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BALI MEDICAL JOURNAL (BMJ)
Published by Universitas Udayana
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.
Articles
184
Articles
Association of P16 Expression with Clinicopathological Features of Oral Cavity Squamous Cell Carcinoma Patients in Bali

Ampur, O. Y. ( Surgical Oncology Sub-Division, Department of General Surgery, Udayana Faculty of Medicine/Sanglah General Hospital Denpasar ) , Sudarsa, I Wayan ( Surgical Oncology Sub-Division, Department of General Surgery, Udayana Faculty of Medicine/Sanglah General Hospital Denpasar ) , Suryawisesa, Ida Bagus ( Surgical Oncology Sub-Division, Department of General Surgery, Udayana Faculty of Medicine/Sanglah General Hospital Denpasar )

BALI MEDICAL JOURNAL Vol 5, No 3 (2016)
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Abstract

Background: Oral cavity cancer is considered as a major health problem worldwide and has been associated with high recurrence rate and poor prognosis. Oral cavity squamous cell carcinoma (OCSCC) in Sanglah General Hospital Denpasar contributed to 71.7% of all head and neck cancer from 2002-2011 with an increasing trend annually. Advances in our understanding of OCSCC have not improved the outcome in OCSCC management significantly. Therefore, many studies have focused on the roles of biomolecular markers in OCSCC. One of biomolecular marker that has been the focus of many OCSCC studies is p16. Method: This was an analytic cross sectional study with 31 samples to determine the association of p16 expression with age group, tumor location, stage, and grade in OCSCC. Data was analyzed descriptively and the association between variables were evaluated with Chi-Square or Fisher’s Exact Test with a p value

Angiogenesis in Ischemic Stroke Patients Aged 30 - 80 years at Gatot Subroto Army Central Hospital (RSPAD) Jakarta

Hidayat, Andri ( Prodia Clinical Laboratory, Indonesia ) , Arief, Mansyur ( Postgraduate Program Faculty of Medicine, Hasanuddin University, Indonesia ) , Wijaya, Andi ( Prodia Clinical Laboratory, Indonesia ) , As’ad, Suryani ( Postgraduate Program Faculty of Medicine, Hasanuddin University, Indonesia )

BALI MEDICAL JOURNAL Vol 5, No 3 (2016)
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Abstract

Background: Angiogenesis, is one of the neurorepair process which plays an important role after ischemic stroke incident. vascular-endothelial growth factor (VEGF), Angiopoietin-1 (ANG1) and fibroblast growth factor (FGF) are the angiogenic factors involved in the process of angiogenesis. In this study we observed VEGF, ANG1 and FGF concentration to represent the angiogenesis process occurred in ischemic stroke patients with different onset time. Methods: This was a cross sectional study involving 63 ischemic stroke subjects aged 30 – 80 years old from The Central Hospital of the Army (RSPAD) Gatot Subroto Jakarta. Subjects were divided into 3 groups due to stroke onset time.: < than 7 days (Group A: 11 subjects), onset 7 – 30 days (Group B: 26 subjects) and > 30 days (Group C: 26 Subjects). VEGF, FGF and ANG1 serum levels were measured using multiplex method with luminex Magpix instrument. Results: VEGF, ANG1, and FGF were not significantly different between all groups. We did not find any significant correlation in all groups except FGF with ANG1 in group C. VEGF and ANG1 levels found to be highest in group B, and FGF levels in group A. Conclusions: VEGF, FGF and ANG1 increased soon after ischemic injury. FGF immediately increased in first week after onset and then decreased. VEGF and ANG1 levels reach their peak levels between 7-30 days after injury, showed that the optimal process of angiogenesis occurs in this period. There is no significant correlation between VEGF, FGF and ANG1 in all groups but we found a correlation between FGF and ANG1 in subjects with onset > 30 days after injury.

The Relationship Between Self-Efficacy and Sexual Function in Patients with Type II Diabetes

Haddadi, Samira ( Master of Psychology, Department of Management, Qazvin Branch, Islamic Azad University, Qazvin, Iran ) , Mirkohi, Mahdi Ghodrati ( Department of Psychology, Payame Noor University, Tehran, Iran ) , Akbari-Kamrani, Mahnaz ( Department of Midwifery, Faculty of Nursing & Midwifery, Alborz University of Medical Sciences, Karaj, Iran )

BALI MEDICAL JOURNAL Vol 5, No 3 (2016)
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Abstract

Background: Diabetes is a common chronic disease that is increasingly observed in almost all countries of the world. The treatment and prevention of diabetes largely depend on patients’ self-efficacy in performing self-care behaviors. Accordingly, the present study was conducted to examine the relationship between self-efficacy and sexual performance in patients with type II diabetes. Methods: In the present correlational study, 200 patients with type II diabetes (based on physicians’ diagnosis) participated. Using convenience sampling method, the samples were selected out of the whole population of diabetic patients who referred to Shahid Bahonar and Rajaei Hospitals in the city of Karaj (Iran). The data were collected through a multi-faceted questionnaire covering demographic characteristics of the participants, the Diabetes Management Self-Efficacy Scale (DMSES), the Female Sexual Function Index (FSFI) and the Male Sexual Function Index (MSFI). Then, the collected data were analyzed through Pearson correlation test, multiple linear regression analysis, independent t-test and ANOVA. Results: The results showed a positive significant relationship between self-efficacy and sexual function (p

Self-Medication and Contributing Factors: A Questionnaire Survey Among Iranian Households

Ezzatabadi, Mohammad Ranjbar ( Ph.D. in Health Policy, Health Policy Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ) , Rafiei, Sima ( Ph.D. in Healthcare Management, Health Services Management Department, Qazvin University of Medical Sciences, Qazvin, Iran ) , Shafiei, Milad ( Ph.D. in Healthcare Management, hospital management research center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ) , Tafti, Arefeh Dehghani ( MS. C in Biostatistics, Biostatistics Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ) , Saghafi, Fatemeh ( MS. C in Healthcare Management, Health Services Management Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ) , Bahrami, Mohammad Amin ( Ph.D. in Health Care Management, hospital management research center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ) , Abdarzadeh, Nadia ( MS. C in Healthcare Management, Health Services Management Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran )

BALI MEDICAL JOURNAL Vol 5, No 3 (2016)
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Abstract

Background: Self-medication is a serious danger in every health sector which potentially brings harmful side effects for the society. The aim of this research was to investigate self-medication and its contributing factors among residents of Yazd province in Iran in 2014. Methods: A descriptive, cross sectional study was conducted in 2014 using a self-constructed questionnaire. A total of 580 families living in Yazd in the time period of study were contributed to fill out the questions organized in two sections of demographic and self-medication factors. Data were analyzed by SPSS software version 16 through appropriate descriptive and analytical statistical tests. Results: Self-medication was reported in 53.4% of the cases. The most frequent self-prescribed medications were related to pain killer drugs (26.6%). There was a significant statistical relation between self-medication and households’ age, occupation and income, level of parents’ education, number of children and place of residence. Among different reasons for self-medication the most important one was reported to be accessibility (3.44+1.3). Conclusion: Due to the considerable prevalence of self-medication and its harmful effects on every society, such an issue should be appropriately controlled through legal regulations particularly in the area of selling dangerous drugs. Furthermore, provision of proper information and warning the population about harmful side effects can be helpful in this regard.

Transfusion Reactions as an Indicator of Service Quality of Blood Transfusion in Sanglah General Hospital Denpasar Bali-Indonesia

Mulyantari, Ni Kadek ( Department of Clinical Pathology Faculty of Medicine Udayana University, Bali-Indonesia ) , Subawa, Anak Agung Ngurah ( Department of Clinical Pathology Faculty of Medicine Udayana University, Bali-Indonesia ) , Yasa, I Wayan Putu Sutirta ( Department of Clinical Pathology Faculty of Medicine Udayana University, Bali-Indonesia )

BALI MEDICAL JOURNAL Vol 5, No 3 (2016)
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Abstract

Background: One of the fatal side effects of transfusion is transfusion reactions. The incidence of transfusion reaction in Sanglah Hospital is still relatively high and far from national target which is 0.01%. To achieve the target of quality, it is necessary to set up an active program so that the number of incidence of transfusion reactions can be decreased. Methods: Pre and post test interventional study was conducted for 6 months in Sanglah Hospital Bali. All nurses in wards which is blood product frequently used was involved in this study. The intervention in this study was in the form of education and training programs on the application of the closed system and cold chain in the distribution of blood products as well as improved service system. Results: The results showed a decline in the incidence of transfusion reactions occurred every month during the study. The incidence of transfusion reactions occurred each month was 0.77%, 0.56%, 0.5%, 0.49%, 0.45% and 0.38% respectively. The average reduction in the incidence of transfusion reactions was 0.08% every month. The type of transfusion reaction that occurred was 59% urticaria, 29% fever, 7% shortness of breath, 4% fever and chills, and 1% shock. Conclusion: Education and training programs on the application of the cold chain system and closed system in the distribution of blood products as well as the improvement of service system helped reduce the number of the incidence of transfusion reactions in Sanglah Hospital Bali.

Purandare Hysteropexy Technique in a 28-year-old Female with Pelvic Organ Prolapse Stage III: A Rare Case Report

Putra, I Gede Mega ( Obstetrician and Gynecologist, Staff of Division of Urogynecology and Reconstructive ) , Kawilarang, Stella ( Resident of Obstetrics and Gynecology Department of Obstetrics and Gynecology, Faculty of Medicine, Udayana University Sanglah General Hospital, Denpasar, Bali )

BALI MEDICAL JOURNAL Vol 5, No 3 (2016)
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Abstract

Background: Pelvic organ prolapse is rarely found in reproductive-age women or in women with low parity. However, the finding has be further investigated to determine any risk factor involved, as well as to decide on the most appropriate management. This case report discusses the management of Purandare hysteropexy in a 28-year-old female with pelvic organ prolapse stage III. Case: A conservative surgical management on a reproductive-age woman with pelvic organ prolapse stage III, who wants to preserve her uterus. Result: The patient had an anatomical reconstruction. She had a better quality of life after the Purandare hysteropexy, and had less complains. Conclusion: Purandare hysteropexy is one of the conservative surgical management on reproductive-age women with pelvic organ prolapse who still wants to conserve their uterus or reproductive organ

Aqueous Extract of Purple Sweet Potato Tubers Decrease MDA and Increase SOD2 in Kidney of Diabetic Rats

Satriyasa, Bagus Komang ( Department of Pharmacology, Medical School, Udayana University Denpasar-Bali )

BALI MEDICAL JOURNAL Vol 5, No 3 (2016)
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Abstract

Diabetes mellitus (DM) is a metabolic disease characterized by increase of blood glucose levels or hyperglycemia. Hyperglycemia results in oxidative stress and increase of AGEs. Oxidative stress and metabolic stress lead to reduction of endogenous antioxidant activity resulted in various organs injury especially kidney. The complication is caused by the formation of advanced glycation end products (AGEs), and free radicals. Increase free radicals that occur in diabetics accompanied with decline in endogenous antioxidant activity, such as superoxide dismutase (SOD) and catalase. One way to overcome the complications due to oxidative stress is through utilize the foods which possess natural antioxidant such as purple sweet potato. It has been proven in animals that purple sweet potato had antioxidant properties to prevent various complications in DM. Balinese purple sweet potato tubers contain high anthocyanin and it had been researched as antioxidant in rats in vivo. The aims of this research are to determine the effect of aqueous extract of purple sweet potato tubers to decrease malondialdehyde (MDA) and increase SOD2 in kidney of diabetic rats. This experimental study was conducted with randomized posttest only control group design. Research subject is 38 diabetic rats that divided into 2 groups, controlled group and treatment group, with 18 diabetic rats in each group. Treatment was given for 60 days to each group. Treatment group (P1) is diabetic rats group that was given a standard diet and ad libitum drinks, and 4CC/day/rat of purple sweet potato tubers aqueous extract for 60 days. Controlled group (P0) is diabetic rats group as control that was given a standard diet and ad libitum drinks only. After 60 days of treatment, evaluation was performed. The results of this research found that mean MDA in kidney of control and treatment group was 8.40?0.17 and 1.47?0.15, respectively. There was a significant decreae of MDA (p

The Effects of Syphilis Infection on CD4 Counts and HIV-1 RNA Viral Loads in Blood: A Cohort Study Among MSM with HIV Infection in Sanglah Hospital Bali-Indonesia

Somia, I Ketut Agus ( Tropical and Infectious Disease Division, Department of Internal Medicine, Udayana University- Sanglah Hospital Bali-Indonesia. ) , Merati, Ketut Tuti Parwati ( Tropical and Infectious Disease Division, Department of Internal Medicine, Udayana University- Sanglah Hospital Bali-Indonesia. ) , Sukmawati, Dewi Dian ( Tropical and Infectious Disease Division, Department of Internal Medicine, Udayana University- Sanglah Hospital Bali-Indonesia. ) , Phanuphak, Nittaya ( The Thai Red Cross AIDS Research Centre ) , Indira, IGAA Elis ( Department of Dermatology and Venerology, Udayana University - Sanglah Hospital Bali-Indonesia ) , Prasetia, Made Yogi Oktavian ( Nusa Indah VCT Clinic, Sanglah Hospital Bali-Indonesia ) , Amijaya, Komang Agus Trisna ( Nusa Indah VCT Clinic, Sanglah Hospital Bali-Indonesia ) , Sawitri, AA Sagung ( Department of Public Health, Udayana University Bali-Indonesia )

BALI MEDICAL JOURNAL Vol 5, No 3 (2016)
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Abstract

Background: Men who have sex with men (MSM), particularly those with HIV infection, are at high risk for contracting syphilis. However, little is known about the effect of syphilis on HIV-1 RNA and CD4 count among HIV infected MSM. Methods: MSM were enrolled into the MSM-VCT study cohort at Sanglah Hospital in Bali between June 22 nd 2011 to February 13 rd 2012. All participants had anti-HIV test and VDRL test at baseline, with TPHA confirmation for reactive VDRL results. Plasma HIV-1 RNA levels and CD4 counts were measured at baseline and month 6 visits. T-test or non-parametric Mann-Whitney test were used to compare changes in CD4 counts and HIV-1 RNA levels between those with and without syphilis. To analyze difference of baseline and 6 month visit in each group, we used paired students t-test. Results: HIV positive MSM with syphilis co-infection had significantly higher mean baseline CD4 count than those without syphilis (P=0.017). No difference was seen for median baseline plasma HIV-1 RNA between HIV positive MSM with and without syphilis (P=0.885). Mean change in CD4 count from baseline to month 6 was similar between HIV positive MSM with syphilis (n=11) and without syphilis (n=20) (P=0.860). Similarly, no significant difference in median HIV-1 RNA change was identified between those with (n=8) and without syphilis (n=11) (P=1.000). Conclusions: HIV positive MSM with syphilis co-infection had higher CD4 cell counts. However, syphilis influences the changes of CD4 cell count and HIV-1 RNA 6 months after HIV diagnosis, but not statistically significance.

High Interleukin-6 Level Increases Depression Risk on Geriatric Population in Denpasar, Bali-Indonesia

Purnamasidhi, Cokorda Agung Wahyu ( Internal Medicine Department Medical Faculty Udayana University Denpasar, Bali, Indonesia ) , Kuswardhani, R.A. Tuty ( Geriatric Division, Internal Medicine Department Medical Faculty Udayana University Denpasar, Bali, Indonesia )

BALI MEDICAL JOURNAL Vol 5, No 3 (2016)
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Abstract

Background: High interleukin-6 (IL-6) serum level was responsible in inflammatory regulation through the interaction within macrophage, glial melatonin production and regulation of methyl CpG- binding protein 2 (MeCP2) and influenced neuro-inflammation process, thus, it increased the risk of depression. The aim of this study was to determine whether high interleukin-6 serum level increased the risk of depression in geriatrics. Methods: A case control was performed as the design of this study. Geriatric populations with depression enrolled as the case group and without depression as control group. Assessment of IL-6 serum level was conducted by the patient’s venous blood. The IL-6 serum> 10 pg/ml was categorized as high. Results: In this study, 30 cases and 30 controls who met the criteria included as samples. There were 20 males (66.7%) and 10 females (33.3%). Factors associated with an increased risk of depression in geriatric were a high level of serum interleukin-6 (OR=3.60; CI95%: 1.22-10.64, p=0.018) and a marital status (OR=3.50; CI95%: 1.11- 1.02, p=0.028). High level of interleukin-6 was a significant and an independent risk factor of depression in geriatric (OR=3.60; CI95%: 1.22-10.64, p=0.021) in multivariate analysis. Conclusion: This study concluded that high IL- 6 serum level increased the risk of depression in geriatric.

Postoperative Bleeding in CABG Patients: New Study in Southwest of Iran

Heidari, Amanollah ( Department of Cardiac surgery, Atherosclerosis Research Center and Imam Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran ) , Firoozabadi, Mehdi Dehghani ( Department of anesthesiology, Shahid Sadoughi University of Medical Sciences-Yazd, Iran ) , Sheikhi, Mohammad Ali ( Department of Cardiac surgery, Atherosclerosis Research Center Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran )

BALI MEDICAL JOURNAL Vol 5, No 3 (2016)
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Abstract

Background: A common complication after Coronary Artery Bypass Grafting (CABG) is postoperative bleeding, which is considered as an important problem. Objective: The aim of this study is to study only patients who have never used drugs above so that it can assess postoperative bleeding in CABG with the absence of high-risk medications related to postoperative bleeding. Method: 50 patients who were candidates for CABG surgery participated in the study. Inclusions criteria included who were candidates for CABG surgery, avoiding the use of blood-clotting drugs before surgery, avoiding the use of immunosuppressant, and the absence of an underlying medical condition such as kidney diseases. Patients with inflammatory, platelet diseases, or any coagulation disorder were excluded. All patients initially tested for hemoglobin, platelets and hemoglobin and INR. In addition to testing for hemoglobin, the amount of bleeding and packed red cell; frozen plasma and platelets were recorded. Results: Fifty patients who were candidates for elective surgery, including 33 men (66%) and 17 women (34%) were enrolled in this study. The mean patient age was 8.70+57.9years old. Test showed that mean hemoglobin level of patients before surgery was pre- operative of 1.5 + 12.4 g/dL, mean platelet was equal to 54.14 + 250.8 thousand/µL and an average international normalized ratio (INR) was equal to 0.12+1.07. The results after surgery also showed that: The total units of given packed red cell; frozen plasma and platelets were (3.14 + 1.90; 2.34 + 2.36 and 0.06 + 0.42). Also, postoperative hemoglobin was 1.30 + 10.30 g/dL, which significantly decreased compared to pre-operative hemoglobin. Bleeding in patients was observed with an average of 537.5 + 973 mL. Of course, the amount of bleeding in any patient was not caused further surgery, Conclusion: that the use of some drugs surgery can be a good way to reduce the risk of bleeding after surgery or on-use of some drugs can reduce the risk of bleeding after surgery with a minimum of morbidity and mortality. It is suggested that other researchers after designing clinical trials and using lower doses for effective drugs such as Clopidogrel and compared to control groups, or different doses of the N-acetylcysteine drug be reported more documentation to improve the bleeding after surgery.