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Acute Limb Ischemia (Ali): An Overview Of Clinical Diagnosis And Treatment Laksono, Gerardo AK; Erwin, Ferdinand; Tahalele, Paul L
JOURNAL OF WIDYA MEDIKA JUNIOR Vol 2, No 2 (2020): April
Publisher : FAKULTAS KEDOKTERAN UNIVERSITAS KATOLIK WIDYA MANDALA SURABAYA

Acute limb ischemia (ALI) is one of vascular emergency. It is defined as a rapid and sudden decrease in limb blood flow due to acute occlusion It is considered to be acute if it occurs within 14 days after the first symptom onset. The incidence of ALI is around 1.5/10.000 people per year. It has reported a mortality rate of 15%-20% in 30 days and high amputation rates 10%-15% if appropriate treatment not administered. The causes of ALI are divided into embolism and thrombosis. Thrombosis can occurred due to atherosclerotic lesion while most cases of embolism are cardiogenic one. Classic features of ALI are known as 6Ps: pain, pallor, paralysis, paraesthesia, pulselessness, poikilothermia. A good history taking and physical examination are needed to assess further treatment needed. Severity of ALI also need to be set based on Rutherford Classification. If the limb was diagnosed as irreversible damage, amputation should be taken as treatment choice without hesitation. ALI can be treated with administered of heparin, endovascular and open surgical. Post treatment follow up also needed to rule out any possible complication such as compartment syndrome and ischemic-reperfusion injury.

Spontaneous Pneumothorax Following Bronchopleural Fistula In Geriatric Patient: A Case Report And Emergency Management Erwin, Ferdinand; Laksono, Gerardo AK; Sarvasti, Dyana; Tahalele, Paul L
JOURNAL OF WIDYA MEDIKA JUNIOR Vol 3, No 1 (2021): January
Publisher : FAKULTAS KEDOKTERAN UNIVERSITAS KATOLIK WIDYA MANDALA SURABAYA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33508/jwmj.v3i1.3009

Introduction: Bronchopleural fistula (BPF) is a pathological connection between thebronchial tree and the pleural space. Clinical manifestation of BPF may be classified as acute,subacute, and delayed or chronic forms. Acute BPF can be a life-threatening condition due totension pneumothorax or asphyxiation from pulmonary flooding. Purpose: To report the patient survival from the upper lobe of the right lung bronchopleuralfistula wedge resection and to use staplers as upper lobe pulmonary wound closure. Case Report: 72-year-old male referred from pulmonologist with a chief complaint ofprogressive shortness of breath and nonproductive cough for four days. The patient had ahistory of tuberculosis and COPD and a heavy smoker for the last 50 years. Chestradiography showed a decreased opacity of the right hemithorax, with 40% collapsed of the lung parenchyma. Chest tube insertion performed on the right hemithorax, then the patient got immediate relief. On the seventh day, the patient complained of worsening dyspnea. Achest x-ray showed lung collapsed on the right hemithorax. Multislice CT-scan (MSCT) ofthe chest showed right-sided pneumothorax with bronchopleural fistula. Wedge resection forthe 3 cm in diameter fistula was performed. On the seventh day postoperative, the patient wasfully recovered then discharged from the hospital.Conclusion: Seven days postoperatively of wedge resection, the patient discharge from thehospital without any complication and stable hemodynamic. The patient went to theoutpatient department for follow up one week after.

HEMOTHORAX FOLLOWING PENETRATING THORACIC INJURY (GUNSHOT WOUND) IN GERIATRIC PATIENT: A CASE REPORT AND EMERGENCY MANAGEMENT Laksono, Gerardo AK; Erwin, Ferdinand; Sarvasti, Dyana; Tahalele, Paul L
JOURNAL OF WIDYA MEDIKA JUNIOR Vol 3, No 2 (2021): April
Publisher : FAKULTAS KEDOKTERAN UNIVERSITAS KATOLIK WIDYA MANDALA SURABAYA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33508/jwmj.v3i2.3180

Introduction: Penetrating chest trauma is highly lethal. Studies have reported up to 60% mortality depending on the mechanism of injury. While penetrating chest trauma is lesscommon than blunt trauma, it can be more deadly. High-velocity gunshot injury resulting inpenetrating thoracic trauma in geriatric patients poses a significant challenge for the traumaticsurgeon. Hemothorax is usually a consequence of penetrating chest trauma. It can be caused byintercostal arterial bleeding, especially the posterior part. Initial treatment, including chest tubedrainage insertion, is needed to avoid lung compression and to assess future treatment needed. Purpose: To report the patient survival from massive hemothorax caused by penetratingThoracic injury caused by an air rifle, treated by chest tube insertion and posterolateralthoracotomy to take out the bullet several days after.Case Report: 70-year male patient came to the Emergency Room (ER) Adihusada HospitalSurabaya with a penetrating chest injury caused by an air rifle on the right side of the chest. The patient had chest pain, shortness of breath, and hypoxia. By inserting a chest tube,emergency management was done by a general surgeon due to the massive right hemothorax.An immediate chest tube insertion was needed to overcome the patientâ€™s breathing problem toassess the future treatment needed. Chest X-ray and CT-Scan was done immediately after thepatientâ€™s hemodynamic were stable. Three days after hospitalizing, the Cardiothoracic andvascular surgeon performed posterolateral thoracotomy to take the bullet out of the chest.Conclusion: Seven days postoperatively, the patient was discharged from the hospital withoutany complications and stable hemodynamic. The patient went to the outpatient department forfollow-up one week after.

The Effectiveness of Using Laser Therapy on Outcome of Carpal Tunnel Syndrome Patients : A Literature Review Tjahyanto, Teddy; Mayung, Claraiva; Yohanes, Guntur; Erwin, Ferdinand; Wiracakra, I Gusti Lanang Krisna
International Journal of Public Health Excellence (IJPHE) Vol. 3 No. 1 (2023): June-December
Publisher : PT Inovasi Pratama Internasional

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55299/ijphe.v3i1.523

Carpal Tunnel Syndrome (CTS) is a neuropathy caused by compression of the median nerve that passes through the carpal tunnel structure in the wrist. If the CTS condition is not treated, complications will occur such as irreversible damage to the median nerve resulting in permanent impairment and disability, chronic wrist pain, and muscle atrophy and weakness. Currently there are various CTS therapies such as splinting , local injection of corticosteroids, oral medications such as prednisone, physical therapy such as carpal bone mobilization, ultrasound therapy , and nerve glides exercises , as well as surgical therapy. However, these various therapies have not provided optimal results and there are complications such as neuromas, hypertrophic wounds, dysesthesia, wrist joint stiffness, and the inability of various to reduce CTS symptoms. Therefore, more effective therapy with minimal side effects is needed. Therefore, in this literature review, an analysis of the effect of laser therapy on various outcomes of CTS patients as an innovative therapy was carried out. Study searches were performed on various databases such as Pubmed, ScienceDirect , Directory of Open Access Journal , Epistemonikos, and Cochrane Library . From the search results obtained a total of 389 studies. The 7 studies that met the inclusion and exclusion criteria were the studies that were analyzed in this literature review. Various types of laser therapy showed better outcome results than the control group, with LLLT laser therapy showing the best results in various outcomes in CTS patients. LLLT laser therapy also shows better results when combined with other types of therapy. No adverse events were reported with any type of laser therapy in all inclusion studies. Therapy is the newest type of innovative therapy with better effects and minimal side effects compared to conventional therapy in CTS patients.

CLINICAL PROFILE OF STROKE PATIENTS IN GOTONG ROYONG HOSPITAL Supit, Paulus; Kurniawati, Nita; Kartikasari, Desy; Raymond Desun, Evander Aloysius; Erwin, Ferdinand
JOURNAL OF WIDYA MEDIKA JUNIOR Vol 6, No 3 (2024): July
Publisher : FAKULTAS KEDOKTERAN UNIVERSITAS KATOLIK WIDYA MANDALA SURABAYA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33508/jwmj.v6i3.5781

Background: Stroke is a global health issue due to its high prevalence, mortality, and associated disabilities. The Global Burden of Disease Study identifies ischemic and hemorrhagic strokes as significant contributors to global health burdens. Understanding these factors in different populations is crucial for developing targeted interventions and improving patient outcomes.Methods: This retrospective descriptive study analyzed medical records of stroke patients at Gotong Royong Hospital from January to December 2023. Patients aged 18 years or older with acute stroke confirmed by CT or MRI were included.Results: Out of 224 stroke patients, 58% were male and 42% female. Most patients were over 70 years old (31.7%), with 29% aged 51-60 and 26.3% aged 61-70. Ischemic stroke was predominant (91.5%), while 8.5% had hemorrhagic stroke. Many patients (40.2%) arrived at the emergency department more than 24 hours after symptom onset. Hypertension was present in 68.8% of patients, diabetes in 36.6%, and dyslipidemia in 24.1%. The average length of stay was 4.13 days. Blood pressure measurements showed high prevalence of Grade 2 hypertension in systolic (37.05%) and prehypertension in diastolic (30.80%). Laboratory results revealed mean random blood glucose of 174.3 mg/dL, fasting blood glucose of 110.42 mg/dL, HbA1C of 8.06%, LDL cholesterol of 120.31 mg/dL, and triglycerides of 151.26 mg/dL.Conclusion: The majority of acute stroke patients at Gotong Royong Hospital are male, over 60, with ischemic stroke, and present more than 24 hours post-onset. These patients typically have a history of hypertension but no previous strokes, with an average hospital stay of 4 days. Many exhibit Grade 2 hypertension in systolic blood pressure and prehypertension in diastolic pressure. Understanding these profiles can guide better management and preventive strategies for stroke patients.

PENYULUHAN KESEHATAN PENCEGAHAN DAN PENANGANAN NYERI PUNGGUNG BAWAH Kartikasari, Desy; Supit, Paulus Alexander; Kurniawati, Nita; Erwin, Ferdinand
Community Development Journal : Jurnal Pengabdian Masyarakat Vol. 4 No. 6 (2023): Volume 4 Nomor 6 Tahun 2023
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/cdj.v4i6.22061

Nyeri punggung bawah (NPB), seperti yang didefinisikan oleh Persatuan Dokter Saraf Indonesia (PERDOSSI), merupakan persepsi nyeri yang terlokalisasi pada daerah punggung bagian bawah, dapat berupa nyeri lokal atau radikuler, atau keduanya. Nyeri ini terjadi di antara sudut iga terbawah dan lipat bokong bawah, yang merupakan daerah lumbal atau lumbosakral, seringkali disertai dengan penjalaran nyeri ke arah tungkai dan kaki. Berdasarkan penelitian multisenter PERDOSSI, sebanyak 18,37% dari 819 orang yang menjadi subjek penelitian pada 14 rumah sakit pendidikan Indonesia pada Mei 2002 mengalami NPB. Kejadian NPB ini terkait dengan berbagai faktor risiko, termasuk karakteristik pekerjaan, faktor lingkungan, aktivitas fisik, serta faktor genetik. NPB menjadi masalah kesehatan global yang umum, menyebabkan pembatasan aktivitas dan disabilitas kerja. Pentingnya penanganan NPB tercermin dalam data disabilitas terkait NPB di negara Barat, di mana sekitar 45-55% populasi pekerja mengalami NPB dalam periode 12 bulan. Penanganan NPB melibatkan pendekatan farmakologis dan non-farmakologis. Kegiatan ini merupakan kegiatan penyuluhan kesehatan yang bertujuan untuk meningkatkan pengetahuan masyarakat umum mengenai nyeri punggung bawah.

Fungal Meningoencephalitis Masquerading as Metabolic Encephalopathy: A Case Report in a 65-Year-Old Geriatric Patient Kurniawati, Nita; Erwin, Ferdinand
AKSONA Vol. 5 No. 1 (2025): JANUARY 2025
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v5i1.55844

Highlight: A geriatric patient may present with subtle or nonspecific symptoms of meningoencephalitis, such as confusion, altered mental status, or lethargy, rather than classic signs like fever and neck stiffness. Negative CSF cultures of fungal infection should not delay the initiation of antifungal therapy. ABSTRACT Introduction: Infectious pathogens or autoimmune disorders can cause meningoencephalitis. Symptoms include headache, fever, altered mental status, seizure, or neurological deficits. Symptoms frequently manifest atypically in the elderly, which can result in delayed treatment. This case emphasizes how important it is to consider meningoencephalitis in elderly patients with altered consciousness, even without typical signs of it. Case: A 65-year-old female with a history of recurrent hyponatremia and hypokalemia arrived at the emergency room with sudden loss of consciousness, vomiting, and behavioral changes that persisted for a week. The neurological examination and brain CT scan revealed no abnormalities. Severe electrolyte imbalances prompted the initial diagnosis of metabolic encephalopathy. Following progressive electrolyte correction, the patient’s mental condition improved. On the second day, she had generalized seizures and developed right-sided hemiparesis. An MRI of the head with contrast showed thicker dura mater and leptomeningeal enhancement in both hemispheres, indicating meningoencephalitis. Ceftriaxone and dexamethasone were administered intravenously, along with levetiracetam, to treat seizures. The next day, cerebrospinal fluid analysis showed Candida spores, but cultures were negative. Intravenous fluconazole was then added to the therapy. Throughout her two-week stay, the patient’s neurological condition improved consistently. Conclusion:Fungal causes should be considered in cases with unclear meningoencephalitis in the elderly, even if fever or meningeal signs are not present. Although CSF culture continues to be the gold standard for diagnosing fungal CNS infection, negative results should not delay the start of antifungal therapy. Early initiation of targeted antimicrobial therapy is crucial for successful results in these cases.

VITAMIN B SUPPLEMENTATION IN GERIATRIC PATIENTS: A POTENTIAL STRATEGY TO MANAGING HYPERHOMOCYSTEINEMIA IN CEREBROVASCULAR DISEASE Meryana, Meryana,; Sugianto, Paulus; Erwin, Ferdinand; Jaya, David Karunia
JURNAL WIDYA MEDIKA Vol. 10 No. 2 (2024): October
Publisher : FAKULTAS KEDOKTERAN UNIVERSITAS KATOLIK WIDYA MANDALA SURABAYA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33508/jwm.v10i2.6024

Homocysteine is a non-essential amino acid produced in the biosynthesis pathway between methionine and cysteine. Its levels tend to rise with age due to physiological, lifestyle, and nutritional factors. Elevated homocysteine can induce oxidative stress, inflammation, and endothelial dysfunction, which are critical in the development of cerebrovascular diseases. These mechanisms involve increased free radicals, decreased antioxidant enzyme activity, and enhanced inflammatory responses. Specifically, elevated homocysteine heightens oxidative stress and inflammation by increasing pro-inflammatory cytokines and decreasing anti-inflammatory cytokines, leading to endothelial cell damage and apoptosis. Supplementation with vitamins B6, B9, and B12 has been shown to lower homocysteine levels and reduce the risk of ischemic stroke. However, there is currently no established guideline for the appropriate dosing of these vitamins.

ANALYSIS OF STROKE RISK FACTORS ON THE FREQUENCY OF RECURRENT STROKE EVENTS IN ACUTE ISCHEMIC STROKE PATIENTS Kurniawati, Nita; Supit, Paulus Alexander; Erwin, Ferdinand
JURNAL WIDYA MEDIKA Vol. 10 No. 2 (2024): October
Publisher : FAKULTAS KEDOKTERAN UNIVERSITAS KATOLIK WIDYA MANDALA SURABAYA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33508/jwm.v10i2.6033

Introduction: Ischemic strokes making up over three quarters of all cases are a major global cause of disability and mortality. Survivors face a 15% risk of recurrence within two years, with recurrent strokes often resulting in more severe neurological damage and increasing the risk of death and long-term disability. Methods: This retrospective cross-sectional study analyzed medical records from Gotong Royong Hospital in Surabaya from January 2023 to June 2024, selecting patients with acute ischemic stroke and a history of prior strokes. The data were descriptively analyzed and further examined using bivariate analysis to identify correlations with recurrent stroke episodes, followed by a multivariate regression analysis. Results: The study recruited 87 participants, predominantly male (64.4%), with an average age of 63.2 years and varying medical histories, including hypertension (79.3%), diabetes mellitus (46%), and dyslipidemia (31%). Bivariate analysis revealed no significant correlations between hyperten

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