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INDONESIA
ISM (Intisari Sains Medis) : Jurnal Kedokteran
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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Pemberian pasta ekstrak daun pegagan 10% lebih meningkatkan jumlah sel fibroblas dan reepitelisasi pada soket mandibula daripada pasta ekstrak daun mengkudu 10% pasca pencabutan gigi marmut jantan Ni Made Ista Prestiyanti; I Putu Gede Adiatmika; I Made Muliarta
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (328.734 KB) | DOI: 10.15562/ism.v12i3.1114

Abstract

Background: The process of wound healing after a tooth extraction is expected to occur more quickly to restore normal functioning of the tissue and reduce the risk of complications. Pegagan leaf (Centella asiatica) and mengkudu leaf (Morinda citrifolia. L) contain active compounds such as flavonoids, tannins, and triterpenoids that accelerate wound healing. This study aims to evaluate the pegagan leaf extract paste increased the number of fibroblast cells and reepitelization more than mengkudu leaf extract paste after tooth extraction.Methods: This study used a post-test-only control group design to the 30 male guinea pigs. The three groups were the placebo paste group, the pegagan leaf extract paste 10% group, and the mengkudu leaf extract paste 10% group, which were treated for 6 days. Examination of the number of fibroblast cells and reepitelization was carried out by taking tissue of the mandibular socket on day 7, histological preparations with HE staining were made. The data obtained were analyzed by SPSS version 20 for WindowsResults: The average difference in the number of fibroblast cells and reepithelization showed a significant difference (p<0.05) between groups. The highest average for the number of fibroblast cells was found in the group that applied topically with pegagan leaf extract paste 10% was 97.98±25.67 cells followed by the group that applied topically with mengkudu leaf extract paste 10% was 64.28±12.22 cells and the group applied topically with placebo paste was 46.36±14.27 cells. The highest average for the reepithelization was found in the group that applied topically with pegagan leaf extract paste 10% was 69.64±24.53 µm.Conclusion: It was concluded that pegagan leaf extract paste 10% increased the number of fibroblast cells and reepitelization than mengkudu leaf extract paste 10%.  Latar Belakang: Proses penyembuhan luka setelah pencabutan gigi diharapkan lebih cepat terjadi sehingga dapat mengembalikan fungsi normal dari jaringan dan mengurangi risiko terjadinya komplikasi. Daun pegagan dan daun mengkudu mengandung senyawa aktif seperti flavonoid, tanin dan triterpenoid yang dapat mempercepat penyembuhan luka. Penelitian ini bertujuan untuk mengevaluasi ekstrak daun pegagan dalam meningkatkan jumlah sel fibroblas dan reepitelisasi daripada pasta ekstrak daun mengkudu pasca pencabutan gigi.Metode: Penelitian ini menggunakan rancangan post-test only control group design terhadap 30 ekor marmut jantan. Terdapat 3 kelompok secara acak yaitu kelompok pasta plasebo, kelompok pasta ekstrak daun pegagan 10% dan kelompok pasta ekstrak daun mengkudu 10% yang diberikan perlakuan selama 6 hari. Pemeriksaan jumlah sel fibroblas dan reepitelisasi dilakukan dengan pengambilan jaringan soket mandibula pada hari ke 7, kemudian dibuat preparat histologis dengan pengecatan HE. Data yang diperoleh dianalisis menggunakan uji SPSS versi 20 untuk Windows.Hasil: Perbedaan rerata jumlah sel fibroblas dan reepitelisasi menunjukkan perbedaan yang signifikan (p<0,05) antar kelompok. Rerata jumlah sel fibroblas tertinggi terdapat pada kelompok yang diolesi pasta ekstrak daun pegagan 10% dengan rerata yaitu sebesar 97,98 ± 25,67 sel diikuti oleh kelompok yang diolesi pasta ekstrak daun mengkudu 10% dengan rerata sebesar 64,28 ± 12,22 sel dan kelompok yang diolesi pasta plasebo dengan rerata sebesar 46,36 ± 14,27 sel. Sedangkan rerata reepitelisasi tertinggi terdapat pada kelompok yang diberi pasta ekstrak daun pegagan 10% dengan rerata yaitu sebesar 69,64 ± 24,53 µm.Kesimpulan: Dapat disimpulkan bahwa pasta ekstrak daun pegagan 10% lebih meningkatkan jumlah sel fibroblas dan reepitelisasi daripada pasta ekstrak daun mengkudu 10%. 
Temuan radiologi dalam kelainan kongenital atresia jejunum: serial kasus Listyani Gunawan; Pande Putu Yuli Anandasari; Putu Patriawan
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (873.798 KB) | DOI: 10.15562/ism.v12i3.1116

Abstract

Background: Jejunoileal atresia is an emergency due to mechanical gastrointestinal obstruction, a rare case with a prevalence rate of 1-3 per 10,000 births. There is no difference in incidence by gender. Delay in treatment results in huge losses in terms of malnutrition, failure to thrive, and even death. These case series aim to evaluate radiological findings in congenital jejunal atresia.Case Presentation: There were 3 patients with the main complaint of bilious vomiting. These three patients underwent a plain abdominal x-ray examination, obtained a picture of a high total obstruction with a triple bubble picture, or had a dilated picture of the proximal obstruction. Partial obstruction based on plain radiographs in one of the patients was found, followed by an examination of contrast meal which filled smoothly up to the jejunum segment with a windsock appearance. The three cases have been proven through surgery, various types of jejunal atresia were obtained. Intestinal resection was performed, followed by an end-to-end jejunal anastomosis.Conclusion: Correct diagnosis determines the appropriate treatment for the patient. Plain abdominal radiograph as an initial examination in assessing total or partial obstruction in the jejunum, with a typical triple bubble or dilated bowel segment proximal to the obstruction. The windsock appearance of the jejunal segment on the contrast meal confirms the diagnosis of the jejunal web.  Latar Belakang: Atresia jejunoileal merupakan kegawatdaruratan akibat obstruksi mekanik gastrointestinal, yang merupakan kasus jarang dengan angka prevalensi 1-3 per 10000 kelahiran, tidak ada perbedaan insiden berdasarkan gender. Terlambatnya tatalaksana mengakibatkan kerugian yang besar baik malnutrisi, gagal tumbuh, hingga kematian. Laporan kasus ini bertujuan untuk mengevaluasi temuan radiologi dalam kelainan kongenital atresia jejunum.Laporan Kasus: Terdapat 3 pasien dengan keluhan utama muntah bilosa. Kemudian dari pemeriksaan foto polos abdomen didapatkan gambaran obstruksi total letak tinggi dengan gambaran triple bubble atau memiliki gambaran dilatasi dari proksimal obstruksi. Obstruksi parsial berdasarkan foto polos pada salah satu pasien, dilanjutkan pemeriksaan contrast meal yang mengisi lancar hingga segmen jejunum dengan windsock appearance. Ketiga kasus tersebut telah terbukti melalui hasil operasi, didapatkan atresia jejunum berbagai tipe. Dilakukan reseksi usus dilanjutkan anastomosis end-to-end jejunal.Kesimpulan: Diagnosis yang tepat, menentukan tatalaksana yang sesuai bagi pasien. Foto polos abdomen sebagai pemeriksaan inisial dalam menilai obstruksi total atau parsial pada jejunum, dengan gambaran khas triple bubble atau dilatasi segmen usus proksimal dari obstruksi. Windsock appearance segmen jejunum pada contrast meal mempertajam diagnosis jejunal web.
Karakteristik penderita psoriasis di poliklinik rawat jalan dermatologi dan venereologi Rumah Sakit Umum Daerah Provinsi Nusa Tenggara Barat periode Januari 2016 – Desember 2020 Lisa Alverina; Dedianto Hidajat; I Wayan Hendrawan; I Gusti Agung Ayu Ratna Medikawati
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (296.255 KB) | DOI: 10.15562/ism.v12i3.1118

Abstract

Introduction: Psoriasis is an immunologically mediated chronic disease characterized by skin inflammation and epidermal hyperplasia. The incidence in the total population in the United States is 63.8 per 100,000 person-years. The incidence increases with age and peaks among individuals aged 70 to 79 years at a rate of 92.3 per 100,000 person-years. This research aims to determine the characteristics of psoriasis sufferers in the Dermatology and Venereology Outpatient Polyclinic of the Regional General Hospital of West Nusa Tenggara Province for the period January 2016 - December 2020Method: The research design used was a descriptive retrospective by taking secondary data from medical records in new psoriasis patients for the period January 2016 – December 2020 who came for treatment.Result: The total number of patient visits at the Dermatology and Venereology Outpatient Polyclinic of the Regional General Hospital of West Nusa Tenggara Province for the January 2016 – December 2020 period was 8,524 people. The study found 140 new patients (92.7%), which were dominated by women (52.1%). The incidence of psoriasis in 2016-2020 was 16.42%. The highest age group was found at the age of 41-50 years as many as 33 people (23.6%), the most visits in 2018 were 37 people (26.4%), the predominant diagnosis was psoriasis vulgaris as many as 105 people (75%) with the site of the lession in the trunk as many as 93 people (66.4%). Therapy was dominated by topical therapy as many as 131 people (93.6%) and systemic therapy as many as 108 people (77.1%). Systemic therapy with methotrexate injection was 78 people (72.2%), and the topical combination of steroids and salicylic acid were 79 people (60.3%) were the most frequently used.Conclusion: Psoriasis sufferers in the Dermatology and Venereology Outpatient Polyclinic of the Regional General Hospital of West Nusa Tenggara Province have a tendency to increase every year. The therapy given is topical therapy with the most administration in the form of a combination of topical corticosteroids and salicylic acid, and the most systemic therapy is methotrexate injection.  Latar Belakang: Psoriasis merupakan penyakit inflamasi kronik yang diperantarai secara imunologis serta ditandai dengan adanya inflamasi kulit dan hiperplasia epidermal. Insidensi dalam populasi keseluruhan di Amerika Serikat adalah 63,8 per 100.000 orang-tahun. Insiden meningkat dengan usia dan memuncak di antara individu berusia 70 sampai 79 tahun dengan angka 92,3 per 100.000 orang-tahun. Penelitian ini bertujuan untuk mengetahui karakteristik penderita psoriasis di Poliklinik Rawat Jalan Dermatologi dan Venereologi Rumah Sakit Umum Daerah Provinsi Nusa Tenggara Barat periode Januari 2016 – Desember 2020Metode: Desain penelitian yang digunakan adalah retrospektif deskriptif dengan cara mengambil data sekunder dari rekam medis pada pasien psoriasis baru periode Januari 2016 – Desember 2020 yang datang berobat.Hasil: Total kunjungan pasien di poliklinik rawat jalan Dermatologi dan Venereologi Rumah Sakit Umum Daerah Provinsi Nusa Tenggara Barat Periode Januari 2016 – Desember 2020 adalah sebanyak 8.524 orang. Pada penelitian didapatkan 140 pasien baru (92,7%) yang didominasi oleh perempuan (52,1%). Angka insidensi psoriasis pada tahun 2016-2020 didapatkan sebesar 16,42%. Kelompok usia terbanyak didapatkan pada usia 41-50 tahun sebanyak 33 orang (23,6%), kunjungan terbanyak pada tahun 2018 sebanyak 37 orang (26,4%), diagnosis yang mendominasi adalah psoriasis vulgaris sebanyak 105 orang (75%) dengan lokasi lesi badan sebanyak 93 orang (66,4%). Terapi didominasi oleh terapi topikal sebanyak 131 orang (93,6%) dan terapi sistemik sebanyak 108 orang (77,1%). Pemberian terapi sistemik methotrexate injeksi sebanyak 78 orang (72,2%) serta pada topikal kombinasi dari steroid dan asam salisilat sebanyak 79 orang (60,3%) merupakan yang paling sering digunakan.Simpulan: Penderita psoriasis di Poliklinik Rawat Jalan Dermatologi dan Venereologi RSUD Provinsi Nusa Tenggara Barat memiliki kecenderungan meningkat setiap tahunnya. Terapi yang diberikan yaitu terapi topikal dengan pemberian terbanyak berupa kombinasi topikal kortikosteroid dan asam salisilat serta pemberian terapi sistemik terbanyak berupa injeksi metotreksat. Data ini diharapkan dapat menjadi acuan bagi penelitian selanjutnya terkait psoriasis di Nusa Tenggara Barat.
Potential effect of secondary metabolites in Persea americana seeds as an ?-amylase inhibitor on type 2 diabetes mellitus Anak Agung Bagus Putra Indrakusuma; Luh Putu Sudi Wahyuni; I Gede Wikania Wira Wiguna; Anggi Amanda Triana Devy; I Gede Aswin Parisya Sasmana; Agung Wiwiek Indrayani
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (777.761 KB) | DOI: 10.15562/ism.v12i3.1119

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a disease that has a high prevalence in the world. The development of plants with medicinal potential is an alternative to control blood sugar levels in T2DM disease, such as avocado (Persea americana). Persea americana seeds contain secondary metabolites that have anti-diabetic activity, but their bioavailability is low.Aim: This study aims to review various secondary metabolites in Persea americana seeds that can reduce blood glucose levels in ?-amylase pathway along with the type of potential encapsulation as a delivery system.Review: Secondary metabolites contained in Persea americana seeds which have activity as anti-diabetic are tannin, quercetin, rutin, kaempferol, saponin, triterpenoid, and alkaloid. Each of them has several mechanisms in diabetes, but their role as ?-amylase inhibitor on T2DM be in focus. There are various types of encapsulation that are known to be able to serve as a delivery system for these secondary metabolites. Those encapsulations are SNEDDS, chitosan-alginate nanoparticle, PLGA nanoparticle, lipid carrier, liposome, and polysaccharide-based enteric-coated nanoparticle. All of them showed good results in improving bioavailability.Conclusion: It is known that various secondary metabolites found in Persea americana seeds influence reducing blood glucose levels notably in the ?-amylase pathway. The low bioavailability of secondary metabolites can be improved by several forms of potential encapsulation. Therefore, herbal substances as adjuvant therapy in T2DM might be a viable management option.
Suplementasi seng (Zn) menurunkan kadar IgM anti PGL-1 pada narakontak serumah pasien kusta tipe multibasiler Elice Wijaya; Luh Made Mas Rusyati; I Gusti Ayu Agung Praharsini
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (366.176 KB) | DOI: 10.15562/ism.v12i3.1122

Abstract

Background: Indonesia ranks third highest of new cases of leprosy after India and Brazil. Transmission of leprosy through inhalation and prolonged close contact. Families who live in the same house have the highest risk for infection. Currently, several studies have found a correlation between IgM anti-PGL-1 levels with micronutrient deficiencies, especially zinc, which is associated with cellular immunity. This study aimed to investigate the effect of 40 mg elemental zinc supplementation per day for four weeks on IgM anti-PGL-1 levels. Methods: An experimental one-group pre-test and post-test design conducted from February to May 2021. The samples were all close contact persons with multibacillary leprosy patients aged 18-65 years who visited the Dermatology and Venereology Outpatient Clinic, Sanglah General Hospital, Denpasar during the study period by consecutive sampling. The history taking, physical examination, and blood sampling were carried out at the to evaluate IgM anti-PGL-1 and zinc levels. Results: Mean serum zinc level before and after supplementation were 79.00±9.67 g/dl and 95.16±31.84 g/dl, mean difference 25.21±32.12 g/dl (p<0.001). IgM anti-PGL-1 mean level before and after supplementation were 843.21±878.51 u/ml and 465.68±735.21 u/ml, mean difference 377.52±309.62 u/ml (p<0.001). Correlation test of different mean levels of zinc with different mean levels of IgM anti-PGL-1 resulted with r=0.630 and p=0.004. Conclusion: Forty mg elemental zinc per day for four weeks may increase serum zinc levels and reduce IgM anti-PGL-1 in close contact with multibacillary leprosy patients (p<0.05). Higher mean increase in serum zinc levels follower by higher mean decrease of IgM anti-PGL-1 levels.   Latar Belakang: Indonesia menduduki peringkat ketiga jumlah kasus baru kusta terbanyak setelah India dan Brazil. Keluarga yang tinggal serumah memiliki resiko yang paling tinggi untuk terkena infeksi. Saat ini ditemukan beberapa penelitian yang menghubungkan kadar PGL-1 dengan defisiensi mikronutrien, salah satunya yaitu seng. Penelitian ini bertujuan untuk meneliti efek pemberian suplementasi seng elemental 40 mg per hari selama 4 minggu terhadap kadar IgM anti PGL-1. Metode: Penelitian eksperimental one group pre-test post-test design yang dilakukan pada Februari hingga Mei 2021. Sampel adalah seluruh individu narakontak dengan pasien kusta tipe multibasiler berusia 18-65 tahun yang berkunjung ke Poliklinik Kulit dan Kelamin RSUP Sanglah Denpasar selama periode penelitian berlangsung secara consecutive sampling. Anamnesis, pemeriksaan fisik, dan pengambilan sampel darah dilakukan untuk pemeriksaan IgM anti PGL-1 dan kadar serum seng. Hasil: Rerata kadar serum seng sebelum dan sesudah diberikan suplementasi yaitu 79,00±9,67 µg/dl dan 95,16±31,84 µg/dl dengan beda rerata 25,21±32,12 µg/dl (p<0,001). Rerata kadar IgM anti PGL-1 sebelum dan sesudah diberikan suplementasi yaitu 843,21±878,51 u/ml dan 465,68 ± 735,21 u/ml dengan beda rerata 377,52±309,62 u/ml (p<0,001). Uji korelasi beda rerata kadar seng dengan beda rerata kadar IgM anti PGL-1 yaitu r=0,630 dan p=0,004. Simpulan: Pemberian suplementasi seng elemental 40 mg perhari selama 4 minggu dapat meningkatkan kadar serum seng dan menurunkan kadar serum IgM anti PGL-1 pada narakontak pasien kusta tipe multibasiler (p<0,05). Semakin tinggi selisih rerata peningkatan kadar seng serum, semakin tinggi selisih rerata penurunan kadar IgM anti PGL-1.
Hubungan antara status tumor budding dengan berbagai parameter klinikopatologi pada adenokarsinoma kolorektal di RSUP Sanglah, Bali, Indonesia Luh Putu Iin Indrayani Maker; Ni Putu Sriwidyani
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (503.532 KB) | DOI: 10.15562/ism.v12i3.1123

Abstract

Background: Colorectal malignancies are common, with adenocarcinoma as the most prevalent type. Recently, studies of specific morphology like tumor budding have already started and related with tumor’s aggressivity as well as several parameters. This study aims to evaluate the association between tumor budding grade with patient age, sex, tumor location, histological grade, depth of invasion, and nodal status in colorectal adenocarcinoma at Sanglah General Hospital.Methods: This cross-sectional descriptive study used samples of intestinal resection specimens accompanied by Regional Lymph Node (RLN) removal of colorectal adenocarcinoma patients at Sanglah Hospital in 2018-2020. The sampling technique was carried out consecutively, which met the inclusion and exclusion criteria. Data on age, sex, tumor location, histologic grade, depth of invasion, and nodal status were obtained from the archives of examination results. At the same time, tumor budding data were obtained from observations of histopathological preparations with Hematoxylin-Eosin (H&E) staining. The results of the observations were tested statistically and presented descriptively. Data were analyzed with Chi-Square using SPSS version 22 for Windows.Results: Most of the study samples were 50 years old (84.0%), followed by male gender (62.0%), tumor location in the left colon (67.0%), low-grade (90.0%), T3-T4 invasion depth (77.0%), negative nodal status (60.0%), and high-tumor budding grade (51.0%). The Chi-Square test showed a significant relationship between the depth of invasion (p=0.001) and nodal status (p=0.009) variables on tumor budding grade.Conclusion: There were significant correlations between tumor budding grade and depth on invasion and nodal status. Latar Belakang: Kanker kolorektal merupakan keganasan yang sering ditemukan dengan adenokarsinoma merupakan tipe histopatologi terbanyak. Dewasa ini telah mulai diteliti morfologi spesifik yaitu tumor budding yang dikaitkan dengan agresivitas tumor maupun parameter lainnya. Penelitian ini bertujuan untuk mengetahui hubungan antara tumor budding grade dengan umur pasien, jenis kelamin, lokasi tumor, grade histopatologi, kedalaman invasi, dan status nodal pada adenokarsinoma kolorektal di RSUP Sanglah Denpasar.Metode: Penelitian deskriptif potong lintang ini menggunakan sampel spesimen reseksi usus disertai pengangkatan Kelenjar Getah Bening (KGB) regional pasien adenokarsinoma kolorektal di RSUP Sanglah tahun 2018-2020. Teknik pengambilan sampel dilakukan secara konsekutif, yang memenuhi kriteria inklusi dan eksklusi. Data umur, jenis kelamin, lokasi tumor, grade histopatologi, kedalaman invasi dan status nodal diperoleh dari arsip hasil pemeriksaan. Sedangkan data tumor budding diperoleh dari pengamatan sediaan histopatologi pewarnaan Hematoksilin-Eosin (H&E). Hasil pengamatan diuji secara statistik dan ditampilkan secara deskriptif. Data dianalisis dengan Chi-Square menggunakan SPSS versi 22 untuk Windows.Hasil: Sebagian besar sampel penelitian berusia ? 50 tahun (84,0%), diikuti dengan jenis kelamin laki-laki (62,0%), lokasi tumor pada kolon kiri (67,0%), low-grade (90,0%), kedalaman invasi T3-T4 (77,0%), status nodal negatif (60,0%), dan high-tumor budding grade (51,0%). Uji Chi-Square menunjukkan bahwa terdapat hubungan yang bermakna antara variabel kedalaman invasi (p=0,001) dan status nodal (p=0,009) terhadap tumor budding grade.Kesimpulan: Terdapat hubungan yang bermakna antara tumor budding grade dengan kedalaman invasi dan status nodal adenokarsinoma kolorektal.
Pria 80 tahun dengan tumor ganas dinding dada: laporan kasus Raissa Andi Soekrisno; Dewa Gde Mahiswara Sudiatmika; Elysanti Dwi Martadiani; Firman Parulian Sitanggang; Herman Suputra
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (708.427 KB) | DOI: 10.15562/ism.v12i3.1127

Abstract

Background: Malignant tumors that form in bone, soft tissue, or cartilage, are called sarcomas. Symptoms of these tumors vary, and may include shortness of breath, chest pain, and swelling around the tumor. Imaging such as X-rays and CT scans can be helpful, although imaging features of the few malignant chest wall tumors that are less specific, knowledge of the typical radiographic manifestations of these tumors can often make it easier for experts to differentiate between benign and malignant tumors and help lead to a more specific diagnosis.Case presentation: An 80-year-old man complains of a lump in the right chest. The results of laboratory tests showed anemia, decreased kidney function, and hypercalcemia. The CT scan of the thorax with contrast showed a solid mass in the right pleural cavity infiltrating the surrounding chest wall muscles, bilateral pneumonia, and osteolytic lesions on the spine suspected of being a metastatic process or spreading malignancy. The results of the biopsy showed a diffuse morphological appearance of immature plasma cells with an approach to the diagnosis of cutaneous infiltration plasma cell myeloma with a differential diagnosis of plasmablastic lymphoma.Conclusion: The results of X-ray imaging and CT scan of the thorax help narrow the differential diagnosis, where there is an image of a tumor on the chest wall with destruction of the surrounding bone and soft tissue and an image of infiltration into the pleura accompanied by multiple osteolytic images of the vertebrae. Assisted by a biopsy (anatomical pathology), the closest diagnosis in this patient is plasma cell myeloma chest wall.  Latar Belakang: Tumor ganas yang terbentuk pada tulang, jaringan lunak, atau kartilago disebut sarcoma. Gejala dari tumor ini bervariasi, dapat berupa sesak nafas, nyeri dada, dan pembengkakan pada sekitar tumor. Pencitraan seperti rontgen dan CT scan dapat membantu, walaupun gambaran pencitraan dari beberapa tumor ganas dinding dada kurang spesifik, pengetahuan tentang manifestasi tipikal pada radilogi dari berbagai tumor ini seringkali dapat memudahkan para ahli untuk membedakan jenis tumor jinak dan ganas dan membantu mengarahkan diagnosis yang lebih spesifik.Kasus: Seorang laki – laki berusia 80 tahun dengan keluhan benjolan di dada sebelah kanan. Hasil pemeriksaan laboratorium didapatkan hasil anemia, penurunan fungsi ginjal, dan hiperkalsemia. Hasil CT Scan thorax dengan kontras menunjukkan adanya massa solid pada cavum pleura kanan yang menginfiltrasi otot dinding dada di sekitarnya, pneumonia bilateral, serta lesi osteolitik pada tulang belakang yang dicurigai sebagai suatu proses metastase atau penyebaran keganasan. Hasil biopsi menunjukkan gambaran morfologi sebaran difus sel plasma imatur-matur dengan pendekatan pada diagnosis cutaneus infiltration plasma cell myeloma dengan diagnosis banding plasmablastic lymphoma.Simpulan: Hasil pencitraan rontgen dan CT scan thorax membantu menyempitkan diagnosis banding, di mana terdapat gambaran tumor pada dinding dada dengan destruksi tulang dan jaringan lunak di sekitarnya serta gambaran infiltrasi ke pleura disertai gambaran osteolitik multipel pada vertebrae. Dibantu dengan pemeriksaan biopsi (patologi anatomi)  maka diagnosis yang paling mendekati pada pasien ini adalah plasma cell myeloma dinding dada
Pruritus dan modalitas terapi terkini: Sebuah tinjauan pustaka Odilia Dea Novena; Ni Gusti Putu Raka Ariani
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (212.795 KB) | DOI: 10.15562/ism.v12i3.1128

Abstract

Pruritus or itching is an unpleasant feeling that causes the urge to scratch, the most common symptom found in skin diseases. Histamine and several other mediators such as opioid peptides and 5-hydroxytryptamine (5-HT) also influence the occurrence of pruritus. The prevalence of pruritus in the general population varies from 8% to 38% worldwide. Pruritus is categorized into 4 types, neuropathic, psychogenic, neurogenic, and pruriroceptive pruritus. When physically examining the skin, primary skin lesions must be distinguished from secondary lesions due to chronic scratching. Dermatological signs of chronic scratching include excoriation, lichenification, prurigo nodularis or a combination of these. Management of pruritus depends on the underlying etiology. Therapy should be focused on the underlying etiology. There are pharmacological and non-pharmacological therapies, where non-pharmacological therapies focus on avoiding precipitating factors and phototherapy. Pharmacological therapy can be in the form of topical and oral therapy. Some examples of topical therapies used in daily practice are emollients, corticosteroids, immunomodulators, capsaicin, antihistamines and topical anesthetics. Oral drugs that are currently the main choice for treating pruritus are antihistamines, but there are several other options being considered, namely anticonvulsants, opioid modulators, and antidepressants. A comprehensive history and physical examination are needed to determine the triggering factors for the onset of pruritus. The management of pruritus depends on the underlying etiology and the success of therapy is also influenced by the patient's adherence to treatment. Treatment of pruritus can be in the form of non-pharmacological therapy and pharmacological therapy. Pharmacological therapy can be both topical and systemic. Commonly used topical therapies are emollients, corticosteroids and topical anesthetics. Antihistamines remain the mainstay of systemic therapy used for pruritus. The purpose of writing this article is to discuss more deeply about the treatment modalities of pruritus which are summarized from various journals and research in order to provide consideration when choosing the right therapy in daily practice.  Pruritus atau rasa gatal adalah perasaan tidak menyenangkan yang menyebabkan keinginan untuk menggaruk merupakan gejala yang paling umum ditemukan pada penyakit kulit. Histamin dan beberapa mediator lainnya seperti peptida opiod dan 5-hidroksitriptamin (5-HT) juga memengaruhi terjadinya pruritus. Prevalensi pruritus pada populasi umum bervariasi mulai dari 8% sampai dengan 38% di seluruh dunia. Pruritus dikategorikan menjadi 4 tipe, yaitu pruritus neuropatik, psikogenik, neurogenik, dan pruriroseptif. Saat memeriksa kulit secara fisik, lesi kulit primer harus dibedakan dari lesi sekunder akibat garukan kronis. Tanda-tanda dermatologis dari garukan kronis termasuk ekskoriasi, likenifikasi, prurigo nodularis atau kombinasi dari semuanya. Penatalaksanaan pruritus bergantung pada etiologi yang mendasari. Terapi yang diberikan harus difokuskan pada etiologi yang mendasari. Terdapat terapi farmakologi dan non-farmakologi, dimana terapi non farmakologi fokus terhadap menghindari faktor pencetus serta fototerapi. Terapi farmakologi dapat berupa terapi topikal dan oral. Beberapa contoh terapi topikal yang digunakan dalam praktik sehari-hari adalah emolien, kortikosteroid, imunomodulator, capsaisin, antihistamin dan anestesi topikal. Obat oral yang hingga saat ini menjadi pilihan utama terapi pruritus adalah antihistamin, namun terdapat beberapa pilihan lain yang dipertimbangkan yaitu antikonvulsan, modulator opioid, antidepresan. Anamnesis dan pemeriksaan fisik yang komprehensif sangat diperlukan untuk mengetahui faktor pencetus timbulnya pruritus. Penatalaksanaan pruritus bergantung pada etiologi yang mendasari dan keberhasilan terapi juga dipengaruhi oleh ketaatan pasien dalam berobat. Terapi pruritus dapat berupa terapi non-farmakologis dan terapi farmakologis. Terapi farmakologis dapat berupa topikal dan sistemik. Terapi topikal yang umum digunakan adalah emolien, kortikosteroid dan anestesi topikal. Antihistamin tetap menjadi pilihan utama terapi sistemik yang digunakan untuk pruritus. Penulisan artikel ini bertujuan untuk membahas lebih dalam tentang modalitas terapi pruritus yang dirangkum dari berbagai jurnal serta penelitian agar dapat memberikan pertimbangan saat memilih terapi yang tepat dalam praktik sehari-hari.
Glioma saraf optik sebagai perluasan dari glioma cerebrii: sebuah laporan kasus Anak Agung Surya Nirmala Dewi; Putu Yuliawati; Ni Made Laksmi Utari; Anak Agung Ayu Sukartini Djelantik; I Made Agus Kusumadjaja
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1556.624 KB) | DOI: 10.15562/ism.v12i3.1129

Abstract

Introduction: Optic Nerve Gliomas (ONG) are the most common primary Cerebral Nervous System tumor in childhood with greatest tendency for growth in the first 3-5 years of life (Huang, 2020). Most children diagnosed with ONGs have neurofibromatosis type 1 (NF-1) (Simmons,2013) with painless and slowly progressive decreace of vision. Imaging investigation with CT-scan or MRI is important to diagnose patient with ONG. The aim of this paper is to report a case of optic pathway glioma resulting rapid death of a child.Case Illustration: A 7-year-old girl complained that her eyes could not see in the past 1 year and protrusion with a white spot that is getting wider in the middle of the eye on her right eye since 3 months ago. Her left eye could not see in the past 3 weeks. She also complained about pain on her head. From ophthalmology examination visual acuity both eyes are no light perception. On her right eye we found protrusion with scleral show and lagophthalmos on her right eye, periconjunctival injection with corneal edema, deep anterior chamber and IOP 47. On the left eye we found midilated pupil with decreased reflex and the posterior segment we found optic nerve head hazy demarcated, cup-disc ratio difficult to be evaluated, good retina, decreased macular reflex and macular star (+). From right eye USG we found severe vitreous opacity. The MRI result from June 15th 2020 is suggested for optich pathway glioma dd/ pylocystic astrocytoma and suspected expand to internal auditory canal dextra. The patient was diagnosed with OD Proptosis ec retrobulbar tumor susp optic nerve glioma that expand from chiasma / cerebrii + vitreous bleeding+secondary glaucoma. OS Optic Nerve Edema ec intracranial mass. The patient was planned for OD extended enucleation join op Tumor Removal from Neuro Surgery under General Anesthesia. However, the surgery was postponed due to unstable condition and patient died from septic shock 2 months after the first arrival at the eye clinic.Conclusion: Optic Nerve Glioma are the most common primary Cerebral Nervous System tumor in childhood. This patient came with decrease of vision, protrusion on her right eye and pain with MRI finding suggested for optic nerve glioma. This patient should have done surgery but her condition was unstable. Good handling and multidisciplinary cooperation in the diagnosis and management of intraocular and intracranial masses are needed to provide a good outcome for the patient. Pendahuluan: Glioma Saraf Optik (GSO) merupakan tumor otak primer yang paling banyak terjadi pada 1 dekade kehidupan dengan kecenderungan terjadi pada usia 3-5 tahun. Anak-anak yang didiagnosa dengan GSO biasanya memiliki neurofibromatosis tipe 1 (NF-1) yang timbul secara sporadik. GSO memiliki gejala penurunan penglihatan tanpa adanya rasa nyeri yang dirasakan perlahan. Pemeriksaan penunjang dalam menegakkan diagnosis GSO bisa menggunakan CT-scan ataupun MRI. Tujuan dari makalah ini adalah untuk melaporkan sebuah kasus bagaimana cara mendiagnosa glioma saraf optic pada anak-anak.Ilustrasi kasus: Pasien perempuan, 7 tahun, datang (2 Juni 2020) dengan keluhan kedua mata tidak dapat melihat sejak 1 tahun yang lalu dan mata kanan menonjol sejak 3 bulan disertai bintik putih yang semakin melebar di bagian tengah mata. Mata kiri dikatakan tidak bisa melihat sejak 3 minggu yang lalu. Nyeri kepala sering dikeluhkan oleh pasien di seluruh kepala. Pemeriksaan oftalmologi didapatkan visus kedua mata no light perception (NLP), proptosis dengan scleral show dan lagoftalmos 2 mm pada mata kanan. Konjungtiva mata kanan didapatkan injeksi perikorna dengan edema kornea. Bilik mata depan mata kanan kesan dalam. Tekanan intraokular mata kanan 47 mmHg. Middilatasi dengan penurunan reflek pupil didapatkan pada mata kiri, lensa jernih dan pada pemeriksaan segmen posterior didapatkan papil nervus optik batas kabur, cup-disc ratio (CDR) sulit dievaluasi, retina kesan baik, reflex makula menurun dengan macular star. Hasil USG mata kanan didapatkan kesan kekeruhan vitreous berat. Pada 15 Juni 2020 pasien dilakukan MRI dengan kesan mengarah pada optic pathway glioma dd/ pylocytic astrocytoma dan suspek perluasan ke regio internal auditory canal dextra. Pasien didiagnosis dengan OD proptosis ec tumor retrobulber susp glioma saraf optik yang berasal dari chiasma / cerebri + perdarahan vitreus + glaukoma sekunder, OS Papil edema ec massa intracranial dan direncanakan OD extended enukleasi join op tumor removal oleh Bedah Saraf dengan General Anestesi. Namun, pasien belum dilakukan operasi karena keadaan pasien memburuk dan meninggal akibat syok sepsis 2 bulan pasca kedatangan pertama ke poli mata. Simpulan: Glioma saraf optik merupakan tumor yang sering ditemukan pada anak-anak. Pada pasien sudah didapatkan nyeri, penurunan tajam penglihatan dan proptosis serta gambaran MRI yang mendukung diagnose glioma saraf optic. Sebaiknya pasien dilakukan tindakan pembedahan namun keadaan umum pasien tidak memungkinkan. Penanganan yang baik dan kerjasama multidisiplin dalam penegakan diagnosis dan tatalaksana massa intraocular maupun intracranial dibutuhkan untuk memberikan luaran yang baik bagi pasien.
Perbandingan efektivitas dan keamanan antara roxadustat dan epoetin alfa sebagai terapi anemia pada pasien yang menjalani hemodialisis reguler: meta analisis Kadek Wisnu Segara Karya; Ni Luh Parameswari Praptika; Nyoman Yudia Trianadewi Nurbudhi; Yenny Kandarini
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1481.005 KB) | DOI: 10.15562/ism.v12i3.1130

Abstract

Introduction: Chronic kidney disease (CKD) is a global health problem. Hemodialysis (HD) is one of the treatment modalities for end-stage renal disease which is commonly used. A complication that is often found in patients undergoing regular HD is anemia. Roxadustat is a prolyl hydroxylase inhibitor (PHI) which has a potential as an alternative therapy for anemia in patients undergoing regular HD. The aim of this meta-analysis was to compare the efficacy and safety of roxadustat and epoetin alfa as anemia management in patients undergoing regular HD.Methods: We searched the literature sources in the PubMed, MEDLINE, Cochrane, Scopus, Embase, Elsevier, and Proquest databases until June 1, 2021. The search terms used were chronic kidney disease, hemodialysis, dialysis, roxadustat, epoetin alfa, anemia management, incidence of side effects, randomize, and randomization. We excluded the study population with acute kidney injury/dyslipidemia/metabolic syndrome. All analyzes in this meta-analysis were performed using Review Manager version 5.3 (RevMan Cochrane, London, UK).Result: We have found five eligible studies (2777 patients). Funnel plots and p-Egger were examined to assess publication bias. The results showed a statistically significant difference between roxadustat and epoetin alfa with respect to the mean difference of hemoglobin (Hb) (WMD: 0.31; p<0.05), hepcidin (WMD: -18.94; p<0.05), transferrin (WMD: 67.88; p<0.05), transferrin saturation (WMD: 2.78; p<0.05), iron (WMD: 5.02; p<0.05) and risk of adverse events (OR: 1.25; p<0.05) displayed on the forest plot.Conclusion: Based on this meta-analysis, it can be concluded that anemia management with roxadustat is better than epoetin alfa in patients undergoing regular HD. Latar Belakang: Penyakit ginjal kronis (PGK) merupakan masalah kesehatan global. Hemodialisis (HD) merupakan salah satu modalitas terapi PGK stadium akhir yang umum digunakan. Komplikasi yang sering ditemukan pada pasien yang menjalani HD reguler adalah anemia. Roxadustat adalah suatu prolyl hydroxylase inhibitor (PHI) yang memiliki potensi sebagai alternatif terapi anemia pada pasien yang menjalani HD reguler. Tujuan dari meta-analisis ini adalah untuk membandingkan efektivitas dan keamanan antara roxadustat dan epoetin alfa sebagai manajemen anemia pada pasien yang menjalani HD reguler.Metode: Kami mencari sumber literatur pada database PubMed, MEDLINE, Cochrane, Scopus, Embase, Elsevier, dan Proquest hingga 1 Juni 2021. Istilah pencarian yang digunakan yaitu penyakit ginjal kronis, hemodialisis, dialisis, roxadustat, epoetin alfa, manajemen anemia, kejadian efek samping, acak, dan pengacakan. Kami mengeksklusi populasi penelitian dengan cedera ginjal akut/dislipidemia/sindrom metabolik. Semua analisis dalam meta-analisis ini dilaksanakan dengan menggunakan Review Manager versi 5.3 (RevMan Cochrane, London, UK).Hasil: Kami menemukan lima studi yang memenuhi syarat (2777 pasien). Funnel plot dan p-Egger diperiksa untuk menilai bias publikasi. Hasil menunjukkan perbedaan signifikan secara statistik antara roxadustat dan epoetin alfa terhadap perbedaan rerata dari hemoglobin (Hb) (WMD: 0,31; p<0,05), hepsidin (WMD: -18,94; p<0,05), transferin (WMD: 67,88; p<0,05), saturasi transferin (WMD: 2,78; p<0,05), zat besi (WMD: 5,02; p<0,05) dan risiko kejadian efek samping (OR: 1,25; p<0,05) yang ditampilkan pada forest plot.Kesimpulan: Berdasarkan meta-analisis ini, dapat disimpulkan bahwa manajemen anemia dengan roxadustat lebih baik dibandingkan dengan epoetin alfa pada pasien yang menjalani HD reguler.

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