Karakteristik Pasien Anemia pada End Stage Renal Disease (ESRD) dengan Hemodialisis di Instalasi Hemodialisis RSUD Dr. Soetomo

Abstrak Latar belakang: Anemia merupakan salah satu komplikasi yang sering terjadi pada pasien dengan penyakit ginjal kronis dan sering mengakibatkan terjadinya penurunan kualitas hidup pasien, peningkatan morbiditas dan mortalitas pasien, serta meningkatkan laju progresivitas pada PGK. Pada pasien PGK stadium terminal, biasa disebut ESRD. Terapi pengganti ginjal untuk pasien ESRD salah satunya adalah hemodialisis. Tujuan: Untuk mendeskripsikan karakteristik pasien anemia pada ESRD dengan hemodialiasis di Instalasi Hemodialisis RSUD Soetomo Surabaya. Metode: Penelitian ini merupakan penelitian deskriptif observasional dengan metode cross sectional menggunakan data sekunder dari rekam medis pasien di Instalasi Hemodialisis RSUD Dr. Soetomo Surabaya. Hasil: Data dari 80 subjek penelitian, terdapat 17 orang (21,3%) berusia 18-40 tahun, berusia 41-60 dengan jumlah 53 orang (66,3%), dan usia > 60 tahun sebanyak 10 orang (12,5%) dengan hasil rerata usia 48,08 ± 10,598. Berdasarkan jenis kelamin pada pria ada 39 orang (48,8%), dan pada wanita 41 orang (51,2%), rerata jenis kelamin pria 9,46 ± 1,592 dan wanita 9,04 ± 1,329. Jenis penyakit komorbid yang paling banyak adalah hipertensi sebesar 49 orang (61,3%) dan yang paling sedikit adalah penyakit autoimun (lupus) dan glomerulonefritis serta urolithiasis yaitu 2 orang (2,5%).Total Saturasi Transferin (ST) terbanyak dengan kadar ST > 20% sejumlah 52 orang (65%) dan pada ST < 20% sebanyak 28 orang (35%). Subjek penelitian yang mendapatkan terapi eritropoietin (EPO) yaitu terdapat 55 orang (68,75%). Subjek penelitian yang mendapatkan terapi zat besi intravena (IV) sebesar 25 orang (31,25%). Kesimpulan: Pasien anemia pada ESRD terbanyak pada interval usia 41-60 tahun, dengan jenis kelamin dominan pada wanita, dengan penyakit komorbid terbesar adalah hipertensi, dengan hasil ST dominan yaitu ST > 20, dan terdapat lebih banyak pasien yang menerima terapi EPO dibandingkan dengan menerima terapi zat besi intravena (dialifer). ---- Abstract Background: Anemia is a one of complication that often occurs in patients with chronic kidney disease and often results in a decrease in the patient's quality of life, an increase in patient morbidity and mortality, and an increase in the rate of progression of CKD. In patients with terminal stage CKD, it is known as ESRD. One of the renal replacement therapies for ESRD patients is hemodialysis. Objective: To describe the characteristics of anemia patients in ESRD with hemodialiasis at the Hemodialysis Installation of Dr. Soetomo General Hospital Surabaya. Methods: This research is a descriptive observational study with a cross sectional method using secondary data from the medical records of patients at the Hemodialysis Installation in Dr. Soetomo General Hospital Surabaya. Results: Data from 80 research subjects, there are 17 people (21.3%) aged 18-40 years, aged 41-60 with a total of 53 people (66.3%), and age > 60 years as many as 10 people (12.5 %) with a average age of 48.08 ± 10.598. Based on gender, there were 39 men (48.8%), and 41 women (51.2%), the average gender was 9.46 ± 1.592 for men and 9.04 ± 1.329 for women. The most common type of comorbid disease was hypertension by 49 people (61.3%) and the least was autoimmune disease (lupus) and glomerulonephritis and urolithiasis, namely 2 people (2.5%). ST > 20% a total of 52 people (65%) and on ST <20% as many as 28 people (35%). The research subjects who received erythropoietin (EPO) therapy were 55 people (68.75%). The research subjects who received intravenous (IV) iron therapy were 25 people (31.25%). Conclusion: The most anemia patients in ESRD were at the age interval of 41-60 years, with the dominant gender in women, with the largest comorbid disease being hypertension, with a dominant ST result of ST > 20, and there were more patients receiving EPO therapy compared to receiving intravenous iron therapy (dialifer).

In-Hospital Cardiac Arrest: Patient Characteristics and Factors Influencing Survival and Neurologic Outcomes

Objective: We aimed to determine the characteristics of in-hospital cardiac arrest (IHCA) patients, as well as the factors influencing survival to discharge and good neurologic outcome.Methods: We examined patients who experienced IHCA from January 1, 2011, to December 31, 2013, in Soonchunhyang University Seoul Hospital. They were divided into a survival group and non-survival group. The patient characteristics, including age, sex, comorbid disease, arrest time, arrest location, witnessed arrest, monitoring, arrest cause, arrest rhythm, and cardiopulmonary resuscitation (CPR) duration, were compared between the groups. Moreover, we assessed the factors associated with survival to discharge and good neurologic outcomes by using multivariate logistic regression analysis.Results: In total, 453 patients of IHCA were observed. The comorbidities in the survival group included neurologic disease (P < 0.001), arrhythmia (P = 0.001), and myocardial infarction (P = 0.032), pneumonia (P = 0.016). Other characteristics included cardiac arrest at daytime (P = 0.032), cardiogenic arrest cause (P = 0.019), and CPR duration < 15 minutes (P < 0.001). The factors associated with survival to discharge included comorbid neurologic disease (odds ratio [OR], 2.191; P = 0.031), arrhythmia (OR, 3.027; P = 0.009), pneumonia (OR, 3.243; P = 0.002), and CPR duration < 15 minutes (OR, 9.638; P < 0.001). The factors influencing good neurologic outcomes included age < 65 years (OR, 3.158; P = 0.007), comorbid disease as arrhythmia (OR, 4.921; P = 0.001), pneumonia (OR, 4.551; P = 0.001), hypotension (OR, 4.264; P = 0.021), and CPR duration < 15 minutes (OR, 6.652; P = 0.001).Conclusion: The factors influencing survival to discharge and good neurologic outcomes among IHCA patients included comorbidities, arrest cause, and CPR duration.

Implementing Health Related Social Needs Screening in an Outpatient Clinic: A Cross-Sectional Study

BackgroundTo date, health-related social needs (HRSN) screening implementation efforts have reported high rates of identified social needs. However, little is known about how screening processes may fail to leverage implementation strategies to optimize reach, and thereby unintentionally target non-representative groups for screening and referral programs. MethodsElectronic medical data were abstracted from 2016-2020 for 4,731 screened patients from 7 affiliated clinics of a federally-qualified health center (FQHC). Unscreened patients were pulled first as a random sample from the study period, then matched based on clinic site and clinic visit frequency. Sociodemographic traits, comorbid conditions, and outpatient encounter type and frequency were compared between the screened and unscreened patient cohorts using descriptive statistics.ResultsScreened patients (n-4731) had a median of 3.3 (+/- 2.5) unmet HRSN. Compared to a random sample of unscreened FQHC patients, screened patients had significantly more clinic visits (26.8 vs 16.3; p<0.05) and carried a higher comorbid disease burden (3+ conditions: 8% vs 2%; p<0.05). When the unscreened cohort was matched to the screened cohort for clinic site, these findings remained constant. Due to high visit frequency in the screened cohort, our analysis was matched for clinic visit frequency. Screened patients continued to demonstrate a higher comorbid disease burden (3+ conditions, 8% vs 3%; p<0.05), but only had a higher prevalence of 4 chronic conditions (diabetes, hypertension, chronic kidney disease, and anxiety/depression). ConclusionsWithout an a priori plan for implementation, we have found a predisposition to screen patients who visit outpatient services more often and have a higher comorbid disease burden. HRSN screening processes will benefit from implementation strategies to improve reach and to ensure maximal uptake of screening.

Epidemiologic, Clinical and Immunological Consequences of Co-Infections during Canine Leishmaniosis

Canine leishmaniosis (CanL) is a vector-borne, parasitic disease. CanL is endemic in the Mediterranean basin and South America but also found in Northern Africa, Asia, and the U.S. Regions with both competent sand fly vectors and L. infantum parasites are also endemic for additional infectious diseases that could cause co-infections in dogs. Growing evidence indicates that co-infections can impact immunologic responses and thus the clinical course of both CanL and the comorbid disease(s). The aim for this review is to summarize epidemiologic, clinical, and immunologic factors contributing to eight primary co-infections reported with CanL: Ehrlichia spp., Anaplasma spp., Borrelia spp., Babesia spp., Trypanosoma cruzi, Toxoplasma gondii, Dirofilaria immitis, Paracoccidioides braziliensis. Co-infection causes mechanistic differences in immunity which can alter diagnostics, therapeutic management, and prognosis of dogs with CanL. More research is needed to further explore immunomodulation during CanL co-infection(s) and their clinical impact.

Integrating patients with chronic respiratory disease and heart failure into a combined breathlessness rehabilitation programme: a service redesign and pilot evaluation

IntroductionThe successful integration of patients with chronic heart failure (CHF) into a traditional pulmonary rehabilitation (PR) programme has previously been reported. Our aim was to reconfigure both our cardiac rehabilitation (CR) and PR services to enable us to deliver a symptom-based programme—breathlessness rehabilitation (BR), for patients with a primary symptom of breathlessness irrespective of the index diagnosis, or comorbid disease.MethodsAfter a service redesign process, patients attended a two times per week, group-based, tailored exercise and education programme for 6 weeks, delivered by CR and PR staff. The classes included both aerobic and resistance exercises and an overarching generic education programme alongside disease-specific components. Home programmes were reviewed at each session to facilitate progress and influence changes in exercise behaviour beyond the supervised programme. Generic clinical outcome measures were performed pre and post BR.Staff focus groups were conducted to identify barriers and facilitators and explore staff perceptions.Results272 patients (n=193 chronic respiratory disease (CRD) and n=79 CHF) were assessed and enrolled into BR (153 men, mean (SD) age 68.8 (12.7) years, body mass index 28.8 (7.3), Medical Research Council 3 (IQR 2–4), New York Heart Association 2 (IQR 2–3)). 164 patients completed the programme. Statistically significant improvements were seen in both exercise capacity (incremental shuttle walking test: mean change 47.4 m; endurance shuttle walking test: mean change 310.7 s) and quadriceps strength (quadriceps maximal voluntary contraction: mean change 3.7 kg) (p≤0.0001) alongside a statistically significant reduction in dyspnoea (chronic respiratory questionnaire/chronic heart questionnaire - self reported - dyspnoea: mean change 0.4) and anxiety and depression scores (Hospital Anxiety and Depression Scale (HADS) - anxiety: −1.6; HADS - depression: −1.3) (p≤0.0001).Qualitative staff focus groups identified three subthemes: collaboration and integration, service quality and future challenges.DiscussionOverall the service redesign indicates the feasibility for staff and individuals with CRD and CHF to integrate into a breathlessness programme. Early data suggests clinical effectiveness. Given the significance of comorbid disease it is an approach that warrants further consideration.

Sleep Monitoring of Children With Nocturnal Enuresis: A Narrative Review

The purpose of this article is to provide a succinct summary of the sleep monitoring efforts that have been used in nocturnal enuresis (NE) and an overview of the knowledge that has accrued. This is not intended to be a comprehensive review, but rather is intended to highlight how polysomnography (PSG), a common sleep detection tool, has contributed to our understanding of NE, as arousal disorder is considered to be one of the important mechanisms. The authors have organized this report by analysis and display of different ingredients of PSG, starting with comparing the electroencephalogram (EEG) of controls and the enuretic children and then moving to evaluation of respiratory patterns of NE and comorbid disease obstructive sleep apnea (OSA). In addition, the authors' goal is to better understand the mechanism of NE by integrating various levels of sleep monitoring; those sleep-related clinical scale scores for NE are presented to date. Finally, we propose further research of NE to explore the microstructure alterations via PSG combined with EEG–fMRI or to use novel technology like portable device internet and deep learning strategy.

The Relationship of Chest X-Ray in COVID-19 Patients and Disease Severity in Arifin Achmad General Hospital Riau

Introduction: Coronavirus Disease 2019 (COVID-19) pandemic is caused by SARS-CoV-2 which spreads rapidly throughout the world and causes clinical manifestations in various organs, especially in the lungs. Clinical symptoms arise from asymptomatic, mild, moderate, severe, and critical symptoms in patients with or without comorbid disease. Chest X-ray examination is one of the modalities in the management of COVID-19 which is cheap and easy to do.Methods: This study was performed by analyzing medical record data of confirmed COVID-19 patients from March to December 2020. This study aimed to examine the relationship between chest X-ray and the degree of disease severity.Results: The results showed that from the examined 542 total samples, the highest number was found in the age group of 40-49 years old (23.6%), women (53%), mild degree of COVID-19 (67.9%), normal chest X-ray (54.6%), predominance on the lower zone of the lung, peripheral and bilateral on abnormal chest X-ray, no comorbid (56.3%), hypertensive in comorbid disease (26.6%). There was a significant relationship between chest X-ray and comorbidity towards COVID-19 severity (p = 0.000).Conclusion:Chest X-ray can determine disease severity, therefore it can be used as the first modality for triage and treatment evaluation in COVID-19 patients.

DUKUNGAN SOSIAL MENGURANGI BEBAN PENGASUHAN ANAK DENGAN DISABILITAS INTELEKTUAL SELAMA MASA PANDEMI COVID19 DI KABUPATEN JEMBER

Latar belakang: Masa pandemi COVID-19 adalah masalah besar bagi seluruh negara dari sudut pandang Kesehatan dengan karakter corona virus disease yaitu kecepatan penularan dan konsekuensi kematian bagi individu dengan penyakit penyerta (comorbid disease). Individu DI adalah salah satu kelompok di komunitas yang rentan terhadap inveksi COVID-19, akibatnya orang tua sebagai pengasuh atau pendamping utama anak dengan DI memiliki beban tinggi selama masa pandemi. Metode: peneltian ini menggunakan pendekatan cross-sectional dengan melibatkan 59 responden (orang tuda individu DI). Social support questionnaire (SSQ)dan Zarit Burden Interview (ZBI) digunakan dalam pengumpulan data. Analisa data penelitian ini menggunakan spearmen rho. Hasil: Terdapat hubungan yang signifikan antara dukungan sosial dan tingkat beban pengasuhan dengan nilai p = 0,002, r = 0,314, mayoritas dukungan sosial dalam ketogori cukup 47,45 % dan kategori kurang baik 40,6%, sedangkan pada beban pengasuhan berada pada ketegori sedang 33,8% dam berat (52,5 %). Kesimpulan: Pentingnya dukungan sosial yang konsisten pada orang tua atau keluarga yang memiliki anak DI karena dukungan sosial yang baik adalah cara menjaga Kesehatan emosional bagi orang tua DI.

Prevalence and Associated Factors of Chronic Kidney Disease among Adult Hypertensive Patients at Northwest Amhara Referral Hospitals, Northwest Ethiopia, 2020

Background. Chronic kidney disease (CKD) is a progressive loss of the kidney function which leads to a decreased kidneys’ ability to process waste in the blood and it affects the other important functions of the kidney. The disease has different stages that can alter the health status of individuals. During the early stages, patients may present with a normal or slight decrease in glomerular filtration rate (GFR) and albuminuria. Later, it progresses and leads to end-stage renal disease (ESRD) or kidney failure. Hypertension is considered as the major contributing risk factor of CKD. Objective. This study was aimed to assess the prevalence and associated factors of chronic kidney disease among adult hypertensive patients in referral hospitals of the Northwest Ethiopia. Methods. An institution-based cross-sectional study was conducted among 581 adult hypertensive patients in a chronic follow-up clinic in referral hospitals, Northwest Ethiopia, from July to August 2020. Systematic random sampling was used to select the study participants. Data were collected using the interviewer-administered questionnaire and participants medical records. Both bivariable and multiple logistic regression analyses were performed. Model fitness was assessed using a Hosmer—Lemeshow test. Result. The total prevalence of CKD among adult hypertensive patients was 17.6% (95% CI: 14.7–20.8). Diastolic blood pressure ≥90 mmHg (AOR = 8.65; 95% CI: 4.77–15.68), duration of hypertension ≥10 years (AOR = 8.81; 95% CI: 2.47–31.45), stage II HTN (AOR = 2.61; 95% CI: 1.04–6.50), comorbid disease (AOR = 7.0; 95% CI: 2.20–22.21), proteinuria (AOR = 4.59; 95% CI: 2.08–10.12), dyslipidemia (AOR = 3.40; 95% CI: 1.56–7.24), and serum creatinine ≥1 mg/dl (AOR = 8.88; 95% CI: 4.40–17.91) were associated with chronic kidney disease among adult hypertensive patients. Conclusion. In this study, the prevalence of CKD among hypertensive patients found was 17.6%. Regarding associated factors, dyslipidemia, proteinuria, comorbid disease, serum creatinine greater than 0.9 mg/dl, duration of hypertension greater than 10 years, and diastolic blood pressure greater than 90 mmHg are factors associated with the occurrence of chronic kidney disease among hypertensive patients.

The Association between Sarcopenia as a Comorbid Disease and Incidence of Institutionalisation and Mortality in Geriatric Rehabilitation Inpatients: REStORing health of acutely unwell adulTs (RESORT)

Introduction: Sarcopenia is associated with poor health outcomes and highly prevalent in individuals with age-related diseases. This study aimed to determine whether sarcopenia as a comorbid disease is associated with the incidence of institutionalisation and mortality in geriatric rehabilitation inpatients. Methods: REStORing health of acutely unwell adulTs (RESORT) includes geriatric rehabilitation patients assessed for sarcopenia (the European Working Group on Sarcopenia in Older People [EWGSOP, 2010], EWGSOP2 [2018], and the Asian Working Group for Sarcopenia [AWGS 2019]), multimorbidity, disease severity, and specific diseases (Charlson Comorbidity Index and Cumulative Illness Rating Scale) at admission. The incidence of institutionalisation and mortality was recorded 3 months after discharge. Logistic regressions were adjusted for age and sex with “low morbidity and no sarcopenia” as the reference group. Results: In 549 included patients (median age was 82.2 [77.4–87.7] years, 58.3% female), sarcopenia prevalence was 37.9, 18.6, and 26.1% according to EWGSOP, EWGSOP2, and AWGS 2019, respectively. Sarcopenia as a comorbid disease with high multimorbidity, dementia, diabetes mellitus, and renal impairment had higher odds of institutionalisation incidence. Sarcopenia as a comorbid disease with high multimorbidity, high disease severity, chronic obstructive pulmonary disease, osteoporosis, and renal impairment had higher odds of mortality. Conclusion: Sarcopenia as a comorbid disease is associated with a higher incidence of institutionalisation and mortality in geriatric rehabilitation inpatients. This highlights the need for in-hospital sarcopenia diagnostics and interventions.