Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Seorang penderita syok anafilaksis dengan allergic myocardial infarction (kounis syndrome)
I Putu Ary Wismayana, I Ketut SuardamanaOnline First: Dec 30, 2021
- Abstract
Seorang penderita syok anafilaksis dengan allergic myocardial infarction (kounis syndrome)
Background: Kounis syndrome (KS) is defined as the concurrence of acute coronary syndromes associated with mast-cell and platelet activation in the setting of allergic or anaphylactic insults. Prevalence of KS is considered rare, estimated 1.1% of hospitalized allergic reaction patient, with mortality rate 7%.
Case Report: Case of 39 years old male without history of coronary artery disease, having dyspnea, chest discomfort, and pruritus after eating skipjack tuna. 12 lead electrocardiogram showing ST depression segment on lead II, III, and aVF. Patient diagnose as Kounis syndrome variant type I. Treatment of Kounis Syndrome begins with cessation of the causative agent. After therapy using epinephrine and intravenous corticosteroid, clinical improvement was achieved, and ST segment depression on electrocardiogram resolved.
Conclusion: Kounis syndrome is a rare disorder which need careful assessment and swift management. The diagnosis confirmed with sign and symptoms of allergic along with disorder in cardiovascular system.
Latar Belakang: Kounis Syndrome (KS) didefinisikan sebagai sindrom koroner akut yang terjadi bersamaan dengan aktivasi sel mast dan trombosit dalam keadaan alergi atau anafilaksis. Prevalensi KS tergolong jarang, diperkirakan 1,1% dari pasien reaksi alergi yang dirawat di rumah sakit, dengan angka kematian 7%.
Laporan Kasus: Laki-laki 39 tahun tanpa riwayat penyakit jantung koroner, sesak nafas, rasa tidak nyaman di dada, dan pruritus setelah makan ikan cakalang. Elektrokardiogram 12 sadapan menunjukkan segmen depresi ST pada sadapan II, III, dan aVF. Diagnosis pasien sebagai sindrom Kounis varian tipe I. Pengobatan Sindrom Kounis dimulai dengan penghentian agen penyebab. Setelah terapi menggunakan epinefrin dan kortikosteroid intravena, perbaikan klinis dicapai serta depresi segmen ST pada elektrokardiogram teratasi.
Simpulan: Kounis syndrome adalah kelainan langka yang membutuhkan penilaian yang cermat dan penanganan yang cepat. Diagnosis ditegakkan dengan adanya tanda dan gejala alergi disertai gangguan pada sistem kardiovaskular.
Androgenetic alopecia in woman treated with botulinum toxin
Henny Wijaya, Ketut Kwartantaya WinayaOnline First: Dec 30, 2021
- Abstract
Androgenetic alopecia in woman treated with botulinum toxin
Background: Androgenetic alopecia (AGA) is the most common type of alopecia. AGA in women is called Female Pattern Hair Loss (FHPL). FHPL occurs in 50% of adolescence women.
Case Description: A 29-year-old woman presented with hair thinning on the top of her head in the last 3 years. Dermatological status in the parietal region showed a diffuse and ill-define patch of alopecia, and hair thinning was found along the midline of the scalp. The hair pull test in frontal, temporal, and parietal regions was negative. The Severity of Alopecia Tool (SALT) score is 10, and patient belonged to stage 2 according to The Sinclair Scale. Dermoscopy examination revealed scattered white dots over the vertex of the scalp with various hair diameters. Miniaturized hair and vellus hair were found in several areas. The ratio of terminal to vellus hair was 20:6 or 3:1. Injection of 100-unit botulinum toxin in the alopecia area was done every 3 months. After 1 month of treatment, the hair thinning was reduced.
Conclusion: Appropriate treatment will affect the prognosis of AGA patients. Appropriate treatment that based on the pathophysiology of the disease and the patient's genetics will provide a good therapeutic response.
Anak laki-laki usia 4 tahun dengan paraparesis lower motor neuron, gizi kurang, pendek, dan masalah makan di RS tipe B: sebuah laporan kasus
Fitriana Melinda, Made Ratna DewiOnline First: Dec 30, 2021
- Abstract
Anak laki-laki usia 4 tahun dengan paraparesis lower motor neuron, gizi kurang, pendek, dan masalah makan di RS tipe B: sebuah laporan kasus
Background: Paralysis is a symptom of various diseases, disorders, or certain conditions, ranging from mild to severe and can be caused by infectious processes, trauma, malignancies, autoimmune diseases, and other abnormal processes. Eating problems in children is one of the developmental disorders that can occur in healthy infants or children. Eating problems have the potential to cause cognitive and behavioral disorders, and are associated with anxiety disorders and eating disorders in children, adolescents, and young adults.
Case description: A 4 years 2 months old male, complained not being able to walk and his legs shrinking since 2 weeks of SMRS. His male cousin has experienced paralysis of the right leg since the 3rd grade of elementary school. There were multiple enlarged right inguinal lymph nodes accompanied by refusal to take meal for the past 3 months. Neurological examination found normal energy in all four extremities but decreased patellar and achilles reflex. Body weight (BW) was 11 kg, body length (BL) 94 cm, BW/BL (-3) - (-2) SD (wasted). Leukocytes 6.4/ul, hemoglobin 11.0 g/dl, hematocrit 33.3%, MCV 69.4 fl, MCH 22.9 pg, MCHC 33.0 g/L, platelets 396.000 /ul, ESR 41 mm / hours, CRP 11 mg/L and CK 1,441 U/L. Radiological examination of lumbosacral photo showed the impression of paraspinal muscle spasm. The patient diagnose with lower motor neuron paraparesis.
Conclusion: Handling of patients with eating problems and LMN paraparesis is given non-medical management by meeting fluid needs, nutrition according to patient needs and education about feeding rules to the patient's parents, consultation with psychologists, and medical rehabilitation seek treatment. improvement of eating problems and medical problems in the form of weak legs more optimally.
Latar belakang: Kelumpuhan adalah gejala dari berbagai penyakit, kelainan, atau kondisi tertentu, mulai dari yang ringan sampai berat, yang disebabkan oleh proses infeksi, trauma, keganasan, penyakit autoimun, dan proses abnormal lainnya. Masalah makan pada anak merupakan salah satu gangguan perkembangan yang dapat terjadi pada bayi atau anak sehat. Selain itu, masalah makan berpotensi menyebabkan gangguan kognitif dan perilaku, serta dikaitkan dengan gangguan cemas dan kelainan makan pada anak, remaja, dan dewasa muda.
Deskripsi kasus: Anak laki-laki berusia 4 tahun 2 bulan, keluhan tidak bisa berjalan dan kaki mengecil sejak 2 minggu SMRS. Kakak sepupu laki-laki dari ibu pasien mengalami kelumpuhan kaki kanan sejak kelas 3 SD. Ditemukan adanya pembesaran kelenjar getah bening inguinal dekstra multipel disertai tidak mau makan sejak 3 bulan lalu. Pemeriksaan neurologis didapatkan tenaga normal pada keempat ekstremitas namun penurunan refleks fisiologis kniepeesreflex (KPR) dan achillespeesreflex (APR). Status antropometri yaitu BB 11 kg, PB 94 cm, BB/PB (-3)-(-2) SD (wasted). Leukosit 6.4 /ul, hemoglobin 11.0 g/dl, hematokrit 33,3%, MCV 69,4 fl, MCH 22,9 pg, MCHC 33,0 g/L, trombosit 396.000/ul, LED 41 mm/jam, CRP 11 mg/L dan CK 1,441 U/L. Radiologi lumbosakral antero-posterior/lateral didapatkan kesan paraspinal muscle spasm. Pasien didiagnosis paraparesis lower motor neuron (LMN).
Simpulan: Penanganan pasien dengan anak dengan masalah makan dan paraparesis LMN diberikan penatalaksanaan non-medikamentosa dengan pemenuhan kebutuhan cairan, nutrisi sesuai kebutuhan pasien dan edukasi mengenai feeding rules kepada orang tua pasien, konsultasi dengan psikolog, serta rehabilitasi medik untuk mengupayakan perbaikan masalah makan dan masalah medis berupa kaki lemas dengan lebih maksimal.
Diagnosis dan penatalaksanaan nodul tiroid tunggal: Sebuah laporan kasus
Nyoman Pramudita, Anak Agung Gede Budhi KusumaOnline First: Sep 10, 2021
- Abstract
Diagnosis dan penatalaksanaan nodul tiroid tunggal: Sebuah laporan kasus
Background: Thyroid nodules are abnormal lesions in the form of masses or nodules found in thyroid tissue. Thyroid nodules have a prevalence of about 8% in the adult population. A single thyroid nodule is asymptomatic and is generally discovered incidentally on physical examination or imaging. Diagnosis is made by physical examination, imaging examination and cytopathological examination. The management of a single thyroid nodule can be done by providing interventional therapy and surgery. The purpose of this case report is to describe the diagnosis and management of a single thyroid nodule case in Wangaya General Hospital.
Case description: A 52-year-old male patient came to the Surgical Clinic at Wangaya General Hospital with complaints of a lump on the left neck in the past eight months. The lump is felt to be enlarged and painless. The patient's diagnosis was confirmed by cytologic examination, which revealed a follicular nodule with a benign tendency. The patient was given surgical therapy in the form of left thyroidectomy.
Conclusion: Single thyroid nodule is quite rare. Treatment of a single thyroid nodule was adjusted according to the results of the cytologic examination. The prognosis for a single thyroid nodule with benign cytology results is generally reasonable. However, it is necessary to follow-up the patient considering the false negative value of the cytological examination.
Latar belakang: Nodul tiroid adalah lesi abnormal berupa massa atau nodul yang terdapat dalam jaringan tiroid. Nodul tiroid memiliki prevalensi sekitar 8% pada populasi dewasa. Nodul tiroid tunggal bersifat asimtomatik dan umumnya ditemukan secara tidak sengaja saat pasien melakukan pemeriksaan fisik atau pencitraan. Penegakan diagnosis dilakukan dengan pemeriksaan fisik, pemeriksaan pencitraan dan pemeriksaan sitopatologi. Penatalaksanaan nodul tiroid tunggal dapat dilakukan dengan pemberian terapi intervensi dan pembedahan. Tujuan pelaporan kasus ini adalah untuk menjabarkan diagnosis dan penatalaksanaan pada salah satu kasus nodul tiroid tunggal di RSUD Wangaya.
Deskripsi kasus: Seorang pasien laki-laki berusia 52 tahun datang ke Poli Bedah RSUD Wangaya dengan keluhan benjolan pada leher kiri sejak 8 bulan yang lalu. Benjolan dirasakan membesar dan tidak nyeri. Diagnosis pasien ini dikonfirmasi melalui pemeriksaan sitologi yang menunjukkan suatu nodul folikular dengan kecenderungan ke arah jinak. Pasien diberikan terapi pembedahan berupa tiroidektomi sinistra.
Simpulan: Nodul tiroid tunggal cukup jarang terjadi. Terapi nodul tiroid tunggal disesuaikan dengan hasil pemeriksaan sitologi. Prognosis nodul tiroid tunggal dengan hasil sitologi jinak umumnya baik, namun perlu dilakukan follow-up terhadap pasien menimbang nilai negatif palsu dari pemeriksaan sitologi.
Diagnosa dan Tatalaksana pada Hemoroid Derajat IV: Laporan Kasus
Ni Nyoman Amik Indrayani, Agung Aditya Arnaya, Kevin Kristanto Wiguna, Ida Bagus Putu WiyasaOnline First: Oct 9, 2021
- Abstract
Diagnosa dan Tatalaksana pada Hemoroid Derajat IV: Laporan Kasus
Background : Hemorrhoids affect millions of people around the world and become one of the main medical and socioeconomic problems Hemorrhoids are symptomatic widening of the hemorrhoidal plexus and distal displacement of the normal cushion. This case report aims to discuss cases of hemorrhoids from diagnosis to management.
Case Report: A 30-year-old male came with complaints of fresh blood discharge during defecation. Complaints have been felt for 1 month ago and have worsened for 1 day before being admitted to the hospital. On local examination in the anal region, there was a mass with an irregular shape around the anal, some of which were blackish red in color and partly the same color as the surrounding skin with a diameter of 3 cm. On palpation, the mass was palpable, firm, tenderness, the mass could not be given with a finger. Based on the history and physical examination, the patient was diagnosed with grade IV internal hemorrhoids and an open hemorrhoidectomy (Miligan-Morgan method) was planned.
Conclusion: The diagnosis of hemorrhoids is obtained from the patient's medical history, physical examination and supporting examinations. Therapeutic management of hemorrhoids can be in the form of animation and surgery.
Latar Belakang : Hemoroid mengenai jutaan orang diseluruh dunia dan menjadi salah satu masalah medis utama dan masalah sosioekonomi Hemoroid adalah pelebaran simptomatis dari pleksus hemoroid dan pergeseran bantalan anus ke arah distal dari normal. Laporan kasus ini bertujuan untuk membahas kasus hemoroid dari diagnosa sampai dengan tatalaksananya.
Laporan Kasus: Seorang laki-laki usia 30 tahun datang dengan keluhan keluar darah berwarna merah segar saat buang air besar. Keluhan dirasakan sejak 1 bulan yang lalu dan memberat sejak 1 hari sebelum masuk rumah sakit. Pada pemeriksaan lokalis di regio anal terlihat adanya benjolan dengan bentuk iregular mengitari anus yang sebagian berwarna merah kehitaman dan sebagian sama dengan warna kulit disekitarnya dengan ukuran diameter 3 cm. Saat dilakukan palpasi didapatkan benjolan teraba kenyal, batas tegas, nyeri tekan (+) benjolan tidak dapat dimasukkan dengan jari. Berdasarkan dari anamnesa dan pemeriksaan fisik, pasien kemudian didiagnosa dengan Hemorroid interna grade IV dan ditangani dengan metode open hemorrhoidectomy (Miligan-Morgan Method). Pasien dirawat selama dua hari dimana pasien sudah bisa buang air besar tetapi masih terasa nyeri namun benjolan sudah tidak terlihat dari anus.
Simpulan: Hemoroid dapat didiagnosa dari riwayat medis pasien, pemeriksaan fisik serta pemeriksaan penunjang. Manajemen terapi pada hemoroid dapat berupa konservatif dan operasi.
Herniasi nukleus pulposus lumbal multipel disertai kanal stenosis dengan drop foot syndrome dan atrofi otot unilateral: sebuah laporan kasus
Anak Agung Ngurah Agung Harawikrama Adityawarma, I Nyoman Gede WahyudanaOnline First: Oct 12, 2021
- Abstract
Herniasi nukleus pulposus lumbal multipel disertai kanal stenosis dengan drop foot syndrome dan atrofi otot unilateral: sebuah laporan kasus
Background: Low back pain is a fairly common health problem, with a worldwide prevalence of 1.4-20% and an annual incidence of 0.024-7% per year. One of the causes of lower back pain is a herniated nucleus pulposus. The prevalence of nucleus pulposus herniation in Indonesia is not well documented. One of the complications caused by HNP is drop foot syndrome. Drop Foot Syndrome is the inability to perform flexion dorsum movement of the ankle or big toe. The prevalence of drop foot syndrome is quite rare, with around 8.1% of patients suffering from HN.
Case Illustration: A 71-year-old male patient presented with complaints of lower back pain radiating to the left rear thigh since two months ago. The pain was getting worse, and the legs were getting weaker, so that he had to drag his legs. The patient was also often experiencing back pain since five years ago. The patient has a history as a truck driver with the Bali-Java-Sumatra route for 30 years. On physical examination, there ware significant atrophy in the left calf. Motor examination found that the left foot could not lift against the gravity force, and when walking, the big toe touched the floor first. There was no interference with defecation or bowel movements. Lumbar MRI examination was performed with the results of the disc herniation of L1-L2, L2-L3, L4-L5, L5-S1, multiple canal stenosis, and lumbar spondylosis. Discectomy laminectomy and posterior vertebral fusion were performed.
Conclusion: HNP is one of the most frequent causes of lower back pain. The lack of knowledge about HNP makes people underestimate this problem, and this is one of the causes of complications in the form of drop foot to muscle atrophy due to the delayed treatment.
Latar belakang: Nyeri punggung bawah merupakan permasalahan kesehatan yang cukup umum dengan prevalensi di seluruh dunia sebesar 1,4-20% dan insiden setiap tahunnya 0,024-7%. Salah satu penyebab nyeri punggung bawah adalah herniasi nukleus pulposus. Herniasi nukleus pulposus didefinisikan sebagai rupturnya anulus fibrosus sehingga nukleus pulposus menonjol dan menekan ke arah kanalis spinalis. Salah satu komplikasi yang disebabkan oleh HNP adalah drop foot syndrome. Prevalensi terjadinya drop foot syndrome cukup jarang yakni 8,1% dari pasien yang menderita HNP.
Ilustrasi Kasus: Pasien laki-laki berusia 71 tahun datang dengan keluhan nyeri punggung bawah menjalar hingga paha kiri belakang sejak 2 bulan yang lalu. Pasien baru memeriksakan diri ke dokter karena nyeri semakin berat dan kaki semakin lemas sehingga harus menyeret kaki serta mengalami nyeri punggung belakang sejak 5 tahun yang lalu. Pasien memiliki riwayat sebagai pengemudi truk Bali-Jawa-Sumatra selama 30 tahun. Pada pemeriksaan fisik ditemukan atrofi signifikan pada betis kiri, pemeriksaan motorik didapatkan punggung kaki kiri tidak mampu mengangkat melawan gaya gravitasi dan ketika berjalan bagian jempol kaki menyentuh lantai terlebih dahulu serta tidak didapatkan adanya gangguan pada BAB ataupun BAK. Pemeriksaan MRI lumbalis dilakukan dengan hasil herniasi diskus L1-L2, L2-L3, L4-L5, L5-S1, stenosis kanal multipel dan spondilosis lumbalis. Dilakukan laminektomi disektomi dan fusi vertebra posterior.
Simpulan: HNP merupakan salah satu penyebab nyeri punggung bawah yang paling sering. HNP menjadi salah satu penyebab terjadinya komplikasi berupa drop foot hingga terjadinya atropi otot karena tidak ditangani lebih awal.
Parametrial hematoma following fetal craniotomy and curettage in intrauterine fetal death: a case report
Ida Bagus Yudhistira Anantasurya Vidhisvara, Ida Bagus Putu Widiarsa, Margaret Gabriele Helena, I Putu Ivan Cahya HimawanOnline First: Oct 19, 2021
- Abstract
Parametrial hematoma following fetal craniotomy and curettage in intrauterine fetal death: a case report
Background: Parametrial hematoma is collection of blood located in the parametrial area, which is a type of hematoma that can occur in the pelvic cavity. Postpartum hematoma is a rare but life-threatening complication of childbirth. Common risk factors to developing parametrial hematomas include multiple pregnancies, traumatic deliveries, operative vaginal delivery, prolonged labour, manual removal of placenta, inadequate hemostasis at Caesarean section, pre-eclampsia, and anticoagulation therapy. We reported a rare case of parametrial hematoma post-craniotomy and curettage of a fetus with intrauterine fetal death (IUFD) in a 28-year-old pregnant woman 24 weeks into her fourth pregnancy.
Case report: A pregnant woman with 24 weeks gestation age came to emergency room with complaints of abdominal pain and bloody discharge without clear fluids 9 hours prior. She was diagnosed with preterm delivery and was given tocolytic. The following day, ultrasound examination was done and fetal heart rate (FHR) was not found, suggesting an intrauterine fetal death (IUFD). Termination was carried out with oxytocin induction but due to maternal exhaustion, pain, and lack of cooperation, a craniotomy was done in operating room followed by curettage. Twenty-four hours after curettage, patient complained of an acute lower right abdominal pain and ultrasound showed a complex mass in right adnexa measuring 8 x 8 cm, suggesting a right adnexal hematoma with a differential diagnosis of a right tubo-ovarian abscess. The patient’s haemoglobin was found to decrease to 6.0 g/dl. A laparotomy was performed and a hematoma was found in the right parametrium without active bleeding.
Conclusion: Parametrial hematoma is a rare disease that can occur due to trauma (in labor) or spontaneously due to abnormalities of the uterine arteries that supply blood to the uterus. The patient present in this case report had acute abdominal pain with decreased haemoglobin without signs of bleeding after an operative vaginal birth which may or may not be the cause of the parametrial hematoma due to limitations of examination on the patients. Further observation of similar cases will be required to determine the association between parametrial hematoma and operative vaginal birth.
Temuan radiologi dalam kelainan kongenital atresia jejunum: serial kasus
Listyani Gunawan, Pande Putu Yuli Anandasari, Putu PatriawanOnline First: Oct 19, 2021
- Abstract
Temuan radiologi dalam kelainan kongenital atresia jejunum: serial kasus
Background: Jejunoileal atresia is an emergency due to mechanical gastrointestinal obstruction, a rare case with a prevalence rate of 1-3 per 10,000 births. There is no difference in incidence by gender. Delay in treatment results in huge losses in terms of malnutrition, failure to thrive, and even death. These case series aim to evaluate radiological findings in congenital jejunal atresia.
Case Presentation: There were 3 patients with the main complaint of bilious vomiting. These three patients underwent a plain abdominal x-ray examination, obtained a picture of a high total obstruction with a triple bubble picture, or had a dilated picture of the proximal obstruction. Partial obstruction based on plain radiographs in one of the patients was found, followed by an examination of contrast meal which filled smoothly up to the jejunum segment with a windsock appearance. The three cases have been proven through surgery, various types of jejunal atresia were obtained. Intestinal resection was performed, followed by an end-to-end jejunal anastomosis.
Conclusion: Correct diagnosis determines the appropriate treatment for the patient. Plain abdominal radiograph as an initial examination in assessing total or partial obstruction in the jejunum, with a typical triple bubble or dilated bowel segment proximal to the obstruction. The windsock appearance of the jejunal segment on the contrast meal confirms the diagnosis of the jejunal web.
Latar Belakang: Atresia jejunoileal merupakan kegawatdaruratan akibat obstruksi mekanik gastrointestinal, yang merupakan kasus jarang dengan angka prevalensi 1-3 per 10000 kelahiran, tidak ada perbedaan insiden berdasarkan gender. Terlambatnya tatalaksana mengakibatkan kerugian yang besar baik malnutrisi, gagal tumbuh, hingga kematian. Laporan kasus ini bertujuan untuk mengevaluasi temuan radiologi dalam kelainan kongenital atresia jejunum.
Laporan Kasus: Terdapat 3 pasien dengan keluhan utama muntah bilosa. Kemudian dari pemeriksaan foto polos abdomen didapatkan gambaran obstruksi total letak tinggi dengan gambaran triple bubble atau memiliki gambaran dilatasi dari proksimal obstruksi. Obstruksi parsial berdasarkan foto polos pada salah satu pasien, dilanjutkan pemeriksaan contrast meal yang mengisi lancar hingga segmen jejunum dengan windsock appearance. Ketiga kasus tersebut telah terbukti melalui hasil operasi, didapatkan atresia jejunum berbagai tipe. Dilakukan reseksi usus dilanjutkan anastomosis end-to-end jejunal.
Kesimpulan: Diagnosis yang tepat, menentukan tatalaksana yang sesuai bagi pasien. Foto polos abdomen sebagai pemeriksaan inisial dalam menilai obstruksi total atau parsial pada jejunum, dengan gambaran khas triple bubble atau dilatasi segmen usus proksimal dari obstruksi. Windsock appearance segmen jejunum pada contrast meal mempertajam diagnosis jejunal web.
Gambaran neurogenic bladder pada pemeriksaan voiding cystourethrography: serial kasus
Kadek Ieke Sugeng Kurniawan, Nyoman Srie Laksminingsih, Firman Parulian SitanggangOnline First: Oct 21, 2021
- Abstract
Gambaran neurogenic bladder pada pemeriksaan voiding cystourethrography: serial kasus
Latar Belakang: Neurogenic bladder (kandung kemih neurogenik) adalah suatu kelainan pada kandung kemih yang disebabkan karena terdapat kerusakan maupun penyakit yang menyerang sistem saraf pada daerah inervasi saluran kemih bagian bawah. Neurogenic bladder merupakan suatu proses yang kompleks di mana diperlukan suatu proses anamnesis, pemeriksaan fisik dan pemeriksaan penunjang yang seksama dalam menentukan diagnosis penyakit tersebut. Voiding Cystouretrography (VCUG) merupakan salah satu pemeriksaan radiologi yang memiliki peran penting dalam menegakan diagnosis neurogenic bladder serta penentuan terapi dan pencegahan komplikasi lebih lanjut. Serial kasus ini akan membahas tiga kasus neurogenic bladder berdasarkan pemeriksaan voiding cystourethrography serta beberapa etiologi dan komplikasi yang dapat menyertainya.
Kasus: Pasien pertama yaitu wanita usia 13 tahun dengan klinis neurogenic bladder dan vesicoureteric reflux (VUR). Pada pemeriksaan VCUG didapatkan neurogenic bladder tipe UMN dengan gambaran cystitis kronis, vesicoureteric reflux (VUR) kiri grade V, parsial obstruksi pada ureter kiri 1/3 distal setinggi UVJ, spina bifida pada corpus vertebra L4, dan sacralisasi pada L5. Pasien kedua adalah laki-laki usia 7 bulan dengan manifestasi klinis infeksi saluran kemih. Hasil pemeriksaan VCUG didapatkan gambaran neurogenic bladder tipe UMN dengan posterior urethral valve disertai dengan cystitis dan divertikulosis. Pasien ketiga merupakan laki-laki usia 34 tahun dengan gambaran klinis striktur uretra. Pada pemeriksaan VCUG didapatkan striktur total urethra pars membranacea, neurogenic bladder tipe UMN dengan cystitis dan divertikel dinding posterior buli serta vesicolithiasis multipel.
Simpulan: Pemerikasan VCUG memegang peranan penting dalam mendiagnosis neurogenic bladderbeserta beberapa etiologi dan komplikasi yang dapat menyertainya, sehingga penatalaksanaan pasien optimal dan prognosis pasien menjadi lebih baik.
Background: Neurogenic bladder is a bladder disorder caused by any damage or disease that attacks the nervous system in the lower urinary tract. Neurogenic bladder is a complex process that requires thorough history taking, physical examination, and supporting radiology examination in determining the diagnosis of the disease. The voiding cystourethrography (VCUG) is radiological imaging that has an essential role in establishing the diagnosis of the neurogenic bladder. It also helps in determining therapy and preventing further complications. This case series aims to elaborate on three neurogenic bladder patients focusing on voiding cystourethrography and the etiology and complications concerning the disease.
Cases: The first patient was a 13-year-old girl with clinical neurogenic bladder and vesicoureteral reflux (VUR). The radiograph from VCUG examination revealed UMN type neurogenic bladder with chronic cystitis, left vesicoureteral reflux (VUR) grade V, partial obstruction in the left 1/3 distal ureter at UVJ level, spina bifida in the L4 vertebral body, and sacralization at L5. The second patient was a 7-month-old boy with clinical manifestations of urinary tract infection. The results of the VCUG examination found a neurogenic bladder of the UMN type with a posterior urethral valve accompanied by cystitis and diverticulosis. The third patient was a 34-year-old man with clinical features of urethral stricture. On VCUG examination, total stricture of the urethra pars membranacea, neurogenic bladder UMN type with cystitis and posterior bladder wall diverticula, and multiple vesicolithiasis were found.
Conclusion: VCUG examination plays an important role in diagnosing neurogenic bladder and several etiologies and complications that can accompany it. In addition, optimal patient management and better prognosis can be achieved.
Kelainan elektrolit berulang pada pasien dengan kecurigaan Sindrom Gitelman
Beny Surya Wijaya, Kadek Wisnu Segara KaryaOnline First: Oct 25, 2021
- Abstract
Kelainan elektrolit berulang pada pasien dengan kecurigaan Sindrom Gitelman
Pendahuluan: Sindrom Gitelman merupakan tubulopati yang terjadi akibat mutasi pada gen Solute Carrier Family 12 Member 3 (SLC12A3), yang mengkode thiazide-sensitive natrium chloride co-transporter (NCCT) pada membran apikal sel tubulus distal. Sindrom ini bersifat autosomal resesif yang ditandai dengan hipokalemia, alkalosis metabolik, hipomagnesemia, dan hipokalsiuria. Gejala yang sering muncul adalah kram dan kelemahan mulai dari keterbatasan aktivitas ringan hingga berat.
Laporan kasus: Laki-laki usia 19 tahun datang dengan keluhan lemas disertai kaku otot seluruh anggota gerak dan leher, mual, muntah, nyeri kepala, dan nyeri ulu hati. Pasien memiliki riwayat rawat inap tiga kali dengan keluhan serupa. Pada pemeriksaan fisik ditemukan tanda vital dalam batas normal, serta adanya tanda Chvostek. Pemeriksaan darah lengkap dalam batas normal. Pemeriksaan elektrolit menunjukan kadar natrium 118 mmol/L, kalium 2,16 mmol/L, dan klorida 74 mmol/L. Pasien sudah berulang kali melakukan pemeriksaan elektrolit dengan hasil hipokalemia. Delapan bulan sebelumnya, pasien dirawat akibat penurunan kesadaran dengan gambaran alkalosis metabolik, hipokalemia (2,59 mmol/L), hipomagnesemia (0,76 mg/dL) dan hipokalsemia (8,2 mg/dL). Pemeriksaan fungsi ginjal, urinalisis, dan elektrokardiografi dalam batas normal. Berdasarkan keluhan, riwayat penyakit, dan pemeriksaan penunjang berupa hipokalemia berulang, alkalosis metabolik, dan hipomagnesemia, maka dicurigai suatu Sindrom Gitelman. Pasien diterapi dengan kalium klorida (KCl) intravena 50 mEq dalam natrium klorida (NaCl) 0,9% 500 cc dengan laju 20 tetes per menit, tablet KCl 600 mg tiap 8 jam, kapsul garam dapur 500 mg tiap 12 jam, omeprazole serta ondansetron intravena sesuai keluhan. Pasien dirawat inap satu hari dan dipulangkan setelah kadar kalium terkoreksi (3,1 mmol/L) dan keadaan klinis membaik. Pemeriksaan analisis DNA untuk penegakan diagnosis tidak dilakukan karena keterbatasan fasilitas dan biaya.
Kesimpulan: Sindrom Gitelman merupakan tubulopati yang bersifat autosomal resesif ditandai dengan hipokalemia, alkalosis metabolik, hipomagnesemia, dan hipokalsiuria. Tatalaksana sindrom ini tergantung pada klinis dan gangguan laboratorium. Suplemen natrium, kalium, dan magnesium merupakan terapi yang paling sering dibutuhkan.
Introduction: Gitelman syndrome is a tubulopathy that occurs due to mutations in the Solute Carrier Family 12 Member 3 (SLC12A3) gene, which encodes thiazide-sensitive sodium chloride co-transporter (NCCT) in the apical membrane of distal tubule cells. This autosomal recessive syndrome characterized by hypokalemia, metabolic alkalosis, hypomagnesemia, and hypocalsiuria. Common symptoms are cramps and weakness ranging from mild to severe limitation of activity.
Case Report: a 19 years-old-man present a general weakness accompanied by muscle stiffness throughout the limbs and neck, nausea, vomiting, headache, and heartburn. The patient had a history of hospitalization three times with similar complaints. Normal vital signs and Chvostek's sign were found on physical examination. Complete blood count was within normal limits. Electrolyte examination showed sodium 118 mmol/L, potassium 2.16 mmol/L, and chloride 74 mmol/L. The patient had repeated episode of hypokalemia. In the previous eight months, he was admitted due to decreased of consciousness with metabolic alkalosis, hypokalemia (2.59 mmol/L), hypomagnesemia (0.76 mg/dL) and hypocalcemia (8.2 mg/dL). Kidney function, urinalysis, and electrocardiography within normal limits. Based on complaints, medical history, and the results of investigations a Gitelman syndrome was suspected. The patient was treated with 50 mEq intravenous KCL in 500cc NaCl 0,9% at a rate of 20 drops per minute, 600 mg KCl tablets every 8 hours, 500 mg table salt capsules every 12 hours, intravenous omeprazole and ondansetron as needed. The patient discharged after the potassium level was corrected (3.1 mmol/L) and improved clinical condition. Follow-up examination in the form of DNA analysis was not carried out due to limited facilities and funding.
Conclusion: Gitelman syndrome is an autosomal recessive tubulopathy characterized by hypokalemia, metabolic alkalosis, hypomagnesemia, and hypocalciuria. Management of this syndrome in accordance with clinical and laboratory abnormalities that occur. The most frequently needed therapy are sodium, potassium, and magnesium supplement.
Case report of acute epiglottitis in a 44-year-old man: a rare case
I Gusti Ayu Putu Wahyu Widiantari, Nyoman Dian Permatasari, Ida Bagus Semara PutraOnline First: Oct 26, 2021
- Abstract
Case report of acute epiglottitis in a 44-year-old man: a rare case
Background: Acute epiglottitis, also known as supraglottitis or supraglottic laryngitis, is an acute inflammation of the supraglottic area of the larynx. The diagnosis can be made based on clinical signs and symptoms as well as several investigations.
Case Description: We reported a case of a 44-year-old man who presented to our emergency department and whose condition was ultimately diagnosed as epiglottitis. Indirect laryngoscopy and lateral soft tissue neck radiograph had an important role in determining the diagnosis. The patient was treated conservatively by giving a high dosed antibiotic, anti-inflammatory, and analgesic drugs.
Conclusion: Acute epiglottitis can be a life-threatening condition because it can cause sudden upper airway obstruction. Therefore, management must be given quickly and precisely so as not to fall into a life-threatening condition.
Hemolytic anemia in a 2-years old caused by Glucose 6 Phosphate Dehydrogenase Deficiency (G6PD): a case report
Paulus Arief Budiman, Ketut Ariawati, Anak Agung Ngurah Ketut Putra WidnyanaOnline First: Nov 4, 2021
- Abstract
Hemolytic anemia in a 2-years old caused by Glucose 6 Phosphate Dehydrogenase Deficiency (G6PD): a case report
Background: Glucose-6-Phosphate-Dehydrogenase (G6PD) deficiency is an enzyme abnormality related to sex chromosomes (x-linked), which is inherited. The activity or stability of the G6PD enzyme decreases, thus causing the breakdown of red blood cells when an individual is exposed to exogenous substances that can cause oxidative damage. This case study aims to describe a rare case of hemolytic anemia caused by glucose 6 phosphate dehydrogenase deficiency in a two-year-old boy.
Case Presentation: A two-year-old boy presented with agitated, pale, yellowish eyes and body and projectile vomiting after consuming fava beans. He had a prior history of packed red cell transfusion. Physical examination found the conjunctivae were pale with the icteric sclera. Laboratory examination revealed leukocytosis, moderate normochromic normocytic anemia, increased reticulocytes count, and elevated total and unconjugated bilirubin. Peripheral blood smear examination found microcytes, spherocytes, fragmentocytes, and burr cells. Coomb test was negative with decreased G6PD result.
Conclusion: G6PD deficient patients have no symptoms until exposed to oxidizing drugs, infections or after fava beans ingestion which may cause hemolytic anemia and jaundice. Several methods of screening and diagnosis of G6PD can be performed to avoid morbidity and mortality.
Diagnosis dan tatalaksana rinosinusitis maksilaris odontogenik yang meluas sampai etmoid dan frontal: laporan kasus
Agus Santosa, Nyoman Dian Permata Sari, Ida Bagus Semara Putra, Dewa Ayu Putu Sri MasyeniOnline First: Nov 4, 2021
- Abstract
Diagnosis dan tatalaksana rinosinusitis maksilaris odontogenik yang meluas sampai etmoid dan frontal: laporan kasus
Background: Sinusitis is an inflammatory process in the nasal mucosa, especially in the paranasal sinuses. Sinusitis problems are important and need special attention in cases of sinusitis that do not improve after being given conventional therapy. The purpose of this paper is to establish the diagnosis and management of odontogenic maxillary rhinosinusitis that extends to the ethmoid and frontal areas.
Case presentation: A male patient, aged 22 years, came to the ENT clinic at Mangusada Hospital, Badung. Based on the history, physical examination, supporting examination in the form of CT-scan so that it was diagnosed as chronic rhinosinusitis et causa odontogenic which extends to the ethmoid and frontal. The treatment chosen was surgery in the form of Functional Endoscopic Sinus Surgery (FESS) and septorhinoplasty because in this case the patient had complications and did not respond to medical therapy. Postoperative evaluation, complaints of smelly mucus, nasal congestion and headache were not felt.
Conclusion: The diagnosis of chronic rhinosinusitis et causa odontogenic which extends to the ethmoid and frontal based on CT-Scan and the treatment given to the patient in the form of FESS and septorhinoplasty.
Latar belakang: Sinusitis merupakan proses inflamasi pada mukosa hidung, lebih khususnya pada sinus paranasal. Masalah sinusitis menjadi penting dan perlu perhatian khusus pada kasus sinusitis yang tidak membaik setelah diberikan terapi konvensional. Tujuan penulisan ini adalah untuk menegakkan diagnosis dan penatalaksan rinosinusitis maksilaris odontogenik yang meluas sampai etmoid dan frontal.
Presentasi kasus: Seorang pasien laki-laki, berusia 22 tahun datang ke poli THT RS Mangusada, Badung. Berdasarkan anamnesis, pemeriksaan fisik, pemeriksaan penunjang berupa CT-scan sehingga didiagnosis sebagai rinosinusitis kronis et causa odontogenic yang meluas sampai etmoid dan frontal. Penatalaksanaan yang dipilih adalah pembedahan berupa Functional Endoscopic Sinus Surgery (FESS) dan septorhinoplasti, karena pada kasus ini pasien mengalami komplikasi dan tidak memberikan respon dengan terapi medikamentosa. Evaluasi pasca operasi, keluhan ingus berbau, hidung tersumbat dan nyeri kepala sudah tidak dirasakan.
Kesimpulan: Diagnosis rinosinusitis kronis et causa odontogenic yang meluas sampai etmoid dan frontal berdasarkan dari CT-Scan dan tatalaksana yang diberikan pada pasien berupa FESS dan septorhinoplasti.
Strabismus sebagai komplikasi pemasangan sclera buckle pada ablasio retina regmatogen: laporan kasus
Pande Putu Adityo Ananta Ardika, Ari Andayani, Ni Made Ayu Surasmiati, Ni Made Ari Suryathi, I Made Agus KusumadjajaOnline First: Dec 7, 2021
- Abstract
Strabismus sebagai komplikasi pemasangan sclera buckle pada ablasio retina regmatogen: laporan kasus
Introduction: Sclera buckle is one of the operative management of rhegmatogenous retinal detachment. Sclera buckle can combine with vitrectomy in young people, phakic, myopia more than 6 dioptri, axial length more than 26mm, proliferative vitreoretinopathy stage C, multiple inferior break and recurrent break. Complications from the installation of sclera buckle is one of them the occurrence of strabismus after the installation of sclera buckle. Treatment can be done to remove the sclera buckle and further surgery for extraocular muscle.
Case Description: Male patients aged 31 years, patients present with complaints right eyes rolling inward since 8 months ago. The patient had a history of surgical sclera buckle and tamponade with silicone oil. Patient also complain blurry vision since 1 month ago after removing silicone oil. The patient has a history of -5.00 glasses in both eyes. In examination obtained Hirschberg esotropia 15 degrees and retinal detachment on right eyes. Patient was diagnosed with right eye Detached Retina post evacuation of silicone oil (16 days), acquired esotropia Suspect et cause sclera buckle installation. Patients are planned to undergo Re-Vitrectomy Pars Plana (VPP), Release Sclera Buckle , Endolaser, Silicon Oil tamponade, and evaluation of extraocular muscle at surgery. During evaluation of extraocular muscle there was fibrosis cover four rectus muscle and no tear was found. Then we removed of fibrosis and released sclera buckle. Strabismus complaint did not feel better after removed of fibrosis so we planned for further action was medial rectus recess with adjustable suture
Conclusion: Sclera buckle can combine with vitrectomy on young people, phakic, myopia more than 6 dioptri, axial length more than 26mm, proliferative vitreoretinopathy, multiple inferior break and recurrent break. Installation of sclera buckle can cause complications in the form of postoperative strabismus. One of the causes of this complication is fibrosis of the extraocular muscles, so there is an attachment called fat adherent syndrome. Treatment that can be taken to treat strabismus after sclera buckle surgery is one of them with the release of sclera buckle, but if strabismus complaints did not improve, surgery can be done on extraocular muscles to improve the position of the ball
Pendahuluan: Sclera buckle merupakan salah satu tindakan operatif dalam menangani ablasio retina regmatogen. Tindakan sclera buckle dapat dikombinasikan dengan vitrektomi pada orang muda, phakia, riwayat miopia lebih dari 6 dioptri, panjang bola mata lebih dari 26 milimeter, ditemukan adanya proliferatif vitreoretinopati stadium C, robekan multiple pada bagian inferior retina dan robekan berulang. Komplikasi dari pemasangan sclera buckle ini adalah salah satunya terjadinya strabismus pasca pemasangan sclera buckle. Penanganan yang dapat dilakukan berupa pelepasan sclera buckle, dan operasi strabismus jika kondisi otot ekstraokular tidak membaik.
Deskripsi Kasus: Pasien laki-laki, usia 31 tahun, datang dengan keluhan mata kanan bergulir ke dalam sejak 8 bulan yang lalu. Keluhan dirasakan setelah pasien melakukan operasi pemasangan sclera buckle dan silicon oil 8 bulan yang lalu. Saat ini pasien juga mengeluhkan pandangan kabur yang sudah dirasakan sejak 1 bulan yang lalu setelah dilakukan pengangkatan silicon oil. Pada pemeriksaan ditemukan Hirschberg esotropia 15 derajat dan ditemukan ablasio retina pada mata kanan. Pasien didiagnosis dengan okuli dekstra rekuren ablasio retina pasca pengeluaran silicon oil (16 hari), dan kecurigaan esotropia didapat (acquired esotropia) ec pasca pemasangan sclera buckle. Pasien direncanakan untuk dilakukan Re-Vitrektomi Pars Plana (VPP), pelepasan sclera buckle, endolaser, re-tamponade silicon oil dan evaluasi otot ekstraokular durante operasi. Pada saat dilakukan evaluasi otot ekstraokular ditemukan adanya fibrosis pada keempat otot rektus dan tidak ditemukan adanya robekan pada otot ekstraokular. Kemudian dilakukan pembersihan dari fibrosis dan pelepasan dari sclera buckle. Keluhan strabismus tidak dirasakan membaik pasca dilakukan pembersihan fibrosis sehingga direncanakan untuk dilakukan tindakan lanjutan yaitu medial rectus reses dengan adjustable suture.
Simpulan: Tindakan sclera buckle ini dapat dikombinasi dengan vitrektomi pada pasien muda, phakia, riwayat miopia tinggi lebih dari 6 dioptri, panjang bola mata lebih dari 26 milimeter, ditemukan adanya proliferatif vitreoretinopati, robekan multiple di bagian inferior retina dan robekan berulang. Pemasangan sclera buckle ini dapat menimbulkan komplikasi berupa strabismus pasca operasi. Penyebab dari terjadinya komplikasi ini salah satunya fibrosis pada otot ekstraokular sehingga terjadi perlekatan yang disebut dengan fat adheren syndrome. Tindakan yang dapat dilakukan untuk penanganan strabismus pasca operasi sclera buckle ini adalah salah satunya dengan pelepasan dari sclera buckle, namun apabila keluhan strabismus tidak membaik bisa dilakukan operasi pada otot ekstraokular untuk memperbaiki posisi bola mata.
Laporan kasus: demam rematik akut pada anak
Fitriana Melinda, Anak Agung Made SuciptaOnline First: Dec 7, 2021
- Abstract
Laporan kasus: demam rematik akut pada anak
Background: Acute rheumatic fever is an autoimmune sequelae caused by group A streptococcal infection. Acute rheumatic fever causes a systemic inflammatory response followed by disorders of the brain, heart, skin, and joints. This disease tends to recur and begins with Streptococcus beta-hemolytic group A infection in the respiratory tract.
Case description: A boy aged 9 years 7 months with complaints of pain in both legs so that his legs are difficult to move since one day before being admitted to the hospital. The patient also had a fever for about 1 week, cough and sore throat before complaining of joint pain but the patient did not seek treatment. The patient had a history of recurrent sore throat and was rarely treated. Physical examination revealed that both knees were erythematous, warm and there was tenderness and limited leg movement due to pain. On examination of the tonsils found T2-T2 is not hyperemic. Laboratory examination showed positive ASTO. The diagnosis was made as acute rheumatic fever and treated with erythromycin and aspirin.
Conclusion: Acute rheumatic fever can be established using the Jones criteria and modified WHO. In patients with typical symptoms or manifestations according to the major and minor criteria, it will be easier to establish the diagnosis.
Latar belakang: Demam rematik akut adalah suatu sekuele autoimun akibat infeksi streptokokus grup A. Kondisi demam rematik akut menyebabkan suatu respon inflamasi sistemik yang diikuti oleh adanya gangguan pada organ otak, jantung, kulit, dan sendi. Penyakit ini cenderung terjadi berulang dan diawali dengan infeksi Streptococcus beta hemolyticus grup A pada saluran napas.
Deskripsi kasus: Anak laki-laki berusia 9 tahun 7 bulan dengan keluhan nyeri pada kedua kaki sehingga kaki sulit untuk digerakkan sejak satu hari sebelum masuk RS. Pasien juga mengalami demam sekitar 1 minggu, batuk dan nyeri tenggorok sebelum mengalami keluhan nyeri sendi namun pasien tidak berobat. Pasien memiliki riwayat nyeri tenggorok berulang dan jarang diobati. Pemeriksaan fisik didapatkan kedua lutut eritema, teraba hangat dan terdapat nyeri tekan serta gerakan kaki terbatas karena nyeri. Pada pemeriksaan tonsil didapatkan T2-T2 tidak hiperemis. Pemeriksaan laboratorium menunjukkan ASTO positif. Diagnosis ditegakkan sebagai demam reumatik akut dan diberikan terapi eritromisin dan aspirin.
Simpulan: Demam rematik akut dapat ditegakkan menggunakan kriteria Jones dan modifikasi WHO. Pada pasien dengan gejala khas atau manifestasi sesuai dengan kriteria mayor dan minor akan mempermudah penegakkan diagnosis.
Pria 80 tahun dengan tumor ganas dinding dada: laporan kasus
Raissa Andi Soekrisno, Dewa Gde Mahiswara Sudiatmika, Elysanti Dwi Martadiani, Firman Parulian Sitanggang, Herman SuputraOnline First: Dec 13, 2021
- Abstract
Pria 80 tahun dengan tumor ganas dinding dada: laporan kasus
Background: Malignant tumors that form in bone, soft tissue, or cartilage, are called sarcomas. Symptoms of these tumors vary, and may include shortness of breath, chest pain, and swelling around the tumor. Imaging such as X-rays and CT scans can be helpful, although imaging features of the few malignant chest wall tumors that are less specific, knowledge of the typical radiographic manifestations of these tumors can often make it easier for experts to differentiate between benign and malignant tumors and help lead to a more specific diagnosis.
Case presentation: An 80-year-old man complains of a lump in the right chest. The results of laboratory tests showed anemia, decreased kidney function, and hypercalcemia. The CT scan of the thorax with contrast showed a solid mass in the right pleural cavity infiltrating the surrounding chest wall muscles, bilateral pneumonia, and osteolytic lesions on the spine suspected of being a metastatic process or spreading malignancy. The results of the biopsy showed a diffuse morphological appearance of immature plasma cells with an approach to the diagnosis of cutaneous infiltration plasma cell myeloma with a differential diagnosis of plasmablastic lymphoma.
Conclusion: The results of X-ray imaging and CT scan of the thorax help narrow the differential diagnosis, where there is an image of a tumor on the chest wall with destruction of the surrounding bone and soft tissue and an image of infiltration into the pleura accompanied by multiple osteolytic images of the vertebrae. Assisted by a biopsy (anatomical pathology), the closest diagnosis in this patient is plasma cell myeloma chest wall.
Latar Belakang: Tumor ganas yang terbentuk pada tulang, jaringan lunak, atau kartilago disebut sarcoma. Gejala dari tumor ini bervariasi, dapat berupa sesak nafas, nyeri dada, dan pembengkakan pada sekitar tumor. Pencitraan seperti rontgen dan CT scan dapat membantu, walaupun gambaran pencitraan dari beberapa tumor ganas dinding dada kurang spesifik, pengetahuan tentang manifestasi tipikal pada radilogi dari berbagai tumor ini seringkali dapat memudahkan para ahli untuk membedakan jenis tumor jinak dan ganas dan membantu mengarahkan diagnosis yang lebih spesifik.
Kasus: Seorang laki – laki berusia 80 tahun dengan keluhan benjolan di dada sebelah kanan. Hasil pemeriksaan laboratorium didapatkan hasil anemia, penurunan fungsi ginjal, dan hiperkalsemia. Hasil CT Scan thorax dengan kontras menunjukkan adanya massa solid pada cavum pleura kanan yang menginfiltrasi otot dinding dada di sekitarnya, pneumonia bilateral, serta lesi osteolitik pada tulang belakang yang dicurigai sebagai suatu proses metastase atau penyebaran keganasan. Hasil biopsi menunjukkan gambaran morfologi sebaran difus sel plasma imatur-matur dengan pendekatan pada diagnosis cutaneus infiltration plasma cell myeloma dengan diagnosis banding plasmablastic lymphoma.
Simpulan: Hasil pencitraan rontgen dan CT scan thorax membantu menyempitkan diagnosis banding, di mana terdapat gambaran tumor pada dinding dada dengan destruksi tulang dan jaringan lunak di sekitarnya serta gambaran infiltrasi ke pleura disertai gambaran osteolitik multipel pada vertebrae. Dibantu dengan pemeriksaan biopsi (patologi anatomi) maka diagnosis yang paling mendekati pada pasien ini adalah plasma cell myeloma dinding dada
Diagnosis dan penatalaksanaan tuberkulosis sistem saraf pusat
Prima Yogi, I Putu Andrika, I Gede Ketut Sajinadiyasa, I Made BagiadaOnline First: Dec 21, 2021
- Abstract
Diagnosis dan penatalaksanaan tuberkulosis sistem saraf pusat
Introduction: Central nervous system (CNS) tuberculous are the most dangerous form of extrapulmonary TB. CNS tuberculous can present as meningoencephalitis, intracranial tuberculomas, and vasculitis. CNS tuberculous accounts for about 1% of all TB cases and is associated with high mortality. Tuberculous meningoencephalitis commonly presents with classic symptoms of fever, headache, meningism (neck stiffness), seizures as well as focal neurologic deficits, and altered consciousness. The diagnosis and treatment of CNS tuberculosis is still a formidable clinical challenge.
Case report: Patient presented with fever, headache, meningismus, convulsion, and decreased consciousness. CT scan showed cerebral tuberculoma in the left parietal lobe. Examination gene-Xpert of the cerebrospinal fluid showed Mycobacterium tuberculosis. The patient was given category 1 of anti-tuberculosis drugs.
Conclusion: CNS tuberculosis has non-specific symptoms, difficult diagnosis, and high mortality. In this case report, the diagnosis of CNS tuberculosis was established based on the presence of Mycobacterium tuberculosis on the CSF molecular rapid test examination, and a CT scan of the head with contrast found cerebral tuberculoma.
Sindroma Steven–Johnson terinduksi carbamazepine: laporan kasus
Peter Prayogo Hsieh, Nurmawatin Nurmawatin, Nur Khalisah, Nurjannah Nurjannah, Olivia Iriani Tantu, Orlando Pikatan, Pradita Zulfi Karisma DianaOnline First: Dec 30, 2021
- Abstract
Sindroma Steven–Johnson terinduksi carbamazepine: laporan kasus
Background: Steven-Johnson syndrome (SJS) is characterized by skin, mucosal, and eyes lesions caused by complex immune mechanisms or hypersensitivity reactions. In children, SJS incidence isn’t well–known because its clinical profiles aren’t well–recognized. One of the causes of SJS is due to the use of drugs. This report aims to describe carbamazepine–induced SJS.
Case: Twelve–year–old girl came with oral lesions for 1 week preceded by vesicles all over her body. This happened 3 days after taking carbamazepine, and it was her first time consuming it. On examinations, she was alert but weak with good nutritional status, had an axillary temperature of 37.7°C. Both her eyes were red and watery. She developed multiple ulcers in her mouth with a hyperemic pharynx. There were vesicles all over her body, but no abnormalities were found on thorax and abdomen examinations. Laboratory tests results showed neutrophilia, lymphocytopenia, eosinophenia, and hyponatremia. She was then diagnosed with SJS and was hospitalized. The doctor advised her to stop taking carbamazepine, and she received D5 ½ NS 2,000 cc/ 24 hours, dexamethasone injection 3 x ½ ampule, paracetamol injection 3 x 500 mg, betamethasone cream, triamcinolone oral-based cream, and oral cetirizine 1 x 10 mg. After 8 days she was discharged in good condition.
Conclusion: SJS is characterized by skin, mucosal, and eyes lesions which are mostly caused by drugs. One of the most common drugs causing SJS is antiepileptic such as carbamazepine.
Latar Belakang: Sindroma Steven - Johnson (SSJ) ditandai dengan berbagai tanda diantaranya kelainan kulit, mukosa orifisium, dan lesi pada mata yang disebabkan oleh reaksi kompleks imun atau hipersensitivitas. Angka kejadian SSJ pada anak tidak diketahui dengan pasti, hal ini kemungkinan disebabkan oleh manifestasinya yang kurang dikenali. Salah satu sebab timbulnya SSJ adalah oleh karena penggunaan obat-obatan. Laporan kasus ini ditulis dengan tujuan untuk memberi gambaran mengenai SSJ pada remaja akibat obat carbamazepine.
Kasus: Remaja perempuan berusia 12 tahun datang dengan luka pada mulut dan lidah sejak 1 minggu sebelumnya yang didahului oleh mata merah dan bintik merah berisi cairan di seluruh tubuh. Keluhan timbul 3 hari setelah mengkonsumsi carbamazepine dan ini adalah pertama kalinya pasien mengkonsumsi obat tersebut. Pada pemeriksaan ditemukan pasien sadar, tampak sakit berat, didapatkan status gizi baik, suhu tubuh 37,7°C, kedua mata hiperemis difus, hiperlakrimasi, ulkus multipel berkrusta pada bibir dan lidah disertai faring hiperemis. Ditemukan adanya vesikel generalisata namun tidak ditemukan kelainan pada pemeriksaan thoraks dan abdomen. Hasil laboratorium menunjukkan neutrofilia, limfopenia, eosinopenia, dan hiponatremia. Pasien didiagnosis dengan SSJ. Pasien disarankan untuk menghentikan carbamazepine dan mendapatkan terapi cairan D5 ½ NS 2.000 cc/24 jam, injeksi deksametason 3 x ½ ampul, injeksi parasetamol 3 x 500 mg, krim betametason, sediaan krim oral triamsinolon, dan cetirizine oral 1 x 10 mg. Setelah dirawat selama 8 hari pasien dinyatakan sembuh dan dipulangkan.
Simpulan: SSJ memiliki gambaran klinis yang melibatkan lesi pada kulit, mukosa orifisium, mata, dan sebagian besar dicetuskan oleh obat. Salah satu obat yang sering menyebabkan SSJ adalah obat antikonvulsan pada pasien yang memiliki kecenderungan genetik.
Chorioretinitis with retinal ablation complications in patients with cytomegalovirus infections and high myopia: a case report
Thedius Watu, I Gusti Made Ayu Juliari, I Made Agus Kusumadjaja, Ida Ayu Ari PramitaOnline First: Dec 30, 2021
- Abstract
Chorioretinitis with retinal ablation complications in patients with cytomegalovirus infections and high myopia: a case report
Background: Chorioretinitis is uveitis that causes choroidal and retinal inflammation. Chorioretinitis in general due to cytomegalovirus (CMV) infection has been recognized as a major cause of congenital virus infections. A common complication in patients with uveitis is retinal detachment. In addition, high myopia can also cause retinal detachment.
Case Illustration: We reported a 33-year-old male patient who came with chief complaints of a sudden blurred left eye the couple of weeks before admission. The patient had a history of high myopia -5D in both eyes and was HIV positive. One week before the complaint, patient underwent laser therapy because of retinal detachment and was also given Neomicin and Potassium Iodide eye drops. Patients presented with vision 1/60. In funduscopy examination, we found vasculitis, retinal detachment, bleeding and exudate. The patient was then diagnosed with OS Rhegmatogenous Retinal Detachment (RRD) caused by CMV chorioretinitis and high myopia ODS. The patient was treated with valganciclovir 1x900mg, methylprednisolone 2x32mg, prednisone eye drops 6x1 OD and underwent pars plana vitrectomy (VPP). The patient had complicated cataracts, therefore phacoemulsification, evacuation and reinjection of silicon oil and endolaser were performed. Unfortunately, the results obtained are not optimal where the patient's vision becomes the patient's no light perception (NLP).
Discussion: Retinal detachment is a frequent complication in patients with CMV chorioretinitis. The main therapy is HAART, anti-CMV and operative management. This therapy regimen is proven to improve overall patients’ prognosis.
Conclusion: Early diagnosis and appropriate treatment have a very important role in determining the prognosis of patients with CMV chorioretinitis.
Satu Kasus Langka: Harlequin Ichthyosis
I Gusti Ayu Sattwika Pramita, Ni Luh Putu Ratih Vibriyanti KarnaOnline First: Dec 30, 2021
- Abstract
Satu Kasus Langka: Harlequin Ichthyosis
Introduction: Harlequin ichthyosis is a genetic skin disease due to mutations in the ABCA12 gene inherited in an autosomal recessive manner. It is a severe form of ichthyosis characterized by a distinct clinical appearance of a thick stratum corneum. Harlequin ichthyosis is rarely found, and patients generally die a few days after birth.
Case description: We reported a baby girl aged one day with thick and cracked skin since birth. Physical examination revealed eclabium, ectropion, microtia, hyperflexion of the arms and legs, and hypoplasia of the fingers and toes. Dermatological examination showed thick yellowish-white scales separated by deep and erythematous fissures. The patient was placed in an incubator and was given supportive care, including nutrition and fluid through an orogastric tube, oleum olivarum as a moisturizer, gentamicin cream 0.1%, and gentamicin eye ointment 0.3%. The patient died after 21 days of treatment.
Conclusion: Harlequin ichthyosis has a poor prognosis and a high mortality rate due to impaired skin barrier functions that lead to dehydration, impaired thermoregulation, respiratory problems, and infections. Management of harlequin ichthyosis needs a multidisciplinary team and supportive care, consisting of fluid, electrolyte, and nutrition management, maintaining skin hydration, eye care, and preventing respiratory failure or sepsis.
Pendahuluan: Harlequin ichthyosis adalah penyakit kulit genetik yang diturunkan secara resesif autosomal dan merupakan bentuk berat dari iktiosis akibat adanya mutasi pada gen ABCA12. Penyakit ini ditandai dengan adanya gambaran klinis yang khas berupa penebalan stratum korneum. Harlequin ichthyosis jarang ditemukan dan umumnya pasien meninggal beberapa hari setelah kelahiran.
Kasus: Dilaporkan seorang bayi perempuan berumur 1 hari dengan keluhan kulit tebal dan pecah-pecah sejak lahir. Pada pemeriksaan fisik ditemukan eklabium, ektropion, mikrotia, hiperfleksi lengan dan kaki, serta hipoplasia jari-jari tangan dan kaki. Berdasarkan pemeriksaan status dermatologikus didapatkan skuama tebal berwarna putih kekuningan yang dipisahkan fisura. Pasien diberikan perawatan suportif berupa perawatan dalam inkubator, pemberian nutrisi melalui OGT, pelembab topikal oleum olivarum, antibiotik topikal gentamisin krim 0,1 %, dan salep mata gentamisin 0,3%. Pasien meninggal setelah perawatan selama 21 hari.
Simpulan: Harlequin ichthyosis memiliki prognosis yang buruk dan angka kematian yang tinggi akibat gangguan dari barier kulit yang menyebabkan dehidrasi, gangguan termoregulasi, gangguan nafas dan infeksi. Penatalaksanaan pasien harlequin ichthyosis adalah multidisiplin dan bersifat suportif, terdiri atas manajemen cairan dan elektrolit, perawatan secara intensif dalam inkubator, pemberian nutrisi, menjaga hidrasi kulit, perawatan mata, dan pencegahan terjadinya gangguan napas, atau sepsis.
Glioma saraf optik sebagai perluasan dari glioma cerebrii: sebuah laporan kasus
Anak Agung Surya Nirmala Dewi, Putu Yuliawati, Ni Made Laksmi Utari, Anak Agung Ayu Sukartini Djelantik, I Made Agus KusumadjajaOnline First: Dec 30, 2021
- Abstract
Glioma saraf optik sebagai perluasan dari glioma cerebrii: sebuah laporan kasus
Introduction: Optic Nerve Gliomas (ONG) are the most common primary Cerebral Nervous System tumor in childhood with greatest tendency for growth in the first 3-5 years of life (Huang, 2020). Most children diagnosed with ONGs have neurofibromatosis type 1 (NF-1) (Simmons,2013) with painless and slowly progressive decreace of vision. Imaging investigation with CT-scan or MRI is important to diagnose patient with ONG. The aim of this paper is to report a case of optic pathway glioma resulting rapid death of a child.
Case Illustration: A 7-year-old girl complained that her eyes could not see in the past 1 year and protrusion with a white spot that is getting wider in the middle of the eye on her right eye since 3 months ago. Her left eye could not see in the past 3 weeks. She also complained about pain on her head. From ophthalmology examination visual acuity both eyes are no light perception. On her right eye we found protrusion with scleral show and lagophthalmos on her right eye, periconjunctival injection with corneal edema, deep anterior chamber and IOP 47. On the left eye we found midilated pupil with decreased reflex and the posterior segment we found optic nerve head hazy demarcated, cup-disc ratio difficult to be evaluated, good retina, decreased macular reflex and macular star (+). From right eye USG we found severe vitreous opacity. The MRI result from June 15th 2020 is suggested for optich pathway glioma dd/ pylocystic astrocytoma and suspected expand to internal auditory canal dextra. The patient was diagnosed with OD Proptosis ec retrobulbar tumor susp optic nerve glioma that expand from chiasma / cerebrii + vitreous bleeding+secondary glaucoma. OS Optic Nerve Edema ec intracranial mass. The patient was planned for OD extended enucleation join op Tumor Removal from Neuro Surgery under General Anesthesia. However, the surgery was postponed due to unstable condition and patient died from septic shock 2 months after the first arrival at the eye clinic.
Conclusion: Optic Nerve Glioma are the most common primary Cerebral Nervous System tumor in childhood. This patient came with decrease of vision, protrusion on her right eye and pain with MRI finding suggested for optic nerve glioma. This patient should have done surgery but her condition was unstable. Good handling and multidisciplinary cooperation in the diagnosis and management of intraocular and intracranial masses are needed to provide a good outcome for the patient.
Pendahuluan: Glioma Saraf Optik (GSO) merupakan tumor otak primer yang paling banyak terjadi pada 1 dekade kehidupan dengan kecenderungan terjadi pada usia 3-5 tahun. Anak-anak yang didiagnosa dengan GSO biasanya memiliki neurofibromatosis tipe 1 (NF-1) yang timbul secara sporadik. GSO memiliki gejala penurunan penglihatan tanpa adanya rasa nyeri yang dirasakan perlahan. Pemeriksaan penunjang dalam menegakkan diagnosis GSO bisa menggunakan CT-scan ataupun MRI. Tujuan dari makalah ini adalah untuk melaporkan sebuah kasus bagaimana cara mendiagnosa glioma saraf optic pada anak-anak.
Ilustrasi kasus: Pasien perempuan, 7 tahun, datang (2 Juni 2020) dengan keluhan kedua mata tidak dapat melihat sejak 1 tahun yang lalu dan mata kanan menonjol sejak 3 bulan disertai bintik putih yang semakin melebar di bagian tengah mata. Mata kiri dikatakan tidak bisa melihat sejak 3 minggu yang lalu. Nyeri kepala sering dikeluhkan oleh pasien di seluruh kepala. Pemeriksaan oftalmologi didapatkan visus kedua mata no light perception (NLP), proptosis dengan scleral show dan lagoftalmos 2 mm pada mata kanan. Konjungtiva mata kanan didapatkan injeksi perikorna dengan edema kornea. Bilik mata depan mata kanan kesan dalam. Tekanan intraokular mata kanan 47 mmHg. Middilatasi dengan penurunan reflek pupil didapatkan pada mata kiri, lensa jernih dan pada pemeriksaan segmen posterior didapatkan papil nervus optik batas kabur, cup-disc ratio (CDR) sulit dievaluasi, retina kesan baik, reflex makula menurun dengan macular star. Hasil USG mata kanan didapatkan kesan kekeruhan vitreous berat. Pada 15 Juni 2020 pasien dilakukan MRI dengan kesan mengarah pada optic pathway glioma dd/ pylocytic astrocytoma dan suspek perluasan ke regio internal auditory canal dextra. Pasien didiagnosis dengan OD proptosis ec tumor retrobulber susp glioma saraf optik yang berasal dari chiasma / cerebri + perdarahan vitreus + glaukoma sekunder, OS Papil edema ec massa intracranial dan direncanakan OD extended enukleasi join op tumor removal oleh Bedah Saraf dengan General Anestesi. Namun, pasien belum dilakukan operasi karena keadaan pasien memburuk dan meninggal akibat syok sepsis 2 bulan pasca kedatangan pertama ke poli mata.
Simpulan: Glioma saraf optik merupakan tumor yang sering ditemukan pada anak-anak. Pada pasien sudah didapatkan nyeri, penurunan tajam penglihatan dan proptosis serta gambaran MRI yang mendukung diagnose glioma saraf optic. Sebaiknya pasien dilakukan tindakan pembedahan namun keadaan umum pasien tidak memungkinkan. Penanganan yang baik dan kerjasama multidisiplin dalam penegakan diagnosis dan tatalaksana massa intraocular maupun intracranial dibutuhkan untuk memberikan luaran yang baik bagi pasien.
Limited Cutaneous Scleroderma
Putu Gde Hari Wangsa, Prima Sanjiwani Saraswati Sudarsa, Made Hermina LaksmiOnline First: Dec 30, 2021
- Abstract
Limited Cutaneous Scleroderma
Introduction: Scleroderma is a rare autoimmune disease of connective tissue characterized by extensive fibrosis, inflammation, and vasculopathy. It classified as limited cutaneous and diffuse based on the degree of skin involvement. The management is still a challenge since it has a high morbidity and mortality rate. This case report aims to understand scleroderma and provide appropriate treatment that can improve the patient's prognosis.
Case report: A 55-year-old female came with complaints of stiff skin on the forearms, lower legs and face since approximately eight months ago, initially on the right and left forearms, then to face, right and left lower legs. On physical examination, there was sclerosis of the skin on the face, forearms and lower legs, and salt and pepper appearance with Rodnan score were 26. The result from histopathological examination were sceleroderma. The patient was diagnosed with limited cutaneous scleroderma. The management consisted of methotrexate, folic acid, sulpha ferrous, vitamins B1, B6, B12 intraorally and 10% urea cream topically. She also was informed to practice moving the hands and fingers slowly.
Conclusion: The diagnosis of limited cutaneous scleroderma is based on history, physical examination and investigations. It is still a life-threatening disease, however multidisciplinary management with early detection and treatment of complications can improve the prognosis.
Congenital syphilis present with pemphigus syphilitics and atelectatic congenital pneumonia: a case report
Callista Beatrice, Indriana Triastuti, I Gde Doddy Kurnia IndrawanOnline First: Dec 30, 2021
- Abstract
Congenital syphilis present with pemphigus syphilitics and atelectatic congenital pneumonia: a case report
Background: Congenital syphilis is an infectious disease of newborns caused by Treponema pallidum, a spirochete bacterium, from vertical transmission from infected mother to fetus. Diagnosis of congenital syphilis can be difficult because two-thirds of affected infants are asymptomatic at birth, and the signs of symptomatic infants are diverse. Familiarity with the various presentations is essential to early diagnosis and treatment.
Case Description: A male preterm, 35 weeks gestation baby, born by vaginal delivery from G1P0 mother with syphilis latent phase, with Treponema pallidum hemagglutination assay (TPHA) titer reactive (1:2560) with no treatment during the antenatal period. The baby was born with low birth weight, respiratory distress syndrome, hepatosplenomegaly, and skin rash. Diffuse desquamation and fissures also multiple eroded pale blisters are known as pemphigus syphilitics. TPHA was also reactive at the same level as the mother. Complete blood count showed severe respiratory acidosis (pH: 6,8), leucocytosis (46.420/uL), thrombocytosis (414.000/uL), lymphocytosis (40,3%), and monocytosis (16%). Radiology showed severe atelectatic left lung and course nodular congenital pneumonia of the right lung. The baby was intubated and injected with penicillin procaine 50.000 IU/kg/day intramuscularly in the neonatal intensive care unit (NICU). However, due to severe atelectatic lung and acidosis, this case resulted in a fatal outcome.
Conclusion: Broad desquamation, multiple fissures, and eroded pale blisters (vesiculobullous lesions) known as pemphigus syphilitics should alert clinicians as an early manifestation of congenital syphilis. Other manifestations include congenital pneumonia, typically atelectatic or nodular type, and hepatosplenomegaly. Treatment should be started promptly to decrease its morbidity and mortality.
Prosedur tato kornea: sebuah laporan kasus
Tiara Alexander, Eunike CahyaningsihOnline First: Dec 30, 2021
- Abstract
Prosedur tato kornea: sebuah laporan kasus
Background: Leukoma adherent is a condition where the formation of white cicatrix with iris incarceration involvement of the cornea. In addition to causing a decrease in visual acuity and blindness, leukoma adherent can also interfere with the appearance of the patient's eye. Corneal tattoo or keratopigmentation (KTP) is a procedure that disguises the color of the leukoma according to the color of the patient's eyes or irises. Corneal tattoo procedures can be performed superficially, intrastromal, or with a femtosecond laser. Corneal tattoo procedures can be carried out in various ways. It is necessary to study keratopigmentation thoroughly.
Case: An 18-year-old male patient complained of white patches on his left eye, expanding for a year. The first spots appeared five years ago after being exposed to wood. On physical examination, visual acuity was 1/~ in the left eye and 20/20 in the right eye. The patient underwent a corneal tattoo on the left eye using Vicryl 7.0 with Chinese ink.
Conclusions: Corneal tattoo with intrastromal technique is one of the commonly used techniques. This procedure can use a suture needle or an angled knife to introduce the ink. The results of this procedure are quite satisfactory. However, the patient must still be educated on the possibility of further action for color fading or other complications that can harm the eyes.
Latar belakang: Leukoma adherent merupakan kondisi terbentuknya sikatriks berwarna putih dengan keterlibatan inkarserasi iris pada kornea. Selain menyebabkan penurunan tajam penglihatan dan kebutaan, leukoma adherent juga dapat mengganggu penampilan mata pasien. Tattoo kornea atau kerato pigmentasi (KTP) merupakan prosedur yang menyamarkan warna leukoma sesuai dengan warna mata atau iris pasien. Prosedur tato kornea dapat dilakukan superfisial, intrastromal, ataupun dengan femtosecond laser. Prosedur tattoo kornea dapat dilaksanakan secara beragam, maka diperlukan studi yang membahas prosedur tattoo kornea secara menyeluruh.
Kasus: Pasien laki-laki usia 18 tahun mengeluhkan bercak putih pada mata kiri yang semakin meluas sejak setahun. Bercak pertama kali timbul sejak 5 tahun lalu, setelah mata kiri terkena kayu. Pada pemeriksaan fisik didapatkan tajam penglihatan 1/~ pada mata kiri dan 20/20 pada mata kanan. Pasien menjalani tindakan tattoo kornea pada mata kiri menggunakan vicryl 7.0 dengan tinta cina.
Simpulan: Tattoo kornea dengan teknik intrastromal merupakan salah satu teknik yang umum digunakan. Prosedur ini dapat menggunakan suture needle ataupun angled knife untuk mengintroduksi tinta. Hasil dari prosedur ini cukup memuaskan namun pasien tetap harus diedukasi kemungkinan tindakan lanjutan atas peluruhan warna ataupun komplikasi lain yang dapat membahayakan mata.
Rekurensi tinggi pada melanoma maligna konjungtiva: laporan kasus
Ni Putu Mariati, Putu Yuliawati, I Wayan Juli Sumadi, I Made Agus KusumadjajaOnline First: Dec 30, 2021
- Abstract
Rekurensi tinggi pada melanoma maligna konjungtiva: laporan kasus
Introduction: Ocular malignant melanoma is a rare but deadly disease that most often appears in the uvea, conjunctiva or orbit. Melanoma can be asymptomatic or give symptoms and signs depending on development of neoplasm. This case report aims to discuss the clinical sign of conjunctival malignant melanoma and the treatment given to better understand the disease.
Case Report: Female patient, 57 years old complained lump in the left eye since 1 month ago. Red eyes, pain and blurry vision (-). Previously, patients with a history of malignant melanoma in the left eye and had performed surgery 5 times since 2015. Ophthalmology examination obtained visual acuity on right eye 6/18 and left eye 6/45. Anterior segment evaluation of the left eye found mass on palpebra, size 2x1 cm, color according to skin, mobile (-), tenderness (-). In conjunctiva found CVI (+) and symblepharon. There are 3 masses in conjunctiva. First mass in bulbi conjunctival superior to limbus with round shape, diameter 3 mm, brown color and smooth surface. The second mass in superotemporal conjunctival fornix, brownish color, size 1,5x1,5 cm with solid consistency, mobile (+). The third mass in the superior tarsal conjunctival, oval shape, 5x3 mm, brownish color and smooth surface. Lens of right and left eye found hazy. Segmen posterior on both eye within normal limit. Patient was diagnosed with post wide excision + cryotherapy + 5 fu (8 months) + suspected conjunctival tumor ec malignant melanoma + right left eye immature senile cataract. Patient underwent tumor multiple excision + cryotherapy + PA with general anesthesia. The biopsy results showed histomorphology consistent with malignant melanoma. There were no regional or distant metastasis.
Conclusion: There are several therapeutic modalities for conjunctival melanoma, such as wide local excision with adjuvant therapy (brachytherapy, cryotherapy, and the use of topical chemotherapeutic agent like Mytomicin C). If tumor become a multiple recurrence or rapidly growing local tumor, the exenteration is needed.
Pendahuluan: Melanoma maligna okular merupakan suatu penyakit yang jarang dengan angka kematian yang tinggi dan paling sering muncul pada uvea, konjungtiva maupun orbita. Melanoma dapat bersifat asimptomatis hingga menimbulkan sekumpulan gejala dan tanda tergantung dari perkembangan neoplasma. Laporan kasus ini bertujuan untuk membahas tanda klinis melanoma maligna konjungtiva dan tatalaksana yang diberikan untuk lebih dapat memahami mengenai penyakit ini.
Laporan kasus: Pasien wanita, 57 tahun, mengeluh muncul benjolan pada mata kiri yang disadari sejak 1 bulan yang lalu. Mata merah, nyeri, keluhan kabur (-). Sebelumnya pasien dengan riwayat melanoma maligna pada mata kiri dan telah dilakukan operasi sebanyak 5x sejak tahun 2015. Pemeriksaan oftalmologi didapatkan tajam penglihatan mata kanan 6/18 dan mata kiri 6/45. Evaluasi segmen anterior pada mata kanan ditemukan lensa keruh minimal. Evaluasi segmen anterior mata kiri ditemukan massa pada palpebra, ukuran 2x1 cm, warna sesuai dengan kulit, mobile, padat, nyeri tekan (-). Pada konjungtiva ditemukan conjunctival vascular injection (CVI) (+) dan simblefaron inferior di konjungtiva serta ditemukan 3 buah massa. Massa pertama pada konjungtiva bulbi superior hingga limbus, bentuk bulat, diameter 3 mm, batas tegas, permukaan licin, warna kecoklatan. Massa kedua di konjungtiva fornix superotemporal, warna kecoklatan, teraba bulat, ukuran 1,5x1,5 cm, permukaan rata, konsistensi padat kenyal, mobile, nyeri tekan (-). Massa ketiga di konjungtiva tarsal superior, bentuk oval, uk 5x3 mm, warna kecoklatan, permukaan licin. Lensa keruh minimal dan segmen anterior lain dalam batas normal. Evaluasi segmen posterior mata kanan dan kiri dalam batas normal. Pasien didiagnosis dengan oculi sinistra (OS) post wide eksisi + cryotherapy + 5 fluorouracil (5fu) (8 bulan) + suspek tumor konjungtiva rekuren ec melanoma maligna dan oculi dekstra et sinistra (ODS) KSI dan dilakukan tindakan eksisi tumor multiple + cryotherapy + patologi anatomi (PA) dengan general anesthesia (GA). Hasil histopatologi dari open biopsy sesuai untuk melanoma maligna. Tidak ditemukan adanya metastase regional maupun metastase jauh.
Simpulan: Terdapat beberapa modalitas terapi untuk melanoma konjungtiva yaitu wide local excision dengan terapi adjuvant seperti brachytherapy, cryotherapy, dan penggunaan agen topikal kemoterapeutik (mytomicin C). Apabila dalam perjalanannya penyakit menjadi rekurensi multipel atau tumor lokal yang berkembang pesat maka tindakan eksenterasi sangat diperlukan.
Efektivitas tatalaksana tas-102 pada pasien kanker kolorektal metastasis
Christian Axel Cassidy, Ni Nyoman Ayu Dewi, I Wayan Gede Sutadarma, Ida Ayu Dewi WiryanthiniOnline First: Dec 30, 2021
- Abstract
Efektivitas tatalaksana tas-102 pada pasien kanker kolorektal metastasis
Background: Colorectal cancer is uncontrolled cell growth in the colon and rectum. On diagnosis, 20% of patients came with metastasis, and almost 50% will develop into one. On the third line and later, trifluridine/tipiracil (TAS-102) is available for metastatic colorectal cancer. This systematic review aimed to evaluate the efficacy of TAS-102 as monotherapy compared to a placebo or combined with bevacizumab.
Method: Systematic computer-based literature search for randomized controlled trials was conducted from Sept 23 until Oct 1, 2020, on PubMed and ASCO using the keywords (1)‘‘Metastatic Colorectal Cancer”, (2)‘‘TAS-102’’, (3)“management,” “treatment.” Results from the study were taken, such as overall survival and progression-free survival.
Results: From 225 articles on Pubmed and 62 from ASCO, 3 study articles from 2015 – 2020 that fit the inclusion criteria were taken. From 3 articles that match the inclusion criteria, the total population sample was 1299 colorectal cancer patients treated by TAS-102. Two studies compared TAS-102 and placebo showed that TAS-102 effectively increased overall and progression-free survival. The third article compared TAS-102 as monotherapy and, combined with bevacizumab, showed that TAS-102 was effective in improving overall survival and progression-free survival, and bevacizumab was able to increase the effects.
Conclusion: TAS-102 increased overall survival and progression-free survival in patients with metastatic colorectal cancer.
Latar Belakang: Kanker kolorektal adalah perkembangan sel-sel pada kolon dan rektum yang tidak terkontrol. Pada saat diagnosis, 20% pasien datang dengan keadaan metastasis dan hampir 50% akan berkembang menjadi metastasis. Pada lini ketiga atau lini lanjut, trifluridine/tipiracil (TAS-102) tersedia untuk pasien kanker kolorektal yang sudah bermetastasis. Systematic review ini bertujuan untuk mengevaluasi efektivitas TAS-102 pada beberapa penelitian yang meneliti TAS-102 sebagai monoterapi dibandingkan dengan plasebo atau dikombinasi dengan bevacizumab.
Metode: Pencarian literatur berupa randomized controlled trial dilakukan berbasis komputer pada tanggal 23 September 2020 hingga 1 Oktober 2020 di PubMed dan ASCO menggunakan kata kunci (1)‘‘Metastatic Colorectal Cancer”, (2)‘‘TAS-102’’, (3)“management”, “treatment”. Hasil artikel penelitian berupa overall survival dan progression-free survival kemudian dicatat.
Hasil: Hasil identifikasi 225 artikel dari Pubmed, 62 dari ASCO didapatkan 3 artikel yang memenuhi kriteria inklusi dan diambil dari kurun waktu tahun 2015 – 2020. Dari 3 artikel penelitian yang memenuhi kriteria inklusi, total populasi sampel 1299 dengan kanker kolorektal metastasis. Dua penelitian yang membandingkan tatalaksana TAS-102 dengan plasebo dan satu penelitian membandingkan TAS-102 sebagai monoterapi dan kombinasi TAS-102 dengan bevacizumab. Ketiga penelitian tersebut menunjukkan bahwa TAS-102 mampu meningkatkan overall survival dan progression-free survival.
Simpulan: TAS-102 mampu meningkatkan overall survival dan progression-free survival pada pasien kanker kolorektal yang sudah bermetastasis.
Terapi jangka panjang antiplatelet ganda (≥ 12 bulan) pada acute coronary syndrome sebagai pencegah sekunder terhadap major adverse cardiac event : a systematic review and meta-analysis of randomized controlled trials
Ni Putu Gita Raditya Sanjiwani, IGN Putra Gunadhi, Wayan AryadanaOnline First: Dec 30, 2021
- Abstract
Terapi jangka panjang antiplatelet ganda (≥ 12 bulan) pada acute coronary syndrome sebagai pencegah sekunder terhadap major adverse cardiac event : a systematic review and meta-analysis of randomized controlled trials
Background: Long-term use of dual antiplatelet therapy increases the risk of bleeding but reduces the risk of major adverse cardiac events. This systematic review will discuss the effectiveness of long-term dual antiplatelet therapy as a secondary deterrent to major adverse cardiac events presented in the meta-analysis.
Results: Four RCTs with 8.797 patients were included in this study. A total of 4.414 patients received multiple antiplatelet therapies for ≥ 12 months. Patients involved in this study were aged 60 to 67 years. The patient was diagnosed with STEMI (n = 896), NSTEMI (1.206), unstable angina pectoris (3.288), and stable angina pectoris (n = 2.869). Regarding survival endpoints, there was no significant difference in all-cause mortality. The analysis showed that the OR of myocardial infarction was 0.96 [0.66, 1.37], the OR of thrombosis was 0.75 [0.32, 1.75], and the OR of stroke was 1.04 [0.57, 1.88]. Regarding bleeding endpoints, there was a significant difference between the two groups, the OR of bleeding was 1.18 [0.66, 2.11]. Multiple antiplatelets taken for ≥ 12 months may reduce the risk of developing myocardial infarction and thrombosis compared with short antiplatelet agents. The incidence of stroke and bleeding in both treatment groups receiving long-term dual antiplatelet therapy increased.
Conclusion: Long-term antiplatelet therapy can reduce the risk of major adverse cardiac events and be a secondary deterrent. However, long-term consumption of antiplatelets can increase the risk of bleeding, and the bleeding events are not fatal.
Latar Belakang: Penggunaan antiplatelet jangka panjang dilaporkan dapat meningkatkan risiko terjadinya perdarahan namun menurunkan risiko major adverse cardiac event. Dalam tinjauan sistematis ini akan dibahas lebih jauh mengenai efektivitas terapi antiplatelet ganda jangka panjang sebagai pencegah sekunder major adverse cardiac event yang disajikan dalam meta analisis.
Hasil: Dalam tinjauan ini terdapat 4 studi yang relevan dengan seluruh studi merupakan studi blinded. Terdapat total 8,797 pasien acute coronary syndrome dengan persentase laki-laki sebesar 76%. Total 4,414 pasien yang mendapatkan terapi antiplatelet ganda ≥ 12 bulan. Dalam tinjauan ini digunakan kelompok yang mendapatkan terapi antiplatelet ≤ 6 bulan sebagai pembanding. Partisipan yang terlibat dalam studi ini berusia 60 sampai 67 tahun. Pasien terdiagnosa dengan STEMI (n=896), NSTEMI (1,206), angina pektoris tidak stabil (3,288), dan angina pektoris stabil (n=2,869). Hasil analisis didapatkan OR kejadian infark miokard 0,96 [0,66, 1,37], OR kejadian trombosis 0,75 [0,32, 1,75], OR kejadian stroke 1,04 [0,57, 1,88] dan OR kejadian perdarahan 1,18 [0,66, 2,11]. Antiplatelet ganda yang dikonsumsi dalam waktu ≥ 12 bulan dapat menurunkan risiko terjadinya infark miokard dan trombosis dibandingkan dengan antiplatelet jangka pendek. Kejadian stroke dan perdarahan pada kedua kelompok perlakukan yang mendapatkan terapi antiplatelet ganda jangka panjang meningkat.
Kesimpulan: Terapi antiplatelet jangka panjang dapat menurunkan risiko terjadinya major adverse cardiac event dan dapat dijadikan sebagai pencegah sekunder. Namun, konsumsi antiplatelet jangka panjang dapat meningkatkan risiko terjadinya perdarahan. Meskipun demikian, kejadian perdarahan tidak bersifat fatal.
Peran HbA1c dalam progresi dan prognosis COVID-19 pada pasien diabetes mellitus
Ni Luh Parameswari Praptika, Kadek Wisnu Segara KaryaOnline First: Sep 14, 2021
- Abstract
Peran HbA1c dalam progresi dan prognosis COVID-19 pada pasien diabetes mellitus
Objective: This systematic review determined the role of HbA1c in the progression and prognosis of COVID-19 in patients with diabetes mellitus from several previously published articles.
Method: We searched from an open-access database according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the PICO criteria. The inclusion criteria for the article search included: 1) COVID-19 patients with diabetes mellitus; 2) full articles; 3) English articles; 4) article publication time range from 2016 to 2021. Quality assessment for each article is evaluated using a checklist from Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).
Result: We obtained two cohort studies and four cross-sectional studies of all the articles reviewed from 2019-2021. All studies evaluated the role of HbA1c in the progression, prognosis, and mortality of COVID-19 patients with diabetes mellitus. Most of the reported studies showed an association between elevated HbA1c and worsening of the COVID-19 disease prognosis. The association was assessed by the patient's clinical deterioration included lower oxygen saturation, increased NLR (neutrophil-lymphocyte ratio), the tendency to lymphopenia, improved renal function, increased ICU admission, and mechanical ventilation and increased ventilation mortality.
Conclusion: A high HbA1c was closely related to a worse COVID-19 prognosis in clinical development and mortality. We found the potential for developing a scoring system to predict the worsening and mortality of COVID-19 and improve the quality of prevention and management of COVID-19, especially in patients with diabetes mellitus.
Tujuan: mengkaji peran HbA1c dalam progresi dan prognosis COVID-19 pada pasien diabetes mellitus dari beberapa literatur yang telah dipublikasi sebelumnya.
Metode: Pencarian literatur secara sistematis dilakukan pada basis data dengan akses terbuka sesuai dengan pedoman PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) dan kriteria PICO. Kriteria inklusi pencarian artikel antara lain: 1) pasien COVID-19 dengan diabetes mellitus; 2) artikel lengkap; 3) artikel berbahasa Inggris; 4) rentang waktu terbit artikel dari tahun 2016 hingga tahun 2021. Penilaian kualitas pada setiap artikel yang dievaluasi menggunakan checklist dari Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).
Hasil: Dari seluruh artikel yang dikaji dari tahun 2019-2021, didapatkan 2 studi kohort dan 4 studi potong lintang. Keseluruhan studi mengevaluasi peran HbA1c dalam progresi, prognosis, maupun mortalitas pada pasien COVID-19 dengan diabetes mellitus. Sebagian besar penelitian yang dilaporkan menunjukkan keterkaitan antara peningkatan HbA1c dan perburukan prognosis penyakit COVID-19 yang dinilai dari perburukan klinis pasien yaitu saturasi oksigen yang lebih rendah, meningkatnya NLR (neutrophil lymphocyte ratio), kecenderungan limfopenia, fungsi ginjal yang meningkat, peningkatan admisi ICU dan pemanfaatan ventilator mekanik serta meningkatnya mortalitas.
Simpulan: HbA1c yang tinggi terbukti berhubungan erat dengan prognosis COVID-19 yang lebih buruk ditinjau dari perkembangan klinis hingga tingkat mortalitas yang terjadi. Hal ini menunjukkan potensi berkembangnya sistem skoring untuk memprediksi perburukan dan mortalitas COVID-19 serta peningkatan kualitas pencegahan dan tatalaksana COVID-19 terutama pada pasien diabetes mellitus.
Pruritus dan modalitas terapi terkini: Sebuah tinjauan pustaka
Odilia Dea Novena, Ni Gusti Putu Raka ArianiOnline First: Oct 5, 2021
- Abstract
Pruritus dan modalitas terapi terkini: Sebuah tinjauan pustaka
Pruritus or itching is an unpleasant feeling that causes the urge to scratch, the most common symptom found in skin diseases. Histamine and several other mediators such as opioid peptides and 5-hydroxytryptamine (5-HT) also influence the occurrence of pruritus. The prevalence of pruritus in the general population varies from 8% to 38% worldwide. Pruritus is categorized into 4 types, neuropathic, psychogenic, neurogenic, and pruriroceptive pruritus. When physically examining the skin, primary skin lesions must be distinguished from secondary lesions due to chronic scratching. Dermatological signs of chronic scratching include excoriation, lichenification, prurigo nodularis or a combination of these. Management of pruritus depends on the underlying etiology. Therapy should be focused on the underlying etiology. There are pharmacological and non-pharmacological therapies, where non-pharmacological therapies focus on avoiding precipitating factors and phototherapy. Pharmacological therapy can be in the form of topical and oral therapy. Some examples of topical therapies used in daily practice are emollients, corticosteroids, immunomodulators, capsaicin, antihistamines and topical anesthetics. Oral drugs that are currently the main choice for treating pruritus are antihistamines, but there are several other options being considered, namely anticonvulsants, opioid modulators, and antidepressants. A comprehensive history and physical examination are needed to determine the triggering factors for the onset of pruritus. The management of pruritus depends on the underlying etiology and the success of therapy is also influenced by the patient's adherence to treatment. Treatment of pruritus can be in the form of non-pharmacological therapy and pharmacological therapy. Pharmacological therapy can be both topical and systemic. Commonly used topical therapies are emollients, corticosteroids and topical anesthetics. Antihistamines remain the mainstay of systemic therapy used for pruritus. The purpose of writing this article is to discuss more deeply about the treatment modalities of pruritus which are summarized from various journals and research in order to provide consideration when choosing the right therapy in daily practice.
Pruritus atau rasa gatal adalah perasaan tidak menyenangkan yang menyebabkan keinginan untuk menggaruk merupakan gejala yang paling umum ditemukan pada penyakit kulit. Histamin dan beberapa mediator lainnya seperti peptida opiod dan 5-hidroksitriptamin (5-HT) juga memengaruhi terjadinya pruritus. Prevalensi pruritus pada populasi umum bervariasi mulai dari 8% sampai dengan 38% di seluruh dunia. Pruritus dikategorikan menjadi 4 tipe, yaitu pruritus neuropatik, psikogenik, neurogenik, dan pruriroseptif. Saat memeriksa kulit secara fisik, lesi kulit primer harus dibedakan dari lesi sekunder akibat garukan kronis. Tanda-tanda dermatologis dari garukan kronis termasuk ekskoriasi, likenifikasi, prurigo nodularis atau kombinasi dari semuanya. Penatalaksanaan pruritus bergantung pada etiologi yang mendasari. Terapi yang diberikan harus difokuskan pada etiologi yang mendasari. Terdapat terapi farmakologi dan non-farmakologi, dimana terapi non farmakologi fokus terhadap menghindari faktor pencetus serta fototerapi. Terapi farmakologi dapat berupa terapi topikal dan oral. Beberapa contoh terapi topikal yang digunakan dalam praktik sehari-hari adalah emolien, kortikosteroid, imunomodulator, capsaisin, antihistamin dan anestesi topikal. Obat oral yang hingga saat ini menjadi pilihan utama terapi pruritus adalah antihistamin, namun terdapat beberapa pilihan lain yang dipertimbangkan yaitu antikonvulsan, modulator opioid, antidepresan. Anamnesis dan pemeriksaan fisik yang komprehensif sangat diperlukan untuk mengetahui faktor pencetus timbulnya pruritus. Penatalaksanaan pruritus bergantung pada etiologi yang mendasari dan keberhasilan terapi juga dipengaruhi oleh ketaatan pasien dalam berobat. Terapi pruritus dapat berupa terapi non-farmakologis dan terapi farmakologis. Terapi farmakologis dapat berupa topikal dan sistemik. Terapi topikal yang umum digunakan adalah emolien, kortikosteroid dan anestesi topikal. Antihistamin tetap menjadi pilihan utama terapi sistemik yang digunakan untuk pruritus. Penulisan artikel ini bertujuan untuk membahas lebih dalam tentang modalitas terapi pruritus yang dirangkum dari berbagai jurnal serta penelitian agar dapat memberikan pertimbangan saat memilih terapi yang tepat dalam praktik sehari-hari.
Peran vitamin B6 terhadap inflamasi pada adhesi peritoneal pasca laparotomi: tinjauan pustaka
Made Agus Dwianthara Sueta, I Dewa Made SukramaOnline First: Oct 5, 2021
- Abstract
Peran vitamin B6 terhadap inflamasi pada adhesi peritoneal pasca laparotomi: tinjauan pustaka
Vitamin B6 or pyridoxine has been shown to modulate hypoxia and inflammation, but it has not yet confirmed their local effects on the peritoneum. Although there was no study regarding this issue, pyridoxine effects on suppressing these two pathways look promising as a preventing agent against peritoneal adhesion. The development of intraperitoneal adhesion post-operation is one of the most common complications after abdominal surgery. Approximately 95% of patients who underwent laparotomy can develop adhesions in the future. Pathogenesis of adhesion consists of three important processes which were induced by trauma: trauma or direct tissue injury-induced suppression of degradation of fibrinolytic matrix and extracellular system, inflammation response with cytokine production, particularly TGF-? and interleukin, also tissue hypoxia as the impact from circulation disorder toward mesothelial cell and sub-mesothelial fibroblasts, which results as increasing hypoxia-inducible factor-alpha (HIF-1?) and vascular endothelial growth factor (VEGF), which are responsible for generating collagen and angiogenesis process. Pyridoxine has biological activity and interesting characteristics in avoiding intra-peritoneal adhesion by dealing with inflammation effects and hypoxia. From the inflammation process, pyridoxine has been shown can hinder macrophage, decrease IL-6, suppress TLR-mediated TAK1 phosphorylation, JNK, IKK-I?B?, which can cause a reduction in NF-?B activation and NLRP3-mediated caspase-1, also suppress iNOS and cyclooxygenase-2 (COX2), which contributed to developing intra-peritoneal adhesion.
Vitamin B6 (Vit B6), atau piridoksin telah ditunjukkan dapat memodulasi efek hipoksia dan inflamasi, tetapi belum dikonfirmasi efek lokalnya pada peritoneum. Walaupun belum ada penelitian langsung, efek supresi vitamin B6 terhadap kedua jalur tersebut sangat menjanjikan sebagai agen prevensi adhesi peritoneal. Perkembangan adhesi intraperitoneal pasca operasi adalah salah satu komplikasi paling umum setelah operasi abdominal. Sekitar 95% pasien yang menjalani laparotomi akan mengalami perlengketan di kemudian hari. Patogenesis adhesi melibatkan tiga proses penting yang diinduksi trauma: trauma atau kerusakan jaringan langsung menginduksi penghambatan sistem degradasi matriks fibrinolitik dan ekstraseluler, respons inflamasi dengan produksi sitokin, terutama TGF-? dan interleukin, serta hipoksia jaringan sebagai akibat dari gangguan suplai darah ke sel mesothelial dan fibroblas submesothelial, yang mengarah pada peningkatan hypoxia inducible factor-alpha (HIF-1?) dan faktor pertumbuhan endotel vaskular (VEGF), yang bertanggung jawab untuk pembentukan kolagen dan angiogenesis. Vitamin B6 menyajikan sifat dan aktivitas biologis yang menarik untuk mencegah adhesi intraperitoneal dengan mengatasi efek inflamasi dan hipoksia. Pada jalur inflamasi, vitamin B6 terbukti menghambat makrofag, menurunkan IL-6, menghambat fosforilasi TLR-mediated TAK1, JNK, serta IKK-I?B?, yang menyebabkan penurunan aktivasi NF-?B and NLRP3-mediated caspase-1, serta menghambat iNOS dan cyclooxygenase-2 (COX2) yang berkontribusi terhadap pembentukkan adhesi intraperitoneal.
Predictors of Mortality for Critically Ill COVID-19 Patients: Systematic Review
Lya Lusyana, Randika Rea Ariady, Gede Benny Setia WirawanOnline First: Oct 27, 2021
- Abstract
Predictors of Mortality for Critically Ill COVID-19 Patients: Systematic Review
Objective: To identify mortality predictors of critically ill COVID-19 patients in ICU based on current available literatures.
Methods: Systematic literature search was conducted in open-access databases. Data extraction was conducted for publication date, methodology employed, sample size, and results of multivariate analysis. Eligibility criteria for analysis was observational analytic design, sample size of 100 or more, and availability of multivariate results. Primary measures assessed was risk ratio, presented as odds ratio or hazard ratio. Data was analyzed qualitatively for themes that emerged for mortality predictors.
Results: Several mortality predictors were identified, which included demographic, clinical history, laboratory results, and oxygenation profile at ICU admission. Several of the most consistently reported mortality predictors was older age, one or more comorbidities that constitute metabolic syndrome, chronic pulmonary disorder, low lymphocyte and platelet count, elevated d-dimer, and low PaO2/FiO2 ratio.
Conclusions: Mortality predictors identified in this review were similar to previously known mortality and severity predictors of COVID-19 patients in general. This consistency may point to the potential of developing a scoring system to predict COVID-19 severity and mortality for clinical practice use.
Dietary management in colorectal cancer prevention: a review
Yudi Kristanto, Angeline Rosa HartonoOnline First: Nov 4, 2021
- Abstract
Dietary management in colorectal cancer prevention: a review
Colorectal cancer (CRC) is still a health problem with a high incidence worldwide. Genetic factors and environmental factors are the etiology of colorectal cancer. Eating habits are one of the environmental factors that can be regulated so as to prevent colorectal cancer. Diet food in the development of colorectal cancer has an important role. Several studies in the last decade have shown an association between the consumption of several foods and nutrients and the risk of colorectal cancer in epidemiological and experimental studies.
Effect of prone positioning for improving oxygenation in awake non-intubated COVID-19 patient: a systematic review
I Made Yoga Prabawa, Dedi Silakarma, Sisca SusantioOnline First: Dec 7, 2021
- Abstract
Effect of prone positioning for improving oxygenation in awake non-intubated COVID-19 patient: a systematic review
Background. The rapid rise of COVID-19 cases in many regions impacted on increasing needs of intensive care units and oxygen supplementation. The exponential COVID-19 infection with moderate to severe hypoxia that needs oxygen supplementation causes medical oxygen shortage in most hospitals and swamped the health care system. Prone positioning can be an alternate way for non-hospitalized COVID-19 patients, especially in the region facing oxygen and ward shortage in hospitals. This systematic review will describe the impact of the prone positioning method for improving oxygenation in awake non-intubated COVID-19 patients.
Method. A systematic review using PubMed and Google Scholar was conducted based on PRISMA guidelines. We used inclusion criteria such as observational study with cross sectional, cohort, case-control or clinical trial study design regarding the effect of prone positioning for improving oxygenation in COVID-19 patients. Exclusion criteria were a letter to the editor, commentary reports, systematic review or meta-analysis, study involving non-awake and or intubated patients and study not available in full-text.
Result. We gathered eleven studies consisting of six retrospective observational studies, three prospective observational studies and two clinical trials comprised of one randomized controlled trial and one interventional study. There are 791 awake non-intubated COVID-19 patients as the study sample. The measured outcomes are changes in SaO2, P/F ratio, S/F ratio, ROX index, intubation and mortality rate. The prone positioning duration varies between 29 minutes until 12 hours and helps improve oxygenation, reducing intubation and mortality.
Conclusion. Prone positioning is feasible to apply in awake non-intubated COVID-19 patients. It can improve oxygenation, reduce intubation, mortality rate and be beneficial to overcome oxygen and mechanical intubation shortage during the COVID-19 pandemic.
Potential effect of secondary metabolites in Persea americana seeds as an ?-amylase inhibitor on type 2 diabetes mellitus
Anak Agung Bagus Putra Indrakusuma, Luh Putu Sudi Wahyuni, I Gede Wikania Wira Wiguna, Anggi Amanda Triana Devy, I Gede Aswin Parisya Sasmana, Agung Wiwiek IndrayaniOnline First: Dec 20, 2021
- Abstract
Potential effect of secondary metabolites in Persea americana seeds as an ?-amylase inhibitor on type 2 diabetes mellitus
Background: Type 2 diabetes mellitus (T2DM) is a disease that has a high prevalence in the world. The development of plants with medicinal potential is an alternative to control blood sugar levels in T2DM disease, such as avocado (Persea americana). Persea americana seeds contain secondary metabolites that have anti-diabetic activity, but their bioavailability is low.
Aim: This study aims to review various secondary metabolites in Persea americana seeds that can reduce blood glucose levels in ?-amylase pathway along with the type of potential encapsulation as a delivery system.
Review: Secondary metabolites contained in Persea americana seeds which have activity as anti-diabetic are tannin, quercetin, rutin, kaempferol, saponin, triterpenoid, and alkaloid. Each of them has several mechanisms in diabetes, but their role as ?-amylase inhibitor on T2DM be in focus. There are various types of encapsulation that are known to be able to serve as a delivery system for these secondary metabolites. Those encapsulations are SNEDDS, chitosan-alginate nanoparticle, PLGA nanoparticle, lipid carrier, liposome, and polysaccharide-based enteric-coated nanoparticle. All of them showed good results in improving bioavailability.
Conclusion: It is known that various secondary metabolites found in Persea americana seeds influence reducing blood glucose levels notably in the ?-amylase pathway. The low bioavailability of secondary metabolites can be improved by several forms of potential encapsulation. Therefore, herbal substances as adjuvant therapy in T2DM might be a viable management option.
Pengukuran Interleukin-6 (IL-6), C-Reactive Protein (CRP) dan D-Dimer sebagai prediktor prognosis pada pasien COVID-19 gejala berat: sebuah tinjauan pustaka
I Ketut Wardika, I Gusti Putu Hery SikesaOnline First: Dec 20, 2021
- Abstract
Pengukuran Interleukin-6 (IL-6), C-Reactive Protein (CRP) dan D-Dimer sebagai prediktor prognosis pada pasien COVID-19 gejala berat: sebuah tinjauan pustaka
Background: Patients with severe symptoms of Coronavirus disease-19 (COVID-19) experience a cytokine storm and coagulopathy that contribute to increased mortality requires a clinical parameter that is useful for risk stratification of COVID-19 patients. This literature review will discuss further the role of measuring D-Dimer, CRP and IL-6 levels as predictors of severe COVID-19 symptoms and prognostic predictors in severe COVID-19 patients.
Methods: This literature review involved the relevant literature on CRP, IL-6, D-dimer and COVID-19. Different data sources or manual literature search methods were used to search for articles related to the literature topic.
Results: In COVID-19, severe hyperinflammatory response cytokine storm symptoms were characterized by the release of excessive proinflammatory cytokines such as IL-6 and an increase in CRP as an acute phase reactant. In addition, there is also a coagulopathy condition which is characterized by an increase in D-dimer. There were significant differences in CRP, IL-6 and D-dimer levels between COVID-19 patients with mild and severe symptoms. levels of CRP, IL-6 and D-dimer also showed a significant relationship with increased severity and mortality
Conclusion: Measurement of CRP, IL-6 and D-dimer levels is useful for predicting the occurrence of severe COVID-19 symptoms and a prognostic predictor in patients with severe COVID-19 symptoms.
Latar Belakang: Pasien Coronavirus disease-19 (COVID-19) gejala berat mengalami badai sitokin dan koagulopati yang berkontribusi terhadap tingginya angka mortalitas. Diperlukan suatu parameter klinis yang berguna untuk stratifikasi risiko pasien COVID-19. Tinjauan pustaka ini akan membahas lebih lanjut mengenai peran pengukuran kadar D-Dimer, CRP dan IL-6 sebagai prediktor terjadinya COVID-19 gejala berat dan prediktor prognostik pada pasien COVID-19 gejala berat.
Metode: Tinjauan pustaka ini melibatkan literatur yang relevan tentang CRP, IL-6, D-dimer dan COVID-19. Sumber data yang berbeda atau metode pencarian literatur manual digunakan untuk mencari artikel yang berkaitan dengan topik literatur.
Hasil: Pada infeksi COVID-19 gejala berat terjadi badai sitokin akibat respon hiperinflamasi ditandai dengan dilepasnya sitokin pro-inflamasi berlebih seperti IL-6 serta peningkatan CRP sebagai reaktan fase akut. Selain itu terjadi pula kondisi koagulopati yang ditandai dengan peningkatan D-dimer. Terdapat perbedaan kadar CRP, IL-6 dan D-dimer yang signfikan antara pasien COVID-19 dengan gejala ringan dan gejala berat. Peningkatan kadar CRP, IL-6 dan D-dimer juga menunjukkan hubungan signifikan dengan peningkatan keparahan infeksi serta mortalitas
Simpulan: Pengukuran kadar CRP, IL-6 dan D-dimer bermanfaat sebagai prediktor terjadinya COVID-19 gejala berat dan prediktor prognostik pada pasien COVID-19 gejala berat.
Peran terapi mesenchymal stem cell (MSC) dalam penatalaksanaan luka bakar: sebuah tinjauan sistematis
Zendio Abednego SantosoOnline First: Dec 28, 2021
- Abstract
Peran terapi mesenchymal stem cell (MSC) dalam penatalaksanaan luka bakar: sebuah tinjauan sistematis
Background: Burn cases are still a challenge and a burden in the health sector due to the morbidity and mortality it causes. The current management of burns has not produced satisfactory clinical outcomes in terms of wound healing. Mesenchymal stem cell (MSC) therapy is known to have an effective curative effect in healing burns. This systematic review aims to determine the role of MSCs in the management of burns.
Methods: A systematic literature review was carried out by searching the literature on Google Scholar, Pubmed and Cochrane Library, where the literature selection used PRISMA diagrams. The inclusion criteria used were studies in the form of clinical trials examining the role of MSCs in the management of thermal burns. The study was not a clinical trial, studies with research samples in the form of non-thermal burns, research subjects were not rats or mice, MSC was not used as the main intervention therapy, and did not involve the control group in the study were excluded so that 12 studies that met the eligibility criteria were obtained.
Results: 12 studies carried out the synthetic analysis in randomized clinical trials using research subjects in the form of mice and rats. The MSC therapy was isolated from bone marrow, cord blood and adipose tissue. MSC therapy plays a role in accelerating the healing process of burns through several biomolecular mechanisms such as reducing apoptosis, suppressing inflammatory responses and oxidative stress, triggering angiogenesis, accelerating re-epithelialization and tissue remodeling. MSC therapy has also been shown to minimize the formation of contractures and scar tissue,
Conclusion: The role of MSC therapy in burns is to accelerate the wound healing process, reduce the occurrence of contractures and scar tissue so that it is very potential to be applied in the management of burns.
Latar Belakang Kasus luka bakar masih menjadi tantangan dan beban di bidang kesehatan akibat morbiditas dan mortalitas yang ditimbulkannya. Penatalaksanaan luka bakar saat ini belum mampu menghasilkan luaran klinis yang memuaskan dari segi penyembuhan luka. Terapi mesenchymal stem cell (MSC) diketahui memiliki efek kuratif yang efektif dalam proses penyembuhan luka bakar. Tujuan dari tinjauan pustaka sistematis ini adalah untuk mengetahui peranan MSC dalam penatalaksanaan luka bakar.
Metode: Tinjauan pustaka sistematis dilakukan dengan pencarian literatur pada Google Scholar, Pubmed, dan Cochrane Library dimana pemilihan literatur menggunakan diagram PRISMA. Kriteria inklusi yang digunakan adalah studi berupa uji klinis yang meneliti peran MSC dalam tatalaksana luka bakar termal. Studi bukan berupa uji klinis, studi dengan sampel penelitian berupa luka bakar non-termal, subjek penelitian bukan berupa tikus atau mencit, MSC tidak digunakan sebagai terapi intervensi utama, serta tidak melibatkan kelompok kontrol dalam studinya dilakukan eksklusi sehingga didapatkan 12 studi yang memenuhi kriteria eligibilitas.
Hasil: Terdapat 12 studi yang dilakukan analisis sintesis berupa uji klinis acak menggunakan subjek penelitian berupa mencit dan tikus. Terapi MSC yang digunakan diisolasi dari sumsum tulang belakang, darah tali pusat dan jaringan adiposa. Terapi MSC berperan mempercepat proses penyembuhan luka bakar melalui sejumlah mekanisme biomolekuler berupa mengurangi apoptosis, menekan respon inflamasi dan stress oksidatif, memicu angiogenesis, mempercepat re-epitelisasi, serta remodelling jaringan. Terapi MSC juga terbukti meminimalisir terbentuknya kontraktur dan jaringan parut,
Simpulan: Peran terapi MSC dalam luka bakar adalah mempercepat proses penyembuhan luka, mengurangi terjadinya kontraktur dan jaringan parut sehingga sangat potensial untuk diaplikasikan dalam tatalaksana luka bakar.
Efektifitas dan keamanan dari terapi kombinasi methotrexate dan secukinumab pada Psoriasis vulgaris berat: tinjauan sistematis
Ovienanda Kristi Purbasari, Ni Putu Wina Widyastuti, Carolina SenakOnline First: Dec 28, 2021
- Abstract
Efektifitas dan keamanan dari terapi kombinasi methotrexate dan secukinumab pada Psoriasis vulgaris berat: tinjauan sistematis
Introduction: Psoriasis is a chronic inflammatory disease of the skin that requires comprehensive treatment. Combination therapy can be a good option in optimizing psoriasis treatment outcomes. However, the effectiveness and safety of combination therapy are still not fully understood. This study reviewed the literature examining the effectiveness and safety of the combination treatment of secukinumab and methotrexate in patients with severe Psoriasis vulgaris.
Methods: A literature search was performed on PubMed and Google Scholar databases, with several inclusion criteria. The research method used is a case report and controlled trial, with the critical appraisal method using the JBI Critical Appraisal.
Result: There were 6 pieces of literature that met the inclusion criteria. All literature describes in detail the clinical condition, course of the disease, management and side effects of treatment, but supporting examinations are not specifically described. In general, all literature shows a clinical improvement in severe psoriasis patients who are given combination treatment, and some literature also explains systemic side effects and residual plaque. The combination of biological agents with conventional systemic treatment has been proposed to optimize the results of psoriasis treatment. One study reported lightweight gastrointestinal disorders related to the use of a combination of secukinumab and methotrexate administration along with biological agents that could prevent or reduce the development of anti-drug antibodies and increase response levels to treatment. Advanced research is still needed in assessing this specific mechanism for this combination therapy
Conclusion: Combination therapy of secukinumab and methotrexate is effective in treating psoriasis skin manifestations without significant side effects. This drug combination is useful in overcoming the limitations of monotherapy drugs, such as decreasing effectiveness due to prolonged use.
Pendahuluan: Psoriasis merupakan penyakit inflamasi kronik pada kulit yang membutuhkan penanganan yang baik. Terapi kombinasi dapat menjadi pilihan yang baik dalam mengoptimalkan luaran pengobatan psoriasis. Namun, efektifitas dan keamanan terapi kombinasi masih belum dipahami sepenuhnya dan masih harus di pertimbangkan. Studi ini menilai beberapa literatur yang menguji efektifitas dan keamanan dari pengobatan kombinasi secukinumab dan methotrexate pada pasien dengan Psoriasis vulgaris berat.
Metode: Pencarian literatur dilakukan pada database PubMed dan Google Scholar, dengan beberapa kriteria inklusi. Metode penelitian yang digunakan adalah case report dan controlled trial, dengan metode critical appraisal menggunakan JBI Critical Appraisal.
Hasil: Didapatkan sebanyak 6 literatur yang memenuhi kriteria inklusi. Semua literatur menjelaskan secara detail terkait kondisi klinis, perjalanan penyakit, tatalaksana dan efek samping pengobatan, namun pemeriksaaan penunjang tidak dijelaskan secara spesifik. Secara umum, semua literatur menunjukan adanya perbaikan klinis pada pasien psoriasis berat yang diberikan pengobatan kombinasi, beberapa literatur juga menjelaskan efek samping sistemik dan plak residu. Terapi kombinasi agen biologis dengan pengobatan sistemik konvensional telah diusulkan untuk mengoptimalkan hasil pengobatan psoriasis. Satu studi melaporkan adanya gangguan gastrointestinal ringan terkait penggunaan kombinasi secukinumab dan methotrexate. Pemberian methotrexate bersamaan dengan agen biologis dapat mencegah atau mengurangi pengembangan antibodi anti-drug dan meningkatkan tingkat respon terhadap pengobatan. Penelitian lanjutan tetap diperlukan dalam menilai mekanisme spesifik terapi kombinasi ini.
Kesimpulan: Terapi kombinasi secukinumab dan methotrexate efektif dalam mengobati manifestasi kulit psoriasis tanpa adanya efek samping bermakna. Kombinasi obat ini berguna dalam mengatasi keterbatasan obat monoterapi, seperti efektifitas yang menurun akibat penggunaan yang berkepanjangan.
Immunopathogenesis of erythema nodosum leprosum
Made Sanitca Indah, I Gusti Agung Ayu Dwi KarmilaOnline First: Dec 31, 2021
- Abstract
Immunopathogenesis of erythema nodosum leprosum
Leprosy is a chronic granulomatous disease. Its etiology is caused by Mycobacterium leprae (M. leprae). This disease may affect the skin, however it also may affect peripheral nervous system and other organs. The immunologic mechanism of erythema nodosum leprosum (ENL) has not been fully understood. The ENL reaction is the reaction of deposition in immune complex in the blood vessels. Recent studies have reported the association of several immunological markers with leprosy reactions, but inconsistent results have been obtained. Neutrophils are considered a histologic feature of ENL, histologic examination of ENL skin lesions revealed a strong perivascular neutrophil infiltrate throughout the dermis and subcutis. Another thing to note is T lymphocytes. It has been showed that the T-cell counts in peripheral blood of ENL patients is higher. Other immunological processes that play a role in EL immunopathogenesis involve T-helper (Th) cells, T regulatory cells, B cells, and other cytokines.
Suplementasi seng (Zn) menurunkan kadar IgM anti PGL-1 pada narakontak serumah pasien kusta tipe multibasiler
Elice Wijaya, Luh Made Mas Rusyati, I Gusti Ayu Agung PraharsiniOnline First: Dec 30, 2021
- Abstract
Suplementasi seng (Zn) menurunkan kadar IgM anti PGL-1 pada narakontak serumah pasien kusta tipe multibasiler
Background: Indonesia ranks third highest of new cases of leprosy after India and Brazil. Transmission of leprosy through inhalation and prolonged close contact. Families who live in the same house have the highest risk for infection. Currently, several studies have found a correlation between IgM anti-PGL-1 levels with micronutrient deficiencies, especially zinc, which is associated with cellular immunity. This study aimed to investigate the effect of 40 mg elemental zinc supplementation per day for four weeks on IgM anti-PGL-1 levels.
Methods: An experimental one-group pre-test and post-test design conducted from February to May 2021. The samples were all close contact persons with multibacillary leprosy patients aged 18-65 years who visited the Dermatology and Venereology Outpatient Clinic, Sanglah General Hospital, Denpasar during the study period by consecutive sampling. The history taking, physical examination, and blood sampling were carried out at the to evaluate IgM anti-PGL-1 and zinc levels.
Results: Mean serum zinc level before and after supplementation were 79.00±9.67 g/dl and 95.16±31.84 g/dl, mean difference 25.21±32.12 g/dl (p<0.001). IgM anti-PGL-1 mean level before and after supplementation were 843.21±878.51 u/ml and 465.68±735.21 u/ml, mean difference 377.52±309.62 u/ml (p<0.001). Correlation test of different mean levels of zinc with different mean levels of IgM anti-PGL-1 resulted with r=0.630 and p=0.004.
Conclusion: Forty mg elemental zinc per day for four weeks may increase serum zinc levels and reduce IgM anti-PGL-1 in close contact with multibacillary leprosy patients (p<0.05). Higher mean increase in serum zinc levels follower by higher mean decrease of IgM anti-PGL-1 levels.
Latar Belakang: Indonesia menduduki peringkat ketiga jumlah kasus baru kusta terbanyak setelah India dan Brazil. Keluarga yang tinggal serumah memiliki resiko yang paling tinggi untuk terkena infeksi. Saat ini ditemukan beberapa penelitian yang menghubungkan kadar PGL-1 dengan defisiensi mikronutrien, salah satunya yaitu seng. Penelitian ini bertujuan untuk meneliti efek pemberian suplementasi seng elemental 40 mg per hari selama 4 minggu terhadap kadar IgM anti PGL-1.
Metode: Penelitian eksperimental one group pre-test post-test design yang dilakukan pada Februari hingga Mei 2021. Sampel adalah seluruh individu narakontak dengan pasien kusta tipe multibasiler berusia 18-65 tahun yang berkunjung ke Poliklinik Kulit dan Kelamin RSUP Sanglah Denpasar selama periode penelitian berlangsung secara consecutive sampling. Anamnesis, pemeriksaan fisik, dan pengambilan sampel darah dilakukan untuk pemeriksaan IgM anti PGL-1 dan kadar serum seng.
Hasil: Rerata kadar serum seng sebelum dan sesudah diberikan suplementasi yaitu 79,00±9,67 µg/dl dan 95,16±31,84 µg/dl dengan beda rerata 25,21±32,12 µg/dl (p<0,001). Rerata kadar IgM anti PGL-1 sebelum dan sesudah diberikan suplementasi yaitu 843,21±878,51 u/ml dan 465,68 ± 735,21 u/ml dengan beda rerata 377,52±309,62 u/ml (p<0,001). Uji korelasi beda rerata kadar seng dengan beda rerata kadar IgM anti PGL-1 yaitu r=0,630 dan p=0,004.
Simpulan: Pemberian suplementasi seng elemental 40 mg perhari selama 4 minggu dapat meningkatkan kadar serum seng dan menurunkan kadar serum IgM anti PGL-1 pada narakontak pasien kusta tipe multibasiler (p<0,05). Semakin tinggi selisih rerata peningkatan kadar seng serum, semakin tinggi selisih rerata penurunan kadar IgM anti PGL-1.
Prevalence of dry eye syndrome associated to face mask among Tabanan General Hospital Health workers in 2021
Rania Ayu Permata Putri Kornia, I Putu Rustama Putra, Ni Wayan Sedani, Cynthia Dewi MOnline First: Dec 30, 2021
- Abstract
Prevalence of dry eye syndrome associated to face mask among Tabanan General Hospital Health workers in 2021
Background: The continuous development of COVID-19 has made face masks became a mandatory part of our daily routine, but there has been an increase in dry eye syndrome (DES) from the regular used of face masks. Health workers who are obliged to use face masks are the one that has risk factors for experiencing DES, including health workers at Tabanan General Hospital, as one of the COVID-19 referral hospitals in Bali. The purpose of this study was to calculate the prevalence of DES associated to face masks and characteristics of DES among Tabanan General Hospital health workers in 2021.
Methods: This research was a descriptive cross sectional study that conducted at Tabanan General Hospital from March to April 202. The sample was 64 health workers at Tabanan General Hospital with consecutive sampling techniques using the Ocular Surface Disease Index (OSDI) questionnaire. Data were collected by using questionnaire. Data were annalyse descriptively by using SPSS 25 and the result were provide in table.
Results: The prevalence of DES associated to face masks among Tabanan General Hospital health workers in 2021 was 70.3%, with a prevalence of mild degrees 15.6%, moderate 12.5%, and severe 42.2%. The prevalence of surgical mask users was greater than Filtering Face Piece (FFP) 2 mask users in mild and severe degrees of DES. Characteristics of DES among Tabanan General Hospital health workers in 2021 were found mostly in age 30-39 years old, more in females, without DM history, non-smokers, and without eye surgery history.
Conclusion: Most of the health workers at Tabanan General Hospital experiencing DES associated to face masks, and mostly with a severe degree. Among those with DES, there were more surgical mask users than FFP2 mask users. Future studies are needed to analyze the association between DES and face masks.
Karakteristik pasien fraktur kruris di RSUD Sanjiwani Gianyar tahun 2020
Gede Agastya Pracheta Ewari, Yoga PremanaOnline First: Oct 5, 2021
- Abstract
Karakteristik pasien fraktur kruris di RSUD Sanjiwani Gianyar tahun 2020
Background: The location of the most fractures in traffic accident victims is the lower extremity bone. Data from the Basic Health Research (Riskesdas) also shows that fractures in the lower extremities due to traffic accidents have the highest prevalence among other fractures. Cruris fractures generally occur as a result of high-energy trauma such as a traffic accident or low-energy torsional trauma. The increase in cases of trauma, especially traffic accidents cause an increase in the incidence of tibial and fibular fractures. This study aims to determine the prevalence and characteristics of cruris fractures at the Sanjiwani Hospital, Gianyar in 2020.
Methods: The design of this study was retrospective descriptive using 30 samples of cruris fractures taken from secondary data from patient medical records at the Sanjiwani Hospital, Gianyar. The variables of this study included gender, age, cause of fracture and type of cruris fracture. Data analysis using SPSS software.
Results: The most common fractures of the tibia and fibula occurred in male patients (56%). The age group most frequently experiencing cruris fractures is the adult age (18-59 years). The most common cause of cruris fractures was traffic accidents as many as 19 people (64%). The most common type of cruris fracture found in this study was a fracture of the tibia fibula as many as 21 people (70%).
Conclusion: The most common cruris fractures are tibia and fibula fractures in men, with the most common cause of traffic accidents. This study is expected to be able to become a basic data material for conducting a wider study on the prevalence and characteristics of cruris fractures in Bali, so that the public can be more aware of the incidence of fractures that still occur frequently.
Latar belakang: Lokasi fraktur terbanyak pada korban meninggal kecelakaan lalu lintas adalah pada tulang bagian ekstremitas bawah. Data dari Riset Kesehatan Dasar (Riskesdas) juga menunjukkan bahwa fraktur pada ekstremitas bawah akibat kecelakaan lalu lintas memiliki prevalensi yang paling tinggi diantara fraktur lainnya. Fraktur kruris pada umumnya terjadi akibat trauma dengan energi tinggi seperti kecelakan lalu lintas atau trauma torsional energi rendah. Peningkatan kasus trauma, terutama kecelakaan lalu lintas menyebabkan peningkatan insidens fraktur tibial dan fibular. Penelitian ini bertujuan untuk mengetahui prevalensi dan karakteristik dari fraktur kruris di RSUD Sanjiwani Gianyar pada tahun 2020.
Metode: Rancangan penelitian ini adalah deskriptif retrospektif dengan menggunakan 30 sampel fraktur kruris yang diambil dari data sekunder rekam medis pasien di RSUD Sanjiwani Gianyar. Variabel penelitian ini meliputi jenis kelamin, usia, penyebab fraktur dan jenis fraktur kruris. Analisa data menggunakan perangkat lunak SPSS.
Hasil: Fraktur tibia dan fibula paling banyak terjadi pada pasien laki – laki (56%). Kelompok usia yang paling sering mengalami fraktur kruris adalah usia dewasa (18 – 59 tahun). Penyebab terbanyak fraktur kruris adalah kecelakaan lalu lintas sebanyak 19 orang (64%). Jenis fraktur kruris tersering yang ditemukan pada penelitian ini adalah fraktur tibia fibula sebanyak 21 orang (70%).
Simpulan: Fraktur kruris paling banyak didapatkan adalah fraktur tibia dan fibula pada laki-laki, dengan penyebab tersering kecelakaan lalu lintas. Penelitian ini diharapkan mampu menjadi bahan data dasar untuk dilakukannya penelitian lebih luas mengenai prevalensi dan karakteristik fraktur kruris di Bali, sehingga masyarakat dapat lebih waspada mengenai kejadian fraktur yang masih sering terjadi.
Efektivitas pelatihan tutorial simulasi Early Warning Score (EWS) COVID-19 dewasa terhadap pengetahuan dan kinerja tenaga kesehatan dalam pendokumentasian di RSUD Sanjiwani, Gianyar, Indonesia
Ni Komang Ady Tri Hapsari, I Gede Putu Darma Suyasa, Ni Putu Ayu Jelantik Sastamidhyani, Ni Made Dewi WahyunadiOnline First: Oct 12, 2021
- Abstract
Efektivitas pelatihan tutorial simulasi Early Warning Score (EWS) COVID-19 dewasa terhadap pengetahuan dan kinerja tenaga kesehatan dalam pendokumentasian di RSUD Sanjiwani, Gianyar, Indonesia
Background: Monitoring vital signs in COVID-19 patients with severe symptoms could be conducted by documenting Early Warning Score (EWS). However, health care workers are not trained to apply EWS. The purpose of this study was to determine the effectiveness of the adult EWS COVID-19 simulation tutorial training on the knowledge and performance of health workers in documentation.
Methods: The research method used was Quasi Experiment with a pre-test post-test approach with control design. Samples were 40 health workers divided into 2 groups. The intervention group 1 was the health workers from the Kamboja Room by providing simulation tutorial training consisting of the Tutorial (Lecture) method, case studies and simulations, while the intervention group 2 was the Arjuna Room health worker by providing the Tutorial (Lecture) method. Data were analyzed using SPSS version 25 for Windows.
Results: There was a significant difference in knowledge and performance related to the documentation before and after training was carried out using the Wilcoxon Sign Rank Test (p<0.001). In addition, a significant difference was also found in the effectiveness of the training method using the Independent T-Test test for knowledge (p=0.041) and performance (p=0.029) in documentation.
Conclusion: Simulation Tutorial Training is more effective in increasing knowledge and performance of health workers in documentation compared to Tutorial Training (Lecture). Based on the results of this study, it is recommended to provide training using the Adult COVID-19 EWS Simulation Tutorial method on an ongoing basis
Latar Belakang: Monitoring tanda-tanda vital pada pasien dengan Coronavirus Disease-2019 (COVID-19) dengan gejala berat dapat dilakukan melalui pendokumentasian Early Warning Score (EWS). Namun, tenaga kesehatan belum mendapatkan pelatihan tentang EWS COVID-19. Penelitian ini bertujuan untuk mengetahui efektivitas pelatihan tutorial simulasi EWS COVID-19 dewasa terhadap pengetahuan dan kinerja tenaga kesehatan dalam pendokumentasian.
Metode: Desain penelitian ini adalah Quasi-eksperimental dengan pendekatan pre-test-post-test with control design. Sampel adalah 40 orang tenaga kesehatan yang terbagi dalam dua kelompok. Kelompok intervensi 1 yaitu tenaga kesehatan Ruang Kamboja dengan pemberian pelatihan tutorial simulasi yang terdiri dari metode Tutorial (Lecture), studi kasus, dan simulasi, sedangkan kelompok intervensi 2 yaitu tenaga kesehatan Ruang Arjuna dengan pemberian metode Tutorial (Lecture). Data dianalisis dengan SPSS versi 25 untuk Windows.
Hasil: Terdapat perbedaan yang bermakna antara pengetahuan dan kinerja dalam pendokumentasian sebelum dan setelah pelatihan dengan uji Wilcoxon Sign Rank Test (p<0,001). Disamping itu juga terdapat perbedaan yang bermakna efektivitas metode pelatihan dengan uji Independent T-Test untuk pengetahuan (p=0.041) dan untuk kinerja dalam pendokumentasian (p=0.029).
Kesimpulan: Pelatihan Tutorial Simulasi lebih efektif dalam meningkatkan pengetahuan dan kinerja tenaga kesehatan dalam pendokumentasian dibandingkan dengan Pelatihan Tutorial (Lecture). Berdasarkan hasil penelitian ini disarankan untuk memberikan pelatihan dengan metode Tutorial Simulasi EWS COVID-19 dewasa secara berkesinambungan.
Pemberian pasta ekstrak daun pegagan 10% lebih meningkatkan jumlah sel fibroblas dan reepitelisasi pada soket mandibula daripada pasta ekstrak daun mengkudu 10% pasca pencabutan gigi marmut jantan
Ni Made Ista Prestiyanti, I Putu Gede Adiatmika, I Made MuliartaOnline First: Oct 12, 2021
- Abstract
Pemberian pasta ekstrak daun pegagan 10% lebih meningkatkan jumlah sel fibroblas dan reepitelisasi pada soket mandibula daripada pasta ekstrak daun mengkudu 10% pasca pencabutan gigi marmut jantan
Background: The process of wound healing after a tooth extraction is expected to occur more quickly to restore normal functioning of the tissue and reduce the risk of complications. Pegagan leaf (Centella asiatica) and mengkudu leaf (Morinda citrifolia. L) contain active compounds such as flavonoids, tannins, and triterpenoids that accelerate wound healing. This study aims to evaluate the pegagan leaf extract paste increased the number of fibroblast cells and reepitelization more than mengkudu leaf extract paste after tooth extraction.
Methods: This study used a post-test-only control group design to the 30 male guinea pigs. The three groups were the placebo paste group, the pegagan leaf extract paste 10% group, and the mengkudu leaf extract paste 10% group, which were treated for 6 days. Examination of the number of fibroblast cells and reepitelization was carried out by taking tissue of the mandibular socket on day 7, histological preparations with HE staining were made. The data obtained were analyzed by SPSS version 20 for Windows
Results: The average difference in the number of fibroblast cells and reepithelization showed a significant difference (p<0.05) between groups. The highest average for the number of fibroblast cells was found in the group that applied topically with pegagan leaf extract paste 10% was 97.98±25.67 cells followed by the group that applied topically with mengkudu leaf extract paste 10% was 64.28±12.22 cells and the group applied topically with placebo paste was 46.36±14.27 cells. The highest average for the reepithelization was found in the group that applied topically with pegagan leaf extract paste 10% was 69.64±24.53 µm.
Conclusion: It was concluded that pegagan leaf extract paste 10% increased the number of fibroblast cells and reepitelization than mengkudu leaf extract paste 10%.
Latar Belakang: Proses penyembuhan luka setelah pencabutan gigi diharapkan lebih cepat terjadi sehingga dapat mengembalikan fungsi normal dari jaringan dan mengurangi risiko terjadinya komplikasi. Daun pegagan dan daun mengkudu mengandung senyawa aktif seperti flavonoid, tanin dan triterpenoid yang dapat mempercepat penyembuhan luka. Penelitian ini bertujuan untuk mengevaluasi ekstrak daun pegagan dalam meningkatkan jumlah sel fibroblas dan reepitelisasi daripada pasta ekstrak daun mengkudu pasca pencabutan gigi.
Metode: Penelitian ini menggunakan rancangan post-test only control group design terhadap 30 ekor marmut jantan. Terdapat 3 kelompok secara acak yaitu kelompok pasta plasebo, kelompok pasta ekstrak daun pegagan 10% dan kelompok pasta ekstrak daun mengkudu 10% yang diberikan perlakuan selama 6 hari. Pemeriksaan jumlah sel fibroblas dan reepitelisasi dilakukan dengan pengambilan jaringan soket mandibula pada hari ke 7, kemudian dibuat preparat histologis dengan pengecatan HE. Data yang diperoleh dianalisis menggunakan uji SPSS versi 20 untuk Windows.
Hasil: Perbedaan rerata jumlah sel fibroblas dan reepitelisasi menunjukkan perbedaan yang signifikan (p<0,05) antar kelompok. Rerata jumlah sel fibroblas tertinggi terdapat pada kelompok yang diolesi pasta ekstrak daun pegagan 10% dengan rerata yaitu sebesar 97,98 ± 25,67 sel diikuti oleh kelompok yang diolesi pasta ekstrak daun mengkudu 10% dengan rerata sebesar 64,28 ± 12,22 sel dan kelompok yang diolesi pasta plasebo dengan rerata sebesar 46,36 ± 14,27 sel. Sedangkan rerata reepitelisasi tertinggi terdapat pada kelompok yang diberi pasta ekstrak daun pegagan 10% dengan rerata yaitu sebesar 69,64 ± 24,53 µm.
Kesimpulan: Dapat disimpulkan bahwa pasta ekstrak daun pegagan 10% lebih meningkatkan jumlah sel fibroblas dan reepitelisasi daripada pasta ekstrak daun mengkudu 10%.
Incidence report of traumatic brain injury in Mimika Public Hospital Papua
Kevin Kristian Putra, Putu Ayu Indra Shanti Wardani, I Wayan NiryanaOnline First: Oct 12, 2021
- Abstract
Incidence report of traumatic brain injury in Mimika Public Hospital Papua
Introduction: Traumatic brain injury is a functional brain disorder caused by an external force, which giving persistent consequences, progressive, long-term care, and rehabilitation might be needed. It is also called a “silent epidemic” due to the increased global incidence rate, socio-economic burden, and quality of life. The major cause of TBI was road traffic injury, fall, and blunt trauma.
Methods: This research was conducted with a descriptive research design using a prospective cross-sectional design. The research sampling was using medical records in accordance with inclusion and exclusion criteria from 2018 to 2019.
Result: The collected sample was 393 cases. There were 66.16% and 67.18% cases occurred to man and productive age with incidence rate 178.89 in 100.000 people. The major cause of TBI was road traffic injury and intentional injury with 58.52% and 24.17% consecutively. The involvement of alcohol in TBI cases was found in 24.42% of cases. The usage of the helmet was not found in 96.6% of cases of RTI.
Conclusion: The majority of TBI patients at Mimika Public Hospital in 2018-2019 occurred in men and in the productive age, which was majorly caused by road traffic injury and intentional injury.
Colonoscopy surveillance of colorectal cancer post-surgery in Sanglah General Hospital, Bali, Indonesia: a descriptive study
Gede Eka Rusdi AntaraOnline First: Oct 18, 2021
- Abstract
Colonoscopy surveillance of colorectal cancer post-surgery in Sanglah General Hospital, Bali, Indonesia: a descriptive study
Background: The postoperative surveillance of patients treated for colorectal cancer is intended to prolong survival by diagnosing recurrent and metachronous cancers at a curable stage as well as preventing metachronous cancer by detection and removal of precancerous polyps. This study evaluates the surveillance colonoscopy and its association with sociodemographic and clinical findings in a descriptive study.
Methods: This is a cross sectional study of colorectal cancer patients who underwent surveillance colonoscopy as follow up after tumor resection from January 2020 to September 2021 in Sanglah General Hospital. Clinical data were gathered from medical records and databases by a qualified reviewer. Data were analyzed descriptively using SPSS version 20 for Windows.
Results: The majority of patients who underwent surveillance colonoscopy were male (82.40%), tumor location at rectum (58.8%), stage IV (29.40%), underwent low anterior resection surgery (35.30%) and received Folfox (35.30%) or Capeox (35.30%) adjuvant chemotherapy. There was 2 (11.80%) residual mass found in this study. There was no significant difference between subjects who underwent surveillance colonoscopy with residual mass and without residual mass in all variables assessed (p>0.05).
Conclusion: Colonoscopy surveillance plays an important role in early detection for any recurrence or pre-cancer lesion and metachronous cancer in a patient with colorectal malignancies in Sanglah General Hospital, Bali, Indonesia.
Pengembangan sistem pengelolaan alat kesehatan pada ruang perawatan berbasis teknologi informasi di RSUD Sanjiwani, Gianyar tahun 2021
Ni Made Milapastiniari, I Gede Putu Darma Suyasa, I Ketut Alit Adianta, Ni Kadek SriasihOnline First: Oct 19, 2021
- Abstract
Pengembangan sistem pengelolaan alat kesehatan pada ruang perawatan berbasis teknologi informasi di RSUD Sanjiwani, Gianyar tahun 2021
Background: Health equipment is one of the important factors in the implementation of health services. An increase in the number and types of medical equipment requires a good management system, so that the number, condition and presence can be monitored at any time. Currently, there is no system that can facilitate the management of medical devices in the treatment room so that it can be integrated with other units in the hospital. The purpose of this study was to develop an information system for managing medical devices in an appropriate and efficient treatment room based on the managerial functions of the head of the room.
Methods: The type of research used is action research where total sampling is done on 29 employees of RSUD Sanjiwani Gianyar This research consists of six stages, namely Focus Group Discussion (FGD), information system design, socialization and testing, evaluation of user satisfaction with information system design, application and evaluation of the real benefits of information systems. Data were analyzed with SPSS version 21 for Windows.
Results: There were thirteen themes obtained through Focus Group Discussions (FGD), then the themes obtained were integrated into the designed information system. After conducting socialization and testing, the researchers evaluated user satisfaction with the design of this information system, where 58.6% stated that they were satisfied and 41.4% said they were very satisfied. The application of this information system was carried out for four weeks, and finally an evaluation of the real benefits was carried out. Based on the results of this evaluation, it was found that 51.7% said this system was useful and 48.3% said it was very useful.
Conclusion: The development of this medical device management information system is useful to support the task of the head of the room in carrying out the management of medical devices in the treatment room.
Latar Belakang: Peralatan kesehatan merupakan salah satu faktor penting dalam penyelenggaraan pelayanan kesehatan. Peningkatan jumlah dan jenis peralatan kesehatan, memerlukan sistem pengelolaan yang baik, sehingga jumlah, kondisi dan keberadaannya dapat dipantau setiap waktu. Saat ini belum tersedia sistem yang dapat memfasilitasi pengelolaan alat kesehatan di ruang perawatan sehinga dapat terintegrasi dengan unit- unit terkait yang ada di rumah sakit. Tujuan penelitian ini adalah untuk mengembangkan sistem informasi pengelolaan alat kesehatan di ruang perawatan yang tepat dan efisien berdasarkan fungsi- fungsi manajerial kepala ruangan
Metode: Jenis penelitian yang digunakan adalah action research dimana pengambilan sampel dilakukan secara total sampling terhadap 29 orang pegawai RSUD Sanjiwani Gianyar Penelitian ini terdiri atas enam tahap yaitu Focus Group Discussion (FGD), perancangan sistem informasi,sosialisasi dan uji coba, evaluasi kepuasan user terhadap rancangan sistem informasi, aplikasi dan evaluasi terhadap manfaat nyata dari sistem informasi. Data dianalisis dengan SPSS versi 21 untuk Windows.
Hasil: Terdapat tiga belas tema yang didapatkan melalui Focus Group Discussion (FGD), selanjutnya tema yang didapatkan diintegrasikan kedalam sistem informasi yang dirancang. Setelah dilakukan sosialisasi dan uji coba, peneliti melakukan evaluasi kepuasan user terhadap rancangan sistem informasi ini, dimana didapatkan 58,6% menyatakan puas dan 41,4% menyatakan sangat puas. Pengaplikasian sistem informasi ini dilaksanakan selama empat minggu, dan terakhir dilakukan evaluasi terhadap manfaat nyata. Berdasarkan hasil evaluasi ini, didapatkan bahwa 51,7% menyatakan sistem ini bermanfaat dan 48,3% menyatakan sangat bermanfaat.
Kesimpulan: Pengembangan sistem informasi pengelolaan alat kesehatan ini bermanfaat untuk mendukung tugas kepala ruangan dalam melaksanakan pengelolaan alat kesehatan di ruang perawatan.
Angka insiden dan faktor risiko malnutrisi rumah sakit pada anak rawat inap di RSUP Sanglah, Bali, Indonesia
Anak Agung Ratna Purnama Santhi, I Gusti Lanang Sidiartha, I Gusti Ayu Putu Eka PratiwiOnline First: Oct 19, 2021
- Abstract
Angka insiden dan faktor risiko malnutrisi rumah sakit pada anak rawat inap di RSUP Sanglah, Bali, Indonesia
Background: Nutritional support is an important aspect of the clinical management of hospitalized children. Several factors contribute to prevalence of malnutrition in hospitalized children and it can led to deterioration of nutritional status. Research on factors related to malnutrition in pediatric hospitalized patients is still limited, especially in Indonesia. This study aims to evaluate the incidence rate and risk factors of malnutrition in hospitalized children at Sanglah General Hospital, Bali, Indonesia.
Methods: This study was a prospective analytic observational study in children who underwent hospitalization in class II and III inpatient rooms for the period August 2020-February 2021. Inclusion criteria were pediatric patients aged 1 to 18 years who were hospitalized for at least 48 hours and had complete medical records. Samples were taken by consecutive sampling until the number of subjects was met. A significant variable is a variable that has a p-value <0.05. Data were analyzed using SPSS version 20 for Windows.
Results: A total of 95 subjects who met the inclusion and exclusion criteria. The incidence of hospital malnutrition was 28%. The risk factors associated with hospital malnutrition were fever, diarrhea and vomiting. Multiple diagnosis, acute and chronic malnutrition, low maternal education, surgical and medical departments also contribute to hospital malnutrition. The results of multivariate analysis were acute malnutrition and length of stay as independent risk factors for hospital malnutrition (OR, 3.843; 95% CI, 1.762-5.431; p=0.005) and length of stay (OR, 5.791; 95% CI, 2.157-6.491; p=0.026)
Conclusion: The incidence of patients with hospital malnutrition in children at Sanglah Hospital Denpasar is 28%. Acute malnutrition and length of stay are independent risk factors for malnutrition during hospitalization.
Latar belakang: Dukungan nutrisi adalah aspek penting dalam manajemen klinis anak yang dirawat di rumah sakit. Beberapa faktor berkontribusi terhadap meluasnya malnutrisi pada anak yang dirawat di rumah sakit dan menyebabkan eksaserbasi status gizi. Penelitian mengenai faktor-faktor yang berkaitan dengan malnutrisi pada pasien pediatri yang menjalani rawat inap masih sangatlah terbatas khususnya di Indonesia meskipun memiliki urgensi yang tinggi. Penelitian ini bertujuan untuk mengevaluasi angka insiden dan faktor risiko malnutrisi rumah sakit pada anak rawat inap di RSUP Sanglah, Bali, Indonesia
Metode: Penelitian ini merupakan penelitian observasional analitik pada anak dengan metode penelitian kohort prospektif yang menjalani rawat inap di ruang rawat inap kelas II dan III periode bulan Agustus 2020-Februari 2021. Kriteria inklusi yaitu pasien anak berusia 1 hingga 18 tahun, menjalani rawat inap di RS minimal 48 jam, dan memiliki catatan medis yang lengkap. sampel diambil secara konsekutif sampai jumlah subyek terpenuhi. Variabel yang signifikan adalah variabel yang mempunyai nilai p<0,05. Data dianalisis dengan SPSS versi 20 untuk Windows.
Hasil: Sebanyak 95 subjek yang memenuhi kriteria inklusi dan eksklusi. Insiden malnutrisi rumah sakit didapatkan sebesar 28%. Faktor RISIKO yang berhubungan dengan malnutrisi rumah sakit adalah demam, diare dan muntah. Diagnosis multipel, kurang gizi akut dan kronis, lama rawat,pendidikan ibu rendah, dan departemen rawat juga sebagai faktor RISIKO malnutrisi rumah sakit. Hasil analisis multivariat dilakukan dengan hasil kurang gizi akut dan lama rawat sebagai faktor risiko independen terjadinya malnutrisi rumah sakit (OR, 3.843; 95% CI, 1.762-5.431; p=0.005) dan lama rawat (OR, 5.791; 95% CI, 2.157-6.491; p=0.026)
Simpulan: Insiden pasien dengan malnutrisi rumah sakit pada anak di RSUP Sanglah Denpasar adalah sebesar 28%. Kondisi kurang gizi akut dan lama rawat merupakan faktor risiko independen terjadinya malnutrisi selama perawatan di rumah sakit.
Hubungan nilai Red Cell Distribution Width (RDW) dengan tingkat keparahan pneumonia pada pasien anak di RSUD Wangaya Denpasar, Bali-Indonesia
Made Cynthia Mahardika Putri, I Wayan Bikin Suryawan, I Kadek SuarcaOnline First: Oct 21, 2021
- Abstract
Hubungan nilai Red Cell Distribution Width (RDW) dengan tingkat keparahan pneumonia pada pasien anak di RSUD Wangaya Denpasar, Bali-Indonesia
Latar Belakang: Pneumonia merupakan penyebab kematian tertinggi pada anak usia kurang dari lima tahun. Berdasarkan Profil Kesehatan Indonesia 2019 terdapat 52,7% kasus pneumonia anak di Indoneisa. Tingginya kasus kematian akibat pneumonia pada anak menandakan beratnya gejala yang timbul dan perburukan klinis yang terjadi, sehingga penting untuk menemukan penanda yang dapat memprediksi anak yang cenderung akan mengalami perburukan klinis. Red cell distribution width (RDW) adalah suatu penanda pada pemeriksaan darah standar namun klinisnya jarang diperhatikan. Tujuan penelitian ini adalah untuk mengetahui hubungan nilai RDW dengan tingkat keparahan pneumonia pada pasien anak.
Metode: Jenis penelitian yang digunakan adalah studi analitik observasional dengan pendekatan cross-sectional. Pengambilan sampel menggunakan metode consecutive sampling. Data yang diperoleh dianalisis secara analitik, menggunakan program computer SPSS versi 25.0 dengan uji chi square dan uji independent t-test.
Hasil: Rerata RDW didapatkan lebih tinggi pada kelompok subjek dengan pneumonia berat (15,48 ± 1,95) dibandingkan kelompok dengan pneumonia ringan (13,73 ± 1,11) (p=0,000).
Simpulan: Terdapat hubungan bermakna antara RDW dengan tingkat keparahan pneumonia.
Background: Pneumonia is the highest cause of death in children less than five years old. Based on the 2019 Indonesian Health Profile, there were 52.7% cases of childhood pneumonia in Indonesia. The high number of deaths from pneumonia in children indicates the severity of the symptoms and the clinical deterioration that occurs, so it is essential to find markers that can predict children who are likely to experience clinical deterioration. Red cell distribution width (RDW) is a marker on standard blood tests but is rarely seen clinically. This study aimed to determine the relationship between the RDW value and the severity of pneumonia in pediatric patients.
Methods: The type of research used is an observational analytic study with a cross-sectional approach. Sampling used the consecutive sampling method. The data obtained were analyzed analytically, using the computer program SPSS version 25.0 with chi-square test and independent t-test.
Results: The mean RDW was higher in person with severe pneumonia (15.48 ± 1.95) than the group with mild pneumonia (13.73 ± 1.11) (p=0.000).
Conclusion: There is a significant relationship between RDW and the severity of pneumonia.
Perbandingan efektivitas dan keamanan antara roxadustat dan epoetin alfa sebagai terapi anemia pada pasien yang menjalani hemodialisis reguler: meta analisis
Kadek Wisnu Segara Karya, Ni Luh Parameswari Praptika, Nyoman Yudia Trianadewi Nurbudhi, Yenny KandariniOnline First: Oct 22, 2021
- Abstract
Perbandingan efektivitas dan keamanan antara roxadustat dan epoetin alfa sebagai terapi anemia pada pasien yang menjalani hemodialisis reguler: meta analisis
Introduction: Chronic kidney disease (CKD) is a global health problem. Hemodialysis (HD) is one of the treatment modalities for end-stage renal disease which is commonly used. A complication that is often found in patients undergoing regular HD is anemia. Roxadustat is a prolyl hydroxylase inhibitor (PHI) which has a potential as an alternative therapy for anemia in patients undergoing regular HD. The aim of this meta-analysis was to compare the efficacy and safety of roxadustat and epoetin alfa as anemia management in patients undergoing regular HD.
Methods: We searched the literature sources in the PubMed, MEDLINE, Cochrane, Scopus, Embase, Elsevier, and Proquest databases until June 1, 2021. The search terms used were chronic kidney disease, hemodialysis, dialysis, roxadustat, epoetin alfa, anemia management, incidence of side effects, randomize, and randomization. We excluded the study population with acute kidney injury/dyslipidemia/metabolic syndrome. All analyzes in this meta-analysis were performed using Review Manager version 5.3 (RevMan Cochrane, London, UK).
Result: We have found five eligible studies (2777 patients). Funnel plots and p-Egger were examined to assess publication bias. The results showed a statistically significant difference between roxadustat and epoetin alfa with respect to the mean difference of hemoglobin (Hb) (WMD: 0.31; p<0.05), hepcidin (WMD: -18.94; p<0.05), transferrin (WMD: 67.88; p<0.05), transferrin saturation (WMD: 2.78; p<0.05), iron (WMD: 5.02; p<0.05) and risk of adverse events (OR: 1.25; p<0.05) displayed on the forest plot.
Conclusion: Based on this meta-analysis, it can be concluded that anemia management with roxadustat is better than epoetin alfa in patients undergoing regular HD.
Latar Belakang: Penyakit ginjal kronis (PGK) merupakan masalah kesehatan global. Hemodialisis (HD) merupakan salah satu modalitas terapi PGK stadium akhir yang umum digunakan. Komplikasi yang sering ditemukan pada pasien yang menjalani HD reguler adalah anemia. Roxadustat adalah suatu prolyl hydroxylase inhibitor (PHI) yang memiliki potensi sebagai alternatif terapi anemia pada pasien yang menjalani HD reguler. Tujuan dari meta-analisis ini adalah untuk membandingkan efektivitas dan keamanan antara roxadustat dan epoetin alfa sebagai manajemen anemia pada pasien yang menjalani HD reguler.
Metode: Kami mencari sumber literatur pada database PubMed, MEDLINE, Cochrane, Scopus, Embase, Elsevier, dan Proquest hingga 1 Juni 2021. Istilah pencarian yang digunakan yaitu penyakit ginjal kronis, hemodialisis, dialisis, roxadustat, epoetin alfa, manajemen anemia, kejadian efek samping, acak, dan pengacakan. Kami mengeksklusi populasi penelitian dengan cedera ginjal akut/dislipidemia/sindrom metabolik. Semua analisis dalam meta-analisis ini dilaksanakan dengan menggunakan Review Manager versi 5.3 (RevMan Cochrane, London, UK).
Hasil: Kami menemukan lima studi yang memenuhi syarat (2777 pasien). Funnel plot dan p-Egger diperiksa untuk menilai bias publikasi. Hasil menunjukkan perbedaan signifikan secara statistik antara roxadustat dan epoetin alfa terhadap perbedaan rerata dari hemoglobin (Hb) (WMD: 0,31; p<0,05), hepsidin (WMD: -18,94; p<0,05), transferin (WMD: 67,88; p<0,05), saturasi transferin (WMD: 2,78; p<0,05), zat besi (WMD: 5,02; p<0,05) dan risiko kejadian efek samping (OR: 1,25; p<0,05) yang ditampilkan pada forest plot.
Kesimpulan: Berdasarkan meta-analisis ini, dapat disimpulkan bahwa manajemen anemia dengan roxadustat lebih baik dibandingkan dengan epoetin alfa pada pasien yang menjalani HD reguler.
Facial Skin Injury Related to Personal Protective Equipment Among Healthcare Workers: Single Center Cross-Sectional Study
I Gusti Ayu Agung Bella Jayaningrum, Gede Benny Setia Wirawan, Anak Agung Ngurah Krisna Dwipayana, Anak Agung Ngurah Bagus Surya Darma, Lya Lusyana, Sang Nyoman SurianaOnline First: Oct 27, 2021
- Abstract
Facial Skin Injury Related to Personal Protective Equipment Among Healthcare Workers: Single Center Cross-Sectional Study
Objective: Our study aimed to learn the phenomenon of facial skin injuries related to PPE use, their characteristics, as well as risk and protective factors.
Methods: We conducted a single-center cross-sectional study. Samples was collected consecutively by disseminating self-filled questionnaire to all departments in Sanjiwani General Hospital, Gianyar, Bali, Indonesia. Variables studied included demographic, characteristics of PPE usage, characteristics of facial skin injuries suffered, and preventive measures practiced by healthcare workers. We conducted multivariate analysis for independent determinants of more severe skin injuries and any injuries located on the nasal bridge, cheekbones, and behind the ears.
Results: Final analysis included 161 respondents. Male make up 26.7% of respondents, mean age was 35.00 (± 8.91). The majority was nurses (78.3%). Prevalence of skin injury was 90.7%, 39.1% of them being partial or full thickness skin injuries. Only 27.4% respondents practiced preventive measures, including application of polyester tape layering and emollient. The most frequently reported location of skin injury was nasal bridge (77%), followed by behind the ears (57.1%), and on the cheekbones (47.2%). Multivariate analyses discovered that KN95 respirator poses less risk for more severe injuries compared to N95. Protective measures were found effective to prevent skin injuries in all locations, including for more severe injuries.
Conclusions: We found high prevalence of facial skin injuries among healthcare workers accompanied by inadequate practice of preventive behaviors. These preventive behaviors have been found effective in other study as well and existing evidence support its promotion for more widespread practice.
Efek ekstrak sambiloto (Andrographis paniculata) terhadap ekspresi vascular cell adhesion molecule-1 (VCAM-1) dan intimal media thickness (IMT) pada mencit yang terpapar asap rokok
I Made Adi Satria Darma, Wayan Aryadana, I Nyoman Wiryawan, I Gede Raka Widiana, I Gusti Nyoman Kamasan Arijana, Made Satria Yudha DewanggaOnline First: Nov 12, 2021
- Abstract
Efek ekstrak sambiloto (Andrographis paniculata) terhadap ekspresi vascular cell adhesion molecule-1 (VCAM-1) dan intimal media thickness (IMT) pada mencit yang terpapar asap rokok
Introduction: Sambiloto (Andrographis paniculata) is a plant that spread almost throughout the Indonesian archipelago and has been used for a long time as traditional medicine. Several previous literatures reported that sambiloto has anti-inflammatory and antioxidant effects, so its use is useful in cardiovascular disease, especially in reducing the process of atherosclerosis. The purpose of this study was to determine the effect of giving sambiloto extract on markers of inflammation and atherosclerosis in the form of VCAM-1 expression and IMT in mice exposed to cigarette smoke.
Methods: This study used an experimental analytical method with a post-test-only group design. Using 32 healthy adult male mice weighing 20-30 grams were divided into four treatment groups, namely: control group (P0) only given exposure to cigarette smoke and treatment group 1 (P1), 2 (P2), and 3 (P3) given exposure cigarettes and sambiloto extract with doses of 18, 29, and 40 mg/kg/day. Exposure is given for 60 days, then the VCAM-1 expression and IMT in the aortic arch were examined histologically.
Results: There were significant differences in VCAM-1 expression and IMT between the control group and all treatment groups. There was a significant decrease in VCAM-1 expression between P1 and P2 and P2 and P3. There was a significant decrease in IMT between P1 and P2 and P2 and P3.
Conclusion: Sambiloto extract has effect in decreasing VCAM-1 expression and IMT. That effect strengthens with increasing dose. The maximum effect is obtained with the use of a dose of 40 mg/kg/day.
Latar Belakang: Sambiloto (Andrographis paniculata) merupakan tanaman yang tersebar hampir di seluruh nusantara dan telah digunakan sejak lama oleh masyarakat Indonesia sebagai obat tradisional. Dari beberapa literatur sebelumnya melaporkan sambiloto memiliki efek antiinflamasi dan antioksidan sehingga bermaafaat dalam bidang penyakit kardiovaskular terutama mengurangi proses aterosklerosis. Tujuan dari penelitian ini untuk mengetahui efek pemberian ekstrak sambiloto terhadap petanda inflamasi dan atherosklerosis berupa ekspresi VCAM-1 dan IMT pada mencit yang terpapar asap rokok.
Metode: Penelitian ini menggunakan metode analitik eksperimental dengan rancangan post test only group design. Menggunakan 32 ekor mencit jantan dewasa kondisi sehat dengan berat 20-30 gram dibagi menjadi empat kelompok perlakuan yaitu kelompok kontrol (P0) hanya diberikan paparan asap rokok dan kelompok perlakuan 1 (P1), 2 (P2), dan 3 (P3) diberikan paparan rokok sigaret dan ekstrak sambiloto dengan dosis 18, 29, dan 40 mg/kg/hari. Paparan diberikan selama 60 hari, kemudian dilakukan pemeriksaan histologi ekspresi VCAM-1 dan IMT pada arkus aorta mencit.
Hasil: Terdapat perbedaan yang bermakna ekspresi VCAM-1 dan IMT antara kelompok kontrol dengan semua kelompok perlakuan. Terdapat penurunan bermakna ekspresi VCAM-1 antara P1 dengan P2 dan P2 dengan P3. Terdapat penurunan bermakna tebal IMT antara P1 dengan P2 dan P2 dengan P3.
Simpulan: Ekstrak sambiloto memiliki efek menurunkan ekspresi VCAM-1 dan tebal IMT. Efek tersebut meningkat dengan peningkatan dosis. Efek maksimal diperoleh dengan penggunaan dosis 40 mg/kg/hari.
Hubungan antara status tumor budding dengan berbagai parameter klinikopatologi pada adenokarsinoma kolorektal di RSUP Sanglah, Bali, Indonesia
Luh Putu Iin Indrayani Maker, Ni Putu SriwidyaniOnline First: Dec 7, 2021
- Abstract
Hubungan antara status tumor budding dengan berbagai parameter klinikopatologi pada adenokarsinoma kolorektal di RSUP Sanglah, Bali, Indonesia
Background: Colorectal malignancies are common, with adenocarcinoma as the most prevalent type. Recently, studies of specific morphology like tumor budding have already started and related with tumor’s aggressivity as well as several parameters. This study aims to evaluate the association between tumor budding grade with patient age, sex, tumor location, histological grade, depth of invasion, and nodal status in colorectal adenocarcinoma at Sanglah General Hospital.
Methods: This cross-sectional descriptive study used samples of intestinal resection specimens accompanied by Regional Lymph Node (RLN) removal of colorectal adenocarcinoma patients at Sanglah Hospital in 2018-2020. The sampling technique was carried out consecutively, which met the inclusion and exclusion criteria. Data on age, sex, tumor location, histologic grade, depth of invasion, and nodal status were obtained from the archives of examination results. At the same time, tumor budding data were obtained from observations of histopathological preparations with Hematoxylin-Eosin (H&E) staining. The results of the observations were tested statistically and presented descriptively. Data were analyzed with Chi-Square using SPSS version 22 for Windows.
Results: Most of the study samples were 50 years old (84.0%), followed by male gender (62.0%), tumor location in the left colon (67.0%), low-grade (90.0%), T3-T4 invasion depth (77.0%), negative nodal status (60.0%), and high-tumor budding grade (51.0%). The Chi-Square test showed a significant relationship between the depth of invasion (p=0.001) and nodal status (p=0.009) variables on tumor budding grade.
Conclusion: There were significant correlations between tumor budding grade and depth on invasion and nodal status.
Latar Belakang: Kanker kolorektal merupakan keganasan yang sering ditemukan dengan adenokarsinoma merupakan tipe histopatologi terbanyak. Dewasa ini telah mulai diteliti morfologi spesifik yaitu tumor budding yang dikaitkan dengan agresivitas tumor maupun parameter lainnya. Penelitian ini bertujuan untuk mengetahui hubungan antara tumor budding grade dengan umur pasien, jenis kelamin, lokasi tumor, grade histopatologi, kedalaman invasi, dan status nodal pada adenokarsinoma kolorektal di RSUP Sanglah Denpasar.
Metode: Penelitian deskriptif potong lintang ini menggunakan sampel spesimen reseksi usus disertai pengangkatan Kelenjar Getah Bening (KGB) regional pasien adenokarsinoma kolorektal di RSUP Sanglah tahun 2018-2020. Teknik pengambilan sampel dilakukan secara konsekutif, yang memenuhi kriteria inklusi dan eksklusi. Data umur, jenis kelamin, lokasi tumor, grade histopatologi, kedalaman invasi dan status nodal diperoleh dari arsip hasil pemeriksaan. Sedangkan data tumor budding diperoleh dari pengamatan sediaan histopatologi pewarnaan Hematoksilin-Eosin (H&E). Hasil pengamatan diuji secara statistik dan ditampilkan secara deskriptif. Data dianalisis dengan Chi-Square menggunakan SPSS versi 22 untuk Windows.
Hasil: Sebagian besar sampel penelitian berusia ? 50 tahun (84,0%), diikuti dengan jenis kelamin laki-laki (62,0%), lokasi tumor pada kolon kiri (67,0%), low-grade (90,0%), kedalaman invasi T3-T4 (77,0%), status nodal negatif (60,0%), dan high-tumor budding grade (51,0%). Uji Chi-Square menunjukkan bahwa terdapat hubungan yang bermakna antara variabel kedalaman invasi (p=0,001) dan status nodal (p=0,009) terhadap tumor budding grade.
Kesimpulan: Terdapat hubungan yang bermakna antara tumor budding grade dengan kedalaman invasi dan status nodal adenokarsinoma kolorektal.
Efek pemberian formulasi SMEDDS ekstrak biji kedelai (glycine soja) terhadap kadar LDL dan HDL pada tikus yang diinduksi jantung koroner
Adrian Wiryanata Gorintha, I Nengah Raka Swastika, Ni Ketut Risitani, Agung Wiwiek IndrayaniOnline First: Dec 7, 2021
- Abstract
Efek pemberian formulasi SMEDDS ekstrak biji kedelai (glycine soja) terhadap kadar LDL dan HDL pada tikus yang diinduksi jantung koroner
Introduction: Coronary heart disease is one of the national health problems that gets attention. One of the efforts to develop the treatment of coronary heart disease includes the use of natural ingredients such as soybean seed extract which contains aglycone isoflavones which affect preventing endothelial dysfunction and reducing LDL levels in the blood, where high LDL levels and low HDL levels in the blood are one of the factors. The risk of coronary heart disease. Aglycone isoflavone compounds are non-polar compounds that are difficult to dissolve in water, so they require other ingredients to increase the absorption of aglycone isoflavones, one of which is the Self Microemulsifying Drug Delivery System (SMEDDS) formulation that can help improve solubilization and access drug to lymphatic tissue
Methods: This experimental study was conducted with a post-test only approach. The research sample used 35 white rats which were divided into the first group which was given a normal diet, the second group which was given a high-fat diet and the third to fifth groups which were given a high-fat diet and the SMEDDS formulation of soybean seed extract. The SMEDDS formulation of soybean seed extract was administered at 200 mg/mL, 300 mg/mL and 400 mg/mL using a probe for seven days, twenty-one days after rats were induced with coronary heart disease with a high-fat diet. The rat blood was then taken for analysis of LDL and HDL levels. Data were analyzed by SPSS for windows.
Results: The results showed that there was no significant difference in LDL and HDL levels from each experimental group (p>0.05). This can be caused by the short period of administration of the SMEDDS formulation and the dosage of the formulation that has not been able to provide clinical effects on experimental animals.
Conclusion: The SMEDDS formulation of soybean seed extract did not show the ability to reduce LDL lizards or increase HDL levels in rats induced by coronary heart disease.
Pendahuluan: Penyakit jantung koroner merupakan salah satu masalah kesehatan nasional yang mendapat perhatian. Salah satu upaya pengembangan pengobatan penyakit jantung koroner meliputi pemanfaatan bahan alami seperti ekstrak biji kedelai yang memiliki kandungan isoflavon aglikon yang memiliki efek untuk pencegahan disfungsi endotel serta penurunan kadar LDL dalam darah, dimana tingginya kadar LDL dan rendahnya kadar HDL dalam darah sendiri merupakan salah satu faktor risiko dari kejadian penyakit jantung koroner. Senyawa isoflavon aglikon sendiri adalah senyawa non polar yang sulit untuk terlarut dalam air sehingga memerlukan bahan lain untuk meningkatkan penyerapan isoflavon aglikon, salah satunya adalah formulasi Self Microemulsifying Drug Delivery System (SMEDDS) yang dapat membantu meningkatkan solubilisasi dan akses obat ke jaringan limfatik
Metode: Penelitian eksperimental ini dilakukan dengan pendekatan post-test only. Sampel penelitian menggunakan 35 ekor tikus putih yang dibagi menjadi kelompok pertama yang diberikan pakan normal, kelompok kedua yang diberikan pakan tinggi lemak serta kelompok ketiga hingga kelima yang diberikan pakan tinggi lemak dan formulasi SMEDDS ekstrak biji kedelai. Formulasi SMEDDS ekstrak biji kedelai diberikan sebanyak 200mg/mL, 300 mg/mL dan 400 mg/mL dengan menggunakan sonde selama tujuh hari, dua puluh satu hari setelah tikus diinduksi penyakit jantung koroner dengan diet tinggi lemak. Darah tikus kemudia diambil untuk analisis kadar LDL dan HDL. Data dianalisis dengan SPSS untuk windows.
Hasil: Hasil penelitian menunjukkan bahwa tidak terdapat perbedaan yang signifikan pada kadar LDL dan HDL dari tiap kelompok percobaan (p>0,05). Hal ini dapat diakibatkan karena jangka waktu pemberian formulasi SMEDDS yang cukup singkat dan dosis formulasi yang belum dapat memberikan efek klinis terhadap hewan coba
Simpulan: Pemberian formulasi SMEDDS ekstrak biji kedelai tidak menunjukkan kemampuan untuk menurunkan kadal LDL ataupun meningkatkan kadar HDL pada tikus yang diinduksi penyakit jantung koroner
Pengaruh dukungan sosial dan regulasi emosi terhadap kecenderungan depresi di Surabaya
Harir Putriana, Elly Yuliandari GunatirinOnline First: Dec 7, 2021
- Abstract
Pengaruh dukungan sosial dan regulasi emosi terhadap kecenderungan depresi di Surabaya
Background: Cases of depression are increasing during the pandemic. It is necessary to understand the various things that can prevent the possibility of depression. A person's mental health condition is affected because they have to adjust to different needs and situations they experience, where their lives will never be the same again. This study aims to determine the effect of social support and emotional regulation on depression tendencies.
Methods: This research is a cross-sectional study with quantitative research using a survey. The measuring instrument used is the PHQ-9 to measure the tendency to depression, PSQ to see social support and ERQ to see the ability to manage emotions. There were 291 informants included in this study—selection of informants by purposive sampling method. Analysis of the data using regression analysis showed the social support model and emotional regulation of depression tendencies.
Results: The result showed a significant correlation in the social support and emotional regulation model on depression tendencies (R=0918, p<0.01). The higher the emotional support and emotional regulation, the smaller the risk of experiencing depression. These two variables contribute 84% to the likelihood of depression.
Conclusion: Emotional support and emotion regulation are two significant variables to keep someone from experiencing depression. Efforts to maintain relationships and social communication, and emotional management still need to be done to maintain the risk of experiencing depression.
Pendahuluan: Kasus depresi semakin meningkat pada saat pandemi berlangsung. Masalah tersebut harus diberikan perhatian untuk mencegah kemungkinan timbulnya depresi. Kondisi kesehatan mental seseorang terpengaruh karena harus menyesuaikan berbagai kondisi dan situasi yang dialaminya, dimana kehidupan yang dijalani tidak akan pernah sama lagi. Penelitian ini bertujuan untuk mengetahui pengaruh dukungan sosial dan regulasi emosi terhadap kecenderungan depresi.
Metode: Penelitian ini merupakan penelitian dengan desain studi cross-sectional dengan menggunakan survey. Alat ukur yang digunakan adalah PHQ-9 untuk mengukur kecenderungan depresi, PSQ untuk melihat dukungan sosial dan ERQ untuk melihat kemampuan pengelolaan emosi. Responden yang disertakan dalam penelitian ini sejumlah 291 orang. Pemilihan responden dengan metode purposive sampling. Analisa data menggunakan analisis regresi yang diperoleh menunjukkan bahwa model dukungan sosial dan regulasi emosi terhadap kecenderungan depresi.
Hasil: Penelitian ini menunjukkan adanya korelasi yang signifikan pada model dukungan sosial dan regulasi emosi terhadap kecenderungan depresi (R=0.918, p <0.01). Semakin tinggi dukungan emosi dan regulasi emosi maka semakin kecil risiko mengalami depresi. Kedua variabel ini memberikan sumbangan 84% terhadap kemungkinan depresi.
Simpulan: Dukungan emosi dan regulasi emosi merupakan dua variabel yang signifikan untuk menjaga seseorang dari kemungkinan mengalami depresi. Upaya untuk bisa menjaga relasi dan komunikasi sosial serta pengelolaan emosi tetap perlu dilakukan untuk menjaga risiko mengalami depresi.
Physical activity and vasomotor symptoms in perimenopausal women at Wukirsari Village, Yogyakarta, Indonesia
Iwi Liesdiyanata, Dicky Moch Rizal, Djaswadi DasukiOnline First: Dec 14, 2021
- Abstract
Physical activity and vasomotor symptoms in perimenopausal women at Wukirsari Village, Yogyakarta, Indonesia
Background: Menopause is an event that marks the end of the reproductive phase of a woman. Vasomotor symptoms are one of the primary symptoms of menopausal women and affect about 40-60% of perimenopausal women. This research aims to investigate the relationship of physical activity with vasomotor symptoms in perimenopausal women.
Methods: The population in this study were 173 women aged 45-54 years who are still experiencing menstruation in the Wukirsari village working area of Puskesmas Cangkringan Sleman-Yogyakarta. The instrument for measuring vasomotor symptoms adopted two questions from the menopause rating scale (hot flushes and night sweats) questionnaire while measuring physical activity using a questionnaire from Riskesdas. Data were analyzed using SPSS version 23 for Windows.
Results: Most of the participants were in the 45-50 years age group (75.73%), followed by severe vasomotor symptoms (95.95%), sufficient physical activity (91.91%), medium level education (49.71%), and informal occupation (94.80%). In addition, this study found that most of the participants were normal Body Mass Index (BMI) (54.34%), passive smoking (64.74%), and pre-hypertension (46.20%). There was a significant relationship between physical activities and BMI to the vasomotor symptoms among women of perimenopausal age (p<0.05).
Conclusion: There was a significant relationship between physical activities and BMI the vasomotor symptoms among women of perimenopausal age.
Karakteristik penderita psoriasis di poliklinik rawat jalan dermatologi dan venereologi Rumah Sakit Umum Daerah Provinsi Nusa Tenggara Barat periode Januari 2016 – Desember 2020
Lisa Alverina, Dedianto Hidajat, I Wayan Hendrawan, I Gusti Agung Ayu Ratna MedikawatiOnline First: Dec 19, 2021
- Abstract
Karakteristik penderita psoriasis di poliklinik rawat jalan dermatologi dan venereologi Rumah Sakit Umum Daerah Provinsi Nusa Tenggara Barat periode Januari 2016 – Desember 2020
Introduction: Psoriasis is an immunologically mediated chronic disease characterized by skin inflammation and epidermal hyperplasia. The incidence in the total population in the United States is 63.8 per 100,000 person-years. The incidence increases with age and peaks among individuals aged 70 to 79 years at a rate of 92.3 per 100,000 person-years. This research aims to determine the characteristics of psoriasis sufferers in the Dermatology and Venereology Outpatient Polyclinic of the Regional General Hospital of West Nusa Tenggara Province for the period January 2016 - December 2020
Method: The research design used was a descriptive retrospective by taking secondary data from medical records in new psoriasis patients for the period January 2016 – December 2020 who came for treatment.
Result: The total number of patient visits at the Dermatology and Venereology Outpatient Polyclinic of the Regional General Hospital of West Nusa Tenggara Province for the January 2016 – December 2020 period was 8,524 people. The study found 140 new patients (92.7%), which were dominated by women (52.1%). The incidence of psoriasis in 2016-2020 was 16.42%. The highest age group was found at the age of 41-50 years as many as 33 people (23.6%), the most visits in 2018 were 37 people (26.4%), the predominant diagnosis was psoriasis vulgaris as many as 105 people (75%) with the site of the lession in the trunk as many as 93 people (66.4%). Therapy was dominated by topical therapy as many as 131 people (93.6%) and systemic therapy as many as 108 people (77.1%). Systemic therapy with methotrexate injection was 78 people (72.2%), and the topical combination of steroids and salicylic acid were 79 people (60.3%) were the most frequently used.
Conclusion: Psoriasis sufferers in the Dermatology and Venereology Outpatient Polyclinic of the Regional General Hospital of West Nusa Tenggara Province have a tendency to increase every year. The therapy given is topical therapy with the most administration in the form of a combination of topical corticosteroids and salicylic acid, and the most systemic therapy is methotrexate injection.
Latar Belakang: Psoriasis merupakan penyakit inflamasi kronik yang diperantarai secara imunologis serta ditandai dengan adanya inflamasi kulit dan hiperplasia epidermal. Insidensi dalam populasi keseluruhan di Amerika Serikat adalah 63,8 per 100.000 orang-tahun. Insiden meningkat dengan usia dan memuncak di antara individu berusia 70 sampai 79 tahun dengan angka 92,3 per 100.000 orang-tahun. Penelitian ini bertujuan untuk mengetahui karakteristik penderita psoriasis di Poliklinik Rawat Jalan Dermatologi dan Venereologi Rumah Sakit Umum Daerah Provinsi Nusa Tenggara Barat periode Januari 2016 – Desember 2020
Metode: Desain penelitian yang digunakan adalah retrospektif deskriptif dengan cara mengambil data sekunder dari rekam medis pada pasien psoriasis baru periode Januari 2016 – Desember 2020 yang datang berobat.
Hasil: Total kunjungan pasien di poliklinik rawat jalan Dermatologi dan Venereologi Rumah Sakit Umum Daerah Provinsi Nusa Tenggara Barat Periode Januari 2016 – Desember 2020 adalah sebanyak 8.524 orang. Pada penelitian didapatkan 140 pasien baru (92,7%) yang didominasi oleh perempuan (52,1%). Angka insidensi psoriasis pada tahun 2016-2020 didapatkan sebesar 16,42%. Kelompok usia terbanyak didapatkan pada usia 41-50 tahun sebanyak 33 orang (23,6%), kunjungan terbanyak pada tahun 2018 sebanyak 37 orang (26,4%), diagnosis yang mendominasi adalah psoriasis vulgaris sebanyak 105 orang (75%) dengan lokasi lesi badan sebanyak 93 orang (66,4%). Terapi didominasi oleh terapi topikal sebanyak 131 orang (93,6%) dan terapi sistemik sebanyak 108 orang (77,1%). Pemberian terapi sistemik methotrexate injeksi sebanyak 78 orang (72,2%) serta pada topikal kombinasi dari steroid dan asam salisilat sebanyak 79 orang (60,3%) merupakan yang paling sering digunakan.
Simpulan: Penderita psoriasis di Poliklinik Rawat Jalan Dermatologi dan Venereologi RSUD Provinsi Nusa Tenggara Barat memiliki kecenderungan meningkat setiap tahunnya. Terapi yang diberikan yaitu terapi topikal dengan pemberian terbanyak berupa kombinasi topikal kortikosteroid dan asam salisilat serta pemberian terapi sistemik terbanyak berupa injeksi metotreksat. Data ini diharapkan dapat menjadi acuan bagi penelitian selanjutnya terkait psoriasis di Nusa Tenggara Barat.
Interpretasi nilai Cycle Threshold (CT) Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) SARS-CoV-2 pada pasien hamil dengan uji antibodi SARS-CoV-2 positif dan COVID-19 asimtomatik
Ni Wayan Candrawati, William Ray CassidyOnline First: Nov 9, 2021
- Abstract
Interpretasi nilai Cycle Threshold (CT) Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) SARS-CoV-2 pada pasien hamil dengan uji antibodi SARS-CoV-2 positif dan COVID-19 asimtomatik
Background: The majority of pregnant women with COVID-19 will be asymptomatic throughout the disease period. SARS-CoV-2 antibody tests were utilized as a screening tool for patients giving birth in a hospital. Cycle Threshold (CT) value in asymptomatic pregnant women may guide patient management and isolation protocol.
Methods: Research data were obtained from medical records from March until October 2020 with a total sampling method. Pregnant women with positive SARS-CoV-2 antibody and asymptomatic COVID-19 were included. CT-value based on gene primers were grouped and analyzed by Microsoft Excel 365 for Windows.
Results: Twenty-five pregnant women with asymptomatic COVID-19 fulfilled the inclusion criteria. All patients had positive SARS-CoV-2 antibodies. The highest and lowest CT-value for the RdRp gene were 37.91 and 26.90, followed by N-gene (34.37 and 32.16), E-gene (38.36 and 27.60), helicase gene (35.65 and 24.29), ORF1a (35.87 and 26.80), and ORF1ab (41.28 and 27.82).
Conclusion: SARS-CoV-2 antibody test is not a recommended screening tool as it can reveal past infection or immunity to SARS-CoV-2. CT-value is incapable of determining COVID-19 severity and infection period.
Latar Belakang: Mayoritas pasien COVID-19 dengan kehamilan tidak bergejala sepanjang periode perjalanan penyakit. Uji antibodi SARS-CoV-2 sempat digunakan sebagai alat skrining pasien yang akan melahirkan di rumah sakit. Nilai Cycle Threshold (CT) pada pasien hamil dengan COVID-19 asimtomatik kemungkinan dapat memandu tatalaksana dan isolasi pasien.
Metode: Penelitian ini menggunakan data sekunder rekam medis dari bulan Maret hingga Oktober 2020 dengan total sampling. Data pasien hamil dengan uji antibodi SARS-CoV-2 positif dan terkonfirmasi COVID-19 asimtomatik dianalisis. Nilai cycle threshold (CT-value) berdasar primer dikelompokkan dan dianalisis menggunakan Microsoft Excel 365 untuk Windows.
Hasil: Sebanyak 25 pasien hamil dengan terkonfirmasi COVID-19 asimtomatik memenuhi kriteria inklusi. Seluruh pasien memiliki hasil tes cepat antibodi SARS-CoV-2 reaktif. Nilai CT tertinggi dan terendah untuk gen RdRp sebesar 37,91 dan 26,9, diikuti dengan gen N (34,37 dan 32,16), gen E (38,36 dan 27,60), gen helicase (35,65 dan 24,29), ORF1a (35,87 dan 26,80), dan ORF1ab (41,28 dan 27,82).
Simpulan: Nilai CT tidak dapat digunakan sebagai indikator keparahan gejala dan periode infeksi COVID-19. Pasien hamil dengan COVID-19 asimtomatik tidak harus menjalani isolasi di rumah sakit.
Correlation between albumin serum and frailty in geriatric inpatient and outpatient clinic at Sanglah Hospital Denpasar
Putu Shely Prihastuti Rudy, RA Tuty Kuswardhani, I Gusti Putu Suka Aryana, Nyoman Astika, Ida Bagus Putu Putrawan, Ni Ketut Rai PurnamiOnline First: Dec 20, 2021
- Abstract
Correlation between albumin serum and frailty in geriatric inpatient and outpatient clinic at Sanglah Hospital Denpasar
Background. Frailty in the elderly has a bad impact on health, especially in the elderly with acute illness. Elderly with frailty has an increase susceptibility to falls, disability and death. Frailty is a common problem in elderly patients, and hypoalbuminemia suggested to increase the risk of death. This study aimed to determine the relationship between albumin and frailty.
Method: A Cross-Sectional Study was conducted from February 2018 to January 2019 at Sanglah Hospital with total 60 patients. Patients were divided into two groups, patients with hypoalbuminemia (albumin < 3.5 g/dL) and patients with normal serum albumin levels (albumin ? 3.5 g/dL). The frailty status assessment was measured with Fried's Frailty Phenotype questionnaire. Chi-square test was used to find the relationship between serum albumin and frailty.
Result: We evaluated 60 patients, 36 patients (60%) were male and 24 patients (40%) were female. The age of the study subjects ranged from 62 to 92 years. In this study 26 patients (43.3%) with hypoalbuminemia and 34 patients (56.7%) with normal serum albumin. There were 20 patients (76.9%) with frailty in the hypoalbuminemia group, compared to 11 patients (32.4%) in the group of patients with normal serum albumin. Hypoalbuminemia has a risk of 6.97 times greater frailty compared to normal albumin in elderly patients (p = 0.001).
Conclusion: This study exhibited a significant relationship between serum albumin and frailty in elderly admitted to inpatient unit and outpatient clinic. The lower the serum albumin level, the higher the probability of the elderly to experience frailty.
Hubungan derajat leukopenia terhadap tingkat keparahan penyakit Demam Berdarah Dengue (DBD) pada pasien anak yang dirawat di Ruang Kaswari RSUD Wangaya, Denpasar, Indonesia
Erica Lidya Yanti, I Wayan Bikin Suryawan, Made WidiasaOnline First: Dec 21, 2021
- Abstract
Hubungan derajat leukopenia terhadap tingkat keparahan penyakit Demam Berdarah Dengue (DBD) pada pasien anak yang dirawat di Ruang Kaswari RSUD Wangaya, Denpasar, Indonesia
Background: Dengue Hemorrhagic Fever (DHF) still becomes a public health problem in Indonesia even in the world. DHF is caused by the dengue virus with various clinical manifestations such as fever, bleeding manifestations and circulatory failure as well. One of the risk factors of severe dengue infection is leukopenia. This study aims to determine the relationship between the degree of leukopenia and the severity of DHF in pediatric patients treated in the Kaswari room of Wangaya Hospital, Denpasar.
Methods: The research was conducted from December 2018 until February 2019 with a cross-sectional analytical method. The subjects of research were children with DHF, admitted in the Wangaya Hospital and fulfilled the inclusion and exclusion criteria. 58 samples were obtained by using consecutive sampling methods. Data were analyzed using SPSS version 21 for Windows.
Results: Most of the respondents with DHF were known to be > 10 years old, both in the shock group (52.9%) and without shock (48.8%). The dominant sex was male (77.4%) in the shock group while female (62.7%) in the group without shock. There was a significant difference between the degree of leukopenia and the severity of DHF (RP=4.29; 95% CI=1.58-11.57; p=0.003) in this study.
Conclusion: There is a significant association between the degree of leucopenia especially with leukocyte value of <5000/Ul and the severity of dengue hemorrhagic fever especially DHF with shock.
Latar Belakang: Demam Berdarah Dengue (DBD) hingga saat ini masih menjadi masalah kesehatan baik di dunia maupun di Indonesia. DBD disebabkan oleh virus dengue dengan beragam manifestasi klinis, diantaranya adakah demam, manifestasi perdarahan hingga kegagalan sirkulasi darah. Salah satu faktor resiko dari infeksi dengue berat adalah leukopenia. Penelitian ini bertujuan untuk mengetahui hubungan derajat leukopenia terhadap tingkat keparahan penyakit DBD pada pasien anak yang dirawat di ruang Kaswari RSUD Wangaya kota Denpasar.
Metodologi: Penelitian ini menggunakan metode analitik potong lintang yang dilakukan pada bulan Februari 2019. Penelitian ini melibatkan anak dengan DBD yang dirawat di ruang Kaswari RSUD Wangaya kota Denpasar mulai 1 Desember 2018 sampai 28 Februari 2019. Pengambilan sampel menggunakan metode consecutive sampling. Sampel yang memenuhi kriteria inklusi dan eksklusi adalah 58 sampel. Data dianalisis dengan SPSS versi 21 untuk Windows.
Hasil: Sebagian besar responden dengan DBD diketahui berusia > 10 tahun baik pada kelompok syok (52,9%) maupun tanpa syok (48,8%). Jenis kelamin laki-laki dominan (77,4%) pada kelompok syok sedangkan perempuan (62,7%) pada kelompok tanpa syok. Terdapat perbedaan yang bermakna antara derajat leukopenia dengan tingkat keparahan DBD (RP=4,29; 95%IK=1,58-11,57; p=0.003) pada penelitian ini.
Kesimpulan: Terdapat hubungan yang bermakna antara derajat leukopenia khususnya pada nilai leukosit <5000/Ul terhadap tingkat keparahan demam berdarah dengue khususnya DBD dengan syok.
Karakteristik faktor penyebab hiperbilirubinemia pada neonatus di RSIA Puri Bunda Tabanan, Bali Tahun 2021
Intan Astariani, I Wayan Dharma Artana, Ni Made Rini SuariOnline First: Dec 21, 2021
- Abstract
Karakteristik faktor penyebab hiperbilirubinemia pada neonatus di RSIA Puri Bunda Tabanan, Bali Tahun 2021
Background: Neonatal hyperbilirubinemia is a clinical problem that often occurs in neonates, 60% occurs in term neonates and 80% in preterm neonates.. There are non pathological and pathological hyperbilirubinemia. Unconjugated hyperbilirubinemia caused by 4 board groups, which are increased bilirubin production, deficiency of hepatic uptake, impaired bilirubin conjugation, and increased enterohepatic circulation. The purpose of this study was to determine the characteristics of the factors causing hyperbilirubinemia.
Methods: This study used a restrospective cross-sectional method by taking 1 year data, from June 2020 until May 2021. Amount of samples was 146 neonates with diagnosis of hyperbilirubinemia and receiving intensive phototherapy treatment in the Intermediate Room and Neonatal HCU at Puri Bunda Tabanan Mother and Child Hospital. The causative factors collected were ABO incompatibility, prematurity, neonatal asphyxia, breastfeeding jaundice, breastmilk jaundice, low birth weight baby, cephal hematome, and neonatal sepsis. Data collected through medical record and analyzed, subsequently explained descriptively with table.
Result: The result show that from 146 samples that met the inclusion criteria, the most causative factor of hyperbilirubinemia was ABO incompatibility 29 (19.9%), prematurity 16 (11%), low birth weight 15 (10.3%), breastfeeding jaundice 15 (10.3%), neonatal sepsis 15 (10.3%), breastmilk jaundice 12 (8.2%), neonatal asphyxia 7 (4.8%), and no sample with cephal hematome.
Conclusion: Factors causing hyperbilirubinemia found at Puri Bunda Tabanan Mother and Child Hospital were ABO icompatibility as the most common cause and neonatal asphyxia as the least cause.
Pendahuluan: Hiperbilirubinemia neonatal merupakan permasalahan klinis yang sering terjadi pada neonatus, sekitar 60% terjadi pada neonatus aterm dan 80% pada neonatus preterm. Kernicterus sebagai komplikasi dari hiperbilirubinemia memiliki angka kematian 10% dan morbiditas jangka panjang 70%. Hiperbilirubinemia ada yang non patologis dan patologis. Unconjugated hyperbilirubinemia disebabkan oleh 4 kelompok besar yaitu peningkatan produksi bilirubin, defisiensi uptake hepar, gangguan konjugasi bilirubin, dan peningkatan sirkulasi enterohepatik. Tujuan dari penelitian ini adalah untuk mengetahui karakteristik faktor penyebab hiperbilirubinemia.
Metode: Penelitian ini menggunakan metode cross-sectional retrospective dengan mengambil data selama 1 tahun yaitu periode Juni 2020-Mei 2021. Jumlah sampel sebanyak 146 neonatus dengan diagnosis hiperbilirubinemia dan mendapatkan tatalaksana fototerapi di ruang Intermediate dan HCU Neonatus di RSIA Puri Bunda Tabanan. Faktor penyebab yang dikumpulkan yaitu inkompatibilitas ABO, prematuritas, asfiksia neonatorum, breastfeeding jaundice, breastmilk jaundice, BBLR, cephal hematoma, dan sepsis neonatorum. Data dikumpulkan melalui rekam medis dan dianalisa untuk kemudian disajikan secara deskriptif.
Hasil: Dari 146 sampel yang memenuhi kriteria inklusi, didapatkan penyebab pertama yaitu inkompatibilitas ABO sebanyak 29 (19,9%), prematuritas sebanyak 16 (11%), BBLR sebanyak 15 (10,3%), breastfeeding jaundice sebanyak 15 (10,3%), sepsis neonatorum sebanyak 15 (10,3%), breastmilk jaundice sebanyak 12(8,2%), asfiksia neonatorum sebanyak 7 (4,8%), dan tidak ada penyebab berupa cephal hematoma yang ditemukan.
Simpulan: Faktor penyebab hiperbilirubinemia yang didapatkan di RSIA Puri Bunda Tabanan yaitu inkompatibilitas ABO sebagai penyebab terbanyak dan asfiksia neonatorum sebagai penyebab paling sedikit.
Karakteristik gambaran Tuberkulosis (TB) paru pada foto toraks pasien Human Immunodeficiency Virus (HIV) tahun 2017-2021 di RSUP Sanglah, Bali, Indonesia
Tiffany Rebecca, Dewa Gde Mahiswara Suadiatmika, Ni Nyoman MargianiOnline First: Dec 28, 2021
- Abstract
Karakteristik gambaran Tuberkulosis (TB) paru pada foto toraks pasien Human Immunodeficiency Virus (HIV) tahun 2017-2021 di RSUP Sanglah, Bali, Indonesia
Background: Tuberculosis is a disease caused by Mycobacterium tuberculosis that mostly attacks the lungs. HIV is a virus that causes damage to the immune system. HIV infection increases the risk of developing pulmonary TB because TB is an opportunistic disease; vice versa TB infection increases HIV progression. This study is about researching the characteristics of TB in HIV patients radiologically at Sanglah Hospital Denpasar.
Methods: This study is a cross-sectional descriptive study conducted retrospectively. The data in this study used medical records of HIV-infected pulmonary TB patients from Sanglah Hospital, especially the characteristics of chest radiographs in the medical records and chest X-rays of patients. For the data collecting technique, a total sample is used to analyze all 47 cases. Data were analyzed using SPSS version 25 for Windows.
Results: Most HIV patients with pulmonary TB coinfection at Sanglah Hospital, Denpasar, were obtained from as many as 47 people. It was found that the age between 30 - 39 recorded to be the highest at 31.3%, men were the most dominant with 81.3%, most of the patients diagnosed with HIV stage 4 were 72.9%, and the most dominant characteristics of the chest radiograph are 41.7% consolidation.
Conclusion: Most cases of pulmonary TB with HIV coinfection at Sanglah Hospital Denpasar in 2017 - 2021 are male around 30 - 39 years. In addition, most of them were diagnosed with HIV stage 4 and finally almost all the patients had consolidation characteristics on chest radiographs.
Latar Belakang: Tuberkulosis adalah penyakit yang disebabkan oleh Mycobacterium tuberculosis yang paling banyak menyerang paru-paru. HIV adalah virus yang menyebabkan kerusakan pada sistem kekebalan tubuh. Infeksi HIV meningkatkan risiko berkembangnya TB paru karena TB adalah penyakit oportunistik sebaliknya infeksi TB meningkatkan perkembangan HIV. Penelitian ini bertujuan untuk mengetahui karakteristik TB pada pasien HIV secara radiologis di RSUP Sanglah Denpasar.
Metode: Penelitian ini merupakan penelitian deskriptif potong lintang yang dilakukan secara retrospektif. Data dalam penelitian ini menggunakan rekam medis pasien TB paru terinfeksi HIV dari RSUP Sanglah, terutama karakteristik foto toraks pada rekam medis dan foto rontgen dada pasien. Untuk teknik pengumpulan data, sampel total digunakan untuk menganalisis semua 47 kasus. Data dianalisis dengan SPSS versi 25 untuk Windows.
Hasil: Pasien HIV koinfeksi TB paru terbanyak di RS Sanglah Denpasar didapatkan sebanyak 47 orang. Didapatkan usia antara 30-39 tahun tercatat paling tinggi 31,3%, laki-laki paling dominan dengan 81,3%, sebagian besar pasien terdiagnosis HIV stadium 4 sebanyak 72,9%, dan karakteristik foto toraks yang paling dominan adalah konsolidasi 41,7%.
Kesimpulan: Kasus TB paru koinfeksi HIV terbanyak di RSUP Sanglah Denpasar tahun 2017 – 2021 adalah laki-laki berusia sekitar 30–39 tahun. Selain itu, sebagian besar terdiagnosis HIV stadium 4 serta hampir semua pasien memiliki karakteristik konsolidasi pada radiografi dada.
Prevalensi dan persepsi disfagia pada populasi lanjut usia di Kota Denpasar periode September-Desember 2021
I Putu Santhi Dewantara, I Wayan SuciptaOnline First: Dec 29, 2021
- Abstract
Prevalensi dan persepsi disfagia pada populasi lanjut usia di Kota Denpasar periode September-Desember 2021
Background: To investigate prevalence and perception of dysphagia in Denpasar City. The causes of dysphagia in the elderly include changes in the function and structure of the organs involved in the swallowing process, which are multifactorial. Dysphagia does affect not only the health aspect of the sufferer but also the social and economic aspects, especially in the elderly population. This study aims to determine the prevalence and perception of dysphagia in the elderly in Denpasar City.
Methods: This is a descriptive cross-sectional study that obtains data from the public health center in Denpasar City. Dysphagia was detected using the Swallowing Disturbances Questionaire (SDQ) and perception of dysphagia was obtained using direct questions. Data were analyzed using SPSS version 21 for Windows.
Results: 102 samples were obtained, with the most gender being female (61.75%), and the age group was 60-69 years old (68.63%). A total of 11.76% of the sample stated that they had swallowing difficulties, while based on SDQ 10.78% had dysphagia. The most common comorbidities in the dysphagia group were head and neck malignancy (27.7%) and hypertension (27.7%), while in the non-dysphagic group were joint and skeletal disorders (34.09%).
Conclusion: The prevalence of dysphagia in the elderly in Denpasar City is quite high, 10.78% based on SDQ and 11.76% based on the direct question. This requires special attention to overcome or prevent problems that may arise from dysphagia in the elderly.
Latar Belakang: Disfagia diartikan sebagai gangguan menelan saliva, makanan padat dan cair, termasuk obat-obatan. Penyebab disfagia pada lansia diantaranya adalah perubahan fungsi dan struktur organ yang terlibat dalam proses menelan yang bersifat multifaktorial. Disfagia tidak hanya mempengaruhi aspek kesehatan penderitanya, namun juga aspek sosial dan ekonominya terutama pada populasi lanjut usia. Penelitian ini bertujuan untuk mengetahui prevalensi dan persepsi disfagia pada lanjut usia di Kota Denpasar.
Metode: Penelitian ini menggunakan rancangan penelitian deskriptif potong lintang dengan mengambil data di puskesmas-puskesmas kota Denpasar menggunakan kuisioner. Disfagia dideteksi menggunakan Swallowing Disturbances Questionnaire (SDQ) sedangkan persepsi disfagia didapatkan dengan pertanyaan langsung. Data dianalisis dengan SPSS versi 21 untuk Windoes
Hasil: Didapatkan sampel sebanyak 102 orang, dengan jenis kelamin terbanyak adalah perempuan (61,75%) dan rentang usia 60-69 tahun (68,63%). Sebanyak 11,76% menyatakan mengalami gangguan menelan, sedangkan berdasarkan SDQ didapatkan 10,78% mengalami disfagia. Penyakit penyerta terbanyak pada kelompok disfagia adalah keganasan kepala leher (27,27%) dan hipertensi (27,27%). Sedangkan pada kelompok tidak disfagia adalah gangguan sendi dan tulang (34,09%).
Kesimpulan: Prevalensi disfagia pada populasi lansia di Kota Denpasar cukup tinggi. Hal ini memerlukan perhatian khusus untuk mengatasi dan mencegah permasalahan yang dapat timbul akibat disfagia pada lansia.
The relationship between nutritional status, severity of diarrhea, and length of stay among pediatric patients with diarrhea in Wangaya Regional General Hospital
Mayland Margaretha Sunata, I Wayan Bikin Suryawan, Anak Agung Made WidiasaOnline First: Dec 29, 2021
- Abstract
The relationship between nutritional status, severity of diarrhea, and length of stay among pediatric patients with diarrhea in Wangaya Regional General Hospital
Background: Diarrhea is a disease still often encountered in society and is one of the biggest causes of death in children. Many factors contributed to the process of diarrhea, including poor nutritional status. According to the data from Riskesdas in 2018, 17.7% of children under five in Indonesia still have nutritional problems. This study was conducted with the aim to know the relationship between nutritional status, the severity of diarrhea and the length of stay among pediatric patients with diarrhea.
Methods: This analytical study uses a cross-sectional design, with a total of 87 samples. Pediatric patients in Kaswari room from January 2019 to July 2020 with diarrhea or gastroenteritis, whose body’s length or height, weight and duration of stay listed in the medical record were included in this study, while patients with congenital abnormality like Hirschsprung disease were excluded from this study. The data collected were analyzed using the Fisher test and Chi-square test.
Results: Out of 87 children, 49 (56%) of them had normal nutritional status, 78 (87.4%) children had modified vesikari score ? 11, and 68 children had a length of stay < 5 days (78.2%). The results of bivariate analysis between nutritional status and diarrhea severity showed that there was no relationship between the two variables (p = 0.426). The same results were obtained in bivariate analysis between nutritional status and length of stay (p = 0.916).
Conclusion: In this study, there was no relationship found between nutritional status, the severity of diarrhea and length of stay among pediatric patients with diarrhea in Wangaya Regional General Hospital.
Situasi analisis pelayanan kesehatan mata di Provinsi Bali, Indonesia
Anak Agung Ayu Githasari Dewi, Ni Made Ari Suryathi, Ni Made Suryanadi, I Made Agus Kusumadjaja, I Wayan Eka Sutyawan, Anak Agung Mas Putrawati Triningrat, I Wayan Gede JayanegaraOnline First: Dec 29, 2021
- Abstract
Situasi analisis pelayanan kesehatan mata di Provinsi Bali, Indonesia
Introduction: The prevalence of blindness in Bali based on Rapid Assessment of Avoidable Blindness (RAAB) survey in 2015 was 2%. This prevalence rate is still high according to WHO guidelines. Bali has challenges in providing eye care services. The aim of this study was to report situational analysis of the eye care in Bali.
Method: This is a descriptive study with quantitative and qualitative approach. Data collection was carried out through interviews and questionnaires targeting respective stakeholders involved in the eye care services in Bali.
Result: Bali consists of 9 districts with total 4,337 million people. Eye care in Bali consist of 43 hospitals, 120 primary health care (Puskesmas), 73 general ophthalmologist and subspecialists, 18 trained opthalmic nurses, and 12 refractionist. Bali has mobile eye care unit covering remotes area and a Non-Government Organization (NGO) actively contributing in community eye care service. Total number of cataract surgery in 2019 was 8.225 eyes with cataract surgical rate (CSR) was 1.896. Komite Mata Daerah (Komatda) dan health insurance for eye service and eye surgery is a form of support from the government.
Conclusion: The implementation of eye care services in Bali is yet under evaluation. Things needed to consider to improve eye care services including providing better distribution of ophthalmologist to districts, and empowering voluntary local manpower as village health workers / cadres through regularly organized training. Education on blindness and preventable visual disturbances also must be carried out regularly.
Pendahuluan: Prevalensi kebutaan di Bali berdasarkan survei Rapid Assessment of Avoidable Blindness (RAAB) tahun 2015 sebesar 2%. Angka prevalensi ini masih tinggi menurut pedoman WHO. Bali memiliki tantangan dalam memberikan pelayanan perawatan mata. Tujuan dari penelitian ini adalah untuk melaporkan analisis situasi perawatan mata di Bali.
Metode: Penelitian ini merupakan penelitian deskriptif dengan pendekatan kuantitatif dan kualitatif. Pengumpulan data dilakukan melalui wawancara dan kuesioner dengan sasaran masing-masing pemangku kepentingan yang terlibat dalam layanan perawatan mata di Bali.
Hasil: Bali terdiri dari 9 kabupaten dengan jumlah penduduk 4.337 juta jiwa. Perawatan mata di Bali terdiri dari 43 rumah sakit, 120 Puskesmas, 73 dokter spesialis mata umum dan subspesialis, 18 perawat mata terlatih, dan 12 dokter spesialis mata. Bali memiliki unit perawatan mata keliling yang mencakup daerah terpencil dan Lembaga Swadaya Masyarakat (LSM) yang aktif berkontribusi dalam layanan perawatan mata masyarakat. Jumlah operasi katarak pada tahun 2019 sebanyak 8.225 mata dengan angka bedah katarak (CSR) sebanyak 1.896. Komite Mata Daerah (Komatda) dan jaminan kesehatan untuk pelayanan mata dan operasi mata merupakan bentuk dukungan dari pemerintah.
Simpulan: Pelaksanaan pelayanan kesehatan mata di Bali masih dalam tahap evaluasi. Hal-hal yang perlu diperhatikan untuk meningkatkan pelayanan kesehatan mata antara lain penyediaan dokter spesialis mata yang lebih merata ke kabupaten, dan pemberdayaan tenaga sukarelawan lokal sebagai kader/petugas kesehatan desa melalui pelatihan yang diselenggarakan secara rutin. Edukasi tentang kebutaan dan gangguan penglihatan yang dapat dicegah juga harus dilakukan secara berkala.Hubungan antara ekspresi Epidermal Growth Factor Receptor (EGFR) dengan berbagai parameter klinik dan patologis Triple Negative Breast Cancer (TNBC) di RSUP Sanglah, Bali, Indonesia
Volman Tampubolon, Ni Putu Sriwidyani, Luh Putu Iin Indrayani Maker, I Gusti Ayu Sri Mahendra Dewi, Ni Made Mahastuti, I Made MuliartaOnline First: Dec 30, 2021
- Abstract
Hubungan antara ekspresi Epidermal Growth Factor Receptor (EGFR) dengan berbagai parameter klinik dan patologis Triple Negative Breast Cancer (TNBC) di RSUP Sanglah, Bali, Indonesia
Background: Triple Negative Breast Cancer (TNBC) is a heterogeneous group of breast cancer. Some cases show a good outcome; others show higher recurrence and metastasis. There are several molecular subtypes of TNBC. Basal-like 2 (BL-2) subtype involves Epidermal Growth Factor (EGF) signaling pathway, enriched with many growth factor receptors such as EGFR. This study aims to determine the association between EGFR expression and various clinicopathological parameters in TNBC patients in Sanglah Hospital Denpasar.
Methods: This study was an analytical cross-sectional study involving 35 patients TNBC who were examined histopathologically at the Anatomical Pathology Laboratory in Sanglah Hospital Denpasar from January 1st 2016 to December 31st 2020. Re-evaluation of the specimen was conducted to assess histopathological diagnosis, grade, tumor size (T), Lymphovascular Invasion (LVI) and nodal status (N). EGFR expression was evaluated by immunohistochemistry staining and then interpreted based on the intensity and continuity of the stained cell membrane. The association between EGFR expression and clinicopathological parameters was analyzed with a Chi-Square test with a 0.05 significance level.
Result: The result of this study showed the age range of TNBC patients was 29-70 years with mean age was 49.7±11.4 years. There were significant association between EGFR expression with T (p=0.008; PR = 2.7; 95%CI 1.4-5.1), LVI (p=0.018; PR = 3.0; CI95% 1.300-7.137) and N (p=0.033; PR=2.7; CI95% 1.121-6.543). There were no significant association between EGFR expression with age (p=1.000), grade (p=0.689) and Ki67 index (0.689).
Conclusion: It can be concluded that there are associations between EGFR expression with T, LVI and N. There was no association between EGFR expression with age, grade and Ki67 index.
Latar Belakang: Triple negative breast cancer (TNBC) merupakan kelompok kanker payudara yang heterogen. Sebagian kasus menunjukkan survival yang baik, namun sebagian lainnya dengan rekurensi dan metastasis yang lebih tinggi. Terdapat beberapa subtipe molekuler dari TNBC, salah satunya subtipe Basal-like 2 (BL2) yang melibatkan jalur pensignalan Epidermal Growth Factor (EGF), melalui berbagai reseptor factor pertumbuhan, salah satunya EGFR. Penelitian ini bertujuan untuk mengetahui hubungan antara ekspresi EGFR dengan berbagai parameter klinikopatologi pada kasus TNBC di RSUP Sanglah Denpasar.
Metode: Penelitian ini merupakan studi analitik potong lintang dengan besar sampel 35 kasus TNBC yang diperiksa histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah Denpasar dari 1 Januari 2016 hingga 31 Desember 2020. Evaluasi ulang preparat dilakukan untuk menilai diagnosis histopatologi, grade, ukuran tumor (T), Lymphvascular Invasion (LVI) dan status nodal (N). Ekspresi EGFR dinilai dengan pewarnaan imunohistokimia selanjutnya di interpretasi berdasarkan intensitas dan kuntinuitas membran sel yang terpulas. Hubungan antara ekspresi EGFR dengan parameter klinikopatologi dianalisis dengan uji Chi-Square dengan nilai kemaknaan p<0,05.
Hasil: Hasil penelitian ini menunjukkan rentang usia pasien TNBC 29-70 tahun dan rerata 49,7±11,4 tahun. Terdapat hubungan bermakna antara ekspresi EGFR dengan T (p=0,008; RP=2,7; IK95% 1,4-5,1), LVI (p=0,018; RP = 3,0; IK 95% 1,300-7,137), dan N (p=0,033; RP=2,7; IK95% 1,121-6,543). Tidak terdapat hubungan bermakna antara umur (p=1,000), grade (p=0,689) dan indeks Ki67 (p=0,689).
Simpulan: Hasil dari penelitian ini adalah terdapat hubungan antara ekspresi EGFR dengan ukuran tumor, LVI dan status nodal (N). Tidak terdapat hubungan antara ekspresi EGFR dengan umur, grade dan indeks Ki67.
Clinical characteristic of dengue fever and dengue hemorrhagic fever among patients at Sanglah Hospital, Denpasar, Bali
Shabrina Inderjit, I Made Sudarmaja, I Kadek SwastikaOnline First: Dec 30, 2021
- Abstract
Clinical characteristic of dengue fever and dengue hemorrhagic fever among patients at Sanglah Hospital, Denpasar, Bali
Background: Mosquito-borne diseases are one of the most significant public health risks globally, and dengue fever seems to be one of the most important arboviral diseases in humans. In humans, dengue viruses are the supreme agents that cause dengue fever (DF) and dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). Following that, the virus's presence, sufficient numbers of susceptible populations, and mosquito vectors are required to transmit dengue infection. This study aimed to identify the clinical characteristics of dengue fever and dengue hemorrhagic fever among patients at Sanglah Hospital, Denpasar, Bali
Method: The study is a descriptive retrospective study design. The data was collected from the medical records of patients diagnosed with dengue and dengue hemorrhagic fever in Sanglah Hospital, Denpasar, Bali, from June 2015- June 2016. We took 50 patients according to sample size calculation by randomized sampling technic. Data were analyzed descriptively.
Result: The study found the age range from 5 to 53 years old. The mean age for DF and DHF were 11 and 31, respectively. Secondly, the proportion of gender in this research was male by 21 (42%) and 29 (58%) female. Further to this, Denpasar showed the maximum number of cases between all the nine regencies. Both DF and DHF cases recorded the highest total cases in April 2016.
Conclusion: Expected clinical characteristics prior knowledge and prognosticators of DF and DHF development will be able to provide data to detect persons who are higher risk category and provide adequate time to clinicians to lessen dengue related morbidity and mortality
Pencapaian vaksinasi COVID-19 pada anak usia 12 - 18 tahun periode Agustus - September 2021 di Puskesmas Kelurahan Cililitan
Luh Kadek Shastri Utami Wijayanti, Aan Kurniawan, Amalia Farahtika Srikandi, Jovian Lutfi Daniko, Setya Bayu KurniawanOnline First: Dec 30, 2021
- Abstract
Pencapaian vaksinasi COVID-19 pada anak usia 12 - 18 tahun periode Agustus - September 2021 di Puskesmas Kelurahan Cililitan
Background: The morbidity and mortality rate of COVID-19 in Indonesia is increasing. Various efforts have been made to prevent the transmission process which is expected to have a significant impact in reducing morbidity and mortality due to COVID-19. One of the steps taken by the Indonesian government is the implementation of COVID-19 vaccination for the entire community. The COVID-19 vaccination program in Indonesia is planned to run from February 2021 to March 2022, where one of the targets for COVID-19 vaccination is children.
Aim: The study was conducted to assess the achievement of COVID-19 vaccination in children aged 12-18 years at the Cililitan Urban Village Health Center for the period August - September 2021.
Method: This research is a cross-sectional study conducted at the Cililitan Urban Village Health Center in October 2021. The research sample was all vaccine participants at the Cililitan Urban Village Health Center who attended the first and second vaccines with a total sampling technique. The research data were obtained through documentation of vaccination records at the Cililitan Urban Village Health Center. The data obtained are presented as part of personal data and vaccination achievements in graphic form.
Result: The recording of the results of vaccination services is carried out electronically through the information system for one COVID-19 vaccination data, namely the Pcare application which is carried out during the COVID-19 vaccination service. The COVID-19 vaccination program for children aged 12-18 years has been implemented since July 1, 2021. The Cililitan Urban Village Health Center area has 16 Neighborhood Units with a total population of children aged 12-18 years as many as 2955 people. The results of the achievements of children aged 12-18 years in the Cililitan Urban Village area for the period August - September 2021 who were vaccinated with the first dose were 13.73% and the second dose vaccinated was 24.53%.
Conclusion: The Cililitan Urban Village Health Center has run a vaccination program for children aged 12-18 years, but the vaccination coverage in August-September 2021 has not reached the target of 50%.
Latar Belakang: Angka kesakitan dan kematian COVID-19 di Indonesia semakin meningkat. Berbagai upaya dilakukan untuk mencegah proses penularan yang diharapkan berdampak signifikan dalam menurunkan angka kesakitan dan kematian akibat penyakit COVID-19. Salah satu langkah yang diambil dari pemerintah Indonesia yaitu pelaksanaan vaksinasi COVID-19 untuk seluruh masyarakat. Program vaksinasi COVID-19 di Indonesia direncanakan berlangsung dari bulan Februari 2021 hingga Maret 2022, dimana salah satu sasaran vaksinasi COVID-19 adalah anak - anak.
Tujuan: Penelitian dilaksanakan untuk melakukan penilaian terhadap pencapaian vaksinasi COVID-19 pada anak usia 12 – 18 tahun di Puskesmas Kelurahan Cililitan periode Agustus - September 2021.
Metode: Penelitian ini merupakan studi potong lintang yang dilaksanakan di Puskesmas Kelurahan Cililitan pada bulan Oktober 2021. Sampel penelitian adalah semua peserta vaksin Puskesmas Kelurahan Cililitan yang hadir vaksin pertama dan kedua dengan teknik total sampling. Data penelitian didapatkan melalui dokumen pencatatan vaksinasi di Puskesmas Kelurahan Cililitan. Data yang diperoleh disajikan menjadi bagian data diri dan capaian vaksinasi dalam bentuk grafik.
Hasil: Pencatatan hasil pelayanan vaksinasi dilakukan secara elektronik melalui sistem informasi satu data vaksinasi COVID-19, yaitu aplikasi Pcare yang dilakukan saat pelayanan vaksinasi COVID-19 berlangsung. Program vaksinasi COVID-19 untuk anak usia 12 – 18 tahun sudah dilaksanakan sejak 1 Juli 2021. Wilayah puskesmas memiliki 16 Rukun Warga dengan total populasi anak usia 12 – 18 tahun sebanyak 2955 orang. Hasil capaian anak usia 12 – 18 tahun di wilayah Kelurahan Cililitan periode Agustus – September 2021 yang tervaksinasi dosis I sebesar 13,73% dan tervaksinasi dosis II sebesar 24,53%.
Kesimpulan: Puskesmas Kelurahan Cililitan telah menjalankan program vaksinasi anak usia 12 – 18 tahun, namun cakupan vaksinasi pada bulan Agustus – September 2021 belum mencapai target hingga 50%.
Karakteristik metastasis tulang belakang di Rumah Sakit Umum Pusat Sanglah
P. Gde Daniswara Raditya Rahman, Ni Putu Witari, Anak Agung Ayu Putri Laksmidewi, I Made Oka AdnyanaOnline First: Dec 30, 2021
- Abstract
Karakteristik metastasis tulang belakang di Rumah Sakit Umum Pusat Sanglah
Introduction: Spinal metastases constitute 90% of spine tumors. Primary tumors originate from a variety of malignancies. However, there are no data on the characteristics of spinal metastases in the local population. This study collected data from one of the Tertiary hospitals in Bali to be used as a reference for the initial description regarding the characteristics of spinal metastases.
Methods: A cross-sectional descriptive study was conducted by collecting medical record data of patients with spinal metastases at the Sanglah General Hospital for a year (January–December 2019) by total sampling.
Results: This study obtained 39 samples. Most primary cancers that metastasize to the spine were lung cancers (30.77%), followed by multiple myeloma (10.26%), prostate cancer (7.69%), and colorectal cancer (5.13%). There were also contributions from breast, cervix, bladder, thyroid, lymphoma, nasal cavity, acute myeloid leukemia, and plasmacytoma. There were 25.64% cases where the primary cancer was unknown. Most of the metastases were in the thoracic segment (35.90%), followed by the lumbar region (28.21%) and the cervical region (12.82%). There were still many lesions that were less visible or unclear (38.46%). Patients generally experienced sensory (94.87%) and motor (92.31%) deficit. Sensory disturbances include paresthesia, hypesthesia and pain. Meanwhile, motor deficit include parapharesis, paraplegia, and tetrapharesis depending on the location of the lesion. Other disorders were related to the autonomic nerves (56.41%) such as defecation and urination problem.
Conclusion: Most of the patients aged ?60 years and male. Spinal metastases frequently found in lung cancer patient. There was a high percentage cases with unknown primary origin. In general, the lesions were found in the thoracic and lumbar segments. There were many lesions which unclear or less visible in location. Almost all patients had sensory and motor deficit and only about half of patients had autonomic disorders.
Pendahuluan: Metastasis tulang belakang merupakan 90% kasus tumor pada tulang belakang. Tumor primer dapat berasal dari berbagai keganasan. Akan tetap, belum ada data karakteristik metastasis tulang belakang di populasi lokal. Penelitian ini mengumpulkan data dari salah satu rumah sakit Tersier di Bali untuk dapat menjadi acuan gambaran awal terkait karakteristik metastasis tulang belakang.
Metode: Penelitian deskriptif potong lintang dilakukan dengan mengumpulkan data rekam medis pasien dengan metastasis tulang belakang di Rumah Sakit Umum Pusat Sanglah selama satu tahun (bulan Januari - Desember 2019) secara total sampling.
Hasil: Penelitian ini mendapatkan 39 sampel. Kanker primer terbanyak yang bermetastasis ke tulang belakang adalah kanker paru (30,77%), lalu disusul dengan multiple myeloma (10,26%), kanker prostat (7,69%), dan kanker kolorektal (5,13%). Terdapat pula kontribusi dari kanker payudara, serviks, buli, tiroid, limfoma, cavum nasi, leukemia myeloid akut, dan plasmasitoma. Terdapat 25,64% kasus tidak ditemukan lokasi kanker primernya. Lokasi metastasis paling banyak pada segmen thorakal (35,90%) kemudian regio lumbal (28,21%) dan regio servikal (12,82%). Masih banyak lesi yang kurang terlihat atau tidak jelas (38,46%). Pasien secara umum mengalami gangguan sensorik (94,87%) dan motorik (92,31%). Gangguan sensorik termasuk parestesia, hipestesia, dan rasa nyeri. Sedangkan gangguan motorik termasuk paraparesis, paraplegia, dan tetraparesis tergantung dari letak lesi. Gangguan lainnya yaitu gangguan pada saraf otonom (56,41%) dengan kelainan seperti gangguan buang air besar dan berkemih.
Simpulan: Sebagian besar pada pasien usia ?60 tahun dan berjenis kelamin laki-laki. Metastasis tulang belakang cenderung lebih sering pada penderita kanker paru. Selain lokasi primer tersebut, terdapat persentase tinggi dimana tidak ditemukannya dari lokasi kanker primer. Pada umumnya hasil lesi terdapat pada segmen thorakal dan segmen lumbal. Masih banyak pula lesi ini masih kurang terlihat atau tidak jelas lokasinya. Pada umumnya pasien memiliki gangguan sensorik dan motorik serta hanya sekitar setengah pasien mengalami gangguan otonom.
Hubungan disfungsi ereksi pada pasien dislipidemia dengan lama pengobatan statin di Puskesmas Denpasar Barat I
Anak Agung Gde Ryantha Indra Pranamartha, I Gusti Ngurah Pramesemara, Yukhi Kurniawan KurniawanOnline First: Dec 30, 2021
- Abstract
Hubungan disfungsi ereksi pada pasien dislipidemia dengan lama pengobatan statin di Puskesmas Denpasar Barat I
Introduction: There has been change in people's lifestyles that affect disease patterns, and dyslipidemia is one of those disease. Statins are the main pharmacological therapy for dyslipidemia. Many studies have researched the relationship between statin therapy in dyslipidemia and erectile dysfunction. However, existing research has not specifically explained this relationship.
Objective: This study aims to determine the relationship between erectile dysfunction in dyslipidemic patients and duration of statin treatment at Community Health Center I West Denpasar.
Methods: This research is analytic observational with cross sectional design. The study was conducted on dyslipidemic patients who took statins and met inclusion and exclusion criteria at Community Health Center I West Denpasar in May-June 2021. The sample size was 35. Duration of statin consumption was obtained through medical records and reconfirmed through questionnaire. Erectile dysfunction was measured by IIEF-5 questionnaire. Data analysis using SPSS version 21 with chi square test and Cramer's V correlation test.
Results: The prevalence of erectile dysfunction in dyslipidemic patients with statin treatment at Community Health Center I West Denpasar was 85.7% with majority of the patients experiencing mild erectile dysfunction (37.1%) and taking statins for less than 12 months (51.4%). Characteristics of the patients were mostly aged 45-60 years (74.2%), obesity I (42.8%), smoking (60%), and drinking alcohol (57%). Statistical tests showed significant relationship between erectile dysfunction in dyslipidemic patients and duration of statin treatment at Community Health Center I West Denpasar (p=0.031) with moderate correlation (r=0.552). Statins with treatment duration >12 months had protective effect against erectile dysfunction (RR = 0.81).
Conclusion: There is a relationship between erectile dysfunction in dyslipidemic patients and duration of statin treatment with moderate correlation. Statins with duration of treatment >12 months have protective effect toward erectile dysfunction.
Pendahuluan: Terdapat perubahan gaya hidup masyarakat yang dapat memengaruhi pola penyakit pada manusia, dimana dislipidemia adalah salah satu penyakit tersebut. Statin merupakan salah satu terapi utama untuk dislipidemia. Terdapat banyak penelitian yang telah meneliti hubungan antara terapi statin pada dislipidemia dan disfungsi ereksi. Namun, penelitian yang ada belum secara spesifik menjelaskan hubungan ini.
Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan disfungsi ereksi pada pasien dislipidemia dengan lama pengobatan statin di Puskesmas Denpasar Barat I.
Metode: Penelitian ini adalah penelitian analitik observasional dengan desain cross-sectional. Penelitian dilakukan pada pasien dislipidemia yang mengonsumsu statin dan memenuhi kriteria inklusi dan eksklusi di Puskesmas Denpasar Barat I pada bulan Mei sampai Juni 2021. Sampel pada penelitian ini adalah 35 orang. Durasi konsumsi statin diperoleh melalui rekam medis dan dikonfirmasi ulang melalui kuisioner. Disfungsi ereksi diukur dengan kuisioner IIEF-5. Analisis data menggunakan SPSS versi 21 dengan uji chi-square dan uji korelasi Cramer’s V.
Hasil: Prevalensi disfungsi ereksi pada pasien dislipidemia dengan pengobatan statin di Puskesmas Denpasar Barat I sebesar 85,7% dengan mayoritas pasien mengalami disfungsi ereksi ringan (37,1%) dan mengonsumsi statin kurang dari 12 bulan (51,4%). Karakteristik pasien sebagian besar berusia 45-60 tahun (74,2%), dengan obesitas I (42,8%), merokok (60%), dan minum alkohol (57%). Hasil uji statistic menunjukkan hubungan yang bermakna antara disfungsi ereksi pada pasien dislipidemia dengan lama pengobatan statin di Puskesmas Denpasar Barat I (p=0,031) dengan korelasi sedang (r=0,552). Statin dengan lama pengobatan lebih dari 12 bulan memiliki efek protektif terhadap disfungsi ereksi (RR = 0,81).
Kesimpulan: Terdapat hubungan antara disfungsi ereksi pada pasien dislipidemia dan lama pengobatan statin dengan korelasi sedang. Pengobatan statin dengan lama pengobatan lebih dari 12 bulan memiliki efek protektif terhadap disfungsi ereksi.
Korelasi nilai Homeostasis Model Assesment for Insulin Resistance (HOMA-IR) dan kadar vitamin D pada remaja dengan obesitas di Kota Denpasar, Bali, Indonesia
Luh Gede Yuliadewi NS, I Made Arimbawa, Ketut Suarta, I Gde Raka Widiana, Made Kardana, Ni Putu Veny Kartika Yantie, Komang Ayu WitariniOnline First: Dec 30, 2021
- Abstract
Korelasi nilai Homeostasis Model Assesment for Insulin Resistance (HOMA-IR) dan kadar vitamin D pada remaja dengan obesitas di Kota Denpasar, Bali, Indonesia
Background: Obesity during adolescence can developed into obesity in adulthood and will increase the risk of metabolic dissease sush as insulin resistance. Recent years the role of vitamin D begin to be connection with insulin resistance. Vitamin D plays a role in regulation of synthesis dan insulin secretions from pancreatic beta cells, increase peripheral and hepatic glucose uptake. In obesity there is decrease in vitamin D bioavailability that causes low levels of vitamin D. This study aimed to proves a correlation between insulin resistance and vitamin D levels in adolescents with obesity.
Methods: A observational analytic research with crossestional design has been done in junior and senior high school in Denpasar. Adolescennts performed anthropometric screening covers weight, height, body mass index (BMI), obesity if BMI > 95th percentile of CDC 2000 curve. Examined vitamin D levels and insulin resistance through calculation of HOMA-IR levels. Sample size calculation with ? 0,05, correlation coefficient (r) set to 0,5 with minimum sampel size 50. Data were analyzed using SPSS versin 17 for Windows.
Results: Anthropometric screening performed obtained 135 students (3,3%) with obesity. Mean of vitamin D levels was 18,9 ng/mL, 10 (20 %) classified as vitamin D insufficiency and 39 (78 %) vitamin D deficiencies. The average of HOMA-IR levels 3,84, 24 (48 %) with insulin resistance based on HOMA-IR levels. Correlation coefficient between HOMA-IR levels and vitamin D was obtained – 0,37 (p=0,007). There was significant difference of prevalence of insulin resistance between obese adolescent with vitamin D deficiency compared with insuficiency and suficiency group (OR=5.8; 95%CI=1.1-30.6; p=0.025).
Conclusion: This study concluded that There is a moderate negative correlation between HOMA-IR levels and vitamin D in obese adolescents.
Latar Belakang: Obesitas pada masa remaja berisiko menjadi obesitas pada masa dewasa dan meningkatkan risiko penyakit metabolik seperti resistensi insulin. Beberapa tahun terakhir peran vitamin D mulai dihubungkan dengan resistensi insulin. Vitamin D berperan dalam regulasi sintesis dan sekresi insulin oleh sel beta pankreas, meningkatkan uptake glukosa perifer dan hepatik. Pada obesitas terjadi penurunan bioavaibilitas vitamin D yang menyebabkan rendahnya kadar vitamin D. Penelitian ini bertujuan untuk membuktikan adanya korelasi antara kadar vitamin D dengan resistensi insulin pada remaja dengan obesitas.
Metode: Penelitian ini merupakan penelitian observasional analitik dengan desain potong lintang pada remaja SMP dan SMA di kota Denpasar. Remaja dilakukan skrining antropometri meliputi berat badan, tinggi badan, Indeks Masa Tubuh (IMT). Diagnosis obesitas jika IMT > persentil 95 kurva CDC 2000. Dilakukan pemeriksaan kadar vitamin D darah dan resistensi insulin melalui perhitungan kadar HOMA-IR. Perhitungan besar sampel dengan ? 0,05 ( tingkat kemaknaan 0,95), koefesien korelasi (r) ditetapkan 0,5 dengan jumlah sampel minimal 50. Data dianalisis dengan SPSS versi 17 untuk Windows.
Hasil: Skrining antropometri dilakukan pada 135 subyek (3,3%) dengan obesitas. Rerata kadar vitamin D 18,9 ng/mL, dimana 10 ( 20 %) tergolong insufiseiensi vitamin D dan 39 (79%) defisiensi vitamin D. Rerata kadar HOMA-IR 3,84, 24 (48 %) mengalami resistensi insulin berdasarkan kadar HOMA-IR. Besar koefesien korelasi antara kadar HOMA-IR dan kadar vitamin D didapatkan – 0,37 (nilai p 0,007). Terdapat perbedaan bermakna kejadian resistensi insulin antara kelompok remaja obesitas dengan status defisiensi vitamin D dan kelompok dengan status vitamin D pada kelompok sufisien dan insufisien (OR=5,8; 95%IK=1,1-30,6; p=0,025).
Kesimpulan: Penelitian ini menyimpulkan terdapat korelasi negatif sedang antara kadar HOMA-IR dan kadar vitamin D pada remaja dengan obesitas.