Latar belakang: Ko-infeksi jamur pada pasien Corona Virus Disease 2019 (COVID-19) acapkali terjadi. Hal itu dikarenakan kegagalan sistem imun karena infeksi COVID-19 maupun karena pengobatan anti inflamasi yang diberikan.Kasus: Seorang laki-laki 39 tahun dengan acute respiratory distress syndrome (ARDS) berat akibat infeksi COVID-19 dan disertai dengan ko-infeksi jamur. Pasien ini mendapatkan pengobatan steroid dari awal masuk dan pada hari ke-6 hasil kultur sputumnya menunjukkan adanya ko-infeksi jamur. Pasien ini memiliki komorbid berupa riwayat diabetes mellitus. Dari pemeriksaan fisik ditemukan dispnea, takipnea, takikardia sejak hari pertama. Dari hasil laboratorium menunjukkan angka leukosit, high sensitivity c-reactive protein (HsCRP), serum glutamic oxaloacetic (SGOT), gula darah, d-dimmer, lactat dehydrogenase (LDH) dan limfosit netrophyl ratio (LNR) yang tinggi. Pada pasien ini didapatkan rasio PaO2 / FiO2 rendah dan procalcitonin (PCT) yang normal. Dari kultur sputum ditemukan adanya infeksi jamur dan dari hasil rontgen toraks (CXR) menunjukkan pneumonia bilateral. Pasien ini dirawat dengan terapi standar dan mendapatkan dexametason 5 mg / 8 jam, setelah kultur sputum menunjukkan infeksi jamur, pasien juga mendapat mycafungin untuk pengobatan jamurnya.Diskusi: Kecurigaan terhadap ko-infeksi jamur pada pasien COVID-19 yang mendapatkan terapi steroid dalam jangka waktu lama maupun adanya penyerta diabetes harus dipikirkan. Penggunaan terapi anti jamur empiris pun acapkali diperlukan untuk mengurangi morbiditas dan mortalitas.Kesimpulan: Infeksi COVID-19 memiliki risiko terjadinya ko-infeksi, salah satunya adalah infeksi jamur. Insiden koinfeksi jamur diperberat dengan pemberian pengobatan steroid dan riwayat diabetes mellitus.
Introduction: Scoliosis is a three-dimensional spinal deformity that is mainly determined based on the lateral curvature of the spine. Furthermore, regional anesthesia often infiltrates the peripheral nerves with an anesthetic agent and blocks transmission to avoid or relieve pain. A previous study revealed that scoliosis in patients is one of the factors affecting the success of spinal anesthesia. Objective: To obtain a theoretical basis that can support the solution to the RASAB problem. The acceptance of the theory is the first step to providing a better understanding of the study problem based on the scientific framework of thinking. Furthermore, the similarities, differences, and views of several pieces of literature that discussed related issues were evaluated in this review. Review: Regional anesthesia subarachnoid blockade (RASAB) or spinal anesthesia, is a procedure, which involves the administration of local anesthetic drugs into the subarachnoid space. Furthermore, the process is carried out between the lumbar (L) vertebrae L2-L3, L3-L4, or L4-L5. Spinal anesthesia is often used in surgical procedures involving the lower abdomen, pelvis, perineum, and lower extremities. Summary: In the setting of scoliosis, spinal anesthesia is challenging, but is not an absolute contraindication. Patients with scoliosis have unique characteristics, hence, anesthetists need to understand the impact of the disease on the body.
Anestesi spinal merupakan metode yang ekonomis, aman, nyaman, dan efektif yang memberikan anestesi cepat dan dapat diandalkan. Pasien pascaoperasi dengan anestesi spinal yang dilakukan mobilisasi cepat memberikan keuntungan dibanding dengan mobilisasi setelah tirah baring 24 jam. Penelitian ini bertujuan menilai perbandingan antara pasien mobilisasi cepat dan mobilisasi lambat pada pasien pasca-anestesi spinal terhadap komplikasi neurologis yang terjadi. Penelitian dilakukan di Instalasi Bedah Sentral RSUD Dr. Moewardi Surakarta selama Juli–Agustus 2018. Penelitian ini menggunakan uji klinis acak tersamar ganda pada 30 pasien yang menjalani operasi dengan anestesi spinal yang memenuhi kriteria inklusi. Sampel dibagi menjadi 2 kelompok, yaitu kelompok yang mendapat perlakuan mobilisasi setelah efek anestesi spinal hilang dan kelompok yang mendapat perlakuan mobilisasi setelah tirah baring 24 jam. Hasil penelitian didapat tidak ada perbedaan yang signifikan komplikasi neurologis pada pasien pascaanestesi spinal yang dilakukan mobilisasi cepat dibanding dengan mobilisasi lambat dengan nilai p=0,456. Simpulan penelitian ini tidak ada perbedaan kejadian komplikasi neurologis antara pasien pascaanestesi spinal dengan mobilisasi cepat dan mobilisasi setelah tirah baring 24 jam.
<p><strong></strong>Surgery in patients with astrocytoma is performed based on the size of the tumor in the brain and the functional status of the patients. Management of patients with intracranial hypertension can be guided by monitoring intracranial pressure (ICP) perioperatively. A variety of ventricular, intraparenchymal, and subdural equipment can be installed by neurosurgeons to provide ICP measurements.</p><p>We reported a 50-year-old female patient, with a complaint of having a speech disorder since four years ago. Preoperative physical examination showed GCS E4V5M6, patient's body mass index was 29.29 kg/m<sup>2</sup> (obese). Patient’s physical status was assessed with ASA 3. There was no significant abnormality in laboratory examination. MRI Brain contrast examination showed solid cystic lesion in supratentorial left temporal lobe with size 2.3x3.5x4.7cm accompanied by broad perifocal edema in the left frontal, temporal and parietal lobe. The chest X-ray showed cardiomegaly and pneumonia. Electrocardiography showed normal sinus rhythm.</p><p>Craniotomy in patients with astrocytoma is performed based on the size of the tumor in the brain and the functional status of the patient. Preoperative evaluation for patients undergoing craniotomy should be carried out to determine the presence or absence of intracranial hypertension. In principle, postoperative management in the ICU is to control the respiratory system, optimize the cardiovascular system, and prevent possible complications.</p><p>Management of intracranial pressure control in reciprocal grade 3 astrocytoma patient should be paid attention to various things and consider the condition of the patients. Preoperative preparations, as well as perioperative and postoperative monitoring, should be carefully observed to prevent complications that will adversely affect patients.</p><p> </p>
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