Bali Mandara Research Articles

The Effectiveness of Discharge Planning Implementation in Diabetes Mellitus Patient to Improve Patient’s Discharge Readiness

Diabetes mellitus sufferers experience disturbances in the system of regulating blood sugar levels, insulin is not sufficient to cope so that blood sugar levels increase. This causes patients to require long-term care, so they must be given discharge planning. This research aims to analyze the effectiveness of implementing discharge planning in diabetes mellitus patients to increase patient readiness to go home in the Cempaka Room at Bali Mandara Hospital. The research method used univariate descriptive analysis, and the sample used was in accordance with predetermined inclusion and exclusion criteria and then one respondent was selected. The research results showed that a 61-year-old patient with a diagnosis of diabetes mellitus who met the criteria was given discharge planning and measured using the adult Indonesian version of the patient discharge readiness scale instrument. The pre-test results showed that the patient's readiness level for discharge was 49.52% with a total score of 104 (level II). After implementing discharge planning, the level of patient readiness for discharge increased to 64.28% with a total score of 135 (level III). The implementation of patient discharge planning has proven to be effective in increasing patient discharge readiness, as evidenced by an increase in patient discharge readiness from level II to level III. Therefore, in providing nursing care, it is necessary to pay attention to the patient's detailed needs and fulfill them by implementing discharge planning so that patients have a good level of readiness to go home to reduce recurrence, complications, and patient readmissions.

Clinical characteristics of COVID-19 patients at Bali Mandara hospital

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease that has spread in various parts of the world, including Bali, Indonesia. This study aims to identify the clinical characteristics of COVID-19 patients at Bali Mandara hospital. Methods: This research is a descriptive observational study with a cross-sectional approach. This research uses secondary data from medical records at Bali Mandara hospital. The sample in this study was all COVID-19 patients treated at Bali Mandara hospital in the period January 2022-August 2023. Results: There were 59 patients in this study. Most were female (n=37;62.70%) and aged >61 years (n=29; 49.20%) with a median age of 60 years. The median white blood cells and neutrophils to lymphocytes ratio (NLR) in patients were 7.20×103/uL and 4.40, respectively. The type of comorbidity most frequently found in patients was hypertension (n=23; 39.00%), followed by kidney disease (n=17; 28.80%) and type 2 diabetes mellitus (n=11;18.60%). Most patients had a hospital stay of >6 days (n=40; ​​67.80%) with a median of 6 days. The prevalence of death in patients was 15.30%. A total of 15 patients suffered from severe COVID-19. Conclusions: Most of the patients were female and aged >61 years. The most common comorbidity found in patients is hypertension. Most patients had a hospital stay of >6 days.

Compliance Analysis of Nurses in Implementing Fall Risk Prevention in Post-Op Patients in the Jepun Room of Bali Mandara Hospital: A Case Study

Falling risk is an increased sensitivity to falling that can result in physical injury and health problems. Nurses play a crucial role in reducing the risk of falls among patients in hospitals; therefore, nurses must adhere to established fall prevention protocols. The aim of this study is to assess nurses' compliance in implementing fall prevention measures for post-operative patients in the Jepun Room of Bali Mandara Regional General Hospital. The research design used is descriptive analysis in the form of a case study, with the study population consisting of 3 nurses from the Jepun Room at Bali Mandara Regional General Hospital. This study observes nurses' compliance in implementing fall risk prevention measures for patients. Based on observations, it was found that the implementation of mild fall risk prevention measures by 3 responsible nurses achieved 100% compliance. Specifically, ensuring non-slip footwear was applied 100% on the first day, with the lowest application being 0% on day 2 and 3. Meanwhile, measures such as providing patient orientation, obtaining patient consent to keep night lights on, and ensuring walking aids are within reach (if used) were never implemented, also at 0%. Regarding moderate fall risk prevention measures by these nurses, it was found that implementation was 100%. However, the installation of fall risk signs outside patient rooms had 0% implementation. From these findings, the role of these nurses as care coordinators in implementing fall risk prevention measures for patients is crucial to prevent undesired incidents.

Screening for Postpartum Depression Risk Using Edinburgh Postnatal Depression Scale (EPDS) In Postpartum Mothers

Postpartum depression seems to be one of the prior causes of stress and anxiety for women worldwide during the current COVID-19 pandemic. This percentage is quite high in Asian countries, ranging from 26 to 85%, and 50 to 70% in Indonesia. This research aims to describe the prevalence of postpartum depression risk in postpartum mothers using EPDS in Bali Mandara Public Hospital, Bali Province. With a sample size of 75 postpartum mothers, the design of this descriptive study was the cross-sectional approach of seventh to tenth-day postpartum mothers from November to December 2022. The sampling technique involved consecutive sampling. The research instrument is the EPDS questionnaire. Approximately 41.3% of postpartum mothers who gave birth in Bali Mandara Public Hospital had a high risk of experiencing postpartum depression. The respondents are 16-20 years old, have an elementary education level, work as entrepreneurs, have middle to low economic status, and have multiparity. The majority of postpartum mothers are at high risk of experiencing postpartum depression, which is why early detection is critical and must be established as the new operational standard in perinatal health services.

The relationship between individual characteristics and quality of life in patients with Nasopharyngeal Carcinoma (NPC) at Bali Mandara General Hospital

Background: Nasopharyngeal carcinoma (NPC) is the most commonly found malignancy in the head and neck. NPC patients generally experience a decrease in quality of life. Currently, assessments of the quality of life of NPC patients and their relationship to individual characteristics are still rarely carried out. This study aims to determine the relationship between individual characteristics and the quality of life of NPC patients at Bali Mandara General Hospital. Methods: This research is analytical observational with a cross sectional design conducted at Bali Mandara General Hospital in February - April 2024. The independent variables were age, gender, body surface area (BSA), stage, and type of treatment. Meanwhile, the dependent variable is the quality of life, which was assessed by the FACT-G questionnaire. It consists of physical, social/family, emotional, and functional well-being. Data analysis was done using SPSS 27 software. The data normality test was carried out by the Shapiro-Wilk test followed by the chi-square test. The relationship between the variables is significant if the value is ≤0.05. Results: A total of 16 patients were involved in this study with an age range of 32-68 years and were dominated by men (70.6%) and stage > III (64.7%). The FACT-G score has a result range of 58-101, with the highest domain obtained in social/family well-being. It was found that BSA (p=0.006) and stage (p=0.018) had a significant relationship with the quality of life of NPC patients. Meanwhile, other individual profiles such as age (p=0.424), gender (p=0.551), and type of treatment (p=0.302) did not have a significant impact on the patient's quality of life. Conclusion: BSA and disease stage were related to the quality of life of NPC patients. Identifying factors influencing the patient's quality of life will provide further considerations regarding NPC management.

Hubungan Kepercayaan Diri dengan Kemandirian pada Pasien Kanker Payudara yang Menjalani Kemoterapi

The most common cause of death among women worldwide is breast cancer, which is the most commonly diagnosed type of cancer. Breast cancer is a condition where cells lose control of their normal activity, resulting in abnormal growth. One of the treatments for breast cancer is chemotherapy. Chemotherapy can cause side effects, which can have an impact on the fulfillment of daily activities that cause the inability to perform self-care independently. The purpose of this study was to determine the relationship between self-confidence and independence in breast cancer patients undergoing chemotherapy at Bali Mandara Hospital in 2024. The type of research used is correlational with a cross-sectional approach. Sampling using purposive sampling technique as many as 79 people. Data collection instruments used a self-confidence questionnaire and a Barthel index questionnaire. The results of the study of self-confidence of breast cancer patients undergoing chemotherapy in the very confident category 55.7%, the independence of breast cancer patients undergoing chemotherapy in the moderate category 45.6%. The hypothesis test used is the spearman rank test with a p-value = 0.000 α (0.05), it can be concluded that there is a relationship between self-confidence and independence in breast cancer patients undergoing chemotherapy.

Characteristics of Corneal Ulcer Patients at Bali Mandara Eye Hospital in 2021-2022

Background: A corneal ulcer is a pathological discontinuity of corneal epithelium surface. The incidence in developing countries reached 1.5-2 million per year and one of the causes of blindness. Corneal ulcers can occur at any age and gender which is influenced by geographic conditions. The causes of corneal ulcers vary depend on the region, predisposing factors, and microorganisms in the particular community. Purpose: To know the characteristics of corneal ulcers particularly at the Bali Mandara Eye Hospital and as a basic data for further research. Methods: A total of 77 selected medical records at Bali Mandara Hospital from January 2021–May 2022 were used in this descriptive study using a retrospective method. Patient characteristics, etiology, clinical characteristics, management, and complications were identified in this study. Descriptive analysis was performed on all data and presented in frequency tabulation. Results: In this study, 52 cases (67.5%) were male and 25 cases (32.5%) were female. The largest age group was 24-64 years with 34 cases (44.2%). All cases with corneal ulcers (100%) complained of red eye symptoms. Trauma (61.0%) as the most common predisposing factors that was caused by plants (24.7%). The most common etiologies were bacteria (46.8%) followed by fungi (5.2%), and mixed (28.6%). Most of the cases were managed without treatment (66.2%) with the outcome of improvement (55.8%), without complications (53.2%), perforation (28.6%), and descemetocele (15.6%). Conclusion: Most patients with corneal ulcers at the Bali Mandara Eye Hospital are male than female with range of 24-64 years and trauma being the most common predisposing factor. This is because it is the range for productive age and the majority of the population in Indonesia, especially Bali, works as farmers. Most microorganisms that cause corneal ulcers are bacteria. Most patients receive non-surgical treatment with more than 50% of patients experiencing improvements in vision and no complications. Keywords: Corneal Ulcers, keratitis, ocular trauma, visual impairment

CHARACTERISTICS OF INTERTROCHANTERIC FEMUR FRACTURE AT BALI MANDARA GENERAL HOSPITAL

Abstract: Characteristics of Intertrochanteric Femur Fracture at Bali Mandara General Hospital. An intertrochanteric femur fracture is an extracapsular fracture that occurs along the line that is located between the greater and lesser trochanters. This study aims to determine the characteristics of intertrochanteric femur fracture cases. This retrospective descriptive study evaluated the characteristics of intertrochanteric femur fracture patients at Bali. Mandara General Hospital Denpasar from January to August 2022. There were 36 intertrochanteric femur fracture patients (8.78%). Intertrochanteric femur fracture patients are mostly found in female patients (25 patients [69.4%]) and the elderly. Based on the mechanism of trauma, 33 patients had a fracture due to low-energy trauma. According to Boyd and Griffin’s classification, type 2 intertrochanteric femur fracture was more common (14 patients [38.9%]). All patients had PFNA (100%) and most of them had a grade B Singh index (16 patients [44.4%]). The incidence of intertrochanteric femur fracture was 8.78%. The intertrochanteric femur fracture was more common in the female patient, aged more than 60 years old, occurs due to low energy trauma, has a type 2 Boyd and Griffin classification, has a grade B Singh index, and was treated using PFNA.

Characteristics of syphilis in the Dermato-Venereology Department of Bali Mandara General Hospital

Introduction: Treponema pallidum is the sexually transmitted pathogen that causes syphilis. Congenital or acquired syphilis are the two categories. In 2020, the World Health Organization (WHO) anticipates 7 million additional cases of syphilis. 76,923 new patients were reported in 2020 by the Ministry of Health of the Republic of Indonesia. There is still inadequate information about Bali's incidence or prevalence of syphilis. This study aims to describe the characteristics of syphilis patients seeking treatment at Bali Mandara Hospital's Dermato-Venereology Department between 1st January 2020 to 31st December 2022. Methods: In this descriptive cross-sectional retrospective study from 1st January 2020 to 31st December 2022, we used 56 samples from secondary data collected from the patient register book and medical records of the dermatovenereology outpatient clinic at Bali Mandara General Hospital. Data were analyzed descriptively using SPSS version 26. Results: According to the study, there were 56 syphilis patients, including 32 men (57.1%) and 24 women (42.9%). The most common age group was 25 to 44 years old, with 36 patients (64.3%), while the most common clinical stage of syphilis was early latent syphilis, with 20 patients (35.7%). Venereal Disease Research Laboratory (VDRL) titer of 1:2 was the most frequent finding, with 16 patients (28.6%). Conclusion: It may be concluded that syphilis cases at Bali Mandara General Hospital have a different description that varies according to each variable. Future studies on syphilis cases are anticipated to build on the findings of this study.

The Correlation Spiritual Intelligence of Nurse’s Toward Fulfillment of Spiritual Nursing Care at Bali Mandara Regional General Hospital

Background : English Arial italic 9 terdiri dari Introduction, Method, result and Conclusion Fulfillment of spiritual nursing care is a form of holistic nursing care that is influenced by spiritual intelligence, in providing nursing care, nurses will not only focus on physical nursing care, but also approach holistic care, namely bio-psycho-social-spiritual because nurses are professional workforce in providing nursing care such as playing a role in helping healing and providing care among human beings. Objective : The purpose of this research is to determine the correlation spiritual intelligence of nurse’s toward fulfillment of spiritual nursing care at Bali Mandara Regional General Hospital. The type of quantitative research, is correlative analysis with a cross-sectional study approach involving 209 respondents selected by probability sampling technique namely random sampling, conducted in March-April 2023. The analysis used the Spearman rho test. The research instrument used a questionnaire. Based on the results of the study, it was found that the spiritual intelligence of nurse’s was in the high category (61.2%) and the fulfillment of spiritual nursing care was mostly in the high category (55%). Results: the results of analysis by test Spearman rho’ shows that the spiritual intelligence of nurses is related to the fulfillment of spiritual nursing care with a moderate correlation (p-value 0.001 <0.05, r = 0.408). Conclusion : It can be concluded that there is a significant correlation the spiritual intelligence of nurse’s toward fulfillment of spiritual nursing care at the Bali Mandara Regional General Hospital with a positive correlation direction.

Characteristics of Intertrochanteric Femur Fracture at Bali Mandara General Hospital

Characteristics of Intertrochanteric Femur Fracture at Bali Mandara General Hospital

Cicatricial Ectropion After Maxillofacial Surgery

Introduction : cicatricial ectropion is a malposition lower eyelid by shortening and/ or scarring of the anterior lamella of eyelid but it can occur in the upper eyelid. Ocular manifestations in cicatricial ectropion occurred epiphora, redness eyes, foreign body sensation, dry eyes due to direct exposure to the outside. In severe case may occur ulceration and loss of vision
 Case Illustration : A 33 year old male patient was being came to ophthalmologist department at Bali Mandara General Hospital with complaints that the right eye could not close completely, the felt dry eyes, foreign body sensation, and sometimes redness eyes after maxillofacial surgery one month ago before admitted to hospital. The physical examination the patient was normal. The ophthalmological examination visual acuity 6/6 for both eyes, intraocular pressure was normal for both eyes. The movement of the eyeballs was normal. The segment anterior examination was a scar on the lower right eyelid, inferior palpebral retraction, lagophthalmos 4 mm. The segment anterior examination of the left eye was normal.
 Discussion : The patient was treated to repair the cicatricial ectropion with surgery under general anesthesia with postauricular full thickness skin graft, antibiotic eye ointment, antibiotic oral, and lubricant eye drop.
 Conclusion : Cicatricial ectropion is a complication that occurs due to trauma or surgery. Reconstructive surgery to repair eyelid function, improve cosmetic appearance and minimize complications of further eye damage such as keratitis to blindness. Knowing the etiology along with the progression of the disease is necessary for early diagnosis and prompt treatment.

MEDITASI TRANSENDENTAL DI SEKOLAH MENENGAH KEJURUAN (SMK) NEGERI BALI MANDARA DALAM PERSPEKTIF TEOPSIKOLOGI

This research aims to describe the implementation process of Transcendental Meditation (TM) in Bali Mandara State Vocational High School; describe the perception of school members after participating in TM activities; describe the mental state of students after participating in TM from the perspective of Theopsychology; and describe the implications of TM implementation for school members. This research is a qualitative research conducted at Bali Mandara State Vocational High School through an ethnographic approach. The research subjects are school members at Bali Mandara State Vocational High School who practice TM. The data collection methods used include observation, interviews, and documentation. Several research findings can be summarized as follows. (1) The implementation process of TM in Bali Mandara State Vocational High School is through the teaching pattern provided by meditation teachers from Maharishi Global Raam Raj Foundation by applying 7 (seven) steps to learn TM including: socialization, preparation, personal interview, individual teaching, first-day check-up, second-day check-up, and third-day check-up. (2) The perception of school members collectively views that TM provides positive benefits, reduces stress, helps with deeper rest, and improves academic achievement by being calm and stable in learning. (3) The mental state of students after practicing TM from the perspective of Theopsychology is that TM can be a useful tool to help individuals achieve greater spiritual depth and mental health. (4) The implications of TM implementation for school members include: fostering spiritual awareness, improving learning ability, enhancing the relationship with God, academic and non-academic achievement, and strengthening social relationships.

The Impact of Education Budget Politics on Discontinuation of Scholarship: A Case Study of SMAN Bali Mandara

The issue of politicization in the education sector has garnered significant attention in everyday discourse, yet its exploration in academia remains limited. Often, government policies fail to align with public expectations. This study delved into the public debate surrounding the abrupt discontinuation of the scholarship program at SMAN Bali Mandara by the government, seeking to investigate the underlying reasons. The rationale behind the government's decision to discontinue scholarships, while allocating substantial funds to other sectors, remained unclear, as did the subsequent impact of the discontinuation. Consequently, the public and education activists demanded clarification from the government. This study aimed to examine the politicization of the education budget by analyzing the APBD report and public responses. Rather than providing scholarships, the government prioritized the construction of new school infrastructure in various regions. This study employed a qualitative approach with a literature review method. The author collected data from APBD reports, BPS data, online mass media, scientific articles, and other sources to support an in-depth analysis. The study encompassed problem identification, literature review, determination of the study's purpose and objectives, data collection, data analysis, interpretation, and reporting of results. The study revealed that the government abruptly and unilaterally discontinued the scholarships at SMAN Bali Mandara. The government justified this action by claiming it aimed to equalize all schools. Under the pretext that all schools should admit underprivileged students, not just SMAN Bali Mandara, the government concentrated its efforts on constructing 14 new schools. However, based on the analyzed data, this study found that this policy was neither effective nor efficient.

An Overview of Chronic Kidney Disease with Anemia at Bali Mandara Hospital in 2021-2022

Chronic kidney disease remains a problem in the field of nephrology, with a high incidence rate and a complex and broad etiology. Chronic kidney disease can cause several complications such as hypertension, anemia, metabolic acidosis, albuminuria, mineral and bone disorders, electrolyte imbalance, malnutrition and depression. Anemia is a condition in which the circulating mass of erythrocytes and/or hemoglobin cannot fulfill its function of providing oxygen to the body's tissues. Anemia significantly increases the risk of morbidity and mortality of chronic kidney disease. The aim of this study was to describe cases of chronic kidney disease with anemia at Bali Mandara Hospital in 2021 and 2022. This research is an observational descriptive study with a cross sectional approach, using secondary data in the form of patient medical records. Data were analyzed using SPSS software version 25 to obtain an overview of cases of chronic kidney disease with anemia based on gender, age, place of residence, degree of chronic kidney disease, degree of anemia, and anemia morphology. The results showed that most cases of chronic kidney disease with anemia at Bali Mandara Hospital at 2021-2022 were mostly experienced by men (69.0%) with the most common age range being between 46-55 years old (early elderly) of 34.5%, and the majority of chronic disease patients with anemia patients resides in the city of Denpasar (73.6%). The observed degree of severity of CKD was mostly at stage 5, accounting for 87.4%. The degree of anemia seen in patients with chronic kidney disease at Bali Mandara General Hospital was mostly moderate anemia (72.4%), with the most common morphological appearance being normochromic normocytic anemia at 75.9%. Keywords: chronic kidney disease, anemia, anemia morphology

Effect of Slice Thickness Variation on Spatial Resolution of CT-Scan Device Images at the Bali Mandara Hospital Radiology Installation

Aims: Slice thickness variation analysis on spatial resolution on CT-scan images by determining CNR and SNR values, by making ROI on object and background images. ROI size of objects and backgrounds can be observed with several criteria based on the provisions of the ACR program, so that optimization of CT-Scan image quality can be achieved.
 Place and Duration of Study: The Radiology Installation in Bali Mandara Hospital, between 23 March to 20 May 2022.
 Methodology: Data collection begins with preparing the equipment used, namely CT-Scan, head holder, phantom, and computer. After that, the head holder is placed in the middle of the gantry and then the phantom is placed with the guidance of the laser beam (alignment system). Set the axial beam on the vertical line of section 1 and then set the coronal beam on the horizontal line of section 2. After that, setting the type of examination using the adult head protocol and setting the scan parameters to 80 kV, 100 mAs, and slice thicknesses 1, 2, 3, 4, 6, and 8 mm. After the preparation is done then the next exposure to the phantom. Then the research data in the form of phantom images will be seen as a whole to program on the computer monitor. Measurements were made 5 times for each slice thickness. Next is to analyze the CNR of digital phantom image data on a computer. So that it can be determined object ROI, background ROI, object mean, background mean, and standard deviation of the background.
 Results: The results showed that the thicker the Slice Thickness, the higher the CNR and SNR values. The highest CNR value occurred in air medium (13.70) and the lowest occurred in Nylon (0.86). Likewise, the highest SNR value occurred in air medium (13.84) and the lowest in Nylon (0.99). The highest CNR and SNR values ​​occurred in air medium and the lowest occurred in Nylon. 
 Conclusion: Slice Thickness variations affect the spatial resolution of CT-Scan images as indicated by the CNR and SNR values however, the CNR and SNR values ​​are still above 1.0 for adult head examination and above 0.7 for children's head examination. So that the quality of CT-Scan images at Bali Mandara Hospital is still very good.

Determinants of Visitor Compliance Factors in the Implementation of Health Protocols in the Perinatology Room of Bali Mandara Hospital

The end of 2019 to the beginning of 2022, the world is experiencing major health problems with an incident that makes people nervous, namely a new virus known as Coronavirus Disease From 2019 (Covid-19). Compliance with the 5M health protocol is important to prevent transmission of the Covid-19 virus. The purpose of this study was to determine the determinants of factors related to visitor compliance in implementing health protocols in the Perinatology Room of Bali Mandara Hospital. This type of research is descriptive analytic with cross sectional approach. The sampling technique used is a non-probability sampling technique with a purposive sampling approach. The sample in this research is 56 respondents. The data collection instrument used in this study was a health protocol adherence questionnaire which was declared valid and reliable. Data were analyzed using Kruskall Wallis test for bivariate analysis and logistic regression test for multivariate analysis. Factors related to visitor compliance in implementing health protocols in the Perinatology Room of the Bali Mandara Hospital, namely age, gender and education.Based on the multivariate analysis, the most dominant factor was gender with an odds ratio of 32.018 which meant that there was a tendency for women to have compliance 32.018 or 32 times higher than men. People with the male gender need to increase adherence to implementing health protocols.

Clinical profile of patients with pseudoexfoliation glaucoma in Bali Mandara Eye Hospital from January to December 2022: a descriptive retrospective Study

Background: Pseudoexfoliative glaucoma (PEX glaucoma) is a type of secondary either open or closed-angle glaucoma that is characterized by the accumulation of flaky, whitish material on the surface of the eye. This material, known as pseudoexfoliative material (PEX), can clog the eye's drainage system, leading to increased intraocular pressure and eventual optic nerve damage if left untreated. This study aimed to describe the characteristic and management of PEXG in the Bali Mandara Eye Hospital Denpasar. Methods: A descriptive retrospective study was conducted in March-April 2023 using electronic medical records of PEXG patients in the Bali Mandara Eye Hospital Denpasar from January–December 2022. Results: There were 26 patients (37 eyes) diagnosed as PEXG; most of them were male (88.4%), aged 60-69 years old (34.4%), and followed by those in the range of age 70–79 years old (42.3%). Most of the cases were bilateral (59.5%) with a decrease of visual acuity of less than 3/60 (54%), an increase of intraocular pressure (IOP) with the majority in the range of 20-29 mmHg (35.1%), and 10-19 mmHg (29.8%), and followed by those who have a history of metabolic disease with Hypertension found on ten patients (38.4%) and Diabetes Mellitus on three patients (11.5%). The treatment combined several types of antiglaucoma medication and glaucoma surgery with patients who had undergone surgery in 19 eyes (51.3%). And the post-operative visual acuity was measured and showed the most favorable results, with normal eyes found in 14 eyes (73.6%). Conclusion: PEX Glaucoma is commonly found in elderly patients. At the same time, most patients come with high IOP and late stage of the disease. The most frequent treatment is triple procedure surgery which produces a significant visual acuity improvement.

Severe case of Streptococcus suis meningitis in Bali Mandara Hospital: a case report

Background: Streptococcus suis meningitis (SSM) is one of the zoonotic disease that can cause serious illness in humans. The major risk factor in many cases of SSM is associated with pig husbandry and consuming undercooked pork products. In Indonesia, especially in Bali, the cases of this acute bacterial meningitis has been strongly correlated with consuming Balinese traditional food called “red lawar”, a mixture of raw pork, fresh pork blood and traditional Balinese herbs. This study aims to report a case of SSM in Bali Mandara Hospital. Case description: A 63-year-old man admitted to the Emergency Department because of a decrease in consciousness (Glasgow coma scale 3/15). This patient was transferred from a private hospital with septic shock and suspicious to acute bacterial meningitis. He had other related symptoms like fever, headache, and cough since two days prior to admission. He also had a history of consuming “red lawar” 2 days before the symptoms appeared. Laboratory findings from cerebrospinal fluid analysis and septic marker indicate the patient had bacterial meningitis. The patient was initially started by Meropenem due to his septic shock. The broad spectrum antibiotics were then de-escalate to Ceftriaxone once the culture and sensitivity test completed and yielded Streptococcus suis. The course of Ceftriaxone as definitive therapy has been administered for 14 days and showed clinical improvement without specific sequelae related to SSM infection like hearing loss. Conclusion: Severe meningitis e.c Streptococcus suis leading to septic shock is a life threatening health condition. Adequate antibiotic therapy and multidisciplinary approach can reduce mortality and morbidity of this case.

Analisis Diagnostic Reference Level (DRL) Pasien Pada Pemeriksaan Abdomen Kontras dan Nonkontras Dengan Pesawat CT Scan Di RSUD Bali Mandara

In this study, data were obtained from 35 patients aged 27-76 years. The current used varies from 46-185 mAs and a constant tube voltage of 130 kV, with different clinical symptoms. The patient's DRL value on contrast and non-contrast abdominal examination was determined by calculating the third quartile value. On non-contrast abdominal examination, the DRL CTDIvol value was 10.62 mGy and the DLP DRL was 607.76 mGy.cm and on the non-contrast abdominal examination, the DRL CTDIvol value was 32.73 mGy and the DRL DLP value was 1825.10 mGy.cm. These results indicate that the DRL CTDI vol and DRL DLP values on contrast abdominal examination at Bali Mandara Hospital were still below the actor's limits set by BAPETEN, while on abdominal examination the DRL CTDI vol and DRL DLP values exceeded the limits set by BAPETEN. This is caused by exposure which is done three times. Therefore, it is necessary to restore both the Patient Operational Standards (SOP) and the exposure factor on an abdominal contrast CT scan at Bali Mandara Hospital.