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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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Hubungan antara ekspresi Vascular Endothelial Growth Factor (VEGF) dengan karakteristik klinikopatologi osteosarkoma di RSUP Sanglah Denpasar, Bali Johanes Prasetyo Harjanto; I Wayan Juli Sumadi; I Made Gotra; Ni Putu Ekawati
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: Osteosarcoma is the most common malignant primary bone tumor. Although osteosarcoma cases are relatively rare compare to carcinoma, the mortality rate is quite high. Osteosarcoma prognosis can be seen from conventional pathology and biological markers, such as Vascular Endothelial Growth Factor (VEGF). In various studies, the presence of VEGF expression has been associated with the worsening prognosis of osteosarcoma. This study aims to determine the relationship between VEGF expression and osteosarcoma's clinicopathological characteristics at Sanglah General Hospital, Denpasar, 2015-2019.Method: This research is a cross-sectional analytic study. The sampling technique used all affordable populations that were included in the inclusion criteria, with a total sample of 30 samples. The research data used secondary data obtained from the archive of histopathological examination reports at the Anatomical Pathology Laboratory at Sanglah General Hospital and paraffin blocks from all available samples for immunohistochemical examination. Data were analyzed using SPSS version 22 for Windows.Results: The clinicopathological characteristics of the osteosarcoma studied were age, tumor location, histological type, and grading. Patients with osteosarcoma in this study were predominantly found in the age group <20 years (66.67%), femur locations (60.00%), mixed type osteosarcoma (53.33%), and high grade (100.00%). A total of 26 samples (86.67%) had high VEGF expression and 4 samples had low VEGF expression (13.30%). There was no significant relationship between age (p=0.241), location of the tumor (p=0.739), and histological type (p=1.000) to the VEGF expression.Conclusion: The relation between each osteosarcoma clinicopathological characteristic associated with VEGF expression showed insignificant results in age, location, and histological type. Further research is needed with a more significant number of samples to get better results. Latar Belakang: Osteosarkoma adalah tumor tulang primer ganas yang paling umum. Meskipun kasus osteosarkoma relatif jarang dibandingkan dengan karsinoma, angka kematiannya cukup tinggi. Prognosis osteosarkoma dapat dilihat dari patologi konvensional dan penanda biologis, salah satunya adalah Vascular Endothelial Growth Factor (VEGF). Dalam berbagai penelitian, kehadiran ekspresi VEGF telah dikaitkan dengan prognosis yang memburuk dari osteosarcoma. Penelitian ini bertujuan untuk mengetahui hubungan ekspresi VEGF dengan karakteristik klinikopatologi osteosarkoma di RSUP Sanglah Denpasar tahun 2015-2019.Metode: Penelitian ini merupakan penelitian analitik potong lintang. Teknik pengambilan sampel menggunakan semua populasi terjangkau yang termasuk dalam kriteria inklusi, dengan jumlah sampel sebanyak 30 sampel. Data penelitian menggunakan data sekunder yang diperoleh dari arsip laporan pemeriksaan histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah dan blok parafin dari semua sampel yang tersedia untuk pemeriksaan imunohistokimia. Data dianalisis dengan SPSS versi 22 untuk Windows.Hasil: Karakteristik klinikopatologi dari osteosarkoma yang diteliti adalah usia, lokasi tumor, tipe histologis, dan grading. Penderita osteosarkoma pada penelitian ini paling banyak ditemukan pada kelompok usia <20 tahun (66,67%), lokasi femur (60%), tipe campuran osteosarkoma (53,33%) dan High-Grade (100.00%). Sebanyak 26 sampel (86,67%) memiliki ekspresi VEGF tinggi dan 4 sampel memiliki ekspresi VEGF rendah (13,30%). Tidak terdapat hubungan yang bermakna antara usia (p=0,241), lokasi (p=0,739), dan tipe histologis (p=1,000).Kesimpulan: Hubungan antara masing-masing karakteristik klinikopatologi osteosarkoma yang terkait dengan ekspresi VEGF menunjukkan hasil yang tidak bermakna pada usia, lokasi, dan tipe histologis. Diperlukan penelitian lebih lanjut dengan jumlah sampel yang lebih banyak untuk mendapatkan hasil yang lebih baik.

Rheumatic mitral stenosis based on Wilkins score and echo score revisited for patients undergoing balloon mitral valvuloplasty Prayoga Setiawan; Ni Made Ayu Wulan Sari; Luh Oliva Saraswati Suastika; Ida Bagus Rangga Wibhuti
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: An important factor for obtaining good results with good clinical outcomes from BMV procedure in rheumatic mitral stenosis is selecting the right candidate. This study aimed to determine rheumatic mitral stenosis characteristics based on conventional scoring system and echo score revisited for patients undergoing balloon mitral valvuloplasty.Method: This was a retrospective descriptive study with a cross-sectional approach. The study was conducted at the Department of Cardiology and Vascular Medicine, Sanglah Hospital Denpasar. Data were collected between January 1, 2019 and December 31, 2019 from registry and medical records.Result: Both groups had the same median age, which is 43 years old. The majority of research subjects were female, namely 16 people or 94.4%. There were no subjects from the failed group who had low echo score revisited. A total of 3 subjects (100.0%) with Wilkins score of 7 and high echo score revisited categorized as failed because of occurrence of significant mitral regurgitation post-procedure. In the successful group with Wilkins score of 8, there were no subjects who had a low echo score revisited value. In subjects with a Wilkins score of 8 and high echo score revisited value, 3 subjects categorized as failed and 1 subject obtained significant mitral regurgitation post-procedure.Conclusion: Patients with a low Wilkins score, but a high echo score revisited had a higher procedure failure rate.

Correlation of glutamine and serial absolute neutrophil count as a parameter of infection in major burn trauma patients at Sanglah General Hospital, Bali, Indonesia Shita Diwyani Sudarsa; Agus Roy Rusly Hariantana Hamid; Agustinus I Wayan Harimawan; Ni Nyoman Sri Budayanti
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: Burns are thermal trauma that often results in high morbidity. In major burns, gastrointestinal dysfunction plays a vital role in the progression of infection to organ failure. Glutamine is a pharmaconutrient that has important implications for burn patients, including in the prevention of infection. This study evaluates the relationship between glutamine administration and the serial absolute neutrophil count as a parameter for infection incidence in patients with major burns.Methods: This study was an analytical study with a cross-sectional design to see the relationship between glutamine administration and the serial absolute neutrophil count levels of major burn patients at Sanglah General Hospital. The sample consisted of 56 patients from the medical records of burn patients. The data were extracted from the medical records and then inserted into the data collection sheet. Then performed data analysis using SPSS version 21 for Windows.Results: Bivariate analysis showed that there was a significant difference between glutamine administration and the absolute neutrophil count levels on days 3, 5, and 14 (p = 0.004, 95% CI: 1.70-8.46), (p = 0.000, 95% CI: 2.71-7.83), and (p = 0.035, 95% CI: 0.61-7.27), respectively. This showed that patients given glutamine had lower neutrophil levels on days 3, 5, and 14 than patients who were not given glutamine. Multivariate analysis confirmed that glutamine administration did independently affect and decrease the absolute neutrophil count levels on days 3, 5, 14, and the mean without being influenced by other variables with p value = 0.004 (95% CI: [-8.445] - [-1,732]), p = 0.000 (95% CI: [-7,808]-[-2,743]), p = 0.020 (95% CI: [-7.251]-[-0.639]), and p = 0.017 (95% CI: [-5,815]-[-0.588]), respectively.Conclusion: This study has shown that glutamine administration was significantly associated with and decreased the serial absolute neutrophil count in major burn patients.

Pengaruh pemberian edukasi kepada pengasuh terhadap tingkat kepatuhan pemberian obat anti epilepsi pada anak dengan epilepsi I Gusti Ngurah Made Suwarba; Ni Made Dani Febriansiswanti; Anita Purnamayanti
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: Adherence was the main problem in anti-epilepsy drug therapy because it has to be consumed up to 2 years free of seizures to require education intervention. This research aimed to analyze the effect of oral and written (leaflet) education on patient carer's adherence level in administering epilepsy medicines to the pediatric patient (?18 years old).Methods: The design of This study was one group pre - post-test research. Subjects were collected using consecutive sampling.Results: This study's subject was 24 patient carers with low and moderate levels of medication adherence. Oral and written education material was provided every week for eight weeks, and the adherence level was analyzed through the pills count and self-report checklist every week during the study. The Wilcoxon signed-rank test results were significantly different between pre and post-pill counts, and the result of repeated measure test showed that there was an increasing level of medication adherence significantly in third obtained by pill count method week ( p=0,000 ) and remained high until the end of this study.Conclusion: Oral and written education could improve the caregivers administering medication adherence level to their epilepsy children. Latar belakang: Kepatuhan merupakan masalah utama dalam terapi obat anti epilepsi karena obat anti epilepsi harus dikonsumsi sampai 2 tahun bebas kejang, sehingga diperlukan edukasi. Penelitian ini bertujuan untuk menganalisis pengaruh pemberian edukasi berupa lisan dan tertulis (leaflet) terhadap tingkat kepatuhan pemberian obat oleh pengasuh kepada pasien epilepsi anak usia ?18 tahun.Metode: Rancangan penelitian ini adalah one group pre – post test design. Pengumpulan subjek dengan consecutive sampling.Hasil: Subjek penelitian sebanyak 24 orang dengan kriteria tingkat kepatuhan rendah dan sedang. Edukasi lisan dan tertulis diberikan setiap minggu selama 8 minggu, penilaian tingkat kepatuhan melalui pill count dan self report checklist setiap minggu selama 8 minggu. Hasil uji wilcoxon signed rank terdapat perbedaan pre pill count dan post pill count, dan hasil uji repeated measure terdapat pengaruh pemberian edukasi, yang dapat dilihat dari peningkatan nilai pill count secara signifikan pada minggu ke-3 (p=0,000) dan tetap tinggi sampai akhir penelitian.Simpulan: Pemberian edukasi berupa lisan dan tertulis memberikan pengaruh peningkatan kepatuhan pemberian obat oleh pengasuh kepada pasien epilepsi anak.

Differences in union time, dash score and range of motion between giving bisphosphonate and without giving bisphosphonate of osteoporosis patients with distal radius fracture: a systematic review and meta-analysis Dwiwahyonokusuma Dwiwahyonokusuma; Putu Astawa; I Wayan Suryanto Dusak; I Ketut Suyasa; Made Bramantya Karna
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: Osteoporosis is a common health problem. Meanwhile, the incidence of distal radius fracture increases with osteoporosis. The standard modality for osteoporosis is a combination of pharmacological therapy, one example of which is the administration of bisphosphonates. There is some disagreement about bisphosphonates' effect on the treatment of distal radius fractures in osteoporosis patients. This study aims to conclude the effect of bisphosphonates for this condition on both functional and radiological outcomesMethods: A systematic search was carried out on the PUBMED database and Google Scholar on studies comparing the timing of bone fusion, Disability of Arm, Shoulder, And Hand (DASH) scores, and wrist Range of Motion (ROM) among distal radius fracture patients with or without additional bisphosphonate therapy. A prospective or retrospective cohort study and a randomized controlled trial were included in this study during 2000-2020. Inclusion and exclusion criteria were used for sample selection. Weight Mean Difference (WMD) was used to assess the statistical results in RevMan version 5.3 for Windows.Results: A search through the PUBMED and Google Scholar databases yielded 376 studies. Scanning titles and abstracts from studies that met the inclusion and exclusion criteria resulted in 6 articles. In total, there were 973 patients with distal radius fractures who received different treatment on bisphosphonate therapy. There was a significant difference in time to union with bisphosphonates (WMD=0.56; 95% CI=-0.94-2.06). Meanwhile, there was no significant difference in the assessment of DASH and ROM scores (WMD=0.27; 95% CI= -1.01-1.55).Conclusion Bisphosphonates provide a slower time to union in osteoporotic patients with distal radius fracture.

The use of compression stockings produces lower Interleukin-6 (IL-6) levels, Higher American Orthopaedic Foot and Ankle Society Score (AOFAS), and does not produce higher alkaline phosphatase level in postoperative patients with fracture around the ankle Gede Agung Krisna Yudha; I Ketut Siki Kawiyana; Ketut Gede Mulyadi Ridia; I Ketut Suyasa; I Gede Eka Wiratnaya
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: Fractures around the ankles are common injuries. The use of compression stockings is one of the postoperative modalities that has been widely used in developing countries but is rarely used in Indonesia. This study aimed to determine the effect of using compression stockings on changes in inflammatory biomarkers level and functional outcomes in postoperative patients with fractures around the ankle.Methods: This study was a randomized clinical trial (post-operative-only design) in 26 patients with fractures around the ankle. The study subjects were divided into groups using postoperative compression stockings and groups without compression stockings. Its efficacy was assessed by measuring levels of Interleukin-6 (IL-6), Alkaline Phosphatase (ALP), and American Orthopedic Foot and Ankle Society (AOFAS) scores. Data were analyzed using SPSS version 20 for Windows.Results: Postoperative 24-hour IL-6 levels were not significantly different (p=0.200; -59.93–266.42), but they were significantly different postoperatively in 3 days (p = 0.001; 8.76-30.21), 14 days (p=0.015; 2.40-20.49), and 30 days (p=0.000; -15.49–[-5.03]). ALP was not different significantly, both at 24 hours (p=0.160; -16.0-2.80), 3 days (p=0.072; -0.65-14.19), 14 days (p=0.098; -1,310–12,54), and 30 days (p=0.419; -5.00–11.61) after surgery. The AOFAS scores was different significantly 30 days postoperatively (p=0.000; -3.915– [-1.469]).Conclusion: The use of compression stockings can be considered as postoperative therapy to lower the IL-6 levels but do not affect ALP levels in postoperative patients with fractures around the ankle. The use of compression stocking resulted in a higher AOFAS score than without wearing compression stockings in postoperative patients with fractures around the ankle.

Laminoplasty provides better functional outcomes than laminectomy in the management of cervical stenosis myelopathy: a systematic review Putu Kermawan; I Ketut Siki Kawiyana; I Gusti Ngurah Wien Aryana; I Gusti Lanang Ngurah Agung Artha Wiguna; I Gede Eka Wiratnaya; I Ketut Suyasa
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: Increasing the life expectancy of an individual will be accompanied by the emergence of various degenerative diseases such as cervical stenosis myelopathy (CSM). CSM is characterized by the presence of signs and symptoms of spinal cord compression associated with narrowing the spinal canal dimensions. Decompression can be achieved by conventional methods such as laminectomy or a lamina reshaping procedure known as a laminoplasty. This study reports recent evidence regarding laminectomy and laminoplasty procedures in managing CSM in terms of functional outcomes.Methods: A systematic search was conducted on the PUBMED database to identify and find studies comparing laminoplasty and laminectomy procedures. Inclusion criteria included patients older than 65 years diagnosed with cervical myelopathy, including CSM and/or ossified posterior longitudinal ligament (OPLL). Randomized controlled studies and prospective and retrospective cohorts were included in this study, while case series and case reports were excluded. The comparison of effectiveness is based on the results of measuring functional outcomes using the Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and the visual analogue scale (VAS) for pain assessment.Results: A thorough search through the PUBMED database yielded 156 citations. Scanning titles and abstracts from studies that met the inclusion and exclusion criteria resulted in 14 articles. All articles have a retrospective cohort design. In total, there were 187 patients in the laminoplasty group and 161 patients in the laminectomy group. There was no significant difference between laminoplasty and laminectomy when viewed from the JOA score in weighted mean difference (WMD) (WMD 0.28; 95% Confidence Interval [CI]:-0.34-0.91) and VAS score (WMD 0.06; 95% CI: -1.13-1.02). However, laminoplasty was shown to have a better NDI score (WMD 3.32; 95% CI: -6.50-0.14).Conclusion: Laminoplasty is superior to laminectomy for managing cervical myelopathic stenosis in terms of NDI score.

Risk factors of superficial surgical site infection post debridement and internal fixation of open fractures in long bones at Sanglah General Hospital, Bali, Indonesia Stedy Adnyana Christian; Putu Astawa; I Ketut Suyasa
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: The fracture condition exposed to the environment can damage muscle, vascular, and nerve tissue due to infection. This study aims to determine whether age, Hb, OF grade II, duration and surgery time are risk factors of superficial surgical site infection for post-debridement and internal fixation in long bone fractures.Methods: This study used cohort retrospective. Samples of patients with open long bone fractures at Sanglah Denpasar from February to July 2020 were assessed for their risk factors for infection based on secondary data from medical records, physical and laboratory examinations. Monitoring for infection incidence was performed 1-4 weeks postoperatively, based on clinical and infection markers (Procalcitonin). After that, descriptive and inferential statistical analysis was performed using the Chi-square test and Logistic Regression using SPSS version 24 for Windows.Results: Hb level < 10 g/dLwas proven to be a risk factor (p=0.027). There was a significant difference in patients with grade II (p=0.049; RR=10.00). There was a significant difference in the risk with patients with surgery duration ? 2 hours (p=0.011; RR=15). There was a significant difference in the patients with time to operation ? 12 hours (p=0.005; RR=8). Logistic Regression Test proves that the most influencing factor for superficial surgical site infection is operation duration (RR=9.328).Conclusion: Hb, OF grade II, duration, and time to operation are risk factors of superficial surgical site infection for post-debridement and internal fixation in open fractures of the long bone. The most important risk factor for superficial surgical site infection is the duration of surgery.

Bacterial growth from the surgical wound base smear at the end of the operation and superficial surgical site infection in the administration of cefazolin single dose, ceftriaxone single dose, and ceftriaxone 3 days as prophylactic antibiotics in cases of Mario Daniel Simatupang; I Wayan Suryanto Dusak; I Ketut Suyasa; I Gede Eka Wiratnaya
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: The use of prophylactic antibiotics in hospitals still often found to be not in accordance with the guidelines of prophylactic antibiotics used and therapy published by the hospital itself. This study aims to compare the effectiveness of prophylactic antibiotics between cefazolin and ceftriaxone in single-dose administration in patients with closed long bone fractures after implant surgery in Sanglah General Hospital on the incidence of Surgical Site Infection (SSI) and germ growth on the base of the surgical wound.Methods: This study used a randomized clinical trial design from a population of closed long bone fracture patients who underwent implant surgery at Sanglah General Hospital. The sample selection was carried out by consecutive sampling during the period July-August 2020. The statistical test was the Chi-Square Test or Fisher Exact Test using the SPSS version 20 for Windows.Results It was found that there was no growth of germs, or in other words, negative culture results were obtained in all study subjects (growth of N (%) 0 (0%), p = -) bacteria in all three groups on a single dose and 3-days dose. SSI did not occur in all study subjects in the three groups so that it could automatically be concluded that there was no difference in the proportion of SSI incidents in the three groups (SSI incidence N (%) 0 (0%), p = -) on single-dose and 3 days dose antibiotics administration, so that the proportional comparison test, either the Chi-Square test or the Fisher Exact test, cannot be performed.Conclusion The prophylactic antibiotics (which are the cephalosporins, namely single dose generic cefazolin and single-dose generic ceftriaxone and 3 days dose) have the same effectiveness in preventing the growth of germs on the surgical wound base smear and prevent the occurrence of superficial SSI on the 30th postoperative day.

Seorang penderita tiroiditis hashimoto dan kaitannya dengan riwayat utikaria kronis serta keganasan rahim I Komang Realiska; I Made Pande Dwipayana
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: Hashimoto's thyroiditis (TH) is a spectrum of autoimmune diseases in the presence of a thyroid. The spectrum begins pathologically from auto-antibodies that attack the thyroid tissue and progress to fibrosis.Case report: A 28-year-old woman diagnosed with Hashimoto's Thyroiditis (TH) and a history of chronic urticaria and uterine malignancies. Thyroid hormone profile examination showed primary abnormalities thyroid by autoimmune with TSH 8.63 (0.25-5.00) ?IU / mL, FT4 1.06 (0.93-1.70) ng / dL, and anti-thyroid peroxidase (anti-TPO) 3155.38 IU / mL. Thyroid ultrasound examination showed increased parenchymal vascularization, no nodules or cysts, calcifications. Histopathological examination revealed a lymphocytic thyroiditis process—management of patients given levothyroxine, achieve the appropriate clinical resolution and therapeutic targets.Conclusion: Chronic urticaria condition and uterine malignancy history in patients are suspected to be related to TH. Based on the cycle model theory of autoimmunity and carcinogenesis, malignancy can cause activated immune response, and loss of self-tolerance occurs as induction of autoimmune processes and vice versa inflammation in autoimmune induces malignancy.Latar Belakang: Tiroiditis Hashimoto (TH) merupakan salah satu spektrum penyakit autoimun pada kelenjar tiroid. Spektrum ini dimulai secara patologi dari terbentuknya auto-antibodi yang menyerang jaringan tiroid, dan berpogresif menjadi fibrosis.Laporan kasus: Seorang wanita 28 tahun dengan diagnosa Tiroiditis Hashimoto (TH) dan riwayat urtikaria kronis dan keganasan rahim. Pemeriksaan profil hormon tiroid menunjukkan kelainan primer kelenjar tiroid oleh autoimun dengan TSH 8.63 (0.25-5.00) ?IU/mL, FT4 1.06 (0.93-1.70) ng/dL, dan anti-thyroid peroxidase (anti-TPO) 3155.38 IU/mL. Pemeriksaan USG tiroid menunjukkan peningkatan vaskularisasi parenkim, tak tampak nodul/kista, ataupun kalsifikasi. Pemeriksaan histopatologi menunjukkan proses limphocytic thyroiditis. Tatalaksana pada pasien diberikan levotiroksin yang mencapai resolusi klinis dan target terapi yang sesuai.Simpulan: Pasien memiliki riwayat keganasan rahim yang diasosiasikan dengan TH. Berdasarkan teori cyclic model of autoimmunity and carcinogenesis mengatakan keganasan dapat menyebabkan teraktivasi respons imun dan terjadi self-tolerance sebagai induksi dari proses autoimun dan sebaliknya inflamasi yang terjadi pada autoimun menginduksi keganasan.

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