Fahr’s syndrome is a rare neurodegenerative disorder characterized by bilateral basal ganglia calcification. The exact incidence of Fahr’s syndrome is still unknown but estimated to be <1/1,000,000. On routine non-contrast-CT scan examination, 0.3-1.2% cases of intracranial calcification can be incidentally detected. It is caused by several medical conditions, with hypothyroidism as the most common one. Patient may come with neurologic or psychiatric symptoms. CT scan is the main supportive examination; it is used to determine the location and extension of calcification. Therapy is directed to the underlying etiology and usually symptomatic. A female, 46 years old, came with stiffness on both hands. This symptom appeared multiple times during past decade but with mild intensity. CT scan revealed calcification in both cerebral hemisphere and cerebellum. Blood test showed low calcium concentration. Patient was diagnosed with Fahr’s syndrome and given anticonvulsant and calcium supplementation. She was getting better during hospitalization and then discharged 4 days later with oral home medication.

A dilemma can happen to a physician when managing bleeding case on a patient with mechanical heart valve with anticoagulant therapy. Major bleeding on anticoagulant treatment usually affects gastrointestinal tract (40-60 %) and urinary tract (15%). To manage the bleeding, vitamin K was restrictedly used in a patient with a mechanical heart valve and only can be used if there is major bleeding. The hypercoagulable state also must be considered when reinitiating warfarin therapy, once the bleeding already stopped. A 51-year-old female with St Jude Medical mechanical mitral valve replacement for 13 years and on regular warfarin therapy came with gross hematuria. INR l evel was 5.6, and nothing was found that can be the cause of the bleeding from the urinalysis, U rology ultrasonography, and CT scan. Warfarin was stopped for 3 days, and bleeding still occurred. Unfractionated heparin then was given to the patient to prevent thromboembolism event and as a bridging therapy. On the sixth day, hematuria was stopped, and hemoglobin was reduced only by 2 mg/dL. No rebleeding was found from the patient until 3 months later.

Background: HIV infection is a disease that currently becomes a global problem. Bali is one of the provinces in Indonesia with very high HIV infection new case. Badan Rumah Sakit Umum (BRSU) Tabanan is one of the leading hospitals in Tabanan. Based on data in Voluntary Counseling and Testing (VCT) clinic in BRSU Tabanan, new diagnosed HIV patients are increasing from year to year, so research about new diagnosed HIV patient profile is needed. This research is a descriptive research. Methods: The research design used in this study is cross-sectional study. Population and sample in this study were all newly diagnosed patients with HIV infection in BRSU Tabanan VCT clinic from 2009 to 2017 with a total of 872 people were obtained by total sampling. Secondary data were then processed statistically using statistical software. Results: From this research obtained that new case is the most in the year 2016 (18,5%). With the most patient in age 30-39 years old age group (34,9%), male (60.1%), still in employment (22.4%), still living (93.9%), and predicted risk factor heterosexual (93,7%). When the sample is diagnosed HIV most of the patient in stadium 3 (53,6%), with the most clinical sign is weight loss more than 10% in one month (50,2%), and opportunistic infection Candidiasis (55.6%). Conclusions: In an attempt to reduce spreading of HIV, education about transmitted sexual disease and reproduction health are important, especially in high-risk groups.

Background: Djenkolic poisoning or djenkolism is one of the causes of acute kidney failure common in Southeast Asia. Djenkol bean or jering (Archidendron pauciflorum) is one of the foods commonly found in Southeast Asia. These seed plants are usually processed by boiling or frying, but often they are also consumed raw. Djenkolism sometimes occurs, albeit infrequently after ingesting djenkol beans. The clinical presentation of djenkolism is varied but generally presents as a spasmodic loin to groin pain and acute kidney injury (AKI), with evidence of urinary obstruction.Case description: We report a previously healthy 40-year-old male developed AKI after consuming a large amount of uncooked djenkol beans, which was resolved with rehydration with normal saline and conservative therapy.Conclusion: We highlight the importance of healthcare practitioners, especially in the Southeast Asian region to consider this rare cause of acute kidney injury to provide early diagnosis and prompt treatments.

No abstract

Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae, which mainly damages the skin and peripheral nerves, and can also infect joints and bones. Clinical manifestations are complex, varied, and often underdiagnosed. The clinical manifestations vary and are called "the great imitator". musculoskeletal features are common in leprosy but infrequently reported. A case of borderline lepromatous (BL) type leprosy was initially suspected as rheumatoid arthritis in a 20-year-old Balinese male who complained of pain and swelling in small joints, accompanied by lesions in the form of multiple erythema macules, round-shaped geography, indistinct boundaries, with bilateral distribution is almost symmetrical in the face, thoracoabdominal, and extremity regions. The diagnosis of BL type leprosy is based on history taking, physical examination, and investigations in the form of Ziehl-Neelsen stain and blood tests.