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

Background: Locally advanced breast cancer (LABC) is a term that refers to advanced non metastatic stage breast cancer. Neoadjuvant chemotherapy is one of the therapies given to patients with LABC. Many factors can affect the chemotherapy response, platelets produce growth factors, and cytokines promote angiogenesis and tumor growth. Inflammatory biomarkers such as platelet lymphocyte ratio (PLR) may indicate tumor progressiveness. The Ki67 proliferation index is a marker of the aggressiveness or growth of tumor cells. This study aimed to determine the correlation of platelet count, platelet lymphocyte ratio and Ki67 proliferation index before chemotherapy with neoadjuvant chemotherapy response.

Method: This research used the cohort retrospective design method. A sample of 155 patients was selected using a simple random sampling technique. The inclusion criteria of this research are having complete data about pre-treatment platelet, lymphocyte platelet ratio, Ki67 and the neoadjuvant chemotherapy response result assessed by the oncologist that is written in the medical record. Patient data from other types of cancer, chronic, systemic or autoimmune diseases are excluded from this research. The data of each variable was analyzed with the Spearman correlation test.

Result: There was no correlation between platelet count and neoadjuvant chemotherapy response (p=0.301). There was a negative correlation between the platelet lymphocyte ratio (p=0.026) and the Ki67 index (p=0.040) with neoadjuvant chemotherapy response.

Conclusion: Based on this study, it can be concluded that platelet count is not significant in relation to chemotherapy responses. The higher the platelet lymphocyte ratio and the proliferation index of Ki67, the lower the response to neoadjuvant chemotherapy.

Background: Human Immunodeficiency Virus (HIV) is an RNA virus from the Retroviridae family, Lentiviri subfamily, which attacks the immune system, especially T lymphocytes, namely Cluster of Differentiation 4+ (CD4+) cells. Human Immunodeficiency Virus destroys T lymphocyte CD4+ cells, decreasing immunity against opportunistic infections. For monitoring of HIV, an examination of T lymphocyte CD4+ cells and complete blood counts were conducted.

Methods: A cross-sectional quantitative analytic study was conducted from October 2021 to January 2022 at Prof. Dr. IGNG Ngoerah Hospital. Measurements were made on the total number of lymphocytes, hemoglobin levels, neutrophil-to-lymphocyte ratio (NLR), CD4+ levels and CD4+/CD8+ ratios. We analyze normality data using Kolmogorov-Smirnov and correlation using Pearson and Spearman tests. The p-value < 0.05 was considered significant.

Results: 56 patients met the inclusion and exclusion criteria, with 46 males (82.1%) and 10 females (17.9%). Mean age 38.98±11.58 years, mean total lymphocyte 0.64 x 10³ μL, median T lymphocyte CD4+ 133.50 sel/mm³, mean hemoglobin 10.11±1.49 g/dL, median NLR 6.51, median CD4+/CD8+ ratio 0.06. The hemoglobin variable was normally distributed, while the other variables were abnormal. The Pearson Correlation test showed a significant relationship between T lymphocytes CD4+ and hemoglobin with r=0.329 (p=0.013). Spearman's Correlation test showed a significant relationship between T lymphocytes CD4+ and NLR, total lymphocytes, CD4+/CD8+ ratio with r-0.334 (p=0.012), r=0.777 (p=0.000), r=0.729 (p=0.000) respectively.

Conclusion: There is a strong and significant correlation between the level of T lymphocytes CD4+ and total lymphocyte count and the ratio of CD4+/CD8+, a weak and significant correlation between the level of T lymphocytes CD4+ with hemoglobin and NLR in HIV patients at Prof. Dr. IGNG Ngoerah Hospital.

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

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

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

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

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

Link of Video Abstract: https://youtu.be/9chL7pTn3bA

Backgrounds: Liver injury induced by antituberculosis drugs showed high proportions in many countries and might result in serious effects. Previous studies had proved the increase of reactive oxygen species formation and induction of apoptosis related to antituberculosis treatment. There has been no standard therapy for protecting the liver from damage related to antituberculosis. Purple sweet potato extract is one of natural sources that possess hepatoprotector action regarding its antioxidant activity. This research aimed to prove the action of purple sweet potato ethanol extract on apoptosis related to liver injury caused by antituberculosis.

Method: This research was an experimental study with randomized post-test only control group design. The samples were male rats (Rattus norvegicus) strain Wistar, age 8-12 weeks, weight 150-200 grams (divided into two groups: control and experimental group). Purple sweet potato ethanol extract was prepared with maceration technique. The measurement of bcl-2 and caspase-3 expression was conducted with ELISA method. Data analysis was performed using independent t-test.

Results: Our study result revealed that the liver expression of bcl-2 in treatment group was significantly higher than control group (15.83 ± 3.14 vs. 12.11 ± 1.53), whereas the liver expression of caspase-3 in treatment group was significantly lower than control group (1.96 ± 0.38 vs. 2.41 ± 0.30; p < 0.05).

Conclusion: Purple sweet potato extract potentially protects the liver from apoptosis induced by antituberculosis.

Link Video Abstract: https://youtu.be/5cvWJq-8s0w

Background: Nocturia is the need or the number of waking up at night to urinate, with each void preceded and followed by sleep. It is included in lower urinary tract symptoms and reported as the most bothersome and common. Nocturia causes long term sleep deprivation and lowers someone's quality of life. Thus, they need to know how to diagnose and treat nocturia, including time to refer to a specialist. This study aims to review the management and diagnosis of nocturia among Indonesian general practitioners.

Methods: This study used cross sectional design. The data was collected by distributing a self-made online survey with Google Forms about the overview of nocturia among general practitioners in Indonesia, taken from October 2021 to March 2022. Data were analyzed using SPSS version 20.0 for Windows.

Results: There were 252 participants in this study that filled in the questionnaire from October 2021 to March 2022. Most patients (57.8%) were between 50 and 65 years old. Different approaches for nocturia were made, with mainly chose education and lifestyle change (88.1%) and medication such as alpha blocker (19.8%) compared to desmopressin (13.5%). Only 65.5% of respondents referred their patients to urologists for further therapy.

Conclusion: General practitioners in Indonesia face difficulty in dealing with nocturia. It is better to refer these patients to a urologist or other related specialist after they perform the diagnostic examinations and standard therapy.

link of Video Abstract: https://youtu.be/-6sruWeh-_Q

Introduction: Coronavirus-2 (SARS-COV2) is the agent that causes Coronavirus Disease (COVID-19), an acute respiratory tract illness. Early in December 2019, COVID-19 was created in Wuhan, China. On March 11th, 2020, COVID-19 was classified as a pandemic by WHO. As a result, the Indonesian government enacted extensive social restrictions on March 31, 2021. This rule prohibits unnecessary public actions. This study aimed to ascertain how COVID-19 affected This study sought to ascertain how COVID-19 affected orthopedic treatments provided in the spine area at the Orthopaedic Center Hospital in Indonesia.

Methods: This research is cross-sectional and comparative. The population in Indonesia during the COVID-19 epidemic was compared to the same population one year earlier in the research. This report covers every patient who visited Prof. Dr. R. Soeharso Orthopaedic Hospital with a spine-related diagnosis from the emergency room, an outpatient clinic, or an inpatient setting. Patients with other orthopedic subspecialty diagnoses and those registered at orthopedic service support facilities like radiography, laboratories, or physiotherapy were excluded. SPSS version 26 was used to analyze the data.

Results: The overall number of spine patients decreased significantly (30%) from 2440 (pre-covid) to 1695 (during covid). Additionally, there was a significant decline in outpatient visits and surgical procedures (p≤0.05). Patients with trauma reported a crucial decrease during outpatient visits and during surgery (p≤0.05).

Conclusions: During the COVID-19 pandemic, the overall number of spine patients from outpatient visits and patient surgery decreased significantly. Additionally, orthopedic care provided during outpatient visits and surgeries decreased.

Introduction: The demand for health treatment in hospitals has arisen since the Indonesian government launched the National Health Insurance. Admission delay to medical wards (MWs), which makes patients board in the emergency department (ED), disrupts patient flow. This study aims to explore the barriers to boarding patients at the ED by identifying waiting time, waste, and resource adequacy.

Methods: A case study was conducted in the ED of RSUD by Dr. Moewardi. The subject was 45 patients with internal diseases. Collecting data by direct observation using a real-time method is described in value stream mapping. Problem-finding was sharpened by in-depth interviews with health workers and non-health workers in the ED and internal MWs.

Results: Prominent causes of patient flow disruptions depended on service in the ED and inpatient room. Disruptions of patient flow indicated by waiting time amounted to 3 hours, 3 minutes, and 52 seconds. Patients who transferred to the transition room were considered to have gone into MWs, although patients can be treated for more than 3 days due to waiting for bed availability in the inpatient room. Waiting and motion were the most frequent. Inadequate resources both in the ED and inpatient rooms made a wide impact on patient flow, which was worsened by problems with tool layout, fragmented work, and poor utilization of the hospital information management system.

Conclusion: The bottleneck in ED’s and MW's processes contributes to the degeneration of the stacked bed of boarding patients in ED. The improvements must be integrated to address the issues of waiting time, waste, and capacity. Improvements in the flow of boarding patients focus on fixing the documentation of laboratory result problems, arranging patient discharges, and optimizing the use of the hospital information system.

Link of Video Abstract: https://youtu.be/9kem7M9SNWI

Background: Ovarian cancer remains as major problem worldwide. BRCA1 and BRCA2 play a unique role in deoxyribonucleic acid (DNA) damage repair, especially in homologous recombination repair. There are no data on the prevalence of BRCA1 and BRCA2 somatic mutations in the Indonesian population. This study aimed to determine the incidence of BRCA1 and BRCA2 somatic mutations among a cohort of patients with high-grade serous epithelial ovarian cancer, and assess its correlation with clinical characteristics of the cohort.

Methods: This was an analytical observational study of 26 patients admitted to our hospital from 2019 to 2021. Pathological specimens were obtained from the patients and examined for BRCA1 and BRCA2 somatic mutations. Data on clinical characteristics were collected from medical records. Statistical analysis was performed to determine the relationship between BRCA mutation status and clinical characteristics, including age, stage, menopausal status, parity, family history of malignancy, and patient outcomes.

Results: Twenty-six patients with high-grade serous epithelial ovarian cancer were included in the study. Six patients (27% of 22 patients) had BRCA1 and BRCA2 somatic mutations, four did not pass the quality control test, and the remaining tested negative for these mutations. Most patients were over 50 years of age (73%). Additionally, 84% of patients were diagnosed at stage III, and only one patient had a family history of malignancy. At the end of the study, most patients (65%) had died. Statistical analysis showed no significant differences between the clinical characteristics of the groups.

Conclusion: The incidence of BRCA1 and BRCA2 somatic mutations among patients with high-grade serous epithelial ovarian cancer at our hospital during 2019–2021 was 27%. There were no significant differences in the clinical characteristics of those with and without mutations, hence NGS screening following diagnosis establishment may be beneficial in further management plans.

Introduction: Hypercholesterolemia is an indicator of atherosclerosis in blood vessels and is currently a top priority in overcoming health problems, especially non-communicable diseases in developed and developing countries. Thyroid hormones regulate various metabolic processes in the body including synthesis, mobilization, and lipid degradation. A lack of thyroid hormone in the body or called hypothyroidism will decrease the number of LDL receptors in the liver. This causes an increase in plasma LDL levels which also increases total cholesterol levels. Despite the lack of study, Fermented Honey-Garlic (FHG) is now widely developed for its high antioxidant activity. This study aims to determine the content of bioactive compounds in FHG by qualitative secondary metabolite testing and GC-MS analysis and to evaluate the activity of the enzyme glucose-6-phosphate dehydrogenase (G6PD) in rats with hypothyroidism.

Method: Rats were grouped into 6 groups: positive control group induced by propylthiouracil (PTU) with a dose of 20 mg/day, negative control treated with distilled water, treatment group with a dose of FHG 0.2 g/kg BW (P1), treatment group with a dose of FHG 0.5 g/kg BW (P2), treatment group with a dose of FHG 1 g/kg BW (P3) and standard drug Simvastatin group with the dose 0,18 mg/day/200 g BW.

Results: Results showed that FHG contained flavonoid compounds, alkaloids, tannins, and saponins, and statistical results showed that the significance value for G6PD activity was 0.014 (P<0.05).

Conclusion: Therefore, it can be concluded that FHG administration yields a significant effect on G6PD levels.

Introduction: The high cases of hypertension are increasing due to the lack of public knowledge in the management of eating patterns. This revolves around cultural, environmental, and educational factors that can affect knowledge and attitudes in people with hypertension. The aim of this study is to determine the effect of health education on knowledge and attitudes of hypertension patients.

Method: This study used a one group pre-post test design. The study was conducted in one village in Java region of Indonesia, which involved 56 respondents, selected by purposive sampling. The research instruments used were knowledge and attitude questionnaire sheets. Statistic analysis by utilizing Wilcoxon sign rank test to determine the difference between pre and post test with a significance value of p < 0.05.

Results: The results of the knowledge variable before and after being given health education with a p-value = 0.000, and for the attitude variable with a p-value = 0.000. This shows that there is a difference in average between the results of knowledge and attitudes of hypertensive patients before and after being given health.

Conclusion: Health education about the DASH diet affects knowledge and attitudes in patients with hypertension. 

Link of Video Abstract: https://youtu.be/r399GEt3guo

Introduction: Tubularized Incised Plate Urethroplasty (TIPU) is a technique that is widely used in distal hypospadias repair. The advantages possessed by this technique are better cosmetics, the meatus is at the tip of the penis, and the phallus is straight. Some researchers believe that a urethral plate with a size of less than 8 mm is unsuitable for the TIPU technique so augmentation with a graft using the dorsal inlay graft urethroplasty (DIGU) technique is needed. To date, there have been no systematic reviews and meta-analyses that have directly compared the efficacy and complications of DIGU and TIPU. Therefore, this study aimed to compare the effectiveness and complications of these two modalities for repair in primary distal hypospadias patients.

Methods: This study is a systematic review study and meta-analysis. The protocol for conducting and compiling this study was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was performed on six databases: PubMed, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. The risk of bias in the study will be analyzed using the Cochrane Risk of Bias Tools for Randomized Trials version 2 (RoB 2).

Results: Six studies that met the inclusion criteria were included in the meta-analysis with a total of 381 samples. The success rates (OR 1.46, 95% CI 0.74-2.87, p = 0.28) and urine output (OR 2.54, 95% CI 0.63-10.20, p = 0.19) were not significantly different, while the mean operating time (MOT) (SMD 1.96, 95% CI 1.10-2.82, p < 0.0001) was significantly shorter in TIPU (P < 0.05). The incidence of meatal stenosis was significantly more in TIPU than DIGU significantly (OR 5.11, 95% CI 1.46-17.92, p = 0.01), while fistula (OR 2.93, 95% CI 0.92-9.35, p = 0.07) and dehiscence (OR 3.05, 95% CI 0.81-11.45, p = 0.10) was not significantly different between the two techniques.

Conclusion: TIPU has the advantage of shorter operating time but a higher incidence of meatal stenosis than DIGU.

Link of Video Abstract: https://youtu.be/FcVVr3DoiOs

Background: Obesity is an issue with public health that affects people worldwide and raises morbidity and mortality rates. In addition to dietary factors, non-nutritional factors like meal frequency and duration also contribute to the increased risk of obesity. This study aims to evaluate the duration of meals that will be compared between obese subjects who receive a mini low carbohydrate diet and those who do not.

Methods: Used a cross-sectional, quasi-experimental design in this study. Seven days of testing on 70 obese subjects who met the inclusion criteria for this study were conducted in November at the Palangka Raya city health center. Using a stopwatch to time the length of each meal in seconds and fasting blood glucose tests. Paired T-test and Independent Sample T-test are used in statistical analysis, while Wilcoxon and Mann-Whitney tests are used in the non-parametric analysis. Data were analyzed using SPSS version 20.0 for Windows.

Results: Blood glucose levels and eating speed did not correlate significantly in the mini low carbohydrate diet (M-LCD) group (p>0.05), but they correlated significantly in the control group (CG) (p<0.05). There was a significant difference in fasting blood glucose of the M-LCD and CG groups (p<0.05).

Conclusion: There was no correlation between meal speed and fasting glucose levels in the M-LCD group, but there was a significant difference between the M-LCD and CG groups' fasting blood glucose levels.

Link of Video: https://youtu.be/KtNkkeJmbh4

Background: Chronic kidney disease (CKD) is a progressive disease whose prevalence increases annually. Studies in recent years report that statins (hydroxy-3-nethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors) affect preventing the progression of kidney damage, in addition to their ability to prevent cardiovascular risk in patients with CKD. This study aims to determine the effect of statins on kidney function and renal fibrosis in chronic kidney disease.

Methods: This research is pure experimental (randomized post-test only control group design). The research sample consisted of 20 white mice (Mus musculus L.), Swiss line, aged 3-4 months, and weight 30-40 grams. Samples were randomly grouped into four treatment groups: control (K, n = 5), treatment with simvastatin at a dose of 5.2 mg/kgBW (P1), treatment with simvastatin at a dose of 10.4 mg/kgBW (P2), and treatment with simvastatin at a dose of 20.8 mg/kgBW (P3). Interstitial fibrosis was assessed using Picrosirus Red staining. Data analysis used One-Way ANOVA and Tukey's post hoc tests with a significance value of p<0.05 in SPSS version 25.0 for Windows.

Results: The results showed that the control group (K) was the group with the highest serum creatinine level (1.07 ± 0.43) compared to the other treatment groups (p <0.05). Administration of simvastatin at doses of 5.2 mg/kgBW, 10.4 mg/kgBW, and 20.8 mg/kg BW in CKD mice resulted in lower interstitial fibrosis than controls. There was a significant difference between renal tissue fibrosis in the simvastatin group at a dose of 5.2 mg/kgBW (P1) with a dose of 10.4 mg/kgBW (P2) and a dose of 20.8 mg/kgBW (P3).

Conclusion: Simvastatin can improve kidney function and reduce the degree of renal fibrosis in animal models of CKD. Thus, it can be a therapeutic strategy for CKD.

Introduction: Lifting equipment operators risk having work accidents when loading/unloading containers. One of the risks can be minimized by doing a fit-to-work/ health check before work. This study aimed to analyze the relationship between the level of participation in implementing fit to work on the unsafe behavior of lifting equipment operators at PT. BJTI.

Methods: The research design was cross-sectional from March to May 2022. Monthly data fit to work, questionnaire sheets were used to collect data, and data were analyzed by chi-square. The respondents were as many as 77 randomly selected through cluster sampling. Data analysis was tested using chi-square test (α = 0.05).

Results: As many as 69 (89.6%) showed that operators tended to behave unsafely in the high category, with details of 28 operators participating fit to work medium and 41 operators in the low sort. The chi-square results showed a significant relationship between participation fit to work and unsafe behavior with a significance p<0.05.

Conclusion: There was a significant relationship between the level of participation fit to work on the unsafe action operator lifting equipment PT. BJTI. Therefore, it is recommended that companies provide programs to increase involvement in implementing fit-to-work by giving awards to every worker who actively participates in fit-to-work.

Introduction: Seborrheic keratosis (SK) is a benign tumor of the epidermis, its development is associated with various hypotheses, but none came out as the main culprit. A few study results regarding the oxidative stress strongly associated with skin tumors have been reported. Superoxide dismutase (SOD) is a potent protective enzymatic antioxidant. Malondialdehyde (MDA) is the end product of lipid peroxidation produced by free radicals in the body. Increased levels of MDA usually accompany low levels of antioxidants.

Methods: This study was an observational analytic study with a cross-sectional method involving 42 seborrheic keratosis subjects based on inclusion and exclusion criteria. We recorded the gender, age, family history, and occupation of the subjects. Diagnosis of seborrheic keratosis was made based on history taking and clinical examination—measurement of SOD level by ELISA method and MDA levels by TBARS method. The Spearman correlation test was measured and was considered significant if the p-value was <0.05.

Results: Seborrheic keratosis was more common in females (92.9%), with the most common age group being 40 ̶ 50 years old (57.1%), had a family history of SK (26.2%), and worked in agriculture, forestry, and fisheries (26.2%). The average blood plasma SOD level was 1.68 mmol/L, and the blood plasma MDA level was 181.19 U/L. The correlation coefficient between blood plasma SOD levels and blood plasma MDA levels was -0.393, with a significant value of p=0.01. This study showed that the lower the SOD level, the higher the MDA level in the blood plasma of seborrheic keratosis.

Conclusion: There is a significant correlation between SOD and MDA levels in the blood plasma of seborrheic keratosis subjects.

Introduction: Preeclampsia is an important problem in obstetrics because it is a pregnancy complication often found and results in high morbidity and mortality in both mother and baby. Preeclampsia is one of the complications of pregnancy that needs to be detected or monitored for symptoms, because in addition to being risky for the mother, it will also have an impact on the occurrence of preterm birth and even further impact, namely fetal death in the womb. This study aimed to determine the effectiveness of CRP and leukocyte examination to detect preeclampsia.

Method: This research was conducted at the Jagir Health Center Surabaya in March-July 2022. The research used case control with 30 pregnant women as samples divided into 15 as a control group of normal pregnant women and 15 pregnant women with preeclampsia.

Result: The results showed that of the 15 respondents who had preeclampsia more than half (60%) had high leukocyte and CRP levels, the remaining less than half (40%) had normal CRP and leukocyte levels. While in the control group more than half (67%) had normal CRP and leukocyte levels and less than half (33%) had normal CRP and leukocyte levels. The results of data analysis showed p value 0.001 (<0.005), which means there is a relationship between the CRP and leukocytes on the incidence of preeclampsia.

Conclusion: Examination of CRP levels and leukocyte count proved effective for detecting the incidence of preeclampsia in pregnant women. It is expected that pregnant women carry out routine pregnancy checks and health workers are expected to routinely carry out early detection to prevent pregnancy complications such as preeclampsia

Link of Video Abstract: https://youtu.be/K2R3dfdvi20

Background: Simple, cost-effective, and practical laboratory indicators are required to diagnose and evaluate COVID-19 disease severity. This study assessed the diagnostic value and predictor of severity and outcome parameters of NLR, d-NLR, MLR, PLR, and ALC in COVID-19 patients.

Methods: A retrospective study used medical record data from 100 COVID-19 patients from November 2020 to March 2021. SPSS version 22 was used to analyze the data. The severity of COVID-19 was predicted using a ROC curve. Kaplan-Meier analysis was employed to evaluate the ability of various inflammatory markers to predict COVID-19 prognosis. A multivariate analysis with logistic regression was conducted to assess the ability of an independent predictor of COVID-19 severity. A p-value of <0.05 was considered significant.

Results: ALC values were lower in the severe-critical COVID-19 group, whereas NLR, d-NLR, MLR, and PLR values were higher. The NLR, d-NLR, and ALC parameters had sufficient accuracy, whereas the MLR and PLR parameters had low accuracy. NLR, d-NLR, MLR, PLR, and ALC had optimal cut-off values of 7.865, 4.82, 0.455, 235.000, and 0.895, respectively. The multivariate odds ratio for ALC was 7.348 (95% CI = 1.914-28.214; p = 0.004). Kaplan-Meier analysis revealed differences in survival time based on the optimal NLR, MLR, d-NLR, and ALC cut-offs obtained.

Conclusion: NLR, d-NLR, MLR, PLR, and ALC are all potential predictors of COVID-19 severity and prognosis. ALC is a reliable predictor of COVID-19 severity.

Link of Video Abstract: https://youtu.be/kSlkMRdPkO8

Introduction: Intestinal anastomosis leakage is a significant concern following intestinal suturing due to its potential to cause morbidity and mortality. Curcuma longa, commonly known as turmeric, has been observed to have wound-healing properties by promoting collagen deposition and increasing the number of fibroblasts. However, the effect of Curcuma longa on left colon anastomosis with acute intra operative loss of 15% circulating blood volume is unknown. This study aimed to determine the impact of oral administration of Curcuma longa extract on the number of fibroblasts and collagen density in the left colon anastomosis with acute intraoperative loss of 15% circulating blood volume.

Methods: This is an experimental study; the researchers investigated the effect of Curcuma longa extract on the healing process of colon anastomosis in white rats - Rattus norvegicus.

Results: A total of 30 white rats - Rattus norvegicus underwent laparotomy for left colon anastomosis resection, and they were randomly divided into two groups. One group was given Curcuma longa extract orally after surgery, and the other group did not received it. After five days of treatment, the group that received Curcuma longa extract orally had a significantly higher mean number of fibroblasts (1168.13) compared to the control group (749.60) (p-value: 0.006). Moreover, the collagen density in the treated group was also higher, with a density range of 50-72% (60% of rats) and 75-100% (33.30% of rats), compared to the control group's density range of 25-50% (66.70% of rats) and 10-25% (13.30% of rats) (p-value: 0.000).

Conclusion: Oral administration of Curcuma longa extract can increase the number of fibroblasts and collagen density in the left colon anastomosis with acute intra operative loss of 15% circulating blood volume.

Introduction: Food consumption has a substantial impact on the physical condition of work for unskilled individuals like construction workers because their activity demands a lot of energy. Consumption of bananas can increase energy, so it is hoped that the results of this study can be used as a consideration to maintain the health of construction workers so that they are kept in good condition. The aim of the study was to determine the effectiveness of bananas on blood pressure, liver function, and lipid function.

Methods: This is an experimental study with samples taken from the total population of 15 employees. The blood pressure, liver function, and lipid function measurements in construction workers were made before and after consuming bananas. The analysis of the data in this study was conducted by a paired t test.

Results: Based on the data analysis, the result showed that there was no significant difference in blood pressure and liver function measurements between the workers before and after consuming bananas (p>​​0.05). Meanwhile, the results showed that there was a significant difference in lipid function measurements between the workers before and after consuming bananas (p<​​0.05).

Conclusion: The effectiveness of banana consumption can be seen in the examination of lipid function. However, there is no effect on the blood pressure or liver function of the workers.

Introduction: Classical music has beneficial effects on heart rate variability and also reduces one's stress levels due to parasympathetic dominance. Mozart's classical music was shown to provide subsequent short-term enhancement of spatial-temporal reasoning ability. This research aimed to study the effect of Mozart's classical music on blood pressure.

Methods: The design of this study is true experimental with a post-test-only design with a control group.

Thirty Wistar white rats were randomized by simple random sampling method into the control group and experimental group receiving Mozart’s classical music for 90 minutes, twice daily for 1, 3, and 4 weeks. SBP, DBP, and MAP were measured and analyzed using descriptive analysis, Shapiro Wilk, Mann-Whitney U, and Wilcoxon Sign Rank test.

Results: DBP and MAP of the experimental group week 1 and 3 were significantly different from the control group. There were significant differences between SBP, DBP, and MAP of experimental group week 1 from week 3 (p=0.00, p=0.00, p=0.00 respectively) and week 1 from week 4 (p=0.00, p=0.00, p=0.00).

Conclusion: Listening to Mozart's classical music has a direct effect on blood pressure.

Introduction: Vitamins have a main role in controlling metabolism in the body and the immune system. Vitamins A, C, and E are known as antioxidant nutrients and vitamin D is essential for innate and adaptive immune function. This study is aimed to analyze the effect of vitamin intake regularly on malondialdehyde (MDA) levels, white blood cell (WBCs) and platelet counts, and differences count of leukocyte

Method: The study used 6 groups including the control group without intervention and the intervention group intake of one tablet of vitamin a day for 7 days which were divided into groups of vitamin A 2000 IU, vitamin C 1000 mg, vitamin D 400 IU, vitamin E 100 IU and multivitamins C 1000 mg and D 400 IU

Results: Based on the study was explained that vitamins C, D, and E and multivitamins C and D were able to reduce MDA levels and leukocyte counts descriptively but not significantly. The differential leukocyte count has various levels depending on the type of vitamin.

Conclusion: Therefore, the consumption of vitamins A, C, D, and E and multivitamins C and D had no significant effect on MDA levels, WBCs count, platelets count, and differential count of leukocyte.

Introduction: Hemodialysis is one of the treatments for kidney failure patients, although it is not always effective and has a tendency to make the patient's health worse. One such effect is a rise in interdialytic weight. In this study, patients with chronic kidney failure receiving hemodialysis at the Islamic Hospital A. yani Surabaya were examined to establish the association between family support and weight growth.

Method: a cross-sectional research strategy for analysis. 70 respondents made up the population of all hemodialysis patients with chronic renal failure, and 60 respondents made up the purposive sampling sample size. The unrestricted factor is family support. The weight gain between dialysis sessions was the dependent variable. A questionnaire and an observation sheet were used as instruments. The Spearman Rank test was utilized in data analysis.

Results: According to the findings, out of the 60 respondents, the majority's (70%) family support was excellent, and the majority (76.7%) of those who had dialysis saw modest weight gain. According to statistical analysis, the p value was 0.001, which indicates that among hemodialysis patients with chronic renal failure who receive family support, there is a relationship between weight gain.

Conclusion: In patients with chronic renal failure receiving hemodialysis, the more well-controlled the interdialytic weight increase, the better the family support. The requirement for support and assistance for dialysis patients so they can follow the recommended course of treatment.

Introduction: The Objective Structured Clinical Examination (OSCE) is an acceptable measure to assess nursing students' skill competencies. To date, rapid changes in the education system, technology information, and pandemic enforced the need to develop and implement an online OSCE scoring management system, an online system to score the student during the OSCE. Although the satisfaction of the online OSCE scoring management system has been studied, the study to assess readiness to implement the online OSCE scoring management system is still lacking. This study aimed to identify the nursing education institution readiness level in implementing an online OSCE scoring management system named ON-OSCE.

Methods: The online survey involved 144 nursing lecturers across Indonesia. The survey consisted of 30 questions with a 5-point Likert scale that entails technology, innovation, people, and self-development dimensions. Each dimension was constructed by the questions related to resources, skills, and attitudes. The readiness levels were categorized into not ready (average score of 1-3.39) and ready (average score of 3.40-5.00).

Results: Mostly, the participants worked at a private institution (93%) with an accreditation level of B level (75.5%) and implemented an e-Learning system (85.4%). However, the common OSCE scoring management system was paper-based/hardcopy (73.2%). About two third of participants (67.4%) were ready to implement an online OSCE scoring management system (Mean = 3.57, SD = 0.57).

Conclusion: Most participants perceived that their institution was ready to implement an online OSCE scoring management system. Further study is needed to pilot an online OSCE scoring management system in a nursing education institution and explore the student and examiner's satisfaction before implementing an online OSCE scoring management system.

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

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

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

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

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

Background. One of the fundamental pathogenesis of endometriosis to grow and develop is to carry out a cellular invasion of the surrounding tissue where it attaches. The invasion process of endometriotic focus is linked with the activity of matrix metalloproteinases-2 (MMP-2) and tissue inhibitors of metalloproteinases-2 (TIMP-2). In this study, we used endometrioma tissue to be implanted in chick chorioallantoic membrane (CAM) as a medium culture model to reconstruct and evaluate the invasion process of endometriosis. Then the MMP-2, TIMP-2 and invasion pattern can be invitro observed.

Methods. Endometrioma tissue fragments were taken from ovarian endometrioma patients, reproductive age, no medication and no malignancy who underwent laparoscopic surgery. Sample research was taken in consecutive and non-probability sampling. The tissue fragments were divided into 4-8 strips, each dimension of 2 x 2 mm². Two strips were assessed for the activity of MMP-2. Two remaining strips were transplanted onto the CAM. After incubation for five days, the transplanted tissues were harvested for assessment of MMP-2 by gelatin zymography, TIMP-2 by western blot and histological assessment by hematoxylin-eosin staining. The assessment was carried out by two qualified biologists as an observer.

Result. Twenty-four fragments of endometrioma have been collected from 24 endometrioma patients who underwent laparoscopy surgery. The average age was 31±5 years, the BMI was 22±3 kg/m², the duration of infertility was 58 ± 3 months, and r-ASRM was 67±35. In CAM of transplanted endometriomas tissue, MMP-2 activity was positively correlated with TIMP-2 in a moderate relationship (r_ô = 0.56, p-value < 0.05), very weak positive correlation with invasion level (r_ô = 0.08, p-value >0.05). TIMP-2 expression was negatively correlated with invasion level in a strong relationship (r_ô = -0.35, p-value <0.05). The ratio between MMP-2/TIMP-2 was positively correlated with invasion level in a very strong relationship (r_ô = 0.72, p-value < 0.05). ICC (intraclass correlation coefficient) value was 0.96, and p-value= 0.01, CI 95%. It shows that there was high reliability between observers.

Conclusion. The invasion level of endometrioma transplanted onto CAM was determined by the balance between MMP-2 and TIMP-2.

Background: The making of batik in Malon Village utilized natural dyes. The process of making batik was done through 7 stages: designing pattern, tracing, outlining, coloring, fixating, masking and rinsing. Those processes were conducted with poor ergonomic working positions and were highly potential to cause injury for the batik workers. This study aimed at finding out the potential health risks that exist for the natural batik workers and the occupational health profiles of batik workers in Malon Village which is an icon for naturally dyed batik.

Method: This study was descriptive quantitative research by using observational design. The data were collected from subjective complaint questionnaires, workplace observation and measurement of Vital Lung Capacity (VLC) of the batik workers.

Results: The results showed that 45.5% of the working tools used poor ergonomic designs. Batik in Malon Village used four chemical irritants: wax, alum, soda ash and lime. All of them could potentially lead to health problems. The result also showed that around 61% of batik workers complained about stinging/ burning eyes, 28% watery eyes and 11% red eyes. In addition, 22% of them complained about itchy skin, 6% redness in the skin and 6% pain in the skin. The VLC showed that 50% of respondents had normal VLC, 47% mild restriction and 3% severe restriction.

Conclusion: The area where the batik workers worked had high health and safety risks, but only 22% of respondents used Personal Protective Equipment (PPE) and all of the worn PPE did not meet the standards.

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

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

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

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

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

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

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

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

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

Link of Video Abstract: https://youtu.be/-i3vr4qpQUU

Background: Chronic kidney disease (CKD) patients on hemodialysis are more susceptible to COVID-19 infections. Mortality and morbidity rate are higher in this population. Thus, it is critical to understand which parameters are associated with mortality in this population. C-reactive protein (CRP), albumin, and d-dimer were shown in several studies to be associated with mortality in COVID-19-infected hemodialysis patients.

Methods: This study was a comparative observational, retrospective study from the medical records of Dr. Soetomo General Hospital in Surabaya, Indonesia. Chronic kidney disease patients on maintenance hemodialysis who tested positive for COVID-19 from June 2020 to January 2021 and underwent treatment in the isolation ward were included in this study. Data were analyzed using SPSS version 21.0 for Windows.

Results: The non-survivor groups have statistically significant lower albumin (2.78 (2.21-3.40) g/dL vs. 3.20 (2.45-3.80) g/dL; p=0.040) and higher CRP (10.40 (4.10-28.6) mg/L vs. 3.20 (0.10-80.0) mg/L; p=0.020) compared to the survivor group (Table 2). D-dimer value has no significant difference between the non-survivor and survivor groups (4,290 (190-18,310) ng/mL vs. 2,630 (190-19,430) ng/mL; p=0.140)

Conclusion: Non-survivor CKD patients with COVID-19 infections have significantly lower serum albumin and higher CRP concentrations. There is no significant difference in D-dimer concentrations in the survivor and non-survivor groups.

Purpose: The National Health Insurance (JKN) implemented by the Indonesian government since 2014 has brought Indonesia to a new phase in realizing the right to health for its people. The social insurance system managed by Social Health Insurance Administration Body (BPJS) is felt to bring many benefits to the community despite many obstacles in its implementation. This study seeks to find the ethical dilemmas experienced by surgical and non-surgical specialists in implementing the JKN program in hospitals.

Methods: The study was conducted using the qualitative method with the phenomenological approach by conducting in-depth interviews with five surgical specialists (an obstetric and gynecology, an otolaryngologist specialist, a surgeon, an eye specialist, and an anaesthesiologist) and six non-surgical specialists (children, mental health, internal medicine, medical rehabilitation, nerves, and skin specialists) in Semarang, Indonesia. In each specialization, there are two respondents interviewed. The data were analyzed using a qualitative approach.

Results: Some problems still exist when specialist doctors treat BPJS patients in hospitals, which include: 1) lack of socialization, making doctors as implementers find it difficult to implement the rules; 2) different implementations in various hospitals, making doctors find it difficult to adjust when they practice at type C hospitals because the number of claims is often insufficient to provide services to patients; 3) the JKN program that has increased the number of patients, resulting in doctors' concerns about lawsuits if they make mistakes; moreover, doctors also have to adjust to existing cost claims; and 4) doctors still trying to uphold the doctor's oath and The Indonesian Medical Ethics Code (KODEKI) and always do the best for patients whatever the problem. Conclusion: The implementation of JKN must always be evaluated continuously, and the government still has to pay attention to the obstacles faced by doctors in the field. In carrying out their practice full of dilemmas, doctors must always receive adequate legal and ethical protection.

Introduction: Obesity is a nutritional disorder that can affect all ages, including teenagers. Obesity can affect gut microbiota and cause increased intestinal permeability. This process leads to interleukin-6 and TNF-α production which can increase leptin levels. The soluble leptin receptor (sLR) is a leptin receptor in the plasma that transports leptin to the hypothalamus. Low sLR numbers are associated with high leptin levels in obesity. Obesity in hyperleptinemia conditions indicates leptin resistance (defects in leptin receptors) which causes hyperphagia and reduces energy expenditure. This study was conducted to prove high TG and IL-6 serum levels and low sLR levels in obese adolescents who have a higher risk of developing leptin resistance than normal adolescents.

Methods: This research is a case-control study. The subjects underwent an assessment including food recall, anthropometric status, and lipid profile. The food recall assessment was obtained by means of a questionnaire given to parents. Blood sampling and laboratory examination are carried out by the Prodia® Clinical Laboratory. Data analysis was performed by computer, using the Independent t-test, Mann-Whitney test. Chi-Square test, and analysis of the ROC curve.

Results: ROC curve analysis obtained the optimal cut points for TG and IL-6 levels, respectively 101.5 mg/dL (sensitivity 82.1%, specificity 89.7%) and 11.95 pg/mL (sensitivity 84.6%, specificity of 80%), with area under the curve (AUC) values of 0.96 and 0.89, respectively. ROC curve analysis obtained the optimal cut point for sLR levels of 19.3 ng/mL (sensitivity 64.1%, specificity 71.8%) with an AUC value of 0.77. Multivariate analysis using logistic regression found a significant relationship between TG and IL-6 levels on the incidence of hyperleptinemia.

Conclusion: This study reinforces the theory of chronic low-grade inflammation and proved that inflammation and high TG levels play a role in hyperleptinemia in obese adolescents.

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

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

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

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

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

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

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

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

Background: Traumatic brain injury (TBI) is damage to the head caused by an external physical attack/impact. Deaths that occur from brain injury are 14-30 out of 100,000 population each year. TBI is diagnosed using Computed Tomography (CT) as the gold standard. Different densities of the pathological feature on CT can be measured by Hounsfield Unit (HU) to define its pathology. We try to asses if the HU can predict the hematoma expansion in TBI.

Methods: This research is an observational study. The data is taken from the radiology installation data of the emergency care installation at the Dr. Soetomo Regional General Hospital regarding factors that play a role in hematoma expansion with related factors in patients with subdural and epidural bleeding. Data were taken from January 2021 to December 2021. The factors analyzed were Hounsfield Unit, age, and hemostasis factors.

Results: In this study, there were 30 patients. This study was dominated by men (73.00%) and the age group of 16-20 years (26.6%). The mean PTT value in this study's subjects was 13.3±3.27. The mean value of APTT is 29.8±2.82. The average Hounsfield Unit is 43.60±5.82. No significant relationship was found between Houndsfield Unit, Age, APTT level, and age with hematoma expansion. A significant relationship was found between PTT and hematoma expansion. Simultaneously Hounsfield Unit, PTT, APTT, and age had a significant relationship with hematoma expansion.

Conclusion: There was no statistically significant relationship between Hounsfield Unit and hematoma expansion. There is a statistically significant relationship between PTT and hematoma expansion. Simultaneously found a significant relationship between Hounsfield Unit, PTT, APTT, age, and bleeding activity.

Link of Video Abstract: https://youtu.be/JOzTSty10v4

Background: Brucein D (BrD), a quassinoid isolated from Brucea javanica fruit, reportedly demonstrates anti-tumor activity. Bcl-2 is an anti-apoptotic protein that inhibits apoptosis and leads to cancer progression. This study aims to evaluate the inhibitory effect of BrD against the anti-apoptotic protein Bcl-2 by molecular docking study.

Methods: We investigated the activity of BrD against Bcl-2 through molecular docking in silico compared to the chemotherapeutic drugs doxorubicin and docetaxel. Molecular docking analysis was conducted using the Lipinski rule of five drug-likeness analyses, PASS Online prediction, PyRx v0.8, Discovery Studio DS BIOVIA 2016 v16, and PyMol v2.4.

Results: Current results show that BrD is qualified as a drug and can pass cell membranes without toxicity. The PASS prediction also shows that BrD can be activated as an anti-neoplastic inside the human body with Pa higher than Pi. BrD can make a constant and stable bond to Bcl-2 with a binding energy of -8.3 kcal/mol, almost equal to doxorubicin and docetaxel. BrD can form six types of hydrogen bonds that show stability to temperature and pressure.

Conclusion: BrD has shown to be a promising alternative for an anti-cancer drug by inhibiting the Bcl-2 anti-apoptotic protein with low toxicity in normal cells.

Background: Postoperative Cognitive Dysfunction or POCD is a reversible decline in the cognitive function of patients after surgery. The risk factors for POCD are age, comorbidities, duration of CPB, intraoperative hypoperfusion, duration of ventilator use, and postoperative sedation are risk factors of POCD. This study aims to determine the prevalence and characteristics of postoperative cognitive dysfunction (POCD) in patients who undergo on-pump cardiac surgery at Dr. Kariadi General Hospital.

Methods: This study's population was all patients undergoing on-pump cardiac surgery at Dr. RSUP. Kariadi in July 2021-December 2021. The study subject was 97 patients, obtained by total sampling technique. The study subjects were examined for cognitive function with MoCA-INA one day before surgery and the third day after surgery. Data were analyzed using SPSS version 23 for Windows.

Results: There were 68 (70.1%) patients who experienced POCD and 29 (29.9%) patients who did not experience POCD. The median age of patients with POCD is 50 (18-68) years and 36 (18-63) years for patients without POCD. Based on MAP during CPB, patients with POCD had a median of 64 (51-80) minutes. In patients with POCD, the median length of CPB was 53 (22-92) minutes, and the median length of the aortic cross-clamp clamp was 35 (11-69) minutes.

Conclusion: We found a high prevalence of POCD patients after on-pump cardiac surgery, as many as 70.1% at Dr. Kariadi General Hospital.

Introduction: Hepcidin is a hormone that regulates systemic iron homeostasis and is mostly produced in the liver. In pregnant women with inflammation, there are two opposing mechanisms in hepcidin expression: the suppression of hepcidin synthesis by pregnancy and the induction of hepcidin by inflammation. These conditions must receive special attention so clinicians can properly treat and manage pregnant women with inflammation. Therefore, this study aims to prove changes in hepcidin and serum iron levels in pregnant mice with inflammation.

Method: This study involved sixteen-second-week pregnant mice divided into two groups. Pregnant mice were injected with lipopolysaccharide (LPS) Escherichia coli serotype O111:B4 as much as 1 µg/g body weight intraperitoneally as the treatment group. In contrast, pregnant mice were injected with phosphate buffer saline (PBS) as a control group. Serum was measured using ELISA to determine hepcidin levels and colorimetry to determine serum iron. Mice livers were measured using Real-Time PCR to determine Hamp1 mRNA expression. The data obtained were analyzed using an independent t-test.

Result: Our results show that pregnant mice with inflammation show there was no difference in Hamp1 mRNA expression (p-value=0.163) and hepcidin level (p-value=0.789), but there was a significant difference in serum iron level (p-value=0.035).

Conclusion: This study demonstrates that inflammation in pregnancy does not affect changes in Hamp1 expression and hepcidin level but reduces serum iron, which could be caused by regulating hepcidin in the fetus.

Link of Video Abstract: https://youtu.be/9Gip7ztxLJk

Background: Colorectal cancer is reaching the third highest incidence globally, including in Indonesia. Members of the RAS family are frequently discovered in colorectal cancers and may be a contributing factor for the successfulness of anti-epidermal growth factor receptor monoclonal antibodies therapy. Microtubule-associated protein 1 light chain 3 (LC3) is one of the autophagy markers in colorectal cancer cells routinely tested. The relevance of RAS mutation and expression of LC3 as a prognostic factor in CRC has so far only been discussed in several reports. This study aimed to describe the different clinicopathological characteristics of colorectal patients with mutations of the RAS family and LC3 overexpression.

Methods: This study was a cross-sectional study, and the subjects for this study were patient from the Digestive Surgery division at the Tertiary Hospital in West Java, Indonesia with colorectal cancer. A total of 40 study subjects were included in this study. Examination of RAS mutations was carried out by polymerase chain reaction. Meanwhile, the LC3 examination was performed with immunohistochemistry.

Results: The RAS family mutation, which is a mutation of either KRAS, NRAS, or both, was shown in 22 (55%) colorectal cancer patients, and a positive LC3 test was shown in 24 (60%) patients. A univariate analysis of the mutations of the RAS family and expression of the LC3 showed non-significant relationships.

Conclusion: No association observed between RAS family mutations and LC3 expression in colorectal cancer patients.

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

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

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

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

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

Introduction: Many therapies that have been done to overcome the problem of menopausal syndrome have been carried out using hormonal therapy or using drugs, but complementary therapies have not been carried out in Indonesia. The purpose of this study was to analyze the use of citrus aurantium l var amara to overcome the problem of menopausal syndrome.

Method: The data used in this study were data on menopausal syndrome experienced by respondents without giving therapy and after giving complementary therapy, as well as factors of occupation, age, and history of contraception of 42 respondents who had menopause. Data analysis was done by comparing the two groups of intervention (women who had been given the complementary therapy of aurantium l var amara) and control group (women who had not received the complementary treatment).

Results: Women in control group experienced no difference in terms of their menopause complaints (p = 0.206), while women in the intervention group showed improvement of their complaints after routine administration of aurantium l var amara therapy for 5 days (p=0.032).

Conclusion: Research conducted to analyze the use of citrus aurantium l var amara to treat menopausal syndrome problems proves that aurantium l var amara is effective in dealing with menopausal syndrome problems.

Link of Video Abstract: https://youtu.be/qPty3GvoyYo

Background: While prompt surgical intervention is still the gold standard, controlling the inflammation may prevent or reduce the progression of PVR, thus increasing the surgical success rate. The arachidonic acid pathway has been reported to play a significant role in the development of PVR. This study aims to investigate the role of the arachidonic acid pathway and assess the related vitreous inflammatory biomarkers in cases of RRD with PVR.

Methods: Thirty patients scheduled for a pars plana vitrectomy for RRD with PVR were included in the study. At the beginning of surgery, a sample of undiluted vitreous was collected in each patient to assess vitreous levels of inflammatory biomarkers, including PGE2, COX-2, TGF-β, monocytes (comparison of CD14 and CD45), and total protein. The vitreous inflammatory biomarkers were also analyzed based on the severity of PVR and the onset of RRD.

Results: The mean of PGE2 level was 91.77 ± 31.87 pg/mL, the median (range) of COX-2 level was 1.32 (1.25–1.55) ng/mL; TGF-β was 51.83 (15.61–319.58) pg/mL; monocytes were 90.25 (24.85–95.24) %; and total protein was 4.81 (0.19–20.4) mg/dL. A noticeable trend was found towards the elevation of PGE2, COX-2, TGF- β, monocytes, and total protein vitreous levels in conjunction with the severity of PVR, although no significant differences between the groups (p > 0.05 in each group).

Conclusion: Inflammation, particularly the arachidonic acid pathway, plays a vital role in the early stage of the pathogenesis of PVR. Inhibition of the arachidonic pathway by the anti-inflammatory agent at the early stage may provide a therapeutic approach for PVR prevention.

Introduction: Many studies have found the effect of Mozart’s music on the spatial memory of humans, but there are still very few studies that examine the effect of the Murotal Alquran approach on spatial memory improvement. This study aimed to evaluate the effect of Mozart's classical music and the Murotal approach on improving spatial memory in mice. This is an experimental study with 24 adult BALB/c male mice.

Method: The mice were divided into four groups: K (untreated control), P1 (Murotal approach with surah Al-Fatihah and Al-Baqarah by Qori' Al-Mathrud), P2 (Mozart’s classical music approach "Sonata in D for two pianos KV448-Allegro con spirito"), and P3 (combined approach). Each group was placed in a cage and treated for 2 hours/day for 20 days. The memory level was measured with an eight-arm radial maze instrument for ten days. The data were analyzed with non-parametric Kruskal Wallis and Mann-Whitney tests.

Result: This study found there were no significant differences between groups toward increasing spatial memory. The highest and fastest memory score was in the P3 group compared to the others.

Conclusion: There is no difference in the effect between classical music Mozart’s and Murotal approach on increasing the spatial memory of mice (Mus musculus), but mice given a combination of approaches have a better level of spatial memory with a higher level of aggressiveness.

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


Background: Mesenchymal stem cells (MSCs) differentiate into pacemaker-like cells by activating TBX3 and downregulating Pitx2c by inhibiting the nodal signaling pathway. This optimization study aimed to determine the optimal conditions for differentiating MSCs into pacemaker-like cells.

Methods: The differentiation of MSCs into pacemaker-like cells was carried out in three ways: transfecting TBX3 pcDNA into MSCs, inhibiting the nodal signaling pathway using the small molecule SB431542, and a combination of both methods. This optimization study was conducted in two batches. The first batch was an experiment with transfection carried out on the 5th day of differentiation and addition of 20 μM/mL of the small molecule SB431542. The second batch was an experiment with transfection carried out on the 3rd day of differentiation and the addition of 2 μM/mL of the small molecule SB431542. From the two batches, the expression patterns of TBX3, Cx30.2, Cx40, Cx43, HCN4, HCN1, HCN3, and KCNN4 genes were analyzed using the qRT-PCR method.

Results: The results showed that the second batch had a better gene expression pattern in pacemaker-like cells than the first batch. These results were indicated by the increased expression of the TBX3, Cx30.2, HCN4, HCN1, HCN3, and KCNN4 genes. Furthermore, there was a decrease in Cx40 and Cx43 expression levels.

Conclusion: The results showed that TBX3 transfection on the third day and a smaller dose (2 μM/mL) of small molecules and combination treatment induced differentiation from the initial MSC, leading to the expression of pacemaker-like cells.

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

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

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

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

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

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

Background: Colorectal cancer is the third most common cancer worldwide. Along with the development of science and technology, life expectancy has also increased, but the number of geriatric patients with colorectal cancer and undergoing surgery has also increased. Geriatric patients have many factors that can affect the patient's prognosis. Thus, a screening tool to predict the outcome of rectal cancer geriatric is needed. 

Methods: An observational analytic study with a retrospective cohort study design. This research was conducted by taking medical record data and laboratory results of patients with rectal cancer treated at Dr. Sardjito General Hospital, Yogyakarta, Indonesia. Data were analyzed using SPSS version 20.0 for Windows.

Results: Patients with malnutrition, decreased hemoglobin levels, albumin, and increased platelets affect mortality and postoperative complications of rectal cancer patients. There was a significant association between the Geriatric Nutritional Risk Index (GNRI) and preoperative Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) scores on mortality and postoperative complications in geriatric patients with rectal cancer (p<0.05). GNRI associated with length of stay in geriatric patients with rectal cancer. However, there is no significant relationship between Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) preoperative scores on length of stay in geriatric patients with rectal cancer (p>0.05).

Conclusion: Both screening predictors of rectal cancer outcome, namely GNRI and HALP, have a significant relationship with patient mortality and complications.

Link of Video Abstract: https://youtu.be/YsAWA4NoiPw

Background: The tracheotomy profile, including the degree of airway obstruction, underlying disease, following procedures, and complications, is important. The latest data regarding the profile of tracheotomy patients at ORL-HNS Dr. Soetomo General Academic Hospital has not been published yet. This research to describe the profile of tracheotomy patients at ORL-HNS Department Dr. Soetomo General Academic Hospital, Surabaya

Methods: A retrospective descriptive study with total sampling covering tracheotomy patients in 2015-1019 at ORL-HNS Department Dr. Soetomo General Academic Hospital, Surabaya. Data were analyzed using SPSS version 23.0 for Windows.

Result: There were 590 tracheotomy patients consisting of 452 men and 138 women, with the largest age group of 51-60 years with 167 patients (28.31%). Jackson 1 in 306 (51.86%), impending upper airway obstruction in 209 (35.42%), Jackson 2 in 38 (6.44%), Jackson 3 in 31 patients (5.25%), Jackson 4 in 3 patients (0.51%). The diagnosis includes tumors (87.29%), especially laryngeal carcinoma, then infection, neurological, trauma, and others. Procedures following tracheotomy are biopsies (11.19%), tumor surgery, and abscess incision and drainage. Complications were found in 65 patients (11.02%). Subcutaneous emphysema in 45 patients (7.63%), followed by bleeding and pneumothorax with subcutaneous emphysema (1.02%), 5 died (0.85%). Subcutaneous emphysema and bleeding in 2 patients (0.34%). Pneumothorax without subcutaneous emphysema in 1 patient (0.17%).

Conclusions: There were more male tracheotomy patients than female. The age group of most patients was 51-60 years. The majority were Jackson 1, and most were diagnosed with tumors. A biopsy is the most following procedure in tracheotomy. Complications were found in 11.02% of tracheotomy patients; the most common is subcutaneous emphysema.

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

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

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

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

Link of Video Abstract: https://youtu.be/ivpwfj9PxWQ

Background: Microvascular coronary thrombosis is an emerging risk factor that worsens the prognosis of COVID-19 patients. This study aims to show for the first time a descriptive of histopathologic findings from post-mortem COVID-19 patients and to analyze whether D-Dimer serum level, a marker of hyper-coagulopathy, correlates with coronary microvascular thrombosis from the cardiac core biopsy.

Method: This was an observational analytic study with a retrospective cohort design from July-December 2020. Cardiac core biopsy was taken from patients who died while treated at the isolation ICU at Dr. Soetomo due to severe COVID-19. The samples were taken in 1-hour post-mortem and then analyzed histopathologically with Hematoxylin-eosin staining under a light microscope to evaluate the presence of coronary microvascular thrombosis and other pathological findings from the cardiac biopsy. Clinical information and D-Dimer levels from medical records and analyzed for coronary microvascular thrombosis using Man-Whitney and C-statistic analysis using SPSS 22 software.

Result: There were 39 samples of post-mortem patients in this study. The majority were men (71.8%), with a mean age of 48.9 years old. Focal microvessel coronary thrombosis was found in 28%). The median D-Dimer level was increased from the average baseline (3460 mg/dl). However, there was no significant difference in D-dimer levels between focal microvessel coronary thrombosis incidents (p-value 0.827, C statistic AUC 0.523). The lack of focal necrosis in the surrounding tissue suggests that the thrombosis resulted from proximal embolization to distal capillary coronary, which already happened before, rather than the primary in-situ process in microvascular, hence may explain why D-Dimer was not correlated with the finding of coronary microvascular thrombosis in this study.

Conclusion: D-dimer serum levels were not associated with focal microvessel thrombi in post-mortem COVID-19 patients. This result supports previous studies that showed D-Dimer was not specific to detect thrombosis in microvascular.

Introduction: Diet is one component of diabetes mellitus (DM) self-management for controlling blood sugar levels. Several obstacles in the implementation of the diet program have the potential for non-compliance, so that blood sugar levels tend to increase. Mindfulness eating based on spiritual intervention is one of the interventions that is expected to form adaptive eating behavior control to achieve dietary compliance and controlled blood sugar levels. The purpose of this study was to analyze the effect of mindfulness eating based on spiritual intervention on dietary compliance and blood sugar levels in patients with type 2 diabetes.

Methods: The study's quasi-experimental, untreated control group design included dependent pre- and post-test samples. The population used was all patients with type 2 diabetes. The sample was taken using a simple random sampling technique with determination according to inclusion and exclusion criteria. The independent variables in this study were mindfulness eating based on spiritual intervention, while the dependent variables were dietary compliance and blood sugar levels. A glucometer and the Personal Diabetes Questionnaire (PDQ) were the tools employed in this investigation. The t-test was used as the statistical test.

Results: There were a total of 50 samples that were divided between the control group and the intervention group. The results of the statistical test showed that mindfulness eating based on spiritual intervention had a statistically significant effect on dietary compliance (p < 0.001) and blood glucose levels (p < 0.001) compared to the control group.

Conclusion: The value of diet adherence is greatly increased by mindfulness eating practices based on spiritual intervention, and mean blood glucose levels are significantly reduced at the conclusion of the study. Exercises in mindfulness eating that are based on spiritual intervention can be popularized as a way to deal with dietary issues and blood sugar regulation.

Link of Video Abstract: https://www.youtube.com/watch?v=mzVt00Yaibk

Introduction: Atherosclerosis causes coronary artery stenosis in a lot of patients with acute coronary syndrome (ACS). By controlling platelet activity and destroying the extracellular matrix, a group of enzymes known as matrix metalloproteinases (MMPs) contribute to the plaque rupture process that causes ACS. The study aimed to determine whether there was any correlation between the amount of serum MMP-9 and the severity of coronary artery stenosis in ACS patients.

Methods: Cross-sectional analytical observational design was employed in this investigation. The research population consisted of ACS patients at the Dr. Zainoel Abidin General Hospital in Banda Aceh, Indonesia. Patients who were included as samples had to satisfy the inclusion and exclusion requirements. This study used analysis of variance (ANOVA) as a bivariate analysis to examine the connection between blood MMP-9 levels and the severity of coronary artery stenosis. The threshold for statistical significance was a p-value≤0.05.

Results: This research comprised 40 patients with ACS, of which 14 had STEMI, 11 had NSTEMI, and 15 had unstable angina pectoris (UAP). Eleven individuals had mild coronary artery stenosis, eleven had moderate stenosis, and eighteen had severe stenosis, according to an analysis of the Gensini score. Bivariate analysis revealed no significant relationship between blood MMP-9 levels and the degree of coronary artery stenosis in ACS patients (p-value = 0.434).

Conclusions: In patients with ACS at the Dr. Zainoel Abidin General Hospital in Banda Aceh, Indonesia, there was no statistically significant association between serum MMP-9 levels and the degree of coronary artery stenosis, according to this study.

Background: The loss of the uterus means the loss of one of the functions of a woman's life, namely the reproductive function. The impact of a hysterectomy will have a major influence on the quality of life; this can be seen in how to carry out life, such as activities, social relations and interactions with the environment. All of these things can lead to changes in daily behavior, namely changes in self-image that will lead to insecurity, withdrawn behavior, distrust of God and ultimately, self-injury behavior. This study analyzes the self-acceptance model's effect on maintaining the quality of life after a hysterectomy.

Methods: This type of research is an experiment to compare 2 design groups. This research was conducted for 4 weeks in May-June 2022, with a total sample of 12 respondents, with details of 6 respondents in the control group and 6 in the treatment group. The type of sampling used is non-probability sampling with a purposive sampling method. Data analysis used the Wilcoxon, and Mann Whitney marked rank test with a significance value of p < 0.05. The questionnaire used in this study was designed using a reference and behavioral theory approach with a reliability of 0.89 and a validity test that obtained a Cronbach alpha value of 0.86.

Results: The value of behavior of caring for sexual function after hysterectomy before intervention in the control group was 29.00±1.789, and after being given the intervention, the value changed to 29.33±0.816 (p=0.564). In the treatment group, the value of behavior of caring for sexual function after hysterectomy before the intervention was 28.50±1.225 and after the intervention was 33.83±2.639 (p=0.027). Behavioral analysis of caring for sexual function after hysterectomy before intervention in the control and treatment groups showed no difference (p=0.591). The self-acceptance model affects the behavior of maintaining the quality of life after hysterectomy in the control and treatment groups (p=0.006).

Conclusion: This study proves that the self-acceptance model affects the behavior of maintaining the quality of life after a hysterectomy.

Link of Video Abstract: https://www.youtube.com/watch?v=8PNO8KPQFTY

Purpose: Achieving an optimal result in mitral valve repair can be challenging in children due to the delicate nature of the mitral valve tissue, a wide range of pathologies, and a high incidence of co-existing cardiac anomalies. This study aimed to evaluate a novel adjuvant technique, posterior annulus elevation using pledget stitch, to improve mitral valve coaptation in pediatric mitral valve repair.

Patients and methods: A retrospective cohort study was conducted at the National Cardiovascular Center Harapan Kita. Patients with severe mitral regurgitation who underwent mitral valve repair with posterior annulus elevation using pledget stitch between January 2021 and October 2021 were included. Transesophageal echocardiography (TEE) at day-0 and transthoracic echocardiography (TTE) at day-5 and 3 months after surgery was performed to assess coaptation length and residual regurgitation.

Results: Twelve patients were included in this study with a mean age of 13.13 ± 2.98 years. The mean coaptation length was 6.94 ± 1.44 mm immediately after surgery. At day 5, 11 patients exhibited no or only trivial regurgitation (91.67%), with a mean coaptation length of 7.18 ± 1.72 mm. During a three-month follow-up period, 10 patients had no or only trivial regurgitation (83.33%) with the rest only developing mild regurgitation (16.67%), with a mean coaptation length of 7.60 ± 1.41 mm. No mortality or adverse events related to the procedure were observed during the follow-up.

Conclusion: Posterior annulus elevation using pledget stitch as a novel adjuvant technique during mitral valve repair showed promising results in improving leaflet coaptation in pediatric patients. This technique may provide an additional option for mitral valve repair when the conventional technique yields unsatisfactory results.

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

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

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

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

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

Background: Primary spinal cord tumors are rare central nervous system tumors that could develop at any age and have different management strategies based on the histopathological types. However, there is a lack of literature in Indonesia regarding the epidemiology and surgical treatment of patients with spinal cord tumors. This study aims to review and address the incidence of primary spinal cord tumors in Dr. Kariadi Hospital, Semarang.

Methods: A retrospective descriptive study was conducted using medical records of patients with spinal cord tumors at Dr. Kariadi Hospital, Semarang, Central Java, from 2019 to 2022. The frequency of each tumor, classified by gender, age, histologic type, anatomical position, and location based on vertebral segment, was analyzed to provide a descriptive result. Data were analyzed using SPSS version 25.0 for Windows.

Results: A total of 125 patients were identified with the mean age of patients being 43.95 ± 15.28 years old and a slight predominance of males (52.00%). Schwannoma (26.40%) and meningioma (24.80%) were the two most common histological types of tumors. Most of the tumor was intradural extramedullary (47.20%) and at the level of thoracic vertebrae (46.80%). The histologic type of the tumors was found to be associated with the patient’s age and the tumor’s anatomical position.

Conclusion: The incidence of spinal cord tumors in Dr. Kariadi Hospital, Semarang, is dominated by meningioma and schwannoma, mostly located at the thoracal level with an intradural extramedullary position. There is a significant association between the histological type of tumor and the patient's age and the location of the tumor

Background: The emergence of severe acute respiratory syndromes coronavirus 2 (SARS-CoV-2) variants such as B.1.17 (alpha), B.1351 (beta), and B.1.617.2 (delta) have caused a significant rise in coronavirus disease 2019 (COVID-19) cases worldwide. In response, the Indonesian government imposed restrictions on international and domestic travel, especially in areas with a high number of COVID-19 cases including Java Island and Bali. The aim of this study was to investigate the mutation patterns of indigenous SARS-CoV-2 strains in Bali.

Methods: We conducted whole-genome sequencing on isolates collected from COVID-19-confirmed patients at the end of the first wave (January – March 2021). The sequencing was carried out at the 1^st BASE Pte Ltd Laboratory (Singapore) using Oxford Nanopore Platform (GridION) using IDT ARTIC nCoV-2019 V3 Panel. The phylogenetic tree was constructed on MEGA 7.0 with hCoV-19/Wuhan/WIV04/2019 as the genomic reference.

Results: Our data revealed that none of the isolates were variants of concern. Among the five lineages tracked, the viral isolates were most likely from B.1.466.2 (n=4). All viruses had D614G mutation in the spike protein with clade GH being most predominant (n=10) and followed by GR (n=1) and O (n=1). Additionally, mutations at NS3, NSP3, NSP12, and NSP6 were found.

Conclusion: At the end of the first COVID-19 wave in Bali, variants of concern were not detected which could be attributed to the heavy mobility restrictions.

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

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

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

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

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

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

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

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

Background: Emesis gravidarum is an inconvenience that often occurs in the first trimester of pregnancy. Continuous emission of gravidarum can be bad for the health of pregnant women and the fetus is conceived, so it must be overcome as early as possible, one of which can use non-pharmacological therapy, namely applying self-hypnosis and prenatal gentle yoga to reduce emissions of gravidarum can make pregnant women relax. This study aimed to analyze the application of self-hypnosis with Prenatal Gentle Yoga on emissions of gravidarum in first-trimester pregnant women.

Methods: The design of this study used a Quasi experimental design with a Two group pretest-posttest design without control using purposive sampling. This research was conducted on first-trimester pregnant women who experienced the emission of gravidarum in the PMB Nanik Sidoarjo of ​​32 pregnant women in the first trimester. The self-hypnosis was carried out every day for approximately 15-30 minutes for 1 week, while prenatal yoga was carried out 3 times a week for 30 minutes. Data collection on the intensity of nausea and vomiting used the Pregnancy Unique Quantification of Emesis and Nausea (PUQE)-24 scoring system questionnaire. Data analysis used an independent T-Test test.

Results: The results of the analysis of this study indicate that the mean difference in the Self Hypnosis treatment group is greater (1.77) than in the Prenatal Gentle Yoga group (1.25), which means that Self Hypnosis is more effective in reducing the intensity of nausea and vomiting in emesis gravidarum versus Prenatal Gentle Yoga.

Conclusion: Therapy Self Hypnosis and Prenatal Gentle Yoga can reduce the emission level of gravidarum in first-trimester pregnant women so that it can be used as an alternative therapy that is easy to apply and has minimal side effects by pregnant women who experience gravidarum emissions.

Link of Video Abstract: https://youtu.be/KymxBUAr9eI

Background: Bladder Urothelial Carcinoma (BUC) is common cancer in the genitourinary organs. One important determinant for its therapy modality is the presence of tumor invasion into Muscularis Propria (MP). Assessing MP invasion in routine Hematoxylin-Eosin (HE) slides of Transurethral Resection of Bladder (TUR-B) specimens is not always easy due to tissue fragmentation and morphological similarities of MP to muscularis mucosa (MM) and myofibroblasts. This study was done to determine the interobserver agreement in evaluating MP invasion and to find alternatives to overcome this diagnostic problem.

Methods: This cross-sectional observational analytic study was conducted in the Pathology Laboratory of the Faculty of Medicine, Universitas Udayana/Prof. Dr. I.G.N.G. Ngoerah Hospital, Bali, in 2022. As many as 72 HE slides of TUR-B specimens of BUC patients were examined separately by five experienced pathologists. Smoothelin immunostaining, a marker to identify MP, was also examined as a comparison. Data were processed and statistically tested using the SPSS version 20.0 program for Windows.

Results: The interobserver agreement of those five pathologists was found to be low to moderate, with an average = 0.48, ranging between 0.18-0.69. One pathologist had a low agreement with four others (<0.4) and indicated diagnostic uncertainty in 41% of the samples examined. Among four other pathologists, the agreements were moderate, with  = 0.40-0.69. The proportion of concordant examination results was only 45.8%. When the outcome of each HE slide was concluded by consensus, it was found that there was no statistically significant difference with smoothelin immunostaining results.

Conclusion: Evaluation of MP invasion of BUC in TUR-B specimens had low to moderate interobserver agreement, which indicated that this examination was subjective. However, the consensus of several pathologists seems to lead to better accuracy, close to the result of smoothelin immunostaining.

Purpose: This study aims to assess the effectiveness of mono pharmacy and polypharmacy on the post-TKR outcome, the speed of recovery, time to partial weight-bearing, VAS, and the side effects of single, double, and triple analgesia in elderly TKR patients.

Methods: This observational retrospective comparative study comparing the post-TKR surgical outcome and using mono pharmacy or polypharmacy analgesics was conducted in an Orthopaedic Hospital during 2012-2021. Patients who underwent TKR with a subarachnoid spinal block were diagnosed with osteoarthritis grade IV and treated with single/ unilateral TKR were included in this study. Data would be analyzed using either ANOVA or Kruskal Walis. Treatment of analgesia was given by the anesthesiologist, who determined the types and methods of administration.

Results: A total of 152 patients were included in this study. Most samples were females (N=106, 69.7%) aged 63.75 ± 6.31 years. There was no significant difference between analgetic use on LOS, time to PWB, and VAS on days 1, 3, and 5 (p > 0.05). A significant linear difference was found between nausea and gastric pain incidence with the amount of postoperative analgetic administration (p = 0.01).

Conclusion: The effectiveness of mono pharmacy and polypharmacy is similar regarding the speed of recovery, time to partial weight-bearing, VAS, and side effects of post-TKR patients.

Link of Video Abstract: https://youtu.be/HvI9j8B9vqE

Introduction: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and is the main cause of ovulation disorders. Primary ovarian insufficiency (POI) is a clinical syndrome characterized by loss of ovarian activity before the age of 40 years. All of these disorders lead to the risk of infertility. Therefore, this study aims to assess the AMH gene sequence and the effect of SNP on AMH levels and function.

Method: This research was a cross-sectional study. The sample was divided into three groups such as PCOS, POI, and control. This study used ELISA and PCR examination methods. Research data were analyzed using IBM SPSS version 22. The statistical analyses used were the ANOVA, Kruskal-Wallis, chi-square, and Spearman tests. A significant p-value was ≤ 0.05.

Results: There were 31 research subjects, 8 POI subjects, 16 PCOS subjects, and 7 control subjects. Overall 30 mutations were found, with two mutations in the gene promoter and 28 mutations in the structure of the AMH gene. Five mutations in the AMH gene structure were missense mutations. 14 SNPs were found in the POI group and 15 SNPs in the PCOS group. There was a significant difference in AMH AMH gene promoter mutation frequency distribution between the POI and PCOS groups at the mutation point 19:g.2249146T>G (p=0.007). In contrast, the mutation point 19:g.2249158T>A was not significantly different (p=0.536). There was no significant correlation between the number of promoter mutations and AMH gene structure with AMH levels in the POI, PCOS and control groups.

Conclusion: There were mutations in the promoter and AMH gene structure of the POI, PCOS, and control groups which caused differences in base sequences. However, in this study, the differences in mutations were not significantly different.

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

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

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

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

Background: Sepsis has become the most common postoperative complication caused by major surgery. Early diagnosis of sepsis is very important to know the patient's prognosis and survival. Changes in mean platelet volume (MPV) and platelet distribution width (PDW) were assessed to have a relationship with the incidence of sepsis. The use of MPV and PDW platelet preoperative indicators is expected to help predict sepsis so that appropriate interventions can be given immediately.

Methods: A total of 50 patients who met the inclusion criteria became the subjects of this study to determine the potential of MPV and PDW preoperative biomarkers for predicting sepsis in laparotomy patients. All blood tests for the diagnosis of sepsis were examined. Spearman's test and ROC curve were performed for statistical calculations to determine the cut-off point for MPV and PDW.

Results: Analysis of the relationship between PDW and MPV values ​​as an indicator of sepsis using the Spearman test found a significant relationship between MPV and PDW ​​on the incidence of sepsis (p<0.05). Furthermore, statistical tests using the ROC area under the curve (AUC) curve, MPV levels were 0.968, which indicates that if MPV were examined in 100 patients, it would predict sepsis in 96 patients. Meanwhile, the AUC of PDW is 0.770, which shows that if MPV examination is performed in 100 patients, it will predict sepsis in 77 patients. . The best cut-off point ​​that the researchers got in this study was MPV levels 9.8 fL (sensitivity 93.3% and specificity 85%) and PDW levels 9.45 fL (70% sensitivity and 70% specificity).

Conclusion: Preoperative MPV and PDW can be predictive indicators of sepsis in laparotomy surgery, with MPV sensitivity and specificity of 93.3% and 85% and sensitivity and specificity of PDW of 70% and 70%, respectively.

Introduction: Work nutrition refers to the nutrient or food substance needed by the workforce to meet their needs according to the type of work. The aim of work nutrition is to increase the work power and health of the workforce as much as possible in accordance with the person's nutritional status. The suitability of energy intake can also affect a person's productivity Long-term energy consumption patterns can have an impact on a person's health or nutritional status. If unchecked, they can also have an impact on their activities and productivity. Therefore, the purpose of this study is to determine the energy needs and energy intake associated with health status in field workers.

Methods: This research used a quantitative approach with the type of observational research and a cross-sectional design. The population in this study was based on a total sample of workers at PT. A in the city of Samarinda, with a sample size of 41 workers.

Results: The results of this study indicate that most workers have an abnormal nutritional status. Only 29% of the 41 workers have a normal nutritional status. Then, in the comparison between energy intake and energy needs, it is known from 41 workers that only 32% of respondents have sufficient energy in accordance with what is consumed.

Conclusion: There is still a mismatch between energy intake and energy needs of the workers, and there are still many workers who have abnormal nutritional status. Therefore, it needs to be done, from socialization to supervision, such as implementing fitness at work, a healthy diet, adjusting workload, and getting enough rest.

Background: Oocyte vitrification is a helpful fertility preservation technique for women at risk of losing their ovarian functions. Meanwhile, its application extends with the emerging trend of delayed childbearing, postponed marriage, and further diverse ethical, medical, legal, and social implications. Whereas its effect on oocytes has been widely elucidated, the potential impact of this procedure on the biological functions of granulosa cells remains poorly understood. The present study aimed to assess vitrification’s effect on the granulosa cells (GCs).

Methods: 35 women with polycystic ovary syndromes who underwent in vitro fertilization (IVF) in Morula IVF Jakarta Clinic were recruited. The expression of prominent oocytes secreted factors (OSFs), including GDF-9 and BMP-15, were measured at messenger RNA (mRNA) levels. GCs from mature and immature oocytes were collected and calculated separately. Relative expression of GDF-9 and BMP-15 was quantified by a real-time quantitative PCR (RT-qPCR). All of the data was analyzed by using SPSS.  Bivariate analysis used the Mann-Whitney test at a 95% confidence level. A significant p-value was ≤ 0.05.

Results: The mean age of subjects was 32,39 ± 3,33 years old, with the mean duration of infertility being six years. The mean BMI, anti-Mullerian hormone (AMH) level, and antral follicle count (AFC) were 24.04 kg/m2, 3.43 ng/mL, and 15 follicles, respectively. The basal FSH, LH, estradiol, and progesterone were at the normal level. The expression of GDF-9 decreased significantly (0.5-fold, p < 0.01) in the immature vitrified GC group but was not in the mature-vitrified GC group. Meanwhile, the expression of BMP-15 was stable in all examined groups (P>0.05).

Conclusion: Our results suggest that vitrification may alter oocyte maturation, as demonstrated by reduced GDF-9 expression in the immature vitrified GC group.

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

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

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

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

Link of Video Abstract: https://youtu.be/YEQ3ICJPmxA

Background: Ventilator-associated pneumonia (VAP) occurs after endotracheal intubation and ventilator for more than 48 hours therefore it is an emerging threat to patient safety. The aim of this study is to determine the incidence and compare the risk factors of ventilator patients diagnosed with ventilator-associated pneumonia and patients with ventilators who are not diagnosed with ventilator-associated pneumonia.

Methods: This study used a retrospective observational with a case-control approach. Data was collected from January 2019 to December 2021. The risk factors to be analysed were comorbidities, antibiotic therapy, length of stay in the intensive care unit, duration of ventilator use, and history of surgery.

Results: There were 18 patients in the VAP and the control groups met the inclusion and exclusion criteria. The incidence of incidents in 2019 was 3.2 per 1000 ventilator days; in 2020, it was 1.2 per 1000 ventilator days; and in 2021, it was 1.2 per 1000 ventilator days. Comparison test results using Mann-Whitney showed a difference with a p<0.05. Patients with prolonged use of ventilators (p<0.05) and prolonged hospitalization (p<0.05) have a higher risk of developing ventilator-associated pneumonia. The average VAP occurs on the fourth day on a ventilator. Gram-negative bacteria, Pseudomonas aeruginosa, Acinetobacter baumanii, and Klebsiella pneumoniae cause most bacterial infections

Conclusion: There is a high risk of developing VAP in patients with prolonged use of ventilators and extended stays in the intensive care unit of the Tertiary Referral Hospital.

Introduction: Blood service is a health service that utilizes human blood as a basic ingredient for humanitarian and non-commercial purposes. Donors in Indonesia are required to have a minimum Hemoglobin (Hb) level of 12.5 g/dL in accordance with National Regulations. It aims to ensure that the donor can tolerate the loss of blood without the appearance of anemia symptoms. This study aims to analyze the Hb levels of donors at the Blood Transfusion Service of Dr. Sardjito Hospital, Yogyakarta, Indonesia.

Method: This analytic observational study applied a retrospective design. The data of 62,221 donors were taken from the donor database of the Blood Transfusion Service of Dr. Sardjito Hospital. The inclusion criteria were donors aged ≥ 17 years and met other donor selection criteria. Donors with incomplete data were excluded. The chi-Square test was performed using the SPSS version 22. The p < 0.05 was considered significant.

Results: The subjects were dominated by male donors, i.e., 48,348 (77.7%), and the most Hb level were 14.1-15.5 g/dL. This range of Hb levels was identified as the highest proportion in all age groups. The Hb levels of 14.1-15.5 g/dL were determined in 5,874 (39.6%) blood group A, 7,332 (39%) blood group B; 1,830 (39.6%) blood group AB and 9,486 (39.5%) blood group O donors.

Conclusions: There was a significant difference in the proportion of donors based on Hb levels, sexes, ABO groups, Rhesus D groups, donation types, and donor statuses (p < 0.001).

Link of Video Abstract: https://youtu.be/Nr9MKgu2v2E

Background: Chronic suppurative otitis media (CSOM) causes partial or complete damage to the tympanic membrane and ossicles, causing hearing loss in the form of conductive and mixed hearing loss with a decrease of up to 60 dB. This study aimed to evaluate the hearing threshold before and after tympanoplasty surgery in CSOM patients.

Methods: This type of research was carried out in a retrospective descriptive manner. The materials in this study were the medical records of CSOM patients who underwent canal wall up (CWU) tympanoplasty and canal wall down (CWD) tympanoplasty at the outpatients of ear, nose, and throat – head and neck surgery (ENT-HNS) Otology Division Dr. Soetomo Hospital Surabaya for the period January 1, 2018 to December 31, 2018 with a total of 51 patients. This study analyzed with the Wilcoxon test.

Results: The mean age was 30.96 years (51% female and 49% male). Postoperatively 40 (78.5%) patients experienced an increase in hearing threshold, 10 (19.6%) patients experienced a decrease and 1 (1.9%) patient remained. The average increase in air-bone gap (ABG) pre and post tympanoplasty surgery was 9.78 dB, from 38.92 dB to 29.14 dB.

Conclusion: There was an increase in hearing threshold after tympanoplasty.

Introduction: During the COVID-19 pandemic, the stay-at-home policy, which requires people to carry out activities at home, avoid crowds and minimize contact with people, is a problem for baby spa businesses due to the decline in baby spa patients at their clinics. This study aimed to evaluate the mother's motivation and attitude toward baby spa services during the COVID-19 pandemic.

Methods: This cross-sectional study involves parents who are consumers of baby spas and independent practice midwives who provide baby spa services in the Sidoarjo Regency that met inclusion criteria. Sample determination used purposive sampling. All data were obtained directly as primary data, then collected and analyzed using univariate and bivariate analysis in SPSS ver. 20.

Results: Most of the mothers and children were aged 36-40 years (32.0%) and <2 years (72.0%), respectively. Most respondents had high motivation and attitude (70.4% and 74.1%). Chi-square and Fisher exact test showed a significant relationship between the mother's motivation and attitude towards mother's interest in baby spa services (p<0.001)

Conclusion: The mother's attitude and motivation are related to the mother's interest in coming to the baby spa service during the COVID-19 pandemic.

One of the most common types of microbial keratitis is bacterial keratitis. The most common cause is Pseudomonas aeruginosa, which is more severe and causes local tissue damage. Fibrosis can form and cause vision loss, and perforation and spread to surrounding tissues in severe cases. Platelet-rich fibrin (PRF) membrane grafting is a new surgical technique that can optimize wound healing by preventing fibrosis formation by modifying Transforming Growth Factor Beta (TGF-β) expression and suppressing its overexpression. In addition, It preserves the structural integrity of the eye. It promotes the sustained release of growth factors, both of which are necessary for tissue regeneration and the induction of new collagen lamellae production. We suggest that in Pseudomonas aeruginosa keratitis, PRF may affect the expression of TGF- and Alpha Smooth Muscle Actin (-SMA). This literature review will reveal more details on how PRF can control inflammation and aid in Pseudomonas aeruginosa keratitis wound healing.

Background: The treatment of spinal cord injuries (SCIs) is a controversial topic and is not yet effective. Stem cell secretome is an emerging alternative treatment that uses the paracrine effect of stem cells. Although there have been many studies on this subject, there are still differences regarding the origin, dose, route of secretome administration, type of experimental animal, phase of the SCI, and outputs evaluated. The topic needs a systematic review and meta-analysis.

Methods: This systematic review and meta-analysis were reported based on criteria from Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The authors searched PubMed, ScienceDirect, Cochrane Library, and Google Scholar with multiple electronic databases until October 2021.

Results: Twenty-eight studies that met the inclusion criteria were included in this research. The stem cell secretome was very beneficial as the axonal regeneration agent (n=12); it increases the locomotor recovery (n=28) and growth factors (n=2) and reduces the size of the cystic cavity (n=1) and lesion extension (n=14). We recognized 28 studies that met our inclusion criteria. Stem cell secretome therapies showed improvement in the locomotor score (standard mean difference [SMD]: 0.94; 95% confidence interval [CI]: 0.75–1.13, p<0.000001, I²=90%) and reduction in the lesion size (SMD: 5.06; 95% CI: 3.44–6.67, p<0.00001, I²=94%).

Conclusion: The stem cell secretome greatly affects treating SCI rodent models. Future studies should focus on chronic SCIs in the primary research, translational research, and neurological research stage of stem cell secretome.

Introduction: Omega-3 is an essential fatty acid that is needed but the body cannot synthesize it. Omega-3s have good benefits for the body; such as can reduce the production of pro-inflammatory cytokines. Pro-inflammatory cytokines are one of the causes of cachexia in cancer patients. This study wanted to know about the intake of omega-3 either from food or supplements with the incidence of cachexia risk in cancer patients.

Method: A systematic literature review search was conducted using Search Engines, such as PubMed, Google Scholar, Science Direct, and DOAJ. The articles identified with the inclusion and exclusion criteria specified in the PICOS table. Then an assessment of the quality of the article was carried out using the JBI Critical Appraisal Tool.

Result: From 127 articles, only four studies that eligible to further analysis. In 4 literature studies, three studies used clinical research methods and a retrospective cohort study. Three literature studies show an association between omega-3 supplements with increased body weight, fat mass, and serum albumin. Only one literature study did not show an association between omega-3 supplements with increased body weight, body fat mass, serum albumin, decreased serum CRP, or serum IL-6. The forms of omega-3 supplementations consumed by most cancer patients are Fish Oil (FO) and Marine Phospholipids (MPL). FO with a 1-7 grams dose can increase body weight and serum albumin levels in cancer patients. MPL with a dose of 8.5 grams can also increase body weight.

Conclusion: This review found varying certainties of evidence of omega-3 supplementation to prevent cachexia. The recommendation for taking FO and MPL supplements is three times a day.

Introduction: The goal of surgeons to avoid Pseudophakic Cystoid Macular Edema (PCMO) has led to the widespread use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) after cataract surgery, although current research into the best anti-inflammatory drugs to avoid PCMO is still underway. This review aimed to determine the efficacy of topical NSAIDs in preventing PCMO following phacoemulsification.

Methods: This systematic review was built on the recommended reporting items for systematic reviews and meta-analyses (PRISMA) and PICO criteria for papers during the previous 10 years. The keywords was searched by Boolean operator: “NSAIDs” AND “Prevention” AND “Cystoid Macular Edema” AND “Optical Coherence Tomography” AND “Phacoemulsification”. According to  STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist, the quality of each chosen article was evaluated.

Results: We have selected five articles of prospective cohort studies, which involved 756 patients whom received topical NSAIDs (Nepafenac 0.3%, Ketorolac Tromethamine 0.4%Nepafenac 0.1%, , and Diclofenac 0.1%) in treatment group and 700 patients received Placebo (Artificial tears) in control group. There was significant difference of central macular thickness based on OCT results between NSAIDs and control (placebo) group after uneventful phacoemulsification. Additionally, NSAIDs used as a preventative before phacoemulsification procedure exhibited a significantly reduced rise in central foveal thickness compared to placebo. There were changes of central macular thicknes postoperatively, and were significantly different from preoperative.

Conclusion: It has been demonstrated that topical NSAIDs successfully lower the incidence of Pseudophakic Cystoid Macular Edema following phacoemulsification.

Link of Video Abstract: https://youtu.be/w1aBTIalQSY

One way the community is financially protected from unforeseen health risks is through health insurance. The ability and willingness to pay for health insurance has been linked to improvements in public health, including better access to healthcare services, better public health, and financial protection from health risks, according to earlier research. Since 2014, Indonesia has had a government health insurance scheme under the National Health Insurance (JKN) program with the goal of enhancing community welfare and health access. However, despite the benefits provided by the JKN program, many people are still not registered and have not received benefits from the program. Recent studies have shown that high health insurance costs remain the main obstacle for people with low income to buy health insurance. The aim of this study was to identify the ability and willingness to pay for social insurance premiums in the framework of the National Health Insurance System. Utilizing the terms "impact of ability," "willingness," and "health insurance," the database search includes Google Scholar, ScienceDirect, and PubMed. The last step is to choose the articles that meet the criteria, which include being published between 2011 and 2022 and having the complete text accessible. The criteria for including 13 articles were met.  According to the review's findings, the majority of publications link knowledge, income, how people view health care, and family support to health insurance payment compliance. Additionally, there are barriers and constraints affecting participation in National Health Insurance (NHI), such as registration procedures, benefits received, premiums, and private insurance ownership. There are several factors that affect compliance with health insurance payment, including knowledge, income, perception of health services, and family support.

Background: Traumatic spinal cord injury (tSCI) is a severe neurological condition that causes long-term nerve function impairment and can even cause death. Further efforts are needed to find better therapy for this condition to improve patients' quality and life expectancy. Moleac 901 (MLC901) is a phytopharmacological refinement that incorporates important molecules to facilitate progenitor nerve cell amplification and differentiation and has significant neuroprotective effects in tSCI cases. This systematic review aims to discover the potential of MLC901 as adjuvant therapy for traumatic spinal cord injury by multi-pathway biomechanism.

Methods: Researchers searched for data sources using three databases (PubMed, Science Direct, and Google Scholar) using the keywords “MLC901” and “Spinal Cord Injury.” Articles are included if related to the potential and biomechanism of MLC901 and/or its constituent components in tSCI therapy, using RCT designs, observational, animal studies, and/or original research, including national and international articles from 2013-2023. Article selection followed PRISMA's guidelines for measuring the quality of systematic reviews.

Results: Total of 123 articles were obtained from the database search, and then 13 articles were identified that met the review requirements. Of the 13 articles reviewed, two were related to MLC901 therapy in tSCI: one animal study article and one cohort study in humans. In contrast, the other 11 articles are animal and pharmacological analysis studies discussing the benefits of MLC901 components for tSCI therapy. The MLC901's active ingredients, such as paeoniflorin, safflower yellow, salvianolic acid B, and astragali radix-angelicae sinensis radix, have demonstrated their potential in targeting multiple pathways involved to prevent inflammation, improve microcirculation, protect damaged nerve cells, and promote nerve repair and regeneration.

Conclusion: MLC901 acts primarily as an adjuvant treatment for spinal cord injury by promoting a neuroprotective effect, inhibiting apoptosis, stimulating neurite growth, and reducing pro-inflammatory cytokines.

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

Introduction: Readiness for the discharge process to caring for low birth weight (LBW) is a top priority in providing quality nursing services in the perinatology room. The process of readiness for discharge is considered successful if the LBW is safe and comfortable during discharge. This study aimed to identify interventions relevant to readiness for discharge to improve transitional care for LBW and to assess the quality of available evidence using a systematic scientific approach.

Methods: Following the PRISMA checklist, a systematic review of randomized controlled trials and quasi-experimental studies was identified in eight electronic databases published from 2015 to 2022. All articles were discovered using the PICO framework and assessed using the Critical Appraisal Skills Program (CASP) tool. All articles were analyzed and synthesized narratively.

Results: A total of 201 titles were identified, and 25 studies met the inclusion criteria involving 3158 parents. Ten studies were RCT studies, and fifteen were quasi-experimental studies. The results of the narrative synthesis carried out on twenty-five articles showed that interventions relevant to readiness for discharge were effective in improving the transition care for LBW, including the transition to parenthood and the transition from hospital to home related to the ability to care for LBW.

Conclusion: This study provides evidence that nurses can modify and effectively carry out interventions relevant to discharge readiness to improve the transition care for LBW. Perinatology nurses must actively involve families in supporting mothers in optimal readiness for discharge.

Diagnosis of Dengue Hemorrhagic Fever (DHF) is based on clinical and supporting examinations, including leukocytes and platelets examinations and antigen and antibody tests for the dengue virus. Examining leucocytes, thrombocytes, and immature platelets is a routine protocol in DHF patients. Leucocytes, thrombocytes, and immature platelets in dengue hemorrhagic fever have their characteristics and roles in relation to the disease severity. Prompt and early diagnosis will reduce the risk of disease severity. This review described the characteristics and role of leucocytes, thrombocytes, and immature platelets in dengue hemorrhagic fever.

Link of Video Abstract: https://youtu.be/TWDe9uP4QX8

The levator ani muscle (LAM) is thought to be of central importance concerning pelvic organ support. 10-30% of women experience overstretched or 'ballooning' of the levator hiatus, sometimes followed by detachment or 'avulsion' of the muscle from its insertion. Both ballooning and avulsion of the LAM can occur by itself or co-exist at the same time. This literature review was conducted on multiple databases from previous studies, to help clinicians better understand the ballooning and avulsion phenomenon, thus making early diagnosis possible for earlier prolapse prevention for the patients. LAM avulsion can be diagnosed clinically using digital palpation or using imaging modalities such as ultrasound and magnetic resonance imaging (MRI). During maximal contraction (or at rest) using ultrasound, levator avulsion is indicated through a levator-urethra gap (LUG) diameter > 2.5 cm. MRI is considered highly sensitive, but it requires a higher cost and an experienced radiologist. Hiatal ballooning can be diagnosed by clinical examination based on the sum of Genital hiatus and Perineal body (Gh+Pb) and imaging with 2D, 3D, or 4D ultrasound during the Valsava maneuver. Ballooning is diagnosed clinically if Gh+Pb > 7 cm, by 2D imaging of levator hiatal anteroposterior (LHAP) diameter ≥ 6 cm, and by 3D/4D imaging of the hiatal area ≥ 25 cm². Physiotherapeutic treatment and pelvic floor muscle (PFM) exercises can be used to treat ballooning and LAM avulsion to avoid urogynecological sequelae. There is some evidence to prevent this condition, including vitamin D consumption, epidural analgesia, kegel exercise, and vaginal dilator. PFM strength, posterior vaginal wall support, and ultrasound evidence of LAM tear can be used as potential indicators to predict pelvic floor injury. Since ballooning and avulsion of the LAM have lifelong morbidity and are not often identified early by clinicians, further research is still needed.

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

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

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

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

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

Background: Central nervous system (CNS) tumors have been recognized as a type of tumor with high progressivity and a five-year survival rate of just 36%. SRY-related high mobility group box-2 (SOX2) is a gene encoding the Sox2 protein which is found to be overexpressed in various CNS tumors and contribute to its progressiveness. This gene contributes to CNS tumors through several signaling pathways, including Shh, Wnt, FGFR, and TGF-β signaling pathways. This meta-analysis aims to evaluate the clinicopathological and prognostic significance of SOX2 overexpression in CNS tumor.

Patients and methods: The literature searches on Cochrane Library, PubMed, and ScienceDirect were conducted systematically up to December 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method to find relevant references. The effect of SOX2 overexpression on clinicopathological characteristics and prognostic value were analyzed using Review Manager 5.4 (Cochrane Collaboration, Oxford, UK).

Results: Ten suitable studies with a total of 466 patients with CNS tumors including gliomas (glioblastoma, astrocytoma, oligoastrocytoma, and oligodendrogliomas) and meningiomas, were included. Our analysis shows a significant association between the overexpression of SOX2 with the grade of CNS tumor (OR 7.05; 95%CI: 2.83 to 17.53; I² = 53%; p< 0.0001) both in gliomas and meningiomas, with gender (OR 2.08; 95%CI: 1.30 to 3.34; I² = 13%; p = 0.002) especially in non-Asian population, and higher in primary tumor than recurrent tumor (OR 4.31; 95%CI: 1.41 to 13.14; I² = 13%; p = 0.01). On the prognostic value, SOX2 overexpression insignificantly associates with poor overall survival (HR 1.73; 95%CI: 0.49 to 6.18; I² = 83%; p = 0.40)

Conclusion: SOX2 overexpression suggests a role as a biomarker in predicting the poorer grade of CNS tumors.

Link of Video Abstract: https://youtu.be/VANVlW_pP94

Background: The most common form of degenerative joint disease is osteoarthritis. Concomitant with the increased prevalence of osteoarthritis, the incidence of total knee arthroplasty (TKA) also rises. Total knee arthroplasty (TKA) is a surgical procedure for replacing an abnormal knee joint with artificial materials. Total knee arthroplasty (TKA) is a cost-effective orthopedic surgery with good patient outcomes. This literature review aimed to elaborate on the determinants of patient satisfaction after TKA surgery.

Methods: This literature review was carried out by searching studies in three online databases consisting of Google Scholar, PubMed, and Wiley Online Library using the keywords “total knee arthroplasty”, “total knee replacement”, “osteoarthritis”, “satisfaction”, and “determinants” to specify our study results. Appropriate studies were then carried out through a narrative synthesis analysis.

Results: The satisfaction of patients after two broad components determines TKA. Internal and external. The internal component consists of the patient's age, gender, personality, expectations, comorbidity, the severity of the disease, and other factors such as BMI, economic and educational class. While the external component consists of anesthesia and pain management, surgery technique, implant or prosthesis type, post-operative rehabilitation and length of hospital stay. Therefore, the surgical technique, including its indications, alternatives, prospective results, and risk of issues, must be fully discussed between doctors and patients to maintain patient satisfaction following TKA.

Conclusion: The determinant of patient satisfaction following TKA surgery can be classified into internal components (patient-related factor) and external components (surgery-related factor). Although important, patient satisfaction shouldn't be the determining factor for evaluating the efficacy of surgical treatments and patient care.

Link of Vidio  Abstract: https://youtu.be/nsnfWQ81oRU

Background: Basal encephalocele (BEC) is the rarest type of all encephaloceles. Several methods were used to close and repair the bony defect and prevent CSF leakage. Here we present a case of a 1-month-old pediatric patient who presented with a sphenoethmoidal basal encephalocele with a single transfrontobasal approach.

Case Presentation: A female infant one-month-old with diagnosed large sphenoethmoid encephalocele (basal encephalocele). From the 3D CT scan reconstruction, we found a defect in the planum sellae and ethmoid region with a maximum line of 2.84 cm x 2.89 cm. We performed a transfrontobasal approach by using titanium mesh/plate. After follow-up, we did not find CSF leakage.

Conclusion: Uncertainty persists on the best way to restore BEC. In this instance, we used single TBF approaches to seal and repair the basal encephalocele. There are no signs of infection or CSF leakage throughout the follow-up.

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

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

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

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

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

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

Link Video Abstract: https://youtu.be/vfAwOXSjbCE

Background: Hydrocephalus is still commonly found in pediatric neurosurgery managed by endoscopic third ventriculostomy (ETV) and Ventriculoperitoneal Shunt (VPS). Subcutaneous emphysema and pneumocephalus as a complication of VPS surgery is rare. Subcutaneous emphysema is the presence of air in the skin, while pneumocephalus is the presence of air in the intracranial space. This case study aims to evaluate subcutaneous emphysema and pneumocephalus following ventriculoperitoneal shunt surgery for hydrocephalus.

Case Presentation: We report an 11-month-old girl with hydrocephalus due to aqueductal stenosis who postoperatively had subcutaneous emphysema and pneumocephalus. 1 week after VPS insertion, there was a crepitation under the skin of the neck and chest. The patient occasionally appeared breathless and had a fever. The respiratory rate increased with rales on the right lung, along with the gradually decreased consciousness, and the abdominal wound slowly became dehiscent. There was subcutaneous emphysema along the shunt track and pneumocephalus.

Conclusion: The interest, in this case, could be that of the patient’s other morbid conditions, including pneumonia and the dehiscent abdominal wound on the post-VP shunt insertion incision that may have also contributed to causing the subcutaneous emphysema and pneumocephalus.

Introduction: Minimal change disease (MCD) is the cause of primary nephrotic syndrome in about 90% of children but is rare in adults and only found in about 10% to 15% of adults. Adequate steroid therapy can lead to complete remission in more than 80% of adults with MCD nephrotic syndrome. This study aimed to report a case of an adult patient with nephrotic syndrome with renal biopsy results of MCD and her clinical improvement after adequate therapy with glucocorticoids.

Case Presentation: We report a case of a female patient, 35 years old, who complained of swelling all over the body 3 months before admission. Previously, the patient was diagnosed with nephrotic syndrome on December 2020 and received oral steroid therapy that had been tapered down early, which caused the clinical symptoms to recur. The patient underwent a kidney biopsy, and MCD was found on histopathological examination. The patient received supportive therapy and resumed steroid therapy with adequate dosage. On the six-month follow-up, the patient was in complete remission.

Conclusion: MCD is a nephrotic syndrome with a good prognosis, and 80% of patients will respond to adequate therapy. Our patient's previous medical history was re-evaluated, and concluded that the previous patient had received inadequate therapy. The patient has now reached a state of complete remission. This case highlighted the importance of adequate therapy in managing nephrotic syndrome.

Link of Video Abstract: https://youtu.be/gC8cCxUUSQc

Background: Scleromalacia perforans is a systemic autoimmune disease such as rheumatoid arthritis, lupus, and Wegener's granulomatosis that may compromise vision and globe integrity. The great challenge to treat disease is determined by the genetic examination. This case report aims to describe a unique case of Scleromalacia perforans in young patient.

Case description: A 19-year-old female with a progressed protrusion of the left eye since she was 1 year old. Six years ago, she had redness, worsen protrusion, photophobia, tearing, and pain, but resolved without treatment. Her cousin had the same condition but refused to continue the examination. Visual acuity of the left eye was no light perception with 4x4 mm of corneal leukoma, and 360 degrees of anterior scleral ectasia covered with conjunctival neovascularization. USG showed posterior vitreous detachment and 28,9 mm axial length. ANA test and HLA B27 were normal, positive hypermobility joint, and Rheumatologists ruled out the possibility of autoimmune disease. Myoconjuctival enucleation was performed with a dermis fatty graft for cosmetics, and histopathological examination showed nonspecific chronic inflammation.

Conclusion: Scleromalacia perforans is a rare case that is strongly believed to have an association with systemic autoimmune disease. Collaboration between ophthalmologists, rheumatologists, and geneticists is essential to manage this case.

Introduction: Atrial septal defect (ASD) is one of the most common congenital heart diseases and often diagnosed in adulthood. ASD represents a spectrum of disease with symptoms that vary from asymptomatic to right-sided cardiac volume overload, pulmonary arterial hypertension and atrial arrhythmias depending on the size of the defect, size of the shunt and associated anomalies. We reported a patient with large ostium primum ASD who underwent surgical closure with a pericardial patch.

Case Description: A 18 years old man came with chief complaint of abnormal ECG results of the screening examination of police candidates from Bhayangkara Hospital Manado. The patient had no complaints during admission. The patient could still carry out daily activities without any obstacles. The patient also could do high intensity sport without complaints of shortness of breath, heavy chest, or headaches. .Electrocardiogram (ECG) examination showed sinus rhythm, heart rate 74 beats per minute, left anterior fascicular block (LAFB), complete right bundle branch block (RBBB) and fragmented QRS at inferior leads. Transthoracic and transesophageal echocardiography revealed large ostium primum ASD L-R shunt.  Open heart ASD surgical closure with pericardial patch was done with good results and no residual shunt.

Conclusion: Large ostium primum ASD are associated with significant systemic-to-pulmonary shunts that results in desaturation requiring surgical closure. Large shunt of ASD patients who have a dilated right heart are associated with increased age-related morbidity and mortality. ASD with right heart dilatation should be considered for closure once the diagnosis is established regardless of the patient's age.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and potentially fatal hypersensitivity reactions that can be drug-induced, especially in patients with AIDS. This report aims to highlight the diagnosis and management of a patient with acquired immunodeficiency syndrome (AIDS) that consumed multiple drugs including anti-tuberculosis drugs that develop SJS.

Case presentation: A 30-year-old male patient with AIDS administered with chief complaints of burning sensation all over the bodies and erythematous macules scattered across the stomach and back, followed by blisters distributed across the chest, back, face, lips, hands and feet, as well as genitals for 3 days. Patient was diagnosed with AIDS and under ARV medication since about 5 years ago and dan cotrimoxazole for 9 months. Couple months before admission, patient was diagnosed with tuberculosis and under anti-tuberculosis treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE)) but stopped due to drug-induced hepatitis (DIH) which then changed to another regiment (streptomycin, levofloxacin, and ethambutol (SLE)) followed by another regiment (rifampicin, isoniazid and ethambutol (RHE)). The patient diagnosed with drug-induced SJS, however, in order to find out the SJS drugs inducer, an algorithm for assessment of drug causality in Stevens-Johnson Syndrome and toxic epidermal necrolysis (ALDEN) score as causality assessments tool was applied and rifampicin decided to be the precursor. The patient was managed for 13 days prior to discharge with improved condition.

Conclusion: Diagnosing process for drug-induced in patient with AIDS, in addition to multiple drugs consumption, is a challenge. A multidisciplinary approach and appropriate causality assessments tool should be considered before administering further management and medications.

Background: Air gun shot injury is a gunshot wound from a pistol or rifle that fires a bullet. The most common part of the body that penetrates in air gunshot injuries is the head, especially the orbit. The majority of fatal cases have been reported to enter that location and commonly involve children and adults. This report presents an interesting point of air gunshot injuries with brain damage surgical management.

Case Description: A 6-year-old boy got referred from other hospitals and came unconscious after being shot in the head by an air gun about eight hours before being admitted to the hospital with a range of about two meters. The patient was said to have accidentally been shot from the front of the head. The patient had a history of vomiting without a history of consciousness and seizure. On the primary survey, the airway, breathing, and circulation were clear, with a Glasgow Coma Scale (GCS) of 13. Based on the clinical examination and the result of the head CT scan, the patient was diagnosed with penetrating brain injury at the left parietal region, with multiple fragmented objects, intracerebral hemorrhage, and intraventricular hemorrhage. We then perform urgent surgery to debride and extract the bullet. There was no surgical morbidity in this patient, who was allowed to go home.

Conclusion: Penetrating brain injuries resulting from air gunshot wounds require exceptional management. Early surgery to debride the wound with consideration of bullet extraction is needed to prevent further complications and for a better outcome for the patient.

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

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

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

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

Link of Video Abstract: https://youtu.be/ZYpxn1S7yjw

Background: Coronary artery fistula is a rare entity of cardiovascular anomaly. The etiology is often congenital due to malformation of coronary artery vessels. They are mostly asymptomatic, while some cases may be present with complications such as congestive heart failure, myocardial infarction, or pulmonary hypertension. This case study aims to evaluate the Successful coronary artery fistula closure using Amplatzer duct occluder II device in a 10-months-old infant.

Case Presentation: The 10-month-old female infant was present with a coronary artery fistula diagnosed at three months old. The echocardiography revealed a right coronary artery fistula to the right atrium with an ampulla size of 7.29 mm, waist of 3.11 mm, and length of 4.71 mm. The patient underwent cardiac catheterization and coronary artery fistula closure with a transvenous technique approach using Amplatzer duct occluder II. The procedure was successful, and the echocardiography examination found no residual flow from the fistula. This is the first reported case of successful coronary artery fistula closure using the Amplatzer duct occluder II device.

Conclusion: Fistula closure using the Amplatzer Duct Occluder II device, in this case, is preferred because it is safe and efficient to use in small infants due to its small sheath delivery catheter caliber.

Background: Criminal profiles are also often referred to as psychological profiles or engagement profiles. Profile means a description the term profile to be discussed when discussing techniques and determining the possible characteristics of the debate about the results of research on crime itself. The following paper aims to present the case in predicting criminal profiles in Banda Aceh Indonesia based on forensic medical investigations.

Case presentation: The victim is a male 16-year-old which is conducted a forensic medical examination. The result of forensic medical autopsy findings is the destruction of face-forming bones and skull fractures in the victim. According to the autopsy finding, the doctor concluded that the violence was carried out by someone who is powerful. The doctor states that the alleged criminal's profile consists of someone close to the victim, someone likely to be male, and someone who engaged in violence by using blunt objects. The police investigator is an Indonesian National Police in Banda Aceh district who has done the interview. The discussion with police investigators was conducted to predict the alleged perpetrator's profile. Based on the doctor's statement, the police conducted an investigation looking for the suspect, and the doctor's prediction was correct about the criminal profile of the perpetrator. During the trial, the panel of judges stated that the perpetrators used blunt objects to attack the victim.

Conclusion: There is an association between the results of forensic medical examination, police investigations and facts at the trial in predicting the profiles of criminals.

Link of Video Abstract: https://youtu.be/7m2n6og9EUI

Background: Shunt fracture is a ventriculoperitoneal (VP) complication requiring shunt revision. The author discusses the experience of treating 5 cases of hydrocephalus patients with shunt fracture, including a clinical manifestation, nutritional status, and age of VP shunt insertion as a risk factor of shunt fracture will be discussed further in this case series report.

Case Presentation: This study analyzed all cases treated in 6 years from 2016 to 2021, with an inclusion criterion of all pediatric patients with shunt fractures. This study is a retrospective report of the clinical manifestations and diagnoses assessed for pre-procedural and post-procedural conditions. Eight hundred fifty-two patients with hydrocephalus with VP shunt insertion and 5 patients with shunt fracture were reported. Headache, lump in the shunt line, vomiting, and seizure were the main complaints of all patients. Four of the five patients had poor nutritional status (<50th and <3rd percentile). One patient had a shunt removal, two had a shunt revision, and two had a laparoscopic shunt extraction and VP shunt insertion. All patients had improved clinical outcomes.

Conclusion: Knowing the process of shunt fracture is essential as a modality to determine the subsequent management. A comprehensive clinical and radiological examination is mandatory to rule out a shunt fracture. Monitoring patients with VP shunt is an important thing that must be done to prevent further complications.

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

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

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

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

Link of Video Abstract: https://youtu.be/rMasD6pMero

Introduction: Induced abortion with misoprostol in the second trimester can be harmful to both mother and fetus, especially when the abortion is self-administered with telemedicine. Considering the effects that might occur in misoprostol usage to induce abortion, we ought to present our experience through this article regarding the effect of misoprostol as a drug to induce abortion in the second trimester.

Case Description: In the first case, a 30-year-old woman engaged in a self-induced abortion at her residence subsequent to consulting with medical personnel at a local community health centre, where she received oral and vaginal administration of misoprostol. Unfortunately, complications arose as the mother experienced post-abortion bleeding, which necessitated a curative procedure. Tragically, the fetus perished in utero due to asphyxia. In the second case, a 20-year-old woman opted to undergo a self-induced abortion at home following consultation and the acquisition of misoprostol from an online source. In cases where fetuses experience asphyxia within the womb, they are unable to exit the uterus spontaneously. Consequently, the mother experienced post-abortion bleeding as an aftermath of the procedure.

Conclusions: Misoprostol-induced abortion in the second trimester causes maternal bleeding and intrauterine fetal mortality. Medical staff should handle abortions professionally, considering into account both the patient's health and the legal considerations.

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

Background: Prostate cancer frequently presents with a non-specific clinical appearance, similar to benign prostatic hyperplasia (BPH). In many countries, early detection and treatment of prostate cancer are associated with lower mortality rates. Several prostate cancer biomarkers have been studied, one of which is programmed death ligand-1 (PD-L1), currently used as a therapeutic method. This study aimed to examine the expression of PD-L1 in prostate cancer and BPH.

Methods: This was a cross-sectional retrospective study involving subjects diagnosed with prostate cancer by histopathological examination. The expression of PD-L1 from 30 prostate tissues was analyzed using qRT-PCR. Data were then analyzed using the ANOVA test and continued with the Post Hoc test. P < 0.05 was considered significant.

Results: From a total of 30 prostate tissues that were examined histopathologically, ten samples were BPH (33.3%), ten samples were non-metastatic prostate cancer (non-MPCa) (33.3%), ten samples were metastatic prostate cancer (MPCa) (33.3%). The data analysis showed significant differences in PD-L1 expression between groups (p=0.000). The Post Hoc test showed significant differences between the non-MPCa group and BPH (p=0.003; 95% CI 36.1-142.8) and the MPCa group with BPH (p=0.000; 95% CI 50.9-127.3).

Conclusion: PD-L1 was overexpressed in the prostate cancer group, both in non-metastatic Pca and metastatic Pca. As a result, using PD-L1 inhibitors in the early stages of the disease may improve survival and prognosis.