Agung Budi Sutiono

Characteristic tetanus infection in disaster-affected areas: case study of the Yogyakarta earthquakes in Indonesia.

Tetanus is an infectious disease caused by the contamination of wounds from bacteria that live in soil. The tetanus mortality rate remains high in developing countries affected by natural disasters. Whether the socio-demography and geographical conditions may influence the tetanus treatment outcome on the earthquake situation in Yogyakarta, Indonesia has not been investigated. We present 26 tetanus patients who were admitted to eight hospitals following the earthquakes that occurred on May, 27, 2006, in Yogyakarta, Indonesia. The independent variables were age, gender, distance, admission, hospitalization, and type of hospital with the dependent variable surviving or perishing. Data were analyzed by logistic regression methods on SPSS 17.0. The distance from the patients place of residence to the hospital were obtained and analyzed by using geospatial tools MapInfo 7.8 SCP and Global Mapper 7. Eight of the 26 patients were dead (30.8%) and statistical results showed that the distance (OR = 1.740, 95% CI = 1.068–2.835) and type of hospital (OR = 0.067, 95% CI = 0.001–3.520) were significant predictors of death. Our findings show that in order to reduce the mortality rates, performing triage systems based on the distance and type of hospital priority for internally displaced persons could be proposed as well as making provisions for the generally old population in order to prevent an outbreak of tetanus following earthquakes in Yogyakarta, Indonesia.BackgroundTetanus is an infectious disease caused by the contamination of wounds from bacteria that live in soil. The tetanus mortality rate remains high in developing countries affected by natural disasters. Whether the socio-demography and geographical conditions may influence the tetanus treatment outcome on the earthquake situation in Yogyakarta, Indonesia has not been investigated.FindingsWe present 26 tetanus patients who were admitted to eight hospitals following the earthquakes that occurred on May, 27, 2006, in Yogyakarta, Indonesia. The independent variables were age, gender, distance, admission, hospitalization, and type of hospital with the dependent variable surviving or perishing. Data were analyzed by logistic regression methods on SPSS 17.0. The distance from the patients place of residence to the hospital were obtained and analyzed by using geospatial tools MapInfo 7.8 SCP and Global Mapper 7. Eight of the 26 patients were dead (30.8%) and statistical results showed that the distance (OR = 1.740, 95% CI = 1.068–2.835) and type of hospital (OR = 0.067, 95% CI = 0.001–3.520) were significant predictors of death.ConclusionOur findings show that in order to reduce the mortality rates, performing triage systems based on the distance and type of hospital priority for internally displaced persons could be proposed as well as making provisions for the generally old population in order to prevent an outbreak of tetanus following earthquakes in Yogyakarta, Indonesia.

Designing an Emergency Medical Information System for the Early Stages of Disasters in Developing Countries: The Human Interface Advantage, Simplicity and Efficiency

The means of designing an effective user interface software package varies from one application to another. Almost the entire ICT infrastructure was damaged following the impact of the tsunami tidal wave. Under such circumstances, transporting critically ill patients is a must and becomes the first priority. Many considerations are needed when designing a specific user interface for emergency situations in developing countries. In this study we proposed how to design the user interface in order to support emergency medical care in the early stages of disasters. The user interface was classified into two tabs, firstly to indicate critically ill patients and secondly to notify details of the medicine having been administered to the patients. Classifying the user interface of emergency medical care information systems by using VHF radio connections will be beneficial, especially for the early stages of disaster-stricken developing countries, in order to preserve the lives of more victims.

Characteristics and risk factors for typhoid fever after the tsunami, earthquake and under normal conditions in Indonesia

BackgroundAlthough typhoid transmitted by food and water is a common problem in daily life, its characteristics and risk factors may differ in disaster-affected areas, which reinforces the need for rapid public health intervention. Surveys were carried out post-tsunami in Banda Aceh, post-earthquake in Yogyakarta, and under normal conditions in Bandung, Indonesia. Logistic regression analysis was used to assess the risk factors with the dependent variable of typhoid fever, with or without complications.FindingsCharacteristic typhoid fever with complications was found in 5 patients (11.9%) affected by the tsunami in Aceh, 8 (20.5%) after the earthquake in Yogyakarta, and 13 (18.6%) in Bandung. After the tsunami in Aceh, clean water (OR = 0.05; 95%CI: 0.01-0.47) and drug availability (OR = 0.23; 95%CI: 0.02-2.43) are significant independent risk factors, while for the earthquake in Yogyakarta, contact with other typhoid patients (OR = 20.30; 95%CI: 1.93-213.02) and education (OR = 0.08; 95%CI: 0.01-0.98) were significant risk factors. Under normal conditions in Bandung, hand washing (OR = 0.07; 95%CI: 0.01-0.50) and education (OR = 0.08; 95%CI: 0.01-0.64) emerged as significant risk factors.ConclusionThe change in risk factors for typhoid complication after the tsunami in Aceh and the earthquake in Yogyakarta emphasizes the need for rapid public health intervention in natural disasters in Indonesia.

Grüber's ligament as a useful landmark for the abducens nerve in the transnasal approach

OBJECT Extended endoscopic transnasal surgeries for skull base lesions have recently been performed. Some expert surgeons have attempted to remove tumors such as chordomas, meningiomas, and pituitary adenomas in the clival region using the transnasal approach and have reported abducens nerve injury as a common complication. There have been many microsurgical anatomical studies of the abducens nerve, but none of these studies has described an anatomical landmark of the abducens nerve in the transnasal approach. In this study the authors used cadaver dissections to describe Grübers ligament as the most reliable landmark of the abducens nerve in the transnasal transclival view. METHODS The petroclival segment of the abducens nerve was dissected in the interdural space-which is also called Dorellos canal, the petroclival venous gulf, or the sphenopetroclival venous confluence-using the transnasal approach in 20 specimens obtained from 10 adult cadaveric heads. RESULTS The petroclival segment of the abducens nerve clearly crossed and attached to Grübers ligament in the interdural space, as noted in the transnasal view. The average length of the dural porus to the intersection on the abducens nerve was 5.2 ± 1.0 mm. The length of the posterior clinoid process (PCP) to the intersection on Grübers ligament was 6.4 ± 2.6 mm. The average width of Grübers ligament at the midsection was 1.6 ± 0.5 mm. CONCLUSIONS Grübers ligament is considered a useful landmark, and it is visible in most adults. Thus, surgeons can find the abducens nerve safely by visualizing inferolaterally along Grübers ligament from the PCP.

3G Mobile TV Acceptance in Indonesia

Studies on intention to use, adopting the technology acceptance model (TAM), have been reported but their extended models do not provide a good explanation of the determinants of intention to use 3G mobile TV. The present study develops and examines a more comprehensive technology acceptance model by introducing new typical constructs and identifying their role in promoting the behavioral intention to use 3G mobile TV service. The results show that constructs such as normative pressure, price level, perceived availability, and perceived quality are meaningful extensions of TAM, since they were found to be strong determinants in predicting the behavioral intention to use a 3G mobile TV service in Indonesia.

Mother and children health reporting system: Innovative information system application in the rural West Bandung Area, Indonesia, by using multimodal communications systems

Objectives: Digitalization of maternal and post-natal care system (DigiMAPS) is a system consist of electronic medical record for mother and children health (KIA) also for tele-consultation facility called “Tele-Obgyn”. Our project focuses on the development of KIA Online and a cloud computing-based video conferencing as a basis of Tele-Obgyn platform. The web-based network allows online access not only among primary health care but also between government and private institution. DigiMAPS platform is designed to meet the needs of database management and its interphase with other services that are responsible for data acquisition and visualization. Methods: DigiMAPS combines the open-source flexible system design that benefits for implementation and development needs as well as support for mobile devices to enable high quality of patient care. The system has been developed gradually following lean-innovation management concept which focuses on customer-problem-solution matching with rapid prototyping and validation from idea to solution. There was significant effort to establish a close relationship and learning process with prospective users of DigiMAPS, hence in the broader perspective we used a participatory research approach. DigiMAPS act as central-portal and -data base in the communication information system (ICT), designed to compile patient report paperless and equipped with tele-consultation. Results: DigiMAPS developed for a variety of administrative processes. This system will simplify the work process and can be integrated with primary health care system, Health Department and the Ministry of Health. A good ICT will be useful in collecting clinical information than conventional paper-based reporting system and to minimize errors in the reporting chain. Conclusions: By using lean innovation management, several inputs are gathered from prospective users including health authority, head of local clinics, midwifes, obgyn doctors, and public health staffs. Our system may bridging gap between clinical needs and digital documentation, telemedicine-monitoring and improve the quality of patient care, facilitate communication within both the scope of the internal (primary health care) and external (stakeholders and follow-up), increasing productivity and reduce overall expenses.

Comprehensive management of frontal and cerebellar tumor patients with personality changes and suicidal tendencies.

Background: Brain tumor patients have a tendency to suffer from psychiatric disturbances. One of the most frequent disturbance experienced by frontal area tumor patients are personality changes. Case Description: In this paper, the authors report a 28-year-old male patient who presented with headache and personality changes, with no other neurological disturbance. The patient became increasingly pensive and apathetic with frontal and cerebellopontine angle tumor. The diagnosis is based on computed tomography scanning images, and histopathological examination of the excised tumor results in meningioma. Conclusion: Before the operation was performed, the patient suffered from personality changes and suicidal tendencies. After the operation, the patients suicidal tendency was gone, but the personality changes still persist. For this reason, a comprehensive management of the patient is required, including postoperative pharmacological and psychological treatment.

Comparison of Electroencephalography Power Spectral Density between Duramater and Brain Cortex

The intracranial electroencephalography (EEG) or electrocorticography (ECoG) is an invasive type of EEG which its electrodes are placed on the brain surface. It might be increases the amplitude of a recorded brain signal compared with the common EEG due to an impedance reduction. This study tries to analyze the difference by comparing the Power Spectral Density (PSD) of brain signals between duramater and brain cortex. The result shows that there is a distinction between the two sites, where the EEG recorded from brain cortex has a higher PSD than from duramater. Short Research Article Faried et al.; BJAST, 19(2): 1-6, 2017; Article no.BJAST.30908 2

A rare giant scalp dermatofibrosarcoma protuberans.

Background: Giant dermatofibrosarcoma protuberans (DFSP) of the scalp is a rare case, which is an intermediate grade soft tissue neoplasm originating from the dermal layer of the skin, which usually occurs in adults. Case Description: We describe such a case in a 26-year-old male. A wide local excision of the tumor with a generous tissue margin was performed; microscopic and immunohistochemical findings established the diagnosis of recurrent DFSP. Conclusion: Our case is unique in that it is presented as a dermatofibrosarcoma protuberans of the scalp, which is an extremely rare clinical entity, and the patient remains well after 14 months with no further treatment, without any tumor recurrence.

The Management of Medical Services in the Early and Late Phase of Tsunami: A Preparation for Humanitarian Health Assistance

Tsunami is a series of ocean waves produced by a submarine earthquake, landslide, or volcanic eruption. These waves may reach enormous dimensions and may have sufficient energy to travel across the entire ocean and to destroy human lives near the beach up to a distance of some kilometers from the shoreline. Severe damage can be caused by large tsunamis to boats and other fishing equipments, to houses, to tourist resorts, to schools, to water and sanitation, and to infrastructures. In addition they can cause substantial damage to health services, which becomes an essential issue since these services are immediately needed for a quick medical response. If the medical response is late, then it leads to prolonging the provision of medical assistance especially to persons severely injured as well as to spreading of infectious diseases [1]. Indeed, suddenly after tsunami strikes the land, many people suffer traumatic injuries, that are caused by the impact of sharp or blunt objects. In this phase, sometimes there can be a further trouble when treating traumatic patients, because medical equipments might be broken as a consequence of the tsunami. Tsunami produce mud, causing contamination of water, which in turn results into sanitation and hygiene problems that may cause infectious diseases that may be complicated to treat. There are conditions that can be more difficult compared to other types of disasters. For example, the logistical problems of distributing goods could be very difficult due to bad weather, problematic access and limited transportation. Air, sea and land transportations need much more effort for distribution of medical services. Because of the tsunami damage, aircrafts could not land, ships or boats could only anchor at 500 m – 1 km far from the new coastline, made by tsunami, and trooper cars, trucks, and other land transportation vehicles could find it impossible to reach the disaster area. Usually, there is only one way to distribute the medical supplies in the early phase of tsunamis, i.e. by helicopter. Based on this situation, the medical assistance can be divided into two phases, that is the early and the late phase of a tsunami attack.