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BALI MEDICAL JOURNAL (BMJ)
Published by Universitas Udayana
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Core Subject : Health,
Bali Medical Journal (BMJ), P-ISSN 2089-1180, E-ISSN 2302-2914 is an international and peer-reviewed journal published quarterly in print and online by Sanglah General Hospital in collaboration to Indonesian Physician Forum and Indonesian College of Surgeon, Bali-Indonesia which was founded in 2011. The Journal aims to bridge and integrate the intellectual, methodological, and substantive diversity of medical scholarship, and to encourage a vigorous dialogue between medical scholars and practitioners. The Journal welcomes contributions which promote the exchange of ideas and rational discourse between practicing educators and medical researchers all over the world.
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Articles 184 Documents
The Clinical Features of Penile Cancer Patients at Sanglah General Hospital Bali-Indonesia Kusmawan, E; *, Bowolaksono; Widiana, R
BALI MEDICAL JOURNAL (BMJ) Volume 1, Number 1, January-April 2012
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Abstract

Objectives: To explore clinical characteristics, treatment modalities and outcomes after the follow-up of penile cancer patients. Method: We reviewed penile cancer patients during 8 years, started from April 1993 to March 2001. The data collected through medical record consisted of patient identities, history takings, physical and pathological findings, treatment modalities and their follow-up after  3±4  years Results:  During eight years of study there were 46 patients aged 58+3 years. Out of 46 patients, 33 patients (72%) have history of urogenital infection and 40 patients (87%) with phymosis. With regard to physical examination, 24 patients (52%) presented as stage III (Jackson classification). Pathological findings showed that 100% patients were keratinizing squamous cell carcinoma. Partial penectomy alone was carried out in 21 patients (46%),  total penectomy alone was done in 17 patients (37%), and total penectomy with lymph node dissection was done in 8 patients (17%). During the follow-up, majority of the patients (42) showed no complications or recurrence, only 2 patients showed recurrent tumor and the rest 2 were lost to follow-up. Conclusions: During eight years at Sanglah General Hospital there were 46 penile cancer patients, mean of age was 58±3 years. Predispositioning factors were urogenital infection and phymosis. All of them were keratinizing squamous cell carcinoma. Total or partial penectomy with or without lymph node dissection was carried out with good results.
Inhibition of Bifidobacterium Cell Wall 51.74 kDa Adhesin Isolated from Infants Feces Towards Adhesion of Enteric Phatogen E. Coli on Enterocyte Balb/C Mice Sukrama, I D. M.
BALI MEDICAL JOURNAL (BMJ) Volume 1, Number 1, January-April 2012
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Objectives: To determine 51.74 kDa adhesin of Bifidobacterium sp cell wall isolated from infants feces as an anti adhesion of E. coli on enterocyte mice. Methods: Randomized Posttest-Only Control Group Design was employed to investigate adherence ability of this adhesin towards E.coli adhesion on mice entherocyte. Results: In this research, it was obtained, that the 51.74 kDa adhesin cell wall of Bifidobacterium sp has an ability to inhibit adhesion of E. coli on mice enterocyte. The ability was increased as an increase of adhsein concentration. Conclusions: that can be drawn from this research is the finding of 51.74 kDa adhesin cell wall of Bifidobacterium sp isolated from infants feces that can inhibit adhseion of E. coli on mice enterocyte. Future work that can be carried out are further researches concerning whether these protein can be applied to inhibit adherence of other pathogen bacteria.
Clinical Initial Response of Neoadjuvant Chemotheraphy in Triple Negative, HER-2, and Luminal Types of Breast Cancer in Denpasar (A Preliminary Study) Yarso, K. Y.; Sudarsa, I W; Wibawa-Manuaba, I B. T
BALI MEDICAL JOURNAL (BMJ) Volume 1, Number 1, January-April 2012
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Objectives: Triple Negative, Luminal, HER-2 subtypes of breast cancer are markers to predict behavior, aggressiveness, and response to chemotherapy. The aim of this study is to understand character and response to standard neoadjuvant chemotherapy in different subtypes of breast cancer. Method: This is a descriptive study of breast cancer subtypes. From 687 patients (2003-2010) 351 patients have IHC data which divided into 3 groups, Triple negative, Luminal, and HER-2. We used 10% as a cut off point for ER, PR, while 30% & positive 3 for HER-2. We determined initial clinical response after 3 cycles of neoadjuvant chemotherapy although only 77 got standard neoadjuvant chemotherapy and had clinical response data. We used 50% diameters depreciation & no metastasis as cut off point for respond group. Results: There were 116 (33%) Triple Negative, 60 (17%) HER-2, and 175 (50%) Luminal Subtypes. The mean of age for 351 patients are 48.32 (23-82) years. In this study, it was obtained that no significant difference of means of age (p=0.24) in these 3 groups. Triple negative group significantly more advance in grade if compared with the other two groups (p=0.02). HER-2 group had highest response with standard neoadjuvant chemotherapy (50%), Luminal group had (49%), and Triple negative group had only (15%) response. One pCR in HER-2 group. There were no difference ages in subtypes.  Triple negative has more advances in grade. HER-2 group has highest response to standard neoadjuvant chemotherapy and Triple negative has lowest response to standard neoadjuvant chemotherapy.
Immersion of Alginate Impression (Hydrocolloid Irreversible) On Two Percent Glutaraldehyde Prevent Contamination of Mycobacterium Tuberculosis on The Stone Cast Rusmiany, P
BALI MEDICAL JOURNAL (BMJ) Volume 1, Number 1, January-April 2012
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Objectives: to observe the effect of alginate impression (hydrocolloid irreversible) immersed on 2% glutaraldehyde on preventing contamination of Mycobacterium tuberculosis contamination on stone cast. Methods: This is an experimental research with post test only control group design, with alginate impression material (hydrocolloid irreversible) is immersed in the 2% glutaraldehyde  for 10, 15, and 25 minutes. Results:  This result shows that there is no Mycobacterium tuberculosis contamination on the stone cast after the immersion of alginate impression material for 10, 15, and 25 minutes. Immersion of alginate impression material (hydrocolloid reversible) in the glutaraldehyde 2% for 10 minutes is effective to prevent Mycobacterium tuberculosis contamination on the stone cast. Conclusions: Immersion of alginate impression on 2% glutaraldehyde for 10 minute was effective to prevent contamination of Mycobacterium tuberculosis
The Role of Blood Lactate Levels as Outcome Predictor of Isolated Traumatic Brain Injury Patients Laode RA, Djoko W; -, Andi AI; -, Mansyur A; -, Burhanuddin B
BALI MEDICAL JOURNAL (BMJ) Volume 1, Number 1, January-April 2012
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Objectives: Traumatic brain injury (TBI) is accompanied by regional alterations of brain metabolism, reduction in metabolic rates and possible energy crisis. This metabolic disturbance reflected by increase and accumulation of the brain lactate levels. Objective of this study was to determine the correlation between abnormalities in lactate metabolism for predicting neurologic outcome after moderate or severe traumatic brain injury. Methods: An observational prospective study in 60 patients with isolated TBI. Blood sample taken from vein of the limbs after underwent initial resuscitation. Serial assessment of the blood lactate level was measured in 1st, 2nd and 7th day with Lact2 Roche Cobas® C-System. Neurologic outcome assessed on 7th days using Modified GCS. Results: On initial assessment, 38.3% of patients with normal lactate (? 2 mMol/L), 61.7% of patients was hyperlactatemia ( > 2 mMol/L). In this study, it was obtained that the lower of GCS level, the higher of blood lactate level, and vice versa (p = 0.033). In both treatment, there was a significant lactate clearance 24-hour as 37.96% ± 32.76 (p = 0.001) and 13.49% ± 40.32 (p = 0.011), respectively. No significant changes between blood lactate level on the 2nd and 7th day, both operative (p = 0.938; p > 0.05) neither conservative (p = 0.280; p > 0.05) patient. While, there was no correlation between neurologic outcome with 24-hour lactate clearance (p = 0.349). The higher of the initial blood lactate level, the patient’s outcome was worsen (p = 0.029). Conclusion: There is a significant correlation between blood lactate level and severity TBI according to GCS level. The lower GCS level, the higher blood lactate level and vice versa. This study also demonstrates that 24-hour lactate clearance did not affect patient’s outcome, but more influence by initial blood lactate level. Therefore, initial blood lactate level can used as an outcome predictor in TBI patients.
Risk Factors for Neuroworsening of Moderate Head Injury Cases in Emergency Department Sanglah General Hospital Bali-Indonesia Sasongko, J; Niryana, W; Golden, N
BALI MEDICAL JOURNAL (BMJ) Volume 1, Number 1, January-April 2012
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Objectives: To determine risk factors such as hypoxia, hypotension, age >40 years old, amount of focal lesion, low GCS upon arrival, and female associated with neuroworsening of moderate head injury cases. Method: The study was a cohort study on 152 cases of moderate head injury admitted in Surgery Department/Udayana University Faculty of Medicine/Sanglah General Hospital from April 2010 – March 2011. The variables were analyzed using multiple logistic regression model (p<0.05). Results:  The multivariate analysis showed age group ?40 years old {OR 4,490 (CI 95%: 1,750 – 11,521) p=0,002}, male sex {OR 2,276 (CI 95%: 0,810 – 6,395) p=0,119}, initial GCS 9-12 {OR 2,905 (CI 95%: 0,097 – 24,440) p=0,048}, hypoxia {OR 13,582 (IK 95%: 4,315 – 42,750) p=0,000},  hypotension {OR 5,179 (CI 95%: 1,097 – 24,440) p=0,038}, and multiple focal lesion {OR 5,674 (CI 95%: 2,008 – 16,038) p=0,001} were risk factors for neuroworsening in moderate head injury cases. Area Under Curve value was 84.7% from the Receiver Operator Curve. Conclusions: This study showed that hypoxia, multiple focal lesion, age ?40 years old, and hypotension were risk factors for neuroworsening in moderate injury cases.
Hyaluronic Acid Caused of Wider Epithelialization Compare to Normal Saline in Severe Diabetic Ulcer Sudarsa, I W; Semadi, I N; Riasa, N P
BALI MEDICAL JOURNAL (BMJ) Volume 1, Number 1, January-April 2012
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Objectives: Diabetic ulcer, one of chronic complications of diabetes mellitus (DM), showed a high morbidity and mortality rate. The main treatment modality for diabetic ulcer was debridement, followed by wound treatment as local control to promote wound healing. This study aims to compare efficacy of hyaluronic acid (HA) and 0.9% sodium chloride (NaCl) in severe diabetic ulcus two after debridement. Method: This study was a randomized clinical study to compare the efficacy of HA and NaCl 0.9% in severe diabetic ulcer two weeks post debridement. Thirty six severe diabetic ulcer (Wagner ?3) samples were collected using consecutive sampling method and divided into 2 treatment groups: standard wound treatment using NaCl 0.9% and using hyaluronic acid. T-independent test was applied for statistical analysis data and  p<0.05 was consider a statisticalle significant. Results: The two treatment groups showed insignificant difference in characteristics and laboratory findings. The mean tissue epithelialization width after two weeks of wound treatment using NaCl 0.9% was 17,22 ± 3,25 and using HA was 27,33 ± 2,43. Statistical analysis using t-independent test showed t = 10.59, p = 0.001 for both treatment groups. Conclusions: HA improves wound healing rate in severe diabetic ulcer 2 weeks post debridement compared to 0.9% NaCl.
Pregnancy Exercise Increase Enzymatic Antioxidant In Pregnant Women Wagey, F. W.
BALI MEDICAL JOURNAL (BMJ) Volume 1, Number 1, January-April 2012
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Objectives: Pregnancy is a vulnerable condition to all kinds of "stress", resulting in changes of physiological and metabolic functions. This research aims to determine effect of exercise during pregnancy in increasing enzymatic antioxidant marked by increase of superoxide dismutase (SOD), gluthation peroxidase (GSHPx), and catalase (CAT) levels. Methods: Randomized pre and posttest control group design was employed in this study. A number of 66 pregnant women were recruited in this study and grouped into two groups, i.e 30 of them as control group and the rest as treatment group. Pregnancy exercise was performed to all 36 pregnant women from 20 weeks gestation on treatment group. The exercise was performed in the morning for about 30 minutes, twice a weeks. On the other hand, daily activities was sugested for control group. Student’s t-test was then applied to determine the mean different of treatment and control group with 5 % of significant value. Results: This study reveals that there were significantly higher increase of (superoxide dismutase (SOD), gluthation peroxidase (GSHPx), and catalse (CAT) levels of treatment group compare to control group. These enzymatic antioxidant increase among these two group were around 1.36 mg/gHb for SOD; 1.14 IU/gHb for GSHPx; and 0.97 IU/gHb for CAT, (p < 0.05).  Clinical outcomes, such as strengten of pelvic muscle and quality of life of treatment group were significantly better compared to control group (p < 0.05). Conclusions: This means that exercise during pregnancy ages of 20 weeks increase enzymatic antioxidant levels SOD, GSHPx, and CAT higher compare to control group without exercise.
Basic Assesment of Neck Spine Injury -, Sri-Maliawan; Mahadewa, T. G. B
BALI MEDICAL JOURNAL (BMJ) Volume 1, Number 1, January-April 2012
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This study aims to present a review of the basic assessment of spine and spinal cord injury. This is a review of published articles between 1978 and 2005 on the neck spine and spinal cord injury. We present a summary about the basic principles according to the literatures.
Langerhans Cell Histiocytosis: A Case Report Suzy-Indharty, Rr.
BALI MEDICAL JOURNAL (BMJ) Volume 1, Number 2, May-August 2012
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Objective: Langerhans Cell Histiocytosis (LCH) is a rare proliferative disorder of a distinct cell type that is similar to Langerhans cell. Prevalence is estimated at 1:200.000/year in children. Clinical presentations are variable, ranging from a single location in the bone to severe multivisceral involvement leading to dysfunction of vital organs. Therefore, objective of this study was to explore LCH based on clinical findings, skull x-ray, head CT-Scan, cytology, histopathology. and Immunohistochemistry. Method: We report a case of Langerhans Cell Histiocytosis of a 3-year-old boy. Fine needle aspiration biopsy was performed from a nodule in parietal area on the scalp; dry fixation was made and stained with Giemsa. Immunohistochemistry examination was performed with CD1a and S100. Histopathology examination was done post-operatively and cytology examination were consistent with LCH, composing Langerhans cells with complex, clefted, grooved, irregular or convoluted nuclei with fine chromatins and one or more small nucleoli and moderate to abundant quantities of eosinophilic cytoplasm, mixed with multinucleated eosinophils. Results:  The finding of pentalaminar Birbeck granules by electron microscope is diagnostic of LCH, but this examination cannot be performed in our institution, so diagnosis was supported by immunohistochemistry with CD1a and S 100. Conclusions: Based on clinical findings, skull x ray, Head CT-Scan, cytology, histopathology and Immunohistochemistry, this case was concluded as a Langerhans Cell Histiocytosis.

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