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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR) Jurnal Ilmiah Ilmu Terapan Universitas Jambi Folia Medica Indonesiana
Armando, Alivery Raihanada
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Biochemistry, Genetics & Molecular Biology Education Engineering Health Professions Industrial & Manufacturing Engineering Medicine & Pharmacology Neuroscience

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Mortality Determinants in Severe Traumatic Brain Injury with Pneumonia: A Retrospective Study Apriawan, Tedy; Armando, Alivery Raihanada; Kamaruddin, Muhammad Fadhil
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 2 (2025): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V7I22025.66-75

Abstract

Introduction: Traumatic brain injury (TBI) is defined as an acute brain injury caused by mechanical forces to the head, excluding those related to drugs, alcohol, medications, or other conditions, such as systemic injuries, psychological trauma, or coexisting medical issues. TBI is a global public health issue responsible for significant disability and mortality, with an estimated global incidence of 69 to over 100 million new cases annually. This burden may be higher due to underreporting, particularly in low- and middle-income countries (LMICs). Several methods have been established to classify TBI, one of them is based on its severity with the Glasgow Coma Score (GCS). Pneumonia is a frequent complication in traumatic brain injury (TBI) patients, especially those on prolonged mechanical ventilation. Pneumonia could be classified based on the source of infection into ventilator-associated pneumonia (VAP), hospital-associated pneumonia (HAP), and community-acquired pneumonia (CAP). Objective: To evaluate the mortality and risk factors of severe traumatic brain injury (sTBI) with pneumonia. Methods: This study is a cross-sectional study with observational analytical investigations. The sample of this study is sTBI patients who were treated in Dr. Soetomo General Academic Hospital in 2023. Descriptive statistics were used to summarize the patients' characteristics. Chi-square tests and logistic regression were used to find relationship between factors that increase the risk of death and the development of pneumonia. Results: In 2023, we documented 832 TBI cases, of these, 479 cases (57.6%) were mild TBI, 273 cases (32.8%) were moderate brain injuries, while severe brain injuries (sTBI) with 80 cases (9.6%). Our study shows that 50% of patients with sTBI have pneumonia, and VAP itself is one of the contributing factors to mortality in this population (p<0.001). Conclusion: Of all types of pneumonia in this study, there is a statistical correlation between mortality and VAP in sTBI patients.
DELAYED MANAGEMENT OF BILATERAL MASSIVE EPIDURAL HEMATOMA INVOLVING PARASAGITTAL SINUS: A COMPREHENSIVE SCOPING REVIEW FROM INDONESIAN PERSPECTIVES Suryaningtyas, Wihasto; Armando, Alivery Raihanada; Ramadhan, Candra Dwantara; Kamaruddin, Muhammad Fadhil; Zamzam, Ramadhani Rizki; Nathania, Nathania
Folia Medica Indonesiana Vol. 61, No. 2
Publisher : Folia Medica Indonesiana

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Abstract

Introduction: Vertex epidural hematomas (VEDH) involving the superior sagittal sinus (SSS) are rare, critical injuries often complicated by massive venous hemorrhage. This study evaluates the clinical outcomes of VEDH and identifies systemic barriers contributing to treatment delays in Low- and Middle-Income Countries (LMICs). Methods: We present a case series of three patients managed at an Indonesian tertiary center alongside a scoping review of 33 studies. Delayed management was defined as prolonged injury-to-surgery intervals resulting from referral inefficiencies and transport logistics. Results: The series highlights a unique case of a 66-year-old male with bilateral VEDH and SSS laceration who underwent surgery 32 hours post-injury. Despite massive intraoperative blood loss (6000cc) requiring aggressive transfusion and sinus repair, the patient achieved a good functional recovery. The scoping review identified primary barriers to timely care, including geographical constraints, lack of organized emergency transport, and a scarcity of neurosurgical specialists and CT scanners in rural regions. Conclusion: While delayed presentation exacerbates surgical risks, aggressive management via bicoronal craniotomy remains effective. Improving prehospital infrastructure and referral networks is essential to reducing preventable delays in neurotrauma management.
PERICRANIAL MEMBRANE-INDUCED OSSIFICATION IN CRANIOPLASTY AUTOGRAFT: EVIDENCE OF RANKL-MEDIATED BONE REMODELING Apriawan, Tedy; Armando, Alivery Raihanada; Fauzi, Asra Al
Jurnal Ilmiah Ilmu Terapan Universitas Jambi Vol. 10 No. 3 (2026): Volume 10, Nomor 3, June 2026
Publisher : LPPM Universitas Jambi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22437/jiituj.v10i3.56078

Abstract

Bone resorption is a major complication after cranioplasty, often due to impaired osteogenesis and vascularization. The pericranial membrane has osteogenic properties and can enhance bone regeneration by modulating signaling pathways involved in bone remodeling. RANKL is a key regulator of osteoblast and osteoclast activity during bone healing. This study aimed to analyzed the mechanism of RANKL present in the pericranial membrane to Induced Accelerated Ossification in the cranioplasty procedure. The methods was an experimental study using 35 male Oryctolagus cuniculus rabbits divided into three groups, a negative control (bone defect without graft), a positive control (autograft without pericranial membrane), and a treatment group (autograft with pericranial membrane). RANKL expression was evaluated at weeks 6 and 12 using immunohistochemistry. Data were analyzed using ANOVA and Mann-Whitney test with a significance level of p<0,05. The result are RANKL expression in weeks 6, the treatment group shows the highest RANKL expression (5,2) compared to the positive control (4,7) and negative control (4,3). At week 12, RANKL expression decreases in all groups, with the lowest value in the treatment group (0,9). Comparison of weeks 6 and 12 showed a significant difference in all groups (p<0,05). Conclusion: The pericranial membrane plays a role in accelerating the ossification process of cranioplasty autografts by modulating RANKL expression. Increased RANKL in the early phase and decreased in the late phase indicate faster bone formation and remodeling in the treatment group. These findings support the use of the success of cranioplasty and reduce the risk of bone resorption.
Co-Authors Fauzi, Asra Al Kamaruddin, Muhammad Fadhil Nathania Nathania, Nathania Ramadhan, Candra Dwantara Tedy Apriawan wihasto suryaningtyas Zamzam, Ramadhani Rizki