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Pendekatan Diagnosis dan Tatalaksana Endokarditis Infektif dengan Komplikasi Emboli Septik Pulmoner pada Pasien Hemodialisis Kronik Siregar, Jeremia Immanuel; Loho, Imelda Maria; Alwi, Idrus
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 4
Publisher : UI Scholars Hub

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Pendahuluan. Endokarditis infektif (EI) pada pasien hemodialisis (HD) merupakan salah satu contoh EI yang terkait dengan perawatan kesehatan dan menjadi penyebab kematian kedua pada pasien HD setelah penyakit kardiovaskuler. Penggunaan kateter intravaskuler sebagai akses HD meningkatkan risiko kejadian bakteremia sebesar sepuluh kali lipat serta infeksi “metastatik” seperti EI dan emboli septik pulmoner sebesar 10-40%. Ilustrasi Kasus. Seorang laki-laki berusia 35 tahun datang dengan keluhan dyspnea d’effort, orthopnea, dan post-nocturnal dyspnea, disertai batuk dengan bercak darah dan demam tinggi sejak lima hari sebelum masuk rumah sakit. Pasien menjalani HD kronik selama 15 bulan dengan menggunakan catheter double-lumen (CDL). Dari pemeriksaan fisik didapatkan ronki basah kasar bilateral, murmur pansistolik grade 3/6 pada sela iga keempat linea sternalis sinistra, dan gallop S3. Pada ekokardiografi ditemukan vegetasi di katup trikuspid dan pemeriksaan CT-scan toraks memberikan gambaran emboli septik pulmoner. Didapatkan satu dari tiga kultur darah yang positif untuk infeksi methicillin-resistant Staphylococcus aureus (MRSA). Pengobatan dengan vankomisin yang adekuat selama enam minggu memberikan kemajuan klinis signifikan, meskipun pada ekokardiografi evaluasi masih didapatkan adanya vegetasi. Pasien kemudian menjalani operasi pengangkatan vegetasi, perbaikan katup jantung, dan penggantian CDL, dimana kondisinya semakin membaik dan masih menjalani HD secara rutin hingga saat ini. Simpulan. Pengenalan dini EI dan emboli septik pulmoner pada pasien yang menjalani HD kronik dengan akses kateter intravaskuler sangat penting agar tatalaksana awal yang adekuat dan komprehensif dapat dilakukan. Hal ini dapat memperbaiki kondisi klinis serta memperpanjang kesintasan hidup pasien.

Sudden Onset of Diabetic Ketoacidosis in a Patient with Discordant HbA1C: A Unique Case of Fulminant Type 1 Diabetes Mellitus (FT1DM) in a Middle-aged Man Nadine, I Gusti Ayu; Siregar, Jeremia Immanuel; Prasetya, Yonesha Rahmania
Medicinus Vol 13, No 3 (2024): June
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v13i3.8887

Introduction: Diabetic Ketoacidosis (DKA) is an acute complication of diabetes mellitus (DM) which present as the first manifestation in fulminant type 1 diabetes mellitus (FT1DM) without significant elevation of HbA1C. We present a unique case of a 52-years-old male with DKA without previous history of DM and HbA1c of 6.6.Case Illustration: A 52-years-old male was brought to hospital due to persistent vomiting. He experienced polyuria and unexplained weight loss but denied previous history of DM. He was diagnosed with DKA due to his blood glucose of 1107 mg/dL along with elevated blood ketone and metabolic acidosis. However, his HbA1c was a mere 6.6. His serum lipase was increased, consistent with pancreatic damage. He was then discharged with basal-bolus insulin. Discussion: Although the symptoms of this patient was consistent with hyperglycemic crisis, the presentation of DKA is usually associated with elevated HbA1c, approximately 10.4 - 16.9%. This unusual HbA1c points to the diagnosis of FT1DM. It is caused by sudden beta-cell destruction triggered by viral infections, alongside genetic disposition, leading to sudden depletion of insulin occurred less than a week and presents with ketoacidosis. It is characterized by low HbA1c (< 8.7%) yet extremely high blood glucose (≥ 288 mg/dl) and elevated pancreatic enzymes (depicting pancreatic damage). A diagnosis of FT1DM can be ascertained in this patient as his presentations matches its characteristics.Conclusion: FT1DM is a sub-type of T1DM which can suddenly occur in patients and associated with discordant HbA1c. It is important to recognize and treat it accordingly to avoid fatal outcomes.

Anemia and Erythropoietin Use Among Hemodialysis Chronic Kidney Disease Patients at Rumah Sakit Umum Siloam Tjiang, Margaret Merlyn; Caroline, Elliscia; Siregar, Jeremia Immanuel
Medicinus Vol 13, No 3 (2024): June
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v13i3.8885

Background: Chronic kidney disease (CKD) affects an estimated 8-16% of the population and is increasing in prevalence. Anemia, a common and significant complication of CKD, is primarily caused by reduced erythropoietin production, which is essential for red blood cell production. Erythropoietin, a kidney-produced hormone, stimulates bone marrow to produce red blood cells. This study examines trends in the use of erythropoiesis-stimulating agents (ESAs) and the management of anemia in dialysis CKD patients before and after the implementation of ESA reimbursemen.Methods: This cohort study was conducted at Rumah Sakit Umum Siloam, Tangerang, Indonesia, from February to July 2017. Patients who received blood transfusions or iron supplements during the study were excluded. Data collected included age, gender, dry weight, history of diabetes mellitus, hypertension, hemodialysis adequacy, and nutritional status. Statistical analysis with a 95% confidence interval (CI) was used to assess the association between hemoglobin levels (Hb) and erythropoietin use.Results: Sixty patients completed the study. The proportion of anemic patients (Hb <10 g/dL) increased from 22 (36.7%) to 28 (46.7%) after erythropoietin administration. A mean dose of 6000 IU/week (CI: 4679 to 7321 IU/week) was effective in achieving target hemoglobin levels, while a dose of 4131 IU/week (CI: 3479 to 4782 IU/week) was sufficient to maintain them. Additionally, a dosage of 103.31 IU/kg/week increased hemoglobin by 1 g/dL in anemic patients.Conclusions: Erythropoietin use should be optimized given the increasing prevalence of anemia. A dosage of 103.31 IU/kg/week is recommended to achieve target hemoglobin levels, while 4131 IU/week is suggested for maintaining hemoglobin within the target range.

Comparison of Early Postoperative Pain between Lightweight Mesh and Heavyweight Mesh in Lichtenstein Hernia Repair for Geriatric Patients at Rumah Sakit Siloam Karawaci from January 2018 - December 2019 Sidharta, Nicholas Axel; Irawan, Andry; Siregar, Jeremia Immanuel; Lugito, Nata Pratama Hardjo
Medicinus Vol 11, No 3 (2022): June
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v10i1.6989

Background: Inguinal hernias are one of the most often cases in surgery. Inguinal hernias are usually found in males rather than females. There are two types of meshes in inguinal hernia repairs: heavyweight and lightweight mesh. There were still a lot of differences in the outcome of each mesh that was used. Therefore, with various different post operative pain results from past research, the author expresses an interest to conduct a research on this topic towards geriatric patients.Methods: In this cross-sectional comparative study, 45 patients using heavyweight mesh and 45 patients using lightweight mesh herniorrhaphy with Lichtenstein technique in inguinal hernias at RS Siloam Karawaci Lippo Village and RSU were reviewed retrospectively. Patient's data were taken from medical record using purposive-sampling method. Early Postoperative pain on day 1 until 7 were classified following the Visual Analogue Scale (VAS). Incidence of postoperative infection and seroma were assessed in both groups. Collected samples will be processed using Pearson's Chi-Squared test.Result: This study shows that there is a significant difference between the use of lightweight mesh in reducing moderate early postoperative pain for men above the age of 60 years old (p = 0.025) rather than the use of heavyweight mesh. Incidence of other postoperative complications such as infection and seroma have no statistically difference between both groups.Conclusions: The use of lightweight mesh has the advantage in reducing early postoperative pain from herniorrhaphy using Lichtenstein technique rather than heavyweight mesh in men above 60 years old.

Anemia and Erythropoietin Use Among Hemodialysis Chronic Kidney Disease Patients at Rumah Sakit Umum Siloam Tjiang, Margaret Merlyn; Caroline, Elliscia; Siregar, Jeremia Immanuel
Medicinus Vol. 13 No. 3 (2024): June
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v13i3.8885

Background: Chronic kidney disease (CKD) affects an estimated 8-16% of the population and is increasing in prevalence. Anemia, a common and significant complication of CKD, is primarily caused by reduced erythropoietin production, which is essential for red blood cell production. Erythropoietin, a kidney-produced hormone, stimulates bone marrow to produce red blood cells. This study examines trends in the use of erythropoiesis-stimulating agents (ESAs) and the management of anemia in dialysis CKD patients before and after the implementation of ESA reimbursemen.Methods: This cohort study was conducted at Rumah Sakit Umum Siloam, Tangerang, Indonesia, from February to July 2017. Patients who received blood transfusions or iron supplements during the study were excluded. Data collected included age, gender, dry weight, history of diabetes mellitus, hypertension, hemodialysis adequacy, and nutritional status. Statistical analysis with a 95% confidence interval (CI) was used to assess the association between hemoglobin levels (Hb) and erythropoietin use.Results: Sixty patients completed the study. The proportion of anemic patients (Hb <10 g/dL) increased from 22 (36.7%) to 28 (46.7%) after erythropoietin administration. A mean dose of 6000 IU/week (CI: 4679 to 7321 IU/week) was effective in achieving target hemoglobin levels, while a dose of 4131 IU/week (CI: 3479 to 4782 IU/week) was sufficient to maintain them. Additionally, a dosage of 103.31 IU/kg/week increased hemoglobin by 1 g/dL in anemic patients.Conclusions: Erythropoietin use should be optimized given the increasing prevalence of anemia. A dosage of 103.31 IU/kg/week is recommended to achieve target hemoglobin levels, while 4131 IU/week is suggested for maintaining hemoglobin within the target range.

Sudden Onset of Diabetic Ketoacidosis in a Patient with Discordant HbA1C: A Unique Case of Fulminant Type 1 Diabetes Mellitus (FT1DM) in a Middle-aged Man Nadine, I Gusti Ayu; Siregar, Jeremia Immanuel; Prasetya, Yonesha Rahmania
Medicinus Vol. 13 No. 3 (2024): June
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v13i3.8887

Introduction: Diabetic Ketoacidosis (DKA) is an acute complication of diabetes mellitus (DM) which present as the first manifestation in fulminant type 1 diabetes mellitus (FT1DM) without significant elevation of HbA1C. We present a unique case of a 52-years-old male with DKA without previous history of DM and HbA1c of 6.6.Case Illustration: A 52-years-old male was brought to hospital due to persistent vomiting. He experienced polyuria and unexplained weight loss but denied previous history of DM. He was diagnosed with DKA due to his blood glucose of 1107 mg/dL along with elevated blood ketone and metabolic acidosis. However, his HbA1c was a mere 6.6. His serum lipase was increased, consistent with pancreatic damage. He was then discharged with basal-bolus insulin. Discussion: Although the symptoms of this patient was consistent with hyperglycemic crisis, the presentation of DKA is usually associated with elevated HbA1c, approximately 10.4 - 16.9%. This unusual HbA1c points to the diagnosis of FT1DM. It is caused by sudden beta-cell destruction triggered by viral infections, alongside genetic disposition, leading to sudden depletion of insulin occurred less than a week and presents with ketoacidosis. It is characterized by low HbA1c (< 8.7%) yet extremely high blood glucose (‰¥ 288 mg/dl) and elevated pancreatic enzymes (depicting pancreatic damage). A diagnosis of FT1DM can be ascertained in this patient as his presentations matches its characteristics.Conclusion: FT1DM is a sub-type of T1DM which can suddenly occur in patients and associated with discordant HbA1c. It is important to recognize and treat it accordingly to avoid fatal outcomes.

Comparison of Early Postoperative Pain between Lightweight Mesh and Heavyweight Mesh in Lichtenstein Hernia Repair for Geriatric Patients at Rumah Sakit Siloam Karawaci from January 2018 - December 2019 Sidharta, Nicholas Axel; Irawan, Andry; Siregar, Jeremia Immanuel; Lugito, Nata Pratama Hardjo
Medicinus Vol. 11 No. 3 (2022): June
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v10i1.6989

Background: Inguinal hernias are one of the most often cases in surgery. Inguinal hernias are usually found in males rather than females. There are two types of meshes in inguinal hernia repairs: heavyweight and lightweight mesh. There were still a lot of differences in the outcome of each mesh that was used. Therefore, with various different post operative pain results from past research, the author expresses an interest to conduct a research on this topic towards geriatric patients.Methods: In this cross-sectional comparative study, 45 patients using heavyweight mesh and 45 patients using lightweight mesh herniorrhaphy with Lichtenstein technique in inguinal hernias at RS Siloam Karawaci Lippo Village and RSU were reviewed retrospectively. Patient's data were taken from medical record using purposive-sampling method. Early Postoperative pain on day 1 until 7 were classified following the Visual Analogue Scale (VAS). Incidence of postoperative infection and seroma were assessed in both groups. Collected samples will be processed using Pearson's Chi-Squared test.Result: This study shows that there is a significant difference between the use of lightweight mesh in reducing moderate early postoperative pain for men above the age of 60 years old (p = 0.025) rather than the use of heavyweight mesh. Incidence of other postoperative complications such as infection and seroma have no statistically difference between both groups.Conclusions: The use of lightweight mesh has the advantage in reducing early postoperative pain from herniorrhaphy using Lichtenstein technique rather than heavyweight mesh in men above 60 years old.

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