Introduction: Fracture femur distal third is a common orthopedic problem in patients of all ages. Malunion is common due to neglected conditions; an osteotomy plus ORIF PS procedure is required in the management. Surgery is currently the treatment of choice for distal femoral malunion fractures. Malunion requires deep fixation of compression using lag screws, cortical screws or cancellous screws depending on the type of fracture. Patients with distal femoral malunion are also treated with grafting using bone graft, allograft, autograft, synthetic graft and blade plate with screws in combination with a safe quadriceps approach.

Case description: A 16-year-old female patient complained of unbalanced walking and cramps in the right leg for the last 3 months. The patient had a history of traffic accidents and then suffered  femur fracture 9 months ago, debridement and a plaster cast. The physical examination found that the right leg was shorter than the left, and the  AVN and active ROM distal right leg were still good. Then X-Ray examination obtained the results of his Malunion fracture of the middle 1/3 right femur and then decided to do an osteotomy + ORIF PS. The patient returned home in good condition and then controlled through the outpatient polyclinic.

Conclusion: In most malunion patients, osteotomy and PS ORIF are surgical methods. Corrective osteotomy with ORIF PS should be regarded as a salvage procedure for treating distal third malunion.

Introduction: The most typical primary bone tumour of the hand is an enchondroma. A pathologic fracture is a common presentation of this benign cartilaginous tumour. It is common for asymptomatic solitary enchondromas to be discovered during regular x-rays. However, in nearly half of the cases, acute pain, swelling, and deformity indicate a pathologic fracture. For symptomatic lesions, surgical therapy with curettage and bone graft is the norm.

Case Presentation: A 15-year-old girl with chief complain of pain on her right little finger and history of trauma after playing basketball 5 days before admission. At inspection, the fifth finger was painful during movement, with a discrete residual hematoma around the proximal phalanx. The x-rays showed a minimally displaced fracture at the shaft of the proximal phalanx of the 5^th finger of the right hand, and lytic lesion occupying the whole middle third of the phalanx. We assessed the patient with pathological fracture suggestive of an enchondroma. A 1-stage surgical treatment was decided: a curettage followed by open reduction internal fixation using miniplate titanium matrix, and bone graft to fill the defect. Postoperative x-rays showed complete healing of the fracture at 4 weeks.

Conclusion: Enchondromas pose the risk of pathological fracture, recurrence and, to a lesser extent, malign transformation. We describe an option of surgical management which is simple and results in good and excellent short-term results. Successful treatment of these lesions is dependent on the complete removal of the tumour bed followed by stabilization.

Background: Multiple myeloma (MM) is a haematological malignancy characterized by destructive bone lesions, renal injury, anemia and hypercalcemia. Multiple myeloma is a neoplasm that often occurs in adults to the elderly. Complications of pathological fractures occur as a result of lytic lesions of the bone. Complications of MM can appear as a clinical manifestation of the patient so that further examination is needed in patients with pathological fractures to establish MM.

Case: A 67-year-old female patient came to the hospital emergency room accompanied by her family in August 2022 with complaints of pain in her right thigh after falling on the homestairs. The patient has a history of heart disease and hypertension. The patient then underwent an examination and found anemia, an increase in serum creatinine and a complete fracture of the distal 1/3 of the right femur with multiple lytic lesions with decreased bone trabeculation in the skull and pelvis, clavicle, humerus, and femur bilaterally, left costae 7-8^th  with suspected multiple myeloma, differential diagnosis of malignant metastases and vertebral body compression 12^th. Bone survey examination and sampling for histopathological examination were then carried out during the operative management of fractures with the impression of plasmacytosis so that the patient was diagnosed with Post ORIF PS, bone graft and post biopsy e.c. pathological fracture right supracondylar femur with multiple lytic lesions e.c. multiple myeloma. The patient was then referred to the orthopedic oncology department.

Conclusion: Patients with pathological fracture manifestations need to be investigated further regarding the underlying cause of the condition. Multiple myeloma is one of the hematological malignancies that can cause bone lesions due to an imbalance of bone destructive factors so that it can increase the risk of pathological fracture complications. Knowing the complications, clinical manifestations and supporting characteristics of multiple myeloma can help in making the diagnosis of myeloma in patients with pathological fractures.

Latar belakang: Mieloma multipel (MM) adalah keganasan hematologi yang ditandai dengan lesi tulang yang destruktif, cedera ginjal, anemia dan hiperkalsemia. Mieloma multipel merupakan neoplasma yang sering terjadi pada orang dewasa hingga lanjut usia. Komplikasi fraktur patologis terjadi akibat lesi litik pada tulang. Komplikasi MM dapat muncul sebagai manifestasi klinis pasien sehingga perlu dilakukan pemeriksaan lanjutan pada pasien fraktur patologis untuk menegakkan MM.

Laporan Kasus: Pasien perempuan berusia 67 tahun datang ke IGD Rumah Sakit diantar oleh keluarganya pada Agustus 2022 dengan keluhan nyeri pada paha kanan setelah terjatuh di tangga rumah. Pasien memiliki Riwayat penyakit jantung dan hipertensi. Pasien kemudian melakukan pemeriksaan dan ditemukan kondisi anemia, peningkatan serum kreatinin dan fraktur komplit 1/3 distal os femur kanan dengan lesi litik multipel dengan penurunan trabekulasi tulang pada skull dan pelvis, os klavikula, humerus, dan femur bilateral, costae 7-8 kiri dengan suspek mieloma multipel diagnosis banding metastasis keganasan dan kompresi korpus vertebra 12. Pemeriksaan survei tulang dan pengambilan sampel untuk pemeriksaan histopatologi kemudian dilakukan saat tatalaksana operatif penanganan fraktur dengan kesan plasmasitosis sehingga pasien didiagnosis  dengan Post ORIF PS dan pemasangan bone graft dan pasca biopsi e.c. pathological fracture right supracondylar femur with multiple lytic lesion e.c. multiple myeloma. Pasien kemudian dirujuk ke bagian orthopaedi onkologi.

Simpulan: Pasien dengan manifestasi fraktur patologis perlu dilakukan pemeriksaan lebih lanjut mengenai penyebab yang mendasari keadaan tersebut. Mieloma multipel menjadi salah satu keganasan hematologi yang dapat menimbulkan lesi tulang akibat ketidakseimbangan faktor destruktif tulang sehingga dapat meningkatkan risiko komplikasi fraktur patologis. Mengetahui komplikasi, manifestasi klinis dan penunjang yang menjadi karakteristik dari mieloma multipel dapat membantu dalam menegakkan diagnosis mieloma pada pasien dengan fraktur patologis.

Background: Alopecia universalis is an autoimmune disease of the hair follicles, which results in complete loss of head and body hair. Until now there is no proven effective therapy in dealing with this disease. We report a case of alopecia universalis that responded well to combination therapy.

Case: Female, 22 months old, complained by her parents due to hair loss on her head, eyebrows and eyelashes that had not grown back since the age of 8 months. On the fingernails and toenails found pitting nails, trachonycia. On scalp dermoscopy examination, multiple yellow dots were found. Severity of Alopecia Tool Score (SALT) was 100%. The patient was treated with minoxidil 5%, mometasone 0.1%, triamcinolone 12 mg and excimer laser. Administration of minoxidil increases prostaglandin production and maintains the anagen phase. Corticosteroids are immunosuppressive which suppress the immune attack of T cells on hair follicles. UV light on the excimer laser can reduce the proliferation of T lymphocytes, thereby reducing perifollicular inflammation and hair follicle damage. In this case, after 4 months of observation, the growth of terminal hair and vellus hair on the scalp, eyebrows and eyelashes was seen. On the patient's nails, the trachonycia was improved, with pitting nails remaining. SALT decreased to 58%.

Conclusion: The combination therapy of minoxidil, corticosteroid and excimer laser gave good results in this case. During treatment, there were no side effects or recurrences.

Latar belakang : Alopesia universalis adalah penyakit autoimun pada folikel rambut, yang mengakibatkan kerontokan seluruh rambut kepala dan tubuh. Hingga saat ini belum ada terapi yang terbukti efektif dalam menangani penyakit ini. Berikut dilaporkan kasus alopesia universalis yang memberikan respon baik dengan terapi kombinasi.

Kasus: Pasien perempuan, 22 bulan, dikeluhkan orang tuanya mengalami rambut kepala, alis dan bulu mata yang rontok dan tidak tumbuh kembali sejak usia 8 bulan. Pada kuku tangan dan kaki didapatkan adanya pitting nails, trachonycia. Pada pemeriksaan dermoskopi kulit kepala didapatkan adanya multiple yellow dots. Severity of Alopecia Tool Score (SALT) 100%. Pasien diberikan terapi minoksidil 5%, mometason 0.1%, triamsinolone 12 mg dan laser excimer. Pemberian minoksidil meningkatkan produksi prostaglandin dan mempertahankan fase anagen. Kortikosteroid bersifat imunosupresif yang menekan serangan imunitas sel T pada folikel rambut. Sinar UV pada laser excimer dapat menurunkan proliferasi sel T limfosit sehingga mengurangi peradangan perifolikular dan kerusakan folikel rambut. Pada kasus, setelah pengamatan selama 4 bulan nampak adanya pertumbuhan rambut terminal dan rambut vellus pada kulit kepala, alis dan bulu mata. Pada kuku pasien nampak trachonycia membaik, tersisa pitting nails. SALT menurun menjadi 58%.

Simpulan: Terapi kombinasi minoksidil, kortikosteroid dan laser excimer memberikan hasil yang baik pada kasus ini. Selama pengobatan tidak didapatkan adanya efek samping dan rekurensi.

Background: Fractures in the elderly population arise primarily from fall injuries and low bone density. Osteoporosis fracture is a condition with comorbid osteoporosis that can occur due to minor trauma. Osteoporosis fractures are associated with significant morbidity. Osteoporosis fracture recovery takes a long time and increases the risk of complications. Many patients lose independence and require full daily activity care from caregivers.

Case: A 66-year-old female patient came to the hospital emergency room in July 2022 complaining of pain and swelling in her right leg after a fall in her home. Local examination of the patient's right leg showed edema, deformity, shortening without visible open wound, and palpable stiffness with normal arterial pulsation. The patient has limited movement due to pain. The patient was diagnosed with Closed Fracture Right Subtrochanter Femur Russel Taylor Type 1B with Severe Osteoporosis. The patient underwent open elective reduction and internal fixation percutaneous surgery (ORIF PS). After treatment, the patient's family assists the patient's daily activities. A month later, the patient fell back in her yard. The patient came to the emergency room complaining of pain in the left hip. Local examination found swelling in the proximal left thigh and decreased ROM in the hip joint. The patient received operative management of bipolar hemiarthroplasty. The patient's daily activities still depend on the patient's family due to the patient's limited mobility.

Conclusion: Patients with comorbid osteoporosis are highly susceptible to fracture and have worse long-term morbidity and increased dependence on others for long-term rehabilitation.

Latar belakang: Fraktur pada populasi lanjut usia muncul terutama dari kombinasi cedera akibat jatuh dan kepadatan tulang yang rendah. Fraktur osteoporotik merupakan kondisi fraktur pada populasi dengan komorbid osteoporosis yang dapat terjadi akibat trauma ringan. Fraktur osteoporotik dikaitkan dengan morbiditas yang signifikan. Pemulihan fraktur osteoporotik memerlukan waktu yang lama dan meningkatkan risiko komplikasi. banyak pasien kehilangan kemandirian dan membutuhkan perawatan penuh dari orang lain.

Laporan Kasus: Pasien perempuan dengan usia 66 tahun datang ke IGD Rumah Sakit pada Juli 2022 dengan keluhan nyeri dan bengkak pada kaki kanan setelah terjatuh di halaman rumah. Pemeriksaan lokalis pada kaki kanan pasien menunjukkan pada regio femur kanan ditemukan edema, deformitas, pemendekkan tanpa adanya luka terbuka yang terlihat, teraba kaku dengan pulsasi arteri yang masih baik. Pasien mengalami keterbatasan pergerakan karena nyeri. Berdasarkan pemeriksaan fisik dan penunjang, pasien didiagnosis dengan Closed Fracture Right Subtrochanter Femur Russel Taylor Type 1B dengan Severe Osteoporosis. Pasien menjalani tatalaksan operatif open reduction and internal fixation percutaneous surgery (ORIF PS) elektif. Pasca tatalaksana, aktivitas harian pasien dibantu oleh keluarga pasien. Sebulan kemudian pasien kembali terjatuh dihalaman rumahnya. Pasien datang ke IGD RS dengan keluhan nyeri pada pinggul kiri. Pada pemeriksaan lokalis ditemukan pembengkakan pada paha kiri proksimal dan penurunan ROM pada sendi panggul. Pasien mendapatkan tatalaksana operatif bipolar hemiarthoplasty. Aktivitas harian pasien masih tergantung pada keluarga pasien akibat keterbatasan mobilitas pasien.

Simpulan: Pasien dengan komorbid osteoporosis memiliki kerentanan yang tinggi untuk terjadinya fraktur dan meningkatkan luaran morbiditas yang lebih buruk panjang dan meningkatkan ketergantungan terhadap orang lain untuk proses rehabilitasi dalam waktu yang panjang.

Background: Interrupted aortic arch (IAA) is a congenital abnormality in which there is a discontinuity between the lumen of the ascending and descending aorta. This disorder is classified as a rare congenital disorder with an incidence of 0.003 out of 1000 live births. It is important to detect this disorder early because of the high mortality rate of untreated patients with the interrupted aortic arch in the first year of life, reaching 90%. This case report aims to report the sign and symptoms of interrupted aortic arch abnormalities, other accompanying congenital abnormalities, and the radiological feature of this disorder.

Case Presentation: In this case, a baby boy was born at 37 weeks 6 days of gestation with a birth weight of 2100 grams. At birth, the patient did not cry immediately, with an Apgar score of 6-8. It was found that there were differences in oxygen saturation rates of the upper and lower extremities. Initially, the patient underwent echocardiography and cardiac catheterization and the results were severe coarctation of the aorta and bidirectional large tubular patent ductus arteriosus. Then when the patient was 9 months old, a CT angiography examination was performed. A separation between the ascending and descending aortic lumen and several other congenital heart defects was obtained.

Conclusion: Although an interrupted aortic arch is a rare congenital abnormality, it is important to detect early signs and symptoms, other accompanying congenital abnormalities, and the radiological feature of this disorder. CT angiography is an imaging modality that plays an important role in establishing the diagnosis and determining the management of this case to prevent patient morbidity and mortality.

Latar Belakang: Interrupted aortic arch adalah kelainan kongenital dimana terdapat diskontinuitas antara lumen aorta ascenden dan descenden. Kelainan ini tergolong kelainan kongenital yang jarang terjadi dengan insiden 0.003 dari 1000 bayi yang lahir hidup. Penting untuk mendeteksi kelainan ini secara dini karena tingginya angka mortalitas pasien interrupted aortic arch yang tidak di treatment dalam satu tahun pertama kehidupan mencapai 90%. Laporan kasus ini bertujuan untuk melaporkan gejala dan tanda kelainan interrupted aortic arch, kelainan kongenital lain yang menyertai, serta bagaimana gambaran radiologis dari kelainan ini.

Presentasi Kasus :  Dalam kasus ini dilaporkan bayi laki-laki yang lahir pada umur kehamilan 37 minggu 6 hari dengan berat badan lahir 2100 gram. Pada saat lahir pasien tidak segera menangis dengan apgar score 6-8. Saat dilakukan pengecekan saturasi oksigen, didapatkan perbedaan angka saturasi oksigen ekstremitas atas dan bawah. Awalnya pasien menjalani pemeriksaan echocardiografi dan kateterisasi jantung didapatkan hasil severe coarctatio aorta dan large tubular patent ductus arteriosus bidirectional. Kemudian saat pasien berusia 9 bulan dilakukan pemeriksaan CT angiography dan didapatkan hasil pemisahan antara lumen aorta ascenden dan descenden serta beberapa kelainan jantung bawaan yang lain.

Simpulan: Walaupun interrupted aortic arch merupakan kelainan kongenital yang jarang terjadi, namun penting untuk dapat mendeteksi gejala dan tanda awal, kelainan kongenital lain yang menyertai, serta bagaimana gambaran radiologis dari kelainan ini. Modalitas pencitraan CT angiography memegang peranan penting dalam penegakkan diagnosis dan penentuan tatalaksana kasus ini untuk mencegah morbiditas dan mortalitas pasien.

Introduction: Electrical burns are uncommon but result in high morbidity and mortality due to severe tissue damage. Geriatrics are vulnerable to aggressive burns because of skin atrophy, comorbidities, diminished host defence mechanisms and reduced mobility. A high-voltage electrical injury has complex complications, especially long-term complications. This study aimed to present the case of geriatric patient outcomes of major burn due to high-voltage electrical injury.

Case Presentation: This is a case report of electrical burn injuries; a 70 years old man came to the emergency room approximately 1 hour after the incident, and a chief complaint was burning due to electrical shock. The patient had a history of electrical shock when fishing on the side of the river bank, where there is a high-voltage electrical central behind him. When he threw his fishing line, the fishing line caught on the exposed high-voltage transformer cable causing an electric shock. The examination showed that the patient was conscious of burns on the right chest to the abdomen and palm to the right hand, as well as on both soles of the feet. Another complaint was a pain in the wound due to electrical shock without a history of fainting, shortness of breath, chest pain, headache, and vomiting. The patient’s previous medical history showed uncontrolled hypertension.

Conclusion: Our study demonstrates a rare geriatric patient discharged without complications due to a high-voltage injury. Strict multi-specialty management and rehabilitation are required to treat electrical injuries properly.

Background: Confluent and reticulated papillomatosis (CARP) or Gougerot-Carteaud syndrome is a rare and chronic skin disorder characterized by hyperpigmented and cofluent papules/macules/plaques forming a reticular pattern. The characteristics especially occur in adolescents and young adults. Treatment of CARP is difficult and has not yielded good results. This case describes CARP in a young male patient.

Case: A 6-year-old male complained of brownish spots on his face, hands and feet since 5 years ago. It were initially appeared small without itching or pain. Dermatological exmaniation showed hyperpigmented macules, hyperpigmented plaques, confluent to form a reticular pattern. Dermoscopy examination showed a brownish appearance, homogeneous separated by white striae. Histopathological examination revealed acanthosis down growth, reticulated, mild distribution of lymphocytes and perivascular mast cells in the superficial and mild dermis. The patient was diagnosed with CARP and given intraoral azithromycin 250 mg every 24 hours for 2 weeks and ketoconazole 2% shampoo 3 times a week. Follow-up at week 4 there was no significant improvement.

Conslucion: Incident cases of CARP are rare, so there is no alternative therapy for the management of this disease. In this case, new lesions were found after administration of therapy and the prognosis for the patient was poor.

Latar belakang: Confluent and reticulated papillomatosis (CARP) atau sindrom Gougerot-Carteaud merupakan suatu kelainan kulit langka dan kronis dengan karakteristik papul/makula/plak hiperpigmentasi konfluen membentuk pola retikuler. Kelainan ini terutama pada remaja dan dewasa muda. Terapi CARP sulit dan belum memberikan hasil yang baik. Kasus ini mendeskripsikan CARP pada seorang anak laki-laki.

Kasus: Seorang anak laki-laki 6 tahun dengan keluhan bercak kecoklatan pada wajah, tangan dan kaki sejak 5 tahun lalu, awalnya muncul kecil, tanpa disertai gatal maupun nyeri. Status dermatologi didapatkan makula hiperpigmentasi, plak hiperpigmentasi, berkonfluens membentuk pola retikuler. Pemeriksaan dermoskopi didapatkan gambaran kecoklatan, homogen dipisahkan oleh striae putih. Pemeriksaan histopatologi didapatkan gambaran acanthosis down growth, reticulated, sebaran ringan limfosit dan sel mast perivascular pada superfisial dan mild dermis. Pasien didiagnosis CARP dan diberi terapi  Azitromisin 250 mg tiap 24 jam  intraoral selama 2 minggu dan ketokonazol 2% sampo 3 kali seminggu. Follow-up minggu ke-4 tidak terdapat perbaikan signifikan.

Simpulan: Insiden kasus CARP jarang ditemukan sehingga belum terdapat terapi pilihan untuk tatalaksana penyakit ini. Pada kasus ini masih ditemukan muncul lesi baru setelah pemberian terapi dan prognosis pada pasien adalah dubia ad malam.

Objective: To assess the effectiveness of negative pressure wound therapy (NPWT) in treating diabetic foot ulcers as well as its drawbacks

Method: We selected articles systematically based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PICO criteria for studies in the last 10 years.  Keywords were searched by Boolean operator. All selected articles were assesed for their quality by STROBE checklist.

Results: Seven articles of randomized-controlled trials were selected, which involved 564 patients whom received NPWT for their diabetic foot ulcers, while 404 others received non-NPWT such as those of standard or moist wound care. Although some studies still showed varying results due to different data collection tools, overall data showed better outcome of NPWT with faster rate of ulcer size reduction and wound closure compared to its counterparts. With different methods of NPWT, this procedure did not show any difference of respected outcomes. On the other hand, complications of NPWT seemed to be lower than comparison groups in most of the reviewed studies. Nonetheless, it does not rule out the possibilty of complication after the treatment, thus meticulous surgery procedure, timely wound management and prophylaxis of infection are absolutely essential.

Conclusion: It has been demonstrated that NPWT is more successful than non-NPWT wound care at treating patients with diabetic foot ulcers and results in fewer complications.

A number of facelift procedures have been introduced by many surgeons but there is no consensus has yet been established to carry. Since the first description of superficial musculoaponeurotic system (SMAS), it is used as the basis for many facelift methods that produce superior result in rejuvenation compared to traditional skin only facelift. Extended SMAS facelift becoming SMAS modification techniques that is still being developed. It produces two different vector of subcutaneous and SMAS flap, that is essential to restore drooping deep facial tissue with natural appearance. Despite the beneficial use of extended SMAS flap, most of plastic surgeons still traditionally incise the SMAS under the zygomatic arch. However, the low SMAS incision results only on rejuvenation of the lower face and is not sufficient to correct mid-facial aging. Fundamental concepts of high SMAS facelift by  reviewing some literatures explain that high SMAS flap transection allowing the surgeon to achieve greater vertical elevation of the deep structures of the face by undermining the middle face, combined with fixation to a fixed structure produces lasting results and oblique vector of skin envelope creating no tension look. Incision above zygomatic arch turns out to be safely performed without facial nerve injury thorough knowledge of the anatomy. The final result is a balanced and harmonious elevation of sagging tissues of the midface, cheek, and jawline, to such an extent that high SMAS facelift becomes optimal, durable, technically simple, reproducible and with a comparatively high safety margin in facelift procedures.

Global pandemic of Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2, a novel virus which first reported in Wuhan in December 2019. It can cause severe respiratory conditions including respiratory failure. Different from adults, children usually have milder symptoms of the disease. A post-infection complication that involves multisystem organ failure in children is reported in numerous countries. It is mentioned as multisystem inflammatory syndrome in children (MIS-C) or Kawa-COVID-19, because it resembles Kawasaki Disease. The pathogenesis remains unclear, but it is presumed that hosts’ innate immune response triggered the condition. Modulating the immune response is the main target of the therapy. High doses of intravenous immunoglobulins, low doses of corticosteroids (methylprednisolone), anti-IL-1 (anakinra), antiplatelet such as aspirin can be used to treat MIS-C. Antiviral therapy is not proven to be effective and other immunomodulatory agents still needed further studies.

Background. Stunting is short according to age as measured by the index of height/body length according to age (TB/U or PB/U). Stunting is a major nutritional problem in developing countries, with a global incidence of 149 million in 2020. Prevention of stunting can be done with nutritional interventions in the first thousand days of life, one of which is exclusive breastfeeding. This systematic review aims to determine exclusive breastfeeding as a protective factor for stunting in toddlers.

Method. This systematic review was conducted by searching for studies on electronic databases such as Google Scholar, Cochrane Library, and PubMed. The study selection was done according to the PRISMA diagram and the eligibility criteria. The study assessment was performed using a checklist from the Joanna Briggs Institute for cross-sectional and case-control studies.

Results. A total of 24 studies consisting of 14 cross-sectional studies and 10 case-control studies were included in the analysis. The majority of studies are from Indonesia. The majority of the study samples were male and received exclusive breastfeeding. The incidence of stunting is more common in toddlers who do not receive exclusive breastfeeding. A total of 22 out of 24 studies found a significant relationship between exclusive breastfeeding and the incidence of stunting in toddlers. Exclusive breastfeeding as a protective factor for stunting was found to have varying odds ratio (OR) values, ranging from 0.15 (0.07-0.31) to 61 (21-174).

Conclusion. The incidence of stunting is more common in toddlers who do not receive exclusive breastfeeding. Exclusive breastfeeding is a protective factor against stunting in toddlers.

Latar belakang. Stunting merupakan pendek menurut umur yang diukur melalui indeks tinggi/panjang badan menurut umur (TB/U atau PB/U). Stunting merupakan permasalahan gizi utamanya di negara berkembang dengan angka kejadian global sebanyak 149 juta pada tahun 2020. Pencegahan stunting dapat dilakukan dengan intervensi gizi dalam seribu hari pertama kehidupan, salah satunya dengan pemberian ASI eksklusif. Systematic review ini bertujuan untuk mengetahui pemberian ASI eksklusif sebagai faktor protektif terjadinya stunting pada balita.  

Metode. Tinjauan sistematik ini dilakukan pencarian studi pada basis data elektronik berupa Google Scholar, Cochrane Library, dan PubMed. Pemilihan studi dilakukan sesuai dengan diagram PRISMA dan menggunakan kriteria eligibilitas. Penilaian studi dilakukan dengan menggunakan ceklist dari the Joanna Briggs Institute untuk studi cross-sectional dan kasus-kontrol.

Hasil. Sebanyak 24 studi yang terdiri atas 14 studi cross-sectional dan 10 studi kasus-kontrol diikutkan dalam analisis. Studi mayoritas berasal dari Indonesia. Mayoritas sampel penelitian berjenis kelamin laki-laki dan mendapatkan ASI eksklusif. Kejadian stunting lebih banyak ditemukan pada balita yang tidak mendapatkan ASI eksklusif. Sebanyak 22 dari 24 studi menemukan hubungan signifikan antara pemberian ASI eksklusif dengan kejadian stunting pada balita. Pemberian ASI eksklusif sebagai faktor protektif stunting ditemukan memiliki nilai odds ratio (OR) yang bervariasi, yakni antara 0,15 (0,07-0,31) hingga 61 (21-174).    

Simpulan. Kejadian stunting lebih banyak ditemukan pada balita yang tidak mendapatkan ASI eksklusif. Pemberian ASI eksklusif merupakan faktor protektif terhadap kejadian stunting pada balita.

Penyakit infeksi menular seksual (IMS) dan Human Immunodeficiency Virus (HIV) banyak diderita oleh kelompok LGBT, namun orang-orang LGBT yang mengalami masalah kesehatan masih mengalami kesenjangan dalam perawatan kesehatan. Masyarakat Indonesia, memandang kelompok lesbian, gay, biseksual, dan transgender (LGBT) sebagai suatu bentuk penyimpangan terhadap budaya, norma sosial, dan agama. Meski demikian populasinya kian meningkat disetiap tahunnya. Secara keseluruhan pernah terjadi peningkatan jumlah waria secara bermakna antara tahun 2002 dan 2009, namun dari tahun 2009 dan 2012 peningkatan tidak sebanyak periode sebelumnya. Sayangnya, jumlah populasi LGBT di Indonesia tidak diketahui secara pasti, namun mengacu data populasi rawan terdampak HIV pada waria diperkirakan mencapai 597.000 orang. Hingga kini kelompok LGBT masih dipandang negatif oleh masyarakat sehingga hal tersebut berdampak pada populasi tersebut. Gay yang menggunakan layanan kesehatan akan cenderung menyembunyikan seksualitas mereka karena takut mendapatkan stigma sehingga menyembunyikan orientasi seksual merupakan solusi terbaik mengobati penyakit yang dideritanya. Pada akhirnya, hal tersebut akan menurunkan kualitas hidup mereka. Selain HIV, tidak menutup kemungkinan seorang gay mengalami infeksi menular seksual lainnya seperti infeksi klamidia, gonore, treponema pallidum, herpes simpleks, dan kondiloma. Untuk itu konseling pada kelompok LGBT saat dilakukan skrining untuk IMS harus selalu dilakukan bersamaan dengan konseling pencegahan IMS. Secara umum, yang terbaik adalah memberikan konseling kesehatan seksual dalam konteks kesehatan preventif yang positif daripada berfokus pada pesan-pesan yang berbasis pada rasa takut, yang mungkin menstigmatisasi. Kelompok LGBT harus diberi konseling tentang cara menggunakan kondom lateks saat berhubungan seks oral, anal, dan vagina, yang bertujuan untuk mengurangi risiko penularan HIV dan IMS.

Background: Coronavirus disease (COVID-19) infection has become a worldwide pandemic. Diabetes Mellitus is a comorbid disease that can increase in severity. The most common clinical finding in severe COVID-19 infection is a high Neutrophil Lymphocyte Ratio (NLR). In patients with Diabetes Mellitus (DM) type 2, it is also known that high NLR values ​​have a poor prognosis. This study analyzes the risk factors associated with high NLR values ​​in type 2 DM patients infected with COVID-19 at Sanglah General Hospital.

Methods: A cross-sectional analytical study was conducted on the medical records of 70 patients with COVID-19 infection with type 2 DM who were treated at Sanglah General Hospital, Denpasar, for the period April 2020-October 2020. The samples were divided into two groups, namely high and normal NLR. The analysis was conducted to see which risk factors were significantly associated with high NLR values ​​in COVID-19 patients with type 2 diabetes. The analysis was carried out using an independent T-test for numerical variables and chi-square for nominal variables.

Results: Most of the study samples had high levels of NLR (65.71%). Risk factors that had a significant relationship with high NLR values ​​were random blood sugar levels (p=0.00), fasting blood sugar levels (p=0.00), HbA1c (p=0.002), CRP levels (p=0.00), leukocyte level (p=0.00), BUN level (p=0.004), history of type 2 DM before COVID-19 infection (p=0.009) and control HbA1c (0.001).

Conclusion: The risk factors associated with high NLR values ​​in COVID-19 patients with type 2 DM at Sanglah Hospital Denpasar are random blood sugar levels, fasting blood sugar levels, HbA1c, CRP levels, leukocyte levels, BUN levels, history of type 2 diabetes before COVID-19 infection and HbA1c control.

Latar Belakang: Infeksi Coronavirus disease (COVID-19) telah menjadi pandemik di seluruh dunia. Diabetes Mellitus merupakan penyakit komorbid yang dapat meningkatkan keparahan. Temuan klinis yang banyak ditemukan pada infeksi COVID-19 berat adalah nilai neutrophil lymphocyte ratio (NLR) yang tinggi. Pada pasien Diebetes Mellitus (DM) tipe 2 juga diketahui nilai NLR yang tinggi memiliki prognosis buruk. Penelitian ini bertujuan untuk menganalisis faktor risiko yang berhubungan dengan nilai NLR tinggi pada pasien DM tipe 2 yang terinfeksi COVID-19 di RSUP Sanglah.

Metode: Studi analitik potong lintang dilakukan pada rekam medik 70 pasien dengan infeksi COVID-19 dengan DM tipe 2 yang dirawat di RSUP Sanglah Denpasar periode April 2020-Oktober 2020. Sampel dibagi menjadi dua kelompok yakni NLR tinggi dan normal. Analisis dilakukan untuk melihat faktor risiko yang signifikan berhubungan dengan nilai NLR tinggi pada pasien COVID-19 dengan DM tipe 2. Analisis dilakukan menggunakan uji independent T-test untuk variabel numerik dan chi-square untuk variabel nominal.

Hasil: Mayoritas sampel penelitian memiliki kadar NLR tinggi (65,71%). Faktor risiko yang memiliki hubungan signifikan dengan nilai NLR tinggi adalah kadar gula darah acak (p=0,00), kadar gula darah puasa (p=0,00), HbA1c (p=0,002), kadar CRP (p=0,00), kadar leukosit (p=0,00), kadar BUN (p=0,004), riwayat DM tipe 2 sebelum infeksi COVID-19 (p=0,009) dan kontrol HbA1c (0,001).

Kesimpulan: Faktor risiko yang berhubungan dengan nilai NLR tinggi pada pasien COVID-19 dengan DM tipe 2 di RSUP Sanglah Denpasar adalah kadar gula darah acak, kadar gula darah puasa, HbA1c, kadar CRP, kadar leukosit, kadar BUN, riwayat DM tipe 2 sebelum infeksi COVID-19 dan kontrol HbA1c.

Background: Anosmia and ageusia are early symptoms that are widely reported in COVID 19 patients and are associated with low rates of intensive care and mortality, so the hypothesis arises that anosmia and ageusia can be good prognostic factors in COVID-19 patients. This study aims to examine anosmia and ageusia as prognostic factors in COVID-19 patients.

Methods: This study is an observational analytic study with a retrospective cohort design conducted at Sanglah General Hospital Denpasar from January to June 2022.

Results: obtained a total of 1048 subjects with 344 subjects experiencing anosmia, 210 subjects experiencing ageusia, and 474 subjects experiencing a combination of anosmia and ageusia. Variable symptoms of anosmia and ageusia were statistically significant predictors for the recovery of COVID-19 patients (p<0.05). The cure rate in the group of patients with symptoms of anosmia was 1.8 times (RR = 1.783, 95% CI = 1.667-1.908) and the group of patients with symptoms of ageusia experienced 1.6 times higher recovery (RR = 1.564, 95% CI = 1.478 -1,655). After adjusting for other variables as confounders, the combination of symptoms of anosmia and ageusia in patients was a significant predictor of recovery for COVID-19 patients by 1.5 times compared to patients who did not experience the combination of symptoms of anosmia and ageusia (ARR = 1.523, 95% CI = 1.245- 1.864, p<0.05).

Conclusion: Anosmia, ageusia and the combination of both, indicate protective factors against possible mortality and indicate a good prognosis in COVID-19 patients.

Latar belakang: Anosmia dan ageusia merupakan gejala awal yang banyak dilaporkan pada pasien COVID-19 serta dikaitkan dengan tingkat rawat intensif dan mortalitas yang rendah sehingga muncul hipotesis bahwa anosmia dan ageusia dapat menjadi faktor prognosis yang baik pada pasien COVID-19. Penelitian ini bertujuan untuk meneliti anosmia dan ageusia sebagai faktor prognosis pada pasien COVID- 19.

Metode: Penelitian ini merupakan studi analitik observasional dengan rancangan kohort retrospektif yang dilakukan di RSUP Sanglah Denpasar pada bulan Januari    hingga Juni 2022.

Hasil: Didapatkan total 1048 subjek dengan 344 subjek mengalami anosmia, 210 subjek mengalami ageusia, serta 474 subjek mengalami kombinasi anosmia dan ageusia. Variabel gejala anosmia maupun ageusia secara statistik merupakan prediktor signifikan untuk kesembuhan pasien COVID-19 (p<0,05). Tingkat kesembuhan pada kelompok pasien bergejala anosmia mencapai 1,8 kali (RR = 1,783, IK 95% = 1,667-1,908) lebih tinggi dan kelompok pasien bergejala  ageusia mengalami kesembuhan 1,6 kali lebih tinggi (RR = 1,564, IK 95% = 1,478-1,655). Setelah disesuaikan dengan variabel lain sebagai perancu, kombinasi gejala anosmia dan ageusia pada pasien menjadi prediktor kesembuhan pasien COVID-19 secara signifikan sebesar 1,5 kali lipat dibandingkan pasien yang tidak mengalami kombinasi gejala anosmia dan ageusia (ARR = 1,523, IK95% = 1,245-1,864, p<0,05).

Simpulan: Anosmia, ageusia, dan kombinasi keduanya menunjukkan adanya faktor  protektif terhadap kemungkinan mortalitas serta menandakan adanya prognosis yang baik pada pasien COVID-19

Background: Asphyxia neonatorum is one of the most frequent perinatal issues caused by preeclampsia, which is one of the most common prenatal disorders. Neonatal asphyxia is one of the health problems that is very important to pay attention to because this condition is associated with perinatal morbidity and mortality. Several maternal conditions are thought to be associated with neonatal asphyxia, including maternal age, gestational age, obstetric history, degree of preeclampsia, and method of delivery. This study aims to confirm this hypothesis.

Methods: This study used an observational analytic design with a cross sectional design conducted between June 2021 and June 2022 at the Department of Obstetrics and Gynecology at Wangaya Hospital Denpasar, 97 pregnant women with preeclampsia were included. The research data were obtained through direct recording from medical records. The data collected were maternal age, gestational age, gravida, parity, history of abortion, degree of preeclampsia and method of delivery.

Results: Pregnant women with preeclampsia who had gestational age <37 weeks [p = 0.021; OR = 3.27 (1,2-8.8)], has a gravida of 1 and > 3 [p = 0.019; OR = 2.97 (1,2-7,1)], has a parity of 1 and > 3 [p = 0.033; OR = 2.62 (1.1-6.1)], had preeclampsia with severe features [p = 0.002; OR = 5.62 (1.7-17.8)], and delivered by SC [p = 0.005; OR = 6.9 (1.5-31.9)] had a higher probability of having a child with asphyxia neonatorum. Meanwhile, the mother's age at delivery [p = 0,516; OR = 0.72 (0.3-1.7)] and history of abortion [p = 0.074; OR = 2.53 (0.9-6.7)] is not a factor that causes asphyxia neonatorum.

Conclusions: Factors related to the incidence of asphyxia neonatorum in pregnant women with preeclampsia are gestational age, gravida, parity, degree of preeclampsia, and method of delivery.

Latar Belakang: Preeklampsia merupakan salah satu penyulit kehamilan yang sangat umum ditemukan dan menyebabkan berbagai masalah perinatal, salah satunya asfiksia neonatorum. Asfiksia neonatorum merupakan salah satu masalah kesehatan yang sangat penting untuk diperhatikan karena kondisi ini terkait dengan morbiditas dan mortalitas perinatal. Beberapa kondisi maternal diduga terkait dengan asfiksia neonatorum, antara lain usia ibu, usia kehamilan, riwayat obstetri, derajat preeklampsia, dan metode persalinan. Penelitian ini bertujuan untuk mengkonfirmasi hipotesis tersebut.

Metode: Penelitian ini menggunakan rancangan analitik observasional dengan desain cross sectional yang melibatkan 97 orang ibu hamil dengan preeklampsia di Departemen Obstetri dan Ginekologi RSUD Wangaya Denpasar periode bulan Juni 2021 sampai Juni 2022. Data penelitian diperoleh melalui pencatatan langsung dari rekam medis. Data yang dikumpulkan adalah usia ibu, usia kehamilan, gravida, paritas, riwayat abortus, derajat preeclampsia dan metode persalinan

Hasil: Ibu hamil dengan preeklampsia yang memiliki usia kehamilan < 37 minggu [p = 0,021; OR = 3,27 (1,2-8,8)], memiliki gravida 1 dan > 3 [p = 0,019; OR = 2,97 (1,2-7,1)], memiliki paritas 1 dan > 3 [p = 0,033; OR = 2,62 (1,1-6,1)], mengalami preeklampsia dengan gambaran berat [p = 0,002; OR = 5,62 (1,7-17,8)], dan bersalin secara SC [p = 0,005; OR = 6,9 (1,5-31,9)] memiliki kemungkinan lebih besar untuk memiliki anak yang mengalami asfiksia neonatorum. Sedangkan usia ibu saat bersalin [p = 0,516; OR = 0,72 (0,3-1,7)] dan riwayat abortus [p = 0,074; OR = 2,53 (0,9-6,7)] bukanlah faktor yang menyebabkan terjadinya asfiksia neonatorum.

Kesimpulan: Faktor yang berhubungan dengan kejadian asfiksia neonatorum pada ibu hamil dengan preeklampsia adalah usia kehamilan, gravida, paritas, derajat preeklampsia, dan metode persalinan

Background: In Indonesia, the incidence of breast cancer is 42,1 per 100,000 people, whereas the average mortality rate is 17 per 100,000 people. 8-10% of women with breast cancer will experience locoregional recurrence, and 15-30% may develop distant metastases. This study aimed to examine if cancer subtypes, histological grading, and LVI were linked with breast cancer recurrence in patients after Modified Radical Mastectomy at Prof. RSUP. Dr. I G.N.G. Ngoerah.

Methods: Medical record data are used as the study data source to discover the factors that impact breast cancer recurrence in patients who have had a modified radical mastectomy. This research was done using a sequential sampling method. This study's sample utilized inclusion and exclusion criteria to generate 363 patients. The data obtained were analyzed using SPSS ver 22.

Results: The results revealed that 327 patients, or 90.1%, did not have a recurrence, whereas 36 patients, or 9.9%, did. There were 50 Luminal A subtype patients, 127 Luminal B subtype patients, 61 Luminal-Her2 subtype patients, 65 Her2 subtype patients, and 60 TNBC subtype patients. 231 individuals were found to have a negative LVI, whereas 132 patients had a positive LVI. Forty-seven individuals were diagnosed with grade I, 174 with grade II, and 142 with grade III. Breast cancer recurrence was significantly impacted by LVI (p<0.05).

Conclusion: LVI is strongly related to breast cancer recurrence in patients undergoing Modified Radical Mastectomy, but subtype and histological grading are not.

Latar Belakang: Angka kejadian kanker untuk kanker payudara di Indonesia sebesar 42,1 per 100.000 penduduk dengan rata-rata kematian sebesar 17 per 100.000 penduduk. Antara 8-10% wanita yang didiagnosis dengan kanker payudara akan mengalami kekambuhan locoregional dan 15-30% akan mengalami metastasis jauh. Tujuan penelitian ini dilakukan yaitu untuk mengetahui apakah subtipe kanker, grading histopatologi dan LVI menjadi faktor yang berhubungan dengan terjadinya rekurensi kanker payudara pada pasien pasca Modified Radical Mastectomy di RSUP Prof. Dr. I G.N.G Ngoerah.

Metode: Desain penelitian cross sectional digunakan dalam penelitian ini, dimana data rekam medis menjadi sumber data penelitian. Penelitian menggunakan pengambilan sampel secara konsekutif. Sampel dalam penelitian menggunakan kriteria inklusi dan eksklusi dan diperoleh jumlah sampel 363 pasien. Data yang didapatkan dianalisis dengan menggunakan SPSS ver 22.

Hasil: Hasil penelitian menunjukkan sebanyak 327 pasien atau sebesar 90,1% tidak rekuren, sedangkan 36 pasien atau sebesar 9,9% mengalami rekurensi. Terdapat 50 pasien dengan subtipe Luminal A, 127 pasien dengan subtipe Luminal B, 61 pasien dengan subtipe Luminal-Her2, 65 pasien dengan subtipe Her2, dan 60 pasien dengan subtipe TNBC. Dari 231 pasien didapatkan dalam kategori LVI negatif, sedangkan 132 pasien memiliki LVI positif. Sebanyak 47 pasien didapatkan dengan grade I, 174 pasien dengan dengan grade II, dan 142 pasien memiliki grade III. LVI memiliki pengaruh signifikan (p<0,05) terhadap rekurensi kanker payudara.

Simpulan: LVI berhubungan signifikan terhadap rekurensi kanker payudara pada pasien pasca Modified Radical Mastectomy, sedangkan subtipe dan grading histopatologis tidak.

Introduction: Leprosy is a contagious disease that has the potential to cause health problems, giving a psychological impact due to discrimination and stigma caused by the disabilities it causes. Leprosy, also known as Morbus Hansen (MH), is a chronic inflammatory disease caused by Mycobacterium leprae (M. leprae), which has obligate intracellular. Apart from bacterial factors, the incidence of leprosy is strongly influenced by the host, immunity status, and also genetic variation. Lepromatous type (LL) leprosy is characterized by the appearance of skin lesions, high bacterial index, nerve damage, and also the production of T helper-2 cytokines, such as interleukin-4, I interleukin-5 and interleukin-10. One of the cytokines that play a role in multibacillary type leprosy is interleukin -10 (IL-10). The aim of this study is to determine the correlation between IL-10 serum with bacterial index in multibacillary type of leprosy.

Method: This study was a cross-sectional observational analytic study involving 50 subjects of multibacillary type leprosy, consist of 25 subjects who were receiving MDT therapy and 25 subjects who had completed therapy or release from treatment (RFT). Sample were taken using consecutive sampling and have fulfilled inclusion and exclusion criteria, with age range of 18-65 years. Interleukin-10 serum levels were derived from venous blood sampling that was measured by the ELISA method.

Result: The results of this study were significant differences between IL-10 serum levels between MB type of leprosy that receiving therapy and MB type leprosy that had completed therapy with median 22,67 (12,87) dan 2,22 (5,87), p<0,001. In this study, a very strong positive correlation (Spearman Correlation r = 0.974; p <0.001) was found between serum IL-10 levels and the bacterial index.

Conclusion: The conclusion of this study is that there is a significant between IL-10 serum levels in multibacillary type leprosy patients who are receiving MDT therapy and who have completed therapy or release from treatment (RFT), and high IL-10 serum levels are correlated with a high bacterial index in patient with multibacillary type of leprosy.

Pendahuluan: Kusta merupakan salah satu penyakit menular yang berpotensi menimbulkan masalah kesehatan, memberikan dampak psikologis akibat diskriminasi dan stigma yang disebabkan oleh karena kecacatan yang ditimbulkan. Kusta dikenal juga dengan sebutan Morbus Hansen (MH) merupakan penyakit inflamasi kronik yang disebabkan oleh Mycobacterium leprae (M. leprae), yang memiliki sifat obligat intraseluler. Selain faktor bakteri, kejadian kusta sangat dipengaruhi oleh host yaitu status imunitas, dan juga variasi genetik. Kusta tipe lepromatosa (LL) ditandai dengan munculnya lesi di kulit, indeks bakteri yang tinggi, dan adanya kerusakan saraf, serta adanya produksi berbagai sitokin  oleh T helper-2 yaitu interleukin-4, interleukin-5 dan interleukin-10. Salah satu sitokin yang berperan pada kusta tipe multibasiler adalah interleukin-10 (IL-10). Penelitian ini bertujuan untuk mengetahui korelasi IL-10 serum dengan indeks bakteri penderita kusta tipe multibasiler.

Metode: Penelitian ini adalah penelitian analitik observasional cross sectional yang melibatkan 50 subjek kusta tipe multibasiler, yang terdiri dari 25 subjek yang sedang mendapat terapi MDT dan 25 subjek yang telah menyelesaikan terapi atau release from treatment (RFT). Pengambilan sampel menggunakan cara consecutive sampling dan telah memenuhi kriteria inklusi dan eksklusi, dengan rentang usia 18-65 tahun. Kadar IL-10 serum berasal dari pengambilan darah vena yang diperiksa dengan metode ELISA.

Hasil: Hasil penelitian ini terdapat perbedaan kadar IL-10 serum antara kusta tipe MB yang sedang mendapat terapi dan kusta tipe MB yang telah menyelesaikan terapi secara bermakna dengan nilai median 22,67 (12,87) dan 2,22 (5,87), p<0,001. Pada penelitian ini juga didapatkan korelasi positif sangat kuat (Spearman Correlation r = 0,974; p<0,001) antara kadar IL-10 serum dengan indeks bakteri.

Simpulan: Terdapat perbedaan antara kadar IL-10 serum pada penderita kusta tipe multibasiler yang sedang mendapat terapi MDT dan yang telah menyelesaikan terapi atau release from treatment (RFT) secara bermakna, dan kadar IL-10 serum yang tinggi berkorelasi dengan indeks bakteri yang tinggi pada penderita kusta tipe multibasiler.

Background: Since March 2020, Coronavirus Disease 2019 (COVID-19) has been declared a pandemic. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) underwent genetic evolution and changes in the nature of the virus, clinical manifestations, and response to treatment. This study aims to determine the profile of hospitalized COVID-19 patients at  Ari Canti Hospital (RSAC), one of the COVID-19 referral hospitals in Gianyar, Bali.

Methods: The design was a descriptive cross-sectional retrospective study, using the medical records of confirmed COVID-19 by Real Time Polymerase Chain Reaction (RT-PCR) patients selected by a simple random sampling technique.

Results: From 290 samples, the majority of COVID-19 patients treated at RSAC were 60.7% male, in the age range of 50-59 years 26.5%, with severe symptoms 45.8% and recovered 83.4%. The dominant symptoms were fever 85.2%, cough 80%, and shortness of breath 60%. The most common comorbidities were >1 comorbidity, hypertension, and diabetes mellitus. Hematological examination at the first time of hospitalization showed leukopenia (4.8%), lymphopenia (14.5%), thrombocytopenia (12.8%),  and anemia (21.7%). The results also showed an increase in Neutrophil to Lymphocyte ratio (NLR) (31.4%), Platelet to lymphocyte ratio (PLR) (11.7%), Red Cell Distribution Width (RDW) (40.7%), D-Dimer  (73.4% ) dan High sensivity C-Reactive Protein (Hs-CRP)  (66.6%). Most showed bilateral infiltrates on chest x-ray. The most common treatment for COVID-19 at RSAC uses antiviral remdesivir (77.9%), quinolone antibiotics (73.4%), and Low Molecular Weight Heparin (LMWH) (53.4%).  A total of 56.6% of patients received corticosteroid therapy.

Conclusion: Patients hospitalized at RSAC mostly showed severe symptoms and recovered. The treament folowing the standard of inpatient treatment for COVID-19 patients.

Latar belakang: Sejak Maret 2020, Coronavirus Disease 2019 (COVID 19) dinyatakan sebagai pandemi. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mengalami evolusi genetik dan perubahan sifat virus, manifestasi klinis serta respon pengobatan. Penelitian ini bertujuan untuk mengetahui profil pasien COVID-19 yang dirawat di Rumah Sakit Ari Canti (RSAC), salah satu rumah sakit rujukan COVID-19 di Gianyar, Bali

Metode: Rancangan penelitian ini adalah cross-sectional deskriptif retrospektif, menggunakan rekam medis pasien terkonfirmasi COVID-19 dengan Real Time Polymerase Chain Reaction (RT-PCR) sejak Juli 2020 - Maret 2022 yang dipilih dengan teknik simple random sampling.

Hasil: Dari 290 sampel, mayoritas pasien COVID-19 yang dirawat di RSAC adalah laki-laki 60.7%, berada pada rentang usia 50-59 tahun 26.5%, dengan gejala berat 45.8% dan sembuh 83.4%. Gejala didominasi demam 85.2%, batuk 80%, dan sesak 60%. Komorbid tersering yaitu >1 komorbid, hipertensi, dan diabetes melitus. Gambaran hematologi menunjukkan leukopenia (4.8%), limfopenia (14.5%), trombositopenia (12.8%), dan  anemia (21.7%). Hasil juga menunjukkan peningkatan Neutrophil to Lymphocyte ratio (NLR) (31.4%), Platelet to lymphocyte ratio (PLR) (11.7%), Red Cell Distribution Width (RDW) (40.7%), D-Dimer (73.4% ) dan High sensivity C-Reactive Protein (Hs-CRP) (66.6%). Sebagian besar menunjukkan infiltrat bilateral pada x-ray thorax. Tatalaksana COVID-19 di RSAC tersering menggunakan antivirus remdesivir (77.9%), antibiotik golongan kuinolon (73.4%), dan antikoagulan Low Molecule Weight Heparin (LMWH) (53.4%). Sebanyak 56.6 % pasien mendapat terapi kortikosteroid.

Kesimpulan: Pasien COVID-19 yang dirawat di RSAC sebagian besar menunjukkan gejala berat dan sembuh. Terapi yang diberikan mengikuti standar terapi rawat inap pasien COVID-19.

Introduction: Presbycusis or age-related hearing loss has several risk factors, with hypertension as one of them. Hypertension might cause presbycusis since it can interfere with nutrient and oxygen intake to the auditory nerve cells of the ear. This study aimed to determine the relationship between hypertension with the incidence of presbycusis at the Poliklinik THT-KL RSUP Sanglah Denpasar.

Methods: This study used an analytic retrospective design and cross-sectional method. The study was conducted at the Poliklinik THT-KL RSUP Sanglah Denpasar with a sample of 60 people. Data were obtained using medical records and analyzed univariately and bivariate using SPSS for Windows with a p-value of 0.05.

Results: Most subjects are 65-75 years old rather than >75, with male subjects of the same amount as female subjects. Chi-square test (x²) distribution table analysis demonstrated an association between hypertension and presbycusis incident in Poliklinik THT-KL RSUP Sanglah Denpasar with a p-value of 0,002.

Conclusion: Most samples are in the 65-75 age range with the same proportionate amount of gender. There is an association between hypertension and presbycusis in Poliklinik THT-KL RSUP Sanglah Denpasar.

Latar Belakang: Presbikusis atau age related hearing loss memiliki beberapa faktor resiko dengan hipertensi sebagai salah satunya. Hipertensi dapat menyebabkan presbikusis karena dapat mengganggu asupan nutrisi dan oksigen sel-sel saraf auditori di telinga. Penelitian ini bertujuan mengidentifikasi hubungan hipertensi dan kejadian presbikusis di poliklinik Telinga, Hidung, Tenggorokan, Bedah Kepala dan Leher (THT-KL) RSUP Sanglah Denpasar.

Metode: Desain yang digunakan yakni retrospektif analitik dan metode cross-sectional. Lokasi penenlitian yakni poliklinik THT-KL RSUP Sanglah Denpasar dan jumlah sampel 60 orang. Data diperoleh dengan menggunakan rekam medis dan dianalisis secara univariat dan bivariat melalui aplikasi SPSS dengan nilai p ≤ 0,05.

Hasil: Didapatkan sampel lebih banyak berumur 65-75 tahun dibanding sampel berumur >75 tahun. Untuk jenis kelamin, ditemukan sampel dalam proporsi yang sama dan dari hasil uji chi square, didapat adanya korelasi antara hipertensi dengan kejadian presbikusis di Poliklinik THT-KL RSUP Sanglah Denpasar dengan nilai p = 0,002.

Simpulan: Mayoritas sampel berumur 65-75 tahun dengan proporsi jenis kelamin yang sama. Diperoleh hubungan hipertensi dan kejadian presbikusis di poliklinik THT-KL RSUP Sanglah Denpasar.

Background: Nutrition problems in adolescents both malnutrition and overnutrition in Indonesia are quite high. Nutrition problems are multifactorial, but several previous studies have shown that eating behavior will interfere with eating disorders related to nutritional quality. This study aims to analyze the relationship between eating attitude and eating disorders on nutritional status in adolescent girls.

Methods: This research design was cross sectional observation conducted at SMAN 1 Denpasar, Bali. The samples were 119 adolescent girls that were selected by simple random sampling. Assessment of eating behavior used the adolescent food habit checklist, and eating disorders were assessed by EAT-26 questionnaire.

Results: The subjects were 119 adolescent girls. Most of them were 15 and 16 years old. There were 53.8% of subjects having unhealthy food behavior and 86.6% did not experience eating disorders. There were 75.6% of students having normal nutritional status, followed by thin, overweight, and obese respectively 3.4%, 15.1%, and 5.9%. There was a significant relationship between eating attitude with nutritional status of adolescent girls (p value = 0.04; PR (95% CI) = 2.15 (1.09-4.21)). There is also a significant relationship between eating disorder with nutritional status of adolescent girls (p value=0.01; PR (95% CI) = 2.45 (1.32-4.56))

Conclusion: This study found that eating behavior was not related to nutritional status. The condition of eating disorders has a significant relationship with adolescent nutritional disorders. Individuals with eating disorders have a greater risk of experiencing nutritional disorders than individuals without eating disorders.

Latar Belakang: Masalah gizi pada remaja baik undernutrition ataupun overnutrition di Indonesia cukuplah tinggi. Masalah gizi pada remaja bersifat multifaktorial, namun beberapa penelitian sebelumnya menunjukkan bahwa faktor perilaku makan yang tidak baik akan memicu eating disorder yang berhubungan dengan kualitas gizi remaja putri. Sejauh ini belum terdapat studi terkait hubungan eating disorder dengan status gizi remaja putri di Bali. penelitian ini bertujuan untuk menganalisis hubungan antara perilaku makan dan eating disorder terhadap status gizi pada remaja putri.

Metode: Desain penelitian yaitu observasi cross sectional yang dilakukan di SMAN 1 Denpasar, Bali. Sampel berjumlah 119 orang remaja putri berusia 14-18 tahun yang dipilih dengan simple random sampling. Penilaian perilaku makan menggunakan the adolescent food habbit checklist, dan gangguan makan dinilai menggunakan kuesioner EAT-26.

Hasil: Dari 119 subjek penelitian, dominasis siswi putri berusia 16 tahun. Sebanyak 53.8% remaja putri memiliki perilaku makanan yang tidak sehat dan 86.6% tidak mengalami eating disorder. Mayoritas siswi memiliki status gizi yang normal yaitu 75.6%, diikuti dengan status gizi kurus, gemuk, dan obesitas berturut-turut yaitu sebesar 3.4%, 15.1% dan 5.9%. Terdapat hubungan yang signifikan antara perilaku makan buruk dengan gangguan gizi (p value=0.049; PR(95%CI) = 0.52 (0.27-1.01)) dan terdapat pula hubungan yang signifikan antara eating disorder dengan gangguan gizi remaja putri (p value=0.01; PR (95% CI) = 2.45 (1.32-4.56))

Simpulan: Penelitian ini mendapatkan bahwa perilaku makan dan kondisi eating disorder memiliki hubungan signifikan dengan gangguan gizi remaja putri.  Individu dengan eating disorder memiliki risiko lebih besar mengalami gangguan gizi dibandingkan individu tanpa eating disorder.

Background: Urine urea nitrogen (UUN) is an examination of nitrogen balance with the concept of calculating the amount of urea excreted through urine. The amount of urea that comes out of the urine is in line with the amount of protein breakdown in the body and the amount of protein that enters the body. This study aimed to evaluate UUN levels on days 1, 3 and 7 as a predictor of mortality in burn patients >20%.

Methods: This study was an observational analytic retrospective study. Data were collected from January 2020 to December 2021. This study used secondary data from medical records of patients with IIAB-III degree burns with burn area > 20% TBSA treated at Prof. Dr. I. G. N. G. Ngoerah General Hospital for 2020-2021. Data were analyzed using SPSS version 21 for Windows.

Results: The majority of burn patients were male, about 73.9%. The average age of burn patients is 48.26±15.95 years. On the first examination day, the UUN value was still low (29.4 mg/24 hours). Then on the 3rd day, there was an increase in the average UUN level, namely the maximum value of 61,987 mg/24 hours. Examination on the 7th day showed an increase in line with the previous day, namely the maximum value of 57,489 mg/24 hours. On day 1, the mean UUN value was higher in patients who died, while on days 3 and 7 the mean UUN level in patients with living outcomes was higher than in patients who died, but not significantly (p>0.05).

Conclusion: Urine urea nitrogen levels on days 1, 3 and 7 in burn patients >20% at Prof. Dr. I. G. N. G. Ngoerah General Hospital showed an increasing trend. Urine urea nitrogen levels cannot be used to predict mortality in burn patients because the results were insignificant.

Latar Belakang: Urin urea nitrogen (UUN) merupakan pemeriksaan keseimbangan nitrogen yang berkonsep pada perhitungan jumlah urea yang dieksresikan lewat urin. Jumlah urea yang keluar bersama urine sejalan dengan jumlah pemecahan protein dalam tubuh serta jumlah protein yang masuk dalam tubuh. Penelitian ini bertujuan untuk mengevaluasi kadar UUN hari ke-1,3, dan 7 sebagai prediktor mortalitas pasien luka bakar >20%.

Metode: Studi ini merupakan studi retrospektif analitik observasional. Data dikumpulkan dari Januari 2020 hingga Desember 2021. Studi ini menggunakan data sekunder dari catatan rekam medis pasien luka bakar derajat IIAB-III dengan luas luka bakar > 20% TBSA yang dirawat di RSUP Prof. Dr. I. G. N. G. Ngoerah periode 2020-2021. Data dianalisis dengan SPSS versi 21 untuk Windows.

Hasil: Mayoritas pasien luka bakar berjenis kelamin laki-laki yaitu sebesar 73,9%. Usia rata-rata pasien luka bakar yaitu 48,26±15,95 tahun. Pada pemeriksaan hari pertama didapatkan nilai UUN masih rendah (29,4 mg/24 jam). Kemudian pada hari ke-3 didapatkan peningkatan rata-rata kadar UUN yakni nilai maksimum 61.987 mg/24 jam. Pemeriksaan pada hari ke-7 menunjukkan peningkatan yang sejalan dengan hari sebelumnya yakni nilai maksimum 57.489 mg/24 jam. Pada hari ke-1, nilai rerata UUN lebih tinggi pada pasien meninggal, sedangkan pada hari ke 3 dan 7 kadar rerata UUN pasien dengan luaran hidup lebih tinggi dibandingkan pasien yang meninggal, namun tidak bermakna secara signifikan (p>0,05).

Simpulan: Kadar UUN pada hari ke-1, 3 dan 7 pada pasien luka bakar >20% di RSUP Prof. Dr. I. G. N. G. Ngoerah menunjukkan adanya trend peningkatan. Kadar UUN tidak dapat dipakai sebagai prediktor mortalitas pada pasien luka bakar karena hasil tidak signifikan.