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ISM (Intisari Sains Medis) : Jurnal Kedokteran

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Published by Universitas Udayana

ISSN : 25033638 EISSN : - DOI : -

Core Subject : Health, Science,

Biochemistry, Genetics & Molecular Biology Medicine & Pharmacology

Intisari Sains Medis is published by Medical Scientific Community, Indonesia. Intisari Sains Medis is an international, multidisciplinary, peer-reviewed, open access journal accepts papers for publication in all aspects of Science Digest, Medical Research Development, Research Medical Field and Theory. We also publish cases from third world country, that is considered very rare and special cases.

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Karakteristik infeksi virus dengue di RSUD Lewoleba Kabupaten Lembata pada periode Januari 2019 – Desember 2021 Vennia Riskia Tristianti; Juliana Manurung; Rosalia Theodosia Daten Beyeng
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: Dengue virus infection has become an international problem that has increased in the last three years. East Nusa Tenggara is always included in the top five provinces with the most cases of dengue, as well as Lembata Regency. Therefore, this study aims to determine the characteristics of dengue virus infection in pediatric patients in Lembata Regency. Methods: A retrospective descriptive study using a simple random sampling method on 81 children with dengue virus infection who were treated at Lewoleba General Hospital during January 2019 – December 2021. The data collected through medical records. Data analysis was performed with SPSS version 22 for Windows. Results: Dengue infections’ characteristics in Lewoleba General Hospital were male (60.5%), range from 5 – 10 years old (46.9%), with good nutritional status (63%). The most clinical symptoms were fever, which was mostly on day 5 accompanied by abdominal pain (76.5%), vomiting (75.3%), headache (49.4%), muscle pain (37%), spontaneous bleeding (25.9%), hepatomegaly (55.6%), and petechiae (33.3%). The length of stay is 3 – 5 days (53.1%). 55.6% patients had secondary infection, 30,9% had grade II dengue hemorrhagic fever, with leukopenia (<5000/µL) (49.4%) and trombositopenia (50,000 – 100,000/µL) (42%). All subjects went home recovered (100%). Conclusion: The characteristics of dengue virus infection in Lewoleba General Hospital mostly men aged 5-10 years, with good nutrition, had fever, abdominal pain, vomiting, headache, joint pain, spontaneous bleeding, hepatomegaly, and petechiae. Most dengue infections are secondary. The highest degree is grade II, laboratory findings showed leukopenia and thrombocytopenia. Latar Belakang: Infeksi virus dengue telah menjadi masalah internasional yang mengalami peningkatan frekuensi dalam tiga tahun terakhir. Nusa Tenggara Timur selalu masuk dalam lima besar provinsi dengan kasus terbanyak infeksi virus dengue, demikian pula dengan Kabupaten Lembata. Oleh karena itu penelitian ini bertujuan untuk mengetahui karakteristik infeksi virus dengue pada pasien anak di Kabupaten Lembata. Metode: Penelitian dengan metode deskriptif retrospektif dengan pengambilan sampel acak terhadap 81 anak dengan infeksi virus dengue yang dirawat di RSUD Lewoleba periode Januari 2019 – Desember 2021. Data diambil melalui rekam medis pasien. Analisis data dilakukan dengan SPSS versi 22 untuk Windows. Hasil: Karakteristik infeksi dengue di RSUD Lewoleba terbanyak adalah laki-laki (60,5%), usia 5 – 10 tahun (46,9%), dengan status gizi baik (63%). Gejala klinis terbanyak adalah demam pada hari ke-5, disertai dengan nyeri perut (76,5%), muntah (75,3%), nyeri kepala (49,4%), nyeri otot (37%), perdarahan spontan (25,9%), hepatomegali (55,6%), dan petechiae (33,3%). Lama hari rawat adalah 3 – 5 hari (53,1%). 55,6% pasien mengalami infeksi sekunder, 30,9% mengalami demam berdarah derajat II, dengan leukopenia (5.000/µL) (49,4%) serta trombositopenia (50.000 – 100.000 /µL) (42%). Seluruh subyek penelitian pulang dengan keadaan sembuh (100%). Kesimpulan: Karakteristik infeksi virus dengue di RSUD Lewoleba adalah lebih banyak mengenai laki-laki usia 5-10 tahun dengan gizi baik, disertai gejala demam, nyeri perut, muntah, nyeri kepala, nyeri sendi, perdarahan spontan, hepatomegali, petechiae. Infeksi dengue terbanyak adalah infeksi sekunder, infeksi terbanyak adalah derajat II, serta ditemukan adanya leukopenia dan trombositopenia.

Conjungtival autograft menggunakan fiksasi autologus pada kasus pterigium: laporan kasus Raymond Tanjung; Melvin Manuel Philips; Rizky Magnadi
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: Pterygium is a growth disorder of fibrovascular tissue from the white part of the eye towards the cornea. Surgery is the main treatment option at this time. Several surgical techniques have been developed and can be performed to treat pterygium cases, one of which is conjunctival autograft. This surgical technique is performed by excising the pterygium tissue and then taking healthy conjunctival tissue to close the excision of the pterygium. Autologous is one way of attaching healthy conjunctival grafts to the site of pterygium excision. This case report aims to evaluate conjunctival autograft using autologous fixation in pterygium cases. Case Description: A 50-year-old woman working as a housewife came to the eye clinic complaining of pain in the patient's left eye accompanied by itching, red eyes, and watering. Complaints have been felt for about 1 week. The patient also complained about the appearance of a white spot that was felt to be getting bigger in his left eye. Ophthalmological examination of the anterior segment of the left eye revealed a reddish-white tissue arising from the conjunctiva through the limbus but not yet reaching the center of the cornea. The patient has been diagnosed with stage 3 pterygium and is planned to perform autologous conjunctival autograft surgery on the patient. Conclusion: Conjunctival autograft surgery using autologous fixation is an option for surgery in pterygium cases. The results obtained after this operation are satisfactory, but the patient is still informed about possible complications or recurrences. Latar Belakang: Pterigium merupakan sebuah kelainan pertumbuhan jaringan fibrovaskular dari bagian putih mata mengarah kearah kornea. Tindakan operasi merupakan pilihan terapi utama saat ini. Beberapa teknik operasi telah berkembang dan dapat dilakukan untuk menangani kasus pterigium, salah satunya adalah conjungtival autograft. Teknik operasi ini dilakukan dengan mengeksisi jaringan pterigium lalu mengambil jaringan konjungtiva yang sehat untuk menutup bekas eksisi pterigium. Autologus merupakan salah satu cara untuk merekatkan cangkuk konjungtiva sehat di tempat eksisi pterigium. Laporan kasus ini bertujuan untuk mengevaluasi conjungtival autograft menggunakan fiksasi autologus pada kasus pterygium. Deskripsi Kasus: Seorang wanita berusia 50 tahun, bekerja sebagai ibu rumah tangga datang ke poliklinik mata dengan keluhan rasa perih di mata kiri pasien dan disertai dengan rasa gatal, mata merah, serta berair. Keluhan dirasakan sejak kurang lebih 1 minggu. Pasien juga mengeluhkan muncul bercak putih yang dirasa makin membesar di mata kirinya. Pemeriksaan oftalmologi segmen anterior mata kiri didapatkan sebuah jaringan berwarna putih kemerahan yang timbul dari arah konjugtiva melewati limbus tetapi belum sampai ke tengah kornea. Pasien didiagnosis dengan pterigium stadium 3 dan direncanakan untuk dilakukan operasi conjungtival autograft dengan autologus kepada pasien tersebut. Kesimpulan: Teknik operasi conjungtival autograft dengan menggunakan fiksasi autologus merupakan salah satu pilihan operasi pada kasus pterigium. Hasil yang didapat setelah operasi ini cukup memuaskan, tetapi pasien tetap diinformasikan tentang kemungkinan komplikasi ataupun kekambuhan yang dapat terjadi.

Resection of a mature giant teratoma with clamshell incision thoracotomy approach: Case report and literature review Adhyasta Nata Prawira Subianto; Maz Isa Ansyori Arsatt
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

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

Perbandingan kadar C-reactive protein (CRP) berdasarkan jenis herniotomi dan hubungannya dengan keluaran klinis pada hernia inguinalis indirek anak Giovani Fatrio Odo; I Made Darmajaya; Nyoman Golden
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: Hernia is a protrusion or protrusion of the contents of a cavity through a defect or weak part of the abdominal cavity wall. The standard procedure in the form of herniotomy for indirect inguinal hernias in children can be performed open surgically or laparoscopically. Because there is still a lot of debate about the inflammatory response and outcomes that arise in patients undergoing laparoscopy and open herniotomy, this study was conducted with the aim of evaluating differences in CRP levels in pediatric patients after open herniotomy and laparoscopic herniotomy and their impact on surgical outcomes in the form of wound healing time, length of hospitalization and postoperative pain. Methods: This study is a prospective cohort study using primary data carried out at Sanglah Central General Hospital (RSUP) Sanglah from January to December 2020. Data in the form of gender, the side of the hernia, age, CRP levels, duration of hospitalization, duration of wound healing , postoperative pain scale, duration of surgery, hemoglobin, and BMI were taken from the patient's medical record. After the data was collected, univariate and bivariate analysis was carried out using SPSS 20. Result: A total of 38 patients who were the subjects of this study in the open surgical and laparoscopic groups were 19 subjects each. The mean CRP level in the open surgical group was higher (4.58 ± 1.82 mg/L) than the laparoscopic group (3.53 ± 1.53 mg/L). The duration of hospitalization and wound healing in the open surgical group was found to be longer (1.11 ± 0.32 days; 6.58 ± 0.51 days) when compared to the laparoscopic group (1.05 ± 0.23 days; 4.42 ± 0.51 days). The mean postoperative pain scale measurement results were higher in the open surgical group (2.84 ± 0.77) compared to the laparoscopic group (1.53 ± 0.51). The results showed that there was a statistically significant correlation (p<0.05; p<0.05) with a weak correlation coefficient (r = 0.468; r = 0.457). Conclusion: The laparoscopic technique was found to be superior in terms of the resulting inflammatory response, duration of wound healing, postoperative pain scale, and duration of hospitalization when compared to the open surgery technique. While the duration of hospitalization between the two groups was the same. Latar belakang: Hernia merupakan protrusi atau penonjolan isi suatu rongga melalui defek atau bagian lemah dari dinding rongga abdomen. Prosedur standar berupa herniotomi pada hernia inguinal indirek anak dapat dilakukan secara open surgical ataupun laparoskopi. Oleh karena masih banyaknya perdebatan mengenai respon inflamasi dan luaran yang timbul pada pasien yang menjalani laparoskopi dan open herniotomy, penilitian ini dilakukan dengan tujuan untuk mengevaluasi perbedaan kadar CRP pada pasien anak pasca open herniotomy dan laparoskopi herniotomi serta dampaknya terhadap luaran operasi berupa lama penyembuhan luka, lama rawat inap serta nyeri paska operasi. Metode: Studi ini merupakan studi kohort prospektif dengan menggunakan data primer yang dilaksanakan di Rumah Sakit Umum Pusat Sanglah (RSUP) Sanglah sejak Januari hingga Desember 2020. Data berupa jenis kelamin, sisi yang mengalami hernia, usia, kadar CRP, durasi rawat inap, lama penyembuhan luka, skala nyeri pasca operasi, durasi operasi, hemoglobin, dan IMT diambil dari rekam medis pasien. Setelah data terkumpul, dilakukan analisis univariat dan bivariat dengan menggunakan SPSS 20. Hasil: Sebanyak 38 pasien yang menjadi subjek penelitian ini dengan kelompok open surgical dan laparoskopi terdapat masing-masing 19 subjek. Rerata kadar CRP pada kelompok open surgical lebih tinggi (4.58 ± 1.82 mg/L) dibandingkan dengan kelompok laparoskopi (3.53 ± 1.53 mg/L). Durasi rawat inap dan penyembuhan luka pada kelompok open surgical didapatkan lebih lama (1.11 ± 0.32 hari; 6.58 ± 0.51 hari) jika dibandingkan dengan kelompok laparoskopi (1.05 ± 0.23 hari; 4.42 ± 0.51 hari). Rerata hasil pengukuran skala nyeri pasca operasi didapatkan lebih tinggi pada kelompok open surgical (2.84 ± 0.77) dibandingkan dengan kelompok laparoskopi (1.53 ± 0.51). Hasil menunjukkan antara kadar CRP dengan variabel durasi penyembuhan luka dan dengan durasi operasi didapatkan korelasi yang bermakna secara statistika (p<0.05; p<0.05) dengan koefisien korelasi yang lemah (r = 0.468; r = 0.457). Simpulan: Teknik laparoskopi ditemukan lebih unggul dalam hal respon inflamasi yang dihasilkan, durasi penyembuhan luka, skala nyeri pasca operasi, dan durasi rawat inap jika dibandingkan dengan teknik open surgery. Sedangkan durasi rawat inap diantara kedua kelompok adalah sama. Kata Kunci: C-reactive protein, open herniotomy, herniotomi laparoskopi, hernia inguinalis indirek, luaran operasi

Hubungan kadar Laju Endap Darah (LED) dan C-Reactive Protein (CRP) sebagai nilai prediktor dalam diagnosis osteomielitis dengan infeksi kaki pasien Diabetes Mellitus Tipe-2 (DM2) di RSUP DR. Wahidin Sudirohusodo, Makassar, Indonesia Mulawardi; Jancung; Muhammad Nasser Mustari; Joko Hendarto
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: Diabetes Mellitus Type-2 (DM2) is a disease that can cause various complications, one of the common complications is diabetic foot, especially in osteomyelitis patients. Several parameters are known to contribute to the occurrence of diabetic foot such as ESR and C-Reactive Protein (CRP). This study aims to evaluate the relationship between ESR and CRP levels as a predictor value in the diagnosis of osteomyelitis with foot infection in DM2 patients. Methods: This study is a diagnostic study with cross-sectional data collection techniques on 67 patient medical records from the Department of Surgery, Dr. RSUP. Wahidin Sudirohusodho consecutively during the period from June to October 2020. The variables assessed in this study included age, gender, Body Mass Index (BMI), comorbidities, duration of diabetes, HbA1c, ESR, C-Reactive Protein (CRP), and osteomyelitis. Data were analyzed with SPSS version 20 for Windows. Results: There was a significant difference in ESR levels (96.00 (79.00-115.00) vs. 67.50 (22.00-88.00 mm/hour; p=0.000), procalcitonin (16.04 (0.05) -42.03 vs. 30.17 (0.21-56.08) ng/mL; p=0.003), and female gender (72.00% vs. 28.00%; p=0.022) in both the osteomyelitis group and non-osteomyelitis. From the ROC curve analysis, the parameters with significant results were ESR (Cut-Off: 83.75 mm/hour; p=0.000) and procalcitonin (Cut-Off: 19.72 ng/mL; p=0.003) in the diagnosis of osteomyelitis in DM2 patients. Conclusion: There is a significant difference in terms of ESR values and procalcitonin levels between the group of T2DM patients with osteomyelitis and without osteomyelitis. Of the three inflammatory marker parameters, namely CRP, ESR and procalcitonin, the ESR value is known to have the highest accuracy as a predictor of osteomyelitis. Latar Belakang: Diabetes Mellitus Tipe-2 (DM2) merupakan penyakit yang dapat menimbulkan berbagai macam komplikasi, salah satu komplikasi yang umum terjadi adalah kaki diabetes khususnya pada pasien osteomielitis. Beberapa parameter diketahui berkontribusi terhadap terjadinya kaki diabetes seperti Laju Endap Darah (LED) maupun C-Reactive Protein (CRP). Penelitian ini bertujuan untuk mengevaluasi hubungan kadar LED dan CRP sebagai nilai prediktor dalam diagnosis osteomielitis dengan infeksi kaki pasien DM2 Metode: Penelitian ini merupakan penelitian diagnostik dengan teknik pengambilan data potong lintang terhadap 67 rekam medis pasien dari Departemen Ilmu Bedah RSUP Dr. Wahidin Sudirohusodho secara konsekutif selama periode Juni hingga Oktober 2020. Variabel yang dinilai pada penelitian ini meliputi usia, jenis kelamin, Indeks Massa Tubuh (IMT), komorbiditas, durasi menderita diabetes, HbA1c, Laju Endap Darah (LED), C-Reaktif Protein (CRP), dan osteomielitis. Data dianalisis dengan SPSS versi 20 untuk Windows. Hasil: Terdapat perbedaan bermakna kadar LED (96,00 (79,00-115,00) vs 67,50 (22,00-88,00 mm/jam; p=0,000), prokalsitonin (16,04 (0,05-42,03 vs 30,17 (0,21-56,08) ng/mL; p=0,003), dan jenis kelamin perempuan (72,00% vs 28,00%; p=0,022) baik pada kelompok osteomielitis dan non-osteomielitis. Dari hasil analisis kurva ROC didapatkan parameter dengan hasil bermakna adalah LED (Cut-Off: 83,75 mm/jam; p=0,000) dan prokalsitonin (Cut-Off: 19,72 ng/mL; p=0,003) dalam penegakakan diagnosis osteomielitis pada pasien DM2. Kesimpulan: Terdapat perbedaan yang bermakna dari segi nilai LED dan kadar prokalsitonin antara kelompok pasien DMT2 dengan osteomielitis dan tanpa osteomielitis. Dari ketiga parameter penanda inflamasi yakni CRP, LED dan prokalsitonin, nilai LED diketahui memiliki akurasi paling tinggi sebagai prediktor terjaidnya osteomielitis

Hubungan fungsi motorik dan derajat kekuatan otot dengan kejadian fatigue pasca stroke Putu Yogi Pramana; Cokorda Istri Dyah Sintarani Sintarani; Ida Ayu Sri Wijayanti Wijayanti; Anak Agung Raka Sudewi Sudewi
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: Fatigue is an experience in the form of fatigue that is often experienced by post-stroke patients. Pharmacological therapy used in the treatment of post-stroke fatigue has not been effective in treating fatigue. Several studies also mention the presence of impaired motor function and a decrease in the degree of strength in post-stroke patients, which causes patients to avoid physical activity, causing fatigue. The purpose of this study was to determine the relationship between motor function and the degree of muscle strength with post-stroke fatigue. Method: This analytic observational study with the Pearson correlation test was conducted using a questionnaire, examined and collected data from the register of outpatients at the Neurology Polyclinic of Dharma Yadnya General Hospital, Denpasar, from March to May 2022. Fatigue was assessed using a Fatigue Severity Scale questionnaire, and motor function was assessed using the Fatigue Severity Scale questionnaire. Pulg Meyer questionnaire. The significance level of the relationship was assessed by chi-square, and the strength of the relationship was assessed by the Pearson correlation test. Result: There were 82 sample subjects. 46 subjects (60%) experienced fatigue, and 36 (40%) subjects did not experience fatigue. With the Pearson correlation test, it was found that there was a significant relationship between motor function and the degree of muscle strength with post-stroke fatigue with a value of (r) 0.712 and (r) 0.527.Conclusion: There is a significant relationship between motor function and the degree of muscle strength with post-stroke fatigue. Latar Belakang: Fatigue merupakan suatu pengalaman subjektif berupa perasaan kelelahan yang sering dialami oleh pada pasien pasca stroke. Terapi farmakologi yang digunakan dalam penanganan fatigue pasca stroke selama ini masih belum efektif dalam penanganan fatigue. Beberapa studi juga menyebutkan dengan adanya gangguan fungsi motorik dan penurunan derajat kekuatan otot pada pasien pasca stroke menyebabkan pasien cenderung menghindari aktivitas fisik sehingga menimbulkan terjadinya fatigue. Tujuan penelitian ini adalah untuk mengetahui hubungan dari fungsi motorik dan derajat kekuatan otot dengan fatigue pasca stroke. Metode: Studi observasional analitik dengan uji korelasi pearson ini dilakukan dengan menggunakan kuisioner, melakukan pemeriksaan dan mengumpulkan data dari register pasien yang dirawat jalan di Poli Saraf Rumah Sakit Umum Dharma Yadnya, Denpasar dari Maret hingga Mei 2022. Fatigue dinilai menggunakan kuisioner Fatigue Severity Scale dan fungsi motorik dinilai menggunakan kuisioner Pulg Meyer.Tingkat kemaknaan hubungan dinilai dengan chi-square dan kekuatan hubungan dinilai dengan uji korelasi Pearson. Hasil: terdapat 82 subjek sampel, didapatkan subjek yang mengalami fatigue sebesar 46 subjek (60%) dan 36 subjek (40%) tidak mengalami fatigue. Dengan uji korelasi pearson didapatkan adanya hubungan bermakna antara fungsi motorik dan derajat kekuatan otot dengan fatigue pasca stroke dengan nilai (r) 0,712 dan (r) 0,527. Kesimpulan: Terdapat hubungan bermakna antara fungsi motorik dan derajat kekuatan otot dengan fatigue pasca stroke.

Meningioma pada akseptor kontrasepsi hormonal: laporan kasus Putu Ayu Kartika Putri Saraswati; Ni Ketut Ayu Sudiariani; I Made Dommy Astika; Ni Putu Sukarini
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: Meningiomas are the most common primary central nervous system (CNS) tumors. The incidence of meningioma is mostly found in women. There is an association between hormones and the incidence of meningioma. The symptoms of meningioma are unspecified and depend on the tumor's location. This case study aims to evaluate meningioma in the hormonal contraceptive acceptor. Case Presentation: A 36-years-old female patient was hospitalized with a chronic progressive headache that occurred for approximately two months. It was a throbbing headache in the left area of the head that worsened in the lying position. The patients deny other symptoms, such as weakness on one side of the body, nausea, vomiting, blurred visions or double visions, or convulsions. The patient had a history of receiving hormonal contraception for over 10 years. CT with contrast reveals a strong contrast enhancement, a well-defined, round-shaped lesion in the left sphenoid wing. In this case, tumor resection was done. From the histopathological examination, chordoid meningioma was found. Based on WHO grading, chordoid meningioma belongs to WHO grade II. Conclusion: The longer exposure to the exogenous progesterone injection, the lower the expression of Progesterone Receptors (PR) and mRNA Neurofibromatosis-2 (NF2) in the serum, and that lower expression of PR and NF2 was significantly and independently associated with a higher risk of females to suffer from meningioma. Latar Belakang: Meningioma adalah tumor primer sistem saraf pusat (SSP) yang paling sering ditemukan. Insiden meningioma lebih banyak ditemukan pada wanita, dimana diduga ada keterkaitan hormon pada wanita dengan kejadian meningioma. Gejala meningioma seringkali tidak spesifik dan tergantung dari lokasi tumbuhnya tumor. Laporan kasus ini bertujuan mengevaluasi meningioma pada akseptor kontrasepsi hormonal. Presentasi Kasus: Pasien wanita berusia 36 tahun dirawat dengan keluhan nyeri kepala kronik progresif yang dialami selama kurang-lebih dua bulan. Keluhan dirasakan seperti berdenyut di kepala sebelah kiri, memberat dengan posisi berbaring. Keluhan lain seperti lemah separuh tubuh, mual, muntah, pandangan kabur atau ganda, serta kejang disangkal oleh pasien. Pasien memiliki riwayat penggunaan kontrasepsi hormonal injeksi setiap 3 bulan selama lebih dari 10 tahun. Pada pemeriksaan CT kepala dengan kontras didapatkan gambaran lesi menyangat kontras berbentuk bulat, berbatas tegas pada sphenoid wing kiri. Dilakukan reseksi tumor serta dilakukan pemeriksaan histopatologis dengan hasil chordoid meningioma, yang merupakan WHO derajat II. Simpulan: Semakin lama paparan terhadap progesteron eksogen injeksi, maka ekspresi Reseptor Progesteron (RP) dan mRNA Neurofibromatosis-2 (NF2) dalam serum akan semakin rendah yang secara signifikan dan independen berhubungan dengan risiko yang lebih tinggi bagi wanita untuk menderita meningioma.

The outcome of early rehabilitation therapy for the patient after percutaneous coronary intervention: a systematic review and meta-analysis Pande Made Dwi Budiarta; Adhyasta Nata Prawira S; Citra Wulandari Sofyan; Putu Topan Bagaskara
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: Acute myocardial infarction (AMI) is one of the leading causes of mortality, morbidity and physical disability worldwide. The chief treatment for AMI is primary percutaneous coronary intervention (PCI). However, the effectiveness of early rehabilitation therapy after PCI patients still lacks documentation. Therefore, a meta-analysis has assessed the patient's outcome of early rehabilitation therapy after PCI. Methods: The searching protocol was carried out using several databases, such as PubMed, ScienceDirect, and Google Scholar, to identify relevant topics in June 2022. This study used the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 (PRISMA) guidelines. Result: There were nine studies included in this systematic review and meta-analysis. All of the reviewed studies were written in English. Most of the included studies were carried out in China. Most of the included studies were carried out in China. The mean age of the patient were all above 18 years. The total participants were 858 patients with PCI. There was a significant difference in 6-minute walk distance (MD = 85.64; 95% CI = 78.68–92.60; p < 0.01); left ventricle ejection fraction (LVEF) (MD = 5.97; 95% CI = 5.30–6.63; p < 0.01) and body mass index (BMI) score score (MD = 1.43; 95% CI = 0.86–2.00; p < 0.01) between groups in overall analysis. Conclusion: Early rehabilitation in patients with PCI has better outcomes (6-minutes walk distances, LVEF, and BMI score) than in the control group.

Lumbar spinal stenosis: pendekatan tatalaksana bedah Kevin Giovani Mandua; Alvarez Zefanya Moningka
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: Lumbar spinal stenosis (LSS) is the most common subtype of spinal stenosis. This pathologic disorder is the most common cause of low back pain in elderly. LSS can be either congenital or acquired, which the disorder is mainly caused by the degenerative process. Diagnosis of LSS is made by combination of clinical manifestations and radiological findings. Management of LSS may include conservative measures in form of physical therapy, steroid injection on facet joints or epidural space, and also surgical decompression procedure. LSS often reduces invididuals’ quality of life and productivity; hence, it is the most common indication for lumbar spinal canal decompression procedure. Case report: A 41 years old woman complained of low back pain that was referred to the left buttock and leg area. The complaints were also accompanied by numbing sensation on the antero-lateral side of the left leg. Complaints have been felt continuously since 5 months ago. From physical examination, the Visual Analogue Scale (VAS) was 5-6 with positive laseque test on left leg accompanied with hypoesthesia in L4, L5, and S1 dermatome. MRI findings suggested the diagnosis of canalis stenosis of L4-L5 and L5-S1. We perfomed laminectomy and Posterior Lumbar Interbody Fusion (PLIF) on this patient. Conclusion: Surgical approaches are based on the anatomic location, number of segment affected, involvement of thoracolumbar junction, transitional anatomy, instability, and deformity. Factors that affect patients’ clinical outcome after the surgical procedure should be considered before starting the procedure. Latar belakang: Lumbar spinal stenosis (LSS) merupakan jenis stenosis spinal yang paling sering dijumpai, dimana kelainan ini merupakan salah satu penyebab patologis tersering dari nyeri punggung bawah pada populasi lansia. LSS dapat berupa kelainan kongenital ataupun kelainan yang didapat, dimana kebanyakan LSS diakibatkan oleh proses degeneratif. Diagnosis LSS melibatkan kombinasi dari temuan klinis dan radiologis. Tatalaksana pasien LSS dapat meliputi upaya konservatif berupa terapi fisik, injeksi steroid pada persendian facet ataupun ruang epidural, hingga tindakan operasi dekompresi. LSS seringkali menurunkan kualitas hidup serta produktivitas seseorang, sehingga LSS sering dijadikan sebagai indikasi untuk dilakukan prosedur operasi medula spinalis lumbal. Laporan kasus: Wanita, 41 tahun mengeluh nyeri punggung bawah serta nyeri yang menjalar ke bokong dan tungkai kiri, yang disertai sensasi kebas pada tungkai kiri sisi antero-lateral. Keluhan dirasakan terus menerus sejak 5 bulan lalu. Pemeriksaan fisik di dapatkan Visual Analogue Scale (VAS): 5-6, tes laseque positif tungkai kiri serta hipoestesia pada dermatom L4, L5 dan S1. Temuan MRI lumbal mengarah kepada diagnosis stenosis kanalis L4-L5 dan L5-S1. Dilakukan laminektomi dan Posterior Lumbar Interbody Fusion (PLIF). Kesimpulan: Pemilihan modalitas bedah didasarkan pada lokasi anatomis, jumlah segmen, keterlibatan thoracolumbar junction, adanya anatomi transisional, instabilitas, ataupun deformitas. Beberapa faktor yang mempengaruhi luaran klinis pasien pasca prosedur operasi perlu menjadi pertimbangan sebelum memulai tindakan bedah.

Kemampuan Tutor dalam Menstimulasi Self Directed Learning Mahasiswa Kedokteran I Gusti Ayu Harry Sundariyati; Putu Gede Sudira; Ida Bagus Amertha Putra Manuaba; I Gusti Ayu Sri Darmayani
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: Self-directed learning (SDL) is a skill that must be possessed by medical students as a form of adult learning. To train these skills, students need tutors to stimulate students' SDL abilities. Methodology: This study was conducted quantitatively using a Dolman and Ginns questionnaire on third-year medical students. Results: Tutors in the Medical Emergency block were able to provide a good explanation of the issues in the case and stimulate students to look for other learning resources. Conclusion: Tutors with academic backgrounds that match the discussion material can be considered as one of the factors that can stimulate students' SDL. Latar Belakang: Self-directed learning (SDL) merupakan keterampilan yang harus dimiliki oleh mahasiswa kedokteran sebagai bentuk pembelajaran dewasa. Untuk melatih keterampilan ini mahasiswa memerlukan tutor dalam menstimulasi kemampuan SDL mahasiswa. Metodologi: penelitian ini dilakukan secara kuantitatif dengan menggunakan kuisioner Dolman dan Ginns pada mahasiswa kedokteran tahun ke-tiga. Hasil: tutor pada blok Medical Emergency mampu memberikan penjelasan yang baik mengenai issue yang ada pada kasus serta menstimulasi mahasiswa untuk mencari sumber pembelajaran yang lainnya. Simpulan: tutor dengan latar belakang akademik yang sesuai dengan materi diskusi dapat dipertimbangan sebagai salah satu factor yang dapat menstimulasi SDL mahasiswa.

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