Ultrasonography feature and Clinical Finding of Trisomy 13 (Patau Syndrome): A Case Report

Background: Trisomy 13 is a trisomy disorder of chromosome 13 which causes many fetal structural defects. The prognosis is very poor and the majority is still birth. Major structural anomalies are occasionally identified in the late-first or early-second trimester. Any discovery of multiple structural anomalies in the fetus increases the chances of chromosomal anomalies. Case Report: Here we report trisomy 13 case of A 34-years-old housewife, third gravida, prenatal diagnosis during antenatal ultrasonography showed diaphragmatic hernias, cardiovascular dextroposition, ventricular septal defect, labiognatopalatoschizis and renal dextra pyeletaxis. From the chromosomal analysis, the fetal karyotype was 47 XY+13. A male infant was born with weight of 2600 grams, 46 cm, cyanosis, and severe respiratory distress with congenital abnormalities of micrognathia, diaphragmatic hernia, dextrocardia, ventricular septal defect, persistent pulmonary hypertension of newborn, undescended testis, labiognatopalatoshizis, and polydactily. Discussion: Prenatal diagnosis can be done through amniocentesis for karyotyping which is the gold standard for diagnosis trisomy 13. In addition, screening can also be done since the first trimester.Conclusion: All pregnancies in second trimester must be evaluated for structural abnormalities through ultrasonography and cytogenetic examination if necessary for early diagnosed.Key word: Congenital Abnormalities, Ultrasonography, Clinical Finding, Trisomy 13, Patau SyndromeAbstrakLatar Belakang: Trisomi 13 merupakan kelainan jumlah kromosom 13 yang menyebabkan defek struktural pada fetus. Prognosisnya sangat buruk dan kebanyakan lahir mati. Kelainan struktural mayor sering teridentifikasi pada akhir trimester pertama atau awal trimester kedua. Setiap temuan kelainan struktural pada fetus berpotensi kelainan kromosom.Laporan Kasus: Di sini akan dijelaskan kasus trisomi 13 yang didiagnosis prenatal dari wanita G3P1011, 34 tahun, terdiagnosis melalui pemeriksaan ultrasonografi. Antenatal scan dilakukan pada usia kehamilan 21 minggu dan gambaran ultrasonografi menunjukkan hernia diafragmatika, dextrokardia, ventricular septal defect, labiognatopalatoschizis dan pielektasis ginjal kanan. Kemudian dilanjutkan pemeriksaan kromosom melalui amniosintesis dan didapatkan hasil 47 XY+13.  Bayi laki-laki lahir secara sectio secarea dengan berat 2600 gram, panjang badan 46 cm, sianosis, asfiksia berat, kelainan kongenital micrognatia, hernia diafragmatika, dextrokardia, defek septum ventrikular, hipertensi pulmonal, labiognatopalatoshizis, dan polidactili. Diskusi: Diagnosis prenatal dapat dilakukan melalui pemeriksaan amniosintesis bertujuan untuk melihat karyotyping yang merupakan gold standard untuk mendiagnosis  trisomi 13. Selain itu, screening juga dapat dikerjakan sejak trimester pertama.Kesimpulan: Semua kehamilan pada trimester kedua harus dievaluasi kelainan struktural melalui ultrasonografi dan bila perlu pemeriksaan sitogenetik sehingga dapat mendiagnosis lebih awal.Kata kunci: Kelainan Kongenital, Ultrasonografi, Klinis, Trisomi 13, Patau Sindrom

ANALISIS KELAYAKAN FINANSIAL PADA PEMBANGUNAN VILLA (Studi Kasus: Pembangunan The Mesare Villa Nusa Penida)

Kecamatan Nusa Penida merupakan salah satu tujuan wisata di Bali yang terus mengalami perkembangan, ini ditunjukkan dengan meningkatnya jumlah kunjungan wisatawan setiap tahun baik wisatawan lokal maupun wisatawanmancanegara. Seiring meningkatnya jumlah kunjungan wisatawan juga berdampak tingginya akan kebutuhan akomodasi serta pembangunan yang semakin meningkat. Hal inilah yang menjadi dasar dibangunnya The Mesare VillaPenelitian ini menggunakan pendekatan deskriftif kuantitatif untuk mengolah data yang diperoleh dari lokasi penelitian, data tersebut berupa data primer dan data sekunder. Data primer diantaranya kondisi lokasi penelitian, perhitungan anggaran biaya kolam renang, biaya operasional dan pendapatan villa sedangkan data sekunder terdiri dari jumlah kunjungan wisatawan lima tahun terakhir, suku bunga bank, harga bahan bangunan, gambar rencana dan tingkat inflasi. Dari data tersebut kemudian dilakukan analisis finansial pembangunan The Mesare Villa untuk mengetahuiapakah pembangunan tersebut layak atau tidak dari segi aspek finansial dengan menggunakan perhitungan Net Present Value (NPV), Benefit Cost Ratio (BCR), Internal Rate of Return (IRR), Annual Eqiuvalent (AE), Payback Period dan analisis sensitifitas. Dari hasil analisis finansial dengan suku bunga 12% dan biaya investasi sebesar Rp. 10.297.255.000,00 ada 4 (empat) sumber pemasukan antara lain bidang akomodasi, spa, fasilitas yoga dan fasilitas-fasilitas lain, dimana anlisis finansial menunjukkan nilai NPV positif sebesar Rp. 3.069.536.483,92, nilai IRR 16% dimanaangka tersebut lebih besar dari nilai MARR yaitu 12%, nilai BCR menunjukkan angka 1,79 dimana angka tersebut telah memenuhi syarat lebih dari satu, nilai AE positif sebesar Rp. 11.379.456.257,14 , dan Break Event Point terjadi pada tahun2036. Dari sisi uji sensitifitas menunjukkan nilai investasi sensitif pada angka Rp. 27.794.462.817,00, nilai benefit sensitif pada angka Rp. 4.992.839.448, dan nilai cost sensitif pada angka Rp. 6.145.999.356 . Dari data-data tersebut makapembangungan The Mesare Villa layak untuk dilaksanakan

PENGARUH BUDAYA K3 TERHADAP KEBERHASILAN PROYEK KONSTRUKSI GEDUNG DI KABUPATEN BADUNG

Dalam pelaksanaan pembangunan konstruksi gedung banyak hal yang harus diperhatikan, salah satunya adalah Keselamatan dan Kesehatan Kerja (K3). K3 merupakan suatu upaya dalam mengatasi potensi bahaya dan resiko kesehatan dan keselamatan yang mungkin terjadi. Penelitian ini bertujuan untuk mengetahui pengaruh budaya K3 terhadap keberhasilan proyek konstruksi gedung di Kabupaten Badung secara parsial dan simultan. Jenis penelitian ini adalah deskriptif kuantitatif, metode yang digunakan adalah metode pengumpulan data observasi, kuisioner, wawancara dan studi pustaka. Analisis data menggunakan analisis regresi linier berganda. Model regresi yang dihasilkan dalam penelitian ini adalah adalah Y = 17,466 + 1,039 X1 + 0,906 X2 + 0,439 X3 + 0,348 X4. Hubungan antara variabel tenaga kerja (X1), lingkungan kerja (X2), organisasi K3 (X3) dan Alat Pelindung Diri (X4) terhadap keberhasilan proyek (Y) secara simultan berpengaruh. Hal ini dibuktikan dengan nilai Fhitung = 27,452 dibandingkan dengan nilai Ftabel = 2,59 , maka ternyata nilai Fhitung lebih besar dari nilai Ftabel, dan thitung berada pada daerah penolakan H0. Dengan demikian H0 ditolak dan H1 diterima. Ini berarti bahwa secara statistik untuk uji satu sisi pada taraf kepercayaan () = 5%, secara simultan dari variabel tenaga kerja (X1), lingkungan kerja (X2), organisasi K3 (X3) dan Alat Pelindung diri (X4) berpengaruh positif dan signifikan terhadap keberhasilan proyek (Y), dan secara parsial dari variable tenaga kerja(X1), lingkungan kerja (X2), organisasi K3 (X3) dan alat pelindung diri (X4) juga berpengaruh positif dan signifikan terhadap keberhasilan proyek (Y)

High neutrophils to lymphocytes ratio in maternal blood serum as risk factor for preterm premature rupture of membrane

Background: Neutrophil-to-lymphocyte ratio has been extensively studied as a prognostic factor for various diseases based on systemic inflammation. Premature rupture of membranes is an obstetric problem that does not only occur in term pregnancies but can also occur in preterm pregnancies. One of the main etiologies for premature rupture of membranes is inflammation. Knowing the difference in the NLR between preterm premature rupture of membranes and without PPROM is important to increase understanding of the crucial role of NLR in predicting the incidence of PPROM. Methods:  This analytic case-control study compared NLR values ​​in maternal blood serum between PPROM and without PPROM. This research was conducted in the emergency delivery room and obstetrics and gynecology outpatient clinic at Prof. dr. I.G.N.G. Ngoerah Hospital Denpasar from February to June 2022. Results: A high NLR in maternal blood serum may be a risk factor for PPROM. Patients with a high NLR had a 4.5 times greater likelihood of experiencing PPROM than those with a low NLR (OR=4.5; 95% CI=1.4-13.83; p=0.007). Conclusions: A high NLR in maternal blood serum is a marker of inflammation with an increased risk of 4.5 times for the occurrence of PPROM

Management Comprehensive Multidisciplinary of Malignant Ovarian Germ Cell Tumors and Feto - Maternal Outcome: A Case Series Report and Literature Review

BACKGROUND: Malignant Ovarian Germ Cell Tumors (MOGCT) most commonly occur in young women in the reproductive age group. Timely antenatal diagnosis and treatment of the tumour to enhance maternal and perinatal outcomes are the main challenges confronting the obstetrician and the gyne-oncologist. CASE PRESENTATION: Here we present three cases of pregnancy complicated with MOGCTs. The first case (immature teratoma) was complicated by maternal psychological symptoms consistent with stress and histopathological examination confirmed the diagnosis of premature ovarian failure (POF). The second case (dysgerminoma) preterm labour occurred as an obstetric complication, but the baby was born in good condition without IUGR. The third case (yolk sac tumour) treated with docetaxel (brexel)-carboplatin chemotherapy administration there was no maternal or fetal complication. At the end of the pregnancy and delivery, complete surgical staging and cytoreduction were performed, and no metastases were found. CONCLUSION: Optimal management strategies centre on a multi-disciplinary comprehensive team approach is critical resulting in better outcomes for the mother and the baby by avoiding complications

Friedman Curve Positively Correlates with Cesarean Section and Oxytocin Augmentation in Active Phase Delivery as Compared to Partograph: Kurva Friedman Berkorelasi Positif dengan Seksio Sesarea dan Augmentasi Oksitosin pada Fase Aktif Persalinan dibandingkan Partograf

Objective: To investigate the correlation between cesareansection and oxytocin augmentation in childbirth monitoredwith the Friedman curve compared to the World HealthOrganization (WHO) partographs.Methods: An analytic cross-sectional study was conductedfrom March to May 2021, involving mothers giving birthwhose delivery process was monitored using either theFriedman curve or the WHO partograph (n=28 for eachgroup) at Wangaya Hospital in Denpasar City. The durationof the active phase until delivery, occurrence of cesareansection, and administration of oxytocin augmentationwere assessed using the Friedman curve and the WHOpartograph. The normality of the data was tested using theKolmogorov-Smirnov test, and the Spearman correlationtest was employed to measure the direction and strengthof the correlation.Results: There was no signifi cant difference between thegroups in terms of monitoring the active phase until deliveryusing the Friedman curve compared to the WHO partograph(p=1.000 > 0.05). Maternal monitoring with the Friedmancurve showed a positive correlation with the occurrenceof cesarean section compared to the WHO partograph(r=0.296, p=0.027). Additionally, monitoring childbirth withthe Friedman curve exhibited a positive correlation with theadministration of oxytocin augmentation compared to theWHO partograph (r=0.298, p=0.026).Conclusion: The fi ndings suggest a stronger positivecorrelation between the incidence of cesarean section andthe administration of oxytocin augmentation in childbirthmonitored with the Friedman curve compared to the WHOpartograph.Keywords: cesarean section, Friedman curve, oxytocinaugmentation, WHO partograph.AbstrakTujuan: Untuk menentukan korelasi antara operasi sesardan augmentasi oksitosin pada persalinan yang dipantaudengan kurva Friedman dibandingkan dengan partografOrganisasi Kesehatan Dunia (WHO).Metode: Desain penelitian analitik potong lintangdilakukan pada Maret-Mei 2021, dengan melibatkan ibubersalin yang proses persalinannya dipantau menggunakankurva Friedman atau Partograf WHO (n=28 untuk setiapkelompok) di ruang bersalin di Rumah Sakit Wangaya,Kota Denpasar. Waktu fase aktif hingga kelahiran bayi,persalinan seksio sesarea, dan augmentasi oksitosin dinilaidengan menggunakan kurva Friedman dan Partograf WHO.Uji normalitas dilakukan dengan uji Kolmogorov-Smirnov,dilanjutkan dengan uji korelasi Spearman untuk mengukurarah dan kekuatan korelasi.Hasil: Pemantauan ibu bersalin dengan kurva Friedmandibandingkan dengan Partograf WHO dalam hal faseaktif-persalinan bayi menunjukkan tidak ada perbedaanyang signifi kan di antara kedua kelompok (p = 0,000 >0,05). Pemantauan ibu dengan kurva Friedman berkorelasipositif dengan kejadian bedah sesar dibandingkandengan Partograf WHO (r = 0,296, p = 0,027). Selain itu,pemantauan persalinan dengan kurva Friedman berkorelasipositif dengan pemberian oksitosin dibandingkan denganpartograf WHO (r = 0,298, p = 0,026).Kesimpulan: Terdapat korelasi positif yang lebih tinggiantara kejadian bedah sesar dan pemberian augmentasioksitosin pada proses persalinan yang dipantau dengankurva Friedman dibandingkan dengan partograf WHO.Kata kunci: augmentasi oksitosin, kurva friedman, partografWHO, seksio sesare

Ekspresi Enzim 1 Alfa-Hidroksilase Plasenta yang Rendah sebagai Faktor Risiko Terjadinya Preeklamsia Berat

Abstrak Tujuan: Untuk mengetahui ekspresi enzim 1-alfa-hidroksilase (CYP27B1) pada plasenta yang rendah sebagai faktor risiko terjadinya preeklamsia (PE) berat.Metode: Penelitian ini merupakan studi kasus-kontrol yang tak berpasangan, dengan total sampel 44 kasus dan kontrol. Sampel berupa plasenta yang diproses secara imunohistokimia, untuk melihat ekspresi enzim berdasarkan histoscore kumulatif (H-score) sebagai ekspresi rendah (H-score 200). Regresi logistik ganda digunakan untuk memperkirakan rasio odds yang disesuaikan (OR) dengan interval kepercayaan 95% (95% CI).Hasil: Ekspresi enzim 1alfa-hidroksilase plasenta yang rendah merupakan faktor risiko terjadinya PE berat sebesar sembilan kali lebih tinggi dibandingkan dengan ekspresi enzim 1-alfa-hidroksilase yang tinggi pada plasenta (OR 9,148; IK05% 2,072-40,386, p=0,002).Kesimpulan: Ekspresi rendah 1alfa-hidroksilase plasenta meningkatkan risiko terjadinya PE berat.Low Expression of 1 Alpha-Hydroxylase Enzyme in The Placenta as Arisk Factor for Preeclampsia with Severe FeaturesAbstractObjective: This study aims to determine the low expression of the 1-alpha-hydroxylase (CYP27B1) enzyme in the placenta as a risk factor for severe preeclampsia (PE).Methods: This study is an unpaired case-control study, with a total sample of 44 cases and controls. Samples were placentas that were immunohistochemically processed, to see enzyme expression based on the cumulative histoscore (H-score) as low expression (H-score 200). Multiple logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence interval (95% CI).Results: Low placental 1-alpha-hydroxylase expression was a risk factor for severe PE which was nine times higher than placental 1-alpha-hydroxylase expression (OR 9,148; 05% CI 2.072-40,386, p=0.002).Conclusions: Low placental 1alpha-hydroxylase expression increases the risk of severe PE.Key words: 1aplha-hydroxylase, expression, placenta, risk factor, severe preeclampsi

Characteristics of referral neonates in Sanglah Hospital: reviewed from the S.T.A.B.L.E program

The purpose of this study was to investigate the number of referral neonates that came with an unstable condition (according to a S.T.A.B.L.E program) and characteristic of unstable conditions of the referred neonates. An observational prospective study was conducted for two years from 1st January 2018 to 31st December 2019 in the Emergency Department of Sanglah Hospital, Bali, Indonesia. Referred neonates were assessed in terms of gender, gestational age, referral characteristic, and condition on arrival at the hospital according to S.T.A.B.L.E criteria. According to S.T.A.B.L.E criteria, 283 neonates (54.8%) came on unstable condition. Prematurity (42.6%) was the main reason for referral, 37.9% of them were very low birth weight. Most of them were referred from Denpasar (33.9%), the equipment of transportation was incubator transport (41.8%). T-piece resuscitator was used in 30.4% of referred neonates. Characteristics of unstable conditions were mostly hypoglycemia (33%) and 36% of unstable neonates had more than one condition of instability. This study revealed 283 neonates were unstable and the main reason of transfer neonates is prematurity. Most of them come with unstable conditions that could lead to higher mortality. This study could be a reference for improvement in the neonatal transportation system in Bali

Analisis Kegagalan Korosi pada Tangki Penyimpan Air Panas Terbuat dari Baja Nirkarat

Abstrak : Suatu tangki penyimpanan air panas yang dalam kasus ini terbuat dari baja nirkarat (stainless steel)mengalami kegagalan karena korosi terutama pada bagian sambungan las. Korosi juga terjadipada bagian bawah tanki. Tanki telah digunakan kurang lebih di bawah satu tahun namun sudahmengalami korosi parah terutama pada bagian sambungan las dan juga mengalami korosi padabagian bawah. Penelitian ini bertujuan mengetahui penyebab terjadinya korosi. Penelitiandilakukan dengan menggunakan teknik pengamatan metalografi langsung dilapangan denganmenggunakan mikroskop metalurgi portable. Hasil pengujian menunjukkan korosi terjadi akibatkorosi galvanik yaitu sambungan dua jenis logam nirkarat yang berbeda dan diperparah denganterjadinya korosi pitting. Pengujian dengan menggunakan sinar X fluorisensi juga membuktikanbahwa pelat bagian bawah tanki dan pelat bagian samping dan atas ternyata memiliki kandunganyang berbeda. Untuk mengatasi hal ini maka teknik pengelasan harus ditingkatkan denganmenggunakan logam pengisi yang tepatKata kunci: tanki, air panas, korosi, baja nirkarat, galvanik, pitting Abstract : Hot water storage tank that was made from stainless still was investigated in this case. The tankwas found failure in service due to corrosion in welded section. Corrosion also was found at thebottom part of the storage tank. The tank was used for no longer than one year but unfortunatelysevere corrosion was found. The purpose of this research is to find the reason why the tank easilycorroded especially at the bottom part and at the welding section. The research was carried out byconducting metallographic examination directly in situ by utilizing portable metallographicmicroscope. It is found from investigation that the corrosion was happen due to galvanic corrosion.Investigation by using X ray fluorescence also agree that the composition of the bottom part of thetank was different with the wall, and upper section. The welding filler also was found not correctlyprepared that make pitting corrosion to occur. It is suggested to conduct advance research toinvestigate the correct composition for the filler during welding.Key word: Tank, hot water, corrosion, stainless steel, galvanik,pittin

Nutritional status of preterm neonates at discharge in sanglah hospital

The purpose of this study was to determine the nutritional status of preterm neonates when discharged from the hospital. A descriptive study was reviewed from the register of preterm neonate after hospitalization in neonatal ward Sanglah Hospital Denpasar. The number of total samples in this study was 190 patients. Most of the preterm neonates in this study were low birth weight (59.47%). At the beginning of the hospitalization, there were 83.86% preterm neonates with good nutritional status, decreased to 54.73% at discharge from the hospital. The group of neonates that had the highest number of decreases in the good nutritional status at discharge was found in 28-32 weeks gestational age. Most of the samples used breast milk for enteral feeding (68,42%). In preterm neonates with sepsis, only 42.52% neonates discharge with good nutritional status. Low birth weight preterm neonates with kangaroo method care were found increased weight gain in 78.57% neonates. The nutritional status of preterm neonates following hospitalization at Sanglah hospital is still not good. The preterm neonates with good nutritional status were decreased at discharge from the hospital