Ferdy Iskandar - Academia.edu (original) (raw)

Papers by Ferdy Iskandar

Research paper thumbnail of Devastating Mooren Ulcer Halt by Timely Aggressive Treatment - A Case Report

Ophthalmologica Indonesiana, Feb 12, 2024

Research paper thumbnail of Silent Progressive Glaucoma in Encephalofacial angiomatosis (Sturge-Weber Syndrome): A Vision-Preserving Trabeculectomy

Ophthalmologica Indonesiana, Feb 12, 2024

Research paper thumbnail of Into the Darkness and Silence: Evisceration in a Deaf-Mute- Blind Patient with Neglected Glaucoma

Ophthalmologica Indonesiana, Feb 12, 2024

Research paper thumbnail of Combined Virna Glaucoma Implant (VGI) Implantation and Pars Plana Vitrectomy for Refractory Aphakic Glaucoma

Ophthalmologica Indonesiana, Feb 12, 2024

Research paper thumbnail of Safe Conception Choices for Human Immunodeficiency Virus (HIV)-Positive Couples

Advanced Science Letters, Sep 1, 2018

Research paper thumbnail of Ipsilateral Ophthalmic Artery Stenosis in Amaurosis Fugax: A Case Report

IJRETINA (International Journal of Retina), Feb 22, 2021

Introduction: Amaurosis fugax is caused by an abrupt reduction of blood flow to the retina. Deter... more Introduction: Amaurosis fugax is caused by an abrupt reduction of blood flow to the retina. Determining the etiology of amaurosis fugax should ensure proper management. Case Report: A 47-year-old female patient complaint about the first episode of sudden vision loss in her right eye and was referred to our hospital. The vision loss resolved spontaneously, however, we found a 3 mm long stenosis at her right ophthalmic artery during magnetic resonance angiography. She had clinical histories of untreated hypertension and dyslipidemia. Transient ischemic attack (TIA) was suspected and unfractionated heparin, aspirin, antihypertensive agent, and statin were given. Treatments were maintained, the symptoms had not recurred in the following 6 months after the event. Discussion: Stenosis of the ophthalmic artery is very rare. It occurs in approximately 2% of patient suffering from amaurosis fugax. In our case, stenosis of the right ophthalmic artery due to thromboembolism might cause retinal ischemia leading to a transient visual loss. Conclusion: This case suggests stenosis of ophthalmic artery as the cause of amaurosis fugax.

Research paper thumbnail of Mini Health Technology Assessment of Urban and Rural Health Care in Indonesia

Bali Medical Journal, Oct 3, 2018

Background: Health Technology Assessment (HTA) is a program to evaluate the use of technology in ... more Background: Health Technology Assessment (HTA) is a program to evaluate the use of technology in healthcare. HTA proposed by World Health Organization (WHO) will affect the government's decision-making in the development of healthcare technology. The use of technology should assess from its cost-effectiveness to its potential ethical problems. HTA Unit-a division who organizes HTA in government in Indonesia-has emerged in the ministry of health in 2003 and focused on drugs and vaccines problems. However, HTA in Indonesia has not been formally valid until today. This study aimed to evaluate the usage, supply, and demand of the health technology and the spread of health technology in urban and rural areas. Methods: This study is a cross-sectional study using a questionnaire to gather quantitative and qualitative data. The respondents of this study are medical doctors in Indonesia, and the selection of the respondents is made consecutively. We divide respondents' area into urban and rural areas and health practitioners as field executors (general practitioners or GP and specialists) and head of healthcare facilities. Results: The total samples are 48 health practitioners and 14 head of healthcare facilities. Statistical analysis shows that the two settings (urban and rural) are not significantly different (p=0.478), while descriptive analysis shows that the inadequacy of health technology is higher in rural than that in urban areas (70% VS 52.63%). The relationship between the field of health practitioners (GP and specialist) and the adequacy of health technology is not significant. More GP than specialists complain about the inadequacy of health technology in giving the health service to the patients. About 92.8% head of health facility said that technology is needed to support the health service, while only 35.71% agreed that their health facilities still have low health technology. Conclusion: The use of health technology in Indonesia is still inadequate. The spread of health technology is not equal in urban and rural areas. The lack of health technology in rural areas, especially for GP, affect in diagnosing and giving therapy to patients. The poor spread of technology in healthcare also make a gap between health research and health clinical practice.

Research paper thumbnail of Manifestasi Okular Coronavirus Disease 2019 (COVID-19): Klinis dan pencegahan

Cermin Dunia Kedokteran, Oct 1, 2020

Pandemi global Coronavirus Disease 2019 (COVID-19) memiliki gejala utama batuk, demam, kelelahan,... more Pandemi global Coronavirus Disease 2019 (COVID-19) memiliki gejala utama batuk, demam, kelelahan, sesak napas, dan gejala respiratori lainnya. Didapatkan kasus pasien COVID-19 yang memiliki keluhan okular seperti konjungtivitis. Angiotensin-converting enzyme 2 (ACE2), yang merupakan reseptor SARS-CoV-2, juga didapatkan pada sel epitel konjungtiva dan kornea manusia, sehingga memungkinkan transmisi melalui okular. Tatalaksana gejala okular pada COVID-19 hingga saat ini masih terus dikembangkan serta diuji coba.

Research paper thumbnail of Global economic burden of unmet surgical need for appendicitis

British Journal of Surgery

Background There is a substantial gap in provision of adequate surgical care in many low- and mid... more Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality wa...

Research paper thumbnail of Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

BJS Open, 2019

Background: End colostomy rates following colorectal resection vary across institutions in high-i... more Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6⋅9 per cent) from low-HDI, 254 (15⋅5 per cent) from middle-HDI and 1268 (77⋅6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57⋅5, 40⋅9 and 35⋅4 per cent; P < 0⋅001) and subsequent use of end colostomy (52⋅2, 24⋅8 and 18⋅9 per cent; P < 0⋅001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3⋅20, 95 per cent c.i. 1⋅35 to 7⋅57; P = 0⋅008) after risk adjustment for malignant disease (OR 2⋅34, 1⋅65 to 3⋅32; P < 0⋅001), emergency surgery (OR 4⋅08, 2⋅73 to 6⋅10; P < 0⋅001), time to operation at least 48 h (OR 1⋅99, 1⋅28 to 3⋅09; P = 0⋅002) and disease perforation (OR 4⋅00, 2⋅81 to 5⋅69; P < 0⋅001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.

Research paper thumbnail of Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

British Journal of Surgery, 2019

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practi... more Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle...

Research paper thumbnail of Selenium sebagai Terapi Oftalmopati Graves Derajat Ringan

Journal Of The Indonesian Medical Association

Oftalmopati Graves (OG) merupakan manifestasi ekstra-tiroid tersering dari penyakit Graves. Seban... more Oftalmopati Graves (OG) merupakan manifestasi ekstra-tiroid tersering dari penyakit Graves. Sebanyak lebih dari 50% penderita Graves akan mengalami OG, bahkan 10% diantaranya menderita OG derajat berat. Mekanisme terjadinya OG berhubungan dengan reaksi autoimun yang sangat kompleks dan dicurigai juga berhubungan dengan ketidakseimbangan kadar antioksidan serta oksidan di dalam tubuh. Selain itu, faktor lingkungan (rokok) dan juga kontrol yang buruk dari penyakit Graves semakin memicu progresifitas dari oftalmopati.Salah satu komponen antioksidan yang paling banyak terdapat pada kelenjar tiroid adalah selenium. Selenium diharapkan dapat membantu mengatasi OG terutama pada derajat ringan dengan memperbaiki ketidakseimbangan antara kadar oksidan dan antioksidan di dalam tubuh. Namun, pemberian selenium tidak dapat dilakukan secara bebas karena pemberian dalam jumlah yang tidak tepat dapat memicu timbulnya beberapa jenis kanker dan juga diabetes mellitus tipe II.

Research paper thumbnail of Aspirin Dosis Rendah untuk Pencegahan Preeklampsia dan Komplikasinya

Preeklampsia merupakan penyebab utama morbiditas dan mortalitas ibu hamil (bumil), persalinan pre... more Preeklampsia merupakan penyebab utama morbiditas dan mortalitas ibu hamil (bumil), persalinan prematur, kematian perinatal, dan pertumbuhan janin terhambat (PJT). Aspirin dosis rendah dapat mengurangi risiko tersebut, terutama pada kehamilan risiko tinggi. Terapi ini menghambat vasokonstriksi yang diperantarai tromboksan dan mencegah kegagalan transformasi fisiologis arteri spiralis. Penggunaannya tidak berhubungan dengan komplikasi yang signifikan. Preeclampsia is the major cause of morbidity and mortality of pregnant women, premature delivery, perinatal mortality, and intrauterine growth retardation (IUGR). Low-dose aspirin can reduce the risk, especially in high-risk pregnancies. This therapy inhibits thromboxane-mediated vasoconstriction and prevents the failure of a physiological transformation of spiral arteries. Its use is not associated with significant complications.

Research paper thumbnail of Funduskopi untuk Prognosis Preeklampsia

Hipertensi dalam kehamilan (HDK) merupakan masalah kesehatan yang perlu mendapat perhatian karena... more Hipertensi dalam kehamilan (HDK) merupakan masalah kesehatan yang perlu mendapat perhatian karena mengakibatkan lebih dari 25% kematian ibu di Indonesia pada tahun 2013. Pada preeklampsia – yang merupakan salah satu HDK – terjadi disfungsi endotel berbagai organ ibu hamil, termasuk organ mata. Konsekuensi tersering adalah vasospasme umum disertai kebocoran plasma yang menyebabkan iskemi retina hingga kerusakan visus permanen. Derajat kelainan retina ibu hamil berdasarkan klasifikasi Keith-Wagener-Barker berbanding lurus dengan angka kematian serta angka kecacatan penglihatan. Funduskopi sebagai salah satu sarana pelengkap dapat menjadi sarana objektif memperkirakan prognosis ibu hamil dan juga status janin.

Research paper thumbnail of Ipsilateral Ophthalmic Artery Stenosis in Amaurosis Fugax: A Case Report

Introduction: Amaurosis fugax is caused by an abrupt reduction of blood flow to the retina. Deter... more Introduction: Amaurosis fugax is caused by an abrupt reduction of blood flow to the retina. Determining the etiology of amaurosis fugax should ensure proper management. Case Report: A 47-year-old female patient who had the first episode of amaurosis fugax in her right eye was referred to our hospital. The amaurosis fugax resolved spontaneously, however, we found a 3 mm long stenosis at her right ophthalmic artery during magnetic resonance angiography. She had clinical histories of untreated hypertension and dyslipidemia. Transient ischemic attack (TIA) was suspected and unfractionated heparin, aspirin, antihypertensive agent, and statin were given. Treatments were maintained, the symptoms had not recurred in the following 6 months after the event. Discussion: Stenosis of the ophthalmic artery is very rare. It occurs in approximately 2% of patient suffering from amaurosis fugax. In our case, stenosis of the right ophthalmic artery due to thromboembolism might cause retinal ischemia l...

Research paper thumbnail of Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

The Lancet. Infectious diseases, Jan 13, 2018

Surgical site infection (SSI) is one of the most common infections associated with health care, b... more Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with e...

Research paper thumbnail of Kontroversi Persalinan Spontan pada Miopia Tinggi

Cermin Dunia Kedokteran

Gangguan refraksi khususnya miopia tinggi pada wanita hamil sering dikaitkan dengan kejadian abla... more Gangguan refraksi khususnya miopia tinggi pada wanita hamil sering dikaitkan dengan kejadian ablasio retina pasca-persalinan, sehingga persalinan per abdominam atau bantuan instrumen cenderung direkomendasikan pada wanita hamil dengan miopia tinggi. Padahal, indikasi persalinan per abdominam pada miopia tinggi adalah adanya neovaskularisasi koroid dan subretinal (dengan bintik Fuchs). Hingga saat ini belum didapatkan bukti bahwa miopia tinggi dan riwayat operasi retina sebelumnya meningkatkan risiko ablasio retina saat persalinan per vaginam.Refractive disorders, especially high myopia in pregnant women are often associated with postpartum retinal detachment, thus there is a tendency to recommend cesarean section or instrument-assisted labor in pregnant women with high myopia. In fact, the indications for cesarean section in patients with high myopia are choroidal and subretinal neovascularization (with Fuchs spots). There is no evidence of increased risk of retinal detachment durin...

Research paper thumbnail of Manifestasi Okular Coronavirus Disease 2019 (COVID-19): Klinis dan pencegahan

Pandemi global Coronavirus Disease 2019 (COVID-19) memiliki gejala utama batuk, demam, kelelahan,... more Pandemi global Coronavirus Disease 2019 (COVID-19) memiliki gejala utama batuk, demam, kelelahan, sesak napas, dan gejala respiratori lainnya. Didapatkan kasus pasien COVID-19 yang memiliki keluhan okular seperti konjungtivitis. Angiotensin-converting enzyme 2 (ACE2), yang merupakan reseptor SARS-CoV-2 juga didapatkan pada sel epitel konjungtiva dan kornea manusia, sehingga memungkinkan transmisi melalui okular. Tatalaksana gejala okular pada COVID-19 hingga saat ini masih terus dikembangkan serta diuji coba. The Global Coronavirus Disease 2019 (COVID-19) pandemic has cough, fever, fatigue, shortness of breath, and other respiratory symptoms as the main symptoms. There were cases of COVID-19 patients with ocular complaints such as conjunctivitis. Angiotensin-converting enzyme 2 (ACE2) – SARS-CoV-2 receptor, is also found in human conjunctival and corneal epithelial cells, thus allowing ocular transmission. Treatment for ocular symptoms in COVID-19 are still being developed and tested.

Research paper thumbnail of Diquafosol Tetrasodium: Tatalaksana Terkini untuk Dry Eye Disease (DED) ?

Keratokonjungtivitis sicca (dry eye disease/DED) adalah penyakit multifaktorial permukaan okular ... more Keratokonjungtivitis sicca (dry eye disease/DED) adalah penyakit multifaktorial permukaan okular yang ditandai dengan hilangnya homeostasis film air mata disertai gejala okular. Diagnosis dan tatalaksana DED terbatas serta tidak memuaskan. Diquafosol tetrasodium “diquafosol” merupakan agonis reseptor P2Y2 yang dapat digunakan untuk mengobati DED dengan cara merehidrasi permukaan okular. Keratoconjunctivitis sicca (dry eye disease/DED) is a multifactorial disease of the ocular surface characterized by loss of tear film homeostasis accompanied by ocular symptoms. Diagnosis and treatment of DED is limited, and the result is not promising. Diquafosol tetrasodium “diquafosol” is a P2Y2 receptor agonist that can be used for DED treatment by rehydrating the ocular surface.

Research paper thumbnail of Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

The Lancet. Infectious diseases, Jan 13, 2018

Surgical site infection (SSI) is one of the most common infections associated with health care, b... more Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with e...

Research paper thumbnail of Devastating Mooren Ulcer Halt by Timely Aggressive Treatment - A Case Report

Ophthalmologica Indonesiana, Feb 12, 2024

Research paper thumbnail of Silent Progressive Glaucoma in Encephalofacial angiomatosis (Sturge-Weber Syndrome): A Vision-Preserving Trabeculectomy

Ophthalmologica Indonesiana, Feb 12, 2024

Research paper thumbnail of Into the Darkness and Silence: Evisceration in a Deaf-Mute- Blind Patient with Neglected Glaucoma

Ophthalmologica Indonesiana, Feb 12, 2024

Research paper thumbnail of Combined Virna Glaucoma Implant (VGI) Implantation and Pars Plana Vitrectomy for Refractory Aphakic Glaucoma

Ophthalmologica Indonesiana, Feb 12, 2024

Research paper thumbnail of Safe Conception Choices for Human Immunodeficiency Virus (HIV)-Positive Couples

Advanced Science Letters, Sep 1, 2018

Research paper thumbnail of Ipsilateral Ophthalmic Artery Stenosis in Amaurosis Fugax: A Case Report

IJRETINA (International Journal of Retina), Feb 22, 2021

Introduction: Amaurosis fugax is caused by an abrupt reduction of blood flow to the retina. Deter... more Introduction: Amaurosis fugax is caused by an abrupt reduction of blood flow to the retina. Determining the etiology of amaurosis fugax should ensure proper management. Case Report: A 47-year-old female patient complaint about the first episode of sudden vision loss in her right eye and was referred to our hospital. The vision loss resolved spontaneously, however, we found a 3 mm long stenosis at her right ophthalmic artery during magnetic resonance angiography. She had clinical histories of untreated hypertension and dyslipidemia. Transient ischemic attack (TIA) was suspected and unfractionated heparin, aspirin, antihypertensive agent, and statin were given. Treatments were maintained, the symptoms had not recurred in the following 6 months after the event. Discussion: Stenosis of the ophthalmic artery is very rare. It occurs in approximately 2% of patient suffering from amaurosis fugax. In our case, stenosis of the right ophthalmic artery due to thromboembolism might cause retinal ischemia leading to a transient visual loss. Conclusion: This case suggests stenosis of ophthalmic artery as the cause of amaurosis fugax.

Research paper thumbnail of Mini Health Technology Assessment of Urban and Rural Health Care in Indonesia

Bali Medical Journal, Oct 3, 2018

Background: Health Technology Assessment (HTA) is a program to evaluate the use of technology in ... more Background: Health Technology Assessment (HTA) is a program to evaluate the use of technology in healthcare. HTA proposed by World Health Organization (WHO) will affect the government's decision-making in the development of healthcare technology. The use of technology should assess from its cost-effectiveness to its potential ethical problems. HTA Unit-a division who organizes HTA in government in Indonesia-has emerged in the ministry of health in 2003 and focused on drugs and vaccines problems. However, HTA in Indonesia has not been formally valid until today. This study aimed to evaluate the usage, supply, and demand of the health technology and the spread of health technology in urban and rural areas. Methods: This study is a cross-sectional study using a questionnaire to gather quantitative and qualitative data. The respondents of this study are medical doctors in Indonesia, and the selection of the respondents is made consecutively. We divide respondents' area into urban and rural areas and health practitioners as field executors (general practitioners or GP and specialists) and head of healthcare facilities. Results: The total samples are 48 health practitioners and 14 head of healthcare facilities. Statistical analysis shows that the two settings (urban and rural) are not significantly different (p=0.478), while descriptive analysis shows that the inadequacy of health technology is higher in rural than that in urban areas (70% VS 52.63%). The relationship between the field of health practitioners (GP and specialist) and the adequacy of health technology is not significant. More GP than specialists complain about the inadequacy of health technology in giving the health service to the patients. About 92.8% head of health facility said that technology is needed to support the health service, while only 35.71% agreed that their health facilities still have low health technology. Conclusion: The use of health technology in Indonesia is still inadequate. The spread of health technology is not equal in urban and rural areas. The lack of health technology in rural areas, especially for GP, affect in diagnosing and giving therapy to patients. The poor spread of technology in healthcare also make a gap between health research and health clinical practice.

Research paper thumbnail of Manifestasi Okular Coronavirus Disease 2019 (COVID-19): Klinis dan pencegahan

Cermin Dunia Kedokteran, Oct 1, 2020

Pandemi global Coronavirus Disease 2019 (COVID-19) memiliki gejala utama batuk, demam, kelelahan,... more Pandemi global Coronavirus Disease 2019 (COVID-19) memiliki gejala utama batuk, demam, kelelahan, sesak napas, dan gejala respiratori lainnya. Didapatkan kasus pasien COVID-19 yang memiliki keluhan okular seperti konjungtivitis. Angiotensin-converting enzyme 2 (ACE2), yang merupakan reseptor SARS-CoV-2, juga didapatkan pada sel epitel konjungtiva dan kornea manusia, sehingga memungkinkan transmisi melalui okular. Tatalaksana gejala okular pada COVID-19 hingga saat ini masih terus dikembangkan serta diuji coba.

Research paper thumbnail of Global economic burden of unmet surgical need for appendicitis

British Journal of Surgery

Background There is a substantial gap in provision of adequate surgical care in many low- and mid... more Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality wa...

Research paper thumbnail of Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

BJS Open, 2019

Background: End colostomy rates following colorectal resection vary across institutions in high-i... more Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6⋅9 per cent) from low-HDI, 254 (15⋅5 per cent) from middle-HDI and 1268 (77⋅6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57⋅5, 40⋅9 and 35⋅4 per cent; P < 0⋅001) and subsequent use of end colostomy (52⋅2, 24⋅8 and 18⋅9 per cent; P < 0⋅001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3⋅20, 95 per cent c.i. 1⋅35 to 7⋅57; P = 0⋅008) after risk adjustment for malignant disease (OR 2⋅34, 1⋅65 to 3⋅32; P < 0⋅001), emergency surgery (OR 4⋅08, 2⋅73 to 6⋅10; P < 0⋅001), time to operation at least 48 h (OR 1⋅99, 1⋅28 to 3⋅09; P = 0⋅002) and disease perforation (OR 4⋅00, 2⋅81 to 5⋅69; P < 0⋅001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.

Research paper thumbnail of Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

British Journal of Surgery, 2019

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practi... more Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle...

Research paper thumbnail of Selenium sebagai Terapi Oftalmopati Graves Derajat Ringan

Journal Of The Indonesian Medical Association

Oftalmopati Graves (OG) merupakan manifestasi ekstra-tiroid tersering dari penyakit Graves. Seban... more Oftalmopati Graves (OG) merupakan manifestasi ekstra-tiroid tersering dari penyakit Graves. Sebanyak lebih dari 50% penderita Graves akan mengalami OG, bahkan 10% diantaranya menderita OG derajat berat. Mekanisme terjadinya OG berhubungan dengan reaksi autoimun yang sangat kompleks dan dicurigai juga berhubungan dengan ketidakseimbangan kadar antioksidan serta oksidan di dalam tubuh. Selain itu, faktor lingkungan (rokok) dan juga kontrol yang buruk dari penyakit Graves semakin memicu progresifitas dari oftalmopati.Salah satu komponen antioksidan yang paling banyak terdapat pada kelenjar tiroid adalah selenium. Selenium diharapkan dapat membantu mengatasi OG terutama pada derajat ringan dengan memperbaiki ketidakseimbangan antara kadar oksidan dan antioksidan di dalam tubuh. Namun, pemberian selenium tidak dapat dilakukan secara bebas karena pemberian dalam jumlah yang tidak tepat dapat memicu timbulnya beberapa jenis kanker dan juga diabetes mellitus tipe II.

Research paper thumbnail of Aspirin Dosis Rendah untuk Pencegahan Preeklampsia dan Komplikasinya

Preeklampsia merupakan penyebab utama morbiditas dan mortalitas ibu hamil (bumil), persalinan pre... more Preeklampsia merupakan penyebab utama morbiditas dan mortalitas ibu hamil (bumil), persalinan prematur, kematian perinatal, dan pertumbuhan janin terhambat (PJT). Aspirin dosis rendah dapat mengurangi risiko tersebut, terutama pada kehamilan risiko tinggi. Terapi ini menghambat vasokonstriksi yang diperantarai tromboksan dan mencegah kegagalan transformasi fisiologis arteri spiralis. Penggunaannya tidak berhubungan dengan komplikasi yang signifikan. Preeclampsia is the major cause of morbidity and mortality of pregnant women, premature delivery, perinatal mortality, and intrauterine growth retardation (IUGR). Low-dose aspirin can reduce the risk, especially in high-risk pregnancies. This therapy inhibits thromboxane-mediated vasoconstriction and prevents the failure of a physiological transformation of spiral arteries. Its use is not associated with significant complications.

Research paper thumbnail of Funduskopi untuk Prognosis Preeklampsia

Hipertensi dalam kehamilan (HDK) merupakan masalah kesehatan yang perlu mendapat perhatian karena... more Hipertensi dalam kehamilan (HDK) merupakan masalah kesehatan yang perlu mendapat perhatian karena mengakibatkan lebih dari 25% kematian ibu di Indonesia pada tahun 2013. Pada preeklampsia – yang merupakan salah satu HDK – terjadi disfungsi endotel berbagai organ ibu hamil, termasuk organ mata. Konsekuensi tersering adalah vasospasme umum disertai kebocoran plasma yang menyebabkan iskemi retina hingga kerusakan visus permanen. Derajat kelainan retina ibu hamil berdasarkan klasifikasi Keith-Wagener-Barker berbanding lurus dengan angka kematian serta angka kecacatan penglihatan. Funduskopi sebagai salah satu sarana pelengkap dapat menjadi sarana objektif memperkirakan prognosis ibu hamil dan juga status janin.

Research paper thumbnail of Ipsilateral Ophthalmic Artery Stenosis in Amaurosis Fugax: A Case Report

Introduction: Amaurosis fugax is caused by an abrupt reduction of blood flow to the retina. Deter... more Introduction: Amaurosis fugax is caused by an abrupt reduction of blood flow to the retina. Determining the etiology of amaurosis fugax should ensure proper management. Case Report: A 47-year-old female patient who had the first episode of amaurosis fugax in her right eye was referred to our hospital. The amaurosis fugax resolved spontaneously, however, we found a 3 mm long stenosis at her right ophthalmic artery during magnetic resonance angiography. She had clinical histories of untreated hypertension and dyslipidemia. Transient ischemic attack (TIA) was suspected and unfractionated heparin, aspirin, antihypertensive agent, and statin were given. Treatments were maintained, the symptoms had not recurred in the following 6 months after the event. Discussion: Stenosis of the ophthalmic artery is very rare. It occurs in approximately 2% of patient suffering from amaurosis fugax. In our case, stenosis of the right ophthalmic artery due to thromboembolism might cause retinal ischemia l...

Research paper thumbnail of Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

The Lancet. Infectious diseases, Jan 13, 2018

Surgical site infection (SSI) is one of the most common infections associated with health care, b... more Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with e...

Research paper thumbnail of Kontroversi Persalinan Spontan pada Miopia Tinggi

Cermin Dunia Kedokteran

Gangguan refraksi khususnya miopia tinggi pada wanita hamil sering dikaitkan dengan kejadian abla... more Gangguan refraksi khususnya miopia tinggi pada wanita hamil sering dikaitkan dengan kejadian ablasio retina pasca-persalinan, sehingga persalinan per abdominam atau bantuan instrumen cenderung direkomendasikan pada wanita hamil dengan miopia tinggi. Padahal, indikasi persalinan per abdominam pada miopia tinggi adalah adanya neovaskularisasi koroid dan subretinal (dengan bintik Fuchs). Hingga saat ini belum didapatkan bukti bahwa miopia tinggi dan riwayat operasi retina sebelumnya meningkatkan risiko ablasio retina saat persalinan per vaginam.Refractive disorders, especially high myopia in pregnant women are often associated with postpartum retinal detachment, thus there is a tendency to recommend cesarean section or instrument-assisted labor in pregnant women with high myopia. In fact, the indications for cesarean section in patients with high myopia are choroidal and subretinal neovascularization (with Fuchs spots). There is no evidence of increased risk of retinal detachment durin...

Research paper thumbnail of Manifestasi Okular Coronavirus Disease 2019 (COVID-19): Klinis dan pencegahan

Pandemi global Coronavirus Disease 2019 (COVID-19) memiliki gejala utama batuk, demam, kelelahan,... more Pandemi global Coronavirus Disease 2019 (COVID-19) memiliki gejala utama batuk, demam, kelelahan, sesak napas, dan gejala respiratori lainnya. Didapatkan kasus pasien COVID-19 yang memiliki keluhan okular seperti konjungtivitis. Angiotensin-converting enzyme 2 (ACE2), yang merupakan reseptor SARS-CoV-2 juga didapatkan pada sel epitel konjungtiva dan kornea manusia, sehingga memungkinkan transmisi melalui okular. Tatalaksana gejala okular pada COVID-19 hingga saat ini masih terus dikembangkan serta diuji coba. The Global Coronavirus Disease 2019 (COVID-19) pandemic has cough, fever, fatigue, shortness of breath, and other respiratory symptoms as the main symptoms. There were cases of COVID-19 patients with ocular complaints such as conjunctivitis. Angiotensin-converting enzyme 2 (ACE2) – SARS-CoV-2 receptor, is also found in human conjunctival and corneal epithelial cells, thus allowing ocular transmission. Treatment for ocular symptoms in COVID-19 are still being developed and tested.

Research paper thumbnail of Diquafosol Tetrasodium: Tatalaksana Terkini untuk Dry Eye Disease (DED) ?

Keratokonjungtivitis sicca (dry eye disease/DED) adalah penyakit multifaktorial permukaan okular ... more Keratokonjungtivitis sicca (dry eye disease/DED) adalah penyakit multifaktorial permukaan okular yang ditandai dengan hilangnya homeostasis film air mata disertai gejala okular. Diagnosis dan tatalaksana DED terbatas serta tidak memuaskan. Diquafosol tetrasodium “diquafosol” merupakan agonis reseptor P2Y2 yang dapat digunakan untuk mengobati DED dengan cara merehidrasi permukaan okular. Keratoconjunctivitis sicca (dry eye disease/DED) is a multifactorial disease of the ocular surface characterized by loss of tear film homeostasis accompanied by ocular symptoms. Diagnosis and treatment of DED is limited, and the result is not promising. Diquafosol tetrasodium “diquafosol” is a P2Y2 receptor agonist that can be used for DED treatment by rehydrating the ocular surface.

Research paper thumbnail of Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

The Lancet. Infectious diseases, Jan 13, 2018

Surgical site infection (SSI) is one of the most common infections associated with health care, b... more Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with e...