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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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Priapism as an initial presentation in Chronic Myeloid Leukemia (CML): a case report Ni Luh Putu Herawati; Tjokorda Gde Dharmayuda
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: Priapism is a persistent, usually painful erection that lasts for more than four hours and occurs without sexual stimulation. Priapism is a rare clinical sign of Chronic Myeloid Leukemia (CML), with an incidence of 1-5 cases per 100,000 people per year. In men who suffer from CML, ischemic priapism occurs secondary to hyperleukocytosis and venous obstruction by thrombus and microthrombus. Case Presentation: In this case, a 24-year-old male, a Balinese ethnicity, present with prolonged erectile complaints accompanied by increased pain. From the examination performed, it was concluded that the patients had the ischemic type of priapism. From CBC, the patient was obtained hyperleukocytosis and continued with peripheral blood smear and bone marrow puncture. The patients concluded with CML, and initial intervention includes therapeutic aspiration, irrigation, hydroxyurea and other supportive therapies. It is a urological emergency requiring urgent treatment to prevent long-term complications, in particular erectile dysfunction.Conclusion: Priapism is an unusual clinical manifestation of CML, whereas priapism is a urological emergency requiring immediate therapy. Treatment delay can cause complications of erectile dysfunction in men.

Predictors of Mortality for Critically Ill COVID-19 Patients: Systematic Review Lya Lusyana; Randika Rea Ariady; Gede Benny Setia Wirawan
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Objective: To identify mortality predictors of critically ill COVID-19 patients in ICU based on current available literatures.Methods: Systematic literature search was conducted in open-access databases. Data extraction was conducted for publication date, methodology employed, sample size, and results of multivariate analysis. Eligibility criteria for analysis was observational analytic design, sample size of 100 or more, and availability of multivariate results. Primary measures assessed was risk ratio, presented as odds ratio or hazard ratio. Data was analyzed qualitatively for themes that emerged for mortality predictors.Results: Several mortality predictors were identified, which included demographic, clinical history, laboratory results, and oxygenation profile at ICU admission. Several of the most consistently reported mortality predictors was older age, one or more comorbidities that constitute metabolic syndrome, chronic pulmonary disorder, low lymphocyte and platelet count, elevated d-dimer, and low PaO2/FiO2 ratio.Conclusions: Mortality predictors identified in this review were similar to previously known mortality and severity predictors of COVID-19 patients in general. This consistency may point to the potential of developing a scoring system to predict COVID-19 severity and mortality for clinical practice use.

Facial Skin Injury Related to Personal Protective Equipment Among Healthcare Workers: Single Center Cross-Sectional Study I Gusti Ayu Agung Bella Jayaningrum; Gede Benny Setia Wirawan; Anak Agung Ngurah Krisna Dwipayana; Anak Agung Ngurah Bagus Surya Darma; Lya Lusyana; Sang Nyoman Suriana
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Objective: Our study aimed to learn the phenomenon of facial skin injuries related to PPE use, their characteristics, as well as risk and protective factors.Methods: We conducted a single-center cross-sectional study. Samples was collected consecutively by disseminating self-filled questionnaire to all departments in Sanjiwani General Hospital, Gianyar, Bali, Indonesia. Variables studied included demographic, characteristics of PPE usage, characteristics of facial skin injuries suffered, and preventive measures practiced by healthcare workers. We conducted multivariate analysis for independent determinants of more severe skin injuries and any injuries located on the nasal bridge, cheekbones, and behind the ears.Results: Final analysis included 161 respondents. Male make up 26.7% of respondents, mean age was 35.00 (± 8.91). The majority was nurses (78.3%). Prevalence of skin injury was 90.7%, 39.1% of them being partial or full thickness skin injuries. Only 27.4% respondents practiced preventive measures, including application of polyester tape layering and emollient. The most frequently reported location of skin injury was nasal bridge (77%), followed by behind the ears (57.1%), and on the cheekbones (47.2%). Multivariate analyses discovered that KN95 respirator poses less risk for more severe injuries compared to N95. Protective measures were found effective to prevent skin injuries in all locations, including for more severe injuries.Conclusions: We found high prevalence of facial skin injuries among healthcare workers accompanied by inadequate practice of preventive behaviors. These preventive behaviors have been found effective in other study as well and existing evidence support its promotion for more widespread practice.

Infeksi COVID-19 pada pasien myasthenia gravis: sebuah tinjauan pustaka Made Ratna Dewi Setiawan; I Ketut Sumada
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Coronavirus disease (COVID-19) has rapidly become a global pandemic and during this condition, there might be at greater risk of exacerbation in patients with myasthenia gravis. This is related to the viral infection that has been known to increase the risk of a myasthenic crisis. In addition, some experimental drugs used in COVID-19 has been reported to increase the risk of exacerbation in patient with myasthenia gravis. In the other hand, several studies show higher morbidity and mortality rates due to COVID-19 in patient with myasthenia gravis. Myasthenia gravis might be a risk factor for severe COVID-19 infection due to several mechanisms, such as the effect of the immunosuppressive therapy and the inherent respiratory muscle weakness and vulnerabilities. The comprehensive study based on several case report is needed to respond the needs of adaptation in treating patient with myasthenia gravis during this pandemic era. Coronavirus disease (COVID-19) telah menjadi pandemi global dalam waktu singkat. Selama pandemi ini, terdapat peningkatan resiko eksaserbasi pada pasien dengan myasthenia gravis. Hal ini terjadi karena sejak lama telah diketahui bahwa infeksi virus dapat meningkatkan resiko krisis myasthenia pada pasien myasthenia gravis. Beberapa obat eksperimental yang diberikan pada pasien dengan infeksi COVID-19 juga dilaporkan memiliki resiko yang tinggi dalam menimbulkan eksaserbasi gejala myasthenia gravis. Di sisi lain, beberapa studi terkait COVID-19 menunjukkan angka morbiditas dan mortalitas yang lebih tinggi pada pasien dengan myasthenia gravis. Myasthenia gravis juga merupakan faktor resiko untuk infeksi COVID-19 berat yang berhubungan degan beberapa mekanisme seperti efek dari terapi imunosupresan dan kondisi kelemahan otot pernafasan pada penyakit myasthenia gravis. Telaah yang komprehensif berdasarkan beberapa laporan kasus terkait infeksi COVID-19 pada pasien myasthenia gravis sangat diperlukan untuk melakukan adaptasi manajemen terapi pada era pandemi ini.

Hubungan indeks platelet dengan derajat keparahan penyakit demam berdarah dengue pada anak di RSUD Wangaya Valerie Michaela Wilhelmina; I Wayan Bikin Suryawan; Kadek Suarca
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Background: Indonesia is an endemic country for Dengue Hemorrhagic Fever (DHF). Over 80% of children at age ?10 in Indonesia have been infected with dengue at least once. Dengue shock syndrome (DSS), as a severe clinical manifestation of DHF, has a high risk of mortality. The wide spectrum of dengue clinical manifestations poses a challenge to predict the progression of dengue infection into severe symptoms. Platelet indices (PI) are readily available laboratory parameters that mark the activity and quality of platelets. The purpose of this study is to investigate PI profile on pediatric DHF and the association with disease severity.Methods: This is an analytical observational study with a cross-sectional design. Samples are obtained consecutively from secondary data of children diagnosed with DHF in Wangaya Regional Hospital. Chi-square analysis was used to assess the association between groups of platelet indices; mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR), and plateletcrit (PCT) with severity parameter, namely; DHF grade, length of hospitalization, shock, and bleeding. Results: 150 subjects were included in the study. Bivariate analysis shows that MPV, PDW, and P-LCR does not correlate with any of the severity parameters. There is a significant correlation between PCT with the length of hospitalization (p=<0.001), shock (p=<0.001), and DHF grade (p=<0.001). PCT does not correlate with bleeding.Conclusion: There is a significant association between PCT PI and several parameters of DHF severity. PCT can be considered to predict DHF grade, length of hospitalization, and shock. Latar belakang: Indonesia merupakan negara endemis Demam Berdarah Dengue (DBD). Lebih dari 80% anak usia ?10 tahun di Indonesia telah terinfeksi dengue setidaknya satu kali. Sindrom syok dengue (SSD) sebagai manifestasi klinis berat dari DBD memiliki resiko kematian yang tinggi. Spektrum manifestasi klinis yang luas menjadi tantangan untuk memprediksi DBD yang akan berujung menjadi gejala berat. Indeks platelet (IP) merupakan parameter laboratorium yang mudah didapat dan menggambarkan aktivitas dan kualitas platelet. Tujuan dari studi ini adalah untuk mempelajari profil IP pada penyakit DBD anak dan hubungannya terhadap derajat keparahan penyakit.Metode: Studi penelitian merupakan penelitian observasional analitik dengan desain potong lintang. Sampel diambil dari data sekunder pasien anak terdiagnosa DBD di unit rawat inap RSUD Wangaya dengan metode consecutive sampling. Analisis chi-square digunakan untuk menilai hubungan kelompok Indeks Platelet; mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR), dan plateletcrit (PCT) dengan parameter derajat keparahan yaitu grade DBD, lama rawat, syok, dan perdarahan.Hasil: Sebanyak 150 subjek masuk dalam kriteria inklusi. Analisis bivariat menunjukkan MPV, PDW, dan PLCR tidak berhubungan dengan parameter derajat keparahan. Terdapat hasil signifikan PCT dengan lama rawat (p=<0,001), syok (p=<0,001), dan grade DBD (p=<0,001). PCT tidak berhubungan dengan perdarahan.Kesimpulan: Terdapat hubungan bermakna antara IP PCT dengan beberapa parameter derajat keparahan DBD. PCT dapat dipertimbangkan untuk memprediksi derajat keparahan penyakit yaitu grade DBD, lama rawat, dan syok.

Herniasi nukleus pulposus lumbal multipel disertai kanal stenosis dengan drop foot syndrome dan atrofi otot unilateral: sebuah laporan kasus Anak Agung Ngurah Agung Harawikrama Adityawarma; I Nyoman Gede Wahyudana
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Background: Low back pain is a fairly common health problem, with a worldwide prevalence of 1.4-20% and an annual incidence of 0.024-7% per year. One of the causes of lower back pain is a herniated nucleus pulposus. The prevalence of nucleus pulposus herniation in Indonesia is not well documented. One of the complications caused by HNP is drop foot syndrome. Drop Foot Syndrome is the inability to perform flexion dorsum movement of the ankle or big toe. The prevalence of drop foot syndrome is quite rare, with around 8.1% of patients suffering from HN.Case Illustration: A 71-year-old male patient presented with complaints of lower back pain radiating to the left rear thigh since two months ago. The pain was getting worse, and the legs were getting weaker, so that he had to drag his legs. The patient was also often experiencing back pain since five years ago. The patient has a history as a truck driver with the Bali-Java-Sumatra route for 30 years. On physical examination, there ware significant atrophy in the left calf. Motor examination found that the left foot could not lift against the gravity force, and when walking, the big toe touched the floor first. There was no interference with defecation or bowel movements. Lumbar MRI examination was performed with the results of the disc herniation of L1-L2, L2-L3, L4-L5, L5-S1, multiple canal stenosis, and lumbar spondylosis. Discectomy laminectomy and posterior vertebral fusion were performed.Conclusion: HNP is one of the most frequent causes of lower back pain. The lack of knowledge about HNP makes people underestimate this problem, and this is one of the causes of complications in the form of drop foot to muscle atrophy due to the delayed treatment. Latar belakang: Nyeri punggung bawah merupakan permasalahan kesehatan yang cukup umum dengan prevalensi di seluruh dunia sebesar 1,4-20% dan insiden setiap tahunnya 0,024-7%. Salah satu penyebab nyeri punggung bawah adalah herniasi nukleus pulposus. Herniasi nukleus pulposus didefinisikan sebagai rupturnya anulus fibrosus sehingga nukleus pulposus menonjol dan menekan ke arah kanalis spinalis. Salah satu komplikasi yang disebabkan oleh HNP adalah drop foot syndrome. Prevalensi terjadinya drop foot syndrome cukup jarang yakni 8,1% dari pasien yang menderita HNP.Ilustrasi Kasus: Pasien laki-laki berusia 71 tahun datang dengan keluhan nyeri punggung bawah menjalar hingga paha kiri belakang sejak 2 bulan yang lalu. Pasien baru memeriksakan diri ke dokter karena nyeri semakin berat dan kaki semakin lemas sehingga harus menyeret kaki serta mengalami nyeri punggung belakang sejak 5 tahun yang lalu. Pasien memiliki riwayat sebagai pengemudi truk Bali-Jawa-Sumatra selama 30 tahun. Pada pemeriksaan fisik ditemukan atrofi signifikan pada betis kiri, pemeriksaan motorik didapatkan punggung kaki kiri tidak mampu mengangkat melawan gaya gravitasi dan ketika berjalan bagian jempol kaki menyentuh lantai terlebih dahulu serta tidak didapatkan adanya gangguan pada BAB ataupun BAK. Pemeriksaan MRI lumbalis dilakukan dengan hasil herniasi diskus L1-L2, L2-L3, L4-L5, L5-S1, stenosis kanal multipel dan spondilosis lumbalis. Dilakukan laminektomi disektomi dan fusi vertebra posterior.Simpulan: HNP merupakan salah satu penyebab nyeri punggung bawah yang paling sering. HNP menjadi salah satu penyebab terjadinya komplikasi berupa drop foot hingga terjadinya atropi otot karena tidak ditangani lebih awal.

Mikrobiota usus pada dermatitis atopik Dewi Gotama; Made Wardhana; Adeline Santoso; Sissy Sissy
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Atopic dermatitis (AD) is a multifactorial disease caused by immune dysregulation, genetic susceptibility, environmental factors, and impaired barrier function. The health burden caused by this disease is significant and can impact psychological, social and financial costs, along with systemic comorbidities. Several studies have reported the gut microbiota in AD patients. Several studies have reported the gut microbiota in AD patients. The gut microbiota is thought to play an important role in the development of AD by regulating the immune system's maturation. Intestinal microbiota alteration affects the balance of the immune system through metabolites' production, which will cause the microenvironment to become inflamed. Currently, the close relationship between the gut microbiota and the development of the immune system, especially in maintaining the balance of Th-1 and Th-2 responses, is the rationale for providing probiotic supplements to prevent or treat allergic and atopic diseases. Dermatitis atopik (DA) merupakan penyakit multifaktorial yang diakibatkan disregulasi imun, suseptibilitas genetik, faktor lingkungan, dan gangguan fungsi barier. Beban kesehatan yang diakibatkan penyakit ini bersifat signifikan dan dapat berdampak pada kerugian psikologis, sosial, dan finansial, disertai komorbiditas sistemik. Terdapat beberapa studi yang telah melaporkan mikrobiota usus pada pasien DA. Mikrobiota usus diduga memainkan peran penting dalam perkembangan DA dengan meregulasi maturasi sistem imun. Alterasi mikrobiota usus mempengaruhi keseimbangan sistem imun melalui produksi metabolit, yang akan menyebabkan lingkungan mikro mengalami inflamasi. Saat ini hubungan erat antara mikrobiota usus dan perkembangan sistem imun, khususnya dalam menjaga keseimbangan respon Th-1 dan Th-2 menjadi dasar pemikiran pemberian suplemen probiotik untuk mencegah atau mengatasi penyakit alergi dan atopi.

Terapi non bedah pada karsinoma sel basal Adeline Santoso; I Gusti Ngurah Darmaputra; Dewi Gotama; Sissy Sissy
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Basal cell carcinoma accounts for approximately 75% of non-melanoma skin cancer and 25% of all diagnosed skin cancer in the United States. Epidemiological data show the incidence is increasing significantly by 3% -10% per year worldwide. Changes in life expectancy patterns are associated with an increase in this skin cancer, and the incidence is predicted to increase until 2040. Many factors must be considered in the choice of therapy for a patient, including the patient's general condition, the presence or absence of serious medical problems, the use of antiplatelet or anticoagulant medication. Conservative treatment of asymptomatic and low-risk lesions is recommended, as overly aggressive therapy may have a greater effect than the lesions themselves. Topical therapy and non-surgical therapy are currently quite effective as therapeutic options for low-risk basal cell carcinoma and high-risk basal cell carcinoma. They can be an option in conditions that are contraindicated for surgery. Kasus keganasan karsinoma sel basal (KSB) mencakup sekitar 75% dari kasus kanker kulit non melanoma dan mencakup 25% dari semua kasus kanker yang didiagnosa di Amerika Serikat.Data epidemiologi menunjukkan insiden meningkat signifikan sebanyak 3%-10% per tahun di seluruh dunia. Perubahan pola usia harapan hidup berhubungan dengan peningkatan kanker kulit ini, dan di prediksi insiden akan terus meningkat sampai tahun 2040. Terdapat banyak faktor yang harus dipikirkan dalam pemilihan terapi pada pasien, antara lain keadaan umum pasien, ada atau tidaknya masalah medis serius, penggunaan obat anti platelet atau anti koagulan. Perawatan konservatif pada lesi asimptomatik dan beresiko rendah dianjurkan, dikarenakan terapi yang terlalu agresif mungkin akan memberikan efek yang lebih besar dibandingkan dengan lesi itu sendiri. Saat ini terapi topikal dan terapi non-bedah dikatakan cukup efektif sebagai pilihan terapi untuk KSB resiko rendah dan KSB resiko tinggi serta dapat menjadi pilihan pada kondisi kontraindikasi terhadap tindakan pembedahan.

Effectivity of glutathione and curcumin in hepatic fibrosis induced by cholestasis in Wistar rats Rodijaya Putra; Adeodatus Yuda Handaya; Agus Barmawi
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Background: Cholestasis occurs from the accumulation of bile product in the biliary tract due to obstruction of the hepatobiliary tract. Without early interventions, this condition will be continuing as chronic hepatic injury and form hepatic fibrosis, ending in cirrhosis. Glutathione (GSH) and curcumin were known as antioxidants and anti-inflammatory used as a therapeutic agent for the treatment of hepatopathy. This study aims to determine the effectivity of GSH and curcumin in the hepatic fibrosis mechanism induced by cholestasis. Methods: This is an experimental study using Wistar rats. They are divided into three groups of 5 rats each. All the rats regard the choledochus duct ligation surgery, rats without intervention define as first group (control), other rats treated with GSH as the second group and the third group consist of rats treated with curcumin. Data were analyzed using SPSS version 17 for Windows.Results: There was liver injury and hepatic fibrosis induced by cholestasis from this study. This condition was significantly lower in groups treated with GSH and curcumin (p<0.05). Therefore, there was a different result between GSH and curcumin in reducing the process of liver injury and hepatic fibrosis, but the difference was not statistically significant (p>0.05).Conclusion: GSH and curcumin were statistically effective in reducing liver injury and hepatic fibrosis induced by cholestasis. Despite, there were no significant difference results between them in reducing liver injury and hepatic fibrosis.

Klasifikasi, diagnosis, dan pengobatan saat ini untuk penyakit mata kering: tinjauan pustaka Anthea Casey; Sari Marina
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Background: Dry eye disease (DED) is one of the most prevalent ocular diseases in the world. In Indonesia, lifestyles driven by information technology have brought DED a severe public health concern. Affected individuals usually come with varied symptoms, such as photophobia, fatigue, itchiness, burning sensation, irritation, and visual disturbance. The aim of this study is to provide a review of the current classification, diagnosis, and treatment for dry eye disease.Method: We conducted a literature review using Pubmed, Proquest, and Google Scholar databases. Relevant articles from 2015 to 2021 were collected and analyzed based on the results of previous studies.Result: According to the Asia Dry Eye Society (ADES) report in 2020, DED is classified into three types: aqueous-deficient, decreased wettability, and increased evaporation. This classification is based on the concept of tear film-oriented diagnosis and respectively coincide with the problem of each layer: aqueous, membrane-associated mucins, and lipid/secretory mucin. A practical diagnostic tool based on the fluorescein breakup patterns (FBUP) is recommended to differentiate the type of DED and, furthermore, help to select the choices of treatment.Conclusion: This classification proposed by ADES is simple to use through use of fluorescein, which is available even to non-dry eye specialists, and which hopefully contribute to an effective diagnosis and treatment for dry eye disease. Latar Belakang: Penyakit mata kering (dry eye disease/DED) merupakan salah satu penyakit mata tersering di dunia. Di Indonesia, seiring dengan kemajuan teknologi informatika, DED menjadi masalah kesehatan yang serius. Pasien umumnya datang dengan keluhan yang bervariasi, seperti fotofobia, mata lelah, gatal, terasa panas atau terbakar, iritasi, dan gangguan penglihatan. Tujuan dari tinjauan pustaka ini adalah memberikan ulasan mengenai klasifikasi, diagnosis, dan tatalaksana mata kering saat ini.Metode: Sumber pustaka diperoleh dari database Pubmed, Proquest, dan Google Scholar. Artikel-artikel yang relevan yang dipublikasi dalam rentang waktu tahun 2015 sampai 2021 dikumpulkan dan dianalisis berdasarkan hasil dari penelitian sebelumnya.Hasil: Berdasarkan laporan Asia Dry Eye Society (ADES) di tahun 2020, DED diklasifikasikan menjadi tiga tipe, yaitu defisiensi aqueous, penurunan keterbasahan, dan peningkatan evaporasi. Klasifikasi ini didasarkan pada konsep tear film-oriented diagnosis (TFOD) di mana ketiga tipe ini sesuai dengan letak lapisan air mata yang mengalami kelainan, yaitu lapisan aqueous, membrane-associated mucins, dan lipid/secretory mucin. Diagnosis tipe DED dapat dilakukan dengan pemeriksaan fluorescein breakup pattern (FBUP) yang kemudian hal ini akan membantu dalam menentukan tatalaksana yang sesuai untuk penyakit mata kering. Simpulan: Klasifikasi DED oleh ADES ini mudah dan praktis digunakan, hanya dengan menggunakan fluoresein. Hal ini diharapkan dapat membantu menegakkan diagnosis yang efektif dan tatalaksana penyakit mata kering bahkan bagi dokter non-spesialis penyakit mata kering.

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