Comparative Analysis of Actual Cost and INA CBG Rate in Diabetic Gangrene Inpatients

Background: Diabetic gangrene is a complication of diabetes mellitus that imposes a substantial financial burden on patients and their families as well as the health care system. Objective: To determine the total cost of disease, and the difference between real cost and INA CBG rate for diabetic gangrene inpatients from January - December 2017 at Universitas Airlangga Hospital, Surabaya Methods: The study was conducted retrospectively by using a total sampling method. The perspective used was the hospital perspective. This study's direct medical costs were laboratory, drug and consumable medical device costs, medical equipment rental, radiology examination, red cross, oxygen, service, and room costs. Data analysis was performed using an independent samples t-test. Results: The results showed that 148 patients met the inclusion criteria. The total real cost of diabetic gangrene inpatients at Universitas Airlangga Hospital in 2017 was IDR 1,339,949,381, and the total INA CBG rate for inpatients with diabetic gangrene was IDR 1,365,047,500. The difference was (p = 0.000) between real cost and INA CBG rate. Conclusion: There is a difference between the actual cost and the INA CBG rate for diabetic gangrene inpatients.

Insufficient procedural anticoagulation during leadless pacing led to catheter-related thrombosis in a hemodialysis patient

Background Leadless pacemaker was a promising innovation than traditional transvenous pacemaker, the procedural complications were prone to be bleeding-related. However, very few reports also concerned about the thrombus formation during the procedure. Case presentation A hemodialysis patient with diabetic gangrene of right foot suffered from catheter-related thrombosis during leadless pacing, resulting in failure of recapture the pacemaker. A low activated clotting time (ACT) level of 104 s confirmed the insufficiency of anticoagulation. Finally, the whole delivery catheter had to be removed from the delivery sheath, another new pacemaker system was applied and successfully implanted after adjusting the ACT level to 248 s. Conclusion Catheter-related thrombosis could be a large obstacle for leadless pacemaker implantation. In addition to routine anticoagulation, ACT monitoring might be necessary during the procedure.

Learning Bioavailability Of “Diabderm” Ointment With Method Of “In Vitro”

In diabetes mellitus, a small focus of infection causes significant gangrene of the foot due to thrombosis of the peripheral and central vessels of the fingers. In 35–40% of patients with diabetes mellitus, isolated gangrene of several fingers is noted, and in 20–25% - only one finger. Gangrene of the foot can be dry or with a predominance of anaerobic-non-clostridial infection. Some patients have necrosis or gangrene of certain areas of the skin of the foot or lower leg. The main goal of diabetic gangrene treatment is to keep the areas of wet skin necrosis dry.

Konseling Efektif sebagai Upaya Preventif Gangren pada Penderita Diabetes Mellitus di RSUD Gambiran Kota Kediri

Diabetes is a metabolic disorder characterized by hyperglycemia due to a disruption of insulin secretion or defective insulin action. Diabetes Mellitus can cause several metabolic complications such as retinopathy, nephropathy, and neuropathy, including diabetic gangrene. Gangrene is a state of tissue damage or necrosis that can be triggered by bacterial infections, lack of self-care and a diet high in glucose. Patient's attitudes influence the occurrence of complications. In this case, doctors and nurses have an important role to provide counseling to patients as an effort to prevent the onset of gangrene. This study applied qualitative research method which data was getting from the true situation and use observation and interview with participant as an instruments. The results of this study indicate that there are important things to do to realize effective counseling as an effort to prevent gangrene. Cooperation between counselors, doctors and nurses, with patients very decisive.

Peta Kuman Dan Sensitifitasnya Pada Penderita Gangren Diabetikum Di Rumah Sakit Angkatan Laut Dr. Ramelan Surabaya

<p><strong>Background:</strong> Diabetic gangrene is one of the complications of Diabetes Mellitus (DM) characterized by open wounds on the skin surface to the dermis layer. One of the complicating factors of the wound healing process is the infection of germs. For infection therapy in diabetic gangrene often associated with the use of antibiotics. The purpose of this study was to determine the germs that found in diabetic gangrene and its sensitivity to antibiotic in diabetic gangrene patients at Naval Hospital Dr. Ramelan Surabaya.</p><p><strong>Methods:</strong> This study is a retrospective descriptive study using 60 data samples that have fulfilled the inclusion criteria and obtained from the result of pus culture in diabetic gangrene at the Clinical Pathology Laboratory of Naval Hospital Dr. Ramelan Surabaya.</p><p><strong>Results:</strong> The results obtained from this study indicate the presence of 13 types of germs found in pus culture of diabetic gangrene patients and the most common found were <em>Escherichia coli</em> (33,3%). While the results on the sensitivity test showed that antibiotics with the highest sensitivity were Cefoperazone/ Sulbactam, Meropenem, and Levofloxacin (92.3%), whereas the lowest sensitivity antibiotic was Ampicilin (15.3%).</p><p><strong>Conclusion:</strong> Diabetic gangrene is often followed by the occurrence of infections that can be caused by various germs, and each germ has a different sensitivity to antibiotics. The culture of gangrene must be done because it is used to determine the type of antibiotic used for the treatment of diabetic gangrene based on the type of germs that infects. However, Cefoperazone/ Sulbactam, Meropenem, and Levofloxacin antibiotics may be the primary antibiotic choice because they have a high level of sensitivity.</p><p><strong>Keywords:</strong> Diabetic gangrene, germ infections, antibiotic sensitivity.</p><p> </p>

Epidural Anaesthesia Saved A Patient With Multiple Co-Morbid Condition

Epidural anaesthesia has been routinely used for many years and widely accepted as an effective mathod of pain relief . The procedure is commonly performed as a sole anaesthesic or in combination with spinal or general anaesthesia. In our case Md. Alauddin, 59 years old male was admitted in KYAMCH with complaints of diabetic gangrene of right foot with features of septicemia and he has a long history uncontrolled diabetes mellitus and hypertension leading to developed ischemia heart disease and CRF. After proper evaluation patient's physical status was graded as ASA (American society of Anesthesiologists) class-IV, and selected for above knee amputation of right lower limb but patient was unfit for anesthesia due to his co morbid conditions. As a life saving procedure the operation was done under epidural anesthesia and per- operative and postoperative recovery was uneventful.KYAMC Journal Vol. 7, No.-1, Jul 2016, Page 729-730

INHIBITION OF MOBILITY OF NEUTROPHILS OF SURGICAL PATIENTS WITH PURULENT WOUNDS AND WOUND INFECTION AS AN INDICATOR OF INTOXICATION OF THE ORGANISM

The method for automatic recording and analysis of motor activity of neutrophils based upon the Magiscan 2A image analysis system allows conducting express diagnostics of motility of neutrophils of patients. It was shown that cells with various speed of movement on glass are contained in the population of neutrophils. The average speed of movement of neutrophil population is a stable indicator of movement activity of the population and can serve as an objective parameter of the functional state of neutrophils with various diseases. Patients with purulent surgical infections manifest correlation between inhibition of neutrophil motility and deteriorating of clinical status of patients (speed in μm / min, healthy donors – 8.8; patients of average severity – 6.5; serious patients – 3.3). Blood serum of serious patients had an inhibitory effect on the migration of neutrophils from healthy donors. Increasing of the average speed of movement of neutrophils from 3.4 to 7.1 μm / min in 1 to 2 days after a radical surgery (amputation) was demonstrated among 11 patients with the diabetic gangrene of the foot. Previously, we have shown the existence of reciprocal relationships between motility of neutrophils and their activation. Inhibition of motility of neutrophils with surgical diseases can be explained by their priming or activation.