http://localhost:8080/xmlui/handle/123456789/9669 2026-04-18T18:15:23Z 2026-04-18T18:15:23Z Adip Pradipta, Eka Rossimarina, Vienna Kemalasari, Indira Suridanda Danny, Siska http://localhost:8080/xmlui/handle/123456789/9682 2025-02-17T01:34:06Z 2024-01-01T00:00:00Z

Title: Critical Management of Haemodynamically Unstable Acute Pulmonary Embolism in COVID-19 Authors: Adip Pradipta, Eka; Rossimarina, Vienna; Kemalasari, Indira; Suridanda Danny, Siska Abstract: Thrombotic events occur in up to one-third of patients with COVID-19, predominantly manifesting as pulmonary emboli (PE), which are associated with higher morbidity and mortality. Acute PE should therefore be one of the main differential diagnoses of COVID-19 patients who develop hemodynamic instability. Early systemic thrombolysis remains the first line of treatment for hemodynamically unstable PE in those infected with COVID-19, particularly considering the risks of infection to other personnel during catheter-directed thrombolysis procedures. This report aims to describe a typical case of hemodynamically unstable acute PE with COVID-19 management in our center. A 66-year-old male presented to ER with shortness of breath and desaturation was suspected of having COVID-19. Despite unremarkable physical examination, he was later confirmed to be COVID-19 positive. While in the isolation ward, he experienced a cardiac arrest. 12-lead ECG showed sign of right ventricular strain and subsequently bedside echocardiography showed a fresh thrombus in the right atria with signs of acute right ventricular dysfunction. The diagnosis of acute PE with hemodynamic instability was made, and systemic thrombolysis was immediately initiated. Despite the bleeding complication, his symptoms and hemodynamic improved and he was discharged safely with oral anticoagulant. Our case demonstrates how early recognition and prompt treatment of acute PE especially in COVID-19 patients with hemodynamic instability, can be life saving. Recognizing the subtle signs of acute PE during emergency improves patients outcome considerably. Keywords: hemodynamic instability, acute pulmonary embolism, COVID-19.

2024-01-01T00:00:00Z Chen Lie, Khie Yonggara, Yosia Pasaribu, Adeline Shakinah, Sharifah Nainggolan, Leonard http://localhost:8080/xmlui/handle/123456789/9681 2025-02-17T01:29:52Z 2024-01-01T00:00:00Z

Title: Outcome Prediction in Infectious Disease Authors: Chen Lie, Khie; Yonggara, Yosia; Pasaribu, Adeline; Shakinah, Sharifah; Nainggolan, Leonard Abstract: Sepsis is a critical, life-threatening condition that demands precise prediction to mitigate adverse outcomes. The heterogeneity of sepsis leads to variable prognoses, making early and accurate identification increasingly difficult. Despite ongoing advancements, no single gold standard has emerged for sepsis prediction. Current research explores a range of prognostic tools, from traditional scoring systems and biomarkers to cutting-edge omics technologies and artificial intelligence. These tools can differ significantly across patient populations and clinical settings, such as the emergency department (ED) and intensive care unit (ICU). This review aims to critically evaluate the development and application of outcome prediction modalities in sepsis and other infectious diseases, highlighting the progress made and identifying areas for further research. Keywords: Outcome prediction, Infectious Disease, Sepsis

2024-01-01T00:00:00Z Arıcı, Cumhur Calis, Hasan Demirbakan, Kenan Demirok, Zeki http://localhost:8080/xmlui/handle/123456789/9680 2025-02-17T01:27:08Z 2024-01-01T00:00:00Z

Title: Axillary Lymph Node Metastasis in Papillary Thyroid Carcinoma at Early Perioperative Period: Report of a Case and Review of the Literature Authors: Arıcı, Cumhur; Calis, Hasan; Demirbakan, Kenan; Demirok, Zeki Abstract: 36-year-old woman with a history of neck swelling was diagnosed with papillary thyroid carcinoma, a common but typically slow-growing thyroid cancer with a good prognosis. Despite frequent lymph node metastasis, mortality rates are low. This cancer can rarely spread to unusual areas like the axillary region. The patient had multiple nodules in her thyroid and metastasis to cervical lymph nodes. After a total thyroidectomy and neck dissection, 14 metastatic lymph nodes were found. Post-surgery, radioactive iodine treatment and a whole-body scan revealed axillary lymph node involvement, confirmed as metastasis from the thyroid cancer. Papillary thyroid carcinomas usually have an excellent survival rate, but some can be aggressive. Risk factors for poor outcomes include larger tumors, extracapsular spread, older age, specific variants, and distant metastasis. Surgical removal is the primary treatment, aiming to eliminate local and regional spread. However, metastasis to atypical regions like the axilla is rare and not well understood due to limited data. It’s thought to spread retrograde from the neck or due to abnormal lymphatic flow caused by surgery. Axillary metastasis is often found during or after surgery and may indicate systemic disease. Imaging techniques are used for detection. While it’s usually a sign of poor prognosis, isolated cases without distant metastasis exist. Aggressive thyroid cancer treatment should consider the potential for distant metastases. Keywords:Axillary metastasis, Thyroid cancer

2024-01-01T00:00:00Z Kimberly Tjahjadi, Angela Tjempakasari, Artaria http://localhost:8080/xmlui/handle/123456789/9679 2025-02-17T01:24:26Z 2024-01-01T00:00:00Z

Title: Anuric Acute Kidney Injury in Chronic Myeloid Leukemia: A Rare Complication Case Authors: Kimberly Tjahjadi, Angela; Tjempakasari, Artaria Abstract: This report describes a rare case of anuric acute kidney injury related to suspected urate nephropathy in a 23-year-old male with chronic phase of Chronic Myeloid Leukemia (CML). The patient presented with anuria and limb edema, with a history of imatinib-treated CML. Investigations revealed probable urate crystals causing bilateral hydronephrosis and hydroureters. Management included fluid restriction to maintain euvolemic status, hypouricemic agents, urinary alkalinization, urgent hemodialysis for acute kidney injury, and blood product transfusions to address haematological imbalances. The continued use of imatinib and aforementioned treatments resulted in the restoration of renal function depicted through normalization of serum urea, creatinine and uric acid levels. This case highlights the importance of meticulous assessment and management of anuric acute kidney injury in CML patients to ensure a positive outcome. Keywords: anuria; acute kidney injury; chronic myeloid leukemia

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