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"Extra-pulmonary tuberculosis covers all forms of tuberculosis in which the disease process occurs outside the lungs. Tuberculosis is one of the common infectious causes of splenic enlargement, but tuberculous splenic abscess is a rare presentation.We report the finding of tuberculous multiple splenic abscesses in a young male patient aged 33 years with prolonged fever. The main clinical feature was fever for 6 months prior to admission. Abdominal ultrasound revealed the spleen was normal in size but showed multiple abscesses. CT scan abdomen showed splenomegaly with multiple solid nodules. Patient underwent laparatomy and splenectomy, the spleen indeed showed multiple abscesses. Histopatology result showed Langhan's multi nucleated giant cells, caseous necrosis. The patients was diagnosed to have tuberculous multiple abscesses of the spleen. The patient was started on daily short-course antituberculosix drugs with isoniazid, rifampicin, pyrazinamide and ethambutol. He responded well to oral antituberculosis treatment."

"Demam merupakan salah satu permasalahan terbesar ketika anak dilarikan ke Instalasi Gawat Darurat. Keberlangsungan demam bergantung kepada waktu patogen berinvasi di dalam tubuh sehingga memicu proses inflamasi. Demam berkepanjangan merupakan demam yang terjadi lebih dari lima hari dengan salah satu penyebabnya adalah infeksi bakteri. Bakteri tuberkulosis, Mycobacterium tuberculosis kompleks, menjadi etiologi dari kejadian demam berkepanjangan, termasuk pada anak. Penanganan demam dapat dilakukan dengan melakukan kompres menggunakan metode tepid water sponge bersamaan dengan pemberian antipiretik, hal ini telah dibuktikan oleh berbagai penelitian yang ada. Maka dari itu, peneliti hendak membuktikan efektivitas tepid water sponge kepada anak dengan diagnosis medis prolonged fever suspect tuberculosis. Peneliti melakukan penelitian pada Anak AF dengan prolonged fever suspect tuberculosis dengan menimplementasikan asuhan keperawatan untuk mengatasi hipertermia, gangguan nutrisi, dan ketidakefektifan bersihan jalan napas pasien. Rangkaian asuhan keperawatan dimulai dari pengkajian secara holistik pada anak, penegakan diagnosis keperawatan dan menentukan prioritas diagnosis, perencanaan intervensi keperawatan, implementasi tindakan, serta evaluasi. Asuhan keperawatan yang dilakukan didokumentasikan ke dalam Catatan Perkembangan Pasien Terintegrasi. Tindakan utama yang diteliti adalah penerapan tepid water sponge terhadap penurunan suhu tubuh anak. Berdasarkan evaluasi yang dilakukan, tepid water sponge mampu menurunkan suhu tubuh anak hingga sebesar 1°C. Peneliti menarik kesimpulan bahwa penerapan tindakan tepid water sponge pada anak dengan prolonged fever efektif dalam menurunkan demam yang dialami oleh anak.

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Fever is one of the biggest problems when a child is taken to the Emergency Room. The persistence of fever depends on the time when pathogen invades the body then trigger the inflammatory process. Prolonged fever is a fever that lasts more than five days with one of the causes is bacterial infection. The bacteria of tuberculosis, Mycobacterium tuberculosis complex, is an etiology of prolonged fever, even in pediatrics. Fever treatment can be done by applying warm compress using the warm water sponge method along with administering antipyretics, and the effectivity has been proven by various existing studies. Therefore, the researcher would like to prove the effectiveness of warm water sponges for a child with prolonged fever, suspected of being tuberculosis. The writer did the research on AF, a toddler with suspected prolonged tuberculosis fever by implementing nursing care to overcome hyperthermia, nutritional disorders, and ineffectiveness in clearing the patient's airway. The preparation started with a holistic assessment, establishing a diagnosis and determine the nursing diagnosis priorities, planning the interventions, implementing the interventions, and evaluate the nursing care. The nursing care is documented with Integrated Patient Progress Note format. The main intervention to be studied was an application of tepid water sponge to reduce the child's body temperature. Based on the evaluation, tepid water sponge can reduce a child's body temperature by up to 1°C. The writer conclude that applying tepid water sponges to pediatrics with prolonged fever was effective in reducing their fever."

"Adult onset Stills disease is a rare systemic disease that may involve many organs and may mimick many disease such as infection, autoimmune disease, and also malignancy. The diagnostic approach and treatment strategies have not been well established due to its rarity; however, there are some diagnostic criteria that may help. We present a case of 36-year old man who experienced high prolonged fever which firstly thought as infection. He also had unilateral wrist and knee joint pain and maculopapular rash. Laboratory examination showed high leukocytes count with elevated polymorphonuclear neutrophil count, high platelet count, high ferritin level, and negative results of many infection markers (typhoid antibody, procalcitonin, malaria test, blood culture, urine culture, IgM pneumonia, ASTO, syphilis test, antiHIV, HBsAg, antiHCV, etc). Chest X-ray, joint X-ray, ultrasonography, and echocardiography showed normal result. The patient was then diagnosed with Adult-onset Stills disease and received intravenous methylprednisolone and the fever was disappeared in 3 days. Six months later the arthralgia appeared again, methotrexate was administered and the pain was then relieved.

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Adult onset Still’s disease merupakan penyakit sistemik jarang yang melibatkan berbagai organ serta menyerupai penyakit lain seperti infeksi, penyakit autoimun dan juga keganasan. Diagnosis dan pengobatan belum terlalu baik karena penyakit ini jarang. Meskipun demikian, sudah terdapat beberapa kriteria diagnosis yang dapat membantu. Kami memaparkan suatu kasus, pria berusia 36 tahun datang dengan demam tinggi terus menerus yang pertama kali dianggap sebagai infeksi. Pasien juga mengalami nyeri sendi pergelangan tangan dan lutut unilateral disertai ruam makulopapular. Pemeriksaan laboratorium menunjukkan leukosit tinggi dengan hitung jenis netrofil polimorfonuklear tinggi, trombosit tinggi, feritin tinggi, dan berbagai penanda infeksi negatif (antibodi tifoid, prokalsitonin, malaria, kultur darah, kultur urin, IgM pneumonia, ASTO, tes sifilis, antiHIV, HBsAg, antiHCV dan sebagainya). Rontgen dada, rontgen sendi, ultrasonografi, dan ekokardiografi menunjukkan hasil normal. Pasien ini kemudian didiagnosis adult onset Still’s disease dan diberikan metilprednisolon intravena dan demam hilang dalam tiga hari. Enam bulan kemudian pasien mengeluhkan nyeri sendi dan diberikan metrotreksat, kemudian nyeri membaik."

"Why do some individuals commit violent offenses while others restrict themselves to nonviolent crime? Most people probably assume that criminologists know a great deal about the causes of violent offending. It might surprise them to know that there is little consensus about what distinguishes violent offenders from those who commit less serious crime. Further, most criminological theory and research applies mainly to lesser criminal offenses and most of the work published in developmental psychology applies best to general conduct problems, not necessarily physical aggression. The purpose of this book is to narrowly delineate the causes of violence and physical aggression as they contrast with the causes of other forms of antisocial behavior. In each substantive chapter, we select one potential cause of violence (attachment insecurity, parental rejection, low intelligence, school problems, child abuse, poverty, community disorder, and substance use) and assess the state of published evidence related to its ability to differentially predict violent behavior. To that end, we conducted extensive literature searches to unearth all existing relevant empirical work, published in English, for each topic. While the book is first and foremost a scholarly contribution to the fields of developmental psychology and criminology, the early chapters introducing the problem, discussing the development of violent behavior, and reviewing the sociological views of violence and motivation, will make it suitable for use as a text for an advanced course on violence or as a secondary text in an introductory criminology course."

"Infertilitas merupakan penyakit yang kompleks dan dapatdisebabkan oleh faktor laki-laki dan perempuan. Etiologi darikedua faktor infertilitas tersebut perlu ditelusuri lebih lanjut.Terdapat beberapa pendekatan untuk memahami infertilitas,salah satunya adalah epigenetik. Modifikasi epigenetik terdiridari metilasi DNA, modifikasi histon, dan pembentukankromatin. Sel germinal laki-laki dan perempuan mengalamimodifikasi epigenetik secara dinamis dan membentuk sel spermadan oosit yang matang. Pada laki-laki, perubahan metilasi DNApada spermatogenesis dapat menyebabkan kelainan berupaoligo/astenozoospermia. Selain itu, metilasi dan asetilasi histonserta modifikasi histon lainnya dapat menyebabkan spermatidak mampu untuk membuahi oosit. Serupa dengan laki-laki,pada perempuan pun dapat terjadi perubahan metilasi DNAdan modifikasi histon yang dapat mempengaruhi oogenesis,menciptakan anueploidi pada oosit yang terbuahi, danmengakibatkan kematian janin di uterus. Perubahan pada polamodifikasi epigenetik dapat mengakibatkan infertilitas, baikpada laki-laki maupun perempuan."

"Kifosis tuberkulosis adalah kelainan tidak stabil yang cenderung bertambah dan menyebabkan banyak masalah. Ada berbagai macam osteotomi yang dilakukan untuk mengkoreksi kifosis yang disebabkan banyak kondisi, namun bukan untuk tuberkulosis. Makalah ini mengajukan shortening procedure untuk mengkoreksi kifosis tuberkulosis. Penelitian praeksperimental dilakukan dengan melibatkan 49 pasien kifosis tuberkulosis yang dioperasi di RSCM dan RS Fatmawati sejak Juni 1996 hingga Juni 2001. Seluruh pasien dievaluasi secara radiografis saat sebelum operasi, setelah operasi, hingga kontrol terakhir (6-36 bulan). Resiko operasi berupa defisit neurologis juga dievaluasi berdasarkan Frankel. Kifosis dikelompokkan dalam tiga grup, yaitu grup A ( kifosis 30°-59°) grup B (60°-89°) dan grup C (90°-120°). Kifosis pasca operasi rata-rata terkoreksi sebesar 30,82° (67,5%), pada grup A 28° (75,49%), pada grup B 42,3° (62,43%) dan pada grup C 27° (23,36%). Komplikasi neurologis ditemukan pada 6 pasien (12,2%); 4 (11,8%) pada grup A dan 2 (40%) pada grup C, namun tidak ada perbedaan secara statistik berdasarkan komplikasi yang ditimbulkan antara kedua grup (p=0,1023). Dari hasil diatas disimpulkan bahwa Shortening procedure untuk kifosis tuberculosis memberikan koreksi yang signifikan. Pada kifosis TB > 90°, prosedur ini masih memberikan koreksi yang bermakna secara statistik namun dengan risiko komplikasi neurologis. (Med J Indones 2004; 13: 47-52)

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Tuberculous kyphosis is an unstable lesion that tends to progress and lead to many problems.Various corrective osteotomies for kyphosis have been described for various conditions, but not for tuberculosis. This articles proposed shortening procedure to correct tuberculous kyphosis. The preexperimental study was conducted in 49 patients with tuberculous kyphosis treated surgically at Cipto Mangunkusumo and Fatmawati hospital since June 1996 till June 2001. All patients were evaluated radiographically in the preoperative period, postoperative period, and at the latest follow-up (6-36 months). Neurological deficit risk of operation was also evaluated by Frankel grading. The kyphosis were classified into three group, group A (kyphosis 30° - 59°) group B (60° - 89°) and group C (90° - 120°). The average postoperative kyphosis correction was 30.82° (67.5%); in group A 28° (75.49%), in group B 42.3° (62.43%), and in group C 27° (23.36%). Anova test gave significant difference in persentage of postoperative correction. Paired t-test also gave significance postoperative correction in all groups. Neurological complication was found in 6 patients (12.2%); 4 (11,8%) in group A dan 2 (40%) in group C, and no statistical difference between the two groups concerning this complication (p=0.1023). We concluded that shortening procedure for tuberculous kyphosis gave significant correction. In TB-kyphosis > 90° shortening procedure still gave significant correction although a potential risk of serious neurologic complication. (Med J Indones 2004; 13: 47-52)"

"Introduction: Portal hypertension may cause gastrointestinal complications; one of the most serious is a ruptured esophageal varices. Portal hypertension is also the main cause of hypersplenism, which in turn could lead to pancytopenia. Despite adequate therapy, some cases of hypersplenism could not be resolved. Partial splenic embolization (PSE) is an effective alternative method to treat this condition. Method: We reported two cases of hypersplenism treated with PSE. The first case was a 10- year-old girl with pancytopenia and a history of recurrent esophageal ligation. The second case was a 32-year-old man with recurrent episodes of hematemesis for two years before admission. Results: After the PSE procedure, the first patient’s white blood cell and platelet doubled in one month after procedure and stable at follow-up three months later, with no complaint of hematemesis. The second patient’s platelet doubled five days after the procedure. The first patient developed a complication of a splenic abscess, but after antibiotic administration and pus drainage, the condition was resolved. Conclusion: PSE is an effective method to treat hypersplenism secondary to the hypertensive portal. Treatment goals successfully achieved include improvement in blood count and control of bleeding. There are risks following PSE, but with adequate treatment, it can be overcome. Keywords: hypersplenism, partial splenic embolization, portal hypertension, pancytopenia"

"Latar Belakang: Mycobacterium tuberculosis merupakan penyebab tuberkulosis pada paru dan organ lain, seperti meningen meningitis tuberkulosis . Meningitis tuberkulosis dapat merupakan komplikasi tuberkulosis primer, yang bersifat laten/asimptomatik, namun risiko reaktivasi meningkat pada penurunan sistem imun/malnutrisi. Disfagia, defisit kognitif, hemiparese, dan ketidakmampuan makan mandiri juga dapat menyebabkan malnutrisi, sehingga akan meningkatkan lama rawat dan mengganggu perbaikan kapasitas fungsional. Tatalaksana nutrisi diperlukan untuk meminimalisasi kehilangan berat badan, mendapatkan imbang nitrogen positif, dan menyediakan nutrisi untuk membangun system imun. Pada pelaksanaannya, pemberian nutrisi harus memperhatikan kondisi klinis serta komplikasi berupa peningkatan tekanan intrakranial dan defisit neurologi yang terjadi. Metode: Laporan serial kasus ini menguraikan empat kasus meningitis tuberkulosis dengan tuberkulosis paru. Semua pasien datang dengan penurunan kesadaran dan telah terdiagnosis tuberkulosis paru sebelumnya, namun pasien minum obat tidak sesuai dengan anjuran dokter. Status gizi keempat pasien adalah malnutrisi ringan dan berat, obes 1 dan normal. Selama dirawat, tatalaksana nutrisi diberikan sesuai pedoman terapi nutrisi untuk penderita tuberkulosis. Asupan makronutrien diberikan meningkat bertahap sesuai kondisi klinis dan toleransi pasien. Suplementasi mikronutrien juga diberikan. Pemantauan meliputi keluhan subjektif, hemodinamik, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan, dan kapasitas fungsional. Hasil: Dua orang pasien menunjukkan perbaikan klinis, kapasitas fungsional, hasil laboratorium, toleransi asupan, dan outcome, sedangkan dua orang lainnya mengalami perburukan dan meninggal pada hari perawatan ke-44 dan ke-24. Kesimpulan: Dukungan nutrisi infeksi tuberkulosis pada paru dan susunan saraf, dapat memberikan manfaat untuk pemulihan pasien.

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Objective: Mycobacterium tuberculosis is the cause of tuberculous in the lung and other organs, such as the meninges tuberculous meningitis . Tuberculous meningitis can be a complication of primary tuberculous, latent asymptomatic, but the risk of reactivation increases to a decrease in the immune system malnutrition. Dysphagia, defisit kognitif, hemiparese, and inability to eat independently can also cause malnutrition, thereby increasing the length of stay and interfere with the functional capacity improvement. Management of nutrients needed to minimize the lose weight, get a positive nitrogen balance, and provide nutrients for building the immune system. In practice, the nutrition must consider the clinical condition and the complications in the form of increased intracranial pressure and neurological deficits that occur.

Methods: This case series report outlines four cases of tuberculous meningitis with pulmonary tuberculous. All patients present with loss of consciousness and have been diagnosed with pulmonary tuberculous before, but patients taking the medicine does not comply with doctor's advice. Nutritional status of the four patients was mild and severe malnutrition, obese and normal one. During the treatment, management of nutrition was given according to the guidelines of nutrition therapy for patients with tuberculosis. Macronutrient intake increased gradually given appropriate clinical condition and patient tolerance. Micronutrient supplementation are also given. Monitoring included subjective complaints, hemodynamic, analysis and tolerance intake, laboratory tests, anthropometric, fluid balance, and functional capacity.

Results: Two patients showed clinical improvement, functional capacity, laboratory results, tolerance intake, and outcome, while two other people suffered deterioration and died on the 44th and 24th day of treatment.

Conclusion: Nutritional support tuberkulosis infection in the lungs and nervous system, can provide benefit to the patient's recovery."

"Background: Oral malodor, a generic descriptor term for foul smells emanating from the mouth can be classified as either pathological or physiological halitosis. Some problems are often confounded by the climcian's mismanagement.Objective: This paper reviews the etiology of classification and determination of treatment needs (TN) for oral malodor.Literature review and discussion: In the majority of cases the problem has been shown to originate in the oral cavity. Although oral malodor cases are often telated to physiological aspects, sometimes they can be related to extra oral sources and psychological aspects. Classification methods of oral malodor with corresponding treatment needs (TN) have already been established. Although PTC & tongue brushing and appropriate mouthrinses are both important and basic treatment measures for halitosis, other dental treatments are sometimes required.Conclusion: Accurate screening and diagnosis of halitosis followed by appropriate TN may give better results and consequently reduce the risk of mismanagement."