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BALI MEDICAL JOURNAL (BMJ)
Published by Universitas Udayana
ISSN : -     EISSN : -     DOI : -
Core Subject : Health,
Medicine & Pharmacology
Bali Medical Journal (BMJ), P-ISSN 2089-1180, E-ISSN 2302-2914 is an international and peer-reviewed journal published quarterly in print and online by Sanglah General Hospital in collaboration to Indonesian Physician Forum and Indonesian College of Surgeon, Bali-Indonesia which was founded in 2011. The Journal aims to bridge and integrate the intellectual, methodological, and substantive diversity of medical scholarship, and to encourage a vigorous dialogue between medical scholars and practitioners. The Journal welcomes contributions which promote the exchange of ideas and rational discourse between practicing educators and medical researchers all over the world.
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Articles 29 Documents
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Search results for , issue "Vol 5 No 2 (2016)" : 29 Documents clear
Hospital Accreditation: What is its Effect on Quality and Safety Indicators? Experience of an Iranian Teaching Hospital Janati, Ali; Sadegh, Tabrizi Jafar; Toofan, Firooz; Algalandis, Khadijeh Nadim; Ebrahimoghli, Reza
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Abstract

Background: program evaluation is an integral and expected component in the development of any healthcare program. It helps decision-makers to base their decisions on facts. Objective: This paper analyzes the effect of accreditation on three indicators related to patient safety and hospital care quality in ICU wards of an Iranian teaching hospital. Methods: This interventional study was accomplished based on executive management and scientific methods such as plan-do-check-act (PDCA) cycle and audit to improve quality and safety. We used data reported from ICU wards of the hospital to analyze the effect of accreditation on the three selected indicators. (SPSS) version 22.00 was used for the statistical analysis. Results: In total, 6997 patients were analyzed. The accreditation interventions appeared to be effective at reducing pressure ulcer incidence average (from an average of 6.8 percent to 4.1 percent) (p=0.045). The accreditation also. The average stays of the patients during the study also positively changed from an average of 1.58 days to 10.13 days (1.45 improvements) (p=0.0303). In relation to hospital acquired infection but, unexpectedly, its effect on hospital was negative, then it considerably increased and rose from 1.5 percent to 8.1 percent (p=0.001). However, this increasing was due to enhanced infection incident report system. Conclusion: hospital accreditation has presented ample opportunity a significant positive effect on hospitals.
Relation between Fiber Diet and Appendicitis Incidence in Children at H. Adam Malik Central Hospital Medan North Sumatra-Indonesia Damanik, Boyke; Fikri, Erjan; Nasution, Iqbal Pahlevi
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Background: Appendicitis is the most occurred acute abdominal case found in children.1 In United States of America alone, there were 250,000 cases annually. The ratio between boys and girls are 3:2, with most cases caused by late diagnosis and the morbidity factor. Previous studies found that there’s a relation between eating patterns, fiber diet and food hygiene as risk factors for appendicitis.1, 2 At the time this paper is written, there hasn’t been any study that explains the relation between appendicitis and the diet pattern of children from various places in Indonesia. Another condition that further motivates this study is a common conception that children hate to consume vegetables and fruits, which contain the much-needed fiber. Obstruction of the appendix lumen is the main cause of inflammation in the appendix. Fecalith makes up one third of appendicitis cases, which is consists of fats (coprosterols), inorganic salts (calcium phosphate), and organic residual (fibers).3 Other causes including obstruction process by hypertrophy of mural lymphoid follicle as a response from the inflammation of the appendix lumen.3 Obstruction of appendix lumen can be caused by low fiber diet, which causes fecalith to build up in appendix lumen.4 The mechanism of lumen appendix inflammation can be caused by lymphoid hyperplasia, fecalith buildup, foreign object or parasite.4 Therefore, a study needs to be done to determine the mortality prediction easier, more efficient, and not static, in which it’s harder to measure the therapeutic response. In this case, lactate clearance is hoped to have the capability to determine the mortality rate in patients with severe sepsis. Method: This research is an analytic with cross-sectional design. The subjects were 35 child patients with appendicitis in RSHAM which fulfilled the criteria of severe sepsis diagnosis, and were receiving treatment in the period of January-December 2014. Results: Male children are the majority of the patients (62.9%) with average age of 11.89 ± 4.16. Laparotomy is the most administered treatment (54.3%), and most of the subjects have low-fiber diet (54.3%). 19 of the subjects have perforated appendicitis (54.3%). Conclusion: There’s a significant correlation between low-fiber diet with appendicitis incidence (p=0.0001). From the 19 patients with low-fiber diet, 14 of them (73.7%) have acute appendicitis. Meanwhile only 2 of the patients (12.5%) with high-fiber diet have acute appendicitis.
High Ki-67 and Vascular Endothelial Growth Factor (VEGF) Protein Expression as Negative Predictive Factor for Combined Neoadjuvant Chemotherapy in Young Age Stage III Breast Cancer Sudarsa, I. W.; Manuaba, I. B. Tjakra W.; Maliawan, Sri; Sutirtayasa, I. W. P.
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Abstract

Background: Breast cancer was, in general, a heterogeneous disease with diverse biological characteristics, types, subtypes and clinical behavior. Its treatment and management need to be personalized and individualized. Breast cancer in young ages, although rare, is usually a unique and more aggressive cancer associated with poorer prognosis. The combination of young age and advanced stages of breast cancer would make this particular breast cancer harder to treat and cure. Unfortunately, majority of Breast Cancer Patients in Bali were in younger ages, and at advanced stages, that the mainstay of treatment was neo adjuvant chemotherapy followed by other treatment modalities. Improve prognosis only, those patients who had had a complete pathological response involving primary tumor and regional lymph nodes in the axilla. Several factors had been studied and contributed to breast cancer response to combined neo-adjuvant chemotherapy. Usually, younger patients, was associated with high proliferation rate represented by Ki-67 and early distant metastasis represented by VEGF, which also had role as prognostic markers. The purpose of this study was to determine whether high Ki-67 and VEGF expression correlate with response to NAC and hence, they would be important predictive factors for response to NAC. Method: This study was a cross-sectional and a nested case-control study of stage III breast cancers affecting patients 40 years of age or less, at Sanglah General Hospital and Prima Medika Hospital, conducted from September 1st, 2012 until March 31st, 2014. Clinical and pathology reports were traced and recorded from both hospitals; routine Immunohistochemistry (IHC) examinations were performed by both pathology labs. Statistical analysis was performed using Chi-Square test, Odds Ratio (OR), and logistic regression analysis with p
In connection with the publication in Bali Med J 2016, Volume 5, Number 2: 25-29, entitled "Intra-Arterial Heparin Flushing Increases Manual Muscle Test – Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient " Machfoed, Moh Hasan; Usman, Fritz Sumantri; Barus, Jimmy; Wreksoatmodjo, Budi Riyanto; Gunawan, Dede; Bintang, Andi Kurnia; Tugasworo, Dodik; Subroto, Gatot; Lamsudin, Rusdi; Harsono, H.; Sulthan, Riza
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Abstract

In connection with the publication in Bali Med J 2016, Volume 5, Number 2: 25-29,entitled "Intra-Arterial Heparin Flushing Increases Manual Muscle Test – Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient ", herewith, please allow us to do reviews of the study discussion. By assessing the discussion, it can be proved whether there are references that support the results of study.
Antihypertensive and Antioxidant Potential of Purple Sweet Potato Tuber Dry Extract in Hypertensive Rats Jawi, I Made; Sutirta-Yasa, I. W. P.; Mahendra, Agung Nova
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Abstract

Background: Purple sweet potato tuber extract in liquid form, shown to lower blood pressure of hypertensive rats and hypertensive patients. Liquid dosage form, increasingly unstable when stored for long periods, thus it is necessary to find a more stable dosage form. The objective of this research was to prove that dry extract of purple sweet potato tuber has the same effects with liquid extract in hypertensive rats. Method: The is a randomized pre-test and post-test control group design study. Thirty hypertensive model rats were divided into 5 groups (6 animals for each group). Group 1 was treated as a control group. Group 2 to group 5 were treated as treatment groups. Treatment groups were given liquid extract at a dose of 3 ml, dry extract with the dose of 200 mg, dry extract that stored in a certain time with a dose of 200 mg and given a mixture of dry extract with a carrier substance (capsule formula) with a dose of 200 mg, respectively, for 4 weeks. Variables observed were blood pressure, SOD and MDA level of the blood. Results: The results showed that the group given the purple sweet potato tuber extract lowers blood pressure were significantly in liquid extract or dry extract (p <0.01). The group that was treated with capsule formula showed more decrease in blood pressure than dry extract group (p <0.01). The similar results happened on MDA and SOD level in blood. Conclusions: Thus, it can be concluded that dried extract of purple sweet potato tubers has the same effectiveness with liquid extract, both as an antihypertensive and also antioxidant. Capsules formula is more effective than liquid extract and dry extract.
Cinnamon Extract Effect on Osteoblast Activity in Diabetic Wistar Rats Andiwijaya, Fahrin Ramadan; Prihatanto, Fundhy Sinar Ikrar; Susanto, Hermawan
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Background: Diabetes is clinically known to cause prolongation to bone fracture healing. This research aims to find the effect of cinnamon in the process of bone remodeling, and changes in the activity of osteoblast cells in diabetic bone after giving cinnamon as a supplement in diabetic rats. Method: The design employed was experimental with randomized post-test group design research. A total of 24 Wistar Rats was randomly divided into four groups, which consist of normal without treatment, normal with treatment, diabetic without treatment and diabetic with treatment. Treatment of 300 mg/kg cinnamon extract was given per orally. Upon euthanizing the samples, femur samples were taken and processed to histopathological slides. All slides were analyzed under light microscopes to find the osteoblast cells. The Kruskal-Wallis method was used to test the results; due to the population of sample was not normally distributed. Results: The osteoblast cells found were scored in mean ranks. The normal group mean rank 12.25, normal with treatment group 12.17, diabetic without treatment group 8.58, and diabetic with treatment group 17.00. Asymptotic significance was 0.195. Conclusion: This research concludes that there is no significant increase in osteoblast activity in diabetic Wistar rats after the administration of 300 mg/kg cinnamon extract.
Management of Spinal Tuberculosis (TB) in Developing Country Mahadewa, Tjokorda G. B.
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Background: Tuberculosis on the spine is involved approximately 1 % of all tuberculosis cases. It is a lethal type of TB skeletal due to highly neurologic compromised because of adjacent medullary compression and incidence kyphotic deformity. Early diagnosis and management of this disease is mandatory to prevent serious complications. Method: Serial case report was conducted in Sanglah General Hospital from January 2014 until December 2015. All patients were diagnosed based on local protocol using appropriate imaging technique. All patients were treated by anti-tuberculosis drugs for 2 weeks followed by functional assessment by MMT, ASIA, and JOA. Result: The author reported 10 patients of spinal TB whom were treated in Sanglah Hospital, Bali between January 2014-Desember 2015. Among pts 8 male and 2 female with location of spinal TB i.e 4 in thoracal, 4 in lumbal and 2 in cervicothoracal. Preoperative ASIA scale was an average scale C and postoperative ASIA scale was in D. The average JOA pre-surgical score was 10.5 and postsurgical was 14.5. Improvement using the formula JOA achieved with an average of 21.6 %. All patients neurologically improved, no complications and surgical implant failures in this series. Conclusions: Surgical management of spinal tuberculosis, if delivered with appropriate indication, proved to be effective in correcting spinal kyphosis. Early management is mandatory in order to ensure better prognosis.
Fetal Sex Determination Using Cell-Free Fetal Dna (cffDNA) in Maternal Blood Sanjaya, I Nyoman Hariyasa; Suwardewa, Tjok Gde Agung; Arijana, I G. Kamasan N.
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Background: Prenatal test has routinely performed in antenatal care and has become a part of the obstetric care feature in many countries. Prenatal test is divided into screening and diagnostic test. Recently, the early noninvasive method in order to found and lessen the risk factors of pregnancy loss, has been studied. One of the methods is molecular test using cffDNA which has many screening purpose such as sex determination, aneuploidy, paternal inherited genetic disorder, fetus rhesus, and performed early at 7 weeks of pregnancy. Objective: The purpose of this study is to measure diagnostic value of cffDNA in determining fetal sex prenatally. Methods: In a diagnostic test study, 18 randomized samples were selected and divided based on fetal gender confirmed at birth. The group consisted of 9 pregnant women with male babies and 9 pregnant women with female babies. CffDNA then isolated from maternal blood sample and specific region in Y chromosome termed SRY is detected by PCR and electrophoresis. The data obtained analyzed both descriptively for baseline characteristic and analytically to determine its diagnostic value. Results: This study found significant correlation between SRY detection in cffDNA with male fetal phenotype (p<0.05). The sensitivity of the method is 100% with 89% specificity. In addition, we found 9.09 values for positive likelihood ratio (LR+) and 0 for negative likelihood ratio (LR-). Moreover, the result yielded 100% positive predictive value (PPV+) and 88.8% of negative predictive value (PPV-). Conclusion: This study proofed that cffDNA have a great diagnostic value to determine fetal sex prenatally. However, further study with several group of gestational age mother and better matching is required to further confirm the diagnostic potential of cffDNA.
The Characteristics of Cervical Cancer Patients Who Underwent a Radical Hysterectomy at Sanglah Hospital Denpasar in 2015 Mahendra, I Nyoman Bayu
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Background: Cervical cancer is the most common gynecologic cancer in women. It is the main cause of cancer-related death in women in developing countries. Cervical cancer in Indonesia is the second most cancer affecting Indonesian women and the prevalence is relatively stable in the last 30 years. Cervical cancer was closely related to the histologic type of itself. A squamous cell carcinoma has a specific route of local spreading and a lymphatic route. The sample of this study are cervical cancer patients who underwent a radical hysterectomy from January 1 to December 31, 2015 in Sanglah Hospital Denpasar, Bali. The aim of this study is to discover the characteristics of the patients by age, parity, education level, marital status, sexual activity, the first symptoms and the early screening done, and the clinical staging. Methods: This descriptive study involved 20 patients in Sanglah Hospital Denpasar who had a radical hysterectomy from January 1 until December 31, 2015. The characteristics are gathered from the patients’ medical record. Results: The most cases done radical hysterectomy between 41-45 years old which proportion was 40%, the most parity was parity 2 (60%), elementary school was the most education level (35%), all of the samples only married once and sexually active, the most first symptom was vaginal bleeding (55%), only 10% had pap smear as early detection, and the most clinical stage was stage IIB (50%).
Lactate Clearance: Predictor for Mortality and Therapeutic Response on Severe Sepsis Patient Siregar, Edwin Saleh; Purnama, Andriana; Rudiman, Reno
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Abstract

Background: Severe sepsis and septic shock are at high mortality rate. This high mortality persists as important aspect in the term of patient treatment which take account in determining aggressiveness of relevant therapy. Lactate level consideration was considered important among patient under shock, septicemia, post-operative, acute lung injury, and critical condition. Lactate concentration in static blood was widely studied and suggested as prognostic value among severe sepsis and septic shock patient due to the nature of lactate as the result of anaerobic metabolism. Several study documented the use of lactate as prognostic indicator for shock condition. The increase of lactate concentration could be useful as the indicator of inadequate oxygen delivery and the existence of anaerobic metabolism. Lactate clearance investigation is more superior therapeutic target compared with others oxygen derivate variables. Methods: This research is a cohort observational study involving secondary data which was collected from laboratory examination results of study subjects. The research held from August 2015 to December 2015 in Digestive Division, Surgery Department, Hasan Sadikin Hospital. 42 patient involved in this study. Results: Comparative test results revealed significant lactate clearance based on mortality in LCH (6) (p = 0.000) and H (24) (p =0.000) as well. The level of LC H (6) and H (24) seemed lower in died patient compared with life patient. Conclusion: This study concluded that lactate clearance in died patient was lower in comparison with life patient.

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