Jurnal Kedokteran Meditek

Ileus Obstruksi Parsial akibat Intususepsi Ileocaecal dan Tumor Colon Ascendens pada Pasien Perempuan Dewasa

2025-03-25T09:06:12+00:00

Introduction: Intussusception is a rare condition in adults. It can cause ischemic necrosis, perforation, and peritonitis. Objective: This case report highlights the clinical presentation, diagnosis, and management of bowel obstruction due to intussusception in an adult. Case Illustration: A 43-year-old female patient presented with watery stools mixed with blackish blood, abdominal pain, vomiting, and decreased appetite. Abdominal examination revealed mild distension, reduced bowel sounds, generalized tenderness, and a firm, mobile mass (10 × 10 × 5 cm) in the right lower quadrant. Digital rectal examination showed a dilated rectal ampulla, extra luminal protrusion, and blackish blood-stained feces. Imaging studies confirmed a high-level obstruction and ileocecal intussusception with bowel wall edema. The patient was diagnosed with partial bowel obstruction. Discussion: This unusual case involves a localized tumor in the ascending colon acting as a lead point, leading to ischemia and mucosal necrosis. Accurate diagnosis in adults relies on timely imaging examinations. While plain radiography (BNO) may show signs of intestinal obstruction, its sensitivity is limited. Initial management focuses on stabilizing the patient’s condition by using a gastric tube for decompression, providing intravenous fluids for rehydration, administering analgesics and antibiotics, and, if appropriate, performing a barium or air enema to help reposition the affected segment. Prompt management is essential to prevent serious complications. Conclusion: Adult intussusception is rare and requires diagnosis through history, physical examination, and radiologic studies. Management involves initial medical stabilization and surgical intervention.

Kortikosteroid Oral Jangka Pendek sebagai Tata Laksana Psoriasis Vulgaris: Sebuah Laporan Kasus

2025-05-15T00:43:16+00:00

Introduction: While oral corticosteroids are not included in the psoriasis systemic therapy algorithm, they are still utilized in certain cases because of their anti-inflammatory and immunosuppressive properties. This case report describes a case of psoriasis vulgaris treated with oral corticosteroids as replacement therapy for first-line drugs. Case Illustration: A 53-year-old male presented to Ciawi Regional Hospital with a complaint of a red, scaly rash that had been itchy on his back for a year, which was spreading to his entire body and worsening over the last 3 months. The physical examination revealed erythematous papules and plaques with thick, silver scales throughout his body. He was diagnosed with psoriasis vulgaris, with a Psoriasis Area Severity Index (PASI) score of 32.6. The patient utilized National Health Insurance, which did not cover the first-line drugs; therefore, he was prescribed oral methylprednisolone instead. After two weeks of medication, his clinical manifestations improved, resulting in a PASI score of 5.5. Discussion: The oral corticosteroid provided a significant improvement in skin lesions for this patient. This improvement may be due to its anti-inflammatory and immunosuppressive effects. Close monitoring after treatment is crucial, as flare-ups and side effects may occur after treatment with oral corticosteroids. Conclusion: The use of oral corticosteroids in the treatment of psoriasis vulgaris is an option when first-line drugs are not available, followed by post-treatment observation

Lingkar Pinggang Sebagai Faktor Risiko Utama Osteoartritis Lutut dan Peran Penting Depresi

2025-01-27T10:19:18+00:00

Background: As the elderly population increases, the incidence of osteoarthritis (OA) also rises. In Indonesia, the prevalence of OA is 15.5% in men and 12.7% in women. Research on OA in Indonesia remains limited, particularly regarding population-based studies. Purpose: This study aimed to provide an overview of knee OA and its risk factors among older adults living in Pusaka Kebon Jeruk, West Jakarta. Methods: This cross-sectional study involved 100 respondents. Data were collected through interviews using questionnaires. Bivariate analysis was conducted using chi-square tests, and multivariate analysis was performed using multiple logistic regression (p<0.05). Results: The study found that 28% of the elderly had knee OA, with the majority aged 60-74 years (75%), female (71%), unemployed (82%), educated for 12 years or more (90%), and married (55%). Bivariate analysis identified waist circumference (p<0.001) and depression (p=0.032) as variables significantly associated with knee OA. Multivariate analysis indicated that waist circumference was the most significant factor affecting knee OA, with an odds ratio (OR) of 24.239. The prevalence of knee OA requires serious attention from the government and healthcare providers. Conclusion: Knee OA is significantly related to waist circumference and depression, with waist circumference being the most critical factor. Central obesity is associated with a higher risk of knee OA. Therefore, it is essential to prevent central obesity through a balanced diet and regular exercise.

Antibiotic Therapy Evaluation of Patients Diagnosed with Sepsis in ICU of dr. Mohamad Soewandhie General Hospital based on the Gyssens Method

2025-01-30T06:05:40+00:00

ABSTRACT

In the high-stakes world of Intensive Care Units (ICUs), the judicious application of empirical antibiotic therapy is crucial for managing sepsis in critically ill patients, as its misuse is often linked with unfavorable patient outcomes. Thus, timely and precise treatment strategies are indispensable. This study was designed to evaluate the rationality of such treatments among sepsis patients at RSUD Dr. Mohamad Soewandhie between January 2021 and September 2024. Using an observational and descriptive approach, researchers scrutinized secondary data from 120 patient medical records, with expert reviewers employing the Gyssens method to assess treatment rationality. Findings revealed that 60% of patients received appropriate empirical antibiotic therapy, most commonly intravenous Ceftriaxone. Alarmingly, culture and antibiotic sensitivity tests were conducted on only 18 patients, yielding 11 positive results, and among these were 19 gram-negative and 2 gram-positive bacterial isolates, with a troubling 67.9% being multidrug-resistant organisms (MDRO). Despite the empirical therapy's rationality, the study noted a concerning mortality rate of 81.67%, possibly owing to delays in obtaining culture results and the use of outdated local guidelines for antibiotic therapy in sepsis management, highlighting gaps in existing approaches.

Keywords:Empirical Antibiotic Therapy, Intensive Care Unit, Sepsis, Septic Shock, Gyssens Method

Analisis Neutrophil-to-Lymphocyte Ratio dan Platelet-to-Lymphocyte Ratio pada Pasien Infark Miokard Akut

2025-04-17T06:12:27+00:00

Introduction: Acute myocardial infarction (AMI) is a clinical manifestation of coronary atherosclerosis involving chronic inflammation. Neutrophilia, lymphopenia, and thrombocytosis due to systemic inflammation can be measured using hematological markers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Previous studies have reported using NLR and PLR to determine the prognosis of cardiovascular disease. Purpose: This study aims to investigate whether NLR and PLR differ in the incidence of AMI, both NSTEMI (non-ST elevation myocardial infarction) and STEMI (ST elevation myocardial infarction), and to evaluate their predictive value. Methods: A cross-sectional study was conducted using complete blood count data from 141 AMI patients treated at Tzu Chi Hospital from 2018 to 2024 upon their arrival at the emergency room. The data were analyzed using SPSS, utilizing the Mann-Whitney test to identify significant differences, and Receiver Operating Characteristic analysis to assess the predictive value and cut-off points for NLR and PLR. Results: There was a statistically significant difference in NLR in the incidence of AMI (p = 0.013) but no statistically significant difference in PLR in the incidence of AMI (p = 0.549). NLR with a cut-off of 4.34 (sensitivity 60.6%, specificity 60%) showed a low predictive value (AUC = 0.622), and PLR with a cut-off of 158.90 (sensitivity 53%, specificity 57.3%) had no predictive value (AUC = 0.529) to distinguish between NSTEMI and STEMI events. Conclusion: The difference in NLR was more significant and had better predictive value than PLR in AMI

Faktor yang Memengaruhi Gejala Dermatitis Kontak pada Tangan Pekerja Wet Work di Rumah Sakit dan Kampus UKRIDA

2025-04-16T03:42:52+00:00

Introduction: Contact dermatitis is one of the occupational skin diseases caused by exposure to irritants or allergens. This condition can arise during work activities or may be influenced by other factors within the work environment. Purpose: The purpose of this study was to determine the frequency of contact dermatitis symptoms on the hands and to identify factors associated with these conditions among workers engaged in wet work (such as cleaning, laundry, and kitchen) at Ukrida Hospital and Campus in West Jakarta. Methods: This study utilized an analytic cross-sectional design conducted from August to September 2024. Individual characteristics and job information were collected through a questionnaire, while symptoms of contact dermatitis were assessed using the Nordic Occupational Skin Questionnaire 2002 (NOSQ-2002). Data were analyzed using the chi-squared test, the Mann-Whitney U test, and logistic regression. Results: A total of 44 workers (45.8%) experienced symptoms of contact dermatitis on their hands, with the most common symptoms including dry, rough, scaly, itchy, and chapped skin. The study found that wet work and a history of allergies are associated with these symptoms of contact dermatitis. Conclusion: Workers in wet environments and those with a history of allergies are at a higher risk of experiencing symptoms of contact dermatitis on their hands. Implementing exposure control measures in the workplace is essentialn to managing symptoms of contact dermatitis.

Relationship Between Clarke’s Angle and Radiological Severity of Knee Osteoarthritis: A Cross-Sectional Study

2025-05-08T03:57:24+00:00

Introduction: Knee osteoarthritis (OA) is a degenerative joint disease causing disability, especially in older adults. Flatfoot, marked by reduced medial arch height, alters lower limb biomechanics and may influence knee OA severity. Objective: To evaluate the association between foot arch, measured by Clarke’s angle, and knee OA severity based on the Kellgren-Lawrence (K-L) grading to provide clinical insight for guiding management decisions. Methods: A cross-sectional study of 57 knee OA patients at Siloam Karawaci Hospital was conducted. Clarke’s angle was measured using ink footprints, and K-L grading assessed radiological severity. Statistical tests included Kolmogorov-Smirnov, one-way ANOVA, and Kruskal-Wallis, with p < 0.05 considered significant. Results: Most participants were female (77.2%) with a mean age of 65.85 ± 9.69 years. OA severity was mostly mild to moderate (K-L 2 and 3). Flatfoot prevalence was 47.4%, and lower Clarke’s angles were significantly associated with higher K-L grades (p = 0.029). No significant differences in age or BMI were found across severity groups, though BMI trended higher with severity. Conclusion: Lower Clarke’s angle correlates with increased knee OA severity. Flatfoot may contribute to or result from OA progression. Further research is needed to clarify causation and inform management strategies.