Sanus Medical Journal

D-Dimer Sebagai Salah Satu Parameter Perbaikan Klinis pada Kasus Covid-19 Gejala Berat

Antin Trilaksmi — 2022-11-30

Background. Coronavirus Disease 2019 (COVID-19) has been a global pandemic since March 2020. The number of patients is massive and clinical symptoms vary from mild to severe symptoms. Several laboratory results showed abnormal values in Covid-19 patients, including an increase in the value of D-dimer. Elevated levels of D-dimer in COVID-19 patients are strongly associated with severity and increased mortality. We report a case of a severe symptomatic COVID-19 patient with high D dimer levels at the start of treatment and showing clinical improvement according to a decrease in D dimer levels.

Methods. We treat and follow the clinical and laboratory developments of COVID-19 patients with severe symptoms from the time they enter the Intensive Care Unit (ICU) until they move to a regular ward.

Results. A 53-year-old male patient diagnosed with viral pneumonia et causa covid-19 was admitted to the ICU with severe symptoms and high initial d-dimer levels (1,413 ug/ml). The patient received ventilator assistance and standard therapy according to the Covid 19 management protocol of the Ministry of Health of the Republic of Indonesia. Anticoagulation using heparin intravenously with a dose adjusted to the level of d dimer, aPTT, and clinical condition of the patient who is monitored regularly. The trend of d dimers decreased parallel to the decrease in C reactive protein (CRP) levels, increased lung gas exchange function was evaluated from the PaO2/Fio2 ratio (PF ratio) and the clinical improvement of the patients.

Conclusion. D-dimer is closely related to the severity of covid 19 patients. D dimer can be used as one of the parameters of patient clinical improvement.

Pengaruh Pemakaian Masker Bedah dan Masker Kain pada Wajah

Hans Sutanto — 2022-11-30

Background. Face masks are indispensable in preventing the spread of COVID-19 transmission. Face mask use can have beneficial and detrimental effects on a person. In this study, participants' faces were observed before and after wearing surgical and cloth masks for 4 hours per day for five consecutive days.

Methods. The research design is experimental.

Results. Thirty-two Trisakti University Faculty of Medicine employees aged 26 to 46 years and 18 men and 14 women, participated in this study. Sociodemographic data and facial examination were assessed at the start and end of the study. The research data obtained the results of p = 0.392.

Conclusion. There is no significant difference between surgical and cloth masks in terms of acne, skin irritation, and redness.

Acute Abdominal Case Report: Ruptured Ovarian Endometriotic Cyst Concurrent with Acute Appendicitis

Gupita Nareswari — 2022-11-30

Acute pain of pelvic origin is a common symptom necessitating emergent medical evaluation. Acute pelvic pain in young women can present as a unique diagnostic dilemma. Differential diagnosis in acute pelvis pain can vary according to risk. Possible causes span a gamut from functional ovarian cysts that require routine follow-up to adnexal torsion and ectopic pregnancy requiring urgent surgical management.

This case report illustrates how concomitant gynecologic disorders can occur in patients with acute appendicitis. The laparoscopic operation revealed a ruptured ovarian endometriotic cyst concurrent with acute appendicitis and was proven by histopathology. This serves as a reminder that even though a rare case is contemporary, two different entities can occur.

Emfisema Subkutis sebagai Komplikasi pada Pasien Covid-19 dengan Penggunaan Ventilasi Mekanik

Lira Panduwaty — 2022-11-30

Background. The incidence of subcutaneous emphysema in patients with severe pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infection has been in the spotlight recently. Subcutaneous emphysema is a rare complication. With the increasing prevalence of subcutaneous emphysema in patients with confirmed coronavirus disease (COVID-19), it is necessary to know what factors can cause this and how to treat it.

Case Description. Two patients, a man and a woman aged 50 and 70 years, diagnosed with COVID-19, came to the Emergency Room (IGD) of Bunda Menteng General Hospital, Jakarta, with symptoms of acute respiratory distress syndrome (ARDS). Both patients experienced severe shortness of breath with a respiratory rate above 30 times per minute. Then the two patients were treated in the intensive care Unit (ICU) isolation room and required mechanical ventilation assistance. After 3-4 days of mechanical ventilation treatment, subcutaneous emphysema develops, characterized by subcutaneous crepitus. After chest x-rays were carried out in both patients, the results were subcutaneous emphysema and pneumomediastinum. Several invasive procedures have been performed, such as subcutaneous insertion of an intravenous cannula, mediastinoscopy, and chest tube insertion.

Conclusion. Complications of subcutaneous emphysema in COVID-19 patients are rare and require further research to determine the cause, where the infection is still the focus. With this case report, it is hoped that clinicians will pay more attention to the initial clinical findings of subcutaneous emphysema to reduce even more severe complications such as pneumothorax.

Strategi Pemasaran pada Sistem Layanan Kesehatan

Sidhi Laksono Purwowiyoto — 2022-11-30

Health marketing is interdisciplinary because it uses certain concepts, methods, and techniques for classical and social marketing. The specialty of health marketing is that there are services and markets but no money equivalent.

Healthcare marketing differs mainly by the nature of the demand for health services. The beneficiary may not be the target of a marketing campaign, and the physician decides what, where, when, and how much to provide for a particular service. To understand the impact of marketing strategies on healthcare quality, it is essential to understand today's medical consumers who prefer to seek medical information online. They also have many health services, healthcare providers, and reviews from patients who contact providers.