Dr. Kariadi Hospital

The bedside monitor is an indispensable tool in the intensive care setting for the continuous assessment of patients’ vital signs. However, the prolonged and intermittent compression inherent in Non-Invasive Blood Pressure (NIBP) monitoring presents a significant risk for Medical Device-Related Pressure Injury (MDRPI), frequently manifesting as skin irritation. This quasi-experimental study, using a time-series design, investigated the optimal frequency of cuff relocation to minimise this risk in the Intensive Care Unit of Dr. Kariadi General Hospital, Semarang. A total of 60 respondents were equally divided into two protocol groups: standard care (cuff relocation every 8 hours) and intervention (cuff relocation every 4 hours). Data were collected via systematic observation and analysed using a simple logistic regression test. The results demonstrated that the 4-hourly relocation protocol significantly reduced the incidence of skin irritation (1.6%) compared to the 8-hourly protocol (3.3%) (p = 0.002). This finding established a statistically significant and clinically relevant influence of increased relocation frequency on reducing the risk of cutaneous injury. The study concludes that mandatory cuff relocation every 4 hours should be adopted as a fundamental practice to enhance patient safety and skin integrity in critical care.

Background: BPaL is a new oral drug combination consisting of Bedaquiline (B), Pretomanid (Pa) and Linezolid (L) for multi-drug resistance tuberculosis. In Indonesia BPaL has been officially launched by the government as a therapeutic regimen for multidrug resistant tuberculosis patients since August 2023. One of the drugs in this regimen has the side effect of anemia. Until now, there are still no references explaining the effect of BPaL on the hematological profile.Objective: To determine the differences in the hematological profile of multidrug resistance tuberculosis patients before receiving the multi drug resistance regimen BPaL anti-tuberculosis drug regimen and while receiving the multi drug resistance regimen BPaL anti-tuberculosis drug regimen.Methods: This research was a retrospective observational analytical study with a retrospective cohort design involving patients with multidrug-resistant tuberculosis in Kariadi Hospital based on medical records. The difference test used the paired T-test and the Wilcoxon test.Results: 40 subjects were recruited, there were significant differences in hemoglobin level (p=0.003), hematocrit (p=0.002), red blood cells count (p=<0.001), white blood cells count (p=0.004), platelet count (p=<0.001) and RDW (p=<0.001) before therapy with the BPaL regimen and during therapy with the BPaL regimen.Conclusion: There are significant differences in the hematological profile of multidrug resistant patients, before treatment with the BPaL regimen and while receiving the BPaL regimen.

Patient safety in low-resource primary health care (PHC) remains an under-prioritized aspect of health system strengthening, despite its central role in reducing preventable harm and advancing universal health coverage. This narrative review synthesizes current evidence (2019–2025) to identify key barriers affecting patient safety in low-resource PHC settings and examine strategic approaches to address them. Major barriers include workforce shortages, weak safety culture, underreporting of adverse events, medication safety vulnerabilities, infrastructural limitations, and insufficient community health literacy. Strategic pathways emphasize strengthening leadership commitment, building non-punitive reporting systems, expanding workforce capacity, improving medication safety, adopting digital health innovations, engaging communities, and investing in essential diagnostic and infrastructure components. Addressing patient safety in low-resource PHC requires coordinated system-level and frontline interventions supported by policy alignment, adequate financing, and sustained capacity building.

Objective: Biportal endoscopic spine surgery (BESS) has emerged as a minimally invasive alternative for lumbar decompression, offering improved visualization with reduced tissue disruption. Therefore, this study aims to identify key anatomical considerations, particularly interlaminar-disc mismatch and the “banana-shaped” curvature of the lamina, and to examine their impact on portal trajectory, alignment of the surgical corridor, and preservation of spinal structures.Methods: A retrospective, video-based analysis was conducted on 23 BESS lumbar decompression cases performed between January and March 2024. Surgical levels included L3–4 (n=3), L4–5 (n=17), and L5–S1 (n=3). Intraoperative anatomical landmarks were assessed independently by 2 spine surgeons. Interobserver agreement was evaluated using Cohen kappa, based on the identification of 3 landmarks per case in 23 cases, calculated with unweighted kappa. Visualization quality was scored on a 3-point scale. Cranial and caudal interlaminar-disc mismatches were measured and averaged.Results: Interlaminar-disc mismatch was identified in 93% of cases, with cranial and caudal mismatches ranging from 5.5±1.02 mm to 8±1.2 mm. Laminar curvature was consistently observed at L4–5 and L5–S1, which required a medial-caudal portal. In addition, the superior articular process (SAP) served as a reliable fluoroscopic and endoscopic landmark, facilitating safe access to the intervertebral disc. A limited medial facetectomy provided adequate operating space. The findings also demonstrated high interobserver reliability for anatomical identification (κ=0.84), and the use of layer-specific flavectomy preserved the inner layer of the ligamentum flavum.Conclusion: Successful BESS requires integrating detailed anatomical understanding with intraoperative adaptability. Recognizing interlaminar-disc mismatch, laminar curvature, and SAP orientation enables optimal portal placement and targeted decompression. These principles are essential for achieving reproducible and safe outcomes in BESS.

Objective. Thyroid dysfunction is associated with metabolic disturbances and an increased risk of atherosclerosis. This cross-sectional study investigated the relationships between the triglyceride-glucose index (TyG index), complement C5, lipoprotein(a) (Lp(a)), and carotid intima-media thickness (cIMT). Methods. Clinical data were collected, blood samples analyzed, and cIMT measured using high-resolution ultrasound in 54 participants with thyroid dysfunction (27 with hypothyroidism and 27 with hyperthyroidism). Results. The study found a significant positive correlation between the TyG index and cIMT in both hypothyroid and hyperthyroid patients. Complement C5 levels were also positively correlated with cIMT. No significant association was found between Lp(a) and cIMT. Discussion. These findings highlight the complex interplay between thyroid dysfunction, metabolic dysregulation, and vascular health emphasizing the need for comprehensive cardiovascular risk assessment and management in patients with thyroid disorders.