Relationship of gallbladder histopathology towards types of stones in cholelithiasis patients at Universitas Sumatera Utara Hospital, Medan, Indonesia

Background: Cholelithiasis is a common disease of the gall bladder. It is estimated that around 10-15% of the population in western countries suffer from cholelithiasis. Types of gall bladder stones can be classified into cholesterol stones (containing cholesterol> 50%), mixed stones (containing 20-50% cholesterol), and pigment stones (containing cholesterol <20%). Cholelithiasis causes various histopathological changes in the gallbladder mucosa such as acute and chronic inflammation, Cholelithiasis, hyperplasia and carcinoma. The general objective of this study was to determine the histopathological relationship of the gallbladder to the type of stone in cholelithiasis patients at USU Hospital.

Method: The design in this study was cross-sectional. The sample of this study was 49 samples of patients with cholelithiasis who underwent cholecystectomy either by open cholecystectomy or per-laparoscopic cholecystectomy at Universitas Sumatera Utara (USU) Hospital. Gallstones and gall bladder will be examined in the laboratory. Data analysis will use the chi-square test.

Result: From 49 research samples found the most types of stones were mixed stones with 24 (49%) and histopathological results showed 18 examples (36.7%) were chronic inflammation. Based on the Chi-Square test found a significant relationship between the types of stones with histopathology of the gallbladder with a p-value of 0.001.

Conclusion: There is a significant relationship between the type of stone with histopathology in patients with cholelithiasis.

Mean pulmonary artery diameter in chest CT scan in the Thai population

Introduction: Pulmonary hypertension has been associated with a significant increase in morbidity and mortality. The pulmonary artery diameter measurement from a CT scan is routinely used to predict possible evidence of pulmonary hypertension. However, no data available as a reference for the normal range, especially in the Thai Population. The primary purpose of this study was to determine the normal diameter of the main pulmonary artery (MPA) and ascending aorta (AAo) and the ratio between MPA and AAo diameter in the Thai population.

Methods: Patients who met the inclusion criteria and had a chest CT performed in Songklanagarind hospital between 1 January 2014 and 14 July 2014 were enrolled. Measurement of the MPA diameter at the level of its bifurcation and the AAo from an axial-view contrast-enhanced CT chest (venous phase) image was done. The ratio between the diameter of MPA and AAo was then calculated.

Results: 2395 patients were included in this study (male = 1271 patients, female = 1124 patients, aged between 20-96 years; mean = 57 years old). The mean diameter of the MPA was 25.21 mm, and the mean diameter of the AAo was 30.78 mm. The mean MPA/ AAo ratio was 0.83. The sex-specific mean diameters of the MPA were 25.4 mm in men and 25.0 mm in women. The mean diameters of the AAo in men and women were 31 mm and 30 mm, respectively.

Conclusion: The mean MPA diameter obtained from chest CT scans in this study was about 25.4 mm in men and 25.0 mm in women. These values are easily obtained from chest CT scans and are highly reproducible. Therefore, it may be used as a reference value for a healthy Thai population.

Functional assessment of operative and non-operative management in major pelvic fracture at Dr. Moewardi Hospital, Surakarta, Indonesia

Introduction: Pelvic fractures are responsible for skeletal injuries and soft tissue-related injuries. Pelvic fracture is a disorder of the pelvis bones' structure, including the hip bone, sacrum, and coccyx. The condition will result in stable status if the pelvis can resist weight-bearing loads without the incidence of any displacement. This study aims to determine pelvic fracture outcome, in which operative and non-operative management used the Majeed score to evaluate the functional results.

Method: A retrospective case-control study was performed to retrieve data from medical records of patients with pelvic fractures at Dr. Moewardi Hospital Surakarta for the period from January 1^st, 2017, until December 31^st, 2019. The evaluation of reduction quality was conducted following the scores put forward by Majeed to evaluate the clinical outcomes. Data analyzing used SPSS V.24.0 (IBM Corp). P-value of <0.05 was determined as the statistical significance.

Results: In this study, there were 40 samples of pelvic fracture cases; 60% were male, 55% were aged 19 – 40 y.o, motor crash caused 67%, 37.5% were cases of pubic rami fractures. Besides, operative management was 52,5%, while non-operative was 47,5%. Further, operative management's functional outcome was excellent at 66%, good at 19%, fair at 9%, and poor at 8% of the patients. Patients treated with operative management had significantly fewer severe injuries, as rated using the Majeed score than the non-operative group.

Conclusion: The results suggest that operative treatment may be a viable option in treating major pelvic fracture as it provides better functional results than non-operative treatment.

Sexual satisfaction of Indonesian women with breast cancer in Central Java, Indonesia

Background: The negative impact of breast cancer diagnosis on the sexuality of women patients is well-known. Sexual dissatisfaction arises from the disruption of physical appearance by the tumor or as a result of both operative or non-operative treatments. This study aimed to describe the perception of sexuality and its quality of breast cancer in Indonesian women.

Methods: This descriptive study recruited women diagnosed with breast cancer that have undergone chemotherapy, radiotherapy, and surgery, either in singular, combination, or no treatment at all. The sexuality was assessed using the Indonesian version of the Sexual Satisfaction Questionnaire (SEXSAT-Q).

Results: A total of 113 female breast cancer patients ranging from 20 to 71 years old participated in the study. The majority of respondents were clinically diagnosed with stage II (36.2%) or higher (54.9%). Most patients underwent surgery (91.1%) and chemotherapy (85.8%). Before the diagnosis of cancer, the level of sexual satisfaction was good on average, which remained stagnant for 64 (56.6%) participants during cancer treatment. Significant anxiety and distress were reported by 35 patients (31.0%), depression by 21 patients (18.6%), and tiredness by 48 patients (42.5%).

Conclusion: The sexual satisfaction of women with breast cancer patients in our study group is average on general, prior or after cancer diagnosis. However, the treatment's negative psychological impact is quite profound, affecting almost half of the study participants.

The role of cholelithiasis risk factors in stone types in cholelithiasis patients at Universitas Sumatera Utara Hospital

Introduction: Cholelithiasis is the most common disease in the biliary tract. Several risk factors have been known as risk factors of cholelithiasis, such as obesity and female gender. Meanwhile, only few studies evaluate correlation between clinical characteristics and stone type in cholelithiasis. The study aims to evaluate correlation between clinical characteristics and stone type in cholelithiasis patients at Universitas Sumatera Utara Hospital.

Method: The study design was cross sectional. The sample of this study was 35 people with cholelithiasis patients who underwent cholecystectomy either by open or laparoscopic cholecystectomy at Universitas Sumatera Utara Hospital. Gallstones will be examined by a laboratory. Risk factors assessed were age, gender, body mass index, hemoglobin bilirubin, cholesterol levels. Data analysis will use the Kruskal Wallis test.

Result: From 35 study samples was found the most types of stones were mixed stones with 17 (48.6%). Based on the Kruskal Wallis test found a significant relationship between the type of stone with gender, body mass index, total bilirubin, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C).

Conclusion: Factors related to the type of cholelithiasis stone are gender, body mass index, bilirubin levels, total cholesterol levels, HDL-C, and LDL-C.

Intracranial stenosis in patients with post-ischemic stroke: a case-control study Rizaldy Pinzon1, Andre Dharmawan Wijono1

Background: Despite its remained position as the main culprit of stroke worldwide, studies on intracranial stenosis in Indonesia are still very limited. It is necessary to research to measure the prevalence and risk factors of intracranial stenosis in post-ischemic stroke.

Method: We conducted case-control research with participants of 234 ischemic stroke patients. Each patient was listed for their risk factors and analyzed for their association with intracranial stenosis. Intracranial circulation was determined by transcranial doppler (TCD) sonography TD-DOP 9000 with a 2-MHz probe. A peak systolic velocity (PSV) of >140cm/s or mean systolic velocity of (MSV) >80cm/s were used as criteria for middle cerebral artery (MCA) stenosis. In contrast, PSV>90 cm/s or MSV>60cm/s were used to determine the posterior circulation stenosis. Statistical analysis used SPSS 18.0 software which The Independent t-test and chi-square test were used to assess significant differences in correlation to intracranial stenosis. P-value <0.05 was statistically significant.

Result: Intracranial stenosis cases were 38%, with the anterior circulation being the most common stenosis location. Hypertension, diabetes mellitus and dyslipidemia were the most often risk factors. Only hypertension with OR=2.97 (95%CI=1.76-4.98) and diabetes mellitus with OR=1.48 (95%CI=1.12-2.43) were positively correlated with increased risk intracranial stenosis.

Conclusion: The occurrence of intracranial stenosis in ischemic stroke patients was high and increased with the presence of hypertension or diabetes mellitus.

Correlation of CD44 and CD24 expression with the positive response after neoadjuvant chemotherapy in stage IIIB breast cancer patient at Dr. Saiful Anwar Hospital, Malang, Indonesia

Background: Breast cancer is a type of cancer due to abnormal cell growth of breast tissue. CD44 and CD24 is a potential target in breast cancer therapy. This study aims to evaluate the responsiveness of stage 3 breast cancer to chemotherapy by measuring the expression levels of CD44 and CD24 molecules

Methods: We conducted an observational study with pre-and –post-intervention or test research types. This study was performed on 49 Luminal Stadium IIIB subtype breast cancer patients who received 3 series of neoadjuvant chemotherapy at RSUD dr. Saiful Anwar Malang, immunohistochemical examination, and painting of tissue specimens from the biopsy results. Data were analyzed using SPSS version 20 for Windows.

Results: Based on the Paired t-test and discriminant analysis, there were no significant differences between CD44 and CD24 expression before and after chemotherapy (p=0.501 and p=0.097, respectively). Therefore, the results of the study prompt that the expression of CD44 and CD24 could not be a predictor of the chemotherapy response.

Conclusion: There are different expressions of CD44 and CD44 in primary breast cancer before and after chemotherapy, but no significant difference was found.

The effects of cyclophosphamide, adriamycin and 5-fluorouracil chemotherapy on blood cells and cardiac hemodynamics in breast carcinoma patients: a case study at Dr. Kariadi General Hospital, Semarang, Indonesia

Background: One of the treatment modalities for breast malignancy is chemotherapy. Chemotherapy could kill cancer cells as well as normal cells, including blood cells and cardiac cells. Early detection of adverse events includes myelosuppression and cardiotoxicity could reduce morbidity and mortality rates. This study aims to determine a decrease in blood cells and cardiac hemodynamics in breast carcinoma patients who underwent Cyclophosphamide, Adriamycin, and 5-Fluorouracil (CAF) chemotherapy.

Methods: Analytical prospective observational study with breast carcinoma. The measurements were Haemoglobin (Hb), Hematocrit (Ht), Erythrocyte (Ery), Leukocyte (Leu), Platelet (Plt), Left Ventricle Ejection Fraction (LVEF), Stroke Volume (SV), and Cardiac Output (CO) until 3^rd cycles of chemotherapy. Data were analyzed using SPSS version 17 for Windows.

Results: There were 35 subjects enrolled in this study. Decreases in Hb, Ht, Ery, Leu, and Plt after the 1^st, 2^nd, and 3^rd cycles of chemotherapy were statistically significant (p<0.05). There was a statistically significant decrease in LVEF, SV, and CO after the 1^st, 2^rd and 3rd cycles of chemotherapy (p<0.05). Besides, the SV and CO after the 2^nd and 3^rd cycles of chemotherapy were also decreased significantly (p<0.05).

Conclusions: There is a decrease in blood cells (Hb, Ht, Ery, Leu, Plt) and cardiac hemodynamics (LVEF, SV, and CO) in breast carcinoma patients who underwent CAF chemotherapy.

The role of psychosocial stressors, carbohydrate and protein intake on serum serotonin and cortisol levels in patients with depression: a preliminary evaluation

Introduction: Depression is a mental disorder associated with biological, environmental and psychological factors. Depression is estimated to be a disease that requires the second largest expense on treatment. Chronic stress will reduce serotonin activity and storage and also stimulate the adrenal cortex to release cortisol and other glucocorticoid hormones. Nutritional intake such as carbohydrates and protein also plays a role in depression with various mechanisms. The study aims to investigate the role of psychosocial stressors, carbohydrate and protein intake on serum cortisol and serotonin levels in patients with depression

Methods: The study used an analytic observational approach with a cross sectional design. Subjects were selected by consecutive sampling and were asked to fill out the general characteristics questionnaire, Beck Depression Inventory (BDI) - II to determine depression levels, Holmes Rahe scale to measure psychosocial stressors, food frequency questionnaires to measure carbohydrate and protein intake. Subjects who met the inclusion criteria were taken blood samples to measure the cortisol and serotonin levels.

Result: Of the 79 subjects, 57 (72%) women and 22 (28%) men with an average age of 43 ± 3 years. A total of 64 (81%) subjects were with mild psychosocial stressors and 5 (6%) were severe. Psychosocial stressor were not significantly correlated with either serotonin (p=0.479), nor cortisol level (p=0.625) Carbohydrate were not significantly correlated with serotonin level (p=0.628) and cortisol level (p=0.252). Protein was not significantly correlated with serotonin level (p=0.688) and cortisol level (p=0.110).

Conclusion: There was no correlation between psychosocial stressors, carbohydrate and protein intake with serum cortisol and serotonin levels in depressed patients.

The ethanol extract of Garcinia mangostana L peel reduces the isoniazid-induced liver damage in rats

Background: The long-term use of Isoniazid (INH) as the Tuberculosis (TB) treatment increases the risk of possible liver damage. The peel from Garcinia Mangostana L. has been shown to reduce hepatotoxicity in the rat model. However, the molecular mechanism of this effect is not well-understood

Objective: This study aims to investigate the effect of the ethanol extract of the peel of Garcinia Mangostana L or mangosteen in preventing INH-induced liver damage at the cellular and molecular levels.

Methods: A total of 32 male Wistar rats (Rattus Norvegicus) three to four months old with bodyweight between 170 and 200 grams are randomly enrolled into the negative control (NC), Positive control (PC), Treatment 1, and treatment 2 groups. The rats in the positive control (PC) and the treatment groups (T1, T2) were injected with 80 mg INH per kilogram body weight to induce liver fibrosis at the beginning of the study. The rats in the negative control group (NC) are injected with normal saline. The T1 and T2 groups are given 250 mg and 500 mg per kilogram body weight of mangosteen peel ethanol extract, respectively. After 35-days of treatment, blood samples were drawn from the rats, and the SGPT level was measured. Following the sacrifice, the liver tissues were prepared into slides and immunohistochemically stained and the TGF-β1 expression and fibrosis level were examined.

Results: The expression of TGF-β1 is significantly higher in the PC and T1 groups than in the NC group (p-value <0.05). Compared with the NC groups, the SGPT level is significantly higher in the PC, T1, and T2 groups with a p-value less than 0.05. The fibrosis scoring in the T2 group is statistically lower than the PC group. (p-value <0.05)

Conclusion: The ethanol extract of Garcinia mangostana L peel at a dose of 500 mg/kg of body weight shows a significant difference in the fibrosis score between the treatment group and the positive control group.

Comparison of skin hydration degrees based on moisturizing time in children's atopic dermatitis

Background: Atopic dermatitis (AD) is a skin disease accompanied by an inflammatory reaction influenced by heredity and environment. Atopic dermatitis commonly occurs in infants and children. Overcoming dryness of the skin is an important strategy in the management of AD. One way is by using a moisturizer (emollient) to increase the skin barrier function. This study aimed to compare the degree of skin hydration based on moisturizing time in children with AD, immediately after bathing and 30 minutes after bathing.

Methods: This analytical study's design was quasi-experimental (pre-post clinical trial) conducted in dermatology-venereology policlinic of Universitas Sumatra Utara Hospital. Subjects who met inclusion criteria were children with AD, 2-14 years who met William's criteria,  no recent use of topical preparations, and informed consent approved. The bath soap and moisturizer used were Johnson's® baby milk soap and those containing ceramide-3 (Atocalm®), respectively, applied twice a day.  Moisturizing time is given immediately and 30 minutes after bathing on the volar part of the right forearm and left forearm, respectively. The degree of skin hydration was measured by Corneometer CM 825®, taken four times on the 1st, 8th, 15th, and 21st day, and categorized into very dry skin, dry skin, and normal skin.  Test analysis using SPSS software with p<0.05 was significant.

Result: Thirty-seven children with AD followed this study. The median age was 5 (2-13) years, female sex (21 children [56.8%]). There were differences in skin hydration between these groups. There was also significant right forearm volar skin hydration measured immediately after bathing, 1st, 8th, 15th, 21st day (42.3; 48.0; 55.3; 61.3 AU (Arbitrary Unit); p<0.001), respectively. Skin hydration on the left forearm's volar part is significant between 30 minutes after bathing, respectively 1st, 8th, 15th, 21st day (42.3; 44th,7th; 47.7; 52.0 AU; p<0.001). The total amount of dry skin and very dry skin was more in the moisturizing group 30 minutes after bathing than immediately after bathing. 

Conclusion: Significant difference in skin hydration degrees found between immediately after the bathing group (on the right forearm volar) and 30 minutes after bathing (on the left forearm volar).

The correlation of blood thiamine concentrations with lactate acidosis in peritonitis patients with sepsis

Background: Vitamin B1 (Thiamine) functions as a pyruvate dehydrogenase cofactor to produce acetyl Co-A and activate the Krebs cycle in cellular metabolism. The hypermetabolic state in septic condition requires excess thiamin to keep the Krebs cycle functioning well. The thiamin level in the blood decreases and causes mitochondrial dysfunction and vice versa results in an increase in lactate levels. This study aims to evaluate the correlation of blood thiamine concentrations with lactate acidosis in peritonitis patients with sepsis

Methods: Prospective observational study in 65 adult septic patients who came to the hospital with peritonitis and underwent laparotomy. Thiamine concentration was assessed on days 1, 3, and 5 by liquid chromatography-mass spectrometry (LC-MS). The primary outcome was lactate levels. Data was analyzed using SPSS version 23 for Windows.

Results: The incidence of thiamine deficiency (TD) was 61.5% of patients. Specifically, 29 cases (44.6%) had absolute thiamine deficiency (TD) on presentation, 4 patients (6.1%) developed it on day 3, and another 7 patients (10.8%) on day 5. Thiamine was negatively correlated with lactate levels (r=-0.600; p=0.020). The relationship appeared after multivariable regression analysis controlling for sex, septic shock, and malnutrition. Overall, for the TD group, there was a significant association with septic shock, malnourishment, and Mortality (p<0.05).

Conclusion: Thiamine deficiency had significantly raised lactate levels, which might increase the risk of Mortality.

A new hope of CD133+ bone marrow stem cell for functional exercise capacity improvement in low ejection fraction coronary artery bypass graft patients: a clinical trial

Background: Patients with low ejection fraction who are undergoing coronary artery bypass graft (CABG) only have an insignificant improvement in ejection fraction. This condition will make a little hope to achieve an improvement in physical performance. But now, from a view study, CD133⁺ stem cells offer new hope for this situation. This study evaluates CD133+ bone marrow stem cells' role for functional exercise capacity improvement in low ejection fraction coronary artery bypass graft patients.

Methods: Thirty patients with ischemic heart disease who had ejection fraction <35% at the National Cardiovascular Center were randomized into 2 groups. The treatment group undergoes the CABG + CD133⁺ procedure and the control group undergoes the CABG only. All research subjects underwent follow-up before and 6 months after the procedure. Fraction ejection, scar size, wall motion score index, ventricular dimensions, myocardial perfusion measured by cardiac MRI, 6 Minutes Walking Test (6MWT) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) as an additional parameter for physical performance and quality of life. Data was analyzed using SPSS version 21 for Windows.

Results: The results of the fraction ejection parameters showed a significant improvement in the treatment group, from 25.88±5.66% to 34.57%±11.31% compared to CABG only 30.18±3.85% to 31.61±7.89% (p=0.040), in the perfusion defect showed improvement but not significant, left ventricular end-systolic volume and left ventricular end-diastolic volume showed improvement with no significant result, scar size was found to be an improvement in the treatment group 10 persons (76.92%) compared to the control group 5 persons (38, 46%) (p=0.040), the wall motion score index and 6MWT showed a significant improvement in the treatment group (p=0.003 and p=0.03, respectively). The MLHFQ parameter showed improvement but not significant.

Conclusion: CD 133+ stem cell implantation in patients with low ejection fraction who undergo CABG provides improved myocardial function and indirectly improves functional exercise capacity and patients' quality of life.

The role of epidermal growth factor receptor as progression factor in cervical intraepithelial neoplasia and squamous cell carcinoma

Background: Cervical carcinoma is the most common cancer with a prevalence of 28.6% of all cancers in women in Indonesia and is one of the leading causes of death among gynecologic malignancies. Prevention and understanding are needed in terms of initiation and development of precancerous lesions into cervical cancer. About 90% of cervical cancers are squamous cell carcinomas that develop from intraepithelial neoplasia. Epidermal Growth Factor Receptor (EGFR) is an expression product of the proto-oncogene c-erbB-1 (HER-1), which plays a role in the proliferation, differentiation and acceleration of the transformation of malignant cells. This study aimed to prove the role of EGFR as a progression factor of cervical intraepithelial neoplasia and cervical squamous cell carcinoma.

Methods: The study design was a cross-sectional analytic observational study, with a total sample of 36, which was taken from biopsy or surgery from patients with cervical intraepithelial neoplasia (CIN) and cervical invasive squamous cell carcinoma (SCC), whose tissues were examined at the Anatomical Pathology Laboratory, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital. Histopathological diagnosis and determination of the type of malignancy were carried out by staining with Hematoxylin and Eosin (H & E). The immunohistochemical stain evaluated EGFR expression.

Results: The age range of CIN was 21-48 years and SSC 33-61 years, mean age 41.8 ± 10.55 years. A total of 16 (44.4%) showed CIN namely 9 (25%) low-grade CIN, 7 (19.4%) high-grade CIN, and 20 (55.6%) SCC. There was a significant difference in the expression of EGFR at low-grade CIN, high-grade CIN and SCC (p = 0.004). There was a significant difference in EGFR expression between low-grade CIN and high-grade CIN (p = 0.035) and between low-grade CIN and SCC (p = 0.003). There was no significant difference in EGFR expression between high-grade CIN and SCC (p = 0.441).

Conclusion: EGFR has a role as a progression factor in CIN and SCC. There was no difference in the expression of EGFR between high-grade CIN and SCC, probably because in this study, carcinoma in situ was also included in high-grade CIN.

Predicting factors for walking ability of postoperative patients with hemiarthroplasty at Wahidin Sudirohusodo Hospital in Makassar

Background: The ability to make early predictors in post-surgery includes health workers preparing patients for outpatient care. The purpose of this study is to determine the factors that influence the ability to walk postoperative hemiarthroplasty patients when patients are admitted. We hypnotized that age, sex, preoperative walking status, time interval between injury to surgery, preoperative hemoglobin level, muscle weakness, muscle atrophy, anxiety level and body mass index would be predictive factors for walking ability post hemiarthroplasty surgery.

Method: An descriptive-analytic study with a cross sectional retrospective approach was conducted at the Wahidin Sudirohusodo Hospital in Makassar 2020. Patients with fractures of the proximal femur had undergone hemiarthroplasty surgery and were over 50 years of age at admission from September 2019 to October 2020. Bivariate and multivariate with logistic regression was used

Result: 39 samples according to inclusion criteria were analyzed. Muscle atrophy has a significant correlation with p = 0,04 (p<0,05). Body mass index and muscle atrophy have the most dominant factors for predict walking ability post hemiarthroplasty (EXP (B) 7,282 & EXP (B) 0,083) eventhough not significant statistically (p = 0,116 & p = 0,073)

Conclusion: The muscle atrophy variable in this study was the most significant factor in prediction walking ability post hemiarthroplasty surgery. Also, patient with normal BMI will encourage early walk after surgery better than abnormal BMI in the same muscle-wasting condition

The dynamic of Soluble Vascular Cellular Adhesion Molecule -1 (sVCAM-1) level in Overnutritious children with Dengue Infection

Introduction: Dengue infection is still posed a significant medical challenge for pediatric population in developing countries. However, increased prevalence of overweight and obesity among children in those countries increased the possibility of the coexistence of these conditions. However, their interaction is still under investigated. Therefore, this study was aimed to study the dynamic of sVCAM-1 level as the known predictor of the severity of dengue infection with over nutritional status in children with dengue infection.

Method: An analytic observational nested case-control study was conducted in Paediatric Division Sanglah General Hospital, Bali. The children with DHF between 6 months old to 12 years old were included as the case group while control groups consisted of pediatric patients with just Dengue Fever (DF) with the same age range. The diagnosis of dengue was established using 1997 WHO criteria while nutritional status was assessed using WHO curve. The sVCAM-1 was evaluated using ELISA technique.

Results: The level of sVCAM-1 was significantly higher in patients with DHF than patients with DF only. The level was also fluctuated more in DHF patients. Likewise, the sVCAM-1 level was also significantly higher in DHF patients with overnutrition compared to normal DHF patients with a more fluctuated pattern over the course of 3 days (starting from day 4 to day 7). Finally, no significant finding was observed in sVCAM-1 level in DSS patients albeit the difference in concentration pattern.

Conclusion: Overnutrition is seems to be associated with higher concentration of sVCAM-1 and higher fluctuation of its concentration in children with DHF.

Evaluation of chronic disease management programs in developed and underdeveloped regions in Indonesia

Introduction: Chronic diseases have become a major cause of death in the world, and a major source of morbidity and misery. Approximately 80% of related deaths occur in developing countries. Chronic Disease Management Program (CDMP) is an integrative program aimed to control the prevalence of chronic diseases. Therefore, this study aimed to evaluate the interaction between context and process in CDMP services, and to determine how CDMP was implemented in developed and underdeveloped regions.

Methods: This qualitative study used the Consolidated Framework for Implementation Research (CFIR). Subjects were selected by purposive sampling from CDMP organizers in Primary Health Centers for a commitment-based capitation assessment. Transcript data were analyzed thematically by summarizing and identifying major themes based on the CFIR domains.

Results: The main activities of the CDMP (medical consultations, monitoring of health status, health educational, reminders, home visit and group activities/gymnastics) in developed regions were conducted according to the technical manual. However, in underdeveloped regions, some modifications were needed, i.e. the medical consultations, medical checkups and health education undertaken by a nurse in charge and not always conducted by a doctor; and, the services were conducted at the village meeting halls. Also, the reminders were delivered through socialization by local governments and direct invitation by team members when they met the participants on the roadway or in the neighborhood around the participants’ homes.

Conclusion: CDMP cannot fully be implemented in underdeveloped regions and some modifications were needed according to local conditions.

Correlation of low vitamin D status with atopic dermatitis severity in children

Introduction: Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disorder. Vitamin D has some roles in immunologic mechanisms. Vitamin D may influence the severity of AD. Previous studies of vitamin D correlation in children with atopic dermatitis have revealed conflicting results. This study determines the correlation between low vitamin D status with the severity of atopic dermatitis in children. 

Methods: This is a cross-sectional analytical study with a cross-sectional approach that involved DA subjects aged ≤17 years with low vitamin D status. The recording of basics data and examination of subjects included assessing the scoring atopic dermatitis (SCORAD) score and measuring 25-hydroxyvitamin D (25(OH)D) level for all subjects. Statistical analyses were performed using Pearson's correlation coefficients, with P<0.05 was considered statistically significant. 

Result: A total of 30 subjects with AD with the most extensive distribution was in the age group of 11–17 years (53.33%), sex proportions were equal both male (50%) and female (50%), all subjects have an atopic family history (100%). The mean vitamin D level was 18,02 ± 4,56 ng/ ml (deficiency), and the mean SCORAD score was 20,03 ± 5,80 (mild). There was a significantly strong negative correlation between low serum vitamin D level and severity of AD in children (r = -0.666, p = 0.001). 

Conclusion: Lower vitamin D status is inversely associated with the severity of AD in children.

The role of endoscopic spinal surgery for the management of degenerative spinal diseases

Background: Degenerative spinal disease increases in proportion to life expectancy. Surgical treatments that play an essential role in the management of degenerative spinal disease have evolved from open surgery to minimally invasive surgery as well as endoscopic spinal surgery. Advanced pathological understanding, diagnostic imaging, and instrument progress have support for endoscopic spinal surgery. The study aims to report the current situation of endoscopic spinal surgery to treat degenerative spinal diseases in the Department of Neurosurgery of Kariadi Hospital.

Method: Review the Endoscopy Spine Surgery case in the Department of Neurosurgery of Kariadi Hospital with degenerative spinal diseases including canal stenosis and disc herniation at all levels.

Results: A total of 123 degenerative spinal diseases have been treated with endoscopic spinal surgery. Most of patients comes with HNP (89 patients, 72.4%) and operated in lumbal segment (87 patients, 70,7%). Estimated blood loss parameter in <50 years group had mean 72.85 ± 44.79 ml and >50 years group had mean 115.00 ± 95.25 ml with p=0.001. We got high correlation between operation time and estimated blood loss with r = 0.779 and statistically significant (p=0.000)

Conclusion: Endoscopic surgery appears to be an option for treating degenerative spinal diseases especially for herniation and canal stenosis. The lumbar and thoracic regions are common areas for endoscopic spinal surgery.

Fat intake in Javanese breast cancer patients: any difference?

Background: Breast cancer is the second most prevalent women’s malignancy in Central Java. The risk of breast cancer incidence drops by 2.5 times for breast cancer if fat consumption is reduced by 50%, although not all types of fat intake increase the risk of breast cancer incidence. Fat consumption in Indonesia increased by 11% in the last 7 years. The study aims to analyze the differences in fat intake between breast cancer subjects and healthy subjects.

Methods: This study is a cross-sectional study. We invited 45 outpatients diagnosed with breast cancer in Kariadi Hospital from January to August 2019 as well as 45 healthy subjects who are relatives or friends of the patients who met the inclusion criteria to participate in this study. Various types of fat intake were measured with quantitative food frequency questionnaires. The statistical analysis employed a chi-square test and Mann-Whitney test for non-parametric tests and an independent t-test for parametric data.

Results: There was a significant difference in polyunsaturated fatty acid (PUFA) intake between breast cancer patients and healthy subjects (p=0.022). This study found no significant differences in total fat intake (p=0.677), saturated fatty acid (SFA) (p=0.368), monounsaturated fatty acid (MUFA) (p=0.593), omega 3 (p=0.095), omega 6 (p=0.092), and TFA (p=0.669) between breast cancer patients and healthy subjects.

Conclusion: There is a significant difference in PUFA intake, but not in the other types of fat between breast cancer patients and healthy subjects. For further study, more precise and objective fat intake measurements may be achieved in studies with animal models.

Differences in AGEs-N-Carboxymethyllysine and Kidney Injury Molecule-1 in non-diabetic subjects, diabetic with and without diabetic nephropathy

Background: Diabetic nephropathy (ND) is a complication of diabetes mellitus (DM), characterized by persistent albuminuria. N-carboxymethyl lysine (CML) is the most extensive advanced glycation end products (AGEs), formed from the fructoselysine amadori. Kidney Injury Molecule 1 (KIM-1) is a type 1 transmembrane glycoprotein. The aim of the study is to analyze the differences in AGEs-CML and KIM-1 levels in the non-DM subject, DM without and with DN.

Methods: A cross-sectional analytic observational study was conducted on 25 non-DM subjects (K1), 25 DM without DN (K2), and 25 DM with  DN (K3) in PROLANIS Semarang. AGEs-CML and KIM-1 levels were measured using the ELISA method. Inter-group AGEs-CML levels were analyzed using the One way ANOVA test, followed by post hoc Games-Howell. The levels KIM-1 between groups were analyzed using the Kruskal-Wallis test levels, followed by Mann Whitney post hoc test and p<0.05, were considered significant.

Results: There were differences in AGEs-CML levels between K1 (739.89±227.37 ng/ml) and K3 (911.79±107.44) (p = 0.005), between K2 (798.82±153.03) and K3 (911.79 ± 107.44) (p = 0.012) and there was no difference in K1 and K2 (p =0.535). There were differences in KIM-1 level between K1 [9.82 (5.99 – 14.83) pg/ml] and K2 [15.31 (10.12 – 30.21) (p <0.001)], between K1 [9.82 (5.99 – 14.83)] and K3 [15.11 (8.27 – 25.63) (p <0.001)] and there was no difference between K2 and K3 (p=0.720)

Conclusion: The highest AGEs-CML levels were significantly found in the K3 group, followed by K2 and the lowest in K3. KIM-1 levels were significantly found in the K2 group, followed by K3 and the lowest in K1.

Relationship between IL-6, IL-1β, and vitamin D on frailty status in elderly women

Background: The aging process is associated with an increase in proinflammatory markers' serum levels, indicating that a chronic inflammatory process is correlated with an increase in disability, mortality, and frailty. Pro-inflammatory cytokines that increase with the incidence of frailty syndrome are IL-6, IL-1β and TNF-α. 25-hydroxyvitamin D (25 (OH) D) deficiency is also a potential risk factor for frailty, especially in the elderly. Vitamin D deficiency is associated with a risk of falling, which can speed up the frailty process. The aim of the study is to determine the relationship between IL-6, IL-1β and Vitamin D on frailty status in elderly women in elderly integrated health services (posyandu lansia), Semarang City.

Methods: This study used a cross sectional design with a consecutive sampling method of 27 subjects. Subjects measured vital signs, weight and height measurements. The study subjects were then taken venous blood to measure the levels of IL-6, IL-1β and vitamin D in blood serum and assessed their frailty status. Data analysis using SPSS 25 with Spearman correlation test.

Results: There were 27 elderly women who followed this study with an average age of 67.93 years. There are 16 people with pre-frail status and 3 people with frail status. There is a significant relationship between vitamin D levels in serum and frailty status (p = 0.008; r = 0.497). Variables IL-6 (p=0.328) and IL-1β (p=0.095) had no significant relationship with frailty status.

Conclusion: Most of the elderly women have a pre-frailty status, namely as much as 59.3%. Vitamin D levels in the body have a significant and unidirectional relationship with frailty status in elderly women.

The effect of cigarette smoke on the histopathological changes of the eustachian tube of Wistar rat

Background: Inflammation due to irritation of cigarette smoke causes metaplasia of the squamous epithelium of the Eustachian tube. Data on the prevalence and incidence of Eustachian tube dysfunction are still limited. The study aims to determine the effect of exposure to a stratified dose of cigarette smoke on the histopathological changes of the Eustachian tubes of Wistar rats.

Method: This study was a true experimental study with post-test only control group design using Wistar rats as the subjects. We included 24 Wistar rats in the study and divided them into four groups. The number of Wistar rats in each group was 6. The control group was not exposed to cigarette smoke. The treatment group 1, 2, and 3 were each exposed to four cigarettes, eight cigarettes, twelve cigarettes per day for thirty days, respectively. We assessed the Eustachian tube histopathological changes using four parameters, namely inflammatory cells, cilia, goblet cells, and epithelium. Finally, we analyzed the data using the Kruskal-Wallis test and the Mann-Whitney test.

Result: The Eustachian tube's histopathological changes occurred in inflammatory cells, cilia, goblet cells, and epithelial metaplasia. Group 1 showed grade 1 changes in all parameters assessed. Group 2 showed grade 2 changes in all parameters evaluated. Meanwhile, group 3 showed grade 3 changes in all parameters evaluated compared to other groups (p<0.05). There was a significant difference between the treatment group and the control group (p<0.05).

Conclusion: Cigarette smoke with stratified doses affects the histopathological changes of the Eustachian tube.

Prognostic significance of double expressor lymphoma subtype in patient with diffuse large B-cell lymphoma

Background: DLBCL is the most common type of non-Hodgkin lymphoma in Asia and Indonesia. DLBCL, based on cell of origin is divided into germinal center B-cell-like (GCB) and non-GCB subtypes. 20% of patients have a molecular profile double expressor lymphoma (DEL), which has a worse prognosis. The study aims to determine the relationship between DEL subtypes and cell of origin subtypes with clinical stage and 3-year overall survival of double large B-cell lymphoma (DLBCL) patients in Kariadi General Hospital Semarang.

Methods: This study sample was 36 DLBCL patients in Kariadi General Hospital from January to September 2017. The data collection including age of diagnosis, location, stage, cell of origin subtype, DEL subtype and 3-year overall survival. Data analysis using chi-square test and Kaplan Meier curve.

Results: DLBCL DEL subtype patients were significantly associated with advanced-stage (p: 0.028). DLBCL non-GCB subtype and DEL subtype patients had a 3-year overall survival that was significantly worse than GCB subtype and non-DEL subtypes (p: 0.026 and p: 0.006, respectively), with a 3-year survival rate of non-GCB subtypes was 38.9% and DEL subtypes were 33.3%. DLBCL patients with advanced stages also have a 3-year overall survival significantly worse than the early stage (p: 0.000), with a 3-year survival rate of 14.3%.

Conclusion: DLBCL non-GCB subtype patients, DEL subtypes and advanced stages have a lower 3-year overall survival rate and thus have a worse prognosis

The correlation between C-Reactive Protein, Vascular Cell Adhesion Molecule-1, and S100b with Alberta stroke program early CT Score in non-hemorrhagic stroke patients

Background: Stroke is the leading cause of disability and the second-most cause of death in Indonesia, caused by atherosclerotic obstructions in the cerebral and cervical arteries. C-reactive protein (CRP) is an acute-phase protein synthesized after the stimulation of the pro-inflammatory cytokines. Vascular cell adhesion molecule 1 (VCAM-1) is a sign of both inflammation and atherosclerosis. S100B protein is the dominant protein in the central nervous system released in the event of inflammation in the brain, such as stroke. CT-scan is a gold-standard diagnosis of non-hemorrhagic stroke. However, it has a limit to the onset of <6 hours. The Alberta stroke program early CT-score (ASPECTS) system enhances non-contrast CT-scan sensitivity in assessing early ischemic changes in areas supplied by the middle cerebral artery (MCA). The correlation between inflammatory variables and ischemic assessments on CT-scan needs to be analyzed further. This study aimed to prove the correlation between acute inflammatory signs and ischemic assessment using ASPECTS in non-hemorrhagic stroke patients.

Methods: This study was a cross-sectional study conducted in April-September 2019 on 47 non-hemorrhagic stroke patients in Diponegoro National Hospital, Telogorejo Hospital, and Tugurejo Hospital, Semarang. The diagnosis of non-hemorrhagic stroke was based on the non-contrast CT-scan and subsequent ASPECTS assessment. CRP, VCAM-1, and S100B levels were examined using the ELISA principle. The correlation test between variables was also performed employing the Spearman test.

Results: The correlation test results between the CRP, VCAM-1, and S100B levels with the ASPECTS were r = -0.035, p = 0.815; r = -0.117, p = 0,432; and r = 0.145, p = 0.332, respectively.

Conclusions: There was no significant correlation between the CRP, VCAM-1, and S100B levels with the ASPECTS. The increase in CRP and S100B inflammatory signs was not accompanied by low ASPECTS assessment, which depended on the appearance of lesions on the CT-scan.

Correlation between nutric score and adequacy of energy and protein intake with duration of mechanical ventilation in the intensive care unit Dr. Kariadi Hospital, Semarang-Indonesia

Background: Malnutrition in the ICU patients increases morbidity, mortality, cost, and mechanical ventilation (MV) duration. Nutric score has been validated as a screening tool in critically ill patients to identify patients at risk of malnutrition. The pathophysiology of malnutrition in critically ill is caused by severity of disease and inflammation resulting in hypercatabolism. Delivering protein-energy intake will reduce hypercatabolism and maintain lean body mass that affects outcome. The study aims to analyze the correlation between nutric score and adequacy of energy and protein intake with MV duration.

Methods: This cross sectional study enrolled 65 subjects ≥18 years with mechanical ventilation in the ICU of Dr. Kariadi Hospital Semarang during May to July 2020. The nutric score was determined within 24 - 48 hours. Statistical analysis used correlation test.

Results: The mean nutric score was 2.3 ± 1.49, duration of MV was 3.9 ± 4.44. There was significant correlation between nutric score and duration of MV (r = 0.685; p <0.001). The mean adequacy of energy intake was 1448.7 ± 235.87 and protein intake was 57.9 ± 11.94. There was significant negative correlation between adequacy of energy intake and MV duration (r=-0.246; p = 0.048). There was significant negative correlation between protein adequacy intake and MV duration (r=-0.34; p=0.006).

Conclusion: Nutric score was correlated with duration of MV in the ICU patients. Adequacy of energy and protein intake had significant correlation with duration of MV.

Risk score of contrast-induced nephropathy in patients after percutaneous coronary intervention

Background: Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) is still an issue in modern revascularization era. Recent risk stratification model used creatinine as biomarker which has some limitations. Increased ≥ 10 % of Cystatin-C after PCI has proven to be one of the earliest and accurate CIN after PCI biomarkers. The study aims to develop risk score based on predictors of contrast-induced nephropathy in patients after PCI with Cystatin-C as biomarker

Methods: A prospective cohort study of 129 patients after PCI at Dr. Kariadi General Hospital Semarang. Predictor analysis was carried out using bivariate chi-square test and multivariate logistic regression. The independent predictors obtained were then used as risk score variables. The Hosmer and Lemeshow calibration test and AUC ROC analysis for discrimination test tested the quality of the risk score.

Results: There were 3 independent predictors used as the risk score variables: Hypotension (score 1), anemia (score 1), creatinine baseline >1.5 mg/dl (score 1). Patients with total score ≥1 have higher risk to have CIN after PCI. The risk score had a good quality with the Hosmer and Lemeshow calibration test > 0.05 and relative modest discrimination ROC AUC 0.700 (95% IK 0.585-0.815;  p=0.001).

Conclusions: A risk score for risk stratification CIN after PCI has been created. The score has  good calibration and modest discrimination in predicting the risk of CIN after PCI.

Mentalization-based psychotherapy practices in patients with borderline personality disorder

Introduction: Mentalization-based psychotherapy (MBT) develops with the importance of establishing attachment relations with patients. MBT focuses on internal mental processes that occur in the therapeutic process that actively improve patient-therapist relationships.

Methods: A woman with preoccupied/anxious attachment is given mentalization-based psychotherapy. The goal of psychotherapy based on mentalization is to develop secure attachment relationships in therapy, use empathy and validation in reciprocal relationships, strengthen the patient's capacity to reduce emotional dysregulation and impulsive behavior, increase self-awareness, control of attention and flexible thinking in the context of emotions and relationships.

Results: The patient has begun to form a secure base attachment. Patients' mentalization has improved along with the formation of secure base attachments, patients are better able to do self-soothing and regulate emotions properly.

Conclusion: In the early years of life, patients have a pattern of interaction with caregivers who lack the need for mirroring. Furthermore, the patient develops into an insecure self and has an inherent preoccupied/anxious attachment. It has an effective representation and attention regulation system that is not functioning so that patients use existing stimuli as the basis of an insecure sense of self. Fonagy termed this condition with incoherent, disruptive "alien self" through controlling and manipulative behavior. The patient externalizes the alien self against the attachment figure. This externalization appears as a countertransference experience in a therapy session, if it can be appropriately managed it will emerge a feeling of coherence in the patient's internal world.

Maternal and perinatal outcomes with covid-19: lesson learned from the tertiary hospital

Background: The COVID-19 pandemic has led to global health crisis. Most studies have focused on evaluating the effects of COVID-19 on the general population, and there is still insufficient data on its impact on vulnerable populations, such as pregnant women. The study evaluates maternal and perinatal outcomes on pregnant women with COVID-19 in Kariadi as tertiary hospital in Central Java.

Methods: We prospectively collected and analyzed data for a cohort of 45 pregnant patients with COVID-19 between March 31^st and September 23^th 2020 in Kariadi hospital.

Results: A total of 45 pregnant women with COVID-19 delivered 46 babies including one twin pregnancy. The symptoms ranged from asymptomatic (54.3%), mild (26.6%), moderate (8.8%), severe (2.2%), and critical (6.6%). Gestational age was 22 to 41 weeks. Cesarean section was the most mode of delivery (86.7 %). Diabetes in pregnancy and HIV were the most common comorbidities found in this study, there were also seven patients came with preeclampsia. There were three maternal mortalities, we reported one maternal death (2.2 %) caused by severe respiratory disease COVID-19 in second trimester. The other two death cases were pregnancy complicated with severe preeclampsia with hyperthyroid and preeclampsia with diabetes in pregnancy.  Perinatal outcomes were intrauterine fetal death (8.7%), stillbirth (2.2%), and severe asphyxia (2.2%).

Conclusion: Although we obtain mostly maternal and perinatal outcomes in good outcomes, it is urgent to analyze potential high-risk maternal death with COVID 19.

The Role of MMP-9 rs 3918242 genetic variant in association between MMP-9 serum level with risk factors of acute ischemic stroke

Background: Increased serum MMP-9 level is known to be biomarker of atherosclerotic events and risk of cerebrovascular disease. Risk factors for acute ischemic stroke are known to be related to serum MMP-9 level. The genetic variant of MMP-9 rs3918242 is known to have a role in serum MMP-9 level. The aim of the study is to determine the role of MMP-9 rs 3918242 genetic variant in association between MMP-9 serum level with risk factors of acute ischemic stroke.

Methods: This was a cross-sectional study with an observational analytic design. 62 subjects of acute ischemic stroke treated at Dr. Kariadi Hospital Semarang from October 2018 to February 2019 were involved in this study. Statistical analysis was assessed by the bivariate test and followed by a logistic regression test.

Results: From 62 subjects in this study, 45 (72.6%) had high serum MMP-9 level. The association between serum MMP-9 level with risk factors of acute ischemic stroke was statistically significant in hypertension, diabetes mellitus, dyslipidemia, obesity, and hyperuricemia. There is a positive correlation of serum MMP-9 level with a number of acute ischemic stroke factors. In multivariate analysis, the most influential variables were obesity and hyperuricemia. CC Genetic Variant has a role in the association between serum MMP-9 level with risk factors of acute ischemic stroke, which are hypertension, diabetes mellitus, dyslipidemia, obesity, and hyperuricemia. Meanwhile, CT genetic variants only play a role in the association of serum MMP-9 levels with obesity and hyperuricemia as the risk factors for acute ischemic stroke,

Conclusion: CC genetic variants with high serum MMP-9 levels are associated with more acute ischemic stroke risk factors than CT genetic variants with high MMP-9 serum levels. Therefore, CC genetic variants have the potential to pose more risk of acute ischemic stroke.

A review of chest X-ray in pulmonary hypertension: correlation of right descending pulmonary artery diameter with mean pulmonary artery pressure

Background: Pulmonary hypertension is a condition which there is an increase in mean pulmonary artery pressure measured at ≥25 mmHg. The gold standard in diagnosing this condition is right heart catheterization. Enlargement of right descending pulmonary artery on chest radiographs is a sign of pulmonary hypertension. However, the value of radiographic measurements reported was diverse. The study analyzes the correlation between the right descending pulmonary artery (RDPA) diameter on chest radiographs and means pulmonary artery pressure on right heart catheterization to understand whether RDPA diameter on chest X-ray could be a predictor in determining the severity of pulmonary hypertension.

Methods: Thirty-five subjects were reviewed to compare RDPA diameter from a chest X-ray on posteroanterior projection and mPAP value from the right heart catheterization. The correlation between them was analyzed using Pearson's correlation test.  RDPA diameter cut-off point was defined using the ROC curve.

Result: RDPA diameter and mPAP revealed a high positive correlation (p<0.001; r=0.824). The cut-off value of the RDPA diameter was 21.8 mm (sensitivity 81% and specificity 85.7%; AUC =0.9)

Conclusion: The measurement of right descending pulmonary artery diameter on chest x-ray positively correlates with mean pulmonary artery pressure. Therefore, the diameter of the right pulmonary artery on the chest x-ray can predict the severity of pulmonary hypertension.

The association between tension-type headache (TTH) and the severity of insomnia

Introduction: Sleep can reduce headaches, but on the other hand, sleep disturbances can provoke the onset of headaches. Research showed that sleep quality was a complex interaction of people with Tension Type Headache (TTH), due to depression and emotional burden with sleep quality. The study aims to determine the association between the type of tension-type headache and the severity of insomnia.

Methods: This was a cross sectional observational study. The subjects were tension-type headache patients who went to the neurological clinic of dr. Kariadi Hospital and Puskesmas (Primary Healthcare Facility) Pandanaran Semarang who met the inclusion and exclusion criteria. It was conducted from February to July 2020. Insomnia examination was carried out using the ISI questionnaire. Data were analyzed using chi-square significant test. The result was considered significant if the p-value  <0.05.

Results: From 29 TTH patients, 5 (17.2%) subjects experienced rare ETTH, 18 (62.1%) had frequent ETTH, 6 (20.7%) had CTTH, and 2 (6.9%) subjects with depression. There was a significant association between TTH  type and  the degree of  insomnia (p 0.034) and between depression and the degree of insomnia (p 0.041). The regression analysis reported that depression and chronic TTH caused an increase in insomnia by 0.366 and 0.410, respectively.

Conclusion: There was an association between the type of TTH and the severity of insomnia, also between depression and the severity of insomnia. Moreover, depression increases the incidence of insomnia in TTH

The future of three-dimensional skin graft: a mini-review

Over the last few years, the development of three-dimensional (3D) skin bioprinting has increased rapidly. The concept of bioprinting involves a computer in designing using conventional 3D printing. 3D bioprinting can produce tissue structures such as skin and have the opportunity to substitute autografts, which are still the gold standard today. Network construction in bioprinting requires stages in the network structure design, selection of cell and biomaterial raw materials, and the molding process. The use of keratinocytes and fibroblasts is used as the main raw material in the manufacture of the dermis and epidermis layers. The biomimetic technique will combine these raw materials with other biomaterials (hydrogel, collagen, fibrin, gelatin, alginate, chitosan, and chitin) and growth factors (hydrocortisone, thrombin, and FGF-2) so that the physiological condition of the skin can be created. Currently, 3D bioprinting research continues to develop in response to the various shortcomings and challenges faced. The purpose of this review is to discuss the current use of 3D bioprinting technology, the principles of this technology and the prospects for 3D skin bioprinting in the future.

Does a higher degree of education affect the performance of healthcare leaders? A systematic review

Introduction: Healthcare leaders must have management skills, administrative competency, and leadership roles to fulfill the market demands, patient satisfaction, health policy, and complexity of the healthcare environment. Healthcare leader is expected to improve the competency through educational and professional program attainment to maximize measurable performance outcome for the hospital. The study aimed to systematically review the existing literature and carefully examine the findings to investigate the relationship between higher education and the performance of healthcare leaders.

Methods: Three independent reviewers conducted a literature search in electronic databases for publications that met the inclusion and exclusion criteria. Each of the included studies' risk of bias was independently evaluated by the lead author, who then discussed their findings with the other two authors to reach a consensus. Five papers out of 529 found by database searching met the requirements for this study.

Results: The Majority of the study designs were cross-sectional (4 of 5). Most of the studies discussed the outcome of the higher degree of education in healthcare leaders.

Conclusion: Higher and advanced degrees of education affect the better leadership role, administrative competence, and patient experience. Top healthcare leaders mostly have higher degrees of education focused on healthcare.

An overview of overactive bladder

Overactive bladder (OAB) is a common multifactorial disease that can cause a burden to the patient. Despite being a symptomatic diagnosis, several urological examinations need to be done to rule out other possible causes. The management of OAB is specific to each individual, from the very first line of behavioral therapy to surgical for an extremely rare case of OAB. This overview will look out for OAB thoroughly from the epidemiological burden, pathophysiology, clinical presentation and diagnosis, and the current treatment of OAB.

A 3-days old infant with neonatal soft tissue sarcoma: a case report

Background :The incidence of sarcomas occurs in less than 1% of all malignant tumors but sarcoma is the cause of 2% of total cancer deaths. Based on the National Registry the incidence of neonatal sarcomas is 2.6 per million live births.

Case Description : A baby girl aged 3 days, complaining of a mass on the patient's left thigh since birth. the mass was large from birth and there was only one on the left thigh. In the prenatal history, the mother and baby with routine ANC history to the midwife, and never having a control with an obstetrician, the mother was not sick during pregnancy and took medication during pregnancy outside of a doctor's prescription. In the perinatal history, the baby was born to mother G1P1A0, gestational age at term, was born by cesarean section, with birth weight 2800 grams, was born crying, active movement, reddish color, vomiting (-) genitalia (+) anus (+)

Conclusion : Soft tissue sarcomas (STS) require proper diagnosis and management. The results of rhomboid flap in the tumor resection area are better than skin grafts of similar shape and location and provide cosmetic advantages with very few complications.

Single Umbilical Artery (SUA) - prenatal sonography diagnosis and vascular imaging features postnatal cord: a case report

Background: Single umbilical artery (SUA) is a rare presentation in obstetrics practice, yet it comprises most of the umbilical anomaly. Despite its rare occurrence, a proper prenatal diagnosis needs to be established timely in order to prevent morbidity and mortality from commonly coexisting abnormalities. This case report presents a delayed diagnosis of SUA by prenatal sonography diagnosis and vascular imaging features postnatal cord at the third trimester of pregnancy and discusses the proper diagnosis and management of such cases.

Case Presentation: We reported a case of a 37 year old pregnant woman who found to have one artery one vein in her umbilical cord on ultrasound. This is very rare case and precise concern for us. Unfortunately we found this case in the third trimester of pregnancy (37w5d), therefore we have slightly to evaluate. Female baby was born by elective C-section. The baby cried immediately, with an Apgar score of 8-9. We didn’t find major abnormalities in the baby. Birth weight 3700 grams. There were not sign of heart diseases and kidney’s abnormality. Baby was monitoring for one weeks and the baby has good growth and development.

Conclusion: This report is expected to increase the awareness of this disease entity as a fundamental basis for developing its screening and management protocols.      

Delayed laparotomy and gastric repair in gastric perforation: a case report in the neonatal patient

Background: The incidence of gastric perforation in neonates is rare but has a high mortality rate of 15-70%. Spontaneous gastric perforation in neonates is estimated to occur in one of 2,900 live births and accounts for approximately 7% of all gastrointestinal perforations in neonates and children.

Case: We present a case of gastric perforation complicated by sepsis, anemia, thrombocytopenia, and hypoalbuminemia in a 3-day-old girl. The patient was brought to the emergency room of Dr. Soetomo Hospital Surabaya with blood vomiting complaints from 1 day. On physical examination, it was found that the general condition was weak, with an axillary temperature of 38.2° C. The abdomen looked distended from inspection of the abdominal region, with the dilated vein and periumbilical hyperemia. Its percussion revealed the loss of liver dullness. The results of laboratory examinations: Hb 10.7 g/dl, Platelet 14,000/mm³, Albumin 2,6 g/dl. Plain thoracoabdominal X-Ray study showed a pneumoperitoneum. Needle decompression was performed because there were signs of Abdominal Compartment Syndrome (ACS). After five days of optimization in the Intensive Care Unit, a laparotomy exploration and primary repair of gastric perforation were conducted.

Conclusion: Gastric perforation in neonates is a rare condition. The management principle for each patient is different depending on the patient's condition. Needle decompression is indicated when ACS is present or the patient's condition is not optimal for surgery. Definitive laparotomy can be done after the patient's condition has been stabilized. Proper selection of treatment can improve the patient's outcome and reduce the risk of morbidity and mortality.

Video-assisted thoracoscopic surgery in the treatment of empyema: a case series

Background: Empyema is a condition that can be treated depending on the etiology of the empyema and the phase of empyema development. Open thoracotomy surgery is a conventional technique commonly used in empyema that has greater risk and more extended postoperative hospital stay. This case series aims to evaluate Video-Assisted Thoracoscopic Surgery (VATS) to shorten postoperative hospital stay and lower the risk during the surgery.

Case Presentation: We describe a case series of empyema in five patients, each with a different presentation, clinical course, and outcome. All of our patients were performed VATS procedures under General Anesthesia and evaluated for postoperative hospital stays and complications that occur after the surgery. Most of the patients experienced tolerable pain on the site of surgery and only need 3 – 4 days post-operation hospital stays after VATS before being discharged. Only one patient with a poor prognosis after VATS in this case series caused the patient to be admitted to the Intensive Care Unit and using a mechanical ventilator.

Conclusion: In this case series, VATS has a promising result for the patient and can become a choice of treatment for empyema.

Penile gangrene as a priapism sequele due to Chronic Myeloid Leukemia (CML): the first report in Indonesia

Background: Priapism is defined as a prolonged erection of the penis lasting over 6 hours in the absence of sexual stimulation. Priapism is divided into two types, Low-Flow (ischemic priapism) and High-Flow (trauma). This case study aims to evaluate penile gangrene as a priapism sequele due to Chronic Myeloid Leukemia (CML) as the first report in Indonesia.

Case Presentation: A 45-years old male patient admitted at Muara Teweh hospital before referred to Ulin Hospital presented with Fournier gangrene with unconfirmed leukemia as comorbidities used in this case report. In his medical history, “Snake Maneuver Shunting” has been carried out in this patient as an indication for priapism lasting more than 24 hours.

Conclusion: Hyperleukocytosis is thought to be the cause of priapism in patients with leukemia. Leukostasis is the most common medical emergency seen on CML patients in blast crisis.

Pectoralis major myocutaneous flap for head and neck reconstruction: a case report

Introduction: Cancer surgery in the head and neck area generally causes a wide defect and usually cannot be closed primarily or by using the surrounding tissue, thus a flap is needed. There are several types of flaps, namely local flaps, pedicle flaps, and free flaps. Although the free flap is currently the gold standard for reconstruction of the head and neck in developing countries, the resources for a free flap in most healthcare center are still lacking, as well as the large number of patients with poor economic and nutritional status. Thus, the pectoralis major myocutaneous flap (PMMF) remains popularly used.

Case Description: A 46-year-old male patient with squamous cell carcinoma in the neck area, underwent wide excision procedure and the surgical defect was reconstructed with a pectoralis major myocutaneous flap.  The results of reconstruction with pectoralis major myocutaneous flap were viable, and were functionally and aesthetically acceptable. There are no postoperative complications such as hematoma or abscess observed.

Conclusion: Pectoralis major myocutaneous flap was one of the main and easy to learn modalities for head and neck reconstruction surgery and it was acceptable functionally and aesthetically in situations where free flap could not be performed for one or many reasons.

Aggressiveness tumor: a case report of recurrent ameloblastoma in the mandible

Background: Ameloblastomas are rare odontogenic neoplasms of the mandible and maxilla. They have high recurrence rates if improperly treated. Due to their aggressive nature and high recurrence rate, treatment remains a matter of debate. Complete excision of the lesion with the least morbidity would be the therapeutic challenge.

Case Report: A 67 years old woman complained of swelling on her left jaw four years ago, the jaw was small swelling initially, and then it has grown to the size of a tennis ball. She had a history of similar swelling on the same site 12 years back for which she was operated on (enucleation). On physical examination, there is a mass in the left mandibular bone above the surgical wound, hard, painless and motionless, with a size of 18 cm x 11 cm x 11 cm. Plain x-ray examination showed multiple cystic lesions in the left mandible. In this case, segmental mandibular resection was performed, followed by reconstruction using a K-wire.

Discussion: Many treatment options range from conservative treatment of curettage, enucleation to radical surgical approaches of wide margin excision. Radical treatment approaches have the advantage of lowering the recurrence rates but at the same time pose extremely difficult challenges of reconstruction of the surgical defects.

Conclusion: Ameloblastoma has high recurrence rate if it is not treated properly. At least 1 cm of healthy bone should be removed during surgical procedure beyond panoramic radiograph visible margins. In our patient, though radical surgery eliminated a large possibility of recurrence.

Case report of Laryngeal Amyloidosis: Unusual cause of hoarseness

Background: Laryngeal amyloidosis is a rare pathology of the airway in which the diagnosis can only be made via tissue biopsy. We reported a case of laryngeal amyloidosis presenting with symptoms of hoarseness and voice fatigue.

Case report: This is a case report of laryngeal amyloidosis in a middle-aged female patient who presented with hoarseness of voice. Upon obtaining a further history and performing a clinical examination, it was noted that the patient had a laryngeal mass. She underwent surgery, and the mass was histopathologically confirmed as laryngeal amyloidosis. She was successfully treated with a combination of surgical and medical treatment. This case presentation describes these rare pathological findings, their clinical manifestations, the histopathological and surgical diagnostic problems, treatment and patient’s progress that we followed up till presence.

Conclusion: Isolated laryngeal amyloidosis is a rare benign laryngeal tumor that is often presented with various symptoms depending on the tumor location and can even cause upper airway obstruction. It is a histological diagnosis confirmed by histopathological specimens that are stained with Congo red. Treatment of laryngeal amyloidosis includes symptomatic relief, surgical or even conservative treatment. 

Myasthenia gravis and arrhythmias in COVID-19: a case report

Background: Myasthenia Gravis (MG) is an autoimmune disorder, which autoantibodies against postsynaptic (muscle) nicotinic acetylcholine receptors (nAChR). MG patients have a higher prevalence of cardiac manifestations in the presence of thymoma. It is not known whether Coronavirus disease 2019 (COVID-19) can cause more severe illness in patients with chronic neuromuscular disorders such as MG, which can cause respiratory muscle weakness, or in those who are immunosuppressed. This case report will discuss patient with MG, thymoma, atrial fibrillation, and COVID-19.

Case presentation:  A 60-year old man came to the hospital with difficulty of swallowing. He had nasal voice and dropping of eyelids. These complaints were happened repeatedly, worsened at night and got better in the next morning. From the neurological examination, it was also obtained Wartenberg test (+), counting test (+), and prostigmine test (+). Atrial fibrillation was found with normal ventricular response and decreased systolic left ventricular function on the electrocardiogram and echocardiography. On the chest MSCT, a lobulated homogeneous solid mass was found in anterior mediastinum which supported the image of thymoma, and there was the imaging of typical viral pneumonia. The patient also had the positive result of COVID-19 PCR test.

Conclusion: MG patients have been shown with abnormal manifestations of heart rhythm. This may reflect as a complication of myocarditis or autonomic nervous system dysfunction. COVID-19 infection in MG can be challenging for many reasons. Current guidelines recommend continuing the current standard care treatment of MG during hospitalization.

Endoscopic spine surgery for cervicothoracic spine neurofibroma: a case report

Introduction: Spinal tumors are rare lesions. The incidence of spinal tumors is about 0.5-2.5 cases per 100,000 population per year.¹ Thirty percent of spinal tumors are located intradural. Twenty to thirty percent of intradural tumors are schwannoma and spinal neurofibroma.² Surgery is the leading choice for schwannomas and neurofibromas that grow progressively or cause neurological deficits.^2,3,4 Currently, minimally invasive surgery is developing rapidly, including minimally invasive surgery on spine surgery.Better outcomes are expected in endoscopic spine surgery compared to conventional spine surgery techniques.This paper aims to provide an overview of endoscopic procedures for the surgical removal of spinal tumors.

Case description: A 59-year-old man presented paraplegia of both lower limbs. The patient complained difficulty walking for nine months before admitted to the hospital. The patient also complained of difficulty moving both of his legs, burning pain sensation, pain and numbness sensation that radiates from chest region to both of his toes, he felt that his chest was tied, and he complained hard to breathe when he feels pain. Complaints are getting worse until the patient was unable to walk. We found intra-dural extramedullary lesion from the MRI that was suspicious of a nerve cell sheath tumor. The patient underwent surgical treatment for tumor removal with an endoscopic technique, the cancer was complete. From the histopathology, the tumor was a neurofibroma tumor.

Conclusion: Neurofibroma is one of the most frequently intradural extramedullary spinal tumors. Good imaging can guide the diagnosis and a good plan for manage patients with spinal tumors. Complete tumor resection provides a better prognosis in patients with neurofibromas. With endoscopic techniques, total spinal tumor removal surgery can be performed. The surgical procedure for spinal tumors using an endoscopic approach may be an option for spinal neurofibromas patients.

Emergency immune reconstitution inflammatory syndrome (IRIS) in HIV drug discontinued with tuberculous meningoencephalitis: a case report

Background: Immune reconstitution inflammatory syndrome (IRIS) is a paradoxical condition in which the administration of ART (antiretroviral therapy) to human immune virus (HIV) patients causes a deterioration in clinical situations. This article describes IRIS in an HIV patient who discontinued the drugs and was accompanied by opportunistic infection with tuberculous meningoencephalitis.

Case Presentation: A 40-year-old male complained of high fever and severe headache for 1 week, then the patient had general tonic-clonic seizures twice and less than 5 minutes. After seizure, patient experiences a loss of consciousness with the only response to pain stimuli. He was diagnosed with HIV since 3 years ago and only taking ART 2 months after being diagnosed. The physical examination revealed neck stiffness with a positive Brudzinski I and Kernig Sign, as well as lateralization to the right side. Oral candidiasis was found. HIV screening tests were reactive with CD4 65 cells/mm³. Cerebrospinal fluid (CSF) examination showed 172.8 mg/dL protein, 23 mg/dL glucose, MN 13/mm³ dominant cells, clear CSF fluid and colorless, supporting tuberculous meningoencephalitis (METB). Multi sliced CT-Scan (MSCT) head contrast shows enhancement of the basal cistern. The patient received the ART tenofovir-lamivudine-efavirenz. Then he has experienced a deterioration in clinical condition. He had ARDS, respiratory failure and was intubated, but failed resuscitation attempts.

Conclusion: The patient was diagnosed with HIV 3 years ago but discontinued the treatment. HIV causes diffuse inflammation throughout the body including the cardiac, where myocarditis cannot be ruled out as a cause of death. IRIS may occur when the patient has risk factors for not getting previous ART (withdrawal of drugs) and has a low CD4 count. According to the criteria proposed by Robertson, there were worsening clinical symptoms, associated with initiation of ART administration, not explained by the presence of previously acquired infection, we suggest IRIS as causes of death in this patient. 

Visual function recovery post decompression surgery in meningioma: a case report

Background: Meningiomas represent about 20% of intracranial tumors. Due to these tumors' proximity to the optic nerve, typically progressive unilateral vision loss, over several months to years, is the classic clinical presentation.

Case Presentation: A 23 y.o. male presented with a progressive monocular visual loss of the right eye since 4 months. Visual acuity on the right eye was 1/300 and 6/6 on the left eye. Color vision and contrast sensitivity of the left eye was excellent. Fundus examination showed papilledema on right eye and left eye was within normal limit. MRI reveals a strong enhancing mass along the right and left sphenoid wing, measuring approximately 3.9 x 5.5 x 3.3 cm, extending into the parasellar region, compressing optic chiasm and encasing right and left N.III, N.IV and N.V. Patient were diagnosed with compressive optic neuropathy on the right eye due to meningioma. Following the decompression surgery, visual acuity on the right eye improved to 6/24, color vision 25/38 and contrast sensitivity was 5%. The patient was discharged 4 days after surgery and scheduled for routine follow-up at the polyclinic.

Conclusion: Vision loss due to the compressive effect of meningioma may be reversible. The severity and the duration of vision loss due to compression may affect the final visual recovery. Early detection and prompt multidisciplinary approach are necessary to obtain a better outcome.

The relationship between self-esteem and husband support with body image perception in post-vaginal delivery primiparous mother in independent Delima midwife practice in Denpasar

Background: Childbirth is a big, happy event for a mother. In post-partum mothers, physical changes and psychological changes can occur. It is reported that 50% to 70% of post-partum mothers experience psychological disorders, such as a mother can feel uncomfortable with body image perception changes, which result in feelings of lack of husband support. Body image perception itself can cause an effect on self-esteem. This study aimed to analyze the relationship between self-esteem and husband's support with body image perception among primiparous mothers after vaginal delivery.

Methods: An observational analytic study was conducted among 30 post-vaginal delivery primiparous mothers in independent Delima midwife practice in Denpasar. Data regarding respondents’ characteristics, self-esteem, husband’s support and body image perception were obtained using the Rosenberg self-esteem questionnaire, the Revised Dyadic Adjustment Scale (R-DAS) questionnaire Multidimensional Body-Self Relations Questionnaire Appearance Scales (MBSRQ-AS). The relationship between self-esteem and husband's support with body image perception was analyzed using SPSS version 23 for Windows.

Results: The average age of the respondents were 24.73 years old, and most of them were graduated from high school (50%), employed (53.3%) and have no conflict in their marriage (80%), have normal self-esteem (96.6%), didn’t get enough husband’s support (56.7%) and have positive perception regarding the evaluation of physical appearance (96.6%). We found a significant relationship between self-esteem and body image perception (p = 0.001), husband's support and body image perception (p = 0.001) and husband's support and self-esteem (p = 0.010) in post-vaginal delivery primiparous mother in independent Delima midwife practice in Denpasar.

Conclusion: Self-esteem, husband's support and body image perception were essentials factors that contributed to post-partum woman mental health stability that should be understood by family and health workers to avoid psychological disorder in post-partum woman.

The 4th Aceh Surgery Update 2021

Assalamualaikum Wr.Wb

Praise and gratitude we pray the presence of Allah SWT for all His grace and guidance so we can still work to help in the fields of education and humanity. With greetings and prayers we praise the prophet Rahmatan lil alamin Rasulullah Muhammad SAW who has brought us from the realm of darkness to a realm full of knowledge.

 In the fourth year it was held during the Covid 19 pandemic, 4th Aceh Surgery Update International Conference in 2021 will be held virtually on February 26-28, with theme Current Update on Covid 19; Clinical and Surgery. This virtual science event will be attended by international and national speakers who have expertise in the field of surgery and the latest information regarding Covid 19 from the Indonesia government. This scientific event felt very special with the presence of the Bali Medical Journal indexed by SCOPUS and Web of Science in scientific publications for all topics presented, both in symposium and free paper sessions.

I would like to welcome all experts who are willing to attend to be native speaker at this scientific even. I would like to thank all the committees and sponsors who have helped make this scientific webinar a success. Finally, I am also welcome all the participants and delegated, really hope you all get valuable scientific experiences in extra ordinary city of Banda Aceh.

Sincerelly Yours,

Yopie Afriandi Habibie, MD, Sp. BTKV (K)-D, FIHA, FICS, FACS

Chairman