bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroproteksi Otak Janin pada Persalinan Preterm dan Pertumbuhan Janin Terhambat
Authors: Bachnas Adrianes
Published: September 2022

Exalted obstetrics not merely fulfill the obligation to deliver babies safely but beyond, to deliver babies on their most optimal condition to grow up and to be a noble person. Neuroprotection should be implemented in daily practice. Brain, as the central part of the human body, plays an extremely important role for all of the human cells, tissue, organs, and systems activities. Any kind of physiological process in human body is related to brain control. There would be no human in optimal condition without optimal brain function. Preterm delivery and fetal growth restriction are two of the many pathologic conditions in pregnancy that could potentially injure fetal brain. Injured brain would result in major lifelong neurological deficits. There isn’t any cure for these, so prediction and prevention are barely necessary. Neuroprotection is a concept which all efforts are given to minimize the insult to the fetal brain due to such pathologic problems as mentioned before. Preterm birth, either spontaneously or iatrogenic, puts the risk for fetus to get brain damage. Hypoxic situations in the early minutes after birth lead to inflammation and apoptosis process, causing neuronal injury, neuronal death, and demyelination. Antenatal magnesium sulfate administration has found to give significant aid to hinder this condition and in the end showing a substantial reduction in the number of cerebral palsy cases. Fetal growth restriction remains an unsolved dilemma in maternal-fetal medicine. It is mostly related with placental insufficiency that causes chronic hypoxia and nutrition deprivation. Low dose aspirin in the first trimester soon as the poor placentation is known to be happen remains the solid evidence exists. Nutritional intervention such as a balanced intake of protein and calory, also micronutrients supplementation are somehow still worthy enough to accompany the timely decision of terminating pregnancy.
Lymphedema Diagnosis dan Terapi
Authors: Primasari Medisa
Published: September 2022

Lymphedema merupakan kondisi akibat gangguan transportasi aliran limfa yang menyebabkan terjadinya akumulasi cairan limfatik di ruang interstitial. Gangguan transportasi aliran limfa dapat disebabkan oleh kelainan kongenital ataupun yang didapat, seperti akibat trauma, infeksi, keganasan, dan pascatrombosis vena. Tindakan yang dapat dilakukan untuk mencegah komplikasi dan progresi penyakit berupa terapi non-operatif dan terapi operatif. Terapi konservatif yang dilakukan berupa edukasi perawatan kulit, manual lymphatic drainage (MLD), kompresi dengan short-stretch bandage, serta latihan ringan. Adapun terapi pembedahan dilakukan pada kondisi berat dan mengalami gangguan fungsional yang tidak membaik dengan terapi non-operatif. Pada lymphedema derajat awal, terapi yang dapat dilakukan adalah metode fisiologis seperti lympholymphatic bypass, lymphovenous bypass serta transfer kelenjar limfa; sedangkan pada lymphedema berat dengan jumlah jaringan fibroadiposa yang tinggi, digunakan metode reduksi yang terdiri dari eksisi langsung atau liposuction.
Congenital Analbuminemia
Authors: Santosa Putu Adi , Widijanti Anik , Susianti Hani , Intanwati Sherly , Meilani Rossy
Published: September 2022

Congenital analbuminemia (CAA) is a rare autosomal recessive disorder, characterized by the absence or very low level of serum albumin (human serum albumin/HSA) as a result of defect on chromosome 4 which encodes albumin. It is defined as albumin level <1 g/l with normal liver function and the absence of protein loss.1,2 Estimated CAA prevalence is less than 1 in 1 million.A 10-year-old boy suffered from generalized edema that got worsened since last month. The patient had been misdiagnosed with nephrotic syndrome 2 years earlier, and then became protein-losing enteropathy. Neither cough nor diarrhea were reported. The patient had history of food allergy. Physical examination showed moderately ill condition, Glasgow Coma Scale (GCS) score E4 V5 M6, blood pressure 90/50 mmHg, pulse 120 x/min, respiratory rate 30x/min, palpebral edema, shifting dullness, undulation (+), with nonpitting edema on the extremities. Laboratory findings: leukocytosis (neutrophilia), peripheral blood smear showed hypochromic microcytic anisositosis erythrocyte. AAT serum 246 mg/dl, GGT serum: 88 U/l, iron serum 28 µg/dl, TIBC 411 µg/dl, transferrin saturation 7%, total IgE 775,90 U/ml. Serum Protein Electrophoresis (SPE) results were hypoalbuminemia (1,4 g/dl), hypogammaglobulinemia (0,21 g/dl), and total protein 2,91 g/dl. Chest X-ray showed pneumonia with minimal right pleural effusion. Overestimation of serum albumin level was caused by alpha and beta globulin that were detected as albumin in bromocresol green (BCG) methods. CAA aggravated with by allergy caused malnutrition in this patient.
These data support the diagnosis of CAA with sepsis and iron deficiency anemia. Suggestion for the management consist of blood culture, procalcitonin level measurement, inguinal lymph node biopsy, DNA sequence analysis, also analysis of pleural and ascites fluid.
Patofisiologi dan Manajemen Terapi Sindrom Stevens-Johnson(SSJ) dan Nekrolisis Epidermal Toksik (NET)
Authors: Diana Rina , Eko Irawanto Muhammad
Published: September 2022

Nekrolisis epidermis (NE) adalah sindrom reaksi mukokutan akut yang ditandai dengan nekrosis dan pengelupasan epidermis yang luas serta dapat menyebabkan kematian. Lesi awal berupa makula eritematosa, kemudian berkembang secara progresif menjadi lesi lepuh kendur dan selanjutnya terjadi pengelupasan epidermis. Berdasarkan luas permukaan tubuh yang terlibat, NE diklasifikasikan menjadi tiga kategori, yaitu sindrom Stevens-Johnson (SSJ) jika luas lesi <10%, overlap SSJ-nekrolisis epidermal toksik (SSJ-NET) jika luas lesi 10–30%, dan nekrolisis epidermal toksik (NET) jika luas lesi >30%. Patofisiologi NE belum diketahui dengan jelas hingga saat ini. Sindrom Stevens-Johnson (SSJ) dan nekrolisis epidermal toksik (NET) merupakan kondisi yang dapat menyebabkan kematian, oleh karena itu memerlukan penanganan yang cepat dan tepat. Mengidentifikasi kemungkinan penyebab dan memberikan perawatan yang diperlukan di rumah sakit diharapkan mampu meminimalisasi kejadian fatal akibat kondisi ini. Penanganan utama pada SSJ-NET adalah dengan menghentikan penggunaan substansi yang dicurigai sebagai penyebab. Terapi lain yang dapat diberikan masih cukup kontroversial, seperti pemberian corticosteroid, IVIG, plasmapheeresis, dan ciclosporin.
Acute Mesentric Venous Thrombosis with a History Recurrent DVT in Young Age : A Case Report
Authors: Z. A. Haldis  , B. A. Kuncoro
Published: September 2022

Acute mesenteric ischemia (AMI) may be defined as a sudden interruption of the blood supply to a segment of the small intestine, leading to ischemia, cellular damage, intestinal necrosis, and eventually patient death if left untreated. Mesenteric venous thrombosis (MVT) is an emergency condition that is rarely found as a cause of AMI compared to arterial thrombosis, and accounts for only 16% of all mesenteric ischemia cases. The overall incidence is low (0.09-0.2% of all acute admissions to emergency department), prompt diagnostic and intervention are essential in order to reduce the high mortality rate (50-80%).
Pubertas Prekoks Perifer Isoseksual akibat Juvenille Granulosa Cell Tumor
Authors: Santosa Putu Adi , Widijanti Anik , Susianti Hani , Engli Katherina Alfa
Published: September 2022

A 16-month-old girl with peripheral isosexual precocious puberty due to juvenile granulosa cell tumor underwent unilateral salpingo-oophorectomy procedure to stop the symptoms of precocious puberty. The diagnosis was established based on the patient’s medical history, physical findings, laboratory and other examinations which demonstrated secondary sexual characteristics according to Tanner scale M3P2, presence of abdominal mass, elevated serum estradiol, and a histological finding of juvenile granulosa cell tumor. Karyotyping results was normal. Left salpingo-oophorectomy successfully reduced estradiol concentration and stop the menstruation, while the other secondary sexual characteristics is monthly assessed at the clinic.
Inflamasi dalam Patologi Penyaki Alzheimer
Authors: Jan S. Purba
Published: September 2022

The worldwide incidence of Alzheimer's disease (AD) in 2006 was estimated to be 26.6 million; and is expected to quadruple by 2050 because of the increasing life expectancy in many countries. The main cause of AD is generally attributed to increased production and accumulation of β-amyloid (Aβ), in association with neurofibrillary tangles (NFT) formation and synaptic degeneration. Increased levels of proinflammatory factors such as cytokines and chemokines, and the activation of complement cascade that occurs in the brains of AD patients contributes to local inflammatory response triggered by amyloid plaque. The same type of amyloid beta proteins which is the hallmark of Alzheimer's when found in the brain are also found in the lens and ocular fluid. These proteins produce an unusual type of cataract in a different part of the eye than common cataracts. Studies showed that after the release of Aβ, synaptic activity in the neurons is increased through a positive feedback loop, and disrupting this positive feedback loop might be the key for the prevention of the earliest signs of Alzheimer's. Epidemiological findings show reduced prevalence of AD upon long-term medication with nonsteroid antiinflammatory drugs (NSAID). On the other hand, neuronal-type nicotinic acetylcholine receptors (nAChRs), peroxisomal proliferator-activated receptors (PPARs) are involved in AD-induced neuroinflammation and in this regard, future therapy may focus on their specific targeting in the AD brain.
Tata Laksana Gastroesophageal Reflux Disease dalam Masa Pandemi Covid
Authors: Surya Haryanto
Published: September 2022

Gastroesophageal reflux disease (GERD) merupakan gejala atau komplikasi dari aliran balik isi lambung ke arah esofagus sampai ke rongga mulut, dan dapat juga mengiritasi saluran pernapasan. Tingkat keparahan dari GERD ditentukan oleh durasi paparan esofagus dan organ lainnya oleh asam lambung. Durasi paparan tersebut dipengaruhi oleh kemampuan pengosongan esofagus. Proton pump inhibitor (PPI) masih dianggap sebagai terapi empiris yang superior dibandingkan terapi lain untuk mengatasi gejala GERD. Terdapat beberapa isu terkait penggunaan PPI yang menyebabkan kekhawatiran dalam pemberian terapi PPI di masa pandemi Covid-19, seperti yang menyatakan bahwa penggunaan PPI berisiko meningkatkan keparahan pneumonia, berpotensi menyebabkan terjadinya secondary infection, hingga terjadinya ARDS. Sejauh terapi dengan PPI telah dinilai dengan saksama melalui penilaian risiko yang menyeluruh, penggunaan PPI selama masa pandemi Covid-19 dapat dilakukan pada indikasi yang sesuai menggunakan dosis efektif terendah untuk mencapai kontrol pH lambung dan kualitas hidup yang baik pada penderita GERD.
Pengaruh Astaxantine Oral terhadap Kadar Serum Tumor Necrosis Factor Alpha pada Pasien Akne Vulgaris-lores
Authors: Reti Anggraeni  , Niluh Widjayanti  , Harijono Kariosentono  , Indah Julianto  , Endra Yustin  , Muhammad Eko Irawanto  , Prasetyadi Mawardi
Published: September 2022

Background: Acne vulgaris (AV) is chronic inflammatory disease affecting the pilosebaceous unit manifested as closed and open comedones, papules, pustules, and nodules. Treatment of AV generally involves more than one drug due to multifactorial pathogenesis. Objective: This study aims to determine the efficacy of 4 mg oral astaxanthin as an adjuvant AV therapy in decreasing serum level of inflammatory marker tumor necrosis factor alpha (TNF-α). Method: This is a double-blind randomized controlled trial. Subjects were 34 patients with mild and moderate AV (Global Acne Grading System/GAGS 1-30) that were treated with combination of tretinoin 0.025% and clindamycin phosphate 1.2%. Astaxanthin was added to the treatment group and lactulose as placebo was added to the control groups, given for 4 weeks. The pretest and posttest results in both groups were analyzed statistically using nonparametric test. Results: Decrease in TNF-α serum levels occurred in both groups but significant difference compared to baseline were only found in treatment group (p=0.015). There was no significant difference in the reduction of TNF-α levels between both groups (p=0.459). Conclusion: Although the results did not show a significant difference overall, but in the treatment group, astaxanthin can significantly lower TNF-α serum levels compared to baseline.
Dislipidemia Aterogenik pada Pasien Diabetes Melitus Tipe 2: Patofisiologi dan Pilihan Terapi
Authors: Rosandi Rulli
Published: September 2022

Atherogenic dyslipidemia is characterized by increase in triglyceride and small dense lipoprotein (sdLDL) level and decrease in high-density lipoprotein (HDL) level. This condition is accompanied by increased TG-rich very-low-density lipoprotein, apolipoprotein B, and oxidized low-density lipoprotein (oxLDL). This lipid profile plays an important role in the pathogenesis of cardiovascular disorders such as coronary heart disease, peripheral artery disease, and stroke. Diabetes mellitus is an independent risk factor for premature atherosclerosis. High- and moderate-intensity statins are recommended therapeutic options in the management of this disorder. Currently, there are also some therapeutic options other than statin to accompany statin therapy. Ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor are mentioned a lot in current lipid management guidelines in addition to nonpharmacologic approach such as diet and physical exercise.
Faktor Risiko Disabilitas Berat pada Anak dengan Guillain-Barré Syndrome di RSUD Dr. Soetomo Surabaya
Authors: Ratih Dwi Andini  , Darto Saharso  , Prastiya Indra Gunawan
Published: September 2022

Latar Belakang: Guillain-Barré Syndrome (GBS) merupakan penyebab paralisis neuromuskular akut yang paling sering ditemukan. Prognosis anak-anak dengan GBS pada umumnya tergolong baik, namun terdapat kemungkinan prognosis buruk yang membutuhkan ventilasi mekanis dan mengakibatkan terjadinya defisit neurologis. Penelitian ini bertujuan untuk mengamati faktor risiko disabilitas yang berpengaruh pada anak dengan GBS di RSUD Dr. Soetomo Surabaya. Metode: Penelitian ini menggunakan desain cross-sectional yang dilakukan pada anak dengan GBS, menggunakan data yang diperoleh dari rekam medis. Outcome pasien selama perawatan pada penelitian ini adalah sembuh, disabilitas, dan meninggal. Analisis statistik menggunakan uji Chi-Square dengan nilai signifikansi p<0,05. Hasil: Sebanyak 61 anak dengan GBS memenuhi kriteria inklusi selama masa studi penelitian. Anak laki-laki didapatkan sebanyak 54,1% dan infeksi saluran pernafasan atas merupakan penyebab paling sering (73,8% kasus). Mean usia pada penelitian ini adalah 8,4(±3,79) tahun. Sebagian besar jenis GBS adalah acute inflammatory demyelinating polyradiculoneuropathy (AIDP) yakni sebanyak 89,1% kasus. Hasil analisis menunjukan bahwa pasien GBS yang mengalami gagal napas dengan penggunaan ventilasi mekanis, menunjukkan odds ratio terjadinya disabilitas berat sebesar 8,9(1/0,112) kali lebih besar dibandingkan pasien yang tidak menggunakan ventilasi mekanis. Kesimpulan: Penggunaan ventilasi mekanis merupakan faktor risiko terjadinya disabilitas berat pada anak dengan GBS.
Hyperglycemia in Childhood Acute Lymphoblastic Leukemia During Induction Chemotherapy
Authors: Nengcy Erlina Tasik Rerung  , Cahyadi Andi , Nur Rochmah  , Maria Christina Shanty Larasati  , Andarsini Mia Ratwita , Muhammad Faizi  , IDG Ugrasena  , Bambang Permono
Published: September 2022

Introduction: Hyperglycemia is a well-known adverse effect of the corticosteroids and asparaginase given during induction chemotherapy for pediatric acute lymphoblastic leukemia (ALL). ALL is a type of hematologic malignancy with high incidence in the childhood. The aim of this study is to investigate the impact of hyperglycemia during induction chemotherapy in childhood ALL.
Methods: This prospective study was done in Dr. Soetomo hospital from January to April 2018. The subject was newly diagnosed as ALL under the age of 18 years, treated with Indonesian childhood ALL 2013 protocol (standard risk (SR) group and high risk (HR) group). Hyperglycemia was defined as at least two separate random plasma glucose levels >200 mg/dL, which was evaluated before and during induction chemotherapy. Statistical analysis using Paired T-test for parametric and Wilcoxon test for nonparametric.
Results: Thirty-three children were enrolled, 18/33 boys with mean age 5.8 (SD 3.78) years, compromised as ALL-L1 30/33. They were treated with ALL-HR 19/33 and ALL-SR 14/33. In overall groups, the mean random blood glucose level significantly increased from 108 (SD 21.3) mg/dl to 147 (SD 48.1) mg/dl, (mean difference 38.67 mg/dl; 95% CI 18.08 to 59.26 mg/dl, p=0.008). In SR group, there was a significant increase of mean random blood glucose level from 102 (SD 13.5) mg/dl to 133 (SD 37.3) mg/dl, (mean difference 31.8 mg/dl; 95% CI 8.78 to 54.8 mg/dl; p=0.01). In HR group, the mean random blood glucose level increased from 113 (SD 51.9) mg/dl to 165 (SD 25.4) mg/dl, (mean difference 51.9 mg/dl; 95% CI 18.6 to 85.2 mg/dl, p=0.004).
Conclusion: Blood glucose level is significantly increase during induction chemotherapy in both SR and HR Indonesian childhood ALL 2013 protocol.
Terapi Doxycycline pada Laki-laki Homoseksual dengan Sifilis Sekunder dan Infeksi Human Immunodeficiency Virus
Authors: Anggana Rafika Paramitasari  , Imroatul Ulya  , Agung Triana Hartati  , Susanti Rosmala Dewi  , Prasetyadi Mawardi
Published: September 2022

Background: Re-emergence of syphilis is increasing especially among MSM (men who have sex with men) patients. Syphilis in HIV-infected patients is reported to show faster and higher risk for progression to neurosyphilis. Co-infection of syphilis and human immunodeficiency virus (HIV) is correlated with decrease in CD4 and increase in HIV-RNA. Doxycycline has an antiinflammatory effect associated with decrease of HIV-RNA and increase of CD4 in HIV patients. Case: A 20 years old foreigner MSM man complained about non-itchy red spots throughout his body for 2 days with slight fever. He has a history of more than 10 sexual partners and rarely use condom. Physical examination revealed various sizes of erythematous macules and papules on his trunk and extremities. We found erythematous plaques with regular border but no ulcer on his scrotum and no secrete from his urethra. There was enlargement in the inguinal lymph node. VDRL and TPHA examinations were 1:32 and 1:640, respectively. HIV test was reactive with CD4 value 558 cells/ml. Treatment consists of doxycycline 2x100 mg for 14 days and also ARV (nevirapine, lamivudine and zidovudine). His symptoms were improved after a month accompanied with decreased VDRL to 1:2 and slightly increased CD4 to 570 cells/ml. Discussion: Doxycycline is a second line treatment for syphilis that is known to help decreasing the viral load and increasing CD4 level in syphilis with HIV. A significant decrease in VDRL titer in this patient indicates a successful therapy.
Anestesi Spinal Levobupivacaine Isobarik pada Sectio Caesarea
Authors: Nasman Puar
Published: September 2022

Sectio caesarea (SC) atau operasi sesar merupakan metode persalinan di mana janin dilahirkan melalui insisi pada dinding rahim. Menurut WHO, jumlah tindakan sectio caesarea pada tahun 2011 dilaporkan mengalami peningkatan 5 kali dibandingkan dengan tahun-tahun sebelumnya. Penggunaan teknik anestesi yang aman dan efektif pada tindakan sectio caesarea membutuhkan pemahaman yang menyeluruh mengenai perubahan fisiologi yang terjadi pada kehamilan, proses melahirkan, dan kelahiran bayi. Salah satu agen anestesi lokal yang sering digunakan untuk anestesi spinal adalah bupivacaine. Bupivacaine adalah obat anestesi lokal jenis amida yang memiliki masa kerja panjang dan mula kerja yang pendek. Bupivacaine merupakan campuran rasemat dari isomer optik levobupivacaine dan dextrobupivacaine dengan perbandingan yang sama, yang dikenal juga sebagai enantiomer S(-) dan R(+). Levobupivacaine adalah enantiomer S(-) murni dari bupivacaine dengan profil toksisitas yang lebih minimal terhadap sistem saraf dan kardiovaskular. Penelitian menunjukkan bahwa penggunaan levobupivacaine isobarik pada pasien yang menjalani tindakan sectio caesarea menghasilkan efek yang sebanding dengan bupivacaine hiperbarik dengan profil keamanan yang lebih baik.
Breast Lumpectomy Surgery by Pectoral Nerve Block (Pecs Block) Without General Anesthesia – A Case Report
Authors: Ida Bagus Reza Nanda Iswara  , Wayan Widana
Published: September 2022

Breast conserving surgery is usually performed under general anesthesia, or more recently combined with regional anesthesia techniques. Thoracic spinal block, thoracic epidural block, and thoracic paravertebral block are options of regional anesthesia that have been used in breast surgery, but anesthesiologists avoid them due to concern in potency of complications and side effects. After introduced by Blanco in 2011, pectoral nerves (Pecs) block appears as alternative procedure with fewer complications and lower incident of postoperative pain.
In this case report we describe a 32-year-old female patient admitted for elective lumpectomy of the left upper quadrant of the breast. Ultrasound guided Pecs II block was chosen as the anesthetic technique for this patient.
The authors reported succesful management of anesthesia and pain without complications in breast surgery. Pecs II block as single anesthetic technique can be considered safe, advantageous, and effective in breast surgery with good hemodinamic stability and few side effects.
Strategi Penatalaksaan Rinitis Alergi untuk Mengoptimalkan Kualitas Hidup Pasien
Authors: Teti Madiadipoera
Published: September 2022

Rinitis alergi merupakan kondisi inflamasi pada mukosa hidung yang terjadi setelah paparan alergen dan diperantarai oleh immunoglobulin E (IgE). Rinitis alergi tidak hanya ditemukan oleh para spesialis THT, namun juga banyak ditemukan oleh dokter umum. Gejala umum dari rinitis alergi antara lain hidung tersumbat, rinore, hidung gatal, dan/atau bersin. Adanya dua atau lebih gejala nasal selama lebih dari satu jam per hari dapat digolongkan sebagai suspek rinitis alergi. Diagnosis rinitis alergi dapat dilakukan berdasarkan anamnesis riwayat alergi, penilaian derajat keparahan penyakit menggunakan visual analog scale (VAS) sesuai dengan ARIA guidelines, endoskopi nasal, dan skin prick test (SPT). Tata laksana rinitis alergi terjadi dari menghindari paparan alergen, edukasi pasien, penggunaan irigasi nasal dan beberapa golongan agen farmakologi seperti antihistamine, cromolyn, decongestant, intranasal corticosteroid, allergen-specific immunotherapy, dan reduksi konka. Antihistamine oral merupakan agen farmakologis pilihan yang berperan penting dalam pengobatan rinitis alergi pada semua derajat keparahan. Beberapa waktu terakhir telah tersedia antihistamine generasi kedua yang dilaporkan menunjukkan efektivitas dan keamanan pada pengobatan rinitis alergi, yaitu levocetirizine (efektivitas tinggi), rupatadine (dual antihistamine dengan efek anti-PAF), dan desloratadine (profil keamanan sangat baik). Studi-studi terbaru juga menunjukkan bahwa penggunaan antagonis reseptor leukotriene seperti montelukast terbukti efektif menurunkan gejala nasal keseluruhan termasuk hidung tersumbat.
Korelasi Kadar Serum Nitric Oxide (NO) dengan Tipe dan Derajat Keparahan Psoriasis
Authors: Fiska Rosita  , Bobby Febrianto  , Ambar Aliwardani  , Putti Fatiharani  , Wibisono Nugraha  , Muhammad Eko Irawanto  , Nurrachmat Mulianto
Published: September 2022

Psoriasis is a chronic, immune-mediated disorder that results from a polygenic predisposition. Nitric oxide (NO) has been considered as important factors in the pathogenesis of psoriasis. This study aims to determine the correlation of serum NO levels with the type and severity of psoriasis. This cross-sectional study was conducted from May to September 2018. Difference in the average of serum NO levels in psoriasis patients with control groups is analyzed using t-test. The Spearman correlation test was used to see the correlation of serum NO levels with type and severity of psoriasis measured by Psoriasis Area and Severity Index (PASI) score. There was significant difference between serum NO level in the control group compared to the group of psoriasis patients (p=0.037). Patient with generalized pustular psoriasis has the highest mean of NO level (59.07 µmol/L). There was no significant correlation between serum NO level with type (r=0.008, p=0.9710 and severity (r=0.157, p=0.486) of psoriasis. Nitric oxide levels are elevated in psoriasis patients, which indicate that oxidative stress plays an important role in the etiopathogenesis of psoriasis.
Analisis In Silico Potensi Minyak Kedelai (Glycine max) dalam Terapi Dermatitis Atopik
Authors: Primadhanty. R. S. Bhadra  , Mardiana  , Ahmad Fiqri  , Ummi Rinandari  , Didik H. Utomo  , Muhammad Eko Irawanto
Published: September 2022

Soybean oil contains various bioactive phytochemicals such as phenolic acids, flavonoids, isoflavones, saponins, phytosterols and sphingolipids which might give benefit in the treatment of atopic dermatitis (AD). This study aimed to evaluate the soybean oil compounds using computational in silico analysis for the treatment of atopic dermatitis. The active compounds of soybean oil were extracted from the KNApSAcK database. Results showed that soybean oil might possess some potential bioactivity such as immunosuppressant, antiinflammatory, improves skin barrier function, antieczema and histamine inhibitor. The highest potential bioactivity of soybean oil was as antiinflammatory, with an average value of probable to be active (Pa) 0.684; while the high potency active compound is alpha-tocopherol (Pa: 0.956).
Ulkus Marjolin yang Berkembang dari Ulkus Trofik Kronis pada Pasien Kusta
Authors: Adniana Nareswari  , Harijono Kariosentono  , Nugrohoaji Dharmawan  , Muhammad Eko Irawanto  , Nurrachmat Mulianto
Published: September 2022

Marjolin’s ulcer is a malignant complication of chronic ulcer. Changes in ulcer lesions to malignancy can be caused by chronic irritation, infection, decreased vascular variation, and increased expression of proto-oncogene. The most common histopathological form of Marjolin's ulcer is squamous cell carcinoma. A 55-year-old man, complaining of a protruding wound on his left hand that has not healed since three years ago. The patient was diagnosed with leprosy 30 years ago with a history of incomplete treatment. On physical examination, the left palmar region showed solitary ulcer, ±10x8x1.5 cm in size, nodular surface, reddish, hard consistency, with bulging and irregular edge. Slit-skin smear (SSS) examination with Ziehl-Neelsen staining found abundant acid-fast bacilli. Histopathological examination of the ulcer edge shows appearance of epithelial tumor, with differentiated epidermal cells invading the dermis, tumor cells arranged focally and concentrically with a mass of keratin appeared as horn pearl cells. Fite-Faraco staining found abundant M. leprae acid-fast bacilli. Based on the patient’s medical history and clinical examination, patient was diagnosed with Marjolin's ulcer in multibacillary (MB) leprosy. Patient was treated with MB multidrug therapy for 12 months and below-wrist amputation.
Studi Kasus Covid-19 Akibat Kerja
Authors: Anna Suraya  , Zulfikli Dharma  , Putri Tresnasari  , Putri Dwi Ginanti  , Fani Syafani
Published: September 2022

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) yang menjadi penyebab Coronavirus Disease 2019 (Covid-19) merupakan pajanan biologis di fasilitas kesehatan, di mana perawat, dokter, serta petugas medis maupun nonmedis lainnya menjadi kelompok pekerja yang rentan tertular Covid-19 saat bekerja. Studi kasus ini bertujuan untuk memberikan gambaran penerapan tujuh langkah diagnosis okupasi pada tiga kasus Covid-19 yang terjadi pada tenaga kesehatan. Kasus pertama adalah Covid-19 pada perawat ICCU yang terbukti mengalami kontak dengan pasien Covid-19 saat bertugas kurang dari 14 hari sebelumnya. Kasus kedua merupakan kasus Covid-19 pada dokter yang terjadi akibat penularan di rumah tangga, dan kasus ketiga adalah kasus Covid-19 pada dokter UGD yang merawat pasien Covid-19 beberapa hari sebelum munculnya gejala. Kasus ini merupakan kasus fatalitas yang mendapatkan kompensasi dari BPJS Ketenagakerjaan. Penegakkan diagnosis okupasi sangat penting karena dapat menjadi umpan balik atau evaluasi terhadap tindakan pencegahan yang sudah dilakukan di tempat kerja. Adanya penyakit akibat kerja (PAK) di kalangan pekerja merupakan sinyal diperlukannya peningkatan perlindungan bagi pekerja.
Granulomatosis Wegener dengan Antineutrophil Cytoplasmic Antibodies (ANCA) Negatif pada Laki-laki Usia 38 Tahun
Authors: Achmad Satya Negara  , Harijono Kariosentono  , Endra Yustin Elistasari
Published: September 2022

Background : Wegener’s granulomatosis or granulomatosis with polyangiitis is a systemic necrotizing vasculitis, which affects small- and medium-sized blood vessels. This disease is often associated with antineutrophil cytoplasmic antibodies (ANCA). Etiology of Wegener’s granulomatosis may originate from infectious, environmental, chemical, toxic or pharmacological triggers in people who are genetically predisposed to this autoimmune disease. The disease can present with nonspecific symptoms such as malaise, myalgia, arthralgia, anorexia, and weight loss. Skin manifestations of Wegener’s granulomatosis includes leukocytoclastic vasculitis, purpura, ulcer and subcutaneus nodul. It also known could affect different organs.
Case: A 38-year-old man came with a chief complaint of erythematous patches and stiffness on his face, body, arms and legs. The dermatological status showed a saddle nose and discrete multiple purpura on the superior and inferior extremities. ANCA examination result was negative. Histopathological examination of the epidermal layer showed dense proliferation of lymphocyte cells, perivascular infiltrates and a few neutrophil cells. In the dermis layer, there were granulomas consisting of many epitheloid histiocytes and foamy macrophages also damaged blood vessels with neutrophil infiltration on the walls and erythrocyte extravasation.
Discussion: Wegener’s granulomatosis is a rare autoimmune disease of localized granulomatous inflammation of the upper and lower respiratory tract and systemic vasculitis associated with ANCA. Symptoms that arise in Wegener’s granulomatosis are often mild at first, but may progress to a more severe clinical features. A negative ANCA examination cannot immediately rule out the diagnosis. Initial therapy for Wegener’s granulomatosis are cyclophosphamide and glucocorticoids for 3-6 months. Patient showed clinical improvement with the reduction of purpura throughout the body after five weeks treatment.
Faktor yang Berpengaruh Terhadap Kejadian Hipertensi pada Remaja di Indonesia
Authors: Nina Widyasari
Published: September 2022

Prevalensi penyakit tidak menular (PTM) semakin meningkat dalam beberapa tahun terakhir. Hipertensi merupakan salah satu penyakit tidak menular (PTM) yang menjadi masalah serius dan termasuk dalam sepuluh penyakit kronis dengan angka kejadian tertinggi di Amerika. Umumnya hipertensi terjadi pada orang dengan usia lanjut, namun data menunjukkan bahwa hipertensi juga dapat muncul sejak remaja. Sayangnya, remaja pada umumnya tidak menyadari bahwa mereka menderita hipertensi, sehingga berpeluang menjadi masalah serius di kemudian hari, serta dapat berlanjut hingga usia dewasa dan berdampak pada peningkatan risiko morbiditas dan mortalitas. Tujuan dari kajian literatur ini adalah menganalisis berbagai faktor yang memengaruhi kejadian hipertensi pada remaja di Indonesia. Artikel-artikel yang diperoleh melalui mesin pencari merupakan artikel penelitian cross-sectional dengan responden berusia antara 11–19 tahun dan area penelitian di Indonesia. Kriteria inklusi artikel yang dipilih adalah subjek remaja dengan hipertensi atau ancaman hipertensi. Hasil analisis menunjukkan bahwa terdapat beberapa faktor risiko yang berkaitan dengan kejadian hipertensi pada remaja di Indonesia, antara lain kualitas tidur, indeks massa tubuh terhadap usia (IMT/U), pola asupan gizi, merokok, aktifitas fisik, serta riwayat hipertensi dalam keluarga. Remaja dengan kualitas tidur buruk memiliki risiko hipertensi 4,1 kali lebih besar, IMT/U yang tinggi memiliki risiko hipertensi sebesar 4,85 kali, merokok memiliki potensi hipertensi di masa yang akan datang, sementara remaja dengan riwayat hipertensi dalam keluarga memiliki risiko hipertensi sebesar 3,9 kali. IMT/U merupakan faktor dominan terhadap risiko hipertensi pada remaja. Deteksi dini hipertensi pada remaja perlu diperhatikan guna mencegah risiko penyakit kardiovaskular yang tidak diinginkan.
Tata Laksana Terkini untuk Endometriosis
Authors: Binarwan Halim  , Timothy Adiwinata
Published: September 2022

Endometriosis is a benign gynecological disease that is often found among women in reproductive age with 10% of incidence. There are many theories regarding development of endometriosis, and to date the etiopathogenesis of this disease is still controversial. Understanding the various pathogenesis of endometriosis is important for the management of endometriosis. The current management of endometriosis is still focused on the main symptoms experienced by the patients, such as pain and infertility. A number of therapeutic approaches have been developed based on the pathogenesis of endometriosis, in terms of immunological, angiogenic, hormonal, genetic, local neurogenesis, and central sensitization aspects. However, the ideal and curative treatment for endometriosis has not been found.
Profil Pemphigus Vulgaris di Instalasi Rawat Inap RSUD Dr. Moewardi Surakarta Periode Januari 2014-Desember 2019
Authors: Eka Devinta Novi Diana  , Wibisono Nugraha  , Alfina Rahma  , Frieda  , Anindya Oktafiani  , Rieska Widyaswari  , Muhammad Eko Irawanto
Published: September 2022

Latar belakang: Pemphigus vulgaris adalah penyakit vesikobulosa autoimun yang mengancam jiwa, yang disebabkan oleh adanya akantolisis sel keratinosit akibat gangguan adhesi pada desmoglein 1 (Dsg1) dan desmoglein 3 (Dsg3). Gambaran klinis pada pemphigus vulgaris berupa lepuhan (bullae) kendur yang dapat mengenai seluruh bagian tubuh disertai keterlibatan mukosa. Penelitian ini bertujuan untuk mengetahui profil kasus pemphigus vulgaris di Instalasi Rawat Inap Rumah Sakit Dr. Moewardi Surakarta periode Januari 2014-Desember 2019. Metode: Penelitian dilakukan secara deskriptif retrospektif dengan melihat data rekam medis pasien pemphigus vulgaris di Instalasi Rawat Inap Rumah Sakit Dr. Moewardi Surakarta periode Januari 2014-Desember 2019. Hasil: Didapatkan 25 orang pasien pemphigus vulgaris dalam kurun waktu 6 tahun, dengan kelompok usia terbanyak adalah 51-60 tahun (36%) dan jenis kelamin terbanyak pada wanita (80%). Pemphigus vulgaris melibatkan mukokutan mulut pada 60% pasien dengan komorbiditas terbanyak adalah hiperglikemia (20%) dan kelainan laboratorium tersering adalah hipoalbuminemia (32%). Terapi yang diberikan pada 52% pasien berupa corticosteroid sistemik, sedangkan sisanya (48%) diberikan terapi kombinasi dengan immunosuppressant, antara lain mycophenolate mofetil (20%), cyclosporine (16%) dan azathioprine (12%). Kesimpulan: Pemphigus vulgaris sering dijumpai pada wanita rentang usia 51-60 tahun. Tata laksana kasus pemphigus vulgaris dilakukan dengan menggunakan terapi tunggal corticosteroid sistemik (52%) atau terapi kombinasi menggunakan agen immunosuppressant.
Familial Erythema Annulare Centrifugum pada Anak Berusia 9 Tahun
Authors: Achmad Satya Negara  , Endra Yustin Elistasari
Published: September 2022

Latar belakang: Erythema annulare centrifugum (EAC) merupakan penyakit kulit langka yang ditandai oleh papul merah muda erupsi yang meluas secara sentrifugal, membentuk plak anular atau polisiklik dengan central clearing, dengan lokasi predileksi pada ekstremitas inferior dan trunkus. Etiologi EAC masih belum diketahui secara pasti, namun diperkirakan berkaitan dengan riwayat konsumsi obat tertentu, infeksi, keganasan, atau stress. Diagnosis EAC ditegakkan berdasarkan manifestasi klinis dan pemeriksaan histopatologi. Secara histopatologi, EAC dapat dibedakan menjadi 2 bentuk, yaitu superfisial dan profunda. Tanda patognomonik dari histopatologi EAC berupa gambaran coat sleeve dan trailing scale. Tata laksana simtomatik EAC dapat dilakukan dengan pemberian corticosteroid topikal, analog vitamin D, dan antihistamine. Laporan kasus ini bertujuan untuk memberi gambaran penegakkan diagnosis EAC. Kasus: Seorang anak laki-laki berusia 9 tahun datang dengan keluhan bercak kemerahan di wajah dan badan. Pemeriksaan biopsi histopatologi menunjukkan gambaran hiperkeratosis dan spongiosis ringan pada lapisan epidermis serta infiltrat limfositik perivaskular pada lapisan dermis. Dari hasil pemeriksaan fisik dan histopatologi, pasien didiagnosis dengan erythema annulare centrifugum. Pasien diberikan terapi menggunakan antihistamine dan corticosteroid topikal. Diskusi: Erythema annulare centrifugum (EAC) merupakan kelainan kulit yang jarang dijumpai, di mana sebagian besar kasus bersifat idiopatik. Pemeriksaan biopsi histopatologi merupakan pemeriksaan yang dapat digunakan untuk membantu penegakkan diagnosis EAC. Pada kasus EAC idiopatik, pemberian terapi corticosteroid topikal maupun sistemik menjadi pilihan utama, namun terapi empiris menggunakan antibiotik atau antijamur topikal mungkin dapat dipertimbangkan.
Terapi Oral dan Tetes Mata Topikal pada Green Nail Syndrome
Authors: Putti Fatiharani Dewi  , Ambar Aliwardani  , Nugrohoaji Dharmawan
Published: September 2022

Latar belakang: Green nail syndrome merupakan salah satu kejadian kromonikia yang disebabkan oleh bakteri Pseudomonas aeruginosa, dan ditandai dengan onikolisis serta diskolorisasi berwarna hijau kehitaman. Belum terdapat laporan mengenai insiden green nail syndrome di Indonesia. Faktor predisposisi terjadinya green nail syndrome antara lain onikomikosis, aktivitas tinggi pada kondisi yang lembap, diabetes melitus, dan kondisi imunosupresi. Kasus: Seorang laki-laki berusia 51 tahun datang dengan keluhan utama bercak hitam kehijauan di area kuku jari tangan. Pemeriksaan dermatologi pada regio unguium digiti 1,3 dextra et unguium digiti 1 sinistra tampak patch hiperpigmentasi multipel disertai onikodistrofi. Pada pemeriksaan dermoskopi terlihat pigmentasi berwarna hijau kehitaman pada distolateral kuku. Dari biakan kultur bakteri dengan media agar MacConkey didapatkan koloni pigmen berwarna coklat kehijauan. Pasien diobati dengan ciprofloxacin 500 mg/hari serta pengobatan topikal dengan tetes mata polymyxin B 2 kali sehari selama 3 minggu dan menunjukkan perbaikan lesi. Diskusi: Diagnosis green nail syndrome dapat ditegakkan berdasarkan anamnesis, pemeriksaan fisik, serta kultur bakteri yang menunjukkan gambaran khas. Faktor predisposisi pada kasus ini adalah kebiasaan pasien dalam mencuci tangan hingga lebih dari sepuluh kali sehari. Terapi menggunakan tetes mata topikal membantu penyerapan bahan aktif ke dalam kuku.
Tata Laksana Herpes Zoster
Authors: Fatimah Fitriani  , Harijono Kariosentono  , Budi Eko Prasetyorini  , Putri Oktriana  , Nathania Amelinda
Published: September 2022

Herpes zoster (HZ) merupakan penyakit neurokutaneus yang disebabkan oleh reaktivasi dan multiplikasi varicella zoster virus (VZV) pada ganglion yang terinfeksi. Karakteristik klinis HZ berupa ruam unilateral dermatomal yang terasa nyeri. Ruam berupa vesikel berkelompok, makulopapular dengan dasar kemerahan terlokalisasi pada daerah persarafan ganglion. Herpes zoster menjadi penyakit yang umum terjadi dan berpotensi menyebabkan komplikasi serius yang memengaruhi kualitas hidup.
The Promising Therapeutic Effects of Nigella Sativa
Authors: Rimenda Sitepu  , Kirsten Putriani Hartman  , Yessy Adhi Utami
Published: September 2022

Medicinal plants can be potential source to improve general health and perhaps for the treatment of various diseases. However, despite the fact that herbal medicine has been used among various civilizations worldwide, scientific research regarding many herbal medicines was still limited. Nigella sativa (N. sativa), commonly known as fennel flower, black caraway, black cumin, jintan hitam, or kalonji, is a widely used medicinal plant that has been used for the treatment of various health problems. N. sativa contains some compounds that are potentially beneficial for health and wellness, particularly thymoquinone (TQ). Studies have shown some therapeutic benefits of N. sativa, however most them require further investigations to evaluate its efficacy and safety profile. This paper provides summary of available studies and reviews of N. sativa, including findings and limitations of the studies.
Tingkat Perbedaan Serum Nitric Oxide terhadap Derajat Keparahan dan Durasi Psoriasis
Authors: Ambar Aliwardani  , Bobby Febrianto  , Fiska Rosita  , Putti Fatiharani Dewi  , Muhammad Eko Irawanto
Published: September 2022

Psoriasis belongs to erythrosquamous dermatosis with uncertain etiology. Nitric oxide (NO) that acts as growth and differentiation regulator of keratinocytes is thought to play an important role in the pathogenesis of this disease. This study was aimed to determine the difference of nitric oxide serum level with the severity and duration of psoriasis patients. A cross-sectional study was conducted in 22 subjects with psoriasis vulgaris in the outpatient clinic of Dr. Moewardi Hospital Surakarta from May-September 2018 with 22 healthy individuals as control group. The severity of psoriasis was assessed using psoriasis area severity index (PASI), and serum NO is measured using Greiss method. Data then analysed using T-test and Kruskal Wallis tests (p<0.05). There was a significant difference in serum NO between the psoriasis patients and control group (p=0.020); there was no significant difference between serum NO patients and PASI score and duration of disease. It can be concluded that NO is an important factor in the inflammatory process in psoriasis, especially in active lesion.
Laporan Kasus Pyoderma Gangrenosum disertai Kandidiasis Kutis pada Wanita dengan Sindrom Metabolik
Authors: Ambar Aliwardani  , Fiska Rosita  , Putti Fatiharani  , Endra Yustin Ellistasari
Published: September 2022

Introduction: Pyoderma gangrenosum (PG) is a rare inflammatory disease characterized by sterile, predominantly neutrophilic infiltration of the skin and other organs. PG is found particularly in women aged between 40-60 years. Metabolic syndrome is reported to have a potential role to induce PG. Case: A 45-year-old woman came to Dr. Moewardi Hospital with chief complaints of ulcer in the chest and legs that was preceded by reddish fluid filled bump which then broke into painful wound. History of trauma, gastrointestinal, and joint pain was denied. Dermatological examination of anterior trunk region and inferior extremity showed erythematous patches with multiple ulcers with irregular border covered with hemorrhagic crusts and necrotic tissue. Pathergy test was negative. In the right and left axillary, inframammary and inguinal, there were hyperpigmented patches with scales and satellite lesions, KOH 10% examination obtained pseudohyphae and cell budding. The patient also has metabolic syndrome. Diagnosis of PG was made based on the presence of 2 major and 2 minor criteria. Patient was given intravenous methylprednisolone 93.75 mg/24 hours, analgesics, antibiotics, topical antifungals, debridement and breast reconstructive surgery after response to steroid therapy was seen. The patient was discharges from hospital with improvement. Discussion: Metabolic syndrome is considered to be a risk factor contributing to the development of systemic chronic inflammatory processes and has been described as one of the precipitating factors for PG and skin candidiasis. Management of metabolic syndrome as the known risk factor aims to minimize the recurrence of PG in the future.
Prosedur Pembedahan pada Hiperhidrosis Aksilaris dengan Teknik Tumesen Liposuction-Curettage
Authors: Danu Yuliarto  , Wibisono Nugraha  , Moerbono Mochtar  , Ammarilis Murastami
Published: September 2022

Hyperhidrosis is an excessive sweat production due to autonomic nerve dysfunction that occurs in areas with higher concentration of eccrine gland such as palms, soles of the feet, and axilla. Management of hyperhidrosis includes pharmacological and nonpharmacological approach. Patients with severe focal hyperhidrosis should consider surgical treatment or botulinum toxin injection. Tumescent liposuction with curettage is one of surgical technique option for the treatment of axillary hyperhidrosis. Case: A 32-year-old woman with complaint of excessive sweating, especially in the axillary area. The patient had received oral therapy from a dermatologist prior, but there was no improvement, so the patient was advised to undergo a surgical procedure. In this patient the tumescent liposuction-curettage procedure was performed. Discussion: Treatment of hyperhidrosis with both topical and systemic agents generally provides only temporary suppression of hyperhidrosis. In severe, disturbing cases, the treatment of choice for axillary hyperhidrosis is the surgical procedure. Combination of liposuction-curettage surgical method using tumescent anesthesia is relatively simple and safe. Reduction of apocrine gland secretion after liposuction-curettage takes a relatively long time. This surgical technique has many advantages, such as relatively minimal injury dan short recovery period. Follow-up after this combined liposuction-curettage procedure should be performed subjectively and objectively at 3, 6, and 12 months postoperative.
Pendekatan Diagnosis dan Tata Laksana Alopesia Androgenetik
Authors: Ardhiah Iswanda Putri  , M Yulianto Listiawan
Published: September 2022

Androgenetic alopecia (AGA) is the most common form of alopecia, and affects both men and women. It is described as a progressive reduction in hair diameter, length, and pigmentation. The early signs of AGA can begin in adolescence, where family history is the most predisposing factor. AGA interferes with physical appearance which is an important factor in human self-image. Patients suffering from AGA can experience a significant reduction in quality of life, so they tend to seek for effective hair loss treatments to prevent further thinning and stimulate optimal regrowth. Unfortunately, drugs that have been approved for the treatment of AGA are still limited, have some potential side effects, and do not always give satisfactory results. The limited efficacy of the therapeutic regimen, poor tolerance, and lack of information about the duration of treatment as well as possible side effects can affect adherence to medications, also lead to disappointment and early discontinuation of treatment. Therefore, comprehensive AGA management and proper education are essential to obtain optimal results in the management of AGA.