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"ABSTRAKDuring 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO). There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE) were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents.The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100%) and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO) is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety."

"During 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO). There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE) were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents. The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100%) and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO) is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety.

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Dalam kurun waktu 11 tahun antara 1Januari 2005 sampai 31 Desember 20015 sebanyak 18 kasus PDA

pada anak remaja dan dewasa dilakukan penutupan PDA dengan alat Amplatzer Duct Occluder (ADO). Terdapat 9 kasus anak remaja yang berumur antara 14-18 tahun dan 9 orang dewasa yang berumur di atas 18 tahun dengan umur yang tertua 46 tahun. Sebelum pelaksanaan tindakan, dilakukan pemeriksaan klinis, EKG dan foto toraks serta ekokardiografi transtorakal untuk konfirmasi diagnostik PDA. Prosedur implantasi ADO dilakukan dengan anastesi umum pada remaja dan anestesi lokal dan sedasi pada pasien dewasa. Ukuran diameter PDA berkisar antara 1,6 mm-11,1 mm. Berdasarkan klasifikasi Kritchenko terdiri dari 15 PDA tipe A1 dan 3 kasus tipe A2. Flow rati oantara sirkulasi pulmonal dan sirkulasi sistemik berkisar antara 1,1?5,9. Waktu pelaksanaan prosedur berkisar antara 60-189 menit dengan waktu florsokopi antara 7,1-77,3 menit. Tekanan rata-rata pada arteri pulmonalis berkisar antara 22-63 mmHg dengan tekanan tertinggi sebesar 63 mmHg terdapat pada 2 kasus (no 12 dan 13). Segera setelah prosedur tindakan menujukkan penutupan total pada 14 kasus dan pada4 kasus terdapat pirau residual minimal pada gambaran angiografi yang kemungkinan disebabkan kebocoron sementara melalui sela-sela device. Dalam 24 jam pertama setelah tindakan ditemukan penutupan total pada semua kasus (100%) dan hasil tersebut ditemukan sampai 1 bulan dan 6 bulan setelah tindakan. Selama kurun waktu tersebut tidak ditemukan sisa pirau (residual shunts) dan komplikasi berarti lainnya seperti embolisasi device atau rekanalisasi pada duktus. Hasil studi seri kasus ini ini menunjukkan bahwa penutupan PDA dengan prosedur transkateter menggunakan ADO pada pasien remaja dan dewasa dalam jangka pendek sangat baik dan efektif serta tidak ada komplikasi yang berarti. Namundemikian masih diperlukan pemantauan jangka panjang untuk menilai efektivitas dan keamanan prosedur ini."

"ABSTRAKTuberculosis was still a global health problem. Beside lung, tuberculosis also manifest in other organs, one among them  is in abdominal organs. Abdominal tuberculosis was a complex disease with unspecific sign and symptoms so that its diagnostic procedure was not rarely inconclusive. We reported a 24 years old woman with chief complain of worsening abdominal pain in all region, accompanied by nausea, vomiting, bloating, and  absent bowel movement. She also had a fresh bloody stool. She had an active pulmonary tuberculosis on initiation phase treatment. Physical examination suggest a bowel obstruction sign with distended abdomen and increase bowel sound. Colonoscopy procedure findings was a mass that obstruct bowel lumen in ileocaecal region, suggest for malignancy similar to computerized tomography (CT) scan result, but pathlogic result showed an active colitis without any sign of malignancy. Because of its contradiction, the second colonoscopy was performed and concluded as intestinal tuberculosis, matched with second pathologic examination. Although polymerase chain reaction (PCR) tuberculosis (TB) showed a negative result, a further clinical judgement concluded this as an intestinal tuberculosis case. Patient was finally treated as intestinal tuberculosis with first-line antituberculosis drugs and planned to have colonoscopy evaluation. After general condition was good and obstructive ileus sign was relieved, patient planned for outpatient care.Tuberculosis was still a global health problem. Beside lung, tuberculosis also manifest in other organs, one among them is in abdominal organs. Abdominal tuberculosis was a complex disease with unspecific sign and symptoms so that its diagnostic procedure was not rarely inconclusive. We reported a 24 years old woman with chief complain of worsening abdominal pain in all region, accompanied by nausea, vomiting, bloating, and  absent bowel movement. She also had a fresh bloody stool. She had an active pulmonary tuberculosis on initiation phase treatment. Physical examination suggest a bowel obstruction sign with distended abdomen and increase bowel sound. Colonoscopy procedure findings was a mass that obstruct bowel lumen in ileocaecal region, suggest for malignancy similar to computerized tomography (CT) scan result, but pathlogic result showed an active colitis without any sign of malignancy. Because of its contradiction, the second colonoscopy was performed and concluded as intestinal tuberculosis, matched with second pathologic examination. Although polymerase chain reaction (PCR) tuberculosis (TB) showed a negative result, a further clinical judgement concluded this as an intestinal tuberculosis case. Patient was finally treated as intestinal tuberculosis with first-line antituberculosis drugs and planned to have colonoscopy evaluation. After general condition was good and obstructive ileus sign was relieved, patient planned for outpatient care."

"AbstrakA 43-year old male presented with persistent discomfort and pain upper abdomen (epigastrium) more on left side associated with fever on and off, along with fatigue and loss of appetite for the last four months. Physical examination revealed mass on left hypochondrium extending to epigastrium with mild distension of the abdomen. Imaging studies of the patient showed dextrocardia on chest x-ray postero-anterior (PA) view, thoracic and abdominal CT scan showed situs inversus totalis with multiple SOL (space occupying lesion) in right lobe of liver with largest measuring 8x6 cm2 in the 4th segment. USG-guided FNAC of the mass showed features of hepatocellular carcinoma. Thereupon, hepatocellular carcinoma in situs inversus totalis was diagosed to this patient and was clinically staged as T3aN0M0. He was given sorafenib 400 mg orally twice daily with an advice to come for regular assessment every 4 week."

"Pneumonia kemunitas adalah infeksi akut pada paru-paru yang tidak memilki riwayat rawat inap dalam waktu dekat atau tidak terpapar dengan perawatan medis secara teratur. Terdapat dua sistem skoring untuk menentukan prognosis pneumonia komnitas yaitu pneumonia severity index (PSI) and CURB-65. Pnemonia Serverity Index (PSI) lebih rumit dalam penghitungannya dibandingkan CURB-65 dimana PSI menilai 19 variabel sementara CURB-65 hanya 5 variabel. Tujuan menentukan apakah pneumonia serverity index (PSI) score lebih superior dibandingkan skor CURB-65.Metode pencarian literatur dilakukan menggunakan pubmed dan OVID Medline. Literatur dipilih bila tidak lebih lama dari 10 tahun, dan bukan review articel. Enam Literatur memenuhi kriteria dan dimasukan dalam analisis. Hasil lima literatur menyatakan bahwa PSI lebih akurat dalam menentukan dalam prognosis mortalitas 30 hari dan kebutuhan ICU pada pasien risiko tinggi (PSI kelas IV/V and skor CURB-65>3). satu literatur ( Luque et al ) menemukan bahwa CURB-65 sama akuratnya dalam menentukan prognosis mortalitas 30 hari pasien pnemonia komunitas secara keseluruhan. Kesimpulan skor PSI lebih dipilih dibandingkan skor CURB-65 dalam menentukan prognosis mortalitas 30 hari pasien secara keseluruhan pada pasien pneumonia kemunitas."

"Snakebite is an important medical problem in India. Among their various manifestations, cerebral complications are uncommonly found in literature. Moreover, Ischemic stroke following snake bite is quite rare. Here we report a case series of two such cases that developed neurological manifestations following Russell’s viper bite. On computerized tomography (CT) scan of brain; cerebral infarcts were revealed. Their likely mechanisms are discussed in present study which include disseminated intravascular coagulation, toxin induced vasculitis and endothelial damage.

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Gigitan ular adalah masalah medis yang utama di India. Di antara berbagai manifestasinya, komplikasi serebral jarang ditemukan pada literatur. Terlebih lagi, stroke iskemik akibat gigitan ular cukup langka. Kami melaporkan serangkaian kasus dari dua kasus serupa yang mengembangkan manifestasi neurologis setelah gigitan ular viper Russell. Pada pemeriksaan CT scan menunjukkan infark serebral. Kemungkinan mekanisme penyebab kejadian yang mencakup koagulasi intravaskular diseminata, toksin yang diinduksi vaskulitis, dan kerusakan endotel akan dibahas pada artikel ini."

"Ruang lingkup dan cara penelitian: Kemampuan tangan mengendalikan arah bidik pada saat melepas tembakan adalah kemampuan yang sangat penting dalam menentukan kinerja seorang petembak . khususnya petembak nomor pistol. Pengendalian yang dimaksud adalah kemampuan mempertahankan senjata dalam keadaan diam dan gerakan yang terjadi hanya pada jari penarik picu. Seorang petembak mahir seyogyanya telah cukup menguasai teknik dasar menembak yaitu membangun posisi kuda·kuda dan membidik, sehingga kinerjanya lebih dipengaruhi oleh kemampuan teknik menembak taraf lanjut yaitu pengendalian senjata. Oengan menggolongkan petembak peringkat atas OKI Jaya nomor air pistol putra sebagai petembak mahir, dilakukan penelitian terhadap 12 petembak dengan melakukan rekaman EMG m. opponens pol/icis dan m. flexor digiti minimi brevis yang bertindak sebagai otot tangan pengendali arah picu pada saat menembak. Rekaman EMG dilakukan dengan menggunakan elektrode permukaan dan hasilnya dianalisis secara manual dengan planimetri yang diproses berdasarkan waktu.Hasil tembakan pada kertas sasaran dinilai oleh reading machine untuk ditentukan skornya. Hubungan gambaran EMG otot pengendali picu dengan kinerja ditentukan dengan melakukan analisis korelasi antara rata· rata nilai konversi EMG selama rentang waktu menarik picu dengan skor. Selanjutnya untuk m~mperoleh gambaran karakteristik petembak peringkat atas OKI Jaya nomor air pistol putra dalam hal karakteristik umum, pola latihan dan konsumsi zat yang dapat mempengaruhi fungsi motorik dilakukan wawancara dan beberapa pemeriksaan lain.Hasil dan Kesimpulan: Analisis gambaran EMG otot pengendali picu 2 detik sebelum dan 2 detik sesudah melepas tembakan menunjukkan keragaman kemampuan petembak dalam mempertahankan stabilitas genggaman (p>0,05). Oalam penelitian, petembak menghasilkan kinerja yang tidak berbeda dengan kinerja terbaik selama 2 tahun terakhir (p>0,05). Hipotesis adanya korelasi linier negatif antara aktivitas listrik otot pengendali picu saat menarik picu dengan kinerja pada penelitian ini tidak terbukti (r=-0,024 dengan p>0,05). Gambaran karakteristik umum petembak peringkat atas OKI Jaya nomor air pistol putra adalah anggota ABRI, berumur di atas 30 tahun dengan titik berat tubuh (center of gravity) yang rendah. Para petembak melakukan latihan fisik maupun teknik menembak dengan cara yang beragam, dengan penekanan pada latihan teknik. Petembak mengkonsumsi zat yang dapat mempengaruhi fungsi motorik dalam jumlah rendah."