Introduction: Typhoid fever is a disease caused by Salmonella typhi, Salmonella paratyphi A, B, C. An estimated 200,000 people die each year from about 21.6 million people infected with typhoid fever. This study aims to determine the hematological profile in typhoid fever cases in children under five at Idaman Banjarbaru Hospital.

Methods: The research was carried out with a retrospective descriptive approach with a consecutive sampling technique. The research subjects were children under five diagnosed with typhoid fever recorded in the Idaman Banjarbaru Hospital's medical records for July 2018 to January 2019.

Results: The sample consisted of 58 patients, 32 boys, and 26 girls. Most patients were found in 12 - <36 months, namely 28 (48.28%) children. Thirty-eight (65.52%) children have a normal weight. The hematological profile showed that 46.55% of the patients had iron deficiency anemia (IDA). Hematocrit levels decreased in 51.72% of patients. Erythrocyte levels in 86.21% of patients were normal. Low MCV, low MCH, IDA were found in 46.55%, 36.21%, 46.55% of patients. Leukopenia was present in 17.24% of children. All patients had normal basophil values. Eosinopenia, band neutropenia, segmented neutropenia,  lymphocytosis, monocytosis  were found in 69.09%, 90.90%, 56.37%, 58.18%, 58.18% of children, respectively. Thrombocytopenia and thrombocytosis were found in the same percentage, 13.80%.

Conclusion: The haematological profile of typhoid fever patients in children under five can have different results depending on each child's body's response to S. typhi and S. paratyphi that enter the body.

Background: Acute lymphoblastic leukemia (ALL) is a bone marrow malignancy that is the most common cause of death in children. This study aims to determine the characteristics of ALL patients in 2016-2020 at Sanglah Hospital Denpasar, Bali.

Methods: This study used a retrospective descriptive study with secondary data from 166 patients. Variables assessed in this study included: demographic characteristics (age, gender, place of origin), complete blood count results include of hemoglobin levels, leukocyte (white blood cell) count, absolute neutrophil count, absolute lymphocyte count, thrombocyte count, and morphology subtype of ALL based on FAB classification from bone marrow aspiration (BMA).

Results: From demographic characteristics: most patients' age was in school-age children (>6 - <18 years) about 59.7%, dominated by male (60.2%), place of origin from Bali (71.7%) which is from Denpasar city (23.5%). From the laboratory results, complete blood count found that the most results are moderate anemia in children (54.7%), in adult female (70%), and in adult male (52.9%); leukocytosis in children (41%), in adult (77.8%); neutropenia in children (61.2%), in adult (59.3%); lymphocytosis in children (43.2%), in adult (81.5%); thrombocytopenia in children (97.1%), in adult (100%). From the results of the BMA examination, based on the FAB (French, American, and British) classification, the most common morphology of ALL was L2 subtype (78.9%).

Conclusion: Characteristics of patients with ALL at Sanglah General Hospital are dominated by children, male, from Denpasar, Bali, with laboratory results showing moderate anemia, leukocytosis, neutropenia, lymphocytosis, thrombocytopenia, and the most common morphological variants are ALL-L2 subtype.

Background: Limiting close physical contact is key to helping reduce the spread of the coronavirus by using the portable eye examination kit (Peek Acuity), which has been recognized as a reliable and valid tool to measure visual acuity. This study is aimed to compare the effectiveness of the Peek Acuity and ETDRS (Early Treatment Diabetic Retinopathy Study) chart as the gold standard for screening in school-age students.

Methods: This study used an observational research design with cross-sectional data collection methods to compare the effectiveness of the Peek Acuity application diagnostic test and ETDRS chart for screening in school-age students. Sample collection was done by total sampling technique on students aged 6-12 from one of the elementary schools in Surabaya. The study was conducted from October 2019 to November 2019. OpenEpi analyzed the validity and reliability of the results to compare the effectiveness of Peek Acuity and the ETDRS chart.

Results: There were 231 students with details aged 6-9 years, as many as 150 students and aged 10-12 years, as many as 81 students. On examination of visual acuity using peek acuity and ETDRS chart, it indicated that the number of subjects with refractive errors was more than normal eyes. Peek acuity has been shown to have low sensitivity and high specificity. Higher specificity was found in children aged 10-12 years compared to 6-9 years.

Conclusion: The Peek Acuity application has higher effectiveness in screening than the ETDRS chart. It is practical, fast, and easy to use. The Peek Acuity application is considered effective for screening school-age students due to its high rate of specificity

Introduction: Customer relationship management (CRM) is a strategy hospitals can use to realize patient-centered care. The study was based on the low interest in inpatient visits by company guarantees, where only 11.4% of employees used inpatient facilities at Ciputra Mitra Hospital (CMH). This study aimed to develop an effort to increase inpatient visits by company guarantees at CMH Banjarmasin.

Methods: This study was conducted on 95 respondents from company customers. Of the 95 customers, they are divided into actual customers, namely those who have used inpatient services, as many as 58 people and potential customers who have not utilized as many as 37 people. The data is processed by classifying some between actual and potential customers and processed descriptively from several variables, including Satisfaction, Interact and Loyalty.

Results: This study informs that the low interest in visiting is strongly influenced by customer knowledge regarding the company's cooperation with hospitals and services following customer needs. The actual customer differentiation is mostly just first-timers and repeat customers, while the rest are prospects who have not taken advantage of the services at CMH. The interaction of the hospital with partner company customers at CMH influences satisfaction with a significance of <0.001, while the resulting patient satisfaction influences loyalty with a significance of <0.001, thereby increasing customer loyalty.

Conclusion: Based on this study, most customers were prospective customers who had never used inpatient services. The service experience felt by customers is the same as other customers, while customer loyalty to CMH is higher than customer loyalty to other hospitals.

Background: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous unit. AV therapy is given based on the severity of AV. Oral antibiotic therapy is routinely prescribed to treat moderate to severe inflammatory acne. The purpose of this study is to determine the relationship between systemic antibiotic administration and the decrease in the severity of acne vulgaris.

Methods: This was a retrospective study with an analytical design, carried out on 49 medical records that met the inclusion criteria for acceptance of the sample; new AV patients come with grades 2, 3, and 4 to the Medical Cosmetics division Dermatovenereology Outpatient Clinic of Dr. Soetomo General Teaching Hospital Surabaya in the period January 2017 - December 2019.

Results: This study was conducted on 49 patients with acne vulgaris grade 2,3,4 who came to follow-up in a week 2,4,8 treatment. Data from the first follow-up group, 26 subjects (53.1%) experienced a decrease in grade; from the second follow-up group, 25 subjects (51.0%) experienced a decrease in grade; from the third follow-up group, 38 subjects (77, 6%) experienced a decrease in the group comparing with condition patient before treatment. Analytic comparative showed that the condition of the first visit compared to the first, second and third follow-up groups were 0,180, 0,000, and 0,000, respectively. The significance test results showed a value of 0.000 (p ≤ 0.05) in the second and third follow-up groups, which is statistically significant.

Conclusion: An oral antibiotic can effectively reduce the severity degree of acne vulgaris in four to eight weeks after treatment with an oral antibiotic.

Introduction: It is widely recognized that stress cannot be eliminated from one's life and that stress may be associated with the prevalence of hypertension, for which the role of stress as a risk factor is being debated in terms of its correlation with hypertension incidence. This study examined the correlation between the stress of the middle-aged and elderly with hypertension.

Methods: This study applied a cross-sectional study using purposive sampling to recruit the respondents in Binong Tangerang, Indonesia. A modified questionnaire was used to collect the demographic data, stress, and smoking behavior. Blood pressure examinations were also conducted to identify the level of hypertension.

Results: A total of 145 respondents consisted of 79 (54.5%) middle age and 66 (45.5%) elderly were examined. Most of the respondents (82.8%) were female, and half of them were Sundanese (50.3%). Half of the respondents were categorized as pre-hypertension (42.8- 53.1%), where most of the respondents had non-smoking behavior (82%), and half of them were at the level of severe stress (57.2%). There was a significant correlation between respondents’ stress levels and hypertension (p-value < 0.05). 

Conclusion: Stress is related to hypertension in middle age and elderly in the Binong community. Therefore, stress management training is needed to promote the quality of life for middle age and elderly with hypertension at Posbindu in the Binong community.

Background: The quality of a blood product is determined by collecting, processing, storing, and transporting it. When blood is stored, there will be mechanical and biochemical changes. Mechanical changes consist of morphological changes and hemolysis, while one of the biochemical changes is increased plasma potassium levels. This study aimed to determine the correlation between the hemolysis index and the storage period to potassium levels of the packed red cell (PRC).

Methods: This study was a cross-sectional study at Sanglah Hospital. The sample was taken from the tube in the PRC blood bag and then a complete blood count and potassium analysis were performed. Data were analyzed using SPSS version 25 for Windows.

Results: From 70 subjects, the median hemolysis index was 0.15% (0-1.69%), the mean storage period was 12.06±4.95 days, and the mean potassium level was 12.06±3.92 mmol/L. The Spearman test results showed a positive weak significant correlation between the hemolysis index and potassium levels (r=0.360; p=0.002). The Pearson test results also showed a positive weak significant correlation between the parameter of the storage period and potassium levels (r=0.357; p=0.002).

Conclusion: There was a positive weak significant correlation between the hemolysis index and the storage period to potassium levels of the PRC.

Background: Coronavirus disease 2019 (COVID-19) has had a profound global effect on mortality rates. There were many studies about mortality and COVID-19, but there is no study about bibliometric analysis of these studies. This study provides a general overview of studies on the mortality rate of COVID-19.

Methods: Publications on mortality rate during the COVID-19 pandemic from December 1, 2019, to November 17, 2021, were extracted from the Pubmed database. Bibliometrics indicator analysis was performed using Bibliometric/Biblioshiny, We used the following keywords: “covid-19 mortality[Title]”; “SARS-CoV-2 mortality[Title]”; “2019-nCoV mortality[Title]”; "SARS-CoV-2"[MeSH Terms]”; "SARS-CoV-2"; "2019 ncov"; "mortality"[Title]”.

Results: From December 1, 2019, to November 17, 2021, 2,848 documents were retrieved, with 2,202 (or 77.3 %) being journal articles. Most publications were produced by the Plos One journal (93 3,3 %). Wang Y, a Chinese author, has authored the most articles on this topic (64, 8.91 %). The strongest cooperating countries' network consisted of the United States, Italy, France, China, and Spain. Ten keyword clusters identifying mortality hotspots were discovered.

Conclusion: Bibliometrix analysis of the mortality rate in COVID-19 is helpful for mapping studies related to the mortality rate of COVID-19. This article provides an overview of further research related to mortality in COVID-19

Background: Cervical cancer is the leading cause of cancer in the world, especially in developing countries. Kefir is a goat's milk product that contains a lot of nutrients and bioactive complex which are involved in the synthesis of the anticancer, and have anticarcinogenic and antimutagenic effect. Integrins are involved in various biological processes associated with cancer development, such as migration, invasion, differentiation and proliferation. MMP-9 can also degrade ECM through proteolytic action, affecting cell-cell interactions in ECM. This research aimed to see the effect of kefir on MMP-9 and integrins activation. Thus, it is expected that kefir can be used as an additional supplement in patients with cervical cancer.

Methods: This research study was conducted in an experimental laboratory in vitro using HeLa cells as the object of research. Data were analyzed using the SPSS program to determine the most effective dose of kefir and a regression test to determine the effect between integrins and MMP-9.

Results: The mean value of MMP-9 and integrin at a dose of 180 µg/ml was 165.1 ± 5.8 and 378.5 ± 12.6 respectively. This result had a significant value of p = 0.0000 for both MMP-9 and integrin-b. In the regression test, the value of p = 0.05 was obtained while the coefficient value was positive (0.565).

Conclusion: The higher the expression of MMP-9, the activation of the integrin-b would increase. Kefir extract dosage of 180 µg/ml significantly reduced MMP-9 and Integrin-b expression. MMP-9 affects improving Integrin-b

Introduction:  Betel leaf is very popular in Asia and known to have a function as traditional medicine. And is often referred to as the "Golden Heart of Nature". This is because the betel leaf has an effect such as antimicrobial, antiviral, radioprotective, antioxidant, antiseptic, bactericidal, anti-inflammatory, antiallergic, wound healing, antiplatelet, antibacterial, antifungal, and immunomodulatory activity. Nutraceutical nano-betel leaf extract contains rich in minerals, vitamins, antioxidants, phenolic compounds, and essential oils. Effectively protects the mouth from pathogens. This research aims to review the nutraceuticals of nano-betel leaf extract to prevent COVID-19 and oral cavity disease.

Methods:  This systematic review study was conducted through six steps: (1) framing the questions (based on theory); (2) Run a search (on Scopus, Google Scholar, EBSCO, ProQuest, and Science Direct publishing articles from 2020 to 2022); (3) Determine the relevant research; (4)  Determine the articles come from diverse backgrounds; (5) Extraction of data from individual studies; (6) Synthesis of results using the narrative method.

Results:  Betel leaf contains nutrients for oral health, immunomodulators, and COVID-19, namely protein, amino acids, vitamins A, B, C, and K, as well as minerals such as Mg, K, Ca, Fe, I, P, Zn, essential oil (eugenol, hydroxylchavicol, allylpyrocatechol, quercetin, etc). Betel leaf nano extract has a significant role as antioxidants, anti-inflammatory, antimicrobial, and antivirus, which act as anti-oral cavity disease and anti-COVID-19. Betel leaf nano extract has a significant role in curing various oral cavity diseases related to COVID-19, including fungal infections, toothache, conjunctivitis, re-current HSV, oral ulcerations, xerostomia or decreased salivary flow, and gingivitis.

Conclusion:  Betel leaf nano extract has a significant role in curing oral cavity disease and COVID-19. It is recommended that research into the oral disease and COVID-19 drugs combined with viable ingredients substances from betel leaf.

Background: The main factor causing failure of root canal treatment is re-infection of the bacterium Enterococcus faecalis, so it is necessary to give the right intracanal medicament. Calcium hydroxide (Ca(OH)2) is an intracanal medicament often used in endodontic treatment. To increase the effectiveness of calcium hydroxide, a mixing agent is needed. Mixing agents such as Chlorhexidine digluconate (CHX) 2% (aqueous) and Clindamycin hydrochloride 5% (viscous). The viscous mixing agent can penetrate well into the dentinal tubules, and the antibiotic can fight various root canal endodontic pathogens and dentinal tubules without causing discoloration. This study aims to determine the differential effectiveness of calcium hydroxide combination of chlorhexidine digluconate 2% and Clindamycin hydrochloride 5% as an intracanal medicament against Enterococcus faecalis (in vitro).

Methods: The design was in vitro experimental laboratories that tested the value of turbidity (Optical Density) using a spectrophotometer before and after being treated. Data were analyzed by the Kruskal-Wallis test and then Mann-Whitney U Test.

Results: The positive control group had the largest negative Optical Density (OD) difference, followed by a calcium hydroxide combination of Chlorhexidine digluconate 2%, and the third sequence was a calcium hydroxide combination of Clindamycin hydrochloride 5%. A negative OD difference indicates a decrease in the number of bacterial cells.

Conclusion: There are differences in the effectiveness of the antibacterial of intracanal medicament calcium hydroxide combination of Chlorhexidine digluconate 2% and calcium hydroxide combination of Clindamycin hydrochloride 5%.

Introduction: The COVID-19 pandemic has fundamentally altered how society functions, including the conditions under which health professionals work. Nurses, who are at the forefront of providing care to COVID-19 patients, spend extended periods in close contact with infected patients. These stressful conditions may increase nurses' risk of developing depression and other mental health problems. This study aimed to explore the experiences of Indonesian nurses working in two COVID-19-designated hospitals that provide direct patient care.

Methods: The qualitative phenomenological design was used in this study. Between June and December 2020, 15 nurses at two COVID-19-designated hospitals participated in in-depth telephone interviews, and four nurses were selected to participate in a focus group discussion for data triangulation. Following that, data were analyzed according to Colizzi's phenomenological method.

Results: The data were categorized into four themes: 1) Responsibility to maintain nursing professionalism; 2) Challenges in caring for COVID-19 patients; 3) Support in caring for COVID-19 patients; 4) Increase insights while caring for COVID-19 patients. These themes indicate that, while nurses felt supported by hospital administration and close family members, they were also affected by the high workload, which resulted in behavioral changes associated with mental illness.

Conclusion: These findings shed light on the benefits and drawbacks of nurses caring for COVID-19 patients. These findings can serve as a starting point for hospital administration in developing policies and systems that promote nursing staff well-being.

Introduction: Based on the low interest in inpatient visits by company insurance, only 11.4% of employees utilize inpatient facilities at CMH. This study aimed to find the relationship between demographics and infographics of company insurance patients on the use of inpatient services.

Methods: This study was conducted on 95 respondents from a customer's company. Ninety-five customers are divided into actual customers who have used inpatient services (58 people) and potential customers who have not utilized (37 people). The data is processed by grouping some between actual and potential customers and processed descriptively using a chi-square of several variables, including demographics and infographics.

Results: This study informs that the distance from home and the length of time known to the hospital did not affect inpatient care. At the same time, knowledge of cooperation and socialization of HRD influences the utilization of inpatient services. Repeated socialization and the hospital's proximity to HRD can cause more patients to visit and take advantage of inpatient services

Conclusion: In carrying out inpatient services, the company's role as a guarantor is very decisive in directing customers to CMH. Utilization of inpatient services is not influenced by distance from home and length of time with CMH but by customer knowledge regarding collaboration with CMH and socialization by HRD.

Introduction: The new daily activities undertaken by students at the Islamic boarding school are a time of change, in terms of individual religiosity and social interaction. This is because not all new students have the experience of living in boarding schools. The purpose of this study was to analyze the relationship between religiosity and social support with student adaptation in Islamic boarding schools.

Method: The design of this study was cross-sectional. The sample was 102 new students who were living in a boarding school for less than a year which were taken by simple random sampling. The independent variables were religiosity and social support, the dependent variable was student adaptation. The research instrument used a questionnaire. Data were analyzed using the Chi-Square test and Binary Logistic Regression test

Results: The results of the Chi-Square test analysis showed that p-value = 0.042 and p-value = 0.021, which means that there is a significant relationship between the two variables. Meanwhile, the results of the binary logistic regression analysis showed that p-value = 0.220, which means that 22% of the student adaptation variable can be explained by the variable of religiosity and social support.

Conclusions: The higher the level of religiosity and social support, the higher and easier the students will adapt. It is hoped that the Islamic boarding school caretakers will be able to carry out mentoring activities for new students so that it can make it easier for students to adapt.

Background: Hamstring autograft (HA) is the most common graft used in ACL reconstruction procedures. However, harvesting HA could weaken the secondary stabilizer of the knee joint. Peroneus longus grafts (PL) is a novel option secondary to hamstring graft with less morbidity at the knee joint. We intended to determine whether peroneus longus autograft (PL) is a comparable alternative to hamstring autograft for ACL Reconstruction.

Methods: 84 patients were grouped into "hamstring" (n = 51) and "peroneus longus" (n = 33) groups, with a mean age of 26.2 ± 5.9 in the Hamstring group and a mean age of 26.4 ± 6.6 in peroneus group. We obtain secondary data from the medical records of several hospitals in Makassar.

Results: There was a significant difference in Lysholm score (p<0.05) in the hamstring group with peroneus at 6 months and 12 months postoperatively for IKDC score, anterior translation, Power Grading Flexi-Extension, ROM on flexion, and extension. In addition, in muscle atrophy, the Hamstring group compared to the peroneus group also showed a significant difference (p=0.001).

Conclusion: The study's results did not show significant differences between the hamstring and peroneus groups other than atrophy of thigh muscles in the hamstring group. Based on the results of this study, we conclude peroneus longus graft is one of the graft options in ACL reconstruction surgery.

Introduction: An instrument that is frequently used to gauge academic procrastination is the Procrastination Assessment Scale for Students (PASS). During covid-19 pandemic the chance to get more into procrastination mode is higher because while students is studying at home they have something distracted their mind such as watching movie, using social media and the others things. The objective of this study was to evaluate the constructs of validity and reliability of the procrastination assessment scale for nursing students during the pandemic COVID-19 are examined.

Method: It is a cross sectional study where distributed to 416 nursing students and the data taken by stratified sampling. The scale consists of two part, part one is area of procrastination had 18 items and second part is reason for procrastination had 26 items. The data was analyzed with Stata.

Results: The reliability of first part was 0.6615 and the second part was 0.9136. The model was acceptable where root mean squared error of approximation (RMSEA) = 0.108, standardized root mean square residual (SMRS) = 0.063, comparative fit index 0.957, CI 90%.

Conclusion: Based on the investigation, the dimensions and indicators that make up the academic procrastination construct are credible and valid ways to assess it among Indonesian nursing students.

Introduction: Tuberculosis is still a public health problem. Indonesia is the third rank of highest TB in the world. Community empowerment is one of the strategies for finding TB suspects. Community empowerment in Probolinggo Regency is carried out by forming the local TB Association. Evaluation of the role of this TB community has never been done. There is no available measure of community empowerment in this TB community. A measuring tool for community empowerment models is needed for the TB community to increase empowerment. This study aimed to develop a measuring tool for community empowerment through the TB community in finding TB suspects.

Methods: This type of research is quantitative with a cross-sectional design. The population and sample are all local TB communities in Probolinggo Regency are about 325 people. Determination of the sample using simple random sampling according to the inclusion criteria of 128 respondents. Instruments using questionnaires and data analysis with exploratory factor analysis.

Results: The results showed that the measuring instrument for community empowerment was personal factors, knowledge, communication, motivation, self-efficacy, motivational incentives, group factors, and community empowerment factors in finding TB suspects, participation, leadership, and organizational structure having a Bartlett test of sphericity value P < 0.001, Reliability of Life Satisfaction Questionnaire with Cronbach Alpha > 0.800.

Conclusion: This instrument is valid and reliable to be applied to measure local TB community empowerment in finding TB suspects.

Background: Nasal polyps are benign chronic inflammatory masses with epithelial tissues of the nasal mucosa and paranasal sinuses. The clinical diagnosis is made based on sinonasal symptoms for more than three months and the presence of polyps in the nasal cavity. The classification of nasal polyps based on the histopathological structure is divided into three types, i.e., oedematous, eosinophilic polyps, inflammatory polyps, and chronic seromucous inflammatory polyps. This study aims to describe the profile of patients with nasal polyps at Dr. Soetomo Public Hospital Surabaya.

Methods: This study applied a descriptive method with a retrospective approach by obtaining data from the medical records of the outpatient unit in the Ear, Nose, Throat, and Head-Neck (ENT-HN) Department of Dr. Soetomo Public Hospital Surabaya for the period January 2017-December 2018 based on age, gender, clinical symptoms, symptoms duration, polyp types, location of nasal polyp, and comorbidities.

Results: The number of patients with nasal polyps was slightly more in women, as many as 13 patients or 52%, mostly aged 51-60 years old, amounting to 11 patients or 44%. The most common clinical symptom experienced by patients was nasal obstruction, as many as 24 patients or 96%. Patients who experienced symptom duration for one to three years before treatment amounted to 13 patients or 52%. Patients with histopathology of inflammatory nasal polyps were 19 patients or 76%, while patients of nasal eosinophil polyps were six patients or 24%. Additionally, patients with comorbidity in nasal polyps of allergic rhinitis medical history were 11 patients or 44%. Also, bilateral nasal polyps were mostly experienced by patients, reaching 14 patients or 56%.

Conclusion: This study reveals nasal polyps in women aged 51-60 years with clinical symptoms of nasal obstruction with the results of a histopathological examination of the inflammation type at bilateral polyps.

Background: Fungal keratitis is one of the most difficult forms of microbial keratitis to treat successfully. Aspergillus flavus is a type of filamentous fungus that often causes suppurative keratitis. Complications that often arise from fungal keratitis are corneal perforation and blindness due to scar tissue formation.

Methods: Aspergillus flavus was injected into the corneas of 28 Sprague Dawley rats intrastromal and divided into 4 groups, with each group consisting of 7 rats, fungal injection into the cornea as a fungal injection without therapy, natamycin therapy, cryotherapy, and combination therapy. Therapy was given five days after the fungal injection into the cornea and the formation of keratitis and corneal central thinning. After four days of therapy, the eyes were enucleated to determine the effect of cryotherapy on MMP-8 and TIMP-1 expression in the cornea with an immunohistochemistry (IHC) staining examination. The differences in MMP-8 and TIMP-1 expressions between groups were analyzed using the Kruskal Wallis test and Mann-Whitney post hoc test with a significant p <0.05. Data were analyzed using SPSS version 26 for Windows.

Results: The highest MMP-8 expression was found in the natamycin therapy group (3), and the lowest was in the negative control group and cryotherapy (1). There were no significant differences in MMP-8 expression in the 4 groups (p=0.482). The highest TIMP-1 expression was found in the negative control group (8) and the lowest was in the cryotherapy group (2). There were significant differences in TIMP-1 expression in the 4 groups (p=0.002).

Conclusion: It was found that the expression of TIMP-1 and MMP-8, although the last one was not significant, were lower in the cryotherapy group than in the non-cryotherapy group.

Introduction: The allocation of village funds to the health sector focused on reducing nutritional problems and involving the village in controlling non-natural disasters caused by COVID-19. The study aimed to analyze the implication of the village fund toward public health performance in the pandemic era.

Methods: Ecological analysis was conducted using secondary data from the East Java Health Profile 2020. The sample was 29 districts of East Java, where all the villages receive village funds. Apart from village fund utilization as the dependent variable, the independent variable consists of nutritional status, active Posyandu, case of COVID-19 and recovery rate of COVID-19. Data were analyzed by univariate and bivariate. The bivariate analysis was performed using the chi-squared test.

Results: Undernourished and wasting were silent health burdens in the pandemic. The pandemic also made the active Posyandu is lower. High attention to Kediri dan Jombang was grouped to vulnerable health areas. Statistically, no correlation between the village fund utilization with public health improvement in the pandemic era

Conclusion: Although there is no statistical correlation, nutrition issues and the impact of using village funds on health must be a concern. An in-depth evaluation needs to be carried out on the use of village funds to get clear implications for public health

Background: The novel coronavirus disease (COVID-19) emerged in Wuhan, China, in December 2019. Since then, it has spread to 215 countries, and 42 million people around the globe are affected. The knowledge, attitudes, and practices (KAP) toward COVID-19 play a role in determining the acceptance of behavioral change measures from health authorities to suppress this pandemic status. The KAP on COVID-19 is also important among university students during the COVID-19 pandemic to mitigate the outbreak of COVID-19. Hence, this study aimed to determine the level of knowledge, attitudes and practices towards COVID-19 and its association with sociodemographic factors among nursing students of Universiti Malaysia Sabah.

Methods: A cross-sectional, questionnaire-based study was conducted among the Year 1, Year 2 and Year 3 nursing students. The questionnaire consists of four parts: 1) demographics, which surveys participants' sociodemographic information; 2) knowledge about COVID-19; 3) attitude towards COVID-19; and 4) practices relevant to COVID-19. Statistical Package for Social Science (SPSS) version 26.0 was used for data entry and analysis

Result: A total of 113 Nursing Students participated in the study. More than half of the respondents have good general knowledge and practices of COVID-19. However, only one in three respondents have positive attitudes towards COVID-19. Older age was associated with good knowledge about COVID-19 (p=0.02). Female (P=0.02) and high household income (P=0.02) has a better attitude towards COVID-19. However, no significant association between sociodemographic and practices towards COVID-19.

Conclusion: Most of the respondents demonstrate a good level of knowledge and practices towards COVID-19 but not for attitudes. Sociodemographic characteristics such as younger, male respondents and those with lower-income families have inadequate knowledge and practices towards COVID-19. Hence, health education programs such as campaigns need to be conducted to increase the knowledge and encourage adequate preventive practice towards COVID-19 should be targeted towards this group.

Introduction: The condition that appears in patients who have had a stroke is cognitive impairment. Cognitive impairment can worsen the condition of stroke patients so that it can slow down the recovery process and have a high risk of disability. This study aims to analyze the correlation between cognitive impairment and the level of disability in post-stroke patients.

Methods: This study uses a correlational analytical design with a cross sectional technique design with a population of 70 participants and a sampling technique using consecutive sampling obtained a sample of 64 participants. The independent variable in this study is cognitive impairment of post-stroke patients while the dependent variable is the level of disability of post-stroke patients. The instrument for collecting data on cognitive impairment was using the MoCA-Ina questionnaire and the level of disability using the WHODAS questionnaire. The data were analyzed using the Spearman Rank test with significance < 0.05.

Results: The results of this study showed that most of the 52 (81.2%) participants had cognitive impairment and most of the 42 (65.6%) participants had moderate disabilities and a small portion of 10 (15.6%) participants had severe disabilities. The results of statistical tests on the relationship between cognitive impairment and the level of disability in post-stroke patients through the Spearman Rank test showed p = 0.000 with coefficient correlation 0.665.

Conclusions: The analysis test showed a strong correlation between cognitive impairment and the level of disability in post-stroke patients. Post-stroke patients with cognitive impairment must be treated properly so that it does not result in disability in patients that has a direct impact on the psychosocial and quality of life of the patient.

Introduction: Healthcare is a complex system that requires collaboration across health professions. However, a plethora of reports has identified poor communication and collaboration within healthcare teams which could lead to patient safety issues. Interprofessional education (IPE) is an educational strategy to promote communication and collaboration between healthcare professionals. Despite knowing the readiness among students, opinions among faculty members regarding the need for IPE at UPH (Universitas Pelita Harapan) have yet to be examined despite the important roles of both students and faculties in developing an IPE curriculum. This study aimed to investigate the readiness among medical and nursing faculty members in establishing an IPE curriculum at UPH.

Methods: This study applied a quantitative study design using the Readiness for Interprofessional Learning Scale (RIPLS) by Parsell and Bligh (1999) which was translated to Indonesian and tested for its validity and reliability. The translated RIPLS questionnaire was administered to a total of 60 participants which consisted of 30 nursing and 30 medical faculty members. Subsequently, both descriptive and Mann-Whitney statistical analyses were conducted.

Results: Findings revealed a statistically significant difference between the IPE scores (RIPLS) of nursing faculties and medical faculties  (U = 652, z = 3.028; p = 0.012, r = 0.390). This demonstrates that the nursing faculty members (Median 4.30) indicated a higher level of readiness or more positive attitude towards IPE compared to the medical faculty members (Median 4.07).

Conclusions: This study highlights that faculty members have a positive attitude or readiness toward IPE, with nursing faculties indicating higher levels of readiness than their counterparts in the medical faculty. Further exploration using a qualitative method is also important to understand the faculty members’ readiness for IPE as well as the commitments of faculty members and leadership on delivering IPE.

Introduction: Noni, which has the scientific name Morinda citrifolia L., is a plant often found in Indonesia and has many properties used for generations. However, this noni fruit has potential toxicity that needs to be studied further. This study aimed to determine the phytochemical compounds and determine the toxicity of the ethanol extract of noni fruit using the Brine Shrimp Lethality Test (BSLT) method.

Methods: The research was conducted at the Chemistry Laboratory, Universitas Nahdlatul Ulama Surabaya. This research includes experimental research. Artemia salina L. larvae aged 48 hours were put into a test tube containing a solution of noni fruit extract with concentrations of 10, 50, 100, 250, 500, 750, and 1000 ppm, then observed after 24 hours.

Results: In the phytochemical screening results, noni fruit ethanol extract contains tannins, saponins, flavonoids, and terpenoids. The test results obtained an LC50 value of 17.78 ppm, which indicates that the ethanol extract of the noni fruit is toxic.

Conclusion: The ethanol extract of the noni fruit contains tannins, saponins, flavonoids, and terpenoids and has toxicity to Artemia salina L. larvae. It can be concluded that the ethanolic extract of noni fruit has the potential as an anticancer.

Background: Endometrial cancer is the second most common type of gynecologic malignancy. Studies on factors of lymphatic metastases are few. This study aimed to determine the clinical and pathological characteristics that can predict lymph node metastases.

Purpose: To determine the correlation of clinicopathological characteristics with LNM (Lymph Node Metastases) in Endometrial Cancer (EC).

Methods: This study used observational analysis and a cross-sectional methodology to examine medical records of endometrial cancer patients who underwent lymphadenectomy sampling surgery in 2018-2020. The risk factors are determined using multivariate analysis.

Results: The stage IB and IIIC1 patients accounted for the most (17.27%) of the 63 research participants. Only one patient (1.1%) is in stage IIIB. The rests are stage IA and IIIA, each including eight patients (8.13%), and stage II, which has twelve people (12.19% ). There were 17 patients with endometrial cancer who had lymph node metastases (27% ). The incidence of LNM is 23.2% in endometrioid types, while the incidence of metastases is 57.1% in non-endometrioid kinds. The incidence of LNM in EC was not linked with the patient's age (p=0.628), BMI (p=0.190), parity (p=0.194), or menopausal status (p=0.970). The study found no correlation between LNM and histological kinds (p=0.078), histopathological degrees (p=0.514), or myometrium invasion (p=0.134) in EC. The risk factors most linked with LNM in EC are LVSI (+) (OR = 0.10; IK 95% 0.19–0.56; p = 0.009) and cervical invasion (OR = 0.07; IK95 percent 0.008–0.64; p = 0.019) according to the results of multivariate analysis.

Conclusion: Cervical invasion and LVSI (+) are the risk factors most associated with the incidence of LNM.

Background: Grafts and flaps are commonly used for wound closure which can be caused by trauma, chronic disease, post excision tumors, burns, and infections. Reconstructive can fail because of the poor wound bed, radiation, vascular insufficiency and reperfusion injury (IR). EPA and DHA (omega-3) are new compounds that have a strong effect on controlling inflammation in the resolution phase. Some studies say that EPA and DHA (omega-3) are described not only to lower plasma triglyceride levels but also have anti-inflammatory effects and improve endothelial function, all of which mediate anti-atherogenic effects. This study aimed to prove whether preoperative omega-3 administration could increase the viability of extended random skin flaps

Method: This is an experimental post-test-only control group design. 24 rats were divided into 4 groups. The control group (I and II) only had an extended random skin flap, and the sample was taken on the 3rd day (Group I) and 7th day (Group II) and the treatment group (II and IV). Omega was administered according to the animal dose for 21 days. The extended random skin flap was performed, and the sample was taken 3rd day (Group III) and 7th day (Group IV) and the viability of the extended random skin flap in the study was assessed from the expression of VEGF, the number of capillaries and clinical examination assessed from survival area.

Results: Independent T test for each pair in groups I and III showed a significant difference between the mean number of blood vessels in group I and the average number of blood vessels in group III, P=0.000, p<0.005, a significant difference between the mean number of blood vessels in group II and the mean number of blood vessels in group II. group IV blood vessels obtained P = 0.000, p <0.005. Mann-Whitney test found a significant difference between the intensity of VEGF in groups I and III with a value of p=0.031 (p<0.05) and a significant difference in VEGF expression in groups II and IV with p=0.038 (p<0.05). The results of the statistical test of survival area independent T-test for pairs in groups I and III obtained p: 0.353 (p>0.05), and the Mann-Whitney test for groups II and IV obtained p: 0.749 (p>0.05).

Conclusion: Consumption of omega 3 oral before surgery increased the viability of the extended random skin flap by histopathologically increasing VEGF expression and capillary count, and omega 3 oral administration before surgery did not increase the viability of the extended random skin flap assessed from the survival area on the first week.

Introduction: There is no much information on how admission rates of non-coronavirus disease 2019 (COVID-19) diseases altered after two years of COVID-19 pandemic. The aim of this study was to determine the pattern of ischemic stroke admission rates within the two years of the COVID-19 pandemic in Indonesia.

Method: A cross-sectional retrospective study investigated the admissions data of ischemic stroke was conducted at a tertiary hospital in Indonesia between January 2019 and December 2021. Ischemic stroke patients aged over 18 years old were identified using the ICD-10 I63 code. The data was accumulated every month and analyzed descriptively. We also analyzed the admissions data of ischemic stroke patients with COVID-19 and in-hospital mortality was calculated.

Results: There were 2,710 ischemic stroke patients treated between 2019 and 2021 of which the number decreased from 1535 patients in 2019 to 730 in 2020 and only 445 cases in 2021. During 2019-2021, a total of 777 patients (28.67%) died during hospitalization; the most was in 2021 (33.3%). There is a consistent downward trend in ischemic stroke admissions during the COVID-19 pandemic with the monthly average admissions decreased 52.4% in 2020 compared to 2019 and 38.9% in 2021. Despite that, the mortality rate of ischemic stroke patients in the hospital increased from 26.5% in 2019 to 30.4% in 2020, and 33.3% in 2021. The number of ischemic stroke patients coinfected with COVID-19 was 3.5% (26/730) in 2020 and 8.1% (36/445) in 2021. Of all 62 ischemic stroke cases with COVID-19 in 2020-2021, 36 died yielded 58.1% in-hospital mortality rate.

Conclusion: The decreased admissions and the increased mortality rate of ischemic stroke patients in particular those coinfected with COVID-19 during the first two years of pandemic should draw government attention to the necessity of improving stroke managements in Indonesia.

Purpose: The implementation of online learning during Covid-19 presents challenges especially for nursing education. Nurse students during online learning did not receive enough opportunities to learn clinical skill.  Blended learning becomes an alternative in nursing education during Covid-19 pandemic because it offers both face-to-face and online learning.

Participants and methods: The participants of the current study were nurse students in nursing education university in Bali. 105 nurse students were invited to join blended learning program. After blended learning program, they were asked to fill an online questionnaire. 10 students were also invited to join interview.

Results: The results confirmed that students are satisfied with the interaction (M=3.77, SD=.783), instruction (M=4.04, SD=.794), instructor (M=3.88, SD=.685), and course management (M=4.06, SD=.657) of blended learning implementation. However, in terms of technology the students are neither satisfied nor dissatisfied (M=3.41, SD=.800) with blended learning program.

Conclusion: This study concluded that blended learning could be used as an alternative teaching and learning approach for nursing education especially in Covid-19 pandemic era.

Introduction: Imperata cylindrica or cogon grass can be found throughout the world. This wild plant, which is considered a weed, has several properties including antidiabetic, antihypertensive, antidiuretic, anti-inflammatory, and antioxidant properties. This review article aimed to discuss the antidiabetic effects of I. cylindrica.

Methods: There were 12 full text articles published from 2005 to 2021 which were relevant for review. Through in vitro and in vivo studies which show that the active compounds of I. cylindrica have the potential to be antidiabetic agents.

Results: Several studies have shown that I. cylindrica has phenolic compounds, flavonoids and tannin which have antioxidant effects. Flavonoids as antioxidative properties prevent cell damage caused by free radicals reactive. By donating their hydrogen atoms or the ability to adhere metals, in the form of glucosides or a form called aglycones so that they can reduce blood glucose levels. I. cylindrica was processed as extracts or decoction.

Conclusion: It was concluded that I. cylindrica is the potential to have an anti-diabetic effect.

Background: As part of the surgery, sternotomy is a common technique to expose the underlying organs, allowing surgeons to explore the targeted organ. Despite the benefits offered, it has several considerable complications; one of them is wound healing defect. The impairment of sternal wound healing after sternotomy could be superficial and/or deep. This condition is influenced by many factors, including diabetes mellitus, obesity, and other comorbidities. These anomalies will affect the normal healing process of the bone and other connective tissue, particularly after a major invasive event, such as in sternotomy. This study aimed to review the outcome of sternum healing among diabetics that underwent heart surgery with a sternotomy approach.

Methods: Works of literature reviewed in this study were obtained from Pubmed and Google Scholar databases starting from 1992 until April 2022. The keywords used were ‘sternal wound healing’, ‘cardiac surgery’, and ‘diabetes mellitus’. An advanced search based on the exact phrases was conducted on Google Scholar. Gathered kinds of literature were then selected based on relevancy.

Results: The majority of articles reviewed were observational, and most of them had CABG as a part of open heart surgery, followed by valvular and aortic surgeries and others. The incidence of impaired sternal healing and other complications (superficial and/or deep) was more commonly seen among patients with diabetes. Most studies also reported a significant correlation between DM and the incidence of impaired sternal healing, suggesting that DM was a significant predictor of it.

Conclusion: Diabetes mellitus is a medical condition that must be taken into account among the candidates for open heart surgery, particularly if it is poorly controlled. The Hyperglycaemic state experienced by the patients will lead to multiorgan damage and immunological dysfunction that could affect the healing process of the sternum.

Introduction: Guillain-Barre syndrome is the most common and most severe acute paralytic neuropathy with any clinical features. Some patients present with the neurogenic bladder in which bladder dysfunction happens, resulting in urinary retention. The delayed diagnosis often leads to some complications, including bladder perforation. Vesico-peritoneal is lined by epithelial cells that communicate between the peritoneal cavity and the urinary bladder. In this location, can occur a fistula called vesico-peritoneal fistula. This type of fistula leads to peritonitis with high morbidity and mortality.

Case description: A 22- year- old female was admitted to a neurologist with lower extremities paralysis. The surgery department then consulted the patient for suspicion of generalized peritonitis. The patient had a history of taking medication for Guillain-Barre syndrome and complaint of abdominal pain, bloating, nausea, hematemesis, and hematuria. The abdominal radiograph showed pneumoperitoneum. The patient received antibiotics and underwent exploratory laparotomy. Exploratory laparotomy revealed vesico-peritoneal fistula. In this case, the defect was achieved by dissection of the fistulous tract and the primary closure of the bladder. Postoperative follow-up indicated no sign of complication.

Conclusion: Fistulation between the bladder and peritoneal in GBS could cost high morbidity and mortality. Dissection of the fistulous tract and primary closure of the bladder could overcome this condition without any concerning complications.

Background: Diabetes mellitus (DM) is characterized by hyperglycemia due to a defect in insulin secretion, action, or both. Immunocompromised individuals such as those with DM tend to suffer from skin disorders, including crusted scabies (Norwegian scabies). However, studies regarding the incidence of Norwegian scabies are still limited. This article reports a case of an elderly diabetic patient suffering from crusted scabies.

Case Presentation: A 67-year-old male patient was referred to Dr. Soetomo Hospital with sepsis caused by suspected skin infection, hypertension, and type 2 DM. The patient presented with a chief complaint of recurrent skin diseases throughout the body and itching for the past three years. The itching became severe in the last three weeks prior to the hospital admission. The patient had a medical history of diabetes, tuberculosis, hypertension, and arrhythmia. Based on our assessments the patient was diagnosed with crusted scabies, septic shock, sepsis, pneumonia, pulmonary tuberculosis, hypoalbuminemia, type 2 DM, and erythroderma. The patient received oxygen, antibiotics, norepinephrine, albumin, ranitidine, metoclopramide, NovoRapid, ventolin nebules, rehydration, topical keratolytic cream, and scabicidal cream as therapies. However, on the 3^rd day of the treatment, the patient suffered from type 1 respiratory failure and passed away the next day due to septic shock.

Conclusion: We reported a diabetic male patient suffering from crusted scabies, accompanied by pneumonia, pulmonary tuberculosis, hypoalbuminemia, and type 1 respiratory failure. Secondary infections had been developed at the time of presentation. Therefore, establishing an early diagnosis of Norwegian scabies will help prevent the disease's progression.

Background: Aging process commonly associated with multiple comorbidities such as metabolic disorders, vascular, visual, gait, balance and psycho-social problems. Atherosclerosis is one of comorbidities that could occur as a pre-existing condition in elderly with peripheral artery disease (PAD). Elderly patients associated with complex and multi-factorial medical conditions need to be addressed in a comprehensive approach. Here we report the complexity of perioperative management of an elderly with acute limb ischemia in elderly with multiple comorbidities and underlying diseases.

Case Presentation: An elderly woman, 77-year-old, was referred to emergency room due to decreased level of consciousness. There were complaints of loss appetite, inactivity, bedridden, pain, paresthesia and muscle weakness in the right lower limb. There was history of chronic hypertension and dyspepsia. Since there was a sign of right lower limb acute limb ischemia, the patient was discussed with the multi-discipline team, planned for primary amputation, and received systemic anticoagulant treatment. Due to multiple comorbidities and underlying diseases, the patient died prior to amputation surgery.

Conclusion: Surgery is not contraindication to elderly; however, from this case it shed light the needs of multi-discipline approach to decide the best treatment options for patient’s needs. Utilizing a Comprehensive Geriatric Assessment (CGA) could be an alternative to non-invasive, simple, and effective approach available in any healthcare setting.

Background: Guillain-Barré syndrome (GBS) is a peripheral nervous system inflammatory disease that is the most prevalent cause of acute flaccid paralysis, with an annual global incidence of 1-2 per 100,000 person-years. GBS typically appears with acute ascending flaccid paralysis and sensory abnormalities in anesthetic glove stockings; paralysis may extend to cranial muscles. Although the disease’s clinical presentation is diverse and there are multiple discrete clinical forms, myelopathy as a sign of GBS is a relatively unusual condition.

Case presentation: GBS is diagnosed in a 29-year-old woman with myelopathy symptoms such as tetraparesis, hypoesthesia below the level of second thoracal myelum, aberrant proprioceptive in lower extremities, retention of urine and anhidrosis. We perform a lumbar puncture, and a cerebrospinal fluid (CSF) examination reveals albumin-cytological dissociation. Cervico-thoracic magnetic resonance imaging (MRI) revealed no abnormalities. Demyelinating polyradiculopathy was discovered using electromyography (EMG) and nerve conduction studies (NCS).

Discussion: The classical presentation of GBS is progressive (ascending) limb weakness with decreased or absent physiological reflexes. Pharyngeal–cervical–brachial variation and face diplegia with paraesthesia are rare variations of GBS. Our patient presented with ascending limb weakness accompanied by a disturbance in the central nervous system but had similiar serological biomarker, which may be another rare variant of GBS.

Conclusion: Diagnosis of GBS is quite challenging. GBS has a wide range of clinical symptoms. EMG-NCV and lumbar puncture are still required in myelopathic individuals with normal MRI, and unusual GBS symptoms should be explored. As a result, the choice of therapy and management becomes more appropriate.

Background: Alopecia universalis is an autoimmune condition on hair follicles with the characteristics of ovoid or round-shaped hair loss (focal) that develops into multiple hair losses and is the most severe form of alopecia. The pathogenesis of alopecia universalis is unclear. However, the most accepted hypothesis is based on the immunologic factor, especially T-cell mediated autoimmune process.

Case: A 19-year-old male Indonesian complained of hair loss all over his body. Efflorescence of the whole body showed an alopecia patch. The Severity of Alopecia Tool (SALT) score showed 100%. Skin dermoscopy indicated yellow dots. The patient was given 8 mg of intraoral methylprednisolone every 8 hours and 100 mg of intraoral cyclosporine every 12 hours for four weeks and slowly tapering off. The patient experienced acneiform eruption and was topically treated with 2% sulfur lotion every 12 hours. After 51 days of observation, an improvement was found in terminal hair growth on the head, eyelashes, and eyebrows, visible growth of vellus hair on the body, and a SALT score of 40%.

Conclusion: Alopecia universalis is rare and can cause significant damage and psychological pressure to the affected individuals. Treatment with corticosteroid and cyclosporine resulted in good therapy response.

Background: Blastocystis hominis is an intestinal parasite that can induce both intra- and extraintestinal symptoms. This article aims to describe the symptom findings in cases of HIV children co-infected with B. hominis.

Case Presentation: A 3-year-old boy with HIV/AIDS came with diarrhea and skin rashes. The direct smear technique, formalin-ethyl acetate concentration technique, Jones medium culture, and trichrome staining were all used to investigate a single stool specimen from this patient. The results of the examination showed B. hominis infection with intensity <5/high power field (HPF). Extraintestinal symptoms such as skin rashes were not seen in this patient after appropriate treatment.

Conclusion: B. hominis infection can cause extraintestinal symptoms such as a red rash on the skin. When a patient presents with a skin rash of unknown origin, having their stool tested for parasites is a concern.

Introduction: Psoriatic arthritis is a spondyloarthropathy subtype with a broad clinical spectrum and diverse symptoms. The use of biological disease-modifying antirheumatic medications (DMARDs), such as TNF inhibitors is recommended as pharmacological therapy for PSA in cases of axial involvement and high disease activity level. Since Indonesia has the second-highest tuberculosis (TB) cases globally, and patients receiving TNF inhibitors have an elevated risk of latent TB reactivation, evaluation of latent TB before starting TNFi is necessary and challenging.

Case Presentation: A 63-year-old male psoriatic arthritis patient with bilateral hip joint osteoarthritis, bilateral knee effusions and bilateral frozen shoulder. The patient also had coronary heart disease with a history of underwent coronary artery bypass graft (CABG), diabetes mellites type 2 and confirmed latent TB. Psoriatic arthritis had high activity based on the Bath Ankylosing Spondylitis Disease Activity (BASDAI) score and Ankylosing Spondylitis Disease Activity Score (ASDAS). TNF inhibitor treatment started a month after latent TB treatment. The patient responded satisfactorily to the TNFi treatment, as demonstrated by clinical evaluation and decreased disease activity. Latent TB treatment was continued for up to six months, followed by latent TB activity monitoring during TNFi administration to prevent latent TB reactivation.

Conclusion: This case highlights the challenges in management of axial psoriatic arthritis patients with high disease activity, concomitant latent TB infection, and early extra-articular symptoms of cardiovascular disease.