Miastenia Gravis Okular Juvenil: Laporan Kasus

Purpose: This study aimed to summarize the general history, physical exam findings, confirmation test, and treatment of a patient with juvenile ocular myasthenia gravis. Research Methodology: This article is a pediatric RSUD Abdoel Moeloek Lampung case report in April 2021. The subject of the case is a 3-year-old girl who is hospitalized in the hospital ward with juvenile ocular myasthenia gravis. Result: A 3-year-old girl, an inpatient in the Pediatric Ward, RSUD Abdoel Moeloek Lampung, with complaints of decreased left upper eyelid since three months ago. On physical examination, there was ptosis of the left superior palpebra. Prostigmine test was performed on day 2 of treatment in patients with positive test results. The patient was clinically diagnosed with “Juvenile Ocular Myasthenia Gravis.” Management of the patient during treatment was the injection of methylprednisolone 10 mg/12 hours and neostigmine orally 2.5 mg/8 hours. Limitations: This case report is limited to juvenile ocular myasthenia gravis cases with a scarce number of cases and rare cases in children. Contribution: This case report can be helpful in medical education or used as a reference in making relevant case reports and can be applied in the hospital area when there are cases of juvenile ocular myasthenia gravis.

Mikrobiota Usus dan Osteoartritis

Osteoarthritis (OA) is one of the most commonly experienced musculoskeletal diseases. Various studies were conducted to find the relationship between the gut microbiota and the incidence of osteoarthritis. The gut microbiota encourages the production of proinflammatory cytokines and bacterial metabolites which are considered to be part of the pathophysiological mechanisms of osteoarthritis. Various risk factors that trigger osteoarthritis, such as age, gender, diet, and obesity have an influence on the gut microbiota. This suggests the possible involvement of the microbiota in the incidence of osteoarthritis. The increasing prevalence of osteoarthritis calls for an effective disease-modifying therapy strategy to relieve symptoms and slow the progression of the condition. The investigators hypothesized that modulation of the gut microbiota by external approaches might influence the progression of osteoarthritis. To date, some evidence suggests that gut microbiota intervention can be realized through probiotics, prebiotics, exercise, and fecal microbiota transplantation (FMT). Keywords: Osteoarthritis, Microbiota, Risk Factor

Manajemen Holistik dengan Pendekatan Kedokteran Keluarga pada Pasien Wanita 37 Tahun dengan Hipertensi Primer

Purpose: This study aimed to identify risk factors, clinical problems and provide management of patients with the implementation of holistic family physician services based on evidence-based medicine approach to patient and family-centered approach. Research methodology: This study is a case report. Primary data were obtained through history taking (directly from the patient and indirectly from family members), physical examination, and a home visit to complete the family, psychosocial and environmental data. Secondary data were obtained from the medical records of the patient at the health center. The assessment was based on a holistic diagnosis from the beginning, process, and the end of quantitative and qualitative studies. Results: A 37-year-old female was diagnosed with primary hypertension with worries that his disease would get worsen into a stroke. Patients do not know exactly what diet is recommended for hypertensive patients. The evaluation results obtained that complaints and worries of patients were reduced, the knowledge of patients and their families regarding hypertension increased and behavior related to hypertension improved. Contribution: Holistic management has been done with the approach of a family doctor, Mrs. S age 37 years with primary hypertension adjusted for EBM based on baseline holistic diagnostics. These interventions have increased the patient's knowledge and changed some of the patient's behavior and his family, as indicated by improvements in the final holistic diagnostics.

Hubungan antara Mikrobiota dan Psoriasis

As the largest organ of the human body, the skin is colonized by a variety of microorganisms, most of which are harmless and have benefits for the host. This microbiota contributes to the metabolism and immunity of the host. The human microbiota includes bacteria, fungi, viruses and archaea, which inhabit various areas of the body. Most of the microbiota resides in the intestine, only a small part of which inhabit epithelial surfaces such as the mouth, airways, vagina and skin. The total number of microbiota on the surface of the skin is usually in the range 104 to 106 cells per cm2. Psoriasis is one of the most common immune-mediated inflammatory skin diseases. The prevalence of disease has been reported, with a range of 0.09- 11.43% by the WHO Global Report 2016. To date the causes of this disease are not fully understood, genetic and environmental interactions play an important role in disease progression. Recently, immunological approaches have helped to clarify the pathophysiology of the disease significantly. The skin microbiota has been shown to play a role in the pathogenesis of lichenified plaque formation in psoriasis. Corynebacterium, Propionibacterium, Staphylococcus, and also Streptococcus have been identified as the main microbiota. It has not been determined whether these changes in the microbiota are a cause or consequence of psoriasis. For this reason, further research on selective modulation of the skin microbiota is needed. This systematic review aims to elucidate the correlation between the microbiome and pathogenesis of psoriasis and the modulation of the microbiota that could lead to possible therapeutic interventions. Keywords: Microbiota, Psoriasis, Skin

The Efek Neuroprotektif Kafein terhadap Fungsi Motorik pada Penyakit Parkinson

Background: Coffee is one of the most consumed drinks in the world and has become a routine part of everyday life. Coffee is known to be a stimulant because of its high caffeine content. Parkinson's disease is the second most common neurodegenerative disorder characterized by the clinical presentation of motor and non-motor disorders. Neuroinflammation plays a major role in the pathogenesis of Parkinson's disease which is regulated by reactive microglia and causes neurodegeneration of dopaminergic neurons. Consumption of caffeine can exert anti-inflammatory effects on nerves in a variety of pathological conditions. Method: The method used is a literature study from various national and international journals. This method is used with the aim of summarizing a current topic in order to increase an understanding. The literature study restates previously published material and reports new facts or analyzes from relevant literature studies and then compares the results in the article. Results: Caffeine can act as a neuroprotective against the development of Parkinson's disease by keeping the blood-brain barrier intact so that the function of the central nervous system remains stable. Caffeine can improve motor function in Parkinson's disease patients by modulating adenosine A2AR receptors at different doses. Caffeine as an adjuvant drug in the treatment of Parkinson's disease is given together with Trihexyphenidyl (THP) which is an anti-Parkinson's agent that has been used clinically to treat Parkinson's disease. Conclusion: Caffeine is a neuroprotective agent that is widely available and can be used in the treatment of Parkinson's disease with current therapies. However, the correct dosage and safety of caffeine are of particular concern, especially when given at high doses for a period of time and concurrently with other Parkinson's drugs.

Penatalaksanaan Holistik Scabies pada Anak Usia 4 Tahun di Puskesmas Panjang melalui Pendekatan Kedokteran Keluarga

Scabies is a skin disease caused by the infestation and sensitization of Sarcoptes scabiei var. hominis. Scabies attacks in groups because of transmission that quickly occurs through direct or indirect skin contact. This contact occurs especially when living in the same place of residence. In Indonesia, scabies is a skin disease that can often be found in public health centers. The prevalence of scabies in public health centers throughout Indonesia in 2008 reached 5.6-12.9% and is the third-largest skin disease. Primary health services play an important role in scabies in enforcing the right diagnosis and therapy, preventing the disease and spreading the disease to the community because this disease is easily transmitted, especially in dense settlements. Therefore, the appropriate handling of this case is using a family medicine approach. Patient An. H, 4 years of age, complained of itching between the fingers of both hands, especially at night since 3 days ago. The patient had never previously complained of complaints like this. The patient is worried because the complaint spreads to other parts of the body, spreads to people around him, is ridiculed and shunned by his friends. The patient hopes that the itching will disappear, the disease can be cured quickly, does not recur, and does not spread to other people. Patients previously believed that the complaints that arose were viral or bacterial diseases transmitted by other people. Clinically the patient was diagnosed with scabies (ICD 10 B.86). Internal risks include lack of personal hygiene, lack of knowledge, and curative treatment patterns. External threats include similar complaints in the surrounding environment, low-income family hygiene, adequate socioeconomic, and lack of family knowledge—functional degree 1, which is being able to perform activities such as before being sick without difficulty. Furthermore, holistic management is carried out, namely intervention using poster media. In the evaluation, results were obtained in the form of a better understanding of the disease and behavior changes that impacted the success of therapy.