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ASTIGMATISMA MIOP SIMPLEX

DRY EYE SYNDROME


Kadek Mas Teddy Sabdha Bhyantara
dr. Ni Nyoman Geriputri, Sp. M.
INTRODUCTION

Dry Eye Syndrome


5% dan >30% around the world

Refractive Errors
WHO  285 million people
Patient Identity

• Name : Nn. FH
• Year : 19years old
• Gender : Female
• Address : Sweta
• Religion : Christian
• Job : College student
• Examination Date : 7 November 2019
• Medical Record : 010899
Blured vision
Since 2 years ago
• History of wear the eyeglasses
• Feel discomfort wearing glasess
• Vision slightly worsen
• Sometimes fatigue when over used
Eye Discomfort
Itchy
Sandy
redness
Personality
A young girl student

• Watching movies • Study


• Youtube • Doin’ homework
• Another unimportant stuff
physical examination

Movement
General Eyes visus Ocular Position And
Condition Visual field

WELL
DECREASE WELL
WELL

GCS = 456 ODS = SC 6/10 orthoforia


R L

Naturalis (Sine Correctio) 6/10 6/10

Pin Hole (Ph) increase increase

Correction (Cum Correctio) C-0,50 x85o C-0,50 x80o


6/6 6/6
Ocular Inner
Periorbital Structure
surface

• Eyelid (N) • Conjungtiva • AOC (N)


• Eyelashes (N) (N) • Iris (N)
• Sclera (N) • Pupil (N)
3mm
• Cornea isochoric
o Clear • Lens clear
o smooth
10 1,5
JUTA JUTA

anak meninggal anak meninggal


setiap tahunnya akibat Diare
Berhubungan 2 arah

Diare dapat memperburuk MALNUTRISI


keadaan malnutrisi
AKUT BERAT

DIARE
Malnutrisi merupakan
predisposisi terjadinya diare
Dengan menggunakan protokol manajemen World Health
Organization (WHO) dan rehabilitasi gizi, tingkat
kematian Berkurang dari 30% menjadi 5% –10%

Rehydration Solution for Malnutrition (ReSoMal) untuk


anak-anak yang kekurangan gizi akut dengan kadar
natrium yang lebih rendah dan kadar gluko berserta
kalium yang lebih tinggi

diet terapi khusus (F-75 / F-100)


direkomendasikan untuk stabilisasi dan
rehabilitasi anak-anak dengan MAB
Anak-anak yang kekurangan gizi berat dengan diare mungkin juga
mengalami diare osmotik karena intoleransi karbohidrat akibat atrofi vili

Gula (termasuk glukosa) dalam diet dan cairan rehidrasi dapat


menyebabkan peningkatan kehilangan cairan dari usus

Dengan demikian, ada kemungkinan bahwa makanan


terapeutik dapat memperburuk diare
METODE PENELITIAN
“Outcome of Children with Severe Acute Malnutrition and
Diarrhea: a Cohort Study”
Metode penelitian

Anak-anak berusia 2 hingga 59 bulan yang memenuhi


kriteria MAB

untuk anak-anak> 6 bulan: berat untuk tinggi ≤ − 3


standar deviasi (SD) dan / atau lingkar lengan bagian
atas [LLA] <11,5 cm dan / atau edema dari kedua
kaki

MAB untuk bayi <6 bulan: berat untuk tinggi ≤ − 3SD


dan / atau edema kedua kaki
Metode penelitian
Metode penelitian

Dehidrasi menggunakan kenaikan berat badan dipantau Setelah keluar, mereka


Cairan rehidrasi osmolalitas setiap hari (gr/ kg / hari), asupan tetap diawasi selama satu
rendah + suplemen kalium makanan 24 jam, hilangnya minggu, lalu setiap 15 hari
(20 mEq / L) + multivitamin edema, dan panjang / tinggi hingga 12 minggu
dan mineral mingguan serta LLA.

2015 2017
Start 2019
2014 2016 2018

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Analisis dasar, gula darah, jumlah Semua anak dimonitor untuk makan awal 2 jam (F-75), jika
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darah lengkap, elektrolit serum, komplikasi hipoglikemia, jumlah feses (> 10 tinja / hari),
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X-ray dada, tes Mantoux, hipotermia, syok, dehidrasi, penurunan berat badan setelah 48
urinalisis rutin dan mikroskopis, dan gagal jantung kongestif. jam diet awal, diet diubah menjadi
dan sensitivitas kultur Feses diet sereal atau bubur saring. anak
yang tidak merespons, diet diubah
menjadi diet lactose-free
Metode penelitian

kriteria dipulangkan  kenaikan berat badan> 5 gr / kg / hari pada tiga hari berturut-turut dan
resolusi kondisi medis

kekambuhan sekunder  pasien yang dipulangkan sebagai sembuh dalam dua bulan terakhir
tetapi sekali lagi memenuhi syarat untuk masuk.

Kegagalan primer  kegagalan untuk mendapatkan kembali nafsu makan atau mulai
kehilangan edema pada hari keempat atau adanya edema atau kegagalan untuk mendapatkan
setidaknya 5 gr/ kg / hari pada hari 10.

Kegagalan sekunder  sebagai kegagalan untuk mendapatkan setidaknya 5 gr / kg / hari


selama tiga hari berturut-turut selama fase rehabilitasi.
HASIL
“Outcome of Children with Severe Acute Malnutrition and
Diarrhea: a Cohort Study”
diare
berair
akut
Pulang Dehidrasi
berat / tinggi
> -2SD

68% 50% 71,1% 58,3%

HASIL
Selama menjaladi terapi di Rumah Sakit
TABEL HASIL
Indikator hasil MAB dengan MAB dengan Nilai p
diare (n=60) komplikasi
selain diare
(n=60)
Rata-rata peningkatan 10.35±6.65 10.39±6.27 0.782
BB (gr/Kg/hari)
Rata-rata lama rawat 13.25±6.36 10.73±5.35 0.039
Kematian (selama 2 (3.3) 0 (0) 0.496
rawat inap)
Tingat yang berhasil 37 (66.1) 42 (71.2) 0.838
dipulangkan
Defaulter 2 (3.4) 1 (1.7) 1.000
(n=56) (n=59)
Kegagalan primer 20 (35.7) 16 (27.1) 0.320
Kegagalan sekunder 13 (23.2) 25 (42.4) 0.024
Tingkat kekambuhan 8 (14.3) 7 (11.9) 0.783
Tingkat re-admisi 4 (7.1) 2 (3.4) 0.783
TABEL HASIL
Indikator hasil MAB dengan MAB dengan Nilai p
diare (n=53) komplikasi selain
diare (n=54)

Peningkatab BB 15% 27 (51) 35 (64.8) 0.146


Berat/tinggi badan ≥ -2SD 24 (45.3) 29 (53.7) 0.384

LLA > 12,5 cm 16 (30.2) 18 (33.3) 0.727

Rata-rata lama perawatan pada pasien dengan diare tiga hari lebih lama dibandingkan
yang mengalami komplikasi selain diare (13,25 ± 6,36 vs 10,73 ± 5,35 hari) Pada saat di
followed up, kedua kelompok memiliki parameter hasil yang sama (kenaikan berat badan
>15%, berat / tinggi > −2SD atau lebih, dan LLA > 12,5 cm)
DISKUSI
“Outcome of Children with Severe Acute Malnutrition and
Diarrhea: a Cohort Study”
DISKUSI

Rata-rata kenaikan berat badan serupa pada kedua


kelompok, sekitar 10,37 gr/kg/hari, yang dapat diterima
menurut standar Sphere (> 8 gr/kg/hari) dan lebih tinggi dari
yang dicapai dalam penelitian sebelumnya yang dilakukan
di India.

penelitian menunjukkan bahwa, bahkan pada anak-


anak dengan MAB dengan diare, penambahan
berat badan yang memuaskan dapat dicapai
dengan manajemen berbasis protokol
DISKUSI
Rata-rata lama tinggal di rumah sakit adalah 12,12±5,89 hari,
menunjukkan bahwa sebagian besar pasien distabilkan dan
dipulangkan dalam waktu dua minggu.

Lama tinggal di anak-anak MAB dengan diare adalah tiga hari lebih
lama daripada mereka yang mengalami komplikasi medis selain diare.
DISKUSI
Rata-rata lama tinggal di rumah sakit adalah 12,12±5,89 hari,
menunjukkan bahwa sebagian besar pasien distabilkan dan
dipulangkan dalam waktu dua minggu.

Lama tinggal di anak-anak MAB dengan diare adalah tiga hari lebih
lama daripada mereka yang mengalami komplikasi medis selain diare.
DISKUSI
tingkat fatality rate 2,5%
tingkat yang dapat diterima dalam standar perawatan Sphere dan mirip dengan
penelitian lain di India. Meskipun, itu lebih rendah daripada penelitian dari
Bangladesh.

2,5%

• perbedaan penyebab sekunder.

• Ketersediaan sumber daya dan staf ahli


KESIMPULAN

penelitian ini menunjukkan bahwa protokol


manajemen saat ini sama efektifnya pada
anak-anak dengan MAB dengan diare dan
MAB dengan komplikasi medis lainnya

Peningkatan berat badan yang baik


diamati pada kedua kelompok

anak-anak dengan MAB dan diare


memerlukan waktu untuk rawat
inap yang lebih lama
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Analisis dasar, termasuk gula darah, jumlah darah lengkap,


elektrolit serum, X-ray dada, tes Mantoux, urinalisis rutin dan
mikroskopis, dan sensitivitas kultur Feses, dilakukan dan
semua anak dikelola sesuai dengan protokol standar dalam
Rumah sakit Pusat Rehabilitasi Nutrisi.
Metode penelitian

Dehidrasi dikelola menggunakan Cairan rehidrasi osmolalitas rendah dengan


tambahan suplemen kalium (20 mEq / L) dan semua pasien menerima dosis
multivitamin dan mineral sesuai usia sesuai protokol WHO. Besi ditambahkan selama
fase rehabilitasi. Semua anak dimonitor untuk komplikasi hipoglikemia, hipotermia,
syok, dehidrasi, dan gagal jantung kongestif. Kemajuan setiap anak dipantau setiap
hari dengan menghitung kenaikan berat badan (gr/ kg / hari), asupan makanan 24 jam,
hilangnya edema, dan panjang / tinggi mingguan serta LLA.
Metode penelitian

Anak-anak dengan SAM dengan diare akut mulai diberi terapi makan awal 2 jam
(F-75), namun, jika jumlah feses tetap tinggi (> 10 tinja / hari), bersama dengan
penurunan berat badan, bahkan setelah 48 jam diet awal, diet diubah menjadi diet
awal berbasis sereal atau bubur saring. Semua anak yang tidak merespons diet ini
diubah menjadi diet lactose-free
Metode penelitian

Setelah keluar, mereka tetap diawasi selama satu minggu, lalu setiap 15 hari
hingga 12 minggu. Parameter hasil, termasuk pertambahan berat badan rata-rata,
lama tinggal (dalam hari), tingkat kematian selama rawat inap atau setelah
pemulangan selama masa tindak lanjut, tingkat default, tingkat pemulangan yang
berhasil, tingkat kambuhan sekunder, dan proporsi dengan kegagalan (primer dan
sekunder), dihitung untuk kedua kelompok
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You can simply impress your audience and add a unique zing and appeal to
your Presentations. I hope and I believe that this Template will your Time,
Money and Reputation. You can simply impress your audience and add a
unique zing and appeal to your Presentations. Get a modern PowerPoint
Presentation that is beautifully designed.
Thank You
Insert the Sub Title of Your Presentation
Fully Editable Shapes
Fully Editable Shapes
PNG IMAGES
Fully Editable Icon Sets: A
You can Resize without
losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com
Fully Editable Icon Sets: B
You can Resize without
losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com
Fully Editable Icon Sets: C
You can Resize without
losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com