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"ABSTRAKAcute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly, diabetics, and patients with prior stroke or heart failure.1 Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality.2 Abstract : Acute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly and diabetics. Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality. Herein we report a case of 46 yearsold male presenting with a sudden onset of severe acute upper back pain 6 hours prior to hospital admission. Diagnosis of AMI was delayed until 12 hours later after typical ischemic chest pain manifested and ECG reading showed evolution of ST-Elevation Myocardial In- farction (STEMI). Due to the atypical clinical presentation, diagnosis of AMI in this patient was delayed. Vigilant observation and low threshold for acute coronary syndrome (ACS) work-up are obligatory to prevent delayed diagnosis and management. "

"ABSTRACTAcute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly and diabetics. Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality. Herein we report a case of 46 years old male presenting with a sudden onset of severe acute upper back pain 6 hours prior to hospital admission. Diagnosis of AMI was delayed until 12 hours later after typical ischemic chest pain manifested and ECG reading showed evolution of ST Elevation Myocardial Infarction (STEMI). Due to the atypical clinical presentation, diagnosis of AMI in this patient was delayed. Vigilant observation and low threshold for acute coronary syndrome (AC5) work up are obligatory to prevent delayed diagnosis and management."

"Nyeri punggung atas adalah salah satu gejala atipikal dari infark miokard akut (IMA) yang lebih sering ditemukan pada perempuan, lanjut usia dan penderita diabetes. Kegagalan untuk mengenali presentasi atipik dari IMA menyebabkan telatnya diagnosis yang dihubungkan dengan meningkatnya mortalitas dan morbiditas. Dalam kasus ini kami melaporkan seorang laki-laki berusia 46 tahun datang dengan keluhan nyeri punggung atas yang berat dan mendadak sejak 6 jam sebelum masuk rumah sakit. Diagnosis IMA tertunda hingga 12 jam kemudian ketika nyeri dada tipikal dirasakan dan EKG menunjukan evolusi dari STEMI. Karena presentasi klinis yang atipikal, diagnosis IMA pada pasien ini tertunda. Pemantauan yang jeli dan pemeriksaan lanjutan untuk sindrom koroner akut (SKA) wajib dilaksanakan untuk mencegah tertundanya diagnosis dan tata laksana yang sesuai."

"Latar Belakang: Penanda prognostik dapat menunjang tata laksana stroke iskemik (SI) akut. Protein neuroglobin (Ngb), yang berperan dalam transpor oksigen intrasel neuron dan mengurangi dampak hipoksia, adalah salah satu penanda potensial memenuhi fungsi tersebut.Metode: Studi potong lintang dilakukan pada pasien SI akut yang dirawat di RSUPN dr. Cipto Mangunkusumo pada Maret-April 2023. Sampel serum untuk pemeriksaan Ngb diambil pada tiga hari pasca awitan stroke, sedangkan modified Rankin scale (mRS), National Institutes of Health Stroke Scale (NIHSS), indeks Barthel (BI) dan Montreal Cognitive Assessment (MoCA-Ina) diperiksa pada hari ketujuh. Analisis kemaknaan dan kurva receiver operating characteristic (ROC) digunakan untuk mengetahui hubungan Ngb dengan luaran stroke iskemik akut.Hasil: Sebanyak 42 subjek menjalani analisis. Kadar Ngb serum lebih tinggi pada kelompok dengan skor mRS 3-6 dibandingkan 0-2 (12,42 ng/mL [3,57-50,43] vs 4,79ng/mL [2,25-37,32], p=0,005), dengan skor area di bawah kurva ROC sebesar 0,75. Kadar Ngb juga lebih tinggi pada kelompok dengan NIHSS pulang lebih tinggi (p=0,03), serta BI dan MoCA-Ina yang lebih rendah (p=0,01 dan p=0,002).Kesimpulan: Kadar Ngb serum pada SI akut yang lebih tinggi berkaitan dengan luaran fungsional jangka pendek yang lebih buruk. Penelitian lebih lanjut dibutuhkan sebelum terapan klinis.

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Background: Prognostic markers can optimize the management of acute ischemic stroke (AIS). The neuroglobin (Ngb), which plays a role in intraneuronal oxygen transport and reduces the effects of hypoxia, is a marker that may perform this function.

Methods: A cross-sectional study was conducted on AIS patients who were treated at RSUPN dr. Cipto Mangunkusumo in March-April 2023. Serum samples for Ngb examination were taken three days after the onset of stroke, while modified Rankin scale (mRS), National Institutes of Health Stroke Scale (NIHSS), Barthel index (BI) and Montreal Cognitive Assessment (MoCA-Ina) were examined on the seventh day. Significance analysis and receiver operating characteristic (ROC) curve were used to determine the relationship between Ngb and AIS outcomes.

Results: A total of 42 subjects underwent analysis. Serum Ngb levels were higher in subjects with mRS score of 3-6 than 0-2 (12.42 ng/mL [3.57-50.43] vs 4.79 ng/mL [2.25-37.32], p=0.005). The area under the ROC curve score was 0.75. Ngb levels were also higher in the group with higher NIHSS at discharge (p=0.03), lower BI (p=0.01) and lower MoCA-Ina score (p=0.002).

Conclusion: Higher serum Ngb levels in AIS are associated with poorer short-term functional outcomes. Further research is needed before clinical application."

"Low Performance Presenteeism (LPP) atau presenteisme dengan kinerja rendah sering terjadi, di mana karyawan tetap bekerja meskipun memiliki masalah kesehatan, sehingga mempengaruhi produktivitas dan meningkatkan biaya perawatan kesehatan. Di industri kelapa sawit Indonesia, terutama di Jambi, data mengenai LPP di antara pekerja pertanian masih jarang. Satu perkebunan melaporkan tingkat penyakit bulanan 11-28%, yang menunjukkan potensi presenteisme. Gangguan muskuloskeletal (MSDs) seperti sindrom carpal tunnel (CTS), nyeri punggung bawah (LBP), dan nyeri leher umum terjadi di sektor ini. Studi ini menyelidiki hubungan antara MSD dan LPP di antara pekerja perkebunan kelapa sawit di Provinsi Jambi. Sebuah studi cross-sectional dilakukan pada Mei 2024 bekerja sama dengan klinik kesehatan perusahaan. Kuesioner SPS-6 menilai LPP di antara pekerja pemanen yang dipilih melalui stratified random dan convenience sampling. Variabel independen termasuk MSD (CTS, LBP, nyeri leher), faktor demografis (usia, jenis kelamin), dan faktor pekerjaan (masa kerja, status pekerjaan). Data dikumpulkan dari 150 subjek di 9 departemen, mayoritas laki-laki dengan usia rata-rata >37 tahun. Sebagian besar memiliki masa kerja >7 tahun dan pekerja kontrak. Prevalensi MSD termasuk nyeri leher (38%), LBP (33,3%), dan CTS (24%). Analisis regresi logistik mengungkapkan hubungan signifikan antara LPP dan CTS, LBP, nyeri leher, serta masa kerja ≥7 tahun. MSD dan masa kerja yang lebih lama muncul sebagai prediktor penting LPP di industri kelapa sawit Jambi.

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Low performance presenteeism (LPP) is prevalent, where employees work despite health issues, impacting productivity and increasing healthcare costs. In Indonesia's palm oil industry, primarily in Jambi, data on LPP among agricultural workers is sparse. One plantation reported monthly illness rates of 11-28%, suggesting potential presenteeism. Musculoskeletal disorders (MSDs) such as carpal tunnel syndrome (CTS), low back pain (LBP), and cervical pain are common in this sector. This study investigates the relationship between MSDs and LPP among palm oil plantation workers in Jambi Province. A cross-sectional study was conducted in May 2024 in collaboration with a company health clinic. The SPS-6 questionnaire assessed LPP among harvesting workers selected through stratified random and convenience sampling. Independent variables included MSDs (CTS, LBP, cervical pain), demographic factors (age, gender), and job-related factors (tenure, employment status). Data were collected from 150 subjects across 9 departments, predominantly male, with a mean age >37 years. Most had tenures >7 years and held non-permanent positions. MSD prevalence included cervical pain (38%), LBP (33.3%), and CTS (24%). Logistic regression revealed significant associations between LPP and CTS, LBP, cervical pain, and tenure ≥7 years. MSDs and longer tenure emerged as crucial predictors of LPP in Jambi's palm oil industry."

"Latar belakang : Seiring dengan dominasi penggunaan komputer di tempat kerja, dampak terhadap kesehatan pekerja termasuk nyeri bahu pun meningkat. Penelitian ini bertujuan untuk mengetahui hubungan antara nyeri bahu dengan posisi janggal dan faktor-faktor risiko yang berhubungan pada pengguna komputer. Metode : Penelitian ini menggunakan disain cross sectional , dilakukan di perusahaan X pada bulan Mei-Juli 2010. Responden dipilih dengan mctode consecufive sampling Faktor-faktor yang diteliti ialah sosiodemogmfi, gaya hidup dan pekeljaan. Data dikumpulkan melalui pengisian kuesioner, pemeriksaan iisik, wawancara dan pengukuran tempat kerja. Analisis multivariate dengan metode regresi logistik digunakan untuk mcncntukan variabel-variabel predictor dengan interval kepercayaan 95% dan batas kemaknaan 0,05. Hasil : Terpilih 78 responde dari 402 populasi .Prevalensi nyeri bahu 47,4% dengan posisi janggal paling sering dijumpai ialah ante fleksi 2 60°. Faktor-falctor risiko signitikan adalah posisi janggal (OR=l3,58; 95%CI:2,25-82,18), perempuan (0R:4,54; 95%CI:l,l0-l8,73), kcbiasaan berolah raga (OR=2,65;95%CI:0,72-9,83), lama mcnggunakan komputer >8 jam (OR:7,46; 95%CI:l,77~3l,35), pelatihan crgonomi (0R:3,43; 95%CI:O,93-l2,60).

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Background: In alignment with dominant use of computers at the workplace, the toward worker health impact as well shoulder pain is increasing. This study aims to determine the relationship between shoulder pain with awkward position of the upper arm and others related risk factors.

Methods: This cross sectional study was conducted at company X during May to July 2010. Respondents were selected by consecutive sampling method. Risk factors included in this study were sociodetnographic, lifestyle and work environment. Data were collected by using questionnaires, conducting physical examinations, interview and workplace measurements. Multivariate analysis with logistic regression method has been used to identify detemtinant factors with 95% confidence interval and significance linrit of 0.05.

Results: There are 78 respondents of 402 total population. Prevalence of shoulder pain 47.4% with the most frequent awkward position is forward flexion 260°. Signijicant risk factors were awkward position (OR=13,58; 95%CI:2,25-82,l8), fema1e(OR:4,54; 95%CI:l,l0-l8,73), physical exercise (OR=2,65;95%CI:0,72-9,83), using computer 28 hrs per day (OR:7,46; 95%CI:1,77-3l,35), ergonomic training (0R:3,43; 95%CI:0,93-l2,60)."

"Penyakit kardiovaskular menjadi masalah kesehatan global dan menempati urutan pertama penyebab kematian. Prevalensinya semakin meningkat seiring peningkatan faktor risiko diabetes melitus (DM), hipertensi, dislipidemia, dan merokok. Infark miokard akut (IMA) merupakan iskemia miokard yang disebabkan oleh ruptur plak arteri koroner yang menyebabkan trombosis dan oklusi. Upaya penanganan IMA dapat dilakukan dengan tindakan revaskularisasi, namun tindakan tersebut berpotensi menyebabkan cedera miokard ireversibel dan kematian kardiomiosit yang dikenal sebagai cedera iskemia reperfusi miokard. Mekanisme cedera iskemia reperfusi miokard menginduksi respons inflamasi yang memicu pembentukan inflamasom NLRP3 sehingga terjadi aktivasi kaspase-1 yang berperan pada maturasi dan pelepasan interleukin (IL)-18. Kolkisin merupakan obat antiinflamasi yang sederhana, murah, dengan masa kerja cepat yang dapat menghambat inflamasom, sehingga tidak terjadi aktivasi dan pelepasan IL-18. Penelitian mengenai efektivitas kolkisin terhadap penyakit kardiovaskular telah banyak dilakukan, namun penelitian mengenai perubahan kadar IL-18 pada pasien IMA belum banyak dilakukan. Penelitian ini bertujuan untuk mengkaji perubahan kadar IL-18 pada 48 jam pasca IKPP pada pasien IMA dengan elevasi segmen ST (EST) dengan pemberian kolkisin. Desain penelitian uji klinik tersamar ganda,  dengan total 60 pasien IMA-EST yang menjalani IKPP, terdiri dari 30 subjek kelompok kolkisin dan 30 subjek kelompok plasebo. Penurunan kadar IL-18 pada 48 jam pasca IKPP pada kelompok kolkisin lebih besar daripada kelompok plasebo, namun tidak didapatkan perbedaan bermakna antara keduanya. Perlu dilakukan penelitian lebih lanjut dengan berbagai rentang waktu untuk menilai penurunannya. 

Kata Kunci : IMA-EST, cedera iskemia reperfusi miokard, IL-18, kolkisin, penurunan kadar

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Cardiovascular diseases have become a global health problem and are the leading cause of death. The prevalence is increasing due to the rise in risk factors such as diabetes mellitus (DM), hypertension, dyslipidemia, and smoking. Acute myocardial infarction (AMI) is myocardial ischemia caused by the rupture of a coronary artery plaque, leading to thrombosis and occlusion. The management of AMI can be done through revascularization procedures, but these interventions have the potential to cause irreversible myocardial injury and cardiomyocyte death, known as ischemia-reperfusion myocardial injury. The mechanism of ischemia-reperfusion myocardial injury induces an inflammatory response that triggers the formation of the NLRP3 inflammasome, leading to caspase-1 activation involved in interleukin (IL)-18 maturation and release. Colchicine is a simple, inexpensive, fast-acting anti-inflammatory drug that can inhibit the inflammasome, thus preventing the activation and release of IL-18. Studies on the effectiveness of colchicine in cardiovascular diseases have been conducted extensively, but research on changes in IL-18 levels in AMI patients is limited. This study aims to assess the changes in IL-18 levels within 48 hours post-primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI) patients treated with colchicine. The study design is a double-blinded, randomized clinical trial, involving a total of 60 STEMI patients undergoing PPCI, with 30 subjects in the colchicine group and 30 subjects in the placebo group. The reduction in IL-18 levels at 48 hours post-PPCI in the colchicine group was greater than in the placebo group, although no significant difference was observed between the two groups. Further research with different time intervals is needed to assess the extent of IL-18 reduction.

Keyword : STEMI, ischemia-reperfusion myocardial injury, IL-18, colchicine, reduction levels"

"Pendahuluan: Acute kidney injury AKI merupakan komplikasi gagal organ pada sepsis yang dapat meningkatkan morbiditas dan mortalitas di ICU. Hasil dan pembahasan: Pemenuhan nutrisi pada pasien sepsis dengan AKI sangat tergantung pada keadaan klinis pasien dan terapi AKI. Pada serial kasus ini terdapat satu pasien sepsis dengan AKI klasifikasi AKIN 2 dan 3 pasien dengan AKI klasifikasi AKIN 3. Kebutuhan nutrisi pada pasien sepsis dengan AKI klasifikasi AKIN 2 maupun sepsis dengan AKI AKIN 3 selama perawatan di ICU diberikan dengan target energi 30 kkal/kg BB/hari dan protein 1,5 g/kg BB/hari. Perburukan fungsi ginjal pada pasien sepsis dengan AKI tidak disebabkan oleh pemberian nutrisi tinggi protein melainkan disebabkan oleh keadaan sepsis yang tidak teratasi. Terapi renal replacement therapy RRT dibutuhkan pada pasien sepsis dengan AKI klasifikasi AKIN 2 dan AKIN 3 agar nutrisi dapat diberikan secara optimal untuk menunjang perbaikan klinis. Terapi nutrisi optimal pada pasien sepsis dengan AKI dapat mempertahankan lean body mass, memperbaiki sistem imun, dan memperbaiki fungsi metabolik. Kesimpulan: Terapi nutrisi yang adekuat dengan energi 30 kkal/kg BB/hari dan protein 1,5 g/kg BB/hari pada pasien sepsis dengan AKI dapat menunjang perbaikan klinis.

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Introduction Acute kidney injury AKI is an organ failure complication in sepsis that increased morbidity and mortality in ICU.Results and discussion Nutrition in sepsis with AKI patients are dependent on clinical condition and AKI treatment. In this serial case displayed one case septic AKI classification AKIN 2 and three cases septic AKI classification AKIN 3.

Nutritional requirements for sepsis with AKI classification AKIN 2 and AKI classification AKIN 3 in ICU setting were targetted at 30 kkal kg body weight day and protein 1,5 g kg body weight day. Worsening renal function in sepsis with AKI are not caused by high protein intake but caused by unresolved infection. Renal replacement therapy is required in sepsis with AKI classification AKIN 2 and AKIN 3 to maintain adequate nutritional therapy for better clinical outcomes.

The optimal nutritional therapy in sepsis with AKI aimed to maintain lean body mass, improved immune function, and metabolism.Conclusion Adequate nutritional therapy with energy 30 kkal kg body weight day and protein 1,5 g kg body weight day in sepsis with AKI can bolster better clinical outcomes."

"Nyeri radikular pada lengan atas kiri sering dihubungkan dengan masalah diskus servikal. Jika hasil MRI servikal tidak sesuai dengan gejala, maka kecurigaan adanya tumor saraf perifer harus dipertimbangkan. Laki-laki 54 tahun dengan presentasi nyeri radikuler pada lengan kiri, menjalani pemeriksaan untuk masalah diskus servikal, sementara hasil MRI servikalnya normal. Pada pemeriksaan fisis ditemukan Tinel?s sign pada lengan atas kiri penderita. MRI fokal memperlihatkan massa berlobus pada n. radialis dengan diameter 1,5 cm. Penderita menjalani operasi dan tumor dapat diangkat secara total. Pemeriksaan histopatologi memperlihatkan suatu schwannoma.

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AbstractRadicular pain on the arm often referred to cervical disc problems. If cervical MRI is normal, then it is necessary to rule out peripheral nerve tumor. A 54-year old man presented with radicular pain in his left arm, investigated for cervical disc problems, with normal cervical MRI. Examination shows a positive Tinel?s sign on the proximal part of his left arm. Focal MRI revealed a lobulated tumor in the radial nerve 1.5 cm in diameter. The patient was operated and the tumor was completely removed. Histopathology confirmed the diagnosis of schwannoma."