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Medica Hospitalia
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 584 Documents
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Radiologic Severity Index (RSI) Score in COVID-19 Patients After Administration of Remdesivir: A Study on High CRP and D-dimer Levels in a Group of Patients Adhi Rommy Setyawan; Bambang Satoto; Sofyan Budi Raharjo; Christina Hari Nawangsih; Hermina Sukmaningtyas; Nurdopo Baskoro
Medica Hospitalia : Journal of Clinical Medicine Vol. 12 No. 1 (2025): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v12i1.1012

Abstract

BACKGROUND: The COVID-19 pandemic has high mortality and morbidity. The lungs are the main target organ with a variety of symptoms ranging from asymptomatic to respiratory failure. Chest X-ray plays an important role in diagnosis, management, and prognosis. One of the chest X-ray assessment systems used is the Radiology Severity Index (RSI). Serum CRP and D-dimer levels can also be used to determine the severity of COVID-19. AIM: To examine changes in RSI scores after remdesivir therapy in COVID-19 patients with high CRP and D-dimer values. METHOD: A prospective cohort study of 64 COVID-19 patients at Dr. Kariadi Hospital Semarang from July 2020 to July 2021. Each consisted of 32 patients with high CRP (>5 mg/L) and D-dimer (>500 ng/mL) levels. Patients were given Remdesivir 200 mg therapy on day 1, followed by 100 mg/day until day 9. Chest X-rays were performed before and on day 7 after initial therapy. Patients with CHF, malignancy, autoimmune, pulmonary TB, interstitial lung disease and receiving azythromycin therapy were excluded from the study. Correlation analysis between variables was performed using the Spearman rho test and comparison test between groups. Significant results if p <0.05. RESULT:  There was a significant decrease in the RSI score of COVID-19 patients with high CRP and D-dimer levels after therapy, from 21.97±16.88 and 21.22±19.92 to 15.69±14.12 and 15.78±15.69, respectively (p<0.001). There was a weak significant relationship between high CRP levels and pre-therapy RSI scores (r=0.473, p=0.006) and high D-dimer levels and post-therapy RSI scores (r=0.362, p=0.041). CONCLUSION: Remdesivir provides a significant correlation in the form of a decrease in RSI scores in COVID-19 patients with high CRP or D-dimer levels.
Effect of R-CHOP Chemotherapy on Creatinine Clearance in Diffuse Large B-Cell Lymphoma Handhika Mustika; Willy Yusmawan; Rery Budiarti; Dwi Antono; Kanti Yunika
Medica Hospitalia : Journal of Clinical Medicine Vol. 12 No. 2 (2025): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v12i2.1153

Abstract

BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (LNH). First-line therapy for DLBCL is a combination regimen of Rituximab, Cyclophosphamide, Hydroxydoxorubicin, Vincristine (Oncovin), and Prednisone (R-CHOP). The CHOP regimen causes acute kidney injury (AKI) directly or mediated by reactive oxygen species (ROS). AKI is associated with significant morbidity and mortality in cancer patients, including high mortality, increased hospitalization, and a lower cancer remission. AIM:  Analyzing the effect of R-CHOP chemotherapy on creatinine clearance values ​​in DLBCL lymphoma patients METHOD: Analytical observational study with a retrospective design involved 38 patients diagnosed with DLBCL who underwent R-CHOP chemotherapy at RSUP dr. Kariadi Semarang. The independent variable of the study was the frequency of chemotherapy. The dependent variables of the study were serum creatinine levels and creatinine clearance which were measured in 4 phases, namely before, post 3x-, post 4x- and post 5x- R-CHOP chemotherapy. Analysis used the Friedman, T-dependent, and Wilcoxon tests. RESULT:  The creatinine clearance value of DLBCL lymphoma patients before administering R-CHOP had a normal value with an average of 68.98 mL/min. The creatinine clearance value of DLBCL lymphoma patients after administering R-CHOP after 3x chemotherapy was found to be an average of 78.26 mL/min, after 4x chemotherapy the average was 75.50 mL/min and after 5x chemotherapy the average was 73.24 mL/min. There was a significant difference in creatinine clearance values ​​for DLBCL lymphoma patients before and after administration of R-CHOP (p=0.018). CONCLUSION: Administration of R-CHOP chemotherapy has a significant effect on the creatinine clearance value of DLBCL lymphoma patients.
The Role of Mammography in Early Detection of Breast Cancer: A Case Collection Report Lilik Lestari; Muhammad Harris Sis Sulthansyah
Medica Hospitalia : Journal of Clinical Medicine Vol. 12 No. 2 (2025): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v12i2.1171

Abstract

Background: Breast cancer is still the main cause of death in women, both globally and nationally. Therefore, mammography screening needs to be carried at to detect breast cancer early. Cases Presentation: This paper presents the mammography findings of the 83 patients at dr. Ario Wirawan Pulmonary Hospital, Salatiga, Indonesia. Mammography examination used projection cuts, namely craniocaudal (CC) and mediolateral oblique (MLO). The classification used for this case series is BI-RADS. Discussion:  The results showed that of the 83 patients examined with mammography, 2 patients showed BI-RADS 4, indicating breast cancer, and 9 patients showed BI-RADS 2, indicating benign tumors. This case series report is consistent with previous studies explaining that mammography is important for making an accurate diagnosis of breast cancer between benign and malignant calcifications. Conclusion: Mammography has a role in the early detection of breast cancer. Mammography examination using CC and MLO projections is a standard procedure that aims to obtain high-quality breast images and provide accurate information for early diagnosis of breast cancer.
Radiologic Features Of Anencephaly : A Serial Case Report Nadia Citradibyaguna; Besari Adi Pramono; Farah Hendara Ningrum; Sukma Imawati
Medica Hospitalia : Journal of Clinical Medicine Vol. 12 No. 1 (2025): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v12i1.1186

Abstract

Background : Anencephaly is a lethal central nervous system anomaly characterized by absence of cerebral structures and cranial vault. It is the most common open neural tube defect that occurs in 0.5 – 2 per 1,000 live births. This anomaly can be detected as early as 11 weeks of pregnancy by transvaginal ultrasonography. Micronutrient deficiency, such as anemia and folic acid deficiency, was known to be the potential risk factor for anencephaly. Case Report : We reported 4 cases of anencephaly diagnosed using ultrasonography during pregnancy. All patients were referred to Dr. Kariadi General Hospital from private hospitals in Central Java. 3 out of 4 cases were diagnosed in the first trimester and 1 case was diagnosed in the third trimester. Ultrasonography features showed typical signs of anencephaly including ‘frog eyes sign’, ‘Mickey mouse sign’ and acrania. All of the patients underwent termination of pregnancy with variable route of delivery according to each patients’ condition and gestational age. Discussion : Routine antenatal ultrasonography is recommended for early detection of fetal viability and other congenital anomalies including anencephaly. Ultrasonography is able to detect typical findings of anencephaly and therefore is able to accurately establish the diagnosis. Advanced imaging technique such as MRI is unnecessary unless diagnosis using ultrasonography is indeterminate. Establishing the diagnosis of anencephaly is very important due to determining its definitive treatment, in which termination of pregnancy. Conclusion : In this serial case series, we present various radiologic features of anencephaly using ultrasonography so that clinicians will be able to diagnose this anomaly in earlier age of pregnancy. Hence, definitive treatment can be done and complications during pregnancy can be prevented.
The Association Vitamin D and Left Ventricular Hypertrophy in Metabolic Syndrome Patients Charles Limantoro; Andreas Arie Setiawan; Nur Alaydrus; Theofilus Ardy Pradhana; Friska Anggraini Helena Silitonga
Medica Hospitalia : Journal of Clinical Medicine Vol. 12 No. 1 (2025): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v12i1.1196

Abstract

Background: Vitamin D deficiency is common, especially in people with metabolic syndrome. This condition increases the risk of cardiovascular problems, including left ventricular hypertrophy (LVH). While the connection between metabolic syndrome and LVH is well-documented, it is still unclear whether vitamin D deficiency alone contributes to the development of LVH in these patients. Aim: To study the association between vitamin D levels and LVH in patients with metabolic syndrome. Methods: A cross-sectional study was conducted with 38 patients diagnosed with metabolic syndrome  in Kariadi Hospital, Semarang. Serum vitamin D levels were measured using the ELISA method, and LVH was diagnosed via echocardiography. Patients were categorized into normal and LVH groups. Vitamin D levels were classified as sufficient, insufficient, or deficient. The relationship between vitamin D levels, metabolic syndrome components, and LVH was analyzed. Results: Our findings revealed no significant difference in vitamin D levels between patients with LVH and those without it (mean 19.98 ± 5.59 ng/mL for the LVH group vs. 20.91 ± 6.56 ng/mL for the normal group, p=0.65). However, patients with LVH had a significantly higher number of metabolic syndrome components compared to those without LVH (p=0.044). Conclusion: While no direct association was found between vitamin D levels and LVH, the cumulative burden of metabolic syndrome components plays a significant role in the development of LVH. Future research should explore larger populations to investigate the therapeutic potential of vitamin D in cardiovascular outcomes.
Effectiveness of ProlotherapyInjection in Elderly Patients with Knee Osteoarthritis: A Double-Blind Randomized Controlled Trial Faizal Muhammad; Afifah Syifaul Ummah; Farida Aisyah; Isa Ridwan; Yulie Erida Nur Rahmawati
Medica Hospitalia : Journal of Clinical Medicine Vol. 12 No. 1 (2025): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v12i1.1201

Abstract

BACKGROUND : Knee osteoarthritis (OA) is a painful chronic disease in elderly population. Research has shown that prolotherapy is an effective pain-relieving treatment, particularly when used in combination with other therapies. AIMS :  To evaluate the effectiveness of prolotherapy for knee OA based on The Western Ontario McMaster University OA Index (WOMAC) composite score (100 points), Knee Pain Scale, and self-reported satisfaction. We performed a randomized-controlled trial (RCT) with a double-blinded approach. METHOD: An injection saline, 10% dextrose (D10) prolotherapy, or at-home knee exercise was administered to twenty-seven elderly patients (≥60 years old) experiencing painful knee OA for at least three months. Extra- and intra-articular injections were administered at weeks 1, 4, and 7, with follow-up at weeks 11 and 15. Exercise group received in-person training and an exercise guidebook. WOMAC composite score (100 points), Knee Pain Scale, and self-reported satisfaction evaluated the outcomes. The results were considered statistically significant if p < 0.05. RESULT:  There are no significant difference in baseline among groups. At 21 weeks, all groups exhibited improved composite WOMAC scores (p <0.02) compared to baseline. After adjusting for age, sex, and body mass index, D10 prolotherapy showed a significant WOMAC score improvement at 21 weeks (p <0.04) compared to saline and exercise (score change: 16.2 ± 4.4 vs. 8.5 ± 4.3, and 9.1 ± 3.2, respectively), surpassing the minimal clinically significant difference based on WOMAC. Self-reported satisfaction with D10 prolotherapy was high without reported adverse effects. CONCLUSION: When compared to saline injections and at-home exercises, D10 prolotherapy resulted in a clinically significant sustained improvement in pain, function, and stiffness scores for knee OA in elderly.
Integrating Neck Massage and Progressive Muscle Relaxation: A Comprehensive Approach for Reducing Migraine Disability and Enhancing Quality of Life Rina Budi Kristiani; Novita Fajriyah; Sosilo Yobel
Medica Hospitalia : Journal of Clinical Medicine Vol. 12 No. 2 (2025): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v12i2.1205

Abstract

BACKGROUND: Migraine is a highly disruptive and common neurological disorder characterized by intense headache and transient somatosensory and motor disturbances that affects approximately 1 billion people worldwide with many common causative factors and often results in disability and reduced quality of life. This study aims to determine the effect of combined neck massage and progressive muscle relaxation therapy on disability and quality of life of migraine sufferers. METHOD: This quasi-experimental study used a pre-test-post-test control group design over eight weeks (May to July 2024), selecting 50 participants aged 18–60 years with migraines for over three months based on ICHD-3 criteria. The study utilized the Migraine Disability Assessment Questionnaire and the Migraine-Specific Quality of Life Questionnaire as instruments. RESULT: The combination therapy of neck massage and progressive muscle relaxation both has a significant effect on reducing the severity, frequency, and duration of migraine attacks, as well as improving migraine-related disability (p =0.000) and quality of life (p-value = 0.001). CONCLUSION: Combination therapy of neck massage and progressive muscle relaxation is effective in reducing migraine disability and improving the quality of life of migraine sufferers.
Association of Pre-treatment Serum Fibrinogen-Albumin Ratio Index (FARI) and Concurrent Chemoradiotherapy (CCRT) Therapeutic Response in Patients with Locally Advanced Cervical Cancer (LACC) Gezta Nasafir Hermawan; Bismarck Joel Laihad; Joice Margretha Mathilda Sondakh
Medica Hospitalia : Journal of Clinical Medicine Vol. 12 No. 2 (2025): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v12i2.1207

Abstract

BACKGROUND: Cervical cancer is currently the second most prevalent women malignancy cases in Indonesia. High prevalence of cases diagnosed as locally advanced cervical cancer / LACC (FIGO Stage IIB-IVA), where concurrent chemoradiotherapy (CCRT) is the main treatment modality. Several therapeutic efficacy predictors in other malignancy cases including the pre-treatment serum fibrinogen-albumin ratio index (FARI) have been associated with therapeutic response to CCRT. However, there were no recent studies in cervical cancer cases. AIMS: To determine the association of pre-treatment FARI and CCRT therapeutic response in patients with LACC. METHOD: This is a prospective cohort study in patients with LACC from January – May 2024 whose clinical stage was determined. The pre-treatment FARI was calculated in patients who had met both inclusion and exclusion criteria, and undergone the CCRT regimen. Patients who completed the regimen were evaluated for therapeutic response. Data processing was carried out using SPSS 25 for Windows software. RESULT: In this study, it was found that the complete response (CR) group with the best outcome had the smallest pre-treatment FARI (9.79 ± 1.71), on the other hand the progressive disease (PD) group had largest pre-treatment FARI (33.72 ± 12.78). In addition, all CCRT therapeutic response groups had significantly different FARI values ​​(P value < 0.05) and the FARI cut point value of 12.44 had a sensitivity of 100% and a specificity of 78.1% for predicting complete response (CR) to CCRT. CONCLUSION: Low pre-treatment FARI is significantly associated with the likelihood of patients having a complete response (CR), which is the best outcome to CCRT.
Evaluation of Definitive Antibiotic Therapy Effectiveness in Sepsis Patients at Tabanan Hospital, Indonesia Luh Rai Maduretno Asvinigita; Ketut Tunas; Ida Ayu Alit Widhiartini; Agata Widatama; Rini Noviyani
Medica Hospitalia : Journal of Clinical Medicine Vol. 12 No. 1 (2025): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v12i1.1210

Abstract

BACKGROUND : The study evaluated the use of definitive antibiotics and examined the association between the causative bacteria, resistance patterns, and antibiotic regimens with clinical outcomes in sepsis. AIMS :  To assess the suitability of definitive antibiotics in sepsis patients at Tabanan Hospital, focusing on the correlation between bacterial type, antibiotics, and resistance profiles with clinical outcomes, aiming to improve sepsis management and reduce antibiotic resistance. METHOD : The observational cross-sectional study analyzed data descriptively to evaluate antibiotic-pathogen compatibility retrospectively. Chi-square tests were used for bivariate analysis of mortality-related variables. Survival analysis employed the Kaplan-Meier method. RESULT : Among 112 sepsis patient records (Jan 2020 - Dec 2022), 62% received antibiotics based on bacterial sensitivity test contradiction to another 38% who were given inappropriately antibiotic. Empiric antibiotic treatment was associated with increased mortality (OR=4.379; CI 95% 1.274-15.052; P=0.022). Bacterial type and resistance status showed no significant association with mortality (OR=0.417; CI 95% 0.030-5.708; P=1.000 and OR=1.500; CI 95% 0.156-14.420; P=1.000, respectively). CONCLUSION : Definitive antibiotic use for sepsis patients at Tabanan Hospital was mostly appropriate, and the empiric antibiotics treatment was associated with mortality, while the causal bacteria and resistance status were not significantly associated with mortality.  Findings highlight the importance of transitioning from empiric to targeted therapy to potentially reduce mortality in sepsis management.
Comparative Effectiveness of Betahistine vs Dimenhydrinate in Reducing Dizziness Handicap Scores in Patients with Peripheral Vestibular Disorders Christin Rony Nayoan; Muyassaroh Muyassaroh; Zulfikar Naftali
Medica Hospitalia : Journal of Clinical Medicine Vol. 12 No. 1 (2025): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v12i1.1213

Abstract

BACKGROUND: Peripheral vestibular disorder is a disorder of the peripheral vestibular system. Its symptoms affect the quality of life from moderate to severe. An objective assessment is quite difficult therefore a questionnaire method has been developed such as Dizziness Handicap Inventory  (DHI). Aim of the treatment is to achieved optimal quality of life by using symptomatic treatment like dimenhydrinate and betahistine. AIMS :  To prove the effectiveness of betahistine and dimenhydrinate and to compare the effectiveness in reducing DHI score METHOD : : This was an intervention study with pretest and posttest control group designs, randomized control trial, double blind study at ENT-HNS Clinic, CDC Dr. Kariadi Hospital  and Dr.Soetrasno Hospital Rembang. Data was collected from September 2015 to June 2016. Subject filled out the DHI pre-test questionnaire,  stratified randomly divided into 2 group. One group received betahistine 12 mg / 8 hours and the other received dimenhydrinate 50 mg / 8 hours in a double-blind selection process. After 2 weeks of drug administration, subject filled out a post test questionnaire of DHI. RESULT :  Subjects  were 44 people; dimenhydrinate, 20 people (45.5%) and betahistine, 24 people (54.4%). Result showed that DHI score of post test is lower than pre test in both group with significance value of p < 0.05. There is no significant difference in DHI score of dimenhydrinate compared with betahistine group (p = 0.137). CONCLUSION : Betahistine and dimenhydrinate are shown to be effective in lowering the DHI score.and betahistine not proven to be more effective

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