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PERBEDAAN ZONA WAKTU BERKORELASI POSITIF DENGAN LAMA JET LAG PADA WISATAWAN ASING YANG BERKUNJUNG KE BALI Stefanus Soewito Sutanto
E-Jurnal Medika Udayana Vol 7 No 8 (2018): Vol 7 No 8 (2018): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (135.921 KB)

Jet lag merupakan gangguan tidur yang muncul akibat dari perpindahan zona waktu yang terlalu cepat bagi circadian rhythm untuk beradaptasi. Kegagalan circadian rhythm untuk beradaptasi dikarenakan tubuh manusia sudah terbiasa dengan jadwal terang dan gelap pada zona waktu tempat tinggal dan harus beradaptasi pada saat berpergian lintas zona waktu dengan jadwal terang dan gelap tempat tujuan. Penelitian ini bertujuan untuk membuktikan apakah perbedaan zona waktu berkorelasi positif dengan lama jet lag pada wisatawan asing yang berkunjung ke Bali.Jenis penelitian ini adalah analitik dengan rancangan potong lintang (cross sectional) analitik untuk mengetahui korelasi antara perbedaan zona waktu dengan lama jet lag. Dilanjutkan dengan uji korelasi dengan skala numerik yaitu uji parametric pearson bila data berdistribusi normal, apabila data tidak berdistribusi normal maka akan digunakan uji spearman. Median perbedaan zona waktu sebesar 3.5 jam dengan data minimum 1 jam dan maksimum 13 jam sedangkan median lama penerbangan sebesar 12.5 jam dengan data minimum 3 jam dan data maksimum 30 jam. Sebagai kesimpulan bahwa perbedaan zona waktu berkorelasi sedang positif dengan lama jet lag pada wisatawan asing yang berkunjung ke Bali. Kata kunci: Jet Lag, Zona Waktu, Lama Penerbangan, Wisatawan Asing, Bali

The Silent Saboteur: Chronic Refractory Erythema Nodosum Leprosum Perpetuated by Neglected Odontogenic Foci in a Post-RFT Borderline Lepromatous Patient Antonio Orson Ongkowidjojo; Luh Made Mas Rusyati; Stefanus Soewito Sutanto
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1523

Background: Erythema nodosum leprosum (ENL) is a severe, immune-complex mediated complication of lepromatous leprosy that can manifest before, during, or after multidrug therapy (MDT). While the primary etiology involves the release of Mycobacterium leprae antigens, the chronicity of ENL is frequently driven by secondary, often occult, triggers. Focal infections, particularly of odontogenic origin, are frequently overlooked in standard dermatological assessments, leading to refractory clinical courses. Case presentation: We report the case of a 32-year-old male with a history of borderline lepromatous (BL) leprosy who had achieved release from treatment (RFT). The patient presented with severe, chronic, and recurrent ENL characterized by painful erythematous nodules, high-grade fever, and acute neuritis, occurring more than one year post-RFT. Laboratory evaluation revealed significant inflammatory markers, including a C-Reactive Protein level of 172.7 mg/L and leukocytosis. Crucially, intraoral examination identified neglected chronic dental caries (gangrene radix) and generalized periodontal inflammation. Despite medical advice, the patient refused dental intervention. The reactional state was managed with a combination of intravenous methylprednisolone and high-dose oral clofazimine. While cutaneous symptoms improved, the persistence of the focal infection poses a substantial risk for further recurrence. Conclusion: This case highlights the critical and often underestimated role of odontogenic focal infections as perpetuating factors in chronic ENL. It underscores the necessity for a multidisciplinary approach integrating dentistry and dermatology. We propose that recalcitrant ENL in post-RFT patients should trigger mandatory screening for occult dental infections to disrupt the cycle of systemic inflammation.

Mycobacterium marinum Co-infection Masquerading as Treatment-Resistant Chromoblastomycosis: A Diagnostic and Therapeutic Challenge in Cutaneous Co-infection Stefanus Soewito Sutanto; Ni Luh Putu Ratih Vibriyanti Karna; Herman Saputra; Robert Thiodorus
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 7 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i7.1624

Background: Co-infection of chromoblastomycosis and Mycobacterium marinum (fish tank granuloma) within a single cutaneous lesion is exceptionally rare and presents a formidable diagnostic challenge owing to overlapping clinical and histopathologic features. The chronic verrucous or nodular morphology, predilection for distal extremities, and aquatic exposure history common to both conditions can lead to misdiagnosis, prolonged ineffective therapy, and patient morbidity. Case presentation: A 31-year-old Indonesian male with a fishkeeping hobby presented with a persistent erythematous plaque on the right middle finger, present since 2022, following a puncture injury sustained while collecting mosquito larvae and water fleas as fish food. He was initially diagnosed with chromoblastomycosis (Phialophora spp. on culture) in September 2023 and treated with itraconazole 200 mg daily and topical miconazole 2% for 48 weeks without resolution. Repeat biopsy in 2024 demonstrated negative periodic acid-Schiff and Ziehl-Neelsen stains but revealed non-caseating tuberculoid granulomas. Considering the patient's aquatic exposure, antifungal failure, and granulomatous histopathology, a diagnosis of fish tank granuloma due to M. marinum co-infection was established. Combination antimycobacterial therapy with rifampicin 600 mg and ethambutol 1500 mg daily produced clinical resolution at six-month follow-up. Conclusion: This case underscores the necessity of considering M. marinum in patients with antifungal-refractory chronic skin lesions and aquatic exposure, and highlights the diagnostic value of repeat histopathology with directed staining when initial therapy fails.

The Silent Saboteur: Chronic Refractory Erythema Nodosum Leprosum Perpetuated by Neglected Odontogenic Foci in a Post-RFT Borderline Lepromatous Patient Antonio Orson Ongkowidjojo; Luh Made Mas Rusyati; Stefanus Soewito Sutanto
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1523

Background: Erythema nodosum leprosum (ENL) is a severe, immune-complex mediated complication of lepromatous leprosy that can manifest before, during, or after multidrug therapy (MDT). While the primary etiology involves the release of Mycobacterium leprae antigens, the chronicity of ENL is frequently driven by secondary, often occult, triggers. Focal infections, particularly of odontogenic origin, are frequently overlooked in standard dermatological assessments, leading to refractory clinical courses. Case presentation: We report the case of a 32-year-old male with a history of borderline lepromatous (BL) leprosy who had achieved release from treatment (RFT). The patient presented with severe, chronic, and recurrent ENL characterized by painful erythematous nodules, high-grade fever, and acute neuritis, occurring more than one year post-RFT. Laboratory evaluation revealed significant inflammatory markers, including a C-Reactive Protein level of 172.7 mg/L and leukocytosis. Crucially, intraoral examination identified neglected chronic dental caries (gangrene radix) and generalized periodontal inflammation. Despite medical advice, the patient refused dental intervention. The reactional state was managed with a combination of intravenous methylprednisolone and high-dose oral clofazimine. While cutaneous symptoms improved, the persistence of the focal infection poses a substantial risk for further recurrence. Conclusion: This case highlights the critical and often underestimated role of odontogenic focal infections as perpetuating factors in chronic ENL. It underscores the necessity for a multidisciplinary approach integrating dentistry and dermatology. We propose that recalcitrant ENL in post-RFT patients should trigger mandatory screening for occult dental infections to disrupt the cycle of systemic inflammation.

Mycobacterium marinum Co-infection Masquerading as Treatment-Resistant Chromoblastomycosis: A Diagnostic and Therapeutic Challenge in Cutaneous Co-infection Stefanus Soewito Sutanto; Ni Luh Putu Ratih Vibriyanti Karna; Herman Saputra; Robert Thiodorus
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 7 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i7.1624

Background: Co-infection of chromoblastomycosis and Mycobacterium marinum (fish tank granuloma) within a single cutaneous lesion is exceptionally rare and presents a formidable diagnostic challenge owing to overlapping clinical and histopathologic features. The chronic verrucous or nodular morphology, predilection for distal extremities, and aquatic exposure history common to both conditions can lead to misdiagnosis, prolonged ineffective therapy, and patient morbidity. Case presentation: A 31-year-old Indonesian male with a fishkeeping hobby presented with a persistent erythematous plaque on the right middle finger, present since 2022, following a puncture injury sustained while collecting mosquito larvae and water fleas as fish food. He was initially diagnosed with chromoblastomycosis (Phialophora spp. on culture) in September 2023 and treated with itraconazole 200 mg daily and topical miconazole 2% for 48 weeks without resolution. Repeat biopsy in 2024 demonstrated negative periodic acid-Schiff and Ziehl-Neelsen stains but revealed non-caseating tuberculoid granulomas. Considering the patient's aquatic exposure, antifungal failure, and granulomatous histopathology, a diagnosis of fish tank granuloma due to M. marinum co-infection was established. Combination antimycobacterial therapy with rifampicin 600 mg and ethambutol 1500 mg daily produced clinical resolution at six-month follow-up. Conclusion: This case underscores the necessity of considering M. marinum in patients with antifungal-refractory chronic skin lesions and aquatic exposure, and highlights the diagnostic value of repeat histopathology with directed staining when initial therapy fails.

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