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BALI MEDICAL JOURNAL (BMJ)
Published by Universitas Udayana
ISSN : -     EISSN : -     DOI : -
Core Subject : Health,
Medicine & Pharmacology
Bali Medical Journal (BMJ), P-ISSN 2089-1180, E-ISSN 2302-2914 is an international and peer-reviewed journal published quarterly in print and online by Sanglah General Hospital in collaboration to Indonesian Physician Forum and Indonesian College of Surgeon, Bali-Indonesia which was founded in 2011. The Journal aims to bridge and integrate the intellectual, methodological, and substantive diversity of medical scholarship, and to encourage a vigorous dialogue between medical scholars and practitioners. The Journal welcomes contributions which promote the exchange of ideas and rational discourse between practicing educators and medical researchers all over the world.
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Articles 9 Documents
 1 
Search results for , issue "Volume 1, Number 2, May-August 2012" : 9 Documents clear
The Effect of Phytosterol on Serum Beta-Carotene Concentration of Hypercholesterolaemic Subjects Dina-Keumala, S.; -, Sri-Sukmaniah; -, Sri-Widya A. J
BALI MEDICAL JOURNAL Volume 1, Number 2, May-August 2012
Publisher : BALI MEDICAL JOURNAL

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Abstract

Objective: Treatment of optic neuritic as recommended by the Optic Neuritic Treatment Trial (ONTT) was intravenous methylprednisolon followed by oral prednisone. This study aims to describe  characteristics and response to intravenous methylprednisolon followed by oral prednisone treatment of optic neuritic patient in Sanglah General Hospital Denpasar. Method: The study was a parallel clinical trial, forty subjects with hipercholesterolaemia were selected using certain criteria. The subjects were divided into two groups using block randomization. Twenty subjects in phytosterol group received phytosterol 2x0.6 g/day and dietary counseling (P), while twenty subjects in counseling group received only dietary counseling (C). Serum total cholesterol and ?-carotene concentration were assessed on day 0 and 42. Before and after treatment, dietary intake were assessed with 2x24 hour recall methods. Results: Seventeen subjects in P group and fourteen subjects in C group completed the study. There was no significant differences in baseline data both groups. After 42 days treatment, there was no significant differences in nutrients intakes in two groups except for ?-carotene and phytosterol intakes in P group. There was a 9.17% significant reduction in serum total cholesterol concentration in P group while no change was observed in the C group (p<0.05). Serum ?-carotene concentration was increased significantly in P group, 0.44±0.376 ?mol/L to 0.536(0.21–1.95) ?mol/L, while there was no significant increased in C group, 0.493±0.349 ?mol/L to 0.56±0.33 ?mol/L. There was a significant difference in serum ?-carotene concentration after adjusted with serum total cholesterol concentration between two groups (p<0.05). Conclusions: Dietary advice to consume an additionally of high ?-carotene sources when consuming phytosterol 2x0.6 g/day for 42 consecutive days maintains serum ?-carotene concentration while lowering serum total cholesterol concentration significantly in hypercholesterolaemic subjects, proved by statistical analysis.
Initial Clinical Findings as a Predictor of Abnormal Scan on Minor Head Injury Patients at Sanglah General Hospital, Bali-Indonesia -, Ade-Chandra; Niryana, W; Golden, N
BALI MEDICAL JOURNAL Volume 1, Number 2, May-August 2012
Publisher : BALI MEDICAL JOURNAL

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Abstract

Objective: Minor Head Injury (MHI) patients should not cause severe sequelae. In fact, many studies had reported that some MHI patients had abnormal scan, clinical deteoritation, and many of them have had neurosurgical intervention. This study analyzed correlations between clinical signs with abnormal scan, clinical deteoritation and surgery intervention on minor head injury patients. Methods: A series of 364 MHI patients were prospectively enrolled in this study. In all cases clinical data were collected and a CT Scan was obtained. The relationship between clinical findings (loss of conciousness, amnesia, seizure, vomiting, headache, cepalhameatome, skull fracture, age more than 60 years),were identified as independent risk factors in corelations to abnormal scan, clinical deteoritation and surgery intervention using bivariate and logistic regresion multivariate analitycs with 95 % CI. Results: the incidence of abnormal scan was 13.8% (48 patients), 3.3% (12 patients) with clinical deteoritation, and incidence of surgery intervention was 3.8% (14 patiens).  Lost of conciousness, amnesia, cepalhematoma, skull fracture, and age more than 60 years old  are independent variabels had statisiticly significant with abnormal scan. Amnesia, cepalhematome, skull fracture are independent variables which had statisitc significantly with  clinical deterioritation and surgical intervention. Conclusions: Clinical variables which had statistic significanly can be used as predictors of abnormal scan, clinical deteoritation, and surgical intervension. Avoiding systematic CT Scan indication implies a rate of misdiagnosis, but liberal scan can be increasing the cost of patients.
Epilepsy Surgery in Indonesia: Achieving a Better Result with Limited Resources Muttaqin, Zainal
BALI MEDICAL JOURNAL Volume 1, Number 2, May-August 2012
Publisher : BALI MEDICAL JOURNAL

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Abstract

Objective: There is around 1.5 million of epileptic in Indonesia within prevalence of 0.5-0.6%. Of these 440,000 will be intractable, and 220,000 of them are potential candidates for epilepsy surgery (ES).  A decade has passed since the first ES performed on July 1999 and the number increases every year reaching of 35-47 ES per year in 2007-2009. Despite  the excellent results, all of these ES were still performed in Semarang (Diponegoro University) while the patients were from all part of Indonesia. The major reason behind the unavailability of ES in most part of the country should be discussed for the sake of future development of ES in Indonesia. Methods: Epilepsy surgery was started in July 1999 with anterior temporal lobectomy for a 34 Y-old female with left mesial temporal sclerosis (MTS) causing a long standing intractable seizures. The number of cases increases every year. Until the end of 2009, there were 238 cases of epilepsy surgery, including 212 anterior temporal lobectomies.  Among these, 106 cases had been follow up more than 36 months, and evaluated for surgical results. To evaluate the patient’s selection and the presurgical evaluation, we divide the ES cases into the first 5 years (56 cases) and the recent 5 years (182 cases). But for the purpose of evaluating surgical results, only those with at least 36 months postoperative follow-up were included (106 cases) and grouped into those operated before or after the age of 25 Y-old (group A and group B), and into those operated before or after the length of epilepsy of 10 years (group I and group II). Results: For the first five years-period, decision to operate were based on MRI and routine interictal EEG in 54 out of 56 TLE cases. One patient had long-term ictal EEG and another had subdural grid EEG implanted, since MRI in both patients showed visually normal MRI. For the last five years, decision to operate were based on MRI and routine EEG in 91 out of 156 TLE cases. Long term ictal EEG were performed in 46 patients, subdural grid EEG in 10 patients, PET study in 7 patients, and EcoG in 2 patients. The overall seizure free (SF) rate were 70.75%, but if grouped according to patient’s age at surgery ( less than or over 25 Y-old ), the SF rates were 75.4% vs 66.04% respectively. So did if grouped according to length of disease ( less than or more than 10 years ), the SF rates were 78.72% vs 64.40% respectively. Conclusions: MRI plays very important role to decide the side of the epileptic temporal side, but this role is decreasing as it was 96.4% during the beginning five years to become 58.34% for the last five years. This means that we are working on more difficult epilepsy cases recently. SF rate was significantly higher for those who was operated at younger age and for those with shorter duration of epilepsy. This means that surgery should be offered earlier for those intractable TLE patients with obvious focus on MRI.
The Characteristic of Central Serous Chorioretinophaty Patients at Sanglah General Hospital Bali-Indonesia Lienderi-Wati, N. M.; Budhiastra, P.; -, Ari-Andayani
BALI MEDICAL JOURNAL Volume 1, Number 2, May-August 2012
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Abstract

Objective: to describe characteristics of central serous chorioretinophaty (CSC) patients in Sanglah General Hospital, correlation between visual acuity and foveal thickness before and after oral acetazolamide theraphy, the differences of visual acuity and foveal thickness of CSC’s patients before and after oral acetazolamide theraphy. Methods: This study is a descriptive study, than followed by cross sectional study. Data were collected retrospectively from medical report of CSC patients who came to Sanglah General Hospital during period Januari 1st 2010 until December 31st 2011. Results: Central serous chorioretinopathy were found in 22 patients (22 eyes), male predominance (72.7%), majority were in age group 30-40 years (54.55%), and all of cases were unilateral. Most of CSC patients worked as private employees (77.3%). Mean onset patients presented to the hospital was 14.64±5.68 days, with the most common symptom was decreasing vision (86.4%). Mean of follow ups in CSC patients were 64.11±6.15 days. There was correlation between visual acuity and foveal thickness before and after oral acetazolamide theraphy, respectively r=0.76; p=0.001 and r=0.73; p=0.001 (Spearman test). The differences between visual acuity of CSC patients before and after oral acetazolamide theraphy was significant (0.55±0.26 logMAR vs 0.11±0.12 logMAR; p=0.001; Wilcoxon test). The differences between foveal thickness of CSC patients before and after oral acetazolamide theraphy  was also significant (484.23±6.42 vs 258.41±4.21; p=0.001; Wilcoxon test). Conclusions: CSC patients was male predominance, majority in decade 3-4, all of cases were unilateral and most of the patients worked as private employees. There is a strong correlation between visual acuity and foveal thickness before and after oral acetazolamide theraphy. A significant differences found in visual acuity and foveal thickness of CSC’s patients before and after oral acetazolamide theraphy. In this study, the role of oral acetazolamide in clinical resolution improvement of CSC’patients can not be concluded. Further study with control group needed to find it’s role.
Blood hsCRP And PGE2 Content With Clinical Outcome Using Modified Fenestratio-Restorative Spinoplasty Better Than Lamonectomy-Fusion In Lumbar Stenosis Mahadewa, T. B. G.; -, Sri-Maliawan; Raka-Sudewi, A. A.; Wiryana, M
BALI MEDICAL JOURNAL Volume 1, Number 2, May-August 2012
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Abstract

Objective: Modified Fenestration-Restorative Spinoplasty (MFRS) technique is an alternative to lumbar stenosis treatment, providing the equal decompression comparing with laminectomy techniques, without the implant, less expensive and complication rates. The purpose of this study was to determine which technique gives better inflammation and clinical outcome based on high sensitive C-Reactive Protein biomarker (hsCRP) and Prostaglandin E2 (PGE2), Visual Analog Scale (VAS) of the day 7th postsurgery and ODI scores 3rd month post surgery. Methods: This study design is an experimental pretest-posttest randomized control group design. Results:  This study results showed that the mean levels of hsCRP day 7th postsurgery were differ significantly between MFRS (23,09 ± 15,3 mg/L) compared to LF (39,53 ± 24,4 mg/L). Likewise for the mean levels of PGE2 day 7th postsurgery were differ significantly between MFRS (491,39 ± 528,5 pg/ml) compared to LF (1103,7 ± 1033,6 pg/ml) at the significance level of p <0.05). MFRS clinical outcomes better than LF (p <0.05), for means of VAS value day 7th postsurgery and ODI score 3rd month postsurgery. Perioperative variable analysis shows that MFRS was better than LF in: length of surgery, blood loss, postsurgery Hb and patient length of stay (p<0,05). Conclusions: MFRS technique is an alternative technique of lumbar stenosis treatment better than the LF, in terms of improved levels of hsCRP and PGE2, leading to faster clinical outcomes improvement, less complications and lower costs. MFRS technique should be used as a treatment of lumbar stenosis.
Langerhans Cell Histiocytosis: A Case Report Suzy-Indharty, Rr.
BALI MEDICAL JOURNAL Volume 1, Number 2, May-August 2012
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Abstract

Objective: Langerhans Cell Histiocytosis (LCH) is a rare proliferative disorder of a distinct cell type that is similar to Langerhans cell. Prevalence is estimated at 1:200.000/year in children. Clinical presentations are variable, ranging from a single location in the bone to severe multivisceral involvement leading to dysfunction of vital organs. Therefore, objective of this study was to explore LCH based on clinical findings, skull x-ray, head CT-Scan, cytology, histopathology. and Immunohistochemistry. Method: We report a case of Langerhans Cell Histiocytosis of a 3-year-old boy. Fine needle aspiration biopsy was performed from a nodule in parietal area on the scalp; dry fixation was made and stained with Giemsa. Immunohistochemistry examination was performed with CD1a and S100. Histopathology examination was done post-operatively and cytology examination were consistent with LCH, composing Langerhans cells with complex, clefted, grooved, irregular or convoluted nuclei with fine chromatins and one or more small nucleoli and moderate to abundant quantities of eosinophilic cytoplasm, mixed with multinucleated eosinophils. Results:  The finding of pentalaminar Birbeck granules by electron microscope is diagnostic of LCH, but this examination cannot be performed in our institution, so diagnosis was supported by immunohistochemistry with CD1a and S 100. Conclusions: Based on clinical findings, skull x ray, Head CT-Scan, cytology, histopathology and Immunohistochemistry, this case was concluded as a Langerhans Cell Histiocytosis.
Correlation Between Full Outline Unresponsiveness Score and Glasgow Coma Scale for Severe Head Injury Patients at Prof. dr. R. D. Kandou General Hospital, Manado-Indonesia Jusuf, W. R. A.; Prasetyo, E; Oley, M. C.
BALI MEDICAL JOURNAL Volume 1, Number 2, May-August 2012
Publisher : BALI MEDICAL JOURNAL

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Abstract

Objective: Glasgow Coma Scale (GCS) has been widely used to assess level of consciousness related to trauma, however, its use have a limitation especially in intubated patients. Full Outline Unresponsiveness Score (FOUR) consists of four components (eye, motor, brainstem, and respiration) and each component has a maximal score of 4 and total score 17. This study aims to evaluate correlation between FOUR score and GCS to evaluate level of consciousness in severe head injury patients. Methods: This is a prospective study with correlation approach. We prospectively studied all severe head injury patients at surgical emergency department Kandou Hospital, Manado from March to May 2010. Level of consciousness was assessed using GCS and FOUR score. Data were analysed with Pearson correlation coefficient. Results: From March to May 2010 at surgical emergency department there were 27 severe head injury patients (24 males and 3 females) with average range of age 10-20 years old (29,6%). The highest distribution of GCS in severe head injury patients were GCS 8 (33.3%) and GCS 3 (22.2%) while in FOUR score were 8 (33.3%) and 7 (14.8%). Conclusions: we concluded that FOUR score can be used as important tools to assess level of consciousness of severe head injury patents. FOUR score provides greater neurological detail than GCS which can assess brainstem reflexes, breathing pattern, and herniation.
Characteristics and Response to Methylprednisolone and Prednisone Treatment of Optic Neuritic Patient at Sanglah General Hospital Denpasar Dita-Rinjani, N. P.; Mas-Putrawati, A. A.; Putra-Manuaba, I. B.
BALI MEDICAL JOURNAL Volume 1, Number 2, May-August 2012
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Abstract

Objective: Treatment of optic neuritic as recommended by the Optic Neuritic Treatment Trial (ONTT) was intravenous methylprednisolon followed by oral prednisone. This study aims to describe  characteristics and response to intravenous methylprednisolon followed by oral prednisone treatment of optic neuritic patient in Sanglah General Hospital Denpasar. Method: This report is an analytical cross sectional study. Data were collected retrospectively from medical report of optic neuritic patient who came to Sanglah General Hospital during a period of January 1st 2010 until December 31st 2011. Patient characteristics were analyzed with descriptive analyses and presented as frequency, percentage, mean and standar deviation. Visual acuity and contrast sensitivity improvement after intravenous methylprednisolon followed by oral prednisone treatment were statistically analyzed with Wilcoxon test Results:  Optic neuritic were found in twenty-three patients (33 eyes), majority was in age group of 15-40 years (56.5%) with female predominance (65.2%) and unilateral involvement was 56.3%. Mean onset patient presented to the hospital was 21.7±2.21 days and the most common symptom was decreasing vision (87.9%).  The majority of patient presented with papillitis (54.5%), totally color blindness found in 39.4% eyes, and the type of visual field defect at presentation was central scotoma (18.2%). All cases show lesion of optic nerve from visual evoked potential (VEP) examination and magnetic resonance imaging (MRI) shows normal results (39.1% patient). The mean of pretreatment logMAR visual acuity and contrast sensitivity were significant improve after treatment from 1.59±0.47 to 0.59±0.62 (p=0.0001) and 0.31±0.56 to 1.25±0.56 (p=0.0001), respectively. All cases in this study were idiopathic. Recurrence were seen in 2 eyes and none of patient had clinical features suggestive of multiple sclerosis. Conclusions: Visual acuity and contrast sensitivity improvement after intravenous methylprednisolon followed by oral prednisone treatment in this study is good, with lower rate of recurrence and none of cases associated with multiple sclerosis.
Application Anti Microbial Activity Test and Direct Inoculation of Urinary Specimen Test to Increase the Quality of Results and Decrease the Production Cost in Clinical Microbiology Laboratory, Sanglah General Hospital Hospital, Bali-Indonesia Sri-Budayanti, N.; Sukrama, I. D. M.; Aditarini, M.; Sukardika, I. K.; Suata, I.K.
BALI MEDICAL JOURNAL Volume 1, Number 2, May-August 2012
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Abstract

Objective: Urinary tract infection (UTI) is the most common bacterial infection in general practice and in hospitals. Fast and accurate urine culture and sensitivity test are needed for adequate therapy. Anti Microbial Activity test (AMA test) that is used to detect the presence of antibiotics in urine specimens is not commonly used in clinical microbiology laboratories. Some laboratories are still using indirect inoculation technique using enriched media before inoculating onto the agar media. The aim of this research is to compare results of urinary examination of direct inoculation technique with AMA test with indirect inoculation technique without AMA test. Methods: A number of 210 urine specimens were collected in Clinical Microbiology Laboratory at Sanglah General Hospital within a time period between 16 June until 16 July 2009. Results: Antibiotics were detected in 40% of the urinary specimens; whereas 48.1% showed no evidence of UTI, that is negative AMA test and sterile urinary culture or colony growth < 105 CFU/ml. Only 11.9% of the specimens indicates urinary tract infections. The examination can be completed within 2-3 days which is shorter than indirect inoculation test which require 5-7 days. Direct inoculation technique can reduce the cost of production three-fold the costs require for an indirect inoculation test. Conclusions: Application of AMA test and direct inoculation technique can give results more rapidly, reliable and useful for clinicians. This also decrease the laboratory’s cost of production.

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