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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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Uji daya hambat sediaan tetes telinga ekstrak daun â€œTebel-Tebelâ€ (Hoya carnosa) terhadap bakteri gram positif dan gram negatif penyebab Otitis Media Supuratif Kronik (OMSK) aktif tipe benigna secara in-vitro di RSUP Sanglah, Bali, Indonesia I Wayan Lolik Lesmana; Eka Putra Setiawan; I Made Jawi
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: The recent Chronic Suppurative Otitis Media (CSOM) management by antibiotic Chloramphenicol 1% ear drop seems to be ineffective due to the bacterial resistance, ototoxic effects, and the idiosyncratic response. Traditional medicine from Hoya carnosa leaf as ear drops has been suggested for alternative medicine because of its antibacterial properties. This study aims to evaluate the inhibition test of Hoya carnosa leaf-extract towards gram-positive and gram-negative bacteria causeMethods: An experimental study with a completely randomized post-test control group design has been conducted to the American Type Culture Collection (ATCC), which consists of Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa dan Enterobacter spp. The Hoya carnosa leaf extract in-ear drop emulsion has been divided into 3 concentrations, such as 1%, 3%, and 5% w/v by simple random technique. As a positive control used Chloramphenicol 1% and as a negative control using 96% ethanol. Each treatment was repeated 5 times and data were analyzed by SPSS version 17 for Windows.Results: There was a significant difference in inhibitory diameter (IH) from ear drop dosage of (Hoya carnosa) leaf emulsions to Streptococcus pyogenes bacteria in concentrations of 3% and 5% (p<0.05). There was a significant difference from the inhibitory drug resistance (DDH) ear drop emulsion preparation leaf extract "tebel-tebel" (Hoya carnosa) concentrations of 1%, 3% and 5% with Cholrampenicol 1% against Streptococcus pyogenes bacteria (p<0.05)Conclusion: There was a significant difference in inhibitory diameter (DDH) and inhibitory drug resistance from Hoya carnosa leaf emulsions ear drops to Streptococcus pyogenes bacteria.Â Latar Belakang: Penatalaksanaan Otitis Media Supuratif Kronis (OMSK) saat ini dengan antibiotik Kloramfenikol tetes telinga 1% tampaknya tidak efektif karena adanya resistensi bakteri, efek ototoksik, dan respon idiosinkratik. Obat tradisional dari daun Hoya carnosa sebagai obat tetes telinga telah disarankan untuk pengobatan alternatif karena sifat antibakterinya. Penelitian ini bertujuan untuk mengevaluasi uji daya hambat ekstrak daun Hoya carnosa terhadap bakteri penyebab gram positif dan gram negatifMetode: Telah dilakukan penelitian eksperimental dengan rancangan acak kelompok kontrol post-test pada American Type Culture Collection (ATCC) yang terdiri dari Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa dan Enterobacter spp. Ekstrak daun Hoya carnosa dalam emulsi tetes telinga dibagi menjadi 3 konsentrasi yaitu 1%, 3% dan 5% b / v dengan teknik acak sederhana. Sebagai kontrol positif digunakan Kloramfenikol 1% dan sebagai kontrol negatif menggunakan etanol 96%. Tiap perlakuan diulang sebanyak 5 kali dan data dianalisis dengan SPSS versi 17 untuk Windows.Hasil: Terdapat perbedaan bermakna dalam uji diameter daya hambat (DDH) antara dosis tetes telinga emulsi daun Hoya carnosa terhadap bakteri Streptococcus pyogenes pada konsentrasi 3% dan 5% (p <0,05). Ada perbedaan yang bermakna antara ekstrak daun â€œtebel-tebelâ€ (Hoya carnosa) sediaan emulsi tetes telinga konsentrasi 1%, 3% dan 5% dengan Cholrampenicol 1% terhadap bakteri Streptococcus pyogenes (p <0,05).Kesimpulan: Ada perbedaan yang bermakna pada diameter hambat (DDH) dan resistensi obat penghambat emulsi daun Hoya carnosa tetes telinga terhadap bakteri Streptococcus pyogenes.

Hubungan antara Tumor Infiltrating Lymphocytes (TIL), ekspresi Programmed Death-Ligan 1 (PD-L1) pada sel tumor dan TIL dengan kedalaman invasi pada karsinoma urotelial kandung kemih tipe tidak spesifik di RSUP Sanglah, Bali, Indonesia Luh Ayu Widayanti; I Gusti Ayu Sri Mahendra Dewi; Herman Saputra; Anak Agung Ayu Ngurah Susraini; Ni Putu Sriwidyani; I Made Muliarta
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Background: Urotelial carcinoma is one of carcinoma with increasing morbidity and mortality. The depth of invasion is one of risk factors that influence recurrence and survival rate in urotelial carcinoma. Patient with deeper invasion has poorer prognosis in recurrence and survival rate. Generally, carcinoma have microenvironment such as tumor infiltrating lymphocytes (TIL) to eliminate the tumor cells, in proliferative area. Cancer cells can avoid host immunity through PD-1/PD-L1 pathway. This study aimed to determine the association between TIL and PD-L1 expression with the depth of invasion of urotelial carcinoma.Methods: This study was a cross sectional analytic study with 37 samples size. The samples were taken from paraffin block of patients with urotelial bladder carcinoma non-specific type, that has performed resection and histopathological examination at Anatomical Pathology Laboratory Sanglah Hospital Denpasar, from January 1st, 2015 to December 31th, 2019. Rediagnosis was carried out to assess the histopathological diagnosis, TIL and depth of invasion. Then PD-L1 immunohistochemistry was performed. Data were analyzed by Chi-Square test with p<0.05. Data were analyzed using SPSS version 20 for Windows.Results: In this study on bladder urothelial carcinoma non-specific type at Sanglah Hospital Denpasar, we found there is no association between TIL and the depth of invasion (p=0.471). There is association between PD-L1 expression in tumor cells with the depth of invasion (p=0.006), OR 7.04 (CI 95% =1.64-30.20). There is association between PD-L1 expression in TIL with the depth of invasion (p=0.001), OR 13.2 (CI 95% = 2.62-66.43).Conclusion: There is association between PD-L1 expression in tumor cells an PD-L1 expresion in TIL with the depth of invasion. Positive expression of PD-L1 in tumor cells and TIL are more likely to become advance invasion. Tumor Infiltrating Lymphocytes (TIL) and PD-L1 expression on TIL can be used as predictive factors for the depth of invasion in urotelial carcinoma. Latar Belakang: Karsinoma urotelial merupakan salah satu karsinoma dengan morbiditas dan mortalitas yang terus meningkat. Salah satu faktor risiko yang mempengaruhi rekurensi dan survival rate pada karsinoma urotelial adalah kedalaman invasi. Invasi yang lebih dalam memiliki prognosis yang lebih buruk. Karsinoma umumnya disertai lingkungan mikro antara lain tumor infiltrating lymphocytes (TIL) yang berfungsi untuk mengeliminasi tumor. Sel kanker memiliki kemampuan untuk menghindari imun host antara lain melalui ikatan PD-1 dengan PD-L1. Tujuan dari penelitian ini untuk mengetahui hubungan antara TIL dan ekspresi PD-L1 dengan kedalaman invasi pada karsinoma urotelial.Metode: Penelitian ini merupakan studi analitik potong lintang dengan besar sampel adalah 37, yang berasal dari blok parafin penderita karsinoma urotelial kandung kemih tipe tidak spesifik yang diperiksa histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah Denpasar dari 1 Januari 2015 sampai 31 Desember 2019. Rediagnosis preparat dilakukan untuk menilai diagnosis histopatologi, TIL serta kedalaman invasi. Kemudian dilakukan pulasan imunohistokimia PD-L1. Data dianalisis dengan uji Chi-Square dengan nilai p<0,05. Data dianalisis dengan SPSS versi 20 untuk Windows.Hasil: Hasil penelitian ini menunjukkan bahwa pada karsinoma urotelial kandung kemih tipe tidak spesifik di RSUP Sanglah Denpasar, tidak terdapat hubungan yang signifikan antara TIL dengan kedalaman invasi (p=0,471). Terdapat hubungan yang signifikan antara ekspresi PD-L1 pada sel tumor dengan kedalaman invasi (p=0,006) dengan OR 7,04 (IK 95% =1,64-30,20), antara ekspresi PD-L1 pada TIL dengan kedalaman invasi (p=0,001) dengan OR 13,20 (IK 95% = 2,62-66,43).Kesimpulan: Terdapat hubungan antara ekspresi PD-L1 pada sel tumor dan pada TIL dengan kedalaman invasi pada karsinoma urotelial kandung kemih tipe tidak spesifik di RSUP Sanglah Denpasar. Ekspresi positif PD-L1 pada sel tumor dan pada TIL memiliki kemungkinan lebih besar untuk menjadi invasi lanjut.

Diabetes insipidus after suprasellar tumor surgery: case report Yuriz Bakhtiar; Muhamad Thohar Arifin; Adrian Pratama; Jacob Bunyamin
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Introduction: Diabetes insipidus (DI) is a rare water and electrolyte imbalance with hypovolemic hypernatremia characteristic (1:25.000) however can be potentially fatal if not well-anticipated and managed adequately. Brain tumors, either operated or not, may lead to DI (25%). Based on anatomical location, the suprasellar tumor may cause hypophyseal hormone dysfunction. Sellar region tumors can be classified into hypophyseal (90%) and non-hypophyseal (10%). Non-hypophyseal tumors with neurological deficits are more often causing hypophyseal hormone hyposecretion including DI. Sellar tubercle meningioma is one of the sellar region non-hypophyseal tumors which is often encountered and surgically managed. Worsening symptoms may become the surgical indication e.g. headache and visual disturbance.Â Case: We are reporting two meningioma cases in Salatiga local hospital with almost similar tumor characteristics either size and frontal lobe location. Both cases were managed by similar transcranial tumor excision craniotomy. Their differences were in the presence of neurological manifestations and the degree of hypothalamic compression. One patient developed postoperative DI without thirst thus the clinical manifestation was polyuria which was closely monitored in the intensive ward. We were convinced that the DI incidence was affected by the tumor manifestation and location which can be assessed by computed tomography (CT) scans. Conclusion: The clinicians should anticipate the possibility of post craniotomy DI thus may provide adequate monitoring and management in patients developing postoperative DI.

Validitas modified Pediatric Early Warning System/Score di Rumah Sakit Umum Pusat Sanglah I Made Karma Setiyawan; Dyah Kanya Wati; I Nyoman Budi Hartawan; Ida Bagus Gede Suparyatha; Made Pande Lilik Lestari
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Background: Early identification of patient at risk influence the chance of appropriate management and thus patient’s outcome. Pediatric Early Warning System/Score (PEWS) was developed to evaluate patient clinical development while hospitalized. Sanglah General Hospital has implemented PEWS to evaluate early clinical deterioration since 2015 in accordance with quality control program, even though it is not validated yet.Methods: A single-center, cross-sectional analytic observational study was conducted in pediatric ward Sanglah General Hospital in 2019. The scores ranged from 0 to 9 and were assessed in the 6 to 8 hours prior to unplanned intensive care transfer. Cut-off point, sensitivity, and specificity of modified PEWS was obtained in terms of unplanned intensive care transfer.Results: Amongst 200 children at pediatric ward, 22 children (11%) had unplanned intensive transfer. The most common intensive consultation problems were respiratory failure (63.6%), followed by decrease of consciousness (22.8%) and shock (13.6%). Median of time to clinical deterioration occured within 6 days of hospitalization (range, 1- 41). Majority clinical deterioration event was found in hematology oncology group. The AUC score was 0,99 (95% CI, 0,99 - 1) with the optimal cut-off point on score ? 4 (sensitivity 95,5% and spesificity 100%).Conclusion: Modified PEWS at Sanglah General Hospital is a valid instrument in identifying early clinical deterioration in children. Prospective clinical evaluation of modified Sanglah General PEWS is needed to determine improvement quality of care and patient outcomes. Latar Belakang: Identifikasi pasien yang berisiko mengalami perburukan klinis sejak dini dapat mempengaruhi pemberian tatalaksana yang akan meningkatkan luaran. Instrumen Pediatic Early Warning System/Score (PEWS) disusun untuk mengetahui perkembangan klinis dari pasien selama perawatan di rumah sakit. RSUP Sanglah menerapkan deteksi dini perburukan klinis menggunakan instrumen PEWS yang dimodifikasi sejak tahun 2015 dalam menjalankan Gugus Kendali Mutu (GKM), namun belum tervalidasi.Metode: Penelitian observasi analitik, single-center, menggunakan desain potong lintang yang dilakukan di ruang perawatan anak RSUP Sanglah pada tahun 2019. Skor memiliki rentang 0 sampai 9 dan dinilai saat 6-8 jam sebelum terjadinya pemindahan ke perawatan intensif yang tidak terencana. Titik potong, sensitivitas dan spesifisitas skor modified PEWS didapatkan terkait perburukan klinis yang memerlukan perawatan intensif tidak terencana.Hasil: Sebanyak 22 anak (11%) dari 200 anak yang dirawat di ruang perawatan memerlukan perawatan ruang intensif tidak terencana. Penyebab terbanyak dilakukannya konsultasi untuk perawatan intensif adalah gagal napas (63,6%) diikuti oleh penurunan kesadaran (22,8%) dan syok (13,6%). Median waktu terjadinya perburukan klinis didapatkan setelah 6 hari perawatan (rentang, 1- 41). Mayoritas perburukan klinis didapatkan pada kelompok diagnosis hematologi onkologi. Nilai AUC skor modified PEWS RSUP Sanglah didapatkan sebesar 0,99 (IK 95%, 0,99-1) dengan titik potong optimal pada skor ? 4 (sensitivitas 95,5%, spesifisitas 100%).Kesimpulan: Skor modified PEWS RSUP Sanglah merupakan instrumen yang valid dalam mengenali perburukan klinis pada anak sejak awal. Evaluasi klinis secara prospektif menggunakan skor PEWS tersebut diperlukan untuk melihat perbaikan dalam hal kualitas perawatan dan luaran pada pasien.

Faktor–faktor yang berhubungan dengan batu empedu pada Diabetes Melitus Tipe 2 (DMT2) di RSUP Sanglah, Bali, Indonesia I Dewa Agung Sutanjaya Giri Nugraha; Made Agus Dwianthara Sueta; I Gde Raka Widiana
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Background: Diabetes mellitus is a metabolic disorder characterized by hyperglycemia due to impaired insulin secretion, insulin action, or both. The purpose of this study was to determine the risk factors for gallstones formation in patients with type 2 diabetes mellitus.Methods: This study was a cross-sectional retrospective study with analytic observational design. The study samples were taken using secondary data. The sample size was determined by consecutive non-probable sampling method. A total of 47 samples were included in this study. Data were analyzed using SPSS version 17 for Windows. Results: Sex (r=0.404; p=0.005), lipid profile (r=0.323; p=0.027), and HbA1c (r=0.431; p=0.002) had a moderate relationship with the incidence of gallstones. In addition, BMI had a strong relationship with the incidence of gallstones (r=0.528; p=0,000). However, the duration of DM (r=0.291; p=0.047) had a weak relationship with the incidence of gallstones. Multivariate results showed that patients with higher BMI were 10.9 times more likely to developed gallstones and it was the most dominant risk factor for gallstones.Conclusion: There were significant relationships between sex, BMI, lipid profile, HbA1c, duration of DM with the occurrence of gallstones. BMI was proved to be a dominant risk factor. Latar Belakang: DM merupakan kelainan metabolik dengan ciri hiperglikemia akibat gangguan sekresi insulin, kerja insulin, atau keduanya. Tujuan penelitian untuk mengetahui faktor-faktor risiko terjadinya batu empedu pada pasien dengan diabetes melitus tipe 2.Metode: Penelitian ini menggunakan desain observasional analitik cross-sectional retrospektif dimana sampel penelitian diambil menggunakan data sekunder dalam satuan waktu tertentu. Sampel ditentukan secara consecutive non probable sampling yaitu setiap penderita DMT2 yang memiliki rekam medis dalam periode tahun 2018 di RSUP Sanglah pada periode penelitian diambil sebagai sampel. Sebanyak 47 sampel dilibatkan dalam penelitian ini. Data dianalisis dengan SPSS versi 17 untuk Windows.Hasil: Jenis kelamin (r=0,404; p=0,005), profil lipid (r=0,323; p=0,027), dan HbA1c (r=0,431; p=0,002) memiliki hubungan sedang bermakna dengan kejadian batu empedu. Selain itu, IMT memiliki hubungan yang kuat dengan kejadian batu empedu (r=0,528; p=0,000). Namun lama waktu DM (r=0,291; p=0,047) memiliki hubungan yang lemah dengan kejadian batu empedu. Hasil multivariat menunjukkan bahwa pasien dengan BMI tinggi 10,9 kali lebih mungkin mengembangkan batu empedu dan hal tersebut merupakan faktor risiko paling dominan untuk batu empedu.Kesimpulan: ada hubungan jenis kelamin, IMT, profil lipid, Hba1c, durasi DM dengan terjadinya batu empedu. IMT merupakan faktor risiko dominan.

Rasio Neutrofil-Limfosit (RNL) dan nilai HbA1c sebagai prediktor amputasi pada pasien kaki diabetik di RSUP Sanglah, Bali, Indonesia Nyoman Maharmaya; Ketut Putu Yasa; I Gde Raka Widiana
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Background: Amputation is a management that is needed in cases of diabetic foot but is still challenging to predict. In diabetic foot infections, there can be a disturbance in the balance of inflammatory mediators as a cause of tissue damage. Inflammation is assessed by the Neutrophil Lymphocyte Ratio (NLR), and the HbA1c value is associated with an increased risk of amputation. Wagner's classification describes the extent and weight of diabetic foot ulcers.Methods: This study is a predictive diagnostic test on diabetic foot patients who meet the inclusion criteria. Consecutive sampling was conducted from medical records of Sanglah Hospital Denpasar patients from 2017 to 2019. NLR and HbA1c records were taken from the examination before receiving the medical intervention. An analysis using a 2x2 table is used to determine sensitivity and specificity, and a ROC curve analysis to determine the cut-off point with the best sensitivity and specificity. Data were analyzed using SPSS version 20 for Windows.Results: A total of 82 patients met the inclusion criteria with an average age of 57 (46-69) years. There was 43 (52.4%) male and 39 (47.6%) females enrolled in this study. Most diabetic foot samples with Wagner III degree 35 (42.7%) and Wagner IV 34 (41.5%). A total of 31 (37.8%) patients underwent amputation. The ROC analysis showed an NLR cut-off point of 13.67 (AUC=0.617; p=0.078) with a sensitivity of 54.8% and specificity of 66.7%. ROC HbA1c analysis showed a cut-off point of 9.5% (AUC=0.455) with a sensitivity of 45.2% and specificity of 47.1%. Secondary data and operating reliability are limitations in this study, and it makes a lower sensitivity.Conclusion: The results of this study indicate that the Neutrophil-Lymphocyte Ratio (RNL) and the HbA1c value can be used as predictors of amputation in diabetic foot patients at Sanglah General Hospital, Bali, Indonesia. Latar Belakang: Amputasi merupakan penatalaksanaan yang diperlukan pada kasus kaki diabetik, namun masih sulit untuk diprediksi. Pada infeksi kaki diabetik dapat terjadi gangguan keseimbangan mediator inflamasi sebagai penyebab kerusakan jaringan. Inflamasi dinilai dari Rasio Neutrofil Limfosit (RNL) dan nilai HbA1c dihubungkan dengan meningkatnya resiko amputasi. Klasifikasi Wagner menggambarkan derajat luas dan berat ulkus kaki diabetik.Metode: Penelitian ini adalah uji diagnostik prediktif pada pasien kaki diabetik yang memenuhi kriteria inklusi. Pengambilan sampel dari rekam medis pasien RSUP Sanglah Denpasar secara konsekutif dari tahun 2017 sampai 2019. Pencatatan NLR dan HbA1c diambil dari pemeriksaan sebelum mendapatkan intervensi medis. Kemudian dilakukan analisa menggunakan tabel 2x2 untuk menentukan sensitivitas dan spesifisitas, serta analisa kurva ROC untuk menentukan cut-off point dengan sensitivitas dan spesifisitas terbaik. Data dianalisis dengan SPSS versi 20 untuk Windows.Hasil: Sebanyak 82 pasien memenuhi kriteria inklusi dengan rata-rata umur 57 (46-69) tahun. Terdapat 43 (52,4%) laki-laki dan 39 (47,6%) perempuan dalam penelitian ini. Sebagian besar sampel kaki diabetik dengan derajat wagner III 35 (42,7%) dan wagner IV 34 (41,5%). Sebanyak 31 (37,8%) pasien menjalani amputasi. Dari analisa ROC menunjukkan cut-off point RNL sebesar 13,67 (AUC=0,617; p=0,078) dengan sensitivitas 54,8% dan spesifisitas 66,7%. Analisa ROC HbA1c menunjukkan cut-off point sebesar 9,5% (AUC=0,455) dengan sensitivitas 45,2% dan spesifisitas 47,1%. Data sekunder dan reliabilitas operasi menjadi keterbatasan dalam penelitian ini, sehingga sensitivitasnya rendahKesimpulan: Hasil penelitian ini menunjukkan bahwa Rasio Neutrofil-Limfosit (RNL) dan nilai HbA1c dapat dipergunakan sebagai prediktor amputasi pada pasien kaki diabetik di RSUP Sanglah, Bali, Indonesia

Pencitraan pada pankreolithiasis dengan pankreatitis kronis: laporan kasus Indira Prawita Martini; Nyoman Srie Laksminingsih; Elysanti Dwi Martadiani
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Background: Pancreolithiasis or pancreatic calculus is a rare case. Men suffer more than women with a ratio of 2-3:1 and have an incidence of 1-8:100.000. Pancretolithiasis itself is a sequela of chronic pancreatitis. Accompanied by non-specific complaints, epigastric abdominal pain that radiates to the back to the left shoulder and nausea, vomiting which causes weight loss and malnutrition. Radiological examination can help the clinician in. establish a diagnosis where the laboratory results are also not specific enough to diagnose chronic pancreatitis. The aim of this report is to determine the radiological features of pancreolithiasis accompanied by chronic pancreatitis.Case: A 54-year-old woman with complaints of pain in the epigastric region for approximately 3 months, accompanied by nausea and vomiting, especially after eating which resulted in weight loss of approximately 10 kilograms. In laboratory tests, an increase in total cholesterol, LDH and hyperkalemia was found. There is no increase in amylase and lipase and hepatic function. On plain abdominal radiograph, ultrasound and CT scan, it is found that there is a stone image accompanied by imaging of chronic pancreatitis.Conclusion: Pancreatic calculus is a rare condition. More common in male gender, patients with pancreolithiasis have non-specific discharge. Alcohol use is said to be the biggest factor in pancreolithiasis. On plain abdominal radiograph, ultrasound and CT scan can reveal the presence of stones in the pancreas and the presence or absence of involvement of the pancreatic parenchyma.

Typically active ocular toxoplasmosis: a case report Priscilla Dwianggita
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Background: Ocular toxoplasmosis, a potentially blinding and non-curable disease with a progressive and relapsing course, is the most common cause of infectious posterior uveitis. Infection may be congenital or acquired through ingestion of uncooked meat, contaminated vegetables, or water of different parasite Toxoplasma gondii. Case Presentation: We report a case of a 58-year-old female who came with blurred vision and floaters in her left eye for a month. She had contact with cats, birds, and dogs, as well as eaten raw food before. On examination, anterior segments were normal with visual acuity of 6/6 in the right eye and 6/9 in the left eye. Fundus examination revealed a vitreous haze with a yellow-white exudate located between pupil and macula. Since the disease's progress may lead to recurrence and potential blindness, it must be recognized clinically, and treatment should be started as early as possible, especially in the active period. Our patient was treated with oral trimethoprim (160 mg)/sulfamethoxazole (800 mg) twice daily and topical eye drops of prednisone four times daily on the left eye. These drugs were prescribed instead of sulfadiazine/pyrimethamine, which is classical and standard therapy. After 4 weeks, the fundus examination showed the toxoplasmic lesion was significantly decreased in size, and vitreous haze was improved.Conclusion: Trimethoprim-Sulfamethoxazole regiments as the alternative option for active ocular toxoplasmosis also shows significant improvement with less adverse effect.

Pengaruh pemberian kombinasi ekstrak etanol bunga Tahi Kotok (Tagetes erecta l.) dan daun Jamblang (Syzygium cumini l.) terhadap pertumbuhan bakteri Methicillin-resistant Staphylococcus aureus (MRSA) dan Multidrug-resistant Pseudomonas aeruginosa secara Kadek Tresna Yuwana; I Dewa Made Sukrama; Ni Nengah Dwi Fatmawati
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Introduction: The increasing number of resistance cases of Methicillin-resistant Staphylococcus aureus (MRSA) and Multidrug-resistant Pseudomonas aeruginosa (MRPA) to common antibiotics has called the need for new modalities to combat these resistance problems. The ingredients that are thought to influence the growth of MRSA and MRPA are Tahi Kotok flowers (T. erecta) and Jamblang leaves (S. cumini). This study aimed to evaluate the effect of the combined Tahi Kotok flowers and Jamblang leaves ethanol extract on the growth of MRSA and MRPA bacteria.Methods: The research was conducted as a true experimental design using a post test only control group design. The combination of ethanol extract in several concentrations (25%, 50%, 75%, 100%) were tested on MRSA ATCC 3351 bacteria and MRPA bacteria cultured on agar media. The data obtained are the results of laboratory observations with the disk diffusion methods which are then statistically analyzed parametrically using the SPSS application which is shown as mean ± SEM.Results: The inhibitory activity of T. erecta flower extract with MRSA and MRPA bacteria was found. The largest inhibition zone diameter was at 75% extract concentration, with inhibition zones of 17.25 ± 1.25 cm and 11.25 ± 0.50 cm, respectively. The largest inhibition zone of S. cumini leaf experiment with MRSA bacteria was at concentration of 75 percent, which resulted in a 9.50 ± 0.57 cm inhibition diameter. In MRPA bacteria, however, there was no inhibition zone. At a concentration of 75 percent, the combination of T. erecta flower extract and S. cumini leaf had the highest inhibitory activity against MRSA bacteria, but had no inhibitory activity against MRPA bacteria.Conclusion: The concentration of extract combination in 96% ethanol influences the diameter of the MRSA inhibition zone, whereas in MRPA no inhibition zones were generated from this in vitro experiments. Latar Belakang: Meningkatnya kasus resistensi bakteri Methicillin-resistant Staphylococcus aureus (MRSA) dan Multidrug-resistant Pseudomonas aeruginosa (MRPA) terhadap antibiotik menyebabkan perlunya modalitas baru sebagai potensi untuk mengatasi masalah resistensi tersebut. Salah satu bahan yang diduga berpengaruh terhadap pertumbuhan MRSA dan MRPA adalah bunga Tahi Kotok (T. erecta) dan daun Jamblang (S. cumini). Penelitian ini ditujukan untuk melihat adanya pengaruh kombinasi ekstrak etanol bunga Tahi Kotok dan daun Jamblang terhadap pertumbuhan bakteri MRSA dan MRPA.Metode: Penelitian ini menggunakan rancangan true experimental post test only control group design. Kombinasi ekstrak etanol dalam beberapa konsentrasi (25%, 50%, 75%, 100%) diujikan pada bakteri MRSA ATCC 3351 dan MRPA yang dikultur pada media agar. Data yang diperoleh merupakan hasil pengamatan laboratorium dengan metode disk diffusion yang selanjutnya dianalisis secara statistik dengan statistik parametrik menggunakan aplikasi SPSS untuk menghitung nilai mean ± SEM. Hasil: Pada percobaan ekstrak bunga T. erecta dengan bakteri MRSA dan MRPA menunjukkan adanya daya hambat dengan daya hambat tertinggi terdapat pada konsentrasi 75%, zona hambat 17,25 ± 1,25 cm dan 11,25 ± 0,50 cm berturut-turut. Pada percobaan daun S. cumini dengan bakteri MRSA didapatkan zona hambat tertinggi pada konsentrasi 75% sebesar 9,50 ± 0,57 cm. Akan tetapi, tidak terdapat zona hambat pada bakteri MRPA. Kombinasi ekstrak bunga T. erecta dan daun S. cumini memiliki daya hambat terhadap bakteri MRSA yang tertinggi pada konsentrasi 75%, akan tetapi tidak memiliki daya hambat pada bakteri MRPA.Simpulan: Konsentrasi ekstrak kombinasi dalam etanol 96% berpengaruh terhadap diameter zona hambat MRSA tetapi tidak ditemukan zona hambat yang dihasilkan pada MRPA dari percobaan in vitro.

Hubungan antara Platelet Lymphocyte Ratio (PLR) dan Neutrofil Lymphocyte Ratio (NLR) dengan amputasi pasca intervensi endovaskular pada pasien Peripheral Artery Disease (PAD) Rutherford 2–4 di RSUP Sanglah, Bali, Indonesia Ade Sinyo Aristantrisna; Ketut Putu Yasa; I Gde Raka Widiana
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Background: Endovascular intervention is an effort to reduce amputation number in Peripheral Artery Disease (PAD) patients. The latest studies show a correlation between platelet lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) to the prognosis of PAD. This study aims to evaluate if PLR and NLR can be used to determine the prognosis of PAD patients.Methods: An observational analytic study using a cross sectional approach has been conducted among 56 patients with PAD. The research was conducted in Sanglah Hospital Medical Report room Denpasar, using a patient medical report from January 2014 to December 2018. Variables assessed in this study include NLR, PLR, and ROC analysis to determine the cut-off point used in this study. Data were analyzed using SPSS version 23 for Windows.Results: The ROC analysis results showed that the cut-off point value of 140.5 on the PLR based on the Youden Index had a significant sensitivity level of 75% and a specificity of 64.3% (AUC = 0.739; p = 0.02). While the cut point was 3.14 for the NLR, which had a sensitivity level of 82% and a specificity of 75% (AUC = 0.844; p <0.001). PLR values ? 140.5 had a significant 2.4 times chance of occurrence of amputation after endovascular intervention compared to patients who had PLR values <140.5 (p <0.001; 95% CI = 1.233-4.746). Patients with an NLR ? 3.14 had a 3.9 times chance of having an amputation after the endovascular intervention than patients who had an NLR <3.14 (p <0.001; 95% CI = 1.770 -8.981).Conclusion: High PLR and NLR are associated with the risk of amputation after endovascular intervention in PAD Rutherford 2–4. Latar Belakang: Salah satu usaha mengurangi angka amputasi pada pasien Periheral Artery Diseasse (PAD) adalah dengan intervensi endovascular. Beberapa studi terbaru menunjukkan adanya hubungan antara Platelet Lymphocyte Ratio (PLR) dan Neutrophil Lymphocyte Ratio (NLR) terhadap prognosis PAD. Penelitian ini bertujuan untuk mengetahui apakah PLR dan NLR dapat dipergunakan untuk menentukan prognosis pasien PAD.Metode: Penelitian observasional analitik dengan pendekatan potong-lintang dilakukan terhadap 56 pasien dengan GAD. Tempat penelitian dilakukan di rekam medik RSUP Sanglah Denpasar. Pengambilan data penelitian adalah rekam medis Januari tahun 2014 sampai dengan Desember 2018. Variabel yang dinilai pada penelitian ini meliputi NLR, PLR, dan analisis ROC untuk menentukan titik potong (cut-off) yang dipergunakan pada penelitian ini. Data dianalisis dengan SPSS versi 23 untuk Windows.Hasil: Hasil analisis ROC menunjukkan bahwa nilai titik potong 140,5 pada PLR berdasarkan Youden Indeks yang memiliki tingkat sensitivitas 75% dan spesifitas 64,3% secara bermakna (AUC=0,739; p=0,02). Sedangkan titik potong 3,14 pada NLR yang memiliki tingkat sensitivitas 82% dan spesifitas 75% (AUC=0,844; p<0,001). Nilai PLR ? 140,5 memiliki peluang 2,4 kali secara bermakna untuk terjadi amputasi pasca intervensi endovaskular dibandingkan dengan pasien yang memiliki nilai PLR < 140,5 (p<0,001; 95% IK=1,233-4,746). Pasien dengan NLR ? 3,14 memiliki peluang 3,9 kali untuk terjadi amputasi pasca intervensi endovaskular dibandingkan dengan pasien yang memiliki NLR <3,14 (p < 0,001; 95% IK=1,770 -8,981).Kesimpulan: PLR dan NLR yang tinggi meningkatkan resiko amputasi pada pasien PAD Rutherford 2-4 yang sudah mendapatkan terapi intervensi endovascular

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