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"Pendahuluan: Anterior cervical discectomy and fusion (ACDF) merupakan operasi standar terapi untuk mengatasi masalah tulang servikal seperti herniasi diskus serta spondilosis sevikal refrakter. Komplikasi Adjacent segment degeneration setelah ACDF merupakan kejadian yang dapat menyebabkan gejala dan mungkin membutuhkan reoperasi. Sampai saat ini, faktor risiko adjacent segment degeneration setelah operasi ACDF masih menjadi topik diskusi karena perbedaan dari beberapa hasil penelitian yang ada. Maka dari itu, penelitian ini bertujuan untuk menambah informasi terkait faktor risiko adjacent segment degeneration.Metode: Sebuah penelitian cross sectional dilakukan pada pasien pascaoperasi ACDF lebih dari satu tahun di RSCM dan RSUP Fatmawati. Penelitian ini menilai hubungan faktor risiko usia, jenis kelamin, indeks massa tubuh, riwayat merokok, riwayat diabetes mellitus, jumlah level fusi, dan lokasi fusi terhadap kejadian adjacent segment degeneration pascaoperasi ACDF.Hasil dan Diskusi: Sebanyak 41 pasien yang menjalani penelitian ini dengan melibatkan 79 level tulang belakang. Rata – rata usia sampel 52,85 ± 10,41 tahun dan sebagian besar sampel berjenis kelamin perempuan (n = 21; 56,1%). Operasi paling banyak melibatkan lebih dari satu level tulang belakang (75,6%) dengan paling banyak melibatkan tulang belakang C5/C6 (n=34; 82,92%). Adjacent segment degeneration terjadi pada 10 pasien (24,39%) pasca ACDF. Tidak ditemukan hubungan signifikan antara faktor risiko usia, jenis kelamin, indeks massa tubuh, riwayat merokok, riwayat diabetes mellitus, jumlah level fusi, dan lokasi fusi terhadap kejadian adjacent segment degeneration pascaoperasi ACDF (p > 0.05).Kesimpulan: Pada studi ini tidak ditemukan hubungan signifikan antara usia, jenis kelamin, indeks massa tubuh, riwayat merokok, riwayat diabetes mellitus, jumlah level fusi, dan lokasi fusi terhadap kejadian adjacent segment degeneration pascaoperasi ACDF.

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Introduction: Anterior cervical discectomy and fusion (ACDF) is a standard surgical therapy for cervical spine issues such as disc herniation and refractory cervical spondylosis. Adjacent segment degeneration (ASD) after ACDF is a complication that can cause symptoms and may necessitate reoperation. To date, risk factors for adjacent segment degeneration following ACDF surgery remain a topic of discussion due to discrepancies in existing research. Hence, this study aims to provide additional information regarding risk factors for adjacent segment degeneration.

Methods: A cross-sectional study was conducted on patients one year or more after ACDF surgery at Cipto Mangunkusumo Hospital and Fatmawati Hospital. This research assesses the relationships between risk factors such as age, gender, body mass index, smoking history, diabetes mellitus history, number of fusion levels, and fusion location with the occurrence of adjacent segment degeneration after ACDF surgery.

Results and Discussion: A total of 41 patients were included in this study, involving 79 spinal levels. The mean age of the sample was 52.85 ± 10.41 years, with the majority being female (n = 21; 56.1%). Most surgeries involved more than one spinal level (75.6%), with the most common level C5/C6 (n=34; 82.92%). Adjacent segment degeneration occurred in 10 patients (24.39%) after ACDF. No significant differences were found between age, gender, body mass index, smoking history, diabetes mellitus history, number of fusion levels, and fusion location with the occurrence of adjacent segment degeneration after ACDF surgery (p > 0.05).

Conclusion: This study did not found significant differences between age, gender, body mass index, smoking history, diabetes mellitus history, number of fusion levels, and fusion location with the occurrence of adjacent segment degeneration after ACDF surgery."

"Latar belakang: Uveitis merupakan sekelompok penyakit yang ditandai dengan adanya inflamasi intraokular. Derajat inflamasi bilik mata depan yang dinilai secara semi-kuantitatif berdasarkan penghitungan sel dan flare, digunakan untuk menentukan keparahan penyakit, efektivitas terapi serta pemantauan jangka panjang pada uveitis anterior dan panuveitis.Tujuan: Menilai validitas dan reliabilitas optical coherence tomography (OCT) segmen anterior dalam mengukur inflamasi bilik mata depan secara kuantitatif sebagai metode alternatif dari standar baku pengukuran semi-kuantitatif, Kriteria SUN.Metode: Studi ini adalah studi potong lintang, prospektif. Penghitungan jumlah sel menggunakan optical coherence tomography dengan bantuan ImageJ dilakukan oleh dua penilai yang berbeda. Hasil: Sebanyak 30 mata yang berasal dari 24 pasien diikutkan dalam penelitian. Sebanyak 80% pasien menderita panuveitis dengan tuberkulosis sebagai etiologi tersering (50%). Uji kesesuaian Cohen’s kappa pada protokol multiple line scans didapatkan nilai 0,352 (p=0,000) sedangkan protokol single line scan didapatkan nilai -0,218 (p=0,032). Uji korelasi Gamma protokol multiple line scans didapatkan nilai rho=0,595 (p=0,002) sedangkan protokol single line scan didapatkan nilai rho=-0,210 (p=0,313). Nilai inter-rater protokol multiple line scans menunjukkan hasil sangat baik sedangkan protokol single line scan baik (0,986 dan 0,892, p<0,001).Kesimpulan: OCT segmen anterior menghasilkan data kuantitatif sel inflamasi pada bilik mata depan. Jumlah sel bilik mata depan yang dihitung menggunakan OCT segmen anterior protokol multiple line scans menunjukkan korelasi sedang dan kesesuaian minimal dengan Kriteria SUN.

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Background: Uveitis is a group of diseases characterised by intraocular inflammation. The evaluation of anterior chamber inflammation, conducted through a semi-quantitative assessment involving cell counts and flares, plays a pivotal role in determining disease severity, assessing therapeutic effectiveness, and facilitating long-term monitoring in anterior uveitis and panuveitis cases.

Purpose: To evaluate the validity and reliability of anterior segment optical coherence tomography (AS-OCT) as a quantitative measurement tool for assessing anterior chamber inflammation. The objective is to explore its potential as an alternative method to the standard semi-quantitative measurement defined by the SUN Criteria.

Methods: A prospective, cross-sectional study was conducted for this purpose. The anterior chamber cell numbers were quantified using anterior segment optical coherence tomography, assisted by ImageJ, and assessed independently by two raters.

Result: The study included a total of 30 eyes from 24 patients. Panuveitis was observed in 80% of the patients, with tuberculosis identified as the predominant etiology (50%). The Cohen’s kappa test, conducted on the multiple-line scan protocol, yielded a value of 0.352 (p=0.000), while the single-line scan protocol showed a value of -0.218 (p=0.032). The Gamma correlation test for the multiple-line scan protocol demonstrated a value of rho=0.595 (p=0.002), whereas the single-line scan protocol had a value of rho=-0.210 (p=0.313). Inter-rater values for the multiple-line scan protocol indicated excellent agreement (0,986, p<0.001), while the single-line scan protocol showed good agreement (0.892, p<0.001).

Conclusion: OCT yielded quantitative data on anterior chamber inflammatory cells. Quantifying anterior chamber cells through the multiple line scan protocols of anterior segment OCT showed a moderate correlation and minimal agreement with the SUN Criteria."

"Tujuan: Membandingkan perubahan segmen anterior dan tekanan intraokular (TIO) antara tetes mata pilokarpin 2% dan laser iridotomi perifer (LIP) pada sudut tertutup primer. Desain: Penelitian ini merupakan uji klinis tunggal (one group pretest post-test design). Metode: Sebanyak 34 mata dari 29 subyek penelitian dengan sudut tertutup primer mendapatkan perlakuan tetes mata pilokarpin 2% selama 3-5 hari dan kemudian LIP. Seluruh subyek mendapatkan perlakuan yang sama. Dilakukan pemeriksaan TIO dan anterior segment optical coherence tomography (AS-OCT) sebanyak tiga kali, yaitu pada kondisi awal, 3-5 hari setelah pemberian tetes mata pilokarpin 2%, dan 1 minggu setelah laser iridotomi perifer. Parameter sudut yang dinilai adalah angle opening distance (AOD) dan trabecular-iris space area (TISA) yang diukur pada jarak 500 dan 750 μm dari scleral spur pada kuadran nasal dan temporal. Perubahan dihitung berdasarkan selisih antara nilai pasca pilokarpin 2% dan LIP dengan nilai awal. Hasil: Terdapat peningkatan nilai parameter sudut dan penurunan TIO baik pasca LIP maupun pasca tetes mata pilokarpin 2%. Terdapat penurunan nilai kedalaman bilik mata depan setelah tetes mata pilokarpin 2%. Kesimpulan: LIP membuka sudut lebih besar dibandingkan tetes mata pilokarpin 2%, namun tetes mata pilokarpin 2% menurunkan TIO lebih besar. Tetes mata pilokarpin 2% lebih mendangkalkan bilik mata depan dibandingkan LIP.

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Purpose : To compare anterior segment and intraocular pressure changes between pilocarpine eye drops 2% and Laser Peripheral Iridotomy (LPI) in primary angle closure.

Methods : This was a clinical trial one group pretest post-test design. A total of 34 eyes of 29 subjects got treatment pilocarpine eye drops 2% for 3-5 days and then LPI. All subjects got the same treatment. Intraocular presssure and anterior segment optical coherence tomography examination was done three times, on the initial conditions, 3-5 days after administration of pilocarpine eye drops 2%, and 1 week after LPI. Angle parameters were the angle opening measured at a distance of 500 and 750 μm from the scleral spur on the nasal and temporal quadrants. The changes are calculated based on the difference between the post-pilocarpine 2% and LPI with initial values.

Result : There is an increase in the value of the angle parameters and reduction of IOP after the LPI and pilocarpine eye drops 2%. There is a decline in anterior chamber depth after pilocarpine eye drops 2%.

Conclusion : LPI widening the angle greater than pilocarpine eye drops 2%, but pilocarpine eye drops 2% lowering the IOP greater than LPI. Pilocarpine eye drops 2% shallowing the anterior chamber depth."

"Dental fusion is the most common problem seen in the primary dentition. The incidence of dental fusion was approximately 0,5 % for deciduous dentition and 0,1% for permanent dentition. Fusion may be complete or incomplete. Its etiology was related to genetic or local factor. These anomaly could result in dental caries, esthetic problem, periodontal disease, dental malocclusion, and hypodontia in permanent dentition. Treatment of fused teeth depends on the location and the extent of fusion. This report describes an incomplete dental fusion wilh dentinal caries occurred on 72 and 73 while 32 was agenesis. The purpose of the treatment was to improve the esthetic performance and subsequently to keep the teeth until the exfoliation time. After the restoration of 72 and 73, the patient feel satisfied."

"Perubahan aliran darah serebral (cerebral blood flow) merupakan salah satu penyebab kelainan neurologis neonatus. Ultrasonografi dengan teknik Doppler merupakan teknik pemeriksaan noninvasif untuk evaluasi hemodinamika serebral yang memberikan informasi perfusi serta penilaian kuantitatif dari resistensi vaskular dengan mengukur resistive index arteri serebri. Tujuan penelitian ini untuk mengetahui nilai resistive index arteri serebri anterior pada neonatus normal. Dilakukan pemeriksaan ultrasonografi Doppler melalui jendela akustik fontanella anterior menggunakan transduser phase array frekuensi 2 - 4 MHz pada 51 neonatus yang memenuhi kriteria normal (24 laki-laki dan 27 perempuan). Analisis normalitas variabel subyek penelitian dengan menggunakan Shappiro Wilks didapatkan p > 0,05 menggambarkan distribusi data yang normal. Hasil rerata rerata nilai resistive index arteri serebri anterior pada neonatus normal yang didapatkan adalah 0,62 ± 0.03 dengan Confidence Interval (CI) 95% : 0,62 - 0,63.

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Cerebral blood flow changes is one of the causes of neurological disorders in neonates. Ultrasound with Doppler technique is a noninvasive examination technique for the evaluation of cerebral hemodynamics that provide information on the quantitative assessment of perfusion and vascular resistance by measuring resistive index of the cerebral artery. The purpose of this study to determine the value of the resistive index of the anterior cerebral artery in normal neonates. Doppler ultrasound examination was performed through anterior fontanella using phase array transducer frequency of 2-4 MHz in 51 neonates who meet normal criteria (24 male and 27 female). Analysis of the research subjects variables for normality using Wilks Shappiro obtained p>0.05, illustrates the normal distribution of data. The mean value of anterior cerebral artery resistive index in normal neonates is 0.62 ± 0,03 with Confidence Interval (CI) 95%: 0.62 - 0.63."

"Latar belakang: Prolaps organ panggul (POP) merupakan masalah ginekologi dengan insidensi POP 2,04 per 1000 wanita per tahun. Di RSCM, sistokel grade 3 dan 4 terjadi pada 71% wanita dengan POP. Keberhasilan kolporafi anterior sebagai tatalaksana sistokel ditandai dengan rekurensi pasca tindakan, yaitu paling tinggi sebesar 65%. Sehingga perlu dilakukan pengkajian faktor risiko rekurensi tersebut. Tujuan: Untuk mengetahui faktor risiko rekurensi sistokel pasca kolporafi anterior Metode: Penelitian ini menggunakan desain kohort retrospektif dengan mengambil data sekunder dari rekam medis pasien yang dilakukan tindakan kolporafi anterior, saat preoperatif dan saat pasien kontrol minimal 6 bulan pasca tindakan. Tindakan diambil dari RSCM dan RSF tahun 2012 sampai Juli 2019. Total sampel yang memenuhi kriteria inklusi dan eksklusi adalah 91 orang. Selanjutnya dilakukan analisis dengan uji MannWhitney untuk variabel numerik dan uji Fischer untuk kategorik. Beberapa variabel yang dianggap bermakna dilakukan uji multivariat dengan metode regresi logistik.Hasil: Rekurensi anatomis didapatkan sebesar 24,2% dan rekurensi simptomatik 12,1%. Faktor usia, indeks massa tubuh, status menopause, paritas dan berat lahir terbesar, serta tindakan histerektomi, tidak bermakna terhadap rekurensi sistokel. Total panjang GH dan PB didapatkan bermakna pada uji univariat dengan p = 0,008 namun tidak bermakna pada uji regresi logistik. Sistokel derajat berat didapatkan hasil bermakna dengan p=0,023 dan RR 6,12. Tindakan gantung tidak menunjukkan hasil bermakna, namun bila dipisahkan menjadi antara jenis tindakan, USLS menurunkan kejadian rekurensi sistokel dengan RR 0,25 (p=0,025). Kesimpulan: Tindakan kolporafi anterior dengan native tissue didapatkan cukup baik dalam menatalaksana sistokel. Adanya data rekurensi dan faktor risiko ini dapat menjadi dasar pemilihan tindakan, dan sebagai informasi yang bermanfaat untuk diinformasikan pada pasien sebelum tindakan.

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Background: Pelvic Organ Prolapse (POP) is one of gynecological problem with incidence 2,04 every 1000 women every year. In RSCM, cystocele grade 3 and 4 occured in 71% women with POP. Anterior colporraphy as surgical management of cystocele is evaluated by the recurrence of cystocele after surgery, that reached 65% in the previous study. To decrease this number, we need to evaluate the risk factor of the recurrence.

Objective: To determine the risk factors of cystocele recurrence after anterior colporraphy

Method: This is a retrospective cohort study, using documented data from medical record. Data of patients underwent anterior colporraphy were taken, preoperative and after at least 6 months after surgery. Data were collected in RSCM and RSF from 2012- July 2019. Total sample met the inclusion and exclusion criteria was 91. We analyzed these data using Mann-whitney and Fischer test. Finally, we performed multivariate analysis using logistic regression method.

Result: We found the anatomical recurrence was 24,2% and symptomatic recurrence 12,1%. Age, body mass index, menopausal status, parity, largest birth weight, and hysterectomy was not significantly related to cystocele recurrence. total length of GH and PB found statistically significant by univariate analysis with p =0,008, but not significant by logistic regression test. Preoperative diagnosis of cystocele found statistically significant with p=0,023 and RR 6,12. Apical suspension found not statistically significant, but when we analyzed the types separately, USLS reduce the risk for cystocele recurrence with RR 0,25 (p=0,025).

Conclusion: Colporraphy anterior found to be reliable for cystocele management. Understanding the risk factors for recurrence could help us to decide the best option for management and additional important information to be delivered to the patient before surgery.

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