Link of Video Abstract: https://youtu.be/K2R3dfdvi20

Background: Simple, cost-effective, and practical laboratory indicators are required to diagnose and evaluate COVID-19 disease severity. This study assessed the diagnostic value and predictor of severity and outcome parameters of NLR, d-NLR, MLR, PLR, and ALC in COVID-19 patients.

Methods: A retrospective study used medical record data from 100 COVID-19 patients from November 2020 to March 2021. SPSS version 22 was used to analyze the data. The severity of COVID-19 was predicted using a ROC curve. Kaplan-Meier analysis was employed to evaluate the ability of various inflammatory markers to predict COVID-19 prognosis. A multivariate analysis with logistic regression was conducted to assess the ability of an independent predictor of COVID-19 severity. A p-value of <0.05 was considered significant.

Results: ALC values were lower in the severe-critical COVID-19 group, whereas NLR, d-NLR, MLR, and PLR values were higher. The NLR, d-NLR, and ALC parameters had sufficient accuracy, whereas the MLR and PLR parameters had low accuracy. NLR, d-NLR, MLR, PLR, and ALC had optimal cut-off values of 7.865, 4.82, 0.455, 235.000, and 0.895, respectively. The multivariate odds ratio for ALC was 7.348 (95% CI = 1.914-28.214; p = 0.004). Kaplan-Meier analysis revealed differences in survival time based on the optimal NLR, MLR, d-NLR, and ALC cut-offs obtained.

Conclusion: NLR, d-NLR, MLR, PLR, and ALC are all potential predictors of COVID-19 severity and prognosis. ALC is a reliable predictor of COVID-19 severity.

Link of Video Abstract: https://youtu.be/kSlkMRdPkO8

Introduction: Intestinal anastomosis leakage is a significant concern following intestinal suturing due to its potential to cause morbidity and mortality. Curcuma longa, commonly known as turmeric, has been observed to have wound-healing properties by promoting collagen deposition and increasing the number of fibroblasts. However, the effect of Curcuma longa on left colon anastomosis with acute intra operative loss of 15% circulating blood volume is unknown. This study aimed to determine the impact of oral administration of Curcuma longa extract on the number of fibroblasts and collagen density in the left colon anastomosis with acute intraoperative loss of 15% circulating blood volume.

Methods: This is an experimental study; the researchers investigated the effect of Curcuma longa extract on the healing process of colon anastomosis in white rats - Rattus norvegicus.

Results: A total of 30 white rats - Rattus norvegicus underwent laparotomy for left colon anastomosis resection, and they were randomly divided into two groups. One group was given Curcuma longa extract orally after surgery, and the other group did not received it. After five days of treatment, the group that received Curcuma longa extract orally had a significantly higher mean number of fibroblasts (1168.13) compared to the control group (749.60) (p-value: 0.006). Moreover, the collagen density in the treated group was also higher, with a density range of 50-72% (60% of rats) and 75-100% (33.30% of rats), compared to the control group's density range of 25-50% (66.70% of rats) and 10-25% (13.30% of rats) (p-value: 0.000).

Conclusion: Oral administration of Curcuma longa extract can increase the number of fibroblasts and collagen density in the left colon anastomosis with acute intra operative loss of 15% circulating blood volume.

Introduction: Food consumption has a substantial impact on the physical condition of work for unskilled individuals like construction workers because their activity demands a lot of energy. Consumption of bananas can increase energy, so it is hoped that the results of this study can be used as a consideration to maintain the health of construction workers so that they are kept in good condition. The aim of the study was to determine the effectiveness of bananas on blood pressure, liver function, and lipid function.

Methods: This is an experimental study with samples taken from the total population of 15 employees. The blood pressure, liver function, and lipid function measurements in construction workers were made before and after consuming bananas. The analysis of the data in this study was conducted by a paired t test.

Results: Based on the data analysis, the result showed that there was no significant difference in blood pressure and liver function measurements between the workers before and after consuming bananas (p>​​0.05). Meanwhile, the results showed that there was a significant difference in lipid function measurements between the workers before and after consuming bananas (p<​​0.05).

Conclusion: The effectiveness of banana consumption can be seen in the examination of lipid function. However, there is no effect on the blood pressure or liver function of the workers.

Introduction: Classical music has beneficial effects on heart rate variability and also reduces one's stress levels due to parasympathetic dominance. Mozart's classical music was shown to provide subsequent short-term enhancement of spatial-temporal reasoning ability. This research aimed to study the effect of Mozart's classical music on blood pressure.

Methods: The design of this study is true experimental with a post-test-only design with a control group.

Thirty Wistar white rats were randomized by simple random sampling method into the control group and experimental group receiving Mozart’s classical music for 90 minutes, twice daily for 1, 3, and 4 weeks. SBP, DBP, and MAP were measured and analyzed using descriptive analysis, Shapiro Wilk, Mann-Whitney U, and Wilcoxon Sign Rank test.

Results: DBP and MAP of the experimental group week 1 and 3 were significantly different from the control group. There were significant differences between SBP, DBP, and MAP of experimental group week 1 from week 3 (p=0.00, p=0.00, p=0.00 respectively) and week 1 from week 4 (p=0.00, p=0.00, p=0.00).

Conclusion: Listening to Mozart's classical music has a direct effect on blood pressure.

Introduction: Vitamins have a main role in controlling metabolism in the body and the immune system. Vitamins A, C, and E are known as antioxidant nutrients and vitamin D is essential for innate and adaptive immune function. This study is aimed to analyze the effect of vitamin intake regularly on malondialdehyde (MDA) levels, white blood cell (WBCs) and platelet counts, and differences count of leukocyte

Method: The study used 6 groups including the control group without intervention and the intervention group intake of one tablet of vitamin a day for 7 days which were divided into groups of vitamin A 2000 IU, vitamin C 1000 mg, vitamin D 400 IU, vitamin E 100 IU and multivitamins C 1000 mg and D 400 IU

Results: Based on the study was explained that vitamins C, D, and E and multivitamins C and D were able to reduce MDA levels and leukocyte counts descriptively but not significantly. The differential leukocyte count has various levels depending on the type of vitamin.

Conclusion: Therefore, the consumption of vitamins A, C, D, and E and multivitamins C and D had no significant effect on MDA levels, WBCs count, platelets count, and differential count of leukocyte.

Introduction: Hemodialysis is one of the treatments for kidney failure patients, although it is not always effective and has a tendency to make the patient's health worse. One such effect is a rise in interdialytic weight. In this study, patients with chronic kidney failure receiving hemodialysis at the Islamic Hospital A. yani Surabaya were examined to establish the association between family support and weight growth.

Method: a cross-sectional research strategy for analysis. 70 respondents made up the population of all hemodialysis patients with chronic renal failure, and 60 respondents made up the purposive sampling sample size. The unrestricted factor is family support. The weight gain between dialysis sessions was the dependent variable. A questionnaire and an observation sheet were used as instruments. The Spearman Rank test was utilized in data analysis.

Results: According to the findings, out of the 60 respondents, the majority's (70%) family support was excellent, and the majority (76.7%) of those who had dialysis saw modest weight gain. According to statistical analysis, the p value was 0.001, which indicates that among hemodialysis patients with chronic renal failure who receive family support, there is a relationship between weight gain.

Conclusion: In patients with chronic renal failure receiving hemodialysis, the more well-controlled the interdialytic weight increase, the better the family support. The requirement for support and assistance for dialysis patients so they can follow the recommended course of treatment.

Introduction: The Objective Structured Clinical Examination (OSCE) is an acceptable measure to assess nursing students' skill competencies. To date, rapid changes in the education system, technology information, and pandemic enforced the need to develop and implement an online OSCE scoring management system, an online system to score the student during the OSCE. Although the satisfaction of the online OSCE scoring management system has been studied, the study to assess readiness to implement the online OSCE scoring management system is still lacking. This study aimed to identify the nursing education institution readiness level in implementing an online OSCE scoring management system named ON-OSCE.

Methods: The online survey involved 144 nursing lecturers across Indonesia. The survey consisted of 30 questions with a 5-point Likert scale that entails technology, innovation, people, and self-development dimensions. Each dimension was constructed by the questions related to resources, skills, and attitudes. The readiness levels were categorized into not ready (average score of 1-3.39) and ready (average score of 3.40-5.00).

Results: Mostly, the participants worked at a private institution (93%) with an accreditation level of B level (75.5%) and implemented an e-Learning system (85.4%). However, the common OSCE scoring management system was paper-based/hardcopy (73.2%). About two third of participants (67.4%) were ready to implement an online OSCE scoring management system (Mean = 3.57, SD = 0.57).

Conclusion: Most participants perceived that their institution was ready to implement an online OSCE scoring management system. Further study is needed to pilot an online OSCE scoring management system in a nursing education institution and explore the student and examiner's satisfaction before implementing an online OSCE scoring management system.

Link of Video Abstract: https://youtu.be/5LTsY60dY0s

Background: Myopia is one of the numerous visual problems that continue to increase in incidence throughout the world. Various genetic and environmental factors are thought to influence the onset of myopia. Myopia is known to have a significant impact on the economy, vision problems, and a decrease in quality of life so that it needs serious attention. This study aims to explore the relationship between parental risk factors with degree severity of myopia.

Methods: This study is an analytic observational study research design. The population of this study are patients diagnosed with myopia in the Ophthalmology Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Patients who met the inclusion and exclusion criteria were included as samples. Data are gathered through medical records and by questionnaire, this includes age and spherical equivalent (SE) in right eye or left eye. Degree of severity was classified based on SE. Myopia’s degree of severity and parental history are then analyzed to determine the relationship.

Results: A total 72 patients were included in this study. The majority of participants have a familial history of parental myopia. The degree of severity with the highest frequency is low myopia. The results of statistical tests showed that there was no relationship between history of parental myopia and the severity of myopia in the right eye (RE) (p-value = 0.712) and the severity of myopia in the left eye (LE) (p-value = 0.565).

Conclusion: There was no relationship between the history of parental myopia and the severity of myopia.

Background. One of the fundamental pathogenesis of endometriosis to grow and develop is to carry out a cellular invasion of the surrounding tissue where it attaches. The invasion process of endometriotic focus is linked with the activity of matrix metalloproteinases-2 (MMP-2) and tissue inhibitors of metalloproteinases-2 (TIMP-2). In this study, we used endometrioma tissue to be implanted in chick chorioallantoic membrane (CAM) as a medium culture model to reconstruct and evaluate the invasion process of endometriosis. Then the MMP-2, TIMP-2 and invasion pattern can be invitro observed.

Methods. Endometrioma tissue fragments were taken from ovarian endometrioma patients, reproductive age, no medication and no malignancy who underwent laparoscopic surgery. Sample research was taken in consecutive and non-probability sampling. The tissue fragments were divided into 4-8 strips, each dimension of 2 x 2 mm². Two strips were assessed for the activity of MMP-2. Two remaining strips were transplanted onto the CAM. After incubation for five days, the transplanted tissues were harvested for assessment of MMP-2 by gelatin zymography, TIMP-2 by western blot and histological assessment by hematoxylin-eosin staining. The assessment was carried out by two qualified biologists as an observer.

Result. Twenty-four fragments of endometrioma have been collected from 24 endometrioma patients who underwent laparoscopy surgery. The average age was 31±5 years, the BMI was 22±3 kg/m², the duration of infertility was 58 ± 3 months, and r-ASRM was 67±35. In CAM of transplanted endometriomas tissue, MMP-2 activity was positively correlated with TIMP-2 in a moderate relationship (r_ô = 0.56, p-value < 0.05), very weak positive correlation with invasion level (r_ô = 0.08, p-value >0.05). TIMP-2 expression was negatively correlated with invasion level in a strong relationship (r_ô = -0.35, p-value <0.05). The ratio between MMP-2/TIMP-2 was positively correlated with invasion level in a very strong relationship (r_ô = 0.72, p-value < 0.05). ICC (intraclass correlation coefficient) value was 0.96, and p-value= 0.01, CI 95%. It shows that there was high reliability between observers.

Conclusion. The invasion level of endometrioma transplanted onto CAM was determined by the balance between MMP-2 and TIMP-2.

Background: The making of batik in Malon Village utilized natural dyes. The process of making batik was done through 7 stages: designing pattern, tracing, outlining, coloring, fixating, masking and rinsing. Those processes were conducted with poor ergonomic working positions and were highly potential to cause injury for the batik workers. This study aimed at finding out the potential health risks that exist for the natural batik workers and the occupational health profiles of batik workers in Malon Village which is an icon for naturally dyed batik.

Method: This study was descriptive quantitative research by using observational design. The data were collected from subjective complaint questionnaires, workplace observation and measurement of Vital Lung Capacity (VLC) of the batik workers.

Results: The results showed that 45.5% of the working tools used poor ergonomic designs. Batik in Malon Village used four chemical irritants: wax, alum, soda ash and lime. All of them could potentially lead to health problems. The result also showed that around 61% of batik workers complained about stinging/ burning eyes, 28% watery eyes and 11% red eyes. In addition, 22% of them complained about itchy skin, 6% redness in the skin and 6% pain in the skin. The VLC showed that 50% of respondents had normal VLC, 47% mild restriction and 3% severe restriction.

Conclusion: The area where the batik workers worked had high health and safety risks, but only 22% of respondents used Personal Protective Equipment (PPE) and all of the worn PPE did not meet the standards.

Link of Video Abstract: https://youtu.be/8WQpmpndIfA

Background: Bipolar Transurethral Vaporization of the Prostate (B-TUVP) is a surgical technique for Benign Prostatic Hyperplasia (BPH) patients that known for its technical reliability, short operating time, and low risk of intraoperative bleeding. However, despite these advantages, it appears to be an unpopular choice among urologists. Previous studies have produced conflicting results when comparing B-TUVP to Transurethral Resection of the Prostate (TURP), particularly bipolar TURP (B-TURP). To date, no studies have directly compared the efficacy and complications of B-TUVP and B-TURP, which using the same energy type. Therefore, the objective of this study is to compare the efficacy and potential complications of these two modalities for the treatment of BPH.

Methods: The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) were followed to perform a systematic search in six databases. The risk of bias in RCT was evaluated using the Cochrane Risk of Bias (RoB) tool version 2. The Review Manager® 5.4 software was used for analyzing all the data.

Results: Six eligible RCTs were included with a total of 940 samples. International Prostate Symptom Score (IPSS), fastest flow rate (Qmax), and post void residual (PVR) were not significantly different, while the quality of life (QoL) score (SMD = -0.64; 95%CI = -1.09 – -0.18; I² = 86%) were significantly lower in B-TUVP (p < 0.05).  Hemoglobin drop (SMD = -2.05; 95%CI = -2.78 – -1.31; I² = 95%), catheterization period (SMD = -1.14; 95%CI = -1.45 – -0.84; I² = 60%), and hospital stay (SMD = -0.68; 95%CI = -1.04 – -0.31; I² = 61%) were significantly lower in B-TUVP (p < 0.05). The analysis of complications did not differ significantly between the B-TUVP and B-TURP groups.

Conclusion: B-TUVP had similar short- to medium-term efficacy and complications as B-TURP, with advantages in terms of significantly better QoL score, lower hemoglobin drop, shorter catheterization period and hospital stay.

Background: Striae distensae (SD) is a harmless skin disorder that can cause cosmetic and psychological problems. Until now, no easy-to-use, useful and non-invasive method can be used to determine the severity of SD. The scoring system can be used as a guide for selecting and administering effective therapy for striae distensae. This study aimed to assess the severity of striae distensae using INA score.

Methods: This research was a descriptive observational study with a cross-sectional approach involving 72 female health workers at the Universitas Sumatera Utara Hospital. The diagnosis of stretch marks is made through history and physical examination. We did the whole body examination for scoring of striae distensae. This research has been approved by the Research Ethics Commission of the Universitas Sumatera Utara.

Results: A new scoring system, namely the INA score, to assess the severity of striae distensae at the mammae, axilla, abdomen, femoral, gluteus, and popliteal locations. The assessment of the INA score based on the entire region of the study subjects was obtained at a mild degree (54.2%). The characteristics of majority of the subjects were in the age range of 18-25 years (93.1%) and had a family history of striae distensae (54.2%). The distribution of the majority of striae distensae locations is in the femoral and gluteus region (47.2%). Based on each region, the majority of the subjects had striae distensae with severe degree in the mammae (20.8%), abdomen (8.3%), femoral (90.3%), gluteus (94.4%), and popliteal (22.2%);. In comparison, the axilla was dominant with a moderate degree (5.5%).

Conclusion: The new scoring system named INA score assesses the severity of striae distensae at the mammary, axillary, abdominal, femur, gluteus and popliteal locations.

Link of Video Abstract: https://youtu.be/-i3vr4qpQUU

Background: Chronic kidney disease (CKD) patients on hemodialysis are more susceptible to COVID-19 infections. Mortality and morbidity rate are higher in this population. Thus, it is critical to understand which parameters are associated with mortality in this population. C-reactive protein (CRP), albumin, and d-dimer were shown in several studies to be associated with mortality in COVID-19-infected hemodialysis patients.

Methods: This study was a comparative observational, retrospective study from the medical records of Dr. Soetomo General Hospital in Surabaya, Indonesia. Chronic kidney disease patients on maintenance hemodialysis who tested positive for COVID-19 from June 2020 to January 2021 and underwent treatment in the isolation ward were included in this study. Data were analyzed using SPSS version 21.0 for Windows.

Results: The non-survivor groups have statistically significant lower albumin (2.78 (2.21-3.40) g/dL vs. 3.20 (2.45-3.80) g/dL; p=0.040) and higher CRP (10.40 (4.10-28.6) mg/L vs. 3.20 (0.10-80.0) mg/L; p=0.020) compared to the survivor group (Table 2). D-dimer value has no significant difference between the non-survivor and survivor groups (4,290 (190-18,310) ng/mL vs. 2,630 (190-19,430) ng/mL; p=0.140)

Conclusion: Non-survivor CKD patients with COVID-19 infections have significantly lower serum albumin and higher CRP concentrations. There is no significant difference in D-dimer concentrations in the survivor and non-survivor groups.

Purpose: The National Health Insurance (JKN) implemented by the Indonesian government since 2014 has brought Indonesia to a new phase in realizing the right to health for its people. The social insurance system managed by Social Health Insurance Administration Body (BPJS) is felt to bring many benefits to the community despite many obstacles in its implementation. This study seeks to find the ethical dilemmas experienced by surgical and non-surgical specialists in implementing the JKN program in hospitals.

Methods: The study was conducted using the qualitative method with the phenomenological approach by conducting in-depth interviews with five surgical specialists (an obstetric and gynecology, an otolaryngologist specialist, a surgeon, an eye specialist, and an anaesthesiologist) and six non-surgical specialists (children, mental health, internal medicine, medical rehabilitation, nerves, and skin specialists) in Semarang, Indonesia. In each specialization, there are two respondents interviewed. The data were analyzed using a qualitative approach.

Results: Some problems still exist when specialist doctors treat BPJS patients in hospitals, which include: 1) lack of socialization, making doctors as implementers find it difficult to implement the rules; 2) different implementations in various hospitals, making doctors find it difficult to adjust when they practice at type C hospitals because the number of claims is often insufficient to provide services to patients; 3) the JKN program that has increased the number of patients, resulting in doctors' concerns about lawsuits if they make mistakes; moreover, doctors also have to adjust to existing cost claims; and 4) doctors still trying to uphold the doctor's oath and The Indonesian Medical Ethics Code (KODEKI) and always do the best for patients whatever the problem. Conclusion: The implementation of JKN must always be evaluated continuously, and the government still has to pay attention to the obstacles faced by doctors in the field. In carrying out their practice full of dilemmas, doctors must always receive adequate legal and ethical protection.

Introduction: Obesity is a nutritional disorder that can affect all ages, including teenagers. Obesity can affect gut microbiota and cause increased intestinal permeability. This process leads to interleukin-6 and TNF-α production which can increase leptin levels. The soluble leptin receptor (sLR) is a leptin receptor in the plasma that transports leptin to the hypothalamus. Low sLR numbers are associated with high leptin levels in obesity. Obesity in hyperleptinemia conditions indicates leptin resistance (defects in leptin receptors) which causes hyperphagia and reduces energy expenditure. This study was conducted to prove high TG and IL-6 serum levels and low sLR levels in obese adolescents who have a higher risk of developing leptin resistance than normal adolescents.

Methods: This research is a case-control study. The subjects underwent an assessment including food recall, anthropometric status, and lipid profile. The food recall assessment was obtained by means of a questionnaire given to parents. Blood sampling and laboratory examination are carried out by the Prodia® Clinical Laboratory. Data analysis was performed by computer, using the Independent t-test, Mann-Whitney test. Chi-Square test, and analysis of the ROC curve.

Results: ROC curve analysis obtained the optimal cut points for TG and IL-6 levels, respectively 101.5 mg/dL (sensitivity 82.1%, specificity 89.7%) and 11.95 pg/mL (sensitivity 84.6%, specificity of 80%), with area under the curve (AUC) values of 0.96 and 0.89, respectively. ROC curve analysis obtained the optimal cut point for sLR levels of 19.3 ng/mL (sensitivity 64.1%, specificity 71.8%) with an AUC value of 0.77. Multivariate analysis using logistic regression found a significant relationship between TG and IL-6 levels on the incidence of hyperleptinemia.

Conclusion: This study reinforces the theory of chronic low-grade inflammation and proved that inflammation and high TG levels play a role in hyperleptinemia in obese adolescents.

Background: Androgenetic alopecia is the main concern hair problem in the male which is characterized by progressive miniaturization of hair follicles. One factor which contributed in androgenetic alopecia progression is sebum level. This study determined the correlation between sebum level and the severity of AGA in men.

Patients and methods: This study was an observational analytic study with a cross sectional method involving 50 male androgenetic alopecia (AGA) patients based on inclusion and exclusion criteria. Recorded age, education, occupation, family history and duration of illness. AGA severity was determined by the Hamilton- Norwood classification I–VII. Sebum levels were measured using Sebumeter® SM 815. The correlation between sebum level and severity of AGA was analyzed using the Gamma correlation test and significant if p-value<0.05.

Results: Most AGA patients were found in the 36–45 age group, had a diploma/bachelor education level, worked in business services and salespeople, had a family history of their father suffering from AGA, and had suffered from AGA for >20 years. Most AGA patients were found in Hamilton-Norwood III (50%) with the most sebum levels were found to be normal (60%). The results of this study showed a positive correlation (p<0.01) with a very strong strength between sebum level and severity of AGA (r=0.94).

Conclusion: There is a very strong correlation between sebum level and severity of AGA.

Introduction: The use of a tourniquet in lower extremity surgery can help surgeons optimize the surgical field. However, tourniquet inflation may create ischemic conditions in the extremity, and tourniquet deflation may pose a risk of ischemic reperfusion injury (IRI). Ischemic conditions can increase the production of reactive oxidative stress (ROS), which, if it occurs simultaneously with IRI, will produce malondialdehyde (MDA), a toxic metabolite. The prolonged use of tourniquets can cause damage to the local skin tissue at the tourniquet inflation and poses a risk of IRI to other organs. This study aims to observe the effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets.

Methods: This study is an observational study with a prospective cohort design to measure malondialdehyde levels in lower extremity surgery using tourniquets. When the data were normally distributed, a statistical test was performed using an independent sample t-test to compare the demographic data of the two groups. To compare the results of the observation after the induction, 15 and 120 minutes after the release of the tourniquets, a repeated measures ANOVA was performed when the data were normally distributed. Then, to examine the correlation between variables, Spearman's correlation test was applied when the data were not normally distributed.

Results: In this study, almost all the subjects in the isoflurane and dex-iso groups had no significantly different characteristics, and also showed no effect of tourniquet pressure on malondialdehyde levels.

Conclusion: Based on statistical analysis and discussion of the effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets, it can be concluded that there was no statistically significant effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets.

Background: Traumatic brain injury (TBI) is damage to the head caused by an external physical attack/impact. Deaths that occur from brain injury are 14-30 out of 100,000 population each year. TBI is diagnosed using Computed Tomography (CT) as the gold standard. Different densities of the pathological feature on CT can be measured by Hounsfield Unit (HU) to define its pathology. We try to asses if the HU can predict the hematoma expansion in TBI.

Methods: This research is an observational study. The data is taken from the radiology installation data of the emergency care installation at the Dr. Soetomo Regional General Hospital regarding factors that play a role in hematoma expansion with related factors in patients with subdural and epidural bleeding. Data were taken from January 2021 to December 2021. The factors analyzed were Hounsfield Unit, age, and hemostasis factors.

Results: In this study, there were 30 patients. This study was dominated by men (73.00%) and the age group of 16-20 years (26.6%). The mean PTT value in this study's subjects was 13.3±3.27. The mean value of APTT is 29.8±2.82. The average Hounsfield Unit is 43.60±5.82. No significant relationship was found between Houndsfield Unit, Age, APTT level, and age with hematoma expansion. A significant relationship was found between PTT and hematoma expansion. Simultaneously Hounsfield Unit, PTT, APTT, and age had a significant relationship with hematoma expansion.

Conclusion: There was no statistically significant relationship between Hounsfield Unit and hematoma expansion. There is a statistically significant relationship between PTT and hematoma expansion. Simultaneously found a significant relationship between Hounsfield Unit, PTT, APTT, age, and bleeding activity.

Link of Video Abstract: https://youtu.be/JOzTSty10v4

Background: Brucein D (BrD), a quassinoid isolated from Brucea javanica fruit, reportedly demonstrates anti-tumor activity. Bcl-2 is an anti-apoptotic protein that inhibits apoptosis and leads to cancer progression. This study aims to evaluate the inhibitory effect of BrD against the anti-apoptotic protein Bcl-2 by molecular docking study.

Methods: We investigated the activity of BrD against Bcl-2 through molecular docking in silico compared to the chemotherapeutic drugs doxorubicin and docetaxel. Molecular docking analysis was conducted using the Lipinski rule of five drug-likeness analyses, PASS Online prediction, PyRx v0.8, Discovery Studio DS BIOVIA 2016 v16, and PyMol v2.4.

Results: Current results show that BrD is qualified as a drug and can pass cell membranes without toxicity. The PASS prediction also shows that BrD can be activated as an anti-neoplastic inside the human body with Pa higher than Pi. BrD can make a constant and stable bond to Bcl-2 with a binding energy of -8.3 kcal/mol, almost equal to doxorubicin and docetaxel. BrD can form six types of hydrogen bonds that show stability to temperature and pressure.

Conclusion: BrD has shown to be a promising alternative for an anti-cancer drug by inhibiting the Bcl-2 anti-apoptotic protein with low toxicity in normal cells.

Background: Postoperative Cognitive Dysfunction or POCD is a reversible decline in the cognitive function of patients after surgery. The risk factors for POCD are age, comorbidities, duration of CPB, intraoperative hypoperfusion, duration of ventilator use, and postoperative sedation are risk factors of POCD. This study aims to determine the prevalence and characteristics of postoperative cognitive dysfunction (POCD) in patients who undergo on-pump cardiac surgery at Dr. Kariadi General Hospital.

Methods: This study's population was all patients undergoing on-pump cardiac surgery at Dr. RSUP. Kariadi in July 2021-December 2021. The study subject was 97 patients, obtained by total sampling technique. The study subjects were examined for cognitive function with MoCA-INA one day before surgery and the third day after surgery. Data were analyzed using SPSS version 23 for Windows.

Results: There were 68 (70.1%) patients who experienced POCD and 29 (29.9%) patients who did not experience POCD. The median age of patients with POCD is 50 (18-68) years and 36 (18-63) years for patients without POCD. Based on MAP during CPB, patients with POCD had a median of 64 (51-80) minutes. In patients with POCD, the median length of CPB was 53 (22-92) minutes, and the median length of the aortic cross-clamp clamp was 35 (11-69) minutes.

Conclusion: We found a high prevalence of POCD patients after on-pump cardiac surgery, as many as 70.1% at Dr. Kariadi General Hospital.

Introduction: Hepcidin is a hormone that regulates systemic iron homeostasis and is mostly produced in the liver. In pregnant women with inflammation, there are two opposing mechanisms in hepcidin expression: the suppression of hepcidin synthesis by pregnancy and the induction of hepcidin by inflammation. These conditions must receive special attention so clinicians can properly treat and manage pregnant women with inflammation. Therefore, this study aims to prove changes in hepcidin and serum iron levels in pregnant mice with inflammation.

Method: This study involved sixteen-second-week pregnant mice divided into two groups. Pregnant mice were injected with lipopolysaccharide (LPS) Escherichia coli serotype O111:B4 as much as 1 µg/g body weight intraperitoneally as the treatment group. In contrast, pregnant mice were injected with phosphate buffer saline (PBS) as a control group. Serum was measured using ELISA to determine hepcidin levels and colorimetry to determine serum iron. Mice livers were measured using Real-Time PCR to determine Hamp1 mRNA expression. The data obtained were analyzed using an independent t-test.

Result: Our results show that pregnant mice with inflammation show there was no difference in Hamp1 mRNA expression (p-value=0.163) and hepcidin level (p-value=0.789), but there was a significant difference in serum iron level (p-value=0.035).

Conclusion: This study demonstrates that inflammation in pregnancy does not affect changes in Hamp1 expression and hepcidin level but reduces serum iron, which could be caused by regulating hepcidin in the fetus.

Link of Video Abstract: https://youtu.be/9Gip7ztxLJk

Background: Colorectal cancer is reaching the third highest incidence globally, including in Indonesia. Members of the RAS family are frequently discovered in colorectal cancers and may be a contributing factor for the successfulness of anti-epidermal growth factor receptor monoclonal antibodies therapy. Microtubule-associated protein 1 light chain 3 (LC3) is one of the autophagy markers in colorectal cancer cells routinely tested. The relevance of RAS mutation and expression of LC3 as a prognostic factor in CRC has so far only been discussed in several reports. This study aimed to describe the different clinicopathological characteristics of colorectal patients with mutations of the RAS family and LC3 overexpression.

Methods: This study was a cross-sectional study, and the subjects for this study were patient from the Digestive Surgery division at the Tertiary Hospital in West Java, Indonesia with colorectal cancer. A total of 40 study subjects were included in this study. Examination of RAS mutations was carried out by polymerase chain reaction. Meanwhile, the LC3 examination was performed with immunohistochemistry.

Results: The RAS family mutation, which is a mutation of either KRAS, NRAS, or both, was shown in 22 (55%) colorectal cancer patients, and a positive LC3 test was shown in 24 (60%) patients. A univariate analysis of the mutations of the RAS family and expression of the LC3 showed non-significant relationships.

Conclusion: No association observed between RAS family mutations and LC3 expression in colorectal cancer patients.

Link of Video Abstract: https://youtu.be/szoOkhYlQwY

Introduction: The pandemic of COVID-19 has put healthcare workers under high pressure with possible psychological problems and its most common effects are insomnia, depression, distress, anxiety, and somatization symptoms. Previous studies in several centers have shown different results between frontline and non-frontline healthcare workers. This study aims to evaluate the levels of anxiety and perceived needs for mental healthcare among non-frontline healthcare workers during the COVID-19 pandemic in a referral hospital in Surabaya.

Patients and methods: This cross-sectional study involved forty respondents, but one was discontinued due to technical problems. Questionnaire of The Hospital Anxiety and Depression Scale (HADS) was adopted that has 14 scales with two subscales. The subscales include HADS-A for Anxiety and HADS-D for depression

Results: The results show that both HADS-A and HADS-D have significant differences between the indirect and direct groups of contact healthcare workers, except in gender and depression, as shown in Table 3, with an average score of 8.000 (SD 5.02169) and 8.7333 (SD 4.71270), respectively.

Conclusion: Anxiety and depression remain a problem for all healthcare workers, whether frontline or non-frontline. Therefore, issues must be used to mitigate both the frontline and non-frontline healthcare workers.

Introduction: Many therapies that have been done to overcome the problem of menopausal syndrome have been carried out using hormonal therapy or using drugs, but complementary therapies have not been carried out in Indonesia. The purpose of this study was to analyze the use of citrus aurantium l var amara to overcome the problem of menopausal syndrome.

Method: The data used in this study were data on menopausal syndrome experienced by respondents without giving therapy and after giving complementary therapy, as well as factors of occupation, age, and history of contraception of 42 respondents who had menopause. Data analysis was done by comparing the two groups of intervention (women who had been given the complementary therapy of aurantium l var amara) and control group (women who had not received the complementary treatment).

Results: Women in control group experienced no difference in terms of their menopause complaints (p = 0.206), while women in the intervention group showed improvement of their complaints after routine administration of aurantium l var amara therapy for 5 days (p=0.032).

Conclusion: Research conducted to analyze the use of citrus aurantium l var amara to treat menopausal syndrome problems proves that aurantium l var amara is effective in dealing with menopausal syndrome problems.

Link of Video Abstract: https://youtu.be/qPty3GvoyYo

Background: While prompt surgical intervention is still the gold standard, controlling the inflammation may prevent or reduce the progression of PVR, thus increasing the surgical success rate. The arachidonic acid pathway has been reported to play a significant role in the development of PVR. This study aims to investigate the role of the arachidonic acid pathway and assess the related vitreous inflammatory biomarkers in cases of RRD with PVR.

Methods: Thirty patients scheduled for a pars plana vitrectomy for RRD with PVR were included in the study. At the beginning of surgery, a sample of undiluted vitreous was collected in each patient to assess vitreous levels of inflammatory biomarkers, including PGE2, COX-2, TGF-β, monocytes (comparison of CD14 and CD45), and total protein. The vitreous inflammatory biomarkers were also analyzed based on the severity of PVR and the onset of RRD.

Results: The mean of PGE2 level was 91.77 ± 31.87 pg/mL, the median (range) of COX-2 level was 1.32 (1.25–1.55) ng/mL; TGF-β was 51.83 (15.61–319.58) pg/mL; monocytes were 90.25 (24.85–95.24) %; and total protein was 4.81 (0.19–20.4) mg/dL. A noticeable trend was found towards the elevation of PGE2, COX-2, TGF- β, monocytes, and total protein vitreous levels in conjunction with the severity of PVR, although no significant differences between the groups (p > 0.05 in each group).

Conclusion: Inflammation, particularly the arachidonic acid pathway, plays a vital role in the early stage of the pathogenesis of PVR. Inhibition of the arachidonic pathway by the anti-inflammatory agent at the early stage may provide a therapeutic approach for PVR prevention.

Introduction: Many studies have found the effect of Mozart’s music on the spatial memory of humans, but there are still very few studies that examine the effect of the Murotal Alquran approach on spatial memory improvement. This study aimed to evaluate the effect of Mozart's classical music and the Murotal approach on improving spatial memory in mice. This is an experimental study with 24 adult BALB/c male mice.

Method: The mice were divided into four groups: K (untreated control), P1 (Murotal approach with surah Al-Fatihah and Al-Baqarah by Qori' Al-Mathrud), P2 (Mozart’s classical music approach "Sonata in D for two pianos KV448-Allegro con spirito"), and P3 (combined approach). Each group was placed in a cage and treated for 2 hours/day for 20 days. The memory level was measured with an eight-arm radial maze instrument for ten days. The data were analyzed with non-parametric Kruskal Wallis and Mann-Whitney tests.

Result: This study found there were no significant differences between groups toward increasing spatial memory. The highest and fastest memory score was in the P3 group compared to the others.

Conclusion: There is no difference in the effect between classical music Mozart’s and Murotal approach on increasing the spatial memory of mice (Mus musculus), but mice given a combination of approaches have a better level of spatial memory with a higher level of aggressiveness.

Link of Video Abstract: https://www.youtube.com/watch?v=HIbeTAOCFcA


Background: Mesenchymal stem cells (MSCs) differentiate into pacemaker-like cells by activating TBX3 and downregulating Pitx2c by inhibiting the nodal signaling pathway. This optimization study aimed to determine the optimal conditions for differentiating MSCs into pacemaker-like cells.

Methods: The differentiation of MSCs into pacemaker-like cells was carried out in three ways: transfecting TBX3 pcDNA into MSCs, inhibiting the nodal signaling pathway using the small molecule SB431542, and a combination of both methods. This optimization study was conducted in two batches. The first batch was an experiment with transfection carried out on the 5th day of differentiation and addition of 20 μM/mL of the small molecule SB431542. The second batch was an experiment with transfection carried out on the 3rd day of differentiation and the addition of 2 μM/mL of the small molecule SB431542. From the two batches, the expression patterns of TBX3, Cx30.2, Cx40, Cx43, HCN4, HCN1, HCN3, and KCNN4 genes were analyzed using the qRT-PCR method.

Results: The results showed that the second batch had a better gene expression pattern in pacemaker-like cells than the first batch. These results were indicated by the increased expression of the TBX3, Cx30.2, HCN4, HCN1, HCN3, and KCNN4 genes. Furthermore, there was a decrease in Cx40 and Cx43 expression levels.

Conclusion: The results showed that TBX3 transfection on the third day and a smaller dose (2 μM/mL) of small molecules and combination treatment induced differentiation from the initial MSC, leading to the expression of pacemaker-like cells.

Background: Burns is one of society's most common types of trauma. It is estimated that around 1.2 million people experience burns each year and 100,000 of them require hospitalization. The giwang fern cactus leaf (Euphorbia milii) extract contains many antimicrobial compounds in almost all plant parts. This study determined the effect of giwang fern cactus leaf extract (Euphorbia milii) on the number of fibroblasts in burnt white rats infected with Pseudomonas aeruginosa.

Methods: This experimental study uses a randomized post-test research design with a control group using three groups of rats. The data results were analyzed statistically using a parametric test with Anova (One Way Anova). Data were analyzed using SPSS version 20.0 for Windows.

Results: This study showed that the 50% giwang fern cactus leaf (Euphorbia milli) extract had the highest average number of fibroblasts (38.3±8.77), compared with the control (23.3±1.86) and P1 group (25%) (27.6±6.65). Based on the analysis test, it is known that there is a significant comparison between groups (p<0.05).

Conclusion: There is a significant difference in the number of fibroblast cells among groups after providing giwang fern cactus leaf (Euphorbia milii) extract.

Ocular chemical trauma is a true emergency in ophthalmology. Chemical trauma on the ocular area may disturb vision, reduce the quality of life, and functional state. Prompt and adequate treatment is needed to prevent further complications, such as a decrease in vision due to corneal neovascularization. Treatment started with immediate eradication of the chemical agent by continuous rinsing and followed by inflammation and epithelial defect control. Medroxyprogesterone and doxycycline are two common treatments used in ocular chemical trauma. We speculate that both medications may influence VEGF expression and corneal neovascularization in corneal alkali trauma. It was demonstrated that medroxyprogesterone and doxycycline reduce the expression of VEGF, hence, reducing corneal neovascularization.

Link of Video Abstract: https://youtu.be/mBRqppCkDcM

Background: Colorectal cancer is the third most common cancer worldwide. Along with the development of science and technology, life expectancy has also increased, but the number of geriatric patients with colorectal cancer and undergoing surgery has also increased. Geriatric patients have many factors that can affect the patient's prognosis. Thus, a screening tool to predict the outcome of rectal cancer geriatric is needed. 

Methods: An observational analytic study with a retrospective cohort study design. This research was conducted by taking medical record data and laboratory results of patients with rectal cancer treated at Dr. Sardjito General Hospital, Yogyakarta, Indonesia. Data were analyzed using SPSS version 20.0 for Windows.

Results: Patients with malnutrition, decreased hemoglobin levels, albumin, and increased platelets affect mortality and postoperative complications of rectal cancer patients. There was a significant association between the Geriatric Nutritional Risk Index (GNRI) and preoperative Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) scores on mortality and postoperative complications in geriatric patients with rectal cancer (p<0.05). GNRI associated with length of stay in geriatric patients with rectal cancer. However, there is no significant relationship between Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) preoperative scores on length of stay in geriatric patients with rectal cancer (p>0.05).

Conclusion: Both screening predictors of rectal cancer outcome, namely GNRI and HALP, have a significant relationship with patient mortality and complications.

Link of Video Abstract: https://youtu.be/YsAWA4NoiPw

Background: The tracheotomy profile, including the degree of airway obstruction, underlying disease, following procedures, and complications, is important. The latest data regarding the profile of tracheotomy patients at ORL-HNS Dr. Soetomo General Academic Hospital has not been published yet. This research to describe the profile of tracheotomy patients at ORL-HNS Department Dr. Soetomo General Academic Hospital, Surabaya

Methods: A retrospective descriptive study with total sampling covering tracheotomy patients in 2015-1019 at ORL-HNS Department Dr. Soetomo General Academic Hospital, Surabaya. Data were analyzed using SPSS version 23.0 for Windows.

Result: There were 590 tracheotomy patients consisting of 452 men and 138 women, with the largest age group of 51-60 years with 167 patients (28.31%). Jackson 1 in 306 (51.86%), impending upper airway obstruction in 209 (35.42%), Jackson 2 in 38 (6.44%), Jackson 3 in 31 patients (5.25%), Jackson 4 in 3 patients (0.51%). The diagnosis includes tumors (87.29%), especially laryngeal carcinoma, then infection, neurological, trauma, and others. Procedures following tracheotomy are biopsies (11.19%), tumor surgery, and abscess incision and drainage. Complications were found in 65 patients (11.02%). Subcutaneous emphysema in 45 patients (7.63%), followed by bleeding and pneumothorax with subcutaneous emphysema (1.02%), 5 died (0.85%). Subcutaneous emphysema and bleeding in 2 patients (0.34%). Pneumothorax without subcutaneous emphysema in 1 patient (0.17%).

Conclusions: There were more male tracheotomy patients than female. The age group of most patients was 51-60 years. The majority were Jackson 1, and most were diagnosed with tumors. A biopsy is the most following procedure in tracheotomy. Complications were found in 11.02% of tracheotomy patients; the most common is subcutaneous emphysema.

Introduction: School closures and online learning during the Coronavirus Disease-19 (Covid-19) pandemic have raised concerns about school-aged children's learning loss during the epidemic. This study aims to evaluate the effects of school closures and online learning during the Covid-19 pandemic on the academic performance of elementary school-aged children in East Java.

Methods: The data taken were basic characteristic data as well as academic performance statistics in Mathematics, Indonesian Language, and Science from six elementary schools in two major cities (Surabaya and Sidoarjo) during the 2018–2019 and 2021–2022 academic years. Inclusion criteria were the academic reports of fourth- through sixth-grade elementary school-aged children. Chi-Square, ANOVA, and independent sample T-test were used for statistical analysis.

Results: Overall, academic performance decreased near the end of online learning as compared to the beginning of online learning (87 ± 5.8 vs. 84.7 ± 6.2; p-value = 0.043). Lower academic performances were also shown by children from private schools during online learning compared to before online learning (89.9 ± 4.7 vs. 87.8 ± 4.9; p-value = 0.003), and at the end of online learning compared to the beginning of online learning (89.8 ± 4.5 vs. 86.9 ± 3.3; p-value = 0.013). Lower academic performance was also shown by children in Sidoarjo during online learning compared to before online learning (90.4 ± 4 vs. 89 .1 ± 2.9; p-value = 0.009), and at the end of online learning compared to the beginning of online learning (90.3 ± 3.5 vs. 88 ± 2.1; p-value = 0.004).

Conclusion: We found differences in children's academic performance at the beginning and end periods of online learning, as well as differences between private and public school students. Considering online learning has impacted children's academic performance, offline learning should be undertaken to optimize comprehension effectively.

Link of Video Abstract: https://youtu.be/ivpwfj9PxWQ

Background: Microvascular coronary thrombosis is an emerging risk factor that worsens the prognosis of COVID-19 patients. This study aims to show for the first time a descriptive of histopathologic findings from post-mortem COVID-19 patients and to analyze whether D-Dimer serum level, a marker of hyper-coagulopathy, correlates with coronary microvascular thrombosis from the cardiac core biopsy.

Method: This was an observational analytic study with a retrospective cohort design from July-December 2020. Cardiac core biopsy was taken from patients who died while treated at the isolation ICU at Dr. Soetomo due to severe COVID-19. The samples were taken in 1-hour post-mortem and then analyzed histopathologically with Hematoxylin-eosin staining under a light microscope to evaluate the presence of coronary microvascular thrombosis and other pathological findings from the cardiac biopsy. Clinical information and D-Dimer levels from medical records and analyzed for coronary microvascular thrombosis using Man-Whitney and C-statistic analysis using SPSS 22 software.

Result: There were 39 samples of post-mortem patients in this study. The majority were men (71.8%), with a mean age of 48.9 years old. Focal microvessel coronary thrombosis was found in 28%). The median D-Dimer level was increased from the average baseline (3460 mg/dl). However, there was no significant difference in D-dimer levels between focal microvessel coronary thrombosis incidents (p-value 0.827, C statistic AUC 0.523). The lack of focal necrosis in the surrounding tissue suggests that the thrombosis resulted from proximal embolization to distal capillary coronary, which already happened before, rather than the primary in-situ process in microvascular, hence may explain why D-Dimer was not correlated with the finding of coronary microvascular thrombosis in this study.

Conclusion: D-dimer serum levels were not associated with focal microvessel thrombi in post-mortem COVID-19 patients. This result supports previous studies that showed D-Dimer was not specific to detect thrombosis in microvascular.

Introduction: Diet is one component of diabetes mellitus (DM) self-management for controlling blood sugar levels. Several obstacles in the implementation of the diet program have the potential for non-compliance, so that blood sugar levels tend to increase. Mindfulness eating based on spiritual intervention is one of the interventions that is expected to form adaptive eating behavior control to achieve dietary compliance and controlled blood sugar levels. The purpose of this study was to analyze the effect of mindfulness eating based on spiritual intervention on dietary compliance and blood sugar levels in patients with type 2 diabetes.

Methods: The study's quasi-experimental, untreated control group design included dependent pre- and post-test samples. The population used was all patients with type 2 diabetes. The sample was taken using a simple random sampling technique with determination according to inclusion and exclusion criteria. The independent variables in this study were mindfulness eating based on spiritual intervention, while the dependent variables were dietary compliance and blood sugar levels. A glucometer and the Personal Diabetes Questionnaire (PDQ) were the tools employed in this investigation. The t-test was used as the statistical test.

Results: There were a total of 50 samples that were divided between the control group and the intervention group. The results of the statistical test showed that mindfulness eating based on spiritual intervention had a statistically significant effect on dietary compliance (p < 0.001) and blood glucose levels (p < 0.001) compared to the control group.

Conclusion: The value of diet adherence is greatly increased by mindfulness eating practices based on spiritual intervention, and mean blood glucose levels are significantly reduced at the conclusion of the study. Exercises in mindfulness eating that are based on spiritual intervention can be popularized as a way to deal with dietary issues and blood sugar regulation.

Link of Video Abstract: https://www.youtube.com/watch?v=mzVt00Yaibk

Introduction: Atherosclerosis causes coronary artery stenosis in a lot of patients with acute coronary syndrome (ACS). By controlling platelet activity and destroying the extracellular matrix, a group of enzymes known as matrix metalloproteinases (MMPs) contribute to the plaque rupture process that causes ACS. The study aimed to determine whether there was any correlation between the amount of serum MMP-9 and the severity of coronary artery stenosis in ACS patients.

Methods: Cross-sectional analytical observational design was employed in this investigation. The research population consisted of ACS patients at the Dr. Zainoel Abidin General Hospital in Banda Aceh, Indonesia. Patients who were included as samples had to satisfy the inclusion and exclusion requirements. This study used analysis of variance (ANOVA) as a bivariate analysis to examine the connection between blood MMP-9 levels and the severity of coronary artery stenosis. The threshold for statistical significance was a p-value≤0.05.

Results: This research comprised 40 patients with ACS, of which 14 had STEMI, 11 had NSTEMI, and 15 had unstable angina pectoris (UAP). Eleven individuals had mild coronary artery stenosis, eleven had moderate stenosis, and eighteen had severe stenosis, according to an analysis of the Gensini score. Bivariate analysis revealed no significant relationship between blood MMP-9 levels and the degree of coronary artery stenosis in ACS patients (p-value = 0.434).

Conclusions: In patients with ACS at the Dr. Zainoel Abidin General Hospital in Banda Aceh, Indonesia, there was no statistically significant association between serum MMP-9 levels and the degree of coronary artery stenosis, according to this study.

Background: The loss of the uterus means the loss of one of the functions of a woman's life, namely the reproductive function. The impact of a hysterectomy will have a major influence on the quality of life; this can be seen in how to carry out life, such as activities, social relations and interactions with the environment. All of these things can lead to changes in daily behavior, namely changes in self-image that will lead to insecurity, withdrawn behavior, distrust of God and ultimately, self-injury behavior. This study analyzes the self-acceptance model's effect on maintaining the quality of life after a hysterectomy.

Methods: This type of research is an experiment to compare 2 design groups. This research was conducted for 4 weeks in May-June 2022, with a total sample of 12 respondents, with details of 6 respondents in the control group and 6 in the treatment group. The type of sampling used is non-probability sampling with a purposive sampling method. Data analysis used the Wilcoxon, and Mann Whitney marked rank test with a significance value of p < 0.05. The questionnaire used in this study was designed using a reference and behavioral theory approach with a reliability of 0.89 and a validity test that obtained a Cronbach alpha value of 0.86.

Results: The value of behavior of caring for sexual function after hysterectomy before intervention in the control group was 29.00±1.789, and after being given the intervention, the value changed to 29.33±0.816 (p=0.564). In the treatment group, the value of behavior of caring for sexual function after hysterectomy before the intervention was 28.50±1.225 and after the intervention was 33.83±2.639 (p=0.027). Behavioral analysis of caring for sexual function after hysterectomy before intervention in the control and treatment groups showed no difference (p=0.591). The self-acceptance model affects the behavior of maintaining the quality of life after hysterectomy in the control and treatment groups (p=0.006).

Conclusion: This study proves that the self-acceptance model affects the behavior of maintaining the quality of life after a hysterectomy.

Link of Video Abstract: https://www.youtube.com/watch?v=8PNO8KPQFTY

Purpose: Achieving an optimal result in mitral valve repair can be challenging in children due to the delicate nature of the mitral valve tissue, a wide range of pathologies, and a high incidence of co-existing cardiac anomalies. This study aimed to evaluate a novel adjuvant technique, posterior annulus elevation using pledget stitch, to improve mitral valve coaptation in pediatric mitral valve repair.

Patients and methods: A retrospective cohort study was conducted at the National Cardiovascular Center Harapan Kita. Patients with severe mitral regurgitation who underwent mitral valve repair with posterior annulus elevation using pledget stitch between January 2021 and October 2021 were included. Transesophageal echocardiography (TEE) at day-0 and transthoracic echocardiography (TTE) at day-5 and 3 months after surgery was performed to assess coaptation length and residual regurgitation.

Results: Twelve patients were included in this study with a mean age of 13.13 ± 2.98 years. The mean coaptation length was 6.94 ± 1.44 mm immediately after surgery. At day 5, 11 patients exhibited no or only trivial regurgitation (91.67%), with a mean coaptation length of 7.18 ± 1.72 mm. During a three-month follow-up period, 10 patients had no or only trivial regurgitation (83.33%) with the rest only developing mild regurgitation (16.67%), with a mean coaptation length of 7.60 ± 1.41 mm. No mortality or adverse events related to the procedure were observed during the follow-up.

Conclusion: Posterior annulus elevation using pledget stitch as a novel adjuvant technique during mitral valve repair showed promising results in improving leaflet coaptation in pediatric patients. This technique may provide an additional option for mitral valve repair when the conventional technique yields unsatisfactory results.

Background: Diabetes mellitus (DM) could hamper the immune responses, including that induced by the vaccine. The aim of this study was to evaluate the immunogenicity of coronavirus disease 2019 (COVID-19-19) inactivated vaccines in patients with DM either controlled or uncontrolled through a systematic review approach.

Methods: Without regard to time constraints, searches were conducted in ProQuest, Embase, and PubMed  to assess the available data on the impact of DM regulation on the immunogenicity of post-vaccinated DM patients. The PRISMA guideline and the PICO criteria were used. The quality of studies was assessed using the National Institutes of Health (NIH) quality assessment tool. There is not enough Available data comparing the immunogenicity of the vaccine in controlled and uncontrolled DM patients is limited.

Results: Out of 20,657 articles, five studies were included, of which three had good quality and two had fair quality. Our data suggested that DM patients vaccinated with CoronaVac/SinoVac had lower seroconversion rates significantly lower compared to non-DM patients. The immunogenicity of BBV-152 vaccine in DM patients was also significantly lower than in patients without DM. Studies comparing the immunogenicity of the vaccine between controlled and uncontrolled DM patients are limited.

Conclusion: Patients with DM have lower antibody levels than non-DM patients who received inactivated COVID-19 patients. Glycemic management has emerged as critical to maximizing the immunogenicity induced by inactivated vaccines in a small number of patients; however, to support this conclusion, studies with adequate number of patients are critical.

Link of Video Abstract: https://youtu.be/JhROjWPKuAc

Background: Primary spinal cord tumors are rare central nervous system tumors that could develop at any age and have different management strategies based on the histopathological types. However, there is a lack of literature in Indonesia regarding the epidemiology and surgical treatment of patients with spinal cord tumors. This study aims to review and address the incidence of primary spinal cord tumors in Dr. Kariadi Hospital, Semarang.

Methods: A retrospective descriptive study was conducted using medical records of patients with spinal cord tumors at Dr. Kariadi Hospital, Semarang, Central Java, from 2019 to 2022. The frequency of each tumor, classified by gender, age, histologic type, anatomical position, and location based on vertebral segment, was analyzed to provide a descriptive result. Data were analyzed using SPSS version 25.0 for Windows.

Results: A total of 125 patients were identified with the mean age of patients being 43.95 ± 15.28 years old and a slight predominance of males (52.00%). Schwannoma (26.40%) and meningioma (24.80%) were the two most common histological types of tumors. Most of the tumor was intradural extramedullary (47.20%) and at the level of thoracic vertebrae (46.80%). The histologic type of the tumors was found to be associated with the patient’s age and the tumor’s anatomical position.

Conclusion: The incidence of spinal cord tumors in Dr. Kariadi Hospital, Semarang, is dominated by meningioma and schwannoma, mostly located at the thoracal level with an intradural extramedullary position. There is a significant association between the histological type of tumor and the patient's age and the location of the tumor

Background: The emergence of severe acute respiratory syndromes coronavirus 2 (SARS-CoV-2) variants such as B.1.17 (alpha), B.1351 (beta), and B.1.617.2 (delta) have caused a significant rise in coronavirus disease 2019 (COVID-19) cases worldwide. In response, the Indonesian government imposed restrictions on international and domestic travel, especially in areas with a high number of COVID-19 cases including Java Island and Bali. The aim of this study was to investigate the mutation patterns of indigenous SARS-CoV-2 strains in Bali.

Methods: We conducted whole-genome sequencing on isolates collected from COVID-19-confirmed patients at the end of the first wave (January – March 2021). The sequencing was carried out at the 1^st BASE Pte Ltd Laboratory (Singapore) using Oxford Nanopore Platform (GridION) using IDT ARTIC nCoV-2019 V3 Panel. The phylogenetic tree was constructed on MEGA 7.0 with hCoV-19/Wuhan/WIV04/2019 as the genomic reference.

Results: Our data revealed that none of the isolates were variants of concern. Among the five lineages tracked, the viral isolates were most likely from B.1.466.2 (n=4). All viruses had D614G mutation in the spike protein with clade GH being most predominant (n=10) and followed by GR (n=1) and O (n=1). Additionally, mutations at NS3, NSP3, NSP12, and NSP6 were found.

Conclusion: At the end of the first COVID-19 wave in Bali, variants of concern were not detected which could be attributed to the heavy mobility restrictions.

Introduction: Adolescents suffer from various forms of psychosocial, behavioral, mental and emotional problems. The relationship between salivary cortisol levels and the risk of behavioral-psychosocial-emotional disorders in adolescents is still controversial. To analyze the relationship between salivary cortisol levels and the risk of behavioral-psychosocial-emotional disorders in adolescents aged 12-16 years using PSC-17.

Methods:  An observational analysis with a cross-sectional research design and simple random sampling was conducted from November 2022 - March 2023. Adolescents aged 12-16 years filled out biodata, characteristics and PSC-17 questionnaires. Salivary cortisol levels were measured by the Enzyme-linked immunosorbent assay method. Data analysis with univariate and multivariate tests.

Results: Of 170 adolescents, 53 (31.2%) were at risk of behavioral-psychosocial-emotional disorders with PSC-17 total score ≥15, consisting of risk of internalizing disorders at 73 (42.9%) adolescents, risk of externalizing disorders at 14 ( 8.2%), risk of attention disorder at 23 (13.5%) adolescents. The majority of adolescents who have normal salivary cortisol levels are 117 (68.8%) adolescents, and salivary cortisol levels are abnormal (high) in 53 (31.2%) adolescents. Salivary cortisol levels were associated with adolescents' risk of behavioral-psychosocial-emotional disorders (p<0.001).

Conclusion: Salivary cortisol levels are associated with the risk of behavioral-psychosocial-emotional disorders in adolescents. Likewise, salivary cortisol levels are related to the risk of internalizing disorders, the risk of externalizing disorders, and the risk of attention disorders in adolescents.

Background: Diabetes mellitus is becoming a public health problem and can be found in every population, including a pregnant women. Hyperglycemia conditions in pregnancy can lead to gestational diabetes mellitus involving proinflammatory cytokines such as Tumor Necrosis Factor-Alpha (TNF-α) and Transforming Growth Factor- β (TGF-β). Isothiocyanate is a bioactive compound found in Moringa leaf extract with anti-glycemic activity and anti-inflammatory effects. This study aims to evaluate the impact of isothiocyanate therapy on trophoblast cell culture-hyperglycemia atmosphere toward the levels of tumor necrosis factor- α (TNF-α) and transforming growth factor- β (TGF-β).

Methods: An experimental study with a post-test-only control group design was conducted using trophoblast cell culture from placental tissue. To create a gestational diabetes event, glucose was administered into the trophoblast cell culture. The sample was divided into six groups: negative control without treatment, positive control by glucose administration, and treatment groups P1, P2, P3 and P4 with the treatment of isothiocyanate with doses of 0.1; 0.2; 0.4 and 0.8 mg/ml, respectively. The TNF-α and TGF-β levels in each group are quantified using immunoassay by ELISA method.

Results: The mean TNF-α in the negative control, positive control, P1, P2, P3, and P4 groups were 20.59, 43.54, 32.76, 30.15, 27.32, and 24.05, respectively. While the mean of TGF-β levels in the negative control, positive control, P1, P2, P3, and P4 groups were 15.76, 10.44, 11.05, 11.70, 12.46, and 14.32, respectively. The lowest TNF-α and the highest TGF-β levels were found in the treatment group (P4) that received isothiocyanate with a dose of 0.8 mg/ml.

Conclusion: The administration of isothiocyanates from Moringa leaf extract significantly lowered the level of TNF-α and increased the level of TGF-β in hyperglycemic trophoblast cell culture compared with the positive control group.

Background: Emesis gravidarum is an inconvenience that often occurs in the first trimester of pregnancy. Continuous emission of gravidarum can be bad for the health of pregnant women and the fetus is conceived, so it must be overcome as early as possible, one of which can use non-pharmacological therapy, namely applying self-hypnosis and prenatal gentle yoga to reduce emissions of gravidarum can make pregnant women relax. This study aimed to analyze the application of self-hypnosis with Prenatal Gentle Yoga on emissions of gravidarum in first-trimester pregnant women.

Methods: The design of this study used a Quasi experimental design with a Two group pretest-posttest design without control using purposive sampling. This research was conducted on first-trimester pregnant women who experienced the emission of gravidarum in the PMB Nanik Sidoarjo of ​​32 pregnant women in the first trimester. The self-hypnosis was carried out every day for approximately 15-30 minutes for 1 week, while prenatal yoga was carried out 3 times a week for 30 minutes. Data collection on the intensity of nausea and vomiting used the Pregnancy Unique Quantification of Emesis and Nausea (PUQE)-24 scoring system questionnaire. Data analysis used an independent T-Test test.

Results: The results of the analysis of this study indicate that the mean difference in the Self Hypnosis treatment group is greater (1.77) than in the Prenatal Gentle Yoga group (1.25), which means that Self Hypnosis is more effective in reducing the intensity of nausea and vomiting in emesis gravidarum versus Prenatal Gentle Yoga.

Conclusion: Therapy Self Hypnosis and Prenatal Gentle Yoga can reduce the emission level of gravidarum in first-trimester pregnant women so that it can be used as an alternative therapy that is easy to apply and has minimal side effects by pregnant women who experience gravidarum emissions.

Link of Video Abstract: https://youtu.be/KymxBUAr9eI

Background: Bladder Urothelial Carcinoma (BUC) is common cancer in the genitourinary organs. One important determinant for its therapy modality is the presence of tumor invasion into Muscularis Propria (MP). Assessing MP invasion in routine Hematoxylin-Eosin (HE) slides of Transurethral Resection of Bladder (TUR-B) specimens is not always easy due to tissue fragmentation and morphological similarities of MP to muscularis mucosa (MM) and myofibroblasts. This study was done to determine the interobserver agreement in evaluating MP invasion and to find alternatives to overcome this diagnostic problem.

Methods: This cross-sectional observational analytic study was conducted in the Pathology Laboratory of the Faculty of Medicine, Universitas Udayana/Prof. Dr. I.G.N.G. Ngoerah Hospital, Bali, in 2022. As many as 72 HE slides of TUR-B specimens of BUC patients were examined separately by five experienced pathologists. Smoothelin immunostaining, a marker to identify MP, was also examined as a comparison. Data were processed and statistically tested using the SPSS version 20.0 program for Windows.

Results: The interobserver agreement of those five pathologists was found to be low to moderate, with an average = 0.48, ranging between 0.18-0.69. One pathologist had a low agreement with four others (<0.4) and indicated diagnostic uncertainty in 41% of the samples examined. Among four other pathologists, the agreements were moderate, with  = 0.40-0.69. The proportion of concordant examination results was only 45.8%. When the outcome of each HE slide was concluded by consensus, it was found that there was no statistically significant difference with smoothelin immunostaining results.

Conclusion: Evaluation of MP invasion of BUC in TUR-B specimens had low to moderate interobserver agreement, which indicated that this examination was subjective. However, the consensus of several pathologists seems to lead to better accuracy, close to the result of smoothelin immunostaining.

Purpose: This study aims to assess the effectiveness of mono pharmacy and polypharmacy on the post-TKR outcome, the speed of recovery, time to partial weight-bearing, VAS, and the side effects of single, double, and triple analgesia in elderly TKR patients.

Methods: This observational retrospective comparative study comparing the post-TKR surgical outcome and using mono pharmacy or polypharmacy analgesics was conducted in an Orthopaedic Hospital during 2012-2021. Patients who underwent TKR with a subarachnoid spinal block were diagnosed with osteoarthritis grade IV and treated with single/ unilateral TKR were included in this study. Data would be analyzed using either ANOVA or Kruskal Walis. Treatment of analgesia was given by the anesthesiologist, who determined the types and methods of administration.

Results: A total of 152 patients were included in this study. Most samples were females (N=106, 69.7%) aged 63.75 ± 6.31 years. There was no significant difference between analgetic use on LOS, time to PWB, and VAS on days 1, 3, and 5 (p > 0.05). A significant linear difference was found between nausea and gastric pain incidence with the amount of postoperative analgetic administration (p = 0.01).

Conclusion: The effectiveness of mono pharmacy and polypharmacy is similar regarding the speed of recovery, time to partial weight-bearing, VAS, and side effects of post-TKR patients.

Link of Video Abstract: https://youtu.be/HvI9j8B9vqE

Introduction: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and is the main cause of ovulation disorders. Primary ovarian insufficiency (POI) is a clinical syndrome characterized by loss of ovarian activity before the age of 40 years. All of these disorders lead to the risk of infertility. Therefore, this study aims to assess the AMH gene sequence and the effect of SNP on AMH levels and function.

Method: This research was a cross-sectional study. The sample was divided into three groups such as PCOS, POI, and control. This study used ELISA and PCR examination methods. Research data were analyzed using IBM SPSS version 22. The statistical analyses used were the ANOVA, Kruskal-Wallis, chi-square, and Spearman tests. A significant p-value was ≤ 0.05.

Results: There were 31 research subjects, 8 POI subjects, 16 PCOS subjects, and 7 control subjects. Overall 30 mutations were found, with two mutations in the gene promoter and 28 mutations in the structure of the AMH gene. Five mutations in the AMH gene structure were missense mutations. 14 SNPs were found in the POI group and 15 SNPs in the PCOS group. There was a significant difference in AMH AMH gene promoter mutation frequency distribution between the POI and PCOS groups at the mutation point 19:g.2249146T>G (p=0.007). In contrast, the mutation point 19:g.2249158T>A was not significantly different (p=0.536). There was no significant correlation between the number of promoter mutations and AMH gene structure with AMH levels in the POI, PCOS and control groups.

Conclusion: There were mutations in the promoter and AMH gene structure of the POI, PCOS, and control groups which caused differences in base sequences. However, in this study, the differences in mutations were not significantly different.

Introduction: The active substance of pyrethroids, especially dimefluthrin, in insect repellent not only plays a role in killing mosquitoes but is also toxic to human health. This study aims to analyze the effect of insect repellent exposure on the histopathological findings in the liver and kidneys of the Wistar rat.

Methods: This experimental study used 24 male wistar rats, which were divided into four groups, namely control, type of insect repellent, which included mat electric (dimefluthrin 0.566%), liquid electric (dimefluthrin 0.014%), and coil (dimefluthrin 0.031%), with a duration of exposure a day for 8 hours in 20 days.

Results: There was a significant effect of the type of insect repellent exposure on the histopathological findings of the liver and kidneys (p<0.05). This study also showed the highest rate of cell degeneration and necrosis in the liver and kidneys belonged to Mat electric repellent exposure in the liver and kidney. Higher concentrations of dimefluthrin in insect repellent have a significant effect on the histopathology of the liver and kidney.

Conclusions: The use of mosquito coils, electric mats, and liquid electricity for 8 hours over 20 days affects the histopathological evaluation of the liver and kidneys. The higher the concentration of dimetfluthrin in insect repellent, the higher the level of damage.

Background: Sepsis has become the most common postoperative complication caused by major surgery. Early diagnosis of sepsis is very important to know the patient's prognosis and survival. Changes in mean platelet volume (MPV) and platelet distribution width (PDW) were assessed to have a relationship with the incidence of sepsis. The use of MPV and PDW platelet preoperative indicators is expected to help predict sepsis so that appropriate interventions can be given immediately.

Methods: A total of 50 patients who met the inclusion criteria became the subjects of this study to determine the potential of MPV and PDW preoperative biomarkers for predicting sepsis in laparotomy patients. All blood tests for the diagnosis of sepsis were examined. Spearman's test and ROC curve were performed for statistical calculations to determine the cut-off point for MPV and PDW.

Results: Analysis of the relationship between PDW and MPV values ​​as an indicator of sepsis using the Spearman test found a significant relationship between MPV and PDW ​​on the incidence of sepsis (p<0.05). Furthermore, statistical tests using the ROC area under the curve (AUC) curve, MPV levels were 0.968, which indicates that if MPV were examined in 100 patients, it would predict sepsis in 96 patients. Meanwhile, the AUC of PDW is 0.770, which shows that if MPV examination is performed in 100 patients, it will predict sepsis in 77 patients. . The best cut-off point ​​that the researchers got in this study was MPV levels 9.8 fL (sensitivity 93.3% and specificity 85%) and PDW levels 9.45 fL (70% sensitivity and 70% specificity).

Conclusion: Preoperative MPV and PDW can be predictive indicators of sepsis in laparotomy surgery, with MPV sensitivity and specificity of 93.3% and 85% and sensitivity and specificity of PDW of 70% and 70%, respectively.

Introduction: Work nutrition refers to the nutrient or food substance needed by the workforce to meet their needs according to the type of work. The aim of work nutrition is to increase the work power and health of the workforce as much as possible in accordance with the person's nutritional status. The suitability of energy intake can also affect a person's productivity Long-term energy consumption patterns can have an impact on a person's health or nutritional status. If unchecked, they can also have an impact on their activities and productivity. Therefore, the purpose of this study is to determine the energy needs and energy intake associated with health status in field workers.

Methods: This research used a quantitative approach with the type of observational research and a cross-sectional design. The population in this study was based on a total sample of workers at PT. A in the city of Samarinda, with a sample size of 41 workers.

Results: The results of this study indicate that most workers have an abnormal nutritional status. Only 29% of the 41 workers have a normal nutritional status. Then, in the comparison between energy intake and energy needs, it is known from 41 workers that only 32% of respondents have sufficient energy in accordance with what is consumed.

Conclusion: There is still a mismatch between energy intake and energy needs of the workers, and there are still many workers who have abnormal nutritional status. Therefore, it needs to be done, from socialization to supervision, such as implementing fitness at work, a healthy diet, adjusting workload, and getting enough rest.

Background: Oocyte vitrification is a helpful fertility preservation technique for women at risk of losing their ovarian functions. Meanwhile, its application extends with the emerging trend of delayed childbearing, postponed marriage, and further diverse ethical, medical, legal, and social implications. Whereas its effect on oocytes has been widely elucidated, the potential impact of this procedure on the biological functions of granulosa cells remains poorly understood. The present study aimed to assess vitrification’s effect on the granulosa cells (GCs).

Methods: 35 women with polycystic ovary syndromes who underwent in vitro fertilization (IVF) in Morula IVF Jakarta Clinic were recruited. The expression of prominent oocytes secreted factors (OSFs), including GDF-9 and BMP-15, were measured at messenger RNA (mRNA) levels. GCs from mature and immature oocytes were collected and calculated separately. Relative expression of GDF-9 and BMP-15 was quantified by a real-time quantitative PCR (RT-qPCR). All of the data was analyzed by using SPSS.  Bivariate analysis used the Mann-Whitney test at a 95% confidence level. A significant p-value was ≤ 0.05.

Results: The mean age of subjects was 32,39 ± 3,33 years old, with the mean duration of infertility being six years. The mean BMI, anti-Mullerian hormone (AMH) level, and antral follicle count (AFC) were 24.04 kg/m2, 3.43 ng/mL, and 15 follicles, respectively. The basal FSH, LH, estradiol, and progesterone were at the normal level. The expression of GDF-9 decreased significantly (0.5-fold, p < 0.01) in the immature vitrified GC group but was not in the mature-vitrified GC group. Meanwhile, the expression of BMP-15 was stable in all examined groups (P>0.05).

Conclusion: Our results suggest that vitrification may alter oocyte maturation, as demonstrated by reduced GDF-9 expression in the immature vitrified GC group.

Introduction: Iron deficiency anemia (IDA) is still a problem of pregnant women's health related to its high prevalence and its negative effects on health. Prevention efforts have been carried out through administration of oral iron tablets to women during their pregnancy; however, the expected results have not been satisfied yet. This failure is probably due to the assumption that, especially in developing countries, the iron store in pre-pregnant women is very low or may be empty, so that iron supplementation during pregnancy is not enough to prevent IDA. The aim of study is to know the difference of effect of iron supplementation in treated and control groups in terms of hemoglobin concentration, serum ferritin level and prevalence of IDA.

Method: A quasi-experimental study was conducted on 99 non-pregnant new couple women. Iron tablets were administered to the treated group from the beginning of pre-pregnant period, continuing until the first 3 months of pregnancy, while in the control group iron tablets were only given during the first 3 months of pregnancy.  IDA was measured by serum ferritin and hemoglobin concentration using WHO’s criteria, the benefit of iron tablet was measured by BCR technique.

Result: The administration of an oral iron tablet from the prepregnant period (treated group) could decrease prevalence of IDA higher than the administration of oral iron tablet during pregnancy only (control group) (0% vs 38.46%, p<0.05). A significant difference was also observed on mean serum ferritin concentration at the end of observation (the third month of pregnancy) 33.45±14.12 µg/dL in the treated group, and 19.65±8.99 µg/dL in the control group. This difference was statistically significant (p<0.05). Meanwhile, the hemoglobin concentration was 12.25±1.20 g/dL in the treated group and 10.91±0.67 g/dL in the control group. This difference was also statistically significant (p<0.05). Benefit analysis showed that administration of an oral iron tablet starting from pre-pregnancy is more advantageous (BCR >1) compared to oral administration of iron tablet during the pregnancy period only. There were no significant differences in side effects and compliance of the patient to consume iron pills in both treated and control groups.

Conclusion: The administration of oral iron tablets (iron supplementation) to pregnant women starting from pre-pregnant period results in a better effect compared to oral iron supplementation during pregnancy only. This program is feasible to be implemented in a community setting because its compliance is good.

Link of Video Abstract: https://youtu.be/YEQ3ICJPmxA

Background: Ventilator-associated pneumonia (VAP) occurs after endotracheal intubation and ventilator for more than 48 hours therefore it is an emerging threat to patient safety. The aim of this study is to determine the incidence and compare the risk factors of ventilator patients diagnosed with ventilator-associated pneumonia and patients with ventilators who are not diagnosed with ventilator-associated pneumonia.

Methods: This study used a retrospective observational with a case-control approach. Data was collected from January 2019 to December 2021. The risk factors to be analysed were comorbidities, antibiotic therapy, length of stay in the intensive care unit, duration of ventilator use, and history of surgery.

Results: There were 18 patients in the VAP and the control groups met the inclusion and exclusion criteria. The incidence of incidents in 2019 was 3.2 per 1000 ventilator days; in 2020, it was 1.2 per 1000 ventilator days; and in 2021, it was 1.2 per 1000 ventilator days. Comparison test results using Mann-Whitney showed a difference with a p<0.05. Patients with prolonged use of ventilators (p<0.05) and prolonged hospitalization (p<0.05) have a higher risk of developing ventilator-associated pneumonia. The average VAP occurs on the fourth day on a ventilator. Gram-negative bacteria, Pseudomonas aeruginosa, Acinetobacter baumanii, and Klebsiella pneumoniae cause most bacterial infections

Conclusion: There is a high risk of developing VAP in patients with prolonged use of ventilators and extended stays in the intensive care unit of the Tertiary Referral Hospital.

Introduction: Blood service is a health service that utilizes human blood as a basic ingredient for humanitarian and non-commercial purposes. Donors in Indonesia are required to have a minimum Hemoglobin (Hb) level of 12.5 g/dL in accordance with National Regulations. It aims to ensure that the donor can tolerate the loss of blood without the appearance of anemia symptoms. This study aims to analyze the Hb levels of donors at the Blood Transfusion Service of Dr. Sardjito Hospital, Yogyakarta, Indonesia.

Method: This analytic observational study applied a retrospective design. The data of 62,221 donors were taken from the donor database of the Blood Transfusion Service of Dr. Sardjito Hospital. The inclusion criteria were donors aged ≥ 17 years and met other donor selection criteria. Donors with incomplete data were excluded. The chi-Square test was performed using the SPSS version 22. The p < 0.05 was considered significant.

Results: The subjects were dominated by male donors, i.e., 48,348 (77.7%), and the most Hb level were 14.1-15.5 g/dL. This range of Hb levels was identified as the highest proportion in all age groups. The Hb levels of 14.1-15.5 g/dL were determined in 5,874 (39.6%) blood group A, 7,332 (39%) blood group B; 1,830 (39.6%) blood group AB and 9,486 (39.5%) blood group O donors.

Conclusions: There was a significant difference in the proportion of donors based on Hb levels, sexes, ABO groups, Rhesus D groups, donation types, and donor statuses (p < 0.001).

Link of Video Abstract: https://youtu.be/Nr9MKgu2v2E

Background: Chronic suppurative otitis media (CSOM) causes partial or complete damage to the tympanic membrane and ossicles, causing hearing loss in the form of conductive and mixed hearing loss with a decrease of up to 60 dB. This study aimed to evaluate the hearing threshold before and after tympanoplasty surgery in CSOM patients.

Methods: This type of research was carried out in a retrospective descriptive manner. The materials in this study were the medical records of CSOM patients who underwent canal wall up (CWU) tympanoplasty and canal wall down (CWD) tympanoplasty at the outpatients of ear, nose, and throat – head and neck surgery (ENT-HNS) Otology Division Dr. Soetomo Hospital Surabaya for the period January 1, 2018 to December 31, 2018 with a total of 51 patients. This study analyzed with the Wilcoxon test.

Results: The mean age was 30.96 years (51% female and 49% male). Postoperatively 40 (78.5%) patients experienced an increase in hearing threshold, 10 (19.6%) patients experienced a decrease and 1 (1.9%) patient remained. The average increase in air-bone gap (ABG) pre and post tympanoplasty surgery was 9.78 dB, from 38.92 dB to 29.14 dB.

Conclusion: There was an increase in hearing threshold after tympanoplasty.

Introduction: During the COVID-19 pandemic, the stay-at-home policy, which requires people to carry out activities at home, avoid crowds and minimize contact with people, is a problem for baby spa businesses due to the decline in baby spa patients at their clinics. This study aimed to evaluate the mother's motivation and attitude toward baby spa services during the COVID-19 pandemic.

Methods: This cross-sectional study involves parents who are consumers of baby spas and independent practice midwives who provide baby spa services in the Sidoarjo Regency that met inclusion criteria. Sample determination used purposive sampling. All data were obtained directly as primary data, then collected and analyzed using univariate and bivariate analysis in SPSS ver. 20.

Results: Most of the mothers and children were aged 36-40 years (32.0%) and <2 years (72.0%), respectively. Most respondents had high motivation and attitude (70.4% and 74.1%). Chi-square and Fisher exact test showed a significant relationship between the mother's motivation and attitude towards mother's interest in baby spa services (p<0.001)

Conclusion: The mother's attitude and motivation are related to the mother's interest in coming to the baby spa service during the COVID-19 pandemic.

Background: The COVID-19 pandemic mandated people to use masks to control the disease spreading. However, mask usage can cause skin-related problems such as acne, which is called maskne. This study aimed to find out whether there is a relationship between the use of masks and the event of maskne in Universitas Sumatera Utara (USU) Hospital healthcare workers during the COVID-19 pandemic.

Subjects dan Methods: This study was an observational analytic study with a cross sectional approach with consecutive sampling methods involving 100 healthcare workers at USU Hospital. Diagnosis of maskne was established through history taking and dermatological examination. The data collected was analyzed using Chi-square, Kruskal Wallis and Fisher Exact tests. This research has received approval from the Research Ethics Commission of the Faculty of Medicine Universitas Sumatera Utara and Universitas Sumatera Utara Hospital.

Results: Maskne was more common in women (84.9%) in the age group 26-35 years old (69.9%). Doctors and nurses (31.5%) had more maskne, polyclinic (23.3%) was the work location that often has maskne. The use of medical masks (74.0%) had a significant relationship with the event of maskne (p=0.002), while the duration of wearing masks was 36 hours/day (80.8%), frequency of masks replacement 2 times/day (52.1%) and using 1 layer of masks (74.0%) was more often found in subjects who has maskne but did not have a significant relationship with the event of maskne.

Conclusion: There is a relationship between the use of masks and the event of maskne based on the type of masks in healthcare workers Universitas Sumatera Utara Hospital during the COVID-19 pandemic.

Link of Video Abstract: https://youtu.be/FvU45HL3HyE

Introduction: Human amniotic membrane and platelet rich fibrin (PRF) are biological materials that can accelerate wound healing through their content of growth factors and cytokines. This study aimed to determine the effectiveness of the combination of these two biological agents for wound healing.

Methods: This study used an experimental method with a randomized post-test only control group design, to compare the use of human amniotic membrane alone with a combination of human amniotic membrane and PRF in acute full thickness wounds of the skin of Wistar rats. The research subjects were 32 rats which were divided into four groups. Groups 1 and 2 used human amniotic membrane, while groups 3 and 4 used a combination of human amniotic membrane and PRF, then the epithelialization process was observed on the 3rd and 6th day.

Result: There was no statistically significant difference in the speed of epithelialization of excision wounds on the backs of rats on the third day (Significance 0.498) and Sixth (Significance 0.9) between the Amnion group and the combination of amnion and PRF because it was greater than α = 0.05.

Conclusion: The use of a combination of freeze dried human amniotic membrane and platelet rich fibrin was not significantly more effective than freeze dried human amniotic membrane in accelerating the epithelialization of acute full thickness excision wounds in rats (Rattus novergicus).

Introduction: Inverted papilloma is a benign tumor that generally arises from the lateral wall of the nasal cavity and mostly grows on the middle meatus.The incidence is rarely found in the ear, throat, nose, throat, head and neck, which is around 0.5% -4% of all nasal and paranasal sinus tumors.The etiology of inverted papilloma remains unknown.Clinical features of inverted papilloma are unilateral nasal obstruction, rhinorrhea, epistaxis, anosmia, tinnitus and some other symptoms.The diagnostic examination are histopathological examinations, CT scans and magnetic resonance imaging (MRI). Histopathology is the gold standard in diagnosing of inverted papilloma.Management of inverted papilloma is carried out with surgical approach including lateral rhinotomy, maxillectomy, degloving, and non-invasive surgery via endoscopy depending to the krouse classification.

Case description: A 44-year-old female patient diagnosed with inverted papilloma was reported.The patient complained of progressive right nasal obstruction appeared two years ago which turned into total obstruction and rhinorrhea in the last 6 months.A biopsy was done with the result of inverted papilloma. CT scan of the paranasal sinuses showed a mass filling the right nasal cavity, right maxillary sinus and right ethmoid sinus. Patientwas diagnosed with sinonasal inverted papilloma with Krouse 2 classification based on clinical examination, radiological findings and preoperative endoscopy. The patient was treated with sinonasal inverted papilloma extirpation via endoscopic approach.

Conclusion: Inverted papilloma is a benign tumor of the nasal and paranasal sinuses in which biopsy is the gold standard for diagnostic test while the main treatment is done by surgical approach depending on the krouse classification.

Introduction: Gender-based violence (GBV) is an important issue, especially violence experienced by women in the household. Social norms and beliefs (SNB) held by a person in society also affect the occurrence of violence. The purpose of this study was to examine the construct validity and reliability of SNB on the GBV scale in Indonesia.

Methods: Cross-sectional research was used in this study. A questionnaire on gender-based SNB was used to gather data. It had two domains—injunctive social norms and personal beliefs—each with three subscales: the husband's right to use violence, preserving family honor, and responding to sexual violence. By using a random sampling technique, data were obtained from 234 people consisting of 197 women and 37 men aged over 18 years. Data were analyzed using SmartPLS.

Results: The item which was strong on social norms with Cronbach's alpha 0.844 was protecting family honor. All items were above 0.5 so it can be stated that the gender-based SNB scale was valid and reliable to be used in measuring gender-based violence in Indonesia.

Conclusions: Psychometrics of SNB about GBV scale in the Indonesian version is valid and reliable.

Background: Ultrasonography is a method that is commonly used today to measure endometrial thickness. It is useful as the initial step to detect endometrial hyperplasia or cancer in women with abnormal uterine bleeding. This study seeks to explore the predictive role of endometrial thickness in the development of endometrial cancer and identify the variables that affect endometrial thickness.

Methods: This study is a cross sectional retrospective analytical study of women with a history of endometrial cancer who underwent transabdominal ultrasonography or transvaginal ultrasonography (TVS) followed by complete surgical staging between January 2019 and December 2021 at Dr. Kariadi General Hospital Semarang. Patients were categorized by endometrial thickness into ≤8 mm and >8 mm. In order to compare the endometrial thickness and clinicopathology traits, a bivariate analysis was done. The study proceeded with multivariate analysis and logistic regression if more than one bivariate analysis revealed a significant correlation (p<0.25).

Results: This study involved 55 participants who had endometrial thickness measurements taken. Endometrial thickness was used to divide the patient population into two groups: ≤8 mm (n=28) and >8 mm (n=27). Tumor differentiation grading showed a significant difference between the two groups (p<0.001). The thickness of the endometrium is a significant prognostic of endometrial carcinoma based on the degree of tumor differentiation (p<0.001). With each millimeter increase in the endometrium, the likelihood of endometrial carcinoma increases significantly by 1,25 [p<0.001; 95%CI =1.112-1.404] times.

Conclusion: As a result, the degree of tumor differentiation on post-operative histological analysis is correlated with the thickness of the endometrium. The endometrium's thickness considerably increased as the tumor differentiation level deteriorated. These findings highlight the significance of endometrial thickness as a possible predictor of tumor differentiation and prognosis in endometrial cancer.

Introduction: Sexual needs are very important for domestic harmony. The incidence of pain during sexual intercourse often occurs in postpartum mothers, which causes concern and fear of mothers doing these activities. One of the efforts to reduce the pain is lavender aromatherapy. This study aimed to analyze the effect of lavender aromatherapy on the incidence of dyspareunia in postpartum mothers.

Methods: The research design, which takes the form of a nonequivalent control group design, is quasi-experimental. Aromatherapy with lavender is the independent variable, and dyspareunia is the dependent variable. In Wonokromo Village, Surabaya, 102 respondents with accidental sampling for 3 months made up the population of postpartum mothers in 2022. The survey served as the research tool. The Spearman's test was used to assess the data.

Results: The majority of mothers who did not use lavender aromatherapy (55.9%) experienced severe dyspareunia, almost half of the mothers who used lavender aromatherapy (41.2%) experienced moderate dyspareunia, and mothers who always used lavender aromatherapy almost half (44.1%) had mild dyspareunia. There is a significant effect of lavender aromatherapy on the incidence of dyspareunia in postpartum mothers (p = 0.001).

Conclusions: The more mothers do not use lavender aromatherapy before having sex, the more severe the incidence of dyspareunia or pain during sexual intercourse.

Link of Video Abstract: https://youtu.be/iDWJ07s4En8

Background: The utilization of social media in digital marketing offers various benefits, notably improved accessibility and the ability to disseminate information widely among diverse populations. Notably, social media has emerged as the leading marketing strategy to generate interest among people visiting healthcare facilities in Timor Leste. This study examines the impact of Social Media Marketing Efforts (SMME) on visit intentions through Flodova Clinic's Facebook page in Timor Leste. The mediating factors of brand image and online trust are investigated while controlling for health threats and gender.

Methods: The study collects data from visitors and Facebook followers of Flodova Clinic. A cross-sectional data collection was done through an online survey. The analysis includes 184 samples that meet the inclusion criteria, employing Partial Least Squares Structural Equation Modeling (PLS-SEM).

Results: The findings demonstrate a significant influence of SMME on visit intentions, indicating its efficacy in attracting potential visitors. However, no direct or mediating effects are observed on brand image and online trust. The study identifies the most influential domains of SMME, with electronic word of mouth (EWOM) having the most substantial impact, followed by entertainment and interaction. Additionally, health threats and gender are found to affect visit intentions significantly. Health threats positively influence patients' intent to visit, while females show comparatively lower interest in visiting the Flodova clinic.

Conclusions: These results have managerial implications for developing SMME strategies in marketing health clinics, mainly through social media platforms like Facebook. The study underscores the importance of leveraging electronic word of mouth, entertainment, and interactive elements to maximize the effectiveness of SMME strategies. Additionally, it emphasizes the need for tailored approaches considering health threats and gender differences to optimize visit intentions and enhance engagement.

Background. Breast cancer has the highest incidence of cancer in women. The first-line chemotherapy, Adriamycin-cyclophosphamide (AC) has good results, but its efficacy is not optimal. The fruit lectin substance Abelmoschus esculentus has an anti-cancer effect, so it is widely used as a chemotherapy supplement. The aim of the study is to prove Abelmoschus esculentus extract can increase the apoptotic index against chemotherapy

Method. In vivo laboratory trial study, we are using Sprague Dawley female rats aged 28 days with mammary adenocarcinoma induced by DMBA. There are 4 groups, namely; control (K): placebo, treatment1 (P1): AC chemotherapy (Adriamycin 1.5 mg and cyclophosphamide 15 mg), treatment2 (P2): Abelmoschus esculentus extract 150 mg/kgBB/day, and treatment3 (P3): a combination of AC and Abelmoschus esculentus extract.

Results. The P3 group had the highest levels of Endonuclease_G (EndoG) and apoptosis at (38.66 ± 0.73) and (21.03 ± 0.69), respectively. Combination of Abelmoschus esculentus extract with chemotherapeutic agents can improve the anticancer outcome by significantly increasing EndoG expression and apoptosis index (p<0.05) in comparison to other groups.

Conclusion. Extract from Abelmoschus esculentus fruit shows high apoptotic index and EndoG expression which means that this extract can increase the apoptotic response to in vivo in-cyclophosphamide adriamis chemotherapy.

Link of Video Abstract: https://youtu.be/g_ys7cQCuDY

Background: Complicated intraabdominal infection (cIAI) is a surgical emergency reported to be a major contributor to non-traumatic mortality worldwide. Identifying the mortality risk before any operation is important in guiding clinical decision-making and informed patient consent about the risk of complicated intraabdominal infection (cIAI). The study aimed to develop a novel scoring system for predicting postoperative mortality in cIAI.

Methods: Data were collected retrospectively from all consecutive patients 396 patients met the inclusion criteria after excluding missing data undergoing cIAI surgery in Dr. Soetomo Hospital 2020 - 2022. Multivariate logistic regression analysis was performed to correlate the explanatory variable postoperative mortality. Data were analyzed using SPSS version 20.0 for Windows and MedCalc.

Results: Postoperative mortality rate cIAI was  32,2% (128 of 396), and variables identified as the strongest predictors of postoperative mortality were age > 60 y.o (OR 3,196), systolic blood pressure < 100 mmHg (OR 5,894), thrombocyte < 100.000 /uL (OR 5,593), albumin ≤ 2,9 g/dL (OR 6,764), total bilirubin > 1,8 mg/dL (OR 2,180), creatinine serum ≥ 1,58 mg/dL (OR 4,290), cancer comorbidity (OR 3,578), and appendix perforation as negative predictor (OR 5,853). These parameters were included in the prediction model of the novel simplified Airlangga Scoring System.

Conclusion: Despite the relatively low number of risk factors, the Airlangga score has been shown as a good predictor of postoperative mortality after cIAI. External validation is required in hospitals different from those in which the novel scoring system was developed.

Background: Special needs students come from many diverse and different family backgrounds. It may become a factor in special needs student learning performance. The purposes of this study are to find out how family background can affect special needs students in Pronunciation mastery and the process of special needs students in pronunciation mastery.

Methods: This study is a descriptive qualitative study using the case study method with three data collections. There are interviews, observations, and documentation. It becomes a unique single case study because the object of the study is an autism spectrum disorder student who continues his study until college and has good English pronunciation.

Results: The result of the study found that the most influential factor that can affect an autism spectrum disorder child’s pronunciation mastery is family motivation. The term motivation here is the desire from the parents who want to develop their skills and also motivation to develop their special needs child, in the hope that the special needs child can be Independent with their skills.

Conclusion: This autism spectrum disorder student has certain unique repetitive behavior: checking an English word through google translate. He often listens to how to pronounce words correctly. Although the parents come from a low social class, they can still improve their special needs child's Pronunciation by giving a supportive educational environment.

Link of Video Abstract: https://youtu.be/ZNusQRjFEH0

Introduction: Several methods have been explored to increase the effectiveness of prostate-specific antigen (PSA) for prostate cancer screening. A lower prostate-specific antigen-age volume (PSA-AV) score is associated with higher cancer risk. This study aimed to evaluate the value of PSA-AV scores in the detection of prostate cancer among the Indonesian population.

Methods: A retrospective study was conducted on 844 prostate biopsies performed at our center between January 2015 and December 2019. The score of PSA-AV was derived by multiplication of the patient's age and prostate volume and then division with PSA level. A ROC curve analysis was conducted to determine the cutoff for the PSA-AV score. The sensitivities and specificities of the PSA-AV score were contrasted with total PSA, PSA density, and age-adjusted PSA.

Results: The mean age of the patient was 63.63±8.6 years, with a mean PSA of 16.3±13.9 ng/mL and a mean volume of 42.7±16.0 cm³. Among 844 biopsies, 25.5% tested positive for prostate cancer. Prostate cancer patients had significantly higher mean age, PSA levels, and positive digital rectal examinations (P<0.05). In predicting prostate cancer, the PSA-AV score demonstrated a higher AUC of 0.772, surpassing the AUC of 0.762 achieved by the total PSA. The analysis identified a cutoff of 700 for the PSA-AV score, which showed significant sensitivity (94%) and sufficient specificity (8.4%). These values outperformed the total PSA cutoff of 4 ng/mL (sensitivity 91.6%; specificity 5.4%), PSA density cutoff of 0.15 (sensitivity 85.1%; specificity 30.0%), and age-adjusted PSA cutoff (sensitivity 88.4%; specificity 11.8%). The superiority of the PSA-AV score of <700 was more prominent in the subgroup analysis of patients below 70 years of age and those with a low-moderate prostate volume (<60 cm³).

Conclusions: The PSA-AV score demonstrated superior sensitivities and specificities compared to total PSA, PSA density, and age-adjusted PSA. Therefore, it is recommended to utilize a PSA-AV score of <700, particularly for men below 70 years of age with low-moderate prostate volumes (< 60 cm³).

Introduction: The high workload of nurses can cause burnout. Burnout can occur if the number of patients admitted does not match the number of available nurses and facilities, and occurs for a long time. Burnout in nurses causes a lack of attention to the application of patient safety culture. This study aims to find out the correlation between burnout and patient safety culture among nurses at Private Hospital in Yogyakarta.

Methods: Research design was descriptive cross-sectional method. There were 58 nurses, acquired by total sampling technique. We used the MBI-questionnaire to measure burnout levels and the HSOPSC questionnaire to measure patient safety culture.

Results: The results of this study indicate that the burnout level is low as many as 58 people (100.0%), patient safety culture is fairly good as many as 41 people (70,7%) and burnout has a negative effect on patient safety culture, but has no significant relationship (p 0,200 and r -0,171).

Conclusion: The burnout level of nurses is in low category, the patient safety culture of most nurses is fairly good and burnout has a negative effect on patient safety culture, this is because when burnout is felt by an individual, it will affect all individual activities both physically and mentally. Nurses are expected to be able to manage the workload so that they can avoid burnout and cooperate with hospital management to improve patient safety culture.

Introduction: Helicobacter pylori (H. pylori) infection is one serious disease that could result in complications such as gastritis, peptic ulcer and gastric cancer. Both invasive and non-invasive methods have been used to detect the infection, however the best detection depends on the clinical setting. One way to determine this is by graphical radar plot analysis, as it provides practical and useful data for many clinical aspects. The aim of this study was to investigate the prevalence rate of H. pylori ureA genotypes infection with a graphical technique.

Method: We conducted a cross-sectional study in which data was collected from patients with infection symptoms in north peninsular Malaysia. All eligible subjects were required to perform a simple clinical procedure to provide their cell and saliva samples. Subjects were also examined by the medical staff based on their symptoms. Detection of H.pylori in the samples were conducted with three different detection methods such as culture, biopsy, saliva and the combination of thee three methods.

Results: Biopsies were cultured and revealed 19.2% (48/250) of the patients had H. pylori infection. However, when PCR and culture were combined, the prevalence of H. pylori infection jumped by three times to 59.6% (149/250), indicating that PCR on biopsies and saliva was more sensitive. Males who were not Malay and Malay males in the age range of 41 to 60 were found to have significantly different rates of H. pylori infection (p 0.05), according to age group. According to ethnicity, 49.5% (28/58) Malay men were infected compared to 68.1% (62/91) non-Malaysia men (p0.05), while there was no difference between 64.2% (34/53) non-Malaysia women and 51.1% (23/45) Malay women.

Conclusion: This study found that saliva method is accurate for the identification of H. pylori. This approach has several advantages that could be helpful to patients worldwide, thus diagnosis and treatment can be done earlier to prevent complications.

Link of Video Abstract: https://youtu.be/2L4njgfd3SE

Background: The dissemination of coronavirus disease (COVID-19) has led to delayed infertility treatment and fear of contracting the virus which can affect the mental status of women with infertility. This research aimed to investigate whether fear, depression, perceptions, and knowledge related to COVID-19 affected infertility patients in seeking treatment and analyzed factors associated with depression during COVID-19 pandemic.

Method: This is a cross-sectional study utilizing an electronic survey distributed to infertility patients attending fertility services between May and July 2021. The primary outcomes were demographic characteristics, clinical parameters of infertility, depressive symptoms based on the Patient Health Questionnaire-9 (PHQ-9) score, and fear of COVID-19 scale (FCV-1 and FCV-2).

Results: A total of 533 patients were included. The fear of infertility treatment suspension due to COVID-19 was perceived by 34.1% of patients. The mean Patient Health Questionnaire-9 (PHQ-9) score was 4.55 ± 4.248, with mild depression occurring in 33.4% of patients. Low income, delayed treatment, and fear of COVID-19 scale (FCV-1) score together could significantly predict depression status. Despite the pandemic, 94.7% of patients decided to continue the treatment.

Conclusion: The COVID-19 pandemic has given rise to stressors that may aggravate the psychological condition of women with infertility. However, the enthusiasm to continue the treatment remains undisturbed. It is imperative to offer emotional support and address the consequences of COVID-19 infection in women with infertility during the pandemic era.

Introduction: Alkali ocular injury causes disintegration of the cornea by changes in pH level, proteolysis, ulceration, and impairment of collagen synthesis. Doxycycline was found to alter the remodeling of human conjunctival and skin fibroblasts. Doxycycline also reduced collagenolytic degradation of the cornea due to chemical injury by inhibiting matrix metalloprotease (MMP) activity, including in other non-infectious corneal ulcers. This study aimed to determine the efficacy and safety of topical doxycycline to manage corneal alkali burns. A systematic review was conducted in adherence to the PRISMA statement.

Method: Searching was conducted in five databases and inclusion and exclusion criteria were applied afterwards. Three studies were found, considered good, and eligible for inclusion after appraisal using SYRCLE critical appraisal tools for animal studies. All studies used mice models.

Result: We found a significant reduction of IL-1β, IL-6, MMP-8, MMP-9, α-SMA, and NF-κB by doxycycline usage starting from two days of usage. In addition, mRNA angiogenic factors and corneal neovascularization decreased after doxycycline usage. This contributes to better corneal repair after trauma, reflected by better corneal healing and opacity scores after doxycycline usage compared to other groups.

Conclusion: Doxycycline management improved outcomes for patients with corneal alkali burn by decreasing inflammatory cytokine and promoting tissue repair.

Link of Video Abstract: https://youtu.be/vwaMtqzZyI0

Background: Nasopharyngeal carcinoma (NPC) is a malignant tumor in the nasopharynx with a high incidence of metastasis. NPC is one of the most common cancers in Indonesia, and from the age distribution, it often affects the productive age population. This study aims to describe the characteristics of NPC patients in Dr.Soetomo General Academic Hospital from January 2017 – December 2018.

Methods: This study is a retrospective descriptive by taking medical records of patients with NPC at Dr. Soetomo Hospital, Surabaya, from January 2017-December 2018, that meet the inclusion and exclusion criteria. The basic data taken are gender, age, education, and occupation. Complaints assessed are the main complaints of patients who make patients come for treatment listed in the medical record data.

Results: Data from 262 patients showed that the five-year life expectancy for NPC sufferers in women is 84%, while in men, it is 78%. The main complaints of patients in this study were lumps in the neck in 130 patients (49.61%), with the highest distribution of patients based on stage IV a with 78 patients (29.77%), and the majority were non-keratinizing carcinoma undifferentiated type, with a total of 245 patients (93.51%).

Conclusion: Male sufferers are more than females; the largest age group is 41-50. Most jobs are private employees, and most sufferers' last education is high school. The main complaint of most patients was a lump in the neck, and the patient came with an advanced stage where the most found was stage IV. The histopathological type of most patients is non-keratinizing carcinoma undifferentiated type.

Introduction: Many virulence factors of Pseudomonas aeruginosa PAO1 are regulated by temperature and host conditions upon infection. Based on microarray data, the PA3235 gene is one of the upregulated genes during cell growth at 37 °C. Until now, no information about its role in PAO1 pathogenicity.

Methods: The PAO1∆PA3235 strain was constructed by overlapping polymerase chain reaction (PCR) method and through biparental mating. The deletion was confirmed by PCR and restriction analyses. The virulence factors of both P. aeruginosa PAO1 wild type and ∆PA3235 mutant strains were examined, which consisted of the amount of pyocyanin and pyoverdine, swarming, swimming, and twitching motility, biofilm formation, 3-oxo-dodecanoyl-homoserine lactone concentration, and growth curve profile. Data were analyzed using Student’s t-tests to determine differences between treatments. P-value < 0.05 were considered significant.

Results: The ∆PA3235 strain was successfully constructed. At 37 ºC, the mutant produced less pyocyanin (p-value 0.0004), pyoverdine (p-value 0.0009), and swarm area than the wild-type. The dendrites pattern of both strains was similar. The mutant and parental strains showed no differences in swimming and twitching motility when incubated at 22 ºC and 37 ºC. The mutant produced more biofilm compared to the wild-type strain (p-value 0.0013). The AHL was higher in the mutant than in wild type strain (p-value 0.0095) after 24 h incubation. Both the wild type and mutant strains exhibited similar growth patterns in LB broth. The mutant colonies also showed the same morphology as the wild type on the LB plate (not shown here).

Conclusion: The deletion of the PA3235 gene from the Pseudomonas aeruginosa genome caused some changes in virulence factors production, as the bacterium grew at body temperature 37°C. We predicted that the PA3235 gene might function to transport molecules involved in the early infection of this bacterium to humans.

Link of Video Abstract: https://youtu.be/Ja9klXNlw5A

Background: Keratitis Pseudomonas aeruginosa is the most frequently occurring eye infection. It is a rapidly developing condition that can lead to ocular infections (endophthalmitis) and corneal perforation resulting in vision loss. Although prompt administration of antibiotics can effectively kill the bacteria, the corneal damage caused by toxins persists. The following inflammatory process results in corneal thinning, fibrosis, and eventual perforation.

Methods: This study is a literature review to support future experimental studies which will be conducted to examine the expression of IL-1b and MMP-9 on pseudomonas keratitis after administration of EGCG.  

Results: Interleukin-1ß is a proinflammatory cytokine secreted by various immune cells in response to acute and chronic inflammation. At the same time, matrix metalloproteinase (MMP) is a group of proteolytic enzymes involved in the pathophysiology of various ocular surface diseases. Epigallocatechin gallate (EGCG) is the major polyphenol compound in green tea, produced from the Camellia sinensis plant. Recent studies suggest that EGCG has anti-inflammatory and antioxidant effects on various cell types, including the cornea. EGCG inhibits IL-1β, which induces the activation of the NF-kB signaling pathway, which may explain the decrease in uPA expression and the reduction of collagen degradation by corneal fibroblasts. EGCG inhibits the activation of pro-MMP 9 produced by corneal fibroblasts in response to IL-1β stimulation, and this effect is mediated by the inhibition of uPA upregulation without a significant impact on pro-MMP 9 expressions.

Conclusion: Epigallocatechin gallate (EGCG) in Camellia sinensis extract has the potential as an alternative adjuvant therapy for bacterial keratitis because it has antibacterial, anti-inflammatory and antioxidant effects.

Link of Video Abstract: https://youtu.be/KigXgHWz0JU

Background: The common neuroaesthetics used for neurosurgery was inhalation of Sevoflurane and the newest, by continuous infusion of propofol called Total Intravenous Anesthetic (TIVA). Anesthesia procedures are one of the biggest healthcare expenditures in hospitals. Thus, finding the most effective and efficient anesthetic technique but in the same time can maintain patient safety is important. This literature review compares a cost-effective Sevoflurane and propofol TIVA analysis in craniotomy surgery.

Methods: This literature review was carried out by searching studies in three online databases consisted of PubMed, the Cochrane Library, and Google Scholar using the keywords "sevoflurane inhalation anesthetic", "propofol total intravenous anesthesia", "TIVA”, “craniotomy’, "cost-effective analysis", and “pharmacoeconomic”. Appropriate studies were then carried out through a narrative synthesis analysis.

Results: The assessment of cost-effective analysis in anesthesia is broadly divided into fixed commodities and various commodities. The analysis found the highest use of costs in the TIVA group and the lowest in the isoflurane inhalation group. The high cost in the TIVA group was caused by propofol being the most expensive compared to other inhalation agents such as isoflurane and Sevoflurane. Based on the average intraoperative anesthetic cost, it was also found that the anesthetic cost per patient was Rp. 957,870,- for the TIVA propofol group and Rp. 1,318,130,- for the sevoflurane group. Sevoflurane use for induction and maintenance of anesthesia resulted in a further modest decrease in costs (especially if fresh gas flow was reduced early), primarily through less drug waste.

Conclusion: The cost-effective analysis showed that Sevoflurane was less expensive than propofol. Yet, in terms of pharmacoeconomics, using TIVA propofol results in much fewer PONV episodes, unplanned hospital admissions, and patient lengths of stay, all of which improve pharmacoeconomic benefits.

Link of Video Abstract: https://youtu.be/rXb-E8We3vU

Background: COVID-19 vaccines involve a humoral response to produce a neutralizing antibody that could protect subjects from severe COVID-19 infection. However, obesity tends to lower the immune response to the COVID-19 vaccine. Therefore, we conducted a systematic review to determine the immune response of various types of COVID-19 vaccines in a population with obesity.

Methods: We conducted a systematic review based on The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Using keywords, we search studies from Taylor & Francis, PubMed, ScienceDirect, Cochrane, and EBSCOHost.

Results: We included eight cohort studies with 21,280 subjects after thorough selection and appraisal. Four studies stated that obesity was related to lower antibody titer post-SARS-CoV-2 vaccination, even though one study stated that obesity was not associated with long-term immune response. Another prospective cohort study involving approximately nine million populations stated that SARS-CoV-2 vaccination provided similar protection against COVID-19 compared to normoweight when underweight was a risk factor for lower protection. One study found that antibody titer wanes faster in obesity compared to normoweight. In addition, another study found lower antibody titer in obese men, whereas no significant findings were found in obese women.

Conclusion: Therefore, it should be noted that COVID-19 vaccination in an obese population tends to provide a lower immune response regardless of vaccine type and doses are given. This should inform clinicians who want to administer the COVID-19 vaccine to obese populations.

Link of Video Abstract: https://youtu.be/lODjSgZ6vm0

Background: Glaucoma is a progressive neurodegenerative disease characterized by glaucomatous optic neuropathy, including loss of retinal ganglion cells and axons. Optic neuropathy causes progressive vision loss and is managed by reducing intraocular pressure. However, even when the intraocular pressure has dropped to normal, the damage to the retinal ganglion cells may linger in certain situations. Thus, commence investigations on natural sources such as neuroprotection to prevent the loss of retinal ganglion cells.

Methods:  This literature review compiles and elaborates on previous studies to support future experimental studies that will be conducted to comprehend the effect of intravitreal Resveratrol as a glaucoma treatment to prevent the loss of retinal ganglion cells.

Results: Resveratrol is a naturally occurring phenol and phytoalexin detected in the skins of grapes and berries like raspberries, blueberries, and mulberries. Resveratrol inhibits the production of reactive oxygen species (ROS) and apoptosis as well as lengthens the life span of nerve cells via multiple mechanisms. Resveratrol treatment can reverse the progression of apoptosis, preserve mitochondrial membrane potential by reducing caspase-3, and inhibit cytochrome-C release, enhancing cell survival, as shown in many previous studies. Before the systemic administration of resveratrol in eye disease, it is necessary to consider the presence of the blood-ocular barrier—about 10 out of 35 eyes detected resveratrol in the conjunctiva after oral trans-resveratrol supplementation. Several studies have administered intravitreal injections of resveratrol to increase intraocular resveratrol concentrations.

Conclusion: Resveratrol may be utilized as an alternative adjuvant treatment for glaucoma due to its antioxidant and antiapoptosis properties.

Link of Video Abstract: https://youtu.be/rypOUr0MPxA

Corneal alkali burn is a typical ophthalmology emergency which requires immediate management and treatment. Alongside conventional treatment, medroxyprogesterone and doxycycline are considered potent add-on treatments. This literature review was conducted to determine their impact towards corneal wound healing after an alkali burn. It was proven from studies extracted from literature searching among various databases that medroxyprogesterone and doxycycline proven to reduce the inflammatory condition of corneal wounds after alkali trauma. In addition, they are subjected to reduce matrix metalloproteinase (MMP-9) and transforming growth factor (TGF-β1), which are abundant and over-expressed in a corneal wound and could cause excessive inflammation and neovascularization of cornea, which results in hazy and disintegrated corneal tissue after recovery. Therefore, the usage of topical medroxyprogesterone acetate 1% and doxycycline is proven beneficial for patients with corneal wounds after being exposed to alkali burns.

Link of Video Abstract: https://youtu.be/d3xTL9HvM2U

Background: Systemic lupus erythematosus (SLE), an autoimmune inflammatory disease that affects various organ systems, has a severe form called lupus nephritis (LN). The management of LN has changed over the past few decades due to the discovery of new immunosuppressive drugs and advances in our understanding of the disease process. This study evaluates lupus nephritis and kidney transplantation in the past, present, and future challenges.

Methods: This literature review compiles and elaborates on previous studies from many authors to support future experimental studies, which will be conducted to evaluate the challenges of lupus nephritis and kidney transplantation management according to past, present, and future data.

Results: Treatment strategies for LN typically involve a combination of immunosuppressive medications, such as corticosteroids, cyclophosphamide, and mycophenolate mofetil, to induce and maintain remission. Many LN patients progress to ESRD, necessitating renal replacement therapy (RRT) through dialysis or kidney transplantation. The results of kidney transplantation in LN patients have been progressively improving. Developing novel immunosuppressive agents may improve graft survival and reduce complications in LN patients undergoing kidney transplantation.

Conclusion: The future of kidney transplantation for LN patients appears promising, with emerging research focused on novel immunosuppressive agents, personalized medicine, biomarkers for predicting recurrence and graft rejection, preventive strategies for recurrent LN, and cell-based therapies

Link of Video Abstract: https://youtu.be/VVibnyUdBx4

Background: Proliferative vitreoretinopathy (PVR) is common following an open globe injury (OGI) due to aberrant wound healing that can result in retinal detachment or vitreous hemorrhage. Despite the anatomical success, visual acuity improvement remains unsatisfactory. Triamcinolone acetonide (TCA) and Bevacizumab are among these therapies. This study aims to explore the effect of TCA and Bevacizumab intravitreal injection as potential preventive therapies for PVR in OGI.

Methods: This literature review compiles and elaborates on previous studies from many authors to support future experimental studies, which will be conducted to evaluate the intravitreal triamcinolone acetonide and bevacizumab injection as prevention of proliferative vitreoretinopathy in open globe injury through several relevant articles.

Results: The healing process requires inflammation that stimulates inflammatory cells and mediators, such as transforming growth factor-β (TGF-β), tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), interleukin-1 (IL-1), IL-2, IL-3, IL-6, IL-8, and IL-10. Plasminogen activator inhibitor-1 (PAI) is upregulated during inflammation, resulting in continued collagen deposition due to fibrosis. The injection of corticosteroids as immunosuppressants and anti-VEGFs as antiangiogenesis is thought to have a positive impact by reducing inflammation and the development of new blood vessels, thus suppressing fibrosis.

Conclusion: TCA injection was associated with improved anatomical and visual acuity in humans, pre-operatively or during pars plana vitrectomy. Anti-VEGFs, such as Bevacizumab, ranibizumab, conbercept, and aflibercept, demonstrated protective effects on the eyes of animal models and showed their ability to reduce VEGF, TGF-β, and PAI-1, thereby inhibiting wound fibrosis.

Link of Video Abstract: https://youtu.be/8w4jBvx0pJc

Background: Plasma-rich fibrine (PRF) membrane is a new biomembrane useful in ocular surface reconstruction technique. Since its development, PRF membrane has been used successfully in many studies; however, some controversies maintained. This literature study aims to evaluate the role of Platelet Rich Fibrin (PRF) membrane and conjunctival autograft on TGF-β and collagen type 1 expression in conjunctival wound healing.

Methods: This literature review compiles and elaborates on previous studies from many authors to support future experimental studies, which will be conducted to compare the effect of PRF membrane and conjunctival autograft on TGF-β and type 1 collagen expression.

Results: PRF has many advantages, such as the ability to reduce inflammation, rich in growth factors, and can be a temporary scaffold for fibroblast migration. However, despite its advantages, PRF is not widely used, unlike its counterpart techniques, such as conjunctival autograft. Conjunctival autograft has long been used as an option for ocular surface reconstruction techniques, but it has some limitations. The conjunctival autograft technique cannot be performed in large or bilateral conjunctival damage. Thus, the PRF membrane technique can become a perfect solution for such a case. This literature review will provide more information on how PRF can regulate inflammation and support the conjunctival wound healing process.

Conclusion: Some impacts of PRF membrane and conjunctival autograft are still unclear, especially their effect on TGF-β and type 1 collagen expression. This literature review is expected to encourage and support future experimental studies about the impact of PRF and conjunctival autograft on TGF-β and type 1 collagen expression.

Link of Video Abstract: https://youtu.be/Rg5QfPqxtqA

Background. Breast emptying causes more milk to be released, which stimulates the production of breast milk. One of the crucial hormones that will rise with breastfeeding is oxytocin. This literature study aims to evaluate the mothers' attitudes toward giving breastfeeding and how it relates to the mother's oxytocin levels is reviewed in this study.

Methods. We used the phrases "mother's attitude," "breastfeeding," and "oxytocin level" in several databases, including PubMed (NIH), Scopus, EMBASE, and Google Scholar, as keywords for literature searching. Also manually searched were pertinent reference databases. This review article integrated any previously recognized relevant publications from the database, explained the findings in a narrative format, and offered a thorough evaluation and analysis of the literature findings.

Results. According to this study, oxytocin levels are linked to many mothers' attitudes toward nursing, most favorable. Several studies indicate that the oxytocin levels increase high empathy, reduce stress, reduce cortisol hormone, typical of bonding, and mother will feel confident.

Conclusion. The mother's mindset and the increase in oxytocin are related to breastfeeding.

Strabismus surgery aims to improve visual function, binocular vision, and cosmetics by fixing the position of the eyeball. However, inflammation after surgery can lead to fibrous tissue formation. Dexamethasone is routinely used as an anti-inflammatory but has unwanted side effects. On the other hand, Asiatic acid, the most important saponin constituent of Centella asiatica, has anti-inflammatory and anti-fibrous properties. It has been widely used as a traditional medicine plant in China, India, and Indonesia. The findings show that Asiatic acid has been shown to affect wound healing after strabismus surgery positively. Asiatic acid inhibits inflammation, increases cell proliferation, and inhibits fibrosis. It promotes wound healing by increasing the strength of the incision wound, epithelialization, keratinization, and angiogenesis. Overall, using natural compounds like Asiatic acid in wound healing is promising and should be explored further. It can be a safer and more effective alternative to dexamethasone, which has known side effects. However, further studies are required to determine the optimal dosage and administration method of Asiatic acid for post-operative strabismus wound healing. The results of this study are expected to be the basis for selecting alternative therapies to reduce inflammation and fibrosis after strabismus surgery.

Bacterial keratitis is an ocular emergency and is one of the leading causes of blindness worldwide. Pseudomonas aeruginosa is the most frequent causative agent of keratitis. The infectious process of P. aeruginosa is highly invasive and can rapidly lead to corneal ulcers, ocular infections (endophthalmitis), and corneal perforation. Delayed or inadequate treatment may result in complications such as corneal fibrosis and neovascularization. Platelet-rich fibrin (PRF), which contains high levels of platelets, can aid in hemostasis, cell migration, and proliferation to accelerate the wound healing process. PRF contains several growth factors, such as Platelet-derived growth factor (PDGF), Vascular endothelial growth factor (VEGF), and Transforming growth factor (TGF- β), which are released in a time-dependent manner during the wound healing process, ranging from 7 to 28 days. TGF- β regulates the expression and activity of matrix metalloproteinases (MMP-1, MMP-2, MMP-3, MMP-9) involved in wound remodeling and healing, where MMPs are regulated or balanced with tissue inhibitors of metalloproteinases (TIMP-1, TIMP-2). In previous studies, PRF was found to be effective in managing bacterial keratitis in cats. In this discussion, we explore the molecular effects of PRF as an adjuvant therapy for bacterial keratitis

Link of Video Abstract: https://youtu.be/fn9kA601YVo

ACL rupture is a common injury often resulting from previously healthy individuals' non-contact knee injuries. ACL rupture in young adults and teenagers are becoming more common, contrary to earlier theories that suggested ACL damage was uncommon in skeletally immature people. This risk is significantly raised by concomitant meniscal injury whether or not an ACL reconstruction is undertaken. Although surgical management with allograft or autograft reconstruction can be achieved successfully, there are some serious complications following ACL reconstruction. The supply of autografts is limited, especially in situations with numerous ligament injuries or re-ruptures, which might result in morbidity at the donor site. Allografts can increase the spread of illness and trigger an inflammatory response, which is a drawback. There has been much interest in a tissue-engineered ACL graft because of these issues and current developments in bioengineering and regenerative medicine. According to recent research, following an ACL repair, the bone marrow density surrounding the knee area diminishes. Platelet Rich Plasma (PRP) and Bisphosphonate are the substrates that could ameliorate this phenomenon.  Therefore, this review aims to compile evidence of PRP and bisphosphonate and its effect on the tendon-bone interface in ACL reconstruction.

Link of Video Abstract: https://www.youtube.com/watch?v=1zdsWuZBGgc

Introduction: Stroke has been reported in symptomatic and asymptomatic COVID-19 patients with undetermined characteristics and outcomes. Stroke is one of the non-respiratory pathology reported amongst COVID-19 patients with various manifestations. We elucidated the characteristics and outcomes in symptomatic and asymptomatic COVID-19 patients.

Methods: A systematic review was performed from 01/01/2020 to 16/03/2022 in EBSCOhost, Google Scholar, Pubmed, Scopus, and Web of Science with search terms, i.e., COVID-19, Coronavirus, SARS-CoV-2, Coronavirus Disease-19, stroke, CVA (cerebrovascular accident), brain MRI, head MRI, magnetic resonance imaging, antithrombotic agent, thrombectomy, using the PRISMA guidelines. Inclusion criteria include case reports or series of adult stroke patients with confirmed COVID-19 written in English; other articles were excluded.

Results: From 239 articles screened initially, 23 articles were included. Twenty-five patients are classified as symptomatic (n=17) and asymptomatic (n=8). In symptomatic patients, motor and sensory abnormalities with loss of consciousness and alteration of memory were detected. Eight symptomatic patients had elevated D-dimer, and 2 had elevated fibrinogen levels. Complete resolution was found 6 times higher in symptomatic vs. asymptomatic cases, while the mortality rate was lower in symptomatic compared to asymptomatic patients.

Conclusions: Stroke in symptomatic patients occurred more frequently than the asymptomatic and was observed pre- or post-diagnosis of COVID-19; thus could be the comorbidity and/ or complication.

Link of Video Abstract: https://youtu.be/d196XKGsPek

Background: Parathyroidectomy is a method of treating secondary hyperparathyroidism associated with Chronic Kidney Disease (CKD), which has been largely abandoned in developed countries due to the existence of calcimimetic drugs which are reported to be effective in treating secondary hyperparathyroidism in this population. However, in developing countries like Indonesia, the availability of Calcimimetic drugs is still rare and expensive, so that parathyroidectomy can be an option. The study aimed to present four case reports of chronic HD patients with SHPT accompanied by clinical symptoms. As far as our knowledge goes, this is the first case series reported from Indonesia.

Case Presentation: This research is a multicenter case series study. All patients had undergone dialysis for five years and complained of body aches. All calcium levels were within the normal range, while three patients had hyperphosphatemia and one patient had normal phosphate levels. All patients had iPTH levels >1000 pg/ml in the last six months. Before the surgery, all patients had received long-term phosphate-binding drugs, including calcium-based and non-calcium-based drugs and vitamin D3 agonists. All patients underwent total parathyroidectomy with autotransplantation of parathyroid tissue in the right antebrachial regions, except for the second patient who received the transplant in the left antebrachial region due to an AV fistula in the right arm.

Conclusion: In dialysis patients, especially in developing countries, approximately 10.7% of them experience SHPT with PTH levels >1,000 pg/mL, and one study in Indonesia showed that around 35% of patients undergoing chronic hemodialysis had PTH levels >200 pg/ml, making parathyroidectomy a highly possible option considering that medications such as cinacalcet are more expensive and not widely available.

Link of Video Abstract: https://youtu.be/FZsJ7mtGsW8

Introduction: Superior vena cava syndrome (SVCS) associated with jugular internal vein thrombosis can be dangerous. Diagnosing SVCS and venous thromboembolism (VTE) must be done precisely and accurately to minimize the risk of pulmonary embolism.

Case Presentation: Male, 55 years old, complaining of shortness of breath, the feeling of choking in the neck, and a lump in the neck for one month. The patient has a history of type 2 diabetes mellitus and does not routinely take medication. The patient experienced tachypnea and tachycardia, and there was an enlargement in the submental to the submandibular region; the boundaries were not firm, supple, or fixed, approximately ten centimeters in diameter, and the collateral veins were enlarged and felt pain. Chest examination revealed telangiectasia, crackles, and bronchovesicular breath sounds over both lungs at the base and medial side. The patient had mild anemia and leukocytosis, increased HbA1c levels, total cholesterol levels, and increased D-dimer and Lactate dehydrogenase (LDH). Antero-posterior (AP) lateral cervical radiograph shows a widening of the soft tissue in the retro tracheal space at the level of the second cervix. The patient given warfarin, enoxaparin, methylprednisolone, and heparin. Improvement of the condition was shown.

Conclusion: Superior vena cava syndrome due to internal jugular vein thrombosis is a challenging case. Careful diagnostic measurement based on history and physical examination, in addition of additional investigation may lead to the diagnosis. Management with warfarin, enoxaparin, methylprednisolone, and heparin show clinical benefit.

Link of Video Abstract: https://youtu.be/f6IaLnu3sz8

Introduction: Spinal cord injury (SCI) rehabilitation is a resource-intensive and time-consuming process and this is problem in particular for patients from a rural, remote areas, or low socioeconomic backgrounds. This problem is further exacerbated by social restriction policies in place due to coronavirus disease 2019 (COVID-19). This case report aimed to describe how telerehabilitation could overcome these challenges

Case presentation: A 20-year-old female involved in a motor vehicle accident. Preoperative magnetic resonance imaging (MRI) indicated  a complete burst fracture of the L1 vertebral body. The patient experiences paraplegia and loss of autonomic control. Long spine fusion was performed. After being discharged, the patient could only visit the hospital once one-month post-surgery due to personal financial reasons and COVID-19-related social distancing policy. Telerehabilitation was used for the remaining follow-ups and rehabilitation programs were monitored through instant messaging platform between the patient, the operating surgeon, and the rehabilitation specialist. Telerehabilitation using instant messaging was an affordable and practical platform of communication for patient self-reporting and monitoring of progress. With intensive telerehabilitation program, the patient’s functional abilities recovered from Frankel B to D after 6 months of following the domiciliary telerehabilitation plan.

Conclusion: We report a case of satisfactory functional outcome of SCI rehabilitation following the use of instant messaging to assist the rehabilitation. This highlights that instant messaging may be utilized to guide the rehabilitation process with the consideration of other factors such as the patient's engagement and the healthcare provider’s commitment. We recommend for further refinements in the adoption and use of telerehabilitation for  orthopaedic and traumatology cases that need long-term rehabilitation.

Introduction: MDR-TB is an infectious disease that can cause death and stigma for those infected. MDR-TB patients with depression are at risk for LTFU, which will worsen their condition and strengthen the stigma they receive.

Case report: A 52-year-old female psychiatric interview and assessment using the Beck Depression Inventory (BDI) found that BDI score of 4 (no depression), and the patient adhered to TB treatment. She was found to be laid off, and an assessment using the BDI to detect depression in the patient found potential stigma in the patient, such as being laid off from work, prohibited from teaching face-to-face, and shunned by colleagues. Interventions given were prescribing Fluoxetine 20 mg per day and Clobazam 10 mg per day, a brief intervention using the FRAMES technique, psychoeducation about disease and drug effects and the duration of treatment, and an office visit. A worksite intervention was performed by the patient's husband. Antituberculosis drugs were monitored by both a pulmonologist and a psychiatrist. Her work-related problems were resolved through interventions at the school with psychoeducation about drug-resistant tuberculosis, the transmission method, the duration of treatment, and the side effects of the treatment. The results of the last sputum examination after one month of treatment showed drug resistance, and the patient was advised to undergo 18 months of treatment. The patient could finally work offline with fewer responsibilities after getting negative laboratory test results twice in a row.

Conclusion Work-related psychosocial interventions are required to address rejection at work, which results in depression and nonadherence to treatment. Liaison services with social interventions at work in drug-resistant tuberculosis-infected patients are necessary to improve their quality of life and maintain their treatment adherence.

Link of Video Abstract: https://youtu.be/tHcMqNHfLyY

Background: Subaortic stenosis (SAS) is the second most common form of left ventricular outflow obstruction, accounting for 14% of LVOT obstruction in the general population. This obstruction is in the area of the heart under the aortic valve. While only a few cases have been reported in pediatrics, SAS is a gradually progressive disorder rarely seen at birth and infancy. This case study aims to evaluate the successful treatment of severe SAS with left ventricular dysfunction in children

Case Presentation: We present the case of an 8-year-old boy who presented with shortness of breath on exertion and diaphoresis 3 months ago. Transthoracic echocardiography revealed severe aortic stenosis (PG 69.86 mmHg) with discrete tissue in the anterior LVOT and left ventricular systolic function decreased (EF Teich 29.44%), with global hypokinetic. Transesophageal echocardiography (TEE) results in severe subvalvular AS with a fixed subaortic membrane (PG 51.16 mmHg; Stenotic area 0.1 cm2), anterior to the aortic valve 1 cm long. There was mild mitral regurgitation and moderate tricuspid regurgitation. The patient then undergoes successful medical treatment and surgical subaortic membrane resection with tricuspid repair. After one year's operation, the patient remained stable, in good condition and free of symptoms.

Conclusion: Subaortic stenosis is a gradually progressive disorder and could develop into heart failure with significant left ventricular dysfunction. Monitoring is an important aspect, given the nature of disease progression. Successful management of a patient with subaortic stenosis involves a multidisciplinary approach, including an early diagnosis, a comprehensive understanding of cardiac pathophysiology, risk factors of recurrence, optimal medical management and surgical strategy.

Introduction:  In 10% of head injury cases, nonmotor seizures were detected by electroencephalography (EEG) performed in the acute phase.  Nonmotor seizures are often not diagnosed at the start of treatment because the symptoms are often not recognized by the patient's family or doctor. The incidence of seizures in patients with minor head injuries is very low. From the literature, it was found that the type and severity of the head injury is a significant factors in the incidence of post-traumatic seizure. Thus, in this article, we report a case of nonmotor seizures in a patient after a minor head injury.

Case description: An Indonesian female, 53 years old, complained of sudden silence when speaking after 4 days earlier, she fell and hit her head on the right side. There was no loss of consciousness, headache, vomiting or limb weakness. Complaints of motor seizures and a history of previous seizures were denied. There were no cranium defects, hematomas, or open wounds on examination. The results of laboratory tests and non-contrast head CT scans were expected. On electroencephalography (EEG) examination, epileptiform waves were found in the left temporal region. The patient was given anti-seizure drugs, and complaints improved within 2 days of therapy. It is crucial to carry out an EEG examination in the acute phase of a head injury to exclude the possibility of nonmotor seizures and brain dysfunction, which will be at risk of causing seizures later in life after trauma.        
Conclusion: EEG examination in the acute phase of head injury is used to exclude the possibility of nonmotor seizures and brain dysfunction, which will be at risk of causing seizures later in life after trauma.

Introduction: Lupus enteritis is a rare first manifestation of active systemic lupus erythematosus (SLE). diagnosis of this condition is hard, specially without other signs and symptoms associated with active SLE. this article will report a woman with SLE and lupus enteritis as the first manifestation of active systemic lupus erythematosus

Case presentation: A 25-year-old woman presented to the Emergency department complaining of abdominal pain and vomiting. From her medical history, four years in the past, she reported the same signs and symptoms as now and turned into identified with appendicitis. Her abdomen examination found out mild abdominal distention without a abdominal tenderness. Wall thickening and irregularity of small and big bowel loops were observed on the CT abdomen. She turned into given a excessive dose glucocorticoid as initial treatment and turned into maintained with low dose glucocorticoid and cyclosporin. After 6 months of follow-up, the patient did not have a recurrence of signs and symptoms.

Conclusion: A high index of suspicions is essential to differentiate lupus enteritis from other differential diagnoses. For lupus enteritis, excessive-dose steroids were an efficient initial treatment.

Link of Video Abstract: https://youtu.be/ep7OSDbigho

Background: Intracranial subdural empyema, although rare, represents an extreme medical and neurosurgical emergency. Multiple burr holes or a craniotomy for drainage and antibiotics are the treatment of choice. This case study aims to evaluate the complete recovery of interhemispheric subdural empyema extending to cerebellar tentorium treated with antibiotics as unimodal therapy.

Case Presentation: We present a case of a 40-year-old male with severe headache, a decrease of consciousness GCS E3V1M5, generalized onset tonic-clonic seizure, right abducens palsy, and right hemiparesis. Interhemispheric subdural empyema extending to cerebellar tentorium with associated intracranial abscess was seen from brain magnetic resonance imaging (MRI). Antibiotics were administered without surgical intervention due to the patient's family rejection. The patient regained full consciousness within 1 week and complete neurological function after 4 weeks of continuous use of antibiotics. The patient was discharged, and his recovery was uneventful on subsequent follow-up.

Conclusion: The use of antibiotics as monotherapy in subdural empyema is controversial, as it is widely accepted that surgery must be initiated as soon as possible in this pathology. It is indicated in small portions of cases without major neurological deficits or in particular conditions where surgery could not be performed. Still, more recent studies found it justifiable in patients with documented initial good responses. This case report highlights the complete recovery and the clinical outcome of antibiotics as monotherapy for subdural empyema.

Introduction: Ovarian Sertoli – Leydig Cell Tumor (SLCT) are one of sex cord tumor that has incidence rate less than 0,2% of all ovarian tumors. It occurs predominantly in second and third decades of lifetime. It has characteristics mostly low–grade malignant although poorly differentiated type may behave more aggressively. Clinical characterstic of ovarian SLCT usually hormonal changes, nevertheless in patients without hormonal changes, the manifestation of the disease consists of abdominal pain and abdominal enlargement, and palpable adnexal mass on physical diagnostic.

Case: a 52 years woman that has been undergo right salpingooforectomy 5 months prior with PA result shows poorly differentiated sertoli – leydig cell tumor, and refusing to chemotherapy. She came with chief complaint of abdominal enlargement since 3 months accompanied with lower abdominal pain 2 weeks prior. Ultrasound examination shows cystic ovarian neoplasm with solid part size 9 x 9 x 9 cm from left adnexa. Tumor markers that arise are Alpha–Fetoprotein (AFP)  52 ng/mL and Lactate Dehydrogenase (LDH) = 432 U/mL which correspond to sex cord tumor. She has undergone Laparotomy Total Abdominal Hysterectomy Left Salpingooforectomy and chemotherapy afterward.

Conclusion: Ovarian Sertoli – Leydig Cell Tumors (SLCT) are a rare sex cord ovarian tumor that may behave more aggressively as it poorly differentiated. It has manifestations of hormonal changes and also abdominal enlargement.

Background: Liver disease in pregnancy can be related to the process of pregnancy (liver disease of pregnancy) or not associated with pregnancy (liver disease in pregnancy). Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening cause of jaundice in the third trimester of pregnancy and early postpartum period which in most cases no definitive risk factors are found. In this case report, we report a patient with AFLP with acute pancreatitis manifestations.

Case presentation: A 33-year-old woman referred to the Dr Soetomo General Academic Hospital, Surabaya, Indonesia with diagnosis of day-4 post-section caesarian (SC) accompanied by ileus paralytic, obstructive jaundice hypoalbuminemia hyperbilirubinemia, acalculi cholecystitis, acute kidney injury (AKI) with dd acute on chronic kidney disease (ACKD), suspect pneumonia, and sepsis. Indications for SC were premature rupture of membrane (PROM). The patient initially complained of yellow body and eyes 10 days before delivery with additional complaints including tea-colored urine and brown feces. Chest x-ray results showed infiltrates on the right paracardial suggesting pulmonary inflammation. Abdominal x-rays showed normal result. Abdominal ultrasound results suggested acalculi cholecystitis, however, liver, lien, pancreas, kidney right and left, urinary bladder, uterus, adnexa right and left showed no abnormality. The patient was treated with intravenous fluids, nasogastric insertion for nutrition, analgesics and antibiotics and other symptomatic therapy. The patient was discharged after 20 days of treatment.

Conclusion: This case highlights a potentially fatal complication of AFLP case with acute pancreatitis manifestations and the need of rapid diagnosis and comprehensive management to avoid the complicaton and death.

Link of Video Abstract: https://youtu.be/9-ynkRS_wo8

Introduction: Brunner’s glands are acinotubular glands which are located mostly  in the deep mucosal or submocosal layers of the proximal duodenum. Hyperplasia of these glands is reported in almost 1 in 50 upper gastrointestinal endoscopies and accounts for approximately 5 to 10 percent of all benign duodenal tumors. Brunner’s gland hyperplasia is usually asymptomatic. It  can take form of polypoid or mass lesions and precipitate pyloric obstruction, gastrointestinal hemorrhage, and intussusception in children. Due to its rarity in pediatric population, it tends to be misdiagnosed.

Case Description: This case report presents a case of seven year old boy with Brunner’s gland hyperplasia presented with recurrent vomiting. A seven year-old boy was admitted to the hospital due to of worsening of intractable vomiting since five months prior to admission. He also felt abdominal discomfort, bloating, and early satiety since he was 3 years old. The patient had been treated with several medications without significant improvement. Epigastric pain was observed on abdominal palpation. Gastroscopy showed partial gastric outlet obstruction (pyloric obstruction), erosive gastritis, multiple ulcers, and erosive esophagitis. Histopatologic results from biopsy revealed chronic gastritis and positive for  Helicobacter pylori. Abdominal CT scan showed protrusion solid lesion intraluminal with diameter 1.18 x 1 x 1.25 cm in part II duodenum. Patient was consulted to pediatric surgeon for laparotomy exploration and duodeno-duodenostomy. Excision of Brunner’s gland dan biopsy were performed. Surgical report showed gastric dilatation with duodenal wall hypertrophy on part I-II of duodenum. Histopathological from biopsy revealed Brunner’s gland hyperplasia with lymphoid tissue.  Post surgery patient recovered well and eventually discharged without any complains. The prognosis was good.

Conclusion: Generally, Brunner’s gland hypertrophy is benign and has a good prognosis. However, with the growth of benign proliferative lesions of Brunner’s glands, mucosal ulcers may develop, thereby leading to the repair of gastric foveolar metaplasia with papillary architecture and then malignant transformation.

Introduction: Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non-pharmacological therapies can be viable alternatives to conventional therapies. Recently, laser therapy has been widely used in the treatment of acne vulgaris due to its effectiveness and safety as it provides a more rapid response with less rate of recurrence, specifically 1064nm Nd: YAG laser. Few studies have investigated laser combinations. Combination 1064nm Nd: YAG and 2940nm fractional erbium laser for severe acne with acne scar has not been reported.

Case report: We report a case of severe acne with acne scars in a 21-year-old female, skin type IV, treated using 1064nm Nd: YAG laser in five sessions and 2940nm fractional erbium laser two sessions. Reduction of acne lesions counts and acne scars improvement prominent after Nd:YAG laser at least four sessions. Our patient's acne scars improved not significantly after 2940nm fractional erbium laser. Acne remission was sustained through the follow-up period. There were no post-inflammatory hyperpigmentation and no exacerbation of acne lesions after the procedures.

Conclusion: 1064nm Nd: YAG laser is very effective for mild to severe acne and improves new acne scars. While 2940nm fractional erbium laser is more effective for mature scars.

Introduction: Transverse vaginal septum or known as partial vaginal agenesis, is a rare case. The most frequent causes are defects or fusion disorders of the Mullerian Ductus and defect formation of the urogenital ducts of the urogenital sinuses. The septum may obstruct the entire vaginal opening and cause hematocolpos. The diagnosis is based on a detailed physical and gynecological examination supported by ultrasound and magnetic resonance imaging (MRI). The management option is surgery which is performed as soon as possible.

Case Report: An 11-year-old girl came with lower abdominal pain and amenorrhea, diagnosed with a transverse vaginal septum complicated with hematocolpos based on anamnesis, physical and gynecological examination, and imaging study by ultrasound and MRI. The management includes excision and cross-incision of the septum followed by diagnostic laparoscopy. Endometriosis was found at the broad ligament during laparoscopy and continued with endometriosis resection.

Conclusion: The transverse vaginal septum is still one of the rare anomalies of the Mullerian Duct. The diagnosis was made from a history of low abdominal pain, primary amenorrhea, and a pelvic examination that revealed the vaginal septum. MRI is a gold standard examination procedure of anomalies or abnormalities involving the vagina. The management of the transverse vaginal septum is a surgical approach involving drainage of hematocolpos.

Introduction: Ovarian cyst torsion is a rare gynecological emergency characterized by acute abdominal pain due to torsion of the ovarian vascular pedicle. Most cases are associated with several risk factors including pregnancy, ovarian cyst size, and pelvic organ anatomy. Despite the incidence of detected ovarian cysts during pregnancy increasing along with better antenatal care, the clinician needs to consider appropriate management for the safety of the mother and fetus.

Case description: A 25-years old woman who was pregnant with a gestational age of 10 weeks was referred to the Emergency Department of Zainoel Abidin General Hospital. The patient complained of sudden abdominal pain at the lower right abdominal quadrant within the last 5 hours before hospital admission. The patient stated the history of the ovarian cyst based on previous ultrasonography assessment on previous antenatal care. Abdominal tenderness on the relevant quadrant was positive during the physical examination. A vaginal examination revealed a regular non-tender cystic mass with a diameter of 5 cm on the right adnexa. The ultrasonographic finding showed the presence of a cystic mass on the right ovary with a size of 6.52 cm x 5.6 cm x 4.06 cm and a positive whirlpool sign. The patient was diagnosed with ovarian cyst torsion in the first trimester of pregnancy. Due to the patient refractoriness to conservative management, the patient was treated surgically by cystectomy laparotomy in an emergency setting. Histopathology examination of the intraoperative specimen revealed a luteoma. The pregnancy was successfully maintained until full-term pregnancy and the baby was delivered by caesarian section due to malposition.

Conclusion: Appropriate supportive management was required to maintain pregnancy and prevent fetal loss.

Link of Video Abstract: https://youtu.be/ahjJloTwZQE

Introduction: Apert syndrome (AS) is a rare type 1 acrocephalosyndactyly syndrome, characterized by craniosynostosis, severe syndactyly of the hands and feet, and dysmorphic facial features. It exhibits autosomal dominant inheritance assigned to mutations in the fibroblast growth factor receptor gene.

Case Illustration: We presently describe the case of a 14 years old male patient with acrocephaly, prominent forehead, ocular hypertelorism, proptosis, short and broad nose, pseudoprognathism, crowding of teeth and ectopia, maxillary hypoplasia, low hairline, webbed neck, pectus excavatum, and severe bilateral syndactyly of hands and feet. The examination revealed apical cranium, occipital flattening, enlargement and hypoplasia of the premaxillary opening, crowding, ectopic teeth, tapering of the mandibular apex, and pseudognathia.

Conclusion: We reported a 14 years old male patient with AS with craniosynostosis and acrocephalosyndactyly. The characteristics of clinical manifestation of AS should be aware by physicians to be able to diagnose the disease.

Title:
“The First Mulawarman International Conference on Tropical Public Health”

Theme:
“Digital Health for Public Health on Post-Pandemic Covid-19”

This conference will be held on:
Day, date : Saturday , November 12, 2022