bluuebunny/crossref_metadata_2025 huggingface dataset:
ENSINO LÚDICO PARA CRIANÇAS DO ENSINO FUNDAMENTAL I: RELATO DE EXPERIÊNCIA
Authors: Coelho Ana Clara da Silva , Dos Reis Gemírson de Paula , Palazzi Solange Sabino
Published: March 2023

O projeto de extensão universitário “Coletivo Ameopema”, projeto do departamento de Medicina de Família, Saúde Mental e Saúde Cultiva (DEMSC) da Escola de Medicina da Universidade Federal de Ouro Preto (UFOP) se desenvolveu na Escola Municipal Izaura Mendes, situada na cidade de Ouro Preto-MG. Teve seu início em vinte e quatro de maio de 2022 e se desenvolve na escola até os dias atuais com a oferta de aulas de apoio escolar e ensino lúdico por dois dias na semana, terças -feiras e quintas -feiras, das 8h às 10h, no período da manhã.
COMPETÊNCIAS E HABILIDADES NA FORMAÇÃO DO ADMINISTRADOR: PARA ONDE APONTAM O PROJETO CURRICULAR DO CURSO
Authors: Portela Francimeire Farrapo , Paixão e Vasconcelos Francisco Ullissis , Lazarri Fernanda , Aguiar Talita Souza , Solano Wládia Fernandes da Rocha , De Sousa Natacha Martins , Brasil Thamylles França Moita , Da Silva Hugo Barros
Published: March 2023

Esta pesquisa, resultante dos movimentos do Mestrado em Administração, objetivou identificar, no projeto pedagógico, as habilidades e competências a serem adquiridas pelos egressos do curso superior em Administração, de uma Universidade cearense. Este recorte de pesquisa é de caráter qualitativo, do tipo exploratório e documental, onde se analisa o Projeto Curricular do Curso (PPC) a partir do foco nas competências e habilidades constantes no mesmo, tecendo um paralelo com as perspectivas legais.  Os achados da pesquisa apontam para uma grande dificuldade curricular na compreensão do conceito central deste trabalho (competências e habilidades) o que fragiliza a construção do perfil do egresso para satisfazer as demandas atuais da sociedade do trabalho.
SUBSTRATOS NO ENRAIZAMENTO DE ESTACAS DE AMOREIRA
Authors: Faustino Carlos Silvério , Tomazelli Oriana Carla , Bridi Samara , Barloesius Guilherme Corona , Paixão Marcus Vinicius Sandoval
Published: March 2023

Os substratos são considerados o primeiro fator de produção, quando se produz uma muda, devendo este apresentar condições adequadas a espécie que se deseja produzir. Objetivou-se se avaliar de diferentes substratos no enraizamento de estacas de amoreira. Foram utilizados como propágulos de estacas herbáceas de amoreira, obtidas de ramos jovens não-lignificados com 25 cm de comprimento, e preparadas de modo a conterem três nós, colocadas para enraizamento em tubetes de 280 mL, em um delineamento experimental em blocos ao acaso (4x5), utilizando os substratos: terra, bioplant®, vermiculita e areia, sendo cada tratamento composto por 10 estacas da cultura e 5 repetições. Noventa dias após o estaqueamento foram avaliadas as variáveis: sobrevivência das estacas, número de folhas, comprimento do broto, comprimento da raiz, massa verde e seca das folhas, massa verde e seca das raízes. A sobrevivência das estacas não apresentou diferença estatística, O substrato terra apresentou os melhores resultados nas variáveis comprimento do broto e número de folhas e massa das raízes. Na variável comprimento da raiz e massa das raízes o substrato vermiculita apresentou os melhores resultados.
Phân tích các yếu tố ảnh hưởng đến sự chậm thanh toán cho nhà thầu phụ trong các dự án nhà cao tầng
Authors: Việt Nguyễn Thanh , Sỹ Đỗ Tiến , Mùi Võ Đình
Published: March 2023

Nghiên cứu này nhằm mục tiêu phân tích các yếu tố ảnh hưởng và các tác động của sự chậm thanh toán đến các nhà thầu phụ trong các dự án nhà cao tầng tại thành phố Hồ Chí Minh. Dựa trên các nghiên cứu trước đây, tham khảo công trình thực tế và ý kiến chuyên gia, nghiên cứu xác định được 20 yếu tố ảnh hưởng đến sự chậm thanh toán và 08 tác động đến nhà thầu phụ. Các yếu tố ảnh hưởng lớn đến sự chậm thanh toán là “nhà thầu phụ trình chủ đầu tư/ nhà thầu chính hồ sơ thanh toán không hợp lệ, không đúng yêu cầu, không chứng minh được các yêu cầu thanh toán”, “năng lực về quản lý tài chính yếu kém, giải quyết các khoản thanh toán gặp khó khăn”. Trong khi đó các tác động lớn nhất của sự chậm thanh toán đến nhà thầu phụ là “kéo dài thời gian thực hiện, phá vỡ kế hoạch làm việc của nhà thầu phụ trong dự án này, và các dự án khác”, “giảm năng suất nhà thầu do khó khăn về nguyên vật liệu, thiết bị, thiếu lương nhân công”. Nghiên cứu này hy vọng giúp các nhà thầu phụ có cái nhìn tổng thể về các yếu tố dẫn đến sự chậm thanh toán, nhận diện được các yếu tố ảnh hưởng quan trọng nhất, và các tác động của sự chậm thanh toán, từ đó có thể giúp các nhà thầu phụ đưa ra các giải pháp phù hợp và chiến lược hiệu quả đối với chính công ty mình để hạn chế sự chậm trễ thanh toán từ chủ đầu tư và nhà thầu chính.
Ischemic Stroke with Anticoagulant Protein C Deficiency
Authors: Cynthia  , Aulia Diana
Published: March 2023

Ischemic stroke is a circulatory disorder in brain is caused by reduced or stopped blood flow in some areas of brain. It can be caused by thrombotic lesions resulting from atherosclerosis and by emboli that have detached from the lesions atherosclerosis in the heart or cerebral arteries. Ischemic stroke category consists of emboli and lacunae. Characteristic profile clinical manifestations of acute embolic stroke are sudden onset with maximal neurologic deficits. Embolic often originate from heart or from ulcerative carotid plaques. Atrial fibrillation is a predisposing factor for cardiac thrombus, associated with six times of risk increase in strokes. The patient had a diagnosis with a clinical description of a history of post cerebrovascular disorder non hemorrhagic (CVD-NH/ischemic stroke) with hypercoagulable state from an outpatient clinic on April 13th, 2016 for examination antithrombin III (AT III), protein C, protein S, ACA IgG, ACA IgM, fibrinogen, D-dimer, and INR.
Nuclear Security During Armed Conflict: Lessons From Ukraine
Authors: Fedchenko Vitaly
Published: March 2023

The attacks on nuclear installations in Ukraine by the Russian military in 2022 were unprecedented. Nuclear security aims at prevention, detection and response to malicious or unauthorized acts by non-state actors, not the armed forces of a state. However, an international armed conflict creates new circumstances in which a national nuclear security regime must operate. In March 2022 the director general of the International Atomic Energy Agency (IAEA) highlighted ‘seven indispensable pillars of nuclear safety and security’ in extraordinary circumstances. There are three further areas in which the international nuclear security framework can be strengthened and prepared for extraordinary events, including armed conflict. First, there is a need to further clarify and plan the actions of competent authorities. Second, the IAEA may be able to assist member states in developing guidance for specific scenarios during extraordinary events. Third, there should be further integration of nuclear security with nuclear safety and emergency preparedness and response.
Sindrom Felty – Diagnosis dan Tata Laksana
Authors: Apriliana Hardika Putu Stephanie
Published: March 2023

Sindrom Felty merupakan kondisi medis dengan karakteristik trias yaitu artritis reumatoid, neutropenia, dan splenomegali; terjadi pada beberapa kasus artritis reumatoid erosif yang sudah berlangsung lama. Hanya 1 – 3% pasien artritis reumatoid akan berkembang menjadi Sindrom Felty. Genetik (HLA-DR4) dan faktor lingkungan berperan dalam terjadinya kondisi ini. Neutropenia persisten dengan hitung neutrofil absolut umumnya kurang dari 1500/mm3 merupakan ciri khas diagnosis Sindrom Felty. Kondisi medis ini biasanya asimtomatik, infeksi lokal serius atau sistemik bisa menjadi petunjuk awal. Terapi farmakologi menggunakan disease-modifying anti-rheumatic drugs (DMARDs); methotrexate oral dosis rendah menjadi modalitas terapi lini pertama. Splenektomi merupakan upaya terakhir dalam algoritma penatalaksanaan Sindrom Felty.

Felty Syndrome is a medical condition characterized by triad of rheumatoid arthritis, neutropenia, and splenomegaly; occurs in few cases of longstanding erosive rheumatoid arthritis. Only 1 – 3% rheumatoid arthritis patient developed Felty Syndrome. Genetic (HLA-DR4) and environmental factors are involved in its pathophysiology. Persistent neutropenia with absolute neutrophil count less than 1500/mm3 is a diagnosis hallmark. Felty syndrome may be asymptomatic, but local serious or systemic infections may be the first clue to the diagnosis. Pharmacological therapy as the first-line therapy use disease-modifying anti-rheumatic drugs (DMARDs) such as oral low dose methotrexate. Surgical approach (splenectomy) is the last resort in Felty Syndrome management.
Pencegahan dan Manajemen Vaginosis Bakterial
Authors: Rosita Fiska , Dewi Putti Fatiharani , Aliwardani Ambar , Kusuma Halim Perdana , Mawardi Prasetyadi
Published: March 2023

Gangguan keseimbangan flora bakteri normal dalam vagina menyebabkan vaginosis bakterial. Vaginosis bakterial dapat tidak menunjukkan gejala atau ditandai dengan adanya tubuh putih keabuan disertai bau amis. Skor Nugent merupakan standar emas untuk diagnosis. Penggunaan probiotik menunjukkan hasil memuaskan sehingga dipertimbangkan dalam manajemen bakterial vaginosis.

Bacterial vaginosis is caused by disruption of normal bacterial flora balance in the vagina. This disease may show no symptoms; can be characterized by the presence of agrayish-white discharge accompanied by a fishy odor. Nugent score is the gold standard for diagnosis. The use of probiotics shows satisfactory results; and may be considered in the management of bacterial vaginosis.
Function after Wrist Arthrodesis with Non-Vascularized Fibular Graft in Distal Radius Giant Cell Tumor: Case Series
Authors: Rahmadhany Heru
Published: March 2023

Giant cell tumor (GCT) of bone, the most common benign locally aggressive bone tumor, accounts for 4% to 5% of all primary bone neoplasms and 20% of benign bone tumors. The distal radius is the third commonest site of involvement in about 10% of GCT cases. Due to the high recurrence rate after curettage of the more progressed lesions, most surgeons prefer en bloc resection followed by reconstruction. Cases: Three distal radius GCT Campanacci III cases underwent en bloc resection and wrist arthrodesis with non-vascularized fibular graft. The mean follow-up period was nine months (6-12 months). Patients were evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) Score. Results: Union had been achieved in 2 patients, and implant removal was done. One patient needs cancellous bone grafting after implant removal—no sign of recurrence after one year. DASH score showed moderate disability. Conclusion: Autogenous non-vascularized fibular graft reconstruction can be considered a reasonable option after en bloc resection of distal radius GCT.

Giant Cell Tumor (GCT) adalah tumor tulang jinak yang paling sering dijumpai, bersifat agresif secara lokal, merupakan 4-5% dari seluruh neoplasma tulang primer dan 20% dari seluruh tumor tulang jinak. Radius distal merupakan lokasi GCT terbanyak ketiga, mencakup 10% kasus GCT. Mengingat tingginya rekurensi setelah prosedur kuretase, lebih disukai reseksi en bloc diikuti rekonstruksi. Kasus: Tiga pasien GCT pada radius distal (Campanacci III) menjalani reseksi en bloc disertai arthrodesis pergelangan tangan. Follow-up rata-rata selama 9 bulan (range 6-12 bulan). Pasien dinilai menggunakan skor Disabilities of the Arm, Shoulder, and Hand (DASH). Hasil: Union tulang tercapai pada 2 pasien, dan implan telah dicabut. Satu pasien membutuhkan graft dari tulanag cancellous setelah pencabutan implan. Tidak didapatkan rekurensi pada periode follow-up satu tahun. Skor DASH menunjukkan disabilitas sedang pada ketiga pasien. Simpulan: Prosedur rekonstruksi menggunakan nonvascularized fibular graft baik dilakukan setelah reseksi en bloc pada pasien GCT radius distal.
Sirosis Hepatis - Reversibel atau Irreversibel?
Authors: Christian Yong Bernard Jonathan , Vidor Marco
Published: March 2023

Sirosis hepatis adalah tahap akhir penyakit hati dengan berbagai penyebab, antara lain kelainan metabolik atau infeksi hepatitis B dan hepatitis C. Hingga saat ini, sirosis hepatis diyakini sebagai proses tidak reversibel, yang berujung dengan transplantasi hati. Namun, seiring dengan perkembangan teknologi dan pemahaman tentang patogenesis, sirosis hepatis mungkin bersifat reversibel.

Liver cirrhosis is a final stage of liver disease with many etiologies, i.e. metabolic disorder or infection like type B hepatitis and type C hepatitis. Liver cirrhosis is still being considered as an irreversible disease, which leads to liver transplantation. But as far as the development of technology and knowledge of liver cirrhosis pathogenesis, liver cirrhosis might be considered as a reversible process.
Pemeriksaan Radiologi dan Imaging untuk Perforasi Hollow Organ Abdomen
Authors: Widayana Komang Ady
Published: March 2023

Perforasi saluran gastrointestinal melibatkan organ lambung, duodenum, usus kecil, atau usus besar terjadi akibat kerusakan dinding saluran gastrointestinal disertai pelepasan konten intraluminal ke dalam rongga peritoneal atau retroperitoneal. Perforasi saluran gastrointestinal merupakan keadaan darurat medis umum dengan angka kematian tinggi; biasanya membutuhkan pembedahan darurat. Diagnosis dan pengobatan segera sangat penting untuk mengurangi morbiditas dan mortalitas. Foto polos abdomen dapat menjadi bantuan penting untuk diagnosis perforasi saluran gastrointestinal. Ultrasonografi dapat berguna untuk menentukan tidak hanya keberadaan, tetapi juga penyebab pneumoperitoneum. Multidetector computed tomography merupakan modalitas pilihan untuk evaluasi dugaan perforasi karena sensitivitas dan akurasinya yang tinggi.

Perforation of the gastrointestinal tract involves organs of the stomach, duodenum, small intestine, or large intestine that result from damage of the gastrointestinal tract accompanied by intraluminal content release into the peritoneal or retroperitoneal cavities. Gastrointestinal perforation is a common medical emergency associated with high mortality; usually requires emergency surgery. Prompt diagnosis and treatment is essential. Plain abdominal radiographs can be an important aid for diagnosis gastrointestinal perforation. Ultrasound can also be used to determine not only the presence, but also the cause of pneumoperitoneum. Multidetector computed tomography is the modality of choice for the evaluation of suspected perforation because of its high sensitivity and accuracy.
Cutaneous Mucormycosis
Authors: Karyadi Erlinda , Agnes Leoni
Published: March 2023

Cutaneous mucormycosis is an emerging fungal infection caused by opportunistic fungi from phylum Glomeromycota. This disease is frequently found in poorly controlled diabetic patients and immunosuppressed individuals. It is usually acquired by direct inoculation through trauma. The clinical presentation is nonspecific indurated plaque rapidly evolves to necrosis. Diagnosis should be confirmed by demonstration of the etiological agent and molecular tests. First-line therapy is amphotericin B combined with surgery; second line treatment include posaconazole and isavuconazole.

Cutaneous mucormycosis adalah infeksi jamur oportunistik dari filum Glomerycota. Penyakit ini sering dijumpai pada pasien diabetes tidak terkontrol serta pada pasien imunosupresi. Penyebaran penyakit ini umumnya inokulasi langsung melalui trauma. Gambaran klinis berupa plak berindurasi nonspesifik yang berkembang cepat menjadi nekrosis. Diagnosis melalui pemeriksaan kultur dan sejumlah tes molekular. Terapi lini pertama yaitu amphotericin B dengan pembedahan, lini kedua dapat menggunakan posaconazole dan isavuconazole.
Mukormikosis Rino-Orbito-Serebral pada Diabetes Melitus
Authors: Wijaya Meiliyana , Mujono Aivi , Lukito Elizabeth Feloni
Published: March 2023

Mukormikosis rino-orbito-serebral (ROS) adalah penyakit angioinvasif akibat infeksi jamur Mucorales yang sering ditemukan pada pasien diabetes melitus (DM). Penyakit ini memiliki gambaran khas jaringan nekrotik kehitaman disebut eschar, sehingga disebut juga infeksi “jamur hitam”. Tingkat mortalitas penyakit ini tinggi terutama jika diagnosis dan tata laksana terlambat. Patogenesis mukormikosis ROS pada pasien DM antara lain: interaksi reseptor sel epitel dengan protein jamur, kadar besi bebas dalam darah, dan penurunan imunitas seluler. Diagnosis berdasarkan gambaran klinis dengan faktor risiko, identifikasi jamur, dan pencitraan. Pemeriksaan histopatologis dari jaringan biopsi dapat dikonfirmasi dengan hasil kultur. Tata laksana mukormikosis ROS pada penderita DM meliputi kombinasi debridemen, pemberian antijamur, dan mengatasi kondisi hiperglikemia.

Rhino-orbital-cerebral mucormycosis (ROCM) is an angioinvasive disease caused by Mucorales fungal infection; it is common in diabetes mellitus (DM) patients. The disease has a characteristic feature of black necrotic appearance called eschar, thus also called as “black fungus” infection. The mortality rate of this disease is high, especially in delayed diagnosis and treatment. The pathogenesis of ROCM in diabetic patients includes the interaction of epithelial cell receptors with fungal proteins, free iron blood levels, and decreased cellular immunity. Diagnosis is based on clinical features, supporting risk factors, fungus identification, and imaging. Histopathological examination on biopsy tissue confirmed by culture can establish the diagnosis. Management includes a combination of surgical debridement, antifungals, and glycemia control.
Diagnosis dan Tata Laksana Varikokel
Authors: Singgih Nicholas Andrian
Published: March 2023

Varikokel merupakan dilatasi abnormal dan pembesaran sistem vena pleksus pampiniformis dan vena testis dengan refluks darah vena secara terus-menerus ataupun intermiten. Modalitas pencitraan dapat digunakan untuk konfirmasi diagnosis varikokel. Varikokel merupakan salah satu penyebab infertilitas pada laki-laki. Tata laksana yang tepat akan meningkatkan parameter semen. Varikokelektomi dengan teknik bedah mikro efektif dengan tingkat rekurensi dan komplikasi yang rendah.

Varicocele is an abnormal dilatation and enlargement of the pampiniform plexus and testicular veins with continuous or intermittent venous reflux. Imaging modalities can confirm the diagnosis. Varicocele may cause male infertility; appropriate management may improve semen parameters. Varicocelectomy with microsurgical technique is effective with low recurrence and complication rate.
Hipotiroid Kongenital dan Hypertrophic Pyloric Stenosis: Pemantauan Selama 3 Bulan
Authors: Gultom Lanny Christine , Vivian The Valensia
Published: March 2023

Angka kejadian hipotiroid kongenital (HK) berkisar 1 : 2000-4000 bayi. Deteksi dan tata laksana dini diperlukan agar fungsi neurologi dan perkembangan pasien optimal. Salah satu penyebab muntah berulang pada bayi adalah hypertrophic pyloric stenosis (HPS). Deteksi dan tata laksana HPS penting karena HPS dapat menyebabkan gagal tumbuh hingga gizi buruk yang berdampak pada IQ. Kasus: Bayi usia 2 bulan tanpa skrining hipotiroid kongenital, masuk ke rumah sakit dengan gejala khas hipotiroid kongenital, yaitu ubun-ubun terbuka, wajah tampak kasar, makroglosia, kulit kering dan dingin, gagal tumbuh, dan hernia umbilikalis. Selain gejala HK, bayi juga memiliki keluhan muntah berulang yang kemudian didiagnosis HPS. Terapi medikamentosa yang tepat dengan levothyroxine, tindakan pembedahan, dan nutrisi yang adekuat harus diberikan agar tumbuh kembang optimal.

The incidence of congenital hypothyroidism (CH) is 1 in 2000 to 4000 babies. Screening and early detection are important to improve neurodevelopmental prognosis. Recurrent vomiting in infant can be caused by hypertrophic pyloric stenosis (HPS). Early detection and management is important to prevent growth retardation and malnutrition. Case: A 2-month-old baby, who was not previously screened, presented with features of CH such asopen fontanelle, coarse facial feature, macroglossia, hypothermia, failure to thrive, and umbilical hernia. The infant also has recurrent vomiting due to HPS. Medical treatment with levothyroxine, surgery, and adequate nutrition should be given to ensure optimal growth and development.
Pengukuran Diameter Selubung Nervus Optikus (Optic Nerve Sheath Diameter) Berbasis Ultrasonografi: Metode Pemantauan Tekanan Intrakranial Non-invasif Selanjutnya?
Authors: Hioe Andy Santoso
Published: March 2023

Pemantauan tekanan intrakranial dibutuhkan sebagai upaya untuk menghindari kerusakan otak sekunder. Pemeriksaan baku emas untuk pemantauan ini masih bersifat invasif dan meningkatkan risiko infeksi dan perdarahan. Oleh karena itu, diperlukan pemeriksaan non-invasif yang dapat menggambarkan tekanan intrakranial secara kontinu. Salah satu pemeriksaan tersebut adalah pengukuran diameter selubung nervus optikus berbasis ultrasonografi. Pemeriksaan ini telah terbukti mempunyai sensitivitas dan spesifisitas yang baik dan berkorelasi baik dengan tekanan intrakranial. Pemeriksaan ini juga murah, aman, cepat, dan dapat diulang.

Intracranial pressure monitoring is important to prevent secondary brain injury. The “gold standard” measurement is still invasive and with infection and haemorrhage risks. Hence, non-invasive measurement of intracranial pressure is needed. One of the measurements is ultrasonographic measurement of optic nerve sheath diameter. This method has been proven to have high sensitivity and specificity and has a good correlation to intracranial pressure. It is also a low-cost, safe, quick, and easily repeatable measurement.
Penggunaan Asam Valproat pada Pasien Epilepsi di Poliklinik Saraf Rumah Sakit Tingkat III Brawijaya Surabaya Periode Maret-Agustus 2021
Authors: Agustina Sri , Widjaja Johanes Singoreto , Puspasari Riska
Published: March 2023

Latar Belakang. Asam valproat (VPA) telah digunakan sebagai obat antikonvulsan selama 40 tahun. Tujuan. Mengetahui pola terapi asam valproat pada pasien epilepsi di poliklinik saraf Rumah Sakit Tingkat III Brawijaya Surabaya. Metode. Penelitian cross-sectional deskriptif noneksperimental. Data dari rekam medis pasien epilepsi dengan terapi asam valproat periode Maret – Agustus tahun 2021 di Rumah Sakit Tingkat III Brawijaya Surabaya. Hasil. Didapatkan 27 pasien, 16 pasien laki-laki (59,2%), 21 pasien dengan rentang usia 19-65 tahun (77,7%), 23 pasien (85,1%) dengan kategori kejang umum. Politerapi asam valproat pada 14 pasien (51,8%), 9 pasien dengan kombinasi fenitoin. Dosis obat tepat pada 100% pasien, 70,3% pasien memiliki respons klinis terkontrol. Sebagian besar pasien (70,3%) tidak melaporkan efek samping. Simpulan. Penderita epilepsi terutama laki-laki usia 19-65 tahun dengan jenis kejang umum. Jenis terapi terbanyak adalah politerapi kombinasi asam valproat dengan fenitoin. Dosis sudah tepat, sebagian besar tanpa efek samping obat dan respons klinis terkontrol baik.

Introduction.Valproic acid (VPA) is a well established anticonvulsant drug for the last 40 years. Objective. To observe the pattern ofvalproic aciduse amongepilepsy patients at Neurology Clinic in Brawijaya level III Hospital Surabaya. Methods. A cross-sectional descriptive nonexperimental research on data from medical records of epilepsy patients with valproic acid therapy during March-August 2021 in Brawijaya level III Hospital, Surabaya, Indonesia. Result. During survey period, 27 epilepsy patients were recorded, 16 patients (59.2%) are male, 21 patients (77.7%) aged between 19-65 year-old; 23 patients (28.1%) with generalized seizure. Majority of patients (14 – 51.8%) used polytherapy; 9 patients used combination of valproic acid and phenytoin. The dosage are adequate in 100% patients, 70.3% are having no adverse effects and 70.3% are well controlled. Conclusion. Most epilepsy patients are male, aged 19-65 years with generalized seizures. Majority used combination of valproic acid and phenytoin. The dosage is adequate, 70.3 % patients are well controlled without adverse effects.
Terapi Berbasis Sel: Perkembangan Terkini
Authors: Mahendra Cipta
Published: March 2023

Terapi berbasis sel mulai mendapat perhatian ketika James P. Allison dan Tasuku Honjo mendapat hadiah Nobel bidang fisiologi/kedokteran pada tahun 2018 atas penemuan mekanisme inhibisi regulasi sel T dalam sistem imun, yang sangat berguna untuk memajukan modalitas imunoterapi. Terapi berbasis sel sejauh ini menggunakan dua jenis sel, yaitu sel imun dan sel punca. Terapi berbasis sel potensial sebagai terapi medis di masa depan, meskipun kini masih dalam tahap penelitian. Artikel ini bertujuan memberikan pengantar seputar terapi berbasis sel dan perkembangan terkininya.

Cell-based therapies start to gain attention when Nobel prize in physiology/medicine was awarded to James P. Allison and Tasuku Honjo in 2018 for their discovery in immune system’s T cell inhibition mechanism which is very valuable in immunotherapy. To date, cell-based therapies consist of two types of cells: immune cells and stem cells. Cell-based therapies are deemed future therapy in medicine, although their use are currently still in the research phase. This review is an overview and recent updates regarding cell-based therapies.
Collodion Baby
Authors: Anis Savitri A. A. Made Berastia , Sri Kusuma Dewi Ida Ayu
Published: March 2023

Collodion baby (CB) is a rare dermatological condition worldwide of 1: 300.000 birth. A Collodion baby is a newborn whose entire body is covered with an adherent, supple, parchment-like membrane. Collodion baby in a manifestation of various hereditary conditions, including Harlequin orchestras’ (HI), lamelar orchestras’ (LI), non-bullous congenital ichtyosiform erythroderma (NBCIE), trichothiodystrophy metabolic disease, and endocrine disease. We report two collodion babies cases with peeling skin, passive movement, and poor feeding. Both cases were hospitalized in the humidity-controlled incubator. Water and topical treatment were used for daily bathing to prevent infection.

Collodion baby merupakan kelainan dermatologi yang sangat jarang; prevalensi di dunia adalah 1:300.000. Istilah ini mengacu pada kondisi bayi baru lahir dengan kulit yang ditutupi membran tipis seperti perkamen. Collodion baby merupakan manifestasi berbagai kondisi yang diturunkan seperti Harlequin ichthyosis (HI), lamelar ichthyosis (LI), non-bullous congenital ichthyosiform erytroderma (NBCIE), trichothiodystrophy metabolic disease, dan endocrine disease. Kami melaporkan dua kasus bayi collodion dengan kulit terkelupas, gerakan pasif, dan kesulitan menyusu. Kedua kasus dirawat di ruang Perinatologi dalam inkubator dengan kelembapan terkontrol dan perawatan topikal untuk mencegah infeksi dan menjaga kulit tetap lembap.
Efikasi Suplementasi Asam Folat terhadap Kejadian Stroke pada Pasien Hiperhomosisteinemia dengan Riwayat Penyakit Jantung Koroner – Telaah Kasus Berbasis Bukti
Authors: Santoso Erlina , Haryadi Didi , Louisa Melva
Published: March 2023

Beberapa studi uji klinis yang meneliti efikasi asam folat untuk mencegah kejadian stroke pada pasien hiperhomosisteinemia dengan penyakit kardiovaskular memberikan simpulan yang inkonklusif. Tujuan laporan kasus berbasis bukti ini untuk menilai apakah suplementasi asam folat dapat menurunkan risiko stroke pada pasien dengan riwayat jantung koroner dengan hiperhomosisteinemia. Pencarian komprehensif melalui beberapa basis data online. Telaah kritis menggunakan alat penilaian dari Centre of Evidence Based Medicine (CEBM). Diperoleh dua studi kajian sistematik yang sesuai kriteria seleksi. Hasil telaah kritis mendapatkan bahwa kedua studi tersebut memiliki validitas baik. Analisis menunjukkan bahwa suplementasi asam folat dapat menurunkan kejadian stroke pada pasien dengan riwayat penyakit kardiovaskular.

Many studies investigating the efficacy of folic acid in hyperhomocysteineemia patients with cardiovascular disease for stroke prevention has been inconclusive. This evidence-based case report was to assess whether folic acid supplementation could reduce stroke risk in patients with a history of coronary heart disease with hyperhomocysteinemia. We performed comprehensive literature search in several online databases. Critical reviews use the assessment tool from the Center of Evidence Based Medicine (CEBM). Two systematic reviews met our selection criteria. Critical appraisals had shown that both studies have good validity. Analysis showed that folic acid supplementation could reduce the incidence of stroke in patients with history of cardiovascular diseases.
Diagnosis dan Tata Laksana Dismenore Primer
Authors: Anggraini Meilisva Audila , Lasiaprillianty Intan Wahyu , Danianto Ario
Published: March 2023

Dismenore dibagi atas jenis primer (tanpa kondisi patologik pelvis) dan sekunder (dengan kondisi patologik pelvis). Diagnosis dismenore primer berdasarkan anamnesis dan pemeriksaan fisik yang teliti. Penanganan di fasilitas kesehatan primer adalah diagnosis dan tata laksana dismenore primer dan menyingkirkan kecurigaan dismenore sekunder. Obat anti-inflamasi non-steroid (OAINS) dan terapi hormonal merupakan terapi lini pertama untuk dismenore primer.

Dysmenorrhea is categorized into primary (without pelvic pathologic conditions) and secondary (with pelvic pathologic conditions) forms. Diagnosis of primary dysmenorrhea is based on a complete history and physical examination. Management in primary health facilities is to diagnose and manage primary dysmenorrhea and to rule out secondary dysmenorrhea. Non-steroid anti-inflammatory drugs (NSAIDs) and hormonal therapy are first-line therapy for primary dysmenorrhea.
Diagnosis Alopesia Areata Pada Anak: Kasus Serial
Authors: Toena Haken Tennizar , Danarti Retno
Published: March 2023

Alopesia areata (AA) merupakan penyakit autoimun yang ditandai dengan alopesia non-sikatrisial. Kondisi ini merupakan dermatosis yang umum ditemui pada anak. Gambaran klinisnya berupa alopesia non-sikatrisial fokal, perlu dibedakan dari kondisi dapatan serupa lainnya, terutama yang sering terjadi pada anak. Kami melaporkan 5 kasus AA pada anak berusia di bawah 18 tahun. Diagnosis berdasarkan pemeriksaan klinis dan penunjang. Pemahaman karakteristik AA perlu diketahui untuk diagnosis, terutama pada pasien anak.

Alopecia areata (AA) is a chronic autoimmune disease characterized by non-scarring alopecia. It is one of the most commonly found dermatosis in pediatric population. The clinical manifestations of focal non-scarring alopecia must be differentiated from other acquired focal non-scarring alopecia, especially those in children. This paper report 5 AA cases in children. Diagnosis was based on clinical and supporting examinations. Understanding the characteristics of AA, particularly in children, is important to make correct diagnosis.
Myocardial Bridging: Nyeri Dada Atipikal pada Pria Paruh Baya
Authors: Mugiarto Thea Saphira , Paramita Dewi Ayu
Published: March 2023

Myocardial bridging merupakan anomali kongenital; prevalensinya 5-86%, rata-rata 25%. Beberapa data otopsi menunjukkan bahwa myocardial bridging didapatkan pada lebih dari 50% subjek, sehingga ada yang menganggap myocardial bridging merupakan variasi anatomi. Myocardial bridging dapat memiliki signifikansi kardiovaskular, tergantung kedalaman segmen arteri koroner yang tertanam di dalam miokardium. Gejala dapat berupa nyeri dada, berdebar-debar, mudah lelah, serta manifestasi kardiologis lainnya. Obat ß-blocker merupakan terapi lini pertama karena memiliki efek kronotropik dan inotropik negatif. Revaskularisasi sebaiknya dilakukan hanya pada pasien dengan gejala berat yang refrakter terhadap perawatan medis optimal. Pilihan tindakan bedah meliputi miotomi supraarterial dan/atau CABG. Laporan kasus ini mengenai pria 40 tahun dengan nyeri dada karena myocardial bridging, diagnosis ditegakkan setelah pemeriksaan angiografi.

Myocardial bridging is a congenital anomaly, its prevalence ranged from 5-86% with a mean of 25%. Autopsy data show that myocardial bridging can occur in more than 50% subjects, so it can be considered myocardial bridging as an anatomical variation. Symptoms can include chest pain, palpitation, fatigue, and other cardiac manifestations. The first line therapy is ß-blockers with negative chronotropic and inotropic effects. Revascularization should be limited to patients with severe symptoms refractory to maximal medical care; the surgical options are supra-arterial myotomy and/or CABG. This case report is a 40 year-old male with chest pain caused by myocardial bridging, diagnosed after angiography.
Penyakit Graves pada Anak Perempuan Usia 10 Tahun
Authors: Ning Purwani Ni Putu Ayu Elistya , Sucipta Anak Agung Made
Published: March 2023

Penyakit Graves (PG) adalah penyakit autoimun akibat pembentukan antibodi TSH receptor-stimulating immunoglobulin (TSI) yang menyebabkan produksi hormon tiroid meningkat. Seorang anak perempuan, usia 10 tahun, dengan benjolan pada leher bagian kanan dan kiri depan yang baru disadari sejak 3 hari, tidak nyeri. Prestasi belajar seperti biasa. Tangannya bergetar ringan saat menulis. Penyakit Graves didiagnosis berdasarkan pemeriksaan fisik dan ultrasonografi tiroid, fungsi tiroid, dan pemeriksaan antibodi tiroid. Terapi dengan methimazole tablet 5 mg setiap 12 jam dan kontrol FT4 dan TSH setelah 1 bulan.

Graves’ disease is an autoimmune disease with formation of TSH receptor-stimulating immunoglobulin (TSI) antibodies resulting in increased thyroid hormone production. A 10 year-old girl with a painless lump in the right and left side of her anterior neck, noticed since 3 days ago. Learning achievement is still good. Her hands were slightly trembling while writing. Graves’ disease was diagnosed based on physical examination and thyroid ultrasound, thyroid function, and thyroid antibody tests. The treatment was methimazole 5 mg tablets every 12 hours and laboratory check for FT4 and TSH after 1 month.
Nutrisi Pasien Anak dengan Chronic Kidney Disease (CKD)
Authors: Panggabean Martinova Sari
Published: March 2023

Chronic kidney disease (CKD) atau penyakit ginjal kronik adalah kerusakan ginjal yang berlangsung selama tiga bulan atau lebih, ditandai dengan kelainan struktur ataupun fungsi ginjal, baik disertai maupun tanpa penurunan laju filtrasi glomerulus (glomerular filtration rate/GFR). Anak dengan CKD berisiko mengalami gangguan nutrisi. Prevalensi malnutrisi pada anak dengan CKD dilaporkan sekitar 20%-45%. Malnutrisi pada anak dengan CKD telah terbukti meningkatkan risiko morbiditas dan mortalitas. Selain berdampak gangguan pertumbuhan, malnutrisi pada anak dengan CKD dapat meningkatkan risiko infeksi, kelemahan, depresi, penyakit kardiovaskular, hospitalisasi, dan kematian. Oleh karena itu, pemberian nutrisi yang adekuat sangat penting pada anak dengan CKD. Intervensi pemberian nutrisi dini diperlukan untuk mendukung tumbuh kejar dan merupakan komponen kunci dalam mempertahankan pertumbuhan anak dengan CKD.

Chronic kidney disease (CKD) is defined as kidney damage lasting for at least 3 months, characterized by structural and functional abnormalities of the kidneys, either with or without a decrease in the glomerular filtration rate (GFR). Children with CKD are at risk for nutritional derangements. The prevalence of malnutrition among children with CKD was 20%-45%. Malnutrition in children with CKD is associated with significant morbidity and mortality. Besides risk of growth development, malnutrition in children with CKD can increase the risk of infection, frailty, depression, cardiovascular disease, hospitalization, and death. Adequate nutrition is pivotal in children with CKD. Early nutritional intervention is important to promote catch-up growth and is key components in the preservation of growth in children with CKD.
Aspek Klinis Dermatitis Seboroik
Authors: Dewi Nadia Puspa
Published: March 2023

Dermatitis seboroik adalah inflamasi kulit kronis berulang yang ditandai dengan patch dan plak eritematosa disertai skuama berminyak. Lesi bermanifestasi di area tubuh yang kaya akan kelenjar sebasea. Prevalensinya terutama pada usia bayi dan remaja atau dewasa muda. Patogenesis dermatitis seboroik multifaktorial, dipengaruhi oleh aktivitas kelenjar sebasea, kolonisasi Malassezia, komposisi lipid pada permukaan kulit, sistem imun, barrier kulit, dan faktor genetik. Tata laksana bertujuan untuk mengurangi keluhan dan lesi penyakit, dengan menggunakan agen topikal dan sistemik sesuai keparahan penyakit.

Seborrheic dermatitis is an chronic recurrent inflammatory skin disorder characterized by erythematous patches and plaques with oily scales. The lesions manifest in sebaceous gland-rich areas. Its prevalence is mostly in infants and adolescents or young adults. The pathogenesis of seborrheic dermatitis is multifactorial, influenced by sebaceous glands activity, Malassezia colonization, skin surface lipid composition, immune system, skin barrier, and genetic factors. Management aims to reduce symptoms and lesions, with topical and systemic agents according to disease severity.
Relapsing Nephrotic Syndrome Associated with COVID-19
Authors: Aras Jusli , Dwi Rahayu Andi Utari , Albar Husein
Published: March 2023

An 8-year and 2-month-old girl presented with generalized edema for two days with a mild cough and shortness of breath. She was diagnosed with a relapsing nephrotic syndrome (NS) and Community Acquired Pneumonia due to a COVID-19 infection. The patient was discharged with complete remission NS and repeated negative PCR for SARS-CoV-2 from nasopharyngeal swabs. It is important to consider COVID-19 infection as a likely trigger of relapsing NS in children.

Seorang anak perempuan usia 8 tahun 2 bulan masuk rumah sakit dengan keluhan edema anasarka selama 2 hari disertai batuk ringan dan sulit bernapas. Diagnosis adalah sindrom nefrotik relaps, pneumonia COVID-19, dan malnutrisi. Pasien dipulangkan setelah sindrom nefrotik remisi dan hasil PCR SARS-CoV-2 negatif. Infeksi COVID-19 penting dipertimbangkan sebagai pencetus relaps sindrom nefrotik.
Granuloma Piogenik Konjungtiva: Komplikasi Pasca-Bedah Eksisi Pterigium
Authors: Satwika Anak Agung Putri , Made Juliari I Gusti Ayu
Published: March 2023

Granuloma piogenik konjungtiva merupakan tumor vaskular jinak setelah episode peradangan seperti pasca-bedah eksisi pterigium. Kondisi ini diduga akibat penyembuhan luka yang tidak sempurna. Kasus: Laki-laki, usia 44 tahun, mengeluh rasa mengganjal pada mata kiri disertai merah sejak 1 minggu. Pasien memiliki riwayat eksisi pterigium 1 bulan sebelumnya. Pada segmen anterior ditemukan massa granuloma pada konjungtiva bulbi dekat limbus bagian temporal. Terapi awal diberikan corticosteroid topikal dan bedah eksisi sebagai pilihan terapi lanjut.

Conjunctival pyogenic granuloma is a benign vascular tumor after inflammation, such as post pterygium excision. This condition is thought due to incomplete wound healing. Case: Male, 44 year-old feels a lump in his left eye accompanied by redness since 1 week. He had a history of pterygium excision 1 month before. A granulomatous mass was found on the conjunctiva bulbi near the temporal limbus. Therapy consists of topical corticosteroids as initial therapy and surgical excision as further treatment option.
Reproductive Health Care for HIV+ Young Women: What Should We Do?
Authors: Surya Raymond , Tantry Harry Prawiro , Ocviyanti Dwiana
Published: March 2023

Introduction: This article discusses reproductive health for a young woman with positive HIV during postnatal care. Discussion: In HIV-positive patients, ART treatment protocols may vary. Hormonal contraception in combined oral contraception (COC), progestin-only pill, depo-medroxyprogesterone acetate (DMPA), and implant are considered safe. An intrauterine device (IUD) is also safe for positive HIV women. Cervical cancer screening with Pap smear is performed at the initial diagnosis of HIV in patients less than 30 years of age. Summary: Antiretroviral therapy should be initiated early. HIV patients can safely use either hormonal contraception or an IUD. Cervical cancer screening should be performed at the initial diagnosis of HIV.

Pendahuluan: Artikel ini mendiskusikan kesehatan reproduksi wanita muda HIV positif selama perawatan pasca-melahirkan. Diskusi: Pada pasien positif HIV, protokol terapi antiretrovirus cukup bervariasi. Kontrasepsi hormonal dalam bentuk pil oral kombinasi (POK), pil berbasis progestin, depo-medroxyprogesterone acetate (DMPA), dan implan aman untuk pasien HIV positif. Alat kontrasepsi dalam rahim (AKDR) juga aman untuk perempuan HIV positif. Skrining kanker serviks dengan Pap smear sebaiknya dilakukan saat awal terdiagnosis HIV pada pasien usia <30 tahun. Simpulan: Terapi antiretrovirus sebaiknya dimulai sedini mungkin. Pasien HIV aman menggunakan kontrasepsi hormonal maupun AKDR. Skrining kanker serviks sebaiknya dilakukan saat awal terdiagnosis HIV.
Pemeriksaan Adenosine Deaminase (ADA) sebagai Alternatif Diagnosis TB pada Anak
Authors: Tarigan Lupita Yessica , Iskandar Deddy
Published: March 2023

Pendahuluan. Diagnosis tuberkulosis (TB) pada anak merupakan masalah tersendiri karena manifestasi klinis yang beragam dan tidak tersedianya standar baku penegakan diagnosis. Kasus. Anak perempuan usia 6 tahun, dengan klinis demam, batuk, dan sesak napas. Pada pemeriksaan fisik didapatkan penurunan suara napas di rongga dada kanan. Hasil pemeriksaan radiologi didukung ultrasonografi tampak gambaran efusi pleura kanan yang sebagian sudah terorganisasi. Hasil uji laboratorium didapatkan leukositosis dan hasil tes IGRA negatif. Analisis cairan pleura menunjukkan peningkatan kadar adenosine deaminase. Pengobatan TB menghasilkan perbaikan klinis dan radiologi bermakna. Simpulan. Pemeriksaan adenosine deaminase dapat dipertimbangkan untuk alternatif diagnosis TB pada anak.

Diagnosis of tuberculosis (TB) in children is still problematic because of various clinical manifestations and the unavailability of diagnostic standard. Case. A 6-year old girl with fever, cough, and shortness of breath. On physical examination, there was a decreased breath sounds in the right chest. Radiology examination showed a partially organized right pleural effusion, supported with ultrasound finding. Lab test found leucocytosis and IGRA test was negative. Pleural fluid analysis showed increased adenosine deaminase level. TB treatment resulted in significant clinical and radiological improvement. Conclusion. Adenosine deaminase test can be considered as an alternative to TB diagnosis in children.
Herpes Zoster Oftalmika dengan Komplikasi Uveitis Anterior
Authors: Chrisdianudya Theresia Dita , Nikita Hyasinta Arlette , Setyawan Nernere Marselino Galuh
Published: March 2023

Herpes zoster adalah penyakit infeksi akibat reaktivasi virus varisela zoster laten. Terdapat 8%-56% kasus herpes zoster oftalmika dan pada sekitar 50%-72% pasien zoster periokular akan terjadi gangguan mata dan kehilangan visual derajat sedang sampai berat. Kasus. Laki-laki usia 16 tahun dengan lenting-lenting di sekitar dahi, kelopak mata, mata, dan hidung sisi kanan disertai mata kanan nyeri, memerah, berkabut, penurunan tajam penglihatan, dan kotoran mata putih kekuningan yang lengket sejak kurang lebih satu minggu. Hutchinson sign positif. Pasien memiliki riwayat cacar air, tetapi tidak memiliki komorbid. Diagnosis herpes zoster oftalmika okuli dekstra dengan uveitis anterior. Tata laksana dengan paracetamol oral 3 x 500 mg, acyclovir oral 5 x 800 mg, amoxicillin oral 3x500 mg, methylprednisolone 2x8 mg, salep mata acyclovir 5 kali sehari, salep kulit acyclovir 5 kali sehari. Simpulan. Pada pasien herpes zoster oftalmika dengan penurunan tajam penglihatan perlu diwaspadai komplikasi uveitis anterior; terapi kortikosteroid dapat berhasil lebih baik.

Herpes Zoster is caused by reactivation of latent varicella zoster virus. Approximately 8%-56% from herpes zoster cases were reported with ophthalmic signs, and 50%- 72% cases show moderate to severe visual loss. Case. Male, 16 y.o., with multiple vesicles surrounding right eye area, forehead, nose, with pain, redness, haziness, visual disturbance, and purulent secretion in the right eye since a week ago. Hutchinson sign was positive. Patient had a history of chicken pox without other comorbidities. Diagnosis was herpes zoster ophthalmica oculi dextra with anterior uveitis. Management consist of oral paracetamol 3 x 500 mg, acyclovir 5 x 800 mg, amoxicillin 3 x 500 mg, methylprednisolon 2 x 8 mg, acyclovir eye ointment 5 times a day, acyclovir skin ointment 5 times a day. Conclusion. Herpes zoster ophthalmica with decreased visual function should be monitored for complications like uveitis anterior and managed with corticosteroid for a better outcome.
Efektivitas Suplementasi Vitamin D Oral sebagai Terapi Adjuvan Ulkus Kaki Diabetikum
Authors: Soetedjo Ariel Valentino , Cahyadirga Johan , Kusuma Ko Abel Ardana , Lusiani
Published: March 2023

Ulkus kaki diabetikum (UKD), salah satu komplikasi terberat dari diabetes melitus (DM) dengan angka amputasi dan mortalitas tinggi. Penyembuhan luka tidak hanya mengandalkan perfusi jaringan, tetapi juga dari perspektif imunologi. Beberapa studi telah menunjukkan asosiasi vitamin D dan UKD serta peran vitamin D dalam menurunkan inflamasi. Studi ini bertujuan untuk menelaah bukti terkait efektivitas suplementasi vitamin D per oral dalam penyembuhan luka pasien UKD. Penelusuran literatur menggunakan 4 database: PubMed, Scopus, Cochrane, dan EBSCO Host. Dari 645 studi yang teridentifikasi pada awal penelusuran, 3 artikel dipilih untuk telaah kritis. Studi Kamble menunjukkan pengurangan luas permukaan luka lebih signifikan di kelompok vitamin D (8,06±6,82 cm2; p=0,02) dibandingkan di kelompok kontrol (3,76±1,73 cm2; p=0,28). Studi Razzaghi menunjukkan hasil signifikan terkait pengurangan panjang luka (−2,1±1,1 vs −1,1±1,1 cm; p=0,001), lebar luka (−2,0±1,2 vs −1,1±1,0 cm, p=0,02), kedalaman luka (−1,0±0,5 vs −0,5±0,5 cm; p<0,001), dan persentase eritema (100% vs 80%; p=0,01). Studi Rahman menunjukkan persentase penurunan luas luka yang lebih signifikan di kelompok vitamin D dibandingkan di kelompok kontrol (71,86±4,79% vs 32,06±4,28%; p<0,01). Suplementasi vitamin D per oral dapat membantu penyembuhan UKD.

Diabetic foot ulcer (DFU) is one of the most devastating complications of diabetes mellitus, associated with high amputation rate and mortality. Previous studies have shown association between vitamin D and DFU, also the promising role of vitamin D in reducing inflammation. This study aims to appraise the current evidence regarding effectiveness of oral vitamin D supplementation on wound healing in DFU. Literature search was carried out using 4 databases: PubMed, Scopus, Cochrane, and EBSCOHost. From 645 studies identified at the start of the search, 3 articles were selected for critical appraisal. The study by Kamble shows significant wound surface area reduction in vitamin D group (8.06±6.82 cm2; p = 0.02) compared to the control group (3.76±1.73 cm2; p=0.28). The study by Razzaghi shows significant results regarding reduction in ulcer length (−2.1±1.1 vs −1.1±1.1 cm; p = 0.001), width (−2.0±1.2 vs −1.1±1.0 cm; p = 0.02), depth (−1.0±0.5 vs −0.5±0.5 cm; p < 0.001), and erythema rate (100% vs 80%; p = 0.01). The study by Rahman shows significant percentage of ulcer area reduction between vitamin D group and control group (71.86±4.79% vs 32.06±4.28%; p<0.01). Oral vitamin D supplementation can be used to aid wound healing in DFU.