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Faktor-faktor Prediktor Mortalitas 30 Hari pada Pasien dengan Efusi Pleura Maligna yang Telah Dilakukan Chest Tube Thoracostomy di RSUP DR. Hasan Sadikin Hendro, Immanuel; Nusjirwan, Rama; Hapsari, Putie
Jurnal llmu Bedah Indonesia Vol 47 No 1 (2019): Artikel Penelitian
Publisher : Ikatan Ahli Bedah Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.46800/jibi-ikabi.v47i1.15

Latar Belakang: Efusi pleura maligna (EPM) adalah salah satu bentuk infiltrasi dan metastasis suatu kanker. Adanya EPM menunjukkan penyakit keganasan sudah berada pada tahap lanjut. Hal ini akan mempengaruhi kualitas hidup pasien serta mengindikasikan angka harapan hidup rendah. Dengan angka harapan hidup yang berkisar antara beberapa hari hingga 12 bulan, pasien kanker stadium lanjut akan menderita dari segi fisik, psikososial, dan spiritual, karenanya pengobatan bersifat paliatif dan fokus pada perbaikan kualitas hidup. Tatalaksana pasien dengan EPM adalah melakukan drainase cairan pleura, yang dapat dilakukan dengan chest tube thoracostomy (CTT) atau torakosintesis. Beberapa faktor dipercaya berpengaruh pada tingkat mortalitas pasien dengan EPM yang dilakukan CTT. Penelitian ini untuk mengetahui faktor- faktor prediktor mortalitas 30 hari pasien dengan EPM yang dilakukan CTT. Metode: Penelitian ini adalah studi kohort prospektif terhadap pasien EPM dan dilakukan CTT di RSUP Dr. Hasan Sadikin (RSHS) selama periode Desember 2017 â€“ April 2018. Dilihat asal tumor, leukositosis, anemia, hipoprotein cairan pleura, kadar pH cairan pleura, skor performa ECOG, dan asidosis respiratorik, kemudian pasien di observasi selama 30 hari. Selanjutnya dilakukan uji statistik bivariat dengan uji Chi-Square dan Fisher, kemudian dilakukan uji statistik multivariat dengan menggunakan regresi logistik. Hasil: Terdapat 34 pasien EPM yang memenuhi syarat penelitian, mayoritas pasien hidup, yaitu sebanyak 23 pasien (67,6%). Rata-rata usia pasien yang hidup adalah 48,09 Â± 16,209 tahun, sedangkan yang meninggal adalah 42,18 Â± 18,110 tahun. Rata-rata lama rawat pasien yang hidup adalah 31,70 Â± 11,392 hari, sedangkan yang meninggal adalah 6,64 Â± 4,154 hari. Pada pasien EPM yang meninggal didapatkan beberapa faktor yang memiliki hubungan bermakna dengan angka mortalitas, yaitu asal tumor (p = 0,044), leukositosis (p = 0,039), anemia (p = 0,039), hipoprotein cairan pleura (p < 0,01), kadar pH cairan pleura (p < 0,01), dan skor performa ECOG (p < 0,01), sedangkan asidosis respiratorik tidak memiliki hubungan yang bermakna terhadap angka mortalitas (p = 0,549). Simpulan: Asal tumor, leukositosis, anemia, hipoprotein cairan pleura, kadar pH cairan pleura dan skor performa ECOG dapat dijadikan sebagai prediktor mortalitas 30 hari pada pasien dengan EPM yang dilakukan CTT.

SURGICAL EDUCATION AND TRAINING ADAPTATION IN RESPONSE TO THE COVID-19 PANDEMIC: A LITERATURE REVIEW Rudiman, Reno; Hapsari, Putie
Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education Vol 12, No 3 (2023): September
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jpki.76235

Background: As a global health emergency, the COVID-19 pandemic has affected all medical education and training, including surgical specialities. The number of elective surgeries dropped significantly as both an impact of the pandemic and a way of limiting the spread of the disease. There was confusion about continuing surgical education and training at the beginning of the pandemic. However, as the pandemic continued, we adapted to the new conditions and regulations. Social distancing, testing, and quarantine were promoted. The study aimed to show how surgical education and training adapt to the COVID-19 pandemic worldwide and share how we do it in Indonesia.Methods: The authors gathered relevant literature from several publications sites, using the keywords “surgical education,” “surgical adaptation,” and “COVID-19.”Results: In order to decrease contacts, the number of people in the operating room was reduced, clinical rounds were cancelled, and face-to-face training and lectures were moved to online platforms, namely Zoom and Google Meet. The number of residents on clinical duties was decreased to limit the transmission. They are encouraged to study using different models by themselves to keep up with the required skills. They were required to learn and then be tested or reviewed by the supervisor. The use of simulation models and online learning platforms provided by several worldwide institutions has become popular.Conclusion: We learn that surgical education and training from the pandemic can develop into a more modern way of learning, consisting of a virtual learning strategy and simulation model. This hybrid learning of offline and online courses can aid the growth of not only the residents but also the experienced surgeon.

Correlation of Nutritional Status and Early Feeding with Post-Laparotomy Surgical Site Infection in Perforated Peptic Ulcer patients Pradana, Ibrahim Risyad; Sulthana, Bambang Am'am Setya; Hapsari, Putie
Majalah Kedokteran Bandung Vol 56, No 2 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v56.3204

A perforated peptic ulcer is an emergency requiring immediate treatment by laparotomy. Special attention needs to be established on systemic nutritional status. The postoperative early feeding is important to patients with preoperative non optimum nutritional status. This study aimed to examine the correlation between nutritional status, early feeding, and post-laparotomy surgical site infection in perforated peptic ulcer patients. This was a prospective observational study on 32 patients with perforated peptic ulcers underwent emergency laparotomy at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from October 2021–2022. The nutritional status was assessed using Albumin, SGA. Eleven subjects had severe hypoalbuminemia and six subjects had severe malnutrition (SGA C). Early feeding was not performed on 7 subjects. The highest surgical wound infection rate was found on the 7th day with an incidence rate of 18.8%. Among patients experiencing infection, six (6) had SGA C (p<0.001) and severe hypoalbuminemia (p=0.001) and 4 subjects were given early feeding (p=0.451). On the 14th day, Three SGA C and one SGA B experienced infection (p=0.01), while 3 subjects and 1 subjects who experienced infection had moderate hypoalbuminemia and severe hypoalbuminemia, respectively (p=0.16), Three subjects were not given early feeding p=0.01. On the 21st day to the 30th day, 1 subject with SGA C (p=0.10) and severe hypoalbuminemia (p=0.37), and early feeding was not performed (p>0.05). There is no association among albumin level, SGA, and early feeding in post-laparotomy wound infection in perforated peptic ulcer patients.

Lactic Acid Level as A Predictor of Severity in Patients with Acute Appendicitis Aditya, Raka; Rudiman, Reno; Hapsari, Putie
Majalah Kedokteran Bandung Vol 56, No 1 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v56.3086

Perforated appendicitis is the leading cause of morbidity and mortality of all appendicitis cases in adults and children, with delayed preoperative diagnosis as the main reason. In previous studies, diagnostic modalities such as radiological examination and the current scoring system have been demonstrated as unable to predict the onset of perforated appendicitis. Serological biomarkers of lactic acid are associated with intestinal obstruction and ischemia. The serological value of lactic acid in identifying perforated appendicitis compared to acute one was shown to increase significantly by 0.25 mmol/L (p<0.05) in a previous study. This study aimed to determine the correlation between lactic acid and the severity of appendicitis. This was a cross-sectional prospective analytic observational study in patients treated in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Subjects were adult patients diagnosed with appendicitis during the period of 2021 in the Emergency Room of the hospital. Data were analyzed using the bivariate analysis and correlation test of difference. This study involved 54 subjects, divided into the complicated appendicitis (study) and control groups, with a mean of lactic acid level of 2,5093 mmol/L (0.9 mmol/L–11.8 mmol/L). In the complicated appendicitis group, 20 subjects (37%) demonstrated an increase in lactic acid level (OR 1.07; 95% CI: -0.03–0.22; p=0.14). The correlation analysis resulted in a negative correlation. This study concluded that there is no significant correlation between lactic acid levels and the severity of appendicitis in these patients.

Correlation between Duration of Placement of Non-tunneled Hemodialysis Catheter and Positive Bacterial Culture Incidence in Hemodialysis Patients Djajakusumah, Teguh Marfen; Hapsari, Putie; Yarman, Indra Prasetya; Utomo, Hafidh Seno Radi; Lukman, Kiki; Sulastri, Dian; Ulurrosyad, Muhammad Faiz
Majalah Kedokteran Bandung Vol 56, No 1 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v56.3042

Non-tunneling hemodialysis catheter is one of the most convenient vascular accesses for hemodialysis in End Stage Kidney Disease (ESRD) patients. However, these catheters have the highest morbidity among all available accesses. Current guidelines recommend that non-tunneled hemodialysis catheters be placed for no more than 2 weeks to prevent bacterial contamination. This study was conducted in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, throughout January-December 2021. A correlation test with a prospective observational analysis design was applied to find the link between the duration of non-tunneled hemodialysis catheter placement and the incidence of positive bacterial culture on the catheter. Pearson correlation test was used to see the strength of the correlation, with a significance limit of 0.05. This study involved 28 subjects. The most common location for catheter placement was in the jugular vein, and laboratory examinations showed no correlation between leukocyte values and positive bacterial culture results. Hypertension and diabetes mellitus were not significant risk factors (p-value 0.887). At ≤14 days of catheter placement, only 1 (6.7%) of the subjects presented a positive culture result. Most of the positive bacterial culture results were found at a duration of 15-30 days of placement, (n=8; 53.3%). The results of the Pearson test showed a p-value of 0.036 and an r-value of 0.399, indicating a significant result with a strong correlation between the two variables. The duration of placement of hemodialysis catheters has a positive correlation with the incidence of positive bacterial cultures, which can increase the risk of systemic infection associated with hemodialysis catheters.

Neutrophil Lymphocyte Ratio and Mortality in Patients with Acute Limb Ischemia Hapsari, Putie; Djajakusumah, Teguh Marfen; Nugroho, Hendri Bayu
Majalah Kedokteran Bandung Vol 57, No 1 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v57.3848

Acute Limb Ischemia (ALI) is a sudden decrease in limb perfusion with a potential of limb loss and is an indication for immediate vascular intervention. Apart from reducing the quality of life, the mortality rate in ALI is reported to be high, i.e., around 40%. Neutrophil Lymphocyte Ratio (NLR) can be used to reflect the inflammatory process in this condition. This study aimed to assess the correlation of NLR to mortality rate in ALI Rutherford Category III patients treated in Dr. Hasan Sadikin General Hospital Bandung, Indonesia. This was a cross-sectional analytical observative retrospective study on data collected from medical records of ALI Rutherford Category III patients treated in the hospital from 2019 to 2022. Sampling was performed consecutively and data were processed using the SPSS with univariate analysis and bivariate analysis using Kendall's tau b analysis test. Results demonstrated that of a total of 46 patients, the majority were female patients (n=31) and 28 patients died. The mean NLR levels in patients who survived was 5.8, in contrast with 9.7 observed among those who died. The statistical test results showed a significant correlation between the NLR and mortality rate of ALI Rutherford category III patients (p

Correlation of Nutritional Status, HbA1c, and Duration of Diabetes Mellitus with Amputation Incidence in Patients with Diabetic Foot Ulcers Hapsari, Putie; Kharisma, Surti Wulan; Yarman, Indra Prasetya; Faried, Ahmad; Djajakusumah, Teguh Marfen; Maryani, Euis
Majalah Kedokteran Bandung Vol 57, No 2 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v57.4094

Diabetic foot ulcer (DFU) is a severe complication of diabetes that significantly impairs quality of life and may often lead to amputation, particularly when infections become extensive. This study investigated the correlation of nutritional status, HbA1c levels, and duration of diabetes exposure with the incidence of amputation in DFU patients. Using an observational analytic study with a retrospective cohort design, data from 47 DFU patients treated at the Vascular and Endovascular Surgery clinic and Emergency Room of a hospital from 2019-2024 were analyzed. The majority of subjects were men aged 40-60 years (59.57%). Among the amputee group, 55.31% experienced neuropathy, primarily classified as Wagner's degree 4. Patients requiring amputation had significantly higher levels of urea, creatinine, and leukocytes compared to those who did not. A significant correlation was observed between the incidence of amputation and nutritional status—specifically, serum albumin (r=-0.616) and Body Mass Index (BMI) (r=0.823)—as well as HbA1c levels (r=0.806) and duration of diabetes exposure (r=0.445) (p<0.05). However, the Subjective Global Assessment (SGA) did not show a significant relationship with amputation incidence. The findings of this study suggest that nutritional status, HbA1c levels, and duration of diabetes exposure are significantly correlated with the likelihood of amputation in patients with diabetic foot ulcers (DFU).

Correlation Between ERCP Implementation Time and Outcomes of Patients with Acute Cholangitis Due to Choledocholithiasis Ayundra, Muhammad Hilmy; Rudiman, Reno; Hapsari, Putie
Majalah Kedokteran Bandung Vol 57, No 2 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v57.3965

Acute cholangitis is a serious condition, and timely ERCP is essential for effective management. This prospective cohort study was conducted at Dr. Hasan Sadikin Hospital in Bandung, Indonesia, from June 2023 to April 2024, to evaluate the feasibility of performing ERCP beyond 48 hours in the presence of various limitations. The study included patients with acute cholangitis caused by common bile duct stones. The ERCP timing was categorized into three groups: less than 48 hours, 48-72 hours, and more than 72 hours. Outcomes measured were hospital stay duration, ICU admission, and 30-day mortality. Of these patients, 52.8% underwent ERCP at 48-72 hours, 27.8% after 72 hours, and 19.4% before 48 hours. The median hospital stay was 7.5 days (IQR 3-15). ICU admissions occurred only in patients receiving ERCP after 72 hours (30.0%), a significantly higher rate compared to the other groups (p=0.014). A strong correlation was found between delayed ERCP and longer hospital stays (r=0.711, p<0.01), as well as ICU admission (r=0.405, p=0.014), though no significant correlation with mortality was observed (r=-0.021, p=0.905).

Closure Techniques and Postoperative Outcomes of Major Lower Limb Amputation in Acute Limb Ischemia Khadafy, Reza; Hapsari, Putie; Utomo, Hafidh Seno Radi
Majalah Kedokteran Bandung Vol 57, No 3 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v57.4149

Amputation, derived from the Latin "amputare," refers to the removal of a body part covered by skin, often necessitated by acute limb ischemia (ALI). Effective wound closure is critical for minimizing complications, length of stay, costs, and the risk of re-amputation. This study compared postoperative outcomes of major lower limb amputation in ALI patients with primary versus delayed wound closure. A descriptive analytic study was conducted at Dr. Hasan Sadikin Hospital, Bandung, Indonesia, from January 2020 to December 2023, analyzing medical records of 46 patients aged 19–85 years, with a predominance of female patients. Thrombosis was the leading cause of ALI (76.1%), and hypertension was the most frequent comorbidity. Significant differences were observed in stump complications and revision surgery rates between primary and delayed wound closure groups (p<0.05), while length of stay and mortality did not show statistically significant differencesy. In conclusion, the study highlights a significant relationship between different wound closure methods and complications, suggesting that choice of closure technique may influence the postoperative outcomes in ALI patients.

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