Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Diagnosis dan tatalaksana tromboangitis obliterans/penyakit buerger dengan fenomena raynaud
Tjok Ngurah Prasanta Adityaputra, Bagus Ari Pradnyana Dwi Sutanegara, Agung Pradnyana SuwiryaOnline First: Jun 22, 2021
- Abstract
Diagnosis dan tatalaksana tromboangitis obliterans/penyakit buerger dengan fenomena raynaud
Introduction: Thromboangitis obliterans (TAO) is segmental, non-atherosclerotic inflammatory disease involving small to moderate arteries, veins, and nerves of extremities. TAO or Buerger's disease has very strong association with tobacco use. The adoption of stricter diagnostic criteria and reduced tobacco use have led to a decline in the number of new TAO patients in United States, Europe, and Asia. Typical TAO patients are young men with history of heavy smoking who present with limb ischemic symptoms before age 45 years. The most common symptoms are due to arterial occlusion disease, secondary vasospasm (Raynaud’s phenomenon), and superficial thrombophlebitis. Clinical diagnosis of TAO requires exclusion of diseases that mimic this diseases such as atherosclerotic vascular disease, thromboembolic disease, and autoimmune diseases such as scleroderma. Therapeutic foundation for TAO is complete cessation of any tobacco use. The use of vasodilators is largely for palliative. Therapeutic anticoagulants have not been shown to be effective in the treatment of TAO. Nonetheless, some physicians have used anticoagulants in attempt to delay amputation and increase collateral flow in severe critical limb ischemia.
Case report: A 56 year old man complained of bluish and pain on the finger tips of both right and left hand. Smoking four packs a day. Dupplex ultrasound and CT scan of the superior limb angiography showed no abnormalities in the proximal artery. Echocardiography showed result within normal limit.
Conclusion: These findings suggest diagnosis of thromboangitis obliterans with Raynaud's phenomenon, even if he is over 45 years of age.
Pendahuluan: Tromboangitis obliterans (TAO) adalah penyakit inflamasi nonaterosklerotik segmental yang melibatkan arteri, vena, dan saraf kecil dan sedang pada ekstremitas. TAO atau penyakit Buerger memiliki hubungan yang sangat kuat dengan penggunaan tembakau. Penerapan kriteria diagnostik yang lebih ketat dan pengurangan penggunaan tembakau telah menyebabkan penurunan jumlah pasien baru TAO di Amerika Serikat, Eropa, dan Asia. Tipikal pasien TAO adalah pria muda dengan riwayat perokok berat yang muncul dengan gejala iskemik ekstremitas sebelum usia 45 tahun. Gejala paling umum akibat penyakit oklusi arteri, vasospasme sekunder (fenomena Raynaud), dan tromboflebitis superfisial. Diagnosis klinis TAO membutuhkan eksklusi penyakit yang menyerupai penyakit tersebut seperti penyakit pembuluh darah aterosklerotik, penyakit tromboemboli, dan penyakit autoimun seperti scleroderma. Landasan terapi untuk TAO adalah penghentian total setiap penggunaan tembakau. Penggunaan vasodilator pada pasien dengan TAO sebagian besar bersifat paliatif. Antikoagulan terapeutik belum pernah terbukti secara efektif dalam pengobatan TAO. Meskipun demikian, beberapa dokter telah menggunakan antikoagulan dalam upaya untuk menunda amputasi dan meningkatkan aliran kolateral pada iskemia ekstremitas kritis yang berat.
Laporan kasus: Seorang laki-laki berusia 56 tahun mengeluh kebiruan dan nyeri pada ujung kedua jari tangan kanan dan kiri. Merokok empat bungkus sehari. Temuan dupplex ultrasound dan CT scan angiografi ekstremitas superior menunjukkan tidak ditemukan kelainan pada arteri proksimal. Pemeriksaan ekokardiografi juga menunjukkan hasil dalam batas normal.
Simpulan: Dari temuan-temuan tersebut mengarahkan diagnosis pasien dengan tromboangitis obliterans dengan fenomena Raynaud, walaupun usia sudah lebih dari 45 tahun.
Aberrant expression of CD5 in a B-lineage Acute Lymphoblastic Leukemia (ALL): a case report
Ni Ketut Puspa Sari, Ni Nyoman Mahartini, Ni Kadek Mulyantari, Anak Agung Ayu Lydia Prawita, Ni Komang Krisnawati, I Putu Yuda Prabawa, Sianny Herawati, Made Minarti Witarini Dewi, Ekarini Katharina Yunarti NabuOnline First: Jul 15, 2021
- Abstract
Aberrant expression of CD5 in a B-lineage Acute Lymphoblastic Leukemia (ALL): a case report
Background: CD5 is expressed in several B-lymphocyte malignancies, including Chronic Lymphocytic Leukemia (CLL), Mantle Cell Lymphoma (MCL), but CD5 positive B-cell lineage Acute Lymphoblastic Leukemia (ALL) is extremely rare. Aberrant T-cell antigen expression is associated with poor prognosis and is a useful marker to identify patients at increased risk. This case report aims to elaborate on the aberrant expression of CD5 in B-lineage ALL.
Case Presentation: A 16-years-old male presented with a history of gum bleeding and abdominal pain of 7 days with associated fever, weakness and bone pain of 2-month duration. The bone marrow aspiration showed lymphoblast 30 % with the positive vacuole. In addition, the immunophenotyping test indicates for leukemia B-lineage with expression CD19, CD10, HLA-DR, CD 34, and there is the aberrant expression of CD5.
Conclusion: Aberrant expression CD5 in cases of ALL B lineage is very rare. This can be associated with a poor prognosis.
Pansinusitis kronis dengan komplikasi abses serebri dan selulitis preseptal: laporan kasus
Iriana Maharani, David SantosoOnline First: Jul 15, 2021
- Abstract
Pansinusitis kronis dengan komplikasi abses serebri dan selulitis preseptal: laporan kasus
Background: Rhinosinusitis is an inflammation of the sinuses of the paranasal mucosa, while pansinusitis is an inflammatory process in several sinuses. Rhinosinusitis is one of the most prevalent health problems in the world. Although rare, rhinosinusitis can also lead to serious complications, including intracranial complications such as a cerebral abscess. This case report attempts to evaluate a cerebral abscess and preseptal cellulitis caused by chronic pansinusitis.
Case Presentation: A 56 years old woman, after trepanation, was consulted by the neurosurgery department to the ear, nose, throat, head, and neck department at dr. Saiful Anwar Hospital. Patients with complaints of decreased consciousness. A gradual decrease in consciousness was felt 3 weeks before admission to the hospital (SMRS). CT scan showed a cerebral abscess with a single lesion located in the frontal (unilocular) lobe as a complication of chronic pansinusitis. In this case, there was also preseptal cellulitis due to the spread of infection from the ethmoid sinus to the orbit. Treatment with ceftriaxone, metronidazole, omeprazole, ketorolac, Levemir, Apidra, Levocin, and anterior ethmoidectomy showed clinical improvement.
Conclusion: Cerebral abscess is a rare complication of chronic pansinusitis but has a high morbidity and mortality rate. Medical intervention and anterior ethmoidectomy showed clinical improvement in patients.
Latar Belakang: Rinosinusitis adalah peradangan sinus mukosa paranasal sedangkan pansinusitis merupakan proses inflamasi pada beberapa sinus. Rinosinusitis adalah salah satu masalah kesehatan yang memiliki prevalensi besar di dunia. Meskipun jarang terjadi, rinosinusitis juga dapat mengakibatkan komplikasi serius termasuk komplikasi intrakranial seperti abses serebri. Laporan kasus ini berupaya untuk mengevaluasi abses serebri dan selulitis preseptal yang disebabkan oleh pansinusitis kronis.
Presentasi Kasus: Seorang wanita berusia 56 tahun pasca trepanasi dikonsultasikan oleh departemen bedah saraf ke departemen telinga hidung tenggorok kepala leher (THT-KL) RSUD dr. Saiful Anwar Pasien dengan keluhan terjadi penurunan kesadaran. Penurunan kesadaran secara gradual dirasakan semenjak 3 minggu sebelum masuk rumah sakit (SMRS). Pemeriksaan CT-Scan menunjukkan keberadaan abses serebri dengan lesi tunggal yang terletak pada lobus frontalis (unilokuler) sebagai komplikasi pansinusitis kronis. Pada kasus ini juga didapatkan selulitis preseptal akibat penyebaran infeksi dari sinus ethmoidalis ke orbita. Pengobatan dengan pemberian ceftriaxone, metronidazole, omeprazole, ketorolac, Levemir, Apidra, Levocin, dan etmoidektomi anterior menunjukkan perbaikan klinis.
Kesimpulan: Abses serebri adalah komplikasi yang jarang pada pansinusitis kronis tetapi memiliki angka morbiditas dan mortalitas yang tinggi. Intervensi medikamentosa dan etmoidektomi anterior menunjukkan perbaikan klinis pada pasien.
Problem diagnostik seorang penderita endokarditis infektif dengan komplikasi perdarahan intrakranial: Sebuah laporan kasus
Franky Simarmata, Ida Bagus Aditya Nugraha, I Wayan Wita, Dwijo Anargha SindhughosaOnline First: Jul 16, 2021
- Abstract
Problem diagnostik seorang penderita endokarditis infektif dengan komplikasi perdarahan intrakranial: Sebuah laporan kasus
Introduction: Infective Endocarditis (IE) is a disease frequently affecting heart valves. The diagnosis is relatively simple, however it could be difficult in unspecific symptoms. Intracranial complications of patients with IE rarely happen.
Case: The case was a 64 years-old male with sudden decrease of consciousness 12 hours prior to admission and diagnosed as a hemorrhagic stroke. He had a history of heavy smoking for about 10 years. Infective Endocarditis (IE) was diagnosed by Duke Criteria, and from this patient we found the vegetation at mitral valve with diameter 1.09 x 0.73 cm. Treatment for the patient is antibiotic according to sensitivity test of blood culture. The patient was discharged with improvement of condition. However, in approximately three months after discharge, the patient got hospitalized again due to the same condition and passed away.
Conclusion: Infective endocarditis is a relatively rare disease. In our case we had a definite IE patient with a spectrum of neurological events complicating this disease. The presence of cerebral hemorrhage complications makes the patient's prognosis worse.
Pendahuluan: Endokarditis Infektif (IE) merupakan penyakit yang umumnya menyerang katup jantung. Diagnosis pada umumnya relatif sederhana, namun dapat menjadi sulit gejala yang ditemukan tidak spesifik. Komplikasi intrakranial pasien dengan IE jarang terjadi.
Laporan Kasus: Seorang laki-laki 64 tahun dengan penurunan kesadaran mendadak 12 jam sebelum masuk rumah sakit (MRS) dan didiagnosis sebagai stroke hemoragik. Pasien memiliki riwayat perokok berat selama kurang lebih 10 tahun. Endokarditis infektif (IE) di diagnosis dengan kriteria Duke, dan dari pasien ini ditemukan vegetasi pada katup mitral dengan diameter 1,09 x 0,73 cm. Pengobatan untuk pasien adalah antibiotik berdasarkan uji sensitivitas kultur darah. Pasien dipulangkan dengan kondisi perbaikan. Namun, sekitar tiga bulan setelah keluar, pasien kembali dirawat di rumah sakit karena kondisi yang sama dan meninggal dunia.
Simpulan: Endokarditis infektif merupakan penyakit yang relatif jarang. Dalam laporan kasus ini, pasien dengan spektrum kejadian neurologis yang menyulitkan penyakit IE. Adanya komplikasi perdarahan otak membuat prognosis pasien semakin buruk.
Acute Decompensated Heart Failure (ADHF) with aortic dissection Stanford A in middle aged man: a case report
Anbiya Khairul Umam, Ida Bagus Wisnu Widiarta, Marwa Humaira Intizam, Aizar Vesa Prasetyo, Ketut Putu YasaOnline First: Jul 17, 2021
- Abstract
Acute Decompensated Heart Failure (ADHF) with aortic dissection Stanford A in middle aged man: a case report
Background: Heart failure is a clinical syndrome with shortness of breath, fluid retention, and the heart's structural and functional disorder. Each year, there were 7,2 cases every 1000 people on male and 4,7 cases every 1000 people on the female. Aortic dissection is an emergency disease in which the symptoms are similar to ischemic heart disease, that 38% of patients got misdiagnosed on the first evaluations. Because of the clinical course of heart failure and misdiagnosed aortic dissection that frequently happened, authors are interested in making a case report with both conditions.
Case report: A male patient, 39 years old, complained of shortness of breath and epigastrium pain. The patient was diagnosed with Acute Decompensated Heart Failure (ADHF) profile B with emergency hypertension and suspected aortic dissection based on history and physical examination. The patient was also diagnosed with acute kidney injury stage 1. CT angiography showed widening of the aorta ascending until arcus aorta with a Stanford type A aortic dissection diagnosis.
Conclusion: The condition of aortic dissection can coincide with acute heart failure. Therefore, a clinician must be aware of the emergency of dissection and know the initial symptoms of dissection. The typical clinical symptoms of dissection lead us to perform imaging studies that ultimately lead to a thoracoabdominal CTA to diagnose the dissection.
Sindroma Bartter pada laki-laki berusia 44 tahun: laporan kasus
Anak Agung Ayu Lydia Prawita, Anak Agung Wiradewi Lestari, Sianny Herawati, Ni Kadek Mulyantari, Ni Komang Krisnawati, Ekarini Katharina Yunarti NabuOnline First: Aug 10, 2021
- Abstract
Sindroma Bartter pada laki-laki berusia 44 tahun: laporan kasus
Background: Bartter's syndrome is a hereditary condition characterized by polyuria, hypokalemia, metabolic alkalosis with normal or slightly low blood pressure due to loss of sodium and renal hyperplasia. Most Bartter syndrome occurs in children and is very rare in adulthood, with a prevalence of 1 in 1,000,000 populations. This case report aims to evaluate the laboratory aspects of Bartter's syndrome in a 44-year-old man at Sanglah Hospital, Bali, Indonesia.
Case Presentation: A 44-year-old male patient complaining of vomiting and weakness. Other complaints such as diarrhea, fever, shortness of breath, stiffness and seizures are denied. The patient's previous medical history, treatment history, and family history were denied. Physical examination showed a general weakness with hypotension and polyuria. On laboratory examination, there was severe hypokalemia, hypocalcemia, hypomagnesemia, increased urinary potassium levels, increased urinary chloride levels, and metabolic alkalosis. To differentiate with Gitelman syndrome, an examination of the ratio of urine calcium and creatinine is performed. In this patient, the urine calcium and creatinine ratio increased, which indicated Bartter's syndrome. Patients receive electrolyte replacement therapy.
Conclusion: Bartter syndrome is very rare in adulthood. Several tests are needed to make the diagnosis in accordance with the diagnostic approach of hypokalemia, namely electrolyte examination in urine serum, urine creatinine, and blood gas analysis.
Latar Belakang: Sindroma Bartter merupakan suatu kondisi herediter yang ditandai oleh poliuria, hipokalemia, metabolik alkalosis dengan tekanan darah normal atau sedikit rendah karena kehilangan natrium dan hiperplasia ginjal. Sebagian besar sindroma Bartter terjadi pada anak-anak dan sangat jarang terjadi pada usia dewasa dengan prevalensi 1 dalam 1.000.000 populasi. Laporan kasus ini bertujuan untuk mengevaluasi aspek laboratorium sindroma Bartter pada laki-laki berusia 44 tahun di RSUP Sanglah, Bali, Indonesia.
Presentasi Kasus: Pasien laki-laki 44 tahun dengan keluhan muntah dan lemas. Keluhan lain seperti diare, demam, sesak nafas, kaku dan kejang tidak ada. Riwayat penyakit sebelumnya, riwayat pengobatan, dan riwayat penyakit pada keluarga disangkal pasien. Pada pemeriksaan fisik didapatkan keadaan umum lemah dengan hipotensi dan poliuria. Pada pemeriksaan laboratorium ditemukan hipokalemia berat, hipokalsemia, hipomagnesemia, peningkatan kadar kalium urine, peningkatan kadar klorida urine, dan alkalosis metabolik. Untuk membedakan dengan sindroma Gitelman dilakukan pemeriksaan rasio kalsium dan kreatinin urine. Pada pasien ini didapatkan hasil rasio kalsium dan kreatinin urine yang meningkat, yang mengindikasikan sindroma Bartter. Pasien mendapatkan terapi penggantian elektrolit .
Kesimpulan: Sindroma Bartter sangat jarang terjadi pada usia dewasa. Beberapa pemeriksaan diperlukan untuk menegakkan diagnosis sesuai dengan alur pendekatan diagnostik hipokalemia yaitu pemeriksaan elektrolit pada serum urine, kreatinin urine, dan analisis gas darah.
Disseminated Intravascular Coagulation (DIC) akibat gigitan ular: laporan kasus
Ni Komang Krisnawati, Ida Ayu Putri Wirawati, Sianny Herawati, Ni Nyoman Mahartini, Anak Agung Ayu Lydia Prawita, Ekarini Katharina Yunarti NabuOnline First: Aug 24, 2021
- Abstract
Disseminated Intravascular Coagulation (DIC) akibat gigitan ular: laporan kasus
Background: Snakebite cases are cases of emergency that are often found in the Emergency Unit, especially in rice fields, forests, plantations and swamps. There is no definitive data on the number of snakebite cases in Indonesia. Morbidity and mortality of snakebite cases are highly dependent on the type of snake species, the number and type of can that enter the body, as well as the availability of anti-snake serum.In these patients were found Disseminated Intravascular Coagulation (DIC) due to snake bites.
Case Presentation: A 5-years female patient complained of pain in the right hand due to snakebite about 30 minutes before entering the hospital. The snake is green with a red tail, a triangular head shape and a length of about 30 centimeters, biting the middle finger of the patient's right hand. Swollen redness and pain are felt spreading to the shoulders. Physical examination of compos mentis patients with a pulse rate of 96 times per minute, breath rate of 20 times per minute and temperature of 36.7oC. There was found edema and bullae in digiti III in the right manus region, palpably warm, and there is press pain. In the antebrachial region to the right humerus also found the presence of edema and press pain. Patients with normochromic normositer anemia with thrombocytopenia as well as lengthening of coagulation physiology decreased fibrinogen and increased D-dimer.
Conclusion: Snake venom can be hemotoxic, neurotoxic and cytotoxic. Snakebite cases require rapid and comprehensive management to minimize the possibility of disability and death.
Latar Belakang: Kasus gigitan ular merupakan kasus kegawatan yang sering dijumpai di Unit Gawat Darurat terutama di daerah area persawahan, hutan, perkebunan dan rawa. Tidak ada data yang pasti mengenai jumlah kasus gigitan ular di Indonesia. Morbiditas dan mortalitas kasus gigitan ular sangat tergantung dari jenis spesies ular, jumlah dan jenis bisa yang masuk ke dalam tubuh serta ketersediaan serum anti bisa ular.
Presentasi Kasus: Pada pasien ini ditemukan Disseminated Intravascular Coagulation (DIC) akibat gigitan ular. Pasien perempuan, usia 5 tahun dengan keluhan nyeri pada tangan kanan akibat gigitan ular sejak sekitar 30 menit sebelum masuk rumah sakit. Ular berwarna hijau dengan ekor merah, bentuk kepala segitiga dan panjang sekitar 30 centimeter, menggigit jari tengah tangan kanan pasien. Bengkak kemerahan dan nyeri dirasakan menjalar sampai ke bahu. Pemeriksaan fisik pasien compos mentis dengan laju nadi 96 kali per menit, laju nafas 20 kali per menit dan suhu 36,7oC. Pada regio manus kanan ditemukan adanya edema dan bullae pada digiti III, teraba hangat dan terdapat nyeri tekan. Pada region antebrachii sampai humerus kanan juga ditemukan adanya edema dan nyeri tekan. Pasien mengalami anemia normokromik normositer dengan trombositopenia serta pemanjangan faal koagulasi, penurunan fibrinogen dan peningkatan D-dimer.
Kesimpulan: Bisa ular dapat bersifat hemotoksik, neurotoksik dan sitotoksik. Kasus gigitan ular memerlukan penatalaksanaan yang cepat dan komprehensif sehingga dapat meminimalkan kemungkinan kecacatan dan kematian.
Inflammation after corneoscleral rupture and traumatic cataract due to blunt trauma in a child: a case report
Clara Verlina Suhardi, Graecia Bungaran, Nashrul IhsanOnline First: Aug 31, 2021
- Abstract
Inflammation after corneoscleral rupture and traumatic cataract due to blunt trauma in a child: a case report
Background: Ocular trauma is the most common cause of acquired monocular blindness in children. It is because of the inflammation following corneoscleral rupture and traumatic cataracts due to blunt trauma. This case study aims to evaluate the corneoscleral rupture and traumatic cataracts due to blunt trauma in a child.
Case Presentation: We present a 5-year-old male who sustained blunt trauma to his right eye. He presented with blurry vision, mild pain and watering from the affected eye. His examination revealed visual acuity of 6/60 in the right eye (RE), corneal laceration extending from 3 o’clock towards 11 o’clock with possible extension to the sclera, and cortical lens matter in the anterior chamber. The patient underwent globe rupture repair under general anesthesia immediately. Postoperative day one revealed 2 mm hypopyon thick inflammation cells and fibrin. He was on topical steroids and topical antibiotics. The fourth postoperative day showed reduced inflammation, wound sutures in place and absence of hypopyon, thick membranous in the pupil. The patient is then referred to the Pediatric Ophthalmology department for a follow-up operation of clearing lens particle remnants to reduce inflammation and IOL insertion.
Conclusion: Management of the injury and traumatic cataract is crucial to prevent vision loss and amblyopia, to maintain binocularity, prevent strabismus or even phthisis bulbi. Along with early management, routine follow-up examination for prevention of other unwanted complications is advised.
Manajemen multidisiplin Oral Squamous Cell Carcinoma (OSCC): laporan kasus
Ni Putu Riskayanti, Dahlia Riyanto, Saka WiniasOnline First: Aug 31, 2021
- Abstract
Manajemen multidisiplin Oral Squamous Cell Carcinoma (OSCC): laporan kasus
Background: Oral squamous cell carcinoma (OSCC) is the most common type of oral cancer and represents more than 90% of all head and neck cancers. The etiology of OSCC is multifactorial. The uses of tobacco, heavy alcohol drinking, less consumption of vegetables and fruit, genetics, trauma and viruses are considered possible risk factors of the OSCC. This case study aims to evaluate the multidiscipline management of OSCC at Universitas Airlangga Dental and Oral Hospital, Surabaya, Indonesia.
Case Presentation: This case report presents a 45-year-old female patient who came with chief complaints of ulcer on the lateral right of the tongue that persistent for 3 months ago. The patient also complained of pain when speaking, eating, swallowing, and the pain felt into the right head. The patient has no history of tobacco and alcohol consumption, but her sister has a history of breast cancer. No extraoral abnormalities were found. Intraoral examination results showed a single ulcer with induration on the lateral dextra of the tongue and diffuse pseudomembranous on the dorsal of the tongue. Based on history taking and clinical examination, the patient was suspected of OSCC. The management included debridement of the lesion, complete blood count, fasting blood glucose, HbA1c, and anatomical pathology examination. The patient has also been prescribed anesthetics, antiinflammation and antiseptic mouthwash. The patient was then referred to the head and neck oncologist for hemiglossectomy. Two months after the surgery, there is no complaint of the lateral right of the tongue. The patient also has no complaint about eating and swallowing.
Conclusion: The dentist plays an important role in identifying OSCC. The early diagnosis and proper multidisciplinary management of OSCC could improve the prognosis of the case and the patient's life quality.
Latar belakang: Oral squamous cell carcinoma (OSCC) adalah jenis kanker mulut yang paling umum dan ditemukan hampir pada 90% dari semua kasus karsinoma di rongga mulut. Etiologi OSCC adalah multifaktorial. Penggunaan tembakau, konsumsi alkohol berlebihan, konsumsi sayur dan buah yang lebih sedikit, genetika, trauma dan virus dianggap sebagai faktor risiko OSCC. Laporan kasus ini bertujuan untuk mengevaluasi manajemen multidisipin OSCC pada Rumah Sakit Gigi dan Mulut (RSGM) Universitas Airlangga, Surabaya, Indonesia.
Presentasi Kasus: laporan kasus ini menyajikan kasus seorang pasien wanita berusia 45 tahun yang datang dengan keluhan utama ulserasi pada lateral lidah kanan yang menetap sejak 3 bulan yang lalu. Pasien juga mengeluh nyeri saat berbicara, makan, menelan dan nyeri terasa di kepala kanan. Pasien tidak memiliki riwayat konsumsi tembakau dan alkohol tetapi saudara perempuannya memiliki riwayat kanker payudara. Tidak ditemukan kelainan ekstraoral. Hasil pemeriksaan intraoral menunjukkan ulser tunggal dengan indurasi pada lateral lidah dekstra dan pseudomembran difus pada dorsal lidah. Berdasarkan anamnesis dan pemeriksaan klinis, diagnosa sementara adalah OSCC. Penatalaksanaan meliputi debridement lesi, hitung darah lengkap, glukosa darah puasa, HbA1c, dan pemeriksaan patologi anatomi. Pasien juga diresepkan obat kumur anestetikum, antiinflamasi dan antiseptik. Pasien kemudian dirujuk ke Departemen Bedah Onkologi Kepala Leher untuk dilakukan hemiglosektomi. Dua bulan setelah operasi, tidak ada keluhan pada lidah pasien. Pasien juga tidak memiliki keluhan saat makan dan menelan.
Simpulan: Dokter gigi memiliki peran yang penting dalam mengidentifikasi OSCC. Diagnosis dini dan manajemen multidisplin tepat dapat meningkatkan prognosis kasus dan kualitas hidup pasien.
Penanganan kandidiasis orofaring pada pasien Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) dengan nilai CD4 dibawah 10 sel/µL: laporan kasus
Winda Dwi Malinda Masuku, Dian Angriany, Saka Winias, Adiastuti Endah ParmadiatiOnline First: Aug 31, 2021
- Abstract
Penanganan kandidiasis orofaring pada pasien Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) dengan nilai CD4 dibawah 10 sel/µL: laporan kasus
Background: The oral manifestation of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is an important indicator because it is a disorder that usually appears first when the immune system is suppressed. Oropharyngeal candidiasis is an opportunistic infection that most often occurs in people suffering from HIV infection or AIDS. It is also an important marker in immunosuppressed states with CD4 values below 200 cells/mm3. This case study aims to evaluate the treatment of oropharyngeal candidiasis in patients with HIV/AIDS with CD4 values below 10 cells/µL
Case Presentation: A 30-year-old man complained of a thick and uncomfortable feeling in the entire oral cavity felt since 4 months ago. Clinical examination revealed multiple pseudomembranous, which were removed and left a reddish area at the base of most of the oral cavity to the pharynx. The results of the fungal examination showed that the hyphae were not insulated with the results of candida albicans culture, and the absolute CD4 value was 9 cells/µl. On the second visit, the patient admitted that he was HIV positive by bringing a reactive result on the 3-method anti-HIV examination conducted 3 months earlier. This case was handled by administering an antiseptic mouthwash, topical and systemic antifungal, and referred to the IHAN RSUA polyclinic for ARV therapy.
Conclusion: The successful treatment of oropharyngeal candidiasis, in this case, depends on integrated therapy between dentists and internists as well as patient compliance in following doctor's instructions.
Latar Belakang: Manifestasi oral Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) menjadi indikator penting karena merupakan kelainan yang biasanya muncul pertama kali saat kondisi imun tersupresi. Kandidiasis orofaring merupakan suatu infeksi oportunistik yang paling sering terjadi pada orang yang menderita infeksi HIV atau AIDS. Hal ini juga disadari sebagai suatu pertanda penting pada keadaan imunosupresi dengan nilai CD4 dibawah 200 sel/mm3. Laporan kasus ini bertujuan untuk mengevaluasi penanganan kandidiasis orofaring pada pasien (HIV/AIDS) dengan nilai CD4 dibawah 10 sel/µL
Presentasi Kasus: Seorang laki-laki berusia 30 tahun mengeluhkan rasa tebal dan tidak nyaman pada seluruh rongga mulut yang dirasakan sejak 4 bulan yang lalu. Pemeriksaan klinis ditemukan pseudomembran multipel yang dapat dihapus dan meninggalkan area kemerahan di dasarnya pada hampir seluruh rongga mulut hingga ke faring. Hasil pemeriksaan jamur menunjukkan hyphae tidak bersekat dengan hasil biakan candida albicans, dan nilai CD4 absolut 9 cell/µl. Kunjungan kedua Pasien mengakui sebagai pengidap HIV dengan membawa hasil reaktif pada pemeriksaan anti-HIV 3 metode yang telah dilakukan 3 bulan sebelumnya. Penanganan kasus ini dengan pemberian antiseptik kumur, anti jamur topikal dan sistemik serta dirujuk ke poli IHAN RSUA untuk melakukan terapi ARV.
Kesimpulan: Keberhasilan penanganan kandidiasis orofaringeal pada kasus ini bergantung pada terapi yang terintegrasi antara dokter gigi dan dokter penyakit dalam serta kepatuhan pasien dalam mengikuti instruksi dokter.
Sifilis sekunder pada seorang remaja perempuan: laporan kasus
Ida Ayu Uttari Priyadarshini, Elice Wijaya, Ni Made Dwi PuspawatiOnline First: Aug 31, 2021
- Abstract
Sifilis sekunder pada seorang remaja perempuan: laporan kasus
Introduction: Syphilis is one of the most common sexually transmitted infections worldwide. Syphilis can be acute to chronic. Syphilis is caused by the parasite Treponema pallidum (T. pallidum). Transmitted through sexual contact and blood. In this case, we report a case of secondary syphilis in an adolescent girl.
Case report: an 18-year-old girl came with complaints of red spots on the palms of the hands and soles of the feet, with a history of sores in the pubic area that were painless and odorless and then healed on their own so no treatment was given. A history of positive sexual contact approximately one week before the patient came for examination. On dermatological status, right and left palmar and plantar locations found erythematous macules, round to geographical in shape with diameters of 0.5 cm - 1.5 cm and 0.5 cm x 0.7 cm - 0.7 cm x 1 cm, scattered discrete and localized distributions. The patient was differentially diagnosed with secondary syphilis with syphilitic roseola, pityriasis rosea and palmoplantar psoriasis. To confirm the diagnosis, a serological examination was carried out on June 10th 2020, Venereal disease research laboratory test (VDRL) examination with reactive results with a titer of 1:32 and reactive treponema pallidum hemagglutination assay (TPHA) with a TPHA titer of 1:2560. He was given a single dose of intramuscular (IM) injection of benzathine penicillin G 2.4 million international units (IU) and education on further follow up for VDRL laboratory test.
Conclusion: A case of secondary syphilis with manifestations of syphilitic roseola has been reported in an 18-year-old teenager. The patient's has a generally good prognosis because in general the patient's condition is good, but considering the patient is still a teenager, it is possible to have irresponsible sexual relations later in life.
Pendahuluan: Sifilis merupakan salah satu penyakit infeksi menular seksual yang sering ditemukan. Sifilis dapat berbentuk akut hingga kronis. Sifilis disebabkan oleh parasit Treponema pallidum (T. pallidum). Menular melalui kontak seksual dan darah. Pada kasus ini dilaporkan sebuah kasus sifilis sekunder pada remaja perempuan.
Laporan kasus: remaja perempuan 18 tahun datang dengan keluhan bercak-bercak kemerahan pada telapak tangan dan telapak kaki, dengan riwayat luka pada daerah kemaluan tidak nyeri dan tidak berbau kemudian sembuh sendiri sehingga tidak dilakukan pengobatan. Riwayat kontak seksual positif kurang lebih satu minggu sebelum pasien datang melakukan pemeriksaan. Pada status dermatologi, lokasi palmar dan plantar dekstra et sinistra ditemukan makula eritema, berbentuk bulat hingga geografika dengan ukuran diameter 0,5 cm - 1,5 cm dan 0,5 cm x 0,7 cm – 0,7 cm x 1 cm, tersebar diskret dan distribusi lokalisata. Pasien didiagnosis banding dengan sifilis sekunder dengan roseola sifilitika, pitiriasis rosea dan palmoplantar psoriasis. Untuk menegakkan diagnosis dilakukan pemeriksaan serologis pada tanggal 10 Juni 2020 yakni pemeriksaan VDRL dengan hasil reaktif dengan titer 1:32 dan TPHA reaktif dengan titer TPHA 1:2560. Diberikan terapi injeksi benzatin penisilin G 2,4 juta international unit (IU) intramuskular (IM) dosis tunggal dan edukasi pemantauan pengobatan yang akan dilakukan yakni pemeriksaan VDRL ulang pada bulan ke-1 setelah terapi.
Simpulan: Telah dilaporkan satu kasus sifilis sekunder dengan manifestasi roseola sifilitika pada remaja berusia 18 tahun. Prognosis pasien adalah dubia ad bonam karena pada umumnya kondisi pasien baik, namun mengingat pasien masih remaja, ada kemungkinan untuk melakukan hubungan seksual yang tidak bertanggung jawab di kemudian hari.
Alat ukur untuk menilai kemampuan fungsional pasien dengan osteoartritis lutut: tinjauan pustaka
Sayu Aryantari Putri Thanaya, Stanisela Agatha, Luh Putu Ratna SundariOnline First: Jun 21, 2021
- Abstract
Alat ukur untuk menilai kemampuan fungsional pasien dengan osteoartritis lutut: tinjauan pustaka
Background: Osteoarthritis is a common disease that has become one of the main causes of disability and is ranked fourth as a contributing factor of disability. In Indonesia, many healthcare professionals, including physiotherapists, treat patients with various stages of osteoarthritis. Physiotherapists have a crucial role in improving the functional ability of patients with knee osteoarthritis. However, many of them do not use appropriate outcome measures to document patients’ improvements.
Objective: This literature review aimed to summarize the available outcome measures that can be used to measure the functional ability of patients with knee osteoarthritis, in order to increase the awareness and knowledge of healthcare professionals, particularly physiotherapists, regarding the use of available outcome measures.
Methods: The method used was literature review. Literature search was conducted in PubMed and Google Scholar databases using the main keywords: “outcome measure”, “scale”, “questionnaire”, “knee”, “osteoarthritis”, “functional ability”, “validity” and “reliability”.
Result: This review identified 7 outcome measures in the form of questionnaires that can be used to measure the functional ability of patients with knee osteoarthritis. The most commonly used measure is the Western Ontario and McMaster University osteoarthritis index, which has been translated and validated in various languages. All measuring instruments were established in developed countries, except for the Ibadan Knee Osteoarthritis Outcome Measure. None of the 7 outcome measures have been translated and validated into Indonesian.
Conclusion: This literature review has summarized measuring tools that can be used to measure the functional ability of patients with knee osteoarthritis. To date, no tools have been translated and validated into Indonesian. In the future, it is hoped that further research can be conducted in the form of cross-cultural adaptations studies on the validity and reliability of these outcome measures into Indonesian to support the effectiveness of using these measures to assess the functional ability of patients with knee osteoarthritis.
Latar belakang: Osteoartritis merupakan penyakit umum yang menjadi salah satu penyebab utama kecacatandan menempati urutan keempat untuk faktor penyebab kecacatan. Di Indonesia, banyak tenaga kesehatan, termasuk fisioterapis, yang merawat pasien dengan bebagai stadium osteoartritis. Fisioterapis sangat berperan dalam meningkatkan aspek fungsional pasien dengan osteoartritis lutut. Namun, banyak yang masih belum menggunakan alat ukur yang sesuai untuk mendokumentasikan kemajuan pasien.
Tujuan: Tujuan tinjauan pustaka ini adalah untuk merangkum alat ukur yang dapat digunakan untuk mengukur kemampuan fungsional pasien dengan osteoartritis lutut, guna meningkatkan pengetahuan dan kesadaran tenaga kesehatan, terutama fisioterapis, dalam penggunaan alat ukur yang tersedia.
Metode: Metode penelitian yang digunakan adalah tinjauan pustaka. Penelusuran artikel dilakukan pada database PubMed dan Google Scholar dengan kata kunci utama: “outcome measure”, “scale”, “questionnaire”, “knee”, “osteoarthritis”, “validity” dan “reliability”.
Hasil: Tinjauan pustaka ini menemukan 7 alat ukur dalam bentuk kuisioner yang dapat digunakan untuk mengukur kemampuan fungsional pasien dengan osteoartritis lutut. Alat ukur yang paling sering digunakan adalah Western Ontario and McMaster University osteoarthritis index, yang sudah diterjemahkan dan divalidasi ke dalam berbagai bahasa. Semua instrumen pengukuran dibuat oleh negara maju, kecuali Ibadan Knee Osteoarthritis Outcome Measure. Dari 7 kuisioner, belum ada yang diterjemahkan dan divalidasi ke dalam Bahasa Indonesia.
Kesimpulan: Tinjauan pustaka ini telah merangkum alat ukur yang dapat digunakan untuk mengukur kemampuan fungsional pasien dengan osteoartritis lutut. Sampai saat ini, belum ada kuisioner yang sudah diterjemahkan dan divalidasi ke dalam bahasa Indonesia. Diharapkan adanya pengembangan penelitian berupa studi adaptasi lintas budaya terhadap validitas dan realibilitas kuisioner lainnya ke dalam bahasa Indonesia untuk menunjang efektivitas penggunaan alat ukur dalam menilai kemampuan fungsional pasien dengan osteoartritis lutut.
Tuberculosis cases comparison in developed country (Australia) and developing country (Indonesia): a comprehensive review from clinical, epidemiological, and microbiological aspects
Ni Luh Putu Harta Wedari, I Wayan Adi Pranata, Ni Nyoman Sri Budayanti, I Dewa Made SukramaOnline First: Jun 22, 2021
- Abstract
Tuberculosis cases comparison in developed country (Australia) and developing country (Indonesia): a comprehensive review from clinical, epidemiological, and microbiological aspects
Background: Tuberculosis (TB) is one of most crucial public health issues around the world. TB is an entity of a complex disease with the socio-economic aspect that has very strong correlation in regard to combat this disease. Migration from developing country to developed country inevitably possesses big influence on global epidemiologic of TB. In Australia, TB still becomes the main threat not only in native population but also regarding the migrant movement into Australia. Indonesia is one of among the TB endemic countries with high TB cases, in which not merely due to its high TB prevalence and incidence but also influenced by very high and dense population.
Aim: This literature aims to review the clinical, epidemiological, and microbiological aspects of tuberculosis as a comparison between developed country (Australia) and developing country (Indonesia).
Conclusion: Tuberculosis cases in Australia remains low compared to Indonesia, however, the close proximity to adjacent developing countries with high endemic of TB contributes significantly to increase number of TB in Australia. Tuberculosis can be cured by following the treatment guidelines with proper monitoring. Moreover, the collaboration between public and private sector along with active collaboration from the family or people surrounding the patients is required to eliminate TB disease.
Gangguan pola bangun-tidur setelah cedera kepala
Moses Kharisma Setyawan, Sri Maliawan, Tjokorda Gde Bagus Mahadewa, I Wayan Niryana, Dewa Putu Wisnu WardhanaOnline First: Jul 14, 2021
- Abstract
Gangguan pola bangun-tidur setelah cedera kepala
Traumatic brain injury is a common trauma. Traumatic brain injury is commonly followed by sleep disorder such as insomnia, hypersomnia and circadian rhythm disturbance. Sleep disorder can cause many complications, including the worsening of the brain injury prognosis. Insomnia occurs in 29% traumatic brain injury patient. Insomnia suspected due injury in inferior frontal, anterior temporal including basal forebrain, also sympathetic nerve hyperactivity. Insomnia increase the risk of stroke, disability and mood disturbance. Hypersomnia occurs in 28% traumatic brain injury patients. Hypersomnia suspected due orexin decrease and injury in sleep promoting area. Hypersomnia suspected related to recovery, less activity time and accident due sleepiness. There are no prevalence data of circadian rhythm disturbance after traumatic brain injury. This disturbance is caused by injury in supra-chiasmatic nucleus and related to global worsening on the patient. Insomnia and circadian rhythm disturbance are highly linked with injury area, but hypersomnia is not particularly linked to any area and only related to orexin decrease. Insomnia and circadian rhythm disturbance are highly related to the worsening condition on the patient, but hypersomnia is associated with recovery and not particularly related to any disturbances. It is hoped that understanding the sleep disorder after traumatic brain injury can rise the alertness of this matter and encourage clinicians to increase the quality of sleep disorder due to traumatic brain injury management.
Cedera kepala merupakan salah satu cedera yang umum terjadi. Cedera ini sering diikuti dengan gangguan tidur seperti insomnia, hipersomnia dan gangguan ritme sirkadian. Gangguan ini sering dapat menyebabkan berbagai komplikasi termasuk memperparah penyembuhan cedera kepala. Insomnia setelah cedera kepala terjadi sebanyak 29%. Insomnia diduga disebabkan oleh cedera pada daerah inferior frontal, anterior temporal termasuk basal otak depan, juga peningkatan kerja saraf simpatis. Insomnia meningkatkan resiko stroke, disabilitas dan gangguan suasana hati. Hipersomnia setelah cedera kepala terjadi sebanyak 28%. Hipersomnia diduga akibat penurunan orexin dan akibat kerusakan pada area yang mempertahankan bangun. Hipersomnia diduga berhubungan dengan penyembuhan, waktu tersita akibat tidur dan kecelakaan akibat mengantuk. Belum ada data prevalensi gangguan ritme sirkadian setelah cedera kepala. Gangguan ini disebabkan oleh cedera pada nukleus suprakiasmatik dan sering dikaitkan dengan perburukan kondisi pasien. Insomnia dan gangguan ritme sirkadian sering dihubungkan dengan lokasi tertentu dari cedera, namun hipersomnia berhubungan dengan kadar orexin dan tidak terlalu dikaitkan terhadap area tertentu. Insomnia dan gangguan ritme sirkadian berhubungan dengan perburukan, namun hipersomnia bisa menandakan perbaikan dan tidak berhubungan signifikan dengan gangguan lainnya. Diharapkan dengan memahami gangguan tidur ini dapat meningkatkan kewaspadaan bagi para klinisi dan mendorong untuk penelitian berikutnya sehingga penanganan pasien gangguan tidur akibat cedera kepala dapat menjadi lebih baik.
Mechanism of action of metformin as an anti-aging agent: a literature review
Aceng Hamudin, Nur AtikOnline First: Jul 14, 2021
- Abstract
Mechanism of action of metformin as an anti-aging agent: a literature review
Aging is a complex process consisting of various mechanisms that can cause damage and decrease the body's extrinsic and intrinsic functions. Metformin has been indicated for the treatment of degenerative diseases. It also has been reported to be used as an anti-aging agent. Various studies reported different mechanisms of action, but human studies are limited. This literature aims to review the multiple mechanisms of action of metformin as an anti-aging agent. Metformin has been reported to exert anti-aging effects by prolonging life in humans and animals. The effectiveness of metformin as an anti-aging agent is influenced by the dosage and age of the subjects studied. Various mechanisms of action of metformin concerning anti-aging have been reported, including autophagy pathways with AMPK activation and inhibition of mTOR, increased antioxidants, inhibition of ROS, inhibition or enhancement of mitochondrial function and inhibition of inflammation. It was found that there were biomarkers in the form of GPx7, Nrf2, PPAR and SREBP, SOD2, TrxR1, NQO1, NQO2, pNF-kB, FOXO, mTOR, AMPK, which could be used as predictors to explain the anti-aging effect of metformin.
Obesitas sebagai faktor risiko terjadinya peningkatan kadar trigliserida dalam darah: tinjauan pustaka
Baiq Rissa Khaerawati Salim, Desak Made Wihandani, Ni Nyoman Ayu DewiOnline First: Jul 31, 2021
- Abstract
Obesitas sebagai faktor risiko terjadinya peningkatan kadar trigliserida dalam darah: tinjauan pustaka
Obesity is considered a major factor in the emergence of various diseases such as coronary heart disease, stroke ischemia, and type 2 diabetes mellitus in developed and developing countries. Obesity is defined as an increase in body weight above 20% of normal limits and is associated with abnormal serum lipoprotein levels. Obese people are more at risk for diseases such as Diabetes Mellitus type 2, stroke and other diseases. Excessive fat accumulation in obese people results in increased amounts of free fatty acids hydrolyzed by endothelial lipoprotein lipases. This increase triggers the production of oxidants that have a negative effect on the endoplasmic reticulum and mitochondria. The free fatty acids released due to excessive fat accumulation also inhibit lipogenesis, resulting in an increase in triglyceride levels in the blood. This literature study aims to determine whether obesity is a risk factor for increased blood triglyceride levels based on the relevant literature.
Obesitas dianggap sebagai faktor utama munculnya berbagai macam penyakit seperti penyakit jantung koroner, stroke iskemik, dan diabetes mellitus tipe 2 yang terjadi di negara maju maupun negara berkembang. Obesitas diartikan sebagai peningkatan berat badan di atas 20% dari batas normal dan berhubungan dengan kadar lipoprotein serum tidak normal. Orang obesitas lebih berisiko untuk mengalami penyakit seperti Diabetes Mellitus tipe 2, stroke dan penyakit lainnya. Penumpukan lemak yang berlebihan yang terjadi pada orang obesitas mengakibatkan meningkatnya jumlah asam lemak bebas yang dihidrolisis oleh lipoprotein lipase endotel. Peningkatan ini memicu produksi oksidan yang berefek negatif terhadap retikulum endoplasma dan mitokondria. Asam lemak bebas yang dilepaskan karena adanya penimbunan lemak yang berlebihan juga menghambat terjadinya lipogenesis sehingga mengakibatkan peningkatan kadar trigliserida dalam darah. Tinjauan pustaka ini bertujuan untuk mengetahui apakah obesitas sebagai faktor risiko peningkatan kadar trigliserida dalam darah berdasarkan pada studi literatur yang relevan.
Pencegahan penularan infeksi Human Immunodeficiency Virus (HIV) dari ibu ke anak di Indonesia: sebuah tinjauan pustaka
Komang Ayu WitariniOnline First: Aug 30, 2021
- Abstract
Pencegahan penularan infeksi Human Immunodeficiency Virus (HIV) dari ibu ke anak di Indonesia: sebuah tinjauan pustaka
Human Immunodeficiency Virus (HIV) can be transmitted from an HIV-positive woman to her child during pregnancy, childbirth, and breastfeeding. Mother-to-child transmission (MTCT), also known as ‘vertical transmission’, accounts for the vast majority of infection in children (0-14 years). Prevention of mother-to-child HIV infection transmission (PMTCT) programs offers a range of services for women of reproductive age (15-49 years) living with or at risk of HIV to maintain their health and stop their infants from acquiring HIV. WHO promotes a comprehensive approach to PMTCT programs which include: preventing new HIV infections among women of reproductive age, preventing unintended pregnancies among women living with HIV, preventing HIV transmission from women living with HIV to her baby, and providing appropriate treatment, care, and support to mothers living with HIV, their children, and families. The health service program to prevent HIV transmission from HIV-infected pregnant women to their babies includes the following activities: integrated ANC services, including offering and testing HIV to pregnant women; HIV diagnosis in pregnant women; administering antiretroviral therapy to pregnant women; safe delivery; arrange for subsequent pregnancies; management of feeding for infants and children; administration of Antiretroviral (ARV) prophylaxis and cotrimoxazole in children; HIV diagnostic testing in children; and immunization. The risk of MTCT of HIV can be reduced to less than 2% with optimal PMTCT programs.
Human Immunodeficiency Virus (HIV) dapat ditularkan dari ibu yang terinfeksi kepada bayi yang dikandung selama kehamilan, persalinan dan menyusui. Penularan infeksi HIV dari ibu kepada bayi yang dikandung, dikenal dengan istilah transmisi vertikal, merupakan cara penularan infeksi tersering dijumpai pada anak usia 0-14 tahun. Program pencegahan penularan infeksi HIV dari ibu ke anak (PPIA) merupakan upaya terhadap perempuan usia produktif (15-49 tahun) yang terinfeksi atau memiliki risiko terinfeksi HIV untuk tetap terjaga kesehatannya, serta mencegah menularkan infeksi HIV kepada bayi yang dikandung. World Health Organization (WHO) mempromosikan upaya komprehensif dari PPIA, terdiri dari: mencegah terjadinya penularan HIV pada perempuan usia reproduksi, mencegah kehamilan yang tidak direncanakan pada perempuan dengan HIV, mencegah terjadinya penularan HIV dari ibu hamil HIV positif ke bayi yang dikandungnya, serta memberikan dukungan psikologis, sosial, dan perawatan kesehatan kepada ibu HIV positif beserta bayi dan keluarganya. Program pelayanan kesehatan untuk mencegah penularan HIV dari ibu hamil terinfeksi HIV kepada bayi yang dikandung mencakup kegiatan sebagai berikut: layanan antenatal care (ANC) terpadu termasuk penawaran dan tes HIV pada ibu hamil; diagnosis HIV pada ibu hamil; pemberian terapi antiretroviral pada ibu hamil; persalinan yang aman; menunda dan mengatur kehamilan berikutnya; tatalaksana pemberian makanan bagi bayi dan anak; pemberian profilaksis Antiretroviral (ARV) dan kotrimoksazol pada anak; pemeriksaan diagnostik HIV pada anak; serta imunisasi. Dengan upaya PPIA yang optimal, risiko penularan HIV dari ibu ke anak dapat diturunkan sampai kurang dari 2%.
Klasifikasi, diagnosis, dan pengobatan saat ini untuk penyakit mata kering: tinjauan pustaka
Anthea Casey, Sari MarinaOnline First: Aug 31, 2021
- Abstract
Klasifikasi, diagnosis, dan pengobatan saat ini untuk penyakit mata kering: tinjauan pustaka
Background: Dry eye disease (DED) is one of the most prevalent ocular diseases in the world. In Indonesia, lifestyles driven by information technology have brought DED a severe public health concern. Affected individuals usually come with varied symptoms, such as photophobia, fatigue, itchiness, burning sensation, irritation, and visual disturbance. The aim of this study is to provide a review of the current classification, diagnosis, and treatment for dry eye disease.
Method: We conducted a literature review using Pubmed, Proquest, and Google Scholar databases. Relevant articles from 2015 to 2021 were collected and analyzed based on the results of previous studies.
Result: According to the Asia Dry Eye Society (ADES) report in 2020, DED is classified into three types: aqueous-deficient, decreased wettability, and increased evaporation. This classification is based on the concept of tear film-oriented diagnosis and respectively coincide with the problem of each layer: aqueous, membrane-associated mucins, and lipid/secretory mucin. A practical diagnostic tool based on the fluorescein breakup patterns (FBUP) is recommended to differentiate the type of DED and, furthermore, help to select the choices of treatment.
Conclusion: This classification proposed by ADES is simple to use through use of fluorescein, which is available even to non-dry eye specialists, and which hopefully contribute to an effective diagnosis and treatment for dry eye disease.
Latar Belakang: Penyakit mata kering (dry eye disease/DED) merupakan salah satu penyakit mata tersering di dunia. Di Indonesia, seiring dengan kemajuan teknologi informatika, DED menjadi masalah kesehatan yang serius. Pasien umumnya datang dengan keluhan yang bervariasi, seperti fotofobia, mata lelah, gatal, terasa panas atau terbakar, iritasi, dan gangguan penglihatan. Tujuan dari tinjauan pustaka ini adalah memberikan ulasan mengenai klasifikasi, diagnosis, dan tatalaksana mata kering saat ini.
Metode: Sumber pustaka diperoleh dari database Pubmed, Proquest, dan Google Scholar. Artikel-artikel yang relevan yang dipublikasi dalam rentang waktu tahun 2015 sampai 2021 dikumpulkan dan dianalisis berdasarkan hasil dari penelitian sebelumnya.
Hasil: Berdasarkan laporan Asia Dry Eye Society (ADES) di tahun 2020, DED diklasifikasikan menjadi tiga tipe, yaitu defisiensi aqueous, penurunan keterbasahan, dan peningkatan evaporasi. Klasifikasi ini didasarkan pada konsep tear film-oriented diagnosis (TFOD) di mana ketiga tipe ini sesuai dengan letak lapisan air mata yang mengalami kelainan, yaitu lapisan aqueous, membrane-associated mucins, dan lipid/secretory mucin. Diagnosis tipe DED dapat dilakukan dengan pemeriksaan fluorescein breakup pattern (FBUP) yang kemudian hal ini akan membantu dalam menentukan tatalaksana yang sesuai untuk penyakit mata kering.
Simpulan: Klasifikasi DED oleh ADES ini mudah dan praktis digunakan, hanya dengan menggunakan fluoresein. Hal ini diharapkan dapat membantu menegakkan diagnosis yang efektif dan tatalaksana penyakit mata kering bahkan bagi dokter non-spesialis penyakit mata kering.
Gejala konjungtivitis pada pasien dengan COVID-19: sebuah tinjauan sistematis
Anggari Purnama DewiOnline First: Aug 31, 2021
- Abstract
Gejala konjungtivitis pada pasien dengan COVID-19: sebuah tinjauan sistematis
Background: Infection of severe acute respiratory coronavirus syndrome 2 (SARS-CoV-2) or Coronavirus disease 2019 (COVID-19) has become a global pandemic. The clinical symptoms are not typical, making clinical diagnosis difficult to do. A number of studies have stated that ocular involvement in the form of conjunctivitis can be one of the symptoms of COVID-19 infection. The purpose of this systematic review is to determine the symptoms of conjunctivitis in patients with COVID-19 infection.
Methods: A systematic literature review was carried out by searching the literature on the Cochrane Library, Pubmed, and Google Scholar, also selecting the literature using the PRISMA diagram. The inclusion criteria used were studies that examined the symptoms of conjunctivitis in COVID-19 patients published in the range of 2020-2021. Studies in the form of editorials, commentaries, reviews or meta-analyses, articles are not available in full-text, not available in English or Indonesian, do not discuss ocular manifestations of COVID-19 infection, or only discuss the detection of the SARS CoV-2 virus in conjunctival secretions. So that there were 12 studies that met the eligibility criteria.
Results: There were 12 studies that carried out synthetic analysis, namely 4 cross-sectional studies, one case-control study, one case series study, and six case reports. The prevalence of conjunctivitis symptoms in COVID-19 infection ranges from 5.04-31.75%. Conjunctivitis is more common in male COVID-19 patients, with mild to moderate symptoms and duration of illness ranging from 5-26 days. Conjunctivitis in COVID-19 patients was reported as an early symptom of COVID-19 infection and the data became the sole symptom of COVID-19 infection. The habit of rubbing the eyes, impaired smell and taste were found to be significantly associated with conjunctivitis symptoms.
Conclusion: Although conjunctivitis is found in only a minority of COVID-19 cases, the conjunctiva can be one of the routes of transmission of COVID-19 infection. The use of goggles and face shields is important as an effort to prevent infection transmission.
Latar Belakang Infeksi severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) atau Coronavirus disease 2019 (COVID-19) telah menjadi pandemi global. Gejala klinisnya yang tidak khas membuat penegakkan diagnosis klinis sulit dilakukan. Sejumlah studi menyebutkan keterlibatan okuler berupa konjungtivitis dapat menjadi salah satu gejala infeksi COVID-19. Tujuan dari systematic review ini adalah untuk mengetahui gejala konjungtivitis pada pasien dengan infeksi COVID-19.
Metode: Tinjauan pustaka sistematis dilakukan dengan pencarian literatur pada Cochrane Library, Pubmed dan Google Scholar, juga pemilihan literatur menggunakan diagram PRISMA. Kriteria inklusi yang digunakan adalah studi yang meneliti gejala konjungtivitis pada pasien COVID-19 yang terpublikasi pada rentang tahun 2020-2021. Studi berupa editorial, commentary, review maupun meta analisis, artikel tidak tersedia secara full-text, tidak tersedia dalam Bahasa Inggris atau Indonesia, tidak membahas manifestasi okuler pada infeksi COVID-19, atau hanya membahas mengenai deteksi virus SARS CoV-2 pada sekresi konjungtiva dilakukan eksklusi sehingga didapatkan 12 studi yang memenuhi kriteria eligibilitas.
Hasil: Terdapat 12 studi yang dilakukan analisis sintesis, yakni 4 studi cross sectional, satu studi kasus kontrol, satu studi serial kasus dan enam laporan kasus. Prevalensi gejala konjungtivitis pada infeksi COVID-19 berkisar 5,04-31,75%. Konjungtivitis lebih banyak ditemukan pada pasien COVID-19 berjenis kelamin laki-laki, dengan gejala ringan sedang dan durasi penyakit berkisar 5-26 hari. Konjungtivitis pada pasien COVID-19 dilaporkan sebagai gejala awal infeksi COVID-19 dan data menjadi gejala tunggal infeksi COVID-19. Kebiasaan menggosok mata, gangguan penciuman dan pengecap ditemukan signifikan berhubungan dengan gejala konjungtivitis.
Simpulan: Meskipun konjungtivitis ditemukan hanya pada sebagian kecil kasus COVID-19, konjungtiva dapat menjadi salah satu rute transmisi infeksi COVID-19. Penggunaan goggles dan face shield penting dilakukan sebagai upaya pencegahan transmisi infeksi.
Is a high concentration of high-density lipoprotein cholesterol still relevant?
Hanselim HanselimOnline First: Aug 31, 2021
- Abstract
Is a high concentration of high-density lipoprotein cholesterol still relevant?
The importance of cholesterol management, particularly high-density lipoprotein (HDL) cholesterol, has always been believed to be essential in preventing and managing cardiovascular disease (CVD). While HDL has long been accepted as the 'good' cholesterol, various studies have started to challenge this paradigm. Most of these studies found that HDL cholesterol concentrations did not linearly translate into a reduction in CVD risk. There is a suspicion of dysfunctional HDL particles leading to the loss of HDL's cardioprotective function. Some of these dysfunctions were caused by changes in the structure of HDL particles due to an underlying disease or genetic mutations, causing defects in the reverse cholesterol transport (RCT) mechanism and vascular inflammation inhibition. Therefore, therapies that focus on these two mechanisms are expected to be one of the new cornerstones in reducing CVD. Simultaneously, cholesterol efflux capacity (CEC) assay could become the new therapeutic target as it has an inverse correlation with CVD risk regardless of HDL cholesterol concentration, increasing the accuracy in stratifying CVD risk in patients. However, standardization and a more thorough study on CEC assay and various subcellular cholesterol metabolism should be conducted before stepping further.
Glaucoma drainage devices implantation in uveitic glaucoma: a systematic review
Ardelia Emily, Novanita Shirley Satolom, Franky Richard Kasih, Kevin Kevin, Bobby KristiantoOnline First: Aug 31, 2021
- Abstract
Glaucoma drainage devices implantation in uveitic glaucoma: a systematic review
Background: Uveitis is broadly defined as inflammation of the uvea. Glaucoma is the third most common complication of uveitis. Uveitic Glaucoma (UG) is known to be refractory, and multiple surgeries are often required for proper treatment. The purpose of this study is to determine the effectiveness of Glaucoma Drainage Device (GDD) implantation as a surgical procedure in UG patients.
Method: We conducted a systematic search of electronic databases from PubMed, Science Direct, and SpringerLink using a combination of relevant keywords was performed by 5 independent reviewers. Various search terms, including 'glaucoma drainage device', 'glaucoma drainage implants', 'glaucoma filtration implants', 'aqueous shunts', 'uveitic glaucoma', 'inflammatory glaucoma'.
Result: A total of 143 articles were retrieved, but only 14 articles were eligible for data extraction. There are 631 eyes from 583 patients who had UG, 442 eyes underwent GDD implantation. Overall, intraocular pressure and the use of glaucoma medication were reduced. Mean IOP preoperative is 31.57 mmHg, and IOP postoperative is 14.48 mmHg. There is a reduction in IOP of an average of 17.09 mmHg. The number of glaucoma medications has decreased from 3.24 to 1.29 postoperatively.
Conclusion: UG has been shown to be managed successfully by GDD implantation. GDD implantation may be considered a long-term effective surgical option for patients with UG.
Efektivitas terapi inhibitor janus kinase pada vitiligo: tinjauan pustaka
Harry Gunawan, Flora Anisah RakhmawatiOnline First: Aug 31, 2021
- Abstract
Efektivitas terapi inhibitor janus kinase pada vitiligo: tinjauan pustaka
Background: Vitiligo is an autoimmune disease that causes progressive skin melanocyte destruction, clinically seen as asymptomatic depigmentation macule and poliosis. CD8+ T cell is the primary effector of melanocyte destruction, and the activities of CD8+ T cell are driven by interferon-? (IFN-?). The current vitiligo treatment options are often not satisfied with many limitations and a high recurrence rate. Janus Kinase (JAK) inhibitor is one of the emerging vitiligo therapies which has a more specific target with a direct effect on CD8+ T cell cytotoxicity and IFN-?.
Methods: In writing this article, the literature review method was used, and sources consist of relevant journals obtained through online search engines.
Result: Several studies show that repigmentation in the facial area increases between 51-92%. Repigmentation occurs better in areas exposed to sunlight or a combination of phototherapy because repigmentation in vitiligo lesions requires suppression of the autoimmune process and melanocyte regeneration.
Conclusion: Many studies showed the results of vitiligo therapy using JAK inhibitors were very promising and safe. The vitiligo therapy using JAK inhibitor showed higher efficacy on the facial area and combined with ultraviolet exposure.
Latar belakang: Vitiligo merupakan penyakit autoimun yang menyebabkan destruksi melanosit secara progresif pada kulit, menimbulkan makula depigmentasi asimtomatik dan poliosis. Sel T CD8+ merupakan efektor primer yang menyebabkan kematian melanosit dan aktivitasnya ditingkatkan oleh interferon-? (IFN-?). Pilihan terapi vitiligo saat ini seringkali tidak memuaskan, memiliki keterbatasan, dan memiliki tingkat kekambuhan yang tinggi. Inhibitor Janus Kinase (JAK) merupakan salah satu terapi baru vitiligo yang memiliki target lebih spesifik dengan efek langsung terhadap sitotoksisitas sel T CD8+ dan IFN-?.
Metode: Dalam penulisan artikel ini digunakan metode tinjauan pustaka dengan bersumber pada artikel relevan yang didapatkan melalui pencarian secara daring.
Hasil: Beberapa studi menunjukkan adanya repigmentasi pada area wajah meningkat antara 51-92%. Repigmentasi terjadi lebih baik pada area terpapar sinar matahari atau kombinasi fototerapi disebabkan karena repigmentasi pada lesi vitiligo membutuhkan supresi dari proses autoimun dan regenerasi melanosit.
Simpulan: Berbagai studi menunjukkan hasil terapi inhibitor JAK terhadap vitiligo sangat menjanjikan dan cukup aman. Terapi inhibitor JAK menunjukkan efektivitas lebih tinggi pada area wajah dan dengan kombinasi paparan ultraviolet.
Mikrobiota usus pada dermatitis atopik
Dewi Gotama, Made Wardhana, Adeline Santoso, Sissy SissyOnline First: Aug 31, 2021
- Abstract
Mikrobiota usus pada dermatitis atopik
Atopic dermatitis (AD) is a multifactorial disease caused by immune dysregulation, genetic susceptibility, environmental factors, and impaired barrier function. The health burden caused by this disease is significant and can impact psychological, social and financial costs, along with systemic comorbidities. Several studies have reported the gut microbiota in AD patients. Several studies have reported the gut microbiota in AD patients. The gut microbiota is thought to play an important role in the development of AD by regulating the immune system's maturation. Intestinal microbiota alteration affects the balance of the immune system through metabolites' production, which will cause the microenvironment to become inflamed. Currently, the close relationship between the gut microbiota and the development of the immune system, especially in maintaining the balance of Th-1 and Th-2 responses, is the rationale for providing probiotic supplements to prevent or treat allergic and atopic diseases.
Dermatitis atopik (DA) merupakan penyakit multifaktorial yang diakibatkan disregulasi imun, suseptibilitas genetik, faktor lingkungan, dan gangguan fungsi barier. Beban kesehatan yang diakibatkan penyakit ini bersifat signifikan dan dapat berdampak pada kerugian psikologis, sosial, dan finansial, disertai komorbiditas sistemik. Terdapat beberapa studi yang telah melaporkan mikrobiota usus pada pasien DA. Mikrobiota usus diduga memainkan peran penting dalam perkembangan DA dengan meregulasi maturasi sistem imun. Alterasi mikrobiota usus mempengaruhi keseimbangan sistem imun melalui produksi metabolit, yang akan menyebabkan lingkungan mikro mengalami inflamasi. Saat ini hubungan erat antara mikrobiota usus dan perkembangan sistem imun, khususnya dalam menjaga keseimbangan respon Th-1 dan Th-2 menjadi dasar pemikiran pemberian suplemen probiotik untuk mencegah atau mengatasi penyakit alergi dan atopi.
Terapi non bedah pada karsinoma sel basal
Adeline Santoso, I Gusti Ngurah Darmaputra, Dewi Gotama, Sissy SissyOnline First: Aug 31, 2021
- Abstract
Terapi non bedah pada karsinoma sel basal
Basal cell carcinoma accounts for approximately 75% of non-melanoma skin cancer and 25% of all diagnosed skin cancer in the United States. Epidemiological data show the incidence is increasing significantly by 3% -10% per year worldwide. Changes in life expectancy patterns are associated with an increase in this skin cancer, and the incidence is predicted to increase until 2040. Many factors must be considered in the choice of therapy for a patient, including the patient's general condition, the presence or absence of serious medical problems, the use of antiplatelet or anticoagulant medication. Conservative treatment of asymptomatic and low-risk lesions is recommended, as overly aggressive therapy may have a greater effect than the lesions themselves. Topical therapy and non-surgical therapy are currently quite effective as therapeutic options for low-risk basal cell carcinoma and high-risk basal cell carcinoma. They can be an option in conditions that are contraindicated for surgery.
Kasus keganasan karsinoma sel basal (KSB) mencakup sekitar 75% dari kasus kanker kulit non melanoma dan mencakup 25% dari semua kasus kanker yang didiagnosa di Amerika Serikat.Data epidemiologi menunjukkan insiden meningkat signifikan sebanyak 3%-10% per tahun di seluruh dunia. Perubahan pola usia harapan hidup berhubungan dengan peningkatan kanker kulit ini, dan di prediksi insiden akan terus meningkat sampai tahun 2040. Terdapat banyak faktor yang harus dipikirkan dalam pemilihan terapi pada pasien, antara lain keadaan umum pasien, ada atau tidaknya masalah medis serius, penggunaan obat anti platelet atau anti koagulan. Perawatan konservatif pada lesi asimptomatik dan beresiko rendah dianjurkan, dikarenakan terapi yang terlalu agresif mungkin akan memberikan efek yang lebih besar dibandingkan dengan lesi itu sendiri. Saat ini terapi topikal dan terapi non-bedah dikatakan cukup efektif sebagai pilihan terapi untuk KSB resiko rendah dan KSB resiko tinggi serta dapat menjadi pilihan pada kondisi kontraindikasi terhadap tindakan pembedahan.
Evaluasi penggunaan antibiotik profilaksis pada pasien bedah ortopedi di Rumah Sakit Bangil
Yolanda Virgi Firdaus, Abdul Kadir Jaelani, Fauna Herawati, Rika YuliaOnline First: Jun 1, 2021
- Abstract
Evaluasi penggunaan antibiotik profilaksis pada pasien bedah ortopedi di Rumah Sakit Bangil
Introduction: Trauma to the bones causes fractures and generally increases the risk of infection. To reduce the risk of infection, prophylactic therapy can be given before surgery. Previous studies have suggested that prophylactic antibiotics were irrational and can increase the incidence of antibiotic resistance. This study aims to determine the compatibility of antibiotics prescription for prophylactic fracture surgery based on hospital antibiotics (PPAB) and ASHP guidelines. In addition, this study also determined the quantity of prophylactic antibiotic used.
Methods: This was an observational study by taking data from patient medical records and data on antibiotic sales during the period January to November 2020 at Bangil Hospital retrospectively. The data were analyzed descriptively to determine the suitability of the six indicators of accuracy namely right indication, the right type, the right route, the right dose, the right time of administration and the right duration of administration. Antibiotics quantity analyzed quantitatively by using DDD/100 days patient method and DU 90%.
Results: A total of 83 samples were obtained by purposive sampling that met the criteria. The evaluation results of the appropriateness of prophylactic antibiotics based on the guidelines were the right type (28.92%), right indication (100%), right dose (55.42%), right route (100%), right duration of administration (66.27%) and right timing of administration (98.80%). Evaluation of the quantity concluded that the total value of DDD was 86.71 DDD/100 days of patients with the highest value on the use of Cefuroxime and Ceftriaxone.
Conclusion: The highest use of antibiotics focuses on the use of Cefuroxime and Ceftriaxone. The appropriateness of the use of prophylactic antibiotics in orthopedic surgery patients is the right indication, right route, and right time of administration based on PPAB and ASHP guidelines. The accuracy of the type, dose, and duration of administration still needs to be improved.
Pendahuluan: Trauma pada tulang menyebabkan keretakan tulang (patah tulang atau fraktur). Patofisiologi fraktur terbagi menjadi dua yaitu fraktur tertutup (closed fracture (CF)) dan fraktur terbuka (open fracture (OF)). Kondisi fraktur umumnya dapat memicu resiko infeksi. Untuk mengurangi risiko infeksi, dapat diberikan terapi profilaksis yang dilanjutkan dengan pembedahan. Penelitian terdahulu mencantumkan bahwa penggunaan antibiotik profilaksis digunakan secara irasional pada pasien bedah yang dapat meningkatkan kejadian resistensi antibiotik. Penelitian ini bertujuan untuk mengetahui kesesuaian PPAB dan guideline (ASHP) serta mengetahui kuantitas penggunaan antibiotik profilaksis menggunakan metode DDD/100 hari pasien.
Metode: Desain penelitian ini adalah observasional dengan pengambilan data dari rekam medis pasien dan data penjualan antibiotik selama periode Januari hingga November 2020 di Rumah Sakit Bangil secara retrospektif dan dianalisis secara deskriptif. Data dianalisis untuk mengetahui kesesuaian terhadap enam indikator ketepatan yaitu tepat indikasi, tepat jenis, tepat rute, tepat dosis, tepat lama pemberian dan tepat waktu pemberian. Data dianalisis secara kuantitatif dengan metode DDD/100 hari pasien dan DU 90%.
Hasil: Total diperoleh 83 sampel penelitian secara purposive sampling yang memenuhi kriteria inklusi. Hasil evaluasi terhadap kesesuaian antibiotik profilaksis berdasarkan PPAB RS Bangil dan pedoman ASHP adalah tepat jenis (28,92%), tepat indikasi (100%), tepat dosis (55,42%), tepat rute (100%), tepat lama pemberian (66,27%) dan tepat waktu pemberian (98,8%). Evaluasi kuantitas disimpulkan bahwa didapatkan total nilai DDD yaitu 86,71 DDD/100 hari pasien dengan nilai tertinggi pada penggunaan Sefuroksim dan Seftriakson.
Simpulan: Penggunaan antibiotik tertinggi terfokus pada sefuroksim dan seftriakson. Kesesuaian penggunaan antibiotik profilaksis pada pasien bedah ortopedi adalah tepat indikasi, tepat rute, dan tepat waktu pemberian berdasarkan PPAB dan pedoman ASHP. Ketepatan jenis, dosis, dan lama pemberian masih perlu ditingkatkan.
Faktor risiko kejadian berat bayi lahir rendah di RSUP Sanglah, Denpasar, Bali, Indonesia
I Gusti Ngurah Yuda Bagus Aryana, Komang Ayu Kartika Sari, Putu AryaniOnline First: Jun 22, 2021
- Abstract
Faktor risiko kejadian berat bayi lahir rendah di RSUP Sanglah, Denpasar, Bali, Indonesia
Introduction: Maternal and child health has become a primary health focus in Indonesia and the maternal and child mortality rate in Indonesia is higher than those in South-East Asia countries. The incidence of Low Birth Weight (LBW) contributes to more than 50% of all neonatal mortality of all births in Indonesia. Therefore, identification of the risk factors that contributes to the incidence of LBW is important.
Method: This retrospective case-control study involved 50 cases of LBW and 50 controls (baby with normal birth-weight), The data were analyzed using SPSS version 22.
Result: The results of multivariate analysis showed that the factors significantly associated with LBW incidence were maternal blood pressure (p=0.000), history of giving birth to LBW babies (p=0.000), and the mode of current labor (p=0.034). The maternal age, maternal education level, maternal occupation, maternal anemia, parity, history of smoking, history of alcohol consumption, history of abortion, parity distance, and maternal BMI had no significant association (p>0.005).
Conclusion: Thus, the incidence of LBW can be prevented through maternal blood control during the pregnancy. Careful history taking of past history of giving birth to LBW babies and the mode of delivery must be done to reduce the incidence of LBW.
Pendahuluan: Kesehatan ibu dan anak merupakan salah satu fokus utama kesehatan di Indonesia. Kasus kematian ibu dan anak di Indonesia lebih tinggi dibandingkan dengan negara-negara di Asia Tenggara. Kejadian bayi berat lahir rendah (BBLR) berkontribusi terhadap lebih dari 50% total kematian neonatal di seluruh kelahiran di Indonesia. Oleh karena itu, identifikasi faktor-faktor risiko yang mendasari kejadian BBLR menjadi penting untuk dilakukan.
Metode: Penelitian kasus kontrol retrospektif ini melibatkan 50 kasus (BBLR) dan 50 kontrol (bayi lahir dengan berat badan normal. Data yang diperoleh kemudian dianalisis menggunakan perangkat SPSS versi 22.
Hasil: Hasil analisis multivariat didapatkan faktor-faktor yang memiliki hubungan signifikan dengan kejadian BBLR adalah tekanan darah ibu (p=0,000), riwayat melahirkan bayi BBLR (p=0,000), dan tipe persalinan bayi saat ini (p=0,034). Sebaliknya, faktor usia ibu, tingkat pendidikan ibu, pekerjaan ibu, anemia pada ibu, jumlah paritas, riwayat merokok, riwayat konsumsi alkohol, riwayat abortus, jarak paritas, dan IMT ibu tidak memiliki hubungan yang signifikan (p>0,005).
Simpulan: Pencegahan kejadian BBLR dapat dilakukan dengan mengontrol tekanan darah ibu selama kehamilan. Penggalian riwayat melahirkan bayi BBLR sebelumnya dan pemilihan metode persalinan juga harus dilakukan dengan seksama untuk mengurangi kejadian BBLR.
Hubungan homosistein dan Mean Platelet Volume (MPV) terhadap skor modifikasi Gensini pada pasien Coronary Artery Disease (CAD) stabil
Made Kris Budiman, Bagus Ari Pradnyana Dwi Sutanegara, Anak Agung Wiradewi LestariOnline First: Jul 12, 2021
- Abstract
Hubungan homosistein dan Mean Platelet Volume (MPV) terhadap skor modifikasi Gensini pada pasien Coronary Artery Disease (CAD) stabil
Background: Stable Coronary Artery Disease (CAD) is one of Indonesia's most common cardiovascular diseases. One of the most influential risk factors of CAD is homocysteine and Mean Platelet Volume (MPV) levels. Research in Acute Coronary Syndrome (ACS) showed that the increase of homocysteine and MPV positively correlates with coronary artery stenosis showed by angiography. This study evaluates the relationship between MPV and homocysteine to the modified Gensini score in stable CAD.
Methods: This is a cross-sectional observational study conducted in Integrated Heart Service (IHS) Sanglah General Hospital, Bali, Indonesia. Homocysteine and MPV levels were measured and correlated with the Gensini score using the Pearson correlation test. Data were analyzed using SPSS version 20 for Windows and considered statistically significant if the p-value less than 0.05.
Results: The results showed that most of the patients were male (88.2%), non-obese (94.2%), comorbid hypertension (61.1%), taking statins (98.0%), Ejection Fraction (EF) >40% (84.3%), Glomerular Filtration Rate (GFR) > 60 ml/min/1.7 m2 (86.27%), MPV value < 9.4 (86.3%), and homocysteine levels < 15 (64.7%). There was no significant correlation between homocysteine (r = 0.071; p > 0.05) and MVP (r = 0.088; p > 0.05) on the Gensini score. Meanwhile, Pearson correlation analysis showed a significant negative correlation between serum creatinine levels and Gensini score (r = -0.383; p = 0.006) and also statistically significant in logistic regression analysis (p = 0.022).
Conclusion: The results of this study indicate that there is no significant correlation between the examination of homocysteine levels and MPV on the Gensini score in patients with stable CHD.
Latar Belakang: Penyakit Arteri Koroner (PJK) stabil merupakan salah satu penyakit kardiovaskular yang paling umum di Indonesia. Salah satu faktor risiko PJK yang paling berpengaruh adalah kadar homosistein dan Mean Platelet Volume (MPV). Penelitian pada Sindrom Koroner Akut (SKA) menunjukkan bahwa peningkatan kadar homosistein dan MPV berkorelasi positif dengan stenosis arteri koroner yang ditunjukkan oleh angiografi. Penelitian ini bertujuan untuk mengevaluasi hubungan antara MPV dan homosistein terhadap skor Gensini termodifikasi pada pasien dengan PJK stabil.
Metode: Studi observasional potong lintang dilakukan pada Pelayanan Jantung Terpadu (IHS) RSUP Sanglah, Bali, Indonesia. Kadar homosistein dan MPV diukur dan dikorelasikan dengan skor Gensini menggunakan uji korelasi Pearson. Data dianalisis menggunakan SPSS versi 20 untuk Windows dan dianggap bermakna secara statistik jika nilai p kurang dari 0,05.
Hasil: Hasil penelitian menunjukkan bahwa sebagian besar pasien berjenis kelamin laki-laki (88,2%), non-obese (94,2%), komorbid hipertensi (61,1%), mengonsumsi statin (98,0%), Ejection Fraction (EF) >40% (84,3%), Glomerular Filtration Rate (GFR) > 60 ml/min/1,7 m2 (86,27%), nilai MPV < 9,4 (86,3%), dan kadar homosistein < 15 (64,7%). Tidak ditemukan korelasi yang bermakna antara homosistein (r = 0,071; p > 0,05) dan MVP (r = 0,088; p > 0,05) terhadap skor Gensini. Sedangkan analisis korelasi Pearson menunjukkan korelasi negatif lemah bermakna antara kadar serum kreatinin dengan skor Gensini (r = -0,383; p = 0,006) dan juga bermakna secara statistik pada analisis regresi logistik (p=0,022).
Simpulan: Hasil penelitian ini menunjukkan bahwa bahwa tidak terdapat korelasi yang bermakna terhadap pemeriksaan kadar homosistein dan MPV terhadap skor Gensini pada pasien dengan PJK stabil.
Hubungan antara rasio neutrofil limfosit dengan derajat klinis COVID-19 pada pasien anak di RSUD Tarakan provinsi Kalimantan Utara
Daniel kurniawan Sintoro, Franky Sientoro, Dian ArtantiOnline First: Jul 12, 2021
- Abstract
Hubungan antara rasio neutrofil limfosit dengan derajat klinis COVID-19 pada pasien anak di RSUD Tarakan provinsi Kalimantan Utara
Introduction: Coronavirus Disease-19 (COVID-19) is an outbreak that spread in early 2020 caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), this disease has a wide spectrum of symptoms from asymptomatic to severe respiratory symptoms. Neutrophil-lymphocyte ratio (NLR) is widely used as a marker of inflammation against viral infections, including SARS-CoV-2. This study was conducted to determine the relationship between NLR and the clinical degree of COVID-19 in pediatric patients at the Tarakan General Hospital in North Kalimantan Province.
Methods: A cross-sectional study was conducted on pediatric patients with COVID-19 infection who were treated in the COVID-19 isolation room at Tarakan Hospital, North Kalimantan for the period March 2020 – February 2021. There were 32 children who met the inclusion and exclusion criteria. Data on age, sex, body weight, neutrophil and lymphocyte counts, as well as the clinical degree of COVID-19 were collected from medical records. The NLR data was then categorized to NLR >3.13 or NLR <3.13 and searched for the relationship with the clinical degree of COVID-19. Spearman correlation test was used for bivariate analysis.
Results: The clinical degree of mild COVID-19 was found in 21 children (65.62%). NLR values in mild clinical grade were mostly increased (46.87%) than than which did not increase (21.87%). All children with moderate clinical COVID-19 infection had RNL > 3.13 (18.74%). In asymptomatic infection, no children having an increase in RNL (12.5%). The Spearman correlation test between NLR and the clinical degree of COVID-19 resulted in a correlation coefficient (r) = 0.758 (p < 0.001).
Conclusion: There is a strong relationship between the Neutrophil-Lymphocyte ratio and the clinical degree of COVID-19 in pediatric patients at Tarakan Hospital, North Kalimantan Province.
Pendahuluan: Coronavirus Disease-19 (COVID-19) adalah wabah yang menyebar pada awal 2020 disebabkan oleh virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), penyakit ini memiliki spektrum gejala yang luas dari asimptomatis hingga gejala respiratori yang berat. Rasio neutrofil-limfosit (RNL) banyak digunakan sebagai penanda inflamasi terhadap infeksi virus, termasuk SARS-CoV-2. Penelitian ini dilakukan untuk mengetahui besar hubungan antara RNL dengan derajat klinis COVID-19 pada pasien anak di Rumah Sakit Umum Daerah (RSUD) Tarakan Provinsi Kalimantan Utara.
Metode: Studi potong lintang dilakukan pada pasien anak dengan infeksi COVID-19 yang dirawat di ruang isolasi COVID-19 RSUD Tarakan Kalimantan Utara periode Maret 2020 – Febuari 2021. Terdapat 32 anak yang memenuhi kriteria inklusi dan eksklusi. Data mengenai usia, jenis kelamin, berat badan, jumlah hitung neutrofil dan limfosit, serta derajat klinis COVID-19 dikumpulkan dari rekam medis. Data RNL kemudian dikategorikan berdasarkan adanya peningkatan >3,13 atau tidak adanya peningkatan <3,13 dan dicari hubungan dengan derajat klinis COVID-19. Uji korelasi Spearman digunakan untuk analisis bivariat.
Hasil: Derajat klinis COVID-19 ringan ditemukan pada 21 anak (65,62%). Nilai RNL pada derajat klinis ringan sebagian besar meningkat (46,87%) daripada pada derajat klinis ringan dengan RNL yang tidak meningkat (21,87%). Semua anak yang mengalami infeksi COVID-19 dengan derajat klinis sedang memiliki RNL >3,13 (18,74%). Hal ini berbanding terbalik dengan derajat klinis asimtomatik, dengan semua anak tidak mengalami peningkatan RNL (12,5%). Uji korelasi Spearman antara RNL dengan derajat klinis COVID-19 menghasilkan koefisien korelasi (r) = 0,758 (p< 0,001).
Kesimpulan: Terdapat hubungan kuat antara rasio Neutrofil-Limfosit dengan derajat klinis COVID-19 pada pasien anak di RSUD Tarakan Provinsi Kalimantan Utara.
Effectivity of glutathione and curcumin in hepatic fibrosis induced by cholestasis in Wistar rats
Rodijaya Putra, Adeodatus Yuda Handaya, Agus BarmawiOnline First: Jul 15, 2021
- Abstract
Effectivity of glutathione and curcumin in hepatic fibrosis induced by cholestasis in Wistar rats
Background: Cholestasis occurs from the accumulation of bile product in the biliary tract due to obstruction of the hepatobiliary tract. Without early interventions, this condition will be continuing as chronic hepatic injury and form hepatic fibrosis, ending in cirrhosis. Glutathione (GSH) and curcumin were known as antioxidants and anti-inflammatory used as a therapeutic agent for the treatment of hepatopathy. This study aims to determine the effectivity of GSH and curcumin in the hepatic fibrosis mechanism induced by cholestasis.
Methods: This is an experimental study using Wistar rats. They are divided into three groups of 5 rats each. All the rats regard the choledochus duct ligation surgery, rats without intervention define as first group (control), other rats treated with GSH as the second group and the third group consist of rats treated with curcumin. Data were analyzed using SPSS version 17 for Windows.
Results: There was liver injury and hepatic fibrosis induced by cholestasis from this study. This condition was significantly lower in groups treated with GSH and curcumin (p<0.05). Therefore, there was a different result between GSH and curcumin in reducing the process of liver injury and hepatic fibrosis, but the difference was not statistically significant (p>0.05).
Conclusion: GSH and curcumin were statistically effective in reducing liver injury and hepatic fibrosis induced by cholestasis. Despite, there were no significant difference results between them in reducing liver injury and hepatic fibrosis.
Gambaran anemia pada kehamilan trimester III di bagian obstetri dan ginekologi RSUD Waikabubak, Nusa Tenggara Timur periode 2019–2020
Edwin Aryanto, Andre Dominggus Sugiarto, Putu Heri Darmawan, Ni Putu Yuni Anggreni PandeOnline First: Jul 15, 2021
- Abstract
Gambaran anemia pada kehamilan trimester III di bagian obstetri dan ginekologi RSUD Waikabubak, Nusa Tenggara Timur periode 2019–2020
Background: Anemia is still a global public health problem. It is estimated that one third of women of childbearing age suffer from anemia and more than 40% of pregnant women suffer from anemia worldwide. Anemia in pregnancy can cause complications that affect both the mother and the fetus. This study aims to determine the description of anemia in the third trimester of pregnancy in the Obstetrics-Gynecology section of the Waikabubak Hospital during the 2019-2020 period.
Methods: A descriptive cross-sectional study on 355 pregnant women in the third trimester with anemia was conducted in the Obstetrics and Gynecology Section of Waikabubak Hospital for the period 1 July 2019 – 30 June 2020, who met the inclusion and exclusion criteria. Data were taken from the patient's medical record such as maternal age, gestational age, hemoglobin (Hb) level, erythrocyte index and pregnancy outcome. Data were analyzed with SPSS version 25 for Windows.
Results: The results of the examination of hemoglobin (Hb) levels showed that 49.58% of pregnant women in the third trimester at Waikabubak Hospital suffered from anemia. Based on the majority of respondents aged 20-35 years (76.62%), term (72.96%), moderate anemia (54.37%), microcytic hypochromic anemia (63.10%), and had an Appropriate for gestational Age (AGA) (83.98%) in pregnancy outcomes.
Conclusion: The third trimester pregnant women with anemia in Waikabubak Hospital mostly suffered at the age of 20-35 years, at term gestational age, with moderate degree of anemia, the most common type was microcytic hypochromic and with AGA pregnancy outcomes.
Latar Belakang: Anemia masih menjadi masalah kesehatan masyarakat global. Diperkirakan sepertiga wanita usia subur menderita anemia dan lebih dari 40% ibu hamil menderita anemia diseluruh dunia. Anemia dalam kehamilan dapat menyebabkan komplikasi yang berdampak pada ibu maupun janin. Penelitian ini bertujuan untuk mengetahui gambaran anemia pada kehamilan trimester III di bagian Obstetri–Ginekologi RSUD Waikabubak selama periode 2019-2020.
Metode: Penelitian deskriptif potong lintang pada 355 ibu hamil trimester III dengan anemia dilakukan pada Bagian Obstetri – Ginekologi RSUD Waikabubak periode 1 Juli 2019 – 30 Juni 2020, yang memenuhi kriteria inklusi dan eksklusi. Data yang diambil dari rekam medis pasien adalah usia ibu, usia kehamilan, kadar hemoglobin (Hb), indeks eritrosit dan luaran kehamilan. Data dianalisis dengan SPSS versi 25 untuk Windows.
Hasil: Hasil pemeriksaan kadar hemoglobin (Hb) didapatkan 49,58% ibu hamil trimester III di RSUD Waikabubak menderita anemia. Berdasarkan usia, sebagian besar responden berusia 20-35 tahun (76,62%), aterm (72,96%), anemia sedang (54,37%), anemia hipokrom mikrositer (63,10%), dan memiliki luaran kehamilan Sedang Masa Kehamilan (SMK) (83,98%).
Simpulan: Ibu hamil trimester III dengan anemia di RSUD Waikabubak paling banyak diderita pada usia 20–35 tahun, pada usia kehamilan aterm, dengan derajat anemia sedang, tipe tersering hipokrom mikrositer dan dengan luaran kehamilan SMK.
Faktor-faktor yang berhubungan dengan kematian neonatus di RSUD Sanjiwani Gianyar
Ni Kadek Risa Astria, Made Ayu Cynthia WindasariOnline First: Jul 16, 2021
- Abstract
Faktor-faktor yang berhubungan dengan kematian neonatus di RSUD Sanjiwani Gianyar
Introduction: World Health Organization (WHO) data in 2019 estimated around 2.4 million neonates died at the age of 1 month of life worldwide. Indonesia ranked the seventh position out of 10 countries in terms of the highest neonatal mortality rate, which was around 60,000 neonatal deaths in 2019. Among the leading causes of neonatal mortality are asphyxia, low birth weight (LBW) infants, preterm gestational age, neonatal sepsis and parity. This study aimed to determine the factors associated with neonatal mortality in Sanjiwani Hospital, Gianyar.
Methods: This study was a cross-sectional analytic study. The data were obtained from secondary data. The sampling technique was consecutive sampling with a total sample of 104 neonates who met the inclusion and exclusion criteria of the study. The dependent variable was neonatal mortality, while the independent variables were asphyxia, low birth weight, preterm gestational age, neonatal sepsis, and parity. The data were analysed with the chi-square test on SPSS version 26. The relationship between variables was determined to be significant if the p value <0.05 with a 95% confidence interval (CI).
Results: Risk factors associated with neonatal mortality included asphyxia (p=0.0001; RP=15.47; 95% CI: 5.93-40.39), preterm gestational age (p=0.0001; RP=5.00; 95% CI: 2.15-11.59), LBW (p=0.0001; RP=8.20; 95% CI: 3.39-19.79), and neonatal sepsis (p=0.005; RP=3.23; 95% CI: 1.42-7.33). Meanwhile, parity was found not to be significantly associated with neonatal mortality (p=0.551; RP=1.28; 95% CI: 0.58-2.84).
Conclusion: There is a significant relationship between asphyxia, preterm gestational age, low birth weight and neonatal sepsis with neonatal mortality in Sanjiwani Hospital, Gianyar.
Latar Belakang: Berdasarkan data dari World Health Organization (WHO), pada tahun 2019 diperkirakan sekitar 2,4 juta bayi meninggal pada usia 1 bulan kehidupannya di seluruh dunia. Indonesia menduduki posisi ketujuh dari 10 negara dengan angka kematian neonatus tertinggi yaitu sekitar 60.000 kematian neonatus pada tahun 2019. Faktor-faktor yang dapat mempengaruhi kematian neonatus seperti asfiksia, bayi dengan berat lahir rendah (BBLR), usia kehamilan preterm, sepsis neonatorum dan jumlah paritas. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kematian neonatus di RSUD Sanjiwani Gianyar.
Metode: Penelitian ini menggunakan metode analitik dengan desain cross-sectional. Data penelitian diperoleh dari data sekunder. Teknik pengambilan sampel berupa consecutive sampling dengan jumlah sampel yang terlibat sebanyak 104 neonatus yang memenuhi kriteria inklusi dan eksklusi penelitian. Variabel terikat penelitian adalah kematian neonatus, sementara variabel bebas berupa asfiksia, BBLR, usia kehamilan preterm, sepsis neonatorum, dan jumlah paritas. Data dianalisis dengan menggunakan uji chi-square pada SPSS versi 26. Hubungan antar variabel dinyatakan bermakna secara signifikan jika nilai p<0,05 dengan interval kepercayaan (IK) 95%.
Hasil: Faktor risiko yang berhubungan dengan kematian neonatus meliputi asfiksia (p=0,0001; RP=15,47; 95% IK: 5,93 - 40,39), usia kehamilan preterm (p=0,0001; RP=5,00; 95% IK: 2,15-11,59), BBLR (p=0,0001; RP=8,20; 95% IK: 3,39-19,79), dan sepsis neonatorum (p=0,005; RP=3,23; 95% IK: 1,42-7,33). Sementara jumlah paritas ditemukan tidak berhubungan secara signifikan dengan kematian neonatus (p=0,551; RP=1,28; 95% IK: 0,58-2,84).
Simpulan: Terdapat hubungan yang bermakna antara asfiksia, usia kehamilan preterm, BBLR dan sepsis neonatorum dengan kematian neonatus di RSUD Sanjiwani Gianyar.
Kesesuaian pewarnaan gram dengan kultur darah sebagai prediktor nilai kritis kasus bakteremia di Rumah Sakit Umum Pusat Sanglah, Denpasar
Putu Yoska Arya Harindana, Ida Sri Iswari, Indramawan Setyojatmiko, Ni Nengah Dwi FatmawatiOnline First: Jul 17, 2021
- Abstract
Kesesuaian pewarnaan gram dengan kultur darah sebagai prediktor nilai kritis kasus bakteremia di Rumah Sakit Umum Pusat Sanglah, Denpasar
Background: One of the considerations for giving empiric antibiotics in bacteremia cases is gram staining (GS) results. Accurate and fast results are required in distinguishing infection-caused bacteria. However, the data on how much the corresponding gram stain results with bacterial growth in blood cultures are still insufficient.
Aim: The study aims to compare Gram stain results with bacterial growth in positive blood cultures.
Methods: A cross-sectional analytic study obtained data from the VITEK® 2 Compact (bioMérieux) results for six months (January - June 2020). Data involved all blood cultures examined as many as 509.
Results: Of the 509 blood samples, 46 were reported as critical values for bacteremia. Gram-negative bacillus bacteria were identified in 39.13% of the gram staining (GS) and 45.65% of the blood culture (BC) samples. Gram-positive bacteria appeared in 56.52% of GS and 52.17% of BC. MBRO (multidrug-resistant organisms) bacteria were identified in the proportion of 11%, then 13% from ESBL (extended-spectrum beta-lactamase) bacteria, and they remain as 4% MRSA (methicillin-resistant Staphylococcus aureus) bacteria. The higher result, 76% of the data was confirmed from the non-ICU patients.
Conclusion: GS can be used as a reference for empiric antibiotic therapy due to its effectiveness, and it has a high degree of similarity with positive blood culture results.
Latar belakang: Salah satu pertimbangan pemberian antibiotika empiris pada kasus bakteremia adalah berdasarkan hasil pewarnaan gram. Dibutuhkan hasil yang akurat dan cepat dalam membedakan bakteri penyebab infeksi. Namun sedikit data tentang berapa besar kesesuaian hasil pewarnaan gram dengan pertumbuhan bakteri pada kultur darah. Untuk membandingkan hasil pewarnaan gram dengan pertumbuhan bakteri pada kultur darah yang positif.
Metode: Penelitian ini merupakan penelitian analitik cross-sectional. Data diperoleh dari hasil VITEK® 2 Compact (bioMérieux) selama enam bulan (Januari – Juni 2020). Sampel penelitian adalah semua kultur darah yang diperiksa pada periode penelitian berjumlah 509.
Hasil: Dari 509 sampel spesimen darah, 46 sampel dilaporkan sebagai nilai kritis prediktor bakteremia. Bakteri batang gram negatif teridentifikasi pada 39,13% sampel pewarnaan gram dan 45,65% sampel hasil kultur darah. Bakteri gram positif muncul pada 56,52% sampel pewarnaan gram dan 52,17% sampel hasil kultur darah. Bakteri MDRO (multidrug resistant organisms) teridentifikasi sebanyak 11%, 13% bakteri ESBL (extended spectrum beta lactamase), dan 4% bakteri MRSA (methicillin-resistant Staphylococcus aureus). Proporsi 76% sampel berasal dari pasien non-ICU.
Simpulan: Hasil pewarnaan gram dapat digunakan sebagai acuan terapi antibiotika empiris karena memiliki tingkat kesesuaian yang tinggi dengan hasil kultur darah positif.
Cast immobilization and addition of platelet rich plasma in intraarticular distal radius fracture resulting a better functional outcome to the internal fixation and radius union scorings system
Komang Indra Teguh Wisesa, I Ketut Siki Kawiyana, I Ketut SuyasaOnline First: Jul 23, 2021
- Abstract
Cast immobilization and addition of platelet rich plasma in intraarticular distal radius fracture resulting a better functional outcome to the internal fixation and radius union scorings system
Introduction: Intra-articular distal radius fracture is one of the most frequent injuries, especially in adults (20%). In this condition, anatomic reduction is required to reduce the possibility of complications, either with internal plate screw fixation (ORIF-PS) or conservatives such as the use of casting. Giving Platelet Rich Plasma (PRP) as one of the biologic agents to conservative management is expected to improve the outcome and become a promising alternative therapy.
Methods: This study was an experimental study with a post-test control only group design on patients with intra-articular radius fractures at Sanglah General Hospital Denpasar during the period September 2019 to March 2020. The samples were selected by random sampling. Evaluation of the functional outcomes of the therapy given through DASH and RUSS scores was evaluated twice, namely at week 6 and week 12 post-therapy. Descriptive data analysis, General Linear Model (GLM) test and post hoc test were also carried out.
Results: There were 45 patients divided into 3 groups; the first group of a plaster cast therapy and PRP injection, the second group of only plaster cast and the third group of ORIF. The first group showed better in DASH scores than the second group but not better than the third group, both at week 6 and 12. The results of the GLM and post hoc analysis also showed that the first group showed better RUSS scores than the second group.
Conclusion: The addition of PRP has a better result than conservative therapy without PRP but ORIF still was the best therapy.
Pengaruh lama paparan trauma listrik terhadap sistem saraf traktus gastrointestinal pada tikus Wistar galur murni
Slamet Rahardja, Adeodatus Yuda Handaya, Agus BarmawiOnline First: Jul 30, 2021
- Abstract
Pengaruh lama paparan trauma listrik terhadap sistem saraf traktus gastrointestinal pada tikus Wistar galur murni
Background: Electrical trauma can cause injury to the body tissues it passes through, causing death. The injury is part of the process of cell damage, including the digestive organs. This study aims to determine the effect of the duration of electrical trauma on the nervous system of the gastrointestinal tract histopathologically.
Methods: This study was experimental with the research subjects were 24 pure strain Wistar rats, which were divided into 4 groups. The first group is the control group (K) without treatment. Then, group (X) was exposed to electricity for 15 seconds, group (Y) was given exposure for 30 seconds, and group (Z) was exposed to 60 seconds. From the preparations, the number of nerve cells was counted. Data were analyzed with SPSS version 20 for Windows.
Results: There was a significant effect on the duration of electrical trauma on the number of the gastrointestinal tract nervous system histopathologically (p<0.05). In the control group (K), the number of nerve cells for the stomach was 91.33±0.60, followed by the ileum (89.50±07.09), and colon (94.33±6.18). In group (X), the number of nerve cells in the stomach was 79.50±11.823, followed by the ileum (62.00±15.31), and colon (78.83±5.04). In group (Y), the number of nerve cells for gastric was 45.33±7.66, followed by ileum (34.00±16.27), and colon (47.17±9.56). Meanwhile, in the group (Z), the number of nerve cells for the stomach was 2.40±0.55, followed by the ileum (1.40±1.52), and colon (1.80±1.10). Thus, there was a significant difference between the study groups (p<0.001).
Conclusion: The duration of electrical trauma significantly affects the number of the gastrointestinal tract nervous system histopathologically.
Latar Belakang: Trauma listrik dapat menimbulkan perlukaan pada jaringan tubuh yang dilewatinya hingga menyebabkan kematian. Perlukaan tersebut merupakan bagian dari proses kerusakan sel, termasuk pada organ digestif. Penelitian ini bertujuan untuk mengetahui pengaruh lama paparan trauma listrik terhadap sistem saraf traktus gastrointestinal secara histopatologi.
Metode: Penelitian ini bersifat eksperimental dengan subyek penelitian adalah 24 ekor tikus Wistar galur murni, yang terbagi dalam 4 kelompok. Kelompok pertama merupakan kelompok kontrol (K) tanpa perlakuan. Kelompok (X) diberi paparan listrik selama 15 detik, kelompok (Y) diberi paparan selama 30 detik, dan kelompok (Z) diberi paparan selama 60 detik. Dari preparat, dilakukan penghitungan terhadap jumlah sel saraf. Data dianalisis dengan SPSS versi 20 untuk Windows.
Hasil: Terdapat pengaruh yang bermakna pada lama trauma listrik terhadap jumlah sistem saraf traktus gastrointestinal secara histopatologis (p<0,05). Pada kelompok kontrol (K), jumlah sel saraf untuk gaster adalah 91,33±0,60, diikuti dengan ileum (89,50±07,09), dan kolon (94,33±6,18). Pada kelompok (X), jumlah sel saraf pada gaster adalah 79,50±11,823, diikuti dengan ileum (62,00±15,31), dan kolon (78.83±5.04). Pada kelompok (Y), jumlah sel saraf untuk gaster adalah 45,33±7,66, diikuti dengan ileum (34,00±16,27), dan kolon (47,17±9,56). Sedangkan pada kelompok (Z), jumlah sel saraf untuk gaster adalah 2,40±0,55, diikuti dengan ileum (1,40±1,52), dan kolon (1,80±1,10). Didapatkan perbedaan bermakna antara kelompok penelitian (p<0,001).
Kesimpulan: Lama trauma listrik memiliki pengaruh secara bermakna terhadap jumlah sistem saraf traktus gastrointestinal secara histopatologi.
Efek pemberian propolis pada fungsi ginjal dan hepar tikus putih (Rattus Norvegicus) yang diinduksi cisplatin
Novriantika Lestari, Fajrianti Haniyah, Annisa Puspa Sari, Liya Agustin Umar, Elvira YunitaOnline First: Jul 30, 2021
- Abstract
Efek pemberian propolis pada fungsi ginjal dan hepar tikus putih (Rattus Norvegicus) yang diinduksi cisplatin
Background: Cisplatin as an anticancer drug results in nephrotoxicity and hepatotoxicity. Accumulation of cisplatin in the body will produce reactive compounds in the form of free radicals which induce oxidative stress that affects kidney and liver functions. Propolis contains flavonoids, phenolic acid, and Caffeic Acid Phenethyl Ester (CAPE) which have the ability to prevent free radical formation and improve kidney and liver function. This study aims to determine the effect of propolis administration to ameliorate of BUN, creatinine, ALT and AST levels in cisplatin-induced rats (Rattus norvegicus).
Methods: The experimental study was conducted with the pre-post-test with control group design approach. The research sample used 30 white rats which were divided into normal (aquadest), Cisplatin (5mg/kg i.p), and cisplatin+propolis groups. Propolis was given at a dose of 50mg/kg, 100mg/kg and 200mg/kg orally for seven days, four days after cisplatin induction. Rat blood was taken for analysis of Bloof Urea Nitrogen (BUN), Creatinine, ALT, and AST levels. Data were analyzed using SPSS version 26 for Windows.
Results: The results showed that there were significant differences in levels of BUN, Creatinine, ALT and AST between groups (p<0.05). Propolis treatment at doses of 50 mg/kg, 100mg/kg and 200mg/kg can reduce levels of BUN/urea, creatinine, ALT, and AST in rats that have been induced by cisplatin significantly (p<0,05).
Conclusion: Propolis has a therapeutic effect on cisplatin drug-induced nephrotoxicity and hepatotoxicity by affecting the BUN, creatinine, ALT, and AST levels in rats.
Latar Belakang: Penggunaan cisplatin sebagai obat antikanker menghasilkan efek nefrotoksisitas dan hepatotoksisitas imbas obat. Akumulasi cisplatin di dalam tubuh akan menghasilkan senyawa reaktif berupa radikal bebas yang menginduksi terjadinya stress oksidatif sehingga akan berpengaruh ke fungsi ginjal dan hepar. Propolis mengandung flavonoid, asam fenolat, dan Caffeic Acid Phenethyl Ester (CAPE) yang memiliki kemampuan mencegah pembentukan radikal bebas dan memperbaiki fungsi ginjal dan hepar. Penelitian ini bertujuan untuk mengetahui pengaruh pemberian propolis terhadap pemulihan kadar ureum, kreatinin, ALT dan AST darah pada tikus putih (Rattus norvegicus) yang telah diinduksi cisplatin.
Metode: Penelitian eksperimental ini dilakukan dengan pendekatan pre-post-test with control group design. Sampel penelitian menggunakan 30 ekor tikus putih yang dibagi menjadi kelompok normal (aquadest), Cisplatin (5mg/kgbb i.p) dan kelompok cisplatin+propolis. Propolis diberikan dengan dosis 50mg/kgbb, 100mg/kgbb dan 200mg/kgbb secara oral selama tujuh hari, empat hari setelah induksi cisplatin. Darah tikus diambil untuk analisis kadar Blood Urea Nitrogen (BUN), Kreatinin, ALT, dan AST. Data dianalisis dengan SPSS versi 26 untuk Windows.
Hasil: Hasil penelitian menunjukkan terdapat perbedaan kadar BUN, Kreatinin, ALT, dan AST yang bermakna antar kelompok (p<0,05). Pemberian propolis dengan dosis 50 mg/kgBB, 100 mg/kgBB dan 200 mg/kgBB dapat menurunkan kadar BUN/ureum, kreatinin, ALT, dan AST pada tikus yang telah diinduksi cisplatin secara bermakna (p<0,05).
Kesimpulan: Propolis memiliki efek terapi pada nefrotoksisitas dan hepatotoksisitas akibat obat cisplatin dengan mempengaruhi kadar BUN/ureum, kreatinin, ALT, dan AST pada tikus.
Hubungan antara ekspresi c-MET dengan derajat diferensiasi histologi dan tingkat kedalaman invasi pada infiltrating urothelial carcinoma kandung kemih di RSUP Sanglah, Bali, Indonesia
Kadek Agus Suhardinatha Putra, I Gusti Ayu Sri Mahendra Dewi, Herman Saputra, Ni Wayan Winarti, Anak Agung Ayu Ngurah Susraini, Ni Putu Ekawati, I Made MuliartaOnline First: Jul 31, 2021
- Abstract
Hubungan antara ekspresi c-MET dengan derajat diferensiasi histologi dan tingkat kedalaman invasi pada infiltrating urothelial carcinoma kandung kemih di RSUP Sanglah, Bali, Indonesia
Background: c-MET is a tyrosine kinase receptor that binds specifically to its ligand, namely hepatocyte growth factor (HGF). c-MET signaling deviations play a role in the progressivity of a wide variety of malignancies including bladder cancer. This study aims to determine the relationship between c-MET expression with the histological differentiation and depth of invasion in infiltrating urothelial carcinoma of bladder.
Methods: This study was a cross-sectional analytical study with 42 sample sizes. The samples were taken from a paraffin block of patients with infiltrating urothelial carcinoma of the bladder, that has performed resection and histopathological examination who were examined at the Anatomical Pathology Laboratory of Sanglah Hospital Denpasar from 2015-2020. The c-MET expression was examined by immunohistochemical staining of c-MET and evaluated using the H-score method. Data were analyzed using SPSS version 20 for Windows.
Results: Fisher's Exact test showed a statistically significant association between c-MET expression and the histological differentiation grade (p = 0.000). There was also a significant association between c-MET expression and depth of invasion with the Chi-Square test (p = 0.016), the Prevalence Ratio (PR) was 2.0 (95% CI = 1.2-3.6).
Conclusion: In conclusion, there is an association between c-MET expression with the histological differentiation grade and depth of invasion in the infiltrating urothelial carcinoma of bladder. High c-MET expression had twice the risk of developing advanced invasion.
Latar Belakang: c-MET merupakan reseptor tirosin kinase yang berikatan secara spesifik dengan ligannya, yaitu faktor pertumbuhan hepatosit (HGF). Penyimpangan c-MET signaling diketahui berperan dalam agresivitas berbagai macam keganasan termasuk kanker kandung kemih. Penelitian ini bertujuan untuk mengetahui hubungan antara ekspresi c-MET dengan derajat diferensiasi histologi dan tingkat kedalaman invasi pada infiltrating urothelial carcinoma kandung kemih.
Metode: Penelitian ini merupakan studi analitik potong lintang dengan besar sampel adalah 42, yang berasal dari blok parafin penderita infiltrating urothelial carcinoma kandung kemih yang diperiksa histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah Denpasar dari 2015-2020. Ekspresi c-MET diperiksa dengan pengecatan imunohistokimia c-MET dan dievaluasi menggunakan metode H-score. Data dianalisis dengan SPSS versi 20 untuk Windows.
Hasil: Uji Fisher’s Exact menunjukkan hubungan yang bermakna secara statistik antara ekspresi c-MET dengan derajat diferensiasi histologi (p=0,000). Didapatkan juga hubungan yang bermakna antara ekspresi c-MET dengan tingkat kedalaman invasi dengan uji Chi-Square (p=0,016), prevalence ratio 2,0 (IK 95%=1,2-3,6).
Kesimpulan: Sebagai simpulan terdapat hubungan antara ekspresi c-MET dengan derajat diferensiasi histologi dan tingkat kedalaman invasi pada infiltrating urothelial carcinoma kandung kemih. Ekspresi c-MET tinggi memiliki risiko dua kali lebih besar mengalami invasi lanjut. c-MET diharapkan dapat menjadi faktor prognostik yang bermanfaat dalam penatalaksanaan infiltrating urothelial carcinoma kandung kemih.
Hubungan antara ekspresi BRAF V600E dengan metastasis dan derajat diferensiasi pada adenokarsinoma kolorektal
Ni Kadek Ayu Maya Damayanti, Ni Wayan Winarti, Ni Putu Sriwidyani, Luh Putu Iin Indrayani Maker, Herman Saputra, I Made MuliartaOnline First: Aug 2, 2021
- Abstract
Hubungan antara ekspresi BRAF V600E dengan metastasis dan derajat diferensiasi pada adenokarsinoma kolorektal
Background: Colorectal carcinoma is a malignant epithelial tumor of the large bowel that occurs due to extrinsic and intrinsic factors. BRAF V600E gene mutation was found in about 10-15% of colorectal carcinoma. This mutation was associated with aggressive biologic behaviors, metastasis and lesser responsiveness to EGFR inhibitors therapy. This study aims to determine the association between BRAF V600E expression with metastasis and the degree of differentiation of colorectal adenocarcinoma.
Methods: This cross sectional study involved 43 samples of adenocarcinoma colorectal patients who had histopathological examinations in the period 2018-2019. Immunohistochemical were performed to assess the expression of BRAF V600E. This expression was concluded positively if 75% or more tumor cells showed intense cytoplasmic staining. Data were analyzed using SPSS version 20 for Windows.
Results: Within 43 colorectal adenocarcinoma cases, it was found 7 cases (16.3%) had a positive expression of BRAF V600E. This expression was found in metastasis cases (7/25), not found in cases without metastasis (0/18). There was an association between BRAF V600E expression and metastasis (p=0.014). The positive expressions of BRAF V600E were only found in low-grade differentiation (7/35 cases), were not found in high-grade differentiation (0/8 cases), and no association between BRAF V600E mutation and the degree of differentiation (p=0.167).
Conclusion: There was an association between BRAF V600E expression and metastasis of colorectal adenocarcinoma. There was no significant association between BRAF V600E expression and the degree of differentiation of colorectal adenocarcinoma.
Latar Belakang: Karsinoma kolorektal merupakan suatu tumor ganas epitelial usus besar yang terjadi akibat pengaruh dari faktor ekstrinsik dan intrinsik. Mutasi gen BRAF V600E ditemukan pada sekitar 10-15% kasus karsinoma kolorektal. Mutasi ini berkaitan dengan perilaku biologik agresif, metastasis, serta kurangnya respon terhadap terapi dengan inhibitor EGFR. Penelitian ini bertujuan untuk mengetahui adanya hubungan antara ekspresi BRAF V600E dengan metastasis dan derajat diferensiasi adenokarsinoma kolorektal.
Metode: Penelitian menggunakan rancangan analitik potong lintang dengan 43 sampel penderita adenokarsinoma kolorektal yang telah dilakukan pemeriksaan histopatologi pada periode tahun 2018-2019. Pulasan imunohistokimia dikerjakan untuk menilai ekspresi BRAF V600E. Ekspresi BRAF V600E dinyatakan positif jika 75% atau lebih sel tumor mununjukkan pulasan sitoplasma dengan intensitas kuat. Data dianalisis dengan SPSS versi 20 untuk Windows.
Hasil: Dari 43 kasus, ditemukan 7 kasus (16,3%) dengan ekspresi BRAF V600E positif. Ekspresi ini hanya dijumpai pada kasus dengan metastasis (7 dari 25 kasus), tidak dijumpai pada kasus tanpa metastasis (0 dari 18 kasus). Didapatkan hubungan bermakna antara ekspresi BRAF V600E dengan metastasis (p=0,014). Ekspresi BRAF V600E positif hanya ditemukan pada kasus derajat diferensiasi rendah (7 dari 35 kasus), tidak ditemukan pada derajat tinggi (0 dari 8 kasus), dan hubungan tersebut tidak bermakna secara statistik (p=0,167).
Kesimpulan: Terdapat hubungan antara ekspresi BRAF V600E dengan metastasis pada adenokarsinoma kolorektal. Tidak terdapat hubungan antara ekspresi BRAF V600E dengan derajat diferensiasi pada adenokarsinoma kolorektal.
Nilai rasio neutrofil-limfosit sebagai prediktor kasus COVID-19 serangan berat pada pasien dewasa
I Gusti Agung Ayu Sri Pramita Pramana, Putu Utamia Suma Masyuni, I Dewa Putu SurawanOnline First: Aug 6, 2021
- Abstract
Nilai rasio neutrofil-limfosit sebagai prediktor kasus COVID-19 serangan berat pada pasien dewasa
Background: The pandemic condition that has been experienced since 2020 due to Coronavirus Disease (COVID-19) is still a national and international problem that needs full attention with number of cases continues to grow over time. Most cases of COVID-19 are cases with mild clinical manifestation, but some of these mild cases might then worsen in a matter of days due to the widespread inflammatory process that occurs due to viral infection. The use of Neutrophil-Lymphocyte Ratio (NLR) values in general has been known for its function as a biomarker of systemic inflammatory status. Therefore, this study is expected to be able to predict the incidence of severe COVID-19 in adult patients in BRSUD Tabanan, Bali.
Methods: The study was conducted using secondary data from 137 adult COVID-19 patients at BRSUD Tabanan in June – December 2020. The sampling method used was consecutive sampling of all adult patients aged 18 years who had been diagnosed with COVID-19 and treated in the isolation room.
Results: There were 61 cases (44.5%) of severe COVID-19. Of 88 cases of COVID-19 with NLR > 3.3, 56 cases (63.6%) were classified as severe COVID-19 and of 49 cases of COVID-19 with NLR 3.3 only 5 cases (10.2%) were classified as severe COVID-19. Patients with NLR values > 3.3 were found to have 6.2 times as likely to suffer from severe COVID-19 than patients with 3.3 NLR values.
Conclusion: The NLR value as one of the easy and simple tests can be used to predict the incidence of severe COVID-19 in patients.
Pendahuluan: Kondisi pandemi yang telah dialami sejak tahun 2020 akibat Coronavirus Disease (COVID-19) masih merupakan masalah nasional dan internasional yang perlu perhatian penuh dengan jumlah kasus yang terus bertambah seiring berjalannya waktu. Sebagian besar kasus COVID-19 merupakan kasus dengan keluhan ringan namun tidak sedikit kasus ringan tersebut kemudian dapat mengalami perburukan dalam hitungan hari akibat proses inflamasi luas yang terjadi karena infeksi virus. Penggunaan nilai rasio neutrofil-limfosit atau Neutrofil-Lymphocyte Ratio (NLR) secara umum telah diketahui fungsinya sebagai biomarker status inflamasi sistemik. Oleh karena itu, melalui penelitian ini diharapkan mampu memprediksi kejadian COVID-19 serangan berat pada pasien dewasa di BRSUD Tabanan.
Metode: Penelitian ini merupakan penelitian observasional dengan rancang penelitian cross-sectional analitik menggunakan data sekunder dari 137 pasien dewasa COVID-19 di BRSUD Tabanan bulan Juni – Desember 2020. Metode sampling yang digunakan adalah consecutive sampling terhadap seluruh pasien dewasa usia ? 18 tahun yang telah terdiagnosis COVID-19 dan dirawat di ruang isolasi.
Hasil: Ditemukan sebanyak 61 kasus (44,5%) tergolong kasus COVID-19 serangan berat. Dari 88 kasus COVID-19 dengan NLR > 3,3 56 kasus (63,6%) tergolong kasus COVID-19 serangan berat dan dari 49 kasus COVID-19 dengan NLR ? 3,3 hanya 5 kasus (10,2%) tergolong kasus COVID-19 serangan berat. Pasien dengan nilai NLR > 3,3 ditemukan memiliki risiko 6,2 kali lebih besar menderita keluhan COVID-19 serangan berat dibandingkan pasien dengan nilai NLR ? 3,3.
Simpulan: Nilai NLR sebagai salah satu pemeriksaan mudah dan sederhana dapat digunakan untuk memprediksi lebih awal terjadinya COVID-19 serangan berat pada pasien.
Preoperative factors influencing surgical site infections (SSIS) in inguinal hernia patients undergoing tension-free mesh hernia repair at regional public hospitals in Bali
Putu Anggia Dimitri Pramesti, Made Dharmesti Wijaya, Made Dwi Yoga BharataOnline First: Aug 7, 2021
- Abstract
Preoperative factors influencing surgical site infections (SSIS) in inguinal hernia patients undergoing tension-free mesh hernia repair at regional public hospitals in Bali
Introduction: Surgical site infection (SSI) is the most common nosocomial infection, affecting one out of three patients undergoing surgical procedures. The incidence of SSI in clean surgical wounds is still higher, especially in inguinal hernia repair. Today, tension-free mesh hernia repair is the primary method used in inguinal hernia management to reduce the risk of recurrence. This study aims to analyze preoperative factors influencing the incidence of SSIs in inguinal hernia patients that underwent tension-free mesh hernia repair at several regional public hospitals in Bali.
Methods: This is a case-control study with samples taken from seven regional hospitals in Bali. Data used in this study were obtained from patients’ medical records from 2017-February 2021. Samples included in this study are inguinal hernia patients that underwent tension-free mesh hernia repair and postoperative check-up. Samples are selected through the purposive sampling method. Statistical analysis was done using SPSS 18.0 software. Univariate and bivariate analysis was performed, and Pearson chi-square and Fisher’s exact test were applied.
Results: From the 61 samples in the case group and 61 samples in the control group, the results showed a significant relationship between the incidence of SSIs and elderly patients (OR = 2.262, 95% CI 1.086-4.711), between SSIs and obesity (OR = 9.057, 95% CI 1.096-74.808), and between SSIs and diabetes mellitus (OR = 9.620, 95% CI 2.094-44.201).
Conclusion: It is concluded that there is a significant relationship between these preoperative factors and the incidence of SSIs in inguinal hernia patients that underwent tension-free mesh hernia repair at seven regional public hospitals in Bali.
Membedah peran bank sampah guna menilik efektivitas pengelolaan limbah medis B3 rumah sakit
I Nyoman Yustra Karna, I Nyoman Rasmen AdiOnline First: Aug 9, 2021
- Abstract
Membedah peran bank sampah guna menilik efektivitas pengelolaan limbah medis B3 rumah sakit
Background: The implementation of the waste bank to reduce the cost of hazardous and toxic medical waste management needs to be optimized so that it is effective to reduce costs and additional hospital income.
Aim: The study aims to determine the factors causing the non-optimal management of medical waste at Surya Husadha Hospital through the implementation of the waste bank.
Methods: This study applied a qualitative approach with purposive sampling at Surya Husadha Hospital. Data were collected through observation, in-depth interviews and documentation from six informants.
Result: Some obstacles cause the implementation of the waste bank at Surya Husadha Hospital in reducing medical waste management costs to be not optimal, such as limited human resources and equipment. This obstacle causes only two of the four types of medical waste according to the Regulation of the Minister of Environment and Forestry of the Republic of Indonesia No. 56 of 2015, which can be managed through waste banks such as used infusion bottles and used hemodialysis fluid packaging.
Conclusion: The implementation of the waste bank at Surya Husadha Hospital has met the proper regulation, but it is necessary to evaluate the constraints, and planning for the needs of human resource and equipment in reducing medical waste management costs.
Latar Belakang: Penerapan bank sampah dalam membantu beban biaya pengelolaan limbah medis bahan berbahaya dan beracun (B3) perlu lebih dioptimalkan sehingga bisa efektif untuk meringankan biaya sekaligus bisa sebagai pendapatan tambahan untuk rumah sakit.
Tujuan: Studi ini bertujuan untuk mengetahui faktor-faktor penyebab kurang optimalnya pengelolaan limbah medis B3 di Rumah Sakit Umum (RSU) Surya Husadha melalui pemberdayaan bank sampah.
Metode: Penelitian ini menggunakan pendekatan kualitatif dengan purposive sampling di RSU Surya Husadha. Teknik pengumpulan data yang dilakukan adalah melalui observasi, wawancara mendalam serta dokumentasi dari enam informan.
Hasil: Ditemukan adanya beberapa kendala yang menyebabkan penerapan bank sampah di RSU Surya Husadha dalam mengurangi beban biaya pengelolaan limbah medis B3 menjadi kurang optimal. Kendala tersebut berupa keterbatasan sumber daya manusia serta keterbatasan ketersediaan sarana prasarana. Adanya kendala tersebut menyebabkan dari empat jenis limbah medis B3 yang bisa dikelola melalui bank sampah sesuai Peraturan Menteri Lingkungan Hidup dan Kehutanan (LHK) RI No 56 Tahun 2015 hanya dua yang bisa dikelola yaitu botol infus bekas dan bekas kemasan cairan hemodialisis.
Kesimpulan: Pelaksanaan pengelolaan limbah medis B3 di RSU Surya Husadha sudah sesuai regulasi, namun evaluasi terhadap kendala-kendala, perencanaan kebutuhan tenaga, dan juga pengadaan sarana prasarana yang dibutuhkan dalam menunjang kegiatan bank Sampah sangat diperlukan untuk membantu mengurangi biaya pengelolaan limbah medis B3.
Hubungan antara Stromal Tumor Infiltrating Lymphocytes (TIL) dengan ekspresi Programmed Death-Ligand 1 (PD-L1) pada karsinoma payudara invasif tipe tidak spesifik subtipe Human Epidermal Growth Factor Receptor-2 (HER-2) enriched di RSUP Sanglah, Bali, Ind
Popi Imelda Margareth Sitompul, Herman Saputra, Luh Putu Iin Indrayani Maker, I Gusti Ayu Sri Mahendra Dewi, Ni Putu Sriwidyani, I Made MuliartaOnline First: Aug 10, 2021
- Abstract
Hubungan antara Stromal Tumor Infiltrating Lymphocytes (TIL) dengan ekspresi Programmed Death-Ligand 1 (PD-L1) pada karsinoma payudara invasif tipe tidak spesifik subtipe Human Epidermal Growth Factor Receptor-2 (HER-2) enriched di RSUP Sanglah, Bali, Ind
Background: Breast cancer is the most common malignancy cancer in women. This malignancy is molecularly heterogeneous, where overexpression of the HER-2 growth factor receptor generally has a more aggressive nature. The role of immune system interaction, namely Tumor Infiltrating Lymphocytes (TIL) and Programmed Death-Ligand 1 (PD-L1) expression, is associated with prognostic and predictive factors. Therefore, this study aims to investigate the association between stromal TIL with PD-L1 expression in invasive breast carcinoma non-specific type HER-2 enriched subtype.
Methods: This study was an observational analytical study with cross-sectional design from January 1st 2015 to December 31st 2019. The samples were taken from a paraffin block of patients with invasive breast carcinoma non-specific type, that has performed histopathological examination, ER, PR, HER-2 and FISH/CISH immunohistochemistry examination at the Anatomical Pathology Laboratory of Sanglah Hospital Denpasar. The samples obtained were stained with PD-L1 immunohistochemistry. The preparation was evaluated to assess TIL. Data were analyzed using SPSS version 20 for Windows.
Results: The study found a statistically significant association between stromal TIL with PD-L1 expression in tumor cells (p = 0.018). There is statistically significant association between stromal TIL with PD-L1 expression in TIL (p = 0.001). There is statistically significant association between stromal TIL with PD-L1 expression in total tumor cells and TIL (p = 0.007) in invasive breast carcinoma non-specific type HER-2 enriched subtype at Sanglah Hospital, Denpasar.
Conclusion: In conclusion, there is an association between stromal TIL with the expression of PD-L1 in tumor cells and TIL in invasive breast carcinoma non-specific type HER-2 enriched subtype.
Latar Belakang: Kanker payudara merupakan keganasan tersering pada wanita. Keganasan ini bersifat heterogen ditinjau dari aspek molekuler, dimana overekspresi HER-2 umumnya memiliki sifat yang lebih agresif. Peranan sistem imun, yakni ekspresi Tumor Infiltrating Lymphocytes (TIL) dan Programmed Death-Ligand 1 (PDL-1) dihubungkan dengan faktor prognostik. Oleh karena itu, penelitian ini bertujuan untuk mengevaluasi hubungan antara stromal TIL dengan ekspresi PD-L1 pada karsinoma payudara invasif tipe tidak spesifik subtipe HER-2 enriched.
Metode: Penelitian ini merupakan penelitian observasional analitik dengan rancangan studi potong lintang mulai dari 1 Januari 2015 sampai 31 Desember 2019. Sampel adalah blok parafin penderita karsinoma payudara invasif tipe tidak spesifik yang telah dilakukan pemeriksaan histopatologi, imunohistokimia ER, PR, HER-2 dan FISH/CISH di Laboratorium Patologi Anatomi RSUP Sanglah Denpasar. Sampel yang diperoleh dilakukan pulasan imunohistokimia PD-L1 Preparat sampel digunakan untuk menilai TIL. Data dianalisis dengan SPSS versi 20 untuk Windows.
Hasil: Pada penelitian ditemukan hubungan yang signifikan secara statistik antara stromal TIL dengan ekspresi PD-L1 pada sel tumor (p=0,018). Terdapat hubungan yang signifikan secara statistik antara stromal TIL dengan ekspresi PD-L1 pada TIL (p=0,001). Terdapat hubungan yang signifikan secara statistik antara stromal TIL dengan ekspresi PD-L1 pada total sel tumor dan TIL (p=0,007) pada karsinoma payudara invasif tipe tidak spesifik subtipe HER-2 enriched di RSUP Sanglah Denpasar.
Kesimpulan: Hasil penelitian ini menunjukkan terdapat hubungan bermakna antara stromal TIL dengan ekspresi PD-L1 sel tumor dan TIL pada karsinoma payudara invasif tipe tidak spesifik subtipe HER-2 enriched.
Hubungan antara ekspresi Vascular Cell Adhesion Molecule-1 (VCAM-1) dengan tipe dan stadium T karsinoma epitel permukaan ovarium di RSUP Sanglah, Bali, Indonesia
I Made Wirya Sastra, Luh Putu Iin Indrayani Maker, Anak Agung Ayu Ngurah Susraini, I Wayan Juli Sumadi, I Gusti Ayu Sri Mahendra Dewi, Herman Saputra, I Made MuliartaOnline First: Aug 10, 2021
- Abstract
Hubungan antara ekspresi Vascular Cell Adhesion Molecule-1 (VCAM-1) dengan tipe dan stadium T karsinoma epitel permukaan ovarium di RSUP Sanglah, Bali, Indonesia
Background: Vascular Cell Adhesion Molecule-1 (VCAM-1) is an important protein in oncogenesis, angiogenesis, tumor development, and metastasis. Studies regarding the expression of VCAM-1 in ovarian carcinoma have found both supportive and contradictory results. Therefore, this study evaluates the relationship between VCAM-1 expression and the type and stage of ovarian surface epithelial carcinoma at Sanglah General Hospital, Bali, Indonesia.
Methods: This study was a cross-sectional analytical study with a sample size of 36, which came from paraffin block of patients with ovarian surface epithelial carcinoma who were examined histopathologically at the Anatomical Pathology Laboratory of Sanglah Hospital Denpasar from 1 January 2017 to 31 December 2019. Samples are grouped into type I and type II, then the stage I or II and III groups. After that, the VCAM-1 immunohistochemical streak was performed to assess high or low expression in these groups and analyzed its relationship with the type and stage T of ovarian surface epithelial carcinoma. Data were analyzed using SPSS version 25 for Windows.
Results: The analysis results using the Chi-Square test showed a statistically significant relationship (p=0.001) between the VCAM-1 expression with type and stage surface epithelial ovarian carcinoma (p=0.007). The results of the mean difference test are 0.48 (95% CI=0.33-0.70) and showed a statistically significant difference (p=0.001) between VCAM-1 expression with a type of ovarian carcinoma.
Conclusion: In conclusion, there is an association between expression VCAM-1 with the type of surface epithelial ovarian carcinoma and at a stage, with a 2.3 times higher probability of VCAM-1 expression in the stage III group than in stage I or II group.
Latar Belakang: Vascular Cell Adhesion Molecule-1 (VCAM-1) merupakan salah satu protein yang penting dalam onkogenesis, angiogenesis, perkembangan tumor dan metastasis. Penelitian-penelitian mengenai ekspresi VCAM-1 pada karsinoma ovarium mendapatkan hasil yang pro dan kontra. Oleh karena itu, penelitian ini bertujuan untuk mengetahui hubungan antara ekspresi VCAM-1 dengan tipe dan stadium T karsinoma epitel permukaan ovarium di RSUP Sanglah, Bali, Indonesia.
Metode: Penelitian ini merupakan studi analitik potong lintang dengan besar sampel adalah 36, yang berasal dari dari blok parafin penderita karsinoma epitel permukaan ovarium yang diperiksa secara histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah Denpasar dari 1 Januari 2017 sampai 31 Desember 2019. Sampel dikelompokkan menjadi tipe I dan tipe II, kemudian kelompok stadium I atau II dan III. Setelah itu dilakukan pulasan imunohistokimia VCAM-1 untuk menilai ekspresi tinggi ataupun rendah pada kelompok-kelompok tersebut dan dianalisis hubungannya dengan tipe dan stadium T karsinoma epitel permukaan ovarium. Data dianalisis dengan uji Chi-Square dengan nilai p <0,05.
Hasil: Hasil penelitian menunjukkan terdapat hubungan yang bermakna secara statistik (p=0,001) antara ekpresi VCAM-1 dengan tipe karsinoma dan stadium T (p=0,007). Hasil uji beda rerata adalah 0,48 (IK 95%=0,33-0,70) dan menunjukkan perbedaan bermakna secara statistik (p=0,001) antara ekspresi VCAM-1 dengan tipe karsinoma ovarium.
Kesimpulan: Sebagai simpulan, terdapat hubungan antara ekspresi VCAM-1 dengan tipe karsinoma epitel permukaan ovarium dan pada stadium, dengan kemungkinan 2,3 kali terjadi ekspresi VCAM-1 yang tinggi pada kelompok stadium III dibandingkan stadium I atau II.
Perbedaan ekspresi Vascular Endothelial Growth Factor (VEGF) pada meningioma risiko rendah dan risiko tinggi di RSUP Sanglah, Bali, Indonesia
Ivana Juliarty Sitanggang, Ni Putu Sriwidyani, I Wayan Juli Sumadi, I Gusti Ayu Sri Mahendra Dewi, Luh Putu Iin Indrayani Maker, I Made MuliartaOnline First: Aug 10, 2021
- Abstract
Perbedaan ekspresi Vascular Endothelial Growth Factor (VEGF) pada meningioma risiko rendah dan risiko tinggi di RSUP Sanglah, Bali, Indonesia
Background: Vascular Endothelial Growth Factor (VEGF) is an angiogenic factor that plays an important role in tumor angiogenesis. VEGF in meningioma is up-regulated and indicates its role as a proangiogenic factor. It has an association with tumor recurrence and progression. This study aims to determine the differences in VEGF expression in low-risk and high-risk meningiomas at Sanglah General Hospital, Bali, Indonesia.
Methods: This study was a cross-sectional analytical study with a sample size of 52, which came from meningioma patients examined histopathologically at the Anatomical Pathology Laboratory of Sanglah General Hospital from January to December 2019. The VEGF immunohistochemical staining was performed and interpreted using Histo score (H-score). VEGF expression was categorized into high and low expression, with the cut-off value determined based on the median value. Data were analyzed using SPSS version 20 for Windows.
Methods: The results showed that out of 52 meningioma samples, 37 (71.1%) cases of low-risk meningiomas with low VEGF expression, 6 cases (11.5%) of low-risk meningiomas with high VEGF expression, and 9 cases (17.3%) of high-risk meningiomas with high VEGF expression. There was no high-risk meningioma with low VEGF expression. There was a significant difference in VEGF expression between the low-risk and high-risk meningioma groups (p = 0.00), and high VEGF expression had a prevalence risk for the incidence of high-risk meningioma by 2.5 times (95% CI=1.3-4.6).
Conclusion: Based on the results of this study, it was concluded that there was a VEGF expression difference between low-risk and high-risk meningiomas in Sanglah General Hospital Denpasar and high VEGF had a prevalence risk for the occurrence of high-risk meningiomas by 2.5 times.
Latar Belakang: Vascular Endothelial Growth Factor (VEGF) merupakan faktor angiogenik yang berperan penting dalam angiogenesis tumor. VEGF pada meningioma mengalami up-regulation yang menunjukkan perannya sebagai faktor proangiogenik yang berkaitan dengan rekurensi dan perkembangan tumor. Penelitian ini bertujuan untuk menentukan perbedaan ekspresi VEGF pada meningioma risiko rendah dan risiko tinggi di RSUP Sanglah, Bali, Indonesia.
Metode: Penelitian ini merupakan studi analitik potong lintang dengan besar sampel adalah 52, yang berasal dari blok parafin penderita meningioma yang diperiksa histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah Denpasar dari Januari - Desember 2019. Dilakukan pulasan imunohistokimia VEGF dan penilaiannya menggunakan Histo score (H-score). Ekspresi VEGF dikategorikan menjadi tinggi dan rendah dengan nilai cut-off yang ditentukan berdasarkan nilai median. Data dianalisis dengan SPSS versi 20 untuk Windows.
Hasil: Hasil penelitian ini menunjukkan bahwa dari 52 sampel meningioma, terdapat 37 kasus (71,1%) meningioma risiko rendah dengan ekspresi VEGF rendah, 6 kasus (11,5%) meningioma risiko rendah dengan ekspresi VEGF yang tinggi, dan 9 kasus (17,3%) meningioma risiko tinggi dengan ekspresi VEGF tinggi. Tidak didapatkan meningioma risiko rendah dengan ekspresi VEGF rendah. Didapatkan perbedaan ekspresi VEGF yang bermakna antara kelompok meningioma risiko rendah dan risiko tinggi (p=0,00) dan ekspresi VEGF tinggi mempunyai risiko prevalensi untuk terjadinya meningioma risiko tinggi sebesar 2,5 kali (95% IK=1,3-4,6).
Kesimpulan: Berdasarkan hasil penelitian ini didapatkan perbedaan ekspresi VEGF antara meningioma risiko rendah dan risiko tinggi di RSUP Sanglah Denpasar dan pada VEGF tinggi mempunyai risiko prevalensi untuk terjadinya meningioma risiko tinggi sebesar 2,5 kali.
Gelombang Brainstem Evoked Response Audiometry (BERA) pada anak di bawah lima tahun dengan keterlambatan bicara dan bahasa disertai gangguan pendengaran di RSUP Sanglah, Bali, Indonesia
Ni Made Ary Wisma Dewi, I Made WiranadhaOnline First: Aug 10, 2021
- Abstract
Gelombang Brainstem Evoked Response Audiometry (BERA) pada anak di bawah lima tahun dengan keterlambatan bicara dan bahasa disertai gangguan pendengaran di RSUP Sanglah, Bali, Indonesia
Background: Hearing loss is one factor that influences speech and language development in children, especially in the first five years of life. The detection of hearing loss in a child can be done with an objective Brainstem Evoked Response Audiometry (BERA). This study aims to evaluate the value of BERA waves in children under five with speech and language delays at the ENT outpatient clinic of Sanglah General Hospital Denpasar.
Methods: This study is a retrospective descriptive study design by taking secondary data from the medical records of patients with speech and language delays accompanied by hearing loss who were subjected to BERA examination. Samples were taken by consecutive sampling. Data analysis in this study consisted of descriptive statistical analysis, independent T test, and one-way ANOVA. Data were analyzed using SPSS version 24 for Windows.
Results: This study involved 65 people as a sample. Based on gender, it was found that male (76.9%) was more than female (23.1%). Most of them were aged 24-35 months (43.1%). The most hearing loss was Moderate SNHL on the right ear (38.5%), while Mild SNHL on the left ear (38.5%). The mean latency time between I-V waves in the left ear of boys was longer, that was 4.96 ms with a variation of 0.56 ms, compared to 4.59 ms for girls with a deviation of 0.64 ms. There was a significant difference in the mean latency between waves I-V of the left ear between male and female toddlers (p=0.033).
Conclusion: Based on the research, it was found that the absolute latency time and between waves of BERA on the right ear did not have a significant difference in boys and girls, but on the left ear, there was a statistically significant difference in the mean of latency time between waves IV in boys and girls.
Latar Belakang: Gangguan pendengaran merupakan salah satu faktor yang mempengaruhi perkembangan bicara dan bahasa pada anak terutama pada lima tahun pertama kehidupan. Deteksi gangguan pendengaran pada seorang anak dapat dilakukan dengan pemeriksaan Brainstem Evoked Response Audiometry (BERA) yang objektif. Penelitian ini bertujuan untuk melihat nilai gelombang BERA pada anak balita dengan keterlambatan bicara dan bahasa di Poliklinik THTKL RSUP Sanglah Denpasar.
Metode: Penelitian ini menggunakan rancangan penelitian deskriptif retrospektif dengan mengambil data sekunder dari catatan medis pasien keterlambatan bicara dan bahasa disertai gangguan pendengaran yang dilakukan pemeriksaan BERA. Sampel diambil dengan cara consecutive sampling. Analisis data pada penelitian ini terdiri dari analisis statistik deskriptif, uji T independen, dan one way ANOVA. Data dianalisis dengan SPSS versi 24 untuk Windows.
Hasil: Penelitian ini melibatkan 65 orang sebagai sampel. Berdasarkan jenis kelamin didapatkan jenis kelamin laki-laki (76,9%) lebih banyak dari perempuan (23,1%). Usia terbanyak pada usia 24-35 bulan (43,1%). Gangguan pendengaran paling banyak yaitu SNHL Sedang pada telinga kanan (38,5%), sedangkan pada telinga kiri SNHL Ringan (38,5%). Rerata masa laten antar gelombang I-V pada telinga kiri balita laki-laki lebih panjang yaitu 4,96 ms dengan variasi 0,56 ms, dibandingkan balita perempuan 4,59 ms dengan variasi 0,64 ms. Terdapat perbedaan bermakna rerata masa laten antar gelombang I-V telinga kiri antara balita laki-laki dan perempuan (p=0,033).
Simpulan: Berdasarkan penelitian didapatkan bahwa masa laten absolut dan antar gelombang BERA pada telinga kanan tidak ada perbedaan bermakna pada balita laki-laki dan perempuan, namun pada telinga kiri secara statistik terdapat perbedaan bermakna rerata masa laten antar gelombang I-V pada balita laki-laki dengan perempuan.
The effect of Modified Radical Mastectomy (MRM) with and without latissimus dorsi flap on seroma of Locally Advanced Breast Cancer (LABC) in Sanglah Hospital
Anak Agung Chris Tedy Pramana, I Ketut Widiana, I Gde Raka WidianaOnline First: Aug 10, 2021
- Abstract
The effect of Modified Radical Mastectomy (MRM) with and without latissimus dorsi flap on seroma of Locally Advanced Breast Cancer (LABC) in Sanglah Hospital
Background: Locally Advanced Breast Cancer (LABC) is defined as breast cancer spread locoregionally and without any signs of metastasis. Stage IIIA breast cancer is one type of LABC that can be removed surgically, and Modified Radical Mastectomy (MRM) remains the first surgical option. Seroma production is one of the most common complications post MRM, with the hypothesis stating that the Latissimus Dorsi (LD) flap technique is responsible for resulting in higher seroma output. This study aims to compare seroma production in LABC patients post MRM with and without LD flap.
Methods: This prospective cohort study was conducted in Sanglah General Hospital, Denpasar, between November 2018 and January 2020. The study sample was divided into 2 groups: LABC patients post MRM with and without LD flap reconstruction. Seroma was measured in milliliters (ml) and collected from the first to fifth day post-operation. Data were analyzed using SPSS version 21 for Windows.
Results: Forty LABC patients were enrolled in this study. The mean age for the group without latissimus dorsi flap was 48.45±7.01 years and 49.40±10.77 years for the group with latissimus dorsi flap. The mean seroma production in LABC patients who underwent MRM without and with LD flap reconstruction was 696.45±66.37 ml and 490.10±62.11 ml. There was a significant difference in the total of seroma between the treatment group without-LD flap and compared to with-LD flap reconstruction (p<0.001).
Conclusion: Seroma production is significantly higher in LABC patients post MRM without LD flap reconstruction than LABC patients with LD flap.
Neutrophil-Lymphocyte Ratio (NLR) as an output-outcome predictor in moderate-severe head injury at Sanglah General Hospital, Denpasar, Indonesia
Melissa Krisanty, Tjokorda Gde Bagus Mahadewa, I Wayan Niryana, I Nyoman Semadi, I Gede Suwedagatha, I Gusti Agung Bagus Krisna WibawaOnline First: Aug 10, 2021
- Abstract
Neutrophil-Lymphocyte Ratio (NLR) as an output-outcome predictor in moderate-severe head injury at Sanglah General Hospital, Denpasar, Indonesia
Background: This prospective cohort study aims to determine the best cut point value and the ability to predict Neutrophil Lymphocyte Ratio (NLR), analyze the most dominant factors, and the direct influence of the NLR to output and outcome in moderate and severe trauma to the head injury at Sanglah General Hospital, Denpasar, Indonesia.
Methods: This study was an observational analytic with a prospective cohort design. The subjects of this study were head injury patients over 16 years old with Glasgow Coma Scale (GCS) ? 12 who visited and were treated at Sanglah General Hospital, Denpasar, Indonesia. Patients less than 16 years old, history of alcohol intoxication, stroke, metabolic disease, and multiple traumas were not included as research subjects. Data were analyzed using SPSS version 20 for Windows.
Results: The research conducted on 49 respondents found that the best cut-off point of NLR was 6.05 has the most significant predictor (OR=7.6; p=0.001) and dominant (OR=64.97; p=0.002) factors to the output-outcome predictor in moderate-severe head injury. In addition, this cut-off value (6.05) also has a direct influence (x-value=0.523) in the occurrence of output and outcome unfavorable in moderate-severe head injury.
Conclusion: the cut-off NLR values of 6.05 became the dominant predictor that directly affected the output and outcome unfavorable in moderate-severe head injury.
Kematian janin dalam kandungan pada ibu hamil dengan infeksi sifilis laten: laporan kasus
Hani Lusyana, Lina Damayanti, Agus WalujoOnline First: Aug 21, 2021
- Abstract
Kematian janin dalam kandungan pada ibu hamil dengan infeksi sifilis laten: laporan kasus
Background: Pregnant women and newborns are a group that is prone to contracting sexually transmitted infections, although they do not directly engage in high-risk sexual behavior. One that has an unexpected impact on pregnant women and newborns is syphilis by the bacterium Treponema pallidum. Transmission of syphilis from mother to fetus is usually worse when the infection in pregnant women is not detected or not appropriately treated early in pregnancy. This case report aims to evaluate fetal death in the womb in pregnant women with latent syphilis infection
Case Presentation: A 19-year-old pregnant woman aged 31-32 weeks diagnosed with late postpartum spontaneous Intrauterine Fetal Death (IUFD) with early latent syphilis. The diagnosis of syphilis was made based on the Veneral Disease Research Laboratory (VDRL) serological test (1:64), Treponema Pallidum Hemagglutination Assay (TPHA) (1:1,280), and without any mucocutaneous complaints. The patient received Benzathine Penicillin G 2.4 million IU single dose intramuscularly. The diagnosis of IUFD was made one day after the administration of therapy and the baby was born with multiple congenital abnormalities.
Conclusion: Undiagnosed and adequately treated syphilis in pregnant women can result in perinatal death caused by multiple congenital abnormalities.
Latar Belakang: Ibu hamil dan bayi baru lahir merupakan kelompok rawan tertular infeksi menular seksual, walaupun tidak secara langsung berperilaku seksual resiko tinggi. Salah satu yang memiliki dampak kelahiran yang tidak diharapkan pada ibu hamil dan bayi baru lahir adalah Sifilis oleh bakteri Treponema pallidum. Transmisi sifilis dari ibu ke janin biasanya berakibat buruk ketika infeksi pada ibu hamil tidak terdeteksi atau tidak diobati secara benar di awal kehamilan. Laporan kasus ini bertujuan mengevaluasi kematian janin dalam kandungan pada ibu hamil dengan infeksi sifilis laten
Presentasi Kasus: Seorang wanita hamil berusia 19 tahun usia kehamilan 31-32 minggu dengan diagnosis akhir postpartum spontan Intrauterine Fetal Death (IUFD) dengan sifilis laten dini. Diagnosis sifilis ditegakkan berdasarkan tes serologis Veneral Disease Research Laboratory (VDRL) (1:64), Treponema Pallidum Hemagglutination Assay (TPHA) (1:1.280), dan tanpa adanya keluhan mukokutaneus. Pasien mendapatkan terapi Benzatin Penisilin G 2.4 juta IU single dose secara intramuskular. Diagnosis IUFD ditegakkan satu hari setelah pemberian terapi dan bayi yang dilahirkan memiliki kelainan kongenital multipel.
Kesimpulan: Sifilis pada ibu hamil yang tidak terdiagnosis dan diterapi dengan adekuat dapat mengakibatkan terjadinya kematian perinatal yang disebabkan oleh kelainan kongenital multipel.
Efek ekstrak sambiloto (Andrographis paniculata) terhadap ekspresi matrix metalloproteinase-1 dan hipertrofi jantung pada mencit yang terpapar asap rokok
I Made Agus Endra Permana, I Nyoman Wiryawan, Wayan Aryadana, I Gde Raka Widiana, I Gusti Kamasan Nyoman Arijana, I Made Satria Yudha DewanggaOnline First: Aug 24, 2021
- Abstract
Efek ekstrak sambiloto (Andrographis paniculata) terhadap ekspresi matrix metalloproteinase-1 dan hipertrofi jantung pada mencit yang terpapar asap rokok
Introduction: Sambiloto (Andrographis paniculata) is a plant that is often used in traditional medicine and is known to have antioxidant, anti-inflammatory and cardiovascular effects. There are many studies of sambiloto on inflammatory markers, but there is no study on the effect of sambiloto on MMP-1 expression. The purpose of this study was to determine the effect of sambiloto on MMP-1 expression and cardiac hypertrophy in mice exposed to cigarette smoke.
Methods: This research is an experimental analytic study with a randomized post test only control group design. Thirty-two healthy male Swiss Webster mice aged 8-10 weeks weighing 20-30 grams were divided into 4 groups, namely: control group (standard feed + exposure to cigarette smoke), P1 (standard feed + exposure to cigarette smoke + sambiloto extract 18 mg/ kg BW), P2 (standard feed + exposure to cigarette smoke + sambiloto extract 29 mg/kg BW), P3 (standard feed + exposure to cigarette smoke + sambiloto extract 40 mg/kg BW). All groups were followed for 60 days.
Results: There was a significant difference in MMP-1 expression between the control group and all treatment groups. There were significant differences in MMP-1 expression between groups P1 and P2, and between P1 and P3 groups. There was a significant difference in heart weight/weight ratio between the control group and all treatment groups. There was a significant difference in the heart weight/body weight ratio between the P1 and P3 groups.
Conclusion: The administration of sambiloto extract decreased the expression of MMP-1 with a tendency for its effect to increase with increasing dose and the optimal dose was found in the sambiloto extract 29 mg/kg BW. The difference in the effect of sambiloto extract on cardiac hypertrophy only appeared after the dose was increased to 40 mg/kg BW
Latar Belakang: Sambiloto (Andrographis paniculata) merupakan tanaman yang sering dipakai dalam pengobatan tradisional dan diketahui mempunyai efek antioksidan, anti inflamasi dan efek pada sistem kardiovaskular. Terdapat banyak penelitian sambiloto terhadap marker inflamasi, tetapi belum ada penelitian tentang efek ekstrak sambiloto terhadap ekspresi MMP-1. Tujuan dari penelitian ini untuk mengetahui efek ekstrak sambiloto terhadap ekspresi MMP-1 dan hipertrofi jantung pada mencit yang terpapar asap rokok.
Metode: Penelitian ini adalah penelitian analitik eksperimental dengan rancangan randomized post test only control group design. Tiga puluh dua mencit Swiss Webster jantan sehat berumur 8-10 minggu dengan berat 20-30 gram dibagi menjadi 4 kelompok yaitu: kelompok kontrol (pakan standar + paparan asap rokok), P1 (pakan standar + paparan asap rokok + ekstrak sambiloto 18 mg/kg BB), P2 (pakan standar + paparan asap rokok + ekstrak sambiloto 29 mg/kg BB), P3 (pakan standar + paparan asap rokok + ekstrak sambiloto 40 mg/kg BB). Semua kelompok diikuti selama 60 hari.
Hasil: Terdapat perbedaan signifikan ekspresi MMP-1 antara kelompok kontrol dengan semua kelompok perlakuan. Terdapat perbedaan signifikan ekspresi MMP-1 antara kelompok P1 dengan P2, dan antara P1 dengan P3. Terdapat perbedaan signifikan rasio berat jantung/berat badan antara kelompok kontrol dengan semua kelompok perlakuan. Terdapat perbedaan signifikan rasio berat jantung/berat badan antara kelompok P1 dengan P3.
Simpulan: Pemberian ekstrak sambiloto menurunkan ekspresi MMP-1 dengan kecenderungan efeknya meningkat dengan peningkatan dosis dan dosis optimal terdapat pada ekstrak sambiloto 29 mg/kg BB. Perbedaan efek ekstrak sambiloto terhadap hipertrofi jantung baru muncul setelah dosis ditingkatkan menjadi 40 mg/kg BB.
Peran sirkumsisi sebagai pencegahan infeksi herpes genetalis: suatu studi kohort retrospektif
Made Wardhana, Martina Windari, Marrietta Sugiarti Sadeli, Anak Agung Gde Putra Wiraguna, Ni Made Dwi Puspawati, I Gusti Ayu Agung Elis Indira, Pande Agung MahariskiOnline First: Aug 26, 2021
- Abstract
Peran sirkumsisi sebagai pencegahan infeksi herpes genetalis: suatu studi kohort retrospektif
Background: Recurrent genital herpes (RGH) is a sexually transmitted infection that is a serious public health problem and is quite prominent in most countries worldwide. Management for this infection is antiviral and circumcision. Male circumcision significantly reduces human immunodeficiency virus (HIV) infection and other sexually transmitted infections. This research aims to evaluate circumcision efficacy as the prevention for herpes simplex virus type 2 (HSV-2) infection compared with oral acyclovir.
Methods: This research is an experimental study with a retrospective cohort approach. We included 45 males, 24 subjects circumcised and 21 subjects without circumcision and took oral acyclovir as standard treatment. RGH was diagnosed based on typical clinical manifestation. Follow up treatment every two weeks and continued to 2 months after circumcised and given with oral acyclovir. Successful treatment was stated without recurrent genital herpes.
Results: Of 24 circumcised subjects, 19 were cured, and five non-circumcised subjects suffered recurrent genital herpes (not cured). Among 21 subjects without circumcision was cured, and 12 subjects were not cured. Based on these results, the value of NNT= 2.7.
Conclusion: Circumcision can be considered effective in reducing the incidence of HGR and prevent recurrence of HGR with the NNT value of 2.7.
Latar Belakang: Herpes genetalis rekuren (HGR) merupakan infeksi menular seksual menjadi masalah kesehatan masyarakat yang serius dan cukup menonjol pada sebagian besar negara di dunia. Penanganannya adalah oral dengan antivirus dan tindakan sirkumsisi. Sirkumsisi pada pria secara signifikan mengurangi insiden infeksi human immunodeficiency virus (HIV) dan penyakit infeksi menular lainnya. Penelitian ini mengevaluasi efikasi sirkumsisi sebagai pencegahan infeksi virus herpes simpleks tipe 2 (HSV-2) dibandingkan dengan pemberian obat asiklovir.
Metode: Studi ekperimental dengan pendekatan retrospektif kohort dengan mengikutsertakan 45 subjek pria dewasa, 24 subjek disirkumsisi dan 21 tanpa sirkumsisi dan hanya diberikan asiklovir sebagai obat standar. Diagnosis HGR dilakukan secara klinis dengan yang manifestasi klinis yang khas da pemeriksaan Tzanck. Setelah pemberian terapi dilakukan kontrol setiap 2 minggu sampai 2 bulan. Terapi dinyatakan berhasil bila tidak ada kekambuhan.
Hasil: Dari 24 subjek disirkumsisi, 19 subjek dinyatakan sembuh dan 5 subjek mengalami kekambuhan (tidak sembuh). Dari 21 subjek tanpa sirkumsisi, 9 subjek dinyatakan sembuh dan 12 subjek dinyatakan tidak sembuh. Berdasarkan hasil ini didapatkan nilai NNT=2,7.
Simpulan: Sirkumsisi dapat dinilai cukup efektif mengurangi angka kejadian HGR dan dapat mencegah kekambuhan HGR dengan nilai NNT 2.7.
Hubungan Lymph Vessel Density (LVD) dengan invasi limfatik dan metastasis kelenjar getah bening regional pada karsinoma payudara invasif tipe tidak spesifik di RSUP Sanglah, Bali, Indonesia
Katrin Rotua Simbolon, I Gusti Ayu Sri Mahendra Dewi, Ni Putu Sriwidyani, Luh Putu Iin Indrayani Maker, Herman Saputra, I Made MuliartaOnline First: Aug 1, 2021
- Abstract
Hubungan Lymph Vessel Density (LVD) dengan invasi limfatik dan metastasis kelenjar getah bening regional pada karsinoma payudara invasif tipe tidak spesifik di RSUP Sanglah, Bali, Indonesia
Background: Lymph Node Metastasis (LNM) is considered the most important prognostic factor in breast cancer. The progress of lymphatic metastasis is thought to involve the proliferation of lymphatic vessels (lymphangiogenesis), Lymph Vessel Invasion (LVI), and lymph node metastasis step by step. This study aims to evaluate the association between LVD with LVI and regional LNM in invasive breast carcinoma of no special type.
Methods: This study used a cross-sectional analytical study, using a sample of 38 paraffin-embedded tissue from the patient with invasive breast carcinoma of no special type in Sanglah General Hospital, Bali, Indonesia, in 2018. The sample will be used to assess LVD and LVI by D2-40 immunohistochemistry. Expression of D2-40 with vigorous-intensity was evaluated on the membrane and cytoplasm of lymphatic endothelial cells to determine the definition of lymphatic vessels. Lymph vessel density was determined by counting the number of lumens of peritumoral lymphatic vessels in five fields of view with the densest lymphatic vessel lumen using a Leica microscope (DM750, 400x, area 0.225mm2). Data were analyzed using SPSS version 24 for Windows.
Results: The LVD cut-off value is 16.5 lymphatic vessel lumens/0.225 mm2 (65.4% for sensitivity and area Under the Curve (AUC)=70.2%). Then cases were classified into the category of high LVD (?16,5 lymphatic vessel lumen/0,225 mm2) and low LVD (<16.5 lymphatic vessels lumen/0,225 mm2). The study found a statistically significant association between LVD and lymph vessel invasion (PR=3.6; p=0.043; 95%CI=0.88-14.78) and regional lymph node metastases (PR =1.7; p=0.02; 95%CI=1.03-2.79).
Conclusion: This study proved an association between LVD with lymph vessel invasion and regional lymph node metastases.
Latar Belakang: Metastasis Kelenjar Getah Bening (KGB) dianggap sebagai faktor prognostik yang paling penting pada kanker payudara. Perkembangan metastasis limfatik diduga melibatkan proliferasi pembuluh limfatik (limfangiogenesis), Lymph Vessel Invasion (LVI) atau invasi limfatik, dan metastasis kelenjar getah bening secara bertahap. Penelitian ini bertujuan untuk mengevaluasi hubungan antara Lymph Vessel Density (LVD) dengan invasi limfatik dan metastasis kelenjar getah bening regional pada karsinoma payudara invasif tipe tidak spesifik.
Metode: Penelitian ini menggunakan metode analitik potong lintang dengan sampel 38 blok parafin dari pasien karsinoma payudara invasif tipe tidak spesifik di RSUP Sanglah, Bali, Indonesia tahun 2018. Penilaian LVD dan LVI dengan pulasan imunohistokimia D2-40. Ekspresi D2-40 dengan intensitas yang kuat dievaluasi pada membran dan sitoplasma sel endotel limfatik untuk menetapkan definisi pembuluh limfatik. Lymph vessel density ditentukan dengan menghitung jumlah lumen pembuluh limfatik peritumoral pada lima lapangan pandang yang memiliki lumen pembuluh limfatik terpadat, menggunakan mikroskop Leica (DM750, 400x, luas area 0,225mm2). Data dianalisis dengan SPSS versi 24 untuk Windows.
Hasil: Nilai cut-off LVD adalah 16,5 lumen pembuluh limfatik/0,225 mm2 (sensitivitas 65,4% dan Area Under the Curve (AUC)=70,2%). Kemudian kasus dikategorikan menjadi LVD tinggi (?16,5 lumen pembuluh limfatik / 0,225 mm2) dan LVD rendah (<16,5 lumen pembuluh limfatik / 0,225 mm2). Hasil analisis statistik menunjukkan bahwa terdapat hubungan antara LVD dengan invasi limfatik (PR=3,6; p=0,043; IK 95%=0,88-14,78) dan metastasis KGB regional (PR=1,7; p=0,02; IK 95%=1,03-2,79).
Kesimpulan: Penelitian ini membuktikan bahwa terdapat hubungan antara LVD dengan invasi limfatik dan metastasis KGB regional.
Perbandingan kadar Thyroid Stimulating Hormone (TSH) dan kadar Free T4 (FT4) antara metode Fluorescence Immunoassay (FIA) dan metode Electrochemiluminescence Immunoassay (ECLIA) di RSUP Sanglah, Bali, Indonesia
Ekarini Katharina Yunarti Nabu, Sianny Herawati, Ni Kadek Mulyantari, Anak Agung Wiradewi Lestari, I Putu Yuda PrabawaOnline First: Aug 31, 2021
- Abstract
Perbandingan kadar Thyroid Stimulating Hormone (TSH) dan kadar Free T4 (FT4) antara metode Fluorescence Immunoassay (FIA) dan metode Electrochemiluminescence Immunoassay (ECLIA) di RSUP Sanglah, Bali, Indonesia
Background: Diagnostic and therapeutic cases of hyperthyroidism can be identified by examining the levels of Thyroid Stimulating Hormone (TSH) and Free T4 (FT4). There are several examination methods, namely the Fluorescence Immunoassay (FIA) and the Electro-Chemiluminescence Immunoassay (ECLIA) method. This study aims to evaluate the difference in TSH and FT4 level in the FIA method and ECLIA method.
Method: This study used observational analytic methods cross sectional design, with 45 samples serum patient with hyperthyroid in January-March 2019. Examine level TSH and FT4 levels with FIA methods (NANO ENTEK FRENDTM) and ECLIA method (Cobas e601 ROCHE). Data were analyzed using SPSS version 17 for Windows.
Results: Most of the respondents were aged 25-34 years (28.8%) and female (86.7%). There was no significant difference in the mean TSH level on examination using the ECLIA method (0.60±0.79 mIU/L) and the FIA method (0.63±0.76 mIU/L) (p=0.639). In addition, there was no significant difference in FT4 both in the examination using the ECLIA method (1.67±1.05 ng/dl) and the FIA method (1.69±1.72 ng/dl) (p=0.745).
Conclusions: There was no significant difference between TSH and FT4 in both ECLIA and FIA methods.
Latar Belakang: Diagnosis maupun pemantauan terapi kasus hipertiroid dapat diketahui dengan pemeriksaan kadar hormon Thyroid Stimulating Hormone (TSH) dan Free T4 (FT4). Terdapat beberapa metode pemeriksaan yaitu metode Fluorescence Immunoassay (FIA) dan metode Electro-Chemiluminescence Immunoassay (ECLIA). Penelitian ini bertujuan untuk mengevaluasi perbedaan kadar TSH dan FT4 metode FIA dan metode ECLIA.
Metode: Penelitian ini menggunakan metode observasional analitik dengan desain potong lintang pada 45 sampel serum penderita hipertiroid selama periode Januari-Maret 2019. Dilakukan pemeriksaan kadar TSH dan FT4 dengan metode FIA (NANO ENTEK FRENDTM) dan metode ECLIA (Cobas e601 Roche). Data dianalisis dengan SPSS versi 17 untuk Windows.
Hasil: Sebagian besar responden berusia 25-34 tahun (28,8%) dan berjenis kelamin perempuan (86,7%). Tidak terdapat perbedaan bermakna rerata kadar TSH pada pemeriksaan menggunakan metode ECLIA (0,60±0,79 mIU/L) maupun metode FIA (0,63±0,76 mIU/L) (p=0,639). Disamping itu, tidak juga terdapat perbedaan bermakna rerata kadar FT4 baik pada pemeriksaan menggunakan metode ECLIA (1,67±1,05 ng/dl) maupun metode FIA (1,69±1,72 ng/dl) (p=0,745).
Kesimpulan: Tidak ada perbedaan yang bermakna antara kadar TSH dan FT4 pada metode ECLIA dan FIA.
Faktor risiko yang mempengaruhi outcome pada pasien cedera kepala di RSUP Sanglah, Bali, Indonesia pada tahun 2018-2019
I Gede Sutawan, Sri Maliawan, I Wayan NiryanaOnline First: Aug 31, 2021
- Abstract
Faktor risiko yang mempengaruhi outcome pada pasien cedera kepala di RSUP Sanglah, Bali, Indonesia pada tahun 2018-2019
Background: Head injury or capitis trauma is a blunt/sharp force to the head or face resulting in temporary or persistent cerebral dysfunction. From a socio-economic point of view, the prognostic model by looking at baseline data on admission is an important factor in supporting cost-effective clinical decisions. This study aims to evaluate the risk factors that influence outcomes in head injury patients at Sanglah Hospital, Bali, Indonesia, in 2018-2019.
Method: Prospective cohort study to see the effect of risk factors for head injury patients (exposure) with the outcome in the form of unfavorable conditions within 7 days. This research was conducted at the Surgery Department and Emergency Room Sanglah Hospital Denpasar- Bali for 6 months from September 2018-February 2019. Data were analyzed using SPSS version 16 for Windows.
Results: Some of the factors significantly associated with and risk factors for the unfavorable outcome within 7 days in head injury patients who were treated at Sanglah General Hospital in 2018-2019 were hypotension, initial GCS 3-8, anisocoria pupil reflex, hypoxia, focal lesions, midline shift, and length of time operation ? 6 hours (p<0.05). Hypotensive blood pressure is the most dominant risk factor for the unfavorable outcome within 7 days of head injury patients admitted to Sanglah General Hospital (Adjusted OR: 5.4; 95% CI: 2.47-12.07; p=0.000).
Conclusion: Hypotensive blood pressure is the most dominant risk factor for the unfavorable outcome within 7 days of head injury patients treated at Sanglah General Hospital in 2018-2019.
Latar belakang: Cedera kepala atau trauma kapitis merupakan kekerasan tumpul/tajam pada kepala atau wajah yang berakibat disfungsi serebral sementara atau menetap. Dari sudut pandang sosioekonomi, model prognostik dengan melihat data awal saat masuk rumah sakit merupakan faktor penting dalam mendukung keputusan klinis yang cost-effective. Penelitian ini bertujuan untuk mengevaluasi faktor risiko yang mempengaruhi outcome pada pasien cedera kepala di RSUP Sanglah, Bali, Indonesia pada tahun 2018-2019
Metode: Studi kohort prospektif untuk melihat pengaruh faktor resiko yang dimiliki pasien cedera kepala (exposure) dengan hasil luaran (outcome) berupa kondisi unfavourable dalam 7 hari. Penelitian ini dilakukan di Bagian Bedah FK UNUD/SMF Bedah Saraf RSUP Sanglah, Denpasar-Bali dan Instalasi Rawat Darurat RS Sanglah Denpasar-Bali selama 6 bulan dari bulan September 2018-Februari 2019. Data dianalisis menggunakan SPSS versi 16 untuk Windows.
Hasil: Beberapa faktor yang berhubungan secara bermakna dan menjadi faktor risiko terjadinya outcome unfavorable dalam 7 hari pada pasien cedera kepala yang dirawat di RSUP Sanglah tahun 2018-2019 adalah hipotensi, GCS awal 3-8, reflek pupil anisokor, hipoksia, fokal lesi, midline shift, dan lama waktu tindakan operasi ? 6 jam (p<0,05). Tekanan darah hipotensi merupakan faktor risiko yang paling dominan terhadap outcome unfavorable dalam 7 hari pasien cedera kepala yang dirawat di RSUP Sanglah (Adjusted OR: 5,4; 95% IK: 2,47-12,07; p=0,000)
Kesimpulan: Tekanan darah hipotensi merupakan faktor risiko yang paling dominan terhadap outcome unfavorable dalam 7 hari pasien cedera kepala yang dirawat di RSUP Sanglah tahun 2018-2019.
Hubungan indeks platelet dengan derajat keparahan penyakit demam berdarah dengue pada anak di RSUD Wangaya
Valerie Michaela Wilhelmina, I Wayan Bikin Suryawan, Kadek SuarcaOnline First: Aug 31, 2021
- Abstract
Hubungan indeks platelet dengan derajat keparahan penyakit demam berdarah dengue pada anak di RSUD Wangaya
Background: Indonesia is an endemic country for Dengue Hemorrhagic Fever (DHF). Over 80% of children at age ?10 in Indonesia have been infected with dengue at least once. Dengue shock syndrome (DSS), as a severe clinical manifestation of DHF, has a high risk of mortality. The wide spectrum of dengue clinical manifestations poses a challenge to predict the progression of dengue infection into severe symptoms. Platelet indices (PI) are readily available laboratory parameters that mark the activity and quality of platelets. The purpose of this study is to investigate PI profile on pediatric DHF and the association with disease severity.
Methods: This is an analytical observational study with a cross-sectional design. Samples are obtained consecutively from secondary data of children diagnosed with DHF in Wangaya Regional Hospital. Chi-square analysis was used to assess the association between groups of platelet indices; mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR), and plateletcrit (PCT) with severity parameter, namely; DHF grade, length of hospitalization, shock, and bleeding.
Results: 150 subjects were included in the study. Bivariate analysis shows that MPV, PDW, and P-LCR does not correlate with any of the severity parameters. There is a significant correlation between PCT with the length of hospitalization (p=<0.001), shock (p=<0.001), and DHF grade (p=<0.001). PCT does not correlate with bleeding.
Conclusion: There is a significant association between PCT PI and several parameters of DHF severity. PCT can be considered to predict DHF grade, length of hospitalization, and shock.
Latar belakang: Indonesia merupakan negara endemis Demam Berdarah Dengue (DBD). Lebih dari 80% anak usia ?10 tahun di Indonesia telah terinfeksi dengue setidaknya satu kali. Sindrom syok dengue (SSD) sebagai manifestasi klinis berat dari DBD memiliki resiko kematian yang tinggi. Spektrum manifestasi klinis yang luas menjadi tantangan untuk memprediksi DBD yang akan berujung menjadi gejala berat. Indeks platelet (IP) merupakan parameter laboratorium yang mudah didapat dan menggambarkan aktivitas dan kualitas platelet. Tujuan dari studi ini adalah untuk mempelajari profil IP pada penyakit DBD anak dan hubungannya terhadap derajat keparahan penyakit.
Metode: Studi penelitian merupakan penelitian observasional analitik dengan desain potong lintang. Sampel diambil dari data sekunder pasien anak terdiagnosa DBD di unit rawat inap RSUD Wangaya dengan metode consecutive sampling. Analisis chi-square digunakan untuk menilai hubungan kelompok Indeks Platelet; mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR), dan plateletcrit (PCT) dengan parameter derajat keparahan yaitu grade DBD, lama rawat, syok, dan perdarahan.
Hasil: Sebanyak 150 subjek masuk dalam kriteria inklusi. Analisis bivariat menunjukkan MPV, PDW, dan PLCR tidak berhubungan dengan parameter derajat keparahan. Terdapat hasil signifikan PCT dengan lama rawat (p=<0,001), syok (p=<0,001), dan grade DBD (p=<0,001). PCT tidak berhubungan dengan perdarahan.
Kesimpulan: Terdapat hubungan bermakna antara IP PCT dengan beberapa parameter derajat keparahan DBD. PCT dapat dipertimbangkan untuk memprediksi derajat keparahan penyakit yaitu grade DBD, lama rawat, dan syok.
Karakteristik malnutrisi rumah sakit pada pasien anak di RSUP Sanglah, Bali, Indonesia
Hanzelina Hanzelina, I Gusti Lanang Sidiartha, I Gusti Ayu Putu Eka PratiwiOnline First: Aug 31, 2021
- Abstract
Karakteristik malnutrisi rumah sakit pada pasien anak di RSUP Sanglah, Bali, Indonesia
Background: Hospital Malnutrition (HM) is malnutrition diagnosed while being treated at the hospital either when admitted to the hospital, during treatment or even when discharged from the hospital, which is closely related to hospital care. The incidence of HM is still quite high and can increase morbidity and mortality among inpatient children. This study aims to determine the characteristics of in-hospital malnutrition cases in children undergoing treatment at Sanglah Hospital.
Methods: This study used a prospective cohort design using primary data obtained from interviews and anthropometry of 120 children hospitalized at Sanglah Hospital in the 2019-2020 period. HM was defined as a decrease in a Z-score of Weight/Height (W/H) > 0.5 Standard Deviation (SD) at the time of hospital discharge. Data were analyzed using SPSS version 20 for Windows.
Results: The incidence of HM was 47.1%, of which 54.0% of patients were female. The incidence of in-hospital malnutrition was primarily found in patients aged 1-3 years (50.0%) and >5 years (42.0%). Approximately 64.0% of children with HM were malnourished before being admitted to the hospital and 14.0% got parenteral nutrition. It was found that 72% of children with HM had a hospital stay length of > 7 days. More than half of children with HM (56.0%) have parents with low levels of education (less than secondary education) and 58.0% have more than 3 siblings.
Conclusion: The incidence of hospital malnutrition is more often found in girls, age >5 years old, malnutrition before admitted, get parenteral nutrition, had parents with low education levels, number of siblings > 3, had a single diagnosis and length of stay > 7 days.
Latar Belakang: Malnutrisi rumah sakit (MRS) adalah malnutrisi yang didiagnosis saat dirawat di Rumah Sakit (RS) baik saat masuk RS, selama perawatan atau bahkan saat pasien keluar dari rumah sakit yang erat kaitannya dengan perawatan di RS. Kejadian MRS masih cukup tinggi dan dapat meningkatkan morbiditas dan mortalitas pada anak yang dirawat. Penelitian ini bertujuan untuk mengetahui karakteristik dari kasus MRS pada anak yang menjalani perawatan di RSUP Sanglah.
Metode: Studi ini menggunakan desain kohort prospektif dengan menggunakan data primer dari wawancara dan pemeriksaan antropometri terhadap 120 anak yang dirawat inap di RSUP Sanglah pada periode 2019-2020. MRS didefinisikan sebagai penurunan Z-score Berat Badan/Tinggi Badan (BB/TB) > 0,5 Standard Deviation (SD) pada saat keluar RS. Data dianalisis dengan SPSS versi 25 untuk Windows.
Hasil: Kejadian MRS ditemukan sebanyak 47,1% dengan 54,0% sampel berjenis kelamin perempuan. Insidens MRS paling banyak ditemukan pada pasien kelompok usia 1-3 tahun (50,0%) dan >5 tahun (42,0%). Sebanyak 64,0% anak dengan MRS sudah mengalami malnutrisi sebelum masuk RS dan 14,0% mendapatkan nutrisi parenteral. Ditemukan bahwa 72,0% anak dengan MRS memiliki lama rawat di RS >7 hari. Lebih dari separuh anak dengan MRS (56,0%) memiliki orang tua dengan tingkat pendidikan rendah (<SMP) dan 58,0% memiliki jumlah saudara lebih dari > 3.
Kesimpulan: Insiden MRS lebih sering ditemukan pada anak perempuan, kelompok usia >5 tahun, malnutrisi sebelum masuk RS, mendapatkan nutrisi parenteral, memiliki orang tua dengan tingkat pendidikan rendah, jumlah saudara kandung > 3, serta memiliki diagnosis tunggal serta lama rawat > 7 hari.
Hubungan konsentrasi serum C-Reactive Protein dan D-dimer dengan derajat keparahan dan mortalitas pasien COVID-19
Kadek Surya Atmaja, Anak Agung Gede Oka Suta Wicaksana, I Wayan Angga Suarmerta Putra, Wayan Wahyu Semara PutraOnline First: Aug 31, 2021
- Abstract
Hubungan konsentrasi serum C-Reactive Protein dan D-dimer dengan derajat keparahan dan mortalitas pasien COVID-19
Background: Clinical features of COVID-19 are variably from asymptomatic, to severe symptoms including acute respiratory distress syndrome (ARDS), multiple organ failure, and death. A specific biomarker is needed to predict the possibility of COVID-19 patients fall into severe complications and disease severity. D-dimer and C-Reactive Protein (CRP) are biomarkers that are elevated in COVID-19 patients.
Method: This is an observational analytic study. The purpose of this research is to explore the correlation between D-dimer serum concentration and CRP with disease severity and mortality in hospitalized COVID-19 patients. This research used secondary data from a medical record with inclusion criteria patient more than 18 years old, confirmed COVID-19 by real-time Polymerase chain reaction (rt-PCR), that hospitalized in Wangaya General Hospital during July 2020 until December 2020.
Result: Statistical analysis show that there is significant mean difference between D-dimer and CRP concentration based on COVID-19 disease severity (p <0.001 dan p <0.001). AUC value on ROC curve for CRP and D-dimer concentration in predict the mortality of COVID-19 patient are 0.88 (p <0.001, 95% CI: 0.829 – 0.48) and 0.88 (p < 0.001, 95% CI = 0.821 – 0.950) respectively. In this research, serum D-dimer with concentration more than 4,181 ng/mL statistically significant affect the mortality of COVID-19 patient (OR = 11.713; CI = 1.620 - 84.682; p = 0.015). CRP concentration statistically is not significant affect the mortality of COVID-19 patient.
Conclusion: There is a statistically mean difference in both D-dimer and CRP concentration based on COVID-19 disease severity. D-dimer concentration of more than 4,181 ng/mL significantly affects the COVID-19 mortality. CRP concentration is not correlated with COVID-19 mortality
Latar Belakang: Fitur klinis pasien dengan COVID-19 bervariasi dari tanpa gejala maupun dengan gejala ringan hingga terjadinya acute respiratory distress syndrome (ARDS), gagal multi organ, dan kematian. Dibutuhkan suatu biomarker yang dapat digunakan dalam memprediksi kemungkinan pasien yang akan jatuh kedalam derajat penyakit maupun komplikasi yang berat. D-dimer dan C-Reactive Protein (CRP) merupakan biomarker yang diketahui meningkat pada pasien COVID-19.
Metode: Penelitian ini merupakan penelitian analitik observasional, yang bertujuan untuk mengetahui hubungan konsentrasi D-dimer serum dan CRP dengan derajat keparahan dan mortalitas pasien COVID-19 yang dirawat inap. Penelitian ini menggunakan data sekunder yang bersumber dari rekam medis dengan kriteria inklusi pasien usia diatas 18 tahun dengan diagnosis terkonfirmasi COVID-19 dengan real-time Polymerase chain reaction (rt-PCR), yang dirawat inap di RSUD Wangaya Denpasar periode Juli 2020 hingga Desember 2020.
Hasil: Hasil uji statistik menunjukan terdapat perbedaan rerata konsentrasi D-dimer dan CRP berdasarkan derajat keparahan pasien COVID-19 yang bermakna secara statistik (p <0,001 dan p <0,001). Nilai AUC kurva ROC konsentrasi CRP dan D-dimer dalam memprediksi mortalitas pasien secara berturut-turut didapatkan sebesar 0.88 (p <0,001, 95% IK: 0,829 – 0,48 ) dan 0.88 (p <0,001, 95% IK: 0,821 – 0,950). D-dimer serum dengan konsentrasi diatas 4.181 ng/mL pada penelitian ini terbukti secara statistik bermakna mempengaruhi mortalitas pasien COVID-19 (OR OR 11,713; IK:1,620-84,682; p=0,015). Konsentrasi CRP serum tidak terbukti secara statistik bermakna dalam mempengaruhi mortalitas pasien COVID-19.
Simpulan: Terdapat perbedaan rerata yang bermakna secara statistik konsentrasi serum D-dimer dan CRP berdasarkan derajat keparahan penyakit COVID-19. Konsentrasi serum D-dimer diatas 4.181 ng/mL terbukti mempengaruhi mortalitas pasien dengan COVID-19 secara bermakna. Konsentrasi CRP tidak berhubungan terhadap mortalitas pada pasien COVID-19.
Karakteristik pasien kanker kulit non-melanoma di RSUP Sanglah pada periode tahun 2014 - 2018
I Gusti Agung Ivan Yogiswara, Herman Saputra, Ni Putu EkawatiOnline First: Aug 31, 2021
- Abstract
Karakteristik pasien kanker kulit non-melanoma di RSUP Sanglah pada periode tahun 2014 - 2018
Background: Skin cancer is a disease caused by changes in the properties of the constituent skin cells from normal to malignant. There are 3 most common types of skin cancer: Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), and malignant melanoma. This study aims to determine the clinicopathological characteristics of non-melanoma skin cancer patients, especially BCC and SCC, at Sanglah General Hospital, Denpasar, in 2014 – 2018.
Methods: This study is a retrospective descriptive study. Clinicopathological data of non-melanoma skin cancer patients were obtained from the histopathological examination archive at the Anatomical Pathology Laboratory of Sanglah General Hospital from 2014 – 2018. Data were analyzed using SPSS version 20 for Windows.
Results: During 2014 – 2018, there were 100 patients with non-melanoma skin cancer at Sanglah Hospital. Based on histopathological type, there were 39 cases (39.0%) of BCC and 61 cases (61.0%) of SCC. BCC was predominant in the age group above 70 years (33.33%) and the highest type of SCC in the age group 50-59 years (32.79%). Based on gender, BCC is more frequent in women by 53.85% and SCC is more frequent in men by 54.10%.
Conclusion: The highest non-melanoma skin cancer cases were SCC with age more than 50 years and were more commonly found in men.
Latar Belakang: Kanker kulit adalah salah satu penyakit yang diakibatkan oleh berubahnya sifat-sifat penyusun sel kulit yang awalnya normal menjadi ganas. Terdapat 3 jenis kanker kulit yang tersering, yaitu Karsinoma Sel Basal (KSB), Karsinoma Sel Skuamosa (KSS), dan melanoma maligna. Tujuan penelitian ini adalah untuk mengetahui karakteristik klinikopatologi pasien kanker kulit non-melanoma khususnya karsinoma sel basal dan karsinoma sel skuamosa di RSUP Sanglah Denpasar pada periode tahun 2014 – 2018.
Metode: Penelitian ini adalah penelitian deskriptif retrospektif. Data klinikopatologi pasien kanker kulit non-melanoma diperoleh dari arsip pemeriksaan histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah Denpasar tahun 2014 – 2018. Data dianalisis dengan SPSS versi 20 untuk Windows.
Hasil: Selama periode tahun 2014 – 2018 terdapat 100 pasien kanker kulit non-melanoma. Berdasarkan tipe histopatologi, terdapat 39 kasus (39,00%) KSB dan 61 kasus (61,00%) KSS. KSB ditemukan terbanyak pada kelompok usia diatas 70 tahun (33,33%) dan tipe KSS terbanyak pada kelompok usia 50-59 tahun (32,79%). Berdasarkan jenis kelamin, KSB lebih banyak pada perempuan sebesar 53,85% dan KSS lebih banyak pada laki – laki sebesar 54,10%.
Kesimpulan: Kasus kanker kulit non-melanoma tertinggi adalah KSS dengan usia lebih dari 50 tahun dan lebih banyak ditemukan pada laki – laki.
The comparison of Body Mass Index (BMI) and Muscle Mass Index (MMI) as a mortality predictor in patients with malignant jaundice at Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Briand Iggreinus Pollah, Adeodatus Yuda Handaya, Agus BarmawiOnline First: Aug 31, 2021
- Abstract
The comparison of Body Mass Index (BMI) and Muscle Mass Index (MMI) as a mortality predictor in patients with malignant jaundice at Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Background: Jaundice is found to be a clinical manifestation of malignancy. Around 70% of all jaundice cases are caused by malignancy. Another complication of malignancy is decreasing the Muscle Mass Index (MMI), also called sarcopenia. MMI in malignant jaundice increases the mortality rate. Body Mass Index (BMI) is describing the nutritional status of a person. Due to malnutrition, morbidity and mortality increase. This study aims to compare the MMI and BMI in patients with malignant jaundice to predict the outcome of mortality
Methods: This study is a retrospective cross sectional non-experimental epidemiologic analysis. Samples were taken from medical reports at Sardjito Hospital from April 2019 - March 2020. A CT scan calculated MMI at the third lumbar vertebrae. BMI was evaluated by body weight (kg) divided by height (m) square (kg/m2). Data were analyzed using SPSS version 20 for Windows.
Results: Most of respondents were males (55.0%), following by age > 50 (62.5%), stage 3 (62.5%), ASA 2 (92.5%), albumin < 3.5 g/dL (82.5%), CA19-9 > 37 U/ml (57.5%), CEA < 5 ng/ml (62.5%), and total bilirubin > 1.5 mg/dL (90.0%), normal BMI (62.5%), survive (77.5%), and low MMI (72.5%). There was no significant relationship between MMI (OR: 5.71; 95%CI: 0.60-134.12) and BMI (OR: 0.15; 95%CI: 0.02-1.34) to the mortality risk (p>0.05).
Conclusion: MMI had a higher incidence of mortality compared to BMI in malignant jaundice. However, there was no significant relationship between MMI and BMI to predict mortality.
Hubungan ASI eksklusif dengan angka kejadian diare pada anak usia 6 – 24 bulan di RSUD Wangaya
Andrew Permana Suliarta, I Wayan Bikin Suryawan, Anak Agung Made SuciptaOnline First: Aug 31, 2021
- Abstract
Hubungan ASI eksklusif dengan angka kejadian diare pada anak usia 6 – 24 bulan di RSUD Wangaya
Background: Diarrhea is a gastrointestinal tract disease with the highest incidence rate and the most common cause of death in children under five years old. Based on Riskesdas 2013, the prevalence of diarrhoea in Indonesia is between 1 – 4 years old. Diarrhea is particularly common in developing countries due to inadequate sanitation and hygiene, including a lack of safe, clean water for drinking and a lack of concern for nutrition and overall health. The risk of diarrhoea in children is also influenced by the pattern of breastfeeding. Exclusive breastfeeding in infants is known to protect the babies against diarrhea.
Methods: This is an observational study where the data was collected from inpatient medical records between January – December 2019. This study was conducted analytically using a retrospective cross-sectional design. For sampling, a systematic random sampling technique was used. In this study, univariate analysis was used to get the distribution and the proportion of each variable. The relationship between exclusive breastfeeding and the incidence of diarrhea was analyzed using chi-square. Statistical analysis was performed in a 95% coefficient interval (alpha = 0.05).
Results: Fifty-six patients were enrolled after meeting the inclusion criteria; 58.3% are male. The number of children who had diarrhea was 36 (64.3%), from that number 38.9% are aged 6 to 12 months, and 61.1% are aged 13 to 24 months. Children who have received exclusive breastfeeding were 22 children (39.3%). There is a relationship between exclusive breastfeeding to the incidence rate of diarrhea in children aged 6-24 months (p= 0.003). To determine the relative risk estimation using prevalence ratio (RP), with the study calculation obtained 0.51 (< 1).
Conclusion: There is a significant relationship between exclusive breastfeeding and the incidence of diarrhea in children aged 6-24 months. The prevalence ratio results in 0.51 it tells that exclusive breastfeeding is a protective factor against diarrhea.
Latar Belakang: Diare adalah salah satu penyakit sistem pencernaan yang memiliki angka kejadian tertinggi dan paling sering menyebabkan kematian pada anak berusia dibawah lima tahun. Faktor risiko diare pada anak juga dipengaruhi oleh pola pemberian ASI eksklusif. ASI eksklusif diketahui memiliki efek perlindungan pada bayi terhadap diare. Penelitian ini bertujuan untuk membuktikan adanya hubungan antara pemberian ASI eksklusif dengan angka kejadian diare pada anak usia 6 – 24 bulan.
Metode: Penelitian ini merupakan penelitian observasional yang mengambil data dari rekam medis pasien anak berusia 6 – 24 bulan yang rawat inap bulan Januari – Desember 2019 di ruang Kaswari RSUD Wangaya. Penelitian ini dilakukan secara analitik menggunakan desain cross-sectional retrospektif. Untuk pengambilan sampel menggunakan cara systematic random sampling. Pengolahan dan analisis data dilakukan secara bertahap yaitu dengan melakukan analisis univariat untuk memperoleh distribusi dan proporsi dari variabel-variabel yang diteliti serta analisis bivariat dengan uji statistik chi-square. Analitik yang dilakukan menggunakan interval kepercayaan 95% (alpha = 0,05).
Hasil: Terdapat lima puluh enam sampel yang memenuhi kriteria inklusi, 58,3% diantaranya adalah laki-laki. Angka kejadian diare yang terjadi pada anak sebanyak 36 (64,3%), dari angka tersebut 38,9% berusia 6 – 12 bulan dan 61,1% berusia 13 – 24 bulan. Anak yang mendapat ASI eksklusif sebanyak 22 anak (39,3%). Dari hasil penelitian ini didapatkan hubungan antara ASI Eksklusif dengan angka kejadian diare pada anak usia 6 – 24 bulan (p = 0,003). Rasio prevalensi pada penelitian ini didapatkan sebesar 0,51 (< 1).
Kesimpulan: Terdapat hubungan yg signifikan antara ASI eksklusif dengan angka kejadian diare pada anak usia 6 – 24 bulan. Dari hasil rasio prevalensi 0,51, menunjukkan bahwa anak yang mendapatkan ASI eksklusif memiliki risiko mengalami diare lebih rendah yaitu 0,51 kali apabila dibandingkan dengan anak yang tidak mendapat ASI eksklusif.
Adverse skin reactions of healthcare workers using N95 mask and latex gloves at Kasih Ibu Denpasar General Hospital Bali Indonesia during coronavirus disease 2019 (COVID-19) pandemic – a descriptive study
Firly Clarissa Suyanto, Ariana Ariana, Ni Made Dwi PuspawatiOnline First: Jul 1, 2021
- Abstract
Adverse skin reactions of healthcare workers using N95 mask and latex gloves at Kasih Ibu Denpasar General Hospital Bali Indonesia during coronavirus disease 2019 (COVID-19) pandemic – a descriptive study
Introduction: Corona virus disease 2019 (COVID-19), caused by SARS-CoV-2, was first identified in Wuhan, Hubei Province, China in December 2019. World Health Organization (WHO) then officially declared the disease as a global pandemic in March 2020. It has rapidly spread throughout the world, causing a huge burden to the health sector. With the increasing number of cases, healthcare workers (HCWs) were exposed to the regular use of personal protective equipment (PPE) such as N95 masks, latex gloves, and gowns. As a result of long term use of PPE, many adverse skin reactions may occur. Hence, this study aims to determine the adverse skin reactions among healthcare workers using PPE.
Method: This study is a cross-sectional descriptive study conducted at Kasih Ibu Denpasar General Hospital Bali Indonesia. Questionnaires were used for the research. A total of 45 valid questionnaires were collected, with the majority being women (88.9%) and with an age range of 20 – 30 years old (55.6%).
Result: The result showed that the most common adverse skin reactions among HCWs wearing N95 masks were indentation and ear pain (73.3%) and nasal bridge scarring (48.9%). The most common adverse skin reactions among HCWs wearing latex gloves were dry skin (46.7%) and skin soaked with sweat (17.8%).
Conclusion: Our study explored the adverse skin reactions due to long term use of PPE, N95 mask and latex gloves in particular. These adverse skin reactions are mostly mild because they continue using PPE.
Hubungan penyakit komorbiditas terhadap derajat klinis COVID-19
Kadek Wisnu Segara Karya, I Made Suwidnya, Beny Surya WijayaOnline First: Aug 31, 2021
- Abstract
Hubungan penyakit komorbiditas terhadap derajat klinis COVID-19
Pendahuluan: Coronavirus Disease 2019 (COVID-19) adalah penyakit infeksi virus yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Komorbiditas merupakan faktor risiko keparahan dan mortalitas pada pasien COVID-19. Tingginya prevalensi COVID-19 disertai dengan variasi klinis yang luas mengindikasikan bahwa telaah prediktor derajat klinis COVID-19 sangat diperlukan
Metode: Penelitian analitik potong lintang dilakukan di Rumah Sakit Bhayangkara Denpasar. Data demografi dan klinis pasien rawat inap usia usia ?18 tahun dengan COVID-19 dikumpulkan pada periode Agustus 2020-Januari 2021 dengan metode Total Sampling. Kriteria inklusi meliputi pasien usia ?18 tahun yang menjalani rawat inap dengan diagnosis COVID-19 yang terkonfirmasi dengan pemeriksaan RT-PCR SARS-CoV-2. Sampel dikategorikan menjadi derajat berat-kritis dan sedang. Analisis data dilakukan secara deskriptif dan analitik
Hasil: Terdapat 153 pasien COVID-19 dengan rerata usia 47±15 tahun dan mayoritas laki-laki (60%). Sebagian besar pasien mengalami gejala sedang (77,1%). Gejala utama meliputi demam (71,9%), sesak (16,3%) dan batuk (7,2%). Sebagian pasien memiliki komorbiditas (42,8%). Komorbiditas yang ada paling banyak ditemukan adalah hipertensi (21,6%) dan diabetes melitus (17,6%), diikuti dengan gagal ginjal kronis (5,9%) dan penyakit jantung (4,6%). Sebagian besar pasien (71,9%) menunjukkan hasil bacaan x-ray thorax normal. Mayoritas pasien tidak dirujuk (86,3%) dengan median lama rawat inap 12,5 hari. Hanya 2% pasien yang meninggal. Hasil analisis bivariat menunjukkan pasien dengan usia >50 tahun, adanya komorbid dan gambaran x-ray thorax abnormal berhubungan dengan derajat berat-kritis. Komorbiditas hipertensi, diabetes melitus dan gagal ginjal kronik yang masing-masing berhubungan dengan derajat klinis COVID-19 berat-kritis. Pada analisis multivariat hanya gambaran x-ray thorax abnormal dan adanya penyakit komorbiditas yang berhubungan dengan derajat klinis COVID-19 berat-kritis.
Simpulan: Adanya penyakit komorbid hipertensi, diabetes melitus, penyakit ginjal kronis disertai gambaran x-ray thoraks abnormal merupakan faktor prediktor infeksi COVID-19 derajat berat-kritis.
Introduction: Coronavirus Disease 2019 (COVID-19) is a viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Comorbidity is a risk factor for severity and mortality in COVID-19. The high prevalence of COVID-19 accompanied by a wide clinical variation makes determining the predictors of COVID-19 clinical severity an important endeavor.
Methods: A cross-sectional study was conducted at Bhayangkara Hospital Denpasar. Demographic and clinical data of inpatients aged 18 years with COVID-19 were collected from August 2020-January 2021 with the total sampling method. Inclusion criteria included 18 years of age hospitalized with a confirmed COVID-19 diagnosis by SARS-CoV-2 RT-PCR examination. The samples were categorized into severe-critical and moderate infection. Data was analyzed in both descriptive and analytics manner.
Results: There were 153 COVID-19 patients with an average age of 47±15 years, and the majority were male (60%). Most experienced moderate symptoms (77.1%). The main symptoms included fever (71.9%), shortness of breath (16.3%) and cough (7.2%). Almost half had comorbidities (42.8%). The most common were hypertension (21.6%) and diabetes mellitus (17.6%), followed by chronic kidney disease (5.9%) and heart disease (4.6%). Most of the patients (71.9%) had a normal chest x-ray. Most patients did not need a referral (86.3%) and were treated with a median length of stay of 12.5 days. The mortality rate was 2%. The results of bivariate analysis showed that patients aged >50 years, comorbidities and abnormal chest x-rays were associated with severe infection. Comorbidities of hypertension, diabetes mellitus and chronic kidney disease were associated with severe-critical infection. In the multivariate analysis, only abnormal chest x-ray images and the presence of comorbid diseases were associated with the clinical degree of severe-critical COVID-19.
Conclusion: The presence of comorbid hypertension, diabetes mellitus, chronic disease accompanied by an abnormal chest x-ray was a predictor of severe-critical COVID-19 infection.
Faktor-faktor yang berhubungan dengan kinerja pegawai administrasi rumah sakit di era new normal
Ellen Deivi Tamuntuan, Starry Homenta Rampengan, Oksfriani Jufri Sumampouw, Aaltje Elleb ManampiringOnline First: Aug 31, 2021
- Abstract
Faktor-faktor yang berhubungan dengan kinerja pegawai administrasi rumah sakit di era new normal
Background: Administrative employees as non-health workers in hospitals must provide excellent service so that organizational goals can be achieved, even though there are changes in the employee work system in this new normal era. Employee performance can be determined by factors related to performance, namely work discipline, motivation, leadership style, and work environment. This study aims to analyze the factors related to the performance of the administrative staff of the Ratatotok Buyat Central General Hospital (RSUP) in the new normal era.
Methods: This study is an analytical study with a cross-sectional approach. This research was conducted at Ratatotok Buyat Hospital in May-June 2021. The research sample consisted of 50 respondents. The research instrument is a questionnaire that has been tested for validity and reliability—research data obtained through closed interviews. The data obtained were analyzed by univariate, bivariate, and multivariate. We used bivariate analysis using Pearson correlation test and multivariate analysis using multiple linear regression, with =0.05.
Results: The results of this study indicate that the majority of the respondents are female (58%), aged 20-35 years (62%), have undergraduate education (72%), and have worked 6-10 years (52%). In addition, the results obtained in this study are work discipline, work motivation, leadership style, and work environment, p <0.05. The most influential factor on the performance of the administrative staff of Ratatotok Buyat Hospital is the work discipline variable (B=0.520). This study also obtained an R-square value of 0.661, which means work discipline, work motivation, leadership style, and work environment influence 66.1% on performance.
Conclusion: There is a significant and positive relationship between work discipline, work motivation, leadership style, and work environment with the performance of administrative employees. The most influential variable is work discipline.
Latar belakang: Pegawai administrasi sebagai tenaga non kesehatan di rumah sakit harus mampu memberikan pelayanan prima agar tujuan organisasi dapat tercapai, meskipun terdapat perubahan pada sistem kerja pegawai di era new normal ini. Kinerja pegawai dapat ditentukan oleh faktor-faktor yang berhubungan dengan kinerja yaitu disiplin kerja, motivasi, gaya kepemimpinan dan lingkungan kerja. Tujuan penelitian ini yaitu untuk menganalisis faktor-faktor yang berhubungan dengan kinerja pegawai administrasi Rumah Sakit Umum Pusat (RSUP) Ratatotok Buyat di era new normal.
Metode: Penelitian ini merupakan penelitian analitik dengan pendekatan potong lintang. Penelitian ini dilaksanakan di RSUP Ratatotok Buyat pada bulan Mei-Juni 2021. Sampel penelitian berjumlah 50 responden. Instrumen penelitian yaitu kuesioner yang telah diuji validitas dan reliabilitas. Data penelitian diperoleh melalui wawancara tertutup. Data yang diperoleh dianalisis secara univariat, bivariat dan multivariat. Analisis bivariat menggunakan uji korelasi pearson dan analisis multivariat menggunakan uji regresi linear berganda, dengan ?=0,05.
Hasil: Hasil penelitian ini menunjukkan bahwa responden paling banyak berjenis kelamin perempuan (58%), berusia 20-35 tahun (62%), berpendidikan sarjana/S1 (72%) dan masa kerja 6-10 tahun (52%). Selain itu hasil yang diperoleh dalam penelitian ini yaitu disiplin kerja, motivasi kerja, gaya kepemimpinan dan lingkungan kerja nilai p<0,05. Faktor yang paling berpengaruh terhadap kinerja pegawai administrasi RSUP Ratatotok Buyat yaitu variabel disiplin kerja (B=0,520). Diperoleh juga dalam penelitian ini nilai R2 sebesar 0,661 yang berarti disiplin kerja, motivasi kerja, gaya kepemimpinan dan lingkungan kerja memiliki pengaruh sebesar 66,1% terhadap kinerja.
Kesimpulan: Terdapat hubungan bermakna dan positif antara disiplin kerja, motivasi kerja, gaya kepemimpinan dan lingkungan kerja dengan kinerja pegawai administrasi. Variabel yang paling berpengaruh yaitu disiplin kerja.