General Hospital Denpasar Research Articles

Profile of Degenerative Spine Diseases at Prof. Dr. I.G.N.G. Ngoerah Central General Hospital Denpasar in 2022-2023

Background: Degenerative spine disease is a chronic condition with an increasing prevalence as age and life expectancy. There are approximately 266 million cases annually, with the highest incidence reported in Southeast Asia. In Indonesia, there is a lack of specific data on this disease. The Basic Health Research (Riskesdas) in 2018 only reported data on joint diseases in individuals aged ≥15 years, while the Ministry of Health Center for Data and Information (Pusdatin)’s publication in 2016 focused solely on osteoporosis. This study, conducted at Prof. Dr. I.G.N.G. Ngoerah Central General Hospital Denpasar, aims to determine the profile of degenerative spine disease at Prof. Dr. I.G.N.G. Ngoerah Central General Hospital Denpasar in 2022–2023 based on age, sex, BMI, occupation, and pathoanatomical location. Methods: This descriptive study included 164 samples collected from the Medical Records Department of Prof. Dr. I.G.N.G. Ngoerah Central General Hospital Denpasar over six months in 2024. Results: Among 164 medical records meeting the inclusion criteria, 55.5% of patients were classified as old age (65–90 years), and 50.6% were male. Approximately 29.3% of patients had obesity (BMI 25.0–29.9) and a normal BMI (18.5–22.9). Regarding occupation, 61% of patients had sedentary jobs, and 87.2% had degenerative spine disease primarily in the lumbar region. Conclusion: Most patients with degenerative spine disease were old age, predominantly male, with obesity and a normal BMI, engaged in sedentary occupations, and predominantly affected in the lumbar region. Keywords: Profile, degenerative spine disease, degenerative disease

Differences in Stride Length, Stance Width and Modified Harris Hip Score between Patients with Mild Limb Lengthening and Those Without Limb Lengthening at Three Months After Total Hip Arthroplasty at Prof. Dr. I G. N. G. Ngoerah General Hospital Denpasar

Differences in Stride Length, Stance Width and Modified Harris Hip Score between Patients with Mild Limb Lengthening and Those Without Limb Lengthening at Three Months After Total Hip Arthroplasty at Prof. Dr. I G. N. G. Ngoerah General Hospital Denpasar

Correlation Between Incidences of Preterm Premature Rupture of Membrane with Leukocyturia and Bacteriuria at Wangaya General Hospital

Prematurity or preterm birth can lead to perinatal and neonatal deaths. The leading cause of preterm labor is premature rupture of membranes. Infections are one of the leading causes of premature rupture of membranes, including urinary tract infections. This study aims to evaluate the correlation between bacteriuria and leukocyturia and the incidence of preterm premature rupture of membrane at Wangaya General Hospital Denpasar. This cross-sectional study used the target population of pregnant women undergoing treatment at Wangaya General Hospital. Sampling was carried out using the purposive sampling method. A total of 112 samples were enrolled in this study. Data was taken from the patient’s medical record from January 1, 2023, to December 31, 2023 and then analyzed. Based on the results, the mean age is 27.43 ± 5.95 years. The bivariate analysis showed significant results with an OR of 2.485; CI 95% 1.120–5.510; p = 0.024 for bacteriuria and OR 4.697; CI 95% 1.903–11.595; p < 0.001 for leukocyturia. Furthermore, the multivariate analysis obtained significant results for the leukocyturia variable with an adjusted OR value of 4.697; CI 95% 1.903–11.595; p = 0.001. Therefore, it can be concluded that positive bacteriuria and leukocyturia increase the risk of pregnant patients experiencing preterm PROM.

High C-Reactive Protein Serum Levels as a Risk Factor for Preeclampsia

Introduction: Preeclampsia is a hypertensive syndrome in pregnancy characterized by increased blood pressure, proteinuria, and complications such as liver dysfunction and visual impairment. This condition is associated with an inflammatory reaction and failure of trophoblast invasion of maternal arteries, which involves an increase in proinflammatory cytokines that indirectly induce CRP production. However, data showing the value of CRP levels as an indicator of the incidence of preeclampsia in Indonesia is minimal. This study aims to evaluate CRP levels as a predictor of preeclampsia.Methods: This case-control study involved pregnant women with preeclampsia and normal pregnant women who went to the Obstetric Emergency Installation at Prof. Hospital. Dr. I.G.N.G Ngoerah Denpasar. All data were obtained from patient medical records and then analyzed using the SPSS v.22.Results: This study involved 56 pregnant women consisting of 28 normotensive pregnant women (control) and 28 pregnant women with preeclampsia (cases) at Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar from January to December 2023. The median age was 27.5 years (control) and 26.0 years (cases), with an age range of 18–40 years. The median BMI WAS 21.65 kg/m2 (controls) and 21.80 kg/m2 (cases). Most patients in both groups were nulliparous (50.0%, controls; 42.9%, cases). Based on ROC analysis, the CRP cut-off value of 7.76 mg/dL has a sensitivity of 76.7%, specificity of 78.6%, and an area under the curve (AUC) of 0.737, where pregnant women with high CRP (≥7.76 mg/dL) had a 12.048-fold higher risk (95%CI 3.496–41.515; p < 0.001) of experiencing preeclampsia compared to pregnant women with low CRP levels.Conclusion: High serum CRP levels are a risk factor for preeclampsia. These findings indicate that measuring CRP levels can be a potential tool for identifying the risk of preeclampsia in the pregnant population.

Overview of Acute Kidney Injury (AKI) in the Intensive Care Unit: Observational Study at Prof. Dr. I.G.N.G Ngoerah General Hospital, Denpasar, Indonesia

Introduction: Acute kidney injury (AKI) is a serious clinical syndrome with complications that can be life-threatening. AKI is associated with increased length of stay and mortality in patients in the intensive care unit (ICU). This study aims to determine the incidence and characteristics of AKI in ICU patients at Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar. Methods: This descriptive observational research was conducted by collecting data from medical records of ICU patients for three months. Data were analyzed to determine the incidence of AKI, stage of severity, and mortality rate. Results: Of the 388 patients treated in the ICU, 87 (22.37%) experienced AKI. The mortality rate in AKI patients was 12.9% (n=50). A total of 11.05% (n=25) of AKI patients were classified as stage 1, 5.91% (n=17) as stage 2, and 5.40% (n=8) as stage 3. Conclusion: The incidence of AKI in the ICU of Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar. is quite high (22.37%). AKI is associated with a significant mortality rate (12.9%). This study provides a preliminary description of the incidence and characteristics of AKI in the ICU of this hospital, which may be useful for improving the quality of patient care and prevention of AKI.

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.

INCIDENCE OF HYPOTENSION AND NAUSEA VOMITING IN SUBARACHNOID BLOCK ANESTHESIA TECHNIQUE IN CESAREAN SURGERY

Hypotension and nausea vomiting are common side effects in patients undergoing cesarean surgery with subarachnoid block anesthesia techniques. Cases of hypotension and nausea vomiting in this case are often found but research data in Indonesia, especially in Bali, is still very limited. Therefore, this research is important to do with the aim of knowing the incidence of hypotension and nausea vomiting in cesarean surgery with the subarachnoid block anesthesia technique at Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar. This study used a prospective cross-sectional observational descriptive method. The study data were taken from the presence or absence of hypotension and nausea vomiting during and after cesarean surgery from April 2022 – June 2022. The data were analyzed using Microsoft Excel 2013 software to obtain characteristics of patient demographic data in the form of maternal age and gestational age, patient distribution based on height of sensory blockade, type and dose of antiemetics, type and dose of opioids, bleeding, incidence of hypotension, and incidence of nausea vomiting. The results showed that the number of patients who experienced hypotension was 13 people (28.3%), and those who did not experience hypotension were 33 people (71.7%). A total of 30 people (65.2%) patients did not experience nausea vomiting, 8 people (17.4%) experienced nausea and 8 people (17.4%) experienced vomiting. By taking good precautions, it can reduce the side effects of hypotension and nausea vomiting.

An overview of treatment for atrial septal defect with pulmonary hypertension

Background: Atrial Septal Defect (ASD) is a congenital heart defect which can be the cause of comorbidities in the form of Pulmonary Arterial Hypertension (PAH) and therapy cannot be done simply by correcting the ASD but requires further study and evaluation.Purpose: Describe the treatment given to patients with ASD and PAH and the correlation between the administration of interventional therapy and the patient's probability of PH.Method: This study is a descriptive quantitative using a cross-sectional research design. The sampling technique was total sampling method. The samples were 41 ASD patients with PAH at Prof. Ngoerah General Hospital in Denpasar in 2022. Patients under 18 years of age and those with other congenital heart disease will be excluded. The demographic characteristics assessed were the patient's age and gender. The therapy data included information on medical therapy and intervention therapy.Results: Focus of medical therapy was supportive therapy rather than specific PAH therapy. Percutaneous ASD closure was the most widely-used intervention therapy compared to surgical ASD closure. Based on statistical analysis, the p value > 0.05 is 0.284, so there is no significant correlation between the probability of the patient's pH and the provision of intervention therapy.Conclusion: At Prof Ngoerah General Hospital Denpasar, the majority of ASD patients with complications of pulmonary hypertension were females aged between 21 to 30 years. The medical therapy given is adjusted based on the severity of PH as assessed through echocardiography examination. Majority of patients received supportive therapy compared to specific therapy for PAH. Medical therapy is prioritized for patients who have contraindication criteria for interventional therapy. Percutaneous ASD Closure was found to be the largest percentage in interventional therapy regardless of the severity, except for patients who were indicated to undergo surgical ASD closure. There is no significant relationship between the patient's PH probability level and the choice of intervention therapy.

Survival Analysis of Triple Negative Breast Cancer Patients Based on Ki-67 Protein Expression in Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar

Aim: To prove that 2-year mortality of triple-negative breast cancer (TNBC) patients with protein Ki-67 expression ≥ 40% is higher than patients with protein Ki-67 expression < 40% in Prof. dr. I.G.N.G. Ngoerah General Hospital Denpasar. Methods: This was a bidirectional cohort study with survival analysis. The end of follow-up was the mortality state (survived or deceased) of patients observed for 24 months (2 years) since the patient was diagnosed with TNBC. This study was conducted in the Surgical Oncology Department, Prof. dr. I.G.N.G. Ngoerah General Hospital Denpasar from January 2018 until January 2022. The sample was recruited by a consecutive sampling method. The Kaplan-Meier curve and log-rank test determined overall survival (OS) and its difference between the Ki-67 expression group. Multivariate analysis using Cox regression was also conducted. Results: 58 TNBC patients were included in this study. At the end of the study, 31 patients survived, with an OS of 53.4%. The mean OS time was 19 months (95%CI = 17.12-20.88). The two-year OS of TNBC patients with Ki-67 ≥ 40% group was 37.5%; meanwhile, in Ki-67 expression < 40% was 88.9%. It was statistically significant (p = 0.001). Multivariate analysis revealed that Ki-67 ≥ 40% expression was a significant and independent predictor factor for a high 2-year mortality rate (adjusted HR = 9.140; p = 0.008). Tumor-resection history also had a significant result in multivariate analysis (p < 0.05). Conclusion: TNBC patients with Ki-67 ≥ 40% have a higher 2-year mortality rate than patients with Ki-67 expression < 40%.

Analysis of Determinant Factors of Hyperemesis Gravidarum in 1st Trimester Pregnant Women at Prima Medika General Hospital Denpasar, Bali

Hyperemesis gravidarum is excessive nausea and vomiting that can disrupt daily activities and endanger the health of pregnant women. The cause of hyperemesis gravidarum is currently unknown. This study aimed to analyse the determinant factors for the incidence of hyperemesis gravidarum in first-trimester pregnant women at Prima Medika General Hospital Denpasar, Bali, for the period January 2023 – July 2024. The design of this research was cross-sectional. The number of samples was 60 first-trimester pregnant women. The data was collected from the medical records of Prima Medika General Hospital Denpasar. Data analysis uses Chi-Square analysis. The results of the study showed that there was an influence of several variables on the incidence of hyperemesis gravidarum, namely maternal age (p-value = 0.02, OR: 10.7), anemia (p-value = <0.001, OR: 45.0), history of gastritis (p = 0.017, OR: 4.3), while the variables gravida (p-value = 0.301), education (p-value = 0.299) and mother’s occupation (p-value = 0.195) do not affect the incidence of hyperemesis gravidarum in first-trimester pregnant women. Suggestions for pregnant women can increase their knowledge about hyperemesis gravidarum so that more serious and dangerous complications do not occur.

Characteristic of Subcutaneous Mycosis Patients at Prof. Dr. I.G.N.G Hospital, Denpasar, Bali: An Observational Retrospective Study

Introduction: Subcutaneous mycosis infections can occur in tropical and subtropical countries. Indonesia’s geographic location is in a tropical country and is a developing country with the majority of its population working in agriculture, which is a risk factors associated with subcutaneous mycosis. Methods: This is a retrospective observational descriptive study with a cross-sectional design. Data were obtained through medical records from all patients who came for treatment in Prof IGNG Ngoerah General Hospital Denpasar from January 2018 to December 2023. The inclusion criteria in this study were all patients diagnosed with subcutaneous mycosis. The variables studied were age, gender, occupation, comorbidities, first symptoms, skin efflorescence, dermatoscopy finding, and type of mycosis based on yeast culture. Results: A total of 21 cases of subcutaneous mycosis within 5 years. The majority of patients were female, (67%), with the most common age group being 45-64 years (57%). Based on occupation, farmers account for at most (33%). The majority of patients had itchiness (33%) and redness (33%) as the first symptoms, nodule erythema was the most common skin efflorescence (57%), and the most common dermatoscopy finding was yellow dots (57%). The most common fungal infection based on culture was chromoblastomycosis (71%). Conclusion: The majority of patients of subcutaneous mycosis were female, with age group 45-64 years old, and farmers. Itchiness and redness were the common symptoms of the disease. On examination, nodule erythema is the most common skin efflorescence. Chromoblastomycosis was the most common type of infection.

Correlation of systemic immune-inflammation index with immature to total neutrophil ratio (IT Ratio) in septic neonates admitted to Wangaya Regional General Hospital Denpasar

Introduction: Early diagnosis and management of neonatal sepsis plays an important role in determining patient outcomes. The Immature to Total Neutrophil Ratio (IT ratio) is one of the diagnostic criteria for neonatal sepsis. However, the IT ratio examination is separate from the complete blood examination, and must be carried out manually or with an automatic microscope. The systemic immune-inflammation index (SII) is calculated by multiplying the number of platelets by the number of neutrophils and dividing by the number of lymphocytes derived from the complete blood count (CBC) examination. Recent studies have shown that SII values increase significantly at the time of diagnosis of neonatal sepsis. This study aims to find the correlation between the IT ratio and SII in septic neonates. Methods: This cross-sectional analytical observational study was conducted at the Wangaya Regional General Hospital, Denpasar. Data was taken from medical records of patients admitted from June 2022 to September 2023. Neonates with major congenital abnormalities, autoimmune diseases, immunodeficiency conditions and incomplete medical record data were excluded from the study. The correlation between the SII value and the IT ratio was analyzed using the Pearson correlation test. Data analysis was carried out using the SPSS version 25 software. Results: This study consisted of 31 septic neonates who met the inclusion and exclusion criteria. Most of the subjects in this study were male and preterm neonates. The median IT ratio and SII were 0.20 and 875.92 x103/ul respectively. The correlation value or r value between SII and the IT ratio was 0.386 with a P value of 0.060. Conclusion: Increased SII in septic neonates occurs due to thrombocytosis and neutrophilia as a response to systemic inflammation. Meanwhile, lymphocyte activation is inhibited which causes a decrease in immune function. Although no correlation between the IT ratio and SII was observed, further diagnostic research needs to be carried out to analyze the ability of SII to diagnose neonatal sepsis.

Relationship between physical activity and who assist scores in substance addiction clients at the addiction Polyclinic of Prof Ngoerah General Hospital Denpasar

Drug abuse which includes narcotic, psychotropic, and addictive substances can affect the central nervous system function. Substances are often abused because of the pleasurable and calming effects of their use. Physical activity is said to have the potential as an adjunct therapy for substance addiction disorders. The purpose of the study was to determine the relationship between physical activity and WHO ASSIST scores in substance addiction clients. This study used a cross-sectional design on substance addiction clients undergoing treatment at the Addiction Polyclinic of Prof Ngoerah General Hospital Denpasar. Physical activity score checks were conducted using GPAQ questionnaires and WHO ASSIST scores. Data collection to patients as research subjects was carried out after obtaining informed consent. After data collected, the next stages was data analysis using SPSS, with descriptive statistical analysis, normality test and spearman correlation test. From 30 samples, an average GPAQ score of 2099.33 ± 2225.32 was obtained. The average WHO ASSIST score for each substance was highest in tobacco 15.57 ± 8.98 and lowest in hallucinogen 0.70 ± 1.664.

Analisis Perhitungan Nilai Rata-Rata Pergeseran Verifikasi Geometri Menggunakan EPID Pada Pasien Kanker Payudara Di Sub Instalasi Radioterapi RSUP Prof. Dr. I.G.N.G Ngoerah

Breasts are organs that play a role in the lactation process. In men, this organ does not develop and does not have a function in the lactation process like in women. According to. cancer is characterized by the growth of abnormal cells beyond normal limits and can attack adjacent parts of the body or metastasize to other organs which can result in death for the sufferer. Cancer is also called malignant tumor and neoplasm. Breast cancer sufferers often find out about their disease too late, so they come to the hospital when it is in the final stage. Early detection is very necessary so that breast cancer sufferers can be treated more quickly. The prevalence of cancer in Bali Province in 2018 was 2.3 per 1000 population. This incidence increased compared to the 2013 Riskesdas results of 2.0 per 1000 population (Riskesdas, 2018). The total number of breast cancer cases recorded in the Medical Records Installation at Sanglah General Hospital Denpasar for the period 1 January – 31 December 2022 and which met the inclusion criteria was 70 people with a monthly average of 5.83%, around 6 patients. Inclusion criteria are breast cancer patients with stage II-IV and who have had a mastectomy. Based on a report from the Bali Province Integrated Disease Survey, it was found that the incidence of breast cancer in 2019 was 437 cases. especially in Denpasar City, the incidence of breast cancer was 293 cases. Denpasar City is an area that has the highest incidence of breast cancer in Bali.

Herpes zoster and postherpetic neuralgia progression rate: an epidemiological study at Tertiary Hospital in Bali, Indonesia

Link of Video Abstract: https://youtu.be/bmHkb4pnp9I Background: Herpes zoster is an infectious disease caused by the reactivation of the latent varicella zoster virus. One of the complications that has the potential to cause long-term problems is post-herpetic neuralgia. This study aims to evaluate the Herpes zoster and postherpetic neuralgia progression rate: an epidemiological study at Tertiary Hospital in Bali, Indonesia Methods: This is a retrospective descriptive cross-sectional study. The data was obtained from the patient's medical records in Dermatovenereology Clinic at Sanglah General Hospital Denpasar from January 2020 to December 2021. The samples were all new patients diagnosed with herpes zoster and post-herpetic neuralgia. The variable is sex, age, occupation, comorbid, and location. Data were analyzed using SPSS version 25.0 for Windows. Results: A total of 23 new patients were diagnosed with herpes zoster and the total visit was 132. Most patients were male 12 (52.3% vs 47.7%). The highest age group was more than 65 years old with 12 (51.5%) patients, followed by 45-64 years with 8 (35.6%) patients. The lesion location in most patients was thoracic in 9 patients (38.1%), followed by cervical in 7 patients (29.5%), lumbar in 6 patients (25.8%), and ophthalmic in 1 patient (6.6%). Six patients (26.0%) had comorbid diseases. Ten patients experienced PHN. Conclusion: Most herpes zoster patients in Dermatovenereology Clinic, Sanglah Hospital from January 2020 to December 2021 were more than 65 years old, predominantly male sex, with the most common location of herpes zoster in the thoracic region 9 patients (38.1%), and 10 patients (43.5%) had PHN.

Clinico-Pathological Characteristics of Penile Cancer Patients at Sanglah General Hospital Denpasar, Bali between 2013-2020

Aim: To know prevalence and clinico-pathological characteristic of penile cancer patients at Sanglah General Hospital Denpasar between 2013 until 2020 or for 7 years periode. Methods: A cross-sectional study to collect retrospective data of penile cancer patients at Sanglah Genaral Hospital from medical records between August 2013 until August 2020. Demographics data consisted of age group and patient’s origin, meanwhile histopathological data included pathological staging, histological subtype, grading, and lymphovascular invasion. Results: 96 penile cancer patients were collected for 7 years. The highest incidence was in 2020. Mean age was 57.60 ± 12.28 years old which dominantly in 60–69 years old groups. Most of patients origin from the rural area. The highest proportions were T3 stage (41,7%), N0 stage (38,5%), M0 stage (94,7%), SCC subtype (89,6%), G2 grade (71,9%), and LVI negative (65,4%). Conclusion: The prevalence of penile cancer patients are fluctuating but tended to increase since 2017. The peak incidence was in 60-69 years old group and from the rural area. Based on TNM staging system, the highest proportion was T3, N0, M0 and G2.

Characteristics of Patient atRinology Divison of Ear, Nose, and Throat Polyclinic in Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar in1 January 2020 –31 December 2021

Rhinology-related diseases are very common worldwide. Although not fatal, they may cause significant morbidity and reduce quality of life. We ai0med to describe the characteristics of patients in the rhinology division at the eye, nose and throat (ENT) Polyclinic, Prof. Hospital. Dr. I.G.N.G Ngoerah Denpasar in the period 1 January 2020 to 31 December 2021. It was a retrospective descriptive study which conducted in the rhinology division of the ENT Polyclinic, Prof. Hospital. Dr. I.G.N.G Ngoerah Denpasar from 1 January 2020 to 31 December 2021. A total of 752 patients underwent outpatient care during the period January 1, 2020, to December 31, 2021. Various rhinology cases found included inferior turbinate hypertrophy, nasal septum deviation, allergic rhinitis, bullous turbinate, nasal polyps, maxillary sinusitis, ethmoidal sinusitis, frontal sinusitis, sphenoidal sinusitis and pansinusitis. The most common diagnosis is inferior turbinate hypertrophy, and the least is frontal sinusitis. Inferior turbinate hypertrophy is commonly found in men and at the age of 41-50 years. The similar results also found in other cases, where it is more commonly found in men and at the age of 31-50 years. These results may contribute as a basic information to provide health care in general and to develop prevention strategy related to rhinology disease.

Characteristic of Anatomical Variations in Paranasal Sinus CT-Scan of Chronic Rhinosinusitis Patients at the ENT Clinic Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar in 2021

Background: Anatomical variations and pathological processes in the nose and paranasal sinuses have been widely studied by experts. Many anatomical variations cause chronic sinusitis by causing obstruction of the osteomeatal complex (OMC) and influencing mucociliary transport patterns. Methods: This is a retrospective study based on radiology data of all rhinosinusitis cases that performed a computed tomography scan of the paranasal sinuses at Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar for one year (January 2021 to December 2021). The sample of this study was all rhinosinusitis patients undergoing surgery, both male and female, from January 1 to December 31, 2021. Results: Based on the results of the research data, the highest anatomical variation was concha hypertrophy in as many as 26 people (38.2%). Conclusion: The most common anatomic variation is concha hypertrophy. Preoperative CT scan examination is essential because it can be helpful as navigation for sinus surgeons. Early detection of anatomic variations is the key for surgical planning and the prevention of complications.

Correlation of Total Protein in Cerebrospinal Fluid with the Type of Guillain-Barre Syndrome based on the Electrodiagnostic Examination at Prof. Dr. IGNG Ngoerah General Hospital Denpasar

Introduction: Guillain-Barre syndrome (GBS) is an autoimmune disease of the peripheral nervous system with an incidence of around 0.6 to 2.4 cases per 100,000 population. GBS pathogenesis is related to inflammatory factors, cytokines, chemokines, and complement. Protein levels in the cerebrospinal fluid of GBS patients will increase due to damage or increased permeability of the blood-nerve barrier and blood-cerebrospinal fluid (CSF) barrier. However, there are still pros and cons to the relationship between the amount of CSF protein and the subtype of GBS. Objective: To determine the most common GBS subtype and the characteristics of electrodiagnostic examination at Prof Dr IGNG Ngoerah General Hospital and the relationship between the GBS subtype characteristics on electrodiagnostic examination and CSF protein levels. Methods: This study used an analytic observational study with a cross-sectional study design with consecutive sampling. The sample of this study is 42 GBS patients (21 patients with normal total protein and 21 patients with increased total protein) at Prof Dr IGNG Ngoerah General Hospital, Denpasar-Bali. Data is collected through medical records and analyzed by Chi-Square test. Results: There is no correlation between the increase in total CSF protein in GBS patients and the GBS subtype on electrodiagnostic examination (p=0.215). Discussion: The most common GBS subtype is the AIDP type. Although the average amount of CSF protein was higher in the AIDP, AMAN and AMSAN subtypes respectively, the increase in total CSF protein did not have a significant relationship to the GBS subtype in Prof Dr IGNG Ngoerah General Hospital, Denpasar-Bali. Keywords: Guillain-Barre syndrome, autoimmune, total protein, cerebrospinal fluid, AIDP, AMAN, AMSAN

Psycho-Social Impact of Stigmatization against Pregnant Women with HIV

Background: Stigmatization, discrimination, and poor social support are challenges faced by people living with HIV, and the stigmatization of pregnant women with HIV is still very frequent, which can have a profound negative impact on patient's health. This can have a psychosocial impact on the sufferer. Objective: To study and determine the psychosocial impact of discriminatory behavior towards pregnant patients with HIV. Methods: This is a case report of two cases of pregnant women with HIV at the Voluntary Counseling and Testing (VCT) Polyclinic of RSUP Prof. Dr. I.G.N.G. Go to Denpasar. In-depth interviews were conducted with them regarding their views on openness to their families and communities about their condition. Results and Discussion: It was reported that two cases of pregnant women with HIV who were carrying out antenatal care in the Obstetrics and Gynecology Polyclinic Room, Prof. dr. I.G.N.G Ngoerah Central General Hospital Denpasar. In both cases, discriminatory treatment and stigma still strongly haunt the sufferers even though the form and source are slightly different. In the first case, the patient was afraid of getting discriminatory treatment and stigmatization that came from the family environment and the wider environment. Meanwhile, in the second case, it shows that the discriminatory treatment that causes stigma does not only come from far away but also comes from the people themselves. Both have a psychosocial impact that creates a sense of social discomfort, even though the race is slowly diminishing with the assistance of a counselor. There is a need for a wide range of active education by health workers to the patient's family and the community in reducing the stigma and discrimination against pregnant women with HIV. Conclusion: Women with HIV, especially those who are pregnant, are still full of negative judgments, and discriminatory behavior towards them. This can cause psychosocial impacts on patients. The disparity between knowledge about unknown patterns of HIV transmission on the one hand and risky sexual behavior, on the other hand, can be one of the risk factors for contracting HIV. This also contributes to stigma and discrimination against pregnant women with HIV.