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: Cerebral palsy (CP) diplegia is a neurological condition that occurs in infancy or early childhood, and permanently affects muscle control and coordination, with lower limb conditions more severe than upper limb. Symptoms can be an increase in muscle tone that causes spasticity in the feet. The arm muscles are generally less affected or not affected at all. Symptoms in addition to motor disorders can be accompanied by sensory and cognitive disorders. Management of physiotherapy with passive stretching (PS), peripheral joint mobilization (PJM), myofascial release technique (MRT), neurodevelopmental technique (NDT), boccia rehabilitation program (BRP) and aquatic exercise increase boccia sports performance in children with cerebral palsy diplegia.

Case Report: A 16-year-old male patients with complaints of unable to stand upright, both legs experience stiffness, and hunchbacked body posture (kyphosis) and forward head. Complaints in patients cause limitations and disorders of motion and function, such as stiffness in both feet, decreased balance capability, decreased gross motor skills and decreased precision ability in throwing. The physiotherapy program was conducted in four meetings in four weeks and patients get physiotherapy programs in the form of PS, PJM, MRT, NDT, BRP and aquatic exercise. Physiotherapy programs get the results of an increase in functional abilities of balance and increase precision capabilities in the throw.

Conclusion: Provision of PS, PJM, MRT, NDT, BRP and aquatic exercise programs increases the ability of functional balance and increase precision capabilities in throwing.

Latar Belakang: Cerebral palsy (CP) diplegia merupakan suatu kondisi neurologis yang terjadi pada masa bayi atau anak usia dini, dan secara permanen mempengaruhi kontrol dan koordinasi otot, dengan kondisi ekstremitas bawah lebih berat daripada ekstremitas atas. Gejalanya bisa berupa peningkatan tonus otot yang menyebabkan spastisitas di kaki. Otot lengan umumnya kurang terpengaruh atau tidak terpengaruh sama sekali. Gejala selain gangguan motorik bisa disertai gangguan sensori maupun kognitif. Penanganan fisioterapi dengan passive stretching (PS), peripheral joint mobilization (PJM), myofascial release technique (MRT), neurodevelopmental technique (NDT), boccia rehabilitation program (BRP) dan aquatic exercise meningkatkan performa olahraga boccia pada anak dengan diagnosa CP diplegia.

Laporan Kasus: Pasien laki-laki berusia 16 tahun dengan keluhan belum bisa berdiri dengan tegak, kedua kaki mengalami kekakuan, dan postur tubuh bungkuk (kifosis) serta forward head. Keluhan pada pasien menyebabkan timbulnya keterbatasan dan gangguan gerak dan fungsi antara lain seperti kekakuan pada kedua kaki, penurunan kemampuan keseimbangan, penurunan kemampuan motorik kasar serta penurunan kemampuan presisi dalam lemparan. Program fisioterapi dilakukan sebanyak empat kali pertemuan dalam empat minggu dan pasien mendapatkan program fisioterapi berupa PS, PJM, MRT, NDT, BRP dan aquatic exercise. Program fisioterapi mendapatkan hasil adanya peningkatan kemampuan fungsional keseimbangan dan peningkatan kemampuan presisi dalam lemparan.

Kesimpulan: Pemberian program PS, PJM, MRT, NDT, BRP dan aquatic exercise meningkatkan kemampuan keseimbangan fungsional serta meningkatkan kemampuan presisi dalam lemparan.

Background: Elizabethkingia infections were reportedly rare, but if it was found, it had been known to cause neonatal meningitis, bloodstream infections and respiratory infections. Elizabethkingia meningoseptica had a unique antibiotic susceptibility pattern, usually resistant to most antibiotics. Elizabethkingia infections were associated with a high mortality rate because of the lack of effective therapeutic regimens, antibiotic resistance and virulence.

Case Presentation: Fourteen days old boy patient came with the chief complaint of seizure, which occurred twice. Before the seizure, the patient had a fever with the highest temperature was 39°C. The patient looked lethargic, tended to sleep more often, cried occasionally and was not as active as previously. Septic marker revealed an Immature to Total neutrophil (IT) ratio of 0.2 and C-Reactive Protein (CRP) 49.30 mg/dL. A blood smear examination showed toxic granules, vacuolization of the leucocyte and reactive thrombocytosis. Cerebrospinal fluid analysis revealed a cell number of 2520 cell/uL, polymorphonuclear (PMN) cell 80%, mononuclear (MN) cell 20%, Nonne and Pandy was positive, protein level at 300 mg/dL and cerebrospinal fluid glucose level below 20 mg/dL. The patient was initially diagnosed with sepsis and meningitis and was given ampicillin and gentamicin. Blood and cerebrospinal fluid culture isolated Elizabethkingia meningoseptica and significantly as the infection-causing agent. The antibiotic sensitivity of the blood culture was ciprofloxacin and levofloxacin. The antibiotic sensitivity of the cerebrospinal fluid culture was levofloxacin. During the treatment, there were several inappropriate results between clinical manifestation and laboratory results; the antibiotic was changed to levofloxacin according to the sensitivity of the blood and cerebrospinal fluid culture.

Conclusion: Elizabethkingia meningoseptica was a rare case, and the nature of this bacteria was resistant to multiple antibiotics. Treatment should be considered carefully.

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.

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: Fahr's syndrome is a rare disorder characterized by bilateral abnormal calcium deposits in the cerebral cortex and basal ganglia. This condition is often asymptomatic but can also cause symptoms of neurological dysfunction, movement disorders, and psychiatric symptoms. Radiological imaging, such as a CT scan, can be used to confirm the diagnosis. This case report discusses the clinical manifestations and radiological features of Fahr's syndrome in a 45-year-old female patient with a history of thyroidectomy.

Case Report: A 45-year-old woman was referred with complaints of weakness, fever, and pain in the chest, lower abdomen, right thighs, and right upper back after being exposed to hot water. The patient was found suddenly unconscious while carrying a pot of hot water. The patient has a history of enlargement of the thyroid gland, has undergone thyroid removal surgery 10 years ago, and has had epilepsy since 2 years ago. Physical examination showed low blood pressure, fever, and burns in the right chest area, right lower abdomen, right thigh, and right upper back. Neurologic examination within normal limits. A laboratory examination found leukocytosis, hyponatremia, and hypokalemia. A CT scan of the head without contrast showed multiple symmetrical calcifications in the cerebellum, caudate nucleus, thalamus, lentiform nucleus, and white and gray matter of the frontal lobes, parietal lobes, and occipital lobes.

Conclusion: Radiological examinations such as CT scans can be performed in patients with neurological symptoms and a history of total thyroidectomy to establish the diagnosis of Fahr's syndrome.

Pendahuluan: Sindrom Fahr merupakan kelainan langka yang ditandai dengan adanya deposit kalsium abnormal bilateral pada korteks serebral dan ganglia basalis. Kondisi ini seringkali tanpa gejala, namun juga dapat menyebabkan gejala disfungsi neurologis, gangguan gerakan dan gejala psikiatri. Pencitraan radiologi seperti CT scan dapat digunakan untuk menegakkan diagnosis. Laporan kasus ini membahas tentang manifestasi klinis dan gambaran radiologis sindroma Fahr pasien perempuan usia 45 tahun dengan riwayat tiroidektomi.

Laporan Kasus: Wanita berusia 45 tahun dirujuk dengan keluhan lemas, demam, nyeri pada dada, perut bawah, paha, dan punggung atas sebelah kanan setelah terkena air panas. Pasien ditemukan tiba-tiba tidak sadarkan diri ketika sedang membawa panci berisi air panas. Pasien memiliki riwayat epilepsi sejak 2 tahun yang lalu serta memiliki riwayat pembesaran kelenjar tiroid dan sudah menjalani operasi pengangkatan tiroid. Pemeriksaan fisik menunjukkan tekanan darah rendah, demam, dan luka bakar pada daerah dada kanan, perut bawah kanan, paha kanan, dan punggung atas sebelah kanan. Pemeriksaan neurologis dalam batas normal. Pada pemeriksaan laboratorium ditemukan leukositosis, hiponatremia dan hipokalemia.  Pemeriksaan CT scan kepala tanpa kontras menunjukkan kalsifikasi multiple simetris pada daerah cerebellum, nukleus kaudatus, talamus, nukleus lentiformis, dan white serta gray matters lobus frontalis, lobus parietalis, dan lobus occipitalis.

Kesimpulan: Pemeriksaan radiologis seperti CT scan dapat dilakukan pada pasien dengan gejala neurologis dan riwayat total tiroidektomi untuk menegakkan diagnosis sindrom Fahr.

Background: Bladder stone is a rare disease accounting for 5% of all urinary calculi. It is more common in middle- and low-income countries due to nutritional obstacles, water sanitation, and warm climates. Primary bladder calculi are most common in children younger than 10 years old, with a peak incidence at 2 to 4 years. There have been no reports of bladder stones in children under 2 years of age. This case study aims to evaluate the bladder stone in a 1-year infant with recurrent urinary tract infections.

Case Presentation: An infant boy 1 year and 2 months presented with a 6-month history of complaints of pain on micturition presented with pulling the penis, cloudy urine, and recurrent fever in our clinic. During the 6 months before admission, he visited several pediatric clinics and was diagnosed with and treated for UTI. On ultrasonography, we found a bladder stone 1,9 x 1,3 cm in size. Then we performed open cystolithotomy under general anesthesia. One day after surgery, the patient was discharged from the hospital.

Conclusion: Children who live in endemic areas are more likely to develop bladder stones due to dietary issues. Preventing dehydration, treating urinary tract infections effectively, and securing metabolic abnormalities are the methods for reducing the prevalence of pediatric bladder stones. Pediatric bladder stones must be diagnosed and treated to avoid the stones' recurrence and improve quality of life.

Background: A disorder that manifests on the skin and can be a marker of acquired immunodeficiency syndrome (AIDS) is Kaposi sarcoma (KS). Kaposi sarcoma is a vascular and lymphatic neoplasm caused by human herpesvirus-8 (HHV-8). AIDS-related Kaposi sarcoma is common in homosexuals, bisexuals, and intravenous drug users. This case report will discuss a case of KS in a patient with stage IV human immunodeficiency virus (HIV) infection.

Case description:  A male, 25 years old, with a chief complaint of lumps on the face and body since 7 months ago. Initially, the lumps were few and small, but they have increased in number and size in the last 2 months. Some lumps are purplish red, but there are also skin-colored lumps. There is a history of fever with diarrhea since the previous 6 months and a drastic weight loss in the last 7 months. Dermatological status in the fascial region, anterior and posterior thorax, efflorescences were found multiple nodules, purplish red to skin color, varying in size. Histopathologic examination showed a picture consistent with KS. There was no specific therapy for this patient from the Department of Dermatology and Venereology. Gradually, the patient continued treatment for HIV infection and tracing of other opportunistic infections.

Conclusion: Kaposi sarcoma is a vascular and lymphatic neoplasm sign of AIDS. Treatment in KS focuses more on antiretrovirals for HIV infection.

Latar belakang: Salah satu kelainan yang bermanifestasi pada kulit dan dapat menjadi penanda acquired immunodeficiency syndrome (AIDS) adalah sarkoma Kaposi (SK). Sarkoma Kaposi merupakan neoplasma vaskular dan limfatik yang disebabkan human herpesvirus-8 (HHV-8). Sarkoma Kaposi terkait AIDS paling sering ditemukan pada kelompok homoseksual, biseksual, dan pengguna obat-obatan intravena. Laporan kasus ini akan membahas kasus SK pada pasien dengan infeksi human immunodeficiency virus (HIV) stadium IV.

Deskripsi kasus: Seorang laki-laki, 25 tahun, dengan keluhan utama benjolan di wajah dan badan sejak 7 bulan yang lalu. Awalnya benjolan berjumlah sedikit dan berukuran kecil, namun makin lama makin banyak dan bertambah besar dalam 2 bulan terakhir. Beberapa benjolan berwarna merah keunguan, namun terdapat juga yang sewarna kulit. Terdapat riwayat demam hilang timbul disertai diare sejak 6 bulan terakhir dan penurunan berat badan drastis dalam 7 bulan terakhir. Status dermatologis pada regio fasialis, toraks anterior et posterior didapatkan efloresensi nodul multipel, berwarna merah keunguan hingga sewarna kulit, ukuran bervariasi. Pada pemeriksaan histopatologi didapatkan gambaran sesuai dengan sarkoma Kaposi. Tidak ada terapi spesifik untuk pasien ini dari Departemen Dermatologi dam Venereologi. Secara bertahap, pasien melanjutkan terapi untuk infeksi HIV dan penelusuran infeksi oportunistik lain.

Simpulan: Sarkoma kaposi merupakan neoplasma vaskular dan limfatik yang menjadi penanda kondisi AIDS. Terapi pada SK lebih menitikberatkan pada terapi penyakit dasar yaitu pemberian antiretroviral untuk infeksi HIV.

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 Mother-to-child transmission (MTCT) of human immune virus (HIV), syphilis, and hepatitis B can lead to significant health burdens and even mortality in children. This study aimed to evaluate the effectiveness of triple elimination of MTCT in a secondary hospital in Buleleng, North Bali

Method: This study conducted a retrospective review of 345 pregnancy case in Buleleng General Hospital from January to December 2022

Result: In this study, 98.5% of the 345 pregnant women seeking antenatal care were tested for HIV, syphilis, and hepatitis B. Among the tested patients, 100%, 99.7%, and 98.8% were tested for HIV and hepatitis B, HIV and syphilis, and syphilis and hepatitis B, respectively. The prevalence of HIV, syphilis, and hepatitis B was 1.4%, 2.1%, and 4.3 %, respectively. Antiretroviral therapy was administered to 80 % of HIV-positive patients, and 71.4 % of syphilis patients received benzathine penicillin G. Only 6.6% of hepatitis B patients received hepatitis B virus deoxyribonucleic acid (HBV DNA) & hepatitis B  envelope antigen (HBeAg) examination followed by Lamivudine administration.

Conclusion: Early detection of HIV, syphilis, and hepatitis B in pregnant women is important for preventing MTCT. Coverage of triple elimination screening is in accordance with WHO targets, but further management of hepatitis B needs to be improved

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.

Background: Bifurcated rib or Bifid rib is considered to be an anatomical overgrowth anomaly of the chest wall, forming a forked sternal end. Diagnosis of this condition is generally an incidental finding on imaging or post-mortem examination. Most of the cases were asymptomatic and established as part of Gorlin syndrome. Here we describe a rare case of chest wall deformity in a paediatric patient, and our approach for this case with limited cost and resources.

Case Presentation: A 5-year-old boy, presented at orthopedic outpatient clinic with complaint of a painless lump in his upper left chest. No significant history of infection, malignancy or any congenital syndromes. Chest imaging revealed a bifid left 4^th rib at the sternal end.

Conclusion: There is currently no data on the best approach to managing bifid ribs. In addition, genetic testing for susceptible genes should be strongly considered. In this situation with limited cost and resources, we suggest close monitoring with regular follow-ups for the patient as the best approach, including detection of any other diagnostic criteria of Gorlin syndrome, to ensure better prognosis and quality of life for this patient.

-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: Indonesia ranks 4th in terms of the number of people with diabetes mellitus in the world, and chronic complications in DM include disorders of the nerves (neuropathy). Paraparesis causes disturbances in mobility and disturbances to the person, namely the perception of his disability which can lead to reactions of disappointment, low self-esteem and ends in despair and depression. This case report aims to describe insulin-induced depression and chronic pain in diabetic neuropathy patient with lower motor neuron paraparesis.

Case Presentation: A 36-year-old Balinese woman could not walk, she had been complaining of sadness for a long time, since she was told she had diabetes, thus limiting her daily activities. The patient has a history of diabetic disease since childhood and was definitely diagnosed at the age of 15 around 18 years ago, and started a history of back pain since December 2021 and worsened with cramps and weakness in both legs since January 2022. Vital signs were good, on waist is attached plate metal as high as vertebrae L3–L4, extremities: edema +/- warm +/+, cruris dextra: edema (+), clinical neurology: lower motor neuron type paraparesis, motor weakness, atrophy of musculus gastrocnemius dextra et sinistra and musculus tibialis dextra et sinistra paresthesia of the glove and stocking type. Psychiatric status: reasonable appearance of consciousness: clear, affective. Mood affect: sad/depressive/ appropriate. Thought process: logical realist/coherent/preoccupation with back pain and weak legs. Mixed-type insomnia exists; history of raptus and hypobulia is present. Impulse control: poor.

Conclusion: Patients with diabetes on insulin treatment were associated with the prevalence of depressive syndromes.

Latar belakang: Indonesia menempati urutan ke-4 terbesar dalam jumlah penderita diabetes melitus di dunia, dan komplikasi kronis pada diabetes antara lain kelainan pada saraf (neuropati). Paraparese menyebabkan gangguan dalam mobilitas serta gangguan terhadap pribadinya yaitu persepsi kecacatannya yang dapat menimbulkan reaksi kecewa, rendah diri dan berakhir pada keadaan putus asa dan depresi. Laporan kasus ini bertujuan mendeskripsikan depresi yang diinduksi insulin dan nyeri kronis pada pasien neuropati diabetik dengan paraparesis tipe lower motor neuron.

Presentasi Kasus:  Perempuan 36 tahun suku Bali, tidak bisa berjalan, keluhan sedih sudah lama, semenjak dikatakan mempunyai penyakit diabetes, sehingga membatasi aktivitasnya sehari hari. Pasien memiliki riwayat penyakit diabetes dari kecil dan terdiagnosis pasti pada umur 15 tahun sekitar 18 tahun yang lalu, dan mulai riwayat nyeri punggung sejak bulan desember 2021 dan memberat dengan kram dan lemah pada kedua kaki sejak Januari 2022.  Tanda vital baik, pada pinggang terpasang: plat logam setinggi vertebra L3–L4, ekstremitas: edema +/- hangat +/+, kruris dekstra: edema (+). Klinis neurologis: paraparesis tipe lower motor neuron, kelemahan motorik, atrofi musculus gastrocnemius dekstra et sinistra dan musculus tibialis dekstra et sinistra, parestesia tipe gloves and stocking. Status psikiatri: penampilan wajar kesadaran: jernih. Mood afek: sedih/depresif/appropriate. Proses pikir: logis realis/koheren/preokupasi nyeri punggung dan lemah kaki. Insomnia tipe campuran ada; raptus ada riwayat dan hipobulia ada. Pengendalian impuls: kurang baik.

Simpulan: Diabetes pada pengobatan insulin dikaitkan dengan prevalensi sindrom depresi, menunjukkan hubungan yang permanen dan signifikan.

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.

Background: Acute Myocardial Infarction (AMI) is a type of coronary heart disease with high morbidity and mortality. The renin-angiotensin-aldosterone system (RAAS) is an important endocrine system in controlling blood pressure and cardiovascular homeostasis and is responsible for AMI. In patients with AMI or a heart attack, sacubitril/valsartan has been shown to reduce the risk of heart failure and death. This study aims to evaluate the effect of sacubitril/valsartan in AMI patients.

Methods: In order to evaluate the effects of sacubitril/valsartan in patients with AMI, three databases, including PubMed, Cochrane Library, and the ClinicalTrials website, were searched. The final search was performed in January 2023. The meta‑analysis was subsequently performed with Revman 5.4 software and a total of three studies were included.

Results: The results of the main outcomes showed that sacubitril/valsartan has no significant reduction in major adverse cardiovascular and cerebrovascular events (MACCEs) odds ratio (OR), 0.70; 95% confidence interval (CI), 0.38‑1.30; P=0.26] and incidence of acute heart failure (AHF) (OR, 0.52; 95% CI, 0.24‑1.15; P=0.11). The secondary outcomes showed no effect of sacubitril/valsartan to increase left ventricular remodeling.

Conclusion: In conclusion, the present meta‑analysis revealed that sacubitril/valsartan could not effectively reduce the incidence of MACCEs and AHF in patients with AMI. In the future, a meta‑analysis study will be designed with many studies to reduce the incidence of MACCEs and AHF effectively.

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.

As part of a comprehensive strategy to prevent human immunodeficiency virus (HIV) infection, pre-exposure prophylaxis (PrEP), safe sex practices, routine HIV testing, HIV risk reduction counseling, and consistent and correct use of condoms are largely effective in HIV prevention. Pre-exposure prophylaxis is intended for people who engage in high-risk sexual behavior and do not use condoms consistently. The use of PrEP is widely promoted in the man who have sex with men (MSM) community, including MSM who wish to practice safer sex in sexual relationships with casual partners who have difficulty sharing HIV status and sexually transmitted infections (STIs) with sexual partners. However, due to the inconsistent practice of using condoms when using PrEP, there is an impact, namely an increase in the incidence of other sexually transmitted infections. In addition to the increased transmission of disease, especially bacterial infections, PrEP also has a protective effect against the herpes simplex virus (HSV). This literature review discusses PrEP and its impact on sexually transmitted infections.

Sebagai bagian dari strategi pencegahan komprehensif infeksi human immunodeficiency virus (HIV), penggunaan pre-exposure prophylaxis (PrEP) disertai praktik seks aman, tes HIV rutin, konseling pengurangan risiko HIV, dan penggunaan kondom yang konsisten dan benar sebagian besar efektif terhadap pencegahan HIV. Pre-exposure prophylaxis ditujukan untuk orang yang melakukan perilaku seksual berisiko tinggi dan tidak menggunakan kondom secara konsisten. Penggunaan PrEP dipromosikan secara luas pada komunitas laki-laki suka dengan laki-laki (LSL), termasuk LSL yang ingin mempraktekkan seks yang lebih aman pada hubungan seksual dengan pasangan tidak tetap yang sulit berbagi status HIV dan infeksi menular seksual (IMS) pada pasangan seksual tersebut. Namun, oleh karena praktik penggunaan kondom yang tidak konsisten saat menggunakan PrEP, terdapat dampak yang timbul yaitu adanya peningkatan kejadian infeksi menular seksual lainnya. Selain adanya transmisi penyakit terutama infeksi bakteri yang meningkat, penggunaan PrEP ternyata juga memiliki dampak efek protektif terhadap herpes simplex virus (HSV). Tinjauan pustaka ini membahas mengenai PrEP dan dampaknya pada infeksi menular seksual.

Background: Shivering can increase oxygen use, the risk of hypoxemia, and post-operative sequelae. The many properties of clonidine make this medication versatile enough to be employed not just to avoid shivering, but also to treat additional spinal anesthesia adverse effects.

Methods: Researchers combed the PubMed database for randomized clinical trials (RCTs) conducted between 2012 and 2022. Each study must be accessible and written in English. Individuals older than 18 who received spinal anesthesia operations.

Results: A total of 41 article abstracts and 12 full-length studies were evaluated, and seven papers met the inclusion criteria. The studied clinical outcome was the frequency of post-spinal anesthesia shivering. The majority of prior investigations found no significant difference in the shivering impact between the clonidine and midazolam groups. Shivering was much less common after tramadol treatment than after clonidine administration. Dexmedetomidine is known to be more effective than clonidine in controlling post-spinal blockade shivering.

Conclusion: Clonidine is beneficial in lowering the occurrence of post-spinal anesthesia shivering.

Latar Belakang: Shivering dapat meningkatkan konsumsi oksigen, meningkatkan risiko hipoksemia, dan meningkatkan komplikasi setelah operasi. Berbagai efek klonidin membuat agen ini cukup potensial untuk digunakan tidak hanya sebagai pencegahan shivering tetapi juga untuk mengatasi efek samping lain dari anestesi spinal.

Metode: Peneliti mencari database PubMed untuk uji coba terkontrol acak/randomized clinical trial (RCT) dalam periode 2012-2022. Setiap studi harus dalam bahasa Inggris dan dapat diakses untuk full review. Subjek berusia >18 tahun yang menjalani prosedur anestesi spinal.

Hasil: Total 41 abstrak artikel yang ditelaah, 12 studi full paper ditelaah dan 7 studi yang memenuhi kriteria inklusi. Keluaran klinis yang dievaluasi adalah kejadian shivering pasca anestesi spinal. Hasil sebagian besar studi sebelumnya menunjukkan bahwa tidak terdapat perbedaan bermakna efek shivering pada kelompok klonidin dan midazolam. Insiden shivering pasca pemberian tramadol secara bermakna lebih rendah dibandingkan kelompok klonidin. Pemberian dexmedetomidine diketahui lebih efisien dibandingkan klonidin untuk mengontrol post spinal blockade shivering

Kesimpulan: Klonidin efektif mengurangi kejadian shivering pasca anestesi spinal.

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).

Diabetes mellitus (DM) is a major cause of death and disability worldwide where insulin resistance is a fundamental etiological factor of the pathogenesis of Type 2 DM (T2DM). The global prevalence of DM reached 425 million sufferers in 2017 and it is estimated that in 2040 it will reach 615 million people. Efforts to manage diabetes are by controlling blood sugar levels and preventing complications in this disease. Management modalities based on herbal medicine as an alternative have been extensively researched and analyzed. One of them is the use of the Syzygium cumini plant, because it has various bioactive compounds that are antihyperglycemic, anti-diabetic, anti-inflammatory, and antioxidant such as oleanolic acid (OA). The aim of the study was to discuss the potential of Nano-Oleanolic Acid-Lactoferrin (NOAL) in its ability to reduce blood glucose levels in the management of T2DM. The construction mechanism for NOAL using the Nanoparticle Albumin-Bound (NAB) method includes the preparation and construction stages of a combination of OA and lactoferrin (Lf) nanoparticles while the administration mechanism uses the oral route. The mechanism of action of NOAL is through postprandial blood sugar regulation, revitalization and regeneration of pancreatic β cells and increased sensitivity to insulin receptors. OA is known to inhibit PTP1B (Protein Thyrosine Phosphatase 1B) which increases insulin sensitivity through inhibition of PTP1B-mediated negative regulation of bypass insulin signaling. Reasoning creative ideas in this paper, requires an assessment and further research on the potential of NOAL in the management of T2DM.

Diabetes mellitus (DM) merupakan penyebab utama kematian dan kecacatan di seluruh dunia dimana resistensi insulin merupakan faktor etiologi mendasar dari patogenesis DM Tipe 2 (DMT2). Prevalensi global DM mencapai 425 juta penderita pada tahun 2017 dan diperkirakan pada tahun 2040 mencapai 615 juta orang. Upaya penatalaksanaan DM adalah dengan pengendalian kadar gula darah dan pencegahan komplikasi pada penyakit ini. Modalitas penatalaksanaan berbasis pengobatan herbal sebagai alternatif telah banyak diteliti dan dianalisis. Salah satunya adalah pemanfaatan tumbuhan Syzygium cumini, karena memiliki berbagai senyawa bioaktif yang bersifat antihiperglikemia, antidiabetes, antiinflamasi, dan antioksidan seperti oleanolic acid (OA). Tujuan kajian adalah untuk membahas potensi Nano-Oleanolic Acid- Lactoferrin (NOAL) dalam kemampuannya menurunkan kadar glukosa darah dalam penatalaksanaan DMT2. Mekanisme konstruksi NOAL menggunakan metode Nanoparticle Albumin-Bound (NAB) meliputi tahap preparasi dan konstruksi dari kombinasi OA dan nanopartikel lactoferrin (Lf) sedangkan mekanisme adminitrasinya menggunakan jalur oral. Mekanisme kerja NOAL yakni melalui regulasi gula darah postprandial, revitalisasi dan regenerasi sel β pankreas serta peningkatan sensitivitas reseptor insulin. OA diketahui menghambat PTP1B (Protein Thyrosine Phosphatase 1B) yang meningkatkan sensitivitas insulin melalui penghambatan regulasi negatif termediasi PTP1B dari pintasan persinyalan insulin. Penalaran ide kreatif dalam karya tulis ini, memerlukan suatu pengkajian dan penelitian lebih lanjut mengenai potensi NOAL dalam penatalaksaan DMT2.

Background: Acute Respiratory Infection (ARI) is the main cause of morbidity and mortality from infectious diseases in the world. Nearly four million people die from ARI each year, 98% of which are caused by lower respiratory tract infections. ARI is the most common disease in children. Incidence by age group under five is estimated to be 0.29 episodes per child/year in developing countries and 0.05 episodes per child/year in developed countries. One of the risk factors that contribute to the incidence of ARI is the low level of exclusive breastfeeding. This study aims to determine the incidence of ARI in infants who have been exclusively breastfed.

Methods: The research design was cross-sectional descriptive. Sampling was carried out using the non-probability sampling method of consecutive sampling. Subjects came sequentially and those who met the selection criteria were included in the study until the required number of subjects was met. In this study, subjects who met the research criteria were infants aged 0-12 months who were exclusively breastfed. Data were analyzed using SPSS version 20.0 for Windows.

Result: Based on the results of bivariate analysis of 100 samples consisting of 53 women and 47 men and 53 women, 43 babies or 43% of the samples had experienced ARI, namely 21 babies or 21% of the samples with mild ARI, 12 babies or 12% of the sample with moderate ARI and 10 infants or 10% of the sample with severe ARI.

Conclusion: As many as 43% had experienced ARI. This is caused by several factors, one of which is the mother's education level and mother's occupation. This is directly related to the mother's mindset in fulfilling baby nutrition through exclusive breastfeeding as an effort to form the baby's immune system in preventing babies from getting sick.

Latar belakang: Infeksi Saluran Pernapasan Akut (ISPA) adalah penyebab utama morbiditas dan mortalitas penyakit menular di dunia. Hampir empat juta orang meninggal akibat ISPA setiap tahun, 98% disebabkan oleh infeksi saluran pernapasan bawah. ISPA merupakan penyakit yang paling sering terjadi pada anak. Insiden menurut kelompok umur balita diperkirakan 0,29 episode per anak/tahun di negara berkembang dan 0,05 episode per anak/tahun di negara maju. Salah satu faktor risiko yang berkontribusi terhadap insiden ISPA adalah masih rendahnya peberian ASI eksklusif. Penelitian ini bertujuan untuk mengetahui angka kejadian ISPA pada bayi yang telah memperoleh ASI eksklusif.

Metode: Desain penelitian cross-sectional deskriptif Pengambilan sampel dilakukan dengan metode non-probability sampling jenis consecutive sampling, subjek datang secara berurutan dan yang memenuhi kriteria pemilihan dimasukkan dalam penelitian sampai jumlah subjek yang diperlukan terpenuhi. Dalam penelitian ini subjek yang memenuhi kriteria penelitian adalah bayi usia 0-12 bulan yang memperoleh ASI Eksklusif. Data dianalisis dengan SPSS versi 20.0 untuk Windows.

Hasil: Berdasarkan hasil analisis secara bivariat dari 100 sampel yang terdiri dari 53 perempuan dan 47 laki-laki dan 53 perempuan diperoleh sebanyak 43 bayi atau 43% sampel pernah mengalami ISPA, yaitu 21 bayi atau 21% sampel dengan ISPA ringan, 12 bayi atau 12% sampel dengan ISPA sedang dan 10 bayi atau 10% sampel dengan ISPA berat.

Simpulan: Sebanyak 43% pernah mengalami ISPA. Hal ini disebabkan oleh beberapa faktor salah satunya adalah tingkat Pendidikan ibu dan pekerjaan ibu. Hal ini berhubungan langsung terhadap pola pikir ibu dalam pemenuhan nutrisi bayi melalui pemberian ASI Eksklusif sebagai usaha pembentukan sistem imun bayi dalam mencegah bayi terserang penyakit.

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: COVID-19 is a disease caused by the SARS-CoV-2 virus. Until now, the current understanding of the COVID-19 transmission pattern in the pediatric population is still limited. Data regarding the comorbid presented in the pediatric population is also limited, despite its importance as a determinant of COVID-19 severity. The aim of this study is to know the transmission pattern and comorbid in confirmed COVID-19 cases in pediatrics so that prevention can be made in children at risk of the virus transmission.

Methods: Observational, cross-sectional study was conducted in children aged 0-18 years with confirmed COVID-19 cases based on RT-PCR between March 2020-2022 in the Department of Child Health/Ulin Hospital Banjarmasin. There were 92 patients hospitalized with confirmed COVID-19. Parents were interviewed to know the source of the virus transmission. Comorbid that were present were also recorded.

Results: There were 53% confirmed COVID-19 cases in the age group 0-5 years. Out of 92 samples, 67% presented with comorbid, mostly with haemato-oncology disease. There were only 10% of cases classified as severe cases. Based on an interview with the parents, the primary source of the virus transmission depends on the age group. Parents (71.3%) were the primary source within the age group 0-5 years, while school and community were the primary sources within the age group >5 – 10 years and >10 – 18 years, respectively 66% and 32%.

Conclusion: COVID-19 transmission in the pediatric population has different primary sources of infection depending on the age group. The most comorbid that were presented in COVID-19 cases is haemato-oncology disease which can be classified as immunocompromised patients.

Latar Belakang: COVID-19 merupakan penyakit yang disebabkan oleh virus SARS-CoV-2. Hingga saat ini, pola transmisi COVID-19 maupun data terkait komorbid pada populasi pediatri masih terbatas, meskipun hal tersebut sangat penting sebagai salah satu faktor penentu derajat keparahan COVID-19. Tujuan penelitian ini adalah mengetahui pola transmisi serta ada terkait komorbid pada kasus COVID-19 terkonfirmasi pada pediatri, agar pencegahan penularan dapat dilakukan terutama pada anak yang berisiko tertular virus tersebut.

Metode: Studi observasional dengan metode potong lintang ini dilakukan pada anak berusia 0-18 tahun yang terkonfirmasi COVID-19 berdasarkan pemeriksaaan RT-PCR selama periode Maret 2020-2022 pada departemen Ilmu Kesehatan Anak/Rumah Sakit Ulin Banjarmasin. Total anak yang dirawat dengan diagnose COVID-19 terkonfirmasi adalah 92 pasien. Data terkait komorbid yang ada juga dicatat dan dianalisa.

Hasil: Terdapat 53% kasus COVID-19 terkonfirmasi pada kelompok usia 0-5 tahun. Dari total 92 sampel penelitian, 67% pasien memiliki komorbid, dengan yang terbesar adalah penyakit hemato-onkologi. Hanya terdapat 10% kasus yang tergolong kasus COVID-19 derajat berat. Berdasarkan hasil wawancara orangtua sampel, sumber penularan primer transmisi virus berbeda-beda tiap kelompok umur. Orangtua (71,3%) merupakan sumber penularan primer transmisi virus pada kelompok usia 0-5 tahun, sedangkan sekolah dan komunitas menjadi sumber utama pada kelompok usia >5 -10 tahun dan usia >10-18 tahun, berturut-turut 66% dan 32%.

Kesimpulan: Transmisi COVID-19 pada populasi pediatri memiliki perbedaan sumber penularan primer virus tergantung kelompok usia. Komorbid terbanyak yang ditemui pada kasus COVID-19 terkonfirmasi adalah penyakit hemato-onkologi, yang termasuk kedalam pasien dengan imunokompromais.

Background: It is an important effort to do a visual and intraocular pressure by conducting examination directly to the community due to support the Indonesian Ministry of Health to reduce the prevalence of blindness by 2030. This examination will produce epidemiological data.

Aim: To find out the characteristics of visual acuity, intraocular pressure and eye disease in the people of Celuk Village, Gianyar, Bali in the Era of Covid 19 pandemic.

Methods: Observational descriptive of the people of Celuk Village, Gianyar Regency, Bali

Results: Visual examination results in the right and left eyes were mostly normal. The results of tonometry showed that most people still have normal eye pressure. The data obtained from the examination results to the public can be used as a reference value in the normal population. Strategies that can be taken to prevent the transmission of COVID-19 during external examinations are choosing a large location, adjusting the seat distance, setting the time of patient arrival, officers must be vaccinated, antigen swabs are carried out, and use PPE.

Conclusion: In this study, the most common visual disturbance was age-related presbyopia.

Latar belakang: Pemeriksaan visus dan tekanan bola mata dengan turun langsung ke masyarakat sangat penting untuk dilakukan karena menunjang harapan Kemenkes RI menurunkan prevalensi kebutaaan tahun 2030. Pemeriksaan ini akan menghasilkan data epidemiologis.

Tujuan:  Untuk mengetahui karakteristik tajam penglihatan, tekanan bola mata dan penyakit mata masyarakat Desa Celuk, Gianyar Provinsi Bali di era pandemi COVID 19

Metode: Deskriptif observasional pada masyarakat Desa Celuk, Kabupaten Gianyar, Provinsi Bali.

Hasil: Visus mata kanan dan kiri sebagian besar normal. Hasil tonometri mendapatkan sebagian besar masyarakat masih memiliki tekanan bola mata normal. Data yang diperoleh dari hasil pemeriksaan tersebut ke masyarakat dapat digunakan sebagai referensi nilai normal di populasi. Strategi yang dapat dilakukan untuk pencegahan transmisi COVID-19 selama skrining dan pemeriksaan luar adalah memilih lokasi yang luas, mengatur jarak kursi tunggu, mengatur waktu kedatangan pasien, seluruh petugas wajib divaksinasi, dilakukan swab antigen, dan menggunakan APD.  

Simpulan: Pada penelitian ini gangguan penglihatan yang paling banyak adalah presbiopia terkait dengan usia.

Background: Early detection and proper management are crucial to prevent rapid mortality caused by severe dengue, particularly in children, and it is essential to identify potential risk factors that may lead to dengue shock syndrome (DSS) to anticipate and manage potential worsening in pediatric patients. This study aims to evaluate the factors associated with the development of DSS in children with dengue.

Methods: Between January 2021 and September 2022, a cross-sectional study was conducted at the Sanjiwani Regional General Hospital in Gianyar City. The study involved the use of secondary data from medical records of pediatric patients aged 0-18 years, who were diagnosed with dengue during the period under investigation. The variables of age, gender, nutritional status, abdominal pain, persistent vomiting, bleeding, leukocyte levels, hemoglobin, hematocrit, platelets, and hemoconcentration were analyzed for their association with the prevalence of DSS.

Results: The study subjects were 62 children who met the criteria. A total of 31 (50%) patients were diagnosed with DSS. The results of this study indicate that the factors that have an association with the incidence of DSS in children at Sanjiwani Gianyar Hospital are age (p=0.038; prevalence ratio [PR]=0.359), nutritional status (p=0.020; PR=1.897), abdominal pain (p=0.038; PR=2.154), platelet levels (p=0.046; PR=1.672), and the presence of hemoconcentration (p=0.002; PR=2.122). 

Conclusion: Age,  nutritional status, abdominal pain, platelet levels, and hemoconcentration factors were found to be associated with the incidence of DSS.

Latar belakang: Severe dengue dapat menyebabkan kematian yang cepat terutama pada anak-anak jika tidak terdeteksi sejak dini dan dikelola dengan baik. Mengidentifikasi faktor-faktor risiko yang berpotensi mempengaruhi dengue shock syndrome (DSS) penting untuk mengantisipasi dan mengelola potensi perburukan pada pasien anak. Penelitian ini bertujuan mengevaluasi faktor-faktor yang berkontribusi dalam perkembangan DSS pada anak-anak dengan dengue.

Metode: Penelitian cross-sectional dilakukan menggunakan data sekunder dari rekam medik di Rumah Sakit Umum Daerah (RSUD) Sanjiwani Gianyar, pada pasien anak berusia 0-18 tahun yang terinfeksi dengue dan dirawat pada periode Januari 2021-September 2022. Variabel usia, jenis kelamin, status gizi, nyeri perut, muntah persisten, perdarahan, kadar leukosit, hemoglobin, hematokrit, trombosit, dan hemokonsentrasi dianalisis hubungannya dengan kejadian DSS.

Hasil: Subyek penelitian sebanyak 62 sampel yang memenuhi kriteria. Sebanyak 31 (50%) pasien terdiagnosis DSS. Hasil penelitian ini menunjukkan bahwa faktor-faktor yang memiliki hubungan dengan kejadian DSS pada anak di RSUD Sanjiwani Gianyar yaitu usia (p=0,038; prevalence ratio [PR]=0,359), status gizi (p=0,020; PR=1,897), nyeri perut (p=0,038; PR=2,154), kadar trombosit (p=0,046; PR=1,672), dan adanya hemokonsentrasi (p=0,002; PR=2,122).

Kesimpulan: Faktor risiko yang ditemukan berhubungan dengan kejadian DSS meliputi usia, status gizi, nyeri perut, kadar trombosit, dan kejadian hemokonsentrasi.

Background: Persistent pulmonary hypertension of the newborn (PPHN), also known as persistent fetal circulation, is a failure of the transition/adaptation process from fetal to extrauterine life with significant morbidity and mortality rates. This study determined the incidence and outcome of PPHN in infants.

Methods: From January 2017 to March 2022, an observational study was conducted on newborns with PPHN who were hospitalized in the second and third-level neonatology wards of Prof. Dr. I.G.N.G. Ngoerah Hospital. Based on a clinical and echocardiographic examination, PPHN was confirmed. Missing data on infants were excluded. PPHN incidence and outcomes were the main outcomes. The clinical profile of newborns with PPHN was one of the secondary outcomes.

Results: There were 42 neonates, with a median age of 1 (range 0-5 days) day at diagnosis. PPHN occurred in 2.5 cases per 1000 neonates admitted, with 60% male and 40% female. Referrals accounted for 74% of all PPHN cases. The majority of cases were born cesarean delivery (83%), at term (74%), and with birth weights of more than 2500 grams (65%). In 55% of cases, asphyxia history was discovered. The median oxygen index (OI) was 5.3 (range 1.90-57.30), with pneumonia/sepsis accounting for 95% of the causes. The median length of stay was 9.50 days (range 1-89), and 20 (48%) of the 42 cases had death.

Conclusion: The incidence of PPHN in a tertiary referral center in Indonesia is 2.5 cases per 1000 patients treated with a 48% mortality rate.

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: Sepsis is clinical syndrome characterized by hemodynamic, respiratory and metabolic changes resulting from infectious processes that trigger systemic inflammatory response syndrome. The latest diagnosis enforcement of neonatal sepsis in the form of biomarker, presepsin. This research was established to estimate the accuracy of presepsin in diagnosing neonatal sepsis in preterm

Methods: This study is cross-sectional study with diagnostic test design to determine the accuracy of presepsin examination in diagnosing neonatal sepsis with gold standard used double-sided blood culture. Sample size was 62 samples. Data analysis including sensitivity, specificity, positive predictive value, negative predictive value and accuracy of presepsin as diagnostic test calculated by using 2x2 table.

Results: This study involved 62 subjects. Subjects were dominated by median age 3, male 66.1%, birth weight 1500-<2500 grams 53.2%, vigorous baby 51.6%, caesarean section 67.7%, median leukocytes 4.8, median platelets 101.4, median IT-ratio 0.33, procalcitonin 2.21 and positive blood culture 77.4%. The AUC value is 85% and ROC curve showed 2 cut off values, namely 150 pg/mL, 44 subjects suffer neonatal sepsis with sensitivity 91.7%, specificity 78.57%, positive predictive value 93.62%, negative predictive value 73.3%, positive trend ratio 4.28, prevalence 77% and accuracy 88.71%. Cut off 243 pg/mL sensitivity 75%, specificity 85.7%, positive predictive value 94.6%, negative predictive value 50.6%, positive trend ratio 5.25, prevalence 77% and accuracy 77.46%.

Conclusion:  A cut off value 150 pg/mL, sensitivity 91.67% presepsin can be used as screening tool and cut off 243 pg/mL with specificity 85.7% as high specificity diagnostic test.

Introduction: Secondary glaucoma refers to any form of glaucoma in which there is identifiable cause of increased eye pressure, resulting in optic nerve damage and vision loss. Secondary glaucoma can be caused by lens, diabetes (neovascular glaucoma), trauma, post-operation of vitrectomy, corneal abnormality, uveitis and many more. Glaucoma is a condition presents in 80 million people worldwide, in which 6 million of them had secondary glaucoma. Causes of secondary glaucoma may differ from place to place. This study aims to determine the characteristics of secondary glaucoma patients at the eye polyclinic Prof Dr IGNG Ngoerah Hospital Denpasar in 2018-2022.

Patients and methods: This research is a descriptive analytical study with retrospective data. Study were done by collecting data based on observations of the medical records of patients who visited Eye Polyclinic at Prof Ngoerah General Hospital in the period of 2018-2020. A total of 55 people (67 eyes) who met the inclusion and exclusion criteria were analysed using SPSS for windows version 23.0

Results: The majority of subjects aged > 60 years (41.8%), male (71.6%), came with chief complaints of blurry vision (97%), unilateral (64.2%), open-angle (67.2%) and mostly had chronic onset (97%). There was significant improvement of visual acuity and intraocular pressure after surgery. The amount of drug used also decreased significantly after having surgery. There is significant improvement in visual acuity in patients after surgery from logmar 1.61 to logmar 0.85. Average intraocular pressure in patients receiving therapy decreased from 30.93 to 17.39. Considering drugs usage, it decreased from average of 1.64 to 0.68. Paired T-test analysis were used, resulting in statistically meaningful results.

Conclusion: Treatment for patients with secondary glaucoma in our hospital results in better visual acuity, decreased intraocular pressure, and decreased of anti-glaucoma drugs usage.

Latar Belakang: Glaukoma sekunder mengacu pada kondisi glaukoma dimana penyebab peningkatan tekanan mata telah diketahui, dimana hal ini menyebabkan kerusakan saraf optik dan kehilangan penglihatan. Penyebab glaukoma sekunder bervariasi meliputi lensa, diabetes (glaukoma neovaskuler), trauma, post-operasi vitrektomi, kelainan kornea, uveitis, dan lain-lain. Glaukoma diderita 80 juta orang di seluruh dunia, dimana 6 juta diantaranya dengan glaukoma sekunder. Penelitian bertujuan mengetahui karakteristik pasien glaukoma sekunder yang datang ke poliklinik mata di RSUP Prof Dr IGNG Ngoerah Denpasar pada tahun 2018-2020.

Metode: Penelitian ini merupakan penelitian deskriptif analitik. Data dikumpulkan secara retrospektif berdasarkan catatan medis pasien yang berkunjung ke Poliklinik Mata RSUP Prof Ngoerah periode 2018-2020. Sebanyak 55 orang (67 mata) subjek penelitian yang memenuhi kriteria inklusi dan eksklusi dianalisis menggunakan SPSS for windows versi 23.0

Hasil: Total 55 pasien (67 mata) dengan mayoritas subjek berusia > 60 tahun (41,8%), berjenis kelamin laki-laki (71,6%), datang dengan keluhan pandangan buram (97%). Sebagian besar glaukoma pada penelitian ini terjadi unilateral (64,2%) dengan onset kronis (97%) dan sebesar 67,2% diantaranya merupakan glaukoma sudut terbuka. Terdapat perbaikan signifikan rerata tajam penglihatan pasien yang telah dioperasi logmar 1.61 menjadi logmar 0.85. Untuk rerata tekanan intraokular pasien yang mendapatkan terapi mengalami penurunan dari 30.93 mmHg menjadi 17,39 mmHg. Dilihat dari jumlah obat glaukoma yang digunakan setelah operasi mengalami penurunan dari 1,64 menjadi 0,68. Analisa statistik menggunakan uji T-berpasangan dimana didapatkan hasil yang bermakna secara statistik.

Kesimpulan: Pasien glaukoma sekunder yang mendapatkan pengobatan, didapatkan perbaikan tajam penglihatan, penurunan tekanan intraokuler, serta penurunan jumlah obat antiglaukoma.

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.

Background: Neonatal sepsis has the main cause of mortality and morbidity in neonates worldwide; the most frequent cause is bacteria. This study examined the bacterial patterns and antibiotic susceptibility in neonatal sepsis at Prof Ngoerah Hospital, Bali.

Methods: This observational, descriptive study was conducted in Prof Ngoerah Hospital, Bali, Indonesia involving neonatal sepsis confirmed with blood culture. Data on antibiotic susceptibility and bacterial patterns were collected retrospectively from the registry of neonates patients with neonatal sepsis from January 2021 to August 2022.

Results: The predominance of gram-negative bacteria was Acinetobacter baumannii (29.17%), Klebsiella pneumonia (10.42%), and the predominance of gram-positive bacteria was Staphylococcus haemolyticus (14.58%), Staphylococcus epidermidis (8.35%). The susceptibility was Gentamicin (57.29%), Ciprofloxacin (56.84%), Levofloxacin (55.21%), Trimethoprim/sulfamethoxazole (54.17%), Amikacin (50%), Meropenem (39.58%), Ampicilin/sulbactam (34.38%), Cefepim (32.29%), Piperacillin/Tazobactam (28.13%), Cefoperazone sulbactam (25%), Tigecycline (25%), Ceftriaxone (23.96%), and Vancomycin (22.92%).

Conclusion: Gram-negative bacteria were a common infection. This study suggests that the reconsideration of gentamicin still can be an option as an empirical antibiotic, but ampicillin has low sensitivity; another broad-spectrum antibiotic with better sensitivity is another option due to its significantly higher susceptibility.

Background: Stroke is the third most common disease after cancer and heart disease. According to the South East Asian Medical Information Centre (SEAMIC), Indonesia has the highest death rate from stroke in Southeast Asia. A hemorrhage stroke occurs when a blood artery in the brain ruptures or leaks, so bleeding can occur around the organ and reduce blood supply to part of the brain.

Methods: This research is a retrospective descriptive study using a cross-sectional design. Data were taken from the patient's medical records using a consecutive sampling technique. This study aims to describe the characteristics of hemorrhagic stroke patients at Prof. Dr. I.G.N.G Ngoerah from January 2019 to January 2021. Data were analyzed using SPSS version 20.0 for Windows.

Results: In this study, the characteristics of the patients observed included the percentage of age between 30 to 60 years of 53,1%, male patients as much as 68,8%, the type of work reached 52.1%, CT-scan examination of the head found intracerebral hemorrhage as much as 50%, the last level of education in high school reached 65,6%, the history of the disease reached 81,2%, the initial diagnosis when entering the hospital with suspected hemorrhage stroke was 32,2%, and patients who did not experience complications were 77,1%. As many as 43.8% of patients died.

Conclusion: Characteristics of hemorrhagic stroke patients at Prof. Dr. dr. I.G.N.G Ngoerah Hospital in the period January 2019–January 2021 mostly had an age range of 30–60 years, were male, had a last high school education, had a job, had an intracerebral hemorrhage, had a history of previous illness, and most of the patients did not experience complications.

Latar Belakang: Setelah kanker dan penyakit jantung, stroke menjadi penyakit paling umum ketiga. Menurut South East Asian Medical Information Centre (SEAMIC), Indonesia memiliki tingkat kematian tertinggi akibat stroke di Asia Tenggara. Stroke hemoragik terjadi ketika arteri darah di otak pecah atau bocor, sehingga perdarahan dapat terjadi di sekitar organ dan mengurangi suplai darah ke sebagian otak.

Metode: Penelitian ini merupakan penelitian deskriptif retrospektif yang menggunakan desain potongan melintang (cross-sectional). Data diambil dari rekam medis pasien dengan teknik pengambilan sampel secara consecutive sampling. Penelitian ini bertujuan untuk mendeskripsikan karakteristik penderita stroke hemoragik di RSUP Prof. Dr. I.G.N.G Ngoerah selama periode Januari 2019 hingga Januari 2021. Data dianalisis dengan SPSS versi 20.0 untuk Windows.

Hasil: Dalam penelitian ini, ciri-ciri pasien yang diamati meliputi persentase usia antara 30 hingga 60 tahun sebesar 53,1%, pasien laki-laki sebanyak 68,8%, pasien yang memiliki pekerjaan mencapai 52,1%, pemeriksaan CT-Scan kepala didapat pendarahan intraserebral sebanyak 50%, tingkat pendidikan terakhir di sekolah menengah atas mencapai 65,6%, pasien yang memiliki riwayat penyakit mencapai 81,2%, diagnosis awal ketika masuk rumah sakit dengan suspek stroke hemoragik sebanyak 32,2%, dan pasien yang tidak mengalami komplikasi sebanyak 77,1%. Sebanyak 43,8% pasien meninggal dunia.

Kesimpulan: Karakteristik pasien stroke hemoragik di RSUP Prof. Dr. I.G.N.G Ngoerah pada periode Januari 2019 – Januari 2021 sebagian besar memiliki rentang usia dari 30-60 tahun, laki-laki, pendidikan terakhir SMA, memiliki pekerjaan, intracerebral hemorrhage. memiliki riwayat penyakit sebelumnya, dan sebagian besar pasien tidak memiliki komplikasi.

Background: Research and utilization of natural materials from the leaf extract of the Dewandaru plant (Eugenia uniflora L) in the Ear, Nose and Throat (ENT) field as an alternative therapy for bacterial infections in the nose and sinus area has never been studied before. This study aims to determine the inhibitory power of Dewandaru leaf extract (Eugenia uniflora L) against Gram Positive (Staphylococcus aureus) and Gram Negative (Pseudomonas aeruginosa) bacteria that cause infection in the sinonasal area.

Methods: This study took an approach in identifying the leaves of the Dewandaru plant (Eugenia uniflora L), identifying the active antibacterial compounds in the leaves of Dewandaru, and processing the leaves of Dewandaru into pure extracts in several concentrations through standard processing of the Udayana University Pharmacy Laboratory. To determine the effectiveness of Dewandaru leaves against Pseudomonas aeruginosa and Staphylococcus aureus bacteria as the most common causes of sinonasal infection, an in-vitro test was carried out on Dewandaru leaf extract at concentrations of 100%, 90% and 80%, compared to 1% Chloramphenicol drops on agar media. Data were analyzed using SPSS version 23.0 for Windows.

Results: The average inhibition results at 80 percent of Dewandaru leaf extract was 13.60 mm, at 90 percent concentration was 13.60 mm and at 100 percent concentration was 12.60 mm for Staphylococcus aureus. Meanwhile, the average inhibition at 80 percent of Dewandaru leaf extract was 7.20 mm, 7.20 mm at 90 percent concentration and 7.20 mm at 100 percent concentration for Pseudomonas aeruginosa bacteria.

Conclusion: The results of this study indicate that there is an inhibitory power from the antibacterial test results of Dewandaru leaf extract (Eugenia uniflora L) with concentrations of 80%, 90% and 100% respectively against Staphylococcus aureus and Pseudomonas aeruginosa.

Latar Belakang: Penelitian dan pemanfaatan bahan alam dari ekstrak daun tanaman Dewandaru (Eugenia uniflora L) pada bidang Telinga Hidung dan Tenggorok (THT) sebagai terapi alternatif infeksi bakteri pada daerah hidung dan sinus belum pernah diteliti sebelumnya. Penelitian ini bertujuan untuk mengetahui daya hambat ekstrak daun Dewandaru (Eugenia uniflora L) terhadap bakteri Gram Positif (Staphylococcus aureus) dan Gram Negatif (Pseudomonas aeruginosa) penyebab infeksi pada  daerah sinonasal

Metode: Penelitian ini melakukan pendekatan dalam identifikasi daun tanaman Dewandaru (Eugenia uniflora L), identifikasi senyawa aktif antibakteri daun dewandaru, serta upaya pengolahan daun Dewandaru menjadi ekstrak murni dalam beberapa konsentrasi melalui standar pengolahan laboratorium Farmasi Universitas Udayana. Untuk mengetahui efektivitas daun Dewandaru terhadap bakteri Pseudomonas aeruginosa dan Staphylococcus aureus sebagai penyebab tersering infeksi daerah sinonasal, dilakukan uji secara in-vitro dari ekstrak daun Dewandaru pada konsentrasi 100%, 90% dan 80%, dibandingkan dengan obat tetes Chloramphenicol 1% pada media agar. Data dianalisis dengan SPSS versi 23.0 untuk Windows.

Hasil: Hasil rerata daya hambat pada konsentrasi ekstrak daun Dewandaru 80 persen sebesar 13,60 mm, pada konsentrasi 90 persen sebesar 13,60 mm dan pada konsentrasi 100 persen sebesar 12,60 mm pada Staphylococcus aureus. Sedangkan hasil rerata daya hambat pada konsentrasi ekstrak daun Dewandaru 80 persen sebesar 7,20 mm, pada konsentrasi 90 persen sebesar 7,20 mm dan pada konsentrasi 100 persen sebesar 7,20 mm terhadap bakteri Pseudomonas aeruginosa.

Kesimpulan: Hasil penelitian ini menunjukkan bahwa terdapat daya hambat dari hasil uji antibakteri sediaan Ekstrak daun Dewandaru (Eugenia uniflora L) dengan konsentrasi masing-masing 80%, 90% dan 100% terhadap bakteri Staphylococcus aureus maupun Pseudomonas aeruginosa.

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: 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: Chemotherapy is an important curative therapy modality in ALL patients. 8-Hydroxy-2'-Deoxyguanosine (8-OHdG) has been studied as a biomarker of oxidative stress as a trigger for DNA damage, which is statistically significantly increased in ALL patients after chemotherapy compared to healthy children. This study aims to prove that 8-OHdG levels in children with ALL post-chemotherapy induction phases were higher than in the post-chemotherapy maintenance phase.

Methods: This study used a cross-sectional design. The subjects were children aged 1-18 years, with ALL who received treatment at Prof Dr. I.G.N.G Ngoerah Hospital from September 2019-January 2021. The Mann-Whitney test assessed the 8-OHdG levels in children with ALL post-chemotherapy induction and post-chemotherapy maintenance phase. Logistic regression multivariate analysis was used to evaluate the factors that influence 8-OHdG levels in pediatric patients with ALL. The value of p<0,05 determined the level of significance.

Results: A total of 27 subjects who underwent the post-chemotherapy induction phase and 19 subjects who underwent the post-chemotherapy maintenance phase were analyzed in this study. In the post-chemotherapy induction group, the median 8-OHdG level was 0.163 (0.104-1.864), and the median 8-OHdG level in the post-chemotherapy maintenance phase group was 0.158 (0.094-0.512). There was no significant difference in 8-OHdG levels between the two groups. Logistic regression multivariate analysis found that the post-chemotherapy induction phase was a prognostic factor at risk of increasing 8-OHdG levels (RO 16.55; 95% CI 1.118-245.277).

Conclusion: This study concluded that 8-OHdG levels were higher in children post-chemotherapy induction phase than in children post-chemotherapy maintenance phase.

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.

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.

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.

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.