AIM: This study aimed to design a predictive score model of clinical outcome sepsis and bacterial profiles of blood and sputum cultures in the intensive care unit (ICU) of a tertiary referral hospital. METHODS: An observational retrospective study was conducted in 2017–2020 using medical record data in the ICU of Dr. Soetomo Hospital as tertiary referral hospital. The predictor of sepsis prognosis was Acute Physiology and Chronic Health Evaluation II (APACHE II), blood and sputum culture results, procalcitonin (PCT) levels, and antimicrobial resistance in blood and sputum cultures. The model was prepared by logistic regression analysis and receiver operating characteristic (ROC) curves. RESULTS: Data from 355 subjects showed that predictor score was APACHE II, blood and sputum culture results; besides PCT levels were found to contribute significantly to predictive score of sepsis clinical output (p<0.05), while the predictor test of antimicrobial resistance in blood and sputum cultures was not significant to predictive score of sepsis clinical output (p > 0.05). The resulting scores to predict sepsis clinical outcomes include PCT level >2 ng/mL (1.61), APACHE score >20 (1), sputum culture as true pathogen (1.1), and blood culture as true pathogen (1.35). When the total score ≥3, the patient will die, while when the score <3, the patient will survive. ROC curves analysis obtained area under curve 0.859 (p < 0.05) which indicates that the equation is statistically significant in predicting the sepsis clinical outcome. Probability scores and death outcomes indicate that the higher the predictive score, the higher the probability of dying, with a score >3 the probability of dying is above 95.27%, whereas if the score is 5, the probability of dying is above 99%. The bacterial profile of blood cultures leading to mortality is predominately Gram-positive (34.4%), consisting of coagulase-negative Staphylococcus (22.9%), and Staphylococcus aureus (4.3%), while Gram-negative is only 14.7%, which consists of Enterobacteriaceae group (8.7%), Acinetobacter baumannii (4%), polymicrobial infection (2%), Burkholderia cepacia (0.8%), and Pseudomonas aeruginosa (0.4%). Sputum culture profile of patients with sepsis who died in the ICU of a tertiary referral RSUD Soetomo is dominated by Gram-negative, namely, A. baumannii (22.1%), Enterobacteriaceae group (20.6%), P. aeruginosa (11.1%), while Gram-positive is S. aureus (22.9%). CONCLUSION: The predictive score model for sepsis clinical outcomes in the ICU of a tertiary referral hospitals can be used as a basis for determining of patient management and the profile of the bacteria that causes sepsis that results in death.
Background: The initial presentation of hospitalized End-Stage Kidney Disease (ESKD) patients with and without coronavirus disease 2019 (COVID-19) is similar and can overlap. We aimed to compare clinical dan laboratory characteristics of the COVID-19 positive and negative patients to help clinicians screen and differentiate hospitalized ESKD patients. Methods: We reviewed data from the medical record of ESKD patients hospitalized between May 1, 2020, and April 30, 2021. The study comprised all suspected COVID-19 patients. The COVID-19 positive was based on results from RT-PCR for SARS-CoV-2. The bivariate analysis was used to compare the positive and negative groups. The association of all characteristics and diagnosis of COVID-19 were then evaluated by multivariable analysis. Results: There was twenty-nine percent of confirmed COVID-19 in 176 ESKD patients. The proportion of dyspnea, pulmonary edema, pleural effusion, and cardiomegaly were lower in the COVID-19 positive group. Diastolic blood pressure, pulse rate, white blood cell differential counts, and potassium were lower in the COVID-19 positive group. Using a multivariate analysis, eosinophil count <0.04 x103µl (P<0.001, OR 3.50, 95%CI:0.123-0.665), monocyte count <0.69 x103µl (P=0.004, OR 2.54, 95%CI:0.166-0.931), and neutrophil-to-lymphocyte ratio (NLR) <3.13 (P=0.044, OR 3.18, 95%CI:0.102-0.968) were associated with the presence of COVID-19. Conclusions: Leukocyte differential count and chest x-ray should be evaluated as an initial screening of COVID-19 in hospitalized ESKD. Low levels of monocyte and eosinophil count and mild elevation of NLR were associated with COVID-19 in ESKD patients.
Latar belakang: International Labour Organtization (ILO) memperkirakan sekitar 1,9 juta kematian terjadi setiap tahunnya di dunia akibat penyakit terkait pekerjaan. Penyakit terkait kerja yang relatif baru, seperti keluhan muskuloskeletal, sedang meningkat angka kejadiannya di beberapa negara. Keluhan muskuloskeletal dilaporkan memiliki prevalensi yang tinggi di antara pekerja pertambangan, namun terdapat kekurangan dalam hal pendataan dan kurangnya kesadaran akan masalah tersebut. Postur kerja merupakan salah satu faktor yang dapat meningkatkan kejadian gangguan tersebut. Penelitian ini bertujuan untuk mengetahui hubungan antara postur kerja dengan keluhan muskuloskeletal pada penambang emas di Sekotong. Metode: Penelitian ini adalah penelitian analitik observasional dengan rancangan cross sectional. Sampel penelitian sebanyak 53 orang didapatkan dengan teknik consecutive sampling. Penilaian risiko postur kerja menggunakan lembar kerja REBA dan keluhan muskuloskeletal menggunakan Standardised Nordic Questionnaire. Data dianalisis dengan uji korelasi koefisien kontingensi. Hasil: Dari 53 subyek penelitian, terdapat 31 orang (58,5%) dengan risiko postur kerja sedang, 16 orang (30,2%) risiko tinggi, dan 6 orang (11,3%) risiko sangat tinggi. Responden yang mengalami keluhan muskuloskeletal berjumlah 38 orang (71,7%). Berdasarkan uji koefisien kontingensi diperoleh hasil bahwa terdapat hubungan yang signifikan antara postur kerja dengan keluhan muskuloskeletal pada penambang (p=0,028), terutama keluhan pada bahu, punggung, dan pinggang Kesimpulan: Terdapat hubungan antara postur kerja yang tidak ergonomis dengan keluhan muskuloskeletal pada penambang emas di Sekotong, Lombok Barat
ABSTRAKCOVID-19 merupakan penyakit infeksi saluran pernapasan yang dapat menginfeksi semua orangdengan berbagai kelompok usia maupun jenis kelamin. COVID-19 dapat ditularkan melalui droplet(bantuk dan bersin), kontak langsung dengan penderita maupun kontak tidak langsung setelahmemegang barang yang terkena percikan air liur penderita. Masyarakat yang tidak mendapatkaninformasi yang baik dan tepat, rentan menerima berita yang salah atau hoax. Selain itu rendahnya dayabeli masyarakat daerah juga menjadi faktor rendahnya kesadaran masyarakat untuk menerapkanprotokol kesehatan 3M (masker, mencuci tangan dan menjaga jarak). Kegiatan ini bertujuan untukmemberikan pengetahuan yang benar kepada masyarakat mengenai COVID-19 serta melatihmasyarakat di Dusun Batu Layar Utara, Lombok Barat, bagaimana cara menggunakan masker yangbenar, membersihkan masker dan mencuci tangan dengan baik dan benar, sehingga pencegahanCOVID-19 dapat dilakukan secara optimal. Dengan demikian angka morbitas dan mortalitas COVID19 dapat diturunkan secepatnya. Kegiatan ini juga bertujuan membantu pemenuhan kebutuhan maskerdan hand hygiene bagi masyarakat setempat serta memberikan bantuan donasi kepada PuskesmasMeninting berupa APD (masker dan hazmat) sehingga dapat meningkatkan kinerja dan mencegahpenularan yang banyak dialami oleh para nakes.
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