Ahmad Ramdan’s research while affiliated with Rumah Sakit Hasan Sadikin and other places

Introduction: Tuberculous spondylitis (TBS) in children can be severe, non-specific, and slowly progressive. Disruptions in tuberculosis (TB) services were observed amid the coronavirus disease (COVID-19) pandemic, prompting a closer examination of its impact on TBS patients. This study compared the presenting symptoms of TBS in children before (A) and during (B) the pandemic. Methodology: An analytic retrospective study was conducted using medical charts and the pediatric respirology registry of all patients (aged ≤ 18 years) diagnosed with TBS before and after the pandemic. Demographic data, clinical features, confirmatory examination, and treatments were analyzed. Statistical significance was determined at p < 0.05. Results: The common presenting symptoms before and after the pandemic were gibbus (A 25; 93% vs. B 19; 79%, p = 0.232), back pain (A 20, 74% vs. B 20, 83%; p = 0.508), and inability to walk (A 15, 56% vs. B 16, 67%; p = 0.567). Involvement of ≥ 3 vertebrae was significantly more prevalent in group B (A 6, 23% vs. B 11, 46%; p = 0.09). The median time from symptom onset to diagnosis was longer in group B (A 13 weeks vs. B 21 weeks; p = 0.07). Conclusions: The pandemic had minimal effect on the clinical characteristics of TBS patients at presentation. However, most patients were in a serious condition at the time of presentation, suggesting that the symptoms had existed, but did not receive appropriate care from primary healthcare facilities. A meticulous assessment enabling early diagnosis and initiation of therapy is crucial.

Chondrosarcomas are one of malignant tumors in which cartilaginous matrix is produced. It is divided into 2 groups including primary or secondary. Primary chondrosarcomas are the third most common primary malignant tumors of the bone. Chondrosarcoma represents 20%–27% of all primary malignant bone tumors. Primary spinal chondrosarcoma is exceedingly rare among spinal tumors. A 36-year-old man presented to hospital with the swelling on the back accompanied with pain. Swelling and pain have been felt for approximately 3 years. The symptoms gradually worsened. On thoracolumbal X-ray a lytic sclerotic expansile lesion on the right posterior aspect of thoracal T5-T6. MRI showed the mass infiltrated intradural and intramedullary, reaching up to the level of vertebrae T4-T5. This infiltration resulted in stenosis of the spinal canal, obliterating the ligamentum flavum, supraspinous ligament, and interspinous ligament. Chondrosarcomas are uncommon malignant bone tumours that form cartilage; they rarely involve the spine, while most of them occur in young men. The thoracic spine is most commonly involved, but there is usually a long history of pain and possible neurological symptoms. Imaging techniques, such as conventional examination, CT, and MRI, are very important for diagnosis and classification and show typical bone destruction with matrix mineralization. Imaging revealed a lytic sclerotic lesion at the T5-T6 level. CT scans performed subsequently showed an expansile mass with a typical ``rings and arcs'' appearance of chondrosarcomas. MRI further delineated the extent of the mass and the surrounding tissue infiltration, and confirmation of low-grade chondrosarcoma, grade I was based on histological examination. The most effective treatment has been en bloc resection, and high-dose adjuvant radiotherapy might improve local control and survival rates. Recommended follow-ups are for the purpose of monitoring recurrence. Primary spinal chondrosarcoma is a rare malignant tumor that predominantly affects adolescents. The standard treatment typically involves surgical intervention, often supplemented with adjuvant radiotherapy. Many patients experience considerable improvements in neurological function following treatment. Long-term monitoring and follow-up are crucial for ensuring the best possible outcomes for individuals with primary spinal chondrosarcoma.

Osteoporosis is a condition of decreased bone mass density. Pharmacological management uses drugs that decrease bone resorption or increase bone formation. The most commonly used drugs are bisphosphonates. Risedronate is one of these bisphosphonates. It inhibits osteoclasts, resulting in osteoclast apoptosis. Denosumab is a human monoclonal antibody that inhibits receptor activator kappa-B ligand, inhibiting osteoclast activation. Both drugs are widely used. Research on the efficacy of these two mechanisms has yet to obtain conclusive results. β-cross-laps is a parameter that can be used to evaluate the effectiveness of therapy through monitoring the bone resorption process. This experimental study used female rats >9 weeks old and was conducted at the Pharmacology and Therapeutic Laboratory, Universitas Padjadjaran Bandung, Indonesia, from June to September 2021. This study utilized a simple random sampling to allocate 24 experimental animals into three groups: control, risedronate, and denosumab. β-Crosslaps expression values before ovariectomy, post ovariectomy before receiving medication, and post ovariectomy and receiving medication was recorded and statistically analyzed using the SPSS version 24.0. The analysis of 24 samples revealed a statistically significant decrease in the median value of β-Crosslaps after ovariectomy in the denosumab group (p=0.036) when compared to the control group, whereas the decrease in the risedronate group was not significant (p=0.687). Administration of denosumab in rat models is more effective in reducing bone resorption compared to risedronate.

Background: Tuberculous (TB) spondylitis is a chronic infectious disease associated with Mycobacterium tuberculosis that affects the spine. This disease is a challenging disease to treat due to its serious complications and high morbidity rate. Neurological deficits and spinal deformities that can occur along with gibbus are some of the most common complications. Early diagnosis and treatment are essential to cure this disease, with the administration of anti-TB drugs and operative intervention. This study aimed to analyze the correlation between gibbus and neurological status as well as the impact of operative intervention on the degree of gibbus and neurological status.Methods: This was an observational-analytic study with a cross-sectional design on 32 medical records of TB spondylitis patients who underwent operative intervention from January 2018 to December 2021 at Dr. Hasan Sadikin General Hospital. Gibbus determined by x-ray analysis and neurological status determined by the American Spinal Injury Association (ASIA) impairment scale (AIS) were examined before and after the intervention. The sample was chosen based on consecutive sampling. All data collected was tested using Spearman's correlative analysis, paired t-test, and Wilcoxon sign-rank test with a p-value <0.05 considered statistically significant.Results: There was a significant correlation between gibbus and neurological status-AIS (r=-0.708; p<0.05); and a significant positive impact of operative intervention on the degree of gibbus (p<0.05) and neurological status-AIS (p<0.05).Conclusion: There is a correlation between gibbus and neurological status-AIS. In addition, operative intervention also has a significant positive impact on the degree of gibbus and AIS, resulting in good clinical and radiological outcomes.

Introduction Spinal tuberculosis is an extra-pulmonary tuberculosis infection caused by Mycobacterium tuberculosis (MTB) which affects the vertebrae. Culture test is the «gold standard» diagnostic method, but it takes a long time. PCR is a method of a shorter time than the culture test, so it can be an alternative diagnostic method for MTB. Materials and Methods This study is a cross-sectional study. The data were analyzed with diagnostic tests on patients with suspected spinal tuberculosis who performed surgery in Hasan Sadikin Hospital in Bandung. Clinical examinations and diagnostic examinations were done in 40 patients and surgery was performed to obtain samples from the spinal cord and the infected tissue. GeneXpert, PCR targeting IS6110 and culture tests were performed. The research was conducted at the Department of Orthopaedics and Traumatology and the Clinical Pathology Laboratory of FK UNPAD/RSHS from September 2019 to September 2020. Results GeneXpert assay compared with culture tests as the standard diagnostic method showed sensitivity of 96.67 %; specificity of 90.00 %; positive predictive value 96.67 %; and a negative predictive value of 90.00 %, with an accuracy of 95.00 %. The PCR targeting IS6110 against culture showed that the sensitivity of MTB bacterial infection was 93.33 %, the specificity was 80.00 %, the positive predictive value was 93.33 %, the negative predictive value was 80.00 %, and the accuracy was 90.00 %. Conclusion This study concluded that the GeneXpert MTB/RIF RT-PCR assay has a high sensitivity, specificity, and accuracy compared to PCR targeting IS6110 in examining tissue samples in patients with spinal TB.

Patellofemoral pain syndrome (PFPS) is a common source of knee problems found mostly in physically active young adults. Causative factors are multifactorial, including lower extremity weakness, especially quadriceps muscles. Conservative treatment of PFPS consists mainly of knee bracing and knee taping combined with physical therapy. This study was aimed to analyse the outcome comparison between knee bracing and knee taping in combination with rehabilitative exercise for PFPS management. A prospective study was performed involving twenty-five basketball players suffering from PFPS, aged 19-30 years old with regular practice sessions. The subjects were each grouped randomly into a taping or a bracing group. Follow-up evaluations in term of Kujala patellofemoral score were done in the 1 st , 2 nd , and 4 th weeks after treatment. Unpaired t-test and chi-square were used to analyse the difference between both groups in pre-and post-intervention. Baseline characteristics of each group did not differ significantly (p>0.05). Both groups had significantly higher functional scores after the 1 st , 2 nd , and 4 th weeks of intervention (p<0.05). Significantly higher functional scores were found in the bracing group on the 2 nd (p=0.013) and 4 th weeks (p=0.002). No significant differences were found in functional scores between both groups in the 1 st week (p=0.142). While both methods were efficacious, knee bracing is more effective compared to knee taping in improving functional outcomes as an adjunct to rehabilitative exercise in PFPS management.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Spinal TB is associated with poor functional outcomes. Histopathological examination requires a long waiting times to obtain the results thus impractical for screening and may delay diagnosis. GeneXpert offers rapid tests for prompt screening and diagnosis. This study aimed to assess the diagnostic accuracy of GeneXpert in patients with spinal TB when compared to the histopathology test as the gold standard. This study was performed on patients in the Spine Clinic of the Department of Orthopedic and Traumatology, Dr. Hasan Sadikin General Hospital Bandung who were diagnosed with spinal TB during the period of May 2019–May 2020. Blood samples were collected from the patients and tested using GeneXpert and histopathological assessment. Results demonstrated 34 patients with a positive result and 6 patients with negative results on both diagnostic methods. Twenty nine out of 40 patients (72.5%) had rifampin-sensitive TB. Diagnostic accuracy of GeneXpert, when compared to histopathological examination, is represented by the sensitivity of 88.2%, specificity of 33.3%, positive predictive value of 88.2%, and negative predictive value of 33.3%. High sensitivity results forpatients with spinal TB on GeneXpert suggests that the test is appropriate to be used as a screening method and as a high-yield rapid diagnostic test for patients suspected for spinal TB.

Fibrous dysplasia of the spine in a polyostotic form is very rare, with fewer than 36 cases discussed in the literature and there is no such case in Indonesia that has been reported. The aim of this report is to present a case from Indonesia of polyostotic fibrous dysplasia isolated in the spine. We report a case of a 38-year-old Sundanese man with a 1-year history of progressive back pain and weakness of both lower extremities. There was no history leading to infection and no previous trauma. A physical examination revealed kyphoscoliotic deformity, a café au lait spot, tenderness at the thoracolumbar region, and neurological deficits. Laboratory studies were within normal ranges. Plain radiographs showed lytic lesion and kyphoscoliosis. Magnetic resonance imaging showed an endosteal scalloping, infiltrative process, expansion, and destruction in the vertebral bodies from T2 to L5. The findings of an aggressive destructive process was highly suspicious of a malignant process, relying on differential diagnosis and metastases, plasma cell myeloma, bone tumor and chronic infectious spondylitis. Histology revealed an irregularly oriented osteoid without osteoblastic rimming but surrounded by fibroblastic proliferation with a C-shaped sign. Investigations revealed a diagnosis of polyostotic fibrous dysplasia of the thoracolumbar spine in isolation. The patient underwent T5-S1 stabilization and bone grafting. At 1 year postoperative, the patient was asymptomatic; there was no recurrence and minimal neurological deficit with grade II on the modified McCormick scale. A case of the polyostotic form of fibrous dysplasia of the spine in isolation has never been reported in Indonesia. The extreme rarity of this type of presentation can pose a diagnostic dilemma, and in cases isolated to the spine, surgical treatment with posterior stabilization, decompression, and bone grafting gives a good functional outcome.

Introduction: Chondrosarcoma is the second most common primary bone sarcoma and arising in the spine. It is estimated to be 2% to 12% in incidence from various series. The use of neoadjuvant and adjuvant chemotherapy for chondrosarcomas is controversial. Low- and intermediate-grade chondrosarcomas respond poorly to chemotherapy. Although not much data on the efficacy of chemotherapy in the treatment of high-grade chondrosarcomas, it should be considered in any young patient with a high-grade tumor. Radiation is recommended when anything other than wide excision is performed for chondrosarcoma of any grade.Case Presentation: A 24-year old female presented to the clinic with a chief complaint of persistent low back pain and a lump in her back. Initially, the lump was the size of a tennis ball three years ago. At the time of the examination, the lump was at the size of a volleyball about 65 x 63 x 58 centimeters. Systemic and general examinations were unremarkable. There were no comorbid conditions. From the results of the Clinicopathological Conference conducted by neurologists, pathologists, radiologists, orthopedic spine and oncology surgeons, it is advisable to conduct investigations such as x-rays, CT scans, MRI, biopsy, and surgery is recommended for evaluation of expansion of chondrosarcoma, evolving the spinal cord, and for resection of tumors.Conclusion: Early diagnosis and complete resection of tumor and treatment of relevant symptoms represent a viable treatment for this rare disorder to achieve increased life expectancy, low recurrence of tumor, and improvement of quality of life.