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WMJ (Warmadewa Medical Journal)
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Published by Universitas Warmadewa
ISSN : 25274627     EISSN : 25799010     DOI : doi.org/10.22225/wmj
Core Subject : Health,
Health Professions Medicine & Pharmacology
WMJ (Warmadewa Medical Journal) is the Journal of Medicine & Health, contains scientific articles (Original/ Research Articles, Review Articles, Case Reports) by academic community of the Faculty of Medicine and Health Sciences Warmadewa University, other Faculties of Medicine and Health Sciences and other related Institutions. It is the medium for hardskill and softskills development as an integral part of the Tri Dharma Perguruan Tinggi (Education, Research, Public Service) and health services in the forms of media of communication, information, scientific education, as a subsystem of Medicine and Health holistic and comprehensive services.
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Articles 117 Documents
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Jumlah Profil Pasien dengan Gaster Perforasi di RSUD Tabanan Tahun 2021-2022: - I Putu Gosen Partama; Made Kurniawan; I Gusti Ngurah Sumantri; Anak Agung Gede Indraningrat
WMJ (Warmadewa Medical Journal) Vol 10 No 2 (2025): November
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.10.2.9550.70-74

Abstract

Gastric perforation is a life-threatening surgical emergency that frequently arises as a complication of peptic ulcer disease and carries a high mortality rate. This study aimed to describe the clinical profile and outcomes of gastric perforation patients treated at Tabanan Hospital. A retrospective review of medical records was conducted for all gastric perforation cases from January 2021 to December 2022. Seventeen patients were identified. Most were older than 50 years (94%) and female (65%). More than half had no formal education and were unemployed. A history of nonsteroidal anti-inflammatory drug use was present in 59% of cases. Most patients arrived more than 6 hours after symptom onset, and many presented in critical condition, including shock (24%), tachypnea (76%), and acute kidney injury (53%). Intraoperatively, most perforations were located in the gastric antrum (65%) and measured 1–2 cm (82%). Postoperatively, hypoalbuminemia (94%), sepsis (35%), and pneumonia (24%) were common. The in-hospital mortality rate was 29%. In conclusion, gastric perforation at our institution predominantly affected elderly patients, with delayed presentation, severe initial clinical status, and high complication and mortality rates. Enhanced community awareness of ulcer symptoms, early referral, rational NSAID use, and timely surgical intervention are essential to improving outcomes.
Role of Secretome in Age-related Changes in the Male Reproductive System: An Add-on Review on the Gut-Brain Axis Gembong Satria Mahardhika; Norina Agatri
WMJ (Warmadewa Medical Journal) Vol 10 No 2 (2025): November
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.10.2.10116.110-116

Abstract

Humans are unable to prevent the ageing process. The secretome is a group of bioactive molecules released by cells that may exert paracrine effects on adjacent cells. Recent research indicates that the cellular secretome of mesenchymal stem cells (MSCs) may be useful in the management of idiopathic male infertility. This narrative review was derived from journal articles retrieved through various search engines, including PubMed, Google Scholar, and EBSCO, which were used to compile the reference list. Subsequently, relevant information and journals were collected and reviewed by the authors. The secretome can be examined from multiple perspectives. It may be linked to morphological, histological, and physiological changes in the male reproductive system associated with ageing. These processes may be improved by incorporating the secretome as an anti-inflammatory, anti-apoptotic, and anti-aging agent. Normal gut–testis microbial cooperation supports overall health. Food intake or illness can disrupt the gut microbiota, triggering a cascade that affects fertility. Dysbiotic conditions increase inflammatory markers and damage the gut epithelium, allowing bacteria and inflammatory cytokines to enter the circulation. The secretome also plays a role in balancing the microbiome within the gut–brain axis, thereby contributing to the prevention of fertility impairment. The presence of the secretome may serve as a modulatory factor for age-related changes in male reproductive function, particularly fertility components. Further investigation through additional related studies and systematic reviews is needed to enhance understanding of the relationship between these variables.
The Relationship Between Hypertension and Mortality in COVID-19 Patients at Soedirman M. S. Wonogiri Hospital Devisda Shafiy Anisa; Desie Dwi Wisudanti; Pipiet Wulandari
WMJ (Warmadewa Medical Journal) Vol 10 No 2 (2025): November
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.10.2.12434.80-87

Abstract

According to data from the Ministry of Health of the Republic of Indonesia, there were 6,103,533 confirmed positive cases of COVID-19, with 156,776 deaths. One factor contributing to the high mortality rate of COVID-19 is the presence of comorbidities. Hypertension and diabetes mellitus are the most common comorbidities found in COVID-19 patients. In cases of hypertension, the SARS-CoV-2 virus can interfere with blood pressure regulation, resulting in sustained increases in blood pressure in infected patients. If this condition is not managed, organ damage may occur and worsen the patient’s clinical status. This study aims to evaluate the effect of comorbid hypertension on the mortality of COVID-19 patients at dr. Soediran M. S. Wonogiri Hospital. This research employed an analytical observational method with a cross-sectional design. Medical record data from 94 COVID-19 patients, consisting of 47 patients with hypertension and 47 patients without hypertension, were analyzed using the Chi-square test. The highest age distribution among COVID-19 patients was in the 51–60-year age group (21.3%). The results showed a significant association between comorbid hypertension and mortality in COVID-19 patients (p = 0.001), with an RR value of 1.27. COVID-19 patients with comorbid hypertension were 1.27 times more likely to die than those without hypertension. This study provides a better understanding of health risks in COVID-19 patients with comorbid hypertension and may assist in developing more effective health policies.
Early Parenteral Nutrition (PN) As A Mortality Risk Factor in COVID-19 Patients at the Intensive Care Unit (ICU) of RSUP Dr. Kariadi Putu Prayoga Ratha; Niken Puruhita; Aryu Candra; Siti Fatimah Muis; Enny Probosari
WMJ (Warmadewa Medical Journal) Vol 10 No 2 (2025): November
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.10.2.12741.56-69

Abstract

Mortality in COVID-19 patients in the ICU is reported to be higher than non-ICU. Early parenteral nutrition is avoided considering the complications, but COVID-19 patients in the ICU require parenteral nutrition because enteral intake is inadequate or contraindicated. This study aims to identify early parenteral nutrition and other risk factors that cause mortality of COVID-19 patients in the ICU of Dr. Kariadi Hospital. Observational analytic study using a retrospective cohort approach using secondary data involving COVID-19 patients treated in the ICU of RSUP dr. Kariadi in March – September 2020. The sampling technique used total sampling with the following criteria: inclusion: confirmed COVID-19, age >18 years and given PN and EN therapy or a combination thereof. Statistical analysis using Chi Square test and Logistic Regression. Total of 188 subjects met the inclusion criteria. There was no difference in the mortality of patients who were given early or late PN p:0.92 RR 0.90 (95% CI 0.43-1.84). The risk factors for mortality were the presence of comorbidities p=0.023 RR 2.13 (95% CI 1.15-3.95), use of VM p=<0.0001 RR 43.68 (95% CI 18.52 – 102.99) , energy deficit p=0.002 RR 3.09 (95% CI 1.52-5.99) and protein deficit p=0.039 RR 1.93 (95% CI 1.07-3.49). In the multivariate analysis of controlled VM usage with ARDS status p=0.022 RR 6.20 (95% CI 1.29 – 29.72) and energy deficit p=0.045 RR 2.15 (1.01 – 4.57) together -the same as a risk factor for mortality in COVID-19 patients in the ICU of Dr. Kariadi Hospital. Early PN is not a risk factor for mortality in COVID-19 patients while the use of VM is controlled by ARDS status and energy deficit together are risk factors for mortality in COVID-19 patients in the ICU of RSUP dr. Kariadi.
Infark Miokard Non-Segmen Elevasi ST pada Kasus Fraktur Terbuka Multipel: Laporan Kasus Made Ratih Santi Devinta; I Gusti Agung Bagus Krisna Jayantika
WMJ (Warmadewa Medical Journal) Vol 10 No 2 (2025): November
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.10.2.13400.75-79

Abstract

Myocardial infarction (MI) generally occurs due to coronary atherosclerosis. However, under certain circumstances, trauma can act as a trigger for MI. This case report discusses the occurrence of NSTEMI in a patient with multiple open fractures and explores several hypotheses that may contribute to the development of myocardial infarction in the setting of non-thoracic trauma. A 53-year-old man presented to the emergency department following a motorcycle accident. He was treated for multiple open fractures and developed a myocardial infarction on the first day of hospitalization, approximately 40 hours after the trauma. Electrocardiography (ECG) revealed no significant ST-segment changes, while high-sensitivity troponin I levels were markedly elevated at 609.5 ng/mL, and the hemoglobin level was 8.3 g/dL. The patient was co-managed with the cardiology team and received dual antiplatelet therapy (DAPT) and anticoagulation. The orthopedic procedure was postponed until hemodynamic stability was achieved. Myocardial infarction following an open fracture may occur due to rupture of an atherosclerotic plaque, an imbalance between myocardial oxygen supply and demand, and/or increased pro-inflammatory mediators resulting from the bone remodeling process or post-traumatic stress. Myocardial infarction in the setting of open fractures may result from atherosclerotic plaque rupture, oxygen supply–demand imbalance, and/or elevated pro-inflammatory mediators associated with bone remodeling or post-traumatic stress. Increased awareness of potential cardiovascular complications is essential, particularly in trauma patients with pre-existing cardiovascular risk factors.
Bridging Knowledge and Readiness: The Relationship Between Menstrual Awareness and Menarche Preparedness Among Elementary School Girls in Badung, Bali Hesteria Friska Armynia Subratha; Nabila Amelia Hanisyah Putri; Nis&#039;atul Khoiroh; Made Suadnyani Pasek; Ida Ayu Diah Purnama Sari; Luh Ita Mahendrayani
WMJ (Warmadewa Medical Journal) Vol 10 No 2 (2025): November
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.10.2.13646.101-109

Abstract

Menarche represents a key developmental transition in early adolescence, making it essential to understand how menstrual knowledge shapes girls’ preparedness for this event. This cross-sectional study examined the relationship between menstrual knowledge and menarche preparedness among elementary school girls in Badung, Bali. A total of 150 students in grades 4–6 from five public schools, purposively selected due to low literacy and numeracy indicators, participated in the study. Data were collected using validated, self-administered questionnaires assessing menstrual knowledge and preparedness. Chi-square analysis with Odds Ratio (OR) estimation was employed. Most participants demonstrated good menstrual knowledge (60.0%) and were categorized as prepared for menarche (63.3%). A significant association was observed between menstrual knowledge and preparedness (p < 0.001; OR = 5.50; 95% CI: 2.65–11.41), indicating that students with higher knowledge levels were substantially more likely to be well prepared. Parental support and exposure to information from schools or health professionals also appeared to contribute to improved preparedness. These findings underscore the importance of strengthening school-based reproductive health education, complemented by active family engagement and culturally appropriate learning materials, to enhance early menarche readiness among young girls.
Nutritional Status and Food Preference Differences Among Primary School Students in Karangasem, Bali Mellysa Kowara; I Putu Suiraoka; Yessi Crosita Octaria; Eny Kurnia Sari; Agnes A Malipu
WMJ (Warmadewa Medical Journal) Vol 10 No 2 (2025): November
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.10.2.13770.88-100

Abstract

Nutritional status during primary school age is essential for optimal physical growth and cognitive development. Dietary transitions driven by modernization—including increased consumption of fast foods and sweetened beverages—may reduce the intake of nutrient-dense foods. This study aimed to describe the nutritional status and food preferences of students at SDN 2 Besakih, Karangasem, Bali. A cross-sectional study was conducted. Anthropometric measurements were obtained from all students present (n = 211) and assessed using BMI-for-age and height-for-age indicators based on WHO AnthroPlus standards. Food preference data were collected from 72 students selected through stratified sampling using a pictorial Likert-scale questionnaire. Data were analysed using univariate, bivariate, and multifactorial tests. Most students exhibited normal nutritional status, although both undernutrition and overnutrition were present. The leftward shift in BMI-for-age and height-for-age z-score curves indicated vulnerability to undernutrition and stunting. Female students demonstrated significantly higher preference scores for chicken dishes (p = 0.003) and milk-based or sweetened beverages (p = 0.009). Grade level influenced preferences for chicken dishes and beverages, with no significant interaction between gender and grade. Vegetable preference was relatively low across all groups. Primary school children in rural Karangasem face a double burden of malnutrition accompanied by shifting dietary preferences toward less balanced food choices. Strengthening school-based nutrition interventions, including nutrition education, healthy canteen programs, and routine growth monitoring, is critical to fostering healthy dietary habits early in life.
Potensi Penggunaan Materi Genetik Fetus pada Sirkulasi Maternal untuk Diagnosis Prenatal Noninvasif Penyakit Genetik Anak Agung Dewi Megawati; Ita M. Nainggolan; Agung Nova Mahendra; Nanis S. Marzuki
WMJ (Warmadewa Medical Journal) Vol 1 No 1 (2016): Mei 2016
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.1.1.4.1-9

Abstract

Diagnosis prenatal adalah teknik diagnostik untuk menentukan kondisi fetus yang belum lahir apakah memiliki kelainan genetik ataupun kelainan lainnya. Teknik ini umumnya dilakukan pada penyakit genetik yang tidak dapat diobati di mana terminasi menjadi bahan pertimbangan. Teknik ini juga dilakukan pada kasus yang memerlukan penanganan segera pada saat prenatal dan pada kondisi yang dapat menimbulkan morbiditas atau mortalitas pada ibu. Diagnosis prenatal dapat dilakukan melalui metode invasif dan noninvasif. Metode invasif seperti amniocentesis dan biopsi villi korialis (CVS) memiliki resiko menimbulkan kecacatan bahkan kematian fetus. Pendekatan nonivasif melalui ultrasonografi belum cukup akurat untuk diagnosis penyakit genetik, sehingga masih memerlukan pengambilan sampel fetus untuk menegakkan diagnosis. Pendekatan terbaru pengambilan sampel fetus secara noninvasif dilakukan melalui pengambilan sel fetus, DNA dan mRNA fetus yang terdapat dalam sirkulasi darah maternal. Pada artikel ini dipaparkan mengenai perkembangan riset, kendala, serta potensi aplikasi klinis ketiga metode pengambilan sampel fetus tersebut.Kata kunci: diagnosis prenatal nonivasif, penyakit genetik, cell-free fetal DNA/mRNA, sel fetus.  [Potential Use of Fetal Genetic Material in Maternal Circulation for Prenatal Noninvasive Diagnosis of Genetic Disease].Prenatal diagnostic technique is used to determine whether the unborn fetus is affected with a genetic disorder or other abnormality. This technique is generally carried out for a genetic disease that is not treatable, in which the termination should be considered. This technique is also performed in cases that require immediate action during the prenatal period and in conditions that can lead to morbidity or mortality of the mother. Prenatal diagnosis can be done by invasive and noninvasive methods. Invasive methods such as amniocentesis and chorionic villus sampling (CVS) have a risk of causing disability and even death of the fetus. While noninvasive approach by ultrasound is not sufficiently accurate for the diagnosis of genetic diseases, therefore further  fetal sampling is required. Noninvasive prenatal diagnosis is a new type of genetic testing done through taking fetal cells, fetal DNA and mRNA, which are found in maternal blood circulation. In this review, we present development of research, constraints, and potential clinical applications of these three methods for noninvasive sampling of the fetus.Keywords: noninvasive prenatal diagnosis, genetic disease, cell-free fetal DNA/mRNA, fetal cell.
Korelasi Kadar Angiopoietin-2 Plasma dan Petanda Inflamasi Dengan Resistensi Insulin Pada Penderita Obesitas Abdominal Anak Agung Gede Budhitresna
WMJ (Warmadewa Medical Journal) Vol 1 No 1 (2016): Mei 2016
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.1.1.5.10-16

Abstract

Obesitas abdominal (Ob-Ab) merupakan komponen utama resistensi insulin (RI) yaitu kekutan pendorong utama untuk terjadinya diabetes mellitus (DM)  tipe-2. Kadar angiopoietin-2  (Ang-2) plasma dilaporkan mengalami peningkatan pada  penderita Ob-Ab dan diduga bahwa Ang-2 berpengaruh untuk terjadinya RI. Tujuan penelitian ini adalah untuk mengetahui korelasi kadar Ang-2, Inflamasi dan RI pada penderita Ob-Ab. Dilakukan penelitian secara cross-sectional analitik pada 81 penderita dengan Ob-Ab. Kadar  TNF-α, sTNFR1 dan Ang-2 plasma diukur menggunakan metode ELISA. RI diukur menggunakan HOMA-IR. Analisis varian (ANOVA) dipergunakan untuk mengetahui persamaan variabel kontinyu. Analisis multivariat dipergunakan untuk mengetahui peran kadar TNF-α, s-TNFR-1, Ang-2 terhadap RI. Model analisis jalur (path analysis) dipergunakan untuk mengetahui pengaruh faktor risiko terjadinya RI. Hasil penelitian menunjukkan bahwa kadar TNF-α plasma tidak berkorelasi dengan HOMA-IR, sedangkan sTNFR-1 dan  Ang-2 plasma berkorelasi positif bermakna dengan HOMA-IR (masing-masing r=0,323; p=0,003 dan r=0,641; p=<0,001). Pada analisis multivariat ditemukan Ang-2 merupakan faktor bebas berhubungan dengan HOMA-IR (p=<0,001). Kadar Ang-2 plasma yang tinggi merupakan faktor dominan (64,1%, p=<0,001). Simpulan: pada penderita Ob-Ab kadar Ang-2 berkorelasi dengan terjadinya RI dan inflamasi.Kata kunci: Ang-2, resistensi insulin, inflamasi, obesitas abdominal. [Correlation of Plasma Angiopoietin-2 and Inflammation Marker with Insulin Resistence in Patients with Central Obesity]Abdominal obesity (Ab-Ob) is a central component of insulin resistance (IR) and it is suggested that IR is a driving factor in the development of type 2 diabetes mellitus (T2DM).  Plasma Ang-2 levels have been reported to increase in the Ab-Ob and it has been hypothesized that Ang-2 plays important role in the occurrence of IR. We assessed the relationship between plasma Ang-2 levels, Inflammation and IR in Ab-Ob. A cross-sectional analytic study on 81 abdominally obese subjects was performed. The concentrations of TNF-α, sTNFR1 and Ang-2 plasma were measured using ELISA method. IR was measured using HOMA-IR. Analysis of variance (ANOVA) was used to test the equality of continuous variables. Multivariate analyses were performed to examine the influence of TNF-α, s-TNFR-1, and Ang-2 on IR. Path analysis models were performed to assess the influence of risk factors on occurrence of IR. Plasma of TNF-α was not correlated with HOMA-IR (r=160; p=0.154) whereasTNFR-1 and Ang-2 were significantly positive correlated with HOMA-IR (r=0.323, p=0.003 and r=0.641, p=<0.001, respectively).  The multivariate analysis showed Ang-2 was independently associated with HOMA-IR (p <0.001). It was found that high Ang-2 level was a dominant risk factor (64.1%, p=<0.001) for influencing IR in the abdominally obese subjects. It is concluded that plasma Ang-2 level is correlated with occurrence of IR and inflammation in abdominally obese subjects.Keywords: Ang-2, insulin resistance, inflammation, abdominal-obesity.
Penggunaan Metode Role playing Meningkatkan Nilai Ujian Akhir Mahasiswa Blok Profesionalisme Kedokteran Luh Gede Sri Yenny; I Made Wandia
WMJ (Warmadewa Medical Journal) Vol 1 No 1 (2016): Mei 2016
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.1.1.6.17-23

Abstract

Pendidikan profesionalisme kedokteran merupakan  salah satu komponen kurikulum yang sangat penting dalam kurikulum pendidikan dokter. Pengembangan dan perbaikan modul Blok Profesionalisme Kedokteran merupakan jembatan untuk menghasilkan lulusan kedokteran yang mampu bersikap dan berperilaku professional. Pengembangan modul dapat dilakukan dengan berbagai cara salah satunya yaitu dengan menerapkan metode role playing. Penerapan metode role playing dilakukan pada Blok Profesionalisme Kedokteran 2012 dan dibandingkan dengan Blok Profesionalisme kedokteran 2011 dimana pada saat itu metode role playing belum diterapkan. Penelitian ini bertujuan untuk mengetahui apakah terjadi peningkatan nilai ujian akhir mahasiswa, jumlah lulusan dan motivasi mahasiswa untuk belajar mandiri. Didapatkan kelulusan yang lebih tinggi pada Blok Profesionalisme Kedokteran 2012 dibandingkan dengan Blok Profesionalisme Kedokteran 2011 yaitu 83.7%: 32.2%. Terdapat hubungan yang bermakna antara penggunaan metode role playing dengan nilai ujian akhir mahasiswa (p<0.05) dan dengan kelulusan (p<0.05). Sebagian besar mahasiswa merasa lebih termotivasi untuk belajar profesionalisme kedokteran (94.55%). Penggunaan metode role playing dapat meningkatkan nilai ujian akhir, jumlah lulusan dan motivasi mahasiswa untuk belajar mandiri Blok Profesionalisme Kedokteran 2012.Kata Kunci: role playing, profesionalisme kedokteran, pendidikan kedokteran.[Role Playing Increases Students’ Scores of Final Examination in the Block Medical Professionalism].Medical professionalism education is one of very important curriculum components in medical education. Development and improvement of the module of the Block Medical Professionalism are the bridge to yielding a good, capable and professional medical doctor. The development of the module can be conducted in various ways, one of which is by applying the method of role playing. Role playing method applied at Block Medical Professionalism of 2012 was compared to Block Medical Professionalism of 201in which role playing was not applied This research aimed to assess if there was  increase of the result score of the students’ final test, total  number of passing students, and students’ self motivation to study  individually. The study results showed a higher number of passing students   in medical professionalism block of 2012  as compared to medical professionalism block of 2011 (83.7% vs 32.2%). There was a significant correlation between role playing and the mean score of the students’ final test (p<0.05) and with the number of passing students (p<0.05). Most student felt more motivated to learn medical professionalism (94.55%). Application of role playing method can improve the final test score, total number of passing students, and students’ self motivation to study medical professionalism of 2012.Key words: role playing, medical professionalism, medical education.

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