Journal of International Surgery and Clinical Medicine

Delayed Surgical Reconstruction of Chronic Fourth-Degree Perineal Laceration: Impact on Female Sexual Function - A Case Report

Hasanuddin — 2025-12-10

Introduction : Among the gravest complications occurring during childbirth are fourth-degree perineal lacerations, characterized by complete disruption of the anal sphincter mechanism with potential for persistent sequelae including fecal incontinence and impaired sexual health. These traumatic injuries profoundly compromise women's wellbeing, with sexual health disturbances documented in 30-60% of affected women three months following delivery. The Female Sexual Function Index (FSFI) provides validated assessment across six critical dimensions: libido, arousal capacity, vaginal lubrication, orgasmic function, overall satisfaction, and dyspareunia.

Case presentation: We present the clinical course of a 33 year old multiparous woman who sought consultation nine months postpartum with chronic fourth-degree perineal disruption accompanied by anal incontinence and sexual dysfunction. Initial FSFI assessment revealed a score of 16.2, demonstrating substantial sexual impairment. Surgical intervention employed a comprehensive ten-stage reconstruction protocol involving systematic restoration of anal mucosa, internal and external sphincter components, vaginal wall integrity, and perineal tissue architecture. At five-month postoperative evaluation, the patient exhibited complete continence restoration and remarkable sexual function recovery, with FSFI scoring advancing to 28.0, indicating normalization of sexual health parameters. Quality of life indicators demonstrated meaningful enhancement across all assessed dimensions.

Conclusion: Secondary reconstruction of chronic fourth-degree perineal disruptions can successfully restore both continence mechanisms and sexual function when executed using meticulous surgical methodology. Prompt recognition and appropriate timing of intervention remain paramount for achieving optimal patient outcomes and restoring quality of life.

The Correlation Between Neutrophil Lymphocyte Ratio And Length Of Stay Of COVID-19 Patients At Dr. Zainoel Abidin General Public Hospital Banda Aceh

Vivi Keumala Mutiawati — 2025-12-05

Introduction: Coronavirus disease 2019 or COVID-19 infection has showed an immunologic disregulation that could affect the clinical outcomes. Neutrophil lymphocyte ratio or NLR is one of inflammation marker that rapid and easily available at the initial moment of hospitalization. This study aimed to determine the correlation between NLR and length of stay of COVID-19 patients at Dr. Zainoel Abidin General Public Hospital Banda Aceh.

Methods: This was an analitic retrospective study that observed medical records and complete blood count data of 577 COVID-19 hospitalized patients on January – March 2022 .The sample of this study was elected by purposive sampling and the sample size was 83 that obtained by lemeshow formula (1990).

Result: The results showed that COVID-19 was dominated by male (53%) and 26 – 35 age group (19.3%). The value of NLR was dominated by ≥ 3.13 group (60.2%). The length of stay was dominated by ≤ 11 days group (69.9%). Bivariate analysis of this study was Spearman Rank test. The results of correlation test obtained p-value was 0.003 and r was 0.319.

Conclusion: This study obtained that was a significant correlation between NLR and length of stay of COVID-19 patients at Dr. Zainoel Abidin General Public Hospital Banda Aceh.

The Effects of Prednisone and Aspirin Administration on Pregnancy Outcomes in Mothers with RhD Isoimmunization and a History of Recurrent Pregnancy Loss: A Case Report

Devi Susanty — 2025-12-12

Introduction: Rhesus incompatibility arises when an Rh-negative mother becomes sensitized to the D antigen of an Rh-positive fetus, triggering the production of anti-D antibodies, a process known as isoimmunization. This condition is associated with severe obstetric complications, including Recurrent Pregnancy Loss (RPL) and Hemolytic Disease of the Fetus and Newborn (HDFN). Clinical management remains challenging, as no single therapeutic modality can comprehensively eliminate the adverse effects of isoimmunization. A targeted and integrated management approach is therefore imperative to optimize pregnancy outcomes. Emerging evidence suggests that corticosteroids combined with aspirin may confer beneficial effects in patients with rhesus incompatibility.

Case Presentation: A 27-year-old woman, G5P0A4, with RhD-negative status, experienced recurrent pregnancy loss and was managed with prednisone (10 mg/day), aspirin, and Rh immunoglobulin (RhIg) at appropriate gestational intervals. The patient successfully carried the pregnancy to 36 weeks and six days, resulting in the birth of a healthy neonate.

Discussion: Rhesus incompatibility is a clinically significant condition in which Rh-negative mothers develop isoimmunization following exposure to Rh-positive fetal blood, producing antibodies against fetal red blood cell antigens. This immunological response contributes to adverse pregnancy outcomes, most notably RPL and HDFN, both carrying substantial maternal and neonatal morbidity. Effective management continues to pose considerable clinical challenges due to limited therapeutic interventions capable of mitigating the immunological consequences of isoimmunization. Evidence from published case reports indicates that combined prednisone and aspirin administration may represent a promising adjunctive therapeutic strategy alongside RhIg prophylaxis.

Conclusion: The integrated management incorporating RhIg prophylaxis as the cornerstone of therapy alongside adjunctive prednisone and aspirin was associated with a successful pregnancy outcome in this RhD-negative mother with a history of RPL. The relative contribution of each therapeutic component cannot be determined from a single case report. Further prospective studies with larger sample sizes are needed to evaluate the independent efficacy of corticosteroids and aspirin in this clinical context.

The Correlation between Blood Flow Rate with Arteriovenous Fistula Thrombosis in Patients with End-Stage Renal Disease at Dr. Zainoel Abidin General Hospital in Banda Aceh

Chikita Adinda Raudhatun Shafira — 2025-12-07

Introduction: Thrombosis is a complication that may arise in End-Stage Renal Disease (ESRD) patients with an arteriovenous fistula (AVF), usually caused by stenosis (narrowing of the vein more than 50% of its diameter) and changes in blood flow rate (BFR). The aim of this study is to explore the relationship between blood flow rate and the incidence of AVF thrombosis in patients with ESRD at Dr. Zainoel Abidin General Hospital Banda Aceh.

Methods: In this study, a cross-sectional design was employed to investigate ESRD patients who had undergone the AVF procedure at Dr. Zainoel Abidin General Hospital Banda Aceh from October to November 2023. The study examined Blood Flow Rate values obtained via Doppler ultrasound. The data were analyzed using SPSS version 26 and the contingency coefficient (Cramer's V) to assess the relationship between the variables.

Result: 51 patients were sampled. The average BFR value six weeks after surgery in the event of thrombosis and non-thrombosis was 274 ml/min and 786,8 ml/min. There was a significant correlation between BFR values with the incidence of AVF thrombosis (p = 0.000 and Cramer’s V = 0,658)

Conclusion: Inadequate blood flow through the fistula may contribute to clot formation, leading to fistula failure in patients undergoing hemodialysis. Optimizing monitoring and early intervention for blood flow in AVF may help reduce the incidence of thrombosis and improve patient outcomes.