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"ABSTRACTA 59-year-old lady with underlying hypothyroidism presented with acute contact dermatitis progressed to cellulitis with superimposed bacterial infection and acute kidney injury. She responded to initial management with antibiotics, but a week later, she had cutaneous and systemic vasculitis. Her skin biopsy consistent with immune-mediated leuko-cytoclastic vasculitis and her blood test was positive for cytoplasmic-anti-neutrophil cytoplasmic antibody (c-ANCA). A diagnosis of ANCA-associated vasculitis was made and she was treated with immunosuppressant with plasmapheresis and hemodialysis support for her kidney failure. Despite aggressive measures, the patient succumbed to her illness. This case report demonstrates that soft tissue infection could trigger the development of ANCA-associated vasculitis whilst a background of hypothyroidism serves as a predisposing factor as both condition were reported separately in a couple of case studies before."

"The prompt diagnosis of systemic vasculitis is essential as a missed diagnosis can be disastrous. Imaging is of vital importance in achieving a correct diagnosis and in some cases also plays a role in endovascular treatment. In this book, the imaging features of the many different types of vasculitis are clearly demonstrated by means of numerous high-quality illustrations. All relevant imaging modalities are considered, and key distinctive characteristics are highlighted. In addition, each chapter discusses the etiology, epidemiology, pathogenesis, clinical presentation, biology, and treatment of the vasculitis in question. This book is the result of cooperation between expert teams from a range of countries. The wealth of illustrations and informative clinical case studies will prove invaluable for all who may be confronted with these problematic disorders."

"Vasculitis is an inflammation of the blood vessel accompanied by the presence of leukocytes on the vascular wall, followed by structural damage. It often involves the liver and gastrointestinal system, with manifestations of hematemesis and melena. We report a case of hematesis and melena due to leukocytoclastic vasculitis due to the use of antibiotics."

"Incontinence-Associated Dermatitis (IAD) merupakan peradangan pada kulit ketika urin dan feses bersentuhan dengan kulit perianal atau perigenital. Berbagai intervensi dilakukan untuk menjaga integritas kulit pada lansia salah satunya dengan penggunaan spray skin barrier yang bertujuan sebagai pelindung dari stratum korneum yang mulai mengalami penurunan pada lansia. Studi kasus ini bertujuan untuk menganalisis penerapan penggunaan spray skin barrier terhadap pencegahan Incontinence-Associated Dermatitis (IAD) pada lansia. Penelitian ini menggunakan desain penelitian studi kasus (case study) yang melibatkan tiga kasus kelolaan. Intervensi dilakukan dengan penggunaan no-sting barrier film dan melakukan monitoring harian menggunakan The Ghent Global IAD Monitoring Tool (GLOBIAD-M). Hasil intervensi memperlihatkan bahwa terjadinya penurunan tanda dan gejala IAD pada kulit lansia. Penelitian ini diharapkan dapat berguna menjadi sumber pengetahuan perawat dalam menerapkan intervensi perawatan integritas kulit dalam pencegahan IAD.

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Incontinence-Associated Dermatitis (IAD) is inflammation of the skin when urine and feces come into contact with perianal or perigenital skin. Various interventions are carried out to maintain skin integrity in the elderly, one of which is the use of spray skin barrier which aims to protect the stratum corneum which begins to decline in the elderly. This case study aims to analyze the application of the use of spray skin barrier to prevent Incontinence-Associated Dermatitis (IAD) in the elderly. This study used a case study research design involving three managed cases. Intervention is carried out by using no-sting barrier film and conducting daily monitoring using The Ghent Global IAD Monitoring Tool (GLOBIAD-M). The results of the intervention showed that there was a decrease in signs and symptoms of IAD in the skin of the elderly. This research is expected to be useful as a source of knowledge for nurses in implementing skin integrity care interventions in the prevention of IAD."

"Malnutrisi sering ditemukan pada pasien stroke. Malnutrisi dapat menyebabkan komplikasi seperti pneumonia, perdarahan gastrointestinal, mengurangi perbaikan fungsional dan memperpanjang lama rawat. Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan malnutrisi pada pasien stroke. Penelitian ini merupakan penelitian kuantitatif dengan desain deskriptif analitik menggunakan pendekatan Cross Sectional yang melibatkan 106 responden. Analisis data menggunakan Mann Withney, Chi-Square dan regresi logistik prediktif. Hasil penelitian menunjukkan bahwa sebagian besar pasien mengalami malnutrisi ringan (86,8%). Hasil penelitian menunjukkan terdapat hubungan antara stroke berulang (p=0,012), DM (p=0,037), penggunaan NGT (p=0,037), depresi (p=0,016) dan dukungan keluarga (p=0,001), dimana dukungan keluarga merupakan faktor yang paling berhubungan dengan malnutrisi pada pasien stroke (OR=8,699). Namun tidak terdapat hubungan antara usia (p=0,733), jenis kelamin (p=1,000) dan penerimaan penyakit (p=0,136) dengan malnutrisi pada pasien stroke. Perawat dianjurkan melakukan pengkajian faktor yang berhubungan dengan malnutrisi pada pasien stroke untuk mencegah komplikasi malnutrisi.

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Malnutrition is often found in stroke patients. Malnutrition may cause complications such as pneumonia, gastrointestinal bleeding, reduce functional improvement and prolong the length of stay. This study aimed to determine the factors associated with malnutrition in stroke patients. This research is a quantitative research with descriptive analytic design using a Cross Sectional approach involving 106 respondents. Data analysis used Mann Whitney, Chi-Square and predictive logistic regression.

The results showed that the majority of patients experienced mild malnutrition (86.8%). The results showed that there was a relationship among recurrent strokes (p = 0.012), DM (p = 0.037), NGT (p = 0.037), depression (p = 0.016) and family support (p = 0.001), where family support was the most factor associated with malnutrition in stroke patients (OR = 8,699). But there was no relationship between age (p = 0.733), sex (p = 1,000) and acceptance of illness (p = 0.136) with malnutrition in stroke patients. Nurses might be recommend to assess malnutrition factors in stroke patients to prevent complications of malnutrition. Nurses might be recommend to assess factors related to malnutrition and motivate families to provide support to stroke patients to prevent complications of malnutrition."

"Latar Belakang: Penyakit paru interstisial (ILD) merupakan salah satu manifestasi sklerosis sistemik (SSc) pada paru dan faktor mortalitas utama SSc. SSc-ILD meningkatkan angka mortalitas 5 tahun pasien SSc sebesar 3 kali lipat. Hampir dua pertiga pasien SSc-ILD dengan kelainan minimal pada high resolution computed tomography (HRCT) toraks memperlihatkan progresivitas signifikan dalam 2 tahun. Model prediksi progresivitas SSc-ILD yang tersedia, yakni GAP (gender, age, and lung physiology) dan SADL (smoking history, age, and diffusion capacity of the lung), terbukti memiliki nilai prognostik yang baik. Model prognostik yang melibatkan parameter HRCT toraks dan Modified Rodnan Skin Score (mRSS) diharapkan dapat membantu seleksi pasien SSc-ILD yang memerlukan pemantauan ketat atau terapi dini untuk mencegah progresivitas.Metode: Studi ini melibatkan pasien SSc-ILD yang menjalani pemeriksaan HRCT toraks awal dan evaluasi di Rumah Sakit Umum Pusat Nasional Dokter Cipto Mangunkusumo pada periode Januari 2016 hingga Desember 2021. Dilakukan volumetri kuantitatif menggunakan piranti lunak 3DSlicer® pada HRCT toraks awal untuk menghasilkan persentase volume paru abnormal, high attenuation area (HAA), dan low attenuation area (LAA) yang selanjutnya dianalisa sebagai faktor prognostik. Pola ILD pada HRCT toraks awal dan nilai mRSS masing-masing subyek diidentifikasi dan dianalisa sebagai faktor prognostik progresivitas SSc-ILD. Progresivitas SSc-ILD dikategorikan menjadi progresif dan non-progresif berdasarkan selisih persentase volume paru abnormal antara HRCT toraks awal dan evaluasi.Hasil: Perbedaan rerata yang bermakna ditemukan pada volume paru abnormal, volume HAA, dan volume LAA, nilai mRSS antara SSc-ILD progresif dan non-progresif (p < 0,001). Berdasarkan receiver operating characteristic curve, ditetapkan nilai titik potong dari masing-masing variabel. Nilai titik potong persentase volume paru abnormal ditetapkan sebesar 32,82% dengan nilai sensitivitas 100% dan spesifisitas 93,8%. Nilai titik potong persentase volume HAA ditetapkan sebesar 19,76% dengan nilai sensitivitas 93,8% dan spesifisitas 93,8%. Nilai titik potong persentase volume LAA ditetapkan sebesar 9,89% dengan nilai sensitivitas 62,5% dan spesifisitas 62,5%. Nilai titik potong mRSS ditetapkan sebesar 18,5 dengan sensitivitas 93,8% dan spesifisitas 100%. Tidak ada perbedaan proporsi pola ILD antara kedua kelompok tersebut (p 0,220).Kesimpulan: Volume paru abnormal > 32,82%, volume HAA > 19,76%, volume LAA > 9,89%, dan/atau nilai mRSS > 18,5 merupakan prediktor progresivitas SSc-ILD. Hasil volumetri kuantitatif abnormalitas paru pada HRCT toraks dan nilai mRSS merupakan faktor prognostik progresivitas SSc-ILD yang mudah diperoleh dan diaplikasikan dalam praktik klinis sehari-hari.

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Background: Interstitial pulmonary disease (ILD) is one of the manifestations of systemic sclerosis (SSc) in the lungs and the main mortality factor of SSc. SSc-ILD multiplies the 5-year mortality rate of SSc patients by 3 times. Nearly two-thirds of SSc-ILD patients with minimal abnormalities in chest high resolution computed tomography (HRCT) showed significant progressivity within 2 years. The available prediction models of SSc-ILD progression, namely GAP (gender, age, and lung physiology) and SADL (smoking history, age, and diffusion capacity of the lungs), have been proven to demonstrate excellent prognostic values. Prognostic models involving chest HRCT parameters and Modified Rodnan Skin Score (mRSS) are expected to aid the selection of SSc-ILD patients who require close monitoring or early therapy to prevent progression.

Method: This study involved SSc-ILD patients who underwent initial and follow-up chest HRCT examination and evaluation at the National Central General Hospital of Doctor Cipto Mangunkusumo in the period from January 2016 to December 2021. Quantitative volumetric measurement was performed using 3DSlicer® software on the initial chest HRCT to yield abnormal pulmonary volume, high attenuation area (HAA) volume, and low attenuation area (LAA) volume percentage which were subsequently analyzed as prognostic factors. ILD patterns in the initial chest HRCT and mRSS values of each subject were identified and analyzed as prognostic factors of SSc-ILD progression. The progression of SSc-ILD is classified into progressive and non-progressive based on the abnormal pulmonary volume percentage difference between the initial and follow-up chest HRCT.

Result: Significant mean differences were found in abnormal lung volume percentage, HAA volume percentage, LAA volume percentage, and mRSS values between progressive and non-progressive SSc-ILD groups (p < 0.001). Based on the receiver operating characteristic curve, the cut-off point value of each variable is determined. The cut-off point value of the percentage of abnormal pulmonary volume was set at 32.82% with a sensitivity value of 100% and a specificity of 93.8%. The cut point value of the HAA volume percentage was set at 19.76% with a sensitivity value of 93.8% and a specificity of 93.8%. The LAA volume percentage cut point value was set at 9.89% with a sensitivity value of 62.5% and a specificity of 62.5%. The mRSS cut-off value was set at 18.5 with a sensitivity of 93.8% and a specificity of 100%. There was no significant in the proportion of ILD patterns between the two groups (p 0.220).

Conclusion: Abnormal lung volume > 32.82%, HAA volume > 19.76%, LAA volume > 9.89%, and/or mRSS value > 18.5 are predictors of SSc-ILD progression. Quantitative volumetric results of pulmonary abnormalities in chest HRCT and mRSS values are prognostic factors of SSc-ILD progression that are easily obtained and applied in daily clinical practice."

"Latar Belakang: Faktor transkripsi Hypoxia inducible factor-1 (HIF-1 merupakanpengatur utama hipoksia, termasuk menyebabkan penekanan sistem perbaikan deoxyribose nucleic acid (DNA), sehingga menghasilkan instabilitas genetik pada sel kanker. Varian genetik HIF-1α C1772T (P582S) dan G1790A (A588T) dipercaya mempunyai aktivitas transkripsi yang lebih tinggi.Peranan polimorfisme HIF-1α ini sudah diteliti pada beberapa jenis kanker seperti kanker ginjal, payudara, ovarium, tetapi belum ada penelitian pada kanker paru. Metode: Polimorfisme HIF-1α diperiksa dengan menggunakan direct sequencing dengan total sampel 83 pasien kanker paru (42 adenokarsinoma, 30 skuamous sel karsinoma, empat adenoskuamous sel karsinoma dan tujuh kanker paru karsinoma sel kecil (KPKSK) dan 110 subjek sehat sebagai kontrol. Hubungan polimorfisme HIF-1α dengan kelainan genetik/epigentik loss of heterozygot (LOH) TP53, LOH 1p34, LOH retinoblastoma-1 (RB1), inaktivasi p16 dan kelainan epidermal growth factor receptor (EGFR) kemudian diperiksa. Hasil: Frekuensi polimorfisme HIF-1α pada kanker paru dan kontrol telah sesuai dengan keseimbangan Hardy-Weinberg. Pada penelitian ini tidak ditemukan perbedaan frekuensi genotipe C1772T atau G1790A antara kanker paru dengan kontrol sehat. Tetapi, frekuensi varian HIF1A C1772T ditemukan tinggi bermakna di pasien kanker paru dengan LOH TP53 (p=0,015). Pada pasien adenokarsinoma, individu dengan varian alel memiliki frekuensi tinggi LOH TP53 (p=0,047), LOH 1p34 (p=0,009) atau keduanya (LOH TP53 dan LOH 1p34) (p=0,008). Aktivitas transkripsi juga diperiksa secara in vitro dan ditemukan HIF1A varian pada sel kanker paru A549 mempunyai aktivitas yang meningkat secara bermakna dibanding wild type HI1F1A baik di kondisi normoksia atau hipoksia, terutama P582A di sel dengan mutan p53 (p< 0,0005 dan p< 0,005). Kesimpulan: Penelitian ini mengindikasikan polimorfisme gen HIF-1α mempunyai peranan penting dalam karsinogenesis paru terutama pada adenokarsinoma, diduga melalui peningkatan instabilitas genetik.

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Background and objective: The transcription factor, hypoxia-inducible factor-1 (HIF-1), is a master regulator of hypoxia, including repression of DNA repair systems, resulting in genomic instability in cancer cells. The roles of the polymorphic HIF-1a variants, C1772T (P582S) and G1790A (A588T), which are known to enhance transcriptional activity, were evaluated in lung cancers.

Methods: HIF-1a polymorphisms were assessed by direct sequencing in a total of 83 lung cancer patients (42 adenocarcinomas, 30 squamous cell, four adenosquamous cell and seven small cell lung carcinomas) and in 110 healthy control subjects. The relationship between these polymorphisms and the frequently observed genetic and/or epigenetic aberrations, TP53 loss of heterozygosity (LOH), 1p34 LOH, retinoblastoma-1 (RB1) LOH, p16 inactivation and epidermal growth factor receptor aberrations, was then assessed.

Results: There were no significant differences in genotype frequencies for either C1772T or G1790A between lung cancer patients and healthy controls. However, the frequency of the HIF1A C1772T variant allele was significantly higher in lung cancer patients with TP53 LOH (P = 0.015). Among adenocarcinoma patients, individuals with variant alleles of either polymorphism showed significantly higher frequencies of TP53 LOH (P = 0.047), 1p34 LOH (P = 0.009), or either of these (P = 0.008) in the tumours. The in vitro transcriptional activity of these HIF1A variants in A549 lung cancer cells was significantly greater than that of the wild type under either normoxic or hypoxic conditions, especially for P582S in cells containing mutant p53 (P < 0.0005 and P < 0.005, respectively).

Conclusions: These findings indicate that functional polymorphisms in the HIF-1a gene may have an important impact on lung carcinogenesis, especially in adenocarcinomas, possibly by increasing genomic instability."