bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness comparison of atorvastatin vs. rosuvastatin in reducing CRP level in acute coronary syndrome: A systematic review and meta-analysis
Authors: Pratiwi I Gusti Ayu Inten Heny , Putra Anak Agung Gde Waisampayana
Published: December 2022

Background: Acute coronary syndrome (ACS) is a group of various clinical symptoms, including acute myocardial ischemia. When administered for coronary artery instability, one of the targets for statins is to reduce inflammation factor-like c-reactive protein (CRP). Increased levels of CRP are related to ischemic heart disease. Therefore, a meta-analysis was assessed to compare atorvastatin vs. rosuvastatin as the most effective for reducing CRP of a patient with acute coronary syndromeMethods: We searched PubMed and Cochrane databases until October 23th 2020. Search terms included acute coronary syndrome, C-reactive protein or CRP, rosuvastatin, atorvastatin, randomized, random, and randomization. We excluded study populations with acute kidney injury/dyslipidemia/metabolic syndrome. All analyses in our study were carried out using Review Manager version 5.3 (RevMan Cochrane, London, UK).Result: We have found four eligible studies (487 patients) were included. Funnel plots and p-Egger were inspected to assess publication bias. The pooled analysis demonstrated the benefit of atorvastatin or rosuvastatin over therapy for all studies. The result shown (WMD: 2.41; P=0.06; 95% CI: -0.07 – 4.90) on the forest plot.Conclusion: Our meta-analysis clarifies that atorvastatin, compared to rosuvastatin, or vice versa, is not statistically significant in reducing CRP in acute coronary syndrome patients.
Melanoma maligna orbita: sebuah laporan kasus
Authors: Sukmawati Ni Luh Putu Nurindah , Putu Yuliawati  , Ni Made Laksmi Utari
Published: December 2022

Introduction: Orbital melanoma (OM) is the most common type of primary intraocular neoplasm in adults. Although the incidence of OM is only 5% of melanoma tumors, OM causes death in 13% of melanoma tumors. The management of orbital melanoma originating from the uveal tissue is still controversial between surgical and nonsurgical therapy.
Case Report: A male patient, 63 years old, complained that the patient's right eye was said to have appeared a lump since five months ago with a size of 6 x 6 x 7 cm, blackish red in color with clinical signs of malignancy. The patient underwent orbital exenteration and the patient's condition had no recurrence or other complaints until four months after the procedure.
Conclusion: Orbital melanoma of uveal origin is a complex malignancy that requires a multidisciplinary approach to therapy and management. Early detection and adequate therapy are very important in increasing survival rates.
 
Pendahuluan: Melanoma orbita (MO) merupakan tipe yang paling sering dari neoplasma primer intraokular pada dewasa. Meskipun insiden MO hanya 5% dari tumor melanoma, namun MO menimbulkan kematian pada 13% akibat tumor melanoma. Tatalaksana melanoma orbita yang berasal dari jaringan uvea sampai saat ini masih kontroversial antara terapi bedah dan nonbedah. Laporan Kasus: Seorang pasien laki-laki, 63 tahun, mengeluh mata kanan pasien dikatakan muncul benjolan sejak lima bulan yang lalu dengan ukuran 6 x 6 x 7 cm, berwarna merah kehitaman dengan klinis mengarah keganasan. Pasien dilakukan eksenterasi orbita dan kondisi pasien tidak terdapat kekambuhan ataupun keluhan lain hingga empat bulan setelah tindakan.
Simpulan: Melanoma orbita yang berasal dari uvea merupakan keganasan yang kompleks yang membutuhkan pendekatan multidisiplin dalam terapi dan tatalaksana. Deteksi dini dan terapi yang adekuat sangat penting dalam upaya meningkatkan angka ketahanan hidup.
Analisis kinerja pegawai bagian administrasi RSUP Ratatotok buyat di era sebelum pandemi COVID-19, saat pandemic, dan new normal
Authors: Manitik Riliani , Rampengan Starry Homenta , Wagey Freddy W. , Manampiring Aaltje Ellen
Published: December 2022

Introduction: The success of hospitals (RS) in carrying out their functions as health service institutions is characterized by good quality hospital services. Administrative employees as non-health workers must have good performance in order to realize quality health services. This study aimed to analyze the description of employee performance in the administration section of the Ratatotok Buyat Hospital in terms of aspects of work culture and work environment in the era before the Covid-19 pandemic, during the pandemic and the new normal era.Methods: This type of research uses a qualitative descriptive method. Data collection techniques were carried out by in-depth interviews and then documented and analyzed. To obtain the validity of the data, inspection techniques were carried out through several activities, namely triangulation. Qualitative data was obtained based on the results of in-depth interviews using the Mile and Huberman data analysis modelResults: The performance of employees in the administration section shows that systems and activities related to employee work experience changes during the pandemic when there is a decrease in employee performance when compared to performance before the pandemic, in the new normal era, employee performance has increased.Conclusion: The performance of employees in the administration of Ratatotok Buyat Hospital before the Covid-19 pandemic was very good, there was a decline in performance during the pandemic, but increased again in the new normal era. Pendahuluan: Keberhasilan rumah sakit (RS) dalam menjalankan fungsinya sebagai lembaga pelayanan kesehatan ditandai dengan kualitas pelayanan rumah sakit yang baik. Pegawai administrasi sebagai tenaga non kesehatan harus memiliki kinerja yang baik agar dapat mewujudkan pelayanan kesehatan yang berkualitas. Penelitian ini bertujuan untuk menganalisis gambaran kinerja pegawai pada bagian administrasi Rumah Sakit Umum Pusat (RSUP) Ratatotok Buyat ditinjau dari aspek budaya kerja dan lingkungan kerja pada era sebelum pandemi Covid-19, saat pandemi dan era new normal.Metode: Jenis penelitian ini menggunakan metode deskriptif kualitatif. Teknik pengumpulan data dilakukan dengan wawancara mendalam kemudian didokumentasikan dan dianalisis. Untuk mendapatkan keabsahan data, dilakukan teknik pemeriksaan yaitu dengan triangulasi. Data kualitatif diperoleh berdasarkan hasil wawancara mendalam dengan menggunakan model analisis data Mile dan Huberman.Hasil: Kinerja pegawai dibagian administrasi menunjukkan bahwa saat pandemi terjadi penurunan jika dibandingkan dengan dengan kinerja sebelum pandemi, diera new normal kinerja pegawai kembali mengalami peningkatan.Kesimpulan: Kinerja pegawai di bagian administrasi RSUP Ratatotok Buyat sebelum pandemi Covid-19 sangat baik, dan terjadi penurunan kinerja saat pandemi, namun kembali mengalami peningkatan di era new normal.
Relationship between Monocarboxylate Transporter 4 (MCT-4) Expression and Breast Cancer Clinicopathology and Subtype in Sanglah General Hospital, Denpasar, Indonesia
Authors: Nicolas Gede Andry Nicolas Andry , Sudarsa I Wayan , Adiputra Putu Anda Tusta , Wihandani Desak Made , Supadmanaba I Gede Putu
Published: December 2022

Background: Breast cancer is the second leading cause of death in women in developing countries. The activity of Warburg and Reverse-Warburg effects on breast cancer is reflected by the expression patterns of two molecules, namely caveolin-1 and Monocarboxylate Transporter-4 (MCT-4). MCT-4 is a transmembrane transport protein that transports lactate from the cytoplasm to the intercellular fluid.Method: This is a cross-sectional analytical study to determine the relationship between MCT-4 expression and breast cancer clinicopathology and subtypes. The study was conducted between April and May of 2020 with 62  breast cancer patients as samples in Sanglah General Hospital, Denpasar. Analysis was done with SPSS 25.Results: A logistic regression analysis was performed to analyze the relationship between the dependent variable (MCT-4) and the covariates (stage, grade, and subtype). Of the three variables significantly associated with MCT-4 expression, only clinical-stage and subtype (luminal and non-luminal) remained independently associated with MCT-4 expression. Analysis on the clinical stage and subtype variables showed an adjusted OR of 4.727 (p = 0.047; 95% CI: 1.109 - 21.922) and 17.850 (p = 0.009; 95% CI: 2.069 - 154.003) , respectively. This suggests that MCT-4 has a significant association with subtype and clinical-stage, increasing the risk of cancer stage progression and developing a more malignant (non-luminal) subtype.Conclusion: High MCT-4 expression was significantly associated with malignant subtypes, high histological-grade cancer and advanced breast cancer.
Case report: a rare case of ocular leptospirosis
Authors: Dinajaya I Made Surya , Pramita Ida Ayu Ary , Juliari I Gusti Ayu Made , Susila Ni Ketut Niti , Kusumadjaja I Made Agus
Published: December 2022

Background: Ocular leptospirosis is a rare condition. Transmission of leptospirosis is caused by the bacterium leptospira interrogans transmitted directly or indirectly from animals to humans (zoonosis). Ocular manifestations often caused by leptospirosis are conjunctivitis, keratitis, uveitis (anterior, intermediate, posterior, and panuveitis), complicated cataracts, choroiditis, papillitis, and macular edema. Uveitis is a latent manifestation of leptospirosis. Proper management can lead to a good prognosis of visual.Case Presentation: Male patient, 55 years old, with complaints of both red and blurry eyes since 5 days. Blurring comes slowly with pain, glare, and seeing shadows like spider webs. The patient's previous medical history was hospitalized because of Weil's disease. Examination of the anterior segment of both eyes revealed eyelid spasm, conjunctival injection, corneal infiltrate, keratic precipitate, and posterior synechiae on both eyes. While in the posterior segment found cells 4+ in the vitreous. The patient was treated with antibiotics and topical steroids, and visual acuity was improved.Conclusion: Leptospirosis uveitis can have various presentations during the acute and chronic phases of the disease. Even when ocular involvement is extensive and severe, most patients have a good visual prognosis with appropriate therapy. Timely diagnosis is essential to maximize the potential for visual acuity improvement and appropriate systemic monitoring and treatment of extraocular involvement in this potentially fatal condition. Good sanitation in the community plays an important role in preventing exposure to leptospirosis.
Karakteristik dan perjalanan penyakit pasien infark miokard akut dengan elevasi segmen ST (IMA-EST) tanpa tatalaksana reperfusi pada rumah sakit perifer
Authors: Simanungkalit Arina Papita , Supit Alice Inda
Published: December 2022

Introduction: Acute myocardial infarction is coronary heart disease that causes an increase in length of stay in hospital and a high mortality rate. Reperfusion strategy is the main modality in treating ST-elevation myocardial infarction (STEMI), but a limitation in facilities and human resources in peripheral hospitals has made it impossible to do. This study aims to observe the characteristics and course of disease in patients diagnosed by STEMI without reperfusion strategy in peripheral hospitals.Method: This study is a descriptive observational study with a cross sectional research design--retrieving research data using the total sampling method, using secondary data from medical records at Ade M Djoen Sintang Public Hospital in March - December 2021.Results: 56 samples fulfilled inclusion and exclusion criteria, with the majority of the sample being male, the average age was 53 years. Most of the patients had the same complaint during their stay in the hospital, most of the patients were able to discharge from the hospital, and 57,14% of the patients were admitted back to the hospital with the same chief complaints after less than six months of follow-up.Conclusion: Management of patients with STEMI without a reperfusion strategy leads to remain of chief complaints and increase of readmission within 6 months follow-up after discharge. Latar Belakang: Infark miokard akut adalah suatu penyakit jantung koroner yang mengakibatkan peningkatan angka perawatan di rumah sakit dan angka kematian yang tinggi. Strategi reperfusi merupakan modalitas utama dalam penanganan infark miokard akut dengan elevasi segmen ST (IMA-EST), namun pada rumah sakit di perifer, keterbatasan sarana dan prasarana serta sumber daya manusia menyebabkan hal tersebut tidak memungkinkan. Tujuan penelitian ini adalah untuk mengetahui karakteristik dan perjalanan penyakit pasien yang terdiagnosis IMA-EST tanpa tatalaksana reperfusi di rumah sakit di perifer.Metode:  Penelitian ini merupakan penelitian observasional dengan desain penelitian potong lintang. Data penelitian diambil menggunakan metode total sampling, melalui data sekunder dari rekam medis selama periode Maret - Desember 2021 di Rumah Sakit Umum Daerah (RSUD) Ade M Djoen Sintang.Hasil: Terdapat 56 sampel yang memenuhi kriteria inklusi dan eksklusi, mayoritas sampel adalah laki-laki, rata-rata usia 53 tahun. Sebagian besar pasien mengakami keluhan yang menetap selama perawatan, sebagian besar boleh pulang dari rumah sakit. Dalam periode kurang dari 6 bulan, sebanyak 57,14% pasien masuk kembali ke rumah sakit dengan keluhan yang sama.Simpulan: Tatalaksana pasien dengan IMA-EST tanpa strategi reperfusi menyebabkan keluhan yang menetap selama perawatan dan peningkatan pasien masuk kembali ke rumah sakit dengan keluhan yang sama setelah 6 bulan dipulangkan dari rumah sakit.
Small group training as an effort to reduce stunting on toddlers in the working area of Puskesmas Kandang Sapi, Pasuruan
Authors: Hsieh Peter Prayogo , Tangkau Christianto Samuel Pieter , Farizqi Helviansyah El , Shohib Ahmad
Published: December 2022

Background: The World Health Organization (WHO) said that South East Asia has a high stunting prevalence, where it is estimated that 22.2% of toddlers are stunted globally. The reality is that there are still many cases of inaccurate measurement methods, which question the validity of stunting prevalence. This study aims to know if small group training is effective in reducing stunting prevalence in toddlers.
Methods: This descriptive study was done at all Posyandu in Bugul Lor from August to September 2019. Populations in this study were all helpers at Posyandu. Samples in this study were all helpers who met inclusive criteria but didn’t meet exclusive criteria. The inclusion criteria were helpers who attended when the study was conducted (5 helpers in each Posyandu), and the exclusive criteria were illiterate helpers. We used measurement guidelines from IDAI. The Group workshop started with a briefing about making sure that all tools were correctly set. Next, all helpers were asked to do height measurements, and if there was any error, we showed them how to do it correctly and let them do it again. We then compared the data before and after the intervention. Data from February 2019 were used as data before the intervention.
Results: No helper in 10 Posyandu measured correctly. But after the group workshop, a helper from 8 Posyandu could measure correctly. Stunting prevalence in Bugul Lor decreased by about 4%.
Conclusion: Group workshop seems to be effective in reducing stunting prevalence in toddlers.
Autoimmune Hemolytic Anemia (AHA) with hyperglycemia in a 22-year-old woman: a case report
Authors: Siska Fran , Ramadhani Saskia , Widijianti Anik
Published: December 2022

Background: Autoimmune hemolytic anemia (AIHA) is defined as increased erythrocyte destruction due to anti-erythrocyte autoantibodies with or without complement activation. Diabetes Mellitus (DM) is a chronic metabolic disease characterized by elevated blood glucose levels, which cause serious damage to various organs, including the heart, blood vessels, eyes, kidneys, and nerves. The impact of DM on a patient's survival with AIHA is unknown.
Case Presentation: A 22-year-old woman complained of dizziness and fainting before admission. The patient looked pale; on physical examination, we found jaundice on the sclera. This patient was diagnosed with AIHA and DM with increased HbA1c (10.8%) since 2017 but did not take the anti-diabetic drugs regularly. Hematological examination showed anemia, increased reticulocytes, and a positive direct Coombs test. The result of increased fasting glucose, 2 hours OGTT, and HbA1c levels (4.6%) tests were not relevant to hyperglycemia. In this patient, we also found normal C-peptide levels. The decrease in HbA1c levels was thought to be due to hemolytic anemia; therefore, HbA1c was falsely low due to rapid erythrocyte turnover.
Conclusion: This patient was diagnosed with DM based on American Diabetes Association criteria with normal C-peptide levels, suggesting Maturity Onset Diabetes of the Young with HbA1c incompatibility with glucose levels may be due to rapid erythrocyte turnover.
Osteomielitis kronis pada pasien anak laki-laki setelah cakaran kucing: laporan kasus
Authors: Sihotang Martin Gabe Tua , Kesuma Anak Agung Ngurah Ronny , Saputra I Komang Agus Krisna , Laksana I Komang Mahendra
Published: December 2022

Background: Chronic osteomyelitis is still an important problem in the orthopedic field, especially in developing countries. Cat's claws contain many harmful microorganisms and can cause significant morbidity ranging from infection of skin tissue, muscle, and even deeper to bone tissue (osteomyelitis). The aim of this study was to report that injuries caused by cat-scratches and not receiving proper treatment can develop into chronic osteomyelitis.
Case presentation: A 14-year-old boy came to the orthopedic polyclinic of Wangaya General Hospital with complaints of a left leg wound that had not healed since 2 years ago after got cat-scratches. The wound was oozing pus, tenderness, and the ankle area was found to be difficult to move because the patient's leg felt stiff. On physical, laboratory, and radiographic examination were found to be suggestive of chronic osteomyelitis.
Conclusion: In general, cat scratch injuries are simple and harmless wounds, but if left untreated can lead to infection and morbidity in the future. Persistent symptoms and unrelieved wound conditions should be important indications for patients and practitioners of the possibility of infection that extends to soft tissue or bone tissue. A good understanding of acute wound management is very important in preventing serious infections.
 
Latar belakang: Osteomielitis kronik masih merupakan masalah penting di bidang ortopedi terutama di negara berkembang. Pada cakaran kuku kucing mengandung banyak mikroorganisme berbahaya dan dapat menyebabkan morbiditas yang signifikan mulai dari infeksi jaringan kulit, otot, bahkan lebih dalam sampai mengenai jaringan tulang (osteomielitis). Tujuan dari penelitian ini adalah untuk melaporkan cidera yang disebabkan oleh cakaran kucing dan tidak mendapatkan pengobatan dengan baik dapat berkembang menjadi osteomielitis kronis.
Laporan kasus: Seorang anak laki-laki berusia 14 tahun datang ke poliklinik ortopedi RSUD Wangaya dengan keluhan luka kaki kiri yang tidak kunjung sembuh sejak 2 tahun yang lalu, luka mengeluarkan nanah, nyeri tekan, serta pada daerah ankle ditemukan sulit untuk digerakkan yang dikarenakan kaki pasien terasa kaku. Pada pemeriksaan fisik dan laboratorium ditemukan mengarah pada osteomielitis kronis. 
Simpulan: Pada umumnya cidera cakaran kucing hanya luka sederhana dan tidak berbahaya, tetapi jika diabaikan dapat menyebabkan infeksi dan morbiditas dikemudian hari. Gejala yang menetap dan kondisi luka yang tidak membaik harus menjadi indikasi penting bagi penderita dan praktisi terhadap kemungkinan infeksi yang meluas ke jaringan lunak ataupun jaringan tulang. Pemahaman yang baik tentang penanganan luka akut menjadi sangat penting dalam mencegah terjadinya infeksi yang serius.
Infiltrative multifocal glioblastoma progression in a twelve-year-old boy after COVID-19 infection: a case report
Authors: Saputra Angky , Bajamal Zaky , Notopuro Francisca , Puspitasari Lucia Dwi
Published: December 2022

Background: Glioblastoma is one of the most malignant types of primary central nervous system tumors with a high recurrence rate and dismal prognosis. Multifocal glioblastoma has been shown to have a poorer prognosis than solitary glioblastoma. Cancer patients are at risk of contracting COVID-19. It is hypothesized that COVID-19 may induce glioma tumorigenesis via angiotensin enzyme 2 receptor. We reported a rare pediatric multifocal glioblastoma in a twelve-year-old boy complicated with COVID-19.
Case Presentation: The patient was a twelve-year-old boy with a new-onset unprovoked seizure and headache. Magnetic resonance imaging (MRI) showed a heterogeneous solid cystic mass in the left temporal region (2.1x2.1x2.8 cm) with an increased choline/creatinine ratio and choline/n-acetyl acetate aspartate (NAA) ratio suggestive for high-grade glioma. The patient was contracting COVID-19 shortly after the diagnosis of glioblastoma. Two weeks later, patients came with significant neurological deterioration, hemiparesis, headache, and vomiting. MRI showed an infiltrative mass in the temporal and parietal region (5.05x8.03x8.3 cm) with intratumoral hemorrhage, also causing midline shift deviation (11.9 mm). The patient underwent trepanation and total safe resection of the tumor. Histopathological findings showed neoplastic cells with abundant mitotic figures, necrotic foci and pseudopalisading necrosis. These findings confirmed the diagnosis of multifocal glioblastoma.
Conclusion: Glioblastoma is a rare disease in the pediatric population with a poor prognosis due to its infiltrative nature and high recurrence rate. The patient had an acute deterioration of the neurological condition and rapid growth of the tumor after he contracted COVID-19, which may or may not be incidental. Further observation of similar cases will be required to determine the association between glioblastoma and COVID-19.
Myoepithelial carcinoma of lacrimal gland in HIV patient: A rare case
Authors: L.P. Suryantini Septia Dewi  , Putu Yuliawati  , Made laksmiNi Made Laksmi Utari  , SukartiniA.A.A. Sukartini Djelantik
Published: December 2022

Introduction: Lacrimal gland tumors have 1: 1,000,000 cases per year, accounting for one-fourth of lesions that occupy the orbital space. The rarity of lacrimal gland tumors and the many types of tumors with various types of lesions make determining optimal treatment difficult. A myoepithelial tumor is a rare epithelial neoplasm of the lacrimal gland. This paper aims to report a good outcome case of myoepithelial carcinoma.
Case Report: A 30-year-old male complained of protruding his left eye since 2014, accompanied by pain and clear white discharge. The vision was getting blurry and also double vision. Patients with Human Immunodeficiency Virus (HIV) disease since 2013 on Anti Retro Viral (ARV) therapy. Right eye visual acuity was 6 / 7.5, and good eyeball examination. The left eye was 6/10 with no pinhole improvement, non-axial proptosis, and superolateral mass. The movement of his left eye was restricted. Other anterior and posterior segments were promising. The patient was diagnosed with pseudotumor and was given oral methylprednisolone. The eye condition is said to be getting better. The patient complained that the left eye was more prominent and protruding three years later, with blurred vision accompanied by infection. Left eye visual acuity becomes Light Perception Bad Projection with non-axial proptosis, retraction of palpebra and pus. Orbital exenteration was performed, and anatomical pathology examination revealed myoepithelial carcinoma of the lacrimal gland. The patient was planned for radiotherapy.
Conclusion: These rare cases have made setting up a regimen in randomized controlled trials difficult. The rapid development of therapy gives more hope to treating patients with lacrimal gland tumors.
Hubungan antara kadar homosistein (Hcy) dengan kejadian ketuban pecah dini (KPD) pada kehamilan preterm
Authors: Sembiring Agrifa Eko Albert , Suwardewa Tjokorda Gde Agung , Negara Ketut Surya , Budiana I Nyoman Gede , Adnyana Ida Bagus Putra , Pangkahila Evert Solomon
Published: December 2022

Background: Premature rupture of membranes (PROM) has been a problem in obstetrics since ancient times until now. The incidence of PROM in the world ranges from 5% - 15% of all pregnancies, while the incidence in developing countries, especially Indonesia ranges from 4.5% to 7.6% of all pregnancies. Preterm is one of the highest contributors to perinatal mortality and morbidity. The incidence of preterm pregnancy in the world is around 9.6% of all births, while in Southeast Asia is around 11.1% It has been shown to have a significant effect on vascular endothelial pathology. 
Methods: The study was conducted with an analytic cross-sectional design involving  70 respondents of pregnant women with gestational age of 20 - < 37 weeks with and without PPROM who came to the outpatient clinic and maternity ward of Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar from May 2021 – July 2021. 
Results: The results of the analysis of this study found a statistically significant relationship between homocysteine (Hcy) levels and the incidence of preterm premature rupture of membranes (p = 0.001). The prevalence ratio value of 2.2 means that high homocysteine levels is a risk factor for premature rupture of membranes in preterm pregnancy (RP = 2.2; 95% CI = 1.33-2.94; p = 0.001).
Conclusion: High homocysteine level is a risk factor for premature rupture of membranes in preterm pregnancy.
 
Latar Belakang: Ketuban pecah dini (KPD) preterm merupakan masalah di bidang obstetrik sejak dahulu sampai sekarang. Insiden KPD di dunia berkisar antara 5% - 15% dari seluruh kehamilan. Insiden KPD di negara berkembang khususnya Indonesia berkisar 4,5% - 7,6% dari seluruh kehamilan. Kehamilan preterm menjadi salah satu penyumbang tertinggi angka mortalitas dan morbiditas perinatal. Insiden kehamilan preterm di dunia sekitar 9.6% dari semua kelahiran, sedangkan di Asia tenggara terdapat sekitar 11,1%. Hcy telah terbukti signifikan berpengaruh pada patologi endotel pembuluh darah.
Metode: Penelitian dilakukan dengan rancangan cross sectional analitik dengan melibatkan 70 responden wanita hamil dengan usia gestasi 20 - <70 minggu dengan atau tanpa KPD yang dating ke poliklinik dan ruang bersalin RSUP Prof. Dr. I.G.N.G. Ngoerah bulan Mei 2021 – Juli 2021.
Hasil: Diperoleh hubungan bermaksana secara statistik antara kadar homocycteine dengan kejadian ketuban pecah dini pada kehamilan preterm (p = 0, 001), dan rasio prevalensi 2,2 berarti kadar homosisteine yang tinggi merupakan faktor risiko terjadinya ketuban pecah dini pada kehamilan preterm (RP = 2.2; 95% CI = 1.33-2.94; p = 0.001).
Kesimpulan: Kadar homosistein yang tinggi merupakan faktor risiko terjadinya ketuban pecah dini pada kehamilan preterm.
Effect of uncontrolled glycemic on cataract surgery outcome in patient with diabetic retinopathy
Authors: NLP Wistya Eka Mahadewi  , Jayanegara I Wayan Gede , Siska  , I Made Agus Kusumadjaja
Published: December 2022

Objective: This study aims to report a case of catarct surgey outcome in cataract diabetic patient with uncontrolled glycemic.
Case Presentation: A 54-year-old woman has catarct on both eye and history of diabetes mellitus for 15 years. The patients was planned for cataract surgery when blood sugar below 200mg/dL in left eye,blood sugar patients from 248 mg/dL become 168 mg/dL. One week post operation evaluation revealed corneal edema, due to phaco time intra surgery in this patient increased. Visual acuity was 6/120 BCVA on the right eye and 6/18 BCVA on the left eye. Visual acuity has decreased in 2 months after surgery, 1/60 BCVA on the right eye and 6/18 BCVA on the left eye, as well as funduscopy presence of dot blot, flame-shaped, and traction on both eyes. This outcome was contributed by an uncontrolled blood glucose of the patient.
Conclusion: Preoperative preparations in diabetic cataract patients are mandatory, including blood sugar and HbA1C control, to achieve a better outcome of ocular surgery in patients with diabetes mellitus.
Resection of a mature giant teratoma with clamshell incision thoracotomy approach: Case report and literature review
Authors: Adhyasta Nata Prawira Subianto  , Maz Isa Ansyori Arsatt
Published: December 2022

Introduction: Resection of giant teratomas can be challenging. An advanced surgical technique should be designed to ensure surgical safety and complete removal of giant teratomas. We describe a case of a mature giant teratoma successfully resected with a clamshell incision thoracotomy approach.
Case Description: A female, 11 years complained of shortness of breath for the last two weeks before being admitted to the hospital.  Physical examination revealed a retraction of the patient's chest wall, decreased breath sounds in the left lung field, and dull percussion in the left lung field. Chest CT scan with contrast was carried out with a minimal right pleural effusion with mediastinal mass size 14 x 17 x 16 cm. The patient underwent surgery to extract the mediastinal mass; an anterior thoracotomy was performed using the Clamshell incision method on the patient's chest. Complete resection of the mass was performed. Histopathology examination was performed on the mass with the results in accordance with the description of Mature Cystic Teratoma. The patient returned home in good condition and then controlled through the outpatient polyclinic.
Discussion: Clamshell incisions provide enough exposure for tumors in the mediastinum that extend into the thoracic cavity. For complete removal of a gigantic teratoma, extensive surgical and visual fields are required, as in this case.
Conclusion: Clamshell incisions in anterior thoracotomy give a good surgical field and can be safely performed in patients with large mediastinal teratomas.
Kemampuan Tutor dalam Menstimulasi Self Directed Learning Mahasiswa Kedokteran
Authors: I Gusti Ayu Harry Sundariyati  , Putu Gede Sudira  , Ida Bagus Amertha Putra Manuaba  , I Gusti Ayu Sri Darmayani
Published: December 2022

Background: Self-directed learning (SDL) is a skill that must be possessed by medical students as a form of adult learning. To train these skills, students need tutors to stimulate students' SDL abilities.

Methodology: This study was conducted quantitatively using a Dolman and Ginns questionnaire on third-year medical students.

Results: Tutors in the Medical Emergency block were able to provide a good explanation of the issues in the case and stimulate students to look for other learning resources.

Conclusion: Tutors with academic backgrounds that match the discussion material can be considered as one of the factors that can stimulate students' SDL.

 

Latar Belakang: Self-directed learning (SDL) merupakan keterampilan yang harus dimiliki oleh mahasiswa kedokteran sebagai bentuk pembelajaran dewasa. Untuk melatih keterampilan ini mahasiswa memerlukan tutor dalam menstimulasi kemampuan SDL mahasiswa.

Metodologi: penelitian ini dilakukan secara kuantitatif dengan menggunakan kuisioner Dolman dan Ginns pada mahasiswa kedokteran tahun ke-tiga.

Hasil: tutor pada blok Medical Emergency mampu memberikan penjelasan yang baik mengenai issue yang ada pada kasus serta menstimulasi mahasiswa untuk mencari sumber pembelajaran yang lainnya.

Simpulan: tutor dengan latar belakang akademik yang sesuai dengan materi diskusi dapat dipertimbangan sebagai salah satu factor yang dapat menstimulasi SDL mahasiswa.
Acute and severe ocular manifestations of a patient with Stevens-Johnson Syndrome in RSUD Wangaya: a case report
Authors: Oeiyano Jelly Vianti Fransisca , Hadisusanto Jessica Yolanda , Tanaya Lisa Berliani , Kartiningsih Ida Ayu Putri
Published: December 2022

Background: Stevens-Johnson syndrome is a severe mucocutaneous disorder with high mortality rates and potentially life-threatening. Ocular manifestations in SJS occurred up to 81%, with manifestation ranging from conjunctiva hyperemia, cicatrizing conjunctivitis with symblepharon, corneal ulceration, corneal blisters and perforation, which can potentially lead to permanent vision loss.

 

Case Description: A 34-year-old male patient was being consulted to ophthalmologist department with the diagnosis Stevens-Johnson syndrome, he was complaint bilateral upper and lower eyelid palpebral conjunctiva adhesion to bulbar conjunctiva. The ophthalmological examination cannot be examined due to the adhesion then the patient was performed bilateral symblepharon separation of the eyelid using blunt-tip of surgical scissors under local anesthesia. After the procedure, the visual acuity was around 3/60 for both eyes. The anterior segment examination in both eyes showed that the palpebral was edema, peeling of the skin. The conjunctiva appears to be chemosis, conjunctival injection, with mucopurulent secret in both eyes. The patient was treated with antibiotic combined with steroid eye ointment and eye drop.

Conclusion: Ocular manifestations of SJS are mostly mild-moderate. However, several cases possess grave complication and may progress to vision loss. Treatment for the ocular sequelae can reduce the risk of long-term visual morbidity. Knowing the etiology along with the progression of the disease is necessary for early diagnosis and prompt treatment.
Karsinoma sel basal tipe campuran yang diterapi dengan eksisi dan island pedicle flap: laporan kasus
Authors: Sanjaya I Dewa Made Rendy , Darmaputra I Gusti Nyoman , Winaya Ketut Kwartantaya , Indira I Gusti Ayu Agung Elis , Saputra Herman
Published: December 2022

Introduction: Basal cell carcinoma (BCC) is a malignant neoplasm originating from non-keratinized cells. The incidence increases worldwide and one of the triggering factors is excessive exposure to ultraviolet (UV) rays. The therapy aims to eradicate the tumor and maintain optimal organ function and cosmetic results after the procedure, one of which is the excision technique accompanied by an island pedicle flap.
Case Description: A man, 67 years old, came with a complaint of a black lump on the left cheek accompanied by a wound that did not heal. Based on the history, physical examination, and investigations, the patient was diagnosed with mixed type BCC. Excision and wound closure were performed with the island pedicle flap technique.
Conclusion: The treatment chosen in this case is surgical excision and island pedicle flap. Although the wound healing is classified as good, the prognosis of the patient is dubius. Considering the location of the lesion and the histopathological results showing an aggressive tumor with a tendency to metastasize, the patient is advised to take precautions.
 
Pendahuluan: Karsinoma sel basal (KSB) adalah neoplasma ganas yang berasal dari sel non keratin. Terjadi peningkatan insiden KSB di seluruh dunia dan salah satu faktor pencetusnya adalah paparan sinar ultraviolet (UV) berlebih. Terapi yang dilakukan bertujuan untuk mengeradikasi tumor serta tetap mempertahankan fungsi organ dan hasil kosmetik yang optimal paska tindakan, salah satunya dalah dengan teknik eksisi yang disertai island pedicle flap. Deskripsi kasus: Seorang laki-laki, usia 67 tahun, datang dengan keluhan benjolan kehitaman pada pipi kiri yang disertai luka yang tidak kunjung sembuh di atas benjolan. Berdasarkan anamnesis, pemeriksaan fisik dan penunjang, pasien terdiagnosis KSB tipe campuran. Dilakukan tindakan eksisi dan penutupan luka dengan teknik island pedicle flap.
Simpulan: Tatalaksana yang dipilih pada kasus ini adalah pembedahan eksisi serta island pedicle flap. Meskipun penyembuhan luka tergolong baik, namun prognosis pasien dubius. Mengingat lokasi lesi dan hasil histopatologi yang menunjukkan tumor agresif yang memiliki kecenderungan metastase, pasien disarankan untuk melakukan pencegahan.
A neglected case of blunt eye injury leading to pediatric cataract: a lifetime consequence case report
Authors: Oeiyano Jelly Vianti Fransisca , Mantu Raymond Oliver , Samatara Samuel
Published: December 2022

Background: A pediatric traumatic cataract is one of the children's main causes of unilateral visual impairment. It is defined as a permanent opacification of the lens caused by penetrating or blunt trauma to the eye, which might damage the vision. A traumatic pediatric cataract is preventable and treatable. This case study aims to evaluate a neglected case of blunt eye injury leading to pediatric cataracts.
Case Description: A 15-year-old boy came with chief complaints of decreased visual acuity in his left eye for the last 2 years. He has a history of blunt eye injury around 3 years prior in the left eye but left untreated. The patient's visual acuity was 1 per light perception in the left eye. An ophthalmologic examination of the left eye showed an opacity in the lens. The posterior segment cannot be examined. The patient was assessed with a traumatic cataract and was planned to be operated on, but the parents refused.
Conclusion: Prompt first aid and timely surgical intervention are necessary for optimal results. Parents play a critical role in the patient's prognosis by observing closely after eye trauma and bringing their children to the right medical facility.
Comparison between serum pleural effusion albumin gradient, total protein, lactate dehydrogenase, and erythrocyte count in malignant and non-malignant pleural effusion
Authors: Wijaya Victor Nugroho , Sajinadiyasa I Gede Ketut , Candrawati Ni Wayan , Kusumawardani Ida Ayu Jasminarti Dwi , Arisanti Ni Luh Putu Eka , Artana I Gusti Ngurah Bagus , Rai Ida Bagus Ngurah
Published: December 2022

Background: Malignant pleural effusion carries a bad prognosis. Pathologic examination as the gold-standard diagnosis of malignant pleural effusion has sensitivity limitations and may cause delayed diagnosis. Several affordable examinations, such as serum pleural effusion albumin gradient, total protein, lactate dehydrogenase (LDH), and erythrocyte count, might be useful as malignant pleural effusion diagnostic tools.
Methods: This is an observational analytic study with a cross-sectional design conducted at Sanglah Central General Hospital in Denpasar from December 2021 to July 2022. Pleural effusion fluid and blood were taken from subjects with malignant and non-malignant pleural effusion. Data were analyzed with SPSS version 25 software for Windows.
Results: Total subjects were 47 persons consisting of 26 subjects with malignant pleural effusion and 21 subjects with non-malignant pleural effusion. Results from statistical analysis of malignant and non-malignant pleural effusion were serum pleural effusion albumin gradient median (IQR) 0.91 (0.65) g/dL vs. 1.22 (1.2) g/dL (p=0.129), total protein mean 3.92±0.95 g/dL vs. 3.52±1.67 g/dL (p=0.334), LDH median 535 (840) IU/L vs. 187 (1,016) IU/L (p=0.057), and erythrocyte count median 23,500 (109,250) cells/mm3 vs. 3,000 (11,000) cells/mm3 (p=0.004). The AUC of erythrocyte count from the ROC method was 0.745 (95%CI=0.599-0.890; p=0.004). Using a cut-off point ≥ 4,500 cells/mm3, it had a sensitivity of 80.8%, specificity of 61.9%, and Odds Ratio (OR) of 6.8 (95%CI=1.8-25.4).
Conclusion: Erythrocyte count as routine examination showed good validity for diagnosing malignant pleural effusion and expected to reduce diagnosis delay. Meanwhile, albumin gradient, total protein, and LDH delivered no difference.
Variations of dengue shock syndrome cases and their management: report of three cases
Authors: Wirajaya Gede Bagus Mahendra , Sutanegara Ayu Agung Pradnya Paramitha Dwi , Lestari Desak Nyoman Desy
Published: December 2022

Background: Dengue hemorrhagic fever (DHF) occurs due to plasma leakage due to increased vascular permeability, which is also supported by an active complement system, which makes DHF fall into complications such as shock or dengue shock syndrome (DSS). The comprehensive management of DSS could prevent morbidity and mortality in patients. We aimed to report three variations of dengue shock syndrome cases and their management.
Case presentation: Three cases of DSS from our hospital. Two case reports with clinical dengue fever patients with shock and one case report with clinical dengue patients with shock and complications of acute liver failure. The first case was a 24 years olds male patient with classic signs of dengue fever plus spontaneous bleeding in the form of nosebleeds accompanied by hemodynamic disturbances. Laboratory examination revealed severe thrombocytopenia. In the second case, a male patient with dengue shock syndrome accompanied acute liver failure. The patient complains of heartburn and nausea accompanied by tea-like urine. Dengue patients with abdominal pain typical of liver disorders, nausea, vomiting and anorexia, and hepatomegaly with or without jaundice are typical of liver disorders. The third case, a male patient with dengue shock syndrome, accompanied the suspicion of ascites. The main treatment is the administration of isotonic crystalloid fluids according to body weight. While in cases of acute liver failure, NAC can be given.
Conclusion: We found three cases of DSS with some complications. It is important to know the right treatment immediately so that complications do not occur.
Anemia on Chronic Kidney Disease: The Role of Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors
Authors: Ni Wayan Anantika Riani  , I Gde Raka Widiana
Published: December 2022

Anemia is one of the homeostatic abnormalities caused by chronic kidney disease and also frequently problem encountered in end-stage renal disease patients, regardless of the hemodialysis treatment. Anemia in chronic kidney disease significantly impairs kidney function, increases morbidity and mortality risk, and deteriorates the quality of life. Chronic kidney disease’s patients with anemia conditions are affected by numerous factors, including decreased production of endogenous erythropoietin, functional and absolute iron deficiency, and elevated hepcidin levels due to inflammation, particularly in hemodialysis patients. Treatment options for anemia in chronic kidney disease include exogenous erythropoietin and iron supplementation. A new mechanism known as the "hypoxia-sensing system" termed a mediator of erythropoietin synthesis, has been proposed to boost endogenous erythropoietin synthesis. The hypoxia-inducible factor activates specific gene expression and contributes to a physiological response to lower tissue oxygen levels. Chronic kidney disease’s patients who are contraindicated or are hyporesponsive to therapy with erythropoiesis-stimulating drugs may utilize this mechanism as an alternative.
The Fundamental Concepts of High SMAS Facelift: Literature Review
Authors: Samsarga Gede Wara , I Made Suka Adnyana  , Astrinita Lestari Suyata  , Shita Diwyani Sudarsa  , Dewa Ayu Agung Anggita Ningrat
Published: December 2022

A number of facelift procedures have been introduced by many surgeons but there is no consensus has yet been established to carry. Since the first description of superficial musculoaponeurotic system (SMAS), it is used as the basis for many facelift methods that produce superior result in rejuvenation compared to traditional skin only facelift. Extended SMAS facelift becoming SMAS modification techniques that is still being developed. It produces two different vector of subcutaneous and SMAS flap, that is essential to restore drooping deep facial tissue with natural appearance. Despite the beneficial use of extended SMAS flap, most of plastic surgeons still traditionally incise the SMAS under the zygomatic arch. However, the low SMAS incision results only on rejuvenation of the lower face and is not sufficient to correct mid-facial aging. Fundamental concepts of high SMAS facelift by  reviewing some literatures explain that high SMAS flap transection allowing the surgeon to achieve greater vertical elevation of the deep structures of the face by undermining the middle face, combined with fixation to a fixed structure produces lasting results and oblique vector of skin envelope creating no tension look. Incision above zygomatic arch turns out to be safely performed without facial nerve injury thorough knowledge of the anatomy. The final result is a balanced and harmonious elevation of sagging tissues of the midface, cheek, and jawline, to such an extent that high SMAS facelift becomes optimal, durable, technically simple, reproducible and with a comparatively high safety margin in facelift procedures.
Gambaran sikap dan perilaku merokok siswa SMA/SMK terhadap bahaya rokok pasca pencantuman gambar peringatan pada kemasan rokok di wilayah kerja upt puskesmas Mengwi I Kabupaten Badung Bali 2014
Authors: Agus Sukarna Putu
Published: December 2022

Figures higher cigarette consumption in Indonesia is a crucial national issues. Indonesia is the fourth largest cigarette consuming country in the world after China, Russia and the United States. Number of cigarettes consumed reached 260.8 billion cigarettes per year.The prevalence of smokers aged adolescents reported increased from year to year. Data up to the year 2010 indicate that there is a pattern increased prevalence of smoking in adolescence. Increased reaching up to 12.9% of adolescents, especially in the age group 15-19 years. The prevalence of smoking in adolescent males increased by 24.6% (13.7% - 38.4%) and among girls increased by 0.6% (0.3% - 0.9%).Indonesian government imposed a new policy regarding the display cigarette packs stipulated in Government Regulation No. 109 of 2012 on securing material containing addictive substances such as tobacco products for health. In the policy set back the pictures warning of the dangers of smoking on cigarette packs are expanded to an area of 40% from 15% in the form of text.Research on the picture of the attitudes and behavior of SMA / SMK in Mengwi against the dangers of smoking after the inclusion of picture warnings on cigarette packs until now still not been done. Therefore, this study aims to describe the attitudes and behavior of SMA / SMK against the dangers of cigarettes post a picture had note warning the dangers of smoking in the work area UPT Puskesmas Mengwi 1 BadungÂ
Epilepsi bangkitan umum tonik-klonik di UGD RSUP Sanglah Denpasar-Bali
Authors: Kristanto Andre
Published: December 2022

Introduction: Epilepsy is a neurological disease that is characterized by episodes of seizures which can be accompanied by loss of consciousness of the patient. Although it is usually accompanied by loss of consciousness, there are several types of seizures without loss of consciousness. The disease is caused by the instability of electrical charges in the brain which in turn interfere with muscle coordination and manifest in muscle stiffness or repetitive pounding on the muscle. Classification of epileptic seizure according to ILAE 1981 include some general seizures, partial / focal seizures, and not classified seizures. Case: A 57-year-old woman, Balinese, come to the ER with complaints a limp, escorted by residents because of fainting. Patients do not know what happened so he brought the ER. Patients know who she is, what's her name, where she was, and the current time. Patient say she felt a little dizziness, no nausea, no vomiting. Patients are found to fall unconscious. At that time the patient was at work with his daily activity carrying stuff. Before fainting said patient lying at the scene while stamping hands and feet. Not checked how long the patient was lying. From families were dropping, the patient has a history of epilepsy, had been hospitalized in the hospital with a diagnosis of epilepsy, but never control the drug after the return of hospitalization.