Background: Language development of children starts early in infantcy and surges in 2 years of life, updated knowledge about association of language delay with its aggravating risk factor, in this case prolong sreening time, is very important to determine the prognosis of language development in children. Objective: To investigate the association between increased risk of language delay in toddlers with prolonged screen time. Methods: All included studies were collected from Pubmed, Scopus, EBSCO, Clinical Key and Science Direct on February 11th  2020. These articles were then critically appraised using standard Oxford criteria of Evidence Based Medicine prognostic checklist. Result: Two eligible retrospective cohort studies from Lin et al (2014) and Byeon and Hong (2015) are included in this EBCR. Both were calculating the risk of language delay in toddlers between 15-35 months and 24-30 months exposed to screen viewing. Toddlers with more than 2 hours of watching television have higher risk of language delay (Odds Ratio: 3.3 (95%CI 1.5-7.3) and 2.74 (95%CI 1.13-6.65) respectively). Conclusion : The risk of language delay in toddlers is confirmed to be proportionately increased with the increases of screen duration. Maximum language development may be achieved by giving more two-way communication opportunities other than screen viewing.Keywords: Language delay, Toddlers, Screen time. ABSTRAKLatar belakang : Perkembangan bahasa anak-anak dimulai sejak kanak-kanak dan melonjak dalam dua tahun awal kehidupan, pengetahuan terbaru tentang hubungan antara keterlambatan bahasa dengan faktor risiko yang memburuk, dalam hal ini memperpanjang waktu menonton televisi sangat penting untuk menentukan prognosis perkembangan bahasa pada anak-anak. Tujuan : Untuk menyelidiki hubungan antara peningkatan risiko keterlambatan bahasa pada balita dengan  waktu menonton televisi yang lama. Metode : Semua studi literatur yang dimasukkan dan dikumpulkan dari Pubmed, Scopus, EBSCO, Clinical Key dan Science direct pada 11 Februari 2020. Jurnal-jurnal ini kemudian di nilai secara appraisal menggunakan kriteria standar Oxford dalam kaidah laporan kasus berbasis bukti. Hasil : Dua studi kohort retrospektif yang memenuhi syarat kaidah laporan kasus berbasis bukti / EBCR yaitu Lin et al (2014) dan Byeon dan Hong (2015) dimasukkan dalam EBCR ini. Keduanya melakukan penelitian dan menghitung risiko keterlambatan bahasa pada balita usia antara 15-35 bulan dan 24-30 bulan yang terpapar menonton televisi dalam waktu lama . Balita yang menonton televise lebih dari dua jam sehari memiliki risiko keterlambatan bahasa yang lebih tinggi masing-masing(Odds Ratio: 3.3 (95%CI 1.5-7.3) dan 2.74 (95%CI 1.13-6.65). Kesimpulan : Risiko keterlambatan bahasa pada balita dipastikan akan meningkat secara proporsional dengan meningkatnya durasi menonton televise. Perkembangan bahasa pada anak lebih maksimal dapat dicapai dengan memberikan lebih banyak waktu untuk berkomunikasi dua arah antara keluarga selain dari menonton televisi.

Introduction : Hearing impairment in children happened in 6 per 1000 newborn in developing country. The etiology of most of those case is unknown as stated by WHO that 60% of children hearing loss caused by genetics. Aim : This condition could lead to delayed speech in children. Method : A-6-years-old children referred to ENT department with delayed speech and bilateral profound sensorineural hearing loss to get a choclear implant. Result : Her condition suspected to be caused by rubella infection during pregnancy. She was already using hearing aid occasionaly and her mother complain that she still couldn’t hear effectively. The comprehensive management of infant with congenital hearing loss could be diagnosed early by applying hearing screening on all newborns at 1 month of age based on EHDI recommendation. This case represents the society low awareness and diagnostic tools limitation of congenital hearing loss prevention in Indonesia. Therefore, we suggest newborn hearing screening on all high-risked babies based on the risk factor stratification. Habilitation strategy for this patient includes auditory-verbal therapy. In order to maximize the benefit, parents are required to give maximum contribution to each therapy session. The therapy compliance becomes the important parameter in outcome optimization. Early diagnosis and intervention is the key to the management of congenital hearing loss. The EHDI programs provide recommended timeline for newborn hearing screenings, diagnostic examinations, and early interventions. The treatment consists of conventional hearing aid and cochlear implantation, combined with speech and language therapy in an appropriate educational environment, to promote development of communication and educational achievements

Abstrak: Sekitar 5% sampai 10% pasien dengan karsinoma tiroid papiler (PTC) memiliki metastasis lokoregional, sedangkan metastasis jauh sangat sedikit ditemui. Metastasis tulang hanya ditemukan pada sekitar 4% dari semua pasien kanker tiroid dan akibatnya kurang banyak dipelajari tetapi tetap berasosiasi dengan morbiditas dan mortalitas yang jauh lebih tinggi. Terapi klinis dan rehabilitasi mungkin sangat dipengaruhi oleh resorpsi tulang yang disebabkan oleh kanker tiroid. Seorang wanita berusia 58 tahun datang dengan keluhan nyeri pada pangkal paha sebelah kanan nya sejak 5 bulan SMRS. Sebelumnya pasien memiliki Riwayat terpeleset kurang lebih 1 tahun SMRS sehingga kesulitan untuk berjalan. Selain nyeri pada pangkal paha pasien merasakan jantungnya sering berdebar, mudah lelah, berat badan turun, disertai kerontokan pada rambut yang dirasakan kurang lebih 6 bulan SMRS. Pemeriksaan lanjutan menunjukkan kadar TSH rendah dengan Riwayat Plummer’s disease dan suspek massa tihyroid kanan dan kiri (TIRADS 4). Pada pemeriksaan thyroid scan terdapat gambaran cold nodul di kedua thyroid dan bone scan menggambarkan adanya lesi metastasis dengan fraktur patologi pada di collum femur kanan disertai lesi metastasis C5-7. Patogenesis metastasis tulang nampak menunjukkan asosiasi antara kanker dan lingkungan mikro tulang yang menciptakan “siklus destruktif” penghancuran tulang. Selain itu, tumor tiroid folikuler dan meduler lebih mungkin berkembang menjadi metastase tulang, menunjukkan kebutuhan follow up yang lebih detail pada individu dengan histologi ini. Karsinoma tiroid berdiferensiasi memiliki kelangsungan hidup rata-rata hanya 4 tahun dengan adanya metastasis tulang. Dibandingkan dengan kelenjar getah bening lokal dan metastasis paru, metastasis tulang sering terlewatkan dan tidak banyak diteliti. Kanker tiroid yang terkait dengan penyakit Plummer’s menunjukkan perilaku biologis yang agresif dan lebih sering bermetastasis jauh ke area tulang. Meskipun kanker tiroid yang terdiferensiasi dengan baik memiliki progresi yang lambat, metastasis tulang yang terabaikan pada diagnosis awal dapat berdampak buruk pada kualitas hidup dan prognosis pasien.

Background: Pancreatic cancer is a lethal disease associated with poor prognosis. CA 19-9 is one of the elevated tumor markers in pancreatic cancer. However, data regarding CA 19-9 serum levels in pancreatic cancer in Indonesia is still scarce. This study aims to evaluate the clinical use of CA 19-9 in pancreatic cancer patients in Dr. Cipto Mangunkusumo National Central General Hospital.Method: This study is a cross-sectional study that served data of demographic information, CA 19-9 level, TNM stage, site, histopathology, and resectability of pancreatic cancer. This study included 77 subjects. The data were collected from electronic medical records and registered data of patients in the Gastrointestinal Endoscopy Center, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta between 2014 to 2019. Sensitivity and specificity analysis of CA 19-9 were performed using the ROC curve.Results: We found 77 pancreatic cancer patients with a mean age of 54.2+10.4 years old. Most of them were males (59,7%), were found at stadium IV (41,6%) and unresectable tumor (68,8%). Non-adenocarcinoma which was mainly found in the head of the pancreas (76,6%) were confirmed in 67,5% of patients. The sensitivity and specificity of CA-19 9 to diagnose adenocarcinoma pancreas were 32% and 62% (p=0.939).Conclusion: CA 19-9 should be used in aiding diagnosis, in conjunction with other modalities, such as radiological procedures and histopathology results. Measuring serum CA19-9 level in the early diagnosis could guide clinicians in determining the treatment and prognosis of pancreatic cancer.

Heart failure is one of the major cause of patient’s admittance to the hospital. Primary hypertension is one of the most universal comorbidities that precedes heart failure and is one of the more common risk factors held by the majority of the population. Right now, antihypertension that are generally used is from Angiotensin-Converting Enzyme Inhibitor (ACE-I) and Angiotensin Receptor Blocker (ARB). A new group of an antihypertensive agent called “Angiotensin Receptor Neprilysin Inhibitor (ARNI)” to further improve the patient condition. This study aims to evaluate the effectivity of ARNI against ACE-I regarding its cardiac reverse remodeling effect. Search strategy was done using electronic databases, which are Pubmed, Scopus, and Cochrane. Articles included are therapeutic study that is in line with the clinical question and fulfills the inclusion and exclusion criteria. Critical appraisal was done by assessing the article’s validity, importance, and applicability according to Oxford Center of Evidence-Based Medicine 2011 to two chosen articles. 2 articles are chosen and appraised. Both of the study are shown to be valid and shows that ARNI has a significantly better result on improving cardiac reverse remodeling via the left ventricle ejection fraction compared to ACE-I. However, the applicability of ARNI is still debatable in Indonesia as it was not covered by national insurance and there is no generic form. ARNI shows to be significantly better to reverse cardiac remodeling compared to ACE-I, but its applicability has to be improved to be implemented in Indonesia.