Vol 10 No 1 (2023)

 EDITORIAL

Sub-spesialis Konsultan Pulmonologi dan Medik Kritis

Seorang Konsultan Pulmonologj dan Medik Kritis (KPMK) merupakan seorang yang telah menjadi spesialis penyakit dalam dan melajutkan pendidikan subspesialis/konsultan di bidang pulmonologi. Seorang KPMK adalah anggota Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia (PAPDI) dan juga anggota komunitas seminat Perhimpunan Respirologi Indonesia (PERPARI). Subspesialis ini memiliki kompetensi yang lebih dalam dan dapat menangani kasus-kasus yang lebih kompleks atau yang membutuhkan tindakan di bidang Respirologi dan Penyakit Kritis. Adapun kompetensi SpPD-KMPK yaitu respirologi, intervensi pulmonologi, ventilasi mekanik (di HCU/ICU), dan juga penyakit kritis. Sekitar tahun 1952, ilmu penyakit kritis/medik kritis baru dikembangkan sebagai suatu ilmu tersendiri.

 

Vol 10 No 1 (2023)

 Dampak Keterlambatan Pengembalian Rekam Medis Pasien Rawat Inap Terhadap Pelaporan RS Dan Pengajuan Klaim BPJS Kesehatan Di RSU Ganesha Kabupaten Gianyar

I Gusti Ayu Dina Lasmi Putri1, Bambang Hadi Kartiko, 2, Dylla Hanggaeni Dyah Puspaningrum 3

Program Studi Perekam dan Informasi Kesehatan, Universitas Dhyana Pura1,2,3

ABSTRACT

 In accordance with the standard operating procedures set by the Ganesha General Hospital, the late return of inpatient medical records is defined as the return of medical records from the inpatient room to the medical record unit beyond the time limit of 3 x 24 hours from the time of collection. The aim of this research is to determine the impact of late returns on home reporting of pain and claims from the Social Security Administration (BPJS).The research is based on a descriptive qualitative analysis of 224 overdue medical records and a sample of 10 officers at the Medical Record Installation. returned in July-December 2022. The results of the analysis showed that data from July 2022 through December 2022 showed that out of 510 inpatient medical records, 138 (27%) had medical records. returned not timely before the 25th of the current month, and there are 86 (17%) medical records that were returned not on time after the 25th of the current month. The impact of the late return of inpatient medical records is the delay in reporting RL 4a and RL.5.3 to the Department of Central Health, the increased workload of reporting officers, and the decreased ability of hospital management to make informed decisions. Aside from that, it has an effect on the time it takes for BPJS insurance documents to be sent in with claims, on the time it takes to give health services to patients, especially for repeat visits, on the amount of work that medical record keepers have to do, and on the amount of money that hospitals make. Based on the results of the study, it can be concluded that: late reports on hospital activities (RL 4a and RL.5.3) to the Department of Central Health; the increased workload of reporting officers and medical record officers; and delays in providing BPJS insurance documents have had an impact on hospital income.

Keywords: Impact of late return of Medical Records, Hospital Reporting RL4a and RL.5.3, BPJS Claims

 

 

Vol 10 No 1 (2023)

Acute Digitalis Toxicity presenting as Bradycardia in patient with Atrial Fibrillation with Heart Failure         

 RaymondPranata1,Emir Yonas2, Veresa Chintya3

1General Practitioner, Tabanan General Hospital, Tabanan, Bali, Indonesia 2Faculty of Medicine, YARSI University, Jakarta, DKI Jakarta, Indonesia 3General Practitioner, Sanjiwani General Hospital, Gianyar, Bali, Indonesia

ABSTRACT

 

INTRODUCTION: Digitalis is used for atrial fibrillation to reduce the ventricular rate and has narrow therapeuticwindow. Mortality associated with unrecognized digitalis intoxication is high and often unacknowledged.

CASE ILLUSTRATION:A86 years old male presented with fatigue since 1 day before admission. PMH of AF, HHD, CHF and CKD.PE: BP 90/60, HR: 48 bpm, RR: 20x/minute. ECG: AF SVR 40-50x/minute ‘reverse tick sign’ ST depression, LAD. Lab: Hyperkalemia andeGFR 22.92 mL/min. Previous echocardiography: Grade III diastolic dysfunction + LVH. IV hydration was given using normal saline 200 mL initially, insulin and glucose were administered to reduce potassium level.

DISCUSSION:Digitalis cause an increase in vagal activity and prolong conduction in the AV node, excessive effect in this patient cause reduced ventricular rate. ST-segment depression resembling a ‘reverse tick’ signified digitalis effect not necessarily toxicity. Digitalis toxicity can emerge even when the serum digitalis concentration is within the therapeutic range.The narrow therapeutic index of and pharmacokinetic changes associated with aging increases the risk of toxicity. The elimination of digitalis is mainly by renal clearance and is prolonged inCKD. This patient was an elderly and has eGFR of 22.92 mL/min, hence in high risk of digoxin toxicity.Ideally, digitalis Fab fragments is indicated for a K + level greater than 5 mmol/L. CONCLUSION:Atrial fibrillation is the most common sustained arrhythmia and digoxin is widely used as rate control especially in those with heart failure.Digitalistoxicity is important to recognize and receive prompt treatment should toxicity arises.

Keywords:digitalis, digoxin, toxicity, atrial fibrillation

 

 

Vol 10 No 1 (2023)

A Case of Spontaneous Hemorrhagic Transformation in a patient with Cardioembolic Stroke due to Atrial Fibrillation

Raymond Pranata1, Veresa Chintya2, Emir Yonas3

1General Practitioner, Tabanan General Hospital, Tabanan, Bali, Indonesia 2General Practitioner, Sanjiwani General Hospital, Gianyar, Bali, Indonesia 3Faculty of Medicine, YARSI University, Jakarta, Indonesia

ABSTRACT

INTRODUCTION: Hemorrhagic transformation (HT) refers to aspectrum of ischemia-related brain hemorrhage and is associated with increased morbidity and mortality of acute ischemic stroke.

CASE ILLUSTRATION: An 83 years old female presented with loss of consciousness 30 minutes before admission. Her past medcal history of congestive heart failure, hypertension, atrial fibrillation (AF), and stroke. Physical examination showed GCS 7 andBP 190/100 mmHg. Electrocardiography showed Atrial Fibrillation NormoVentricular Response and Left Ventricular Hypertrophy. Laboratory examination showed thrombocytopenia, hypokalemia,and INR of 1,8. National Institutes of Health Stroke ScaleScore: 16CHA₂ DS₂ -VASc: 7, HAS-BLED: 4.Thorax Xray revealed cardiomegaly and Thorax CT Scan depicted characteristic of hemorrhagic transformation of an ischemic infarct. The patient was treated with hemorrhagic stroke protocol and mannitol.

DISCUSSION: Atrial fibrillation is associated with greater volumes of more severe baseline hypoperfusion, leading to higher infarct growth, more frequent severe HT and worse stroke outcomes. This patient has massive infarction andAFwhich were independent predictors of HT risk. In patients with AF probability of bleeding was about 95% if the volume of infarction edema >10 cm3.Hemorrhagic transformations may occur in patients with acute ischemic stroke who received thrombolytic, however, it may also occur spontaneously in 12.3 % of patients with ischemic stroke. Warfarin has been associated with increased HT riskirrespective of INR and aPTT values. Hemorrhage risk stratification score might be used to predict HT in acute ischemic stroke.Anticoagulant may be reinitiated after 4-8 weeks. Long-term anticoagulation with NOAC (similar efficacy with lower bleeding risk compared to VKA) or Left atrial appendage occlusion.

CONCLUSION: One-third of ischemic stroke patient may experience hemorrhagic transformation.Physician must strike a balance between stroke recurrence and HT.

Keywords:Atrial Fibrillation, Stroke, Anticoagulant

 

 

Vol 10 No 1 (2023)

Difficulty in Controlling Malignant Pleural Effusion

Ignatius B Prasetya1, Eric D Tenda2
1Department of Internal Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
2Division of Respirology and Critical Care, Department of Internal Medicine, Universitas Indonesia, Cipto
Mangunkusumo Hospital, Jakarta, Indonesia

ABSTRACT

Malignant pleural effusion is the second leading cause of exudative pleural effusions, usually recurrent and represents advanced malignant disease. Treatment options were restricted to symptomatic purpose in order to increase functional capacity and quality of life. In this case, a 35-years old woman with history of breast cancer was admitted with worsening dyspnea since 4 months prior. The patient was told that there was fluid in her left lung. She underwent thoracocentesis twice, pleuroscopy and pleurodesis with little success. The treatment option switches to placement of pleural catheter to control the effusion. This option, however, may leave the patient and caregivers with routine task of aspiration of the fluid and with greater risk of infection.
Key words: Malignant pleural effusion

Vol 10 No 1 (2023)

The Role of Chronic Inflammation in the Development of Depression in COPD Patients

Vania Tryanni 1 , Hamzah Shatri1,3, Dika Sinulingga1, Vinandia Irvianita1, Edward Faisal1, Rudi Putranto1, Gurmeet Singh2, Ceva W. Pitoyo2
1 Psychosomatic and Palliative Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
2 Respirology and Critical Care Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
3 Clinical Epidemiology in Department of Internal Medicine, Faculty of Medicine Universitas Indonesia- Cipto Mangunkusumo Hospital, Jakarta, Indonesia

ABSTRACT

COPD is one of the most prevalent disease and the prevalence is still increasing. Depression is one of the most prevalent comorbid found in COPD and associated with increase mortality and reduced quality of life. The linked between booth of them can’t be fully elucidated. One of the theories is chronic inflammation. Increase inflammatory state is associated development of depression to some pathway, and there is direct link between serotonin-inflammation. COPD is a well-known inflammatory state with same increasing inflammatory state. There are also similar characteristics between depression with inflammatory stated and depression in COPD such as atypical symptom and resistance to therapy. Studies also proved that there were increase in cytokine especially IL-6 , IL-2 and IFN gamma in COPD -Depression.
Keyword: COPD, Depression, Chronic Inflammation

Vol 10 No 1 (2023)

GAMBARAN EFEK SAMPING PANDUAN STANDAR JANGKA PENDEK DAN PANJANG PADA TUBERKULOSIS RESISTEN OBAT
Annisa Nurfaujiah1, Ferdy Ferdian2, Basti Andriyoko3
1Program Studi Pendidikan Dokter, Fakultas Kedokteran, Universitas Padjadjaran
2Divisi Respirologi, Departemen Penyakit Dalam, Rumah Sakit Umum Hasan sadikin, Fakultas Kedokteran Universitas Padjadjaran, Bandung.
3Departemen Patologi Klinik, Rumah Sakit Umum Hasan sadikin, Fakultas Kedokteran Universitas Padjadjaran, Bandung

ABSTRACT

Drug resistant TB treatment requires more drugs, longer duration and more side effects. In 2020 WHO introduced an all-oral combination with a higher success rate but with additional side effect challenges. It is a descriptive observational study with a cross-sectional study design. The data used are medical records of patients aged over 18 years who have been declared complete treatment of TB-RO in January 2020 – June 2022 with an oral regimen of short-term and long-term treatment. Abnormal data results at the initial examination before starting treatment and incomplete or missing medical record data were not included in the study. The number of samples is determined by the total sampling method. The result from 69 patients who received short-term treatment combinations, nausea was the most common side effect (76.19%), followed by hyperuricemia (69.8%), vomit (55.56%), and QTc interval prolongation (44.44%). Out of 16 patients who received a combination of long-term treatment, the highest incidence was nausea (75%), arthralgia (62.5%) rash, itching, and headache (56.25%).The incidence of gastrointestinal disturbances, QTc prolongation, skin discoloration, hyperuricemia, hepatotoxicity, chest pain and tightness, and psychiatric disorders was higher in the short-term group. Meanwhile in the long-term regimen, tachycardia, itching and rash, arthralgia, visual and hearing impairment, neurological disorders, and neuropathy. Peripheral anemia and anemia were more common.
Keywords: Side Effects; Drug Resistant Tuberculosis; STR; LTR

Vol 10 No 1 (2023)

TRAKEOSTOMI DILATASIONAL PERKUTAN PADA PASIEN PERAWATAN INTENSIF
Harris Soetanto, Gurmeet Singh
Internal Medicine Department, Universitas Indonesia, Faculty of Medicine. Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Vol 10 No 1 (2023)

PROGNOSTIC NUTRITIONAL INDEX (PNI) AS A PROGNOSTIC FACTOR IN STAGE IV LUNG ADENOCARCINOMA
Subroto 1, Eko Budiono 2, Sumardi 2
1Resident of Internal Medicine, Department of Internal Medicine Faculty of Medicine Public Health and Nursing Gadjah Mada University/Dr. Sardjito Hospital Yogyakarta
2Division of Pulmonology, Department of Internal Medicine Faculty of Medicine Public Health and Nursing Gadjah Mada University/Dr .Sardjito Hospital Yogyakarta

 

Vol 10 No 1 (2023)

STUDI KUALITATIF RISIKO KESELAMATAN DAN KESEHATAN KERJA DENGAN METODE JOB SAFETY ANALYSIS PADA TENAGA PERAWAT

Sarah Linda Ginting1, Egi Dahan1, Andi Alim1, Asriani Minarti S2
1Fakultas Kesehatan Masyarakat, Universitas Pejuang Republik Indonesia
2Program Megister Kesehatan Masyarakat, Universitas Muslim Indonesia

ABSTRACT
Occupational safety and health in hospitals as health services is an important thing to consider. Nurses as one of the medical personnel in the hospital have risks and hazards that are quite vulnerable in every process of their work. Data from the PPI (Infection Prevention and Control) committee at DR Tadjuddin Chalid Makassar Hospital found 16 cases of needle stick accidents in the last 5 years. The purpose of this study was to determine the level of occupational safety and health risks that can occur in nurses in the emergency room unit of DR Tadjuddin Chalid Makassar Hospital. The research design used is qualitative with the approach method, namely risk management AS/NZS 4360: 2004 with the instruments of interview guidelines, observation, camera for documentation and JSA (Job Safety Analysis) to identify the risks and hazards of nurses’ work. Risk assessment using the semi-quantitative method of W. T. Fine from AS/NZS 4360:2004. The results of this study indicate that the highest risk in the emergency room with a value of 300 (Priority 1) is at the stage of anamnase and TTV (vital signs) of patients there is a risk of droplet contact hazards infected with infectious diseases of patients and in the installation of infusions there is a risk of needle stick hazards. The conclusion from the research results obtained is that technical improvements are needed, it is hoped that better supervision is expected in the implementation of SOPs for nursing actions and the active role of K3RS in identifying more stages of nurses’ work in the hospital.
Keywords: OHS, Nurses, JSA (Job Safety Analysis), AS/NZS 4360:2004

Vol 10 No 1 (2023)

Pneumonectomy in Congenital Lobar Emphysema: A Case Report

Susan Hendriarini Mety, I Putu Kokohana Arisutawan, Muhammad Aris Furqon

Staff of Cardiothoracic and Vascular Surgery Department, Persahabatan Hospital, Jakarta, Indonesia

Abstract

Background: Congenital lobar emphysema is a rare congenital disease which caused by anomaly on bronchial cartilage development. Usually, it is limited to a single lobe. It could be treated conservatively or surgically depend on the clinical condition. In this case report we would like to discuss the management strategy for congenital lobar emphysema that affected the whole lung in 17 days old baby.

Case presentation: The patient was admitted to NICU due to respiratory distress. The patient had a difficulty to wean from ventilator. Radiologic examination revealed the whole left hemithorax is filled by multiple bullae which push mediastinal organ contralaterally. Intraoperatively, we found the whole left lung is emphysematous and there is PDA which is not detected preoperatively. Surgeon decided to do pneumonectomy and PDA ligation. After operation, patient recovered on NICU slowly and discharged from hospital 34 days post operation.

Discussion : our case of congenital lobar emphysema which affect one side of lung is a rare case. Our decision to do pneumonectomy was challenging post operatively.

Conclusion: Multidisciplinary team should be involved in treatment of congenital lobar emphysema. Team should be prepared for prolonged intensive care if decision to do lung resection is chosen.

Keywords: Congenital lobar emphysema, pneumonectomy, neonates