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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.

Arjuna Subject : -

Articles 1,063 Documents

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Cast immobilization and addition of platelet rich plasma in intraarticular distal radius fracture resulting a better functional outcome to the internal fixation and radius union scorings system Komang Indra Teguh Wisesa; I Ketut Siki Kawiyana; I Ketut Suyasa
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Introduction: Intra-articular distal radius fracture is one of the most frequent injuries, especially in adults (20%). In this condition, anatomic reduction is required to reduce the possibility of complications, either with internal plate screw fixation (ORIF-PS) or conservatives such as the use of casting. Giving Platelet Rich Plasma (PRP) as one of the biologic agents to conservative management is expected to improve the outcome and become a promising alternative therapy.Methods: This study was an experimental study with a post-test control only group design on patients with intra-articular radius fractures at Sanglah General Hospital Denpasar during the period September 2019 to March 2020. The samples were selected by random sampling. Evaluation of the functional outcomes of the therapy given through DASH and RUSS scores was evaluated twice, namely at week 6 and week 12 post-therapy. Descriptive data analysis, General Linear Model (GLM) test and post hoc test were also carried out.Results: There were 45 patients divided into 3 groups; the first group of a plaster cast therapy and PRP injection, the second group of only plaster cast and the third group of ORIF. The first group showed better in DASH scores than the second group but not better than the third group, both at week 6 and 12. The results of the GLM and post hoc analysis also showed that the first group showed better RUSS scores than the second group.Conclusion: The addition of PRP has a better result than conservative therapy without PRP but ORIF still was the best therapy.

Glaucoma drainage devices implantation in uveitic glaucoma: a systematic review Ardelia Emily; Novanita Shirley Satolom; Franky Richard Kasih; Kevin Kevin; Bobby Kristianto
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Background: Uveitis is broadly defined as inflammation of the uvea. Glaucoma is the third most common complication of uveitis. Uveitic Glaucoma (UG) is known to be refractory, and multiple surgeries are often required for proper treatment. The purpose of this study is to determine the effectiveness of Glaucoma Drainage Device (GDD) implantation as a surgical procedure in UG patients.Method: We conducted a systematic search of electronic databases from PubMed, Science Direct, and SpringerLink using a combination of relevant keywords was performed by 5 independent reviewers. Various search terms, including 'glaucoma drainage device', 'glaucoma drainage implants', 'glaucoma filtration implants', 'aqueous shunts', 'uveitic glaucoma', 'inflammatory glaucoma'.Result: A total of 143 articles were retrieved, but only 14 articles were eligible for data extraction. There are 631 eyes from 583 patients who had UG, 442 eyes underwent GDD implantation. Overall, intraocular pressure and the use of glaucoma medication were reduced. Mean IOP preoperative is 31.57 mmHg, and IOP postoperative is 14.48 mmHg. There is a reduction in IOP of an average of 17.09 mmHg. The number of glaucoma medications has decreased from 3.24 to 1.29 postoperatively.Conclusion: UG has been shown to be managed successfully by GDD implantation. GDD implantation may be considered a long-term effective surgical option for patients with UG.

Preoperative factors influencing surgical site infections (SSIS) in inguinal hernia patients undergoing tension-free mesh hernia repair at regional public hospitals in Bali Putu Anggia Dimitri Pramesti; Made Dharmesti Wijaya; Made Dwi Yoga Bharata
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Introduction: Surgical site infection (SSI) is the most common nosocomial infection, affecting one out of three patients undergoing surgical procedures. The incidence of SSI in clean surgical wounds is still higher, especially in inguinal hernia repair. Today, tension-free mesh hernia repair is the primary method used in inguinal hernia management to reduce the risk of recurrence. This study aims to analyze preoperative factors influencing the incidence of SSIs in inguinal hernia patients that underwent tension-free mesh hernia repair at several regional public hospitals in Bali.Methods: This is a case-control study with samples taken from seven regional hospitals in Bali. Data used in this study were obtained from patients’ medical records from 2017-February 2021. Samples included in this study are inguinal hernia patients that underwent tension-free mesh hernia repair and postoperative check-up. Samples are selected through the purposive sampling method. Statistical analysis was done using SPSS 18.0 software. Univariate and bivariate analysis was performed, and Pearson chi-square and Fisher’s exact test were applied.Results: From the 61 samples in the case group and 61 samples in the control group, the results showed a significant relationship between the incidence of SSIs and elderly patients (OR = 2.262, 95% CI 1.086-4.711), between SSIs and obesity (OR = 9.057, 95% CI 1.096-74.808), and between SSIs and diabetes mellitus (OR = 9.620, 95% CI 2.094-44.201).Conclusion: It is concluded that there is a significant relationship between these preoperative factors and the incidence of SSIs in inguinal hernia patients that underwent tension-free mesh hernia repair at seven regional public hospitals in Bali.

Pencegahan penularan infeksi Human Immunodeficiency Virus (HIV) dari ibu ke anak di Indonesia: sebuah tinjauan pustaka Komang Ayu Witarini
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Human Immunodeficiency Virus (HIV) can be transmitted from an HIV-positive woman to her child during pregnancy, childbirth, and breastfeeding. Mother-to-child transmission (MTCT), also known as ‘vertical transmission’, accounts for the vast majority of infection in children (0-14 years). Prevention of mother-to-child HIV infection transmission (PMTCT) programs offers a range of services for women of reproductive age (15-49 years) living with or at risk of HIV to maintain their health and stop their infants from acquiring HIV. WHO promotes a comprehensive approach to PMTCT programs which include: preventing new HIV infections among women of reproductive age, preventing unintended pregnancies among women living with HIV, preventing HIV transmission from women living with HIV to her baby, and providing appropriate treatment, care, and support to mothers living with HIV, their children, and families. The health service program to prevent HIV transmission from HIV-infected pregnant women to their babies includes the following activities: integrated ANC services, including offering and testing HIV to pregnant women; HIV diagnosis in pregnant women; administering antiretroviral therapy to pregnant women; safe delivery; arrange for subsequent pregnancies; management of feeding for infants and children; administration of Antiretroviral (ARV) prophylaxis and cotrimoxazole in children; HIV diagnostic testing in children; and immunization. The risk of MTCT of HIV can be reduced to less than 2% with optimal PMTCT programs. Human Immunodeficiency Virus (HIV) dapat ditularkan dari ibu yang terinfeksi kepada bayi yang dikandung selama kehamilan, persalinan dan menyusui. Penularan infeksi HIV dari ibu kepada bayi yang dikandung, dikenal dengan istilah transmisi vertikal, merupakan cara penularan infeksi tersering dijumpai pada anak usia 0-14 tahun. Program pencegahan penularan infeksi HIV dari ibu ke anak (PPIA) merupakan upaya terhadap perempuan usia produktif (15-49 tahun) yang terinfeksi atau memiliki risiko terinfeksi HIV untuk tetap terjaga kesehatannya, serta mencegah menularkan infeksi HIV kepada bayi yang dikandung. World Health Organization (WHO) mempromosikan upaya komprehensif dari PPIA, terdiri dari: mencegah terjadinya penularan HIV pada perempuan usia reproduksi, mencegah kehamilan yang tidak direncanakan pada perempuan dengan HIV, mencegah terjadinya penularan HIV dari ibu hamil HIV positif ke bayi yang dikandungnya, serta memberikan dukungan psikologis, sosial, dan perawatan kesehatan kepada ibu HIV positif beserta bayi dan keluarganya. Program pelayanan kesehatan untuk mencegah penularan HIV dari ibu hamil terinfeksi HIV kepada bayi yang dikandung mencakup kegiatan sebagai berikut: layanan antenatal care (ANC) terpadu termasuk penawaran dan tes HIV pada ibu hamil; diagnosis HIV pada ibu hamil; pemberian terapi antiretroviral pada ibu hamil; persalinan yang aman; menunda dan mengatur kehamilan berikutnya; tatalaksana pemberian makanan bagi bayi dan anak; pemberian profilaksis Antiretroviral (ARV) dan kotrimoksazol pada anak; pemeriksaan diagnostik HIV pada anak; serta imunisasi. Dengan upaya PPIA yang optimal, risiko penularan HIV dari ibu ke anak dapat diturunkan sampai kurang dari 2%.

Efek ekstrak sambiloto (Andrographis paniculata) terhadap ekspresi matrix metalloproteinase-1 dan hipertrofi jantung pada mencit yang terpapar asap rokok I Made Agus Endra Permana; I Nyoman Wiryawan; Wayan Aryadana; I Gde Raka Widiana; I Gusti Kamasan Nyoman Arijana; I Made Satria Yudha Dewangga
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Introduction: Sambiloto (Andrographis paniculata) is a plant that is often used in traditional medicine and is known to have antioxidant, anti-inflammatory and cardiovascular effects. There are many studies of sambiloto on inflammatory markers, but there is no study on the effect of sambiloto on MMP-1 expression. The purpose of this study was to determine the effect of sambiloto on MMP-1 expression and cardiac hypertrophy in mice exposed to cigarette smoke.Methods: This research is an experimental analytic study with a randomized post test only control group design. Thirty-two healthy male Swiss Webster mice aged 8-10 weeks weighing 20-30 grams were divided into 4 groups, namely: control group (standard feed + exposure to cigarette smoke), P1 (standard feed + exposure to cigarette smoke + sambiloto extract 18 mg/ kg BW), P2 (standard feed + exposure to cigarette smoke + sambiloto extract 29 mg/kg BW), P3 (standard feed + exposure to cigarette smoke + sambiloto extract 40 mg/kg BW). All groups were followed for 60 days.Results: There was a significant difference in MMP-1 expression between the control group and all treatment groups. There were significant differences in MMP-1 expression between groups P1 and P2, and between P1 and P3 groups. There was a significant difference in heart weight/weight ratio between the control group and all treatment groups. There was a significant difference in the heart weight/body weight ratio between the P1 and P3 groups.Conclusion: The administration of sambiloto extract decreased the expression of MMP-1 with a tendency for its effect to increase with increasing dose and the optimal dose was found in the sambiloto extract 29 mg/kg BW. The difference in the effect of sambiloto extract on cardiac hypertrophy only appeared after the dose was increased to 40 mg/kg BW Latar Belakang: Sambiloto (Andrographis paniculata) merupakan tanaman yang sering dipakai dalam pengobatan tradisional dan diketahui mempunyai efek antioksidan, anti inflamasi dan efek pada sistem kardiovaskular. Terdapat banyak penelitian sambiloto terhadap marker inflamasi, tetapi belum ada penelitian tentang efek ekstrak sambiloto terhadap ekspresi MMP-1. Tujuan dari penelitian ini untuk mengetahui efek ekstrak sambiloto terhadap ekspresi MMP-1 dan hipertrofi jantung pada mencit yang terpapar asap rokok.Metode: Penelitian ini adalah penelitian analitik eksperimental dengan rancangan randomized post test only control group design. Tiga puluh dua mencit Swiss Webster jantan sehat berumur 8-10 minggu dengan berat 20-30 gram dibagi menjadi 4 kelompok yaitu: kelompok kontrol (pakan standar + paparan asap rokok), P1 (pakan standar + paparan asap rokok + ekstrak sambiloto 18 mg/kg BB), P2 (pakan standar + paparan asap rokok + ekstrak sambiloto 29 mg/kg BB), P3 (pakan standar + paparan asap rokok + ekstrak sambiloto 40 mg/kg BB). Semua kelompok diikuti selama 60 hari.Hasil: Terdapat perbedaan signifikan ekspresi MMP-1 antara kelompok kontrol dengan semua kelompok perlakuan. Terdapat perbedaan signifikan ekspresi MMP-1 antara kelompok P1 dengan P2, dan antara P1 dengan P3. Terdapat perbedaan signifikan rasio berat jantung/berat badan antara kelompok kontrol dengan semua kelompok perlakuan. Terdapat perbedaan signifikan rasio berat jantung/berat badan antara kelompok P1 dengan P3. Simpulan: Pemberian ekstrak sambiloto menurunkan ekspresi MMP-1 dengan kecenderungan efeknya meningkat dengan peningkatan dosis dan dosis optimal terdapat pada ekstrak sambiloto 29 mg/kg BB. Perbedaan efek ekstrak sambiloto terhadap hipertrofi jantung baru muncul setelah dosis ditingkatkan menjadi 40 mg/kg BB.

Rekurensi tinggi pada melanoma maligna konjungtiva: laporan kasus Ni Putu Mariati; Putu Yuliawati; I Wayan Juli Sumadi; I Made Agus Kusumadjaja
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Introduction: Ocular malignant melanoma is a rare but deadly disease that most often appears in the uvea, conjunctiva or orbit. Melanoma can be asymptomatic or give symptoms and signs depending on development of neoplasm. This case report aims to discuss the clinical sign of conjunctival malignant melanoma and the treatment given to better understand the disease.Case Report: Female patient, 57 years old complained lump in the left eye since 1 month ago. Red eyes, pain and blurry vision (-). Previously, patients with a history of malignant melanoma in the left eye and had performed surgery 5 times since 2015. Ophthalmology examination obtained visual acuity on right eye 6/18 and left eye 6/45. Anterior segment evaluation of the left eye found mass on palpebra, size 2x1 cm, color according to skin, mobile (-), tenderness (-). In conjunctiva found CVI (+) and symblepharon. There are 3 masses in conjunctiva. First mass in bulbi conjunctival superior to limbus with round shape, diameter 3 mm, brown color and smooth surface. The second mass in superotemporal conjunctival fornix, brownish color, size 1,5x1,5 cm with solid consistency, mobile (+). The third mass in the superior tarsal conjunctival, oval shape, 5x3 mm, brownish color and smooth surface. Lens of right and left eye found hazy. Segmen posterior on both eye within normal limit. Patient was diagnosed with post wide excision + cryotherapy + 5 fu (8 months) + suspected conjunctival tumor ec malignant melanoma + right left eye immature senile cataract. Patient underwent tumor multiple excision + cryotherapy + PA with general anesthesia. The biopsy results showed histomorphology consistent with malignant melanoma. There were no regional or distant metastasis.Conclusion: There are several therapeutic modalities for conjunctival melanoma, such as wide local excision with adjuvant therapy (brachytherapy, cryotherapy, and the use of topical chemotherapeutic agent like Mytomicin C). If tumor become a multiple recurrence or rapidly growing local tumor, the exenteration is needed. Pendahuluan: Melanoma maligna okular merupakan suatu penyakit yang jarang dengan angka kematian yang tinggi dan paling sering muncul pada uvea, konjungtiva maupun orbita. Melanoma dapat bersifat asimptomatis hingga menimbulkan sekumpulan gejala dan tanda tergantung dari perkembangan neoplasma. Laporan kasus ini bertujuan untuk membahas tanda klinis melanoma maligna konjungtiva dan tatalaksana yang diberikan untuk lebih dapat memahami mengenai penyakit ini. Laporan kasus: Pasien wanita, 57 tahun, mengeluh muncul benjolan pada mata kiri yang disadari sejak 1 bulan yang lalu. Mata merah, nyeri, keluhan kabur (-). Sebelumnya pasien dengan riwayat melanoma maligna pada mata kiri dan telah dilakukan operasi sebanyak 5x sejak tahun 2015. Pemeriksaan oftalmologi didapatkan tajam penglihatan mata kanan 6/18 dan mata kiri 6/45. Evaluasi segmen anterior pada mata kanan ditemukan lensa keruh minimal. Evaluasi segmen anterior mata kiri ditemukan massa pada palpebra, ukuran 2x1 cm, warna sesuai dengan kulit, mobile, padat, nyeri tekan (-). Pada konjungtiva ditemukan conjunctival vascular injection (CVI) (+) dan simblefaron inferior di konjungtiva serta ditemukan 3 buah massa. Massa pertama pada konjungtiva bulbi superior hingga limbus, bentuk bulat, diameter 3 mm, batas tegas, permukaan licin, warna kecoklatan. Massa kedua di konjungtiva fornix superotemporal, warna kecoklatan, teraba bulat, ukuran 1,5x1,5 cm, permukaan rata, konsistensi padat kenyal, mobile, nyeri tekan (-). Massa ketiga di konjungtiva tarsal superior, bentuk oval, uk 5x3 mm, warna kecoklatan, permukaan licin. Lensa keruh minimal dan segmen anterior lain dalam batas normal. Evaluasi segmen posterior mata kanan dan kiri dalam batas normal. Pasien didiagnosis dengan oculi sinistra (OS) post wide eksisi + cryotherapy + 5 fluorouracil (5fu) (8 bulan) + suspek tumor konjungtiva rekuren ec melanoma maligna dan oculi dekstra et sinistra (ODS) KSI dan dilakukan tindakan eksisi tumor multiple + cryotherapy + patologi anatomi (PA) dengan general anesthesia (GA). Hasil histopatologi dari open biopsy sesuai untuk melanoma maligna. Tidak ditemukan adanya metastase regional maupun metastase jauh.Simpulan: Terdapat beberapa modalitas terapi untuk melanoma konjungtiva yaitu wide local excision dengan terapi adjuvant seperti brachytherapy, cryotherapy, dan penggunaan agen topikal kemoterapeutik (mytomicin C). Apabila dalam perjalanannya penyakit menjadi rekurensi multipel atau tumor lokal yang berkembang pesat maka tindakan eksenterasi sangat diperlukan.

Faktor-faktor yang berhubungan dengan kinerja pegawai administrasi rumah sakit di era new normal Ellen Deivi Tamuntuan; Starry Homenta Rampengan; Oksfriani Jufri Sumampouw; Aaltje Elleb Manampiring
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Background: Administrative employees as non-health workers in hospitals must provide excellent service so that organizational goals can be achieved, even though there are changes in the employee work system in this new normal era. Employee performance can be determined by factors related to performance, namely work discipline, motivation, leadership style, and work environment. This study aims to analyze the factors related to the performance of the administrative staff of the Ratatotok Buyat Central General Hospital (RSUP) in the new normal era.Methods: This study is an analytical study with a cross-sectional approach. This research was conducted at Ratatotok Buyat Hospital in May-June 2021. The research sample consisted of 50 respondents. The research instrument is a questionnaire that has been tested for validity and reliability—research data obtained through closed interviews. The data obtained were analyzed by univariate, bivariate, and multivariate. We used bivariate analysis using Pearson correlation test and multivariate analysis using multiple linear regression, with =0.05.Results: The results of this study indicate that the majority of the respondents are female (58%), aged 20-35 years (62%), have undergraduate education (72%), and have worked 6-10 years (52%). In addition, the results obtained in this study are work discipline, work motivation, leadership style, and work environment, p <0.05. The most influential factor on the performance of the administrative staff of Ratatotok Buyat Hospital is the work discipline variable (B=0.520). This study also obtained an R-square value of 0.661, which means work discipline, work motivation, leadership style, and work environment influence 66.1% on performance.Conclusion: There is a significant and positive relationship between work discipline, work motivation, leadership style, and work environment with the performance of administrative employees. The most influential variable is work discipline. Latar belakang: Pegawai administrasi sebagai tenaga non kesehatan di rumah sakit harus mampu memberikan pelayanan prima agar tujuan organisasi dapat tercapai, meskipun terdapat perubahan pada sistem kerja pegawai di era new normal ini. Kinerja pegawai dapat ditentukan oleh faktor-faktor yang berhubungan dengan kinerja yaitu disiplin kerja, motivasi, gaya kepemimpinan dan lingkungan kerja. Tujuan penelitian ini yaitu untuk menganalisis faktor-faktor yang berhubungan dengan kinerja pegawai administrasi Rumah Sakit Umum Pusat (RSUP) Ratatotok Buyat di era new normal.Metode: Penelitian ini merupakan penelitian analitik dengan pendekatan potong lintang. Penelitian ini dilaksanakan di RSUP Ratatotok Buyat pada bulan Mei-Juni 2021. Sampel penelitian berjumlah 50 responden. Instrumen penelitian yaitu kuesioner yang telah diuji validitas dan reliabilitas. Data penelitian diperoleh melalui wawancara tertutup. Data yang diperoleh dianalisis secara univariat, bivariat dan multivariat. Analisis bivariat menggunakan uji korelasi pearson dan analisis multivariat menggunakan uji regresi linear berganda, dengan ?=0,05.Hasil: Hasil penelitian ini menunjukkan bahwa responden paling banyak berjenis kelamin perempuan (58%), berusia 20-35 tahun (62%), berpendidikan sarjana/S1 (72%) dan masa kerja 6-10 tahun (52%). Selain itu hasil yang diperoleh dalam penelitian ini yaitu disiplin kerja, motivasi kerja, gaya kepemimpinan dan lingkungan kerja nilai p<0,05. Faktor yang paling berpengaruh terhadap kinerja pegawai administrasi RSUP Ratatotok Buyat yaitu variabel disiplin kerja (B=0,520). Diperoleh juga dalam penelitian ini nilai R2 sebesar 0,661 yang berarti disiplin kerja, motivasi kerja, gaya kepemimpinan dan lingkungan kerja memiliki pengaruh sebesar 66,1% terhadap kinerja.Kesimpulan: Terdapat hubungan bermakna dan positif antara disiplin kerja, motivasi kerja, gaya kepemimpinan dan lingkungan kerja dengan kinerja pegawai administrasi. Variabel yang paling berpengaruh yaitu disiplin kerja.

Nilai rasio neutrofil-limfosit sebagai prediktor kasus COVID-19 serangan berat pada pasien dewasa I Gusti Agung Ayu Sri Pramita Pramana; Putu Utamia Suma Masyuni; I Dewa Putu Surawan
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Background: The pandemic condition that has been experienced since 2020 due to Coronavirus Disease (COVID-19) is still a national and international problem that needs full attention with number of cases continues to grow over time. Most cases of COVID-19 are cases with mild clinical manifestation, but some of these mild cases might then worsen in a matter of days due to the widespread inflammatory process that occurs due to viral infection. The use of Neutrophil-Lymphocyte Ratio (NLR) values in general has been known for its function as a biomarker of systemic inflammatory status. Therefore, this study is expected to be able to predict the incidence of severe COVID-19 in adult patients in BRSUD Tabanan, Bali.Methods: The study was conducted using secondary data from 137 adult COVID-19 patients at BRSUD Tabanan in June – December 2020. The sampling method used was consecutive sampling of all adult patients aged 18 years who had been diagnosed with COVID-19 and treated in the isolation room.Results: There were 61 cases (44.5%) of severe COVID-19. Of 88 cases of COVID-19 with NLR > 3.3, 56 cases (63.6%) were classified as severe COVID-19 and of 49 cases of COVID-19 with NLR 3.3 only 5 cases (10.2%) were classified as severe COVID-19. Patients with NLR values > 3.3 were found to have 6.2 times as likely to suffer from severe COVID-19 than patients with 3.3 NLR values.Conclusion: The NLR value as one of the easy and simple tests can be used to predict the incidence of severe COVID-19 in patients. Pendahuluan: Kondisi pandemi yang telah dialami sejak tahun 2020 akibat Coronavirus Disease (COVID-19) masih merupakan masalah nasional dan internasional yang perlu perhatian penuh dengan jumlah kasus yang terus bertambah seiring berjalannya waktu. Sebagian besar kasus COVID-19 merupakan kasus dengan keluhan ringan namun tidak sedikit kasus ringan tersebut kemudian dapat mengalami perburukan dalam hitungan hari akibat proses inflamasi luas yang terjadi karena infeksi virus. Penggunaan nilai rasio neutrofil-limfosit atau Neutrofil-Lymphocyte Ratio (NLR) secara umum telah diketahui fungsinya sebagai biomarker status inflamasi sistemik. Oleh karena itu, melalui penelitian ini diharapkan mampu memprediksi kejadian COVID-19 serangan berat pada pasien dewasa di BRSUD Tabanan.Metode: Penelitian ini merupakan penelitian observasional dengan rancang penelitian cross-sectional analitik menggunakan data sekunder dari 137 pasien dewasa COVID-19 di BRSUD Tabanan bulan Juni – Desember 2020. Metode sampling yang digunakan adalah consecutive sampling terhadap seluruh pasien dewasa usia ? 18 tahun yang telah terdiagnosis COVID-19 dan dirawat di ruang isolasi.Hasil: Ditemukan sebanyak 61 kasus (44,5%) tergolong kasus COVID-19 serangan berat. Dari 88 kasus COVID-19 dengan NLR > 3,3 56 kasus (63,6%) tergolong kasus COVID-19 serangan berat dan dari 49 kasus COVID-19 dengan NLR ? 3,3 hanya 5 kasus (10,2%) tergolong kasus COVID-19 serangan berat. Pasien dengan nilai NLR > 3,3 ditemukan memiliki risiko 6,2 kali lebih besar menderita keluhan COVID-19 serangan berat dibandingkan pasien dengan nilai NLR ? 3,3.Simpulan: Nilai NLR sebagai salah satu pemeriksaan mudah dan sederhana dapat digunakan untuk memprediksi lebih awal terjadinya COVID-19 serangan berat pada pasien.

Prosedur tato kornea: sebuah laporan kasus Tiara Alexander; Eunike Cahyaningsih
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Background: Leukoma adherent is a condition where the formation of white cicatrix with iris incarceration involvement of the cornea. In addition to causing a decrease in visual acuity and blindness, leukoma adherent can also interfere with the appearance of the patient's eye. Corneal tattoo or keratopigmentation (KTP) is a procedure that disguises the color of the leukoma according to the color of the patient's eyes or irises. Corneal tattoo procedures can be performed superficially, intrastromal, or with a femtosecond laser. Corneal tattoo procedures can be carried out in various ways. It is necessary to study keratopigmentation thoroughly.Case: An 18-year-old male patient complained of white patches on his left eye, expanding for a year. The first spots appeared five years ago after being exposed to wood. On physical examination, visual acuity was 1/~ in the left eye and 20/20 in the right eye. The patient underwent a corneal tattoo on the left eye using Vicryl 7.0 with Chinese ink.Conclusions: Corneal tattoo with intrastromal technique is one of the commonly used techniques. This procedure can use a suture needle or an angled knife to introduce the ink. The results of this procedure are quite satisfactory. However, the patient must still be educated on the possibility of further action for color fading or other complications that can harm the eyes. Latar belakang: Leukoma adherent merupakan kondisi terbentuknya sikatriks berwarna putih dengan keterlibatan inkarserasi iris pada kornea. Selain menyebabkan penurunan tajam penglihatan dan kebutaan, leukoma adherent juga dapat mengganggu penampilan mata pasien. Tattoo kornea atau kerato pigmentasi (KTP) merupakan prosedur yang menyamarkan warna leukoma sesuai dengan warna mata atau iris pasien. Prosedur tato kornea dapat dilakukan superfisial, intrastromal, ataupun dengan femtosecond laser. Prosedur tattoo kornea dapat dilaksanakan secara beragam, maka diperlukan studi yang membahas prosedur tattoo kornea secara menyeluruh.Kasus: Pasien laki-laki usia 18 tahun mengeluhkan bercak putih pada mata kiri yang semakin meluas sejak setahun. Bercak pertama kali timbul sejak 5 tahun lalu, setelah mata kiri terkena kayu. Pada pemeriksaan fisik didapatkan tajam penglihatan 1/~ pada mata kiri dan 20/20 pada mata kanan. Pasien menjalani tindakan tattoo kornea pada mata kiri menggunakan vicryl 7.0 dengan tinta cina.Simpulan: Tattoo kornea dengan teknik intrastromal merupakan salah satu teknik yang umum digunakan. Prosedur ini dapat menggunakan suture needle ataupun angled knife untuk mengintroduksi tinta. Hasil dari prosedur ini cukup memuaskan namun pasien tetap harus diedukasi kemungkinan tindakan lanjutan atas peluruhan warna ataupun komplikasi lain yang dapat membahayakan mata.

Efektifitas dan keamanan dari terapi kombinasi methotrexate dan secukinumab pada Psoriasis vulgaris berat: tinjauan sistematis Ovienanda Kristi Purbasari; Ni Putu Wina Widyastuti; Carolina Senak
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Introduction: Psoriasis is a chronic inflammatory disease of the skin that requires comprehensive treatment. Combination therapy can be a good option in optimizing psoriasis treatment outcomes. However, the effectiveness and safety of combination therapy are still not fully understood. This study reviewed the literature examining the effectiveness and safety of the combination treatment of secukinumab and methotrexate in patients with severe Psoriasis vulgaris.Methods: A literature search was performed on PubMed and Google Scholar databases, with several inclusion criteria. The research method used is a case report and controlled trial, with the critical appraisal method using the JBI Critical Appraisal.Result: There were 6 pieces of literature that met the inclusion criteria. All literature describes in detail the clinical condition, course of the disease, management and side effects of treatment, but supporting examinations are not specifically described. In general, all literature shows a clinical improvement in severe psoriasis patients who are given combination treatment, and some literature also explains systemic side effects and residual plaque. The combination of biological agents with conventional systemic treatment has been proposed to optimize the results of psoriasis treatment. One study reported lightweight gastrointestinal disorders related to the use of a combination of secukinumab and methotrexate administration along with biological agents that could prevent or reduce the development of anti-drug antibodies and increase response levels to treatment. Advanced research is still needed in assessing this specific mechanism for this combination therapyConclusion: Combination therapy of secukinumab and methotrexate is effective in treating psoriasis skin manifestations without significant side effects. This drug combination is useful in overcoming the limitations of monotherapy drugs, such as decreasing effectiveness due to prolonged use. Pendahuluan: Psoriasis merupakan penyakit inflamasi kronik pada kulit yang membutuhkan penanganan yang baik. Terapi kombinasi dapat menjadi pilihan yang baik dalam mengoptimalkan luaran pengobatan psoriasis. Namun, efektifitas dan keamanan terapi kombinasi masih belum dipahami sepenuhnya dan masih harus di pertimbangkan. Studi ini menilai beberapa literatur yang menguji efektifitas dan keamanan dari pengobatan kombinasi secukinumab dan methotrexate pada pasien dengan Psoriasis vulgaris berat. Metode: Pencarian literatur dilakukan pada database PubMed dan Google Scholar, dengan beberapa kriteria inklusi. Metode penelitian yang digunakan adalah case report dan controlled trial, dengan metode critical appraisal menggunakan JBI Critical Appraisal.Hasil: Didapatkan sebanyak 6 literatur yang memenuhi kriteria inklusi. Semua literatur menjelaskan secara detail terkait kondisi klinis, perjalanan penyakit, tatalaksana dan efek samping pengobatan, namun pemeriksaaan penunjang tidak dijelaskan secara spesifik. Secara umum, semua literatur menunjukan adanya perbaikan klinis pada pasien psoriasis berat yang diberikan pengobatan kombinasi, beberapa literatur juga menjelaskan efek samping sistemik dan plak residu. Terapi kombinasi agen biologis dengan pengobatan sistemik konvensional telah diusulkan untuk mengoptimalkan hasil pengobatan psoriasis. Satu studi melaporkan adanya gangguan gastrointestinal ringan terkait penggunaan kombinasi secukinumab dan methotrexate. Pemberian methotrexate bersamaan dengan agen biologis dapat mencegah atau mengurangi pengembangan antibodi anti-drug dan meningkatkan tingkat respon terhadap pengobatan. Penelitian lanjutan tetap diperlukan dalam menilai mekanisme spesifik terapi kombinasi ini.Kesimpulan: Terapi kombinasi secukinumab dan methotrexate efektif dalam mengobati manifestasi kulit psoriasis tanpa adanya efek samping bermakna. Kombinasi obat ini berguna dalam mengatasi keterbatasan obat monoterapi, seperti efektifitas yang menurun akibat penggunaan yang berkepanjangan.

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