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ISM (Intisari Sains Medis) : Jurnal Kedokteran

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Published by Universitas Udayana

ISSN : 25033638 EISSN : - DOI : -

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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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Noma management in a 47-years-old female patient using estlander flap: a case report Anak Agung Bagus Satria Brahmananta; Ida Bagus Adiguna Wibawa; Anak Agung Ngurah Asmarajaya
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: Noma or cancrum oris is an uncommon disease that results in loss of tissue in the oronasal region secondary to gangrenous slough. As most patients with noma do not report until the disease is at an advanced stage, its onset and progression remain a mystery. Survivors of this disease suffer severe facial deformity due to loss of facial tissues and scarring. Reconstruction of such type of defects was aimed to maintain oral competence, sufficient oral access, and preservation of sensation.Case: A woman, 47 years old, experience with a chief complaint of the deformed right upper lip for the past 45 years. The patient is known to have a history of deformity on the right upper lip region when the patient was two years old. The patient stated that it originally started with swelling on the right cheek accompanied by redness and painful sensation.Result: An extensive scar along with half of the upper lip missing was found in the physical examination, causing exposure of anterior maxillary teeth. A full-thickness defect of half of the upper lip with severe scar contracture was also found in the further examination, thereby constricting the oris. The patient was planned for surgical management under general anesthesia. Lip reconstruction using an Estlander flap was done.Conclusion: Reconstruction must be planned carefully to restore the natural contours of the lip. The Estlander flap is one of the treatment choices used for labial defects that include the commissure.

Stevens-Johnson Syndrome (SJS)-Toxic Epidermal Necrolysis (TEN) overlap in a 61-year old woman: a case report Luh Gede Melia Puspita Sari; Tjok Dalem Pemayun
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: Epidermal necrolysis (EN) is a rare life-threatening reaction. The exact cause of this disease is unknown. However, the drug is one of the main factors as a cause. EN differentiated based on the extent of skin detachment limited to less than 10% of the body surface area (BSA) in SJS, 10%-30% BSA in SJS/TEN overlap, and greater than 30% of the BSA in TEN. SJS and TEN can occur at various ages, but more often occur at the age of 40 years. Mortality was almost 30% in SJS/TEN overlap patients. Management for SJS and TEN is the cessation of drugs that are thought to be the cause and other supportive therapies.Case presentation: A 61-year-old female with SJS-TEN overlap, who presented epidermal detachment, is about 10-30% with a positive Nikolsky sign. She had a history of taking medication, such as paracetamol, amoxicillin, and buscopan, before lesion appeared. There were multiple lesions widespread, macula hyperpigmentation multiple, erosion from the bullae that has broken, there also erosion covered by black crust, and various erosions covered with black, brown crusts on lip mucosa and also secret on both eyes. The management of this patient was a cessation of suspected drug and supportive therapy. The patientâ€™s condition was improved within a few weeks, and no sequelae found.Conclusion: SJS-TEN overlap is one of the epidermal necrolysis in which skin detachment 10-30% BSA. The management was a cessation of all suspected drugs, administering high doses of steroids and other supportive therapies.

Karakteristik kasus otitis eksterna di RSUP Sanglah Denpasar periode April 2015-April 2016 N.P Mirah Ayunda Kartika Wulandari; I Made Sudipta
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: External Otitis (OE) is one of the most common cases in ENT. There are an estimated 8.1 visits with an OE diagnosis per 1,000 annually. The low understanding of the community about OE caused the cases to become frequent. This study aims to increase public understanding of OE by knowing the characteristics of OE in Sanglah Hospital.Methods: A study with descriptive cross sectional method. Samples were taken from Sanglah Hospital's medical record data on period 2015-2016 with total sampling method.Results: A total of 84 samples were successfully analyzed, and found: OE was most common in the 15-49 years age group (55.9%). Gender dominating is female (52.4%). The most clinical symptoms of OE patients were ear pain (67.9%), followed by ear discharge (55.9%), ear that felt full (22.6%), itchiness (20.2%), ringing (21.4%), hearing loss (15.5%), and accompanied (4.8%). The most frequent cause of OE is due to trauma (58.3%), followed by fungi or bacterial infection (20.3%), combined causes (11.9%), and the least caused by systemic disease (9.5%).Conclusions: The OE case at Sanglah Hospital is most commonly found in the female population, age group 15-49 years, with the most common symptom of earache and caused by mechanical trauma.Â Latar Belakang: Otitis Eksternal (OE) merupakan salah satu kasus yang sering ditemukan dalam bidang THT. Diperkirakan terdapat 8.1 kunjungan dengan diagnosis OE per 1.000 per tahunnya. Rendahnya pemahaman masyarakat mengenai OE menyebabkan kasus ini menjadi sering terjadi. Studi ini bertujuan untuk meningkatkan pemahaman masyarakat mengenai OE dengan mengetahui gambaran kejadian OE di RSUP Sanglah.Metode: Sebuah studi dengan metode deskriptif potong lintang. Sampel diambil dari data rekam medis RSUP Sanglah pada periode 2015-2016 dengan metode total sampling .Hasil: Sebanyak 84 sampel berhasil di analisis, dan ditemukan: OE paling sering terjadi pada kelompok umur 15-49 tahun, (55,9%). Jenis kelamin yang mendominasi adalah perempuan (52,4%). Gejala klinis penderita OE terbanyak adalah nyeri telinga (67,9%), diikuti berair atau keluar cairan dari telinga (55,9%), terasa penuh (22,6%), rasa gatal (20,2%), berdenging (21,4%), gangguan pendengaran (15,5%), dan yang disertai (4,8%). Penyebab OE terbanyak adalah karena trauma (58,3%), diikuti karena jamur atau bakteri (20,3%), penyebab gabungan (11,9%), dan paling sedikit disebabkan oleh penyakit sistemis (9,5%).Simpulan: Kasus OE di RSUP Sanglah paling sering ditemui pada populasi wanita, kelompok umur 15-49 tahun, dengan gejala tersering berupa nyeri telinga dan disebabkan oleh trauma mekanis. Â

Transient Elastography sebagai Alat Skrining Kecurigaan Hipertensi Portal pada Penderita Sirosis Hepatis I Made Wisnu Wardhana; Gde Somayana; Ketut Mariadi; I Dewa Nyoman Wibawa
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: Portal hypertension was causes by extensive fibrosis on liver cirrhosis. The diagnosis of portal hypertension can only be identified by invasive procedure. Transient elastography (TE) is a non-invasive examination to determine the level of liver fibrosis by liver stiffness (LS).Objective: Transient elastography is expected to predict the possibility of portal hypertension in liver cirrhosis.Methods: The study used a cross-sectional design, where data were analyzed using a receiver operating curve (ROC) to determine the area under the curve (AUC). Data was collected from 2015 to 2018 using consecutive sampling. Analysis were done using SPSS and Medcalc to determine the cut-off point that has the best sensitivity, specificity, positive likelihood ratio (+ LR) and negative likelihood ratio (-LR).Results: In this study we found 69 patients with hepatic cirrhosis which consisted of 57 men (82.6%) and 12 women (17.4%) with a mean age of 48.57. From 69 patients with cirrhosis, portal hypertension manifestations were found by endoscopy in 45 patients (65.2%), while 24 (34.8%) were absent. TE was examined to determine LS, where the lowest value was 11.0 kPa, the highest value was 75.0 kPa, with mean value of 29.89 kPa. AUC results for LS were 0.763 (95% CI 0.645-0.857, p <0.001). The best cut-off point for LS is above 17.5 kPa with a sensitivity of 82.22% (95% CI 67.9-92.0%), specificity 62.50% (95% CI 40.6-81.2%), + LR 2.19 (95% CI 1.3-3.7), and -LR 0.28 (95% CI 0.1-0.6).Conclusion: Transient elastography with liver stiffness above 17.5 kPa can be used as a screening tool to predict manifestations of portal hypertension in patients with liver cirrhosis.Â Latar belakang: Hipertensi portal adalah dampak fibrosis ekstensif pada sirosis hepatis. Dimana diagnosis hipertensi portal hanya dapat ditegakkan melalui prosedur invasif. Transient elastography (TE) merupakan pemeriksaan non invasif untuk mengetahui tingkat fibrosis hati dengan hasil berupa liver stiffness (LS).Tujuan: TE diharapkan dapat digunakan sebagai alat screening bagi penderita sirosis hepatis yang memerlukan tindakan endoskopi.Â Metode: Penelitian menggunakan desain potong lintang, dimana data dianalisis dengan menggunakan receiver operating curve (ROC) untuk menentukan area under curve (AUC). Data dikumpulkan dari tahun 2015 hingga 2018 secara konsekutif. Analisis menggunakan SPSS dan Medcalc untuk menentukan titik potong yang memiliki sensitivitas, spesifisitas, positive likelihood ratio (+LR) dan negative likelihood ratio (-LR).Hasil: Pada penelitian ini didapatkan 69 penderita sirosis hepatis yang terdiri dari 57 orang laki-laki (82,6%) dan 12 orang perempuan (17,4%) dengan rata-rata usia 48,57 tahun. Dari 69 penderita sirosis hepatis dilakukan dievaluasi dengan menggunakan endoskopi dimana didapatkan 45 orang (65,2%) mengalami manifestasi hipertensi portal, sedangkan 24 orang (34,8%) lainnya tidak. Kemudian dilakukan pemeriksaan TE untuk mengetahui LS, dimana didapatkan nilai terendah adalah 11,0 kPa, nilai tertinggi 75,0 kPa, dengan rata-rata 29,89 kPa. Analisis kurva ROC terhadap LS yang diperoleh dari TE, diperoleh hasil AUC 0,763 (95% CI 0,645-0.857, p<0,001). Titik potong untuk LS adalah >17,5 kPa dengan sensitivitas 82,22% (95% CI 67,9-92,0%), spesifisitas 62,50% (95% CI 40,6-81,2%), +LR 2,19 (95% CI 1,3-3,7), dan -LR 0,28 (95% CI 0,1-0,6).Simpulan: TE dengan LS>17,5 kPa dapat digunakan sebagai alat screening untuk memprediksi adanya manifestasi hipertensi portal dengan interpretasi sedang.Â

The physiological aspect of thyroid-induced breast cancer: a case report Putu Austin Widyasari Wijaya
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background: Breast cancer has the second-highest prevalence of cancer in Indonesia. The aetiology of breast cancer involves endogenous sex hormone activity, estrogen. Besides, thyroid hormones have estrogen-like effects on breast tissue which are thought to play a role in the development of breast cancer. This case report aims to evaluate the physiological aspect of thyroid-induced breast cancer.Case Report: A 49-year-old Balinese woman came to the Primary Health Care with a history of uncontrolled hyperthyroidism for 5 years (2014-2019), complaining of a lump in her left breast. Open biopsy and immunohistochemistry were done (Grade III Invasive Carcinoma ER + 50%, Her + 2-3). Patients were diagnosed with stage 3B breast cancer and conservative treatment has been taken. The examination of TSH thyroid hormone was 0.204 ÂµIU/mL (normal = 0.5 - 6 ÂµIU/mL) and FT4 3.1 ng/dL (normal = 0.7-1.9 ng/dL).The primary management of patients was chemotherapy following by Modified Radical Mastectomy (MRM), hormone suppressant injection, as well as Herceptin. Those medications were effective in reducing the development of breast cancer through thyroid hormone pathway.Conclusion: Some studies showed hyperthyroidism increase the risk of breast cancer and that high thyroid levels can cause estrogen-like effects, trigger proliferation and angiogenesis by activating the same pathway as estrogen those are mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinase Â½ (ERK Â½).

The role of salivary biomarker as a diagnostic tool in oral cancer: a literature review Ni Made Ista Prestiyanti
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background: Saliva is an informative biological fluid that has gained a lot of interest because of its physiologic diagnostic medium. The recent findings suggest that saliva could be used as a biomarker in diagnosing oral cancer. This study aims to elaborate further on the role of salivary biomarker as a diagnostic tool in oral cancer through literature review.Methods: A total of 44 relevant kinds of literature were studied regarding saliva and oral cancer. The data collection for eligible articles were conducted from 1997 to 2019. Different database and manual search methods were used to find the topic-related articles.Results: The study of saliva as a biological matrix has been identified as a new landmark initiative in search of a useful biomarker to diagnose oral cancer through proteomics and transcriptomics. Most oral cancers are oral squamous cell carcinoma. Using saliva for early oral cancer detection in the search for new clinical markers is a promising approach because of its noninvasive sampling and easy collection method. Identification of this salivary biomarker could help to screen patients at risk, predict disease outcome and effectively contribute to planning treatment strategies.Conclusion: proteomics and transcriptomics molecules on the saliva could be used as a biomarker in diagnosing oral cancer.

Periodontitis as early detection of diabetes mellitus: a literature review Ade Indah Pratiwi
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background: Diabetes mellitus (DM) is a growing health problem and its prevalence is dramatically increasing, particularly in Indonesia. It can affect every organ in the body, and one of the oral manifestations is periodontitis characterized by the loss of tissue attachment. This review aims to identify further the periodontitis as early detection of diabetes mellitusMethods: A review of relevant literature was performed to elaborate on periodontitis involvement in diabetes mellitus. A total of 25 qualified published literature of all years were collected from several electronic database and manual search and included in this review.Results: On average, patients with periodontitis showed higher glycated haemoglobin (HbA1c) plasma levels compared with individuals without periodontitis. Diabetes and periodontitis are complex chronic diseases with an established bidirectional relationship. There is long-established evidence that hyperglycemia in diabetes is associated with adverse periodontal outcomes. Here, we show that periodontitis is an early sign of diabetes mellitus and may, therefore, serve as a valuable risk indicator. A dentist who got patient with periodontitis is a suitable location for screening for diabetes by a simple finger stick and validated HbA1c dry spot analysis.Conclusion: Literature from a different type of study concluded that periodontitis is one of the oral manifestations that could be used as early detection in diabetes mellitus

Profil penderita Chronic Kidney Disease (CKD) stadium 5 yang menjalani hemodialisis reguler di Rumah Sakit Umum Daerah (RSUD) Klungkung, Bali, Indonesia Dewa Ayu Sri Agung Suandewi; I Gede Restu Mahendra Sugiarta; Nyoman Tri Astawa; I Putu Ekariawan
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background:Â Chronic Kidney DiseaseÂ (CKD) is one of theÂ chronic diseases which becomes a major public health problem in Indonesia. The proportion of CKD patient that underwent hemodialysis in Indonesia and Bali in 2018 was 19,3% and 38,7%. This study aims to determine the sociodemographic and clinical profile of patients with CKD stage 5 who underwent regular hemodialysis at Klungkung District General Hospital in 2019.Â Method: A retrospective cross-sectional study was conducted among 77 samples in the hemodialysis unit of Klungkung District General Hospital by using secondary data obtained from medical records by the total sampling method. The inclusion criteria were patients with CKD stage 5, who underwent regular hemodialysis. The variables evaluated in this study were age, level of education, work status, marriage status, HD period, etiology, vascular access, HBsAg, and level of hemoglobin. Data were analyzed by SPSS version 21 for Windows.Result: The proportion of patient with CKD stage 5 who underwent hemodialysis was 51 to 60 years (33.8%), male gender patients (63.6%), senior high school education (42.9%), working (59.7%), married (93.5%), the duration of year that underwent hemodialysis between 1 to 5 years (85.7%), the most common etiology is chronic pyelonephritis (32.5%), with AV Shunt as vascular access (63.6%), HBsAg test was negative (96.1%), and Hb levels > 10 g/dL (54.5%).Conclusion: Most patients with CKD stage 5 who underwent hemodialysis at Klungkung District General Hospital are male patients, middle age, secondary education level, dominant is working and married, with the first year undergoing hemodialysis 1-5 years. The most common cause of CKD is chronic pyelonephritis in males and hypertension in females.Â Latar Belakang: Chronic Kidney Disease (CKD) merupakan salah satu penyakit kronis terbanyak yang menjadi masalah kesehatan masyarakat di Indonesia. Angka proporsi penderita CKD yang menjalani hemodialisis di Indonesia dan di Bali tahun 2018 adalah 19,3% dan 38,7%. Penelitian ini bertujuan untuk mengetahui profil sosiodemografi dan klinis penderita CKD stadium 5 yang menjalani hemodialisis reguler di RSUD Klungkung tahun 2019.Metode: Penelitian retrospektif potong lintang dilakukan terhadap 77 sampel di unit hemodialisis Rumah Sakit Umum Daerah Klungkung dengan menggunakan data sekunder yang diperoleh dari catatan medis dengan metode total sampling. Kriteria inklusi adalah pasien dengan CKD stadium 5 yang menjalani hemodialisis reguler. Variabel yang dievaluasi dalam penelitian ini adalah usia, tingkat pendidikan, status pekerjaan, status pernikahan, masa HD, etiologi, akses vaskular, HBsAg, dan kadar hemoglobin. Data dianalisis oleh SPSS versi 21 untuk Windows.Hasil: Proporsi penderita CKD stadium 5 yang menjalani hemodialisis umumnya berada pada rentang umur 51 s/d 60 tahun (33,8%), dengan jenis kelamin penderita terbanyak laki-laki (63,6%), pendidikan SMA (42,9%), bekerja (59,7%), menikah (93,5%), durasi tahun menjalani hemodialisis antara 1 s/d 5 tahun (85,7%), etiologi yang umum ditemui adalah pielonefritis kronis (32,5%), dengan akses vaskular AV Shunt (63,6%), tes HbsAg umumnya negatif (96,1%), dan kadar Hb > 10 gram/dL (54,5%).Simpulan: Sebagian besar penderita CKD stadium 5 yang menjalani hemodialisis di RSUD Klungkung adalah penderita laki â€“ laki, umur pertengahan, tingkat pendidikan menengah, dominan sudah bekerja dan sudah menikah, dengan tahun pertama menjalani hemodialisis 1-5 tahun. Penyebab paling umum dari CKD adalah pielonefritis kronis pada pria dan hipertensi pada wanita.

Hubungan antara kejadian delirium dengan anemia pada pasien geriatri di bangsal rawat inap geriatri RSUP sanglah Shelvy Florence Gousario; RA Tuty Kuswardhani
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: Delirium is common, occurs in 20% to 79% of hospitalized older patients. It has been associated with increased health care costs, long-term cognition deficits, and increase mortality. Anemia has been noted as one of predisposing factors for delirium. Elderly patients with many risk factors will be vulnerable to a low level precipitating insult, whereas those without risk factors may only become delirious after a high level insult. The objective of this study was to find association between delirium status and anemia among elderly patients.Method: cross-sectional design using analytic observational was conducted with purposive sampling. Total subject of this study was one hundred and sixteen elderly patients, taken at geriatric ward Sanglah general hospital from January to May 2016. Delirium status was screened using Confusion Assessment Method (CAM). Assessment of delirium was confirmed if meet the criteria acute, fluctuating onset an inattention, plus disorganized thinking and/or changes in consciousness. Anemia was defined as level of serum hemoglobin < 10 g/dL. Statistical analysis used was chi square comparative test .Results: One hundred and sixteen elderly patients age 60 to 95 years old with mean 72.16 + 8.179 were included. The prevalence of delirium and anemia were 28 (24.1%) and 40 (34.5%) respectively. We found significant association between delirium status and anemia (p= 0.034).Conclusion: there was significant association between delirium status and anemia among elderly patients at geriatric ward Sanglah general hospital.Â Pendahuluan: Delirium merupakan suatu keadaan yang sering terjadi pada 20 hingga 70% pasien geriatri yang menjalani rawat inap. Keadaan ini dihubungkan dengan peningkatan biaya kesehatan, defisit kognitif jangka panjang, serta peningkatan mortalitas. Anemia telah diketahui sebagai salah satu faktor predisposisi terjadinya delirium. Pasien geriatri dengan banyak faktor risiko akan lebih rentan terhadap jejas yang kadarnya rendah. Penelitian ini bertujuan untuk mengetahui hubungan antara delirium dan anemia pada pasien geriatri.Metode: penelitian ini merupakan penelitian observasional dengan rancangan potong lintang analitik menggunakan consecutive sampling. Subjek dalam penelitian ini berjumlah 116 pasien yang berasal dari bangsal rawat inap geriatri RSUP Sanglah Denpasar pada Januari hingga Mei 2016. Delirium dievaluasi menggunakan metode CAM (Confusion Assessment Method). Anemia didefenisikan sebagai kadar hemoglobin serum <10 g/dL. Analisa statistik menggunakan uji komparatif chi-square.Hasil: Dari 116 pasien yang menjadi sampel dalam penelitian ini, didapatkan rata-rata umur 72,16 + 8,179 dengan umur terendah 65 tahun dan tertinggi 95 tahun. Prevalensi delirium dan anemia sebesar 28 (24,1%) dan 40 (34,5%) berturut-turut. Didapatkan adanya hubungan yang bermakna antara kejadian delirium dengan anemia (p= 0,034)Kesimpulan: Ada hubungan yang bermakna antara kejadian delirium dengan anemia pada pasien-pasien geriatri di bangsal rawat inap geriatri RSUP Sanglah Denpasar.

Anemia and metabolic acidosis are a predictor for mortality in children with severe acute malnutrition at Sanglah General Hospital, Bali Ni Putu Andina Kluniari; I Gusti Lanang Sidiartha
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in children in developing countries.Â Nutritional disorders are frequent in hospitalized patients, of which malnutrition is the most prevalent Anemia and PH disturbance was commonly found in this condition. This study aims to determine the association between anemia and metabolic acidosis with the mortality among children with severe acute malnutrition.Methods: A retrospective cohort study was conducted among 135 severe acute malnutrition children in the pediatric care unit of Sanglah General Hospital from the 2017-2018 period. The inclusion criteria were children aged 1 month to 18 years diagnosed with SAM. Exclusion criteria were a patient diagnosed with a hematological disorder or renal disorder. Data were analyzed using SPSS version 20 for Windows.Results: Anemia was diagnosed in 89 (65.9%) subjects in this study. Anemia increases the risk of death significantly by 3.98 times (95% CI 2.167-10.389; p<0.001). Metabolic acidosis was found in 35 (25.9%) subjects; this condition was also shown to significantly increase the risk of death by 1.5 times (95% CI 1.005-2.145; p=0.018).Conclusion: Anemia and metabolic acidosis can be used as predictors for mortality in severe acute malnutrition patient significantly.

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