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Medicina
Published by Universitas Udayana
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Medicine & Pharmacology
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Articles 234 Documents
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PENGARUH METFORMIN DOSIS RENDAH JANGKA PENDEK TERHADAP RISIKO BERKEMBANGNYA MENJADI DM TIPE-2 PADA PREDIABETES NON OBES Hardiman, Djoko
Medicina Vol 39 No 1 (2008): Januari 2008
Publisher : Medicina

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Abstract

Metformin was reported to decrease the risk of type-2 DM establishment in the obese prediabetic individual. While whether low-dose short-term metformin administration decrease the risk of type-2 DM establishment in the non-obese prediabetic individual was not yet reported so far. The study was to determine if insulin resistance control by low-dose short-term metformin administration in the non-obese prediabetic individual might decrease the risk of type-2 DM establishment. The present study was prospective, experimental study with pretest-posttest control group design. It was conducted on the first degree relative of the type-2 DM patient who met the criteria of non obese prediabetic individual. Subjects were randomly classified into treatment group (designed for metformin administration), and the control group (designed for placebo administration). The prediction of atherosclerosis risk was based on the formula of Insulin Resistance In dex (IRI). The results show that significant difference between pre and post metformin administration term were p=0.003, p=0.051 and p=0,259 for insulin level, insulin 2 hrs postprandial and IRI in the treatment and control group, respectively. While for the fasting glucose level and glucose 2 hrs post-prandial level, the significant differences were p=0.004 and p=0.395 in the treatment and control group, respectively. The study concluded that the low-dose short-term metformin administration might significantly decrease the risk of type-2 DM establishment in the non-obese prediabetic individual.
Emboli koroner sebagai komplikasi penutupan defek septum ventrikel transkateter dengan amplatzer duct occluder –II pada pasien berusia 2 tahun Putra, AA Sg Mas Meiswaryasti; Pradnyana, Bagus Ari; Gunawijaya, Eka
Medicina Vol 47 No 2 (2016): Mei 2016
Publisher : Medicina

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Abstract

Sejak pelaporan pertama penutupan defek septum ventrikel (DSV) transkateter pada tahun 1988, tindakan penutupan DSV berbasis pendekatan transkateter ini merupakan alternatif dari penutupan secara pembedahan dengan angka mortalitas dan morbiditas yang dapat diterima dengan hasil yang memuaskan. Beberapa komplikasi tindakan ini yang telah dilaporkan adalah gangguan irama jantung, regurgitasi katup, device embolization, haemolisis, haematoma, dan demam. Emboli koroner merupakan komplikasi peri-prosedural yang jarang terjadi. Kami melaporkan seorang anak perempuan berusia 2 tahun yang menjalani penutupan DSV transkateter dengan menggunakan amplatzer duct occluder-II, saat tindakan tampak elevasi segmen ST lead III dan aVF pada monitor elektrokardiografi. Pemeriksaan aortografi menunjukkan suatu oklusi total pada proksimal arteri koroner kanan, sedangkan arteri anterior descending dan sirkumfleks kiri normal. Intervensi koroner perkutan (IKP) dilakukan untuk evakuasi trombus. Restorasi aliran koroner bagian distal berhasil dilakukan dan pasien membaik tanpa komplikasi. Since the first report of transcatheter ventricular septal defect (VSD) closure in 1988, this catheter-based approach for VSD has been shown to be an alternative to surgical closure with acceptable mortality and morbidity as well as encouraging results. Some of its complications had been reported including heart rhythm disturbances, valvular regurgitation, device embolization, haemolysis, haematoma, and fever. Coronary embolism is a rare peri-procedural complication of this procedure. We reported a 2 year old girl who underwent transcatheter VSD closure using amplatzer duct occluder-II, during the procedure electrocardiography on monitor showed ST elevation in Lead III and aVF. The aortography revealed total occlusion with thrombus at proximal right coronary artery, the left anterior descending and left circumflex arteries were normal. Percutaneus coronary intervention was done for removing the thrombus. Restoration of distal coronary flow was achieved and patient recovery was uncomplicated.
OBESITY IS ASSOCIATED WITH HYPERTENSION IN ADOLESCENTS Hendy, Hendy; Lanang Sidiartha, I Gusti; Putu Nilawati, Gusti Ayu
Medicina Vol 44 No 3 (2013): September 2013
Publisher : Medicina

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Abstract

Obesity has become a global issue. Previous studies in Bali reveal an increase in the proportionof obesity in adolescents. Obesity causes hypertension; hence there should also be an increase inthe prevalence of hypertension as well in Bali. Hypertension in obese adolescents could be causedby various factors, hence identification of the risks factors is crucial as a preventive approach.The aim of this study was to prove an association between obesity and hypertension in adolescents,and to look for the risk factors. We used an analitical cross sectional design conducted to 12-14years old samples. We took body weight, height, waist circumference, hip circumference, andblood pressure measurements with appropriate devices and asked for information regarding lifestyle and familial history by a questionnare filled in by the samples. The association of obeseadolescents with hypertension and their risk factors was analyzed by Chi-square and multivariatetests. A total of 225 subjects from Santo Yoseph junior high school students, west Denpasar,Bali, met the inclusion criteria. The proportion of obese subjects in this study was 25.7%. Wefound that proportion in familial history of obesity was greater in obese than non-obese subjects(70.7 % vs 41.3%). Logistic regression test revealed that obese subjects with hypertension had abody mass index (BMI) > 30 with odds ratio of 7.3 (CI 95% = 1.8 to 28.8) and P = 0.005. Weconcluded that there was an association between obesity and adolescents with hypertension,and BMI > 30 could be a risk factor for obese adolescents with hypertension.
EVENTRATION OF DIAPHRAGM Eka Pratiwi, I G A P; Purniti, P Siadi; Subanada, IB; Putu Yasa, Ketut
Medicina Vol 39 No 1 (2008): Januari 2008
Publisher : Medicina

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Abstract

Eventration of diaphragm (ED) refers to an abnormally high position of part or all of the diaphragm, but intact diaphragm, usually associated with a marked decrease in muscle fibers and a membranous appearance of the abnormal area with only the peripheral thoracic attachments showing normal muscle. Etiologically ED is congenital or acquired. Congenital diaphragmatic abnormalities occur in 1 per 2000 to 4000 birth, which 7% is diaphragmatic eventration. Most children with ED are asymptomatic when incidentally first seen, will not need theraphy. Those with symptoms develop acute respiratory distress, feeding difficulties, and recurrent pneumonitis. If the patient need assissted ventilation or cannot be weaned off the ventilator, she or he should be plicated. Failure to achieve extubation within a week of plication is an ominous prognostic sign. We reported a case of one month and four days old girl who was dispnea, feeding difficulty and bronchopneumonia caused by right ED with acquired etiology. Plication was done to repaired the symptom. But unfortunately this was not succeded because there was complication of postoperative treatment.
CRYOTHERAPY PADA DESCEMETOCELE REKUREN POST-PERIOSTEAL GRAFT : LAPORAN KASUS PADA KERATOKONJUNGTIVITIS GONOKOKUS Yenny K, Nyoman; Susila, NK Niti; Budayanti, Nyoman Sri
Medicina Vol 46 No 3 (2015): September 2015
Publisher : Medicina

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Abstract

Keratokonjungtivitis gonokokus disebabkan oleh Neisseria gonorrhoeae, kokus gram negatif yangmenginvasi epitel kornea intak menyebabkan keratolisis stroma kornea hingga perforasi. Membrandescemet merupakan barrier terhadap mikroorganisme, namun ketika ditembus oleh mikroorganisme,akan  menonjol ke depan membentuk descemetocele. Dilaporkan satu kasus descemetocele padakeratokonjungtivitis gonokokus pada wanita usia 45 tahun di Rumah Sakit Umum Pusat SanglahDenpasar. Penderita mengeluh pandangan buram, kotoran mata kekuningan, kental sejak 6 hari,kelopak mata bengkak dan bintik hitam di mata kanan. Tajam penglihatan mata kanan 5/60.Pemeriksaan oftalmologi pada mata kanan didapat udem palpebra , konjungtiva sekret mukopurulenmasif, conjunctival vascular injection dan pericorneal vascular injection, udemkornea dan descemetoceledi jam 1, ukuran  3x2 mm, bilik mata depan dangkal dan fibrin, iris retraksi, pupil ireguler dan reflekpupil negatif, lensa tertutup fibrin, vitreus sulit dievaluasi, reflek fundus positif. Pada penderita telahdilakukan periosteal graft namun flap bergeser sehingga dilakukan tindakan ulangan cryotherapy yangmemberikan hasil baik. [MEDICINA 2015;46:184-8]Gonococcus keratoconjunctivitis caused by Neisseria gonorrhoeae, a gram-negative coccus thatinvading intact corneal epithel causing keratolysis until perforation. Descemet membrane is a barrierfor microorganism, but when penetrated by microorganism, it will bulging forming descemetocele.Wereported a case descemetoceleon gonococcus keratoconjunctivitis of a 45 years old woman in SanglahHospital-Denpasar.Patient complained blurry vision, white-yellowish secrete, purulent since 6 days,palpebra edema, and black dot on right eye. Right eye visual acuity was 5/60. Ophthalmologyexamination of palpebra was edema, massive conjunctival mucopurulene secrete, conjunctival vascularinjection, pericorneal vascular injection, corneal edema, and descemetocele at 1o’clock hour, size 3x2mm, shallow anterior chamber and fibrin, iris retracted, irregular pupil, negative pupil reflex, fibrincovered by lens, can not evaluated vitreous, funduscopy reflex positive.Patient had been treated withgraft periosteal but then the flap was sliding, so we treated patient with cryotherapy and gave goodresult. [MEDICINA 2015;46:184-8].
RETINOBLASTOMA FAMILIAL IN A 3-YEAR-OLD GIRL Wini Mardewi, Kadek; Ariawati, Ketut
Medicina Vol 44 No 2 (2013): Mei 2013
Publisher : Medicina

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Abstract

Retinoblastoma is the commonest intraocular tumor in childhood. About one thirds  of all cases are bilateral. It is recognized that bilateral and familial retinoblastoma are cause by germline mutation and are thus a heritable tumor. We reported a case, 3-year-old girl showing proptosis of the right eye since six months before admission. She had family history (his father) of retinoblastoma. Physical examination showed mass of the righ eye and leucorea of the left eye. Computed tomography scan showed  retinoblastoma extraoccular of the right eye and retinoblastoma intraoccular of the left eye without spread to the pinealis gland or Parsellar. Bone marrow aspration showed non hemopoitic cell (metastatic tumor). Patient was diagnosed with bilateral retinoblastoma familial grade V. Despite the management of this patient is chemotherapy and still on treatment chemotherapy continuous phase, the prognosis still worse. [MEDICINA 2013;44:128-134]
LEVEL OF NUTTRITION ADEQUACY, PHYSICAL ACTIVITY AND NUTRITIONAL STATUS OF YOUNG MEN ATHLETES SOCCER SENIOR HIGH SCHOOL IN DENPASAR 2011 Karyamitha, Ni Luh Gede; Tresna Adhi, Kadek
Medicina Vol 43 No 2 (2012): Mei 2012
Publisher : Medicina

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Abstract

Soccer is a favorite sport for  people around the world including in Indonesia. Not only the method of training or talent that will determine the achievement, but the intake of daily nutrients directly proper also provide a positive influence on performance and achievements of athletes. The purpose of this study was to determine the adequacy of nutrition, physical activity, and nutritional status of young men athletes soccer. This study useds cross-sectional method. The number of samples taken as much as 96 athletes from all senior high schools in Denpasar and selected systematic random sampling. Results showed the average level of nutritional adequacy of athletes still in the category of less (<80%). Respectively for energy, carbohydrates, proteins, and fats are 75.95%, 77.24%, 78.96% and 75.83%. If seen the proportion of athletes that sufficient levels of nutrients in enough categories, then each for energy, carbohydrates, proteins, and fats are 58.3%, 57.3%, 51%, and 53.1%. Level of physical activity in athletes only low (56.3%) and moderate category (43.8%). Most athletes have normal nutritional status (94.8%), there was only 1% having thin status, and 4.2% had nutritional status of overweight. The advice can be given to provide knowledges that related with intake of nutrients for the coaches and athletes, increasing physical activity for athletes who have low physical activity, and can be the nutritional status as a selection soccer athletes. However, further research can be done is to measure the physical endurance athletes associated with the intake of nutrients or physical activity.
Dampakanemiapadafungsikognitifpasiengeriatri yangdirawatdiRumah Sakit Umum Pusat Sanglah Denpasar Laksono, Baskoro Tri; Kuswardhani, RA Tuty
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Abstract

Anemiamerupakanmasalahyang seringdijumpai padagolongan geriatrikdengankonsekuensi yangserius. Belumbanyak penelitian yang meneliti pengaruh anemia terhadap fungsi kognitif. Penelitianinibertujuanuntukmengetahuihubungan antaraanemiadangangguan kognitif pada pasiengeriatrik yang dirawat di RSUP Sanglah Denpasar.Penelitianinimerupakan studianalisispotong-lintang. Penelitiandilakukanpadapasiengeriatri (usia?60tahun)yangdirawat di BagianPenyakit Dalam RSUP Sanglah Denpasar. Sebanyak121pasien terdaftar dalampenelitian ini.Status anemia dan fungsi kognitif didefinisikan dengan menggunakan kriteria WHOdan mini-mental stateexamination(MMSE). Uji Chi-square atauFisher-exact digunakanuntuk menguji signifikansi antara keduanya.Risikodiperkirakan menggunakanrasioodds (RO) dan interval kepercayaan(IK) 95%. Prevalens anemia dangangguan kognitifpada pasiengeriatrikyangdirawat diRSUPSanglahadalah62,8%dan47,2%. Gangguan kognitiflebih umumterjadi di kalangan perempuan dibanding lelaki (50,88%vs 49,12%) dan pasien usia ?70 tahundibandingkan<70 tahun(63,15%vs 36,84%). Tidakditemukanhubunganyang signifikan antara anemia dangangguan kognitifpadapasiengeriatri (P=0,32).Disimpulkan bahwa tidak adahubungan antaraanemiadangangguankognitifpada pasiengeriatriyang dirawatdiRSUP Sanglah Denpasar.[MEDICINA.2016;50(3):6-9].Anemia isa common problem with serious consequences ingeriatricpatients but the impact of anemia on cognitivefunction has not been extensivelystudied.The aimof this study wasto evaluate the association between anemia andcognitive impairment in hospitalizedgeriatric patients at Sanglah Hospital Denpasar. This was a hospital-basedanalytic cross-sectional study. The data were derived from the medical records ofgeriatricpatients (age?60 years)admitted toDepartment ofInternal Medicine SanglahHospitalDenpsar. A total of 121elderly patients were enrolled.Anemic status and cognitivefunction were defined using WHO-criteria andmini-mental state examination(MMSE)questionnaires, respectively. Chi-square or Fisher-exact test wasused to test thesignificance between 2 proportions.The risk was estimated by usingoddsratio(OR) and 95%confidence interval(CI). The overall-prevalence of anemiaand cognitive impairment among hospitalized elderly patients was 62.8% and 47.2%, respectively. Cognitiveimpairment was more prevalent infemalethan male (50.88% vs. 49.12%) and inpatientswith the age>70 vs<70years(63.15% vs. 36.84%). We found no significantassociationbetween anemia and cognitive impairment ingeriatricpatient (P=0.32). It was concluded that there is no association between anemia and cognitive impairment inhospitalizedgeriatricpatientsatSanglah hospital.[MEDICINA.2016;50(3):6-9].
PENATALAKSANAAN ANESTESI PADA BAYI DENGAN EMPHYSEMATOUS BULLOSA KONGENITAL Supradnyawati, Ni Made; Kurniyanta, Putu; Heryana Putra, Kadek Agus
Medicina Vol 45 No 2 (2014): Mei 2014
Publisher : Medicina

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Abstract

Emphysematous bullosakongenital merupakan penyebab distress respirasi yang jarang dijumpai, umumnya pada usia neonatus sampai enam bulan pertama. Insiden dilaporkan sebesar 1:70.000- 1:90.000 kelahiran hidup dan biasanya disertai dengan kelainan kongenital lainnya. Etiologi tidak diketahui, namun diduga terjadi akibat displasi kartilago bronkial. Hiperinflasi dan udara yang terperangkap secara progresif akan menimbulkan ekspansi paru ke sisi yang sehat, mendesak parenkim yang sehat, pergeseran mediastinum, dan mengganggu aliran darah balik vena.Secara klinis ditandai dengan distress napas yang semakin memburuk akibat akumulasi progresif udara pada lobus yang sakit. Kami melaporkan kasus pada bayi perempuan berusia 1 bulan, dengan keluhan sesak napas yang semakin memberat sejak 1 minggu sebelumnya. Diagnosis ditegakkan dari klinis, foto dada, dan computed tomography scan dada. Tindakan torakotomi lobektomi lobus medius telah dilakukan untuk menghilangkan lesi desak ruang sekaligus melindungi jaringan paru fungsional.Penatalaksanaan anestesi menitikberatkan pada saat induksi. Pemberian ventilasi manual secara gentle, menghindari pemberian ventilasi tekanan positif dan penggunaan N2O sampai torakotomi dilakukan untuk mencegahpeningkatan volume lobus yangmengalami emphysematous, serta pemberian analgesi perioperatif yang adekuat.Bila terjadi ekspansi lobus emphysematoussecara tiba-tiba, seorang dokter bedah harus siap melakukan torakotomi dengan segera. Pasien ini menunjukkan perkembangan yang baik dan akhirnya pulang pada hari ke-5 pascaoperasi. [MEDICINA 2014;45:134-8]  
A 7 YEAR-7-MONTH OLD BOY WITH LEUKEMIC RETINOPATHY Rini Suari, Ni Made; **, Widnyana; Budhiastra, Putu
Medicina Vol 44 No 1 (2013): Januari 2013
Publisher : Medicina

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Abstract

Ocular problems in patient with leukemia which are called leukemic retinopathy and subhyaloid hemorrhage is one of its feature. Subhyaloid hemorrhage in children with acute lymphoblastic leukemia (ALL) is rarely happened. We reported a boy 7 year 7 month old, complained sudden blurred vision on his both eyes and diagnosed with acute lymphoblastic leukemia. When patient had complained his vision, result of routine hematology showed anemia, thrombocytopenia, and leukocytosis. Treatment of leukemic retinopathy in this patient was supportive and causal therapy with transfusion of thrombocyte concentrate, hydration for leukocytosis, giving chemotherapy intrathecal methotrexate and systemic (vincristine, daunorubicin, L-asparginase). We found gradually undergone resolution of subhyaloid hemorrhages, visible flame shaped thin, and his vision recovered nearly completely to 6/6 OD and 6/20 OS

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