KEPUTUSAN DEKAN FAKULTAS KEDOKTERAN NOMOR 160/UN3.1.1/HK.04/2020 TENTANG PENYANGGAH UJIAN DOKTOR TERBUKA PROGRAM DOKTOR PROGRAM STUD! ILMU KEDOKTERAN FAKULTAS KEDOKTERAN ATAS NAMA ANNA SURGEAN VETERINI, dr., Sp.An.KIC

Menetapkan Penyanggah Ujian Doktor Terbuka Program Doktor Program Studi Ilmu Kedokteran Fakultas Kedokteran atas nama Anna Surgean Veterini, dr.,Sp.An.KIC yang dilaksanakan pada tanggal, 12 Mei 202

THE INFLUENCE OF SEAMLESS AND COMPLETENESS DISCHARGE SUMMARY FILLING TO SUITABILITY OF SEVERITY LEVEL IN TERTIARY REFERRAL HOSPITAL.

Background: The implementation of the national health insurance program to fulfill the payment system related to a claim needs the documentation of services in the discharge summary. The discharge summary’s content becomes the basis for determining the code of disease especially the suitability between diagnoses and examination to determine the severity level of disease. Objective: To determine the influence of the seamless and completeness of discharge summary filling to the suitability of severity levels in tertiary referral hospitals. Method: Using a retrospective design analytic study with cross sectional method. The data was collected from observation completeness filling and seamless of information in inpatient’s discharge summary in October to December 2018. 99 samples were taken by random sampling system. Results: The results of the study showed that the seamless between diagnosis and supporting medical examinations was 75.78%, the completeness of discharge summary filling was 80.3%, and the non-conformity of severity level was 9.1%. The results of the statistical significance test showed that the congeniality between the diagnoses and the supporting medical examination (p=0.00) and the completeness of discharge summaries (p=0.00) had an influence on the suitability of severity levels. Conclusion: The seamless and the completeness of discharge summary filling is one of the factor that can influence the suitability of severity level. The completeness of discharge summary filling and intervention coding influences the amount of insurance expense and the severity level. A tertiary referral hospital is aimed for the patient’s condition categorized in advanced severity level. Therefore, completing the discharge summary is needed and should comply with the clinical pathway

Correlation Between Mutant p53 Protein Expression and Histopathological Grading in Astrocytoma Patients

Mutation of p53 gene plays an important role in astrocytoma carcinogenesis. The mutation process results in p53 mutant which fails to stop the tumor's cellular proliferation or apoptotic process resulting new cells with persistent genetic mutation. p53 mutant expression detected by imunnohistochemistry staining shows the biological behavior of tumor cell. Some authors found that p53 protein expression relates to histopathological grading which affects the prognosis. However, some studies showed different results. These findings invite debatable subject around p53 mutant and histophatological grading. The objective of this study was to prove the correlation between p53 mutant protein expression with histophatologic grading in astrocytoma patients. This was an analytic cross-sectional study using imunohistochemical staining for p53 mutant expression, conducted from January to August 2005. Data were analyzed to find the relation between WHO histopathological grading, age, and sex, and p53 protein expression. The confidence interval was a = .05. The results found that 33 astrocytoma patients were operated, with age range from 4 to 62 years old, averagely 30.91 years old. Most patients aged between 31-40 years old., predominantly male (male: female = 60.6% : 39.4%). Histopathological diagnosis mostly was diffuse astrocytoma (WHO grade II) found in 48.5% cases,pilocytic astrocytoma (WHO grade III) 30.3%, and Globlastoma multiforme 6.1%. Mild expression of p53 was found in WHO grade I. Mild expression of p53 increased to 14 (42.4%) in WHO grade II and 2 patients had severe degree. Percentage of patients of WHO grade III showed severe grade of expression increasing to 6 patients (18.2%). In WHO grade IV group, there was 1 patient (3.0%) with severe expression and 1 patient with very severe expression. Statistical analysis using Spearman correlation test showed that there was a correlation between p53 mutant expression with increasing histopathological grading of astrocytoma, p=.001 (p<.0001) with correlation coefficient 0.736. In conclusion, there is positive correlation between p53 mutant protein expression and histopathological grading (p<.0001; correlation coefficient 0.736), as well as age (p<0.05; correlation coefficient 0.434

Kernohan’s notch syndrome in acute subdural hematoma: significance of coronal views of computed tomography scan imaging for emergent preoperative diagnosis

Kernohan’s notch has been well studied clinically and pathologically, although radiographic investigation has been rare. Here, we reported a case in which computed tomography scan imaging performed as an important tool for emergent preoperative diagnosis related to unusual neurological deficits appearance (Kernohan's notch syndrome) and evaluation of the treatment outcomes. Acute spontaneus subdural hematoma may rarely cause Kernohan Notch syndrome. The investigation of cerebral peduncles via emergent preoperative head computed tomography scan is useful and could provide an important contribution in preoperative diagnosis related to unusual neurological deficits appearance (Kernohan’s notch syndrome) and evaluation of the treatment and outcome in such cases

Risk of meningioma associated with exposure of hormonal contraception. A case control study

Objective: To identify the effect of hormonal contraceptive exposure to the occurrence of meningioma. Materials and Methods: This study, conducted in 2016, was a case-control study by collecting a group of cases comprising all patients diagnosed histopathologically with meningioma in 2012-2013 and treated in dr. Soetomo Hospital, Surabaya, Indonesia. Medical record data were analyzed and compared to control group of patients diagnosed with non-meningioma who underwent contrast head ct scan and direct interviews. We obtained 101 cases and 101 controls. Data were analyzed using univariate logistic regression test. Results: Based on the history of hormonal contraceptive use, patients who had history of hormonal contraceptive use had 12.31 times higher risk (p=0.000). In this study, those who had contraceptive injections for one month and used contraceptive pills had a meningioma risk lower than those who used injectables 3 months. Patients who used hormonal contraception more than 10 years had an increased risk for meningioma as much as 18.216 times (p=0.000). Histopathologically, we found a non-significant association between history of hormonal contraceptive use and the distribution of histopathology, but based on descriptive data showed it was found that the most histopatological meningioma was of the transitional type in cases group. Conclusion: There is a significant association between hormonal contraceptive use, the type of injectable hormonal contraception for 3 months, the duration of hormonal contraceptive use >10 years, and no significant association between meningioma grade and the history of hormonal contraception exposure

Psychiatric Assistance at Cataract Juvenile

Background: Psychiatric assistance is required in the integrated handling of physical health disorders in the field of other disciplines known as CLP. A collaborative approach to the field of psychiatry with other scientific disciplines in accordance with WHO health criteria that includes physical and mental health for improving health and quality of life. Case presentation: A boy, 8 years, was consulted from the Ophthalmology Department with Right eye cataract juvenile, and left eye ptisis bulbi to give pre-operative psychological assistance for eye assessment and diagnostics. Patient also complained the blurred vision since last year and cannot see anything since 10 months ago. The current condition represents the patient cannot speak, often screams, likes to injure his head and scratch his face. Patients treated in the pediatric’s ward with global developmental delay. Patients were also consulted to the child psychiatry section with childhood autism, audiology, nutrition and metabolic diseases of children, pediatric neurology, and finally collaboration with the Surabaya City Health Office for a follow-up management plan. Conclusions: Child psychiatrist as a liaison, interacting with multidisciplinary medical or rehabilitation teams, families, schools, community and local city government are beneficial in the management of child disorders and improving family wellbeing

Diffusion Weighted Imaging (DWI) Classification and Apparent Diffusion Coefficient (ADC) Value Tendency Based on Cerebral Glioma Grading in Patients at Dr. Soetomo General Academic Hospital in 2016-2020

Highlight: • Many studies conclude that the prognosis of gliomas can be determined using the DWI sequence and ADC value on MRI • The correlation between DWI and ADC values with glioma grading is related to tumor cellularity, nuclear-cytoplasmic ratio, and extracellular space, which affect the movement of water molecules.   ABSTRACT Introduction: Glioma grading is crucial to know its prognosis. Magnetic resonance imaging (MRI) is used as a preoperative examination that contains diffusion-weighted imaging (DWI) sequences confirmed by an apparent diffusion coefficient (ADC) value that helps assess tissue based on water diffusion. Objective: To prove the relationship between DWI and ADC values with cerebral glioma grading in patients at Dr. Soetomo General Academic Hospital in 2016—2020. Methods: This retrospective study collected medical records and MRI files in DICOM (Digital Imaging and Communications in Medicine) format. Gender, age, tumor histopathology, and glioma grading were collected. DWI and ADC values were obtained using the RadiAnt DICOM Viewer application. The data were analyzed using descriptive and analytical statistics. The chi-square test was used to analyze the relationship of DWI with glioma grading, and the spearman rank test was used to analyze the relationship of ADC value with glioma grading. Results: The majority of 35 patients were male (54.3%), aged 31–40 years old (22.9%), and the most common histopathology was glioblastoma (37.1%), WHO grade IV. On DWI, most low-grade glioma (LGG) patients showed unrestricted diffusion, and most high-grade glioma (HGG) patients showed restricted diffusion. The ADC value of HGG was lower than the ADC value of LGG. Statistical tests showed a relationship between DWI and glioma grading (p<0.05) and a relationship between the ADC value and glioma grading (p<0.05). Conclusion: There was a relationship between DWI and ADC with glioma grading in Dr. Soetomo General Academic Hospital patients for the period 2016—202

Brain Death: Diagnosis and Clinical Application

Brain death has a story of nearly one full century. In most cases brain death occurs as a sequelae toincreased intracranial pressure. Nearly every neurosurgeon has experienced it. In addition, neurologist,emergency care physicians and intensivists may also experienced brain death state. However it is unlikelythat all clinicians will encounter this condition. The fact is that there are a large number of medicalprofessional lacking on criteria of drain death. A particular aim of this article is to give every neurosurgeonand intensivist sufficient theoretical knowledge to feel confident in diagnosing brain death

Clinical Outcome of Patients with Diffuse Axonal Injury Receiving Adrenocorticotropin Analogue at Dr. Soetomo Hospital

Brain traumatic injury (BTI) is one of the causes of death and disability worldwide that affects people regardless of sex, age, income and social status, race, or nationality. In patients with brain traumatic injury, one of the problems that occurs is Diffuse Axonal Injury (DAI) that can produce a direct clinical effect, leading to coma and death. Adrenocorticotropin analogues (ACTH) is one of neuroprotective therapy in brain injury. The aim of this study was to analyze the effect of ACTH analogue on the clinical output (Glasgow Outcome Score/GOS and Bartle Index) in patients with DAI at hospital discharge, 3 months and 6 months post-treatment. This study revealed that ACTH analogue administration resulted in higher GOS and Barthel Index scores than that in control. Further study will required with other variables, such as cognitive and motor examination, and some biomarkers can also be examined serially. Brain traumatic injury (BTI) is one of the causes of death and disability worldwide that affects people regardless of sex, age, income and social status, race, or nationality. In patients with brain traumatic injury, one of the problems that occurs is Diffuse Axonal Injury (DAI) that can produce a direct clinical effect, leading to coma and death. Adrenocorticotropin analogues (ACTH) is one of neuroprotective therapy in brain injury. The aim of this study was to analyze the effect of ACTH analogue on the clinical output (Glasgow Outcome Score/GOS and Bartle Index) in patients with DAI at hospital discharge, 3 months and 6 months post-treatment. This study revealed that ACTH analogue administration resulted in higher GOS and Barthel Index scores than that in control. Further study will required with other variables, such as cognitive and motor examination, and some biomarkers can also be examined serially

Patient's Life Ability With Malignant Astrocytoma Grade IV

Grade IV astrocytoma is a primary brain tumor with a high mortality rate. The survival time for astrocytoma grade IV is about 6-12 months. Conventional therapies that exist to date in the form of surgery, radiation and chemotherapy. The main problem with malignant astrocytoma is that tumor cells grow infiltratively into the surrounding brain tissue and are always recurrent despite conventional therapy. This condition results from a complex gliomagenesis process involving the role of neural cancer stem cells (NCSC). The lack of an efficient immune response and the micro-invasive nature of malignant astrocytoma cells has been explained by many immune surveillance mechanisms in brain malignancies. The survival ability of these tumors results in a complex interaction between the tumor and the body's immune system. The aim of this study was to evaluate the survival time of malignant astrocytoma grade IV  patients treated with surgery, radiotherapy with or without chemotherapy. A retrospective study of the survival time of patients with malignant astrocytoma grade IV treated by us during the period 2005 - 2015 was 12 patients. All patients postoperative craniotomy resection of tumors undergoing radiation with 42 Gay. Among these 6 patients received chemotherapy as well. Sexually male proportion more than female with ratio 1.6 : 1. Most were over 50 years old (83%), 2 patients under the age of 50 years. Four patients (33%) survived for one year, survived for two years found 5 patients (41%), survived more than 3 years 3 patients (25%) and none survived more than 5 years .. This syudy suggests that chemotherapy have no effect on the survival time of the patient