Handling and implementation of good nutrition care in various conditions needs to be done in the right way and well documented, in the future every nutritionist working at the puskesmas can understand the Nutrition Care Process (NCP), able to apply it in daily work, and be  handled properly and appropriately. Analysis of situation at all Puskesmas in Kampar District, not all nutritionist understand and apply the NCP method in a structured daily work. This activity aims to increase the knowledge, roles and functions of professional nutritionist in Puskesmas by implementing the NCP. The training method used focuses on discussion and discussion of case studies that occur in the field. The results of the pre and posttest showed that there was an increase in the knowledge of health center nutritionists in preparing the NCP by 52%. While the results of the paired t test showed an increase in knowledge before and after training (p-value = 0.0001). The success of understanding and implementing NCP can be influenced by several factors such as the practitioner's knowledge and skills of practitioners so that it is expected to increase the success of the puskesmas nutrition program.

Introduction Modified Passerini-Glazel feminizing genitoplasty is typically performed in children with atypical genitalia. In our article, we have performed the procedure in adults with genital anomalies. Case presentation The first case was a 22 years old woman who was planning to get married. She presented with a chief complaint of having no vaginal canal. Gynecological examination showed no vaginal opening. The common channel was visible, and the size of the perineal body was 3 cm. The patient underwent vaginal reconstruction using a modified Passerini-Glazel technique without amnion graft. The second case was a 20 years old girl planning to get married, with a chief complaint of small vaginal introitus. Gynecology examination showed small minor labia with an introitus size of 1 cm. The patients underwent vaginal reconstruction and labioplasty using a modified Passerini-Glazel technique with an amnion graft. Both patients have undergone anal atresia surgery in childhood. Discussion There was no difference in outcome between using amnion graft and without amnion graft following the modified Passerini-Glazel feminizing genitoplasty procedure. The first patient had been pregnant and had successful delivery by elective cesarean section. Moreover, the second patient had no complaint of sexual disorders after the procedure. No cases of dysuria, urinary tract infection, leukorrhea, hematocolpos, or malodorous vaginal discharge were reported in both cases. Conclusion Modified Passerini-Glazel feminizing genitoplasty is a safe and effective procedure. Daily vaginal dilation in the postoperative period was unnecessary, and it allowed for an excellent cosmetic result.

Sistemik lupus eritematosus (SLE) merupakan salah satu penyulit kehamilan, dimana mempunyai potensi untuk mengakibatkan kematian janin, kelahiran preterm maupun kelainan pertumbuhan janin. Kehamilan dapat mempengaruhi jalannya SLE dan janin bisa menjadi sasaran auto antibodi yang akan menyebabkan kegagalan kehamilan itu sendiri. Mengingat manifestasi klinik, perjalanan penyakit SLE sangat beragam dan risiko kematian yang cukup tinggi pada kehamilan dengan SLE maka diperlukan upaya dini serta penatalaksanaan yang tepat pada pasien SLE dalam kehamilan. Penelitian ini bertujuan untuk melihat perbandingan luaran ibu dan bayi pada penderita SLE dengan berbagai manifestasi klinis yang berbeda di RSUD dr. Zainoel Abidin Desember 2016-November 2017. Penelitian ini adalah serial kasus yang terdiri dari 3 sampel ibu hamil yang menderita SLE. Hasil penelitian menunjukkan terdapat perbandingan luaran ibu dan janin  antara ketiga kasus SLE dengan manifestasi klinis yang berbeda – beda.

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