Surabaya Medical Journal

Unveiling the link: exploring the relationship between hypertensive disorders in pregnancy and maternal dietary patterns

Roro Sri Tanjung Wigid Putri Kinasih, Gordon Jaya Pranata — Sat, 30 Nov 2024 00:00:00 +0000

Background: The increasing prevalence of pregnancy-related hypertension, a leading cause of maternal and neonatal mortality, emphasizes the need for safer management strategies. Due to potential risks associated with antihypertensive drugs, dietary interventions have gained interest as a promising alternative to help regulate blood pressure and improve pregnancy outcomes by targeting mechanisms such as inflammation and oxidative stress. Objective: To examine the relationship between the incidence of hypertensive disorders and maternal dietary patterns as a potential strategy for preventing maternal health problems. Pros and Cons: Diet is the main modifiable determinant of inflammation. Research has examined dietary patterns that may reduce the risk of hypertension in pregnancy. Discussion: Dietary choices during pregnancy significantly influenced the risk of hypertensive disorders, including preeclampsia. While plant-based and Mediterranean-diets are often associated with reduced risks, other studies present conflicting results due to individual physiological differences and unmeasured dietary factors. Further research into effective dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH), could provide clearer guidelines to help reduce hypertensive risks in pregnancy. Conclusion: The relationship between dietary patterns and the incidence of hypertensive disorders remains inconclusive. Despite the inconsistent findings, maintaining a well-balanced plant-based diet may be beneficial in all stages of life, especially in preventing HDP. Such a diet can help lower blood pressure, reduce the risk of heart disease, and improve cholesterol levels. Moreover, maintaining a well-balanced diet can provide adequate nutrients if combined with supplementation with folic acid, iron, zinc, calcium, iodine, vitamin D, vitamin B12, and omega-3 fatty acids

Surgical excision of sebaceous gland carcinoma of the eyelid: a comprehensive case study

Maria Evane Navy Cahaya Putri, Empi Irawan — Sat, 30 Nov 2024 00:00:00 +0000

Background: Sebaceous gland carcinoma is a rare but aggressive malignancy with a propensity for metastasis. Delayed diagnosis contributed to increased mortality rates. This carcinoma is primarily found in the periocular region and originates from various sebaceous glands, posing diagnostic challenges. Objective: to provide a detailed clinical description and management approach for sebaceous gland carcinoma treated with surgical intervention. Case: A 59-year-old male presented with a lesion on his right lower eyelid, accompanied by itching and intermittent discharge. Clinical examination revealed a cauliflower-like lesion on the right lower eyelid. An excisional biopsy confirmed the diagnosis of sebaceous gland carcinoma. Surgical intervention involved wide excision, preserving adjacent structures. Postoperative care included prophylactic measures for dry eye syndrome and antibiotic therapy to prevent infection. Postoperative follow-up demonstrated satisfactory outcomes, with resolution of symptoms and no signs of recurrence. Discussion: Sebaceous gland carcinoma can present with various manifestations. Surgical excision is the standard treatment, with adjuvant therapies considered for advanced cases. Dry eye syndrome, ectropion, and entropion are common post-surgical complications, particularly following procedures involving the eyelids as observed in this case. These conditions may resolve spontaneously with appropriate management of the underlying causative factors. Meanwhile, symptomatic relief can be achieved through ocular lubrication. Conclusion: This case report emphasizes the importance of timely diagnosis, precise surgery, and thorough postoperative care for sebaceous gland carcinoma. While acknowledging the limitations of this study, further research is necessary to improve therapeutic strategies for this challenging malignancy.

Epilepsy therapy using phenytoin reduces leukocytes

Nungky Kusuma, Aliffadinya Paramarisa, Suliman Purwoko — Sat, 30 Nov 2024 00:00:00 +0000

Background: Epilepsy is a neurological disorder, and the primary goal of treatment is to eliminate seizures while minimizing the side effects of treatment as much as possible. Phenytoin is one of the main drugs in epilepsy treatment. One of the side effects of phenytoin is that it can reduce the number of leukocytes in the blood, thereby increasing the possibility of infection. The minimum number of white blood cells ever counted due to the effects of phenytoin use is 300/mm3. Objective: This report aims to present a rare case of the side effects of phenytoin. Case: a 40-year-old woman with a history of epilepsy, chronic kidney disease, diabetes mellitus, and thrombocytopenia presented with leukopenia was referred to our hospital. She had taken phenytoin for 16 days, and her leukocyte had decreased from 1,700/mm³ at a previous hospital to 470/mm³ upon admission to our hospital. After discontinuing phenytoin and witching to valproic acid, her leukocyte gradually increased to 2,210/mm³, thereby that she was able to recover and return home. Conclusion: Phenytoin is an antiepileptic drug that can cause leukopenia due to its immunotoxin effects. However, this leukopenia is reversible and typically asymptomatic

Minimal intestinal resection during primary repair of type IV congenital small intestinal atresia

Ageng Budiananti, Fendy Matulatan — Sat, 30 Nov 2024 00:00:00 +0000

Background: Multiple intestinal resection and anastomosis are common surgery options for type IV jejunoileal atresia, although anastomotic leakage is associated with a 15% mortality rate. Objectives: to describe a surgical approach involving a single intestinal anastomosis bypassed through additional intraluminal obstructions using an intravenous (IV) catheter followed by enteroplasty. Case Report: A six-hour-old low-birth-weight preterm female newborn presented from the neonatal division with bilious vomiting prior to initial feeding, accompanied by generalized abdominal distention. A plain abdominal radiograph revealed the “countable bubble” sign. Exploratory laparotomy was performed and discovered multiple jejunoileal atresia and microcolon. A resection of 20 cm of jejunum, followed by and end-to-oblique jejunal anastomosis, was performed. An IV catheter was used to bypass additional intraluminal obstructions in the jejunum and ileum, followed by jejuno-ileoplasty at the catheter insertion site. Routine rectal irrigations and total parenteral nutrition were administered postoperatively. By five weeks, the patient was able to defecate spontaneously, fully breastfeeding, and discharged from the hospital. Conclusion: The use of an IV catheter to bypass intraluminal obstructions may be an option to avoid multiple intestinal resection and anastomosis in type IV congenital jejunoileal atresia

Bell's Palsy Complicated by Hypertensive Crisis: A Case Report and Review of Diagnostic and Therapeutic Challenges

Sat, 30 Nov 2024 00:00:00 +0000

Background: Bell's palsy is a neurological condition characterized by acute unilateral facial paralysis. While it is often idiopathic, it can sometimes be associated with other underlying conditions, complicating diagnosis and management. Objectives: This case report aims to present a unique case of Bell's palsy complicated by a hypertensive crisis, emphasizing the importance of differential diagnosis and careful pharmacotherapy management. Case Presentation: A 63-year-old male presented to Ngletih Community Health Center with a four-day history of right-sided facial paralysis and slurred speech, following exposure to a fan while sleeping. Physical examination revealed a hypertensive crisis with a blood pressure of 185/144 mmHg. Neurological assessment showed no signs of stroke, such as limb weakness or other lateralizing signs. Conclusion: This case underscores the importance of a comprehensive diagnostic approach and an individualized treatment plan for patients with Bell's palsy and concurrent hypertensive crisis. Awareness of such complications can aid clinicians in optimizing patient outcomes while minimizing risks.

Multibacillary leprosy in an adolescent with a family history of leprosy at Kedurus health center, Surabaya

I Dewa Putu Gede Bagus Krishna Pradnyandika — Sat, 30 Nov 2024 00:00:00 +0000

Background: Leprosy is a chronic human infection caused by Mycobacterium leprae which primarily affects peripheral nerves and can cause various disabilities. One of the main risk factors for leprosy transmission is direct contact with leprosy patients, which significantly increases the likelihood of contracting this disease compared to the general population. Objective: This case report aims to describe the clinical presentation and risk factors of leprosy in an adolescent with a family history of leprosy. Case: An 18-year-old male was diagnosed with multibacillary leprosy based on clinical findings, despite having a negative laboratory test result. The patient had a family history of leprosy. Discussion: The diagnosis was primarily made from clinical evidence, with direct transmission identified as the main risk factor. Conclusion: The patient was diagnosed with multibacillary leprosy accompanied by a type I reaction and no signs of disability. The main risk factor for transmission was interfamilial contact. The patient’s prognosis was good, given the absence of disability and the positive response to treatment

Severe and recurrent hypoglycemia in an elderly patient with type 2 diabetes: the role of Glibenclamide and urinary tract infection

Jansen Irawan, Irawan Melissa, Wibowo Dharma Mulya E — Sat, 30 Nov 2024 00:00:00 +0000

Background: Hypoglycemia is an acute complication of diabetes especially in elderly patients and a leading cause of emergency room visits and hospital admissions. Several risk factors, such as age, polypharmacy, inadequate food intake, and infections, can further increase the risk of recurrent hypoglycemia and complicate its management. Objective: This report aims to present a case of severe and recurrent hypoglycemia induced by Glibenclamide in an elderly patient with concurrent infection. Case: A 66-year-old female was admitted to the emergency department (ED) in an unconscious state. After a thorough history taking and examination, the patient was diagnosed with profound hypoglycemia induced by sulfonylurea and urinary tract infection. Recurrent episodes of hypoglycemia were observed during treatment despite the administration of Dextrose 40%. Conclusion: Severe hypoglycemia is a common and life-threatening complication. Glibenclamide is a known cause of severe hypoglycemia, although other risk factors may also contribute to its occurrence. Infections can exacerbate hypoglycemic episodes, making them more difficult to manage. Clinicians must remain vigilant about recurrent episodes of hypoglycemia as prompt treatment is associated with a good prognosis

Femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification in cataract management: a systematic review

Vitria Sari Dewi, Sarah Dwitya, Retno Diah Triasna — Sat, 30 Nov 2024 00:00:00 +0000

Background: Cataracts remain the leading cause of reversible blindness and visual impairment worldwide. While phacoemulsification surgery (PCS) remains a highly effective and safe procedure, its success can be influenced by associated complications. Femtosecond laser-assisted cataract surgery (FLACS) has emerged as an alternative, offering greater safety, efficacy, and predictability, particularly for complex cataracts. Objective: This study aims to compare FLACS with PCS to evaluate differences in outcomes such as uncorrected distance visual acuity (UDVA), best-corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss (ECL), and intraoperative complications. Materials and Methods: Following PRISMA guidelines, a systematic review was conducted. Studies published between 2015 and 2021 were identified through databases including PubMed, ScienceDirect, and Cochrane Library. Included studies involved cataract patients undergoing either FLACS or PCS, with outcomes measured for visual acuity, corneal cell integrity, and surgical complications. Results: FLACS demonstrated faster recovery in UDVA and BCVA within the initial postoperative period compared to PCS, although visual acuity results were similar by three to 12 months. While short-term endothelial preservation was similar, FLACS was associated with slightly higher long-term ECL, suggesting that PCS may better preserve corneal health over time. Complications such as anterior capsule tears were more frequent in FLACS. However, serious events were rare across both groups. FLACS yielded more precise corneal incisions, which may contribute to more stable wound healing during the early recovery stage. Conclusion: FLACS offers advantages in early postoperative visual recovery. However, PCS may provide slightly better long-term endothelial preservation. Both techniques ultimately result in similar visual outcomes in the long term, with FLACS presenting unique yet manageable intraoperative risks

Magnetic resonance imaging (MRI) findings in pediatric epilepsy

Astri Soetanto, Laurensius Kevin Bewina — Sat, 30 Nov 2024 00:00:00 +0000

Background: Epilepsy is a neurological condition characterized by irregular, rapid, and synchronized neuronal discharges from the cerebral cortex. Advances in neuroimaging have significantly enhanced the diagnosis, treatment, and management of pediatric epilepsy. Structural magnetic resonance imaging (MRI), when evaluated by skilled neuroradiologists, facilitates improved identification of the seizure onset zone using epilepsy-specific MRI protocols. Objective: This review aims to analyze cerebral MRI findings in pediatric epilepsy across age groups and sexes. Materials and Methods: A comprehensive literature review was conducted using major scientific databases, including PubMed, ScienceDirect, and SciELO. Articles were screened based on inclusion criteria, starting with titles, followed by abstract and full-text evaluations. The following keywords were used in the literature search: "Magnetic Resonance Imaging" or "MRI" AND "Childhood" or "Pediatric" AND "Epilepsy." Results: Analysis of 16 studies revealed 1,504 MRI anomalies. Cortical malformations were the most frequent anomaly, identified in 230 cases (15%). The second most frequent finding, hippocampal/mesial temporal sclerosis, was observed in 160 subjects (10%). Other anomalies included infections in 76 subjects (5%), brain tumors in 37 subjects (2%), periventricular leukomalacia in 37 subjects (2%), encephalomalacia in 65 subjects (4%), vascular disorders in 41 subjects (2.7%), cysts in 75 subjects (5%), hydrocephalus in 33 subjects (2.1%), and demyelination disorders in 33 subjects (2.1%). Conclusion: MRI scanning is particularly beneficial for children with newly diagnosed epilepsy, especially those with focal seizures, focal EEG abnormalities, or abnormal neurological examinations. It is also valuable for children who present with refractory seizures that other imaging modalities are unable to detect.

Impact of COVID-19 pandemic on giving basic immunization, weight measurement, and vitamin A to toddlers in Surabaya 2019-2020

Muh. Zaki Anshari Farid, Irwanto Irwanto, Linda Dewanti, Dwiyanti Puspitasari — Sat, 30 Nov 2024 00:00:00 +0000

Background: On January 30, 2020, the World Health Organization (WHO) declared the COVID-19 pandemic a Public Health Emergency of International Concern. Surabaya, East Java, reported the highest number of COVID-19 cases, with 24,545 confirmed cases. The pandemic caused significant disruptions to healthcare services, particularly the Posyandu, a community-based health initiative providing vital services such as immunizations, weight monitoring, and vitamin A supplementation to toddlers. Objective: This study aims to examine the impact of the COVID-19 pandemic on the provision of basic immunizations, weight monitoring, and vitamin A administration to toddlers in Surabaya during the years 2019 to 2020. Method: A retrospective analytical study was conducted using secondary data from public health centers and the Surabaya Health Office. The data were analyzed descriptively, and paired T-tests were used to determine statistical significance in changes in coverage rates. Results: The study observed a decline in coverage for BCG (5.78%), hepatitis B (3.33%), polio (5.19%), pentabio (4.08%), and MR (3.12%) immunizations. Weight monitoring coverage decreased by 1.07%, while vitamin A administration increased slightly by 0.05%. Significant reductions were found for BCG, MR, and polio immunizations, while changes in hepatitis B, pentabio, and weight monitoring were not statistically significant. The increase in vitamin A administration was also not significant. Conclusion: The COVID-19 pandemic led to a notable decline in immunization coverage and weight monitoring for toddlers in Surabaya, although vitamin A administration saw a minor increase. These results emphasize the importance of maintaining essential healthcare services during global health crises.

The role of the Neonatal Emergency Transportation Service (NETS) ambulance at dr. Ramelan Central Naval Hospital in reducing neonatal mortality rates in Surabaya

Maria Adventia Debi Mustika Martin, Stefani Miranda, Aminuddin Harahap — Sat, 30 Nov 2024 00:00:00 +0000

Background: Limited access to health services is one of the factors that increases the risk of neonatal death. Previous studies identified inadequate transportation as a problem in the neonatal referral system in Indonesia. The Neonatal Emergency Transportation Service (NETS) was established to address this problem. NETS is equipped with an incubator, transport ventilator, and mobile vital sign monitor. Newborns transported via NETS are accompanied by a doctor and trained nurses. Objective: This study aims to compare the survival rates of newborns referred with and without using the NETS ambulance. Materials and Methods: This descriptive observational study employed a total sampling technique. Data were collected retrospectively from the electronic medical records at dr. Ramelan Central Naval Hospital, comparing the number of referrals and neonatal deaths between September 2021 and August 2022 (without the NETS ambulance) and between September 2022 and August 2023 (with the NETS ambulance). The data were analyzed using a chi-squared test (p = 0.004). Results: A total of 81 newborns were referred to the hospital using the NETS ambulance. The survival rate of newborns transported with the NETS ambulance was higher (69.1%) compared to those transported without the NETS ambulance (48.1%) (p = 0.004). The risk ratio was calculated at 0.413. Conclusion: Neonatal survival rates were higher for referrals using the ambulance compared to those without using the ambulance.

From bullying to suicide: the pathways road in adolescent

Budi Santoso — Sat, 30 Nov 2024 00:00:00 +0000

Introduction: Suicide is a traumatic event for close relatives due to various factors, with bullying acting as a mediator. Bullying has been identified as a primary predictor of suicidal ideation and a contributing factor to suicide. Objective: This study aims to describe the pathway from bullying victimization to suicidal attempts in adolescents. Results: Adolescence is a period of peak physical health and a time of behavioral and emotional problems due to developmental factors, which can increase susceptibility to suicidal behavior. Adolescents who experience bullying report suicidal ideation more frequently, often on a weekly basis, due to psychiatric morbidity (OR = 7.78). The relationship between bullying and suicide is mediated by poor physical and mental health, especially among victims. Bullying victimization triggers psychological or behavioral problems that can lead to suicidal behavior, often mediated by mental health or psychological problems, such as internalization or substance use which serve as maladaptive coping strategies, with suicide ultimately becoming a final coping strategy. Conclusion: Psychological or mental health problems mediate the risk of suicidal attempts among bullied adolescents, although other pathways may also be involved.