Background: Special needs students come from many diverse and different family backgrounds. It may become a factor in special needs student learning performance. The purposes of this study are to find out how family background can affect special needs students in Pronunciation mastery and the process of special needs students in pronunciation mastery.

Methods: This study is a descriptive qualitative study using the case study method with three data collections. There are interviews, observations, and documentation. It becomes a unique single case study because the object of the study is an autism spectrum disorder student who continues his study until college and has good English pronunciation.

Results: The result of the study found that the most influential factor that can affect an autism spectrum disorder child’s pronunciation mastery is family motivation. The term motivation here is the desire from the parents who want to develop their skills and also motivation to develop their special needs child, in the hope that the special needs child can be Independent with their skills.

Conclusion: This autism spectrum disorder student has certain unique repetitive behavior: checking an English word through google translate. He often listens to how to pronounce words correctly. Although the parents come from a low social class, they can still improve their special needs child's Pronunciation by giving a supportive educational environment.

Background: Burns is one of society's most common types of trauma. It is estimated that around 1.2 million people experience burns each year and 100,000 of them require hospitalization. The giwang fern cactus leaf (Euphorbia milii) extract contains many antimicrobial compounds in almost all plant parts. This study determined the effect of giwang fern cactus leaf extract (Euphorbia milii) on the number of fibroblasts in burnt white rats infected with Pseudomonas aeruginosa.

Methods: This experimental study uses a randomized post-test research design with a control group using three groups of rats. The data results were analyzed statistically using a parametric test with Anova (One Way Anova). Data were analyzed using SPSS version 20.0 for Windows.

Results: This study showed that the 50% giwang fern cactus leaf (Euphorbia milli) extract had the highest average number of fibroblasts (38.3±8.77), compared with the control (23.3±1.86) and P1 group (25%) (27.6±6.65). Based on the analysis test, it is known that there is a significant comparison between groups (p<0.05).

Conclusion: There is a significant difference in the number of fibroblast cells among groups after providing giwang fern cactus leaf (Euphorbia milii) extract.

Link of Video Abstract: https://youtu.be/8WQpmpndIfA

Background: Bipolar Transurethral Vaporization of the Prostate (B-TUVP) is a surgical technique for Benign Prostatic Hyperplasia (BPH) patients that known for its technical reliability, short operating time, and low risk of intraoperative bleeding. However, despite these advantages, it appears to be an unpopular choice among urologists. Previous studies have produced conflicting results when comparing B-TUVP to Transurethral Resection of the Prostate (TURP), particularly bipolar TURP (B-TURP). To date, no studies have directly compared the efficacy and complications of B-TUVP and B-TURP, which using the same energy type. Therefore, the objective of this study is to compare the efficacy and potential complications of these two modalities for the treatment of BPH.

Methods: The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) were followed to perform a systematic search in six databases. The risk of bias in RCT was evaluated using the Cochrane Risk of Bias (RoB) tool version 2. The Review Manager® 5.4 software was used for analyzing all the data.

Results: Six eligible RCTs were included with a total of 940 samples. International Prostate Symptom Score (IPSS), fastest flow rate (Qmax), and post void residual (PVR) were not significantly different, while the quality of life (QoL) score (SMD = -0.64; 95%CI = -1.09 – -0.18; I² = 86%) were significantly lower in B-TUVP (p < 0.05).  Hemoglobin drop (SMD = -2.05; 95%CI = -2.78 – -1.31; I² = 95%), catheterization period (SMD = -1.14; 95%CI = -1.45 – -0.84; I² = 60%), and hospital stay (SMD = -0.68; 95%CI = -1.04 – -0.31; I² = 61%) were significantly lower in B-TUVP (p < 0.05). The analysis of complications did not differ significantly between the B-TUVP and B-TURP groups.

Conclusion: B-TUVP had similar short- to medium-term efficacy and complications as B-TURP, with advantages in terms of significantly better QoL score, lower hemoglobin drop, shorter catheterization period and hospital stay.

Introduction: The COVID-19 pandemic has not only had an impact on health problems, but also brought many changes in other aspects of human life, including the education sector. Difficulty in adapting with the learning process can affect the mental health, especially medical students who are quite susceptible to depression and anxiety. We aimed to aims to provide an overview of mental health problems in medical students during the COVID-19 pandemic.

Method: The method used was an online cross-sectional survey using student characteristics instruments, the GAD-7 and PHQ-2 questionnaires. Respondents were 7949 medical students from 49 medical faculties in Indonesia from February to May 2021. All data were analyzed by univariate and bivariate statistics to see the relationship between several variables using SPSS version 22.0.

Results: The majority of respondents were women (69.4%) with an average age of 20.9±2.1 years and domiciled in Java (63.4%). The survey was joined by students from all years of education and the most followed by students in the second year (20.3%). Based on the GAD-7 questionnaire, 3471 respondents (43.7%) experienced symptoms of anxiety (mild, moderate, severe) and the most experienced mild anxiety (29.8%), while from the PHQ-2 questionnaire it was found that 1332 respondents (16.8%) experienced symptoms of depression. Analysis of the mean GAD-7 and PHQ-2 on several factors (gender, year of education, education phase, and place of domicile showed a significant relationship (p<0.05), except for the PHQ-2 score which was not significant for place of domicile (p=0.06).

Conclusion: The results of this survey describe the mental health conditions of medical students in Indonesia during the pandemic. This study emphasizes the importance of early detection, support, and mental health services to improve the ability and resilience of medical students in dealing with various changes during the COVID-19 pandemic.

Background: Diabetes mellitus (DM) could hamper the immune responses, including that induced by the vaccine. The aim of this study was to evaluate the immunogenicity of coronavirus disease 2019 (COVID-19-19) inactivated vaccines in patients with DM either controlled or uncontrolled through a systematic review approach.

Methods: Without regard to time constraints, searches were conducted in ProQuest, Embase, and PubMed  to assess the available data on the impact of DM regulation on the immunogenicity of post-vaccinated DM patients. The PRISMA guideline and the PICO criteria were used. The quality of studies was assessed using the National Institutes of Health (NIH) quality assessment tool. There is not enough Available data comparing the immunogenicity of the vaccine in controlled and uncontrolled DM patients is limited.

Results: Out of 20,657 articles, five studies were included, of which three had good quality and two had fair quality. Our data suggested that DM patients vaccinated with CoronaVac/SinoVac had lower seroconversion rates significantly lower compared to non-DM patients. The immunogenicity of BBV-152 vaccine in DM patients was also significantly lower than in patients without DM. Studies comparing the immunogenicity of the vaccine between controlled and uncontrolled DM patients are limited.

Conclusion: Patients with DM have lower antibody levels than non-DM patients who received inactivated COVID-19 patients. Glycemic management has emerged as critical to maximizing the immunogenicity induced by inactivated vaccines in a small number of patients; however, to support this conclusion, studies with adequate number of patients are critical.

Link of Video Abstract: https://youtu.be/-B5Z8H6e4o0

Background: During pandemic, the amount of screen time in individuals is tremendously expanding. Excessive screen time may result in eye blinks reduction, tears evaporation, and eventually dry eye syndrome (DES). This study aims to show the descriptions of the duration of screen time and dry eye symptoms in medical students during the pandemic.

Methods: This study uses a descriptive and cross-sectional methods.  The subjects were students of The School of Medicine at UIN Alauddin Makassar, who were undergoing online learning. The data were collected through a questionnaire containing subjects' activities using gadgets per day and the Ocular Surface Disease Index (OSDI) to assess dry eye symptoms. Ophthalmological examinations for DES (blink rate, tear meniscus height, tear break-up time, Schirmer test) were also performed on the study subjects.

Results: Most of the subjects are female and 22 years old. The average screen time of the subjects was 17.7 hours per day. Two subjects (4.55%) had mild dry eye symptoms, 14 subjects (31.82%) had moderate dry eye symptoms, and 28 subjects (63.64%), had severe dry eye symptoms. This study also found that the average blink rate of the subjects was 11.36±7.45 times per minute, and the average TBUT value was 10.58±2.69 seconds. Schirmer 1 examination showed a value with a mean of 23.67±12.76 mm, and Schirmer 2 examination showed a value of 20.21±11.64 mm.

Conclusion: The average screen time of the subjects was 17.7 hours. Most subjects had severe dry eye symptoms (63.64%) and low blink rate (59.09%).

Background: Riskesdas in 2018 showed that the Caesarean birth rate in Indonesia was 17.6%. In addition to the many benefits of Caesarean section, postoperative patients face various problems ranging from healing after surgery, lactation process constraints and other discomforts. Various studies have been carried out to prove the superiority of the Enhanced Recovery after Caesarean Surgery (ERACS) method. This investigation seeks to evaluate the impact of ERACS on postoperative discomfort and the beginning of colostrum excretion.

Methods: In this study, a control group was used in a quasi-experimental study to assess the degree of postoperative discomfort and the beginning of colostrum excretion between the control group (non-ERACS) and the treatment group (Sectio Caesarean with ERACS method). For this study's simple random sample, there are 30 respondents in each group. The Chi-Square and multivariate logistic regression tests were used to evaluate the data and discover the variables' relationship.

Results: Based on the data analysis, it was found that ERACS was effective in reducing post-operative pain (p<0.001), and the coefficient of determination is 0.645, which means that the ERACS can influence 64.5% of the variation in the postoperative pain score variable. ERACS method is ineffective for accelerating the onset of colostrum excretion p=0.267 (p>0.05).

Conclusion: The type of mother's birth, the mother's psychological changes, pain, and the administration of medicines to the mother are all factors that can impact the mother's ability to excrete colostrum right away after delivery.

Background: Diabetes mellitus is becoming a public health problem and can be found in every population, including a pregnant women. Hyperglycemia conditions in pregnancy can lead to gestational diabetes mellitus involving proinflammatory cytokines such as Tumor Necrosis Factor-Alpha (TNF-α) and Transforming Growth Factor- β (TGF-β). Isothiocyanate is a bioactive compound found in Moringa leaf extract with anti-glycemic activity and anti-inflammatory effects. This study aims to evaluate the impact of isothiocyanate therapy on trophoblast cell culture-hyperglycemia atmosphere toward the levels of tumor necrosis factor- α (TNF-α) and transforming growth factor- β (TGF-β).

Methods: An experimental study with a post-test-only control group design was conducted using trophoblast cell culture from placental tissue. To create a gestational diabetes event, glucose was administered into the trophoblast cell culture. The sample was divided into six groups: negative control without treatment, positive control by glucose administration, and treatment groups P1, P2, P3 and P4 with the treatment of isothiocyanate with doses of 0.1; 0.2; 0.4 and 0.8 mg/ml, respectively. The TNF-α and TGF-β levels in each group are quantified using immunoassay by ELISA method.

Results: The mean TNF-α in the negative control, positive control, P1, P2, P3, and P4 groups were 20.59, 43.54, 32.76, 30.15, 27.32, and 24.05, respectively. While the mean of TGF-β levels in the negative control, positive control, P1, P2, P3, and P4 groups were 15.76, 10.44, 11.05, 11.70, 12.46, and 14.32, respectively. The lowest TNF-α and the highest TGF-β levels were found in the treatment group (P4) that received isothiocyanate with a dose of 0.8 mg/ml.

Conclusion: The administration of isothiocyanates from Moringa leaf extract significantly lowered the level of TNF-α and increased the level of TGF-β in hyperglycemic trophoblast cell culture compared with the positive control group.

Link of Video Abstract: https://youtu.be/Pp9SqvVDzlw

Backgrounds: The COVID-19 outbreaks began at 2020 and spreading fast throughout the world. Infection in pregnancy is associated with increasing number of mortality and morbidity reports as well as increasing reports of preeclampsia (PE) cases complicating the cases. This study aimed to analyze the impact of preeclampsia  on the outcome of COVID-19 patients during pregnancy and determine the effect of these variables on maternal and neonatal morbidity and mortality.

Methods: A retrospective study was performed on 711 COVID-19 patients admitted at Dr. Soetomo Hospital during 2020 - 2021. Demographic, clinical, laboratory, complication, and patient outcomes data were collected. Patients were then classified as COVID-19 with preeclampsia and COVID-19 without preeclampsia. Data were collected from hospital medical records, and statistical analysis was carried out to analyze these variables.

Results: We reported 711 pregnant patients with COVID-19, of which 510 patients (72%) had no preeclampsia and 201 patients (28%) had preeclampsia. There were statistically significant differences in maternal age, referral status, gestational age at admission, comorbidities, complications, and symptoms of COVID-19. COVID-19 with PE had higher comorbidities and severe performance than COVID-19 without PE : > 50% were preterm pregnancy, oxygen saturation < 90% on admission reported on 5.9% cases, 35.8% had symptoms, 20.4 % cases suffered severity/ critical condition, 24.4% need ventilation support. However, there was no significant difference in maternal death cases between COVID-19 with and without PE. Risk analysis shows an increased risk of morbidity in pregnant patients with COVID-19 infection: pulmonary edema, critical condition, ICU admission, and Ventilation needed with OR 18.9, 12.5, 5.1, and 2.7, respectively. 

Conclusion: Preeclampsia increases the risk of morbidity in COVID-19 pregnant patients.

Link of Video Abstract: https://youtu.be/j5NtdcbvTE4

Background: Concern for behavior change in compliance with health protocols during this pandemic continues to increase, especially when the coronavirus disease (COVID-19) vaccination is carried out. During the initial pandemic, the public perceived it as risky to be infected with COVID-19. However, this situation manifests itself in the emergence of a phase where public awareness of wearing masks, maintaining distance, and washing hands is decreasing. This study aimed to understand the impact of implementing the vaccine on the compliance behavior of wearing masks, washing hands, and keeping a distance, as well as attitudes towards behavior complying with health protocols during the COVID-19 vaccination period and the implementation of level 1 restriction on community activities (PPKM).

Method: We used a cross-sectional design, recruiting 110 respondents at the Menteng Primary Health Care Center, Palangka Raya City. Recruited patients were those over 18 years of age. This research instrument is an adaptation of several research questionnaires carried out in Indonesia, and we asked respondents using Indonesian.

Results: Of the 110 respondents, 59.1% were dominated by women, and 61.8% were in the 17-25 age group. A total of 106 respondents (96.4%) revealed that they had received information regarding health protocols. More than 70% obtained information from television (77.3%). Only half of the respondents received the 3rd dose or booster I. Knowledge was not the dominant factor influencing adherence to health protocols, but people's attitudes towards the Covid-19 health protocol. No relationship was found between knowledge and people's behavior toward health protocols.

Conclusion: Most of the respondents (80%) still adhere to health protocols as recommended by the government even though 74.5% of the people have received the 2nd and booster doses of the vaccine.

Introduction: The use of a tourniquet in lower extremity surgery can help surgeons optimize the surgical field. However, tourniquet inflation may create ischemic conditions in the extremity, and tourniquet deflation may pose a risk of ischemic reperfusion injury (IRI). Ischemic conditions can increase the production of reactive oxidative stress (ROS), which, if it occurs simultaneously with IRI, will produce malondialdehyde (MDA), a toxic metabolite. The prolonged use of tourniquets can cause damage to the local skin tissue at the tourniquet inflation and poses a risk of IRI to other organs. This study aims to observe the effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets.

Methods: This study is an observational study with a prospective cohort design to measure malondialdehyde levels in lower extremity surgery using tourniquets. When the data were normally distributed, a statistical test was performed using an independent sample t-test to compare the demographic data of the two groups. To compare the results of the observation after the induction, 15 and 120 minutes after the release of the tourniquets, a repeated measures ANOVA was performed when the data were normally distributed. Then, to examine the correlation between variables, Spearman's correlation test was applied when the data were not normally distributed.

Results: In this study, almost all the subjects in the isoflurane and dex-iso groups had no significantly different characteristics, and also showed no effect of tourniquet pressure on malondialdehyde levels.

Conclusion: Based on statistical analysis and discussion of the effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets, it can be concluded that there was no statistically significant effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets.

Link of Video Abstract: https://youtu.be/FvU45HL3HyE

Introduction: Human amniotic membrane and platelet rich fibrin (PRF) are biological materials that can accelerate wound healing through their content of growth factors and cytokines. This study aimed to determine the effectiveness of the combination of these two biological agents for wound healing.

Methods: This study used an experimental method with a randomized post-test only control group design, to compare the use of human amniotic membrane alone with a combination of human amniotic membrane and PRF in acute full thickness wounds of the skin of Wistar rats. The research subjects were 32 rats which were divided into four groups. Groups 1 and 2 used human amniotic membrane, while groups 3 and 4 used a combination of human amniotic membrane and PRF, then the epithelialization process was observed on the 3rd and 6th day.

Result: There was no statistically significant difference in the speed of epithelialization of excision wounds on the backs of rats on the third day (Significance 0.498) and Sixth (Significance 0.9) between the Amnion group and the combination of amnion and PRF because it was greater than α = 0.05.

Conclusion: The use of a combination of freeze dried human amniotic membrane and platelet rich fibrin was not significantly more effective than freeze dried human amniotic membrane in accelerating the epithelialization of acute full thickness excision wounds in rats (Rattus novergicus).

Introduction: Iron deficiency anemia (IDA) is still a problem of pregnant women's health related to its high prevalence and its negative effects on health. Prevention efforts have been carried out through administration of oral iron tablets to women during their pregnancy; however, the expected results have not been satisfied yet. This failure is probably due to the assumption that, especially in developing countries, the iron store in pre-pregnant women is very low or may be empty, so that iron supplementation during pregnancy is not enough to prevent IDA. The aim of study is to know the difference of effect of iron supplementation in treated and control groups in terms of hemoglobin concentration, serum ferritin level and prevalence of IDA.

Method: A quasi-experimental study was conducted on 99 non-pregnant new couple women. Iron tablets were administered to the treated group from the beginning of pre-pregnant period, continuing until the first 3 months of pregnancy, while in the control group iron tablets were only given during the first 3 months of pregnancy.  IDA was measured by serum ferritin and hemoglobin concentration using WHO’s criteria, the benefit of iron tablet was measured by BCR technique.

Result: The administration of an oral iron tablet from the prepregnant period (treated group) could decrease prevalence of IDA higher than the administration of oral iron tablet during pregnancy only (control group) (0% vs 38.46%, p<0.05). A significant difference was also observed on mean serum ferritin concentration at the end of observation (the third month of pregnancy) 33.45±14.12 µg/dL in the treated group, and 19.65±8.99 µg/dL in the control group. This difference was statistically significant (p<0.05). Meanwhile, the hemoglobin concentration was 12.25±1.20 g/dL in the treated group and 10.91±0.67 g/dL in the control group. This difference was also statistically significant (p<0.05). Benefit analysis showed that administration of an oral iron tablet starting from pre-pregnancy is more advantageous (BCR >1) compared to oral administration of iron tablet during the pregnancy period only. There were no significant differences in side effects and compliance of the patient to consume iron pills in both treated and control groups.

Conclusion: The administration of oral iron tablets (iron supplementation) to pregnant women starting from pre-pregnant period results in a better effect compared to oral iron supplementation during pregnancy only. This program is feasible to be implemented in a community setting because its compliance is good.

Link of Video Abstract: https://www.youtube.com/watch?v=RG95aJkUndg

Background: Thalassemia and hemoglobinopathies are caused by mutations in the globin genes that reduce haemoglobin synthesis. In many Asian countries, including Indonesia, thalassemia is a common inherited disorder. Thalassemia has specific characteristics due to the wide variability of the mutations from various populations. Therefore, screening protocol should be designed on specific populations’ regional gene mutation patterns. This study aims to investigate the mutational diversity of the globin genes in thalassemia major patients in Rembang Regency, Central Java, Indonesia.

Methods: Genetic mutations were carried out in all major thalassemia patients who were recorded and underwent routine blood transfusions at the Rembang District Hospital from 2018 – 2020. Mutation identification was carried out using a PCR- RFLP  (Polymerase Chain Reaction-Restriction Fragment Length Polymorphism) based method, the ACRS (Amplified Created Restriction Site) method, and genome sequencing.

Results: The most common genotypes are double heterozygous HbE and Cd 35 mutation (-C) (42.87%), HbE and IVS1-nt.5 mutations (G> C) (28.57%), HbE and IVS1- nt.2 mutations (T> C), HbE and codon 8/9 (insertion + G), codon 8/9 (insertion + G) and Hb Malay, as well as Hb Adana and Hb Constant Spring (1.74%).

Conclusion: The β-thalassemia and α-thalassemia mutations most commonly found in Rembang Regency are Cd 35 (-C) and non-deletional mutations.

Link of Video Abstract: https://youtu.be/szoOkhYlQwY

Introduction: The pandemic of COVID-19 has put healthcare workers under high pressure with possible psychological problems and its most common effects are insomnia, depression, distress, anxiety, and somatization symptoms. Previous studies in several centers have shown different results between frontline and non-frontline healthcare workers. This study aims to evaluate the levels of anxiety and perceived needs for mental healthcare among non-frontline healthcare workers during the COVID-19 pandemic in a referral hospital in Surabaya.

Patients and methods: This cross-sectional study involved forty respondents, but one was discontinued due to technical problems. Questionnaire of The Hospital Anxiety and Depression Scale (HADS) was adopted that has 14 scales with two subscales. The subscales include HADS-A for Anxiety and HADS-D for depression

Results: The results show that both HADS-A and HADS-D have significant differences between the indirect and direct groups of contact healthcare workers, except in gender and depression, as shown in Table 3, with an average score of 8.000 (SD 5.02169) and 8.7333 (SD 4.71270), respectively.

Conclusion: Anxiety and depression remain a problem for all healthcare workers, whether frontline or non-frontline. Therefore, issues must be used to mitigate both the frontline and non-frontline healthcare workers.

Background: The COVID-19 pandemic mandated people to use masks to control the disease spreading. However, mask usage can cause skin-related problems such as acne, which is called maskne. This study aimed to find out whether there is a relationship between the use of masks and the event of maskne in Universitas Sumatera Utara (USU) Hospital healthcare workers during the COVID-19 pandemic.

Subjects dan Methods: This study was an observational analytic study with a cross sectional approach with consecutive sampling methods involving 100 healthcare workers at USU Hospital. Diagnosis of maskne was established through history taking and dermatological examination. The data collected was analyzed using Chi-square, Kruskal Wallis and Fisher Exact tests. This research has received approval from the Research Ethics Commission of the Faculty of Medicine Universitas Sumatera Utara and Universitas Sumatera Utara Hospital.

Results: Maskne was more common in women (84.9%) in the age group 26-35 years old (69.9%). Doctors and nurses (31.5%) had more maskne, polyclinic (23.3%) was the work location that often has maskne. The use of medical masks (74.0%) had a significant relationship with the event of maskne (p=0.002), while the duration of wearing masks was 36 hours/day (80.8%), frequency of masks replacement 2 times/day (52.1%) and using 1 layer of masks (74.0%) was more often found in subjects who has maskne but did not have a significant relationship with the event of maskne.

Conclusion: There is a relationship between the use of masks and the event of maskne based on the type of masks in healthcare workers Universitas Sumatera Utara Hospital during the COVID-19 pandemic.

Background: Soft tissue engineering has widely explored freeze-dried human amniotic membrane (FdHAM) and human adipose-derived stromal cells (hADSC) as separate components. In this study, the composite of FdHAM and hADSC combination was investigated regarding cell morphology and density, constituent components, and cytotoxicity evaluation.

Methods: In vitro experimental laboratory research was conducted to analysis of the FdHAM and hADSC composites. Evaluation of cell viability and CD105 for hADSC, evaluation of pore diameter for amniotic membrane and assessment of composite cell morphology, constituent components, evaluation of cytotoxicity, and cell density was conducted.

Results: Our morphology data indicated that clusters of hADSC with homogenous distribution on FdHAM. The viability test showed that the hADSCs were still dominantly alive with an average percentage of 69.3% with the mean cell concentration being 1.53 x 10⁶/mL. The average FdHAM pore diameter was 1.90±0.30 µM. Our data suggested that FdHAM was nontoxic with good cell survivability after exposure to FdHAM.

Conclusions: The structure of FdHAM and hADSC has excellent basic properties and therefore suitable for use as carriers of hADSC or in soft tissue engineering. Compared to the available literature, the characteristic of the FdHAM and hADSC composite is ideal and may be used as an end-product for use in humans.

Introduction: Inverted papilloma is a benign tumor that generally arises from the lateral wall of the nasal cavity and mostly grows on the middle meatus.The incidence is rarely found in the ear, throat, nose, throat, head and neck, which is around 0.5% -4% of all nasal and paranasal sinus tumors.The etiology of inverted papilloma remains unknown.Clinical features of inverted papilloma are unilateral nasal obstruction, rhinorrhea, epistaxis, anosmia, tinnitus and some other symptoms.The diagnostic examination are histopathological examinations, CT scans and magnetic resonance imaging (MRI). Histopathology is the gold standard in diagnosing of inverted papilloma.Management of inverted papilloma is carried out with surgical approach including lateral rhinotomy, maxillectomy, degloving, and non-invasive surgery via endoscopy depending to the krouse classification.

Case description: A 44-year-old female patient diagnosed with inverted papilloma was reported.The patient complained of progressive right nasal obstruction appeared two years ago which turned into total obstruction and rhinorrhea in the last 6 months.A biopsy was done with the result of inverted papilloma. CT scan of the paranasal sinuses showed a mass filling the right nasal cavity, right maxillary sinus and right ethmoid sinus. Patientwas diagnosed with sinonasal inverted papilloma with Krouse 2 classification based on clinical examination, radiological findings and preoperative endoscopy. The patient was treated with sinonasal inverted papilloma extirpation via endoscopic approach.

Conclusion: Inverted papilloma is a benign tumor of the nasal and paranasal sinuses in which biopsy is the gold standard for diagnostic test while the main treatment is done by surgical approach depending on the krouse classification.

Ocular chemical trauma is a true emergency in ophthalmology. Chemical trauma on the ocular area may disturb vision, reduce the quality of life, and functional state. Prompt and adequate treatment is needed to prevent further complications, such as a decrease in vision due to corneal neovascularization. Treatment started with immediate eradication of the chemical agent by continuous rinsing and followed by inflammation and epithelial defect control. Medroxyprogesterone and doxycycline are two common treatments used in ocular chemical trauma. We speculate that both medications may influence VEGF expression and corneal neovascularization in corneal alkali trauma. It was demonstrated that medroxyprogesterone and doxycycline reduce the expression of VEGF, hence, reducing corneal neovascularization.

Introduction: School closures and online learning during the Coronavirus Disease-19 (Covid-19) pandemic have raised concerns about school-aged children's learning loss during the epidemic. This study aims to evaluate the effects of school closures and online learning during the Covid-19 pandemic on the academic performance of elementary school-aged children in East Java.

Methods: The data taken were basic characteristic data as well as academic performance statistics in Mathematics, Indonesian Language, and Science from six elementary schools in two major cities (Surabaya and Sidoarjo) during the 2018–2019 and 2021–2022 academic years. Inclusion criteria were the academic reports of fourth- through sixth-grade elementary school-aged children. Chi-Square, ANOVA, and independent sample T-test were used for statistical analysis.

Results: Overall, academic performance decreased near the end of online learning as compared to the beginning of online learning (87 ± 5.8 vs. 84.7 ± 6.2; p-value = 0.043). Lower academic performances were also shown by children from private schools during online learning compared to before online learning (89.9 ± 4.7 vs. 87.8 ± 4.9; p-value = 0.003), and at the end of online learning compared to the beginning of online learning (89.8 ± 4.5 vs. 86.9 ± 3.3; p-value = 0.013). Lower academic performance was also shown by children in Sidoarjo during online learning compared to before online learning (90.4 ± 4 vs. 89 .1 ± 2.9; p-value = 0.009), and at the end of online learning compared to the beginning of online learning (90.3 ± 3.5 vs. 88 ± 2.1; p-value = 0.004).

Conclusion: We found differences in children's academic performance at the beginning and end periods of online learning, as well as differences between private and public school students. Considering online learning has impacted children's academic performance, offline learning should be undertaken to optimize comprehension effectively.

Link of Video Abstract: https://youtu.be/8kcI8mX5A6Y

Background: Hemodialysis vascular access dysfunction is a significant cause of morbidity and mortality in hemodialysis patients. Over the past decades, numerous animal models have been developed. However, there needs to be more animal model protocol with rabbits to investigate neointimal hyperplasia in the arteriovenous fistula. This study aimed to explore an alternative rabbit model using a wild-type local model for investigating neointimal hyperplasia in the arteriovenous fistula.

Methods: One local-type male rabbit performed arteriovenous fistula, in which the right carotid communis artery was anastomosed end-to-side to the right internal jugular vein. When examining vascular tissue, measurements were taken of the thicknesses of the tunica intima and tunica media, as well as the areas of the tunica intima and tunica media, vascular diameters, and vascular lumen areas.

Result: We successfully induced neointimal hyperplasia in local-type rabbits, indicated by increased tunica intima thickness after 28 days of the arteriovenous fistula procedure.

Conclusion: Optimation of the Rabbit model using a wild-type local model for investigating neointimal hyperplasia in arteriovenous fistula may be susceptible and considered as it is accessible and cost-effective besides producing the same outcome as a laboratory rabbit

Link of Video Abstract: https://youtu.be/mYpKu0PcJrM

Background: Colorectal cancer remains as the major problem worldwide. Numerous studies have investigated factors associated with mortality and recurrence rates in colorectal cancer. To facilitate the everyday use of mortality predictors, they should be incorporated into a prognostic scoring system. This study aimed to identify factors affecting mortality in resectable colorectal cancer patients after surgery and to develop a prognostic scoring system capable of predicting mortality in these patients.

Methods: This retrospective cohort study involved colorectal cancer patients at Cipto Mangunkusumo Hospital, Indonesia, from January 2016 – April 2020 diagnosed with resectable colorectal cancer. Data were collected from medical records, operation reports, histopathology reports, and laboratory test results. Mortality was assessed three years after curative surgery.

Result: A total of 214 resectable colorectal cancer patients were included in the study. Tumor size ≥ 5 cm, T3/T4 staging, absence of adjuvant chemotherapy, unachieved free circumferential margin, and CEA levels > 11.4 ng/mL were significantly associated with increased three-year mortality. The constructed three-year mortality prognostic scoring system was able to predict outcomes with a sensitivity of 91.3% and a specificity of 67.6%.

Conclusion: The prognostic scoring system, consisting of five variables, is significantly capable of predicting three-year mortality rates with high sensitivity

Link of Video Abstract: https://youtu.be/2L4njgfd3SE

Background: The dissemination of coronavirus disease (COVID-19) has led to delayed infertility treatment and fear of contracting the virus which can affect the mental status of women with infertility. This research aimed to investigate whether fear, depression, perceptions, and knowledge related to COVID-19 affected infertility patients in seeking treatment and analyzed factors associated with depression during COVID-19 pandemic.

Method: This is a cross-sectional study utilizing an electronic survey distributed to infertility patients attending fertility services between May and July 2021. The primary outcomes were demographic characteristics, clinical parameters of infertility, depressive symptoms based on the Patient Health Questionnaire-9 (PHQ-9) score, and fear of COVID-19 scale (FCV-1 and FCV-2).

Results: A total of 533 patients were included. The fear of infertility treatment suspension due to COVID-19 was perceived by 34.1% of patients. The mean Patient Health Questionnaire-9 (PHQ-9) score was 4.55 ± 4.248, with mild depression occurring in 33.4% of patients. Low income, delayed treatment, and fear of COVID-19 scale (FCV-1) score together could significantly predict depression status. Despite the pandemic, 94.7% of patients decided to continue the treatment.

Conclusion: The COVID-19 pandemic has given rise to stressors that may aggravate the psychological condition of women with infertility. However, the enthusiasm to continue the treatment remains undisturbed. It is imperative to offer emotional support and address the consequences of COVID-19 infection in women with infertility during the pandemic era.

Link of Video Abstract: https://youtu.be/ZNusQRjFEH0

Introduction: Several methods have been explored to increase the effectiveness of prostate-specific antigen (PSA) for prostate cancer screening. A lower prostate-specific antigen-age volume (PSA-AV) score is associated with higher cancer risk. This study aimed to evaluate the value of PSA-AV scores in the detection of prostate cancer among the Indonesian population.

Methods: A retrospective study was conducted on 844 prostate biopsies performed at our center between January 2015 and December 2019. The score of PSA-AV was derived by multiplication of the patient's age and prostate volume and then division with PSA level. A ROC curve analysis was conducted to determine the cutoff for the PSA-AV score. The sensitivities and specificities of the PSA-AV score were contrasted with total PSA, PSA density, and age-adjusted PSA.

Results: The mean age of the patient was 63.63±8.6 years, with a mean PSA of 16.3±13.9 ng/mL and a mean volume of 42.7±16.0 cm³. Among 844 biopsies, 25.5% tested positive for prostate cancer. Prostate cancer patients had significantly higher mean age, PSA levels, and positive digital rectal examinations (P<0.05). In predicting prostate cancer, the PSA-AV score demonstrated a higher AUC of 0.772, surpassing the AUC of 0.762 achieved by the total PSA. The analysis identified a cutoff of 700 for the PSA-AV score, which showed significant sensitivity (94%) and sufficient specificity (8.4%). These values outperformed the total PSA cutoff of 4 ng/mL (sensitivity 91.6%; specificity 5.4%), PSA density cutoff of 0.15 (sensitivity 85.1%; specificity 30.0%), and age-adjusted PSA cutoff (sensitivity 88.4%; specificity 11.8%). The superiority of the PSA-AV score of <700 was more prominent in the subgroup analysis of patients below 70 years of age and those with a low-moderate prostate volume (<60 cm³).

Conclusions: The PSA-AV score demonstrated superior sensitivities and specificities compared to total PSA, PSA density, and age-adjusted PSA. Therefore, it is recommended to utilize a PSA-AV score of <700, particularly for men below 70 years of age with low-moderate prostate volumes (< 60 cm³).

Link of Video Abstract: https://youtu.be/15Du23GFCWc

Introduction: A niche (also called an isthmocele) is a defect or uterine scar that can be detected by ultrasound a few weeks or months after delivery by cesarean section. A niche is often associated with obstetric complications in subsequent pregnancies, including uterine dehiscence and/or rupture, placenta previa, and placenta accreta. Placenta accreta is characterized by abnormal attachment of the placenta to the uterine wall and is one of the leading causes of maternal morbidity and mortality in developing countries. Therefore, this study aims to evaluate the healing of surgical wounds with the figure of eight suturing techniques.

Methods: This study included 32 primigravida patients who underwent cesarean section at RSIA (Mother & Child Hospital) Rosiva from March 2006 to July 2006. On day 6 of the puerperium, the uterine sutures were examined with transvaginal ultrasound. Patients were subsequently allowed to return to their homes to receive outpatient treatment. On day 40, the patients were requested to return to the hospital for a follow-up ultrasound examination.

Results: On day 6, incomplete wound healing was found in 31 patients (96.9%) and complete wound healing in 1 patient (3.1%). On day 40, 31 patients (96.9%) experienced perfect or complete healing. Statistical analysis showed a significant difference in wound healing between day 6 and day 40 (p = 0.0001).

Conclusion: On day 40 after cesarean section, as many as 96.9% of patients showed perfect/complete wound healing (type I) without a niche. Therefore, these patients had a low risk of obstetric complications associated with uterine scarring in subsequent pregnancies.

Background: With 1 in 10 women receiving a new cancer diagnosis each year, breast cancer is the most frequent cancer among women. Luminal B breast cancer incidence rates are rising in non-Hispanic white women aged 55 to 69 in Asia/Pacific and Indonesia subtype across all age groups. In Bali, Luminal B is the most prevalent subtype with the greatest fatality rate. This study aims to prove the survival analysis of Luminal B subtype breast cancer patients based on lymphovascular invasion (LVI), tumor-infiltrating lymphocyte (TIL), and mammaglobin A expression.

Methods: This study is a survival analysis using nested and prospective cohort methods. Retrospective data were taken from the Cancer Registry and Medical Records (MR) of patients in Sanglah General Hospital, mammaglobin results (Paraffin block test) on anatomical pathology analysis. Statistical Kaplan Meier and Cox Proportional hazard calculations performed with the SPSS program were significant (p<0.05).

Results: The number of research subjects was 60, with 32 subjects dying and 28 still alive until the data collection was completed. There was no difference in age between the two groups. The mean of all ages is 50.12 ± 9.93 years. Positive LVI has 9 months median survival (95% CI 8-10) with p= 0.013 risk 2,797 times. TIL high (positive 2- positive 3) median survival 8 months (95% CI 6.3-9.7) with p=0.003 and risk 3,151 times. Strong expression of mammaglobin A (3-4) had a median survival of 12 months (95% CI 4.4-19.5 months; p=0.015) and risk 3.34 times.

Conclusion: LVI, TIL, and mammaglobin A expression significantly affected poor survival in the breast cancer Luminal B subtype.

Link of Video Abstract: https://youtu.be/Qw5E3Le-WJk

Background: Alkaline trauma of cornea often causes irreversible vision loss, even though it is quickly treated. The effectiveness of anti-inflammatory therapy as a main treatment is still limited clinically, as well as has dangerous side effects. Platelet-rich fibrin (PRF) is quite safe and effective in the treatment of descemetocele and also important in wound healing process. PRF membrane also provides a mechanical function as a framework for cell proliferation, differentiation and migration which is important for tissue regeneration. This study aimed to analyse the effectiveness of PRF grafts on expression of interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) in cornea post NaOH exposure.

Methods: An experimental study was conducted on Oryctolagus cuniculus which was exposed to 1 N NAOH for 30 seconds. The study subjects were 14 rabbits consisting of 7 PRF graft rabbits and 7 control rabbits. The rabbit's right eye was then irrigated, dripped with 1% levofloxacin 1 drop and a PRF graft was placed.

The effectiveness of PRF graft was analysed by percentage of expression of IL-1 and TNF-α in cornea post NaOH exposure

Results: No significant differences were found in expression of IL-1 (p>0.05) and expression of TNF-α (p>0.05) in cornea post NaOH exposure. There was a decrease in the expression of IL-1 between control and PRF graft groups. The combination of the mechanical and chemotactic functions of PRF membranes makes them suitable as an autologous biomaterial for reconstruction, repair, and maintenance of ocular surfaces.

Conclusion: PRF plays a significant role in wound healing and preventing excessive fibrosis, therefore it has the enormous potential to reduce the expression of IL-1 in corneal alkaline damage.

Introduction: The large number of TB cases was  caused by the boredom of treatment for too long, the lack of knowledge of patients about pulmonary TB, the distance between the patient's home and public health services. The purpose was to analyze effect interventions of self-management education based on the health belief model on adherence medications and visiting compliance in pulmonary tuberculosis patients at Community health center Pamekasan Regency.

Method: This research is conducted using a quantitative approach, type of intervention research. Participants in this study were the >20 year old age group. This study has certain characteristics on the selection of subjects; therefore use purposive sampling techniques. Intervention Researchers gave treatment self-management education based on a health belief model. The collected data is then analyzed using a statistical test independent T-test with the level of significance α = 0,05.

Result: The average difference in drug administration adherence in the intervention group was 17.89 with a standard deviation of 9,650. The control group showed a difference in drug adherence value of 5.23 and a standard deviation of 3,456. The average difference in visiting compliance in the intervention group was 15.37 with a standard deviation of 6,130. In the control group it showed a visiting compliance difference value of 5.76 and a standard deviation of 4,162.

Conclusion: There was an influence of self-management education based on health belief model on increasing adherence to taking medications and increasing visiting compliance in tuberculosis patients at community health centers in Pamekasan Regency, East Java, Indonesia

Background: Antenatal depression in pregnant women becomes less of a concern, leading to the worse condition of developing postpartum blues, ranging from moderate to severe degrees. In this study, antenatal depression was detected as a psychosocial impact on pregnant women, and their perspective on accepting pregnancy may alter due to the COVID-19 pandemic.

Methods: This study used a cross-sectional study design. A total of 257 pregnant women were enrolled in this study with a purposive sampling technique. Inclusion criteria: healthy pregnant women (over 18 years) from trimester I until trimester III. Antenatal depression was measured using a PHQ-9 scale questionnaire. Data were analyzed using SPSS version 20.0 for Windows.

Results: The prevalence of antenatal depression of 257 pregnant women was: 80.95% had mild depression, 14.12% had moderate depression, 4.69% had moderate or severe depression, and 0.79% had severe depression. The factor analysis results indicated that refusal of pregnancy had the highest correlation coefficient (coef. 0.586; p=0.000) on the incidence of antenatal depression compared to the history of abortion, parity, financial deficits, and conflicts with partners. During the assessment, pregnant women who reported refusal of their pregnancy felt that their pregnancy was a burden because it occurred at a challenging time.

Conclusion: Changes in psychosocial status through determinants of antenatal depression in pregnant women in East Kalimantan during the COVID-19 pandemic are expected to be the initiation of policy and antenatal depression screening formulation for each pregnant woman and mental health improvement during pregnancy.

Introduction: The active substance of pyrethroids, especially dimefluthrin, in insect repellent not only plays a role in killing mosquitoes but is also toxic to human health. This study aims to analyze the effect of insect repellent exposure on the histopathological findings in the liver and kidneys of the Wistar rat.

Methods: This experimental study used 24 male wistar rats, which were divided into four groups, namely control, type of insect repellent, which included mat electric (dimefluthrin 0.566%), liquid electric (dimefluthrin 0.014%), and coil (dimefluthrin 0.031%), with a duration of exposure a day for 8 hours in 20 days.

Results: There was a significant effect of the type of insect repellent exposure on the histopathological findings of the liver and kidneys (p<0.05). This study also showed the highest rate of cell degeneration and necrosis in the liver and kidneys belonged to Mat electric repellent exposure in the liver and kidney. Higher concentrations of dimefluthrin in insect repellent have a significant effect on the histopathology of the liver and kidney.

Conclusions: The use of mosquito coils, electric mats, and liquid electricity for 8 hours over 20 days affects the histopathological evaluation of the liver and kidneys. The higher the concentration of dimetfluthrin in insect repellent, the higher the level of damage.

Background: Striae distensae (SD) is a harmless skin disorder that can cause cosmetic and psychological problems. Until now, no easy-to-use, useful and non-invasive method can be used to determine the severity of SD. The scoring system can be used as a guide for selecting and administering effective therapy for striae distensae. This study aimed to assess the severity of striae distensae using INA score.

Methods: This research was a descriptive observational study with a cross-sectional approach involving 72 female health workers at the Universitas Sumatera Utara Hospital. The diagnosis of stretch marks is made through history and physical examination. We did the whole body examination for scoring of striae distensae. This research has been approved by the Research Ethics Commission of the Universitas Sumatera Utara.

Results: A new scoring system, namely the INA score, to assess the severity of striae distensae at the mammae, axilla, abdomen, femoral, gluteus, and popliteal locations. The assessment of the INA score based on the entire region of the study subjects was obtained at a mild degree (54.2%). The characteristics of majority of the subjects were in the age range of 18-25 years (93.1%) and had a family history of striae distensae (54.2%). The distribution of the majority of striae distensae locations is in the femoral and gluteus region (47.2%). Based on each region, the majority of the subjects had striae distensae with severe degree in the mammae (20.8%), abdomen (8.3%), femoral (90.3%), gluteus (94.4%), and popliteal (22.2%);. In comparison, the axilla was dominant with a moderate degree (5.5%).

Conclusion: The new scoring system named INA score assesses the severity of striae distensae at the mammary, axillary, abdominal, femur, gluteus and popliteal locations.

Link of Video Abstract: https://youtu.be/5LTsY60dY0s

Background: Myopia is one of the numerous visual problems that continue to increase in incidence throughout the world. Various genetic and environmental factors are thought to influence the onset of myopia. Myopia is known to have a significant impact on the economy, vision problems, and a decrease in quality of life so that it needs serious attention. This study aims to explore the relationship between parental risk factors with degree severity of myopia.

Methods: This study is an analytic observational study research design. The population of this study are patients diagnosed with myopia in the Ophthalmology Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Patients who met the inclusion and exclusion criteria were included as samples. Data are gathered through medical records and by questionnaire, this includes age and spherical equivalent (SE) in right eye or left eye. Degree of severity was classified based on SE. Myopia’s degree of severity and parental history are then analyzed to determine the relationship.

Results: A total 72 patients were included in this study. The majority of participants have a familial history of parental myopia. The degree of severity with the highest frequency is low myopia. The results of statistical tests showed that there was no relationship between history of parental myopia and the severity of myopia in the right eye (RE) (p-value = 0.712) and the severity of myopia in the left eye (LE) (p-value = 0.565).

Conclusion: There was no relationship between the history of parental myopia and the severity of myopia.

Link of Video Abstract : https://youtu.be/umLlj1K4l2w

Background: Depression is one of the most common causes of disability in the world, and one third of patients do not respond to currently available antidepressants, so a strategy is needed in its management. There have been many studies looking for a relationship between the role of the gut and mental health. Probiotics are the focus of much research in the field of psychiatry today due to their alleged role in improving mental health through gut health.

Methods: This research was a true experimental study with a posttest-only design with a control group design. Brain-derived neurotrophic factor (BDNF) plasma levels, serum serotonin (ST) serum levels, and sucrose preference test (SPT) values were analysed in 39 male Wistar rats with anhedonic behavior.

Results: Average BDNF plasma level in treatment group was 1.63 ng/mL with a standard deviation of 0.56 ng/mL, while the mean BDNF plasma level in control group was 0.89 ng/mL with a standard deviation of 0.46 ng/mL. There was a significant difference in that the BDNF plasma levels in the control group were lower than in the treatment group, with a p<0.001 (CI = 95%). The median ST serum level in the treatment group was 25.78 with an IQR of 9.61 ng/mL, while the median ST serum level in the control group was 7.5 with an IQR of 0.38 ng/mL. Statistically, the difference is significant from the p value <0.001. The median SPT score in the treatment group was 84.5 with an interquartile range (IQR) of 12%, while the median SPT value in the control group was 67 with an IQR of 8%.

Conclusion: There was an effect of probiotics as an adjuvant antidepressant therapy in male Wistar rats with anhedonic behavior.

Background: Androgenetic alopecia is the main concern hair problem in the male which is characterized by progressive miniaturization of hair follicles. One factor which contributed in androgenetic alopecia progression is sebum level. This study determined the correlation between sebum level and the severity of AGA in men.

Patients and methods: This study was an observational analytic study with a cross sectional method involving 50 male androgenetic alopecia (AGA) patients based on inclusion and exclusion criteria. Recorded age, education, occupation, family history and duration of illness. AGA severity was determined by the Hamilton- Norwood classification I–VII. Sebum levels were measured using Sebumeter® SM 815. The correlation between sebum level and severity of AGA was analyzed using the Gamma correlation test and significant if p-value<0.05.

Results: Most AGA patients were found in the 36–45 age group, had a diploma/bachelor education level, worked in business services and salespeople, had a family history of their father suffering from AGA, and had suffered from AGA for >20 years. Most AGA patients were found in Hamilton-Norwood III (50%) with the most sebum levels were found to be normal (60%). The results of this study showed a positive correlation (p<0.01) with a very strong strength between sebum level and severity of AGA (r=0.94).

Conclusion: There is a very strong correlation between sebum level and severity of AGA.

In recent years, the national usage of Plasma Derived Medicinal Products (PDMPs), particularly albumin and immunoglobulin, has expanded due to a rise in disease prevalence, as well as enhanced patient management practices and broader assurance coverage. Now, Indonesia is a country that imports all of its PDMPs, resulting in high pricing and market reliance; nevertheless, barely a third of recovered plasma gets transfused to patients. The plasma that has not been used should be discarded, at a cost. The government intended to begin meeting the needs of the PDMP by implementing the plasma fractionation program. The decision was taken to use contract fractionation for three years, after which a national fractionation manufacturer was anticipated. The potential utility of recovered plasma and the prospective requirement for plasmapheresis collection have been assessed. The Minister of Health has enacted legislation concerning plasma fractionation, including the potential of establishing plasmapheresis centers to facilitate plasma collections. The Food and Drug Administration of Indonesia has also initiated a certification scheme for blood establishments (BEs), and only certified BEs can provide plasma for fractionation. After the epidemic, the government restarted the fractionation program by modifying existing laws to allow private manufacturers to participate. The difficulty was obtaining plasma from uncompensated donors, recruiting plasma donors, increasing the number of qualified biological examiners, of which only 19 out of 469 have been certified, and increasing technology and personnel capacities. Other significant obstacles were the harmonization or consolidation of existing biological entities (BEs) and the expense of paying for recovered and source plasma. The government and other parties involved had to make substantial efforts and collaborate to overcome these problems.

Background: Kidney stones are the most common case in the field of urology, particularly in Indonesia. Extracorporeal shock wave lithotripsy (ESWL) is one of the therapeutic modalities with the aid of fluoroscopy and/or ultrasonography to visualize the location of the stone. To date, there is no research in Indonesia on the efficacy, safety and cost compatibility between ESWL and their implementation in various hospitals. This study aimed to compare the efficacy, safety and cost of fluoroscopy-ultrasonography-guided ESWL (FU-ESWL) and ultrasonography-guided ESWL (U-ESWL) as target devices in type-C hospitals in Denpasar.

Methods: This research is a quantitative study with a prospective cohort approach that involved two group pre-post-test designs. The intervention was performed using the target device of FU-ESWL at Surya Husadha Hospital and U-ESWL at Balimed Hospital. The population of this study was patients with kidney stones less than 1.5 cm who underwent ESWL. The post-treatment assessment was the efficacy (stone size, stone-free rate (SFR), frequency, re-treatment, auxiliary procedure), safety (complication) and cost (unit cost, perceived cost, actual cost, Average Cost Effectiveness Ratio (ACER), Efficiency Quotient (EQ)).

Results: After treatment, the FU-ESWL group showed a smaller remaining stone size than the U-ESWL group. The ESWL frequency and re-treatment in FU-ESWL showed significantly better results than in U-ESWL. No significant differences in complication and SFR between the two groups. The unit cost of FU-ESWL was significantly higher than U-ESWL. However, the perceived cost and actual cost were not significantly different between the two groups. Moreover, the cost aspect of the average cost-effectiveness ratio (ACER) and efficiency Quotient (EQ) of FU-ESWL is better than U-ESWL.

Conclusion: The combination targeting of FU-ESWL has better efficacy, ACER and EQ than U-ESWL.  However, no significant differences were found in complication and SFR between the two groups. Important findings in this research are expected to contribute to monitoring and evaluating the national health insurance implementation in the field of Urology.

Introduction: Adolescents suffer from various forms of psychosocial, behavioral, mental and emotional problems. The relationship between salivary cortisol levels and the risk of behavioral-psychosocial-emotional disorders in adolescents is still controversial. To analyze the relationship between salivary cortisol levels and the risk of behavioral-psychosocial-emotional disorders in adolescents aged 12-16 years using PSC-17.

Methods:  An observational analysis with a cross-sectional research design and simple random sampling was conducted from November 2022 - March 2023. Adolescents aged 12-16 years filled out biodata, characteristics and PSC-17 questionnaires. Salivary cortisol levels were measured by the Enzyme-linked immunosorbent assay method. Data analysis with univariate and multivariate tests.

Results: Of 170 adolescents, 53 (31.2%) were at risk of behavioral-psychosocial-emotional disorders with PSC-17 total score ≥15, consisting of risk of internalizing disorders at 73 (42.9%) adolescents, risk of externalizing disorders at 14 ( 8.2%), risk of attention disorder at 23 (13.5%) adolescents. The majority of adolescents who have normal salivary cortisol levels are 117 (68.8%) adolescents, and salivary cortisol levels are abnormal (high) in 53 (31.2%) adolescents. Salivary cortisol levels were associated with adolescents' risk of behavioral-psychosocial-emotional disorders (p<0.001).

Conclusion: Salivary cortisol levels are associated with the risk of behavioral-psychosocial-emotional disorders in adolescents. Likewise, salivary cortisol levels are related to the risk of internalizing disorders, the risk of externalizing disorders, and the risk of attention disorders in adolescents.

Introduction: Sexual needs are very important for domestic harmony. The incidence of pain during sexual intercourse often occurs in postpartum mothers, which causes concern and fear of mothers doing these activities. One of the efforts to reduce the pain is lavender aromatherapy. This study aimed to analyze the effect of lavender aromatherapy on the incidence of dyspareunia in postpartum mothers.

Methods: The research design, which takes the form of a nonequivalent control group design, is quasi-experimental. Aromatherapy with lavender is the independent variable, and dyspareunia is the dependent variable. In Wonokromo Village, Surabaya, 102 respondents with accidental sampling for 3 months made up the population of postpartum mothers in 2022. The survey served as the research tool. The Spearman's test was used to assess the data.

Results: The majority of mothers who did not use lavender aromatherapy (55.9%) experienced severe dyspareunia, almost half of the mothers who used lavender aromatherapy (41.2%) experienced moderate dyspareunia, and mothers who always used lavender aromatherapy almost half (44.1%) had mild dyspareunia. There is a significant effect of lavender aromatherapy on the incidence of dyspareunia in postpartum mothers (p = 0.001).

Conclusions: The more mothers do not use lavender aromatherapy before having sex, the more severe the incidence of dyspareunia or pain during sexual intercourse.

Link of Video Abstract: https://youtu.be/Ja9klXNlw5A

Background: Keratitis Pseudomonas aeruginosa is the most frequently occurring eye infection. It is a rapidly developing condition that can lead to ocular infections (endophthalmitis) and corneal perforation resulting in vision loss. Although prompt administration of antibiotics can effectively kill the bacteria, the corneal damage caused by toxins persists. The following inflammatory process results in corneal thinning, fibrosis, and eventual perforation.

Methods: This study is a literature review to support future experimental studies which will be conducted to examine the expression of IL-1b and MMP-9 on pseudomonas keratitis after administration of EGCG.  

Results: Interleukin-1ß is a proinflammatory cytokine secreted by various immune cells in response to acute and chronic inflammation. At the same time, matrix metalloproteinase (MMP) is a group of proteolytic enzymes involved in the pathophysiology of various ocular surface diseases. Epigallocatechin gallate (EGCG) is the major polyphenol compound in green tea, produced from the Camellia sinensis plant. Recent studies suggest that EGCG has anti-inflammatory and antioxidant effects on various cell types, including the cornea. EGCG inhibits IL-1β, which induces the activation of the NF-kB signaling pathway, which may explain the decrease in uPA expression and the reduction of collagen degradation by corneal fibroblasts. EGCG inhibits the activation of pro-MMP 9 produced by corneal fibroblasts in response to IL-1β stimulation, and this effect is mediated by the inhibition of uPA upregulation without a significant impact on pro-MMP 9 expressions.

Conclusion: Epigallocatechin gallate (EGCG) in Camellia sinensis extract has the potential as an alternative adjuvant therapy for bacterial keratitis because it has antibacterial, anti-inflammatory and antioxidant effects.

Link of Video Abstract: https://youtu.be/lODjSgZ6vm0

Background: Glaucoma is a progressive neurodegenerative disease characterized by glaucomatous optic neuropathy, including loss of retinal ganglion cells and axons. Optic neuropathy causes progressive vision loss and is managed by reducing intraocular pressure. However, even when the intraocular pressure has dropped to normal, the damage to the retinal ganglion cells may linger in certain situations. Thus, commence investigations on natural sources such as neuroprotection to prevent the loss of retinal ganglion cells.

Methods:  This literature review compiles and elaborates on previous studies to support future experimental studies that will be conducted to comprehend the effect of intravitreal Resveratrol as a glaucoma treatment to prevent the loss of retinal ganglion cells.

Results: Resveratrol is a naturally occurring phenol and phytoalexin detected in the skins of grapes and berries like raspberries, blueberries, and mulberries. Resveratrol inhibits the production of reactive oxygen species (ROS) and apoptosis as well as lengthens the life span of nerve cells via multiple mechanisms. Resveratrol treatment can reverse the progression of apoptosis, preserve mitochondrial membrane potential by reducing caspase-3, and inhibit cytochrome-C release, enhancing cell survival, as shown in many previous studies. Before the systemic administration of resveratrol in eye disease, it is necessary to consider the presence of the blood-ocular barrier—about 10 out of 35 eyes detected resveratrol in the conjunctiva after oral trans-resveratrol supplementation. Several studies have administered intravitreal injections of resveratrol to increase intraocular resveratrol concentrations.

Conclusion: Resveratrol may be utilized as an alternative adjuvant treatment for glaucoma due to its antioxidant and antiapoptosis properties.

Link of Video Abstract: https://youtu.be/fn9kA601YVo

ACL rupture is a common injury often resulting from previously healthy individuals' non-contact knee injuries. ACL rupture in young adults and teenagers are becoming more common, contrary to earlier theories that suggested ACL damage was uncommon in skeletally immature people. This risk is significantly raised by concomitant meniscal injury whether or not an ACL reconstruction is undertaken. Although surgical management with allograft or autograft reconstruction can be achieved successfully, there are some serious complications following ACL reconstruction. The supply of autografts is limited, especially in situations with numerous ligament injuries or re-ruptures, which might result in morbidity at the donor site. Allografts can increase the spread of illness and trigger an inflammatory response, which is a drawback. There has been much interest in a tissue-engineered ACL graft because of these issues and current developments in bioengineering and regenerative medicine. According to recent research, following an ACL repair, the bone marrow density surrounding the knee area diminishes. Platelet Rich Plasma (PRP) and Bisphosphonate are the substrates that could ameliorate this phenomenon.  Therefore, this review aims to compile evidence of PRP and bisphosphonate and its effect on the tendon-bone interface in ACL reconstruction.

Link of Video Abstract: https://youtu.be/wEp6PioGVqw

Background: Hot saline irrigation and tranexamic acid are techniques used to control bleeding during functional endoscopic sinus surgery (FESS). Hot saline irrigation and tranexamic acid can help control bleeding originating from microvascular located in the nasal cavity and paranasal sinuses. This study aims to compare the efficacy of these two techniques on Boezaart score, intraoperative blood loss, and duration of surgery in functional endoscopic sinus surgery.

Methods: This study is an intervention meta-analysis, the research formulated based on the population, intervention, comparison, outcome, and study design (PICOS). Articles were searched from five databases, including PubMed Central and publisher websites, Cochrane Library, ResearchGate, SAGE Journals, and Web of Science. There were no publication year or publication status restrictions on the selected research articles, and the date of the last search was up to February 2023. The efficacy of hot saline irrigation as a bleeding control method compared to tranexamic acid was assessed based on Boezaart surgical field score, intraoperative bleeding, and duration of surgery in functional endoscopic sinus surgery (FESS).

Results: A total of 532 research articles were identified, and fifteen articles that met the inclusion and exclusion criteria were selected. Hot saline irrigation p-value p=0.0002 and for tranexamic acid p=<0.00001 based on Boezaart score. Hot saline irrigation p= 0.0001 and tranexamic acid had a p= 0.0002 based on the Intraoperative blood loss, but the standardized mean difference in the hot saline irrigation group was smaller compared to the tranexamic acid topical group. Hot saline irrigation p=0.06 and tranexamic acid p=0.13 for duration of surgery.

Conclusion: This meta-analysis showed that the administration of tranexamic acid or hot saline irrigation could significantly reduce duration of surgery, intraoperative blood loss and improved surgical feld quality compared with room temperature saline irrigation. There is no statistically significant difference between tranexamic acid topical and hot saline irrigation.

Fibromyalgia (FM) is a chronic pain syndrome that is quite common. This syndrome is often not diagnosed correctly because the symptoms are heterogeneous and often overlap with other diseases. In 2010, the American College of Rheumatology (ACR) established a feasible diagnostic criterion for FM then in 2016 ACR revised FM criteria. The clinical problems of FM vary widely and depend on the individual's management, depending on the severity and severity of the complexity, the degree of damage that occurs and the comorbidities in the psychiatric field that most commonly occur in anxiety disorders and depression.

Link of Video Abstract: https://youtu.be/8w4jBvx0pJc

Background: Plasma-rich fibrine (PRF) membrane is a new biomembrane useful in ocular surface reconstruction technique. Since its development, PRF membrane has been used successfully in many studies; however, some controversies maintained. This literature study aims to evaluate the role of Platelet Rich Fibrin (PRF) membrane and conjunctival autograft on TGF-β and collagen type 1 expression in conjunctival wound healing.

Methods: This literature review compiles and elaborates on previous studies from many authors to support future experimental studies, which will be conducted to compare the effect of PRF membrane and conjunctival autograft on TGF-β and type 1 collagen expression.

Results: PRF has many advantages, such as the ability to reduce inflammation, rich in growth factors, and can be a temporary scaffold for fibroblast migration. However, despite its advantages, PRF is not widely used, unlike its counterpart techniques, such as conjunctival autograft. Conjunctival autograft has long been used as an option for ocular surface reconstruction techniques, but it has some limitations. The conjunctival autograft technique cannot be performed in large or bilateral conjunctival damage. Thus, the PRF membrane technique can become a perfect solution for such a case. This literature review will provide more information on how PRF can regulate inflammation and support the conjunctival wound healing process.

Conclusion: Some impacts of PRF membrane and conjunctival autograft are still unclear, especially their effect on TGF-β and type 1 collagen expression. This literature review is expected to encourage and support future experimental studies about the impact of PRF and conjunctival autograft on TGF-β and type 1 collagen expression.

Bacterial keratitis is an ocular emergency and is one of the leading causes of blindness worldwide. Pseudomonas aeruginosa is the most frequent causative agent of keratitis. The infectious process of P. aeruginosa is highly invasive and can rapidly lead to corneal ulcers, ocular infections (endophthalmitis), and corneal perforation. Delayed or inadequate treatment may result in complications such as corneal fibrosis and neovascularization. Platelet-rich fibrin (PRF), which contains high levels of platelets, can aid in hemostasis, cell migration, and proliferation to accelerate the wound healing process. PRF contains several growth factors, such as Platelet-derived growth factor (PDGF), Vascular endothelial growth factor (VEGF), and Transforming growth factor (TGF- β), which are released in a time-dependent manner during the wound healing process, ranging from 7 to 28 days. TGF- β regulates the expression and activity of matrix metalloproteinases (MMP-1, MMP-2, MMP-3, MMP-9) involved in wound remodeling and healing, where MMPs are regulated or balanced with tissue inhibitors of metalloproteinases (TIMP-1, TIMP-2). In previous studies, PRF was found to be effective in managing bacterial keratitis in cats. In this discussion, we explore the molecular effects of PRF as an adjuvant therapy for bacterial keratitis

Introduction: Chronic limb-threatening ischemia (CLTI) is a remarkably morbid condition that causes significant mortality, limb loss, pain, as well as reduce health-related quality of life in those who are affected. The cornerstone of CLTI therapy is revascularization, which can lower the amputation rate.

Case description:  A diabetic type II 68-year-old female patient presented with complaints of pain, swelling, and itching in the left leg that was felt for approximately 1 month ago. The wound persists although the ankle was already amputated. CT-angiography showed total occlusion in 1/3 distal of left femoral artery and no visualization of left popliteal artery. She was diagnosed as left CLTI femoral popliteal Rutherford VI TASC II type D with ischemic rest pain. The patient planned for an endovascular revascularization procedure. Victory 14 wire 0.014” was inserted but recanalization did not penetrate, continued with Victory 18 wire the lesion could penetrate. Digital Subtract Angiography (DSA) evaluation found significant residual stenosis, thus continued using Abbott Supera peripheral stent system. The patient was successfully treated showed left femoral artery was seen well visualized with TIMI flow 3, left popliteal artery was still seen 50% no significant residual stenosis with TIMI flow 2. Followed up after 3 months, she did not complain any ischemic pain at left leg.

Discussion: The Supera peripheral stent system was developed to withstand the femoropopliteal artery's unique stressors. There have been few studies on the use of supera stenting in complex CLTI, and the primary patency at 1 year was 77% in lesions measuring 92-236 mm. In this case report, the procedure was successfully applied in complex CLTI (mean length >200mm) with no restenosis and repeat target limb revascularization after one year of procedure.

Conclusion: We successfully performed revascularization using supera stenting, and the femoropopliteal artery showed good TIMI flow results. In CLTI patients, stenting may be an option to lower the risk of major lower limb amputation.

Introduction: Lupus enteritis is a rare first manifestation of active systemic lupus erythematosus (SLE). diagnosis of this condition is hard, specially without other signs and symptoms associated with active SLE. this article will report a woman with SLE and lupus enteritis as the first manifestation of active systemic lupus erythematosus

Case presentation: A 25-year-old woman presented to the Emergency department complaining of abdominal pain and vomiting. From her medical history, four years in the past, she reported the same signs and symptoms as now and turned into identified with appendicitis. Her abdomen examination found out mild abdominal distention without a abdominal tenderness. Wall thickening and irregularity of small and big bowel loops were observed on the CT abdomen. She turned into given a excessive dose glucocorticoid as initial treatment and turned into maintained with low dose glucocorticoid and cyclosporin. After 6 months of follow-up, the patient did not have a recurrence of signs and symptoms.

Conclusion: A high index of suspicions is essential to differentiate lupus enteritis from other differential diagnoses. For lupus enteritis, excessive-dose steroids were an efficient initial treatment.

Link of Video Abstract: https://youtu.be/PfhZ7H4kszQ

Background:  Prostate cancer is regarded as one of the most common leading causes of male cancer-related death worldwide. Clinicians agree that prostate specific antigen (PSA) is the best prostate cancer predictor. High PSA levels increase prostate cancer risk in most men. However, other research suggests that prostate cancer with low PSA levels is aggressive. In this uncommon case series, we present three high-grade prostate cancer patients with low PSA.

Case Description:  Between 2018 and 2019, three patients were referred for further therapeutic management after initial evaluation and treatment from secondary hospitals. All patients underwent complete diagnostic procedures including Laboratory examination, Pathological examination, and Radiologic imaging. PSA levels were 0.67 ng/mL, 4.0 ng/ml, and 4.93 ng/mL in the first, second, and third patients, respectively. The first two of three patients had a Gleason score (GS) of 9 (5+4), and one patient presented with GS of 8 (5+3). Distant metastatic disease was not found in our series. All of the patients underwent hormonal therapy, and none of them underwent radical prostatectomy. Follow-ups were completed in all patients, with the survival of 3 months, 4 months, and 12 months respectively.

Conclusion: High-grade prostate cancer in patients with low PSA levels emphasizes the need for rigorous history taking and physical examination and quick investigation of new biomarkers and criteria for prostate cancer detection. These patients' prognosis and optimal therapy are unknown. These patients have a worse prognosis than those with high PSA values, according to multiple studies.

Background: Liver disease in pregnancy can be related to the process of pregnancy (liver disease of pregnancy) or not associated with pregnancy (liver disease in pregnancy). Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening cause of jaundice in the third trimester of pregnancy and early postpartum period which in most cases no definitive risk factors are found. In this case report, we report a patient with AFLP with acute pancreatitis manifestations.

Case presentation: A 33-year-old woman referred to the Dr Soetomo General Academic Hospital, Surabaya, Indonesia with diagnosis of day-4 post-section caesarian (SC) accompanied by ileus paralytic, obstructive jaundice hypoalbuminemia hyperbilirubinemia, acalculi cholecystitis, acute kidney injury (AKI) with dd acute on chronic kidney disease (ACKD), suspect pneumonia, and sepsis. Indications for SC were premature rupture of membrane (PROM). The patient initially complained of yellow body and eyes 10 days before delivery with additional complaints including tea-colored urine and brown feces. Chest x-ray results showed infiltrates on the right paracardial suggesting pulmonary inflammation. Abdominal x-rays showed normal result. Abdominal ultrasound results suggested acalculi cholecystitis, however, liver, lien, pancreas, kidney right and left, urinary bladder, uterus, adnexa right and left showed no abnormality. The patient was treated with intravenous fluids, nasogastric insertion for nutrition, analgesics and antibiotics and other symptomatic therapy. The patient was discharged after 20 days of treatment.

Conclusion: This case highlights a potentially fatal complication of AFLP case with acute pancreatitis manifestations and the need of rapid diagnosis and comprehensive management to avoid the complicaton and death.

Introduction: Asthma bronchial is a disease characterized by increased sensitivity of the tracheobronchial tree to various stimuli. During an asthma attack, there will be bronchospasm, mucosal swelling, and increased secretions in the airway. The incidence of asthma in pregnancy in Indonesia is around 3.7- 4%, most commonly occurring at 24 to 36 weeks of gestation. The effect of asthma on the mother and fetus depends on the frequency and severity of asthma attacks because it can cause effects in the form of hypoxia. The state of hypoxia affects the fetus in the form of abortion, premature delivery, and fetal weight that is not in accordance with gestational age. Symptoms that can be felt are shortness of breath, cough, wheezing and can be accompanied by chest pain.

Case description: A 35-year-old woman came with complaints of heartburn for 2 hours before admission to the hospital, the patient denied amniotic fluid flow, blood was found to come out. Fetal movements felt active. The patient claimed to be 9 months pregnant with LMP on 27 December 2021, and EDD on 27 September 2022, with a gestational age of 39-40 weeks. ANC to the obstetrician was 3 times and the midwife was 5 times. No complaints of vaginal discharge, bowel and bladder within normal limits. The patient also had a history of asthma when she was 8 months pregnant, with complaints of shortness of breath, easily fatigued and coughing, the patient denied chest pain. Wheezing was also claimed sometimes. The patient had been treated by a pulmonologist, given 3 drugs to take if shortness of breath occurred. The patient complained of painless lesions on the hands, trunk and feet. This complaint has been felt since 3 months ago. There is no thickening of the nerves or numbness in the joints. The patient was diagnosed at the regional hospital with Morbus Hansen and is currently on treatment.

Conclusion: Asthma in pregnancy will cause hypoxia to the fetus which affects the development of the fetus, therefore prompt and appropriate management will reduce the risk to the mother and fetus. Outcome infants showed no sign of Morbus Hansen infection.

Introduction:  In 10% of head injury cases, nonmotor seizures were detected by electroencephalography (EEG) performed in the acute phase.  Nonmotor seizures are often not diagnosed at the start of treatment because the symptoms are often not recognized by the patient's family or doctor. The incidence of seizures in patients with minor head injuries is very low. From the literature, it was found that the type and severity of the head injury is a significant factors in the incidence of post-traumatic seizure. Thus, in this article, we report a case of nonmotor seizures in a patient after a minor head injury.

Case description: An Indonesian female, 53 years old, complained of sudden silence when speaking after 4 days earlier, she fell and hit her head on the right side. There was no loss of consciousness, headache, vomiting or limb weakness. Complaints of motor seizures and a history of previous seizures were denied. There were no cranium defects, hematomas, or open wounds on examination. The results of laboratory tests and non-contrast head CT scans were expected. On electroencephalography (EEG) examination, epileptiform waves were found in the left temporal region. The patient was given anti-seizure drugs, and complaints improved within 2 days of therapy. It is crucial to carry out an EEG examination in the acute phase of a head injury to exclude the possibility of nonmotor seizures and brain dysfunction, which will be at risk of causing seizures later in life after trauma.        
Conclusion: EEG examination in the acute phase of head injury is used to exclude the possibility of nonmotor seizures and brain dysfunction, which will be at risk of causing seizures later in life after trauma.

Introduction: The most common neoplasm of the uterus, uterine leiomyomas, or fibroids, are benign growths that affect 20–30% of women between the ages of 30 and 50. The smooth muscle of the uterus gives rise to leiomyomas. In this case report, we sought to highlight the case of a 39-year-old nulligravida lady with a fast expanding abdominal mass and abdominal pain.

Case Presentation: The gynecologist department at Dr. Kariadi General Hospital Semarang received a visit from a 39-year-old nulligravida lady complaining of a fast-expanding lump in her belly and extreme weight loss over the past year. During the abdominal exam, an immovable mass that could have been an 8-month pregnancy was felt in the midline of the abdominal area, extending from the lower abdomen to the epigastric area. Ascites were also discovered. The multislice computerized tomography (MSCT) results showed a solid lobulated inhomogeneous mass with internal calcification which extended from the abdominal cavity to the pelvic cavity and visualized the size of (anteroposterior 21.7 cm x laterolateral 24.1 cm x craniocaudal 36.8 cm), compressing the surrounding bowel structures, liver, spleen, and bladder. Several lymphadenopathies were also discovered. A frozen section, a bilateral salpingo-oophorectomy, and a total abdominal hysterectomy were performed. The results of the histology suggested a benign leiomyoma. Her vital signs were steady after surgery, and she fully recovered. The patient was called for a follow-up one week after being released for surgical suture removal and evaluation. The patient was discharged on the sixth postoperative day in good condition.

Conclusion: In determining if uterine smooth muscle tumors are benign or malignant, clinical characteristics, physical examination, imaging, and pathological findings are still considered very useful. The histopathology examination is still the most reliable diagnostic tool. The decision to perform a hysterectomy on this patient was determined accordingly to the tumor's size, probability of malignancy, and increasing morbidity.

Introduction: MDR-TB is an infectious disease that can cause death and stigma for those infected. MDR-TB patients with depression are at risk for LTFU, which will worsen their condition and strengthen the stigma they receive.

Case report: A 52-year-old female psychiatric interview and assessment using the Beck Depression Inventory (BDI) found that BDI score of 4 (no depression), and the patient adhered to TB treatment. She was found to be laid off, and an assessment using the BDI to detect depression in the patient found potential stigma in the patient, such as being laid off from work, prohibited from teaching face-to-face, and shunned by colleagues. Interventions given were prescribing Fluoxetine 20 mg per day and Clobazam 10 mg per day, a brief intervention using the FRAMES technique, psychoeducation about disease and drug effects and the duration of treatment, and an office visit. A worksite intervention was performed by the patient's husband. Antituberculosis drugs were monitored by both a pulmonologist and a psychiatrist. Her work-related problems were resolved through interventions at the school with psychoeducation about drug-resistant tuberculosis, the transmission method, the duration of treatment, and the side effects of the treatment. The results of the last sputum examination after one month of treatment showed drug resistance, and the patient was advised to undergo 18 months of treatment. The patient could finally work offline with fewer responsibilities after getting negative laboratory test results twice in a row.

Conclusion Work-related psychosocial interventions are required to address rejection at work, which results in depression and nonadherence to treatment. Liaison services with social interventions at work in drug-resistant tuberculosis-infected patients are necessary to improve their quality of life and maintain their treatment adherence.