Multiple myelomas (MM) is the proliferation of malignant plasma cells in the bone marrow, characterized by the production of monoclonal immunoglobulins that are secreted in the blood and urine. However, in 1 - 5% of cases, the protein is undetectable and defined as non-secretory type of myeloma. A 36-year-old woman presented with complaints of weakness in both legs so she could not walk. She also felt pain in the head, back, and thighs since one year before. Physical examination showed anemic conjunctiva, gibus as high as T4, hypoesthesia as high as T6 segment. She had anemia (Hb 10.2 g/dL), decreased kidney function (eGFR: 30 mL/min/1.73m2), and multiple lytic lesions in the calvaria, ribs, superior-inferior pubic ramus, and left humeral os in the 1/3 proximal to 1/3 distal. Protein electrophoresis and Bence Jonce protein were negative. There was no hypercalcemia, and bone marrow aspiration showed myelodysplasia syndrome. A thoracolumbar MRI showed an extradural solid mass and the histopathology examination result was plasmacytoma. Non-secretory MM was defined into two groups, non-producers and multiple non-secretory myeloma patients who produce tumor proteins but cannot be excreted. This patients was categorized as non-producers non-secretory MM because she did not show a protein that can be measured in blood nor urine, but has significant plasma cells in tissue biopsy. The absence of paraprotein in the blood does not rule out multiple myeloma. Suspicion of multiple myeloma needs to be increased in patients who have symptoms of CRAB (calcium, renal impairment, anemia, bone lytic).

The information system is a set tools to present information that has been managed well in order to make it easy and useful for its users. One indicator of the successful implementation of information system is how the end-user satisfaction. User satisfaction can be measured using user satisfaction methods. This study aims to develop a measurement framework to measure the user satisfaction of IT services. The measurement framework will be developed using 3 (three) basic theories such as Servqual by Parasuraman, Webqual by Barnes and Vidgen, and Information System Succes Model (ISSM) by DeLone and McLean. The model will be applied to a case study that an IT Service called Sistem Informasi Terintegrasi (SISTER) of the Jember University. This measurements using 100 respondents are students as SISTER's users and will be tested using t testing and GAP analysis. Based on the measurement results, the variable service quality has no significant influence on user satisfaction, and another variable is website quality has a significant influence on user satisfaction. Based on GAP analysis, it's found that the average gap value for service quality variable is-1.12, website quality is-1.00, and user satisfaction is-1.00. It means, the service quality that represents the tangible components, reliability, responsiveness, assurance, and emphaty of SISTER's provider according the students perceptions are still not good. In the future, SISTER's provider need to improve the quality of measurement items of indicators of reliability, responsiveness, assurance, and emphaty if they want to increase the user satisfaction of SISTER.

The information system is a set tools to present information that has been managed well in order to make it easy and useful for its users. One indicator of the successful implementation of information system is how the end-user satisfaction. User satisfaction can be measured using user satisfaction methods. This study aims to develop a measurement framework to measure the user satisfaction of IT services. The measurement framework will be developed using 3 (three) basic theories such as Servqual by Parasuraman, Webqual by Barnes and Vidgen, and Information System Succes Model (ISSM) by DeLone and McLean. The model will be applied to a case study that an IT Service called Sistem Informasi Terintegrasi (SISTER) of the Jember University. This measurements using 100 respondents are students as SISTER's users and will be tested using t testing and GAP analysis. Based on the measurement results, the variable service quality has no significant influence on user satisfaction, and another variable is website quality has a significant influence on user satisfaction. Based on GAP analysis, it's found that the average gap value for service quality variable is-1.12, website quality is-1.00, and user satisfaction is-1.00. It means, the service quality that represents the tangible components, reliability, responsiveness, assurance, and emphaty of SISTER's provider according the students perceptions are still not good. In the future, SISTER's provider need to improve the quality of measurement items of indicators of reliability, responsiveness, assurance, and emphaty if they want to increase the user satisfaction of SISTER.