PERBANDINGAN PEMBERIAN HEPARIN INTRAVENA DAN SUBKUTAN TERHADAP KADAR PPT DAN PTTK PADA PENCEGAHAN DEEP VEIN THROMBOSIS

Background: Thrombosis in the United States is the leading cause of death. About 2 million people die every year either because of an artery or vein thrombosis. In Indonesia, the incidence of diseases caused by thrombosis, such as stroke and heart attack, have the highest mortality rate. Morbidity of this disease is also quite high, one of them is Deep Vein Thrombosis (DVT) which can be a complicated to pulmonary embolism. Prophylaxis for DVT is relatively easy, by using the anticoagulant heparin. However, control of the dose of heparin must also be considered because it can cause bleeding if the dose is too high. One way to monitor the heparin was to assess the Plasma Prothrombin Time (PPT) and Partial Thromboplastin Time with Kaolin (PTTK). Objectives: To determine the effect of intravenous and subcutaneous heparin distribution on the value of PPT and PTTK towards DVT prevention. Methods: This design was observational - analytic with a cross sectional design by collecting data from the medical records in dr. Kariadi central hospital Semarang. 20 patients who has fulfill the inclusion and exclusion criteria, which the data taken was PPT and PTTK levels among ICU / HCU patients who has given the anticoagulant heparin in intravenously or subcutaneously. Data described in the table and performed by chi-square, Wilcoxon and Mann-whitney tests with SPSS for Windows 17.0. Results: There is no significant difference (p = 0.386) between the value of the PPT before and after distribution of intravenous heparin (15.580 4.405seconds vs 14,210 3,627 seconds). While, the distribution of subcutaneous heparin found no significant difference (p = 0.553) in the PPT between before and after distribution of heparin (14.680 2.907 seconds vs. 13.690 2.978 seconds). And there were no significant differences (p = 0.646) between the PTTK before and after intravenous heparin (43.490 40.803 seconds vs. 41.480 30.030 seconds). While the value of PTTK to the subcutaneous heparin given between before and after administration of heparin (31.110 11.157 seconds vs. 43.040 20.008 seconds) found no significant difference (p = 0.203) After the difference in PPT values between intravenous and subcutaneous administration of heparin, found no significant difference (p = 0.832). And the difference on the PTTK between intravenous and subcutaneous administration of heparin found no significant difference (p = 0.597) Conclusion: There was no significant difference in the value of PPT and PTTK between the distribution of intravenous and subcutaneous heparin in the prevention of deep vein thrombosis. Key words: DVT, PPT, PTTK, anticoagulant heparin

Cushing’s Syndrome: A Large Adenoma of Adrenal Gland

A 20-year old  man was admitted for evaluation of Cushing’s syndrome. He presented with a history of headache, fatique, mood disorder, hypertension (Blood Pressure 170/120 mmHg), moon face, buffalo hump, striae rubrae.  Cortisol serum laboratory increased  33.53 µgr/dl (Normal range: 3.09 – 16.6µgr/dl). Abdominal CT Scan showed a right adrenal mass diameter 10.53 x 6.83 cm, with calcified and necrotized area.Levels of ACTH < 5 pg/ml (Normal range : 6 – 50 pg/ml), absence hypothalamus pituitary defect in brain MRI angiography lead the primary site on adrenal.Patient was given ketoconazole 600 mg daily to treat hypercortisolemia. The patient underwent laparoscopic right adrenalectomy. Preparation of hydrocortisone 100 mg during anesthesia-surgery to prevent occurrence of adrenal crisis.Patient position was LLD, 11mm trocar port with 0, 30 degree optic, 2 port 5mm was used for working element. Harmonic ultrasoundshear was used for dissection, hemoLock clip to control vascular. Right subcostal incision make to remove adrenal gland. EBL 1000 cc, close monitoring in ICU ward.Hydrocortison was continued 5 days after surgery. Ventilatory support removed in 2 day after surgery. On the fifth day condition stable without signs of adrenal crisis, and the patient sent to elective ward. The pathology report revealed a cushing adenoma of adrenal gland.On the fifth day after surgical intervention,  postoperative cortisol levels at 12 µgr/dl. On seventh day, surgical wound healing was well with minimum dose NSAID orally. Striae thining, ginecomastia, buffalo neck, moon face was reduced.The patient was regularly followed up at Endocrine division, Department of Internal medicine. Moon face have been eliminated, no striae and  good mood condition. Blood pressure was 130/ 70 mmHg (without antihypertensive drugs) and cortisol serum was 4.52 µgr/dL and independent from steroid medication.Multidisciplinary approach including endocrine treatment, prevention adrenal crisis and laparoscopic adrenalectomy procedure have good result for Cushing’s syndrome due to adenoma of adrenal gland

PERBANDINGAN PEMBERIAN HEPARIN SUBKUTAN DAN INTRAVENA TERHADAP KADAR D-DIMER PADA PENCEGAHAN DEEP VEIN THROMBOSIS

Background: Deep vein thrombosis ( DVT ) is a condition in which thrombus formed in a deep vein especially in the lower limbs and inguinal. One way to find out thrombosis in the blood vessels circulation is by d-dimer levels examination. Giving anticoagulants such as heparin either intravenously or subcutaneously can prevent thrombus formation. Aim: This study aimed to compare subcutaneous and intravenous heparin against d-dimer levels in the prevention of deep vein thrombosis. Methods: An observational study with cross-sectional approach. Data were derived from secondary data with total sample of 20 patients which divided into two groups. Group 1 was an ICU patient who given intravenous heparin and Group 2 given subcutaneous heparin. D-dimer levels were recorded before and after getting treatment. Statistical test using paired t-test, Wilcoxon, and Mann Whitney (with degrees of significance <0,05). Results: In this study, a decrease in the d-dimer levels of intravenous group 207.60748.544 μg/L (no significant difference, p=0,403) while in subcutaneous group amounted to 337.701445.950 μg/L (no significant difference, p=0,514). The comparative difference test result obtained both groups did not differ significantly (p=0,909). Conclusions: There is no significant difference between administering subcutaneous and intravenous heparin against d-dimer levels in the prevention of deep vein thrombosis. Key words: Intravenous heparin, subcutaneous heparin, deep vein thrombosis, d-dimer level

PERBANDINGAN PEMBERIAN HEPARIN SUBKUTAN DAN INTRAVENA TERHADAP KADAR FIBRINOGEN PADA PENCEGAHAN DEEP VEIN THROMBOSIS

Latar belakang penelitian: Deep vein thrombosis (DVT) adalah suatu kondisi dimana trombus terbentuk pada vena dalam, terutama di tungkai bawah dan inguinal. Bekuan darah dapat menghambat darah dari tungkai bawah ke jantung. DVT merupakan penyakit yang sering terjadi dan dapat berakibat fatal serta kematian jika tidak didiagnosa dan diobati secara efektif. Pemberian antikoagulan seperti heparin baik secara intravena maupun subkutan dapat membantu mencegah terjadinya thrombus. Kadar fibrinogen berbanding lurus dengan risiko terjadinya thrombus. Tujuan: Untuk mengetahui perbedaan pengaruh heparin intravena dan subkutan sebagai profilaksis DVT terhadap kadar fibrinogen pasien di ICU. Metode: Penelitian ini merupakan penelitian observasional dengan pendekatan cross-sectional. Data diambil dari data sekunder dengan jumlah sampel 20 yang dibagi kedalam dua kelompok. Kelompok 1 adalah data pasien ICU yang diberikan heparin intravena dan kelompok 2 diberikan heparin subkutan. Kadar fibrinogen dicatat sebelum dan sesudah pemberian satu hari heparin, kemudian dibandingkan perbedaannya. Hasil : Ada perbedaan yang tidak signifikan (p=0,226) antara kadar fibrinogen sebelum dan sesudah pemberian heparin intravena (388,56209,31 mg/dl vs 468,93178,38 mg/dl). Pada pemberian subkutan didapatkan kenaikan kadar fibrinogen yang signifikan (p=0,006) sebelum dan sesudah pemberian heparin (265,2790,67 mg/dl vs 453,93112,49 mg/dl). Setelah selisih pre-post kadar fibrinogen kedua kelompok dibandingkan (60,37228,85 mg/dl vs 188,66169,19 mg/dl), didapatkan hasil yang tidak signifikan (p=0,171). Kesimpulan: Tidak didapatkan perbedaan yang bermakna pada pemberian heparin intravena dan subkutan terhadap kadar fibrinogen sebagai profilaksis deep vein thrombosis di ICU. Kata kunci: heparin intravena, heparin subkutan, kadar fibrinogen, deep vein thrombosi

PENGARUH PEMBERIAN RINGER ASETAT MALAT DAN RINGER LAKTAT TERHADAP KADAR BASE EXCESS PASIEN OPERASI BEDAH SESAR DENGAN ANESTESI SPINAL

Latar Belakang Pemberian cairan ringer laktat sering dikaitkan dengan kejadian asidosis. Keadaan asidosis dapat menyebabkan vasodilatasi pembuluh darah yang akan memperburuk keadaan hipotensi. Kejadian asidosis dapat dicegah melalui pemberian cairan yang sesuai dengan konsentrasi plasma tubuh. Ringer asetat malat memiliki kandungan asetat dan malat untuk mencegah asidosis. Keadaan asam basa dapat dilihat melalui pemeriksaan sederhana BGA yang dapat dilihat dari kadar base excess. Tujuan Meneliti perbedaan perubahan kadar base excess antara preload 20cc/kgBB ringer laktat dengan preload 20cc/kgBB ringer asetat malat. Metode Penelitian ini menggunakan rancangan deskriptif analitik dengan metode belah lintang. Sampel diambil secara purposive sampling dan didapatkan data catatan medis 15 orang dengan ringer laktat sebagai cairan preload dan data catatan medis 15 orang dengan ringer asetat malat sebagai cairan preload dan menjalani operasi bedah sesar dengan anestesi spinal pada bulan September – Oktober 2013. Digunakan uji T - tidak berpasangan untuk analisis statistik. Hasil Perbedaan perubahan kadar base excess sebelum dan sesudah pemberian preload kelompok yang menggunakan ringer laktat 1,50 1,577. Perbedaan perubahan kadar base excess sebelum dan sesudah pemberian preload kelompok yang menggunakan ringer asetat malat 1,28 1,688 dengan nilai kemaknaan (p>0,05). Kesimpulan Perbedaan perubahan kadar base excess pada pemberian ringer laktat dan ringer asetat malat sebagai cairan preload tidak memiliki kemaknaan yang bermakna secara statistik. Kata kunci: base excess, ringer laktat, ringer asetat mala

Comorbid Factors Affecting the Outcome of Covid 19 in the Intensive Care Unit of Dr. Kariadi Hospital, Semarang

BACKGROUND : Sars-Cov2 has become a pandemic and caused health problems. Several factors that worsen the condition of Covid-19 include age, previous comorbid diseases, secondary infections, and increased inflammatory indicators. There are many studies on the factors that influence the outcome of Covid-19, but the results are inconsistent. Thus, specific research in certain areas is needed so that it can be used in local management. OBJECTIVE: This study aims to determine the factors that influence the outcome of Covid-19 in the intensive care unit of the Dr. Kariadi Hospital METHOD : This study analyzed covid 19 patients in the ICU of Dr Kariadi Hospital for the period March-September 2020 with a retrospective method and purposive sampling. The hypothesis test used is adjusted to the measurement scale of each variable. The initial analysis was univariate using chi-square, fisher, t-test, and mann-whitney. RESULT : From this study, it was found that the factors that influence the covid-19 outcome in a bivariate include a history of heart disease (p = 0.037), temperature (p = 0.012), respiratory rate (p = 0.030), oxygen saturation (p = 0.021), platelets ( p = 0.015), ureum (p = 0.034), PO2 (p = 0.002), oxygen fraction (FiO2) (p = 0.034), AaDO2 (p = 0.004), and PFR (p = 0.001). CONCLUSION : History of heart disease, temperature, respiratory rate, oxygen saturation, platelets, urea, PO2, required oxygen fraction (FiO2), AaDO2, and PFR were predictors of Covid-19 mortality which were both theoretically and statistically significant.,independent or simultaneousl

Cushing’s Syndrome: A Large Adenoma of Adrenal Gland

A 20-year old  man was admitted for evaluation of Cushing’s syndrome. He presented with a history of headache, fatique, mood disorder, hypertension (Blood Pressure 170/120 mmHg), moon face, buffalo hump, striae rubrae.  Cortisol serum laboratory increased  33.53 µgr/dl (Normal range: 3.09 – 16.6µgr/dl). Abdominal CT Scan showed a right adrenal mass diameter 10.53 x 6.83 cm, with calcified and necrotized area. Levels of ACTH < 5 pg/ml (Normal range : 6 – 50 pg/ml), absence hypothalamus pituitary defect in brain MRI angiography lead the primary site on adrenal. Patient was given ketoconazole 600 mg daily to treat hypercortisolemia. The patient underwent laparoscopic right adrenalectomy. Preparation of hydrocortisone 100 mg during anesthesia-surgery to prevent occurrence of adrenal crisis. Patient position was LLD, 11mm trocar port with 0, 30 degree optic, 2 port 5mm was used for working element. Harmonic ultrasoundshear was used for dissection, hemoLock clip to control vascular. Right subcostal incision make to remove adrenal gland. EBL 1000 cc, close monitoring in ICU ward. Hydrocortison was continued 5 days after surgery. Ventilatory support removed in 2 day after surgery. On the fifth day condition stable without signs of adrenal crisis, and the patient sent to elective ward. The pathology report revealed a cushing adenoma of adrenal gland. On the fifth day after surgical intervention,  postoperative cortisol levels at 12 µgr/dl. On seventh day, surgical wound healing was well with minimum dose NSAID orally. Striae thining, ginecomastia, buffalo neck, moon face was reduced. The patient was regularly followed up at Endocrine division, Department of Internal medicine. Moon face have been eliminated, no striae and  good mood condition. Blood pressure was 130/ 70 mmHg (without antihypertensive drugs) and cortisol serum was 4.52 µgr/dL and independent from steroid medication. Multidisciplinary approach including endocrine treatment, prevention adrenal crisis and laparoscopic adrenalectomy procedure have good result for Cushing’s syndrome due to adenoma of adrenal gland