Background: Papillary thyroid carcinoma (PTC) is the most prevalent subtype of thyroid cancer, accounting for 80–85% of thyroid malignancies. Diagnosis is primarily established through fine needle aspiration biopsy (FNAB) categorized by the Bethesda system. Thyroid dysfunction and elevated inflammatory markers are commonly associated with advanced stages of thyroid cancer. Case Presentation: A 51-year-old male presented with a gradually enlarging left neck mass over four years, accompanied by hoarseness and a history of discontinued chemotherapy. Laboratory findings revealed an elevated erythrocyte sedimentation rate (107 mm/hour), mild anemia (Hb 10 g/dL), hyperuricemia (7.5–11.5 mg/dL), and a hyperthyroid profile with FT4 3.63 ng/dL and suppressed TSHs (<0.05 mIU/L). MRI demonstrated a left thyroid mass with multiple lymphadenopathies. FNAB identified typical features of papillary carcinoma, including follicular epithelial cells, intranuclear inclusions, and papillary structures, consistent with Bethesda category VI papillary thyroid adenocarcinoma. The patient was treated with systemic chemotherapy using doxorubicin and cisplatin. Conclusion: This case underscores the value of integrating clinical, laboratory, and cytopathological assessments in diagnosing papillary thyroid carcinoma. A Bethesda VI FNAB result provides a definitive diagnosis, while laboratory abnormalities corroborate systemic malignancy. Multimodal therapy with systemic chemotherapy is a reasonable option in patients with regional metastasis. Latar Belakang: Karsinoma tiroid papiler (KTP) merupakan jenis kanker tiroid yang paling sering ditemukan, mencakup sekitar 80–85% dari seluruh keganasan tiroid. Diagnosis biasanya ditegakkan melalui aspirasi jarum halus (FNAB) dengan sistem klasifikasi Bethesda. Gangguan fungsi tiroid serta peningkatan marker inflamasi sering dijumpai pada keganasan tiroid stadium lanjut. Presentasi Kasus: Seorang laki-laki berusia 51 tahun datang dengan benjolan di leher kiri yang membesar progresif selama empat tahun terakhir, disertai suara serak dan riwayat kemoterapi yang terhenti. Pemeriksaan laboratorium menunjukkan laju endap darah (LED) 107 mm/jam, anemia ringan (Hb 10 g/dL), hiperurisemia (7,5–11,5 mg/dL), serta pola hipertiroid dengan FT4 3,63 ng/dL dan TSHs <0,05 mIU/L. MRI memperlihatkan massa tiroid kiri dengan limfadenopati multipel. FNAB menunjukkan ciri khas karsinoma papiler berupa sel epitel folikel, inklusi intranuklear, dan pola pertumbuhan papiler, sesuai dengan kategori Bethesda VI adenokarsinoma papiler tiroid. Pasien menjalani kemoterapi sistemik dengan doxorubicin dan cisplatin. Kesimpulan: Kasus ini menekankan pentingnya mengintegrasikan data klinis, laboratorium, dan sitopatologi dalam menegakkan diagnosis karsinoma tiroid papiler. Hasil FNAB Bethesda VI memberikan konfirmasi diagnosis, sementara kelainan laboratorium mendukung adanya proses keganasan sistemik. Pendekatan multimodal dengan kemoterapi sistemik dapat menjadi pilihan rasional pada kasus dengan metastasis regional.
Background: Meningioma is a tumor that originates from meningothelial cells in the brain, and 4% of all meningiomas are orbital tumors. Most meningiomas are benign, develop slowly, and often do not cause any symptoms initially. MRI and marker examinations can predict Meningioma. Hematological examination related to inflammatory markers can provide information. This mechanism is not clearly understood yet, but many cases have used NLR as a marker of systemic inflammation associated with cancer. This research aimed to determine the differences in NLR levels between meningioma patients and controls. Methods: This research was a cross-sectional analytical study and a historical control. Researchers compared the results of a group of meningioma patients from 2018 until June 2023, with a control group of healthy ophthalmology residents that did not receive treatment, with a total of 60 subjects. This will be analyzed descriptively, bivariately, and using an ANCOVA test. Results: The Mann-Whitney test yielded a median value of 2.285 in the meningioma group, with an interquartile range (IQR) of 2.2, while in the control group, it was 1.845 with an IQR of 0.69. Analysis of Covariance (ANCOVA) found that the NLR levels were not statistically significantly different (p=0.104). Conclusions: There is a difference in NLR levels in meningioma patients when compared to controls.
Introduction: There have been very few cases of glioma in the corpus callosum documented this far. Butterfly glioblastoma in the corpus callosum is 2.9% of all instances and the median overall survival is six months. Gliomas frequently cause headaches, elevated intracranial pressure, cognitive decline (difficulty thinking and understanding, memory issues), seizures, and personality changes. Central vertigo, however, is not a typical symptom of corpus callosum glioma, according to the literature Central vertigo is an uncommon early symptom in patients with butterfly glioma in the corpus callosum, and this case report intends to describe a patient with this condition who experienced it. Case Presentation: A 75-year-old male patient came to the emergency room with complaints of dizziness, nausea, and vomiting. After 3 days of treatment in the hospital, the patient complained of a severe headache. Motor examination found hemiparesis flaccid dextra grade 4. Sensory examination was normal, the patient said there were no complaints about vision. Nystagmus was positive. MRI examination of the head with contrast showed an impression that pointed to a butterfly glioma of the posterior corpus callosum (splenium) with a differential diagnosis of primary CNS lymphoma. The patient in this case was diagnosed with central vertigo et causa primary cerebral tumor (butterfly glioma) with a differential diagnosis of primary CNS lymphoma. Conclusion: In this case, patient with butterfly glioma had vertigo as an early symptom, where vertigo is a rare manifestation in cases of butterfly glioma in the corpus callosum. In glioma patients, symptoms generally show headache, vomiting, seizures, decreased consciousness as symptoms of increased intracranial pressure (ICP). In previous studies, vertigo was rarely found as an early manifestation in cases of glioma and vertigo symptoms can be caused by pressure on the cerebellum. Further examination is needed to determine the exact diagnosis of the case. Pendahuluan: Glioma pada corpus callosum merupakan kasus yang jarang dilaporkan hingga saat ini. Prevalensi glioblastoma butterfly pada corpus callosum adalah 2,9% dari semua kasus dan median overall survival mencapai 6 bulan. Gejala umum glioma meliputi gejala peningkatan tekanan intrakranial, sakit kepala, penurunan kognitif (masalah memori, kesulitan berpikir dan memahami), kejang, dan perubahan kepribadian. Namun, menurut literatur, vertigo sentral bukan merupakan manifestasi umum dari glioma corpus callosum. Manifestasi ini dapat terjadi karena adanya desakan di cerebellum. Laporan kasus ini bertujuan untuk memaparkan kasus pasien butterfly glioma dengan manifestasi klinis awal vertigo sentral yang merupakan gejala awal yang jarang terjadi pada pasien butterfly glioma pada corpus callosum. Kasus: Pasien laki-laki berusia 75 tahun datang ke IGD dengan keluhan pusing berputar, mual, dan muntah. Setelah perawatan selama tiga hari di rumah sakit, pasien mengeluh nyeri kepala yang terasa berat. Pemeriksaan motorik didapatkan hemiparesis flaksid desktra grade 4. Pemeriksaan sensorik dalam batas normal, pasien mengatakan tidak ada keluhan pada penglihatan. Nistagmus didapatkan positif. Pemeriksaan MRI kepala dengan kontras menunjukkan kesan yang mengarah pada gambaran butterfly glioma corpus callosum posterior (splenium) dengan diagnosis banding primary CNS lympoma. Pasien pada kasus ini yang didiagnosis dengan vertigo sentral et causa tumor serebri primer (butterfly glioma) dengan diagnosis banding primary CNS lymphoma. Simpulan: Pada kasus ini pasien dengan butterfly glioma didapatkan vertigo sebagai gejala awal, dimana vertigo merupakan manifestasi jarang pada kasus glioma butterfly pada corpus callosum. Pada pasien glioma umumnya menunjukan gejala nyeri kepala, muntah, kejang, penurunan kesadaran sebagai gejala peningkatan tekanan intracranial (TIK). Pada penelitian sebelumnya jarang dijumpai vertigo sebagai manifestasi awal pada kasus glioma dan gejala vertigo dapat disebabkan oleh penekanan terhadap cerebellum. Pemeriksaan lebih lanjut diperlukan untuk menentukan diagnosis pasti dari kasus.
Introduction: Mental health problems can affect various groups such as the disabled, domestic helpers, workers, and the unemployed. Unfortunately, it is often ignored, even though its impact can affect the overall quality of life. Therefore, this study aims to determine the description of mental health in a group of kite craftsmen in Sinduwati Village, Sidemen District, Karangasem Regency. Methods: This study uses a cross-sectional study design in Sinduwat Village, Sidemen District, Karangasem. Screening will be conducted offline using a deep interview using the GAD-7 and PHQ-9 questionnaires. Data were analyzed in the form of descriptive data using spss. Results: This study obtained 26 respondents who met the inclusion criteria. The average age of respondents was 42.23 years. A total of 34.61% of the sample experienced mild depression, 19.20% experienced mild depression, and 46, 19% did not experience depression. In addition, 26.92% experienced mild anxiety, 19.20% with moderate anxiety, 15.38% experienced severe and 38.5% did not experience anxiety. Conclusion: Based on the results it can be concluded that the level of depressive symptoms, and anxiety in the community of Sinduwati Village, Karangasem. Pendahuluan: Masalah kesehatan mental dapat menyerang berbagai golongan seperti disabilitas, pembantu rumah tangga, pekerja, dan pengangguran. Sayangnya, seringkali diabaikan, padahal dampaknya dapat memengaruhi kualitas hidup secara keseluruhan. Untuk itu penelitian ini bertujuan mengetahui gambaran kesehatan mental pada kelompok pengerajin layang - layang di Desa Sinduwati, Kecamatan Sidemen, Kabupaten Karangasem. Metode: Penilitain ini menggunakan desain studi potong lintang di Desa Sinduwat, Kecamatan Sidemen, Karangasem. Skrining akan dilakukan secara offline menggunakan deep interview menggunakan kuisioner GAD-7 dan PHQ-9. Data dianalisis dalam bentuk data deskriptif menggunakan spss. Hasil: Pada penelitian ini diperoleh 26 responden yang memenuhi kriteria inklusi. Usia rerata responden adalah 42,23 tahun. Sebanyak 34,61% sampel mengalami depresi ringan, 19,20% mengalami deprrsi ringan, dan 46, 19% tidak megalami depresi. Selain itu, didaptkan 26,92% mengalami kecemasan ringan, 19,20% dengan cemasan sedang, 15,38% mengalami berat dan 38,5% tidak mengalami kecemasan. Simpulan: Berdasarkan hasil dapat disimpulkan bahwa didapatkan tingkat gejala depresi, dan kecemasan dalam masyarakat Desa Sinduwati, Karangasem.
Introduction: Cholangitis is a frequent and severe complication following Kasai portoenterostomy in children with biliary atresia, significantly impacting native liver survival. Although prophylactic strategies such as antibiotics have been widely employed, their effectiveness remains inconclusive. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Comprehensive literature searches were performed in PubMed, Cochrane Library, Scopus, and Web of Science up to June 2025. Eligible studies included randomized controlled trials and observational cohorts evaluating prophylactic interventions to prevent cholangitis post-Kasai in pediatric patients. Data extraction focused on study characteristics, interventions, outcomes, and methodological quality assessed using RoB 2 and the Newcastle-Ottawa Scale. Results: Six primary studies involving 454 patients were included. One randomized controlled trial demonstrated that oral TMP-SMX or neomycin for six months postoperatively significantly reduced cholangitis recurrence compared to historical controls. Another study showed early intravenous antibiotics followed by oral TMP-SMX reduced cholangitis incidence. However, three retrospective cohorts found no significant benefit of antibiotic prophylaxis in reducing infection rates or improving transplant-free survival. One study evaluating Roux-en-Y limb length suggested that surgical configuration may influence cholangitis risk. Methodological quality ranged from low to high, with heterogeneity in interventions and follow-up duration. Conclusion: Oral prophylactic antibiotics, particularly TMP-SMX, may offer benefit in reducing postoperative cholangitis following the Kasai procedure. Nonetheless, current evidence remains inconsistent. Standardized multicenter trials are warranted to establish optimal preventive strategies.
Background: Managing type 1 diabetes in children is often challenging due to significant variations in insulin requirements, high insulin sensitivity, and unpredictable eating and physical activity patterns. Parental concerns about the risk of hypoglycemia frequently hinder the achievement of recommended glycemic targets or lead to difficulties in maintaining optimal glycemic control. The use of a closed-loop system has been proven effective in improving glycemic control and reducing the burden of type 1 diabetes management in children. However, the long-term effectiveness of the closed-loop system compared to conventional therapy remains incompletely understood. Therefore, this systematic review aims to evaluate the efficacy of the closed-loop system compared to conventional therapy in children with type 1 diabetes. Methods: This study was descriptive research conducted through a review of published scientific articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Literature searches were performed across multiple databases, including PubMed, Science Direct, Google Scholar, and The Cochrane Library. Results: This systematic review analyzed 10 scientific articles, consisting of 9 randomized clinical trials (RCTs) and 1 retrospective cohort study. The findings indicate that the closed-loop system significantly improves glycemic control in children with type 1 diabetes without increasing the risk of hypoglycemia. Moreover, its long-term use has been shown to be superior in maintaining glycemic control compared to conventional therapy. Conclusion: The closed-loop system demonstrates significant effectiveness in improving glycemic control in children shortly after its implementation, with sustained long-term benefits and a favorable safety profile. Latar belakang: Manajemen diabetes tipe 1 pada anak-anak sering kali menjadi tantangan karena adanya variasi kebutuhan insulin yang signifikan, sensitivitas insulin yang tinggi, serta pola makan dan aktivitas fisik yang sulit diprediksi. Kekhawatiran orang tua terhadap risiko hipoglikemia sering kali menghambat pencapaian target glikemik yang direkomendasikan atau menyebabkan kesulitan dalam mempertahankan kontrol glikemik yang optimal. Penggunaan sistem closed-loop telah terbukti efektif dalam meningkatkan kontrol glikemik serta mengurangi beban terapi diabetes tipe 1 pada anak. Namun, efektivitas jangka panjang sistem closed-loop dibandingkan dengan terapi konvensional masih belum sepenuhnya dipahami. Oleh karena itu, tinjauan sistematis ini bertujuan untuk mengevaluasi efektivitas sistem closed-loop dibandingkan terapi konvensional pada anak dengan diabetes tipe 1. Metode: Penelitian ini merupakan studi deskriptif yang dilakukan dengan meninjau artikel ilmiah yang telah dipublikasikan menggunakan metode Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pencarian literatur dilakukan melalui berbagai basis data, termasuk PubMed, Science Direct, Google Scholar, dan The Cochrane Library. Hasil: Tinjauan sistematis ini menganalisis 10 artikel ilmiah, yang terdiri dari 9 penelitian uji klinis acak (RCT) dan 1 studi kohort retrospektif. Hasil menunjukkan bahwa sistem closed-loop secara signifikan meningkatkan kontrol glikemik pada anak-anak dengan diabetes tipe 1 tanpa meningkatkan risiko hipoglikemia. Penggunaan sistem ini juga terbukti lebih unggul dalam mempertahankan kontrol glikemik dalam jangka panjang dibandingkan terapi konvensional. Kesimpulan: Sistem closed-loop menunjukkan efektivitas yang signifikan dalam meningkatkan kontrol glikemik pada anak-anak dalam waktu singkat setelah penggunaannya, dengan manfaat jangka panjang yang berkelanjutan serta profil keamanan yang baik.
Background: Amoebiasis is an infection caused by the protozoan parasite genus Entamoeba which is transmitted through the fecal-oral route. The prevalence of amoebiasis in Indonesia reaches 17.9%. Children are more susceptible to infection, due to low immunity and dirty environments. The purpose of this study was to determine the characteristics and proportion of amoebiasis incidence in pediatric patients at Wangaya Hospital in the period July 2022 - December 2023. Methods: The design of this study is descriptive retrospective using secondary data from medical records with total sampling technique. Results: The proportion of amoebiasis incidence to diarrhea in pediatric patients at Wangaya Regional Hospital for the period July 2022 - December 2023 was 2.1%, the majority of patients had characteristics of age ≤ 5 years of 69.2%, male gender of 61.5%, residing in Denpasar of 84.6%, having good nutritional status of 76.9%, length of treatment of ≤ 4 days of 84.6%, and the results of stool examination found Entamoeba histolytica cysts of 30.8% and Entamoeba coli cysts of 69.2%. Conclusion: Characteristics of pediatric patients with amebiasis at Wangaya Regional Hospital, most of whom found Entamoeba histolytica and Entamoeba coli cysts in stool examination. The proportion of incidents is in the low category. Latar Belakang: Amebiasis merupakan infeksi yang disebabkan oleh parasit protozoa genus Entamoeba yang ditularkan melalui fecal-oral. Prevalensi amebiasis di Indonesia mencapai 17.9%. Anak-anak lebih rentan terinfeksi, karena rendahnya imunitas dan lingkungan kotor. Tujuan penelitian ini adalah untuk mengetahui karakteristik dan proporsi kejadian amebiasis pada pasien anak di RSUD Wangaya periode Juli 2022 – Desember 2023. Metode: Desain penelitian ini adalah deskriptif retrospektif menggunakan data sekunder dari rekam medis dengan teknik total sampling. Hasil: Proporsi kejadian amebiasis terhadap diare pada pasien anak di RSUD Wangaya periode Juli 2022 – Desember 2023 adalah 2.1%, mayoritas pasien memiliki karakteristik usia ≤ 5 tahun sebesar 69.2%, berjenis kelamin laki-laki sebesar 61.5%, bertempat tinggal di Denpasar sebesar 84.6%, memiliki status gizi baik sebesar 76.9%, lama perawatan ≤ 4 hari sebesar 84.6%, serta hasil pemeriksaan feses mendapatkan kista Entamoeba histolytica sebesar 30.8% dan Entamoeba coli sebesar 69.2%. Simpulan: Karakteristik pasien anak dengan amebiasis di RSUD Wangaya sebagian besar ditemukan kista Entamoeba histolytica dan Entamoeba coli pada pemeriksaan feses. Proporsi kejadian dalam kategori rendah.
Background: Diabetic retinopathy is a complication in patients with diabetes mellitus, with the risk of dry eye disease. Its prevalence reached 54.3% worldwide in 2018. This study aims to reveal the differences in dry eye disease complaints in patients with diabetes mellitus with and without diabetic retinopathy. Methods: This study employed an analytical method with cross-sectional approach on 96 diabetes mellitus patients at Prof. Ngoerah General Hospital who fulfilled the inclusion and exclusion criteria. Results: In the group of patients without diabetic retinopathy, the biggest complaints were complaints in windy environments (68.8%), difficulty reading (58.3%), complaints in dry environments (50%), sensitivity to light, gritty sensation in the eyes, and mild dry eye disease (39.6%), and disturbances when working with computers (25%). Meanwhile, among patients with diabetic retinopathy, the majority had difficulty reading (89.6%), complaints of poor vision (81.3%), complaints in dry environments (54.2%), disturbances when working with computers (52.1%), pain in the eyes (45.8%), moderate dry eye disease (39.6%), complaints in windy environments (37.5%), and severe dry eye disease (22.9%). A significant difference (p<0.001) was obtained in dry eye complaints in diabetic patients with and without diabetic retinopathy. Conclusion: There is a significant difference in dry eye disease complaints between diabetes mellitus patients with and without diabetic retinopathy. Dry eye disease complaints tend to be worse in diabetes mellitus patients with diabetic retinopathy than without diabetic retinopathy. Latar Belakang: Retinopati diabetik merupakan komplikasi pada pasien diabetes melitus, dengan risiko penyakit mata kering. Prevalensinya mencapai 54,3% di seluruh dunia pada tahun 2018. Penelitian ini memiliki tujuan untuk mengungkapkan perbedaan keluhan penyakit mata kering pada pasien diabetes melitus dengan dan tanpa retinopati diabetik. Metode: Penelitian ini menerapkan metode analitik melalui pendekatan cross-sectional terhadap 96 pasien diabetes melitus di RSUP Prof. Ngoerah yang sesuai dengan kriteria inklusi dan eksklusi. Hasil: Pada kelompok pasien tanpa retinopati diabetik, keluhan terbesar adalah keluhan di lingkungan berangin (68,8%), sulit membaca (58,3%), keluhan di lingkungan kering (50%), sensitivitas terhadap cahaya, rasa berpasir pada mata, dan penyakit mata kering ringan (39,6%), serta gangguan saat bekerja dengan komputer (25%). Sedangkan, pada kelompok pasien dengan retinopati diabetik didominasi oleh sulit membaca (89,6%), keluhan penglihatan buruk (81,3%), keluhan di lingkungan kering (54,2%), gangguan saat bekerja dengan komputer (52,1%), terasa nyeri pada mata (45,8%), penyakit mata kering sedang (39,6%), keluhan di lingkungan berangin (37,5%), dan penyakit mata kering berat (22,9%). Diperoleh perbedaan bermakna (p<0,001) pada keluhan penyakit mata kering pasien diabetes dengan dan tanpa retinopati diabetik. Simpulan: Terdapat perbedaan signifikan dalam keluhan penyakit mata kering antara pasien diabetes melitus dengan dan tanpa retinopati diabetik. Keluhan penyakit mata kering cenderung lebih buruk pada pasien diabetes melitus dengan retinopati diabetik dibandingkan tanpa retinopati diabetik.
Background: Recurrent and refractory pericarditis can significantly impair quality of life and often responds inadequately to conventional anti-inflammatory therapies. Interleukin-1 blockade with Anakinra has emerged as a potential targeted therapy. We conducted a systematic review to evaluate the efficacy and safety of Anakinra for treating pericarditis. Methods: A comprehensive search of PubMed, Embase, Scopus, and Cochrane Library databases was performed from inception through September 2024. Eligible studies included randomized controlled trials (RCTs) and observational studies assessing Anakinra in recurrent pericarditis. Primary outcomes included recurrence rates and symptom resolution, while secondary outcomes evaluated corticosteroid tapering and adverse effects. Results: Eight studies (n = 614 patients) met the inclusion criteria, with sample sizes ranging from 12 to 256 patients and Anakinra doses varying between 1 mg/kg/day to 2 mg/kg/day or a fixed 100 mg/day regimen. Anakinra significantly reduced pericarditis recurrence rates, with some studies reporting up to a six-fold reduction and substantial decreases in emergency department visits (11-fold) and hospitalizations (seven-fold). Symptom resolution was rapid, with most patients achieving complete remission within days, allowing for corticosteroid tapering. No serious adverse events were reported, with transient injection site reactions being the most common side effect (31–38%). Conclusions: Anakinra is an effective and well-tolerated treatment for recurrent pericarditis, particularly in corticosteroid-dependent and colchicine-resistant cases. It significantly reduces recurrence rates, facilitates rapid symptom relief, and minimizes corticosteroid use. While no serious adverse events were observed, long-term safety data remain limited. Future large-scale, placebo-controlled trials are needed to establish the optimal dosing regimen and long-term risk-benefit profile of Anakinra in recurrent pericarditis management.
Preeclampsia remains a leading cause of maternal and perinatal morbidity and mortality worldwide, affecting approximately 2–8% of pregnancies. Characterized by new-onset hypertension and end-organ dysfunction after 20 weeks of gestation, its pathophysiology involves impaired trophoblast invasion, defective spiral artery remodeling, placental hypoxia, oxidative stress, systemic inflammation, and endothelial dysfunction. These processes are further exacerbated by increased levels of anti-angiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng), disrupting maternal vascular integrity and perfusion. Acetylsalicylic acid (ASA), commonly known as aspirin, has been increasingly recommended in low doses (75–150 mg/day) as a preventive strategy, particularly among high-risk women. ASA exerts its therapeutic effects through irreversible inhibition of cyclooxygenase-1 (COX-1), leading to decreased thromboxane A2 (TXA2) production, a potent vasoconstrictor and platelet aggregator. Concurrently, it enhances prostacyclin (PGI2) activity, promoting vasodilation and anti-aggregation. Moreover, ASA demonstrates anti-inflammatory and antioxidant properties, stabilizes endothelial function, and modulates angiogenic balance by lowering sFlt-1 and increasing VEGF and PlGF levels. Recent clinical trials and meta-analyses have established that ASA, when initiated before 16 weeks of gestation, significantly reduces the incidence of preeclampsia, preterm birth, intrauterine growth restriction, and fetal demise. Its efficacy is especially pronounced in women with prior history of preeclampsia, chronic hypertension, multifetal gestation, autoimmune disease, or chronic kidney disease. ASA is generally well tolerated, with a favorable safety profile for both mother and fetus when administered at recommended doses. This review consolidates current evidence on the mechanistic pathways and clinical utility of ASA in preeclampsia prevention. Understanding these mechanisms provides a rationale for early risk assessment and timely intervention to improve maternal and neonatal outcomes. Continued research is essential to refine patient selection criteria and to optimize dosing strategies for broader clinical application.
Background: The pathogenesis of preeclampsia involves immunological factors, such as Human Leukocyte Antigen-G (HLA-G), Killer Immunoglobulin-Like Receptor (KIR), and Human Leukocyte Antigen-C (HLA-C), which influence trophoblast invasion and spiral artery remodeling. This study aimed to assess differences in HLA-G, KIR, and HLA-C expression in the placental tissue of mothers with and without preeclampsia. Methods: This cross-sectional analytic study involved 22 pregnant women (11 with PE and 11 without) selected by purposive sampling at Prof. Dr. I.G.N.G. Ngoerah Hospital. Placental tissues obtained at delivery were preserved in formalin, processed into paraffin blocks, and sectioned for histological and immunohistochemical analysis. Expression of HLA-G, KIR, and HLA-C was assessed using standard staining protocols and categorized by intensity and frequency. Data were analyzed using SPSS version 25. Results: A total of 22 pregnant women were included in the analysis, consisting of 11 with preeclampsia and 11 without. Maternal characteristics did not show significant age differences (26.0 vs. 28.0 years; p = 0.41) or gestational age (35.0 vs. 34.0 weeks; p = 0.27), although parity was significantly lower in the preeclampsia group (p = 0.03). Bivariate analysis of immunological markers revealed that preeclampsia was significantly associated with low KIR expression (PR 4.67; 95% CI: 1.712–12.724; p = 0.001), high HLA-C expression (PR 4.50; 95% CI: 1.246–16.253; p = 0.003), and low HLA-G expression (PR 3.06; 95% CI: 1.285–7.300; p = 0.024). Conclusion: Low HLA-G expression, low KIR, and high HLA-C are significantly associated with an increased risk of preeclampsia.
Parkinson's disease is a chronic neurodegenerative disorder characterized by motor symptoms like tremors, bradykinesia, and rigidity, along with non-motor symptoms such as cognitive decline and autonomic dysfunction. The disease's prevalence increases with age, particularly affecting individuals over 60. Alpha-synuclein, a presynaptic nerve protein implicated in PD's pathogenesis involves the formation of Lewy bodies and neurites. Studies indicate that Lewy bodies could arise from the enteric nervous system, migrating to central dopaminergic neurons through the gut-brain axis. This suggests that changes in gut microbiota might affect the disease's progression development. The pathogenesis of PD involves complex interactions between genetic, environmental, and biochemical factors leading to dopaminergic cell degeneration. The accumulation of Lewy bodies contributes to oxidative stress and neuronal dysfunction, affecting both motor and non-motor symptoms. Recent research emphasizes the significance of the gut microbiome in Parkinson's disease (PD), noting that dysbiosis is associated with inflammation and neurodegeneration. In PD patients, enhanced intestinal permeability and inflammatory bacteria have been observed patients. Understanding these mechanisms may reveal new therapeutic strategies to slow or prevent PD progression, underscoring the importance of gut health in neurodegenerative diseases. This article provides a narrative review examining recent literature on the gut-brain axis and alpha-synuclein pathology in Parkinson's disease, emphasizing both pathophysiological mechanisms and potential therapeutic insights.
Background: Pelvic organ prolapse (POP) is a common condition affecting women worldwide, particularly in older age groups, leading to significant impairment in social, economic, and sexual quality of life. While the etiology is multifactorial, genetic predisposition involving extracellular matrix remodeling proteins has been suggested as an important contributing factor. The ADAMTS1 gene, which encodes an enzyme involved in matrix degradation, is a promising candidate for influencing POP risk. Method: This case-control study involved 66 Balinese women, with 33 diagnosed with POP and 33 controls without POP. Blood samples were collected for DNA extraction and genotyping of the ADAMTS1 rs370850 polymorphism. Multivariate logistic regression analysis was performed to evaluate the association between the polymorphism and POP risk while adjusting for confounders including age, parity, body mass index, and heavy physical labor. Result: The presence of the ADAMTS1 rs370850 polymorphism was significantly associated with increased risk of POP. Women carrying this polymorphism had a 3.91-fold higher risk of developing POP compared to those without the polymorphism (adjusted OR = 3.91; 95% CI: 1.17–14.65; p = 0.04), independent of other known risk factors. Conclusion: The ADAMTS1 rs370850 gene polymorphism is a significant genetic risk factor for pelvic organ prolapse in Balinese women. These findings may aid in identifying individuals at higher risk and contribute to the development of targeted preventive strategies. Further research with larger and more diverse populations is recommended to confirm and extend these results.
Introduction: Low body mass index (BMI) in Human Immunodeficiency Virus (HIV) patients is a risk factor that greatly influences the progression, morbidity, and mortality of patients. Ready-to-use food (RUF) is one of the effective strategies recommended by WHO to handle malnutrition cases in HIV. This systematic review aimed to determine the effect of RUF supplementation on body mass index (BMI) in adolescents and adults with HIV. Method: This systematic review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with the databases used were PubMed, ScienceDirect, ClinicalTrial.gov, and Cochrane. Studies investigating RUF supplementation on BMI in HIV-infected individuals aged 13 to 65 years were included in the analysis of this systematic review. Cochrane RoB 2.0 tools were used for risk of bias assessment in this study. Results: There were 3353 HIV cases aged 13 to 65 years of 7 studies included in this systematic review. Significant positive results on BMI in HIV patients were found in 3 studies (p=0.004; p=0.0009; p=0.0048). One study found that RUF supplementation increased body weight more than standard therapy. A total of 3 studies found no significant results. The differences of these results are highly dependent on various factors such as age, gender, clinical and immunological factors, opportunistic infections, initial nutritional status, ART treatment, and CD4 cell percentage that can affect the variability of nutritional status improvement time in HIV patients. These factors need to be considered in the management of the nutritional status of HIV patients to achieve optimal results. Conclusion: Supplementation of RUF provides positive outcomes on BMI of HIV patients with malnutrition. However, studies with strong level of evidence are still limited, so more related studies are needed in the future.
Background: The Death certificate plays a central role in recording the cause of death and determining public health policies, especially during the COVID-19 pandemic. Completion of the death certificate must be in accordance with the ICD-10 guidelines to ensure the validity of mortality data. This study aims to evaluate the description of the filling of the death certificate in COVID-19 patients according to ICD-10 at the Prof. Dr. I. G. N. G. Ngoerah Hospital in 2020 - 2022 Method: A cross-sectional study was conducted. Data were taken from the death certificate archives of COVID-19 patients who died between 2020 and 2022 at the Prof. I G.N.G. Ngoerah Hospital, Denpasar. Each death certificate was analyzed and classified, and then the data were analyzed descriptively using Microsoft Excel. Results: A total of 96 death certificates were included in this study. Based on its completeness, no death certificate was filled in completely (0%), 93.7% were filled in incompletely, and 6.3% were filled in very incompletely. In the series of causes of death, 94.8% of deaths were found to be caused by COVID-19, and 5.2% of deaths with COVID-19. A series of causes of death was obtained that were in accordance with ICD guidelines of 47.1% and 52.9% were not. Conclusion: Most of the death certificates were filled in incompletely, with 94.8% of deaths caused by COVID-19, and there were 52.9% of death certificates were not in accordance with ICD-10 guidelines. Latar Belakang: Surat keterangan kematian (SKK) memiliki peran sentral dalam pencatatan penyebab kematian dan penentuan kebijakan kesehatan publik, khususnya selama pandemi COVID-19. Pengisian SKK harus sesuai dengan pedoman International Classification of Diseases (ICD) untuk menjamin validitas data mortalitas. Penelitian ini bertujuan untuk mengevaluasi gambaran pengisian SKK pada pasien COVID-19 sesuai dengan ICD-10 di Rumah Sakit Umum Pusat Prof. Dr. I. G. N. G. Ngoerah tahun 2020 - 2022 Metode: Penelitian cross-sectional dengan pendekatan deskriptif observasional dilakukan. Data diambil dari arsip SKK pasien COVID-19 yang meninggal dunia selama periode tahun 2020-2022 di Rumah Sakit Umum Prof I G.N.G. Ngoerah, Denpasar. Setiap SKK dianalisis berdasarkan struktur dan isi yang kemudian diklasifikasikan berdasarkan kelengkapan dan pencatatan penyebab kematian. Data dianalisis secara deskriptif dengan Microsoft Excel. Hasil: Sebanyak 96 SKK di-inklusi pada penelitian ini. Berdasarkan kelengkapannya, tidak ada SKK yang diisi lengkap (0%), diisi tidak lengkap sebesar 93,7% dan diisi dengan sangat tidak lengkap sebesar 6,3%. Pada rangkaian penyebab kematian, ditemukan sebesar 94,8% kematian yang diakibatkan oleh COVID-19 dan sebesar 5,2% kematian dengan COVID-19. Didapatkan rangkaian penyebab kematian yang sesuai dengan pedoman ICD sebesar 47,1% dan rangkaian penyebab kematian yang tidak sesuai dengan pedoman ICD sebesar 52,9% Kesimpulan: Sebagian besar SKK diisi secara tidak lengkap dengan 94,8% kematian diakibatkan oleh COVID-19 dan terdapat sebanyak 52,9% SKK yang tidak sesuai dengan pedoman ICD-10.
Introduction: Human immunodeficiency virus (HIV) is linked to acquired immunodeficiency syndrome (AIDS). While HIV-related visual effects often include cytomegalovirus (CMV) retinitis, cataracts remain understudied. With advancements in HIV treatment, longer lifespans lead to increased cataract incidence. Cataract surgery is a common intervention to restore vision, but its outcomes in HIV-positive patients remain relatively unexplored. This study aims to evaluate the outcomes and complications of cataract surgery in HIV-positive patients at a tertiary hospital in Bali, Indonesia, spanning the period from June 1, 2022, to June 30, 2023, contributing to a better understanding of this specialized context. Methods: A retrospective descriptive study approach on all HIV-positive patients undergoing cataract surgery. Preoperative conditions, surgical interventions, and postoperative outcomes were analyzed. Evaluation was conducted on postoperative visual acuity improvement and the occurrence of complications. Result: Examining 9 eyes of cataract surgery in 8 HIV-positive patients, this study encompassed various preoperative conditions, surgical interventions, and postoperative results. Six eyes had CD4 counts above 200 cells/mm³ prior to surgery. Six eyes showed significant improvement in visual acuity post-surgery, emphasizing the potential benefits of cataract surgery. One case displayed stagnant results, possibly due to preexisting ocular comorbidities. Overall, complications were minimal, and severe occurrences like endophthalmitis were absent. Conclusion: This study provides insights into cataract surgery outcomes in HIV-positive patients. Optimized preoperative assessment and infection control strategies can lead to favorable results, suggesting that cataract surgery is safe and beneficial in this patient population.
Background: More than 1 million neonatal deaths annually, or 25% of all newborn deaths, are thought to be caused by perinatal asphyxia, which is the failure to start and sustain breathing during birth. Low birth weight (LBW) has been linked in the past to the risk of prenatal hypoxia, which is linked to premature birth and serious infection. Therefore, this case report aims to describe a case of a very low birth weight baby with severe asphyxia and respiratory distress. Case: A female baby was born at Sanjiwani Hospital on April 8, 2024 with the main complaint of not crying. The patient was said to be very weak and inactive. The APGAR score was reported as 3-4-6 and weighed 1000 grams. The patient was born by CS with a gestational age of 25 weeks. The patient's mother has a history of eclampsia. The patient underwent neonatal resuscitation, accompanied by gentamicin eye ointment, vitamin K injection 1 mg/IM, Cefotaxime 2x50 mg IV, Aminophylline bolus 6 mg, Ranitidine 2x 2 mg iv, and venti NIV fio2 50 pip 15 peep 6. After 10 days of treatment, the baby worsened and was given cardiopulmonary resuscitation management for 30 minutes and was finally declared dead. Conclusion: This case describes the clinical presentation of a patient with a very low birth weight baby with severe asphyxia and respiratory distress. Very low birth weight in babies contributes to a higher risk of perinatal asphyxia and respiratory distress. Therefore, efficient maternal and neonatal interventions for high-risk populations can reduce the risk of perinatal asphyxia. Latar Belakang : Asfiksia perinatal merupakan kegagalan untuk memulai dan mempertahankan pernapasan saat lahir yang dilaporkan menyebabkan lebih dari 1 juta kematian neonatal setiap tahun atau 25% dari semua kematian bayi baru lahir. Penelitian sebelumnya menunjukkan bahwa berat badan lahir rendah (BBLR) dapat berkontribusi terhadap risiko asfiksia perinatal yang berkaitan dengan kelahiran prematur dan infeksi berat. Maka dari itu, laporan kasus ini bertujuan untuk menjabarkan kasus bayi berat lahir sangat rendah dengan asfiksia berat dan respiratory distress. Kasus: Pasien bayi berjenis kelamin perempuan lahir di RSUD Sanjiwani tanggal 8 April 2024 dengan keluhan utama tidak menangis. Pasien dikatakan sangat lemah dan tidak aktif. APGAR score dilaporkan 3-4-6 dan berat badan 1000 gram. Pasien lahir secara SC dengan usia kehamilan 25 minggu. Ibu pasien memiliki riwayat eklampsia. Pasien dilakukan tatalaksana resusitasi bayi baru lahir, disertai gentamisin salep mata, injeksi vitamin K 1 mg/IM, Cefotaxim 2x50 mg IV, Aminofilin bolus 6 mg, Ranitidin 2x 2 mg iv, dan venti NIV fio2 50 pip 15 peep 6. Setelah dilakukan perawatan selama 10 hari, bayi mengalami perburukan dan dilakukan manajemen resusitasi jantung paru selama 30 menit dan akhirnya dinyatakan meninggal. Simpulan: Kasus ini menggambarkan klinis pasien dengan bayi berat lahir sangat rendah dengan asfiksia berat dan respiratory distress. Berat badan lahir sangat rendah pada bayi berkontribusi terhadap risiko asfiksia perinatal dan respiratory distress yang lebih tinggi. Oleh sebab itu, intervensi ibu dan bayi baru lahir yang efisien untuk populasi berisiko tinggi dapat mengurangi risiko asfiksia perinatal.
Introduction: Pelvic organ prolapse (POP) is a common condition affecting women, particularly the elderly, significantly impacting quality of life despite rarely causing severe morbidity. Previous studies have shown that risk factors such as age, parity, physical labor, and genetic factors, particularly COL5A1 gene polymorphism, play a role in POP development through alterations in pelvic floor collagen structure. This study aims to establish the association of COL5A1 gene polymorphism with the risk of POP in Balinese women. Method: This observational case-control study evaluates the relationship between COL5A1 rs3827852 polymorphism and POP in Balinese women aged 30-70 years. Cases involved POP patients, while controls included non-POP gynecological patients, with matching for parity, occupation, BMI, and menopause status. Venous blood samples were analyzed for genetic polymorphism, and data were processed using SPSS with Chi-Square tests and multivariate analysis to assess the relationship between independent variables and POP. Result: A total of 33 POP patients were matched with 33 non-POP controls. The mean age of participants was 58.44 ± 6.877 years. After controlling for confounding variables like parity, BMI, occupation, and menopause status through multivariate analysis, a significant association was found between COL5A1 rs3827852 polymorphism and POP risk. The Binary Logistic Regression test showed a p-value of 0.026 with an adjusted OR of 3.242 (95% CI: 1.148 – 9.154), indicating that individuals with this polymorphism had a 3.242-fold increased risk of POP compared to those with the wild-type genotype. Conclusion: COL5A1 rs3827852 gene polymorphism is a risk factor for pelvic organ prolapse in Balinese women. Screening for this polymorphism in high-risk Balinese women may help in preventing POP. Pendahuluan: Prolaps organ panggul (POP) adalah kondisi umum yang memengaruhi perempuan, terutama pada usia lanjut, dan berdampak signifikan terhadap kualitas hidup meskipun jarang menyebabkan morbiditas berat. Penelitian sebelumnya menunjukkan bahwa faktor risiko seperti usia, paritas, pekerjaan fisik, serta faktor genetik, khususnya polimorfisme gen COL5A1, berperan dalam perkembangan POP melalui perubahan struktur kolagen dasar panggul. Tujuan penelitian ini adalah untuk membuktikan polimorfisme gen COL5A1 sebagai faktor risiko terjadinya POP pada perempuan Bali. Metode: Penelitian ini merupakan studi observasional kasus-kontrol berpasangan yang mengevaluasi hubungan antara polimorfisme gen COL5A1 rs3827852 dengan kejadian prolaps organ panggul (POP) pada perempuan Bali usia 30-70 tahun. Kasus adalah pasien POP, sementara kontrol adalah pasien ginekologi yang tidak memiliki POP. Matching dilakukan berdasarkan paritas, pekerjaan, indeks massa tubuh (IMT), dan status menopause. Sampel darah vena diambil untuk analisis polimorfisme gen. Data dianalisis menggunakan SPSS dengan uji Chi-Square dan analisis multivariat untuk melihat hubungan antara variabel bebas dan kejadian POP. Hasil: Penelitian ini melibatkan 33 pasien POP sebagai kelompok kasus dan 33 pasien non-POP sebagai kelompok kontrol. Rata-rata usia sampel adalah 58,44 ± 6,877 tahun. Setelah mengontrol variabel perancu seperti paritas, IMT, pekerjaan, dan status menopause melalui analisis multivariat, ditemukan bahwa polimorfisme gen COL5A1 rs3827852 memiliki hubungan signifikan dengan risiko POP. Hasil uji Binary Logistic Regression menunjukkan nilai p = 0,026 dengan adjusted RO 3,242 (IK95% 1,148 – 9,154), yang mengindikasikan bahwa sampel dengan polimorfisme ini memiliki risiko 3,242 kali lebih besar mengalami POP dibandingkan sampel tanpa polimorfisme. Simpulan: Polimorfisme gen COL5A1 rs3827852 merupakan faktor risiko terjadinya prolaps organ panggul (POP) pada perempuan Bali. Peneliti menyarankan penapisan polimorfisme ini pada perempuan Bali dengan risiko tinggi untuk mencegah POP.
Vitamin D is significant in muscle function and avoiding sarcopenia by several mechanisms of action that are biologically complex. Vitamin D deficiency not only affects calcium-phosphate homeostasis but also leads to systemic inflammation, oxidative stress, mitochondrial dysfunction, and dysregulation of myokine marker expression, all of which contribute to decreasing and degrading skeletal muscle mass. Vitamin D in its active form, 1,25(OH)₂D, binds to the Vitamin D Receptor (VDR), found in muscle cells, to mediate the transcription of genes that are essential for muscle protein synthesis and myocyte recovery. VDR activity also inhibits inflammatory pathways through NF-κB transcription inhibition, as well as decreased interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) expression. Additionally, vitamin D has been shown to increase the expression of endogenous anti-oxidant enzymes SOD and GPx, while also maintaining and restoring mitochondrial integrity with PGC-1α activation. Vitamin D also contributes to muscle anabolism by inhibiting myostatin expression and increasing irisin levels, and stimulating insulin-like growth factor 1 (IGF-1) through the PI3K/Akt pathway. Vitamin D deficiency is associated with decreased VDR expression while also showing resistance to mammalian target of rapamycin (mTOR) activation which ultimately impairs anabolic signaling while increasing muscle protein degradation through increased FoxO1/3. The association between low 25(OH)D levels and decreased muscle mass and strength in older adults is further substantiated by epidemiological and clinical trial data which show its effect on muscle performance and sarcopenia.
Background: Hemangioblastoma is a rare benign tumor most commonly found in the adult cerebellum. It is characterized by slow growth and high vascularity, often causing symptoms due to mass effect on brain structures, such as increased intracranial pressure, ataxia, and dysmetria. Accurate diagnosis is crucial for optimal management, with MRI serving as the primary imaging modality to identify hallmark features like peritumoral cysts with mural nodules. This study aims to report and analyze a case of cerebellar hemangioblastoma in an adult based on clinical, radiological, and histopathological findings, highlighting the importance of early diagnosis and appropriate management. Methods: This report presents a case of a 55-year-old male who presented with dizziness, intermittent headache, and balance disturbances without any history of head trauma. Neurological examination revealed ataxia and dysmetria. Brain MRI demonstrated a non-enhancing cystic mass extending from the vermis to the right cerebellar hemisphere, with a small enhancing mural nodule. The patient underwent craniotomy with microsurgical tumor resection, followed by histopathological examination of the tumor tissue. Results: Preoperative MRI showed a well-defined cystic lesion with an enhancing mural nodule, consistent with the typical appearance of cerebellar hemangioblastoma. Postoperative histopathology confirmed the diagnosis of hemangioblastoma (WHO Grade I) with neoplastic stromal and vascular components. Follow-up MRI two months after surgery revealed a significantly smaller residual cystic lesion without enhancement or mural nodule, indicating successful tumor resection. Conclusion: Cerebellar hemangioblastoma is a rare benign tumor that MRI can accurately diagnose based on its morphological characteristics. The mainstay of treatment is microsurgical resection, which yields favorable clinical and radiological outcomes. Early diagnosis and appropriate management are essential to prevent neurological complications and improve patient prognosis. Latar Belakang: Hemangioblastoma adalah tumor jinak langka yang paling sering ditemukan pada cerebellum dewasa. Tumor ini ditandai oleh pertumbuhan yang lambat dan vaskularisasi tinggi, serta dapat menyebabkan gejala akibat efek massa pada struktur otak, seperti peningkatan tekanan intrakranial, ataksia, dan dysmetria. Diagnosis yang tepat sangat penting untuk menentukan penatalaksanaan yang optimal, di mana MRI merupakan modalitas pencitraan utama yang dapat mengidentifikasi karakteristik khas hemangioblastoma, seperti kista peritumoral dengan mural nodul. Tujuan studi ini adalah untuk melaporkan dan menganalisis kasus hemangioblastoma cerebellum pada orang dewasa berdasarkan temuan klinis, radiologis, dan histopatologi guna menyoroti pentingnya diagnosis dini dan penatalaksanaan yang tepat. Metode: Laporan ini membahas kasus seorang pria berusia 55 tahun yang datang dengan keluhan pusing, nyeri kepala hilang timbul, dan gangguan keseimbangan tanpa riwayat trauma kepala. Pemeriksaan neurologis menunjukkan ataksia dan dysmetria. MRI otak dilakukan dan menunjukkan massa kistik non-enhancing di vermis hingga hemisfer cerebellum kanan dengan nodul mural enhancing kecil di dalamnya. Pasien menjalani kraniotomi dengan teknik bedah mikro untuk reseksi tumor, diikuti pemeriksaan histopatologi jaringan tumor. Hasil: MRI pra-operasi memperlihatkan lesi kistik berbatas tegas dengan nodul mural enhancing, sesuai gambaran khas hemangioblastoma cerebellum. Setelah operasi, hasil histopatologi mengonfirmasi diagnosis hemangioblastoma (WHO Grade I) dengan komponen stromal neoplastik dan vaskular. MRI pasca-operasi dua bulan kemudian menunjukkan sisa lesi kistik yang jauh lebih kecil tanpa enhancement dan tanpa nodul mural, menandakan reseksi tumor yang berhasil. Kesimpulan: Hemangioblastoma cerebellum merupakan tumor jinak langka yang dapat didiagnosis secara akurat melalui MRI berdasarkan karakteristik morfologisnya. Penanganan utama adalah reseksi bedah mikro, yang memberikan hasil klinis dan radiologis yang baik. Diagnosis dini dan penatalaksanaan yang tepat sangat penting untuk mencegah komplikasi neurologis dan meningkatkan prognosis pasien
