Introduction: Various surgical procedures have been found to effectively treat intractable temporal lobe epilepsy (TLE), including transcortical selective amygdalohippocampectomy (SAH), which is intended to protect the temporal lobe and to prevent interference with vascular structure. This research analyzed the outcome of post-operative seizure-free with transcortical selective amygdalohippocampectomy for intractable mesial temporal lobe epilepsy patients in a minimum two-year follow-up after surgery.

Methods: Data of one hundred ninety-two patients who had undergone transcortical selective amygdalohippocampectomy for non-lesional, medically intractable, temporal lobe epilepsy were analyzed.

Result: The statistical analysis indicated that Focal to Bilateral Tonic-Clonic Seizure had a more significant outcome (p=0.019) than other seizures. In all research subjects, after three, six, and twelve years of follow-up, the chance for a seizure-free after surgery was respectively 93.2 percent, 67.9 percent, and 36.7 percent with a median average survival period for all subjects of 11.00 years (95 % CI: 8.55 – 13.44)

Conclusions: Transcortical selective amygdalohippocampectomy is an effective therapy for intractable mesial temporal lobe epilepsy and provides a satisfactory outcome. The transcortical approach allows an appropriate operative field by careful dissection with limited retraction to eliminate the epileptogenic target while preventing damage to the underlying vascular and cortical structures.

Purpose: A ruptured intracranial aneurysm has a high mortality rate. Moreover, many of its surviving patients have to live with severe disabilities. Therefore, surgical or endovascular treatment is recommended in some patients with a known aneurysm and a high risk of rupture. However, many patients are reluctant to undergo treatment, fearing its complications. This study aimed to evaluate the treatment outcomes and safety in patients with a ruptured and unruptured intracranial aneurysm.

Methods: We retrospectively reviewed the records of patients treated for intracranial aneurysms in our hospital between 2017 to 2021. Our primary outcome was discharge functional outcome. We also evaluated cerebral infarction, stay duration, and mortality. We used bivariate and multivariate analysis.

Results: 85 patients were included in this study. 69 (77.5%) patients were treated after rupture. Most patients were treated with clipping (78.8%). Patients with a ruptured aneurysm significantly had a higher risk of poor discharge functional outcome (OR 5.708 [1.061 – 30.712]; p 0.042). Six patients with a ruptured aneurysm died. Patients with a ruptured aneurysm also spent more time at the hospital. There was no mortality or complication in patients with an unruptured aneurysm.

Conclusion: Patients treated before their aneurysms ruptured had better outcomes with no complications. Therefore, treatment should be considered for high-risk patients.

Background: Striae distensae (SD) is a common skin disorder in the form of linear atrophy, which arises due to stretching and is one of the most common cosmetic problems. There is no scoring system to assess the severity of striae distensae that is easy to use, non-invasive, and consistent and can be used to evaluate SD treatment. This study formulated and validated a scoring system to assess the severity of striae distensae.

Methods: This study was a descriptive observational study with a cross sectional approach involving 30 female health workers at the Universitas Sumatra Utara Hospital. Assessment of SD severity in six regions using four parameters.

Results: A scoring system for the severity of striae distensae has been formulated, named the INA score, to assess the severity of SD in six regions; mammae, axilla, abdomen, femur, gluteus and poplitea using four parameters; the number of lines, the size of the longest striae distensae line, color, and itchy. The results of the validation test are statistically valid (r-value>0.361), and the reliability test is found to be reliable (Cronbach's Alpha>0.361).

Conclusion: The formulation of a valid and reliable scoring system, named the INA score, has been obtained to assess the severity of striae distensae measured at six locations and four parameters.

Introduction: Lavender essential oils (LEO) have been known to have relaxing effects, improve mood, and treat anxiety, but the effect on multiple organ stress concurrently is unknown. This multiorgan stress is related to depression can be caused by chronic psychological stress due to excessive cortisol levels and can lead to organ damage. This study analyzed LEO in preventing depression and multiorgan failure using intraperitoneal injection of corticosteroids in animal-model.

Methods: Rats (Rattus norvegicus) Wistar strain, male, aged 7-8 weeks were involved in this study. Depression in animal-model is defined by immobilization using tail suspension test and anhedonia using sucrose preference test. LEO 5% was diluted in virgin coconut oils as vehicle. Serum cortisol was analyzed using enzyme-linked immunosorbent assay (ELISA). Organs were extracted and processed using hematoxylin eosin staining.

Results: The results of this study indicate that LEO was able to prevent damage to the glial cells, myocardiac cells, and gastrointestinal mast cells infiltration, but not to the hepatocytes and renal cells damage. LEO also induced behavioral activation as improvement of depression, but anhedonia was still remained.

Conclusion: The effect of LEO is to prevent the increase in blood cortisol levels, thus reduce the reactivity of depressed individuals to stress, although the individual still has anhedonia as a residual symptoms

Background:  Breast milk plays a role in cognitive, sensory, and motor development and protects against infections and chronic diseases. The process of breastfeeding will protect the baby from illness, and increase cognitive intelligence and social-emotional development between mother and baby. Duration of breastfeeding was associated with acute illnesses, diarrhea, constipation, and a lower likelihood of being overweight/obese. Thus, this study aimed to the investigated correlation between pregnancy status and delivery type with successful breastfeeding in postpartum mothers at Roemani Muhammadiyah Hospital Semarang

Methods: This type of research was analytical descriptive, conducted in December 2021 with purposive sampling and a sample size of 120 respondents. The inclusion criteria of postpartum mothers who breastfeed their babies, mothers who are in good health, and baby who has no congenital abnormalities. Respondents who refused and who have babies with congenital abnormalities are excluded from the study. The data was extracted from the questionnaire and also coded into the SPSS 25 ver. Data were analyzed descriptively and analytically by using chi-square analysis.

Results: The participant with a planned pregnancy was 107 mothers (89.2%), unplanned 13 mothers (10,8%), section Caesarea type of delivery was 70 mothers (52%) and vaginal type of delivery was 50 mothers (48%). Based on LATCH score analysis planned pregnancy showed good category 38 mothers (31,7%), medium category 69 mothers (57,5%), and planned pregnancy showed good category 4 mothers (3,4%), medium category 8 mothers (6,7%), bad category 1 mother (0,8%). Based on the type of delivery, the vaginal type score was good for 25 mothers (50%), medium for 25 mothers (25%), and the section Caesarea type score was good for 17 mothers (24%), medium for 52 mothers (75%) and bad 1 mothers (1%). Either pregnancy status and type of delivery have P value scores of 0,016 and 0,012, respectively.

Conclusion: A mother that delivers a vaginal has a better level of breastfeeding than SC, and pregnancy status such as planned pregnancy also shows a better level than they are not.

Background: A diabetic foot ulcer is a complication that often occurs in patients with diabetes mellitus. The healing process of a chronic wound is more complicated and requires more complex treatment. There is an increase in IL-1, IL6, and TNF-α pro-inflammatory cytokines in a chronic wound. Hyaluronic acid (HA) is a component that has been used for a long time and is known to help the wound healing process. This study was at a time to determine the effectiveness of hyaluronic acid on the reduction of interleukin-6 in accelerating the healing of Wagner II-III diabetic foot ulcers.

Methods: This study is an experimental, randomized study of pre and post-test design on diabetic foot ulcer patients with the Wagner II-III classification who were controlled at the thoracic, cardiac, and vascular surgery polyclinic at Dr. Soetomo Hospital Surabaya. Data were analyzed using SPSS version 20 for Windows.

Result: About 39 samples are willing to participate in the study, divided into 20 samples in the treatment group and 19 in the control group. The mean concentrations of IL-6 in the treatment group before and after the intervention were 280.70±155.50 ng/ml and 126.60±145.60 ng/ml. There was a significant decrease in IL-6 levels (p<0.05) before and after the intervention. The mean concentrations of IL-6 in the control group pre and post were 315.20±127.40 ng/ml and 136.30±134.60 (p<0.05). The decrease in the control and treatment groups was no statistically significant difference (p>0.05). There was no significant difference in the PUSH Score (p>0.05) in the two groups before intervention/treatment. The decrease of wound area in the control and treatment groups were -4.80 ((-0.40)-(-24.50)) and -4.8 ((-0.70)-(-30.90)) (p>0.05).

Conclusion: Topical hyaluronic acid and wound care using 0.9% NaCl reduced interleukin-6 levels, PUSH scores, and wound area in Wagner II-III diabetic foot ulcers.

Introduction: Endoscopic endonasal is one of the technological advances used as a supporting examination for diagnosis and therapy. This procedure is often used to evaluate medical problems of the nose and sinuses, such as functional endoscopic sinus surgery or FESS (functional endoscopic sinus surgery), turbinoplasty, and septoplasty. Surgery can be difficult to manage because there is often bleeding due to the large supply of blood vessels in the sinus area. This study aimed to investigate differences in qNOX scores and fentanyl requirement in patients undergoing endoscopic endonasal surgery with sphenopalatine ganglion block.

Methods: The total sample was 18 patients, with each treatment 9 patients. Patients were divided into two groups: group 1 patients who received sphenopalatine ganglion block with 0.75% ropivacaine and group 2 patients who did not receive a block. The selection of patients in groups 1 or 2 was done randomly (simple random) using lottery numbers and with a single blind.

Result: Statistical analysis showed significant differences in intraoperatively in qNOX scores at the 5th, 10th, 15th and 20th minute and the mean qNOX score in the first 1 hour between the control group and the sphenopalatine ganglion block group. Significant differences were also found in fentanyl requirement between the control group and intraoperative sphenopalatine ganglion block, where fentanyl requirement was lower in the treatment group.

Conclusion: The sphenopalatine ganglion block is a useful adjunct in patients undergoing endoscopic surgery and may reduce the need for fentanyl. In addition, it can provide a more stable qNOX score

Introduction: There are still many people in Indonesia who are not aware of the importance of information related to the early symptoms that must be experienced when they become patients. Not infrequently, this lack of information disclosure results in misdiagnosis and even leads to unexpected death. Anamnesis is a process where the doctor or medical record nurse gives several questions about the clinical pathway in the form of a narrative to facilitate early identification of the disease, and the results of this history-taking process are stored in the Electronic Medical Record (EMR). EMR narratives often cannot be processed by computers if language literacy is not standardized or ambiguous, so the need to overcome this problem requires the use of technology to minimize misdiagnosis and facilitate the identification process by developing digitization in the form of mobile applications that are integrated with Natural Language Processing technology and ICD-11 in the symptom identification process. This study aims to identify ICD-11 symptoms based on clinical NLP mobile application to diagnose the disease (ICD-11).

Methods: The applications of Natural language processing includes literature study, Voice Recognition, Tokenization, Stemming, The process of Stopwords Removal, Named Entity Recognition, Data Translation, Access ICD Data, and Mobile User Interfaces.

Results: Named Entity Recognition (NER) is used to identify symptoms of digestive system diseases, with an accuracy rate of 74.3%. In stemming and stopwords processing, the NLP accuracy rates are 95.9% and 97.2%, respectively.

Conclusions: This research focuses on the application mobile and development of the Named Entity Recognition (NER) model. The importance of the NLP process in the development of information, especially for word processing, aims as a device that simplifies speech recognition systems to be more helpful.

Introduction: Low hemoglobin levels in pregnant women are global health problem that adversely affect the mother’s and newborn’s health. There is no study proving the effect of anemia during adolescence in pregnancy, especially in Indonesian population. This study aimed to investigate the effect of anemia in adolescence on the hemoglobin level during pregnancy, using Indonesian Family Life Survey (IFLS) data.

Methods: This retrospective cohort study used the 1997, 2007 and 2014 IFLS data. The hemoglobin levels in adolescents aged 10-18 years were obtained from the IFLS-II data in 1997. Then, the hemoglobin levels during pregnancy from the same individuals were tracked from the IFLS-IV in 2007 and IFLS-V in 2014. Data from 210 subjects were included in the analysis as these subjects had the complete data on hemoglobin levels during adolescence and pregnancy and all other considered confounding variables, such as maternal age, iron protein, vitamin C consumption, education, working status, residence, socioeconomic status, gestational age at data collection, parity, antenatal care, iron supplement consumption. Data was analyzed by T tests, Pearson’s correlation tests and General Linear Model.

Results: The mean hemoglobin levels of pregnant women was 11.23 g/dL with standard deviation 1.271 and the prevalence of anemia during adolescence was 34.3%. There was a significant difference of 0.447 g/dL in the average hemoglobin levels in pregnant women with and without history of anemia during adolescence (p=0.023). The hemoglobin levels in pregnant women also differed among trimesters of gestational age (p=0.001). After being controlled for vitamin C and protein consumption, anemia status during adolescence still has a significant effect on lowering hemoglobin level during pregnancy.

Conclusion: Anemia during adolescence negatively impacts pregnant women's hemoglobin levels. Prevention programs for anemia in pregnant women should be started from adolescence period.

Introduction: The demands of academic life and obstacles during online learning in the Covid-19 pandemic make female students physically and mentally exhausted which can trigger stress. Stress involves the neuroendocrinological system that can affect the menstrual cycle. This study aims to analyze the correlation between stress due to online learning during the Covid-19 pandemic with students' menstrual cycles.

Method: The data measured are the stress due to online learning during the pandemic and the student’s menstrual cycles through the DASS 42 questionnaire (Depression Anxiety Stress Scale 42) to measure stress levels and a questionnaire containing categories to measure students' menstrual cycles.

Results: This study found that stress levels are correlated with the menstrual cycle. Stress levels affect the condition of the menstrual cycle

Conclusion: This study proves that stress due to online learning during the Covid-19 pandemic is related to the menstrual cycle of students.

Background: Post-evisceration fibrosis remains the leading cause of contracted socket. The application of fibrin glue is considered an alternative adjuvant therapy in suppressing profibrotic factor (TGF-β) expression following evisceration surgery to prevent contracted socket. This study aimed to know the role of fibrin glue in suppressing the TGF-β expression following evisceration surgery.

Methods: An in vivo experimental study with a randomized post-test-only control group using twenty New Zealand rabbits were conducted. The sample was divided into four groups, each consisting of five rabbits, and one healthy eye was selected randomly for evisceration. Each rabbit in the study group was given a subconjunctival injection of agents corresponding to each study group, namely: Group I (control [no injection]), Group II (0.1 ml MMC 0.4 mg/ml), Group III (0.1 ml TCA 40 mg/ml), and Group 4 (0.1 ml fibrin glue) at the inferior fornix. Following a 14-day observation period, the animals were euthanized, and tenon conjunctiva in inferior fornix samples was collected for immunohistochemistry (IHC) staining examination. The pathologist calculates the immunoreactive scores (IRS) for each specimen. The differences in TGF-β expression were statistically analyzed with a significant p<0.05. Data were analyzed using SPSS version 26 for Windows.

Result: The highest TGF-β expression was found in the control group (I), and the lowest was in the mitomycin-C group (III), followed by the triamcinolone group (IV) and fibrin glue group (II). There were significant differences in TGF-β expression among the four groups (p=0.004). The difference between fibrin glue, MMC, and triamcinolone acetonide groups was insignificant (p>0.05).

Conclusion: As an alternative to mitomycin-C and triamcinolone acetonide, fibrin glue can be used as adjuvant therapy to prevent constricted sockets after evisceration.

Introduction: Breast cancer is the leading cause of death in women. Many studies of adjuvant therapy have used the Quran recitation (later will be mentioned as the murotal approach). The murotal approach has been shown to induce feelings of well-being, enhance therapeutic response, and aid in patient healing. This study aimed to analyze the effect of the murotal approach on lymphocytic cell activity in inducing programmed cancer cell necrosis in a breast cancer mouse model.

Methods: After testing in a fully randomized design using 24 female mice (Mus musculus) BALB/c strain, a real-world experimental study with a control group design method. The mice were divided into four groups: negative control (K-), positive control (K+), treatment group (P1) which receiving the murotal approach for 2 hours and 30 minutes per day for a week, and the (P2) which receiving the murotal approach for 30 minutes in five times a day for a week. Mice were subcutaneously injected with DMBA 0.56 mg/20 g every 2 days for 3 weeks. The murotal approach was using specifically in Surah al-Faatihah and Al-Baaqarah from Qori' Al-Mathrud. Cancer tissue was harvested 5 weeks after her. The data were analyzed using the Kruskal-Wallis hypothesis test.

Results: There was a significant difference (P<0.05) in the effect between the P2 treatment group that received murotal therapy for 30 minutes at each prayer time and the other groups. The efficacy of treatment murotal for 2 hours and 30 minutes per day does not affect the extent of lymphocytic infiltration.

Conclusion: From the research, the dosage of murotal therapy to increase the degree of lymphocyte infiltration is for 30 minutes five times a day, or during prayer time.

Introduction: Coronary artery disease (CAD) is the accumulation of atherosclerotic plaques in the coronary arteries. CAD is the most common cause of death worldwide, and its prevalence continues to increase, especially in the elderly population. Atherosclerosis is a chronic inflammatory condition that involves various inflammatory markers, including tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). In the inflammatory process, vitamin D plays an essential role in developing atherosclerotic plaques affecting the severity of CAD. The elderly are susceptible to vitamin D deficiency and an increase in the inflammatory process related to the severity of CAD. Therefore, this study aims to prove the relationship between inflammatory markers and vitamin D levels with the severity of CAD in elderly patients.

Methods: This study used a cross-sectional design in stable CAD patients aged 60 - 75 years who had passed through coronary arteriography. The severity was assessed from the angiography results using the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, which 3 cardiovascular consultants evaluated and the average outcome was calculated. TNF-α, IL-6, and vitamin D were taken during angiography and examined using high sensitivity enzyme-linked immunoabsorbent assay (ELISA). The correlation test was analyzed using Spearman's Rank correlation test.

Results: A total of 38 subjects were included in this study, where 30 (78.9%) patients were male. The mean age of the patients was 64.79 years, and the prevalence of vitamin D deficiency was 57.9%. There was a moderately significant positive correlation between markers of inflammation TNF-α (r=0.499, p=0.001) and IL-6 (r=0.518, p=0.001) and the SYNTAX score. A weak negative correlation was also discovered between vitamin D and the SYNTAX score (r=-0.335, p=0.040).

Conclusion: The levels of inflammatory markers (TNF-α and IL-6) and vitamin D correlated with the severity of CAD in elderly patients.

Background: Granulation tissue is formed during the proliferative phase of wound healing. In the presence of granulation tissue, the process of epithelialization can take place. Disturbance in the formation of granulation tissue, especially hyper-granulation, will result in an abnormal wound healing process. Antihistamines have been shown to have an effect on abnormal wound tissue fibroblasts and reduce collagen synthesis both by topical administration in vivo and in vitro culture. This study aimed to investigate the effect of oral antihistamines on granulation tissue formation, collagen deposition, and angiogenesis involved.

Method: The study design used was an experimental randomized post-test only. Thirty-two rats were divided into 2 groups, wherein group 1 was treated as a control while those in the second group were given oral diphenhydramine with a dose according to body weight. Full-thickness wounds were made on the back of all rats. The treatment was carried out every day for 7 days. On the 7^th day, granulation tissue specimens were taken with an excisional biopsy from the wound. From each granulation tissue sample, data taken were the granulation tissue thickness, collagen density, and the number of capillaries formed.

Results: Using an independent T-test, the mean thickness of granulation tissue in the treatment group was significantly smaller than the control group (215.82 ± 44.73 μm vs. 304.43 ± 58.61 μm, p<0.005). Mann-Whitney test revealed that the mean number of capillaries in the treatment group was significantly less than the control group (38.11 ± 5.31 vs. 69.66 ± 11.81, p<0.005). Kruskal-Wallis test revealed that the collagen density of the treatment group was significantly smaller than the control group (p<0.0001).

Conclusion: Administration of oral antihistamines can inhibit the formation of granulation tissue in full-thickness wounds and also reduce collagen density and angiogenesis. This can serve as a reference for the effect of oral antihistamines on wound healing, especially in the process of granulation tissue formation.

Introduction: Aloe vera has anti-bacterial ability against Gram-positive and Gram-negative bacteria; however, anti-bacterial study, especially in multidrug resistant strain of Mycobacterium tuberculosis, has not been evaluated yet. This study aims to determine the potential of Aloe vera as an antituberculosis against drug-resistant strains of tuberculosis.

Method: Stages of research include the production of ethanol extract of Aloe vera, then testing the phytochemicals (identification of alkaloids, steroids/triterpenoids, anthraquinone, flavonoids, saponins, tannins) and chemical content testing by thin layer chromatography (TLC). The anti-bacterial test for Mycobacterium tuberculosis was performed on the Lowenstein Jensen media.

Results: Test results showed the qualitative identification, and TLC contains alkaloids, steroids/triterpenoids, anthraquinone, flavonoids, saponins, and tannins. Antioxidant activity against DPPH radical shows an IC₅₀ value of 6927.133 ppm. Test of anti-bacterial activity to Mycobacterium Tuberculosis H37Rv and MDR TB strains HE (resistant to INH and Ethambutol), and SR (resistant to streptomycin and Rifampicin) showed inhibition ranging concentration of 50 mg/mL in all extracts as well as to test the sensitivity, a sensitive start to a concentration of 50 mg/mL in all extracts.

Conclusions: Aloe vera contains alkaloids, steroids/triterpenoids, anthraquinone, flavonoids, saponins, and tannins that act as antioxidants and antituberculosis against strains of Mycobacterium tuberculosis that are not resistant and resistant to anti-tuberculosis drugs.

Background: Several studies link urinary tract infection (UTI) and bladder cancer. However, the association between bladder cancer muscle invasiveness and the incidence of UTI is not known

Objective: This study aimed to study the association between the occurrence of UTI in bladder cancer and the severity of the bladder cancer, specifically in a patient admitted to Karawang regional hospital, Indonesia.

Material and Methods: This is a single-center retrospective case control. Data were obtained through medical records of the patient admitted with bladder cancer in Karawang Regional Hospital from 2019-2021. Diagnosis of Non-muscle invasive Bladder cancer (NMIBC)/Muscle-invasive Bladder Cancer (MIBC) and UTI were all obtained through medical records. Binary logistic regression analysis was used to determine the odds ratio between these variables and the incidence of UTI

Result: A total of 59 samples were obtained. 57.7% were males, and 42.3% were females, with a mean age of 59 years and distributed into two groups, NMIBC/MIBC. There are also no significant gender and age difference between groups. Our data showed no significant association between bladder cancer muscle invasiveness and the incidence of UTI (OR=1.67; 95%CI 0.218-12.7; p=0.622). Subgroup analysis with different gender also yields no significant result.

Conclusion: UTI incidence increased in MIBC patients compared to NMIBC, but it is not statistically significant.

Introduction: Hypertension is a chronic disease that is the main concern especially in the middle of the Covid-19 pandemic, where hypertension is a dangerous comorbid disease for people infected with the Covid-19 virus. Self-regulation is an important thing that hypertension sufferers must have to help control their blood pressure. Patients with hypertension who can regulate themselves will affect their acceptance of chronic diseases suffered. The purpose of this study was to analyze the relationship of self- regulation to self-acceptance of hypertension sufferers during the Covid-19 pandemic in Indonesia.

Method: The type of research is correlational with a cross-sectional research design. The sampling technique is probability sampling with a random sample size of 100 patients with hypertension in Indonesia. The research instrument was in the form of Self-Regulation and Self Acceptance Scale-Early Blindness (SAS-EB) questionnaires. Data analysis was performed with the Spearman Rank statistical test with a significant p <0.05.

Results: The results showed that almost half of respondents had high self- regulation (40%) and half of the respondents had a high level of self-acceptance (47%). Spearman Rank statistical test shows the result of p = 0,000 and the level of strength is very strong 0.795 and its value is positive.

Conclusion: There is a very strong relationship between self-regulation and self-acceptance of hypertension sufferers during the co-19 pandemic in Indonesia. It is expected that health workers play a role in providing health education about the treatment of hypertension especially during the co-19 pandemic, as well as increasing social support that can help hypertension sufferers in treating their diseases.

Introduction: Infectious mouth diseases are caused by microorganisms such as      Staphylococcus aureus and Streptococcus mutans. Sentul fruit peel extract contains several phytochemical compounds, flavonoid compounds, saponins and tannins are aromatic hydroxyl groups that act as antibacterial so that they can be used as a treatment for infections of the mouth. This study aimed to determine the inhibitory ability of Sentul fruit peel extract (Sandoricum koetjape) against Streptococcus mutans and Staphylococcus Aureus bacteria which can cause oral infections.

Method: Sentul fruit peel simplicia was extracted by maceration method with ethanol for 24 hours. The maceration method was chosen in this study because it is a method that is easy to do and uses simple tools, which is enough to soak the sample in a solvent. A filtering process followed this and the filtrate was then evaporated with a vacuum rotary evaporator at a temperature of 45oC, so that a thick extract was produced. The maceration process was repeated 2 times. After the extraction process, then proceed with liquid-liquid fractionation using distilled water. The thick extract was put into a separating funnel and distilled water was added. Then it was shaken and the aquadest fraction was taken, followed by evaporation with a vacuum rotary evaporator at 45^oC, so that the aqua fraction of the ethanol extract was produced.

Result: The results showed that the Sentul fruit peel extract was able to inhibit the growth of      S. mutans and S. aureus bacteria as seen from the formation of a clear zone. Based on the ANOVA test, the extract concentration treatment had a significant effect (p<0.005) on the diameter of the clear zone on S. mutans and S. aureus bacteria. Positive control (streptomycin) showed significant differences in Duncan's test, because it produced the greatest antibacterial activity against test bacteria compared to negative control and various extract concentrations. The diameter of the clear zone in the positive control against S. mutans and S. aureus bacteria were 17.63±0.28 mm and 17.62±1.04 mm, respectively. Sentul peel ethanol extract of aqua fraction at a concentration of 100% gave the highest inhibition zone compared to concentrations of 75%, 50%, and 25%, although it was still smaller than the diameter of the clear zone in the positive control. In bacteria S. mutans, the ethanol extract of Sentul peel aqua fraction at a concentration of 100% gave a clear zone diameter of 14.31±1.06 mm and in S. aureus bacteria it gave a clear zone diameter of 15.34±1.81 mm.

Conclusion: Sentul fruit peel extract (Sandoricum koetjape) has the ability to inhibit Streptococcus mutans bacteria and Staphylococcus Aureus bacteria.

Introduction: Controlled hypotension is one of the techniques applied to several microscopic ear, nose, and throat (ENT) surgeries. However, this technique has risks and complications, which result in impaired perfusion and oxygenation of organs including the brain that could trigger the postoperative cognitive dysfunction (POCD). Damage that occurs in brain cells can trigger the secretion of biomarker proteins in the blood, one of which is S100B which can indicate nerve damage in the intra and postoperative period. This study aimed to analyze the correlation between S100B protein level and the incidence of POCD in patients who received ENT surgeries with controlled hypotension.

Methods: A cross-sectional study was conducted among patients that underwent elective ENT surgeries at Dr. Soetomo General Academic Hospital, Surabaya, from July to August 2022. Cognitive function was assessed using Mini-mental State Examination (MMSE) at 12 hours before and 2 and 24 hours after surgery. The level of S100B was measured using enzyme-linked immunosorbent assay (ELISA) 12 hours prior surgery and 30 minutes post-surgery.

Results: A total of 31 patients were recruited in the study, including a mean age of 31.7 years. The mean S100B levels in POCD patients pre- and postoperative were 311.97 ng/L, and 415.34 ng/L, respectively. In non-POCD patients, the mean levels of S100B pre and postoperative were 436.90 ng/L, and 444.29 ng/L, respectively. There were 3 (9.7%) patients experienced POCD. Our data suggested there was a significant difference between preoperative and postoperative S100B levels in the groups of patients with POCD (103.37ng/L) and non-POCD (7.38 ng/L) (p<0.001). Patients that experienced POCD had significantly increased S100B compared to those who did not.

Conclusion: There is a correlation between changes of S100B levels and the incidence of POCD in patients undergoing ENT surgeries with controlled hypotension.

Background: Thyroid cancer continues to be a problem all over the world, with the number of cases increasing year after year. We aimed to examine the association between various laboratory parameters and follicular-type thyroid nodules. We also examined the performance of several parameters to differentiate malignant and benign follicular thyroid lesions.

Methods: This is a retrospective cohort study to determine the association between various laboratory parameters and follicular-type thyroid nodules in Dr. Soetomo General Hospital, Surabaya.

Results: A total of 62 patients were examined. The NLR in the follicular carcinoma group was 2.26 ± 1.35, whereas the NLR in the adenoma group was 2.72 ± 0.74. The average lymphocyte in the follicular carcinoma group was significantly higher than the adenoma group, 2.20 ± 0.78 vs. 1.76 ± 0.82. With a cut-off value of 2.405, NLR had a 69.40% accuracy rate for diagnosing a follicular adenoma (sensitivity: 70%; specificity: 69.2%, PPV: 30.4%, NPV: 92.3%). Lymphocyte had an accuracy of 80.6% in detecting follicular carcinoma (cut-off: 1.625; sensitivity: 80.8%; specificity: 80.0%, PPV: 95.5%, NPV: 44.4%). With an accuracy of 72.6% (cut-off: 270.500; sensitivity: 71.2%; specificity: 80.0%, PPV: 94.9%, NPV: 34.8%), platelet value is a promising parameter for differentiating follicular cancer and adenoma. There was a significant relationship between NLR, lymphocyte, and platelet with follicular-type thyroid nodules (P < 0.05 for all).

Conclusion: NLR, lymphocytes, and platelets are potential biomarkers that can be used to differentiate follicular thyroid carcinoma and follicular thyroid adenoma.

Introduction: Recognition of conus medullaris position, contains lumbosacral plexuses which supply motor and sensory innervation to the whole lower limb, pelvic and perineal areas, is critical to avoid injury due to lumbar procedures, such as spinal anesthesia and lumbar punctures. This study aimed to investigate the position of conus medullaris among Indonesians through magnetic resonance imaging (MRI) of the lumbar spine at Dr. Soetomo General Academic Hospital in order to minimize the risk of conus medullaris trauma.

Methods: A retrospective study was conducted to investigate the conus medullaris level and its correlation to gender and age Indonesian patients. The data were collected from lumbar MRI at Dr Soetomo General Academic Hospital during January 2020 and December 2021. The level variations of conus medullaris were recorded and determined as the highest, lowest and most common location descriptively.

Results: A total of 257 patients (126 male and 131 female) were included. The highest level of conus medullaris was in T11-T12 vertebrae (five patients). There were 12 patients in T12 vertebrae, T12–L1 in 86 patients, L1 in 62 patients, L1–L2 in 76 patients, and L2 in 12 patients. The lowest level was in between L2 and L3 vertebrae in 4 patients. Gender and age had no association with conus medullaris level.

Conclusion: The lowest level of conus medullaris was in between L2 and L3 vertebrae. The lumbar procedure such as punctures should be done below the L3 to avoid conus medullaris puncture trauma.

Introduction: The prevalence of diabetes mellitus (DM) is still high and is expected to continue to increase. An increase follows this increase in the number of side events, so innovation is needed in DM therapy. DM induces oxidative stress so antioxidants can be an alternative therapy for DM. One source of antioxidants whose use is still limited is the banana plant, especially the banana stem. This study aimed to determine the effectiveness of kepok banana stem extract (Musa paradisiaca Var. Balbisiana colla) on MDA levels in diabetic rats.

Methodology/Approach: The study used a post-test-only control group design on 24 male rats (Rattus novergicus) Sprague Dawley strain with a bodyweight of 150-250 grams and ± eight weeks old. Rats were divided into four groups, namely the metformin treatment for positive control, distilled water for the negative control, and stem banana extract dose of 200 mg/kg BW and 250 mg/kg BW as treatment group of mice induced diabetes using STZ-NA and given treatment according to the group for 14 days. MDA level measurement using the TBARS method on rat liver. Data were analyzed using the One Way ANOVA comparison test.

Results: MDA levels in the positive control group, negative control, treatment 1 (200 mg), and treatment 2 (250 mg) were 0.9790 + 0.52 mg/dl, 0.7533 + 0.58 mg/dl, 1.2510 + 0.52 mg/dl, 1.5175 + 0.53 mg /dl. There was no statistically significant difference in MDA levels between groups (p=0.182), but there was a decrease in blood glucose levels in the group treatment. The highest decrease in blood glucose levels was in the dose treatment group, 250 mg/kg BW.

Conclusion:The treatment of kepok banana stem extract (Musa paradisiaca Var. Balbisinia colla) for 14 days at 200mg/kg BW and 250mg/kg BW increased malondialdehyde (MDA) levels, although not statistically significant.

Background: Coronavirus disease-19 is a disease caused by the SARS-CoV-2 virus. This virus is the newest type of coronavirus identified in humans. A recent study in 2022 in several different age groups found that older age, men, comorbidities such as hypertension, diabetes, and malignancy, were independent risk factors for mortality in COVID-19 inpatients. This study aimed to determine the risk factors for age and gender in the COVID-19 mortality rate.

Method: The design study was a retrospective case control. The research subjects were 6,697 patients from the secondary data medical record from March 2020 to September 2021 at Pasar Minggu Regional General Hospital.

Results: Results obtained 3313 men (49.5%) and 3384 women (50.5%). Men patients have a 1.5 times greater risk of mortality rate [OR 1.5 (1.3-1. 7)] compared to women. Elderly patients have a 3 times greater mortality risk than non-elderly people [OR 3.1 (2.6-3.7)]. There was a correlation between the after-treatment condition and age (p = 0.05).

Conclusion: This study concludes that the elderly and men are the risk factors for the mortality rate in COVID-19 patients at Pasar Minggu Regional General Hospital.

Background: The golden standard of Hirschsprung's disease diagnosis is through a histopathological examination of the aganglionic site. The significance of serum acetylcholinesterase (AChE) immunohistochemistry for diagnosing Hirschsprung's disease has been widely accepted. However, the study of serum AChE levels in Hirschsprung's disease patients is still scarce. We aimed to examine the serum levels of AChE in individuals with Hirschsprung's disease.

Methods: An analytical observational study with a cross sectional design was conducted on 29 patients with Hirschsprung's disease. We divided the patients into two groups: 14 in Hirschsprung's disease group and 15 in the control group. Serum AChE level was measured using the enzyme-linked immunosorbent assay (ELISA) method. The optimal cut-off value for detecting Hirschsprung’s disease was determined using the ROC analysis.

Results: The prevalence of Hirschsprung was higher in males than in females. The average AChE level in the Hirschsprung group was 95.89 ± 51.11 Units/mL, while the average level of AChE in the control group was 44.45 ± 33.40 Units/mL. The optimal cut-off value was 46.615 Units/mL. We found that this study's sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values ​​were 83.3%, 70.6%, 66.7%, 85.7%, and 75.9%, respectively. There was a significant relationship between serum AChE levels and Hirschsprung's disease (p=0.004).

Conclusion: The AChE levels in blood serum can be used as an alternative diagnostic parameter for Hirschsprung's disease. Patients with Hirschsprung's disease had higher serum AChE levels than patients without Hirschsprung's disease.

Background: Based on the onset of events, the most common neonatal sepsis is early-onset neonatal sepsis (EONS), which occurs within the first 72 hours of life. Blood culture is the gold standard for EONS, but this examination takes a long time to provide the results. However, the latest method is obtained to determine the shift to the left granulocytic image by counting Immature Granulocyte (IG). This study aims to evaluate the accuracy of the IG Ratio for diagnosing EONS in neonates suspected of having sepsis.

Methods: A cross-sectional observational study was conducted among 60 EONS patients consecutively, who met the inclusion criteria from January to June 2022 at Prof. dr. I.G.N.G Ngoerah Hospital, Bali. Variables assessed in this study included age, gender, delivery methods, birth status, birthweight, blood culture, complete blood count (CBC), I/T ratio, and IG ratio. Data were analyzed using SPSS version 23 for Windows.

Results: The cut-off point of the IG Ratio was 2.21 (AUC=0.670 (0,490-0,851); p=0.041; OR: 8.021 (2.283-28.185); p=0.001), which had a sensitivity of 64.7% and a specificity of 81.4% for diagnosing EONS in neonates suspected of having sepsis. The results also obtained a Negative Predictive Value (NPV) of 85.35 and a Positive Predictive Value (PPV) of 57.89.

Conclusion: The cut-off point of the IG Ratio of 2.21 has a risk factor of 8.021 times higher for diagnosing EONS in neonates with sepsis.

Introduction: Tartrazine is still one of the most widely used coloring agents in the pharmaceutical, cosmetic, and food industries; various hazardous consequences have been identified in rodents and humans, including impaired kidney function. This current study aimed to evaluate the effect of tartrazine on the biochemical parameters and structures of the kidney.

Methods: Twenty-four adult male Wistar rats were divided into four groups of 6 each. The experimental animals received tartrazine orally at a dose of 3.75, 7.5, and 15 mg/kg body weight along with a normal diet. The control group received only food and drinking water. The study was carried out for 21 days. At the end of the experiment, biochemical (blood urea nitrogen and serum creatinine) and histopathological examinations were performed on animal kidney tissues.

Results: Our findings revealed a significant increase in urea and creatinine levels in the serum of tartrazine-treated rats compared to controls (p < 0.05). The kidney section of rats treated with tartrazine showed lumen compression of tubular cells and loss of integrity of the renal tubule membrane. Tartrazine was associated with increases in the percentage of renal tubular necrosis in a dose-dependent manner compared to the control group (p < 0.05).

Conclusions: The current study concluded that oral administration of tartrazine affected the kidney by increasing urea nitrogen, creatinine levels, and the percentage of renal tubular necrosis in male Wistar rats. The results showed that tartrazine intake could cause adverse kidney health effects.

Background: Skin is considered a reflection of a person's appearance, so it is normal if many people try to take care of their skin, especially facial skin, and retard the aging process. Dermoscopy is a quick, non-invasive technique that allows physicians to observe the skin. Different ethnic groups may show different signs of aging on the face. Medan is a multiethnic city and thus might show facial skin aging differently. This study aimed to evaluate facial skin aging through the Dermoscopic Photoaging Scale (DPAS) and assess the relationship between DPAS, Glogau and Fitzpatrick scales among various ethnic groups in Medan, Indonesia.

Subjects and Methods: This cross-sectional study enrolled 155 subjects from 10 ethnicities in Medan. The examination of facial aging is based on DPAS using 11 criteria, the Glogau scale, and the Fitzpatrick skin type.

Results: Malay and Karonese got the highest DPAS score. There was a significant difference between DPAS, Glogau, and Fitzpatrick in age (p = <0.001,<0.001 and 0.032), and Fitzpatrick scores in ethnicity (p <0.001). There was a strong and significant correlation between DPAS and Glogau scores (p < 0.001, r = 0.748), while DPAS and Fitzpatrick's scores showed a moderate and significant correlation (p < 0.001, r = 0.288).

Conclusion: The highest DPAS scores were found in the Malay and Karonese ethnic groups. There were significant differences between DPAS, Glogau, and Fitzpatrick in age and Fitzpatrick scores in ethnicity. There was a strong and significant correlation between DPAS scores and the Glogau scale and a moderate and significant correlation between DPAS and Fitzpatrick scores in various ethnic groups.

Introduction: Patients with thalassemia experience a synthesis of one of the beta chains of the globin gene, resulting in reduced hemoglobin formation. Patients with beta-thalassemia major require routine transfusions and iron chelation. Both of these cause impaired kidney function. This study aims to determine the relationship between the amount of blood transfusion and the amount of iron chelation with blood urea and saliva levels in children with beta-thalassemia major.

Methods: An observational cross-sectional study was conducted at Moewardi Hospital, Solo using patients with beta-thalassemia major as subjects, taken by consecutive sampling from September to November 2018. The data on blood transfusion, iron chelation, and blood urea levels were obtained from medical records. Unstimulated saliva was taken in the morning. The urease method was used to assess the salivary urea levels and all data was analyzed using Pearson correlation analysis.

Result: The results showed the mean amount of transfusion was 71.9 ± 34.3, the amount of iron chelation 61.0 ± 32.1, blood urea levels 4.41 ± 1.1 mg / dL, and salivary urea levels 35.6 ± 12.5 mg / dL. Correlation analysis showed a positive correlation between the amount of blood transfusion and the amount of iron chelation with blood and saliva urea levels. There was also a positive correlation between blood urea and saliva levels.

Conclusion: It can be concluded that the amount of blood transfusion and iron chelation affects urea levels in blood and saliva in children with beta-thalassemia major. The close correlation between blood and saliva urea indicates that salivary urea can be used as an alternative assessment of blood urea.

Background: Coronavirus disease 2019 (COVID-19) patients with obesity are more susceptible to liver injury. There is currently no published overview regarding COVID-19 patients with liver injury in Indonesia. Our study reported 7 cases of obese COVID-19 patients with an increase of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT), followed by 5 of them developing severe symptoms of COVID-19 in isolation room of Dr. Soetomo Hospital Surabaya within June-December 2020.

Case Presentation: A total of 7 COVID-19 patients, by the average age 46.2±15.5 years, were obese. The mean body mass index (BMI) was 36,3±3,4 kg/m2. Five of them experienced serious symptoms. There were 3 patients (patient no. 2, 4, 7) who had normal SGOT level, while the rest had an increased SGOT level for <2x upper limit of normal (ULN) at admission. During treatment, SGOT level increased in 5 patients for 1-<3x ULN and normal in the rest of them (patient no. 2, 4). Meanwhile, the normal SGPT levels were shown in 3 patients (patient no. 2, 4, 7) and increased in 4 others at admission for 1-<4x ULN. All of them tended to have an increased SGPT level during treatment for 1-<5x ULN. However, since the increase of SGOT and/or SGPT for >3x ULN is defined as liver injury, it happened in 2 patients that occur since admission (patient no. 3) and during treatment (patient no. 5).

Conclusion: Obesity may impede the recovery of COVID-19 and manifest in the deterioration of liver function.

Background: Alveolar bone remodeling is very helpful in orthodontic treatment to prevent relapse after treatment is completed with new bone formation. Using natural materials that have a mechanism of action on the periodontal ligament and alveolar bone as a relapse prevention triggers osteogenesis with the formation of new bone in the tension area so that orthodontic treatment can be achieved maximally. This study aims to determine the formation of woven bone in the area attraction of orthodontic tooth movement after administration of Mangostin

Methods: A total of 30 male Wistar rats were divided into 3 groups, namely a negative control group (K1) without treatment, K2 and K3 a positive control group K(+), K2 a positive control group K(+), which was given a mechanical stressor without Mangostin administration and observed for 7 days, K3 positive control group K(+) which was given a mechanical stressor without Mangostin administration and observed for 14 days, K4 and K5 treatment group (P), K4 treatment group (P) where the group was given a mechanical stressor and Mangostin which was observed for 7 days, K5 the treatment group (P) where the group was given a mechanical stressor and Mangostin which was observed for 14 days. Dara was analyzed using SPSS version 23 for Windows.

Results: It was seen that the administration of Mangostin was very effective in increasing the expression of Runx-2, IL-10 and the formation of woven bone in the area of ​​higher tension than without the administration of Mangostin significantly (p<0.05). There was a significant increase (p<0.05) of Runx-2 and IL-10 in the treated group compared to the control group on day 7 and day 14, respectively.

Conclusion: The administration of Mangostin effectively prevented orthodontic relapse by increasing the expression of Runx-2 and Il-10 and accelerating the formation of woven bone in the tension area of ​​orthodontic movement.

Background: Coronavirus Disease 2019 (COVID-19) is an easily contagious disease, and not much is known about the characteristics of COVID-19, both in terms of susceptibility, severity, and spreadability of various SARS-CoV-2 strains. Patient genomic factors, especially related to genomic polymorphisms that affect the body's immune system, can influence the course of infectious diseases. The aim of this study is to get an adequate picture regarding gene polymorphisms, both susceptibility and related to the clinical degree in COVID-19 patients.

Methods: The PCR preparations were carried out in the Biomedical laboratory of the Faculty of Medicine, Universitas Sebelas Maret. The qualitative PCR (qPCR) examination was sent to the Genetica Science laboratory, Tangerang, West Java. The research subjects were divided into 3 groups, namely COVID-19 patients with no symptoms, COVID-19 patients with mild-moderate symptoms, COVID-19 patients with severe-critical symptoms. The research subjects were taken 6 cc of venous blood (3 cc for examination of serum IL-6 and TNFα levels and 3 cc for DNA examination).

Results: Serum levels of IL-6 and TNF-α in the clinical grade group were almost all above normal values. The frequency of TNF- α polymorphisms (-376G/A) all showed homozygote GG. TNF-α (-308G/A) also showed homozygote GG was dominant for SARS CoV2. IL-6 (-572G/C) polymorphism for cases requiring medium and severe clinical degree hospitalization was found to have more C allele than G allele. IL-6 polymorphism (intron A/G) the G allele is less common in cases requiring hospitalization.

Conclusion: TNF-α(−308A) allele has an influence on the development of clinical symptoms of SARS CoV2 infection. The rs1800796GG genotype in the IL-6 promoter contributes to milder symptoms in SARS CoV2 infection. Allelic variants of the gene under study may show different effects in other races depending on their interactions with other risk factors.

Background: Tooth extraction is a procedure with the highest prevalence of causing alveolar bone damage. After extraction, the dimension will change. This procedure needs a balance of bone formation and resorption. Osteocytes are the most common cells in bone and have an essential role in bone formation. This study explores the effect of bovine tooth grafts on the number of osteocytes in the socket preservation process post-dental extraction.

Methods: A total of 28 Wistar rats, 14 control and 14 treatment groups, were extracted on the lower left incisor. Control group with PEG without induction and treatment group with bovine tooth graft and PEG induction. On the 14th and 28th days, the rats were euthanized. Then perform histological examination with HE staining and cell counting using a light microscope

Results:  We found the treatment group had higher the average number of the osteocyte, which was 146.43±11.41 on 14th day and 288.14±161.91 on 28th day. There was a significant increase in osteocytes among the treatment group compared to the control (p=0.000).

Conclusion: Bovine tooth graft application as dental socket preservation was proven to increase the number of osteocyte cells in the alveolar bone of Wistar rats after extraction. Bovine tooth grafts as dental socket preservation materials increased the number of osteocytes at a peak at 28 days.

Introduction: The COVID-19 pandemic has impacted the community's disruption of nutrition and health services, including the closure of an integrated healthcare center (posyandu) in many areas in Indonesia. Posyandu plays an important role in nutrition services, particularly in detecting and managing growth and development disorders, such as stunting. This study aims to identify the improvement of knowledge in health cadres and community leaders in areas with high cases of severe acute malnutrition (SAM), namely, Temon, Kalibawang, and Dekso subdistricts in Kulon Progo, DIY, which followed a capacity-building program about strengthening the role of the community in the delivery of nutrition programs.

Methods: The program was conducted through interactive online seminars to ensure the continuity of essential nutrition care services during this pandemic. This study used a one-group pre-test and post-test design. Knowledge measurement was conducted in three consecutive online seminars with 180 participants: health cadres/volunteers, village heads, community leaders, nursery/early years teachers, and academicians. The pre-test and post-test questionnaires were spread through Google Forms before and after online seminars and assessed using the Wilcoxon Signed Ranks Test.

Results: The results showed that the participants improved their knowledge in webinars I and III (p-value 0.001). However, there was no significant improvement in the participants’ knowledge in webinar II (p-value 0.251).

Conclusions: Multi-sectoral collaboration among the government, community leaders, health cadres, health professionals, non-government organizations, institutions, and nursery/early years teachers are needed to reduce stunting, particularly in pandemic situations.

Introduction: Low mood condition is related to a low level of brain serotonin. An early sign of depression with low mood symptoms is generally treated with psychotropic drugs that work as selective serotonin reuptake and monoamine oxidase (MAO) inhibitors (one of which is sertraline), to increase serotonin levels in the brain. There are some concerns regarding side effects available medication like serotonin syndrome, suicidality and aggressive behavior. Thus, development of alternative herbal products made from a combination of pineapple and banana extract with less side effect and its potential affinity with serotonin regulation is important.

Aim of the study: To determine potential herbal rich (banana and pineapple) of L-tryptophan and potential active compounds interaction with the human serotonin transporter.

Method: In the present study, using in silico molecular docking techniques, the active compound of banana and pineapple and its potential interaction with human serotonin transporter were assed. Docking study explored the bioactive compounds interactions with specific target like catechin, dopamine, epigallocatechin, gallic acid, L-tryptophan, malvidin, norepinephrine, pelargonidin, peonidin, and serotonin. Molecular docking simulations were performed using AutoDock 4.2 software. The docking method was validated first by re-docking sertraline (nature ligand) in a complex with PDB ID: 6AWO against the target receptor (SERT).

Result: The molecular docking results had showed that L-tryptophan, peonidin, and catechin could bind to esential amino acid residues in the binding pocket, with binding affinity -5.69,  -8.63, -8.24 kcal/mol respectively.

Conclusion: L-tryptophan, peonidin, and catechin are the most promising compounds that have good potency as anti-depressant agents through SERT inhibitory activity. This compounds in bananas and pineapples have the potential to affect serotonin transporter receptors that play a role in mood and behavior.

Introduction: Skin prick test (SPT) is a method for diagnosing IgE-mediated allergen sensitization. Although the sensitivity and specificity are quite good, false positive and false negative results are possible. The diameter of the wheal and flare of each allergen can affect the skin prick test measurement, especially if the results of the examination overlap. Because of the usage of the SPT and the emphasis on quality control of health services recently, several variables that can affect the results of SPT must be considered. This study aims to analyze the effect of age, gender, family history of allergy, clinical symptoms, and illness duration on SPT's flare diameter.

Method: This is a cross-sectional study conducted from 2015 to 2020 in Surabaya, Indonesia. Children with possible allergies were tested with a skin prick test at the allergy immunology outpatient clinic of the Dr. Soetomo General Academic Hospital. Inclusion criteria were ≤ 18 years old children, possibly diagnosed with allergies, who had skin prick test. Children with incomplete medical record data were excluded.  The Chi-square test or Fisher exact test to determine the relationship between the independent and dependent variables for nominal data. The p-value was declared significant if P<0.05 to determine the effect between variables on flare diameter on skin prick test. We use SmartPLS to analyse the relationships simultaneously to compare relationships with the regression analysis.

Result: Age, gender, clinical symptoms, and duration of illness did not show a significant effect. In contrast, the flare diameter determined by SPT and the presence of an allergic family had a significant correlation (p = 0.017). Therefore, the appropriate distance between allergens must be specified to prevent overlap of SPT flare diameters.

Conclusion: Member of family allergy affects the diameter of the flare on skin prick test.   

Introduction: Noni fruit is one of the plants that is often used in traditional medicine as a medicine for high blood pressure, beriberi, smooth urination, inflammation of the gallbladder, colitis, dysentery, constipation, spleen pain, liver disease, diabetes and back pain. This study aimed to analyze the content of bioactive compounds, antioxidant properties and cytotoxic activity of fermented noni juice and noni juice.

Method: Identification of the content of bioactive compounds was carried out using Gas Chromatography (GC), antioxidant activity testing using the DPPH method (2,2-Diphenyl-1 picrylhydrazine) and cytotoxic testing using the Brine Shrimp Lethality Test (BSLT) method.

Results: The results showed that the content of phenolic compounds contained in noni juice and fermented noni juice had strong antioxidant properties with the IC50 value for noni juice of 22.23 ppm and for fermented noni juice of 13.95 ppm. Meanwhile, the results of the cytotoxic test of noni juice and fermented noni showed that the LC50 values of 33.26 ppm and 2.25 ppm respectively.

Conclusion: It can be concluded that both of these materials have high antioxidant activity and potential as anticancer.

Introduction: The COVID-19 pandemic has dramatically impacted people's lives. Families are affected in many ways, including daily life, the economy, social life, and health. Families who have resilience can face the COVID-19 pandemic situation. This study aims to determine the factors related to family resilience during the Covid-19 pandemic, including Family income, education, family type, family relations, and social support.

Methods: This study is a cross-sectional study conducted on 403 respondents using purposive sampling. Inclusion criteria include Husband or wife (with or without children) who live together, ages 18-65 years, in Jakarta and Tangerang. Data collection using an online questionnaire consisted of demographic data, the Family Resilience Assessment Scale (FRAS), and the Multidimensional Scale of Perceived Social Support (MSPSS). The questionnaire has passed the validity and reliability test. The Ethics Board of the Mochtar Riady Institute of Nanotechnology (MRIN) provided ethical approval.

Results: Multivariate analysis using a logistic regression test showed that factors related to family resilience were income (p-value: 0.028, OR: 3.08) and social support (p-value: 0.001, OR: 7.16). Social support is the dominant variable related to family resilience. An increase in social support increases the likelihood of family resilience by 7.16 times. Furthermore, an increase in family income has a 3.08 times greater chance of increasing family resilience.

Conclusion: Families and the government can collaborate to improve family resilience during the Covid-19 pandemic by optimizing social support and family income.

Introduction: The inflammatory process underlies either osteoarthritis (OA) or metabolic syndrome. Systemic inflammation that occurs in the metabolic syndrome will result in the production of inflammatory cytokines and activation of macrophages and chondrocytes. This can affect the entire body including joints and the surrounding tissues, causing OA. Type 2 Diabetes Mellitus (DMT2) and hypertension are the first and second most common metabolic syndrome components found in OA patients. This study aimed to determine the relationship between metabolic syndrome and knee OA in DMT2 patients with hypertension.

Methods: By using an analytic observational method and cross-sectional design, this study involved the medical records of patients with DMT2. The sample consisted of 50 medical records selected by using the purposive sampling technique and fulfilling the inclusion and exclusion criteria.

Results: This study involved 25 medical records of patients with and without knee (genu) OA. The characteristics of the sample were as follows: 1 medical record of patient aged 36-45 years, 18 medical records of patients aged 46-55 years, 16 medical records of patients aged 56-65 years, 15 medical records of patients aged > 65 years, 21 medical records of male patients, 29 medical records of female patients, 27 medical records with metabolic syndrome, and 23 medical records without metabolic syndrome. The association between metabolic syndrome and knee (genu) OA was analyzed by using the Chi-Square Test using the SPSS application, where the results showed a significance value of p < 0.05 (p = 0.001).

Conclusion: This study shows that there is a significant association between metabolic syndrome and knee (genu) OA.

Abstract: The decision that declared COVID-19 as a pandemic in March 2020 had become a medical emergency that also effects kidney transplantation program and care. Kidney transplantation has been a definitive treatment for end-stage renal disease (ESRD) patients since it improves patient’s quality of life. However great the beneficence is, kidney transplant procedure still carries high risk of COVID-19 infection especially for recipients who are obliged to take immunosuppression agents after transplantation.

Purpose: This study aimed to evaluate kidney transplant procedure in Dr. Sardjito General Hospital within before and during pandemic based on recipients’ and donors’ characteristics and laboratory findings such as creatinine and urine time.

Patients and methods: This study is designed as a cross-sectional analytic research to evaluate 30 patients that underwent kidney transplant in Dr. Sardjito General Hospital within before (April 2019-2020) and during (April 2020-2021) COVID-19 era. Data analyses were carried out using SPSS version 25.0 and were served with simple charts and tables.

Results: There is a decrement of kidney transplant procedure within before (n=16) and during (n=14) COVID-19. Age group of recipients that underwent the most of transplantation before pandemic are 20-29 years old while during pandemic are 40-49 years old. There is no significant difference in length-of-stay within before (12.0±4.17 days) and during (9.29±3.73 days) COVID-19 (p=0,077). Laboratory findings such as creatinine of pre-transplantation (9.47±4.05; 7.81±6.00) and 3 months’ post-transplantation (1,55±0,78; 1,15±0,67) also did not show significant changes (p=0,153) as well as urine time (245.60±225.55; 428.38±657.70; p=0.321).

Conclusion: There is a decrement of kidney transplant procedure in Dr. Sardjito General Hospital within before and during COVID-19 era. There are no significant differences found within length-of-stay, creatinine pre and 3 months’ post-transplantation and urine time. On the whole, transplant outcomes have remained similar within pre and during COVID-19 era.

Introduction: Oxidative damage can be brought on by inhaling free radicals from cigarette smoke. Malondialdehyde (MDA), a byproduct of lipid peroxidation, is a biomarker for oxidative stress. Beta vulgaris L., sometimes known as beetroot, is a root vegetable with phenolic and betalain chemicals that have antioxidant qualities and can reduce oxidative stress in the body.

Determine how beetroot juice affects male Wistar rats exposed to cigarette smoke regarding their MDA levels.

Methods: 24 samples of male Wistar rats, separated into 4 groups, were utilized in this genuine experimental investigation using a posttest-only control group design. Traditional food and beverages were served to Group N. Two cigarettes were smoked each day by the cigarette smoking group, BV1, and BV2. Beta vulgaris L. juice was also administered to group BV1 at a dose of 8 ml/kg BW per day and to group BV2 at 16 ml/kg BW per day. MDA serum levels were measured using the TBARS technique after 28 days of therapy. The one-way ANOVA and the Games-Howell test were used to evaluate the data.

Result: The group control's mean MDA level was 1,539 ppm; the cigarette smoking group was 3,167 ppm; BV1's was 2,452 ppm, and BV2's was 2,0527 ppm. Between-group control and cigarette smoking group BV1 and BV2, as well as between BV1 and BV2, there were significant differences in MDA levels (p 0,05).

Conclusion: The MDA levels of the groups exposed to cigarette smoke and given beetroot juice were lower than those of the groups exposed to cigarette smoke alone, with the MDA levels of the group given a dosage of 8 ml/kg BW being lower than the group given a dose of 16 ml/kg BW.

Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic inflammation that causes a variety of pulmonary and systemic disorders. Pursed-lip breathing and diaphragmatic breathing exercises are useful techniques for improving ventilation, reducing the degree of breathlessness, enhancing performance, and improving quality of life. The aim of this study was to determine the effect of pursed-lip breathing and diaphragmatic breathing exercise on the value of the 6-min walk test and to improve quality of life by SGRQ in stable COPD patients.

Methods: This study was an experimental study using group control before and after examining 60 stable COPD patients at Dr. RSUD Lung Center. Zainoel Abidin from November 2019 to February 2020. Samples were extracted by systematic random sampling and divided into two groups. The intervention group received indacaterol bronchodilator therapy in addition to four weeks of apron and diaphragmatic breathing exercises. The control group received only indacaterol therapy. A 6-minute walk test was administered and a quality of life questionnaire was completed using the SGRQ. A t-test and Wilcoxon test were performed to assess differences between groups, level of significance p < 0.05).

Results: There was a significant effect on the 6-minute walk test in the intervention group compared with the control group (p = 0.001). There was a significant effect in improving quality of life using the SGRQ questionnaire in the intervention group compared with the control group (p = 0.001).

Conclusion: There was a significant effect on the six-minute walking test in the intervention group compared to the control group. There was a significant effect on improving the quality of life using the SGRQ questionnaire in the intervention group compared to the control group.

Background: Tumor-infiltrating lymphocytes (TIL) serves as the host adaptive immune response in breast cancer. TIL has the potential to be an independent prognostic factor in breast cancer patients. In this study, we aimed to examine the association between stromal TIL and recurrence in locally advanced breast cancer patients.

Methods: A cohort retrospective study was conducted using medical records of female breast cancer patients with locally advanced breast cancer. We collected patients' data, including demographic data from the medical record. Stromal TIL was examined following the recommendations of the International TIL Working Group 2014.

Results: 75 samples were included with an average age of 49.5±8.4. Ductal carcinoma was the most common type histologically (88.0%). Luminal B Her2-negative was the predominant breast cancer subtype (32.0%). There was a significant association between the breast cancer subtype and disease-free survival (P – 0.014). The optimal cut-off to determine the recurrence of breast cancer was 15%. The sensitivity, specificity, PPV, NPV, and accuracy of TIL to predict the 24-month disease-free survival (DFS) were 80.5%, 82.4%, 84.6%, 77.8%, and 81.3%, respectively. Every 10% increase in TIL percentage could raise the DFS by 5.45 months (p=0.001). Patients with high TIL values had higher survival than those with low TIL values.

Conclusion: There was a significant correlation between the stromal TIL and the recurrence rate. The pre-therapy stromal TIL percentage can be employed as a potential biomarker to predict breast cancer recurrence, particularly in the first two years.

Background: Infections of the dental pulp and periapical tissues involve bacteria which can induce and enhance the immune response of the dental pulp but are not effective in eliminating root canal bacteria. A study was conducted to determine the effect of giving ethanol extract of green meniran leaves (Phyllanthus niruri Linn) in a mixture of calcium hydroxide and 2% chlorhexidine digluconate on the chronic inflammatory response in periapical tissue by measuring MMP-9, TGF-β₁ levels, osteoclast, and osteoblast cells count.

Methods: An experimental design with a post-test-only control group design involving 24 right molars of male Wistar rats divided into 4 groups. Each group consisted of 6 rats (K-) bacteria, (K+) bacteria, calcium hydroxide and 2% chlorhexidine digluconate, (P₁) bacteria, calcium hydroxide and 10% meniran extract, (P₂) bacteria, calcium hydroxide, 2% chlorhexidine digluconate and 10% meniran extract}. Examination of MMP-9, TGF-β₁ levels, and the number of osteoclasts and osteoblasts were evaluated until day 14.

Results: The administration of ethanol extract of green meniran leaves (Phyllanthus niruri Linn) in a mixture of calcium hydroxide as an intracanal medicament (P1) which was evaluated for 14 days overall showed a significant difference between groups (p<0.005). This condition can be seen in the group (P1), which has a lower MMP-9 level of 2465.88 pg/mL compared to the group (P2), (K+), and (K-). The levels of TGF-β₁ in the group (P1) were 181.57pg/mL, lower than the group (P2), (K+), and (K-). The number of osteoclast cells in the group (P1) was 1.67, which was lower than the group (P2), (K+), and (K-) was 5.00. The number of osteoblast cells in the (P1) group was 52.67, higher than the 32.17 group (P2), (K+), and (K-).

Conclusion: Green meniran extract (Phyllanthus niruri Linn) and its role as an intracanal medicament in teeth with chronic apical periodontitis.

Introduction: Cases of coronavirus that causes Covid-19 disease in the world have reached 1.8 million people. Cases of coronavirus that causes Covid-19 disease in the world have reached 1.8 million people. The purpose of the study analyzed predictions of covid-19 vaccine acceptance based on sufferers and health belief models in Indonesia and Timor Leste. 

Method: Analytical research method with cross-sectional survey approach, the population is taken from community living at Surabaya Indonesia and Timor Leste as many as 250 respondents. Sampling was conducted in a consequent sampling in two regions at Surabaya Indonesia and Timor Leste.  Data collection using google form, share through were respondents. Statistical analysis with rank spearmen.

Result: the relationship of vulnerability perception with acceptance vaccine covid-19 and correlation coefficient showing a figure of 0.29. It refers to the value of 0.20- 0.40 is considered weak. Similarly, the relationship of severity perception with acceptance vaccine covid-19 obtained coefficient correlation 0.41 expressed strong. on the perception of cues doing actions with acceptance vaccine covid-19, there is a strong relationship, because value correlation coefficient 0.41. For the relationship of benefit perception with acceptance vaccine covid-19 get a weak result because the correlation coefficient of 0.23 in the category below 0.40 is considered weak.

Conclusion: there are four components of Health Belief Model associated with Acceptance vaccine covid-19

Background: Hypothermic perfusion can be used as adjunctive therapy to reduce corneal endothelial cell damage during phacoemulsification procedures. This study aims to evaluate the effect of hypothermic perfusion on the expression of Superoxide Dismutase-1 (SOD1) and morphological changes in the corneal endothelium after ultrasound energy of phacoemulsification exposure.

Methods: Sixteen New Zealand white rabbits (n=16 eyes) were randomly divided into two groups and exposed to ultrasound energy of phacoemulsification. The control group was administered room temperature (RT) (24°C) Balanced Salt Solution (BSS) intraocular perfusion, and the treatment group was administered hypothermic (4°C) BSS intraocular perfusion. Coefficient of Variation (CV) and hexagonality were measured before and one day after surgery with specular microscopy. The expression of SOD1 was examined by immunohistochemistry staining. Data were analyzed using SPSS version 26 for Windows.

Results: The result showed that the SOD1 expression was significantly lower in the hypothermic perfusion group compared with the control group (p=0.024, p<0.05). There were no significant differences between the two groups in CV changes (p=0.494, p>0.05) and hexagonality changes (p=0.916, p>0.05). There was no correlation between the expression of SOD1 and change in CV (p=0.188, p>0.05) or the expression of SOD1 and change in hexagonality (p=0.763, p>0.05).

Conclusion: Hypothermic perfusion suppresses all metabolic processes, including the expression of SOD1 and ROS production. The coefficient of variation and hexagonality as a representative of corneal endothelial morphology changes also decrease with hypothermic perfusion after ultrasound exposure but are not statistically significant. There is no correlation between the expression of SOD1 and changes in CV and hexagonality.

Introduction: Colorectal cancer (CRC) occurs, accounting for 11.5% of all patients with cancer in Indonesia. The less the spread of cancer, the higher the life expectancy of patients with cancer. Glutamine is involved in tumor cell proliferation and growth. This study aims to verify the correlation of serum glutamine levels with the one-year survival rate of patients with stadium III colorectal cancer at Dr. Moewardi Hospital, Surakarta, Indonesia.

Method: A quantitative analytic-observational longitudinal study (Cohort) was conducted from May 1^st, 2020, to September 30^th, 2021. Inclusion criteria were the CRC patients with stage III and could be followed up for one year. Exclusion criteria were the CRC patients who had other systemic problems. The patient’s blood glutamine levels were taken three months postoperatively measured by Glutamine Assay kit (Colorimetric) ab197011 and evaluated clinically for one year. Glutamine levels in the blood are low if they are less than 52 ng/µL. The parameters assessed were glutamine serum level and survival rate of colorectal cancer patients. Statistical analysis using the Chi-square test and the Kaplan Meier method was employed to obtain the survival curve. Analysis to compare survival rate with glutamine levels used the Cox regression model.

Results: A one-year survival rate in patients with stadium III colorectal cancer was 95.5% at post-operative glutamine levels of ≥ 52 ng/µL and 65.4% at post-operative glutamine levels of < 52 ng/µL. The mean progressive free survival rate was 11.818 months (95%CI=11.470-12.166) at post-operative glutamine levels of ≥ 52 ng/µL and 10.038 months (95%CI=8.913-11.164) at post-operative glutamine levels of < 52 ng/µL. The overall free survival rate was 11.955 months (95%CI=11.868-12.042) at post-operative glutamine levels of ≥ 52 ng/µL and 10.885 months (95% CI=10.128-11.641) at post-operative glutamine levels of < 52 ng/µL. Patients with glutamine levels of <52 ng/µL were 8.959 times more probable to die than patients with post-operative glutamine levels of ≥ 52 ng/µL.

Conclusion: This study shows a significant relationship between serum glutamine levels and the one-year survival rate of patients with stadium III colorectal cancer at Dr. Moewardi Hospital, Surakarta, Indonesia.

Background: Ultrasound (US) is a reliable, non-invasive, and inexpensive modality for evaluating femoral cartilage (FC) thickness. Several studies evaluated the US accuracy in assessing FC thickness by comparing it to MRI and macroscopic measurements, reporting that the US exhibit highly accurate FC thickness measurement. This study evaluated the FC thickness among healthy Indonesian adults using ultrasound US assessment.

Methods: An analytical observational study with a cross-sectional design was conducted in Surabaya Hajj General Hospital, Indonesia, from April to August 2022. A total of 127 participants with no symptoms or pathologies on both knees were involved in the study. In this study, a certified examiner performed the ultrasound scanning in three sites: medial condyle (MC), intercondylar (IC), and lateral condyle (LC) of both knees.

Results: A total of 254 knees from 127 healthy Indonesian adults were examined. The participants’ mean age was 32.83 years. Most of them were female (69%). Participants’ average weight, height, and BMI were 62.25 kg, 161.17 cm, and 23.93, respectively. The mean FC thickness of the right MC, IC, and LC was 1.76 mm, 1.92 mm, and 1.71 mm, respectively. Meanwhile, the mean FC thickness of left MC, IC, and LC was 1.76 mm, 1.89 mm, and 1.69 mm, respectively. This study found that FC thickness was associated with gender (<0.05) but not age and BMI.

Conclusion: Mean FC thickness among healthy Indonesian adults of MC, IC, and LC were 1.76 mm, 1.89 –1.92 mm, and 1.69 – 1.71 mm, respectively. The IC mean was higher than the MC and LC means. Mean FC thickness on both sides was associated with gender but not age and BMI.

Background: Pregnancy is a uniquely critical and sensitive period in a woman's life. The pregnancy conditions are determinants in the successful growth of the fetus and baby. Zinc is important in fetal bone growth (ossification) because zinc deficiency in pregnancy can interfere with fetal bone formation. Being short (stunted) at birth is associated with a high risk of shortness in childhood and adulthood. Several ultrasound parameters can assess the intrauterine growth and development of the fetus, one of which is the length of the femur: the measurement of the length of the femur can detect intrauterine stunting early. The objective of this study was to investigate the average length of fetal femurs in pregnant women given zinc tablets and assess differences in the percentile changes in fetal femoral length between pregnant women given zinc tablets and those not given zinc tablets.

Methods: This prospective design observational analytic study was conducted at Universitas Sumatera Utara Hospital and other hospitals from June to November 2019. Eligible subjects were pregnant women who met the inclusion criteria and were collected with consecutive sampling techniques.

Results: Fetal femur length was examined using ultrasonography on 31 subjects given zinc tablets and 31 who were not. The average fetal femur length prior to treatment was 61.97 mm (SD=8.13 mm) and 58.84 mm (SD=9.37 mm), respectively. There was no significant difference in the mean length of fetal femurs (p=0,110) prior to treatment. Fetal femur length increase in subjects given zinc tablets was 27.74 mm (SD=5.32 mm), whereas in subjects not given zinc tablets was 23.08 mm (SD=2.81 mm).

Conclusion: There were significant fetal femoral length percentile changes in pregnant women given zinc tablets.

Introduction: In both poor and developed countries, chronic suppurative otitis media affects 1-46 percent of the population. The incidence of chronic suppurative otitis media is much higher in Indonesia due to various of factors, including poor sanitation, low socio-economic and nutritional status, and high population density. To reduce the occurrence of chronic suppurative otitis media, an adequate treatment is required.

Purpose: the study was to identify the bacteria that cause chronic suppurative otitis media and ciprofloxacin and amoxicillin antibiotic sensitivity pattern in Asri Medical Centre and PKU Muhammadiyah Gamping hospital, Yogyakarta.

Patients and methods: This is a prospective descriptive study with 27 patients with chronic suppurative otitis media whom met the inclusion criteria. Bacteria were isolated from ear secretions and cultured on TSA and McConkey agar medium. The antibiotics ciprofloxacin and amoxicillin were tested for susceptibility, and Gram staining, catalase test, and biochemical test were used to identify bacteria.  

Results: 63 bacteria were isolated from 27 chronic suppurative otitis media patients, among of them positive-gram bacteria (52%) and negative-gram bacteria (48%). The sensitivity of positive-gram bacteria and negative-gram bacteria causing chronic suppurative otitis media to ciprofloxacin was 84% and 79%, respectively. The resistance of positive-gram bacteria and negative-gram bacteria to amoxicillin by 100%.

Conclusion: Staphylococcus sp and Pseudomonas aeruginosa were the most caused chronic suppurative otitis media at the Asri Medical Centre and PKU Muhammadiyah Gamping hospital in Yogyakarta. The antibiotic ciprofloxacin is the most effective treatment for bacteria that cause chronic suppurative otitis media.

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. Histopathological diagnosis has been the gold standard for diagnosing and determining the severity of non-alcoholic steatohepatitis (NASH). However, this method is invasive, especially for diagnosing NASH in children. This research aimed to study the effect of probiotics on the De Ritis ratio, TGF-β levels, and histopathological changes in rats given High Fat, High Fructose (HFHFr) diet to look at the correlation between the De Ritis ratio and liver histopathology in diagnosing NAFLD.

Method: Twenty-one male Sprague Dawley rats were included and divided into three groups. In the first group, as control only received a normal chow diet for eight weeks. The second group received an HFHFr diet for eight weeks, and the last group received HFHFr for eight weeks and a combination of HFHFr and probiotics for another eight weeks. After decapitation, we took 3 ml of serum from each rat to measure AST, ALT, and TGF-β. A 4 μm thick liver tissue slide was taken and stained with Hematoxylin – Eosin Stain for histopathological analysis. We used the Non-Alcoholic Steatohepatitis (NAS) Score for measuring liver damage progression.

Results: De Ritis ratio and TGF-β level did not significantly differ between probiotic and non-probiotic groups (p = 0.064 and 0.383), but there was a significant NAS score difference (p = 0.001) in probiotic and non-probiotic groups. This was followed by a significant correlation between the De Ritis ratio and the NAS score (r = 0.613, p = 0.003).

Conclusion: Probiotic supplementation alleviated liver damage caused by the HFHFr diet but did not successfully reduce the De Ritis ratio or improve TGF-β.

Background: Cancer cells increase iron absorption, interfere with iron storage, and reduce iron excretion. Acute lymphoblastic leukemia (ALL) condition may interfere with the iron synthesis, and the patients usually receive a blood transfusion which leads to iron buildup. Excess iron is linked to a poor prognosis and significantly becomes morbidity and mortality factors. Serum ferritin levels that can be assessed from complete blood count may become a low-cost and sensitive biomarker and prognostic marker for ALL. The aim of this research is to assess serum ferritin levels in pediatric patients with ALL in the diagnosis and remission phases.

Methods: An analytical observational cross-sectional study was conducted on pediatric patients with ALL in the pediatric ward Haji Adam Malik hospital Medan from July – October 2021. Physical examination and blood sampling for complete blood count and serum ferritin level assessment were carried out. Bivariate analysis using the Chi-square test was used to compare serum ferritin levels during early diagnosis and remission phases in ALL pediatric patients.

Results: Ferritin levels were higher in the newly diagnosed patient group with a median value of 951 µg/L (28.07-6632 µg/L) than the group in remission phase with a median value of 374.5 µg/L (29-2426 µg/L). There were no significant relationships between ferritin levels and BMI, SGOT, and SGPT in the newly diagnosed group. In contrast, the ferritin levels of the patients in the remission group were significantly correlated with SGOT and SGPT.

Background: Transmission of pathogenic and non-pathogenic microorganisms from animals to humans can affect the composition of gut bacteria (gut microbiome) in humans and can also be a potential source of transmission of zoonotic diseases. Therefore, this study aimed to analyze the gut microbiome interactions between the human and the livestock.

Method: This study was a cross-sectional study conducted in Mlati District, Slemanm Yogyakarta. The fecal sample was used to identify parasites by using trichrome staining. Then NGS selected samples were used to analyze the gut microbiome using Illumina high throughput 16S rRNA region V3-V4 sequencing.

Result: The analysis showed that Bacteroidetes was prevalent in the HCA group (57%), while Firmicutes (70%) were commonly found in HNC. Regarding the potential parasitic infection, direct microscopic examination and trichrome staining showed that Blastocystis sp and Entamoeba coli cyst was found in several subjects in HCA groups, with prevalence rate at 7.69% and 2.5%. Meanwhile, no parasite was found in HNC feces.

Conclusion: There was a significant difference in the gut microbiome and parasitic infections between the HCA and HNC groups, with Blastocystis sp and Entamoeba coli as the most prevalent parasites.

Introduction: The largest public health issue in the globe, particularly for women who are close to childbearing age, is anemia. Anemia during pregnancy is said to be “dangerous to mother and child”. In 2015, Indonesia's maternal mortality rate (MMR) was 305 per 100,000 KH. Pregnancy who experienced anemia in the world are still very high. The prevalence of anemia in pregnancy is 41.8%. In Indonesia, the increasing in the incidence of anemia in pregnancy from 37.1% in 2013 to 48.9% in 2018. One of the causes of anemia in pregnant women is the knowledge and parity. This study aimed to analyze the knowledge and parity of the incidence of anemia in pregnant women.

Methods: The research design is cross-sectional with the independent variables which are knowledge and parity. The dependent variable is the incidence of anemia in pregnant women. The population used by all pregnant women is 48. The sampling technique uses total sampling and collecting data using questionnaires and interviews. Data analysis used univariate and bivariate.

Results: The results of research informed that most pregnant women had anemia, around 56.2%. The results of the statistical analyses revealed a p value of 0.007, indicating a relation between parity and the prevalence of anemia. Besides that, there was a relation between knowledge and the prevalence of anemia.

Conclusion: There is an influence between knowledge and parity on the incidence of anemia in pregnant women. Countermeasures that can be done by providing information communication and education on pre-wedding preparation.

Abstract

Background: Breast cancer is the most common cancer in women. The occurrence of metastasis in breast cancer should be detected early. Tumor necrosis factor-α (TNF-α) is involved in every step of the carcinogenesis process. A rise in TNF-α level is linked to the advancement of breast cancer. We aimed to determine the association between TNF-α levels and breast cancer metastases.

Methods: An analytic cross-sectional study was conducted on women with breast cancer treated at the Oncology Surgery Center between November 2021 and April 2022. The patient's data were collected from the medical record, including age, menopausal status, tumor size and lymph node involvement, and tumor subtype. The serum TNF-α level was measured using ELISA. The optimal cut-off value was determined using the receiver operating characteristics analysis. The association between serum TNF-α and the incidence of breast cancer metastases was analyzed using SPSS version 26 for Windows.

Results: We analyzed a total of 50 patients. The mean age was 48.8 ± 8.3 years. The serum TNF-α level was divided into high-TNF-α and low-TNF-α using a cut-off value of 22.755 pg/mL. There were 27 patients (27/50; 54.0%) with high serum TNF-α levels and 23 patients (23/50; 46.0%) with low TNF-α levels. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 73.9%, 63.0%, 63,0%, 73,9%, and 68%, respectively. There was a statistically significant association between serum TNF-α levels and metastatic breast cancer (p=0.009).

Conclusion: There was a significant association between TNF-α levels and metastatic breast cancer. Serum TNF-α may be a potential biomarker to detect metastasis in breast cancer patients.

Introduction: Carotid intima-media thickness (CIMT) is a predictor marker of subclinical atherosclerosis that can be measured by ultrasound technique. The clinical symptoms of atherosclerosis usually begin with the thickening of the carotid artery walls. Polymorphism in Apolipoprotein E4 (APO-E4) is considered to be an important genetic determinant of atherosclerosis and Coronary Artery Disease (CAD). The genetic role of APO-E4 on plasma lipid has shown that the APO-E4 allele is associated with increased plasma LDL and total lipid concentration. The main objectives of this study were to identify genotype polymorphisms of the APO-E gene and measure the thickness of the carotid intima in subjects with APO-E4 polymorphisms in the first descendant of coronary heart patients.

Patients and methods: A cross-sectional study design was used to determine the polymorphism of the APO-E4 genotype in the first descendant of CAD and non-CAD groups. There were 21 samples in each group. Gene polymorphism examination was carried out by PCR and the CIMT was measured with doppler ultrasound.

Results: The result showed that 21.4% of subjects had polymorphism of the APO-E4 genotype with a significant difference between CHD and non-CHD group. This data shows that the APO-E4 genotype is more dominant in the first descendant of patients with CHD when compared to non-CHD parents. The mean values of CIMT ini right and left-sided carotid arteries among APO-E4 genotype and non-APO-E4 genotype were 0.4743 mm vs. 0.4195 mm and bivariate analysis showed a significant difference with a P-value of 0.017. This shows that there is a significant difference in the thickness of the carotid intima in the first descendant of subjects who have the APO-E4 genotype and those who do not.

Conclusion: The APO-E4 gene polymorphism was more dominant in the first descendant of CAD patients with a higher CIMT mean value.    

Background: Combine Oral Contraceptives (COCs) pills is one of the many popular contraceptives worldwide, with 100 million women who use contraceptive pills. To increase the choice of oral contraceptives, COCs Novadiol® (Pill A) domestic production, which has the same dosage as Microgynon® (Pill B), are still imported drugs. This study aims to determine Pill A's efficacy, safety and acceptance level compared to Pill B for 3 months.

Methods: The study was a randomized control clinical trial, an open-label trial in 200 women of childbearing age who met the inclusion and exclusion criteria from July to November 2015. Data were analyzed using SPSS version 20 for Windows.

Results: About 300 participants were selected and 200 met the inclusion and exclusion criteria who participated study from the beginning to the end of the study period. In the first month of observation, 1 complaint of dizziness in pill A and 2 from pill B. One nausea complaint was found in the participant from Pill A. These differences were not statistically significant (p>0.05). In the second month of observation, 1 complained of dizziness from pill B and 1 nausea from Pill A. In the third month, observation found no complaints about using Pill A and pill B. There were changes in menstrual patterns in both pills and bleeding outside the cycle during the use of 3 months, but they were not statistically significant (p>0.05).

Conclusion: Pills A has the same efficacy, safety and acceptance when compared to the use of birth control pills B for 3 months.

Background: Atopic dermatitis (AD) is the most common skin disease in infants and children, influenced by hereditary and environmental factors and characterized by an inflammatory reaction in the skin. The increase in AD has been explained by two hypotheses: the "hygiene hypothesis" and the "diet–microbiome hypothesis." AD is driven by a familial or personal predisposition to induce immunoglobulin E (IgE) antibodies and sensitize in response to stimuli. Microorganisms on the skin have been shown to play an important role in the pathogenesis of AD, and changes in the composition of the skin microbiome have been investigated in disease progression in pediatric AD patients.

Method: This descriptive observational study with a cross-sectional approach aims to determine the bacteria found in AD. The samples were taken from both the lesion and non-lesion areas in children with AD, which grown anaerobically and aerobically in blood and Brucella agar at 37C. The bacteri then indentified by Vitek® 2 and the data presented in percentage.

Result: Thirty-five pediatric patients (18 males and 17 females) with a mean age of 7.58 (0,17 – 16) years were diagnosed with AD and were examined for bacterial culture on lesions and non-lesions. A total of 4 types of bacteria were found on the neck, 20 on the forearm, 2 on hand folds, 2 on fingers, 1 on the knee, and 5 on the lower limbs.

Conclusion: The most common bacteria were Gram-negative bacilli, namely, Acinetobacter baumannii (15%) and Burkholderia cepacian (14.3%), followed by the Gram-positive coccus Staphylococcus hominis (11.4%).

Background: Arteriovenous fistula (AVF) failure rate in chronic kidney disease patients is relatively high due to inadequate feeding arteries and draining veins. The primary balloon angioplasty (PBA) dilatation technique is a way to mitigate AVF failure. There have not been many studies to determine the patency rate with and without PBA. This study analyzed the patency rate and the number of patency failures in Indonesia AVF patients with and without PBA.

Methods: A retrospective cohort study was conducted in AVF surgery patients from 2019 to 2021 with or without PBA with a total sample technique. The patient was choosen without AVF surgery in the same arm with had follow-up every three months for three years. We excluded incomplete medical record data and unfollowed patients six weeks after surgery. The Kaplan–Meier method used the log-rank test to estimate each group's patency rate. The p-value<0.05 was considered significant.

Results: There were 60 subjects, of which 29 were with PBA and 31 were without PBA. There was a significant difference between the two groups regarding venous diameter and postoperative venous flow volume (p<0.01). The log-rank test showed a significant difference in patency failure in the group without PBA (35.5%, mean patency rate 56.3 weeks) compared to the group with PBA (10.3%, mean patency rate 104.4 weeks) with p=0.028. The median duration showed that 50% of the group without PBA experienced patency failure at week 59.3. In contrast, until the observation's end, the PBA group experienced patency failure of less than 50%.

Conclusion: Using the PBA technique can reduce the incidence of patency failure and maintain longer patency in patients with AVF.

Background: Postpartum contraception is a way to prevent recurrent pregnancies to ensure the health of both mother and baby. Many postpartum mothers think that there will be no pregnancy during amenorrhea in the postpartum period and will use the contraceptive method after the first menstruation. There are still some who do not use contraception. Contraceptive success will be achieved if the counseling and media are effective. Palangka Raya's city has a Bapalas Bidan culture, a ritual in which a newborn baby is declared a midwife's child until the midwife's blessing ceremony is carried out for the baby and the mother.

Methods: This research type is a quasi-experimental study with two group comparison pretest-posttest design with counseling intervention and booklets. The research subjects were postpartum mothers who gave birth or were treated at the Midwives Individual Service in Palangka Raya City, amounting to 30 each per treatment and control group.

Results: There was a difference in the mean and an increase in the group's knowledge score after receiving counseling through the Bapalas Bidan (p = 0.000). The increase in knowledge was higher in the group that received counseling than in those who did not get counseling. Postpartum mothers who have high knowledge of contraception use contraception more than mothers with low knowledge. The proportion of postpartum mothers who used contraception was more in the group who received counseling (p = 0.018), aged 20-35 years (p = 0.015), had parity ≥3 (p = 0.024), and higher education (p = 0.006).

Conclusion: Postpartum mothers who have high knowledge of contraception use contraception more than mothers with low knowledge.

Introduction: Channa striata collagen-chitosan wound dressing (3:1 v/v) was founded contaminate by bacterial and fungal. Therefore, to suppress bacterial and fungal contamination in Channa striata collagen-chitosan composite dressing, it needs several efforts such as sterilization under Ultra-Violet Light Exposure. The study aimed to determine UV-light exposure duration to supress bacterial and fungal growth on C. striata collagen-chitosan composite dressing.

Methods: C. striata collagen was extracted from skin and scales using 2% HCl for 48 hours, then neutralized using NaOH 1 M until collagen fibers appeared. Chitosan powder dissolved in 2% acetic acid. Afterward C. striata collagen and chitosan liquid (1:3 v/v) were mixed and formed until wound dressing was reached. Wound dressing was sterilized under UV exposure for 0, 5, 10, 15, and 30 minutes. Chitosan dressing was used as a negative control.

Results: The results of the study showed that the total number of bacteria and fungi decreased significantly with increasing time of exposure of UV light on composites dressing with a value of p=0.001 for bacterial growth and a value of p= 0.005 for fungus growth. The UV exposure on collagen-chitosan dressing to reduce bacterial and fungal growth proved effective in 10 minutes.

Conclusions: The UV light exposure treatment can reduce bacterial and fungal contamination on collagen-chitosan composites on each addition duration exposure descriptively.

Introduction: Pediatric acupuncture is an interesting subject to study along with strengthening the current development of acupuncture therapy. Not only for adults, but acupuncture is also safe for children. There have been many studies on acupuncture, but publications related to acupuncture for children are still very few compared to adults. The purpose of this study is to visually map and guide future research on Pediatric acupuncture based on bibliometric analysis.

Method: We conducted this study from September 16 to 19, 2022. Publications regarding pediatric acupuncture were extracted from the Scopus database. The search strategy included two keywords: (ACUPUNCTURE)*(PEDIATRIC). The final result was acquired by searching those keywords without limitation because the number of articles was less than 1000. We used VOSviewer and bibliometric indicators to generate a maps-based data network from all keywords-related studies showing association among journals, countries, publication frequency, authors, and citations. Keywords were used to infer pediatric acupuncture. A total of 669 documents related to pediatric acupuncture were retrieved. This includes 432 articles, 176 reviews, and 16 conference papers.

Results: A total of 10,918 citations have been recorded for all publications with an h-index count of 52. The first relevant study is dated on 1966. Since then, there has been a steady increase in total publications each year whereas 2021 as the most productive year with 53 publications. The Medical Acupuncture Journal (25) was the most prolific journal. The United States of America (298) and China (54) are the most productive country and institutions. The article entitled Clinical Practice Guideline: Allergic rhinitis by Seidman et al. (386) is the most cited reference.  

Conclusion: The benefit and potential of acupuncture for several diseases in pediatric patients are promising and no adverse side effects have been reported.

Introduction: Injuries are a major medical problem in military populations. The physical fitness assessment is a series of tests that measure and monitor physical fitness levels. The existing physical fitness assessment and formula used by the Indonesian Military requires a running test that only applies to healthy soldiers. This study attempted to construct a formula for assessing physical fitness using tests that soldiers may perform with lower limb injury/disability.

Method: The design of the study was an internal cross-sectional comparison. This study included 104 healthy, well-trained male normal soldiers (NS) and 50 injured or disabled soldiers (DS) who matched the inclusion criteria. The NS was required to perform a 12-minute running and wheeling test, a ball-throwing test, push-ups, and lunges. The DS was also required to perform the same tests except for the 12-minute running test and lunges. The analysis of the data consisted of four steps: constructing a conceptual framework, describing the characteristics of each group, identifying significant indicators using Partial Least Square-Structural Equation Modeling (PLS-SEM) to develop a physical fitness formula, and determining whether the formula is appropriate for assessing physical fitness in running and wheeling tests.

Result: There is no significant difference in the characteristics of NS and DS (p>0.05); thus, the subjects in both groups are comparable. Physical fitness test has several major contributing factors: distance, test method, muscle strength, and age. There is no significant difference in the number of NS in each category between the running and wheeling tests (p>0.05).

Conclusion: Physical fitness formula= {1.1 × (0.98 × distance^*) + (0.97 × method value^**)} – (0.093 × age) – (0.17 × muscle strength^***) Note: *) Distance traveled during running or wheeling test (meter). **) The running test method value is entered as 1, and the wheeling test method value is entered as 2. ***) The value of wheeling muscle strength is obtained from the ball-throwing test. In contrast, the value of running muscle strength can be determined by multiplying the result of the ball-throwing test by 2. These findings may be used for assessing the physical fitness of normal soldiers or those with lower limb injury/disability.

Background: The use of certain opioids associated differently with the incidence of postoperative delirium (POD). Remifentanil and fentanyl are short-acting opioids widely used in surgery; however, studies assessing their relationship with POD incidence are still limited. This study aimed to determine the association of remifentanil and fentanyl uses with the incidence of POD in elective orthopedic surgery patients.

Methods: A cross-sectional study was conducted in Surgical Unit at Dr Soetomo General Academic Hospital in Surabaya, Indonesia from August to September 2022. Patients who underwent elective orthopedic surgery and used remifentanil (n=16) and fentanyl (n=14) as postoperative analgesia were enrolled in the study. Delirium was assessed using Confusion Assessment Method-ICU tool (CAM-ICU). The associations of remifentanil and fentanyl use as well as patients’ characteristics with POD incidence were assessed statistically.

Results: Our data found that there was no significant difference between the incidence of POD with the use of remifentanil (p=0.125) in orthopedic surgery patients. The total doses of fentanyl and morphine equivalent (of remifentanil or fentanyl) were associated significantly with the POD incidence (p=0.010 and p=0.002, respectively). Other factors associated with POD incidence were the use of bone cement during the surgery (p=0.034), duration of surgery (p<0.001), and bleeding volume during the surgery (p=0.024).

Conclusions: Our study showed high dose of fentanyl, use of bone cement, longer duration of surgery, and high bleeding volume have greater risk of developing POD in orthopedic surgery patients.

Background: Hydrocephalus is a brain disease that requires prompt treatment. The outcome of hydrocephalus is dependent on early detection and treatment. This study was conducted to analyze the medico-socio-economic perspective on the delayed treatment of hydrocephalus patients, which aimed to advance the practice of neurosurgery in the socio-neurosurgery field, including both preventive and therapeutic aspects.

Method: This was an observational analysis study. The study subjects were all patients with congenital hydrocephalus treated in dr. Soetomo Academic General Hospital between January 2017 and December 2019. The study was carried out on January 2017 to December 2019 at the Inpatient Surgery ward, dr Soetomo Academic General Hospital, neurosurgery outpatient unit, and home visits. Research data consists of both primary and medical record data. Data on patient characteristics were obtained through direct interviews with the sample using prepared questionnaires, medical record data, and radiological data of both patients examined at dr. Soetomo Academic General Hospital and other health services. Bivariate correlation analysis was performed to assess the effect of each risk factor on the incidence of delay in treatment, and multivariate logistic regression analysis was performed to assess the magnitude of the effect of risk factors.

Result: The number of cases was 101 subjects. A total of 101 patients included as research samples were congenital hydrocephalus patients who received the first treatment at dr. Soetomo Academic General Hospital from January 2017 to December 2019. Up to 50 individuals (49.5%) were delayed in treatment. The data analysis with Chi-square did not reveal a statistically significant correlation between delay in treatment and level of parent's education (p=0.0951), delay in treatment and economic status ((p=0.4955). Delays in the treatment of congenital hydrocephalus were statistically significant and correlated with Posyandu's role (p=0.0012), health insurance ownership (p=0.0001), family support (p=0.0130), and professional medical decisions (p=0.0001). Health insurance ownership has the smallest p-value (0.000) and largest wald (16.545) in the multivariate logistic regression analysis calculation using the enter method. The insurance ownership variable has the most significant and largest partial influence on the delay in treating congenital hydrocephalus.

Conclusion: There were 101 patients included, and up to 50 individuals (49.5%) were delayed in treatment. Parents' education level and socioeconomic status were not associated with delayed treatment of congenital hydrocephalus. Delays in managing congenital hydrocephalus were influenced by Posyandu's role, health insurance ownership, family support, and professional medical decisions.           

Background: The initial presentation of hospitalized End-Stage Kidney Disease (ESKD) patients with and without coronavirus disease 2019 (COVID-19) is similar and can overlap. We aimed to compare clinical dan laboratory characteristics of the COVID-19 positive and negative patients to help clinicians screen and differentiate hospitalized ESKD patients.

Methods: We reviewed data from the medical record of ESKD patients hospitalized between May 1, 2020, and April 30, 2021. The study comprised all suspected COVID-19 patients. The COVID-19 positive was based on results from RT-PCR for SARS-CoV-2. The bivariate analysis was used to compare the positive and negative groups. The association of all characteristics and diagnosis of COVID-19 were then evaluated by multivariable analysis.

Results: There was twenty-nine percent of confirmed COVID-19 in 176 ESKD patients. The proportion of dyspnea, pulmonary edema, pleural effusion, and cardiomegaly were lower in the COVID-19 positive group. Diastolic blood pressure, pulse rate, white blood cell differential counts, and potassium were lower in the COVID-19 positive group. Using a multivariate analysis, eosinophil count <0.04 x10³µl (P<0.001, OR 3.50, 95%CI:0.123-0.665), monocyte count <0.69 x10³µl (P=0.004, OR 2.54, 95%CI:0.166-0.931), and neutrophil-to-lymphocyte ratio (NLR) <3.13 (P=0.044, OR 3.18, 95%CI:0.102-0.968) were associated with the presence of COVID-19.

Conclusions: Leukocyte differential count and chest x-ray should be evaluated as an initial screening of COVID-19 in hospitalized ESKD. Low levels of monocyte and eosinophil count and mild elevation of NLR were associated with COVID-19 in ESKD patients.

Background: This study determined the effect of adding grape skin extract (Vitis vinifera L.) to the diet of Wistar rats fed with high cholesterol on levels of SGPT and SGOT and the structure of liver tissue.

Methods: This study used 5 groups, namely control (standard diet), P1 (high cholesterol diet), P2 (high cholesterol diet and extract of grape skin as much as 100 mg/200 gBW/day), P3 (high cholesterol diet and extract of grape skin as much as 250 mg/200 gBW/day) and P4 (high cholesterol diet and extract of grape skin 500 mg/200 gBW/day). The study began with the production of extracts, the extracts dosage determination, high cholesterol diet preparation, sample (animals) preparation, extract addition to animals, SGPT and SGOT levels measurement, rat liver histopathology preparation and histopathological features observation, then ended with data analysis.

Results: The results showed that administration of grape skin extract in Wistar rats fed a high-cholesterol diet affected the levels of SGPT and SGOT, as well as parenchymatous degeneration of hepatocytes. Administration of grape skin extract as much as 500 mg/200 g BW/day had the lowest mean levels of SGPT and SGOT and the lowest parenchymatous degeneration of hepatocytes.

Conclusion: Thus, the extract of grape skin (Vitis vinifera L.) has the potential of hepatoprotector because it contains anthocyanin, which functions as an antioxidant and protects against liver damage.

Introduction: The decrease in muscle mass in the elderly is due to a decrease in nerve function and muscle weakness due to the aging process, lack of physical activity, and malnutrition. This study aimed to determine the effect of chair-based exercise and vitamin D levels on the strength of the hand grip on elderly women.

Patients and methods: Cross-sectional study involving 50 female respondents (aged 64.94±5.42 years) The study sample was elderly individuals who met the inclusion criteria at the Semarang Elderly Posyandu. Respondents were divided into 2 groups, namely the chair-based sports group and the chair-based no-sport group for 8 weeks. Checking the strength of the hand grip using a grip dynamometer.

Results: No significant differences was found in hand grip score between chair-based and non chair-based exercise (p>0.05). Meanwhile significant difference was found in hand grip score between person with .

Conclusion: There is an influence of vitamin D levels on the strength of the hand grip in elderly women

Introduction: Tinospora crispa (T. crispa) is an herbaceous plant that commonly grows wild in tropical regions of South East Asian countries such as Indonesia, Malaysia, and Thailand. In Indonesia, this plant is well known to be used as a traditional medicine to treat gout, diabetes, hypertension, rheumatic, fever, and appetite stimulant. Researches worldwide indicate that T. crispa poses several pharmacological properties. One of those is the antioxidant activity, acting as a free radical scavenger. The objective of this study was to determine the antioxidative properties of T. crispa and to compare the different ethanol solvents used for extraction.

Methods: The amount of 300 g T. crispa powder was extracted using 70%, 80%, and 96% ethanol. The spectrophotometry method is used to assess the total flavonoid and polyphenol contents as well athe s DPPH assay.

Results: The 80% ethanol had the highest flavonoid content 0.090% ± [0.453%], while 96% ethanol indicated the lowest 0.038% ± [3.090%]. In the case of phenolic content, 96% ethanol showed the highest result 0.521 ± [11.341%]. However, this value was relatively comparable with the other solvents. The highest DPPH activity was shown by 80% ethanol 6.46 mg ± [3.04 mg].

Conclusion: Despite low in the concentration, flavonoid and polyphenol content was successfully determined from T. crispa by using different ethanol solvents. Based on the result of antioxidants concentration and activity, 80% ethanol is the most ideal solvent to be used for extraction of T. crispa.

Background: The ongoing COVID-19 impacts the world of health, including IRC BDU. There is a need for a rapid response and countermeasures to meet the enormous challenge of balancing blood supply and demand. IRC BDU Banda Aceh in collaboration with the Aceh Government has carried out the civil servant (CS) movement for blood donation. This movement has been carried out since June 2020 until now. The CS donation movement is one of the IRC BDU strategies for the City of Banda Aceh in preserving donors during the COVID-19 pandemic. The study aims to see the impact of the COVID-19 pandemic and the implementation of strategies at IRC BDU Banda Aceh City on the number of blood donors at IRC BDU Banda Aceh City.

Methods: This type of research is a descriptive study with a cross sectional survey design. The first quarter of the analysis was carried out to compare the initial period of the 2020 pandemic with the non-pandemic year 2019 to see the impact of the pandemic on the number of blood donors. The second quarter analyzed the impact of the 2020 pandemic with the implementation of the strategy carried out in 2021 on the number of blood donors at IRC BDU Banda Aceh.

Results: There was a 12.8% decrease in the number of blood donors in the 2020 period compared to the 2019 period (Mann Whitney test, p-value = 0.038). This shows the impact of the COVID-19 pandemic on the decline in the number of blood donors at IRC BDU Banda Aceh in 2020. In the second quarter, the government's strategy to deal with the shortage of blood supply with the CS donor movement succeeded in increasing the number of blood donors by 12.7% (Mann Whitney test, p-value = 0.242) in 2021 (compared to 2020). This shows that the implementation of the COVID-19 handling strategy from the local government plays an important role in increasing the number of blood donors at IRC BDU Banda Aceh. but there was no significant difference in the average number of donors each month.

Conclusion: Management and government participation in mobilizing blood donors and proper utilization are the keys to blood availability during the covid-19 pandemic era.

Background: Excessive physical exercise can cause injury and disrupt the body's homeostasis. Excessive physical exercise also causes increasing oxygen demand and reactive oxygen species production (ROS) that induce damage in various cells and body tissue, including HSC and CD4⁺ cells. This study aims to prove that excessive physical exercise decreases the CD4⁺ and HSC levels in Wistar rats and evaluates the correlation between HSC and CD4⁺ cell levels.

Methods: An experimental study with a randomized post-test-only control group design was conducted among 44 male Wistar rats in Clinical Pathology Laboratory, Mangusada General Hospital, Bali, from June to September 2022. The samples were divided into two groups; 22 rats received excessive physical exercise (treatment group) and 22 rats as the control group. The CD4⁺ cells and HSC were examined after 14 days of intervention. Data regarding the means of CD4⁺ and HSC levels between the two groups were assessed, and the correlation between HSC and CD4⁺ cell levels was analyzed using SPSS version 21 for Windows.   

Results: We used 22 rats for each treatment and control group. The mean level of CD4⁺ and HSC were significantly lower in the treatment group compared to the control group (356.41 vs. 661.41x10⁶ cell/µl; p<0.001) and (359.14 vs. 551.09 x10⁶ cell/µl). We found a statistically significant difference in CD4⁺ and HSC levels between the two groups, p<0.001). We also found a positive correlation between HSC and CD4⁺ level with r=0.636; p<0.001. Excessive physical exercise affected the immune function by decreasing CD4+ ad HSC levels in Wistar rats.

Conclusions: The impact of excessive physical exercise on immune function showed by decreasing the level of CD4⁺ and HSC level in Wistar rats. The HSC number also has a positive correlation with CD4⁺ cell level.

The coronavirus Disease-19 (COVID-19) pandemic was announced in March 2020 by World Health Organization (WHO). Studies showed that the elderly had higher morbidity and mortality rates. Acute sarcopenia in the elderly with COVID-19 is an overlooked problem. Inflammation, malnutrition, immobilization, a side effect of COVID-19 treatment, depression, and hormonal dysregulation contributed to acute sarcopenia in COVID-19, especially in the elderly. Muscle quantity can be assessed with different techniques such as imaging or anthropometric measurements in diagnosing sarcopenia. Imaging such as CT scan was widely used in multiple studies. Still, anthropometric measurements are more fit in developing countries because they are widely available, safe, do not require special skills, and fit in low-resources facilities. Muscle strength can be assessed with grip strength. Acute sarcopenia was associated with immune dysregulation and cytokine storm, length of stay and readmission, and ICU admission and mechanical ventilation. These will contribute to high mortality in sarcopenic elderly with COVID-19.

Introduction: Subclinical varicocele is defined as non-palpable varicocele which diagnosed solely through imaging examination, namely ultrasonography. Despite the current high prevalence of subclinical varicocele as one of the most common cause of men infertility, there is still lack of evidence regarding the need to perform varicocelectomy among these patients. This systematic review aims to evaluate and compare the sperm parameters and fertility rate of subclinical varicocele patients treated with varicocelectomy versus no treatment. 

Methods: A systematic literature search was conducted on the international databases PubMed, Scopus, Cochrane, EMBASE, EBSCOHost, and Google Scholar published in the last ten years up to August 21^st, 2022. Risk of bias assessment was performed using the Newcastle-Ottawa Scale tools for cohort study and converted regarding the AHRQ standards.

Results: Three cohort studies were conducted in three different countries with 363 patients. The risk of bias assessment revealed that all of the three studies included in this review have good quality and low risk of bias. Varicocelectomy significantly improves sperm parameters in terms of sperm concentration (p<0.05) and sperm motility (p<0.05) while its effects on sperm morphology are not significant (p>0.05). The effects of varicocelectomy on fertility rate are reported by one study by Cantoro et al. as significant (p=0.011).

Conclusion: Varicocelectomy correction has been proved to significantly improve sperm parameters in terms of sperm concentration and motility, while its effect on fertility rate remains unclear and no conclusion can be drawn yet. Therefore, this study recommends further randomized controlled studies with larger sample size in the future to prove the effectiveness of varicocelectomy in subclinical varicocele patients before its implementation in clinical settings.

Spine vascular lesions like brain vascular lesions include spinal cord stroke, vascular malformation such as venous malformation or venous angioma, cavernous malformation, arteriovenous malformation or arteriovenous fistula. Embryogenesis of spinal vascular is the basic principle to understand the vascular malformation of the spine. This study aims to report serial cases with review of spinal vascular lesions. MR angiography techniques with contrast injection may reflect the direction of flow epidural veins to describe the site of arterial feeders. Serpiginous veins are commonly visible through the dorsal cord surface in MR myelography. The gold standard for diagnosing vascular malformation is Digital Subtraction Angiography (DSA). MRA helps to guide the location for DSA. Several cases are reported using MRA modalities and show the special location site of the spinal disorder.

Introduction: The curriculum for health profession education uses a variety of teaching techniques. A strategy is needed to create a creative learning environment during the implementation of the academic learning process so that students can achieve the expected competencies. Peer learning is one of the learning methods to facilitate student learning experience. Peer learning (PL) uses peers as tutors in the learning process and the process of students learning with and from each other. The application of the peer learning method in the health student learning curriculum is considered to have several advantages and challenges.

Purpose: To identify the benefits and challenges of implementing peer learning methods on health professional students.

Methodology: This study is a literature review with databases form ScienceDirect, PubMed, Scopus and Emerald. The articles search results obtained 10 articles that were screened using the PRISMA guide. This study is looking for articles about peer learning methods in health students who are included in the inclusion criteria.

Findings: There are total 1273 articles obtained from 4 databases, with details ScienceDirect 499 articles, PubMed 366 articles, Scopus 255 articles and Emerald 153 articles. The results of a review of 10 articles show that the peer learning method can be implemented in academic learning settings as well as clinical learning. The application of peer learning methods in the learning process has several benefits including; improve social skills, increase knowledge and better understanding of learning materials, increase self-confidence, improve clinical skills. Apart from the benefits, there are some challenges in implementing the PL method.

Implication: PL can be applied in health student learning because it has many benefits for health students.

Introduction: Telemedicine is a form of healthcare that uses technology to provide various health services. This method has been widely used during the COVID-19 pandemic when physical distancing is called. This systematic review aimed to review various uses of telemedicine on 11 databases using the PRISMA flowchart from January 1^st, 2020, to December 31^st, 2021.

Methods: This review has been registered in PROSPERO (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269809). The search terms are: "COVID-19," "Coronavirus," "SARS-CoV-2," "2019-nCoV," "Telemedicine," "Telehealth," "Teleconsultation," "Telemonitoring," "Telemanagement," "Teleconferencing," "Video conferencing," "Video consultation," "Virtual care," "Virtual service," "Virtual treatment," "Remote treatment," "Remote service," "Remote consultation," "Digital care," "Digital treatment," "Mobile health," and "E-health." The quality assessment used indexed databases for the SCOPUS, Web of Science (ESCI), and PubMed (PMC and Medline).

Results: On initial scrutiny, 2.031.242 articles were obtained; after screening with inclusion and exclusion criteria, 17 articles were included. Only 4 articles reported the use of telemedicine for respiratory-related diseases patients; 3 of these were COVID-19-related cases. Other 13 articles reported the use of telemedicine for admission, anamnesis, diagnosis, treatment, follow-up, and monitoring purposes for non-respiratory-related diseases. Methods applied include voice calls, video conferences, and specific software on computers and smartphones. There were no significant differences between telemedicine and the face-to-face method, although the lack of health providers' presence has been complained about in the prior method.

Conclusion: From this review, telemedicine is a beneficial tool for delivering health services during the COVID-19 pandemic.

Background: We conducted a systematic review and meta-analysis to determine the efficacy and safety of mini-Percutaneous Nephrolithotomy (PCNL) compared to standard PCNL in children with nephrolithiasis. Clinical trials and observational studies comparing standard PCNL and mini-PCNL in pediatric patients were identified from electronic databases in November 2021.

Method: Studies were extracted for author, year, location, design, subjects’ age, sample size, objective, primary endpoint, level of evidence, and results (stone-free rates and complications). Results were subjected to qualitative analysis using the synthesis method. Adequate results were extracted and analyzed quantitatively using the fixed-effect model on homogenous data or the random-effect model on heterogeneous data for meta-analysis. Outcome variables are shown as odds ratios (ORs) with 95% confidence intervals (CIs). All statistical analyses were performed with Review Manager version 5.4.

Result: We reported that stone-free rate and residual stone vary between two studies with contrary results. However, our quantitative analysis showed an insignificant difference between both groups of stone-free rate (OR 0.75; 95% CI 0.22-2.54) and residual stone (OR 1.27; 95% CI 0.55-2.91). Complications rates were insignificantly different between mini-PCNL group and PCNL group in two studies in Clavien 1 (OR 0.65; 95% CI 0.27-1.54) and Clavien 2 grade (OR 0.48; 95% CI 0.19-1.22). In addition, pooled analysis of both complication grades was also insignificant in the difference between groups (OR 0.56; 95% CI 0.30-1.06).

Conclusion: The efficacy and safety of mini PCNL were neither superior nor inferior compared to standard PCNL in managing nephrolithiasis in pediatric patients. Moreover, mini PCNL was considered better regarding post-operative pain and tract infection; thus, mini PCNL could be considered a treatment option for pediatric patients with nephrolithiasis.

Introduction: A Public Health Emergency of International Concern, the WHO designated the outbreak in China and surrounding countries in 2019. The Global board proclaimed public health emergency after research. The WHO encouraged states to step up their efforts before the instances grow. Six ASEAN members have confirmed early instances. WHO reports that the pandemic has reached all ten ASEAN countries. Unclear and inconsistent information and actions show Asia's delayed response to epidemics.

Methods: This study uses VOSviewer to investigate ASEAN policy responses to the COVID-19 outbreak. A bibliographic data model can handle several data types. Categories, topics, density, and publication date are common article metadata.

Results: Early decisions were taken without a plan to halt COVID-19 from spreading across Asia. Upon confirmation of the first case, national prevention and control measures were launched. Encouraging frequent hand washing, adequate mask usage, and other personal hygiene and sanitation habits were also addressed. Its nature leaves many data and information gaps. Major issues included preventing, detecting, and responding to disease outbreaks in public and medical contexts.

Conclusion: The regional health systems came into action to help national health programs. The ASEAN countries have all responded to the COVID-19 outbreak. In order to prepare for and manage the COVID-19 outbreak, a thorough investigation is required.

Several studies report an incidence of acute limb ischemia of approximately 1.5 cases per 10,000 persons per year. The mortality rate from acute limb ischemia ranges from 15-to 20% and the morbidity rate from 25% by amputation and 5-to 25% to fasciotomy. Revascularization is the main goal in the management of acute limb ischemia. Reperfusion of ischemic limbs can save limbs from amputation, but Ischemia-reperfusion injury can also cause systemic damage in the form of damage to body organs (lung, liver, kidney, heart, and brain tissue) which increases morbidity and mortality rates. Lung tissue is an easily affected target organ, and damage from Ischemia-reperfusion injury can cause acute lung injury and acute respiratory distress syndrome. These conditions damage the endothelium and epithelium of the lung parenchyma resulting in edema and impaired gas diffusion with a very high mortality rate of around 25-40%. The combination therapy of Pentoxifylline and Vitamin C in reducing the effect of Ischemia-reperfusion injury on lung tissues and have shown a protective effect of lung tissue damage due to ischemia-reperfusion injury in lower limbs.

Due to their capacity to reduce acute inflammation by increasing the immune response, honey and its constituents are gaining attention as an efficient natural therapeutic. Studies have suggested that it may be able to treat a variety of chronic illnesses and conditions, including as bacterial and fungal infections, cardiac issues, diabetes, hypertension, and abnormalities of the lungs and heart. More significantly, honey has proven to have virucidal effects on a number of enveloped viruses, including the varicella-zoster virus, herpes simplex, influenza virus, and HIV.

Honey may help patients with COVID-19, a disorder brought on by the SARS-CoV-2 enveloped virus, by boosting the host's immune system, treating comorbid conditions, and engaging in antiviral activities. Additionally, patients with COVID-19 are presently participating in a clinical trial of honey. We've attempted to condense the possible advantages of honey and its components in this review in terms of antibacterial properties, some chronic illnesses, and the host's immune system. Therefore, we have made an effort to develop a relationship with honey in order to treat COVID-19. In light of the COVID-19 epidemic, this review will be useful in reevaluating our understanding of the potential therapeutic benefits of honey. However, more in vitro and in vivo research is required to determine the effects of honey on SARS-CoV-2 replication and/or the host's immune system.

Pregnant women are a population group at high risk of contracting SARS-CoV-2. Several cases have been reported, including diabetic ketoacidosis and hypertension, diabetes mellitus and hypertension, and heart disease associated with COVID-19. In addition, it is also reported that pregnant women are also exposed to SARS-CoV-2. Most pregnant women with COVID-19 show mild symptoms. The placenta is usually an effective barrier to prevent the spread of infection from mother to fetus (vertical transmission). Certain pathogens can overcome this barrier, with effects that are sometimes detrimental to the development of pregnancy. Vertical infection of SARS-CoV-2 from mother to fetus is possible, although there is no adequate evidence. It has been reported that in pregnant women with COVID-19, the vertical transmission of SARS-CoV-2 from mother to fetus is low. The transmission of SARS-CoV-2 from mother to fetus occurs in the third trimester of pregnancy. Although there is vertical transmission of SARS-CoV-2 from mother to fetus, there are no reports of adverse effects in neonates.

The results of another study explained that in the case of pregnant women who were confirmed positive for COVID-19, there was an gene expression of the ACE2 receptor, N and S proteins from SARS-CoV-2 in the placenta. This study's results contradict the opinion that ACE2 and TMPRSS2 in the placenta that mediates viral entry can be ignored. Vertical transmission of SARS-C0V-2 during delivery can occur through close contact with infected cervical secretions or perineal tissue. It is more important to note that the angiotensin-converting enzyme (ACE)-2, the SARS-CoV-2 receptor, is significantly elevated during pregnancy, which may contribute to susceptibility to SARS-CoV-2. The selection of drugs that demonstrate superior maternal and fetal safety should be considered for pregnant women with COVID-19.

Background: Tibial tubercle avulsion fracture is very rare. Its incidence has been reported to account for only 3% of all proximal tibia fractures and less than 1% of all growth plate injuries. This fracture occurs when the quadriceps are forcefully contracted against resistance, such as during jumping, or when rapid knee flexion occurs with contracted quadriceps, such as during landing. Most authors recommended surgical options in type IV tibial tubercle avulsion; however, we reported successful conservative treatment in this case report.

Case report: A 15-year-old male athlete with no significant past medical history presented via emergency medical services after a ground-level fall while playing basketball which landed with his left foot in a pivot position. He felt immediate pain and swelling about the left knee, all sensation was intact, as were pedal pulses, and neurovascularly remained intact. The patient did not want to go for medical evacuation to do surgery and consent to be managed with conservative treatment with close follow-up.

Conclusion: The results and prognosis of these fractures are excellent, despite the fracture pattern or treatment used, as long as an anatomical reduction is obtained

Background: Spinal cystic intradural Schwannoma is a type of tumor that is rarely found, with an incidence of 0.3–0.5/100,000 person per year. The operative procedure for this tumor was simple. However, some patients showed other comorbidities, such as heart failure with low ejection fraction (EF) and atrial fibrillation. Such cases are a challenge to the anaesthesiologist as they are most commonly complicated by progressive cardiac failure.

Case Presentation: A 68-year-old woman was consulted by the Anaesthesiology Department in dr. Kariadi General Hospital Semarang in April 2019. She had been experiencing right lower extremity and lower back pain since April 2018, and they have been getting worse since two weeks ago. She also complained of shortness of breath two weeks before, accompanied by typical symptoms and signs of heart failure. Her electrocardiogram showed atrial fibrillation, and her echocardiogram showed an LVEF of 33.7%. Magnetic resonance imaging (MRI) showed two lobulated intradural-extramedular cystic lesions at thoracal vertebrae 12 until lumbar vertebrae 1 (VTh12–L1) that were a high suspicious of Schwannoma on the anterior aspect and the lateral aspect accompanied by spinal cord compression at that level. The drugs used for premedication were metoclopramide 10 mg and ranitidine 50 mg, for induction was fentanyl 100 μg, and for maintenance were dobutamine 10 μg/kgBW/minute, rocuronium bromide 30 mg/hour via syringe pump, opioid fentanyl 100 μg and muscle relaxant using rocuronium bromide 40 mg. The patient was hemodynamically stable throughout the surgery, and blood loss was minimal.

Conclusion: In patients with heart problems, a moderate reduction in contractility and heart rate often occurs and may induce mild to severe bradyarrhythmia or tachyarrhythmia related to induction agents. It is important to maintain adequate cardiac output that requires inotropic agents to augment contractility and improve circulation. As an inotropic choice, a β-agonist (e.g., dobutamine) causes less vasodilation, increased contractility, and adjuncts to augment contractility in the setting of significant hypotension.

Background: Diabetic ketoacidosis (DKA) has been well-known as the main complication that is a potentially fatal emergency in some teenagers with type 1 diabetes mellitus (DM). Although children with diabetes are not at high risk for severe COVID-19 infection, it can hypothetically lead to type 1 DM and severe DKA. The aim of this article is to briefly discuss a case of a teenager with DKA and COVID-19.

Case: A 13 years old girl came in with abdominal pain, nausea, vomiting and dyspnea. She was alert but weak. Her blood pressure was 100/70 mmHg with 120 pulses and 35 breaths per minute. Oxygen saturation was at 99%. History of previous illness was denied. She was treated using a dyspepsia algorithm while waiting for the laboratory result. Later on, the test showed conditions of hyperglycemia, severe acidosis, ketonuria and a positive rapid COVID–19 antibody test. Hence, a diagnosis of DKA with probable COVID–19 was made and PCR for confirmation of COVID-19 diagnosis was scheduled. Oxygen support, rehydration, and insulin therapy were also given with a precautionary condition of possible COVID–19. In minutes, she developed respiratory distress that led her to be intubated and put on a ventilator. Due to a lack of facilities, a referral to a higher-level hospital was needed. However, since the referral process for probable COVID-19 patients required a long preparation, the patient died during the process.

Conclusion: Besides early diagnosis and prompt treatment, a well-coordinated referral system is crucial in managing DKA patients with possible COVID–19.

Background: Acute Erythroleukemia (AML-M6) is a rare case with approximately 3-4% of all Acute Myeloid Leukemia (AML) cases. AML-M6 is less common in the pediatric population, with an incidence of <1% of all pediatric leukemia cases. This case study aims to evaluate Acute Erythroleukemia (AML-M6) in a one-year-old boy at Prof. dr. IGNG Ngoerah Denpasar.

Case Presentation: A one-year-old boy with clinical manifestations of fluctuating fever for a month, paleness, bleeding gums, bruising all over his body, swelling of both eyelids and splenomegaly. Peripheral Blood Smear (PBS) examination revealed bicytopenia with moderate normochromic normocytic anemia, severe thrombocytopenia and leukocytosis. A hypercellular picture was obtained from the examination of Bone Marrow Aspiration (BMA) with an increase in erythroblast activity of 74%, proerythroblast at 50% and normal myeloblasts activity at 10%. The patient was diagnosed with Acute Erythroleukemia (AML-M6). The patient died on day 16 of treatment.

Conclusion: Based on the examination results, it was concluded that the patient was diagnosed with AML-M6 according to the PBS and BMA evaluation.

Background: Congenital diaphragmatic hernia (CDH) is a rare, complex and severe abnormality in an infant. Globally, neonatal mortality as a consequence of congenital anomalies is increasing and is therefore outlined as an emerging priority to be addressed by the UN Sustainable Development Goals (SDGs) in the post-2015 child health agenda. Although numerous cases are discovered prenatally or in the early postnatal period, 5-25% of CDH are detected in delayed onset after birth. The aim of this article was to discuss the case of CDH with moderate persistent pulmonary hypertension, moderate muscular ventricular septal defect, and small patent ductus arteriosus.

Case Presentation: A-8 days old, 3,060 g, a full-term male infant was referred to our tertiary hospital with transient tachypnea of the newborn and a suspected case of congenital heart disease. The defect was repaired after stabilization of the cardiac output and gas exchange. During recovery after surgery, the patient was placed on high-frequency oscillation after surgery and was given potent inotropic support. The patient made an uneventful postoperative recovery.

Conclusion: The management of CDH patients should be multidisciplinary. More clinical studies were required to elaborate on a suitable management protocol for the CDH

Background: Hypocalcemia, a condition where the serum calcium concentration or total serum calcium is below normal, could be associated with various manifestations including severe symptoms requiring immediate hospitalization. The condition can cause by several causes including iatrogenic thyroidectomy. Here, we report a patient of hypocalcemia associated with hypoparathyroidism due to post-thyroidectomy.

Case presentation: A 32-year-old woman admitted to the hospital complained of stiffness and tingling in the extremities accompanied by recurrent seizures. The serum calcium level was low and this hypocalcemia condition was associated with low parathyroid hormone levels after subtotal thyroidectomy surgery. Laboratory examination indicated calcium 4.8 mg/dL and parathyroid hormone 2.21 pg/ml. The patient had bradycardia with prolonged QT on electrocardiography (ECG) and developed cataracts in both eyes which could be associated with chronic hypocalcemia. The patient's condition improved after correction of hypocalcemia. After discharge, the patient was given calcium and levothyroxine supplementation due to hypothyroid conditions.

Conclusion: The hypocalcemia condition in the patient was associated with low parathyroid hormone level post-subtotal thyroidectomy surgery. This case highlights the impotence of detailed analyses of hormonal, radiological and histological investigations of patients with thyroid gland diseases to diagnose such conditions early and to ensure timely management.

Background: Subdural empyema is an intracranial focal collection of purulent material between the dura and arachnoid mater. The most common causes are purulent meningitis in infants and sinusitis and otitis media in older children through a direct extension of the infection. Although it is very rare, parotitis may also cause subdural empyema. This report presents our case of subdural empyema due to infectious parotitis in a pediatric patient.

Case report: A 1-year-old boy was referred from other hospitals for multiple seizure episodes. He also had a complaint of vomit and fever 3 weeks ago. On the neurological examination, we found that he had a GCS of 8, no meningeal sign was found, and with dilated pupil on the right side. A contrast-enhanced head computed tomography (CT) scan revealed multiple hypodense masses with ring enhancement over the right hemisphere, and a severe midline shift suggested as subdural empyema. We then performed a craniotomy to evacuate the empyema. Two weeks after surgery, he was fully alert without any surgical morbidity.

Conclusion: Although parotitis is the less likely disease that can cause subdural empyema, we should also include the disease as the possible cause before we examine the patient more thoroughly and exclude them as the disease that can cause subdural empyema.

Background: Non-cirrhotic portal hypertension refers to elevated portal vein pressure in the absence of liver cirrhosis. Surgery could be an effective procedure for patients with recurrent variceal bleeding who fail to respond to pharmacotherapy or endoscopic therapy. We report a success story of modified Sugiura technique in managing a patient with non-cirrhotic portal hypertension.

Case presentation: A male, 24-year-old, complained of recurrent vomiting of dark red blood color for six months. Anemic conjunctiva and splenomegaly were discovered during a physical examination. Pancytopenia and normal hepatobiliary function were revealed in the laboratory examination. Ultrasonography of the abdomen demonstrates nonspecific splenomegaly. An abdominal computerized tomography scan revealed hepatosplenomegaly and pelvic fluid accumulations. Grade IV esophageal varices and mild portal hypertensive gastropathy were observed during endoscopic examination. Active bleeding still presented despite initiation of medical treatment and endoscopic ligation. Finally, a surgical procedure using the Sugiura technique was performed. The patient was recovered, no recurrent symptom of hematemesis was reported after one year of follow-up.

Conclusion: Modified Sugiura technique is a useful treatment of choice in non-cirrhotic portal hypertension patients who failed to respond other medical treatments. However, comprehensive assessment is critical prior to choose this procedure.

Background: Acute limb ischemia is a sudden decrease in limb blood perfusion with an onset of less than 14 days, most commonly occurs in lower extremities. Diabetes mellitus, one of diseases underlying peripheral artery disease, complicates the pathophysiology of acute limb ischemia. In this case report we present a patient with type 2 diabetes mellitus and acute limb ischemia in the left upper extremity that had successful thrombectomy treatment.

Case presentation: A 58-year-old female patient came to the Emergency Care Unit of Dr. Soetomo General Hospital with the continuous pain in the five fingers to the palm of the left hand for the past two days. The numbness spread from the elbow to the left fingers, making them weak and difficult to grip. Those five fingers were pale and cold as well. The left hand had no pulsated radialis and ulnar artery, weak brachial pulse and undetected pulse oximetry result. The patient was diagnosed with type 2 diabetes mellitus since 2005 and has a controlled treatment. On the first day of hospitalization, the patient was scheduled for emergency thrombectomy at Dr. Soetomo General Hospital. Follow-up on the seventh-day post-surgery, the patient had no complaints of pain and pale in the left hand and the brachial, ulnar and radial arteries were palpable.

Conclusion: Acute limb ischemia is uncommon in the upper extremities but we found that it has an excellent prognosis with early revascularization, even in a patient with diabetes mellitus. The treatment must be in conjunction with aggressive diabetes mellitus treatment to avoid acute limb ischemia worsening

Background: Nasal myiasis, a type of cavitary myiasis, is an infestation of parasitic insect larvae or eggs in the nasal cavity of the human body. The risk of nasal myiasis increases in individuals with immunocompromised such as diabetes mellitus (DM). The aim of this study was to report a rare case of nasal myiasis in a patient with DM.

Case Presentation: A 54-year-old female patient was referred to Dr. Soetomo General Hospital Surabaya with a chief complaint of spontaneous anterior epistaxis from the left nostril for three days. Anterior rhinoscopy revealed a narrowed left nasal cavity covered with excessive bloody discharge and>50 larvae coming out of the nasal passage. Nasoendoscopy showed ulcerated lesions on the left nasal cavity floor and nasal lateral wall, destructions of the osteomeatal complex and lateral wall, thick bloody discharge with excessive crust, as well as a larva around the osteomeatal complex entering the maxillary sinus. Paranasal sinus CT scan showed no further infection to surrounding organs. The patient had a history of type 2 DM for the past 2.5 years. The patient was diagnosed with nasal myiasis, unregulated type 2 DM, and diabetic neuropathy. Therapies included larval removal by endoscopy, wound irrigation using antiseptic solutions, maxillary sinus irrigation, administration of the topical antiparasitic ivermectin, and insulin therapy. After seven days of the treatment, the patient was discharged from the hospital with a resolved infection and controlled blood sugar levels.

Conclusion: Awareness of risk factors for myiasis along with proper therapy is prominent. Nasal endoscopy, together with nasal irrigation and antiparasitic drug administration was effective in the management of nasal myiasis.

Introduction: Filum terminal is a fibrous tissue to stabilize the position of the spinal cord, located in both intradural and extradural sections anchored caudally to the coccyx. Tumors located at the filum terminal are a rare case. Filum terminal does not have any spinal cord component, but tumours in that area can directly cause a significant neurological disorder. 

Case Presentation: Presenting 43 years old man with chief complaints of drop left foot and tethered cord syndromes. MR Image revealed 9,4x10mm intradural extramedullary mass at L1 with L1-L5 disc desiccation. The patient was untethered by laminectomy and underwent total mass excision. The sample was analyzed pathologically, and the results matched myxopapillary ependymoma. Pain sensation and sensory disturbance immediately improved after surgery. The urinary disorder also gradually improved. The patient was discharged without any urinary problems. After six months of follow-up, painless, mild left lower drop foot and mild gait disturbance was found without residual urinary and other neurological disorder.

Conclusion: Filum terminal ependymomas need to be considered for differential diagnoses in patients with drop foot and adult-onset tethered cord syndromes. 

Introduction: Postoperative cognitive dysfunction (POCD) following general anesthesia is frequent among geriatric patients worldwide. Neuroinflammation and neuronal injury have been associated with the incidence of POCD. Some biomarkers of brain damage including neuron-specific enolase (NSE) and S100B protein have been widely studied; however, their association with the incidence of POCD is still controversial. This study aimed to assess the correlation of serum NSE and S100B levels with the incidence of POCD among geriatric patients receiving general anesthesia.

Methods: A prospective cohort study was conducted among geriatric patients receiving general anesthesia at Dr. Soetomo Hospital, Surabaya from July to October 2022. The Montreal Cognitive Assessment (MoCA) INA instrument was used to assess POCD, and enzyme-linked immunosorbent assay (ELISA) was used to quantify the levels of serum NSE and S100B. Spearman’s rank correlation was implemented to identify the correlation of MoCA INA scores with the levels of NSE and S100B. Mann-Whitney analysis was used to determine the association between NSE and S100B levels with the incidence of POCD. A p-value of ≤0.05 was considered statistically significant.

Results: A total of 48 patients were enrolled in the study and 16.7% of them had POCD. Spearman’s correlation test suggested no significant correlation between MoCA INA score with serum NSE level (r_s:-0.095; p=0.522) and S100B level (r_s:-0.213; p=0.146). Mann-Whitney analysis indicated no significant difference in the NSE and S100B levels of patients with and without POCD (p=0.3470 and p=0.097, respectively).

Conclusion: There was no significant association between NSE and S100B levels with the incidence of POCD among geriatric patients receiving general anesthesia during elective surgeries at Dr. Soetomo Hospital, Surabaya.