Nusantara Medical Science Journal

Positive Fluid Balance as a Prognosis Predictor in Pediatric Sepsis Patients: A Retrospective Cohort Study

Astri Gosal — 2023-07-03

Introduction: Sepsis is one of the leading causes of infant and child morbidity and mortality worldwide. Fluid administration is an important way to reduce morbidity and mortality in septic patients with low blood flow and shock, since sepsis is often linked to low blood volume. The purpose of this study was to investigate the relationship between positive fluid balance and the outcome of pediatric sepsis patients. Methods: A retrospective cohort analysis of 80 pediatric patients diagnosed with sepsis using the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria. The positive fluid balance value was obtained from medical records and was evaluated using the Receiver Operating Characteristic (ROC) curve method. Results: Positive fluid balance was found to have a significant link with the outcome of pediatric sepsis patients (p<0.05).The positive fluid balance value of ≥4.61% was associated with mortality in pediatric patients with sepsis, with a sensitivity value of 62.79%, specificity of 62.16%, negative predictive value of 58.95%, and positive predictive value of 65.85%. The value of fluid balance in the first 24 hours of Pediatric Incentive Care Unit (PICU) care was higher in septic pediatric patients who died compared to those who improved, but not significantly (p=0.37). The value of total fluid balance during PICU care was higher in septic pediatric patients who died compared to those who improved (p<001).

Conclusions: Positive fluid balance with a cut-off value of 4.61% can be used as a prognostic factor in pediatric patients with sepsis.

A Rare Case of Conjoined Pygopagus Twins: Case Report

Christina Saputro — 2023-07-03

Introduction and importance: Conjoined twins are a complication of monozygotic pregnancies with an incidence of 1:50,000-200,000 of life births. Pygopagus is found around 17% of all types of conjoined twins and has a mortality rate of 23%. Proper diagnosis and management in this case is important.

Presentation of case: A 25-year-old primigravida woman presented at 22 weeks of gestation with a Pygopagus ultrasound result at 17 weeks of gestation. MRI was performed at 25 weeks of gestation, showed conjoined pygopagus twins with lumbosacral spina bifida, without visualized bone union, separated bladder, rectum and anus were difficult to evaluate. Caesarean section (CS) is planned at 36 weeks of gestation and postpartum MRI will be performed in preparation for the separation surgery. The patient was admitted to the hospital at 35 weeks of gestation in the active phase of the first stage of labor, then an urgent caesarean section was performed. Both babies were born with an APGAR score of 2/4/7. The second baby died a few hours after delivery. The separation surgery was performed as an emergency, but the first baby died during the procedure.

Conclusions: Pygopagus requires holistic management, starting from diagnosis, preparation for delivery, to postpartum complications. The proper holistic management is expected to reduce infant and maternal morbidity and mortality.

Subcutaneous Endometriosis after Cesarean Section : A Case Report

Ardio Rizky Tansil, Tan — 2023-07-03

Introduction and importance: Endometriosis is a condition in which both the stromal tissue and the functional endometrial glands are observed outside the uterine cavity. Endometriosis can be found in pelvic organs and extra-pelvic. Subcutaneous Endometriosis is a condition which may occur after surgical procedures such as cesarean section. Presentation of case: We report a 37-year-old female patient who had undergone two cesarean sections, presented with cyclic hypogastric pain and vaginal bleeding. Cyclic bleeding also occurred from the cesarean section scar since 1 year ago. Total abdominal hysterectomy, right salpingooophorectomy, left salpingectomy and wide excision of the scar were performed. Histopathology results of stromal tissue and functional endometrial glands on subcutaneous part of the skin were found. Discussion: The incidence of subcutaneous endometriosis can occur months to years after the surgical procedure with an average of about 30 months. Complaints in patients are usually in the form of a painful and enlarged abdominal mass, especially during menstruation. In establishing the diagnosis of subcutaneous endometriosis, the gold standard is pathological examination. The main management of this subcutaneous endometriosis case is a wide excision procedure by performing excision and providing a minimum clearance of 1 cm. Conclusions: Subcutaneous endometriosis is extrapelvic endometriosis, which is mainly caused by surgery, one of which is cesarean section. Establishing a definite diagnosis of subcutaneous endometriosis is difficult without any pathological examination. The main management of subcutaneous endometriosis is wide excision with a margin of 1 cm to prevent recurrence of this disease.

Effectivity of Repetitive Transcranial Magnetic Stimulation Improving Depressive Symptoms and Motoric Strength Ischemic Stroke

INNEKE MAGDALENA RUNTUWENE — 2023-07-03

Introduction: Post-stroke depression often causes problems. Depression can slow motor recovery. Giving antidepressants takes one month, and thus Transcranial Magnetic Stimulation (TMS) was developed, especially repetitive Transcranial Magnetic Stimulation (rTMS). This study aims to assess the effectiveness of rTMS in improving depressive symptoms and motor strength in ischemic stroke patients. Methods: An experimental study with a randomized pretest-posttest control group design was conducted at Wahidin Sudirohusodo Hospital and a network hospital in Makassar from August to October 2022. The treatment group received standard therapy for ischemic stroke, antidepressants, and rTMS; the control group received standard therapy for ischemic stroke and antidepressants for ten days. In this study, the Hamilton Depression Rating Scale (HDRS) and the Medical Research Council (MRC) scale were used and measured in the treatment and control groups on the first and tenth days.

Results: A total of 40 subjects met the criteria and were divided into a treatment group (n = 20) and a control group (n = 20). The HDRS score in the treatment group was smaller than in the control group. The value of left extremity motor strength in the treatment group was greater than that of the control group using the Wilcoxon Test. The correlation of the HDRS score to motor strength in the treatment and control groups showed a negative correlation of the HDRS score to the left extremity using the Spearman Test.

Conclusions: rTMS effectively improves depressive symptoms and motor strength in ischemic stroke, given standard ischemic stroke therapy, antidepressants, and rTMS.

Right Ventricle Free Wall Longitudinal Strain in Cancer Patients Following Chemotherapy

Aussie Fitriani Ghaznawie — 2023-08-02

Introduction: The survival rate of cancer patients was high due to chemotherapy, but it can cause cardiotoxicity and increase morbidity and mortality. Most studies on cancer therapy-related cardiac dysfunction (CTRCD) focus more on the left ventricle. This study assesses chemotherapy's effect on the right ventricle, namely the right ventricle free wall longitudinal strain (RVFWLS).

Methods: This study is a prospective cohort conducted from January to December 2022 on thirty-four cancer patients undergoing chemotherapy at Dr Wahidin Sudirohusodo Hospital Makassar. The RVFWLS was assessed before and after chemotherapy using

echocardiographic.

Result: The RVFWLS value after one cycle chemotherapy decreased compared pre-chemotherapy (4.40±4.84; p=0.001). Conclusion: The effect of chemotherapy is a decrease the RVFWLS value after the first cycle of chemotherapy. It should be considered for echocardiographic evaluation, especially the RVFWLS value every cycle of chemotherapy.

Repetitive Transcranial Magnetic Stimulation (rTMS) as Non-Invasive Therapeutic for Post-Stroke Dysphagia: A Case Report

Jumraini Tammasse — 2023-09-19

Introduction and importance: One of the worst complications that affects people with stroke is dysphagia. Dysphagia causes mortality through dehydration, malnutrition, aspiration pneumonia, and suffocation. For stroke survivors to have better results, post-stroke dysphagia must be adequately addressed using proven treatment methods. Presentation of case: A 64-year-old man complaints of difficulty swallowing with Gugging Swallowing Screen scoring (GUSS)= 7 (severe dysphagia) with left hemiparesis and slurred speech due to ischemic stroke on August 14th 2022. Head CT Scan found bilateral lacunar basal ganglia infarcts with brain atrophy. Patients were treated with standard ischemic stroke therapy, medical rehabilitation and repeated Transcranial Magnetic Stimulation (rTMS) procedures for 10 sessions. GUSS was carried out after the 10th session of rTMS and increased to 14 (moderate dysphagia). Discussion: By stimulating the esophagus cortex bilaterally in post-stroke dysphagia, rTMS is known to be beneficial in modulating cortical excitability and minimizing the imbalance between the hemispheres. Furthermore, it appears to be safe and well-accepted by patients. Conclusions: Our case study shows that rTMS in bilateral esophageal cortex is safe and has therapeutic potential in patients with post-stroke dysphagia.

Estimated VO2 max Analysis with Six-Minute Walking Test on Obese Patients in Primary Health Care in Makassar

Andi Muhammad Akram Kastiran — 2023-11-20

Introduction: Obesity poses a severe threat to global health, making it a significant epidemiological concern that requires special attention. It is associated with several risk factors for various diseases. Alarmingly, one in three Indonesian adults is obese, with the obesity rate steadily increasing. Studies have shown that excess fat mass is linked to higher mortality and morbidity from cardiovascular disease, which is currently Indonesia's leading cause of death. To assess a person's functional capacity and ability for basic physical activity, the 6-minute walking test (6MWT) is utilized, as it proves to be a powerful predictor of morbidity and mortality rates. Therefore, this study aims to analyze the association between VO2 max using 6MWT in obese patients of Makassar City. Methods: This study was a cross-sectional study.

The samples comprised all obese individuals who provided signed approval letters and were registered at Makassar City's 20 Public Health Centers. Consecutive sampling was used to gather the samples. Subsequently, the samples were examined and categorized based on their level of obesity. The 6MWT results are then used with Nury's Formula to produce an estimated VO2max result. To analyze the association between VO2 max using 6MWT and obesity, statistical analysis was conducted using the Mann-Whitney test, with significant results indicated by (p < 0.05). Results: A total of 163 participants comprised the study's sample, with the majority being female and aged 50 years or older. After filling out the questionnaire, data show that most of the obese participants had a family history of cardiovascular disease (CVD), experienced significant stress levels, and had average BMIs falling into the category of obesity. According to the study, the average distance covered in the 6-minute walking test was 340.18 meters (±82.6 meters). When the study participants were ranked by their estimated VO2 max, the average value was 15.10±5.52 for those with first-degree obesity. Following them were participants with second-degree obesity, with results averaging 15.03±5.39 (p = 0.021). Conclusion: A significant inverse association exists between obesity and VO2 max, which means that the more obese a person is, the lower their VO2 max tends to be.