Introduction: Lymph node metastasis is considered one of the most significant prognostic markers in endometrial cancer, particularly in the initial stages. As the incidence rate of endometrial cancer increases, appropriate treatment is needed to increase the survival rate, including lymphadenectomy. This study aims to compare the characteristics of endometrial cancer with or without lymph node metastasis.

Methods: A retrospective analytical study of 155 women with a history of endometrial cancer

following complete surgical staging treatment from January 2017 to December 2021 at Dr. Kariadi General Hospital Semarang. All data were obtained using medical records.

Results: All 155 patients were divided into two groups, with and without lymph node metastasis. Of these, 19 patients have lymph node metastasis (12.25%). The body mass index is the only subject characteristic that is statistically significant between the two groups (p=0.024). In our multivariable risk analysis, three clinical variables were identified that might predict the probability of lymph node metastasis, including ovarian metastasis (OR=2.98, p<0.01) and cervical metastasis (OR=8.27, p=0.002), and tumor differentiation grading (OR=6,77, p<0,01).

Conclusion: The study results indicated ovarian metastasis, cervical metastasis, and tumor differentiation grading were independent prognostic factors for lymph node metastasis.

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: 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.

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%.

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.

Introduction: One serious effect of knee osteoarthritis (OA) is falling. Some predictors caused its vulnerability, one of which was fear of falling. However, few studies investigated how fear of falling leads to falling among the elderly. This study analyzed the fear of falling towards falls incidence among knee OA patients in Malang, and the results of this study might have a significant recommendation for the geriatric fall prevention system policy in Indonesia

Methods: This is a cross-sectional study with 53 participants recruited using the purposive sampling technique from Puskesmas Rampal Celaket and Posyandu Lansia Samaan Malang from March-April 2021. Measurements were the Falls International Efficacy Scale (FES-I) to assess fear of falling, the John Hopkins Grading Scale to measure fall incidence, and the self-reported sociodemographic questionnaire. Data analysis used were the Chi-Square test, Independent T-test, and multivariate logistic regression to analyze significant predictors of falling.

Results: From the bivariate analysis, it was found that the falling group tends to have a higher fear of falling than the non-falling group (34% and 1.9%, respectively). For BMI, the falling group tends to have a higher BMI than the non-falling group (27.2±2.8 and 25.7±3.9, respectively). While multivariate analysis showed that only fear of falling has a significant effect on falling incidence among the elderly (p<0.05), with participants having the risk 2.32 times (OR=2.32; 95%CI= 0.96-4.87) of falling compared to others.

Conclusion: As there was a significant positive correlation between fear of falling and falling incidence among knee OA patients, thus it gives a significant recommendation for the Health Department to design a fall prevention program for the elderly, focusing on managing its predictor.

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.

Introduction: UVB rays are one of the main external factors that play a role in the aging process. Apoptosis of fibroblasts affects skin aging, and the decline in fibroblasts is also caused by the reduced number and ability of growth factors and other hormones. Sunscreen has been used for a long time to protect the skin from the harmful effects of solar radiation, especially UVB rays. Antioxidant activity such as β-carotene and vitamin E from carrots can counteract free radicals and oxidative stress caused by UV radiation. This study aims to test whether in vitro administration of carrot extract can be used as a sunscreen to prevent apoptosis in mouse fibroblast cell cultures exposed to UVB light.

Method: This research is a laboratory experimental study, using a Randomized Post-test Only Control Group Design. The research sample was fibroblast cell culture derived from the back skin of white mice (Mus Musculus) isolated with Collagenase 1 (primary culture). Observation of fibroblast apoptosis using propidium iodide staining. Data were analyzed using Shapiro-Wilk test, Levene's test, One Way Anova and continued with LSD test. The confidence level in this study is 95%.

Result: There was a significant difference between the control group and the carrot extract treatment group, but no significant difference was found between the SPF15 group and the carrot group (p>0.01).

Conclusion: Carrot extract can provide a protective effect on the skin (fibroblasts) and prevent apoptosis.

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: Glaucoma is one of the most common complications in uveitis. The surgical intervention has been known for a lower success rate in Uveitis Glaucoma (UG). However, it is still a treatment of choice when medical therapy no longer could control the intraocular pressure (IOP). This study aims to describe UG's demographic and clinical characteristics that received glaucoma surgery and the outcome.

Methods: Medical records of UG patients that received glaucoma surgery in 2018-2019 were reviewed. Age, gender, type and etiology of uveitis, duration of uveitis, intraocular pressure (IOP), visual acuity, gonioscopy, ocular characteristic, previous surgery and laser, current surgery, and complication were studied. Success was defined as IOP ≤21 mmHg or reduction >20% from baseline and >6mmHg with or without medication. Failure is defined in the presence of surgery complication that leads to a change of IOP, uncontrolled IOP that needs additional surgery, and visual acuity becomes no light perception (NLP).

Results: 48 patients (57 eyes) with UG underwent glaucoma surgery. The mean age was 47,23±14,62. Anterior uveitis was the most common type of UG, with a mean uveitis duration before surgery was 13,75±17,65 months. The mean initial IOP was 35,81±13,30 mmHg, at the final visit 15,09±3,36. The mean follow-up duration was 6,41±4,02 months. The overall partial success was 75,44% in one month, 67,74% in 6 months

Conclusion: A decrease in IOP was found in all surgery interventions, including Glaucoma Drainage Device (GDD) implant, trabeculectomy with 5-Fluorouracil (5FU), and combined trabeculectomy cataract surgery with or without 5FU, and cyclodestructive laser surgery. There was a high percentage of successful surgery but many losses to follow-up eyes in a short follow-up period.

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 aging process is characterized by a gradual decline in physical aspect. Changes in body composition are an important sign of the aging process. Lung disease and respiratory disorders are one of the main health problems in the elderly. Various studies have examined the relationship between decreased muscle mass, obesity, and lung function. However, the results of these studies are still unclear. Aims of this study to determine the relationship between sarcopenia, obesity, and lung function in the elderly group in Tabanan City, Bali.

Methods: This study is an analytical study with cross-sectional design conducted at Tabanan City, Bali, in February 2017. The data was taken using the consecutive sampling technique method; 187 samples were collected from the primary data according to inclusion and exclusion criteria—the analysis using univariate, bivariate and multivariate analysis.

Results: Prevalence of Sarcopenia and obesity in the elderly in Tabanan Regency, Bali was 18.2% and 46%, respectively. Meanwhile, those who experienced sarcopenic obesity were 3.2%. Peak expiratory rates were significantly lower in the elderly group with sarcopenia than those without sarcopenia (p=0.026). Peak expiratory rate was significantly higher in the obese elderly group than in the non-obese group p=0.001).

Conclusion: Peak expiratory rates were significantly different in the elderly group with Sarcopenia and obese than those without Sarcopenia or obese.

Introduction: The global injury death rate is 1.2 million in the world. Airway, breathing, circulation, disability, and exposure can be used for all emergencies with a systematic approach for critical and injured patients. However, not many people understand and are not skilled in doing initial aid handling injured patients. This study aims to analyze the factors that influence the ability in the initial treatment of injured patients with the airway, breathing, circulation, disability, and exposure approach to the community.

Methods: This study used an observational analytic design with a cross-sectional approach. The population is all ordinary people, with a sample size of 110 people taken by simple random sampling. The independent variables are the factors that affect the ability, namely age, education, and experience factors. The dependent variable is ability. Data analysis used linear regression p-value = 0.001.

Results: Research shows that age, gender, and knowledge affect the ability to handle injured patients, so all factors have a significant effect on ability. In general, research was conducted to analyze the factors that affect the skill level in handling injured patients with the airway, breathing, circulation, disability, and exposure approach to the community. The airway, breathing, circulation, disability, and exposure approach proves an ability in the initial treatment of injured patients.

Conclusion: The factors of age, gender, and knowledge affect the ability to handle injured patients. Following that, the BLS guideline 2020 effectively improves the ability for daily emergency management. For health workers, this method is very helpful in reducing morbidity and mortality.

Background: Breast cancer in young women is one of the leading causes of cancer death in young women worldwide, including in Indonesia. Most patients come to the hospital at the advanced stage. Neoadjuvant chemotherapy (NAC) is the standard treatment for locally advanced breast cancer. However, half of breast cancer patients had a negative response to therapy.  

Methods: A retrospective cohort, analytic observational study to determine the association between NLR and anthracycline-based NAC clinical response in locally advanced young age breast cancer in Dr. Soetomo General Hospital, Surabaya.

Results: We analyze a total of 44 patients. 81.8% had stage IIIB, 93.2% >50 mm tumor size. Most of the cases had invasive ductal carcinoma type (86.4%), grade 3 (52.3%), and Luminal B HER2-negative type (34.1%). 52.3% of patients had a negative clinical response. The mean NLR was 3.07 ± 1.69, with a cut-off value of 2.805. There was no significant association between age, tumor size, histopathological type, grade, and subtype with neoadjuvant chemotherapy clinical response. There was a significant relationship between NLR with anthracycline-based NAC clinical response in locally advanced young age breast cancer (p < 0.001).

Conclusion: There was a significant relationship between NLR with the anthracycline-based neoadjuvant chemotherapy clinical response in young women with LABC.

Background: Transfusion reaction is a side effect of giving complete blood or one of the components. They vary in severity, ranging from reactions that can occur during a transfusion (acute transfusion reactions) or reactions occurring days to weeks later (delayed transfusion reactions) and can be immunological and non-immunological. This study investigated the description of transfusion reactions in patients who received blood with incompatible crossmatch results at Sanglah General Hospital

Methods: This research is a descriptive study with a cross-sectional approach. Several parameters were assessed in this study to determine the transfusion reaction in patients who receive blood with incompatible crossmatch. Data were analyzed using SPSS version 20 for Windows.

Results: In this study, from 72 patients who received incompatible blood, 75.0% were found for women and 25.0% for male patients, most of whom were aged 41-65 years (65.0%). Most blood type is blood type O (52.0%). In this study, 6 patients (8.3%) got transfusion reactions such as fever accompanied by chills, urticaria, hypotension, and shortness of breath.

Conclusions: Incompatible crossmatch blood administration can be given. If a reaction is given to a crossmatch transfusion that is not suitable, symptomatic therapy can be given because the response provided is only acute and mild.

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: 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.

Background: A wound is a discontinuity of any bodily tissue due to various causes. Every wound of any severity could result in problems related to its healing process, such as scar tissue formation. According to the duration of its healing process, wound is divided into 2 categories: acute wound that takes approximately 3-4 weeks to heal and chronic wound that needs 4-6 weeks and resulted from inappropriate healing of the acute wound. Tretinoin's use in wound healing has been controversial for more than 40 years. Topical Tretinoin has keratolytic effect that stimulates fibroplasia and epithelization on full-thickness wounds. On the other hand, single administration along with long-contact topical Tretinoin has an irritative effect that could delay healing due to continuous inflammation. This study aims to explore the effectiveness of single administration compared to repeated administration of topical Tretinoin in full-thickness acute wound healing on rats at Faculty of Veterinary Medicine, Airlangga University, Surabaya.

Methods: This experimental study involved 27 male rats which were randomly divided into 3 groups: control (A), single-administration (B), and repeated-administration (C). Full-thickness wound size 20 mm in diameter was made on the skin of each rat. On group A, wounds were covered with Tulle and transparent dressing. On group B, wounds were treated with lidocaine 2% and tretinoin solution 0,05% in single administration, while the same treatment was given repeatedly on group C for 4 days straight. Evaluation was done microscopically on day 5 according to epithelization phase on wound healing with hematoxylin and eosin (H&E) staining.

Results: The result from the calculation showed that group C obtained a significantly higher average number of fibroblast cells count compared to the treatment group A and B. The average number of fibroblast cells in treatment group B was three times higher than the number of fibroblast cells in treatment group A, while the average number of fibroblast cells in treatment group C was three times the number of fibroblast cells in treatment group B. From the statistic, it was proven that the regular application of 0.05% topical tretinoin solution in a full-thickness wound (Group C) has shown a significant increase in the number of fibroblasts during the proliferative phase.

Conclusion: A frequent administration of 0.05% topical tretinoin solution resulted in a higher number of fibroplasia improvements compared to once administered in full thickness acute wound healing, however it did not result in epithelialization on day 5.

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.

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.

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: IL-1 is postulated as a cytokine that plays a fundamental role in the pathophysiology of several skin disorders or diseases. Melasma is a form of hyperpigmentation with a symmetrically distributed predilection for facial features. Due to its elusive pathogenesis, it is believed that the inflammatory factor plays a role in melasma. Increased or decreased IL-1RA concentrations may correlate with the severity of melasma. Therefore, this study aimed to examine the correlation between the IL-1RA (86bp VNTR) polymorphisms and the severity of melasma among a Javanese female population.

Methods: The study involved 79 individuals with melasma and used a cross-sectional design. The severity of melasma was assessed using the MASI (Melasma Area and Severity Index). The data were analyzed using a Chi-square test and Odds Ratio (OR). The genomic DNA from the patients' blood was examined and analyzed using the polymerase chain reaction (PCR) method.

Results: There was an increase in the frequency of IL-1Ra*1/1(410/410) genotype in melasma with a mild severity and of IL-1Ra*1/2(410/240) genotype in melasma with moderate severity (OR: 0.74, 95%CI: 0.26- 2.13, p: 0.42). The allele frequency of IL-1Ra*1/1 was 55.70% at a mild degree and 44.30% at a moderate degree (OR: 0.29-2.11, p: 0.65). 

Conclusions: There was no correlation between IL-1Ra VNTR and the severity of melasma; however, it was found that the IL-1Ra*1/1(410/410) genotype and allele frequency tended to be higher in mild melasma, although it was statistically insignificant.

Background: Acute appendicitis is the most common cause of abdominal surgery. The delay of diagnosis and surgery increases the risk of perforated appendicitis, which is associated with increased morbidity and mortality. The COVID-19 pandemic has an impact on the delays in the diagnosis (time-to-diagnosis) and therapy (time-to-intervention). In this study, we aimed to analyze the profiles and characteristics of acute appendicitis patients in COVID-19 pandemic and non-pandemic periods in Indonesia.

Methods: We collected samples from all patients with acute appendicitis who visited the emergency department from November 10, 2018 – February 10, 2020 (non-COVID-19 pandemic) and March 11, 2020 – August 11, 2021 (COVID-19 pandemic). The data are secondary data taken from medical records. We collected the patient’s demographic data (e.g., age and sex), operation description, length of stay, and duration of the operation.

Results: We recruited a total of 121 patients, consisting of 56 patients during the non-pandemic period and 65 patients during the pandemic. Based on the severity, patients with grade 1 were the most common during the non-pandemic period, while patients with grade 4 were the most common during the pandemic. There was a significant difference between the severity of acute appendicitis during the non-pandemic and the pandemic (P < 0.0001). During non-pandemic periods, the majority of patients were hospitalized for 3-4 days, while during the pandemic, the majority of patients required hospitalization of up to 5-6 days.

Conclusion: There was a substantial difference in the severity of acute appendicitis patients during the COVID-19 pandemic and non-pandemic periods.

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.

Introduction: Charcot neuroarthropathy (CN), also known as Charcot's foot, is consequently causing a reduction in quality of life, high disability, and an increased risk of mortality that poses many clinical challenges in its diagnosis and management. Common surgical interventions typically include ulcer debridement, exostectomy, deformity correction, and minor and major amputations.

Methods: This systematic review was conducted using the PRISMA guideline. Literature research incorporating PubMed/ MEDLINE database for English language studies published in the last 5 years with the key terms defined using the PICO framework, which includes: Charcot, neuroarthropathy/arthropathy, neurogenic, and surgery, which were used interchangeably. A further set of keywords within the topic were then identified, including ankle, hindfoot, foot, fore-foot, and mid-foot.

Result: 221 feet undergone surgical reconstruction. Bony fusion occurred in 154 of 221 feet (71%), 79 of 128 feet (62%) in internal fixation, 47 of 58 feet (81%) in external fixation, and 29 of 34 feet (85%) in the utilization of both internal and external fixation.

Conclusion: Charcot neuroarthropathy poses many clinical challenges in its diagnosis and management. Many experts have proposed the implementation of different strategies to manage this complex condition depending on the acute and chronic phases of its nature. Delayed diagnosis can result in a severe deformity that can act as a gateway to ulceration, and infection and, in the worst case, can lead to limb loss. Further studies aimed at determining selection criteria and treatment algorithms are required for greater standardization of outcomes.

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: Children on dialysis seem to be at greater risk for COVID-19. Acute pancreatitis (AP) is an infrequent but severe complication of chronic peritoneal dialysis (PD). It contributes to morbidity and mortality rates of up to 25%. Patients with PD are exposed to a series of factors associated with AP risk. This report aimed to describe rare and interesting cases of acute pancreatitis in children with CAPD following PD-related peritonitis with a favorable response to conservative treatment.

Case report: We present two cases admitted to our emergency room (ER) with severe abdominal pain preceded by PD-related peritonitis. Poor adherence, lack of monitoring, and healthcare service restriction during the COVID-19 pandemic predisposed these patients to PD-related complications. Patients were diagnosed as AP based on the revised Atlanta criteria. Both met the criteria as they had abdominal pain, a threefold increase of pancreatic enzymes, and evidence of pancreatitis through ultrasonography (USG) investigation. Both patients presented a rapid resolution of AP after receiving conservative treatment, including fasting, total parenteral nutrition (TPN), prophylactic antibiotics, and analgesics. None of them experienced invasive intervention due to AP.

Conclusion: Diagnosing AP in children with CAPD may be challenging since the symptoms mimic other abdominal problems. Our cases are likely to be associated with PD-related peritonitis. This report may prove conservative treatment as a recommendation for managing AP in children with CAPD. The rapid development of innovative clinical management strategies in response to the COVID-19 pandemic is crucial to improving children's health care quality with CAPD.

Introduction: Recent studies have shown that in HIV patients, the incidence of acute myocardial infarction is up to two times higher than in people who are not infected with HIV. HIV patients presenting with the first episode of the acute coronary syndrome are, on average, a decade younger than the general population, more frequently in men and current smokers.

Case Report: We report a case report of a 33-year-old man with a diagnosis of anteroseptal STEMI and recent HIV on first-line ART, a combination of zidovudine 300 mg and lamivudine 150 mg, plus efavirenz 600 mg. The patient had typical angina complaints and had risk factors, namely smoking and a history of dyslipidemia. Patients were treated according to acute coronary syndrome guidelines, given DAPT, heparinization for five days, statins, anti-ischemia, ACE-I, and DCA-PCI. The DCA-PCI result in this patient was CAD 1 VD with 1 DES installed in the proximal LAD (complete revascularization). The patient was discharged from the hospital after seven days of treatment. Prognosis in these patients is still quite good, but preventing recurrent myocardial infarction needs risk factors and control for successful myocardial infarction therapy and ART.

Conclusion: Special attention should be given to the risk of myocardial in HIV patients. Early diagnosis and prompt treatment could significantly lower mortality and improve patients' quality of life.

Background: CD4+ T cells deficiency generally occurs in human immunodeficiency virus (HIV) patients, leading to some infections such as pulmonary and extrapulmonary tuberculosis. A rare case of decreased CD4⁺ T cells is idiopathic CD4+ T cell lymphocytopenia, a rare and unexplained immunodeficiency syndrome with no evidence of HIV infection. In this case report, we are reporting a patient with CD4+ T cells deficiency, pulmonary tuberculosis, pleuritis tuberculosis, and meningitis with HIV test negative.

Case Presentation: A 58-year-old male was referred to the Emergency Department of Dr. Soetomo General Hospital with a gradual decrease of consciousness following six days of hospitalization at a private hospital. During hospitalization, one liter of fluid was evacuated from the right lung and analyzed, revealing tuberculosis infection. History of diabetes, hypertension, stroke, hepatitis, and cardiovascular disease was denied. The patient also never had chemotherapy or radiation treatment. Based on history taking, physical examination, and laboratory results, this patient has been diagnosed new case of pulmonary tuberculosis with deficiency CD4+ T cells and altered consciousness et causes meningitis tuberculosis with pleurisy tuberculosis. After 32 days of hospitalization with anti-mycobacterium therapy, the patient was improved and was discharged.

Conclusion: This case highlights the challenges of having the definitive cause of CD4+ T cells deficiency either active tuberculosis infection or idiopathic CD4+ lymphocytopenia. Therefore, serial analyses of CD4+ T cells are advised on the patient during the treatment with anti-tuberculosis drug.