Accreditation
SINTA 2Nationally Accredited Journal
Vol. 7 No. 8 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Articles
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Anesthesia Management in A Newborn Baby with Tracheoesophageal Fistula: A Case Report
Views: 871Downloads: 1,021Background: In infants with esophageal atresia/tracheoesophageal fistula, excessive salivation, coughing, choking, cyanosis, and regurgitation associated with attempts to eat may be seen, as well as aspiration of gastric contents. Thus difficulties encountered during anesthetic management include ineffective ventilation due to an endotracheal tube placed in the fistula, massive gastric dilatation, preexisting severe lung disease from aspiration of gastric contents and/or respiratory distress syndrome of prematurity, and associated anomalies, especially cardiac. This study aimed to discuss the anesthetic management of neonates with tracheoesophageal fistula.
Case presentation: The patient was a 12-day-old baby girl with type C tracheoesophageal fistula. Anesthesia was performed using general anesthesia. The procedure lasts 3 hours 15 minutes. The patient underwent closure of the esophageal fistula, repair of the trachea in the distal part of the tracheoesophageal fistula, and performed end-to-end anastomosis proximal and distal esophagus. Postoperatively the patient was treated at the neonatal intensive care unit on a ventilator and given a combination of opioid and non-opioid analgesics.
Conclusion: The key to successful anesthetic management in the operation of a patient with a tracheoesophageal fistula is airway management, where the ETT must be properly placed on the trachea and try not to get the ETT into the fistula.
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Diagnosis and Management of Paraquat Intoxication
Views: 3,001Downloads: 1,530Paraquat poisoning is a clinical toxicological emergency due to the active ingredient of this type of herbicide, gramoxone, with a high mortality rate due to high toxicity, and no antidote has yet been found. Paraquat intoxication can cause multi-organ failure if ingested accidentally or spontaneously because paraquat quickly produces ROS (reactive oxygen species), which causes cell damage through lipid peroxidation, NF-kB activation, mitochondrial damage, and apoptosis in many organs. This results in rapid nephrotoxic and hepatotoxic as well as pulmonary fibrosis. Clinical manifestations depend on the level of paraquat ingested, which can be in the form of local toxicological and systemic toxicological effects. Laboratory tests for diagnosing paraquat toxicity can be used for toxicological analysis of plasma and urine. Management of paraquat intoxication is primarily to remove paraquat from the gastrointestinal tract (prevent absorption) by using activated charcoal, changing the toxicokinetics of the herbicide (increasing serum paraquat elimination) by hemoperfusion and hemodialysis, as well as modifying its toxicodynamics with anti-inflammatory drugs such as immunosuppressants (corticosteroids and cyclophosphamide) and antioxidants (N -acetylcysteine and vitamin C).
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Clonidine as an Adjuvant for Caudal Analgesia in Pediatric Patients Undergoing Infraumbilical Surgery: A Case Report
Views: 634Downloads: 440Background: Caudal block is a popular regional anesthetic procedure used in pediatric patients because it is easy and provides a significant analgesic effect, especially infraumbilical surgeries. Clonidine, an alpha 2 agonist, was previously used for antihypertensives but has recently been found to have analgesic properties, which have been demonstrated in several studies. A number of mechanisms have described how clonidine can exert an adjuvant effect on local anesthetic drugs.
Case presentation: A 6-month-old toddler girl with a planned operation posterior sagittal anorectoplasty. The patient underwent a caudal block with a regimen of 0.25% bupivacaine + 8 mcg clonidine in 10 ml of 0.9% NaCl. Postoperative patient care was carried out in the usual ward with the analgesic regimen of paracetamol syrup 80 mg every 6 hours and ibuprofen syrup 80 mg every 8 hours.
Conclusion: Clonidine, as an adjuvant for the caudal block, has greater benefits than its side effects in pediatric patients undergoing surgery, especially in areas infraumbilical.
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Tracheostomy as an Effort to Help Weaning Ventilated Obese Patient: A Case Report
Views: 964Downloads: 437Background: The prevalence of tracheostomy in the ICU was performed in 10%-15% of patients. Tracheostomy is performed in patients with prolonged intubation. The most compelling indications for tracheostomy are acute respiratory failure with prolonged or expected prolonged duration of mechanical ventilation and failure to wean from a mechanical ventilator.
Case presentation: A 60-year-old female patient came to the emergency room of Dr. M. Djamil General Hospital with decreased consciousness 2 days before admission. Vital signs showed Sopor consciousness, RR: 30 x/min, and BMI: 39 kg/m2. Thorax examination of bronchovesicular breath sounds, rhonchi +/+, wheezing +/+. The patient was intubated and put on a ventilator, and admitted to the ICU. A tracheostomy on day 5 was performed on the patient. The patient was able to be weaned from the ventilator and then admitted to the neurology ward on day 18.
Conclusion: Tracheostomy can help weaning patients from mechanical ventilation. In this case, a severely obese patient can be weaned from the ventilator with a tracheostomy.
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How to Fit Toric Soft Contact Lenses?
Views: 697Downloads: 858Background: Refractive error is the first cause of visual impairment and the second cause of vision loss worldwide. Astigmatism is an eye refraction disorder that is characterized by various degrees of refraction in various meridians. Thus, the parallel rays coming into the eye are not focused on one point. One of the treatments is toric soft contact lenses, which is used in astigmatism patients by 47% with astigmatism above 0.75 D. This case report describes the use of toric soft contact lenses using a trial with markers at 6 o'clock, 3 o'clock, and 9 o'clock for the management of regular astigmatism.
Case presentation: In this paper, we report 3 cases of patients using toric soft contact lenses. The first patient was a 29-year-old male, the second patient was a 24-year-old female, and the third patient was a 25-year-old male with slowly blurred vision in both eyes and had been wearing glasses. The three cases were classified as moderate astigmatism with a power of 1.25 D and 1.50 D. The patients were given toric soft contact lenses for correction. Contact lens fitting was performed on the patient.
Conclusion: Correction of astigmatism can be done by giving glasses, contact lenses, or refractive surgery. If the contact lens axis is suitable, a prescription can be given immediately. If the axis of the toric soft contact lens does not match the available trials, it is necessary to order the size of the toric contact lens according to the astigmatism disorder in the patient's eye.
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Comparing the Optical Coherence Tomography Outcomes of Intravitreal Injection Anti Vascular Endothelial Growth Factor in Branch Retinal Vein Occlusion (BRVO)
Views: 611Downloads: 475Background: BRVO is a blockage of the branches of the retinal vein due to a thrombus. The prevalence of 10-year BRVO is 1.6 per 100 subjects. The effect of anti-VEGF injection on BRVO management is effective in improving visual acuity and reducing macular oedema.
Case presentation: A man, 32 years old, presented to the ophthalmology clinic at the Dr. M. Djamil General Hospital with a chief complaint of blurred vision in his left eye 1 week before admission. The blurred vision began suddenly. Visual acuity in LE was 20/50 and did not advance with a pinhole. Funduscopic examination of LE showed clear media, rounded papillae with well-defined borders, blood vessels aa:vv = 1:3, venous tortuosity (+) increased in the inferotemporal quadrant; retina: Bleeding (+) with dot blot and flame-shaped inferiorly, exudate (+) cotton wool spots at the inferotemporal region; foveal reflex (+)↓ on the macula. OCT LE examination showed macular intraretinal hypo-reflection and macular thickening with a central macular thickness of 617 μm. The physical examination showed a body weight of 114.9 kg, a height of 173 cm, and a body mass index of 38.4. Within 5 months after 3 times administrations of intravitreal injections of anti-VEGF bevacizumab and ranibizumab, visual acuity of LE: 20/25 was obtained, and increased appearance of the retinal fundus and OCT LE.
Conclusion: Intravitreal injection therapy of anti-VEGF bevacizumab and ranibizumab is effective in reducing macular oedema and restoring visual acuity in BRVO.
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Intensive Care Management of Preeclampsia: A Case Report
Views: 1,541Downloads: 649Background: The prevalence of preeclampsia is around 5% - 15% of all pregnant women. It can cause severe complications and even death in the mother and fetus if not adequately managed.
Case presentation: A 36-year-old housewife was admitted to the emergency department with a chief complaint of shortness of breath before hospital arrival. The patient also complained of headaches. From the physical examination, consciousness was compos mentis, blood pressure 162/100 mmHg, HR 90 x/min, RR 24x/min, SpO 96%. From abdominal ultrasound gravid 36-37 weeks according to biometry, fetal alive, gemelli, intrauterine, transverse lie right head dorsoinferior- breech presentation, the Laboratory in emergency room result, haemoglobin: 10,4, leukocyte, 13.020, thrombocyte 359.000, hematocrit 31, ureum: 11, creatinin: 0.5, glucose: 72, protein urine: +2.
Conclusion: In patients with preeclampsia, proper diagnosis and appropriate treatment in the intensive care unit and management by a multidisciplinary team can prevent preeclampsia complications and improve preeclamptic patients' outcomes.
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Head and Neck Sarcomas Characteristics at Dr. Hasan Sadikin General Hospital for 5 Years (2017-2021)
Views: 525Downloads: 338Background: Sarcoma is a malignant neoplasm originating from mesodermal tissue with an incidence rate of 1% of neoplasms throughout the body. Head and neck sarcoma requires more complex management and until now, reviews of this disease are still very rare. This study aimed to report the incidence and characteristics of head and neck sarcoma during 2017-2021 at Dr. Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung.
Methods: Research data was taken from patient medical records through SIRS at Dr. Hasan Sadikin General Hospital during the 2017-2021 period according to the ICD10 of head and neck malignancies and histopathological data.
Results: During 2017-2021, 15 cases of head and neck sarcoma were found, consisting of 9 cases (60%) rhabdomyosarcoma, 2 cases (13.3%) fibrosarcoma, and 1 case each (6.7%) synovial sarcoma, undifferentiated pleomorphic sarcoma, angiosarcoma and dermatofibrosarcoma protuberans. The neck and shoulder area are the most frequently affected site (40%), followed by the scalp (26.7%), maxilla (20%), and oral cavity (13.3%). The highest incidence rates were in female (60%) and children aged <17 years (46.7%).
Conclusion: The incidence of head and neck sarcoma at Dr. Hasan Sadikin General Hospital Bandung is rare. The most frequent cases are rhabdomyosarcoma the most commonly affected areas are the neck and shoulders.
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The Effect of Free Radicals on Vitiligo
Views: 712Downloads: 665Vitiligo is a depigmentation disorder that is commonly found in the community. The causes of vitiligo are multifactorial such as genetic and environmental factors accompanied by the presence of non-specific and specific immune system factors. Melanocytes are the main target exposed by reactive oxygen species (ROS) during the process of melanogenesis. Such exposure can cause loss of homeostasis and cell death and has implications for vitiligo. Clinical manifestations of vitiligo are generally white depigmented macular lesions that are well demarcated. Based on its distribution, vitiligo can be divided into segmental and non-segmental vitiligo different in terms of prognosis, treatment and resolution of vitiligo.
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Pathophysiology and Management of Primary Osteoporosis: A Narrative Literature Review
Views: 1,841Downloads: 1,630The pathophysiology of primary osteoporosis primarily involves changes at the cellular and bone tissue levels. This process involves an imbalance between the activity of bone-destroying cells (osteoclasts) and bone-constructing cells (osteoblasts). Osteoclasts are responsible for the resorption of old and damaged bone tissue, while osteoblasts build new bone. In osteoporosis, osteoclast activity increases and osteoblasts decrease, resulting in loss of bone mass. Treatment of primary osteoporosis involves a holistic approach that includes lifestyle changes, use of medications, and fracture prevention. The main goal of management is to slow down the decline in bone density, prevent bone fractures, and improve the quality of life of sufferers. Increasing your intake of calcium and vitamin D, as well as regular physical exercise, can help maintain bone mass. Meanwhile, drugs such as bisphosphonates and teriparatide can be used to inhibit bone breakdown or stimulate new bone formation.
