Background: Clinical features of COVID-19 are variably from asymptomatic, to severe symptoms including acute respiratory distress syndrome (ARDS), multiple organ failure, and death. A specific biomarker is needed to predict the possibility of COVID-19 patients fall into severe complications and disease severity. D-dimer and C-Reactive Protein (CRP) are biomarkers that are elevated in COVID-19 patients. Method: This is an observational analytic study. The purpose of this research is to explore the correlation between D-dimer serum concentration and CRP with disease severity and mortality in hospitalized COVID-19 patients. This research used secondary data from a medical record with inclusion criteria patient more than 18 years old, confirmed COVID-19 by real-time Polymerase chain reaction (rt-PCR), that hospitalized in Wangaya General Hospital during July 2020 until December 2020. Result: Statistical analysis show that there is Latar Belakang: Fitur klinis pasien dengan COVID-19 bervariasi dari tanpa gejala maupun dengan gejala ringan hingga terjadinya acute respiratory distress syndrome (ARDS), gagal multi organ, dan kematian. Dibutuhkan suatu biomarker yang dapat digunakan dalam memprediksi kemungkinan pasien yang akan jatuh kedalam derajat penyakit maupun komplikasi yang berat. D-dimer dan C-Reactive Protein (CRP) merupakan biomarker yang diketahui meningkat pada pasien COVID-19. Metode: Penelitian ini merupakan penelitian analitik observasional, yang bertujuan untuk mengetahui significant mean difference between D-dimer and CRP concentration based on COVID-19 disease severity (p <0.001 dan p <0.001). AUC value on ROC curve for CRP and D-dimer concentration in predict the mortality of COVID-19 patient are 0.88 (p <0.001, 95% CI: 0.829 -0.48) and 0.88 (p < 0.001, 95% CI = 0.821 -0.950) respectively. In this research, serum D-dimer with concentration more than 4,181 ng/mL statistically significant affect the mortality of COVID-19 patient (OR = 11.713; CI = 1.620 -84.682; p = 0.015). CRP concentration statistically is not significant affect the mortality of COVID-19 patient. Conclusion: There is a statistically mean difference in both D-dimer and CRP concentration based on COVID-19 disease severity. D-dimer concentration of more than 4,181 ng/mL significantly affects the COVID-19 mortality. CRP concentration is not correlated with COVID-19 mortality hubungan konsentrasi D-dimer serum dan CRP dengan derajat keparahan dan mortalitas pasien COVID-19 yang dirawat inap. Penelitian ini menggunakan data sekunder yang bersumber dari rekam medis dengan kriteria inklusi pasien usia diatas 18 tahun dengan diagnosis terkonfirmasi COVID-19 dengan real-time Polymerase chain reaction (rt-PCR), yang dirawat inap di RSUD Wangaya Denpasar periode Juli 2020 hingga Desember 2020. Hasil: Hasil uji statistik menunjukan terdapat perbedaan rerata konsentrasi D-dimer dan CRP berdasarkan derajat keparahan pasien COVID-19 yang

Asthma is a common respiratory disorder that characterized by airway hyper-reactivity and chronic inflammation. Asthma and gastroesophageal reflux disease can occur together, both can affect each other. We represent 41 years old male patient with chief complaint of asthma that preceded burning sensation on his throat and also heartburn over the last three months. Patient had visited his family doctor but his symptom still occurred. He had been experienced six episodes of these symptoms since three month ago. On physical examination there were wheezing both of his lung and prolong expiration phase. There was no abnormality on the electrocardiogram, chest X-ray and complete blood count. After administration of short acting bronchodilator and proton pump inhibitor agent, patient clinical status improved dramatically. Patient than given salmoterol fluticasone inhaler, antacid, ANT proton pump inhibitor as take-home medication. On his follow up visit to policlinic on first, fourth- and eight-week patient denied any shortness of breath and heartburn anymore. Various pathological processes play a role in the pathogenesis of GERD and Asthma. There were two theories that suggested in the mechanism that caused GERD induced Asthma, including reflux and reflex theory.

Background: Chronic kidney disease (CKD) still poses a significant health challenges in both developed and developing countries. Patients with CKD, especially those who require regular hemodialysis tend to experience alteration in psychological status. Depression is one of the most common psychiatric disorders found in patients with end-stage CKD undergoing regular hemodialysis.Methods:This study was a cross-sectional analytic study aimed to identify factors associated with depression among patients with CKD on regular hemodialysis in Wangaya regional hospital. Study sample was all CKD patients who were on regular hemodialysis on February to March 2021. This study was done by questionnaire fulfilment with verbal interview. Additional data were also obtained from medical records. Beck depression index (BDI) questionnaire was used to evaluate depression.Results: Sixty four samples were included in this study. Majority of the sample were male (75%), aged >50 years (71.9%), with low educational status (75%), were married (85.9%), unemployed (67.2%), had duration of hemodialysis of <2 years (64.1%) and had single co-morbidity (62.5%). Depression was found in 29.7% patients. Unemployment (p=0.05), duration of hemodialysis of >2 years (p<0.001) and multiple co-morbidities (p=0.02) were significantly associated with depression.Conclusions:It is important to routinely screen hemodialysis patient for depression. Several individual determinants including sociodemographic factors, duration of hemodialysis and co-morbidities should be considered as they may correlate to the incidence of depression.

Introduction: Hemodialysis is one of the renal replacement therapies used for end-stage renal disease (ESRD) patients. Arteriovenous fistula (AVF) is the preferred hemodialysis access type because it has better patency rates and fewer complications than other access types. However, around 31-61% of AVF fail to mature. An early AVF failure may be due to a lack of maturation or thrombosis, and late failure defines as a failure after successful use. Some factors that make AVF fail are injury of the endothelial wall or hypercoagulation. This study aimed to determine the association between pre-operative platelet and hematocrit value with AVF failure in BHCC Clinic Denpasar. Method: This is an analytic cross-sectional study. The data were collected from medical records from all dialytic patients from January 2020-December 2020. Patients with inclusion criteria were collected. Patient with incomplete data was excluded. Data were analyzed using Chi-square analysis. Results: Our study involved 34 patients, 21(61.8%) of them were male, and the mean age was 52.62 years (±10.77 SD). The AVF failure prevalence was 32.4% (n=11). We found no association between platelet value with AVF failure, with a p-value=0.411. There was an association between hematocrit value and AVF failure in hemodialysis patients with a p-value=0.032. Most of the patient was male and aged 45-60 with ESRD from the characteristic found. Conclusion: There was an association between pre-operative hematocrit value and AVF failure in hemodialysis patients. There was no association between pre-operative platelet value with AVF failure.

Background:Intradialytic hypertension (IDH) define as a condition where an increase blood pressure (BP) in hemodialysis patient from pre- to post- hemodialysis. Fluctuations in BP are one of the most common complications among hemodialysis. IDH prevalence was variably reported from 10–15%. IDH has been recently identified as an independent mortality risk factor.Objective:This study was aimed to determine the prevalence and risk factor of IDH among hemodialysis patient in Bali Husada Cipta Canti Clinic (BHCC), Denpasar.Method:This is an analytic cross-sectional study conducted in BHCC, Denpasar. The data collected from medical record from all dialytic patient on December 2020. Patient with inclusion criteria were collected. Patient with incomplete data was excluded. BP measurements perform before and after hemodialysis. Patient defines with IDH if the difference of systolic blood pressure before and after hemodialysis was more than 10 mmHg in 2 times hemodialysis sequentially.Result:Our study involved 100 patients with male patient was 60 (60%) and mean age is 53.66 years (±10.88 SD). The IDH prevalence was 51% (n = 51). We found no significant differences in ages, body mass index (BMI), oral antihypertensive usage, diabetes status, hemoglobin, erythropoietin usage, quick of blood (QB) between IDH and non-IDH group. There was significant different in ultrafiltration between IDH and non IDH group (p = 0.045; OR 0.443; IK95% 0.199–0.987).Conclusion:IDH in BHCC have a higher prevalence (51%) than previous studies. There was significant different in ultrafiltration between IDH and non-IDH group. Patient with higher ultrafiltration have protective risk for IDH.