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All Journal International Journal of Integrated Health Sciences Universa Medicina
Hasan, Melawati
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Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Pulmonary embolism in a 51-year-old woman with chronic kidney disease Indra Dewi, Triwedya; Hasan, Melawati; Fathini, Fathy
Universa Medicina Vol. 40 No. 2 (2021)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2021.v40.160-165

Abstract

Background Chronic kidney disease (CKD) is a worldwide public health problem both in terms of the number of patients and the cost of treatment. Chronic kidney disease seems to be the main driver of pulmonary embolism (PE) in dialysis patients. The diagnosis of PE is difficult due to its non-specific signs and symptoms, especially in many comorbidities with similar features. Chronic kidney disease plays a role in both the incidence of venous thromboembolism and the manifestations of pulmonary hypertension, resulting in an increased risk of morbidity and mortality. Advances in the management of patients with suspected PE have improved diagnostic accuracy. An approach using several diagnostic tools with different characteristics, such as D-dimer measurement, and imaging tests-predominantly computed tomography pulmonary angiography (CTPA) - can help evaluate the diagnosis. Case DescriptionHere we report the case of a 51-year-old woman with a history of chronic kidney disease, who presented with sudden worsening of dyspnea. Further examination showed signs of right heart failure with a high probability of pulmonary hypertension on echocardiography. Based on the general features it is difficult to distinguish between acute pulmonary embolism and chronic pulmonary hypertension, both of which can be caused by the underlying chronic kidney disease. Nevertheless, gold standard imaging using CTPA confirmed the diagnosis of pulmonary embolism, with underlying pulmonary hypertension from chronic kidney disease. ConclusionsThe diagnosis of pulmonary embolism with comorbidities is challenging. The availability of diagnostic modalities will confer different advantages and particular accuracy to meet the challenges in diagnosis.
Predictors of In-Hospital Mortality in Patients with Infective Endocarditis: A Single-Center Study Hanim, Haifany Fauziyah; Ikhsani, Rizkania; Yudharaputri, Digita Natarina; Cool, Charlotte Johanna; Hasan, Melawati
International Journal of Integrated Health Sciences Vol 13, No 1 (2025)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v13n1.3753

Abstract

Background: Infective endocarditis remains a life-threatening condition with high in-hospital mortality, necessitating identification of predictive clinical factors.Objective: To identify predictors of in-hospital mortality in infective endocarditis (IE) patients.Methods: This single-center retrospective study included 88 patients with IE aged ≥ 18 years treated at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, between September 2019 and May 2023. During hospitalization, data regarding clinical characteristics, blood cultures, and clinical outcomes were assessed to identify the predictors of in-hospital mortality. Data were analyzed using chi-square and binary logistic regression.Results: Among 88 patients with IE, the majority were male (56.8%) and aged < 60 years old (78%). More than two-thirds of patients had valvular heart disease. During treatment, 22 patients (25%) underwent cardiac surgery, and the total in-hospital mortality rate was 35.2%. Although not statistically significant, in-hospital mortality rate was lower in operated patients (22.7% vs 39.4%). In multivariate analysis, septic shock was the only significant predictor of in-hospital mortality (OR 40, 95% CI: 4.7–339, p 0.001)Conclusion: Septic shock is a strong predictor of in-hospital mortality among patients with infective endocarditis. Invasive management by cardiac surgery does not significantly decrease the mortality risk.
Subclinical Left Ventricular Dysfunction Prevention in Breast Cancer Patients after FAC Chemotherapy: A Carvedilol Trial Astuti, Astri; Sumantra, I Gede; Aafiyah, Adila; Abdurahman, R. Maman; Sihite, Teddy Arnold; Akbar, Mohammad Rizki; Hasan, Melawati; Martanto, Erwan
International Journal of Integrated Health Sciences Vol 12, No 1 (2024)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v12.n1.3570

Abstract

Objective:  To assess the cardioprotective effects of Carvedilol in preventing subclinical left ventricular dysfunction (SLVD) in breast cancer patients after completing FAC chemotherapy.Methods: This prospective study employed a quasi-experimental clinical trial conducted from September 2018 to May 2019. Breast cancer patients receiving FAC chemotherapy were divided into two groups: intervention (IG) and control (CG). The IG received Carvedilol 6.25 mg b.i.d., which was increased every three weeks until reaching a tolerated dose. The study evaluated changes in left ventricular global longitudinal strain (GLS) and the incidence of SLVD (GLS reduction ≥15% and GLS >-18%) 24 weeks after initiating the FAC regimen.Result: Of the 81 women enrolled in the study, 31 were in the IG. No significant changes in GLS were observed during or after completing FAC chemotherapy in the IG, whereas the CG showed contradictory results. At the end of the follow-up period, the delta GLS reduction was lower in the IG (0.7; 95% CI -0.60, 3.60) compared to the CG (3.00; 95% CI -2.16, 4.19), with a p-value of 0.035. Similarly, the percentage reduction in GLS was 3.6% in the IG and 14.29% in the CG, resulting in a p-value of 0.05. The incidence rate of SLVD (GLS reduction ≥15% and GLS > -18%) was lower in the IG (41.9% and 25.8%) than in the CG (58% and 48%).Conclusion: Carvedilol may have a cardioprotective effect in preventing the incidence of SLVD, as evaluated by GLS reduction and changes, in women with breast cancer after completing a full cycle of the FAC regimen.
Co-Authors Aafiyah, Adila Abdurahman, R. Maman Akbar, Mohammad Rizki ASTRI ASTUTI Cool, Charlotte Johanna Erwan Martanto Fathini, Fathy Hanim, Haifany Fauziyah I Gede Sumantra, I Gede Ikhsani, Rizkania Indra Dewi, Triwedya Sihite, Teddy Arnold Yudharaputri, Digita Natarina