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.

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.

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. 

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.

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.

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.

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.

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.

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.

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.

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 15^th 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.

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. 

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.

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.

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.

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.

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.

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.

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.

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.

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.

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%. 

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.

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.

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.

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

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. 

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. 

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.

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.

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 1^st 2016 to December 31^st 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.          

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%.

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.