Rehabilitasi medik pada sindroma dekondisi pasca COVID-19 derajat berat

ABSTRACT Introduction: COVID-19 is characterized by complaints of fever, cough, weakness, respiratory and gastrointestinal disorders. The existence of treatment in the isolation room accompanied by prolonged bed rest will cause the patient to experience deconditioning syndrome. Case Report: A man, 58 years old, post severe COVID-19 patients with shortness of breath, ineffective cough and feeling weak in all four extremities due to prolonged bed rest (denconditioning syndrome). Deconditioning is defined as a reduction in anatomical and physiological function caused by disease, age, or physical inactivity.The patient was given active gradual mobilization, range of movement exercise, endurance, strengthening, balance and coordination exercise. Patient was also given breathing exercise, chest physical therapy and effective cough. Seven days after rehabilitation, patient could regulate his breathing pattern and ambulate independently. Patient was discharged and continue self training at home. Conclusion: Breathing exercise, chest physical therapy, aerobic exercise, muscle strengthening exercises in all four extremities, coordination, balance exercises and gradual mobilization training are very important in the recovery of  post severe COVID-19 patient. Key Words: breathing exercise, COVID-19, deconditioning syndrome, mobilizationABSTRAK Pendahuluan: COVID-19 ditandai dengan adanya keluhan demam, batuk, lemas, gangguan saluran napas dan saluran cerna. Perawatan pada ruang isolasi disertai dengan tirah baring lama akan membuat pasien mengalami sindroma dekondisi. Laporan Kasus: Pasien laki-laki, 58 tahun pasca COVID-19 derajat berat dengan keluhan sesak bila beraktivitas, mudah lelah, batuk tidak efektif, lemas pada keempat ekstremitas akibat tirah baring lama (sindrom dekondisi). Dekondisi diartikan sebagai berkurangnya fungsi anatomis dan fisiologis yang disebabkan oleh penyakit, usia, atau inaktivitas fisik. Pasien mendapatkan program latihan peningkatan lingkup gerak sendi, ketahanan aerobik, penguatan otot, keseimbangan dan koordinasi serta latihan mobilisasi bertahap. Pasien juga mendapatkan latihan pernapasan, terapi fisik dada dan latihan batuk efektif. Tujuh hari pasca rehabilitasi, Pasien telah dapat mengatur pola napas dan melakukan ambulasi mandiri. Pasien diperbolehkan pulang untuk melanjutkan terapi latihan mandiri di rumah. Simpulan:  Latihan pernapasan, terapi fisik dada, latihan aerobik, latihan penguatan otot pada keempat ekstremitas, latihan koordinasi dan keseimbangan serta latihan mobilisasi aktif secara bertahap sangat penting pada pemulihan pasien pasca COVID-19 derajat berat. Kata Kunci: COVID-19, latihan pernapasan, mobilisasi, sindroma dekondis

Leptospirosis and Pancreatitis Complication

Leptospirosis is a wide-spread zoonosis in the world, especially in the tropical countries. Ninety percent of cases are characterized by abrupt fever and have good prognosis, but in 10% of cases, exacerbation will occur and the mortality rate is about 10%. Leptospirosis may strike the entire organ, including gastrointestinal tract. Pancreatitis in leptospira is characterized by increased serum amylase levels, with mean values of five times normal. Early diagnosis and prompt treatment will engender good prognosis. Treatment of acute pancreatitis caused by leptospira is similar with other acute pancreatitis treatment caused by other agents. The pathophysiology of leptospira infection includes endotoxin, hemolysis and lipase

The Role of Lactate Clearance in Severe Septic Patients Survival

Introduction. Severe Sepsis is a major health problem that known to results high mortality rate, and still its incidents continue to rise. Lactate clearance represents kinetics alteration of anaerobic metabolism in severe septic patients that makes it to become a potential parameter to evaluate severity of one’s illness and intervention adequacy that received by the patient. However, the relationship between lactate clearance and occurrence of death in severe septic patients is still unknown. Methods. This is a prospective cohort study that conducted in Ciptomangunkusumo Hospital, from March to May 2011. Patients were categorized into high lactate clearance group if there were differences in lactate levels ≥ 10% in which occurred within the first 6 hours of the treatment, and contrary were categorized into low lactate clearance group. Occurrences of death were observed within the first 10 days. Afterward, the data were analyzed by means of survival analysis, Kapplan Meier curve were made, survival rate and median survival rate were determined, statistical test were calculated using log-rank test, and hazard ratios were calculated using Cox regression model test. Analysis of Confounder Variable was also performed using multivariate Cox regression test. Results. The survival rate for high and low lactate clearance group were 60.0% vs. 26.7%, respectively (p=0,004). In low lactate clearance group the median survival was 3 days, while the mortality rate did not reach 50% in high lactate clearance group. The first Interquartile for these two groups was 1 day and 4 days, respectively. The hazard ratio that obtained from the analysis was 2.87 (95% CI, 1.41 - 5.83). On multivariate analysis the presence of septic shock, SOFA score, the use of vasopresor/inotropic, blood transfusion, fluid resuscitation didn’t change the hazard ratio value more than 10%. For that reason, these parameters were not considered as confounder. Conclusions. Patients with high lactate clearance have a better survival rate compared to patients with low lactate clearance, and its relationship is not influenced by confounder

Secondary pneumonia in tetanus patients: a review of six selectedcases (Case Report)

<p>Tetanus, an infection by<em> C.tetani</em> continues to be a major health problem in the developing world. The course of the disease is typically prolonged, requiring weeks to months of supportive management to resolve. Several studies have been conducted to determine which factor/s really influenced the outcome of tetanus. Factors such as severity of spasms, age, sedation and tachycardia were found to significantly influence mortality. Patients now surviving the initial acute phase of their illness, but new problems have emerged autonomic dysfunction and hospital acquired pneumonia (often with multiresistant organisms) are now the commonest causes of death. This serial cases report presents six selected cases of tetanus, three patients acquired secondary pneumonia during treatment, among the three, two patients are elderly age 70 and 72 years old. Both of the presented patients died during treatment in the hospital. <em><strong>(Med J Indones 2005; 14: 117-21)</strong></em></p><p><strong>Keywords :</strong> <em>tetanus, pneumonia complication</em></p

The correlation between total lymphocyte count and the number of candida colony from the oral cavity in HIV/AIDS patients

HIV infection causes qualitative and quantitative reduction of the T helper (Th) subset of T lymphocytes, facilitating opportunistic infection. One of the common opportunistic infections among HIV/AIDS patients is Candida infection in the oropharynx and esophagus. Detection of increased Candida colonialization is not always easy, CD4 count is a parameter that could be used as reference. The fact is there’s only few laboratory can provide CD4 count. This study is a cross-sectional correlative study to determine the relation between total lymphocyte count as a much more applicable laboratory parameter and the intensity of Candida colonization in the oropharyngeal cavity of patients with HIV infection/AIDS. It was performed in the outpatient ward and inpatient ward of Dr. Cipto Mangunkusumo Hospital, from August 2004 to January 2005. The selected study subjects underwent interview, physical examination and had their blood samples and gargle samples taken. 60 study subjects were recruited, consisting of 52 males (86.7%) and 8 females (13.3%). The mean total lymphocyte count was 1194.53 cells/μL. Oropharyngeal candidiasis was found in 44 subjects (73.3%). There is a trend of higher Candida colonies number with lower total lymphocyte count despite no significant correlation between total lymphocyte count and the number of Candida colonies in the oral cavity of patients with HIV infection/AIDS. There is significant different between total lymphocyte count in positive and negative Candida colonies. (Med J Indones 2005; 14: 147-51) Keywords: Total lymphocyte count, oral candidiasis, candida colony, AID

Assessment of clinical and laboratory parameters that reflect inflammatory response and organ function in sepsis

Sepsis is a spectrum of clinical conditions caused by the host immune response to infection or other inflammatory stimuli characterized by systemic inflammation. Clinical response to sepsis could be varies according to compensate or decompensate state, inflammatory process and host condition. Aims of this study is to assess the role of some parameters (clinical and biochemical, hematology, arterial blood gas analysis and coagulation) in supporting the diagnosis of sepsis. A cross-sectional study was performed in the Internal Medicine Inpatient Unit of Dr. Cipto Mangunkusumo National General Hospital, Jakarta, from February to July 2002. Forty-two patients who fulfilled the criteria of sepsis, severe sepsis, and septic shock were enrolled in this study. Clinical details and blood specimens for hematological, biochemical, arterial blood gas analysis and coagulation were collected. There were 42 subjects who participated in the study, aged from 19 to 78 years old. Eleven subjects fulfilled the criteria for early sepsis, 20 severe sepsis and 11 septic shock. Clinical examination showed that the Glasgow coma scale (GCS) was significantly reduced in severe sepsis and septic shock. Heart rate, respiration rate and body temperature were increased in all groups. Hemoglobin levels mostly below 10 g/dl and hematocrite levels below 30 %. The leucocyte counts were increased in more than 80%, mostly above 15.000/mm3. The platelet count were low (below 50.000/mm3) especially in septic shock.  The serum creatinine were significantly increased (>2 mg/dl) in severe sepsis and septic shock. Albumin was decreased,  lactate dehydrogenase/LDH and procalcitonin  were increased. The arterial blood gas analysis showed that: pH and HCO3 were decreased especially in  septic shock; the PO2 was lower in severe sepsis and septic shock; and PCO2 was below 32 mmHg in all groups. Coagulation examinations showed that fibrinogen was significantly decreased in septic shock; PT and APTT were prolong in severe sepsis and septic shock more than 18.8 and  48 seconds respectively. The d-dimer was also increased mostly in all groups. In conclusions that clinical examinations include level of consciousness, heart rate, mean arterial pressure, temperature and respiration rate and additional laboratory examinations include hamatological, biochemical, blood gas analysis and coagulation  examinations can be used as parameters in diagnosis of sepsis. Some parameters include level of consciousness (Glasgow coma scale), serum creatinine, hemoglobin, platelet count and fibrinogen can differ sepsis according to severity. (Med J Indones 2005; 14: 26-32) Keywords: Clinical response, SIRS, sepsi

Faktor-Faktor yang Mempengaruhi keberhasilan Terapi Antibiotik Empirik pada Pasien Sepsis Berat dan Syok Sepsis di Bangsal Rawat Inap Penyakit Dalam Rumah Sakit Cipto Mangunkusumo

Pendahuluan. Salah satu faktor utama yang berperan pada keberhasilan terapi pada pasien sepsis berat dan syok sepsis adalah penggunaan antibiotika empirik yang adekuat. Penelitian ini ditujukan untuk mengetahui faktor utama apa yang paling berpengaruh terhadap keberhasilan pengobatan antibiotika empirik pada pasien sepsis berat dan syok sepsis. Metode. Studi kohort retrospektif dengan subyek dari data rekam medik (RM) pasien yang telah di rawat inap di ruang ICU dan perawatan Penyakit dalam RSCM Jakarta antara bulan Januari 2011 - Juni 2012. Kriteria inklusi adalah semua data RM pasien dewasa dengan sepsis, sepsis berat dan syok sepsis yang di rawat di ruang rawat inap penyakit dalam/HCU/ICU RSCM. Kriteria eksklusi adalah data tidak lengkap dan SOFA skor >14. Analisis multivariat dilakukan untuk menilai kuat hubungan relative risk (RR) di antara masing-masing variabel determinan yang memiliki kemaknaan statistik sebagai prediktor kesesuaian dosis, jenis, kombinasi dan waktu pemberian antibiotika empirik terhadap akhir perawatan sepsis berat dan syok sepsis dengan ROC (receiver operator curve) dan nilai AUC (area under curve) serta mencari faktor yang paling berperan dari variabel determinan tersebut. Hasil. Waktu pemberian antibiotika empirik lebih dari 6 jam, pemberian jenis antibiotika empirik yang tidak sesuai berdasarkan sumber infeksi, pemberian dosis antibiotika empirik yang tidak sesuai, pemberian antibiotika empirik tunggal, jumlah disfungsi organ yang lebih dari 3 berdasarkan skor SOFA berpengaruh terhadap meningkatnya angka kematian pada pasien sepsis berat dan syok sepsis. Dari faktor tersebut di atas yang paling berpengaruh terhadap meningkatnya angka kematian adalah waktu pemberian antibiotika lebih dari 6 jam, dosis antibiotika yang tidak sesuai, penggunaan antibiotika empirik tunggal dan skor SOFA yang lebih dari 8. Simpulan. Hal yang paling berpengaruh terhadap meningkatnya angka kematian adalah waktu pemberian antibiotika lebih dari 6 jam, dosis antibiotika yang tidak sesuai, penggunaan antibiotika empirik tunggal dan skor SOFA yang lebih dari 8

Disseminated tuberculosis diagnosed first as leptospirosis in immunocompetent patient

Disseminated tuberculosis, mostly seen in immunocompromised patient, can affect several organs. The diagnosis can be difficult due to various clinical manifestations. A case of disseminated tuberculosis of lung and liver that develops acutely is rare especially in immunocompetent patient. Here, we present a 42 year old immunocompetent woman with lung and hepatic tuberculosis which was confirmed by characteristics histopathological findings of the liver biopsy