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Published by RSUP Dr. Kariadi Semarang

ISSN : 23014369 EISSN : 26857898 DOI : https://doi.org/10.36408/mhjcm

Core Subject : Health,

Dentistry Health Professions Medicine & Pharmacology Nursing Public Health

Medica Hospitalia: Journal of Clinical Medicine adalah jurnal ilmiah yang diterbitkan RSUP Dr. Kariadi dan menerima artikel ilmiah dalam bahasa Indonesia dan bahasa Inggris yang diharapkan dapat menjadi media untuk menyampaikan temuan dan inovasi ilmiah dibidang kedokteran atau kesehatan kepada para praktisi dan akedemisi di bidang kesehatan dan kedokteran.

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Articles 529 Documents

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Erupsi Akneiformis Pada AML Dengan Regimen Kemoterapi “3 + 7” Septiantoro, Bayu Prio; Pradipta, Indra
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 2 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar belakang: Kemoterapi bertanggung jawab terhadap sebagian besar manifestasi kulit dalam perawatan pasien kanker. Daunorubicin selama 3 hari ditambah sitarabin selama 7 hari untuk kemoterapi induksi pada pasien dengan AML dikenal sebagai regimen “3 + 7.” Walaupun erupsi akneiformis biasanya muncul pada pasien yang mendapatkan agen penghambat EGFR dan antibodi monoclonal, reaksi kulit ini juga dapat dialami pasien yang mendapatkan regime daunorubicin atau sitarabin. Laporan kasus: Seorang wanita berusia 19 tahun dengan diagnosa AML masuk rumah sakit untuk menjalani kemoterapi dengan regimen 3+7 (daunorubicin 45mg/m2 selama 3 hari dan sitarabin 100mg/m2 selama 7 hari). Setelah hari pertama kemoterapi diberikan, muncul akne berupa bintik merah di wajah dan bertambah berat setelah sesi kemoterapi selesai dimana meluas hingga ke leher, dada dan punggung bahkan ke daerah kulit kepala, dengan adanya rasa gatal, papul dan eritema. Ia terdiagnosa erupsi akneiformis. Tujuan: Untuk melaporkan kasus reaksi kulit berupa erupsi aneiformis pada pasien dengan diagnose AML yang menjalani kemoterapi dengan regime 3+7. Pembahasan: Lesi erupsi akneiformis biasanya muncul sebagai papula dan pustula inflamasi monomorfik yang biasanya melibatkan wajah, leher, dada, punggung atas dan dapat diperluas hingga selain daerah seboroik. Beberapa karakteristik dapat membantu untuk mendukung hubungan potensial antara obat dengan munculnya akne. Diantaranya yang teridentifikasi pada pasien ini yaitu timbulnya akne secara tiba-tiba tanpa adanya riwayat akne vulgaris sebelumnya, lesi monomorfik dengan inflamasi, serta sedikit komedo dan kista. Terdapat empat tingkatan yang dapat digunakan dalam mengklasifikasikan keparahan efek samping kulit ini dimana tingkat III (berat) dapat diberikan antibiotik secara oral seperti klindamisin 300mg/12 jam. Kesimpulan: Reaksi kulit berupa erupsi akneiformis dapat muncul pada pasien yang mendapatkan obat selain EGFR inhibitor dan antibodi monoclonal yaitu daunorubisin dan atau sitarabin. Perlu dilakukan penelitian lebih lanjut untuk mengetahui agen spesifik yang menjadi penyebab, serta mekanisme terjadinya reaksi tersebut.

Immunoassay interference: Studi kasus Nefritis Lupus kelas IV, Sindroma Mielodisplasia dan Neuropsikiatrilupus Nindhita, Like Rahayu; Widyaningrum, Dian
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 2 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar belakang : Systemic Lupus Erythematosus adalah penyakit kronik inflamatif autoimun dengan manifestasi multiorgan. Pemeriksaan bone marrow punction mengkonfirmasi gangguan hematologi. Imunoassai ANA, anti-dsDNA dan anti Sm mengkonfirmasi imunopatogenesis. Tujuan studi kasus ini adalah untuk menganalisis aspek laboratorium dalam diagnosis dan tatalaksana nefritis Lupus kelas IV dan neuropsikiatri lupus dengan Sindroma Mielodisplasia. Kasus : Seorang wanita 35 tahun mengeluh lemas. Pemeriksaan fisik : hipertensi, konjungtiva palbebra pucat, ulkus dimulut, echimosis dikulit, pleural friction rub paru kanan, edema pitting ekstremitas. Pemeriksaan laboratorium : peningkatan LDH, hiperlipidemia, hipofibrinogenemia, peningkatan D-dimer, proteinuria, hematuria dan silinderuria. Pemeriksaan ANA dan Sel LE positif. Pansitopenia darah tepi dikonfirmasi pemeriksaan BMP didapatkan gambaran MDS. Pasien mengalami kejang, dikonfirmasi MSCT kepala terdapat infark serebri multipel. Anti ds-DNA positif moderate, C3/C4 rendah namun anti Sm negatif. Kesimpulan : Berdasarkan data klinis dan laboratoris pasien ini didiagnosis SLE derajat berat, nefritis lupus kelas IV, sindroma mielodisplasia dan neuropsikiatrilupus. Anti Sm negatif kemungkinan disebabkan fenomena “cross reactivity” atau “Hook Effect” sehingga menyebabkan interferensi hasil negatif palsu. Anti Sm negatif tidak dapat menyingkirkan diagnosis SLE

Full Text Volume 8 Nomor 2 Juli 2021 Hospital, Kariadi General
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 2 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Full Text Volume 8 Nomor 2 Juli 2021

EFEKTIVITAS OZONATED VIRGIN COCONUT OIL TERHADAP PENYEMBUHAN LUKA FULL THICKNESS SKIN GRAFT AUTOLOG TIKUS SPRAGUE DAWLEY Ditinjau dari Ekspresi TGF-? dan Jumlah Neutrofil Kusuma, Nauval Marta; Hardian, Hardian; Najatullah, Najatullah; Yuniati, Renni; Susilaningsih, Neni
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 3 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Abstract Introduction : Skin grafts are now one of treatment option in wound healing process that is always developing. TGF-bexpression and the number of neutrophils have an important role in healing skin graft wounds. Ozone (O3) has disinfecting properties that are effective in wound healing. Objective : Proving the effectiveness of Ozonated VCO for Full Thickness Skin Graft wound healing using parameter of TGF-b expression and neutrophil number. Method : This study is an experimental study with a post-test only design group of 40 Sprague Dawley rats performed autologous skin graft at the same time. Samples were divided randomly into 8 groups (K1 = without Ozonated VCO), (A1 = Ozonated VCO 50 mg / ml), (B1 = Ozonated VCO 100 mg / ml), (C1 = Ozonated VCO 200 mg / ml), ( K2 = without Ozonated VCO) (A2 = Ozonated VCO 50 mg / ml), (B2 = Ozonated VCO 100 mg / ml), (C2 = Ozonated VCO 200 mg / ml). Assessment of TGF-b expression and neutrophil number of tissue was performed by staining hematoxylin & eosin and immunohistochemistry on days 6 and 12 after skin graft. Results : There were significant differences (p <0.05) TGF-b expression and neutrophils number of tissue between the control group and the administration of Ozonated VCO doses of 50 mg / ml, 100 mg / ml and 200 mg / ml on days 6 and 12 post skin graft. Conclusion : The administration of Ozonated VCO effectively improve Full Thickness Skin Graft wound healing seen from macroscopic wounds, increase TGF-b expression and decrease the number of neutrophils.

THE EFFECTIVENESS OF HYDROLYZED VCO CREAM ON VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) EXPRESSION AND COLLAGEN THICKNESS FOR HEALING 2ND DEGREE BURNS INJURY IN WISTAR RATS Fahmi Syarif; Neni Susilaningsih; Yuriz Bakhtiar
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 3 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

ABSTRACT Burn wounds remain a serious problem in several countries. The presence of burn wounds might trigger local or in severe cases also triggers systemic response. Immediate treatment is required to prevent further tissue damage. Silver sulfadiazine cream is commonly used as a burn therapy. However, long-time usage might cause negative side effects. Several effective alternatives with better safety are opted, including virgin coconut oil (VCO). Originating from Cocos nucifera, commonly known as the coconut plant, VCO is a product that contains a lot of beneficial substances, such as lauric acid, polyphenol, and alpha-tocopherol. Hydrolyzed VCO can be an alternative to topical drugs in second-degree burns as it increases Vascular Endothelial Growth Factor (VEGF) expression and collagen thickness in the burn wound healing phase. This randomized post-test only with parallel-group experiment was done using Wistar rats induced to a second-degree burn. The effect of 70% and 100% on second-degree burn healing, measured by hydrolyzed VCO on VEGF expression and collagen thickness was observed between 6 and 12 days of therapy. VEGF expression and collagen expression increased higher in groups treated with 70% and 100% hydrolyzed VCO compared with the control group treated with base cream.

Asosiasi Varian Genetik Angiotensin Converting Enzyme ( ACE ) Terhadap Karakteristik Faktor Risiko Pada Penderita Stroke Iskemik di Rumah Sakit Umum Pusat Dr. Kariadi Semarang Dodik Tugasworo Pramukarso; Herlina Suryawati; Soetedjo Soetedjo; Jimmy Eko Budi Hartono; Trianggoro Budisulistyo; Arinta Puspita Wati; Aditya Kurnianto; Patria Adri Wibhawa
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 3 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

BACKGROUND : Stroke is the leading cause of death and disability in the world. The occurrence of ischemic stroke is indicated by genetic factors, environmental factors and the interaction between it. Angiotensin Converting Enzyme (ACE) genetic variant is associated with various characteristics of risk factors for ischemic stroke. OBJECTIVE : Identifying genetic variants of Angiotensin Converting Enzyme (ACE) with the Polymerase Chain Reaction (PCR) method and to find it’s correlation beetwen risk factor in patients with Ischemic Stroke at Dr. Kariadi Semarang METHOD : The subjects of the study were 72 patients with ishcemic stroke who were treated at the polyclinic of the Neurology Department Dr. Kariadi Semarang in January - December 2013. DNA extraction of research subjects was carried out at the Laboratory of the Center of Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University from January to March 2020. Amplification using the Polymerase Chain Reaction (PCR) method was carried out using an Eppendorf thermocycler. Data were analyzed with SPSS for Windows Version 25 RESULT : 72 samples analyzed obtained genetic variants of ACE II 39 (54.2%) samples, genetic variants of ACE DI 30 samples (41.7%), and genetic variants of ACE DD 3 (4.2%) samples. Meanwhile, there was no significant relationship ( p>0,05 ) between genetic variants of ACE and the characteristics of risk factors for ischemic stroke, namely age, gender, Body Mass Index, smoking history, triglyceride levels, HDL levels, LDL levels, obesity and hypertension. CONCLUSION : There are three types of ACE genetic variants, including the ACE II genetic variant, the ACE DI genetic variant, and the ACE DD genetic variant. Among the three genetic variants, ACE II genetic variant is the most common variant and there is no significant relationship to the various risk factor characteristics found in ischemic stroke patients at Dr. Kariadi Gneeral Hospital Semarang.

Aspirasi Trombus Selektif Memperbaiki Aliran Koroner dan Mengurangi Tingkat Badai Trombus pada Pasien Sindroma Koroner Akut Dengan Elevasi Segmen ST yang dilakukan Intervensi Koroner Perkutan Primer Bramantyo, Liborius; Bahrudin, Udin; Ardhianto, Pipin; Uddin, Ilham; Rifqi, Sodiqur
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 3 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar belakang: Embolisasi distal koroner berkontribusi terhadap tingginya kejadian kardiovaskular mayor (KKVM) pasca intervensi koroner perkutan primer (IKPP). Aspirasi trombus (AT) manual berpotensi mengurangi embolisasi distal dan memperbaiki perfusi mikrovaskular pada pasien sindroma koroner akut dengan elevasi segmen ST (SKA-EST), terutama pasien dengan badai trombus tinggi. Tujuan: Mengetahui pengaruh aspirasi trombus selektif terhadap skor TIMI trombus dan luaran klinis pasca IKPP. Metode: Penelitian retrospektif pada pasien SKA-EST dengan onset ?12 jam dan skor trombus TIMI awal ?3 yang menjalani IKPP dengan aspirasi trombus selektif di RSUP Dr. Kariadi periode Januari 2018 sampai Desember 2019. Luaran klinis yang diobservasi adalah KKVM selama rawat inap yang terdiri dari mortalitas, syok kardiogenik, edema paru akut, aritmia, revaskularisasi ulang, dan stroke. Hasil: Sejumlah 100 pasien memenuhi kriteria, terdiri dari 50 pasien kelompok AT dan 50 pasien kelompok non-AT. Rerata skor trombus TIMI awal kelompok AT dan non-AT, masing-masing 4,76 dan 3,8 (p<0,001). Kelompok AT mengalami penurunan skor trombus TIMI lebih baik dibanding non-AT (4,72 vs. 3,8, p<0,001). Terdapat 8 (16%) pasien kelompok AT dan 11 (22%) pasien non-AT yang mengalami KKVM pasca IKPP (RR 1,08, IK 95% 0,89-1.30, p=0,44). Kesimpulan: Aspirasi trombus selektif mungkin mengurangi tingkat badai thrombus. Aspirasi trombus mungkin menurunkan kejadian kardiovaskular mayor selama rawat inap pasca IKPP pada pasien dengan skor trombus TIMI di atas 4 setara dengan yang memiliki skor trombus TIMI kurang dari 4 tanpa aspirasi trombus.

Effectivity of Exoskeleton Robot-Assisted Therapy on Improving Muscle Strength in Post-Stroke Patient Aulia Salwa Alfaina; Rahmi Isma Asmara Putri; Hari Peni Julianti; Trianggoro Budisulistyo; Rifky Ismail
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 3 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Background: Upper limb weakness is the most disability caused by stroke. The availability of physiotherapists is still limited in Indonesia. The exoskeleton robot is a developing technology that involve in stroke rehabilitation therapy. Objective: To evaluate the effectiveness of exoskeleton robot-assisted therapy on improving muscle strength of patients after stroke. Methods: An experimental study with two groups pre-test and post-test design carried out using consecutive sampling among outpatient stroke patients in Diponegoro National Hospital (RSND) and William Booth Hospital (RSWB), Semarang. Patients in the robotic group (RG) (n=8) received 16 training sessions. Each session consists of 30 passive and ten active-weighted elbow flexion-extension with the exoskeleton robot. Meanwhile, the control group (CG) (n=8) received equivalent training of conventional therapy. The primary outcome of muscle strength was measured by Manual Muscle Testing (MMT) and handheld dynamometer. Pre and post-test MMT score data in each group were analyzed by Wilcoxon test, while handheld dynamometer score data were analyzed by paired t-test. Data between the two groups were analyzed by Mann-Whitney test and unpaired t-test. Results: Significant improvements were shown for the MMT score (RG: p=0.014, CG: p=0.034). There were significant handheld dynamometer score improvements on muscle strength for elbow flexor and extensor in RG (p = 0.008 and p = 0.005 respectively) and in CG (p=0.036 and p=0.008 respectively). No significant differences for MMT and handheld dynamometer score between the two groups. Conclusion: The exoskeleton robot-assisted therapy was as effective as conventional therapy for improving muscle strength in stroke patients.

Dry Eyes Syndrome pada Penderita Diabetes Melitus Tipe 2 Setyorini, Desti Putri; Wildan, Arief; Nugroho, Trilaksana; Julianti, Hari Peni; HS, Heri-Nugroho
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 3 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

BACKGROUND : Type 2 diabetes mellitus patients have risk to suffer from dry eyes syndrome (DES), caused by peripheral and autonomic neuropathy, oxidative stress, and metabolic dysfunction. DES can reduce the patient’s quality of life then it could induce blindness if the patient didn’t get any therapy for DES. It is important to prevent DES by controlling its risk factors. OBJECTIVE : To investigate risk factors of DES in patients with type 2 diabetes mellitus. METHOD : . This study was an analytical observational study with cross-sectional design and purposive sampling. Subjects were examined by using questionnaire and slit lamp, then followed by deep interview in some subjects. This study was also using subject’s medical record to complete the required data. Subjects were diagnosed to suffer DES if OSDI score >12 and schirmer score <10mm. Data was analyzed by using statistic software. RESULT : . From 42 subjects, 19 subjects (45,2%) suffered from DES whereas another 23 subjects (54,8%) didn’t. There was significant relation between diabetic retinopathy (p=0.009) and DES in patients with type 2 diabetes mellitus showed by p value under 0,05 (OR 5.700, 95% CI:1.364-23.821). However, age (p=0.516), gender (p=1.000), level of knowledge (p=0.555), accessibility to health provider (p=1.000), occupation (p=0.644), economic level (p=0.105), smoke exposure (p=0.432), duration of diabetic (p=0.707), diabetic controlling (p=0.305), and history of dyslipidemia (p=0.155) had no significant relations with DES in patients with type 2 diabetes mellitus. CONCLUSION : There is a significant relation between diabetic retinopathy and DES in patients with type 2 diabetes mellitus. Diabetic retinopathy is the most dominant risk factor among the other factors in this study.

GAMBARAN HISTOPATOLOGI KULIT TIKUS WISTAR PADA PERIODE DEKOMPOSISI TERHADAP SUHU UDARA YANG BERBEDA Elim, Marlion Anthonius; Rohma, Intarniati Nur; Haryanto, Julia Ike; Istiadi, Hermawan
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 3 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

LATAR BELAKANG : Salah satu tujuan pemeriksaan forensik pada jenazah adalah menentukan perkiraan waktu kematian. Perubahan pada tubuh manusia setelah mati dapat berkontribusi dalam penentuan waktu kematian, namun hal ini cukup sulit bila kondisi jenazah sudah memasuki tahap pembusukan. Banyak metode telah dikembangkan untuk penentuan waktu kematian secara kuantitatif. Jaringan kulit merupakan bagian paling luar dari tubuh manusia yang juga mengalami perubahan setelah kematian sehingga dapat digunakan sebagai petunjuk waktu kematian tanpa melakukan insisi yang luas pada tubuh. TUJUAN : Penelitian ini bertujuan untuk mengetahui pengaruh suhu udara yang berbeda pada periode dekomposisi terhadap gambaran histopatologi kulit tikus wistar. Periode dekomposisi yang dipakai adalah 24, 48 dan 72 jam. Suhu yang dipakai adalah suhu rata-rata di kota Semarang tahun 2019 yaitu pada suhu 180C, 280C dan 390C. METODE : Penelitian analitik deskriptif dengan pendekatan ekperimental menggunakan kulit tikus wistar sebagai sampel. Sampel kemudian di analisa secara Patologi Anatomi dengan pewarnaan HE, dilihat epidermis, dermis, folikel rambut dan kelenjar sebasea dalam 5 lapang pandang besar untuk melihat derajat kerusakan menurut Carsana (0-5), kemudian dikategorikan menjadi kategori ringan, sedang dan berat. Data kemudian diolah dengan SPSS for windows versi 15. HASIL : Perbadingan derajat kerusakan histopatologi kulit pada periode dekomposisi 24, 48 dan 72 jam terhadap suhu udara memberikan hasil yang signifikan dengan nilai p<0,05. Demikian juga dengan hasil uji kelompok suhu dibandingkan dengan periode dekomposisi memberikan hasil yang signifikan pada suhu 280C dan 390C. KESIMPULAN : Penelitian ini menunjukan peningkatan suhu udara dan periode dekomposisi berbanding lurus dengan gambaran kerusakan histopatologi kulit.

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