The relationship of general health and marital satisfaction with job satisfaction of employees working in Melli Bank of Ahvaz, Iran

The optimal dose of the Low-level laser therapy in the treatment of type 1 Diabetes Mellitus

Background: Type 1 DM (T1DM) is caused by an autoimmune destruction of pancreatic ß cells. We proposed a novel stimulation using a low-level laser therapy (LLLT) through acupuncture points to stimuli the stem cells to be adult pancreatic ß cells. This study aimed to identify an optimal dose of low-level laser therapy (LLLT) for treatment of type 1 diabetes mellitus (T1DM).

Methods: An experimental study was performed with a pretest-posttest control groups design. The intervention was tested in rats (Rattus novergicus, Wistar strain). The rats were made diabetic by injection of streptozotocin (STZ). Rats were treated with different doses of LLLT in 4 groups. The tested laser doses were 0.2 joules (group L1), 0.3 joules (group L2), 0.4 joules (group L3), and 0.5 joules (group L4). The therapy was performed by perpendicularly attaching laser probe to the animal body, at the acupuncture point pishu (BL-20) on respective sides.

Results: Rats in the L2 group were performing better compared to others. The highest decrease of blood glucose level was found in group L2. Two rats in the L2 group achieved normal blood glucose level upon laser therapy. The dose of laser therapy in the L2 group of 0.3 joules was found to be the optimum dose.

Conclusion: Clinical and statistical analyses indicated that 0.3 joule was the optimal dose for LLLT in our animal model. Further investigation of LLLT in human is warranted and validation of the identified dose in future studies should be pursued.

The effect of implementing nursing ethics code as a combined plan, in the School of nursing and clinical setting, Bojnurd, North Khorasan Province (2013-2015)

Background: It is very important when teaching ethics to nurse students to select an educational method and materials that are relevant to their future career as clinical nurses. The aim was to determine the effect of implementing nursing ethics codes as a combined plan in North Khorasan’s University of Medical Sciences.

Methods: This research was an action research conducted in School of Nursing and Clinical setting at Bojnurd, North Khorasan Province, Iran, from September 2013 until September 2015. Data was collected through checklists and interviews with small groups and then analyzed. First, the researchers explored the difficulties in imposing nursing ethics codes. Then a combined plan was considered to solve the ethical codes’ problem. To perform this combined plan, a combination of interferences from three different levels of scope, which are students, college, and clinic, was considered. Permission from the Bojnourd’s Nursing and Midwifery College Educational Council was obtained for this study.

Results: The results of this study showed that 65.5% of students had given the right answers to ethical codes. More than half of the students remarked that respecting the rights of patients and nurses was the most important code. More than half believed that there was a system to supervise the implementation of ethical codes. The results from the ethical rounds with students showed that disobedience to ethical codes occurred in the three fields which are clinical staff, educator, and student administrators. This study offered a practical model for implementing professional ethics code based on Iran’s sociocultural background. Along, this study was done to satisfy the need for ethical education and conduct according to these professional ethics code in the college and the clinical setting.

Conclusion: It is recommended that a suitable evaluation system should be considered to get the feedback from the implementation of this combined plan of teaching professional ethics codes.

Maternal mortality audit based on district maternal health performance in East Java Province, Indonesia

Background: Maternal mortality rate (MMR) in Indonesia is still high, including in East Java Province. Although the successful decline in MMR has been achieved, more action still needed to maintain and accelerate the process. Several factors that affect the maternal mortality, especially referral factor, and districts maternal health services quality, need to analyze. This study was conducted to analyze the correlation between maternal mortality with labour referral and maternal health service quality in 10 regencies/cities in East Java Province, Indonesia. 

Methods: The case-control study among 2 groups of 5 regencies/cities with the highest and lowest MMR in East Java Province in 2015. The indicators used, were maternal referral relay in maternal mortality report, frequencies of antenatal care, labor by health care provider, puerperal health care, obstetric complication management, detection of high-risk pregnancy by community and healthcare personnel, and family planning program.

Results: Total number of maternal mortality in East Java province in 2015 was 531, with MMR were 89,6/100.000 living birth. From the comparative study, we found a significant difference in indicators of high-risk pregnancy detection by healthcare personnel (p=0,035) and obstetrics complications management (p=0,006). There were no significant differences in frequencies of antenatal care, labor by health care provider, puerperal health care, detection of high-risk pregnancy by the community, and family planning program in 10 regencies/cities in East Java Province, Indonesia. 

Conclusion: High-risk pregnancy detection by healthcare personnel and obstetrics complications management were related with MMR in 10 districts in East Java province, Indonesia.

The aerobic-anaerobic bacteria pattern and its sensitivity pattern in chronic rhinosinusitis patients, in Medan, Indonesia

Background: Rhinosinusitis is one of the most concerning illness due to high medical cost and its negative effect on the respiratory tract. The etiology of chronic rhinosinusitis remains unknown. The main cause of chronic rhinosinusitis with or without nasal polyp is bacterial infections; thus antibiotics remain a main therapeutic intervention. Prescription of broad spectrum antibiotics and the inappropriate combination of antibiotics are the main factors of antibiotic resistance. This study aims to obtain the pattern of aerobic and anaerobic bacteria in chronic rhinosinusitis patient (with or without nasal polyp) and its sensitivity pattern, in Medan, Indonesia. Methods: This is a case series. Samples were patient with chronic rhinosinusitis who had undergone functional endoscopic sinus surgery (FESS). Results: The most common aerobic bacteria found is Klebsiella oxytoca (21.7%), and it is sensitive to ceftriaxone, cefotaxime, levofloxacin, and meropenem. While for the anaerobic bacteria, one patient was positive for Peptostreptococcus and it is sensitive to chloramphenicol. Conclusion: The most common bacteria in the maxilla in patients with chronic Rhinosinusitis with and without polyps in Medan are the aerobic bacteria Klebsiella oxytoca and anaerobic bacteria Peptostreptococcus. It is suggested that the antibiotic prescribed should be based on microbiology examination.

The role of single nucleotide Interleukin-6 (IL-6) polymorphism gene in Psoriasis vulgaris patients at Haji Adam Malik Central Hospital, Medan-Indonesia

Background: Psoriasis is a chronic, recidive inflammatory skin disease. The main pathogenesis process is currently unknown. This disease is known as a complex disorder, influenced by both genetic susceptibility and environmental factors.

Aim: This study is aimed to analyze and determine the distribution of single nucleotide polymorphism (SNP) in IL-6 gene of psoriasis vulgaris patients and control patients.

Method: This study uses a case-control design to compare SNP in the IL-6 gene between psoriasis vulgaris group and control group.

Results: The most common genotype of the IL-6 gene Rs 1800795 in psoriasis vulgaris patients is GG (dominant homozygous) with a total of 21 patients (46.7%). The most common genotype allele in the control group is Gc (heterozygous) with a total of 27 patients (60%). We observed a significant correlation between the groups (p = 0.044).

Conclusion:

Homozygote for IL-6 allele G (GG) is a prominent finding in the case group, while in the control group heterozygous allele (Gc) is a more common finding, thus suggesting that a patient with dominant homozygote alleles will have a more severe condition when compared to those who have the heterozygote alleles.

Comparison between ringerfundin (B Braun) and ringer lactate administration towards Interleukin-6 (IL-6) levels in sepsis and septic shock patients at Haji Adam Malik Hospital, Medan-Indonesia

Background: Sepsis is the second leading cause of death in intensive care unit and one of the top 10 cause of deaths worldwide. In sepsis, an inflammation response occurs that leads to the tissue destruction. According to the Survival Sepsis Campaign in 2012, early management in septic patients with 30 ml/kg of crystalloid fluids will have better outcomes. Objective: This study aimed to determine the optimal crystalloid fluid in the resuscitation of septic patients. Method: This double-blinded study was held from March 2017- May 2017 in Haji Adam Malik General Hospital. A total of 40 patients who passed the inclusion and exclusion criteria were assessed for interleukin-6 changes before and after treatment with ringer acetate malate and ringer lactate. Results and Discussion: From 40 Patients who passed the criteria, we compared the administration of Ringer's acetate and Ringer's lactate malate in septic patients. The mean systolic and diastolic blood pressure were increased in both study groups (p <0.05) and a significant decrease in pulse rate was also present in both groups (p <0.001). In both groups, there was a significant decrease in interleukin-6 levels (p <0.001). Administration of ringer acetate malate leads to a stronger decrease of interleukin-6 compared to ringer lactate administration (p <0.001). Conclusion: Ringer's acetate malate in EGDT of septic patients is superior in decreasing interleukin-6 Compared with Ringer lactate.  

Aging changes' inhibition of hemostasis and blood rheological features on the background of antioxidant lipisomal preparation "Lipovitam-Beta" application

Background: One of geroprotectors for mammals are still polyvitaminic preparations, one of which is Lipovitam-beta. Purpose of research: to estimate Lipovitam-beta impact on the indices of hemostasis and blood rheology systems of aging rats.

Methods: We examined 193 healthy outbred male-rats at the age of 24 months being kept in conditions of vivarium and having traditional ration. In experimental group (98 rats) we investigated the impact of Lipovitam-beta feeding on the basis of 5.5 mg on 100 gr of body mass once in 5 days during 6 months on relevant indices. Control group was composed of 95 healthy male-rats. We estimated the basic indices of hemostasis, blood viscosity, aggregation and deformability of erythrocytes at the beginning and in 6 months of investigation.

Results: Lipovitam-beta application has led in case of rats from experimental group to reliable lowering of spontaneous and stimulated platelets' aggregation and activity weakening of plasma hemostasis. On the background of Lipovitam-beta feeding to rats we found lowering of blood viscosity and erythrocytes' aggregation index what was accompanied by increase of erythrocytes' deformability index.

Conclusion: Application of Lipovitam-beta to aging rats led to activity lowering of plasma hemostasis and platelets, improving rheological features what can positively influence microcirculation, the level of vital activity and forthcoming life duration.

The comparative study of pre and post-surgical experience, self-esteem, self-confidence, body image, in patients undergoing blepharoplasty surgery

Introduction: Cosmetic surgery is one of the human’s latest achievements for creating beauty; blepharoplasty surgery is one of its kinds. Psychological issues such as self-esteem, self-confidence, body image are closely related to blepharoplasty surgery. The present study aimed at studying the above-mentioned psychological issues both before and after the surgery as well as comparing real expectations and experiences of some post-surgical complications.

Materials and Methods: In a quasi-experimental study, 60 participants were selected using purposive sampling. The data collection tool of the present study was five questionnaires including demographic questionnaire, Rosenberg self-esteem scale, self-confidence questionnaire, body image questionnaire, and experiences of post-surgical complications questionnaire. The data was classified both qualitatively and quantitatively. The data were analyzed using SPSS 22.

Findings: The findings indicated that blepharoplasty surgery did not result in post-surgical self-esteem (p=0.312) and self-confidence (p=0.251). However, the patients’ post-surgical body image increased (p=0.001). There was a positive correlation between pre and post-surgical self-esteem, self-confidence, and body image (0/4> r >0/5). Given the post-surgical complications such as pain, bruising, swelling, blurred vision, itching, inability to perform daily activities, and number of painkillers taken (p=0.05), the patients’ real experiences were by far less than their speculations. 

Profile of sinonasal malignant tumor patients in Adam Malik General Hospital Medan-Indonesia

Introduction: Malignancy of nose and paranasal sinuses (sinonasal) is 3% of head and neck malignancies, in which etiology is not known, and the prognosis is poor. Methods: This study is a descriptive case series. Samples were taken by purposive sampling method, in which all of the sinonasal malignant tumor patients (inpatient and outpatient) in Otolaryngology Department of Adam Malik General Hospital in 2010 – 2015 were recruited. Results: Nose blockage was the most common symptom (53.6%). The symptoms existed for less than six months (50.9%). Most of the tumor was located in maxillary sinus (70.5%) and was an epithelial tumor (94.6), particularly non-keratinizing squamous cell carcinoma type (47.3%). Most of the tumor graded as T4 (34.8), and most of the lymph nodes involved graded as N0 (83.9%). Tumors treated with surgery mostly by medial maxillectomy method (41.4%). Conclusions: Sinonasal malignant tumor patients in Adam Malik General Hospital, Medan, were mostly had nasal blockage symptom for less than six months. They mostly had maxillary sinus in origin, was an epithelial tumor with non-keratinizing squamous cell carcinoma type, T4 of tumor size, N0 of nodal involvement, and had a medial maxillectomy method in their surgeries.

Development of performance evaluation indicators for pre-hospital emergency centers

Abstract
Introduction
Pre- hospital emergency health care plays an important role in saving people’s lives. Proper performances of various parts of this system result in rapid and timely deployment of ambulance in patient’s place and prevention of death and disability. Thus, the present study was done in order to Compiling of performance evaluation indicators for pre-hospital emergency Centers in 2017.
Methods
The present study is a qualitative- quantitative research which was conducted in 2017. In order to compiling the indexes for evaluating the performance of pre-hospital emergency centers, the study was done in two phases. In phase one of the study, primary items and their fields were identified in accordance with the present literature. In the second phase, Delphi technic in three rounds was used to finalize the items and the fields. In the first round of Delphi technic, the identified items and fields were given to experts in forms of check list. The items and fields with average of >4 and standard deviation of <1 were confirmed, items with average of <2 and standard deviation of <1 were removed, and other items were randomly passed into round two. In the second round, all the items with average of >4 and standard deviation of <1 were confirmed, items with average of <3 and standard deviation of <1 were removed, and other items were randomly passed into round three. In round three, only items with average of >4 and standard deviation of <1 were confirmed and other items were removed.
Results
The results of the study showed that 9 items in field of facilities and physical space, 10 items in field of communication, 10 items in field of ambulance, 8 items in field of human resources, 9 items in field of regulations and protocols, 3 items in field of storing equipment in the center, and 3 items in field of training were identified.
Conclusion
Considering the identification of seven effective factors in improving quantitative and qualitative level of pre-hospital emergency services, it is highly important for authorized managers and decision-makers to plan and enhance all necessary factors.

Quantification analysis of tissue eosinophilia in squamous cell carcinoma of the head and neck region

Background and aim: Tumor-associated tissue eosinophilia (TATE) is commonly present in different neoplasms, yet its relationship with cancers has not been established. Squamous cell carcinoma (SCC) is one of the most common malignancies of the head and neck region. The aim of this study was to evaluate the relationship between TATE and histological grading of head and neck SCC (HNSCC) using Luna staining technique.

Materials and methods: In the present descriptive study, 67 samples consisting of 4-µm cross-sections of HNSCC tissue stained with hematoxylin and eosin (H&E) were re-evaluated for histological grading. The samples were divided into three categories of well differentiated, moderately differentiated, and poorly differentiated. Luna histochemical staining was used to evaluate infiltration of eosinophils in the tumor. Eosinophils were randomly counted in 10 microscopic fields and divided into 4 categories. Kruskal-Wallis test and Spearman's correlation coefficient were used to evaluate the relationship between eosinophilic infiltration and other relevant factors.

Results: The frequency of tissue eosinophilia was zero in only one case (1.5%) and was positive in the rest 66 cases (98.5%). The mean count of eosinophils was 7.5±4.5 cells per high-power field (HPF). There was a significant relationship between histopathological grading and TATE (p = 0.04). However, there were no significant relationships between TATE and factors such as age, gender, and lesion location.

Conclusion: The tissue eosinophil counts in the group with poorly differentiated SCC of the head and neck region were less than those in the two other groups; regardless, no significant relationship was found with other clinicopathological factors.

Correlation of Matrix Metalloproteinase-9 (MMP-9) expression and bone destruction in Chronic Suppurative Otitis Media (CSOM) patients with cholesteatoma at Adam Malik General Hospital Medan-Indonesia

Introduction: Cholesteatoma is a cyst which coated by stratified squamous epithelium containing keratin epithelial desquamation. The recurrence and bone destruction arerelevant features in cholesteatoma pathophysiology, which makes cholesteatoma tend to be dangerous and difficult to treat. Recent studies have shown that variations in cellular systems of matrix metalloproteinase-9 (MMP-9) production contribute to the pathophysiology of cholesteatoma, especially in of bone erosion.

Objective: The aim of this study is to determine the correlation between MMP-9 with bone destruction in CSOM with cholesteatoma patients.

Materials and Methods:This study was conducted by using cross-sectional design to the 40 samples of cholesteatomas patients at Otorhinolaryngology Department of Adam Malik General Hospital in May 2016. The level of MMP-9 expression was assessed by immunohistochemical staining of cholesteatoma tissue. The immunoreactivity score was obtained by calculating the broad scores with the intensity score in the assessment. Then, the correlation test was also carried out between MMP-9 expression and bone destruction statistically.

Results: This study found that most of participants were male gender patients (23 patients; 67.5%), 6-24 years old interval (23 patients; 67.5%), having intratemporal complication (35 patients; 87.5%); moderate level bone destruction (19 patients; 47.5%), and MMP-9 overexpression (34 patients; 85%). In addition, there was a significant correlation between MMP-9 expression and bone destruction (P = 0.000) in this study.

Conclusion: There was a significant correlation between MMP-9 expression with bone destruction in this study.

The Effect of Overnutrition Toward the Risk of Dengue Shock Syndrome in Pediatric Patient: In-Depth Investigation of sVCAM-1 and Adiponectin Level

Introduction: Overnutrition has become an emergent health problem worldwide and could signifcantly alter the normal human physiology. It still unknown how overnutrition could affect the
outcome of pediatric patient with dengue infection. This study aimed to unveil how overnutrition affects the risk of dengue shock syndrome (DSS) in dengue pediatric patient by evaluating the adiponectin which has immune-modulatory property and the inflammation
marker sVCAM-1.

Methods: An analytic observational nested case-control study was conducted in Paediatric Division Sanglah General Hospital, Bali, Indonesia from January 2015 to October 2016. Initially, patient’s anthropometric parameters were measured and the diagnosis of the
dengue infection was established according to the medical record and blood plasma was isolated to determine the level of adiponectin and sVCAM-1.

Result: The study showed that overnutrition increased the risk of DSS as much as 2.67 times greater than normal but it was not statistically signifcant (95%CI: 0.72 - 9.95). The mean level of sVCAM-1 was observed to be higher in overnutrition patients in almost all categories
of dengue infection, but none is statistically signifcant. However, its level appears to be lower in over nutritious DSS patients compared to their non-DSS counterparts (4638.64 (±934.99) vs. 5680.80 (±601.77); P = 0.013). The adiponectin level was found to be consistently lower
in patients with overnutrition regardless the category of dengue infection, but signifcant differences only observed in over nutritious DHF and overnutritious non-DSS comparisons.

Conclusion: It can be concluded that overnutrition increase the risk of DSS in pediatric patient with dengue infection whether it was not statistically signifcant. The lower level of adiponectin and elevated expression of sVCAM-1 could be the explanation of this phenomenon.

The Concentration of Interleukin-27 in the pleural fluid of patients with exudative pleural effusion and its diagnostic value in differentiating between benign and malignant pleural effusion

Introduction: The excessive accumulation of the pleural fluid in the pleural cavity results in pleural effusion, which is either exudative or transudative. The effective treatment of pleural effusion calls for the differential diagnosis of benign pleural effusion (BPE) and malignant pleural effusion (MPE). The present research objective was to measure the concentration of IL-27 and examine its diagnostic value in differentiating BPE from MPE in the pleural fluid of patients with exudative pleural effusion.

Materials and Methods: The samples for this research were obtained from 130 patients with exudative pleural effusion. The concentration of IL-27 in the pleural fluid was measured using the ELISA method. The statistical analysis was carried out using descriptive statistics tests and independent t test in SPSS 19. The significance level in all of the calculations was set to 0.05. The ROC curve analysis was carried out to determine the sensitivity of IL-27 in diagnosis benign pleural effusion.

Findings: Of the 130 patients included in this research, 88 were MPE cases and 42 were suffering BPE. The average age of the patients of the MPE and BPE groups was 57 and 59 years, respectively. The average IL-27 concentration in the BPE group (344.15 236.42) was significantly higher than the MPE group (203.05 76.03) (P=0.000). The area below the ROC curve was 0.803, which reflected the differential power of the IL-27 measurement in differentiating between BPE and MPE.

 Conclusion: Given the significant difference between the levels of IL-27 in the two study groups, the measurement of this biomarker in exudative pleural effusion cases can differentiate between BPE and MPE with good sensitivity and specificity.

Key words:  

Second victim support program and patient safety culture: A quasi experimental study in Bali International Medical Centre (BIMC) Hospital

Background: Patients are the first victims in patient safety incidents. However, healthcare providers are also the victims. In 2000, a doctor named Wu introduced the term “second victim” to describe the healthcare providers who involved in patient safety incidents. In Indonesia, there is no second victim support program implemented in the hospitals. A study needs to be done regarding second victim support program and its effect on patient safety culture.

Objective: To study the effect of second victim support program on patient safety culture.

Method: This study is a quasi-experimental study conducted from 2015 to 2017. The treatment given is the Second Victim Support Program. Healthcare providers in BIMC Hospital Kuta (87) are selected as the treatment group, while healthcare providers in BIMC Hospital Nusa Dua (103) are the control group. The study is analyzed with difference in-differences and paired-sample t-test. Phase 1 (2015) is the baseline, phase 2 (2016) is when the program is implemented up to one year (to study its effect on patient safety culture), and phase 3 is one to two years after the treatment is given (to study the sustainability of its effect).

Result: Difference-in-differences revealed that the treatment significantly increased the patient safety culture (β coefficient of 0.738, SE = 0.258, P-value = 0.007). There is no significant difference between patient safety culture in phase 2 and phase 3 (t (11) = 0.378 with P-value of 0.713 and Cohen’s d of 0.0476).

Conclusion: Second victim support program increases patient safety culture. If the program is maintained, the effect on the patient safety culture will be sustainable. 

Reducing Methicillin-Resistant Staphylococcus Aureus (MRSA) Cross-Infection through Hand Hygiene Improvement in Indonesian Intensive Tertiary Care Hospital

The effect of topiramate as an adjunct therapy to acetazolamide in Idiopathic intracranial hypertension patients.

Background: Idiopathic intracranial hypertension (IIH) is a nervous disease characterized by increased intracranial pressure around the brain. It is induced by increased production or decreased reuptake of cerebrospinal fluid (CSF). The standard treatment of IIH includes medicines to reduce CSF production. Acetazolamide is the most commonly used drug in treating IIH and is also considered as the first-line treatment. Topiramate is used to treat obesity. Since obesity is a risk factor of IIH, topiramate is used to treat IIH. We investigated the effect of topiramate as an adjunct drug along with acetazolamide in patients with IIH who presented to Shahid Sadoughi Hospital in Yazd, central Iran.

Methods: This study was a double-blind clinical trial. Forty-eight IIH patients presenting to Shahid Sadoughi Hospital participated in the study, divided into two groups. The acetazolamide group received acetazolamide 750-1000 mg qd and the Acetazolamide+topiramate group received acetazolamide 750-1000 mg qd and topiramate 25-50 mg qd. CSF pressure, body mass index (BMI), and visual field were assessed at the beginning of treatment and 6 months after intervention. The gleaned data were analyzed with SPSS20 using statistical tests.

Results: Our findings showed significant differences in CSF pressure in acetazolamide group and CSF pressure, BMI, and visual field in acetazolamide+topiramate group at baseline and 6 months after treatment. There were also statistically significant differences between the mean score of retinal examination in IIH patients in both groups at second, fourth, fifth, and sixth months (P-value <0.05).

Conclusion: Topiramate can be used as an adjunct to acetazolamide to increase the effect of treatment in IIH patients. 

The effect of prune on the severity of constipation in elderly women

Background and Aim: Constipation is a common digestive problem in elderly people, which has a negative effect on their quality of life. There are many methods in complementary and alternative medicine to treat this problem in the elderly. The aim of this study was to determine the effect of prune as a complementary and alternative medicine on the severity of constipation in elderly women living at Zabol Elderly House.

Materials and Methods: This study was an experimental study on 60 elderly women who are qualified residents living at Zabol Elderly House with constipation based on the Rom III diagnostic criteria. The samples were randomly assigned to intervention group and control group, consisting of 30 samples each. The[A1]  tools used in this study were a demographic questionnaire and a constipation scale. Data were analyzed by SPSS Software Version 20 and Mann-Whitney Test.

Results: According to the findings, the difference in the mean of constipation severity in the two groups was not significant before intervention (P = 0.61). However, at the end of the first week until the end of the third week after the intervention, there was a significant difference in the mean of constipation severity (P <0.05). This result showed that the effect of the intervention started from the first week and prune was effective in lowering the severity of constipation in the elderly women.

Conclusion: This study indicated that prune could be an effective complementary and non-pharmacological method to reduce the severity of constipation in elderly women. Therefore, nurses can use this simple, inexpensive and uncomplicated method as a complementary method to care for the elderly with constipation.

 [A1]Please explain how the prune intervention was done.

Factors influencing the inpatients satisfaction in public hospitals: a systematic review

Objective: The aim of the current study is designing a model for patient satisfaction and defining priority factors that impact patient satisfaction of healthcare services. Method: The preliminary literature search was undertaken in December 2014. A subsequent search was carried out in October 2015, which covered a majority of databases including PubMed, Scopus, ProQuest, and Magiran. Studies related to inpatients in hospitals included and related to specific area were excluded. No time bound was applied.   Two of the authors independently appraised the quality of studies and subsequently, the grouping of the variables was done using MAXqda 12 software and the analysis was done through vote – counting method. Result: Out of 1315 articles, 85 articles were chosen for final consideration. Most of which have been carried out in developed countries. The main factors affecting consumer satisfaction in hospitals were grouped into two categories. 1- Patient attribute factors: that involved expectations, health status, demographic and socio-economic. 2- Health system factors: that involved service quality, hospital features, staff satisfaction and insurance. Conclusion: In this study the risk of bias for each study not researched. It has been contended that the construct of consumer satisfaction is a multidimensional and subjective one. The finding of the current study suggests that all these variables be considered when evaluating patient satisfaction. The evaluation process should be performed cautiously as service providers have little direct influence over patient attribute factors. 

Degenerative Spondylolisthesis : The preferable surgical technique

Introduction: Degenerative Spondylolisthesis is the major cause of low back pain, radiculopathy, and neurogenic claudication. The incidence rate for the general population ranged from 5% to 7%. Surgical method on degenerative spondylolisthesis is highly recommended. Objective: The purpose of this review is to determine the preferable surgical procedures for degenerative spondylolisthesis, which are still debatable.

Methods: A total of ffty relevant literatures were researched regarding degenerative spondylolisthesis, the diagnostic procedure, and the treatment from the period of 2007-2017. The author has chosen which surgical technique that is preferable between TLIF (Transforaminal
Lumbal Interbody Fusion) and PLF (Posterior Lumbal Fusion), from the so-called 50 literature journals.

Results and Discussion: The results showed that there was no signifcant difference regarding the back pain using Visual Analog Scale (VAS) during the preoperative procedure, in the operating level, the treatment duration, and the post-surgical complications between the two groups. There was also no signifcant difference in terms of leg pain (using VAS) between those two groups. On the other hand, the amount of blood loss, the duration of the surgery and successful fusion were signifcantly higher in the TLIF group than the PLF group.

Conclusion: When determining the surgical procedure, the author discovered the TLIF to be comparatively superior to the PLF regarding the fusion success, despite the longer surgical duration and higher amount of blood loss.

Metachronous Multiple Primary Malignancies (endometrium and breast): A case report

Introduction: Advanced progression the field of diagnosis and treatment of cancer patients causes increased survival of patients. Increasing life expectancy can lead to new health problems, including Multiple primary malignancies (MPM). Although the incidence of MPM is increasing, the diagnosis of MPM remains very rare. Based on the interval between tumor diagnosis, MPM can be divided into synchronous MPM and metachronous. Studies of MPM may provide useful information not only for clinical purposes but also can provide clues about etiology and management of this type of cancer. This case report was a woman with metachronous MPM (endometrium-breast). Case: A 60-year-old female presented with a lump on the right breast since 2 months before admission. Patients also complained multiple marble sized lumps on the right armpit and right neck since 1 ½ months ago. From previous medical record data (5 years ago), the patient was diagnosed with endometrial carcinosarcoma stage IV. On physical examination on neck showed supraclavicula lymph nodes enlargement. Examination of right mammary region showed Peau d’orange skin with hyperemic colour, and a palpable solid mass. On right axillary region, there was lymph nodes enlargement. Mammae and axilla Ultra Sonography (USG) showed solid malignant in right upper-lateral quadrant breast with diffuse skin edema and multiple solid nodules in right axilla. Mammae histopathologic biopsy results conclusion is invasive carcinoma of no special type grade 3. Conclusion: Our case was a woman with a metachronous MPM endometrial and breast, with the first malignancy was endometrial carcinosarcoma stage IV (type II endometrial carcinoma) followed by the appearance of second malignancy as a breast cancer dextra grade 3 stage IIIC. Time interval between these malignancies more than 6 months (5 years).

Maple syrup urine disease: the first case in Bali

Background: Maple syrup urine disease (MSUD) is a rare genetic disease of metabolic disorder inherited as an autosomal recessive trait. The disease is caused by branched-chain alpha-keto acid dehydrogenase (BCKD) deficiency. It results in the accumulation of branched-chain amino acids (BCAA) which are toxic to the nervous system. 

Case Presentation: A one-week-old infant was brought to Siloam Hospital because she suddenly became lethargic, had a poor feeding, and an intermittent muscle spasm. She was the fourth child in her family. At her admission, she was diagnosed with neonatal sepsis. On advanced clinical and laboratory examination, we found ketoacidosis, hypoglycemia, and the typical odor of maple syrup in the urine. Plasma amino acids analysis showed a marked elevation of BCAA (leucine, isoleucine, and valine), confirming the diagnosis of MSUD. The patient was treated with intravenous glucose infusions and dietary support, including formulas free of BCAA. She was monitored for blood sugar and urine ketones. 

Conclusion: Metabolic disease should be considered in an infant who suddenly suffered a critical illness several days following a normal delivery.