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"Veruka vulgaris merupakan lesi kulit yang paling sering disebabkan oleh virus papiloma humanis (HPV). Jarang didapatkan lesi berukuran besar, kronik, terisolasi, dan soliter. Kami melaporkan kasus veruka vulgaris raksasa pada seorang pria berusia 66 tahun pada dorsal pedis sinistra yang membesar perlahan dan mengeras dalam 10 tahun. Lesi berupa nodus soliter verukosa, hiperkeratotik, berwarana abu kecoklatan, berbatas tegas, berbentuk bulat berukuran 3x 2,4x 0,4 cm. Pada pemeriksaan histopatologis terdapat hiperkeratosis/ortokeratosis kompak, banyak koilosit pada lapisan granular dan spinosum atas, akantosis, dan pemanjangan rete ridges yang mengarah ke sentral. Pemeriksaan rantai polimerase (PCR) dan hibridisasi in situ gagal mengidentifikasi DNA HPV. Pasien berhasil diterapi dengan salep asam salisilat 40%.

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Common wart is the most frequent clinical lesion caused by human papillomaviruses (HPVs). Giant, chronic, isolated, and solitary lesion is uncommon. We reported a case of giant verruca vulgaris in a 66 year-old man on left dorsal pedis that slowly enlarged and hardened in 10 years. It was a solitary hyperkeratotic verruca vulgaris, grey brownish in color, circumscribe, round, and 3x2.4x0.4 cm in size. Histopathologic examination revealed compact hyperkeratosis/orthokeratosis, many koilocytes in the granular and upper spinous layer, acanthosis, and elongated rete ridges that were pointing radially toward the center of the lesion. Polymerase chain reaction (PCR) and in situ hybridization failed to identify HPV DNA. The patient was successfully treated with salicylic acid 40% ointment."

"Introduction: This study aims to know the performance of the Vascular – Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (V-POSSUM) score as a predictor of 30-day mortality after the Endovascular Aortic Aneurysm Repair (EVAR) – Thoracic Endovascular Aortic Repair (TEVAR) procedure in Abdominal Aortic Aneurysms (AAA) and Thoracic Aortic Aneurysms (TAA) patients in Cipto Mangunkusumo Hospital. Method: This was a retrospective cohort study using data from medical records. Data were taken according to the variables contained in the V-POSSUM scoring system in the patient who undergone EVAR – TEVAR procedure, on the period of 2013 to July 2018. Results: The study involved 85 patients who met the study requirements. It was known that physiological scores, morbidity risk, and mortality risk could be used as a model to predict mortality outcomes because they had good accuracy and discrimination performance, while the severity of the operation score cannot. The result of the goodness of fit model’s physiological score, morbidity risk, and mortality risk was significant (p <0.001), while the severity score of the operation was 0.18 (p >0.05). The Area Under the Curve (AUC) was 94%, 93%, 93%, with the cut points at 31, 68.8, and 10.6 for the physiological score, morbidity risk, and mortality risk, respectively. Conclusion: The V-POSSUM score had good accuracy and discrimination for the physiological score, morbidity risk, and mortality risk."

"Tesis ini membahas mengenai performa skor V-POSSUM sebagai prediktor mortalitas 30 hari pasca tindakan EVAR TEVAR pada pasien AAA dan TAA di RSUPN Cipto Mangunkusumo.Penelitian ini merupakan studi kohort retrospektif menggunakan data dari rekam medis. Data yang diambil sesuai variabel yang terdapat dalam sistem skoring dalam bentuk kategorik lalu diolah secara statistik untuk menguji validitas skor V-POSSUM. Hasil penelitian melibatkan 85 pasien yang memenuhi syarat penerimaan penelitian. Dari pengolahan data statistik diketahui bahwa skor fisiologis, risiko morbiditas, dan risiko mortalitas dapat digunakan sebagai model untuk memprediksi luaran kematian karena memiliki performa akurasi dan diskriminasi yang baik, sedangkan skor kepelikan operasi tidak dapat digunakan karena secara statistik tidak menunjukkan hal yang sama. Nilai P hasil perhitungan 'Goodnes of Fit Model' skor fisiologis, risiko morbiditas, risiko mortalitas masing-masing adalah 0.00, sedangkan skor kepelikan operasi 0.18 (>0.05). 'Area Under the Curve' (AUC) masing-masing adalah 94%, 93%, 93%, dengan titik potong masing-masing berada di angka 31, 68.8, dan 10.6. Sebagai kesimpulan adalah bahwa skor V-POSSUM memiliki akurasi dan diskriminasi yang baik bukan hanya pada skor risiko mortalitasnya saja, namun pada skor fisiologis dan skor risiko morbiditasnya.

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This thesis discusses the performance of V-POSSUM score as a predictor of 30 days mortality after EVAR TEVAR in AAA and TAA patients at Cipto Mangunkusumo Hospital. This study is a retrospective cohort method using data from medical records. Data taken according to the variables contained in the scoring system in categorical form then processed statistically to test the validity of the V-POSSUM score. The results of the study involved 85 patients who met the research acceptance requirements. From the processing of statistical data it is known that physiological scores, morbidity risk, and mortality risk can be used as a model to predict the outcome of death because it has good performance in accuracy and discrimination, while the severity score of surgery cannot be used because it does not show the same result statistically. The P value calculated by the Goodnes of Fit Model physiological score, the morbidity risk, the mortality risk of each was 0.00, while the severity score of the operation was 0.18 (> 0.05). Area Under the Curve (AUC) are 94%, 93%, 93%, respectively, with points 31, 68.8 and 10.6. The conclusion is that the V-POSSUM score has good accuracy and discrimination not only on the mortality risk score, but also on the physiological score and the morbidity risk score."

"Latar Belakang: Saat ini, endovascular aneurysm repair (EVAR) lebih diutamakan pada sebagian besar kasus aneurisma aorta abdominalis (AAA) dibandingkan open surgical repair (OSR). Namun, terdapat kontroversi keluaran jangka panjang yang diperlihatkan kedua pilihan tatalaksana tersebut, terutama pada kelompok usia tua. Metode: Tinjauan sistematis dilakukan dengan mengikutsertakan studi yang membandingkan mortalitas jangka panjang, kesintasan jangka panjang, tingkat reintervensi, dan ruptur sekunder antara EVAR dan OSR pada pasien AAA berusia ≥65 tahun dengan minimal follow-up selama dua tahun. Pencarian artikel dilakukan pada empat pangkalan data elektronik yaitu Cochrane, Pubmed, EBSCOHost, dan Scopus. Studi yang diikutsertakan merupakan publikasi dari titik waktu awal yang tidak ditentukan sampai dengan bulan Maret 2024. Telaah kritis melalui instrumen yang sesuai dengan desain studi juga dilakukan untuk memastikan kualitas studi. Keluaran pada setiap studi disintesis ulang, disajikan dalam bentuk tabel, serta dilakukan pembahasan. Hasil: Studi sistematis ini berhasil mengikutsertakan 6 studi, yakni 1 studi meta-analisis dan 5 studi kohort. Mayoritas studi menunjukkan tidak adanya perbedaan mortalitas jangka panjang, kesintasan jangka panjang, tingkat reintervensi, dan tingkat ruptur sekunder antara EVAR dan OSR. Terdapat peningkatan mortalitas dan penurunan kesintasan EVAR dibandingkan OSR pada follow-up sampai dengan tahun keempat, namun tidak ada perbedaan pada tahun kelima dan rerata keseluruhan. Terdapat peningkatan mortalitas dan penurunan kesintasan EVAR pada kelompok usia ≥80 tahun dibandingkan kelompok usia 65-79 tahun. Kesimpulan: Tidak ada perbedaan keluaran jangka panjang antara EVAR dan OSR pada pasien AAA berusia ≥65 tahun.

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Introduction: Nowadays, endovascular aneurysm repair (EVAR) is preferred in most cases of abdominal aortic aneurysm (AAA) than open surgical repair (OSR). However, there are controversies regarding the long-term outcomes of both modalities, especially in the geriatric population. Method: We conducted a systematic review of studies comparing the long-term mortality, long-term survival, reintervention rate, and secondary rupture rate between EVAR and OSR in ≥65-year patients with AAA with a minimum of two years of follow-up. The literature search was conducted in four electronic databases, Cochrane, Pubmed, EBSCOHost, and Scopus, from an undefined start point until March 2024. Studies included also critically appraised with relevant instruments based on the study design. The long-term outcomes of every study were synthesized, presented in tables, and discussed thoroughly. Result: A total of six studies were included, consisting of one systematic review/meta-analysis and five cohort studies. Most studies did not show differences in long-term mortality, long-term survival, reintervention rate, or secondary rupture rate between EVAR and OSR. There was higher mortality and lower survival in EVAR compared to OSR after four years of follow-up, but no differences were found in five years and overall follow-up. There was higher mortality and lower survival after EVAR in patients≥80 years old compared to those 65-79 years old. Conclusion: There are no differences in long-term outcomes between EVAR and OSR in ≥65-year patients with AAA."

"Class II division 1 malocclusions have many variation and treatment options. Choosing the right treatment begins with a correct diagnosis. The aim of this article is to describe treatment of Class II division 1 malocclusion in a growing patient using combined cervical headger and non-extraction fixed orthodontic therapy. Class I molar and canine relationship was achieved with normal overbite and overjet. There is a improvement in jaw relationship and facial profile. This correction was achieved by downward displacement and inhibition of the forward growth of maxilla with favorable growth of mandible, upper molar distalization and retraction of upper incisors from cervical headgear use. There was neither downward rotation of the mandible nor maxillary first molar extrusion. Treatment time, favorable mandibular growth pattern and patient vcompliance proved to be determining factors in the success of this treatment."

"Latar Belakang: Peningkatan prevalensi penderita diabetes melitus (DM) meningkatkan risiko aterosklerosis arteri karotis interna (internal carotid artery, ICA). Di negara maju, 85% kasus stroke terjadi akibat aterosklerosis karotis. Short chain fatty acid (SCFA) adalah produk metabolisme bakteri yang terutama disintesis di usus besar dan berperan mengurangi aktivasi endotel oleh mediator proinflamasi. Sehingga mencegah progresi aterosklerosis ICA. Penelitian ini bertujuan mengetahui hubungan SCFA feses dengan gambaran ultrasonografi ICA pada penderita DM tipe 2 di RS Dr. Cipto Mangunkusumo (RSCM).Metode: Desain penelitian ini adalah observasional analitik jenis potong lintang. Data diperoleh dari seluruh pasien DM tipe 2 di Divisi Bedah Vaskular dan Endovaskular RSCM. Meliputi kadar SCFA sampel feses dan gambaran ultrasonografi (carotid intima-media thickness (IMT), diameter lumen, peak systolic velocity (PSV), end diastolic velocity (EDV), dan flow volume). Uji korelasi Spearman dilakuan untuk memperoleh koefisien korelasi. Nilai p <0,05 bermakna signifikan.Hasil: Dari 30 subjek DM tipe 2, terdapat 12 laki-laki (40,0%) dan setengah populasi berusia >60 tahun. Hasil pemeriksaan IMT berhubungan signifikan dengan jenis kelamin (p=0,048). Kadar SCFA berhubungan signifikan dengan usia, yaitu asetat (p=0,029), proprionat (p=0,005), butirat (p=0,039), dan SCFA total (p=0,024). Kadar SCFA valerat berkorelasi signifikan dengan IMT (r = -0,237; p=0,034) dan diameter lumen (r = -0,243; p=0,031).Kesimpulan: Kadar SCFA feses berkorelasi dengan gambaran ultrasonografi arteri karotis interna. Nilai kadar SCFA feses pada pasien DM tipe 2 di RSCM lebih tinggi dibandingkan penelitian lain. Peningkatan kadar SCFA menurunkan risiko penyempitan arteri sklerosis interna

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Background: The increasing prevalence of diabetes mellitus (DM) increases the risk of atherosclerosis of the internal carotid artery (ICA). In developed countries, 85% of stroke cases occur due to carotid atherosclerosis. Short-chain fatty acids (SCFA) are products of bacterial metabolism which are mainly synthesized in the large intestine and play a role in reducing endothelial activation through pro-inflammatory mediators, thus preventing the progression of ICA atherosclerosis. This study aims to determine the correlation between faecal SCFA and ICA ultrasonography in patients with type 2 diabetes at Dr. Cipto Mangunkusumo General Hospital (CMGH).

Methods: This study is cross-sectional. Data were obtained from all type 2 DM patients in the Vascular and Endovascular Surgery Division. Data that were collected included faecal SCFA levels and ultrasonography examination (carotid intima-media thickness (IMT), lumen diameter, peak systolic velocity (PSV), end-diastolic velocity (EDV), and flow volume). Spearman correlation test was conducted to obtain the correlation coefficient. The p-value <0.05 was significant.

Results: Of the 30 subjects, 12 were male (40.0%) and half the population was >60 years old. BMI examination results were significantly related to gender (p=0.048). SCFA levels were significantly related to age, including acetate (p=0.029), proprionate (p=0.005), butyrate (p=0.039), and total SCFA (p=0.024). SCFA valerate levels were significantly correlated with BMI (r = -0.237; p=0.034) and lumen diameter (r = -0.243; p=0.031).

Conclusion: Fecal SCFA levels correlated with ultrasound images of the internal carotid artery. The value of faecal SCFA levels in type 2 DM patients at CMGH was higher than in other studies. Elevated SCFA levels decrease the risk of ICA narrowing or stenosis."

"ABSTRAKTuberous sclerosis complex (TSC) has several renal manifestations including angiomyolipomas (AML) and renal epithelial neoplasms. A bilateral giant renal AML is extremely rare. We report a case of giant bilateral AML and discuss the diagnosis and treatment of it. The 22-year-old man was admitted due to bilateral flank pain, gross hematuria, and abdominal fullness. He had history of epilepsy, mental retardation, and delayed development during childhood. He had angiofibroma on his face since 10 years ago. Abdominal CT and MRI revealed large lobulated heterogeneous mass with fatty content. Based on those findings, we diagnosed the patient with bilateral giant renal AML. We gave conservative management for the patient and planned to total nephrectomy on the left kidney if the continued bleeding occurred. AML associated with TSC occur more frequently as multiple lesions and grows to larger size than idiopathic AML. Bilateral giant AML, which is very rare, could be treated with conservative management if no significant hemorrhage occurred."

"[ABSTRAKLatar belakang : Penyebab kematian nomor tiga di Indonesia adalah Penyakit Jantung Koroner (PJK). PJK dapat dievaluasi dengan menilai skor Coronary Artery Calcium (CAC) menggunakan modalitas radiologi CT cardiac. Permasalahan saat ini adalah modalitas CT cardiac tidak tersedia di semua institusi kesehatan, sehingga dibutuhkan modalitas lain yang berguna untuk skrining skor CAC menggantikan modalitas CT cardiac. Dari 4 modalitas yang dapat mendeteksi skor CAC,pemeriksaan USG Doppler arteri karotis komunis merupakan modalitas terpilih untuk melakukan skrining.Tujuan : Menilai apakah terdapat korelasi antara skor CAC dengan nilai CIMT dan RI arteri karotis komunis menggunakan modalitas USG Doppler arteri karotis komunis.Metode : Penelitian cross sectional ini menggunakan data primer dari pasien yang menjalani pemeriksaan CT cardiac dengan temuan skor CAC. Subjek penelitian yang masuk ke dalam kriteria penerimaan kemudian dilakukan pemeriksaan USG Doppler arteri karotis komunis bilateral dan dilakukan pengukuran terhadap nilai CIMT dan nilai RI.Hasil : Jumlah subjek penelitian adalah 27 orang, dengan hasil terdapat korelasi positif bermakna dengan nilai korelasi sedang antara skor CAC dan nilai CIMT maksimum dengan persamaan : skor CAC = -85.51 + 199.82 x nilai CIMT maksimum. Terdapat korelasi positif bermakna dengan nilai korelasi sedang antara skor CAC dan nilai RI arteri karotis komunis dengan persamaan : skor CAC = -503.53 + 849.00 x nilai RI.Kesimpulan : Modalitas USG Doppler arteri karotis komunis pengukuran nilai CIMT dan nilai RI dapat digunakan sebagai modalitas skrining untuk memperkirakan skor CAC pada pasien.

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ABSTRACTBackground : Coronary artery disease (CAD) known as the third cause of morbidity in Indonesia. CAD can be evaluated using CAC scoring from CT cardiac. Nowadays the issue related to its availability, not all health institution has this modality. We need other modality imaging that can replace CT cardiac for screening CAC scoring. From 4 modalities imaging that can evaluated CAC scoring, common carotid artery Doppler ultrasonography is the modality of choice for screening.Purpose : To evaluate correlation value between CAC scoring and carotid intima media thickness (CIMT) and resistive index common carotid artery using Doppler ultrasonography.Method : Cross sectional research using primary data CAC scoring from CT cardiac. All subject that met research?s criteria will have bilateral common carotid artery Doppler ultrasonography measurement of CIMT and common carotid artery resistive index value.Result : Total subject is 27 people. There is a positive correlation with medium correlation value between CAC scoring and maximum CIMT using this approach : CAC scoring = -85.51 + 199.82 x maximum CIMT value. There is also a positive correlation with medium correlation value between CAC scoring and common carotid artery resistive index value using this approach : CAC scoring = -503.53 + 849.00 x resistive index value.Conclusion : Common carotid artery Doppler ultrasonography measurement of CIMT and common carotid artery resistive index value is a promising screening modality to predict patient?s CAC scoring., Background : Coronary artery disease (CAD) known as the third cause of morbidity in Indonesia. CAD can be evaluated using CAC scoring from CT cardiac. Nowadays the issue related to its availability, not all health institution has this modality. We need other modality imaging that can replace CT cardiac for screening CAC scoring. From 4 modalities imaging that can evaluated CAC scoring, common carotid artery Doppler ultrasonography is the modality of choice for screening.Purpose : To evaluate correlation value between CAC scoring and carotid intima media thickness (CIMT) and resistive index common carotid artery using Doppler ultrasonography.Method : Cross sectional research using primary data CAC scoring from CT cardiac. All subject that met research’s criteria will have bilateral common carotid artery Doppler ultrasonography measurement of CIMT and common carotid artery resistive index value.Result : Total subject is 27 people. There is a positive correlation with medium correlation value between CAC scoring and maximum CIMT using this approach : CAC scoring = -85.51 + 199.82 x maximum CIMT value. There is also a positive correlation with medium correlation value between CAC scoring and common carotid artery resistive index value using this approach : CAC scoring = -503.53 + 849.00 x resistive index value.Conclusion : Common carotid artery Doppler ultrasonography measurement of CIMT and common carotid artery resistive index value is a promising screening modality to predict patient’s CAC scoring.]"