Cermin Dunia Kedokteran

Profile of Neonatal Mortality in Dr M Haulussy Regional Hospital, Indonesia

Marischa Tita Thiono — 2025-02-07

Background: The infant mortality rate (IMR) is one of the indicators commonly used to determine overall public welfare. This study aims to look deeper into the profile of neonatal mortality in Maluku region, particularly at dr. M. Haulussy Regional Hospital. Methods: This study was conducted on the neonatal population in the neonatal intensive care unit (NICU) of dr. M.Haulussy Regional Hospital DR M Haulussy from January 1, 2022, to August 31, 2023. A total of 34 neonates met the inclusion criteria. Results: The main factors causing neonatal death were respiratory failure/asphyxia, LBW, and sepsis with the percentage of 25.6%, 24.4%, and 22.2% respectively. Conclusion: The most common factors of neonatal mortality in this sample population were respiratory failure/asphyxia, LBW/BBLR/BBLT, and sepsis.

D-dimer as a Diagnostic Biomarker of Pulmonary Tuberculosis in Pleural Effusion

Reza Aditya Digambiro — 2025-02-07

Background: Tuberculosis (TB) remains a major health threat, especially in developing countries. Although the lungs are the most affected organ, systemic manifestations are quite significant. D-dimer, as one of the fibrin degradation products and also an indicator of coagulation activity, has been extensively researched for its predictive and diagnostic value in various diseases. This study aims to assess the effectiveness of D-dimer as a diagnostic biomarker for pulmonary tuberculosis (TB) in patients with pleural effusion compared to those with non-TB pleural effusion. Methods: The study was conducted as an observational case-control on 64 patients with pulmonary TB with pleural effusion were compared to 64 non-TB subjects with pleural effusion. Result: In the TB patient group, 62.5% of patients were smokers, 46.9% of patients had been exposed to TB. Patients were assessed based on the TB symptom scale and with radiological lung examinations, either x-rays or CT scans. D-dimer levels were correlated with the TB severity. D-dimer levels above the threshold value were significantly higher in patients with severe TB symptoms. Conclusion: A direct correlation was observed between the size of radiological lung lesions and D-dimer levels. The average D-dimer level in the control group was 220 ± 60 ng/mL, which increased to 450 ± 90 ng/mL in TB patients with severe lesions.

Approach to Diagnosis of Acute Disseminated Encephalomyelitis

Felicia - — 2025-02-07

Acute disseminated encephalomyelitis (ADEM) is an acute neurological disorder characterized by demyelination of the central nervous system (CNS). It can affect individuals of all ages, more commonly observed in boys with prior viral or bacterial infections and immunizations. ADEM typically presents with an acute and monophasic course of polyfocal neurological deficits. There are no specific symptoms in ADEM, clinical manifestations are based on the site of demyelination. Diagnosis relies on exclusion criteria as there is no definitive marker for diagnosing ADEM.

Down Syndrome: Screening, Diagnosis, and Health Consequences

Evita Zevanya — 2025-02-07

Down syndrome is congenital or genetic abnormality with extra chromosome 21 causing various clinical manifestations and health problem. Down syndrome ranked first as the most common cause of birth defect in Indonesia. Chromosomal abnormality cause Down syndrome children have a higher risk and more common health problems. Down syndrome can burden family or caregiver physically, socially, financially, and emotionally. Proper screening and diagnosis criteria need to be done to establish the diagnosis.

Manifestation of Pulmonary Abnormalities in Systemic Lupus Erythematosus

Yessi Apriance — 2025-02-07

Systemic lupus erythematosus (SLE) is an autoimmune disorder with a very dynamic course and various clinical manifestations. With respiratory tract involvement in 50%-70% of patients, pulmonary disorders are one of the causes of the high morbidity and mortality in SLE patients. The high mortality in SLE patients with pulmonary disorders contribute to patients' survival with a hazard ratio of 3.13. This article discusses the manifestations of pulmonary disorders in SLE patients.

Pleural Effusion and Ascites in Child with Dengue Haemorrhagic Fever and Its Management

Asterisa Retno Putri — 2025-02-07

Background: Dengue haemorrhagic fever (DHF) is caused by dengue virus type 1-4; it is still endemic in Indonesia. Case: A 1 year and 11 months--old baby-girl with fever, lethargic, nausea and vomiting, and thrombocytopenia. She was diagnosed with dengue hemorrhagic fever. Pleural effusion and ascites were diagnosed after fluid resuscitation. Clinical improvement was observed after furosemide therapy and could be discharged after seven days of treatment. Conclusion: Diuretic administration can be considered in case of dengue haemorrhagic fever with severe plasma leakage. Further research is needed.

Alcohol Induced Hypoglycemia in Patient with Suspected Chronic Liver Dysfunction-A Case in Remote Area

Berlan Chandra — 2025-02-07

Alcohol has profound effects on glucose metabolism. Alcohol-induced hypoglycemia is rare in healthy individuals with good glycogen reserve, but may be life-threatening in individuals with silent chronic liver dysfunction, due to liver inability to manage glucose uptake. A 39-year-old male was admitted to the emergency room with sudden convulsion after taking local alcoholic beverages. A very low blood glucose level and significantly elevated liver enzyme levels were detected. The patient was stable after 3 days of intensive care without repeated phase of hypoglycemia.

Heart Failure due to Alcoholic Cardiomyopathy in Young Men

Rizky Darmawan — 2025-02-07

Background: Alcoholic cardiomyopathy (ACM) is cardiomyopathy caused by consuming large amounts of alcohol. Diagnosis is determined based on alcohol consumption’s history, clinical, and supporting data. Case: Male, 29 years old, came with shortness of breath especially when walking, lying down, and waking-up at night. The patient has been consuming 4 bottles of “Flores wine”/day for the past 14 years. Physical examination showed BP 124/93, pulse 101 x/min, RR 24 x/min, left apex and parasternal area systolic murmur, basal rhonchi, and edema of both feet. Electrocardiography showed RAD, RAE, LBBB, and LVH. Chest x-ray showed cardiomegaly and minimal pleural effusion. Laboratory examination showed SGOT 986.2 U/L, SGPT 448.3 U/L, and electrolyte imbalance. TTE results showed global hypokinetics, all cardiac chambers dilatation, reduced LV systolic function (EF 21.6%), severe TR, and moderate-severe MR. Angiography results showed no stenosis in all coronary arteries. MRI result is similar to TTE without late gadolinium enhancement (LGE). Therapy given according to guided-directed medical therapies (GDMT). Conclusion: ACM is cardiomyopathy with highly variable objective findings. In-depth history regarding alcohol consumption is crucial and other possible causes must be excluded.

Plasma Fibrinogen Level as Prognostic Factor for Hepatocellular Carcinoma

Abdul Jafar Sidik — 2025-02-07

Introduction: This article aims to determine the role of plasma fibrinogen level as a prognostic factor for hepatocellular carcinoma patients. Method: A structured literature review will be conducted through PubMed, Google Scholar, and ScienceDirect, according to the selected clinical questions. Literature selection was based on inclusion and exclusion criteria. The three selected literature were then critically appraised using criteria that included validity, importance, and applicability. Discussion: The three kinds of literature in this article all state that high plasma fibrinogen levels correlate with poor overall survival in hepatocellular carcinoma patients. Conclusion: Plasma fibrinogen levels may act as a prognostic factor for overall survival in hepatocellular carcinoma patients.

Mortality Prognosis of Tuberculosis Patients with Comorbid Type 2 Diabetes Mellitus

Kemal Akbar Suryoadji — 2025-02-07

Introduction: Indonesia ranks 3rd in tuberculosis (TB) cases in the world, and data from the Ministry of Health in 2020 showed that 10%-15% of TB sufferers had diabetes mellitus (DM). TB is one of the important causes of death, and DM affects the immune system which can increase the severity and mortality of the disease. This evidence-based case report was conducted to examine the mortality risk of tuberculosis patients with DM comorbidity. Methods: An article search was conducted to answer research questions based on 3 databases: PubMed, Cochrane, and ScienceDirect with the keywords “((Tuberculosis) AND (DM type 2) AND (Mortality))”. The search was based on inclusion and exclusion criteria and a critical review was conducted according to the guidelines for prognostic studies. Result: Tuberculosis patients with type 2 DM comorbidities have a 1.51 times higher risk of mortality compared to tuberculosis patients without type 2 DM comorbidities. Conclusion: Study by Huangfu, et al, (2019) can be the best choice to answer the clinical question that the risk of death of tuberculosis patients with comorbid DM increases by 1.51 times compared to patients without DM.

Use of Near Infrared Spectroscopy for Diabetic Foot Evaluation

Ronald Kartika — 2025-02-07

Introduction: Diabetic foot disease requires serious management due to the risk of amputation. Microvascular abnormalities increase the risk of amputation by impairing blood flow, slowing wound healing, and increasing the risk of infection. Methods: Systematic review of the clinical potential of near infrared spectroscopy (NIRS) for identification of peripheral arterial disease (PAD) concomitant with diabetic (DM) microangiopathy. Systematic literature search through PubMed BMC Central published in 2018-April 2024. Discussion: NIRS can provide clues such as prediction of recovery time, deoxygenation of peripheral blood, oxygen consumption (VO2), tissue oxygen saturation (StO2), total hemoglobin (HbT), and oxyhemoglobin area under the curve (O2 HbAUC). NIRS has the potential to help predict wound healing especially in diabetic patients with symptoms masked by peripheral neuropathy. Conclusion: NIRS can assess the effectiveness of treatment and prevent worsening PAD in diabetic foot.

Optimizing Quality Standards in Pharma 4.0 by Implementing Quality Behaviors for Excellence in the Digital Era

Steffen Thomas — 2025-02-07

The pharmaceutical industry is undergoing a significant transformation with the emergence of the Pharma 4.0 concept, driven by technological advancements such as the internet of things (IoT), artificial intelligence (AI), and robotic production systems (continuous manufacturing). One crucial aspect of this transformation is the need for strong data integrity (DI) to ensure the data reliability and security related to pharmaceutical product quality. In the era of Pharma 4.0, performance data from the pharmaceutical industry can be integrated to support real-time decision-making, the presence of DI is crucial to protect consumers and comply with industry regulations. The ALCOA+ principle is used to ensure the integrity of data throughout its lifecycle, including identification, sustainability, and availability of data. Quality behavior is needed to enhance self-awareness in the 4.0 transformation, especially with the increasing focus on cybersecurity and the rising number of data integrity cases, particularly in implementing the ALCOA+ principle. Quality behavior becomes crucial in addressing the challenges and opportunities presented by the Pharma 4.0 transformation and in maintaining data integrity in pharmaceutical industry.