Introduction: Exercise has been believed to prevent metabolic syndrome (Mets) from occurring.  Accumulation of inflammation factors such as monocytes chemoattractant protein-1 (MCP1) in adipose tissue is a factor in the development of MetS. However, the inflammatory mediators that play a role in the accumulation of macrophages are still unclear, so this study aims to determine the expression of MCP-1 in perivascular adipose tissue (PVAT).

Methods: Eight-week-old male wild-type mice, were divided into five groups. One control group was given a standard diet and four groups were given a high-fat diet (HFD) for 2 weeks. Exercise treatment was given to the HFD group by dividing HFD with exercise once a week, HFD with exercise three times a week, and HFD with exercise five times a week. As for the exercise, speed is given 10-18m/minute for 30 minutes. and this exercise is carried out for two weeks. Gene expression of MCP-1 in PVAT tissues was analyzed using quantitative chain reaction (PCR).

Results: The HFD group experienced an increase in body weight (P <0.01) and adipose tissue mass (P <0.01) compared to the control group. Furthermore, exercise decreased body weight (P <0.05) and adipose tissue in the HFD-Exc1 group (P <0.01). Furthermore, exercise tends to decrease the inflammatory mediator in macrophages MCP-1 in PVAT compared to the HFD group.

Conclusion: These results suggested that exercise partially reduces adiposity, tended to decreases MCP-1 in HFD-induced obesity.

Background: Post-evisceration fibrosis remains the leading cause of contracted socket. The application of fibrin glue is considered an alternative adjuvant therapy in suppressing profibrotic factor (TGF-β) expression following evisceration surgery to prevent contracted socket. This study aimed to know the role of fibrin glue in suppressing the TGF-β expression following evisceration surgery.

Methods: An in vivo experimental study with a randomized post-test-only control group using twenty New Zealand rabbits were conducted. The sample was divided into four groups, each consisting of five rabbits, and one healthy eye was selected randomly for evisceration. Each rabbit in the study group was given a subconjunctival injection of agents corresponding to each study group, namely: Group I (control [no injection]), Group II (0.1 ml MMC 0.4 mg/ml), Group III (0.1 ml TCA 40 mg/ml), and Group 4 (0.1 ml fibrin glue) at the inferior fornix. Following a 14-day observation period, the animals were euthanized, and tenon conjunctiva in inferior fornix samples was collected for immunohistochemistry (IHC) staining examination. The pathologist calculates the immunoreactive scores (IRS) for each specimen. The differences in TGF-β expression were statistically analyzed with a significant p<0.05. Data were analyzed using SPSS version 26 for Windows.

Result: The highest TGF-β expression was found in the control group (I), and the lowest was in the mitomycin-C group (III), followed by the triamcinolone group (IV) and fibrin glue group (II). There were significant differences in TGF-β expression among the four groups (p=0.004). The difference between fibrin glue, MMC, and triamcinolone acetonide groups was insignificant (p>0.05).

Conclusion: As an alternative to mitomycin-C and triamcinolone acetonide, fibrin glue can be used as adjuvant therapy to prevent constricted sockets after evisceration.

Introduction: Injuries are a major medical problem in military populations. The physical fitness assessment is a series of tests that measure and monitor physical fitness levels. The existing physical fitness assessment and formula used by the Indonesian Military requires a running test that only applies to healthy soldiers. This study attempted to construct a formula for assessing physical fitness using tests that soldiers may perform with lower limb injury/disability.

Method: The design of the study was an internal cross-sectional comparison. This study included 104 healthy, well-trained male normal soldiers (NS) and 50 injured or disabled soldiers (DS) who matched the inclusion criteria. The NS was required to perform a 12-minute running and wheeling test, a ball-throwing test, push-ups, and lunges. The DS was also required to perform the same tests except for the 12-minute running test and lunges. The analysis of the data consisted of four steps: constructing a conceptual framework, describing the characteristics of each group, identifying significant indicators using Partial Least Square-Structural Equation Modeling (PLS-SEM) to develop a physical fitness formula, and determining whether the formula is appropriate for assessing physical fitness in running and wheeling tests.

Result: There is no significant difference in the characteristics of NS and DS (p>0.05); thus, the subjects in both groups are comparable. Physical fitness test has several major contributing factors: distance, test method, muscle strength, and age. There is no significant difference in the number of NS in each category between the running and wheeling tests (p>0.05).

Conclusion: Physical fitness formula= {1.1 × (0.98 × distance^*) + (0.97 × method value^**)} – (0.093 × age) – (0.17 × muscle strength^***) Note: *) Distance traveled during running or wheeling test (meter). **) The running test method value is entered as 1, and the wheeling test method value is entered as 2. ***) The value of wheeling muscle strength is obtained from the ball-throwing test. In contrast, the value of running muscle strength can be determined by multiplying the result of the ball-throwing test by 2. These findings may be used for assessing the physical fitness of normal soldiers or those with lower limb injury/disability.

Introduction: The elderly will experience a decrease in health status caused by either disease or nature, so they are at risk of suffering from hypertension. Hypertension can be controlled by medication adherence. Self-efficacy is a factor that plays an important role in medication adherence. The important role of self-efficacy lies in a person's self-knowledge, which refers to self-confidence in achieving hypertension treatment goals. To identify the relationship between self-efficacy and the level of medication adherence in the elderly with hypertension.

Methods: This study used a cross-sectional method with a random sampling technique. The sample of this study was 60 older people in Mejing Wetan. The measuring instrument used was MASES-R to measure self-efficacy and MMAS-8 to measure medication adherence. Univariate analysis used descriptive statistical analysis, while Bivariate analysis with SPSS used the Chi-Square analysis method. There will be a significant relationship if p is < 0.05.

Results: The results showed that the respondents' self-efficacy is dominated by the moderate category (41.7%), (73.3%) respondents were disobedient in taking medication, and the significance value was p=0.000. It indicated a significant relationship between self-efficacy and medication adherence as p<0.05. In addition, the correlation results were very strong (r=0.781).

Conclusion: There was a strong relationship and a positive direction between self-efficacy and the level of medication adherence in the elderly with hypertension

Introduction: Pediatric acupuncture is an interesting subject to study along with strengthening the current development of acupuncture therapy. Not only for adults, but acupuncture is also safe for children. There have been many studies on acupuncture, but publications related to acupuncture for children are still very few compared to adults. The purpose of this study is to visually map and guide future research on Pediatric acupuncture based on bibliometric analysis.

Method: We conducted this study from September 16 to 19, 2022. Publications regarding pediatric acupuncture were extracted from the Scopus database. The search strategy included two keywords: (ACUPUNCTURE)*(PEDIATRIC). The final result was acquired by searching those keywords without limitation because the number of articles was less than 1000. We used VOSviewer and bibliometric indicators to generate a maps-based data network from all keywords-related studies showing association among journals, countries, publication frequency, authors, and citations. Keywords were used to infer pediatric acupuncture. A total of 669 documents related to pediatric acupuncture were retrieved. This includes 432 articles, 176 reviews, and 16 conference papers.

Results: A total of 10,918 citations have been recorded for all publications with an h-index count of 52. The first relevant study is dated on 1966. Since then, there has been a steady increase in total publications each year whereas 2021 as the most productive year with 53 publications. The Medical Acupuncture Journal (25) was the most prolific journal. The United States of America (298) and China (54) are the most productive country and institutions. The article entitled Clinical Practice Guideline: Allergic rhinitis by Seidman et al. (386) is the most cited reference.  

Conclusion: The benefit and potential of acupuncture for several diseases in pediatric patients are promising and no adverse side effects have been reported.

Introduction: Although research to analyze the sanitation situation in Indonesia has been intensively carried out, the results of this research are not sufficient to show aspects of community behavior comprehensively based on the components in total community-based sanitation (STBM). A recent study based solely on the availability of sanitation facilities and community affordability found that weak financial support allocated to address sanitation problems was a key factor. Therefore, this study aimed to analyze the sanitation situation comprehensively based on the components in STBM.

Methods: This research was conducted in 34 provinces in Indonesia. All areas were selected so that a complete and comprehensive analysis could be carried out. The data used in this study is secondary data obtained from the Basic Health Research and the Indonesian Demographic and Health Survey (IDHS). Cluster analysis using Fuzzy C-Means (FCM) was performed to cluster sanitation conditions based on the parameters of healthy latrine use; handwashing behavior and facilities; safe drinking water and food management; management of household waste and its facilities; and safe household liquid waste management.

Results: It is found that the value for cluster 1 does not have priority problems in terms of environmental health. There is only one indicator, namely littering, which is above the national average. While in cluster 2, the complexity of the problem is more complex where almost all indicators are above the national average, only the indicators of carelessly throwing garbage and disposing of feces are below the national average. Cluster 3 has complex problems in no defecation, no defecation, no sewerage, and littering. These areas are included in the priority sanitation intervention program; Bangka Belitung, North Sulawesi, Southeast Sulawesi, Gorontalo, West Kalimantan, Central Kalimantan, West Nusa Tenggara, South Kalimantan, Maluku, Central Sulawesi and East Nusa Tenggara.

Conclusions: This study determines the classification of sanitation conditions to provide comprehensive information on which areas are included in the priority sanitation intervention program. The novelty and contribution of this research is a comprehensive analysis based on the components of STBM, which has never been done before.

Introduction: Many studies have provided non-pharmacological therapies to overcome health problems, including maternal and child health. One is how to overcome sleep disorders often complained about in pregnant women's third trimester. Some previous studies have analyzed aromatherapy using floral fragrances by inhaling aromatherapy oil directly or applied to cotton and using one type of aroma only, while inhalation using a diffuser and combining two or more similar scents have not been studied. The combination of both compositionally and beneficial aromas can complement each other, for example, lemongrass and lemon. This study aimed to examine the impact of essential oils diffuser and mix aromatherapy lemon grass on sleep quality and anxiety levels in pregnant women in their third trimester.

Methods: This study used quasi-experimental studies with one group pre-test and post-test. The research sample is 48 pregnant women in the third trimester of Wonokromo were selected with simple random sampling. The Independent variable is aromatherapy interventions (blended lemongrass and lemon) inhalation using diffuser, while the dependent variables are sleep quality. Data collection instrument using Pittsburg Sleep Quality Index (PSQI). Data analysis using Wilcoxon test with α=0.05.

Results: After being given aromatherapy intervention, almost all respondents have good sleep quality, 8-point increase in average sleep quality score. The results of the Wilcoxon test obtained a value of ρ = 0.01.

Conclusion: Essential oils diffuser blend aromatherapy of lemongrass and lemon effectively improves the sleep quality of third-trimester pregnant women. Aromatherapy makes participants feel relaxed, comfortable, and feel sleepy better. For health workers, this technique can be one of the practical options for non-pharmacological therapy to decrease discomfort during pregnancy.

Introduction: Infectious mouth diseases are caused by microorganisms such as      Staphylococcus aureus and Streptococcus mutans. Sentul fruit peel extract contains several phytochemical compounds, flavonoid compounds, saponins and tannins are aromatic hydroxyl groups that act as antibacterial so that they can be used as a treatment for infections of the mouth. This study aimed to determine the inhibitory ability of Sentul fruit peel extract (Sandoricum koetjape) against Streptococcus mutans and Staphylococcus Aureus bacteria which can cause oral infections.

Method: Sentul fruit peel simplicia was extracted by maceration method with ethanol for 24 hours. The maceration method was chosen in this study because it is a method that is easy to do and uses simple tools, which is enough to soak the sample in a solvent. A filtering process followed this and the filtrate was then evaporated with a vacuum rotary evaporator at a temperature of 45oC, so that a thick extract was produced. The maceration process was repeated 2 times. After the extraction process, then proceed with liquid-liquid fractionation using distilled water. The thick extract was put into a separating funnel and distilled water was added. Then it was shaken and the aquadest fraction was taken, followed by evaporation with a vacuum rotary evaporator at 45^oC, so that the aqua fraction of the ethanol extract was produced.

Result: The results showed that the Sentul fruit peel extract was able to inhibit the growth of      S. mutans and S. aureus bacteria as seen from the formation of a clear zone. Based on the ANOVA test, the extract concentration treatment had a significant effect (p<0.005) on the diameter of the clear zone on S. mutans and S. aureus bacteria. Positive control (streptomycin) showed significant differences in Duncan's test, because it produced the greatest antibacterial activity against test bacteria compared to negative control and various extract concentrations. The diameter of the clear zone in the positive control against S. mutans and S. aureus bacteria were 17.63±0.28 mm and 17.62±1.04 mm, respectively. Sentul peel ethanol extract of aqua fraction at a concentration of 100% gave the highest inhibition zone compared to concentrations of 75%, 50%, and 25%, although it was still smaller than the diameter of the clear zone in the positive control. In bacteria S. mutans, the ethanol extract of Sentul peel aqua fraction at a concentration of 100% gave a clear zone diameter of 14.31±1.06 mm and in S. aureus bacteria it gave a clear zone diameter of 15.34±1.81 mm.

Conclusion: Sentul fruit peel extract (Sandoricum koetjape) has the ability to inhibit Streptococcus mutans bacteria and Staphylococcus Aureus bacteria.

Introduction: Breast cancer is the leading cause of death in women. Many studies of adjuvant therapy have used the Quran recitation (later will be mentioned as the murotal approach). The murotal approach has been shown to induce feelings of well-being, enhance therapeutic response, and aid in patient healing. This study aimed to analyze the effect of the murotal approach on lymphocytic cell activity in inducing programmed cancer cell necrosis in a breast cancer mouse model.

Methods: After testing in a fully randomized design using 24 female mice (Mus musculus) BALB/c strain, a real-world experimental study with a control group design method. The mice were divided into four groups: negative control (K-), positive control (K+), treatment group (P1) which receiving the murotal approach for 2 hours and 30 minutes per day for a week, and the (P2) which receiving the murotal approach for 30 minutes in five times a day for a week. Mice were subcutaneously injected with DMBA 0.56 mg/20 g every 2 days for 3 weeks. The murotal approach was using specifically in Surah al-Faatihah and Al-Baaqarah from Qori' Al-Mathrud. Cancer tissue was harvested 5 weeks after her. The data were analyzed using the Kruskal-Wallis hypothesis test.

Results: There was a significant difference (P<0.05) in the effect between the P2 treatment group that received murotal therapy for 30 minutes at each prayer time and the other groups. The efficacy of treatment murotal for 2 hours and 30 minutes per day does not affect the extent of lymphocytic infiltration.

Conclusion: From the research, the dosage of murotal therapy to increase the degree of lymphocyte infiltration is for 30 minutes five times a day, or during prayer time.

Introduction: The prevalence of diabetes mellitus (DM) is still high and is expected to continue to increase. An increase follows this increase in the number of side events, so innovation is needed in DM therapy. DM induces oxidative stress so antioxidants can be an alternative therapy for DM. One source of antioxidants whose use is still limited is the banana plant, especially the banana stem. This study aimed to determine the effectiveness of kepok banana stem extract (Musa paradisiaca Var. Balbisiana colla) on MDA levels in diabetic rats.

Methodology/Approach: The study used a post-test-only control group design on 24 male rats (Rattus novergicus) Sprague Dawley strain with a bodyweight of 150-250 grams and ± eight weeks old. Rats were divided into four groups, namely the metformin treatment for positive control, distilled water for the negative control, and stem banana extract dose of 200 mg/kg BW and 250 mg/kg BW as treatment group of mice induced diabetes using STZ-NA and given treatment according to the group for 14 days. MDA level measurement using the TBARS method on rat liver. Data were analyzed using the One Way ANOVA comparison test.

Results: MDA levels in the positive control group, negative control, treatment 1 (200 mg), and treatment 2 (250 mg) were 0.9790 + 0.52 mg/dl, 0.7533 + 0.58 mg/dl, 1.2510 + 0.52 mg/dl, 1.5175 + 0.53 mg /dl. There was no statistically significant difference in MDA levels between groups (p=0.182), but there was a decrease in blood glucose levels in the group treatment. The highest decrease in blood glucose levels was in the dose treatment group, 250 mg/kg BW.

Conclusion:The treatment of kepok banana stem extract (Musa paradisiaca Var. Balbisinia colla) for 14 days at 200mg/kg BW and 250mg/kg BW increased malondialdehyde (MDA) levels, although not statistically significant.

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

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

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

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

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

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

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

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

Introduction: Colorectal cancer (CRC) occurs, accounting for 11.5% of all patients with cancer in Indonesia. The less the spread of cancer, the higher the life expectancy of patients with cancer. Glutamine is involved in tumor cell proliferation and growth. This study aims to verify the correlation of serum glutamine levels with the one-year survival rate of patients with stadium III colorectal cancer at Dr. Moewardi Hospital, Surakarta, Indonesia.

Method: A quantitative analytic-observational longitudinal study (Cohort) was conducted from May 1^st, 2020, to September 30^th, 2021. Inclusion criteria were the CRC patients with stage III and could be followed up for one year. Exclusion criteria were the CRC patients who had other systemic problems. The patient’s blood glutamine levels were taken three months postoperatively measured by Glutamine Assay kit (Colorimetric) ab197011 and evaluated clinically for one year. Glutamine levels in the blood are low if they are less than 52 ng/µL. The parameters assessed were glutamine serum level and survival rate of colorectal cancer patients. Statistical analysis using the Chi-square test and the Kaplan Meier method was employed to obtain the survival curve. Analysis to compare survival rate with glutamine levels used the Cox regression model.

Results: A one-year survival rate in patients with stadium III colorectal cancer was 95.5% at post-operative glutamine levels of ≥ 52 ng/µL and 65.4% at post-operative glutamine levels of < 52 ng/µL. The mean progressive free survival rate was 11.818 months (95%CI=11.470-12.166) at post-operative glutamine levels of ≥ 52 ng/µL and 10.038 months (95%CI=8.913-11.164) at post-operative glutamine levels of < 52 ng/µL. The overall free survival rate was 11.955 months (95%CI=11.868-12.042) at post-operative glutamine levels of ≥ 52 ng/µL and 10.885 months (95% CI=10.128-11.641) at post-operative glutamine levels of < 52 ng/µL. Patients with glutamine levels of <52 ng/µL were 8.959 times more probable to die than patients with post-operative glutamine levels of ≥ 52 ng/µL.

Conclusion: This study shows a significant relationship between serum glutamine levels and the one-year survival rate of patients with stadium III colorectal cancer at Dr. Moewardi Hospital, Surakarta, Indonesia.

Introduction: Titanium mesh is commonly used to reconstruct the cranium in cranioplasty procedure. Although it is generally well-tolerated, erosion of the overlying soft tissue due to the implant exposure remained as a major risk that could impair patients' outcome. This study aimed to investigate the potential risk factors of titanium mesh exposure.

Methods: Medical records from patients who underwent titanium mesh cranioplasty within the period of July 2016 to July 2020 were retrieved. Patients' demographic and characteristics were reviewed to investigate the potential risk factors in titanium mesh exposure.

Results: Twenty-three patients were included in this study with the mean age of 44.6 (+10.9) years. Fourteen patients (60.9%) acquired titanium mesh exposure in less than 6 months after cranioplasty surgery. In majority, the duration of surgery were more than 3 hours (65.2%). Intraoperative blood loss volume was less than 500 cc in 8 patients (34.8%), 500-1000 cc in 8 patients (34.8%), and more than 1000 cc in 7 patients (30.4%). Nineteen patients had bone defect of >10 cm and the indications for craniectomy were tumor resection in 56.5% patients, followed by infection in 17.4%. The sign of infection was present in 12 patients (52.2%). Only 2 patients (8.7%) had radiotherapy after cranioplasty. One patient was diagnosed with polycythemia vera.

Conclusion: Titanium mesh exposure following cranioplasty surgery is a complication that might affect the patients' overall outcome. Female predominance, long surgery duration, excessive intraoperative blood loss might be correlated with higher risk of titanium mesh exposure.

Background: Cancer cells increase iron absorption, interfere with iron storage, and reduce iron excretion. Acute lymphoblastic leukemia (ALL) condition may interfere with the iron synthesis, and the patients usually receive a blood transfusion which leads to iron buildup. Excess iron is linked to a poor prognosis and significantly becomes morbidity and mortality factors. Serum ferritin levels that can be assessed from complete blood count may become a low-cost and sensitive biomarker and prognostic marker for ALL. The aim of this research is to assess serum ferritin levels in pediatric patients with ALL in the diagnosis and remission phases.

Methods: An analytical observational cross-sectional study was conducted on pediatric patients with ALL in the pediatric ward Haji Adam Malik hospital Medan from July – October 2021. Physical examination and blood sampling for complete blood count and serum ferritin level assessment were carried out. Bivariate analysis using the Chi-square test was used to compare serum ferritin levels during early diagnosis and remission phases in ALL pediatric patients.

Results: Ferritin levels were higher in the newly diagnosed patient group with a median value of 951 µg/L (28.07-6632 µg/L) than the group in remission phase with a median value of 374.5 µg/L (29-2426 µg/L). There were no significant relationships between ferritin levels and BMI, SGOT, and SGPT in the newly diagnosed group. In contrast, the ferritin levels of the patients in the remission group were significantly correlated with SGOT and SGPT.

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

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

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

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

Background: The initial presentation of hospitalized End-Stage Kidney Disease (ESKD) patients with and without coronavirus disease 2019 (COVID-19) is similar and can overlap. We aimed to compare clinical dan laboratory characteristics of the COVID-19 positive and negative patients to help clinicians screen and differentiate hospitalized ESKD patients.

Methods: We reviewed data from the medical record of ESKD patients hospitalized between May 1, 2020, and April 30, 2021. The study comprised all suspected COVID-19 patients. The COVID-19 positive was based on results from RT-PCR for SARS-CoV-2. The bivariate analysis was used to compare the positive and negative groups. The association of all characteristics and diagnosis of COVID-19 were then evaluated by multivariable analysis.

Results: There was twenty-nine percent of confirmed COVID-19 in 176 ESKD patients. The proportion of dyspnea, pulmonary edema, pleural effusion, and cardiomegaly were lower in the COVID-19 positive group. Diastolic blood pressure, pulse rate, white blood cell differential counts, and potassium were lower in the COVID-19 positive group. Using a multivariate analysis, eosinophil count <0.04 x10³µl (P<0.001, OR 3.50, 95%CI:0.123-0.665), monocyte count <0.69 x10³µl (P=0.004, OR 2.54, 95%CI:0.166-0.931), and neutrophil-to-lymphocyte ratio (NLR) <3.13 (P=0.044, OR 3.18, 95%CI:0.102-0.968) were associated with the presence of COVID-19.

Conclusions: Leukocyte differential count and chest x-ray should be evaluated as an initial screening of COVID-19 in hospitalized ESKD. Low levels of monocyte and eosinophil count and mild elevation of NLR were associated with COVID-19 in ESKD patients.

Background: Postpartum contraception is a way to prevent recurrent pregnancies to ensure the health of both mother and baby. Many postpartum mothers think that there will be no pregnancy during amenorrhea in the postpartum period and will use the contraceptive method after the first menstruation. There are still some who do not use contraception. Contraceptive success will be achieved if the counseling and media are effective. Palangka Raya's city has a Bapalas Bidan culture, a ritual in which a newborn baby is declared a midwife's child until the midwife's blessing ceremony is carried out for the baby and the mother.

Methods: This research type is a quasi-experimental study with two group comparison pretest-posttest design with counseling intervention and booklets. The research subjects were postpartum mothers who gave birth or were treated at the Midwives Individual Service in Palangka Raya City, amounting to 30 each per treatment and control group.

Results: There was a difference in the mean and an increase in the group's knowledge score after receiving counseling through the Bapalas Bidan (p = 0.000). The increase in knowledge was higher in the group that received counseling than in those who did not get counseling. Postpartum mothers who have high knowledge of contraception use contraception more than mothers with low knowledge. The proportion of postpartum mothers who used contraception was more in the group who received counseling (p = 0.018), aged 20-35 years (p = 0.015), had parity ≥3 (p = 0.024), and higher education (p = 0.006).

Conclusion: Postpartum mothers who have high knowledge of contraception use contraception more than mothers with low knowledge.

Introduction: School-age children are a critical age group because they are vulnerable to health problems that usually arise related to clean and healthy living behavior. The purpose of this study was to determine the relationship between parental support and clean and healthy living behavior as an effort to prevent covid-19 in students of SDN 1 Panglungan Wonosalam Jombang.

Methods: Analytical research design with "cross sectional" approach. The population was 40 students from class V and VI. A sample of 37 students was taken using the Cluster Sampling technique. The instrument used a parental support questionnaire and clean and healthy living behavior. Data analysis used Spearmen Rank correlation statistical test with a significant level of = 0.05.

Results: The results of the study were obtained from 37 respondents, almost entirely (81.1%) had a good level of support and most (62.2%) had a clean and healthy lifestyle as a good covid 19 prevention effort. Spearman rank correlation test analysis obtained p value of 0.01 <0.05, then h0 is rejected and h1 is accepted.

Conclusion: There is a significant relationship between parental support and clean and healthy living behavior as an effort to prevent covid-19 in students of SDN Panglungan 1 Wonosalam Jombang. The role of nurses can provide nursing care in the form of education for children and parents, so that children are able to carry out clean and healthy living behaviors as an effort to prevent Covid-19.

Background: Arteriovenous fistula (AVF) failure rate in chronic kidney disease patients is relatively high due to inadequate feeding arteries and draining veins. The primary balloon angioplasty (PBA) dilatation technique is a way to mitigate AVF failure. There have not been many studies to determine the patency rate with and without PBA. This study analyzed the patency rate and the number of patency failures in Indonesia AVF patients with and without PBA.

Methods: A retrospective cohort study was conducted in AVF surgery patients from 2019 to 2021 with or without PBA with a total sample technique. The patient was choosen without AVF surgery in the same arm with had follow-up every three months for three years. We excluded incomplete medical record data and unfollowed patients six weeks after surgery. The Kaplan–Meier method used the log-rank test to estimate each group's patency rate. The p-value<0.05 was considered significant.

Results: There were 60 subjects, of which 29 were with PBA and 31 were without PBA. There was a significant difference between the two groups regarding venous diameter and postoperative venous flow volume (p<0.01). The log-rank test showed a significant difference in patency failure in the group without PBA (35.5%, mean patency rate 56.3 weeks) compared to the group with PBA (10.3%, mean patency rate 104.4 weeks) with p=0.028. The median duration showed that 50% of the group without PBA experienced patency failure at week 59.3. In contrast, until the observation's end, the PBA group experienced patency failure of less than 50%.

Conclusion: Using the PBA technique can reduce the incidence of patency failure and maintain longer patency in patients with AVF.

Introduction: The COVID-19 pandemic has dramatically impacted people's lives. Families are affected in many ways, including daily life, the economy, social life, and health. Families who have resilience can face the COVID-19 pandemic situation. This study aims to determine the factors related to family resilience during the Covid-19 pandemic, including Family income, education, family type, family relations, and social support.

Methods: This study is a cross-sectional study conducted on 403 respondents using purposive sampling. Inclusion criteria include Husband or wife (with or without children) who live together, ages 18-65 years, in Jakarta and Tangerang. Data collection using an online questionnaire consisted of demographic data, the Family Resilience Assessment Scale (FRAS), and the Multidimensional Scale of Perceived Social Support (MSPSS). The questionnaire has passed the validity and reliability test. The Ethics Board of the Mochtar Riady Institute of Nanotechnology (MRIN) provided ethical approval.

Results: Multivariate analysis using a logistic regression test showed that factors related to family resilience were income (p-value: 0.028, OR: 3.08) and social support (p-value: 0.001, OR: 7.16). Social support is the dominant variable related to family resilience. An increase in social support increases the likelihood of family resilience by 7.16 times. Furthermore, an increase in family income has a 3.08 times greater chance of increasing family resilience.

Conclusion: Families and the government can collaborate to improve family resilience during the Covid-19 pandemic by optimizing social support and family income.

Introduction: Channa striata collagen-chitosan wound dressing (3:1 v/v) was founded contaminate by bacterial and fungal. Therefore, to suppress bacterial and fungal contamination in Channa striata collagen-chitosan composite dressing, it needs several efforts such as sterilization under Ultra-Violet Light Exposure. The study aimed to determine UV-light exposure duration to supress bacterial and fungal growth on C. striata collagen-chitosan composite dressing.

Methods: C. striata collagen was extracted from skin and scales using 2% HCl for 48 hours, then neutralized using NaOH 1 M until collagen fibers appeared. Chitosan powder dissolved in 2% acetic acid. Afterward C. striata collagen and chitosan liquid (1:3 v/v) were mixed and formed until wound dressing was reached. Wound dressing was sterilized under UV exposure for 0, 5, 10, 15, and 30 minutes. Chitosan dressing was used as a negative control.

Results: The results of the study showed that the total number of bacteria and fungi decreased significantly with increasing time of exposure of UV light on composites dressing with a value of p=0.001 for bacterial growth and a value of p= 0.005 for fungus growth. The UV exposure on collagen-chitosan dressing to reduce bacterial and fungal growth proved effective in 10 minutes.

Conclusions: The UV light exposure treatment can reduce bacterial and fungal contamination on collagen-chitosan composites on each addition duration exposure descriptively.

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

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

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

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

Background: COVID-19 affects the multiorgan system, mostly the respiratory system. Symptoms might vary from upper respiratory manifestation to acute respiratory distress syndrome, with the main feature being impairment of gas exchange. This pulmonary impairment might lead to a decrease in functional capacity, which cause activity limitation. Thus, COVID-19 patient requires the right pulmonary rehabilitation strategy to improve pulmonary function and prevent further pulmonary complications. This study aimed to compare the effectiveness of incentive spirometry and diaphragm breathing exercise on cardiorespiratory functional capacity in COVID-19 patients.

Methods: Subjects were divided into two groups of breathing exercises, the incentive spirometry group and the diaphragm breathing exercise group. They performed breathing exercises for 5 days, and the functional capacity was measured by a test named 4-meter gait time test (4MGT) and 30 sit-to-stand test (30STS). The test was taken before and after performing breathing exercises.

Results: These two respiratory exercises significantly affected the functional capacity in a good manner (p < 0.05). The incentive spirometry had improved 30STS (P = 0.763) and 4MGT results (P = 0.674), as well as diaphragm breathing exercise did to 30STS (P = 0.456) and 4MGS (P = 0.441).

Conclusion: In conclusion, diaphragm breathing exercises and incentive spirometry improved the functional capacity of COVID-19 patients. However, incentive spirometry showed a larger effect on 30STS and 4MGT compared to diaphragm breathing exercises.

Introduction: Early age is the golden age period of growth and development of children. Therefore, it is necessary to monitor the fulfillment of children's nutritional needs based on the quantity and quality of good nutrition. This study aims to examine the relationship between the level of parental knowledge and the teacher's feeding pattern on the nutritional status of early childhood at the Jungle School Nature Kindergarten, Sekaran, Gunungpati District, Semarang City.

Methods: The total sampling technique conducted this analytic observational study with a cross-sectional design by 24 parents of kindergarten students and 11 teachers or caregivers. The parents' knowledge and teachers' feeding parenting styles were obtained from the interviews. The assessment of the nutritional status of kindergarten students was using indicators of WAZ, HAZ, and BAZ. All research subjects had normal nutritional status based on indicators of WAZ and HAZ.

Results: Based on BAZ indicators, as many as 12.5% of students have underweight nutritional status, and 87.5% have normal nutritional status. The results of the association test showed that the level of parental knowledge (p=0.533; 0.845; and 0.372) and eating patterns by teachers in schools (p=0.770; 0.896; and 0.597) were not significantly related to the nutritional status of early childhood (WAZ, HAZ, and BAZ).

Conclusions: Parents with a good level of knowledge do not necessarily have nutritional problems.

Introduction: The ability of pregnant women to detect early-risk pregnancies is still low, which is one of the causes of complications that can endanger the welfare of the mother and fetus. This research analyzed the effectiveness of the Self Care Model in Midwifery Care through an Android Application on the Ability of Pregnant Women to Early Detection of Risky Pregnancy During the Covid-19 pandemic.

Methods: The data of this study of pregnant women who conducted examinations at PMB Ika Mardiyanti in Maret-May 2021 involved a sample of 100 obtained by simple random sampling. This study uses an analytic design with a cross-sectional design. Data analysis using the Wilcoxon Signed Rank Test.

Results: The results show that Asym. Sig. (2-tailed) obtained < (0.0001 < 0.05), this means that the Self Care Model in Midwifery Care through the Android Application is effective for increasing the ability of pregnant women in early detect risky pregnancies during the COVID-19 pandemic.

Conclusion: The research conducted to analyze the self-care model in midwifery care through the android application contributes to increasing the efforts of pregnant women to care for their care during pregnancy to prevent the dangers of pregnancy.

Background: Transmission of pathogenic and non-pathogenic microorganisms from animals to humans can affect the composition of gut bacteria (gut microbiome) in humans and can also be a potential source of transmission of zoonotic diseases. Therefore, this study aimed to analyze the gut microbiome interactions between the human and the livestock.

Method: This study was a cross-sectional study conducted in Mlati District, Slemanm Yogyakarta. The fecal sample was used to identify parasites by using trichrome staining. Then NGS selected samples were used to analyze the gut microbiome using Illumina high throughput 16S rRNA region V3-V4 sequencing.

Result: The analysis showed that Bacteroidetes was prevalent in the HCA group (57%), while Firmicutes (70%) were commonly found in HNC. Regarding the potential parasitic infection, direct microscopic examination and trichrome staining showed that Blastocystis sp and Entamoeba coli cyst was found in several subjects in HCA groups, with prevalence rate at 7.69% and 2.5%. Meanwhile, no parasite was found in HNC feces.

Conclusion: There was a significant difference in the gut microbiome and parasitic infections between the HCA and HNC groups, with Blastocystis sp and Entamoeba coli as the most prevalent parasites.

Background: Excessive physical exercise can cause injury and disrupt the body's homeostasis. Excessive physical exercise also causes increasing oxygen demand and reactive oxygen species production (ROS) that induce damage in various cells and body tissue, including HSC and CD4⁺ cells. This study aims to prove that excessive physical exercise decreases the CD4⁺ and HSC levels in Wistar rats and evaluates the correlation between HSC and CD4⁺ cell levels.

Methods: An experimental study with a randomized post-test-only control group design was conducted among 44 male Wistar rats in Clinical Pathology Laboratory, Mangusada General Hospital, Bali, from June to September 2022. The samples were divided into two groups; 22 rats received excessive physical exercise (treatment group) and 22 rats as the control group. The CD4⁺ cells and HSC were examined after 14 days of intervention. Data regarding the means of CD4⁺ and HSC levels between the two groups were assessed, and the correlation between HSC and CD4⁺ cell levels was analyzed using SPSS version 21 for Windows.   

Results: We used 22 rats for each treatment and control group. The mean level of CD4⁺ and HSC were significantly lower in the treatment group compared to the control group (356.41 vs. 661.41x10⁶ cell/µl; p<0.001) and (359.14 vs. 551.09 x10⁶ cell/µl). We found a statistically significant difference in CD4⁺ and HSC levels between the two groups, p<0.001). We also found a positive correlation between HSC and CD4⁺ level with r=0.636; p<0.001. Excessive physical exercise affected the immune function by decreasing CD4+ ad HSC levels in Wistar rats.

Conclusions: The impact of excessive physical exercise on immune function showed by decreasing the level of CD4⁺ and HSC level in Wistar rats. The HSC number also has a positive correlation with CD4⁺ cell level.

Introduction: Acute ischemic stroke is one of the three main causes of death in developed countries. RISKESDAS data of 2013 depicted the fact that the prevalence rate of stroke was 12.1 per 1,000 population. CT protocol and magnetic resonance imaging (MRI) are excellent evaluations of acute ischemic stroke. Magnetic resonance angiography (MRA) is an MRI technique to delineate arteries and evaluate stenosis and occlusion. Arterial Spin Labeling (ASL) MRI is quantitative and non-invasive, does not require Gadolinium contrast, measures cerebral blood flow, is useful for performing perfusion-based functional MRI (fMRI), and is able to be reevaluated. The study aimed to analyze the correlation between MRA and the relative Cerebral Blood Flow on ASL in patients with acute ischemic stroke.

Methods: The study aimed to analyze the correlation between MRA and the relative Cerebral Blood Flow on ASL in patients with acute ischemic stroke.

Results: The patients with acute ischemic stroke were in the age category of 40 years or more (92.3%) with the average age of the patients was 56.96 years  14.05. The youngest patient was 8 years old and the oldest one was 79 years old. Most of them were women (56.5%) with the most comorbid hypertension (45.7%) and diabetes mellitus (34.8%). The results of the evaluation after agreeing the consent portrayed that MRA was normal in 10 patients (21.7%) and there was stenosis or occlusion in 36 patients (78.3%). ASL examination showed that 20 patients (43.5%) were normal, whereas 26 patients (56.5%) were decreased.

Conclusion: Phi value was 0.601 (p < 0.05), meaning that there was a strong relationship between the results of MRA examination and ASL.

Introduction: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, may result in musculoskeletal tissue injury and is assumingly regulated through central and peripheral pathways. Muscle-specific creatinine kinase (CK-MM) is a specific biomarker used to indicate the presence of musculoskeletal tissue damage. This study aimed to investigate the correlation between the levels of CK-MM and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.

Methods: A cross-sectional study was conducted among COVID-19 survivors at the Faculty of Medicine and Clinical Pathology Laboratory, Universitas Airlangga, Surabaya from June - August 2022. The degree of pain of the myalgia was assessed using a visual analog scale (VAS), while CK-MM level was measured using a sandwich enzyme-linked immunosorbent assay (ELISA). Pearson correlation test at α=0.05 was used to identify the correlation between the levels of CK-MM and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.

Results: A total of 84 participants were enrolled in the study and half (50%) of them reported persistent myalgia post-COVID-19 recovery. Fatigue was the patients' most common persistent symptom (63%). Of the total 42 patients with persistent myalgia, more than half (56%) had mild pain intensity (VAS score: 1–3), and almost all of them (41 patients) experienced myalgia during the COVID-19 diagnosis. All the patients with post-COVID-19 myalgia had normal levels of CK-MM (mean: 32.7 ng/mL; range: 12–93 ng/mL), suggesting no musculoskeletal tissue damage. Anova test suggested no significant different of CK-MM levels between those with and without myalgia in patients with post-COVID-19 syndromes p=0.054).

Conclusion: There was no significant association between CK-MM levels and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.

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

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

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

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

Aortic stenosis is a valvular heart disease commonly found in developed and developing countries. The frequency of aortic valve sclerosis is about 25% in people over 65 years of age. In contrast to developing countries, infectious diseases, such as endocarditis or rheumatic fever, contribute greatly to aortic stenosis. Severe aortic stenosis without valve replacement has a poor prognosis and some patients are at high risk for surgery. Transcatheter aortic valve implantation (TAVI) is emerging as an alternative in patients with aortic stenosis who cannot or are at high risk for surgery. TAVI has revolutionized the management of aortic stenosis. This procedure continues to improve yearly and exceeds surgical aortic valve replacement in 2019. Initially, TAVI generated skepticism and criticism, but with many clinical trials and evidence-based investigations, TAVI is now widely accepted. Until now, the development of TAVI continues, starting with better technology, approaches, and new implantation strategies; TAVI is becoming safer for patients. This literature review will discuss more deeply about TAVI and its development.

Background: Chemotherapy-induced neutropenia (CIN) is chemotherapy's most frequent myelosuppression effect. Previous studies have examined static prognostic factors to assess dynamic neutrophil changes in each cycle. This study focuses on post-chemotherapy monocytopenia as a more dynamic predictor of CIN. This research aimed to know whether post-chemotherapy monocytopenia can be used as a predictor of CIN in breast cancer patients undergoing the chemotherapy cycle.

Methods: This research used a prospective and a retrospective longitudinal cohort of breast cancer patients undergo a CAF regimen at Sanglah Hospital Denpasar. The research was conducted on 30 samples for three cycles (90 total cycles). Monocyte data is taken in the first week (days 4 to 9), and neutrophil data is taken in the second week (days 10 to 16).

Results: From statistical analysis with interval data scale, we obtained that p 0.001 with Pearson correlation 0.613 for cycle 1, p 0.001 with Pearson correlation 0.611 for cycle 2, and p 0.003 with Pearson correlation 0.522 for cycle 3.

Conclusions: In conclusion, post-chemotherapy monocytopenia can be used to predict the occurrence of chemotherapy-induced neutropenia (CIN) with the strongest positive correlation in the first cycle.

Background: Breast cancer is a malignancy originating from breast tissue, where chemotherapy is one of the choice therapy. Doxorubicin, 5-fluorouracil, and cyclophosphamide (FAC) are the most commonly used combination of chemotherapy. One of the side effects of chemotherapy is cardiotoxicity. Multiflora honey prevents cardiotoxic effects through its flavonoids and polyphenols compounds. The aim of this research is to analyze the effectiveness of adding honey in preventing cardiotoxic effects in breast cancer patients receiving FAC chemotherapy.

Methods: An experimental study with double-blind randomized pre and post-test with control group design. Ductal invasive breast cancer patients were divided into 2 groups, the control group, who received FAC chemotherapy (n=18) and the treatment group, who received chemotherapy and 90 ml/day honey consumption for 14 days (n=18). The patient's Troponin I and NT-proBNP enzyme levels before and after 14 days of the study were assessed.

Results: Post-treatment, there was an increase in Troponin I levels from the treatment group (0.22 ± 0.07 vs. 0.24 ± 0.07) vs. control (0.25 ± 0.11 vs. 0.34 ± 0.20) with a significant difference. (p = 0.031). There was a decrease in NT-proBNP levels in the treatment group (461.0 ± 610.4 vs. 215.6 ± 260.3) and an increase in NT-proBNP levels (275.9 ± 392.4 vs. 315.4 ± 293.9) with a significant difference (p = 0.006).

Conclusion: Multiflora honey can prevent cardiotoxic effects in breast cancer patients receiving FAC chemotherapy.

Background: Knee osteoarthritis (KOA) is a degenerative joint disease with relatively high prevalence globally and is one of the leading causes of disability in the elderly population. Dextrose prolotherapy (DPT) has been proven effective in improving functional outcomes in knee osteoarthritis. The effect of hypertonic dextrose on cartilage biomarkers has not been evaluated.

Purpose: To evaluate the association between a cartilage biomarker and changes in clinical outcomes among patients with KOA who received dextrose prolotherapy (DPT).

Patients and methods: This study was conducted with a cross-sectional design. Twenty-six participants received DPT at weeks 1, 5, and 9. Our primary measures were urinary c-terminal telopeptides of type II collagen (uCTX-II), measured by an enzyme-linked immunosorbent assay (ELISA), and the WOMAC score, measured at baseline and week 12.

Results: There were significant improvements in all WOMAC subscales and uCTX-II levels after DPT. There is no significant correlation between biomarker levels with the WOMAC score as a functional outcome indicator in KOA after DPT (p > 0.05), but there are positive correlations between pain, functional, total WOMAC score, and uCTX-II.

Conclusion: DPT may reduce cartilage degradation and improve functional outcomes in osteoarthritic knees. Significant drops in uCTX-II levels can affect functional outcomes, especially pain, functional and total WOMAC scores.

Abstract: The decision that declared COVID-19 as a pandemic in March 2020 had become a medical emergency that also effects kidney transplantation program and care. Kidney transplantation has been a definitive treatment for end-stage renal disease (ESRD) patients since it improves patient’s quality of life. However great the beneficence is, kidney transplant procedure still carries high risk of COVID-19 infection especially for recipients who are obliged to take immunosuppression agents after transplantation.

Purpose: This study aimed to evaluate kidney transplant procedure in Dr. Sardjito General Hospital within before and during pandemic based on recipients’ and donors’ characteristics and laboratory findings such as creatinine and urine time.

Patients and methods: This study is designed as a cross-sectional analytic research to evaluate 30 patients that underwent kidney transplant in Dr. Sardjito General Hospital within before (April 2019-2020) and during (April 2020-2021) COVID-19 era. Data analyses were carried out using SPSS version 25.0 and were served with simple charts and tables.

Results: There is a decrement of kidney transplant procedure within before (n=16) and during (n=14) COVID-19. Age group of recipients that underwent the most of transplantation before pandemic are 20-29 years old while during pandemic are 40-49 years old. There is no significant difference in length-of-stay within before (12.0±4.17 days) and during (9.29±3.73 days) COVID-19 (p=0,077). Laboratory findings such as creatinine of pre-transplantation (9.47±4.05; 7.81±6.00) and 3 months’ post-transplantation (1,55±0,78; 1,15±0,67) also did not show significant changes (p=0,153) as well as urine time (245.60±225.55; 428.38±657.70; p=0.321).

Conclusion: There is a decrement of kidney transplant procedure in Dr. Sardjito General Hospital within before and during COVID-19 era. There are no significant differences found within length-of-stay, creatinine pre and 3 months’ post-transplantation and urine time. On the whole, transplant outcomes have remained similar within pre and during COVID-19 era.

Introduction: The largest public health issue in the globe, particularly for women who are close to childbearing age, is anemia. Anemia during pregnancy is said to be “dangerous to mother and child”. In 2015, Indonesia's maternal mortality rate (MMR) was 305 per 100,000 KH. Pregnancy who experienced anemia in the world are still very high. The prevalence of anemia in pregnancy is 41.8%. In Indonesia, the increasing in the incidence of anemia in pregnancy from 37.1% in 2013 to 48.9% in 2018. One of the causes of anemia in pregnant women is the knowledge and parity. This study aimed to analyze the knowledge and parity of the incidence of anemia in pregnant women.

Methods: The research design is cross-sectional with the independent variables which are knowledge and parity. The dependent variable is the incidence of anemia in pregnant women. The population used by all pregnant women is 48. The sampling technique uses total sampling and collecting data using questionnaires and interviews. Data analysis used univariate and bivariate.

Results: The results of research informed that most pregnant women had anemia, around 56.2%. The results of the statistical analyses revealed a p value of 0.007, indicating a relation between parity and the prevalence of anemia. Besides that, there was a relation between knowledge and the prevalence of anemia.

Conclusion: There is an influence between knowledge and parity on the incidence of anemia in pregnant women. Countermeasures that can be done by providing information communication and education on pre-wedding preparation.

Introduction: Lavender essential oils (LEO) have been known to have relaxing effects, improve mood, and treat anxiety, but the effect on multiple organ stress concurrently is unknown. This multiorgan stress is related to depression can be caused by chronic psychological stress due to excessive cortisol levels and can lead to organ damage. This study analyzed LEO in preventing depression and multiorgan failure using intraperitoneal injection of corticosteroids in animal-model.

Methods: Rats (Rattus norvegicus) Wistar strain, male, aged 7-8 weeks were involved in this study. Depression in animal-model is defined by immobilization using tail suspension test and anhedonia using sucrose preference test. LEO 5% was diluted in virgin coconut oils as vehicle. Serum cortisol was analyzed using enzyme-linked immunosorbent assay (ELISA). Organs were extracted and processed using hematoxylin eosin staining.

Results: The results of this study indicate that LEO was able to prevent damage to the glial cells, myocardiac cells, and gastrointestinal mast cells infiltration, but not to the hepatocytes and renal cells damage. LEO also induced behavioral activation as improvement of depression, but anhedonia was still remained.

Conclusion: The effect of LEO is to prevent the increase in blood cortisol levels, thus reduce the reactivity of depressed individuals to stress, although the individual still has anhedonia as a residual symptoms

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

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

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

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

Introduction: Extrauterine metastases often occur in patients with advanced stages of endometrial carcinoma. Retroperitoneal lymph nodes and pelvic lymph nodes are the most common metastatic sites for endometrial carcinoma, while distant metastases, including those to the lung, liver, and brain, are uncommon. This study compares the characteristics of endometrial carcinoma with or without extrauterine metastases and evaluates risk factors associated with extrauterine metastases.

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. The clinical and pathological characteristics were compared using the Unpaired T-test and Chi-Square test. Multivariate logistic models were performed to estimate the odds ratio (OR) and 95% CI to analyze independent risk factors for extrauterine metastases.

Results A total of 155 endometrial cancer patients were included in this study. Of these, 77 patients have extrauterine metastases (49.67%). The most common site for extrauterine metastases is ovarian metastases (26.5%). Using univariable and bivariate analysis, tumor differentiation grading (OR=3.69, p=0.027) and myometrial invasion (OR=2.84, p=0.027) were the two risk factors associated with extrauterine metastases. 

Conclusion: There were significant differences in clinicopathological characteristics between the two groups with and without extrauterine metastases. Tumor differentiation grading and myometrial invasion were two independent risk factors.

Introduction: Skin prick test (SPT) is a method for diagnosing IgE-mediated allergen sensitization. Although the sensitivity and specificity are quite good, false positive and false negative results are possible. The diameter of the wheal and flare of each allergen can affect the skin prick test measurement, especially if the results of the examination overlap. Because of the usage of the SPT and the emphasis on quality control of health services recently, several variables that can affect the results of SPT must be considered. This study aims to analyze the effect of age, gender, family history of allergy, clinical symptoms, and illness duration on SPT's flare diameter.

Method: This is a cross-sectional study conducted from 2015 to 2020 in Surabaya, Indonesia. Children with possible allergies were tested with a skin prick test at the allergy immunology outpatient clinic of the Dr. Soetomo General Academic Hospital. Inclusion criteria were ≤ 18 years old children, possibly diagnosed with allergies, who had skin prick test. Children with incomplete medical record data were excluded.  The Chi-square test or Fisher exact test to determine the relationship between the independent and dependent variables for nominal data. The p-value was declared significant if P<0.05 to determine the effect between variables on flare diameter on skin prick test. We use SmartPLS to analyse the relationships simultaneously to compare relationships with the regression analysis.

Result: Age, gender, clinical symptoms, and duration of illness did not show a significant effect. In contrast, the flare diameter determined by SPT and the presence of an allergic family had a significant correlation (p = 0.017). Therefore, the appropriate distance between allergens must be specified to prevent overlap of SPT flare diameters.

Conclusion: Member of family allergy affects the diameter of the flare on skin prick test.   

Introduction: Unachieved exclusive breastfeeding is still a problem in Indonesia. During pandemic covid-19 situation, the condition required to keep the distance from other people resulting the limited access between breastfeeding mothers and midwives. The role of the closest person that is husband is needed to constantly provide support. The objective of this research is to determine the relationship between husband's support during the covid-19 pandemic with exclusive breastfeeding

Methods: The type of research used is an analytic survey with a cross sectional method. The total population are 51 people and the sample of 45 people is taken using purposive sampling technique. Collecting data using questionnaire sheets given to respondents. Data analysis using Chi Square test (X2).

Results: Based on analysis, we found that husband’s support has a significant association with the quality of exclusive breastfeeding with p=0.000.

Conclusion: The result of the research informed husbands who want to provide support in the form of effective communication between husband and wife during the breastfeeding process, able to help breastfeeding mothers to keep the spirit of breastfeeding, and will help provide breast milk as the best food for their babies. There is a significant relationship between husband's support in the success of exclusive breastfeeding during the covid-19 pandemic.

Introduction: Coronary Heart Disease (CHD) is a degenerative disease caused by fat accumulation and chronic inflammation. The elderly have a significant CHD risk due to the prevalence of vitamin D insufficiency and decreased platelet function, influencing the inflammatory response in this population. Therefore, this study aims to assess the relationship between vitamin D levels and platelet function measured by the mean platelet volume (MPV) and P-Selectin serum levels of CHD patients.

Method: The cross-sectional design was carried out on stable CHD patients aged 60-75. Meanwhile, vitamin D, MPV, and P-Selectin were taken through venous blood, and an ELISA examination was performed to determine their levels in serum. A correlation test using the Pearson product-moment was also conducted between vitamin D and platelet function.

Result: The subjects involved were 45 male and 16 female at 73.8% and 23.2%, respectively. The highest risk factor was dyslipidemia found in 45 (73.8%) and all subjects (100%) received statins. This study showed no correlation between vitamin D levels and MPV levels (p= 0.094) and P-Selectin (p=0.362).

Conclusion: Vitamin D levels are not associated with platelet function levels (MPV and P-Selectin) in elderly patients with CHD.

Background: A diabetic foot ulcer is a complication that often occurs in patients with diabetes mellitus. The healing process of a chronic wound is more complicated and requires more complex treatment. There is an increase in IL-1, IL6, and TNF-α pro-inflammatory cytokines in a chronic wound. Hyaluronic acid (HA) is a component that has been used for a long time and is known to help the wound healing process. This study was at a time to determine the effectiveness of hyaluronic acid on the reduction of interleukin-6 in accelerating the healing of Wagner II-III diabetic foot ulcers.

Methods: This study is an experimental, randomized study of pre and post-test design on diabetic foot ulcer patients with the Wagner II-III classification who were controlled at the thoracic, cardiac, and vascular surgery polyclinic at Dr. Soetomo Hospital Surabaya. Data were analyzed using SPSS version 20 for Windows.

Result: About 39 samples are willing to participate in the study, divided into 20 samples in the treatment group and 19 in the control group. The mean concentrations of IL-6 in the treatment group before and after the intervention were 280.70±155.50 ng/ml and 126.60±145.60 ng/ml. There was a significant decrease in IL-6 levels (p<0.05) before and after the intervention. The mean concentrations of IL-6 in the control group pre and post were 315.20±127.40 ng/ml and 136.30±134.60 (p<0.05). The decrease in the control and treatment groups was no statistically significant difference (p>0.05). There was no significant difference in the PUSH Score (p>0.05) in the two groups before intervention/treatment. The decrease of wound area in the control and treatment groups were -4.80 ((-0.40)-(-24.50)) and -4.8 ((-0.70)-(-30.90)) (p>0.05).

Conclusion: Topical hyaluronic acid and wound care using 0.9% NaCl reduced interleukin-6 levels, PUSH scores, and wound area in Wagner II-III diabetic foot ulcers.

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

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

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

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

Abstract

Background: Breast cancer is the most common cancer in women. The occurrence of metastasis in breast cancer should be detected early. Tumor necrosis factor-α (TNF-α) is involved in every step of the carcinogenesis process. A rise in TNF-α level is linked to the advancement of breast cancer. We aimed to determine the association between TNF-α levels and breast cancer metastases.

Methods: An analytic cross-sectional study was conducted on women with breast cancer treated at the Oncology Surgery Center between November 2021 and April 2022. The patient's data were collected from the medical record, including age, menopausal status, tumor size and lymph node involvement, and tumor subtype. The serum TNF-α level was measured using ELISA. The optimal cut-off value was determined using the receiver operating characteristics analysis. The association between serum TNF-α and the incidence of breast cancer metastases was analyzed using SPSS version 26 for Windows.

Results: We analyzed a total of 50 patients. The mean age was 48.8 ± 8.3 years. The serum TNF-α level was divided into high-TNF-α and low-TNF-α using a cut-off value of 22.755 pg/mL. There were 27 patients (27/50; 54.0%) with high serum TNF-α levels and 23 patients (23/50; 46.0%) with low TNF-α levels. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 73.9%, 63.0%, 63,0%, 73,9%, and 68%, respectively. There was a statistically significant association between serum TNF-α levels and metastatic breast cancer (p=0.009).

Conclusion: There was a significant association between TNF-α levels and metastatic breast cancer. Serum TNF-α may be a potential biomarker to detect metastasis in breast cancer patients.

Introduction: The demands of academic life and obstacles during online learning in the Covid-19 pandemic make female students physically and mentally exhausted which can trigger stress. Stress involves the neuroendocrinological system that can affect the menstrual cycle. This study aims to analyze the correlation between stress due to online learning during the Covid-19 pandemic with students' menstrual cycles.

Method: The data measured are the stress due to online learning during the pandemic and the student’s menstrual cycles through the DASS 42 questionnaire (Depression Anxiety Stress Scale 42) to measure stress levels and a questionnaire containing categories to measure students' menstrual cycles.

Results: This study found that stress levels are correlated with the menstrual cycle. Stress levels affect the condition of the menstrual cycle

Conclusion: This study proves that stress due to online learning during the Covid-19 pandemic is related to the menstrual cycle of students.

Introduction: Tinospora crispa (T. crispa) is an herbaceous plant that commonly grows wild in tropical regions of South East Asian countries such as Indonesia, Malaysia, and Thailand. In Indonesia, this plant is well known to be used as a traditional medicine to treat gout, diabetes, hypertension, rheumatic, fever, and appetite stimulant. Researches worldwide indicate that T. crispa poses several pharmacological properties. One of those is the antioxidant activity, acting as a free radical scavenger. The objective of this study was to determine the antioxidative properties of T. crispa and to compare the different ethanol solvents used for extraction.

Methods: The amount of 300 g T. crispa powder was extracted using 70%, 80%, and 96% ethanol. The spectrophotometry method is used to assess the total flavonoid and polyphenol contents as well athe s DPPH assay.

Results: The 80% ethanol had the highest flavonoid content 0.090% ± [0.453%], while 96% ethanol indicated the lowest 0.038% ± [3.090%]. In the case of phenolic content, 96% ethanol showed the highest result 0.521 ± [11.341%]. However, this value was relatively comparable with the other solvents. The highest DPPH activity was shown by 80% ethanol 6.46 mg ± [3.04 mg].

Conclusion: Despite low in the concentration, flavonoid and polyphenol content was successfully determined from T. crispa by using different ethanol solvents. Based on the result of antioxidants concentration and activity, 80% ethanol is the most ideal solvent to be used for extraction of T. crispa.

Introduction: Various surgical procedures have been found to effectively treat intractable temporal lobe epilepsy (TLE), including transcortical selective amygdalohippocampectomy (SAH), which is intended to protect the temporal lobe and to prevent interference with vascular structure. This research analyzed the outcome of post-operative seizure-free with transcortical selective amygdalohippocampectomy for intractable mesial temporal lobe epilepsy patients in a minimum two-year follow-up after surgery.

Methods: Data of one hundred ninety-two patients who had undergone transcortical selective amygdalohippocampectomy for non-lesional, medically intractable, temporal lobe epilepsy were analyzed.

Result: The statistical analysis indicated that Focal to Bilateral Tonic-Clonic Seizure had a more significant outcome (p=0.019) than other seizures. In all research subjects, after three, six, and twelve years of follow-up, the chance for a seizure-free after surgery was respectively 93.2 percent, 67.9 percent, and 36.7 percent with a median average survival period for all subjects of 11.00 years (95 % CI: 8.55 – 13.44)

Conclusions: Transcortical selective amygdalohippocampectomy is an effective therapy for intractable mesial temporal lobe epilepsy and provides a satisfactory outcome. The transcortical approach allows an appropriate operative field by careful dissection with limited retraction to eliminate the epileptogenic target while preventing damage to the underlying vascular and cortical structures.

Background: Tooth extraction is a procedure with the highest prevalence of causing alveolar bone damage. After extraction, the dimension will change. This procedure needs a balance of bone formation and resorption. Osteocytes are the most common cells in bone and have an essential role in bone formation. This study explores the effect of bovine tooth grafts on the number of osteocytes in the socket preservation process post-dental extraction.

Methods: A total of 28 Wistar rats, 14 control and 14 treatment groups, were extracted on the lower left incisor. Control group with PEG without induction and treatment group with bovine tooth graft and PEG induction. On the 14th and 28th days, the rats were euthanized. Then perform histological examination with HE staining and cell counting using a light microscope

Results:  We found the treatment group had higher the average number of the osteocyte, which was 146.43±11.41 on 14th day and 288.14±161.91 on 28th day. There was a significant increase in osteocytes among the treatment group compared to the control (p=0.000).

Conclusion: Bovine tooth graft application as dental socket preservation was proven to increase the number of osteocyte cells in the alveolar bone of Wistar rats after extraction. Bovine tooth grafts as dental socket preservation materials increased the number of osteocytes at a peak at 28 days.

Introduction: A Public Health Emergency of International Concern, the WHO designated the outbreak in China and surrounding countries in 2019. The Global board proclaimed public health emergency after research. The WHO encouraged states to step up their efforts before the instances grow. Six ASEAN members have confirmed early instances. WHO reports that the pandemic has reached all ten ASEAN countries. Unclear and inconsistent information and actions show Asia's delayed response to epidemics.

Methods: This study uses VOSviewer to investigate ASEAN policy responses to the COVID-19 outbreak. A bibliographic data model can handle several data types. Categories, topics, density, and publication date are common article metadata.

Results: Early decisions were taken without a plan to halt COVID-19 from spreading across Asia. Upon confirmation of the first case, national prevention and control measures were launched. Encouraging frequent hand washing, adequate mask usage, and other personal hygiene and sanitation habits were also addressed. Its nature leaves many data and information gaps. Major issues included preventing, detecting, and responding to disease outbreaks in public and medical contexts.

Conclusion: The regional health systems came into action to help national health programs. The ASEAN countries have all responded to the COVID-19 outbreak. In order to prepare for and manage the COVID-19 outbreak, a thorough investigation is required.

The coronavirus Disease-19 (COVID-19) pandemic was announced in March 2020 by World Health Organization (WHO). Studies showed that the elderly had higher morbidity and mortality rates. Acute sarcopenia in the elderly with COVID-19 is an overlooked problem. Inflammation, malnutrition, immobilization, a side effect of COVID-19 treatment, depression, and hormonal dysregulation contributed to acute sarcopenia in COVID-19, especially in the elderly. Muscle quantity can be assessed with different techniques such as imaging or anthropometric measurements in diagnosing sarcopenia. Imaging such as CT scan was widely used in multiple studies. Still, anthropometric measurements are more fit in developing countries because they are widely available, safe, do not require special skills, and fit in low-resources facilities. Muscle strength can be assessed with grip strength. Acute sarcopenia was associated with immune dysregulation and cytokine storm, length of stay and readmission, and ICU admission and mechanical ventilation. These will contribute to high mortality in sarcopenic elderly with COVID-19.

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

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

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

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

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

Due to their capacity to reduce acute inflammation by increasing the immune response, honey and its constituents are gaining attention as an efficient natural therapeutic. Studies have suggested that it may be able to treat a variety of chronic illnesses and conditions, including as bacterial and fungal infections, cardiac issues, diabetes, hypertension, and abnormalities of the lungs and heart. More significantly, honey has proven to have virucidal effects on a number of enveloped viruses, including the varicella-zoster virus, herpes simplex, influenza virus, and HIV.

Honey may help patients with COVID-19, a disorder brought on by the SARS-CoV-2 enveloped virus, by boosting the host's immune system, treating comorbid conditions, and engaging in antiviral activities. Additionally, patients with COVID-19 are presently participating in a clinical trial of honey. We've attempted to condense the possible advantages of honey and its components in this review in terms of antibacterial properties, some chronic illnesses, and the host's immune system. Therefore, we have made an effort to develop a relationship with honey in order to treat COVID-19. In light of the COVID-19 epidemic, this review will be useful in reevaluating our understanding of the potential therapeutic benefits of honey. However, more in vitro and in vivo research is required to determine the effects of honey on SARS-CoV-2 replication and/or the host's immune system.

Introduction: The curriculum for health profession education uses a variety of teaching techniques. A strategy is needed to create a creative learning environment during the implementation of the academic learning process so that students can achieve the expected competencies. Peer learning is one of the learning methods to facilitate student learning experience. Peer learning (PL) uses peers as tutors in the learning process and the process of students learning with and from each other. The application of the peer learning method in the health student learning curriculum is considered to have several advantages and challenges.

Purpose: To identify the benefits and challenges of implementing peer learning methods on health professional students.

Methodology: This study is a literature review with databases form ScienceDirect, PubMed, Scopus and Emerald. The articles search results obtained 10 articles that were screened using the PRISMA guide. This study is looking for articles about peer learning methods in health students who are included in the inclusion criteria.

Findings: There are total 1273 articles obtained from 4 databases, with details ScienceDirect 499 articles, PubMed 366 articles, Scopus 255 articles and Emerald 153 articles. The results of a review of 10 articles show that the peer learning method can be implemented in academic learning settings as well as clinical learning. The application of peer learning methods in the learning process has several benefits including; improve social skills, increase knowledge and better understanding of learning materials, increase self-confidence, improve clinical skills. Apart from the benefits, there are some challenges in implementing the PL method.

Implication: PL can be applied in health student learning because it has many benefits for health students.

Spine vascular lesions like brain vascular lesions include spinal cord stroke, vascular malformation such as venous malformation or venous angioma, cavernous malformation, arteriovenous malformation or arteriovenous fistula. Embryogenesis of spinal vascular is the basic principle to understand the vascular malformation of the spine. This study aims to report serial cases with review of spinal vascular lesions. MR angiography techniques with contrast injection may reflect the direction of flow epidural veins to describe the site of arterial feeders. Serpiginous veins are commonly visible through the dorsal cord surface in MR myelography. The gold standard for diagnosing vascular malformation is Digital Subtraction Angiography (DSA). MRA helps to guide the location for DSA. Several cases are reported using MRA modalities and show the special location site of the spinal disorder.

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

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

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

Background: Congenital diaphragmatic hernia (CDH) is a rare, complex and severe abnormality in an infant. Globally, neonatal mortality as a consequence of congenital anomalies is increasing and is therefore outlined as an emerging priority to be addressed by the UN Sustainable Development Goals (SDGs) in the post-2015 child health agenda. Although numerous cases are discovered prenatally or in the early postnatal period, 5-25% of CDH are detected in delayed onset after birth. The aim of this article was to discuss the case of CDH with moderate persistent pulmonary hypertension, moderate muscular ventricular septal defect, and small patent ductus arteriosus.

Case Presentation: A-8 days old, 3,060 g, a full-term male infant was referred to our tertiary hospital with transient tachypnea of the newborn and a suspected case of congenital heart disease. The defect was repaired after stabilization of the cardiac output and gas exchange. During recovery after surgery, the patient was placed on high-frequency oscillation after surgery and was given potent inotropic support. The patient made an uneventful postoperative recovery.

Conclusion: The management of CDH patients should be multidisciplinary. More clinical studies were required to elaborate on a suitable management protocol for the CDH

Background: Diabetic ketoacidosis (DKA) has been well-known as the main complication that is a potentially fatal emergency in some teenagers with type 1 diabetes mellitus (DM). Although children with diabetes are not at high risk for severe COVID-19 infection, it can hypothetically lead to type 1 DM and severe DKA. The aim of this article is to briefly discuss a case of a teenager with DKA and COVID-19.

Case: A 13 years old girl came in with abdominal pain, nausea, vomiting and dyspnea. She was alert but weak. Her blood pressure was 100/70 mmHg with 120 pulses and 35 breaths per minute. Oxygen saturation was at 99%. History of previous illness was denied. She was treated using a dyspepsia algorithm while waiting for the laboratory result. Later on, the test showed conditions of hyperglycemia, severe acidosis, ketonuria and a positive rapid COVID–19 antibody test. Hence, a diagnosis of DKA with probable COVID–19 was made and PCR for confirmation of COVID-19 diagnosis was scheduled. Oxygen support, rehydration, and insulin therapy were also given with a precautionary condition of possible COVID–19. In minutes, she developed respiratory distress that led her to be intubated and put on a ventilator. Due to a lack of facilities, a referral to a higher-level hospital was needed. However, since the referral process for probable COVID-19 patients required a long preparation, the patient died during the process.

Conclusion: Besides early diagnosis and prompt treatment, a well-coordinated referral system is crucial in managing DKA patients with possible COVID–19.

Background: Spinal cystic intradural Schwannoma is a type of tumor that is rarely found, with an incidence of 0.3–0.5/100,000 person per year. The operative procedure for this tumor was simple. However, some patients showed other comorbidities, such as heart failure with low ejection fraction (EF) and atrial fibrillation. Such cases are a challenge to the anaesthesiologist as they are most commonly complicated by progressive cardiac failure.

Case Presentation: A 68-year-old woman was consulted by the Anaesthesiology Department in dr. Kariadi General Hospital Semarang in April 2019. She had been experiencing right lower extremity and lower back pain since April 2018, and they have been getting worse since two weeks ago. She also complained of shortness of breath two weeks before, accompanied by typical symptoms and signs of heart failure. Her electrocardiogram showed atrial fibrillation, and her echocardiogram showed an LVEF of 33.7%. Magnetic resonance imaging (MRI) showed two lobulated intradural-extramedular cystic lesions at thoracal vertebrae 12 until lumbar vertebrae 1 (VTh12–L1) that were a high suspicious of Schwannoma on the anterior aspect and the lateral aspect accompanied by spinal cord compression at that level. The drugs used for premedication were metoclopramide 10 mg and ranitidine 50 mg, for induction was fentanyl 100 μg, and for maintenance were dobutamine 10 μg/kgBW/minute, rocuronium bromide 30 mg/hour via syringe pump, opioid fentanyl 100 μg and muscle relaxant using rocuronium bromide 40 mg. The patient was hemodynamically stable throughout the surgery, and blood loss was minimal.

Conclusion: In patients with heart problems, a moderate reduction in contractility and heart rate often occurs and may induce mild to severe bradyarrhythmia or tachyarrhythmia related to induction agents. It is important to maintain adequate cardiac output that requires inotropic agents to augment contractility and improve circulation. As an inotropic choice, a β-agonist (e.g., dobutamine) causes less vasodilation, increased contractility, and adjuncts to augment contractility in the setting of significant hypotension.

Background: Tibial tubercle avulsion fracture is very rare. Its incidence has been reported to account for only 3% of all proximal tibia fractures and less than 1% of all growth plate injuries. This fracture occurs when the quadriceps are forcefully contracted against resistance, such as during jumping, or when rapid knee flexion occurs with contracted quadriceps, such as during landing. Most authors recommended surgical options in type IV tibial tubercle avulsion; however, we reported successful conservative treatment in this case report.

Case report: A 15-year-old male athlete with no significant past medical history presented via emergency medical services after a ground-level fall while playing basketball which landed with his left foot in a pivot position. He felt immediate pain and swelling about the left knee, all sensation was intact, as were pedal pulses, and neurovascularly remained intact. The patient did not want to go for medical evacuation to do surgery and consent to be managed with conservative treatment with close follow-up.

Conclusion: The results and prognosis of these fractures are excellent, despite the fracture pattern or treatment used, as long as an anatomical reduction is obtained

Airlangga International Endodontic Symposium is aimed as a platform for scientific communication for Endodontists as well as those who work this topic. The symposium upheld “The Roles of Endodontist to Achieve Sustainable Development Goals (SDGs)” as the theme to highlight the importance of Endodontists and Endodontist science in achieving SDGs in national level. This symposium hosted several notable experts in endodontists who have acknowledge as legend in endodontist and restorative expertise. Nevertheless, this symposium was hoped to enhance scientific interaction, scientific and expert networks, as well as to update the practical and scientific knowledge in endodontic area.