AIM: Although absolute values for C-reactive protein (CRP) and procalcitonin (PCT) are well known to predict sepsis, it remains unclear how their diagnostic value in major burn patients as metabolic changes in burn patient mimic signs and symptoms for sepsis. This paper attempts to clarify these points for both of the markers. METHODS: A comprehensive literature search of PubMed, Scopus, DOAJ, Web of Science, and the Cochrane Library databases for studies published up to June 1, 2020, that evaluated PCT and/or CRP as a marker for diagnosing sepsis in burn patients was conducted. Review Manager 5.3 was used to analyze the data. RESULTS: A total of 11 literatures were obtained. The combined sensitivity and specificity for PCT as assessed by meta-analysis were 88% and 89%, respectively. The combined sensitivity and specificity of CRP were described as 85.5% and 57.5%, respectively. Meta-analysis cannot be performed for CRP parameters because there are only two literatures that include CRP diagnostic test values. DISCUSSION: PCT and CRP have additional diagnostic value for sepsis in patients with major burns. The pooled sensitivity and specificity of PCT are excellent. Although the difference in sensitivity between PCT and CRP is not very large, there are distinct differences in specificity. A low CRP specificity value will show many “false positives” when CRP is used as a biomarker. CONCLUSION: PCT provides a better diagnostic value than CRP in cases of sepsis in major burn patients. More study on combination of biomarker, clinical presentation, and microbial culture for diagnosing sepsis are needed. Further large-scale research with cohort or case control design should be done.

Background: Radius distal fracture is the most common fracture seen in emergency department which involves the upper extremity. Radius distal fracture can occur in any age, ranging from children, teenager until elderly patients. There is an increasing trend of radius distal fracture. However, the research on radius distal fracture characteristic, especially in Bali, is still limited.Method: This study was a descriptive-retrospective study which aims to find out the characteristic of radius distal fracture at Sanglah General Hospital, Denpasar, Bali. For data collection, we used total sampling technique using secondary data from patients’ medical records. The study sample was all patient diagnosed with radius distal fractures between the year 2013-2017 with incomplete medical record as the exclusion criteria.Result: This study obtained 677 radius distal fracture samples. Most of the patients were male [434 cases (64,1%)] with the most common age range was between 20-29 years old [147 cases (21,7%)]. The most common etiology of radius distal fracture was traffic accident [322 cases (47,6%)]. Fracture of the other upper extremity parts, in addition to radius distal, was the most common complaints accompanying radius distal fractures [333 cases (49,2%]. Based on the length of stay, 84% patients were hospitalized less than 5 days.Conclusion: Distal radial fracture was commonly seen in men with the age range between 20-29 years old. Traffic accident was the most common cause of distal radial fracture with the average length of stay less than 5 days.

Background: In Toxic Epidermal Necrolysis (TEN), age has been reported to be not only a risk factor but also associated with increased mortality. The presence of underlying illness and comorbidities also increased the burden of TEN in elderly patients.Case: A-70-years old male patient was consulted with a history of pulmonary tuberculosis and skin detachment. Symptoms started since four weeks before admitted to the hospital with redness in the face and extremities that spread to the chest and back accompanied by fever and malaise. The patient also complained of a wound in the lips and genitalia. Physical examination found multiple erosion, geographical shape, varied in size with positive nickolsky sign. The detachment covered 40% of the body surface area. From the laboratory, a result found a decrease in hemoglobin, blood glucose, albumin, and potassium. The patient was diagnosed with TEN, treated in the burn care unit, given supportive care and intravenous dexamethasone 10 mg every 8 hours, and then tapered off. The mortality rate from SCORTEN count was 12,1%.Discussion: The incidence and mortality of TEN were higher in the elderly than among younger adults. Supportive care was the key feature of management with various adjunctive therapy, including systemic corticosteroids, intravenous immunoglobulin, and other immunosuppressant agents. Giving more comorbidities, more observation, and a multidisciplinary approach for TEN in elderly patients might be needed.Conclusion: In the elderly, the risk and mortality of TEN were even higher, and the presence of comorbidities require more observation and supportive care.

Background: Trauma is the fourth leading cause of death in the world and occurs at all ages. The high incidence of traffic accidents is equivalent to the increasing incidence of maxillofacial trauma, especially mandibular fracture. This study aims to determine the characteristics by age, gender, mechanism of injury and anatomical site of mandibular fractures among patients attending the Plastic Surgery Unit of Sanglah General Hospital as a preliminary studyMethods: A descriptive cross-sectional study was enrolled among 45 patients attending plastic surgery who recorded in medical records from January 2014 until December 2016 as well as met the inclusion criteria. Data were analyzed using SPSS version 17 and presented in percentage regarding Age, mechanism of injury, gender, and fracture siteResults: There were 45 patients with 61 mandibular fracture sites. Most of the patients were male (84.4%). Based on age, the mandibular fracture is most common in the productive age (20-30 years old) at 22 cases (36.1%). Majority cause of fractures was road traffic accident (82.2%). Parasymphysis region was the most common site of fracture (39.3%).Conclusion: The characteristics of mandibular fracture patients describe trauma patterns in the community. This finding is similar with some readily available literature with RTAs was the most common etiology and parasymphysis was the most common fracture site.