Acta medica academica最新文献

Objective: Airway management has undergone a dramatic transformation since the arrival of video laryngoscope (VL). VL has higher intubation success rate on first try and lower complications in comparison to direct laryngoscope (DL). The use of VL is recommended in intubating COVID-19 patients to speed up intubation time and reduce failure rate. A team from Airlangga University developed Wycope Video Laryngoscope (Wycope VL), a VL with Wi-Fi connection to smartphones for an easier VL with low cost. This study aimed to compare the effectiveness of Wycope VL, C-MAC Video Laryngoscope (C-MAC VL), and DL.

Materials and methods: This study was an analytic observational study with a cross sectional design, involving 63 patients who were divided into 3 groups based on the type of laryngoscope, namely Wycope VL, C-MAC VL, and DL. Intubation is carried out by 4th year anaesthesiology resident. Research subjects were patients who will undergo elective surgery at Dr. Soetomo General Hospital under general anaesthesia using orotracheal tube. Inclusion age of 19-64 years, PS ASA 1-2, no anatomical abnormalities of the airway, did not have difficult airway, and was willing to participate in the study.

Results: All patients were successfully intubated without complications. C-MAC VL (5.33±1.42 seconds) and Wycope VL (5.95±0.74 seconds) was significantly faster in seeing vocal folds and glottis compared to DL (7.14±0.72 seconds) with P=0.000. DL was significantly faster in average time of intubation (15.52±5.90 seconds) compared to C-MAC VL (16.95±1.11 seconds) and Wycope VL (20.29±2.81 seconds) with P=0.000.

Conclusion: DL was faster compared to VL in speed of intubation while C-MAC VL and Wycope VL was faster in viewing the vocal folds and glottis compared to DL.

Objective: To examine and identify sciatic nerve variations in relation to the piriformis muscle, its prevalence, pattern and the course of its bifurcation loci.

Materials and methods: Twenty-eight formalin fixed male cadavers comprising 56 lower limbs were used for this study. Dissection of the gluteal region and posterior compartment of the thigh was conducted to expose the sciatic nerve. Variations in the sciatic nerve anatomy, their relationship to the piriformis muscle and points of bifurcation, and other observable features were noted and recorded.

Results: Fifty-two lower limbs (93%) showed normal anatomy of the sciatic nerve. Four regions (7.1%) showed variations in the morphology of the sciatic nerve. Of these, one (1.8%) showed a variation of the sciatic nerve with the piriformis muscle. This single case showed a common peroneal nerve emerging on the left between the heads of a double piriformis muscle - a variant not described in the original Beaton and Anson classification, with the tibial nerve deep to the muscle. In two other limbs, the sciatic nerves showed a normal relationship with the piriformis, but had variations in the bifurcation loci (bilateral). The divisions were in upper third and middle third of the right and left thighs respectively.

Conclusion: Knowledge of the level of bifurcation and distribution of the sciatic nerve and its location is important. This nerve is commonly encountered by neurologists, orthopaedics, and anaesthesiologists. The uncommon anatomical findings described are relevant to surgeons to enable them to perform efficient surgical procedures and avoid errors.

Objectives: Total Knee Replacement Surgery (TKR) is one of the most common elective orthopedic operations. Postoperative pain after total knee replacement, remains a challenge. In this retrospective observational study, we evaluated the effectiveness of 3-in-1 nerve block in patients after total knee arthroplasty compared to standard opioid treatment, and we state the reasons why this approach should still be considered.

Methods: To evaluate the effectiveness of the 3-in-1 nerve block, we assessed the acute pain service archive and compared the values of the visual analog scale, by separating patients into two groups according to the analgesic regimen they received as per local protocols. In group A, patients received 0.25% bupivacaine through a 3 in 1 block catheter and additional meperidine IM if needed, while in group B they received meperidine every six hours.

Results: Our analysis showed the statistically significant better effectiveness of 3-in-1 nerve block with bupivacaine administration in postoperative TKR pain control compared to repeated administration of meperidine.

Conclusion: The results of our study suggest that 3-in-1 nerve block with bupivacaine is an option that must always be considered in order to alleviate post-operative pain after TKR.

Objective: The objective of this study was to study the morphometry of the styloid process of the temporal bone and the prevalence of an elongated styloid process in relation to side and gender.

Material and method: The present study included 200 human skulls which were procured from the rich osteological collections of the Department of Anatomy, Faculty of Medicine, University of Sarajevo. The styloid process was observed macroscopically on both sides of all the skulls and elongations, if any, were noted. The lengths of the styloid processes were measured using digital vernier calipers. The measurements were taken from the point of emergence of the process (base) up to the tip.

Results: Out of 200 specimens, only 14 cases (7%) exhibited an elongated styloid process. The mean length of the styloid process was 25.8±4.68 mm and 24.2±4.54 mm for the right and left sides, respectively. The size of the styloid process did not different significantly between the two sides (P=0.724). The mean length of the styloid process was 24.05±3.54 mm in females and 25.95±5.68 mm in males, and the difference was statistically significant (P=0.023).

Conclusion: The study and knowledge of the anatomical variations of the styloid process in the Bosnian population may help clinicians to diagnose Eagle's syndrome. Knowledge of this disorder can prevent the worsening of the painful symptoms related to an elongated styloid process.

Objective: The aim of this case report is to illustrate a very rare case of emphysematous pyelonephritis complicated by IgAdominant postinfectious glomerulonephritis.

Case report: We report the case of a 53-year-old woman with emphysematous pyelonephritis who initially presented with unintentional weight loss for 3 months and subnephrotic range proteinuria without fever. Urinalysis revealed proteinuria, microscopic hematuria, and pyuria. A kidney biopsy was performed for suspected glomerulonephritis. The patient's right kidney biopsy was consistent with immunoglobulin A (IgA)-dominant infection-related glomerulonephritis. Abdominal computed tomography to seek the possible source of infection revealed staghorn stones obstructing dilated calyces and gas collection within the collecting system. The final diagnosis was emphysematous pyelonephritis of the left kidney complicated by IgA-dominant infection-related glomerulonephritis of the right kidney.

Conclusion: We present an atypical presentation of emphysematous pyelonephritis in terms of clinical presentation (prolonged course of illness without fever) and its complications (IgA-dominant infection-related glomerulonephritis). This case study highlights the critical role of kidney biopsy in the diagnosis and the diverse clinical manifestations in clinical medicine.

Objectives: The present study aimed to assess changes in the perception of and willingness to participate in organ donation (OD) among immigrants from Bosnia and Herzegovina living in Sweden from the perspective of gender differences.

Materials and methods: A cross-sectional study with 60 participants born in Bosnia and Herzegovina and living in Sweden was performed. Data were collected using a self-administrative questionnaire, providing demographic characteristics, information about opinions, awareness, and knowledge on the donation process and religious approach to the subject, willingness to donate/ receive organs, and possession of a donor card.

Results: Our results showed significant differences between genders regarding the definition of transplantation (P<0.0001), information about OD (P<0.0001), knowledge (P<0.0001) and importance of OD (P<0.003), religious permitting (P=0.0001), and religious opposing (P=0.0007) to OD. Furthermore, a significant difference was observed regarding the preferred recipient (P=0.0062) and the possession of the donor card (P<0.0001). Regression analysis showed that female gender and higher income were statistically significant in prediction of positive attitudes toward OD (P=0.0027, P=0.0002, respectively).

Conclusion: Change of social background and integration into Swedish society undoubtedly led to change in the attitudes toward OD, regardless of the perspective of gender differences. However, women were found to have more positive attitudes toward OD.

Objective: Clopidogrel is a common antiplatelet used as secondary prevention of ischemic stroke, known to have better efficacy than aspirin, with a equivalent safety profile. However, clopidogrel resistance is not uncommon but has not been widely studied in Asia. This study will further assess clopidogrel resistance and its risk factors.

Materials and methods: A cross-sectional study was conducted at Rumah Sakit Universitas, Indonesia, and Rumah Sakit Cipto Mangunkusumo, Indonesia in 2020-2021. All patients had had at least one episode of ischemic stroke. Clopidogrel resistance was assessed using a VerifyNow assay.

Results: 57 subjects were enrolled in this study. We found 15.8% of subjects were clopidogrel resistant. Gender was significantly associated with clopidogrel resistance, with males having 80% lower clopidogrel resistance (OR 0.2 (95% CI 0.022 - 0.638); P=0.006). Meanwhile, smoking was not associated with clopidogrel responsiveness (P=0.051). We found no association between haemoglobin, blood glucose, HbA1c, cholesterol, liver enzymes, serum urea concentration or creatinine levels and clopidogrel resistance.

Conclusion: Clopidogrel remains an effective treatment to prevent recurrent ischemic stroke in Indonesia. Further studies are needed to assess gene polymorphism and clopidogrel resistance, which may explain the findings of this study.

Objective: The purpose of this research was to investigate the correlation between serum levels of surfactant protein-D (SPD) with acute respiratory distress syndrome (ARDS) severity and mortality in COVID-19.

Materials and method: This was a prospective cohort research study that included 76 patients in the period from July to October 2020. SP-D serum levels were taken upon admission to the hospital, the diagnosis of ARDS and its grade were confirmed according to the WHO criteria, and then patients were observed for 28-day mortality.

Results: The mean SP-D serum levels from 76 patients were 39.33 ng/ml (SD±31.884 ng/ml). The statistical analysis showed that there was a significant correlation between SP-D serum levels and the severity of ARDS upon admission to the hospital (P=0.04, Spearman's rank correlation coefficient (rs)=0.26), but the correlation between serum levels of SP-D and mortality was not statistically significant (P=0.89; rs=-0.016).

Conclusion: SP-D serum levels had a significant but weak correlation with ARDS severity, but were not significant for mortality.