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Abstrak :
Latar Belakang: Akne vulgaris (AV) adalah peradangan kronik pilosebasea yang umum terjadi pada semua usia, terutama remaja dan dewasa muda serta dapat memengaruhi psikologis pasien. Tata laksana AV merupakan sebuah tantangan karena keberagaman dalam menentukan diagnosis dan pilihan terapi antar negara. Indonesia mempunyai beberapa pedoman tatalaksana AV yang mempunyai similaritas antara lain konsensus IAEM 2015, PPK Perdoski dan PPK RSCM di tahun 2017. Tujuan: Penelitian ini bertujuan untuk menganalisis efektivitas terapi standar AV berdasarkan panduan praktik klinis di Indonesia. Metode: Penelitian merupakan studi observasional analitik secara retrospektif di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo menggunakan rekam medis tahun 2017-2019. Sampel penelitian merupakan rekam medis pasien AV baru yang diikuti selama 3 bulan dan dengan metode total sampling. Data subjek yang diambil termasuk karakteristik sosiodemografi, karakteristik klinis, diagnosis, terapi berdasarkan PPK RSCM 2017, dan hasil terapi. Studi dan analisis dilakukan pada bulan April 2023 hingga Juli 2023. Hasil: Terdapat 131 SP yang memenuhi kriteria, 63,4% AV sedang, 20,6% AV ringan, dan 16% AV berat. Sebagian besar SP (92,4%) mempunyai AV dengan awitan sebelum usia 25 tahun. Median lama sakit AV yaitu 48 bulan. Riwayat terapi AV sebelumnya ditemukan pada 58% SP dan riwayat konsumsi obat akne pada 16% SP. Faktor risiko terbanyak berupa riwayat AV pada orang tua. Terapi utama paling banyak digunakan yaitu kombinasi retinoic acid, benzoyl peroxide, antibiotik topikal dan antibiotik oral pada 22,2% SP. Terapi standar AV secara bermakna menurunkan median jumlah lesi noninflamasi (25 vs. 8; p<0,001), median jumlah lesi inflamasi (10 vs. 2; p<001), median jumlah lesi total (41 vs. 10; p<0,001) setelah 3 bulan terapi, dengan median penurunan ketiga jumlah lesi lebih dari 50%. Proporsi derajat keparahan AV berbeda secara bermakna pada 3 bulan (p<0,001), dimana AV ringan meningkat (20,6% vs 93,1%) dan AV sedang atau berat menurun (sedang = 63,6% vs. 6,1%; berat = 16% vs. 0,8%). Kesimpulan: Terapi standar AV berdasarkan PPK di Indonesia efektif dalam mengurangi jumlah lesi noninflamasi, lesi inflamasi, dan lesi total, dan menurunkan derajat keparahan AV. ......Background: Acne vulgaris is a prevalent chronic inflammation of the pilosebaceous unit affecting all ages, especially teenagers and young adults, and often leads to psychological impairment. Management of acne vulgaris has been challenging due to various diagnostic parameters and treatment options across nations. Several treatment guidelines are available in Indonesia, of which have similarities among one another, such as consensus by Indonesian Acne Expert Meeting in 2015 and clinical practice guidelines by the Indonesian Society of Dermatology and Venereology and by Dr. Cipto Mangunkusumo National Central General Hospital in 2017. Objective: This study aims to investigate the effectiveness of standard therapy for acne based on the clinical practice guidelines in Indonesia Methods: This is an analytical retrospective observational study using medical records from Dr. Cipto Mangunkusumo National Central General Hospital between 2017 – 2019. Research samples were medical records of new acne patients followed for 3 months by a total sampling technique. Extracted data included sociodemographic and clinical characteristics, diagnosis, and therapy based on the clinical practice guideline by Dr.Cipto Mangunkusumo National Central General Hospital in 2017 and the results. This study was conducted from April 2023 to July 2023. Results: There were 131 subjects included, of which 63,4% were with moderate acne, 20,6% with mild acne, and 16% with severe acne. Most participants (92,4%) experienced acne for the first time before 25 years old. The median duration from the first occurrence of acne to the visit was 48 months. History of topical and oral acne therapy was found in 58% and 16% of participants, respectively. History of acne in parents was the most reported risk factor. Most subjects (22,2%) received a combination of retinoic acid, benzoyl peroxide, topical antibiotic, and oral antibiotic. Standard therapies significantly reduced the median of non-inflammatory lesions (25 vs. 8; p<0,001), inflammatory lesions (10 vs. 2; p<001), and total lesions (41 vs. 10; p<0,001) after a 3 month-therapy, with the median of reduction for all type of lesions over 50%. The proportion of acne severity differed significantly after three months (p<0,001), with an increasing proportion of mild acne (20,6% vs 93,1%) and decreasing percentage of moderate and severe acne (moderate = 63,6% vs. 6,1%; severe = 16% vs. 0,8%). Conclusion: Standard therapy for acne vulgaris in clinical practice guidelines in Indonesia is effective for noninflammatory lesions, inflammatory lesions, and total lesions, as well as acne severity after 12 weeks.

Abstrak :
Ulkus kaki diabetik (UKD) merupakan luka kronik pada pasien diabetes melitus (DM). Vitamin D dipercaya memiliki peran penting pada diferensiasi, proliferasi, pertumbuhan sel, dan modulasi sistem imunitas sehingga kadar yang optimal dibutuhkan untuk penyembuhan luka. Defisiensi vitamin D juga diduga mengganggu produksi dan sekresi insulin sehingga berkontribusi pada kronisitas UKD. Penelitian bertujuan membandingkan kadar vitamin D pada pasien DM dengan dan tanpa UKD; serta untuk mengetahui korelasi antara durasi UKD dan keparahan UKD berdasarkan skor PEDIS (perfusion, extension, depth, infection, sensation) dengan kadar vitamin D. Serum 25-hidroksivitamin D (25(OH)D) dianalisis menggunakan in-vitro chemiluminescent immunoassay (CLIA). Analisis statistik yang sesuai dilakukan untuk membuktikan tujuan penelitian. Perbandingan nilai median (Q1-Q3) kadar vitamin D pada pasien DM dengan dan tanpa UKD secara berurutan adalah 8,90 ng/mL (6,52-10,90) dan 16,25 ng/mL (13-19,59), serta bermakna secara statistik (p<0,001). Tidak ada korelasi antara durasi UKD dan keparahan UKD berdasarkan skor PEDIS terhadap kadar vitamin D, serta tidak bermakna secara statistik. Hasil pada penelitian ini menunjukkan bahwa kadar vitamin D pada pasien DM dengan UKD lebih rendah dibandingkan pasien tanpa UKD. Namun belum ada bukti yang cukup untuk menyimpulkan bahwa tidak ada korelasi antara durasi UKD dan keparahan UKD berdasarkan skor PEDIS terhadap kadar vitamin D. ......Diabetic foot ulcers (DFU) are chronic wounds in patients with diabetes mellitus (DM). Vitamin D believed have important role in differentiation, proliferation, cell growth, and immune system modulation hence optimal levels are needed for wound healing. Vitamin D deficiency also thought to interfere insulin production and secretion, thereby contributing to DFU chronicity. This study aims to compare vitamin D levels in DM patients with and without DFU; and determine the correlation between DFU duration and severity by PEDIS (perfusion, extension, depth, infection, sensation) score to vitamin D levels. 25-hydroxyvitamin D serum analyzed using in-vitro chemiluminescent immunoassay. Appropriate statistical analysis was done following the study. Comparison of median values ​​(Q1-Q3) vitamin D levels in DM patients with and without DFU were 8.90 ng/mL (6.52-10.90) and 16.25 ng/mL (13-19.59) respectively, and statistically significant (p<0.001). There was no correlation between DFU duration and severity PEDIS score to vitamin D levels, and it was not statistically significant. The results of this study indicate that vitamin D levels in DM patients with DFU are lower than patients without DFU. However, there is not enough evidence to conclude that there is no correlation between DFU duration and severity by PEDIS score to vitamin D levels.

Abstrak :
Latar Belakang: Psoriatic arthritis (PsA) merupakan inflamasi muskuloskeletal yang progresif. Psoriasis kuku merupakan faktor prediktor kuat PsA dengan prevalensi mencapai 87%. Skor modified nail psoriasis severity index (mNAPSI) merupakan salah satu penilaian derajat keparahan psoriasis kuku dengan reliabilitas interrater yang baik. Beberapa penelitian menunjukkan hubungan antara skor mNAPSI dengan PsA serta kerusakan sendi interfalang distal, sehingga dipikirkan bahwa derajat keparahan kuku dapat dijadikan sebagai penapisan kejadian PsA serta kaitannya dengan aktivitas penyakit PsA. Tujuan: Menilai hubungan derajat keparahan kuku menggunakan skor mNAPSI dengan kejadian PsA dan korelasi skor mNAPSI dengan derajat keparahan PsA menggunakan skor clinical disease activity for psoriatic arthritis (cDAPSA). Sebagai hasil tambahan, dilakukan penilaian korelasi skor psoriasis area severity index (PASI) dan cDAPSA. Secara deskriptif menilai proporsi kelainan psoriasis kuku secara klinis maupun dermoskopi pada pasien PsA dan tanpa PsA. Metode: Penelitian observasional analitik. Setiap subyek penelitian (SP) dengan psoriasis kuku yang telah memenuhi kriteria inklusi dan eksklusi dilakukan perhitungan mNAPSI, diagnosis PsA menggunakan classification criteria for psoriatic arthritis (CASPAR), dan menentukan derajat keparahan PsA dengan cDAPSA. Analisis statistik yang sesuai untuk membuktikan hipotesis penelitian. Nilai p <0,05 dianggap signifikan secara statistik. Hasil: Di antara 34 SP terdapat 15 SP yang mengalami PsA. Hubungan antara skor mNAPSI dengan kejadian PsA dianalisis menggunakan ROC dengan hasil nilai area under ROC curve (AUC) 0,58. Korelasi antara skor mNAPSI dengan cDAPSA adalah 0,217 (p=0,437). Terdapat korelasi positif antara PASI dan cDAPSA (r=0,621; p=0,013). Kelainan kuku terbanyak pada penelitian ini adalah onikolisis (72,6%), leukonikia (19,6%), diikuti dengan oil drop dan crumbling masing-masing 12,8%. Seluruh kelainan kuku lebih mudah dilihat dengan dermoskopi, kecuali pitting dan Beau’s line. Kesimpulan: Skor mNAPSI memiliki hubungan lemah dengan kejadian PsA, sehingga tidak dapat digunakan sebagai penapisan kejadian PsA. Selain itu, mNAPSI memiliki korelasi lemah dengan cDAPSA, sehingga derajat kerusakan kuku tidak mencerminkan derajat keparahan PsA. ......Background: Psoriatic arthritis (PsA) is a progressive musculoskeletal inflammation. Nail psoriasis is a strong predictor of PsA with a prevalence of 87%. The modified nail psoriasis severity index (mNAPSI) score is an objective score for evaluating the severity of nail psoriasis and has excellent interrater reliability. Several studies have shown a correlation between mNAPSI scores and PsA and distal interphalangeal joint damage, so it is thought that the severity of the nail can be used as a screening for the incidence of PsA. Objective: This study aims to assess the relationship between nail severity using the mNAPSI score with the incidence of PsA and to assess the correlation between the mNAPSI score with PsA severity using the clinical disease activity for psoriatic arthritis (cDAPSA) score. In addition, the correlation between psoriasis area severity index (PASI) and cDAPSA scores was also carried out as additional results. This study also descriptively assessed the proportion of psoriasis nail abnormalities both clinically and dermoscopy in patients with PsA and without PsA. Methods: This research is an analytic observational. All research data are recorded in the research status. Each subject met the inclusion and exclusion criteria, calculated the mNAPSI score, diagnosed PsA using the classification criteria for psoriatic arthritis (CASPAR) score, and determined the severity of PsA with the cDAPSA score. Appropriate statistical analysis was performed to prove the research hypothesis. P value < 0.05 was considered statistically significant. Results: Among 34 subject, 15 (44%) experienced PsA. The relationship between the mNAPSI score and the incidence of PsA was analyzed using ROC. Based on this analysis, the area under ROC curve (AUC) value was 0.58. The correlation between mNAPSI and cDAPSA scores was 0.217 (p=0.437). There was a positive correlation between the PASI value and cDAPSA and it was statistically significant (r=0.621; p=0.013). The most common nail abnormalities in this study were onycholysis (72.6%), leukonychia (19.6%), followed by oil drop and crumbling (12.8%). All nail abnormalities are easier to see with dermoscopy, except for pitting and Beau's line. Conclusion: The mNAPSI score has a weak relationship with the incidence of PsA, so it cannot be used as a screening for the incidence of PsA. In addition, this score also has a weak correlation with the cDAPSA score, so the degree of nail damage does not reflect the severity of PsA.