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.
Stunting merupakan salah satu permasalah gizi global, termasuk di Indonesia. Peneltian ini bertujuan untuk meningkatkan pengetahuan dan keterampilan remaja stunting tentang mengolah makanan bergizi seimbang. Kegiatan dilakukan secara tatap muka sebanyak 5 kali. Kegiatan penyediaan makanan dilakukan penilaian dengan cara observasi untuk mengetahui efektifitas penyuluhan yang diberikan. Sebelum dilakukan pelatihan, pengetahuan remaja stunting tentang makanan bergizi seimbang masih rendah yaitu 53% menjawab pertanyaan dengan benar; pengetahuan remaja tentang dasar-dasar pengolahan pangan berdasarkan gizi seimbang termasuk kategori cukup yaitu sebanyak 60% responden mengetahui tentang pengolahan sayur, memasak air, wawasan tentang profesi pengolah makanan. Setelah mengiktu pelatihan remaja mampu mengolah makanan berdasarkan gizi seimbang yaitu menyediakan sarapan, snack pagi, makan siang, snack siang, makan malam dan snack malam. Perlu melakukan kompanye tentang pentingya remaja mempunyai keterampilan menyelenggarakan makanan.
Highlights
Anorectal malformation in adult was rare findings.
Transfistula anorecatoplasty procedure in adult never been published.
Good clinical outcome after procedure.
Introduction and importance
We reported a case of common channel anomaly complicated with vaginal agenesis and rectal stone, which is a long-term complication of PSARP, a combination of very rare conditions with high morbidity and especially difficult treatment.
Presentation of case
A 15-year-old female presented with a chief complaint of cyclic abdominal pain. The patient had no history of menstruation before. Physical examination showed a common channel. The diameter of the common channel was approximately 1 cm and 0.3 cm in length. A sound (±2 mm thickness) was inserted to the small opening between the urethra and anal mucosa with the length of the canal 6 cm. At the end of the opening, a stone-like structure was felt. The management of this case was abdominal hysterectomy with right salpingectomy and stone evacuation.
Discussion
Cloacal malformation is thought to be associated with vaginal agenesis since both malformations are considered to have a similar pathophysiologic background. Treatment can be performed using posterior sagittal combined with laparotomy approach. After surgery, patients will need a long-term follow-up since the conditions may be associated with many possible urologic and gynecologic comorbidities, including recurrent urinary tract infections, hematosalpinx, and vesicourethral reflux, including stone formation.
Conclusion
Our case was considered one of the most complex common channel anomalies because it was complicated with a rare condition called vaginal agenesis and rectal stone after PSARP. A multidiscipline approach was necessary.
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