Journal of Medicine and Health Technology

Interventional Pain Management in Degenerative Spine Disorders: A Case Report

Muhammad Bayu Zohari Hutagalung — 2024-11-10

Low back pain (LBP) is a common health issue affecting a significant portion of the population, particularly adults aged 35-55 years. Nearly 70-80% of individuals in developed countries experience LBP at some point in their lives. We reported a 54-year-old female presenting with LBP persisting for one year. Her pain predominantly occurs during walking, is limited to 100 meters, and is characterized by gripping sensations in the thigh and calf, exacerbated by positional changes but relieved with rest. Imaging revealed anterior listhesis of the L4 vertebral body relative to L5 (<25%) and multiple bulging discs at various lumbar levels, most notably severe at L4-5 with moderate central and severe bilateral neural foraminal stenosis. The patient underwent Selective Nerve Root Block (SNRB) and facet joint blocks with local anesthetic and steroid medication, resulting in a reduction of pain complaints and decreased leg numbness post-intervention. Understanding and addressing specific spinal pathologies in this case was expected to guide effective treatment strategies to alleviate symptoms and improve patient function.

Successful Management of High-Risk Pregnancy with TORCH Infection History and Chronic Hypertension

Rumman Karimah — 2024-11-10

A 41-year-old pregnant woman of Javanese ethnicity attended the outpatient clinic of a private hospital, presented with fifth pregnancy and no living children due to a history of ectopic pregnancy, two times IUFD, and one time neonatal death. The patient also had a history of chronic hypertension and asthma. The examination showed positive IgG Toxoplasma and CMV antibody levels. The patient's blood pressure also never touched the normal limit since the beginning of pregnancy. At the end of pregnancy, she had very high blood pressure and proteinuria. According to WHO Maternal Mortality Rate (MMR) is still very high, where two of the five highest causes are infection and hypertension in pregnancy. High risk pregnancies require special attention in monitoring during pregnancy and management. In a history of bad obstetrical history it is necessary to screen for infection which can be done by antibody serology testing. A positive IgG indicates immunity to the virus, if possible it is necessary to check IgG Avidity to determine whether therapy is still needed or can rely on the immune system that has been formed. Chronic hypertension (Systolic Blood Pressure (SBP) > 140 mmHg and / or Diastolic Blood Pressure (DBP) > 90 mmHg since < 20 Weeks Gestational Age (WGA) until 42 days after delivery). First-line Labetalol and Nifedipine or second-line Methyldopa and Hydrochlorothiazide should be considered depending on the condition and gestational age. If there are signs of preeclampsia, termination should be done if possible, along with antihypertensives and anticonvulsants such as MgSO4.

Epilepsy or Eclampsia in Differential Diagnosis of Recurrent Seizures in Pregnancy Aisyiyah Bojonegoro Hospital: A Diagnostic Dilemma? A Case Report

Reyfal Khaidar — 2024-11-10

Seizures in pregnancy can lead to adverse maternal and perinatal outcomes, often arising from various factors necessitating clear diagnosis for effective therapy. Concurrent occurrence of multiple causative factors can complicate diagnostic and therapeutic decisions. We present a case of a 32-week pregnant woman with poorly managed epilepsy who experienced eclampsia and recurrent seizures. Treatment involved multiple medications and emergency cesarean delivery with meticulous blood pressure control. Close monitoring and therapy adjustment were crucial. Managing seizures in such cases poses a dilemma, necessitating initial focus on airway, breathing, and circulation stabilization. Immediate delivery of a viable fetus and maternal health maintenance are paramount. Anesthetic goals encompass seizure and blood pressure control, hemodynamic stability, and intensive care support for potential complications. While eclampsia is a significant factor, seizures in pregnancy may arise from diverse causes, demanding early diagnosis and tailored treatment for optimal patient outcomes.

Corticosteroid Effect in Acute Spinal Cord Injury in the Rural Area

Muhammad Rafif Amir — 2024-11-10

Spinal cord injuries (SCI) are devastating traumatic events in the lives of patients, often resulting in severe and/or permanent neurologic disabilities. Nearly half a million people are living permanently disabled in the United States due to traumatic SCI and 12,000–15,000 patients per year incur new injuries. A 78-year-old male patient came to the emergency room with a history of falling from a height with a pelvic position below exposed to trees 30 hours before admission, found weakness in the lower limbs, unable to urinate since yesterday. On radiologic examination, a burst fracture was found in the collumna of the 1^stlumbar vertebra. The patient could not be examined for MRI due to limitations and unavailability of equipment at the hospital. The patient was given high dose of Methylprednisolone treatment for 3 days and there was no motoric improvement in the patient. Acute spinal cord injury is a very dangerous disease because it can cause patients both psychological and non psychological disorders. In areas that are left behind and do not have very good facilities and medical personnel to carry out this treatment. There is no treatment option other than using corticosteroids. However, the effect of corticosteroids still needs to be further developed and researched.

Multidisciplinary Treatment on a 69 years-old Male with Kidney Stone and Chronic Kidney Disease

Patricia Prabawati — 2024-11-10

Introduction Obstruction by kidney stones is one of the causes of chronic kidney disease (CKD). Out of all CKD cases, 10.3% are associated with obstruction due to kidney stones. Treatment of kidney stones can restore kidney function, but requires holistic and intense collaboration between urologists to treat the stones, nephrologist to monitor kidney function, and nutritionists to provide proper diet to prevent kidney stone reccurence

Case Presentation A 69-year old male presented to the emergency departement with flank pain since 1 week ago. The patient complained of frequent flank pain since the last year. BOF radiological examination found staghorn stones in the right kidney, and ultrasonography revealed severe hydronephrosis of the right kidney. An impaired kidney function and decreased eGFR related to CKD were also found. The urologist performed bivalve nephrolithotomy on the right kidney. Afterwards, a histopathological examination was done to determine the stone material for further collaborative management with internist and nutritionist. After consultation with nutritionists regarding nutritional needs, monitoring from internist was done to monitor comorbidities and progression of CKD. Kidney function was evaluated after collaborative management and we found improvement on kidney function.

Discussion In patients with CKD caused by obstruction due to kidney stones, it is necessary to treat the kidney stones first to relieve obstruction and restore kidney function. In this case the role of the internist is to control and recover kidney function after urologists have relieved the patient from urinary obstruction. Kidney stones that have been successfully removed are subjected to histopathological examination to determine its composition. After the composition were identified, consultation with a nutritionist is carried out to determine the right diet for the patient. With the right diet, prevention of stone reoccurrence is expected.

Conclusion A history of kidney stones is associated with an increased risk of CKD. Multidisciplinary collaboration between urologists, nephrologist, and nutritionists helps lower the risk of stone recurrence and minimize the need for additional operative procedures through a focus on dietary and medical approaches and improved kidney function.

Traumatic Diaphragmatic Rupture Leading to Tension Gastrothorax: A Critical Case Report and Surgical Insight

Ivor Wiguna Hartanto WIlopo — 2024-11-10

Traumatic diaphragmatic rupture (TDR) is a serious but relatively uncommon injury, often resulting from blunt trauma, particularly motor vehicle accidents. Among these, blunt TDR presents with more severe outcomes than penetrating injuries, including higher mortality rates. A life-threatening complication of TDR is gastrothorax, which occurs when the stomach herniates into the thoracic cavity, leading to elevated intrathoracic pressure and potentially fatal consequences such as respiratory failure or cardiac arrest. This case reported a 23-year-old male who sustained a motor vehicle collision, presenting with progressive shortness of breath, nausea, and vomiting 15 hours post-injury. Imaging confirmed a diaphragmatic rupture with associated tension gastrothorax. Immediate intervention with nasogastric tube placement provided symptom relief, followed by exploratory laparotomy to repair the diaphragmatic defect. The patient's recovery was uneventful, demonstrating the critical importance of early diagnosis and timely surgical management in cases of TDR with gastrothorax. Traumatic diaphragmatic rupture occurs in approximately 0.8–1.6% of trauma cases, with motor vehicle accidents being the leading cause. Due to its potential for delayed diagnosis, the rupture is often missed initially, leading to higher rates of morbidity and mortality. Early detection is critical, as it can prevent serious complications such as bowel herniation into the thoracic cavity, respiratory distress, or even death.