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ENFORCEMENT OF MEDICAL DISCIPLINE VIOLATIONS IN INDONESIA Wibiansyah, Kukuh Tri; Wahyudi, Firdaus; Bhima, Sigid Kirana Lintang; Dhanardhono, Tuntas
DIPONEGORO MEDICAL JOURNAL (JURNAL KEDOKTERAN DIPONEGORO) Vol 9, No 6 (2020): DIPONEGORO MEDICAL JOURNAL (Jurnal Kedokteran Diponegoro)
Publisher : Faculty of Medicine, Diponegoro University, Semarang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dmj.v9i6.29322

Background: The medical profession is closely related to human values and professionalism, but in practice, there are still doctors who breach the medical discipline principles. Method: This is a descriptive study to outline the enforcement outcome. Samples were taken from data of breach of medical discipline in 2014-2018 which were uploaded on the website of the Indonesian Medical Council (KKI) combined with interviews reports. Result: The average complaint of breach is 40.6 complaints per year. The percentage of the case completion compare to the number of complaints each year was 82% in 2015, 103% in 2016, 217% in 2017, and 126% by 2018. Total number of decision from medical discipline council trial in 2018 was 49 cases, consists of 4 cases from 2014, 5 cases from 2015, 21 cases from 2016, 16 cases from 2017, and 3 cases of complaints submitted in 2018. Of the verdict from the trial, 15 decision considered as interlocutory verdict and 34 cases as final decision. The period of handling of medical disciplinary breach requires 1 to 2 years. Conclusion: The enforcement of medical discipline violations experienced progressive resolution annually, with 2017 as the peak year. The performance was influenced by alteration in the management board and the enactment of new council regulations.

Penentuan Intravitalitas Gantung berdasarkan Gambaran Histopatologis Otak Besar Mencit Balb/c Iswara, Raja Al Fath Widya; Bhima, Sigid Kirana Lintang; Rohmah, Intarniati Nur
Medica Hospitalia : Journal of Clinical Medicine Vol. 6 No. 2 (2019): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar Belakang : Asfiksia merupakan salah satu mekanisme kematian yang dapat terjadi akibat gantung. Otak merupakan salah satu organ penting yang dinilai dalam otopsi kasus gantung. Secara makroskopis tidaklah mudah membedakan temuan asfiksia pada otak yang terjadi antemortem dan perimortem. Adanya temuan asfiksia pada pemeriksaan mikrokopis dapat menentukan intravitalitas gantung. Penelitian ini bertujuan untuk mengetahui penentuan intravitalitas gantung berdasarkan gambaran histopatologis otakbesar mencit Balb/c. Metode : Penelitian eksperimental ini menggunakan post test only with control group design yang telah memenuhi kelayakan etik dengan sampel berjumlah 18 mencit Balb/c jantan yang dibagi menjadi tiga kelompok yaitu kelompok kontrol yang tidak diberi perlakuan, kelompok antemortem yang digantung saat masih hidup, kelompok perimortem yang digantung 15 menit setelah mati. Pada kelompok pelakuan mencit digantung selama 1 jam dengan tali yang ditambahkan beban 50 gram. Penilaian gambaran histopatologi otak besar berdasarkan reaksi inflamasi dan perdarahan. Hasil : Pada kelompok kontrol hampir tidak terdapat inflamasi dan perdarahan, pada kelompok antemortem terdapat inflamasi sedang hingga berat dan perdarahan berat, pada kelompok perimortem terdapat inflamasi dan perdarahan ringan hingga sedang. Pada uji Kruskal Wallis didapatkan perbedaan bermakna pada semua kelompok (p<0,05). Pada Uji Man Whitney didapatkan perbedaan yang bermakna pada parameter inflamasi dan perdarahan antara kelompok kontrol dengan kelompok antemortem dan perimortem, antara kelompok antemortem dan perimortem (p<0,05). Simpulan : Intravitalitas Gantung dapat ditentukan berdasarkan gambaran histopatologis otak besar mencit Balb/c dimana reaksi inflamasi dan perdarahan berat didapatkan pada kelompok antemortem. Kata Kunci: gantung, histopatologis, intravital, otak besar Hanging Intravitality Determination based on Cerebrum Histopathological Features in Balb/c Mice Abstract Background: Asphyxia is one of the death mechanisms that can occur due to hanging. The brain is one of the important organs autopsied in a hanging-related death case. Macroscopically, it is challenging to distinguish between asphyxiated brains occuring antemortem and those occurring perimortem. The presence of asphyxia on micro-examination can help determining the hanging intravitality. This study aims to determine hanging intravitality based on cereberum histopathological features in mice Balb/c mice. Method: This is a post test only experimental study with control group examining 18 male Balb/c mice in three groups involving untreated control group, antemortem group hanged during alive, perimortem group hanged 15 minutes after death. In the treatment groups, mice were hanged with 50 grams load for 1 hour. Determination of histopathological features is based on inflammatory and bleeding reactions. Results: Nearly no inflammation and bleeding was found in the control group, moderate to severe inflammation and heavy bleeding was found in the antemortem group, mild to moderate inflammation and bleeding was found in the perimortem group. The Kruskal Wallis test showed significant differences in all groups (p <0.05). The Man Whitney test found significant differences in the inflammatory and bleeding parameters between the control group and the antemortem and perimortem groups; between the antemortem and perimortem groups (p <0.05). Conclusion: The cerebrum histopathological features of the Balb/c mice can indicate hanging intravitality in which the antemortem group shows inflammatory reactions and heavy bleeding. Keywords: hanging, histopathological, intravital, cerebrum

Kematian Mendadak Akibat Kardiomiopati Hipertrofi Pada Dewasa Muda Iswara, Raja Al Fath Widya; Sadad, Arif Rahman; Rohmah, Intarniati Nur; Bhima, Sigid Kirana Lintang
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 2 (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar Belakang : Kematian mendadak merupakan kasus yang paling sering terjadi dan dapat ditemukan dalam berbagai macam kondisi. Penyebab kematian mendadak terbanyak adalah sistem kardiovaskular dan salah satu kelainan yang jarang terjadi adalah kardiomiopati hipertrofi. Kardiomiopati hipertrofi merupakan kelainan jantung yang ditandai dengan hipertrofi miokardial akibat mutasi sarkomer dengan angka kejadian 1 dari 500 orang dewasa. Temuan utama pada kardiomiopati hipertrofi antara lain adanya hipertofi ventrikel dan atau septum interventrikel, kerusakan miosit dan peningkatan fibrosis miokardium. Terdapat variasi manifestasi klinis pada Kardiomiopati hipertrofi, dari asimptomatik hingga mengakibatkan kematian mendadak akibat gagal jantung. Tujuan laporan kasus ini adalah mengetahui diagnosis kematian akibat kardiomiopati hipertrofi pada dewasa muda. Kasus : Seorang laki-laki usia 18 tahun ditemukan meninggal di kamar kostannya dibawa ke kamar jenazah RSUP dr. Kariadi Semarang untuk diotopsi. Pemeriksaan luar tidak ditemukan tanda-tanda kekerasan. Pemeriksaan dalam didapatkan adanya jendalan darah dalam ventrikel, hipertrofi ventrikel kiri, penebalan pada katub jantung, pengerasan pada otot jantung dan penggantung katub serta tanda asfiksia. Pemeriksaan histopatologi menunjukkan kardiomiopati hipertrofi. Pembahasan : Patogenesis kardiomiopati hipertrofi dapat menyebabkan asfiksia yaitu terjadinya mutasi intrasarkomer yang meningkatkan peningkatan sensitivitas dan produksi Calsium yang mengakibatkan peningkatan kontraksi miokardium sehingga menyebabkan hipertrofi ventrikel kiri. Selain itu juga terjadi peningkatan sintesis kolagen yang mengakibatkan terjadinya fibrosis miokard yang menyebabkan hipertrofi ventrikel kiri. Terjadinya hipertrofi ventrikel kiri jangka panjang akan menyebabkan kondisi gagal jantung yang dapat mengakibatkan asfiksia. Simpulan : Kematian mendadak akibat kardiomiopati hipertrofi merupakan hal yang jarang. Oleh karena itu dibutuhkan otopsi yang teliti dan pemeriksaan histopatologi untuk mendiagnosis dengan pasti. Kata Kunci : Kematian mendadak, kardiomiopati hipertrofi, dewasa muda, sarkomer Background : Sudden death is the most common case and can be found in a variety of conditions. The most common cause of death is the cardiovascular system and a rare one disorders is hypertrophic cardiomyopathy. Hypertrophy cardiomyopathy is a heart disorder characterized by myocardial hypertrophy due to sarcomere mutations with an incidence of 1 in 500 adults. The main findings in hypertrophic cardiomyopathy include the presence of ventricular hypertrophy and / or interventricular septum, myocyte damage and increased myocardial fibrosis. There are variations in clinical manifestations in hypertrophic cardiomyopathy, from asymptomatic to sudden death due to heart failure. The purpose of this case report is to know the diagnosis of sudden death due to hypertrophic cardiomyopathy in young adults Case : A 18-year-old man was found dead in his boarding room. On the external examination there were no signs of violence. On the internal examination in the presence of blood in the ventricles, left ventricular hypertrophy, thickening of the entire heart valve, hardening of the heart muscle and hanging valves and signs of asphyxia. Histopathological examination showed hypertrophic cardiomyopathy. Discussion : The pathogenesis of hypertrophic cardiomyopathy can cause asphyxia is the occurrence of intrasarcomere mutations that increase the sensitivity and production of calcium which results in increased contraction of the myocardium causing left ventricular hypertrophy. In addition there is also an increase in collagen synthesis which results in the occurrence of myocardial fibrosis which causes left ventricular hypertrophy. The occurrence of long-term left ventricular hypertrophy will cause a condition of heart failure which can lead to asphyxia. Conclusion : Sudden death due to hypertrophic cardiomyopathy is rare one. Therefore a careful autopsy is needed and histopathological examination is needed to get definitive diagnose. Keywords : Sudden death, hypertrophic cardiomyopathy, young adults, sarcomere

Risk Factors for Mortality Among Confirmed Covid-19 Patients At RSUP Dr.Kariadi Junaedi, Husain; Pramudo, Setyo Gundi; Bhima, Sigid Kirana Lintang; Dhanardono, Tuntas
Medica Hospitalia : Journal of Clinical Medicine Vol. 10 No. 1 (2023): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v10i1.834

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is a communicable disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). On March 11, 2020 the World Health Organization (WHO) declared COVID-19 as pandemic causing mortality in more than 150 countries. China reports the most case is among people aged 30 – 79 years old and male, meanwhile in Italia the most case is among patients with cardiovascular disease, diabetes, chronic diseases, hypertension, and cancer. This encourages researcher to examine risk factors causing mortality among patients with confirmed COVID-19. METHOD: This is an observational study with multivariate analytical test. The samples involved medical records of died patients with confirmed COVID-19 at RSUP Dr.Kariadi. Risk factors being studied involved age, gender and comorbidities such as hypertension, diabetes, pneumonia, chronic obstructive pulmonary disease (COPD), heart disease, kidney disease, and cancer. Data were analyzed using multiple logistic regression with univariate, bivariate, multivariate, confounding and interaction tests. RESULT: An increased risk for mortality was found among confirmed COVID-19 patients aged over 60 years (3.25 times), suffered from hypertension (2.09 times), pneumonia (4.77 times), cancer (11.89 times), heart disease (3.55 times), and kidney disease (5.23 times). CONCLUSION: Risk factors involving age, hypertension, pneumonia, cancer, heart disease, and kidney disease increase risk for mortality among patients with confirmed COVID-19. The risk is heightened as patients aged older than 60 years old suffering from pneumonia and cancer simultaneously.

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