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INDONESIA
ISM (Intisari Sains Medis) : Jurnal Kedokteran
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.
Arjuna Subject : -
Articles 1,063 Documents
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Skor Patient Rated Wrist Examination (PRWE) dan Radius Union Scoring System (RUSS) lebih baik dengan pemberian Platelet Rich Plasma pada kasus fraktur distal radius dengan terapi konservatif I Gusti Ngurah Pramartha Wijaya Putra; I Ketut Siki Kawiyana; I Wayan Suryanto Dusak; Putu Astawa; I Ketut Suyasa; Ketut Gede Mulyadi Ridia; I Gede Eka Wiratnaya
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (272.553 KB) | DOI: 10.15562/ism.v11i3.776

Abstract

Introduction: Platelet Rich Plasma (PRP) is one of the supporting therapies that can increase the rate of tissue regeneration. In orthopedics, PRP is generally considered a therapy to accelerate bone regeneration, especially when combined with bone allografts. This study was conducted to determine whether the administration of platelet rich plasma (PRP) in conservative therapy of distal radius fractures resulted in a functional outcome (Patient Related Wrist Examination / PRWE score) and increased callus formation (Radius Union Scoring System / RUSS score) was better when compared to conservative therapy without PRP administration.Methods: A total of 22 patients with distal radius fracture were divided into two groups, the intervention group who underwent closed reduction, immobilization with short arm cast and PRP injection at the fracture site, and the control group who received a placebo injection of 0.9% NaCl. After 8 weeks, the evaluation was carried out with the PRWE form and radiologic examination to assess RUSS. The research data were then analyzed to determine the difference in mean scores between groups.Results: The mean PRWE score was lower in the conservative + PRP treatment group (73.18 ± 5.96) than in the control group (79.55 ± 3.30), p value = 0.007. In addition, the mean RUSS score was higher in the conservative + PRP treatment group (5.27 ± 1.10) than in the control group (4.00 ± 1.18),  p value = 0.017.Conclusion: Administration of PRP in conservative therapy of distal radius fractures resulted in a lower PRWE score and a higher RUSS score at 8 weeks. It can be used as a basis for administering PRP in adjunct therapy to conservative therapy of distal radius fractures. Pendahuluan: Platelet Rich Plasma (PRP) merupakan salah satu terapi penunjang yang dapat meningkatkan kecepatan regenerasi jaringan. Dalam bidang orthopaedi, PRP umumnya dianggap sebagai terapi untuk mempercepat regenerasi tulang, terutama ketika dikombinasikan dengan allografts tulang. Penelitian ini dilakukan untuk menentukan apakah pemberian platelet rich plasma (PRP) pada terapi konservatif fraktur distal radius menghasilkan luaran fungsional (skor Patient Related Wrist Examination / PRWE) dan peningkatan pembentukan kalus (skor Radius Union Scoring System / RUSS) yang lebih baik apabila dibandingkan dengan terapi konservaif tanpa pemberian PRP.Metode:  Sebanyak total 22 pasien dengan fraktur distal radius dibagi ke dalam dua kelompok, yakni kelompok intervensi yang menjalani reduksi tertutup, imobilisasi dengan short arm cast dan injeksi PRP di lokasi fraktur, serta kelompok kontrol yang mendapat injeksi plasebo berupa NaCl 0,9%. Setelah 8 minggu, evaluasi dilakukan dengan formulir PRWE dan pemeriksaan radiologik untuk menilai RUSS. Data penelitian kemudian dianalisis untuk mengetahui perbedaan rerata skor antar kelompok.Hasil: Didapatkan rerata skor PRWE yang lebih rendah pada kelompok perlakuan konservatif + PRP (73,18 ± 5,96) dibanding pada kelompok kontrol (79,55 ± 3,30) dengan nilai p < 0,05. Selain itu, didapatkan pula rerata skor RUSS yang lebih tinggi pada kelompok perlakuan konservatif + PRP (5,27 ± 1,10) dibanding pada kelompok kontrol (4,00 ± 1,18) dengan nilai p < 0,05.Simpulan: Pemberian PRP pada terapi konservatif fraktur distal radius menghasilkan skor PRWE yang lebih rendah dan skor RUSS yang lebih tinggi dalam waktu 8 minggu. Hal ini dapat digunakan sebagai dasar pemberian PRP dalam terapi tambahan pada terapi konservatif fraktur distal radius. 
Faktor risiko untuk fungsi hip yang buruk pada pasien dengan patah tulang kolum femur pasca hemiarthroplasti bipolar tiga bulan pasca operasi Soehartono Hadi Pranata; Putu Astawa; I Wayan Suryanto Dusak
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (288.172 KB) | DOI: 10.15562/ism.v11i3.777

Abstract

Introduction. As one of the frequent problems globally, fractures of the column femur may cause morbidity and mortality if not well-treated. The most common treatment for hip fracture is bipolar hemiarthroplasty. Hemiarthroplasty generally has good results, but with increasing patient age, implant function deteriorates. Through this research, the authors were interested in investigating the factors that may contribute to the functional outcome of bipolar hemiarthroplasty procedure, including Leg Length Discrepancy (LLD), osteoporosis, the diameter of the femoral head, stem malposition, and implant loosening.Methods. This is a case-control study. The case group was patients with Harris Hip Score (HHS) < 70 (poor hip function), while the control group was patients with HHS > 70. X-ray examination was performed to evaluate for the LLD, stem malposition, osteoporosis, femoral head diameter, and implant loosening three months after surgery. The result was tabulated in 2x2 tables, then descriptive and inferential analysis was conducted.Results. Chi-square tests for LLD, osteoporosis and femoral head diameter yielded p = 0.012, p = 0.026, and p = 0.002 respectively, showing significant differences in HHS at three months after bipolar hemiarthroplasty surgery (p <0.05). While the chi-square test for implant loosening and stem malposition resulted in p = 0.469 and p = 0.115, neither of these showed significant differences between groups (p> 0.05).Conclusion. Differences in leg length (LLD), osteoporosis, and diameter of the femoral head were risk factors for the poor functional outcome (HHS <70) at three months after surgery in patients who underwent bipolar hemiarthroplasty due to fracture of the femoral column. Meanwhile, the stem malposition and loosening of the implant have not been shown any association with HHS <70. Pendahuluan. Sebagai salah satu masalah yang sering terjadi secara global, patah tulang kolum femur dapat menyebabkan morbiditas dan mortalitas jika tidak diobati dengan baik. Pengobatan yang paling umum untuk patah tulang panggul adalah hemiarthroplasti bipolar (bipolar hemiarthroplasty). Hemiarthroplasti umumnya memiliki hasil yang baik, tetapi dengan bertambahnya usia pasien, fungsi implan memburuk. Melalui penelitian ini, penulis tertarik untuk menyelidiki berbagai faktor yang dapat berkontribusi terhadap hasil fungsional setelah prosedur hemiarthroplasti bipolar, termasuk perbedaan panjang tungkai (leg length discrepancy / LLD), osteoporosis, besar diameter kepala femur, malposisi stem, dan pelonggaran implan.Metode. Studi menggunakan desain kasus-kontrol. Kelompok kasus adalah pasien dengan Harris Hip Score (HHS) < 70 (luaran fungsional buruk), sedangkan kelompok kontrol adalah pasien dengan HHS > 70. Pemeriksaan foto polos dilakukan untuk melihat LLD, malposisi stem, osteoporosis, diameter kepala femur, dan pelonggaran implan. Data disusun dalam bentuk tabulasi silang kemudian analisis deskriptif dan inferensial.Hasil. Uji chi-square untuk LLD, osteoporosis dan diameter kepala femur menghasilkan nilai p = 0,012, p = 0,026, dan p = 0,002 berturut-turut, menunjukkan perbedaan yang bermakna dalam hal HHS pada tiga bulan pasca operasi pada pasien dengan fraktur kolum femur setelah hemiarthroplasti bipolar (p < 0,05). Sementara uji chi-square untuk pelonggaran dari implan dan malposisi stem menghasilkan nilai p = 0,469 dan p = 0,115, keduanya tidak menunjukan perbedaan bermakna antar kelompok (p > 0,05).Simpulan. Perbedaan panjang tungkai (LLD), osteoporosis, dan besar diameter kepala dari tulang femur merupakan faktor risiko untuk luaran fungsional yang buruk (HHS < 70) setelah hemiarthroplasti bipolar setidaknya tiga bulan setelah pembedahan pada pasien dengan fraktur kolum dari tulang femur. Faktor malposisi stem dan pelonggaran dari implant belum terbukti menjadi faktor risiko.
Purple Urinary Bag Syndrome (PUBS) in Benign Prostate Hyperplasia (BPH) with long-term indwelling urinary catheter use: a case report and literature review Made Kresna Yudhistira Wiratma; Putu Dewi Octavia; Eric Sebastian Hutauruk
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (347.791 KB) | DOI: 10.15562/ism.v11i3.779

Abstract

Background: PUBS is one of the clinical manifestations of urinary tract infection. This condition often leads patients, patients’ families, and medical workers to worrisome. Metabolism of tryptophan and infection of sulfatase and phosphatase - producing bacteria is the most acceptable pathogenesis explaining PUBS. Many risk factors are underlying this condition, including long-term use of indwelling urinary catheters, constipation, dementia, chronic kidney disease, and bedridden patients. This case study aims to evaluate the recent treatment of supporting factors in treating the underlying urinary infection.Case Presentation: We presented a case report of a 67year-old man with Benign Prostate Hyperplasia (BPH) and long-term use of indwelling urinary catheter who complained of purple discoloration of urine a day prior to Transurethral Resection of the Prostate (TURP) surgery. The patient complained of no fever and pain while urinating and having no history of the same complaint and other diseases. In addition, the patient has diagnosed with BPH and Urinary Tract Infection. The administration of Cefazolin 2 grams dosage was given before the TURP procedure, and the following procedure continued.Conclusion: PUBS is a rare clinical course alarming the urinary tract infection. Appropriate treatment by Cefazolin 2 grams dosage following by TURP shows a favorable outcome in this case study.
Hubungan antara Neutrophil-Lymphocyte Ratio (NLR) dengan Tumor-Infiltrating Lymphocyte (TIL), staging, dan grading histopatologi pasien kanker kolorektal di RSUP Sanglah, Bali, Indonesia Gede Dian Astika Putera; I Made Mulyawan; I Ketut Sudartana
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (343.513 KB) | DOI: 10.15562/ism.v11i3.780

Abstract

Background: Colorectal Cancer (CRC) is a significant public health problem in Indonesia. Inflammation is said to have an essential role in the pathogenesis and progressiveness of the CRC. The ratio of neutrophils and lymphocytes (NLR) is a marker that is easily measured. It is hoped that this ratio can be a useful, inexpensive, and fast marker that is routinely carried out, especially for CRC patients.Methods: This study was an analytic cross-sectional design study to determine the relationship between NLR and TIL, histopathology, and TNM stage in patients with TRC. The variables assessed in this study included age, gender, NLR, TIL, grading, stage, and Receiver Operating Curve (ROC) analysis of the relationship between NLR and colorectal cancer stage. Data were analyzed using SPSS version 17 for Windows.Results: There was no significant correlation (p=0.301) between NLR and TIL. The correlation of NLR with histopathological grading was also not significant (p=0.250). There was a significant correlation between NLR with the CRC staging (p<0.001). NLR's cut-off point for staging was determined to be 4.0 with a sensitivity of 98% and a specificity of 95%. This correlation has an Odd-Ratio (OR) of 465.500 and p<0.001 so that the correlation is significant. Obtained correlation coefficient (r) NLR with CRC patient stage of 0.898, where this value has a strong correlation (r> 0.75).Conclusion: High NLR is associated with advanced stage in CRC with an NLR cut-off point of 4.  Latar Belakang: Kanker kolorektal (KKR) merupakan masalah kesehatan masyarakat di Indonesia.  Inflamasi dikatakan memiliki peran penting dalam patogenesis dan progesifitas KKR. Rasio neutrofil dan limfosit (NLR) merupakan suatu marker yang mudah diukur. Diharapkan rasio ini dapat menjadi salah satu marker yang bermanfaat, murah dan cepat serta rutin dilakukan khususnya pada pasien KKRMetode: Penelitian ini merupakan suatu penelitian rancangan potong lintang analitik untuk mengetahui hubungan antara NLR dengan TIL, histopatologi, dan stadium TNM pada pasien dengan KKR. Variabel yang dinilai pada penelitian ini meliputi Usia, jenis kelamin, NLR, TIL, grading, stadium, maupun analisis Receiver Operating Curve (ROC) hubungan NLR dengan stadium kanker kolorektal. Data dianalisis dengan SPSS versi 17 untuk Windows.Hasil: Tidak didapatkan hubungan yang bermakna (p=0,301) antara NLR dengan TIL. Hubungan NLR dengan grading histopatologi juga tidak bermakna (p=0,250). Terdapat hubungan yang bermakna antara NLR dengan stadium KKR (p<0.001). Cut-off point NLR terhadap stadium ditentukan sebesar 4.0 dengan sensitivitas 98% dan spesifisitas 95%.  Hubungan ini memiliki Odd-Ratio sebesar 465.500 dan p < 0.001 sehingga hubungannya bermakna. Didapatkan koefisien korelasi (r) NLR dengan stadium pasien KKR sebesar 0.898 dimana nilai ini memiliki korelasi yang kuat (r > 0.75). Kesimpulan: NLR tinggi berhubungan dengan stadium yang tinggi pada kasus KKR dengan nilai cut off point NLR adalah 4. 
Hubungan faktor bakteriuria dan leukosituria dengan kejadian persalinan Preterm Premature Rupture of Membrane (PPROM) dan Premature Rupture of Membrane (PROM) di RSUD Mangusada, Badung tahun 2018-2019 I Gusti Ngurah Agung Trisnu Kamajaya; I Made Aryana; Anak Agung Ngurah Made Putra Wirawan
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (321.046 KB) | DOI: 10.15562/ism.v11i3.781

Abstract

Background: Preterm labor is one of the most contributors to morbidity and mortality in perinatal and neonatal. Several factors may cause preterm labor with infection as pathophysiology, including urinary tract infection (UTI), to initiate inflammation cascade. This study aims to determine the relationship between bacteriuria and leukocytic factors with the incidence of preterm premature rupture of membrane (PPROM) and premature rupture of membrane (PROM) delivery at Mangusada Hospital, Badung in 2018-2019.Methods: A cross-sectional observational research toward 92 expectant within PPROM and 92 expectant within PROM was done to know the relation between leukocyturia and bacteriuria with the risk of PPROM and PROM. The research variable involves secondary data from urinalysis of leukocyturia and bacteriuria by flowcytometry Sysmex UX-2000 taken from the patient’s registry at maternity room Mangusada Hospital, Badung in 2018-2019. Data were analyzed using SPSS version 17 for Windows.Results: The study results show leukocyturia in PPROM is about 93.42% and 6.5% in PROM, while 71.67% bacteriuria within PPROM and 28.33% within PROM. There’s no significant relationship between bacteriuria result in PPROM and PROM (p=0.247), but there’s considerable relation between leukocyturia within PPROM and PROM (p=0.000).Conclusion: It can be concluded that there’s a significant relationship between leukocyturia within PPROM and PROM.  Latar Belakang: Persalinan preterm merupakan salah satu penyumbang besar morbiditas dan mortalitas perinatal dan neonatal. Berbagai faktor dapat menyebabkan persalinan preterm dengan mekanisme patofisiologi terutama infeksi, salah satunya infeksi saluran kemih (ISK), yang dapat menginisiasi kaskade inflamasi. Penelitian ini bertujuan untuk mengetahui hubungan faktor bakteriuria dan leukosituria dengan kejadian persalinan Preterm Premature Rupture of Membrane (PPROM) DAN Premature Rupture of Membrane (PROM) di RSUD Mangusada, Badung tahun 2018-2019Metode: Penelitian observational cross-sectional terhadap 92 ibu hamil bersalin dengan PPROM dan 92 ibu dengan PROM dilakukan untuk mengetahui hubungan antara bakteriuria dan leukosituria dengan risiko terjadinya persalinan PPROM dan PROM. Variabel penelitian berupa data sekunder hasil urinanalisa flowcytometry Sysmex UX-2000 (leukosituria dan bakteriuria) diambil dari register pasien di ruang bersalin Rumah Sakit Daerah Mangusada Badung tahun 2018-2019. Data dianalisis dengan SPSS versi 17 untuk Windows.Hasil: Hasil penelitian menunjukkan leukosituria pada PPROM sebanyak 93.42% dan 6.5% pada PROM, sedangkan bakteriuria sebanyak 71.67% pada PPROM dan 28.33% pada PROM. Tidak ada hubungan yang bermakna antara kejadian bakteriuria dengan persalinan PPROM dan PROM (p=0,247). Namun, ditemukan hubungan yang bermakna antara leukosituria dengan persalinan PPROM dan PROM (p=0,000).Kesimpulan: Dapat disimpulkan terdapat hubungan signifikan antara leukosituria dengan persalinan PPROM dan PROM.
Maltracking Patella, Pseudo Patella Baja, dan Patellar Tilt sebagai faktor risiko terjadinya nyeri patellofemoral pasca total knee arthroplasty tanpa mengganti komponen patella di RSUP Sanglah, Bali, Indonesia Gusti Ngurah Putra Stanu; Putu Astawa; I Wayan Suryanto Dusak; Elysanti Dwi Martadiani; I Gede Eka Wiratnaya; I Gusti Ngurah Wien Aryana
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (332.743 KB) | DOI: 10.15562/ism.v11i3.782

Abstract

Background: Total Knee Artrhoplasty (TKA) is the final therapeutic choice for osteoarthritis (OA) if conservative therapy fails. However, some studies show that about 50% of patients undergoing TKA complain on anterior knee pain postoperatively. One of the most common causes of knee pain comes from the patellofemoral components. Some interesting potential risk factors needing investigations include patellar maltracking, pseudo patella baja, and patellar tilt. By knowing the relationship between these potential risk factors and patellofemoral pain after TKA, it is hoped that further modifications can be made intraoperatively to maximalize the functional outcomes of these patients.Methods: This is a Case Control study to investigate the factors affecting patellofemoral pain after TKA without patellar resurfacing, including patellar maltracking, pseudopatella baja, and patellar tilt, compared to those who don’t experience patellofemoral pain. The study was conducted at Sanglah Hospital, Denpasar, Bali in September-December 2019. Clinical and radiographic data were obtained secondarily from patient medical records.Results: Chi Square Test for Maltracking patella test showed a value of P = 0,000 (P <0.05), indicating a significant difference between the group with patellofemoral pain and those without. Chi Square Test for Pseudopatella Baja showed a value of P = 1,000 (P> 0.05), indicating no significant difference. While the Chi Square Test for Patellar Tilt showed a value of P = 0.045 (P <0.05), indicating a significant difference.Conclusion: Patellar maltracking and patellar tilt are proven to be risk factors for higher NRS values compared to those without, in post-TKA patients patellar resurfacing. Whereas Pseudopatella Baja was not proven to be a risk factor for higher NRS values. Latar Belakang: Total Knee Artrhoplasty (TKA) merupakan pilihan terapi tahap akhir dari osteoartritis (OA) lutut bila manajemen konservatif gagal. Walaupun demikian, beberapa studi menunjukan bahwa pasca operasi TKA, sekitar 50% pasien justru mengeluhkan nyeri pada bagian depan lutut. Salah satu penyebab tersering nyeri lutut pada pasien-pasien OA pasca TKA berasal dari komponen patellofemoral. Beberapa faktor risiko yang menarik untuk diteliti sebagai peyebab nyeri patellofemoral pasca TKA antara lain maltracking patella, pseudo patella baja, dan patellar tilt. Dengan mengetahui keterkaitan antara faktor-faktor risiko potensial tersebut dengan nyeri patellofemoral pasca TKA, diharapkan lebih lanjut dapat dilakukan modifikasi saat operasi guna mengurangi insiden nyeri patellofemoral pada pasien-pasien pasca TKA, sehingga dapat meningkatkan keluaran fungsional pasien-pasien tersebut.Metode: Penelitian ini merupakan penelitian Case Control untuk mengetahui faktor risiko terjadinya nyeri patellofemoral pasca TKA tanpa mengganti komponen patella pasien-pasien dengan OA lutut, terkait dengan yang memiliki faktor maltracking patella, pseudopatella baja, dan patellar tilt, dibandingkan dengan yang tidak memiliki faktor tersebut. Penelitian dilakukan di RSUP Sanglah, Denpasar, Bali selama bulan September-Desember 2019. Data klinis dan radiografis didapat dari data sekunder dari rekam medis penderita.Hasil: Uji Chi Square Maltracking patella menunjukkan nilai P = 0,000 ( P < 0,05), menandakan perbedaan yang signifikan antara kelompok yang nyeri dan tidak nyeri. Uji Chi Square Pseudopatella Baja menunjukkan nilai P = 1,000 ( P > 0,05), menandakan tidak adanya perbedaan yang signifikan. Sedangkan Uji Chi-square Patellar Tilt menunjukkan nilai P = 0,045 ( P < 0,05), menandakan perbedaan yang signifikan.Simpulan: Maltracking patella dan patellar tilt merupakan faktor risiko terhadap nilai NRS yang lebih tinggi dibandingkan tanpa maltracking patella pada pasien-pasien pasca-TKA tanpa mengganti komponen patella. Sedangkan Pseudopatella Baja tidak terbukti sebagai faktor risiko terhadap nilai NRS yang lebih tinggi dibandingkan tanpa pseudopatella Baja pada pasien-pasien pasca-TKA tanpa mengganti komponen patella.
Konfigurasi fraktur Schatzker VI dan malalignment merupakan faktor risiko terjadinya joint narrowing pada fraktur tibia plateau di RSUP Sanglah, Bali, Indonesia Herryanto Agustriadi Simanjuntak; Ketut Siki Kawiyana; I Ketut Suyasa; Putu Astawa; Ketut Gede Mulyadi Ridia; I Wayan Suryanto Dusak; I Gede Eka Wiratnaya; I Wayan Subawa
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (322.672 KB) | DOI: 10.15562/ism.v11i3.783

Abstract

Background: Tibia plateau fracture is a fracture that involves the joint surface and dramatically contributes to the early development of knee osteoarthritis, which can lead to disability. The joint narrowing is one of the most initial signs of knee osteoarthritis. Until now, the mechanism of joint narrowing is not known with certainty but is thought to be related to the configuration of the patient's fracture, malalignment, and BMI. This study aims to determine and analyze the effect of Schatzker VI fracture configuration, malalignment, and BMI > 25 kg/m2 on joint narrowing in post-operative tibia plateau fracture patients.Methods: This research is an observational study with a case-control design. Thirty-eight patients with tibia plateau fractures who had surgery with acceptable reduction were followed-up within 12-15 months post-operatively. The control group consisted of patients who did not experience joint narrowing post-operatively, while the case group are patients with joint narrowing. Schatzker classification, malalignment, and BMI were compared and statistically analyzed for significance. Data were analyzed using SPSS version 21 for Windows.Results: Sixteen patients (84,0%) had Schatzker VI with a risk of 11.56 times to experience joint narrowing (p=0.003). Malalignment were 18 samples (47,0%), with a risk of 11,56 times becoming joint narrowing (p=0.003); and 8 samples with BMI > 25 kg/m2 had a risk of 0.802 times to develop joint narrowing (p=1.000).Conclusion: Schatzker VI configuration and malalignment are risk factors for joint narrowing in patients following tibial plateau surgery, while a BMI is not a risk factor for joint narrowing. Latar Belakang: Fraktur tibia plateau merupakan fraktur yang melibatkan permukaan sendi dan sangat berkontribusi terhadap perkembangan dini osteoartritis lutut yang dapat berujung pada timbulnya disabilitas. Joint narrowing merupakan salah satu tanda awal terjadinya osteoartritis lutut. Sampai saat ini mekanisme terjadinya joint narrowing belum diketahui secara pasti namun diduga terkait dengan konfigurasi fraktur, malalignment, dan BMI pasien. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh konfigurasi fraktur Schatzker VI, malalignment, dan BMI > 25 kg/m2 terhadap terjadinya joint narrowing pada pasien pasca operasi fraktur tibia plateau.Metode: Penelitian ini merupakan studi observasional dengan desain case control. Tiga puluh delapan pasien yang menjalani operasi fraktur tibia plateau diamati dalam 12-15 bulan pasca operasi. Kelompok kontrol terdiri dari pasien yang tidak mengalami joint narrowing pasca operasi sedangkan kelompok kasus terdiri dari pasien yang mengalami joint narrowing. Klasifikasi Schatzker, malalignment, dan BMI dibandingkan dan dianalisis secara statistik untuk signifikansi.Hasil: Enam belas pasien (84,0%) memiliki konfigurasi fraktur Schatzker VI berisiko 11,56 kali mengalami joint narrowing (p=0,003); malalignment dengan 18 sampel (47%), berisiko 11,56 kali menjadi joint narrowing (p=0,003); dan sampel dengan BMI> 25 kg/m2 adalah 8 sampel dan berisiko 0,802 kali untuk mengalami joint narrowing (p=1.000). Simpulan: Konfigurasi Schatzker VI fraktur tibia plateau dan malalignment adalah faktor risiko untuk terjadinya joint narrowing pada pasien yang pasca operasi fraktur tibia plateau, sementara BMI > 25kg/m2 bukan merupakan faktor risiko terjadinya joint narrowing.
Lactate Dehydrogenase (LDH) dan prokalsitonin merupakan parameter pembeda yang lebih spesifik dan sensitif dibandingkan dengan Laju Endap Darah (LED), C-Reactive Protein (CRP), dan Alkaline Phosphatase (ALP) antara osteosarkoma dan osteomielitis di RSUP S Ivander Purvance; Putu Astawa; Made Bramantya Karna; I Ketut Siki Kawiyana; Ketut Gede Mulyadi Ridia; I Ketut Suyasa; I Wayan Suryanto Dusak; I Gede Eka Wiratnaya
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (353.331 KB) | DOI: 10.15562/ism.v11i3.784

Abstract

Background: It is often difficult to distinguish between the clinical presentation of osteosarcoma and osteomyelitis in the early stages. Histopathological review, requiring planning, delaying early treatment, is the golden standard diagnosis for this disorder. This research aimed to find out if it is possible to use simple laboratory examinations to distinguish these diseases. Early treatment can also be carried out, which can lead to a stronger prognosis.Methods: A medical database of patients with reported osteosarcoma and osteomyelitis was used to collect data. Initial laboratory test results, including erythrocyte sedimentation rate, C-reactive protein, dehydrogenase lactate, alkaline phosphatase, and procalcitonin, were obtained. Statistical analysis was then conducted to determine the most useful laboratory parameter for distinguishing these two diseases. SPSS version 21 for Windows analyzed the results.Results: The results showed that there was a significant difference between osteosarcoma and osteomyelitis patients' age and body mass index (BMI) (p <0.05). Important variations between all test parameters were found, but the lactate dehydrogenase and procalcitonin parameters were considered to be the most sensitive and specific parameters for the distinction between the two diseases (p<0.05). A sensitivity level of 92.5 % and a specificity of 100% with an AUC value of 0.963 (P = 0.05) were shown to have cut points of 840 U/L for LDH and 0.465 ng/mL for PCT.Conclusion: Lactate dehydrogenase and procalcitonin have been shown to distinguish between early-stage osteomyelitis and osteosarcoma, making early treatment possible.  Latar Belakang: Gambaran klinis osteosarkoma dan osteomielitis seringkali sulit dibedakan pada fase-fase awal. Pemeriksaan gold standard untuk kedua penyakit ini adalah dengan pemeriksaan histopatologi, namun pemeriksaan ini memerlukan persiapan yang cukup lama, sedangkan tatalaksana kedua penyakit ini optimal bila dilakukan seawal mungkin. Penelitian ini bertujuan untuk melihat apakah pemeriksaan laboratorium sederhana dapat membedakan kedua penyakit ini, sehingga terapi dapat dilakukan sedini mungkin, dan menghasilkan prognosis sebaik mungkin.Metode: Dilakukan pengambilan data pasien sesuai desain cross sectional analytics, yaitu pasien yang telah terkonfirmasi osteosarkoma dan osteomielitis dari rekam medis. Kemudian dilakukan penelusuran data laboratorium saat awal pasien masuk, yaitu laju endap darah, C-reactive protein, lactate dehydrogenase, alkaline phosphatase, dan prokalsitonin. Kemudian dilakukan analisis statistik untuk menentukan parameter manakah yang paling berperan membedakan kedua penyakit ini. Data dianalisis dengan SPSS versi 21 untuk Windows.Hasil: Hasil penelitian menunjukkan terdapat perbedaan yang bermakna antara usia dan Indeks Masa Tubuh (IMT) pasien kelompok osteosarkoma dengan osteomielitis (p<0,05). Didapatkan perbedaan yang bermakna dari semua parameter yang diuji, namun parameter lactate dehydrogenase dan prokalsitonin dinilai yang paling sensitif dan spesifik dalam membedakan kedua penyakit tersebut (p<0,05). Titik potong 840 U/L untuk LDH dan 0.465 ng/mL untuk PCT terbukti memiliki tingkat sensitivitas sebesar 92.5% dan spesifisitas 100% dengan nilai AUC 0,963 (P=0,05).Kesimpulan: Pemeriksaan kadar lactate dehydrogenase dan prokalsitonin terbukti dapat membedakan osteomielitis dan osteosarkoma pada awal proses penyakitnya, sehingga terapi dapat dilakukan lebih dini.
Pemberian kombinasi kalsium dengan asam askorbat meningkatkan kadar bone alkaline phosphatase dan osteocalcin serum dibandingkan kombinasi kalsium dengan vitamin D3 pada patah tulang panjang paska fiksasi internal di RSUP Sanglah, Bali, Indonesia Ni Made Puspa Dewi Astawa; I Ketut Siki Kawiyana; Ketut Gede Mulyadi Ridia; Putu Astawa; I Ketut Suyasa; I Wayan Suryanto Dusak; I Gede Eka Wiratnaya
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (289.243 KB) | DOI: 10.15562/ism.v11i3.785

Abstract

Background: It is expected that supplementation will be able to satisfy the needs of calcium as well as improve the process of fracture healing. The goal of this study is to show the efficacy of calcium and ascorbic acid (vitamin C) combination supplements in fracture bone healing compared to calcium and vitamin D3.Methods. This study is a randomized clinical trial involving 30 patients with long bone fractures of the lower extremity who have undergone internal fixation and are split into two classes. The calcium carbonate-ascorbic acid regiment combination was given to one group, while the calcium carbonate-vitamin D3 regiment was given to the other group. The effect of the regiment was tested on serum calcium, bone alkaline phosphatase (BAP) and osteocalcin (OC) levels. The findings were compared and interpreted statistically by SPSS version 21 for Windows.Results. Administration of calcium carbonate and ascorbic acid combination was be able to increase serum calcium significantly (p = 0.00, 95% CI = 0.59 – 0,87), but not as strong as combination of calcium carbonate with vitamin D3. An increased level of serum BAP and OC was found significantly higher in calcium carbonate and ascorbic acid supplementation group (p value = 0,033, CI -4,18 – -0,19 for BAP, p value = 0,04, CI -2,25 – -0,49 for OC).Conclusion. The administration of calcium carbonate and ascorbic acid combination supplement increases the serum calcium level, but not as strong as calcium carbonate and vitamin D3 combination.  Latar Belakang: Pemberian suplemen diharapkan mampu untuk memenuhi kebutuhan kalsium sekaligus mempercepat proses penyembuhan patah tulang. Penelitian ini bertujuan untuk mengetahui keefektifan suplemen kalsium dan asam askorbat (vitamin C) dalam penyembuhan tulang pasca patah tulang dibandingkan pemberian suplemen kalsium dan vitamin D3.Metode: Penelitian ini merupakan uji klinis terandomisasi yang melibatkan 30 pasien patah tulang panjang ekstremitas bawah pasca fiksasi internal yang kemudian dibagi menjadi dua kelompok. Satu kelompok diberikan suplemen kombinasi kalsium karbonat-asam askorbat sedangkan kelompok lainnya diberikan kombinasi kalsium karbonat-vitamin D3. Efeknya terhadap kadar serum kalsium, bone alkaline phosphatase (BAP), dan osteocalcin (OC) kemudian diperiksa dan dibandingkan antara kadar sebelum dengan setelah perlakuan. Analisis statistik dilakukan dengan SPSS versi 21 untuk Windows.Hasil: Pemberian kombinasi kalsium karbonat-asam askorbat mampu meningkatkan serum kalsium secara bermakna (p=0.00, IK 95% = 0.59 – 0,87), namun tidak lebih kuat dibandingkan kombinasi kalsium karbonat-vitamin D3. Peningkatan kadar BAP dan OC juga ditemukan lebih tinggi secara bermakna pada kelompok dengan suplementasi kalsium karbonat-asam askorbat (nilai p 0,033 IK -4,18 – -0,19 untuk BAP, nilai p = 0,04, IK -2,25 – -0,49 untuk OC) apabila dibandingkan dengan suplementasi kalsium karbonat-vitamin D3.Simpulan: Pemberian kombinasi kalsium karbonat dan asam askorbat terbukti dapat meningkatan kadar serum kalsium, namun tidak sekuat pada kombinasi kalsium dan vitamin D3.
Acute fatty liver of pregnancy: a case report Putu Gede Agus Surya Mahardika; Aditya Prabawa; Ketut Suardana
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (378.414 KB) | DOI: 10.15562/ism.v11i2.786

Abstract

Introduction: Acute fatty liver of pregnancy (AFLP) is rare but potentially lethal complication. AFLP characterized by microvascular fatty infiltration of hepatocytes without any inflammation or necrosis.Case Presentation: A 37-year-old multigravida with 29 weeks period of gestation came with chief complains of acute jaundice, nausea, malaise and anorexia since 7 days ago. On examination, her eyes were icteric and her motor power was decreased on both extremities. Abdominal examination showed fetus in cephalic presentation with normal fetal heart rate. There was no opening and effacing of cervix. The ECG result showed prolonged QT interval. She had elevated liver enzyme, decreased renal function, electrolyte imbalance, hypoalbuminemia and hypercholesterolemia. Abdominal ultrasound was within normal limit. Patient was then assessed with differential diagnosed of AFLP, acute hepatitis and HELLP syndrome. She was treated conservatively with ferrous sulfate, high carbohydrate diet, KSR once daily, CDR once daily and Bisoprolol 1.25mg once daily.  Three months later patient delivered a healthy baby boy via caesarian section due to premature rupture of membrane.Conclusion: Since AFLP is a medical and obstetric emergency, early recognition and prompt treatment improves both maternal and fetal survival.

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