http://localhost:8080/xmlui/handle/123456789/8393 2026-04-14T20:56:12Z 2026-04-14T20:56:12Z Tsaqilah, Laila Zulkarnaen, Annisa Febrieza Dharmadji, Hartati Purbo Hidayah, Risa Miliawati Nurul Avriyanti, Erda http://localhost:8080/xmlui/handle/123456789/8590 2024-11-29T04:00:42Z 2024-03-01T00:00:00Z

Title: A Case Report: High Dose Systemic Corticosteroids as the Therapy for Severe Case Impetigo Herpetiformis Authors: Tsaqilah, Laila; Zulkarnaen, Annisa Febrieza; Dharmadji, Hartati Purbo; Hidayah, Risa Miliawati Nurul; Avriyanti, Erda Abstract: recognition and treatment of IH is important because it may cause maternal and fetal morbidity and mortality. Systemic corticosteroids remain the mainstay of treatment for IH and are considered safe for pregnancy. The purpose of this study was to present successful high-dose corticosteroids as a therapy for severe cases of IH. Case: We reported a 34-year-old pregnant woman in third trimester of pregnancy with a two-week history of reddish patches and pustules spread almost all over her body. She had a history of the same complaint in her latest pregnancy. The diagnosis of severe IH was made based on clinical, laboratory, and histopathology findings. She was prescribed 80 mg/day of oral prednisolone. The eruption and systemic symptoms gradually improved after 12 weeks of treatment. The dose was maintained until delivery before tapered gradually and stopped. The baby was born healthy, and there were not any new lesions. Discussion: Given the possibility of fetal and maternal complications that are potentially lifethreatening, IH needs to be detected and treated right away. The mainstay of treatment for IH is systemic corticosteroids. Steroids control the eruption by preventing polymorphonuclear cells from migrating. Due to its limited placental transmission, prednisolone is regarded to be safe for uses during pregnancy. After 12 weeks of treatment of 80 mg daily prednisolone, the eruptions were resolved and there were not any side effects of steroid observed in both the mother and the baby. Conclusion: Impetigo herpetiformis not only needs early treatment to prevent maternal and fetal complications but also the safety of the treatment chosen. High-dose oral prednisolone is considered effective and safe to control a severe case of IH as it has low placental transmission

2024-03-01T00:00:00Z Aditya, Bayu Wardhana, Manggala Pasca Islamy, Tauhid http://localhost:8080/xmlui/handle/123456789/8589 2024-11-29T03:53:09Z 2024-03-01T00:00:00Z

Title: Nephrogenic Diabetes Insipidus or Bartter Syndrome? A Dilemma of Refractory Hypokalemia in Pregnancy: A Case Report from Soedono Regional Public Hospital in Madiun Authors: Aditya, Bayu; Wardhana, Manggala Pasca; Islamy, Tauhid Abstract: Hypokalemia is a rare condition in pregnant women. Muscle weakness and life-threatening heart damage can occur if the baseline condition is not treated, especially if it recurs and persists. The differential diagnosis in recurrent hypokalemia includes nephrogenic diabetes insipidus, characterized by the kidneys' inability to respond to vasopressin to concentrate urine, or Bartter syndrome, a tubulopathy resulting from a rare genetic mutation affecting the loop of Henle, leading to potassium wasting. A 24-year-old primigravida at 35/36 weeks gestation presented with refractory hypokalemia, indicative of diabetes insipidus or a differential diagnosis of Bartter syndrome. The patient complained of limb weakness combined with polydipsia, polyuria, and a history of periodic paralysis due to severe hypokalemia since 2016. She consistently took potassium supplements and monitored her potassium levels. Since becoming pregnant in November 2021, the patient has been hospitalized three times due to limb weakness, with the lowest serum potassium level recorded at 1.6. Throughout her pregnancy, fetal growth and development remained within normal limits, and her blood pressure ranged from 100-120/60-80. In patients with limb weakness, evaluating serum potassium levels is crucial. In this case, the suspicion of nephrogenic diabetes insipidus could not be confirmed due to the unavailability of antidiuretic hormone (ADH) tests. Bartter syndrome, although rarely encountered, should be considered in patients with recurrent hypokalemia. The challenge in Indonesia lies in the lack of specific gene examinations for diagnosis, making diagnostics relatively difficult. Our recommendation for cases like this is to conduct ADH examinations and thoroughly investigate refractory hypokalemia.

2024-03-01T00:00:00Z Wardana, Ardhian Susila, Dedi http://localhost:8080/xmlui/handle/123456789/8585 2024-11-29T03:48:07Z 2024-03-01T00:00:00Z

Title: Pectoralis Block in Geriatric Patients with Breast Cancer Undergoing Modified Radical Dextra Mastectomy Authors: Wardana, Ardhian; Susila, Dedi Abstract: Regional anesthesia has the advantage of minimal use of drugs capable of depressing cardiovascular or pulmonary function, especially in geriatric patients. The pectoral nerve block represents a regional procedure associated with fewer adverse effects compared to alternative regional anesthetic approaches. A 74-year-old woman with a weight of 35 kg and a height of 145 cm, was diagnosed with breast cancer. The patient complained of a lump in the right breast since the last 1 year, the lump felt hard and didn't feel painful. We conducted PECS I and PECS II blocks as part of the surgical protocol for dextra Modified Radical Mastectomy (MRM), with the primary goal of minimizing the requirement for opioids and anesthetic agents in the context of geriatric patients. In the PECS I block, we introduced a needle into the anatomical plane situated between the pectoralis major and pectoralis minor muscles, followed by the injection of 10 mL of 0.5% ropivacaine. In the case of the PECS II block, we administered a 20 mL dosage of ropivacaine at the third rib level above the serratus anterior muscle to ensure a wide distribution of the local anesthetic within the axillary region. The complete PECS block procedure typically spans a duration of approximately 30 minutes. The block was smooth and did not show complications, during the duration of the opioid, fentany 25 mcg was added during the axillary lymph node dissection. VAS scores at first 12 and 24 hours, 1 and 1. Thus, the PECS block can be used as an analgesic either during or postoperatively. The use of PECS 1 and 2 blocks in radical mastectomy may reduce the need for opioids for intraoperative and postoperative pain.

2024-03-01T00:00:00Z Chrisdianto, Aditya Airlangga, Prananda Surya Wirabuana, Belindo Iskandar, Regina Purnama Dewi http://localhost:8080/xmlui/handle/123456789/8584 2024-11-29T03:49:47Z 2024-03-01T00:00:00Z

Title: Vitamin D and Wound Recovery: Illuminating the Path to Enhanced Healing in Diabetic Patients Authors: Chrisdianto, Aditya; Airlangga, Prananda Surya; Wirabuana, Belindo; Iskandar, Regina Purnama Dewi Abstract: Wound healing is a highly coordinated biological event as a response to injured skin. It commonly takes 14 days for a wound to be completely healed. However, the duration of wound healing may vary between individuals due to certain factors. One major factor that delays the wound-healing process is Diabetes Mellitus. Delayed wound healing with poor prognosis commonly occurs in diabetic patients. Chronic hyperglycemia may affect macrophage polarisation, which is essential in the wound healing mechanism. The macrophage polarisation enables the pro-inflammatory M1 phenotype to switch to the anti-inflammatory M2 phenotype. Thus, pro-inflammatory M1 phenotype prevails persistently in diabetic wounds, while the anti-inflammatory M2 phenotype remains deficient. It results in significantly elevated levels of pro-inflammatory cytokines triggered by the M1 phenotype. Prolonged wound healing times increase the risk of infection, which can lead to more severe complications. Vitamin D is widely recognized for its essential role in regulating calcium levels and supporting bone health, as well as its positive effects on the immune system. This vitamin has the potential to skew macrophages towards the M2 phenotype and promote a regenerative and anti-inflammatory environment.

2024-03-01T00:00:00Z