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"Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with various clinical disorders and frequent exacerbations. Psoriasis vulgaris is a common skin disorder which affect 1-3% of general populations. The pathophysiology regarding the coexistence of these diseases is not fully understood. Therapeutic challenges arise since the treatment one of these diseases may aggravate the other. We reported two cases of SLE with psoriasis vulgaris with clinical manifestations as recurrent erythroderma with photosensitivity. Improvement in clinical condition was observed after treating the patients with methylprednisolone combined with methotrexate. The coexistence SLE and psoriasis are considered very rare. The presence of this overlap syndrome may precede one another or occur simultaneously and is closely related with the presence of anti-Ro/SSA. Thus, it raises new challenge regarding its relationships, diagnosis, therapeutic, and management."

"ABSTRAKBackground: Systemic lupus erythematosus (SLE) is an autoimmune disease that more commonly affects women of childbearing age. It is a multi-organ disease and can involve virtually any organ in the body. Pleural effusion can occurred in 30% of patients with SLE, which may be a result of SLE itself, pulmonary emboli, or end-organ damage such as heart or renal failure. The management of pleural effusions in SLE patient can be challenging because the numerous of potential underlying cause and sometimes effusion recur despite appropriate treatment of primary process. Case Report: We reported 33 years old woman patient admitted to our ED with chief complaint of shortness of breath for last 1 week. Chest X-ray result showed bilateral pleural effusion. Serial pleural fluid analysis consistent with conclusion of transudate fluid. Echochardiograpy showed dilatation of left atrium and ventricle and reduced LVEF 34%. These data suggest congestive heart failure as the cause of pleura effusion. A few days after initial thoracocentesis, the patient become dyspnea again because of reccurent pleural effusion. To relieve the symptom, we did insertion of pigtail catheter connected with mini WSD (Water seal drainage). Conclusion: Pleural effusion is a relatively common clinical presentation of a patient with SLE. Pleural effusions may be a result of SLE itself, pulmonary emboli, or end-organ damage such as heart or renal failure. The management of pleural effusions are mainly to relieve the symptoms and treatment of underlying cause."

"Latar belakang dan tujuan : CT scan merupakan modalitas pencitraan utama pada berbagai tumor primer kepala dan leher serta ketersedian modalitas CT yang lebih luas di Indonesia. Penelitian ini bertujuan untuk mendiskusikan peranan CT sebagai modalitas yang berpotensi membantu menegakkan diagnosis keterlibatan lokoregional kelenjar getah bening KGB leher sehingga didapatkan perencanaan tatalaksana karsinoma sel skuamosa KSS dengan nilai terapi dan prognosis terbaik. Penelitian ini modifikasi Choi dan meneliti kesesuaian antara kriteria diagnostik KGB metastasis pada CT scan dibandingkan dengan hasil histopatologik pada pasien KSS. Metode : Penelitian ini merupakan studi asosiatif secara potong lintang pada data primer kasus baru KSS-KL. Pengambilan data berlangsung dari bulan Februari 2018 hingga April 2018 di Poli Onkologi Departemen THT, Departemen Radiologi dan Departemen Patologi Anatomi RSUPN Cipto Mangunkusumo. Sebanyak 90 unit sampel dievaluasi lokasi, morfologi dan kemungkinan metastasis pada CT scan preoperatif menggunakan kriteria diagnostik, kemudian tiap unit sampel diberi label untuk menunjang kesesuaian node-per-node yang kemudian disesuaikan dengan KGB temuan intraoperasi. Operasi diseksi leher dilakukan dengan jarak kurang dari 1 minggu pasca CT scan preoperatif. Pasca diseksi, setiap KGB yang telah diberi label dilakukan pemeriksaan histopatologik. Kemudian asumsi kesesuaian temuan pada CT scan preoperatif dan histopatologik diuji hipotesis komparatif menggunakan uji McNemar. Hasil : Penelitian ini menunjukkan nilai p = 0,000 yaitu terdapat perbedaan bermakna antara kriteria diagnostik KGB maligna pada CT scan dengan histopatologik. Penilaian kesesuaian kriteria diagnostik KGB maligna pada CT scan dengan histopatologik menggunakan Kappa didapatkan R = 0,12 p=0,100 . Kriteria diagnostik KGB maligna pada CT scan pada penelitian ini memiliki nilai sensitivitas 33,3 dan nilai spesifisitas 61,7 dengan nilai spesifisitas ukuran aksis pendek, hipodensitas dan penyangatan heterogen masing-masing 100 dan nilai sensitivitas lokasi drainase primer 100 . Kesimpulan : Tidak terdapat kesesuaian antara kriteria diagnostik KGB maligna pada CT scan dengan hasil histopatologik. Adanya komponen kriteria diagnostik yang sangat sensitif tapi tidak spesifik dan yang sangat spesifik tapi tidak sensitif menyebabkan nilai sensitivitas dan spesifisitas kriteria diagnostik ini rendah.

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Background and Objective CT scan is the main imaging modality in various head and neck primary tumors and broader availability in Indonesia. This study aims to discuss CT as a modality that helps establish the diagnosis of lymph node metastases so the management of head and neck squamous cell carcinoma HNSCC can be done with the best therapeutic value and prognosis. This study of Choi modification is trying to research about association between diagnostic criteria of metastases lymph node in CT Scan and histopathologic in SCC Patients Methods This research is a cross sectional associative study on the primary data of the new case of HNSCC. Data collection took place from February 2018 to April 2018 at the Polyclinic Oncology Department of ENT, Department of Radiology and Department of Pathology Anatomy Cipto Mangunkusumo Hospital. A total of 90 sample units were evaluated for location, morphology and possible metastasis on preoperative CT scans using diagnostic criteria, then each sample unit was labeled to support node per node association which was then adjusted to intraoperative lymph node findings. Neck dissection surgery is performed less than 1 week after a preoperative CT scan. After the operation, every lymph node that has been labeled is carried out to histopathologic examination. Then the hypothesis of association of the findings on preoperative CT scans and histopathologic is tested using McNemar test. Results This study shows p value 0,000 so that there is a significant difference between the diagnostic criteria on CT scan and histopathologic examination. Assessment of the diagnostic criteria for malignant KGB on CT scans and histopathologic examination using Kappa obtained R 0.12 p 0.100 , which shows no suitability between them. The diagnostic criteria for malignant lymph node on CT scan in this study have a sensitivity value of 33.3 and a specificity value of 61.7 with a specificity value of the size of the short axis, hypodensity and heterogeneous enhancement respectively 100 and the sensitivity value of the primary drainage site 100 . Conclusion There is no agreement between the diagnostic criteria for malignant lymph nodes on CT scan with histopathologic examination. The existence of a highly sensitive but non specific and a highly specific but insensitive component of the diagnostic criteria might causes the sensitivity and specificity of these diagnostic criteria to be low."

"Latar Belakang: Lupus Eritematosus Sistemik LES adalah suatu penyakit autoimun kronik yang melibatkan multiorgan dan multietiologi. Komplikasi kardiovaskular pada pasien LES merupakan salah satu penyebab morbiditas dan mortalitas terbesar. Proses aterosklerosis diketahui terjadi pada pasien LES usia muda dan menjadi salah satu faktor penyebab disfungsi diastolik. Penegakkan diagnosis disfungsi diastolik memerlukan pemeriksaan yang cukup mahal dan tidak merata di setiap fasilitas kesehatan. Oleh karena itu, diperlukan suatu metode diagnostik yang lebih mudah dan murah tetapi tetap dapat diandalkan untuk penegakkan diagnostik tersebut, seperti metode sistem skoring. Umur, lama sakit, komorbiditas hipertensi dan atau diabetes mellitus dan atau dislipidemia , anemia, Index Massa Tubuh IMT , kadar serum kreatinin, dan APS diketahui berhubungan dengan disfungsi diastolik dan dapat menjadi determinan diagnosis disfungsi diastolik pada pasien LES. Tujuan: Menetapkan sistem skoring diagnosis disfungsi diastolik pasien LES berdasarkan determinan umur, lama sakit, komorbiditas, anemia, IMT, kadar serum kreatinin, dan APS. Metode: Penelitian uji diagnostik potong-lintang cross sectional terhadap 127 pasien LES di RSCM sejak bulan April 2017 sampai Mei 2017. Data yang digunakan adalah data primer berupa wawancara, pemeriksaan fisik, dan pemeriksaan ekokardiografi transtorakal, serta data sekunder yang diperoleh dari rekam medis. Hasil: Terdapat 9 7.08 subjek penelitian yang mengalami disfungsi diastolik. Lima dari tujuh determinan masuk dalam analisis multivariat. Setelah pemodelan, didapatkan APS dengan bobot skor 2 dan komorbiditas dengan bobot skor 1 yang selanjutnya menjadi bagian dari sistem skoring diagnosis disfungsi diastolik pasien LES. Sistem skoring ini kemudian di uji dengan kurva ROC dan didapatkan AUC sebesar 80.3 95 IK 62.7-97.8 dengan titik potong terbaik adalah lebih sama dengan 2. Skor ge;2 memiliki sensitifitas 44 , spesifisitas 94.9 , nilai prediksi positif 60 , dan nilai prediksi negatif 95.7 . Uji validasi interna dan eksterna menghasilkan nilai yang baik. Simpulan: Proporsi disfungsi diastolik pasien LES di RSCM adalah 7.08 . Determinan diagnosis disfungsi diastolik pasien LES adalah APS dan komorbiditas. Skor ge;2 merupakan titik potong terbaik untuk menentukan bahwa pasien LES mengalami disfungsi diastolik.

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Background : Systemic Lupus Erythematosus SLE is a chronic autoimmune disease involving multiorgan and multietiology. Cardiovascular complication in SLE patients is one of the highest causes of morbidity and mortality. It is known that premature atherosclerosis occurs in young SLE patients and related to diastolic dysfunction. The diagnostic of diastolic dysfunction requires a quite expensive and uneven examination at every health facilities. Therefore, it's necessary to have an accessible and inexpensive but reliable diagnostic method, such as a scoring system. Age, duration of pain, comorbidities hypertension and or diabetes mellitus and or dyslipidemia , anemia, Body Mass Index BMI , serum creatinine level, and APS are known to be associated with diastolic dysfunction and can be a determinant diagnostic of diastolic dysfunction in SLE patients.

Objective : Establish a diagnostic scoring system of diastolic dysfunction in SLE patients with determinants of age, duration of pain, comorbidities, BMI, serum creatinine level, and APS.

Methods : A cross sectional diagnostic study with 127 SLE patients in RSCM from April 2017 to May 2017. The data used are primary data such as interviews, physical examination, and transthoracic echocardiography, as well as secondary data was obtained from medical records.

Results : There were 9 7.08 subjects with diastolic dysfunction. Five from seven determinants can be used in multivariate analysis. After modeling, APS was obtained with score of 2 and comorbidities with score of 1, further it becomes a part of diagnostic scoring system of diastolic dysfunction in SLE patients. The scoring system was tested with ROC curve and obtained AUC of 80.3 95 IK 62.7 97.8 with the best cut off point was ge 2. A score of ge 2 had a sensitivity of 44 , specificity of 94.9 , positive predictive value of 60 , and negative predictive value of 95.7 . Internal and external validation test produce a good value.

Conclusions : The proportion of diastolic dysfunction in SLE patients in RSCM is 7.08 . Diagnostic determinants of diastolic dysfunction in SLE patients are APS and comorbidities. A score of ge 2 is the best cut off point for determining that SLE patients has a diastolic dysfunction."

"ABSTRAKLatar Belakang:Perkembangan dalam tatalaksana Lupus eritematosus sistemik (LES) telah meningkatkankesintasan pasien dengan LES. Kualitas hidup merupakan komponen evaluasi terapi LES danvalue based medicine. Salah satu kuesioner khusus untuk menilai kualitas hidup adalahLupus QoL. Saat ini di Indonesia belum ada kuesioner khusus penilaian kualitas hidup padapasien dengan LES. Penelitian ini bertujuan membuktikan Lupus QoL sahih dan andal dalammenilai kualitas hidup pasien dengan LES di Indonesia.Metode:Penelitian ini merupakan studi potong lintang. Penelitian diawali dengan menerjemahkanLupus QoL ke dalam bahasa Indonesia kemudian diujicobakan pada 10 responden. Penelitiankemudian dilanjutkan pada jumlah sampel yang lebih besar. Keandalan dievaluasi denganIntraclass Correlation Coefficient (ICC) pada tes dan tes ulang dan cronbach α padakonsistensi internal. Kesahihan konstruksi dinilai dengan multi trait scaling analysis.Kesahihan eksternal dinilai dengan menilai korelasi antara Short form 36 (SF36) denganLupus QoL dan aktivitas penyakit.Hasil:Pengambilan data terhadap 65 pasien LES yang berobat di unit rawat jalan Ilmu PenyakitDalam RSCM selama bulan Oktober ? November 2015. Kesahihan eksternal Lupus QoL baikdengan korelasi terhadap SF36 dengan r :0.38 ? 0.66 (p<0.05). Multi trait analysis scalingmenunjukkan korelasi yang baik antara nilai tiap domain dengan nilai total (r:0.46 ? 0.85)dan antara skor tiap butir pertanyaan dan skor total domain (r:0.44 ? 0.93). Nilai ICC(interval 7 hari) baik (ICC>0.7). Nilai cronbach α> 0.7 pada setiap domain. Korelasi LupusQoL terhadap aktivitas penyakit memiliki korelasi yang lemah dan tidak bermakna yangsesuai dengan penelitian ? penelitian sebelumnya.Simpulan:Kuesioner Lupus QoL Indonesia sahih dan andal dalam menilai kualitas hidup pada pasiendengan LES di Indonesia

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ABSTRACTBackground:The development in Systemic Lupus Erythematosus treatment has led into the increasment of survival.Quality of life has become a component to evaluate therapy ini SLE and value based medicine. Onespesific questionnaire to asses quality of life is Lupus Quality of Life (Lupus QoL). Currently inIndonesia there has not been spesific questionnaire to asses quality of life in SLE patients. This studyaims to prove that Lupus QoL is valid and reliable to asses the quality of life in SLE patients inIndonesia.Methods:This study is cross sectional study. This study began with the translation the Lupus QoL intoindonesian language then tested in 10 respondents. After that,this study continued with a largersample size. The intraclass coefficient correlation was used to evaluate test and re test reliability, thecronbach alpha was used to evaluate internal consistency. Construct validity evaluated using multitrait scaling analysis and the extrenal validity evaluated using the correlation between domains inshort form 36 (SF 36) with Lupus QoL and with disease activity. Results:Data collection were doneon 65 SLE patients in Oktober ? November 2015 in RSCM. The external validity with SF 36 was goodwith r:0.38-0.66(p<0.05). The construct validity is good with r > 0.4 (0.44 ? 0.93). The ICC value inone week >0.7 and Cronbach α was >0.7 in each domain. The correlation with disease activity wasweak and consistent with another studies.Conclusion:Lupus QoL questionnaire is valid and reliable to asses quality of life in SLE patients in Indonesia."