Background: In Toxic Epidermal Necrolysis (TEN), age has been reported to be not only a risk factor but also associated with increased mortality. The presence of underlying illness and comorbidities also increased the burden of TEN in elderly patients.Case: A-70-years old male patient was consulted with a history of pulmonary tuberculosis and skin detachment. Symptoms started since four weeks before admitted to the hospital with redness in the face and extremities that spread to the chest and back accompanied by fever and malaise. The patient also complained of a wound in the lips and genitalia. Physical examination found multiple erosion, geographical shape, varied in size with positive nickolsky sign. The detachment covered 40% of the body surface area. From the laboratory, a result found a decrease in hemoglobin, blood glucose, albumin, and potassium. The patient was diagnosed with TEN, treated in the burn care unit, given supportive care and intravenous dexamethasone 10 mg every 8 hours, and then tapered off. The mortality rate from SCORTEN count was 12,1%.Discussion: The incidence and mortality of TEN were higher in the elderly than among younger adults. Supportive care was the key feature of management with various adjunctive therapy, including systemic corticosteroids, intravenous immunoglobulin, and other immunosuppressant agents. Giving more comorbidities, more observation, and a multidisciplinary approach for TEN in elderly patients might be needed.Conclusion: In the elderly, the risk and mortality of TEN were even higher, and the presence of comorbidities require more observation and supportive care.

Major burns are a type of trauma with high mortality risk. Therefore, an accurate predictor of mortality indicators is needed in burn patients. This study used an analytical observational study design with a retrospective case-control approach. One such indicator is the neutrophil-lymphocyte ratio which was studied further in this study. Subjects included 60 burn patients with 30 survivors and 30 mortalities. The sex characteristics of the subjects were predominantly male (70%), with a median age of 38.5 (IQR 30.5 – 52.5) ​​years. Fire (68.3%) was the most common cause of burns. The median neutrophil-lymphocyte ratio decreased from day 1 (median 15.6, IQR 10.1–21.7) to day 3 (median 6.7, IQR 4.4 – 11.8). However, there was a different pattern in which the value of the neutrophil-lymphocyte ratio was found to increase on day 3 in the mortality group. The binomial logistic regression test found that the neutrophil-lymphocyte ratio value greater than or equal to 10 on the 3rd day was significantly associated with mortality risk with an aOR of 13.91 (95% CI 1.77 – 109.47). The conclusion is that A high neutrophil-lymphocyte ratio at day three can be used as a predictor of mortality in major burn patients.

Background: Trauma is the fourth leading cause of death in the world and occurs at all ages. The high incidence of traffic accidents is equivalent to the increasing incidence of maxillofacial trauma, especially mandibular fracture. This study aims to determine the characteristics by age, gender, mechanism of injury and anatomical site of mandibular fractures among patients attending the Plastic Surgery Unit of Sanglah General Hospital as a preliminary studyMethods: A descriptive cross-sectional study was enrolled among 45 patients attending plastic surgery who recorded in medical records from January 2014 until December 2016 as well as met the inclusion criteria. Data were analyzed using SPSS version 17 and presented in percentage regarding Age, mechanism of injury, gender, and fracture siteResults: There were 45 patients with 61 mandibular fracture sites. Most of the patients were male (84.4%). Based on age, the mandibular fracture is most common in the productive age (20-30 years old) at 22 cases (36.1%). Majority cause of fractures was road traffic accident (82.2%). Parasymphysis region was the most common site of fracture (39.3%).Conclusion: The characteristics of mandibular fracture patients describe trauma patterns in the community. This finding is similar with some readily available literature with RTAs was the most common etiology and parasymphysis was the most common fracture site.

Background: Radius distal fracture is the most common fracture seen in emergency department which involves the upper extremity. Radius distal fracture can occur in any age, ranging from children, teenager until elderly patients. There is an increasing trend of radius distal fracture. However, the research on radius distal fracture characteristic, especially in Bali, is still limited.Method: This study was a descriptive-retrospective study which aims to find out the characteristic of radius distal fracture at Sanglah General Hospital, Denpasar, Bali. For data collection, we used total sampling technique using secondary data from patients’ medical records. The study sample was all patient diagnosed with radius distal fractures between the year 2013-2017 with incomplete medical record as the exclusion criteria.Result: This study obtained 677 radius distal fracture samples. Most of the patients were male [434 cases (64,1%)] with the most common age range was between 20-29 years old [147 cases (21,7%)]. The most common etiology of radius distal fracture was traffic accident [322 cases (47,6%)]. Fracture of the other upper extremity parts, in addition to radius distal, was the most common complaints accompanying radius distal fractures [333 cases (49,2%]. Based on the length of stay, 84% patients were hospitalized less than 5 days.Conclusion: Distal radial fracture was commonly seen in men with the age range between 20-29 years old. Traffic accident was the most common cause of distal radial fracture with the average length of stay less than 5 days.

Background: Cleft lips and cleft palate are congenital abnormalities in the form of clefts that occur due to the lips or palate that are not fully integrated or developing separately. Factors causing cleft lips are a multifactorial combination of genetic factors and environmental factors. In Indonesia, the patients of cleft lips and cleft palate increase of 7,500 people per year. This study aims to determine the description of risk factors causing cleft lips and cleft palate in Denpasar 2019.Methods: The research was conducted by a descriptive method using a cross-sectional approach. Samples were selected from the population-based on inclusion and exclusion criteria. This study was conducted to obtain the risk factors causing cleft lips and cleft palate based on a genetic factor, a drug used, smoking, alcohol, pregnancy disorders, chemicals, nutrition, history of antenatal care, obesity and diabetes, parent’s age, economic status, and infant’s gender. Data were analyzed using SPSS software version 22.Results: The results showed that cases of cleft lips and cleft palate in Denpasar 2019 based on genetic factor is 24,0%, drug used (34%), smoking history (52%), no history of alcohol consumption, pregnancy disorders (28%), chemicals exposure (18%), do not get additional nutrition (42%), didn’t take any antenatal care (26%), obesity and diabetes (4%), the most parent’s age in pregnancy are productive age group (60%), majority low economic families status (60%), and infant’s gender dominated by the male (66%).Conclusion: This finding is useful because it can provide insight into the description of the risk factors causing cleft lips and cleft palate in Denpasar 2019. Further analytic research is needed to find the relationship between various risk factor variables.  Latar Belakang: Celah bibir dan celah langitan merupakan kelainan kongenital berupa celah yang terjadi akibat bibir atau atap mulut tidak sepenuhnya menyatu atau berkembang secara terpisah. Faktor penyebab celah bibir adalah kombinasi multifaktor baik itu faktor genetik dan faktor lingkungan. Di Indonesia penderita kelainan celah bibir dan celah langitan bertambah rata-rata 7.500 orang per tahun dan terus meningkat. Penelitian ini bertujuan untuk mengetahui gambaran faktor risiko penyebab terjadinya celah bibir dan celah langitan di Denpasar tahun 2019.Metode: Penelitian dilakukan dengan metode deskriptif menggunakan pendekatan potong lintang. Sampel dipilih dari populasi berdasarkan kriteria inklusi dan eksklusi. Penelitian dilakukan untuk memperoleh gambaran faktor risiko penyebab terjadinya celah bibir dan celah langitan berdasarkan faktor genetik, penggunaan obat-obatan, merokok, alkohol, gangguan kehamilan, zat kimia, nutrisi, riwayat antenatal care, obesitas dan diabetes, usia orang tua, status ekonomi, dan jenis kelamin bayi. Data dianalisis menggunakan software SPSS versi 22Hasil: Hasil penelitian menunjukkan kasus celah bibir dan celah langitan di Denpasar tahun 2019 berdasar faktor keturunan sebesar 24,0%, penggunaan obat-obatan (34,0%), riwayat merokok (52,0%), tidak ada riwayat alkohol, gangguan kehamilan (28,0%), paparan zat kimia (18,0%), tidak mendapat nutrisi (42,0%), tidak melakukan antenatal care (26,0%), obesitas dan diabetes (4,0%), usia orang tua saat kehamilan terbanyak pada kelompok usia produktif (60,0%), status ekonomi mayoritas status keluarga ekonomi rendah (60,0%), jenis kelamin bayi dengan kejadian celah bibir dan celah langitan di dominasi oleh jenis kelamin laki-laki (66,0%).Kesimpulan: Temuan ini bermanfaat karena dapat memberikan wawasan mengenai gambaran faktor risiko penyebab terjadinya celah bibir dan celah langitan di Denpasar tahun 2019. Perlu dilakukan penelitian analitik lebih lanjut guna mencari hubungan antara berbagai variabel faktor risiko.

Background:  The development of new modality for burn wound healing is necessary to reduce morbidity and mortality of burn injury. PRP (Platelet Rich Plasma) is one of potential modality for burn injury because of its ability to deliver various growth factors to initiate and accelerate tissue healing and regeneration. Clinical efficacy of PRP is frequently disturbed because inconsistency and inefficiency of growth factor release in PRP. To increase the effectiveness of PRP in wound healing and increase the bioavailability of growth factor, PRP can be combined with a carrier that can control continuous release of growth factors. Chitosan is one of biomaterial that potential to use because of its biodegradability characteristic and biological activity that important for burn wound healing and prevent the formation of scar tissue in a burn injury. Researches have shown that chitosan is an effective carrier to facilitate growth factor release continuously to burn wound.Aims: This review aims to review potential Combinations of PRP (Platelet Rich Plasma) & Chitosan in Burn WoundConclusion: With chitosan ability to facilitate burn wound healing and as an effective carrier, combination of PRP and chitosan is a promising modality for burn wound healing.

BACKGROUND:Both subciliary and transconjunctival approaches have been used for decades to visualise the site of the maxillofacial fracture. The most common complication following those procedures is lower eyelids malposition.AIM:This meta-analysis will analyse which approach (subciliary and transconjunctival approaches) is more favourable to decrease lower eyelids malposition incidence.METHOD:This meta-analysis was conducted based on PRISMA guidelines. The electronic search was conducted using keywords (“Lower Eyelids Malposition” OR “Complications” OR “Ectropion” OR “Entropion”) AND (Transconjunctival) AND (Subciliary) AND (Maxillofacial Fractures) in PubMed, The Cochrane Library, and Directory of Open Access Journal (DOAJ). This review included full-text studies (observational and randomised controlled trials) in English comparing subciliary and transconjunctival approach in patients with maxillofacial fractures in the last 10 years. The data collected were the type of fractures and approaches, ectropion and entropion incidence as well as follow-up duration. The risk of bias was assessed using Joanna Briggs Institute critical appraisal checklist. Statistical analysis was done using Review Manager 5.3 (Cochrane, Denmark).RESULT:This study included 3 cohort studies and 2 Randomized Controlled Trial (RCT) studies from 2012 to 2017 with a total of 574 samples. Subciliary approach had a significant higher ectropion incidence when compared to transconjunctival approach (RR = 4.64, 95% CI: 1.68-12.81, p = 0.003). There was also a significant reduction of entropion incidence in patients with subciliary approach compared to transconjunctival approach (RR = 0.16, 95% CI: 0.04 – 0.69, p = 0.01).CONCLUSION:There was no superiority between one procedure toward another since each procedure related to different lower eyelids malpositions.

BACKGROUND: Research related to the impact of multidrug resistant organisms (MDRO) infection on clinical outcomes in burns is still limited. AIM: This study evaluated the effect of MDRO infection on morbidity and mortality of burn patients. METHODS: A single-center retrospective cohort study was conducted on burn patients admitted to the burn unit of Sanglah General Hospital, Bali, between 2018 and 2020. MDRO patients were described as those who had at least one positive MDRO culture. All other patients were included in the non-MDRO group. Measurement and analysis included mortality and five indicators of morbidity: length of stay, duration of antibiotic therapy, sepsis, pneumonia, and acute kidney injury (AKI). RESULTS: Significant associations of MDRO infection were found for duration of antibiotic therapy (0 vs. 7 days), sepsis (odds ratio [OR] 13.90 [95% Confidence interval (CI) 95% 2.88–67.10]), pneumonia (OR 12,67 [95% CI 3.26–49.23]), and mortality (OR 9.75 [95% CI 2.00–47.50]). No significant association was found for the length of stay and the incidence of AKI. Multivariate analysis found that MDRO infection increased risk of sepsis (OR 36.53 [95% CI 2.05–652.45], pneumonia (OR 10.75 [95% CI 1.87–61.86]) and mortality (OR 57.09 [95% CI 1.41–2318.87]). Multivariate analysis of MDRO infection with duration of antibiotic therapy found no independent variables that were significantly related. CONCLUSION: These research findings suggest that MDRO infections are associated with increasing length of antibiotic treatment, sepsis, pneumonia, and mortality in burn patients.