KARAKTERISTIK IBU HAMIL DENGAN BAYI BBLR DI RSUD DR. SOETOMO SURABAYA TAHUN 2012

Bayi Berat Lahir Rendah (BBLR) masih merupakan masalah global di bidang kesehatan khususnya di Indonesia, BBLR merupakan salah satu faktor utama penyebab kematian bayi dan anak di dunia [1]. Angka kejadian BBLR di dunia dirincikan sebanyak 15,5% dari 132 juta persalinan pertahun di dunia dan paling banyak terjadi di negara berkembang [2]. BBLR termasuk faktor utama dalam peningkatan mortalitas, morbiditas, dan disabilitas neonatus, bayi, dan anak serta memberikan dampak jangka panjang terhadap kehidupannya di masa depan. Karena Faktor Ibu merupakan faktor determinan utama dari BBLR, maka penelitian ini hanya difokuskan pada faktor ibu, antara lain usia ibu saat hamil, jumlah kehamilan, dan usia kehamilan . Tujuan umum dari penelitian ini adalah untuk mengetahui karakteristik ibu hamil dengan bayi BBLR. Penelitian ini menggunakan data rekam medis pasien anak dan ibu yang masuk rumah sakit pada tahun 2012 Instalasi Rawat Inap Departemen Obstetrik dan Ginekologi RSUD Dr. Soetomo Surabaya. Metode sampling yang digunakan adalah total sampling dan didapatkan 90 sampel yang memenuhi kriteria inklusi. Data yang didapat dianalisis dengan metode statistik deskriptif. Hasil dari penelitian ini adalah 71% ibu dengan bayi BBLR melahirkan di usia 20-35 tahun, 8% oleh ibu berusia lebih dari 35 tahun, dan sisanya oleh ibu berusia kurang dari 20 tahun. 44.5% kejadian BBLR merupakan primigravida, dan semakin banyak jumlah kehamilannya semakin rendah presentase kejadian BBLR. 80% kejadian BBLR terjadi pada usia kehamilan preterm, sedangkan 20% terjadi pada usia kehamilan aterm. Kesimpulan dari penelitian ini adalah sebagian besar ibu hamil yang melahirkan bayi BBLR berusia 20-35 tahun. Sebagian besar ibu hamil yang melahirkan bayi BBLR merupakan primigravida. Sebagian besar ibu hamil yang melahirkan bayi BBLR dengan usia kehamilan preterm

Cardioprotective properties of glucagon-like peptide-1 receptor agonists in type 2 diabetes mellitus patients:A systematic review

Background and aims: Cardiovascular disease is one of the main contributors for the mortality in type 2 diabetes mellitus (T2DM) patients. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) had shown cardiovascular benefits which may be advantageous to reduce mortality in T2DM patients. This systematic review focused on analyzing the effects of GLP-1 RAs on cardiovascular outcomes. Methods: We conducted an extensive search through JSTOR, PubMed, Scopus, EBSCohost, and CENTRAL. All related studies assessing the use of GLP-1 RAs in T2DM patients from inception up to October 2020 were screened. Any cardioprotective properties as the outcomes were obtained. Results: A total of six studies (4 randomized, 2 observational) with a total of 182.205 patients were included in this review. The GLP-1 RAs used were either liraglutide or exenatide in combination with antihypertensive or antilipidemic drugs. All studies showed that GLP-1 RA significantly caused weight loss and improved cardiac functional capacity by increasing left ventricular ejection fraction and reducing end-systolic and end-diastolic left ventricle volume. GLP-1 RA also improved myocardial blood flow without affecting myocardial glucose uptake. However, GLP-1 RA failed to show its effect in reducing blood pressure and improving lipid profiles. Conclusions: Despite the limited number of studies, consistent data showed that GLP-1 RA has several cardioprotective properties. (C) 2021 Diabetes India. Published by Elsevier Ltd. All rights reserved

Inherited thrombophilia transpires with severe coronary arterial thrombosis in wide range of age backgrounds:A report of 3 cases

Introduction and importance: Protein C and S deficiency are some of the coagulation cascade disorders which may also contributes not only to venous thromboembolism (VTE), but also rarely to arterial thrombosis. Here we present a report of 3 severe coronary artery disease (CAD) cases ranging from very young to elderly patients with concomitant inherited thrombophilia. Case presentation: The first case was a chronic coronary syndrome from a very young male patient with history of VTE without any other risk factor of CAD. The second case was about premature CAD with triple chronic total occlusion (RCA, LCX, LAD) in patient under 45 years old, with single risk factor. The third case was about accelerated atherosclerosis progression from previously non significant stenosis in RCA into total occlusion in RCA and inferior STEMI in old patient on supposely adequate double anti platelet agent. Clinical discussion: All patients had protein C and/or S deficiency and first degree family history of VTE, therefore inherited thrombophilia was diagnosed. We gave them oral anticoagulant in addition to their standard treatment for secondary prevention with good outcome and without further adverse event. Conclusion: It is important to raise awareness to perform screening inherited thrombophilia as an important risk factor for CAD in special subgroup such as young age patient with rapid course progression and family history of VTE. The use of oral anticoagulants as either prophylactic or therapeutic purpose in patients with inherited thrombophilia are safe and effective. However, further research is still needed

Hyperbaric Oxygen Therapy Effect on Androgen Receptor and Superoxide Dismutase in Insulin-Resistant Polycystic Ovary Syndrome

It has been found that insulin resistance (IR) affects majority of the women with polycystic ovarian syndrome (PCOS) regardless its correlation with obesity. Hyperinsulinemia leads to hyperandrogenemia state, showed by an over-expression in androgen receptor (AR). It has also been discovered that oxidative stress level is significantly increased in patients with PCOS, showed by an increase in superoxide dismutase (SOD) serum level. Hyperbaric oxygen therapy (HBOT) is proved to be able to reduce IR and oxidative stress level in other cases. This study aims to evaluate the effect of HBOT on AR expression and SOD serum level in insulin-resistant PCOS rat model. This study was an experimental study with randomized posttest only control group design. Twenty female Rattus norvegicus strain Wistar as insulin-resistant PCOS rat model was used in this study, randomly divided into control group and treatment group. HBOT was given at 2.4 ATA pressure with 100% oxygen. AR expression was measured semi-quantitatively with Immunoreactive Score (IRS), while SOD serum level was measured with ELISA method. Mean IRS score between control group and treatment group were significantly different (1.64 ± 1.38 vs 0.8 ± 0.6, p = 0.025). Mean SOD serum level between control group and treatment group was significantly different (0.13 ± 0.03ng/ml vs 0.2 ± 0.06ng/ml, p = 0.011). HBOT could reduce the AR expression and increase the SOD serum level in insulin-resistant PCOS rat model. HBOT therapy could be taken into consideration for treating insulin-resistant PCOS patients

Recurrent Partial Hydatidiform Mole:A Case Report of Seven Consecutive Molar Pregnancies

Hydatidiform mole (HM) is an aberrant pregnancy characterized by atypical trophoblastic hyperplasia, hydropic chorionic villi, and deprived fetal development. There are two types of HM, ie, complete (CHM) and partial (PHM). Both CHM and PHM can recur; however, the recurrence of PHM is very scarce compared to CHM. In this report, we present a case of a 33-year-old woman with recurrent PHM for 7 times without any normal pregnancy in-between. PHM was determined by histology examination. The patient underwent suction curettage and was followed up with serial β-hCG levels. Recurrent PHM, although rare, is associated with an increased incidence of malignancy. A series of clinical and β-hCG evaluation should be warranted because of the possibility of gestational trophoblastic neoplasia development.</p

Recurrent Partial Hydatidiform Mole:A Case Report of Seven Consecutive Molar Pregnancies

Hydatidiform mole (HM) is an aberrant pregnancy characterized by atypical trophoblastic hyperplasia, hydropic chorionic villi, and deprived fetal development. There are two types of HM, ie, complete (CHM) and partial (PHM). Both CHM and PHM can recur; however, the recurrence of PHM is very scarce compared to CHM. In this report, we present a case of a 33-year-old woman with recurrent PHM for 7 times without any normal pregnancy in-between. PHM was determined by histology examination. The patient underwent suction curettage and was followed up with serial β-hCG levels. Recurrent PHM, although rare, is associated with an increased incidence of malignancy. A series of clinical and β-hCG evaluation should be warranted because of the possibility of gestational trophoblastic neoplasia development.</p

Recurrent Partial Hydatidiform Mole:A Case Report of Seven Consecutive Molar Pregnancies

Hydatidiform mole (HM) is an aberrant pregnancy characterized by atypical trophoblastic hyperplasia, hydropic chorionic villi, and deprived fetal development. There are two types of HM, ie, complete (CHM) and partial (PHM). Both CHM and PHM can recur; however, the recurrence of PHM is very scarce compared to CHM. In this report, we present a case of a 33-year-old woman with recurrent PHM for 7 times without any normal pregnancy in-between. PHM was determined by histology examination. The patient underwent suction curettage and was followed up with serial β-hCG levels. Recurrent PHM, although rare, is associated with an increased incidence of malignancy. A series of clinical and β-hCG evaluation should be warranted because of the possibility of gestational trophoblastic neoplasia development.</p

Association between arteriovenous access flow and ventricular function:A cross-sectional study

Background: Permanent hemodialysis access comes with a myriad of problems on top of the well-known benefits; flow disturbances, risk of infection and revision being among them. All of these could eventually lead to impaired cardiac function. Even so, the relationship between impaired cardiac function due to arteriovenous access in patients undergoing hemodialysis has not been clearly described. This study aimed to analyze the relationship of flow in an artificial arteriovenous access with left and right ventricular function in patients with chronic kidney disease (CKD) undergoing hemodialysis at a referral hospital in Indonesia.Material and methods: This was a cross sectional study with consecutive sampling technique. Samples were patients with CKD undergoing hemodialysis at Dr. Soetomo General Hospital from December 2021to January 2022. A total of 47 patients who met the inclusion criteria underwent Doppler ultrasound to assess arteriovenous access flow and transthoracic echocardiography to assess left and right ventricle function.Results: From 47 patients, 26 (55.3%) had high arteriovenous access flow. The clinical characteristics of the patients between the high and low arteriovenous access flow groups were not significantly different. We found that the value of left ventricular ejection fraction in the non-high-flow access group was significantly higher than the high-flow access group (p < 0.05). Other than that, the median right ventricle fractional area changes in the non-high-flow access group was also higher than the high-flow access group (p < 0.05).Conclusion: Arteriovenous access flow as measured by Doppler ultrasonography has a significant relationship with impaired left and right ventricular functions based on systolic function parameters from echocardiography

To reperfuse or not to reperfuse: a case report of Wellens’ syndrome with suspected COVID-19 infection

Background Wellens’ syndrome is known to be associated with left anterior descending artery occlusion that could lead to an extensive anterior wall myocardial infarction. Thus, emergency cardiac catheterization is needed. However, during coronavirus disease 2019 (COVID-19) pandemic, it is recommended for hemodynamically stable acute coronary syndrome patients with COVID-19 infection to be treated conservatively in an isolated hospital ward. Case presentation We report an 85-year-old patient with chief complaints of typical, squeezing chest pain in the past 4 h. The patient had a high fever, dyspnea, sore throat, and fatigue for 3 days. He had previously come into contact with COVID-19 positive relatives. The patient was hemodynamically stable and pulmonary auscultation revealed coarse rales in the entire lung. Electrocardiography (ECG) evaluation during the pain episode showed non-specific ST-T changes in lead V2-V5. After sublingual nitrate was administered, ECG evaluation during the pain-free period revealed a biphasic T wave inversion in lead V2 and V3. Laboratory workup showed elevated cardiac marker and leucopenia with neutrophilia and lymphopenia. Rapid immunochromatographic test and initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) evaluation from nasopharyngeal swab showed negative results. However, radiographic evaluations suggest the diagnosis of COVID-19 infection. While waiting for the second RT-PCR evaluation, the patient was diagnosed with Wellens’ syndrome with suspected COVID-19 infection. The patient was treated conservatively according to national guidelines and scheduled for elective cardiac catheterization. On the third day, the patient felt better and insisted on being discharged home. Ten days after discharged, the patient died of myocardial infarction. Conclusion Emergency cardiac catheterization should be done for patient with Wellens’ syndrome, regardless of the COVID-19 infection status