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).
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Abstract: Fibrolipoma is a rare histological subtype of scrotal lipoma and is often a benign mesenchymal neoplasm. Management of this tumor such as surgical excision provides histopathological diagnosis and resolution of symptoms. We reported a case of 44-year-old male who complained of slow growing and painless mass in the right hemiscrotum. The clinical appearance was a mass with firm boundary, smooth surface, dense and tending to be hard with a size of 20 cm x 20 cm x 8 cm. In this case we performed a simple orchiectomy, and histopathological examination of a fibrolipoma had been carried resulting in no malignant cells were found. Although fibrolipomas are histologically benign, regarding their natural history postoperative follow-up is suggested. During postoperative observation, the wound was well maintained and the patient's mobilization was also good. No signs of infection were found, and the pain was still within normal threshold. In conclusion, simple orchiectomy provides histopathological diagnosis and resolution of symptoms. Keywords: fibrolipoma; scrotum; benign tumor, orchiectomy
Copyright (c) 2025 Brian Sugito, Priscilia Kalitouw, Ferry Kalitouw https://creativecommons.org/licenses/by-nc/4.0
Radical Parotidectomy and Neck Dissection on Carcinoma Parotid Dextra with Lymph Node Bilateral Metastasis: A Case Report
Abstract: Malignant salivary gland is a rare gland tumor, with parotid gland as the most common site. Parotidectomy for parotid gland malignancy includes management of primary salivary cancer, metastatic lymph nodes, and direct extension from surrounding structures or cutaneous malignancies. We reported a 66-year-old male referred to the hospital because of a lump at the bottom of the right ear three months ago. The lump got more significant day by day and suddenly it felt progressively enlarged. The patient complained of pain in the lump. The tumor size was 10x4 cm, immobile, fixed to underlying tissue, and had the same color as the surrounding skin. Ultrasonography showed lymphadenopathy at the right side of neck with multiple malignant node metastasis. Therefore, a radical parotidectomy was performed on this patient. The histopathological examination obtained squamous cell carcinoma identified as keratinized. After the surgery, the patient complained of right facial weakness. The patient then underwent medical rehabilitation for further treatment of his facial weakness. In conclusion, the malignancy of the parotid gland was uncommon, hosting the majority of all salivary gland tumors are benign. Successful management depends on prompt diagnosis, accurate histopathological evaluation, and a comprehensive multidisciplinary approach to develop optimal treatment plans. Keywords: malignancy of parotid gland; radical parotidectomy; neck dissection
Copyright (c) 2025 Nico Lumintang, Sherly Tandililing, Elisse S. Susilo https://creativecommons.org/licenses/by-nc/4.0
Profil Kasus Abses Leher Dalam dengan Diabetes Melitus
Abstract: Deep neck abscess (DNA) is a collection of pus in the deep neck space due to deep neck infection, this disease has rapid disease progression. In patients with diabetes mellitus (DM), there is a decrease in immune response, therefore, they are susceptible to infection. This study aimed to obtain the profile of DNA in patients with DM. This was a systematic literature review using the PICOS framework selection criteria. The results showed that based on the 10 literatures, the majoruty of patients were male, and the most frequent age groups were 44-60 years and 60-75 years. Tonsil infections, poor oral-hygiene, and odontogenic infection could increase the risk of having DNA. The most common pathogen to be found was Klebsiella pneumoniae. Patients with DM tended to have a longer length of stay compared to the patients who did not suffer from DM. In conclusion, deep neck abscess patients with DM tend to be found in males with older ages. The most commmon etiology and pathogen is odontogenic infection and Klebsiella pneumoniae. Diabetic patients with deep neck abscess tend to have longer length of stay compared to those without diabetes mellitus. Keywords: deep neck abscess; diabetes mellitus; Klebsiella pneumoniae Abstrak: Abses leher dalam (deep neck abscess/DNA) merupakan penumpukan pus di ruang leher dalam akibat infeksi leher dalam, yang memiliki progresivitas penyakit yang cepat. Pada pasien diabetes melitus (DM) terjadi penurunan respon imun sehingga pasien DM rentan terhadap infeksi. Penelitian ini bertujuan untuk memaparkan profil kasus DNA dengan DM. Jenis penelitian ialah systematic literature review dengan kriteria seleksi PICOS framework. Hasil penelitian mendapatkan 10 literatur. Mayoritas pasien DNA ialah ialah laki-laki, dan rentang usia 44-60 dan 60-75 tahun. Infeksi tonsil, kebersihan oral yang buruk, dan infeksi odontogenik dapat meningkatkan risiko DNA. Patogen yang sering menjadi penyebab infeksi ialah Klebsiella pneumoniae. Pasien DNA dengan DM cenderung memiliki waktu lama rawat inap yang lebih lama dibandingkan dengan pasien DNA yang tidak memiliki DM. Simpulan penelitian ini ialah pasien abses leher dalam dengan diabetes cenderung ditemukan pada jenis kelamin laki-laki dengan usia yang lebih tua. Etiologi dan patogen yang sering ditemukan ialah infeksi odontogenik dan Klebsiella pneumonie. Pasien abses leher dalam dengan diabetes cenderung memiliki waktu lama rawat inap yang lebih panjang dibandingkan dengan yang tanpa diabetes. Kata kunci: abses leher dalam; diabetes melitus; Klebsiella pneumonie
Copyright (c) 2025 Sontiar P. Mawar, Rizki R. Najoan, Steward K. Mengko https://creativecommons.org/licenses/by-nc/4.0
Efektivitas Suplementasi Vitamin C Terhadap Penurunan Kadar Il-6 Serum dan Aktivitas Penyakit Pasien Lupus Eritematosus Sistemik
Abstract: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease and its activity is related to interleukin-6 (IL-6) level. Lowering IL-6 levels can help to achieve remission. Vitamin C has antioxidant and immunomodulatory properties that have the potential to lower IL-6 level. However, research on vitamin C in SLE patients, especially in Indonesia, is still very limited. This study aimed to determine the effectiveness of vitamin C supplementation in reducing serum IL-6 levels and disease activity in SLE patients. This was a double-blind randomized controlled trial conducted on 34 patients with mild–moderate SLE at Dr. Mohammad Hoesin General Hospital. Subjects were divided into two groups namely intervention (vitamin C 2 x 500 mg/day) and control (placebo) groups, for eight weeks. Serum IL-6 levels and disease activity scores (Mex-SLEDAI) were measured before and after the intervention. The results showed that the vitamin C group had a significant decrease in serum IL-6 levels compared to placebo group, from a median of 6.46 (3.5–14.4) to 3.5 (3.5–8.36) pg/mL (p=0.001), while in the placebo group decreased from 3.7 (3.5–6.45) to 3.9 (3.5–14) pg/mL (p=0.136). The decrease in Mex-SLEDAI scores was statistically more significant in the vitamin C group compared to the placebo group (p=0.048). In conclusion, vitamin C 2x500 mg/day supplementation for eight weeks effectively reduces serum IL-6 levels and disease activity in mild–moderate SLE patients. Keywords: systemic lupus erythematosus; MEX-SLEDAI; vitamin C supplementation; interleukin 6 Abstrak: Lupus eritematosus sistemik (LES) merupakan penyakit autoimun kronik yang derajat aktivitasnya berkaitan dengan kadar interleukin-6 (IL-6). Penurunan kadar IL-6 dapat membantu dalam mencapai remisi. Vitamin C memiliki sifat antioksidan dan imunomodulator yang berpotensi menurunkan kadar IL-6, namun, penelitian mengenai vitamin C pada pasien LES khususnya di Indonesia masih sangat terbatas. Penelitian ini bertujuan untuk mengetahui efektivitas suplementasi vitamin C terhadap penurunan kadar IL-6 serum dan aktivitas penyakit pada pasien LES. Penelitian ini menggunakan uji klinis acak tersamar ganda dilakukan pada 34 pasien LES derajat ringan–sedang di RSUP Dr. Mohammad Hoesin. Subjek dibagi menjadi dua kelompok: intervensi (vitamin C 2x500 mg/hari) dan kontrol (plasebo), selama delapan minggu. Kadar IL-6 serum dan skor aktivitas penyakit (Mex-SLEDAI) diukur sebelum dan sesudah intervensi. Hasil penelitian mendapatkan bahwa kelompok vitamin C menunjukkan penurunan bermakna kadar IL-6 serum dibandingkan placebo dari median 6,46 (3,5–14,4) menjadi 3,5 (3,5–8,36) pg/mL (p=0,001), sedangkan kelompok plasebo dari 3,7 (3,5–6,45) menjadi 3,9 (3,5–14) pg/mL (p=0,136). Penurunan skor Mex-SLEDAI secara statistik lebih bermakna pada kelompok vitamin C dibandingkan plasebo (p=0,048). Simpulan penelitian ini ialah suplementasi vitamin C 2x500 mg/hari selama delapan minggu efektif menurunkan kadar IL-6 serum dan aktivitas penyakit lupus eritematosus sistemik derajat ringan–sedang. Kata kunci: lupus eritematosus sistemik; Mex-SLEDAI; suplementasi vitamin C; interleukin 6
Copyright (c) 2025 Ady F. Saragih, Nova Kurniati, Theodorus Theodorus, Eddy M. Salim, Yuniza Yuniza https://creativecommons.org/licenses/by-nc/4.0
Faktor Risiko Diare Akut pada Bayi Usia 0-12 Bulan di RSUP Prof. Dr. R. D. Kandou
Abstract: Acute diarrhea is a condition of defecation with stool consistency decreasing from loose to liquid three or more times a day, without mucus and blood, with a duration of less than seven days and not more than 14 days. Risk factors for acute diarrhea include low birth weight (LBW), maternal age at delivery, nutritional status, breastfeeding history, and previous antibiotic use. This study aimed to determine risk factors associated with the occurrence of acute diarrhea in infants at Prof. Dr. R. D. Kandou Hospital. This was an observational and analytic study with a cross sectional design. Data were obtained using the medical record data. Total sampling was used for acute diarrhea cases and exclusive sampling for acute diarrhea controls. Data were analyzed with chi-square test and binary logistic regression test with computerized assistance. The results showed that there was a significant relationship between previous antibiotic use and the incidence of acute diarrhea (p=0.034), meanwhile there was no significant relationship between LBW (p=0.440), maternal age at delivery (p=0.801), nutritional status (p=0.799), and breastfeeding history (p=0.404) to the incidence of acute diarrhea. In conclusion, previous antibiotic use can increase the risk of acute diarrhea in infants aged 0-12 months at Prof. Dr. R. D. Kandou Hospital. Keywords: acute diarrhea; low birth weight; maternal age at delivery; nutritional status; breastfeeding history; previous antibiotic use Abstrak: Diare akut adalah kondisi buang air besar dengan konsistensi tinja menurun dari melembek sampai menjadi cair sebanyak tiga kali atau lebih dalam sehari, tanpa disertai lendir dan darah, dengan durasi kurang dari 7 hari dan tidak lebih dari 14 hari. Faktor risiko dari diare akut termasuk berat badan lahir rendah (BBLR), usia ibu saat melahirkan, status gizi, riwayat pemberian air susu ibu (ASI), dan penggunaan antibiotik sebelumnya. Penelitian ini bertujuan untuk mengetahui faktor risiko yang berhubungan dengan terjadinya diare akut pada bayi di RSUP Prof. Dr. R. D. Kandou. Penelitian ini menggunakan metode analitik observasional dengan desain potong lintang. Data diperoleh melalui data rekam medis dengan penentuan sampel total sampling untuk kasus diare akut dan exclusive sampling untuk kontrol diare akut, dan kemudian dianalisis dengan uji statistik chi-square dan uji regresi logistik biner. Hasil uji statistik menunjukkan terdapat hubungan bermakna antara penggunaan antibiotik sebelumnya dengan kejadian diare akut (p=0,034), dan tidak terdapat hubungan bermakna antara BBLR (p=0,440), usia ibu saat melahirkan (p=0,801), status gizi (p=0,799), dan riwayat pemberian ASI (p=0,404) terhadap kejadian diare akut. Simpulan penelitian ini ialah penggunaan antibiotik sebelumnya dapat meningkatkan risiko kejadian diare akut pada bayi usia 0-12 bulan di RSUP Prof. Dr. R. D. Kandou. Kata kunci: diare akut; berat badan lahir rendah; usia ibu saat melahirkan; status gizi; riwayat ASI; penggunaan antibiotik sebelumnya
Copyright (c) 2025 Felix Natanael, Jeanette I. C. Manoppo, Rocky Wilar https://creativecommons.org/licenses/by-nc/4.0
Congenital Chylous Ascites Associated with Polycystic Kidney Disease: A Case Report
Abstract: Congenital chylous ascites is a rare condition caused by abnormalities in the lymphatic system, leading to the leakage of triglyceride-rich lymphatic fluid into the peritoneal cavity. The etiologies include congenital lymphatic malformations, lymphatic obstruction, or increased intra-abdominal pressure. Polycystic kidney disease (PKD) is suspected to impair lymphatic drainage due to elevated intra-abdominal pressure, causing chylous fluid accumulation.. We reported a 16-day-old female neonate born via cesarean section at 38 weeks of gestation due to hydrops fetalis. The infant presented with progressive abdominal distension. Abdominal ultrasound revealed massive ascites, a cystic mass in the left adnexa, and bilateral polycystic kidneys, suggesting secondary lymphatic obstruction. Babygram imaging confirmed significant abdominal distension without intestinal obstruction or skeletal anomalies. Ascitic fluid analysis confirmed its chylous nature, with no signs of malignancy or active infection. Laboratory tests revealed mild anemia, hypoalbuminemia, and elevated inflammatory markers.The underlying pathophysiology in this case suggests that PKD led to secondary lymphatic obstruction due to increased intra-abdominal pressure. The patient underwent ascites drainage using a pigtail catheter, fluid and electrolyte management, analgesics, and antibiotics. After 10 days post-intervention, the infant's condition showed gradual improvement, with reduced abdominal distention, stable respiratory function, and no signs of infection or further complications. In conclusion, congenital chylous ascites in neonates may be secondary to conditions like PKD, which cause lymphatic drainage impairment. Early diagnosis and comprehensive management are essential to prevent long-term complications and optimize outcomes in affected neonates. Keywords: congenital chylous ascites; polycystic kidney disease; neonate; lymphatic obstruction; ascitic fluid analysis
Copyright (c) 2025 Candy Candy, Harsali F. Lampus, Odwin B. Saumur https://creativecommons.org/licenses/by-nc/4.0
Cranioplasty after 25 Years of Implant Rejection
Abstract: Cranioplasty is a common neurosurgical procedure performed to reconstruct cranial defects. Failure of cranioplasty may be early or delayed and further can be attributed to the surgical procedure itself or to the reconstruction material used for the procedure. We reported a 54-year-old man came to the clinic with wound and defect in his scalp. He had previous craniectomy 25 years ago due to an accident that caused a head injury. The size of the wound was 10 x 10 cm with granulation tissue at the base of the wound. There was no discharge at the site of the wound. In physical examination, vital sign was normal, laboratory examination showed slight leukocytosis. Cranioplasty surgery was performed to reconstruct the scalp defect. Implant failure was found characterized by pain at the implant site, erythema, and fever. Therefore, cranioplasty implant rejection was diagnosed. Reconstructive cranioplasty with titanium mesh was done a week later. Thirty years ago, PMMA maybe the most available biomaterial, however, disadvantages may occur such as infections, extrusion, decomposition, fracture of implant in larger defect, and lack of integration to the bone. Spontaneous implementation of the biomaterials leads to CIR, and without proper resolution under two weeks it leads to a foreign body response (FBR) and chronic inflammation. Hence in this study, the use of titanium mesh can overcome those disadvantages, with lower risk of infection, non-corrosive, non-inflammatory, good cosmetic results and great potential of osseointegration. In conclusion, materials in cranioplasty should be considered and follow up regularly and well. Cranioplasty implant rejection was a known complication risk that can leads to chronic inflammation. Associated symptoms including pain, erythema and fever. Using synthetic implants with non-inflammatory and great osseointegration characteristics can lead to great results as shown in this case. Keywords: cranioplasty; implant; rejection
Copyright (c) 2025 Dennis M. Frederik, Mendy J. Hatibie, Stevy C. Suoth, Eko Prasetyo, Maximillian C. Oley , Ferdinan Tjungkagi, Yovanka N. Manuhutu https://creativecommons.org/licenses/by-nc/4.0
Correlation between Arterial Feeding Embolization and Pleural Effusion Dynamics in Breast Cancer Patients
Abstract: Breast cancer is the most common malignancy in women and a leading cause of malignant pleural effusion (MPE). Arterial feeding embolization, as performed in transarterial chemo-embolization (TACE), has the potential to reduce effusion production by obstructing tumor blood supply. This study aimed to evaluate the correlation between arterial embolization and pleural effusion dynamics in patients with breast cancer. This was a prospective cohort study conducted at Prof. Dr. R. D. Kandou Hospital, Manado, from 2022 to 2024. Patients diagnosed with breast cancer were randomly assigned to the TACE or control group. Superselective embolization was performed using a microcatheter and a selected embolic agent to occlude the blood supply to the target lesion. Data were analyzed using SPSS v26 with Shapiro-Wilk normality test, t-test or Mann-Whitney U test, and linear regression. Study phases included subject selection, randomization, and data analysis. The results showed that a total of 21 female patients with breast cancer (mean age 52.19±9.17 years) were enrolled. Eleven patients (52.4%) underwent TACE, while ten (47.6%) did not. Pleural effusion was observed in four patients (19%), more frequently in the non-TACE group (30%) compared to the TACE group (9.1%), though the difference was not statistically significant (p=0.439). Multivariate analysis also revealed no significant association between arterial embolization and pleural effusion (p=0.244; R²=0.071), indicating a low predictive value. Arterial feeding embolization via TACE demonstrated clinical potential in reducing pleural effusion among breast cancer patients, although the results were not statistically significant. The limited efficacy may be attributed to the complex tumor vascularization and heterogeneous biological responses. A multimodal therapeutic approach remains necessary for optimal MPE management. In conclusion, although arterial embolization may clinically reduce tumor perfusion and subsequent effusion formation, this study found no significant correlation between the procedure and pleural effusion reduction. Therefore, arterial embolization alone may not be sufficient as a standalone treatment strategy for managing MPE in breast cancer patients. Keywords: breast cancer; malignant pleural effusion; transarterial chemoembolization
Copyright (c) 2025 Edward Iskandar, Adrian Tangkilisan, Wega Sukanto https://creativecommons.org/licenses/by-nc/4.0
Prediksi Apendisitis dengan Komplikasi Menggunakan Systemic Inflammation Response Index dan Systemic Immune-Inflamation Index
Abstract: This study aimed to predict complications in appendicitis using the Systemic Inflammation Response Index (SIRI) and Systemic Immune-Inflammation Index (SII) values. This was a hospital-based retrospective study. Patients in this study were those who entered the Emergency Room of Daha Sejahtera Hospital, Hulu Sungai Selatan Regency, South Kalimantan, with a diagnosis of appendicitis, and underwent appendectomy by a general surgeon between September 2024 - April 2025. Data were presented in groups of appendicitis with and without complications based on intraoperative characteristics. The results showed that 14 patients met the inclusion criteria. Mean SIRI level in appendicitis with complications was significantly higher than without complications [6.15 (4.96, 7.17) vs 1.44 (0.78, 1.88), p=0.000]. Similiarly, SII level in complicated appendicitis was also significantly higher than in uncomplicated appendicitis [3269.04 (1894.05, 5550.38) vs 649.30 (408.63, 1004.67), p=0.011]. The ability of SIRI in predicting complications was higher than SII, leukocytes, and neutrophils (area under the curve 0.855). In conclusion, SIRI and SII can be used in predicting the presence of complicated appendicitis. Keywords: appendicitis; diagnosis; SII; SIRI Abstrak: Penelitian ini bertujuan untuk memrediksi adanya komplikasi pada apendisitis dengan menggunakan nilai Systemic Inflammation Response Index (SIRI) dan Systemic Immune-Inflammation Index (SII). Penelitian ini menggunakan metode retrospektif berbasis rumah sakit. Pasien dalam penelitian ini yakni yang masuk ke IGD RSUD Daha Sejahtera, Kabupaten Hulu Sungai Selatan, Kalimantan Selatan, dengan diagnosis apendisitis, dan menjalani operasi apendektomi oleh dokter bedah umum antara September 2024 – April 2025. Data disajikan dalam kelompok appendisitis dengan dan tanpa komplikasi berdasarkan temuan intra operasi. Hasil penelitian mendapatkan 14 pasien yang memenuhi kriteria inklusi. Nilai rerata SIRI pada apendisitis dengan komplikasi lebih tinggi secara bermakna dibanding dengan tanpa komplikasi [6,15 (4,96, 7,17) vs 1,44 (0,78, 1,88), p=0,000]. Pada SII nilai rerata pada apendisitis dengan komplikasi juga lebih tinggi secara bermakna dibanding pada apendisitis tanpa komplikasi [3269,04 (1894,05, 5550,38) vs 649,30 (408,63, 1004,67), p=0,011]. Kemampuan SIRI dalam mengindikasikan komplikasi lebih tinggi dibandingkan SII, leukosit, dan neutrofil (area under the curve 0,855). Simpulan penelitian ini ialah SIRI dan SII dapat digunakan dalam memrediksi adanya apendisitis dengan komplikasi. Kata kunci: apendisitis; diagnosis; SII; SIRI
Copyright (c) 2025 Enika N. C. Tilaar https://creativecommons.org/licenses/by-nc/4.0
In Vitro Antibacterial Effectiveness of Stingless Bee Propolis against Infected Breast Cancer Ulcer
Abstract: Breast cancer is the most common cancer in women and often presents with malignant ulcers prone to infection. These wounds are difficult to manage, especially during chemotherapy, due to polymicrobial colonization and rising antibiotic resistance. Stingless bee propolis, rich in bioactive flavonoids, has shown promising antibacterial properties. This study aimed to evaluate in vitro antibacterial effectiveness of stingless bee propolis against bacteria from breast cancer ulcers. This was an in vitro study conducted at the Poltekkes Kemenkes Manado Medical Laboratory (July 2024–January 2025). Methanol-extracted stingless bee propolis was tested against MRSA and P. aeruginosa using disc diffusion, MIC, and MBC methods. Antibacterial activity was evaluated through inhibition zones and bacterial growth in serial dilutions. The outcomes were analyzed based on inhibition zone diameters and bacterial growth in serial dilutions. The results showed that propolis extract demonstrated antibacterial activity against MRSA and P. aeruginosa, with inhibition zones observed in both disc diffusion and dilution methods. Strong inhibition was noted at concentrations ≥80%, while minimal or no effect occurred below 30%. MIC and MBC were estimated at around 20%. Statistical analysis confirmed a significant dose-response relationship (ANOVA, p 0.0003), with stronger correlation in MRSA (R=0.84; p<0.001) than P. aeruginosa (R=–0.09; p 0.046). The minimum effective concentration was estimated at 32% for MRSA and 37% for P. aeruginosa. In conclusion, stingless bee propolis demonstrated concentration-dependent antibacterial activity against both Gram-positive (MRSA) and Gram-negative (P. aeruginosa) bacteria in vitro, with increased activity observed at higher concentrations. Minimum effective concentrations were 32% for MRSA and 37% for P. aeruginosa, supporting its potential use in treating infected breast cancer ulcers. These findings highlight propolis as a potential natural alternative for infection control and wound healing. Keywords: breast cancer; ulcer; stingless bee; propolis; antibacterial effect
Copyright (c) 2025 Christian Manginstar, Marselus Merung, Albert Albert https://creativecommons.org/licenses/by-nc/4.0
Faktor-faktor yang Memengaruhi Fungsi Anus setelah Prosedur PSARP pada Pasien Malformasi Anorektal
Abstract: In anorectal malformations (ARM), posterior sagittal anorectoplasty (PSARP) procedure is the standard management, however, the anorectal functional outcomes vary. This study aimed to assess the factors affecting anorectal function after the PSARP procedure using the Rintala score. This was a retrospective cohort study of 29 ARM patients who underwent PSARP at Prof. Dr. R. D. Kandou Hospital Manado during the 2019–2022 period. Medical records and patient follow-up data were analyzed using the chi-square test and linear regression. The results showed that of the 29 patients (13 males, 16 females), 86.2% underwent staged repair, while the rest had one-stage repair. The mean Rintala score was 14.59±4.17; 24.1% had normal function, 62.1% good, 6.9% fair, and 6.9% poor. Adequate bowel management was performed in all patients. Surgical wound infection was found in one patient (3.4%). Re-do PSARP was performed in four patients (13.8%). There were no cases of malnutrition or musculoskeletal abnormalities. Syndromic diseases were found in three patients (10.3%). Multivariate analysis showed that no variables were significantly associated with the Rintala score (p>0.05). In conclusion, the majority of patients have good–normal anal function after PSARP. There is no significant relationship between bowel management, surgical wound infection, redo PSARP, malnutrition, musculoskeletal abnormalities, or syndromic diseases and anal function. Continuous bowel management education remains important for long-term outcomes. Keywords: anorectal malformation; PSARP; anal function; Rintala score Abstrak: Pada malformasi anorektal (MAR), prosedur posterior sagittal anorectoplasty (PSARP) merupakan standar tatalaksana, namun luaran fungsi anus bervariasi. Penelitian ini bertujuan untuk menilai faktor-faktor yang memengaruhi fungsi anus setelah prosedur PSARP menggunakan skor Rintala. Jenis penelitian ialah kohort retrospektif terhadap 29 pasien MAR yang menjalani PSARP di RSUP Prof. Dr. R. D. Kandou Manado periode 2019–2022. Data rekam medis dan follow-up pasien dianalisis menggunakan uji chi-square dan regresi linear. Hasil penelitian mendapatkan dari 29 pasien (13 laki-laki, 16 perempuan), 86,2% menjalani staged repair, sisanya one stage repair. Skor Rintala rerata 14,59±4,17; 24,1% fungsi normal, 62,1% baik, 6,9% cukup, dan 6,9% buruk. Businasi adekuat dilakukan pada seluruh pasien. Infeksi luka operasi ditemukan pada satu pasien (3,4%). Re-do PSARP dilakukan pada empat pasien (13,8%). Tidak terdapat kasus malnutrisi maupun kelainan muskuloskeletal. Penyakit sindromik penyerta ditemukan pada tiga pasien (10,3%). Analisis multivariat menunjukkan tidak terdapat variabel yang berhubungan bermakna dengan skor Rintala (p>0,05). Simpulan penelitian ini ialah mayoritas pasien memiliki fungsi anus baik–normal pasca-PSARP. Tidak terdapat hubungan bermakna faktor businasi, infeksi luka operasi, re-do PSARP, malnutrisi, kelainan muskuloskeletal, maupun penyakit sindromik terhadap fungsi anus. Edukasi businasi berkelanjutan tetap penting untuk luaran jangka panjang. Kata kunci: malformasi anorektal; PSARP; fungsi anus; skor Rintala
Copyright (c) 2025 Vincent Suryoprabowo, Harsali F. Lampus, Leo Rendy https://creativecommons.org/licenses/by-nc/4.0
Implementasi Critical Care Outreach Team (CCOT) di Rumah Sakit Sentra Medika Minahasa Utara
Abstract: Clinical deterioration among hospitalized patients often occurs suddenly and can be prevented through early identification and timely intervention. The Critical Care Outreach Team (CCOT), as part of the Rapid Response System (RRS), is designed to detect and manage clinical deterioration before patients require admission to the Intensive Care Unit (ICU). This study aimed to describe the implementation of CCOT at Sentra Medika Hospital, North Minahasa, during the period from August 2024 to August 2025. A descriptive observational design was employed, with the researcher acting as a non-participant observer. Data collected included patient demographics, Early Warning Score (EWS) at admission and discharge, and the effectiveness of CCOT interventions based on patient stability, ICU readmission, code blue events, and mortality. Among 136 monitored patients, the highest proportion (30.8%) were aged 56–65 years and presented with moderate to high EWS upon admission. Following CCOT intervention, the average EWS decreased from 5.9 to 4.5. A total of 94.1% of patients remained stable in the ward, 3.7% were readmitted to the ICU, 1.5% experienced code blue events, and 0.7% died. In conclusion, the implementation of CCOT at this hospital has proven effective in the early detection of clinical deterioration and timely intervention, contributing to improved patient safety and service efficiency. Keywords: Early Warning Score (EWS); Rapid Response System (RRS); Critical Care Outreach Team (CCOT); clinical deterioration; early intervention Abstrak: Kemunduran kondisi pasien rawat inap sering kali terjadi secara tiba-tiba dan dapat dicegah melalui identifikasi dini serta intervensi cepat. Critical Care Outreach Team (CCOT) merupakan bagian dari sistem Rapid Response System (RRS) yang bertujuan mendeteksi dan menangani kemunduran kondisi sebelum pasien membutuhkan perawatan di Intensive Care Unit (ICU). Penelitian ini bertujuan untuk memberikan gambaran implementasi CCOT di Rumah Sakit Sentra Medika Minahasa Utara selama periode Agustus 2024 hingga Agustus 2025. Metode penelitian menggunakan desain deskriptif observasional. Peneliti berperan sebagai pengamat yang mencatat data demografis pasien, skor Early Warning Score (EWS) saat masuk dan keluar, serta efektivitas intervensi CCOT berdasarkan stabilitas pasien, kebutuhan masuk ICU ulang, kejadian code blue, dan kematian. Hasil penelitian mendapatkan dari 136 pasien yang dipantau, persentase tertinggi 30,8% di usia 56-65 tahun dan memiliki skor EWS sedang hingga tinggi saat masuk. Setelah intervensi CCOT, terjadi penurunan skor EWS rerata dari 5,9 menjadi 4,5. Sebanyak 94,1% pasien tetap stabil di bangsal, 3,7% kembali ke ICU, 1,5% mengalami code blue, dan 0,7% meninggal. Simpulan penelitian ini ialah implementasi CCOT di rumah sakit ini telah berjalan dengan baik dalam mendeteksi dini kemunduran kondisi pasien dan memberikan intervensi yang tepat waktu, sehingga meningkatkan keselamatan dan efisiensi pelayanan. Kata kunci: Early Warning Score; Rapid Response System; Critical Care Outreach Team (CCOT); kemunduran kondisi; intervensi dini
Copyright (c) 2025 Monica C. Watuna, Eka Y. Lantang https://creativecommons.org/licenses/by-nc/4.0
Partial Intestinal Obstruction Caused by Left Diaphragmatic Hernia: A Case Report
Abstract: Diaphragmatic hernia in adults is a rare but potentially serious condition that often presents with non-specific gastrointestinal and respiratory symptoms. This case highlights a left-sided diaphragmatic hernia complicated by partial intestinal obstruction. We reported a 54-year-old male presented with a one-week history of progressive abdominal bloating and intermittent abdominal pain, accompanied by nausea but no vomiting or fever. Bowel movements and flatus were present. In examination, he was hemodynamically stable with abdominal distension and positive bowel sounds. Nasogastric tube drainage produced greenish fluid. Digital rectal examination showed normal stool without blood or mucus. Chest X-ray suggested a left diaphragmatic hernia, and abdominal X-ray revealed partial bowel obstruction without signs of pneumoperitoneum. Laboratory findings were within normal limits, except for mild hypokalemia (K⁺ 3.3 mmol/L). A diagnosis of partial mechanical intestinal obstruction due to a left diaphragmatic hernia was made. The patient underwent an urgent non-contrast abdominal CT followed by combined laparotomy and thoracotomy. Intraoperatively, a diaphragmatic defect (3×3 cm and 10×10 cm) with adhesions between the left lung and diaphragm was identified. Adhesiolysis was performed, and the defect was repaired using non-absorbable sutures, followed by diaphragmatic plication and chest tube insertion. In conclusion, this case underscores the importance of including diaphragmatic hernia in the differential diagnosis of adult patients with persistent abdominal symptoms. Timely imaging and a multidisciplinary surgical approach enabled resolution of obstruction and definitive repair, preventing serious complications. In conclusion, early recognition and appropriate surgical management are key to optimizing outcomes in adult diaphragmatic hernia with bowel involvement. Keywords: diaphragmatic hernia; intestinal obstruction
Copyright (c) 2026 Audi Pirade, Rigel K. Paat, Adrian Tangkilisan https://creativecommons.org/licenses/by-nc/4.0
Dampak Perundungan terhadap Kesehatan Mental Mahasiswa Fakultas Kedokteran
Abstract: Bullying behavior often occurs in learning environments, including medical education with seniors as executor in most cases. Not everyone has the psychological defense to deal with bullying. Therefore, bullying can cause impacts that not only affect the victims’ psychology but also their performance in the future. This study aimed to obtain bullying behavior among medical students and its impacts on the medical students. This was a systematic review study using databases of Google Scholar, Pubmed, and Clincal Key. The literatures used to be in Indonesian or English, published in last five years. The results obtained nine articles from several countries. Bullying still occurred in medical environments. Moreover, bullying could cause depression, anxiety, and other mental disorders to their victims. The lack of reported cases supported the large number of cases of bullying in the medical environment. In conclusion, bullying is still common in medical environment, and causes decreased academic prestation and many mental disorders. Keywords: bullying; mental impacts; medical students Abstrak: Perilaku perundungan sering terjadi di lingkungan pembelajaran, termasuk pembelajaran kedokteran dengan para senior sebagai pelaku di kebanyakan kasus. Tidak semua individu memiliki pertahanan psikologis untuk menghadapi perundungan. Perundungan menyebabkan dampak yang tidak hanya berdampak bagi psikologis korban tetapi juga bagi kinerja korban di masa depan. Penelitian ini bertujuan untuk mengevaluasi perundungan di kalangan mahasiswa kedokteran serta dampaknya bagi korban perundungan. Jenis penelitian ialah systematic literature review dengan menggunakan database Google Scholar, Pubmed, dan Clinical Key. Literatur yang digunakan menggunakan bahasa Indonesia dan bahasa Inggris, yang diterbitkan dalam lima tahun terakhir. Hasil penelitian mendapatkan sembilan artikel dari berbagai negara. Perundungan masih sering terjadi di lingkungan kedokteran. Perundungan menyebabkan depresi, kecemasan, dan gangguan mental bagi para korban. Kurangnya tingkat pelaporan mendukung tingginya angka perundungan di lingkungan kedokteran. Simpulan penelitian ini ialah perundungan di lingkungan kedokteran masih banyak ditemukan dan menyebabkan penurunan prestasi akademik dan berbagai gangguan mental. Kata kunci: perundungan; dampak mental; mahasiswa kedokteran
Copyright (c) 2026 Brainly M. H. Tatambihe, Anita E. Dundu, Bernabas H. R. Kairupan https://creativecommons.org/licenses/by-nc/4.0
Clinical Characteristics and Outcomes of Pancreaticoduodenectomy (Whipple Procedure) in the Last Five Years at Prof. Dr. R. D. Kandou Hospital
Abstract: Pancreatoduodenectomy (Whipple) is the standard procedure for resectable pancreatic and periampullary neoplasms. Although techniques and postoperative care continue to evolve, this procedure is still associated with high morbidity and significant complications, such as pancreatic fistula and delayed gastric emptying. It is most commonly performed on elderly patients with pancreatic adenocarcinoma and requires ongoing evaluation to improve outcomes. A five-year review is necessary to assess trends, complications, and postoperative outcomes as a basis for improving the quality of surgical management. This was a retrospective descriptive analysis of adult patients who underwent pancreatoduodenectomy at Prof. Dr. R. D. Kandou Hospital between 2020 and 2025. The inclusion criteria were patients with complete medical records, including demographic data, surgical indications, surgical outcomes, and postoperative complications. Cases with incomplete data, surgeries performed outside the study period, or patients who died before postoperative evaluation were excluded. Univariate analysis was performed using SPSS version 30 to describe clinical characteristics and patient outcomes. Of the 35 patients, the distribution of gender and diagnosis (icteric vs. non-icteric obstruction) was relatively balanced. Most underwent a single Whipple procedure (65.7%) using the duct-to-mucosa anastomosis technique (80%). Postoperative complications occurred in 57.1% of patients, and 30-day mortality was 34.3%. The mean age of patients was 55.6 years, the duration of surgery was 370 minutes, the blood loss was 568 cc, and the length of hospital stay was 9.8 days. In conclusion, the Whipple procedure demonstrates variable outcomes with high morbidity and a 30-day mortality rate of 34.3%. End-to-side anastomosis is the most commonly used technique. Age, case complexity, and operative variability influence patient recovery and prognosis. Keywords: pancreatoduodenectomy; pancreatic neoplasm
Copyright (c) 2026 Michael Tendean, Ferdinand Tjandra, Toar Mambu, Marven Ayawaila, Eric Sihaloho https://creativecommons.org/licenses/by-nc/4.0
Profil Kasus Kematian Mendadak di RSUP Prof. Dr. R. D. Kandou Manado pada Tahun 2022-2024
Abstract: Although sudden natural unexpected death is still common in Indonesia, data on sudden natural unexpected death are very limited. This study aimed to determine the profile of sudden natural unexpected death cases at Prof. Dr. R. D. Kandou Manado General Hospital in 2022-2024. This was a retrospective and descriptive study with a cross-sectional design, using secondary data from the medical records of Prof. Dr. R. D. Kandou Manado General Hospital. The results showed that between 2022 and 2024, there were 878 cases of sudden natural unexpected death at Prof. Dr. R. D. Kandou General Hospital in Manado that met the inclusion criteria. Year 2023 had the highest number of cases (331 cases). The highest number of cases was male, with 516 cases. Adults were the largest age group, with 420 cases, and most sudden natural unexpected deaths were caused by respiratory disorders or abnormalities, with 411 cases. In conclusion, the majority of sudden natural unexpected death cases at Prof. Dr. R. D. Kandou Manado General Hospital during 2022-2024 were males, within the adult age group, and had respiratory system disorders as the most common cause. Keywords: death; sudden natural unexpected death; cause of death Abstrak: Kematian mendadak masih banyak terjadi di Indonesia akan tetapi data mengenai kematian mendadak masih sangat terbatas. Penelitian ini bertujuan untuk mengetahui profil kasus kematian mendadak di RSUP Prof. Dr. R.D. Kandou Manado pada tahun 2022-2024. Metode penelitian yang digunakan ialah deskriptif retrospektif dengan desain potong lintang dan menggunakan data sekunder yang berasal dari rekam medis RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian mendapatkan 878 kasus kematian mendadak di RSUP Prof. Dr. R. D. Kandou Manado pada tahun 2022 sampai tahun 2024 yang memenuhi kriteria inklusi. Tahun 2023 merupakan tahun terbanyak dengan jumlah 331 kasus. Jenis kelamin terbanyak merupakan jenis kelamin laki-laki dengan jumlah 516 kasus. Kelompok usia dewasa merupakan kelompok usia terbanyak dengan jumlah 420 kasus, dan kematian mendadak paling banyak disebabkan oleh gangguan atau kelainan dari sistem respirasi dengan 411 kasus. Simpulan penelitian ini ialah jumlah kasus kematian mendadak di RSUP Prof. Dr. R. D. Kandou Manado selama tahun 2022-2024 terbanyak terjadi pada jenis kelamin laki-laki, kelompok usia dewasa, dan dengan penyebab oleh gangguan atau kelainan sistem respirasi. Kata kunci: kematian; kematian mendadak; penyebab kematian
Copyright (c) 2026 Yohana D. E. Tindaon, Erwin G. Kristanto, James F. Siwu https://creativecommons.org/licenses/by-nc/4.0
Perbandingan Luaran Open Surgical Repair dan Endovascular Aneurysm Repair pada Pasien Aneurisma Aorta Abdominalis di Asia
Abstract: Abdominal aortic aneurysm (AAA) is a pathological dilation of the aorta that carries a risk of rupture and high mortality. Two methods of AAA management are Open Surgical Repair (OSR) and Endovascular Aneurysm Repair (EVAR). However, comparative data on the outcomes of these two methods in Asia is still limited. This study aimed to analyze the comparison of OSR and EVAR outcomes in AAA patients in Asia, including length of hospital stay, mortality, complications, and reintervention. This was a systematic review study using articles searched in the Epistemonikos, PubMed, Sage Journals, and ScienceDirect databases. The results obtained a total of 18 articles that met the inclusion and exclusion criteria based on the PICOS framework were obtained. The analysis was performed descriptively on postoperative outcome data. EVAR showed a significantly shorter length of hospital stay compared to OSR, but was accompanied by higher rates of reintervention and long-term complications, such as endoleak. Conversely, OSR was superior in terms of long-term durability and stability. The 30-day mortality rates showed inconsistent and statistically insignificant results. In conclusion, EVAR provides better short-term outcomes, while OSR is more reliable for the long term. The choice of method should consider the patient's condition. Keywords: abdominal aortic aneurysm; Open Surgical Repair; Endovascular Aneurysm Repair Abstrak: Aneurisma aorta abdominalis (AAA) merupakan dilatasi patologis aorta yang berisiko ruptur dan menimbulkan mortalitas tinggi. Terdapat dua metode dalam penatalaksanaan AAA yaitu Open Surgical Repair (OSR) dan Endovascular Aneurysm Repair (EVAR), namun, data perbandingan luaran keduanya di Asia masih terbatas. Penelitian ini bertujuan untuk menganalisis perbandingan luaran OSR dan EVAR pada pasien AAA di Asia yang meliputi lama rawat inap, mortalitas, komplikasi, dan reintervensi. Jenis penelitian ialah systematic review dari artikel-artikel yang ditelusuri pada basis data Epistemonikos, PubMed, Sage Journals, dan ScienceDirect. Didapatkan sebanyak 18 artikel yang memenuhi kriteria inklusi dan eksklusi berbasis PICOS framework. Analisis dilakukan secara deskriptif terhadap data luaran pascaoperatif. EVAR menunjukkan lama rawat inap yang lebih singkat secara bermakna dibandingkan OSR, namun disertai angka reintervensi dan komplikasi jangka panjang, seperti endoleak, yang lebih tinggi. Sebaliknya, OSR unggul dalam durabilitas dan stabilitas jangka panjang. Tingkat 30-day mortality menunjukkan hasil yang tidak konsisten dan tidak bermakna secara statistik. Simpulan penelitian ini ialah EVAR memberikan hasil jangka pendek lebih baik, sedangkan OSR lebih andal untuk jangka panjang. Pemilihan metode perlu mempertimbangkan kondisi pasien. Kata kunci: aneurisma aorta abdominalis; Open Surgical Repair; Endovascular Aneurysm Repair
Copyright (c) 2026 Ochta C. Aritonang, Stephanus J. C. Tangel, Andriessanto C. Lengkong https://creativecommons.org/licenses/by-nc/4.0
Identifikasi Pola Bakteri Aerob dan Uji Sensitivitas Antibiotik di Ruang UGD dan Kamar Operasi RSIA Kirana Manado
Abstract: Healthcare-Associated Infections (HAIs) are infections acquired during healthcare delivery, primarily caused by aerobic bacteria. Emergency rooms and operating rooms pose high HAI risks due to vulnerable patients and invasive procedures. This study aimed to determine aerobic bacterial patterns and antibiotic sensitivity in the emergency room and operating room of RSIA Kirana Manado. This was an observational and cross-sectional. There were 24 samples collected from walls, floors, air, medical equipment and non-medical equipment (14 from emergency room, 10 from operating room). Bacterial identification utilized nutrient agar and MacConkey agar culture, Gram staining, catalase test, coagulase test, and biochemical tests. Antibiotic sensitivity testing employed disc diffusion method on Mueller-Hinton agar against 11 antibiotics. The results showed that emergency room samples yielded 14 colonies on nutrient agar with no MacConkey growth. All were Gram-positive: Bacillus sp. (78.6%), Staphylococcus sp. (14.3%), and Streptococcus sp. (7.1%). Operating room samples produced nine colonies: Bacillus sp. (55.6%) and Staphylococcus sp. (44.4%). High sensitivity was observed for sulphamethoxazole/trimethoprim (90.9-100%), ciprofloxacin (90.9-100%), and meropenem (80-90.9%), while high resistance occurred with aztreonam (100%) and cefepime (54.5-60%). In conclusion, three bacterial genera were identified: Bacillus sp., Staphylococcus sp., and Streptococcus sp., showing high sensitivity to sulphamethoxazole/trimethoprim, ciprofloxacin, and meropenem, but resistance to aztreonam and cefepime. Keywords: aerobic bacterial pattern identification; antibiotic sensitivity test; emergency room; operating room Abstrak: Healthcare-Associated Infections (HAIs) merupakan infeksi yang didapat pasien selama perawatan di rumah sakit, terutama disebabkan bakteri aerob. Ruang UGD dan kamar operasi memiliki risiko tinggi HAIs karena pasien rentan dan prosedur invasif. Penelitian inin bertujuan untuk mengetahui pola bakteri aerob dan uji sensitivitas antibiotik di ruang UGD dan kamar operasi RSIA Kirana Manado. Jenis penelitian ialah observasional deskriptif dengan desain potong lintang. Sebanyak 24 sampel dikumpulkan dari dinding, lantai, udara, peralatan medis dan peralatan non-medis (14 dari UGD, 10 dari kamar operasi). Identifikasi bakteri menggunakan kultur Nutrient Agar dan MacConkey Agar, pewarnaan Gram, uji katalase, koagulase, dan biokimia. Uji sensitivitas antibiotik menggunakan metode difusi cakram pada Mueller-Hinton Agar terhadap 11 jenis antibiotik. Hasil penelitian memperlihatkan sampel UGD menghasilkan 14 koloni pada Nutrient Agar tanpa pertumbuhan pada MacConkey. Semua bakteri Gram positif: Bacillus sp. (78,6%), Staphylococcus sp. (14,3%), dan Streptococcus sp. (7,1%). Sampel kamar operasi menghasilkan sembilan koloni: Bacillus sp. (55,6%) dan Staphylococcus sp. (44,4%). Sensitivitas tinggi terhadap sulphamethoxazole/trimethoprim (90,9-100%), ciprofloxacin (90,9-100%), dan meropenem (80-90,9%), namun resistan terhadap aztreonam (100%) dan cefepime (54,5-60%). Simpulan penelitian ini ialah ditemukan tiga genus bakteri (Bacillus sp., Staphylococcus sp., dan Streptococcus sp.) dengan sensitivitas tinggi terhadap sulphamethoxazole/trimethoprim, ciprofloxacin, dan meropenem, namun resistan terhadap aztreonam dan cefepime. Kata kunci: identifikasi pola bakteri aerob; uji sensitivitas antibiotik; ruang UGD; kamar operasi
Copyright (c) 2026 Sania G. H. Hompas, Heriyannis Homenta, Olivia A. Waworuntu https://creativecommons.org/licenses/by-nc/4.0
Perubahan Kadar Asam Urat dan Estimasi Laju Filtrasi Glomerulus pada Pasien Penyakit Ginjal Kronis yang Menggunakan Terapi Alopurinol
Abstract: Chronic kidney disease (CKD) is closely associated with hyperuricemia. Allopurinol is recommended for patients with CKD stages 2–5 to reduce serum uric acid levels, although its renoprotective effects may vary depending on patient characteristics. This study aimed to obtain changes in serum uric acid and estimated glomerular filtration rate (eGFR) in CKD patients receiving allopurinol therapy at Prof. Dr. R. D. Kandou Hospital Manado during 2021–2024. A retrospective longitudinal descriptive design was employed. As an exploratory purpose, pre–post therapeutic analyses and subgroup comparisons were conducted. The results showed that the greatest reduction in serum uric acid was observed among patients aged 30–65 years, males, those with type 1 diabetes mellitus, and individuals with stage G5 CKD. Increases in eGFR were noted in patients aged <30 years, females, and those with rheumatic heart disease as a comorbidity. Conversely, decreases in eGFR were found in patients aged ≥30 years, males, those with liver cirrhosis, and individuals in CKD stages G2–G3. In conclusion, changes in serum uric acid and eGFR among CKD patients receiving allopurinol vary according to age, sex, comorbidities, and stage of CKD. Keywords: chronic kidney disease; hyperuricemia; allopurinol Abstrak: Penyakit ginjal kronis (PGK) berhubungan erat dengan hiperurisemia. Alopurinol direkomendasikan pada pasien PGK stadium 2-5 untuk menurunkan kadar asam urat, meskipun efek renoprotektifnya dapat bervariasi menurut karakteristik pasien. Penelitian ini bertujuan mendeskripsikan perubahan kadar asam urat dan estimasi laju filtrasi glomerulus (eLFG) pada pasien PGK pengguna alopurinol di RSUP Prof. Dr. R. D. Kandou Manado periode 2021–2024. Jenis penelitian ialah deskriptif longitudinal retrospektif. Sebagai tujuan eksploratif, dilakukan analisis pre–post terapi serta komparatif antar-subkelompok. Hasil penelitian mendapatkan penurunan kadar asam urat terbesar pada kelompok usia 30–65 tahun, laki-laki, komorbid diabetes melitus tipe 1, dan stadium G5. Peningkatan eLFG terjadi pada kelompok usia <30 tahun, perempuan, dan komorbid penyakit jantung rematik. Sebaliknya, penurunan eLFG terlihat pada kelompok usia ≥30 tahun, laki-laki, kelompok komorbid sirosis, serta stadium G2–G3. Simpulan penelitian ini ialah perubahan kadar asam urat dan eLFG pada pasien PGK yang menggunakan alopurinol bervariasi menurut usia, jenis kelamin, komorbid, dan stadium PGK. Kata kunci: penyakit ginjal kronis; hiperurisemia; alopurinol
Copyright (c) 2026 Christina Angelica, Octavianus R. H. Umboh, Frans E. N. Wantania https://creativecommons.org/licenses/by-nc/4.0
Faktor-Faktor yang Berhubungan dengan Tingkat Stres Mahasiswa Profesi Dokter (Co-Assistant) di RSUP Prof. Dr. R. D. Kandou Manado
Abstract: Mental health remains an important issue among medical students, particularly clinical clerkship students (co-assistants) who must simultaneously manage academic and clinical demands. This study aimed to examine factors associated with stress levels among clinical clerkship students (co-assistants) at Prof. Dr. R. D. Kandou Hospital Manado. This was an observational quantitative study with a cross-sectional design. Respondents were selected using the Slovin formula through purposive sampling. Data were collected online using the PSS-10 to measure stress levels and the NASA-TLX to assess workload. Data analysis was performed using the Spearman Rank test and the Mann–Whitney U test. The results obtained 108 students as respondents with a mean age of 23 years (SD=0.85); majority of them were females. Most respondents experienced moderate stress (78.7%), followed by high and low stress levels (19.4% and 1.9%). The mean total workload score was 68.16%, with the highest dimension being effort at 21.29%. Bivariate analysis revealed a significant positive relationship between age and workload with stress levels, while gender and clinical rotation stage were not significantly associated. In conclusion, age and workload are factors associated with stress levels among clinical clerkship students (co-assistants). Therefore, psychosocial support programs, routine counseling, and evaluation of clinical workload are required to help students manage stress adaptively. Keywords: workload; stress level; clinical clerkship students (co-assistants) Abstrak: Kesehatan mental masih menjadi isu penting di kalangan mahasiswa kedokteran, terutama pada mahasiswa profesi dokter (co-assistant) yang menjalani beban akademik dan klinik secara bersamaan. Penelitian ini bertujuan untuk mengkaji faktor-faktor yang berhubungan dengan tingkat stres pada mahasiswa profesi dokter (co-assistant) di RS R.D Kandou Manado. Jenis penelitian ialah observasional kuantitatif dengan desain potong lintang. Responden dipilih menggunakan rumus Slovin melalui teknik purposive sampling. Pengumpulan data dilakukan secara daring menggunakan kuesioner PSS-10 untuk mengukur tingkat stres dan NASA-TLX untuk menilai beban kerja. Analisis data dilakukan menggunakan uji Spearman Rank dan uji Mann-Whitney U. Hasil penelitian mendapatkan sebanyak 108 mahasiswa sebagai responden, mayoritas dengan rerata usia 23 tahun (SD=0,85), didominasi oleh perempuan. Responden terbanyak mengalami stres sedang (78,7%), diikuti stres tinggi (19,4%) dan stres rendah (1,9%). Rerata total skor beban kerja 68,16% dengan dimensi tertinggi yaitu tingkat usaha 21,29%. Analisis bivariat menunjukkan adanya hubungan positif bermakna antara usia dan beban kerja dengan tingkat stres, sedangkan jenis kelamin dan stase profesi pendidikan dokter tidak bermakna. Simpulan penelitian ini ialah usia dan beban kerja merupakan faktor-faktor yang berhubungan dengan tingkat stres pada mahasiswa profesi dokter (co-assistant). Oleh karena itu, diperlukan dukungan psikososial, konseling rutin, dan evaluasi beban kerja klinik untuk membantu mahasiswa mengelola stres secara adaptif. Kata kunci: beban kerja; tingkat stres; mahasiswa profesi dokter (co-assistant)
Copyright (c) 2026 Alida P. Talumedun, Diana V. D. Doda, Herlina I. S. Wungouw https://creativecommons.org/licenses/by-nc/4.0
Profil Kasus Luka Bakar di Rumah Sakit Bhayangkara Tingkat III Manado Tahun 2023 – 2024
Abstract: Burn injury represents a major health problem with both clinical and medicolegal implications, particularly when related to accidents or criminal incidents. This study aimed to describe the profile of burn injury cases at Rumah Sakit Bhayangkara Tingkat III Manado in 2023–2024. This was a descriptive and retrospective study based on secondary data obtained from medical records of burn cases treated during the study period. The results showed a total of 16 burn cases, with 12 patients (75%) survived and four patients (25%) died. The highest number of cases occurred in 2024 (62.5%). The most common cause of burns was fire (62.5%), followed by electricity and hot liquids (12.5% each), and explosion (6.3%). Based on total body surface area, the most frequent category was 10–29% (31.3%), and the most common burn degree was second-degree burns (31.3%). Most patients were adults aged 18–59 years (62.5%), and males constituted the majority (75%). All patients were Indonesian citizens residing in Manado. In conclusion, burn injuries in Manado most commonly affect adult males and are primarily caused by fire. These findings highlight the need for enhanced safety education in both workplace and domestic settings, as well as improved medicolegal documentation to support forensic analysis and inform public health policies. Keywords: burn injury; case profile; forensic aspect Abstrak: Luka bakar menjadi masalah kesehatan yang memiliki implikasi klinis maupun medikolegal, terutama ketika berkaitan dengan kecelakaan atau tindak pidana. Penelitian ini bertujuan untuk mengetahui profil kasus luka bakar di Rumah Sakit Bhayangkara Tingkat III Manado pada tahun 2023–2024. Jenis penelitian ialah deskriptif retrospektif dengan memanfaatkan data sekunder dari rekam medis pasien luka bakar yang dirawat selama periode penelitian. Hasil penelitian menunjukkan bahwa terdapat 16 kasus luka bakar yang tercatat, dengan 12 pasien (75%) hidup dan empat pasien (25%) meninggal dunia. Kasus terbanyak ditemukan pada tahun 2024 (62,5%). Penyebab luka bakar yang paling seringa ialah api (62,5%), diikuti oleh listrik dan cairan panas (masing-masing 12,5%), serta ledakan 6,3%. Berdasarkan luas luka, kategori 10–29% merupakan yang terbanyak (31,3%), sedangkan derajat luka yang paling sering ditemukan ialah derajat II (31,3%). Kelompok usia terbanyak ialah dewasa (18–59 tahun) (62,5%), dengan jenis kelamin terbanyak laki-laki (75%). Seluruh korban merupakan warga negara Indonesia yang berdomisili di Manado. Simpulan penelitian ini ialah luka bakar di wilayah Manado paling sering terjadi pada laki-laki usia produktif akibat paparan api, sehingga diperlukan upaya pencegahan melalui peningkatan edukasi keselamatan kerja, kewaspadaan domestik, serta penguatan dokumentasi medikolegal untuk mendukung analisis forensik dan perencanaan kebijakan kesehatan Kata kunci: luka bakar; profil kasus; aspek forensik
Copyright (c) 2026 Evan Y. Rusly, Djemi Tomuka, Nola T. S. Mallo https://creativecommons.org/licenses/by-nc/4.0
Gambaran Enuresis pada Anak Sekolah Dasar
Abstract: Enuresis is defined as involuntary voiding in children aged ≥5 years, occurring at least twice per week for three consecutive months, and not attributable to underlying medical conditions. Enuresis is influenced by biological, psychological, and environmental factors and remains commonly observed among primary school children. This study aimed to describe the occurrence of enuresis and its associated risk factors among elementary school children at Paal Dua District. A quantitative descriptive design with a cross-sectional approach was used. Samples were obtained through proportionate stratified random sampling from 250 respondents enrolled in SD Advent 3 Paal Dua, SD GMIM 22 Manado, and SD Advent 6 Kairagi Weru. Data were collected using the Clinical Management Tools (CMT) questionnaire from the Indonesian Urological Association and a previously validated and reliable research instrument. The findings showed that among the 15 children with enuresis, most were six years old (66.7%) and male (60%). The highest percentages were found in enuresis occurred predominantly at night (93.3%), the onset began since birth (66.7%), and voided 4–7 times per day (93.3%). The most frequently identified risk factors included toilet training at 3–4 years of age (73.3%), difficulty being awakened from sleep (53.3%), urinary tract infection complaints (33.3%), psychological stress (20%), and a history of constipation (26.7%). A family history of enuresis was present in 60% of cases, and the most common household composition was four family members (33.3%). In conclusion, enuresis remains present among primary school children in Paal Dua District, indicating the need for early detection and continuous parental education. Keywords: enuresis; elementary school children; nocturnal enuresis; risk factors Abstract: Enuresis merupakan pengeluaran urin secara involunter pada anak usia ≥5 tahun dengan frekuensi minimal dua kali per minggu selama tiga bulan berturut-turut tanpa disebabkan oleh kondisi medis tertentu. Enuresis dipengaruhi oleh faktor biologis, psikologis, dan lingkungan, serta masih sering ditemukan pada anak sekolah dasar. Penelitian ini bertujuan untuk menggambarkan kejadian enuresis dan faktor risikonya pada anak sekolah dasar di Kecamatan Paal Dua. Jenis penelitian ialah deskriptif kuantitatif dengan desain potong lintang. Sampel diperoleh melalui teknik proportionate stratified random sampling dari 250 responden yang berasal dari SD Advent 3 Paal Dua, SD GMIM 22 Manado, dan SD Advent 6 Kairagi Weru. Instrumen penelitian menggunakan kuesioner Clinical Management Tools (CMT) dari Ikatan Ahli Urologi Indonesia serta instrumen penelitian sebelumnya yang telah diuji validitas dan reliabilitasnya. Hasil penelitian menunjukkan dari 15 anak dengan enuresis, sebagian besar berusia 6 tahun (66,7%) dan berjenis kelamin laki-laki (60%). Persentase tertinggi didapatkan pada kejadian enuresis terutama terjadi pada malam hari (93,3%), onset enuresis sejak lahir (66,7%), dan frekuensi berkemih 4–7 kali per hari (93,3%). Faktor risiko yang paling banyak ditemukan meliputi toilet training pada usia 3–4 tahun (73,3%), sulit dibangunkan saat tidur (53,3%), keluhan infeksi saluran kemih (33,3%), riwayat stres (20%), serta riwayat sembelit (26,7%). Riwayat enuresis dalam keluarga ditemukan pada 60% anak, dan komposisi keluarga terbanyak adalah empat anggota dalam satu rumah tangga (33,3%). Simpulan penelitian ini ialah enuresis pada anak sekolah dasar di Kecamatan Paal Dua masih cukup sering ditemukan sehingga diperlukan upaya deteksi dini dan edukasi berkelanjutan kepada orang tua. Kata kunci: enuresis; anak sekolah dasar; enuresis nokturnal; faktor risiko
Copyright (c) 2026 Anastasya G. Tumbal, Adrian Umboh, Johnny L. Rompis https://creativecommons.org/licenses/by-nc/4.0
Profil Kasus Benda Asing Saluran Cerna di Bagian Bedah Anak RSUP Prof. Dr. R. D. Kandou Manado Periode Januari 2021 – Juli 2025
Abstract: Pediatric foreign body ingestion is not an uncommon case, approximately 10%–20% require endoscopy, and 1% require surgery. This study aimed to describe the profile of gastrointestinal foreign body cases in the Pediatric Surgery Department of Prof. Dr. R. D. Kandou General Hospital, Manado. This was a descriptive cross-sectional retrospective study using electronic medical records of pediatric gastrointestinal foreign bodies. The results showed that among 42 included data, most cases were found in the school-age group (57.2%) and among males (54.8%). Most cases were symptomatic (64.3%) and had no comorbidities or complicating diseases (81.0%). All patients received X-ray examinations (100.0%). Most foreign bodies had a duration of ≤1 day (73.8%) in the gastrointestinal tract, blunt characteristic (42.9%), and 2-5 cm in size (78.6%). Foreign bodies were initially identified most often in the colon (35.7%). The majority of cases had no complications (76.2%). The most common management was endoscopy (61.9%), with the majority of foreign bodies found and successfully extracted (69.2%). Keywords: foreign body; location in gastrointestinal tract; pediatric surgery Abstrak: Tertelannya benda asing pada anak merupakan kasus yang tidak jarang dijumpai, yaitu sekitar 10%–20% kasus memerlukan tindakan endoskopi, dan 1% memerlukan operasi. Penelitian ini bertujuan untuk mengetahui profil kasus benda asing saluran cerna di Bagian Bedah Anak RSUP Prof. Dr. R. D. Kandou Manado. Jenis penelitian ialah deskriptif retrospektif dengan desain potong lintang menggunakan data rekam medis pasien anak dengan diagnosis benda asing saluran cerna. Hasil penelitian menunjukkan dari 42 pasien yang memenuhi kriteria inklusi berdasarkan total sampling, mayoritas berusia sekolah (57,2%) dan berjenis kelamin laki-laki (54,8%). Sebagian besar pasien simtomatik (64,3%) dan seluruhnya menjalani pemeriksaan X-ray (100%). Tidak ditemukan penyakit penyerta pada 81% kasus. Benda asing umumnya berdurasi ≤1 hari (73,8%), bersifat tumpul (42,9%), berukuran 2–5 cm (78,6%), dan paling sering ditemukan di kolon (35,7%). Sebagian besar kasus tidak mengalami komplikasi (76,2%). Tatalaksana terbanyak berupa endoskopi (61,9%) dengan keberhasilan ekstraksi yang tinggi (69,2%). Kata kunci: benda asing; lokasi di saluran cerna; bedah anak
Copyright (c) 2026 Avanti H. Anggraeni, Harsali F. Lampus, Stephanus J. C. Tangel https://creativecommons.org/licenses/by-nc/4.0
Gambaran Kejadian Bullying dan Aspek Mental Siswa Sekolah Dasar Kelas 5 dan 6
Abstract: Bullying among elementary school students is a frequent issue and has a significant impact on children’s emotional condition, behavior, and mental health. This phenomenon needs to be examined comprehensively to understand its types and implications among fifth- and sixth-grade students. This study employed a mixed-methods approach, specifically an explanatory sequential design. Quantitative samples were obtained through stratified random sampling using the Olweus Bully/Victim Questionnaire-Revised (OBVQ-R), and interviews were conducted with selected victims and perpetrators to explore their mental aspects and subjective experiences. The results obtained 437 students of fifth- and sixth- grade at Malalayang as respondents. Bullying occurred quite frequently, predominantly in the form of verbal bullying, followed by emotional and physical bullying, with students involved as perpetrators, victims, or both. The mental impacts identified included anxiety, fear of attending school, decreased concentration, low self-esteem, and emotional distress, with several cases showing more severe symptoms. In conclusion, bullying among fifth- and sixth-grade students at Malalayang area still occurs and has a significant impact on students’ mental well-being. Keywords: bullying; mental aspect; elementary school students Abstrak: Bullying pada siswa sekolah dasar merupakan masalah yang sering terjadi dan berdampak signifikan terhadap kondisi emosional, perilaku, dan kesehatan mental anak. Fenomena ini perlu ditinjau secara komprehensif untuk memahami bentuk kejadian serta implikasinya pada siswa kelas 5 dan 6 di wilayah Malalayang. Penelitian ini menggunakan metode penelitian campuran, khususnya desain sekuensial eksplanatori. Sampel kuantitatif diperoleh melalui stratified random sampling dengan menggunakan kuesioner Olweus Bully/Victim Questionnaire-Revised (OBVQ-R), serta dilakukan wawancara pada korban dan pelaku terpilih untuk menggali aspek mental dan pengalaman subjektif mereka. Hasil penelitian mendapatkan 437 siswa kelas 5 dan 6 di wilayah Malalayang sebagai responden. Bullying cukup banyak terjadi dengan bentuk yang dominan berupa bullying verbal, diikuti emosional dan fisik, dan siswa terlibat sebagai pelaku, korban, maupun pelaku sekaligus korban. Dampak mental yang muncul meliputi kecemasan, ketakutan bersekolah, penurunan konsentrasi, rendah diri, dan distress emosional, dengan beberapa kasus menunjukkan gejala yang lebih berat. Simpulan penelitian ini menunjukkan bahwa bullying pada siswa Sekolah Dasar kelas 5 dan 6 di wilayah Malalayang masih terjadi dan memberikan dampak signifikan terhadap aspek mental siswa. Kata kunci: bullying; aspek mental; siswa sekolah dasar
Copyright (c) 2026 Omega K. M. George, Theresia M. D. Kaunang, Anita E. Dundu https://creativecommons.org/licenses/by-nc/4.0