Correlation between post-traumatic amnesia with behavioral disorders in the mild- and moderate-traumatic brain injury patient

Introduction: Traumatic brain injuries (TBIs) could have short and long-term sequelae, including cognitive and behavioral changes and physical impairments. This study aimed to determine the correlation between post-traumatic amnesia and neurobehavioral disorders in mild and moderate TBI patients.

Methods: A cross-sectional study was conducted on 75 patients with mild or moderate TBI who had or didn't have a period of post-traumatic amnesia during their hospital stay in the Department of Neurosurgery Dr. Hasan Sadikin Hospital (RSHS), Bandung, from January to August 2019. The Galveston Orientation Amnesia Test (GOAT) was performed, and neurobehavioral functions were examined in post-TBI patients (mild or moderate) using the neurobehavioral rating scale (NRS), which was performed at the time of hospital discharge.

Results: The subjects were predominated with male patients (76%) with a mean age of 25 years old (15 – 35 years old). The analysis showed that the patients with post-traumatic amnesia had a higher median total NRS score (10.4 [5.0-18.0]) compared to those who didn't have any neurobehavioral disorders (2.6 [1.0-12.0]). The statistical analysis showed that the difference was statistically significant (p-value: 001; r: -0.776).

Conclusion: According to the result, it can be concluded that post-traumatic amnesia was significantly associated with neurobehavioral disorders. However, further study is needed to confirm this finding and assess the other potential factors that may affect both variables.

Description of depression in people with epilepsy in Aceh

Background: Depression is the most common comorbid in people with epilepsy (PWE). Detection of depression in PWE is not a routine examination at a neurology clinic because it takes a long time. The education of Acehnese people regarding epilepsy is still limited, leading to discrimination and stigma in society. It is not easy to carry out examinations, and the diagnosis is often overlooked. The objective of this study was to screen and to describe the characteristics of depression in PWE in Aceh.

Method: This study was a descriptive observational study with the total respondents involved 41 PWEs. Detection of depression in PWE was conducted using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), a valid, reliable, shorter and more straightforward instrument test. The sample was determinate using the probability sampling method with a simple random sampling technique.

Results: Our results found that 39% of respondents experienced depression, with the most NDDI-E scores ranged between 11-15, with a percentage of 41.5%. Out of total, 57.1% of the depression occurred in women and those who aged between 18-25 years old were more frequent to experience depression. Depression was more frequent among those who had no formal education (66.7%).

Conclusion: Depression in PWE in Aceh tends to occur in women, those with no education and those who worked as labor or farmer.

Outcome of urinary tract infection caused by Extended Spectrum Beta-Lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae in Dr Zainoel Abidin General Hospital Aceh

Introduction : Extended-spectrum ?-lactamase (ESBL) is a mutated ?-lactamase enzyme that can hydrolyze beta-lactam antibiotics. The aim of this study was to determine the incidence rate, characteristics of patients, antibiotic use and outcome of urinary tract infections (UTIs) due to ESBL-producing Escherichia coli and Klebsiella pneumoniae at Dr Zainoel Abidin General Hospital Aceh.

Method : The samples of this study were all Escherichia coli and Klebsiella pneumoniae isolated from urine culture of UTI cases. Patient characteristics and antibiotic use data were extracted from medical records. UTIs outcome was assessed as clinical improvement or death within a maximum of 30 days of treatment.

Result : The results of this study obtained 63 patients with UTIs caused by E. coli and K. pneumonia of which 52.4% of them were ESBL producers. The incidence of UTIs due to E. coli was higher than that of K. pneumoniae, 63.5% and 36.5% respectively. E. coli ESBL producers were more in number than non-ESBL, conversely K. pneumoniae were mostly non-ESBL. The characteristics of patients with UTIs caused by E. coli and K. pneumoniae were predominant women 52.4%,  and most cases were at 56-64 years old. Antibiotic therapy that given before and after culture results to UTI patients were generally ceftriaxone. UTIs outcome due to ESBL producing Escherichia coli and Klebsiella pneumoniae showed that 26/33 (78.8%) patients experienced improvement, however, 7/33 (21.2%) patients died.

Conclusion : The irrational use of ceftriaxone in patients with UTI caused by ESBL producing E. coli and K. pneumoniae has led to a poor outcome for the patient.

Effect of oncom extract on the level of estrogen hormone of productive white rats

Introduction: Oncom is a processed soybean that contains isoflavone compounds. The types of isoflavones found in soybeans and their dairy products are daidzein and genistein which have an estrogenic effect on animals' reproductive performance. This study aimed to determine the effect of oncom extract on productive age white rats (Rattus norvegicus) estrogen levels.

Methods: This research is an experimental study with a randomized posttest control group design. We used 21 samples divided into three groups. First group was control without being given oncom extract. The second group was given a black oncom extract dose of 0.005 g/g BB. The third group was given red oncom extract of dose 0.005 g/g body weight. Serum collection for estrogen hormone level measurement was collected on day 14 after administration of oncom extract. Data then analyzed to determine the normality and homogeneity. ANOVA test was used to compare the means between groups. P<0.05 was significant.

Result: We found in the control group with the lowest estrogen level mean (16.70±0.581) than the experimental groups. The ANOVA analysis results showed that oncom extract significantly increase estrogen levels of productive age white rats (p<0.05).

Conclusion: Oncom extract can increase the estrogen level in productive age white rats. However, the estrogen levels between red oncom and black oncom showed an insignificant difference.

Analysis of sea bidara leaf (Ziziphus mauritiana) ethanol extract biorespon on hydrophobicity and phospholipase of Streptococcus pyogenes cell surface in tonsillitis isolate

Background: Tonsillitis is an inflammation of the palatine tonsil that is often found in otorhinolaryngology and is one of the world's socio-economic health problems. Streptococcus pyogenes is the most common bacterial cause of tonsillitis, with hydrophobicity and phospholipase activity on the cell surface that has a major effect on tonsillitis pathogenicity. Ethanol extract of the leaves of sea bidara (Ziziphus mauritiana) has an antibacterial impact containing neophytadiene, hexadecanoic acid, linolenic acid, octadecanoic acid, squalene, and vitamin E.

Objective: To determine the ability of sea bidara leaf (Ziziphus mauritiana) ethanol extract inhibiting the hydrophobicity and phospholipase activity of the Streptococcus pyogenes cell surface in tonsillitis isolate. Methods: Laboratory experimental design with a post-test-only control group.

Result: Ethanol extract of Ziziphus mauritiana leaf could inhibit the surface hydrophobicity activity of Streptococcus pyogenes cell with different quantity and quality at each concentration and incubation time. Analysis of independent T test (p>0.05;0.965) and (p>0.05;0.683) proved that there was no significant difference in incubation time inhibiting hydrophobicity and phospholipase activity of Streptococcus pyogenes cell surface. Kruskal-Wallis analysis (p>0.05;0.689) and (p>0.05;0.162) proved that there was no significant difference in inhibiting the hydrophobicity and phospholipase activity of Streptococcus pyogenes cell surface.

Conclusion: Ethanol extract of Ziziphus mauritiana leaf can inhibit the hydrophobicity and phospholipase activity of Streptococcus pyogenes cell surface in isolate tonsillitis.

Antioxidant activity in red mulberries on sperm development exposed by cigarette smoke

Introduction: The adverse effects of exposure to cigarette smoke have been discovered for a long time. However, most people assume that exposure to cigarette smoke merely causes respiratory problems. The increase in free radicals from cigarette smoke will also affect sperm development, decreasing the number of sperm produced. The intake of antioxidants derived from red mulberry is expected to reduce cigarette smoke exposure on sperm count. The study aimed to analyze the antioxidant activity of red mulberries on sperm development exposed by cigarette smoke in experimental animals.

Methods: This study employed experimental animals, Wistar Rats (Rattus norvegicus), divided into five groups with different treatments in each group. The treatment in the form of exposure to cigarette smoke and red mulberry was undertaken for 30 days. The parameters used were histological preparations from the testes by calculating the number of Leydig cells, spermatocytes, and spermatids in each tubule. 

Results: The results showed that the negative control group had the highest mean, while the positive control group had the lowest mean. The treatment group showed that the more red mulberry juice was given, the more sperm count was increased. The study group had a significant difference (p <0.05) and a strong relationship between groups (r> 0.80).

Conclusion: In conclusion, consuming red mulberry juice can increase sperm quantity exposed by cigarette smoke.

Comparison of angle, length, and diameter of the eustachian tube of safe and unsafe CSOM based on CT scan in Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia

Introduction: Damages in middle ear structures correlated with tubal dysfunction and impaired drainage; thus, it's associated with changes in angle, length, and tubal diameter. This study aimed to determine the ratio of angle, length, and diameter of Eustachian tube with safe and unsafe types of chronic suppurative otitis media (CSOM).

Methods: Cross sectional analytical retrospective design, CT-Scan assessment for angle, length, the diameter of the tube on safe and unsafe type CSOM from January to December 2019 Angle is assessed using Reid's line, tube length by a tympanic orifice to pharyngeal orifice line, Tube diameter is measured from anteroposterior pre-tympanic line diameter. 

Results: From 61 CSOM patients, 70.5% safe type, 29.5% unsafe type. Safe type tube angle mean is 29.12⁰, unsafe type 29.95⁰, normal ear 28.23⁰, thus no significant difference. A significant difference in the tube length (P = 0.001) is that the mean normal ear is 35.39 mm, smaller on safe type 33.58 mm, and unsafe type 29.53 mm. A significant difference in tubal diameter ratio (P = 0.001), normal diameter 2.19 mm, on safe type is 2.02 mm smaller, unsafe type 1.86 mm.

Conclusion: The smaller length and diameter of the Eustachian tube will lead to unsafe type CSOM.

Neurological manifestation as an implication of COVID-19 pandemic at a hospital in Aceh, Indonesia

Introduction: Coronavirus disease 19 (COVID-19) has quickly spread to more than 200 countries as a global health pandemic. The outbreak of the COVID-19 infection in Wuhan (China) has brought its clinicians to investigate different manifestations, including neurological presentations of this novel infection. As of 12 October 2020, the number of deaths due to COVID-19 is 1.08 million worldwide, with 11,935 cases in Indonesia and 209 cases in Aceh. This study aimed to determine the neurological manifestations in patients confirmed with COVID-19.

Methods: A Retrospective cross-sectional study design from neurology patients who diagnosed with COVID-19 and were hospitalized at the Dr. Zainoel Abidin Hospital from March to September 2020. COVID-19 diagnosis was confirmed with polymerase chain reaction (PCR) swab test that met the inclusion and exclusion criteria.

Results: We collected 36 cases, consisting of 19 males (53%) and 17 females (47%) with a mean age of> 60 years 47%. According to the comorbidities data, 53% of patients were smoking, 47% had hypertension, 8% had diabetes mellitus, 8% had a history of stroke, and 8% had malignancy. Neurological manifestations included limbs weakness and cranial nerve paresis (55%), decreased consciousness (39%), and headache (22%). At admission, several patients had stroke (47%), cephalgia (14%), metabolic encephalopathy (8%), and vertigo (5%). Finally, 16 patients died during the period of observation.

Conclusion: Patients with COVID-19 commonly have neurological manifestations such as limb weakness, cranial nerve paresis, decreased consciousness, headache, dizziness, olfactory disturbances, and seizures.

O6-Methylguanine-DNA Methyltransferase (MGMT) promoter methylation status of high-grade and low-grade gliomas

Background: O⁶-methylguanine-DNA methyltransferase (MGMT) is a DNA-repair enzyme that correlates with tumor resistance mechanism to chemotherapy. Methylation of the MGMT promoter inhibits the cells from producing MGMT and is useful to predict chemotherapy's effectiveness with alkylating agents. This study aims to evaluate the MGMT promoter methylation of low-grade and high-grade glioma in the Neurosurgery Department of Cipto Mangunkusumo National General Hospital

Methods: We evaluated MGMT promoter methylation status using methylation-specific polymerase chain reaction in low and high-grade glioma patients who underwent surgical resection in the Neurosurgery Department of Cipto Mangunkusomo Hospital Jakarta. The result then correlated with age, sex, Karnofsky Performance Scale (KPS), and glioma grading. Data were analyzed using SPSS version 20 for Windows.

Results: MGMT promoter methylation was observed more often in patients diagnosed with age more than 40 years old than in patients less than 40 years old (85.7% vs. 50.0%), also more in men than women (77.7% vs. 50.0%). In patients with KPS more than 70 and KPS 70 or less, methylation of MGMT promoter was observed in 70.0% and 57.1%, respectively. Based on tumor grading, MGMT promoter methylation was observed more often in low-grade gliomas (WHO grade II) than high-grade gliomas (WHO grade II and IV) (85.7% vs. 50.0%). There was no significant relationship between gender, age, KPS, malignancy degree, and Overall Survival (OS) to the MGMT promoter methylation (p>0.05).

Conclusion:  MGMT promoter methylation was observed less in the higher grade of tumors (grade IV), lower KPS, younger age at the time of diagnosis, and female patients, although the differences were not statistically significant. MGMT promoter methylation was observed more often in gliomas with oligodendroglioma components. 

The correlation of neutrophil-to-lymphocyte ratio (NLR) and monocytes-to-lymphocytes ratio (MLR) with disease severity in hospitalized patients with Coronavirus disease 2019 (COVID-19)

Background: Early intervention of cases with potential progression to severe disease is essential to improve survival probability in Coronavirus disease 2019 (COVID-19). Systemic inflammation plays an essential role in the process of disease aggravation. This study aimed to assess the correlation of systemic inflammatory response related biomarkers neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) on time to admission with the disease severity of inpatients with COVID-19.

Methods: We performed a retrospective study using secondary data from medical records of inpatients with COVID-19 at Murni Teguh Memorial Hospital, Medan, Indonesia, from June 1 to September 30, 2020. The demographic data were collected from the medical record and the hematologic parameter from the laboratory. NLR and MLR were calculated by dividing the absolute neutrophils and monocytes counts by the absolute lymphocyte counts. The data were tabulated and analyzed by univariate and bivariate analysis with a significance level of p<0.05.

Results: Study subjects consisted of 55 non-severe cases and 40 severe cases. The median NLR and MLR of severe and non-severe groups were 7.65 vs 2.92 (p<0.001) and 0.46 vs 0.25 (p=0.013). The correlation coefficients of NLR and MLR with disease severity were 0.564 (p<0.001) and 0.257 (p=0.012). The AUC of ROC analysis was 0.830 (cut-off:>4.81;p<0.001) in NLR and 0.650 (cut-off:>0.31; p=0.013) in MLR to predict the severe disease.

Conclusion: NLR and MLR had a significant positive correlation with the disease severity. NLR is better than MLR in predicting severe disease in hospitalized patients with COVID-19. 

Melatonin prevented the elevation of leukocyte count and the decreased of hematocrit levels in burn-induced Wistar Rats

Background: Burns are commonly caused by thermal injuries that are often encountered in everyday life. Burns may cause tissue damage and tissue infection. Melatonin, a hormone that acts as an antioxidant and anti-inflammatory, can be used as a supportive therapy in patients with burns by preventing excess tissue damage, decreasing inflammatory response, and preventing extreme leukocyte increase. The study aims to investigate the effects of melatonin supplementation on leukocyte count and hematocrit levels in male Wistar rats with burns injury.

Method: This was an experimental animal study with randomized control group design. A total of twelve healthy male Wistar rats were randomized and divided into two groups. All Wistar rats were induced with 30% burns injuries area. The melatonin group was intraperitoneally administered with melatonin at 0, 8, and 16 hours after treatment, while the control group was administered with placebo (aquadest) with similar method. Leukocyte count and hematocrit levels were measured by taking retroorbital venous blood at 0, 3, and 24 hours after treatment. Data were analyzed with Paired t-Test, Independent t-Test, Mann-Whitney, or Wilcoxon test depend on their normality.

Results: There was a higher leukocyte count in control group compared to melatonin group at 3 hours after treatment (T3) (p=0.050), but not at 0 hours after treatment (T0) and at 24 hours after treatment (T24) (p>0.05). There was increased leukocyte count in both melatonin and control groups in T3 in comparison with T0, however the increment was steeper in control group compared to melatonin group. There were no significant differences in hematocrit levels between the melatonin and control groups in T0, T3, and T24 (p>0.05). There was a steeper increased hematocrit levels in the control group than the melatonin group after T24, although it was not statistically significant.

Conclusion: Melatonin might have role in preventing a steeper rise of leukocyte count and hematocrit levels in burns injury. If confirmed by further studies, melatonin might be potential for adjuvant management in burns.

Growth factors of hypoxia Freeze-Dried Adipose Stem Cell- Conditioned Medium (FD ASC-CM) and Fresh Adipose Stem Cell Conditioned-Medium (FR ASC-CM): a comparative study

Background: Adipose Stem Cells (ASC) are multipotent stem cells which mechanism of action is mainly secretion of various paracrine molecules known as secretome or conditioned medium (CM). Adipose Stem Cell-Conditioned Medium (ASC-CM) collects several soluble factors, such as cytokines, chemokines, and Growth Factors (GF) secreted by almost all types of living cells in the extracellular space. The freeze-dried (FD) form of ASC-CM can reduce the instability of the fresh (FR) form of ASC-CM. This study aims to compare the GF levels between FD ASC-CM and FR ASC-CM as a comparative study.

Methods: ASC-CM was prepared from human adipose tissue. After we got the FR ASC-CM, some of them were changed into an FD form. We measured the several GF levels using ELISA methods in ng/L. Data were presented in mean and standard deviation as well as analyzed using SPSS version 25 for Windows.

Results: The average levels of EGF in both FD ASC-CM and FR ASC-CM were 256.80±9.70 ng/L and 290.20±53.20 ng/L, followed by TGF-? (564.20±12.70 ng/L and 633.10±11.40 ng/L), PDGF (2.90±0.19 ng/L and 2.90±0.20 ng/L), and VEGF (711.10±21.70 ng/L and 788.70±204.80 ng/L) respectively. There was a statistically significant difference in TGF-? levels between FD ASC-CM and FR ASC-CM (p=0.002). However, there was no a significant difference in EGF, PDGF, and VEGF levels between FD ASC-CM and FR ASC-CM (p>0.05)

Conclusion: There was a statistically significant difference between FD and FR ASC-CM only in TGF-? levels.

Dual role of Cutibacterium acnes in acne vulgaris pathophysiology

Acne vulgaris (AV) is the most common and multifactorial skin disease in adolescents affecting the pilosebaceous unit that involves hormonal imbalance, increased sebum production, and bacterial colonization, which causes both physical and psychological disorders. Cutibacterium acnes is considered one of the key contributing factors even though many Cutibacterium acnes colonies are on healthy skin. Cutibacterium acnes induces lipogenesis and production of sebum. Through its production of porphyrins, it may act as a catalytic agent in squalene oxidation that is comedogenic, thus aggravating comedogenesis. We review the dual role of Cutibacterium acnes to provide an understanding of the pathophysiology of acne vulgaris.

Nasal rinse and gargling as an effort in preventing COVID-19 infection with Islamic approach – a literature review

Due to the COVID-19 pandemic, the general public must comply with health protocols and adopt new habits as this disease spreads through droplets and enters the respiratory tract through the nose and mouth. Meanwhile, water penetration into the nasal cavity (istinsyaq) and out (istintsar) during ablution corresponds to the nasal rinse and gargling methods, which prevents the mechanical and chemical attachment of viruses. This article discusses the role of Islamic-based nasal rinse and gargling in the prevention of COVID-19 infection.

Various solutions such as plain water, saline, povidone-iodine, and antiseptics have chemical effects. Gargling and nasal rinse mechanically and chemically wash the mucosal surface in the mouth and nose to prevent the attachment of virus and other pathogens. Mechanically, the difference in concentration causes water to move outside the cell by osmosis, reducing mucus secretion and releasing the virus. Meanwhile, a chemical mechanism occurs when the free iodine in povidone-iodine oxidizes fatty acids and damages the virus cell walls and the respiratory chain of cytosolic enzymes, hence preventing inflammation of the host cell. However, the choice of liquid type, concentration, duration, and frequency of use still need to be considered to prevent side effects.

Perspectives on hand hygiene practices in response to the current COVID-19 pandemic: Possible impacts on the homeostasis of cutaneous microbiome

During the current Coronavirus Disease 19 (COVID-19) pandemic, regular handwashing and other hand hygiene practices as the primary infection prevention program are highly encouraged. Notwithstanding the noticeable benefits in combating viral infection, hand hygiene practice potentially promotes dysbiosis of the skin microbiome. This review aimed to summarize the possible impacts of hand hygiene practices using soap products and alcohol-based hand rubs (ABHR) on the homeostasis of human skin microbiota. We discuss recent findings to provide evidence of the effectiveness of hand hygiene practices in viral infection control, the role of the skin microbiome in human health and the effects of hand hygiene practice on the homeostasis of the skin microbiome. Finally, this review also suggests improving research and practice of hand hygiene in response to the ongoing COVID-19 pandemic.

Current concept management of talus fracture: a literature review

Fractures of the talus are uncommon. The relative infrequency of these injuries relates to limited guidelines to treat talus fracture. Talus fracture is always associated with high energy injury critical to the normal function of the ankle, subtalar, and transverse tarsal joints.  Outcomes vary widely and are related to the degree of initial fracture displacement. Nondisplaced fractures have a favorable outcome in most cases. Failure to recognize fracture displacement (even when minimal) can lead to undertreatment and poor outcomes. Current detailed diagnoses through Multidetector CT (MDCT) are preferred to avoid miss diagnosed in talar fracture. Although early treatment and delayed treatment did not significantly differ, multiple-choice to treat talus fracture should be known. Conservative and operative treatment can be done in accordance with clinical findings and fracture patterns. With a high risk of complication, appropriate therapy should be done. Many research and articles have been done to develop the treatment and reduce complications over talar fracture from an invasive procedure to a non-invasive procedure like arthroscopy. Therefore, we compile current treatment to give another perspective for surgeons to treat talar fracture patients

Chest therapy and breathing exercise in COVID-19 patient: a case report

Background: The coronavirus disease (COVID-19) pandemic has several clinical manifestations from asymptomatic to critical condition. Shortness of breath is one of the hallmark symptoms of COVID-19 infection. The main medical management for shortness of breath in COVID-19 infection is oxygen therapy. Physiotherapy and medical rehabilitation such as breathing exercise and chest physiotherapy can be adjuvant therapy that effectively improves breathing effort in COVID-19 patients. This case report will describe breathing exercises and chest therapy done in a patient with a COVID-19 infection.

Case: In this study, we presented the case of a 53-year-old female patient with complaints of fever, cough, fatigue, anosmia, shortness of breath, and diagnosis with confirmed COVID-19 infection based on swab PCR result. On admission in the isolation ward, the patient was on non-invasive ventilation (NIV), medical medication, and physical therapy. The physical therapy done in this patient was breathing exercise and chest therapy once daily. After four series of chest therapy and breathing exercise, the shortness of breath and her breathing effort was improved. The patient was discharged after 15 days of hospitalization.

Conclusion: This case shows the utility of chest therapy and breathing exercise as a physical rehabilitation treatment for the COVID-19 patient. This physical therapy helps to maximize lung expansion and improve the patient's breathing effort.

Complete tubular duplication of colon presenting as rectovestibular fistula: A case report

Background: Duplication of the gastrointestinal tract is a rare congenital disorder in pediatric patients.  Complete resection in case of a total tubular duplication that requires total or subtotal colectomy is undesirable in children.

Case Presentation: This case presented a simple surgical technique for treating complete colonic duplication without colonic resection. A 2 months old female baby with abdominal distention and stool complaint came out from her vaginal vestibular and normal anus. A digital rectal exam showed a palpable mass in the posterior region. Abdominal CT Scan showed a rounded mass with size 2x2 cm in the left posterolateral of rectum region. The initial diagnosis was suspected sacrococcygeal tumor type 4 with rectovestibular fistula. Intraoperative findings showed duplication of the caecum, appendix, total colon (ascending to sigmoid) and rectum (one directed to the vagina and the other to anus). The ileostomy was done 20 cm from the ileocaecal junction as a temporary treatment to relieving distention with definitive repair planned in the following months. The second stage repair was performed after 1-year-old with posterosagital anorectoplasty followed by distal separation of the duplicated colon using a 12 cm linear stapler. For this case, the third stage repair was done one year after the previous surgery to close the remaining ileostomy. The patient’s outcome showed good results with normal defecating function and no complication.

Conclusion: Complete tubular duplication is a rare case without specific clinical symptoms, but the assessment of the diagnosis can be assisted by radiology such as abdominal CT and barium enema. We hope this article could illustrate management for complete tubular duplication of colon presenting as rectovestibular fistula, thus reflect how important clinical judgment and initial diagnostic in our health care system.

Primary amenorrhoea caused by Turner syndrome: A case series

Background: Amenorrhea is a condition where women do not experience menstruation or the cessation of menstrual cycles at reproductive age. Amenorrhea is divided into primary and secondary. Turner syndrome is one example of gonadal dysgensis that cause the most common primary amenorrhea. It is represented by the absence of all or part of the normal second sex chromosome and physical features including short stature, webbed neck, cubitus valgus, pterygium colli, low hairline, edema of the hands and feet, and shield chest. Clinical pictures and karyotype of Acehnesse patients with Turner syndrome are presented in this study. The patients involved in the study were those who came to an endocrinology clinic in a tertiary care center.

Case Presentation: We reported four cases of Turner syndrome which were confirmed from anamnesis, physical examination and chromosomal analysis at the Department of Obstetrics and Gynecology in the Fertility, Endocrine and Reproductive Division of RSUD Dr. Zainoel Abidin Banda Aceh.

Conclusion: All patients with Turner syndrome had amenorrhea,  short stature, bone deformity and underdeveloped primary dan secondary sexual characteristic. Only one case has monosomy X (45, XO), a mosaic chromosomal component was present in the rest of them (45, X with mosaicism). 

Post-traumatic renal artery thrombosis secondary to blunt abdominal trauma: a rare case report

Background: Blunt abdominal trauma is one of the leading causes of morbidity and mortality among populations worldwide. However, renal artery injury due to blunt abdominal trauma is a rare occurrence. In this case, a patient who suffered multiple trauma was found in the emergency department, including blunt abdominal trauma, after a motor vehicle accident.

Case report: A 13-year-old boy with multiple trauma was referred to our emergency department, with the primary consideration being to lose consciousness 3 hours before admission due to a traffic accident. After receiving examination, there was no evidence of abdominal bruising, whereas the results of the head CT scan show epidural hemorrhage. After four days of treatment, the urea and creatinine serum levels increased, abdominal CT scan shows right renal infarction suggestive of right renal arterial rupture. The patient was diagnosed with a moderate head injury and right renal trauma AAST grade IV. The patient was referred to the interventional radiology unit. The endovascular revascularization techniques were performed with renal artery stent placement and vasodilator (nitroglycerin) flush into the renal artery before stent placement. Renal artery stenting placement performed on main right renal artery demonstrates the absence of intraluminal defects and substantially blood flow was established, abdomen CT Scan shows an enhancement on right renal parenchyma which mean right kidney vascularization appears to be improved with the return of glomerular filtration rate to normal value at the time the patient was discharged.

Conclusion: Traumatic renal artery thrombosis is a rare occurrence with devastating consequences if any imaging is missed. Endovascular therapy plays a significant role in the treatment of renal artery thrombosis with a better prognosis.

The characteristics of mandibular fractures in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

Background: Mandibular fractures may lead to several complications, including infection, nonunion, malunion, and temporomandibular joint ankylosis. The incidence of mandibular fractures is quite common in maxillofacial trauma. The characteristics of mandible fractures could be different among countries concerning the condition of the population. The etiological differences depend on age, demographic patterns of a country, environmental conditions, social conditions, socioeconomic status and cultural configuration. This study aimed to perceive the characteristic of mandibular fractures among patients attending The Oral and Maxillofacial Surgery Department in Dr. Hasan Sadikin General Hospital during 2017- 2020.

Methods: This study was a retrospective descriptive study. Samples included medical records of patients with mandibular fractures attending The Oral and Maxillofacial Surgery Department in Dr. Hasan Sadikin General Hospital during January 2017- December 2020. Samples were chosen using inclusion and exclusion criteria. The characteristics of mandibular fracture were based on gender, fracture etiology, mandibular fracture location, and treatment.

Results: This study presented that the incidence of mandibular fracture rate was higher in males with 284 cases (82.08%) than females with 62 cases (17.92%) with a ratio of 4.5 to 1. Based on age, mandibular fractures were often found in the adult age group (20-60 years old) with 215 cases (62.14%). The most common etiology was road traffic accidents, with 287 cases (82.95%). Parasymphisis region was the most common site of mandibular fracture with 94 cases (25.26%).  Most treatments performed were open reduction internal fixation with 199 cases (57.51%).

Conclusion: Mandibular fracture characteristics vary considerably among different study populations depending on demographic characteristics and socioeconomic status. The most frequent mandibular fracture site in Dr. Hasan Sadikin General Hospital Bandung was the parasymphisis region in a young adult age group.