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All Journal Universa Medicina The New Ropanasuri Journal of Surgery
Kloping, Yudhistira Pradnyan
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Atypical Presentation of Acute Appendicitis: A Case Report Kloping, Yudhistira Pradnyan; Putri, R. Cita Resti Anantia
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Abstract

Despite the fact that acute appendicitis is one of the most common surgical emergencies worldwide, delays in establishing a diagnosis still occur. We report a case of acute appendicitis with an atypical presentation based on the patient’s clinical and laboratory findings. A 25-year-old male was brought with pain in his right lower quadrant. Pain migration, fever, anorexia, nausea, vomiting, or dysuria were denied. Laboratory results were within normal limits. USG examination was not able to visualize the appendix. An abdominal CT-Scan showed a sign of acute appendicitis. The patient was planned for appendectomy. It is important to not immediately rule out the diagnosis of appendicitis because an atypical presentation may be presented and could potentially lead to fatal complications.
Outcomes of ureteral stent placement for hydronephrosis in patients with ureteral stone Widyokirono, Dyah Ratih; Kloping, Yudhistira Pradnyan; Rahman, Zakaria Aulia; Hakim, Lukman
Universa Medicina Vol. 40 No. 3 (2021)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2021.v40.226-233

Abstract

BackgroundRoutine ureteral stent placement after ureteroscopy (URS) for ureteral stone treatment is arguable due to the possible stent-related symptoms. Several studies claimed that its use is necessary, while others reported that its use is excessive. Hydronephrosis occurs when urine cannot drain out from the kidney to the bladder due to blockage or obstruction. We aimed to evaluate the role of ureteral stents in hydronephrosis resolution in ureteral stone patients following URS lithotripsy. MethodsThis was a prospective observational study using secondary data involving 130 ureteral stone patients undergoing URS lithotripsy [99 patients (76.2%) with stent placement and 31 patients (23.8%) without stent]. Data consisting of baseline characteristics, pre-operative status, intraoperative characteristics, and postoperative complications were collected from the medical record database and presented descriptively. The patients were divided into two groups based on stent placement. Comparison of hydronephrosis resolution between the groups was analyzed with Chi-square. ResultsUreteral lesions were the most common indication of ureteral stent placement following URS lithotripsy (28.3%). The most bothersome symptoms were dysuria in 18 patients (18.2%); followed by frequency in eight patients (8.1%) and low back pain in six patients (6.1%). All symptoms were successfully treated with oral medications. There were 41 patients (91.1%) with pre-operative hydronephrosis significantly resolved after stent placement compared to 5 (62.5%) patients without stent placement (p=0.027). ConclusionUreteral stenting significantly resolves pre-operative hydronephrosis after URS lithotripsy in patients with ureteral stone. Ureteral stent placement is the preferred method for the treatment of pre-operative hydronephrosis.
Neutrophil-lymphocyte ratio and fournier gangrene severity index are not prognostic factors of mortality in fournier gangrene patients Raizandha, Muhammad Achdiar; Hidayatullah, Furqan; Kloping, Yudhistira Pradnyan; Rizaldi, Fikri
Universa Medicina Vol. 41 No. 1 (2022)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2022.v41.71-78

Abstract

Background Fournier gangrene (FG) is a life-threatening disease, commonly found in diabetic and immunocompromised patients. Recent studies suggested the use of new parameters apart from the commonly used Fournier gangrene severity index (FGSI), such as the neutrophil-lymphocyte ratio (NLR), the clinical use of which remains questionable. Therefore, we aimed to evaluate the role of the NLR and FGSI as a prognostic factor of mortality in patients with FG. MethodsThis is an analytical study with a retrospective approach involving 109 adult patients diagnosed with FG. Data were collected regarding medical history, symptoms, physical examination findings, and laboratory tests. The FGSI score and NLR were determined. Bivariate analysis was performed using chi-square test and independent t-test. Overall survival between groups was compared using Kaplan–Meier survival estimates and Cox regression test. ResultsOf the 109 patients, 90 survived (82.5%, group 1) and 19 died (17.43%, group 2). The cut-off point of NLR among the patients was 10.9, with a 73.7% sensitivity and 60% specificity. The area under curve value was 0.65 (95% CI; 0.524-0.754; p<0.05). The Kaplan Meier survival analysis showed that NLR was as an independent prognostic factor of mortality in FG patients (HR 5.177; 95% CI; 1.092-8.471; p<0.05), but Cox regression analysis showed that NLR and FGSI were not significant prognostic factors of mortality (p=0.09 and p=0.179; respectively). ConclusionThis study demonstrated that NLR and FGSI are not important as prognostic tools for FG mortality.
Co-Authors Furqan Hidayatullah Lukman Hakim Putri, R. Cita Resti Anantia Raizandha, Muhammad Achdiar Rizaldi, Fikri Widyokirono, Dyah Ratih Zakaria Aulia Rahman