Background: Mother-to-child transmission (MTCT) of Human Immunodeficiency Virus (HIV), syphilis, and Hepatitis B can cause a health burden and lead to morbidity and mortality in children. An attempt to eliminate the transmission has been made worldwide. This study aimed to evaluate the triple elimination of MTCT for HIV, syphilis, and hepatitis B in a tertiary hospital in Indonesia.

Methods: We evaluated 690 medical records of new pregnant women seeking antenatal care (ANC) in a tertiary hospital in the east part of Indonesia from January to December 2018.

Results: HIV, syphilis, and hepatitis B testing were performed on 97 patients (14.1%). HIV and hepatitis B, HIV and syphilis, and syphilis and hepatitis B testing were performed on 149 (21.6%), 6 (0.9%), and 6 (0.9%) patients, respectively. The prevalence of HIV, syphilis and hepatitis B was 4.2%, 0.4%, and 3.8%, respectively. HIV treatment by administering antiretroviral therapy (ART) was done in 86.2% of patients. Injection of benzathine penicillin G as the treatment of syphilis was done in 66.7% of syphilis patients. HBV DNA examination followed by tenofovir administration was done in 3.8% of hepatitis B patients.

Conclusion: The testing rate of HIV, syphilis, and hepatitis B in pregnant women in a tertiary hospital in the east part of Indonesia in 2018 (14.1%) was below the target set by World Health Organization (≥ 95%). Increasing access to antenatal screening as early detection is the key to preventing mother-to-child transmission (MTCT).

Background: Astrocytoma is the most common primary intracerebral tumor in adults and causes high morbidity and mortality. Most patients with astrocytomas, especially diffuse gliomas, have a poor prognosis. Recent genetic and epigenetic studies have shown that mutations in the Isocitrate Dehydrogenase (IDH) gene play an important role in the pathogenesis and prognosis of gliomas, thus facilitating IDH1 mutations in the population to become an important marker, not only to assist in the diagnosis and prognostic factors of these gliomas but also to develop therapeutic targets as currently available. This study aims to see differences in the expression of the IDH in each astrocytoma classification.

Methods: A cross-sectional analytic study was conducted at the Anatomical Pathology Laboratory, Faculty of Medicine, Universitas Hasanuddin, from October 2020 to August 2021. The research sample came from 65 paraffin block preparations for primary brain tumors with the diagnosis of Diffuse Astrocytoma (DA), Anaplastic Astrocytoma (AA) and Glioblastoma (GB). The immunohistochemical staining was performed using the monoclonal antibody IDH1-R132H. The microscopic assessment was carried out using a light microscope. Data were analyzed using SPSS version 20 for Windows.

Results: There was a significant relationship between the expression of IDH1-R132H in each astrocytoma classification (p=0.008). The prevalence of astrocytoma with negative IDH1-R132H expression (IDH-wildtype) is lower by 21 samples (32.3%) compared to astrocytoma with positive IDH1-R132H expression (IDH-mutant), which is 44 samples (67.7%).

Conclusion: There are significant differences in the expression of IDH1-R132H in Diffuse Astrocytoma, Anaplastic Astrocytoma and Glioblastoma, where the proportion of IDH-mutant status is higher than IDH-wildtype and IDH1 mutation status has a significant relationship with tumor grade.

Background: Administration of antenatal magnesium sulfate (MgSO₄) to pregnant women is thought to increase the synthesis of Brain-Derived Neurotrophic Factor (BDNF), which functions as a nerve-growth factor for the process of neurogenesis and also strengthen neuronal resilience in the hypoxic condition that occurs during preterm delivery. Protocols for administering antenatal MgSO4 differ between countries and institutions. One of the concerns is whether the dose is given and the time interval to delivery has a big contribution towards a better fetal outcome. These relationships have not been studied before. This study aimed to analyze the correlation of the total dose of MgSO4 and time interval to delivery with BDNF levels in cord blood.

Methods: This study enrolled 72 pregnant women who will deliver the baby prematurely, with gestational age 28-34 weeks. Subjects were divided into three protocols groups: (1) 4 g iv. only, (2) 4 g iv. initial continued with 1 g/hours until maximum 24 hours, and (3) 6 g iv. initial continued with 2 g/hours until a maximum of 24 hours. At the time of delivery, cord blood of preterm babies was collected. The antenatal MgSO4 total dose and time interval to delivery were collected, and BDNF serum levels were then measured with enzyme-linked immunosorbent assay (ELISA). The correlation between antenatal MgSO4 total dose and time interval to delivery with BDNF levels was analyzed using Spearman’s correlation test.

Result: There was a weak significant correlation of antenatal MgSO4 total dose and BDNF cord blood levels (p<0.001; r=0.381). There was no significant correlation between delivery time interval and BDNF cord blood levels (p=0.44; r=0.092).

Conclusion: Regarding the weak correlation of total dose and time interval to delivery with BDNF, we suggest that all protocols provide comparable outcomes if seen only from the BDNF increase perspective. 

Background: Brain metastases have increased over time, and imaging has been considered an important diagnostic tool. In Indonesia, the record of metastatic brain tumors is limited. Therefore, understanding the epidemiology and the imaging characteristics of brain metastases will provide insights into a better diagnosis, management, and therapy towards the disease. This study aimed to evaluate the characteristics of patients with metastatic brain tumors.

Methods: A cross-sectional study was conducted in Neurology Unit at Dr. Soetomo Hospital in Surabaya, Indonesia from August 2018 - July 2019. Patients with metastatic brain tumors were enrolled in the study. Data demographics, clinical, and brain imaging characteristics were collected from the patients’ Brain Tumor Registry. Computerized tomography (CT) scan and magnetic resonance imaging (MRI) was used to assess the images of the brain metastases. Mini-Mental State Exam (MMSE) was used to assess the patient's cognitive function.

Results: Of the total 22 subjects, 14 (63.6%) were male, 13 (59.1%) aged ≥50 years. Headache was the most common clinical symptom, reported by 78.2% of patients. Most of the patients (63.3%) had MMSE score of ≤ 23. CT-scan and MRI imaging suggested that multiple lesions were the most common, 57.8% and 71.4%, respectively. The brain tumor's most frequent was in the parietal and temporal lobes (CT-scan imaging) and temporal and cerebellar lobes based on MRI. Lung tumors were the most common source of brain metastases (50%), followed by breast and nasopharynx cancers (13.6% each); 9% had unknown sources.

Conclusions: Our study suggests that the frequency of metastatic brain tumors is gender and age-specific. Headache with early stage of dementia is common among patients with metastatic brain tumor. Multiple lesions in parietal and temporal lobes with lung cancer as the source are common.

Introduction: There are not many studies that investigate Islamic caring behavior and the factors that influence it. The purpose of this study was to analyze the factors that influence Islamic caring behavior.

Methods: This study was an observational analytic research design that used nurses' perceptions of Islamic caring behavior and the factors that influence it, including organizational characteristics, job characteristics, and individual characteristics. This survey involved 100 respondents that filled out a questionnaire via a google form. Data analysis using Chi-Square and multiple logistic regression test, with a significance level of <0.05.

Results: This study shows that 51% respondents have good Islamic caring behavior. The factors that influence Islamic caring behavior from organizational characteristics are; 1) vision and mission (p = 0.001), 2) reward system (p = 0.001), 3) selection (p = 0.002), 4) organizational structure and culture (p = 0.003), from job characteristics are 1) performance objective (p = 0.000), 2) work schedule (p = 0.001), 3) job design (p = 0.041), 4) correction (p = 0.002), and 5) feedback (p = 0.002), from the individual characteristics of nurses is attitude (p = 0.028. There are three multivariate test results that have an effect, namely objective performance (p = 0.002; B = 3.19), understanding of vision and mission (p = 0.005; B = 1.401), selection (p = 0.017; B = 1.521), and all three show that there is an interaction.

Conclusion: The most dominant factor influencing Islamic caring behavior is Objective performance.

Introduction: Tantrums are a normal condition that occurs in children aged 1-3 years. If not handled properly, Tantrum behavior will affect the formation of the next child's personality. In Indonesia, 23-83% of children aged 2 to 4 years have experienced temper tantrums. One way to overcome tantrums in toddlers is to provide sound to children. However, not all mothers can do sounding to their children; another alternative is to provide sounding using media. The alternative media is audio-visual affirmation. This study aimed to analyze the effect of audio-visual affirmation on tantrum behavior in toddlers.

Methods: This study uses a quasi-experimental study with one group pre-test-post-test. The population is toddlers who attend Raudlatul Jannah Preschool, namely 98 children, then sampling is done with simple random sampling, a sample of 78 respondents is obtained. The data used in this study is data on the temper tantrums of children aged 1-5 years before and after being given an audio-visual affirmation. This data was analyzed by comparing the temper tantrums in toddlers before and after being given audio-visual affirmation therapy.

Results: The results of data analysis using the Paired T-test showed a significant effect between before and after being given the audio-visual affirmation treatment with p = 0.000 (p < 0.05). This study shows that audio-visual affirmation affects tantrum behavior in toddlers.

Conclusion: Audio-visual affirmation affects tantrum behavior in toddlers.

Background: Effective risk stratification is an integral part of acute myocardial infarction (AMI) management. Meanwhile, the stratification system should be performed by using easy instruments or methods, where appropriate management, intervention timing, and prognosis can be determined. A previous study established acute ischemia implicate the diastolic function of the left ventricle. In this situation, echocardiography is an easy-to-use and effective diagnostic tool. Therefore, this study evaluates left ventricular diastolic function using the tissue Doppler imaging (TDI) method to analyze the reduction of early diastolic velocity (e’) as a predictor for numerous cardiovascular events in patients with AMI.

Method: The study design was an observational study with a prospective cohort design. The data for the septal and lateral Early Diastolic Velocities (e’) was acquired using the transthoracic echocardiography procedure on AMI patients. The Hazard Ratio (HR) and survival curve from prognostic factors of major adverse cardiovascular events were also produced.

Results: There were 66 patients diagnosed with AMI. The median was 6.625cm/s, and the cut-off point was to determine the decreasing or abnormal mean e’. Subsequently, this value at RR 2.8 was shown by the multivariate analysis via Cox regression as an independent factor of major adverse cardiovascular events.

Conclusion: Decreased means e’ has been proven as an independent predictor of major adverse cardiovascular events in hospitalized patients with AMI.

Introduction: The main treatment for leukemia is chemotherapy therapy, divided into the induction of remission, consolidation, and maintenance therapy. Early response to remission-induced therapy is an important prognostic factor in ALL. This study aimed to assess the relationship between absolute neutrophil count (ANC) and bone marrow improvement after undergoing induction phase chemotherapy which was characterized by the occurrence of remission.

Methods: Acute Lymphoblastic Leukemia diagnosed based on CBC, peripheral smear, bone marrow morphology, and flow cytometry. Nineteen samples from children with Acute Lymphoblastic Leukemia were evaluated for blast count and absolute neutrophil count (ANC) on day 0, ANC on 3rd week, and blast count and ANC on the 6^th week of remission induction therapy. We compared the results of outcomes after remission induction therapy.

Results: The ANC value at the 3rd week and 6th week of the chemotherapy phase was positively correlated with remission with the r=0.687 and with a p-value=0.001.

Conclusion: The trend of increasing ANC values ​​was moderately positively correlated with the incidence of remission.

Introduction: There was evidence that diabatic foot spa has a crucial role in regulating blood glucose levels, but the combination of diabetic foot spa and sauna bathing have never been carried out to decrease blood glucose. The aim of this study was to analyze the combination of diabetic foot spa and sauna bathing therapy and its impact on blood glucose levels.

Methods: The data studied were blood glucose levels. This data can be obtained after administering a combination of diabetic foot spa and sauna bathing and afterward. Then this data was analyzed using an independent t test with p value of 0.000 (p <0.005).

Results: : This study showed that 60 respondents, mostly 58.3% were aged 45- 60 years, almost half of the respondents (48.3%) had suffered from DM for <1- 5 years, (70%) women, from the independent t test obtained blood glucose p value= 0.000 (p <0.05).

Conclusion: There was a decrease level of blood glucose after the patients receive the diabetic foot spa and sauna bathing therapy.

Background:  Sorafenib is a targeting therapy in Hepatocellular carcinoma (HCC) that targets Vascular Endothelial Growth Factor Receptors 1 (VEGFR-1), VEGFR-2, and VEGFR-3; Platelet-Derived Growth Factor Receptors β (PDGFR-β); c-Kit proto-oncogenes; FLT-3 genes; RET proto-oncogenes; and Raf-1 genes that have the same function in suppressing tumor cell proliferation, angiogenesis, and promotes tumor cell apoptosis;  but its high cost makes necessary to reduce the dosage by combining with other agents. Epigallocatechin-3-Gallate (EGCG) has great potential in cancer treatment because of its anti-angiogenesis, induced apoptosis, and low cost. This study aimed to examine the effects of combination EGCG with low dose sorafenib compared to standard dose sorafenib in apoptosis and PDGFR expression in HCC rats

Methods: Twenty-five male Wistar rats were randomly assigned into 4 groups: sham, control, EGCG+low dose sorafenib, and standard-dose sorafenib. Diethylnitrosamine (DEN) injection to induce HCC was carried out to all Wistar rats except for the sham group. After HCC was developed, the EGCG+low dose sorafenib group and standard-dose sorafenib group received the administration of the drugs for two weeks. PDGFR expression and apoptotic index were assessed in the last 3 groups. Data were analyzed using SPSS version 20 for Windows.

Results: There was a non-significant difference of mean PDGFR expression level between the EGCG+low dose sorafenib group and standard-dose sorafenib group (p>0.05); however, there was a lower significant difference of both groups compared to the control group (p<0.05). There was a non-significant difference of apoptotic index between low dose sorafenib+EGCG group and standard-dose sorafenib group (p>0.05); in addition, there were a higher not significantly different of both groups compared to the control group (p>0.05).

Conclusion: Combining low dose sorafenib with EGCG has a comparable effect with standard-dose sorafenib in reducing PDGFR of HCC, but not for apoptosis.

Introduction: High recurrence of a fibrotic disease, pterygium, following the surgical procedure is perceived as the primary challenge of its management. As the standard procedure, adjuvant therapy of using mitomycin C could dramatically reduce the recurrence of pterygium but could cause multiple serious complications. Our study aimed to investigate curcumin and fibrin glue as alternative candidates for adjuvant therapy in pterygium surgery.

Methods: Human pterygium fibroblast (HPF) was isolated from the patient and cultured in-vitro. The HPF culture was then exposed with mitomycin C (0.4 mg/mL), curcumin (200 μmol/L), and fibrin glue, respectively, for 48 hours. The outcomes were determined by the proliferation of HPF and the expression of transforming growth factor-beta (TGF-β) which were obtained from 2,5-diphenyl-2H-tetrazolium bromide assay and immunofluorescence staining analysis with TGF-β antibody.

Results: The experiment revealed that mitomycin C, curcumin, and fibrin glue could significantly inhibit the proliferation of HPF (p<0.05) suggesting their antifibrotic effect. Further analysis with immunofluorescence staining showed that mitomycin C, curcumin, and fibrin glue could significantly reduce the level of TGF-β as compared with control group (p<0.05).

Conclusion: Mitomycin C was the most potent adjuvant agent to reduce the recurrence of pterygium, followed by curcumin and fibrin glue. Taken altogether, curcumin and fibrin glue have role as adjuvant therapy to prevent recurrence in pterygium surgery.

Background: Psoriasis is a complex, chronic disease with increasing global incidence. Studies on the effectiveness of psoriasis therapy in Indonesia are limited. This study aimed to evaluate the patient’s clinical improvement with moderate-to-severe psoriasis vulgaris using the Psoriasis Area and Severity Index with ≥75% score reduction (PASI75).

Methods: This is a retrospective study involving patients diagnosed with psoriasis vulgaris who visited the Dermatology and Venereology Outpatient Clinic in Dr. Soetomo General Hospital between January 2016 and December 2018. The electronic medical record obtained data on demographic characteristics, the number of visits, psoriasis at initial (PASI) score before and after treatment, type and dose of treatment, and comorbidities. Data were analyzed using SPSS version 23 for Windows.

Results: Overall, 54 patients with psoriasis vulgaris were included. Almost all subjects were adults (≥18 years old) and presented with severe PASI (PASI score > 10) (96.3%). The majority of the subjects (64.8%) successfully achieved PASI75. Most subjects received methotrexate (72.2%); the most frequent dosage was 15 mg/week (61.5%). A significant association was found between methotrexate treatment and a larger improvement in PASI scores (p=0.001).

Conclusion: moderate-to-severe psoriasis therapy in terms of PASI75 achieved a satisfactory success rate of 64.8%, and the improvement of PASI score was significantly better in patients who received methotrexate. Further studies in Indonesia are needed to explore the effectiveness of psoriasis therapy and its factors.

Background: Cigarettes contained addictive substances that may have adverse effects on health, such as memory impairment. The hippocampus is a part of the brain that plays a role in regulating memory. This study aimed to compare the effects of conventional cigarette smoke and e-cigarette vapor on hippocampal pyramidal cells in animal models.

Method: Experimental study used 30 male Sprague Dawley white rats aged 10-12 weeks. Rats were divided into 5 groups consisting of 1 control group and 4 treatment groups and exposed to conventional cigarette smoke and electronic cigarette vapor for 2 weeks and 4 weeks. The amount of exposure given was 12 times each day. After two weeks and four weeks of exposure, rats were necropsied, the Hippocampus was processed and stained using Hematoxylin and eosin. Pyramidal cell nuclei were viewed with a biological microscope CX-33 microcamera DP2 with 400x magnification in 3 fields of view. The average number of pyknotic nucleus pyramidal cells collected was statistically analyzed using the Mann-Whitney test.

Result: The hippocampal pyknotic pyramidal cells number in each treatment group was higher compared to the control group. A correlation was found between 2 weeks groups and 4 weeks groups of treatment. Conventional cigarette smoke groups showed higher means of pyknotic pyramidal cells than electronic cigarette vapor and were statistically significant in both 2 weeks groups and 4 weeks groups of treatment (p<0.05).

Conclusion: The type of cigarette and the duration of cigarettes exposure affects the number of pyknotic pyramidal cells. Conventional cigarette causes more significant changes than electronic cigarettes, and the exposure duration of conventional cigarettes affects pyramidal cells in the hippocampus.

Introduction: Increasing age has the potential to cause hardening of the arteries. Hypertension is also related to sleep quality and stress levels. Hypertension can be controlled with non-pharmacological therapy using Mindfulness Based Stress Reduction (MBSR) and samavriti pranayama. Samavriti pranayama increases the oxygen supply to the brain, lungs and lowers the heart rate. The purpose of this study was to determine the effectiveness of MBSR and samavriti pranayama for lowering blood pressure, improving sleep quality, and reducing stress levels.

Methods: This study utilized a cross-sectional model. Elders analyzed with hypertension were surveyed for qualification. A add up to of 40 seniors were randomized into the mediation and control bunches. Both bunches gotten schedule care. Eight sessions of MBSR and samavritti pranayama were conducted within the intercession bunch, whereas the control gather gotten no mental intercession. Elders were surveyed with respect to diminished hypertension, uneasiness, and rest quality at two unmistakable stages: some time recently and after the mediation.

Results: There were no significant differences in sociodemographic and clinical parameters between the intercession and control bunches at standard. The mediation program essentially lightened mental and physiological complications in elderly with hypertension. Particularly, the consider uncovered that 8 weeks of the combined MBSR and samavritti pranayama mediation viably decreased lower hypertension and uneasiness scores and made strides the quality of rest in elderly.

Conclusion: The conclusion MBSR combined with samavritti pranayama significantly alleviated clinical symptoms, and could be considered a new, effective psychotherapeutic intervention for Elderly with Hypertension.

Background: Cancer patients are at risk of exposing COVID-19 because of their weakened immune system, caused by tumor growth and anti-cancer therapy. Cancer patients can also increase the risk of severe infection. This study aims to determine the characteristic of COVID-19 patients with malignancies in our institution

Methods: We analyze the data of 68 COVID-19 patients with malignancies as comorbidities who were hospitalized or treated in our institution using cohort retrospective design. Variables assessed in this study include gender, age, type of malignancy, organ involved, cancer treatment, the severity of COVID-19, and outcome. Data were analyzed using SPSS version 25 for Windows and interpreted as number and percentage.

Results: Solid malignancy was the most common type (82,4%). The lung and thorax were the most common organ involved, followed by the cervix, abdomen, breast, and nasopharynx. Most patients (66.2%) with malignancy suffered from COVID-19 with mild-moderate (non-severe) symptoms and 33,8% severe symptoms. Sixteen (23.5%) patients have died. Laboratory findings showed elevated NLR and D-dimer in both severe and non-severe cases. The median NLR of all cases was 5.97. The median D-dimer was 1.61 ìg/ml. Patients with solid malignancy (35.7%) are more exposed to severe COVID-19 than the hematological type (p=0.477). Patients with malignancy who had received therapy for their cancer had more severe symptoms than those who had not received cancer therapy (41.7% vs. 25%) (p=0.147), although not statistically significant.

Conclusion: Solid malignancy was the most common type diagnosed with COVID-19. More malignancy patients experienced mild to moderate COVID-19 symptoms, and one-third of them experienced severe symptoms.

Background: Even though pericardiocentesis is a routine life-saving procedure for massive pericardial effusion, there is scarce data regarding risk factors predicting the outcome in patients undergoing pericardiocentesis. This study aimed to investigate the role of various clinical, demographic, and laboratory risk factors as a predictor of in-hospital mortality and Major Adverse Cardiac Events (MACE) in patients undergoing pericardiocentesis at Sanglah General Hospital, Bali, Indonesia.

Methods: Prospective cohort study with consecutive sampling was conducted in patients undergoing pericardiocentesis in Sanglah General Hospital, Bali, Indonesia, from May 2017 until September 2021. Risk factors and blood samples were observed and measured at the first admission. MACE and in-hospital mortality were observed during hospitalization. Data were analyzed using SPSS version 23 for Windows.

Results: Twenty-seven patients were involved in this study. Malignant etiology was associated with increased risk of in-hospital mortality with HR 13.459 (95%CI: 1.378-131.49). Respiratory Failure during admission was associated with increased risk of mortality with HR 5.99 (95% CI: 1.355-26.55) and increased risk of persistent pericardial effusion HR 5.72 (95% CI: 1.570-20.800).

Conclusion: Malignant etiology and respiratory Failure are independent predictors of in-hospital mortality in patients undergoing pericardiocentesis in Sanglah General Hospital. Respiratory Failure was associated with an increased risk of persistent pericardial effusion.

Background: Before the weaning phase, piglets often experience diarrhea and anemia caused by infection with germs such that after weaning, their growth rate reduces, they become pale and also prone to other illnesses which may lead to death. This study aims to determine the effect of earthworm flour (TCT) on growth, morbidity, mortality, blood profile, and antibody titer as an immunomodulator.

Method: Ninety piglets were used before weaning which was divided into four groups, each consisting of 18 members, namely the group that was not given TCT as a control (P0), the one that was given TCT from the age of 20 to 50 (for 30 days total) days with a concentration of 1% in the feed (P1), the concentration of 1.5% (P2), the concentration of 2% (3) and concentration of 2.5% (4 ). At 14 days old, Hog Cholera vaccination was administered by intramuscular injection, and it was repeated at the age of 28 days. Bodyweight was weighed at the beginning of the study, which was at 21 days old, then repeated at 28, 35, 42, 49 and 60 days after treatment to determine performance. Morbidity and mortality were observed from 21 to 60 days old. At 50 days, blood was collected and stored in a vacuum tube containing an anticoagulant (EDTA) for profile examination. The Hog Cholera antibody titer assessment was performed using the ELISA method.

Result: The TCT concentration of 1.5% in piglet feed significantly increased body weight, decreased morbidity, prevented morbidity, elevated WBC, RBC, Hb, PCV, and neutrophils, reduced eosinophils and lymphocytes but still within a normal range. Therefore, it is judged that the preparation of 1.5% is effective and safe, and the % CP value of hog cholera is positive with a rate of 72.9%, which is significantly higher than the control (66.64%).

Conclusion: Earthworm flour with a concentration of 1.5% in feed is harmless, potent in increasing body weight and is indicated as an immunomodulator.

Introduction: Fractures of the hip are common injuries; approximately 50% of fractures occur in the intertrochanteric region. The treatment is to restore patients to their pre-injury level of mobility. Secure fixation is required to allow immediate return to unrestricted weight-bearing. The common fixation methods are dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA). This study compared postoperative walking ability in femoral intertrochanter fractures treated with DHS and PFNA and evaluated the confounding factors.

Methods: We conducted a retrospective cross-sectional conducted at Wahidin Sudirohusodo General Hospital and Universitas Hasanuddin Hospital for patients from 2018 to 2021. The sample was patients with intertrochanteric femoral fracture based on x-ray treated with DHS and PFNA using the purposive sampling method. A total of 107 patients with complete medical record data were included in this research, consisting of 81 DHS cases and 26 PFNA cases. Obtained data from these patients were then statistically analyzed by Chi-square and Fischer exact test. The p-value <0.05 was significant.

Results: In bivariate analysis, the percentage of weight-bearing subjects was higher in DHS (61.7%) than in PFNA (46.2%), although not statistically significant (p>0.05). By controlling for confounding factors such as age, gender, type of fracture, and length of stay, it turns out that there is no significant difference in the results of the postoperative walking ability comparison.

Conclusion: It was concluded that there was no difference in weight-bearing walking ability (full and partial) at discharge between PFNA and DHS.

Background: Differentiation of typical from atypical meningiomas would greatly improve surgical planning and further treatment options. Appparent diffusion coefficient (ADC) has the potential to characterize meningioma subtypes. This study aimed to assess the value of ADC in differentiating typical and atypical meningiomas.

Method: A retrospective study was conducted using medical records at RSUD Dr. Soetomo Surabaya in January 2019 – September 2021. ADC values were obtained by placing three ROIs on tumors. We used receiver operating curve (ROC) analysis to determine the optimal cut-off ADC value to differentiate meningioma grading and Mann-Whitney U test to evaluate the difference in ADC values between the two groups. In addition, Chi-square was used to assess the correlation between ADC values and the type of meningioma.

Results: The ADC values in typical meningiomas ranged from 1.12 - 2.47 × 10-3 mm2/s with an average of 1.45 ± 0.38 × 10-3 mm2/s, while in atypical meningiomas ranged from 0.64 – 1.12 × 10-3 mm2/s with an average of 0.81 ± 0.20 × 10-3 mm2/s. Based on ROC analysis to distinguish typical and atypical meningiomas, the cut-off mean ADC value is 1.12 × 10-3 mm2/s with a sensitivity of 100%, specificity of 96.87%, and area under the curve (AUC) of 0.996. The cut-off difference in the ADC value and the relationship between the ADC value and meningioma type based on histopathology were significant.

Conclusion: Typical meningiomas have higher ADC values than atypical cases. ADC value can help differentiate typical from atypical meningiomas.

Background: Clavus and callus are common hyperkeratotic lesions that can be very painful and affect the quality of life. The clinicians are faced with various factors affecting the resolution of the lesion, and no treatment has been considered ideal. Surgical has been preferable to conservative treatment but is still more likely to increase patients' desirability due to great discomfort. This study aims to evaluate the factors contributing to the resolution of callus and clavus.

Methods: Retrospective analysis was done on 25 medical records of patients who met the inclusion criteria. Factors contributing to the lesion resolution were identified and analyzed using the SPSS version 17 program.

Result: Among 25 (33.7%) patients recruited for the study, 13 were (52%) male and 12 (48%) female. The most common types of lesions were clavus (20 [80%]). In both cases, the distribution of lesion locations was mostly found in the lower extremities (20 [80%]). Excision was performed in 21 cases (84%), and 20 patients (80%) achieved resolution. Treatment modalities were found to be a factor that had a significant relation to the resolution of the lesion after receiving treatment (p = 0.003; Spearman test).

Conclusion: Treatment of callus and clavus has shown satisfactory results in our center. Excision was found to be the most preferred method, with 80% resolution observed during 1 month. The treatment choice was found to be significantly related to the resolution of the lesion after receiving therapy.

Background: Numerous studies have been performed to analyze the effect of proteasome inhibitors on atherosclerosis. However, there is still controversy and the mechanism of action of proteasome inhibitors is still not clearly understood. This study aimed to analyze the effect of proteasome inhibitor on 8-hydroxy-2′-deoxyguanosine (8-OHdG) level in the serum of atherosclerotic rats and the antioxidant expression of Superoxide Dismutase 2 (SOD2) in the aorta.

Methods: The sample was 18 rats with the strain Wistar rats aged 2-3 months. The sample was grouped into normal (N) group got a standard feed, A1 induced by atherosclerosis, and A2 induced by atherosclerosis and given proteasome inhibitor. The proteasome inhibitor was a bortezomib dose of 50 µg/kg BW/day given on days one and three. After four days of treatment, rats were sacrificed, and the aorta removal was done for analyzing the tunica intima-media thickness (IMT) and SOD2 expression assessment using immunohistochemistry, and serum 8-OHdG measurement was done using the ELISA method. SOD2 expression assessment was carried out quantitatively using Adobe Photoshop.

Results: We established a decrease in IMT in the A2 group compared to the A1 group and an enhancement of SOD2 expression and a decrease in 8-OHdG levels in the A2 group compared to the A1 group, although not statistically significant.

Conclusion: In our findings showed bortezomib can prevent thickening tunica intima-media in the aorta, although does not reduce serum 8-OHdG levels and did not significantly increase SOD2 expression in the aorta.

Background: Despite the high burn-related mortality rate, few studies investigate the discriminating power of various mortality prognostic models for burn patients in the Indonesian setting. Thus, the objective of our study is to describe and compare the discriminating power of several prognostic models for burn patients, including the Prognostic Burn Index (PBI), Belgian Outcome of Burn In-jury (BOBI), Revised Baux Score (rBaux), and Abbreviated Burn Severity Index (ABSI).

Patients and methods: We conducted a retrospective study using medical records data with analysis including patients with severe burn (>20% Total Body Surface Area (TBSA), >10% for children and elderly), excluding those with known chronic conditions. Statistical analyses were performed on IBM SPSS 23.0 and included ROC curve and diagnostic values calculation, including sensitivity, specificity, positive, and negative predictive values with 95%CI.

Results: Final analysis included 117 subjects with a 38.9% mortality rate. All prognostic models were statistically significant discriminating power with Area Under the Curve (AUC) values of 0.817, 0.849, 0.929, and 0.859, respectively. Comparing diagnostic values identified rBaux to have the strongest discriminating power with the highest specificity, PPV, and NPV. PBI score was identified with the highest sensitivity score.

Conclusion: Discrepancy of results between our study and another Indonesian study with a similar design pointed to the need for a multi-centered study with a larger sample size to improve generalizability and statistical power of analysis.

Introduction: Catheter-related urinary tract infections for one-third of all health-care related infections in the United States, and have also been shown to increase morbidity, mortality, and length of stay. Various problems are associated with urinary catheter insertion, namely trauma, complications, and patient discomfort. The purpose of this study was to analyze the relationship between catheter placement and the incidence of urinary tract infections in hospitalized patients in Condong Catur Hospital Yogyakarta.

Methods: The design of this study was an analytic observational study using a cross sectional design. The sample was patients diagnosed with UTI for 12 months from August 2019 to July 2020 and inclusion and exclusion criteria. The sample selection was done by consecutive sampling. There were 98 samples of inpatients at the Condong Catur Hospital. The data were taken from the medical records of patients who had UTIs or those with a catheter installed.

Results: There are 98 patients in the Condong Catur Hospital, 18 of them have had UTIs, ten of which were caused by catheter insertion. In this study, bivariate analysis was used to compare the two groups with partners and found a significant association between catheter use and urethral infection, with a p-value of 0.001.

Conclusion: There is a significant relationship between catheter placement and the incidence of urinary tract infections in hospitalized patients in Condong Catur Hospital.

Introduction: Coronary artery disease (CAD) is a disease that has caused death across the world, including in Indonesia. CAD is a multifactorial disease. Many studies have been conducted to examine the causes of CAD. Based on previous research, the risk factors questioned are fixed and nonfixed risk factors. Fixed risk factors include age, gender and family history. Nonfixed risk factors include smoking habits, blood cholesterol levels, behavioral types, socioeconomic status and cultural factors, among others. The purpose of this study is to find a structural model of the influence of Mapalus culture and health behavior on the incidence of CAD in the Minahasa ethnic group in North Sulawesi Province.

Method: This research is a case-control research type that uses 220 respondents (110 case and 110 control respondents). The variables studied were Mapalus culture (ethos and principles) and health behavior (smoking habits, knowledge of CAD, healthy behavior and sickness behavior) as independent variables and CAD incidence as the dependent variable. Data analysis used pathway analysis by employing GeSCA software.

Result: The results of this study indicate that Mapalus culture and health behavior influence the occurrence of CAD. The influence of Mapalus culture will be stronger/greater if it interacts with health behavior.

Conclusion: Based on the results of this study, control must be exercised on smoking habits, increasing knowledge about CAD and having a healthy lifestyle.

Background:  Many academicians in Yogyakarta, Indonesia, face the increased potential for Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) transmission in academic populations. Seroprevalence data can represent the number of infections showing the proportion of people exposed and those potentially immune to the virus and provide evidence for public health policymakers. The seroprevalence of SARS-CoV-2 in the academic population of Universitas Gadjah Mada (UGM) remains unknown, raising concerns about the immune status among the academic population. A cross-sectional study was conducted to estimate the seroprevalence rate of SARS-COV-2 infection in the UGM academic population.

Methods: We conducted a descriptive study of 406 subjects of the UGM academic population. In the cross-sectional analysis of data collected, we performed serological testing for SARS-COV-2 infection for random academicians willing to participate voluntarily. Subjects were categorized as high and low-risk based on SARS-CoV-2 exposure and work history. Data normality was tested with Kolmogorov-Smirnov test. Proportion differences were analyzed with chi-squared tests with a significance set as P<0.05.

Result: 406 subjects were included in this study, with most of the subjects (55.91%) being female. The majority of the subjects were students (82.27%). Most of the subjects were categorized as high-risk (51.72%). Eight subjects (1.97%) had reactive antibody testing. The prevalence of SARS-COV-2 infection was higher in the high-risk group than in the low-risk group (3.57% vs. 0.48%; p=0.01). The high-risk subjects had 7.5 times more incidence of reactive antibody results than low-risk subjects based on the prevalence ratio.

Conclusion: The seroprevalence of SARS-COV-2 immunity in the general academic population of the Universitas Gadjah Mada is 1.97%. These low proportions reflect that more strategies are needed to protect the high-risk group against SARS-CoV-2 exposure.

Background: Human immunodeficiency virus (HIV)-associated nephropathy refers to developing kidney disease associated with HIV infection. Tenofovir is associated with an increased risk of acute kidney injury (AKI). Kidney injury molecule-1 (KIM-1) in urine is very specific for kidney injury. This study aimed to determine the changes in the ratio between the levels of KIM-1/urine creatinine and the increase in serum creatinine levels with the incidence of decreased kidney function in people with HIV.

Method: This was an observational-analytic study. Subjects were taken using consecutive sampling at Sanglah Hospital Denpasar in 2018. KIM-1 levels were measured by the ELISA method.

Results: This study involved 35 patients (21 males and 14 females) with a mean age of 34.89 ± 10.05 years old. The average levels of KIM-1/urine creatinine at 0 hours was 11.039 ± 12.175 ng/ml), KIM-1/urine creatinine at 12  was 12.382 ± 14.671 ng/ml), KIM-1/urine creatinine at 72 was 10.272 ± 11.843 ng/ml). There were no statistically significant differences in the ratio of hours 0 to 12 hours (p = 0.295), and between hours 0-72 (p = 0.413). But there was a significant difference in creatinine levels for 3 months with the initial mean serum (0.848 ± 0.201) and 3 months of evaluation (1.002 ± 0.198) (p = <0.001).

Conclusion: There was no difference in the ratio of changes in serum KIM-1/creatinine levels during the evaluation of 0, 12, and 72 hours. However, there was an increase in serum creatinine levels between the beginning and 3 months of evaluation.

Introduction: Dental and oral diseases are experienced by many children, especially kindergarten or elementary school children. Health promotion with a demonstration method with props is one of the first steps in conveying dental health knowledge and a mouth that is easy to understand by children, using a humorous approach, the demonstration method is one of the most effective methods. The purpose of the study was to determine the effect of counseling demonstration method on increasing knowledge about dental health and mouth in Children at TPQ Al Jakfar Tiris Probolinggo

Methods: Methods: this study used a pre-experimental design that used a one-group pretest-post-test approach with a design of 20 students.  The type of research is used quasi-experimental with pretest-posttest design with control group design. The research subjects were divided into the treatment group (20 people) and the control group (17 people). The research sample is based on purposive sampling. Questionnaire to measure knowledge and check list to measure skills. Data analysis used paired t-test.

Results: The research shows that there is an effect of demonstration method counseling on increasing knowledge about dental and oral health in children at TPQ Al Jakfar Tiris Probolinggo. From the analysis results showed that the significant data equal to <0.001, p <α = 0,05 the result is H1 is accepted.

Conclusion: Health promotion methods with demonstration models have an effect on increasing knowledge about dental and oral health in children at TPQ Al Jakfar Tiris Probolinggo.

Background: Extended random skin flap failure often occurs due to insufficient vascularization. Several attempts have been tried to increase the viability of the flap, but none of these attempts have achieved maximal success. Previous research has shown that Botulinum toxin type A (BTA) increases the viability of cutaneous flaps by inhibiting muscle contraction along with increasing vasodilation and angiogenesis. This study examines the effect of intradermal BTA injection on extended random skin flaps viability.

Methods: In thirty-six Wistar rats, a rectangular random cutaneous flap (6 cm × 1.5 cm) was made on each dorsal rat area and then elevated the flap. The treatment group was intradermally injected evenly with BTA 8 IU and saline solution for the control group. Each rat flap viability was observed after five days. Primary outcome measures are survival flap area using Visitrak, microscopic assessment of the number and diameter of capillaries and Vascular Endothelial Growth Factor (VEGF) expression was analyzed using immunohistochemistry semi-quantitative scoring system. Data were analyzed using SPSS version 21 for Windows.

Results: The treatment group has better results in all observed parameters than the control group. However, Only the VEGF expression of proximal edge showed a statistically significant increase in the group treated with BTA injection (p=0.004).

Conclusion: This study showed that the BTA treatment has a positive effect on random skin flap survival and the reduction of distal necrosis in rats, so it has been proven that BTA has the potential to increase flap survival rates in small animal models. Further studies are needed to determine whether BTA treatment can produce similar findings in humans.

Background: Neurotrophic factors such as NT-3 play an important role in spinal cord regeneration, contributing to spinal cord regeneration assisting functional improvement in SCI. ACTH4-10Pro⁸-Gly⁹-Pro¹⁰, an analog of the N-terminal fragment (4-10) adrenocorticotropic hormone, is one of the neuroprotective compounds that can increase NT-3 levels in brain ischemia. Therefore, we conducted a study with experimental animals to determine the effect of NT-3 expression on ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ administration in acute compression SCI.

Method: We used Sprague Dawley rats with acute compression SCI model using 20 gr and 35 gr aneurysm clips. ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ was administered intranasally to the treatment group, and 0.9% NaCl was administered intranasally to the positive control group. Both of the groups then terminated at 3 and 6 hours.

Results: In rats with mild SCI that were given ACTH4-10Pro⁸-Gly⁹-Pro¹⁰, the NT -3 expression after 3 hours and 6 hours was 14 (12-17) and 10 (7-13). In rats with severe SCI given ACTH4-10Pro⁸-Gly⁹-Pro¹⁰, the NT-3 expression after 3 hours and 6 hours was 9 (6-11) and 8 (7-10). Intranasal administration of ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ showed higher NT-3 expression than the group with 0.9% NaCl in mild and severe SCI.

Conclusion: Intranasal administration of ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ can increase NT-3 expression in mild and severe acute SCI at 3 and 6 hours. Expression of NT-3 in the group with ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ mild acute SCI was higher than in the group with severe acute SCI. Further research needs to be done to determine the neuroregeneration effect of ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ on SCI.

Introduction: The cure rate of Acute Lymphoblastic Leukemia (ALL) in low and middle-income countries is still low. Many factors contribute to relapses event, thus leading to failure of the treatment outcome. However, there are limited studies regarding the relapse of childhood cancer in Indonesia. This study determined demography, clinical, and characteristic laboratory differentiation between relapse and non-relapse in the bone marrow childhood ALL group.

Methods: This was a retrospective descriptive study in children newly diagnosed with ALL ages 0-18 who completed the induction phase using the 2013 treatment protocol during the 2018 period in Pediatrics Hematology-Oncology Unit at a reference center hospital in Indonesia. Of 78 data collected from the Indonesian Pediatric Cancer Registry (IP-CAR) and Hospital Information System after excluding abandoned treatment or death during treatment, only 35 patients completed the overall therapy. We evaluated bone marrow relapse and classified it into 'very early' relapse that occurs at least 18 months from diagnosis, 'early' relapse between 18 and 36 months, and more than 36 months is called 'late' relapse. Chi-square test was used to elaborate association between relapse and sex, leukocyte count, morphological classification, risk stratification, nutritional status. Kruskal Wallis tests were used to elaborate on the association between relapse, age, and induction duration. P value<0.05 was considered statistically significant.

Results: Among 35 patients in this study, seven patients experienced bone marrow relapse. Relapses were dominant in four male patients, four patients aged from 1-10 years old, six patients with leukocytes count below 50.000/mm³, six normal nutritional status patients, and six patients classified as L2 patients. All relapse events occurred in a very early stage. Four patients are classified as standard risk, and three patients are high risk. There were no significant differences among characteristics of the relapse and non-relapse groups.

Conclusions: The observed relapse onset is less than 18 months from diagnosis (very early relapse) during maintenance treatment. However, we found no significant demography, clinical, and laboratory differentiation between relapse and non-relapse groups.

Background: Pig's tonsil is one of the entry points and habitat of commensal microbes and pathogenic bacteria, both Gram-positive and Gram-negative bacteria. Recently, a human meningitis outbreak has reported at Sibang Kaja, Badung-Bali. The cause of this outbreak has been suspected due to the consumption of pig-derived foods. The outbreak was known to be caused by Gram-positive ?-hemolytic bacteria. Based on this fact, PST 10 bacterial isolate with similar characteristics to the outbreak caused interesting identification.

Method: PST 10 isolate was cultivated in a specific medium 5% defibrinated sheep blood agar plate. Subsequently, Gram staining, catalase, oxidase, salt tolerance (6% NaCl), and hemolysis test. This presumptive isolation was then conventionally identified by KIT API 20 STREP and molecularly using the 16S rRNA gene.

Results: PST 10 isolate was identified as Enterococcus faecium using KIT API 20 STREP. Furthermore, the 16S rRNA gene sequencing analysis shows that the isolate has 99.6% similarities with Enterococcus faecalis (MG543832). The isolate shares the same clade in the phylogenetic tree analysis with a 100% bootstrap value.

Background: Dengue hemorrhagic fever (DHF) was one of infectious diseases that is still a concern in Indonesia, especially the Manado city. This study aimed to analyze the variability of temperature, rainfall, humidity, and the incidence of DHF in Manado city 2011-2020.

Method: This ecological research used secondary data obtained from the Health Office and the Central Bureau of Statistics of the Manado City. The variables studied were air temperature, humidity, rainfall and the incidence of DHF in Manado city 2011-2020.

Result: in 2016 there were 567 cases of dengue fever and the highest was in the Malalayang sub-district and the lowest was in the Ranomut sub-district. In 2017 there was a significant decrease to 139 cases, the highest in Malalayang sub-district with 32 cases, and the lowest in Bunaken sub-district with 1 case. In 2018, there was an increase in cases by 294 cases, the highest was in the Malalayang sub-district. The air temperature continues to fluctuate where based on the trendline it is found that the air temperature tends to increase. Whereas, the humidity tends to decrease. The rainfall in the city of Manado continues to fluctuate, where based on the trendline it is found that rainfall tends to decrease. Mosquitoes are cold-blooded animals and their metabolic processes or life cycles depend on the environment's temperature. The DHF cases continue to fluctuate (up and down) where based on the trendline it is found that DHF cases tend to decrease

Conclusion: In the period 2011-2020 in Manado City, air temperature tends to increase but rainfall, humidity, and cases of DHF tend to decrease.

Background: Testicular torsion is one of the urological emergencies that require immediate scrotum exploration. Characteristics of testicular torsion patients, variated time exploration, and the findings of the degree of testicular torsion at the time of exploration can affect the outcome of the testicles. The study aimed to determine the characteristics of testicular torsion diagnosed patients and identify the predictors of testicular salvage.

Method: The method used in the study was cohort retrospective with inclusion and exclusion criteria. Receiver operator characteristics analysis is performed to determine the probability of orchidectomy based on time to exploration and degrees of twist. Multivariate logistic regression tests are performed to identify the factors that cause the testicles to be retained. P<0.05 was significant.

Results: There are 45 patients mostly diagnosed with testicular torsion aged between 12 to 16 years (64.40%). Left testicular torsion was more frequent than the right torsion (82.20%). The etiology of torsion was mostly idiopathic (77.80%). Orchidopexy procedure was performed on 12 testicular torsion patients (26.70%); on follow-up, one patient was found to have testicular atrophy. The time to explore cut-off value 8.5 hours and the 450 degrees of twisting will cause the testis to not survive with the specificity of 83% and 92% and sensitivity of 81% and 82%, respectively. Multivariate analysis shows time to explore and degree of twisting associated with orchidectomy of the affected testis (p<0.05).

Conclusion: Patients are relatively young. Not all patients with testicular torsion will manifest typical symptoms of acute, atypical symptoms such as lower abdominal pain, which can be identified as testicular torsion. Mostly affected left testicle. Orchidectomy is the most commonly performed operation on patients. The outcome of testicular torsion can be predicted by observing the time to exploration factor and the degree of testicular torsion in the patient.

Background: Angle-closure glaucoma is the most common type of glaucoma in Asia, leading worse damage due to its oxidative stress. Another type is  open angle glaucoma in second line. The oxidative stress level can be known by malondialdehyde level examination. The study about MDA levels in aqueous humour in primary angle-closure and open angel glaucoma has not been done before.

Objective: To determine the difference of malondialdehyde levels in aqueous humour between primary open-angle glaucoma and primary angle-closure glaucoma.

Methods: This study was an analytical observational study. Nine subjects were primary open-angle glaucoma patients and ten subjects were primary angle-closure glaucoma patients. The aqueous humour was aspirated from the anterior chamber during trabeculectomy and measured the MDA levels using a spectrophotometer. Data were analyzed by Mann Whitney test.

Results: There was no significant difference (p=0.095) of MDA levels in aqueous humour between primary open-angle glaucoma (62.913±17.259 ?mol/L) and primary angle-closure glaucoma (53.485±9.670 ?mol/L).

Conclusion: The oxidative stress level in primary open-angle glaucoma and primary angle-closure glaucoma are the same, indicate that inflammation status of both condition have been similar.

Introduction: Pregnant women infected with SARS-CoV-2 experienced increased pro-inflammatory cytokines, including TNF-a, resulting in a cytokine storm condition. This study compares TNF-a levels between pregnant women infected and not infected with Covid-19 in the 3rd trimester.

Methods: This observational research was conducted with cross sectional design. Our study included pregnant women who came to delivery room/inpatient at RSUD Dr. Soetomo Surabaya before or during the labor period between May and June in 2021. The inclusion criteria were 3rd trimester gestational age or > 28 weeks with SARS-RT-PCR nasopharyngeal swab result. The exclusion criteria were all significant pregnancy complications. The pregnant woman coming to the delivery room will be screened for COVID-19, and blood samples will be examined using the flow cytometry method for the cytokine Th1: TNF-?.

Results: There were no significant differences in TNF-a levels in pregnant women who were infected and not infected with COVID-19 (median 3.42 (7.24) pg/ml vs. 2.70 (3.06) pg/ml. p=0.138). There were also no significant differences in TNF-a levels in pregnant women with symptomatic vs. asymptomatic COVID infection (3.21(3.97) vs. 2.41(2.71) pg/ml; p=0.314).

Conclusion: This study revealed no significant difference in TNF-a serum level between SARS-CoV-2 infected pregnant women with normal pregnant women. 

Introduction: Inflammation is the body's response to body tissue injury characterized by swelling or edema. Moringa oleifera is known to have many benefits as herbal medicine. Moringa oleifera leaves have been shown to have anti-inflammatory activity. The polyphenol content in Moringa leaves, such as flavonoids and tannins, has been observed as a potential anti-inflammatory.

Methods: Thirty white male Wistar rats were randomly divided into five groups. Group 0 (negative control group) was given base cream, group 1 (positive control) was given 2.5% hydrocortisone cream, group 2 was given 10% moringa leaves extract cream, group 3 was given 12% moringa leaves extract cream, and group 4 was given 14% moringa leaves extract cream. One hour after treatment was applied in the plantar area, all mice were induced with 0.1 ml of 1% carrageenan. The thickness of the rat paw edema was measured every 1 hour for 6 hours using a caliper.

Results: This study showed a significant difference in rat paw edema between the base cream and the entire treatment groups (p<0.05). There was no significant difference between the 2.5% hydrocortisone cream group and the 10%, 12%, and 14% moringa leaves extract cream group (p>0.05). The 14% cream extract had the largest paw edema inhibition among other moringa leaves extract creams which were 27.4%.

The incidence of kidney stone disease has been rising in past decades. The prevalence has doubled in both genders, and
the prevalence ratio is shrinking from 3.4 to 1.3 between males and females. This condition greatly impacts individuals, the
health care system, and socioeconomic levels. Kidney stone diseases are related to various risk factors and medical conditions.
A detailed diagnosis through history taking, urinalysis, metabolic evaluation, and stone analysis is important to direct the
therapy approach. The therapy in managing kidney stone diseases comprises dietary and pharmacological treatment. In
addition to general advice on sufficient fluid intake, citrate intake, maintaining ideal body weight, and restricting sodium and
animal protein, the therapy should be adjusted based on the specific type of stones.

Background: Gigantism is the excessive secretion of growth hormones (GH) during childhood and is mostly caused by benign pituitary adenomas. The signs and symptoms are not specific in early childhood due to growth spurt. An ischemic stroke is rarely present in pituitary adenoma, and here we present a case of ischemic stroke and atrial myxoma associated with pituitary gigantism.

Case Presentation: The patient was an 18-year-old male who complained of continuous growth. In June 2016, the patient suffered from an embolic stroke, and in January 2017 he complained of fatigue and shortness of breath. The echocardiography showed a mass in the left atrium that was removed in March 2017 through open-heart surgery; the pathological histology confirmed a myxoma. The brain magnetic resonance imaging (MRI) showed a pituitary macroadenoma, and the growth hormone (GH) level was 20.6 ng/mL. In October 2019, the patient was referred to Dr. Soetomo Hospital. The height increased from 185 cm in 2017 to 205 cm in 2019. The height was 205cm, weight 85kg, body mass index 20.2 kg/m², GH level >40 ng/mL, cortisol 11.24 ug/dL, prolactin 1.21 ng/mL, testosterone 425.6 ng/dL, free thyroxine (FT4) 1.03 ng/dL, and insulin-like growth factor 1 (IGF-1) 688 ng/mL. The patient was administered oral cabergoline 0.25 mg twice a week and had endoscopic endonasal transsphenoidal hypophysectomy (EETH). The patient developed postoperative polyuria after surgery which indicated diabetes insipidus, and the patient was administered desmopressin 0.05mg/12 h with fluid restriction. One week later, the morning cortisol level was low, and hydrocortisone therapy was administered and was tap-off. One month-post surgery, the level of morning serum cortisol was 0.86 µg/dL.

Conclusion: This case is extremely rare and we demonstrated that the EETH surgery the stability of GH could be achieved.

Background: Lower gastrointestinal bleeding (LGIB) can be caused by irritable bowel disease. Haematochezia is one of the LGIB symptoms. Profuse haematochezia is a rare complication in Crohn’s disease.

Case Presentation: We reported a 24-year-old patient with profuse haematochezia with severe anaemia and hypovolemic shock. Anamnesis, physical examination and colonoscopy showed that haematochezia was caused by Crohn’s disease. Colonoscopy was done after the patient was hemodynamically stable with findings of external haemorrhoid and multiple ulcers with varying size (0.5–2 cm) on ascending colon, caecum and terminal ileum. The tissue histopathology of ileocecal junction indicated intestinal epithelia with partially eroded, crypts infiltrated by inflammatory cells, swollen lamina propria with proliferation and dilation of blood vessels indicting the Crohn’s disease. The patient then treated with Crohn’s disease medical therapy including low dose oral steroid, sulfasalazine and antibiotics. Clinical improvement was found on one week follow-up after discharge from hospital.

Conclusion: Profuse haematochezia could be associated with Crohn’s disease and the comprehensive approaches should be taken to manage the Crohn’s disease with such presentation.

Background: Turner syndrome is a rare condition with high morbidity and mortality rates, it leads to multiple organ damage when left untreated. Meanwhile, liver involvement in this condition ranges from asymptomatic to severe such as cirrhosis with massive gastrointestinal bleeding. This study presents a case of gastrointestinal bleeding due to cirrhosis in Turner syndrome where the patient showed third-grade esophageal varices as a sign of portal hypertension.

Case Presentation: A 26-years old female came to the Emergency Department of Dr. Soetomo General Hospital in Surabaya with massive gastrointestinal bleeding. The patient was a Turner syndrome, diagnosed ten years ago. The patient was negative for hepatitis B surface antigen (HbsAg) and anti-hepatitis C virus (anti-HCV). The gastric lavage was performed to reduce active bleeding with blood transfusion. The upper gastrointestinal endoscopy indicated portal hypertension with third-grade esophageal varices, fibro scan indicated cirrhosis hepatic and abdominal CT-scan showed early cirrhosis and splenomegaly supporting the presence of portal hypertension. Since the patient refused to endoscopic varices ligation, hematemesis repeated three times after the first visit resulting death of the patient.

Conclusion: This is a Turner syndrome patient who experienced life-threatening gastrointestinal bleeding as complication of liver abnormality. This case highlights that liver cirrhosis should be evaluated in individuals with Turner syndrome to prevent such complications.

Background: On average, one-third of patients seeking treatment for skin problems have associated psychological stress or psychiatric disease. Most psychodermatologic patients visit a dermatologist instead of a psychiatrist. It is important to recognize the signs and symptoms immediately, make a prompt diagnosis and do a comprehensive treatment that involves multi-disciplinary approach, including dermatology, psychiatry and other discipline if necessary.

Case Presentation: A 40-year-old female, visited the Dermatology and Venereology (DV) outpatient clinic of Dr. Cipto Mangunkusumo Hospital with a chief complaints of wound on her right ear since 2 weeks ago. The patient was also diagnosed with Chiari malformation type 1 and had undergone surgery twice. The patient confessed of having a habit of intentionally skin picking until they were chafed and bled when she was stressed. The patient was diagnosed as neurotic excoriations, treated with potent topical corticostreroid and consulted to the psychiatric department.

Discussion: Neurotic excoriations is classified as primary psychiatric skin disorders. Symptoms usually occurred when the patient was in the depression state. At first the patient only followed the dermatologist treatment and had a poor compliance with psychiatric management. Therefore the patients keep manipulating the lesions and the outcome was not satisfactory because the underlying disease has not been well treated. After the dermatologist convinced her to see the psychiatrist regularly, accompanied by a good compliance in applying the corticosteroid cream, the result was satisfactory.

Conclusion: The psychocutaneous disease need a comprehensive and multi-disciplinary approach. Dermato-venereologists should work together with the psychiatrist.

Introduction: Tuberculous colitis and Crohn’s disease (CD) are two disorders that possess similarities in clinical features and colonoscopy findings.

Case presentation: The patient had previously undergone colonoscopy and mucosal biopsy in this case report, indicating chronic diarrhea and hematochezia. Based on the results from the colonoscopy, the patient was suspected for Crohn's disease. Meanwhile, the collected mucosal biopsy stained with Hematoxylin-Eosin suggested the early diagnosis of CD. Hence, patient was prescribed with sulfasalazine 2x500 mg for 6 weeks, where no clinical improvement was found afterward. Patients still complained nausea, vomiting, frequent diarrhea and bloody stools. The patient was later suspected of intestinal tuberculous and prepped for interferon-gamma release assay (IGRA) and stool Xpert MTB/RIF test. Both of the additional tests suggested that the patient was positive tuberculous. According to the collective facts and findings, the patient was diagnosed with intestinal tuberculous and prescribed with category 1 anti-tuberculosis.

Conclusion: The patient was followed-up after nine months treated with anti-tuberculosis, where the negative result was obtained from the stool Xpert MTB/RIF test. In the following year after the therapy, the patient felt no complaints.

Background. Patent foramen ovale (PFO) is a part of atrial septal defects (ASD) entities. While mostly asymptomatic, some adults with PFO will develop symptoms, from mild complaints such as migraine or palpitation to more debilitating complications such as syncope or cryptogenic stroke. Therefore, it is highly crucial that PFO be diagnosed and treated promptly. Echocardiography, trans-thoracal and or trans-esophageal, is the main diagnosis modality. For treatment, antiplatelet with or without anticoagulation, trans-catheter closure, and surgery are utilized in accordance with their indications.

Case Presentation. We present four adult patients referred with various symptoms: vertigo, migraine, palpitation, and cryptogenic stroke. Three of them had no explicit risk factors for the cerebrovascular event, with one patient having a co-existing hypercoagulable state. Echocardiography revealed a positive bubble test, which meant that PFO was the primary etiology of those cases. We then treated each of them with transcatheter device closure, which improved their symptoms, before adding antiplatelet for six months.

Conclusion. Proper diagnosis and prompt treatment of PFO are imperative in reducing complications. Echocardiography, mainly TEE, is the main diagnostic tool for PFO. Antithrombotic (with or without anticoagulant), minimally invasive procedure and surgery in some cases are the modalities available.

Introduction: Varicella-zoster virus (VZV) infection in pregnant women in the last three weeks of pregnancy or the days before delivery causes neonatal varicella. It is rare in newborns and infants due to passive immunity received from the mother. Thus we report a rare case of neonatal varicella for an educational purpose.

Case report: A 14-day-old girl was referred to the Department of Pediatrics with a red rash all over her body. The red rash begins on the face and subsequently spreads across the body fever for four days before the appearance of the rash. During the third trimester of pregnancy, the patient's mother had varicella. The patient was delivered vaginally by the midwife at full term, weighing 3,400 g. Macules, papules, pustules, and vesicles, multiple in number, distinct, miliary to guttate in size, and universal distribution, were identified on physical examination in the facial, thoracic, and upper extremities region et inferior bilaterally. The Tzank test found multinucleated giant cells. Skin biopsy found stratum spinosum edema with powdered lymphocyte inflammatory cells (typical for varicella). Treatment with intravenous acyclovir showed improvement after 5 days.

Conclusion: VZV generates a wide spectrum of clinical symptoms in the fetus and newborn and can be a life-threatening condition. Early recognition of pregnant women and newborns who are at risk for VZV infection is very necessary so that prophylaxis and treatment can be started immediately

Background: Fournier gangrene is necrotizing fasciitis of the genitalia and perineum that can extend to the abdominal wall, gluteus or lower extremities. Predisposing factors for Fournier gangrene include obesity, diabetes mellitus (DM), alcoholism, smoking, hypertension, chronic kidney disease, perianal trauma and immunosuppressive conditions. This case report aims to evaluate the management of Fournier gangrene on metabolic and surgical treatment

Case Presentation: A-53 years old-female with Type 2 Diabetes Mellitus (T2DM) came to the Emergency Ward of Dr. Sutomo General Hospital, Surabaya, with the chief complaint of sores on the buttocks for 1 week. The patient was diagnosed with Fournier gangrene. On physical examination in the room, erythematous macular lesions were found in the folds of the breast and armpit on chest examination. Obtained scratch marks were found because the patient is often scratched. The wound from the buttock and keep enlarged due to the Fournier gangrene ( necrotizing infection). In this case, the patient was given the antibiotics ceftriaxone and metronidazole. The patient died during the 8^th day of treatment due to a suspected septic shock.

Conclusion: Surgical management in this patient is debridement. Multi-disciplinary management of obstetrics, urology, digestive surgery, and plastic surgery is required for the management of Fournier gangrene in T2DM patients

Introduction: Desmoid tumors are rare cases that arise from aponeurotic tissue. Parasitic leiomyoma is a rare type of leiomyoma that grows in reproductive age, but differential diagnostics have something in common.

Case report: A case of a 34-year-old Asian woman, secundigravida, outpatient clinic, referred from surgery division with chief complaint of a lump in the stomach that has become bigger in the past 4 years. There was no menstrual complaint, and the patient had a history of one previous cesarean section. Computed Tomography (CT) revealed a mass on the abdominal wall that extends to the abdominal cavity, and the patient underwent a mass biopsy and the histopathology results were obtained in the form of uterine leiomyoma or fibroid. During the operation, the mass was obtained from the abdominal wall and had no connection to internal reproductive organs, and due to the large mass, we consulted to digestive surgery division for mass resection, and a mesh graft was placed. Based on the results of tissue examination, the desmoid fibromatosis tumor was obtained from histological findings.