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e-CliniC
Published by Universitas Sam Ratulangi
ISSN : 23375949     EISSN : -     DOI : -
Core Subject : Health,
Health Professions
Jurnal e-CliniC (eCl) diterbitkan oleh Perhimpunan Ahli Anatomi Indonesia bekerja sama dengan Fakultas Kedokteran Universitas Sam Ratulangi Manado. Jurnal ini diterbitkan 3 (tiga) kali setahun (Maret, Juli, dan November). Sejak tahun 2016 Jurnal e-CliniC diterbitkan 2 (dua) kali setahun (Juni dan Desember). Jurnal e-CliniC memuat artikel penelitian, telaah ilmiah, dan laporan kasus di bidang ilmu kedokteran klinik.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 1,074 Documents
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Profile of Pregnant Women with Previous Cesarean Section during Covid-19 Pandemic Deviestha A. Grace; John J. E. Wantania; Frank M. M. Wagey
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.38124

Abstract

Abstract: Pregnancy with previous cesarean section (CS) is risky due to the presence of stiff uterine scar tissue which may rupture during pregnancy or delivery. However, the restrictions on health services during the Covid-19 pandemic coupled with the unequal distribution of vaccinations for pregnant women become a great concern and challenge. This study aimed to obtain the profile of pregnant women with previous SC during Covid-19 pandemic. This was a descriptive and observa-tional survey study with a cross sectional design. Samples were all pregnant women with previous SC who came for antenatal care at Puskesmas Makale and RSUD Lakipadada Tana Toraja from October to December 2021. The results showed that of 48 pregnant women with previous SC the highest percentages were, as follows: ages of 25-35 years (81.3%); had one previous SC (81.3%); had planned the pregnancy (72.9%); admitted that had known the risk of pregnancy (79.2%); had more frequent antenatal care (43.8%); had known the estimated delivery (89.6%); and preferred VBAC (52.1%) at a health facility (93.8%). In conclusion, most of the pregnant women admitted that they had planned their pregnancies and known the risks of pregnancy with previous SC during the Covid-19 pandemic, therefore, they had more frequent antenatal care. They also knew their esti-mated delivery and tended to choose a VBAC at a health facility.Keywords: risky pregnancy; previous cesarean section; Covid-19 pandemic  Abstrak: Kehamilan dengan bekas seksio sesarea (SC) merupakan salah satu kehamilan berisiko, dikaitkan dengan adanya jaringan kaku parut uterus yang mungkin dapat ruptur selama kehamilan atau persalinan. Dalam masa pandemi pembatasan yang dilakukan di layanan kesehatan ditambah belum meratanya vaksinasi bagi ibu hamil menjadi kekhawatiran dan tantangan tersendiri. Penelitian ini bertujuan untuk mengetahui profil ibu hamil dengan bekas SC, pada masa pandemi Covid-19. Jenis penelitian ialah observasional deskriptif survei dengan desain potong lintang. Sampel penelitian ialah ibu hamil dengan bekas SC yang datang untuk pemeriksaan antenatal di Puskesmas Kecamatan Makale dan RSUD Lakipadada Tana Toraja pada bulan Oktober-Desember 2021. Hasil penelitian mendapatkan 48 ibu hamil bekas SC dengan distribusi terbanyak yaitu usia 25-35 tahun (81,3%); riwayat SC satu kali (81,3%); telah merencanakan kehamilannya (72,9%); mengaku sudah mengetahui risiko kehamilan dengan bekas SC (79,2%); lebih sering melakukan pemeriksaan antenatal (43,8%); dan telah mengetahui taksiran persalinannya (89,6%) dengan preferensi metode persalinan VBAC (52,1%) di fasilitas kesehatan (93,8%). Simpulan penelitian ini sebagian besar ibu memang telah merencanakan kehamilannya dan mengaku sudah mengetahui risiko kehamilan dengan bekas SC pada masa pandemi Covid-19, sehingga mayoritas melakukan pemeriksaan antenatal lebih sering. Mayoritas ibu hamil telah mengetahui taksiran persalinannya dan jika dapat memilih mereka cenderung memilih metode persalinan VBAC di fasilitas kesehatan.Kata kunci: kehamilan berisiko; bekas seksio sesarea; pandemi Covid-19
Evaluation of Labors in COVID-19 Pandemic at Prof. Dr. R. D. Kandou Hospital Manado from January to August 2021 Virgyano L. Dompas; Hermie M. M. Tendean; Erna Suparman
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.38132

Abstract

Abstract: Failure to prioritize maternal health during the COVID-19 pandemic will affect maternal mortality ratio (MMR). This study aimed to obtain the evaluation of labor during the COVID-19 pandemic. This was a descriptive and retrospective study with a cross-sectional design using the medical record data of Prof. Dr. R. D. Kandou Hospital in Manado. The results obtained 858 cases of labor. Based on maternal characteristics, most labors were carried out in the age group of 20-34 years (69.23%), household work (72.14%), senior high school education (51.52%), and parity of 1-4 times (60.72%). The highest percentage of labor was cesarean section (62.35%). Most of the antenatal care was carried out 4-6 times(34.62%) by obstetrician-gynecologists (40.09%). The most common labor complication was fetal distress (27.29%). Maternal deaths were 20 cases, most were caused by respiratory failure (50%). Perinatal mortality was 82 cases with the most common cause of death was intra uterine fetal death/IUFD (41.46%). The maternal mortality rate was 2442 cases per 100,000 live births meanwhile the perinatal mortality rate was 100.12 per 1000 live births. In conclusion, the most common labor was section caesarea. Respiratory failure was the most common cause of maternal mortality and IUFD was the most common cause of perinatal mortality.Keywords:  labor, COVID-19, characteristics, maternal mortality, perinatal death  Abstrak: Kegagalan dalam mengutamakan kesehatan ibu selama pandemi COVID-19 akan memengaruhi angka kematian ibu (AKI). Penelitian ini bertujuan untuk mengetahui evaluasi persalinan di masa pandemi COVID-19. Jenis penelitian ialah retrospektif deskriptif dengan desain potong lintang menggunakan data rekam medik Januari s/d Agustus 2021 di RSUP Prof Dr. R. D. Kandou Manado. Hasil penelitian mendapatkan 858 kasus persalinan. Berdasarkan karakteristik, persalinan paling banyak dilakukan pada kelompok usia 20-34 tahun (69,23%), pekerjaan ibu rumah tangga (IRT) (72,14%), pendidikan SLTA (51,52%), serta paritas 1-4 kali (60,72%). Jenis persalinan tertinggi yaitu persalinan seksio sesarea (62,35%). Pelayanan antenatal paling banyak dilakukan oleh dokter spesialis obstetri dan ginekologi (40,09%). Frekuensi pelayanan antenatal tertinggi yaitu sebanyak 4-6 kali (34,62%). Komplikasi persalinan tertinggi yaitu gawat janin (27,29%). Kematian maternal sebanyak 20 kasus dengan penyebab kematian tertinggi gagal napas (50%). Kematian perinatal sebanyak 82 kasus dengan penyebab kematian tertinggi IUFD (41,46%). Angka kematian maternal yaitu 2442 kasus per 100.000 kelahiran hidup. Angka kematian perinatal yaitu 100,12 per 1000 kelahiran hidup. Simpulan penelitian ini ialah jenis persalinan tertinggi seksio sesarea dengan gagal napas sebagai penyebab utama kematian maternal dan intrauterine fetal death (IUFD) sebagai penyebab utama kematian perinatal.Kata kunci: persalinan; kematian maternal; kematian perinatal; COVID-19
Perception of Pregnant Women in Dealing with Pregnancy and Childbirth during COVID-9 Pandemic in Manado Thesa Soe; John J. E. Wantania; Hermie M. M. Tendean
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.38138

Abstract

Abstract: Currently, COVID-19 pandemics has caused many deaths worldwide, therefore, the attitude of pregnant women in dealing with pregnancy and childbirth during this pandemic might be influenced. This study aimed to obtain the perception of pregnant woman in dealing with pregnancy and childbrith during the pandemic in Manado. This was a descriptive and observational survey study with a cross sectional design. Respondents were pregnant women of 1st to 3rd semester that visited two primary health cares: Puskesmas Bahu and Puskesmas Sario Kotabaru Manado.The results showed that most pregnant women were 21-30 years old (65.71%), high school education (68.57), housewife (75.71%), multigravida parity (68.57%), on the third semester (48,57%), and had no history of confirmed Covid-19 (94.29%). Moreover, most of the respondents felt happy when they knew about their pregnancy (68.57%), did routine antenatal care/ANC (71.43%), chose that vaccination was absolutely necessary (45.71%), and had to give birth at a health facility (71.43%). In conclusion, most pregnant women did plan and felt happy of their pregnancies. The majority of respondents chose that vaccination during pregnancy was absolutely necessary, and they would carry out routine antenatal care as usual, and had to give birth at a health facility.Keywords: pregnancy; childbirth; pandemic of COVID-19; perception Abstrak: Saat ini pandemi COVID-19 telah banyak menyebabkan kematian di seluruh belahan dunia sehingga dianggap dapat berpengaruh terhadap sikap ibu hamil dalam menghadapi kehamilan dan persalinan di masa pandemi. Penelitian ini bertujuan untuk mengkaji persepsi ibu hamil dalam menghadapi kehamilan dan persalinan pada masa pandemi di Manado. Jenis penelitian ialah observasional deskriptif survei dengan desain potong lintang. Responden ialah wanita hamil mulai dari trimester 1 sampai dengan trimester 3 yang berkunjung ke Puskesmas Bahu dan Puskesmas Sario Kotabaru Manado. Hasil penelitian mendapatkan bahwa karakteristik ibu hamil terbanyak berusia 21-30 tahun (65,71%) dengan pendidikan terakhir SMA (68,57%), pekerjaan IRT (75,71%), paritas multigravida (68,57%), usia kehamilan pada trimseter 3 (48,57%), dan tidak pernah terkonfirmasi Covid-19 (94,29%). Selain itu ibu hamil yang merencanakan kehamilan (71,43%), perasaan senang saat mengetahui sedang hamil (68,57%), melakukan antenatal care/ANC seperti biasa (71,43%), dan merasa harus melakukan persalinan di fasilitas kesehatan (71,43%). Simpulan penelitian ini ialah sebagian besar ibu hamil memang merencanakan dan merasa senang karena kehamilannya. Mayoritas ibu hamil merasa bahwa vaksinasi saat kehamilan mutlak dibutuhkan, melakukan antenatal care seperti biasa, dan harus melakukan persalinan di fasilitas kesehatan.Kata kunci: kehamilan; persalinan; pandemi COVID-19; persepsi
Role of Troponin Test in Diagnosis and Management of Acute Myocardial Infarction Ade K. S. Nugraha; Natalia C. I. Polii; Victor G. X. Rooroh
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.38288

Abstract

Abstract: To date, AMI is still an important global health problem because of relatively high morbidity and mortality rates. Diagnosis of AMI can be established if there are at least two of the three criteria to be met, namely chest pain (anamnesis), persistent changes in electrocardiographic (ECG), as well as cardiac biomarker creatine myocardial band (CK-MB), cardiac troponin T (cTnT), or cardiac troponin I (cTnI). Treatment for AMI patients consists of reperfusion therapy and pharmacological therapy. This study aimed to determine the role of troponin examination in the diagnosis and management of AMI. This was a literature review study with a total of 13 literature reviews. The results showed that diagnosis of AMI could be established by conducting a cardiac biomarker examination, the troponin. Troponin was almost specific and highly sensitive to detect the presence of AMI. Moreover, minor damage of myocardium could be demonstrated by checking troponin level. In addition, changes in troponin levels could also be used as predictors of side effects that could occur after treatment or even an increase in late mortality. However, increased troponin level sould also occur in other conditions, such as chronic kidney disease, pulmonary embolism, and sepsis. Therefore, the execution of its interpretation should fit the context of the clinical situation in the patient. In conclusion, troponin plays an important role in the diagnosis and management of AMI.Keywords: troponin; diagnosis and management; acute myocardial infarction Abstrak: Hingga saat ini IMA masih menjadi suatu masalah kesehatan penting dunia dikarenakan angka morbiditas dan mortalitas yang relatif tinggi. Diagnosis IMA dapat ditegakkan jika terdapat minimal dua dari tiga kriteria yang harus dipenuhi, yaitu nyeri dada (anamnesis), gambaran elektrokardiografi (EKG) yang berubah secara persisten, serta pelepasan biomarker jantung yaitu Creatine Kinase Myocardial Band (CK-MB), Cardiac Specific Troponin T (cTnT), atau Cardiac Specific Troponin I (cTnI). Penanganan IMA berupa terapi reperfusi dan terapi farmakologik. Penelitian ini bertujuan untuk mengetahui peran pemeriksaan troponin pada diagnosis dan penanganan IMA. Jenis penelitian ialah suatu literature review, dengan jumlah literatur yang diteliti sebanyak 13 literatur. Hasil penelitian mendapatkan bahwa diagnosis IMA dapat ditegakkan salah satunya dengan melakukan pemeriksaan biomarker jantung, dalam hal ini kadar troponin. Troponin sendiri berperan penting dalam diagnosis IMA dikarenakan hampir spesifik dan sangat sensitif dalam mendeteksi adanya IMA. Kerusakan kecil pada miokard dapat ditunjukkan melalui pemeriksaan kadar troponin. Perubahan kadar troponin juga dapat digunakan sebagai prediktor efek samping yang dapat terjadi setelah penanganan atau bahkan peningkatan mortalitas lanjut. Peningkatan kadar troponin tidak hanya terjadi pada IMA, tetapi juga dapat terjadi pada kondisi lain sehingga dalam pelaksanaan interpretasi nilainya harus sesuai dengan konteks situasi klinis yang terjadi pada pasien. Simpulan penelitian ini ialah pemeriksaan troponin berperan penting dalam diagnosis dan penatalaksanaan IMA.Kata kunci: troponin; diagnosis dan penanganan; infark miokard akut
Influence of Work Discipline and Motivation on Work Performance of Hospital Employees during the Coronavirus Disease 2019 Pandemic Linda E. Mantiri; Martha M. Kaseke; Jeini E. Nelwan; Oksfriani J. Sumampouw
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.38639

Abstract

Abstract: Job performance is a description of the level of achievement of the implementation of a policy in realizing the goals, objectives, mission and vision of the organization. The existence of the corona virus disease 2019 (Covid-19) pandemic demands that the performance of employees must better than before, especially in hospitals. Performance is influenced by various factors including discipline and work motivation. This study aimed to analyze the influence of discipline and work motivation on the employees' performance at RSUD Dr. Sam Ratulangi Tondano. This was a quantitative study with a cross-sectional design. This study was conducted at RSUD Dr. Sam Ratulangi Tondano from March to June 2021 using a questionnaire as instrument. Data were analyzed multivariately. Subjects were 126 employees The results showed that most respondents had good performance (97.6%), good work discipline (94.4%), and good work motivation (77.0%). The multivariate analysis showed that work discipline had a significant effect on employee performance (p=0.000), meanwhile, motivation did not have a significant effect on it (p=0.192). An increase of 1 value of discipline would be associated with an increase of performance by 0.492. In conclusion, discipline is the influencing factor of the performance of employees at RSUD Dr. Sam Ratulangi Tondano during the Covid-19 pandemicKeywords: performance; discipline; motivation; hospital employee; Covid-19 Abstrak: Kinerja adalah gambaran mengenai tingkat pencapaian pelaksanaan suatu kebijakan dalam mewujudkan sasaran, tujuan, misi dan visi organisasi. Adanya pandemik Corona Virus Disease 2019 (Covid-19) menuntut kinerja pegawai khususnya di rumah sakit semakin baik. Kinerja dipengaruhi oleh berbagai faktor termasuk disiplin dan motivasi kerja. Penelitian ini bertujuan untuk menganalisis pengaruh disiplin dan motivasi kerja terhadap kinerja pegawai Rumah Sakit Umum Daerah Dr. Sam Ratulangi Tondano. Jenis penelitian ialah kuantitatif dengan desain potong lintang. Penelitian ini dilaksanakan di RSUD Dr. Sam Ratulangi Tondano pada Maret-Juni 2021. Sebanyak 126 pegawai menjadi subyek penelitian ini. Instrumen penelitian ini yaitu kuesioner. Data dianalisis secara multivariat. Hasil penelitian menunjukkan bahwa responden paling banyak memiliki kinerja yang baik (97,6%), disiplin kerja yang baik (94,4%), dan motivasi kerja yang baik (77,0%). Hasil analisis multivariat menunjukkan disiplin kerja berpengaruh bermakna terhadap kinerja pegawai (p=0,000) sedangkan pengaruh motivasi kerja tidak bermakna (p=0,192). Setiap kenaikan 1 nilai disiplin akan disertai kenaikan kinerja sebesar 0,492. Simpulan penelitian ini yaitu disiplin merupakan faktor yang berpengaruh terhadap kinerja pegawai di RSUD Dr. Sam Ratulangi Tondano pada masa pandemi Covid-19.Kata kunci: kinerja; disiplin; motivasi; pegawai rumah sakit; Covid-19
Relationship between Blood Urea Level and Left Ventricular Ejection Fraction (LVEF) in Patients with ST-Elevation Myocardial Infarction Dewi U. Djafar; Marshell Luntungan; Agnes L. Panda; Steven Setiawan
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.39101

Abstract

Abstract: Lower left ventricular ejection fraction (LVEF) is associated with greater mortality among patients with ST-elevation myocardial infarction (STEMI). Renal dysfunction is considered to worsen the prognosis of STEMI patients. This study aimed to determine the correlation between blood urea level and left ventricular ejection fraction in patients with STEMI. This was a descriptive and analytical study using the Spearman’s rho test. Correlation was significant at the 0.05 level.  Data were collected from iSTEMI Registry database of patients admitted in Prof. Dr. R. D. Kandou General Hospital from October 3rd, 2018 to July 28th, 2019. The results obtained 172 STEMI patients with the mean age of 59.47±9.92 years old, and most were male (77.3%). The median blood urea level was 37 mg/dL (IQR 16) whereas a mean ejection fraction was 46.43%±10.43. The Spearman’s rho test showed that higher blood urea level was significantly associated with lower left ventricular ejection fraction (p=0.01; r=-0.241). In conclusion, higher blood urea level is associated with decreased left ventricular ejection fraction in patients with ST-elevation myocardial infarctionKeywords: blood urea level; left ventricular ejection fraction; STEMI Abstrak: Fraksi ejeksi ventrikel kiri yang menurun dikaitkan dengan tingginya mortalitas pada penderita infark miokard akut (IMA) dengan elevasi segmen ST (STEMI). Disfungsi renal diketahui memperburuk prognosis penderita IMA-EST. Penelitian ini bertujuan untuk meng-evaluasi korelasi antara kadar ureum darah dengan fraksi ejeksi ventrikel kiri pada penderita STEMI. Jenis penelitian ialah deskriptif analitik menggunakan data registri iSTEMI penderita STEMI yang dirawat di RSUP Prof. Dr. R. D. Kandou dari 3 Oktober 2018 hingga 28 Juli 2019. Penyajian deskriptif dan korelasi bivariat Spearman rho dilakukan untuk menganalisis hubungan kadar ureum darah dan fraksi ejeksi ventrikel kiri. Hasil penelitian mendapatkan 172 penderita STEMI dengan usia rerata 59,47±9,92 tahun; mayoritas ialah laki-laki (77,3%); median kadar urea darah ialah 37 mg/dL (rentang interkuartil 16); dan rerata fraksi ejeksi ialah 46,43%±10,43. Hasil uji Spearman rho menunjukkan bahwa peningkatan kadar urea darah secara bermakna berhubungan dengan fraksi ejeksi ventrikel kiri yang menurun (p=0,01; r=-0,241). Simpulan penelitian ini ialah peningkatan kadar urea darah berhubungan dengan menurunnya fraksi ejeksi ventrikel kiri pada penderita STEMI.Kata kunci: kadar urea darah; fraksi ejeksi ventrikel kiri; STEMI
Risk Factors Associated with Postoperative Outcome of Congenital Anomalies Harsali F. Lampus; Candy Candy; Leo Rendy; Sabrandi P. Saputra
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.39161

Abstract

Abstract: Mortality rate of newborns with congenital abnormalities worldwide is still high in the first four weeks after birth every year. This study aimed to obtain the profile of patients with congenital anomalies related with mortality after surgery at the Pediatric Surgery Department, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia. This was a descriptive and retrospective study. There were 98 samples during 2019 to 2021. Dependent variable was postoperative mortality outcome and independent variable risk factors were sex, gestational age, birth weight, and length of stay. Data were analyzed using univariate method. The results showed that postoperative death was 27.6%, and sex ratio was equally distributed (male 51%; female 49%). Gestational age was pre-dominanly aterm 77.5% vs preterm 22.5%. Birth weight of ≥2500 g was 77,5% and low birth weight (<2500 g) was 22.5%. Hospitalitation length of stay probably less than two weeks was 82.7%. Pediatric surgical congenital anomalies were as follows: Hirchsprung Disease (15.1%), anorectal malformation (41.7%), lateral inguinal hernia (11.3%), diaphragm hernia (3.1%), omphalocele (2.1%), gastroschisis (2.1%), undescended testis/UDT (4.1%), invagination (4.1%), duodenal atresia (3.1%), ileojejunal atresia (4.1%), esophageal atresia (5.1%), biliary atresia (1%), and mechanical bowel obstruction (3,1%). In conclusion, in the last two years, pediatric surgery services in surgical congenital anomalies had overall mortality rate of 27,6% without sex predominantly. Most patients were aterm babies with normal birth weight and relatively short length of stay.Keywords:  congenital anomalies; postoperative outcome
Relationship between Serum Fibronectin and Level of Consciousness according to FOUR Score in Traumatic Brain Injury Patients Rinaldy T. Setiawan; Eko Prasetyo; Maximillian Ch. Oley; Fredrik G. Langi
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.39165

Abstract

Abstract: Traumatic brain injuries (TBI) are determined by the severity of the primary and secondary brain damage. Fibronectin and FOUR score are suggested to be diagnostic and prognostic predictors in patients with traumatic brain injuries (TBI). This study aimed to evaluate the relationship between serum fibronectin level and FOUR score in TBI patients. This was an observational study with a prospective cohort method design, conducted on TBI patients admitted to the emergency room at Prof. Dr. R. D. Kandou Hospital. Serum fibronectin examination and assessment of the level of consciousness determined by the FOUR score were performed when the patient entered the emergency room <24 hours. A proportional regression model was used to assess the relationship between serum fibronectin levels and the FOUR score. The results obtained 65 patients, median FOUR score of 13, and 8 patients (12%) with high-risk TBI, median serum fibronectin level of 4 ng/ml, and seven patients (11%) died. The ability of fibronectin as a prognostic factor, especially mortality, did not differ from FOUR score. Logistic regression estimated that serum fibronectin levels >7 ng/ml would increase mortality 33 times and the incidence of mortality increased 23 times. A FOUR score of 8 or less had mortality 34 times and a relative risk of 28 times. In conclusion, there is a significant relationship between serum fibronectin level and FOUR score in terms of stratification of TBI patients. Elevated serum fibronectin level can be used as a diagnostic biomarker and prognostic evaluation of mortality in TBI patients.Keywords: fibronectin; FOUR score; traumatic brain injury Abstrak: Fibronektin dan Skor FOUR disarankan sebagai prediktor diagnostik dan prognositk pada pasien COT. Penelitian ini bertujuan untuk mengevaluasi hubungan antara kadar fibronektin serum dan skor FOUR pada pasien COT. Jenis penelitian ialah observasional dengan desain metode kohort prospektif, dilakukan pada pasien COT yang masuk ke IGD RSUP Prof. Dr. R. D. Kandou Manado. Pemeriksaan fibronektin serum dan penilaian tingkat kesadaran ditentukan dengan skor FOUR dilakukan saat pasien masuk ke IGD <24 jam. Model regresi proporsional digunakan untuk menilai hubungan antara kadar fibronektin serum dan skor FOUR. Hasil penelitian mendapatkan 65 pasien COT. Median skor FOUR 13, 8 pasien (12%) COT risiko tinggi (FOUR 0-7), median kadar serum fibronektin 4 ng/ml, 7 pasien (11%) meninggal. Fibronektin sebagai faktor prognostik, khususnya mortalitas, tidak berbeda dengan skor FOUR, regresi logistik mengestimasi bahwa kadar serum fibronektin >7 ng/ml mening-katkan OR mortalitas 33 kali dan insidens mortalitas 23 kali. skor FOUR 8 memiliki odds mortalitas 34 kali dan resiko relatif 28 kali. Simpulan penelitian ini ialah terdapat hubungan bermakna antara kadar serum fibronektin dan Skor FOUR dalam hal stratifikasi pasien COT. Peningkatan kadar serum fibronektin dapat dijadikan sebagai biomarker diagnostik dan evaluasi prognostik mortalitas pasien COT.Kata kunci: fibronektin; skor FOUR; cedera otak traumatik
Relationship between Level of Serum Fibronectin and Level of Consciousness according to Glasgow Coma Scale in Traumatic Brain Injury Patients Andreas K. Suwito; Eko Prasetyo; Maximillian Ch. Oley; Fredrik G. Langi
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.39168

Abstract

Abstract: Traumatic brain injury (TBI) occurs worldwide causing death and serious disability. Adequate initial assessment of the level of consciousness with GCS and early intervention are critical components of managing a patient with TBI. Levels of fibronectin, especially c-Fn in patients with severe TBI, increase significantly over time for several days after the trauma and are associated with poorer disease prognosis. This study aimed to analyze the relationship between serum fibronectin level and the Glasgow coma scale in patients with TBI and serum fibronectin level as a predictive parameter of trauma severity in TBI. Plasma fibronectin levels were measured blindly using ELISA according to the ELISA kit instructions for fibronectin. There were 65 COT patients as samples. The majority of patients had mild to moderate COT, and only 10 (15%) patients were in the severe COT category (GCS 3-8). The distribution of serum fibronectin level was moderately skewed to the right with a median of 4 ng/ml (IQR 2.7-6.4 ng/ml). In conclusion, there is a negative relationship between serum fibronectin and GCS which could be used for COT stratification. Serum fibronectin levels tend to be high in patients with low GCS or severe COT. Fibronectin is also high in patients that did not survive.Keywords: fibronectin; Glasgow coma scale; traumatic brain injury  Abstrak: Cedera otak traumatik (COT) banyak terjadi di seluruh dunia dan menyebabkan kematian dan disabilitas berat. Penilaian awal dengan Glasgow coma scale (GCS) dan intervensi yang dini merupakan komponen yang penting dalam menangani pasien. Kadar fibronektin khususnya c-Fn pada pasien dengan trauma kepala berat meningkat secara bermakna seiring waktu selama beberapa hari setelah trauma kepala dan berhubungan dengan prognosis penyakit yang lebih buruk. Penelitian ini bertujuan untuk menganalisis hubungan antara kadar serum fibronektin dengan GCS pada pasien COT dan kadar serum fibronektin sebagai parameter prediktif tingkat keparahan trauma. Kadar fibronektin plasma diukur secara blind menggunakan ELISA sesuai instruksi kit ELISA untuk fibronektin. Sampel penelitian berjumlah 65 orang pasien COT. Umumnya pasien mengalami COT ringan atau sedang, dan hanya 10 orang (15%) pasien berada pada kategori COT berat (GCS 3-8). Distribusi kadar serum fibronektin cukup miring ke kanan dengan median 4 ng/ml (IQR 2,7-6,4 ng/ml). Simpulan penelitian ini ialah terdapat hubungan negatif antara fibronektin serum dan GCS yang dapat digunakan untuk stratifikasi COT. Kadar serum fibronektin cenderung tinggi pada pasien dengan GCS rendah atau COT relatif berat. Fibronektin juga ditemukan tinggi pada pasien yang meninggal.Kata kunci: fibronektin; Glasgow coma scale; cedera otak akibat trauma
Effect of Progressive Muscle Relaxation on Anxiety Level of Medical Faculty Students in Indonesia Felisca Carisa; Octavia D. Wahyuni
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.39185

Abstract

Abstract: Developments in various fields at this time provide a lot of pressure that causes anxiety and tension. Anxiety and depression are inhibiting factors for student academic achievement and must be overcome. Each individual responds differently to stressors and requires a different management approach. Many therapies are used to control anxiety, one of them is progressive muscle relaxation. The tension or anxiety felt can be lost or reduced when the position of the tense muscle is known and progressive muscle relaxation therapy is carried out. This study aimed to determine the effect of progressive muscle relaxation on the anxiety level of students of the Faculty of Medicine, Universitas Tarumanagara. This was an analytical study with a pretest-posttest control group design. Subjects were 80 students obtained by using the non-probability sampling technique and divided into control and experimental groups. Anxiety levels were measured using the Hamilton Rating Scale for Anxiety (HRS-A) questionnaire. The data obtained were analyzed using paired t-test. The results showed a significant change in the level of anxiety in the experimental group before being given progressive muscle relaxation with a mean of 34.43 (severe anxiety) then decreased to 15.55 (mild anxiety) right after being given progressive muscle relaxation (p<0.0001). In conclusion, progressive muscle relaxation can be applied to reduce anxiety levels.Keywords: progressive muscle relaxation; anxiety level; medical students Abstrak: Perkembangan di berbagai bidang masa kini memberikan banyak tekanan yang mengakibatkan kecemasan serta ketegangan. Kecemasan dan depresi menjadi salah satu faktor penghambat prestasi akademik mahasiswa yang harus segera diatasi. Setiap individu memberikan tanggapan berbeda terhadap stresor sehingga membutuhkan pendekatan tatalaksana yang berbeda pula. Telah banyak terapi yang digunakan untuk mengendalikan kecemasan, salah satunya relaksasi otot progresif. Ketegangan atau kecemasan yang dirasakan dapat hilang atau berkurang ketika posisi otot yang mengalami ketegangan diketahui dan dilakukan terapi relaksasi otot progresif. Penelitian ini bertujuan untuk mengetahui pengaruh relaksasi otot progresif terhadap tingkat kecemasan mahasiswa Fakultas Kedokteran Universitas Tarumanagara. Jenis penelitian ialah analitik dengan desain pretest-posttest control group. Subyek penelitian sebanyak 80 mahasiswa diambil menggunakan teknik non-probability sampling dan dibagi menjadi kelompok kontrol dan perlakuan. Tingkat kecemasan diukur menggunakan kuesioner Hamilton Rating Scale for Anxiety (HRS-A). Data perolehan dianalisis menggunakan t-test paired. Hasil penelitian menunjukkan perubahan bermakna tingkat kecemasan pada kelompok perlakuan sebelum diberikan relaksasi otot progresif dengan rerata 34,43 (kecemasan berat) kemudian menurun menjadi 15,55 (kecemasan ringan) tepat setelah diberikan relaksasi otot progresif (p<0,0001). Simpulan penelitian ini ialah relaksasi otot progresif dapat diaplikasikan untuk menurunkan tingkat kecemasan.Kata kunci: relaksasi otot progresif; tingkat kecemasan; mahasiswa kedokteran

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