Accreditation
SINTA 2Nationally Accredited Journal
Vol. 8 No. 2 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Articles
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One-Way Valve as Management of Chest Tube Ambulation in Pneumothorax Cases
Views: 825Downloads: 1,025An adequate chest drainage system is the main goal of fluid and air evacuation and restoring negative pressure intrapleural so it can help lung development. The intrapleural is a closed, airtight space filled with a small amount of fluid as a lubricant for lung movement during the breathing process. Accumulation of intrapleural air is known as pneumothorax, and one of the initial management options is the implantation chest tube. Chest tubes, which are connected to a water seal, conventionally show varying results and have shortcomings because they require monitoring and limit patient mobility, so the safety of their use in outpatient settings is questionable. Lungs that are not inflated or have an inflated water seal still show air bubbles even though it has been installed. A chest tube adequate for 48 hours is a condition known as persistent air leak, thus requiring extended usage time from chest tube to the drainage management complex. Use of ambulation management through the use of various tools and equipment devices which can be connected with a chest tube can be an option with the aim of reducing treatment time, lowering funding, increasing comfort and hopefully providing better external results.
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Prognostic Factors for the Occurrence of Recurrent Major Adverse Cardiac Events after Isolated Coronary Arterial Bypass Graft
Views: 612Downloads: 370Background: Coronary heart disease (CHD), commonly known as coronary artery disease (CAD), is a heart disorder that occurs when the arteries supplying blood to the heart walls experience hardening and narrowing, leading to a reduced supply of oxygen and nutrients to the myocardial tissue due to limited coronary blood flow. The treatment of CHD requires revascularization or reperfusion procedures on the coronary blood vessels responsible for supplying the heart muscle. One recommended therapy is coronary artery bypass grafting (CABG). Patients post-CABG are at risk of experiencing major adverse cardiovascular events (MACE).
Methods: This design is a cross-sectional study involving all patients who underwent CABG at Siloam Hospitals in Lippo Village and Kebon Jeruk from January to June 2023. Data analysis using a regression approach aims to evaluate the relationship between various prognostic factors and MACE occurrences, thereby identifying a cross-sectional association between these variables and MACE events.
Results: Findings from this cross-sectional study indicate a correlation between overweight and the occurrence of recurrent MACE in patients with a history of CABG (p-value = 0.037). These results suggest that individuals with obesity undergoing CABG have a higher risk of experiencing recurrent MACE in CHD.
Conclusion: The prognostic factor for recurrent CHD-related major adverse cardiovascular events (MACE) is body mass index (BMI). Monitoring body mass index (BMI) in CHD patients who have undergone CABG is essential to reduce the risk of recurring MACE in the future.
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Axillary Plexus Block for Anesthesia Management in Patients with Acute Compartment Syndrome after Primary Percutaneous Coronary Intervention (PCI) Transradial Approach: A Case Report
Views: 538Downloads: 339Background: Acute compartment syndrome is a rare complication of the percutaneous Coronary Intervention (PCI) transradial approach but it is very hand-threatening. Treatment for acute compartment syndrome is emergent fasciotomy of the affected compartments to reduce intracompartmental pressure. Axillary plexus block is an excellent choice of anesthesia technique for elbow, forearm, and hand surgery.
Case presentation: An 80-year-old, 60 kg, 168 cm man was consulted to our department with a painful swelling on his right upper arm and hand that began three hours after a primary PCI procedure. Previously, the patient had a history of hypertension and diabetes mellitus. The supporting examination results were notable for anemia (Hemoglobin 7,5 g/dL), thrombocytopenia (78 x103/uL), elevated hemostasis function (International Normalized Ratio 1.43), and high blood sugar (360 mg/dL) from echocardiography results anteroseptal and lateral hypokinetic. Before we did block, the patient was given ketamine 10 mcg IV and fentanyl 25 mcg IV for sedation. Axillary plexus block, as a type of regional anesthesia under ultrasound guidance, is a reliable substitute for general anesthesia in high-risk patients, and we do it with a dose of 20 ml of solution (50 mg (10 ml) isobaric bupivacaine 0.5% + 200 mg lidocaine 2% diluted with 20 ml normal saline). During the surgery, the patient was hemodynamically stable. After the operation, the patient was readmitted to the intensive cardiac care unit (ICCU).
Conclusion: Axillary plexus block can be an alternative to general anesthesia in patients who will undergo fasciotomy surgery after percutaneous coronary intervention transradial approach with stable hemodynamics during surgery and well-controlled pain after the surgery.
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The Role of Invasive Hemodynamic Monitoring in Patients with Severe Mitral Regurgitation Undergoing Herniorrhaphy Operation
Views: 526Downloads: 334Background: Mitral regurgitation (MR) indeed presents challenges during noncardiac surgeries, especially as the severity of MR tends to increase with age and poses a higher risk of perioperative complications. Accurate hemodynamic monitoring becomes crucial in these cases to manage potential complications effectively. However, the standard monitoring in MR conditions during operation, such as TEE, is not always available, but there are other options for invasive monitoring, such as arterial lines, which provide accurate hemodynamic monitoring.
Case presentation: A 64-year-old, male, presented with Reponible Lateral Inguinal Hernia with comorbid of severe mitral and tricuspid regurgitation alongside congestive heart failure. The patient was premedicated with fentanyl 25 mcg intravenously, followed by oxygen supplementation with 3 lpm nasal cannula and insertion of the arterial line. Anaesthesia was performed using a lumbar epidural technique, with the insertion of an epidural catheter in the L1-L2 intervertebral space, Reponible Lateral Inguinal Hernia. The local anesthesia agent chosen was plain bupivacaine with a concentration of 0.5% and a volume of 8 ml. The onset of action of epidural anesthesia is achieved within 20 minutes as long as the operation reaches a total blockade as high as T8. The patient is monitored with standard monitors and an artery line during surgery. There were no complaints of shortness of breath, chest heaviness, or chest pain felt by the patient during the operation.
Conclusion: Epidural anesthesia technique can provide stable hemodynamics in patients with severe mitral-tricuspid regurgitation and congestive heart failure and hemodynamic monitoring plays an important role postoperatively to prevent further deterioration and maintain stability.
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Risk Factors of In-Hospital Mortality of Ischemic Stroke Patients in Gunung Jati General Hospital
Views: 560Downloads: 302Background: Stroke is the leading cause of death and the most significant contributor to disabilities worldwide. Predicting the mortality of stroke patients and giving optimal care remain challenges in developing countries like Indonesia. In this study, we aimed to identify factors associated with in-hospital mortality after acute ischemic stroke.
Methods: The study conducted a retrospective cohort of cerebral infarct patients administered in 2022 to Gunung Jati General Hospital, West Java, Indonesia. This study included hospitalized patients with a clinical history of stroke confirmed by a CT scan or MRI. The clinical data, radiology, and laboratory tests were collected at admission or within 24 hours after admission.
Results: This study involved a total of 92 ischemic stroke patients with a median age of 62. The most prevalent comorbidities were dyslipidemia (93.5%), hypertension (83.7% of patients), and concomitant infection (50%). Patients who experienced in-hospital mortality had a significantly higher number of comorbidities, such as chronic kidney disease, concomitant infection, and atrial fibrillation. Statistically higher neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were also shown in non-survived patients. Ischemic stroke patients with concomitant infection and atrial fibrillation, respectively, had 6.679 (aOR: 6.679, 95% CI 1.802-27.029) and 6.904 times (aOR: 6.904, 95% CI 1.290-36.959) greater to have in-hospital mortality.
Conclusion: Concomitant infection and atrial fibrillation were associated with in-hospital mortality in ischemic stroke patients at Gunung Jati General Hospital. The findings indicated the importance of identifying timely management for improving better outcomes.
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Bronchoalveolar Lavage in Interstitial Lung Disease: A Narrative Literature Review
Views: 577Downloads: 574Establishing a diagnosis of interstitial lung disease (ILD) is very important because the diagnosis of ILD is often missed with other lung diseases. Apart from clinical diagnosis of ILD, other tests are also required, such as a lung biopsy, which can be done using open lung biopsy but has high mortality and morbidity rates. Apart from that, lung biopsy can be done using video-assisted thoracoscopy (VATS) and transbronchial biopsy, but it is relatively more expensive compared to examination bronchoalveolar lavage (BAL), which is another diagnostic approach of ILD. Bronchoalveolar lavage is performed using a flexible fiber bronchoscope (fiberoptic bronchoscopy), which has a lower morbidity and mortality rate.
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Anesthesia Approach for Nephrectomy in Full-Term Neonate with Suspected Wilms Tumor and Patent Foramen Ovale: A Case Report
Views: 681Downloads: 342Background: Nephrectomy for Wilms tumor presents a considerable challenge in pediatric anesthesia. This study aimed to describe the anesthesia approach for nephrectomy in a full-term neonate with suspected Wilms tumor and patent foramen ovale.
Case presentation: A 25-day-old male neonate was referred with a longstanding intraabdominal mass present since birth. Echocardiography revealed a patent foramen ovale with a diameter of 2.7 mm and a left-to-right shunt. The patient also had a diagnosis of partial ileus obstruction, likely caused by the tumor's pressure on the left kidney. Preoperative fasting adhered to a "6-4-3-1" regimen. Normoglycemia was maintained throughout the perioperative period. The case was managed under general anesthesia without the use of the rapid sequence induction technique. Caudal analgesia was administered using 1.14 ml of 0.175% bupivacaine. Vigilant monitoring of blood loss, prevention of hypothermia, and effective pain management are vital aspects of the surgical procedure. For postoperative pain management, analgesia and morphine infusion were employed. The patient was then transferred to the neonatal intensive care unit (NICU) for observation for any signs of complications related to anesthesia and surgery.
Conclusion: Nephrectomy in neonates is one of the challenges of pediatric anesthesia. Pre-anesthesia preparation in relation to hypertension control, analgesia plan and postoperative care site, transfusion strategy, and management of intravascular extension.
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Intraoperative Fluid Management Correlates with Intraoperative Complications in Cesarean Section: A Prospective Clinical Trial
Views: 699Downloads: 421Background: This study focused on perioperative fluid administration in pregnant women undergoing a caesarean section (CS) by comparing liberal and non-liberal fluid administration in a multicentre setting across various Hospitals in the Bali province and its surrounding areas.
Methods: Sampling was conducted using a total sampling method. All patients meeting the inclusion criteria were included in this study. A total of 310 samples of pregnant patients undergoing CS surgery in various operating rooms across hospitals in the Bali province and surrounding areas were obtained during the period of January to December 2022. The fluid administration strategy was divided into two types: liberal and non-liberal. Data analysis was performed using the Chi-square test with the correlation test of the contingency coefficient.
Results: The results showed that liberal fluid administration significantly increased complications in the operating room for pregnant patients undergoing cesarean section (p<0.001; r=0.305; OR 6.22) but not in the recovery room or postoperative hospital ward.
Conclusion: Liberal fluid administration could significantly increase complications in the operating room for pregnant patients undergoing cesarean section but not in the postoperative period.
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Pain Management in Blast Crisis Phase of Chronic Myeloid Leukemia: A Case Report
Views: 980Downloads: 532Background: Chronic myeloid leukemia (CML) is a slow-growing type of cancer that begins in the bone marrow's blood-forming cells and is caused by a chromosomal mutation that is assumed to develop spontaneously. As CML advances into the rapid or blast phase, it can cause significant pain. This study aimed to describe pain management in the blast crisis (BC) phase of CML.
Case presentation: A 48-year-old female diagnosed with CML in the BC phase complained of severe pain in the head, shoulders, back, and tailbone area with a numeric rating scale (NRS) of 9/10. The patient received multimodal analgesic therapy with continuous IV fentanyl at a rate of 0.25 mcg/kg/hour and ketamine at 1.3 mcg/kg/minute for 24 hours. The dosage was gradually increased through titration with a target NRS of 4/10. On the fifth day, we replaced fentanyl with morphine at 0.04 mg/kg/hour and ketamine at 1.3 mcg/kg/minute, and we reduced the titration dose according to the patient’s NRS, and her pain was controlled with NRS 3-4/10 after 7 days of treatment. On the 9th day, she was discharged with oral therapy.
Conclusion: Multimodal analgesia has been shown to effectively reduce the intensity of the pain in blast crisis phase.
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Management of Critically Ill Patients with Severe Diabetic Ketoacidosis and Acute Renal Failure: A Case Report
Views: 808Downloads: 648Background: Diabetic ketoacidosis (DKA) is one of the hyperglycemic crises related to diabetes. The main problem in DKA is ketogenesis, a metabolic process that increases the production and decreases the utilization of ketones. DKA is characterized by a biochemical triad such as hyperglycemia, ketonemia, and high anion gap metabolic acidosis. Management of DKA needs to be carried out appropriately and immediately because it may lead to diabetic coma and death.
Case presentation: A 38-year-old woman had decreased consciousness due to metabolic encephalopathy as a complication of severe DKA. The metabolic derangement shows an overlapping high anion gap metabolic acidosis and non-anion gap metabolic acidosis. This case is complicated by acute renal failure. The patient also had been in a hypovolemic state, causing pre-renal acute kidney injury. We treat the patient using a balanced solution to correct hypovolemia. Sonography of the vena cava and blood lactate levels are used to guide fluid resuscitation. We intubate and control the patient's breathing to reduce the metabolic demand. We titrate the insulin infusion until the ketogenesis process is abolished. Antibiotics are given based on sputum culture.
Conclusion: Acute renal failure (ARF) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA). Early recognition and aggressive treatment of ARF during DKA may improve the prognosis of these patients.
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Effectiveness of Nigella sativa Addition against TNF-Alpha in Stage III and IV Breast Cancer Undergoing Doxorubicin and Cyclophosphamide Chemotherapy at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
Views: 1,043Downloads: 573Background: Breast cancer is a malignancy caused by the continuous uncontrolled growth of the component cells of the ducts or lobules of the breast gland. Globally, breast cancer is the second leading cause of death in women. Nigella sativa contains substances thymoquinone. Thymoquinone can inhibit the progression of cancer through anti-inflammatory, anti-oxidant mechanisms, inhibit proliferation, trigger apoptosis, and prevent angiogenesis. Chronic inflammation in breast cancer is mediated by one of them is TNF-alpha tumors. Elevated levels of TNF-α have a significant association with poor prognosis and progression of breast cancer. This study aims to determine the effectiveness of the additional Nigella sativa in declining TNF-α levels in breast cancer patients at Dr. Mohammad Hoesin General Hospital Palembang.
Methods: This research used a randomized, open clinical trial design, which was carried out at the internal medicine hematology-oncology medical polyclinic and the surgical oncology polyclinic of Dr. Mohammad Hoesin General Hospital Palembang from January 2023 to October 2023. Data processing for data analysis used SPSS version 26 for Windows.
Results: There were 36 research subjects followed during the study period and received Doxorubicin chemotherapy and cyclophosphamide (AC), which were divided into treatment groups of 18 people (chemotherapy with the addition of Nigella sativa @600 mg 2x2 capsule/ day and a control group of 18 people. A TNF-alpha examination was carried out before and after to assess the comparison before and after. From the results, it was found that TNF-alpha levels in the treatment group showed a decrease in TNF-alpha with a p-value <0.001.
Conclusion: The addition of Nigella sativa has the effect of reducing TNF-alpha in breast cancer patients receiving AC chemotherapy at Dr. Mohammad Hoesin General Hospital, Palembang.
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Flexi-rigid Pleuroscopy in Diagnostics of Malignancy: A Narrative Literature Review
Views: 546Downloads: 405Pleuroscopy is a less invasive treatment that allows access to the pleural cavity with the use of both visual and surgical equipment. This technique can be conducted with local anesthesia and mild sedation. Pleuroscopy is a medical procedure used for both diagnosis and treatment in the pleural cavity. Pleuroscopy enables direct observation of the pleural surface, enhancing the safety of procedures such as pleural biopsy, pleural fluid drainage, and pleurodesis. One purpose is to assist in verifying the diagnosis of cancer. This review was aimed to describe the use of flexi-rigid pleuroscopy in malignancy.
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Pathogenesis and Minimally Invasive Management of Subcutaneous Emphysema: A Narrative Literature Review
Views: 801Downloads: 852Subcutaneous emphysema is the result of air infiltrating the subcutaneous and soft tissues. The prevalence of subcutaneous emphysema varies between 0.43% and 2.34%. Subcutaneous emphysema typically results in mild symptoms, poses no significant risk, and does not necessitate specific medical intervention. Pathologies affecting underlying tissues can exhibit greater severity and pose a risk to life. Subcutaneous emphysema is a challenge in terms of how to handle it. The treatment should initiate a focused endeavor to determine the underlying etiology of subcutaneous air dissection. This literature review focuses on subcutaneous emphysema, specifically exploring its pathogenesis and therapy strategies for people with this condition.
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Tuberculosis with Drug-Induced Hepatitis: A Narrative Literature Review
Views: 1,068Downloads: 614Tuberculosis (TB) is an infectious disease that is a global health problem. The problem is that 5-28% of patients receiving tuberculosis treatment suffer from drug-induced hepatitis on antituberculosis drugs (OAT). The clinical picture should be differentiated from other liver diseases. The level of symptoms varies from asymptomatic to symptomatic, such as nausea, vomiting, abdominal pain, jaundice, hepatomegaly, and increased liver function. OAT use is stopped if clinical symptoms are found and ALT/AST increases ≥3 times, or if there are no symptoms but there is an increase in bilirubin ≥2 mg/dl or ALT/AST values ≥5 times without clinical symptoms. The use of OAT can be continued, but with supervision, if there are no clinical symptoms and the increase in ALT/AST is <2 times and the bilirubin value is <2 mg/dl. Treatment can be carried out again by reintroducing OATs one by one according to ATS recommendations.
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Mixed Type Basal Cell Carcinoma Treated with Excision and Defect Closure Using Advancement Flap: A Case Report
Views: 694Downloads: 389Background: Basal cell carcinoma (BCC) is a localized malignant tumor in the basal layer of the epidermis thought to be the result of prolonged sun exposure and associated with gene mutations in most cases. Although rarely metastazises, BCC can cause high levels of morbidity due to its locally destructive nature. There are several modalities for managing BCC, and the defect caused by the lesion can reconstructed by local flap.
Case presentation: We present a 55-year-old woman with a chief complaint of a blackish lump on the left maxillary region, growing bigger, and frequent episodes of bleeding. The lesion was excised and followed by histopathological examination, which revealed mixed subtype BCC. Closure of the defect with an advancement flap was performed with favorable results.
Conclusion: Surgical excision is the best option for managing BCC, while a skin flap is preferred to close defects for lesions on the cheek.
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Epidural Anesthesia in Management of Pregnant Eissenmenger’s Syndrome Patient Undergoing Caesarean Section
Views: 465Downloads: 323Background: Eisenmenger syndrome is very rare in pregnant women. Debates remain concerning the management of Eisenmenger syndrome in this patient population, and the prognosis is unclear in terms of maternal and fetoneonatal outcomes. Managing anesthesia in maternal patients with a cardiac abnormality might be particularly difficult because these individuals have inadequate circulatory reserves and altered maternal cardiovascular physiology.
Case presentation: We present a 26-year-old 34 weeks pregnant woman with Eisenmenger’s syndrome (ES) scheduled for an elective caesarean section. The clinical findings reveal slight tachypnea with peripheral oxygen saturation of 82% with oxygen supplementation using a cannula at 3 lpm. The patient's baseline hemodynamics are stable, but a third-degree murmur is heard in the 3rd and 4th left intercostal space. The patient was managed with epidural anesthesia using bupivacaine 0.5% 20 ml without adjuvant. The epidural catheter was inserted in an interspinous process between L3-L4. The surgery was done in 90 minutes with stable hemodynamics, and postoperatively, the patient was monitored in the intensive cardiac care unit (ICCU).
Conclusion: Epidural anesthesia has been shown to provide favorable outcomes due to its slow onset and reducing the likelihood of abrupt hemodynamic changes.
