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MEDICINUS

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Published by PT Dexa Medica

ISSN : 1979391X EISSN : 29638399 DOI : 10.56951

Core Subject : Health, Science,

Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

Tujuan penerbitan jurnal Medicinus adalah untuk meningkatkan wawasan dan menambah khasanah pengetahuan para praktisi medis dan farmasis di bidang kedokteran dan kefarmasian. Ruang lingkup dari jurnal ilmiah ini adalah publikasi artikel-artikel ilmiah yang bisa disajikan dalam bentuk penelitian (research), laporan kasus (case report), teknologi dan klinis kefarmasian, serta ulasan literatur medis.

Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)

Articles 179 Documents

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Hyperglycemia in Childhood Acute Lymphoblastic Leukemia during Induction Chemotherapy Nengcy Erlina Tasik Rerung; Cahyadi, Andi; Nur Rochmah; Maria Christina Shanty Larasati; Andarsini, Mia Ratwita; Muhammad Faizi; IDG Ugrasena; Bambang Permono
MEDICINUS Vol. 34 No. 1 (2021): MEDICINUS
Publisher : PT Dexa Medica

Introduction: Hyperglycemia is a well-known adverse effect of the corticosteroids and asparaginase given during induction chemotherapy for pediatric acute lymphoblastic leukemia (ALL). ALL is a type of hematologic malignancy with high incidence in the childhood. The aim of this study is to investigate the impact of hyperglycemia during induction chemotherapy in childhood ALL. Methods: This prospective study was done in Dr. Soetomo hospital from January to April 2018. The subject was newly diagnosed as ALL under the age of 18 years, treated with Indonesian childhood ALL 2013 protocol (standard risk (SR) group and high risk (HR) group). Hyperglycemia was defined as at least two separate random plasma glucose levels >200 mg/dL, which was evaluated before and during induction chemotherapy. Statistical analysis using Paired T-test for parametric and Wilcoxon test for nonparametric. Results: Thirty-three children were enrolled, 18/33 boys with mean age 5.8 (SD 3.78) years, compromised as ALL-L1 30/33. They were treated with ALL-HR 19/33 and ALL-SR 14/33. In overall groups, the mean random blood glucose level significantly increased from 108 (SD 21.3) mg/dl to 147 (SD 48.1) mg/dl, (mean difference 38.67 mg/dl; 95% CI 18.08 to 59.26 mg/dl, p=0.008). In SR group, there was a significant increase of mean random blood glucose level from 102 (SD 13.5) mg/dl to 133 (SD 37.3) mg/dl, (mean difference 31.8 mg/dl; 95% CI 8.78 to 54.8 mg/dl; p=0.01). In HR group, the mean random blood glucose level increased from 113 (SD 51.9) mg/dl to 165 (SD 25.4) mg/dl, (mean difference 51.9 mg/dl; 95% CI 18.6 to 85.2 mg/dl, p=0.004). Conclusion: Blood glucose level is significantly increase during induction chemotherapy in both SR and HR Indonesian childhood ALL 2013 protocol.

Congenital Analbuminemia Santosa, Putu Adi; Widijanti, Anik; Susianti, Hani; Intanwati, Sherly; Meilani, Rossy
MEDICINUS Vol. 33 No. 2 (2020): MEDICINUS
Publisher : PT Dexa Medica

Congenital analbuminemia (CAA) is a rare autosomal recessive disorder, characterized by the absence or very low level of serum albumin (human serum albumin/HSA) as a result of defect on chromosome 4 which encodes albumin. It is defined as albumin level <1 g/l with normal liver function and the absence of protein loss.1,2 Estimated CAA prevalence is less than 1 in 1 million.A 10-year-old boy suffered from generalized edema that got worsened since last month. The patient had been misdiagnosed with nephrotic syndrome 2 years earlier, and then became protein-losing enteropathy. Neither cough nor diarrhea were reported. The patient had history of food allergy. Physical examination showed moderately ill condition, Glasgow Coma Scale (GCS) score E4 V5 M6, blood pressure 90/50 mmHg, pulse 120 x/min, respiratory rate 30x/min, palpebral edema, shifting dullness, undulation (+), with nonpitting edema on the extremities. Laboratory findings: leukocytosis (neutrophilia), peripheral blood smear showed hypochromic microcytic anisositosis erythrocyte. AAT serum 246 mg/dl, GGT serum: 88 U/l, iron serum 28 µg/dl, TIBC 411 µg/dl, transferrin saturation 7%, total IgE 775,90 U/ml. Serum Protein Electrophoresis (SPE) results were hypoalbuminemia (1,4 g/dl), hypogammaglobulinemia (0,21 g/dl), and total protein 2,91 g/dl. Chest X-ray showed pneumonia with minimal right pleural effusion. Overestimation of serum albumin level was caused by alpha and beta globulin that were detected as albumin in bromocresol green (BCG) methods. CAA aggravated with by allergy caused malnutrition in this patient. These data support the diagnosis of CAA with sepsis and iron deficiency anemia. Suggestion for the management consist of blood culture, procalcitonin level measurement, inguinal lymph node biopsy, DNA sequence analysis, also analysis of pleural and ascites fluid.

Laporan Kasus Acrodermatitis Enteropathica pada Anak 5 Tahun dengan Level Zink Serum Normal Nareswari, Adniana; Mochtar, Moerbono; Widhiati, Suci; Kusumawardani, Arie; Ellistasari, Endra Yustin; Julianto, Indah
MEDICINUS Vol. 34 No. 1 (2021): MEDICINUS
Publisher : PT Dexa Medica

Acrodermatitis enterophatica (AE) is an inherited or acquired condition associated with zinc malabsorption. Clinical symptoms of AE are periorificial and acral dermatitis, alopecia, and diarrhea. Serum zinc levels usually decrease in AE patients. A 5-year-old boy presented with crusted erosion on the face, trunks and extremities that have been appeared for one year and worsened last month. It also accompanied by hair and eyebrow loss, diarrhea, and eating disorder. Patient was also malnourished. Dermatovenereology examination showed papules, patches, multiple erythematous plaques with squama, erosions with brownish yellow crust above located on perioral, periorbital, posterior trunk, inguinal, perianal, cubital, popliteal and dorsum pedis region. The oral region showed stomatitis and cheilitis. The orbital region showed conjunctival injection and eye discharge. The scalp, eyebrows and lashes showed total alopecia. Laboratory test showed normal serum zinc levels and decreased levels of alkaline phosphatase. The patient was diagnosed with acquired form of AE. Clinical improvement was seen after zinc supplementation. The diagnosis of AE cannot be made only by low serum zinc levels. If a classical triad of AE was found, we must be able to recognize it immediately, thus prompt and appropriate therapy could be given.

Terapi Doxycycline pada Laki-laki Homoseksual dengan Sifilis Sekunder dan Infeksi Human Immunodeficiency Virus Anggana Rafika Paramitasari; Imroatul Ulya; Agung Triana Hartati; Susanti Rosmala Dewi; Prasetyadi Mawardi
MEDICINUS Vol. 34 No. 1 (2021): MEDICINUS
Publisher : PT Dexa Medica

Background: Re-emergence of syphilis is increasing especially among MSM (men who have sex with men) patients. Syphilis in HIV-infected patients is reported to show faster and higher risk for progression to neurosyphilis. Co-infection of syphilis and human immunodeficiency virus (HIV) is correlated with decrease in CD4 and increase in HIV-RNA. Doxycycline has an antiinflammatory effect associated with decrease of HIV-RNA and increase of CD4 in HIV patients. Case: A 20 years old foreigner MSM man complained about non-itchy red spots throughout his body for 2 days with slight fever. He has a history of more than 10 sexual partners and rarely use condom. Physical examination revealed various sizes of erythematous macules and papules on his trunk and extremities. We found erythematous plaques with regular border but no ulcer on his scrotum and no secrete from his urethra. There was enlargement in the inguinal lymph node. VDRL and TPHA examinations were 1:32 and 1:640, respectively. HIV test was reactive with CD4 value 558 cells/ml. Treatment consists of doxycycline 2x100 mg for 14 days and also ARV (nevirapine, lamivudine and zidovudine). His symptoms were improved after a month accompanied with decreased VDRL to 1:2 and slightly increased CD4 to 570 cells/ml. Discussion: Doxycycline is a second line treatment for syphilis that is known to help decreasing the viral load and increasing CD4 level in syphilis with HIV. A significant decrease in VDRL titer in this patient indicates a successful therapy.

Patofisiologi dan Manajemen Terapi Sindrom Stevens-Johnson(SSJ) dan Nekrolisis Epidermal Toksik (NET) Diana, Rina; Eko Irawanto, Muhammad
MEDICINUS Vol. 33 No. 2 (2020): MEDICINUS
Publisher : PT Dexa Medica

Nekrolisis epidermis (NE) adalah sindrom reaksi mukokutan akut yang ditandai dengan nekrosis dan pengelupasan epidermis yang luas serta dapat menyebabkan kematian. Lesi awal berupa makula eritematosa, kemudian berkembang secara progresif menjadi lesi lepuh kendur dan selanjutnya terjadi pengelupasan epidermis. Berdasarkan luas permukaan tubuh yang terlibat, NE diklasifikasikan menjadi tiga kategori, yaitu sindrom Stevens-Johnson (SSJ) jika luas lesi <10%, overlap SSJ-nekrolisis epidermal toksik (SSJ-NET) jika luas lesi 10–30%, dan nekrolisis epidermal toksik (NET) jika luas lesi >30%. Patofisiologi NE belum diketahui dengan jelas hingga saat ini. Sindrom Stevens-Johnson (SSJ) dan nekrolisis epidermal toksik (NET) merupakan kondisi yang dapat menyebabkan kematian, oleh karena itu memerlukan penanganan yang cepat dan tepat. Mengidentifikasi kemungkinan penyebab dan memberikan perawatan yang diperlukan di rumah sakit diharapkan mampu meminimalisasi kejadian fatal akibat kondisi ini. Penanganan utama pada SSJ-NET adalah dengan menghentikan penggunaan substansi yang dicurigai sebagai penyebab. Terapi lain yang dapat diberikan masih cukup kontroversial, seperti pemberian corticosteroid, IVIG, plasmapheeresis, dan ciclosporin.

Tata Laksana Oral Mukositis pada Keganasan Anak Siska Natalia Situmeang; Bidasari Lubis; Nelly Rosdiana; Selvi Nafianti; Olga Rasiyanti Siregar
MEDICINUS Vol 34 No 1 (2021): MEDICINUS
Publisher : PT Dexa Medica

Malignant disease or cancer is a disease caused abnormal growth of certain cells, characterized continuous, unlimited growth, uncoordinated with surrounding tissue and not functioning physiologically. According to the National Cancer Institute, there was a significant increase in the number of pediatric cancers in United States from 13.8 per 100,000 children in 1973 to 17.6 per 100,000 children in 2005. Chemotherapy shows high efficacy in the treatment of cancer in children, especially on cancer that can not be treated by surgery or radiation alone. Radiation therapy can be used as a curative therapy to reduce tumor size or as palliative to alleviate symptoms. However, the administration of chemotherapy and radiotherapy associated with many side effects. Mucositis is a reactive process that resembles inflammation on the oropharynx mucous membranes, and often accour as the side effect of chemotherapy or radiotherapy. Management of oral mucositis in children who receive chemoradiation varies, both pharmacologically and nonpharmacologically. At present, there is no gold standard for management of oral mucositis in children.

Clinical and Epidemiological Characteristics of Severe and Very Severe Pneumonia in Infants Mustiko MD, Hedi; Setyoningrum MD, Retno Asih
MEDICINUS Vol. 33 No. 2 (2020): MEDICINUS
Publisher : PT Dexa Medica

Background: Childhood pneumonia is a leading cause of mortality and morbidity in developing countries. World Health Organization (WHO) stated that pneumonia is the cause of mortality of around 1.2 million children under 5 years per year. The high incidence of very severe pneumonia cases with preventable risk factors become the background of this study.Purpose: The aim of our study was to describe clinical and epidemiological characteristics of severe and very severe pneumonia in infants and children.Methods: This is a descriptive cross-sectional study. The study were conducted from January 2017 to December 2018. We obtained clinical and demographic data of each patient based on medical records.The diagnosis of pneumonia was made clinically based on the Indonesian Ministry of Health criteria. Prematurity was defined as babies born with gestational age less than 37 weeks, low birth weight was defined as babies with birth weight less than 2500 grams. The nutritional status of children is clinically and anthropometrically evaluated using 2006 WHO curve of weight-by-age. Results: A total of 465 patients were diagnosed with pneumonia during 48 months study. 212 patients were excluded and 253 pneumonia patients met the inclusion criteria, 140 patients with very severe pneumonia and 113 patients with severe pneumonia. Among 253 patients, 141 were boys. 125 patients were 2-5 months of age. 71 patients were born with low birth weight and 62 patients had history of preterm birth. There were 86 patients receiving exclusive breastfeeding and 138 patients with complete immunization status. There were 131 patients with moderate and severe malnutrition, and 127 patients with comorbidity factors. 94 patients developed pneumonia with suspected bacterial causative agents.Conclusion: Lower age, prematurity, low birth weight, poor nutritional status, exclusive breastfeeding, comorbidities, and suspected bacterial causative agents are common characteristics of severe and very severe pneumonia in infants and children in Dr. Soetomo Surabaya.

Anestesi Spinal Levobupivacaine Isobarik pada Sectio Caesarea Nasman Puar
MEDICINUS Vol. 34 No. 1 (2021): MEDICINUS
Publisher : PT Dexa Medica

Sectio caesarea (SC) atau operasi sesar merupakan metode persalinan di mana janin dilahirkan melalui insisi pada dinding rahim. Menurut WHO, jumlah tindakan sectio caesarea pada tahun 2011 dilaporkan mengalami peningkatan 5 kali dibandingkan dengan tahun-tahun sebelumnya. Penggunaan teknik anestesi yang aman dan efektif pada tindakan sectio caesarea membutuhkan pemahaman yang menyeluruh mengenai perubahan fisiologi yang terjadi pada kehamilan, proses melahirkan, dan kelahiran bayi. Salah satu agen anestesi lokal yang sering digunakan untuk anestesi spinal adalah bupivacaine. Bupivacaine adalah obat anestesi lokal jenis amida yang memiliki masa kerja panjang dan mula kerja yang pendek. Bupivacaine merupakan campuran rasemat dari isomer optik levobupivacaine dan dextrobupivacaine dengan perbandingan yang sama, yang dikenal juga sebagai enantiomer S(-) dan R(+). Levobupivacaine adalah enantiomer S(-) murni dari bupivacaine dengan profil toksisitas yang lebih minimal terhadap sistem saraf dan kardiovaskular. Penelitian menunjukkan bahwa penggunaan levobupivacaine isobarik pada pasien yang menjalani tindakan sectio caesarea menghasilkan efek yang sebanding dengan bupivacaine hiperbarik dengan profil keamanan yang lebih baik.

Manifestasi Klinis Covid-19 pada Kulit Iswinarno Doso Saputro; Medisa Primasari
MEDICINUS Vol. 34 No. 1 (2021): MEDICINUS
Publisher : PT Dexa Medica

Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) is a strain of coronavirus that causes Coronavirus Disease 2019 (Covid-19). The first case was reported in the city of Wuhan, China, through the consumption of bush meat which presumed to be the reservoir of the virus. Human-to-human transmission occurs through respiratory droplet inhalation or touching contaminated surfaces, then without washing hands, virus may enter the body through contact with mucous membrane in the eyes, nose, or mouth. Covid-19 manifested in various level of severity among individuals, from mild, severe, critical, or even symptom-free. Clinical manifestations are not specific and vary among individuals. Common symptoms are fever, cough, fatigue, shortness of breath, upper respiratory symptoms, gastrointestinal disorders, loss of taste or smell, also presentation of skin manifestation. Skin manifestation associated with Covid-19 also varies and may appear at different times without being followed by other symptoms. Laboratory tests, imaging test, and identification of genetic material of SARS-CoV-2 are necessary to confirm the diagnosis of COVID-19.

Breast Lumpectomy Surgery by Pectoral Nerve Block (Pecs Block) without General Anesthesia – A Case Report Ida Bagus Reza Nanda Iswara; Wayan Widana
MEDICINUS Vol. 34 No. 1 (2021): MEDICINUS
Publisher : PT Dexa Medica

Breast conserving surgery is usually performed under general anesthesia, or more recently combined with regional anesthesia techniques. Thoracic spinal block, thoracic epidural block, and thoracic paravertebral block are options of regional anesthesia that have been used in breast surgery, but anesthesiologists avoid them due to concern in potency of complications and side effects. After introduced by Blanco in 2011, pectoral nerves (Pecs) block appears as alternative procedure with fewer complications and lower incident of postoperative pain. In this case report we describe a 32-year-old female patient admitted for elective lumpectomy of the left upper quadrant of the breast. Ultrasound guided Pecs II block was chosen as the anesthetic technique for this patient. The authors reported succesful management of anesthesia and pain without complications in breast surgery. Pecs II block as single anesthetic technique can be considered safe, advantageous, and effective in breast surgery with good hemodinamic stability and few side effects.

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Editorial Address Gedung Titan Center 5th Floor, Jl. Boulevard Bintaro B7/B1 No. 5, Bintaro Jaya Sektor 7, Pokdok Aren, Tangerang Selatan 15224

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Contact Name
Ratna Kumalasari

Contact Email
medicinus@dexagroup.com

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+6287808191388

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medicinus@dexagroup.com

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Gedung Titan Center 5th Floor, Jl. Boulevard Bintaro B7/B1 No. 5, Bintaro Jaya Sektor 7, Pokdok Aren, Tangerang Selatan 15224

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