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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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Diagnosis dan penatalaksanaan nodul tiroid tunggal: Sebuah laporan kasus Nyoman Pramudita; Anak Agung Gede Budhi Kusuma
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Background: Thyroid nodules are abnormal lesions in the form of masses or nodules found in thyroid tissue. Thyroid nodules have a prevalence of about 8% in the adult population. A single thyroid nodule is asymptomatic and is generally discovered incidentally on physical examination or imaging. Diagnosis is made by physical examination, imaging examination and cytopathological examination. The management of a single thyroid nodule can be done by providing interventional therapy and surgery. The purpose of this case report is to describe the diagnosis and management of a single thyroid nodule case in Wangaya General Hospital.Case description: A 52-year-old male patient came to the Surgical Clinic at Wangaya General Hospital with complaints of a lump on the left neck in the past eight months. The lump is felt to be enlarged and painless. The patient's diagnosis was confirmed by cytologic examination, which revealed a follicular nodule with a benign tendency. The patient was given surgical therapy in the form of left thyroidectomy.Conclusion: Single thyroid nodule is quite rare. Treatment of a single thyroid nodule was adjusted according to the results of the cytologic examination. The prognosis for a single thyroid nodule with benign cytology results is generally reasonable. However, it is necessary to follow-up the patient considering the false negative value of the cytological examination. Latar belakang: Nodul tiroid adalah lesi abnormal berupa massa atau nodul yang terdapat dalam jaringan tiroid. Nodul tiroid memiliki prevalensi sekitar 8% pada populasi dewasa. Nodul tiroid tunggal bersifat asimtomatik dan umumnya ditemukan secara tidak sengaja saat pasien melakukan pemeriksaan fisik atau pencitraan. Penegakan diagnosis dilakukan dengan pemeriksaan fisik, pemeriksaan pencitraan dan pemeriksaan sitopatologi. Penatalaksanaan nodul tiroid tunggal dapat dilakukan dengan pemberian terapi intervensi dan pembedahan. Tujuan pelaporan kasus ini adalah untuk menjabarkan diagnosis dan penatalaksanaan pada salah satu kasus nodul tiroid tunggal di RSUD Wangaya.Deskripsi kasus: Seorang pasien laki-laki berusia 52 tahun datang ke Poli Bedah RSUD Wangaya dengan keluhan benjolan pada leher kiri sejak 8 bulan yang lalu. Benjolan dirasakan membesar dan tidak nyeri. Diagnosis pasien ini dikonfirmasi melalui pemeriksaan sitologi yang menunjukkan suatu nodul folikular dengan kecenderungan ke arah jinak. Pasien diberikan terapi pembedahan berupa tiroidektomi sinistra.Simpulan: Nodul tiroid tunggal cukup jarang terjadi. Terapi nodul tiroid tunggal disesuaikan dengan hasil pemeriksaan sitologi. Prognosis nodul tiroid tunggal dengan hasil sitologi jinak umumnya baik, namun perlu dilakukan follow-up terhadap pasien menimbang nilai negatif palsu dari pemeriksaan sitologi.

Hubungan disfungsi ereksi pada pasien dislipidemia dengan lama pengobatan statin di Puskesmas Denpasar Barat I Anak Agung Gde Ryantha Indra Pranamartha; I Gusti Ngurah Pramesemara; Yukhi Kurniawan Kurniawan
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Introduction: There has been change in people's lifestyles that affect disease patterns, and dyslipidemia is one of those disease. Statins are the main pharmacological therapy for dyslipidemia. Many studies have researched the relationship between statin therapy in dyslipidemia and erectile dysfunction. However, existing research has not specifically explained this relationship.Objective: This study aims to determine the relationship between erectile dysfunction in dyslipidemic patients and duration of statin treatment at Community Health Center I West Denpasar.Methods: This research is analytic observational with cross sectional design. The study was conducted on dyslipidemic patients who took statins and met inclusion and exclusion criteria at Community Health Center I West Denpasar in May-June 2021. The sample size was 35. Duration of statin consumption was obtained through medical records and reconfirmed through questionnaire. Erectile dysfunction was measured by IIEF-5 questionnaire. Data analysis using SPSS version 21 with chi square test and Cramer's V correlation test.Results: The prevalence of erectile dysfunction in dyslipidemic patients with statin treatment at Community Health Center I West Denpasar was 85.7% with majority of the patients experiencing mild erectile dysfunction (37.1%) and taking statins for less than 12 months (51.4%). Characteristics of the patients were mostly aged 45-60 years (74.2%), obesity I (42.8%), smoking (60%), and drinking alcohol (57%). Statistical tests showed significant relationship between erectile dysfunction in dyslipidemic patients and duration of statin treatment at Community Health Center I West Denpasar (p=0.031) with moderate correlation (r=0.552). Statins with treatment duration >12 months had protective effect against erectile dysfunction (RR = 0.81).Conclusion: There is a relationship between erectile dysfunction in dyslipidemic patients and duration of statin treatment with moderate correlation. Statins with duration of treatment >12 months have protective effect toward erectile dysfunction. Pendahuluan: Terdapat perubahan gaya hidup masyarakat yang dapat memengaruhi pola penyakit pada manusia, dimana dislipidemia adalah salah satu penyakit tersebut. Statin merupakan salah satu terapi utama untuk dislipidemia. Terdapat banyak penelitian yang telah meneliti hubungan antara terapi statin pada dislipidemia dan disfungsi ereksi. Namun, penelitian yang ada belum secara spesifik menjelaskan hubungan ini. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan disfungsi ereksi pada pasien dislipidemia dengan lama pengobatan statin di Puskesmas Denpasar Barat I.Metode: Penelitian ini adalah penelitian analitik observasional dengan desain cross-sectional. Penelitian dilakukan pada pasien dislipidemia yang mengonsumsu statin dan memenuhi kriteria inklusi dan eksklusi di Puskesmas Denpasar Barat I pada bulan Mei sampai Juni 2021. Sampel pada penelitian ini adalah 35 orang. Durasi konsumsi statin diperoleh melalui rekam medis dan dikonfirmasi ulang melalui kuisioner. Disfungsi ereksi diukur dengan kuisioner IIEF-5. Analisis data menggunakan SPSS versi 21 dengan uji chi-square dan uji korelasi Cramer’s V. Hasil: Prevalensi disfungsi ereksi pada pasien dislipidemia dengan pengobatan statin di Puskesmas Denpasar Barat I sebesar 85,7% dengan mayoritas pasien mengalami disfungsi ereksi ringan (37,1%) dan mengonsumsi statin kurang dari 12 bulan (51,4%). Karakteristik pasien sebagian besar berusia 45-60 tahun (74,2%), dengan obesitas I (42,8%), merokok (60%), dan minum alkohol (57%). Hasil uji statistic menunjukkan hubungan yang bermakna antara disfungsi ereksi pada pasien dislipidemia dengan lama pengobatan statin di Puskesmas Denpasar Barat I (p=0,031) dengan korelasi sedang (r=0,552). Statin dengan lama pengobatan lebih dari 12 bulan memiliki efek protektif terhadap disfungsi ereksi (RR = 0,81).Kesimpulan: Terdapat hubungan antara disfungsi ereksi pada pasien dislipidemia dan lama pengobatan statin dengan korelasi sedang. Pengobatan statin dengan lama pengobatan lebih dari 12 bulan memiliki efek protektif terhadap disfungsi ereksi.

Laporan kasus: demam rematik akut pada anak Fitriana Melinda; Anak Agung Made Sucipta
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Background: Acute rheumatic fever is an autoimmune sequelae caused by group A streptococcal infection. Acute rheumatic fever causes a systemic inflammatory response followed by disorders of the brain, heart, skin, and joints. This disease tends to recur and begins with Streptococcus beta-hemolytic group A infection in the respiratory tract.Case description: A boy aged 9 years 7 months with complaints of pain in both legs so that his legs are difficult to move since one day before being admitted to the hospital. The patient also had a fever for about 1 week, cough and sore throat before complaining of joint pain but the patient did not seek treatment. The patient had a history of recurrent sore throat and was rarely treated. Physical examination revealed that both knees were erythematous, warm and there was tenderness and limited leg movement due to pain. On examination of the tonsils found T2-T2 is not hyperemic. Laboratory examination showed positive ASTO. The diagnosis was made as acute rheumatic fever and treated with erythromycin and aspirin.Conclusion: Acute rheumatic fever can be established using the Jones criteria and modified WHO. In patients with typical symptoms or manifestations according to the major and minor criteria, it will be easier to establish the diagnosis. Latar belakang: Demam rematik akut adalah suatu sekuele autoimun akibat infeksi streptokokus grup A. Kondisi demam rematik akut menyebabkan suatu respon inflamasi sistemik yang diikuti oleh adanya gangguan pada organ otak, jantung, kulit, dan sendi. Penyakit ini cenderung terjadi berulang dan diawali dengan infeksi Streptococcus beta hemolyticus grup A pada saluran napas.Deskripsi kasus: Anak laki-laki berusia 9 tahun 7 bulan dengan keluhan nyeri pada kedua kaki sehingga kaki sulit untuk digerakkan sejak satu hari sebelum masuk RS. Pasien juga mengalami demam sekitar 1 minggu, batuk dan nyeri tenggorok sebelum mengalami keluhan nyeri sendi namun pasien tidak berobat. Pasien memiliki riwayat nyeri tenggorok berulang dan jarang diobati. Pemeriksaan fisik didapatkan kedua lutut eritema, teraba hangat dan terdapat nyeri tekan serta gerakan kaki terbatas karena nyeri. Pada pemeriksaan tonsil didapatkan T2-T2 tidak hiperemis. Pemeriksaan laboratorium menunjukkan ASTO positif. Diagnosis ditegakkan sebagai demam reumatik akut dan diberikan terapi eritromisin dan aspirin.Simpulan: Demam rematik akut dapat ditegakkan menggunakan kriteria Jones dan modifikasi WHO. Pada pasien dengan gejala khas atau manifestasi sesuai dengan kriteria mayor dan minor akan mempermudah penegakkan diagnosis.

Efektivitas pelatihan tutorial simulasi Early Warning Score (EWS) COVID-19 dewasa terhadap pengetahuan dan kinerja tenaga kesehatan dalam pendokumentasian di RSUD Sanjiwani, Gianyar, Indonesia Ni Komang Ady Tri Hapsari; I Gede Putu Darma Suyasa; Ni Putu Ayu Jelantik Sastamidhyani; Ni Made Dewi Wahyunadi
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Background: Monitoring vital signs in COVID-19 patients with severe symptoms could be conducted by documenting Early Warning Score (EWS). However, health care workers are not trained to apply EWS. The purpose of this study was to determine the effectiveness of the adult EWS COVID-19 simulation tutorial training on the knowledge and performance of health workers in documentation.Methods: The research method used was Quasi Experiment with a pre-test post-test approach with control design. Samples were 40 health workers divided into 2 groups. The intervention group 1 was the health workers from the Kamboja Room by providing simulation tutorial training consisting of the Tutorial (Lecture) method, case studies and simulations, while the intervention group 2 was the Arjuna Room health worker by providing the Tutorial (Lecture) method. Data were analyzed using SPSS version 25 for Windows.Results: There was a significant difference in knowledge and performance related to the documentation before and after training was carried out using the Wilcoxon Sign Rank Test (p<0.001). In addition, a significant difference was also found in the effectiveness of the training method using the Independent T-Test test for knowledge (p=0.041) and performance (p=0.029) in documentation.Conclusion: Simulation Tutorial Training is more effective in increasing knowledge and performance of health workers in documentation compared to Tutorial Training (Lecture). Based on the results of this study, it is recommended to provide training using the Adult COVID-19 EWS Simulation Tutorial method on an ongoing basis Latar Belakang: Monitoring tanda-tanda vital pada pasien dengan Coronavirus Disease-2019 (COVID-19) dengan gejala berat dapat dilakukan melalui pendokumentasian Early Warning Score (EWS). Namun, tenaga kesehatan belum mendapatkan pelatihan tentang EWS COVID-19. Penelitian ini bertujuan untuk mengetahui efektivitas pelatihan tutorial simulasi EWS COVID-19 dewasa terhadap pengetahuan dan kinerja tenaga kesehatan dalam pendokumentasian.Metode: Desain penelitian ini adalah Quasi-eksperimental dengan pendekatan pre-test-post-test with control design. Sampel adalah 40 orang tenaga kesehatan yang terbagi dalam dua kelompok. Kelompok intervensi 1 yaitu tenaga kesehatan Ruang Kamboja dengan pemberian pelatihan tutorial simulasi yang terdiri dari metode Tutorial (Lecture), studi kasus, dan simulasi, sedangkan kelompok intervensi 2 yaitu tenaga kesehatan Ruang Arjuna dengan pemberian metode Tutorial (Lecture). Data dianalisis dengan SPSS versi 25 untuk Windows.Hasil: Terdapat perbedaan yang bermakna antara pengetahuan dan kinerja dalam pendokumentasian sebelum dan setelah pelatihan dengan uji Wilcoxon Sign Rank Test (p<0,001). Disamping itu juga terdapat perbedaan yang bermakna efektivitas metode pelatihan dengan uji Independent T-Test untuk pengetahuan (p=0.041) dan untuk kinerja dalam pendokumentasian (p=0.029).Kesimpulan: Pelatihan Tutorial Simulasi lebih efektif dalam meningkatkan pengetahuan dan kinerja tenaga kesehatan dalam pendokumentasian dibandingkan dengan Pelatihan Tutorial (Lecture). Berdasarkan hasil penelitian ini disarankan untuk memberikan pelatihan dengan metode Tutorial Simulasi EWS COVID-19 dewasa secara berkesinambungan.

Situasi analisis pelayanan kesehatan mata di Provinsi Bali, Indonesia Anak Agung Ayu Githasari Dewi; Ni Made Ari Suryathi; Ni Made Suryanadi; I Made Agus Kusumadjaja; I Wayan Eka Sutyawan; Anak Agung Mas Putrawati Triningrat; I Wayan Gede Jayanegara
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Introduction: The prevalence of blindness in Bali based on Rapid Assessment of Avoidable Blindness (RAAB) survey in 2015 was 2%. This prevalence rate is still high according to WHO guidelines. Bali has challenges in providing eye care services. The aim of this study was to report situational analysis of the eye care in Bali.Method: This is a descriptive study with quantitative and qualitative approach. Data collection was carried out through interviews and questionnaires targeting respective stakeholders involved in the eye care services in Bali.Result: Bali consists of 9 districts with total 4,337 million people. Eye care in Bali consist of 43 hospitals, 120 primary health care (Puskesmas), 73 general ophthalmologist and subspecialists, 18 trained opthalmic nurses, and 12 refractionist. Bali has mobile eye care unit covering remotes area and a Non-Government Organization (NGO) actively contributing in community eye care service. Total number of cataract surgery in 2019 was 8.225 eyes with cataract surgical rate (CSR) was 1.896. Komite Mata Daerah (Komatda) dan health insurance for eye service and eye surgery is a form of support from the government.Conclusion: The implementation of eye care services in Bali is yet under evaluation. Things needed to consider to improve eye care services including providing better distribution of ophthalmologist to districts, and empowering voluntary local manpower as village health workers / cadres through regularly organized training. Education on blindness and preventable visual disturbances also must be carried out regularly.Pendahuluan: Prevalensi kebutaan di Bali berdasarkan survei Rapid Assessment of Avoidable Blindness (RAAB) tahun 2015 sebesar 2%. Angka prevalensi ini masih tinggi menurut pedoman WHO. Bali memiliki tantangan dalam memberikan pelayanan perawatan mata. Tujuan dari penelitian ini adalah untuk melaporkan analisis situasi perawatan mata di Bali.Metode: Penelitian ini merupakan penelitian deskriptif dengan pendekatan kuantitatif dan kualitatif. Pengumpulan data dilakukan melalui wawancara dan kuesioner dengan sasaran masing-masing pemangku kepentingan yang terlibat dalam layanan perawatan mata di Bali.Hasil: Bali terdiri dari 9 kabupaten dengan jumlah penduduk 4.337 juta jiwa. Perawatan mata di Bali terdiri dari 43 rumah sakit, 120 Puskesmas, 73 dokter spesialis mata umum dan subspesialis, 18 perawat mata terlatih, dan 12 dokter spesialis mata. Bali memiliki unit perawatan mata keliling yang mencakup daerah terpencil dan Lembaga Swadaya Masyarakat (LSM) yang aktif berkontribusi dalam layanan perawatan mata masyarakat. Jumlah operasi katarak pada tahun 2019 sebanyak 8.225 mata dengan angka bedah katarak (CSR) sebanyak 1.896. Komite Mata Daerah (Komatda) dan jaminan kesehatan untuk pelayanan mata dan operasi mata merupakan bentuk dukungan dari pemerintah.Simpulan: Pelaksanaan pelayanan kesehatan mata di Bali masih dalam tahap evaluasi. Hal-hal yang perlu diperhatikan untuk meningkatkan pelayanan kesehatan mata antara lain penyediaan dokter spesialis mata yang lebih merata ke kabupaten, dan pemberdayaan tenaga sukarelawan lokal sebagai kader/petugas kesehatan desa melalui pelatihan yang diselenggarakan secara rutin. Edukasi tentang kebutaan dan gangguan penglihatan yang dapat dicegah juga harus dilakukan secara berkala.

Peran vitamin B6 terhadap inflamasi pada adhesi peritoneal pasca laparotomi: tinjauan pustaka Made Agus Dwianthara Sueta; I Dewa Made Sukrama
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Vitamin B6 or pyridoxine has been shown to modulate hypoxia and inflammation, but it has not yet confirmed their local effects on the peritoneum. Although there was no study regarding this issue, pyridoxine effects on suppressing these two pathways look promising as a preventing agent against peritoneal adhesion. The development of intraperitoneal adhesion post-operation is one of the most common complications after abdominal surgery. Approximately 95% of patients who underwent laparotomy can develop adhesions in the future. Pathogenesis of adhesion consists of three important processes which were induced by trauma: trauma or direct tissue injury-induced suppression of degradation of fibrinolytic matrix and extracellular system, inflammation response with cytokine production, particularly TGF-? and interleukin, also tissue hypoxia as the impact from circulation disorder toward mesothelial cell and sub-mesothelial fibroblasts, which results as increasing hypoxia-inducible factor-alpha (HIF-1?) and vascular endothelial growth factor (VEGF), which are responsible for generating collagen and angiogenesis process. Pyridoxine has biological activity and interesting characteristics in avoiding intra-peritoneal adhesion by dealing with inflammation effects and hypoxia. From the inflammation process, pyridoxine has been shown can hinder macrophage, decrease IL-6, suppress TLR-mediated TAK1 phosphorylation, JNK, IKK-I?B?, which can cause a reduction in NF-?B activation and NLRP3-mediated caspase-1, also suppress iNOS and cyclooxygenase-2 (COX2), which contributed to developing intra-peritoneal adhesion. Vitamin B6 (Vit B6), atau piridoksin telah ditunjukkan dapat memodulasi efek hipoksia dan inflamasi, tetapi belum dikonfirmasi efek lokalnya pada peritoneum. Walaupun belum ada penelitian langsung, efek supresi vitamin B6 terhadap kedua jalur tersebut sangat menjanjikan sebagai agen prevensi adhesi peritoneal. Perkembangan adhesi intraperitoneal pasca operasi adalah salah satu komplikasi paling umum setelah operasi abdominal. Sekitar 95% pasien yang menjalani laparotomi akan mengalami perlengketan di kemudian hari. Patogenesis adhesi melibatkan tiga proses penting yang diinduksi trauma: trauma atau kerusakan jaringan langsung menginduksi penghambatan sistem degradasi matriks fibrinolitik dan ekstraseluler, respons inflamasi dengan produksi sitokin, terutama TGF-? dan interleukin, serta hipoksia jaringan sebagai akibat dari gangguan suplai darah ke sel mesothelial dan fibroblas submesothelial, yang mengarah pada peningkatan hypoxia inducible factor-alpha (HIF-1?) dan faktor pertumbuhan endotel vaskular (VEGF), yang bertanggung jawab untuk pembentukan kolagen dan angiogenesis. Vitamin B6 menyajikan sifat dan aktivitas biologis yang menarik untuk mencegah adhesi intraperitoneal dengan mengatasi efek inflamasi dan hipoksia. Pada jalur inflamasi, vitamin B6 terbukti menghambat makrofag, menurunkan IL-6, menghambat fosforilasi TLR-mediated TAK1, JNK, serta IKK-I?B?, yang menyebabkan penurunan aktivasi NF-?B and NLRP3-mediated caspase-1, serta menghambat iNOS dan cyclooxygenase-2 (COX2) yang berkontribusi terhadap pembentukkan adhesi intraperitoneal.

Pengembangan sistem pengelolaan alat kesehatan pada ruang perawatan berbasis teknologi informasi di RSUD Sanjiwani, Gianyar tahun 2021 Ni Made Milapastiniari; I Gede Putu Darma Suyasa; I Ketut Alit Adianta; Ni Kadek Sriasih
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Background: Health equipment is one of the important factors in the implementation of health services. An increase in the number and types of medical equipment requires a good management system, so that the number, condition and presence can be monitored at any time. Currently, there is no system that can facilitate the management of medical devices in the treatment room so that it can be integrated with other units in the hospital. The purpose of this study was to develop an information system for managing medical devices in an appropriate and efficient treatment room based on the managerial functions of the head of the room.Methods: The type of research used is action research where total sampling is done on 29 employees of RSUD Sanjiwani Gianyar This research consists of six stages, namely Focus Group Discussion (FGD), information system design, socialization and testing, evaluation of user satisfaction with information system design, application and evaluation of the real benefits of information systems. Data were analyzed with SPSS version 21 for Windows.Results: There were thirteen themes obtained through Focus Group Discussions (FGD), then the themes obtained were integrated into the designed information system. After conducting socialization and testing, the researchers evaluated user satisfaction with the design of this information system, where 58.6% stated that they were satisfied and 41.4% said they were very satisfied. The application of this information system was carried out for four weeks, and finally an evaluation of the real benefits was carried out. Based on the results of this evaluation, it was found that 51.7% said this system was useful and 48.3% said it was very useful.Conclusion: The development of this medical device management information system is useful to support the task of the head of the room in carrying out the management of medical devices in the treatment room. Latar Belakang: Peralatan kesehatan merupakan salah satu faktor penting dalam penyelenggaraan pelayanan kesehatan. Peningkatan jumlah dan jenis peralatan kesehatan, memerlukan sistem pengelolaan yang baik, sehingga jumlah, kondisi dan keberadaannya dapat dipantau setiap waktu. Saat ini belum tersedia sistem yang dapat memfasilitasi pengelolaan alat kesehatan di ruang perawatan sehinga dapat terintegrasi dengan unit- unit terkait yang ada di rumah sakit. Tujuan penelitian ini adalah untuk mengembangkan sistem informasi pengelolaan alat kesehatan di ruang perawatan yang tepat dan efisien berdasarkan fungsi- fungsi manajerial kepala ruanganMetode: Jenis penelitian yang digunakan adalah action research dimana pengambilan sampel dilakukan secara total sampling terhadap 29 orang pegawai RSUD Sanjiwani Gianyar Penelitian ini terdiri atas enam tahap yaitu Focus Group Discussion (FGD), perancangan sistem informasi,sosialisasi dan uji coba, evaluasi kepuasan user terhadap rancangan sistem informasi, aplikasi dan evaluasi terhadap manfaat nyata dari sistem informasi. Data dianalisis dengan SPSS versi 21 untuk Windows.Hasil: Terdapat tiga belas tema yang didapatkan melalui Focus Group Discussion (FGD), selanjutnya tema yang didapatkan diintegrasikan kedalam sistem informasi yang dirancang. Setelah dilakukan sosialisasi dan uji coba, peneliti melakukan evaluasi kepuasan user terhadap rancangan sistem informasi ini, dimana didapatkan 58,6% menyatakan puas dan 41,4% menyatakan sangat puas. Pengaplikasian sistem informasi ini dilaksanakan selama empat minggu, dan terakhir dilakukan evaluasi terhadap manfaat nyata. Berdasarkan hasil evaluasi ini, didapatkan bahwa 51,7% menyatakan sistem ini bermanfaat dan 48,3% menyatakan sangat bermanfaat.Kesimpulan: Pengembangan sistem informasi pengelolaan alat kesehatan ini bermanfaat untuk mendukung tugas kepala ruangan dalam melaksanakan pengelolaan alat kesehatan di ruang perawatan.

Angka insiden dan faktor risiko malnutrisi rumah sakit pada anak rawat inap di RSUP Sanglah, Bali, Indonesia Anak Agung Ratna Purnama Santhi; I Gusti Lanang Sidiartha; I Gusti Ayu Putu Eka Pratiwi
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Background: Nutritional support is an important aspect of the clinical management of hospitalized children. Several factors contribute to prevalence of malnutrition in hospitalized children and it can led to deterioration of nutritional status. Research on factors related to malnutrition in pediatric hospitalized patients is still limited, especially in Indonesia. This study aims to evaluate the incidence rate and risk factors of malnutrition in hospitalized children at Sanglah General Hospital, Bali, Indonesia.Methods: This study was a prospective analytic observational study in children who underwent hospitalization in class II and III inpatient rooms for the period August 2020-February 2021. Inclusion criteria were pediatric patients aged 1 to 18 years who were hospitalized for at least 48 hours and had complete medical records. Samples were taken by consecutive sampling until the number of subjects was met. A significant variable is a variable that has a p-value <0.05. Data were analyzed using SPSS version 20 for Windows.Results: A total of 95 subjects who met the inclusion and exclusion criteria. The incidence of hospital malnutrition was 28%. The risk factors associated with hospital malnutrition were fever, diarrhea and vomiting. Multiple diagnosis, acute and chronic malnutrition, low maternal education, surgical and medical departments also contribute to hospital malnutrition. The results of multivariate analysis were acute malnutrition and length of stay as independent risk factors for hospital malnutrition (OR, 3.843; 95% CI, 1.762-5.431; p=0.005) and length of stay (OR, 5.791; 95% CI, 2.157-6.491; p=0.026)Conclusion: The incidence of patients with hospital malnutrition in children at Sanglah Hospital Denpasar is 28%. Acute malnutrition and length of stay are independent risk factors for malnutrition during hospitalization. Latar belakang: Dukungan nutrisi adalah aspek penting dalam manajemen klinis anak yang dirawat di rumah sakit. Beberapa faktor berkontribusi terhadap meluasnya malnutrisi pada anak yang dirawat di rumah sakit dan menyebabkan eksaserbasi status gizi. Penelitian mengenai faktor-faktor yang berkaitan dengan malnutrisi pada pasien pediatri yang menjalani rawat inap masih sangatlah terbatas khususnya di Indonesia meskipun memiliki urgensi yang tinggi. Penelitian ini bertujuan untuk mengevaluasi angka insiden dan faktor risiko malnutrisi rumah sakit pada anak rawat inap di RSUP Sanglah, Bali, IndonesiaMetode: Penelitian ini merupakan penelitian observasional analitik pada anak dengan metode penelitian kohort prospektif yang menjalani rawat inap di ruang rawat inap kelas II dan III periode bulan Agustus 2020-Februari 2021. Kriteria inklusi yaitu pasien anak berusia 1 hingga 18 tahun, menjalani rawat inap di RS minimal 48 jam, dan memiliki catatan medis yang lengkap. sampel diambil secara konsekutif sampai jumlah subyek terpenuhi. Variabel yang signifikan adalah variabel yang mempunyai nilai p<0,05. Data dianalisis dengan SPSS versi 20 untuk Windows.Hasil: Sebanyak 95 subjek yang memenuhi kriteria inklusi dan eksklusi. Insiden malnutrisi rumah sakit didapatkan sebesar 28%. Faktor RISIKO yang berhubungan dengan malnutrisi rumah sakit adalah demam, diare dan muntah. Diagnosis multipel, kurang gizi akut dan kronis, lama rawat,pendidikan ibu rendah, dan departemen rawat juga sebagai faktor RISIKO malnutrisi rumah sakit. Hasil analisis multivariat dilakukan dengan hasil kurang gizi akut dan lama rawat sebagai faktor risiko independen terjadinya malnutrisi rumah sakit (OR, 3.843; 95% CI, 1.762-5.431; p=0.005) dan lama rawat (OR, 5.791; 95% CI, 2.157-6.491; p=0.026)Simpulan: Insiden pasien dengan malnutrisi rumah sakit pada anak di RSUP Sanglah Denpasar adalah sebesar 28%. Kondisi kurang gizi akut dan lama rawat merupakan faktor risiko independen terjadinya malnutrisi selama perawatan di rumah sakit.

Parametrial hematoma following fetal craniotomy and curettage in intrauterine fetal death: a case report Ida Bagus Yudhistira Anantasurya Vidhisvara; Ida Bagus Putu Widiarsa; Margaret Gabriele Helena; I Putu Ivan Cahya Himawan
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Background: Parametrial hematoma is collection of blood located in the parametrial area, which is a type of hematoma that can occur in the pelvic cavity. Postpartum hematoma is a rare but life-threatening complication of childbirth. Common risk factors to developing parametrial hematomas include multiple pregnancies, traumatic deliveries, operative vaginal delivery, prolonged labour, manual removal of placenta, inadequate hemostasis at Caesarean section, pre-eclampsia, and anticoagulation therapy. We reported a rare case of parametrial hematoma post-craniotomy and curettage of a fetus with intrauterine fetal death (IUFD) in a 28-year-old pregnant woman 24 weeks into her fourth pregnancy. Case report: A pregnant woman with 24 weeks gestation age came to emergency room with complaints of abdominal pain and bloody discharge without clear fluids 9 hours prior. She was diagnosed with preterm delivery and was given tocolytic. The following day, ultrasound examination was done and fetal heart rate (FHR) was not found, suggesting an intrauterine fetal death (IUFD). Termination was carried out with oxytocin induction but due to maternal exhaustion, pain, and lack of cooperation, a craniotomy was done in operating room followed by curettage. Twenty-four hours after curettage, patient complained of an acute lower right abdominal pain and ultrasound showed a complex mass in right adnexa measuring 8 x 8 cm, suggesting a right adnexal hematoma with a differential diagnosis of a right tubo-ovarian abscess. The patient’s haemoglobin was found to decrease to 6.0 g/dl. A laparotomy was performed and a hematoma was found in the right parametrium without active bleeding. Conclusion: Parametrial hematoma is a rare disease that can occur due to trauma (in labor) or spontaneously due to abnormalities of the uterine arteries that supply blood to the uterus. The patient present in this case report had acute abdominal pain with decreased haemoglobin without signs of bleeding after an operative vaginal birth which may or may not be the cause of the parametrial hematoma due to limitations of examination on the patients. Further observation of similar cases will be required to determine the association between parametrial hematoma and operative vaginal birth.

Peran HbA1c dalam progresi dan prognosis COVID-19 pada pasien diabetes mellitus Ni Luh Parameswari Praptika; Kadek Wisnu Segara Karya
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Objective: This systematic review determined the role of HbA1c in the progression and prognosis of COVID-19 in patients with diabetes mellitus from several previously published articles.Method: We searched from an open-access database according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the PICO criteria. The inclusion criteria for the article search included: 1) COVID-19 patients with diabetes mellitus; 2) full articles; 3) English articles; 4) article publication time range from 2016 to 2021. Quality assessment for each article is evaluated using a checklist from Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).Result: We obtained two cohort studies and four cross-sectional studies of all the articles reviewed from 2019-2021. All studies evaluated the role of HbA1c in the progression, prognosis, and mortality of COVID-19 patients with diabetes mellitus. Most of the reported studies showed an association between elevated HbA1c and worsening of the COVID-19 disease prognosis. The association was assessed by the patient's clinical deterioration included lower oxygen saturation, increased NLR (neutrophil-lymphocyte ratio), the tendency to lymphopenia, improved renal function, increased ICU admission, and mechanical ventilation and increased ventilation mortality.Conclusion: A high HbA1c was closely related to a worse COVID-19 prognosis in clinical development and mortality. We found the potential for developing a scoring system to predict the worsening and mortality of COVID-19 and improve the quality of prevention and management of COVID-19, especially in patients with diabetes mellitus. Tujuan: mengkaji peran HbA1c dalam progresi dan prognosis COVID-19 pada pasien diabetes mellitus dari beberapa literatur yang telah dipublikasi sebelumnya.Metode: Pencarian literatur secara sistematis dilakukan pada basis data dengan akses terbuka sesuai dengan pedoman PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) dan kriteria PICO. Kriteria inklusi pencarian artikel antara lain: 1) pasien COVID-19 dengan diabetes mellitus; 2) artikel lengkap; 3) artikel berbahasa Inggris; 4) rentang waktu terbit artikel dari tahun 2016 hingga tahun 2021. Penilaian kualitas pada setiap artikel yang dievaluasi menggunakan checklist dari Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).Hasil: Dari seluruh artikel yang dikaji dari tahun 2019-2021, didapatkan 2 studi kohort dan 4 studi potong lintang. Keseluruhan studi mengevaluasi peran HbA1c dalam progresi, prognosis, maupun mortalitas pada pasien COVID-19 dengan diabetes mellitus. Sebagian besar penelitian yang dilaporkan menunjukkan keterkaitan antara peningkatan HbA1c dan perburukan prognosis penyakit COVID-19 yang dinilai dari perburukan klinis pasien yaitu saturasi oksigen yang lebih rendah, meningkatnya NLR (neutrophil lymphocyte ratio), kecenderungan limfopenia, fungsi ginjal yang meningkat, peningkatan admisi ICU dan pemanfaatan ventilator mekanik serta meningkatnya mortalitas.Simpulan: HbA1c yang tinggi terbukti berhubungan erat dengan prognosis COVID-19 yang lebih buruk ditinjau dari perkembangan klinis hingga tingkat mortalitas yang terjadi. Hal ini menunjukkan potensi berkembangnya sistem skoring untuk memprediksi perburukan dan mortalitas COVID-19 serta peningkatan kualitas pencegahan dan tatalaksana COVID-19 terutama pada pasien diabetes mellitus.

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