Rumi’s cognitive therapy approach to health and disease

Background  In the history of Persian literature, Rumi is a unique figure in terms of the extent of information and ideas, excitement, outpouring, diversity of themes, full awareness of the human psyche, and the knowledge of pain, understanding the causes of diseases and their treatment.

Methods: This is a qualitative study using analytical deduction method. Resources related to the subject matter, the meaning, and implication of cognitive-behavioral concepts, symbols, emblems, and parables in Masnavi and other works of Rumi were studied.

Results: The results indicate Rumi believes that psychological disorders such as depression do not belong to individuals with a history of childhood psychological trauma but it is common in all humans, and it can result from repeated vain thoughts and personal cognitive distortions. From the perspective of Rumi, a seeker prevents the penetration of negative automatic thoughts into psyche (inherent self) by mastering the subjective identity (self). On the contrary, disability and succumbing to the influx of mental automatic and dysfunctional thoughts are the main causes of mental illness; their repetition and continuity end in the dissociation from his inherent self.

 Conclusion: For Rumi, staying away from primordial nature and separation from essence brings the drought and coldness of December that makes human life and existence cold, dry, and barren. Continuation of this condition causes the emergence of mental illness such as depression.

Oral administration of Neem (Azadirachta indica A. Juss) leaf extract increases Cyclin D1 expression in hepatocyte regeneration in acetaminophen-induced hepatotoxic Wistar Rats

Predictors of multidrug resistance among pulmonary tuberculosis patients in a tertiary hospital in North Sumatera, Indonesia

Background: Previous tuberculosis treatment for tuberculosis is known to confer a higher risk of multidrug-resistant tuberculosis (MDR-TB). Indonesia is ranked eighth among the 27 "high-burden" MDR-TB countries.

Objectives: This study aimed to determine the predictors of multi-drug resistance among patients with pulmonary tuberculosis in Indonesia.

Methods: This retrospective study was conducted in a tertiary referral teaching hospital in Medan, North Sumatera Province, Indonesia. Laboratory data and medical histories of all pulmonary tuberculosis patients attending the hospital were reviewed. Patients with culture positive for Mycobacterium tuberculosis and processed for drug-susceptibility testing (DST) to first-line anti-tuberculosis drugs between January 2010 and December 2013 were included. Logistic regression was used to determine significant predictors of MDR-TB based on odds ratios (OR) and 95% confidence intervals (CI).

Results: Of 6,174 patients with suspected pulmonary tuberculosis, 842 were confirmed positive by culture, of which DST results were reported for 765. Of these, 115 (15%) had diabetes mellitus, 73 (9.5%) were HIV-infected, and 98 (12.8%) were MDR-TB. Multivariate analysis indicated that patients with a history of previous tuberculosis treatment (OR = 3.75; 95% C.I. = 2.40 - 5.86 and aged 25 to 45 years (OR = 2.37; 95% C.I. = 1.07 - 5.27) were significant predictors of MDR-TB.

Conclusions: Previous tuberculosis treatment and age 25-45 were significant predictors of MDR-TB. Treating patients with previous tuberculosis treatment based on DST results should therefore be considered. 

Correlation between dental health maintenance behavior with Dental Caries Status (DMF-T)

Background: The maintenance of oral and dental health is closely related to the people’s behavior. Behavior or habits that may influence the development of dental caries is the eating habits as well as oral hygiene such as brushing the teeth regularly and adequately. Dental caries status is a condition that describes a person's experience of dental caries which is calculated by the index DMF-T.

Objective: The study aims to determine the relationship between the behavior or habit of maintaining the teeth and mouth with dental caries status of communities in Indonesia.

Methods: It was an observational study with cross-sectional study design. The samples were household members aged ≥ 15 years with the number of 173,828 people. Data were collected by interview and examination of the teeth and mouth.

Results: The result showed that the respondents with dental caries more than the respondent without dental caries (92.60%). There was a significant relationship between hygienic behavior with dental caries status (P = 0.004; OR = 1.426; 95% CI = 1.123-2.810). However, there was no significant relationship of behaviors/habits of eating fruits and vegetables with dental caries status (P = 0.145; OR = 1.107; 95% CI = 0.966-1.270). But, there was a significant relationship between habitual physical activity with dental caries status (P = 0.000; OR = 1.443; 95% CI = 1.350-1.543).

Conclusion: There is a significant relationship between physical activity and hygiene behavior with dental health maintenance related to dental caries status. However, the behavior of eating fruits and vegetables has no significant relationship with dental caries status. 

Hearing threshold differences between pre and post tympanoplasty in patients with chronic suppurative otitis media

Background: Chronic suppurative otitis media (CSOM) often lead to sequelae of hearing loss. Tympanoplasty is one of the strategies to improve hearing function in patients with CSOM. Aim: To evaluate hearing threshold differences in pre and post tympanoplasty in patients with CSOM. Methods: Patients who undergo tympanoplasty (n = 21) were observed prospectively. Hearing threshold (air conduction, bone conduction, and threshold deviation) were assessed using pure tone audiometry before and 12 weeks after the surgery, at the frequency of 500 Hz, 1 kHz, 2 kHz, and 4 kHz. Results: Significant difference between pre and post tympanoplasty was shown at all frequencies in air conduction (AC), while similar results are shown at 2 kHz and 4 kHz frequencies in bone conduction (BC). There is also an increase in the mean hearing threshold between pre and post tympanoplasty. Conclusion: An average of 0-5 dB of AC enhancement in all frequencies were found after tympanoplasty. Nevertheless, further study is needed on hearing threshold improvement in various types of tympanoplasty.

Low Density Lipoprotein (LDL) values in bacterialistic sepsis patients at Haji Adam Malik Hospital Medan-Indonesia 2017

Background: Infection and inflammation will stimulate the acute phase response (APR) activation which will cause the changes in lipid metabolism. In rodents, the infection will induce an increase in cholesterol, including LDL, whereas in the primates and humans, LDL levels will decrease or normal. As lipopolysaccharides (LPS) and cytokines will lower the total cholesterol level in primates, while in mice will increase due to the stimulation of infection enhance the cholesterol synthesis de novo, reducing the lipoprotein clearance, and lowering the cholesterol conversion into bile acid.

Aim: This study aims to determine the influence of the bacterial sepsis severity to the value of Low-Density Lipoprotein (LDL)

Methods: It was a case-control observational study which conducted from January-March 2017 to the 30 sepsis patients and 30 non-sepsis patients at Haji Adam Malik General Hospital, Medan. Data were collected by measuring LDL and PCT levels in both sepsis and non-sepsis patients on days 0, 3, and 5 of study then was analyzed by using Mann-Whitney test to assess the relationship between them. 

Results :  The result showed that LDL value in sepsis group on pretreatment was 77,70 ± 33,42 mg / dl and increased on day 3 and 5 treatment to 83,50 ± 38,68 mg / dl. In the non-sepsis group, the mean value of LDL at baseline was 102.23 ± 45.90 mg/dl and increased on day 3 and 5 of treatment to 114 ± 38.58 mg/dl. Statistically, there were significant differences in LDL levels between sepsis and non-sepsis groups on the first day of treatment, day 3 and day 5 of care (p <0.05). Spearman correlation test results obtained a significant negative correlation between LDL levels with sepsis degree with correlation strength is moderate (r = -0.318).

Conclusion: There was a significant relationship between the severity of sepsis and the LDL value in patients with sepsis.

Antimicrobial coatings and films on meats: A perspective on the application of antimicrobial edible films or coatings on meats from the past to future

Background: Edible coatings have responded to demands concerning the production of biodegradable and environment friendly packages. Incorporation of antibacterial materials into edible films provides a valuable protective agent against spoilage of meats. Fish, poultry, and red meats due to their high nutritional contents are suitable for bacterial growth and can be preserved a few days in a refrigerator. Aim: This study aimed to investigate the importance of antimicrobial edible coatings or films on meats. In this regard, the types, effects, and traits of edible films, types of antibacterial substances incorporated into films or coatings, bacterial diversity of meats and the function of antibacterial films from the past when collagen-like substances were used on sausages to future trends, including the application of nanoparticles in coatings have been discussed. Results: Applying antibacterial edible films or coatings on meats to extend the shelf life of meats and meat products.

Data mining approach for exploring socioeconomic patterns in cancer

Background: Cancer has become an increasingly important issue for health expenditure and in the public sector. Therefore, identification of socioeconomic patterns is essential for developing novel methods of cancer prevention. A cancer risk prediction system is proposed here, which is easy and cost-effective, also saves time.

Methods: Initial data were collected from surveys with a digital audio recorder on 2014 cancer dependent and independent smokers. Patterns were found using a decision tree model. As socioeconomic patterns are neglected altogether, this study will pave the way for public health policies.

Results: This study shows that a death rate in cancers by smoking around 24.3%. According to them, the type of cancers attributed to smoking was oral cavity (8.2%) and bladder (8.2%) cancer. Some risk factors related to smoking and cancers were included male patients (66%), age <35 years old group (56.3%), employee (86.3%), married (86.2%), as well as have very good public insurance (96.5%). In addition, 98% cancer patients were known have public insurance.

Education levels have been shown most of the patients with cigarette smoking had less than a college education and in the absence of police, they use fewer safety belts.

Those with risk factors for failing to wear a seat belt under a doctor to quit smoking. Although

The health situation in cancers attributed to smoking vs. non-smoking attributed to worse evaluated.

The age factor is effective in counseling for the doctor to quit smoking, and people aged 35-65 are the most advised to quit smoking.

Conclusion: Smoking-related costs in Iran are high. The cost methodology presented is useful for policy making. Cost estimates can be used to evaluate the level of cigarette taxes and other policies related to smoking.

Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) level difference in benign and malignant epithelial ovarian tumor

Background: Malignant ovarian tumor is one of the most common types of cancer in women worldwide, and most patients come with advanced stage. Until now, a pre-operative diagnostic method to determine malignant ovarian tumor was considered unsatisfying. Neutrophil gelatinase-associated lipocalin (NGAL) allegedly plays a role in proliferation and metastasis of the cancer cells, so it is important to explore the difference of serum NGAL levels between benign and malignant epithelial ovarian tumor.

Aim: to determine the characteristics of patients with benign and malignant epithelial ovarian tumor, histologic types, and serum NGAL levels difference in benign and malignant epithelial ovarian tumor.

Method: This was a comparative analytic study with a cross-sectional design. Forty patients were chosen with consecutive sampling; each group consists of 20 female patients who will undergo primary surgery for suspicious of benign and malignant epithelial ovarian tumor. A blood sample was collected one day prior to the surgery and confirmed with histopathologic examination after surgery.

Results: most of the patients aged 20-50 years old, had ≥1 child and the most common histopathology type of malignant epithelial ovarian tumor was mucinous adenocarcinoma while the majority of the benign epithelial ovarian tumor was endometriotic cyst. The median rate of NGAL in the malignant epithelial ovarian tumor was 219.5 ng/ml, higher than median rate of NGAL in benign epithelial ovarian tumor with 132.5 ng/ml, the difference was statistically significant (p < 0.001). The median rate of NGAL in malignant epithelial ovarian tumor according to the stage of disease showed no significant difference.

Conclusion: A new diagnostic criteria of epithelial ovarian tumor needs to be considered which include NGAL as one of the screening components.

Health Information Management: Psychological factors influencing information privacy concerns in psychiatric hospitals

Background: Privacy is one of the fundamental rights of patients and their families in the health sector, and the violation of their privacy is a concern among them. Despite the importance of the issue, little research has been conducted to identify the determinant factors of patients’ privacy concerns in the health sector. Hence, this research aims to address this issue in the psychiatric hospitals, where the violation of patients’ privacy can seriously harm their face.

Methods: The study was a descriptive and also a correlational study. Data gathering tool was a questionnaire adopted from published sources. Four hundred questionnaires were distributed in two psychiatric hospitals in Iran using a non-random sampling method, and 384 questionnaires were returned. SmartPLS software was used to analyze the hypotheses.

Results: The results of the analysis showed that self-efficacy, ethics, and risk-taking could significantly influence individuals’ privacy concerns in health sectors while computer anxiety and trust have no influence on privacy concerns.

Conclusion: hospitals should ensure the ethical practices of their personnel. Hospitals should also communicate with the patients their level of control over their sensitive data. Hospitals should also deploy policies to minimize the risk of privacy violation.

Comparison of life expectancy, quality of life, irrational health beliefs, health locus of control and hospital depression in patients undergoing hemodialysis and heart transplant in Shahid-Rajaee hospital

Introduction: Physical and mental disorders are highly prevalent in patients undergoing hemodialysis and heart transplant and thus reduce the outcomes of patients. Management of these disorders can improve heart and kidney diseases, promote quality of life of patients and reduce their treatment costs. This study compares life expectancy, quality of life, irrational health beliefs, health locus of control, and hospital depression of patients undergoing hemodialysis and heart transplant in Shahid-Rajaee hospital.

Materials and Methods: This cross-sectional study was conducted in 2016 on 190 patients with a history of hemodialysis and heart transplant in Shahid-Rajaee hospital. Data were collected by using adult hope scale, quality of life scale, multidimensional health locus of control (MHLC) scale, irrational belief test, and hospital anxiety and depression scale.

Results: the results showed a significant difference between hemodialysis and heart transplant patients in irrational health beliefs (p=0.001) and hospital depression (p=0.001). Moreover, there was no significant difference between hemodialysis and heart transplant patients in life expectancy (p=0.70), quality of life (p=0.68) and hospital depression (p=0.21).

Conclusion: hemodialysis patients and heart transplant patients are significantly different in irrational health beliefs and hospital depression considering their physical and mental conditions caused by the disease.

Functional heartburn in Iranian patients with non-erosive gastroesophageal reflux disease

Aim: Esophageal multi channel intraluminal impedance-PH (MII-PH) monitoring is a new technique used for detecting the flow of fluids and gas through the esophagus, using the differences in electrical impedance between the mucosal surface, fluids, and gas that surround the catheter. The aim of this study was to determine the frequency of functional heartburn in Iranian patients with non-erosive gastroesophageal reflux disease (NERD).

Methods: In this study, 940 patients aged 11-84 years, with the chief complaint of heartburn were selected. The MII-PH monitoring was done in 215 of the patients who did not have esophageal injuries (NERD).

Results: Of the participants who filled the questionnaire, 29.4% experienced heartburn at least once a week, 24.1% had it twice daily, and 21.3% had it after each meal. The mean age of the patients with heartburn was 36.97 ± 10.8 (Range: 21- 57) years. Of the patients, 51.2% were female. MII-PH monitoring was done in 215 participants, with non-erosive esophagitis.

Esophageal acid exposure of time (EAET) was negative in 42.8% and positive in 57.2% of the NERD patients. Of the patients, 39.1% and 18.1% had functional heartburn (FH) and hypersensitive esophagus (HE), respectively

Conclusion: Functional heartburn and non-erosive gastroesophageal reflux disease are prevalent in the Iranian population. Esophageal multi channel intraluminal impedance-PH (MII-PH) monitoring is essential for discriminating functional heartburn from other types of non-erosive gastroesophageal reflux diseases.

Low Vitamin D serum level increases severity symptoms in schizophrenic patients measured by Positive and Negative Symptoms Scale (PANSS) in Batak Tribe Sumatera Utara, Medan-Indonesia

Background: Schizophrenia is the most common psychotic disorder found in population. It is a severe form of psychotic disorders and tends to be chronic. Nearly 1% people suffer from schizophrenia. It has been proved that vitamin D plays crucial roles in neuroprotection and neurodevelopment, therefore low levels are commonly associated with schizophrenia. Methods: A total of 54 schizophrenic patients, Batak tribe, male, and female are diagnosed with semistructured MINI ICD-X. A Positive and Negative Syndrome Scale (PANSS) was used to evaluate disease activity and serum vitamin D level was measured using ELFA. Regression linear was used to analyze the relationship between serum vitamin D level and disease’s symptom. Results: There was a negative correlation between serum levels of vitamin D and the PANSS score in schizophrenic patients with r = -0.686 (p<0.001) for positive PANSS score, r = -0.773 (p<0.001) for negative PANSS score, r = -0.448 (p<0.001)  for general psychopathology, and r = -0.631 (p<0.001) for total PANSS score. Conclusion: There was a negative correlation between serum vitamin D levels and the total score of PANSS, the lower the serum levels of vitamin D, the higher the total score of the PANSS. 

The effect of garlic and cumin on blood pressure and glycosylated hemoglobin in patients with type 2 diabetes

Introduction:

Type 2 diabetes is one of the most common chronic diseases. High blood pressure is seen in 70% of diabetic patients. Garlic is useful for patients with diabetes due to its active compounds. Cumin is one of the medicinal herbs that is being studied recently with highlighted role in treating diabetes. The aim of this study was to evaluate the effect of cumin and garlic on blood pressure and glycosylated hemoglobin in patients with type 2 diabetes.

Methods:

A clinical trial including 75 patients with type 2 diabetes who referred to Imam Khomeini Diabetes Clinic of Zabol were selected according to entry criteria and randomly divided into 3 groups of 25 individuals. First, glycosylated hemoglobin and blood pressure of the patients were measured. Then, the patients were divided into three groups. The first group received 300 mg of garlic powder three times a day, the second group received 100 mg cumin extract twice a day, and the control group received placebo for two months. Glycosylated hemoglobin and blood pressure of the patients were re-measured after the intervention. Data were analyzed using paired T-test and ANOVA in SPSS software version 22.

Results:

Based on the findings in the garlic consumer group and the cumin group, the difference was significant in mean systolic and diastolic blood pressure before and after the intervention (P <0.0001). In the garlic consumer group, the mean of HbA1c before and after the intervention was not statistically significant (P = 0.11). However, the mean difference was significant in the cumin group (P = 0.001). 

The effect of prune on the severity of constipation in elderly women

Background and Aim: Constipation is a common digestive problem in elderly people, which has a negative effect on their quality of life. There are many methods in complementary and alternative medicine to treat this problem in the elderly. The aim of this study was to determine the effect of prune as a complementary and alternative medicine on the severity of constipation in elderly women living at Zabol Elderly House.

Materials and Methods: This study was an experimental study on 60 elderly women who are qualified residents living at Zabol Elderly House with constipation based on the Rom III diagnostic criteria. The samples were randomly assigned to intervention group and control group, consisting of 30 samples each. The[A1]  tools used in this study were a demographic questionnaire and a constipation scale. Data were analyzed by SPSS Software Version 20 and Mann-Whitney Test.

Results: According to the findings, the difference in the mean of constipation severity in the two groups was not significant before intervention (P = 0.61). However, at the end of the first week until the end of the third week after the intervention, there was a significant difference in the mean of constipation severity (P <0.05). This result showed that the effect of the intervention started from the first week and prune was effective in lowering the severity of constipation in the elderly women.

Conclusion: This study indicated that prune could be an effective complementary and non-pharmacological method to reduce the severity of constipation in elderly women. Therefore, nurses can use this simple, inexpensive and uncomplicated method as a complementary method to care for the elderly with constipation.

 [A1]Please explain how the prune intervention was done.

Comparison of analgesic effect and duration of midazolam and fentanyl addition to intrathecal bupivacaine 0.05% in lower limb orthopedic surgeries

Background and Aim: Local anesthesia has gained popularity in recent years; therefore, the present study was aimed to test the effect of adding midazolam and fentanyl to intrathecal bupivacaine in patients with orthopedic surgeries of lower limbs.

Materials and Methods: A double-blind, randomized clinical trial was conducted on 75 patients who underwent orthopedic surgery of their lower limbs in the 5Azar Teaching Hospital in the city of Gorgan, Iran. Patients were randomly allocated to the test groups of bupivacaine plus normal saline (BN), bupivacaine plus midazolam (BM), and bupivacaine plus fentanyl (BF). Duration of analgesia, pain intensity, chills, nausea, vomiting, systolic and diastolic blood pressure as well as pulse rate and SpO₂ were assessed. Descriptive analysis was used to explain the mean and standard deviation. One-way ANOVA, repeated measure ANOVA, and chi-square tests were carried out using SPSS Statistics software version 19.

Results: The mean age of patients was 45.29 ± 14.02, 42.16 ± 15.68, and 40.7 ± 14.72 years respectively in the groups of BF, BM, and BN. Tukey test showed a considerable difference between the BM and BF groups (p < 0.001), and BM and BN groups (p < 0.001) regarding the duration of analgesia. Moreover, Tukey test showed a significant difference between the BM and BN groups in minutes of 60 (p = 0.02) and 90 (p = 0.001), the BM and BN groups, and in final, between the BM and BF groups in minutes of 120 (p < 0.001).

Conclusion: The combination of either BM or BF may be useful to provide patients with longer duration of analgesia and also enable them to tolerate pain better. 

Distribution of iNOS expressions and TNF neutrofil cells as well as PGE2 and S100 Schwann cell dermal nerves in the erythema nodosum leprosum patients

Background: The infiltration of neutrophil increased in the Erythema Nodusum Leprosum (ENL) which is thought to have a role in releasing the free radicals and TNFα which causes dermal nerve damage. ENL occurs in leprosy type LL and BL which has lipid droplets as a synthesis site of Prostaglandin E2 which plays a role in suppressing nerve inflammation. This study investigates neutrophil distributions that express TNFα and iNOS as well as PGE2 expressions of the S100b distributions on ENL patient’s Schwann cells.

Methods: The cross sectional study used 23 samples of biopsy skin pedis of patients with MB leprosy type (10 ENL samples and 13 as control samples), from the Skin Polyclinic Sanglah Hospital, Denpasar, Indonesia. Punch biopsy of 4 mm in diameter is performed. Slides are conducted with Hematoxylin-Eosin standard staining as a structural confirmation, type of leprosy and distribution of neutrophil cells. Observation of TNFα, iNOS, PGE2, and s100b are conducted with immunohistochemistry techniques. Expression analysis is performed with immune ratio software (freeware). The PGE2, s100b, TNFα and iNOS expression percentage are put on a list, T-test is performed and IBM-SPSS 21 for Windows is used in the relationships between groups test.

Results: In the present study, it was found that the distributions of neutrophil increased in the ENL compared to the ones in the control. The increased neutrophils appeared in the dermis area around the blood vessels. INOS and TNFα distributions on neutrophil cells increased significantly in the ENL. And in line with that, the s100b expressions on the ENL were significantly lower.

Conclusions: The significant increase of the iNOS and TNFα neutrophil cells in the ENL may play a role in the dermal nerve damage. This study digs into the possibility of the role of Prostaglandin E2 in maintaining the peripheral nervous system on leprosy with ENL. Hence the understanding of PGE2 as the main mediator in the inflammatory process especially in the Schwann cell damage is very important.

Effect of Andrographis paniculata tablet (AS201-01) on Transforming Growth Factor Beta (TGF-β) expression and parasite inhibition in mice placenta infected with Plasmodium berghei

Background: Transforming Growth Factor β (TGF-β) is a cytokine regulator of inflammation that important in inhibited parasite growth and preventing inflammation. Andrographis paniculata was empirically used as traditional medicine in Indonesia to cure malaria by activating TGF-β. Preliminary studies showed that AS201-01 tablets containing the ethyl acetate fraction of A. paniculata had been shown to inhibit the growth of Plasmodium berghei.

Aims: This study aims to determine the effect of the AS201-01 tablet on parasite inhibition and TGF-β expression in P.berghei infected mice placenta.

Methods: About 24 pregnant mice were divided into 4 groups: healthy pregnant mice (normal) (G1), untreated infected pregnant mice (negative control) (G2), infected pregnant mice treated by AS201-01 tablets (G3), and infected pregnant mice treated with Dihydroartemisinine-piperaquine (positive control) (G4). About 1x10⁶ parasitemia were infected on the 9^th day of pregnancy, while therapy was administered on the 11^th day of pregnancy. The placenta was collected at the 15^th day of pregnancy. The parasite inhibition and TGF-β expression were evaluated using Hematoxylin-Eosin (HE)  and immunohistochemistry assay.

Results: The results showed that the parasite still found in the placenta of G2, G3, and G4 still, but parasite of placental in G2 was higher than G3 and G4. There was a significant difference in the parasite inhibition between G2 with G3 and G4 (p<0.05). In addition, the immunohistochemistry assay found that there was a significant difference in TGF-β expression between G2 with G3, G4, and G1 (p<0.05).

Conclusion: Administration of the AS201-01 tablets inhibit parasite P. berghei and increase TGF-β expression on the placenta of infected mice.

Determination and comparison of stomach residual volume at two alternate gavage ways with gravity and injection force in premature infants

Background: Prematurity is one of the most important problems of recent years, and the number of premature infants is increasing every year. Babies who are born prematurely due to defects in the coordination of swallowing, sucking and breathing require mouth tube or nasogastric intubation feeding. Because bolus gavage feeding is more appropriate physiologically and improves the secretion of gastric hormones is more common in neonatal intensive care units. Objective: The primary objective of the study is a comparison of two alternate gavage ways with force gravity and injection with syringe in premature infants and find existence difference and compared with the results of the research have been performed yet. Methods: In this study, gastric residual volume indicators collecting method are used. The study used a questionnaire to collect data to measure indicators of the following tools. Results: Results showed that both alternate gravity and injection (push) ways, complications of gavage (vomiting, aspiration, abdominal distention and necrotizing enterocolitis) had not been seen. Conclusions:  Based on the results of both currently study of methods in preterm infants feeding have same effectiveness and safety.

Factors influencing the inpatients satisfaction in public hospitals: a systematic review

Objective: The aim of the current study is designing a model for patient satisfaction and defining priority factors that impact patient satisfaction of healthcare services. Method: The preliminary literature search was undertaken in December 2014. A subsequent search was carried out in October 2015, which covered a majority of databases including PubMed, Scopus, ProQuest, and Magiran. Studies related to inpatients in hospitals included and related to specific area were excluded. No time bound was applied.   Two of the authors independently appraised the quality of studies and subsequently, the grouping of the variables was done using MAXqda 12 software and the analysis was done through vote – counting method. Result: Out of 1315 articles, 85 articles were chosen for final consideration. Most of which have been carried out in developed countries. The main factors affecting consumer satisfaction in hospitals were grouped into two categories. 1- Patient attribute factors: that involved expectations, health status, demographic and socio-economic. 2- Health system factors: that involved service quality, hospital features, staff satisfaction and insurance. Conclusion: In this study the risk of bias for each study not researched. It has been contended that the construct of consumer satisfaction is a multidimensional and subjective one. The finding of the current study suggests that all these variables be considered when evaluating patient satisfaction. The evaluation process should be performed cautiously as service providers have little direct influence over patient attribute factors. 

Degenerative Spondylolisthesis : The preferable surgical technique

Introduction: Degenerative Spondylolisthesis is the major cause of low back pain, radiculopathy, and neurogenic claudication. The incidence rate for the general population ranged from 5% to 7%. Surgical method on degenerative spondylolisthesis is highly recommended. Objective: The purpose of this review is to determine the preferable surgical procedures for degenerative spondylolisthesis, which are still debatable.

Methods: A total of ffty relevant literatures were researched regarding degenerative spondylolisthesis, the diagnostic procedure, and the treatment from the period of 2007-2017. The author has chosen which surgical technique that is preferable between TLIF (Transforaminal
Lumbal Interbody Fusion) and PLF (Posterior Lumbal Fusion), from the so-called 50 literature journals.

Results and Discussion: The results showed that there was no signifcant difference regarding the back pain using Visual Analog Scale (VAS) during the preoperative procedure, in the operating level, the treatment duration, and the post-surgical complications between the two groups. There was also no signifcant difference in terms of leg pain (using VAS) between those two groups. On the other hand, the amount of blood loss, the duration of the surgery and successful fusion were signifcantly higher in the TLIF group than the PLF group.

Conclusion: When determining the surgical procedure, the author discovered the TLIF to be comparatively superior to the PLF regarding the fusion success, despite the longer surgical duration and higher amount of blood loss.

Metachronous Multiple Primary Malignancies (endometrium and breast): A case report

Introduction: Advanced progression the field of diagnosis and treatment of cancer patients causes increased survival of patients. Increasing life expectancy can lead to new health problems, including Multiple primary malignancies (MPM). Although the incidence of MPM is increasing, the diagnosis of MPM remains very rare. Based on the interval between tumor diagnosis, MPM can be divided into synchronous MPM and metachronous. Studies of MPM may provide useful information not only for clinical purposes but also can provide clues about etiology and management of this type of cancer. This case report was a woman with metachronous MPM (endometrium-breast). Case: A 60-year-old female presented with a lump on the right breast since 2 months before admission. Patients also complained multiple marble sized lumps on the right armpit and right neck since 1 ½ months ago. From previous medical record data (5 years ago), the patient was diagnosed with endometrial carcinosarcoma stage IV. On physical examination on neck showed supraclavicula lymph nodes enlargement. Examination of right mammary region showed Peau d’orange skin with hyperemic colour, and a palpable solid mass. On right axillary region, there was lymph nodes enlargement. Mammae and axilla Ultra Sonography (USG) showed solid malignant in right upper-lateral quadrant breast with diffuse skin edema and multiple solid nodules in right axilla. Mammae histopathologic biopsy results conclusion is invasive carcinoma of no special type grade 3. Conclusion: Our case was a woman with a metachronous MPM endometrial and breast, with the first malignancy was endometrial carcinosarcoma stage IV (type II endometrial carcinoma) followed by the appearance of second malignancy as a breast cancer dextra grade 3 stage IIIC. Time interval between these malignancies more than 6 months (5 years).

Maple syrup urine disease: the first case in Bali

Background: Maple syrup urine disease (MSUD) is a rare genetic disease of metabolic disorder inherited as an autosomal recessive trait. The disease is caused by branched-chain alpha-keto acid dehydrogenase (BCKD) deficiency. It results in the accumulation of branched-chain amino acids (BCAA) which are toxic to the nervous system. 

Case Presentation: A one-week-old infant was brought to Siloam Hospital because she suddenly became lethargic, had a poor feeding, and an intermittent muscle spasm. She was the fourth child in her family. At her admission, she was diagnosed with neonatal sepsis. On advanced clinical and laboratory examination, we found ketoacidosis, hypoglycemia, and the typical odor of maple syrup in the urine. Plasma amino acids analysis showed a marked elevation of BCAA (leucine, isoleucine, and valine), confirming the diagnosis of MSUD. The patient was treated with intravenous glucose infusions and dietary support, including formulas free of BCAA. She was monitored for blood sugar and urine ketones. 

Conclusion: Metabolic disease should be considered in an infant who suddenly suffered a critical illness several days following a normal delivery.