Background: The contracted socket is caused by fibrosis leading to the shortening of the orbital tissue. Vascular endothelial growth factor (VEGF) is a profibrotic factor in postoperative wound healing. The novel option to prevent fibrosis is the use of fibrin glue. This study aims to evaluate the role of fibrin glue in reducing the VEGF expression in cells that cause post-socket surgery scar.

Methods: An in vivo experimental study using an animal model was conducted. We used twenty eyes of white rabbit species as the study sample. The evisceration was carried out and distributed to the animals in four experimental groups consisting of the control group, the MMC group (0.1 ml of mitomycin-C (MMC) 0.4 mg/ml), the triamcinolone acetonide (TCA) group (0.1 ml of TCA 40 mg/ml), and the fibrin glue group (0,1 ml of fibrin glue). The treatment was performed through injection of the subconjunctival. After 14 days, rabbits were euthanized, and conjunctiva samples were cut. Immunoreactivity scores (IRS) were used to analyze the expression of VEGF in epithelia conjunctiva with a significant level of p <0.05. Data were analyzed using SPSS version 26 for Windows.

Results: All groups showed a statistically significant difference in VEGF expression with a p-value 0,000 (p<0,05). The VEGF level was significantly lower in the three treatment groups compared with the control group. The VEGF expression was highest for the control group, followed by fibrin glue, TCA and MMC group. We found significant differences between the control group and the three treatment groups; the MMC group (p=0.001), the TCA group (p=0.002), and the fibrin glue group (p=0.005). While differences in VEGF expression between the three treatment groups could not be proven statistically.

Conclusion: Fibrin glue is proven to reduce VEGF expression as a marker of fibrosis; thus, fibrin glue can be an alternative anti-fibrotic agent.

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: 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.   

Background: Decompensated cirrhosis (DC) in children is the main indication of liver transplantation (LT). The lack of access to liver transplantation and impending clinical complications while awaiting transplantation affect the morbidity and mortality in pretransplant patients. Granulocyte colony-stimulating factor (G-CSF) therapy has shown promising results in adult decompensated cirrhosis as a potential bridging treatment. Our study aimed to identify the effect of G-CSF on pediatric end-stage liver disease (PELD) score, liver function,  CD34+ cell mobilization, nutritional status, survival, and short-term side effects in children awaiting LT.

Methods: This study was an open-label, randomized controlled trial that included patients with decompensated liver cirrhosis between 3 months and 12 years of age. The intervention group received 12 courses of G-CSF subcutaneous injection (5 μg/kg/day) plus standard medical treatment (SMT) for liver cirrhosis. Results were obtained regarding PELD scores, liver function, CD34+ cell mobilization, changes in leukocyte and neutrophil counts, nutritional status, survival, and side effects within three months.

Results: Thirty-five pediatric patients were randomized into the intervention (17 patients) and control (18 patients) groups. During the trial, 14 (82%) in the intervention group completed the treatment. The median ages of the patients in the intervention and control groups were 18 and 14.5 months, respectively. The study's primary outcome identified no statistically significant difference in PELD scores between the intervention and control groups after G-CSF treatment. Liver function tests that showed significant changes in the intervention group compared to the control group were from improvements in alanine aminotransferase (ALT) levels. Other liver function tests, nutritional status, and survival did not. CD34+ cell mobilization was increased in the intervention group compared with the control group, but there was no significant difference. Minor side effects of G-CSF were observed in the intervention group.

Conclusion: Multiple doses of G-CSF did not improve the PELD score, nutritional status, and survival after three months but significantly showed temporary improvement in ALT level.

Background: Obesity is an inflammatory condition that results in an increase in high sensitive C-Reactive Protein (hs-CRP), a risk for insulin resistance (IR). Vaspin has the effect of increasing insulin receptor sensitivity and on the other hand is a compensatory response to insulin resistance, one of which is measured by homeostasis models assessment-insulin resistance (HOMA-IR). This study was an analytical cross-sectional observational design, to determine the association between insulin, glucagon, CRP, and HOMA-IR levels with serum vaspin in obesity.

Method: This study is an analytical study with a cross-sectional design.  Criteria of inclusion were subjects in the range 18-60 years Denpasar citizen with BMI above 25 kg/m² and willing to be involved in this study, while exclusion criteria were with either chronic conditions or acute inflammation such as infection, cancer, tumor, or chronic disease which is altered and threatening life. Correlation tests using spearman analysis.

Results: From 131 obese subjects in this study, there were 72 (55%) men and 59 (45%) women. Median age: 33 (22-57) years, fasting insulin: 8.90 (2.20-74.50) ìIU/mL, glucagon: 48.10 (7.58-293.90) pq/mL, hs-CRP: 1.90 (0.20-9.50) mg/L, HOMA-IR: 2 (0.50-23.15), and vaspin levels: 0.16 (0.04-1.46) ng/mL. There was a significant positive correlation between HOMA-IR, insulin and glucagon with vaspin (r = 0.20, p = 0.020; r = 0.20, p = 0.022; and r = 0.28, p = 0.001), and a significant negative correlation between hs-CRP and vaspin (r = -0.24, p = 0.005) in obesity. In the path analysis, there was a direct and total negative effect of hs-CRP on vaspin (coefficient = -0.19; p = 0.027 and coefficient = -0.02; p = 0.038).

Conclusion: This study shows a positive association between insulin, glucagon, and HOMA-IR with serum vaspin, while CRP is negatively associated with serum vaspin in obesity.

Introduction: Mitragyna speciosa is known to have beneficial effects, such as antinociceptive and anti-inflammatory effects. There are some components that involve in inflammatory, such as Inducible nitric oxide synthase (iNOS), cyclooxygenase 2 (COX-2) enzymes, and also cytokines. This study aimed to investigate the anti-inflammatory effect and its mechanism of Mitragyna speciosa leaf.

Methods: Carrageenan-induced rat paw edema model was used for inflammation induction. Rats were given Mitragyna speciosa leaf methanol extract at a dose of 75, 150, and 200 mg/kg.

Results: Intraplantar injection of carrageenan led to the development of time-dependent peripheral inflammation, which, in turn, was a significant increase in the swelling process as measured by a plethysmometer. However, administration of EMS (75,150 and 200mg/kg) can reduce edema in a dose-dependent manner. We also demonstrated that skin histology on EMS administration significantly preserved skin thickness at 4 h after carrageenan injection.

Conclusion: In conclusion, we reveal the role of Mytragyna speciosa methanol extract as anti-inflammatory and maintain skin thickness in the inflammatory process.

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: A lot of hospital management systems, especially open-source ones, still lack interoperability which is holding back the effectiveness of administration. This happens due to different regulations from hospital organizations. Therefore, there must be a system that facilitates interoperability. Blockchain is a decentralized ledger system, to insert the data from the blockchain all parties must agree that the data is valid thus the data can be inserted so, all the data are immutable thus every change can be audited.

Methods: We integrate the Hyperledger fabric network, an open-source modular blockchain platform, into an open-source hospital management system, openEMR. We take the changed data using debezium connect and Kafka and inserted it into the blockchain.

Results: Based on our test, we managed to get average read latency at 27ms, average read throughput at 36 Read per Second, average transaction latency at 45ms, average transaction throughput at 22 Transaction per Second, and average integrated system data transfer at 111.36ms.

Conclusions: All services deployed successfully at the Kubernetes without any error. All services work as they should be. One service can integrate through the internal network of the Kubernetes and from the outside cluster using ingress. OpenEMR can be used normally as indicated in the official documentation and the data change is stored in the blockchain.

Introduction: Diabetes mellitus, or hyperglycemia, is one of the risk factors for atherosclerosis, causing disruption of blood flow through arterial plaque formation and atherosclerosis. Diabetic kidney disease (DKD) is the most common cause of chronic and end-stage renal disease (CKD and ESRD) worldwide and is a stronger predictor of mortality in people with diabetes. Although the concept that the kidney plays a key role in glucose balance is not new, it is only recently that this organ has been viewed as a potential therapeutic target. This study aimed to assess the potential effect of Syzygium polyanthum extract in DKD mice model.

Methods: We administrated Syzygium polyanthum extract for 2-weeks to alloxan-induced diabetic mice.

Results: Treatment with Syzygium polyanthum extract reduced blood glucose levels in dose dependency (2,62mg/20g/day, 5,24mg/20g/day, and 7,86mg/20g/day). Histological analysis showed that Syzygium polyanthum extract significantly (p<0,05) improved the kidney lesions in low dose, but did not show a significant effect on inflammatory cell at glomerulus.

Conclusion: Syzygium polyanthum extract has potential to improve the kidney lesion in low dose and showed therapeutic potential in DKD treatment.

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: 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: The coronavirus disease 19 (COVID-19) and autoimmune disease has been associated bidirectionally, several reports has shown COVID-19 precipitate an exacerbation of an autoimmune disease that has already stable. Recognize and treatment of flare in SLE condition with COVID-19 is challenging in this pandemic era. This review aims to report a case SLE patient who experienced severe flares after being infected with COVID-19 and review of the literature.

Case report: We presented a 27-year-old female with a history of Systemic Lupus Erythematosus (SLE) who experienced severe flares after being infected with COVID-19 and a review.

Methods and Results: A total of 72 potentially relevant citations were identified. After removing the duplicate citations, the title, and abstracts of 61 articles were evaluated and 11 relevant articles were reviewed in detail. A total of 72 potentially relevant citations were identified. After removing the duplicate citations, the title, and abstracts of 61 articles were evaluated and 11 relevant articles were included.

Conclusion: The COVID-19 pandemic is a devastating situation all over the world. SLE patient has already been in a susceptible condition as the disease progressed and continued having immunosuppressant therapy also one of the risk factors. A Flare condition can be happened during the COVID-19 Infection or after the infection is resolved. In SLE patient having COVI-19, close monitoring, high adherence to the therapy, and the health protocol are needed.

Background: A widespread intra-abdominal organ infection or complicated intra-abdominal infection (cIAI) causes localized peritonitis, intra-abdominal abscess, and diffuse peritonitis. Patients suffer from morbidity and mortality as a result of this condition. Sepsis indicators such as SOFA, WSESSSS, and CPIRO scores were predictors of mortality in cIAI patients. We aimed to examine the performance of WSESSSS, CPIRO, and SOFA scoring systems to predict mortality in patients with cIAI.

Methods: A retrospective cohort, analytic observational study was conducted to assess differences in SOFA, WSESSSS, and CPIRO scoring systems' sensitivity, specificity, and accuracy as predictors of death during treatment in cIAI patients in Dr. Soetomo General Hospital, Surabaya.

Results: A total of 265 patients were evaluated. The optimal cutoff for SOFA was score 5 with sensitivity, specificity, PPV, NPV, and accuracy of 77.2%, 87.9%, 77.2%, 87.9%, and 84.2%, respectively. The optimal cutoff for WSESSSS was score 8 with sensitivity, specificity, PPV, NPV, and accuracy of 83.7%, 82.7%, 72.0%, 90.5%, and 83.0%, respectively.  The optimal cutoff for CPIRO was 4 with sensitivity, specificity, PPV, NPV, and accuracy values of 62.0%, 90.2%, 77.0%, 81.7%, and 80.4%, respectively. Patients with high scores had a higher percentage of being hospitalized longer and cost higher than patients with a low score.

Conclusion: The SOFA, WSESSSS, and CPIRO scoring systems had comparable performance in predicting mortality in patients with cIAI. Considering the performance of WSESSSS, the use of WSESSSS alone may be sufficient enough to predict the outcome of patients with cIAI in Indonesia.

Background: Conjunctiva, when injured, can heal spontaneously. However, in extensive wounds, wound healing is often accompanied by scarring and wound contraction. Currently, for cases of disease and trauma to the surface of the eyeball, it can be reconstructed using the amniotic membrane, but there are still weaknesses in the use of amnion. Platelet-rich fibrin (PRF) is currently being developed for the reconstruction of ocular surface wounds.

Methods: A total of 20 male New Zealand rabbits (20 eyes) were divided into two groups. In the first group, conjunctival excision and PRF membrane graft suturing were performed on the right eye conjunctival defect, while the second group had an amniotic membrane sutured on the right eye conjunctival defect. On the 14^th day, enucleation was carried out and continued with histopathological examination using immunohistochemistry using TGF antibodies and type 1 collagen to evaluate the levels of TGF and type 1 collagen in the conjunctiva.

Results: The results after 14 days of treatment showed that there was a very significant difference in TGF Beta expression between the AMT group and the PRF group (p = 0.007*; <0.05). However, in the expression of type 1 collagen, there was no significant difference in the expression of type 1 collagen between the AMT group and the PRF group (p = 0.791; >0.05).

Conclusion: There were differences in the expression of TGF-β and type 1 collagen in the administration of the PRF membrane compared to the administration of the amniotic membrane after conjunctival excision of experimental male New Zealand rabbits on day 14.

Aim: The goal of this study was to compare maternal and neonatal results in diabetic pregnant ladies who were treated either insulin and metformin or insulin only.

Methods: 220 pregnant diabetic women with type 1, 2 or gestational diabetes were randomisely assigned into two groups .each group is 110 pregnant diabetic women. One group takes insulin and metformin treatment to achieve glycemic targets and other take insulin only treatment. Pregnancy results in 110 ladies who stayed solely on insulin have been compared to pregnancy results in 110 pregnant diabetic ladies treated with insulin and metformin who were matching for age, weight, as well as ethnicity.

Results: No significant variations in maternal risk factors existed at the start of the study. Group II from enrolling to term, they gained significantly more weight (5.90 vs. 4.39   kg;   P < 0.000). When it came to gestational hypertension, there was no significant difference between groups I and II (14.5 against 19.1%, P = 0.367), pre-eclampsia (7.27 vs. 9.09%, P = 0.622),insulin dosage was decreased in group I statistically significant (mean 39.5±16.5 vs. 55.4±17.5 units, P= 0.000), vaginal delivery (41.8 vs. 47.3%, P = 0.416) or rate of elective Caesarean section (39.1 vs. 32.7%, P = 0.325), rate of emergency caesarean section (19.1 vs. 20%, P=0.865), perinatal loss  (4 cases in group II vs. 3 cases in group I;P=0.701). Group I had a lower rate of neonatal morbidity; prematurity (16.63 vs. 24.55%, P = 0.417), neonatal hypoglycemia (7.3 vs. 24.5 %, P= 0.000), respiratory distress (13.64 vs. 30 %, P= 0.003), neonatal jaundice (13.6 vs. 33.6%, P < 0.000) and admittance to the newborn intensive care unit (24.55 vs. 35.45%, P = 0.077). Macrosomia occurrence (There was a significant difference in birth weight centiles > 90 [group I (16.4%) vs. group II (29.1%); P = 0.024]. The incidence of polyhydramnios was significantly different [group I (13.6%) vs. group II (32.7%); P = 0.001].Shoulder dystocia [group ? (2.7%) vs. group II (4.5%); P=0.721].

Conclusions: Diabetic pregnant women who were treated with insulin plus metformin who had equal baseline risk factors for unfavourable pregnancy outcomes gained less weight and needed less insulin to maintain glycemic control. Furthermore improved neonatal outcomes as macrosomia, neonatal hypoglycemia, respiratory distress and special care baby admission compared with those treated with insulin alone.

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: Bromage score is used in assessing patients post-spinal anesthesia while the patient is in the recovery room. Patients can be transferred to the treatment room from the recovery room if they have achieved a Bromage score of <2. Post-anesthesia recovery is significant to pay attention to because if there are obstacles in post-anesthesia recovery, it will cause some complications that the patient needs a long time in the treatment room. Several factors may be related to Bromage score, American Society of Anesthesiology (ASA) physical status, age, gender, the dose of local anesthetic drugs, and other factors. 

Methods: This type of research Observational Analytics used secondary data with a cross-sectional study design with 327 participants. Data analysis using coefficient contingency correlation test. 

Results: The majority of 315 (96.6%) patients achieved a Bromage score of 1, with the highest number of patients aged (12-45 years). Patients with ASA physical status 1, a male and spinal anesthetic with a dose of Bupivacaine 10 mg – 15.5 mg achieved the most Bromage score 1. There was a significant relationship between gender and Bromage score in patients after spinal anesthesia, p-value = 0.048 (p-value < 0.05).

Conclusion: There is a significant relationship between sex and the Bromage score, and there is no significant relationship between ASA physical status, age, and local anesthetic dose with the Bromage score.

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.

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.

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

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.

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: Corona Virus Infection 2019 (Covid-19) is still a problem faced by all countries in the world, including Indonesia. Islamic boarding schools are a vulnerable place to be cluster spread of COVID-19 because there is much interactivity in a limited environment. This study aims to study the impact of Covid-19 on the personal hygiene behavior of female students in Islamic Boarding School.

Methods: The research design is cross-sectional. The sample in this study was 117.  Data collection using questionnaires and interviews by applying strict health protocols. Data analysis used univariate and bivariate.

Results: The results of the study informed that before covid-19 there were many female students who did not practice personal hygiene properly. Meanwhile, during the COVID-19 pandemic, most of the female students had practiced personal hygiene with sufficient category. Conclusion: There was a significant change in the personal hygiene behavior of female students in Islamic boarding schools before and during the COVID-19 pandemic.

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: Arteriovenous fistula (AVF) is the gold standard for vascular access for hemodialysis in end-stage renal disease (ESRD) patients. There is a high rate of AVF maturation failure, especially in DM patients, and it takes longer for maturation in diabetes mellitus (DM) patients. This study aimed to obtain the recommendations for the minimum diameter of the brachial artery and cephalic vein as a predictor of brachiocephalic AVF maturation in ESRD patients with type 2 diabetes mellitus after six weeks to eight weeks of AVF creation.

Methods: This study is a retrospective cohort study using secondary data from patients with brachiocephalic arteriovenous fistula. The examined variables were brachial artery diameter, cephalic vein diameter, and brachiocephalic arteriovenous fistula maturation. Comparative analysis and ROC curve analysis were performed.

Results: A total of 72 patients met the inclusion and exclusion criteria. Forty-four (61,11%) patients were mature at six weeks, while 47 (65,28%) were mature at eight weeks postoperatively. At week six, the mature group had a significantly larger cephalic vein diameter (3,20±0,94 vs. 2,65±1,02, p=0,002). At week eight there was a significantly larger brachial artery (4,22±0,70 vs 3,78±0,60, p=0,012), and cephalic vein diameter (3,28±0,98 vs 2,43±0,82, p=0,000) in the mature group.

Conclusion: The best threshold value for preoperative brachial artery diameter predicting AVF maturation eighth week was 3.85 mm. The best threshold value for preoperative cephalic vein diameter predicting AVF maturation at the sixth week was 2.45 mm, and at the eighth week, it was 2.45 mm.

Background: The bone healing of the alveolar socket post-dental extraction is critical in dental services. Delayed healing is a common problem in diabetes mellitus (DM) patients. It is due to the impaired angiogenic response and microvascular complications. Okra fruit extract can control diabetes mellitus (DM) in several ways, delaying glucose absorption and regenerating pancreatic cells. It can impact an increase in insulin secretion and glycogenesis to control hyperglycemia in DM. This study analyzed the regenerative alveolar bone through the expression of TGF-β2 in the tooth socket of Wistar rats with diabetes mellitus post-extraction after administration of okra fruit extract.

Patients and methods: Extraction of the rat mandibular left incisor was performed using a pair of modified forceps. The tooth sockets were then rinsed using a saline solution. Two groups (control & treatment) of four rats were sacrificed on days 3, 5, and 7. The socket tissues from the rats were then immunohistochemically analyzed

Results: The average level of TGF‐β1 expression in the treatment (T) groups was higher compared to the control (C) group: day 3 (10.50±2.67 versus 4.83±1.17), day 5 (12.33±1.63 versus 5.17±2.32), and day 7 (13.00±2.83 versus 4.50±1.05), with P = 0.000

Conclusion: The administration of okra fruit extract can increase regenerative alveolar bone healing through increased expression of TGF-β2 in the dental socket after tooth extraction of diabetic Wistar rats.

Background: Nurses are responsible for ensuring the safety of their patients. It has long been known that weariness and sleepiness can lead to mistakes that jeopardize patient safety. The researchers wanted to see if there was a link between exhaustion and excessive daytime sleepiness among nurses.

Methods: The study used a cross-sectional correlational design with 36 nurses from a Tertiary Eye Care Hospital as participants. Convenience sampling was used to collect data. The Epworth Sleepiness Scale (ESS) and the Three-Dimensional Work Fatigue Inventory (3D-WFI) were used to collect data. Pearson's correlation coefficient was used to calculate the correlation between WFI and ESS.

Results: The statistical analysis with ratio data between exhaustion and Excessive Daytime Sleepiness, we obtained that p 0.000 with Pearson correlation and suggests that there is a strong link between fatigue and excessive daytime sleepiness (EDS) among hospital nurses.

Conclusions: Fatigue and daytime sleepiness are significant occupational health concerns for hospital nurses. According to this study, nurses should optimize their work hours to avoid daytime sleepiness and maintain circumstances to avoid excessive sleepiness, which can lead to adverse outcomes.

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: 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.

Introduction: According to WHO, the COVID-19 epidemic a public health emergency came to international attention in March 2020, and the pandemic quickly spread around the world. This disease is caused by the novel coronavirus SARS-CoV-2, which may enter human target cells via angiotensin-converting enzyme 2 (ACE2). This study aimed to assess the risk factors associated with poor prognosis among COVID-19 patients in the Islamic Hospital of Jemursari, Surabaya, Indonesia.

Methods: This study was a retrospective cohort study that used patients hospitalized with COVID-19 at the Islamic Hospital of Jemursari, Surabaya as a study subject. Patients of all ages who enter the hospital and were confirmed with a positive real-time polymerase chain reaction (RT-PCR) result for SARS-CoV-2 were inclusion criteria of this study.

Results: We included 554 COVID-19-positive patients with the highest age at 26-35 years old as much as 26.72%, followed by the second highest at 36-45 years old at 20.86%. In addition, from all the patients in this study, it was found that the most patients were 281 male and 273 female. Characteristics of comorbidities in COVID-19 patients, where type 2 diabetes mellitus is the most comorbid factor 88.89% in recovered COVID-19 patients and 11.11% in patients who have died. In addition, hypertension is also the second most comorbid 96.55% of Covid-19 patients.

Conclusion: Based on this study, the independent risk factors related to critical outcomes among COVID-19 cases include old age, males, diabetes mellitus, cardiac-related disease history, and the presence of two or more comorbidities. In future research, we suggest designing a unique multi-item scale system to prognosticate COVID-19 patients.

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: 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 2019 (COVID-19) has emerged as a global health catastrophe since its first reported cases in late December 2019. Critically ill COVID-19 patients have been related to cytokine storms leading to acute respiratory distress syndrome and high mortality rates. Therapeutic plasma exchange (TPE) and convalescent plasma (CP) therapy improve clinically by removing inflammatory cytokines excess and using passive antibody-containing blood, respectively. This study aimed to evaluate TPE and CP treatment for moderate-to-severe COVID-19 infection.

Method: The patients were randomly divided into TPE group (n = 10), CP group (n = 11), and control group (n = 10). This 1-week quasi-experimental study with a pretest–post-test control group design was conducted in the Intensive Care Unit (ICU) of Dr. Moewardi General Hospital and Universitas Sebelas Maret (UNS) Hospital. The study comparison between groups included blood gas analysis profile (pH, base excess, PaCO₂, PaO₂, hematocrit, HCO₃, total CO₂, SaO₂), FiO₂, P/F ratio, COVID-19 severity, and D-dimer. The paired t-test was used to analyze every group's pretest–post-test mean difference. One-way ANOVA was performed to analyze the mean difference across the three groups. SPSS version 22.0 for Windows was used to perform statistical analyses.

Result: TPE and CP groups showed significant clinical-laboratory improvement than control (p > 0.05). Furthermore, high clinical-laboratory improvement tendency was observed in CP therapy than TPE.

Conclusion: The use of TPE and CP in moderate-to-severe COVID-19 patients has been related to improving clinical-laboratory outcomes.

Introduction: Several countries, including Indonesia, have made tracing efforts to control the spread of infectious diseases such as COVID-19. In carrying out this tracing, it is not only about tracing close contacts but also about digging up some information related to the epidemiological characteristics of COVID-19. So this information can be useful in analyzing the future incidence of disease or health problems. This paper aims to analyze the management of tracing and epidemiological characteristics of close contacts with COVID-19 in Primary Health Care (Puskesmas). Especially Primary Health Care in Pengasih I, Pengasih II, Sentolo I, and Sentolo II.

Methods: The design of this study is a type of descriptive epidemiological research with retrospective data. Retrospective data were analyzed descriptively regarding the epidemiological characteristics of close contact with COVID-19. They then tested the formulation of the hypothesis with univariate, bivariate, and multivariate data analysis. Total sampling was utilized for the study from February 1^st to March 3^rd, 2022.

Results: Contact tracing was carried out by following the guidelines for tracing implementation issued by the government. Close contact data is 1,450 and dominated by women aged 16-54. The frequency of asymptomatic is more than that of symptomatic. There are 535 close contacts whose status changed to confirmed cases.

Conclusion: Close contacts have the risk of undetected infection, so early control of close contact can control the spread of the COVID-19 outbreak. Therefore, tracing efforts by health workers aimed at early detection of close contacts and quarantine measures for close household contacts are appropriate to break the chain of transmission of COVID-19 so that this tracing can be achieved.

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: 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: 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.

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.

Background: Ludwig's angina is an infection of the submandibular cavity in the form of cellulitis that is rapidly progressive and potentially life-threatening. Neutrophils and lymphocytes play an important role in this infection process. Neutrophil-lymphocyte Ratio (NLR) is a simple biomarker to evaluate systemic inflammation. We aimed to determine the association between NLR and various prognostic parameters in patients with Ludwig's Angina.

Methods: A retrospective cohort study was conducted using medical records of Ludwig's Angina patients treated at Dr. Soetomo General Hospital, Surabaya, Indonesia, between January 2018 – December 2021. The NLR cut-off value was calculated using the receiver operating characteristics (ROC) curve. The association between NLR with severity, length of stay (LoS), and mortality were analyzed using SPSS version 23 for Windows.

Results: We recruited a total of 96 patients. NLR values are divided categorically into low NLR and high NLR using a cut-off value of 16.86. There were 49 patients (51%) with low NLR and 47 (49%) with high NLR. There was a significant relationship between NLR with severity, LoS, and mortality in Ludwig’s angina patients (p=0.032, p=0.002, and p=0.026, respectively). According to a survival study, the high NLR group's survival rate was significantly lower than the low NLR group's (p=0.009).

Conclusion: There was a significant relationship between NLR severity grading, survival, and the length of stay in patients with Ludwig's Angina.

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.

Introduction: Coronavirus Disease 2019 (COVID-19) has spread throughout the world, including Indonesia, so it is designated as a pandemic. To prevent the wider spread of COVID-19 transmission, the Indonesian government has implemented a COVID-19 vaccination program. The community knowledge, attitudes, and behavior towards COVID-19 vaccination are needed to support the success of this program. Therefore, this research aims to determine the Indonesian community knowledge, attitudes, and behavior towards COVID-19 vaccination.

Methods: This research was conducted by non-experimental observation with a cross sectional approach. Sampling using accidental sampling technique with the duration of the distribution of the e-questionnaire for 30 days. The sample of this research is the Indonesian community. The data were processed using descriptive statistical tests.

Results: The results of the univariate analysis with a total of 662 respondents showed that the majority of respondents were female, aged 18 to 25 years, educated in Senior High School/Equivalent, Muslim, domiciled in Riau, student, and received information from social media and other online media. The majority of respondents have a good level of knowledge with a score of 80.1%, have a positive attitude and behavior with a score of 53.5% and 51.8%.

Conclusion: The Indonesian community have a good level of knowledge, as well as positive attitudes and behaviors towards COVID-19 vaccination.

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.

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.

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: 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.

Background: Intraocular hypothermic perfusion can be used as an alternative to reduce corneal endothelial cell damage in phacoemulsification procedures. This study aimed to analyze the effect of hypothermic intraocular perfusion on cell density and expression of the Na⁺/K⁺-ATPase on corneal endothelial cells after exposure to ultrasonic phacoemulsification energy.

Methods: Sixteen New Zealand white rabbits (n=16 eyes) were randomly divided into two groups and exposed to phacoemulsification ultrasonic energy. The control group received room-temperature Intraocular Balanced Salt Solution (BSS) hyperthermic perfusion (24^oC) and the treatment group received low-temperature intraocular BSS hypothermic perfusion (4^oC). Corneal endothelial cell density (ECD) was measured before and 1 day after surgery using a specular microscope. On the first postoperative day, the expression of Na⁺/K⁺ATPase was examined using immunohistochemical antibody staining. Data were analyzed using SPSS version 26 for Windows.

Results: There was no statistically significant difference in the expression of corneal endothelial Na⁺/K⁺-ATPase between the control and treatment groups (p=0.053). There was no significant difference in corneal endothelial cell density changes between the control and treatment groups (p=0.115). There was no correlation between changes in cell density and corneal endothelial Na⁺/K⁺ATPase expression in the control and treatment groups (p=0.216).

Conclusion: The effect of intraocular hypothermic perfusion on phacoemulsification procedures remains controversial. Endothelial cell density decreased in hypothermic perfusion after phacoemulsification and Na⁺/K⁺ATPase expression was not significantly affected by hypothermic perfusion.

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.

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: 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.

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: 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: 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: 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: Several studies showed 324 severe cases of COVID-19 and 1234 mild cases with the highest comorbidities of Hypertension, Diabetes Mellitus, Chronic Obstruvtives Pulmonary Disease (COPD), and Cardiovascular disease. These comorbid factors lead to a poor prognosis in COVID-19. Chest radiography is an important modality as one of the parameters that can indicate the severity of COVID-19. This study aims to determine the relationship between Covid-19, comorbid Hypertension, and Diabetes Mellitus with chest radiography.

Method: This research is analitic observational with cross-sectional, relationship between Covid-19 patients with comorbid Hypertension and Diabetes Mellitus with chest radiography (type, location, and extent of lesions) that Modified Chest X-Ray Scoring System in Evaluating Severity of COVID-19 Patient in Dr. Soetomo General Hospital Surabaya, Indonesia in 2021, COVID-19 radiology category.  The data from PKU Muhammadiyah Gamping Hospital, Yogyakarta retrospectively from the medical records of Covid-19 patients who met the inclusion and exclusion criteria. Chi-Square analyzed the results variables with unpaired categorization.

Result: Most of the respondents who had comorbid diseases had moderate chest radiological features (65.4%) and those who did not have comorbid diseases had mild chest radiological features (71.9%), the results of chi-square data analysis between variables were p: 0.000.

Conclusion: The results of data analysis showed that comorbid diseases had a significant relationship with chest radiography in patients with confirmed COVID-19. The novelty of this study is the importance of radiological modalities as one of the parameters that can indicate the severity of Covid-19 patients with comorbidities.

Introduction: Currently, the coronavirus (Covid-19) is still a global problem that is felt by various countries in the world, including Indonesia. The occurrence of this epidemic greatly affected all sectors of human life, one of which was in the education sector where there was a changing the learning process from face-to-face to an online learning system. The implementation of online learning turned out to have a considerable impact on students, especially nursing students, one of which was the emergence of academic stress that was felt during the learning process. This study aimed to determine the correlation between academic stress due to online learning and the motivation, satisfaction and learning achievement of nursing students during the Covid-19 pandemic.

Methods: This study uses a descriptive correlative method with a cross-sectional approach. Researchers distributed online questionnaires to 259 respondents, namely active nursing students who carried out online learning. Then the data obtained were analyzed by researchers univariately to determine the distribution and frequency distribution and bivariate test using somersd and lambda to determine the correlation of each variable with academic stress.

Results: The results showed that there was a significant correlation between age (ρ=0.001), gender (ρ=0.005), grade education (ρ=0.048), learning understanding (ρ=0.000), and academic stress while the variable of media use did not correlate with academic stress (ρ=. In addition, academic stress is also correlated with variable satisfaction (ρ=0.041), and motivation (ρ=0.002) and is not correlated with learning achievement (ρ=0.388).

Conclusions: The current Covid-19 pandemic situation has greatly impacted the teaching and learning process, especially the emergence of academic stress, and decreased motivation and learning satisfaction of nursing students. This condition will become serious if each variable that is correlated with academic stress is not handled properly.

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.

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.

Clostridium difficile is an anaerobic gram-positive bacillus, capable of forming spores and toxins, transmitted to humans by the faecal-oral route C. difficile infection (CDI) is recognized as a typical cause of healthcare-associated infections (HAIs) and contributes to a significant proportion of morbidity and mortality of hospitalized patients. C. difficile culture and toxin examinations are still minimal in many hospitals in various Asian countries. As a result, reports of C. difficile in Asia are still rare, while reports of cases of CDI in Indonesia are still rare. Several risk factors including advanced age, antibiotic exposure, and hospitalization are strongly associated with CDI. C. difficile has the ability to colonize the large intestine, then release exotoxin proteins (TcdA, TcdB) causing colitis in people with risk factors. A diagnosis of suspected C. difficile infection in a patient with diarrhea without a clear alternative explanation, with relevant risk factors (including long antibiotic consumption, hospitalization events, and elderly age), was then performed microbiological examination to carry out proper management and control of infection. This study aims to review C. difficile virulence factors as the cause of antibiotic-associated diarrhea.

Patients with end-stage chronic kidney disease require hemodialysis treatment to maintain kidney function. The patients should be prepared to manage symptoms that may arise and cope with physical, psychological and financial changes. In addition, the patients are expected to be able to make their own decisions on how to manage the disease and adhere to treatment. This situation requires good health literacy skills. Little is known about the synthesis of health literacy among patients with chronic kidney disease.

Goal: To summarize the available evidence on benefits and factors that affect health literacy in patients undergoing hemodialysis from the available literature.

Method: The study reviewed health literacy among patients undergoing hemodialysis.   A literature search using a database was conducted in  Ebsco, PubMed, Science Direct, Scopus, and Emerald in December 2021 using the terms health literacy, hemodialysis, dialysis, CKD, and ESRD. We included studies from 2010-2021 that involved adult patients. Screening title, abstract, and full text were conducted to check each study's eligibility.

Results: A total number of eight of 1223 articles were included, with 2,036 respondents. Most included studies found that patients had a low level or inadequate health literacy (n = 5). In contrast, one study shows moderate health literacy (n = 2), and one article found a good level of health literacy. Higher health literacy was shown can improve patients' quality of life. The review summarizes several factors influencing health literacy, such as education, health care providers, life experiences, happiness and anxiety.

Conclusion: The review shows that most studies found lower health literacy levels. It is expected that nurses and healthcare professionals can improve health literacy which could positively impact patients' quality of life.

Infections caused by parasites infect millions of people worldwide, especially in developing countries. Most parasites have a life cycle that lives in hosts (animals or humans) and the environment; thus, the One Health approach is an advanced strategy to overcome these challenges. Recently, One Health has become important as it considers several factors of the connection between humans, animals and the environment. This study aims to understand the One Health Approach as a strategy to prevent and control parasitic zoonosis globally and in Indonesia. We used a literature review using PubMed and Google Scholar based on PRISMA guidelines. Our review identified 22 recommendations and applications of the One Health strategy to handle zoonotic parasitic diseases globally and in Indonesia. There are theoretical and practical gaps in the implementation of this strategy. Further studies are needed to implement better One Health of combating parasitic zoonosis globally and in Indonesia.

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.

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: Pregnant women with congenital heart disease tetralogy of fallot who undergo cesarean section have their own challenges for the anesthesiologist, not to mention if they have pregnancy complications such as placenta previa. The choice of the safest anesthetic technique is still debated today. The anesthetic technique must be able to maintain systemic vascular resistance, avoid increasing pulmonary vascular resistance, and be aware of the threat of blood loss due to placenta previa.

Case Report: 29 years old pregnant woman, weighing 46 kg and height 155 cm, G1P0A0, Gravida 27-28 weeks, single alive fetus, fetal distress, comes with complaints of shortness of breath, vaginal bleeding due to placenta previa with tetralogy of fallot planned emergency cesarean section. The patient presented with functional class NYHA II-III. We used low-dose spinal anesthesia with 5 mg bupivacaine 0.5% and 25 ug fentanyl as an adjuvant. Colloading was done with gelofusin colloid fluid to replace the amount of bleeding. Hemodynamics prior to anesthesia were BP 120/80, Heart Rate 80 x/minure, SpO2 72% with a non-rebreathing mask 10 litre/minute. There was no severe hypotension during surgery, and was hemodynamically stable with limited use of vasopressors. After the cesarean section was completed, the patient was transferred to the ICU and treated for 2 days, and was only discharged after 5 days of treatment without additional complications.

Conclusion: The use of low-dose spinal anesthesia in combination with adjuvant fentanyl results in a relatively safe anesthetic technique with minimal hemodynamic changes and adequate analgesia for cesarean delivery.

Background: Spinal cord injury is not only caused by trauma but also by non-trauma, such as spinal epidural abscess (SEA). Tuberculous SEA is a rare infectious disorder, a delayed diagnosis associated with morbidity and mortality. The problems of tuberculous SEA is not only infection but also neurological deficit, axial back pain, pathological fracture, deformity, and socioeconomic and psychogenic problem. There are a few cases of SEA caused by Mycobacterium tuberculosis, mostly caused by Staphylococcus aureus with decreasing body’s defense mechanism caused by a deficiency of vitamin D. This study aimed to evaluate the neurological recovery of non-traumatic spinal cord injury caused by spinal tuberculosis with spinal epidural abscess and vitamin D deficiency that treated with vitamin D as an adjuvant.

Case Report: A 31-year-old female came to the orthopedic clinic with paraparesis ASIA grade C, axial back pain, and spinal deformity for three months, with vitamin D levels of 15.5 ng/ml. MRI showed epidural abscess at the level of the 10th-11th thoracic vertebrae, spondylodiscitis of the 10th-11th thoracic vertebrae accompanied by paraspinal abscess of the 8th thoracic vertebrae to the 1st lumbar vertebra. The diagnosis was confirmed by cultured and histopathological examination. The treatment was surgery, followed by anti-TB drugs and daily vitamin D 5000 IU for one year. After one year of follow-up, the patient returned to work without a neurological deficit and axial back pain.

Conclusion: This report describes the importance of early diagnosis and proper treatment of spinal cord injury in tuberculous SEA with a deficiency of vitamin D.

Introduction: Sezary syndrome defined as a set of symptoms consist of erythroderma, generalized lymphadenopathy, and Sezary cells were detected in peripheral blood, skin and lymph nodes.

Case: Patients with chief complaints red and scaly patches cover almost part of the body accompanied by itching since 1 week ago. The patient had history of taking herbal medicines 2 weeks earlier. There is an erosion and crusting at inferior lips. There is also fissure at left side ventral hand region. There is no generalized lymphadenopathy. The patient has fever, hypertension and hyperglycemia. The laboratory result showed leukocytosis with Sezary cells > 1000 cells/mm³, and bacteremia (coccus). Differential diagnosis of patients was Sezary syndrome, drug-induced erythroderma and mycosis fungoides. The diagnosis was Sezary syndrome because erythroderma and Sezary cells > 1000 cells/ mm³ were found. The patient was treated with injection of corticosteroid, antibiotic, barrier repair moisturizer and potent topical corticosteroid.

Conclusion: Sezary syndrome is often accompanied by bacteremia due to impaired skin barrier function and decreased cellular immunity. Examination of biopsy, bacterial culture and flow cytometer is required for diagnosis.

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. 

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.