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Heart failure remain as major health problem worldwide, causing severe morbidity and high mortality. Strong relationship between cardiac disorders and kidney disorders that affect the patient's prognosis. Cardiorenal syndrome (CRS) is a group of symptoms due to acute or chronic damage to one of the organs, including the heart or kidneys, which will affect the function of other organs. The heart and kidney each play a role as a regulator of the body's hemodynamic balance. The kidneys produce urine based on that produced by glomerular filtration which depends on the level of renal perfusion and arteriolar blood pressure. CRS classified into five. The classification is based on the primary and secondary damage from CRS occurs in the heart, kidney or outside the heart and/or kidney. Understanding the pathophysiology of CRS benefit to comprehensively manage patients with such condition.

Background: Chronic viral hepatitis B causes chronic inflammatory process, hepatocyte damage, progressive fibrosis, and irreversible liver damage, leading to high morbidity. There are two methods of diagnosing liver fibrosis, invasive (biopsy) and non-invasive, including radiological examination using the elastography method and hematological examination. This study aims to determine the relationship between the elasticity of liver parenchyma using the Shear Wave Elastography (SWE) method and fibrosis index in chronic viral hepatitis B patients. Methods: This research is a cross-sectional study using 68 samples that met the inclusion criteria. The 2D-SWE examination was blindly performed by two observers using a convex transducer probe with frequencies ranging from 1.2 to 6 MHz. Data were analyzed using SPSS version 20.0 for Windows. Results: In our study, there was a significant moderate positive correlation between the elasticity of liver parenchyma and the fibrosis index performed by both observers (r=0.52; p < 0.001). After controlling confounding variables, a higher correction was obtained (r=0.61), suggesting a change from moderate to strong correlation (p

Anemia is one of the homeostatic abnormalities caused by chronic kidney disease and also frequently problem encountered in end-stage renal disease patients, regardless of the hemodialysis treatment. Anemia in chronic kidney disease significantly impairs kidney function, increases morbidity and mortality risk, and deteriorates the quality of life. Chronic kidney disease’s patients with anemia conditions are affected by numerous factors, including decreased production of endogenous erythropoietin, functional and absolute iron deficiency, and elevated hepcidin levels due to inflammation, particularly in hemodialysis patients. Treatment options for anemia in chronic kidney disease include exogenous erythropoietin and iron supplementation. A new mechanism known as the "hypoxia-sensing system" termed a mediator of erythropoietin synthesis, has been proposed to boost endogenous erythropoietin synthesis. The hypoxia-inducible factor activates specific gene expression and contributes to a physiological response to lower tissue oxygen levels. Chronic kidney disease’s patients who are contraindicated or are hyporesponsive to therapy with erythropoiesis-stimulating drugs may utilize this mechanism as an alternative.

Background: Human immunodeficiency virus (HIV)-associated nephropathy refers to developing kidney disease associated with HIV infection. Tenofovir is associated with an increased risk of acute kidney injury (AKI). Kidney injury molecule-1 (KIM-1) in urine is very specific for kidney injury. This study aimed to determine the changes in the ratio between the levels of KIM-1/urine creatinine and the increase in serum creatinine levels with the incidence of decreased kidney function in people with HIV. Method: This was an observational-analytic study. Subjects were taken using consecutive sampling at Sanglah Hospital Denpasar in 2018. KIM-1 levels were measured by the ELISA method. Results: This study involved 35 patients (21 males and 14 females) with a mean age of 34.89 ± 10.05 years old. The average levels of KIM-1/urine creatinine at 0 hours was 11.039 ± 12.175 ng/ml), KIM-1/urine creatinine at 12 was 12.382 ± 14.671 ng/ml), KIM-1/urine creatinine at 72 was 10.272 ± 11.843 ng/ml). There were no statistically significant differences in the ratio of hours 0 to 12 hours (p = 0.295), and between hours 0-72 (p = 0.413). But there was a significant difference in creatinine levels for 3 months with the initial mean serum (0.848 ± 0.201) and 3 months of evaluation (1.002 ± 0.198) (p =

Background: Malnutrition, systemic inflammation, and atherosclerosis known as MIA syndrome occurs in patients who have undergone regular hemodialysis (HD) and can lower their quality of life (QoL). Current study aimed to determine the interrelation of malnutrition and inflammation to QoL. Methods: A cross-sectional analytic study was conducted in our hemodialysis installation. We performed Malnutrition Inflammation Score (MIS) and measure serum IL-6 to determine malnutrition and inflammation conditions in regular HD patients and utilized ‘Kidney Disease Quality of Life-Short Form (KDQOL-SF) to assess QoL MIS. IL-6 cut-off point were determined by the Receiver Operating Curves (ROC) then we performed linear regression to analyze the relationship level of MIS and IL-6 with level of QoL. We also used path analysis to prove the mechanism model of MIS and IL-6 to QoL on regular HD patients. Results: This study consisted of 60 regular HD patients, 40 (66.7%) of men with mean age of 51.8 years and 78 months average of dialysis vintage. Good QoL was obtained ≥60 overall health (above the median value) and high level of MIS was obtained ≥5 with 75% sensitivity and 21.8% specificity, while high IL-6 level were ≥47.21 pg/mL, with 62.2% sensitivity and specificity of 78.3%. This study found the prevalence of protein-energy wasting (PEW) in regular HD patients was 81.7% by using high level of MIS. MIS were significantly correlated to IL-6 (r = 0.376, p = 0.003) however high level of MIS were uncorrelated to poor QoL. The mechanism of the interrelation of MIS, IL-6, and QoL showed on path analysis that MIS was 15% directly correlated to QoL, however, IL-6 indirectly correlated to QoL on regular hemodialysis patients. Conclusion: MIS and IL-6 were correlated to QoL and MIS also correlated to IL-6. Malnutrition inflammatory score directly affected QoL but IL-6 indirectly affected QoL in regular HD patients.

The ongoing COVID-19 pandemic remained a major public health concern despite a large-scale deployment of vaccines. One of the vaccines is CoronaVac, an inactivated vaccine. The efficacy of the vaccine was estimated at 50.7–83.5% in clinical trials. However, the real-world efficacy often differed. This study described CoronaVac post-vaccination reactogenicity and immunogenicity. Serum was collected on days 0, 28, 56 and 84 from participants who received CoronaVac in March–May 2021. Anti-SARS-CoV-2 Spike receptor binding domain was measured using an Elecsys® quantitative assay. Participants were interviewed for adverse events (AEs) one week after vaccination. Reported AEs were fatigue, fever, runny nose, headache, muscle pain, pain at injection site, and paresthesia. Females reported more incidents than males. However, the frequency was similar between immunologically naïve and pre-immune participants. In the naïve group, the antibody titer was 61.7 ± 84.2 U/mL (mean ± SD) on day 28 and increased to 99.3 ± 91.9 U/mL on day 56. The titer peaked on day 56 across all age groups, but a reduction of 18.0–26.3% was observed on day 84. A titer-boosting effect was observed in pre-immune participants with a baseline titer of 139.0 ± 101.0 U/mL, which increased to 206.7 ± 77.4 U/mL on day 28, and remained steady until day 84. Hence, CoronaVac elicited an antibody response in naïve and pre-immune participants, with mild AEs.

Background: Increasing number of cancer survivor motivates clinical practitioner to focus on chronic effect of chemotherapy agent, especially those with vascular toxicity effect, which may attenuate the incidence of thrombosis and atherogenesis. Ultrasonography examination on carotid intima media thickness (C-IMT) provides acurate result in evaluating atherosclerotic. The purposes of this research are to find out any structural changes of carotid artery, especially atheroclerosis changes in breast cancer patient after chemoteraphy. Methods: Analytic cross sectional study using a pre post test group design in breast cancer patients. Eligible subjects undergo carotid ultrasonography examination prior to chemoteraphy and after they had completed the 3 cycles of chemoteraphy for the second exam. The examination was perfomed with the same USG machine, high frequency linier transducer (>7mHz) in B-mode under the auspecies of two reputable radiologist consultant. Results: Total patients are 26, mean of age (year) is 47.15 ± 8.11. Most dominant histopathology finding is invasive carcinoma nonspecific type, in 24 patients (92.4%) and the disease stage is in stadium III in 14 patients (53.9%). Mean C-IMT (mm) prior chemotherapy is 0.51 ± 0.06 and after chemotherapy is 0.58 ± 0.05, there is an increase of 0.07 ± 0.06 (p

Background: Obesity during adolescence can developed into obesity in adulthood and will increase the risk of metabolic dissease sush as insulin resistance. Recent years the role of vitamin D begin to be connection with insulin resistance. Vitamin D plays a role in regulation of synthesis dan insulin secretions from pancreatic beta cells, increase peripheral and hepatic glucose uptake. In obesity there is decrease in vitamin D bioavailability that causes low levels of vitamin D. This study aimed to proves a correlation between insulin resistance and vitamin D levels in adolescents with obesity.Methods: A observational analytic research with crossestional design has been done in junior and senior high school in Denpasar. Adolescennts performed anthropometric screening covers weight, height, body mass index (BMI), obesity if BMI > 95th percentile of CDC 2000 curve. Examined vitamin D levels and insulin resistance through calculation of HOMA-IR levels. Sample size calculation with ? 0,05, correlation coefficient (r) set to 0,5 with minimum sampel size 50. Data were analyzed using SPSS versin 17 for Windows.Results: Anthropometric screening performed obtained 135 students (3,3%) with obesity. Mean of vitamin D levels was 18,9 ng/mL, 10 (20 %) classified as vitamin D insufficiency and 39 (78 %) vitamin D deficiencies. The average of HOMA-IR levels 3,84, 24 (48 %) with insulin resistance based on HOMA-IR levels. Correlation coefficient between HOMA-IR levels and vitamin D was obtained – 0,37 (p=0,007). There was significant difference of prevalence of insulin resistance between obese adolescent with vitamin D deficiency compared with insuficiency and suficiency group (OR=5.8; 95%CI=1.1-30.6; p=0.025).Conclusion: This study concluded that There is a moderate negative correlation between HOMA-IR levels and vitamin D in obese adolescents. Latar Belakang: Obesitas pada masa remaja berisiko menjadi obesitas pada masa dewasa dan meningkatkan risiko penyakit metabolik seperti resistensi insulin. Beberapa tahun terakhir peran vitamin D mulai dihubungkan dengan resistensi insulin. Vitamin D berperan dalam regulasi sintesis dan sekresi insulin oleh sel beta pankreas, meningkatkan uptake glukosa perifer dan hepatik. Pada obesitas terjadi penurunan bioavaibilitas vitamin D yang menyebabkan rendahnya kadar vitamin D. Penelitian ini bertujuan untuk membuktikan adanya korelasi antara kadar vitamin D dengan resistensi insulin pada remaja dengan obesitas.Metode: Penelitian ini merupakan penelitian observasional analitik dengan desain potong lintang pada remaja SMP dan SMA di kota Denpasar. Remaja dilakukan skrining antropometri meliputi berat badan, tinggi badan, Indeks Masa Tubuh (IMT). Diagnosis obesitas jika IMT > persentil 95 kurva CDC 2000. Dilakukan pemeriksaan kadar vitamin D darah dan resistensi insulin melalui perhitungan kadar HOMA-IR. Perhitungan besar sampel dengan ? 0,05 ( tingkat kemaknaan 0,95), koefesien korelasi (r) ditetapkan 0,5 dengan jumlah sampel minimal 50. Data dianalisis dengan SPSS versi 17 untuk Windows.Hasil: Skrining antropometri dilakukan pada 135 subyek (3,3%) dengan obesitas. Rerata kadar vitamin D 18,9 ng/mL, dimana 10 ( 20 %) tergolong insufiseiensi vitamin D dan 39 (79%) defisiensi vitamin D. Rerata kadar HOMA-IR 3,84, 24 (48 %) mengalami resistensi insulin berdasarkan kadar HOMA-IR. Besar koefesien korelasi antara kadar HOMA-IR dan kadar vitamin D didapatkan – 0,37 (nilai p 0,007). Terdapat perbedaan bermakna kejadian resistensi insulin antara kelompok remaja obesitas dengan status defisiensi vitamin D dan kelompok dengan status vitamin D pada kelompok sufisien dan insufisien (OR=5,8; 95%IK=1,1-30,6; p=0,025).Kesimpulan: Penelitian ini menyimpulkan terdapat korelasi negatif sedang antara kadar HOMA-IR dan kadar vitamin D pada remaja dengan obesitas.

Introduction: Sambiloto (Andrographis paniculata) is a plant that is often used in traditional medicine and is known to have antioxidant, anti-inflammatory and cardiovascular effects. There are many studies of sambiloto on inflammatory markers, but there is no study on the effect of sambiloto on MMP-1 expression. The purpose of this study was to determine the effect of sambiloto on MMP-1 expression and cardiac hypertrophy in mice exposed to cigarette smoke.Methods: This research is an experimental analytic study with a randomized post test only control group design. Thirty-two healthy male Swiss Webster mice aged 8-10 weeks weighing 20-30 grams were divided into 4 groups, namely: control group (standard feed + exposure to cigarette smoke), P1 (standard feed + exposure to cigarette smoke + sambiloto extract 18 mg/ kg BW), P2 (standard feed + exposure to cigarette smoke + sambiloto extract 29 mg/kg BW), P3 (standard feed + exposure to cigarette smoke + sambiloto extract 40 mg/kg BW). All groups were followed for 60 days.Results: There was a significant difference in MMP-1 expression between the control group and all treatment groups. There were significant differences in MMP-1 expression between groups P1 and P2, and between P1 and P3 groups. There was a significant difference in heart weight/weight ratio between the control group and all treatment groups. There was a significant difference in the heart weight/body weight ratio between the P1 and P3 groups.Conclusion: The administration of sambiloto extract decreased the expression of MMP-1 with a tendency for its effect to increase with increasing dose and the optimal dose was found in the sambiloto extract 29 mg/kg BW. The difference in the effect of sambiloto extract on cardiac hypertrophy only appeared after the dose was increased to 40 mg/kg BW Latar Belakang: Sambiloto (Andrographis paniculata) merupakan tanaman yang sering dipakai dalam pengobatan tradisional dan diketahui mempunyai efek antioksidan, anti inflamasi dan efek pada sistem kardiovaskular. Terdapat banyak penelitian sambiloto terhadap marker inflamasi, tetapi belum ada penelitian tentang efek ekstrak sambiloto terhadap ekspresi MMP-1. Tujuan dari penelitian ini untuk mengetahui efek ekstrak sambiloto terhadap ekspresi MMP-1 dan hipertrofi jantung pada mencit yang terpapar asap rokok.Metode: Penelitian ini adalah penelitian analitik eksperimental dengan rancangan randomized post test only control group design. Tiga puluh dua mencit Swiss Webster jantan sehat berumur 8-10 minggu dengan berat 20-30 gram dibagi menjadi 4 kelompok yaitu: kelompok kontrol (pakan standar + paparan asap rokok), P1 (pakan standar + paparan asap rokok + ekstrak sambiloto 18 mg/kg BB), P2 (pakan standar + paparan asap rokok + ekstrak sambiloto 29 mg/kg BB), P3 (pakan standar + paparan asap rokok + ekstrak sambiloto 40 mg/kg BB). Semua kelompok diikuti selama 60 hari.Hasil: Terdapat perbedaan signifikan ekspresi MMP-1 antara kelompok kontrol dengan semua kelompok perlakuan. Terdapat perbedaan signifikan ekspresi MMP-1 antara kelompok P1 dengan P2, dan antara P1 dengan P3. Terdapat perbedaan signifikan rasio berat jantung/berat badan antara kelompok kontrol dengan semua kelompok perlakuan. Terdapat perbedaan signifikan rasio berat jantung/berat badan antara kelompok P1 dengan P3. Simpulan: Pemberian ekstrak sambiloto menurunkan ekspresi MMP-1 dengan kecenderungan efeknya meningkat dengan peningkatan dosis dan dosis optimal terdapat pada ekstrak sambiloto 29 mg/kg BB. Perbedaan efek ekstrak sambiloto terhadap hipertrofi jantung baru muncul setelah dosis ditingkatkan menjadi 40 mg/kg BB.

Background: Locally Advanced Breast Cancer (LABC) is defined as breast cancer spread locoregionally and without any signs of metastasis. Stage IIIA breast cancer is one type of LABC that can be removed surgically, and Modified Radical Mastectomy (MRM) remains the first surgical option. Seroma production is one of the most common complications post MRM, with the hypothesis stating that the Latissimus Dorsi (LD) flap technique is responsible for resulting in higher seroma output. This study aims to compare seroma production in LABC patients post MRM with and without LD flap.Methods: This prospective cohort study was conducted in Sanglah General Hospital, Denpasar, between November 2018 and January 2020. The study sample was divided into 2 groups: LABC patients post MRM with and without LD flap reconstruction. Seroma was measured in milliliters (ml) and collected from the first to fifth day post-operation. Data were analyzed using SPSS version 21 for Windows.Results: Forty LABC patients were enrolled in this study. The mean age for the group without latissimus dorsi flap was 48.45±7.01 years and 49.40±10.77 years for the group with latissimus dorsi flap. The mean seroma production in LABC patients who underwent MRM without and with LD flap reconstruction was 696.45±66.37 ml and 490.10±62.11 ml. There was a significant difference in the total of seroma between the treatment group without-LD flap and compared to with-LD flap reconstruction (p

Introduction: Decreased renal function is associated with a poor prognosis in acute heart failure (AHF). The current standard for assessing the decline in kidney function, creatinine, has several limitations. Serum Neutrophil gelatinase-associated lipocalin (NGAL) is one of the predictive biomarkers that was shown better at indicating an early AKI. Although several studies have examining the role of NGAL as a predictor for poor prognosis in various medical conditions, the result in AHF condition is still inconsistent. This study aimed to determine the role of serum NGAL and decreased renal function (estimated using serum creatinine) in predicting the mortality and major adverse cardiovascular (MACE) events during hospitalization in acute heart failure patientsMethods: Prospective cohort study with consecutive sampling was conducted in AHF patients who were treated at Sanglah General Hospital from July to September 2017. Serum NGAL and creatinine levels were measured at the onset of hospital admission and observed for mortality and MACE during hospitalization.Results: Seventy-seven patients were involved in this study. We found hazard ratio (HR) serum NGAL to mortality was 7.8 (p = 0.009) and increased to 18,9 in multivariate analysis with cox proportional hazards regression model (p = 0.002). There were significant differences in survival (p = 0.002) between patients with high serum NGAL (424 hours survival rate, 95% CI 296-552) than low serum NGAL (baseline survival 680 hours; 95% CI 584-775) after log rank test. Meanwhile, the effect of serum NGAL on MACE and decreased of kidney function on mortality or MACE did not yield significant result.Conclusion: High serum NGAL is an independent predictor of in-hospital mortality among AHF patients.

BACKGROUND: Monitoring of iron status in chronic kidney disease patients is important, however inflammation may hinder its monitoring. Soluble transferrin receptor (sTfR) is an alternative parameter to overcome this issue, whereas ferritin play a part in the inflammation process. Hence, the correlation between the sTfR ratio and the sTfR/log ferritin ratio with conventional iron status parameters in regular hemodialysis patients is necessary to be evaluated. METHODS: A cross-sectional was conducted in the current study. As many as 5 mL of blood (2 mL for sTfR and 3 mL for serum iron and ferritin levels) was collected. sTfR level was the blood-soluble transferrin receptor level measured by the enzyme-linked immunosorbent assay (ELISA). The amount of ferritin and serum iron was determined using the immunochemiluminescent process. To evaluate the correlation, the Pearson correlation test was used. RESULTS: A total of 80 subjects was included in this study. The mean of hemoglobin was 10.25±1.66 g/dL, serum iron was 58.19±26.56 g/dL, and the median ferritin was 520.4 (49.9-3606) ng/mL. The sTfR was significantly associated only with serum iron levels with a correlation coefficient of r=-0.242; p =0.031. The sTfR/log ferritin was significantly associated with serum iron l evels (InSI)(r=-0.255, p =0.022); and transferrin saturation (r=-0.295; p =0.008). CONCLUSION: sTfR/log ferritin has a negative and significant correlation with serum iron levels and transferrin saturation, while sTfR negatively correlated with serum iron levels. sTfR and sTfR/log ferritin may be considered as an alternative iron marker in inflammation setting such as CKD. KEYWORDS: sTfR/log ferritin, iron status, serum iron, ferritin, chronic kidney disease, hemodialysis

Background: Chronic neck pain is a common health problem and is increasingly relevant in health-related quality of life, not only in industrialized countries. The etiology of neck pain is very complex and may be associated with disc herniation, facet joints, muscles, and ligaments that cervical stability will gradually decrease and can cause damage and lead to loss of cervical lordosis. However, studies rarely report the correlation between cervical lordosis and cervical herniation in patients with neck pain. The purpose of this study was to determine the profile of cervical lordosis curves in patients with chronic neck pain and prove the correlation between the degree of cervical disc herniation with loss of cervical lordosis.Method: This study was designed as an analytic study with a retrospective cross-sectional approach. Cervical lordosis curves are measured from mid sagittal cervical MRI while the degree of cervical disc herniation is evaluated using a herniation score. The Spearman correlation test and a simple linear regression test were performed to assess the relationship between loss of cervical lordosis and cervical herniation severity. Multivariate analysis was performed to adjust for the effect of confounding variables.Result: A total of 67 study samples, 64.2% male and 35.8% female, with an average age of 54.7 ± 12.5. Cervical lordosis angle was found not normal (86.6%), most are in the form of hypolordosis (41.8%) and kyphosis (43.3%). The most herniation was in protrusion stage (47.8%). There was a significant correlation between the loss of the cervical lordosis and the degree of disc herniation (r -0.259, and p-value 0.034), each increase of one cervical disc herniation score affects the angle of the lordosis curve by -1.9 degrees, with a coefficient value of B = -1,914 (95% CI, p = 0.026). Conclusion: there is a significant correlation between loss of cervical lordosis and cervical disc herniation (p

Tujuan: Untuk mengetahui pengaruh antara walking exercise programme (WEP) terhadap cancer related fatigue (CRF) pada pasien kanker payudara di RSUP Sanglah Denpasar. Metode: Penelitian randomized controlled trial group pretest-posttest design ini dilakukan pada seluruh pasien kanker payudara yang dirawat di RSUP Sanglah Denpasar pada tahun 2018, untuk dibedakan dalam kelompok kontrol dan kelompok perlakuan (yang menjalani WEP). Pengambil data dan pengolah data disamarkan mengenai kondisi randomisasi dan perlakuan. WEP dilaksanakan selama tiga minggu yang dilakukan sebanyak 3 kali dalam seminggu selama 30 menit. Pada kedua kelompok dilakukan penilaian skor brief fatigue inventory (BFI) sebelum dan sesudah perlakuan. Data kemudian dikumpulkan dan dilakukan analisis statistik dengan SPSS 25.0. Hasil: Penelitian awalnya terdiri dari 41 peserta di kelompok intervensi dan 41 di kelompok kontrol. Dua peserta dari kelompok kontrol mengundurkan diri dari penelitian. Pada analisis skor BFI setelah latihan, ditemukan bahwa skor BFI pada kelompok intervensi menurun secara signifikan dibandingkan kelompok kontrol (2,8±1,2 vs. 0,2±0,7; p

Background: Chondrosarcoma is the second most common primary bone tumor in adults after osteosarcoma. It is difficult to distinguish between low and high-grade chondrosarcoma radiographically, due to its various imaging appearances. Therefore, an imaging analysis method is needed to increase grading accuracy preoperatively. This study aim was to evaluate the correlation between imaging characteristics and degree of chondrosarcoma from histopathology.Material and methods: This study was approved by the ethical clearance and ethics committee in our centre. A cross sectional study was conducted of 22 subjects with histopathology proven diagnosis of chondrosarcoma and had met both inclusion and exclusion criteria. Bone destruction, endosteal scalloping, transitional zone, chondroid matrix calcification, and periosteal reaction were the imaging characteristic that was re-evaluated by two radiologists with hidden identification.Result: Mean age of all subjects was 43.22 ± 14.28 years old, with slight female predominance (54.5%). 21 out of 22 chondrosarcomas (95.55%) were found in appendicular skeleton and the most frequent site was found in iliac bone (31.82%), followed by femur, humerus, and pubic ramus. Bone destruction and soft tissue mass were the characteristics found on high-grade chondrosarcoma as many as 94% and 100% respectively, in the other hand all low-grade chondrosarcoma none has a picture of endosteal scalloping and periosteal reaction. Still, all low-grade chondrosarcoma has a chondroid matrix. Transitional zone margin 1B and 1C were discovered more on high-grade chondrosarcoma, whereas 1A, 1B, and no 1C were detected on low-grade chondrosarcoma. A radiographic abnormality score ≥3 has 4.7 times more chance to become a high degree greater than

Introduction: Modified radical mastectomy (MRM) is a therapeutic choice for operable breast cancer. The most frequent post-surgery complication is seroma formation, and this can be circumvented by the use of drainage. There is still a debate over the use of drainage time on the effectiveness and cost efficiency used. The purpose of this study is a more in-depth study of the cost-effectiveness of removing drainage in less than three days with more than three days, in patients post-MRM.Method: This research is a cost-effectiveness analysis using a decision tree, with a cross sectional analytic research design. Data collection was performed retrospectively by comparing direct medical cost to evaluate the difference in cost-effectiveness of drain removal for less than three days and for more than three days for modified radical mastectomy (MRM).Results: 36 samples were collected that met the exclusion and inclusion criteria, consisting of 19 samples in the group with drain removal ≤ 3 days, and 17 samples in the group with drain removal> 3 days. Analysis of the cost of removing the drain less than three days showed the average direct medical cost of the patient was Rp. 700,578.00. Whereas patients with drain removal for more than three days showed a direct medical cost of Rp. 981,000.00. The average difference in average cost-effectiveness ratio between the two groups is Rp. 2,599.00.Conclusion: In this study, patients with drain removal ≤ 3 days had better cost-effectiveness compared to drain removal> 3 days. Pendahuluan: Modified radical mastectomy (MRM) adalah pilihan terapi pada kanker payudara dapat dioperasi. Komplikasi pasca tindakan yang paling sering terjadi adalah terbentukya seroma, dan hal tersebut dapat disiasati dengan penggunaan drain. Masih terjadi suatu perdebatan terhadap lama pemakian drain terhadap efektifitas dan efisiensi biaya yang digunakan. Tujuan dari penelitian ini adalah pengkajian lebih mendalam tentang cost-effectiveness pada pengangkatan drain kurang dari tiga hari dengan lebih dari tiga hari, pada pasien pasca tindakan MRMMetode: Penelitian ini merupakan penelitian cost-effectivness analisis menggunakan decision tree, dengan rancangan metode penelitian analytic cross sectional. Pengambilan data dilakukan secara retrospektif dengan membandingkan direct medical cost (biaya medis langsung) untuk mengevaluasi perbedaaan cost-effectiveness pengangkatan drain kurang dari tiga hari dan lebih dari tiga hari pada modified radical mastectomy (MRM).Hasil: Dikumpulkan 36 sampel yang memenuhi kriteria ekslusi dan inklusi, terdiri dari 19 sampel pada kelompok dengan pengangkatan drain ≤ 3 hari, dan 17 sampel pada kelompok dengan pengangkatan drain > 3 hari. Analisis biaya pada pengangkatan drain yang kurang dari tiga hari menunjukkan rerata direct medical cost pasien adalah Rp. 700,578,00. Sedangkan untuk pasien dengan pengangkatan drain lebih dari toga hari menunjukkan direct medical cost sebesar Rp. 981.000,00. Rerata perbedaan average cost-effectiveness ratio antara kedua kelompok adalah Rp. 2,599,00.Simpulan: Pada penelitian ini didapatkan pasien dengan pengangkatan drain ≤ 3 hari memiliki cost-effectiveness lebih baik dibandingkan dengan pengangkatan drain > 3 hari.

Background: Glucagon like peptide 1 (GLP1) is incretin hormone which possess biological effect on the kidneys. In conditions where the estimated glomerular filtration rate (eGFR) decreases or in the condition of chronic kidney disease (CKD), there is an increase in the inactive GLP1 or metabolites levels. Objective: To prove the relationship between eGFR with fasting and response of GLP1 after oral glucose loading in type 2 diabetes mellitus (T2DM) patients. Methods: An analytic cross sectional study on fasting and response of GLP1 after glucose loading in 60 subject with T2DM, age 35-65 years, was conducted. Each subject was obtained for fasting GLP1 and 30 minutes after 75 gram oral glucose loading. Subject were grouped based on eLFG into

Yenny Kandarini,1 Gede Wira Mahadita,1 Sianny Herawati,2 Ida Bagus Rangga Wibhuti,3 I Gde Raka Widiana,1 Nyoman Paramita Ayu1 1Department of Internal Medicine, Division of Nephrology and Hypertension, Udayana University Sanglah Hospital, Denpasar, Bali, Indonesia; 2Department of Clinical Pathology and Laboratory Medicine, Udayana University Sanglah Hospital, Denpasar, Bali, Indonesia; 3Department of Cardiology and Vascular Medicine, Udayana University Sanglah Hospital, Denpasar, Bali, IndonesiaCorrespondence: Yenny Kandarini, Department of Internal Medicine, Division of Nephrology and Hypertension, Udayana University Sanglah Hospital, P.B. Sudirman Street, Dangin Puri Klod, West Denpasar, Denpasar, 80234, Bali, Indonesia, Tel +628123803844 ; +62361 223797, Email yenny_kandarini@unud.ac.idPurpose: Biggest cause of death in chronic kidney disease-hemodialysis (CKD-HD) patients is cardiovascular disease (CVD). Cardiovascular disease is often associated with mineral bone disorders (MBD), especially vascular and valvular calcification. Biomarkers such as C-terminal-fibroblast growth factor-23 (FGF-23), intact parathyroid hormone (iPTH), and interleukin-6 (IL-6) were investigated. Only few studies have focused on valvular calcification in CKD-HD patients, with controversial results. The present study aimed to investigate whether high C-terminal-FGF-23, iPTH, and IL-6 can be used as determinants of valvular calcification in CKD-MBD patients undergoing regular HD.Patients and Methods: This was an analytical cross-sectional study which involved CKD-HD patients aged 18– 60 years with no history of CVD, malignancy, and diabetes mellitus. C-terminal FGF-23 was measured using enzyme-linked immunosorbent assay (ELISA) kit, iPTH using chemiluminescent immunometric method, and IL-6 using sandwich enzyme immunoassay technique. Valvular calcification on aortic and mitral valves was examined with echocardiography. Data analysis was done using Chi-squared test or Fisher’s exact test as appropriate and multivariate logistic regression analysis.Results: Bivariate analysis with Fisher’s exact test showed significant association of prevalence ratio (PR) of C-terminal FGF-23 (PR = 1.33; p = 0.003; CI (1.017– 1.748)), iPTH (PR = 1.361; p = 0.002; CI (1.02– 1.816)), and IL-6 (PR = 1.2; p = 0.019; CI (1.000– 1.446)) with valvular calcification. Multivariate analysis with logistic regression showed high C-terminal FGF-23 (exp (B) value of 16.44; p = 0.045; CI (1.07– 252.75)), iPTH (exp (B) value of 33.312; p = 0.016; CI (1.94– 571.71)), and IL-6 (exp (B) value of 21.58; p = 0.0381; CI (1.18– 394.87)) were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.Conclusion: This study demonstrated that high C-terminal FGF-23, iPTH, and IL-6 were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.Keywords: dialysis, end-stage renal disease, inflammation, hormone

Terdapat banyak informasi hoax di bidang kesehatan yang sangat menyulitkan teman-teman di layanan primer dalam melakukan upaya pencegahan penyakit, terutama penyakit COVID-19. Informasi hoax yang tersebat seperti menyatakan bahwa COVID-19 adalah bentuk konspirasi bisnis, hingga penolakan terhadap vaksinasi membawa dampak pada kesulitan menyelesaikan masalah pandemic ini. Berita hoax yang tersebar lebih banyak dibuat oleh orang-rang yang tidak paham akan kesehatan, seperti kalangan artis atau selebgram yang rata-rata memiliki follower dalam jumlah besar. Sementara para dokter dan tenaga kesehatan yang ahli dalam bidangnya seolah tak bisa meluruskan informasi tersebut karena belum banyak yang paham dan percaya diri untuk memanfaatkan media social dalam edukasi kesehatan. Untuk itulah buku ini kami susun bersama para narasumber pelatihan dengan harapan para dokter dan tenaga kesehatan di layanan primer yang belum sempat mengikuti kegiatan pelatihan juga dapat memiliki pengetahuan, kemampuan dan rasa percaya diri untuk merancang media edukasi online. Buku ini nantinya juga akan kami gunakan sebagai bahan referensi dalam mengajarkan materi promosi kesehatan kepada mahasiswa Fakultas Kedokteran di semua program studi.

Coronavirus Disease-19 (COVID-19) is a highly transmittable disease. While the most common symptoms of COVID-19 include fever, cough, and fatigue, severe symptoms could feature acute respiratory distress syndrome and severe pneumonia. Reverse-transcription polymerase chain reaction (RT-PCR) remains the gold standard for diagnosing COVID-19. Unfortunately, it has high cost, extensive waiting time, and low availability in remote areas. Therefore, we developed the Udayana COVID-19 Scoring System (UCSS) for quick detection of COVID-19. This study aims to determine the cutoff score and measure the sensitivity and specificity of the UCSS. We conducted an observational cross-sectional study from June 2020 to July 2020. A questionnaire consisting of 3 objective and subjective scores assesses COVID-19 symptoms and risk factors. Participants were patients suspected of COVID-19 awaiting RT-PCR test results. The UCSS total score then compared with the RT-PCR test result and analyzed to determine the cutoff score, sensitivity, and specificity. 150 participants were included in this study (74 male, 49.3%; mean age 42 ± 15.7). The UCSS total score was significantly correlated with RT-PCR test result (p-value = 0.000). The receiving operator characteristic analysis showed an optimal cutoff score of 7, with a sensitivity of 72% and specificity of 71%. Therefore, the UCSS’ accuracy is at a moderate level. The UCSS showed acceptable sensitivity and specificity, and has the potential to be used as a diagnostic aid for COVID-19 early detection. Further study in diverse areas and larger sample size are needed.

Background: One type of psychiatric disorder that is still controversial is online game addiction. A massively multiplayer online role-playing game (MMORPG) has the highest prevalence of game addiction, especially in Asian countries. The goal of this study was to see the correlation between personality traits, openness, conscientiousness, extraversion, agreeableness, and neuroticism with the occurrence of online game addiction. Methods: A cross-sectional study was conducted on 248 adult online games players throughout Denpasar through proportional stratified random sampling randomization by searching for online game addiction status based on Indonesian Game Online Questionnaires’ (IGOQ) and Five-Factor Personality Traits based on the International Personality Item Pool (IPIP NEO- PI). Results: The prevalence rate of online game addiction in online game center players in Denpasar obtained 27%, the majority are students, male, Hindu, Bali. On average, playing more than 35 hours a week and playing more than 12 hours in 1 session. From the analysis of personality traits, it was found that the traits of conscientiousness had a protective relationship between the occurrence of online game addiction with adjusted Odd Ratio was 0.895 (p

Background: CKD patients undergoing regular HD experience high rate of hospitalization and mortality compared with general population. The main contributing factors were cardiovascular event and infection. In Indonesia, there has been no comprehensive and representative data available. This study aims to discover the incidence and risk factors of cardio-cerebrovascular events, hospitalization and mortality, as well as the survival rate among patients undergoing regular HD at Sanglah general hospital Denpasar. Methods: The study was an analytic retrospective cohort study conducted in Sanglah general hospital Denpasar from July 1st to December 31st 2017. Inclusion criteria were patients with CKD stage-5, ≥ 18 years old, and have undergone regular HD for at least 3 months. Patients with malignancy and requiring elective hospitalization were excluded. The Kaplan-Meier method was used to calculate the cumulative survival rate, and the log-rank test was used for extracting the risk factors that influenced the survival rate. Multivariate Cox regression analysis was used to test contributing risk factors towards composite outcomes (cardio-cerebrovascular events, hospitalization and mortality) and mortality outcome. The risk factors contributors were declared with a value of relative risk and odds ratio adjusted with the confidence interval (CI) 95%, the level of significance (α) was specified in the value of p

Background: Delirium is common and serious problem with high morbidity and mortality, especially in geriatric patients. Decrease in the number of neuroprotective factors (IGF-I and IL-1RA) and increase in IFN-γ had been correlated with the incidence of delirium. This study aims to understand whether these markers can be used as predictors for mortality in geriatric patients with delirium in an effort to prevent the adverse events of delirium.Methods: In this observational analytic study with prospective cohort design carried out in the Geriatric Installation care room at Sanglah General Hospital in Denpasar in 2018, 76 samples were examined for their IGF-1, IL-1RA, IFN-γ plasma levels. Patients were then followed during their hospital stay until they were declared cured or died due to delirium or its complications. The relationship between each group and mortality rate were then analyzed using univariate, bivariate and multivariate analysis.Results: In this study, median was used as the cutoff point for IGF-1 levels [21.38 (0.00-91.07)], IL-1RA levels [2,491.48 (193,44-6720,13)] and IFN-γ [194.29 (0.00-2200.96)]. In multivariate analysis, low plasma levels of IGF-1 (HR= 4.12 [95% CI: 1,458 - 11,642, p=0.008]) and IL-1RA (HR=2.91 [95 % CI: 1.037 - 8.154, p= 0.043]) proved to be an independent factor in the occurrence of death in geriatric patients with delirium. However, IFN- γ failed to show any correlations.Conclusion: Both low plasma levels of IGF-1 and IL-1RA can be used as predictors for mortality in geriatric patients with delirium.

Background: Systemic lupus erythematosus (SLE) is characterized by remarkable heterogeneity in clinical manifestations with underlying autoimmune mechanisms. The pleiotropic cytokine interleukin-6 (IL-6) is known to be involved in SLE immunopathogenesis and significantly related to disease activity as well as its complications. Additionally, IL-6 has been demonstrated to underlie important roles in lupus nephritis. Objective: To determine the correlation between Interleukin 6 (IL-6) Serum and Glomelular Filtration Rate (GFR) in SLE. Methods: In this study we investigated the correlation of serum IL-6 with glomerular filtration rate (GFR) to assess kidney damage in 67 premenopausal patients aged between 17-50 years with inactive SLE. The study variables including age, duration of illness, cumulative corticosteroid dose, MEX-SLEDAI score, serum creatinine, and GFR were obtained through interview and medical record review; whilst serum level of IL-6 was measured using ELISA. Results: Median level of IL-6 was found to be 2.71 (0.332-10.000) pg/ml. Pearson correlation test showed significant correlation between serum IL-6 and GFR (r = 0.288, P = 0.018). Conclusion: This study result shows that there was positive correlation observed between serum IL-6 and GFR in inactive SLE.

Since 2015, the Committee for International Communication on Academic Research of the Japanese Society for Dialysis Therapy has held its Asian symposium during the society’s Annual Congress to discuss the present status of and demand for dialysis therapy in Asian countries in order to identify needs and find ways to contribute to these countries in the area of dialysis therapy. Five manuscripts are presented here by symposium participants from Cambodia, Laos, Bhutan, Mongolia, and Indonesia from the Asian symposium of 2016. With progress in economic development, hemodialysis (HD) therapy has now been introduced in all countries worldwide. However, the cost of HD is extremely high compared with typical incomes in every country, and as of 2016, many countries still have not established national health insurance systems. In Cambodia and Laos, for example, patients must bear 100% of the cost for dialysis. In contrast, in Bhutan, the government bears all costs and the patients need not pay at all. In Mongolia and Indonesia, dialysis is almost completely covered by national health insurance. Dialyzers tend to be reused in Cambodia, Laos, and Indonesia. In Mongolia and Bhutan, dialyzers are single-use only. Continuous ambulatory peritoneal dialysis is available in Mongolia and Indonesia but is just starting to be introduced in Laos; it is not available in Cambodia and Bhutan. In Cambodia and Laos where there is no national health insurance system, patients with lower socioeconomic status come to the HD center only when they have enough money to pay for an HD session. Viable health insurance systems should be established as soon as possible. However, this will ultimately depend on the countries’ economic development.

Aim: Assessed the correlation between prostate volume and intravesical prostatic protrusion with detrusor wall thickness through transabdominal sonographic examination of benign prostate enlargement (BPE). Methods: The study is a paired-group analytical observational cross-sectional study during April – July 2020. Measurements were made of prostate volume, intravesical prostatic protrusion, and detrusor wall thickness using transabdominal sonography. An analysis was carried out to determine the correlation with bivariate analysis and the calculation of the research power. Results: Thirty-four BPE patients with a mean age of 62.41 years were included in the study. The mean value of prostate volume obtained was 44.24 cc; 8.66 mm for intravesical prostatic protrusion; and detrusor wall thickness is 1.49 mm. The correlation value between prostate volume and detrusor wall thickness was 0.12 (p=0.46), while the intravesical prostatic protrusion and detrusor wall thickness were 0.37 (p=0.03). The research power for correlating prostate volume with detrusor wall thickness and intravesical prostatic protrusion with detrusor wall thickness was 10-20% and 50-60%, respectively. Conclusion: There is a very weak correlation between prostate volume and detrusor wall thickness and a weak correlation between the intravesical prostatic protrusion and detrusor wall thickness. Other variables may influence the thickness of the detrusor wall.

As a developing country and the world’s fourth most populous country, Indonesia faces unique challenges in health, including nephrology. Other than the traditional risk factors for kidney diseases such as diabetes and hypertension, Indonesia also has other risk factors affected by its sociocultural and geographical profile, such as tropical infections and administration of certain herbal or other traditional medicine, which may be nephrotoxic and predispose to acute kidney injury. The Indonesian Society of Nephrology was first established in 1976 and gained international recognition in 1978. Hemodialysis remains the most utilized renal replacement therapy modality for patients with end-stage renal disease; peritoneal dialysis and kidney transplants are far less popular. The number of patients with end-stage kidney disease who underwent routine hemodialysis was 132,142 in 2018, almost two times the number of patients in 2017. Kidney transplant procedures are relatively few, but the number of procedures per year and the centers that are available for the procedure keeps increasing. This chapter gives an overview of nephrology in Indonesia and its challenges in tackling the many aspects of nephrology.

BACKGROUNDKidney transplantation is an expensive procedure, and it is an alternative treatment of end-stage renal disease other than dialysis. Cost-Effectiveness and the cost-utility study was undertaken at Sanglah Hospital Bali Indonesia, aiming to assess whether living-related kidney transplantation is more cost-effective and cost-utility than hemodialysis in the treatment of end-stage renal disease.METHODSA health technology assessment was done in living-related kidney transplant and hemodialysis during 2018. Data search from internet resources using the electronic library and critically appraised the best evidence of the data of the best data of five-year mortality and survival of kidney transplant and hemodialysis. A preliminary study about quality of life was also done among kidney transplant and hemodialysis patients. Data about kidney transplant costs and hemodialysis for five years was taken from the Sanglah General Hospital database. RESULTSDuring the study, Fourteen living-related kidney transplant patients at Sanglah Public Hospital Denpasar Bali Indonesia consisted of 14 recipients, 12 males, and 2 females aged 27 -55 years, and 14 donors, three males and 11 females aged 24-63 years were included. Thirty HEMODIALYSIS patients at the same hospital were recruited. They consisted of 20 males and ten females, with an average age of 50.9 years. The average five-year cost of kidney transplant was 741,078 M IDR. In comparison, hemodialysis's five-year cost was 581,514 M IDR, leading to a cost difference was 159,564 M IDR. Five-year mortality of kidney transplant was 55% (survival 45%), five years survival rate was 18.9%. Five years of survival difference between kidney transplant and hemodialysis was 26.1 %. Meanwhile, QOL for a kidney transplant was 0,7063, and QOL for hemodialysis was 0,5596, leading to a QOL difference of 0.15. Kidney transplantation will spend 6.11 M IDR for every 1% increase of survival for five years with 15% better QOL. In five years, kidney transplantation produces 67% ICER. From cost-utility perspective, kidney transplantation yields 31.04 M IDR per QALY or 2,217 USD per QALY.CONCLUSIONLiving-related kidney transplantation is more cost-effective and cost-utility than hemodialysis in the treatment of end-stage renal disease.

Karsinoma sel renal (KSR) merupakan kanker yang cukup sering terjadi, sekitar 3 sampai 4% kasus di Amerika Serikat, namun di Asia kasusnya cukup jarang. Insiden KSR semakin menigkat dalam beberapa tahun terakhir. Perokok aktif dan pasif seperti juga hipertensi merupakan faktor risiko KSR. Dilaporkan sebuah kasus, perempuan, 61 tahun, dengan Chronic Kidney Disease (CKD) stadium V et causa chronic pyelonephritis (PNC) single kidney, batu ureter 1/3 distal sinistra, hidronefrosis derajat IV ginjal sinistra, adenokarsinoma (Adeno Ca) renal dextra stadium III post radical nefrectomy. Pasca operasi kondisi pasien sempat membaik, produksi urine cukup ± 800 cc/24 jam, dan ada penurunan serum kreatinin. Pasien sempat menjalani beberapa kali hemodialis selama perawatan dan direncanakan hemodialisis regular. Sepuluh hari paska MRS pasien kembali dirawat dengan pneumonia (Health Care Associated Pneumonia) dan diberikan antibiotik empiris, dalam perkembanganya kondisi semakin memburuk dan akhirnya meninggal dengan penyebab kematian syok sepsis. Kasus ini diangkat untuk memperdalam mengenai diagnosis dan tatalaksana seorang penderita dengan renal sel karsinoma sehingga dapat mencegah terjadinya prognosis buruk di kemudian hari.