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INDONESIA
Jurnal Kedokteran Brawijaya
Published by Universitas Brawijaya
ISSN : 02169347     EISSN : 23380772     DOI : http://dx.doi.org/10.21776/ub.jkb
Core Subject : Health,
Medicine & Pharmacology
JKB contains articles from research that focus on basic medicine, clinical medicine, epidemiology, and preventive medicine (social medicine).
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 822 Documents
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Re-engineering Prescription Services as an Alternative Solution Indriastutik, Nunung; Fitriasari, Nikma; Rusdiana, Dina
Jurnal Kedokteran Brawijaya Vol. 32 Supplement 1 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

Medication errors could occur at any stage, including prescribing, transcribing, dispensing, and administration stages. Errors in the prescribing stage accounted for the most significant percentage, ranging from 70% to 99%. The most mistake at the prescribing stage is the illegible prescription. This situation causes high morbidity and mortality in hospitals. This study aimed to analyze the root of the problems of the incidence of illegible prescriptions and find anticipating strategies. This research is a descriptive study initiated by finding the root of the problems, followed by identifying alternative solutions and preparing priority solutions. From the analysis of the root of the problems, the illegible prescription included incomplete identity, drug name and the preparation, unclear usage, the error in assuming the writing in the prescription, and ineffective design of the prescription. The solution chosen was the improvement of prescription service flow (re-engineering) that added an identity labeling procedure to correct the error on patient's identity due to the repetition of manual writing and the addition of an authorization procedure by double-checking. The second solution was creating patient identity labels, creating appropriate prescription designs, and developing prescription service guidelines to support the implementation of prescription services re-engineering. This research concludes that the root of the problems on the illegible prescription is the absence of prescription service procedures that aim to anticipate medication errors. Hence, a re-engineering of prescription service needs to be prepared as an alternative solution
Exploring the Factors explaining Length of Stay at Emergency Department: Study in a C Class Private Hospital Amalia, Eta Riska
Jurnal Kedokteran Brawijaya Vol. 32 Supplement 1 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

ABSTRACTThe process of admitting patients to the inpatient wardfrom the emergency room is of the factors that influence the access block time in services in the emergency room and hospitals. This study aimed to identify the cause of transition time to inpatient services from the emergency room at a private C class hospital in Malang. This research is a descriptive exploratory study using interviews withfour general practitioners, two emergency nurses, two general inpatient nurses, two children inpatient nurses, and one administrative staff, and also observation of the stages and duration of emergency services and inpatient care. The process from arrival, registration, and inspection takes 0-15 minutes. Overall, the stages of registration until the inpatient ward transfer require 1-3.5 hours, which exceeds the hospital quality standards. Factors that influence the transfer time are the condition of the patient, the absence of a transition room, the availability of inpatient wards, and the patient discharge process. To manage ER LOS, especially block access to inpatient services, hospitals need to apply Bed Management properly.  
Effects of Propolis Extract Supplementation during Pregnancy on Stress Oxidative and Pregnancy Outcome: Levels of Malondialdehyde, 8-Oxo-2′-Deoxogunosine, Maternal Body Weight, and Number of Fetuses Joko Wahyu Wibowo; Minidian Fasitasari; Siti Thomas Zulaikhah
Jurnal Kedokteran Brawijaya Vol. 31 No. 3 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.03.5

Abstract

Oxidative stress is related to pregnancy complications that could increase maternal and infant mortality. This study aimed to determine the effect of propolis extract supplementation during pregnancy on oxidative stress level and pregnancy outcomes utilizing Malonedealdehyde (MDA) and 8-Oxo-2′-Deoxogunosine (8-OHdG) levels, maternal body weight, and the average number of fetuses as the parameters. The study was conducted by using a posttest only control group design on 24 pregnant Wistar rats, which were divided into four groups. Group I was control, Group II-IV were the treatment groups given propolis extract of 1.8mg, 3.6mg, and 7.2mg/200gBW/day, respectively. The standard feed given was AIN93G dose of 20g/day and distilled water ad libitum. Propolis extract was given using a gastric feeding tube every morning for 20 days. At the end of the treatment, body weight was meisured and blood collected for assessed MDA and 8-OHdG levels  by ELISA method  and then we performed abdominal surgery to count number of fetuses. The result are there were decreasing level of MDA and 8-OHDG by administration of propolis significantly (p<0.05) group: I: 2,04±0,091, II: 1,55±0,067, III: 1,05±0,176, IV: 0,73±0,075 (mmol/mL) (p=0.001); 8 OHdG level (ng/mL) group I: 10,02±0,403, II: 8,60±0,078, III: 7,89±0,051, IV: 7,53±0,063 (p=0,001). Average of maternal body weight (g) were increased: group I: 228,33±3,93, II: 237,17±4,36, III: 244,83±4,02, IV: 248,00±5,76 (p=0,001) and Average number of fetuses tend to increased as well, group I : 8,5±0,05, II: 7,8±0,41, III: 9,5±1,05, IV: 9,6±0,52 (p=0,02). The conclusion of this research are supplementation of propolis extract in pregnant rats can reduce oxidative stress and improve pregnancy outcomes.
Therapeutic Challenges in Systemic Lupus Erythematosus Patient with Pregnancy, Osteoporosis, and Severe Thrombocytopenia: A Case Report and Review of Literature Yosefin Ratnaningtyas; Perdana Aditya Rahman
Jurnal Kedokteran Brawijaya Vol. 31 No. 3 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.03.6

Abstract

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease that requires long-term corticosteroid treatment that may lead to osteoporosis characterized by low bone mass and microarchitectural deterioration of the trabecular and cortical skeletal. This study presents a severe case of thrombocytopenia in a 25-year old woman with SLE and osteoporosis who underwent routine therapy and was pregnant for the first time. The complexity of pregnancy and autoimmune conditions create therapeutic challenges that need to be considered in SLE patients with pregnancy, osteoporosis, and severe thrombocytopenia.
Gender Differences in Denial-Acceptance Duration Based on Kübler-Ross Cycle After HIV Diagnosis Niniek Budiarti Burhan; Muhammad Reza Febriliant
Jurnal Kedokteran Brawijaya Vol. 31 No. 3 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.03.7

Abstract

Patients who have been diagnosed with HIV often suffer from sadness and grief that, in turn, affect the adherence to HIV treatment. This study aimed to examine gender differences in the denial-acceptance duration based on the Kübler-Ross cycle in patients after diagnosed with HIV. A cross-sectional survey was conducted on 63 adult HIV patients aged 19-60 years who received routine treatment at the HIV/VCT outpatient department of Saiful Anwar General Hospital Malang. Subjects were interviewed using the Acceptance of Disease and Impairments Questionnaire (ADIQ). Gender differences in denial-acceptance duration after diagnosed with HIV were analyzed using the unpaired T-test. Results were statistically significant if p value <0.05. The median duration of denial-acceptance in male subjects was 16 weeks with the shortest duration of 1 week and the longest duration of 144 weeks, while the median duration of female subjects was 12 weeks with the shortest duration of 1 week and the longest duration of 240 weeks. There are no gender differences in the denial-acceptance duration (p value = 0.629). In conclusion, there are no gender differences in denial-acceptance duration based on the Kübler-Ross cycle after diagnosed with HIV.
Intravesical Blood Clot Retention? How We Manage It, a Tertiary Hospital Preference Tetuka Bagus Laksita; Fikri Rizaldi
Jurnal Kedokteran Brawijaya Vol. 31 No. 3 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.03.8

Abstract

Intravesical blood clot retention is one of the Urological emergencies. Ongoing haematuria and blood clot formation in the bladder obstruct the urine outflow and lead to urinary retention, abdominal pain, anemia, urinary tract infection (UTI), and renal function deterioration. Most of the cases required cystoscopy blood clot evacuation and definitive surgery to stop the ongoing bleeding. This study aimed to discover the demography, characteristics, management, and complication of patients with intravesical blood clot retention in Dr. Soetomo General Acadenic Hospital, Surabaya from January 2017 until April 2020. This is an observational study, a retrospective-descriptive design. We conducted a review on the medical records of 97 patients, 76 males and 21 females with an average age of 54.9 years old. Of all patients initially treated conservatively using normal saline irrigation with a large three-way catheter (22-24 fr), four were successfully treated without surgery, and 89 patients underwent cystoscopy and definitive surgery. The mean operation time was 69,6 minutes, with an average blood clot volume of 167,7 ml (25-600 ml). Sources of bleeding were mostly originated from malignancy (58%), Benign Prostatic Hyperplasia (BPH) (10%), and hemorrhagic cystitis (7%).  The most common comorbidity found was hypertension (13) and chronic kidney disease (10). Based on our experience, managing intravesical blood clot retention with cystoscopy continued with definitive surgery in a one-step procedure is a good approach. Urological malignancy is the most frequent abnormality that causes intravesical blood clot retention.
Risk Factors of Urethro-cutaneous Fistula Development in Hypospadias Surgery Wien Permana; Tarmono Tarmono; Johan Renaldo
Jurnal Kedokteran Brawijaya Vol. 31 No. 3 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.03.9

Abstract

Urethrocutaneous fistula development is the most common complication found hypospadias surgery. Several factors associated with the incidence of fistulas are the age at the time the surgery. The type of hypospadias, the degree of chordae, the operative technique applied and catheter type. This study aimed to determine the risk factors associated with the urethro-cutaneous fistula development in hypospadias surgery. The results showed that from 310 hypospadias patients undergoing urethroplasty, urethra cutaneous fistula development occurred among 105 patients (30.6%) with a mean age of surgery 10.89+6.27 years. Hypospadias type has a significant difference with the incidence of urethro-cutaneous fistula development (p = 0.027). Age (p = 0.615), degree of chordae (P=0.805), operative technique (P=0.901) and catheter type (P=691) do not have a significant impact to urethro-cutaneous fistula development. It can be concluded that operative urethroplasty has a risk of urethra-cutaneous fistula that associated with hypospadias type.
Case Report: Multisystem Langerhans Cell Histiocytosis (LCH) and Myelodysplastic Syndrome (MDS) in a 13-Month-Old Female Dian Sukma Hanggara; Desyi Desyi
Jurnal Kedokteran Brawijaya Vol. 31 No. 3 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.03.10

Abstract

Langerhans Cell Histiocytosis or LCH and Myelodysplastic syndrome or MDS in children are rare diseases. It is estimated to be 1 to 4 cases per 1 million population and less than 5% of hematologic cases. MDS in LCH can occur due to genetic predisposition, impaired cytokine production, or secondary to chemotherapy.  The article reported a patient case of a 13-month-old female who came to hospital with paleness since two weeks before admission. The patient also experienced skin redness, abdominal distention, and weight loss. From the physical examination, anemia, maculopapular rash, and hepatosplenomegaly were obtained. From the laboratory test, anemia of hypochromic anisopoikilocytosis, monocytosis, thrombocytopenia, and hypoalbuminemia were obtained. On examination of bone marrow aspiration, MDS with Refractory Cytopenia of Childhood type or RCC was obtained. Positive results confirmed the diagnosis of Langerhans Cell Histiocytosis on CD68 and S100 in histopathological examinations.
Optimation of Combination of N-Hexane Solution and Ethyle Acetate on Secondary Metabolite Compounds Profile of Streptomyces hygroscopicus Dio Giovanni Ariel; Sri Winarsih; Fitria Febriliani Putri; Nabila Erina Erwan; Ajeng Maharani Putri; Alfian Wika Cahyono; Kana Mardhiyyah; Loeki Enggar Fitri; Rivo Yudhinata Brian Nugraha
Jurnal Kedokteran Brawijaya Vol. 31 No. 3 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.03.11

Abstract

Streptomyces hygroscopicus (S.hygroscopicus) is a Gram-positive soil bacterium that can produce secondary metabolites from fermentation that have a therapeutic effect. The fermented S. hygrocospicus metabolites that are still in the form of crude extracts are difficult to develop as drug preparations because the active compounds are not yet known, so it will be challenging to determine the dosage of drugs that have a therapeutic effect. Therefore, it is necessary to carry out exploratory research to narrow down the secondary metabolite profile from the fermentation of S. hygroscopicus, using extraction and fractionation methods, which are then identified by Thin-Layer Chromatography (TLC) using a combination of solvents. This study used the extraction method with a separating funnel. The fractionation was carried out using the BUCHI (Sepacore®) Flash Chromatography and Reveleris® PREP Purification System column chromatography gradually using ethyl acetate and n-hexana.  47 and 60 of the fractionation results were taken as samples, that further were profiled using TLC and given the appearance of 10% KOH stains and p-Anisaldehyde - sulfuric acid, so that various classes of compounds with different Rf values were obtained, namely Monoterpenes, Triterpenes, Steroids, Saponins, Coumarin, Scopoletin, and Alkaloids.
Anal Extrusion of Ventriculoperitoneal Shunt: A Case Report and Review of Literature Farhad Bal'afif; Donny Wisnu Wardhana; Tommy Alfandy Nazwar; Novia Ayuning Nastiti
Jurnal Kedokteran Brawijaya Vol. 31 No. 4 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.04.13

Abstract

Ventriculoperitoneal (VP) Shunt is a commonly performed surgical procedure and offers a good result in the treatment of hydrocephalus. In general, 25% of the complication rate of this surgical procedure is abdominal complications. Anal extrusion of a peritoneal catheter is a rare complication ranging from 0.1 to 0.7% of all shunt surgeries. This study presents a rare case of anal extrusion of ventriculoperitoneal shunt in a 1-year-old female child who was asymptomatic. The physical examination revealed swelling and redness along the shunt tract on the retro auricular region, soft abdomen, and no catheter was observed in the anal. This study found several contributing factors affecting the complications in the anal extrusion of a peritoneal catheter, that are thin bowel wall in children and sharp tip and stiff end of VP shunt. The shunt should be disconnected from the abdominal wall, and the lower end should be removed through the rectum by colonoscopy or sigmoidoscopy/proctoscopy or by applying gentle traction on the protruding tube. This study concludes that due to potentially life-threatening consequences and case rarity, thorough anamnesis, physical examination, and objective investigation are needed to determine the appropriate management for anal extrusion of ventriculoperitoneal shunt. 

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