Introduction: Basal cell carcinoma (BCC) is a malignant neoplasm originating from non-keratinized cells. The incidence increases worldwide and one of the triggering factors is excessive exposure to ultraviolet (UV) rays. The therapy aims to eradicate the tumor and maintain optimal organ function and cosmetic results after the procedure, one of which is the excision technique accompanied by an island pedicle flap.

Case Description: A man, 67 years old, came with a complaint of a black lump on the left cheek accompanied by a wound that did not heal. Based on the history, physical examination, and investigations, the patient was diagnosed with mixed type BCC. Excision and wound closure were performed with the island pedicle flap technique.

Conclusion: The treatment chosen in this case is surgical excision and island pedicle flap. Although the wound healing is classified as good, the prognosis of the patient is dubius. Considering the location of the lesion and the histopathological results showing an aggressive tumor with a tendency to metastasize, the patient is advised to take precautions.

Pendahuluan: Karsinoma sel basal (KSB) adalah neoplasma ganas yang berasal dari sel non keratin. Terjadi peningkatan insiden KSB di seluruh dunia dan salah satu faktor pencetusnya adalah paparan sinar ultraviolet (UV) berlebih. Terapi yang dilakukan bertujuan untuk mengeradikasi tumor serta tetap mempertahankan fungsi organ dan hasil kosmetik yang optimal paska tindakan, salah satunya dalah dengan teknik eksisi yang disertai island pedicle flap. Deskripsi kasus: Seorang laki-laki, usia 67 tahun, datang dengan keluhan benjolan kehitaman pada pipi kiri yang disertai luka yang tidak kunjung sembuh di atas benjolan. Berdasarkan anamnesis, pemeriksaan fisik dan penunjang, pasien terdiagnosis KSB tipe campuran. Dilakukan tindakan eksisi dan penutupan luka dengan teknik island pedicle flap.

Simpulan: Tatalaksana yang dipilih pada kasus ini adalah pembedahan eksisi serta island pedicle flap. Meskipun penyembuhan luka tergolong baik, namun prognosis pasien dubius. Mengingat lokasi lesi dan hasil histopatologi yang menunjukkan tumor agresif yang memiliki kecenderungan metastase, pasien disarankan untuk melakukan pencegahan.

Objective: This study aims to report a case of catarct surgey outcome in cataract diabetic patient with uncontrolled glycemic.

Case Presentation: A 54-year-old woman has catarct on both eye and history of diabetes mellitus for 15 years. The patients was planned for cataract surgery when blood sugar below 200mg/dL in left eye,blood sugar patients from 248 mg/dL become 168 mg/dL. One week post operation evaluation revealed corneal edema, due to phaco time intra surgery in this patient increased. Visual acuity was 6/120 BCVA on the right eye and 6/18 BCVA on the left eye. Visual acuity has decreased in 2 months after surgery, 1/60 BCVA on the right eye and 6/18 BCVA on the left eye, as well as funduscopy presence of dot blot, flame-shaped, and traction on both eyes. This outcome was contributed by an uncontrolled blood glucose of the patient.

Conclusion: Preoperative preparations in diabetic cataract patients are mandatory, including blood sugar and HbA1C control, to achieve a better outcome of ocular surgery in patients with diabetes mellitus.

Background: Epidermolysis bullosa (EB) is characteristized of epithelial cell adhesion disorders that cause skin fragility and bullae after minor trauma or friction. EB Classification is based on the skin's morphological appearance and the degree to which The following reports a case of recessive dystrophic bullous epidermolysis with marasmus type malnutrition 

Case Report: An 8-year-old man, with complaints of wounds almost all over his body, initially in the form of bubbles filled with fluid which then burst into sores and over time, the bullae spread almost all over the body and oral mucosa. The patient has difficulty eating because of the frequent appearance of sores, so he becomes malnourished with the type of marasmus. The type of ED is inherited in an autosomal recessive manner. Since the age of 4 years, the patient's teeth began to decay, and the patient's fingers and toes were pseudosyndactyly. Histopathological examination results support severe generalized dystrophic recessive type EB (Hallopeau-Siemens). The patient treats with a compress of 0.9% NaCl for 10-15 minutes every 8 hours topically on erosional lesions, giving Petroleum jelly every 12 hours on the whole body, treating the wound using tulle, and then covering it with gauze every 24 hours, providing clinical improvement. 

Conclusion: Epidermolysis bullosa (EB) can be inherited in an autosomal recessive manner. Complaints of the fragility of the skin already appear at the age of children. Nutritional disorders are a problem that strengthens the condition of EB patients. Multidisciplinary management is needed to provide a good outcome.

Latar Belakang: Epidermolysis bullosa (EB) memiliki karakteristik gangguan adhesi sel epitel yang menyebabkan kerapuhan pada kulit dan bula setelah terkena trauma atau gesekan ringan. Berikut dilaporkan satu kasus epidermolisis bulosa distrofik resesif dengan gizi buruk tipe marasmus

Laporan Kasus: Laki- laki usia 8 tahun, dengan keluhan adanya luka hampir pada seluruh tubuh, berbentuk awal berupa gelembung berisi cairan yang kemudian pecah menjadi luka dan seiring jalannya waktu bula menyebar hampir seluruh tubuh hingga bagian mukosa mulut. Pasien mengalami kesulitan makan karena sering muncul luka sehingga menjadi gizi buruk dengan tipe marasmus. Tipe ED diturunkan secara autosomal resesif. Sejak usia 4 tahun gigi pasien mulai keropos, jari tangan dan jari kaki pasien pseudosyndactyly. Hasil pemeriksaan histopatologi menunjang gambaran epidermolisis bulosa. Pasien mengarah pada EB tipe resesif distrofik generalisata berat (Hallopeau-Siemens). Penatalaksanaan berupa kompres terbuka NaCl 0.9% selama 10-15 menit tiap 8 jam topikal pada lesi erosi, pemberian Petroleum jelly tiap 12 jam pada seluruh tubuh, rawat luka menggunakan tulle kemudian ditutup dengan kasa tiap 24 jam memberikan perbaikan klinis

Simpulan: Epidermolysis bullosa dapat diturunkan secara autosomal resesif. Keluhan kerapuhan pada kulit sudah tampak pada usia anak-anak. Gangguan nutrisi menjadi permasalahan yang mempererat keadaan penderita EB. Tatalaksana multidisiplin diperlukan untuk memberikan luaran yang baik

Background: Cellulitis is a skin infection involving the deep dermis and subcutaneous tissue, characterized by localized pain, swelling, tenderness, erythema, and warmth. The most common causes of cellulitis are group A streptococci and Staphylococcus aureus. Streptococcus agalactiae or the so-called group B Streptococcus can also cause cellulitis. This case report aims to evaluate the colonization of Citrobacter koseri and Streptococcus agalactiae in a case of cellulitis cruris dextra et sinistra.

Case Presentation: A 53-year-old married woman presented to the outpatient clinic complaining of swelling and redness in her left and right legs since five days ago. At first, there was only a little redness around the calf, but it became wider and pain in that area. On examination, there were multiple erythematous macules, patches, and multiple erosional lesions, warm palpable and tender to palpation, and the diascopy test disappeared with pressure. Based on the wound culture results, isolated Citrobacter koseri and Streptococcus agalactiae bacteria were considered colonization. Both of these bacteria were less virulent. The patient was treated with systemic and topical antibiotics, analgesics, wound care management and elevated lower limbs.

Conclusion: The diagnosis of cellulitis is based on history and physical examination. On examination of the wound culture of this case, Citrobacter koseri and Streptococcus agalactiae were found, considered as colonization. The patient showed clinical improvement at each observation after administration of antibiotics and wound care management. The patient's prognosis is dubious ad bonam.

Background: Pubic symphyseal widening spontaneous vaginal delivery is normal. The stretch that occurs after delivery is less than 10mm. However, separation of symphysis of more than 10 mm is rare and can cause injury to the pubic bone and pelvic floor muscles. The prevalence of pubic symphysis injury is 1 in 300 to 1 in 30,000 live births. Thus, in this study we report a post-partum symphysiolysis as a compilation of labour.

Case Description: A 34-year-old woman G5P4004 40^th weeks gestational, came to Lewoleba Hospital, Lembata was referred with complaints of lacerations and pain in the upper pelvis after vaginal delivery of a male baby with a birth weight of 4,000 grams at the Public Health Service. On physical examination, there was a rupture of the vulva-vaginal wall anterior to the pubis with active bleeding. There is limited ROM in both lower extremities. Then an operative procedure was carried out in the form of repair of the ruptured vulva-vaginal wall to stop the bleeding and repair the anatomical structure of the external genitalia. After the operative procedure, a pelvic radiological examination was performed, which revealed a stretch in the right and left superior ramus pubis ostium with a size of 5.5 cm. The patient underwent conservative measures by placing a splint on the pelvis for one month. After six months, a follow-up was performed, the stretch became 3.5 cm and the patient's complaints were no longer felt.

Conclusion: Symphysiolysis is a very rare obstetric complication. Complaints of pain in the pelvis that arise after childbirth, accompanied by a decrease in the ability to mobilize the lower extremities, can indicate symphysiolysis. A pelvic radiological examination confirms the diagnosis. Conservative management is the main choice in the treatment of symphysiolysis

Background: The morbidity and mortality in Inferior ST-elevation myocardial infarction (STEMI) is also determined by the location of the occlusion. Early Identification of the occlusion site is necessary to assist in the appropriate management of Inferior STEMI. This case study aims to evaluate the Electrocardiogram (ECG) examination, which has a basic role in the diagnosis of STEMI, both in determining the location of myocardial infarction and predicting the location of the culprit lesion.

Case Presentation: A 48-year-old male patient complained of dull chest pain, such as being pressured by a heavy object and radiating to the back, followed by nausea, vomiting and cold sweats, and shortness of breath for 2 hours before coming to the hospital. On arrival, the patient was fully conscious with a blood pressure of 110/70 mmHg, pulse rate of 129x/minute with a SpO2 of 95% with electrocardiography (ECG) results showing atrial fibrillation with inferoposterolateral STEMI. Shortly after the ECG examination, the patient became unconscious, with blood pressure dropping to 60/palpation and bradycardia at 48 beats/minute. The patient underwent a fibrinolytic revascularization strategy with Streptokinase 1,500,000 U for 30 minutes, but soon the patient became unconscious with the ECG monitor showing ventricular fibrillation (VF). Hence, cardiopulmonary resuscitation was immediately performed with 360 J defibrillation twice, and the ECG returned to sinus rhythm. After stabilizing, the patient was referred for Rescue Percutaneous Coronary Intervention (PCI). The results of Coronary Angiography showed that the culprit lesion, in this case, was the Left Circumflex Artery with the Right Coronary Artery normal small, and non-dominant.

Conclusion: ECG is still an important supporting examination in diagnosing and managing Acute Coronary Syndrome (ACS). An ECG can also help determine the culprit lesion in STEMI before angiography. Inferoposterolateral STEMI can be caused by blockage of the Right Coronary Artery (RCA) or Left Circumflex Artery (LCx).

Introduction: In cases of pregnancy with thrombocytopenia, it is sometimes necessary to terminate the pregnancy by caesarean section. This is certainly a challenge and special attention is needed in the perioperative anesthetic management of this case. Attached below is a case series of perioperative anesthesia management in gravida with thrombocytopenia who underwent cesarean section at Sanglah Hospital in 2020-2022.

Case Description: In this case series, we report a number of cases of pregnancies with thrombocytopenia who underwent elective or emergency cesarean section at Sanglah Hospital in 2020 – 2022. In this case series, a total of 9 pregnant women with various comorbidities were to be terminated and will undergo cesarean section surgery with 7 emergency cases and 2 elective cases. Patient characteristics varied from ASA physical status II to III. In all 9 cases, anesthesia was administered under general or regional anesthesia, namely 5 cases under general anesthesia and 4 cases under regional anesthesia. In this case report, 2 out of 9 cases of thrombocytopenia were found in postnatal infants.

Discussion: In this case series, it was found that 5 cases were administered under general anesthesia and 4 cases were treated with regional anesthesia. This is based on clinical assessment of the patient and the platelet count with the safe range for regional anesthesia being 75 x 10³µL – 80 x 10³µL. The dose of opioid used in this case series ranged from 2-2.5 mcg/Kg BW. Based on the literature, opioids are said to be able to cross the placental blood barrier and are feared to have an impact on the fetus at birth. No respiratory depression effect was found in infants due to suspected opioid administration in this case series.

Conclusion: The case of pregnancy with thrombocytopenia is a unique challenge for the anesthesia team. Starting from consultation on the preparation of the action and anesthetic plan, anesthetic action, monitoring, and preparation for anticipating complications that may arise during surgery. With the development of science and research in this field, it is still necessary to establish clear guidelines and boundaries regarding perioperative management of gravida patients with thrombocytopenia.

Pendahuluan: Pada kasus kehamilan dengan trombositopenia, ada kalanya diperlukan terminasi kehamilan per abdominal atau melalui operasi sectio caesarea . Hal ini tentu merupakan suatu tantangan dan diperlukan perhatian khusus dalam manajemen anestesi perioperatif kasus ini. Berikut dilampirkan serial kasus manajemen anestesi perioperatif pada gravida dengan trombositopenia yang menjalani sectio caesarea di RSUP Sanglah pada tahun 2020-2022.

Laporan Kasus: Pada laporan serial kasus ini, kami melaporkan sejumlah kasus kehamilan dengan trombositopenia yang menjalani operasi sectio caesarea baik elektif atau emergensi di RSUP Sanglah pada tahun 2020 – 2022. Pada laporan serial kasus ini didapatkan total 9 pasien ibu hamil dengan berbagai macam komorbiditas yang akan dilakukan terminasi kehamilan per abdominal atau akan menjalani operasi sectio caesarea dengan 7 kasus emergensi dan 2 kasus elektif. Karakteristik pasien bervariasi dari Status Fisik ASA II – III. Pada keseluruhan 9 kasus dilakukan manajemen anestesi dengan pembiusan umum atau regional, yaitu 5 kasus dilakukan manajemen anestesi dengan pembiusan umum dan 4 kasus dilakukan manajemen anestesi regional. Pada laporan kasus ini didapatkan trombositopenia pada bayi paska lahir sebanyak 2 dari 9 kasus.

Diskusi: Pada laporan serial kasus ini didapatkan 5 kasus dilakukan manajemen anestesi dengan pembiusan umum dan 4 kasus dilakukan manajemen anestesi regional. Hal ini didasarkan pada penilaian klinis pada pasien dan jumlah hitung trombosit dengan rentang batasan yang aman untuk dilakukan tindakan regional anestesi adalah 75 x 10³µL – 80 x 10³µL. Dosis opioid yang digunakan pada serial kasus ini berkisar 2-2.5 mcg/KgBB. Berdasarkan literatur, opioid dikatakan dapat menembus sawar darah placenta dan dikhawatirkan akan berdampak pada janin saat lahir. Tidak ditemukan efek depresi napas pada bayi akibat dugaan pemberian opioid pada serial kasus ini.

Simpulan: Kasus gravida dengan trombositopenia merupakan tantangan unik bagi tim anestesi. Mulai dari konsultasi persiapan tindakan dan rencana anestesi, tindakan anestesi, pemantauan, serta persiapan antisipasi komplikasi yang mungkin timbul selama tindakan pembedahan. Dengan terus berkembangnya ilmu dan penelitian dibidang ini, masih perlu dibuat panduan dan batasan yang jelas terkait manajemen perioperatif pada pasien gravida dengan trombositopenia.

Background: Rhegmatogenous retinal detachment in children is rare, accounting for less than ten percent of all rhegmatogenous retinal detachments. While the majority of retinal detachments in the adult population are associated with posterior vitreous detachments, pediatric rhegmatogenous retinal detachments are often associated with trauma or an underlying congenital abnormality, although in some cases they are associated with idiopathic conditions.

Case Description: A 16-year-old male patient complained about blurry vision in the right eye in the last 6 months and in the left eye in the last 5 months. Ophthalmology examination in the right eye found an inferior retinal detachment (+) at 3-9 o’clock, multiple breaks at 7-9 hours, PVR grade C, subretinal fibrosis (+), traction (+), macula off, RM (-). Meanwhile, ophthalmology examination in the left eye found an inferior retinal detachment in the left eye (+) at 3-9 o’clock, break at 5 o'clock, PVR grade C, traction (+), RM (+). The patient underwent pars plana vitrectomy in both eyes and the patient experienced an increase in visual acuity after surgery on both eyes.

Conclusion: This case describes a healthy adolescent male with bilateral rhegmatogenous retinal detachment secondary to spontaneous non-traumatic retinal dialysis. The Pars Plana Vitrectomy (VPP) technique that used in this case could give high final reattachment rate and relatively good functional outcomes. VPP also has the intraocular ability to manipulate tissues and reduce immediate vitreous traction.

Latar Belakang: Ablasio retina rhegmatogenous pada anak-anak jarang terjadi, terhitung kurang dari sepuluh persen dari semua ablasio retina rhegmatogen. Sementara sebagian besar ablasio retina pada populasi orang dewasa terkait dengan ablasio vitreous posterior, ablasio retina hegmatogen pediatrik sering kali berhubungan dengan trauma atau kelainan kongenital yang mendasari, walaupun pada beberapa kasus didapatkan dengan kondisi idiopatik.

Laporan Kasus: Pasien laki-laki berusia 16 tahun mengeluhkan penurunan pengelihatan pada mata kanan sejak 6 bulan sebelumnya dan pada mata kiri 5 bulan sebelumnya. Pemeriksaan oftalmologi didapatkan AAR di mata kanan dengan retinal detachment (+) di inferior pada jam 3-9, multiple break pada jam 7-9, PVR grade C, fibrosis subretina (+), traksi (+), macula off, RM (-). Pemeriksaan pada mata kiri didapatkan retinal detachment di mata kiri (+) di inferior pada jam 3-9, break pada jam 5, PVR grade C, traksi (+), RM (+). Pasien menjalani vitrektomi pars plana pada kedua mata dan pasien mengalami peningkatan tajam penglihatan setelah dilakukan tindakan operasi pada kedua mata.

Kesimpulan: Kasus ini menjelaskan remaja laki-laki sehat dengan bilateral ablasio retina rhegmatogen sekunder akibat retinal spontan non-trauma dialisis. Teknik Vitrektomi Pars Plana (VPP) digunakan pada kasus ini dan mampu memberikan tingkat attachment akhir yang tinggi dan hasil fungsional yang relatif baik serta kemampuan intraokular untuk memanipulasi jaringan dan mengurangi traksi vitreous secara langsung.

Background: Myelodysplastic syndrome (MDS) is a group of bone marrow disorders characterized by ineffective hematopoiesis resulting in cytopenia and an increased risk of Acute Myeloid Leukemia (AML). MDS is a disease that is often found in elderly patients. The mean age at disease onset was 70 years.

Case: A 72-year-old woman complained of feeling tired easily since 5 months throughout the day, not aggravated by activity and starting to gain weight in the last 1 week to interfere with the patient's activities. The patient also complained of intermittent dizziness since 2 months, was not affected by activity or change of position, and was not accompanied by nausea and vomiting. Complaints of fever, prolonged cough, bleeding, yellow body, red skin rash, progressive weight loss, bowel and bladder disorders were denied. Physical examination of the patient revealed vital signs within normal limits. The patient's conjunctiva was anemic, the patient's extremities also looked pale and there was no organ enlargement such as hepatomegaly and splenomegaly. Laboratory examinations at the time of presentation showed an increase in leukocytes, a decrease in erythrocytes, a decrease in hemoglobin, and a decrease in hematocrit. The patient's platelets were still in the normal range and there were no disturbances in kidney and liver function. The results of leukocytes, erythrocytes, and hemoglobin taken consecutively on 3 consecutive days still show an increase in leukocytes despite the downward trend in value. The results of bone marrow examination, namely trephine morphology, showed hypercellular marrow (approximately 80% cellularity) with an increase in blast cells of 10-15%, decreased maturation of myeloid series, erythroid cells and dyserythropoiesis, scattered plasma cells, increased megakaryocytes accompanied by dysmegakaryopoiesis. Patient diagnosed as Myelodysplastic Syndrome with Excess Blast. The therapy given to the patient during hospitalization aims to overcome the symptoms experienced by the patient. Transfusion of PRC (Packed Red Cell) 1 Kolf/day with Furosemide 20 mg by injection before transfusion and administration of Folic Acid 1 x 1 tablet per day provided an improvement in the patient's condition. This is evidenced by the increase in hemoglobin levels during treatment. The patient was referred to a referral hospital for further treatment.

Conclusion: Myelodysplastic syndrome (MDS) is a group of bone marrow disorders characterized by ineffective hematopoiesis resulting in cytopenia and an increased risk of acute myeloid leukemia (AML). The patient was diagnosed with MDS with Excess Blast based on bone marrow biopsy. Other investigations, namely complete blood count, found an increase in leukocytes and hemoglobin, this also supports the diagnosis of MDS in this patient. The prognosis in this patient is classified as high risk based on IPSS-R, which means survival for 1-2 years is 13%.

Latar Belakang: Myelodysplastic syndrome (MDS) adalah kelompok penyakit gangguan sumsum tulang ditandai dengan hematopoiesis yang tidak efektif mengakibatkan sitopenia dan peningkatan risiko terjadinya Leukemia Mieloid Akut (AML). MDS merupakan penyakit yang sering ditemukan pada pasien lanjut usia dengan rerata onset penyakit yaitu usia 70 tahun.

Kasus: Perempuan berusia 72 tahun mengeluh mudah lelah sejak 5 bulan yang dirasakan sepanjang hari, tidak diperberat dengan aktivitas dan mulai bertambah berat 1 minggu terakhir hingga menganggu aktivitas pasien. Keluhan pusing yang hilang timbul sejak 2 bulan, tidak dipengaruhi oleh aktivitas atau perubahan posisi, dan tidak disertai dengan mual dan muntah. Keluhan demam, batuk lama, perdarahan, badan kuning, ruam merah dikulit, penurunan berat badan yang progresif, gangguan BAB dan BAK disangkal. Pasien didapatkan tanda vital dalam batas normal. Konjungtiva pasien anemis, ekstremitas pasien juga tampak pucat dan tidak didapatkan pembesaran organ seperti hepatomegaly dan splenomegaly. Hasil laboratorium diperoleh leukositosis, eritropenia, anemia, dan penurunan hematokrit. Platelet pasien masih berada pada rentang normal dan tidak terdapat gangguan pada fungsi ginjal dan hati. Hasil leukosit, eritrosit, dan hemoglobin yang diambil berturut-turut pada 3 hari berturut-turut tetap menunjukkan peningkatan leukosit meskipun tren nilai mengalami penurunan. Hasil pemeriksaan sumsum tulang yaitu gambaran morfologi trephine menunjukkan sumsum hiperseluler (kurang lebih 80% selularitas) dengan peningkatan sel blast 10 – 15 %, penurunan maturasi seri myeloid, sel eritroid dan diseritropoiesis, scattered sel plasma, peningkatan megakariosit disertai dismegakariopoiesis. Pasien diagnosa sebagai Myelodysplastic Syndrome with Excess Blast. Terapi yang diberikan pada pasien selama perawatan di rumah sakit bertujuan untuk mengatasi gejala yang dialami pasien. Transfusi PRC (Packed Red Cell) 1 Kolf/hari dengan pemberian Furosemide 20 mg secara injeksi sebelum transfusi dan pemberian Asam Folat 1 x 1 tablet per hari memberikan perbaikan kondisi pada pasien. Hal ini dibuktikan dengan peningkatan kadar hemoglobin selama perawatan. Pasien dirujuk ke rumah sakit rujukan untuk penanganan lebih lanjut.

Simpulan: Myelodysplastic syndrome (MDS) adalah kelompok penyakit gangguan sumsum tulang ditandai dengan hematopoiesis yang tidak efektif mengakibatkan sitopenia dan peningkatan risiko terjadinya Leukemia Myeloid Akut (AML). Pasien didiagnosis mengalami MDS with Excess Blast berdasrakan pemeriksaan biopsis sumsum tulang. Prognosis pada pasien ini tergolong high risk berdasarkan IPSS-R yang artinya survival untuk 1 – 2 tahun yaitu 13%.

Introduction: Schwannoma is a benign nerve sheath tumor that occurs more frequently in the peripheral nervous system than in the central nervous system. Spinal schwannomas are most frequently found in the thoracic or lumbar regions but are uncommon in the cervical region. This paper describes a cervical schwannoma that is associated with spastic tetraparesis.

Case Presentation: A 50-year-old man presented with the primary complaint of having difficulty moving his upper and lower limbs. The patient is fully conscious and has a temperature of 36.2°C, a respiratory rate of 22 breaths per minute, and a pulse rate of 108 beats per minute. Neurological evaluation revealed bilaterally diminished strength in the superior and inferior extremities. Cervical magnetic resonance imaging (MRI) with and without contrast revealed a grade 2 hernia nucleus pulposus (HNP) and an extramedullary-intradural mass in the anterior cervical vertebral canal region between C5 and C7, compressing and obliterating the cerebrospinal fluid spaces. A laminectomy was performed, and an intradural tumor mass in the C5-C7 region was obtained.

Conclusion: Schwannomas, although rare, can cause spastic tetraparesis if they compress the cervical spinal cord.

Latar Belakang: Schwannoma adalah tumor selubung saraf jinak yang lebih sering terjadi di luar sistem saraf pusat. Schwannoma spinal dapat terjadi di regio thorakal atau lumbar, namun jarang terjadi pada regio servikal. Studi ini melaporkan schwannoma servikal yang menyebabkan tetraparese spastik.

Presentasi Kasus: Seorang laki-laki umur 50 tahun datang dengan keluhan utama kedua anggota gerak atas dan bawah sulit digerakkan. Pasien sadar penuh dengan suhu 36,2°C, laju respirasi 22 kali per menit, nadi 108 kali per menit. Pemeriksaan neurologis menunjukkan adanya penurunan kekuatan ekstremitas superior dan ekstremitas inferior bilateral. Magnetic resonance imaging (MRI) servikal dengan kontras dan tanpa kontras menunjukkan hernia nucleus pulposus (HNP) grade 2 dan massa ekstramedular-intradural pada regio kanalis vertebra servical anterior setinggi C5-C7 yang menyebabkan kompresi dan obliterasi ruang cairan serebrospinal. Dilakukan laminektomi dan didapatkan massa tumor intradural C5-C7.

Kesimpulan: Schwannoma, walaupun jarang, dapat menyebabkan tetraparese spastik jika menekan medula spinalis servikal.

Background: Hyperglycemic hyperosmolar state (HHS) is a life-threatening rare acute complication of diabetes mellitus (DM). The condition should be distinguished from diabetic ketoacidosis (DKA) as the management differs significantly. HHS is classically associated with type 2 DM, but it has been increasingly reported in type I DM as well. The literature regarding HHS in children is still sparse. The management of HHS in children is extrapolated from the adult study.

Cases: The first case was male 5 years old, and the second case was female 15 years old. Both cases were typed 1 DM patient. The first case was newly diagnosed. Both of the patients came with general weakness, mild dehydration, overly high blood sugar, normal blood pH, hypocalcemia, glucosuria and only mild ketonuria. In the second case develop, both patients were rehydrated, given insulin and discharged in 7-10 days without any sequelae.

Conclusion: These case series emphasize the importance of recognizing HHS and differ it from DKA. These two cases prove that HHS is increasingly reported in children with clinical symptoms resembling DKA. It is also proven that with early diagnosis and correct management, children with HHS can be discharged home without any sequelae.

Background: Meningiomas are the most common primary central nervous system (CNS) tumors. The incidence of meningioma is mostly found in women. There is an association between hormones and the incidence of meningioma. The symptoms of meningioma are unspecified and depend on the tumor's location. This case study aims to evaluate meningioma in the hormonal contraceptive acceptor.

Case Presentation: A 36-years-old female patient was hospitalized with a chronic progressive headache that occurred for approximately two months. It was a throbbing headache in the left area of the head that worsened in the lying position. The patients deny other symptoms, such as weakness on one side of the body, nausea, vomiting, blurred visions or double visions, or convulsions. The patient had a history of receiving hormonal contraception for over 10 years. CT with contrast reveals a strong contrast enhancement, a well-defined, round-shaped lesion in the left sphenoid wing. In this case, tumor resection was done. From the histopathological examination, chordoid meningioma was found. Based on WHO grading, chordoid meningioma belongs to WHO grade II.

Conclusion: The longer exposure to the exogenous progesterone injection, the lower the expression of Progesterone Receptors (PR) and mRNA Neurofibromatosis-2 (NF2) in the serum, and that lower expression of PR and NF2 was significantly and independently associated with a higher risk of females to suffer from meningioma.

Latar Belakang: Meningioma adalah tumor primer sistem saraf pusat (SSP) yang paling sering ditemukan. Insiden meningioma lebih banyak ditemukan pada wanita, dimana diduga ada keterkaitan hormon pada wanita dengan kejadian meningioma. Gejala meningioma seringkali tidak spesifik dan tergantung dari lokasi tumbuhnya tumor. Laporan kasus ini bertujuan mengevaluasi meningioma pada akseptor kontrasepsi hormonal.

Presentasi Kasus: Pasien wanita berusia 36 tahun dirawat dengan keluhan nyeri kepala kronik progresif yang dialami selama kurang-lebih dua bulan. Keluhan dirasakan seperti berdenyut di kepala sebelah kiri, memberat dengan posisi berbaring. Keluhan lain seperti lemah separuh tubuh, mual, muntah, pandangan kabur atau ganda, serta kejang disangkal oleh pasien. Pasien memiliki riwayat penggunaan kontrasepsi hormonal injeksi setiap 3 bulan selama lebih dari 10 tahun. Pada pemeriksaan CT kepala dengan kontras didapatkan gambaran lesi menyangat kontras berbentuk bulat, berbatas tegas pada sphenoid wing kiri. Dilakukan reseksi tumor serta dilakukan pemeriksaan histopatologis dengan hasil chordoid meningioma, yang merupakan WHO derajat II.

Simpulan: Semakin lama paparan terhadap progesteron eksogen injeksi, maka ekspresi Reseptor Progesteron (RP) dan mRNA Neurofibromatosis-2 (NF2) dalam serum akan semakin rendah yang secara signifikan dan independen berhubungan dengan risiko yang lebih tinggi bagi wanita untuk menderita meningioma.

Background: Scrotal fistula are extremely rare, and more common in the pediatric population and very rarely in adults. Fistula recurrence is a common complication after fistula surgery. This case report evaluates the incidence of recurrent scrotal fistula along with current management.

Case Presentation: This report reports a 27-year-old man complaining of an open wound on the scrotum since 8 months ago. accompanied by discharge from the wound without pain. History of abscess in the same area and excision of the abscess bag was done 6 months ago, complaint did not disappear. Four months of wound care, wound size decreased but tunnel like shape formed with a red wound base, increased granulation. Fistulography found a fistula tract of 8.7 cm from the fistula marker. fistula does not go to the rectum and contrast does not come out fromxxx anus and urethra. A fistulectomy was performed in the subscrotal area. 2 weeks after surgery, a new wound was found in the surgical area with elevated granulation and exudate. Discharge of pus on pressure.

Conclusion: Recurrent fistula is the occurrence of the wound in the same area within 1 year postoperatively. Preoperative, intraoperative and postoperative factors need to be considered for the prevention of recurrent fistulas.

Latar Belakang: Fistula skrotal merupakan kasus sangat langka dan lebih sering terjadi pada populasi anak-anak dan sangat jarang ditemukan pada orang dewasa. Fistula berulang merupakan komplikasi yang sering terjadi setelah pembedahan fistula. Laporan kasus ini mengevaluasi kejadian fistula scrotal berulang beserta dengan manajemen terkini.

Presentasi Kasus: Tulisan ini melaporkan seorang Laki-laki usia 27 tahun mengeluh luka terbuka pada skrotum bagian bawah sejak 8 bulan sebelumnya. Keluhan disertai dengan keluar cairan dari luka tersebut berwarna kekuningan tanpa disertai dengan rasa nyeri. Riwayat abses pada area yang sama dan dilakukan eksisi kantong abses 6 bulan yang lalu, keluhan tidak menghilang. Kemudian dikonsulkan ke bedah plastik untuk menutup luka. Perawatan luka 4 bulan, Ukuran luka mengecil tetapi membentuk terowongan dengan dasar luka berwarna merah, granulasi meninggi. Fistulografi ditemukan jalur fistula sepanjang 8,7 cm dari marker fistula. fistula tidak menuju rektum dan kontras tidak keluar dari anus dan uretra. dilakukan tindakan fistulektomi pada area subskrotal. 2 minggu setelah operasi, ditemukan luka baru di daerah operasi dengan granulasi meninggi dan adanya eksudat. Keluar pus pada penekanan.

Simpulan: Fistula berulang adalah timbulnya luka pada daerah yang sama dalam 1 tahun post operasi. Faktor Preoperatif, intraoperatif dan postoperatif perlu diperhatikan untuk pencegahan fistula berulang.  

Background. Steven Johnson Syndrome and Toxic Epidermal Necrolysis are dermatologic emergencies with high mortality rates characterized by extensive skin involvement. TNF-α has a role in inducing the production of granulysin that enhances keratinocyte cell death. Thus, the use of TNF-α inhibitors such as etanercept and infliximab is promising to halt the disease progression. This systematic review aims to evaluate the efficacy of TNF-α inhibitor in SJS/TEN management.

Method. A systematic review using an online database was conducted based on PRISMA guidelines. Inclusion criteria were studied about the role of TNF-α inhibitor in SJS/TEN management. The exclusion criteria were a letter to the editor, commentary report, review, meta-analysis, study not used humans as a study subject, not available in full text and not in English or Bahasa Indonesia.

Result. Fourteen studies are included in this systematic review consisting of ten case reports, three cohort retrospective studies, and one randomized controlled trial. TNF-α inhibitors such as etanercept and infliximab are beneficial for SJS/TEN management because they accelerate skin healing time and re-epithelization, reduce in-hospital duration and mortality rate, and minimal complications and side effects. TNF-α inhibitors should be given quickly after the disease onset, and combination with other immunosuppressive agents should be avoided to prevent the excessive immunosuppressive effect.

Conclusion. TNF-α inhibitors such as etanercept and infliximab promise therapy to halt SJS/TEN progression.  

Burn-related morbidity and mortality are usually caused by secondary infection and long healing time. In these circumstances, the use of products that can accelerate and enhance the wound healing process is urgently needed. One breakthrough in wound healing therapy is platelet-rich plasma (PRP). Platelet-rich plasma is autologous plasma with a platelet concentration above the normal value. This study is a literature review aiming to describe the role of PRP in burn wound healing. PRP has various mechanisms in burn wound healing, such as increasing hemostasis, releasing growth factors, reepithelialization, inducing fibroblast proliferation in the extracellular matrix, and promoting angiogenesis which increases the rate of wound healing. In addition, it also has an antimicrobials effect. Previous studies have been done in animal models and humans to prove the efficacy of PRP in burn wound healing. Most studies have revealed that PRP can accelerate wound healing time and increase the quality of wound healing. So, using PRP in burns can be very useful for patients to reduce burn morbidity and mortality.

Background: COVID-19 infects all patients of all ages including the elderly. Several studies have shown that complete blood counts can be used as a marker of the severity of COVID-19. This study aims to examine complete blood counts with the severity of COVID-19 in elderly patients at the Tabanan Regional General Hospital (RSUD) in 2021.

Methods: This research was conducted using an retrospective study method, using 277 samples taken from secondary data (patient medical records) at Tabanan General Hospital. The independent variables of study including haemoglobin, haematocrit, leukocytes, relative lymphocyte levels, relative neutrophil levels, neutrophil lymphocyte ratio (NLR), relative eosinophil levels, relative basophil levels, relative monocyte levels, platelets, and depending  variable is the severity of the patient, divided to moderate, severe, critically ill. Data analysis using SPSS version 26 for Windows.

Results: Complete blood counts were significantly correlated with Lymphocytes (r² = 0,069; p < 0,001), Monocyte (r² = 0,045; p < 0,001), Leukocyte (r² = 0,037; p = 0,001), NLR (r² = 0,03; p = 0,004), Eosinophil (r² = 0,022; p = 0,013), and Haematocrit (r² = 0,069; p = 0,022).

Conclusion: In this study, complete blood count (leukocytes, NLR, haematocrit with a positive value correlation, and lymphocytes, eosinophils,  monocytes with a negative value correlations) can be used as  predictors to assess the severity of COVID-19 patients. However, neutrophils, basophils, haemoglobin, and platelets were not correlated significantly.

Latar Belakang: COVID-19 menginfeksi semua pasien dari segala usia termasuk lansia. Beberapa studi menunjukkan bahwa pemeriksaan darah lengkap dapat dipergunakan sebagai penanda derajat keparahan COVID-19. Penelitian ini bertujuan untuk mengevaluasi pemeriksaan darah lengkap dengan derajat keparahan COVID-19 pada pasien lansia di Rumah Sakit Umum Daerah (RSUD) Tabanan tahun 2021.

Metode: Penelitian ini dilakukan dengan metode studi retrospektif menggunakan 277 sampel yang diambil dari data sekunder rekam medis pasien di RSUD Tabanan. Variabel independen penelitian meliputi hemoglobin, hematokrit, leukosit, kadar limfosit relatif, kadar neutrofil relatif, neutrofil limfosit ratio (NLR), kadar eosinofil relatif, kadar basofil relatif, kadar monosit relatif, trombosit, dan dependent derajat keparahan pasien yaitu sedang, berat, kritis. Analisis data memakai SPPS versi 26 untuk Windows.

Results: Pemeriksaan darah lengkap menunjukkan hasil yang bermakna pada Limfosit (r² = 0,069; p < 0,001), Monosit (r² = 0,045; p < 0,001), Leukosit (r² = 0,037; p = 0,001), NLR (r² = 0,03; p = 0,004), Eosinofil (r² = 0,022; p = 0,013), dan Hematokrit (r² = 0,069; p = 0,022).

Conclusion: Pada penelitian ini pemeriksaan darah lengkap (leukosit, NLR, hematokrit dengan korelasi positif, dan limfosit, eosinofil, monosit dengan korelasi nilai negatif) dapat digunakan sebagai prediktor untuk menilai derajat keparahan pasien COVID-19. Akan tetapi neutrofil, basofil, hemoglobin, dan trombosit tidak berkorelasi secara bermakna.

Background: The pathogenesis of COVID-19 infection is the occurrence of excessive inflammatory reactions in which one of the markers of inflammation that is easy to work with is the value of the Neutrophil Lymphocyte Ratio (NLR). The NLR value increases in uncontrolled type 2 DM patients and is a prognostic factor for the occurrence of severe symptomatic COVID-19 infection. This study aims to examine the correlation between NLR values ​​and various laboratory parameters of type 2 DM patients with COVID-19 infection at Sanglah Hospital.

Methods: This study used a cross-sectional analytical design and involved 70 research samples from the medical records of type 2 DM patients with COVID-19 who were treated at Sanglah Hospital from April 2020 to October 2020. Analysis with Pearson and Spearman tests to see the correlation between NLR values ​​and 12 laboratory parameters such as GDS, GDP, HbA1c, Leukocytes, Hemoglobin, BUN, D-Dimer, CRP, serum creatinine, SGOT, SGPT and Ferritin using SPSS software version 21 for Windows.

Results: From the results of the correlation test, laboratory parameters that were found to be significantly positively correlated with NLR values ​​were GDS levels (r=0.451; p=0.000), GDP (r=0.037; p=0.001), leukocytes (r=0.479; p=0.000), BUN (r=0.368; p=0002), D-dimer (r=0.348; p=0.011), CRP (r=0.557; p=0.000), serum creatinine (r=0.313; p=0.009) and ferritin (r=0.337; p=0.011).

Conclusion: The NLR value in type 2 DM patients with COVID-19 is positively correlated with glycemic markers, namely GDS and GDP. In addition, it is also positively correlated with leukocytes, BUN, D-dimer, CRP, serum creatinine and ferritin.

Latar belakang: Patogenesis infeksi COVID-19 adalah terjadinya reaksi inflamasi berlebihan dimana salah satu penanda inflamasi yang mudah dikerjakan adalah nilai Neutrophil Lymphocyte Ratio (NLR). Nilai NLR meningkat pada pasien DM tipe 2 yang tidak terkontrol dan menjadi faktor prognostik untuk terjadinya infeksi COVID-19 gejala berat. Penelitian ini bertujuan untuk meneliti korelasi antara nilai NLR dengan berbagai parameter laboratorium pasien DM tipe 2 dengan infeksi COVID-19 di RSUP Sanglah.

Metode: Studi ini menggunakan desain analitik potong lintang dan melibatkan 70 sampel penelitian dari rekam medik pasien DM tipe 2 dengan COVID-19 yang dirawat di RSUP Sanglah bulan April 2020 hingga Oktober 2020. Analisis dengan Uji Pearson dan Spearman untuk melihat korelasi antara nilai NLR dengan 12 parameter laboratorium berupa GDS, GDP, HbA1c, Leukosit, Hemoglobin, BUN, D-Dimer, CRP, serum kreatinin, SGOT, SGPT dan Ferritin menggunakan piranti lunak  SPSS versi 21 untuk Windows.

Hasil: Dari hasil uji korelasi, parameter laboratorium yang ditemukan signifikan berkorelasi positif dengan nilai NLR adalah kadar GDS (r=0,451; p=0,000), GDP (r=0,037; p=0,001), leukosit (r=0,479; p=0,000), BUN (r=0,368; p=0002), D-dimer (r=0,348; p=0,011), CRP (r=0,557; p=0,000), serum kreatinin (r=0,313; p=0,009) dan ferritin (r=0,337; p=0,011).

Kesimpulan: Nilai NLR pada pasien DM tipe 2 dengan COVID-19 berkorelasi positif dengan penanda glikemik yaitu GDS dan GDP. Selain itu berkorelasi positif juga dengan leukosit, BUN, D-dimer, CRP, serum kreatinin dan ferritin.

Introduction: Total Hip Arthroplasty (THA) has become a standard procedure in treating hip coxarthrosis and the treatment of femoral head necrosis and femoral neck fracture. THA effectively reduces pain but has some functional limitations after the patient undergoes the procedure. This study aims to evaluate the effect of intraoperative administration of platelet-rich plasma to the hip capsule and the correlation of the amount of mechanoreceptor in the hip capsule to the Harris Hip Score (HHS) and Berg Balance Test (BBT) 1 month after the procedure of total hip arthroplasty.

Methods: This study is a post-test-only randomized clinical trial. The patient who had to fulfill the inclusion criteria will be assessed using HHS and BBT for the functional outcome 1 month after the total hip arthroplasty procedure. The data was then analyzed using the Pearson test in SPSS version 25 for Windows.

Results: Based on the Independent-T Test result, we found that administration of PRP gave a significant result statistically to increase Harris Hip Score and Berg Balance Test 1 month after undergoing total hip arthroplasty (P<0,05). Based on the Pearson test, we found that there was a strong significant correlation between the amount of mechanoreceptor (free nerve ending) to HHS (r=0.756; p=0.002) and BBT (r=0.660; p=0.010) in the patient who underwent THA with Platelet-Rich Plasma (PRP) administration.

Conclusion: PRP administration gave a better result to the patient who underwent THA 1 month postoperatively assessed by Harris Hip Score and Berg Balance Scale.

Background: The World Health Organization (WHO) said that South East Asia has a high stunting prevalence, where it is estimated that 22.2% of toddlers are stunted globally. The reality is that there are still many cases of inaccurate measurement methods, which question the validity of stunting prevalence. This study aims to know if small group training is effective in reducing stunting prevalence in toddlers.

Methods: This descriptive study was done at all Posyandu in Bugul Lor from August to September 2019. Populations in this study were all helpers at Posyandu. Samples in this study were all helpers who met inclusive criteria but didn’t meet exclusive criteria. The inclusion criteria were helpers who attended when the study was conducted (5 helpers in each Posyandu), and the exclusive criteria were illiterate helpers. We used measurement guidelines from IDAI. The Group workshop started with a briefing about making sure that all tools were correctly set. Next, all helpers were asked to do height measurements, and if there was any error, we showed them how to do it correctly and let them do it again. We then compared the data before and after the intervention. Data from February 2019 were used as data before the intervention.

Results: No helper in 10 Posyandu measured correctly. But after the group workshop, a helper from 8 Posyandu could measure correctly. Stunting prevalence in Bugul Lor decreased by about 4%.

Conclusion: Group workshop seems to be effective in reducing stunting prevalence in toddlers.

Background: Endometrial carcinoma is a malignancy with a fairly frequent prevalence in women. L1 cell adhesion molecule (L1CAM)/CD171 is a cell adhesion molecule belonging to the immunoglobulin superfamily. Overexpression of L1CAM is seen in several carcinomas, such as ovarian, endometrial, colorectal, gastric, and breast. This study aims to evaluate the differences in the expression of L1CAM in endometrial carcinoma with low and high degrees of differentiation at Sanglah  Hospital, Denpasar.

Methods: This research is an analytic observational study with a cross-sectional design. The samples of this study were all patients with endometrial carcinoma whose specimens were examined at the Anatomical Pathology Laboratory of Sanglah Hospital Denpasar from 2 January 2017 to 31 December 2021 according to the inclusion and exclusion criteria set by the researcher with a sample size of 34. The preparations were evaluated to assess the histopathological diagnosis and degree of tumor differentiation. Then L1CAM immunohistochemical staining was performed, where L1CAM was declared positive if 10% stained on the tumor cell membrane with strong and complete intensity. Data were analyzed by a chi-square test with a significance value determined at p<0.05.

Results: The description of the characteristics of the research sample based on 34 cases obtained an average age of 55.29±10.43 years. The youngest age is 37 years and the oldest age is 76 years. L1CAM expression was found more in high-differentiated endometrial carcinoma compared with low-grade differentiation. In the prevalence risk analysis, the positive L1CAM expression had a 29.3 times greater prevalence risk of a high degree of differentiation than the negative L1CAM expression (95% CI 3,086-278,834). There was a statistically significant difference that was 11.58 (p=0.001).

Conclusion: This study concludes that there is a difference between the expression of L1CAM in endometrial carcinoma with low and high degrees of differentiation at Sanglah Hospital, Denpasar.

Latar Belakang : Karsinoma endometrium merupakan keganasan yang prevalensinya cukup sering pada wanita. L1 cell adhesion molecule (L1CAM)/CD171 merupakan molekul adhesi sel yang menjadi bagian dari immunoglobulin superfamily. Penelitian ini bertujuan untuk mengevaluasi perbedaan ekspresi L1CAM pada karsinoma endometrium derajat diferensiasi rendah dan tinggi di RSUP Sanglah Denpasar.

Metode: Penelitian ini merupakan penelitian observasional analitik dengan rancangan studi potong lintang. Sampel penelitian adalah semua penderita karsinoma endometrium yang spesimennya diperiksa di Laboratorium Patologi Anatomi RSUP Sanglah Denpasar dari 2 Januari 2017 sampai 31 Desember 2021 sesuai dengan kriteria inklusi dan eksklusi yang ditetapkan peneliti dengan besar sampel 34. Evaluasi preparat dilakukan untuk menilai diagnosis histopatologi dan derajat diferensiasi tumor. Dilakukan pulasan imunohistokimia L1CAM, dimana L1CAM dinyatakan positif jika terpulas ≥10% pada membran sel tumor dengan intensitas kuat dan komplit. Data dianalisis dengan uji chi-Square dengan nilai kemaknaan ditentukan pada p<0,05.

Hasil: Gambaran karakteristik sampel penelitian berdasarkan 34 kasus didapatkan rerata umur 55,29±10,43 tahun. Umur termuda adalah 37 tahun dan umur tertua 76 tahun. Ekspresi L1CAM lebih banyak ditemukan pada karsinoma endometrium derajat diferensiasi tinggi dibandingkan dengan derajat diferensiasi rendah. Pada analisis risiko prevalensi mendapatkan hasil ekspresi L1CAM positif memiliki risiko prevalensi 29,3 kali lebih besar menjadi derajat diferensiasi tinggi daripada ekspresi L1CAM negatif (IK95% 3,086- 278,834). Didapatkan perbedaan yang bermakna secara statistik yaitu sebesar 11,58 (p=0,001).

Kesimpulan: Terdapat perbedaan antara ekspresi L1CAM pada karsinoma endometrium derajat diferensiasi rendah dan tinggi di RSUP Sanglah Denpasar.

Background: Diabetes mellitus is a prothrombotic state due to ongoing hyperglycemia, dyslipidemia and insulin resistance leading to endothelial injury. Mean Platelet Volume (MPV), HbA1c, and Platelet Distribution Width (PDW) increase with increasing thrombotic potential. Soluble Platelet Selectin (sP-selectin) in plasma indicates increased platelet and endothelial cell activation. This study aims to evaluate the correlation between HbA1c levels, platelet indices, and sP-selectin levels in patients with T2DM.

Methods: A cross sectional study of 42 DMT2 patients in Diponegoro National Hospital aged 30-70 years in the period June 2019 - February 2020. HbA1c was measured by the HPLC ion exchange method. Platelet indices were calculated using an automatic hematology analyzer. The sP-selectin level was examined using the ELISA method. Data were analyzed using SPSS version 20 for Windows.

Results: Average HbA1c levels, MPV values ​​and PDW values ​​were 8.26 ± 1.60%, 10.10±0.85 fL, 11.61±1.65 fL, respectively, while for sP-selectin levels they had median values 42.13 (32.6-162.65) ng/ml. There was a moderate positive correlation test between HbA1c levels with MPV (r=0.43; p<0.05) and PDW (r=0.48; p<0.05). However, there was no significant correlation between HbA1c levels and sP-selectin levels (r=-0.15; p = 0.29).

Conclusion: There is a moderate positive correlation between HbA1c levels and platelet indices but no significant correlation between HbA1c levels and sP-selectin levels.

Latar belakang: Diabetes melitus diindikasikan sebagai suatu keadaan protrombotik karena hiperglikemia berkelanjutan, dislipidemia dan resistensi insulin yang menyebabkan jejas endotelial. Mean Platelet Volume (MPV), HbA1c, dan Platelet Distribution Width (PDW) meningkat seiring dengan peningkatan potensi trombotik. Soluble Platelet Selectin (sP-selectin) pada plasma merupakan salah satu indikator adanya peningkatan aktivasi trombosit dan sel endotel. Penelitian ini bertujuan untuk membuktikan adanya hubungan antara kadar HbA1c dengan indeks trombosit dan kadar sP-selectin pada pasien DMT2.  

Metode: Penelitian potong lintang pada 42 pasien DMT2 di RS Nasional Diponegoro berusia 30-70 tahun periode Juni 2019 – Februari 2020. HbA1c diukur dengan  metode ion-exchange HPLC. Indeks trombosit dihitung menggunakan alat hematologi otomatis. Kadar sP-selectin diperiksa menggunakan metode ELISA. Analisa statistik menggunakan uji korelasi Pearson untuk data terdistribusi normal dan uji korelasi Spearman untuk data terdistribusi tidak normal. 

Hasil : Rerata kadar HbA1c, MPV, dan PDW berturut-turut adalah 8,26±1,60%, 10,10±0,85 fL, 11,61±1,65 fL, sedangkan untuk kadar sP-selectin memiliki nilai median 42,13 (32,6–162,65) ng/ml. Terdapat korelasi positif sedang bermakna antara kadar HbA1c dengan MPV (r=0,43; p<0,05) dan PDW (r=0,48; p<0,05). Namun, tidak ada korelasi yang bermakna antara kadar HbA1c dan kadar sP-selectin (r=-0,15; p = 0,29).

Kesimpulan: Terdapat hubungan positif sedang bermakna antara kadar HbA1c dengan indeks trombosit, namun tidak terdapat hubungan yang bermakna antara kadar HbA1c dengan kadar sP-selectin.

Background: Ovarian cancer is one of the most common malignant tumors found in reproductive organs in vitro. Secretory Leukocyte Protease Inhibitor (SLPI) protein is essential for the growth of ovarian cancer cells, a protein that maintains the survival of ovarian cancer cells, inhibits antiproliferative effects, and reverses the proapoptotic effect of elastase. This study aims to evaluate the role of SLPI in diagnosing ovarium cancer.

Methods: The research was conducted at the Obstetrics and Gynecology Polyclinic, Sanglah Hospital, Denpasar and the Prodia Laboratory. Sampling of this study has been carried out by previous researchers in research on the accuracy of serum levels of insulin-like growth factor binding protein 2 in diagnosing ovarian cancer. The research sample (intended sample) was women aged 18 years and over with ovarian tumors who came to the Obstetrics and Gynecology Polyclinic, Sanglah Hospital, Denpasar. Data were analyzed using SPSS versi 22 for Windows.

Results: The proportion of epithelial types was significantly higher in the ovarian cancer group. In ovarian cancer samples, the most samples were obtained at FIGO III Stage. Median CA125 levels, RMI scores, and SLPI levels were significantly higher in the group with ovarian cancer. The cut off value of serum SLPI used in this study was 54,000 pg/ml which was obtained from preliminary analysis on 26 training samples. Sensitivity: 78.3; specificity:66.7%; Positive predictive value: 78.3%; Negative predictive value: 66.7% Accuracy: 73.6%.

Conclusion: In a diagnostic test study to assess the accuracy of SLPI serum in supporting the diagnosis of ovarian cancer, it was found that SLPI serum had good sensitivity, specificity, PPV, NPV, and accuracy values.

Latar Belakang: Kanker ovarium merupakan salah satu tumor ganas yang paling sering ditemukan pada organ reproduksi secara in vitro. Protein Secretory Leukocyte Protease Inhibitor (SLPI) sangat esensial untuk pertumbuhan sel kanker ovarium, protein yang menjaga kelangsungan hidup sel kanker ovarium, inhibisi efek antiproliferatif, dan membalikkan efek proapoptosis dari elastase. Penelitian ini bertujuan untuk mengevaluasi peran SLPI dalam mendiagnosis kanker ovarium.

Metode: Penelitian dilakukan di Poliklinik Kebidanan dan Penyakit Kandungan RSUP Sanglah Denpasar dan Laboratorium Prodia. Pengambilan sampel penelitian ini sudah dilakukan oleh peneliti sebelumnya pada penelitian tentang akurasi kadar serum insulin-like growth factor binding protein 2 dalam mendiagnosis kanker ovarium. Sampel penelitian (intended sample) adalah wanita berusia 18 tahun ke atas dengan tumor ovarium yang datang ke Poliklinik Kebidanan dan Penyakit Kandungan RSUP Sanglah Denpasar.

Hasil: Proporsi tipe epitelial secara signifikan lebih banyak pada kelompok kanker ovarium. Pada sampel kanker ovarium, didapatkan sampel paling banyak pada Stadium FIGO III. Median kadar CA125, skor RMI, dan kadar SLPI secara signifikan lebih tinggi pada kelompok dengan kanker ovarium. Nilai cut off serum SLPI yang digunakan pada penelitian ini adalah 54.000 pg/ml yang didapatkan dari analisa pendahuluan pada 26 training sample Sensitivitas:78,3; spesifisitas:66,7%; Nilai prediksi positif: 78,3%; Nilai prediksi negatif: 66,7% Akurasi: 73,6%.

Kesimpulan: Pada penelitian uji diagnostik untuk menilai akurasi serum SLPI dalam menunjang diagnosis kanker ovarium didapatkan bahwa serum SLPI memiliki nilai sensitivitas, spesifisitas, PPV, NPV, dan akurasi yang baik.

Background: Acute myocardial infarction (AMI) is one of the leading causes of mortality, morbidity and physical disability worldwide. The chief treatment for AMI is primary percutaneous coronary intervention (PCI). However, the effectiveness of early rehabilitation therapy after PCI patients still lacks documentation. Therefore, a meta-analysis has assessed the patient's outcome of early rehabilitation therapy after PCI.

Methods: The searching protocol was carried out using several databases, such as PubMed, ScienceDirect, and Google Scholar, to identify relevant topics in June 2022. This study used the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 (PRISMA) guidelines.

Result: There were nine studies included in this systematic review and meta-analysis. All of the reviewed studies were written in English. Most of the included studies were carried out in China. Most of the included studies were carried out in China. The mean age of the patient were all above 18 years. The total participants were 858 patients with PCI. There was a significant difference in 6-minute walk distance (MD = 85.64; 95% CI = 78.68–92.60; p < 0.01); left ventricle ejection fraction (LVEF) (MD = 5.97; 95% CI = 5.30–6.63; p < 0.01) and body mass index (BMI) score score (MD = 1.43; 95% CI = 0.86–2.00; p < 0.01) between groups in overall analysis.

Conclusion: Early rehabilitation in patients with PCI has better outcomes (6-minutes walk distances, LVEF, and BMI score) than in the control group.

Introduction: The Coagulopathy of Severe Trauma (COAST) score is a scoring system that predicts the clinical condition of ATC. The COAST score has a high specificity of 96% and a sensitivity of 80% at a cut-off 3, which can accurately predict coagulopathy and has a significant outcome. This study tested the validity of the Coagulopathy of Severe Trauma (COAST) scoring in predicting Acute Traumatic Coagulopathy (ATC) at the Sanglah Central General Hospital (RSUP) Denpasar.

Method: Observational study with diagnostic test and cross-sectional design carried out from December 1, 2020 to February 28, 2021. Patients suspected of ATC are patients who present with a history of trauma with an increase of two out of three, namely, Prothrombin Time (PT) >18 seconds, Activated Partial Thromboplastin Time (aPTT) >36 seconds, and International Normalized Ratio (INR) >1.6. Samples were excluded if they refused to participate in the study, had severe head injury, concomitant severe systemic disease, had blood clotting disorders or were taking blood thinning drugs, burn patients, and pregnant patients. The COAST score was assessed based on the components of the trapped assessment, blood pressure, temperature, chest decompression, and abdominal/pelvic injury. COAST scores were analyzed using ROC curves and diagnostic tests, as well as logistic regression tests. The value of p <0.05 indicates a significant result.

Results: This study involved 60 patients with 10 ATC positive patients and the remaining 50 ATC negative. Significant differences (p<0.05) on the incidence of ATC were found in the variables of age, ISS score, trapped, chest decompression, abdominal/pelvic injury, systolic blood pressure, PT, aPTT, INR, and COAST score. ROC curve analysis showed a COAST score with a cut-off value of 2.5 (60% sensitivity; 88% specificity; p=0.01; 95% CI 0.555-0.965). The results of the diagnostic test cut-off score of 2.5 COAST scores with an OR of 11.00 (p=0.003; 95% CI 2.392-50.589). Multivariate analysis of COAST scores with the incidence of ATC showed a significant relationship (p=0.002).

Conclusion: The COAST score is a valid scoring system to predict ATC at Sanglah Hospital Denpasar with a good level of sensitivity and specificity, with a cut off of 2.5.

Pendahuluan: Skor Coagulopathy of Severe Trauma (COAST) merupakan sistem skor yang memprediksi kondisi klinis ATC. Skor COAST memiliki spesifisitas tinggi 96% dan sensitifitas 80% pada cut-off ≥3, yang dapat secara tepat memprediksi koagulopati dan memiliki hasil yang secara signifikan. Penelitian ini menguji validitas skoring Coagulopathy of Severe Trauma (COAST) dalam memprediksi Acute Traumatic Coagulopathy (ATC) di Rumah Sakit Umum Pusat (RSUP) Sanglah Denpasar.

Metode: Studi observasional dengan uji diagnostik dan desain cross-sectional yang dilaksanakan mulai 1 Desember 2020 sampai 28 Februari 2021. Pasien terduga ATC adalah pasien yang datang dengan riwayat trauma dengan peningkatan dua dari tiga yaitu, Prothrombin Time (PT) >18 detik, Activated Partial Thromboplastin Time (aPTT) >36 detik, dan International Normalized Ratio (INR) >1,6. Sampel dieksklusi apabila menolak keikutsertaan dalam penelitian, mengalami cedera kepala berat, penyakit sistemik berat bersamaan, menderita gangguan pembekuan darah atau mengonsumsi obat pengencer darah, pasien luka bakar, dan pasien hamil. Skor COAST dinilai berdasarkan komponen penilaian terjebak, tekanan darah, suhu, dekompresi dada, dan abdomen/pelvis injuri. Skor COAST dianalisis dengan kurva ROC dan uji diagnostik, serta uji regresi logistik. Nilai p<0,05 menunjukan hasil bermakna.

Hasil: Penelitian ini melibatkan 60 pasien dengan 10 pasien ATC positif dan 50 sisanya ATC negatif. Perbedaan signifikan (p<0,05) terhadap kejadian ATC didapatkan pada variabel usia, skor ISS, terjebak, dekompresi dada, abdomen/pelvis injuri, tekanan darah sistolik, PT, aPTT, INR, dan skor COAST. Analisis kurva ROC menunjukan skor COAST dengan nilai cut-off 2,5 (sensitivitas 60%; spesifisitas 88%; p=0,01; CI95% 0,555-0,965). Hasil uji diagnostik nilai cut-off 2,5 skor COAST dengan OR 11,00 (p=0,003; CI95% 2,392-50,589). Analisis multivariat skor COAST dengan kejadian ATC menunjukan hubungan signifikan (p=0.002).

Kesimpulan: Skor COAST merupakan sistem skoring yang valid untuk memprediksi ATC di RSUP Sanglah Denpasar dengan tingkat sensitivitas dan spesifisitas yang baik, dengan cut off ≥2,5.

Background: The prevalence of Acute Kidney Injury (AKI) varies, ranging from 3% to 20% of hospitalized patients and 25% to 67% of ICU patients, with 5% to 6% of the ICU population requiring renal replacement therapy following AKI. Establishing the diagnosis of AKI with KDIGO criteria using serum creatinine marker. Serum creatinine has a sensitivity of 52.9% and a specificity of 85.7% for AKI. The Sensitivity and specisifity of serum creatinine is not good because it can increase without any real injury or do not change even though acute tubular injury has occurred due to compensation for increased function by the remaining nephrons. L-FABP (Liver type Fatty Acid Binding Protein) and BTP (Beta Trace Protein) serum are newly discovered biomarkers potential for the early diagnosis of acute kidney damage. This study was conducted to determine the change in L-FABP and BTP concentration levels as markers of AKI.

Method: This study is a longitudinal observational study with patients suffering from AKI with serum samples taken before and after an increase in serum creatinine level of ≥0.3 mg/dL in 48 hours. Serum levels of L-FABP and BTP were examined by ELISA method, and serum creatinine by enzymatic colorimetric. Differences between levels before and during AKI were analyzed by the Wilcoxon test.

Results: The number of research subjects was 40 people. There was significant difference between serum creatinine before and during AKI (1.97 (1.36-2.77) mg/dL vs. 3.52 (2.53-4.91). mg/dL, p<0.001). Indeed there were also significant differences in serum L-FABP before and during AKI (3775.48 (1614.11-5086.68) ng/mL vs. 5427.28 (4562.79-5765.14) ng/mL, p<0.001), and serum BTP levels before and during AKI (456.36 (290.35-591.67) mg/L vs. 518.38 (436.37-691.90) mg/L, p<0.001).

Conclusion: Serum levels of L-FABP and BTP increased significantly in the condition of the AKI so that it has the potential to be a marker for the diagnosis of AKI.

Latar belakang: Prevalensi cedera ginjal akut (Acute Kidney Injury/AKI) bervariasi, sekitar 3% hingga 20% dari pasien rawat inap dan 25% hingga 67% dari pasien ICU, dengan 5% hingga 6% dari populasi ICU membutuhkan terapi penggantian ginjal setelah terjadi AKI. Penegakan diagnosis AKI dengan kriteria KDIGO menggunakan marker serum kreatinin. Serum kreatinin mempunyai sensitivitas 52,9% dan spesifisitas 85,7% untuk AKI. Sensitivitas dan spesifisitas serum kreatinin tersebut kurang baik karena kadar serum kreatinin dapat meningkat tanpa ada cedera nyata maupun tidak berubah meskipun telah terjadi cedera tubulus akut karena adanya kompensasi peningkatan fungsi oleh nefron yang tersisa. Serum L-FABP (Liver type Fatty Acid Binding Protein) dan BTP (Beta Trace Protein) adalah biomarker yang ditemukan untuk diagnosis dini AKI. Penelitian ini dilakukan untuk mengetahui perubahan kadar serum L-FABP dan BTP sebagai penanda terjadinya AKI.

Metode: Penelitian ini adalah penelitian observasional longitudinal dengan subyek pasien yang menderita AKI dengan sampel serum yang diambil sebelum dan sesudah terjadi peningkatan kadar serum kreatinin ≥0,3 mg/dL dalam 48 jam. Kadar serum L-FABP dan BTP diperiksa dengan metode ELISA, dan serum kreatinin dengan metode enzimatik kolorimetrik. Perbedaan antara kadar sebelum dan saat AKI dianalisis dengan uji Wilcoxon.

Hasil: Jumlah subyek penelitian adalah 40 orang. Terdapat perbedaan bermakna antara kreatinin serum sebelum dan selama AKI (1,97 (1,36-2,77) mg/dL vs 3,52 (2,53-4,91), mg/dL, p<0,001. Teradapat juga perbedaan yang signifikan dalam serum L-FABP sebelum dan selama AKI (3775,48 (1614,11-5086,68) ng/mL vs 5427,28 (4562,79-5765,14) ng/mL, p<0,001), dan kadar BTP serum sebelum dan selama AKI (456,36 (290,35-591,67) mg/L vs. 518,38 (436,37-691,90) mg/L, p<0,001).

Simpulan: Kadar serum L-FABP dan BTP meningkat signifikan pada kondisi AKI sehingga berpotensi menjadi marker untuk diagnosis AKI.

Background: Preterm Premature Rupture of Membranes (PPROM) is one of the obstetric problems that needs special attention, apart from the high prevalence, cases of PPROM also often cause neonatal morbidity and mortality. Inflammation is thought to be the cause of the incidence of PPROM and has a relationship with the incidence of ascending genital tract infection. The physiological immune response to inflammation is characterized by an increase in the number of circulating platelets and a decrease in the number of lymphocytes. This study aims to evaluate the high ratio of platelets to lymphocytes of maternal blood serum is a risk factor for the occurrence of preterm PROM.

Methods: This study is a cross-sectional study with a sample size of 70 samples, and is divided into a risk group (preterm pregnancy with PROM) and a no-risk group (preterm pregnancy without PROM). This research was conducted in the Emergency Room maternity ward and Obstetrics and Gynecology outward patient at Sanglah Hospital Denpasar for the period December 2020 to May 2021. Data were analyzed using SPSS version 26 for Windows.

Results: The results of the analysis of this study obtained a statistically significant difference (p = 0.000). The group with a high maternal blood serum platelet to lymphocyte ratio had a higher risk of developing preterm PROM compared to the group with a low maternal blood serum platelet to lymphocyte ratio (PR = 2.4, 95% CI = 1.60-3.69, p = 0.000).

Conclusion: The conclusion of this study is the high maternal blood serum platelet to lymphocyte ratio is a risk factor for the occurrence of preterm PROM.

Latar Belakang: Ketuban pecah dini (KPD) preterm merupakan salah satu masalah obstetri yang perlu mendapat perhatian khusus, selain karena prevalensi yang besar, kasus KPD preterm juga sering menyebabkan morbiditas dan mortalitas neonatus. Inflamasi diduga sebagai penyebab dari kejadian KPD preterm dan mempunyai hubungan dengan kejadian infeksi ascending traktus genital. Respon imun fisiologis terhadap inflamasi ditandai oleh peningkatan jumlah platelet yang beredar dan penurunan jumlah limfosit. Penelitian ini bertujuan untuk mengetahui bahwa tingginya rasio platelet terhadap limfosit serum darah ibu merupakan faktor risiko terjadinya KPD preterm.

Metode: Penelitian ini merupakan penelitian cross-sectional dengan jumlah sampel sebanyak 70 sampel, dan terbagi menjadi kelompok berisiko (kehamilan preterm dengan KPD) dan kelompok tanpa risiko (kehamilan preterm tanpa KPD). Penelitian ini dilakukan di kamar bersalin IGD serta Poli Obstetri dan Ginekologi RSUP Sanglah Denpasar periode Desember 2020 hingga Mei 2021. Data dianalisis dengan SPSS versi 26 untuk Windows.

Hasil: Hasil analisis dari penelitian ini didapatkan perbedaan yang bermakna secara statistik (p = 0,000). Kelompok dengan nilai rasio platelet terhadap limfosit serum darah ibu yang tinggi memiliki risiko mengalami kejadian KPD preterm dibandingkan dengan kelompok dengan rasio platelet terhadap limfosit serum darah ibu yang rendah (PR = 2,4, IK 95% = 1,60-3,69, p = 0,000).

Kesimpulan: Simpulan dari penelitian ini adalah rasio platelet terhadap limfosit serum darah ibu yang tinggi merupakan faktor risiko terjadinya kejadian KPD preterm.

Background: Bacterial vaginosis during pregnancy is strongly associated with preterm birth, early miscarriage, postpartum endometritis, and low birth weight. This study aims to evaluate vaginal swabs in pregnant women with preterm labor at Sanglah Hospital – Denpasar. This study was conducted at the Comprehensive Emergency Neonatal Obstetrics Service (PONEK) and Clinical Microbiology laboratory at Sanglah Hospital, Denpasar, for 8 weeks from 1 August 2020 to 26 September 2020.

Methods: Vaginal swabs were performed by obstetricians on 18 patients with preterm pregnancy criteria (gestational age less than 37 weeks) who experienced premature labor or premature rupture of membranes and vaginal swab examination was carried out at the Clinical Microbiology laboratory of Sanglah Hospital-Denpasar. Data were analyzed using SPSS version 24 for Windows.

Results: Gram staining was performed on vaginal swabs and assessed using Nugent's score. From the results of the swab with Nugent's score, 7 samples (38.8%), Intermediate 2 samples (11.1%) and normal 9 samples (50%) were obtained.

Conclusion: The number of bacterial vaginosis is high, resulting in normal vaginal flora being replaced by anaerobic bacteria.

Latar Belakang: Vaginosis bakterial selama kehamilan sangat berkaitan erat dengan terjadinya kelahiran prematur, keguguran dini, endometritis postpartum, dan berat badan lahir rendah. Penelitian ini bertujuan untuk mengevaluasi swab vagina pada ibu hamil dengan persalinan prematur di RSUP Sanglah – Denpasar. Penelitian ini dilakukan di bagian Pelayanan Obstetri Neonatal Emergensi Komprehensif  (PONEK) dan laboratorium Mikrobiologi Klinik RSUP Sanglah, Denpasar, selama 8 minggu dari 1 Agustus 2020 sampai 26 September 2020.

Metode: Swab vagina dilakukan oleh dokter kandungan pada 18 pasien dengan kriteria kehamilan preterm (kehamilan kurang dari 37 minggu) yang mengalami persalinan prematur atau ketuban pecah dini dan pemerikasaan swab vagina dilakukan di laboratorium Mikrobiologi Klinik RSUP Sanglah-Denpasar. Data dianalisis dengan SPSS versi 24 untuk Windows.

Hasil: Pada swab vagina di lakukan pewarnaan gram dan dinilai dengan menggunakan Nugent’s scoreDari hasil swab dengan Nugent’s scoredi dapatkan Bakterial vaginosis sebanyak 7 sampel (38,8%), Intermediate 2 sampel (11,1%) dan normal sebanyak 9 sampel (50%).

Kesimpulan: Angka bakterial vaginosis yang tinggi, sehingga mengakibatkan flora normal vagina digantikan dengan bakteri anaerob.

Introduction: Melasma is an acquired pigmentation disorder characterized by symmetrical hyperpigmented patches, most commonly seen on the face. Melasma and iron deficiency are most common in women of reproductive age. Iron deficiency causes a decrease in ferritin levels, which are iron stores in the body. The mechanism of iron deficiency causing melasma is thought to be due to cell hypoxia in the tissue involving mediators that increase melanogenesis. This study aims to prove that the mean ferritin level is lower in melasma than without melasma and that low ferritin levels are a risk factor for melasma in women.

Methods: A case-control research included 28 participants with melasma and 28 without melasma who visited the dermatovenereology department of Prof. Dr. I.G.N.G Ngoerah Hospital, medical cosmetic division, in May-July 2022. The two groups will compare ferritin mean and ferritin risk factor analysis on the incidence of melasma. Data were tabulated and analyzed using SPSS 26.

Results: The mean age in the melasma group was 40.64±3.39 years old, and the group without melasma was 37.64±3.50 years old (p=0.75). Of the 28 melasma subjects, there were more subjects with low ferritin levels (60.7%) than the group without melasma (32.1%). From the results of the Mann-Whitney test, the mean ferritin level in the melasma group (36.32±31.05) was significantly lower than in the non-melasma group (58.26±5.39); p=0.006. From the results of the Chi-Square test, it was found that low ferritin levels had a risk of 3.2 times the occurrence of melasma [OR (95% CI) = 3.2 (1.098-9.776), p=0.032].

Conclusion: The mean ferritin level in women with melasma is lower than in women without melasma, and low ferritin levels are a risk factor for melasma.

Latar Belakang: Melasma merupakan kelainan pigmentasi didapat yang ditandai dengan adanya bercak hiperpigmentasi simetris, paling sering terlihat pada wajah. Melasma dan defisiensi besi paling sering dijumpai pada wanita usia reproduktif. Defisiensi besi menyebabkan turunnya kadar feritin yang merupakan cadangan besi dalam tubuh. Mekanisme defisiensi zat besi menyebabkan melasma diduga akibat hipoksia sel di dalam jaringan melibatkan mediator yang meningkatkan melanogenesis. Studi ini bertujuan untuk membuktikan rerata kadar feritin lebih rendah pada melasma dibandingkan tanpa melasma serta membuktikan kadar feritin yang rendah merupakan faktor risiko melasma pada wanita.

Metode: Studi case-control yang melibatkan 28 subjek dengan melasma dan 28 subjek tanpa melasma yang berobat ke poliklinik kulit dan kelamin RSUP Prof. Dr. I.G.N.G Ngoerah divisi kosmetik medik periode Mei-Juli 2022. Kedua kelompok akan dibandingkan rerata feritin dan analisis faktor risiko feritin terhadap kejadian melasma. Data ditabulasi dan dianalisis dengan menggunakan SPSS 26.

Hasil: Rerata usia pada kelompok melasma 40.64±3,39 tahun dan kelompok tanpa melasma 37,64±3,50 tahun (p=0,75). Dari 28 subjek melasma, didapatkan lebih banyak subjek dengan kadar feritin rendah (60,7%) dibandingkan kelompok tanpa melasma (32,1%). Dari hasil uji Mann-Whitney didapatkan rerata kadar feritin pada kelompok melasma (36,32±31,05) lebih rendah secara signifikan dibandingkan pada kelompok bukan melasma (58,26±5,39); p=0,006. Dari hasil uji Chi-Square didapatkan kadar feritin yang rendah memiliki risiko sebesar 3,2 kali terjadinya melasma [OR (IK 95%) =3,2 (1,098-9,776), p=0,032].

Simpulan: rerata kadar feritin pada wanita dengan melasma lebih rendah dibandingkan wanita tanpa melasma dan kadar feritin yang rendah merupakan faktor risiko melasma.

Background: Pathogenic bacteria on eggshells or egg contents will be very dangerous for the health of humans who consume them. Chemicals should not be an option for preservatives because they will cause side effects. In this study, we explored the possibility of using bay leaf extract (Syzygium polyanthum (Wight) Walp) to control the growth of polluting bacteria in salted duck eggs so that the shelf life can be extended. The purpose of the study was to determine the potential of the active compounds contained in bay leaves in reducing the total plate count/microbial contamination in salted duck eggs.

Methods: Extraction of bay leaf powder was carried out by the infusion method. The activity test of bay leaf decoction (ARDS) was carried out using the in vitro diffusion well method on Mueller Hinton media. Identification of active compounds was carried out using the GCMS technique.

Results: ARDS crude extract at a concentration of 5% (v/v) could significantly reduce ALT and inhibit the in vitro growth of Proteus mirabilis bacteria at a concentration of 10% (w/v), with an inhibition zone diameter of 19.53 mm, with the minimum value inhibitory concentration (MIC) 0.7%. The results of the GCMS analysis of ARDS showed that the ten peaks produced, possibly synergized, and had antimicrobial activity. These compounds are 2-Pentanone4-Hydroxy-4 Methyl (CAS) Diacetone Alcohol; Ethanol, 2-(Ethoxythoxy) (CAS); 1,2,3 Propanetrriol Cas) Glycerol; Citronella (2,6-Octadien-1-Ol, 3,7-Dimethyl, (CAS); Beta Citronellol 6-Octen-1-Ol, 3,7 Dimethyl-(CAS); Trans Geraniol; Dodecanoic Acid, Methyl Ester (CAS) Methyl Laurate; Tetradecanoic Acid, Methyl Ester (CAS) Methyl Myristate; 1-Tetradecanol (Cas) Alfol 14 and Hexadecanoic Acid Methyl Ester CAS) Methyl Palmitate

Conclusion: Leaf decoction can inhibit the growth of Proteus mirabilis in vitro, and the addition of ARDS with a concentration of 5% (v/v) can significantly reduce the value of bacterial contamination in salted duck eggs.

Latar Belakang: Bakteri pathogen pada kulit telur atau isi telur akan sangat membahayakan kesehatan manusia yang mengkonsumsinya. Bahan kimia seharusnya tidak menjadi pilihan untuk pengawet, karena akan menimbulkan efek samping, Pada penelitian ini dieksplorasi, kemungkinan dipakainya ekstrak daun salam (Syzygium polyanthum (Wight) Walp) untuk mengontrol pertumbuhan bakteri pencemar pada telur itik yang diasinkan, sehingga masa simpannya dapat diperpanjang. Tujuan penelitian untuk mengetahui potensi senyawa aktif yang terdapat pada daun salam dalam menurunkan angka lempeng total/cemaran mikroba pada telur itik yang diasinkan.

Metode: Ekstraksi serbuk daun salam dilakukan dengan metode infusa. Uji aktifitas air rebusan daun salam (ARDS) dilakukan dengan metode sumur difusi secara in vitro pada media Mueller Hinton. Identifikasi senyawa aktif dilakukan dengan teknik GCMS.

Hasil: Ekstrak kasar ARDS pada konsentrasi 5% (v/v) secara nyata dapat menurunkan ALT dan menghambat pertumbuhan in vitro bakteri Proteus mirabilis pada konsentrasi 10% (b/v), dengan diameter zona hambat sebesar 19,53 mm, nilai minimum inhibitory concentration (MIC) 0,7%. Hasil analisis GCMS terhadap ARDS menunjukan bahwa sepuluh puncak yang dihasilkan, kemungkinan bersinergi dan mempunyai aktifitas sebagai antimikroba. Senyawa-senyawa tersebut adalah 2-Pentanone4-Hydroxi-4 Methyl (CAS) Diacetone Alkohol; Ethanol, 2-(Ethoxythoxy) (CAS); 1,2,3 Propanetrriol Cas) Glycerol; Citronella (2,6-Octadien-1-Ol, 3,7-Dimethyl, (CAS); Beta Citronellol 6-Octen-1-Ol, 3,7 Dimethyl-(CAS); Trans Geraniol; Dodecanoic Acid, Methyl Ester(CAS) Methyl Laurate; Tetradecanoic Acid,Methyl Ester (CAS) Methyl Myristate; 1-Tetradecanol (Cas) Alfol 14 dan Hexadecanoic Acid Methyl Ester CAS) Methyl Palmitate.

Simpulan: Air rebusan daun dapat menghambat pertumbuhan Proteus mirablis secara in vitro dan penambahan ARDS dengan konsentrasi 5% (v/v) secara signifikan dapat menurunkan nilai cemaran bakteri (angka lempeng total) pada telur itik yang diasinkan.

Background: Diabetes Mellitus Type-2 (DM2) is a disease that can cause various complications, one of the common complications is diabetic foot, especially in osteomyelitis patients. Several parameters are known to contribute to the occurrence of diabetic foot such as ESR and C-Reactive Protein (CRP). This study aims to evaluate the relationship between ESR and CRP levels as a predictor value in the diagnosis of osteomyelitis with foot infection in DM2 patients.

Methods: This study is a diagnostic study with cross-sectional data collection techniques on 67 patient medical records from the Department of Surgery, Dr. RSUP. Wahidin Sudirohusodho consecutively during the period from June to October 2020. The variables assessed in this study included age, gender, Body Mass Index (BMI), comorbidities, duration of diabetes, HbA1c, ESR, C-Reactive Protein (CRP), and osteomyelitis. Data were analyzed with SPSS version 20 for Windows.

Results: There was a significant difference in ESR levels (96.00 (79.00-115.00) vs. 67.50 (22.00-88.00 mm/hour; p=0.000), procalcitonin (16.04 (0.05) -42.03 vs. 30.17 (0.21-56.08) ng/mL; p=0.003), and female gender (72.00% vs. 28.00%; p=0.022) in both the osteomyelitis group and non-osteomyelitis. From the ROC curve analysis, the parameters with significant results were ESR (Cut-Off: 83.75 mm/hour; p=0.000) and procalcitonin (Cut-Off: 19.72 ng/mL; p=0.003) in the diagnosis of osteomyelitis in DM2 patients.

Conclusion: There is a significant difference in terms of ESR values ​​and procalcitonin levels between the group of T2DM patients with osteomyelitis and without osteomyelitis. Of the three inflammatory marker parameters, namely CRP, ESR and procalcitonin, the ESR value is known to have the highest accuracy as a predictor of osteomyelitis.

Latar Belakang: Diabetes Mellitus Tipe-2 (DM2) merupakan penyakit yang dapat menimbulkan berbagai macam komplikasi, salah satu komplikasi yang umum terjadi adalah kaki diabetes khususnya pada pasien osteomielitis. Beberapa parameter diketahui berkontribusi terhadap terjadinya kaki diabetes seperti Laju Endap Darah (LED) maupun C-Reactive Protein (CRP). Penelitian ini bertujuan untuk mengevaluasi hubungan kadar LED dan CRP sebagai nilai prediktor dalam diagnosis osteomielitis dengan infeksi kaki pasien DM2

Metode: Penelitian ini merupakan penelitian diagnostik dengan teknik pengambilan data potong lintang terhadap 67 rekam medis pasien dari Departemen Ilmu Bedah RSUP Dr. Wahidin Sudirohusodho secara konsekutif selama periode Juni hingga Oktober 2020. Variabel yang dinilai pada penelitian ini meliputi usia, jenis kelamin, Indeks Massa Tubuh (IMT), komorbiditas, durasi menderita diabetes, HbA1c, Laju Endap Darah (LED), C-Reaktif Protein (CRP), dan osteomielitis. Data dianalisis dengan SPSS versi 20 untuk Windows.

Hasil: Terdapat perbedaan bermakna kadar LED (96,00 (79,00-115,00) vs 67,50 (22,00-88,00 mm/jam; p=0,000), prokalsitonin (16,04 (0,05-42,03 vs 30,17 (0,21-56,08) ng/mL; p=0,003), dan jenis kelamin perempuan (72,00% vs 28,00%; p=0,022) baik pada kelompok osteomielitis dan non-osteomielitis. Dari hasil analisis kurva ROC didapatkan parameter dengan hasil bermakna adalah LED (Cut-Off: 83,75 mm/jam; p=0,000) dan prokalsitonin (Cut-Off: 19,72 ng/mL; p=0,003) dalam penegakakan diagnosis osteomielitis pada pasien DM2.

Kesimpulan: Terdapat perbedaan yang bermakna dari segi nilai LED dan kadar prokalsitonin antara kelompok pasien DMT2 dengan osteomielitis dan tanpa osteomielitis. Dari ketiga parameter penanda inflamasi yakni CRP, LED dan prokalsitonin, nilai LED diketahui memiliki akurasi paling tinggi sebagai prediktor terjaidnya osteomielitis

Introduction: Low birth weight babies are still a significant global health issue. One of the primary causes of death and mortality in the neonatal era, it is a global issue. Seizures are a common neurological emergency that doctors see on a daily basis. Seizures affect as many as 21% of children in their first year of life and 64% in their first five years. The goal of this study is to see if there is a link between low birth weight and the occurrence of febrile seizures.

Method: This is a cross-sectional observational analytical study that uses medical records of inpatients at Wangaya Hospital from January to December 2020-2021. There were 30 people who had febrile seizures and another 30 who had other seizures. Consecutive sampling is a strategy for collecting data. The doctor's diagnosis in the medical record is used to make the diagnosis of febrile seizures. The baby's birth weight and the mother's gestational age must be recorded in the medical record. Seizures with a fever below 38.50°C, as well as low birth weight children born prematurely, were excluded from the study. The prevalence ratio was calculated using univariate and bivariate analysis with a 95% confidence interval. The IBM SPSS Statistics Version 23 tool was used to process the data.

Results: Boys and children aged 1-3 years were the most commonly diagnosed with febrile seizures and other seizures among the 59 samples in this study. Two of the respondents had low birth weight and were having febrile convulsions. The chi-square hypothesis testing revealed a p-value of 0.972 and a prevalence ratio of 1.037. (95 percent CI: 0.136-7.896).

Conclusion: There was no statistically significant link between low birth weight newborns and the occurrence of febrile seizures.

Latar Belakang : Bayi berat lahir rendah sampai saat ini masih merupakan masalah kesehatan yang penting di dunia. Hal ini dikarenakan masih menjadi salah satu penyebab utama kesakitan dan kematian pada masa neonatal. Kejang adalah kedaruratan neurologis yang sering dijumpai pada praktik sehari-hari. Sebanyak 21% kejang pada anak terjadi pada satu tahun pertama kehidupan, sedangkan 64% dalam lima tahun pertama. Penelitian ini bertujuan untuk mengetahui adakah hubungan antara berat bayi lahir rendah dengan kejadian kejang demam.

Metode: Penelitian analitik observasional dengan disain potong lintang yang menggunakan rekam medis pasien rawat inap di RSUD Wangaya periode Januari – Desember 2020-2021. Terdapat 30 responden dengan kejang demam dan 30 dengan kejang lainnya. Pengambilan sampel menggunakan teknik consecutive sampling. Diagnosis kejang demam berdasarkan diagnosis dokter pada rekam medis. Rekam medis haruslah mencantumkan data berat bayi lahir dan usia kehamilan ibu. Keadaan seperti kejang dengan demam dibawah 38,5⁰ C dan berat bayi lahir rendah dengan usia kehamilan kurang bulan dieksklusi dari kelompok. Dilakukan analisis univariat dan bivariat serta perhitungan rasio prevalens dengan interval kepercayaan 95%. Pengolahan data menggunakan program IBM SPSS Statistics Version 23.

Hasil: Dari 59 sampel, anak laki-laki dan kelompok usia 1-3 tahun merupakan yang terbanyak di diagnosis kejang demam maupun di kejang lainnya. Terdapat 2 responden yang mempunyai berat lahir rendah dan kejang demam. Hasil uji hipotesis dengan chi-square menunjukkan nilai p = 0,972 dan nilai rasio prevalensi 1,037 (95% IK: 0,136-7,896).

Simpulan: Berat bayi lahir rendah tidak memiliki hubungan yang secara statistik bermakna dengan kejadian kejang demam.

Background: Hernia is a protrusion or protrusion of the contents of a cavity through a defect or weak part of the abdominal cavity wall. The standard procedure in the form of herniotomy for indirect inguinal hernias in children can be performed open surgically or laparoscopically. Because there is still a lot of debate about the inflammatory response and outcomes that arise in patients undergoing laparoscopy and open herniotomy, this study was conducted with the aim of evaluating differences in CRP levels in pediatric patients after open herniotomy and laparoscopic herniotomy and their impact on surgical outcomes in the form of wound healing time, length of hospitalization and postoperative pain.

Methods: This study is a prospective cohort study using primary data carried out at Sanglah Central General Hospital (RSUP) Sanglah from January to December 2020. Data in the form of gender, the side of the hernia, age, CRP levels, duration of hospitalization, duration of wound healing , postoperative pain scale, duration of surgery, hemoglobin, and BMI were taken from the patient's medical record. After the data was collected, univariate and bivariate analysis was carried out using SPSS 20.

Result: A total of 38 patients who were the subjects of this study in the open surgical and laparoscopic groups were 19 subjects each. The mean CRP level in the open surgical group was higher (4.58 ± 1.82 mg/L) than the laparoscopic group (3.53 ± 1.53 mg/L). The duration of hospitalization and wound healing in the open surgical group was found to be longer (1.11 ± 0.32 days; 6.58 ± 0.51 days) when compared to the laparoscopic group (1.05 ± 0.23 days; 4.42 ± 0.51 days). The mean postoperative pain scale measurement results were higher in the open surgical group (2.84 ± 0.77) compared to the laparoscopic group (1.53 ± 0.51). The results showed that there was a statistically significant correlation (p<0.05; p<0.05) with a weak correlation coefficient (r = 0.468; r = 0.457).

Conclusion: The laparoscopic technique was found to be superior in terms of the resulting inflammatory response, duration of wound healing, postoperative pain scale, and duration of hospitalization when compared to the open surgery technique. While the duration of hospitalization between the two groups was the same.

Latar belakang: Hernia merupakan protrusi atau penonjolan isi suatu rongga melalui defek atau bagian lemah dari dinding rongga abdomen. Prosedur standar berupa herniotomi pada hernia inguinal indirek anak dapat dilakukan secara open surgical ataupun laparoskopi. Oleh karena masih banyaknya perdebatan mengenai respon inflamasi dan luaran yang timbul pada pasien yang menjalani laparoskopi dan open herniotomy, penilitian ini dilakukan dengan tujuan untuk mengevaluasi perbedaan kadar CRP pada pasien anak pasca open herniotomy dan laparoskopi herniotomi serta dampaknya terhadap luaran operasi berupa lama penyembuhan luka, lama rawat inap serta nyeri paska operasi.

Metode: Studi ini merupakan studi kohort prospektif dengan menggunakan data primer yang dilaksanakan di Rumah Sakit Umum Pusat Sanglah (RSUP) Sanglah sejak Januari hingga Desember 2020. Data berupa jenis kelamin, sisi yang mengalami hernia, usia, kadar CRP, durasi rawat inap, lama penyembuhan luka, skala nyeri pasca operasi, durasi operasi, hemoglobin, dan IMT diambil dari rekam medis pasien. Setelah data terkumpul, dilakukan analisis univariat dan bivariat dengan menggunakan SPSS 20.

Hasil: Sebanyak 38 pasien yang menjadi subjek penelitian ini dengan kelompok open surgical dan laparoskopi terdapat masing-masing 19 subjek. Rerata kadar CRP pada kelompok open surgical lebih tinggi (4.58 ± 1.82 mg/L) dibandingkan dengan kelompok laparoskopi (3.53 ± 1.53 mg/L). Durasi rawat inap dan penyembuhan luka pada kelompok open surgical didapatkan lebih lama (1.11 ± 0.32 hari; 6.58 ± 0.51 hari) jika dibandingkan dengan kelompok laparoskopi (1.05 ± 0.23 hari; 4.42 ± 0.51 hari). Rerata hasil pengukuran skala nyeri pasca operasi didapatkan lebih tinggi pada kelompok open surgical (2.84 ± 0.77) dibandingkan dengan kelompok laparoskopi (1.53 ± 0.51). Hasil menunjukkan antara kadar CRP dengan variabel durasi penyembuhan luka dan dengan durasi operasi didapatkan korelasi yang bermakna secara statistika (p<0.05; p<0.05) dengan koefisien korelasi yang lemah (r = 0.468; r = 0.457).

Simpulan: Teknik laparoskopi ditemukan lebih unggul dalam hal respon inflamasi yang dihasilkan, durasi penyembuhan luka, skala nyeri pasca operasi, dan durasi rawat inap jika dibandingkan dengan teknik open surgery. Sedangkan durasi rawat inap diantara kedua kelompok adalah sama.

Kata Kunci: C-reactive protein, open herniotomy, herniotomi laparoskopi, hernia inguinalis indirek, luaran operasi

Background: Self-directed learning (SDL) is a skill that must be possessed by medical students as a form of adult learning. To train these skills, students need tutors to stimulate students' SDL abilities.

Methodology: This study was conducted quantitatively using a Dolman and Ginns questionnaire on third-year medical students.

Results: Tutors in the Medical Emergency block were able to provide a good explanation of the issues in the case and stimulate students to look for other learning resources.

Conclusion: Tutors with academic backgrounds that match the discussion material can be considered as one of the factors that can stimulate students' SDL.

Latar Belakang: Self-directed learning (SDL) merupakan keterampilan yang harus dimiliki oleh mahasiswa kedokteran sebagai bentuk pembelajaran dewasa. Untuk melatih keterampilan ini mahasiswa memerlukan tutor dalam menstimulasi kemampuan SDL mahasiswa.

Metodologi: penelitian ini dilakukan secara kuantitatif dengan menggunakan kuisioner Dolman dan Ginns pada mahasiswa kedokteran tahun ke-tiga.

Hasil: tutor pada blok Medical Emergency mampu memberikan penjelasan yang baik mengenai issue yang ada pada kasus serta menstimulasi mahasiswa untuk mencari sumber pembelajaran yang lainnya.

Simpulan: tutor dengan latar belakang akademik yang sesuai dengan materi diskusi dapat dipertimbangan sebagai salah satu factor yang dapat menstimulasi SDL mahasiswa.

Background: HIV-AIDS and sexually transmitted infections are still a public health burden in Indonesia. Women living with HIV have a higher risk of transmitting HIV, Syphilis, and Hepatitis B to their babies. While the effort to increase the services coverage for the prevention of mother-to-child transmission (PMTCT) was detained due to the COVID-19 pandemic and the lack of published studies that explore this, this study aimed to assess the determinant of service utilization for triple elimination of mother-to-child transmission of HIV, Syphilis, and Hepatitis B among women living with HIV during COVID-19 pandemic in Indonesia.

Methods: This cross-sectional study targeted women living with HIV in Indonesia who are planning to get pregnant. A simplified-snowball sampling technique was used in this study. A dependent variable in this study was the service utilization of PMTCT for HIV, Syphilis, and Hepatitis B. In contrast, the independent variables in this study consisted of demographic characteristics, perception according to Health Belief Model constructs, and stigma and discrimination experiences. Multiple logistic regression was used to find the determinants of service utilization.

Results: Among 336 women living with HIV that were interviewed, only 28.27% (95% CI = 23.69 – 33.34) accessed the PMTCT services during the COVID-19 pandemic. Moreover, the likelihood of PMTCT service utilization was decreased among the women living with HIV who perceived higher barriers (aOR = 0.56; 95% CI = 0.31 – 0.99) and experienced stigma and discrimination from partner (aOR = 0.50; 95% CI = 0.25 – 0.99). On the other hand, the PMTCT service utilization was increased among those who perceived less severity (aOR = 2.07; 95% CI = 1.21 – 3.54). No other factors were associated with the PMTCT service utilization among women living with HIV during the COVID-19 pandemic.

Conclusion: The PMTCT service utilization was relatively low, increased by the higher perceived severity, and reduced among those who perceived higher barriers and experienced stigma and discrimination from the partner. Therefore, improving the knowledge about HIV, Syphilis, and Hepatitis B related to PMTCT services is essential, as well as providing social support to reduce the stigmas and discrimination among women living with HIV.