1.

Write a 500 word critical review of the following article, in Bahasa Indonesia:

httPs://www.ncbi.nlm.nih.gov/pubmed/?term=26168322
Am J Respir Crit Care Med. 2015 Oct 15;192(8):974-82. doi: 10.1164/rccm.201501-0017OC.

Early Chest Computed Tomography Scan to Assist Diagnosis and Guide Treatment Decision for
Suspected Community-acquired Pneumonia.

Claessens YE1, Debray MP2, Tubach F3, Brun AL4, Rammaert B5, Hausfater P6, Naccache JM7,
Ray P8, Choquet C9, Carette MF10, Mayaud C7, Leport C11, Duval X12.

Include in your conclusion whether you would advise for Chest CT scan to be
recommended as standard investigation for community acquired pneumonia. Include
consideration of costs and patient safety for patients in Indonesia. Base this conclusion
on this article, your clinical experience and recognised guidelines such as:
https://www.nice.org.uk/guidance/cg191

https://www.brit-thoracic.org.uk/document-librarv/clinical-information/pneumonia/
adult-pneumonia/bts-guidelines-for-the-management-of-community-acquired-pne
umonia-in-adults-2009-update/

https://www.thoracic.org/statements/resources/tb-opi/idsaats-cap.pdf

2. Edit the following article: base the editing on sources linked within the article. Make it
easy to read and understandable for non-medical people? (provide answer in Bahasa
Indonesia)
Apa itu Craniotomy?
Kerusakan pada bagian otak dapat ditangani dengan prosedur operasi pembedahan otak. Salah satu
operasi pembedahan otak adalah craniotomy. (Sumber: http://www.healthline.com/health/brain-
surgery#Types3) Operasi pembedahan otak adalah operasi besar, sehingga sebelum Anda menjalani
prosedur tersebut, Anda wajib mengetahui prosedur serta risiko yang mungkin terjadi.
Otak merupakan bagian penting pada tubuh, otak adalah bagian utama sistem syaraf manusia.
Kerusakan pada otak tidak hanya dapat menyebabkan kelumpuhan tapi juga dapat menyebabkan
kematian. Penyakit yang muncul akibat kerusakan atau masalah pada otak adalah hilangnya memori,
hilang atau penurunan kontrol terhadap gerakan, fungsi kognisi. Kerusakan atau masalah yang
muncul pada otak biasanya menyebabkan munculnya penyakit seperti tumor otak, stroke, Alzheimer,
Parkinson, meningitis, dan masih banyak lagi. (Sumber:http://www.webmd.com/brain/picture-of-the-
brain#1 )
Beberapa kerusakan atau masalah pada otak dapat ditangani dengan melakukan operasi
pembedahan otak. Operasi otak pun ada berbagai macam, salah satunya adalah craniotomy.
Craniotomy adalah proses pembedahan otak yang dilakukan pada bagian kecil otak. Operasi ini
dilakukan dengan mengangkat sebagian kecil tulang tengkorak kepala untuk dapat menggapai
 bagian otak yang mengalami kerusakan.(Sumber:
http://www.hopkinsmedicine.org/healthlibrary/test procedures/neurological/craniotomy 9
2.P08767/)

3. The data below looks at the correlation between TB (tuberculosis) and HIV status. This data
is from WHO (World Health Organization) http://www.who.int/hiv/topics/tb/data/en/
Interpret this data for non-medical people, describing the correlation between TB and HIV, the
trend over the time period on the graph and if in Indonesia patients with TB should be
screened for HIV. Please write this summary in Bahasa Indonesia.
 Estimated HIV prevalence among TB cases, 2011

• so
~J No estimate
Not applicable

^ World Health
41 Collaborative TB/HIV activities, 2011
^Organization
http://www.who.int/hiv/topics/tb/data/en/

4. Using the below information (from Medscape

http://emedicine.medscape.com/article/1164341-overview ) about Subarachnoid Hemorrhage,
make a summary in Bahasa Indonesia for non-medical people, including:

• describing what a subarachnoid hemorrhage is,

• what symptoms the patient may have,
• what signs the doctor will look for during physical examination,
• briefly the cause of subarachnoid haemorrhage

Subarachnoid Hemorrhage

The term subarachnoid hemorrhage (SAH) refers to extravasation of blood into the subarachnoid space
between the pial and arachnoid membranes (see the image below). It occurs in various clinical contexts,
the most common being head trauma. However, the familiar use of the term SAH refers to nontraumatic
(or spontaneous) hemorrhage, which usually occurs in the setting of a ruptured cerebral aneurysm or
arteriovenous malformation (AVM).

Clinical presentations History

The signs and symptoms of subarachnoid hemorrhage (SAH) range from subtle prodromal events to the
classic presentation. Prodromal events often are misdiagnosed, while the classic presentation is one of
the most pathognomonic pictures in all of clinical medicine.

Prodromal events

Signs and symptoms precede ruptured cerebral aneurysm in anywhere from 10-50% of cases.
Premonitory manifestations generally appear 10-20 days prior to rupture. The most common symptoms
are as follows:
• Headache (48%)
• Dizziness (10%)
• Orbital pain (7%)
• Diplopia (4%)
• Visual loss (4%)
Signs present before SAH include the following:
• Sensory or motor disturbance (6%)
• Seizures (4%)
• Ptosis (3%)
• Bruits (3%)
• Dysphasia (2%)
Prodromal signs and symptoms usually are the result of one or more of the following:
• Sentinel leaks
• Mass effect of aneurysm expansion
• Emboli Sentinel leaks
Sentinel, or "warning," leaks with minor loss of blood from the aneurysm are reported to occur in 30-50%
of aneurysmal SAHs. Sentinel leaks produce sudden focal or generalized head pain that may be severe.
Sentinel headaches precede aneurysm rupture by a few hours to a few months, with a reported mean of 2
weeks prior to discovery of the SAH.
In addition to headaches, sentinel leaks may produce nausea, vomiting, photophobia, malaise, or, less
commonly, neck pain. These symptoms may be ignored by the physician. Therefore, a high index of
suspicion is necessary for accurate diagnosis. Sentinel leaks usually do not generate symptoms
suggestive of elevated intracranial pressure (ICP) or meningeal irritation. Sentinel leaks usually do not
occur in patients with arteriovenous malformations.
Mass effect
Prodromal presentations occasionally are caused by the mass effect of an expanding aneurysm and have
characteristic features based on aneurysm location, as follows:
• Posterior communicating artery/internal carotid artery: focal, progressive retro-orbital
headaches and oculomotor nerve palsy
• Middle cerebral artery: contralateral face or hand paresis, aphasia (left side), contralateral
visual neglect (right side)
• Anterior communicating artery: bilateral leg paresis and bilateral Babinski sign
• Basilar artery apex: vertical gaze, paresis, and coma
• Intracranial vertebral artery/posterior inferior cerebellar artery: vertigo, components of lateral
medullary syndrome
Emboli
Emboli originating from intra-aneurysmal thrombus formation can cause transient ischemic attacks.

Classic presentation
The central feature of classic SAH is sudden onset of severe headache (thunderclap headache), often
described as the "worst headache of my life." Less severe hemorrhages may cause headache of
moderate intensity, neck pain, and nonspecific symptoms. Absence of headache in the setting of a
ruptured intracranial aneurysm is rare and probably represents amnesia for the event.
The headache may be accompanied by nausea and/or vomiting from increased ICP and meningeal
irritation. Symptoms of meningeal irritation, including nuchal rigidity and pain, back pain, and bilateral leg
pain, occur in as many as 80% of patients with SAH but may take several hours to manifest. Photophobia
and visual changes are common. Focal neurologic deficits may also occur.
Sudden loss of consciousness (LOC) occurs at the ictus in as many as 45% of patients as intracranial
pressure (ICP) exceeds cerebral perfusion pressure. LOC often is transient; however, approximately 10%
of patients remain comatose for several days, depending on the location of the aneurysm and the amount
of bleeding.
Seizures during the acute phase of SAH occur in 10-25% of patients. Seizures result from the sudden rise
in ICP or direct cortical irritation by blood. No correlation exists between the seizure focus and the
anatomic site of aneurysm rupture.
A proposed decision rule for diagnosis of SAH focuses on the following 7 characteristics, which are
strongly associated with SAH:
• Aged 40 years or older
• Witnessed loss of consciousness
• Complaint of neck pain or stiffness
• Onset of manifestations with exertion
• Arrival by ambulance
• Vomiting
• Diastolic blood pressure >100 mm Hg or systolic blood pressure >160 mm Hg Should
one or more of these be present in a patient with an acute nontraumatic headache reaching maximum
intensity within 1 hour, the possibility of SAH hemorrhage should be investigated. [12] On the other
hand, it may be possible to consider foregoing investigation in patients with none of these
characteristics. [12]This decision rule has not yet been validated. Further study is needed before this
approach can be recommended.
Approximately 30-40% of patients are at rest at the time of SAH. Physical or emotional strain, defecation,
coitus, and head trauma contribute to varying degrees in the remaining 60-70% of cases.
Physical examination

Physical examination findings may be normal. About half of patients have mild to moderate blood pressure
(BP) elevation. BP may become labile as ICP increases. Temperature elevation, secondary to chemical
meningitis from subarachnoid blood products, is common after the fourth day following bleeding.
Tachycardia may be present for several days after the occurrence of a hemorrhage.

Fundoscopy may reveal papilledema. Subhyaloid retinal hemorrhage (small round hemorrhage, perhaps
with visible meniscus, near the optic nerve head) is evident in 20-30% of patients. Other retinal
hemorrhages may be seen.
Global or focal neurologic abnormalities are found in more than 25% of patients. Global depression of
neurologic function may be noted, including altered level of consciousness and confusional state. Motor
neurologic deficits occur in 10-15% of patients, usually from middle cerebral artery aneurysms. In 40% of
patients, no localizing signs are evident. Seizures may occur.

Focal neurologic findings

Cranial nerve palsies, along with memory loss, are present in 25% of patients. The most frequent is
oculomotor nerve palsy with or without ipsilateral mydriasis, which results from rupture of a posterior
communicating artery aneurysm. Abducens nerve palsy is usually due to increased ICP rather than a true
localizing sign. Monocular vision loss can be caused by an ophthalmic artery aneurysm compressing the
ipsilateral optic nerve.
Hemiparesis results from middle cerebral artery (MCA) aneurysm, ischemia or hypoperfusion in the
vascular territory, or intracerebral clot. Patients may also have aphasia, hemineglect, or both. Leg
monoparesis or paraparesis with or without akinetic mutism/abulia points to anterior communicating
aneurysm rupture.