Surabaya Medical Journal

Differences in monocyte-to-lymphocyte ratio of patients with cervical cancer at dr. Ramelan Central Naval Hospital, Surabaya before and after chemoradiation therapy from January 2020 to July 2023

Stella Yuanita Husodo — 2024-05-31

Background: Cervical cancer is a gynecological malignancy resulting from abnormal and unregulated proliferation of cells, which impairs growth, differentiation, and apoptosis of the cells. Cervical cancer is the second most prevalent disease and is responsible for approximately 10 million deaths in 2020. A number of studies have reported that the monocyte-to-lymphocyte ratio (MLR) may be a useful indicator of the prognosis of patients diagnosed with cervical cancer. Objective: This study aims to determine the differences in monocyte-to-lymphocyte ratio of patients with cervical cancer before and after chemoradiation therapy. Materials and Methods: This study used an analytical observational design with secondary data from 62 patients at dr. Ramelan Central Naval Hospital, Surabaya between January 2020 and July 2023. The sample was taken using a consecutive sampling technique. The variables included patients with stage IIB cervical cancer stage and higher who underwent chemoradiation therapy as well as the monocyte-to-lymphocyte ratio (MLR) of the patients before and after chemoradiation therapy. Results: The results of the Wilcoxon signed-rank test indicated that the therapy had an effect on the MLR of patients with stage IIB cervical cancer and higher, with a p-value of less than 0.001. Conclusion: Significant differences were observed in the MLR of patients with cervical cancer before and after chemoradiation therapy.

The effect of type 2 diabetes mellitus (T2DM) as a comorbid factor on the morbidity rate and length of hospital stay (LoS) in patients undergoing cholecystectomy

Albertus Magnus Arya Abisatya — 2024-05-31

Background: Cholecystectomy is a gold standard approach for the treatment of cholelithiasis. The efficacy of this treatment varies considerably, with morbidity and hospital stay depending on the country and hospital. Objective: This study aims to determine the effect of diabetes mellitus as a comorbid factor on morbidity rate and length of stay following cholecystectomy at Dr. Ramelan Naval Hospital, Surabaya between June 2019 and September 2020. Materials and Methods: This study used a descriptive analytical design with a retrospective approach. The total sampling technique was employed to determine the number of samples required. A total of 201 cases of gallstone disease were observed at Dr. Ramelan Naval Hospital, Surabaya between June 2019 and September 2020. However, a sample of 146 cases met the inclusion and exclusion criteria. The secondary data were collected from the medical records of the patients. The data were analyzed using SPSS 25 (IBM, US). Results: The contingency coefficient test revealed a correlation between diabetes as a comorbid factor and disease incidence (p = 0.019). In addition, the results suggested a correlation between diabetes as a comorbid factor and length of hospital stay (p = 0.034). Conclusion: The findings indicated that comorbidities such as diabetes were associated with morbidity rate and length of hospital stay in patients undergoing cholecystectomy.

Geographic distribution of ophthalmologist in East Java 2023

Khansa Dhea Salsabila — 2024-05-28

Background: Based on the results of the Rapid Assessment of Avoidable Blindness conducted across 15 provinces in Indonesia, East Java has the greatest prevalence rate of blindness in Indonesia with 4.4% of the population affected and 81.1% of cases attributed to cataracts. Enhancing the human resource capacity is essential for managing visual impairment. It is necessary to ensure the strategic distribution of ophthalmologists in accordance with the needs and healthcare accessibility of the population. Objectives: This study aims to determine the geographic distribution of ophthalmologists in East Java and to investigate the correlation between the geographic distribution and various socio-economic indicators. Materials and Methods: This study was conducted from December 2023 to January 2024. The researchers used hospital websites and social media platforms to collect data on ophthalmologists at each hospital in East Java, with a ratio of one ophthalmologist per 20,000 population. The Pearson correlation test in SPSS version 27 was used to analyze the correlation between the ratio of ophthalmologists per 20,000 population and the human development index, health index, purchase power index, and education index of each region. Results: In this study, the estimated number of ophthalmologists in East Java in 2023 was 505, which ranged from one in Sampang Regency to 142 in Surabaya City. The regions with the highest ratio of ophthalmologists were Mojokerto, Surabaya, and Malang Cities. The ophthalmologists were concentrated in major urban centers, with a notable absence in rural areas. A significant correlation was identified between the ratio of ophthalmologists and the human development index, education index, purchase power index, health index, and regional minimum wage. Conclusion: The distribution of ophthalmologists in East Java remains imbalanced, with a concentration in major urban centers and a scarcity in rural areas. The ratio of ophthalmologists showed a significant correlation with socio-economic factors, including the human development index, education index, health index, purchase power index, and regional minimum wage.

Pain profile of post-mastectomy pain syndrome (PMPS) in patients at a tertiary oncology center in Surabaya

Radin Kamal — 2024-05-31

Background: Post-mastectomy pain syndrome (PMPS) is a chronic neuropathic pain condition that typically manifests around the surgical area and may persist for more than three months without an identifiable cause. However, data on PMPS in Indonesia are limited. Objectives: This study aims to describe the pain profile of PMPS patients at the Oncology Center of Dr. Soetomo General Hospital, Surabaya in December 2023. Methods: This study used a descriptive cross-sectional design and was conducted at the Oncology Center of Dr. Soetomo General Hopital, Surabaya in December 2023. The patients were selected using a consecutive sampling technique based on their medical record and examination. Results: A total of 180 patients were included in this study. The majority of patients were between the ages of 50 and 59 years (38.3%) and 40 and 49 years (36.1%) with a luminal A subtype (53.5%). In addition, the majority of patients were overweight (36.1%), had no educational background (72.7%), and housewives (93.3%), with a monthly income of less than five million rupiah (97.2%). The majority of PMPS patients reported radiating pain (52.7%) in the surgical area (94%), with VAS score of 4 (69%). The majority of PMPS patients reported the onset of their condition within six months post-surgery (38.8%) and between 9 and 12-months post-surgery (34.4%). Finally, the majority of PMPS patients had a Karnofsky score of 70 or less (65.6%). Conclusion: The pain profile of PMPS patients in Surabaya is distinctive. Oncology professionals should initiate a tailored patient- and community-oriented approaches to research, prevention, and treatment of PMPS in each of their respective community.

Overview of visual acuity improvement in postoperative cataract patients using a monofocal lens and phacoemulsification techniques

Felicia Fortunata — 2024-05-31

Background: In Indonesia, one of the leading causes of blindness is cataract. Phacoemulsification is a surgical procedure that uses ultrasound energy to break the lens into pieces, which are then removed through by a probe. The lens is replaced with an intraocular lens (IOL) of the appropriate size for each patient. Monofocal lenses are among the most common lens types, which offer a single-focus correction for distance vision. However, additional glasses are required for near distances. Objective: to provide an overview of visual acuity improvement in postoperative cataract patients using monofocal lenses and phacoemulsification techniques. Materials and Methods: This study used an observational design and included postoperative cataract patients who underwent phacoemulsification with a monofocal lens at dr. Sjamsu Eye Clinic from September to November 2023. The data collected from the patients included their sex, age, operated eye, cataract type, and preoperative and postoperative visual acuity on days 1, 7, and 30. Results: A total 53 patients were evaluated. The majority of patients were female (57%) and between the ages of 60 and 69 years (43%). The preoperative visual acuity of the majority of patients was between <6/18 and <6/60 (60%). On day 30 post-surgery, the uncorrected visual acuity (UCVA) of 87% of patients was good, while the UCVA of the remaining patients was moderate. Conclusion: The visual acuity improvement in postoperative cataract patients using a monofocal lens and phacoemulsification techniques yielded satisfactory outcomes and met the standards for visual acuity by the World Health Organization (WHO).

Spinal anesthesia in a scoliosis patient: a case report

Andre Fernando Gunadi — 2024-05-31

Background: Scoliosis is a spinal deformity that exceeds a curve of 10 degrees identified at an early age (10 to 16 years old). Neuromuscular scoliosis is associated with a heterogeneous spectrum of muscular or neurological symptoms. Thus it is challenging to give a patient neuraxial/spinal anesthesia treatment before the surgery as it can alter the respiratory mechanism by changing the muscle orientation in the respiratory system. Objectives: This paper reported a challenging case of thoracolumbar scoliosis presenting with osteomyelitis requiring sequestrectomy after the patient had a motorbike accident. Case: The patient had a previous history of difficult spinal anesthesia. Fortunately, it only took one attempt to do the spinal anesthesia for the recent surgery. Conclusion: This report emphasizes the need for anesthesiologists to evaluate the cardiopulmonary functions and radiology features of the spine and anesthesia techniques to provide safe and efficient treatment in such a patient.

Rifampicin mono resistant tuberculosis (RR-TB): a case report

Efyluk Garianto — 2024-05-28

Introduction: Tuberculosis (TB) is a human disease caused by Mycobacterium tuberculosis. The bacteria is a rod-shaped and acid-resistant, hence it is also known as acid fast Bacilli. The disease mainly affects the lungs, making pulmonary disease the most common presentation of Tuberculosis. Despite advances in tuberculosis control and a decline in new cases and deaths, the disease remains a huge burden of morbidity and mortality worldwide. Diagnosis is at the forefront of TB management. Accurate diagnosis will be followed by appropriate management, thereby reducing mortality and morbidity from TB. Case Report: A 41-year-old male patient came to Puskesmas Kedurus after hospitalization at RSUD Dr. Soetomo after being diagnosed with TB-RO. Previously, the patient had a cough and weight loss for about 1 year, cough with greenish-yellow sputum, not containing blood. The patient began complaining about shortness of breath since 1 month ago, with the results of thorax photos and Real-Time Polymerase Chain Reaction (RT-PCR) supporting the diagnosis of Drug-resistant Tuberculosis. The patient received anti-tuberculosis drugs according to standard therapy for Multi-Drug Tuberculosis (MDR-TB) patients with a minimum treatment duration of 20 months. Conclusion: The risk factor for Tuberculosis in this patient was the surrounding community where the patient works daily with many coworkers who suffer from prolonged cough. The patient's prognosis is good if complaints are resolved immediately and anti-tuberculosis drugs was taken regularly. The patient still needs further education, especially regarding the cough etiquette and implementing healthy lifestyle in the household setting.

Evans syndrome and systemic lupus erythematosus (SLE): a case report

Cheifia Krissanti Sasono — 2024-05-29

Background: Evans syndrome is a condition characterized by the simultaneous occurrence of immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AIHA). The diagnosis of Evans syndrome presents a significant challenge due to its overlapping features with other autoimmune disorders. Objective: This case report aims to identify a diverse range of symptoms, including hematological and dermatological manifestations to provide a comprehensive diagnosis. In this case, the coexistence of fatigue, jaundice, pigmented macules, and papules led to the diagnosis of systemic lupus erythematosus (SLE) and Evans syndrome. Case: This case report presents a case of Evans syndrome in a 16-year-old female, delving into the intricate interplay of clinical manifestations and the potential association with SLE. The patient exhibited fatigue, pallor, jaundice, and dark-colored urine, along with the concurrent symptoms of dry cough and runny nose. A dermatological examination revealed hyperpigmented macules and papules on the face and extremities. Laboratory findings indicated severe anemia, thrombocytopenia, abnormal liver function, hyponatremia, and hypokalemia. The positive direct Coombs test and urinalysis findings supported the diagnoses of both Evans syndrome and SLE. The patient responded positively to systemic corticosteroid therapy and supportive care. Conclusion: This case underscores the diagnostic challenges associated with Evans syndrome, especially when overlapping with SLE. A multidisciplinary approach is crucial for accurate diagnosis and effective therapeutic interventions. Further research is necessary to unravel the complex relationships between these autoimmune diseases in cases of coexistence or overlap

Peripheral congenital facial palsy: a rare case report

Masyithoh Budi Dewi — 2024-05-31

Background: Congenital facial nerve palsy is a rare condition that is typically associated with a traumatic birth event or manifests as a characteristic of a syndrome that necessitates a rehabilitation program. Objective: This report aims to present a rare case and its subsequent outcome after undergoing a rehabilitation program. Case: An eight-month-old infant presented with complaints of an asymmetrical mouth when crying and smiling since birth. The left eye was unable to fully close. No evidence of a syndrome was found. The results of the electromyography of the left facial nerve revealed the presence of partial axonal loss, axonal malfunction, or neuropathy. The patient was subjected to a comprehensive treatment plan, involving rehabilitation programs such as neuromuscular electrical stimulation (NMES) and laser therapy over a period of 18 months. Discussion: It is important to determine if congenital facial palsy is a standalone condition or part of a broader syndrome. Rehabilitation programs, such as NMES and laser therapy, can stimulate the neurons and improve muscle weakness. The House-Brackmann scale demonstrated a clinical improvement, moving from grade V to grade II. With consistent physical therapy, the patient demonstrated improvements in facial expressions and eye closure. Conclusion: NMES and laser therapy, as well as facial massage and biofeedback, are potential treatments for congenital facial palsy due to their efficacy and favorable outcomes.

Probiotic supplementation in Parkinson’s Disease

Ayu Nisa — 2024-05-28

Background: Parkinson's disease (PD) is a prevalent neurodegenerative disease with both motor and non-motor symptoms. It has been postulated that dysbiosis and gut infections may have metabolic consequences that go unchecked and exacerbate the neurodegenerative process or peripheral inflammation in PD. Objective: This meta-analysis aims to elucidate the potential benefits of of probiotics as supplemental therapy for PD. Materials and Method: PRISMA 2020 was used for literature search. Multiple databases, such as PubMed, Science Direct, and CINAHL Plus, as well as Full Text, Sage Journals, and Web of Science, and clinical registries were investigated. The quality assessment and statistical analysis were conducted using the Jadad scale and the Review Manager software version 5.4.1. Results: Ten randomized controlled trials (RCTs) were included in this systematic review, six of which were quantitative studies. The results indicated that probiotic treatment significantly improved cognitive function based on the MMSE (mean difference [MD] = 0.4, 95% CI [-0.17, 0.97], I2 = 0%). Probiotic treatment also improved gastrointestinal symptoms as evidenced by the Bristol stool score (MD = 0.28, 95% CI [-0.40, 0.97], I2 = 93%) and the bowel movement score (MD = 1.25, 95% CI [0.74, 1.75], I2 = 0%). Significant effects were observed in the depression scale and quality of life, including the Patient Assessment of Constipation Quality of Life (PACQoL) and the Parkinson’s Disease Questionnaire (PDQ39). Conclusion: Probiotic supplementation significantly improved disease progression, gastrointestinal effects, mental health, and quality of life in patients with PD. This improvement may be attributed to a reduction in the inflammatory response and an increase in the activity of gut-brain axis.

Medical education in Indonesia: medical education curriculum in the future

Budi Santoso — 2024-06-21

Background: As the time goes by, the medical education has been developed since 1849, with the development on the educational system, medical education institution faces a big challenge to control the quality of medical education via curriculum renewal. Objectives: to describe the Indonesia’s medical education curriculum in the future as the implementation of hospital-based education system which will begin to be implemented. Editorial: The medical education was developed after the world-war II, in which medical institution was developed with the new educational models. The main purpose to find the solution of transition problems, from theory to practice, from undergraduate to postgraduate, and from training to unrestricted practice, but the quality of graduation was unequal. Medical curriculum was established as Flexner opinion stated that medical knowledge is not something fixed. This rethorical opinion create the new view of medical education to instilling the proper techniques on acquiring and evaluating the information. Nowadays, many curriculum was adopted in order to produce a good and qualified medical doctor, such as problem based-learning (PBL). Conclusion: Indonesian medical education curriculum faces constant changes from time to time depend on the society healthcare needs. Being a medical doctor means a long journey and long-life education in order to increase the medical skills and updating the medical knowledge. And medical doctor education means university based and hospital setting. This two education settings can’t be separated