The safety of modified digital subtraction angiography in RSPAD Gatot Soebroto: a comprehensive outlook

INTRODUCTION. There are no recent estimates of the complication rate associated with Intra Arterial Heparin Flushing (IAHF). The purpose of this study was to estimate the rate of complication occurring during and after Intra Arterial Heparin Flushing.

METHOD. This report is a descriptive study based on analysis of interventional radiology database. The study involved patients who underwent IAHF procedure started from January 2018 until December 2018 in Rumah Sakit Pusat Angkatan Darat Gatot Soebroto (Indonesian Army Central Hospital). Subjects were assessed for their age, sex, medical history, diagnosis, intra-procedural complication, and post-procedural complication.

RESULT. All IAHF procedures were performed via transfemoral catheterisation and using a vascular closure device to help achieve homeostasis. Our population included 1223 (70,57%) male and 510 (29,43%) Female, with age ranging from 21 to 80 years old. The majority of the subject was in 51-60 years old age group (35,31%). All IAHF were technically successful. No intraprocedural complication was noted, there was no occurrence of iatrogenic vessel injury (dissection) and no neurological deficit secondary to IAHF procedures. There was some local complication after IAHF procedure such as hematoma 44 persons (2,54%), oedema around the puncture site six patients (0,35%), and bleeding at the puncture site three patients (0,17%). Beside local complication, there were several systemic complications such as allergy in 10 persons (0,58%). No neurological complication was reported after IAHF.

CONCLUSION. We concluded that IAHF has a relatively low rate of acute complication. Most complications were related to local hemostasis control, and no severe sequelae were found.

Factors related to the use of internet in Bali by women as a source of information about pregnancy, childbirth, and baby care: a cross-sectional study

Purpose: This study aims to identify the relationship between sociodemographic and obstetric factors with the use of the internet by women as a source of information about pregnancy, childbirth, and baby care.

Method: This cross-sectional study involved 185 women who had babies aged 0-3 months. Data were collected in August and September 2018. Data were collected by interviews using questionnaires. Data analysis was conducted by chi-square and logistic regression

Results: The age factor (p = 0.255), education (p = 0.071), occupation (p = 0.100), income (p = 0.077) and parity (p = 0.380) were not related to the use of the internet. The factor of service provider is significantly related to internet usage (p = 0.031).

Conclusion: The use of the internet by women in Bali to search information about pregnancy, childbirth, and baby care is not related to most sociodemographic and obstetric characteristics. The results of this study could be taken into consideration by health practitioners to create innovative programs in the field of maternal and child health services.

Transarterial Chemoembolization in Hepatocellular Carcinoma: A Clinical Efficacy Study of Ganoderma Lucidum Extract Polysaccharide Peptide β-Glucan

Background: Hepatocellular carcinoma (HCC) is a primary liver malignancy with high prevalence rate, associated primarily with the Hepatitis B Virus. HCC is the third leading cause of death worldwide. The prevalence in Indonesia is estimated at 100 per100,000 inhabitants. Treatment is generally ineffective as patients are already at advanced stages when diagnosed. Trans-arterial Chemoembolization (TACE) is a promising treatment, and β-Glucan combined therapy is expected to treat HCC more efficiently. This study evaluated the treatment response of TACE in HCC combined with β-Glucan orally.

Methods: A randomized clinical trial was conducted on 63 patients with HCC. The subjects of the study were randomly assigned into two groups: 32 administered TACE plus β-Glucan, and 31 with TACE plus placebo.

Results: In the β-Glucan group, there were four patients (12.50%) with complete response, 16 (50%) partial response, 3 (9.38%) no response, and 9 (28.12%) in deteriorated response. In the placebo group, there were 0 complete response, 11(35.48%) partial, 2(6.45%) no response, and 18 (58.07%) deteriorated response. The survival rate of the β-Glucan group was longer (median 39 weeks) than the placebo group (median 26 weeks). CD4, CD8 and IL-2 post-TACE increased significantly (p<0.05). The placebo group had 4.143 times, significantly higher hazard risk (p<0.05).

Conclusion: HCC therapy with a combination of TACE and β-Glucan is beneficial to increase the therapeutic response, immunity and survival rate.

A Randomised Controlled Trial: The effect of oral astaxanthin as an anti-inflammatory agent on serum level of e-selectin in acne vulgaris

Background: E-selectin plays a pivotal role in the inflammatory response of acne. Astaxanthin (AST), an supplement claimed having anti-inflammatory and antioxidant properties, has potential in inflammatory skin therapy. This study aims to determine the effect of oral AST as an anti-inflammatory agent on the serum level of e-selectin in acne vulgaris. 

Methods: This is a double-blind, randomized controlled trial study with a pretest and posttest control group design. The participants were 34 acne vulgaris patients with inflammatory lesions (papulopustular acne). The participants are randomly assigned to the treatment or control group to receive oral tablet of 4 mg of AST or placebo in addition to standard acne therapy of tretinoin cream 0.025% and clindamycin cream 1.2%. Each group was measured for the serum level of E-selectin before therapy (pretest) and after one month of therapy (posttest). 

Results: The pretest and posttest level of the mean serum e-selectin in the treatment  group were 50.21 ± 21.12 ng/ml and 50.04 ± 22.99 ng/ml, respectively. There is no significant difference between the pretest and posttest of the mean e-selectin level in the treatment group (p=0.943). While, the pretest and posttest of mean serum e-selectin level in control group were 57.84 ± 20.71 ng/ml and 55.87 ± 15.98 ng/ml, respectively. There is no significant difference between the pretest and posttest of the mean e-selectin level in the control group (p=0.453). There was a decrease in the mean serum e-selectin level of the treatment and control groups one month after therapy. However, the decrease of the mean e-selectin level between treatment and control group is not significantly different (p=0.547).

Conclusion: The addition of oral AST to standard acne therapy shows no significant difference in reducing the serum e-selectin level compared to placebo.

Case report: a 33-year-old man with recurrent ureteropelvic junction obstruction

Introduction: Ureteropelvic Junction Obstruction (UPJO) is the obstruction of upper urinary tract, present in fetal life until adulthood. Congenital UPJO mostly results from an intrinsic process with dilatation of renal collecting system. Acquired UPJO in adulthood may present without dilatation of renal collecting system, correlated with urolithiasis, infection, postoperative peripyelo-inflammatory fibrotic complication, and urothelial malignancy. In the past, Pyeloplasty, classic dismembered (Anderson-Hynes) or laparoscopic, is the gold standard treatment. In this study we would like to report and discuss comprehensive etiologies, diagnostic, and its treatment based from real case.

Case Presentation: We report case: a 33-year-old Indonesian man with left flank colic pain (VAS:8/10), nausea, and hematuria that did not disappear with medication. He had stone history in right proximal ureter with hydronephrosis and hydroureter, Ureterorenoscopy had been performed two years ago. Other vital signs and hemodynamics were stable. Abdominal USG demonstrated bilateral hydronephrosis and hydroureter. Abdominal X-Ray showed right ureter stone. Right-Left Ureterorenoscopy + Double-J-Stent were performed. The diagnosis was Bilateral Nephrolithiasis, Stenosis, and Proximal Ureter Obstruction leading to Recurrent UPJO. Three months later there was still pain, the patient was undergone Cystoscopy + URS + Laser Endopyelotomy + DJ-Stent Replacement (from 6 to 7 Fr). One month later, DJ-stents were removed but the stenotic ureter remained so Laparoscopic End-to-End Proximal Ureter Anastomosis Resection and DJ-stent Insertion were finally performed. Patient’s complaints were slightly reduced.

Conclusion: The Recurrent UPJO cause inadequate urinary flow leading to renal impairment. Clinical signs, symptoms, etiologies, and diagnostic imaging have significant role in determining the diagnosis. Early surgical intervention is the definitive treatment to reduce renal damage and its complications. Further researches to establish the causes, clinical manifestations, diagnostic imagings, and alternative treatments of UPJO are highly expected.

Surgery in foreign body ingestion and aspiration: descriptive study

Background: Foreign bodies in upper digestive tract, as well as respiratory tract, are common cases in daily life. This incident can occur in all age groups, ranging from children to elderly. Endoscopy and bronchoscopy are the first treatment option, nevertheless, case with complications which endoscopy or bronchoscopy cannot be done, it requires another extraction procedure specifically surgery.

Method: We conducted a retrospective review of patients who came to consult to Thoracic Cardiovascular Surgery Department by ENT Department. The data obtained are from 2009-2019.

Result: Out of 290 patients recorded, experiencing foreign body impaction in both digestive and respiratory tract for the last 10 years, the highest number was digestive tract with 243 cases (83.8%) and 47 respiratory tract cases (16.2%). From 17 patients who underwent surgery, 70.6% men and 29.4% women. The age group of children and adults had the same number as seven patients (41.2%) and elderly with three patients (17.6%). The highest number of surgical procedure was thoracotomy with 10 patients (58.8%) while cervical esophagotomy with seven patients (41.2%).

Conclusion: The failure of the extraction procedure using endoscopy or bronchoscopy in the case of a foreign body leads to surgery as a definitive therapy for patients. The age group of children and adults have same number. Cases of impaction in the esophagus are the most common. The most common surgical procedure performed is thoracotomy. In this study the success rate of extraction by surgery reached 100% without additional morbidity and mortality.

Parent's motivations on sports participation of their children with Down’s syndrome in Russia

Background: Regular physical exercises can improve physical and mental health and especially important for individuals with extensive disorders, such as Down’s syndrome. For the success of rehabilitation, it is necessary to involve the parents of children with Down’s syndrome in the process. By understanding the parents' motivation, a successful training program will be possible.

Aim: This study is aimed to determine the importance degree of various parents’ motivations in sports participation of their children with Down’s syndrome.

Method: A survey was conducted in 137 families from 22 regions of Russia in November 2016. The survey included 23 motivational statements and parents were asked to rate the importance of each statement on a scale of 1 to 10. The results were divided into 5 groups based on the importance of the motivational statements: “absolutely important”, “important”, “difficult to say”, “not important”, and “absolutely not important”. Statistical analysis was done using average values method.

Result: Parents considered the following reasons to let their children participate in sports as “absolutely important”: to implement healthy and active lifestyle; to develop interaction skills in a group, independence, and dexterity; to improve the skills of large-scale body movements and coordination of movements; and to encourage socialization. None of the motivational statements were considered as “absolutely not important”.

Conclusion: This study found that parents considered the majority of the motivational statements as important. Considering the parents’ motives will encourage the sports participation of children with Down’s syndrome.

Efficacy of revision urethroplasty in the treatment of recurrent urethral strictures at a tertiary hospital (Kenyatta National Hospital–KNH), in Nairobi Kenya: 2015-2018

Background: Urethral strictures cause malfunction of the urethra. Urethroplasty is a cost-effective treatment option. Its success rate is greater than 90% where excision and primary anastomosis(EPA)is performed and 80-85% following substitution urethroplasty. Definitive treatment for recurrent urethral strictures after urethroplasty is not defined. Repeat urethroplasty is a viable option with unknown efficacy.

Method: Retrospective analysis of patients who underwent revision urethroplasty for unsuccessful urethroplasty at KNH from 2015 to 2018 was performed. Patients’ age, demographic data, stricture length, location, aetiology, comorbidities and type of urethroplasty was evaluated from records with complete data. Male patients aged 13 to 80years were evaluated. Comparison of urethroplasty outcome between two patient cohorts was made: Fresh urethroplasty patients versus failed urethroplasty who underwent revision so as to determine efficacy of the later. Principal outcome measure was urethral patency, while Subsidiary outcome measures were associated complications. Outcomes were compared using statistical package SPSS version 23.0.

Result: 235 patients who met inclusion criteria underwent urethroplasty, 71.5% (n=168) had a successful outcome, while28.5% (n=67) failed and were subjected to revision urethroplasty. Another 58% were successful upon revision but experienced significant morbidity. Majority of urethral strictures were bulbomembranous. Trauma was the leading cause of urethral strictures followed by idiopathic strictures. EPA was the commonest surgery while Tissue transfer featured prominently in revision urethroplasty. A significant correlation was evident between stricture length, prior surgery, and procedure choice and urethroplasty outcome.

Conclusion: Revision urethroplasty is feasible after failed urethroplasty but less efficacious. Stricture length, number of prior surgeries and procedure choice affected outcome.EPA and Tissue Transfer techniques are essential surgical armamentarium in revision setting.

The association between Body Mass Index (BMI) and Activity of Daily Living (ADL) in the population-based elderly at Buleleng and Tabanan regencies, Bali, Indonesia

Background: High Body Mass Index (BMI) is known associated with mortality and morbidity among the elderly. However, other studies also show the opposite result in high BMI as protective against Activity Daily Living (ADL). Accurate quantification of the role of BMI in the incidence of disability in ADL is desirable in the face of the increasing prevalence of individuals with overweight and obesity and prolonged life span in the population. This study aims to investigate the association between Body Mass Index and Activity of Daily Living in population-based elderly.

Method: A cross-sectional analytic study was conducted in the urban and rural area of Bali Province, particularly in Buleleng and Tabanan regencies. BMI and Barthel Index score were recorded among respondents. Data were analyzed using SPSS version 17 for Windows and aP-value less than 0.05 was considered statistically significant.

Results: A total of 167 respondents, 100 and 67 from the urban and rural area of Bali Province respectively, was predominant by 93 (55.7%) females and followed by 74 (44.3%) males. Spearman test found a significant weak positive correlation between weight and Activity of Daily Living (r= 0.168; p<0.05). In addition, a significant weak positive correlation was also found between BMI and ADL (r= 0.158; p<0.05).

Conclusion: Our study showed increased values of BMI is a protective effect on ADL.

Extracutaneous manifestations of adult psoriatic patients attending Dermatology Teaching Center in Slemani, Iraq

Background: Psoriasis is debilitating, albeit remained underdiagnosed and undertreated, disease typically known for its cutaneous manifestations. Recent evidence pointed towards multisystemic comorbidities that we aim to elucidate further in this study.

Methods: A cross-sectional descriptive study was conducted in Dermatology Teaching Center in Slemani city from April to September 2019. One hundred dermatologist-confirmed psoriasis patients aged 18 years old and above were subjected to structured interview, physical examination and blood investigations to determine the presence of psoriasis extracutaneous manifestations.

Results: There were a total of 100 patients with a mean age of 47.2 ± 15. Majority of the patients comprised of middle age group (42.0%), female (67.0%), with 10-20 years disease duration (36.0%). Only a few of them are currently smoking (16.0%) and consume alcohol (6.0%). Patients with extracutaneous involvement primarily had multiple (37.0%) as opposed to singular (24.0%). Metabolic syndrome was the most prevalent (30.0%) extracutaneous manifestation in this study.

Conclusions: Extracutaneous manifestations of psoriasis were ubiquitous and often coexisted. Emerging progressive comorbidities prompted greater recognition and integrated multidisciplinary approach.

Clinical characteristics of traumatic brain injury patients in Dr. Zainoel Abidin Public Hospital Banda Aceh, Indonesia

Background: Traumatic brain injury (TBI) is responsible for more than one million hospital visits and causes disability and death in all age groups and genders. Every day, 153 people die from injuries including traumatic brain injury.

Methods: We use a retrospective, cross-sectional study design. We collect data from patients admitted to our hospital on November 2018 that was diagnosed and treated for traumatic brain injury. The clinical information at follow-up was also analyzed.

Results: We collected 60 cases of TBI, that consist of 35 male (58%) and 25 females (42%) with an average age of  18-39 years. 42% of patients had post-traumatic amnesia. The leading cause of TBI was from motor vehicles accident, which constitutes to 90%, followed by falls (8%) and others (i.e. self-harm and assaults 2%). Glasgow Coma Scale (GCS) were examined, and we found 85% of patients presented with GCS scores ≥ 9 and 25% with score ≤ 8. Brain Ct scanning findings showed cerebral oedema (25%), epidural hemorrhage (18%), intracranial hemorrhage (15%), and subarachnoid haemorrhage (12%). Laboratory findings showed an increase of leukocyte count (80%), high segmented neutrophils count (72%), hyperglycemia after TBI (7%), hyponatremia (2%), hypernatremia (11%), hypokalemia (22%), hyperkalemia (17%) and hyperchloremia (30%).

Conclusion: We reported 60 cases of TBI and collected demographic data upon patients arrival in the hospital, such as; GCS score, brain imaging and laboratory findings. This information can help prevention strategies, identify research and education priorities, and support service needs among those living with TBI.

Clinical profile of patients with cerebrovascular disease at Stroke Unit, Sanglah General Hospital, Denpasar, Bali

Introduction. Stroke is the leading cause of disability and has a high mortality rate with most death occur in developing countries. Unfortunately, only a few informations available about strokes in developing countries, including Indonesia. Thus, this research aimed to provide a general overview of stroke patients from stroke unit in Bali, Indonesia.

Methods. A cross-sectional study was carried out in Sanglah General Hospital, Denpasar Bali between August 2017 – January 2018 evaluating newly admitted stroke patients. There was no age limit, both male and female were enrolled. Data related to socio-demographic, risk factors, clinical features, and imaging result were extracted from medical records.

Results. A total of 82 subjects were enrolled. Strokes were more common in males (61%) with most affected age group was 50-59 years (29.3%) and young stroke (age ≤45 years) accounted for 19.5% of the cases. Ischemic stroke (53.7%) was more common type encountered, and hypertension (76.8.3%) was leading risk factor. First-time stroke accounts for 80.5% while recurrent stroke accounts for 19.5% with 3.6% admitted for the ≥3 episodes. Overall, territories of middle cerebral artery including basal ganglia (25%) and internal capsule (20.5%) were frequently affected in ischemic stroke while lenticular-capsular (44.7) and lobar structure (18.4%) in hemorrhagic stroke. Typical chief clinical presentation was hemiparesis (42.7%) and altered consciousness (26.8%).

Conclusions. Stroke tends to affect late adult with male predominance and hypertension as leading risk factor. Ischemic stroke was the most common type. There were differences in clinical presentations and anatomic site preferences between hemorrhagic and ischemic stroke.

Class model of family planning based on predisposing, enabling and reinforcing factors in improving knowledge, attitude, family support and use of long-term contraception methods in fertile age pair of high risk

Introduction: This study aims to prove the model of family planning classes based on predisposing, enabling and reinforcing factors to increase knowledge, attitudes, family support, and the use of long-term contraception methods in high risk fertile age pairs.

Method: The design used for this study is the Community Trial with the Randomized Pretest-Posttest Control Group Design approach. The sample in this study were couples of childbearing age who had one or more high risk criteria (age <20 years, age> 35 years, number of children> 3 and birth distance <2 years) as many as 150 respondents as an intervention group (family planning class model based on predisposing, enabling and reinforcing factor) and 150 respondents as a Control group (Conventional Family Planning Class Model). This intervention was carried out for 6 months. Data collected includes data on knowledge, attitudes, family support, and use of contraception methods. Data were analyzed using Chi-Square test.

Result: The family planning class model based on predisposing, enabling and reinforcing factors effectively increases knowledge (p=0.000), attitudes (p=0.000), family support (p=0.037), and long-term contraception method use (p=0.000).

Conclusion: The family planning class model based on predisposing, enabling and reinforcing factors effectively increases knowledge, attitudes, family support, and the use of long-term contraception methods in high risk fertile age couples

Validity S.T.O.N.E. nephrolithometry scoring to predict stone free status in kidney stone patients after percutaneous nephrolithotomy

Background: Kidney stone still a health problem in the world. Today, the choice of therapeutic modality is also increasingly varied, percutaneous nephrolitotomy (PCNL) is still the first line for stone therapy with varying success rates, some high or low. Sometimes need additional measures such as extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) for the rest stone and good preventive behaviour are needed. This can be influenced by several risk factors, a risk factor predictor is required to get a high stone free rate in patients after PCNL.

Methods: This research is a cross sectional retrospective study, we recorded 50 patients at the Medical Records Installation at Sanglah Education General Hospital in Denpasar since January 2018-November 2019 with kidney stones performed by PCNL, each patient will be calculated S.T.O.N.E Nephrolithometry score can be seen on CT Stonography and the presence or absence of stone after PCNL. The parameters of S.T.O.N.E Nephrolithometry are size, tract obstruction, number of calyces, essence. And calculated the best cut off, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of the S.T.O.N.E Nephrolithometry score to predict stone free status after PCNL.

Results: The best cut off value in this study is <9, where patients with S.T.O.N.E Nephrolithometry score  < 9 have a risk stone free after PCNL 25 (50%) patients, while the S.T.O.N.E Nephrolithometry score >9, has a risk of not being free and there are stones left  25 (50%) patients. S.T.O.N.E Nephrolithometry had % sensitivity 60.6%, specificity 70.6%, and 64 % accuracy in this study. Positive predictive value and negative predictive values were 80% and 48%.

Conclusion: from this study the S.T.O.N.E Nephrolithometry score sensitively predicts stone free status in kidney stone patients after PCNL and can be used as a tool to education the patient before PCNL and therapy.

The effect of adding plantar flexors isometric exercise on calf circumference in patient with post open reduction internal fixation non-articular tibia fracture

Background: Post-operative non-articular tibia fracture some problems that often occur include pain, muscles atrophy, muscles weakness, and joint stiffness that makes patients limited in their daily activities. Several factors that play a role in muscles atrophy and weakness prolonged immobilisation and lack of exercise. Plantar flexor isometric exercise might effectively prevent the problem. Not yet known the effect isometric exercise of plantar flexor on calf circumference in patients post open reduction internal fixation of tibia fractures, due to the lack of studies in this field. The aim of investigating the effect of isometric exercise plantar flexor on calf circumference in patients post open reduction internal fixation non-articular tibia fracture.

Methods: Study design using an experimental model with pre-test and post-test control group design divided into two groups, group A obtained treatment of isometric exercises of the plantar flexor muscles, range of motion knee and ankle joint while group B obtained a range of motion knee and ankle joint.

Results: Descriptive analysis in group A there were 13 (81.3%) samples which increased calf circumference and 3 (18.7%) samples did not change while group B there were 4 (25%) samples increased calf circumference, 1 (6%) sample did not change and 11 (69%) samples were reduced calf circumference. The study was found increase mean calf circumference in group A was 0.76 cm and reduction mean calf circumference group B was 0.44 cm. Independent samples differences with α of 0.05 and confidence interval 95% was obtained p-value = 0.003, which has shown there is a significant difference in increased calf circumference group A obtained isometric exercises plantar flexor compared to group B without isometric exercises plantar flexor in patients  post open reduction internal fixation of a non-articular tibia fracture. 

Conclusion: The study found plantar flexor isometric exercise in patients post open reduction internal fixation non- articular tibia fracture enhances calf circumference that will prevent muscle calf atrophy and weakness.

Factors affecting the mini-mental state examination (MMSE) score in the epilepsy patients in Aceh, Indonesia

Background: Epilepsy patients in developing countries is quite high. A person can have epilepsy within a certain time limit, but also not a few people who survive with this condition for life. This situation will affect cognitive function. Cognitive function impairment in epilepsy patients can be triggered by various factors related to aetiology, clinical, and others. Therefore, we tried to find the factors that influence the cognitive function in epilepsy patients.

Methods: This study was an observational analytic study with a cross-sectional design. The study was conducted using primary data obtained from direct interviews and MMSE examination and secondary data obtained from medical records to confirm the diagnosis of epilepsy. Samples were collected based on the diagnosis of neurologist in the patient's medical record at the Regional General Hospital Dr. Zainoel Abidin Banda Aceh from October to December 2019. This study involved thirty-four epilepsy patients.

Result: There were cognitive function decreased in recalling 47,1% and 26,5% in Attention and calculation. The relationship between the frequency of seizure (p = 0.028) and therapy (p = 0.012) on the  MMSE .

Conclusion: Politherapy was the dominant factor affecting the MMSE score of epilepsy patients.

Music and video music therapy are effective in reducing stress among elderly at Yogyakarta Social Service Center of Tresna Werdha, Abiyoso Pakem Unit, Sleman regency

Background: The elderly will experience several physical and psychological changes. Such problems will inevitably lead to stress in the elderly. The prevalence of stress events in the elderly in Indonesia is 8.34% and at Yogyakarta Social Service Center of Tresna Werdha, Abiyoso Pakem Unit, Sleman is 38.4%. If left unchecked, stress can result in a prolonged depression. This study aims to identify the effectiveness of music and music video on stress in the elderly at Yogyakarta Social Service Center of Tresna Werdha, Abiyoso Pakem Unit, Sleman.

Methods: A quasi-experimental study with Pre-and Post-test without control design were conducted. The number of respondents was 24, whereas taken by Simple Random Sampling approach. The music intervention was given to the 12 respondents and music video intervention to the 12 respondents. Stress was measured using DASS. Data were analyzed using paired T-test to determine the effectiveness of therapy and Independent T-test to evaluate the differences in therapy using SPSS version 17 for Windows.

Results: Based on age, the respondents with 60-74 years were predominant (83.3%). Most of the respondents were female (79.2%). The analysis using Paired T-test indicated that there was a significant relationship of music therapy on the elderly (P<0.05). In addition, a significant result in reducing stress was also found in the music-video group on the elderly (P<0.05).

Conclusion: Music and music video therapies are effective to reduce stress in the elderly.

Effect of isoniazid preventive therapy on pulmonary tuberculosis activity in people living with HIV/AIDS at Wangaya hospital in Denpasar, Bali, Indonesia: a prospective cohort study

Background: Isoniazid Preventive Therapy (IPT) can reduce the Active Pulmonary Tuberculosis (APT) in People living with HIV/AIDS (PLWHA).  IPT is recommended by the World Health Organization (WHO). It has not been implemented routinely in all countries.

Aim: To evaluate whether IPT in PLWHA reduces the APT at Wangaya Hospital, in Denpasar, Bali, Indonesia.

Methods: A prospective cohort study was conducted during October 2014 until November 2016. A total of 244 PLWHA were included in this study. The first group were 122 participants received antiretroviral therapy (ART) and IPT and 122 participants received only ART (second group). Cox regression analysis was employed to calculate effects in both groups and to identify predictor factors for active tuberculosis. The statistical analysis performed with cox proportional hazard model.

Results: There were 137 (56.1%) males and 107 (43.9%) females. Incidence of APT in the IPT group was 1.09 per 100 person years and non IPT groups was 12.57 per 100 person years. Incidence of APT in the non IPT groups was significantly higher than in the IPT groups with crude hazard ratio (cHR) of 12.59 (95% CI: 2.70-53.43). After variables adjustment for age, sex and CD4 count, the incidence of APT in the non IPT group were found with adjustment hazard ratio (aHR) of 10.26 (95% CI: 2.15-48.99).

Conclusion:  The incidence of APT was significantly higher in the non IPT group than in the IPT group.

Reducing musculoskeletal complaints and fatigue through participatory ergonomics on the table and chair design of participants of Halal Assurance System (HAS) training in LPPOM MUI of Banten, Indonesia

Background: Halal Assurance System (HAS) training is mandatory for industries that will apply for halal certification at LPPOM MUI of Banten Province. In some trainings, the participants felt uncomfortable which can be seen from the level of fatigue and complaints caused by an uncomfortable sitting position due to poor design of tables and chairs. This condition is very detrimental to participants.

Methods: This treatment by subject design study did from April to November 2019. The participants were who attended the HAS Training-23000 that fulfilled the inclusion and exclusion criteria. Samples then grouped into three group with different condition in each. We took indoor environment data and each sample about sample characteristics and business characteristics. Muscle complaints took by subjective questionnaires before and after training. The data analyzed by SPSS and p<0.05 was significant.

Results: Total 120 participants were included consisting of 40 participants in each condition.  The indoor environment conditions in the three conditions are the same (p>0.05). There were significant reduce of score of musculoskeletal complaints and fatigue before and after trainings in each condition (p<0.0001). Seats with multilevel arrangement (condition III) have the lowest value of musculoskeletal complaints and fatigue.

Conclusions: The smooth communication among participants influences the speed in implementing participatory ergonomics. The use of tables and chairs with a seating capacity of 6 people/table is the most effective when compared to others. The application of participatory ergonomics can reduce musculoskeletal complaints and fatigue of participants of the Halal Assurance System.

Acute toxicity profile and Sun Protection Factor (SPF) nanoemulgel combination of C-phenylcalix[4]resorcinaryl octacinnamate, C-methylcalix[4]resorcinaryl octabenzoate, and quercetin in vitro and in vivo

Background: The ageing process (photoaging) can be caused by sun exposure, especially ultraviolet light. Organic and inorganic sunscreen products are commercially available. Two calixarene organic compounds, namely C-phenylcalix[4]resorcinaryl octacinnamate and C-methylcalix[4]resorcinaryl octabenzoate, have been successfully synthesized. Besides, the antioxidant quercetin can be potentially combined with these two compounds since ultraviolet rays also cause reactive oxygen species. This study aimed to evaluate the acute toxicity profile in vitro by cell line Vero and to develop the optimal activity of the product in New Zealand rabbit skin.

Methods: Optimal formulation of three formulas nanoemulgel of sunscreen was using  D Optimal Mixture Design. Acute cytotoxicity test in vitro by culture cell line Vero was using randomized post-test only control group design. The activity of the product was measured by the value of Sun Protection Factor (SPF) in vivo using randomized post-test only control group design. Data of acute toxicity in vitro test (IC50 value) was analyzed using probit analysis and activity sun protection factor was analyzed using one-way ANOVA on SPSS version 20 for Windows. 

Results: The in-vitro toxicity test of formula 1, 2, 3 nanoemulgel were 2,940.569 µg/mL, 13,489.728 µg/mL, and 6,289.248 µg/mL respectively. The formula 1 nanoemulgel sunscreen products were produced with the three highest SPF values. SPF in vivo test showed that the nanoemulgel protection capability of the formula 1 with three different doses were 34; 36; dan 43 respectively. 

Evaluation of risk factors in patients with ventilator-associated pneumonia caused by Acinetobacter baumannii

Purpose:  Ventilator-associated pneumonia is a significant disease with high mortality rates. Acinetobacter baumannii is one of the most critical pathogens leading to ventilator-associated pneumonia. This study aims to evaluate the underlying risk factors in patients diagnosed with ventilator-associated pneumonia caused by Acinetobacter baumannii, who were followed in intensive care units of our hospital.

Patients and Methods:  The data of 112 patients diagnosed with ventilator-associated pneumonia caused by Acinetobacter baumannii, who were followed in Intensive Care Units other than Pediatric Intensive Care Unit of our hospital from 2013 to 2017, were evaluated retrospectively.

Results: Of the cases included in our study, 70.5% were male, and 29.5% were female patients. Of the cases, 87.5% were followed in Anaesthesiology and Reanimation Intensive Care Unit. The most common modifiable risk factors are mechanical ventilation, antacid use, and the most common non-modifiable risk factors were the presence of trauma and a history of cardiovascular disease.

Conclusion: Ventilator-associated pneumonia is a clinical condition with high mortality and morbidity in intensive care units. Incidence and mortality of ventilator-associated pneumonia can be reduced through the implementation of some necessary policies for the prevention of ventilator-associated pneumonia and the practices for the reduction or elimination of modifiable risk factors.

Wana Seraya Nursing Home (WSNH) integrated services to establish healthy and happy elderly: a qualitative study

Background. The increasing number of elderly people in Indonesia reflects the success in various aspects of service, but on the other hand, these conditions have brought about the consequences of various social problems among the elderly such as physical, spiritual, social, and economic deterioration.

Method. The qualitative study was conducted in April 2019.

Result. Wana Seraya Nursing Home was founded in 1975 with the aim of developing the nursing home as a service center, guidance and information on social welfare for the elderly. The activities of the elderly include mental/spiritual guidance, exercise, recreation, and routine health services. Received the elderly who were escorted by their family and who were found neglected.

Conclusion. Various social and cultural aspects are the reasons for living in a nursing home, and with integrated services, the elderly feel comfortable and meaningful.

The correlation of High-Density Lipoprotein (HDL) with adiponectin levels among obese adolescents in Denpasar, Bali, Indonesia

Background: Obesity is a state of Body Mass Index (BMI) above or equal to 25 kg/m2. In obesity, dyslipidaemia can occur alone or together with other comorbid. This situation could affect pro-inflammatory and anti-inflammatory cytokines that lead to health problems. Several parameters assessed in dyslipidaemia conditions include High-Density Lipoprotein (HDL) and adiponectin. This study aims to evaluate the correlation between HDL and adiponectin levels in obese adolescents. 

Methods: A cross-sectional observational study was conducted among 33 obese adolescence (0-18 years) who met the inclusion criteria at Junior and Senior High School in Denpasar during August 2018-January 2019 period. Variables evaluated in this study were age, sex, weight, height, BMI, HDL, and adiponectin. The correlation assessment of HDL and adiponectin levels was conducted by Partial Correlation test after controlling age and sex using SPSS version 23 for Windows. 

Results: Males (66.70%) were predominant than females (33.30%) with a ratio of 2:1. The average age of respondents was 15.51±0.70 years old. The mean body weight was 91.04±15.40 kilograms, followed by height (163.09±7.40 cm), BMI (34.08±3.90 kg/m2), HDL (43.40±8.00 mg/dl), and adiponectin (4.55±2.1 µg/ml). There was a very weak and not significant correlation by Partial correlation test (r=0.143; p=0.444) between HDL and adiponectin levels.

Conclusion: Our study found There was a very weak and not significant correlation between HDL and adiponectin levels among obese adolescent in Denpasar, Bali, Indonesia

Lecithin- cholesterol acyltransferase and relationship with Platelet-activating factor in AB blood phenotype

Objectives: This study aimed to determine the association between Lecithin-cholesterol acyltransferase (LCAT) and Platelet-activating factor (PAF) with atherogenic potential in the ABO blood system.

Background: The current study is the first study that focuses on healthy blood donors and investigating a relationship between ABO blood groups and LCAT enzyme and PAF, which plays a notable role in atherogenesis.

Methods: ABO blood types characterize the role of the individualistic phenotype. Hence, it is generally assumed that ABO blood phenotypes are involved with many diseases. This cross-sectional study involved 176 healthy subjects with different ABO blood phenotypes. Measurements of routine lipids, LCAT, PAF and atherogenic plasma index (AIP) were performed in these subjects.

Results: Our most important finding was that individuals with blood group AB have statistically significant lower LCAT levels in serum. Additionally, there was a moderately negative correlation between LCAT and triglycerides in the AB blood phenotype (r=-0.452, P=0.02). Nevertheless, there were statistically significant correlations between LCAT levels and PAF levels of subjects with only non –O blood phenotypes (A, B and AB). Serum AIP values were statistically significantly higher in the AB blood group.

Conclusion: The present study suggests that blood group AB can be associated with decreased LCAT   levels when compared to the non- AB phenotypes. We suggest that LACT and AIP may be helpful biomarkers to illustrate atherogenic risk in AB blood phenotype, although this requires further investigation.

Prevalence of giardiasis and its associated factors among livestock and rivers in Mlati, Sleman, Yogyakarta, Indonesia

Abstract: Giardiasis is a gastrointestinal disease caused by the protozoan Giardia sp. Recent data showed that constant contact with livestock could pose greater risk of contracting this disease, especially without any protective gears. Unfortunately, this condition is still prevalent in several areas in Indonesia. Therefore, this study was aimed to evaluate the prevalence of giardiasis and its risk factors in the community around livestock areas and rivers in Mlati, Sleman, DIY, Indonesia.

Methods: A cross-sectional study was conducted from January-August 2019 around the livestock area and rivers in Mlati, Sleman, DIY. Stool samples were obtained from subjects who have livestock and live along the rivers or its tributaries. The status of Giardiasis were determined from microscopic examination and PCR using beta-giardin as the reference conducted in Parasitology and Biomedical Laboratory, Faculty of Medicine, UNS.

Results: A total of 179 subjects were were enrolled in this study. The prevalence of giardiasis among study population was found to be at 5.02% (n=9), 19 (10.6%) of them were cattleman, and 122 (68.1%) had a history of contact with cattle. Subjects who did not own any cattle seemed to have a significantly lower risk of contracting giardiasis (AOR: 0.041, 95%CI: 0.009-0.185; p=0.000) since contact with cattle also proved to be the risk factor of giardiasis (AOR: 1.080, 95%CI: 1.027-1.135; p<0.002).

Conclusion: This study revealed that constant contact with cattle lead to significantly higher risk of giardiasis for those who live among livestock and along the rivers in Mlati, Sleman DIY.

Factors influencing sperm retrieval rate by Microdissection Testicular Sperm Extraction (mTESE) in non-obstructive azoospermia cases: a literature review

Background: Non-Obstructive Azoospermia (NOA) had dominating 60% of all azoospermia cases. Sperm Retrieval Techniques (SRT) continued with Intra-Cytoplasmic Sperm Injection (ICSI) are therapy modalities helping infertile azoospermia to be fertile. There are some options of SRT such as PESA, MESA, TESE, TESA and microdissection-TESE (mTESE) to collect sperm from azoospermia cases. This study aims to evaluate some factors influencing sperm retrieval rate by mTESE in non-obstructive azoospermia cases.

Method: The data collection for eligible articles were conducted from 2011 to 2019. Different database and manual search methods were used to find the topic-related articles, particularly in some factors influencing the sperm retrieval rate of mTESE in NOA cases. A total of 21 relevant kinds of literature were studied regarding some factors that might be increasing or decreasing of sperm retrieval rate by mTESE procedure. However, four literature were elaborated further due to a similar approach to get the results.

Results: A previous study from Saudi Arabia with 264 patients samples found significant different on testosterone level who had successful Sperm Retrieval Rate (SRR) 57.25%. SRR was related by several factors of testosterone, FSH, bilateral testis retrieval and seminiferous tubules diameter taken as the earliest study from India. Besides, taking bilateral testis sperm retrieval also had low SRR 14.4%, but serum FSH level was not influenced by increasing SRR. The previous study found a very weak correlation between FSH and SRR. A different study was conducted in Italy found that all NOA patient who undergone mTESE procedure found the Maturation Arrest (MA) has the significant higher success SRR until 67% after Sertoli Cell Only (SCO) syndrome and sclera-hyalinosis histology.

Conclusion: SRR depends on some factors those influencing by hormonal baseline preoperative such as testosterone level and FSH serum level, technique and how mTESE done by the operator in mTESE procedure.

Melanogenesis and its associated signalings

Introduction: Melanogenesis is the mechanism of melanin formation in the skin or hair, which is produced by melanosomes in melanocytes. Melanin is the main coloring pigment of the skin, hair and eyes, and also functions as a photoprotection against ultra-violet (UV) exposure.

Methods: A total 20 relevant literatures which focused on skin pigmentation and melanogenesis were used to construct this review. The articles were published from 1998-2018. Most of the literatures were basic research and the clinical information were extracted from their discussion.

Result: The process of melanogenesis starts from the migrational process of melanoblasts which are precursors of melanocyte cells originating from the neural crest into the epidermal layer and hair follicles. Many factors play a role in melanogenis both intrinsically and extrinsically, the dominant intrinsic factor is Melanocyte Stimulating Hormone-α (α-MSH) while the extrinsic factor that plays a role is UV ray.

Conclusion: Melanogenesis is a complex process which influenced by a wide array of internal and external factors with α-MSH and UV ray act as the main regulators. Due to delicate nature of this process, defect in a certain stage could result in significant medical condition.

A rare case of penetrating lung and cardiac injury due to late migration of multiple Kirschner-wire after shoulder fracture fixation

Introduction: Penetrating foreign body through lung and cardiac is very uncommon case and may lead to life-threatening complication.

Case: We reported an unusual case of penetrating lung and cardiac injury as a complication of open reduction and internal fixation combined with transfixing wire of right glenohumeral procedure.

Conclusion: The Kirschner wires were successfully extracted by using heart-lung machine (HLM) through thoracotomy and sternotomy approach, consecutively.

Condyloma acuminatum in a 62-year-old patient with HIV infection

Introduction: Condyloma acuminatum is caused by infection from Human Papilloma Virus (HPV), mostly found in the perineum and genital area. Therefore HPV infection is the most common sexually transmitted infection in the world. Infection often occurs in patients with a decreased immune system, such as Human Immunodeficiency Virus (HIV) infection.

Case: A 62-year-old man was diagnosed with condyloma acuminatum in the penis and accompanied by stage IV HIV infection. CD4 + count is 23 cells/μL. Patients were given electric surgical therapy and 80% TCA. After receiving 8 treatments in 3 months, there was no significant improvement.

Discussion: There are several therapeutic modalities in the management of condyloma acuminatum. Some considerations in the selection of condyloma acuminatum therapy include size, number, anatomic location of the lesion, patient comfort, side effects and the experience of the doctor in charge. The immune system plays an important role in the successful treatment of HPV infections. The risk of persistence, recurrence, and malignant transformation can increase with the decrease in the immune system by HIV infection as measured by CD4 + counts. In this case, more aggressive treatment will be needed and immunomodulators can be given to increase the success of the therapy.

Conclusion: Host immune status has a significant impact on the course of HPV disease and response to treatment. HIV patients have an increased risk of HPV infection, with an increase in the duration and persistence of the disease and thus require aggressive therapy.

Forensic investigation in a multiple trauma deceleration case due to road traffic accidents

Background: Road traffic accidents (RTA) are the series of events from road events that are unexpected, and always cause damage to objects, injury and even death. Factors for the occurrence of RTA can be in the form of vehicle, road and human. In this case RTA occurred because of human negligence and road factors. The human factor in the form of the driver driving a vehicle at high speed with an estimated 160 Km/h at night, the other factor is the driver is sleepy or tired. Road factors contribute to the occurrence of accidents due to wide and declining road segments cause the driver unable to control vehicles at high speed, quiet roads and inadequate street lighting conditions. This accident resulted in a heavy damage to the vehicle and all passengers died. The explanation of the causes and patterns of death is important in forensic investigations of RTA victims.

Case description: A case of RTA with multiple deceleration injuries was reported. This traffic accident case involved a minibus car speeding and crashing into a bulk cement tank truck that was stopped on the Banda Aceh-Meulaboh National Road, on 30 October 2016 around 04.15 a.m which caused all passengers of minibus died. The speeding minibus car suddenly stopped and hit the back of the tank truck, as a result the body moving at the speed of the vehicle suddenly slowed down (deceleration) causing multiple trauma. The effects on the bodies of the victims varied in the form of open head trauma, closed head trauma, chest trauma, abdomen and extremities. The mechanism and cause of death of the victims was massive bleeding in several organs, especially the head (traumatic brain injury) and chest (rib fracture).

Late latent syphilis accompanied by ocular syphilis in a geriatric patient: a case report

Background: Syphilis is an infectious disease caused by Treponema pallidum and is transmitted primarily through sexual intercourse. However, late latent syphilis accompanied by ocular syphilis in geriatric patients is quite seldom. This study aims to determine a case report regarding late latent syphilis accompanied by ocular syphilis in a geriatric patient.

Case Description: A 75 years old man, was consulted from the Ophthalmology Department to the Dermatology and Venereology Department with suspect syphilis. Patient came with a chief complaint of blurred vision in the right eye since 2 weeks ago, which is getting worse since 4 days ago. The laboratory results of complete blood routine, renal function tests, liver function tests, blood sugar levels are within normal limits. The titer result of VDRL was 1:16 and TPHA was 1: 160. Based on anamnesis, physical and laboratory examination, the patient was diagnosed with late latent syphilis and ocular syphilis. The patient was given three weekly interval dose of Benzathine Penicillin G 2.4 million international units intramuscularly.

Herpes zoster opthalmicus in geriatric with malnutrition: a case report

Background: Herpes zoster opthalmicus (shingles) is a reactivation of latent Varicella Zoster Virus (VZV) affecting the ophthalmic branch of the trigeminal nerve. One of the risk factors that can cause reactivation of shingles are aging and immunosuppression conditions such as malnutrition.

Case: We reported a case of 75 years old patient with stabbing pain dan stinging sensation on the left forehead with a Visual Analog Scale (VAS) score of 3. Body mass index was calculated and showed underweight status (malnutrition). Dermatological examination showed erythematous, well-defined macules to patch, topped with a blackish-brown crust, with multiple erosions at some part over the left frontal region, superior palpebra and the parietal area (following the dermatome of the ophthalmic branch of the trigeminal nerve). The patient was given oral acyclovir, oral methylprednisolone, gabapentin, amitriptyline and vitamin B. The lesions were compressed with saline solution. The patient was also given high calories and protein intake to fix nutrition status. These interventions showed significant improvement of the lesions.

Discussion: The incidence and severity of shingles increases in geriatric patients. This can also be explained because aging is associated with a greater susceptibility of nutritional deficiency which can suppress specific and non-specific immunity. Nutritional conditions in herpes zoster patients can influence the severity and incidence of postherpetic neuralgia as well.

Conclusion: The purpose of reporting this case is to discuss nutritional status is an important factor that must be considered in dealing with the incidence of herpes zoster as to reduce the incidence of postherpetic neuralgia.

Concurrent infections of Trichomoniasis and nongonococcal cervicitis in a menopausal woman: a case report

Background: Trichomoniasis is a rare, sexually transmitted infection. Trichomoniasis can often coincide with other pathogens that cause genital infections. Menopausal women remain at risk of developing this disease due to physiological and anatomical changes in the female genital organs.

Case: A woman, age 61 years, experience vaginal discharge from one month with itching in the genital area. The last menstruation period was 7 years ago. The patient had one sexual intercourse a month ago with her boyfriend; it was the first sexual contact since 7 years ago, without using a condom.

Result: Pelvic examination reveal vaginal wall erythema, yellowish discharge on the fornix posterior, and cervical, watery consistency. Leukocytes 20-25 per field view and Trichomonas vaginalis was found on laboratory examination. pH examination on the vagina was 8. The patient was diagnosed with Trichomoniasis, and nongonococcal cervicitis was given metronidazole 2 x 500 mg, azithromycin 1000 mg single dose for therapy. After therapy with metronidazole, there is an increase in pH that occurred a week after therapy, which amounted to 10 and decreased one week later to 8. An increase in leukocytes also accompanied increased pH in cases, so that co-infection with other germs should be considered. 

Conclusion: Examination of wet vaginal preparations revealed trichomonas vaginalis that are alive and moving. In follow-up observations, there was an increase in vaginal pH and increased leukocytes in the vaginal gram. Specific causative bacteria were not found, and thus, the patient was diagnosed with a non-specific genital infection on further observation.

Incidental radiographic finding of charm needle or “susuk” in orthodontic panoramic and lateral cephalometric radiograph: a case report

Background: The most common radiographic examinations in orthodontic are panoramic and lateral cephalometry. In panoramic and lateral cephalometric images in adult patients, sometimes can be found a fine foreign object which sometimes confuses as it scattered the radiographic image, such as needles. The needles found in the patients are known as “susuk” in Malay and Indonesian language or charm needles which believed to enhance beauty, charism, health, youth, luck, and to relieve pain. This case reports aim to elaborate the incidental radiographic finding of charm needle or “susuk” in orthodontic panoramic and lateral cephalometric radiograph.

Case Description: There was four adult woman conducted panoramic and cephalometric radiograph as a routine procedure before orthodontic treatment. The number of susuk inserted were varied, as it considered that the more needle increases the magical potency. In Case 1, the panoramic image depicts one “susuk” in the middle of the root of 44 (FDI notation) tooth. Besides, the cephalometric radiographs also show a “susuk” horizontally inserted at the root of the anterior lower teeth area. The panoramic image reveals one susuk around chin area below the apex of 42 teeth on Case 2 as well as on the soft tissue chin area in front of the apex of 41 teeth on cephalometric radiographs. In Case 3, two “susuk” were found inserted bilaterally symmetric at the upper premolar area by the panoramic image. Then, five “susuk” in the mandible and four “susuk” at the upper area of the maxilla were found in Case 4 by the panoramic image. 

Conclusion: The susuk are often exposed as incidental findings in panoramic and lateral cephalometric radiographs that are taken before performing routine orthodontic treatments. Understanding the presence of susuk is essential to avoid misdiagnosis and mismanagement and help radiologists to prevent confusion while interpreting images.

3rd Biennial Meeting "Pendidikan Intensif Fertilitas dan Embriologi" (PIFE) Intensive Education on Fertility And Embryology

Dear Colleagues,

It was a true honor that we accept colleagues at the 3rd Biennial Meeting of Pendidikan Intensif Fertilitas dan Embriologi (PIFE) from the Ikatan Alumni Andrologi Fakultas Kedokteran Universitas Airlangga (IAA FKUA) was held on Aula Fakultas Kedokteran Universitas Airlangga in Surabaya, November 22-24th 2019.

The theme of this conference was “Excellent Infertility Services; Competent and Accredited” and divided in the main form of workshops and symposiums, which are expected to update and improve the knowledge, especially about infertility and embryology. Also, this conference can be used as the right venue for reunion and brainstorming sessions with peers in arms. 

 This conference was participated by a total of almost 500 participants both on symposiums and workshops, also 37 abstracts to be presented. And these proceeding paper contains articles that were accepted for publication to Bali Medical Journal (BMJ) through the single-blind review process.

Finally, we would like to thank the committee, reviewer, and another scientific team who dedicating to finalized this proceeding book. We hope to be able to meet with all of you soon on the next PIFE in 2021.

dr. I Gusti Ngurah Pramesemara, S.Ked., M.Biomed, Sp.And

Coordinator of Organizing Committee