocular muscles of the orbit. GO manifests as an extrathyroidal aspect of autoimmune thyroid diseases in both Grave's disease (GD) and Hashimoto's thyroiditis.

The pathophysiological foundation of GO entails the infiltration of B cells, T cells, and CD34+ fibroblasts in the orbit. B cells generate IGF (insulin-like growth factor), wherein IGF and TRab (Thyroid-Receptor antibodies) stimulate the IGF receptor complex and thyrotropin receptor (respectively) on the surface of CD34+ cells which triggers orbital tissue expansion, orbital protrusion, optic nerve compression, and eyeball displacement, resulting in exophthalmos.

GO progress through an active phase (characterized by inflammation with visible manifestations), followed by a plateau phase (stabilization of GO manifestations), and a gradual resolution of distinctive residual signs and symptoms (inactive phase). This entire process spans between 18-24 months in untreated patients, where disease manifestations significantly depend on the phase during which the disease is identified.

GO therapy is intended to shorten the active phase and supress its residual eye manifestations during the inactive phase. In general, GO therapy is categorized into general and disease severity-specific approaches.

GO therapy often falls short of providing satisfactory results, prompting need of surgery to address lingering clinical manifestations. This review presents the latest insights into the pathogenesis and treatment of GO for better management and outcomes.

Diagnosis and Management of Glaucoma

Azkiya Zahra — 2024-02-25

Glaucoma is one of the leading cause of irreversible blindness in global population. Glaucoma is usually characterized with elevated intraocular pressure (IOP), optic nerve head damage, and decrease of visual field. Continuously high IOP might compress optic nerve head and retinal ganglion cells, causing an irreversible damage. Based on anatomical changes, glaucoma is classified into open angle glaucoma and angle-closure glaucoma. Current management of glaucoma, consisting of pharmachology treatment, laser treatment, and surgery treatment, is focusing to prevent glaucoma progressivity by managing TIO to achieve target range. New management strategies are currently being developed, in an effort to restore vision lost due to glaucoma.

Challenging Task of Depressive Symptoms Assessment in the Elderly

Siti Fatma — 2024-02-25

Depression is one of the common mood disorder of the elderly, which can reduced the ability to rehabilitate and increased the likelihood of death from physical illnessess. Depressed older adults are less likely to endorse affective symptoms and more likely to display cognitive changes, somatic symptoms, and loss of interest than are younger adults. It is also frequently confused with the effects of multipel illnessess and the medicines use to treat them. Risk factors leading to late life depression are genetic vulnerabilities, cognitive diathesis, age associated neurobiological changes, insomnia, and stressful events. Combination therapy is cognitive behavioral therapy or acceptance and commitment therapy with antidepressant drugs.

Tinea Unguium Caused by Microsporum sp. : A Rare Case

Kaorie Bunga Saviestya — 2024-02-25

Onychomycosis is a fungal infection of the nails that can be caused by dermatophytes, non-dermatophytes, and yeast, while tinea unguium is an infection of the nails caused by the dermatophyte group. Onychomycosis is known to occur in 2-18.5% of the population worldwide where it is 4-20 times more common in toenails than fingernails. In patients with systemic lupus erythematosus, it was reported that 25% experienced nail changes where the most common abnormality was onycholysis. The following is a report of a 27-year-old female patient with complaints of damaged and brittle left toe nails accompanied by itching. From the dermatological examination of the left I-V digiti pedis, discoloration and onychodystrophy were found. Examination of 20% KOH on nail clippings shows long-branched hyphae. The results of the fungal culture showed the growth of Microsporum sp. This case report discusses a rare case of tinea unguium caused by Microsporum sp.

TEVAR Procedure in Classic Chronic Type B Aortic Dissection

Merlita Herbani — 2024-02-25

Introduction : Type B aortic dissection still become health burden that can cost quality of life. In this case, TEVAR procedure still become treatment of choice if indicated. However, TEVAR in chronic type B aortic dissection still often questioned between advantage and complication.

Case Illustration : A 42 year old man with complaints of chest pain, was diagnosed with Chronic Type B Aortic Dissection. The TEVAR procedure is performed on the patient, with clinical and radiological indications. A CT scan evaluation was performed 3 months later and found closure of the false lumen, and the left kidney received collateral vascularization with a reduction in size. Currently the patient does not complain of any symptoms.

Discussion : The TEVAR procedure for chronic type B aortic dissection according to indications can increase the patient's life expectancy. Regular evaluation is still needed for early detection of complications and evaluation of the blood vessels around the stent-graft.

Conclusion : The TEVAR procedure in patients with chronic type B aortic dissection can be considered to increase patient survival.