bluuebunny/crossref_metadata_2025 huggingface dataset:
Latissimus dorsi flap after mastectomy surgery: case series
Authors: Young Cecillia , Pribadi Sweety , Baskoro Bernard Agung
Published: November 2023

Background: Breast cancer is the most common type of cancer in women. Breast cancer can be treated with mastectomy surgery, chemotherapy, hormonal, radiation, and biological agent therapy. Surgery is the primary therapy for breast cancer. The most common surgical procedure is a mastectomy which can be continued with breast reconstruction after mastectomy surgery to improve the shape and close the breast defects. Breast reconstructions can be performed with breast implant surgery and autologous or “flap” reconstruction. Latissimus Dorsi (LD) flap is a pedicled flap often used for breast reconstruction. Mastectomy surgery and breast reconstruction complications are seromas, late hypertrophic scars, hematomas, pain, muscle weakness, and infections. This study aimed to describe the case series of latissimus dorsi flaps in breast cancer patients after mastectomy surgery.
Case presentation: The author presents 6 cases of breast cancer patients after mastectomy surgery performed breast reconstruction using an LD flap. Five patients had a history of surgery on the abdomen, and one did not have a history of abdominal surgery but had planned pregnancy in the future. There were no complications after LD flap reconstruction surgery. LD flap surgery may be accompanied by implants so that the shape and size can be close to another breast, but related to the cost, and the patients refuse to use a breast implant. All patients were given chemotherapy before surgery.
Conclusion: Breast reconstructive surgery is used to close defects after mastectomy surgery and can improve the quality of life of breast cancer patients. Pedicled LD flaps are one of the techniques often used for breast reconstruction cases because of rare complications of necrosis in the donor area or flaps.
Laporan kasus: kanker caput pankreas pada pasien dengan infeksi hepatitis B kronis
Authors: Seri Mahayanti Ni Kadek , I Putu Alit Sudarsana
Published: November 2023

Background: Pancreatic cancer is the seventh leading cause of cancer death globally according to the 2020 Global Cancer Statistics. Pancreatic cancer does not show clear clinical signs in its early stages and it is usually diagnosed in the advanced phase with poor response to treatment. The risk is increased in smokers, black race, high-fat diet, alcohol, the elderly, the presence of infection, diabetes mellitus, and chronic pancreatitis.
Case report: We report a 72-year-old female patient with complaints of abdominal enlargement and jaundice. Patients also with complain of light colored stools and dark urine. Physical examination revealed tenderness on palpation of the right upper quadrant of the abdomen accompanied by an enlarged liver. Laboratory examination revealed anemia accompanied by an increase in total bilirubin with predominance in direct bilirubin. HbsAg examination showed positive results. Ultrasound examination showed a mass in the head of the pancreas with dilatation of the common bile duct to the intrahepatic bile duct and there was a hydrops gallbladder. Abdominal CT scan showed a well-defined contrast-enhanced mass measuring 36 cm x 4.4 cm x 6 cm in the head area.
Conclusion: Pancreatic head cancer is a rare type of cancer, but has a high malignancy. Establishing the correct diagnosis is generally difficult. This is because symptoms generally appear after the cancer has reached an advanced stage.
 
Latar Belakang: Kanker pankreas menjadi penyebab kematian ketujuh terbanyak akibat kanker secara global menurut Global Cancer Statistics tahun 2020. Kanker pankreas tidak menunjukkan tanda-tanda klinis yang jelas pada fase awal dan biasanya didiagnosis pada fase lanjut dengan respon yang buruk terhadap pengobatan. Risiko meningkat pada perokok, ras kulit hitam, diet tinggi lemak, alkohol, lansia, adanya infeksi, diabetes mellitus, dan pankreatitis kronis.
Laporan kasus: Kami melaporkan seorang pasien wanita berusia 72 tahun dengan keluhan keluhan pembesaran abdomen dan jaundice. Pasien juga dengan keluhan feses berwarna terang dan urin gelap. Ditemukan nyeri tekan pada palpasi kuadran kanan atas abdomen disertai pembesaran hati. Pemeriksaan laboratorium didapatkan anemia disertai peningkatan pada bilirubin toal dengan dominan pada bilirubin direk. Pemeriksaan HbsAg menunjukkan hasil positif. Pemeriksaan ultrasonograafi menunjukkan adanya massa pada caput pancreas dengan dilatasi common bile duct hinga intrahepatic bile duct dan terdapat hydrops gall bladder. Pemeriksaan CT scan abdomen menunjukkan massa menyangat kontras berbatas tegas ukuran  36 cm x 4,4 cm x 6 cm di daerah caput.
Kesimpulan: Kanker caput pancreas merupakan jenis kanker yang tergolong jarang, namun memiliki keganasan yang tinggi. Penegakan diagnosis yang tepat pada umumnya mengalami kesulitan. Hal ini disebabkan karena gejala pada umumnya muncul setelah kanker telah mencapai stadium lanjut.
Comparison of rotational and orbital atherectomy: A systematic review of efficacy and safety in patients who underwent percutaneous coronary intervention
Authors: Yogita Saraswati Putri , Sumantra I Gede , Tedjokusumo Pintoko
Published: November 2023

Background: To assess the clinical results of CAD patients who underwent orbital atherectomy (OA) and rotational atherectomy (RA).
Methods: PICO criteria for publication in the last 5 years and preferred reporting elements for systematic reviews and meta-analyses (PRISMA) were used to systematically choose publications. Boolean operators were used to search for keywords. The effectiveness of each chosen article was evaluated using the STROBE checklist.
Results: Five articles of non-randomized observational analysis were selected, which involved 72.982 patients whom underwent RA, while 6.431 others underwent OA which is a new atherectomy method that was approved for use in coronary arteries in 2003. Although some studies still showed varying results due to different data collection tools, overall data showed there was no difference between the two techniques in terms of contrast volume, outcomes of coronary artery dissection, periprocedural myocardial infarction (MI), arterial perforation caused by device, cardiac tamponade, in-hospital mortality, slow flow/no reflow, 30-day of mortality, target vessel revascularization (TVR), MI and major adverse cardiovascular events (MACE). The burr size and rotational speed for RA may lead to complication rates.
Conclusion: Except for a shorter fluoroscopy time with OA, there are no discernible differences between OA and RA in patients with calcified CAD undergoing PCI.
Klasifikasi Etiologi Presbikusis Berdasarkan Hasil Audiogram di Poliklinik THT-KL RSUP Prof. Dr. I.G.N.G. Ngoerah Periode Januari-Desember 2020
Authors: Pande Nyoman Bayu Tirtayasa  , I Made Wiranadha
Published: November 2023

Background: Presbycusis or age-related hearing loss, is the most common cause of hearing loss and also the most common neurodegenerative disorder. This age-related hearing loss occurs in the population over 60 years of age. This study aims to determine the type of presbycusis in presbycusis patients at the ENT Polyclinic of Prof. Dr. I.G.N.G. Ngoerah Hospital for the period of January-December 2020.
Methods: This study is a retrospective descriptive study with a total sample of 42 people taken consecutively in presbycusis patients at the ENT Polyclinic of Prof. Dr. I.G.N.G. Ngoerah Hospital for the period of January-December 2020.
Results: The results showed that the audiogram results based on the right and left ears, 42.8% and 45.2% had strial type presbycusis, 30.9% and 28.6% had cochlear type presbycusis, 21.4% and 23.8% had sensory type presbycusis, 4.8% and 2.4% had neural type presbycusis.
Conclusion: From the results of this study, it can be concluded that the average degree of deafness of the right and left ears is moderate-heavy, with the dominant type of presbycusis being the strial or metabolic type. Presbycusis shows a wide variation in the degree of deafness, hearing acuity, age of onset, and progression, so it is likely that the burden of presbycusis in the population may increase in the future.
 
Latar Belakang: Presbikusis atau penurunan pendengaran terkait usia, merupakan penyebab gangguan pendengaran dan sekaligus juga merupakan gangguan neurodegeneratif yang paling sering terjadi. Penurunan pendengaran terkait usia ini terjadi pada populasi usia lebih dari 60 tahun. Penelitian ini bertujuan untuk mengetahui jenis presbikusis pada pasien presbikusis di Poliklinik THT-KL RSUP Prof. Dr. I.G.N.G. Ngoerah periode Januari-Desember 2020.
Metode: Penelitian ini adalah penelitian deskriptif retrospektif dengan total sampel sebanyak 42 orang yang diambil secara konsekutif pada pasien presbikusis di Poliklinik THT-KL RSUP Prof. Dr. I.G.N.G. Ngoerah periode Januari-Desember 2020.
Hasil: Hasil penelitian menunjukkan bahwa hasil audiogram berdasarkan telinga kanan dan kiri, sebanyak 42,8% dan 45,2% mengalami presbikusis tipe strial, 30,9% dan 28,6% mengalami presbikusis tipe koklea, 21,4% dan 23,8% mengalami presbikusis tipe sensori, sebanyak 4,8% dan 2,4% mengalami presbikusis tipe neural.
Simpulan: Dari hasil penelitian ini dapat disimpulkan bahwa derajat ketulian telinga kanan dan kiri rata-rata adalah derajat sedang-berat, dengan tipe presbikusis yang dominan adalah tipe strial atau metabolik. Presbikusis memperlihatkan variasi yang beragam pada derajat ketulian, ketajaman pendengaran, onset umur, dan progresinya sehingga kemungkinan beban presbikusis di populasi dapat meningkat di kemudian hari.
Tingkat Pengetahuan, Sikap, dan Perilaku Mahasiswa PSSK FK Unud Angkatan 2021 Terhadap Pola Makan Sebagai Faktor Risiko Diabetes Melitus Tipe 2
Authors: Kinivaldy Andre Lintang , Wiryanthini Ida Ayu Dewi , Sutadarma I Wayan Gede , Surudarma I Wayan
Published: November 2023

Background: Diabetes mellitus (DM) is still one of the most feared diseases and is the number three disease with the highest mortality risk globally. One of the risk factors for the occurrence of type 2 DM is bad eating habits that lead to obesity, which is the factor that tends to cause type 2 DM. Therefore, this study aims to know diet as a risk factor for type 2 diabetes mellitus in college students.
Methods: This research was conducted at the Faculty of Medicine, Udayana University, from September to November 2022, using a cross-sectional descriptive method. The primary data source was collected using a questionnaire. Data were analyzed univariately using the original SPSS version 25.
Results: Total of 247 respondent was include in this research. It was found that the majority of respondents were women aged 19 years with a good level of knowledge (91.5%) and good attitudes (81.4%) regarding diet as a risk factor for type 2 DM, and had the habit of regularly eating three times a day (66,8%). 
Conclusion: Undergraduate medical students in the faculty of medicine at Udayana University class of 2021 have a good level of knowledge and attitudes towards diet as a risk factor for type 2 DM, and the behavior of regularly eating three times a day.
 
Latar belakang: Penyakit diabetes melitus (DM) sampai sekarang masih menjadi salah satu penyakit yang paling ditakuti dan merupakan penyakit nomor tiga yang paling berisiko tinggi tingkat mortalitasnya di dunia. Salah satu faktor risiko terjadinya DM tipe 2 adalah kebiasaan pola makan yang salah sehingga menimbulkan obesitas yaitu salah satu faktor kecenderungan terjadinya DM tipe 2. Studi ini bertujuan mengetahui pola makan sebagai faktor risiko diabetes melitus tipe 2 pada mahasiswa.
Metode: Penelitian ini dilakukan di Fakultas Kedokteran Universitas Udayana pada bulan September hingga November 2022 menggunakan metode deskriptif potong lintang dan sumber data yaitu data primer yang dikumpulkan menggunakan kuesioner. Data dianalisis secara univariat menggunakan aplikasi SPSS versi 25 original.
Hasil: Terdapat total 247 responden yang termasuk dalam penelitian ini. Didapatkan bahwa mayoritas responden merupakan perempuan dan berusia 19 tahun dengan tingkat pengetahuan baik (91,5%) dan sikap baik (81,4%) terhadap pola makan sebagai faktor risiko DM tipe 2, serta memiliki perilaku teratur makan tiga kali sehari (66,8%).
Kesimpulan: Mahasiswa PSSK FK UNUD angkatan 2021 memiliki tingkat pengetahuan serta sikap yang baik terhadap pola makan sebagai faktor risiko DM tipe 2, dan perilaku teratur makan tiga kali sehari.
Cerebral salt wasting syndrome: A case report
Authors: Wisadianta Resha , Ni Wayan Anantika Riani
Published: November 2023

Introduction: The development of extracellular volume reduction due to decreased renal sodium transport in individuals with the intracranial illness and normal adrenal and thyroid function is known as a cerebral salt wasting syndrome (CSWS). Complications of cerebral salt-wasting syndrome include symptomatic hyponatremia and dehydration. We reported and discussed the diagnostic approach and the management of a 66-year-old woman who experienced severe hyponatremia with a history of head trauma and was treated at Udayana University Hospital.
Case Description: A 66-year-old female patient complained of decreased consciousness. According to family information, the patient complained of having decreased consciousness one hour before admission and was accompanied by vomiting one time. Two weeks before admission, the patient had fallen, and the back of the patient's head had hit the table. The patient also had time to experience stiffness in the right and left hands and stomping. Urine collected 24 hours as much as 3880 ml on the first day of treatment.
Conclusion: In cerebral salt wasting syndrome (CSWS) the management mainly focuses on the correction of intravascular volume depletion using 0.9% sodium chloride and hyponatremia, as well as on the replacement of ongoing urinary sodium loss, usually with iv hypertonic saline solutions, Fludrocortisone/mineralocorticoid that directly acts on the renal tubules to increase sodium reabsorption showed a favorable response in CSWS.
Patency of tertiary vascular access in hemodialysis patients: case series
Authors: Satria Raymen , Sudarma I Wayan , Semadi I Nyoman
Published: November 2023

Background: Transposed brachio-basilic arteriovenous fistula (TBB-AVF) or arteriovenous graft (AVG) can be considered when primary and secondary vascular access options have been exhausted. Evidence that compared both procedures remains scarce. We aimed to report and describe the effectiveness of TBB-AVF and AVG as tertiary vascular access, reviewing literature about the advantages of each procedure.
Case Presentation: We presented a series of end-stage renal disease (ESRD) patients needing tertiary vascular access to compare each procedure's effectiveness. Our study included 17 patients with ESRD and multiple vascular access failures who needed tertiary vascular access for hemodialysis between January 2019 and August 2022. Patency in 6 months and 1 year were compared between TBB-AVF and AVG using the Kaplan-Meier curve. The early failure rate was 14.4% for TBB-AVF and 87.5% for AVG. TBB-AVF had a better patency rate than AVG (p=0.005; log-rank). Cumulative patency rates in six months and one year were 91.7% and 85.7% for TBB-AVF compared to 87.5% and 16.7% for AVG, respectively.
Conclusion: The creation of TBB-AVF should only be suggested if primary and secondary vascular access options have been exhausted. The TBB-AVF was more effective in functional patency than AVG as tertiary vascular access.
Characteristics of vascular risk factor and the presence of ventriculomegaly among patients with white matter changes in Bangli General Hospital, Bali, Indonesia
Authors: Yogiswara Made Dwi Andhika , Adnyani Anak Agung Dewi
Published: November 2023

Background: White matter changes (WMC) is a common yet often incidental and neglected finding among older people in head CT or MRI examinations. This finding rarely becomes the main examination focus, although much research has proven its correlation with elderly disabilities, such as cognitive, executive, and motor function impairment. This lesion form is not fully understood, but chronic ischemic conditions may contribute due to a vascular risk factor (VRF) and ependymal cell impairment at the ventricular wall due to dilatation.
Methods: This research aimed to explore the characteristics of VRF (history of hypertension, diabetes mellitus, and dyslipidemia) and the presence of ventriculomegaly among patients with WMC finding on head CT examination. This research was conducted with a descriptive retrospective method using a data registry at Bangli General Hospital, Bali, Indonesia, in 2022.
Result: From 97 patients with WMC findings, most were aged >60 (77.30%). Ventriculomegaly was found in 33.00% of them. Almost all had a history of hypertension (92.80%), and a history of dyslipidemia was found in 61.9%. Of all VRF components, diabetes mellitus was the least frequently found in patients (19.60%). The majority of WMC lesions involved the periventricular structure.
Conclusion: WMC finding was more frequent among patients aged >60, with a history of hypertension being the most frequent compared to other components of VRF. Ventriculomegaly was found in one-third of them.
Hubungan glukosa darah puasa dengan hipertensi pada pasien diabetes melitus tipe-2 di RSUD Kabupaten Lombok Utara
Authors: Parameswari Desak Made Paramestri Dyah , Pramana Kadek Dwi , Hardinata
Published: November 2023

Latar Belakang         : DM merupakan penyakit yang umum terjadi yakni sebesar 425 juta orang dengan angka mortalitas sebesar 1,5 juta orang. Komplikasi kronis dari DM tipe 2 dapat berupa komplikasi mikrovaskular dan makrovaskular. DM tipe 2 yang tidak terkontrol akan menyebabkan terjadinya hipertensi.  Hal ini dapat dicegah sedini mungkin dengan menilai pemeriksaan rutin kadar glukosa darah dan tekanan darah, namun masih sedikit dokumentasi penelitian mengenai hubungan kadar glukosa pada pasien DM dengan kejadian hipertensi. Oleh karenanya, peneliti tertarik melakukan penelitian untuk mengetahui hubungan glukosa darah puasa dengan hipertensi pada pasien DM tipe 2 yang dirawat jalan di RSUD Kabupaten Lombok Utara

Metode Penelitian     : Penelitian ini merupakan penelitian analitik observasional dengan desain penelitian cross sectional menggunakan metode purposive sampling pada data Rekam Medis pasien DM yang memenuhi kriteria inklusi yakni pasien yang terdiagnosis menderita DM tipe 2 oleh dokter apabila GDP ≥ 126 mg/dl dan pasien yang berusia 18 tahun dan ekslusi yakni pasien DM dengan keadaan tertentu (HIV, CKD, Keganasan) serta pasien yang menjalani kemoterapi di RSUD Kabupaten Lombok Utara

Hasil Penelitian         : Total terdapat 329 responden yang termasuk dalam penelitian ini dengan rerata usia adalah 50-60 tahun dan mayoritas jenis kelamin perempuan (66%). Ditemukan dari seluruh responden dengan kontrol glikemik yang terkontrol sebesar 13,4% dan kejadian hipertensi terjadi sebanyak 35,9%. Berdasarkan hasil uji Chi-square diperoleh bahwa Hasil analisis bivariat menunjukkan bahwa nilai p-value < 0,05 (p-value = 0,006).

Kesimpulan                : Berdasarkan hasil penelitian ini, dapat disimpulkan bahwa terdapat hubungan yang signifikan antara kadar glukosa darah puasa dengan hipertensi pada pasien diabetes melitus tipe 2 di RSUD Kabupaten Lombok Utara.
Karakteristik Pasien COVID-19 Rawat Inap di RSUP Prof. Dr. I.G.N.G. Ngoerah Periode Juni-Agustus 2021
Authors: Nurcahya I Gusti Ngurah Metta , Salim Sonia Elvira , Wulandari Luh , Semadi I Made Siswadi
Published: November 2023

Background: The clinical manifestations of coronavirus disease 2019 (COVID-19) in Indonesia vary, ranging from asymptomatic to severe symptoms, and various factors influence the clinical course. This study aims to determine the characteristics of hospitalized COVID-19 patients.
Methods: A study with descriptive cross-sectional design was conducted at the Prof. Dr. I.G.N.G. Ngoerah General Hospital, involving COVID-19 patients hospitalized during June-August 2021. The characteristics studied included age, gender, body mass index (BMI), domicile, last education level, occupation, smoking history, history of co-morbidities, and increased c-reactive protein and D-Dimer level. Descriptive analysis was conducted for the data obtained through medical records.
Results: 80 COVID-19 patients were recorded during the study period. The majority of patients were >55 years old (51.25%), female (51.25%), with normal BMI (45%), domiciled in Denpasar (48.75%), last education level was Senior High School (46.25 %), did not work (22.5%), did not have a history of smoking (53.75%), had comorbidities (91.25%), and experienced increased CRP (80%) and D-Dimer (88.75%).
Conclusion: The majority of COVID-19 patients hospitalzed in Prof. Dr. I.G.N.G. Ngoerah General Hospital during June-August 2021 were >55 years old, female, had normal BMI, with comorbidities, and had elevated levels of CRP and D-Dimer.
 
Latar belakang: Manifestasi klinis coronavirus disease 2019 (COVID-19) di Indonesia bervariasi, mulai dari asimtomatik hingga gejala berat, dan perjalanan klinisnya dipengaruhi berbagai faktor. Penelitian ini ingin melaporkan karakteristik pasien COVID-19 rawat inap.
Metode: Penelitian cross-sectional deskriptif di Rumah Sakit Umum Pusat (RSUP) Prof. Dr. I.G.N.G. Ngoerah, melibatkan pasien COVID-19 yang dirawat inap, dilakukan pada periode Juni-Agustus 2021. Karakteristik pasien meliputi usia, jenis kelamin, indeks massa tubuh (IMT), domisili, tingkat pendidikan terakhir, pekerjaan, riwayat merokok, riwayat penyakit penyerta, serta peningkatan c-reactive protein dan D-Dimer. Data diperoleh melalui rekam medis dan dianalisis secara univariat.
Hasil: Sebanyak 80 pasien COVID-19 tercatat selama periode penelitian. Mayoritas pasien berusia >55 tahun (51,25%), berjenis kelamin perempuan (51,25%), dengan IMT normal (45%), berdomisili Denpasar (48,75%), tingkat pendidikan terakhir Sekolah Menengah Atas (46,25%), tidak bekerja (22,5%), tidak memiliki riwayat merokok (53,75%), memiliki komorbid (91,25%), serta mengalami peningkatan CRP (80%) dan D-Dimer (88,75%).
Kesimpulan: Pasien COVID-19 dirawat inap di RSUP Prof. Dr. I.G.N.G. Ngoerah pada periode Juni-Agustus 2021 mayoritas berusia >55 tahun, perempuan, memiliki IMT normal, dengan komorbid, dan mengalami peningkatan kadar CRP dan D-Dimer.
Dengue Shock Syndrome Unusual Appearance With Multisystem Inflammatory Syndrome in Children: A Case Report
Authors: Rajani Anak Agung Puteri Indira , Windiyanto Romy , Purnama Anak Agung Ratna
Published: November 2023

Background: Dengue and coronavirus disease 2019 (COVID-19) have recently become endemic in various tropical countries. Multisystem inflammatory syndrome in children (MIS-C) is a clinical manifestation of COVID-19 with a life-threatening syndrome of hyperinflammation, multiorgan failure, and shock, and it closely resembles the manifestations of severe dengue. Many attempts have been made in research to differentiate the two. Here we aims to describe a case of a patient with dengue coinfection with MIS-C.
Case Presentation: A 17-year-old woman came in a state of shock, with cold extremities, fever, jaundice, shortness of breath, acute abdominal pain, and hematuria, decreased urine output. Further investigations reveal increased parameters of hepato-renal organ damage, c-reactive protein, and anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG). Patient was positive for anti-dengue IgM and IgG, but negative for COVID-19 based on SARS-CoV-2 antigen and polymerase chain reaction.
Conclusion: This case demonstrates the possibility of dengue coinfection and MIS-C co-occurring, causing the patient to develop a hyperinflammatory syndrome and clinical deterioration.
Penegakkan diagnosis lupus eritematosus sistemik (LES) pada anak dan multisystem inflammatory syndrome in children (MIS-C) di rumah sakit sekunder : sebuah laporan kasus
Authors: Kadek Enny Pradnyaswari  , Anak Agung Ratna Purnama Santhi  , Romy Windiyanto
Published: November 2023

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can attack various organ systems with varying severity, ranging from mild to life-threatening. Multisystem inflammatory syndrome (MIS-C) is a hyper-inflammatory state characterized by multiorgan dysfunction caused by secondary inflammation to previous SARS-CoV-2 infection. SLE and MIS-C have similar symptoms because both diseases attack various organ systems. This paper aims to provide an overview of pediatric patients who are enforced with two diagnoses, namely SLE and MIS-C.
Case presentation: A 10-year-old female patient came to the emergency room at Sanjiwani Regional General Hospital, Gianyar, with the chief complaint of fever for four days before entering the hospital. Complaints accompanied by swollen eyelids, cough, nausea, abdominal pain, diarrhea, and lymphadenopathy. Clinical manifestations were found in various organ systems based on anamnesis, physical examinations, and laboratory examinations. The patient was diagnosed with SLE based on the EULAR/ACR 2019 criteria (obtained a score of 13) and MIS-C based on the MIS-C case definition criteria according to WHO.
Conclusion: The diagnosis of SLE is established based on EULAR/ACR 2019 criteria (obtained a score of 13), and the diagnosis of MIS-C is selected based on the MIS-C case definition criteria according to WHO.
 
Latar belakang: Lupus eritematosus sistemik (LES) adalah penyakit autoimun kronis yang mampu menyerang berbagai sistem organ dengan tingkat keparahan penyakit yang beragam, mulai dari ringan hingga mengancam nyawa. Multisystem inflammatory syndrome (MIS-C) adalah suatu keadaan hiperinflamasi yang ditandai dengan disfungsi multiorgan yang disebabkan oleh peradangan sekunder akibat infeksi SARS-CoV-2 sebelumnya. LES dan MIS-C memiliki kemiripan gejala karena sama-sama menyerang berbagai sistem organ. Tujuan penulisan ini adalah untuk memberikan gambaran kasus pasien anak yang ditegakkan dengan dua diagnosis yaitu LES dan MIS-C.
Presentasi kasus: Seorang pasien perempuan, berusia 10 tahun datang ke IGD RSUD Sanjiwani, Gianyar dengan keluhan utama demam sejak 4 hari sebelum masuk rumah sakit. Keluhan disertai kedua kelopak mata bengkak, batuk, mual, nyeri perut, diare, dan limfadenopati. Berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang didapatkan adanya manifestasi klinis pada berbagai sistem organ. Pasien didiagnosis dengan LES berdasarkan kriteria EULAR/ACR 2019 (didapatkan skor 13) dan MIS-C berdasarkan kriteria definisi kasus MIS-C menurut WHO.
Simpulan: Diagnosis LES ditegakkan berdasarkan kriteria EULAR/ACR 2019 (didapatkan skor 13) dan diagnosis MIS-C ditegakkan berdasarkan kriteria definisi kasus MIS-C menurut WHO.
Aspek laboratorium pemeriksan keton pada kasus preeklamsia berat: laporan kasus
Authors: Perdana I Gede Sukma Okta , I Nyoman Gde Sumardika  , Made Dharma Pramana  , Ni Luh Putu Siska Kahari Sari
Published: November 2023

Background: Ketones are the product of fat metabolism, consisting of 20% aceto-acetic acid, 78% β-hydroxy butyrate and 2% acetone. Aceto-acetic acid and acetone that experience an increase is called ketosis while ketosis that occurs in the urine is called ketonuria. This case report aims to evaluate the laboratory aspects of ketone testing in cases of severe preeclampsia.
Case Presentation: Increased levels of ketonuria in the body can cause ketoacidosis and a decrease in blood pH if not treated immediately, in pregnant women it can cause fetal death and ketoacidic coma. A 30 year old female patient with a diagnosis of G4P3003 UK 26 mg T/IUFD accompanied by ketonuria and severe preeclampsia. At the diagnostic examination, blood pressure was found: 170/100 mmHg, urine examination: protein 1+ and ketones 2+. The patient was treated with MgSO4, nifedipine, drip transamin 1 ampoule 28 tpm, cefotaxime and observation for bleeding.
Conclusion: During early pregnancy, there were persistent complaints of nausea and vomiting where laboratory tests, especially urine for remote areas and blood ketone examination for urban areas, were needed in early pregnancy to prevent preeclampsia.
 
Latar Belakang: Keton merupakan produk hasil dari metabolisme lemak, terdiri dari 20% asam aseto-asetat, 78% β-hidroksi butirat dan 2% aseton. Asam aseto-asetat dan aseton yang mengalami peningkatan disebut ketosis sedangkan ketosis yang terjadi di dalam urin disebut Ketonuria. Laporan kasus ini bertujuan untuk mengevaluasi aspek laboratorium pemeriksan keton pada kasus preeklamsia berat.
Presentasi Kasus: Peningkatan kadar ketonuria didalam tubuh dapat menyebabkan ketoasidosis dan penurunan pH darah jika tidak segera mendapatkan penanganan, pada ibu hamil dapat menyebabkan kematian janin serta ketoacidic koma. Pasien perempuan umur 30 tahun dengan diagnosis G4P3003 UK 26 mg T/IUFD disertai ketouria dan  Preeklamsia Berat. Pada pemeriksaan penegakan diagnosis didapatkan tekanan darah: 170/100 mmHg, Pemeriksaan urin : protein 1+ dan keton 2+. Pasien diterapi dengan MgSO4, nifedipine, drip transamin 1 ampul 28 tpm, cefotaxime dan observasi perdarahan.
Kesimpulan: Pada masa kehamilan awal didapatkan keluhan mual muntah terus menerus dimana pemeriksaan laboratorium khususnya urin untuk daerah terpencil dan pemeriksaan keton darah untuk daerah perkotaan pada awal kehamilan diperlukan untuk mencegah preeklamsia.
D-dimer correlation as a marker of coagulopathy with neuroimaging abnormalities on head CT scans of COVID-19 patients
Authors: Adnyani Anak Agung Dewi , Anwary Farhan
Published: November 2023

Background: COVID-19 is a coronavirus disease with the main symptoms in the respiratory tract which can cause hypoxia. The duration and severity of the hypoxia can lead to oxidative stress that can affect the brain. The phenomenon of thromboembolism was also found in the form of an increase in coagulopathy markers which can cause abnormalities in small blood vessels in various organs, including the brain.
Methods: We conducted a prospective crossectional study of 23 samples that met the inclusion criteria. Duration of hypoxia, degree of hypoxia based on oxygen saturation, and D-Dimer level as independent variables underwent Spearman correlation test with neuroimaging abnormalities on head CT scan.
Results: The sample population consisted of 14 men (60.90%) and 9 women (39.10%), with the highest age group being 61 – 80 years old (56.50%) who underwent a head CT scan without contrast administration. Eighteen samples were found to have brain infarction, while 5 samples were without abnormalities. The Spearman correlation test found a correlation (p=0.003) with moderate correlation (r=0.558) between the D-Dimer level as a coagulopathy marker and abnormal findings on the head CT scan of samples. Where 15 samples with high D-Dimer levels (D-Dimer values above the normal level) and 3 samples with normal D-Dimer levels were found to have brain infarction. Meanwhile, the duration and degree of hypoxia based on the oxygen saturation value did not show a significant correlation with neuroimaging abnormalities (p>0.05).
Conclusion: There was a moderate correlation between the D-Dimer value. No significant correlation was found between the duration of hypoxia and the degree of oxygen saturation toward neuroimaging abnormalities in COVID-19 patients.
Thoracopagus parasitic twin with omphalocele rupture: a case report
Authors: Pradnya Paramita Made Indah , Kardana I Made , Sukmawati Made , Putra Putu Junara , Artana I Wayan Dharma
Published: November 2023

Background: Heteropagus or parasitic twin is a rare congenital anomaly that affects two connected children with imprecisely understood anatomy and physiology. This case report aims to describe a thoracopagus patient with severe complications.
Case presentation: One-day-old female baby was born with thoracopagus and omphalocele rupture. She was the third child, born aterm from a 36-year-old mother, with a birth weight of 3000 grams. Laboratory and radiography examinations showed leukocytosis, metabolic acidosis, prolonged coagulation profile, acute kidney injury, hypoglycemia, transaminitis, and congenital heart defects. She was treated in the intensive care unit and managed conservatively. Unfortunately, she died on the sixth day of treatment due to severe complications.
Conclusion: Conjoined twins have a poor prognosis. If it is coupled with other congenital anomalies, it will worsen the outcome.
Management of Fuchs endothelial corneal dystrophy (FECD): a case series
Authors: Wulandari Ni Made Ayu , Siska  , Kusumadjaja Made Agus , Jayanegara Wayan Gede , Juliari I Gusti Ayu Made , Kusumadjaja I Made Agus , Pramita Ida Ayu Ary , Safitri Putu Dian Mega
Published: November 2023

Background: Fuchs endothelial corneal dystrophy (FECD) is the most common corneal dystrophy and often results in visual loss. This study aims to discuss the etiology, pathophysiology, diagnosis, and management of FECD.
Case presentations: We reported three cases of FECD. The first patient was 60 years old female diagnosed with corneal scar post-penetrating keratoplasty (PK) and pseudophakia in the right eye (RE) and FECD grade II in the left eye (LE). The right and left eye (RLE) visual acuity was 6/18 and 6/12, respectively. The patient was managed thrice a day with lubricant eye drops in the RE and Phacoemulsification and Descemet membrane endothelial keratoplasty (DMEK) in the LE. The second patient was 80 years old female with RLE FECD grade II, LE Pseudophakia, and RE Immature Cataract. Visual acuity was light perception in the right eye and 1/60 in the LE. She was managed with Siloxane eye drop 2x1, Oculenta gel 1x1 in RLE, and DMEK in LE. The third patient was 73 years old male with pseudophakia, FECD grade III, and corneal neovascularization in the RE. Visual acuity in RE was hand movement, and LE was 6/6. He was planned for PK on RE, Diquafosol sodium (Diquas®) eye drop twice a day, and eye fresh plus eye drops 4x1 in RLE.
Conclusion: FECD is the most common endothelial dystrophy and the main indication for corneal transplantation in the presence of visual disturbances. Medical therapy in the form of topical hyperosmotic agents can be given in the early phase and is useful for reducing corneal edema. The preferred management of FECD is currently Endothelial Keratoplasty (EK), such as DMEK, which has demonstrated excellent corneal clearance. Although the graft rejection rate in DMEK is low, there is a risk of rejection with the discontinuation of topical corticosteroids.
Knowledge regarding cervical cancer and HPV vaccination in adolescent girls
Authors: Jodjana Mikael Stevan , Windiani I Gusti Ayu Trisna , Adnyana I Gusti Agung Ngurah Sugitha , Pratiwi Ni Luh Sukma , Soetjiningsih
Published: November 2023

Introduction: Cervical cancer is the second most common cancer in women worldwide. The highest cancer incidence in women in Indonesia is cervical cancer, with a total of 17 cases per 100,000 female population. Human papillomavirus (HPV) is the main cause of cervical cancer. Acceptance of this vaccine is related to the level of knowledge about the virus and the vaccine itself. Previous systematic studies revealed that most women do not have a sufficient level of knowledge about the relationship between HPV virus infection and cervical cancer. This study aims to know the level of knowledge about cervical cancer and HPV vaccination in an adolescent girl
Methods: This research was conducted with a cross-sectional design. This study uses primary data in the form of answers to questionnaires distributed to respondents, where the questionnaire has been tested for validity and reliability in previous studies. The subjects were girl students aged 14 to 18 years at the senior high school level in the city of Denpasar.
Results: Most of the research subjects (95,3%)  had fairly good-sufficient knowledge about cervical cancer, with a median value of 8 (4-10) of the assessment result. However, the majority of the research subjects (50,4%) had a low level of knowledge about HPV vaccination, with a median value of 11 (0-22) of the assessment result.
Conclusion: This study shows that the majority of students in senior high school have good knowledge about cervical cancer but a lack of knowledge about HPV vaccination.
Prevalence and factors associated with anxiety during echocardiography procedure
Authors: Maharini Kadek , Gunawijaya Eka , Yantie Ni Putu Veny Kartika , Windiani I Gusti Ayu Trisna , Adnyana I Gusti Agung Ngurah Sugitha , Murti Ni Luh Sukma Pratiwi
Published: November 2023

Purpose: Echocardiography is the main modality for definitive diagnosis and evaluation of children with congenital heart disease. Anxiety is the most common feeling experienced by children when they visit healthcare facilities. The first aim of this study was to give an overview of the prevalence of anxiety symptoms, and the second aim was to investigate the factors associated with anxiety during the echocardiography procedure.
Patients and methods: The cross-sectional study was conducted in the pediatric cardiology outpatient clinic at Prof. Dr. I G.N.G. Ngoerah General Hospital, Denpasar-Bali period February 2022 to August 2022. Children aged 18 months-6 years who underwent echocardiography evaluation were included. The visual analog scale of anxiety (VAS-A) was used to measure the severity of anxiety. The analysis is using chi-square test and logistic regression. The significance of risk factors is reported as a prevalence ratio with 95% confidence intervals and p<0.05.
Results: In a total of 156 subjects, the prevalence of anxiety during the procedure was 64,1% with a similar gender proportion. Multivariate analysis found that age ≤3 years old and did not attend school were associated with anxiety (PR 60.53; 95% CI 13.07-280; p<0.001 and PR 5.59; 95% CI 1.31-23.77; p < 0.001).
Conclusion: Anxiety during the echocardiography procedure is common. Age ≤3 years old and did not attend school were associated with anxiety during echocardiography.
Evaluasi Kemampuan Komunikasi dan Kerjasama Tim dalam Pelaksanaan Interprofessional Education (IPE): Sebuah Tinjauan Literatur
Authors: Manuaba Ida Bagus Amertha Putra , Yani Made Violin Weda
Published: November 2023

Collaboration is needed to provide comprehensive services in dealing with complex health problems. However, collaboration in the world of health in Indonesia is still not optimal. So early learning is needed to increase the effectiveness of collaboration, one of which is by organizing interprofessional education (IPE). IPE is a collaborative learning process that involves educators and students from two or more health professions and basic disciplines. IPE can provide various benefits, including training cooperation, communication, leadership, and respect for other professions. With the implementation of the IPE program since college, it is hoped that it will be a provision for students when carrying out professional activities. This study aims to assess communication and teamwork's ability to implement IPE. The method in this study was a literature review, with 19 articles that met the inclusion criteria. Based on a review of several literatures, it was found that implementing IPE can improve communication skills and teamwork.
 
Dalam menghadapi permasalahan kesehatan yang kompleks, diperlukan kolaborasi guna memberikan pelayanan yang komprehensif. Namun, kolaborasi di dunia kesehatan Indonesia masih belum maksimal. Sehingga diperlukan pembelajaran sejak dini untuk meningkatkan efektivitas kolaborasi, salah satunya dengan penyelenggaraan interprofessional education (IPE). IPE merupakan proses pembelajaran kolaboratif yang melibatkan pendidik dan peserta didik dari dua atau lebih profesi kesehatan dan disiplin dasar. IPE dapat memberikan berbagai manfaat mulai dari melatih kerjasama, komunikasi, kepemimpinan, dan menghormati profesi lain. Dengan penerapan program IPE sejak kuliah, diharapkan dapat menjadi bekal mahasiswa saat menjalani kegiatan profesi. Penelitian ini bertujuan untuk menilai kemampuan komunikasi dan kerjasama tim dalam pelaksanaan IPE. Metode pada studi ini adalah tinjauan literatur, dengan 19 artikel yang memenuhi kriteria inklusi. Berdasarkan kajian terhadap beberapa literatur, didapatkan bahwa pelaksanaan IPE dapat meningkatkan kemampuan komunikasi dan kerjasama tim.
Gambaran karakteristik pasien balita dan faktor resiko merokok di pkm manggar periode bulan februari sampai maret 2022
Authors: Prahasari Wismawan Made Nindya , Isdiawati  , Kurniati Ida
Published: November 2023

Introduction: Acute respiratory infection (ARI) is still a major health problem in Indonesia. Parents' smoking habit is a risk factor for the incidence of ARI in children under five. This study aims to assess the relationship between the incidence of ISPA in toddlers and the smoking habits of parents who come to the Manggar Health Center.
Methods: This descriptive observational study was conducted using a cross-sectional method in the period February - March 2022 at PKM Manggar. The independent variable includes the degree of parental smoking behavior. While the dependent variable is the visit of pediatric patients with a diagnosis of ISPA.
Results: Fifty visits of toddler patients during the study period were dominated by ARI patients (52%). As many as 64% of patients were passive smokers with 62% getting exposure to cigarette smoke of more than 5 cigarettes per day. Most of the patients were males with normal birth weight and aged between 2-5 years.
Conclusion: Further analytical exploration to determine the relationship between parents' smoking habits and the incidence of ARI in toddlers is needed.
 
Pendahuluan: Infeksi saluran pernapasan akut (ISPA) masih menjadi masalah kesehatan besar di Indonesia. Kebiasaan merokok orang tua merupakan faktor risiko kejadian ISPA pada balita. Penelitian ini bertujuan untuk menilai hubungan kejadian ISPA pada balita dengan kebiasaan merokok orang tua yang datang ke Puskesmas Manggar .
Metode: Penelitian observasional deskriptif ini dilakukan menggunakan metode potong lintang pada periode Februari - Maret 2022 di PKM Manggar. Variabel bebas meliputi derajat perilaku merokok orang tua. Sementara variabel terikat adalah kunjungan pasien anak dengan diagnosis ISPA.
Hasil: Lima puluh kunjungan pasien balita selama periode penelitian didominasi oleh pasien ISPA (52%). Sebanyak 64% pasien merupakan perokok pasif dengan 62% mendapatkan pajanan asap rokok lebih dari 5 batang per hari. Sebagian besar pasien adalah laki-laki dengan berat badan lahir normal dan berusia antara 2-5 tahun.
Kesimpulan: Eksplorasi lebih lanjut secara analitik untuk mengetahui hubungan antara kebiasaan merokok orang tua dan kejadian ISPA pada balita diperlukan.
Association of Neutrophil-lymphocyte ratio and platelet lymphocyte ratio with GRACE risk score and high-sensitivity Troponin T in acute coronary syndrome patient
Authors: Wikananda Gede Dehandra Dipastraya , Diartoputra Achmad Yusri Rachmani
Published: November 2023

Background: Inflammatory indicators such as alterations in neutrophils, platelets, and lymphocytes are linked to the acute coronary syndrome. This research seeks to understand the association of the Platelet Lymphocyte Ratio (PLR) and Neutrophil-Lymphocyte Ratio (NLR) with the Grace score as well as the association between NLR and PLR with High Sensitivity Troponin T (hs-cTnT) as a serum biomarker that aids in ACS diagnosis.
Methods: The 99 patients who met the inclusion criteria for this study were the subject of an analytical investigation with a retrospective cross-sectional design. Based on the ratio of lymphocytes to neutrophils, NLR is determined. Based on the ratio of platelets to lymphocytes, PLR is determined. hs-cTnT laboratory samples were collected more than three hours after the ischemia complaint first manifested, using the Grace risk score as a predictor of mortality. Using SPSS program 25.0, data were examined.
Results: Bivariate analysis using the Spearman correlation test. There is a correlation between NLR and GRACE risk scores (r=0.348; p<0.001), PLR and GRACE risk scores (r=0.434; p<0.001), NLR and hs-cTnT (r=0.343; p=0.001), PLR and hs-cTnT (r=0.284; p=0.004). ROC curve analysis, NLR cut-off value 4.45 (sensitivity 73.3%; specificity 72.6%), and PLR cut-off value 139.77 (sensitivity 66.7%; specificity 59.5 %) to detect High grace score. NLR cut-off value 2.17 (sensitivity 62.9%; specificity 60 %), and PLR cut-off value 108.38 (sensitivity 60.7%; specificity 60 %) to detect High hs-cTnT.
Conclusion: In this study, there was a relationship between NLR and PLR with the Grace risk score as well as a relationship between NLR and PLR with hs-cTnT.
Gene similarity examination Pseudomonas aeruginosa in Intensive Care Unit (ICU) at Prof. Dr. dr. I.G.N.G Ngoerah hospital using the ERIC-PCR method: case reports
Authors: Pratama I Gede Wahyu Toya , Darwinata Agus Eka , Tarini Ni Made Adi
Published: November 2023

Background: Pseudomonas aeruginosa is an opportunistic pathogen that has the potential to cause severe degrees of healthcare-associated infections, especially in immunocompromised patients who have AIDS, cancer, burns, and respiratory tract infections. Antibiotic resistance genes by genetic elements are increased so that it becomes a worldwide concern and also causes the evolution of resistant strains (MDR) ERIC-PCR technique is a PCR-based method in which the location and number of different ERIC sequences in bacteria are used as genetic markers of bacterial diversity.
Case Presentation: We presented three patients with Pseudomonas aeruginosa infection treated in the ICU (Intensive Care Unit) room of Prof. dr. I. G. N. G Ngoerah Hospital. While being treated in the ICU, the three patients' beds were located side by side in one room. Three patients, in this case, reports were treated in the same room where the beds were side by side and experienced a worsening of their condition. After examination, it was found that the bacteria that caused the infection was Pseudomonas aeruginosa. However, after conducting molecular analysis using the ERIC-PCR method, there was no gene similarity between the three isolates examined. This might have happened because the patient had been treated in a different room before being admitted to the ICU.
Conclusion: We presented a discrepancy between Pseudomonas aeruginosa infection in three patients treated in the same ICU room. However, the ERIC-PCR results found no gene similarity between the three isolates examined.