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.

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: The ability of pregnant women to detect early-risk pregnancies is still low, which is one of the causes of complications that can endanger the welfare of the mother and fetus. This research analyzed the effectiveness of the Self Care Model in Midwifery Care through an Android Application on the Ability of Pregnant Women to Early Detection of Risky Pregnancy During the Covid-19 pandemic.

Methods: The data of this study of pregnant women who conducted examinations at PMB Ika Mardiyanti in Maret-May 2021 involved a sample of 100 obtained by simple random sampling. This study uses an analytic design with a cross-sectional design. Data analysis using the Wilcoxon Signed Rank Test.

Results: The results show that Asym. Sig. (2-tailed) obtained < (0.0001 < 0.05), this means that the Self Care Model in Midwifery Care through the Android Application is effective for increasing the ability of pregnant women in early detect risky pregnancies during the COVID-19 pandemic.

Conclusion: The research conducted to analyze the self-care model in midwifery care through the android application contributes to increasing the efforts of pregnant women to care for their care during pregnancy to prevent the dangers of pregnancy.

Introduction: Health professionals as key players in the health effort, who must prepare to face the 'triple burden' of challenges such as the current pandemic COVID-19. Closely related to interprofessional education is the realization of a workforce that is prepared through independent learning to face change, social order, culture, labor needs and technological advances. The purpose of this study was to assess acceptance of interprofessional education among health-based undergraduate educators.

Methods: Cross-sectional study design. Respondents are 45 educators from 141 educators from the Public Health, Nutrition, Nursing, Medicine, Midwifery, Occupational Health and Safety, and Medical Laboratory Technology Study Program. The instrument is a questionnaire that refers to the Interdisciplinary Education Perception Scale (IEPS) in the form of multiple-choice questions and the results are analyzed descriptively.

Results: The result of the study is respondents agree that educators need to work with other professions through interprofessional education is 62,2%. Respondents that said about individuals in their profession are very positive about their contributions and achievements are 71,1%. 68.9% of respondents trust each other's professional judgment. There are 40% of respondents who do not agree with the assumption that their status profession is looked higher than other professions. 64,4% of respondents understand that they need to make every effort to understand the capabilities and contributions of other professions.

Conclusion: The results of this study indicate that educators' perceptions of IPE can provide an understanding of the need for collaboration and a better attitude in teamwork through interdisciplinary education. Further research is needed to explore other factors that may influence specific perceptions among educators.

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: Many studies have provided non-pharmacological therapies to overcome health problems, including maternal and child health. One is how to overcome sleep disorders often complained about in pregnant women's third trimester. Some previous studies have analyzed aromatherapy using floral fragrances by inhaling aromatherapy oil directly or applied to cotton and using one type of aroma only, while inhalation using a diffuser and combining two or more similar scents have not been studied. The combination of both compositionally and beneficial aromas can complement each other, for example, lemongrass and lemon. This study aimed to examine the impact of essential oils diffuser and mix aromatherapy lemon grass on sleep quality and anxiety levels in pregnant women in their third trimester.

Methods: This study used quasi-experimental studies with one group pre-test and post-test. The research sample is 48 pregnant women in the third trimester of Wonokromo were selected with simple random sampling. The Independent variable is aromatherapy interventions (blended lemongrass and lemon) inhalation using diffuser, while the dependent variables are sleep quality. Data collection instrument using Pittsburg Sleep Quality Index (PSQI). Data analysis using Wilcoxon test with α=0.05.

Results: After being given aromatherapy intervention, almost all respondents have good sleep quality, 8-point increase in average sleep quality score. The results of the Wilcoxon test obtained a value of ρ = 0.01.

Conclusion: Essential oils diffuser blend aromatherapy of lemongrass and lemon effectively improves the sleep quality of third-trimester pregnant women. Aromatherapy makes participants feel relaxed, comfortable, and feel sleepy better. For health workers, this technique can be one of the practical options for non-pharmacological therapy to decrease discomfort during pregnancy.

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.

Introduction: The COVID-19 pandemic creates parenting stress for parents. When parents experience parenting stress, the solution that can be done is to give the gadgets to make children calm at home so they don't interfere with their parents' daily activities. This study aims to analyze the effect of parenting stress on symptoms of gadget addiction in elementary school-aged children.

Methods: The research design used the quantitative correlation method. The research was carried out in July - August 2021. The subjects of this study were parents whose children were in elementary school in Surabaya involving 130 respondents who were taken by random sampling technique. Determination of the parenting stress scale and gadget addiction symptoms using the Parental Stress Scale (PSS) and Internet Addiction Test (IAT) questionnaires. Data analysis used a simple linear regression test with a significance value of p <0.05.

Result: The results of the analysis show that parental stress has an effect on symptoms of gadget addiction in elementary school-aged children (F=6,821, sig.=0,000, R2= 0,554) with the regression equation Y=-17,198 + 1,360 X.

Conclusion: The higher the stress level of parenting, the higher the symptoms of gadget addiction in elementary school-age children. The need to overcome the stress of parenting to prevent early symptoms of gadget addiction in children. Family and professional support is needed to overcome the stress of parenting and how to prevent gadget addiction in elementary school-aged children.

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: Early age is the golden age period of growth and development of children. Therefore, it is necessary to monitor the fulfillment of children's nutritional needs based on the quantity and quality of good nutrition. This study aims to examine the relationship between the level of parental knowledge and the teacher's feeding pattern on the nutritional status of early childhood at the Jungle School Nature Kindergarten, Sekaran, Gunungpati District, Semarang City.

Methods: The total sampling technique conducted this analytic observational study with a cross-sectional design by 24 parents of kindergarten students and 11 teachers or caregivers. The parents' knowledge and teachers' feeding parenting styles were obtained from the interviews. The assessment of the nutritional status of kindergarten students was using indicators of WAZ, HAZ, and BAZ. All research subjects had normal nutritional status based on indicators of WAZ and HAZ.

Results: Based on BAZ indicators, as many as 12.5% of students have underweight nutritional status, and 87.5% have normal nutritional status. The results of the association test showed that the level of parental knowledge (p=0.533; 0.845; and 0.372) and eating patterns by teachers in schools (p=0.770; 0.896; and 0.597) were not significantly related to the nutritional status of early childhood (WAZ, HAZ, and BAZ).

Conclusions: Parents with a good level of knowledge do not necessarily have nutritional problems.

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.

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.

Aortic stenosis is a valvular heart disease commonly found in developed and developing countries. The frequency of aortic valve sclerosis is about 25% in people over 65 years of age. In contrast to developing countries, infectious diseases, such as endocarditis or rheumatic fever, contribute greatly to aortic stenosis. Severe aortic stenosis without valve replacement has a poor prognosis and some patients are at high risk for surgery. Transcatheter aortic valve implantation (TAVI) is emerging as an alternative in patients with aortic stenosis who cannot or are at high risk for surgery. TAVI has revolutionized the management of aortic stenosis. This procedure continues to improve yearly and exceeds surgical aortic valve replacement in 2019. Initially, TAVI generated skepticism and criticism, but with many clinical trials and evidence-based investigations, TAVI is now widely accepted. Until now, the development of TAVI continues, starting with better technology, approaches, and new implantation strategies; TAVI is becoming safer for patients. This literature review will discuss more deeply about TAVI and its development.

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.

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.

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.