As the COVID-19 pandemic has been resolved, we are glad to welcome our colleagues to visit the paradise island, Bali, while joining our annual meeting, the 12^th Bali Cardiology update that will be held offline. We organises workshops, symposiums, plenary talks, lectures with international and national keynote speakers, and interactive gatherings from throughout regions to discuss cutting-edge discoveries to advance the profession and medications specializing in cardiovascular disease managements, providing an absolutely superb framework for professionals in cardiovascular health, researchers, scientists, healthcare specialists, academicians, and individuals with interest in cardiology. This is your best opportunity to network with the most individuals from hospitals, academic institutions, heart associations, and research facilities because there are people from all over the world interested in finding a few solutions in the field of cardiology. The opportunity to network with colleagues and hear from renowned cardiologists and cardiovascular researchers at this cardiology summit is unmatched.

Background: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae and Mycobaterium lepromatosis. Children are one of the populations at risk of M. leprae transmission. Prompt treatment is needed to avoid complications of disability in children with leprosy. Therefore, this study aims to describe a pediatric patient who had borderline lepromatous morbus hansen with a history of close contact multibacillary leprosy.

Case: A 16 years old girl, complained red spots on the right and left legs that are numb. Dermatological examination found multiple erythema macules-patches, firm boundaries, rounded to geographic shapes, discrete distribution on the face and right and left anterior and posterior extremities. Thickening of the right ulnar nerve, right and left common peronial nerve, decreased sensation of touch, pain and temperature were found. Histopathological examination found a non-caseating granulomata lesion, consistent with borderline tuberculoid leprosy type. Slit skin smear found acid fast bacilli (AFB) in the right earlobe 25-30 AFB/1 visual field (VF) (bacterial index (IB): +4)) fragmented, in the left earlobe>100 smear/1 VF (IB: +5) fragmented, and morphological index (IM): 0. The patient was diagnosed with borderline lepromatous (BL) leprosy and given multidrug therapy (MDT) for multibacillary (MB) leprosy. After 6^th package of MDT, leprosy reactions or side effects of treatment were not found.

Conclusion: The highest risk of transmission of leprosy is close contact with leprosy patients, especially the multibacillary type of leprosy. In this case, a child with BL type leprosy was treated with an adult dose of MDT MB according to the patient's age and body weight.

Latar belakang: Morbus hansen (MH) merupakan penyakit granulomatosa kronis yang disebabkan oleh Mycobacterium leprae dan Mycobaterium lepromatosis. Anak-anak merupakan salah satu populasi berisiko terhadap transmisi M. leprae. Terapi lebih dini diperlukan untuk menghindari komplikasi kecacatan pada anak dengan morbus hansen. Untuk itu, tujuan dari studi ini adalah memaparkan seorang pasien anak anak yang mengalami morbus hansen tipe borderline lepromatous dengan riwayat narakontak erat kusta tipe multibasiler.

Kasus: Seorang anak perempuan, 16 tahun, dengan keluhan utama bercak kemerahan pada kaki kanan dan kiri yang mati rasa. Pemeriksaan status dermatologis ditemukan makula hingga patch eritema multipel, batas tegas, bentuk bulat hingga geografika, tersebar diskret di lokasi wajah dan ekstremitas anterior et superior dextra et sinistra serta penebalan nervus ulnaris dekstra dan nervus peronius komunis dekstra et sinistra dan penurunan sensasi raba, nyeri dan suhu. Pemeriksaan histopatologi ditemukan kesan non-caseating granulomata lesion. Pemeriksaan bakteriologis dengan pengecatan Ziehl-Neelsen ditemukan basil tahan asam (BTA) pada cuping telinga kanan 25-30 BTA/1 lapang pandang (LP) (indeks bakteri (IB): +4)) fragmented, pada cuping telinga kiri >100 BTA/1 LP (IB: +5) fragmented, dan indeks morfologi (IM): 0. Pasien didiagnosis dengan MH tipe borderline lepromatous (BL) dan diberikan multidrug theraphy (MDT) untuk MH tipe multibasiler (MB). Evaluasi pada konsumsi MDT paket ke-VI tidak menunjukkan adanya reaksi kusta ataupun efek samping pengobatan.

Simpulan: Risiko tertinggi penularan kusta adalah kontak erat dengan pasien kusta terutama kusta tipe multibasiler. Pada kasus ini didapatkan anak dengan kusta tipe BL dan diterapi dengan MDT MB dosis dewasa menyesuaikan usia dan berat badan pasien.

Background: Dyke-Davidoff-Masson syndrome (DDMS) is a rare neurological condition with unknown global prevalence and incidence. The characteristic clinical features include facial asymmetry, seizures, and contralateral hemiplegia. Signature neuroimaging findings include unilateral brain volume loss, ventriculomegaly, compensatory bone hypertrophy resulting in cerebral hemiatrophy, calvarial thickening and hyperpneumatization of paranasal and frontal sinuses neuroimaging.

Case Presentation: 4-year-old girl patient presented seizures (diagnosed as epilepsy) and complained of left-sided hemiplegia since 1 year ago. Neurological examination revealed left-sided spastic hemiplegia with brisk tendon reflexes and extensor planter response on the left side, increased reflexes physiology in the left limb, and positive Babinski on the left leg. MRI showed right cerebral hemiatrophy with ex vacuo dilatation of the right lateral, III and IV ventricles, with hyper pneumatization of the right ethmoid sinus and right left mastoid Aircell and elevation of the right petrous ridge, and falcine displacement to the right as far as +/- 7mm and blurring right hippocampus, suspected atrophy. Therapy, she got multiple anti-epileptic drugs.

Conclusion: Diagnosis of DDMS is made by a triad of hemiplegia, contralateral hemiatrophy, seizures, and classical radiological features. Imaging is important in diagnosing this rare entity and differentiating it from other causes of cerebral hemiatrophy. The long-term prognosis is good, provided the clinical entity is recognized early and managed appropriately.

Background: Infection is a complication that contributes to morbidity and mortality in SLE patients. Tuberculosis (TB) is an infection that is of particular concern, especially for those living in endemic areas such as Indonesia. Pleural TB is the second most common form of extrapulmonary tuberculosis after lymphatic involvement and is the most common cause of pleural effusion. This case report describes a case of pleural effusion in extrapulmonary tuberculosis with a history of systemic lupus erythematosus for the purpose of determining appropriate management.

Case presentation: A 42-year-old woman complained of fever for 2 weeks, non-productive cough, lower right chest pain when coughing, and shortness of breath. The patient has a history of controlled SLE disease with medication since one year ago. On physical examination found decreased vocal fremitus right chest, dull percussion on the right chest, decreased vesicular breath sounds in the lower right lung. Complete blood count and blood chemistry showed normal results, chest X-ray showed right pleural effusion with pulmonary infiltrate on the ipsilateral pleural effusion, pleural fluid analysis showed an exudate, and adenosine deaminase levels were more than laboratory reference values. This patient was diagnosed with right pleural effusion et causa pleural TB. Management includes evacuation of pleural fluid, administering rivastar therapy at the hospital followed by 2RHZE/4RH anti-tuberculosis drugs at the Sukasada II Health Center. Significant improvement was evident by the reduced number of pleural effusions and pulmonary infiltrates on the chest X-rays of the patients in the second and final month of treatment.

Conclusion: Pleural effusion in extrapulmonary TB patients with a history of SLE can be diagnosed through history, physical examination and supporting examinations such as radiography, pleural fluid analysis and histology. Treatment and monitoring of TB in SLE patients is in line with national guidelines for TB patients without SLE.

Latar Belakang: Infeksi merupakan komplikasi yang berkontribusi terhadap morbiditas dan mortalitas pada pasien SLE. Tuberkulosis (TB) merupakan salah satu infeksi yang menjadi perhatian khusus terutama bagi mereka yang tinggal didaerah endemik seperti di Indonesia. TB pleura adalah bentuk paling umum kedua dari tuberkulosis ekstra paru setelah keterlibatan limfatik dan merupakan penyebab paling umum dari efusi pleura. Laporan kasus ini mendeskripsikan kasus efusi pleura pada tuberkulosis ekstra paru dengan riwayat lupus eritematosus sistemik agar tepat dalam menentukan tatalaksana yang tepat.

Presentasi kasus:  Perempuan 42 tahun mengeluh demam selama 2 minggu, batuk non produktif, nyeri dada kanan bawah jika batuk, dan sesak. Pasien memiliki riwayat penyakit SLE terkontrol dengan pengobatan sejak satu tahun yang lalu. Pada pemeriksaan fisik ditemukan vokal fremitus dada kanan menurun, perkusi redup pada dada kanan, suara napas vesikuler menurun pada paru kanan bawah. Pemeriksaan darah lengkap dan kimia darah menunjukkan hasil normal, foto toraks menunjukkan efusi pleura kanan dengan gambaran infiltrat paru di ipsilateral efusi pleura, analisis cairan pleura menunjukkan suatu eksudat, dan kadar adenosine deaminase lebih dari nilai rujukan laboratorium. Pasien ini didiagnosis dengan efusi pleura dekstra et causa TB pleura. Tatalaksana meliputi evakuasi cairan pleura, pemberian terapi rivastar di rumah sakit dilanjutkan obat anti tuberkulosis 2RHZE/4RH di Puskesmas Sukasada II. Perbaikan yang signifikan terbukti dengan berkurangnya jumlah efusi pleura dan infiltrate paru pada foto toraks pasien bulan kedua dan akhir pengobatan.

Simpulan: Efusi pleura pada pasien TB ekstra paru dengan riwayat SLE dapat ditegakkan diagnosisnya melalui anamnesis, pemeriksaan fisik dan pemeriksaan penunjang seperti radiografi, pemeriksaan analisis cairan pleura dan histologi. Pengobatan dan monitoring TB pada pasien SLE sejalan dengan pedoman nasional pasien TB tanpa SLE.

Background: Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN) is a dermatologic emergency characterized by extensive epidermal detachments. The most frequent etiology is drug reaction within an interval of the last 8 weeks. SJS/TEN may occur in any age, race, and gender; however, there is an increased risk in patients over 65. SJS and TEN are differentiated based on the extent of epidermal detachments, which is <10% in SJS, 10-30% in SJS-TEN overlap, and >30% in TEN. This case study aims to evaluate the Lamotrigine-induced Stevens-Johnson Syndrome Toxic Epidermal Necrolysis (SJS/TEN) overlap with transaminitis in an Asian female.

Case Presentation: A 34-year-old woman presented with a pruritic and burning rash on almost all body parts. The suspected causative drug was lamotrigine, which she consumed within the last 2 weeks. Mucosal involvement was also found on the lips and genital mucosal. The affected body surface area was approximately 20%, with a positive Nikolsky sign. Laboratory studies showed elevated liver function tests. Based on the history, physical examination, and biopsy, the patient was diagnosed with SJS/TEN overlap. The suspected causative drug was immediately stopped, and supportive and systemic corticosteroid treatments were provided. The SCORTEN was 2, with a mortality rate of 12.1%. After a few days, the patient's condition had improved, the liver function test was normal, and there was no significant complication.

Conclusion: SJS-TEN is a part of epidermal necrolysis, characterized by an extensive epidermal detachment. The management of SJS/TEN includes early detection, immediately stopping the suspected drugs, administering systemic corticosteroids, and other supportive treatments.

Background: Breast augmentation is a surgical procedure performed to increase breast size by implanting implants or through fat transfer. MRI is the gold standard for evaluating the integrity of breast implants, with a sensitivity of 80–90% and a specificity of 80–90% for detecting implant rupture. In this case report, we will discuss the role of breast MRI in cases of benign late peri-implant effusion after breast augmentation.

Case Presentation: A 49-year-old female patient has complained of a lump in her left breast since 2017. The patient had surgery to insert right and left breast implants in 2004. The patient underwent ultrasound and MRI examinations at Prof. I.G.N.G Ngoerah Hospital and obtained results in the form of an anechoic area, with internal echo and a solid component in it in the submamary of the left breast, susp. infectious process, and multiple non-suspicious left axillary lymphadenopathy. Meanwhile, no nodules, masses, or cysts were found in the right breast, and no enlarged lymph nodes in the right axilla were found. The patient was diagnosed with benign late peri-implant effusion after breast augmentation and underwent implant removal and capsulectomy after seeing the results of the MRI examination.

Conclusion: An MRI examination can help identify an implant effusion after a breast augmentation procedure.

Latar belakang: Breast augmentation merupakan prosedur pembedahan yang dikerjakan untuk meningkatkan ukuran payudara melalui penanaman implan maupun melalui transfer lemak. MRI merupakan baku emas  standar untuk mengevaluasi integritas dari implan payudara, dengan sensitivitas mencapai 80-90%, dan spesifisitas 80-90% untuk mendeteksi adanya ruptur implan. Pada laporan kasus ini akan dibahas mengenai peranan MRI payudara pada kasus benign late peri- implant effusion pasca breast augmentation.

Presentasi Kasus: Pasien perempuan 49 tahun datang dengan keluhan benjolan pada payudara kiri sejak tahun 2017. Pasien pernah melakukan operasi pemasangan implant payudara kanan kiri pada tahun 2004. Pada pasien dilakukan pemeriksaan ultrasonografi dan MRI di RSUP Prof. I.G.N.G Ngoerah didapatkan hasil berupa area anechoic, dengan internal echo dan komponen solid didalamnya pada submamary payudara kiri, susp. proses infeksi dan multiple non suspicious lymphadenopathy axilla kiri. Sedangkan tidak ditemukan adanya nodul, massa, maupun kista pada payudara kanan serta tidak ditemukan adanya pembesaran kelenjar getah bening pada axilla kanan. Pasien didiagnosis dengan benign late peri- implant effusion pasca breast augmentation dan dilakukan tindakan implant removal dan kapsulektomi setelah melihat hasil dari pemeriksaan MRI.

Simpulan: Pemeriksaan MRI dapat membantu mengidentifikasi suati efusi perimplan pasca tindakan breast augmentation.

-Background: Hemophagocytic lymphohistiocytosis (HLH) is a disease characterized by immune dysregulation. The incidence of this disease is approximately 1.2 cases per one million people each year. HLH is a life-threatening hyperinflammatory syndrome and can be divided into primary and secondary groups. Familial HLH (primary HLH) can be diagnosed under 1 year of age in 70-80% of cases. Patients with mutations in this gene resulting in complete loss of protein function, develop primary HLH in childhood. This study aims to report a case of an infant with suspicion of HLH at Prof. Dr. I.G.N.G. Ngoerah General Hospital.

Case report: A 4-month-old male infant patient came to the health facility with a chief complaint of fever. The fever has been fluctuating since August 1, 2020 and in the last 24 hours the patient has had a fever that has fluctuated 3 times. Other complaints such as cough, runny nose, shortness of breath, nosebleeds, bleeding gums, and red spots on the patient's body were denied by the patient's parents. On physical examination, schuffner III splenomegaly was found. Laboratory examination of hematology and femostasis faeces showed that there was a picture of hypocellular bone marrow with suspicion of metabolic disease, X-ray examination results showed suspected splenomegaly. The patient was diagnosed with observation of bicytopenia with splenomegaly et causa suspected HLH with differential diagnosis of Gaucher disease. The patient was finally given supportive therapy in the form of fluids, zinc peroral, and paracetamol if fever appeared.

Conclusion: This study reports a case of a 4-month-old male patient with suspicion of HLH. Examination showed that this patient met 5 of the 8 criteria based on the HLH-2004 guidelines.

Pendahuluan: Hemofagositik limfohistiositosis (HLH) adalah penyakit yang ditandai dengan disregulasi imun. Insiden dari penyakit ini sekitar 1,2 kasus per satu juta orang setiap tahunnya. HLH merupakan sindrom hiperinflamasi yang dapat membahayakan nyawa dan dapat dibagi menjadi kelompok primer dan sekunder. HLH familial (HLH primer) dapat didiagnosa pada usia dibawah 1 tahun pada 70-80% kasus. Pasien dengan mutasi pada gen ini yang mengakibatkan hilangnya fungsi protein secara total, berkembang menjadi HLH primer di masa anak-anak. Studi ini bertujuan untuk melaporkan sebuah kasus bayi dengan kecurigaan HLH di RSUP Prof. Dr. I.G.N.G. Ngoerah.

Laporan Kasus: Pasien bayi laki-laki berusia 4 bulan datang ke fasilitas kesehatan dengan keluhan utama demam. Demam naik turun sejak tanggal 1 Agustus 2020 dan dalam 24 jam terakhir pasien mengalami demam yang naik turun sebanyak 3 kali. Keluhan lain seperti batuk, pilek, sesak, mimisan, gusi berdarah, dan bintik merah pada tubuh pasien disangkal oleh orang tua pasien. Pada pemeriksaan fisik ditemukan splenomegali schuffner III. Pemeriksaan laboratorium hematologi dan faal femostasis menunjukkan bahwa terdapat gambaran sumsum tulang hiposeluler dengan kecurigaan penyakit metabolik, hasil pemeriksaan rontgen menunjukkan adanya suspek splenomegali. Pasien terdiagnosis dengan observasi bisitopenia dengan splenomegali et causa suspek HLH dengan diagnosis banding penyakit Gaucher. Pasien akhirnya diberikan terapi suportif berupa cairan, zinc peroral, dan parasetamol jika demam muncul.

Simpulan: Studi ini melaporkan satu kasus pasien laki-laki berusia 4 bulan dengan kecurigaan HLH. Pemeriksaan yang telah dilakukan menunjukkan bahwa pasien ini memenuhi 5 dari 8 kriteria berdasarkan pedoman HLH-2004.

Background: The choice of anesthesia technique in pregnant women is determined by several factors, such as maternal safety considerations (airway evaluation and aspiration risk), technical issues, and anesthesiologist experience. Superimposed preeclampsia is chronic hypertension in pregnant women under gestational age >20 weeks. This disease can become an emergency if neurological symptoms arise and require immediate termination of pregnancy with the option of a section caesarian. This case report discusses general anesthesia in a pregnant patient with a history of hypertension.

Case: Female, 42 years old, 38-39 weeks of pregnancy with a history of hypertension and acute decompensated heart failure (ADHF) profile B, in an intubated state, underwent green code caesarean section under general anesthesia using propofol 200 mg, fentanyl 100 mcg and rocuronium 50 mg. The operation lasted for 50 minutes with stable hemodynamics, no desaturation, and a total bleeding of 300 ml. A Born male baby immediately cried with appearance, pulse, grimace, activity, and respiration (APGAR) score 8-9 and a birth weight of 2,410 grams. Post-cesarean section and anesthesia, the patient were in good condition without persistent complications.

Conclusion: The general anesthesia technique of caesarean section is preferred in patients with superimposed preeclampsia with neurological complications because it has rapid induction, optimal airway control, and lower risk of hypotension and cardiovascular instability.

Latar belakang: Pilihan teknik anestesi pada ibu hamil ditentukan beberapa faktor seperti pertimbangan keselamatan ibu (evaluasi jalan napas dan risiko aspirasi), masalah teknik, dan pengalaman ahli anestesi. Superiomposed preeclampsia adalah hipertensi kronik yang terjadi pada ibu hamil dengan usia kehamilan >20 minggu. Penyakit ini dapat menjadi suatu kondisi kegawatan apabila timbul gejala neurologis dan membutuhkan tindakan terminasi kehamilan dengan sesegera mungkin dengan pilihan operasi cesar. Laporan kasus ini membahas anestesi general pada pasien gravida dengan riwayat hipertensi.

Kasus: Perempuan, 42 tahun, gravida 38-39 minggu dengan riwayat penyakit hipertensi dan acute decompensated heart failure (ADHF) profil B, dalam keadaan sudah terintubasi telah menjalani bedah cesar green code dengan anestesi general menggunakan propofol 200 mg, fentanil 100 mcg dan rokuronium 50 mg. Operasi berlangsung selama 50 menit dengan hemodinamik stabil, tidak terjadi desaturasi dengan total perdarahan 300 ml. Lahir bayi laki-laki langsung menangis dengan skor appearance, pulse, grimace, activity, and respiration (APGAR) 8-9 dan berat badan lahir 2.410 gram. Pasca operasi pasien masih dalam pengaruh obat dan dirawat di ruang terapi intensif. Pasca operasi cesar dan anestesi, pasien didapatkan dalam kondisi baik dan tidak didapatkan komplikasi menetap.

Simpulan: Teknik anestesi general pada bedah cesar lebih dipilih pada pasien superimposed preeclampsia dengan komplikasi neurologis karena memiliki induksi yang cepat, pengendalian jalan nafas yang optimal, dan risiko hipotensi dan instabilitas kardiovaskular lebih rendah.

Introduction: Even though endometriosis is relatively common among women of reproductive age, endometriosis of the appendix is rare. It has various clinical presentations and sometimes mimics appendicitis. Diagnosis is made from microscopic examination.

Case Description: Here, we report a case of a 42-year-old woman with severe right lower abdominal pain. An appendectomy was performed, and the tissue specimen was analyzed. Endometrial glands and stroma were found in the muscularis propria and serosa. The diagnosis of appendiceal endometriosis was established histologically.

Conclusion: Endometriosis of the appendix is a rare case. It can mimic appendicitis and is hard to detect preoperatively. A histopathology examination was recommended to confirm the diagnosis. 

Introduction: Blowout fracture is a traumatic deformity of the orbital wall and the repair is indicated when enophthalmos is troublesome to the patient, or when diplopia interferes patient’s activities. Iliac bone has been reported in the immediate and secondary repair of orbital wall deformities following blowout fracture. This case is to report blowout fracture management using iliac bone graft.

Case Illustration: A 35 years old man complains pain on his left eye when moving his eye and diplopia in upgazed since 4 months after fell down from stairs. Eye position is orthophoria, visual acuity 6/6 on both eye, anterior and posterior segments are normal, restricted movement to superior on left eye, Hertel exophthalmometry examination on right eye 15 mm and left eye 10 mm (base 90). On CT-scan examination, it was found that an orbital floor fracture was characterized by herniation of the orbital tissue. The patient was diagnosed with left eye enophthalmos, suspect inferior rectus muscle and adnexal entrapment and neglected blow out fracture. LE Repair Orbital Floor Fracture, Release Muscle Rectus Inferior, Exploration (join op with Plastic Reconstructive and Aesthetic Surgery Department) is done to this patient.

Conclusion: Iliac bone graft can be used as an alternative in orbital floor reconstruction, since it easy to harvest, low risk to rejected or extruded and can be used in large defect. Optimal outcome of blowout fracture repair can be achieved if the surgical management is done before two weeks after the incidence.

Background: Psoriasis vulgaris is an inflammatory skin disease characterized by epidermal hyperplasia, and Hepatitis C Virus (HCV) is reported to be one of the infections that can trigger psoriasis. Treatment safety is a particular concern, especially in patients with comorbidities. This case report describes an asymptomatic hepatitis C condition that can trigger psoriasis and is an important concern in administering biological agent therapy, especially secukinumab.

Case: A 42-year-old man, with the main complaint of reddish spots accompanied by scales on the body, arms and legs that have been worsening since 1 month ago. The patient was diagnosed with psoriasis vulgaris 6 years ago from history and physical examination with methotrexate treatment for 3 years. During therapy, the patient complained of yellowing of the body and tired easily found an increase in liver function 3 times the normal value during monitoring and found reactive anti-HCV and an increase in HCV RNA titer (diagnosed with chronic hepatitis C infection). The therapy was given as direct-acting antiviral (DAA) for 3 months and only topical steroids for skin lesions. After DAA therapy, the patient started subcutaneous injections of secukinumab 150 mg for 6 cycles when the PASI score was 11 and found clinical improvement and markers of hepatitis C infection.

Conclusion: There are not much data regarding the efficacy of using secukinumab in psoriasis with reactive anti-HCV, which hepatitis C is suspected as the trigger of psoriasis. Evaluation after DAA therapy and injection of 6 cycles of secukinumab found improvement of the lesion and undetectable HCV RNA titers.

Latar belakang: Psoriasis vulgaris adalah penyakit inflamasi kulit yang ditandai dengan hiperplasia epidermal dan hepatitis C virus (HCV) dilaporkan menjadi salah satu infeksi yang dapat mencetuskan psoriasis. Keamanan terapi menjadi perhatian khusus terutama pada kondisi pasien dengan komorbiditas. Laporan kasus ini menjelaskan kondisi hepatitis C asimptomatis dapat mencetuskan psoriasis dan menjadi perhatian penting pada pemberian terapi agen biologis, khususnya secukinumab.

Kasus: Seorang laki-laki berumur 42 tahun, dengan keluhan utama berupa bercak kemerahan disertai sisik di badan, lengan dan tungkai yang memberat sejak 1 bulan yang lalu. Pasien didiagnosa psoriasis vulgaris sejak 6 tahun lalu dari anamnesis dan pemeriksaan fisik dengan pengobatan metotrexat selama 3 tahun. Selama terapi pasien mengeluhkan tubuh menguning dan mudah lelah serta ditemukan peningkatan fungsi hati 3 kali nilai normal saat monitoring dan ditemukan anti-HCV reaktif, serta peningkatan titer RNA HCV (didiagnosis dengan infeksi hepatitis c kronis). Terapi yang diberikan berupa direct acting antiviral (DAA) selama 3 bulan dan hanya topikal steroid untuk lesi kulit. Pasca terapi DAA pasien memulai injeksi secukinumab 150 mg subkutan sebanyak 6 siklus saat skor PASI 11 dan ditemukan perbaikan klinis serta marker infeksi hepatitis C.

Simpulan: Belum terdapat banyak data mengenai efikasi penggunaan secukinumab pada psoriasis dengan anti-HCV reaktif, dengan adanya kecurigaan hepatitis C sebagai pencetus psoriasis. Evaluasi pasca terapi DAA dan injeksi 6 siklus secukinumab ditemukan perbaikan lesi dan titer HCV RNA tidak terdeteksi.

Introduction: Small bowel volvulus (SBV) is a rare but significant cause of small intestinal obstruction. Ischemia or even infarction is frequently the result. Morbidity and death rates rise when surgical intervention and diagnosis are delayed. Volvulus is a special form of mechanical intestinal obstruction.  It happens when a loop of small intestine twists abnormally around the axis of its mesentery. An acute abdomen is a clinical presentation. The bowel itself may become constricted, strangulation of the blood supply, or both may be the source of the symptoms.

Case Description: A-49-year old female patient was delivered to the emergency department because of severe pain around her abdomen that lasted for one day with a bloated abdomen. Other symptoms she complained of were nausea, vomiting, fever and constipation since one day before hospitalization. She was transferred to the medical ward and initially diagnosed with abdominal pain due to severe dyspepsia. After four days, her complaints were not improved, and she was diagnosed with intraabdominal obstruction and decided to undergo an emergency laparotomy. During surgery, there was a small bowel volvulus due to multiple adhesion in the small intestine, which caused all of her symptoms. After total 8 days of hospitalization, the patient was finally discharged.

Conclusion: Diagnosing SBV can be difficult, especially if the sign of ileus obstruction is not yet fully developed. Early diagnosis and suspicion are pivotal in SBV because a delay in the surgical treatment can be disastrous.

BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Manifestations of ALL vary from pallor, organomegaly, fever, and pancytopenia. Bone pain caused by vertebrae fracture is an uncommon manifestation of ALL, approximately only 16% of all bone pain occurrences. Fractures in ALL could occur at diagnosis and following treatment initiation. This case report described vertebrae compression fracture due to osteonecrosis as the initial sign of childhood acute lymphoblastic leukemia.

CASE: An 8-year-10-month girl was referred to an orthopedic because of worsened low back pain since 1 month before, with no history of trauma. The pain was throbbing and radiated to the lower extremities. The patient was non-ambulant due to the pain. Physical examination revealed the visual analog scale was 8, tenderness in the spine, decreased strength, and range of movement in the lower extremities. There was no organomegaly in this patient. Serial laboratory examination revealed mild pancytopenia (leukopenia, mild normochromic normocytic anemia, mild thrombocytopenia) with dominancy of lymphocytes (68.1-81.9%). No blast was found in the peripheral blood smear. Magnetic Resonance Imaging of the spine revealed compression of the vertebral corpus with a pincer fracture and bone infarction. Bone marrow aspiration showed ALL-L2 with lymphoblast 50%. The patient started chemotherapy with ALL standard risk protocols and got zoledronic acid during the treatment. The patient's condition gradually improved, and able to undergo chemotherapy protocol. No side effects of zoledronic acid occurred.

CONCLUSION: Vertebrae compression fracture without trauma and pancytopenia can be an early symptom of ALL. Zoledronic acid can be given concurrently with chemotherapy for bone mineralization.

Background: Headache is the most common symptom in patients with brain tumors, whereas a developing brain tumor generally increases intracranial pressure and brain edema. Brain tumors have symptoms including nausea, vomiting, seizures, neurological deficits, and mental status or consciousness changes. Heart rhythm disturbances can occur, including bradycardia (heart rate below 60x/minute), a common symptom in brain tumor patients.

Case Presentation: In this case report, a young adult male patient was found with headache symptoms, a previous history of syncope, and sinus bradycardia on the EKG examination, but on physical examination, there were no symptoms of neurological deficits. Head CT scan with contrast found a tumor in the left frontal lobe associated with high intracranial pressure and brain edema that explained the symptoms.

Conclusion: The relationship between headache and bradycardia, accompanied by a history of syncope, is close and can be regarded as an early sign of a brain tumor. In this case, a brain tumor found based on pathological examination is diffuse astrocytoma.

Background: Laryngomalacia is a congenital disorder caused by collapse of the supraglottis structure that causes stridor in neonates and infants. The cause of laryngomalacia is still under further research but currently there are 3 theories that can cause laryngomalacia, namely neurological disorders, GERD and anatomical abnormalities. This case report aims to evaluate the laryngomalacia case in a child.

Case reports:  A toddler aged 2 months with complaints of choking every time he eats and drinks followed by wheezing. The patient had previously been treated with the same complaint by the Pediatric Surgery Department and was diagnosed with pyloric stenosis, was given therapy and the complaint disappeared but reappeared so that a CT scan was carried out and found hydrocephalus and medulloblastoma. Then, on supporting examination, flexible laryngoscopy found an omega-shaped larynx, with a wide airway and an NGT tube.

Conclusion: In infant and toddler patients with complaints of frequent choking while eating and drinking can still be a clinical sign of laryngomalacia that needs to be proven by flexible laryngoscopy examination and periodic evaluation of clinical complaints and symptoms which are very important in determining further therapy

Latar Belakang: Laringomalasia adalah sebuah kelainan kongenital yang diakibatkan oleh kolaps dari struktur supraglotis, menyebabkan stridor pada neonatus dan bayi. Penyebab terjadinya laringomalasia masih dalam penelitian lanjutan, namun saat ini didapati 3 teori yang menyebabkan terjadinya laringomalasia yaitu gangguan neurologis, adanya GERD serta kelainan anatomis. Laporan kasus ini bertujuan untuk mengevaluasi kasus laringomalasia pada anak.

Presentasi Kasus: Seorang balita usia 2 bulan dengan keluhan tersedak setiap kali makan dan minum diikuti dengan nafas berbunyi. Pasien sebelumnya telah dirawat dengan keluhan yang sama oleh Bagian Bedah Anak dan didiagnosis dengan stenosis pylorus, diberikan terapi dan keluhan menghilang namun muncul kembali sehingga dilakukan pemeriksaan penunjang CT Scan ditemukan adanya hydrosephalus dan medulablastoma. Kemudian pada pemeriksaan penunjang laringoskopi fleksibel didapati gambaran laring berbentuk omega, dengan airway lapang dan tampak pipa NGT.

Kesimpulan: Pada pasien bayi dan balita dengan keluhan sering tersedak pada saat makan dan minum masih merupakan satu tanda klinis laringomalasia yang perlu dibuktikan dengan pemeriksaan laringoskopi fleksibel serta evaluasi berkala terhadap keluhan dan gejala klinis yang sangat penting dalam menentukan terapi lanjutan

Background: Transfusion-associated circulatory overload (TACO) is a serious complication after blood transfusion. Although the incidence of TACO ranges from 0.1% to 10% of all blood transfusions, the mortality rate is quite high, up to 11 cases per 100,000 transfusions. This literature review aims to identify strategies for managing and preventing TACO in daily clinical practice.

Methods: This literature review was conducted by searching studies on online databases in the form of PubMed, Cochrane Library, and Google Scholar using the keywords “Transfusion-Associated Circulatory Overload” (TACO)”, “blood transfusion”, “pathophysiology”, “management”, “prevention”. Appropriate studies then carried out a narrative synthesis analysis.

Results: In TACO, excess fluid causes pulmonary edema, which can lead to respiratory distress. The main mechanism of TACO is hydrostatic pulmonary edema, in which the accumulation of fluid in the pulmonary capillaries then causes an increase in hydrostatic pressure. The management of TACO includes immediately stopping the administration of transfusion products and supportive therapy in the form of supplemental oxygen administration and administration of diuretics such as furosemide. In contrast, prevention of TACO can be done with a restrictive transfusion strategy, rules for using single-dose red blood cell transfusions, identification of high-risk patients using algorithms or checklists, intensive monitoring of at-risk patients, administration of blood product infusions at a slow rate, and use of diuretic drugs preemptive in at-risk patients.

Conclusion: The main key to the management of TACO is to prevent the further formation of pulmonary edema by stopping the administration of transfusions and giving oxygen and diuretics. Meanwhile, preventive measures can be taken by restricting blood product administration, identifying high-risk patients and pre-emptive diuretic administration.

Latar belakang: Transfusion-associated circulatory overload (TACO) merupakan salah satu komplikasi serius pasca transfusi darah. Meskipun insiden TACO berkisar antara 0,1% hingga 10% dari semua transfusi darah., angka mortalitasnya tergolong cukup tinggi yakni hingga 11 kasus per 100.000 transfusi. Tinjauan pustaka ini bertujuan untuk mengetahui strategi penatalaksanaan dan pencegahan TACO dalam praktik klinis sehari-hari.

Metode: Tinjauan pustaka ini dilakukan dengan pencarian studi pada basis data online berupa PubMed, Cochrane library, dan Google Scholar dengan menggunakan kata kunci “Transfusion-Associated Circulatory Overload” “(TACO)”, “blood transfusion”, “pathophysiology”, “management”, “prevention”.  Studi yang sesuai kemudian dilakukan analisis sintesis secara naratif.

Hasil: Pada TACO terjadi kelebihan cairan yang menimbulkan edema paru yang dapat berujung pada distres nafas. Mekanisme utama terjadinya TACO adalah edema pulmoner hidrostatik, dimana akumulasi cairan pada kapiler pulmoner kemudian menyebabkan peningkatan tekanan hidrostatik. Penatalaksanaan TACO meliputi pengehentian pemberian produk transfusi dengan segera dan terapi suportif berupa pemberian oksigen supplemental serta pemberian diuretik seperti furosemide. Sedangkan pencegahan TACO dapat dilakukan dengan strategi transfusi yang restriktif, aturan penggunaan transfusi sel darah merah dosis tunggal, identifikasi pasien berisiko tinggi dengan menggunakan algoritma atau ceklist, monitoring intensif pada pasien berisiko, pemberian infus produk darah dengan kecepatan lambat, dan penggunaan obat-obatan diuretik preemtif pada pasien berisiko.

Simpulan: Kunci utama penatalaksanaan TACO adalah mencegah terbentuknya edema paru lebih lanjut dengan menghentikan pemberian transfusi dan pemberian oksigen serta diuretik. Sedangkan tindakan pencegahan dapat dilakukan dengan restriksi pemberian produk darah, identifikasi pasien berisiko tinggi hingga pemberian diuretik preemtif.

Background: Coronavirus Disease 2019 (COVID-19) is a highly contagious disease and has become a worldwide pandemic due to Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) infection. In post-COVID-19 patients, about 10% of patients remain symptomatic for more than three weeks, and less than 10% of patients experience sequelae for months. Patients who have sequelae, known as long COVID syndrome, can experience various impairments in structure and function. Not only in the respiratory tract, but sequelae can also occur in some organs such as the cardiovascular system, musculoskeletal, and even psychological nervous system.

Literature review: Medical rehabilitation has a role in improving functional abilities and improving the quality of life of patients after COVID-19 infection. To find out the impairment that occurs in patients after COVID-19 infection, screening and assessment are needed to determine the severity experienced in COVID-19 survivors. Rehabilitation services are provided in accordance with the severity of patients after COVID-19 infection. There are three levels of recommended rehabilitation service models, such as specialist multidisciplinary team (MDT) services, community-based therapy teams, and self-management.

Conclusion: The rehabilitation program for post-COVID-19 patients is given specifically and differently for each individual, depending on the severity and functional impairment experienced. For this reason, screening and assessment of COVID-19 survivors is needed, especially those at high risk of experiencing long COVID syndrome.

Latar belakang: Coronavirus Disease 2019 (COVID-19) merupakan penyakit yang sangat menular dan menjadi pandemi di seluruh dunia akibat infeksi Severe Acute Respiratory Syndrome Coronavirus (SARS-COV2). Pada pasien pasca infeksi COVID-19 sekitar 10% pasien tetap mengalami gejala hingga lebih dari tiga minggu dan kurang dari 10% pasien mengalami gejala sisa hingga berbulan-bulan. Pasien yang memiliki gejala sisa atau yang dikenal dengan sindrom long COVID dapat mengalami berbagai gangguan struktur dan fungsi tubuh. Tidak hanya pada saluran pernapasan, gejala sisa juga dapat terjadi pada beberapa organ seperti sistem kardiovaskular, muskuloskeletal dan sistem saraf bahkan psikologis.

Tinjauan kepustakaan: Rehabilitasi medik memiliki peran dalam meningkatkan kemampuan fungsional dan meningkatkan kualitas hidup pasien pasca infeksi COVID 19. Untuk mengetahui gangguan yang terjadi pada pasien pasca infeksi COVID-19 maka dibutuhkan screening dan assessment untuk menentukan tingkat keparahan yang dialami pada penyintas COVID-19. Pelayanan rehabilitasi yang diberikan sesuai dengan tingkat keparahan pasien pasca infeksi COVID 19. Terdapat tiga tingkatan model pelayanan rehabilitasi yang direkomendasikan yaitu pelayanan specialist multidisciplinary team (MDT), tim terapi berbasis komunitas, dan self-management.

Simpulan: Program rehabilitasi pada pasien pasca COVID 19 diberikan secara spesifik dan berbeda pada setiap individu tergantung dari tingkat keparahan dan gangguan fungsi yang dialami. Untuk itu diperlukan screening dan assessment pada penyintas COVID-19 terutama yang berisko tinggi mengalami sindrom long COVID.

Background: Caesarean section is one of the most frequently performed major surgical procedures worldwide. Peritoneal sutures in the cesarean section are performed via absorbable or delayed sutures. There is controversy over the choice of technique (continuous or interrupted) to close this layer, even among surgeons who believe in closing this layer. Overall, there are still differing opinions regarding the closure of this layer. This study examines how the study of the impact of peritoneal closure with no closure at the cesarean section on the risk of adhesions.
Methods: Systematic Literature Review Research is the method selected by researchers in this study. Researchers will describe facts, data and information obtained from literature studies such as books and journals to research results related to the research topic. The quality of the articles was reviewed based on PRISMA and PICO guidelines so that as many as 7 articles were synthesized in the final review report from the literature.
Results: It is known that the incidence of births worldwide by Caesarean section (CS) is increasing. Many births after CS have previously been performed by repeat surgery, either with elective CS or after an unsuccessful delivery attempt. The formation of these adhesions is associated with increased maternal morbidity in patients with recurrent CS. In studies, non-closure of the peritoneum appears to save time and costs and therefore lacks the adhesions that cause infertility. However, not closing the parietal peritoneum will cause adhesions without causing infertility. These adhesions can cause long operating times, recovery, and increased postoperative pain in the second cesarean section.
Conclusion: Caesarean section is a very common surgical procedure worldwide. Suturing the peritoneal lining in the cesarean section can provide benefits or not. Therefore it is necessary to evaluate whether this step should be omitted.

Background: Obesity in children has its impact when the child experiences infectious conditions common in childhood, such as pneumonia. The increasing incidence of obesity in children in the last three decades forms the basis for compiling this review article. This review article aims to provide current insights about the impact of obesity on respiratory physiology, inflammatory conditions in pneumonia, and drug pharmacodynamics.

Methods: This literature review uses the latest literature relevant to matters affecting pneumonia management and clinical approach in children with obesity. This literature was obtained from various sources of other scientific literature.

Results: Obesity affects the respiratory physiology of children to collapse more easily, energy use becomes less efficient, children become tired, and hypoxemia occurs easily. Obesity also increases the degree and ease of inflammation in pneumonia and affects the pharmacodynamics of several drugs commonly used to manage pneumonia.

Conclusion: Management of pneumonia in children with obesity requires vigilance and more stringent monitoring and adjustment of drug doses.

Peritoneal dialysis can be a treatment for kidney replacement therapy, and the lining of the abdomen can be used as the filter for dialysis. The dialysate is inserted into the abdomen through a peritoneal dialysis catheter. Conventionally, people would wait two weeks after getting a catheter insertion before starting dialysis. This period was to give enough time for the wound to heal correctly. But some studies found that chronic kidney disease patients who need to begin dialysis immediately after having a catheter insert (urgent-start peritoneal dialysis) had similar results to those who started dialysis more than two weeks after inserting the catheter (conventional-start peritoneal dialysis). Peritoneal dialysis is a significant method of kidney replacement therapy. Most patients who need dialysis right away are given hemodialysis instead of peritoneal dialysis, which means that peritoneal dialysis is not used as much as it could be. Urgent-start peritoneal dialysis is an effective and cost-effective option instead of starting conventional dialysis. There is not enough evidence to help guide the treatment, but involvement of the knowledge with this technique is required. This article overviews why urgent-start peritoneal dialysis is important and how it can be used in practice.

The term osteosarcopenia has been coined to describe the concomitant occurrence of osteopenia/osteoporosis and sarcopenia. Osteosarcopenia can occur in patients with SLE due to the inflammatory process and long-term use of glucocorticoids which play a role in the pathophysiology of osteosarcopenia. Until now there is no definite recommendation regarding when to carry out early detection of osteosarcopenia in patients with SLE, but there is a recommendation to carry out screening after 3 months of long-term glucocorticoid use to determine the incidence of glucocorticoid-induced osteoporosis. The gold standard for assessing bone mass is dual X-ray absorptiometry (DXA). For prevention of osteosarcopenia, identification and treatment of modifiable risk factors such as endocrine disorders is essential. In addition, the risk of developing sarcopenia and osteopenia can be reduced through healthy lifestyle changes that optimize stem bone mass and maintain musculoskeletal health throughout life, including regular physical activity and adequate nutrition (intake of calcium, vitamin D and protein).

Istilah osteosarkopenia telah diciptakan untuk menggambarkan kejadian bersamaan dari osteopenia/osteoporosis dan sarkopenia. Osteosarkopenia dapat terjadi pada pasien SLE akibat proses inflamasi dan penggunaan glukokortikoid jangka panjang yang berperan dalam patofisiologi osteosarkopenia. Sampai saat ini belum ada anjuran pasti mengenai kapan harus dilakukan deteksi dini osteosarkopenia pada pasien SLE, namun ada anjuran untuk melakukan skrining setelah 3 bulan penggunaan glukokortikoid jangka panjang untuk mengetahui kejadian osteoporosis akibat glukokortikoid. Standar emas untuk menilai massa tulang adalah dual X-ray absorptiometry (DXA). Untuk pencegahan osteosarkopenia, identifikasi dan pengobatan faktor risiko yang dapat dimodifikasi seperti gangguan endokrin sangat penting. Selain itu, risiko terjadinya sarkopenia dan osteopenia dapat dikurangi melalui perubahan gaya hidup sehat yang mengoptimalkan massa tulang induk dan menjaga kesehatan muskuloskeletal sepanjang hidup, termasuk aktivitas fisik secara teratur dan nutrisi yang cukup (asupan kalsium, vitamin D, dan protein).

Introduction: This study aimed to describe the history, clinical presentation, laboratory examination, treatment, and long-term functional characteristics of patients with septic arthritis of the temporomandibular joint (SATMJ).

Methods: All articles in the English literature on SATMJ were queried using PubMed, Science Direct, and Google Scholar (2013 to 8 March 2023), and the keywords "temporomandibular OR TMJ AND septic arthritis". Articles are included if related to the SATMJ in patients of all ages, using case reports, case series, and cohort studies. The Newcastle-Ottawa Scale was applied to all included investigations. Article selection followed PRISMA’s guidelines for measuring the quality of systematic reviews.

Results: A preliminary literature search yielded 220 results, of which 25 matched the inclusion requirements, and one more came via reference checking. There were 25 cases with a mean age of 26.7 years (0.1 to 85). Symptoms mainly consisted of TMJ/preauricular pain (n=17, 42.5%), trismus (n=20, 50%), and facial/preauricular swelling (n=24, 60%). Most patients had no systemic symptoms (n=16, 40%). The average mouth opening measured 16.3 mm (5 to 36). The diagnosis was made using the following imaging techniques: X-ray (n=6, 15%), CT scan (n=33, 82.5%), MRI (n=16, 40%), and ultrasound (n=1, 2.5%). Staphylococcus aureus (n = 10, 25%) was the most frequently isolated. Approximately 40 patients (100%) received antibiotics, 26 (65%) patients underwent surgery (e.g., joint aspiration, arthroscopy, etc.), of which two patients (5%) required further surgical intervention. In general, long-term results were positive. In 10 of the 40 patients (25%) who had documented follow-up, sequelae occurred.

Conclusion: In the event of trismus, jaw pain, or preauricular edema, SATMJ should be considered. Quick examination and broad-spectrum antibiotic treatment are part of management. Although surgery is not always necessary, it can be life-saving in serious circumstances.

Introduction: Vascular access with non-tunneled and tunneled hemodialysis catheters in patients with chronic kidney disease can cause complications such as neointimal hyperplasia. Creating vascular access will cause injury to the endothelium and its underlying layer, which in turn will cause a series of inflammatory reactions. This study was conducted to determine the initial response of neointimal hyperplasia in blood vessels after vascular access in chronic kidney disease by increasing the monocyte lymphocyte ratio, neutrophil lymphocyte ratio, and platelet lymphocyte ratio after insertion of tunneled and non-tunneled catheters.

Methods: The research method is observational analysis with a retrospective cohort design. Sampling was taken using the consecutive sampling method in adult patients with chronic kidney failure who were inserted with tunneled and non-tunneled hemodialysis catheters at Prof. Dr. General Hospital, I.G.N.G. Ngoerah Denpasar. The statistical test uses paired T-test and unpaired T-test with a significance level of 0.05.

Results: A significant difference was found in the value of the neutrophil-lymphocyte ratio in tunneled hemodialysis catheters (mean difference: 0.51; 95% CI: -0.89–(-0.13); p value: 0.01) and non-tunneled (mean difference: 0.04; 95% CI: -0.08–(-0.001); p-value: 0.043). There was no significant difference in the monocyte-lymphocyte ratio after and before insertion of the tunneled hemodialysis catheter (mean difference: 0.04; 95% CI: -0.003–0.81; p value: 0.07) or non-tunneled (median difference: 0.06; p: 0.925). There was a statistically significant difference in the mean platelet-lymphocyte ratio after and before insertion of the tunneled hemodialysis catheter (mean difference: 32.24; 95% CI: -54.11–(-10.38); p-value: 0.005), but no significant difference was found in the placement of non-tunnelled hemodialysis catheters (mean difference: 26.24; 95% CI: -61.47–9.0; p value: 0.14).

Conclusion: There were differences in the inflammatory response after and before the insertion of tunneled and non-tunneled hemodialysis catheters, especially in the value of the neutrophil-lymphocyte ratio.

Pendahuluan: Akses vaskular dengan pemasangan kateter hemodialisa non tunnelled  dan tunnelled  pada pasien penyakit ginjal kronis dapat menimbulkan komplikasi seperti neointimal hiperplasia. Tindakan pembuatan akses vaskuler akan menyebabkan cedera pada endotel dan lapisan dibawahnya yang selanjutnya akan menyebabkan rangkaian reaksi inflamasi. Penelitian ini dilakukan untuk mengetahui respon awal neointimal hiperplasia pada pembuluh darah yang dilakukan pemasangan akses vaskuler pada penyakit ginjal kronis melalui peningkatan nilai rasio monosit limfosit, rasio neutrofil limfosit, dan rasio trombosit limfosit setelah pemasangan kateter tunnelled dan non tunnelled.

Metode: Metode penelitian berupa analitik observasional dengan rancangan kohort retrospektif. Pengambilan sampel dengan metode consecutive sampling, pada pasien dewasa dengan gagal ginjal kronis yang dilakukan insersi kateter hemodialisis tunnelled dan non-tunnelled di RSUP Prof Dr. I.G.N.G Ngoerah Denpasar. Uji statistic menggunakan Uji T-berpasangan dan Uji T-tidak berpasangan dengan tingkat kemaknaan α=0.05.

Hasil: Ditemukan perbedaan yang signifikan dari nilai rasio neutrofil-limfosit pada pemasangan kateter hemodialisis tunnelled (selisih rerata:0,51; IK95%: -0,89 – (-0,13); nilai p: 0,01) dan non-tunnelled (selisih rerata: 0,04; IK95%: -0,08 – (-0,001); nilai p: 0,043). Tidak terdapat perbedaan yang bermakna dari rasio monosit-limfosit setelah dan sebelum pemasangan kateter hemodialisa tunnelled (selisih rerata: 0,04; IK95%: -0,003 – 0,81 ; nilai p: 0,07) maupun non- tunnelled (selisih median: 0,06; p: 0,925). Adanya perbedaan yang bermakna secara statistik dari rerata rasio trombosit limfosit setelah dan sebelum pemasangan kateter hemodialisa tunnelled (selisih rerata: 32,24; IK95%: -54,11 – (-10,38); nilai p: 0,005), namun tidak ditemukan perbedaan yang bermakna pada pemasangan kateter hemodialisa non-tunnelled (selisih rerata: 26,24; IK95%: -61,47 – 9,0; nilai p: 0,14).

Simpulan: Terdapat perbedaan respon inflamasi setelah dan sebelum pemasangan kateter hemodialsis tunnelled dan non-tunnelled, khususnya pada nilai rasio neutrofil-limfosit.

Background: Maintaining the homeostasis of body fat levels is an important thing. ABCA1 is an important protein in cholesterol efflux function, which can maintain lipid profile homeostasis. Purple sweet potato (potato ipomoea batatas) is a Convolvulaceae plant with various biological functions, one of which is anthocyanin content known to prevent hyperlipidemia through ABCA1 synthesis.   This study aims to examine the effect of purple sweet potato tuber extract on increasing levels of ABCA1.

Methods: Post-test-only study design with a control group using 50 male Wistar rats divided into 5 groups (n = 10). The negative treatment group (P0) was given standard feed, while the positive group (P4), treatment 1 (P1), treatment 2 (P2) and treatment 3 (P3) were given a hyperlipidemic diet for 8 weeks. The treatment group was then given purple sweet potato tuber extract with 3 doses, including 200mg/kg (P1), 400mg/kg (P2), and 800mg/kg (P3) for 2 weeks, and the food was returned to standard food.

Results: There was a significant increase in ABCA1 levels in P2 and P3 compared to negative controls (P <0.05), but the increase in ABCA1 in P3 was not different from positive controls.

Latar Belakang : Menjaga homeostasis kadar lemak tubuh merupakan hal yang penting. ABCA1 merupakan protein yang penting dalam fungsi efluks kolestrol yang dapat menjaga homeostasis profil lipid. Ubi ungu (Ipomoea batatas) merupakan tanaman Convolvulaceae yang memiliki berbagai fungsi biologis, salah satunya kandungan Antosianin yang diketahui dapat mencegah hiperlipidemia melalui sintesis ABCA1. Penelitian ini bertujuan untuk menguji efek ekstrak umbi ubi jalar ungu terhadap peningkatan kadar ABCA1

Metode : Desain penelitian post test only dengan kontrol grup menggunakan 50 ekor tikus wistar jantan yang dibagi menjadi 5 kelompok (n=10). Kelompok perlakuan negatif (P0) diberikan pakan standar sedangkan kelompok positif (P4), perlakuan 1(P1), perlakuan 2(P2) dan perlakuan 3(P3) diberikan diet hiperlipidemia selama 8 minggu. Kelompok perlakuan kemudian diberikan ekstrak umbi ubi jalar ungu dengan 3 dosis, antara lain 200mg/kg(P1), 400mg/kg(P2), 800mg/kg(P3) selama 2 minggu dan makanannya dikembalikan ke makanan standar.

Hasil : Terdapat peningkatan kadar ABCA1 yang signifikan pada P2 dan P3 dibandingkan dengan kontrol negatif (P<0,05) tetapi peningkatan ABCA1 pada P3 tidak berbeda dengan kontrol positif.

Background: Neutrophil Lymphocyte Ratio (NLR), which is the sum of neutrophils divided by lymphocytes, has an important role in determining the inflammatory state in the patient. RNL is one of the markers of inflammation that is simple, rapid, and can be performed on routine blood tests.

Methods: This research is a retrospective descriptive study that examined NLR levels in patients confirmed with the Omicron variant of COVID-19 infection at the Wisma Atlet COVID-19 Hospital, Kemayoran, Jakarta. Data were analyzed using SPSS version 20.0 for Windows.

Results: From 331 samples, 187 samples were found to be female and 144 samples were male. A total of 300 samples had no increase in NLR (NLR <3.13), while the other 31 samples had an increase in NLR (NLR >3.13). Cytokine storm associated with immune dysregulation occurs less in women than in men. Almost all patients with confirmed Omicron variant COVID-19 at the Wisma Atlet Kemayoran Hospital did not experience an increase in NLR.

Conclusion: The cytokine storm associated with immune dysregulation occurs less frequently in women than in men. Almost all patients confirmed with the Omicron variant of COVID-19 at Wisma Atlet Hospital Kemayoran did not experience an increase in NLR.

Latar Belakang: Rasio Limfosit Neutrofil (RNL), yang merupakan jumlah neutrofil dibagi dengan limfosit, memiliki peran penting dalam menentukan keadaan inflamasi pada pasien. RNL merupakan salah satu penanda inflamasi yang sederhana, cepat, dan dapat dilakukan pada pemeriksaan darah rutin.

Metode: Penelitian ini merupakan studi deskriptif retrospektif yang meneliti kadar RNL pada pasien terkonfirmasi infeksi COVID-19 varian Omicron di Rumah Sakit COVID-19 Wisma Atlet, Kemayoran, Jakarta. Data dianalisis dengan SPSS versi 20.0 untuk Windows.

Hasil: Dari 331 sampel, ditemukan 187 sampel berjenis kelamin perempuan dan 144 sampel berjenis kelamin laki-laki. Sebanyak 300 sampel tidak mengalami peningkatan NLR (NLR <3,13), sedangkan 31 sampel lainnya mengalami peningkatan NLR (NLR >3,13). Badai sitokin yang terkait dengan disregulasi imun terjadi lebih sedikit pada wanita dibandingkan pada pria. Hampir seluruh pasien terkonfirmasi varian Omicron COVID-19 di RS Wisma Atlet Kemayoran tidak mengalami peningkatan NLR.

Simpulan: Badai sitokin terkait dengan disregulasi imun, terjadi lebih sedikit pada wanita dibandingkan dengan laki-laki.hampir seluruh pasien terkonfirmasi COVID-19 varian Omicron di RSDC Wisma Atlet Kemayoran tidak mengalami peningkatan RNL.

Introduction: Bladder carcinoma is a common malignancy in women and is the fourth most common malignancy in men. LMR (Lymphocyte monocyte ratio) is an inexpensive and practical inflammatory biomarker that has been introduced to determine prognosis in the field of urology. The aim of this study was to determine the relationship between preoperative LMR (lymphocyte monocyte ratio) and performance status in bladder cancer patients.

Methods: This study is observational with an analytic cross-sectional study approach. This research was conducted at Sanglah Hospital in Denpasar to collect secondary data in the form of medical records from 2018 to 2022. This study used primary and secondary data derived from questionnaires and medical records.

Results: Based on this study, the mean age of the research sample was 60.56 ± 7.606 years. The LMR cut point value for Performance Status is 2.474. In the ROC curve analysis, the area under the curve was found to be 0.917, with a sensitivity value of 86.36% and a specificity of 95.45%. The results of the bivariate analysis showed that based on the results of the analysis it was found that LMR had a significant relationship to performance status (p <0.001) with a PR value of 133.00 (95% CI = 20.510-86.473). The results of the logistic regression test show that LMR (categorized based on the cut point of 2.474) is significantly related to Performance Status.

Conclusion: Based on the research results show that the LMR value is related to Performance Status as measured using the Karnofsky Score.

Pendahuluan: Karsinoma buli adalah keganasan yang umum pada wanita dan merupakan keganasan keempat yang paling umum pada pria. Banyak pemeriksaan biomarker terkait keganasan yang berdasarkan pada gambaran patologis dan marker molecular, namun mahal dan tidak selalu rutin dilakukan sehari-hari. LMR (Lymphocyte monocyte ratio) merupakan salah satu biomarker inflamasi yang murah dan praktis ini mulai diperkenalkan untuk menentukan prognosis di bidang urologi. Tujuan penelitian adalah untuk mengetahui hubungan LMR (lymphocyte monocyte ratio) pre operatif dengan performance status pada pasien karsinoma buli.

Metode: Penelitian ini adalah suatu penelitian observasional dengan pendekatan studi potong lintang analitik. Penelitian ini dilaksanakan di RSUP Sanglah Denpasar untuk melakukan pengambilan data sekunder berupa rekam medis, mulai dari tahun 2018 sampai dengan tahun 2022. Penelitian ini menggunakan data primer dan sekunder  berasal dari kuesioner dan rekam medis.

Hasil: Berdasarkan penelitian ini, rerata usia sampel penelitian adalah sebesar 60,56 ± 7,606 tahun. Nilai titik potong LMR terhadap Performance Status adalah sebesar 2,474. Pada analisis kurva ROC ditemukan nilai area di bawah kurva sebesar 0,917 dengan nilai sensitivitas sebesar 86,36% dan spesifisitas sebesar 95,45%. Hasil analisis bivariat menunjukkan bahwa Berdasarkan hasil analisis ditemukan bahwa LMR memiliki hubungan yang signifikan terhadap performance status (p<0,001) dengan nilai PR sebesar 133,00 (IK 95% = 20,510-86,473). Hasil uji regresi logistik menunjukkan bahwa LMR (dikategorikan berdasarkan titik potong 2,474) berhubungan secara signifikan dengan Performance Status.

Simpulan: Berdasarkan hasil penelitian menunjukkan bahwa nilai LMR berhubungan dengan Performance Status yang diukur dengan menggunakan Karnofsky Score.

Background: Newborn babies experience jaundice in about 60% to 80% of cases. Differentiating between intrahepatic and extrahepatic cholestasis may require invasive examinations such as cholangiography and liver biopsy. Liver function tests are used to diagnose early cholestasis, distinguish between intrahepatic and extrahepatic cholestasis, monitor treatment response, and predict prognosis.

Objective: To understand the relationship between liver function tests and intrahepatic and extrahepatic cholestasis.

Methods: An observational analytical study was conducted cross-sectionally, using medical records of cholestasis patients treated at RSUP Prof. Dr. I.G.N.G Ngoerah, Denpasar, from January 2015 to May 2023. The study population comprised infants aged 0-3 months with cholestasis who met the inclusion and exclusion criteria. The diagnosis of intrahepatic and extrahepatic cholestasis was confirmed by liver biopsy.

Results: Among 52 cholestasis patients, 34 had extrahepatic cholestasis (biliary atresia), and 18 had intrahepatic cholestasis. The median AST in the intrahepatic group was 231.0 [31.7 – 790.7], p-value=0.744. The median ALT in the intrahepatic group was 161.6 [10.1 – 408.1], p-value=0.46. The mean ALP in the extrahepatic group was 458.32±152.56, p-value=0.3. The median GGT in the extrahepatic group was 654 [67 – 3568], p-value=0.002. The median total bilirubin in the intrahepatic group was 9.2 [0.19 – 29.35], p-value=0.281. The median conjugated bilirubin in the extrahepatic group was 7.78 [2.07 – 22.9], p-value=0.331.

Conclusion: Laboratory results for liver function tests in patients with intrahepatic and extrahepatic cholestasis did not differ significantly except for GGT, which was higher in patients with extrahepatic cholestasis. GGT showed the best diagnostic ability compared to other liver function test results.

Latar belakang: Bayi baru lahir mengalami penyakit kuning sekitar 60% sampai 80%. Kesulitan dalam membedakan kolestasis intra dan ekstrahepatal memerlukan pemeriksaan invasif seperti kolangiografi dan biopsi hati. Tes fungsi hati digunakan untuk menegakkan diagnosis dini kolestasis, untuk membedakan kolestasis intra dari ekstrahepatik, untuk menindaklanjuti respon pada pengobatan, dan untuk memprediksi prognosis.

Tujuan: Mengetahui hubungan antara tes fungsi hati dengan kolestasis intrahepatik dan ekstrahepatik.

Metode : Penelitian analitik observasional dilakukan secara potong lintang, menggunakan rekam medis pasien kolestasis yang dirawat di RSUP Prof. Dr. I.G.N.G Ngoerah, Denpasar sejak Januari 2015 hingga Mei 2023. Populasi penelitian ini adalah bayi 0-3 bulan dengan kolestasis yang memenuhi kriteria inklusi dan eksklusi. Diagnosis kolestasis intrahepatik dan ekstrahepatik dikonfirmasi oleh biopsi hati.

Hasil: Pada 52 anak kolestasis, 34 anak dengan kolestasis ekstrahepatik (atresia bilier) dan 18 anak dengan kolestasis intrahepatik. Median AST pada kelompok intrahepatal 231,0 [31,7 – 790,7], nilai p=0,744. Median ALT pada intrahepatal 161,6 [10,1 – 408,1], nilai p=0,46. Rerata ALP kelompok ekstrahepatal 458,32±152,56, nilai p=0,3. Median GGT kelompok ekstrahepatal 654 [67 – 3568], nilai p=0,002. Median total bilirubin kelompok intrahepatal 9,2 [0,19 – 29,35], nilai p=0,281. Median bilirubin terkonjugasi kelompok ekstrahepatal 7,78 [2,07 – 22,9], nilai p=0,331.

Simpulan : Hasil laboratorium untuk uji fungsi hati pasien dengan kolestasis intrahepatik dan ekstrahepatik tidak berbeda secara signifikan kecuali untuk GGT yang lebih tinggi pada pasien kolestasis ekstrahepatik. GGT memiliki kemampuan diagnostik terbaik dibandingkan dengan hasil tes fungsi hati lainnya.

Introduction: Skin aging is a biological process that cannot be avoided. Repeated UVB exposure increases collagen degradation by increasing MMP-9 levels. Little is known about TIMP-1's potential role in skin protection or recovery from skin damage caused by photoaging. Sugar apple leaf extract increases cell proliferation, levels and collagen deposition. This study aims to determine the topical application of sugar apple leaf cream extract (Annona squamosa L.) to increase TIMP-1 levels and decrease MMP-9 levels in Wistar rats (Rattus norvegicus) exposed to UVB light.

Methods: Experimental study with a post-test-only design with a control group design using 35 male Wistar rats. There were five groups: negative control, positive control, and treatment (5%, 10%, and 20% sugar apple leaf extract cream). Skin biopsies were taken to measure TIMP-1 and MMP-9 levels using the ELISA method. Data analysis was performed using the SPSS 25.0 application.

Results: The phytochemical test showed total flavonoid levels of 3583.77 mg QE/100 mL, phenol 5244.98 mg GAE/100 mL, IC50 value 226.53 ppm, and alkaloids. The highest mean TIMP-1 level in the treatment group was 38.95 ± 3.31 ng/mL, and the lowest mean MMP-9 level was 2.94 ± 1.66 ng/mL (20% concentration). One Way ANOVA showed that there were significant differences in TIMP-1 and MMP-9 levels between the test groups with a p<0.001. Post hoc LSD analysis showed significantly higher TIMP-1 and lower MMP-9 levels (p<0.05) than the control.

Conclusion: Administration of sugar apple leaf cream extract increased TIMP-1 levels and significantly decreased MMP-9 levels in Wistar rats exposed to UVB light.

Pendahuluan: Penuaan kulit merupakan proses biologis yang tidak dapat dihindari. Paparan UVB berulang meningkatkan degradasi kolagen dengan meningkatkan kadar MMP-9. Potensi keterlibatan TIMP-1 dalam perlindungan kulit atau pemulihan dari adanya kerusakan kulit akibat photoaging masih belum banyak diketahui. Ekstrak daun srikaya diketahui dapat meningkatkan proliferasi sel, kadar dan deposisi kolagen. Tujuan penelitian ini adalah untuk mengetahui aplikasi topikal ekstrak krim daun srikaya (Annona squamosa L.) dalam meningkatkan kadar TIMP-1 dan menurunkan kadar MMP-9 pada tikus wistar (Rattus norvegicus) yang terpapar sinar UVB.

Metode: Penelitian eksperimental dengan rancangan post-test-only with control group design ini menggunakan 35 tikus wistar jantan. Terdapat lima kelompok, yaitu kontrol negatif, kontrol positif, dan perlakuan (krim ekstrak daun srikaya 5%, 10%, dan 20%). Biopsi kulit diambil untuk pengukuran kadar TIMP-1 dan MMP-9 dengan metode ELISA. Analisis data dilakukan dengan menggunakan aplikasi SPSS 25.0.

Hasil: Uji fitokimia menunjukkan kadar total flavonoid sebanyak 3583,77 mg QE/100 mL; fenol 5244,98 mg GAE/100 mL, nilai IC50 226,53 ppm, dan alkaloid positif. Rerata kadar TIMP-1 tertinggi pada kelompok perlakuan adalah 38,95 ± 3,31 ng/mL dan rerata kadar MMP-9 terendah yaitu 2,94 ± 1,66 ng/mL (konsentrasi 20%). Analisis One Way ANOVA menunjukkan terdapat perbedaan kadar TIMP-1 dan MMP-9 yang signifikan antara kelompok uji dengan nilai p<0,001. Analisis post hoc LSD menunjukkan kadar TIMP-1 lebih tinggi dan kadar MMP-9 lebih rendah secara signifikan (p<0,05) dibandingkan kontrol.

Simpulan: Pemberian ekstrak krim daun srikaya dapat meningkatkan kadar TIMP-1 dan menurunkan kadar MMP-9 secara signifikan pada tikus wistar yang terpapar sinar UVB.

Introduction: Type 2 diabetes mellitus in the elderly causes various complications, including sarcopenia, characterized by a decrease in skeletal muscle mass and function. Several previous studies have shown that type 2 diabetes, or high plasma glucose levels cause a reduction in hand grip strength in the elderly. Therefore, this study aims to evaluate the relationship between hand grip strength and blood sugar levels in the elderly in Melinggih Village, Payangan District, Gianyar.

Methods: The study used an analytical method with a cross-sectional approach to 88 elderly people in Melinggih Village, Payangan District, Gianyar. The variables assessed included hand grip strength as the dependent variable and blood sugar levels as the independent variable. Gender, age, education level, body mass index, blood pressure, comorbidities, smoking, and medical history were considered confounding variables. The Asian Working Group guides the criteria for determining hand grip strength for Sarcopenia (AWGS) 2019. Data analysis used the chi-square test and multivariate logistic regression.

Results: Bivariate analysis showed a significant relationship between patients with high plasma glucose levels and weak hand grip strength (p=0.037; OR: 5.938; 95%CI: 1.07-32.75). However, this study found no significant relationship between plasma glucose levels with age, gender, BMI, history of comorbid diseases, smoking, and long-term drug use (p>0.05).

Conclusion: High plasma glucose levels are associated with weak hand grip strength.

Pendahuluan: Diabetes Melitus (DM) tipe 2 pada lansia menyebabkan berbagai macam komplikasi, salah satunya adalah sarkopenia yang ditandai dengan penurunan massa dan fungsi otot rangka tubuh. Beberapa penelitian sebelumnya menunjukkan bahwa DM tipe 2 atau kadar glukosa plasma yang tinggi menyebabkan penurunan kekuatan genggaman tangan pada lansia. Penelitian ini bertujuan untuk mengetahui hubungan antara kekuatan genggaman tangan dengan kadar gula darah sewaktu pada lansia di Desa Melinggih, Kecamatan Payangan Gianyar.

Metode: Penelitian menggunakan metode analitik dengan pendekatan potong lintang terhadap 88 lansia di Desa Melinggih, Kecamatan Payangan, Gianyar. Variabel yang dinilai meliputi kekuatan genggaman tangan sebagai variabel terikat dan kadar gula darah sewaktu sebagai variabel bebas. Jenis kelamin, usia, tingkat pendidikan, indeks massa tubuh, tekanan darah, penyakit penyerta, merokok, dan riwayat pengobatan dianggap sebagai variabel pengganggu. Kriteria untuk menentukan kekuatan genggaman tangan berpedoman pada Asian Working Group for Sarcopenia (AWGS) 2019. Analisis data menggunakan uji chi-square dan regresi logistik multivariat.

Hasil: Analisis bivariat menunjukkan adanya hubungan yang signifikan antara pasien dengan kadar gula darah sewaktu yang tinggi dengan kekuatan genggaman tangan yang lemah (p=0,037; OR: 5,938; 95%CI: 1,07-32,75). Namun dalam penelitian ini tidak ditemukan hubungan yang signifikan antara kadar gula darah sewaktu dengan usia, jenis kelamin, IMT, riwayat penyakit komorbid, merokok, dan penggunaan obat dalam jangka waktu lama (p>0,05).

Simpulan: Kadar gula darah sewaktu yang tinggi berhubungan dengan kekuatan genggaman tangan yang lemah.

Background: Leprosy as one of the neglected tropical diseases which can attack various parts of body causing disability. Indonesia ranks 3^rd in the highest leprosy cases in the world, with six provinces yet to achieve leprosy elimination. Bali Province has achieved leprosy elimination but has yet to achieve free leprosy. Klungkung Regency is included in the top three regencies in Bali, with the highest prevalence of leprosy. In the Pandemic, COVID-19 has impacted efforts to control leprosy. This study aims to determine the prevalence and characteristics of leprosy patients in Klungkung Regency during the COVID-19 pandemic

Methods: A cross-sectional study was conducted using secondary data from Klungkung District Health Office for 2019-2021. The data will be obtained from July-September 2022. The research sample of 22 leprosy patients was obtained by purposive sampling technique.

Results: Leprosy prevalence of 0.95/10,000 population in 2019 (pre-pandemic), 0.1/10,000 population in 2020 (first-year pandemic), and 0.28/10,000 population in 2021 (second-year pandemic). The distribution of leprosy patients is dominant aged 15-64 years (86.4%), male (59.1%), last education SD/equivalent (68.2%), farmer occupation (40.9%), from Nusa Penida sub-district (54.5%), registered in primary health facilities (100%), multibacillary leprosy type (100%), and COVID-19 status is not infected (100%).

Conclusion: The prevalence of leprosy fluctuated in the Klungkung Regency during the COVID-19 pandemic. Has achieved the leprosy elimination target but is categorized as areas with a high burden of leprosy. Leprosy patient in this regency has variant characteristics.

Latar belakang: Kusta sebagai salah satu penyakit tropis terabaikan yang menyerang berbagai bagian tubuh serta dapat menimbulkan kecacatan. Indonesia menempati peringkat ketiga kasus tertinggi di dunia, dengan 6 provinsi belum mencapai eliminasi kusta. Provinsi Bali telah mencapai eleminasi kusta namun belum bebas kusta. Kabupaten Klungkung termasuk dalam 3 besar kabupaten/kota di Bali dengan prevalensi tertinggi. Pandemi COVID-19 membawa dampak pada upaya penanggulangan kusta. Penelitian ini bertujuan untuk mengetahui prevalensi dan karakteristik penderita kusta di Kabupaten Klungkung kurun pandemi COVID-19.

Metode: Penelitian ini menggunakan rancangan cross-sectional dari data sekunder Dinas Kesehatan Kabupaten Klungkung periode tahun 2019-2021. Penarikan data dilakukan selama bulan Juli-September 2022. Sampel penelitian sejumlah 22 penderita kusta didapat dengan teknik purposive sampling.

Hasil: Prevalensi kusta 0,95/10.000 penduduk tahun 2019 (pra pandemi), 0,1/10.000 penduduk tahun 2020 (pandemi tahun pertama), dan 0,28/10.000 penduduk tahun 2021 (pandemi tahun kedua). Distribusi penderita dominan berusia 15-64 tahun (86,4%), laki-laki (59,1%), pendidikan terakhir SD/sederajat (68,2%), pekerjaan petani (40,9%), asal daerah Kecamatan Nusa Penida (54,5%), terdaftar di faskes primer (100%), tipe kusta Multibasiler (100%), dan status COVID-19 tidak terinfeksi (100%).

Simpulan: Prevalensi kusta di Kabupaten Klungkung kurun pandemi COVID-19 berfluktuasi. Telah mencapai target eleminasi kusta namun termasuk daerah dengan beban kusta tinggi (high burden). Karakteristik penderita kusta pada daerah ini beragam. 

Introduction: Lactate was an examination done in patients with shock as a predictor of mortality. The delta shock index (DSI) is one of the parameters that are easy to do but very limited studies related to the benefits of DSI have been found. This study aimed at determining the correlation of DSI and lactate clearance levels in pediatric shock patients treated at the Pediatric Intensive Care Unit (PICU) of Prof Dr. I.G.N.G Ngoerah  Hospital.

Method: This was a prospective cohort study of children diagnosed with shock in a pediatric emergency ward or PICU Prof Dr. I.G.N.G Ngoerah  Hospital. A Spearman correlation test was done since the data distribution was abnormal. Multivariate analysis with multiple regression tests was carried out to assess the pure effect of lactate clearance with DSI. The level of significance was determined based on p <0.05. The general linear model analysis is done on variables that are repeated measurements.

Result: There were 39 subjects obtained in this study, with 34 subjects surviving and 5 subjects not surviving. The median lactate clearance was 28.5 (-95 - 77.7), with a median DSI of 0.45 (0.04-1.3). There were significant differences in the decrease of shock index over time (p = 0.034). The correlation test results showed a weak positive between lactate clearance with DSI (r = +0.351) and p = 0.028. Multivariate analysis test results obtained a value of â 0.002 with p = 0.071.

Conclusion: There was a weak positive correlation between lactate clearance and DSI. There were significant differences in the decrease of shock index over time between survivors and non-survivors.

Introduction. Breast cancer is a disease with complex and heterogeneous condition which can be assessed from its morphology, molecular subtypes, and patient response to treatment. Treatment is individualized based on predictive and prognostic factors. Based on this, molecular examination is very important and the Muhammad Yunus Bengkulu Hospital opened cancer patient services and continues to improve its services, especially for breast cancer. It has been recorded since mid-2021 that were 77 patients who underwent  immunohistochemical examinations independently. The purpose of this study was to determine the distribution of various molecular subtypes of breast cancer at M Yunus Hospital Bengkulu and their relationship with histopathological grading in breast cancer patients.

Method. A cross-sectional study was conducted on breast cancer patients who went  to the Surgical Oncology Polyclinic at M Yunus Bengkulu Hospital. In this study, we used medical record data in the form of laboratory results as research subjects, which were then analyzed  using SPSS 25 for windows. The relationship between variables is stated to  significant if the p-value <0.05.

Results. From 77 breast cancer patients whose molecular subtypes were examined, the average age was 50 (standard deviation of 12) years. Most of the histopathological grades were grade 3 (41.60%), then grade 2 (23.40%), at least grade 1 (5.20%), and could not be determined quite a lot, namely 29.9%. ER status was mostly positive (67.50%), then PR status was more positive (53.20%), HER2 was mostly negative (61.00%), and triple-negative was 13.00%. For Ki67, mostly >20% (75.30%). According to the findings of statistical analyses using the Chi-Square test, p>0.05, indicates that there is no correlation between the histopathological grade and the molecular subtype of breast cancer patients (p=0.199).

Conclusion. Histopathological grading and molecular subtype do not significantly correlate.

Pendahuluan. Kanker pada payudara merupakan suatu penyakit dengan kondisi yang komplek dan heterogen yang dapat dinilai dari bentuk morfologi, subtipe molekuler nya, respon pasien terhadap pengobatan karena pengobatan bersifat individual yang berdasarkan faktor prediktif dan prognostik. Berdasarkan hal tersebut maka pemeriksaan molekuler sangatlah penting, dan di Rumah Sakit Muhammad Yunus Bengkulu membuka layanan pasien kanker dan terus  meningkatkan pelayanannya terutama pada kanker payudara dan sudah tercatat sejak pertengahan 2021 terdapat 77 pasien yang dilakukan pemeriksaan immunohistokimia secara mandiri. Tujuan pada penelitian ini adalah untuk mengetahui distribusi pada berbagai subtipe molekuler kanker payudara di RSUD M Yunus Bengkulu dan  hubungan nya dengan grading histopatologinya pada penderita kanker payudara.

Metode. Studi potong lintang dilakukan pada penderita kanker payudara yang berobat rutin ke Poliklinik Bedah Onkologi di RSUD M Yunus Bengkulu. Pada penelitian ini menggunakan data rekam medik yang berupa hasil laboratorium sebagai subjek penelitiannya yang selanjutnya di analisis menggunakan SPSS 25 for windows. Hubungan antar variabel dinyatakan bermakna apabila nilai p<0,05.

Hasil. Dari total 77 subjek pasien kanker payudara yang di periksa subtipe molekulernya didapatkan rerata usia 50 (simpang baku 12) tahun. Didapatkan grade histopatologis paling banyak grade 3 (41,60%), kemudian grade 2 (23,40%), yang paling sedikit grade 1 (5,20%), dan tidak dapat ditentukan cukup banyak yaitu 29,90%. Status ER sebagian besar positif (67,50%), kemudian status PR lebih banyak positif (53,20%), sedangkan HER2 sebagian besar negatif (61,00%), Triple negatif ada sebesar 13,00%. Ki67 sebagian besar >20% (75,30%). Dari hasil uji statistik dengan Uji Chi-Square p>0.05 yang artinya subtipe molekuler pada pasien kanker payudara tidak memiliki hubungan dengan grading histopatologinya (p=0.199).

Simpulan. Tidak ada hubungan bermakna antara subtipe molekuler dengan grading histopatologis nya.

Background: The characteristics of febrile seizures are generally reported by parents subjectively. The neutrophil-to-lymphocyte ratio (NLR) is proposed as an objective parameter that can distinguish simple and complex febrile seizures. This study aims to assess the difference in NLR in children with simple and complex febrile seizures.

Methods: A cross-sectional study was conducted using secondary data from medical records, at the Sanjiwani Regional General Hospital, Gianyar City, on pediatric patients aged six months to five years diagnosed with febrile seizures and treated in the period January-October 2022. The dependent variable in this study was the classification of febrile seizures, so the sample was divided into simple and complex febrile seizure groups. The NLR value was obtained by calculating the ratio of neutrophil and lymphocyte counts from the complete blood count results. The Mann-Whitney test assessed the difference in NLR value in the two groups.

Results: There were 52 children included as research subjects. The majority of the samples were ≥1 year old (94.2%), female (53.8%), and diagnosed with simple febrile seizure (71.2%). The samples' median (minimum-maximum) NLR was 4.54 (0.4-16.4). This study found no significant difference in NLR values between the simple and complex febrile seizure groups (p = 0.976).

Conclusion: There was no significant difference in NLR values between the groups of simple and complex febrile seizures. Further research is needed to determine NLR's cut-off point and correlation with simple and complex febrile seizures.

Latar belakang: Karakteristik kejang demam umumnya dilaporkan oleh orang tua secara subyektif. Rasio neutrofil dan limfosit (NLR) diusulkan sebagai parameter objektif yang dapat membedakan kejang demam sederhana (KDS) dan kompleks (KDK). Studi ini bertujuan untuk menilai perbedaan NLR pada anak dengan KDS dan KDK.

Metode: Penelitian cross-sectional dilakukan menggunakan data sekunder dari rekam medik di Rumah Sakit Umum Daerah (RSUD) Sanjiwani Gianyar, pada pasien anak berusia enam bulan hingga lima tahun didiagnosis dengan kejang demam dan dirawat pada periode Januari-Oktober 2022. Variabel terikat pada penelitian ini adalah klasifikasi kejang demam, sehingga sampel dibagi menjadi kelompok KDS dan KDK. Nilai NLR diperoleh dengan menghitung rasio jumlah neutrofil dan limfosit dari hasil pemeriksaan darah lengkap. Uji Mann-Whitney digunakan untuk menilai perbedaan nilai NLR pada dua kelompok.

Hasil: Terdapat 52 anak yang diikutkan sebagai subyek penelitian. Mayoritas sampel berusia ≥1 tahun (94,2%), perempuan (53,8%), dan di diagnosis dengan KDS (71,2%). Median (minimum-maksimum) NLR sampel adalah 4,54 (0,4-16,4). Tidak terdapat perbedaan nilai NLR bermakna ditemukan antara kelompok KDS dan KDK pada penelitian ini (p = 0,976).

Kesimpulan: Tidak terdapat perbedaan nilai NLR yang bermakna antara kelompok KDS dan KDK. Penelitian selanjutnya diperlukan untuk menentukan cut off point dan kuat korelasi NLR dengan KDS dan KDK.

Background: Thoracic trauma it often causes ventilation perfusion disorders resulting in tissue oxygenation disorders that cause death. Rapid and systematic evaluation of the patient in the identification and treatment of injuries is essential for immediate recovery of the soul and further definitive treatment. Several factors have been studied to see arrest in increasing the risk of worsening of the condition in cases of blunt thoracic trauma.

Methods: A cross-sectional study with a prospective cohort design conducted by taking secondary data from questionnaire extraction data. Sampling was carried out at the Emergency Room (ER), Prof. Dr. I.G.N.G.Ngoerah Central General Hospital from April 2021 to April 2022. The independent variables studied included risk factors for worsening. The dependent variable includes a worsening of the condition characterized by the presence of ARDS (PaO2/FiO2 ≤ 300 mmHg), or PaO2/FiO2 ≤ 200 mmHg in patients who present with ARDS. Control variables include diabetes mellitus, coronary heart disease, chronic obstructive pulmonary disease, and cancer

Results: The study subjects were 69 children who met the criteria. Age more than or equal to 45 years, sex, oxygen saturation, changes in pH, contusions, bone fractures, infection, hemothorax, and pneumothorax are not risk factors for worsening in patients with blunt thoracic trauma at Prof. Dr. I.G.N.G.Ngoerah Central General Hospital. Only ARDS conditions and worsening of conditions had a meaningful relationship. The condition of ARDS when in the ER for worsening resulted in a relative risk value (RR) of 18.750 (p=0.001; 95% CI: 5.400-65.101).

Conclusion: Risk factors for aggravation in patients with blunt thoracic trauma ARDS

Latar belakang: Pada trauma thorax sering menyebabkan gangguan ventilasi perfusi sehingga terjadinya gangguan oksigenasi jaringan yang menyebabkan kematian. Evaluasi yang cepat dan sistematis pada pasien dalam mengidentifikasi dan penanganan cedera sangat penting untuk penyelamatan jiwa secara langsung dan penanganan definitif lebih lanjut. Beberapa faktor telah dipelajari untuk melihat perannya dalam meningkatkan risiko perburukan kondisi pada kasus trauma tumpul thorax.

Metode: Penelitian cross-sectional dengan desain kohort prospektif yang dilakukan dengan mengambil data sekunder dari kuisioner ekstrasi data. Pengambilan sampel dilakukan di Instalasi Gawat Darurat (IGD), Rumah Sakit Umum Pusat Prof. Dr. I.G.N.G.Ngoerah  pada Bulan April 2021 sampai dengan bulan April 2022. Variabel bebas yang diteliti meliputi faktor-faktor risiko perburukan. Variabel terikat meliputi perburukan kondisi yang ditandai oleh munculnya ARDS (PaO₂/FiO₂ ≤ 300 mmHg), atau PaO₂/FiO₂ ≤ 200 mmHg pada pasien yang datang dengan ARDS. Variabel kendali meliputi diabetes melitus, penyakit jantung coroner, penyakit paru obstruktif kronis, dan kanker

Hasil: Subyek penelitian sebanyak 79 sampel yang memenuhi kriteria. Usia lebih dari atau sama dengan 45 tahun, jenis kelamin, saturasi oksigen, perubahan pH, kontusio, fraktur kosta, infeksi, hemothorax, dan pneumothorax tidak merupakan faktor risiko terjadinya perburukan pada penderita trauma tumpul thorax di Rumah Sakit Umum Pusat Prof. Dr. I.G.N.G.Ngoerah. Hanya kondisi ARDS dan perburukan kondisi yang memiliki hubungan bermakna. Kondisi ARDS saat di UGD terhadap terjadinya perburukan menghasilkan nilai relative risk (RR) 18,750 (p=0,001;95%CI:5,400-65,101).

Kesimpulan: Faktor risiko terjadinya perburukan pada penderita trauma tumpul thorax meliputi ARDS

Background: Intracranial lesions can cause neuroophthalmological disorders in patients. This study aims to describe neuroophthalmological disorders due to intracranial lesions (optic chiasma) at the Optic Hospital of Prof. Dr. IGNG Ngoerah 2021-2022.

Methods: This type of research is a retrospective descriptive using medical record data in 2021 - 2022. The parameters assessed in this study were age, sex, hemianopsia, visual acuity, color vision impairment, optic nerve papillae atrophy, contrast sensitivity, cupping, and Relative Afferent Pupillary Defect (RAPD). Data were analyzed with SPSS version 23.0 for Windows.

Results: There were 22 patients with intracranial lesions in the Neuro-Ophthalmology Division, Ophthalmic Hospital, Prof. Dr. IGNG Ngoerah, during the study period. Most of the research subjects were male and were in the age group of 41-50 years. The most common complaint is blurred vision without other complaints. The most common type of visual field loss is bitemporal hemianopsia. The most visual acuity is 6/6-6/18, as much as 54.5%, while 25% of eyes have visual acuity <6-60. Nearly half of the eye samples (45.5%) had atrophic papillae and 8 eyes (18.2%) had cupping. A total of 9 eyes (20.5%) had impaired color vision, 28 eyes (63.6%) had impaired contrast sensitivity, and 2 eyes (4.5%) had positive RAPD.

Conclusion: There is a significant relationship between visual acuity, color vision impairment, and contrast sensitivity. There is no relationship between complaints of pain and the type of hemianopsia.

Latar Belakang: Lesi intrakranial dapat menyebabkan kelainan neuro oftalmologi pada pasien. Penelitian ini bertujuan untuk mengetahui gambaran kelainan neuro oftalmologi akibat lesi intrakranial (chiasma optikum) di Poliklinik Mata RSUP Prof. Dr. IGNG Ngoerah tahun 2021-2022.

Metode: Jenis penelitian adalah deskriptif retrospektif dengan menggunakan data rekam medik pada tahun 2021 - 2022. Parameter yang dinilai pada penelitian ini adalah usia, jenis kelamin, hemianopsia, tajam penglihatan, gangguan penglihatan warna, atrofi papil nervus optikus, sensitivitas kontras, cupping, dan Relative Afferent Pupillary Defect (RAPD). Data dianalisis dengan SPSS versi 23.0 untuk Windows.

Hasil: Terdapat 22 pasien Lesi Intrakranial di Divisi Neuro Oftalmologi Poli Mata RSUP Prof. Dr. IGNG Ngoerah selama periode penelitian. Subjek penelitian lebih banyak berjenis kelamin laki-laki dan berada pada kelompok usia 41-50 tahun. Keluhan yang paling sering terjadi adalah penglihatan kabur tanpa keluhan lainnya. Jenis gangguan lapang pandang yang paling sering dialami adalah hemianopsia bitemporal. Tajam penglihatan terbanyak adalah 6/6-6/18 sebanyak 54,5% sedangkan 25% mata memiliki tajam penglihatan <6-60. Hampir setengah sampel mata (45,5%) mengalami papil atrofi dan 8 mata (18,2%) mengalami cupping. Sebanyak 9 mata (20,5%) mengalami gangguan penglihatan warna, 28 mata (63,6%) mengalami gangguan sensitivitas kontras, dan 2 mata (4,5%) memiliki RAPD positif.

Kesimpulan: Terdapat hubungan bermakna antara tajam penglihatan dengan gangguan penglihatan warna dan sensitivitas kontras. Tidak terdapat hubungan antara keluhan nyeri dan jenis hemianopsia.

Background: Diffused otitis externa is an external ear infection in the form of ear pain and swelling of the ear canal with or without ear fluid. The most common bacteria that cause this infection are Staphylococcus aureus and Pseudomonas aeruginosa. Research using natural ingredients to treat infectious diseases has been done a lot. The binahong plant (Anredera cordifolia) is one of the interesting natural ingredients to study because of its potential as an antibacterial. This study aims to determine the antibacterial activity and active compounds of the ethanol extract of binahong leaves (Anredera cordifolia) against Staphylococcus aureus and Pseudomonas aeruginosa.

Methods: The method of this study was to test the antibacterial activity of alkaloids, flavonoids and saponins from binahong leaf extract against ATCC 9027 (Pseudomonas aeruginosa) and ATCC 25923 (Staphylococcus aureus) bacteria as the most common causes of diffuse otitis externa. Antibacterial activity was assessed using the Thin Layer Chromatography-Bioautography (TLC-Bioautography) immersion method using a clear area on a purple background on the TLC plate. This data was analyzed with SPSS version 23.0 for Windows.

Results: The mean measurement results of the Inhibitory Diameter Zone (IDZ) of binahong leaf extract (Anredera cordifolia) concentrations of 80%, 90% and 100% against ATCC 25923 bacteria were 7.80 mm, 8.00 mm and 9.60 mm respectively. In contrast, the mean diameter of inhibition (DDH) of binahong leaf extract (Anredera cordifolia) concentrations of 80%, 90% and 100% against ATCC 9027 bacteria was 0.00 mm. Thin Layer Chromatography (TLC)-Bioautography test MTT method of binahong leaf extract on Staphylococcus aureus (ATCC 25923) showed clear areas with a purple background in alkaloids and saponins.

Conclusion: The active compounds of binahong leaf extract (Anredera cordifolia), which inhibit the growth of Staphylococcus aureus bacteria, are alkaloids and saponins.

Latar Belakang: Otitis eksterna difusa adalah infeksi telinga luar berupa nyeri telinga dan pembengkakan liang telinga dengan atau tanpa disertai cairan telinga. Bakteri tersering penyebab infeksi ini adalah Staphylococcus aureus dan Pseudomonas aeruginosa. Penelitian menggunakan bahan alam untuk mengatasi penyakit infeksi telah banyak dilakukan. Tanaman binahong (Anredera cordifolia) menjadi salah satu bahan alam yang menarik untuk diteliti karena potensinya sebagai antibakteri. Penelitian ini bertujuan mengetahui aktivitas antibakteri dan senyawa aktif ekstrak etanol daun binahong (Anredera cordifolia) terhadap Staphylococcus aureus dan Pseudomonas aeruginosa.

Metode: Metode penelitian ini adalah pengujian aktivitas antibakteri golongan senyawa alkaloid, flavonoid dan saponin dari ekstrak daun binahong terhadap bakteri ATCC 9027 (Pseudomonas aeruginosa) dan ATCC 25923 (Staphylococus aureus) sebagai penyebab tersering otitis eksterna difusa. Aktivitas antibakteri dinilai berdasarkan uji Kromatografi Lapis Tipis- Bioautografi (KLT-Bioautografi) metode imersi berupa adanya daerah bening diatas latar belakang ungu pada plat KLT. Data ini dianalisis dengan SPSS versi 23.0 untuk Windows.

Hasil: Hasil pengukuran rerata Diameter Daya Hambat (DDH) ekstrak daun binahong (Anredera cordifolia) konsentrasi 80%, 90% dan 100% terhadap bakteri ATCC 25923 berturut-turut adalah 7,80 mm, 8,00 mm dan 9,60 mm. Sedangkan rerata diameter daya hambat (DDH) ekstrak daun binahong (Anredera cordifolia) konsentrasi 80%, 90% dan 100% terhadap bakteri ATCC 9027 adalah 0,00 mm. Uji Kromatografi Lapis Tipis (KLT)-Bioautografi metode MTT ekstrak daun binahong pada bakteri Staphylococcus aureus (ATCC 25923) menunjukkan adanya daerah bening dengan latar belakang ungu pada senyawa alkaloid dan saponin.

Kesimpulan: Senyawa aktif ekstrak daun binahong (Anredera cordifolia) yang berperan dalam mengahmbat pertumbuhan bakteri Staphylococcus aureus adalah senyawa alkaloid dan saponin.

Background: The Covid-19 pandemic has reportedly resulted in increased layoffs in Indonesia, which has affected people's income. This can lead to a decrease in food purchasing ability, decreasing children's nutritional intake. Furthermore, the first thousand days of life is a critical period that determines the health and welfare of children. This study aimed to determine the relationship between family income during the Covid-19 pandemic and the nutritional status of infants aged 0-2 years at the Dawan I Community Health Center, Dawan District, Klungkung Regency.

Method: This cross-sectional study used infants aged 0-24 months as study subjects, with the respondents being housewives with toddlers aged 0-24 months who were selected according to the study inclusion criteria. Nutritional status and family income were obtained using secondary data, interviews and filling out questionnaires. Data analysis was performed with SPSS v.21 with a p-value ≤0.05.

Results: A total of 80 respondents were obtained as study subjects. Most of the parents were >25 years old (61 respondents; 76.3%) with senior high school education (46 respondents; 57.5%). Most respondents did not work (34 respondents; 42.5%) with family income < Rp. 2,538,000.00 (53 respondents; 66.3%). Most babies have good nutritional status (38 respondents; 47.5%). Based on bivariate analysis, a significant relationship exists between family income and infant nutritional status (chi-square; p=0.008; two-tailed).

Conclusion: There is a significant relationship between family income during the Covid-19 pandemic and the nutritional status of infants aged 0-2 years at the Dawan I Health Center, Dawan District, Klungkung Regency.

Latar Belakang: Pandemi Covid-19 dilaporkan telah mengakibatkan peningkatan angka pemutusan hubungan kerja (PHK) di Indonesia, khususnya di Bali yang berpengaruh terhadap pendapatan masyarakat. Hal ini dapat menyebabkan penurunan daya beli pangan yang berakibat pada penurunan asupan gizi anak. Terlebih lagi, seribu hari pertama kehidupan (1000 HPK) merupakan masa kritis yang menentukan kesehatan dan kesejahteraan anak. Penelitian ini bertujuan untuk mengetahui hubungan antara pendapatan keluarga pada masa pandemi Covid-19 terhadap status gizi bayi usia 0-2 tahun di Puskesmas Dawan I Kecamatan Dawan Kabupaten Klungkung.

Metode: Penelitian ini merupakan studi observasional analitik dengan desain potong lintang. Subjek penelitian adalah bayi usia 0-24 bulan yang tercatat pada Laporan Bulanan Gizi Puskesmas Dawan I Kecamatan Dawan, Kabupaten Klungkung, dengan responden penelitian ini adalah ibu rumah tangga anak balita usia 0-24 bulan sesuai kriteria penelitian. Status gizi dan pendapatan keluarga diperoleh menggunakan data sekunder, wawancara, dan pengisian kuesioner. Analisis data dilakukan dengan SPSS v.21 dengan nilai p≤0,05 dianggap signifikan secara statistik.

Hasil: Sebanyak 80 responden diperoleh sebagai subjek penelitian. Sebagian besar orang tua berusia >25 tahun (61 responden; 76,3%) dengan pendidikan terakhir SMA (46 responden; 57,5%). Sebagian besar responden tidak bekerja (34 responden; 42,5%) dengan pendapatan keluarga < Rp. 2.538.000,00 (53 responden; 66,3%). Sebagian besar bayi memiliki status gizi baik (38 responden; 47,5%). Berdasarkan analisis bivariat, terdapat hubungan signifikan antara pendapatan keluarga dan status gizi bayi (chi-square; p=0,008; two-tailed).

Simpulan: Terdapat hubungan signifikan antara pendapatan keluarga pada masa pandemi Covid-19 terhadap status gizi bayi usia 0-2 tahun di Puskesmas Dawan I Kecamatan Dawan Kabupaten Klungkung.

Background: Nasopharyngeal Carcinoma (NPC) is a tumor or malignancy that manifests in the nasopharynx, in the upper throat and back of the nose. When someone is diagnosed with cancer, many of them experience mental disorders, such as one example of depression. This study aimed to determine the relationship between early and advanced clinical stages with the incidence of depression in nasopharyngeal carcinoma patients before therapy.

Methods: An observational cross sectional comparative study design was conducted. Fifty-four research subjects were obtained with consecutive sampling techniques. The data obtained were analyzed descriptively, followed by the Chi-Square test and ended with the Logistic Regression test by SPSS version 26.0 for Windows.

Results: Based on bivariate analysis, three variables are significantly related to the level of depression in NPC patients, such as age, level of education and stage of cancer (p<0.05). Based on multivariate analysis using Logistic Regression, only one variable had a statistically significant relationship with the level of depression in NPC patients, namely the cancer stadium variable (p=0.001).

Conclusion: These findings suggest a significant relationship between the stage of cancer and the level of depression in NPC patients.

Latar Belakang: Karsinoma Nasofaring (KNF) adalah tumor atau keganasan yang bermanifestasi pada daerah nasofaring yaitu pada daerah atas tenggorokan dan belakang hidung. Ketika seseorang didiagnosa menderita kanker,banyak yang mengalami gangguan mental seperti salah satu contohnya depresi. Tujuan penelitian ini adalah untuk mengetahui hubungan stadium klinis awal dan lanjut dengan kejadian depresi pada pasien karsinoma nasofaring sebelum terapi.

Metode: observasional dengan rancangan cross sectional comparative study. Didapatkan 54 subjek penelitian dengan tehnik consecutive sampling. Data yang diperoleh dianalisis secara deskriptif, dilanjutkan dengan uji Chi-Square dan diakhiri uji Regresi Logistik menggunakan SPSS versi 26.0 untuk Windows.

Hasil: Berdasarkan analisis bivariat, terdapat tiga variabel yang berhubungan secara bermakna dengan tingkat deprersi pada pasien KNF yakni usia, tingkat pendidikan terakhir dan stadium kanker (p<0.05). Berdasarkan analisis multivariat dengan menggunakan Regresi Logistik hanya terdapat satu variabel yang secara statistik memiliki hubungan bermakna dengan tingkat depresi pada pasien KNF yaitu variabel stadium kanker (p=0.001).

Kesimpulan: Hasil penelitian ini menunjukkan bahwa terdapat hubungan yang bermakna antara stadium kanker dengan tingkat depresi pada pasien KNF.

Background: Indonesia is a tropical country with numerous cases of infectious diseases, and one of the causes is fungal infections. Fungal infections on the hair and scalp are known as tinea capitis. Up-to-date epidemiological data is essential for guiding diagnosis and therapy. Therefore, regular reports from each healthcare center are necessary.

Method: This study is a retrospective cross-sectional study that utilizes secondary data from all patients with tinea capitis in the Skin and Venereal Disease Clinic during the period of January 2014 to 2019. Data analysis was conducted using SPSS version 25.0 to perform univariate analysis.

Results: There were 42 cases of tinea capitis during the study period. The cases were predominantly found in males (61.9%) and the age group of 6-18 years (59.5%). The most commonly encountered type of tinea capitis was gray patch (78.6%) with negative Wood's lamp findings (90.5%) and ectothrix spores (54.8%). The common pathogens identified were Trichophyton tonsurans, Trichophyton mentagrophyte, and Microsporum audouinii.

Conclusion: There was fluctuation in the number of cases from 2014 to 2019, with a tendency towards an increase. The majority of tinea capitis patients were males in the age group of 6-18 years. Gray patch was the most common type of tinea capitis, and the most prevalent pathogens were Trichophyton tonsurans, Trichophyton mentagrophyte, and Microsporum audouinii, respectively.

Latar Belakang: Indonesia merupakan negara tropis yang memiliki banyak kasus penyakit infeksi dan jamur merupakan salah satu penyebabnya. Infeksi jamur pada rambut dan kulit kepala dikenal sebagai tinea kapitis. Data epidemiologi terkini sangat bermanfaat untuk mengarahkan diagnosis serta terapi. Oleh sebab itu, dibutuhkan laporan secara berkala dari masing-masing pusat layanan kesehatan.

Metode: Studi ini merupakan studi retrospektif cross sectional yang menggunakan data sekunder dari seluruh pasien tinea kapitis di Poliklinik Kulit dan Kelamin pada periode Januari 2014-2019. Analisis data menggunakan SPSS versi 25.0 untuk melakukan analisis univariat.

Hasil: Terdapat 42 kasus tinea kapitis selama periode penelitian. Kasus didominasi oleh laki-laki (61,9%) dan kelompok usia 6 – 18 tahun (59,5%). Tipe tinea kapitis yang paling banyak dijumpai adalah gray patch (78,6%) dengan hasil temuan lampu Wood negatif (90,5%), dan spora ektotrik (54,8%). Patogen yang umum dijumpai adalah Trichophyton tonsurans, Trichophyton mentagrophyte, serta Microsporum audouinii.

Kesimpulan: Terjadi fluktuasi pada tahun 2014 hingga 2019 dengan kecenderungan peningkatan kasus. Sebagian besar pasien tinea kapitis adalah laki-laki dan kelompok usia 6 – 18 tahun. Gray patch merupakan tipe tinea kapitis yang paling umum dan patogen terbanyak adalah Trichophyton tonsurans, Trichophyton mentagrophyte, serta Microsporum audouinii, secara berurutan.

Background: In Indonesia, diabetes is the third most common cause of death after stroke and ischemic heart disease in 2019. The prevalence of diabetes has increased by approximately 49.9% since 2009. Anemia is a common complication of diabetes and has been identified as a risk factor for cardiovascular disease and end-stage renal disease in diabetic patients. Even so, approximately 25% of anemia in patients with type 2 diabetes mellitus (T2DM) is still not recognized.

Methods: This research is an observational analytic study with a cross-sectional research method. The data were taken from the patient's medical records using the consecutive sampling technique. The subjects of this study were T2DM patients registered at Prof. Dr. I.G.N.G. Ngoerah General Hospital from January 2019 to December 2021. Data that comply with the inclusion and exclusion criteria are then processed with SPSS version 20.0 for Windows.

Results: This study found that 28.9% of T2DM patients at Prof. Dr. I.G.N.G. Ngoerah General Hospital suffered from anemia. Most T2DM patients with anemia came from 50-59 years and 60-69 years (34.6%) and were male (69.2%). The most frequent type of anemia was the normochromic normocytic type (76.9%). When viewed from the severity, the most common anemia found was mild anemia (88.5%).

Conclusion: Compared to the general population, T2DM patients have a higher risk of anemia. Anemia in T2DM can also trigger and worsen complications. Therefore, early detection and management of anemia are needed in T2DM patients.

Latar Belakang: Di Indonesia, diabetes merupakan penyebab kematian terbanyak ketiga setelah stroke dan penyakit jantung iskemik pada tahun 2019. Prevalensi diabetes meningkat sebanyak kira-kira 49,9% dari tahun 2009. Anemia merupakan komplikasi diabetes yang umum ditemukan, dan telah diidentifikasi sebagai faktor risiko dari penyakit kardiovaskular serta penyakit ginjal stadium akhir pada pasien diabetes. Meski begitu, kurang lebih 25% anemia pada penderita diabetes melitus tipe 2 (DMT2) masih tidak dikenali.

Metode: Penelitian ini merupakan penelitian analitik observasional dengan metode penelitian cross-sectional. Data diambil dari rekam medis pasien dengan teknik pengambilan sampel secara konsekutif. Subjek penelitian ini adalah pasien DMT2 yang terdaftar di RSUP Prof. Dr. I.G.N.G. Ngoerah pada Januari 2019 hingga Desember 2021. Data yang sesuai kriteria inklusi dan eksklusi kemudian diolah dengan SPSS versi 20.0 untuk Windows.

Hasil: Pada studi ini ditemukan bahwa 28,9% pasien DMT2 di RSUP Prof. Dr. I.G.N.G. Ngoerah menderita anemia. Pasien DMT2 dengan anemia kebanyakan berasal dari kelompok usia 50-59 tahun dan 60-69 tahun (keduanya 34,6%), dan berjenis kelamin laki-laki (69,2%). Tipe anemia yang paling banyak muncul yaitu tipe normokromik normositer (76,9%). Apabila dilihat dari derajatnya, anemia yang paling banyak diderita adalah anemia ringan (88,5%).

Kesimpulan: Jika dibandingkan dengan populasi umum, pasien DMT2 memiliki risiko lebih tinggi untuk menderita anemia. Anemia pada DMT2 juga dapat memacu serta memperburuk komplikasi. Oleh karena itu, deteksi dini dan manajemen anemia sangat diperlukan pada pasien DMT2.

Background: Based on data from Basic Health Research for Bali province in 2018, Denpasar is a city that has the highest prevalence of chronic energy deficiency (CED) among young women in the Bali province. The purpose of this research is to determine the relationship between physical activity and energy consumption levels with CED in young women in Pemecutan Klod Village, West Denpasar.

Method: This research is an analytical research with a cross-sectional survey design. The sample of this research is 92 samples. The sample determination method used is Cluster Sampling by selecting five banjars. Data about CED status was carried out by measuring the circumference of the upper arm. Data about physical activity was collected using a physical activity questionnaire. Energy consumption level data was collected using the SQ-FFQ questionnaire. Analysis of the data used is Rank Spearman correlation test with α = 0.05.

Results: Most of the samples have a strenuous level of physical activity as many as 13% moderate physical activity level as many as 66,3% and light physical activity level as many as 20,7%. Based on the level of energy consumption it was found that 52,2% have a deficit energy consumption level, 2,2% have a good energy consumption level, and 45,7% have a low energy consumption level. Most of the samples were in CED conditions as many as 56,5% while the rest were not in CED conditions as many ad 43,5%

Conclusion: There is a significant relationship between physical activity and the level of energy consumption with CED in young women in Pemecutan Klod Village, West Denpasar District.

Latar Belakang: Berdasarkan data Riset Kesehatan Dasar Provinsi Bali tahun 2018, Kota Denpasar merupakan kota yang memiliki prevalensi remaja putri dengan kondisi kekurangan energi kronis (KEK) tertinggi di Provinsi Bali. Penelitian ini bertujuan untuk mengetahui hubungan aktivitas fisik dan tingkat konsumsi energi dengan kejadian kurang energi kronis pada remaja putri di Desa Pemecutan Klod Kecamatan Denpasar Barat.

Metode: Penelitian ini merupakan penelitian analitik dengan rancangan survei cross-sectional. Sampel penelitian ini berjumlah 92 sampel. Metode penentuan sampel yang digunakan yaitu cluster sampling dengan memilih lima banjar. Data status KEK dikumpulkan dengan pengukuran lingkar lengan atas. Data aktivitas fisik dikumpulkan menggunakan kuisioner aktivitas fisik. Data tingkat konsumsi energi dikumpulkan menggunakan kuesioner Semi Quantitative Food Frequency Questionnaire (SQ-FFQ). Data dianalisis dengan uji korelasi Rank Spearman dengan α = 0,05.

Hasil: Sebagian besar sampel memiliki tingkat aktivitas fisik yang berat yaitu sebanyak 13%, tingkat aktivitas fisik sedang sebanyak 66,3% serta tingkat aktivitas fisik ringan sebanyak 20,7%. Tingkat konsumsi energi sampel sebanyak 52,2% memiliki tingkat konsumsi energi defisit, tingkat konsumsi energi baik sebanyak 2,2% serta tingkat konsumsi energi kurang sebanyak 45,7%. Sebagian besar sampel dalam kondisi KEK sebanyak 56,5% sedangkan tidak dalam kondisi KEK sebanyak 43,5%.

Simpulan: Terdapat hubungan yang signifikan antara aktivitas fisik dan tingkat konsumsi energi dengan kejadian KEK pada remaja putri di Desa Pemecutan Klod Kecamatan Denpasar Barat.

Introduction: Currently the Internet is an important part of student learning. The internet provides information that is one of the main sources of reference in understanding medical science. The information available on the internet varies over a wide area. Not all of this information can be used as a reference. This study aimed to describe the use of online medical and drug information among university students.

Method: This study used a descriptive cross-sectional research design. Data was collected through a questionnaire conducted online with active students of the Undergraduate Medicine Study Program, Faculty of Medicine, Udayana University, Class of 2019-2022 during the January-March 2023 period.

Results: The number of students who became respondents included 301 people. Most of the respondents (86.14%) have known the internet as a source of medical and drug information for more than 1 year and the devices that are widely used are laptops and mobile phones (85,72% and 87.38%). The frequency is at most once a week (56.82%), and the duration is less than 2 hours (57.81%). Almost all respondents feel that digital information plays a very influential role in medical practice and have utilized electronic journal databases (89,04%). The most frequently used journals are Google Scholar (87,05%) and Pubmed (84.72%). The largest drug database is the official BPOM website (64.46%). Lecturer recommendations are the most common source (55.82%). Most of the reasons were lecture assignments (90,04%) with the most searched topics being information about management (86.72%) and drug dosages (86,05%).

Conclusion: Utilization of online medical and drug information has a big role in student learning activities. Based on this, the availability of access to information in reputable scientific journals will be needed.

Pendahuluan: Saat ini internet menjadi bagian penting dalam pembelajaran mahasiswa. Internet menyediakan informasi yang menjadi salah satu sumber referensi utama dalam memahami ilmu kedokteran. Informasi yang tersedia dalam internet beragam dengan area yang luas. Tidak semua informasi dapat dimanfaatkan sebagai referensi. Penelitian ini bertujuan untuk mendeskripsikan pemanfaatan informasi medis dan obat secara online di kalangan mahasiswa kedokteran.

Metode: Penelitian ini menggunakan rancangan penelitian potong lintas dengan deskriptif analitik. Data dikumpulkan melalui kuesioner yang dilakukan secara daring terhadap mahasiswa aktif Program Studi Sarjana Kedokteran Fakultas Kedokteran Universitas Udayana Angkatan 2019-2022 selama periode Januari-Maret 2023.

Hasil: Jumlah mahasiswa yang menjadi responden mencakup 301 orang. Sebagian besar responden (86,14%) sudah mengenal internet sebagai sumber informasi medis dan obat lebih dari 1 tahun serta perangkat yang banyak digunakan adalah laptop dan mobile phone (85,72% dan 87,38%). Frekuensi paling banyak satu kali seminggu (56,82%), dan durasi yang dihabiskan selama kurang dari 2 jam (57,81%). Hampir keseluruhan responden merasakan peran informasi digital sangat berpengaruh dalam praktik kedokteran dan sudah memanfaatkan database jurnal elektronik (89,04%). Jurnal paling sering digunakan adalah Google Scholar (87,05%) dan Pubmed (84,72%). Basis data obat terbanyak adalah situs resmi BPOM (64,46%). Rekomendasi dosen adalah sumber terbanyak (55,82%). Alasan terbanyak adalah tugas perkuliahan (90,04%) dengan topik yang paling banyak ditelusuri adalah informasi mengenai manajemen (86,72%) dan dosis obat (86,05%).

Simpulan: Pemanfaatan informasi medis dan obat secara online memiliki peran besar dalam kegiatan pembelajaran mahasiswa. Didasari hal tersebut, ketersediaan akses informasi jurnal-jurnal ilmiah bereputasi akan sangat dibutuhkan.

Introduction: Acute respiratory infection (ARI) is still a major health problem in Indonesia. Parents' smoking habit is a risk factor for the incidence of ARI in children under five. This study aims to assess the relationship between the incidence of ISPA in toddlers and the smoking habits of parents who come to the Manggar Health Center.

Methods: This descriptive observational study was conducted using a cross-sectional method in the period February - March 2022 at PKM Manggar. The independent variable includes the degree of parental smoking behavior. While the dependent variable is the visit of pediatric patients with a diagnosis of ISPA.

Results: Fifty visits of toddler patients during the study period were dominated by ARI patients (52%). As many as 64% of patients were passive smokers with 62% getting exposure to cigarette smoke of more than 5 cigarettes per day. Most of the patients were males with normal birth weight and aged between 2-5 years.

Conclusion: Further analytical exploration to determine the relationship between parents' smoking habits and the incidence of ARI in toddlers is needed.

Pendahuluan: Infeksi saluran pernapasan akut (ISPA) masih menjadi masalah kesehatan besar di Indonesia. Kebiasaan merokok orang tua merupakan faktor risiko kejadian ISPA pada balita. Penelitian ini bertujuan untuk menilai hubungan kejadian ISPA pada balita dengan kebiasaan merokok orang tua yang datang ke Puskesmas Manggar .

Metode: Penelitian observasional deskriptif ini dilakukan menggunakan metode potong lintang pada periode Februari - Maret 2022 di PKM Manggar. Variabel bebas meliputi derajat perilaku merokok orang tua. Sementara variabel terikat adalah kunjungan pasien anak dengan diagnosis ISPA.

Hasil: Lima puluh kunjungan pasien balita selama periode penelitian didominasi oleh pasien ISPA (52%). Sebanyak 64% pasien merupakan perokok pasif dengan 62% mendapatkan pajanan asap rokok lebih dari 5 batang per hari. Sebagian besar pasien adalah laki-laki dengan berat badan lahir normal dan berusia antara 2-5 tahun.

Kesimpulan: Eksplorasi lebih lanjut secara analitik untuk mengetahui hubungan antara kebiasaan merokok orang tua dan kejadian ISPA pada balita diperlukan.

Background: Inflammatory indicators such as alterations in neutrophils, platelets, and lymphocytes are linked to the acute coronary syndrome. This research seeks to understand the association of the Platelet Lymphocyte Ratio (PLR) and Neutrophil-Lymphocyte Ratio (NLR) with the Grace score as well as the association between NLR and PLR with High Sensitivity Troponin T (hs-cTnT) as a serum biomarker that aids in ACS diagnosis.

Methods: The 99 patients who met the inclusion criteria for this study were the subject of an analytical investigation with a retrospective cross-sectional design. Based on the ratio of lymphocytes to neutrophils, NLR is determined. Based on the ratio of platelets to lymphocytes, PLR is determined. hs-cTnT laboratory samples were collected more than three hours after the ischemia complaint first manifested, using the Grace risk score as a predictor of mortality. Using SPSS program 25.0, data were examined.

Results: Bivariate analysis using the Spearman correlation test. There is a correlation between NLR and GRACE risk scores (r=0.348; p<0.001), PLR and GRACE risk scores (r=0.434; p<0.001), NLR and hs-cTnT (r=0.343; p=0.001), PLR and hs-cTnT (r=0.284; p=0.004). ROC curve analysis, NLR cut-off value 4.45 (sensitivity 73.3%; specificity 72.6%), and PLR cut-off value 139.77 (sensitivity 66.7%; specificity 59.5 %) to detect High grace score. NLR cut-off value 2.17 (sensitivity 62.9%; specificity 60 %), and PLR cut-off value 108.38 (sensitivity 60.7%; specificity 60 %) to detect High hs-cTnT.

Conclusion: In this study, there was a relationship between NLR and PLR with the Grace risk score as well as a relationship between NLR and PLR with hs-cTnT.

Background: Developmental delay was still a challenging issue especially in high risk infants. Multifactorial reasoning in neonatal history has led to the screening test as an important step to detect suspicion of any developmental delay. The suspicion was made based on the Denver II screening test, that could lead us to such conditions earlier. Determined prevalence and associated factors of developmental delay suspicion in high risk infants were needed to be investigated further. This study aimed to determine prevalence and associated factors of developmental delay suspicion based on the Denver II screening test in high risk infants.

Methods: This was an observational analytic study using a cross-sectional design. Data were collected from the Denver II screening test of infants aged below 12 months whose history of being treated in level II and III neonatal units, who visited outpatient clinics in July 2015 until June 2017.

Results: A total of 197 subjects were conducted in this study. It was dominated by male (58.9%), aged below 6 months (82.7%) with mean age was 77 days, term babies (56.8%), and spontaneous vaginal delivery (55.8%). Prevalence developmental delay suspicion in high risk infants was 46.2%. Significant associated factors were asphyxia and neonatal sepsis [OR=6.88 (CI 95% 3.39-13.94), p=0.00], [OR=2.36 (CI 95% 1.13-4.95), p=0.02].

Conclusion: Almost half of subjects had developmental delay suspicion based on Denver II screening test, with asphyxia and neonatal sepsis were significant associated factors. Further investigation and periodic evaluation were needed to confirm developmental issues in high risk infants.

Latar belakang: Gangguan perkembangan masih sering ditemui terutama pada bayi dengan risiko tinggi. Bayi tersebut memiliki alasan rawat yang bersifat multifaktorial, sehingga uji tapis keterlambatan perkembangan menjadi langkah awal yang penting. Kecurigaan keterlambatan tersebut dinilai menggunakan  uji tapis Denver II yang dapat mengarahkan kecurigaan gangguan tersebut lebih awal. Prevalens kecurigaan keterlambatan perkembangan dan faktor yang berhubungan dengan hasil tersebut pada bayi risiko tinggi perlu dinilai lebih lanjut. Penelitian ini bertujuan untuk mengetahui prevalensi serta menilai faktor yang berhubungan dengan kecurigaan keterlambatan perkembangan pada bayi risiko tinggi.

Metode: Penelitian ini merupakan penelitian analitik observasional menggunakan rancangan potong lintang. Data diambil dari hasil uji tapis Denver II terhadap bayi berusia di bawah 12 bulan yang memiliki riwayat perawatan neonatus level II dan III, yang melakukan kontrol poliklinik pada Juli 2015 hingga Juni 2017.

Hasil: Sebanyak 197 subjek yang diikutsertakan dalam penelitian ini. Subjek didominasi oleh jenis kelamin lelaki (58,9%), berusia di bawah 6 bulan (82,7%) dengan rerata usia 77 hari, usia gestasi cukup bulan (56,8%), dan persalinan spontan (55,8%). Prevalens kecurigaan keterlambatan perkembangan pada bayi risiko tinggi adalah 46,2%. Faktor yang berhubungan secara signifikan adalah asfiksia dan sepsis neonatorum dengan nilai [OR=6,88 (IK 95% 3,39-13,94), p=0,00], [OR=2,36 (IK 95% 1,13-4,95), p=0,02].

Simpulan: Hampir separuh subjek dicurigai mengalami keterlambatan perkembangan pada uji tapis Denver II, dengan asfiksia dan sepsis neonatorum sebagai faktor yang berhubungan secara signifikan. Penelitian lebih lanjut dan pengamatan berkala diperlukan untuk memastikan gangguan perkembangan pada bayi dengan risiko tinggi.

Background: Elderly is one of the risk groups for periodontal disease, one of which is gingivitis. This study aimed to identify the relationship between betel chewing habits and the incidence of gingivitis among elderly in the Kintamani VI Health Center.

Methods: A quantitative analytical research design with a cross-sectional approach was used in this study, involving about 134 elderly respondents aged 55 years and over in the Kintamani VI Public Health Center. The variabels measured in this study included the characteristics of the elderly (age, gender, occupation, and income), the incidence of gingivitis, betel chewing habits, the habit of brushing teeth and rinsing with antiseptiks, and knowledge related to gingivitis.

Results: The results of the analysis showed that most of the incidence of gingivitis was found in the male group, aged between 75 to 90 years, worked as traders/entrepreneurs, earned more than the regional minimum wage Bangli Regency (IDR 2,516,917), had betel chewing habits, had less knowledge, not regularly brushing teeth every day, and not gargling with antiseptik liquid. The proportion of respondents who had betel chewing habit was 43.3% and 61.9% had gingivitis. In addition, the betel chewing habit can increase the risk of gingivitis up to 3,269 times and earning more than the regional minimum wage is at risk of experiencing gingivitis by 3,618 times.

Conclusion: Health promotion to the elderly group and their families is very important to increase awareness that brushing teeth properly and correctly can prevent gingivitis and good for oral and dental health.

Latar Belakang: Lansia merupakan salah satu kelompok berisiko untuk terkena penyakit periodontal, salah satunya adalah gingivitis. Penelitian ini bertujuan untuk mengidentifikasi hubungan kebiasaan menginang dengan kejadian gingivitis pada lansia di wilayah kerja Puskesmas Kintamani VI.

Metode: Rancangan penelitian analitik kuantitatif dengan pendekatan crosssectional digunakan dalam penelitian ini, dengan melibatkan 134 responden lansia yang berusia 55 tahun ke atas di wilayah kerja Puskesmas Kintamani VI. Variabel yang diukur pada penelitian ini meliputi karakteristik lansia (usia, jenis kelamin, pekerjaan, dan penghasilan), kejadian gingivitis, kebiasaan menginang, kebiasaan gosok gigi dan berkumur dengan antiseptik, dan pengetahuan terkait gingivitis.

Hasil: Hasil analisis menunjukkan bahwa sebagian besar kejadian gingivitis ditemukan pada kelompok laki-laki, berusia antara 75 hingga 90 tahun, bekerja sebagai pedagang/wiraswasta, berpenghasilan lebih dari UMK Kabupaten Bangli (Rp. 2.516.917), memiliki kebiasaan menginang, memiliki pengetahuan yang kurang, tidak rutin gosok gigi setiap hari, dan tidak berkumur dengan cairan antiseptik. Proporsi responden yang menginang adalah 43,3% dan sebanyak 61,9% mengalami gingivitis. Selain itu, kebiasaan menginang dapat meningkatkan risiko terkena gingivitis hingga 3,269 kali serta berpenghasilan lebih dari UMK berisiko mengalami gingivitis sebesar 3,618 kali.

Kesimpulan: Promosi kesehatan kepada kelompok lansia dan keluarganya sangat penting dilakukan untuk meningkatkan kesadaran bahwa gosok gigi yang baik dan benar dapat mencegah terjadinya gingivitis serta bermanfaat untuk menjaga kesehatan gigi dan mulut.

Background: For pediatric patients who are hospitalized, full feeding nutritional needs is not only to improve BMI but also very useful for accelerating the healing process, shortening the treatment period, reducing complications, reducing morbidity and mortality, and preventing malnutrition due to treatment or medical action. This study aimed to describe the association between the achievement of full feeding with mortality in children.

Method: The retrospective study was conducted in Pediatric Ward at Sanglah General Hospital, Denpasar Bali period January to December 2021. The inclusion criteria in this study were all pediatric patients who were hospitalized at pediatric wards Sanglah Hospital Denpasar. Inclusion criteria were children aged 1 month-18 years old. Samples were taken by total sampling. Quantitative variables were tested using variables that scale categorical data will be displayed in the form of absolute numbers and percent. The results of the descriptive analysis are presented using a chi-square test used to analyze all indirect variables (depending on whether the assumptions were met). The results of multivariate analysis were  with logistic regression. The results were considered statistically significant at p < 0.05.

Result: Total 258 subjects who met the inclusion criteria. Multivariate analysis with logistic regression shows full feeding (Exp B 0.24; 95% CI 0.032-0.27; P 0.006), nutritional status (Exp B 0.23; 95% CI 0.31-1.55; P 0,004) was statistically significant for mortality.

Conclusion: Full feeding and nutritional status were associated with an increase in child mortality.