Background: Breast cancer is the most common type of cancer in women. Breast cancer can be treated with mastectomy surgery, chemotherapy, hormonal, radiation, and biological agent therapy. Surgery is the primary therapy for breast cancer. The most common surgical procedure is a mastectomy which can be continued with breast reconstruction after mastectomy surgery to improve the shape and close the breast defects. Breast reconstructions can be performed with breast implant surgery and autologous or “flap” reconstruction. Latissimus Dorsi (LD) flap is a pedicled flap often used for breast reconstruction. Mastectomy surgery and breast reconstruction complications are seromas, late hypertrophic scars, hematomas, pain, muscle weakness, and infections. This study aimed to describe the case series of latissimus dorsi flaps in breast cancer patients after mastectomy surgery.

Case presentation: The author presents 6 cases of breast cancer patients after mastectomy surgery performed breast reconstruction using an LD flap. Five patients had a history of surgery on the abdomen, and one did not have a history of abdominal surgery but had planned pregnancy in the future. There were no complications after LD flap reconstruction surgery. LD flap surgery may be accompanied by implants so that the shape and size can be close to another breast, but related to the cost, and the patients refuse to use a breast implant. All patients were given chemotherapy before surgery.

Conclusion: Breast reconstructive surgery is used to close defects after mastectomy surgery and can improve the quality of life of breast cancer patients. Pedicled LD flaps are one of the techniques often used for breast reconstruction cases because of rare complications of necrosis in the donor area or flaps.

Introduction: Multiple myeloma is the second most common hematological malignancy after non-Hodgkin's lymphoma with a case prevalence in Prof. Dr. I.G.N.G. Ngoerah Hospital for the 2013-2017 period was 4.64% with the most cases occurring in 2017 (33.3%), where 45.8% of multiple myeloma patients were in the age group of 51-60 years old. This study aims to describe a case of multiple myeloma monoclonal gammopathy lambda in a young adult male which is a very rare case.

Case Presentation: 35-year-old male patient whose laboratory and radiological findings supported a diagnosis of multiple myeloma, the right clavicle pain was the primary complaint, and radiological imaging revealed brittle bones. Furthermore, the examination of bone marrow aspiration smear, serum protein electrophoresis, routine hematology, erythrocyte sedimentation rate, clinical chemistry (such as calcium, uric acid, liver function tests, urea and creatinine), and radiological examination, such as the plain X-ray of bone) shows prominent and specific laboratory findings to confirm multiple myeloma.

Conclusion: The diagnosis of multiple myeloma was established with manifestations of bone lesions, serum protein electrophoresis and bone marrow biopsy were carried out for diagnosis based on the International Myeloma Working Group (IMWG) diagnostic criteria. Monitoring after administering six series of primary management of multiple myeloma in patient showed significant improvement from the results of laboratory evaluation, radiology, and bone marrow imaging.

Latar Belakang: Multiple myeloma adalah keganasan hematologis kedua yang paling umum setelah limfoma non-Hodgkin dengan prevalensi kasus di RSUP Prof. Dr. I.G.N.G. Ngoerah periode 2013-2017 adalah 4,64% dengan kasus terbanyak terjadi pada tahun 2017 (33,3%), dimana 45,8% pasien multiple myeloma berada pada kelompok umur 51-60 tahun. Studi ini bertujuan ini untuk mendeskripsikan kasus multiple myeloma monoklonal gamopati lambda pada seorang laki-laki dewasa muda yang merupakan kasus sangat jarang.

Presentasi Kasus: Pasien laki-laki berusia 35 tahun dengan hasil laboratorium dan radiologis mendukung diagnosis multiple myeloma, nyeri klavikula kanan adalah keluhan utama, dan pemeriksaan radiologi menunjukkan tulang rapuh. Selanjutnya pemeriksaan apusan aspirasi sumsum tulang, elektroforesis protein serum, hematologi rutin, laju endap darah, kimia klinik (seperti kalsium, asam urat, tes fungsi hati, ureum, dan kreatinin), dan pemeriksaan radiologis, seperti foto polos X- ray tulang) menunjukkan temuan laboratorium yang menonjol dan spesifik untuk mengkonfirmasi multiple myeloma.

Simpulan: Diagnosis multiple myeloma ditegakkan dengan manifestasi lesi tulang, telah dilakukan pemeriksaan elektroforesis protein serum dan biopsi sumsum tulang untuk penegakan diagnosis berdasarkan kriteria diagnostik International Myeloma Working Group (IMWG). Monitoring setelah pemberian enam seri tatalaksana primer multiple myeloma pada pasien didapatkan perbaikan yang signifikan dari hasil evaluasi laboratorium, radiologis, dan gambaran sumsum tulang.

Introduction: Supraventricular tachycardia (SVT) is one of the children's most common heart rhythm abnormalities. Episodes of SVT attacks in children are often recurring and, if not properly recognized, can be life-threatening. This case reports the incidence of SVT in children and its management, supported by a literature review

Case Description: A 1-year-old boy came to the hospital complaining of palpitations accompanied by an increase in carotid pulse and cold sweat 30 minutes before entering the hospital. The patient has a history of dilated cardiomyopathy and had the same complaint at the age of 6 months. On physical examination, blood pressure was 197/68 mmHg, pulse 235x/m, respiratory rate 32x/m accompanied by cold acral. The EKG showed SVT. Initial non-pharmacological management is carried out with vagal maneuvers, namely circular massage in the carotid sinus area for 10 seconds, followed by ice packs for 10 seconds. Then pharmacological cardioversion with amiodarone was carried out and continued with amiodarone maintenance therapy and treatment in the PICU room, as well as chest X-ray investigations and echocardiography.

Conclusion: Diagnosis of SVT is based on a detailed history and physical examination. EKG and echocardiography should be performed in children suspected of having SVT. Successful elimination of SVT results in improved quality of life in pediatrics regarding physical, emotional, social, school and psychosocial functioning.

Pendahuluan : Supraventricular tachycardia (SVT) merupakan salah satu kelainan irama jantung yang paling sering muncul pada anak. Episode serangan SVT pada anak sering berulang dan jika tidak dikenali dengan baik dapat mengancam nyawa. Kasus ini melaporkan kejadian SVT pada anak serta manajemen yang dilakukan dengan ditunjang telaah pustaka

Laporan Kasus : Laki-laki usia 1 tahun datang ke ke rumah sakit dengan keluhan berdebar disertai peningkatan pulsasi nadi karotis dan keringat dingin sejak 30 menit sebelum masuk rumah sakit. Pasien memiliki riwayat kardiomiopati dilatasi dan sempat mengalami keluhan yang sama pada usia 6 bulan. Pada pemeriksaan fisik didapatkan tensi 97/68 mmHg, nadi 235x/m, laju napas 32x/m disertai dengan akral dingin. Pada EKG ditemukan gambaran SVT. Tatalaksana awal non-farmakologi dilakukan dengan vagal manuver yaitu pemijatan sirkular di area sinus karotis selama 10 detik dan dilanjutkan dengan kompres es selama 10 detik. Dilakukan kardioversi farmakologis dengan amiodaron dan dilanjutkan terapi rumatan amiodaron. Dilakukan pemeriksaan penunjang rontgen thorax dan echocardiografi pada pasien.

Kesimpulan : Untuk menegakkan diagnosis SVT,  anamnesis terperinci dan pemeriksaan fisik sangat penting untuk dilakukan. EKG dan ekokardiografi harus dilakukan pada anak yang diduga menderita SVT. Keberhasilan eliminasi SVT menghasilkan peningkatan kualitas hidup pediatrik mengenai fungsi fisik, emosional, sosial, sekolah dan psikososial.

Introduction: Pulmonary hypertension (PH) is a pathological disorder of the pulmonary vessels that results in various clinical manifestations and causes cardiovascular and respiratory complications. This case report will discuss patients with heart failure due to rheumatic heart disease with severe mitral stenosis, moderate aortic stenosis, moderate-severe aortic regurgitation, severe tricuspid stenosis and the role of sildenafil in the preoperative period in patients with left heart valve disease with PH.

Case Description: A 40-year-old man came to the polyclinic complaining of fatigue and shortness of breath 6 months ago. From a regular S1 S2 heart examination, there was a murmur, and no signs of congestion were found in the patient. Electrocardiography showed 94 beats per minute sinus rhythm with poor R wave progression. On echocardiography found, patients with severe mitral stenosis, moderate aortic stenosis and regurgitation, and severe tricuspid regurgitation, with decreased LV systolic function and RV systolic function. The patient was planned for DVR + TV repair by a Cardiothoracic Surgeon. During the 24 hours preoperatively, the patient was given sildenafil 20 mg every 8 hours, which was continued for 72 hours postoperatively. The patient started mobilization on the third postoperative day, and there were no significant complications during the hospitalization. The patient was discharged on the 10th postoperative day with a total stay of 12 days.

Discussion: In patients with PH associated with left heart disease, the main strategy for repairing HP is to treat the underlying left heart condition. This also applies to significant left valve disease. One of the PH therapy options related to heart valve disease is sildenafil. Sildenafil relaxes pulmonary vascular smooth muscle and reduces pulmonary arterial pressure in various types of PH. Studies have shown that preoperative use of sildenafil significantly affects patients with PH associated with valvular heart disease. The administration of sildenafil is also effective for use postoperatively to reduce the need for postoperative inotropic support and reduce postoperative ventilation time.

Conclusion: One of the PH therapy options related to heart valve disease is sildenafil because of its effectiveness and relatively safe use before and after surgery.

Pendahuluan: Hipertensi Pulmonal (HP) merupakan kelainan patologis pada pembuluh darah paru yang mengakibatkan berbagai manifestasi klinis dan menimbulkan komplikasi kardiovaskular maupun respirasi. Pada laporan kasus akan dibahas pasien yang mengalami gagal jantung karena penyakit jantung rematik dengan stenosis mitral berat, stenosis aorta sedang, regurgitasi aorta sedang-berat, stenosis trikuspid berat serta peranan sildenafil pada masa pre-operatif pasien penyakit katup jantung kiri dengan HP.

Deskripsi Kasus:  Laki-laki usia 40 tahun, datang ke poliklinik jantung dengan keluhan cepat lelah dan mudah sesak sejak 6 bulan yang lalu. Dari pemeriksaan jantung S1 S2 reguler didapatkan adanya murmur dan tidak ditemukan tanda kongesti pada pasien Elektrokardiografi menunjukkan irama sinus 94 kali per menit dengan poor R wave progression. Pada ekokardiografi didapatkan pasien dengan stenosis mitral berat, stenosis dan regurgitasi aorta sedang, regurgitasi trikuspid berat, dengan fungsi sistolik LV dan fungsi sistolik RV yang menurun. Pasien direncanakan untuk tindakan double valve replacement dan tricuspid valve repair oleh sejawat Bedah Thoraks Kardiovaskular. Saat 24 jam pre operasi, pasien diberikan sildenafil 20 mg tiap 8 jam yang diteruskan hingga 72 jam pasca operasi. Pasien memulai mobilisasi pada hari ketiga pasca operasi dan tidak ada komplikasi signifikan yang dialami pasien selama rawat inap. Pasien dipulangkan pada hari ke 10 pasca operasi dengan total lama rawat 12 hari.

Diskusi: Salah satu opsi terapi HP terkait dengan penyakit katup jantung adalah sildenafil. Sildenafil merelaksasi otot polos pembuluh darah pulmonal dan menurunkan tekanan arteri paru pada berbagai jenis HP. Penelitian-penelitian menunjukkan penggunaan sildenafil sebelum operasi memiliki efek yang signifikan pada pada pasien dengan HP yang terkait dengan penyakit katup jantung. Pemberian sildenafil juga efektif digunakan pasca operasi sehingga dapat mengurangi kebutuhan akan dukungan inotropik pasca operasi dan mengurangi waktu ventilasi pasca operasi.

Simpulan: Sildenafil merupakan salah satu opsi terapi HP terkait dengan penyakit katup jantung dikarenakan efektivitasnya dan penggunaanya relatif aman untuk digunakan baik sebelum tindakan operasi maupun setelah tindakan operasi.

Introduction: Coronavirus disease 2019 (COVID-19) has a variety of manifestations, from asymptomatic to acute illness that can affect several organs, although being primarily associated with the respiratory system. The virus binds to angiotensin-converting enzyme-2 (ACE-2) receptors in humans and the expression of ACE-2 in heart and kidneys explains the association of COVID-19 with the renal and cardiovascular systems.

Case description: Male, 62-year-old, was admitted to the emergency room (ER) for presented shortness of breath, angina pain, and gastric pain. He was a smoker and denied having comorbidities. At arrival, an examination of vital signs and physical showed tachypnea, tachycardia, hypertension, and bilateral crackles. The electrocardiography (ECG) showed left ventricular hypertrophy and Non-ST-Elevation in anterolateral. The chest x-ray showed pneumonia and cardiomegaly. Laboratory findings showed that decreased renal function and Polymerase Chain Reaction (PCR) test was positive, and increased in serum Troponin level supported the diagnosis of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2) pneumonia with Non-ST elevation myocardial infarct (NSTEMI) and Acute Kidney Injury (AKI). Loading of Aspilet, Clopidogrel, Atorvastatin, and Thrombolysis with Fondaparinux was done. The following day, transthoracic echocardiography was performed anterolateral regional wall motion abnormality with 43% of Left Ventricle Ejection Fraction (LVEF). Two weeks after hospital discharge, the echocardiography evaluation showed no improvement and was diagnosed with Chronic Heart Failure with New York Heart Association (NYHA) Functional Classification II et causa Coronary Artery Disease.

Conclusion: Treatment of covid-19 patients with cardiovascular and renal complications is quite challenging since there is no specific guideline for COVID-19 patients with renal and cardiovascular complications.

Background: Condyloma lata is a form of secondary syphilis that manifest in moist, flat, firm boundaries papules or plaques with macerated surface that resembles the appearance of bowenoid papulosis. Differentiating this disease requires supporting examinations so that appropriate treatment can be determined. This case report discusses a case of condyloma lata, which was originally suspected to be bowenoid papulosis and accompanied by balanitis candida.

Case: A 14 years teenage boy, complained of warts near the anus and white spots on the gland penis since 1 month ago. Dermatovenereology examination on the perianal region showed a hyperpigmented solitary plaque, well-defined margin, geographic shape, flat surface and a solitary ulcer at the edges. On the glans penis, multiple white plaques, well defined, geographic shape, moist surface. Acetowhite examination was negative and a dark field microscope (DFM) examination of perianal lesions found Treponema pallidum. The potassium hydroxide examination on the glans penis found pseudohyphae and blastospores. Gram examination was found normal. The VDRL serology examination was reactive (1:64), and the TPHA was found to be reactive. The patient was diagnosed with condyloma lata coinfection with balanitis candida. Treatment involves a single intramuscular injection of benzathine penicillin 2.4 million IU and fluconazole 150 mg capsules intraorally single dose. Observations within 1 month showed clinical improvement in condyloma lata and balanitis.

Conclusion: This case provides an understanding of condyloma lata's clinical course, which mimics other diseases in an immunocompetent patient. Treatment based on etiology provides a good clinical improvement in patients.

Latar belakang: Kondiloma lata merupakan suatu bentuk sifilis sekunder yang dapat bermanifestasi berupa papul maupun plak yang lembab, datar, berbatas tegas dengan permukaan maserasi. Bowenoid papulosis adalah penyakit yang menyerupai gambaran kondiloma lata. Membedakan penyakit ini diperlukan pemeriksaan penunjang sehingga dapat menentukan pengobatan yang sesuai. Laporan kasus ini membahas kasus kondiloma lata yang semula diduga bowenoid papulosis dan disertai balanitis candida pada remaja laki-laki.

Kasus: Seorang remaja laki-laki, usia 14 tahun, mengeluhkan adanya kutil di dekat dubur dan bercak putih pada kelamin sejak 1 bulan yang lalu. Status dermatovenereologi pada regio perianal didapatkan plak soliter hiperpigmentasi, batas tegas, bentuk geografika, permukaan rata dan di tepinya terdapat ulkus soliter. Pada glans penis didapatkan plak putih multipel, berbatas tegas, bentuk geografika, permukaan lembab. Pemeriksaan acetowhite didapatkan negatif, pemeriksaan dark field microscope (DFM) pada lesi perianal didapatkan Treponema pallidum. Pemeriksaan kalium hidroksida (KOH) pada glans penis didapatkan adanya pseudohifa dan blastospora. Pemeriksaan gram pada glans penis tidak ditemukan adanya leukosit, kokus gram positif maupun batang gram negatif. Pemeriksaaan serologi Venereal Disease Research Laboratory (VDRL) reaktif 1:64  dan Treponema Pallidum Haemagglutination Assay (TPHA) didapatkan reaktif. Pasien didiagnosis kondiloma lata disertai balanitis candida. Penatalaksanaan dengan injeksi benzatin penisilin 2,4 juta IU intramuskular  dosis tunggal  dan flukonazol kapsul 150 mg intraoral dosis tunggal. Pengamatan dalam 1 bulan didapatkan perbaikan klinis pada kondiloma lata dan balanitis.

Simpulan: Kasus ini memberikan pemahaman mengenai klinis kondiloma lata yang menyerupai dengan penyakit lain dan disertai koinfeksi candida pada pasien imunokompeten. Penanganan berdasarkan etiologi memberikan perbaikan klinis yang baik pada pasien.

Background: Pancreatic cancer is the seventh leading cause of cancer death globally according to the 2020 Global Cancer Statistics. Pancreatic cancer does not show clear clinical signs in its early stages and it is usually diagnosed in the advanced phase with poor response to treatment. The risk is increased in smokers, black race, high-fat diet, alcohol, the elderly, the presence of infection, diabetes mellitus, and chronic pancreatitis.

Case report: We report a 72-year-old female patient with complaints of abdominal enlargement and jaundice. Patients also with complain of light colored stools and dark urine. Physical examination revealed tenderness on palpation of the right upper quadrant of the abdomen accompanied by an enlarged liver. Laboratory examination revealed anemia accompanied by an increase in total bilirubin with predominance in direct bilirubin. HbsAg examination showed positive results. Ultrasound examination showed a mass in the head of the pancreas with dilatation of the common bile duct to the intrahepatic bile duct and there was a hydrops gallbladder. Abdominal CT scan showed a well-defined contrast-enhanced mass measuring 36 cm x 4.4 cm x 6 cm in the head area.

Conclusion: Pancreatic head cancer is a rare type of cancer, but has a high malignancy. Establishing the correct diagnosis is generally difficult. This is because symptoms generally appear after the cancer has reached an advanced stage.

Latar Belakang: Kanker pankreas menjadi penyebab kematian ketujuh terbanyak akibat kanker secara global menurut Global Cancer Statistics tahun 2020. Kanker pankreas tidak menunjukkan tanda-tanda klinis yang jelas pada fase awal dan biasanya didiagnosis pada fase lanjut dengan respon yang buruk terhadap pengobatan. Risiko meningkat pada perokok, ras kulit hitam, diet tinggi lemak, alkohol, lansia, adanya infeksi, diabetes mellitus, dan pankreatitis kronis.

Laporan kasus: Kami melaporkan seorang pasien wanita berusia 72 tahun dengan keluhan keluhan pembesaran abdomen dan jaundice. Pasien juga dengan keluhan feses berwarna terang dan urin gelap. Ditemukan nyeri tekan pada palpasi kuadran kanan atas abdomen disertai pembesaran hati. Pemeriksaan laboratorium didapatkan anemia disertai peningkatan pada bilirubin toal dengan dominan pada bilirubin direk. Pemeriksaan HbsAg menunjukkan hasil positif. Pemeriksaan ultrasonograafi menunjukkan adanya massa pada caput pancreas dengan dilatasi common bile duct hinga intrahepatic bile duct dan terdapat hydrops gall bladder. Pemeriksaan CT scan abdomen menunjukkan massa menyangat kontras berbatas tegas ukuran  36 cm x 4,4 cm x 6 cm di daerah caput.

Kesimpulan: Kanker caput pancreas merupakan jenis kanker yang tergolong jarang, namun memiliki keganasan yang tinggi. Penegakan diagnosis yang tepat pada umumnya mengalami kesulitan. Hal ini disebabkan karena gejala pada umumnya muncul setelah kanker telah mencapai stadium lanjut.

Introduction: Multiple Sclerosis (MS) is a chronic autoimmune disorder of the central nervous system characterized by lesions that predominantly attack the brain, optic nerves and spinal cord. The incidence of MS in Asia and Oceania is rare, but with the evolution of diagnostic modalities, the incidence of MS is increasing.

Case Presentation: This is a case report of multiple sclerosis; A 42-year-old Balinese male patient presenting with being unable to walk since 3 months ago as the chief complaint accompanied by tingling, a blurred eye and dripping urine. During the last ten years these complaints lasted for several months but improved on their own without treatment. The physical examination showed visual loss, paraparesis, sensory disturbances, cerebellar ataxia, and urinary incontinence. The patient underwent an MRI and showed lesions suggestive of MS. The patient was diagnosed as MS and treated with methyl-prednisolone 3x16 mg for 3 month and was referred to a medical rehabilitation unit. After one month of treatment, the patient's condition getting better.

Conclusion: This case report provides a deeper understanding of MS as an autoimmune disease of the central nervous system that is rarely found and often misdiagnosed in primary health care, so that knowledge regarding early diagnosis and early management of MS patients should be widely known to prevent worsening of the condition and suppress recurrence rates.

Pendahuluan: Sklerosis multipel (multiple sclerosis/MS) merupakan kelainan autoimun kronis pada sistem saraf pusat yang ditandai dengan lesi-lesi yang predominan menyerang otak, nervus optikus dan medula spinalis. Kejadian MS di benua Asia dan Oseania diketahui jarang ditemukan, namun seiring terjadinya evolusi modalitas diagnostik insiden MS makin tahun ditemukan semakin meningkat.

Laporan Kasus: Laporan kasus ini mengenai sklerosis multipel; Pasien laki-laki 42 tahun, suku bali, datang dengan tidak bisa berjalan sejak 3 bulan yang lalu sebagai keluhan utama, disertai dengan kesemutan pada tangan dan kaki kiri, mata kanan kabur dan urin menetes. Selama sepuluh tahun terakhir keluhan-keluhan tersebut hilang timbul, berlangsung dan menetap selama beberapa bulan namun membaik dengan sendirinya tanpa pengobatan. Hasil pemeriksaan fisik menunjukkan visual loss mata kanan, paraparese, gangguan sensorik, ataksia serebelar, serta inkotinensia urin. Pasien dilakukan MRI dan hasil menunjukkan lesi sugestif MS. Pasien ditegakkan sebagai MS dan diterapi menggunakan metil-prednisolon 3x16 mg selama 3 bulan dan dikonsulkan ke unit rehabilitasi medis. Pasca satu bulan pengobatan, keluhan-keluhan pasien dikatakan membaik.

Conclusion: Laporan kasus ini memberikan pemahanan lebih mendalam mengenai MS sebagai suatu penyakit autoimun pada sistem saraf pusat yang jarang ditemukan dan kerap terjadi misdiagnosis di layanan kersehatan primer, sehingga pengetahuan mengenai diagnosis awal dan tatalaksana awal pada pasien MS sebaiknya diketahui secara luas untuk mecegah perburukan kondisi dan menekan angka kekambuhan.

Background: The high use and pressure on the knee cause osteoarthritis to occur frequently. Prolotherapy is a non-surgical injection therapy used to treat chronic pain in musculoskeletal conditions, including knee OA. This solution can create local irritation, inflammation, and tissue regeneration, thereby increasing the strength of damaged ligaments, tendons, and intra-articular structures. Therefore, the aim of this research is to assess the changes in VAS and WOMAC scores, as well as plain radiographs of knee OA patients after hypertonic dextrose prolotherapy.

Methods: This experimental case series was done at the Physical Medicine and Rehabilitation Polyclinic of dr. Ramelan Navy Hospital Surabaya from December 2021 to April 2022, by giving hypertonic dextrose prolotherapy injection intraarticularly to 3 knee OA subjects using a 22G or 23G needle. This procedure was performed 3 times on each subject, with an interval of 4 weeks each. The assessments were carried out with VAS and WOMAC scores, as well as plain radiographs of the knees before the procedure and 1 month after the third injection for evaluation.

Results: In all 3 subjects, the knee joint spaces were slightly widened on plain radiographs, as well as decreased VAS and WOMAC scores after injection.

Conclusion: Hypertonic dextrose prolotherapy here had minimal side effects, affordable prices, and a fast process. It also causes a reduction in pain and joint stiffness and causes functional improvement. Prolotherapy may be considered a therapy for knee OA patients.

Introduction: Breast cancer is the most prevalent form of malignancy in women, with over two million new cases yearly. The complex instance of advanced breast cancer with visceral crisis occurs when cancer has spread to vital organs such as the liver, lungs, and brain. This case report aims to teach us how to prevent visceral crisis, which will increase mortality, particularly in advanced breast cancer.

Case presentation: A 50-year-old woman who presented with complaints of shortness of breath was diagnosed with advanced breast cancer and visceral crisis. On examination, there were indications of hypervolemia, including a rightward displaced trachea and diminished vocal fremitus. The anatomical pathology results revealed a grade II invasive breast carcinoma. (Luminal B HER2 negative). X-rays of the chest reveal bilateral pleural effusion. The lumbosacral X-ray and abdominal ultrasonography both revealed liver metastases. Before intra-thoracic metastases and visceral crisis, the patient received hormonal therapy (tamoxifen). When intra-thoracic metastases and visceral problems occurred, the treatment was substituted with capecitabine for 3 months. However, capecitabine was discontinued because the cancer spread to the bones and liver. Patients were administered chemotherapy using docetaxel following NCCN and ESMO guidelines. The patient perished during chemotherapy with docetaxel due to complications from the disease and adverse effects.

Conclusion: Patients with advanced breast cancer who are not appropriately treated run a high risk of developing visceral crisis complications. Therefore, it is crucial that clinicians provide education about routine examinations and adhere to established evaluation procedures in order to prevent these complications.

Latar Belakang: Kanker payudara adalah jenis keganasan yang paling umum terjadi pada wanita dengan lebih dari dua juta kasus per tahun. Kanker payudara stadium lanjut dengan krisis viseral merupakan kasus yang kompleks, dimana kanker menyebar ke organ vital seperti hati, paru-paru dan otak. Tujuan diangkatnya laporan kasus ini adalah menjadi pembelajaran bagi kita bagaimana upaya untuk mencegah kondisi krisis viseral terutama pada kanker payudara stadium lanjut yang akan meningkatkan mortalitas.

Presentasi kasus: Seorang perempuan berusia 50 tahun datang dengan keluhan sesak nafas, pasien terdiagnosa kanker payudara stadium lanjut dengan krisis viseral. Pada pemeriksaan didapatkan adanya tanda-tanda hipervolemia, trakea terdorong ke kanan, penurunan fremitus vokal. Hasil patologi anatomi didapatkan gambaran invasive carcinoma mammae grade II. (Luminal B HER2 negative). Gambaran rontgen thorax menunjukkan adanya efusi pleura bilateral. Hasil rontgen lumbosakral didapatkan metastasis ke tulang dan pada ultrasonografi abdomen didapatkan metastasis hati. Sebelumnya pasien mendapatkan terapi hormonal (tamoxifen), dan pada saat terjadi metastasis intra thoracal serta krisis viseral terapi diganti dengan capecitabine selama 3 bulan namun terjadi progresifitas berupa penyebaran ke tulang dan hati, selanjutnya capecitabine dihentikan. Pasien diberikan kemoterapi berupa docetaxel sesuai guidelines pada NCCN dan ESMO. Selama masa kemoterapi menggunakan docetaxel akhirnya pasien meninggal dunia akibat komplikasi penyakit dan efek samping.

Kesimpulan: Pasien yang menderita kanker payudara stadium lanjut dapat mengalami komplikasi krisis viseral yang berisiko tinggi jika tidak ditangani dengan tepat. Oleh karena itu, laporan kasus ini sangat penting bagi klinisi untuk memberikan edukasi tentang pemeriksaan rutin dan mematuhi prosedur evaluasi yang ditetapkan guna mencegah terjadinya komplikasi tersebut.

Background: Heteropagus or parasitic twin is a rare congenital anomaly that affects two connected children with imprecisely understood anatomy and physiology. This case report aims to describe a thoracopagus patient with severe complications.

Case presentation: One-day-old female baby was born with thoracopagus and omphalocele rupture. She was the third child, born aterm from a 36-year-old mother, with a birth weight of 3000 grams. Laboratory and radiography examinations showed leukocytosis, metabolic acidosis, prolonged coagulation profile, acute kidney injury, hypoglycemia, transaminitis, and congenital heart defects. She was treated in the intensive care unit and managed conservatively. Unfortunately, she died on the sixth day of treatment due to severe complications.

Conclusion: Conjoined twins have a poor prognosis. If it is coupled with other congenital anomalies, it will worsen the outcome.

Background: Bee sting venom is quite common in Indonesia. Allergic reactions at the sting site such as edema, erythema, itching and burning sensations are common manifestations of bee venom poisoning. In this case report, we report a 68-year-old man with a bee bite and experiencing complications in the form of a neurological deficit.

Case Presentation: A 68-year-old man was brought by his family to the Dustira Hospital Emergency Room because of complaints of decreased consciousness. The sudden loss of consciousness was felt by the family and the right-side experienced weakness. The patient cannot communicate, understand the contents of the other person's speech or speak to express his intentions. On physical examination, the patient was found to be somnolent with a blood pressure of 150/90mmHg and a temperature of 37.9 degrees Celsius. On neurological examination, a decrease in motor strength was found. On CT scan without contrast, an infarction was found in the cortical subcortical area in the left temporoparietooccipital region (embolism).

Conclusion: Unusual and more severe complications have also been seen such as anaphylactic shock, myocardial infarction, acute renal failure, pulmonary hemorrhage and atrial fibrillation. Neurologic complications are rare in bee venom poisoning.

Latar Belakang: Racun sengatan lebah cukup umum di Indonesia. Reaksi alergi di tempat sengatan seperti edema, eritema, sensasi gatal dan rasa terbakar adalah manifestasi yang umum terjadi dari keracunan racun lebah. Dalam laporan kasus ini kami laporkan seorang laki-laki usia 68 tahun dengan gigitan lebah dan mengalami komplikasi berupa defisit neurologis.

Presentasi Kasus: Seorang laki-laki berusia 68 tahun dibawa oleh keluarga ke Instalasi Gawat Darurat RS Dustira karena keluhan penurunan kesadaran. Penurunan kesadaran dirasakan keluarga mendadak dan sisi sebelah kanan mengalami kelemahan. Pasien tidak dapat berkomunikasi, memahami isi pembicaraan lawan bicara maupun berbicara mengutarakan maksudnya. Pada pemeriksaan fisik pasien ditemukan kesadaran pasien somnolen dengan tekanan darah 150/90mmHg dan suhu 37,9 derajat Celcius. Pada pemeriksaan neurologi ditemukan penurunan kekuatan motorik. Pada pemeriksaan CT-Scan tanpa kontras didapatkan infark di daerah kortikal subkortikal regio temporoparietooksipital sinistra (emboli).

Kesimpulan: Komplikasi yang tidak biasa dan lebih parah juga terlihat seperti syok anafilaksis, infark miokard, gagal ginjal akut, perdarahan paru dan fibrilasi atrium. Komplikasi neurologi jarang terjadi pada keracunan racun lebah.

Background: Nowadays, there are a lot of treatment options available for dry eye syndrome (DES) or disease (DED). Autologous Serum Eye Drops (ASEDs) is one of the options that offer a potential advantage over conventional therapy. Biochemical elements in ASEDs resemble real tears and act as a lacrimal substitute to provide lubrication. As a severe dry eye treatment, using ASEDs has grown in favor.

Aim: This review aims to deliver knowledge from the current literature on applying ASEDs for dry eye disease in the medical worker.

Method: The method used was a literature review. A comprehensive search was performed on Pubmed and Google Scholar databases in December 2022 using each of the following keywords “ASEDs”, “serum”, “eyedrop”, “DED” and “DES”.

Conclusion: Dry eye disease is incurable and symptom management is the focus of therapy.     Studies have shown that ASEDs reduced dry eye symptoms in over 60% of patients by inhibiting the release of inflammatory cytokines and increasing the number of goblet cells and mucin expression in the conjunctiva. The serum eye drop is typically well tolerated and can be one of the best treatment options for severe DED due to its close resemblance to tears, preservatives free and minimum side effects. 

Collaboration is needed to provide comprehensive services in dealing with complex health problems. However, collaboration in the world of health in Indonesia is still not optimal. So early learning is needed to increase the effectiveness of collaboration, one of which is by organizing interprofessional education (IPE). IPE is a collaborative learning process that involves educators and students from two or more health professions and basic disciplines. IPE can provide various benefits, including training cooperation, communication, leadership, and respect for other professions. With the implementation of the IPE program since college, it is hoped that it will be a provision for students when carrying out professional activities. This study aims to assess communication and teamwork's ability to implement IPE. The method in this study was a literature review, with 19 articles that met the inclusion criteria. Based on a review of several literatures, it was found that implementing IPE can improve communication skills and teamwork.

Dalam menghadapi permasalahan kesehatan yang kompleks, diperlukan kolaborasi guna memberikan pelayanan yang komprehensif. Namun, kolaborasi di dunia kesehatan Indonesia masih belum maksimal. Sehingga diperlukan pembelajaran sejak dini untuk meningkatkan efektivitas kolaborasi, salah satunya dengan penyelenggaraan interprofessional education (IPE). IPE merupakan proses pembelajaran kolaboratif yang melibatkan pendidik dan peserta didik dari dua atau lebih profesi kesehatan dan disiplin dasar. IPE dapat memberikan berbagai manfaat mulai dari melatih kerjasama, komunikasi, kepemimpinan, dan menghormati profesi lain. Dengan penerapan program IPE sejak kuliah, diharapkan dapat menjadi bekal mahasiswa saat menjalani kegiatan profesi. Penelitian ini bertujuan untuk menilai kemampuan komunikasi dan kerjasama tim dalam pelaksanaan IPE. Metode pada studi ini adalah tinjauan literatur, dengan 19 artikel yang memenuhi kriteria inklusi. Berdasarkan kajian terhadap beberapa literatur, didapatkan bahwa pelaksanaan IPE dapat meningkatkan kemampuan komunikasi dan kerjasama tim.

Candida auris is a fungal pathogen that can cause emerging infectious disease and infections related to health services (healthcare-associated infections) and threaten global health. It is one of the causes of candidemia, which has been connected to outbreaks and high mortality rates in medical facilities all over the world. Hospitalized patients who are critically ill, primarily in intensive care unit settings, account for the majority of reported infections. C. auris can be multi-resistant to various antifungal classes commonly used to treat other Candida infections. Invasive infection due to C. auris causes high mortality and morbidity rates. C. auris easily survives long enough in the surrounding environment to cause the rapid spread of outbreaks in health facilities. The critical need for novel, candidate antifungal medicines for C. auris therapies is driven by the pathogenicity, drug resistance, and widespread distribution of C. auris. In limiting the spread of C. auris, prompt investigations and aggressive interventions are required. These include alerting public health agencies, implementing contact precautions, thoroughly cleaning and disinfecting the environment, performing infection control assessments, tracing and screening contacts for colonization, reviewing the history of microbiology tests, and conducting prospective surveillance for cases at labs. C. auris poses a unique challenge in clinical settings due to its identification challenges, multidrug resistance traits, evolution of virulence factors, associated high patient fatality rates, and long-term survival on surfaces in the environment. This study aims to understand the epidemiology, clinical manifestations, characteristics, virulence factors, methods of identification, therapy and prevention control of infection by C. auris.

Background: Obesity in children is a serious health problem with a rapidly increasing global prevalence. Children with obesity are at high risk of developing several metabolic diseases as adults. Studies show that short sleep duration is a risk factor for obesity. Short sleep duration will affect the diurnal rhythm and disrupt homeostasis and energy metabolism. This systematic review aims to determine the relationship between sleep duration and obesity in children.

Methods: A systematic literature review was carried out by literature searching on PubMed and Google Scholar using the PRISMA diagram and based on the eligibility criteria in selecting literature. The study was limited to the last five years (2017-2021). Studies that met the criteria were included in the analysis.

Results: There were 17 studies included in the analysis with cross sectional studies, prospective cohorts and clinical trials study designs regarding the relationship between sleep duration and obesity in children. All studies show a strong association between sleep duration and obesity in children and adolescents. The underlying mechanism is short sleep duration affects the balance of hormones controlling hunger and appetite so that appetite increases and causes excess energy intake, resulting in obesity. Children with short sleep duration are 2-4 times more prone to obesity compared to children with normal sleep duration.

Conclusion: There is a significant relationship between sleep duration and obesity in children and adolescents. Adequate sleep duration is recommended to prevent obesity and the risk of metabolic and cardiovascular diseases.

Introduction: Diabetes mellitus (DM) is a health problem that is increasing globally. In 2021, about 19,4 million people in Indonesia were living with DM. This number is predicted to rise to 28.5 million by 2045. The main modifiable risk factors for DM are diet and physical activity. One dietary factor that has not been comprehensively studied is water intake.

Objective: This review aims to demonstrate the effect of water intake to type 2 DM.

Methods: The design used in this study is a literature review. The literature review was done using the PubMed Central® search engine.

Results: Hormone arginine vasopressin (AVP) only known as hormone which play a role in maintaining fluid balance and not linked in glucose metabolism, previously. Through copeptin as a surrogate marker, AVP levels in plasma can be known. When water intake is insufficient to maintain plasma osmolality, AVP will be released. Several researches show unusual role of AVP in glucose metabolism. Increased AVP will stimulate AVP receptors, thereby increasing glycogenolysis and gluconeogenesis and decreasing insulin sensitivity. Increased copeptin is linked to an increased risk of insulin resistance, DM, and metabolic syndrome. By giving more water to individuals with low water drinking habits, as seen from high plasma copeptin values, has proven effective in reducing copeptin and plasma glucose.

Conclusion: Low water intake may increase risk factor for the development of type 2 DM. Individual needs to comply water intake recommendation to reduce the risk of type 2 DM. 

Pendahuluan: Diabetes melitus (DM) merupakan permasalahan kesehatan yang semakin meningkat di dunia. Penderita DM di Indonesia pada tahun 2021 mencapai 19,4 juta jiwa dan diperkirakan akan terus meningkat mencapai 28,5 juta jiwa pada tahun 2045. Faktor risiko utama yang dapat dimodifikasi pada penyakit DM adalah diet dan aktivitas fisik. Satu faktor diet yang belum dipelajari secara komprehensif adalah asupan air putih.

Tujuan: Tinjauan ini bertujuan untuk memberikan ulasan pengaruh asupan air putih terhadap DM tipe 2.

Metode: Metode penelitian yang digunakan adalah tinjauan pustaka. Tinjauan literatur dilakukan dengan menggunakan mesin pencari PubMed Central®.

Hasil: Sebelumnya, hormon arginin vasopresin (AVP) diketahui hanya berperan dalam menjaga keseimbangan cairan dalam tubuh dan tidak terkait dengan metabolisme glukosa. Kadar AVP dapat diketahui melalui kopeptin dalam plasma sebagai penanda pengganti AVP. Ketika asupan air putih tidak cukup untuk mempertahankan osmolalitas plasma, AVP akan dilepaskan. Beberapa penelitian menunjukkan ternyata terdapat peran yang tidak biasa dari AVP dalam metabolisme glukosa. Peningkatan AVP akan menstimulasi reseptor-reseptor AVP sehingga meningkatkan glikogenolisis dan glukoneogenesis serta penurunan sensitivitas insulin. Peningkatan kopeptin berkaitan dengan peningkatan risiko resistensi insulin, diabetes, dan sindrom metabolik. Dengan intervensi pemberian air putih pada individu yang memiliki kebiasaan minum air putih rendah, yang terlihat dari kopeptin plasma yang tinggi, terbukti efektif dalam menurunkan kopeptin dan glukosa plasma.

Kesimpulan: Asupan air yang rendah dapat meningkatkan risiko terjadinya DM tipe 2. Individu perlu mematuhi rekomendasi asupan air putih agar mengurangi risiko DM tipe 2.

The mediastinum is an anatomical space between the lungs that houses the thymus, heart, great vessels, lymph nodes, nerves, and parts of the esophagus and trachea. One of the biggest problems of the mediastinal cavity is mediastinal tumors. Mediastinal tumors have a wide variety of clinical conditions. Difficulties in diagnosing masses in the anterior mediastinal caused by non-specific symptoms and various etiologies can make it difficult to determine the best management for patients. Some masses in the anterior mediastinum that need to be known are thymoma, lipoma, lymphangioma, carcinoma and adenoma. This article aims to describe the various etiologies of masses in the anterior mediastinum along with the management that can be done so that clinicians can provide better treatment.

Mediastinum merupakan sebuah ruang anatomi antara paru-paru yang menampung timus, jantung, pembuluh darah besar, kelenjar getah bening, saraf, dan bagian kerongkongan dan trakea. Salah satu masalah terbesar dari rongga mediastinum yaitu tumor mediastinum. Tumor mediastinum memiliki keragaman yang luas dari kondisi klinis penyakit. Kesulitan dalam mendiagnosis massa pada mediastinal anterior disebabkan oleh gejala yang tidak spesifik dan etiologi yang beragam dapat menjadi penyulit dalam menentukan tatalaksana terbaik bagi pasien. Beberapa massa di mediastinum anterior yang perlu diketahui ialah timoma, lipoma, limfangioma karsinoma dan adenoma. Artikel ini bertujuan untuk memaparkan berbagai etiologi dari massa di mediastinum anterior disertai tatalaksana yang dapat dilakukan sehingga klinisi dapat memberikan penanganan yang lebih baik.

Introduction: Diabetic retinopathy is diabetes mellitus complication which progressively causes microvascular changes in the retina, causing physical and psychosocial impact. According to WHO, diabetic retinopathy ranks fourth in causing blindness with fairly high incidence in Indonesia, namely 42%. There are several risk factors in increasing diabetic retinopathy incidence, one of which is dyslipidemia. Dyslipidemia is disorder body's metabolism of lipid fractions that can be at risk of causing cardiovascular disease. This study aims to determine characteristics dyslipidemia in patients with Diabetic Retinopathy at Sanglah Hospital.

Methods: This research is cross-sectional descriptive study using total sampling technique in taking research samples according inclusion and exclusion criteria. There were five research variables, namely age, sex, body mass index, diabetes duration, and lipid fraction levels.

Results: Diabetic Retinopathy patients with dyslipidemia had prevalence of 76.5% with PDR (64.7%) and mixed dyslipidemia (61.5%) found to be the most dominant. The highest frequency of age, sex, body mass index, and diabetes duration were 45 to 64 years (80.6%), female (92.3%), normoweight (38.5%), more than five years, respectively. years (53.8%).

Conclusion: The prevalence of diabetic retinopathy patients with dyslipidemia in period 2021-2022 is quite high with dominant variable characteristics found in form age 45 to 64 years, female sex, normoweight body mass index, and diabetes duration more than five years.

Pendahuluan: Diabetic retinopathy merupakan suatu komplikasi dari penyakit diabetes melitus yang secara progresif menyebabkan perubahan mikrovaskular di retina sehingga berdampak secara fisik dan psikososial. Menurut WHO, penyakit diabetic retinopathy menempati posisi empat dalam menyebabkan kebutaan dengan kejadian yang cukup tinggi di Indonesia yaitu 42%. Salah satu faktor risiko dalam meningkatkan kejadian penyakit diabetic retinopathy adalah dislipidemia. Dislipidemia merupakan suatu gangguan metabolisme tubuh terhadap fraksi lipid yang bisa berisiko menyebabkan penyakit kardiovaskular. Tujuan dari penelitian ini adalah untuk mengetahui karakteristik dislipidemia pada penderita diabetic retinopathy di RSUP Sanglah.

Metode: Peneltian ini merupakan penelitian deskriptif potong lintang dengan menggunakan teknik total sampling dalam melakukan pengambilan sampel penelitian menyesuaikan kriteria inklusi dan eksklusi. Variabel penelitian berjumlah lima, yaitu umur, jenis kelamin, indeks massa tubuh, durasi diabetes, dan kadar fraksi lipid.

Hasil: Pasien diabetic retinopathy dengan dislipidemia memiliki prevalensi sebesar 76,5% dengan PDR (64,7%) serta dislipidemia campuran (61,5%) ditemukan paling dominan. Frekuensi terbesar pada umur, jenis kelamin, indeks massa tubuh, dan durasi diabetes secara berturut-turut adalah 45 sampai 64 tahun (80,6%), perempuan (92,3%), normoweight (38,5%), lebih dari lima tahun (53,8%).

Simpulan: Prevalensi pasien diabetic retinopathy dengan dislipidemia periode tahun 2021-2022 cukup tinggi dengan karakteristik variabel dominan yang ditemukan berupa umur 45 sampai 64 tahun, jenis kelamin perempuan, indeks massa tubuh normoweight, dan durasi diabetes lebih dari lima tahun.

Background: Infant mortality death is still high, 24 per 1,000 live births, and this is still far from the target of the Sustainable Development Goals (SDG) to decrease the infant mortality rate to 12 per 1,000 live births in 2030. One of the causes of the high burden of infant mortality rate is neonatal sepsis. There are some risk factors that contribute to neonatal sepsis, such as low birth weight and prematurity. The aim of this study was to determine if there were a correlation between low birth weight and prematurity with neonatal sepsis in Wangaya regional general hospital.

Methods: This was an observational analytic study with a cross-sectional design. All data were obtained from secondary data from medical records of patients that were hospitalized in neonatal intensive unit care and perinatology room in Wangaya regional general hospital from January until December 2019. The collected data will be analyzed by univariate and bivariate analysis with statistical Chi-Square at a 95% confidence interval.

Results: Total samples in this study were 50 neonates. The prevalence of neonatal sepsis in this study was 12 neonates (24%), with 6 neonates having early-onset neonatal sepsis (EOS) and 6 neonates having late-onset neonatal sepsis (LOS). Seventeen neonates (34%) were in the low birth weight category, and 15 neonates (30%) were premature. In bivariate analysis, we found that low birth weight had a p-value of 0.009, a prevalence ratio of 3.9, with a 95% CI of 1.36 – 11.07. Meanwhile, prematurity had a p-value of 0.003 with a prevalence ratio of 4.7, with a 95% CI of 1.66 – 13.16.

Conclusion: There was a correlation between low birth weight and prematurity with neonatal sepsis in Wangaya regional general hospital.

Latar Belakang: Angka kematian neonatus hingga saat ini masih cukup tinggi yaitu 24 per 1.000 kelahiran hidup dan belum mencapai target Sustainable Development Goals (SDG) yaitu menurunkan angka kematian neonatus menjadi 12 per 1.000 kelahiran hidup pada tahun 2030. Salah satu penyebab tingginya angka kematian neonatus adalah sepsis neonatorum. Terdapat beberapa faktor risiko yang menyebabkan sepsis neonatorum, antara lain bayi berat lahir rendah (BBLR) dan prematuritas. Tujuan penelitian ini adalah untuk mengetahui hubungan antara BBLR dan prematuritas dengan kejadian sepsis neonatorum di RSUD Wangaya.

Metode: Penelitian ini merupakan penelitian observasional analitik dengan rancangan cross-sectional.  Data penelitian diambil dari data sekunder, berupa rekam medis pasien yang dirawat di ruangan Perina dan Neonatal Intensive Care Unit (NICU) RSUD Wangaya pada periode Januari – Desember 2019. Data yang berhasil dikumpulkan akan dilakukan analisis bivariat menggunakan uji statistik Chi-Square pada interval kepercayaan (IK) 95%.

Hasil: Total sampel pada penelitian ini sebanyak 50 neonatus. Prevalensi sepsis neonatorum pada penelitian ini sebanyak 12 bayi (24%), dengan rincian 6 bayi (50%) menderita sepsis neonatal awitan dini (SNAD) dan sisanya 6 bayi (50%) menderita sepsis neonatal awitan lambat (SNAL). Jumlah bayi BBLR sebanyak 17 bayi (34%) dan prematur sebanyak 15 bayi (30%). Hasil analisis bivariat didapatkan faktor BBLR memiliki p-value 0,009; rasio prevalens (RP) 3,9 dengan 95% IK 1,36 – 11,07, sedangkan faktor prematuritas memiliki p-value 0,003; RP 4,7 dengan 95% IK 1,66 – 13,16.

Simpulan: Terdapat hubungan antara BBLR dan prematuritas dengan sepsis neonatorum di RSUD Wangaya.

Background: Dengue Hemorrhagic Fever (DHF) is an infectious disease caused by the dengue virus that is spread through the bite of the Aedes aegypti. One way in suppressing the hench population is still using larvicides, such as temephos (abate). Compounds such as the alkaloids carpaine, saponin, tannin, and papain found in papaya seeds have toxic properties against the larvae of the Aedes aegypti. This study aimed to find out the effectiveness of the powder of papaya seeds (Carica papaya) as a natural larvicide of the Aedes aegypti.

Methods: The in vitro study used a randomized post-test-only control group design method that used a mosquito larva of Aedes aegypti given four doses of papaya seed powder: 200 mg/200 ml, 300 mg/200 mL, 500 mg/200 mg, and the control group. All data was analyzed statistically using SPSS. 20.

Results: The percentage of larva mortality in the control group was 0%, the 200mg treatment group was 17%; the 300mg treatment group was 27%; and the 500mg treatments group was 60%. Based on bivariate analysis, there were significant differences between the trial groups (p<0,05), except between the 200 mg and 300 mg groups. The results showed that the larger the dose given, the greater the percentage of death in mosquito larvae.

Conclusion: Papaya seed powder as a natural larvicide effectively kills the Aedes aegypti in vitro. The 500mg group has the highest percentage of larva mortality.

Latar Belakang: Demam Berdarah Dengue (DBD) merupakan penyakit infeksi yang disebabkan oleh virus dengue yang disebarkan melalui gigitan nyamuk Aedes aegypti. Salah satu cara dalam menekan populasi jentik masih menggunakan larvasida, seperti temephos (abate). Senyawa seperti alkaloid karpaina, saponin, tannin, dan papain yang terdapat pada biji pepaya memiliki sifat toksik terhadap larva nyamuk Aedes aegypti. Penelitian ini bertujuan untuk mengetahui efektivitas dari bubuk biji buah pepaya (Carica papaya L) sebagai larvasida alami jentik nyamuk Aedes aegypti.

Metode: Penelitian in vitro ini menggunakan metode randomized post-test only control group design yang menggunakan larva nyamuk Aedes aegypti yang diberikan empat dosis bubuk biji pepaya yaitu 200 mg/200 mL, 300 mg/200 mL, 500 mg/200 mL, dan kelompok kontrol. Seluruh data dianalisis secara statistik menggunakan SPSS ver. 20.

Hasil: Didapatkan persentase kematian larva pada kelompok kontrol sebesar 0%, kelompok perlakuan 200mg sebesar 17%; kelompok perlakuan 300mg sebesar 27%; dan kelompok perlakuan 500mg sebesar 60%. Berdasarkan analisis bivariat, terdapat perbedaan yang signifikan antar kelompok uji (p<0,05), kecuali antara kelompok 200 mg dan 300 mg. Hasil tersebut menunjukkan bahwa semakin besar dosis yang diberikan, maka semakin besar persentase kematian pada larva nyamuk.

Kesimpulan: Bubuk biji buah pepaya sebagai larvasida alami efektif mematikan jentik nyamuk Aedes aegypti secara in vitro. Kelompok 500mg memiliki persentase kematian larva tertinggi.

Introduction: The prevalence of musculoskeletal trauma in Indonesia is increasing. Complications that occur due to mishandling are often found in health facilities. The development of medical health facilities has not made people switch from traditional medicine as an alternative treatment for musculoskeletal trauma that has been passed down for generations. Education and attitude can be factors in considering risks in choosing the right treatment. The purpose of this study was to determine the relationship between education level and attitude towards musculoskeletal trauma treatment options.

Method: This research method is an observational analytic with a cross-sectional design. The research subjects were residents of Banda Aceh City was as many as 200 respondents who were carried out in eleven public health centers representing nine sub-districts in Banda Aceh City.

Result: The results of this study indicate that 108 (54.0%) respondents chose traditional medicine while 92 (46.0%) other respondents chose medical treatment as a solution for treating musculoskeletal trauma. Respondents with secondary education chose traditional medicine by 62.7%, while respondents with higher education chose traditional medicine by 42.9%. Respondents with a sufficient attitude chose traditional medicine by 95.6%, while respondents with a good attitude chose traditional medicine by 31.4%. Based on the results of the Spearman rho test, it showed that there was a relationship between educational level (p=0.039) and attitude (p=0.000) towards the choice of musculoskeletal trauma treatment.

Conclusion: Various promotive efforts and health education, especially musculoskeletal trauma, need to be continuously carried out by both health workers and policy makers to improve people's attitudes in choosing the right treatment and reducing the number of complications due to mishandling of musculoskeletal trauma in Banda Aceh City.

Pendahuluan: Prevalensi trauma muskuloskeletal di Indonesia semakin meningkat. Komplikasi yang terjadi akibat kesalahan penanganan banyak ditemukan di fasilitas kesehatan.  Berkembangnya fasilitas kesehatan medis tidak membuat masyarakat beralih dari pengobatan tradisional sebagai alternatif pengobatan trauma muskuloskeletal yang sudah turun temurun. Pendidikan dan sikap dapat menjadi faktor dalam mempertimbangkan risiko dalam memilih pengobatan yang tepat. Tujuan dari penelitian ini adalah untuk mengetahui hubungan tingkat pendidikan dan sikap terhadap pilihan pengobatan trauma muskuloskeletal.

Metode: Metode penelitian ini berupa analitik observasional dengan desain cross-sectional. Subjek penelitian adalah penduduk Kota Banda Aceh sebanyak 200 responden yang dilaksanakan pada sebelas puskesmas yang mewakili sembilan kecamatan di Kota Banda Aceh.

Hasil: Hasil penelitian ini menunjukkan bahwa 108 (54,0%) responden memilih pengobatan tradisional sedangkan 92 (46,0%) responden lainnya memilih pengobatan medis sebagai solusi untuk penanganan trauma muskuloskeletal. Responden dengan pendidikan menengah memilih pengobatan tradisional sebesar 62,7%, sedangkan responden dengan pendidikan tinggi memilih pengobatan tradisional sebesar 42,9%. Responden dengan sikap yang cukup memilih pengobatan tradisional sebesar 95,6%, sedangkan responden dengan sikap yang baik memilih pengobatan tradisional sebesar 31,4%. Berdasarkan hasil uji Spearmann rho menunjukkan bahwa terdapat hubungan antara tingkat pendidikan (p=0,039) dan sikap (p=0,000) terhadap pilihan pengobatan trauma muskuloskeletal.

Simpulan: Berbagai upaya promotif dan penyuluhan kesehatan khususnya trauma muskuloskeletal perlu terus dilakukan baik dari tenaga kesehatan maupun pemegang kebijakan untuk meningkatkan sikap masyarakat dalam memilih pengobatan yang tepat serta menekan angka komplikasi akibat kesalahan penanganan trauma muskuloskeletal di Kota Banda Aceh.

Backgrounds:  Sepsis is one of the causes of neonatal death which is affected by many factors. One of them is asphyxia, a condition lack of oxygen supply that can occure before, during and after birth. The APGAR score is a fastest way to assess wether a newborn has asphyxia. For this reason, this study aims to determine the relationship between APGAR score and the incidence of neonatal sepsis.

Methods: A cross-sectional observational analytic study was conducted by collecting data from the medical records of patients who met the inclution and exclution criterias with consecutive sampling techniques. The research samples were neonates aged 0-28 days who were treated in the Perinatology and NICU rooms at Wangaya General Hospital Bali in January 2018 until March 2022. After the datas were collected, the datas were processed using SPSS software and bivariate analysis by using the chi-square test. Confounder varibles will be controlled by design and by analysis.

Result: From 114 neonates that treated in January 2018 until March 2022, there are 52 (45,6%) of them experienced neonatal sepsis. Factors that have a corellation with the incidendences of neonatal sepsis are the 1st minute APGAR value (P = 0,000) and the 5th minute APGAR value (P= 0,000).

Conclusion: Neonates with APGAR scores < 7 are twice at risk of suffering from neonatal sepsis compared to babies with APGAR values 7 at 1 and 5 minutes.

Latar belakang: Sepsis merupakan salah satu penyebab kematian neonatus yang dipengaruhi banyak faktor. Salah satunya adalah asfiksia, kondisi kekurangan asupan oksigen yang dapat terjadi sebelum, sesaat dan setelah bayi lahir. Nilai APGAR merupakan salah satu cara cepat untuk menilai apakah bayi baru lahir mengalami asfiksia. Untuk itu penelitian ini bertujuan mengetahui hubungan nilai APGAR dengan kejadian sepsis neonatorum.

Metode: Penelitian analitik observasional potong lintang dilakukan dengan mengambil data rekam medis pasien yang memenuhi kriteria inklusi dan eksklusi dengan teknik consecutive sampling sampel. Sampel penelitian adalah neonatus berusia 0-28 hari yang dirawat diruang Perinatologi dan NICU RSUD Wangaya, Denpasar pada bulan Januari 2018 – Maret 2022. Setelah terkumpul, data diolah menggunakan software SPSS dan dianalisa secara bivariat menggunakan uji Chi-square. Variabel perancu akan dikendalikan by design dan by analysis.

Hasil: Dari 114 neonatus yang dirawat pada bulan Januari 2018 – Marat 2022, 52 (45,6%) bayi diantaranya mengalami sepsis neonatorum. Faktor yang memiliki hubungan dengan kejadian sepsis neonatorum adalah nilai APGAR menit ke 1 (P = 0,000) dan nilai APGAR menit ke 5 (P = 0,000).

Kesimpulan: Bayi dengan nilai APGAR < 7 beresiko > 2 kali menderita sepsis neonatorum dibanding bayi dengan nilai APGAR ≥ 7 pada menit ke 1 dan ke 5.

Background: Currently, mast cells are implicated in the pathogenesis of coronary heart disease. Mast cells are the only cell tissue that expresses on the surface of the high affinity receptor for IgE (FCεR) and synthesizes vasoactive, spasmogenic, fibrogenic factors and can damage the connective tissue covering the atheroma plaque so that the plaque is prone to rupture. The aim of this study was to determine the relationship between a history of hypersensitivity and total serum IgE levels with acute coronary syndrome.

Methods: This study was an analytic cross-sectional study to determine the relationship between history of hypersensitivity and total serum IgE levels with acute coronary syndrome. The study was conducted at the Integrated Cardiac Service Unit Sanglah Hospital Denpasar with consecutive sampling according to the inclusion and exclusion criteria of 68 samples.

Results: The results of the history of hypersensitivity analysis with ACS obtained a p value of 0.685; OR 0.778. Analysis of the relationship between total serum IgE levels and ACS resulted in a p value of 0.000; OR 10.385, a history of hypersensitivity with IMA obtained a p value of 0.187; OR 0.281 and total IgE levels with IMA obtained a p value of 0.584; OR 0.273.

Conclusion: There is a relationship between total serum Immunoglobulin E (IgE) levels with acute coronary syndrome and MI. There is no relationship between history of hypersensitivity with acute coronary syndrome or MI.

Latar Belakang: Saat ini, sel mast diimplikasikan dalam patogenesis dari penyakit jantung koroner. Sel mast merupakan satu-satunya jaringan sel yang ekpresinya pada permukaan high affinity receptor untuk IgE (FCεR) dan mensintesis faktor vasoaktif, spasmogenik , fibrogenik dan dapat merusak jaringan ikat yang menutupi plak atheroma sehingga plak rentan pecah. Tujuan Penelitian ini untuk mengetahui hubungan antara riwayat hipersensitivitas dan kadar IgE total serum dengan sindrom koroner akut.

Metode: Penelitian ini merupakan penelitian dengan rancangan potong lintang analitik untuk mengetahui hubungan antara riwayat hipersensitivitas dan kadar IgE total serum dengan sindrom koroner akut. Penelitian dilakukan di Unit Pelayanan Jantung Terpadu RSUP Sanglah Denpasar dengan consecutive sampling sesuai kriteria inklusi dan eksklusi sebesar 68 sampel.

Hasil: Hasil analisis riwayat hipersensitivitas dengan SKA didapatkan nilai p 0,685; OR 0,778. Analisis hubungan antara kadar IgE total serum drngan SKA didapatkan hasil nilai p 0,000; OR 10,385, riwayat hipersensitivitas dengan IMA didapatkan nilai p 0,187;OR 0,281 serta kadar IgE total dengan IMA didapatkan hasil nilai p 0,584; OR 0,273.

Simpulan: Terdapat hubungan antara kadar Immunoglobulin E (IgE) total serum dengan sindrom koroner akut dengan IMA. Tidak terdapat hubungan antara riwayat hipersensitivitas dengan sindom koroner akut maupun IMA.

Introduction: The Lombok earthquake that occurred in July-August 2018 has caused many casualties, both deaths and injuries. North Lombok regency is the district that suffered the most fatalities. Therefore, the data on the number of patients examined in the radiology department of the General Hospital of North Lombok Regency can provide an overview of the condition of injured victims in the district. This retrospective research aims to provide an overview of fracture patients of Lombok earthquake victims conducted in the radiology department.

Method: The data were collected from the medical records of Lombok earthquake victims who were examined in the Radiology department during August 2018.

Result: A total of 378 patients were examined. From the x-ray examination, 111 victims suffered fractures. Most of the victims were female and aged >15 to 65 years old. Most of them suffered single region fractures (75 victims) and multiple region fractures (36 victims). Meanwhile, the most fractures suffered by the victims were the lower limb fractures identified in 60 victims (54%) and the shoulder-upper limb fractures found in 32 victims (28.9%). The remaining 19 victims suffered fractures of ankle –foot, wrist-hand, head, ribs, spine and pelvis.

Conclusion: The 2018 Lombok earthquake has had a health impact and increased morbidity and mortality, a total of 111 victims experienced fractures in the earthquake.

Purpose: Echocardiography is the main modality for definitive diagnosis and evaluation of children with congenital heart disease. Anxiety is the most common feeling experienced by children when they visit healthcare facilities. The first aim of this study was to give an overview of the prevalence of anxiety symptoms, and the second aim was to investigate the factors associated with anxiety during the echocardiography procedure.

Patients and methods: The cross-sectional study was conducted in the pediatric cardiology outpatient clinic at Prof. Dr. I G.N.G. Ngoerah General Hospital, Denpasar-Bali period February 2022 to August 2022. Children aged 18 months-6 years who underwent echocardiography evaluation were included. The visual analog scale of anxiety (VAS-A) was used to measure the severity of anxiety. The analysis is using chi-square test and logistic regression. The significance of risk factors is reported as a prevalence ratio with 95% confidence intervals and p<0.05.

Results: In a total of 156 subjects, the prevalence of anxiety during the procedure was 64,1% with a similar gender proportion. Multivariate analysis found that age ≤3 years old and did not attend school were associated with anxiety (PR 60.53; 95% CI 13.07-280; p<0.001 and PR 5.59; 95% CI 1.31-23.77; p < 0.001).

Conclusion: Anxiety during the echocardiography procedure is common. Age ≤3 years old and did not attend school were associated with anxiety during echocardiography.

Background: Several case series have described the clinical characteristics of COVID-19 in pediatric patients and suggest milder illness severity in children compared with adults. However, some cases presented more severe diseases with small numbers of deaths have been documented. Some studies in developed countries demonstrated that the presence of comorbidities among COVID-19 patients could increase the severity of the disease. Therefore, this study aimed to identify the association of comorbidities with mortality and severity among children with COVID-19.

Methods: This was an analytic retrospective cross-sectional study conducted in Prof. Dr. IGNG Ngoerah Hospital, Denpasar, from May 2020 until March 2022. A total of 94 children aged 28 days-18 years old with confirmed COVID-19 were included in this study and divided into two groups, with comorbidities and without comorbidities. The chi-square test was used to determine the association between comorbidities and their relation to mortality and severity. The statistical significance was set at p less than 0.05.

Results: The normality test showed that the age data distribution is not normal with the median age of 72 months (IQR 45-189) and 108 months (IQR 64-240) in the comorbidities and without comorbidities group, respectively. Bivariate analysis showed there was a significant association between comorbidities with the mortality and severity among children with COVID-19 (PR 3.21; 95% CI 1.04-9.90; p= 0.036) and (PR 10.71; 95%CI 4.12-27.83; p< 0.001), respectively. The multivariate analysis revealed the comorbidities increased risk of mortality and severity with adjusted OR (aOR) 3.74 (95%CI 1.14-12.25) and adjusted OR (aOR) 11.8 (95%CI 4.35-32.41), respectively; after adjusting for  age and nutritional status.

Conclusion: Comorbidities significantly affect mortality and severity among children with COVID-19.

Background: Heart failure is one of the main causes of death in Indonesia. Many factors can cause it, and one factor which is still being debated is heart rate. This research aims to find the correlation between heart rate and rehospitalization in patients with heart failure at Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali.

Methods: Cross-sectional analytical research design is used in this research. The data are taken through consecutive sampling methods from medical records and hospital management information systems, starting from January 2021 - January 2022. The research subjects are the patients who have undergone heart failure hospitalization at the Integrated Cardiac Service (PJT) in Prof.Dr. I.G.N.G. Ngoerah Hospital. The heart rate is taken at the time the patients are discharged after being hospitalized. The bivariate data are analyzed with Spearman correlation and simple regression tests.

Results: Most of the study respondents were male (54.10%), did not have a history of CHD (77.60%), did not have hypertension (54.10%), did not smoke (70.60%), their heart rate was not optimal (≥70 times/minute) (74.10%), and more than 1 hospitalization (51.80%). Based on the results of the bivariate analysis of 85 samples; there are ≥70 with non-optimal heart rate, and there are 60,3 who underwent rehospitalization (>1 hospitalization) (p = 0.007; r=0.290).

Conclusion: This research concludes that heart rate has both significant and weak correlation in increasing the risk of rehospitalization in patients with heart failure. It is not just a single factor, since it is also influenced by hypertension.

Latar Belakang: Penyakit gagal jantung adalah salah satu penyebab utama kematian di Indonesia. Banyak faktor yang dapat menjadi penyebab gagal jantung. Salah satu faktor yang masih menjadi perdebatan adalah laju detak jantung. Tujuan dari penelitian ini adalah mengetahui hubungan laju detak jantung dengan rehospitalisasi pada penderita gagal jantung di RSUP Prof. Dr. I.G.N.G. Ngoerah Denpasar Bali.

Metode: Desain penelitian potong-lintang analitik dilakukan Data diambil dengan metode consecutive sampling dari rekam medis dan sistem informasi manajemen rumah sakit dari periode januari 2021 sampai januari 2022. Subjek penelitian adalah pasien yang mengalami hospitalisasi gagal jantung di pelayanan jantung terpadu (PJT) RSUP Prof.Dr. I.G.N.G. Ngoerah. Laju detak jantung diambil pada saat pasien dipulangkan setelah mengalami hospitalisasi. Analisis data secara bivariat dengan uji korelasi spearman dan regresi sederhana.

Hasil: Sebagian besar responden penelitian berjenis kelamin laki-laki (54,10%), tidak memiliki riwayat PJK (77,60%), tidak hipertensi (54,10%), tidak merokok (70,60%), laju detak jantung tidak optimal (≥70 kali/menit) (74,10%), dan lebih dari 1 kali rawat inap (51,80%). Berdasarkan hasil analisis secara bivariat dari 85 sampel. Pada laju detak jantung tidak optimal ≥70 yang mengalami rehospitalisasi >1 kali rawat inap 60,3 (p = 0,007; r=0,290).

Kesimpulan: Kesimpulan dari penelitian ini adalah laju detak jantung berhubungan signifikan dan lemah dalam meningkatkan risiko rehospitalisasi pada penderita gagal jantung. Laju detak jantung bukan merupakan faktor tunggal melainkan dipengaruhi juga oleh faktor hipertensi.

Introduction: Indonesian Ministry of Health gave a third dose (booster) which was prioritized by the medical staff within 3 months since the second dose was given. The vaccine used for a booster is mRNA-1273 (Moderna) which had been approved by FDA (Food and Drug Administration) with modality mRNA and considerable efficacy. The adverse reaction to the skin which may present post-Moderna vaccination is a local reaction on the injection site on the first dose and increased on the second dose, delayed large local reaction on the first dose and decreased on the second dose. This study aims to determine the characteristics of dermatological lesions in the co-occurrence of post-COVID-19 booster Moderna vaccination in profession stage students of the Faculty of Medicine, Universitas Mataram, class of 2015-2017.

Method: The research design used was descriptive by taking data from respondents who received the Moderna booster who were students of the Faculty of Medicine, Universitas Mataram, class 2015-2017 and were willing to fill out a questionnaire.

Result: It was found that there were adverse reactions after vaccination as many as 90 respondents of 100 respondents with skin manifestations after Moderna booster vaccination, such as pain in the injection area (84%), edema (40%), erythema of the injection area (27%), itching (8%), urticaria (3%) and angioedema (1%). The onset of most symptoms occurred at 12-24 hours post-injection (33.3%) and 6-12 hours post-injection (23.3%).

Conclusion: There were skin manifestations in most of the respondents who received the Moderna vaccine booster (90%), with the most symptoms onset at 12-24 hours post-injection 33.3%.

Latar Belakang: Kementerian Kesehatan Republik Indonesia memberikan vaksinasi dosis ketiga (booster) yang diutamakan untuk tenaga kesehatan dengan jarak minimal 3 bulan setelah dosis kedua. Pemberian vaksin booster berupa vaksin mRNA-1273 (Moderna) yang diakui oleh FDA (Food and Drug Administration) dengan modalitas mRNA dan memiliki efikasi yang cukup besar. Efek samping pada kulit yang dapat muncul pasca vaksinasi Moderna adalah reaksi lokal pada tempat injeksi pada dosis pertama dan meningkat pada dosis kedua, delayed large local reaction pada dosis pertama dan menurun pada dosis kedua.

Tujuan: Penelitian ini bertujuan untuk mengetahui karakteristik lesi dermatologi pada kejadian ikutan pasca vaksinasi COVID-19 booster Moderna pada mahasiswa tahap profesi Fakultas Kedokteran Universitas Mataram angkatan 2015-2017.

Metode: Desain penelitian yang digunakan adalah deskriptif dengan cara mengambil data dari responden penerima booster Moderna yang merupakan mahasiswa tahap profesi Fakultas Kedokteran Universitas Mataram angkatan 2015-2017 dan bersedia mengisi kuesioner.

Hasil: Dari penelitian yang dilakukan didapatkan adanya kejadian ikutan pasca vaksinasi  sebanyak 90 responden dari 100 responden dengan manifestasi kulit pasca vaksinasi booster Moderna berupa nyeri pada daerah injeksi (84%), edema (40%), eritema daerah injeksi (27%), gatal (8%), urtikaria (3%) dan angioedema (1%). Awitan timbulnya gejala terbanyak pada 12-24 jam pasca injeksi (33,3 %) dan 6-12 jam pasca injeksi (23,3%).

Simpulan: Terdapat manifestasi kulit pada sebagian besar responden yang menerima booster vaksin Moderna (90%) dengan awitan timbulnya gejala terbanyak pada 12 jam-24 jam pasca injeksi sebesar 33,3%.

Introduction: The high mortality rate due to pelvic fractures in Indonesia requires the latest data regarding case descriptions related to the causes of pelvic fracture incidents, treatment and complications that can be caused.

Methods: The study design is a retrospective descriptive study with a cross-sectional approach. The sample population was determined by total sampling, namely all patients with pelvic fractures who received treatment at the ER of Prof. Dr. I.G.N.G Nogerah Denpasar. All data were taken from medical records and then analyzed descriptively. The independent variables in this study were age, gender, mechanism of injury, classification of Young-Burges and Tile fractures, emergency management of pelvic fractures and acute complications experienced. While the dependent variable was the incidence of pelvic fractures.

Results: A total of 75 samples of pelvic fracture cases were obtained for the period January 2019 to September 2022. Men dominated the majority of pelvic fracture cases at Prof. Dr. I.G.N.G Ngoerah from January 2019 – September 2022 with a proportion of 64%. Most of the cases were adults aged 25-59 years (66.67%) with the mechanism of injury most often caused by traffic accidents (77.3%). Most cases of pelvic fractures that occur fall into the category of stable pelvic fractures with the Young Burges APC II classification (18.7%) and the Tile A1 classification (14.7%). More than half of the cases (58.7%) of pelvic fractures were treated operatively with the most common procedure being ORIF PS (90.9%). There were 14 cases that experienced acute complications, where most cases of pelvic fractures were accompanied by internal organ injuries (64.3%) and hypovolemic shock (71.4%).

Conclusion: Most pelvic fracture cases at Prof. Dr. I.G.N.G Ngoerah Denpasar Hospital was treated operatively and 19% of them experienced acute complications. Future studies should focus on tracing the causes of acute complications that occur to achieve more effective and efficient management of pelvic fracture cases.

Pendahuluan: Tingginya angka mortalitas akibat fraktur pelvis di Indonesia membutuhkan data terbaru terkait gambaran kasus yang berhubungan dengan penyebab kejadian insiden fraktur pelvis, penanganan serta komplikasi yang dapat disebabkan. 

Metode: Desain studi yaitu penelitian deskriptif retrospektif dengan pendekatan potong lintang. Populasi sampel ditentukan secara total sampling yaitu seluruh pasien dengan fraktur pelvis yang mendapatkan penanganan di UGD RSUP Prof. Dr. I.G.N.G Nogerah Denpasar. Seluruh data diambil dari rekam medis dan kemudian dianalisis secara deskriptif. Variabel bebas dalam penelitian ini adalah usia, jenis kelamin, mekanisme cidera, klasifikasi fraktur Young-Burges dan Tile, penanganan darurat fraktur pelvis dan komplikasi akut yang dialami. Sementara variabel tergantung adalah kejadian fraktur pelvis.

Hasil: Sebanyak 75 sampel kasus fraktur pelvis didapatkan untuk periode Januari 2019 hingga September 2022. Laki-laki mendominasi sebagian besar kasus fraktur pelvis di RSUP Prof. Dr. I.G.N.G Ngoerah dari Januari 2019 – September 2022 dengan proporsi 64%. Sebagian besar kasus merupakan orang dewasa berusia 25-59 tahun (66,67%) dengan mekanisme cidera yang paling sering disebabkan oleh kecelakaan lalu lintas (77,3%). Sebagian besar kasus fraktur pelvis yang terjadi masuk dalam kategori fraktur pelvis stabil dengan klasifikasi Young Burges APC II (18,7%) dan klasifikasi Tile A1 (14,7%). Lebih dari setengah jumlah kasus (58,7%) fraktur pelvis ditangani secara operatif dengan tindakan yang paling sering adalah ORIF PS (90,9%). Terdapat sebanyak 14 kasus yang mengalami komplikasi akut, dimana sebagian besar kasus fraktur pelvis disertai dengan cidera organ dalam (64,3%) dan syok hipovolemik (71,4%).

Simpulan: Kasus fraktur pelvis di RSUP Prof. Dr. I.G.N.G Ngoerah Denpasar sebagian besar ditangani secara operatif dan 19% diantaranya mengalami komplikasi akut, studi selanjutnya agar dapat fokus pada penelusuran penyebab komplikasi akut yang terjadi untuk mencapai tatalaksana kasus fraktur pelvis yang lebih efektif dan efisien.

Introduction: Nephrotic syndrome (NS) is a common chronic renal disease in children. For chronic illness, the patients requested regular hospital visits and required long term use of steroids or immunosuppressive agents. Besides agents needing therapy, the patients also face the probability of recurrent disease, multiple complications, hospitalization, side effect of treatment and fall into chronic renal disease. The impact could be physical or psychological (emotional, social, school performance). Thus, in this article, we provide the quality of life (QoL) evaluation among children with NS in Prof Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali.

Methods: This cross-sectional study was conducted at Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali. The cases included 60 children with NS aged 2–18 years diagnosed as NS based on the medical record and attended a pediatric nephrology clinic from January 2022 until July 2022. The patient’s quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) generated from 4.0. All the data were analyzed descriptively by using SPSS version 25. The data will be provided in the table.

Result: There were sixty children as study subjects, consisting of 36 (60%) male and 24 (40%) female. The Male gender was more dominant in this study (60% of study subjects). Female patients, lower-income families, duration of illness less than 1 year, group B NS (SRNS, steroid dependence NS), and children not in remission phase and on cyclophosphamide therapy demonstrate a higher proportion of QoL disturbance.

Conclusion:  According to this study, we can conclude that most of the NS patients have not disturbed QoL based on the child and the parents’ reports.

Background: Mild Cognitive Impairment (MCI) is a mild cognitive function disorder in the form of decreased memory function but does not interfere with daily activities. Decreased memory and impaired orientation of place and time due to MCI will increase the risk of injury in the elderly in their daily lives. Knowing the incidence of MCI earlier is very important, as finding MCI sufferers earlier can inhibit the progression and improve the quality of life of sufferers. Thus, this study aims to determine the incidence of amnestic and non-amnestic MCI in the elderly, especially in the Puskesmas Uabau working area.

Methods: The research design used a cross-sectional method where data was collected by interviewing using the MMSE-Ina questionnaire. A total of 135 subjects consisting of the elderly (45-60 years) and elderly (>60 years) age group in the Puskesmas Uabau working area were included in the study using consecutive random sampling—selection of the sample according to the eligibility criteria. Data analysis was carried out to determine the incidence of amnestic and non-amnestic MCI types.

Results: There was an incidence of MCI of 47.4% (64 people), which was dominated by women in the elderly group >71 years with comorbidities (diabetes mellitus, hyperuricemia, stroke), and did not have comorbid hypertension and dyslipidemia. Single realm amnestic type MCI was obtained as much as 3.1%, plural amnestic type MCI was 57.8%, plural non-amnestic type MCI was 39.1%, and no elderly group was found with single domain non-amnestic type MCI.

Conclusion: The incidence of MCI in the elderly group at the Uabau Health Center is high, so special attention is needed from an early age so as not to fall into a state of more severe cognitive impairment.

Latar Belakang: Mild Cognitive Impairment (MCI) merupakan gangguan fungsi kognitif ringan berupa menurunnya fungsi memori namun tidak mengganggu aktivitas sehari-hari. Menurunnya daya ingat serta gangguan orientasi tempat dan waktu akibat MCI akan meningkatkan risiko kejadian cedera pada kelompok usia lanjut dalam kesehariannya. Mengetahui insiden MCI sejak dini sangatlah penting, dimana ditemukannya penderita MCI sejak dini dapat menghambat progresifitas serta meningkatkan kualitas hidup penderitanya. Dengan demikian, penelitian ini bertujuan untuk mengetahui insidensi dari MCI tipe amnestik dan non-amnestik pada kelompok usia lanjut, khususnya di lingkungan Puskesmas Uabau.

Metode: Desain penelitian menggunakan metode potong lintang dimana pengambilan data dilakukan dengan wawancara menggunakan kuisioner MMSE-Ina. Sebanyak 135 subjek yang terdiri dari kelompok usia prelansia (45-60 tahun) dan lansia (>60 tahun) di wilayah kerja Puskesmas Uabau dimasukkan dalam penelitian menggunakan consecutive random sampling. Pemilihan sampel sesuai dengan kriteria eligibilitas. Analisis data dilakukan untuk mengetahui insiden MCI tipe amnestik dan non amnestik.

Hasil: Didapatkan insiden MCI sebesar 47.4% (64 orang), dimana didominasi oleh perempuan di kelompok lansia >71 tahun dengan komorbid (diabetes melitus, hiperurisemia, stroke), serta tidak memiliki komorbid hipertensi dan dislipidemia. MCI tipe amnestik ranah tunggal didapatkan sebanyak 3.1%, MCI tipe amnestik ranah jamak sebanyak 57.8%, MCI tipe non-amnestik ranah jamak sebanyak 39.1%, dan tidak ditemukan kelompok usia lanjut dengan MCI tipe non-amnestik ranah tunggal.

Kesimpulan: Insiden MCI pada kelompok usia lanjut di Puskesmas Uabau tinggi sehingga dibutuhkan perhatian khusus sejak dini agar tidak jatuh ke keadaan gangguan kognitif yang lebih berat.

Background: Presbycusis or age-related hearing loss, is the most common cause of hearing loss and also the most common neurodegenerative disorder. This age-related hearing loss occurs in the population over 60 years of age. This study aims to determine the type of presbycusis in presbycusis patients at the ENT Polyclinic of Prof. Dr. I.G.N.G. Ngoerah Hospital for the period of January-December 2020.

Methods: This study is a retrospective descriptive study with a total sample of 42 people taken consecutively in presbycusis patients at the ENT Polyclinic of Prof. Dr. I.G.N.G. Ngoerah Hospital for the period of January-December 2020.

Results: The results showed that the audiogram results based on the right and left ears, 42.8% and 45.2% had strial type presbycusis, 30.9% and 28.6% had cochlear type presbycusis, 21.4% and 23.8% had sensory type presbycusis, 4.8% and 2.4% had neural type presbycusis.

Conclusion: From the results of this study, it can be concluded that the average degree of deafness of the right and left ears is moderate-heavy, with the dominant type of presbycusis being the strial or metabolic type. Presbycusis shows a wide variation in the degree of deafness, hearing acuity, age of onset, and progression, so it is likely that the burden of presbycusis in the population may increase in the future.

Latar Belakang: Presbikusis atau penurunan pendengaran terkait usia, merupakan penyebab gangguan pendengaran dan sekaligus juga merupakan gangguan neurodegeneratif yang paling sering terjadi. Penurunan pendengaran terkait usia ini terjadi pada populasi usia lebih dari 60 tahun. Penelitian ini bertujuan untuk mengetahui jenis presbikusis pada pasien presbikusis di Poliklinik THT-KL RSUP Prof. Dr. I.G.N.G. Ngoerah periode Januari-Desember 2020.

Metode: Penelitian ini adalah penelitian deskriptif retrospektif dengan total sampel sebanyak 42 orang yang diambil secara konsekutif pada pasien presbikusis di Poliklinik THT-KL RSUP Prof. Dr. I.G.N.G. Ngoerah periode Januari-Desember 2020.

Hasil: Hasil penelitian menunjukkan bahwa hasil audiogram berdasarkan telinga kanan dan kiri, sebanyak 42,8% dan 45,2% mengalami presbikusis tipe strial, 30,9% dan 28,6% mengalami presbikusis tipe koklea, 21,4% dan 23,8% mengalami presbikusis tipe sensori, sebanyak 4,8% dan 2,4% mengalami presbikusis tipe neural.

Simpulan: Dari hasil penelitian ini dapat disimpulkan bahwa derajat ketulian telinga kanan dan kiri rata-rata adalah derajat sedang-berat, dengan tipe presbikusis yang dominan adalah tipe strial atau metabolik. Presbikusis memperlihatkan variasi yang beragam pada derajat ketulian, ketajaman pendengaran, onset umur, dan progresinya sehingga kemungkinan beban presbikusis di populasi dapat meningkat di kemudian hari.

Background: Breast cancer is a malignancy that occurs in the breast tissue of the ductal epithelium and lobules of the breast. Indonesia, in this case, ranked first out of the four countries with the highest number of breast cancer cases, namely 58.265 new cases found and 22.692 death cases. Goldhirsch et al. found a classification of breast cancer based on the results of immunohistochemistry (IHC) staining of estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2) receptors using fluorescent in situ hybridization. The classification was determined genetically and molecularly, namely: luminal A, luminal B, HER2- overexpressed cancer and triple negative (basal like) cancer. Obesity which is rated using the body mass index (BMI) is one of the risk factors for some cancers, including postmenopausal breast cancer and especially estrogen receptor (ER)-positive/progesterone receptor (PR)-positive breast cancer. Rose et al stated that obesity is inversely related to pre-menopausal breast cancer, where obesity is a protective factor.

Methods: The research plan for this research is research with a cross-sectional research design which will be using purposive sampling type of non-probability sampling as the sample selection technique.

Result: There are 94 medical records of breast cancer patients who visit Rumah Sakit Umum Ganesha (Ganesha Public Hospital). The value found from the analysis that has been done between the intrinsic subtype and BMI (body mass index) risk factors is p>0.05 which means there is no correlation between the two.

Conclusion: There is no relationship between the patient’s body mass index (BMI) with intrinsic subtypes in breast cancer patients.

Latar Belakang: Kanker payudara merupakan keganasan pada jaringan payudara yang berasal dari epitel duktus maupun lobulusnya. Indonesia merupakan peringkat pertama dari empat negara yang memiliki jumlah kasus kanker payudara tertinggi yaitu sebesar 58.265 kasus baru yang ditemukan dan sebanyak 22.692 kasus mengalami kematian. Goldhirsch et al. menemukan klasifikasi kanker payudara berdasarkan hasil pewarnaan imunohistokimia (IHK) dari reseptor estrogen, progesteron, dan human epidermal growth factor receptor 2 (HER2) menggunakan hibridisasi in situ fluoresen. Klasifikasi tersebut ditentukan secara genetik dan molekuler, yaitu: kanker luminal A, luminal B, HER2- yang diekspresikan secara berlebihan dan kanker triple negative (basal like). Obesitas yang dinilai melalui indeks massa tubuh (IMT) merupakan salah satu faktor risiko timbulnya beberapa kanker, termasuk pascamenopause kanker payudara dan khususnya reseptor estrogen (ER)-positif/ reseptor progesterone (PR)-positif kanker payudara. Rose et al menyebutkan bahwa obesitas berbanding terbalik dengan perimenopause kanker payudara, dimana obesitas merupakan faktor protektif.

Metode: Rancangan penelitian ini menggunakan desain penelitian cross-sectional dengan pemilihan sampel menggunakan teknik non-probability sampling jenis purposive sampling.

Hasil: Didapatkan 94 rekam medis pasien kanker payudara yang datang di Rumah Sakit Umum Ganesha. Dari hasil analisis yang dilakukan antara subtipe intrinsik dengan faktor risiko indeks massa tubuh (IMT) memiliki nilai p>0.05 yang memiliki arti tidak terdapat hubungan antara keduanya.

Simpulan: Tidak terdapat hubungan antara indeks massa tubuh (IMT) pasien dengan subtipe intrinsik pada pasien kanker payudara.

Background: Various laboratory results have been identified as predictors that can assist in diagnosis, disease staging, monitoring and treatment, prognosis, and surveillance in COVID-19 patients. Very little data is available on the analysis of blood gases (AGD) analysis electrolytes in COVID-19 patients.

Method: This study uses a descriptive study research method. The number of subjects was obtained by a total sampling approach with a total of 49 patients. The data was taken from the results of the examination of COVID-19 patients at the Clinical Pathology Laboratory of Wangaya Hospital from January to February 2022. This study used 2 variables, namely blood gas and electrolyte analysis of COVID-19 patients.

Result: A total of 49 patients were obtained. From 49 patients, the average age of patients with COVID-19 was 61.49 years with an age range of 20 to 97 years. Most of the COVID-19 patients had metabolic acidosis (21 patients; 42.9%). Compensatory conditions were found in 19 patients (38.8%). Electrolyte results on sodium levels were mostly normal values. Potassium results in most patients are at normal potassium levels. Chloride levels are mostly at normal chloride levels.

Conclusion: This study is expected to provide an overview of the analysis of blood gases and electrolytes of COVID-19 patients in determining the management of COVID-19 patients and can be used as a reference for further research.

Latar Belakang. Hasil laboratorium telah diidentifikasi sebagai prediktor yang dapat membantu dalam diagnosis, penentuan stadium penyakit, pemantauan dan pengobatan, prognosis hingga surveilenas pada pasien COVID-19. Sangat sedikit data yang tersedia pada hasil analisis gas darah (AGD) dan elektrolit pada pasien COVID-19.

Metode. Penelitian ini menggunakan metode penelitian studi deskriptif. Jumlah subjek didapatkan  dengan pendekatan total sampling  dengan total 49 pasien. Data diambil dari hasil pemeriksaan pasien COVID-19 di Laboratorium Patologi Klinik RSUD Wangaya dari Januari hingga Februari 2022. Penelitian ini menggunakan 2 variabel yaitu Analisa gas darah dan elektrolit pasien COVID-19.

Hasil. Didapatkan total 49 pasien. Dari 49 pasien didapatkan rata-rata usia pasien yang COVID-19 adalah 61,49 tahun dengan rentang usia 20 sampai 97 tahun. Pasien COVID-19 sebagian besar mengalami asidosis metabolik (21 pasien;42,9%). Kondisi kompensasi ditemukan pada 19 pasien (38,8%). Hasil elektrolit pada kadar natrium sebagian besar berada pada nilai normal. Hasil kalium sebagian besar pasien berada pada kadar kalium yang normal. Kadar klorida sebagian besar berada pada kadar klorida yang normal.

Kesimpulan. Penelitian ini diharapkan dapat memberikan gambaran analisa gas darah dan elektrolit pasien COVID-19 dalam menentukan manajemen pasien COVID-19 dan dapat digunakan sebagai dasar acuan penelitian selanjutnya.

Background: Stunting is a chronic nutritional problem due to lack of nutrition in the long term, resulting in impaired growth in children. Stunting in children under five is a consequence of several factors that are often associated with poverty including nutrition, health, sanitation and the environment. There are many factors that influence stunting, one of the main factors causing stunting is an infectious disease that affects mothers and toddlers. The purpose of this study was to determine the relationship between maternal age, maternal infectious diseases, toddler age, sex and toddler infectious diseases with the incidence of stunting in toddlers in Simpang Tiga District and Kembang Tanjong District, Pidie Regency, Aceh, Indonesia in 2022.

Method: this study used an analytic observational design through a cross-sectional approach. The instrument in this study used a questionnaire with a total sampling technique of 25 toddlers and mothers in Simpang Tiga District and 35 mothers and toddlers in Kembang Tanjong District, Pidie Regency.

Results: Simpang Tiga District showed that maternal age (p=0.404), maternal infectious disease (p=0.897), toddler age (p=0.346), toddler infectious disease (p=0.173), and gender (p=0.561) these five variables have nothing to do with the incidence of stunting. Meanwhile in Kembang Tanjung District, the variable mother's age (p=0.002) and toddler's gender (p=0.010) showed a relationship with the incidence of stunting, while the other three variables, namely maternal infectious disease (p=0.445), toddler's age (p=0.096) ), and toddler infectious diseases (p=0.298) showed no association with stunting.

Conclusion: This study can be concluded that the age of the mother and the sex of the toddler greatly influence the incidence of stunting in Kembang Tanjung District, Pidie Regency.

Latar belakang: Stunting merupakan masalah gizi kronis karena kurangnya asupan gizi dalam jangka waktu panjang, sehingga mengakibatkan terganggunya pertumbuhan pada anak. Stunting pada anak balita merupakan konsekuensi dari beberapa faktor yang sering dikaitkan dengan kemiskinan termasuk gizi, kesehatan, sanitasi dan lingkungan. Banyak sekali faktor yang mempengaruhi stunting, salah satu faktor utama penyebab stunting yaitu penyakit infeksi yang diderita oleh ibu dan balita. Tujuan penelitian ini yaitu untuk mengetahui hubungan usia ibu, penyakit infeksi ibu, usia balita, jenis kelamin dan penyakit infeksi balita dengan kejadian stunting pada balita di Kecamatan Simpang Tiga dan Kecamatan Kembang Tanjong Kabupaten Pidie, Aceh, Indonesia tahun 2022.

Metodelogi: penelitian ini menggunakan desain observasional analitik melalui pendekatan cross secitonal. Instrumen dalam penelitian ini menggunakan kuesioner dengan teknik total sampling semuanya sebanyak 25 balita dan ibu di Kecamatan Simpang Tiga dan sebanyak 35 ibu dan balita di Kecamatan Kembang Tanjong Kabupaten Pidie.

Hasil penelitian: Kecamatan Simpang Tiga menunjukkan bahwa usia ibu (p=0,404), Penyakit infeksi ibu (p=0,897), usia balita (p=0,346), penyakit infeksi balita (p=0,173), dan jenis kelamin (p=0,561) kelima variabel tersebut tidak ada hubungan dengan kejadian stunting. Sementara di Kecamatan Kembang Tanjung bahwa variabel usia ibu (p=0,002) dan jenis kelamin balita (p=0,010) menujukkan ada hubungan dengan kejadian stunting, sedangkan ketiga variabel lain yaitu penyakit infeksi ibu (p=0,445),  usia balita (p=0,096), dan penyakit infeksi balita (p=0,298) menunjukkan tidak ada hubungan dengan kejadian stunting.

Simpulan. Penelitian ini dapat disimpulkan bahwa usia ibu dan jenis kelamin balita sangat mempengaruhi terhadap kejadian stunting di Kecamatan Kembang Tanjung Kabupaten Pidie.

Background: Health workers are at high risk of developing depression, anxiety, and sleep disturbances due to increased stress during the COVID-19 pandemic; that matter is closely related to fatigue. The impact of psychosomatic disorders will have an immediate or indirect impact on the quality of health care services. This study aims to evaluate the psychosomatic disorder screening in health officers during the COVID-19 pandemic

Methods: A cross-sectional study was conducted in Esensia Clinic Semarang in February 2022. This study surveyed clinic health workers with completed questionnaires and had their Heart-Rate Variability (HRV) measurement. Data were analyzed using SPSS version 20 for Windows.

Results: About 138 subjects were recruited from Esensia Clinic, 100 subjects underwent this study until analysis. The unanxious subjects have the highest percentage accounting for 61.0%, followed by 25.0% mild anxiety, 12.0% moderate, and 2.0% severe. Furthermore, 86.0% were undepressed, followed by 13% mild and 1% moderate, but there was no severe case. Also, 65.0% did not experience fatigue and the percentage of good sleep quality (8.0%) is significantly lower than the poor (92.0%). The results also showed that 76.0% of the subjects had a balanced autonomic nervous system compared to the 24.0% of subjects with an autonomic imbalance.

Conclusion: The outcomes of psychosomatic disorders such as anxiety, depression, fatigue, and autonomic imbalance are generally poor. However, this study's prevalence of poor sleep quality was very high.

Background: The rapid development of technology accompanied by a shift in sports interest towards eSports or online games in adolescents causes them to spend longer in front of the screen. Poor application of ergofthalmology can trigger Computer Vision Syndrome (CVS), while bad gaming habits can cause Internet Gaming Disorder (IGD).

Purpose: The purpose of this study is to know the characteristics of CVS with IGD in high school students.

Method: A descriptive study using a cross-sectional method with total sampling. Samples were taken from one of the high schools in Tabanan Regency. There were 362 samples that met the inclusion criteria. CVS diagnosis based on the CVS-Q questionnaire and the IGD with the IGDS-9-SF questionnaire in Indonesian. The features are based on gender, screentime and daily leisure time routine.

Results: The mean age of the respondents was 16.64 years ± 0.692. The overall CVS prevalence was 59.9% (n=217). The distribution of CVS symptoms included itchy eyes (53.3%; n=193), headaches (50.5%; n=183) and the sensation of burning and watery eyes (50.3%; n=182). The prevalence of ED was 0.8% (n=3); CVS without IGD 59.4% (n=215); while CVS with IGD was 0.6% (n=2). There are characteristics in screentime of more than 4 hours and daily routine of watching dramas/movies, while differences are found based on gender. Based on gender, CVS without IGD was more common in women (37.6%;n=136), while CVS accompanied by IGD had the same prevalence in both men and women of 0.3% (n=1)

Conclusion: There are similarities between CVS without IGD and CVS accompanied by IGD based on screen time and daily routines. Different characteristics found by sex.

Latar Belakang: Perkembangan teknologi yang semakin pesat diiringi pergeseran minat olahraga menuju eSports atau game online pada remaja menyebabkan mereka lebih lama melakukan aktivitas di depan layar. Penerapan ergoftalmologi yang buruk dapat memicu Computer Vision Syndrome (CVS), sedangkan kebiasaan bermain game yang buruk dapat menimbulkan Internet Gaming Disorder (IGD). Penelitian ini bertujuan untuk mengetahui karakteristik CVS pada siswa SMA dengan IGD

Metode: Studi deskriptif menggunakan metode potong lintang dengan total sampling. Sampel yang diambil dari salah satu SMA di Kabupaten Tabanan. Terdapat 362 sampel yang memenuhi kriteria inklusi. Diagnosis CVS berdasarkan kuisioner CVS-Q serta IGD dengan kuesioner IGDS-9-SF dalam bahasa Indonesia. Karakteristik dibandingkan berdasarkan jenis kelamin, screentime dan rutinitas harian saat senggang.

Hasil: Rerata usia responden 16,64 tahun ±0,692. Prevalensi CVS secara keseluruhan 59.9% (n=217). Distribusi gejala CVS diantaranya mata gatal (53,3%; n=193), sakit kepala (50,5%; n=183) dan sensasi mata perih serta berair (50,3%; n=182). Prevalensi IGD sebesar 0,8% (n=3); CVS tanpa disertai IGD 59,4% (n=215); sedangkan CVS disertai IGD 0,6% (n=2). Terdapat kesamaan karakteristik pada screentime lebih dari 4 jam dan rutinitas harian menonton drama/film, sedangkan perbedaan ditemukan berdasarkan jenis kelamin. Berdasarkan jenis kelamin,  CVS tanpa disertai IGD lebih banyak terjadi pada perempuan (37,6%;n=136), sedangkan CVS disertai IGD memiliki prevalensi yang sama baik pada laki-laki dan perempuan sebesar 0,3% (n=1)

Kesimpulan: Karakteristik antara CVS tanpa disertai IGD dengan CVS disertai IGD terdapat kesamaan berdasarkan screentime dan rutinitas harian. Perbedaan karakteristik ditemukan berdasarkan jenis kelamin.

Introduction: Psoriasis is a chronic inflammation of the skin. The remission rate of psoriasis is 10-60%, with the risk of depression, skin cancer and suicide. Inflammation leads decrease of skin hydration, and pH, thus it makes destruction of skin barrier. Therefore, this study aimed to determine the function and integrity of the skin barrier as seen from TEWL and pH in psoriatic and non-psoriatic lesions in psoriasis vulgaris patients.

Method:  This was a crossectional study, that was conducted in RSUP Prof. Dr. I.G.N.G. Ngoerah, Denpasar around May – July 2022. This study used a consecutive sampling technique, after that the sample was adjusted with the inclusion and exclusion criteria. The data was analyzed by using SPSS version 25. Bivariate analysis used Independent T-Test, for the multivariate analysis used linear regression.

Results: This study obtained 28 samples with the majority was male (60.7%). The average age of the sample was 45.68±15.04. The mean TEWL value in the psoriatic lesion group (24.78 ± 4.77) was higher and the mean pH was lower (5.25 ± 0.18) than the non-psoriatic lesion (TEWL:11.75 ± 2.79; pH 5.63 ± 0.21). TEWL and pH ratio between psoriatic lession and non psoriatic lesion is  (TEWL: 2,19 ± 0,11; pH 0,93 ± 0,01).  The difference was statistically significant (p<0,01).

Conclusion: There was a significant relationship between an increase in TEWL value and a decrease in pH value in the psoriatic group of lesions compared to the non-psoriatic group.

Latar Belakang : Psoriasis merupakan penyakit inflamasi kronis pada kulit. Psoriasis dilaporkan memiliki tingkat remisi yang tinggi sebesar 10-60%, dengan risiko depresi, kanker kulit, dan bunuh diri. Inflamasi dapat menyebabkan penurunan hidrasi dan PH kulit, sehingga menyebakan kerusakan barrier kulit. Tujuan dari penelitian ini adalah untuk mengetahui fungsi dan integritas barrier kulit dilihat dari TEWL dan pH pada lesi psoriatic dan non-lesi psoriatic pada pasien psoriasis vulgaris.

Metode: Penelitian ini merupakan penelitian potong lintang yang dilakukan di RSUP Prof. Dr. I.G.N.G. Ngoerah, Denpasar, dilakukan pada bulan Mei – Juli 2022. Teknik pengambilan sampel yang digunakan yaitu consecutive sampling dan diseleksi berdasarkan kriteria inklusi dan eksklusi yang telah di tentukan. Data di analisis menggunakan SPSS versi 25. Analisis bivariat menggunakan Independent T-Test, dan analisis multivariat yang digunakan menggunakan regresi linear.

Hasil : Penelitian ini mendapatkan 28 sampel dengan mayoritas berjenis kelamin laki-laki (60,7%). Rata-rata sampel berusia 45,68±15,04. Rerata nilai TEWL pada pada kelompok lesi psoriatic (24,78 ± 4,77) lebih tinggi dan rerata pH lebih rendah (5,25 ± 0,18) dibandingkan non-lesi psoriatic (TEWL:11,75 ± 2,79; pH 5,63 ± 0,21). Rasio TEWL dan pH lesi psoriatic dibandingkan non-lesi psoriatic adalah (TEWL: 2,19 ± 0,11; pH 0,93 ± 0,01). Perbedaan tersebut signifikan secara statistik (p<0,01).

Simpulan: Adapun kesimpulan dari penelitian ini yakni lesi psoriatic secara signifikan memiliki nilai TEWL yang lebih tinggi namun pH yang lebih rendah dengan rasio TEWL sebesar 2,19 ± 0,11 dan rasio pH sebesar  0,93 ± 0,01.

Background: Colorectal cancer is commonly found to be regulated by the KRAS gene mutation. Studies reporting the occurrence of mutations in the KRAS gene in Indonesia are still limited. The purpose of this study was to determine the prevalence and characteristics of mutations in the KRAS gene exon 2 codon 12 and codon 13 in colorectal cancer patients at Prof. dr. I.G.N.G. Ngoerah, Denpasar-Bali.

Methods: This study used a quantitative descriptive method with a cross-sectional design. The sample used in this study was the Formalin-Fixed Paraffin-Embedded (FFPE) sample of colorectal cancer patients in year 2018-2019. KRAS gene mutations were identified using PCR and sequencing method. Univariate analysis was used to display data in proportions or graphics with the Microsoft Excel application.

Results: A total of 50 colorectal cancer samples were examined. The majority of patients were aged ≥50 years (76.0%) and male (62.0%). Based on histopathology, the majority cases were adenocarcinoma (80%) and mostly were left tumor location (64.0%). The results of sequencing showed mutations in the KRAS gene that 6 cases of exon 2 codon 12 mutations (13.63%) and 3 cases of exon 2 codon 13 mutations (6.8%); with features of 5 cases (11.36%) of G12D mutations and 1 case (2.27%) of G12V mutation and all the 3 mutations in the KRAS gene exon 2 codon 13 were G13D (6.81%).

Conclusion: This study concluded that exon 2 KRAS gene mutations in colorectal cancer patients at Prof. dr. I.G.N.G Ngoerah in 2018-2019 can be identified by the characteristics of the type of mutation, namely G12D followed by G12V and G13D. The types of mutations sequentially from the most frequent are G12D, G12V, and G13D. Further studies are needed to identify the correlation of this mutation with clinicopathology of colorectal cancer.

Latar belakang: Kanker kolorektal umumnya ditemukan diregulasi oleh mutasi gen KRAS. Studi yang melaporkan kejadian mutasi pada gen KRAS di Indonesia masih terbatas. Tujuan penelitian ini adalah untuk mengetahui prevalensi dan karakteristik mutasi gen KRAS ekson 2 kodon 12 dan 13 pada pasien kanker kolorektal di RSUP Prof. dr. I.G.N.G. Ngoerah tahun 2018-2019.

Metode: Penelitian ini menggunakan metode deskriptif kuantitatif dengan desain potong lintang. Sampel yang digunakan dalam penelitian ini adalah sampel Formalin-Fixed Parrafin-Embedded (FFPE) pasien kanker kolorektal tahun 2018-2019. Penilaian mutasi gen KRAS dengan metode PCR dan sequencing. Analisis univariat digunakan untuk menampilkan data dalam bentuk persentase ataupun grafik dengan aplikasi Microsoft Excel.

Hasil: Total 50 sampel kanker kolorektal diperiksa. Mayoritas pasien berusia ≥50 tahun (76,0%) dan laki-laki (62,0%). Berdasarkan histopatologi mayoritas ditemukan tipe Adenocarcinoma (80%) dan lokasi tumor bagian kiri (64,0%). Hasil pemeriksaan sequencing menunjukkan mutasi gen KRAS diperoleh 6 kasus mutasi ekson 2 kodon 12 (13,63%) dan 3 kasus mutasi ekson 2 kodon 13 (6,8%) dengan karakteristik mutasi yaitu 5 kasus (11,36%) mutasi tipe G12D dan 1 kasus (2,27%) mutasi tipe G12V dan 3 mutasi pada gen KRAS ekson 2 kodon 13 yaitu tipe G13D (6,81%).

Simpulan: Penelitian ini menyimpulkan bahwa mutasi gen KRAS ekson 2 pada pasien kanker kolorektal di RSUP Prof. dr. I.G.N.G Ngoerah tahun 2018-2019 dapat diindentifikasi dengan karakteristik jenis mutasi yaitu G12D diikuti G12V dan G13D. Jenis mutasinya secara berurutan dari yang paling sering adalah G12D, G12V, dan G13D. Studi lebih lanjut diperlukan untuk mengidentifikasi korelasi mutasi ini dengan klinikopatologi kanker kolorektal.

Background: Type 2 Diabetes Mellitus (T2DM) is a metabolic condition defined by uncontrolled blood sugar due to disruptions in insulin secretion, insulin performance, or both, which can lead to Testosterone Deficiency Syndrome (SDT) in males. This study aims to assess the link between the length of T2DM and the occurrence of SDT at the South Denpasar I Health Center in Bali, Indonesia.

Methods: An analytic cross-sectional study was undertaken at the South Denpasar I Health Center in Bali, Indonesia, utilizing purposive sampling based on inclusion and exclusion criteria in 2022. The duration of T2DM was the independent variable in this study, while the dependent variable was Testosterone Deficiency Syndrome (TDS) (ADAM score). TDS was calculated using the ADAM score questionnaire, which consisted of ten validated "yes or no" items translated into Indonesian. SPSS version 20 for Windows was used to analyze the data.

Results: Most of the respondents were aged 36-45 years (46.7%), domiciled in Denpasar (70.0%), had normal BMI (18-25 kg/m2) (66.7%), had smoking habits (63.3%), did not have a habit of consuming alcohol (86.7%), duration of type II DM > 12 months (83.3%), and positive ADAM score (80.0%). The bivariate analysis results showed a significant relationship between the duration of T2DM and the ADAM score (p=0.003).

Conclusion: There is a statistically significant relationship between the length of time experiencing T2DM and the occurrence of testosterone deficiency syndrome obtained through medical record data and filling out the ADAM score questionnaire

Latar Belakang: Diabetes Melitus tipe 2 (DMT2) adalah suatu penyakit metabolik yang dikarakteristikkan dengan tidak terkontrolnya gula darah karena adanya gangguan pada sekresi insulin, kinerja insulin, ataupun keduanya dimana dapat memicu komplikasi pada laki-laki berupa Sindrom Defisiensi Testosteron (SDT). Penelitian ini bertujuan untuk mengevaluasi hubungan lama mengalami DMT2 dengan terjadinya SDT di Puskesmas Denpasar Selatan I, Bali, Indonesia.

Metode: Penelitian observasional analitik dengan pendekatan potong lintang dilakukan di Puskesmas Denpasar Selatan I, Bali, Indonesia pada tahun 2022 dengan purposive sampling berdasarkan kriteria inklusi dan eksklusi. Variabel bebas pada penelitian ini adalah lama mengalami DMT2 sedangkan variabel tergantung pada penelitian ini adalah Sindrom Defisiensi Testosteron (SDT) (skor ADAM). SDT ditetapkan berdasarkan kuesioner skor ADAM yang terdiri dari 10 pertanyaan “ya atau tidak” yang sudah divalidasi dan dialih bahasa ke Bahasa Indonesia. Data dianalisis dengan SPSS versi 20 untuk Windows.

Hasil: Sebagian besar responden berusia 36-45 tahun (46,7%), berdomisili di Denpasar (70,0%), memiliki IMT normal (18-25 kg/m²) (66,7%), memiliki kebiasaan merokok (63,3%), tidak memiliki kebiasaan konsumsi alkohol (86,7%), durasi DM tipe II > 12 bulan (83,3%), dan hasil positif skor ADAM (80,0%). Hasil analisis bivariat menunjukkan bahwa terdapat hubungan yang bermakna antara durasi DMT2 dengan skor ADAM (p=0,003)

Kesimpulan: Terdapat hubungan bermakna secara statistik antara lama waktu mengalami DMT2 dengan terjadinya sindrom defisiensi testosteron yang didapat melalui data rekam medis dan pengisian kuesioner skor ADAM

Background: Cervical cancer still shows a high incidence rate in developing countries. Various factors play roles in cancer progression, including Galectin 3, which contributes to apoptosis, metastasis, immune response, molecular systems, mRNA splicing, gene expression and inflammation. This study aims to prove the association between Galectin 3 expression and FIGO stage of cervical squamous cell carcinoma (SCC) patients at Prof. Dr. I.G.N.G. Ngoerah Hospital, to strengthen the evidence of Galectin 3 roles in cervical SCC prognosis.

Methods: This study is an analytic observational study with a cross-sectional design. Sample size was 42. Evaluation of H-E slides was performed to assess diagnosis and FIGO. Galectin 3 expression was assessed by immunohistochemical method. Data were analyzed by Chi-Square test and prevalence risk ratio analysis using SPSS version 20.0 for Windows.

Results: The mean of patients age was 52.34±9.86 years, with the highest incidence in the sixth decade age and in the early FIGO stage (IB - IIA). About 81% of patients show positive Galectin 3 expression. The relationship between Galectin 3 expression and FIGO stage was statistically significant (p=0.016). The prevalence risk analysis showed that patients with positive Galectin 3 expression had a 1.9 times greater prevalence risk of developing an advanced stage than patients with negative expression (95% CI: 1.376 - 2.593).

Conclusion: There is an association between Galectin 3 expression and FIGO stage in cervical cancer patients at Prof. Dr. I.G.N.G. Ngoerah Hospital, in which patients with positive Galectin 3 have a greater risk of developing an advanced stage.

Latar Belakang : Kanker serviks uteri masih menunjukkan angka insiden tinggi di negara berkembang. Berbagai faktor berperan dalam progresi kanker, salah satunya Galectin 3, yang berkontribusi dalam proses apoptosis, metastasis, respon imun, sistem molecular, mRNA splicing, ekspresi gen dan inflamasi. Penelitian ini bertujuan untuk membuktikan hubungan ekspresi Galectin 3 dengan stadium FIGO pasien karsinoma sel skuamosa (KSS) serviks di RSUP Prof. Dr. I.G.N.G. Ngoerah, untuk memperkuat bukti peran Galectin 3 pada prognosis KSS serviks.

Metode: Penelitian ini merupakan penelitian observasional analitik dengan rancangan potong lintang. Besar sampel 42. Evaluasi preparat hematoxyllin-eosin dilakukan untuk menilai diagnosis dan stadium FIGO. Ekspresi Galectin 3 dinilai dengan metode imunohistokimia. Data dianalisis dengan uji Chi-Square, yang dilanjutkan dengan uji rasio risiko prevalensi menggunakan SPSS versi 20.0 untuk Windows.

Hasil: Rerata usia pasien 52,34±9,86 tahun, dengan kejadian tertinggi pada kelompok umur dekade keenam dan dengan stadium FIGO dini (IB - IIA). Sekitar 81% pasien menunjukkan ekspresi Galectin 3 positif. Hubungan antara ekspresi Galectin 3 dengan stadium FIGO ditemukan signifikan secara statistik (p=0,016). Pada analisis risiko prevalensi didapatkan pasien dengan ekspresi Galectin 3 positif memiliki risiko prevalensi 1,9 kali lebih besar menjadi stadium lanjut daripada pasien dengan ekspresi negatif (95% IK: 1,376 - 2,593).

Kesimpulan: Terdapat hubungan antara ekspresi Galectin 3 dengan stadium FIGO pada pasien KSS serviks di RSUP Prof. Dr. I.G.N.G. Ngoerah, di mana pasien dengan Galectin 3 positif memiliki risiko lebih besar menjadi stadium lanjut.

Introduction: Psoriasis is a chronic autoimmune cutaneous disorder, which the exact etiology remains unknown. There is study showed psoriasis is associated with low levels of vitamin D. In recent years, vitamin D acted by vitamin D receptor (VDR) has been reported, which keratinocyte is one of the tissues presenting vitamin D receptor. This study aims to prove that low levels vitamin D receptor plasma is a risk factor for psoriasis vulgaris.

Method: This case-control study design in 25 patients with psoriasis vulgaris as cases and 25 controls who fulfilled the inclusion and exclusion criteria as well as in matching based on age and gender in Dermatovenereology Polyclinic of I.G.N.G Ngoerah Hosptital, then performed venous blood sampling as material examination vitamin D receptor plasma levels with enzyme-linked immunosorbent assay (ELISA) technique. The collected data was analyzed using SPSS version 20.0 with Pearson Chi square test to obtain Odds Ratio. This study showed that vitamin D receptor plasma levels in the case group were significantly lower than the control group (p<0.05).

Result: Odds ratio for vitamin D receptor plasma was 46.00 (95% CI= 8.03-263.63; p<0.001).

Conclusion: Based on these study results we can conclude low levels vitamin D receptor plasma as a risk factor the occurrence of psoriasis vulgaris. 

Pendahuluan: Psoriasis merupakan penyakit kulit autoimun kronis yang belum diketahui penyebabnya dengan jelas. Terdapat penelitian yang menunjukkan psoriasis berhubungan dengan kadar vitamin D yang rendah. Beberapa tahun terakhir, terdapat penelitian yang menyatakan bahwa vitamin D bekerja melalui vitamin D receptor (VDR), dimana keratinosit merupakan salah satu jaringan yang mempresentasikan VDR. Penelitian ini bertujuan untuk membuktikan bahwa kadar vitamin D receptor plasma yang rendah merupakan faktor risiko terjadinya psoriasis vulgaris.

Metode: Penelitian ini menggunakan rancangan case control study yang melibatkan 25 pasien psoriasis vulgaris sebagai kasus dan 25 kontrol yang memenuhi kriteria inklusi dan eksklusi serta dilakukan matching berdasarkan umur dan jenis kelamin di Poliklinik Ilmu Kesehatan Kulit dan Kelamin RSUP I.G.N.G Ngoerah Denpasar, kemudian dilakukan pengambilan darah vena sebagai pemeriksaan kadar vitamin D receptor plasma menggunakan teknik enzyme-linked immunosorbent assay (ELISA). Data yang terkumpul kemudian dianalisis menggunakan SPSS versi 20.0 dengan uji Pearson Chi Square untuk mendapatkan Odds rasio.

Hasil: Pada penelitian ini menunjukkan bahwa kadar vitamin D receptor plasma pada kelompok kasus lebih rendah secara bermakna dibandingkan kelompok kontrol (p<0,05) dengan Odds rasio untuk kadar vitamin D receptor plasma adalah 46,00 (IK 95%= 8,03-263,63, p<0,001).

Simpulan: Berdasarkan penelitian ini dapat disimpulkan bahwa kadar vitamin D receptor plasma yang rendah merupakan faktor risiko terjadinya psoriasis vulgaris.

Introduction: COVID-19 has been a challenge worldwide. This infection can manifest in various characteristics, from asymptomatic to severe, leading to mortality. Predictive tools to predict mortality are highly important in better therapeutic strategies. Hematology ratios, including neutrophil, platelet, lymphocyte, and monocyte, have been suggested as a prognostic tool that is widely available. The study aimed to assess the prognostic significance of NLR, PLR, and LMR in predicting COVID-19 patients' mortality in a rural setting.

Methods: Hospitalized patients with COVID-19 at Bajawa Regional General Hospital were included in this retrospective cohort study. The patient's medical records from January 2021 to August 2021 were examined. The patients were separated into two groups; in-hospital death and discharged group. The routine blood examination during admission gave NLR, PLR, and LMR results. Data analysis was processed with SPSS 26. The Receiver Operating Characteristic (ROC) curve is used to determine whether NLR, PLR, and LMR may be used as prognostic indicators for hospitalized patients’ outcomes. The area under the curve (AUC) results were used to rate the accuracy.

Results: There were 91 patients in total. NLR, PLR, and LMR, AUCs were 0.689, 0.635, and 0.653, with cut-off values of 4.28, 184.12, and 2.69, respectively. Each indicator’s sensitivity and specificity remained poor. The cut-off value of PLR was the only indicator that had significant differences when compared between the two groups. 

Conclusion: NLR, PLR, and LMR performed poor values as predictors of mortality in hospitalized patients with COVID-19.

Introduction: Hirsprung's case surgery method is usually done through 3 stages. Since the three-step method greatly influences the incidence of postoperative enterocolitis and malnutrition, a single-stage surgery technique was developed. This technique is safe, cost-effective, and avoid stoma-related morbidity in infants. This study aimed to determine the difference in the clinical outcome between Swenson-like transanal and Soave 1 stage transanal procedures in patients with hirschsprung's disease.

Methods: This was a retrospective cohort study by taking secondary data from patient medical records from years 2017 to 2021. The total sample of 100 Hirschprung patients was divided into two groups; patients with transanal Swenson-like surgical techniques and Soave. Data were tabulated and statistically analyzed with descriptive and association analysis.

Results: There were differences in operating time based on the surgical technique used, with a median of 120.00 minutes in the 1st stage Swenson-like transanal technique group and 150.17 minutes in the transanal Soave group. The length of stay of patients with the Swenson-like surgical technique was shorter than the Soave technique (p <0.001). Postoperative complications of enterocolitis were less common with the Swenson-like technique than with the Soave technique.

Conclusion: There are differences in clinical outcomes in postoperative Hirschsprung patients with the Swenson-like and Soave 1 stage transanal technique..

Pendahuluan: Metode pembedahan kasus hirschsprung pada umumnya dilakukan melalui 3 tahap. Namun metode tiga tahap sangat berpengaruh terhadap kejadian enterokolitis dan malnutrisi paska pembedahan, sehingga dikembangkan pembedahan dengan teknik 1 tahap yang diketahui aman, cost-effective, dan menghindari morbiditas akibat stoma pada bayi. Penelitian ini bertujuan untuk mengetahui perbedaan luara klinis antara tindakan transanal Swenson-like dan transanal Soave 1 tahap pada pasien dengan penyakit Hirschsprung.

Metode: Penelitian ini merupakan penelitian retrospective cohort dengan mengambil data sekunder dari rekam medis pasien dari tahun 2017 sampai 2021. Total sampel sebanyak 100 pasien Hirschprung dibagi menajadi dua kelompok, yaitu teknik operasi transanal Swenson-like dan teknik operasi Soave. Data ditabulasi dan dianalisis statistik dengan menggunakan uji deskriptif dan asosiasi.

Hasil: Terdapat perbedaan lama waktu operasi berdasarkan teknik operasi yang digunakan, dengan median 120,00 menit pada kelompok teknik transanal Swenson-like 1 tahap dan 150,17 menit pada kelompok transanal Soave. Durasi lama rawat inap pasien teknik operasi Swenson-like lebih singkat dibandingkan teknik Soave (p < 0,001). Komplikasi enterokolitis paska bedah lebih jarang terjadi pada teknik operasi Swenson-like dibandingkan dengan Soave.

Simpulan: Terdapat perbedaan luara klinis pada pasien hirschsprung paska tindakan bedah dengan teknik transanal Swenson-like dan Soave 1 tahap.

Introduction: Problem-based learning is a method of approach in assisting students in finding problems from a real event. This can affect learning methods to increase skills of critical thinking and active learning, where critical thinking will encourage the formation of knowledge and will be interpreted personally and will be applied to conditions or problems so as to increase active learning. This study aims to determine association between critical thinking skills towards active learning in medical students at Universitas Udayana.

Methods: The respondents of this study were medical students class 2020 in Universitas Udayana. The type of this research is analytic research with a cross-sectional approach. The sampling technique used was the total sampling method and used a questionnaire of critical thinking and active learning.

Results: A total of 165 respondents met the inclusion criteria in this research. The analysis results showed that critical thinking skills increased active learning significantly (p < 0.001) with moderate and direct correlation (r = 0.574).

Conclusion: The ability to think critically can affect the level of active learning in medical education students.

Pendahuluan: Salah satu metode pendekatan untuk membantu mahasiswa dalam menemukan masalah dari suatu peristiwa yang nyata adalah pembelajaran berbasis masalah. Hal ini dapat mempengaruhi metode belajar yang menyebabkan peningkatan kemampuan berpikir dan keaktifan belajar. Berpikir kritis akan mendorong terbentuknya pengetahuan dan akan diinterpretasi personal dan akan diaplikasikan pada kondisi atau masalah sehingga meningkatkan keaktifan belajar. Penelitian ini memiliki tujuan untuk menganalisis hubungan antara kemampuan berpikir kritis dan keaktifan belajar pada mahasiswa sarjana kedokteran Universitas Udayana.

Metode: Responden penelitian ini adalah mahasiswa program studi sarjana kedokteran Universitas Udayana angkatan 2020. Penelitian ini merupakan penelitian analitik dengan pendekatan potong lintang. Teknik pengambilan sampel dilakukan dengan total sampling dan menggunakan kuesioner berpikir kritis dan keaktifan belajar.

Hasil: Sebanyak 165 responden memenuhi kriteria inklusi dalam penelitian ini.  Hasil analisis menunjukkan bahwa kemampuan berpikir kritis meningkatkan keaktifan belajar secara signifikan (p < 0,001) dengan korelasi sedang dan searah (r = 0,574).

Simpulan: Kemampuan berpikir kritis dapat mempengaruhi tingkat keaktifan belajar pada mahasiswa sarjana kedokteran Universitas Udayana.

Background: Prostate cancer or prostate carcinoma is a malignancy that occurs in the cells of the prostate gland and is associated with chronic problems with sexual function, urination, and the patient's psychological well-being. This study was conducted to investigate the clinicopathological profile of prostate cancer patients at Prof dr. I G.N.G. Ngoerah in the period 2017 – 2020.

Methods: This descriptive study used a cross-sectional design conducted at Prof. dr. I G.N.G. Ngoerah Central Hospital. The inclusion criteria were prostate cancer patients in 2017-2020 and the exclusion criteria were patients with incomplete medical record data. The determination of the sample using total sampling with the number of samples that meet the criteria of 82 patients. All statistical analyzes used SPSS ver.25.

Results: Patients in this study had a mean age of 70.89±9.26 years, with the majority aged 50 years and above (97.6%). Most of the patients had the main symptom of urination difficulty (57.5%). PSA levels in patients had a mean of 543.3 ng/mL. Most of the patients had reached stage IV at the time of diagnosis (92.1%). Transurethral resection is the most common specimen retrieval method (47.6%). Almost all samples were diagnosed as acinar adenocarcinoma (95.2%) with the majority categorized into Gleason grade group 5 (64.9%).

Conclusion: Prostate carcinoma cases at Prof. dr. I G.N.G. Ngoerah mostly occurs at the age of >50 years with the main complaint of urination difficulty. The majority of the patients had stage IV with acinar adenocarcinoma histopathological type and Gleason grade group 5.

Latar belakang: Kanker prostat atau karsinoma prostat merupakan keganasan yang terjadi pada sel-sel kelenjar prostat yang berkaitan dengan permasalahan kronis terhadap fungsi seksual, berkemih, serta kesejahteraan psikologis pasien. Penelitian ini dilaksanakan dengan tujuan untuk menyelidiki profil klinikopatologi pasien karsinoma prostat di RSUP Prof dr. I  G.N.G. Ngoerah pada periode tahun 2017 – 2020.

Metode: Penelitian ini bersifat deskriptif dengan desain penelitian cross-sectional yang dilakukan di RSUP Prof. dr. I G.N.G. Ngoerah. Kriteria inklusi berupa pasien karsinoma prostat pada tahun 2017-2020 dan kriteria eksklusi berupa pasien dengan data rekam medis yang tidak lengkap. Adapun penentuan sampel menggunakan total sampling dengan jumlah sampel yang memenuhi kriteria sebanyak 82 orang. Seluruh analisis statistik menggunakan SPSS ver.25.

Hasil: Subjek dalam studi ini memiliki mean usia 70,89 ± 9,26 tahun, dengan mayoritas berusia ≥ 50 tahun (97,6%). Sebagian besar pasien mengalami keluhan utama berupa sulit berkemih (57,5%). Kadar PSA pada pasien memiliki mean 543,3 ng/mL. Mayoritas pasien sudah mencapai stadium IV saat terdiagnosis (92,1%). Reseksi transuretral merupakan cara pengambilan sampel dengan frekuensi terbanyak (47,6%). Hampir semua sampel didiagnosis sebagai adenokarsinoma asinar prostat (95,2%) dengan mayoritas Gleason grade group 5 (64,9%).

Simpulan: Kasus karsinoma prostat di RSUP Prof. dr. I G.N.G. Ngoerah sebagian besar terjadi pada usia >50 tahun dengan keluhan utama sulit berkemih. Mayoritas dari pasien menderita stadium IV dengan tipe histopatologi adenokarsinoma asinar dan Gleason grade group 5.

Introduction: Dysmenorrhea is pain that is quite severe during menstruation which interferes with daily activities and habits. Women who suffer from dysmenorrhea are about 50% of the world's population. Prostaglandin levels that are out of balance in primary dysmenorrhea lead to pain through increased uterine contractility, decreased uterine blood flow, and increased sensitivity of peripheral nerves. Coffee drinking is one of the risk factors for primary dysmenorrhea. This study aims to determine the association between coffee consumption and primary dysmenorrhea of female students of bachelor of medicine programs batch 2021, Faculty Of Medicine, Universitas Udayana.

Methods: This is an analytic study with a cross-sectional approach. The research sample was selected randomly by purposive random sampling technique. The data obtained were then processed and analyzed using Microsoft Excel and SPSS.

Results: The study was conducted on 95 female students of bachelor of medicine programs batch 2021, Faculty Of Medicine, Universitas Udayana. Based on analysis tests, it was found that there was a significant association between coffee consumption and the incidence of primary dysmenorrhea (p = 0,003). The results of the odds ratio (OR) test were 4.03, thus female students who consumed coffee may have a risk of primary dysmenorrhea of 4.03 times.

Conclusion: There is a significant association between coffee consumption and the incidence of primary dysmenorrhea in female students bachelor of medicine programs batch 2021, Faculty Of Medicine, Udayana University.

Pendahuluan: Dismenore adalah rasa nyeri cukup parah pada masa menstruasi yang mengganggu aktivitas dan kebiasaan sehari-hari. Wanita yang menderita dismenore yaitu sekitar 50% dari populasi dunia. Dismenore primer disebabkan oleh ketidakseimbangan level prostaglandin yang menciptakan rasa sakit karena meningkatnya kontraktilitas uterus, penurunan aliran darah uterus, dan peningkatan sensitivitas saraf perifer. Konsumsi kopi merupakan salah satu faktor risiko dari dismenore primer. Penelitian ini memiliki tujuan untuk mengevaluasi hubungan antara konsumsi kopi dan dismenore primer pada mahasiswi Program Studi Sarjana Kedokteran Fakultas Kedokteran Universitas Udayana (PSSK FK UNUD) angkatan 2021.

Metode: Penelitian menggunakan studi analitik dengan desain cross-sectional. Teknik pengambilan sampel adalah purposive random sampling. Data yang diperoleh selanjutnya diolah dan dianalisis menggunakan perangkat lunak Microsoft Excel dan SPSS.

Hasil: Penelitian dilakukan pada 95 mahasiswi PSSK FK UNUD angkatan 2021. Berdasarkan uji analisis, didapatkan hubungan signifikan antara konsumsi kopi (p = 0,003). Hasil dari pengujian odds ratio (OR) didapat sebesar 4,03 sehingga mahasiswi yang mengonsumsi kopi memiliki risiko terjadinya dismenore primer sebesar 4,03 kali.

Simpulan: Terdapat terdapat hubungan yang bermakna antara konsumsi kopi dengan kejadian dismenore primer pada mahasiswi PSSK FK UNUD angkatan 2021.

Introduction: Andropause is clinical syndrome due to testosterone levels reduction below normal in the body experienced by elderly men. The level of physical activity is one of the risk factors for andropause. This study aims to determine the relationship between the level of physical activity and andropause in high school teachers in Denpasar City.

Methods: This study is an observational analysis with a cross-sectional approach. Andropause was assessed using the ADAM questionnaire consisting of 10 questions. Meanwhile, the level of physical activity assessed using the GPAQ questionnaire consisting of 16 questions. The sampling technique used is purposive sampling.

Results: Total 50 respondents include in this study. As many as 66% of respondents have low levels of physical activity, 26% moderate physical activity, and 4% high physical activity. A total of 32 (64.0%) respondents experienced andropause and 18 (36.0%) did not experience andropause. There was a significant association between low levels of physical activity and andropause (p=0,05). The odds ratio (OR 95%CI) between andropause with low levels of physical activity is 11,14 (1,0 – 124,33).

Conclusion: The lower level of physical activity teachers at Denpasar City Senior High School, the higher risk of experiencing andropause. This research is expected to motivate and educate men to be more aware of andropause and keep physically active.

Pendahuluan: Andropause adalah sindrom klinis akibat penurunan kadar testosteron di bawah normal dalam tubuh yang dialami oleh pria lanjut usia. Tingkat aktivitas fisik menjadi salah satu faktor risiko terhadap andropause. Penelitian ini bertujuan untuk mengetahui hubungan tingkat aktivitas fisik dengan andropause pada guru SMA di Kota Denpasar.

Metode: Penelitian ini merupakan analisis observasional dengan pendekatan cross-sectional. Andropause dinilai menggunakan kuesioner ADAM yang terdiri dari 10 buah pertanyaan. Sementara itu, tingkat aktivitas fisik dinilai menggunakan kuesioner GPAQ yang terdiri dari 16 buah pertanyaan. Teknik pengambilan sampel yang digunakan adalah purposive sampling.

Hasil: Responden dalam penelitian ini berjumlah 50 orang. Sebanyak 66% responden memiliki tingkat aktivtas fisik yang rendah, 26% aktivitas fisik sedang, dan 4% aktivitas fisik tinggi. Sebanyak 32 (64,0%) responden mengalami andropause dan 18 (36,0%) tidak mengalami andropause. Terdapat hubungan yang signifikan antara tingkat aktivitas fisik rendah dengan andropause (p = 0,05). Adapun nilai odd ratio (OR 95%CI) antara andropause dengan tingkat aktivitas fisik rendah adalah 11,14 (1,0 – 124,33).

Simpulan: Semakin rendah tingkat aktivitas fisik guru di SMA Kota Denpasar, maka semakin tinggi risiko mengalami andropause. Penelitian ini diharapkan dapat memotivasi dan mengedukasi pria untuk lebih waspada terhadap andropause serta menjaga fisiknya tetap aktif.

Background: During pregnancy there’s an increase of fluid which may cause problems in the cardiovascular system that were previously undiagnosed. Approximately 1–4% of pregnancies globally cause complications of cardiovascular disease. This study aims to determine the characteristics of pregnant patients with heart disease who were inpatients at Dr. Kariadi Hospital in the year 2020-2021.

Methods: This study used a descriptive research design conducted at Dr. Kariadi Hospital with secondary data through medical records for the year period of 1 January 2020 – 31 December  2021. A sample of 157 was all cases of pregnancy with heart disease treated in the obstetrics room or intensive care unit (ICU).

Result: Heart disease most suffered by pregnant patients was hypertensive heart disease as many as 90 cases (57.65%), peripartum cardiomyopathy 18 cases (11.54%). From echocardiography, 17 cases (16.34%) had decreased left ventricular ejection fraction and 14 cases (11.02%) had decreased right ventricular systolic function. 25 cases (19.54%) had impaired cardiac muscle kinesity and 57 cases (50.43%) had diastolic dysfunction. Most valve disorders occurred in the mitral, those were 22 cases (17.33%). Only 5 cases (3.2%) of these patients had COVID-19. Based on vital signs and laboratory examinations, data were obtained for 35 cases (22.29%) patients had a pulse of more than 100x/minute upon arrival at Dr. Kariadi Hospital only 2 cases (1.27%) had a pulse below 60x/minute. On saturation examination, 13 cases (8.26%) patients experienced desaturation.

Conclusion: Hypertensive heart disease has the highest prevalence. Premature birth and the incidence of low birth weight is the highest incidence in pregnant patients with heart disease.

Latar belakang: Selama kehamilan terjadi peningkatan cairan yang dapat menyebabkan masalah pada sistem kardiovaskular yang sebelumnya tidak terdiagnosis. Sekitar 1-4% kehamilan secara global menyebabkan komplikasi penyakit kardiovaskular. Penelitian ini bertujuan untuk mengetahui karakteristik pasien hamil dengan penyakit jantung yang dirawat inap di RSUP Dr. Kariadi periode tahun 2020-2021.

Metode: Studi ini menggunakan desain penelitian deskriptif yang dilakukan di RSUP Dr. Kariadi dengan data sekunder melalui rekam medis periode 1 Januari 2020 - 31 Desember 2021. Sampel sebanyak 157 adalah semua kasus kehamilan dengan penyakit jantung yang dirawat di ruang obstetri maupun intensive care unit (ICU).

Hasil: Penyakit jantung yang paling banyak diderita oleh pasien hamil adalah penyakit jantung hipertensi sebanyak 90 kasus (57,65%), kardiomiopati peripartum 18 kasus (11,54%). Dari ekokardiografi, 17 kasus (16,34%) mengalami penurunan fraksi ejeksi ventrikel kiri dan 14 kasus (11,02%) mengalami penurunan fungsi sistolik ventrikel kanan. 25 kasus (19,54%) mengalami gangguan kinesitas otot jantung dan 57 kasus (50,43%) mengalami disfungsi diastolik. Kelainan katup paling banyak terjadi pada mitral yaitu 22 kasus (17,33%). Hanya 5 kasus (3,2%) dari pasien ini yang memiliki COVID-19. Berdasarkan tanda vital dan pemeriksaan laboratorium didapatkan data sebesar 35 kasus (22,29%) pasien memiliki denyut nadi lebih dari 100x/menit saat tiba di RSUP Dr. Kariadi, hanya 2 kasus (1,27%) yang memiliki denyut nadi dibawah 60x/menit. Pada pemeriksaan saturasi sebesar 13 kasus (8,26%) pasien mengalami desaturasi.

Simpulan: Penyakit jantung hipertensi memiliki prevalensi tertinggi. Kelahiran prematur dan kejadian berat badan lahir rendah merupakan kejadian tertinggi pada pasien hamil dengan penyakit jantung.

Background: Dyspepsia syndrome was a health problem commonly found in everyday life. There were several factors related to the etiology and pathophysiology of dyspepsia, one of them was stress and eating habits. High stress levels and bad eating habits often occur in college students, especially medical students.

Objective: To evaluate the association between stress and eating habits in medical students at the Faculty of Medicine, Udayana University.

Methods: This was an observational analytic study with a cross-sectional approach. The sampling method is consecutive sampling. Primary data was taken from questionnaires filled out online by respondents.

Results: Bivariate analysis showed stress was associated with the incidence of dyspepsia (p = 0.022). Irregular eating habits (p = 0.011), spicy (p = 0.001), sour (p = 0.001), and fatty foods (p <0.001) were significantly associated with the incidence of dyspepsia. Meanwhile, multivariate analysis showed the significance of several factors for dyspepsia, namely irregular eating habits (OR: 2.350 and 95% CI: 1.201-4.599), habit of consuming spicy food (OR: 2.132; 95% CI: 1.075-4.227, habit of consuming sour foods (OR: 2.455; 95% CI: 1.107-5.444), and habit of consuming fatty foods (OR: 2.185; 95% CI: 1.109-4.307).

Conclusion: In medical students at the Faculty of Medicine at Udayana University, there was no significant correlation between stress and the prevalence of dyspepsia, however there was a correlation between eating habits and the condition.

Latar belakang: Sindroma dispepsia merupakan masalah kesehatan yang umum ditemukan. Terdapat beberapa faktor yang berhubungan dengan etiologi dan patofisiologi dispepsia, salah satunya adalah stres dan kebiasaan makan. Mahasiswa kedokteran sering mengalami tingkat stres yang tinggi dan kebiasaan makan yang tidak baik.

Tujuan: Untuk mengevaluasi hubungan antara stres dan kebiasaan makan terhadap dispepsia pada mahasiswa pendidikan dokter Fakultas Kedokteran Universitas Udayana (FK Unud).

Metode: Studi ini menggunakan desain analitik observasional dengan pendekatan potong lintang (cross sectional). Metode pengambilan sampling adalah consecutive sampling. Data primer diambil dari kuesioner yang diisi secara daring oleh responden.

Hasil: Analisis bivariat menunjukkan stres berhubungan signifikan dengan kejadian dispepsia (p = 0,022). Kebiasaan makan yang tidak teratur (p = 0,011), kebiasaan mengkonsumsi makanan pedas (p = 0,001), asam (p = 0,001), dan berlemak (p < 0,001) berhubungan signifikan terhadap kejadian dispepsia. Sementara itu, analisis multivariat menunjukkan signifikansi dari beberapa faktor terhadap dispepsia, yaitu kebiasaan makan yang tidak teratur (OR: 2,350 dan 95% CI: 1,201-4.599), kebiasaan mengkonsumsi makanan pedas (OR: 2,132; 95% CI: 1,075-4,227, kebiasaan mengkonsumsi makanan asam (OR: 2,455; 95% CI : 1,107-5,444), dan kebiasaan mengkonsumsi makanan berlemak (OR: 2,185; 95% CI: 1,109-4,307).

Simpulan: Stres tidak berhubungan signifikan terhadap kejadian dispepsia. Namun, kebiasaan makan yang buruk berhubungan signifikan terhadap kejadian dispepsia pada mahasiswa pendidikan dokter FK Unud.