bluuebunny/crossref_metadata_2025 huggingface dataset:
Hubungan antara TIL (Tumor Infiltrating Lymphocyte) dan MAI (Mitotic Activity Index) dengan kejadian metastase kelenjar getah bening (KGB) aksila pada operable breast cancer di RSUP Sanglah, Denpasar.
Authors: Santhi I Gede Aditya Krishna , Christian I Nengah Wiadnyana Steven , Widiana I Gede Raka
Published: April 2020

Latar belakang: Kanker payudara merupakan penyakit yang menduduki urutan ketiga di Eropa dan United State sebagai jenis kanker yang menyebabkan kematian. Studi dua dekade terakhir mengungkapkan bahwa Tumor microenvironment (TME)juga merupakan penentu penting perilaku tumor.Tumor padat umumnya terdiri dari berbagai sel kekebalan tubuh, termasuk limfosit T dan B, sel NK, makrofag, dan neutrofil. Imunitas adaptif dan imunosupresi selalu menunjukkan tingkat ekspresi yang berbeda pada tumor, dan banyak gen kekebalan terkait dengan inflamasi. Interaksi antara sel imunitas menentukan induksi atau penghambatan perkembangan tumor, angiogenesis, dan metastasis. Sistem imunitas mempengaruhi surveillance pada pasien kanker. Proliferasi telah dikenali sebagai â€œhallmarkâ€ dari kanker dan merupakan faktor prognostik kanker. Evaluasi dari derajat proliferasi sel dalam jaringan tumor digunakan untuk menilai progresifitas tumor. Penilaian indeks mitosis telah digunakan sebagai â€œgold standardâ€ dalam menilai agresivitas tumor. Maka dari itu, tujuan penelitian ini adalah untuk mengetahui hubungan respon imun pada tumor dalam hal ini sel Lymphocyte dan aktifitas pembelahan sel tumor dengan kejadian penyebaran kanker ke KGB aksila pada operable breast cancer di RSUP Sanglah Denpasar.Â Metoda:Lima puluh tiga sampel pasien kanker payudara post MRM (Modified Radical Mastectomy) yang berobat di RSUP Sanglah yang mempunyai catatan medis (data klinis, histopatologis), sampel dipilih secara eligible sampling pada rekam medis pasien di Bagian/ SMF Bedah Onkologi Fakultas Kedokteran Universitas Udayana RSUP Sanglah dari tahun 2016 sampai dengan 2018. Penelitian ini merupakan â€œCross Sectional Analitik" hubungan antara TIL dan MAI dengan kejadian metastase KGB aksila pada pasien operable breast cancer Â Â Â Â secara univariant, bivariat dan multivariant dengan menggunakan perangkat lunak SPSS 20 for windows.Â Hasil: menunjukkan analisa dengan uji Chi-square didapatkan pasien dengan low TIL (P= 0,627), intermediate TIL (P= 0,339) dan pasien dengan MAIÂ  â‰¥ 25 /10 lp (P= 0,531), MAI 13-24 /10 lp (P= 0,531) tidak dijumpai adanya hubungan bermakna dengan kejadian metastase KGB aksila karena tidak signifikan secara statistika. Â Simpulan:tidak dijumpai adanya hubungan bermakna, low dan intermediate TIL memiliki kecenderungan metastase KGB aksila pada Operable Breast Cancer lebih tinggi, dan dijumpai pula adanya kecenderungan makin tinggi MAI, semakin tinggi resiko metastase KGB aksila pada operable breast cancer di RSUP Sanglah Denpasar.Hubungan antara TIL (Tumor Infiltrating Lymphocyte) dan MAI (Mitotic Activity Index) dengan kejadian metastase kelenjar getah bening (KGB) aksila pada operable breast cancer di RSUP Sanglah, Denpasar.
Karakteristik pasien cedera kepala di Rumah Sakit Umum Daerah (RSUD) Umbu Rara Meha Waingapu periode 1 Januari 2017 â€“ 31 Desember 2018
Authors: Putra Made Bhuwana
Published: April 2020

Background: Traumatic Brain Injury is among the leading causes of mortality and morbidity in the world, with the increase of incidence rate every year especially in the developing country concomitant with the rise in motor vehicle usage. In Indonesia, although the number is high, the study concerning the incidence and characteristic of patients with traumatic brain injury are still limited. This study has objective to show the characteristic pattern of traumatic brain injury cases at Umbu Rara Meha general hospital that, as the biggest hospital in Sumba Island, can be the representative for the area.Method: This study is a descriptive study with a retrospective design using the medical record in Umbu Rara Meha general hospital from January 1st until December 31th as secondary data. A non-probability sampling technique using consecutive was conducted. Data were analyzed using SPSS version 25 and depicted in mean, median, frequency, and percentage. Result: A total of 186 cases was included and from there it is shown that the highest prevalence rate of traumatic brain injury was in males (67,7%), and was dominated by the adolescence group (25,3%), although by occupation the highest rate was farmer and fisherman (32,3%). The leading cause of traumatic brain injury is an accident (82,2%) with mild traumatic brain injury (67,7%) as the most frequent type of severity. The average length of stay for traumatic brain injury was two days.Conclusion: The high number of the incidence rate of traumatic brain injury mainly from the accident and on adolescence group can be used as a reference for the local government or related institution to look more carefully about the awareness of safe driving or riding among the society and can be implemented through a program or other governing instrument.
Gambaran karakteristik fraktur radius distal di RSUP Sanglah Tahun 2013-2017
Authors: Tantri Irene Natalia , Asmara A. A. Gde Yuda , Hamid Agus Roy Rusly Hariantana
Published: April 2020

Background: Radius distal fracture is the most common fracture seen in emergency department which involves the upper extremity. Radius distal fracture can occur in any age, ranging from children, teenager until elderly patients. There is an increasing trend of radius distal fracture. However, the research on radius distal fracture characteristic, especially in Bali, is still limited.Method: This study was a descriptive-retrospective study which aims to find out the characteristic of radius distal fracture at Sanglah General Hospital, Denpasar, Bali. For data collection, we used total sampling technique using secondary data from patientsâ€™ medical records. The study sample was all patient diagnosed with radius distal fractures between the year 2013-2017 with incomplete medical record as the exclusion criteria.Result: This study obtained 677 radius distal fracture samples. Most of the patients were male [434 cases (64,1%)] with the most common age range was between 20-29 years old [147 cases (21,7%)]. The most common etiology of radius distal fracture was traffic accident [322 cases (47,6%)]. Fracture of the other upper extremity parts, in addition to radius distal, was the most common complaints accompanying radius distal fractures [333 cases (49,2%]. Based on the length of stay, 84% patients were hospitalized less than 5 days.Conclusion: Distal radial fracture was commonly seen in men with the age range between 20-29 years old. Traffic accident was the most common cause of distal radial fracture with the average length of stay less than 5 days.
Self-esteem formation among people who are in rehabilitation for drug abuse in Bangli Mental Health Hospital, Bali, Indonesia
Authors: Sariyani Mde Dewi , Ekawati Ni Komang , Duarsa Dyah Pradnyaparamita , Ariyanti Kadek Sri
Published: April 2020

Background: Self-esteem formation is an essential aspect for people who use drugs to support the success of a rehabilitation program, and to prevent ongoing relapse. However, self-esteem formation is not a priority in the rehabilitation program. It also tends to ignore the drug abuse status and psychological states of its clients. This study aimed to explore self-esteem formation among people who are in rehabilitation for drug abuse at the Bangli Mental Health Hospital. Findings from this study provide insights to the hospital on the importance of self-esteem formation through a rehabilitation program.Metode: A qualitative study was conducted in the Bangli Mental Health Hospital. We recruited a total of ten informants purposively who are in a rehabilitation program for at least two weeks for drug abuse at the Darmawangsa Ward Bangli Mental Health Hospital. Data were collected through in-depth interviews. Data were analyzed inductively and were presented using a narrative approach.Results: Our in-depth interviews found that self-esteem formation among people who are in rehabilitation for drug abuse depends on various factors such as family support, peer support, life experience, skills and traits, spirituality, policies, parenting history, physical and social environments.Conclusion: Self-esteem formation is determined by various factors and the drug abuse status of informants. We hope that the Bangli Mental Health Hospital can provide rehabilitation services tailored for every drug abuse status during their recovery time at the rehabilitation center.
Characteristic overview of aplastic anemia at Sanglah Hospital, Bali-Indonesia in 2017-2018
Authors: Utama Putra Komang Agus Widhy , Subawa A.A Ngurah , Lestari A.A Wiradewi
Published: April 2020

Background: Aplastic anemia is a rare disease of anemia which characterized by pancytopenia due to spinal cord hypoplasia. This can occur in people of any age, race, and gender with different degree of severity, with incidence rate is two until three times higher in Asia than the West. This study aims to determine the characteristic of aplastic anemia based on age, gender, laboratory examination, and severity in Sanglah Hospital.Methods: This research is a cross sectional descriptive study with sources of data were medical records of aplastic anemia patients at Sanglah Hospital in the last 2 years, 2017-2018. Distribution of research variables is gender, age, laboratory examination, and severity.Results:The result showed that 11 data were 6 (55%) male and 5 female (45%), with the mean age was 48 Â± 14 years. The highest incidence occurred in the age range of 26-60 years old with 7 patients (64%). In this study the average hemoglobin level obtained was 9.94 Â± 1.46 g/dL with range between 6.65 to 12.49 g/dL. The average number of leukocytes was 11.91 Â± 24.52 x 109 L with range of leukocytes is 1.99-84.58 x 109/L. The average number of absolute Neutrophils and percent was 1.53 Â± 1.52 x 109/L and 25.99 Â± 25.79% with range between 0.06 â€“ 4.53 x 109/L and 2.3 - 70.83%. The average platelet count was 24.77 Â± 11.35 x 109/L with range between 4.25 â€“ 42.58 x 109/L. The highest cases were nonsevere aplastic anemia (NSAA) with 7 people (64%).Conclusion: The value of laboratory parameters for complete blood examination (leukocytes, platelets, hemoglobin, and neutrophils) in patients with aplastic anemia at Sanglah General Hospital is still very low, so it is a challenge for clinicians to carry out treatment of aplastic anemia and management related complications.
Karakteristik gambaran sitologi pap-smear sebagai tes skrining untuk lesi pra-kanker serviks di RSUP Sanglah, Denpasar, Bali
Authors: Pradnyana Putu Risky Yoga , Susraini Anak Agung Ayu Ngurah , Dewi I Gusti Ayu Sri Mahendra
Published: April 2020

Background: Cervical cancer is the second most often cancer that occurs in women worldwide after breast cancer and as many as 84% of the cases occur in developing countries. Pap Smear is a screening method that widely used for cervical cancer screening. The aim of the study is to obtain the characteristic data of pap smear cytology as a pre-cervical cancer screening in Sanglah General Hospital 2016 â€“ 2017 period.Methods: This study was descriptive research with cross sectional study design. The sampling technique is total sampling where the research data comes from the cytology registration book results of the Anatomical Pathology Laboratory at Sanglah General Hospital Denpasar 1 January 2016 - 31 December 2017 period which has fulfilled the inclusion criteria and does not meet the exclusion criteria. Data were analyzed using SPSS version 20 for Windows.Results: This study collected as many as 590 samples. Most of the pap smear patients at Sanglah General Hospital Denpasar were 41-50 year old group as many as 188 people (31.86%), most of the patients parities were nullipara parities as many as 324 people (54.92%), most had no complaints as many as 261 people (44.24%) and most of the pap smear cytology description was Reactive Cellular Changes Associated with Inflammation (RCCI) as many as 261 people (44.64%).Conclusion: Most of the respondents who underwent pap-smear test as a screening step for pre-cancerous lesions had a cytological picture of Reactive cellular changes associated with Inflammation (RCCI)
Hubungan kadar TNF-Î± dengan HOMA-IR pada pasien diabetes mellitus tipe-2 di Rumah Sakit Umum Pusat Haji Adam Malik, Medan, Indonesia
Authors: Poltak Poltak , Syafril Santi , Ganie Ratna Akbari
Published: April 2020

Background: The homeostatic assessment (HOMA) of the first cell-Î² (B) and insulin (IR) function is used to determine insulin sensitivity and cell-Î² function of insulin plasma concentrations and fasting glucose. High extracellular glucose levels will trigger an increase in ROS production (which in turn will increase the formation of Reactive Oxygen Species) expression of TNF Î± (Tumor Necrosis Factor-Î±) and exacerbate oxidative stress. The study aimed to determine the relationship between TNF Î± and HOMA-IR in type 2 DM.Method: A cross sectional study was conducted at the H. Adam Malik General Hospital Medan from December-February 2018 in 43 patients with type 2 DM. Fasting insulin levels were examined using Celuminescence Microparticle Immunoassay and fasting glucose levels with Enzymatic and TNF Î± methods with the Elisa method. The relationship of the characteristics of TNF Î± levels with HOMA-IR in type 2 DM using the Kolmogorov Smirnov test used the Spearman's rank correlation test with SPSS version 20 for windows.Results: The total sample was 43 samples of patients with type 2 diabetes mellitus. Most of the respondents were male (62.8%) and had a median age of 57 (39-87) years. In this study, the TNF-alpha levels were 87.28 (18.43-846.05) pg/ml. While the HOMA-IR level was 3.36 (0.41-25.82). There was no significant correlation between serum TNF Î± levels and HOMA-IR in type 2 DM patients (P> 0.05).Conclusion: There is no significant relationship between TNF Î± levels and HOMA-IR in type 2 DM patients.
Karakteristik profil pasien urtikaria akut di poliklinik kulit dan kelamin Rumah Sakit Umum Pusat (RSUP) Sanglah periode Oktober 2017- 2018
Authors: Atmaja Gede Mahadika Pradipta , Suryawati Nyoman , Rusyati Luh Made Mas
Published: April 2020

Background: Acute urticaria is a skin disorder that is often encountered that can cause redness to respiratory obstruction so that emergency emergencies and urticaria lesions that last more than 72 hours are indicative of hospitalized patients. This study aims to describe the characteristics of acute urticaria at Dermato-Venerology Polyclinic, Sanglah General Hospital during October 2017-2018 period.Methods: A cross-sectional study was conducted using secondary data from medical records of patients with urticaria in Sanglah General Hospital in the October 2017-2018 period. Data retrieval was taken by the Total Sampling method. Distribution of research variables namely, gender, age, genetic, causative factors, were collected. Data analysis is described in the form of tables and narratives using SPSS version 20 for Windows.Results: The results showed that there were 23 acute urticaria patients in this study, the age of the most research samples was in the Adult age category with a large percentage of 60.87%, the most gender-based study sample was female gender with a percentage of 78.3%, research genetic samples most of them are in the absence of genetics, with a percentage of 91.3%, the work of most research samples in housewives with a percentage of 34.8%, the most common cause of acute urticaria is in food allergies with a percentage of 56.5%.Conclusion: The incidence of acute urticaria is most common in adulthood, female sex, housewives, and food allergies.
The prevalence of panic disorder among English Class students at Medical Faculty, Universitas Udayana, Bali, Indonesia in 2018
Authors: Ramachandran Thevarani , Wardani Ida Ayu Kusuma , Setyawati Lely
Published: April 2020

Background: Panic disorder is diagnosed in people who experience spontaneous, seemingly out-of-the-blue panic attacks and are very preoccupied with the fear of a recurring attack. Panic disorder usually begins in adulthood (after age 20) and can interfere a lot with daily life, causing people to miss work, go to many doctor visits, and avoid situations where they fear they might experience a panic attack. This study aims to determine the prevalence of panic disorder among English Class students at Medical Faculty, Universitas Udayana, Bali, Indonesia in 2018Methods: An observational cross-sectional study was conducted among 89 medical students from English Class at the Faculty of Medicine, Universitas Udayana in 2018 using total sampling techniques. A self-administered questionnaire was carried out to determine the prevalence of panic disorder by several valid and reliable questions. Data were analysed using SPSS version 20 for Windows and presented in frequency and percentage.Results: Â Most of the respondents were 20 years old (57.3%). There are only 12.0% of English class Semester 7 students are free from panic disorder, 51.0% suffers from mild panic disorder, and 37.0% suffers from moderate panic disorder. Around 64% of female respondents have panic disorder while 34% in male respondents. Female respondents are tended to get more panic attacks than male respondents in a ratio of 2:1.Conclusion: Female medical students tend to have a higher risk of panic disorder compared with males. The majority age of students suffering from panic attacks is from 20 to 23 years old.
The effect of Euphorbia milii tea and its combination with Propolis on number of glomeruli in M.tb-infected mice: a histopathology study
Authors: Kalaichelvam Ruthirar , Linawati Ni Made , Wiryawan I Gusti Nyoman Sri , Wirata Gede , Ratnayanti I Gusti Ayu Dewi , Sugiritama I Wayan , Wahyuniari Ida Ayu Ika , Arijana I Gusti Kamasan Nyoman
Published: April 2020

Background: The role of both Euphorbia milii and Propolis is to increase the effectiveness in pathological condition of the body part damaged, include renal function in maintaining the homeostasis. That combination into mice which are infected by Mycobacterium tuberculosis will change the total number of glomerulus in the kidney.Aim: The study aims to determine the effect of combination tea from Euphorbia milii and Propolis on the number of the glomerulus in mice infected by M. tb.Method: This study confirmed randomized post-test only control group design consisting of 24 mice divided into six groups (G1-G6). E. milli flowers are obtained from flower plantations, in Ketewel, Gianyar, Bali Province took in fresh and dark red sampling. M. tuberculosis used H37Rv strain (ATCC27294) grown on Middlebrook 7H9 liquid medium for two weeks.Result: It was found that Group 3 and Group 5 from the treatment group has the most significant average number of glomerulus which was 13, followed by Group 2 and Group 6 from the control group has the largest average number of glomerulus which was 12. The differences were not significant between groups with P = 0.463 (P <0.05).Conclusion: The Euphorbia milii tea and its combination with Propolis does not affect histological change on the total number of glomerulus in mice infected with M. tb.
Pengaruh kebiasaan merokok terhadap kejadian disfungsi ereksi pada petugas keamanan di Universitas Udayana Sudirman
Authors: Leong Tifania Melucha Miguel , Oka Negara I Made , Kurniawan Yukhi
Published: April 2020

Introduction: Smoking habits are behaviors that are now still seen in various country and these behaviors are really difficult to eliminate. Each cigarette dangerous chemicals like nicotine that can be effect to health especially smokers, one of this effect is erectile dysfunction. In this Study, the aim was to determine how much influence smoking habits can affect to erectile problem in security officers at Udayana University Sudirman.Methods: This is a cross-sectional descriptive study that was conducted at Udayana Universitas Sudirman with 10 participants and obtained from filling IIEF-5 questionnaire (International Index of Erectile Dysfunction) and active smoker questionnaire that were distributed directly to the participants.Result: The results of this study was shown that almost 40% security officers had mild erectile dysfunction. This study is observer from Non-Probability Sampling especially in convenient sampling to look the effect of smoking habits that against erectile dysfunction.Conclusion: The security officer at Udayana University in Sudirman with smoking habits almost all experienced erectile dysfunction with different categories of erectile dysfunction.Latar Belakang: Kebiasaan merokok merupakan perilaku yang sekarang masih terlihat di berbagai negara dan perilaku tersebut sulit untuk menghilangkannya. Pada setiap batang rokok terkandung zat kimia yang berbahaya kesehatan para perokok dan salah satunya adalah Disfungsi Ereksi. Penelitian ini bertujuan untuk mengetahui seberapa besar pengaruh kebiasaan merokok terhadap kejadian DE pada petugas keamanan di Universitas Udayana Sudirman.Metode: Jenis penelitian ini adalah Cross-sectional Descriptive Study. Penelitian ini dilakukan di Kampus Universitas Udayana Sudirman dengan jumlah responden 10 orang dan didapatkan dari pengisian kuesioner IIEF-5 (International Inde of Erectile Function) dan kuesioner perokok aktif yang dibagikan secara langsung pada responden.Hasil: Dari hasil penelitian ini, menunjukan bahwa dari 10 petugas keamanan didapatkan 40% mengalami DE ringan. Di uji dari Non-Probability Sampling khususnya Convenient Sampling terhadap pengaruh kebiasaan merokok pada disfungsi ereksi.Simpulan: Petugas keamanan di Universitas Udayana Sudirman dengan kebiasaan merokok hampir seluruhnya mengalami disfungsi ereksi dengan kategori yang berbeda terhadap kejadian disfungsi ereksinya.
Hubungan indeks massa tubuh terhadap kadar gula darah puasa pengunjung lapangan Niti Mandala Renon bulan Juli Tahun 2018
Authors: Dewi Dinda Yustisia , Subawa Anak Agung Nengah , Mahartini Ni Nyoman
Published: April 2020

Background: Diabetes Mellitus (DM) is one type of degenerative disease that increases annually in countries around the world. Overweight and obesity can be a risk factor for type 2 diabetes mellitus. The leading cause of obesity is the unbalanced energy between the calories consumed and the calories used.Aim: This study aims to find the relationship between BMI with fasting blood glucose in Niti Mandala Renon field in July 2018.Methods: The study used cross sectional analytic approach, with samples were Niti Mandala field visitors Renon July 2018. The total sample was determined by correlation coefficient formula single sample.Results: Fasting blood glucose levels have an average level of 81.6 mg/dl and data are normally distributed (p> 0.05). There was a positive correlation between BMI with fasting blood glucose levels (r = 0.295; p = 0.015).Conclusion: There is a positive and significant weak correlation between BMI and fasting blood glucose levels of visitors to the Niti Mandala, Renon in July 2018.
Management of denture foreign body in esophagus with cervical esophagotomy: case report
Authors: Mahendra Kadek Yudi Fajar , Yasa Ketut Putu
Published: April 2020

Introduction: Impaction of dentures in the esophagus is a distressing experience for a patient and can lead to serious consequences, such as esophageal perforation. Patients with an impacted denture often present with a history of accidental swallowing, frequently during trauma, seizures, or sleep or in association with some degree of psychological dysfunction. The common signs and symptoms of an impacted denture are odynophagia, dysphagia, or simply pain and tenderness in the neck or chest.The preferred method of removal of esophageal foreign bodies is extraction with the flexible endoscope. Surgical removal is rarely indicated except in the event of perforation or other foreign body complications.In situations where this appears potentially hazardous, such as with impacted denture, open surgical extraction by cervical oesophagotomy is promptly performed is a safe option.Cases Report: The successful removal of impacted denture in the esophagus in a patient is reported, with a review of the literature. A women23-year-oldÂ  complained of dysphagia after swallowing his denture. Following unsuccessful attempts at removal via a rigid esophagoscope, open surgery was performed. Without further delay, the impacted denture was removed by cervical oesophagotomy, and the patient recovered uneventfully.Conclusion: The successful removal of impacted denture by cervical oesophagotomy in the esophagus in a patient is reported. We conclude that cervical esophagotomy is a safe method for removing foreign bodies impacted in the cervical esophagus when they cannot be removed endoscopically.
Berättelsen om skolan
Authors: Fritzell Christer
Published: April 2020

Avsikten i denna essä är att granska hur särskilda samhälleliga intressen kan spåras i de bilder av skolan och skolans pedagogik som dominerar i den offentliga debatten. Är det så att den politiska och professionella autonomi som ofta tillskrivs skolan i långa stycken är en chimär? Min argumentering och slutsats innebär att det nyliberala projekt som dominerat samhällsdebatt och partipolitik sedan 1990-talet i latenta men betydelsefulla avseenden har tydliga korresponderande drag i den massmediala Berättelsen om skolan.
COVID-19: Una pandemia en la era de la salud digital
Authors: Quispe-Juli Cender , Vela-Anton Paulo , Meza-Rodriguez Moises , Moquillaza-Alcántara Victor
Published: April 2020

La enfermedad por coronavirus 2019 (COVID-19) ha sido declarada como una pandemia por su rápida propagación, generando una elevada cantidad de muertes en todo el mundo. Este fenómeno se desarrolla en un contexto de salud digital, la cual utiliza las tecnologías de la información emergentes. En este artículo buscamos describir cómo han sido utilizadas estas herramientas para hacer frente al COVID-19, las cuales brindan beneficios a nivel clínico (como el mejor registro clínico de los casos, la atención remota o asistencia diagnóstica mediante inteligencia artificial), epidemiológico (sistemas de información geográfica), académico (e-aprendizaje) y personal (uso de aplicaciones móviles o búsqueda de información mediante redes sociales). Revisar el uso de estas herramientas en el mundo podría permitirnos replicar las mejores prácticas con el fin de mejorar el manejo del COVID-19 por parte de los gobiernos.
Tiroid Hastalıkları ve Erektil Disfonksiyon
Authors: OĞUZ Ayten
Published: April 2020

Erektil disfonksiyon (ED) hasta ve partnerinin yaşam kalitesini önemli derecede etkileyen, seksüel ve üreme fonksiyonunu bozan çok yönlü bir hastalıktır. ED birçok hastalıkla ilişkilidir. ED ve tiroid hormonları arasındaki ilişki ile ilgili veriler sınırlı olmakla birlikte, ED tiroid disfonksiyonlu erkeklerde yaygın olarak görülür. Ötiroidizmin sağlanması ile düzelir. Bu nedenle ED’li erkeklerde tiroid fonksiyonları taranmalı ve ötiroidizm sağlanmadan spesifik tedavi yapılmamalıdır. Bu derlemede literatür ışığında tiroid hastalıklarında ED yönetimi sunulmuştur.
Is Transfusion in Coronary Artery Surgery a Predictor or a Cause of Reduced Long-Term Survival?
Authors: Manché Alexander , Camilleri Liberato
Published: April 2020

Background: Transfusion is common after coronary bypass surgery. Transfused patients present with higher operative risk and increased hazard ratio for curtailed long-term survival. There is debate as to whether transfusion itself may further exacerbate late mortality. Methods: Long-term survival was studied in 2550 survivors following coronary revascularization in this retrospective, observational study. Kaplan-Meier survival curves were constructed to compare all transfused and non-transfused patients, as well as survival in propensity-matched transfused and non-transfused patients. Results: Operative mortality was 1.05% (original cohort 2577). Maximum follow-up was 23 years (mean 11.8, median 12.4 years). 34.7% of patients received a transfusion (mean 2 units pack red blood cells). Baseline risk characteristics (age, female gender, small body habitus, risk stratification scoring, diabetes, hypertension and reduced stroke volume) operative parameters (urgency and no internal thoracic graft) as well as post-operative parameters (intensive care, hospital stay and ventilation time) and complications (haemorrhage, intra-aortic balloon, ventricular arrhythmias, prolonged inotropic support, atrial fibrillation, dialysis, doubling of creatinine and resternotomy) were higher in the transfused patients. The long-term survival of these patients was significantly reduced when compared with that of non-transfused patients (log rank test p<0.001). When analyzed as a sole risk factor, transfusion was associated with reduced long-term survival (log rank test p<0.001) but when analyzed collectively with other risk factors, transfusion failed to demonstrate a causative effect (p=0.953). When propensity matched groups were compared (612 transfused versus 1222 non-transfused patients) long-term survival was similar (log rank test p=0.554). Conclusions: Transfusion was required in higher risk patients undergoing coronary revascularization. Long-term survival was curtailed in this group but this was due to preoperative risk and not directly to transfusion. Transfusion was a predictor but not a cause of reduced long-term survival.
A Novel Hypothetical Method to increase the Dimensions of the Coronary Arteries when Required
Authors: Arokiaraj Mark Christopher
Published: April 2020

Background: The purpose was to develop a novel hypothetical method to increase the size of coronary arteries.Methods: During long-term observation an increase in coronary size has been seen in three unexpected scenarios. Changes in coronary artery sizes were observed in patients with mitral stenosis (n=69) by angiogram prior to percutaneous balloon mitral valvuloplasty or valve replacement surgery for severe mitral stenosis. The coronaries of patients with patent ductus arteriosus who underwent surgical closure in the past (n=14) were examined by echocardiogram. Patients with renal failure on long-term dialysis through peripheral arterio-venous fistula without left ventricular hypertrophy (n=17) were studied by echocardiography. Normal age, weight and sex matched coronary sizes served as controls in the study. All these observations were made over a period of 12 years.Results: The sizes of coronaries in patients with mitral stenosis, patients who underwent closure for patent ductus arteriosus, and in patients on hemodialysis through arteriovenous fistulas were higher than normal controls (p<0.05, for all). A hypothetical model to increase the coronary sizes could be developed based on the analysis of the differential equations of Poiseuille’s. A method is proposed of creating a peripheral arterio-venous fistula, which could be closed later electively by a percutaneous method/surgery. The closure time needs to be determined by experimental studies. The other methods could be a continuous exercise program or by the use of beta-blockers.Conclusion: A novel hypothetical method of peripheral arteriovenous fistula formation is decsribed which could potentially increase the size of the coronaries, which could be closed later.
Monitoring of adverse drug reactions in psychiatry outpatient department of a tertiary care hospital in Central India
Authors: Mahakalkar Sunil , Tiple Prashant , Mohod Bhagyashri , Dhargave Nikhil
Published: April 2020

Background: Adverse drug reactions (ADRs) are prevalent in patients taking psychotropic medications and can occur even at the normal doses used in the management of acute and maintenance phases of psychiatric disorders. Pharmacovigilance have cardinal role in alerting the healthcare providers from the possible ADRs and thus protecting the patients who are using psychotropic medications. To Monitor and estimate the incidence and nature of ADRs in psychiatry OPD of tertiary care hospital in central India and assess the causality, preventability and severity of documented ADRs.Methods: A prospective observational study was conducted in psychiatry out-patient department (OPD). Patients diagnosed with any psychiatric disorder and receiving psychotropic medications was included in the study. The recorded data were filled in the ADR form obtained from pharmacovigilance program of India (PvPI). Causality assessment was done using Naranjo scale and severity was assessed using Hartwig scale and preventability assessment using modified Schumock and Thornton’s scale.Results: The incidence rate of ADR was found to be 15.8%. A total of 61 ADRs were documented. Weight gain 14 (18.1%) followed by nausea 11 (14.2%) was the most commonly reported ADR. Atypical antipsychotics were the most common class of psychotropic drugs implicated in ADRs. Clonazepam 21 (27.2%) followed by amitriptyline 20 (25.9%) were associated with a maximum number of ADRs. Majority of the suspected ADRs were probable in nature (40.9%) followed by possible type (31%).Conclusions: Study revealed a moderate incidence of ADRs in patients attending the psychiatry OPD.  Majority of the ADRs reported during the study were mild in nature and definitely preventable type.
Identification of separation phenomenon during brain death determination of potential organ donor and analysis of relative factors
Authors: Xu Guixing , Yu Ping , Xu Ping , Zheng Donghua
Published: April 2020

Background: With analyzing the incongruent phenomenon of electrical active and cerebral blood flow in brain death determination and screening the related factors, offer correct explanations and countermeasure to ensure the successful implementation of donation after brain death.Methods: Relevant clinical data of potential brain death organ donors were prospectively collected between June 2018 and May 2019. The related parameters of neurological examination, laboratory examination and neuroimaging examination during the period of brain death determination were dynamically recorded. Separation phenomenon was used as grouping factors to screen the factors related to separation phenomena through univariate and multivariate analysis.Results: According to the inclusion criteria, 127 patients were included in the study. Among 22 patients (17.3%) with incongruent phenomenon, 17 (77.3%) had electrical silence earlier than cerebral blood flow arrest, and 9 (22.7%) had cerebral blood flow arrest earlier than electrical silence. Univariate and multivariate analysis showed that age <14 years (OR=6.25, 95%CI 1.21-32.22, p=0.028),  SBP≥140 mmHg (OR=7.43, 95%CI 1.62-33.99, p=0.010), primary brainstem injury (OR=15.89, 95%CI 3.04-82.93, p=0.006), spontaneous respiratory arrest time ≤72 hours (OR=11.96, 95%CI 1.59-89.78, p=0.009) and decompression craniotomy(unilateral or bilateral) (OR=16.28, 95%CI 2.25-117.73, p=0.001) were associated with separation phenomenon..Conclusions: Separation phenomenon is a common during the confirmation test of brain death determination in China, and should be correctly recognized. To adopt corresponding measures according to risk factors is useful for successful implementation of donation after brain death.
Role of computed tomography scan in diagnosis of retroperitoneal masses
Authors: Patel Kiran
Published: April 2020

Background: In the vast and ever-expanding field of surgery there are only few subjects which have provoked controversy; curiosity related to correct management of patients suffering from various condition of the abdomen. This becomes very true when the patient has a retroperitoneal mass clinically. The problem of retroperitoneal mass was intriguing, fascinating and certainly most perplexing. The present study was planned with the objective to study the various clinical presentations of retroperitoneal mass, and their radiological findings, and co-relation between these various findings.Methods: This was a prospective, cross-sectional study. The study included 30 patients clinically diagnosed having retroperitoneal mass, attending the department of general surgery.Results: The most common affected age group was of 40-50 years (9, 30.00%). The most frequent presenting symptoms were abdominal lump (28, 93.33%). Pallor was the commonest clinical sign (20, 66.67%). Retroperitoneal lymph node masses were the commonest (12, 40.00%) malignant lesions. Retroperitoneal lymphadenopathy was the most common lesion.Conclusions: The retroperitoneum has long been an area poorly visualised by conventional radiographic techniques and in this respect, computed tomography scan has great advantages over other modalities. Hence the modern surgeon should no longer be considered a ‘shadow-gazer' but an anatomist in-vivo.
Comparison of post-operative complications in modified radical mastectomy patients with full suction and compression bandage versus half suction and non-compression bandage
Authors: Athar Mohammad , Kala Sanjay , Gupta Abhineet , Varshney Ashish
Published: April 2020

Background: Modified radical mastectomy still remains the most common surgical procedure employed in definitive management of breast cancer. Post mastectomy problems include skin flap necrosis, prolonged axillary drainage, seroma formation, wound gaping etc., among all seroma is commonest. Drainage usage and dressing applied after this procedure is debatable due to varying recommendations.Methods: A prospective randomized control trial was conducted on 84 FNAC/TRUECUT biopsy proven cases of early and locally advanced breast cancer patients admitted in surgery department, GSVM Medical College, Kanpur over a period of two years. Aiming to compare full suction drainage and compression dressing (n=42) (group 1) with half suction drainage and non-compression dressing (n=34) (group 2), in terms of post-operative morbidities like skin flap necrosis, prolonged axillary drainage, seroma formation, wound gaping and length of hospital stay. Romsons 16 number Romovac drains were used for suction and 2 elastic 6” crape bandage were used for compression.Results: During follow-up there was significant lower incidence of seroma formation in group 1 patients compared to group 2 patients (p<0.0019). Full compression dressing patients have increased incidence of superficial skin necrosis compared to non-compression dressing patients (p<0.022). Patients with half suction drainage and non-compression dressing has early drain removal than patients with full suction drainage and compression dressing (p<0.05), the length of hospital stay was less in group 2 compared to group 1.Conclusions: There is markedly lesser incidence of post-operative seroma formation along with reduced morbidity in the form of patients discomfort and flap necrosis in post MRM patients with full suction drainage and compression dressing, but it requires a greater hospital stay and has slightly higher risk of superficial skin necrosis which can be easily managed with topical ointments, compared to patients with half suction drainage and non-compression dressing.
Incidence and management of intestinal perforation in typhoid: a prospective, observational study
Authors: Yadav Bhanwar L. , Bansal Somendra , Gupta Shalu , Verma Pradeep K.
Published: April 2020

Background: Intestinal perforation is a common surgical problem, which need proper attention. Typhoid is the most common cause of bowel perforation. With the concept of a correct diagnosis of perforation in reference to its etiology and further study of etiological factor (typhoid) in relation to epidemiology, surgical treatment and outcome, the present study has been undertaken.Methods: It is a prospective, observational study in which 50 cases of enteric perforation admitting in SMS Hospital at JAIPUR were observed. All patients of enteric perforation peritonitis were evaluated by detailed history, clinical examination and radiological as well as laboratory investigations. After initial resuscitation patient were treated by operative procedures. Postoperatively progress report, morbidity and mortality data were observed.Results: Mean age of patients was 26.38 years. Male to female ratio was 4:1. Enteric perforation is more common in patients with poor nutritional status and rural area. Primary repair of perforation was done in patient with small perforation with relatively healthy bowel, while ileostomy was done in patients with large perforation of longer duration, multiple perforations and edematous bowel with necrotic patches. Mortality was highest in patients who underwent primary repair and proximal loop ileostomy (33.3%) and lowest in patients in which exteriorization of the perforation as loop ileostomy was done (10.3%).Conclusions: The time interval between occurrence of perforation and starting of specific therapy is the most important factor in deciding the ultimate outcome of the typhoid perforation patient and operative procedure is another important factor in deciding the outcome.
Thoraco-laparoscopic management of diaphragmatic hernia of adults: a case series
Authors: Chauhan Siddharth S. , Mishra Ajit , Dave Sandeep , Naqvi Jawwad , Tamaskar Siddharth , Sharma Vikram , Niwas Nitin
Published: April 2020

Diaphragmatic hernia (DH) usually occurs in childhood; however, in adult it is uncommon. Most common aetiology of DH in adult is trauma while spontaneous DH is a rare entity accounting for <1%. The management is primarily surgical repair in the form of open or laparoscopic approach; the later has been associated with low morbidity, mortality and excellent long term outcomes with low rate of recurrence. In this case series, confirmation of the diagnosis was done by CT scan and by laparoscopy in all the patients; laparoscopic repair was performed in all the patients along with thoracoscopic aid in two cases. We found that minimal access techniques can be safely done in DH; in conditions when the herniated content are difficult to get reduced laparoscopically alone, a simultaneous thoracoscopy has helped in great deal in reducing the content and completing the procedure entirely by minimal access techniques. This gives all the advantages of minimally invasive approach like less postoperative pain, shorter hospital stay, quicker recovery and low recurrence rate; provided tissue repair is done in tension free manner by an experienced laparoscopic surgeon.
Rare case of paracaecal hernia with intussusception presenting as small bowel obstruction: case report
Authors: Kalyan Kumar M. S. , R. Shyamsundar , Girieasan M. Sabari , Kannan R. , Nedunchezhiyan S.
Published: April 2020

Primary internal hernias are very rare in adults. They are an unusual cause of small intestinal obstruction and lead to high morbidity and mortality if left untreated. Clinical presentation of internal hernia is highly nonspecific. Imaging has limited role in diagnosing the cause of acute intestinal obstruction. Internal hernias are usually detected at laparotomy. We report a case of a 61-year-old male who presented with acute intestinal obstruction which was attributed later to a very rare type of internal hernia on exploratory laparotomy. A loop of ileum was found to enter the retroperitoneum through a hernia gate which was located lateral to the caecum and ileo ileal intussusception was noted proximal to the herniated loop. The segment of intestine was resected and anastamosed then hernial defect was closed. Paracaecal hernias are the rare type of hernias in internal hernia. In our case, intussusception was noted proximal to the herniated ileal loop which is a very rare presentation. Intussusception was reported previously with paraduodenal type. One should always keep in mind while conducting emergency laparotomy, internal hernias can be a cause for intestinal obstruction.
Fungal infective endocarditis of polytetrafluoroethylene pulmonary valve with Paecilomyces species following tetralogy of Fallot correction
Authors: Anand Sumeet , Vaidyanathan Swaminathan , Janeel Mustafa , Solomon Neville A. G.
Published: April 2020

Fungal infective endocarditis of the prosthetic pulmonary valve in non immunocompromised host is growing phenomena attributed to the increased use of prosthetic materials. High mortality and neurovascular sequalae is commonly seen in such case if treatment is delayed. Often misdiagnosed as bacterial endocarditis due to closely resembling clinical features and lack of inexpensive and readily available laboratory tests, the diagnosis is often delayed. High index of suspicion and early surgical intervention is needed for early diagnosis and management
A case of von Hippel-Lindau disease with multi-organ involvement: a rare case report
Authors: Bhuyan Mrinal , Saha Debadatta , Baishya Basanta Kumar , Ghanghoria Ashish
Published: April 2020

Von Hippel-Lindau (VHL) disease is a rare autosomal dominant syndrome manifested by a spectrum of tumours in the central nervous system (CNS) and other visceral organs. We herein report a case of 35 years aged newly diagnosed diabetic female patient presented with headache, gait instability, loss of vision in both eyes, left sided hearing impairment and subsequently diagnosed to have VHL disease. The pathophysiology involves the inactivation of the VHL tumour suppressor gene. Early recognition and treatment remains the mainstay of management. Even many years after the complete tumour excision, newer neoplasms may develop. Increasing knowledge about the molecular enabled us to investigate the role of anti-angiogenic drugs. Continuous surveillance at regular interval must be conducted in patients with VHL disease.
Prognosis and treatment options in cases of acute liver failure caused by mushroom poisoning due to Amanita phalloides
Authors: Parasher Anant , Aggrawal Akshay
Published: April 2020

Poisoning due to mushroom ingestion is a relatively rare but deadly cause of acute liver failure (ALF). Consumption of the poisonous mushroom Amanita phalloides, also known as ‘death cap’, is one of the most common causes of mushroom poisoning worldwide, being involved in the majority of human fatalities caused due to mushroom ingestion. A major portion of the liver damage due to Amanita phalloides is related to powerful toxins known as amanitins, which cause impairment in protein synthesis and subsequent cell necrosis by the inhibition of RNA polymerase II. Initially the presentation is that of an asymptomatic lag phase, followed by gastrointestinal symptoms and hepato-renal involvement. Amatoxin poisoning may progress into fulminant hepatic failure and eventually death if liver transplantation is not performed. It is based on a careful assessment of history of type and duration of mushroom ingestion, as well as the clinical manifestations. Diagnosis can be confirmed by laboratory tests measuring urinary amatoxin levels and identification of the mushroom. Although N-Acetyl Cysteine and Penicillin-G have proven to be effective therapeutic agents, Orthotopic Liver Transplantation (OLT) or Auxiliary Partial Orthotopic Liver Transplantation (APOLT) is the only treatment option for most of the cases carrying a poor prognosis.