Fistula is an abnormal connection between a channel with another channel (internal fistula), or a channel with the outside through the skin (externa fistula). A male, 48 years old, came to the RSUCM Hospital with complaints of discharge from the wound after a hernia operation on the left hip since 1 month at the SMRS. The liquid comes out in small increments, spontaneously, in lumps the size of corn kernels, blackish brown and sometimes greenish yellow, and smells bad. Surgical scars are often inflamed since 6 months after hernia surgery and have often been constipated since the operation. History of hypertension and diabetes mellitus since 4 years ago, not in control and not taking medication regularly. On physical examination, vital signs revealed hypertension. On physical examination, the status of the left iliac a/rillois was seen, an open wound measuring 1x1.5 cm, smelly discharge (+), felt warm, edema (+), NT (+). On complete blood laboratory examination, found within normal limits. At the time of colonoscopy.

Rheumatic heart disease (RHD) is damage of the heart valves due to acute rheumatic fever (ARF) which results from the body’s autoimmune response to Streptococcus pyogenes (group A Streptococcus bacteria) infection which is a throat infection. Acute rheumatic fever is one of the most important causes of cardiovascular morbidity and mortality in the developing countries. A 25-years-old male patient, domiciled in Alue Dalam, Darul Aman, East Aceh, admitted to emergency department of Cut Mutia hospital, the patient was brought to the hospital by his family at 05.0o pm on January 27th, 2022. Patient referred from Graha Bunda hospital. Patient was admitted to the hospital with complaints shortness of breath. Shortness of breath is felt during activity and worsens at night. Shortness of breath since yesterday. The patient also complained of pounding. The pounding has been felt for five days before arriving at the hospital. The patient also has chest pain, and tired easily. Past medical history such hypertension and diabetes mellitus are denied. Physical examination before treatment was obtained: the patient looked restless, weakness, and akker. Echocardiography examination showed the MR Severe, MS moderate, AR moderate, TR moderate, PH mild, AML calsification, all chamber dilatation, and thrombus LV. The patient was given initial treatment in Cut Mutia General Hospital.

Abstract Introduction: The vagina is normally inhabited by a number of organism, including Lactobacillus acidophilus, diphteroids, Candida and others. Normal vaginal flora contains aerobic and anaerobic bacteria, such as Lactobacillus species being the prominent microorganism with number more than 95% of the total bacteria present. Vaginal discharge can be classified into physiologic and pathologic discharge. Discussion: Bacterial vaginosis is a clinical syndrome caused by the alteration of Lactobacillus Sp that producing hydrogen peroxide with anaerobic bacteria that caused the disruption of the normal flora balance. Risk factors of bacterial vaginosis are sexual activity, vaginal douching, genetic, vaginal manipulation, smoking and using the intrauterine device. Diagnosis of bacterial vaginosis can be enforced by the gram staining and the calculation of Nugent score (positive diagnosis of bacterial vaginosis if nogent score 7-10). Amsel score can also be conducted if the Nugent score examination cannot be performed. Amsel score criteria consists of white homogen vaginal discharge, fishy odor (positive Whift test), pH > 4.5, and the finding of clue cell. The discovery of 3 citeria of Amsel can confirm the diagnosis of bacterial vaginosis. Treatment of bacterial vaginosis including systemic and topical therapy. Systemic antibiotic such as metronidazole and clindamycin is effective against the anaerob bacteria. Conclusion: bacterial vaginosis in an abnormal condition in the vagina caused by the overgrowth of anaerobic bacteria replacing the Lactobacillus hominis that caused the change of normal acidic pH vagina into alkaline. Amsel criteria and Nugent score can be requested to confirm the diagnosis of bacterial vaginosis. Proper diagnosis and treatment with metronidazole and clindamycin can improve the disease.