Identifying the cause of intoxication case without a clear history using flowcharts

Background:Suspicion of intoxication and its causative agents are required in the clinical practice of intensive care units. Patients with loss of consciousness and no history of leading causation present obstacles in emergency room management. An understanding of toxidromes and epidemiological evidence can help clinicians. However, classic toxidromes are not always presented. Objectives:This case was presented to determine the flow of approaches to identify the cause of intoxication and to design early strategies for supportive care in intoxication case management.Case:A woman with loss of consciousness accompanied by seizures, deep and rapid breathing, and hypotension. Since the search for collateral information did not produce any meaningful findings, the toxin diagnosis was given based on vital signs, pupil size, and mental status. Methanol intoxication was suspected based on hypothermia, decreased consciousness, normal pupil size, and Kussmaul breathing. Forensic analysis showed her serum was positive for ethanol and methanol.Conclusion:When facing a case without the classic presentation of the toxidrome, the toxin diagnosis can be directed based on vital signs, pupil size, mental status, and muscle tone. Introduction to epidemiology is also important in tracking intoxication causation

Buku Ajar Trauma: Sebuah Pendekatan Untuk Memecahkan Kasus

Ilmu trauma harus dikuasai oleh mahasiswa kedokteran karena merekalah, saat telah menjadi dokter umum, yang akan menerima pasien trauma pertama kali. Penanganan awal kondisi kegawatannya berperan sangat penting untuk menurunkan morbiditas maupun mortalitas. Penanganan awal membutuhkan mata yang tajam dan pikiran yang awas untuk mengidentifikasi dan menganalisis kondisi yang mengancam nyawa. Buku ini menyajikan langkah-langkah di atas secara runut menggunakan pendekatan bagi mahasiswa kedokteran untuk memudahkan pemecahan masalah yang diawali dari presentasi awal pada sebuah kasus trauma

Three-Way Stopcock As Breathing Circuit In Anesthetic Procedures On Wistar Rats As Animal Models In Research

Introduction: General anesthesia in experimental animals is not limited in the field of anesthesia research. In Indonesia, ventilators and breathing circuit systems utilized in research involving anesthesia in rats are not widely available. The limitations in using ventilators and breathing circuit systems in research are one of the reasons why Indonesia is lacking complex and advanced animal experimental studies. Objective: This study aimed to examine a general anesthesia procedure for intubation in rats using tools and materials commonly discovered in clinical settings. Method: A search on the PubMed database using keywords consisting of animal study, rats, anesthesia, breathing circuit was performed. Review and Discussion: An endotracheal tube insertion procedure may utilize a Miller size 0 laryngoscope, while the endotracheal tube may use a 16 G intravenous cannula in which the needle is replaced by a small wire. The 3-way stopcock system may be considered as a replacement for the Mapleson E system for the breathing circuit system. The Fresh Gas Flow (FGF) source needs to be connected to the angled port, while the other two ports are connected to the reservoir and the intravenous cannula which would be delivered to the experimental animals. FGF three to five times as much as the minute ventilation may be used and the use of a reservoir capacity is similar to the tidal volume of spontaneous ventilation. Therefore, the oxygen flow rate is set to approximately 1-1.5 L per minute. A reservoir is not required for controlled ventilation. Conclusion: The use of a 3-way stopcock as a non-rebreathing circuit system is effective because it utilizes the similar principle as Mapleson E. The ability to use common tools and materials for general anesthesia procedures would significantly boost research of animal models in Indonesia to a further level

Scalp block for analgesia after craniotomy: A meta‑analysis

Background and Aims: A previous meta‑analysis reported that scalp block had limited benefits (low‑quality evidence) compared to no‑scalp block modalities for analgesia after craniotomy. However, it included studies using two different pain intensity measurement scales. Therefore, we performed another meta‑analysis using a single scale. Methods: We conducted the search for all randomised controlled trials evaluating the effect of scalp block on postcraniotomy pain compared to no‑scalp block in Cochrane Central Register of Controlled Trials and PubMed database. We assessed the quality of included studies employing GRADE approach. We performed random‑effects inverse‑variance weighted meta‑analysis of outcomes including pain intensity assessed by a 0‑‑10 visual analog scale and opioid consumption during the first 24 h postoperative period using RevMan 5.3. Results: A total of 10 studies (551 patients) were included. It revealed a statistically significant mean pain intensity reduction in scalp block group when compared to no‑scalp block at very early and early 24 h period (seven trials, very low‑quality evidence, mean difference (MD) = −1.37, 95% confidence interval (CI): −2.23 to ‑0.05, I2 = 70%; nine trials, very low‑quality evidence, MD = −1.16, 95% CI: −2.09 to −0.24, I2 = 57%, respectively). There was also reduction in the opioid requirements over the first 24 h postoperatively. Conclusion: Scalp block might be useful at <6 h postcraniotomy with very‑low quality evidence. Additionally, it had uncertain but moderate effect on reducing total 24 h opioid consumption. Therefore, more studies are needed to reach optimal information size

Optimised reversal without train‑of‑four monitoring versus reversal using quantitative train‑of‑four monitoring: An equivalence study

Background and Aims: Less residual paralysis in recovery room was demonstrated when train‑of‑four (TOF) monitoring was applied. The aim of this study was to know whether optimisation of neostigmine reversal without TOF monitoring was equivalent to reversal using TOF monitoring. Methods: Seventy two patients, aged 18–60 years, undergoing elective surgery under general anaesthesia (sevoflurane and rocuronium) with intubation were randomised into two interventions: an optimised neostigmine reversal strategy without TOF monitoring (group A, n = 36) and a neostigmine reversal strategy using quantitative TOF monitoring (group B, n = 36). Per‑protocol analysis was performed to compare incidence of residual paralysis in the recovery room between the two groups. Results: Six residual paralyses occurred in group A in the recovery room, whereas one case occurred in group B. The equivalence test showed that the 95% confidence interval of this study was outside the range of equivalence margin (15%). The absolute difference was 13.9%: standard error (SE) =0.068 (P = 0.107; 95% confidence interval (CI): 1%, 27.2%). No subjects had TOF ratio <0.70 in the recovery room. The TOF ratio in the recovery room did not differ between the two groups (mean difference: −2.58; P = 0.05; 95% CI: −5.20, 0.29). One respiratory adverse event occurred in this study. Conclusion: An optimised reversal strategy without TOF monitoring is not equivalent to a reversal strategy based on quantitative TOF monitoring. TOF monitoring should be used whenever applicable, although neostigmine is optimised

Blood Glucose Changes between Preoperative Administration of Sorbitol 25Gram / 500ml (Tutofusin®) and Lactated Ringer in Patient Undergoing Elective Surgery

Background: Perioperative blood glucose control affects intraoperative and postoperative morbidity and mortality. Stress response often associated with increase glucagon secretion and insulin resistance causing hyperglycemia. The combination of tissue injury, fasting, bleeding, anesthetic medications and low temperature lead to increased stress responses. Objective: This study aims to compare the changes in postoperative plasma blood glucose between preoperative administration of sorbitol 25 gram / 500 ml (Tutofusin®) and Lactated Ringer (LR) in elective surgery patient. Methods: A total of 66 patients were randomized to one of the following groups: S group received 500 ml intravenous fluid containing sorbitol 25 gram (Tutofusin 500cc); LR group received 500 ml of lactated ringer solution, both were given preoperatively while on fasting period. Blood glucose was measured preoperatively, before induction of anesthesia, and postoperative once the patient arrive at the recovery room. Results: There were no significant differences in the blood glucose values at preoperative and prior to induction of anesthesia. Postoperatively, sorbitol group had significance lower blood glucose level compared to LR group (P= 0.006). Furthermore, preoperative sorbitol administration decreased blood glucose level while LR administration post-operative increased blood glucose level (P= 0.024). Conclusion : Preoperative administration of Sorbitol 25 gram / 500 ml (Tutofusin®) did not increase postoperative plasma glucose level compared with Lactated-Ringer solution

The Comparison of Anxiety Disorder Among Ex-Female Sex Workers and Non-Female Sex Workers in The Ex-localization Area

Abstract—Indonesian localization of Female Sex Workers (FSW) was one of the largest in Southeast Asia, which has been taken by the government since 2014. The impact of mental health disorders has not yet been reported. This study aimed to compare the anxiety disorder among ex-FSW and non-FSW. This was a study to compare the prevalence of anxiety disorders among ex-FSW compared to non-FSW, located in ex-localization in Surabaya, Indonesia. Seventy-five participants met inclusion criteria and were gathered on December 10th, 2022 to complete Beck Anxiety Inventory (BAI) tests. The results showed that 16,67% of participants (n=12) were found with clinical anxiety scores. Among them, 41,67% ex-FSW (n=5) and 58,33% non-FSW (n=7). The prevalence of anxiety disorder, also the total BAI score, compared to the work history of FSWs and non-FSWs were found not associated (p>0.05). The anxiety disorder was found higher in the non-FSW group than ex-FSW group. But there was no difference found in the prevalence of anxiety and the BAI score between ex-FSW and non-FSW. Keywords: anxiety disorder, female sex workers, mental disorders Abstrak—Eks-lokalisasi Pekerja Seks Komersial (PSK) di Indonesia adalah salah satu yang terbesar di Asia Tenggara, yang ditutup pemerintah di tahun 2014. Dampaknya pada kesehatan mental belum pernah dilaporkan. Penelitian ini bertujuan untuk membandingkan gangguan cemas diantara mantan PSK dan non-PSK. Penelitian ini adalah studi untuk membandingkan prevalensi gangguan cemas diantara mantan PSK dan non-PSK sekitar eks-lokalisasi di Surabaya, Indonesia. Didapatkan 75 partisipan yang memenuhi kriteria inklusi, mereka dikumpulkan pada 10 Desember 2022 untuk mengisi tes Beck Anxiety Inventory (BAI). Hasil penelitian menunjukkan bahwa 16,67% partisipan (n=12) didapatkan hasil positif untuk skor kecemasan, di antaranya, 41,67% mantan PSK (n=5) dan 58,33% non-PSK (n=7). Prevalensi kecemasan serta total skor BAI tidak berhubungan dengan riwayat pekerjaan mantan PSK dan non-PSK. Gangguan kecemasan ditemukan lebih tinggi pada non-PSK dibandingkan mantan-PSK. Namun, tidak ditemukan perbedaan prevalensi kecemasan dan skor BAI diantara mantan PSK dan non-PSK. Kata kunci: gangguan cemas, gangguan mental, wanita pekerja seks komersia

The Association of Demographic Factors Among Ex-Female Sex Workers and Non-Female Sex Workers in Ex-Localization Area

Introductions: The localization of Female Sex Workers (FSW), one of the largest in Southeast Asia, has considerably reduced because of the government’s actions since 2014. Minimal research reported on the association factor among ex-FSW and non-FSW. Objectives: This study aimed to determine the association of demographic factors among ex-FSW and non-FSW in the ex-localization area. Methods: This was a cross-sectional study to identify the association of demographic factors among ex-FSW and non-FSW in the ex-localization area in Surabaya, Indonesia. Seventy-five participants met inclusion criteria and were gathered at predetermined locations on December 10th, 2022, to complete demographic data. Also, they had completed Beck Depression Inventory (BDI) tests for screening the clinical depression assessment. Data analysis was performed using the SPSS 24 software. Results: The study determined associated factors within the ex-FSW (p<0.05) in terms of marital status (0.03), history of psychiatric disorders (0.01), and history of smoking (0.02). The clinical depression assessment was higher in the ex-FSW group (22.5%) than in the non-FSW group (11.43%). Conclusions: Based on the work history of FSWs and non-FSWs, it had been found associated in terms of marital status, history of psychiatric disorders, and smoking history. Also, the Clinical Depression occurred more in the ex-FSW than the non-CSW group

The Comparison of Anxiety Disorder Among Ex - Female Sex Workers and Non - Female Sex Workers in The Ex - localization Area

Indonesian localization of Female Sex Workers (FSW) was one of the largest in Southeast Asia, which has been taken by the government since 2014. The impact of mental health disorders has not yet been reported. This study aimed to compare the anxiety disorder among ex-FSW and non-FSW. This was a study to compare the prevalence of anxiety disorders among ex-FSW compared to non-FSW, located in ex-localization in Surabaya, Indonesia. Seventy-five participants met inclusion criteria and were gathered on December 10th, 2022 to complete Beck Anxiety Inventory (BAI) tests. The results showed that 16,67% of participants (n=12) were found with clinical anxiety scores. Among them, 41,67% ex-FSW (n=5) and 58,33% non-FSW (n=7). The prevalence of anxiety disorder, also the total BAI score, compared to the work history of FSWs and non-FSWs were found not associated (p>0.05). The anxiety disorder was found higher in the non-FSW group than ex-FSW group. But there was no difference found in the prevalence of anxiety and the BAI score between ex-FSW and non-FSW

Modification on acute myocardial infarction model through left anterior descending coronary artery ligation: An experimental study on rats(Rattus norvegicus) using readily available materials

Background and Aim: Several difficulties are involved in creating models for myocardial infarction (MI) in animals, such as low survival rates after acute MI, complicated techniques in creating animal models, complexities in confirming acute MI incidence, and complex surgical tools needed in the process. This study aimed to develop an animal model for acute MI using Wistar rats utilizing simple instruments that are readily available in standard animal laboratories. Materials and Methods: We induced MI in 48 Wistar rats using the left anterior descending coronary artery ligation modification technique without tracheal incision and ventilator. This ligation technique was performed 1-2 mm distal to the left atrial appendage. MI occurrence was evaluated using heart enzyme parameters 24 h post-ligation and histological studies of the infarcted area 6 weeks after the ligation. Rats were divided into the coronary artery ligation group and sham group. Results: Of the 48 rats, 24 (50%) died within 24 h post-ligation, but no further deaths occurred in the next follow-up period of 6 weeks. The average infarct size in six rats within 24 h of ligation was 35%±5.7%. The serum glutamic oxaloacetic transaminase level of the group treated with coronary artery ligation was statistically significantly higher than that of the sham group (p=0.000). Conclusion: We developed an MI rat model with consistent infarction size, in which the long-term death of rats was not observed. Our ligation technique for an MI rat model can be a reference for experimental settings without ventilators for small animals