Pneumonia merupakan salah satu jenis infeksi nosokomial dengan jumlah kasus tertinggi dibanding dengan infeksi nosokomial lain di unit perawatan intensif (ICU) disertai jumlah morbiditas dan mortalitas yang tinggi. Pola pneumonia nosokomial merupakan suatu karakteristik pneumonia nosokomial yang digunakan untuk mengidentifikasi masalah dan dapat menjadi indikator untuk perbaikan terapi. Penelitian bertujuan menggambarkan pola pneumonia nosokomial di unit perawatan intensif RSUP Dr. Hasan Sadikin Bandung periode Januari-Desember 2017. Metode penelitian menggunakan deskriptif observasional yang dilakukan secara retrospektif terhadap 70 objek penelitian yang diambil dari rekam medis dan dilakukan dalam waktu 3 bulan, yaitu Oktober-Desember 2017. Hasil penelitian jumlah kematian akibat pneumonia nosokomial masih tinggi, yaitu 60% terutama pada pasien laki-laki usia ≥ 65 tahun. Komorbid terbanyak pada pneumonia nosokomial, yaitu hipertensi (31,4%) diikuti penyakit neuromuskular (15,7%). Mikrob terbanyak penyebab HAP adalah A. baumannii (38,1%), P. aeroginosa (30,4%), dan K. pneumoniae (15,2%), sedangkan mikrob penyebab terbanyak ventilator associated pneumonia (VAP) adalah A. baumannii (32%), P. aeroginosa (30,5%), dan K. pneumoniae (22%). Mikrob A. baumannii juga menjadi penyebab mortalitas tertinggi dengan persentase 45,4% dan terapi empirik yang sering digunakan adalah kombinasi meropenem-levofloxacin (40%), terapi tunggal meropenem (34,3%), dan kombinasi ceftazidime-levofloxacin (20%). Simpulan, pola pneumonia nosokomial di ICU RSUP Dr. Hasan Sadikin Bandung periode Januari-Desember 2017 masih diperlukan perbaikan program penanganan terhadap infeksi ini untuk mencapai pelayanan yang baik.

Background: Sepsis is a common disease in intensive care unit (ICU) with high mortality rate. Administration of antibiotic has an important role to determine the outcome of sepsis patient. This study aimed to evaluate the quality of antibiotic prescription for sepsis treatment in intensive care unit (ICU). Methods: This descriptive study was conducted by retrieving data from 48 medical records of patients with sepsis, severe sepsis, and septic shock admitted to ICU Dr. Hasan Sadikin General Hospital (RSHS) in 2013. The study was conducted from August to October 2014. Empiric therapy in the ICUat RSHS and Surviving Sepsis Campaign (SSC) guidelines in 2012 were used as a standard for antibiotic prescription. The quality of antibiotic prescription was assessed then categorized based on Gyssens criteria. The collected data were analyzed in the form of frequency and percentage and presented in tables.Results: This study discovered that most of the patients had severe sepsis and septic shock. Based on Gyssens criteria, 35% antibiotic uses were included into category 0 (proper); 1.4% category I (improper timing); 10.5% category IIA (improper dosage); 9.1% category IIB (improper interval); 3.5% category IIC (improper route); 12.6% category IIIA (improper duration; too long); 1.4% category IIIB (improper duration; too short); 16.8% category IVA (improper; other antibiotics were more effective); 4.2% category IVD (improper; other antibiotics had narrower spectrum); and 5.6% category V (improper; no indication). Conclusions: There are still improper uses of antibiotic for sepsis, severe sepsis, and septic shock patients in the ICU.

AbstrakGabapentin mempunyai efek antihiperalgesia, antialodinia, dan antinosiseptif. Penelitian ini bertujuan untuk menilai efek gabapentin 600 mg dan 1.200 mg per oral preoperatif terhadap nilai visual analogue scale (VAS) dan pengurangan kebutuhan petidin pascaoperatif. Penelitian dilakukan secara uji acak terkontrol buta ganda terhadap 38 orang pasien di Rumah Sakit Dr. Hasan Sadikin Bandung pada MeiSeptember 2010. Pasien dibagi menjadi dua kelompok yaitu kelompok gabapentin 600 mg dan gabapentin 1.200 mg. Penilaian skala nyeri dilakukan dengan menggunakan nilai VAS. Data hasil penelitian dianalisis menggunakan Uji Mann-Whitney dengan tingkat kepercayaan 95% dan dianggap bermakna bila nilai p<0,05. Hasil penelitian didapatkan nilai VAS saat diam dan saat mobilisasi berbeda bermakna (p<0,05). Kelompok gabapentin 1.200 mg lebih sedikit diberikan analgetik petidin tambahan (10,5% vs 15,8%), tetapi perbedaan tersebut tidak bermakna (p=0,631). Simpulan penelitian ini adalah gabapentin 1.200 mg per oral preoperatif lebih baik bila dibandingkan dengan 600 mg dalam mengurangi nilai VAS pascaoperatif pada operasi modifikasi radikal mastektomi, namun tidak mengurangi kebutuhan petidin. AbstractGabapentin is a GABA analog which has the effect of anti hyperalgesia, anti allodynia, and anti nociceptive. This research was conducted in order to assess the effect of 600mg and 1,200 mg gabapentin given preoperatively to assess visual analogue scale (VAS) score and reduction of pethidine requirement. The study was done by conducting a double blind randomized controlled trial on 38 patients, aged 18-65 years, with ASA physical status I-II. Patients were divided into two groups: 600 mg gabapentin and 1,200 mg gabapentin group. The quality of pain was assessed using VAS score. The results were statistically analyzed using Mann-Whitney Test with 95% confidence interval and considered significant if p value <0.05. From the results, the VAS values obtained at rest and during mobilization were significantly different (p<0.05). The 1,200 mg gabapentin group received less additional pethidine (10.5% vs 15.8%), although no significant difference was shown (p=0.631). The conclusion of this study is that administration of 1,200 mg gabapentin per oral pre operatively is better when compared to 600 mg in reducing post operative visual analog scale score in modified radical mastectomy. However, it do not reduce the need for analgesic significantly.

Background & objective: SARS-CoV-2 virus caused acute respiratory illness called COVID-19 with rising case mortality rates. One of the preventive measures to arrest the spread of a contagious disease is the use of vaccines. We assessed the effectiveness of the inactivated vaccine (Coronavac) through three inflammatory parameters e.g., total lymphocyte count, neutrophil-lymphocyte ratio, and C-reactive protein (CRP), in severe COVID-19 patients. Methodology: This study was an observational study with a retrospective cross-sectional design. The study was conducted in the Intensive Care Unit (ICU) of Hasan Sadikin Hospital Bandung, from January 2021 to December 2021. The data of total lymphocyte count, neutrophil-lymphocyte ratio, and C-reactive protein, was collected retrospectively from the medical record documents of 54 patients of COVID-19. The assessment was performed on severe COVID-19 subjects on the 7th day of illness. Data normality test was done using the Shapiro Wilk test. Study data were not normally distributed, and statistical analyses were performed using the Mann-Whitney test for numerical data and the Chi-Square test for categorical data. Results: There were significant differences in inflammation parameters, e.g., total lymphocyte count, neutrophil-lymphocyte ratio, and CRP, between the two groups (P < 0.0001) and the subject outcome between two groups (P < 0.0001). Total lymphocyte count in severe vaccinated COVID-19 patients was higher than in non-vaccinated patients, while neutrophil-lymphocyte ratio and CRP were lower in vaccinated subjects. Mortality was also lower in the vaccinated patients compared to unvaccinated patients. Conclusion: The inactivated vaccine (Coronavac) effectively reduces the mortality rate of severe COVID-19 patients based on inflammatory parameters including total lymphocyte count, neutrophil-lymphocyte ratio, and C-reactive protein. Abbreviations: ACE: Angiotensin Converting Enzyme; ARB: Angiotensin Receptor Blocker; ARDS: Acute Respiratory Distress Syndrome; BMI: Body Mass Index; CFR: Case Fatality Rate; COVID-19: Coronaviruses Disease 2019; CRP: C-Reactive Protein; IL: Interleukin; NLR: Neutrophil Lymphocyte Ratio; SPSS: Statistical Product Service Solution; TLC: Total Lymphocyte Count; TNF: Tumor Necrosis Factor; VEGF: Vascular Endothelial Growth Factor Citation: Sudjud RW, Zulfariansyah A, Ardiana K. Comparison of total lymphocytes, neutrophils to lymphocytes ratio, and C-reactive protein in vaccinated and unvaccinated severe COVID-19 patients. Anaesth. pain intensive care 2022;26(5):656-662; DOI: 10.35975/apic.v26i5.2018