Urinary tract infection (UTI) is an infection in the urinary tract (urethra, bladder, ureters, or kidneys). Urinary tract infection is one of the most common infection in the pediatric population. The aim of this study was to determine the characteristic and bacterial sensitivity of pediatric patient with UTI in Sanglah hospital. A descriptive study was performed in 34 children infant and children aged 0 month to 18 years who were diagnosed with UTI in Sanglah hospital. The result of the study was 18 were females and 16 were males. The prevalence of UTI patients in children most common in children aged 2 months old - 2 years old was 16 (47.1%). The most common sign and symptoms related to UTI was fever 24 (70.6 %). The other complain was dysuria, nausea and vomiting, failure to thrive, jaundice. Based on the urinalysis result, 52.9% had leukocyturia, 20.6% erythrocyturia, 14.7% nitrite positive, 91.2% bacteriuria positive. The most common uropathogenic was Escherichia coli 15 (44.1%). Escherichia coli was sensitive to Amikacin (100%), and was resistant to Ampicillin (100%).

Bones are the most common distant metastasis site in breast cancer, especially in advanced stages. Bone metastasis involves continuous interaction between tumor cells, osteoblast, osteoclast, and bone matrix. There are many risk factors regarding distant metastasis sites in breast cancer patients, including breast cancer molecular subtypes and mediator known as Receptor Activator of Nuclear Factor Kappa β (RANK). In this study, we explore relationships between Luminal A breast cancer and RANK in association with bone metastasis site.This study is a cross-sectional analysis study conducted in Sanglah General Hospital, Bali Denpasar. Estimated sample size was measured using formula to hypothesize between two proportions, and obtained 34 patients as our minimal sample needed in this study. Data will be presented in 2x2 tables, consist of RANK Protein expression and molecular cancer subtype (Luminal A / Non-Luminal A) in row section and Metastasis (Bone Metastasis or Non-Bone Metastasis) in column section. Univariat analysis were done using comparative method between 2 categorical unrelated groups: Chi Square and Fisher’s Exact Test. OR values were measured and p value <0.05 considered to be significant statistically.From these 106 patients, we used nested sampling to randomize these patients into our study sample, with total of 36 patients. The mean age of our patients is 48.64 ± 9.86 years. Luminal A subtypes tends to metastasize into bone component compared with Non-Luminal A subtypes with p value 0.041 and OR: 3.5; with 95% CI (0.82 – 14.84). Tumor with high RANK expressions tends to metastasize into bone component compared with low RANK expressions with p value 0.045 and OR 3.25; with 95% CI (0.81 – 13.03). There is a significant difference statistically in molecular subtype breast cancer and in RANK protein expressions between two patient groups (bone metastasis site vs another metastasis site)

Komponen tulang merupakan tempat metastasis jauh tersering pada kanker payudara, khususnya pada stadium lanjut. Metastasis tulang melibatkan interaksi berkelanjutan antara sel-sel tumor, osteoblas, osteoklas dan matriks tulang. Banyak faktor resiko yang mempengaruhi tempat metastasis jauh pada pasien kanker payudara, salah satunya adalah subtipe kanker payudara dan mediator Receptor Activator of Nuclear Factor Kappa β (RANK). Pada studi ini, kami akan mengkaji hubungan antara kanker payudara Luminal A, ekspresi protein RANK dengan terjadinya metastasis tulang.Studi ini adalah studi potong lintang analisis yang dilaksanakan di RSUP Sanglah Denpasar, Bali. Perkiraan besar sampel dihitung menggunakan rumus untuk uji hipotesis komparatif antara dua kelompok kategorik, dan didapatkan sampel minimal yang dibutuhkan sejumlah 34 pasien. Data akan dipresentasikan dalam table 2x2, terdiri dari ekspresi protein RANK dan subtipe kanker payudara (Luminal A dan Non-Luminal A) pada bagian baris, dan tempat metastasis (Tulang dan Bukan Tulang) pada bagian kolom. Dilakukan analisis univariat menggunakan metode komparatif antar dua kelompok tidak berpasangan, yaitu uji Chi-square dan Fischer’s Exact. Dilakukan perhitungan odds ratio (OR) tiap uji komparatif dan p value <0.05 dianggap sebagai signifikan secara statistik.Dari total 106 pasien kanker payudara selama durasi penelitian, kami menggunakan nested sampling untuk randomisasi sampel, dan didapatkan 36 pasien sebagai sampel penelitian. Rata-rata usia pasien adalah 48,64 ± 9,86 tahun. Subtipe Luminal A cenderung untuk bermetastsasis ke tulang dibandingkan dengan subtipe Non-Luminal A dengan p value 0,041 dan OR 3,5; dengan IK95%  (0,82 – 14,84). Tumor dengan ekspresi RANK tinggi juga cenderung untuk bermetastasis ke tulang dibandingkan dengan ekspresi RANK rendah dengan p value 0.045 dan OR 3,25; dengan IK95%  (0,81-13,03)Adanya perbedaan signifikan secara statistik pada subtipe kanker payudara dan pada ekspresi protein RANK antara dua kelompok pasien dengan metastasis jauh tulang dan bukan metastasis tulang.

Iron deficiency is the most common cause of anemia. The vegetarian is assumed to provide the risk of iron deficiency due to iron derived from plant sources is a non-heme with low bioavailability which may inhibit iron absorption. The aim of the study is to prove the difference in serum iron, ferritin and transferrin saturation levels between vegetarian and non-vegetarian children. This is an observational comparative cross-sectional study of 62 children aged 5-12 years in several elementary schools in Bali. Subjects are grouped into vegetarian and non-vegetarian. History taking, physical examination, examination of serum iron, ferritin and transferrin saturation were done. Subjects characteristics are presented descriptively. Serum iron, ferritin and transferrin saturation are analyzed by Independent T test and Mann Whitney U test, with p values ​​<0.05 considered to be significant. The results showed that there are differences in mean serum iron, ferritin and transferrin saturation between vegetarian and non-vegetarian children (69.8±29.2 vs 78.6±34.1; p=0.309), (53.5±26.7 vs 70.2±56.3; p=0.190), (19.7±7.8 vs 23.3±10.6; p=0.137). The conclusion of this study is there is no significant difference in serum iron, ferritin and transferrin saturation levels between vegetarian and non-vegetarian children.

Defisiensi besi merupakan penyebab tersering terjadinya anemia. Kecenderungan vegetarian diasumsikan berisiko defisiensi besi karena asupan berasal dari sumber nabati yang merupakan sumber besi non-heme dengan bioavabilitas rendah dan dapat menghambat absorpsi besi. Tujuan penelitian adalah untuk membuktikan adanya perbedaan kadar serum besi, feritin dan saturasi transferin antara anak vegetarian dan non-vegetarian. Penelitian ini merupakan observasional comparative cross sectional study terhadap 62 anak berusia 5-12 tahun di beberapa sekolah dasar di Bali. Subyek dikelompokkan menjadi dua yaitu kelompok vegetarian dan non-vegetarian. Dilakukan anamnesis, pemeriksaan fisis, pemeriksaan kadar serum besi, feritin dan saturasi transferin. Karakteristik subyek disajikan secara deskriptif. Perbedaan kadar serum besi, feritin dan saturasi transferin antar dua kelompok dianalisis dengan Uji T Independen dan Mann Whitney U dengan nilai p < 0,05 dianggap bermakna. Hasil penelitian menunjukkan terdapat perbedaan rerata serum besi, feritin dan saturasi transferin antara anak vegetarian dan non vegetarian yaitu (69,8±29,2 dan 78,6±34,1; p=0,309), (53,5±26,7 dan 70,2±56,3; p=0,190), (19,7±7,8 dan 23,3±10,6; p=0,137). Simpulan penelitian ini adalah tidak terdapat perbedaan yang signifikan pada kadar serum besi, feritin dan saturasi transferin antara anak vegetarian dan non-vegetarian.

Antibiotic used in chronic suppurative otitis media (CSOM) should be based on pathogens and their antibiotic susceptibility test results. This examination takes few days to give a result thus empirical therapy based on bacterial antibiogram become important. The increasing of prevalence of multi resistant bacteria, as well as changes in the sensitivity among the same strains, indicate the need for bacteriological surveys of CSOM to be carried out continuously and periodically. This study aimed to describe the sensitivity pattern of aerobic bacteria in CSOM in the ENT outpatient clinic of Sanglah General Hospital in 2015-2017 as an empirical therapy. This study was a descriptive study using a cross sectional design. The research sample was all CSOM patients who carried out bacterial culture and sensitivity tests at Sanglah General Hospital Denpasar in 2015 to 2017. Of the total 37 samples, 45.9% were male while 54.1% were female. The age range ranged from 1-74 years with the commonest age group being 31-40 years (29.6%). Aerobic bacteria that could be isolated and identified included Pseudomonas aeruginosa as much as 54.1% (20), Staphylococcus aureus, Klebsiella pneumonia, Achromobacter xylosoxidans, Acinetobacter baumanii, Morganella morganii, and Staphylococcus haemolyticus, each of 2.7% (1). Whereas in 5.4% (2) was Candida sp and 24.3% (9) obtained regional normal flora. Pseudomonas aeruginosa was sensitive to meropenem (100%), amikacin (95%), gentamycin (95%), ceftazidime (90%), cefepime (95%), aztreonam (80%), and ciprofloxacin (75%). Isolated Staphylococcus aureus was identified as Methicillin Resistant Staphylococcus aureus (MRSA) and sensitive to quinupristin-dalfopristin, linezolid, vancomycin, doxicyclin, minocycline, tetracyclin, and rifampicin. Staphylococcus haemolyticus was sensitive to quinupristin-dalfopristin, linezolid, vancomycin, doxicyclin, tetracyclin, and rifampicin. Klebsiella pneumonia, Achromobacter xylosoxidans, Acinetobacter baumanii, and Morganella morganii are sensitive to ceftazidime, meropenem, amikasin, and cefepime. In this study, aerob bacterium of CSOM was dominated by Pseudomonas aeruginosa, which were sensitive to meropenem, amikacin, gentamycin, ceftazidime, cefepime, aztreonam, and ciprofloxacin.

Pemilihan antibiotik pada kasus otitis media supuratif kronik (OMSK) sebaiknya berdasarkan jenis bakteri penyebab penyakit serta data uji kepekaan antibiotik. Mengingat hasil pemeriksaan penunjang tersebut memerlukan waktu beberapa hari, maka pengobatan secara empirik berdasarkan antibiogram bakteri penyebab penyakit menjadi sangat penting. Pemetaan bakteri tersebut perlu dilakukan secara kontinyu dan periodik karena pada beberapa penelitian didapatkan prevalensi bakteri multiresisten yang meningkat dan perubahan sensitivitas bakteri dengan strain yang sama. Penelitian ini bertujun untuk mengetahui gambaran pola kepekaan bakteri aerob pada OMSK di Poliklinik THT-KL RSUP Sanglah tahun 2015-2017 yang dapat digunakan sebagai terapi empirik. Penelitian ini bersifat deskriptif dengan menggunakan potong lintang. Sampel penelitian adalah semua pasien OMSK yang dilakukan kultur bakteri dan uji sensitivitas di RSUP Sanglah Denpasar pada tahun 2015 sampai 2017. Pada penelitian ini dari total 37 sampel, 45,9% adalah lelaki sedangkan 54,1% adalah perempuan. Rentang umur berkisar antara 1-74 tahun dengan kelompok umur terbanyak adalah 31-40 tahun (29,6%). Bakteri aerob yang teridentifikasi antara lain Pseudomonas aeruginosa sebanyak 54,1% (20), Staphylococcus aureus, Klebsiella pneumoniae, Achromobacter xylosoxidans, Acinetobacter baumanii, Morganella morganii, serta Staphylococcus haemolyticus yang masing-masing 2,7% (1). Selain itu, 5,4% (2) ditemukan Candida sp dan 24,3% (9) didapatkan flora normal regional. Pseudomonas aeruginosa sensitif terhadap meropenem (100%), amikacin (95%), gentamycin (95%), ceftazidime (90%), cefepime (95%), aztreonam (80%), dan ciprofloxacin (75%). Staphylococcus aureus yang terisolasi merupakan suatu Methicillin Resistant Staphylococcus aureus (MRSA) yang sensitif terhadap quinupristin-dalfopristin, linezolid, vancomycin, doxicyclin, minocycline, tetracyclin, dan rifampicin. Staphylococcus haemolyticus sensitif terhadap quinupristin-dalfopristin, linezolid, vancomycin, doxicyclin, tetracyclin, dan rifampicin. Klebsiella pneumoniae, Achromobacter xylosoxidans, Acinetobacter baumanii, dan Morganella morganii sensitif terhadap ceftazidime, meropenem, amikasin, dan cefepime. Pasien OMSK pada penelitian ini lebih didominasi Pseudomonas aeruginosa yang sensitif terhadap meropenem, amikacin, gentamycin, ceftazidime, cefepime, aztreonam, dan ciprofloxacin.

Background: One of the complications of double lumen catheter (DLC) access in hemodialysis patients is bloodstream infection which increases patient mortality and morbidity. Diabetes mellitus (DM) is one of the comorbid factors. Acknowledging the bacteria causing DLC infection in hemodialysis patients with or without DM at Sanglah Hospital is the aim of this study. 

Materials and methods: This was a cross-sectional descriptive study with a period of 12 months, January to December 2019. The sample included adult hemodialysis regular patients who diagnosed with DLC infection with suspected catheter-related Blood Stream Infection (CRBSI). 

Results: Samples were 72 patients with 58.3% male. There were 50 blood cultures, 60 DLC cultures, and 19 swab cultures. Recorded as many as 52 patients (72%) were examined for 2 types of specimens and 4 patients (5%) had all three. Thirty-four percent (17) of blood culture specimens exhibited the same bacterial growth with DLC or swab cultures or both. The predominant bacteria were Staphylococcus aureus 47% (8 samples), almost half were methicillin-resistant Staphylococcus aureus (MRSA) followed by coagulase-negative staphylococci and Enterococcus spp.  Total of 44.4% (32 patients) known to have DM but revealed no significant correlation with the incidence of DLC infection and CRBSI. The pattern of microorganism growth in cultures was same in DM and non DM groups. 

Conclusion: Staphylococcus aureus and coagulase-negative staphylococci indicated as the most common bacteria found in DLC infections at Sanglah Hospital in 2019.

Latar belakang: Salah satu komplikasi penggunaan akses kateter lumen ganda (KLG) pada pasien hemodialisis adalah infeksi aliran darah yang meningkatkan mortalitas dan morbiditas. Diabetes mellitus (DM) menjadi salah satu faktor komorbidnya. Mengetahui mikroorganisme penyebab kejadian infeksi kateter lumen ganda pada pasien hemodialisis dengan atau tanpa DM di RSUP Sanglah menjadi tujuan  penelitian ini.

Bahan dan metode: Ini adalah studi deskriptif potong lintang dengan jangka waktu 12 bulan (Januari hingga Desember 2019). Sampel meliputi pasien hemodialisis dewasa dengan akses KLG, terdiagnosis KLG terinfeksi dengan kecurigaan infeksi aliran darah terkait kateter (Catheter-Related Blood Stream Infection atau CRBSI).

Hasil: Sampel berjumlah 72 dengan 58,3% laki-laki. Spesimen kultur darah berjumlah 50, kultur KLG 60 dan kultur swab 19. Total 52 pasien (72%) diperiksa 2 jenis spesimennya sedangkan 4 pasien (5%) diperiksa ketiganya. Kultur darah menunjukkan pertumbuhan bakteri yang sama dengan kultur lainnya pada 17 spesimen (34%). Bakteri yang mendominasi adalah Staphylococcus aureus 47% (8 pasien) dengan hampir setengahnya methicillin resistant Staphylococcus aureus (MRSA) diikuti oleh Staphylococcus koagulase negatif dan Enterococcus spp. Sebanyak 44,4% (32 pasien) memiliki riwayat DM namun tidak menunjukkan korelasi yang signifikan dengan kejadian infeksi KLG dan infeksi aliran darah terkait kateter. Pola pertumbuhan mikroorganisme dari kultur ditemukan serupa pada kelompok pasien DM dan tidak DM.

Kesimpulan. Staphylococcus aureus dan Staphylococcus koagulase negatif merupakan bakteri penyebab infeksi KLG terbanyak di RSUP Sanglah pada tahun 2019.

Introduction : Pneumatosis intestinalis is a condition where there is gas inside the intestinal wall. Pneumatosis intestinalis or intramural gas is a particular sign of radiology and is not a disease. Pneumatosis intestinalis in patients with very poor clinical conditions, accompanied by symptoms of abdominal pain or distension, is possible because of the presence of bowel ischemia. One of the causes of Pneumatosis intestinalis is immunodeficiency, such as in AIDS.

Case Presentation : Here in we present a 7-year-old HIV AIDS positive male presented with abdominal distension, acute abdomen, and sepsis. His first abdominal radiographs showed intramural gas in linear and circular form along the descending colon, which migrates to the ascending colon after few days. Intramural gas was also seen on his abdominal CT therefore concluded bowel ischemia diagnosis without life threatening signs such as portal vein gas, pneumoperitoneum, or porto-mesenteric gas. His previous chest CT revealed multiple cystic bronchiectasis in both lung bases.

Discussion : Underlying cause of Pneumatosis intestinalis n this case is HIV AIDS related which causing both lung and bowel disease resulting in intramural gas, hence bowel ischemia diagnosis was made.

Conclusion : Thorough imaging evaluation is needed in diagnosing pneumatosis intestinalis moreover in HIV AIDS patient to determine prognosis and treatment plan.