e-CliniC
https://ejournal.unsrat.ac.id/v3/index.php/eclinic
<p>e-CliniC (eCl) diterbitkan oleh Perhimpunan Ahli Anatomi Indonesia bekerja sama dengan Fakultas Kedokteran Universitas Sam Ratulangi Manado. Jurnal ini diterbitkan 3 (tiga) kali setahun (Maret, Juli, dan November). Sejak tahun 2016 e-CliniC diterbitkan 2 (dua) kali setahun (Juni dan Desember). Sejak tahun 2023 e-CliniC telah diterbitkan kembali 3 (tiga) kali setahun (Maret, Juli, dan November).</p>Universitas Sam Ratulangien-USe-CliniC2337-5949<p>COPYRIGHT</p> <p> </p> <p>Authors who publish with this journal agree to the following terms:</p> <p>Authors hold their copyright and grant this journal the privilege of first publication, with the work simultaneously licensed under a Creative Commons Attribution License that permits others to impart the work with an acknowledgment of the work's origin and initial publication by this journal.</p> <p>Authors can enter into separate or additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (for example, post it to an institutional repository or publish it in a book), with an acknowledgment of its underlying publication in this journal.</p> <p>Authors are permitted and encouraged to post their work online (for example, in institutional repositories or on their website) as it can lead to productive exchanges, as well as earlier and greater citation of the published work (See The Effect of Open Access).</p>Penerapan Sistem Informasi Manajemen Rumah Sakit di RSUD Dr. Sam Ratulangi Tondano
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/52755
<p><strong>Abstract: </strong>Hospital management information system (HMIS) is an integrated information system prepared to handle the entire process of hospital management and services. This study aimed to analyze the implementation of hospital management information systems at RSUD Dr. Sam Ratulangi Tondano. This was a qualitative case study with in-depth interviews and observation methods. Samples were four informants. Data analysis is a content analysis through the data reduction stage, data presentation in a matrix, and the validity of the research results using source and method triangulation to draw conclusions. The results showed that based on infrastructure indicators, there was a lack of available computers in each section, the internet network quality was inadequate, due to a lack of budget allocation for HMIS. Based on human resource indicators, there was a lack of qualified and competent IT personnel as well as indiscipline on duty, absence of a strict reward and punishment system, that actually disrupted the flow of services in the hospital. Based on indicators of the operational procedure system, it is in accordance with the existing standards of the hospital to carry out the duties and functions according to their respective duties. In conclusion, the application of HMIS at RSUD Dr. Sam Ratulangi Tondano related to the quality of infrastructure and human resource indicators is still lacking, on the other hand the standard operating procedure indicators are good which are regulated directly by the hospital leadership.</p> <p><strong>Keywords</strong>: hospital management information system; infrastructure; human resources; standard operating procedures</p> <p><strong> </strong></p> <p><strong> </strong><strong>Abstrak: </strong>Sistem informasi manajemen rumah sakit (SIMRS) merupakan sistem informasi terintegrasi yang disiapkan untuk menangani keseluruhan proses manajemen dan pelayanan rumah sakit. Penelitian ini bertujuan untuk menganalisis penerapan sistem informasi manajemen rumah sakit di RSUD Dr. Sam Ratulangi Tondano. Metode penelitian ialah studi kualitatif kasus melalui wawancara mendalam dan observasi dengan empat informan. Analisis data melalui tahap reduksi data, penyajian data dalam matriks, validitas hasil penelitian menggunakan triangulasi sumber dan metode hingga penarikan simpulan. Hasil penelitian mendapatkan pada indikator infrastruktur ialah kurangnya keter-sediaan komputer di setiap bagian dan kualitas jaringan internet yang belum memadai, disebabkan karena kurangnya anggaran alokasi untuk SIMRS. Pada indikator sumber daya manusia (SDM) didapatkan kurangnya tenaga IT yang sesuai kualifikasi dan kompetensi serta adanya ketidakdisiplinan waktu saat bertugas, dan tidak adanya sistem <em>reward </em>dan <em>punishment </em>yang tegas; hal ini justru mengganggu alur pelayanan di rumah sakit. Indikator sistem operasional prosedur sudah sesuai standar rumah sakit untuk menjalankan tugas tupoksi sesuai tugas masing-masing. Simpulan penelitian ini ialah penerapan SIMRS di RSUD Dr. Sam Ratulangi Tondano dari indikator infrastruktur dan SDM kualitasnya masih kurang, di sisi lain indikator standar operasional prosedur sudah baik yang diatur langsung oleh pimpinan rumah sakit.</p> <p><strong>Kata kunci: </strong>sistem informasi manajemen rumah sakit; infrastruktur; sumber daya manusia; standar operasional prosedur</p>Pricillia T. TangelAaltje E. ManampiringNova H. Kapantow
Copyright (c) 2023 Pricillia T. Tangel, Aaltje E. Manampiring, Nova H. Kapantow
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2023-11-262023-11-2612212113310.35790/ecl.v12i2.52755Median Nerve Repair Using Sural Nerve Grafting: A Case Report
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/46200
<p>Peripheral nerve injuries (PNIs) have increased to nearly 2.8% of all trauma cases. It often occurs in the upper extremities, such as the median nerve. EMG can be used to confirm a PNI diagnosis. When continuity defects are present in the injured nerve, a nerve graft procedure may be indicated. The most common donor nerve for repair is the sural nerve. Different surgical options are available for the repair of PNI. We presented a 39-year-old woman whose left hand was cramping and did not fully clench. On physical examination, there was an irregular scar on the left arm 1/3 upper region. Sensory deficits were found in the distribution areas of the median nerve, from digiti 1 to 3 of the manus sinistra. EMG showed the lesion of the left median nerve, an axonetmesis was suspected. The patient was then treated with sural nerve grafting to the median nerve using fibrin glue. The postoperative result revealed improvement in hand function. Grafting sural nerve to median nerve using fibrin glue was rarely performed. According to several studies, nerve grafts usually used 6-0 sized synthetic, monofilament, non-absorbable polypropylene sutures. however, there was no difference in the results between fibrin glue and sutures, both have good outcomes. In conclusion, repairing of the median nerve injury using autograft (sural nerve) and fibrin glue can be an option to restore the function of the hand.</p> <p><strong>Keywords</strong>: peripheral nerve injury; median nerve; sural nerve; nerve grafting</p>Eko PrasetyoMaximillian C. OleyFerdinan TjungkagiYovanka N. ManuhutuEdwin H. Sitorus
Copyright (c) 2023 Eko Prasetyo, Maximillian C. Oley, Ferdinan Tjungkagi, Yovanka N. Manuhutu, Edwin H. Sitorus
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2023-11-262023-11-2612213413810.35790/ecl.v12i2.46200Management of Crush Injury’s Complications Using Hyperbaric Oxygen Therapy: Case Series
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/46847
<p><strong>Abstract</strong>: Crush injury occurs due to an external trauma mechanism that directly affects the skin, muscle, and bone tissue. Crush injuries can involve several parts of the body at the same time. When accompanied by handling, wound healing in crush injury can be long-term, so that it can affect the function of the patient. Various complications that can occur ranging from secondary infection, necrosis, recurrent bleeding, to compartment syndrome. We reported serial cases of crush injury with various clinical presentations and complications, varying in the age range of 16-65 years. All four patients were given multiple managements, such as open reduction external fixation and extensive debridement. There were complications such as secondary infection and delay in the wound healing process in patients who did not on time for follow-up. The four patients received additional treatment in the form of wound dressings hyperbaric oxygen therapy (HBOT) with 5-10 90-minute sessions under 2.4 ATA pressure for 10 consecutive days. Follow-up was carried out again within a period of one month to compare the wound condition before and after HBOT. The clinical condition was getting better, marked by the formation of granulation tissue. The state of hyperoxia in HBOT accelerated the inflammatory process and angiogenesis during the wound healing process characterized by the eradication of bacteria in the wound tissue and accelerated neovascularization formation. In conclusion, adequate therapy, wound dressing, and patient compliance affect patient outcome. Moreover, the addition of hyperbaric oxygen therapy has shown to accelerate the wound healing process and restore the patient's limb function.</p> <p><strong>Keywords: </strong>crush injury; hyperbaric oxygen therapy; oxygen; wound healing</p>Patrick S. ArikalangMendy J. HatibieMaximillian C. OleyAlbertus D. NoersasongkoTommy Suharso
Copyright (c) 2023 Patrick S. Arikalang, Mendy J. Hatibie, Maximillian C. Oley, Albertus D. Noersasongko, Tommy Suharso
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2023-12-052023-12-0512213914310.35790/ecl.v12i2.46847Hubungan Kadar Fibronektin Serum dengan Tingkat Kesadaran Menurut Klasifikasi CT-Marshall pada Cedera Otak Sedang dan Berat Akibat Trauma
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/52956
<p><strong>Abstract</strong>: Traumatic brain injury (TBI) is the main cause of brain damage in the adolescent and productive age generations, and its incidence is increasing every year. To date, there is still no accurate biological marker for detection of traumatic brain damage or prognosis related to the brain damage. One of the promising biological markers for detection of brain damage is fibronectin. This study aimed to evaluate the relationship between level of serum fibronectin and level of consciousness based on CT-Marshall in TBI patients. This was an observational and analytical study with a cross-sectional design. Samples that met the study criteria were taken sequentially from the study hospital without differentiating exposure status (serum fibronectin levels) or outcome (CT-Marshall category). The regression test on level of serum fibronectin and level of consciousness based on the CT-Marshall category obtained significant result indicating that the higher the serum fibronectin level, the higher the patient's CT-Marshall category which meant the patient had a higher degree of severity and poor consciousness. In conclusion, there is a significant relationship between level of serum fibronectin and level of consciousness based on the CT-Marshall category in moderate and sever traumatic brain injury patients.</p> <p><strong>Keywords: </strong>traumatic brain injury; biological marker; serum fibronectin; CT-Marshall category</p> <p> </p> <p><strong>Abstrak: </strong>Cedera otak akibat trauma (COT) merupakan penyebab utama kerusakan otak pada generasi muda dan usia produktif dengan angka kejadian meningkat setiap tahunnya. Saat ini, belum terdapat penanda biologis yang akurat untuk mendeteksi kerusakan otak traumatik ataupun menilai prognosis terkait kerusakan otak traumatik. Salah satu penanda biologis yang cukup menarik perhatian ialah fibronektin. Penelitian ini bertujuan untuk mengevaluasi hubungan antara kadar fibronektin serum dengan tingkat kesadaran menurut klasifikasi CT-Marshall pada COT. Jenis penelitian ialah analitik observasional dengan desain potong lintang. Sampel yang memenuhi kriteria penelitian diambil berurutan dari rumah sakit tempat penelitian tanpa membedakan status paparan (kadar fibronektin serum) atau luaran (kategori CT-Marshall). Hasil uji regresi pada variabel utama kadar fibronektin serum dengan kesadaran menggunakan kategori CT-Marshall mendapatkan hasil bermakna yaitu semakin tinggi kadar fibronektin serum, semakin tinggi pula kategori CT-Marshall pasien yang berarti pasien memiliki derajat keparahan dan kondisi kesadaran yang buruk. Simpulan penelitian ini ialah terdapat hubungan bermakna antara kadar fibronektin serum dan tingkat kesadaran menggunakan kategori CT-Marshall pada pasien cedera otak traumatic sedang dan berat.</p> <p><strong>Kata kunci: </strong>cedera otak akibat trauma; penanda biologis; fibronektin serum; kategori CT-Marshall</p>Diornald J. MogiEko PrasetyoMaximillian C. OleyFerdinan TjungkagiYovanka N. Manuhutu
Copyright (c) 2023 Diornald J. Mogi, Eko Prasetyo, Maximillian C. Oley, Ferdinan Tjungkagi, Yovanka N. Manuhutu
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2023-12-052023-12-0512214414910.35790/ecl.v12i2.52956Percutaneous Coronary Intervention in a Saphenous Vein Graft Failure: A Case Report
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/52514
<p><strong>Abstract:</strong> Recent published data from the Society of Thoracic Surgery (STS) national database displayed that among patients aged >65 years old who survived following an initial coronary artery bypass graft (CABG) operation, rates of repeat revascularization at 1, 5, 10, and 18 years were 2%, 8%, 16%, and 25%, respectively. The most preferred mode of revascularization was percutaneous coronary intervention (PCI). While remain the most frequently used conduits beside left internal mammary artery (LIMA), saphenous vein grafts (SVGs) have high failure rates. Percutaneous coronary intervention in SVGs is associated with an increased risk of distal coronary embolization, commonly resulting in periprocedural MI. We reported a 79-year-old male patient admitted due to progressive symptoms of chronic coronary syndrome. The patient had a history of hypertension and a CABG surgery in 2012. Electrocardiogram showed ischemia and old myocardial infarction (OMI) in inferior leads as well as poor R wave progression in the precordial leads. Transthoracic echocardiogram displayed a normal ejection fraction but impaired left ventricular (LV) diastolic relaxation. Diagnostic coronary angiography revealed a 70% tubular stenosis in proximal part of SVG supplying posterior descending artery, patent LIMA graft to left anterior descending artery, and complex lesion on native vessel (chronic total occlusion in mid right coronary artery). Implantation of drug eluting stent in SVG-posterior descending artery was performed. Direct-stenting PCI technique using undersized-stent was done to prevent any complications. In conclusion, despite the high risk of complications, vein graft intervention was successfully performed without any complications. Since the high rates of in-stent restenosis following PCI in SVGs, long-term dual antiplatelet therapy should be commenced in this patient.</p> <p><strong>Keywords</strong>: saphenous vein graft; vein graft intervention; percutaneous coronary intervention</p>Edmond L. Jim
Copyright (c) 2023 Edmond L. Jim
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2023-12-272023-12-2712215015610.35790/ecl.v12i2.52514Pattern of Skull and Facial Bone Fracture in Craniomaxillofacial Trauma Associated with Traumatic Brain Injury: A Retrospective Analysis at Tertiary Hospital
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/46477
<p><strong>Abstract: </strong>Trauma is one of the primary causes of death during the first four decade. Craniomaxillo-facial (CMF) trauma has become a common presentation in emergency departments of hospitals. The most presentation of CMF trauma includes skull and facial bone fracture and traumatic brain injury (TBI). This study aimed to obtain the pattern of skull and facial bone fracture in craniomaxillofacial trauma associated with traumatic brain injury. This was a retrospective study conducted on 501 patients from January 2020 to December 2021. Demographic data included age, sex, length of stay (LOS), and Glasgow coma scale (GCS). The results showed that from the total 501 patients with skull and facial bone fracture with or without traumatic brain injury, 406 (81%) were males and 95 (19%) were females. The age range of the patients was between 2 years and 86 years (mean±SD 33.9±18.2). The most common patient affected age ranged from 21 to 30 years. The average of LOS was 7.2±5.7 days (0-33) and the mean of GCS was 10.2±4.2. Based on types of cases, there were 232 cases (60%) of skull and facial bone fractures accompanied by TBI; 154 cases (40%) of only skull and facial bone fracture; and 339 (59.5%) cases of only TBI. In conclusion, the distribution of TBI increases in those with skull and facial bone fractures. On the other hand, the distribution of TBI is more common without fracture. Hence every skull and facial bone fracture must be carefully evaluated clinically and radiologically to rule out any underlying TBI.</p> <p><strong>Keywords</strong>: skull and facial bone fracture; craniomaxillofacial trauma; traumatic brain injury</p>Eko PrasetyoMaximillian C. OleyFerdinan TjungkagiYovanka N. ManuhutuAntonius E. Sonbay
Copyright (c) 2023 Eko Prasetyo, Maximillian C. Oley, Ferdinan Tjungkagi, Yovanka N. Manuhutu, Antonius E. Sonbay
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2023-12-282023-12-2812215716310.35790/ecl.v12i2.46477Keakuratan FNAB pada Limfadenitis Tuberkulosis di Kelenjar Getah Bening Leher di Manado
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/46849
<p><strong>Abstract: </strong>Tuberculous lymphadenitis is the most common type of extrapulmonary tuberculosis (TB). Fine needle biopsy aspiration (FNAB) is an initial diagnostic method to evaluate lymph node enlargement in the neck This study aimed to evaluate the accuracy of FNAB in tuberculous lymphadenitis in neck lymph nodes in Manado. This was is a retrospective and descriptive study using medical record data on the use of FNAB examination in patient with a history of lymph node enlargement years 2017-2018. The results obtained 160 FNAB samples with clinical lymph node enlargement in the neck; 86 samples (54%) with TB lymphadenitis, nine samples (6%) were suspected as TB lymphadenitis, and 65 samples (40%) were not TB lymphadenitis The incidence in women (61%) was higher than in men (39%). TB lymphadenitis was most common in women aged <19 years and men aged 20-30 years. In conclusion, FNAB remains an important option as one of the diagnostic supporting tools for lymph node enlargement especially to confirm the diagnosis of tuberculous lymphadenitis in the neck.</p> <p><strong>Keywords</strong>: fine needle biopsy aspiration; tuberculous lymphadenitis; cytopathological diagnosis</p> <p><strong> </strong></p> <p><strong>Abstrak</strong>: Limfadenitis tuberkulosis (TB) merupakan bentuk TB ekstrapulmoner yang tersering. <em>Fine needle biopsy aspiration</em> (FNAB) ialah metode diagnostik awal untuk mengevaluasi pembesaran kelenjar getah bening di leher. Penelitian ini bertujuan untuk mengetahui keakuratan FNAB pada limfadenitis tuberkulosis di kelenjar getah bening leher di Manado. Jenis penelitian ialah deskriptif retrospektif menggunakan data rekam medik penggunaan pemeriksaan FNAB pada pasien yang memiliki riwayat pembesaran kelenjar getah bening di leher di Laboratorium Patologi Anatomi RSUP Prof R. D. Kandou Manado.tahun 2017-2018. Hasil penelitian mendapatkan 160 sampel FNAB dengan klinis pembesaran pada leher; 86 sampel (54%) dengan hasil FNAB limfadenitis TB, sembilan sampel (6%) dicurigai sebagai limfadenitis TB, dan 65 sampel (40%) bukan limfadenitis TB. Kejadian pada perempuan (61%) lebih tinggi daripada laki-laki (39%). Limfadenitis TB tersering pada perempuan berusia <19 tahun dan laki-laki 20-30 tahun. Simpulan penelitian ini ialah sampai saat ini FNAB tetap menjadi pilihan sebagai salah satu alat penunjang diagnostik untuk evaluasi pembesaran kelenjar getah bening terutama dalam menentukan limfadenitis TB di leher.</p> <p><strong>Kata kunci</strong>: <em>fine needle biopsy aspiration</em>; limfadenitisis tuberculosis; diagnostik sitopatologi</p>Jessie I. IjongNico Lumintang
Copyright (c) 2024 Jessie I Ijong, Nico Lumintang
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2024-02-062024-02-0612216416810.35790/ecl.v12i2.46849Primary Closure of Gastric Perforation Using Seromuscular Omentum Insertion: A Case Report
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/46850
<p><strong>Abstract: </strong>Gastric perforation is the most common disease and a surgical emergency with high morbidity and mortality; therefore, early and precise management is needed. However, no consensus has been accepted regarding the best surgical treatment for gastric perforation closure so far. Although surgery methods are varied, laparotomy, and omental patch repair are still the gold standard. The risk of leakage after primary closure accompanied by omentopexy is still common, resulting high morbidity and mortality. This study aimed to discuss about the modified method by means of primary closure with seromuscular omentum insertion in a gastric perforation case. We modified the usual method using primary closure with seromuscular omentum insertion, to get the best way for perforation closure and reduced risk of leakage. After a week of surgical perforation closure, the patient was discharged and further observation resulted in no leakage. In conclusion, modified method by using primary closure with seromuscular omentum insertion in gastric perforation has good result without any leakage and recurrence.</p> <p><strong>Keywords</strong>: gastric perforation; omentum; primary closure</p>Ferry KalitouwBilly SalemBrian Sugito
Copyright (c) 2024 Ferry Kalitouw, Billy Salem, Brian Sugito
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2024-02-062024-02-0612216917210.35790/ecl.v12i2.46850Endovascular Fistula Salvage for Preserving Arteriovenous Fistula Failure in Haemodialysis Patient: Tertiary Referral Hospital, a Single-Centre Experience
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/46644
<p><strong>Abstract</strong>: Efficacy of endovascular intervention for the preservation of failing accesses is very important in hemodialysis patients. This study aimed to determine the efficacy of endovascular balloon angioplasty in preserving the patency of hemodialysis arteriovenous fistula (AVF) failure. This was a retrospective study of hemodialysis patients who received endovascular intervention due to access difficulties. A single-center study was created between January 2022 and June 2022. Fistulography was conducted on patients suspected of having access stenosis, and balloon angioplasty was performed in the same setting if stenosis of 50% was confirmed. Post-operative complications and access restenosis or failure were monitored. The results obtained 69 patients with hemodialysis access failure due to AVF stenosis, occlusion, and thrombosis that were admitted or referred to our hospital. The majority of patients were 40-60 years (50.7%); 88.4% patients were male and 11.6% were female, with a mean age of 56.3±11.6 (range, 18–77). The sites of AVF failure were brachiocephalic (81.1%) and radiocephalic (18.9%). There was no complication recorded. The procedure succes rate was 81.1%. In conclusion, endovascular balloon angioplasty is effective in restoring hemodialysis access patency. Recurrence is common, and interventions must be repeated. Keeping access open can save lives. Percutaneous transluminal angioplasty (PTA) can be used to achieve safely and successfully repair arteriovenous fistulas failure.</p> <p><strong>Keywords</strong>: angioplasty; arteriovenous fistula; arteriovenous graft; hemodialysis</p>Billy KarundengRichard SumangkutDjony TjandraYuansun KhosamaTomi Juliandi
Copyright (c) 2024 Billy Karundeng, Richard Sumangkut, Djony Tjandra, Yuansun Khosama, Tomi Juliandi
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2024-02-072024-02-07122`17317710.35790/ecl.v12i2.46644Medical Rehabilitation in Patient with Cerebral Palsy Spastic Diplegic GMFCS IV MACS I CFCS IV EDACS II
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/46884
<p><strong>Abstract: </strong>Children with cerebral palsy are present with three types of motor problems. The major disturbances in muscle tone, balance, strength, and selectivity are directly related to damage of the central nervous system. Treatment programs encompass physical and behavioral therapy, pharmacologic and surgical treatments, mechanical aids, and management of associated medical conditions. In physical, occupational, speech, and behavioral therapies, the goals include enhancing patient and caregiver interactions while providing family support. We reported a female, 7-year-old, with cerebral palsy spastic diplegic GMFCS IV MACS I CFCS IV EDACS II. The patient was treated with USD intensity 1 watt/cm<sup>2</sup>, frequency 3.3 MHz in 5 minutes and continuous stretching in four extremity for 10 minutes each. It showed improvement from the popliteal angle assessment and MAS score, therefore, additional invasive therapy, such as botox injection, might be not needed in the meantime. Stiffness in lower extremities especially at gastrocnemius muscle was treated with ESWT energy of 0.15mJ/mm2; total shots dose 1500 shocks per each treated muscle (gastrocnemius); frequency 4 Hz. The patient presented with lumbar hyperlordotic and anterior pelvic tilt, and also tended to sway posteriorly during standing and walking, resulting poor protection reaction on the anterior side. It will be beneficial to add abdominal core and hip extensor strengthening exercise into the program. For walking aids, we considered about using anterior walker or posterior walker. However, since the patient was 4 years old and could not take complex instruction, it might become challenging to modify the exercise protocol. Regular daily stretching was beneficial for the home program and should be continued. Referral to surgery was not required at this moment due to no joint contracture.</p> <p><strong>Keywords: </strong>cerebral palsy; motor problem; gait rehabilitation</p>Gloria RondonuwuJoudy GessalChelsy Angelina
Copyright (c) 2024 Gloria Rondonuwu, Joudy Gessal, Chelsy Angelina
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2024-02-112024-02-1112217818510.35790/ecl.v12i2.46884Effect of Propolis Trigona Sp on Expression of TNF-α in Superficial Dermal Burns through In Vivo Test
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/51816
<p><strong>Abstract: </strong>Burn is caused by exposure to high-temperature substances such as hot, solid liquids or gases such as smoke, steam, engines, stoves, radiators and objects that emit heat energy. In severe burns, there is an excessive neutrophil inflammatory response that triggers SIRS, where there is an excessive increase in pro-inflammatory mediators such as TNFα and IL-6. Propolis contains a number of compounds, such as flavonoids, CAPE, phenol compounds, arginine, ferulic acid and albumin which play a good role in healing burns. This study aimed to find out the effect of propolis on TNF-α expression through in-vivo testing in cases of superficial dermal burns. This was an experimental and laboratory study to assess the bioactive compounds contained in <em>Trigona Sp propolis. </em>Descriptive analysis was performed on the bioactive composition of Trigona Sp propolis and experimental effectiveness of propolis on TNF-α expression in superficial dermal burns. The study was conducted at the laboratory of experimental animals<em> "Alike Quality System", </em>Manado. The results showed that the group treated with propolis had smaller burn areas compared to the groups treated with 1% silver sulfadiazine or with 0.9% NaCl. Granulation had been formed throughout all wounds, however, macroscopically, burns with propolis treatment showed reddish wound appearance while treated wounds with 1% silver sulfadiazine and 0.9% NaCl were darker in color and had thicker crust formation. The one-way ANOVA test showed no significant difference between propolis and 1% silver sulfadiazine on TNF-α expression in dermal superficial burns (p=0.666) meanwhile the effect of propolis compared with NaCl 0.9% on TNF-α expression in dermal superficial burns, showed significant differences (p=0.006 and p=0.040). In conclusion, administration of propolis can reduce the expression of TNF-α in superficial dermal burn.</p> <p><strong>Keywords: </strong>propolis;<em> Trigona sp</em>; burns;<em> in vivo </em>study</p>Melfrits R. SiwabessyChristian ManginstarMarselus A. MerungFredrik G. L. Langi
Copyright (c) 2024 Melfrits Siwabessy, Christian Manginstar, Marselus A. Merung, Fredrik G. L. Langi
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2024-02-152024-02-1512218619410.35790/ecl.v12i2.51816Gambaran Kasus Penganiayaan di Wilayah Kerja Polsek Langowan Periode 2021-2022
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/54472
<p><strong>Abstract: </strong>Illness and death can occur not only as a result of abnormalities or disease, but also through accidents or criminal acts. One form of crimes that is often encountered is persecution. Langowan is one of the areas in North Sulawesi where acts of abuse are often found. This study aimed to describe cases of persecution in the working area of Polsek Langowan in years 2021-2022. This was a descriptive and retrospective study with a cross-sectional design using reports of cases of persecution in the working area of Polsek Langowan in years 2021-2022. The results obtained a total of 55 cases of persecution occurred in 2021-2022, and the highest percentages of cases were in July 2021 and January 2022, each of six cases (10.91%). Gender was dominated by men, namely 52 cases (94.55%). The largest age range is 17-25 years which was late adolescence with a total of 24 cases (43.64%). The most common form of maltreatment was moderate maltreatment in 50 cases (90.91%). The most common type of violence was blunt violence with a total of 34 cases (58,62%). Most of the injuries occurred on the head with a total of 38 cases (50%). In conclusion, the most persecution occurred in July 2021 and January 2022, dominated by male victims, aged 17-25 years, moderate form of persecution, blunt violence, and the location of injury on the head.</p> <p><strong>Keywords:</strong> persecution; blunt trauma; victim</p> <p><strong> </strong></p> <p><strong>Abstrak: </strong>Kesakitan dan kematian bisa terjadi bukan hanya akibat adanya kelainan atau penyakit, tetapi juga melalui kecelakaan maupun tindakan kejahatan. Salah satu bentuk kejahatan yang sering ditemui yaitu penganiayaan. Langowan merupakan salah satu daerah di Sulawesi Utara yang sering didapatkan adanya tindak penganiayaan. Penelitian ini bertujuan untuk mengetahui gambaran kasus penganiayaan di Wilayah Kerja Polsek Langowan Periode 2021-2022. Jenis penelitian ialah potong lintang dengan mengumpulkan data sekunder yaitu laporan kasus penganiayaan di wilayah kerja Polsek Langowan Periode 2021-2022. Hasil penelitian mendapatkan sebanyak 55 kasus penganiayaan di wilayah kerja Polsek Langowan periode 2021-2022, dengan kasus penganiayaan terbanyak terjadi pada bulan Juli 2021 dan Januari 2022 dengan total masing-masing enam kasus (10,91%). Jenis kelamin didominasi oleh laki-laki yaitu sebanyak 52 kasus (94,55%). Rentang usia terbanyak yaitu 17-25 tahun yang merupakan masa remaja akhir dengan total 24 kasus (43,64%). Bentuk penganiayaan terbanyak yaitu penganiayaan sedang sebanyak 50 kasus (90,91%). Jenis kekerasan terbanyak yaitu kekerasan tumpul dengan total 34 kasus (58,62%). Lokasi perlukaan terbanyak terjadi di bagian kepala dengan total 38 kasus (50%). Simpulan penelitian ini ialah penganiayaan paling banyak terjadi di bulan Juli 2021 dan Januari 2022, didominasi oleh korban laki-laki, usia 17-25 tahun, bentuk penganiayaan sedang, jenis kekerasan tumpul, dan lokasi perlukaan di bagian kepala.</p> <p><strong>Kata kunci:</strong> penganiayaan; trauma tumpul; korban</p>Josua S. TumiwaJames F. SiwuDjemi Tomuka
Copyright (c) 2024 Josua S. Tumiwa, James F. Siwu, Djemi Tomuka
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2024-02-172024-02-1712219520010.35790/ecl.v12i2.54472Small Lymphocytic Lymphoma Presenting as Breast Mass: A Rare Case Report
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/46852
<p><strong>Abstract: </strong>Primary breast lymphoma is rare and it accounts for around 0.5% of malignant breast neoplasms. Small lymphocytic lymphoma (SLL) is a subtype of non-Hodgkin lymphoma originating from a B-cell lineage. This report presents a case of primary SLL of the breast with lung metastasis that had excellent clinical response. We reported a 67-year-old female complained a right breast mass that suddenly appeared after she got massage on her right left arm. The mass was swollen and painless with no systemic complications. The specimen was submitted to histopathology department and it revealed small diffuse lymphocytic lymphoma. Chest X-ray showed a lung metastasis. The patient was then treated with CHOP regimens (Cyclophosphamid, Doxorubicin, Vincristin, and Prednison) and the clinical result was excellent. The side effects of the medication were minimal. In conclusion, primary breast lymphocytic lymphoma is rare and this case highlights the differential diagnosis for a painless breast mass. The treatment must be individualized and multimodal, with chemotherapy being the most accepted treatment.</p> <p><strong>Keywords</strong>: breast lymphoma; breast mass; malignancy</p>Christian ManginstarMarselus A. MerungDenny SalehMarcella Merung
Copyright (c) 2024 Christian Manginstar, Marselus A. Merung, Denny Saleh, Marcella Merung
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2024-02-192024-02-1912220120410.35790/ecl.v12i2.46852Korelasi antara Kadar Kalsidiol (25-Oh) dan Rasio Netrofil-Limfosit dengan Keganasan Nodul Tiroid
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/48492
<p><strong>Abstract: </strong>Thyroid malignancy has shown the highest annual incidence rate. Vitamin D deficiency (serum 25-hydroxyvitamin D levels) is one of the risk factors for thyroid malignancy. The neutrophil-lymphocyte ratio (NLR) reflects the balance between pro-tumor inflammatory response and anti-tumor immune response. This study aimed to investigate the relationship between serum 25-hydroxyvitamin D levels, NLR, and thyroid nodule malignancy. This was an observational and analytical study with cross-sectional design. Samples were patients with thyroid nodules admitted to Prof. Dr. R. D. Kandou Hospital, Manado, form August 2022 to March 2023. The results obtained a total of 46 patients with thyroid malignancy that met the inclusion criteria. The patient characteristics were predominantly female (82.6%), with a mean age of 50.2 ± 14.74 years, normal thyroid hormone status (82.6%), mean serum 25-hydroxyvitamin D levels of 32.25 ng/mL, mean NLR of 5, and papillary carcinoma as the most common malignancy (43.48%). Spearman's correlation analysis revealed a significant association between thyroid malignancy and serum 25-hydroxyvitamin D levels (r =-0.501, p=0) as well as NLR (r 0.376, p=0.01). In conclusion<strong>, </strong>serum 25-hydroxyvitamin D levels and NLR can be used as indicators for predicting thyroid nodule malignancy.</p> <p><strong>Keywords: </strong>thyroid malignancy; 25-hydroxyvitamin D; neutrophil-lymphocyte ratio</p> <p> </p> <p><strong>Abstrak: </strong>Keganasan tiroid mengalami peningkatan angka kejadian tertinggi pertahun. Kekurangan vitamin D (kadar kalsidiol) merupakan salah satu faktor risiko terjadinya keganasan tiroid. Rasio netrofil limfosit (RNL) mencerminkan keseimbangan antara respon inflamasi protumor dan respon imun antitumor. Penelitian ini bertujuan untuk mengevaluasi hubungan antara kadar 25-hydroxyvitamin D serum dan RNL dengan keganasan nodul tiroid. Jenis penelitian ialah analitik observasional dengan desain potong lintang. Sampel penelitian ialah pasein dengan nodul tiroid yang dirawat di RSUP Prof. Dr. R. D. Kandou Hospital, Manado, sejak Agustus 2022 s/d Maret 2023. Hasil penelitian mendapatkan 46 pasien dengan keganasan tiroid yang memenuhi kriteria. Karakteristik sampel tebanyak ialah jenis kelamin perempuan (82,6%), rerata usia (50,2±14,74 tahun), status hormon tiroid normal (82,6%), rerata kadar 25-hydroxyvitamin D 32,25 ng/mL, rerata RNL 5, dan jenis keganasan karsinoma papiler (43,48%). Uji analisis Spearman menunjukkan keganasan tiroid secara bermakna berhubungan dengan kadar kalsidiol (r=-0,501, p=0), dan RNL (r=0,376, p=0,01). Simpulan penelitian ini ialah kadar 25-hydroxyvitamin D serum dan RNL dapat digunakan sebagai indikator untuk memrediksi keganasan nodul tiroid.</p> <p><strong>Kata Kunci</strong>: keganasan tiroid; 25-hydroxyvitamin D; rasio netrofil-limfosit</p>Bryan D. BogarNico LumintangSherly TandililingWindy M. Wariki
Copyright (c) 2024 Bryan D. Bogar, Nico Lumintang, Sherly Tandililing, Windy M. Wariki
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2024-02-192024-02-1912220521210.35790/ecl.v12i2.48492Rehabilitation for Marfan Syndrome
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/54474
<p><strong>Abstract: </strong>Marfan syndrome is a spectrum of disorders caused by a heritable genetic defect of connective tissue that has an autosomal dominant mode of transmission. The defect itself has been isolated to the FBN1 gene on chromosome 15, which codes for the connective tissue protein fibrillin<span style="text-decoration: line-through;">. </span>Abnormalities in this protein cause a myriad of distinct clinical problems, of which the musculoskeletal, cardiac, and ocular system problems predominate. The skeleton of patients with Marfan syndrome typically displays multiple deformities. Mitral valve prolapses that requires valve replacement can occur as well. Given the variable expressivity of Marfan Syndrome, no single sign is pathognomonic; the diagnosis is made on clinical grounds on the basis of typical abnormalities. We reported a boy, 12 years old, referred from surgeon with diagnosis <em>pectus carinatum</em> pro brace. Chest protusion appeared since age 6, getting bigger without any complaint but cosmetic. Other complaints on feet which looked flat, sometimes ankle sore after long distance running or futsal. He was the first child and no family history had a condition like him. His hobby was playing futsal, and daily activities were independent without assistive devices. General appearance and vital signs were normal, cardiorespiratory assessment was normal, BMI on percentile 10-25, arm span to height ratio 1.09, lens subluxation of left eye, lens dislocation of right eye, poor standing balance, inadequate toe off, thoracic hyperkyphotic, positive wrist sign, true leg length discrepancy of 1 cm (left>right), bilateral ankle ROM limitation, rigid flat feet suspected bilateral vertical talus, left hallux valgus, Marfan syndrome score 9, and normal echocardiography. In this patient, we gave semi rigid thoraco-lumbo-sacral orthosis (TLSO) with 3 points pressure system and rigid bar on protution area (custom molded). resistance exercise (F: 3x/week, I: moderate fatigue, Borg scale 13-15/20, T: 8-15 reps/ set, 2-3 set/ session, T: major muscle group upper and lower extremities aerobic exercise (F: 3x/week, I: moderate to vigorous, borg scale 13-15/20, T: ≥60 min/session, @5-10 min warming up and cooling down (stretching), T: sport (swimming, running, cycling). The patient was referred to a surgeon for a brace. In conclusion, this case report highlights the multidisciplinary management of patients with Marfan syndrome.</p> <p><strong>Keywords</strong>: Marfan syndrome; typical abnormalities; multiple deformities</p>Christi E. HartantoGloria E . RondonuwuJoudy Gessal
Copyright (c) 2024 Christi E. Hartanto, Gloria E . Rondonuwu, Joudy Gessal
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2024-02-212024-02-2112221321910.35790/ecl.v12i2.54474Pola Bakteri dan Resistensi Antimikroba pada Infeksi Terkait Fraktur Terbuka di RSUP Prof. Dr. R. D. Kandou Manado
https://ejournal.unsrat.ac.id/v3/index.php/eclinic/article/view/54339
<p><strong>Abstract: </strong>Fracture-related infection is a serious complication in orthopedic trauma, both in terms of infection and surgery. The use of antibiotics is a crucial component in the management of fracture-related infection, however, it can also lead to antibiotic resistance. This study aimed to evaluate the patterns of bacteria and antimicrobial resistance in open fracture-related infections at Prof. Dr. R. D. Kandou Hospital in Manado. This was a descriptive study with a cross-sectional design. Samples consisted of patients with open fracture-related infections and had microbiological culture and drug sensitivity data. Secondary data were collected and analyzed using categorical and numerical data. The results obtained 20 subjects with the average age of 42.8±19.0 years, dominated by males (80%), and the most common location of fracture was tibia/fibula (65%). The highest multidrug resistance rates by bacterial type were found in <em>Klebsiella</em> and <em>Enterobacter</em> (medians of 9 and 7, respectively). Based on bacterial type and antimicrobial resistance, the most common bacteria were <em>Staphylococcus aureus</em> and <em>Enterobacter</em> (30%), followed by MRSA and <em>Klebsiella</em> (15%), <em>Acinetobacter baumanni</em> and <em>Pseudomonas</em> (1%). The highest percentage of antibiotic resistance was found in ampicillin-sulbactam, ciprofloxacin, and gentamicin. Meanwhile, the highest distribution of antibiotic sensitivity was found in trimethoprim sulfamethoxazole, amikacin, clindamycin, and meropenem. In conclusion, open fracture cases are most commonly associated with <em>Staphylococcus aureus</em> and <em>Enterobacter</em>. Antibiotic resistance is predominantly observed in ampicillin sulbactam, ciprofloxacin, and gentamicin.</p> <p><strong>Keywords:</strong> infection; open fracture; antibiotics; bacterial resistance</p> <p> </p> <p><strong>Abstrak: </strong>Infeksi terkait fraktur merupakan komplikasi serius dalam trauma ortopedi, baik dari segi infeksi maupun pembedahan. Penggunaan antibiotik menjadi salah satu bagian dalam penatalaksanaan infeksi, namun hal ini dapat mengakibatkan resistensi antibiotik. Penelitian ini bertujuan untuk mengevaluasi pola bakteri dan resistensi antimikroba pada infeksi terkait fraktur terbuka di RSUP Prof. Dr. R. D. Kandou Manado. Jenis penelitian ialah deskriptif dengan desain potong lintang. Sampel penelitian ialah pasien dengan infeksi terkait fraktur terbuka yang memiliki data hasil pemeriksaan kultur mikroba dan sensitivitas obat. Pengumpulan data melalui data sekunder dan dianalisis melalui data kategorik dan numerik. Hasil penelitian mendapatkan 20 subjek, dengan rerata usia 42,8±19,0 tahun. Majoritas subjek ialah laki-laki (80%), dan jenis fraktur terbanyak di tibia/fibula (65%). Hasil <em>multidrug resistance</em> tertinggi menurut jenis bakteri ialah pada <em>Klebsiella</em> dan <em>Enterobacter</em> dengan median masing-masing 9 dan 7. Berdasarkan jenis bakteri dan resistensi antimikroba, yang terbanyak yaitu <em>Staphylo-coccus aureus</em> dan <em>Enterobacter</em> (30%), diikuti MRSA dan <em>Klebsiella</em> (15%), <em>Acinetobacter baumanni</em> dan <em>Pseudomonas</em> (1%). Distribusi resistensi antibiotik tertinggi pada ampicilin-sulbactam, ciprofloxacin, dan gentamisin, sedangkan distribusi sensitivitas antibiotik tertinggi pada trimethoprim sulfomethoxa-zole, amikasin, clindamycin, dan meropenem. Simpulan penelitian ini ialah pada kasus patah tulang terbuka jenis bakteri terbanyak ialah <em>Staphylococcus aureus</em> dan <em>Enterobacter</em>. Resistensi antibiotik didominasi oleh ampicillin sulbactam, ciproflocacin, dan gentamicin.</p> <p><strong>Kata kunci:</strong> infeksi; fraktur terbuka; antibiotik; resistensi bakteri</p>Ryan A. SendukAndriessanto LengkongHaryanto Sunaryo
Copyright (c) 2024 Ryan A. Senduk, Andriessanto Lengkong, Haryanto Sunaryo
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2024-03-022024-03-0212222022610.35790/ecl.v12i2.54339