Intisari Sains Medis en-US (dr. I.B. Amertha Putra Manuaba, SKed, MBiomed) (Dr. Arul Kandasamy) Wed, 29 Jun 2022 18:33:55 +0000 OJS 60 Botox injection for anal fissure management: case report <p><strong>Introduction</strong>: Anal fissure is shallow tear in the anoderm distal to dentate line which is considered most common proctologic condition.&nbsp; Anal fissure is generally located in the posterior midline. The symptoms include anal pain, spasm, and/or bleeding during defecation<sup>1</sup>. The pain can be so intense as to induce the patient to avoid defecation with consequent hardening of the feces and exacerbation of the problem<sup>2</sup>. Management of the anal fissure is improving diet and defecation habit, medical therapy and surgical therapy. The goal of medical treatment for chronic anal fissure is to temporarily reduce pressure of the anal canal to facilitate the healing of the fissure (“reversible sphincterotomy”), thereby reducing muscle tone. Intrasphincteric Botulinum Toxin A injection seems to be a reliable option.</p> <p><strong>Case reports</strong>: two male patients were diagnosed with anal fissures, the patients complained of pain and spasm. They were treated with&nbsp; botulinum toxin type A (100 unit AllergenÒ), injected&nbsp; into three sites of the internal sphincter at 2, 5 and 8 o’clock. The symptoms relieved and the anal fissure healed within one month. There was no sign of relapse or incontinence during 12 months of follow-up.</p> <p><strong>Conclusion: </strong>Botulinum toxin therapy can be considered as efficacious, effective and safe treatment for anal fissures.</p> <p><strong>&nbsp;</strong></p> <p><strong>Keywords: </strong>anal fissure, botox, botulinum toxin, intrasphincteric</p> Gede Eka Rusdi Antara Copyright (c) 2022 Gede Eka Rusdi Antara Wed, 10 Aug 2022 00:00:00 +0000 Myoepithelial carcinoma of lacrimal gland in HIV patient: A rare case <p><strong>Introduction: </strong>Lacrimal gland tumors have 1: 1,000,000 cases per year, accounting for one-fourth of lesions that occupy the orbital space. The rarity of lacrimal gland tumors and the many types of tumors with various types of lesions make determining optimal treatment difficult. A myoepithelial tumor is a rare epithelial neoplasm of the lacrimal gland. This paper aims to report a good outcome case of myoepithelial carcinoma.</p> <p><strong>Case Report:</strong> A 30-year-old male complained of protruding his left eye since 2014, accompanied by pain and clear white discharge. The vision was getting blurry and also double vision. Patients with Human Immunodeficiency Virus (HIV) disease since 2013 on Anti Retro Viral (ARV) therapy. Right eye visual acuity was 6 / 7.5, and good eyeball examination. The left eye was 6/10 with no pinhole improvement, non-axial proptosis, and superolateral mass. The movement of his left eye was restricted. Other anterior and posterior segments were promising. The patient was diagnosed with pseudotumor and was given oral methylprednisolone. The eye condition is said to be getting better. The patient complained that the left eye was more prominent and protruding three years later, with blurred vision accompanied by infection. Left eye visual acuity becomes Light Perception Bad Projection with non-axial proptosis, retraction of palpebra and pus. Orbital exenteration was performed, and anatomical pathology examination revealed myoepithelial carcinoma of the lacrimal gland. The patient was planned for radiotherapy.</p> <p><strong>Conclusion:</strong> These rare cases have made setting up a regimen in randomized controlled trials difficult. The rapid development of therapy gives more hope to treating patients with lacrimal gland tumors.</p> L.P. Suryantini Septia Dewi, Putu Yuliawati, made laksmiNi Made Laksmi Utari, sukartiniA.A.A. Sukartini Djelantik Copyright (c) 2022 suryantini septia, putu yuliawati, made laksmi utari, sukartini djelantik Fri, 12 Aug 2022 00:00:00 +0000 Keloid yang diterapi dengan kombinasi bedah listrik dan bedah beku pada seorang perempuan: sebuah laporan kasus dan tinjauan pustaka <p><strong>Background: </strong>Keloids are nodular tumors with a soft and spongy consistency and have a shiny and soft surface. Lesions are absent in hair follicles and adnexal glands. The main mediators include transforming growth factor-beta (TGF-β), interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor (TNF), and vascular growth factor (VEGF). This case discusses the combination therapy of electrosurgery and frozen surgery in treating keloids.</p> <p><strong>Case description: </strong>A woman, 34 years old, Indonesian, has complained of a lump on her left shoulder since ten years ago, which has been getting harder and harder, sometimes accompanied by pain and itching. There was a solitary hyperpigmented nodule in the left deltoid region with firm boundaries, geographic shape, measuring 5.7 cm x 4 cm x 0.8 cm, regular edges, and a smooth and shiny surface. On palpation, the consistency is firm and firm. Dermoscopy showed multiple erythema nodules with vascular structures in the form of arborizing vessels and linear irregular vessels. Electrocauter surgery was performed with cut mode and continued with cryo surgery and the antibiotic ointment gentamicin 0.1% topically every 12 hours on lesions that have undergone electrosurgery, frozen surgery, and paracetamol tablets 500 mg every 8 hours intraorally if pain. On the 36th day of observation, clinical improvement of the lesions was found.</p> <p><strong>Conclusion:</strong> Cryo surgery is minimally invasive and can be combined with electrocautery surgery to reduce bleeding. The lesion improvement was seen after the combination treatment was given, although there were still hypertrophic scar lesions.</p> <p> </p> <p><strong>Latar belakang: </strong>Keloid merupakan tumor nodular dengan konsistensi lunak dan kenyal, memiliki permukaan berkilauan dan lunak. Lesi tidak terdapat pada folikel rambut dan kelenjar adneksal. Mediator utama meliputi <em>transforming growth factor beta (TGF-β), interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor (TNF), </em>dan <em>vascular growth factor (VEGF).</em> Kasus ini membahas terapi kombinasi bedah listrik dan bedah beku pada penanganan keloid.</p> <p><strong>Kasus: </strong>Wanita, 34 tahun, warga negara Indonesia, mengeluh adanya benjolan pada bahu kiri sejak 10 tahun yang lalu yang semakin lama semakin keras, terkadang disertai rasa nyeri dan gatal. Pada regio deltoid sinistra didapatkan adanya nodul hiperpigmentasi soliter batas tegas, bentuk geografika, berukuran 5,7 cm x 4 cm x 0,8 cm, tepi reguler, permukaan halus dan mengkilat. Pada palpasi didapatkan konsistensi padat kenyal dan terfiksir. Dermoskopi didapatkan gambaran nodul eritema multipel dengan struktur vaskular berupa <em>arborizing vessels</em> dan linear <em>irregular vessels</em>. Dilakukan tindakan bedah listrik dengan mode <em>cut </em>dan dilanjutkan dengan bedah beku serta salep antibiotik gentamisin 0,1% tiap 12 jam secara topikal pada lesi yang telah dilakukan bedah listrik dan bedah beku dan parasetamol tablet 500 mg tiap 8 jam intraoral bila nyeri. Pengamatan hari ke 36 didapatkan perbaikan klinis lesi.</p> <p><strong>Simpulan: </strong>Bedah beku merupakan tindakan invasif minimal dan dapat dikombinasikan dengan bedah listrik untuk mengurangi perdarahan selama tidakan dilakukan. Perbaikan lesi telihat setelah diberikan tindakan kombinasi walaupun masih terdapat lesi skar hiperterofik.</p> NI Putu Ayu Riska Yunita Sari, Ketut Kwartantaya Winaya, Roslina Horo, Luh Nyoman Arya Wisma Ariani Copyright (c) 2022 NI Putu Ayu Riska Yunita Sari, Ketut Kwartantaya Winaya, Roslina Horo, Luh Nyoman Arya Wisma Ariani Mon, 08 Aug 2022 00:00:00 +0000 Anaphylactic reaction: lesson learned from three cases <p><strong>Background: </strong>An anaphylactic reaction is an emergency that can be life-threatening if not recognized immediately. Signs and symptoms that appear vary from mild to severe. After knowing that it is an anaphylactic reaction, it needs immediate action and special attention, especially from general practitioners who work in the emergency unit.</p> <p><strong>Case presentation: </strong>In this scientific publication, three cases will be presented, all of which were found in the emergency room at Cikarang Medika Hospital, Bekasi. These cases of anaphylaxis vary in the onset of signs and symptoms, clinical manifestation, allergen, degree of severity, and therapeutic response. However, in these three cases, the initial management, which was an emergency, was the same for each patient, and all cases occurred at home; thus, education on anaphylaxis in the general community is vital, especially for the patients and their families.</p> <p><strong>Conclusion: </strong>As a physician who works in the emergency room is essential to know how to quickly recognize the signs and symptoms of an anaphylactic reaction and carry out treatment as soon as possible so that patients can be helped. The first line treatment is Epinephrine and other treatment may follow after the first line has been given. It is essential that the public needs to know about the occurrence, the cause or trigger, and first aid (what they should do in the event of an anaphylactic reaction).</p> William Bunga Datu, Emita Raya Katinda, Andrew Suprayogi Copyright (c) 2022 Andrew Suprayogi, William Bunga Datu, Emita Raya Katinda Thu, 30 Jun 2022 00:00:00 +0000 Colonization of Citrobacter koseri and Streptococcus agalactiae in a case of cellulitis cruris dextra et sinistra <p><strong>Background: </strong>Cellulitis is a skin infection involving the deep dermis and subcutaneous tissue, characterized by localized pain, swelling, tenderness, erythema, and warmth. The most common causes of cellulitis are <em>group A streptococci</em> and <em>Staphylococcus aureus</em>. <em>Streptococcus agalactiae</em> or the so-called <em>group B Streptococcus</em> can also cause cellulitis. This case report aims to evaluate the colonization of <em>Citrobacter koseri</em> and <em>Streptococcus agalactiae</em> in a case of cellulitis cruris dextra et sinistra.</p> <p><strong>Case Presentation:</strong> A 53-year-old married woman presented to the outpatient clinic complaining of swelling and redness in her left and right legs since five days ago. At first, there was only a little redness around the calf, but it became wider and pain in that area. On examination, there were multiple erythematous macules, patches, and multiple erosional lesions, warm palpable and tender to palpation, and the diascopy test disappeared with pressure. Based on the wound culture results, isolated <em>Citrobacter koseri</em> and <em>Streptococcus agalactiae</em> bacteria were considered colonization. Both of these bacteria were less virulent. The patient was treated with systemic and topical antibiotics, analgesics, wound care management and elevated lower limbs.</p> <p><strong>Conclusion:</strong> The diagnosis of cellulitis is based on history and physical examination. On examination of the wound culture of this case, <em>Citrobacter koseri</em> and <em>Streptococcus agalactiae</em> were found, considered as colonization. The patient showed clinical improvement at each observation after administration of antibiotics and wound care management. The patient's prognosis is dubious ad bonam.</p> Luh Gede Melia Puspita Sari, Ni Nengah Dwi Fatmawati, I Gusti Ayu Agung Praharsini, Marvin Giantoro Copyright (c) 2022 Luh Gede Melia Puspita Sari, Ni Nengah Dwi Fatmawati, I Gusti Ayu Agung Praharsini, Marvin Giantoro Mon, 08 Aug 2022 00:00:00 +0000 Effect of uncontrolled glycemic on cataract surgery outcome in patient with diabetic retinopathy <p><strong>Objective: </strong>This study aims to report a case of catarct surgey outcome in cataract diabetic patient with uncontrolled glycemic.</p> <p><strong>Case Presentation:</strong> A 54-year-old woman has catarct on both eye and history of diabetes mellitus for 15 years. The patients was planned for cataract surgery when blood sugar below 200mg/dL in left eye,blood sugar patients from 248 mg/dL become 168 mg/dL. One week post operation evaluation revealed corneal edema, due to phaco time intra surgery in this patient increased. Visual acuity was 6/120 BCVA on the right eye and 6/18 BCVA on the left eye. Visual acuity has decreased in 2 months after surgery, 1/60 BCVA on the right eye and 6/18 BCVA on the left eye, as well as funduscopy presence of dot blot, flame-shaped, and traction on both eyes. This outcome was contributed by an uncontrolled blood glucose of the patient.</p> <p><strong>Conclusion: </strong>Preoperative preparations in diabetic cataract patients are mandatory, including blood sugar and HbA1C control, to achieve a better outcome of ocular surgery in patients with diabetes mellitus.</p> NLP Wistya Eka Mahadewi, I Wayan Gede Jayanegara, Siska, I Made Agus Kusumadjaja Copyright (c) 2022 Wistya Eka Mahadewi, I Wayan Gede Jayanegara, siska siska Fri, 12 Aug 2022 00:00:00 +0000 Lumbar spinal stenosis: pendekatan tatalaksana bedah <p><strong>Background: </strong>Lumbar spinal stenosis (LSS) is the most common subtype of spinal stenosis. This pathologic disorder is the most common cause of low back pain in elderly. LSS can be either congenital or acquired, which the disorder is mainly caused by the degenerative process. Diagnosis of LSS is made by combination of clinical manifestations and radiological findings. Management of LSS may include conservative measures in form of physical therapy, steroid injection on facet joints or epidural space, and also surgical decompression procedure. LSS often reduces invididuals’ quality of life and productivity; hence, it is the most common indication for lumbar spinal canal decompression procedure.</p> <p><strong>Case report: </strong>A 41 years old woman complained of low back pain that was referred to the left buttock and leg area. The complaints were also accompanied by numbing sensation on the antero-lateral side of the left leg. Complaints have been felt continuously since 5 months ago. From physical examination, the Visual Analogue Scale (VAS) was 5-6 with positive laseque test on left leg accompanied with hypoesthesia in L4, L5, and S1 dermatome. MRI findings suggested the diagnosis of canalis stenosis of L4-L5 and L5-S1. We perfomed laminectomy and <em>Posterior Lumbar Interbody Fusion</em> (PLIF) on this patient.</p> <p><strong>Conclusion: </strong>Surgical approaches are based on the anatomic location, number of segment affected, involvement of thoracolumbar junction, transitional anatomy, instability, and deformity. Factors that affect patients’ clinical outcome after the surgical procedure should be considered before starting the procedure.</p> <p> </p> <p><strong>Latar belakang: </strong><em>Lumbar spinal stenosis </em>(LSS) merupakan jenis stenosis spinal yang paling sering dijumpai, dimana kelainan ini merupakan salah satu penyebab patologis tersering dari nyeri punggung bawah pada populasi lansia. LSS dapat berupa kelainan kongenital ataupun kelainan yang didapat, dimana kebanyakan LSS diakibatkan oleh proses degeneratif. Diagnosis LSS melibatkan kombinasi dari temuan klinis dan radiologis. Tatalaksana pasien LSS dapat meliputi upaya konservatif berupa terapi fisik, injeksi steroid pada persendian facet ataupun ruang epidural, hingga tindakan operasi dekompresi. LSS seringkali menurunkan kualitas hidup serta produktivitas seseorang, sehingga LSS sering dijadikan sebagai indikasi untuk dilakukan prosedur operasi medula spinalis lumbal.</p> <p><strong>Laporan kasus: </strong>Wanita, 41 tahun mengeluh nyeri punggung bawah serta nyeri yang menjalar ke bokong dan tungkai kiri, yang disertai sensasi kebas pada tungkai kiri sisi antero-lateral. Keluhan dirasakan terus menerus sejak 5 bulan lalu. Pemeriksaan fisik di dapatkan <em>Visual Analogue Scale</em> (VAS): 5-6, tes laseque positif tungkai kiri serta hipoestesia pada dermatom L4, L5 dan S1. Temuan MRI lumbal mengarah kepada diagnosis stenosis kanalis L4-L5 dan L5-S1. Dilakukan laminektomi dan <em>Posterior Lumbar Interbody Fusion</em> (PLIF).</p> <p><strong>Kesimpulan: </strong>Pemilihan modalitas bedah didasarkan pada lokasi anatomis, jumlah segmen, keterlibatan thoracolumbar junction, adanya anatomi transisional, instabilitas, ataupun deformitas. Beberapa faktor yang mempengaruhi luaran klinis pasien pasca prosedur operasi perlu menjadi pertimbangan sebelum memulai tindakan bedah.</p> Kevin Giovani Mandua, Alvarez Zefanya Moningka Copyright (c) 2022 Kevin Giovani Mandua, Alvarez Zefanya Moningka Thu, 18 Aug 2022 00:00:00 +0000 Comparison of knee society scores in osteoarthritis patient before and after total knee arthroplasty: a case report <p><strong>Introduction:</strong> Osteoarthritis is a degenerative disease characterized by joint pain in the cartilage. It requires further management, especially in severe conditions that have not responded to pharmacological therapy, such as Total Knee Arthroplasty (TKA). Therefore, the authors aim to compare the knee quality of patients with Knee Society Scores (KSS) before and after TKA surgery.</p> <p><strong>Case description:</strong> Female patient, 55 years old, came with the chief complaint of stiffness and pain in both knees for the last two years. The patient had previously undergone regular treatment and is now getting worse. The radiological found the impression of right and left knee osteoarthritis was grade IV, and the KSS assessment results were 40. The patient was then treated with TKA surgery. After the total knee arthroplasty procedure was observed for one month, the patient had no complaints of joint stiffness and did not feel severe pain in both knees. The KSS assessment results were 71 with good interpretation results.</p> <p><strong>Conclusion:</strong> There was an improvement in the knee quality of patients with KSS before and after TKA surgery.</p> I Dewa Gede Indra Pratama Putra, Dewa Gede Kurnia Pratama, Putu Budi Sucitra Copyright (c) 2022 I Dewa Gede Indra Pratama Putra, Dewa Gede Kurnia Pratama, Putu Budi Sucitra Fri, 22 Jul 2022 00:00:00 +0000 Autoimmune Hemolytic Anemia (AHA) with hyperglycemia in a 22-year-old woman: a case report <p><strong>Background:</strong> Autoimmune hemolytic anemia (AIHA) is defined as increased erythrocyte destruction due to anti-erythrocyte autoantibodies with or without complement activation. Diabetes Mellitus (DM) is a chronic metabolic disease characterized by elevated blood glucose levels, which cause serious damage to various organs, including the heart, blood vessels, eyes, kidneys, and nerves. The impact of DM on a patient's survival with AIHA is unknown.</p> <p><strong>Case Presentation:</strong> A 22-year-old woman complained of dizziness and fainting before admission. The patient looked pale; on physical examination, we found jaundice on the sclera. This patient was diagnosed with AIHA and DM with increased HbA1c (10.8%) since 2017 but did not take the anti-diabetic drugs regularly. Hematological examination showed anemia, increased reticulocytes, and a positive direct Coombs test. The result of increased fasting glucose, 2 hours OGTT, and HbA1c levels (4.6%) tests were not relevant to hyperglycemia. In this patient, we also found normal C-peptide levels. The decrease in HbA1c levels was thought to be due to hemolytic anemia; therefore, HbA1c was falsely low due to rapid erythrocyte turnover.</p> <p><strong>Conclusion:</strong> This patient was diagnosed with DM based on American Diabetes Association criteria with normal C-peptide levels, suggesting Maturity Onset Diabetes of the Young with HbA1c incompatibility with glucose levels may be due to rapid erythrocyte turnover.</p> Fran Siska, Saskia Ramadhani, Anik Widijianti Copyright (c) 2022 Fran Siska, Saskia Ramadhani, Anik Widijianti Mon, 08 Aug 2022 00:00:00 +0000 Hyperglycemic hyperosmolar state in children: a case series <p><strong>Background: </strong>Hyperglycemic hyperosmolar state (HHS) is a life-threatening rare acute complication of diabetes mellitus (DM). The condition should be distinguished from diabetic ketoacidosis (DKA) as the management differs significantly. HHS is classically associated with type 2 DM, but it has been increasingly reported in type I DM as well. The literature regarding HHS in children is still sparse. The management of HHS in children is extrapolated from the adult study.</p> <p><strong>Cases: </strong>The first case was male 5 years old, and the second case was female 15 years old. Both cases were typed 1 DM patient. The first case was newly diagnosed. Both of the patients came with general weakness, mild dehydration, overly high blood sugar, normal blood pH, hypocalcemia, glucosuria and only mild ketonuria. In the second case develop, both patients were rehydrated, given insulin and discharged in 7-10 days without any sequelae.</p> <p><strong>Conclusion: </strong>These case series emphasize the importance of recognizing HHS and differ it from DKA. These two cases prove that HHS is increasingly reported in children with clinical symptoms resembling DKA. It is also proven that with early diagnosis and correct management, children with HHS can be discharged home without any sequelae.</p> Leni Lukman, I Made Darma Yuda, I Made Arimbawa Copyright (c) 2022 Leni Lukman, I Made Darma Yuda, I Made Arimbawa Wed, 10 Aug 2022 00:00:00 +0000 Ablasio retina rhegmatogen bilateral: sebuah laporan kasus <p><strong>Background: </strong>Rhegmatogenous retinal detachment in children is rare, accounting for less than ten percent of all rhegmatogenous retinal detachments. While the majority of retinal detachments in the adult population are associated with posterior vitreous detachments, pediatric rhegmatogenous retinal detachments are often associated with trauma or an underlying congenital abnormality, although in some cases they are associated with idiopathic conditions.</p> <p><strong>Case Description: </strong>A 16-year-old male patient complained about blurry vision in the right eye in the last 6 months and in the left eye in the last 5 months. Ophthalmology examination in the right eye found an inferior retinal detachment (+) at 3-9 o’clock, multiple breaks at 7-9 hours, PVR grade C, subretinal fibrosis (+), traction (+), macula off, RM (-). Meanwhile, ophthalmology examination in the left eye found an inferior retinal detachment in the left eye (+) at 3-9 o’clock, break at 5 o'clock, PVR grade C, traction (+), RM (+). The patient underwent pars plana vitrectomy in both eyes and the patient experienced an increase in visual acuity after surgery on both eyes.</p> <p><strong>Conclusion: </strong>This case describes a healthy adolescent male with bilateral rhegmatogenous retinal detachment secondary to spontaneous non-traumatic retinal dialysis. The Pars Plana Vitrectomy (VPP) technique that used in this case could give high final reattachment rate and relatively good functional outcomes. VPP also has the intraocular ability to manipulate tissues and reduce immediate vitreous traction.</p> <p> </p> <p><strong>Latar Belakang: </strong>Ablasio retina rhegmatogenous pada anak-anak jarang terjadi, terhitung kurang dari sepuluh persen dari semua ablasio retina rhegmatogen. Sementara sebagian besar ablasio retina pada populasi orang dewasa terkait dengan ablasio vitreous posterior, ablasio retina hegmatogen pediatrik sering kali berhubungan dengan trauma atau kelainan kongenital yang mendasari, walaupun pada beberapa kasus didapatkan dengan kondisi idiopatik.</p> <p><strong>Laporan Kasus: </strong>Pasien laki-laki berusia 16 tahun mengeluhkan penurunan pengelihatan pada mata kanan sejak 6 bulan sebelumnya dan pada mata kiri 5 bulan sebelumnya. Pemeriksaan oftalmologi didapatkan AAR di mata kanan dengan <em>retinal detachment</em> (+) di inferior pada jam 3-9, multiple break pada jam 7-9, PVR grade C, fibrosis subretina (+), traksi (+), macula off, RM (-). Pemeriksaan pada mata kiri didapatkan <em>retinal detachment</em> di mata kiri (+) di inferior pada jam 3-9, break pada jam 5, PVR grade C, traksi (+), RM (+). Pasien menjalani vitrektomi pars plana pada kedua mata dan pasien mengalami peningkatan tajam penglihatan setelah dilakukan tindakan operasi pada kedua mata.</p> <p><strong>Kesimpulan: </strong>Kasus ini menjelaskan remaja laki-laki sehat dengan bilateral ablasio retina rhegmatogen sekunder akibat retinal spontan non-trauma dialisis. Teknik Vitrektomi Pars Plana (VPP) digunakan pada kasus ini dan mampu memberikan tingkat <em>attachment</em> akhir yang tinggi dan hasil fungsional yang relatif baik serta kemampuan intraokular untuk memanipulasi jaringan dan mengurangi traksi vitreous secara langsung.</p> Amicipta Sanjaya, Ari Andayani, I Made Agus Kusumadjaja Copyright (c) 2022 Amicipta Sanjaya, Ari Andayani, I Made Agus Kusumadjaja Mon, 20 Jun 2022 00:00:00 +0000 Perbedaan Kadar serum Liver-Type Fatty Acid Binding Protein (L-FABP) dan Beta Trace Protein (BTP) Dalam Serum Sebelum dan Saat Cedera Ginjal Akut <p><strong>Background:</strong> The prevalence of Acute Kidney Injury (AKI) varies, ranging from 3% to 20% of hospitalized patients and 25% to 67% of ICU patients, with 5% to 6% of the ICU population requiring renal replacement therapy following AKI. Establishing the diagnosis of AKI with KDIGO criteria using serum creatinine marker. Serum creatinine has a sensitivity of 52.9% and a specificity of 85.7% for AKI. The Sensitivity and specisifity of serum creatinine is not good because it can increase without any real injury or do not change even though acute tubular injury has occurred due to compensation for increased function by the remaining nephrons. L-FABP (Liver type Fatty Acid Binding Protein) and BTP (Beta Trace Protein) serum are newly discovered biomarkers potential for the early diagnosis of acute kidney damage. This study was conducted to determine the change in L-FABP and BTP concentration levels as markers of AKI.</p> <p><strong>Method:</strong> This study is a longitudinal observational study with patients suffering from AKI with serum samples taken before and after an increase in serum creatinine level of ≥0.3 mg/dL in 48 hours. Serum levels of L-FABP and BTP were examined by ELISA method, and serum creatinine by enzymatic colorimetric. Differences between levels before and during AKI were analyzed by the Wilcoxon test.</p> <p><strong>Results:</strong> The number of research subjects was 40 people. There was significant difference between serum creatinine before and during AKI (1.97 (1.36-2.77) mg/dL vs. 3.52 (2.53-4.91). mg/dL, p&lt;0.001). Indeed there were also significant differences in serum L-FABP before and during AKI (3775.48 (1614.11-5086.68) ng/mL vs. 5427.28 (4562.79-5765.14) ng/mL, p&lt;0.001), and serum BTP levels before and during AKI (456.36 (290.35-591.67) mg/L vs. 518.38 (436.37-691.90) mg/L, p&lt;0.001).</p> <p><strong>Conclusion:</strong> Serum levels of L-FABP and BTP increased significantly in the condition of the AKI so that it has the potential to be a marker for the diagnosis of AKI.</p> <p> </p> <p><strong>Latar belakang:</strong> Prevalensi cedera ginjal akut (<em>Acute Kidney Injury</em>/AKI) bervariasi, sekitar 3% hingga 20% dari pasien rawat inap dan 25% hingga 67% dari pasien ICU, dengan 5% hingga 6% dari populasi ICU membutuhkan terapi penggantian ginjal setelah terjadi AKI. Penegakan diagnosis AKI dengan kriteria KDIGO menggunakan marker serum kreatinin. Serum kreatinin mempunyai sensitivitas 52,9% dan spesifisitas 85,7% untuk AKI. Sensitivitas dan spesifisitas serum kreatinin tersebut kurang baik karena kadar serum kreatinin dapat meningkat tanpa ada cedera nyata maupun tidak berubah meskipun telah terjadi cedera tubulus akut karena adanya kompensasi peningkatan fungsi oleh nefron yang tersisa. Serum L-FABP (<em>Liver type Fatty Acid Binding Protein</em>) dan BTP (<em>Beta Trace Protein</em>) adalah biomarker yang ditemukan untuk diagnosis dini AKI. Penelitian ini dilakukan untuk mengetahui perubahan kadar serum L-FABP dan BTP sebagai penanda terjadinya AKI.</p> <p><strong>Metode: </strong>Penelitian ini adalah penelitian observasional longitudinal dengan subyek pasien yang menderita AKI dengan sampel serum yang diambil sebelum dan sesudah terjadi peningkatan kadar serum kreatinin ≥0,3 mg/dL dalam 48 jam. Kadar serum L-FABP dan BTP diperiksa dengan metode ELISA, dan serum kreatinin dengan metode enzimatik kolorimetrik. Perbedaan antara kadar sebelum dan saat AKI dianalisis dengan uji Wilcoxon.</p> <p><strong>Hasil:</strong> Jumlah subyek penelitian adalah 40 orang. Terdapat perbedaan bermakna antara kreatinin serum sebelum dan selama AKI (1,97 (1,36-2,77) mg/dL vs 3,52 (2,53-4,91), mg/dL, p&lt;0,001. Teradapat juga perbedaan yang signifikan dalam serum L-FABP sebelum dan selama AKI (3775,48 (1614,11-5086,68) ng/mL vs 5427,28 (4562,79-5765,14) ng/mL, p&lt;0,001), dan kadar BTP serum sebelum dan selama AKI (456,36 (290,35-591,67) mg/L vs. 518,38 (436,37-691,90) mg/L, p&lt;0,001).</p> <p><strong>Simpulan:</strong> Kadar serum L-FABP dan BTP meningkat signifikan pada kondisi AKI sehingga berpotensi menjadi marker untuk diagnosis AKI.</p> Mona Yuliari, Hani Susianti, Deasy Ayuningtyas Tandio Copyright (c) 2022 Mona Yuliari, Hani Susianti, Deasy Ayuningtyas Tandio Mon, 25 Jul 2022 00:00:00 +0000 Kemampuan Tutor dalam Menstimulasi Self Directed Learning Mahasiswa Kedokteran <p><strong>Background:</strong> Self-directed learning (SDL) is a skill that must be possessed by medical students as a form of adult learning. To train these skills, students need tutors to stimulate students' SDL abilities.</p> <p><strong>Methodology:</strong> This study was conducted quantitatively using a Dolman and Ginns questionnaire on third-year medical students.</p> <p><strong>Results:</strong> Tutors in the Medical Emergency block were able to provide a good explanation of the issues in the case and stimulate students to look for other learning resources.</p> <p><strong>Conclusion:</strong> Tutors with academic backgrounds that match the discussion material can be considered as one of the factors that can stimulate students' SDL.</p> <p>&nbsp;</p> <p><strong>Latar Belakang:</strong> <em>Self-directed learning</em> (SDL) merupakan keterampilan yang harus dimiliki oleh mahasiswa kedokteran sebagai bentuk pembelajaran dewasa. Untuk melatih keterampilan ini mahasiswa memerlukan tutor dalam menstimulasi kemampuan SDL mahasiswa.</p> <p><strong>Metodologi:</strong> penelitian ini dilakukan secara kuantitatif dengan menggunakan kuisioner Dolman dan Ginns pada mahasiswa kedokteran tahun ke-tiga.</p> <p><strong>Hasil:</strong> tutor pada blok Medical Emergency mampu memberikan penjelasan yang baik mengenai issue yang ada pada kasus serta menstimulasi mahasiswa untuk mencari sumber pembelajaran yang lainnya.</p> <p><strong>Simpulan:</strong> tutor dengan latar belakang akademik yang sesuai dengan materi diskusi dapat dipertimbangan sebagai salah satu factor yang dapat menstimulasi SDL mahasiswa.</p> I Gusti Ayu Harry Sundariyati, Putu Gede Sudira, Ida Bagus Amertha Putra Manuaba, I Gusti Ayu Sri Darmayani Copyright (c) 2022 I Gusti Ayu Harry Sundariyati, Putu Gede Sudira, Ida Bagus Amertha Putra Manuaba, I Gusti Ayu Sri Darmayani Thu, 28 Jul 2022 00:00:00 +0000 Korelasi pemeriksaan darah lengkap dengan derajat keparahan COVID-19 pada pasien lansia di Rumah Sakit Umum Daerah (RSUD) Tabanan tahun 2021 <p><strong>Background: </strong>COVID-19 infects all patients of all ages including the elderly. Several studies have shown that complete blood counts can be used as a marker of the severity of COVID-19. This study aims to examine complete blood counts with the severity of COVID-19 in elderly patients at the Tabanan Regional General Hospital (RSUD) in 2021.</p> <p><strong>Methods: </strong>This research was conducted using an retrospective study method, using 277 samples taken from secondary data (patient medical records) at Tabanan General Hospital. The independent variables of study including haemoglobin, haematocrit, leukocytes, relative lymphocyte levels, relative neutrophil levels, neutrophil lymphocyte ratio (NLR), relative eosinophil levels, relative basophil levels, relative monocyte levels, platelets, and depending variable is the severity of the patient, divided to moderate, severe, critically ill. Data analysis using SPSS version 26 for Windows.</p> <p><strong>Results: </strong>Complete blood counts were significantly correlated with Lymphocytes (r<sup>2 </sup>= 0,069; p &lt; 0,001), Monocyte (r<sup>2 </sup>= 0,045; p &lt; 0,001), Leukocyte (r<sup>2 </sup>= 0,037; p = 0,001), NLR (r<sup>2 </sup>= 0,03; p = 0,004), Eosinophil (r<sup>2 </sup>= 0,022; p = 0,013), and Haematocrit (r<sup>2 </sup>= 0,069; p = 0,022).</p> <p><strong>Conclusion: </strong>In this study, complete blood count (leukocytes, NLR, haematocrit with a positive value correlation, and lymphocytes, eosinophils, monocytes with a negative value correlations) can be used as predictors to assess the severity of COVID-19 patients. However, neutrophils, basophils, haemoglobin, and platelets were not correlated significantly.</p> <p> </p> <p><strong>Latar Belakang: </strong>COVID-19 menginfeksi semua pasien dari segala usia termasuk lansia. Beberapa studi menunjukkan bahwa pemeriksaan darah lengkap dapat dipergunakan sebagai penanda derajat keparahan COVID-19. Penelitian ini bertujuan untuk mengevaluasi pemeriksaan darah lengkap dengan derajat keparahan COVID-19 pada pasien lansia di Rumah Sakit Umum Daerah (RSUD) Tabanan tahun 2021.</p> <p><strong>Metode: </strong>Penelitian ini dilakukan dengan metode studi retrospektif menggunakan 277 sampel yang diambil dari data sekunder rekam medis pasien di RSUD Tabanan. Variabel independen penelitian meliputi hemoglobin, hematokrit, leukosit, kadar limfosit relatif, kadar neutrofil relatif, neutrofil limfosit ratio (NLR), kadar eosinofil relatif, kadar basofil relatif, kadar monosit relatif, trombosit, dan dependent derajat keparahan pasien yaitu sedang, berat, kritis. Analisis data memakai SPPS versi 26 untuk Windows.</p> <p><strong>Results: </strong>Pemeriksaan darah lengkap menunjukkan hasil yang bermakna pada Limfosit (r<sup>2 </sup>= 0,069; p &lt; 0,001), Monosit (r<sup>2 </sup>= 0,045; p &lt; 0,001), Leukosit (r<sup>2 </sup>= 0,037; p = 0,001), NLR (r<sup>2 </sup>= 0,03; p = 0,004), Eosinofil (r<sup>2 </sup>= 0,022; p = 0,013), dan Hematokrit (r<sup>2 </sup>= 0,069; p = 0,022).</p> <p><strong>Conclusion: </strong>Pada penelitian ini pemeriksaan darah lengkap (leukosit, NLR, hematokrit dengan korelasi positif, dan limfosit, eosinofil, monosit dengan korelasi nilai negatif) dapat digunakan sebagai prediktor untuk menilai derajat keparahan pasien COVID-19. Akan tetapi neutrofil, basofil, hemoglobin, dan trombosit tidak berkorelasi secara bermakna.</p> Richard Samsudin, I Gede Agus Sastrawan, I Gede Risnawan Suastika Ardanayasa, I Gusti Putu Suka Aryana Copyright (c) 2022 Richard Samsudin, I Gede Agus Sastrawan, I Gede Risnawan Suastika Ardanayasa Mon, 08 Aug 2022 00:00:00 +0000 Pengaruh ekstrak etanol umbi ubi jalar ungu terhadap kadar dopamin striatum dan perilaku stereotipi pada tikus wistar yang diinduksi methylphenidate <p><strong>Background</strong>: Anthocyanins are flavonoids that have various potentials such as antioxidant, anti-inflammatory and antiapoptotic. One source of anthocyanins which is common among the Indonesian are purple sweet potato (Ipomoea batatas L.). Its potential can be used to prevent and treat the effects of substances including psychostimulants. Methylphenidate (MPH) is one of the psychostimulants used as therapeutic option for ADHD, but its use has several controversies, such as the occurrence of toxicity and long-term damage. This study aimed to examine the effect of purple sweet potato ethanol extract on levels of the striatum dopamine neurotransmitter and stereotypic behavior in methylphenidate-induced rats.</p> <p><strong>Method:</strong> This research is a randomized posttest–only control group. Samples were male Wistar rats (Rattus norvegicus), aged 6-8 weeks (randomly divided into 2 groups). The treatment group was given purple sweet potato ethanol extract before MPH injection. Examination of dopamine levels using ELISA and stereotyped behavior were assessed using the stereotyped behavior rating scale. Statistical test was by Mann Witney test and independent t-test.</p> <p><strong>Results: </strong>The results showed striatum dopamine levels were significantly lower in the treatment group (given purple sweet potato ethanol extract before MPH was induced) than the control (6.83±2.83 vs. 10.02±4.35; p&lt;0.05). Stereotypic behavior in the treatment group was significantly lower than the control group (3.46±0.63 vs. 3.96±0.70; p&lt;0.05).</p> <p><strong>Conclusion:</strong> The ethanolic extract of purple sweet potato is thought to have antidopaminergic potential and cause a decrease in stereotypic behavior in MPH-induced wistar rats.</p> <p> </p> <p><strong>Latar belakang:</strong> Antosianin merupakan flavonoid yang memiliki berbagai potensi seperti antioksidan, antiinflamasi dan antiapoptosis. Salah satu sumber antosianin yang mudah ditemukan dan cukup umum di kalangan penduduk lokal Indonesia adalah ubi jalar ungu (<em>Ipomoea batatas L</em>.). Potensinya dapat mencegah dan mengobati dampak yang ditimbulkan oleh zat psikostimulan. Methylphenidate (MPH) merupakan salah satu psikostimulan yang digunakan sebagai pilihan terapi untuk <em>Attention-deficit hyperactivity disorder</em> (ADHD), namun pemakaiannya memiliki beberapa kontroversi seperti terjadinya efek toksik, penyalahgunaan dan timbulnya kerusakan jangka panjang. Penelitian ini bertujuan untuk melihat pengaruh pemberian ekstrak etanol ubi jalar ungu terhadap kadar neurotransmiter dopamin striatum dan perilaku stereotipi pada tikus yang diinduksi methylphenidate.</p> <p><strong>Metode:</strong> Rancangan penelitian yang digunakan yaitu <em>randomized posttest–only control group</em>. Sampel penelitian adalah tikus (<em>Rattus norvegicus</em>) galur Wistar jantan, berumur 6-8 minggu (secara random dibagi dalam 2 kelompok). Kelompok perlakuan diberikan ekstrak etanol ubi jalar ungu sebelum diinjeksi MPH, sedangkan kelompok kontrol tidak. Pemeriksaan kadar dopamin menggunakan teknik Elisa dan perilaku stereotipi dinilai memakai stereotyped behavior rating scale. Uji statistik menggunakan uji mann witney dan independent t-test.</p> <p><strong>Hasil:</strong> Hasil penelitian menunjukkan kadar dopamin striatum lebih rendah secara bermakna pada kelompok perlakuan (diberikan ekstrak etanol ubi jalar ungu sebelum diinduksi MPH) dibandingkan kontrol (6,83±2,83 vs. 10,02±4,35; p&lt;0,05). Perilaku stereotipi pada kelompok perlakuan lebih rendah secara signifikan dibandingkan kontrol (3,46±0,63 vs. 3,96±0,70; p&lt;0,05).</p> <p><strong>Kesimpulan:</strong> Ekstrak etanol ubi jalar ungu diperkirakan memiliki potensi antidopaminergik dan menyebabkan penurunan perilaku stereotipi pada tikus wistar yang diinduksi MPH.</p> Putu Asih Primatanti Copyright (c) 2022 Putu Asih Primatanti Fri, 01 Jul 2022 00:00:00 +0000 Perbandingan kadar C-reactive protein (CRP) berdasarkan jenis herniotomi dan hubungannya dengan keluaran klinis pada hernia inguinalis indirek anak <p><strong>Background:</strong> Hernia is a protrusion or protrusion of the contents of a cavity through a defect or weak part of the abdominal cavity wall. The standard procedure in the form of herniotomy for indirect inguinal hernias in children can be performed open surgically or laparoscopically. Because there is still a lot of debate about the inflammatory response and outcomes that arise in patients undergoing laparoscopy and open herniotomy, this study was conducted with the aim of evaluating differences in CRP levels in pediatric patients after open herniotomy and laparoscopic herniotomy and their impact on surgical outcomes in the form of wound healing time, length of hospitalization and postoperative pain.</p> <p><strong>Methods:</strong> This study is a prospective cohort study using primary data carried out at Sanglah Central General Hospital (RSUP) Sanglah from January to December 2020. Data in the form of gender, the side of the hernia, age, CRP levels, duration of hospitalization, duration of wound healing , postoperative pain scale, duration of surgery, hemoglobin, and BMI were taken from the patient's medical record. After the data was collected, univariate and bivariate analysis was carried out using SPSS 20.</p> <p><strong>Result: </strong>A total of 38 patients who were the subjects of this study in the open surgical and laparoscopic groups were 19 subjects each. The mean CRP level in the open surgical group was higher (4.58 ± 1.82 mg/L) than the laparoscopic group (3.53 ± 1.53 mg/L). The duration of hospitalization and wound healing in the open surgical group was found to be longer (1.11 ± 0.32 days; 6.58 ± 0.51 days) when compared to the laparoscopic group (1.05 ± 0.23 days; 4.42 ± 0.51 days). The mean postoperative pain scale measurement results were higher in the open surgical group (2.84 ± 0.77) compared to the laparoscopic group (1.53 ± 0.51). The results showed that there was a statistically significant correlation (p&lt;0.05; p&lt;0.05) with a weak correlation coefficient (r = 0.468; r = 0.457).</p> <p><strong>Conclusion:</strong> The laparoscopic technique was found to be superior in terms of the resulting inflammatory response, duration of wound healing, postoperative pain scale, and duration of hospitalization when compared to the open surgery technique. While the duration of hospitalization between the two groups was the same.</p> <p> </p> <p><strong>Latar belakang:</strong> Hernia merupakan protrusi atau penonjolan isi suatu rongga melalui defek atau bagian lemah dari dinding rongga abdomen. Prosedur standar berupa herniotomi pada hernia inguinal indirek anak dapat dilakukan secara <em>open surgical</em> ataupun laparoskopi. Oleh karena masih banyaknya perdebatan mengenai respon inflamasi dan luaran yang timbul pada pasien yang menjalani laparoskopi dan <em>open herniotomy, </em>penilitian ini dilakukan dengan tujuan untuk mengevaluasi perbedaan kadar CRP pada pasien anak pasca <em>open herniotomy</em> dan laparoskopi herniotomi serta dampaknya terhadap luaran operasi berupa lama penyembuhan luka, lama rawat inap serta nyeri paska operasi.</p> <p><strong>Metode:</strong> Studi ini merupakan studi kohort prospektif dengan menggunakan data primer yang dilaksanakan di Rumah Sakit Umum Pusat Sanglah (RSUP) Sanglah sejak Januari hingga Desember 2020. Data berupa jenis kelamin, sisi yang mengalami hernia, usia, kadar CRP, durasi rawat inap, lama penyembuhan luka, skala nyeri pasca operasi, durasi operasi, hemoglobin, dan IMT diambil dari rekam medis pasien. Setelah data terkumpul, dilakukan analisis univariat dan bivariat dengan menggunakan SPSS 20.</p> <p><strong>Hasil: </strong>Sebanyak 38 pasien yang menjadi subjek penelitian ini dengan kelompok <em>open surgical</em> dan laparoskopi terdapat masing-masing 19 subjek. Rerata kadar CRP pada kelompok <em>open surgical</em> lebih tinggi (4.58 ± 1.82 mg/L) dibandingkan dengan kelompok laparoskopi (3.53 ± 1.53 mg/L). Durasi rawat inap dan penyembuhan luka pada kelompok <em>open surgical</em> didapatkan lebih lama (1.11 ± 0.32 hari; 6.58 ± 0.51 hari) jika dibandingkan dengan kelompok laparoskopi (1.05 ± 0.23 hari; 4.42 ± 0.51 hari). Rerata hasil pengukuran skala nyeri pasca operasi didapatkan lebih tinggi pada kelompok <em>open surgical</em> (2.84 ± 0.77) dibandingkan dengan kelompok laparoskopi (1.53 ± 0.51). Hasil menunjukkan antara kadar CRP dengan variabel durasi penyembuhan luka dan dengan durasi operasi didapatkan korelasi yang bermakna secara statistika (p&lt;0.05; p&lt;0.05) dengan koefisien korelasi yang lemah (r = 0.468; r = 0.457).</p> <p><strong>Simpulan:</strong> Teknik laparoskopi ditemukan lebih unggul dalam hal respon inflamasi yang dihasilkan, durasi penyembuhan luka, skala nyeri pasca operasi, dan durasi rawat inap jika dibandingkan dengan teknik <em>open surgery</em>. Sedangkan durasi rawat inap diantara kedua kelompok adalah sama.</p> <p><strong>Kata Kunci: </strong><em>C-reactive protein</em>, <em>open herniotomy</em>, herniotomi laparoskopi, hernia inguinalis indirek, luaran operasi</p> Giovani Fatrio Odo, I Made Darmajaya, Nyoman Golden Copyright (c) 2022 Giovani Fatrio Odo, I Made Darmajaya, Nyoman Golden Wed, 06 Jul 2022 00:00:00 +0000 Profil kalus dan klavus di Unit Rawat Jalan Kulit dan Kelamin RSUD Dr. Soetomo Surabaya Periode Januari 2016 - Desember 2020 <p><strong>Introduction:</strong> Callus and clavus are skin disorders in the form of hyperkeratotic lesions that are common and can affect the patient's quality of life. Callus and clavus can occur in men or women of all ages. Treatment of callus and clavus has a low cost benefit but has received little attention and until now there is no gold standard of treatment that is considered ideal. Data on callus and clavus characteristics, common treatments, and the final outcome of callus and clavus therapy have not been widely reported so that it has an impact on the standard management of these two lesions. The aim of this study was to evaluate the description of callus and clavus cases in the form of gender, age, location lesions, management, and cure rate 1 month after therapy in the Outpatient Unit (URJ) Skin and Venereology Tumor Division and Skin Surgery (TBK) Regional General Hospital (RSUD) Dr. Soetomo, Surabaya.</p> <p><strong>Methods:</strong> A cross-sectional retrospective descriptive study on 25 Electronic Medical Records (EMR) patients with callus and clavus who met the inclusion and exclusion criteria at the Dermatology and Venereology Outpatient Unit, Skin Surgery Tumor Division (TBK) RSUD Dr. Soetomo Surabaya period January 2016 - December 2020.</p> <p><strong>Results:</strong> Twenty-five samples were recruited in this study consisting of 13 (52%) male patients and 12 (48%) female patients. Clavus dominated all cases in 20 (80%) cases, while callus was in 5 (20%) cases. The lower extremity was the most common site for lesions in 20 (80%) cases. Excision was the most frequently chosen method in 21 (84%) cases. Clinical recovery after 1 month after therapy was obtained in 20 (80%) cases.</p> <p><strong>Conclusion:</strong> Management of callus and clavus in URJ Skin and Venereology, TBK Division, RSUD Dr. Soetomo, Surabaya showed a cure rate of 80% with the most preferred modality being excision.</p> <p> </p> <p><strong>Pendahuluan</strong>: Kalus dan klavus adalah kelainan kulit berupa lesi hiperkeratotik yang umum didapatkan dan dapat mempengaruhi kualitas hidup pasien. Kalus dan klavus dapat terjadi pada pria ataupun wanita di segala rentang usia. Tatalaksana kalus dan klavus memiliki <em>cost</em> <em>benefit</em> yang rendah namun kurang mendapat perhatian dan hingga saat ini belum terdapat standar emas tatalaksana yang dianggap ideal. Data karakteristik kalus dan klavus, tatalaksana yang umum dilakukan, dan hasil akhir dari terapi kalus dan klavus belum banyak dilaporkan sehingga berdampak pada standar manajemen kedua lesi tersebut. Tujuan dari penelitian ini adalah mengevaluasi gambaran kasus kalus dan klavus berupa jenis kelamin, usia, lokasi lesi, tatalaksana, dan angka kesembuhan 1 bulan paska terapi di Unit Rawat Jalan (URJ) Kulit dan Kelamin Divisi Tumor dan Bedah Kulit (TBK) Rumah Sakit Umum Daerah (RSUD) Dr. Soetomo, Surabaya.</p> <p><strong>Metode: </strong>Penelitian deskriptif retrospektif potong lintang pada 25 <em>Electronic Medical Records</em> (EMR) pasien dengan kalus dan klavus yang memenuhi kriteria inklusi dan eksklusi di Unit Rawat Jalan Kulit dan Kelamin Divisi Tumor Bedah Kulit (TBK) RSUD Dr. Soetomo Surabaya periode Januari 2016 - Desember 2020.</p> <p><strong>Hasil</strong>: Dua puluh lima sampel direkrut pada penelitian ini terdiri dari 13 (52%) pasien laki-laki dan 12 (48%) pasien perempuan. Klavus mendominasi keseluruhan kasus yaitu 20 (80%) kasus, sedangkan kalus 5 (20%) kasus. Ekstremitas bawah merupakan lokasi tersering didapatkannya lesi yaitu pada 20 (80%) kasus. Eksisi merupakan metode yang paling sering dipilih yaitu pada 21 (84%) kasus. Kesembuhan klinis setelah 1 bulan paska terapi didapatkan pada 20 (80%) kasus.</p> <p><strong>Simpulan: </strong>Tatalaksana kalus dan klavus di URJ Kulit dan Kelamin Divisi TBK RSUD Dr. Soetomo, Surabaya menunjukkan angka kesembuhan sebesar 80% dengan modalitas yang paling banyak dipilih berupa eksisi.</p> Iskandar Zulkarnain, Arisia Fadila, M. Yulianto Listiawan, Budi Utomo, Afif Nurul Hidayati, Sawitri, Diah Mira Indramaya Copyright (c) 2022 Arisia Fadila, Iskandar Zulkarnain, M. Yulianto Listiawan, Budi Utomo, Maylita Sari, Irmadita Citrashanty, Bagus Haryo Kusumoputro Mon, 01 Aug 2022 00:00:00 +0000 Nonsteroid anti-inflammatory drug choices in patients with juvenile idiopathic arthritis: A systematic review <p><strong>Background</strong>: Disease-modifying anti-rheumatic drugs (DMARDs) are still a priority in treating juvenile idiopathic arthritis (JIA). The choice of drug therapy for the NSAIDs as an alternative to the therapy used in managing JIA cases due to the side effects of DMARDs. However, the former discussion of the choices therapy of NSAID therapy in JIA patients is still limited. This systematic review was conducted to present any choices of NSAIDs used for the treatment JIA and presented their effectiveness and adverse reaction compared with other NSAIDs used for treating JIA.</p> <p><strong>Methods</strong>: Comprehensive electronic searches were performed in PubMed/Medline, EMBASE, and Cochrane Library, choosing Randomized Controlled Trials of NSAIDs for treating children with JIA up to January 2009. The risk of bias was assessed using the Cochrane Risk of Bias Tools for randomized controlled trials.</p> <p><strong>Results</strong>: Eight eligible randomized controlled trials (RCT) out of 1309 studies were included, with a total of 1112 participants with JIA identified, addressing 19 kinds of interventions with nine types of medications. First RCT concluded that Celecoxib 3 mg/kg and Celecoxib 6 mg/kg were at least as effective as naproxen 7.5 mg/kg in terms of reducing clinical symptoms of arthritis and joint swelling. Second RCT concluded that Low Dose (0,3 mg/kg) and High Dose (0.6mg/kg) Rofecoxib showed a greater improvement than the Naproxen group to relieve the pain. The third RCT stated that good efficacy or satisfaction is most frequent in the participant with Meloxicam 0.125 mg/kg rather than Meloxicam 0.25 mg/kg or Naproxen 10 mg/kg. Fourth RCT concluded that Ibuprofen 30-40 mg/kg/d is an effective agent for symptomatic treatment of JIA and is well-tolerated in many children. Fifth RCT informed that Piroxicam show more effective in controlling the symptoms and improving function than Naproxen 10 mg/kg/day. Sixth RCT concluded that Acetylsalicylic acid 75 mg/kg/day has better efficacy than Naproxen 10 mg/kg/d in relieving the symptoms. The seventh study stated that both diclofenac sodium 2-3 mg/kg/day and acetylsalicylic acid 50-100 mg/kg/d at least as good as placebo. The last RCTs study stated that tolmetin 15 mg/kg/day decreased the duration of morning stiffness and reduced joint pain. Also, aspirin 50mg/kg/day resulted in ROM improvement in JIA patients.</p> <p><strong>Conclusions</strong><strong>: </strong>We present Celecoxib, Rofecoxib, Meloxicam, Ibuprofen, Piroxicam, Acetylsalicylic Acid (ASA), Diclofenac Sodium, Tolmetin Sodium, and Naproxen as the NSAIDs choice drugs on pediatric patient diagnosed with JIA. which has each adverse event on each therapy.</p> Yogi Priyatna Biantara, Surya Fajari Widhiarma, Widia Trilaksana Kusuma Copyright (c) 2022 Yogi Priyatna Biantara, Surya Fajari Widhiarma, Widia Trilaksana Kusuma Mon, 08 Aug 2022 00:00:00 +0000 Hubungan D-dimer dengan tingkat keparahan infeksi COVID-19 <p><strong>Introduction</strong>: Inflammation response and endothelial damage caused by COVID-19 resulting coagulopathy by increased D-dimer level. High D-dimer can predict COVID-19 severity. This research conducted to know the correlation, risk, and prediction of severe COVID-19 infection in patients with high D-dimer levels.</p> <p><strong>Method</strong>: Cross-sectional with bivariate and multivariates logistic regression analysis was conducted. Samples are ≥18 years old with COVID-19 hospitalized in Tabanan regional hospital during October 2021- March 2022. Data collected from medical records. Patients with chronic liver disease, congestive heart disease, malignancy, post-surgery, pregnancy, and deep vein thrombosis are excluded. COVID-19 severity criterias are based on COVID-19 management protocol.</p> <p><strong>Result</strong>: Of 84 patients, 63.1% males and 58.3% ≥ 60 years old. Mean D-dimer level in severe COVID-19 patients are 3,256.06 ng/ml, and 1,543.02 ng/ml in non-severe (p = 0.014, CI 95%: 435.568–2,990.51). Cut-off point of D-dimer level is 788.5 ng/ml, with 71.9% sensitivity and 69.2% specificity on the receiver operating characteristics curve. A significant correlation is found between D-dimer level above cut-off and COVID-19 infection severity (OR 5.75, CI 95%: 2.18-15.16, p= 0.001). Correlation is still significant after variables age ≥60 years old and DM comorbidity adjusted (OR 5.32, CI 95%: 1,922-14,729, p=0.001). Probability of severe COVID-19 infection in patients ≥60 years old with D-dimer level &gt; 788.5 ng/ml and has DM comorbidity is 83.24%.</p> <p><strong>Conclusion</strong>: COVID-19 infection severity correlates with increased D-dimer levels with risk more than 5 times after variables age ≥60 years old and DM comorbidity adjusted, with moderate categorized prediction accuracy.</p> <p> </p> <p><strong>Pendahuluan</strong>: Respon inflamasi dan kerusakan endotel akibat COVID-19 menyebabkan terjadinya koagulopati, ditandai dengan peningkatan kadar D-dimer. D-dimer tinggi diperkirakan dapat memprediksi keparahan COVID-19. Penelitian ini dilakukan untuk mengetahui hubungan, besar risiko, dan prediksi terjadinya infeksi COVID-19 berat pada penderita D-dimer tinggi.</p> <p><strong>Metode Penelitian: </strong>Penelitian ini merupakan penelitian <em>cross-sectional</em> dengan analisis bivariat<em> chi-square</em> dan regresi logistik multivariat. Sampel adalah penderita ≥18 tahun dengan COVID-19 yang dirawat di RSUD Tabanan periode Oktober 2021-Maret 2022. Data diambil dari rekam medik. Penderita penyakit hati kronik, penyakit jantung kongestif, keganasan, paska pembedahan, hamil, dan <em>deep vein thrombosis</em> dieksklusi. Kriteria keparahan COVID-19 menggunakan buku pedoman protokol tatalaksana COVID-19.</p> <p><strong>Hasil Penelitian: </strong>Dari 84 penderita memenuhi kriteria, 63,1% laki-laki, 58,3% umur ≥ 60 tahun. Rata-rata kadar D-dimer pada infeksi COVID-19 berat 3.256,06 ng/ml dan 1.543,02 ng/ml pada infeksi COVID-19 tidak berat (p = 0,014, IK 95 %: 435,568 – 2.990,51). Nilai <em>cut off</em> kadar D-dimer didapatkan 788,5 ng/ml dengan sensitivitas 71,9%, spesifisitas 69,2% pada <em>receiver operating characteristics</em> <em>curve</em>. Didapatkan hubungan bermakna D-dimer diatas <em>cut off</em> dengan tingkat keparahan infeksi COVID-19 (OR 5,75, IK 95%: 2,18-15,16, p= 0,001) Hubungan ini tetap bermakna setelah diperhitungkan faktor usia ≥60 tahun dan komorbid DM (OR 5,32, IK 95%: 1.922-14.729, p = 0,001). Probabilitas terjadinya infeksi COVID-19 berat pada penderita usia ≥60 tahun dengan D-dimer &gt; 788,5 ng/ml dan komorbid DM adalah 83,24%.</p> <p><strong>Simpulan: </strong>Keparahan infeksi COVID-19 berhubungan dengan peningkatan kadar D-dimer dengan risiko lebih dari lima kali setelah diperhitungkan faktor usia dan komorbid DM dengan akurasi prediksi kategori sedang.</p> Kadek Anggiswari Pradnya Angela, I Made Duwi Sumohadi Copyright (c) 2022 Kadek Anggiswari Pradnya Angela, I Made Duwi Sumohadi Mon, 01 Aug 2022 00:00:00 +0000 Validasi skor Coagulopathy of Severe Trauma (COAST) dalam memprediksi Acute Trauma Coagulopathy (ATC) di Rumah Sakit Umum Pusat Sanglah Denpasar <p><strong>Introduction</strong>: The Coagulopathy of Severe Trauma (COAST) score is a scoring system that predicts the clinical condition of ATC. The COAST score has a high specificity of 96% and a sensitivity of 80% at a cut-off 3, which can accurately predict coagulopathy and has a significant outcome. This study tested the validity of the Coagulopathy of Severe Trauma (COAST) scoring in predicting Acute Traumatic Coagulopathy (ATC) at the Sanglah Central General Hospital (RSUP) Denpasar.</p> <p><strong>Method</strong>: Observational study with diagnostic test and cross-sectional design carried out from December 1, 2020 to February 28, 2021. Patients suspected of ATC are patients who present with a history of trauma with an increase of two out of three, namely, Prothrombin Time (PT) &gt;18 seconds, Activated Partial Thromboplastin Time (aPTT) &gt;36 seconds, and International Normalized Ratio (INR) &gt;1.6. Samples were excluded if they refused to participate in the study, had severe head injury, concomitant severe systemic disease, had blood clotting disorders or were taking blood thinning drugs, burn patients, and pregnant patients. The COAST score was assessed based on the components of the trapped assessment, blood pressure, temperature, chest decompression, and abdominal/pelvic injury. COAST scores were analyzed using ROC curves and diagnostic tests, as well as logistic regression tests. The value of p &lt;0.05 indicates a significant result.</p> <p><strong>Results</strong>: This study involved 60 patients with 10 ATC positive patients and the remaining 50 ATC negative. Significant differences (p&lt;0.05) on the incidence of ATC were found in the variables of age, ISS score, trapped, chest decompression, abdominal/pelvic injury, systolic blood pressure, PT, aPTT, INR, and COAST score. ROC curve analysis showed a COAST score with a cut-off value of 2.5 (60% sensitivity; 88% specificity; p=0.01; 95% CI 0.555-0.965). The results of the diagnostic test cut-off score of 2.5 COAST scores with an OR of 11.00 (p=0.003; 95% CI 2.392-50.589). Multivariate analysis of COAST scores with the incidence of ATC showed a significant relationship (p=0.002).</p> <p><strong>Conclusion</strong>: The COAST score is a valid scoring system to predict ATC at Sanglah Hospital Denpasar with a good level of sensitivity and specificity, with a cut off of 2.5.</p> <p> </p> <p><strong>Pendahuluan:</strong> Skor <em>Coagulopathy of Severe Trauma</em> (COAST) merupakan sistem skor yang memprediksi kondisi klinis ATC. Skor COAST memiliki spesifisitas tinggi 96% dan sensitifitas 80% pada <em>cut-off</em> ≥3, yang dapat secara tepat memprediksi koagulopati dan memiliki hasil yang secara signifikan. Penelitian ini menguji validitas skoring <em>Coagulopathy of Severe Trauma</em> (COAST) dalam memprediksi <em>Acute Traumatic Coagulopathy</em> (ATC) di Rumah Sakit Umum Pusat (RSUP) Sanglah Denpasar.</p> <p><strong>Metode:</strong> Studi observasional dengan uji diagnostik dan desain <em>cross-sectional</em> yang dilaksanakan mulai 1 Desember 2020 sampai 28 Februari 2021. Pasien terduga ATC adalah pasien yang datang dengan riwayat trauma dengan peningkatan dua dari tiga yaitu, <em>Prothrombin Time</em> (PT) &gt;18 detik, <em>Activated Partial Thromboplastin Time</em> (aPTT) &gt;36 detik, dan <em>International Normalized Ratio</em> (INR) &gt;1,6. Sampel dieksklusi apabila menolak keikutsertaan dalam penelitian, mengalami cedera kepala berat, penyakit sistemik berat bersamaan, menderita gangguan pembekuan darah atau mengonsumsi obat pengencer darah, pasien luka bakar, dan pasien hamil. Skor COAST dinilai berdasarkan komponen penilaian terjebak, tekanan darah, suhu, dekompresi dada, dan abdomen/pelvis injuri. Skor COAST dianalisis dengan kurva ROC dan uji diagnostik, serta uji regresi logistik. Nilai p&lt;0,05 menunjukan hasil bermakna.</p> <p><strong>Hasil:</strong> Penelitian ini melibatkan 60 pasien dengan 10 pasien ATC positif dan 50 sisanya ATC negatif. Perbedaan signifikan (p&lt;0,05) terhadap kejadian ATC didapatkan pada variabel usia, skor ISS, terjebak, dekompresi dada, abdomen/pelvis injuri, tekanan darah sistolik, PT, aPTT, INR, dan skor COAST. Analisis kurva ROC menunjukan skor COAST dengan nilai <em>cut-off</em> 2,5 (sensitivitas 60%; spesifisitas 88%; p=0,01; CI95% 0,555-0,965). Hasil uji diagnostik nilai <em>cut-off</em> 2,5 skor COAST dengan OR 11,00 (p=0,003; CI95% 2,392-50,589). Analisis multivariat skor COAST dengan kejadian ATC menunjukan hubungan signifikan (p=0.002).</p> <p><strong>Kesimpulan:</strong> Skor COAST merupakan sistem skoring yang valid untuk memprediksi ATC di RSUP Sanglah Denpasar dengan tingkat sensitivitas dan spesifisitas yang baik, dengan cut off ≥2,5.</p> Putu Chandra Wibawa, I Gede Suwedagatha, I Wayan Niryana Copyright (c) 2022 Putu Chandra Wibawa, I Gede Suwedagatha, I Wayan Niryana Fri, 12 Aug 2022 00:00:00 +0000 Pengaruh kadar gula darah puasa terhadap ekspresi Glucose transporter type-4 (GLUT4) neuron hipokampus pada tikus model diabetes <p><strong>Background:</strong> Diabetes mellitus causes many complications, both microvascular and macrovascular, especially cognitive function. Related studies are being carried out to determine the relationship between diabetes and cognitive decline as assessed through GLUT4 expression in the hippocampus. The aimed of this study was to determine the effect of fasting blood sugar on hippocampal neuronal GLUT4 expression in STZ and NA-induced diabetic rats.</p> <p><strong>Methods:</strong> This study was an experimental design, using 24 males Rattus novergicus which were divided into a control group terminated on day 14 (A0) and 28 (B0) and a diabetes group terminated on day 14 (A1) and 28 (B2). Diabetes was induced using intraperitoneal injection of streptozotocin (STZ) and Nicotinamide (NA). Spatial memory (travel time) of rats was assessed on days 14 and 28. Sampling used secondary data, fasting blood glucose (FBG) was measured using a glucometer and brain tissue was taken to assess GLUT4 expression using immunohistochemical methods. Differences in the mean FBG and GLUT4 expression between groups on days 14 and 28 and were tested statistically using SPSS version 22</p> <p><strong>Results:</strong> The mean FBG and GLUT4 expression in the diabetic group were significantly higher than those in the control group on day 14 and day 28. However, it was not significant compared between diabetes groups on day 14 and day 28. Immunohistochemical examination confirmed these results. There is a strong correlation between mean FBG levels and mean GLUT4 expression with travel time in the diabetes group on days 14 and 28 (r=0.88, p&lt;0.05).</p> <p><strong>Conclusion:</strong> Fasting blood glucose levels significantly affected hippocampal neuronal GLUT4 expression in STZ and NA-induced diabetic rats.</p> <p> </p> <p><strong>Latar belakang:</strong> Diabetes mellitus banyak menimbulkan komplikasi serius baik mikrovaskuler dan makrovaskuler, khususnya pada fungsi kognitif. Studi terkait sedang terus dilaksanakan untuk mengetahui hubungan terkait antara kondisi diabetes dengan penurunan fungsi kognitif yang dinilai memalui ekspresi GLUT4 di hippocampus. Tujuan dari penelitian ini adalah untuk mengevaluasi pengaruh kadar gula darah puasa terhadap ekspresi GLUT4 neuron hipokampus pada tikus model diabetes.</p> <p><strong>Metode: </strong>Penelitian dengan desain eksperimental, menggunakan 24 ekor <em>Rattus novergicus</em> jantan yang dibagi menjadi kelompok kontrol yang diterminasi pada hari ke-14 (A0) dan 28 (B0) dan kelompok diabetes yang diterminasi pada hari ke-14 (A1) dan 28 (B2). Diabetes diinduksi menggunakan suntikan streptozotocin (STZ) dan Nikotinamid (NA) secara intraperitoneal. Memori spasial (waktu tempuh) tikus dinilai pada hari ke-14 dan 28. Pengambilan sampel menggunakan data sekunder, gula darah puasa (GDP) diukur menggunakan <em>glucometer</em> dan pengambilan jaringan otak dilakukan untuk penilaian ekspresi GLUT4 menggunakan metode imunohistokimia. Perbedaan rerata GDP dan ekspresi GLUT4 antar kelompok pada hari ke-14 dan 28 serta dilakukan uji secara statistik menggunakan SPSS versi 22.</p> <p><strong>Hasil: </strong>Rerata GDP dan ekspresi GLUT4 pada kelompok diabetes secara signifikan lebih tinggi dibandingkan dengan kontrol pada hari ke-14 maupun hari ke 28. Akan tetapi tidak signifikan dibandingkan antar kelompok diabetes pada hari ke-14 dengan hari ke-28. Pemeriksaan imunohistokimia mengkonfirmasi hasil ini. Terdapat korelasi yang kuat pada hubungan yang rerata kadar GDP dengan rerata ekspresi GLUT4 dengan waktu tempuh pada kelompok diabetes pada hari ke-14 dan 28 (r=0,88, p&lt;0,05).</p> <p><strong>Simpulan:</strong> Kadar gula darah puasa berpengaruh secara signifikan terhadap ekspresi GLUT4 neuron hipokampus pada tikus model.</p> Ngakan Putu Proudy Laksmana, Rizka Vidya Lestari, Muhammad Ghalvan Sahidu, Ilsa Hunaifi, Herpan Syafii Harahap, Novrita Padauleng, Nurhidayati Copyright (c) 2022 Ngakan Putu Proudy Laksmana, Rizka Vidya Lestari, Muhammad Ghalvan Sahidu, Ilsa Hunaifi, Herpan Syafii Harahap, Novrita Padauleng, Nurhidayati Thu, 23 Jun 2022 00:00:00 +0000 Determinant of service utilization for triple elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B among women living with HIV during COVID-19 pandemic in Indonesia <p><strong>Background: </strong>HIV-AIDS and sexually transmitted infections are still a public health burden in Indonesia. Women living with HIV have a higher risk of transmitting HIV, Syphilis, and Hepatitis B to their babies. While the effort to increase the services coverage for the prevention of mother-to-child transmission (PMTCT) was detained due to the COVID-19 pandemic and the lack of published studies that explore this, this study aimed to assess the determinant of service utilization for triple elimination of mother-to-child transmission of HIV, Syphilis, and Hepatitis B among women living with HIV during COVID-19 pandemic in Indonesia.</p> <p><strong>Methods: </strong>This cross-sectional study targeted women living with HIV in Indonesia who are planning to get pregnant. A simplified-snowball sampling technique was used in this study. A dependent variable in this study was the service utilization of PMTCT for HIV, Syphilis, and Hepatitis B. In contrast, the independent variables in this study consisted of demographic characteristics, perception according to Health Belief Model constructs, and stigma and discrimination experiences. Multiple logistic regression was used to find the determinants of service utilization.</p> <p><strong>Results: </strong>Among 336 women living with HIV that were interviewed, only 28.27% (95% CI = 23.69 – 33.34) accessed the PMTCT services during the COVID-19 pandemic. Moreover, the likelihood of PMTCT service utilization was decreased among the women living with HIV who perceived higher barriers (aOR = 0.56; 95% CI = 0.31 – 0.99) and experienced stigma and discrimination from partner (aOR = 0.50; 95% CI = 0.25 – 0.99). On the other hand, the PMTCT service utilization was increased among those who perceived less severity (aOR = 2.07; 95% CI = 1.21 – 3.54). No other factors were associated with the PMTCT service utilization among women living with HIV during the COVID-19 pandemic.</p> <p><strong>Conclusion: </strong>The PMTCT service utilization was relatively low, increased by the higher perceived severity, and reduced among those who perceived higher barriers and experienced stigma and discrimination from the partner. Therefore, improving the knowledge about HIV, Syphilis, and Hepatitis B related to PMTCT services is essential, as well as providing social support to reduce the stigmas and discrimination among women living with HIV.</p> Ngakan Putu Anom Harjana, Sally Nita, Meirinda Sebayang, Oldri Sherli Mukuan, Asti Setiawati Widihastuti Copyright (c) 2022 Ngakan Putu Anom Harjana, Sally Nita, Meirinda Sebayang, Oldri Sherli Mukuan, Asti Setiawati Widihastuti Fri, 12 Aug 2022 00:00:00 +0000 Gambaran karekteristik kejadian sifilis kongenital di RSUD Wangaya, Kota Denpasar <p><strong>Background:</strong> Syphilis is one of the most common sexually transmitted infections every year. In mothers who do not receive treatment, transmission of infection from mother to fetus can occur, causing congenital syphilis. The purpose of this study was to describe the characteristics of cases of congenital syphilis in Wangaya Hospital, Denpasar.</p> <p><strong>Methods: </strong>This descriptive study used the medical records of pediatric patients at the Wangaya Hospital, Denpasar, for the period January 2020 to October 2021. The inclusion criteria used were newborns diagnosed with congenital syphilis with complete medical record data. The exclusion criteria used were newborns suffering from congenital syphilis accompanied by other infections, namely <em>Toxoplasma gondii</em>, rubella, cytomegalovirus, herpes simplex, and other congenital disorders not related to syphilis.</p> <p><strong>Results: </strong>Of the 47 study subjects who met the inclusion criteria, 68.1% of cases were asymptomatic and 31.9% symptomatic, 68.1% of term pregnancy, 31.9% preterm, low birth weight 29.8%, very low 4 .3%, and 66% normal body weight. Clinical manifestations found in symptomatic cases were respiratory distress (27.7%), jaundice/jaundice (21.3%), anemia (19.1%), skin lesions/rash (12.8%), sepsis (10 .6%), leukocytosis (10.6%), and thrombocytopenia (10.6%). Outcome of survival was 93.6% and death was 6.4% of cases.</p> <p><strong>Conclusion: </strong>Most cases of congenital syphilis are asymptomatic. In symptomatic cases, the characteristic clinical manifestations that are often encountered are respiratory distress, jaundice, anemia, skin rash, sepsis, leukocytosis, and thrombocytopenia. Recognizing the characteristics of congenital syphilis cases early is very important to reduce mortality from the disease.</p> <p> </p> <p><strong>Latar Belakang: </strong>Sifilis merupakan salah satu infeksi menular seksual yang banyak terjadi setiap tahunnya. Pada ibu yang tidak mendapatkan pengobatan, dapat terjadi transmisi infeksi ibu ke janin sehingga menyebabkan kejadian sifilis kongenital. Tujuan penelitian ini adalah untuk mengetahui gambaran karakteristik dari kasus-kasus sifilis kongenital di RSUD Wangaya kota Denpasar.</p> <p><strong>Met</strong><strong>ode: </strong>Penelitian deskriptif ini menggunakan rekam medis pasien anak di RSUD Wangaya kota Denpasar periode Januari 2020 hingga Oktober 2021. Kriteria inklusi yang digunakan adalah bayi baru lahir yang didiagnosis sifilis kongenital dengan data rekam medis yang lengkap. Kriteria eksklusi yang digunakan adalah bayi baru lahir yang menderita sifilis kongenital disertai infeksi lainnya, yaitu <em>Toxoplasma gondii</em>, <em>r</em><em>ubella</em>, <em>c</em><em>ytomegalovirus</em>, <em>h</em><em>erpes </em><em>s</em><em>implex</em><em>,</em> maupun kelainan kongenital lain yang tidak berkaitan dengan sifilis.</p> <p><strong>Hasil : </strong>Dari 47 subjek penelitian yang masuk di dalam kriteria inklusi, 68,1% kasus asimptomatik dan 31,9% simptomatik, kehamilan aterm 68,1%, kurang bulan 31,9%, berat badan lahir rendah 29,8%, sangat rendah 4,3%, dan berat badan normal 66%. Manifestasi klinis yang ditemukan pada kasus simptomatik, yaitu distres nafas (27,7%), ikterus/jaundice (21,3%), anemia (19,1%), lesi/ruam kulit (12,8%), sepsis (10,6%), leukositosis (10,6%), dan trombositopenia (10,6%). Luaran hidup 93,6% dan meninggal 6,4% kasus.</p> <p><strong>Kesimpulan : </strong>Sebagian besar kasus sifilis kongenital tidak bergejala atau asimptomatik. Pada kasus bergejala, karakteristik manifestasi klinis yang sering ditemui adalah distres nafas, jaundice, anemia, ruam kulit, sepsis, leukositosis, dan trombositopenia. Mengenali karakteristik kasus sifilis kongenital sejak dini sangat penting untuk mengurangi mortalitas dari penyakit.</p> I Gusti Ayu Mahadewi, Peter Prayogo Hsieh, Callista Beatrice, I Gde Doddy Kurnia Indrawan Copyright (c) 2022 I Gusti Ayu Mahadewi, Peter Prayogo Hsieh, Callista Beatrice, I Gde Doddy Kurnia Indrawan Tue, 19 Jul 2022 00:00:00 +0000 Efektifitas daun salam dalam mengurangi cemaran mikroba penyebab busuk telur itik <p><strong>Background:</strong> Pathogenic bacteria on eggshells or egg contents will be very dangerous for the health of humans who consume them. Chemicals should not be an option for preservatives because they will cause side effects. In this study, we explored the possibility of using bay leaf extract (Syzygium polyanthum (Wight) Walp) to control the growth of polluting bacteria in salted duck eggs so that the shelf life can be extended. The purpose of the study was to determine the potential of the active compounds contained in bay leaves in reducing the total plate count/microbial contamination in salted duck eggs.</p> <p><strong>Methods:</strong> Extraction of bay leaf powder was carried out by the infusion method. The activity test of bay leaf decoction (ARDS) was carried out using the in vitro diffusion well method on Mueller Hinton media. Identification of active compounds was carried out using the GCMS technique.</p> <p><strong>Results:</strong> ARDS crude extract at a concentration of 5% (v/v) could significantly reduce ALT and inhibit the in vitro growth of Proteus mirabilis bacteria at a concentration of 10% (w/v), with an inhibition zone diameter of 19.53 mm, with the minimum value inhibitory concentration (MIC) 0.7%. The results of the GCMS analysis of ARDS showed that the ten peaks produced, possibly synergized, and had antimicrobial activity. These compounds are 2-Pentanone4-Hydroxy-4 Methyl (CAS) Diacetone Alcohol; Ethanol, 2-(Ethoxythoxy) (CAS); 1,2,3 Propanetrriol Cas) Glycerol; Citronella (2,6-Octadien-1-Ol, 3,7-Dimethyl, (CAS); Beta Citronellol 6-Octen-1-Ol, 3,7 Dimethyl-(CAS); Trans Geraniol; Dodecanoic Acid, Methyl Ester (CAS) Methyl Laurate; Tetradecanoic Acid, Methyl Ester (CAS) Methyl Myristate; 1-Tetradecanol (Cas) Alfol 14 and Hexadecanoic Acid Methyl Ester CAS) Methyl Palmitate</p> <p><strong>Conclusion: </strong>Leaf decoction can inhibit the growth of <em>Proteus mirabilis in vitro,</em> and the addition of ARDS with a concentration of 5% (v/v) can significantly reduce the value of bacterial contamination in salted duck eggs.</p> <p> </p> <p><strong>Latar Belakang:</strong> Bakteri pathogen pada kulit telur atau isi telur akan sangat membahayakan kesehatan manusia yang mengkonsumsinya. Bahan kimia seharusnya tidak menjadi pilihan untuk pengawet, karena akan menimbulkan efek samping, Pada penelitian ini dieksplorasi, kemungkinan dipakainya ekstrak daun salam (<em>Syzygium polyanthum (Wight) Walp)</em> untuk mengontrol pertumbuhan bakteri pencemar pada telur itik yang diasinkan, sehingga masa simpannya dapat diperpanjang. Tujuan penelitian untuk mengetahui potensi senyawa aktif yang terdapat pada daun salam dalam menurunkan angka lempeng total/cemaran mikroba pada telur itik yang diasinkan.</p> <p><strong>Metode: </strong>Ekstraksi serbuk daun salam dilakukan dengan metode infusa. Uji aktifitas air rebusan daun salam (ARDS) dilakukan dengan metode sumur difusi secara <em>in vitro </em>pada media Mueller Hinton. Identifikasi senyawa aktif dilakukan dengan teknik GCMS.</p> <p><strong>Hasil:</strong> Ekstrak kasar ARDS pada konsentrasi 5% (v/v) secara nyata dapat menurunkan ALT dan menghambat pertumbuhan <em>in vitro </em>bakteri <em>Proteus mirabilis</em> pada konsentrasi 10% (b/v), dengan diameter zona hambat sebesar 19,53 mm, nilai minimum inhibitory concentration (MIC) 0,7%. Hasil analisis GCMS terhadap ARDS menunjukan bahwa sepuluh puncak yang dihasilkan, kemungkinan bersinergi dan mempunyai aktifitas sebagai antimikroba. Senyawa-senyawa tersebut adalah 2-Pentanone4-Hydroxi-4 Methyl (CAS) Diacetone Alkohol; Ethanol, 2-(Ethoxythoxy) (CAS); 1,2,3 Propanetrriol Cas) Glycerol; Citronella (2,6-Octadien-1-Ol, 3,7-Dimethyl, (CAS); Beta Citronellol 6-Octen-1-Ol, 3,7 Dimethyl-(CAS); Trans Geraniol; Dodecanoic Acid, Methyl Ester(CAS) Methyl Laurate; Tetradecanoic Acid,Methyl Ester (CAS) Methyl Myristate; 1-Tetradecanol (Cas) Alfol 14 dan Hexadecanoic Acid Methyl Ester CAS) Methyl Palmitate.</p> <p><strong>Simpulan:</strong> Air rebusan daun dapat menghambat pertumbuhan <em>Proteus mirablis</em> secara <em>in vitro</em> dan penambahan ARDS dengan konsentrasi 5% (v/v) secara signifikan dapat menurunkan nilai cemaran bakteri (angka lempeng total) pada telur itik yang diasinkan.</p> Yulidia Iriani, Yan Ramona, Ni Putu Adriani Astiti Copyright (c) 2022 Yulidia Iriani, Yan Ramona, Ni Putu Adriani Astiti Sun, 17 Jul 2022 00:00:00 +0000 Akurasi kadar serum Secretory Leukocyte Protease Inhibitor (SLPI) dalam menunjang diagnosis kanker ovarium: suatu uji diagnostik <p><strong>Background: </strong>Ovarian cancer is one of the most common malignant tumors found in reproductive organs in vitro. Secretory Leukocyte Protease Inhibitor (SLPI) protein is essential for the growth of ovarian cancer cells, a protein that maintains the survival of ovarian cancer cells, inhibits antiproliferative effects, and reverses the proapoptotic effect of elastase. This study aims to evaluate the role of SLPI in diagnosing ovarium cancer.</p> <p><strong>Methods: </strong>The research was conducted at the Obstetrics and Gynecology Polyclinic, Sanglah Hospital, Denpasar and the Prodia Laboratory. Sampling of this study has been carried out by previous researchers in research on the accuracy of serum levels of insulin-like growth factor binding protein 2 in diagnosing ovarian cancer. The research sample (intended sample) was women aged 18 years and over with ovarian tumors who came to the Obstetrics and Gynecology Polyclinic, Sanglah Hospital, Denpasar. Data were analyzed using SPSS versi 22 for Windows.</p> <p><strong>Results: </strong>The proportion of epithelial types was significantly higher in the ovarian cancer group. In ovarian cancer samples, the most samples were obtained at FIGO III Stage. Median CA125 levels, RMI scores, and SLPI levels were significantly higher in the group with ovarian cancer. The cut off value of serum SLPI used in this study was 54,000 pg/ml which was obtained from preliminary analysis on 26 training samples. Sensitivity: 78.3; specificity:66.7%; Positive predictive value: 78.3%; Negative predictive value: 66.7% Accuracy: 73.6%.</p> <p><strong>Conclusion: </strong>In a diagnostic test study to assess the accuracy of SLPI serum in supporting the diagnosis of ovarian cancer, it was found that SLPI serum had good sensitivity, specificity, PPV, NPV, and accuracy values.</p> <p> </p> <p><strong>Latar Belakang: </strong>Kanker ovarium merupakan salah satu tumor ganas yang paling sering ditemukan pada organ reproduksi secara in vitro. Protein <em>Secretory Leukocyte Protease Inhibitor</em> <strong>(</strong>SLPI) sangat esensial untuk pertumbuhan sel kanker ovarium, protein yang menjaga kelangsungan hidup sel kanker ovarium, inhibisi efek antiproliferatif, dan membalikkan efek proapoptosis dari elastase. Penelitian ini bertujuan untuk mengevaluasi peran SLPI dalam mendiagnosis kanker ovarium.</p> <p><strong>Metode: </strong>Penelitian dilakukan di Poliklinik Kebidanan dan Penyakit Kandungan RSUP Sanglah Denpasar dan Laboratorium Prodia. Pengambilan sampel penelitian ini sudah dilakukan oleh peneliti sebelumnya pada penelitian tentang akurasi kadar serum insulin-like growth factor binding protein 2 dalam mendiagnosis kanker ovarium. Sampel penelitian (intended sample) adalah wanita berusia 18 tahun ke atas dengan tumor ovarium yang datang ke Poliklinik Kebidanan dan Penyakit Kandungan RSUP Sanglah Denpasar.</p> <p><strong>Hasil: </strong>Proporsi tipe epitelial secara signifikan lebih banyak pada kelompok kanker ovarium. Pada sampel kanker ovarium, didapatkan sampel paling banyak pada Stadium FIGO III. Median kadar CA125, skor RMI, dan kadar SLPI secara signifikan lebih tinggi pada kelompok dengan kanker ovarium. Nilai cut off serum SLPI yang digunakan pada penelitian ini adalah 54.000 pg/ml yang didapatkan dari analisa pendahuluan pada 26 training sample Sensitivitas:78,3; spesifisitas:66,7%; Nilai prediksi positif: 78,3%; Nilai prediksi negatif: 66,7% Akurasi: 73,6%.</p> <p><strong>Kesimpulan: </strong>Pada penelitian uji diagnostik untuk menilai akurasi serum SLPI dalam menunjang diagnosis kanker ovarium didapatkan bahwa serum SLPI memiliki nilai sensitivitas, spesifisitas, PPV, NPV, dan akurasi yang baik.</p> Putu Adi Sujana Putra, Ketut Suwiyoga, I Nyoman Gede Budiana, I Wayan Megadhana, I Nyoman Bayu Mahendra, I Made Darmayasa Copyright (c) 2022 Putu Adi Sujana Putra, Ketut Suwiyoga, Nyoman Gede Budiana Mon, 18 Jul 2022 00:00:00 +0000 Prevalensi cemaran patogen Salmonella pada daging babi yang dijual di Pasar Tradisional di Kota Denpasar <p><strong>Background</strong>: Food contamination is a serious problem. Salmonella sp is one of the main bacteria causing gastrointestinal disease, especially in raw pork, due to the production and distribution process. Traditional markets have high risk of pathogenic microbial contamination. The purpose of this study was to detect contamination of Salmonella sp. on pork sold in traditional markets, particularly in Denpasar, Bali.</p> <p><strong>Method:</strong> This research is a cross-sectional descriptive, with the samples coming from the porks sold by traditional market traders in every sub-district in Denpasar, Bali. The sampling technique used is the cluster purposive sampling. The procedure for identification of Salmonella sp. using culture and subculture examination on Salmonella Shigella Agar (SSA), simmon citrate agar media, and identification of the microscope.</p> <p><strong>Results</strong>: Based on SSA culture results from 38 samples, 26 samples of pork showed colony growth, but only 10 samples with typical morphology of Salmonella sp. The 16 samples with atypical morphology were examined for SSA subculture, with 9 samples having clear black colonies. In 19 research samples that showed the results were suspected to be contaminated with Salmonella sp. continued to the Simmons citrate test, but only 8 samples were positive. The 19 samples were also examined under a microscope and all samples showed a rod image and red color indicating that the colonies in the sample were gram-negative bacilli which are typical of the morphology of Salmonella sp.</p> <p><strong>Conclusion:</strong> Contamination of Salmonella was found in pork sold at Traditional Markets in Denpasar with a prevalence of 21%.</p> <p> </p> <p><strong>Latar belakang:</strong> Kontaminasi makanan merupakan suatu masalah serius. <em>Salmonella sp</em> merupakan salah satu bakteri penyebab utama penyakit gastrointestinal, terutama pada daging babi mentah, dikarenakan pada proses produksi dan distribusi. Pasar tradisional merupakan tempat yang sangat rawan dan beresiko cukup tinggi terhadap cemaran mikroba patogen. Tujuan penelitian ini adalah mendeteksi ada tidaknya cemaran bakteri <em>Salmonella sp.</em> pada daging babi yang dijual di Pasar Tradisional, khususnya di Denpasar, Bali.</p> <p><strong>Metode:</strong> Penelitian ini merupakan deskriptif potong lintang, dengan sampel penelitian berupa daging babi yang dijual oleh pedagang pasar tradisional di setiap kecamatan di Kota Denpasar, Bali. Teknik penentuan sampel yang digunakan yaitu teknik <em>cluster purposive sampling</em>. Prosedur identifikasi kontaminasi <em>Salmonella sp. </em>menggunakan pemeriksaan kultur serta subkultur pada <em>Salmonella </em><em>Shigella Aga</em>r (SSA), Kultur pada media simmon citrate agar, dan identifikasi mikroskop.</p> <p><strong>Hasil: </strong>Berdasarkan hasil kultur SSA dari 38 sampel daging babi, 26 sampel daging babi menunjukan adanya pertumbuhan koloni, namun hanya 10 sampel dengan morfologi khas <em>Salmonella sp. </em>Pada 16 sampel dengan morfologi tidak khas dilakukan pemeriksaan subkultur SSA, dengan 9 sampel memiliki warna koloni hitam bening. Pada 19 sampel penelitian yang menunjukan hasil terduga terkontaminasi <em>Salmonella sp.</em> dilanjutkan ke uji <em>Simmons citrate</em>, namun hanya 8 sampel dengan hasil positif. Pada 19 sampel juga dilakukan pemeriksaan mikroskop dan seluruh sampel menunjukkan gambaran batang serta berwarna merah yang menandakan bahwa koloni pada sampel adalah basil gram negatif yang khas pada morfologi bakteri <em>Salmonella sp.</em></p> <p><strong>Kesimpulan: </strong>Terdapat cemaran patogen <em>Salmonella sp.</em> pada daging babi yang dijual di Pasar Tradisional di Denpasar dengan prevalensi sebesar 21%.</p> I Gusti Agung Istri Gladys Elsyaningrat, Komang Januartha Putra Pinatih, Ni Nengah Dwi Fatmawati, Agus Eka Darwinata Copyright (c) 2022 I Gusti Agung Istri Gladys Elsyaningrat, Komang Januartha Putra Pinatih, Ni Nengah Dwi Fatmawati, Agus Eka Darwinata Fri, 07 Jan 2022 00:00:00 +0000 Pengaruh kompetensi dan kinerja sumber daya manusia dalam penerapan prinsip-prinsip Good Corporate Governance pada pegawai di Rumah Sakit Umum Daerah Provinsi Sulawesi Utara <p><strong>Background: </strong>In supporting exist service, hospitals need competent employees and good performance of human resources in order to optimize organizational performance that implements the principles of good corporate governance. The purpose of this study was to analyze the effect of competence and performance of human resources in the application of the principles of good corporate governance at the Regional General Hospital of North Sulawesi Province.<strong>Method: </strong>This type of research is analytic observational with a cross sectional study approach. This research was carried out at the Regional General Hospital of North Sulawesi Province in February 2022. The research sample was taken from existing employees with a simple random sampling technique with a total of 182 samples of respondents. The inclusion criteria in this study were ASN and THL who worked at the Regional General Hospital of North Sulawesi Province. The data in this study were taken through the distribution of questionnaires and filled out by employees as respondents. Data analysis used univariate, bivariate and multivariate tests using SPSS version 25 for Windows.</p> <p><strong>Result: </strong>Respondents of ASN employees were 104 people (57,1%) and THL were 78 people (42,9%). chi square test shows that there is an influence between competence and performance of human resources in the application of good corporate governance principles (p value&lt;0,000). The logistic regression test shows that competence has a positive effect on the application of the principles of good corporate governance with an odd ratio of 29,234 and the performance of human resources has a positive effect on the application of the principles of good corporate governance with an odd ratio of 10,792. Competence and performance of human resources simultaneously affect the application of the principles of good corporate governance seen from the calculated chi square value is greater than the chi square table (88,895&gt;5,991).</p> <p><strong>Conclusion: </strong>Competence and performance of human resources partially have a positive effect on the application of good corporate governance principles to employees at the Regional General Hospital of North Sulawesi Province.</p> <p> </p> <p><strong>Latar Belakang</strong>: Dalam menunjang pelayanan yang ada, rumah sakit membutuhkan pegawai yang kompeten dan juga kinerja sumber daya manusia yang baik dalam rangka optimalisasi kinerja organisasi yang menjalankan prinsip <em>good corporate governance</em>. Tujuan penelitian ini untuk menganalisis pengaruh kompetensi dan kinerja sumber daya manusia dalam penerapan prinsip-prinsip <em>good corporate governance</em> di Rumah Sakit Umum Daerah Provinsi Sulawesi Utara</p> <p><strong>Metode: </strong>Jenis penelitian bersifat obsevasional analitik dengan pendekatan <em>cross sectional study. </em>Penelitian ini dilaksanakan di Rumah Sakit Umum Daerah Provinsi Sulawesi Utara pada bulan Februari 2022. Sampel penelitian diambil dari pegawai yang ada dengan teknik pengambilan sampel <em>simple random sampling </em>dengan jumlah responden sebanyak 182 sampel. Kriteria inklusi dalam penelitian ini adalah ASN dan THL yang bekerja di Rumah Sakit Umum Daerah Provinsi Sulawesi Utara. Data dalam penelitian ini diambil melalui pembagian kuesioner dan diisi oleh oleh pegawai sebagai responden. Analisis data menggunakan uji univariat, bivariat dan multivariat menggunakan SPSS versi 25 untuk WIndows.</p> <p><strong>Hasil: </strong>Responden pegawai ASN 104 orang (57,1%) dan THL sebanyak 78 orang (42,9%). Uji chi square menunjukkan adanya pengaruh antara kopetensi dan kinerja sumber daya manusia dalam penerapan prinsip-prinsip <em>good corporate governance </em>(nilai p&lt;0,000). Uji regresi logsitik menunjukkan kompetensi berpengaruh positif terhadap penerapan prinsip-prinsip <em>good corporate governance</em> dengan odd ratio 29,234 dan kinerja sumber daya manusia berpengaruh positif dalam penerapan prinsip-prinsip <em>good corporate governance</em> dengan odd ratio 10,792. Kompetensi dan kinerja sumber daya manusia berpengaruh secara simultan dalam penerapan prinsip <em>good corporate governance</em> dilihat dari nilai chi square hitung lebih besar dari chi square tabel (88,895&gt;5,991).</p> <p><strong>Kesimpulan: </strong>Kompetensi dan kinerja sumber daya manusia secara parsial berpengaruh positif dalam penerapan prinsip-prnsip <em>good corporate governance</em> pada pegawai di Rumah Sakit Umum Daerah Provinsi Sulawesi Utara.</p> Lydia Elvina Rindengan, Billy Johnson Kepel, Starry Homenta Rampengan, Aaltje Ellen Manampiring Copyright (c) 2022 Lydia Elvina Rindengan, Billy Johnson Kepe, Starry Homenta Rampengan, Aaltje Ellen Manampiring Mon, 25 Jul 2022 00:00:00 +0000 The role of Bone Morphogenetic Protein-2 in craniofacial osteogenesis: A literature review <p>Bone Morphogenetic Protein (BMP) is a type of growth factor that belongs to the Transforming Growth Factor Beta (TGF-B) group. Bone Morphogenetic Protein-2 (BMP-2) is recognized as one of the first commercially available osteoblast inductors. When new bone is needed, mesenchymal stem cells can develop into osteoblasts, which then implant as osteocytes in the bone, providing additional structure and support. The principal agent that differentiates stem cells into osteoblasts is BMP-2. BMP-2 will be released into the bone matrix or serum in performing their job. BMP-2 activates the SMAD1/5/8 signal via mediating the physiological action of type I and II serine/threoninekine receptors. The active SMAD protein will form a complex with the SMAD4 protein, translocate DNA to the nucleus, and bind to particular genes like Dlx-2/5, Osx, and transcription. According to a recent study, BMP-2 boosts osteogenic growth. BMPs are effective in the treatment of craniofacial defects in current research. The subjects of this paper are the molecular mechanism of BMPs and their involvement in the clinical application of craniofacial deformity patients.</p> I Gusti Putu Hendra Sanjaya, Sri Maliawan Copyright (c) 2022 I Gusti Putu Hendra Sanjaya Mon, 01 Aug 2022 00:00:00 +0000 Profil penggunaan antibiotik pada pasien pneumonia di komunitas: tinjauan pustaka <p><strong>Background: </strong>Community pneumonia referred to as community acquired pneumonia is pneumonia that is often found in the community and the leading cause of death for infectious diseases. This pneumonia requires therapy with antibiotics. One of the main problems in using antibiotics is the occurrence of antibiotic resistance. This study aims to determine the profile of antibiotic use in patients with community acquired pneumonia, which is commonly referred as acquired pneumonia in the community.</p> <p><strong>Method</strong><strong>s</strong><strong>:</strong> This study is a literature review that uses articles with a randomized controlled trial design and articles in Indonesian or English and has a publication year, namely the last 10 years. The keywords used were "Treatment" AND "Community acquaired pneumonia" AND "Antibiotic or Antimicrobial" AND "Mortality OR Clinical response OR Severity".</p> <p><strong>Results:</strong> The quality of journals in this study was assessed by means of a critical appraisal skills program checklist and journal reputation. The results obtained were 9 articles that met the inclusion and exclusion criteria. The antibiotic that is often used in outpatient community acquired pneumonia without comorbidities is nemonoxacin 500 mg and in non-severe hospitalized patients the commonly used antibiotic is beta-lactam monotherapy.</p> <p><strong>Conclusion:</strong> The conclusion in this study is that the antibiotic that is often used in outpatient CAP patients is Nemonoxacin 500 mg while inpatient CAP is beta-lactam monotherapy so that in both groups the use of antibiotics is not in accordance with the 2019 ATS guidelines therefore requires monitoring the use of antibiotics in patients with community acquired pneumonia.</p> <p> </p> <p><strong>Latar belakang:</strong> Pneumonia komunitas atau biasanya disebut dengan community acquired pneumonia yaitu pneumonia yang sering didapatkan di masyarakat dan merupakan penyebab kematian penyakit menular tertinggi. Pneumonia ini membutuhkan terapi dengan menggunakan antibiotik. Salah satu masalah utama dalam penggunaan antibiotik adalah terjadinya resistensi antibiotik. Penelitian ini bertujuan untuk mengetahui profil penggunaan antibiotik pada pasien community acquired pneumonia atau biasanya disebut dengan pneumonia yang didapatkan di komunitas.</p> <p><strong>Metode :</strong> Penelitian ini merupakan kajian literatur yang menggunakan artikel dengan desain randomized controlled trial dan artikel yang menggunakan bahasa Indonesia atau bahasa inggris dan memiliki tahun publikasi yaitu 10 tahun terakhir. Kata kunci yang digunakan adalah "Treatment" AND "Community acquaired pneumonia" AND “Antibiotic or Antimicrobial” AND “Mortality or Clinical response or Severity”.</p> <p><strong>Hasil :</strong> Kualitas jurnal pada penelitian ini dinilai dengan checklist critical appraisal skill program dan reputasi jurnal. Hasil yang didapatkan adalah 9 artikel yang memenuhi kriteria inklusi dan ekslusi. Antibiotik yang sering digunakan pada pasien community acquired pneumonia rawat jalan tanpa komorbiditas adalah nemonoxacin 500 mg dan pada pasien rawat inap non severe antibiotik yang sering digunakan adalah monoterapi beta-laktam</p> <p><strong>Kesimpulan :</strong> pada penelitian ini adalah Antibiotik yang sering digunakan pada pasien CAP rawat jalan adalah Nemonoxacin 500 mg sedangkan pada CAP rawat inap adalah monoterapi beta-laktam sehingga pada kedua kelompok tersebut penggunaan antibiotik tidak sesuai dengan guideline ATS tahun 2019 sehingga masih membutuhkan pengawan penggunaan antibiotik pada pasien community acquired pneumonia.</p> Nanda Faradita, Rika Yulia, Fauna Herawati Copyright (c) 2022 Nanda Faradita, Rika Yulia, Fauna Herawati Fri, 01 Jul 2022 00:00:00 +0000 The role of tumor necrosis factor-alpha (TNF-α) inhibitor in steven johnson syndrome/toxic epidermal necrolysis (SJS/TEN) management: a systematic review <p><strong>Background</strong>. Steven Johnson Syndrome and Toxic Epidermal Necrolysis are dermatologic emergencies with high mortality rates characterized by extensive skin involvement. TNF-α has a role in inducing the production of granulysin that enhances keratinocyte cell death. Thus, the use of TNF-α inhibitors such as etanercept and infliximab is promising to halt the disease progression. This systematic review aims to evaluate the efficacy of TNF-α inhibitor in SJS/TEN management.</p> <p><strong>M</strong><strong>ethod</strong>. A systematic review using an online database was conducted based on PRISMA guidelines. Inclusion criteria were studied about the role of TNF-α inhibitor in SJS/TEN management. The exclusion criteria were a letter to the editor, commentary report, review, meta-analysis, study not used humans as a study subject, not available in full text and not in English or Bahasa Indonesia.</p> <p><strong>Result.</strong> Fourteen studies are included in this systematic review consisting of ten case reports, three cohort retrospective studies, and one randomized controlled trial. TNF-α inhibitors such as etanercept and infliximab are beneficial for SJS/TEN management because they accelerate skin healing time and re-epithelization, reduce in-hospital duration and mortality rate, and minimal complications and side effects. TNF-α inhibitors should be given quickly after the disease onset, and combination with other immunosuppressive agents should be avoided to prevent the excessive immunosuppressive effect.</p> <p><strong>Conclusion</strong>. TNF-α inhibitors such as etanercept and infliximab promise therapy to halt SJS/TEN progression. </p> Icasia Yuseli Kurnia Copyright (c) 2022 Icasia Yuseli Kurnia Wed, 10 Aug 2022 00:00:00 +0000