bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of pregnant women with Refractory Immune Thrombocytopenia Purpura (ITP) receiving eltrombopag therapy at Sanjiwani Hospital, Gianyar, Indonesia
Authors: Budayasa Anak Agung Raka , Nugraha Cokorda Gede Angga Ary
Published: December 2022

Background: Immune Thrombocytopenia Purpura (ITP) is an autoimmune disease characterized by a low level of platelets in the blood caused by accelerated platelet destruction or disruption of the thrombopoiesis due to antibodies to platelets. Drugs with similar functions to thrombopoietins (TPO) such as eltrombopag and romiplostim have been widely used and have been shown to be quite successful in treating ITP in nonpregnant patients. This case study aims to evaluate eltrombopag therapy's role in managing the refractory ITP in pregnant women.Case Presentation: A 25-year-old patient, a housewife, presented to the obstetrics clinic at Sanjiwani Hospital for the first time at a gestational age of 13 weeks for her third pregnancy, with a history of two abortions. ITP was diagnosed in 2017 during the second abortion treatment. The platelet examination results were between 32,000-66,000/?l, with platelet count during delivery planning at 34 weeks of 41,000/?l. The patient was diagnosed with chronic refractory ITP and was considered for second-line drug administration. Intravenous Immunoglobulin Therapy (IVIG) and anti-D administration as second-line drugs were not possible due to cost. The patient was given 50 mg eltrombopag per day for a week. The platelet counts increased to 202,000/?l a week after therapy. The patient then underwent vaginal delivery with a baby weight of 2,850 gram, Apgar Score of 8-10. The baby was exclusively breastfed and subjected to clinical monitoring and laboratory tests. The patient's clinical condition was favorable and the platelets fell to 20,000/?l nineteen days after delivery.Conclusion: In this case, the patient with chronic ITP refractory to steroid therapy showed an immediate response to eltrombopag. However, the platelet level decreased two weeks after the treatment cessation. More studies are needed on the use of eltrombopag in pregnant women.
Kimura's disease: a neoplasm mimicking, a rare benign form of chronic inflammatory disorder
Authors: Septian Harley , Asih Made Widhi , Laksminingsih Nyoman Srie , Susraini Anak Agung Ayu Ngurah
Published: December 2022

Background: Kimura's Disease (KD) is a benign, rare form of chronic inflammatory disease of unknown origin, almost exclusively found in Asian males in their second to fourth decades of life. This rare condition is mostly present as soft tissue mass consists of multiple painless solitary subcutaneous nodules mostly localized in the head and neck region, with coexisting lymph node enlargement and eosinophilia. This case study aims to describe Kimura's Disease (KD) characteristics and give an insight into the role of Computed Tomography (CT) scan in identifying KD and its imaging characteristics.Case Presentation: We reported a case of an Asian man with a history of 18 years left-sided painless facial mass, gradually increase in size with no history of hoarseness, epistaxis, previous facial mass or malignancy, and familial malignancy. CT scan findings showed an inhomogeneous contrast enhancement soft tissue mass located on the left parotid-submandibular region with multiple neck lymphadenopathy and left parotid gland involvement. Eosinophilia was found persistently in the laboratory outcomes, and this mass had been confirmed with histological findings consistent with KD features.Conclusion: Recognizing the characteristics of KD and the imaging findings on Ultrasound and CT-scan as accessible and first-line diagnostic tools, might help in facilitating the diagnosis, making a decision and sparing the patient from unnecessary and harmful procedures.
Infeksi COVID-19 pada pasien myasthenia gravis: sebuah tinjauan pustaka
Authors: Setiawan Made Ratna Dewi , Sumada I Ketut
Published: December 2022

Coronavirus disease (COVID-19) has rapidly become a global pandemic and during this condition, there might be at greater risk of exacerbation in patients with myasthenia gravis. This is related to the viral infection that has been known to increase the risk of a myasthenic crisis. In addition, some experimental drugs used in COVID-19 has been reported to increase the risk of exacerbation in patient with myasthenia gravis. In the other hand, several studies show higher morbidity and mortality rates due to COVID-19 in patient with myasthenia gravis. Myasthenia gravis might be a risk factor for severe COVID-19 infection due to several mechanisms, such as the effect of the immunosuppressive therapy and the inherent respiratory muscle weakness and vulnerabilities. The comprehensive study based on several case report is needed to respond the needs of adaptation in treating patient with myasthenia gravis during this pandemic era.  Coronavirus disease (COVID-19) telah menjadi pandemi global dalam waktu singkat. Selama pandemi ini, terdapat peningkatan resiko eksaserbasi pada pasien dengan myasthenia gravis. Hal ini terjadi karena sejak lama telah diketahui bahwa infeksi virus dapat meningkatkan resiko krisis myasthenia pada pasien myasthenia gravis. Beberapa obat eksperimental yang diberikan pada pasien dengan infeksi COVID-19 juga dilaporkan memiliki resiko yang tinggi dalam menimbulkan eksaserbasi gejala myasthenia gravis. Di sisi lain, beberapa studi terkait COVID-19 menunjukkan angka morbiditas dan mortalitas yang lebih tinggi pada pasien dengan myasthenia gravis. Myasthenia gravis juga merupakan faktor resiko untuk infeksi COVID-19 berat yang berhubungan degan beberapa mekanisme seperti efek dari terapi imunosupresan dan kondisi kelemahan otot pernafasan pada penyakit myasthenia gravis. Telaah yang komprehensif berdasarkan beberapa laporan kasus terkait infeksi COVID-19 pada pasien myasthenia gravis sangat diperlukan untuk melakukan adaptasi manajemen terapi pada era pandemi ini.
Congenital syphilis present with pemphigus syphilitics and atelectatic congenital pneumonia: a case report
Authors: Beatrice Callista , Triastuti Indriana , Indrawan I Gde Doddy Kurnia
Published: December 2022

Background: Congenital syphilis is an infectious disease of newborns caused by Treponema pallidum, a spirochete bacterium, from vertical transmission from infected mother to fetus. Diagnosis of congenital syphilis can be difficult because two-thirds of affected infants are asymptomatic at birth, and the signs of symptomatic infants are diverse. Familiarity with the various presentations is essential to early diagnosis and treatment.Case Description: A male preterm, 35 weeks gestation baby, born by vaginal delivery from G1P0 mother with syphilis latent phase, with Treponema pallidum hemagglutination assay (TPHA) titer reactive (1:2560) with no treatment during the antenatal period. The baby was born with low birth weight, respiratory distress syndrome, hepatosplenomegaly, and skin rash.  Diffuse desquamation and fissures also multiple eroded pale blisters are known as pemphigus syphilitics. TPHA was also reactive at the same level as the mother. Complete blood count showed severe respiratory acidosis (pH: 6,8), leucocytosis (46.420/uL), thrombocytosis (414.000/uL), lymphocytosis (40,3%), and monocytosis (16%). Radiology showed severe atelectatic left lung and course nodular congenital pneumonia of the right lung. The baby was intubated and injected with penicillin procaine 50.000 IU/kg/day intramuscularly in the neonatal intensive care unit (NICU). However, due to severe atelectatic lung and acidosis, this case resulted in a fatal outcome.Conclusion: Broad desquamation, multiple fissures, and eroded pale blisters (vesiculobullous lesions) known as pemphigus syphilitics should alert clinicians as an early manifestation of congenital syphilis. Other manifestations include congenital pneumonia, typically atelectatic or nodular type, and hepatosplenomegaly. Treatment should be started promptly to decrease its morbidity and mortality.
Limited Cutaneous Scleroderma
Authors: Wangsa Putu Gde Hari , Sudarsa Prima Sanjiwani Saraswati , Laksmi Made Hermina
Published: December 2022

Introduction: Scleroderma is a rare autoimmune disease of connective tissue characterized by extensive fibrosis, inflammation, and vasculopathy. It classified as limited cutaneous and diffuse based on the degree of skin involvement. The management is still a challenge since it has a high morbidity and mortality rate. This case report aims to understand scleroderma and provide appropriate treatment that can improve the patient's prognosis.Case report: A 55-year-old female came with complaints of stiff skin on the forearms, lower legs and face since approximately eight months ago, initially on the right and left forearms, then to face, right and left lower legs. On physical examination, there was sclerosis of the skin on the face, forearms and lower legs, and salt and pepper appearance with Rodnan score were 26. The result from histopathological examination were sceleroderma. The patient was diagnosed with limited cutaneous scleroderma. The management consisted of methotrexate, folic acid, sulpha ferrous, vitamins B1, B6, B12 intraorally and 10% urea cream topically. She also was informed to practice moving the hands and fingers slowly.Conclusion: The diagnosis of limited cutaneous scleroderma is based on history, physical examination and investigations. It is still a life-threatening disease, however multidisciplinary management with early detection and treatment of complications can improve the prognosis.
Androgenetic alopecia in woman treated with botulinum toxin
Authors: Wijaya Henny , Winaya Ketut Kwartantaya
Published: December 2022

Background: Androgenetic alopecia (AGA) is the most common type of alopecia. AGA in women is called Female Pattern Hair Loss (FHPL). FHPL occurs in 50% of adolescence women.
Case Description: A 29-year-old woman presented with hair thinning on the top of her head in the last 3 years. Dermatological status in the parietal region showed a diffuse and ill-define patch of alopecia, and hair thinning was found along the midline of the scalp. The hair pull test in frontal, temporal, and parietal regions was negative. The Severity of Alopecia Tool (SALT) score is 10, and patient belonged to stage 2 according to The Sinclair Scale. Dermoscopy examination revealed scattered white dots over the vertex of the scalp with various hair diameters. Miniaturized hair and vellus hair were found in several areas. The ratio of terminal to vellus hair was 20:6 or 3:1. Injection of 100-unit botulinum toxin in the alopecia area was done every 3 months. After 1 month of treatment, the hair thinning was reduced.
Conclusion: Appropriate treatment will affect the prognosis of AGA patients. Appropriate treatment that based on the pathophysiology of the disease and the patient's genetics will provide a good therapeutic response.
The efficacy of olmesartan/amlodipine combination in hypertension treatment – a systematic review
Authors: Praptika Ni Luh Parameswari , Ryantama Anak Agung Wira , Bhuwana Ni Nyoman Astrid Tri
Published: December 2022

Introduction: Hypertension is the most common non-communicable disease, which persists as a major risk factor of cardiovascular diseases such as stroke, myocardial infection, and heart failure. Another major problem in clinical practice was the patients' adherence to treatment, directly related to the number of hypertension pills to be taken. Thus, determining the appropriate time duration and action of a hypertensive drug to maintain the blood pressure is needed. Olmesartan is one of the drug compounds frequently used for long-acting anti-hypertensive treatment. It is often combined with amlodipine; however, their combination remains unclear to provide equal efficacy and safety. Thus, in this article, we systematically summarize the combination of Olmesartan with amlodipine.Methods: This systematic literature review was extracted from Science Direct and Pubmed to identify randomized clinical trials (RCT) of the outcome of the Olmesartan/amlodipine effect compared with other hypertension regimens by using PRISMA guideline 2009. The methodological quality of the included studies was assessed independently by two reviewers using The Cochrane Collaboration's RoB 2 tool.Results: We evaluated twelve studies in the last ten years, and there were four studies with an intention-to-treat protocol (25% of articles had some concern, and 75% had a low risk of bias.) and eight studies with per-protocol analysis (37,5% of articles were concerned, and the rest had a low risk of overall bias). We also presented the efficacy and safety outcomes of the study reviewed.Conclusion: Hypertension is a common non-communicable disease, and treatment approaches for hypertension vary widely. Administration of combination drugs is a good approach in reducing the dose of drug administration and reducing the incidence of side effects in monotherapy. Inhibiting the RAA system by olmesartan and reducing vascular smooth muscle tone by amlodipine gives better results and can be a safe and effective option for lowering blood pressure in hypertensive patients. The side effects observed were not severe and only observed in a few cases, making it an option to treat hypertension.
Ekspresi reseptor vitamin D plasenta yang rendah sebagai faktor risiko terjadinya preeklampsia dengan gambaran berat
Authors: Dira I Gede Mahendra Adiguna , Suwiyoga Ketut , Artana Putra I Wayan , Putra I Gede Mega , Manuaba Ida Bagus Gede Fajar , Winata I Gde Sastra , Megadhana I Wayan
Published: December 2022

Introduction: Preeclampsia is the cause of 10-15% of maternal deaths in Indonesia and occurs in about 2-10% of all pregnancies worldwide. The pathogenesis that underlies the occurrence of preeclampsia is not yet clearly known so that preeclampsia is referred to as a disease of theory. Nutritional factors such as vitamin D also play a role in the development of preeclampsia. This study aims to determine the relationship between vitamin D receptor expression as a risk factor for preeclampsia with severe features.Method: This study used a case-control design conducted in the maternity ward of Sanglah General Hospital, Denpasar from February to August 2020. A sample of 44 subjects was obtained and divided into case groups and control groups. Examination of vitamin D receptors using a central area placenta measuring 2x2 cm which was then examined semi-quantitatively at the Histology Laboratory, Faculty of Medicine, Udayana University.Result: The results were analyzed using the chi square test. There was no significant difference in the characteristics of the two groups. There was a significant relationship between low VDR expression in the placenta and the incidence of preeclampsia with severe features (p-value 0.002; 95% CI 1.96-31.57; OR 7.88).Conclusion: Low VDR placenta expression in pregnant women increases the risk of preeclampsia with a severe picture of 7.88 times greater than high VDR expression. Pendahuluan: Preeklampsia menjadi penyebab 10-15% kematian maternal di Indonesia, dan terjadi pada sekitar 2-10% dari seluruh kehamilan di seluruh dunia. Patogenesis yang mendasari terjadinya preeklampsia sampai saat ini belum jelas diketahui sehingga preeklampsia disebut sebagai disease of theory. Faktor nutrisi seperti vitamin D juga memainkan peran dalam terjadinya preeklampsia. Penelitian ini bertujuan mencari hubungan ekspresi reseptor vitamin D sebagai faktor risiko terjadinya preeklamsia dengan gambaran berat.Metode: Penelitian ini menggunakan desain kasus-kontrol yang dilakukan di Ruang Bersalin RSUP Sanglah Denpasar pada Februari sampai Agustus 2020. Didapatkan sampel sebanyak 44 subyek dan dibagi kedalam kelompok kasus dan kelompok kontrol. Pemeriksaan reseptor vitamin D menggunakan plasenta area sentral ukuran 2x2 cm yang kemudian diperiksa secara semikuantitatif di Laboratorium Histologi Fakultas Kedokteran Universitas Udayana. Hasil dianalisa menggunakan uji chi square.Hasil: Tidak terdapat perbedaan karakteristik yang bermakna pada kedua kelompok. Terdapat hubungan yang bermakna antara ekspresi VDR pada plasenta yang rendah terhadap kejadian preeklamsia dengan gambaran berat (p-value 0.002; IK 95% 1.96-31.57; OR 7.88).SimpulanEkspresi VDR plasenta yang rendah pada ibu hamil meningkatkan risiko terjadinya preeklamsia dengan gambaran berat sebesar 7,88 kali lebih besar dibandingkan ekspresi VDR tinggi.
Serial kasus pneumonia neonatal dengan kemungkinan transmisi vertikal SARS-CoV-2 pada masa kehamilan
Authors: Dewi Ida Ayu Sri Kusuma , Indira Ade Tsarina
Published: December 2022

Background: The vertical transmission of SARS-CoV-2 from pregnant women to fetuses during pregnancy is still under debate. However, the incidence of COVID-19 in neonates born to mothers with SARS-Cov-2 infection is increasing. Several case reports suspect that the possibility of transmission of SARS-CoV-2 can occur vertically through the placenta. Most neonates with COVID-19 infection experience mild illness, but some develop severe symptoms.Case Report: We report two cases of neonates with Neonatal Pneumonia born to mothers with COVID-19 infection. The first case is a baby born to a mother infected with COVID-19 with placenta previa totalis. The baby was born with severe asphyxia. The second case was a baby born to a mother infected with COVID-19 with premature membrane rupture. The baby experiences respiratory distress after four days of age. An RT-PCR swab examination was performed in both cases, and the results were positive. After intensive care, both babies were discharged in stable condition.Conclusion: The vertical transmission of SARS-CoV-2 is still under debate. Examinations other than nasopharyngeal RT-PCR swabs such as peripheral blood examinations for mother and baby, placenta, umbilical cord, umbilical cord blood, amniotic fluid are needed to support vertical transmission. In this case report, we could only perform the Nasopharyngeal RT-PCR swab test due to various limitations. Latar Belakang: Transmisi vertical SARS-CoV-2 dari ibu hamil ke janin selama masa kehamilan masih dalam perdebatan. Namun Angka kejadian COVID-19 pada neonatus yang lahir dari ibu dengan infeksi SARS-Cov-2 tersebut kian meningkat. Beberapa laporan kasus mencurigai bahwa kemungkinan transmisi dari SARS-CoV-2 dapat terjadi secara vertikal melalui plasenta. Sebagian besar neonatus dengan infeksi COVID-19 ini mengalami gejala ringan, namun beberapa berkembang menjadi berat. Laporan Kasus: Pada laporan ini, kami melaporkan dua kasus neonatus dengan pneumonia neonatal yang lahir dari ibu dengan infeksi COVID-19. Kasus pertama merupakan bayi yang lahir dari ibu yang terinfeksi COVID-19 dengan plasenta previa totalis, bayi lahir dengan asfiksia berat. Kasus kedua merupakan bayi yang lahir dari ibu yang terinfeksi COVID-19 dengan ketuban pecah dini (KPD), bayi mengalami distress napas setelah usia 4 hari. Pada kedua kasus ini dilakukan pemeriksaan swab RT-PCR dan mendapatkan hasil positif. Setelah dilakukan perawatan intensif, kedua bayi dipulangkan dengan kondisi stabil. Kesimpulan: Transmisi vertikal SARS-CoV-2 masih dalam perdebatan. Pemeriksaan selain swab RT-PCR nasofaring seperti pemeriksaan darah perifer pada ibu dan bayi, plasenta, tali pusat, darah tali pusat, cairanan amnion dibutuhkan untuk menunjang adanya suatu transmisi vertikal. Pada laporan kasus ini kami hanya dapat melakukan tes swab RT-PCR nasofaring dikarenakan keterbatasan pemeriksaan.
Teledermatology for managing COVID-19 patients with cutaneous manifestation: case series study in a rural primary hospital
Authors: Hidajat Dedianto , Kadriyan Hamsu , Tjahjono Slamet
Published: December 2022

Background: To provide information and experience about using WhatsApp as a tool in teledermatology to facilitate the identification, treatment, and follow-up of skin problems in COVID-19 patients hospitalized at one of a rural primary hospital located in Indonesia.Methods: All COVID-19 patients with the dermatology manifestation were included in this study. All symptoms and signs of cutaneous manifestation and teledermatology consultation aspect were recorded.Results: There were 7 cases confirmed with skin manifestation (0.9%) from 783 hospitalized patients from March 2020 to June 2021. There were 5 males and 2 females. The age range was 50 - 66 years old. Pruritus is the main complaint, followed by pain and swelling. The cutaneous lesions were mainly maculopapular, followed by papulovesicular and edematous eruptions. The onset of the lesions appeared between the 2nd and 12th day during hospitalization. Both patients and physicians feel comfortable using this platform in consultation.Conclusion: There are advantages and disadvantages to utilizing this concept in the medicolegal aspects, including non-uniform audio-visual quality and also ethical and privacy issues, especially in a rural area.
Incontinentia pigmenti in neonate: a case report
Authors: Wangsa Putu Gde Hari , Rusyati Luh Made Mas , Karmila I Gusti Ayu Agung Dwi , Karna Ni Luh Putu Ratih Vibriyanti , Komalasari Ketut Wida , Laksmi Made Hermina
Published: December 2022

Background: Incontinentia pigmenti (IP) is a rare X-linked dominant inherited genodermatosis that occurs almost in females and is usually accompanied by other ectodermal tissue diseases such as the central nervous system, eyes, hair, nails, teeth and skeletal system. This case report aims to enhance understanding of incontinentia pigmenti and provide appropriate treatment to patients and proper education to families.

Case report: A 3-days-od baby girl was consulted by the Pediatric department with complaints of blisters and erythematous rashes on almost her entire body with the Blaschko line distribution. The nails on the right and left big toes appeared inward. No history of fever and seizure. No family had similar complaints. There were no eye and nerve abnormalities involved. She treated with hydrocortisone 1% cream every 12 hours on erythematous papules and vesicles, open compresses with 0.9% NaCl every 8 hours for 10-15 minutes on lesions with yellowish crusts. Thus, the patient diagnosed with incontinentia pigmenti.

Conclusion: The diagnosis of incontinentia pigmenti is based on history and physical examination. This case is very rare, so the family needs to understand the course of this disease. Appropriate management and education can prevent secondary infection.
Platelet-rich plasma (PRP) on orthopedic clinical daily practice: a literature review
Authors: Gunawan Anthony , Anak Agung Ngurah Ronny Kesuma  , I Komang Agus Krisna Saputra¬¬  , I Komang Mahendra Laksana
Published: December 2022

The use of PRP (platelet-rich plasma) is beneficial and even more important in the future. The most common indications were tendon damage (77%), osteoarthritis (68%), muscle damage (57%) and cartilage damage (51%). It is a purified autologous blood product with a higher platelet concentration than whole blood. It is rich in various cytokines and growth factors and has been shown to initiate and enhance healing by stimulating cell migration, cell proliferation, angiogenesis, and matrix synthesis. In rotator cuff injury, PRP injection led to significant long-term pain relief but not in functional improvements. In Osteoarthritis, PRP injection is associated with long-term pain relief and function improvements. PRP injection has a better outcome in VAS (visual analog scale) and DASH (The Disabilities of the Arm, Shoulder and Hand) scores in elbow ulnar collateral ligament pathologies, including lateral elbow epicondylitis. In medial epicondylitis, a paucity of studies causing therapeutic modality for PRP has not yet been established. In acute muscle injury, PRP used has no differences in imaging, pain, ROM (range of motion), muscle strength, and muscle function. In Achilles Tendinopathy, PRP injection has been associated with improvement in VAS, but no difference in VISA-A (The Victorian Institute of  Sports Assesment – Achilles Questionnaire) score. However, the majority of published literature is secondary and tertiary evidence. Future studies could provide important information about the optimal concentrations of growth factors, platelets and leukocytes required for the desired effect in many specific tissues, as well as the appropriate method of administration and timing of drug application.
Penetrating ocular injury due to fish hook accident: A case report
Authors: Dewi Nyoman Tarita , Widyasari Putu Rima Adilitha , Sakti Fazella Kirara , Kartiningsih Ida Ayu Putri
Published: December 2022

Introduction: Open globe trauma is caused by sharp objects (lacerations) or blunt objects (ruptures). Lacerations can be divided into three parts:  penetrating wound, intraocular foreign body  (IOFB), and perforating wounds. One of the ocular laceration trauma that needs to be aware of is the penetration of fishing hooks. There are two important aspects of injuries due to fishing hooks: intraocular foreign bodies and infections.Case description: The patient of a 4-year-old  girl with a chief complaint left eye was exposed to a fishing hook approximately 3 hours before coming to the hospital. Ophthalmological examination was obtained visual acuity on the right eye fixes and follow the object. Examination of the anterior segment of the right eye was found corneal edema, penetrating injury due to fish hook direction at nine o'clock. The fish hook was stick on the entire thickness of the cornea. Then we also found iris trauma and opacity in the lens. The patient was diagnosed with traumatic cataracts with ocular iridolysis dextra. Initial therapy is tobroson eye drop 1 drop every 3 hours, cefadroxil syrup three times a day, and methylprednisolone 3x1/2 tablets. The patient was advised to undergo surgery.Conclusion: Initial management should be quick and careful to aggravate the trauma. Adequate eye protection and supervision are necessary to prevent fishing hook trauma, especially children.
Prognostic value of red cell distribution width-to-platelet ratio in mortality of major burn in Sanglah Hospital Bali
Authors: Ananda Nyoman Siska , Sanjaya I Gusti Putu Hendra , Herawati Sianny , Hamid Agus Roy Rusly Hariantana , Adnyana I Made Suka , Niryana I Wayan
Published: December 2022

Introduction: The mortality rate in Sanglah Hospital due to major burns is quite high. The ratio of red cell distribution width (RDW) and platelet (PLT) (RPR) as a prognostic marker of mortality in major burns has never been studied in Indonesia. Calculations of RPR are easy, widely available and cost-efficient.Method: This study was retrospective observational case-control, with 60 patients with major burns consisting of 30 cases and 30 controls. Samples were taken from the Sanglah Hospital Medical Record Unit from April 2019 to April 2021. Cases were samples with mortality after day seven, while controls were samples that survived. RDW and PLT value on day seven are associated with the incidence of mortality.Results: The mean of RPR in the case group was higher than in the control group. RPR mean of the control group was 0.0559, and the case group was 0.0947 (p<0.001). The increase of RPR in the case group was 40.97%. Statistical analysis showed that high RPR was a significant mortality risk factor in patients with major burns (OR = 21.36; p < 0.001).Conclusion: High RPR is a prognostic marker of mortality in major burns at Sanglah Hospital.
Faktor-faktor yang berhubungan dengan kepuasan pasien di instalasi rawat jalan Rumah Sakit Tingkat IV Lanud Sam Ratulangi Manado pada masa pandemi covid-19
Authors: Pangemanan Andrew Christian , Rampengan Starry Homenta , Sumampouw Oksfriani Julfri , Manampiring Aaltje Ellen
Published: December 2022

Latar belakang: Kepuasan pasien dicapai apabila penerima pelayanan memperoleh pelayanan sesuai dengan yang dibutuhkan dan diharapkan. Pandemi Coovid-19 menyebabkan penurunan angka kunjungan pasien, hal ini terjadi karena terdapat alur proses pelayanan kesehatan yang berubah, pembatasan jumlah pasien, serta diterapkannya langkah pencegahan standar, identifikasi awal dan pengendalian sumber virus. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang berhubungan dengan kepuasan pasien di instalasi rawat jalan Rumah Sakit Tingkat IV Lanud Sam Ratulangi Manado pada masa pandemi Covid-19. Metode: Penelitian ini merupakan penelitian kuantitatif dengan pendekatan studi potong lintang. Penelitian ini dilaksanakan di Rumah Sakit Tingkat IV Lanud Sam Ratulangi Manado pada November-Desember 2021. Sampel penelitian berjumlah 334 pasien. Variabel bebas dari peneitian ini yaitu kesehatan fisik dan psikis pasien, kompetensi staf medis dan fasilitas rumah sakit. Variabel terikat dari penelitian ini adalah kepuasan pasien. Data hasil penelitian dianalisis secara univariat, bivariat, dan multivariat. Hasil: Hasil penelitian menunjukkan bahwa responden paling banyak berjenis kelamin laki-laki (52,69%), mayoritas berumur 36-45 tahun (37,72%), pekerjaan terbanyak swasta (35,33%) dan tingkat pendidikan terbanyak SMA/sederajat (46,41%). Hasil uji korelasi pearson ditemukan bahwa faktor kesehatan fisik dan psikis, kompetensi staf medis dan fasilitas rumah sakit nilai p<0,05. Berdasarkan uji regresi linier berganda ditemukan faktor yang paling mempengaruhi kepuasan pasien adalah fasilitas rumah sakit dengan nilai standardized coefficients beta sebesar 0,314. Kesimpulan: Faktor kesehatan fisik dan psikis, kompetensi staf medis, dan fasilitas rumah sakit berhubungan dengan kepuasan pasien di instalasi rawat jalan Rumah Sakit Tingkat IV Lanud Sam Ratulangi Manado pada masa pandemi Covid-19. Fasilitas rumah sakit merupakan faktor yang dominan berpengaruh terhadap kepuasan pasien
Moluskum kontagiosum dengan human immunodeficiency virus stadium IV yang diterapi dengan KOH 20%
Authors: Hostiadi Michael , Indira I Gusti Ayu Agung Elis , Ni Made Dwi Puspawati  , Ketut Wida Komalasari
Published: December 2022

Background: The prevalence of molluscum contagiosum (MC) was found to increase in the HIV population with a prevalence of 5-18%. Persistent molluscum lesions gradually increase in size. Some develop into giant, tumor-like, nodular lesions that can exceed 1 cm in diameter and cause esthetic defects in HIV-positive patients. Conventional treatment is usually not effective enough and requires additional therapy in immunocompromised cases.
Case: A 31-year-old woman with stage IV HIV had the main complaint of a skin-colored rash near the genital area. Venereological examination found multiple papules with smooth, shiny surfaces with central umbilication discrete configuration and localized distribution. The molluscum body comes out after being squeezed. The treatment given is 20% potassium hydroxide spots on MC lesions every 24 hours topically. Two weeks after therapy was given, no new lesions were found without any side effects.
Conclusion: Administration of 20% potassium hydroxide can be considered an MC treatment option in HIV patient with minimal side effects and is easy to use.
 
Latar Belakang: Prevalensi moluskum kontagiosum (MK) didapatkan meningkat pada populasi human immunodeficiency virus (HIV) dengan prevalensi 5-18%. Lesi moluskum persisten yang secara bertahap bertambah besar, beberapa berkembang menjadi raksasa, seperti tumor, lesi nodular yang dapat melebihi diameter 1cm, dan dapat menyebabkan kecacatan secara estetik sering ditemui pada pasien dengan HIV positif. Pengobatan konvensional biasanya tidak cukup ampuh dan membutuhkan tambahan terapi lainnya pada kasus imunokompromais.
Kasus: Seorang perempuan usia 31 tahun, HIV positif stadium IV dengan keluhan utama berupa bintil-bintil bewarna serupa kulit di dekat area genital, bila ditekan keluar bintik putih seperti nasi. Pemeriksaan venereologis ditemukan papul multipel permukaan licin berkilat dengan umbilikasi sentral konfigurasi diskret dengan distribusi lokalisata. Penatalaksanaan yang diberikan adalah tutul kalium hidroksida (KOH) 20% pada lesi MK setiap 24 jam topikal. Dua minggu setelah terapi diberikan tidak ditemukan adanya lesi baru dan tanpa adanya efek samping.
Simpulan: Pemberian KOH 20% dapat dipertimbangkan sebagai pilihan terapi MK pada HIV dengan efek sampung minimal dan mudah digunakan.
Tetraparese spastik akibat schwannoma servikal: sebuah laporan kasus
Authors: Pinzon Rizaldy Taslim , Sinta Shakuntala Gusti Agung , Veronica Vanessa
Published: December 2022

Introduction: Schwannoma is a benign nerve sheath tumor that occurs more frequently in the peripheral nervous system than in the central nervous system. Spinal schwannomas are most frequently found in the thoracic or lumbar regions but are uncommon in the cervical region. This paper describes a cervical schwannoma that is associated with spastic tetraparesis.
Case Presentation: A 50-year-old man presented with the primary complaint of having difficulty moving his upper and lower limbs. The patient is fully conscious and has a temperature of 36.2°C, a respiratory rate of 22 breaths per minute, and a pulse rate of 108 beats per minute. Neurological evaluation revealed bilaterally diminished strength in the superior and inferior extremities. Cervical magnetic resonance imaging (MRI) with and without contrast revealed a grade 2 hernia nucleus pulposus (HNP) and an extramedullary-intradural mass in the anterior cervical vertebral canal region between C5 and C7, compressing and obliterating the cerebrospinal fluid spaces. A laminectomy was performed, and an intradural tumor mass in the C5-C7 region was obtained.
Conclusion: Schwannomas, although rare, can cause spastic tetraparesis if they compress the cervical spinal cord.
 
Latar Belakang: Schwannoma adalah tumor selubung saraf jinak yang lebih sering terjadi di luar sistem saraf pusat. Schwannoma spinal dapat terjadi di regio thorakal atau lumbar, namun jarang terjadi pada regio servikal. Studi ini melaporkan schwannoma servikal yang menyebabkan tetraparese spastik.
Presentasi Kasus: Seorang laki-laki umur 50 tahun datang dengan keluhan utama kedua anggota gerak atas dan bawah sulit digerakkan. Pasien sadar penuh dengan suhu 36,2°C, laju respirasi 22 kali per menit, nadi 108 kali per menit. Pemeriksaan neurologis menunjukkan adanya penurunan kekuatan ekstremitas superior dan ekstremitas inferior bilateral. Magnetic resonance imaging (MRI) servikal dengan kontras dan tanpa kontras menunjukkan hernia nucleus pulposus (HNP) grade 2 dan massa ekstramedular-intradural pada regio kanalis vertebra servical anterior setinggi C5-C7 yang menyebabkan kompresi dan obliterasi ruang cairan serebrospinal. Dilakukan laminektomi dan didapatkan massa tumor intradural C5-C7.
Kesimpulan: Schwannoma, walaupun jarang, dapat menyebabkan tetraparese spastik jika menekan medula spinalis servikal.
Anaphylactic reaction: lesson learned from three cases
Authors: Bunga Datu William , Raya Katinda Emita , Suprayogi Andrew
Published: December 2022

Background: An anaphylactic reaction is an emergency that can be life-threatening if not recognized immediately. Signs and symptoms that appear vary from mild to severe. After knowing that it is an anaphylactic reaction, it needs immediate action and special attention, especially from general practitioners who work in the emergency unit.
Case presentation: In this scientific publication, three cases will be presented, all of which were found in the emergency room at Cikarang Medika Hospital, Bekasi. These cases of anaphylaxis vary in the onset of signs and symptoms, clinical manifestation, allergen, degree of severity, and therapeutic response. However, in these three cases, the initial management, which was an emergency, was the same for each patient, and all cases occurred at home; thus, education on anaphylaxis in the general community is vital, especially for the patients and their families.
Conclusion: As a physician who works in the emergency room is essential to know how to quickly recognize the signs and symptoms of an anaphylactic reaction and carry out treatment as soon as possible so that patients can be helped. The first line treatment is Epinephrine and other treatment may follow after the first line has been given. It is essential that the public needs to know about the occurrence, the cause or trigger, and first aid (what they should do in the event of an anaphylactic reaction).
Botox injection for anal fissure management: case report
Authors: Antara Gede Eka Rusdi
Published: December 2022

Introduction: Anal fissure is shallow tear in the anoderm distal to dentate line which is considered most common proctologic condition.  Anal fissure is generally located in the posterior midline. The symptoms include anal pain, spasm, and/or bleeding during defecation1. The pain can be so intense as to induce the patient to avoid defecation with consequent hardening of the feces and exacerbation of the problem2. Management of the anal fissure is improving diet and defecation habit, medical therapy and surgical therapy. The goal of medical treatment for chronic anal fissure is to temporarily reduce pressure of the anal canal to facilitate the healing of the fissure (“reversible sphincterotomy”), thereby reducing muscle tone. Intrasphincteric Botulinum Toxin A injection seems to be a reliable option.

Case reports: two male patients were diagnosed with anal fissures, the patients complained of pain and spasm. They were treated with  botulinum toxin type A (100 unit AllergenÒ), injected  into three sites of the internal sphincter at 2, 5 and 8 o’clock. The symptoms relieved and the anal fissure healed within one month. There was no sign of relapse or incontinence during 12 months of follow-up.

Conclusion: Botulinum toxin therapy can be considered as efficacious, effective and safe treatment for anal fissures.

 

Keywords: anal fissure, botox, botulinum toxin, intrasphincteric
Geriatric Patient Outcomes of Major Burn due to High-Voltage Electrical Injury: A Case Report
Authors: Anggriant Vincent , Roosseno Ratna Rayeni Natasha , Pramudyo Daniel Puguh , Chandra Yoseph
Published: December 2022

Introduction: Electrical burns are uncommon but result in high morbidity and mortality due to severe tissue damage. Geriatrics are vulnerable to aggressive burns because of skin atrophy, comorbidities, diminished host defence mechanisms and reduced mobility. A high-voltage electrical injury has complex complications, especially long-term complications. This study aimed to present the case of geriatric patient outcomes of major burn due to high-voltage electrical injury.
Case Presentation: This is a case report of electrical burn injuries; a 70 years old man came to the emergency room approximately 1 hour after the incident, and a chief complaint was burning due to electrical shock. The patient had a history of electrical shock when fishing on the side of the river bank, where there is a high-voltage electrical central behind him. When he threw his fishing line, the fishing line caught on the exposed high-voltage transformer cable causing an electric shock. The examination showed that the patient was conscious of burns on the right chest to the abdomen and palm to the right hand, as well as on both soles of the feet. Another complaint was a pain in the wound due to electrical shock without a history of fainting, shortness of breath, chest pain, headache, and vomiting. The patient’s previous medical history showed uncontrolled hypertension.
Conclusion: Our study demonstrates a rare geriatric patient discharged without complications due to a high-voltage injury. Strict multi-specialty management and rehabilitation are required to treat electrical injuries properly.
Tatalaksana laser CO2 pada hiperplasia kelenjar sebasea: laporan kasus
Authors: Sari Maylita , Fadila Arisia , Muhammad Yulianto Listiawan  , Bagus Haryo Kusumaputra  , Irmadita Citrashanty
Published: December 2022

Background: Sebaceous gland hyperplasia is a benign skin disorder in the form of macules or papules which are generally < 1 mm in size, skin color or yellowish at the mouth of the pilosebaceous gland follicle.1 This disorder can cause cosmetic morbidity and psychosocial impacts for patients. There are various treatment modalities for sebaceous gland hyperplasia associated with the risk of pain, depigmentation, bleeding during the procedure, scarring, and recurrence. CO2 laser is one of the therapeutic approaches that are considered effective and safe.
Case: A female patient came with the chief complaint of lumpy skin-colored lumps on the back of the ear to the left neck that had increased in number and had not been painful since about 4 years ago. Histopathological examination was performed on the lump showing hyperplasia of the sebaceous glands. The patient was treated with 2 CO2 Laser sessions with an even skin surface result. Observations made within 9 months after the procedure did not reveal any recurrence of the lesion.
Conclusion: CO2 laser can be an effective and safe alternative therapy for sebaceous gland hyperplasia.
 
Latar Belakang: Hiperplasia kelenjar sebasea adalah kelainan jinak kulit berupa makula atau papula yang umumnya berukuran < 1 mm sewarna kulit atau kekuningan di muara folikel kelenjar pilosebasea.1 Kelainan ini dapat menimbulkan morbiditas kosmetik dan dampak psikososial bagi pasien. Terdapat berbagai modalitas tatalaksana hiperplasia kelenjar sebasea yang berhubungan dengan risiko nyeri, depigmentasi, perdarahan selama prosedur, skar, hingga kekambuhan. Laser CO2 merupakan salah satu pendekatan terapi yang dianggap efektif dan aman.
Kasus: Pasien wanita datang dengan keluhan utama benjolan bergerombol sewarna kulit pada telinga bagian belakang hingga leher kiri yang bertambah banyak dan tidak nyeri sejak kurang lebih 4 tahun yang lalu. Pemeriksaan histopatologi dilakukan pada benjolan menunjukkan hasil hiperplasia kelenjar sebasea. Pasien diterapi dengan 2 sesi Laser CO2 dengan hasil permukaan kulit rata. Observasi yang dilakukan dalam 9 bulan paska tindakan tidak didapatkan rekurensi pada lesi.
Simpulan: Laser CO2 dapat menjadi alternatif terapi pada hiperplasia kelenjar sebasea yang efektif dan aman.
A review of multisystem inflammatory syndrome in children (MIS-C) related to COVID-19
Authors: Kurniawan Carlson
Published: December 2022

Global pandemic of Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2, a novel virus which first reported in Wuhan in December 2019. It can cause severe respiratory conditions including respiratory failure. Different from adults, children usually have milder symptoms of the disease. A post-infection complication that involves multisystem organ failure in children is reported in numerous countries. It is mentioned as multisystem inflammatory syndrome in children (MIS-C) or Kawa-COVID-19, because it resembles Kawasaki Disease. The pathogenesis remains unclear, but it is presumed that hosts’ innate immune response triggered the condition. Modulating the immune response is the main target of the therapy. High doses of intravenous immunoglobulins, low doses of corticosteroids (methylprednisolone), anti-IL-1 (anakinra), antiplatelet such as aspirin can be used to treat MIS-C. Antiviral therapy is not proven to be effective and other immunomodulatory agents still needed further studies.
Pengaruh partisipasi masyarakat dalam pencegahan demam berdarah dengue (DBD) terhadap peningkatan kejadian DBD di Wilayah kerja Puskesmas Tegallalang I
Authors: Kamal Norhara Noorsham , Dharmadi Made
Published: December 2022

This study was conducted to determine the image's participation in the prevention of DHF carried by people in Puskesmas Tegallalang I and prove that the participation of poor people prevention has experienced a higher risk for suffering from DHF. Methods: This was an analytic observational study with case control design. In this study, the researchers distinguish the population into two, namely the population of cases and population control / comparator (not the case). Samples in the case group number of 28 cases were determined by quota sampling technique selected and adapted to the proportion of each banjar in that village. The instrument used was a questionnaire. Results: The results showed as many as 60.7% had poor participation (value score of questionnaire 0-18). While in the control group, only 37.5% had poor participation. From 84 research samples, amounting to 45.2% or 38 people have poor participation on the prevention of DHF. Results showed the value of the odds ratio (OR) of 2.57 with a 95% confidence interval (1.01 to 6.53). Hypothesis test Chi Square shows the results of p = 0.04. It showed statistically with the participation of poor groups will have the possibility of 2.57 times to suffer from DHF than either group participation. Conclusion: Overview of participation in dengue prevention is done by people in Puskesmas Tegallalang I mostly included the participation of both groups. There are significant community participation in prevention of DHF to the increased incidence of DHF in Puskesmas Tegallalang I.
Gambaran perilaku ibu dan sanitasi lingkungan terhadap kejadian diare pada balita di desa Banyubiru Kecamatan Negara Kabupaten Jembrana Bali 2014
Authors: Yudi Mahardika I Made
Published: December 2022

Diarrhea is still potential to grow in Indonesia as a public health problem. In Bali, the prevalence of diarrhea in Jembrana ranks fourth highest. Negara Public Healthcare I have patients with high diarrhea disease. If the distribution of diarrhea cases in 2014 were reported to the Negara Public Healthcare I were analyzed by age group, the most visible cases of diarrhea suffered by a toddler groups, as many as 119 cases or 23% of the total 521 cases were settled in the village Banyubiru Jembrana District of the State. In order to anticipate this public health problem, Negara Public Healthcare I has implemented a range of activities covered by the Environmental Health Program, Disease Eradication Program, and the Community Health Promotion Program.Â The study was conducted in the Village area Banyubiru, District Negara, Jembrana in March-April 2014 using descriptive cross sectional study design with the interview method. The sample in this study were selected through simple random sampling technique. Based on research that has been done, it can be inferred picture characteristics, knowledge, maternal behavior, environment, and the incidence of diarrhea respondents with lower education, children under five suffer from diarrhea in infants in the village Banyubiru
Tingkat depresi dalam kalangan mahasiswa kedokteran semester VII Universitas Udayana dan keterlibatan mereka dalam kegiatan fisik
Authors: Thurai Surain Raaj Thanga , Westa Wayan
Published: December 2022

Depresi adalah perasaan tidak mampu, sedih yang menyebabkan kualitas hidup yang buruk. Seseorang tidak dapat memberikan upaya maksimal mereka jika menghadapi depresi. Keterlibatan dalam aktivitas fisik telah terbukti secara drastis mengurangi depresi .Hal ini menjadikan penting untuk membuktikan bahwa siswa yang terlibat dalam aktivitas fisik benar-benar dapat meningkatkan suasana hati mereka sehingga mereka tidak mengalami depresi. Ini secara otomatis akan meningkatkan kualitas hidup mereka dan akan lebih mampu dalam mencapai tujuan mereka. Penelitian deskriptif observasional ini dilakukan untuk mempelajari hubungan antara tingkat depresi dan keterlibatan mereka dalam aktivitas fisik. Pengumpulan data dilakukan dengan mewawancarai responden menggunakan Pasien Health Questioner (PHQ9) untuk menilai depresi dan Internasional Physical Activity Questionnaire (IPAQ) untuk menilai aktivitas fisik. Dari 132 responden, mereka yang tidak depresi 102 siswa , depresi ringan adalah 19 siswa dan depresi sedang adalah 11 siswa . Hal ini dapat dilihat bahwa mereka yang secara aktif terlibat dalam aktivitas fisik yang berarti dalam kategori sedang dan tinggi, tidak memiliki depresi .Sebagai kesimpulan, siswa harus menjaga diri sibuk dengan aktivitas fisik untuk memastikan mereka tidak memiliki depresi yang kemudian dapat mengganggu kinerja mereka . Siswa harus membagi dan mengatur waktu mereka dengan menyelipkan aktivitas olahraga untuk mencegah depresi.