Jurnal Klinik dan Riset Kesehatan

The Future of Chronic Disease Management: Transforming New Trends from Diagnostic to Rehabilitation

Siti Fatma — Mon, 24 Feb 2025 03:20:09 +0000

Progression Free Survival in Lung Cancer Adenocarcinoma Wild Type Patients with Pemetrexed Regimen Combination of Cisplatin compared to Carboplatin

Ungky Agus Setyawan, Catur Purnamawati, Suryanti Pratiwi — Tue, 25 Feb 2025 00:00:00 +0000

Background: Progression-free survival (PFS) is a parameter to measures the progression of wild type adenocarcinoma lung cancer. Literature studies have shown that the combination platinum based-pemetrexed chemotherapy is more effective to prolonged progressivity of wild type adenocarcinoma.

Aim: The aim of study to compared the PSF of wild type adenocarcinoma patients receiving cisplatin-pemetrexed and pemetrexed-carboplatin regimens at Dr. Saiful Anwar Hospital in 2018-2021.

Methods: A retrospective cohort study based on medical record of wild type adenocarcinoma patients.

Results: The results showed that the administration of a carboplatin-pemetrexed regimen has prolonged PFS (median 4 months, 95% CI 2.657-5.343) compared to the cisplatin-pemetrexed regimen (median 2 months, 95% CI 0.988-3.012). In addition, the risk of lung cancer progression based on PFS is not significantly influenced by the Karnofsky scale value of 70-80 (72.2%, HR 0.278). On the other hand, a history of smoking increases the risk of lung cancer progression, although it does not have a significant effect (HR 1,538).

Conclusion: Administration of the carboplatin-pemetrexed regimen prolongs PFS up to a range of 10-16 months, although there is no statistically significant difference compared to the cisplatin-pemetrexed.

Physiotherapy Program Profile for Stroke Inpatients Based on NIHSS at Dr. Saiful Anwar General Hospital Malang in January-March 2023

Fatma Izzati, Catur Setianto — Sun, 25 Feb 2024 00:00:00 +0000

Introduction: Stroke is one of the highest causes of disability in the world. Indonesia already has guidelines for stroke rehabilitation, but the implementation of these guidelines in hospitals in Indonesia is rarely studied.

Purpose: This study aims to determine the profile of the physiotherapy program in post-acute phase stroke patients who are hospitalized at Dr. Saiful Anwar General Hospital Malang in January-March 2023 based on the National Institutes of Health Stroke Scale (NIHSS).

Methods: The study was conducted using a descriptive-quantitative method. Data taken from the electronic medical records of Dr. Saiful Anwar Malang in January-March 2023.

Results: There were 129 stroke patients who met the inclusion criteria consisting of 56.6% men and 43.4% women, with the most age range being 51-60 years (34.88%). The highest stroke severity was severe stroke (NIHSS 21-42) as much as 34.88%, then moderate stroke (NIHSS 5-15) as much as 31.01%, moderate-severe stroke (NIHSS 16-20) 19.38%, and mild stroke (NIHSS 1-4) 14.73%. Almost all patients in all levels of severity received proper positioning, gradual mobilization, and chest physical therapy (the smallest percentage was 73.68% in mild stroke). Apart from these three interventions, for mild stroke, the most rehabilitation intervention given was AAROM exercise (57.89%), for moderate stroke was AROM exercise (62.5%), for moderate-severe stroke was PROM exercise (72%) , in severe stroke is PROM exercise.

Conclusion: All stroke patients at all severity levels receive proper positioning, gradual mobilization, and chest physical rehabilitation, but motor, sensory, cognitive, and other physioteherapy programs for patients differ depending on the severity.

The Correlation of Platelet Levels with the Extent of the Lesion of Pulmonary Tuberculo¬sis from Chest X-Ray Photos

Yohanes Audric Alimsjah, Yuyun Yueniwati, Rafiq Sulistyo Nugroho — Tue, 25 Feb 2025 00:00:00 +0000

Background: Pulmonary tuberculosis (TB) is a chronic inflammatory disease accompanied by changes in particular haematological parameters within the blood. The changes in the composition of blood cells can be potential biomarkers to assist tuberculosis diagnosis beside using clinical, microbiological, and radiological tools. Platelets play a vital part in chronic inflammation since they contain different sorts of mediators that are involved in lung damage which is reflected in the extent of lesions on radiological examination.

Aim: The research aims to compare the platelets level between minimal/moderate versus extensive lesions in the patient with TB.

Methods: The research was a retrospective, cross-sectional study of patients with pulmonary tuberculosis who were treated at Saiful Anwar Hospital from January 2022 to December 2023. The results of the research were analyzed using the Chi-Square method.

Results: Patients with extensive pulmonary TB lesions have platelet levels that tend to be high, in contrast to patients with minimal/moderate pulmonary TB lesions tend to have low platelet levels.

Conclusion: There was a significant relationship between platelet levels and the extent of pulmonary tuberculosis lesions.

Cardiovascular Risks in Radiation Therapy: A Clinical Overview of Radiation-Induced Heart Disease

Andre Tegar Widhianto — Tue, 25 Feb 2025 00:00:00 +0000

Radiotherapy, which has become a pivotal part of cancer treatment over the past 50 years, has indeed proven to increase patient cure rates. However, despite its success, radiotherapy also carries inevitable side effects on the cardiovascular system, specifically radiation-induced heart disease (RIHD). RIHD encompasses a variety of heart diseases, including pericardial disease, coronary artery disease, valvular heart disease, conduction system abnormalities, cardiomyopathy, and vascular disease of medium or large vessels. These side effects can result from the direct impact of radiation on the function and structure of the heart or by accelerating the progression of pre-existing cardiovascular diseases, especially in patients with prior cardiovascular risk factors. Scientists have now developed non-invasive methods to detect RIHD. Additionally, various efforts are being made to prevent and minimize RIHD. This review delves deeper into the pathogenesis, clinical manifestations, diagnosis, management, and prevention of RIHD.

The Role of Supervised Exercise Therapy of People With Lower Extremity Peripheral Artery Disease

Defyna Lestari, Cholid Tjahjono — Tue, 25 Feb 2025 00:00:00 +0000

Peripheral arterial disease is a disorder caused by decreased blood flow to the extremities. The process of atherosclerosis generally causes it and manifests as claudication. In addition to optimal medical and endovascular therapy, non-pharmacological management of PAP has been proven to be effective in reducing symptoms and improving walking ability and quality of life. Walking exercise can increase blood flow, which allows oxygen and nutrients to reach the muscles more efficiently and triggers the angiogenesis process. Supervised exercise programs in PAP patients are considered important as primary therapy to improve functional capacity and quality of life for long-term management.

Non Invasive Imaging Modalities in Chronic Coronary Syndrome

Pratiwi Indrihapsari, Sasmojo Widito — Tue, 25 Feb 2025 00:00:00 +0000

Advancements in non-invasive cardiovascular imaging technology have introduced robust diagnostic modalities for managing cardiovascular diseases. Three prominent techniques in this domain are stress echocardiography, coronary computed tomography angiography (CCTA), cardiac magnetic resonance imaging (CMR), Single Photon Emission Computed Tomography (SPECT), and Positron Emission Tomography (PET). These modalities provide crucial information for accurate diagnosis and optimal therapeutic planning. Stress echocardiography occupies a strategic position in the diagnostic algorithm, particularly in suspected or confirmed cases of coronary artery disease. The strength of this modality lies in its ability to provide a comprehensive picture of myocardial functional status. Meanwhile, CCTA offers superiority in visualizing and characterizing atherosclerotic plaques in coronary vessels, enabling early detection and more precise risk stratification. This literature review aims to explore critical aspects of non-invasive cardiovascular imaging modalities in the context of diagnosing Chronic Coronary Syndrome.

Deffered Stenting in High Thrombus Load: A Case Report

Catur Kurniawan, Sasmojo Widito, V.Y.S Putri — Tue, 25 Feb 2025 00:00:00 +0000

Direct stent implantation is widely recommended for the management of patients who have acute myocardial infarction with ST-segment elevation. However, in situations where there is HTB in the affected artery, stenting may increase the risk of no flow phenomenon. Delaying stenting may reduce complications.

A 45-year-old man presented with symptoms suggestive of acute right ventricular infarction that started 8 hours before admission. The patient underwent an echocardiogram which showed an ejection fraction of 36%. Pre-PCI pharmacotherapy was administered. Coronary angiography showed a grade IV occlusion in the mid-LAD branch as well as a thrombus in the mid-RCA with TIMI 2 flow. Thrombus aspiration and balloon inflation were performed, but HTB persisted. DS was decided, with additional Enoxaparin 0. 6 cc twice daily. Subsequent angiography after 34 hours, showed CAD in three coronary artery branches with the RCA still showing complete occlusion with HTB. A stent implantation procedure was performed in the mid-RCA segment The final result achieved was TIMI 3 blood flow, with no residual stenosis.

HTB can also be diagnosed based on the TIMI thrombus risk classification. The main goal of deferred stenting is to minimize complications such as the slow-flow phenomenon of distal embolization.

It is important to emphasize that a routine DS strategy has not shown clear benefit and is not recommended.

Diagnosis and Management of Upper Airway Obstruction (Jackson 1) due to Diphtheria Infection in a Pregnant Women

Tue, 25 Feb 2025 00:00:00 +0000

Diphtheria is an infectious disease caused by Corynebacterium diphtheria, which generally causes inflammation of the airways, leading to severe symptoms that can be life-threatening. Indonesia is listed as one of the ten countries with the highest cases of diphtheria worldwide. However, studies on cases of diphtheria infection, especially in the pregnant women population, have rarely been reported.

A 28-year-old woman presented with shortness of breath. Complaints accompanied by difficulty swallowing and speaking. The patient had a child who died due to similar symptoms. Signs of airway obstruction are found as inspiratory stridor and suprasternal retraction, pseudomembranes in the pharynx, and subcutaneous crepitation in the colli. Diphtheria infection was confirmed through a throat swab examination with Neisser staining and culture. In addition to isolation, the patients were administered oxygen therapy, anti-diphtheria toxin, penicillin procaine, dexamethasone, and additional supportive therapy.

Diphtheria infection is transmitted through direct contact, droplets or contaminated items. Manifestations of laryngeal diphtheria generally come from the extension of tonsillar-pharyngeal diphtheria symptoms, including sore throat, hoarseness, and advanced respiratory obstruction. A definite diagnosis is made by isolating the bacteria or finding an increase in serum antibodies. Therapies targeting infectious conditions and supporting obstetrics help improve the overall patient condition.

Diphtheria is a highly contagious and potentially fatal disease, especially for pregnant women; thus, immediate diagnosis is needed. Isolation and appropriate management alleviate upper airway obstruction. Diphtheria management should include both curative therapy and preventive to protect the community further and prevent outbreaks from emerging.