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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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Articles 1,063 Documents

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Vitamin C and ubiquinone have the same ability in reducing the spermatozoa DNA fragmentation index in infertile men at Doctor Soetomo General Hospital, Surabaya, Indonesia Ayang Halim; Supardi Supardi; Hamdani Lunardhi
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background:Â Infertility is one of the most common health problems in the world. Malefactors contribute to 50% of cases and about 15-30% of infertile men are categorized as unexplained infertility. There have been numerous studies investigating the role of spermatozoa DNA fragmentation in male infertility. Spermatozoa nuclear DNA integrity has been suggested as a better predictor of male infertility and oxidative stress has been known related to it. This study was conducted to determine the oral supplementation of Vitamin C and Ubiquinone in reducing the spermatozoa DNA fragmentation index (DFI) among infertile men.Â Methods:Â This was an experimental clinical trial with a pre-test and post-test group design. Thirty infertile men were randomized double-blindingly into 3 groups: Vitamin C and Ubiquinone; Vitamin C and Placebo; Ubiquinone and Placebo groups, each treatment was given for 35 days. The DFI was evaluated by Sperm Chromatin Dispersion (SCD) test, before and after treatment. Data were analyzed using SPSS version 21 for Windows.Results:Â The average age of respondents was 32.6 years old, followed by 4.6 years of infertility duration in 5.8 years of marriage. Most of the respondents had a normal Body Mass Index (BMI) (46.7%), no smoking history (75.0%), no history of heat (90.0%) or chemical (73.3%) exposure, and diagnosed with primary male infertility (90.0%). Vitamin C group showed a significant reduction in the spermatozoa DFI (95% CI, p<0.05), while the other two groups showed no differences in the spermatozoa DFIs (95% CI, p>0.05). Comparison analysis showed no differences in the reduction of the spermatozoa DFIs (95% CI, p>0.05) among these three groups.Â Conclusion:Â The recent findings suggest that oral supplementation of vitamin C can reduce the spermatozoa DFI, while ubiquinone and the combination of vitamin C and ubiquinone could not reduce the spermatozoa DFI.

Faktor yang mempengaruhi kejadian asfiksia neonatorum di RSUD Wangaya Kota Denpasar Bella Kurnia; I Wayan Bikin Suryawan; A.A. Made Sucipta
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background: Birth asphyxia is a serious clinical problem worldwide. There are many reasons a baby may not be able to take in enough oxygen before, during, or just after birth. Birth asphyxia is the inabiity of neonates to start breathing spontaniously right after birth.Objective: This study was designed to assess the risk factors of birth asphyxia in neonates in Wangaya General Hospital.Methods: It is a case control study. The data of the newborn and mother was retrospectively collected from medical record in Wangaya Regional General Hospital between November 2018 to March 2019. It uses consecutive sampling. Bivariate analysis using chi square and multivariate analysis using logistic regresssion.Results: Bivariate analysis of risk factors of birth asphyxia that are studied are: low birth weight p value 0.000 (OR: 30.118); Number of birth p value 0,013 (OR 4,025); Prematurity p value 0.001 (OR 18.286); PROM p value 0.751 (OR 1.508); preeclampsia p value 1.000 (OR 0.804); and Cesarean Section p value 0.218 (OR 0.479). From multivariate analysis, the result was low birth weight p value 0.020; number of birth p value 0.003; prematurity p value 0.766; caesarean section p value 0,028.Conclusion: Risk factor of birth asphyxia in Wangaya General Hospital are low birth weight; number of birth (Primipara); and caesarean section.Â Latar Belakang: Asfiksia neonatorum adalah suatu kondisi yang serius di seluruh dunia. Ada beberapa penyebab dimana bayi tidak bisa mendapatkan oksigen yang cukup sebelum, selama, atau setelah lahir. Asfiksia neonatorum adalah keadaan dimana neonatus tidak dapat memulai bernafas dengan spontan segera setelah lahr.Penelitian ini dilakukan untuk melihat faktor resiko terjadinya asfiksia neonatorum pada neonatus di RSUD Wangaya.Metode: Penelitian ini adalah penelitian case control. Data neonatus dan data ibu diambil dari data rekam medis di RSUD Wangaya sejak November 2018 hingga Maret 2019. Studi ini menggunakan consecutive sampling. Analisa bivariat menggunakan chi square dan analisa multivariat menggunakan regressi logistik.Hasil: Hasil dari analisa bivariat adalah: BBLR p value 0,000 (OR: 30.118); Paritas p value 0,013 (OR 4,025); Prematuritas p value 0.001 (OR 18.286); KPD p value 0.751 (OR 1.508); Preeklampsia p value 1.000 (OR 0.804); and Bedah Caesar p value 0.218 (OR 0.479). Dari analisa multivariat, hasilnya adalah BBLR p value 0.020; Paritas p value 0.003; prematuritas p value 0.766; bedah sesar p value 0,028. Simpulan: Fakor resiko terjadinya asfiksia neonatorum di RSUD Wangaya adalah BBLR; Paritas (Primipara); and bedah sesar.

Profil penderita dengan cedera tulang belakang akibat trauma di RSUP Sanglah tahun 2015 Jonathan Pratama Swannjo; I Ketut Suyasa
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background: Vertebrae are the bones supporting the head and torso. Vertebra protects the spinal cord, and as a liaison ribs and muscles. At the location of the vertebra the spinal cord that are the source of innervation of peripheral and connecting parts neurological signals between the brain with other body parts. Thus, the injuries that occur in the vertebra is fatal and can result in neurological defects such as paralysis. In Indonesia is still very little research on spine injury and spinal cord injury. Therefore, the authors wanted to know about the profile of patients with spine injuries due to trauma in Sanglah Hospital 2015Methods: This study uses descriptive observational research with cross sectional design is to collect data one by using medical records. In terms of retrospective time, respondents in this study were selected through the total sampling. Variables examined in this study include gender, age, location of the injury, and the most common cause of the injury.Results: According on the research profile vertebra due to trauma patients injured in Sanglah Hospital in 2015 is largely male sex (75%), are in the age group 51-60 years (26.7%), with the most common cause is a fall from a height (62.9%), the location of most injured are the cervical part with 45.8%, and most cases of spine injury patients are without SCI with a percentage of 52.4%.Conclusions: Based on the results, it can be concluded profiles of patients with spine injuries due to trauma in 2015 under the Sanglah Hospital is the same when compared to other literatures and experiments with just little differencesÂ Latar Belakang: Tulang belakang merupakan tulang penyangga kepala dan batang tubuh. Tulang belakang berfungsi melindungi spinal cord. Pada lokasi tulang belakang terdapat spinal cord yang menjadi sumber persarafan bagian perifer dan menghubungkan sinyal neurologis antara otak dengan bagian tubuh lainnya. Maka dari itu cedera yang terjadi pada bagian tulang belakang sangatlah fatal dan mengakibatkan defek â€“ defek neurologis seperti kelumpuhan. Di Indonesia masih sedikit penelitian mengenai cedera tulang belakang dan spinal cord injury. Oleh karena itu penulis ingin mengetahui mengenai profil penderita cedera tulang belakang akibat trauma di RSUP Sanglah tahun 2015Metode: Penelitian ini menggunakan metode deskriptif observasional dengan desain cross sectional study yaitu dengan melakukan pengumpulan data satu kali dan menggunakan data rekam medis. Dari segi waktu secara retrospektif, Responden dalam penelitian ini dipilih melalui total sampling. Variabel yang diteliti pada penelitian ini antara lain jenis kelamin, umur, lokasi cedera, penyebab terbanyak cedera pada tulang belakang.Hasil: Hasil penelitian di RSUP Sanglah menunjukkan bahwa profil penderita cedera tulang belakang akibat trauma di RSUP Sanglah tahun 2015 adalah sebagian besar berjenis kelamin laki-laki (75%), berada dalam kelompok umur 51-60 tahun (26.7%), dengan penyebab terbanyak adalah jatuh dari ketinggian (62.9%), lokasi terbanyak yang mengalami cedera adalah pada bagian cervical dengan 45.8% dan paling banyak kasus penderita cedera tulang belakang adalah tanpa disertai SCI dengan presentase 52.4%.Simpulan: Berdasarkan hasil penelitian, dapat disimpulkan profil penderita cedera tulang belakang akibat trauma di RSUP Sanglah tahun 2015 sesuai dengan hasil penelitian lain dan literatur yang ada.

Clinical characteristic of dengue fever and dengue hemorrhagic fever among patients at Sanglah Hospital, Denpasar, Bali Shabrina Inderjit; I Made Sudarmaja; I Kadek Swastika
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Background: Mosquito-borne diseases are one of the most significant public health risks globally, and dengue fever seems to be one of the most important arboviral diseases in humans. In humans, dengue viruses are the supreme agents that cause dengue fever (DF) and dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). Following that, the virus's presence, sufficient numbers of susceptible populations, and mosquito vectors are required to transmit dengue infection. This study aimed to identify the clinical characteristics of dengue fever and dengue hemorrhagic fever among patients at Sanglah Hospital, Denpasar, BaliMethod: The study is a descriptive retrospective study design. The data was collected from the medical records of patients diagnosed with dengue and dengue hemorrhagic fever in Sanglah Hospital, Denpasar, Bali, from June 2015- June 2016. We took 50 patients according to sample size calculation by randomized sampling technic. Data were analyzed descriptively.Result: The study found the age range from 5 to 53 years old. The mean age for DF and DHF were 11 and 31, respectively. Secondly, the proportion of gender in this research was male by 21 (42%) and 29 (58%) female. Further to this, Denpasar showed the maximum number of cases between all the nine regencies. Both DF and DHF cases recorded the highest total cases in April 2016.Conclusion: Expected clinical characteristics prior knowledge and prognosticators of DF and DHF development will be able to provide data to detect persons who are higher risk category and provide adequate time to clinicians to lessen dengue related morbidity and mortality

Sistem tunggal ureter ektopik dengan ginjal multikistik displastik di RSUP Sanglah, Bali, Indonesia: laporan kasus Donny Oktavius; Gede Wirya Kusuma Duarsa
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background:Â Ectopic ureter is a condition when the ureter does not enter the bladder properly. The occurrence of the ectopic ureter is 1:2.000 - 1:4.000 in general population with gender ratio 6:1 in favour of females. More than 80% of cases of ectopic ureters are generally associated with complete duplication of the pelvic-ureteric system. Still, the ectopic ureter can also occur in a single pelvic-ureteric system, which is typically dysplastic or poorly functioning, such as in multicystic dysplastic kidney. This study aims to evaluate the current management of a single ectopic ureteral system with dysplastic multicystic kidneys at Sanglah General Hospital, Bali, Indonesia.Case Description:Â A 3-year-old girl was referred to the urology clinic of Sanglah General Hospital with chief complaint cloudy urinary since 1,5 years ago. Past medical history, the patient had a recurrent urinary tract infection with fever. Physical examination and laboratory findings were normal. However, an abdominal ultrasound showed a multicystic dysplastic kidney. VCUG showed vesicoureteral reflux grade V and ectopic ureter. Cystoscopy with retrograde pyelography and ureterorenoscopy showed an ectopic ureter opening was located in the proximal urethra above the external sphincter. Nephroureterectomy was performed. After the surgical procedure, the patient was treated and had no complaint. The patient was discharged from the hospital four days after surgery.Â Conclusion:Â The management of ectopic ureteral cases varies for each case. In this regard, the nephroureterectomy surgery performed in the case has provided good outcomes.Latar Belakang: Ureter ektopik merupakan suatu kondisi dimana ureter tidak masuk ke buli-buli pada tempat yang seharusnya. Insiden ureter ektopik 1:2.000 - 1:4.000 kelahiran pada populasi secara umum dengan perbandingan jenis kelamin perempuan lebih banyak daripada laki-laki, yaitu 6:1. Lebih dari 80% kasus ureter ektopik umumnya berhubungan dengan duplikasi sistem pelvis-ureter yang lengkap. Tetapi ureter ektopik juga dapat terjadi pada sistem pelvis-ureter tunggal, yang pada umumnya displastik atau fungsinya buruk, seperti pada keadaan ginjal multikistik displastik. Studi ini bertujuan untuk mengevaluasi manajemen terkini pada sistem tunggal ureter ektopik dengan ginjal multikistik displastik di RSUP Sanglah, Bali, Indonesia.Deskripsi Kasus: Seorang anak perempuan berusia 3 tahun dirujuk ke poliklinik urologi Rumah Sakit Sanglah dengan keluhan buang air kecil keruh sejak 1,5 tahun lalu. Riwayat penyakit dahulu, penderita mengalami infeksi saluran kemih berulang disertai demam. Hasil pemeriksaan fisik dan laboratorium normal. Hasil USG abdomen menunjukkan gambaran ginjal multikistik displastik, VCUG menunjukkan vesikoureteral refluks grade V dan ureter ektopik. Sistoskopi dengan retrograde pyelografi dan ureterorenoskopi menunjukkan muara ureter ektopik terletak di uretra proksimal di atas sfingter uretra eksterna. Lalu dilakukan tindakan nefroureterektomi. Setelah dioperasi, selama perawatan, pasien tidak memiliki keluhan. Pasien dipulangkan setelah empat hari perawatan.Kesimpulan: Tatalaksana pada kasus ureter ektopik bervariasi untuk setiap kasus. Berkaitan dengan hal tersebut maka tindakan pembedahan nefrouretektomi yangÂ dilakukan pada kasus tersebut telah memberikan luaran yang baik.

Temuan ultrasonografi pada kecurigaan klinis tumor payudara ganas di RSUP Sanglah periode januari â€“ desember 2015 I Kadek Riyandi Pranadiva Mardana; Elysanti Dwi Martadiani; Firman Parulian Sitanggang
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background: cancer is the second leading cause of death in Indonesia, whereas 70% of patients have themselves examined at an advanced stage. One of the methodes to do breast cancer screening is by ultrasound examination to see each characteristic in several aspects (form, size, ecogenicity, components) found in the clinical suspicion of malignant cases.Methods: This study was conducted to see the importance of the role of ultrasonography in knowing the characteristics of malignant breast tumors in Sanglah General Hospital. This study was a cross-sectional descriptive (retrospective) at Sanglah General Hospital. Ultrasound examination data collection had been done from medical record of breast tumor patients (total sampling from January to December 2015). Data analysis study used digital data processing programs and presented in crosstabulating tables.Results: Total of 52 subjects showed 51 patients with normal characteristics of cutaneous tissue (98.1%), normal ecoparenkim in 47 patients (90.4%), 34 with no abnormalities characteristics of nodules/masses/cysts (65.4 %), 46 with normal ecogeneity characteristics (88.5%), regular lesion characteristics of shape/edge in 47 patients (90.4%), 37 with no abnormalities characteristics of the lesion (71.2%), 49 patients (94.2%) did not show any abnormalities characteristics of papillary calcification and retraction, 49 patients without abnormalities characteristics of papilla retraction, 47 patients (90.4%) without abnormalities characteristics of axilla glands.Conclusions: Ultrasonography characteristics result as the screening tool for malignant breast tumor in this study is able to asess some general features founded in malignant breast tumor cases.Â Â Latar Belakang: Kanker payudara merupakan keganasan penyebab mortalitas kedua tersering di Indonesia, dimana 70% dari penderita memeriksakan dirinya pada stadium lanjut. Salah satu cara skrining kanker payudara yaitu dengan pemeriksaan ultrasonografi. Setiap karakteristik hasil ultrasonografi memiliki tujuan penting untuk mengetahui bentuk, ukuran, ekogenitas, dan komponen lain yang dijumpai pada kecurigaan klinis tumor payudara ganas.Metode: Penelitian ini bertujuan melihat pentingnya peranan ultrasonografi dalam mengetahui karakteristik tumor payudara ganas di RSUP Sanglah. Penelitian ini merupakan penelitian deskriptif cross-sectional retrospektif di RSUP Sanglah. Prosedur penelitian berupa pengumpulan data pemeriksaan ultrasonograsi dari data rekam medis pasien tumor payudara (total sampling dari bulan Januari-Desember 2015). Analisis data menggunakan program pengolah data digital dan menyajikannya dalam tabel crosstabulating.Hasil: Total dari 52 orang subjek, 51 orang (98,1%) menunjukkan hasil normal pada karakteristik jaringan kutis, 47 orang (90,4%) dengan hasil normal pada karakteristik ekoparenkim, dari karakteristik nodul/massa/kista 34 orang pasien (65,4%) tidak tampak adanya kelainan, dari karakteristik ekogenitas 46 orang pasien (88,5%) menunjukan hasil normal, dari karakteristik bentuk/tepi lesi 47 orang pasien (90,4%) dengan bentuk/tepi lesi yang reguler, dari karakteristik batas lesi tidak ditemukan adanya kelainan pada 37 orang pasien (71,2%), dari karakteristik kalsifikasi dan retraksi papilla masing-masing 49 orang pasien (94,2%) tidak tampak adanya kelainan, dari karakteristik retraksi papilla 49 orang pasien tidak ditemukan adanya kelainan, dari karakteristik kelenjar aksila 47 orang pasien (90,4%) tidak ditemukan adanya kelainan.Simpulan: Karakteristik gambaran ultrasonografi sebagai skrining kasus tumor payudara ganas dalam penelitian ini mampu menilai beberapa temuan yang umum terjadi pada pasien tumor payudara ganas.

Mean platelet volume count as a risk factor for bloodstream infection in Pediatric Ward Sanglah General Hospital Denpasar, Bali-Indonesia Ni Putu Wirantari; I Wayan Gustawan; Made Gede Dwilingga Utama; Bagus Ngurah Putu Arhana; Ni Nengah Dwi Fatmawati; Ni Made Adi Tarini
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background: Mean platelet volume (MPV) is a potentially interesting parameter in predicting bacteremia in patients admitted with suspected community-acquiredÂ infections. The incidence of bacteremia, defined as the presence of viable bacteria in the bloodstream, in patients who were being admitted to hospital. Multiple recent studies have confirmed that low-level bacteremia is more common than previously thought, occurring in 38% to 68% of all pediatric patients with a positive blood culture. The mortality rate is 25%â€“30%, increases to 50% when associated with severe sepsis. The objective of this study is to investigate whether MPV as a risk factor for bloodstream infection.Methods: This was a hospital-based case-control study, review of the medical record from January 2016 until December 2018. We collect age, gender, MPV, platelet and blood culture. We analyze the association between MPV to bloodstream infection.Result: Between January 1st 2016 and December 31st 2018, there were 86 patients with positive blood cultures and 89 negative blood cultures. In the case group, there were 48 (53.9%) male and 41 (46.1%) female subjects, while in the control group there were 63 (73.3%) male and 23 (26.1%) female subjects. The median age for case group was 14 months while the median age for control group was 23 months. From the ROC curve, the optimal cutoff value for MPV was determined as 5.59. The odd ratio determined the relationship between MPV to blood stream infection was 2,26 with 95% CI 1.13-4.52. The adjusted odds ratio was 2.24 95% CI (1.10-4.57). The majority diagnosis was pneumonia (46.1%) in case group then early onset neonatal sepsis (28.1%) and meningitis (7.9%).Conclusion: The MPV â‰¥5.59 is a risk factor for developed bloodstream infection. This result can be used as a cutoff point to initially administered antibiotic to prevent the worse prognosis (sepsis, multiple organ failure, and death).

Flushing intramedular dengan epinefrin pada prosedur Cemented Hip Arthroplasty menstabilkan mean arterial pressure tanpa mempengaruhi profil lipid Aakash Aakash; Ketut Siki Kawiyana; I Wayan Suryanto Dusak; Ketut Gede Mulyadi Ridia; I Ketut Suyasa; I Gusti Ngurah Wien Aryana; I Gede Eka Wiratnaya; Anak Agung Wiradewi Lestari
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background: Cemented Hip Arthroplasty is the first choice of surgical treatment in fractures of neck femur and advanced hip osteoarthritis. Nevertheless, the complication, Bone Cement Implantation Syndrome can produce intra/postoperative mortality. The systemic effects of bone cement uses is hemodynamic disturbance and pulmonary embolism. These complications are thought due to the entry of semen particles into the systemic circulation caused by increased intramedullary pressure and local vasodilation. Intramedullary flushing with epinephrine after cement implantation is one of the interventions that is expected to reduce this impact. This study aims to determine the difference in hemodynamic effects and lipid profile in patients undergone flushing with epinephrine versus NaCl 0.9%.Methods: A cross-sectional study involving 30 patients who underwent Cemented Hip Arthroplasty, randomly divided into 2 groups. Surgical procedures differ only in the components used for intramedullary flushing, namely NaCl 0.9% (control) and epinephrine 1: 50000 (intervention). Vital signs are observed and recorded at minute 2,4,6,8, and 10 after cementation. Serial data were analyzed with repeated measures ANOVA. Lipid profile examination was performed before and 12 hours postoperatively and the results were analyzed with Wilcoxon-test.Results: The study observed a decreased of mean arterial pressure (MAP) in the control group after two minutes of cementation, and reached its lowest point in the sixth minute (p <0.05). In the intervention group, the decrease occurred in second to sixth minutes, but the decrease was more stable and there was no significant difference between time-point (p> 0.05). There were no significant differences of triglyceride and cholesterol level before and 12 hours after the procedure (p> 0.05).Conclusion: Intramedullary flushing with epinephrine after semen implantation in the Cemented Hip Arthroplasty procedure results in a minimal reduction of MAP compared to flushing without epinephrine. However, there were no difference in preoperative and postoperative cholesterol and triglyceride levels.Latar Belakang: Cemented Hip Arthroplasty menjadi pilihan utama terapi pembedahan pada fraktur collum femoris (Neck of Femur) serta osteoarthritis sendi panggul stadium lanjut. Meskipun demikian, komplikasi Bone cement implantation syndrome dapat menghasilkan morbiditas dan mortalitas intra/pasca operasi. Efek sistemik dari penggunaan semen tulang adalah gangguan hemodinamik dan emboli paru yang diduga akibat masuknya dari partikel semen ke sirkulasi sistemik akibat peningkatan tekanan intrameduler dan vasodilatasi lokal. Flushing intramedula dengan epinefrin paska implantasi semen merupakan salah satu intervensi yang diharapkan mengurangi dampak tersebut. Penelitian ini dilakukan untuk mengetahui perbedaan dampak hemodinamik dan profil lipid pada pasien dengan flushing epinefrine dan NaCl 0,9%.Metode: Penelitian potong lintang dengan melibatkan 30 pasien yang menjalani cemented arthroplasty, dibagi rata menjadi 2 kelompok secara acak. Prosedur pembedahan hanya berbeda pada komponen yang digunakan untuk flushing intramedula, yakni NaCl 0,9% (kontrol) dan epinefirn 1:50.000 (intervensi). Tanda vital diamati dan dicatat pada menit ke-2,4,6,8, dan 10 setelah sementasi. Data serial dianalisis dengan repeated measure Anova. Pemeriksaan profil lipid dilakukan sebelum dan 12 jam pasca operasi dan hasil dianalisis dengan Wilcoxon-test.Â Hasil: Penurunan mean arterial pressure (MAP) pada kelompok kontrol sejak menit ke 2 setelah sementasi, dan mencapai titik terendah pada menit ke 6 (p<0,05). Pada kelompok intervensi didapatkan penurunan terjadi pada menit ke 2 hingga ke 6, tetapi penurunan lebih stabil dan tidak terdapat perbedaan bermakna (p>0.05). Pada profil lipid (trigliserida dan kolesterol), tidak ditemukan perbedaan yang bermakna antara kadar sebelum operasi dan 12 jam setelah tindakan operatif (p>0,05).Kesimpulan: Flushing epinefrin paska implantasi semen pada prosedur Cemented Hip Arthroplasty menghasilkan penurunan MAP yang minimal dibandingkan flushing tanpa epinefrin. Akan tetapi, flushing epinefrin tidak memberikan perbedaan pada kadar kolesterol dan trigliserida paska operasi.

Hubungan dan titik potong skor Caprini terhadap D-dimer sebagai parameter resiko trombosis vena dalam pada pasien paska fiksasi internal fraktur tulang panjang ekstremitas bawah Made Wirabhawa; Ketut Siki Kawiyana; I Ketut Suyasa; Putu Astawa; Ketut Gede Mulyadi Ridia; I Wayan Suryanto Dusak; I Gede Eka Wiratnaya; Anak Agung Wiradewi Lestari
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background: Fractures contribute to a substantial proportion of the emergency department cases. Surgical procedures such as internal fixation of lower limb fractures posed a risk to develop deep vein thrombosis (DVT). The current diagnosis of DVT is still a challenge, as the current main parameter, the D-dimer, requires additional laboratory time and cost. Threrefore, an easier and faster alternative should be used in clinical decision making. Caprini score is among a simple method to assess the risk of a DVT, but validation is still needed before it can be implemented.Methods: This is an cross-sectional analytic study aimed to determine the relationship between Caprini scores and D-dimer level in patients with post-internal fixation of long bone fractures in lower extrimities at Sanglah Hospital Denpasar. Caprini scores were determined before surgery then D-dimer measurements were taken postoperatively. Statistical analysis was performed using the Pearson correlation method and ROC curve were generated to determine the cut-off point of Caprini Score equivalent of high risk DVT with the D-dimer as the predictor.Result: The average Caprini score was 9.37 (7-13). Mean preoperative D-dimer was 6.59 Âµg/ml (2.50-13.20 Âµg/ml), postoperatively 11.50 Âµg / ml (3.71-19.89 Âµg/ml) and mean delta D -Dimer 5.23 Âµg/ml (0.56-12.28 Âµg/ml). Pearson correlation test obtained a strong positive relationship (r = 0.726 and pâ‰¤0,0001). Analysis of the ROC curve to determine the cut-off point for Caprini score which equivalent to the high risk of DVT from D-dimer prediction (> 7.2 Âµg / ml) resulted in AUC of 0.824 (95% CI 0.669-0.979, p= 0.024) with the optimal cut-off point for Caprini score was 8.Conclusion: Caprini and D-dimer scores show a strong positive correlation.Â Caprini scores can be considered to estimate the risk of DVT in post-internal fixation patients of lower extremities long bone fractures.Â Latar Belakang. Kejadian fraktur memiliki proporsi yang substansial dari total pasien yang datang ke unit gawat darurat rumah sakit. Prosedur operasi seperti pemasangan fiksasi internal pada fraktur ekstremitas bawah memiliki resiko untuk terjadinya trombosis vena dalam (DVT). Penegakan diagnosis DVT saat ini masih merupakan suatu tantangan salah satunya karena pemeriksaan laboratorium D-dimer membutuhkan waktu dan biaya tambahan, sehingga dibutuhkan alternatif yang lebih mudah dan cepat digunakan dalam pengambilan keputusan klinis. Skor Caprini merupakan salah satu cara untuk menilai resiko terjadinya suatu DVT, akan tetapi masih diperlukan validasi sebelum dapat diimplementasikan. Metode: Penelitian cross-sectional analitik dilakukan untuk mengetahui hubungan Skor Caprini dengan kadar D-dimer pada pasien paska operasi fiksasi internal fraktur tulang panjang ekstremitas bawah di RSUP Sanglah Denpasar. Skor Caprini ditentuakan sebelum operasi kemudian pengukuran D-dimer dilakukan paska operasi. Analisis statistik dilakukan dengan metode korelasi Pearson dan penentan titik potong risiko DVT dengan prediktor D-dimer menggunakan metode kurva ROC.Hasil: Rerata Skor Caprini adalah 9,37 dengan rentang skor 7-13. Rerata D-dimer sebelum operasi sebesar 6,59 Âµg/ml (2,50-13,20 Âµg/ml), paska operasi 11,50 Âµg/ml (3,71-19,89 Âµg/ml) dan rerata delta D-Dimer 5,23Âµg/ml (0,56-12,28 Âµg/ml). Uji korelasi Pearson diperoleh hubungan positif kuat antara Skor Caprini dengan kadar D-dimer (nilai r=0,726 dan nilai pâ‰¤0,0001). Analisis kurva ROC untuk menentukan itik potong Â Skor Caprini yang setara dengan resiko tinggi terjadinya DVT dari prediksi D-dimer (>7,2 Âµg/ml) memperoleh Area Under Curve 0,824 (95% CI 0,669-0,979, p = 0,024) dengan titik potong optimal skor Caprini 8.Kesimpulan: Skor Caprini dan D-dimer menunjukkan korelasi positif yang kuat pada pasien paska fiksasi internal fraktur tulang panjang ekstremitas bawah. Skor Caprini dapat dipertimbangkan sebagai acuan dalam menentukan resiko terjadinyaÂ DVT.

Hemiartroplasti Bipolar menghasilkan luaran C-Reactive Protein dan Harris Hip Score yang lebih tinggi dibandingkan Cephalomedulary Nailing Komang Septian Sandiwidayat; Putu Astawa; Ketut Gede Mulyadi Ridia; Ketut Siki Kawiyana; I Wayan Suryanto Dusak; I Ketut Suyasa; I Gede Eka Wiratnaya; Anak Agung Wiradewi Lestari
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background: Bipolar Hemiarthroplasty and Cephalomedullary Nailing (PFNA) are operative procedures for the management of proximal femoral fractures. Both of these surgical techniques have their respective advantages and disadvantages. This study aims to determine the differences in biological and functional outcomes. C-Reactive Protein (CRP) used to measure inflammation due to tissue damage and Harris Hip Score (HHS) used to measure functional output. This study hoped to facilitate the selection of appropriate techniques for the treatment of proximal femoral fractures.Methods: Prospective cohort study conducted among patient with proximal femoral fractures who underwent Bipolar Hemiarthroplasty and PFNA surgery. CRP levels were examined before surgery and 12 hours postoperatively. The HHS assessment was performed at weeks 4, 6, and 8 postoperatively.Results: In general, the preoperative CRP levels of the groups undergoing Bipolar Hemiarthroplasty and PFNA were not significantly different (32.4Â±16.7 and 33.7Â±17.1; p> 0.05), whereas postoperatively, Bipolar Hemiarthroplasty shown significantly higher CRP (76.5Â±27.3 and 42.6Â±17.6; p <0.0001). Similar results were also shown from the âˆ†CRP analysis (45.1Â±22.1 and 8.9Â±3.2; p<0.0001). The mean HHS score was higher in the Bipolar Hemiarthroplasty group than in PFNA group at each measurement. At the 4th week, the mean HHS score did not show a significant difference (52.3Â±4.2 vs 52.2Â±5.4; p>0.05). The 6th week evaluation showed Bipolar Hemiarthroplasty had a mean HHS of 76.5Â±4.6 while PFNA 61.4Â±5.4 (p <0.0001). At week 8, HHS in Bipolar Hemiarthroplasty was consistently higher than PFNA (89.43Â±4.5 and 74.95Â±4.9; p <0.0001). The Bipolar Hemiarthroplasty group was hospitalized 56% longer (6.1Â±1.3 and 3.9Â±1.3 days; p<0.0001) and the Bipolar Hemiarthroplasty had an average bleeding volume of 4.5 times more (407.4Â±122.8 and 90Â±13 ml; p <0.0001).Conclusion: Bipolar Hemiarthroplasty and PFNA procedures have significantly different functional and biological outcomes. The postoperative HHS score in Bipolar Hemiarthroplasty is better but with a higher delta CRP.Â Latar Belakang: Hemiarthroplasti bipolar dan Cephalomedullary Nailing (PFNA) merupakan prosedur operatif penatalaksanaan fraktur proksimal femur. Kedua prosedur tersebut menggunakan pendekatan yang berbeda utamanya pada upaya preservasi bagian proksimal femur. Kedua teknik bedah ini memiliki keuntungan dan kerugian masing-masing. Penelitian ini bertujuan untuk mengetahui perbedaan luaran biologis dan fungsional kedua teknik tersebut. C-Reactive Protein (CRP) digunakan sebagai parameter terkait inflamasi akibat kerusakan jaringan dan Harris Hip Score (HHS) digunakan mengukur luaran fungsional. Studi ini diharapkan dapat mempermudah pemilihan teknik yang tepat untuk penanganan fraktur proksimal femur.Metode: Penelitian ini adalah penelitian kohort prospektif pada pasien dengan fraktur proksimal femur yang menjalani operasi Hemiartroplasti Bipolar dan PFNA. Kadar CRP diperiksa sebelum operasi dan 12 jam paska operasi. Penilaian HHS dilakukan pada minggu ke-4, 6, dan 8 paska operasi.Hasil: Secara umum kadar CRP preoperasi kelompok yang menjalani Hemiarthroplasti Bipolar dan PFNA tidak berbeda signifikan (32,4Â±16,7 dan 33,7Â±17,1; p>0,05), sedangkan pada paska operasi kadar CRP Hemiarthroplasti Bipolar secara signifikan lebih tinggi (76,5Â±27,3 dan 42,6Â±17,6; p<0,0001). Hasil yang sama juga ditunjukan dari analisis âˆ†CRP (45,1Â±22,1 dan 8,9Â±3,2; p < 0,0001). Rerata skor HHS lebih tinggi pada kelompok Hemiarthroplasti Bipolar daripada PFNA pada setiap kali pengukuran. Pada minggu ke-4 nilai rerata HHS tidak menunjukan perbedaan yang signifikan (52,3Â±4,2 vs 52,2Â±5,4, p>0,05). Evaluasi minggu ke-6 menunjukan Hemiarthroplasti Bipolar memiliki rerata HHS 76,5Â±4,6 sementara PFNA 61,4Â±5,4 (p<0,0001). Pada minggu ke-8, HHS pada Hemiarthroplasti Bipolar konsisten lebih tinggi daripada PFNA (89,43Â±4,5 dan 74,95Â±4,9; p<0,0001). Kelompok Hemiarthroplasti Bipolar menjalani rawat inap 56% lebih lama (6,1Â±1,3 dan 3,9Â±1,3 hari; p < 0,0001) serta Hemiarthroplasti Bipolar memiliki rerata volume perdarahan 4,5 kali lebih banyak (407,4Â±122,8 dan 90Â±13 ml; p < 0,0001).Kesimpulan: Prosedur Hemiarthroplasti Bipolar dan PFNA memiliki luaran fungsional dan biologis yang berbeda secara signifikan. Skor HHS pada Hemiarthroplasti Bipolar lebih baik tetapi selisih CRP yang lebih tinggi.

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