Introduction: The use of online Objective Structured Clinical Examination (OSCE) scoring system in medical and nursing education is emerging. To ensure valid student’ score, the OSCE check lists need to be assessed for its validity and reliability. This study aims to test the validity and reliability of several procedural check lists commonly used in nursing profession such as peripheral intravenous insertion, electrocardiogram placement, nasogastric tube insertion, urinary catheter insertion and oxygenation procedure.

Methods: The expert consensus was used to generate items, content validity index and inter-rater reliability was used to evaluate the validity and reliability of the check lists. Five experts assessed the content validity of the checklists and five raters used the check list to evaluate performance of 11 students. Data were collected from April to May 2022. The panel experts rated the content relevance of each instrument using a four-point rating scale. Item level and scale level content validity index were calculated. Inter-rater reliability was calculated using Fleiss Kappa.

Results: The item validity index for the five check lists reviewed showed relatively high content validity among experts. I-CVI for each tool was very good, ranging from 0.8 to 1. The average content agreement (S-CVI/Ave) and the universal agreement (S-CVI/UA) for each check list were also very good. The inter-rater reliability results indicated that the agreement among raters was ranged from moderate to very good/excellent. The lowest Kappa value was for the nasogastric insertion check list (0.40, 95%CI 0.40 – 0.41) and the highest Kappa value was for the oxygenation check list (1, 95% CI 0.99 – 1).

Conclusion: The face validity was reported as easy to understand and presented logically. Nonetheless, re-formatting of some items and addition of details in the checklists are needed to avoid ambiguity, which could lead to confusion for the examiner and examinee.

Background: Stress urinary incontinence is defined as involuntary loss of urine on effort or exertion or with coughing or sneezing. SUI affects as many as 75% of older women, 44-57% of middle-aged, and 25% of young women. Risk factors include age, parity, vaginal birth, menopause, obesity, body mass index, diabetes, hysterectomy, chronically increased abdominal pressure, genetic factors, physical activity level, smoking, diet, and family history. Our purpose was to determine which risk factors are associated with the severity of stress urinary incontinence using a 1-hour pad test.

Method: This cross-sectional multicentered study was performed on 178 women who complained of incontinence and had completed QUID for SUI. We collected data using a pad test, and we classified those women into two main groups, women with mild SUI with 1-hour pad test results 1-10 g and women with moderate and severe SUI with 1-hour pad test results more than 10 g. We use Phi and Cramer’s V to calculate the effect size of each risk factor.

Results: There were 20 women with moderate and severe SUI, and 158 had mild SUI. We analyzed the risk factors associated with moderate-severe SUI women and found that age (p=0.03), perineometer result (p = 0.04), and level of education (p=0.02) are statistically significant.

Conclusion: The severity of stress urinary incontinence is related to age, perineometer result, and level of education.

Purpose: The demand for organ donation is progressively increasing in Malaysia. Healthcare personnel play a crucial role in educating potential donors. This study is aimed to determine the level of knowledge, attitude and practice (KAP) regarding organ donation and associated factors among healthcare workers in UKMMC.

Patients and methods: A cross-sectional study was conducted among 255 healthcare workers in UKMMC. Subjects were divided into three groups: doctors, nurses and health assistants. There were 85 participants in each group. A validated 39-item contain self-administered questionnaire was used to assess participants' level of knowledge, attitude and practice regarding organ donation.

Results: The mean score is highest among doctors as compared to nurses and health assistants respectively in terms of knowledge (121.74 (84.0%) ± 12.19; 115.32 (79.5%) ± 14.16; 109.71 (75.7%) ± 13.63, p <0.001), attitude (50.27 (83.8%) ± 5.70; 43.00 (71.7%) ± 6.88; 42.34 (70.6%) ± 6.85, p <0.001) and practice (6.33 (63.3%) ± 1.75; 4.33 (43.3%) ± 2.19; 3.33 (33.3%) ± 2.31, p <0.001). Further analysis showed the attitude and practice towards organ donation were significantly higher among doctors (p=0.001), those with tertiary education (p=0.001), males (p=0.001), the Indian ethnicity (p=0.001), Hindus (p=0.001) and those with a high monthly income (>RM10000) (p=0.001). However, knowledge was significantly associated with younger age (21-30) (p=0.026), being Chinese (p=0.034) and having a moderate monthly income (RM5000-10000) (p=0.001).

Conclusion: The factors which affect attitude and practice are not associated with knowledge. Despite good knowledge, willingness to donate is low when attitude is poor. An organ donation campaign should be conducted to increase attitude and practice among those who have knowledge but are not willing to practise.

Background: Epilepsy could result in disability and lowered patient's quality of life. Quality of Life in Epilepsy Inventory 10 (QOLIE-10) is a questionnaire to assess epilepsy patients' quality of life, but it has not been translated into Indonesian yet. This study aims to translate QOLIE-10 into Indonesian and analyze its validity and reliability.

Methods: This was a cross sectional study conducted at Neurology Clinic, Universitas Sebelas Maret, Surakarta. The translation process consists of two steps, a forward and backward process; each is done by two independent translators. Participants recruited were then asked to complete the Indonesian version of QOLIE-10 twice, with an interval of approximately one month.

Results: From the data obtained, we observed an r-value ranging from 0.247 to 0.669 on the pretest and post-test, greater than the critical r-value of 0.235 (p<0.05). We also observed Cronbach's alpha coefficient of 0.938 and 0.909 (p<0.05) for the pretest and post-test, respectively, and the test-retest reliability with r=0.871 (p=0.000).

Conclusion: Indonesian version of QOLIE-10 is understandable to Indonesian native speakers, valid, and reliable.

Introduction: Nasopharyngeal carcinoma is a tumor that arises from epithelial cells covering the surface of the nasopharynx. In terms of malignancy, NPC is number 1 in the OHNS and number 5 in Indonesia. Certain risk factors that can predispose an individual to NPC include an EBV infection, salted fish consumption, and smoking. Previous studies also show that the polymorphism of CYP1A1 rs4646903 affect the risk factor and mechanism of NPC incidence.

Methods: This is a case-control study conducted at Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar. The study used 62 samples. The sample then underwent DNA isolation and amplification using PCR and afterward, visualization, DNA sequencing, and analysis.

Results: Bivariate analysis shows that CYP1A1 have a significant relationship with NPC incidence with a p-value of 0.007 (OR: 1.48 ; 95% CI 4.87 (1.5-15.9)).

Conclusions: The polymorphisms of CYP1A1 rs4646903 is proven to be the risk factors in the mechanism of undifferentiated NPC among the Balinese population.  

Introduction: Cardiomyocyte death is the key pathological feature of heart failure with reduced ejection fraction (HFrEF). One of the circulating markers which represent myocardial cell death is cardiac troponin. High sensitivity-troponin I (hs-TnI) has been validated as an acute coronary syndrome diagnostic criteria. But its value and role in chronic heart failure, specifically HFrEF, has been variable in different studies. The aim of this study was to determine whether hs-TnI, an indicator of cardiomyocyte injury, is associated with functional and structural changes in HFrEF patients.

Methods: A hospital-based cross-sectional analytic study was conducted on 72 patients with stable chronic HFrEF between April and October 2022. All subjects underwent echocardiography (Philips EPIQ7 and Affinity 70) and hs-troponin I serum measurement (Abbott Architect assay). Spearman’s test was used to evaluate the correlation between hs-troponin I and left ventricular ejection fraction (LVEF), E/A ratio, left ventricular end-diastolic volume (LVEDV), tricuspid annular plane systolic excursion (TAPSE) and left atrial volume index (LAVI).

Results: hs-TnI concentrations were quantifiable in all samples ranging from 10 to 280.9 pg/mL. hs-TnI was associated significantly with LVEF (r=-0.39; p<0.01), E/A ratio (r=0.328, p=0.01), and LVEDV (r=0.278, p=0.04). hs-TnI was not correlated with TAPSE and LAVI (r=0.241; p=0.07 and r=-0.13; p=0.429, respectively). The correlation between hs-troponin I with LVEF, E/A ratio and LVEDV proved that the degree of myocardial injury is directly associated with left ventricle (LV) systolic and diastolic dysfunction and also with LV dilatation. While it is not correlated with right ventricle (RV) systolic function. Hs-TnI may represent the injury in LV better than RV.

Conclusion: These findings support the association of hs-TnI as a circulating marker of cardiomyocyte injury with LV dysfunction (systolic and diastolic) and dilatation in chronic HFrEF patients. This has expanded the role of hs-TnI in chronic heart disease.

Background: Leg muscular strength may decline as a result of decreased mechanical stress on the muscles brought on by the COVID-19 pandemic's physical inactivity. The hybrid training method uses the force generated by an electrically stimulated antagonist muscle to resist a voluntarily contracting agonist muscle. Due to the lack of external resistance or stability equipment, this exercise may be a good option for strengthening workouts during a pandemic. Modifications were made using conventional stimulation tools because the hybrid training system was difficult to replicate. The study's objective was to analyze the effect of modified hybrid resistance training on concentric quadriceps femoris peak torque (Q_CON) and eccentric hamstring peak torque (H_ECC).

Methods: The study was conducted at the Medical Rehabilitation Installation of Dr. Soetomo General Academic Hospital Surabaya. The subjects were 30 untrained healthy men aged 18-40 years divided into the treatment group, which received modified hybrid resistance training and the control group, which received Russian protocol neuromuscular electrical stimulation 3 times per week for 4 weeks. Due to COVID-19 infection, four participants couldn’t continue in intervention. Statistical tests were carried out on subjects that were able to complete the study (treatment: 13, control:13).

Results: There were increases in 60^o/sec Q_CON (p-value 0.005) and 120^o/sec Q_CON (p-value 0.001) in the non-dominant leg in the treatment group. There were increases in 60^o/sec Q_CON (p-value 0.043), 120^o/sec Q_CON (p-value 0.014), and 120^o/sec H_ECC (p-value 0.043) in the non-dominant leg in the control group. There is a significant difference in non-dominant 120^o/sec ΔQ_CON between the two groups (p-value 0.036).

Conclusion: There was a more significant increase in Q_CON in the modified hybrid training exercises group compared to the Russian stimulation group in untrained healthy subjects.

Background: Non-steroidal Anti-Inflammatory Drugs (NSAIDs) are painkillers that Indonesians widely use. Many people use it because it is easy to get and low price. Although, the public does not pay attention to safety in its use. This study aims to determine the relationship and the level of causality between the use of NSAIDs and chronic kidney disease (CKD) events.

Methods: An observational case-control with retrospective retrieval was adopted, and the risk factors between the use of NSAIDs and CKD events were analyzed. Meanwhile, the study was conducted in Makassar city hospital with consecutive sampling from January 2017 until January 2018.

Results: The results showed that 118 patients from a total of 350 used NSAIDs, while 35 of the 175 with CKD had a history of NSAIDs. Furthermore, the data on the use of NSAIDs in these patients was 40% meloxicam and 10% mefenamic acid, and the result of the Chi-square analysis showed a p-value <0.001 and an OR of 0.277. Additionally, the possible incidence of CKD in men and women is 48.55% and 70.72%, respectively, with a history of using NSAIDs for over 3 months. It was further shown that  2 of 118 patients had side effects from CKD due to the long-term use of NSAIDs.

Conclusion: Conclusively, there is no relationship between CKD incidence and the use of NSAIDs in the community. However, some CKD side effects are related to NSAIDs, which implies that NSAIDs do not result in CKD.

Background: Recent studies have proposed the use of preoperative alpha-blockers to facilitate urethral access sheath (UAS) placement, but the definite role of this practice is still unclear. We aimed to evaluate the efficacy and safety of alpha-blocker use for UAS placement in intrarenal endoscopic procedures.

Methods: The course of this study followed the preferred reporting items for systematic review and meta-analyses guidelines. Articles investigating the use of preoperative alpha-blockers for patients who underwent intrarenal endoscopic procedures were systematically reviewed from PubMed, EMBASE, and Scopus databases. Odds ratio (OR) with 95% confidence intervals (CIs) were applied for the outcome estimates. Analyses were performed with RevMan 5.4 software. The protocol of this study is enlisted in the registry of PROSPERO (CRD42022342811).

Results: Six articles comprising 462 study populations were included in the review. Meta-analysis on the success rate of UAS placement showed a significant advantage of the alpha-blocker group compared to the control group (OR: 3.83; 1.83-8.00; 95% CI; p = 0.0004). Ureteral wall trauma was higher in the control group (OR: 0.38; 0.17-0.84; 95% CI; p = 0.02). Furthermore, there was no clear association between the UAS size and the success rate of UAS insertion.

Conclusion: Preoperative alpha-blockers may increase the success rate of UAS insertion while decreasing the risk of ureteral wall injury in intrarenal endoscopic procedures.

Introduction: Amid the COVID-19 pandemic, nursing educational programs have shifted from physical to online learning, both academic and clinical learning. Case-based learning is one of the clinical learning methods which is adapted to current circumstances. The learning method connects theoretical knowledge and practical experiences on nursing students’ clinical environment. This study aimed to evaluate the effect of online case-based learning on the clinical nursing students' self-confidence.

Methods: Forty-five clinical nursing students participated in this quasi-experimental study with one group pre-post-test design. The students’ self-confidence was evaluated using an instrument consisting of 15 Likert-scale items with cognitive, affective, and psychomotor subscales. The students’ self-confidence was measured before and after the online case-based learning (O-CBL) activities. The activities included case presentation, individual case analysis, small group discussion, and problem-solving practice for students.

Results: This study successfully organized the O-CBL method to enhance the students’ self-confidence. The average self-confidence level of the students increased from 57.84 to 60.62. Paired t-test analysis yielded p=0.006 (p <0.05), which indicated a significant effect of O-CBL on the students’ self-confidence. Significant findings were also discovered from the cognitive (p=0.01) and psychomotor (p=0.004) domains. The students’ affective domain did not significantly improve (p=0.089, p>0.05).

Conclusion: O-CBL increases nursing students' self-confidence specifically in cognitive and psychomotor aspects.

Background: Norepinephrine is the most used vasopressor in intensive care units. It can modulate gene expressions and metabolism pathways in Escherichia coli. As fluoroquinolone’s bactericidal activity is affected by bacterial metabolism and growth rate, simultaneous exposure to these medications might alter the interaction between E. coli and levofloxacin. This study aims to investigate the effect of norepinephrine and levofloxacin given simultaneously on the in vitro growth of E. coli.

Methods: Ten clinical isolates of E. coli were grown in minimal nutrition media with and without norepinephrine, levofloxacin, or both. Bacterial growth was observed for 20 h, and viable cell count was done every 2 h. Growth curves and generation times for each study group were calculated. Statistical analysis compared the viable cell counts on the 4, 14, and 20 h observation time points and the generation times.

Results: Temporary inhibition of E. coli growth was observed until 4h of incubation when therapeutic concentrations of norepinephrine and levofloxacin were given simultaneously, followed by regrowth. The viable cell count of the norepinephrine–levofloxacin group was significantly lower than the control group by the 14 h and 20 h time points. Interestingly, the study group's average generation time of regrowth was 19.3 min, which was significantly faster than the control group (p < 0.05).

Conclusion: Norepinephrine caused alterations in the interaction between E. coli and levofloxacin, which may affect clinical outcomes and increase the risk of bacterial colonization in patients receiving simultaneous norepinephrine and levofloxacin therapy.

Background: People with obesity tend to have balance disturbance and a higher fall risk than those with normal BMI. The Weight-bearing Exercise for Better Balance (WEBB) is an exercise program that could improve balance in the elderly population, but no study implementing the WEBB program on obese subjects. This study aims to analyze the effects of the telerehabilitation WEBB program on dynamic balance in obese subjects, measured by Maximized Reach Distance (%MAXD) and a composite score of the Modified Star Excursion Balance Test (mSEBT).

Methods: Ten male participants aged 18-30 were recruited. Participants underwent the WEBB program 3 times a week for 8 weeks in their own homes under the supervision of the researchers. The intensity of the exercise was increased every 2 weeks. For the analysis, %MAXD and composite score mSEBT were used to assess the dynamic balance before and after the WEBB program.

Results: There was a significant increase (p < 0.05) in %MAXD of both sides and all directions. The mSEBT composite score of both sides also significantly increased (p < 0.05). All the statistical results showed large effect sizes.

Conclusion: The WEBB program through telerehabilitation is proven to significantly improve dynamic balance, as indicated by an increase in %MAXD and mSEBT composite scores in obese subjects.

Introduction: The COVID-19 pandemic has affected various aspects of human life, including education. Educational institutions, including medical faculty, are trying to use the online learning approach to continue teaching and learning. Although it has many advantages due to its flexibility, there are also some disadvantages. Previous studies have shown that online learning is significantly related to student psychological disorders such as stress, anxiety to depression, thereby reducing social skills and competence in medical students. This study aims to determine the level of anxiety and depression in students of the Faculty of Medicine, Universitas Udayana Medical Education Study Program, during the COVID-19 pandemic and responses to the online learning system.

Methods: This study used a cross-sectional design. The questionnaire was compiled using the Indonesian version of the Health and Anxiety Depression Scale (HADS) and distributed online. Data were analyzed using the SPSS ver.23 program by performing the chi-square test, with a p <0.05, considered statistically significant.

Results: Based on demographic characteristics, it was found that female students got more anxiety symptoms than male students (74.8% vs. 25.2%, p=0.009), and preclinical students experienced more depression than clinical students (95.2% vs. 4.8%, p=0.037). Students who experience symptoms of anxiety and depression, as well as normal, are dominated by poor learning responses (66.3% vs. 33.7%). Study programs, family income, place of residence, and semester level do not influence anxiety and depression in students.

Conclusion: The COVID-19 pandemic situation has led to poor learning responses in medical students, both those experiencing symptoms of anxiety/depression and students without symptoms (normal).

Link of Video Abstract: https://youtu.be/3n_K49-K4jM

Introduction: The development of nanotechnology science is so fast that there has been a lot of progress in terms of therapeutic research related to diseases in Neurology. To our knowledge, there have been no bibliometric studies in this field, so this study is needed to see research gaps that world researchers can do to accelerate and multiply nanotechnology that can be applied in patient therapy in clinics and collaborate with existing researchers in this field. This research aims to look for gaps in research fields that have not been widely studied in the field of nanotechnology related to neurological diagnosis and therapy and know research trends.

Method: Documents were collected from the Scopus site from 2002 to 2022, totaling 245 documents, which were then analyzed quantitatively with Biblioshiny and Vosviewer software. Furthermore, a qualitative analysis was also carried out.

Results:  Gathered information on document trends, citation counts, authors, producing nations, affiliations, research topics, and research networks. Three developing domains (niches) are three developing domains (niches) that present research opportunities for researchers worldwide. The United States seems to be the industry leader in document production.

Conclusion: The politics of a nation's financing policies heavily influence the advancement of research in the field of nanotechnology connected to the diagnosis and treatment of neurological illnesses. In order to expedite and replicate applications in the therapeutic use of nanotechnology, establishing new international research networks is required. Research gaps might be found through this research.

Introduction: Axillary lymph node involvement is an important aspect of breast cancer diagnosis in determining treatment and predicting distant metastasis. Lymph node metastasis is associated with higher recurrence and survival rates. Lymph node status is a significant prognostic factor and is widely used. Several factors affect lymph node metastasis, including tumor size, grade, and invasive ductal histological type. FGF2, a lymphangiogenesis factor, influences the occurrence of lymph node metastasis. The present study aimed to determine the association between FGF2 expression and axillary lymph node metastasis in early-stage breast cancer and evaluate the association between FGF2 expression and clinicopathologic factors.

Methods: A cross-sectional design was used to evaluate the expression of FGF2 in 47 early-stage breast cancer patients who underwent either a mastectomy or breast-conserving surgery procedure at Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, from January 2014 to December 2018. FGF2 expression was examined by immunohistochemistry.

Results: FGF2 expression was significantly correlated with axillary lymph node metastasis incidence [p = 0.044, odds ratio 4.22 (95% CI 0.983-18.1)]. Higher FGF2 expression was significantly correlated with the grade, subtype, estrogen receptor (ER) status, and progesterone receptor (PR) status of the tumor (p = 0.017, p = 0.031, p = 0.002, p = 0.013, respectively).

Conclusions: Increased FGF2 expression and tumor size significantly correlated with axillary lymph node metastasis. The tumor's grade, intrinsic subtype, ER and PR status were significantly correlated with increased FGF2 expression. Our study indicated that FGF2 expression might aid in determining the presence of axillary lymph node metastasis.

Background: This study aims to assess the condition of pelvic organ prolapse related to changes in matrix metalloproteinase activity, elastin degradation and markers of collagen, and remodeling observed during pregnancy, childbirth, and the puerperal period 3 months postpartum. This study included 39 primigravida women who underwent vaginal delivery with a gestational age >36 weeks. This study conducted laboratory tests using blood and urine samples including procollagen type I N-propeptide (PINP), procollagen type-III N-propeptide (PIIINP), telopeptide carboxyl-terminal collagen type I (ICTP), matrix metalloproteinase-9 (MMP). -9), desmosin, and tropoelastin. The second and third blood samples will be examined 24-48 hours postpartum and 6 weeks postpartum.

Method: The Mann-Whitney test and Repeated ANOVA were used to assess the median differences between biomarkers.

Results: In the pelvic floor dysfunction and control groups, a significant relationship was found between serum MMP-9 levels 6 weeks postpartum (p=0.025). There were changes in biomarker levels of collagen and elastin during pregnancy, post-partum, and six weeks postpartum. The amount of degradation (MMP-9) seems to be correlated with the event of POP after childbirth.

Conclusion: There were changes in the biomarker levels of collagen and elastin from pregnancy, post-partum, and six weeks postpartum. In addition, the difference was significant in MMP-9 level six weeks after postpartum in POP group compare to control. 

Backgrounds: Rare cases of COVID-19 vertical transmission are reported, even though abnormal findings on placenta histopathology are frequently reported on SARS-CoV-2 infected pregnancies. However, no publications report the impact of COVID-19 infection on the placental apoptotic index. Apoptosis is a physiological process of cell regeneration. SARS-CoV-2 infection during pregnancy may disturb the respiration system, causing hypoxia, thus altering placental perfusion. COVID-19 infection also increases inflammatory mediators, producing reactive oxygen species and affecting placenta tissue in viremia cases. These processes can cause caspase cleavage, resulting in programmed cell death and apoptosis. This study aims to know whether COVID-19 infection with various degrees of symptoms affects placental apoptosis.

Methods: This is a retrospective, cross sectional study. We conduct a study on 34 placenta blocks of COVID-19 pregnancy and 31 placenta blocks of non-COVID-19 pregnancy. The PCR of nasopharyngeal swabs performed on third-trimester patients in Dr. Soetomo Hospital meets the inclusion and exclusion criteria. Those placenta samples were processed into slides and painted with a TUNEL assay kit. Slides are then examined and rated for apoptotic index.

Results: The majority of these patients are multiparous women. Sixty-five patients were included in the study, 2 died, and 63 others lived. Comparison between COVID-19 positive and non-COVID-19 placental apoptotic index shows a significant difference between both groups (p=0.001).

Conclusion: From this study, we can conclude that there is a significant difference in the apoptotic index of the placenta between COVID-19-positive and negative pregnancies.

Background: Cervical cancer has become a significant health problem in developing countries. We researched cervical cancer screening and prevention among all female gynecologic oncologists (FGO) registered with the Indonesian Society of Gynecologic Oncologists (INASGO).

Methods: Participant data and cervical cancer screening and prevention data were collected using an online questionnaire. A total sampling technique was conducted, and 18 of 20 FGOs responded to the survey. All data were analyzed descriptively.

Results: Fourteen FGOs (77.8%) had their first cervical screening at the age of 31-40 years old, primarily using Pap smears (77.8%) and Pap-human papillomavirus (HPV) co-testing (22.2%). Half of the included FGOs (50%) had irregular cervical cancer screening due to lack of time (66.7%), followed by forgetting (33.3%). Most FGOs preferred liquid-based cytology (77.8%) over conventional Pap smears (22.2%). Half of the FGOs preferred the HPV genotyping and half the HPV non-genotyping test. Most of the FGOs had screenings performed by female gynecologists (77.8%), male gynecologists (11.1%), and female general practitioners (5.6%). Most FGOs underwent screenings at health facilities outside their workplace (88.9%) and were funded by themselves (94.4%). Most FGOs were vaccinated with the HPV vaccine (77.8%), and most were with the quadrivalent (85.7%) over the bivalent vaccine (14.3%). All respondents were completely (three doses) vaccinated.

Conclusion: Most of the FGOs in Indonesia have been vaccinated against HPV and screened for cervical cancer, although half are still not regularly screened. The liquid-based cytology Pap smear and the quadrivalent HPV vaccine are the preferred cervical screening and prevention methods among FGOs in Indonesia

Link of Video Abstract : https://youtu.be/Vi3785NsB1A

Introduction: Congenital heart disease (CHD) is the leading cause of birth defect-associated infant illness and death. In developing countries, the mortality related to CHD increased by up to 25%, but the data about predictors of mortality are limited. The purpose of this study was to investigate the predictors of mortality in neonates with CHD.

Methods: We conducted a case-control study of neonatal mortality with CHD from January 2018 to October 2022. Data were collected from the neonatal registry in Prof Ngoerah Hospital, Bali. Characteristics and clinical risk of mortality were analyzed. Chi-square and logistic regression analysis was carried out to determine the potential predictor of mortality. 

Results: A total of 288 neonatal with CHD were analyzed. Neonatal morbidities such as extremely low birth weight (ELBW) were found in 7.6%, asphyxia in 50.7%, multiple congenital anomalies (MCA) in 13.2%, pulmonary hypertension (PH) in 13.5%, sepsis in 66.3%, and severe form of CHD in 50.7%. Patent ductus arteriosus (PDA) was the most acyanotic CHD (35%). Mortality resulting from CHD was 27%. ELBW, severe and moderate asphyxia, MCA, PH, sepsis, and severe form of CHD were significant mortality predictors (p<0.05) with (OR; 95%CI) were (6.21; 1.24-31.12), (4.13; 1.93-8.81), (3.20;1.69-6.08), (2.70; 1.17-6.24), (2.54;1.10-5.84), (2.33; 1.28-4.22), (2.00; 1.15-3.49) respectively.

Conclusion: ELBW, severe and moderate asphyxia, MCA, PH, sepsis, and severe forms of CHD are predictors of neonatal mortality with CHD.

Background: Radical surgery in cancer patients might result in complications like lymphedema. Tissue transfer procedure and lymphatic reconstruction could be done to manage lymphedema. Few biomarker expressions were identified to be associated with lymphangiogenesis and improved lymphatic system function after dissection. This study aims to evaluate the development of new lymphatic vessels by adding flap tissue after lymphatic dissection, assessed by VEGF-C expression, macrophage infiltration, and fibrotic tissue development.

Methods: This is a non-randomized clinical trial at Animal House Skill Laboratory, Faculty of Medicine, Universitas Indonesia, conducted from January to March 2018. Sprague clawley male mice were aged 8-12 weeks were used and divided into control and trial groups. Each mouse underwent inguinal dissection and was randomized to receive additional flap tissue procedures and then evaluated two months after. Methylene blue dye was used to assess the lymphatic flow. Histopathology and immunohistochemistry examination was used to assess the development of fibrotic tissue. Data analysis was done by using SPSS version 20.0 for Windows.

Results: 18 mice were included in the analysis and divided into two groups. Eight out of 9 mice (88.9%) in the trial group, which received flap tissue, showed lymphatic flow from the visualization of methylene blue, compared to two mice (22.2%) from the control group (p=0.15) two months after surgery. Histopathology examination showed wider fibrotic tissue of the lymphatic system from the trial group (p=0.05). Immunohistochemistry analysis also showed higher VEGF-C (p=0.01) and CD68 expression in the trial group (p=0.15).

Conclusion: The addition of flap tissue might improve lymphatic flow, proven by increased lymphatic circulation and VEGF-C expression.

Background: COVID-19 infection causes various sequelae and complications after recovery. Changes in heart rate variability (HRV) were found in patients with COVID-19 infection, suggesting a disturbance in the autonomic system. Breathing exercises with diaphragmatic breathing and incentive spirometry have been shown to increase HRV by increasing lung capacity, respiratory muscle strength, and pulmonary O2 pressure, which can affect baroreflex signals. Incentive spirometry is one of the easy-to-use, safe, inexpensive pulmonary rehabilitation exercises that can be done at home without supervision and are accompanied by a visual display as a guide to the patient. The purpose of the study was to determine the effect of giving breathing exercises using Incentive Spirometry for four weeks on Heart Rate Variability in patients post COVID-19 infection

Method: This research is an experimental study with a pre-post-test control group design. The treatment group was given breathing exercises using Incentive Spirometry, while the control group used diaphragmatic breathing five times a day, seven times per week, for four weeks in each group. HRV measurement was performed before and after four weeks of intervention, using the parameter Root Mean Square of Successive Differences between normal heartbeats (RMSSD), Standard Deviation of N-N intervals (SDNN), and LF/HF ratio of Heart Rate Variability (HRV).

Result: There subject of this study was 20 post-COVID-19 patients divided into a treatment group (n=10) and a control group (n=10). There was no significant increase in RMSSD, SDNN, and LF/HF ratio pre and post-intervention in both groups, suggesting no significant increase in HRV.

Conclusion: Exercise with Incentive Spirometry and Diaphragmatic Breathing for four weeks did not increase the Heart Rate Variability value in post-COVID-19 patients.

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

Background: Tracheotomy is a surgical procedure often performed in the field of ear, nose, throat-head, and neck surgery. This study aims to analyze the risk factors for tracheotomy complications based on age, clinical status, operator characteristics and surgical landmarks.

Methods: This study was analytically observational with a case-control design using secondary data. The study was conducted at Dr. Soetomo Hospital Surabaya. Patients who had a tracheotomy for the period January 1, 2015 to December 31, 2019 and met the research criteria were included as samples.

Results: This study obtained 174 patients with 136 men and 38 women. Analysis of the correlation between age and the incidence of tracheotomy complications obtained p=0.008 (p<0.05). The correlation between clinical status of patients with complications of tracheotomy was found to be significant (p=0.001). The correlation between operator characteristics and tracheotomy complications was significant (p=0.000) and the correlation between surgical landmarks and tracheotomy complications was significant (p= 0.000).

Conclusion: The correlation between age, the patient's clinical status, operator characteristics and surgical landmarks with the incidence of tracheotomy complications from 174 patients who underwent tracheotomy surgery at Dr. Soetomo Hospital Surabaya showed that these factors mutually influence the postoperative complications of tracheotomy.

Background: Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, ranked second among the leading causes of death for all cancers. Treatment depends on the stage of the disease. Platelet activation is considered a part that plays a role in cancer development. Platelet distribution width (PDW) and mean platelet volume (MPV) are markers of platelet activation and are relatively affordable tests.

Method: This research is an analytical study with a cross-sectional design and total sampling taken from medical records at Dr. Zainoel Abidin General Hospital in Banda Aceh. Staging of HCC was carried out using Barcelona Clinic Liver Cancer (BCLC) criteria. Spearman rank correlation test was used to assess the correlation coefficient between PDW and MPV values on the stage of HCC based on the BCLC criteria. The results were considered significant if the p-value <0.05.

Result: This study involved 56 patients who were grouped into 4 grades of HCC based on BCLC criteria (16 patients with BCLC-A, 18 BCLC-B patients, 10 BCLC-C patients, and 12 BCLC-D patients). Results of the Spearman rank correlation test showed the correlation coefficient of platelet distribution width (PDW) with the stage of HCC based on BCLC criteria was 0.79 (p>0.001), while the correlation coefficient of mean platelet volume (MPV) with the stage of HCC based on BCLC criteria was 0.74 (p<0.001).

Conclusion: There is a strong correlation between PDW and MPV with the stage of HCC based on the BCLC criteria. PDW has a stronger correlation in predicting the stage of HCC based on the BCLC criteria than MPV.

Background: Malnutrition in nasopharyngeal carcinoma (NPC) patients is caused by various factors such as tumor localization, metabolic derangement, and side effects of therapy. Poor nutritional status in cancer patients is associated with serious clinical consequences such as poor quality of life, higher treatment toxicity, and poor prognosis. The purpose of this study was to determine the effect of nutritional status before chemotherapy on the nutritional status after chemotherapy in non-metastatic advance-stage NPC patients.

Methods: This study was an observational study with a cross sectional design using secondary data involving non-metastatic advanced-stage NPC patients undergoing chemotherapy at dr. Kariadi Hospital Semarang in January 2020 – June 2022. The sampling technique used was consecutive sampling. Nutritional status was measured by malnutrition criteria according to the American Society for Parenteral and Enteral Nutrition (ASPEN). Statistical analysis was performed with Chi-Square and McNemar analysis test.

Results: Total sample of this study was 55 subjects. The results of this study were there was a relationship between nutritional status before chemotherapy and nutritional status after chemotherapy in non-metastatic advanced-stage NPC patients (P<0.05). All subjects were malnourished before chemotherapy, with 12.7% moderately malnourished and 87.3% severely malnourished. All subjects were malnourished after chemotherapy, with 41.8% moderately malnourished and 58.2% severely malnourished, decreased nutritional status of post-chemotherapy non-metastatic advanced NPC patients was related to the length of chemotherapy (p<0.05), but not related to comorbidities, age, and stage of chemotherapy (p>0.05).

Conclusion: There is a relationship between nutritional status before chemotherapy and nutritional status after chemotherapy in non-metastatic advanced-stage NPC patients.

Background: Lactic acid bacteria (LAB) are a group of probiotic bacteria, which are not at risk and can even have a positive impact on human and animal health. As a source of probiotics, the application of these bacteria must be resistant to environmental conditions such as resistance to low pH and gastrointestinal bile acids. This study aimed to determine the probiotic potential of lactic acid bacteria isolated from the rumen and colon of Bali cattle by testing their resistance to low pH and bile salts.

Methods: The study began with the cultivation of isolates from the rumen and colon of Bali cattle including growth on liquid MRS media, catalase test, and Gram staining. The second stage involved testing the isolate's resistance to low pH (pH 2, 3, and 4) and testing NaDC with concentrations of 0.2 mM, 0.4 mM, and 0.6 mM.

Results: Tests showed that of the 10 isolates from Bali cattle rumen tested, it was found that all had high tolerance at low pH, namely growing well at pH 2 and NaDC levels up to 0.6 mM. The results obtained corroborate the results of previous studies on the resistance of lactic acid bacteria isolates from the gastrointestinal tract of Bali cattle to low pH and bile salt levels as a condition for application as a probiotic.

Conclusion: The resistance of the isolate to low pH and NaDC shows that LAB isolates from the rumen of Bali cattle have the potential to be used as a reliable source of probiotics.

Introduction: Gingivectomy is cutting the gingiva during a gingival enlargement condition that causes an open wound in the gingiva. Jatropha multifida L gel contains active ingredients of alkaloids, flavonoids, saponins and tannins, which are thought to accelerate the wound healing process, but its use in dentistry is limited. The objective of this research is to determine the effectiveness of the application of Jatropha multifida L stem sap gel in the wound healing process post-gingivectomy in Wistar rats (Rattus novergicus) compare with Aloe vera gel (Aloe Barbadensis Miller) by using parameters the number of fibroblasts, blood vessels and the density of collagen fibers

Methods: Rats were divided into 4 groups, namely group K (Aloe vera gel), P1 (Jatropha multifida L stem sap gel 2,5%), P2 (Jatropha multifida L stem sap gel 5%) and P3 (Jatropha multifida L stem sap gel 10%). Each group was given the gel twice a day in the wound area; then the wound was observed microscopically by Haematoxylin Eosin staining to count the number of fibroblasts and blood vessels also Masson Trichrome staining to observe the density of collagen fibers on day 3 and 7.

Results: The data obtained were statistically analyzed using the One Way Anova, Dunnet and Kruskal-Wallis test. One Way Anova test shows there is a significant difference (p<0.05) in the number of fibroblasts, and the Dunnet test shows there is a significant difference (p<0.05) in the number of fibroblasts in Jatropha multifida L stem sap gel group 2.5% and 5 % on day 3. One Way Anova test shows no significant difference (p>0.05) in the number of blood vessels. The Kruskal-Wallis test shows no significant difference (p>0.05) in collagen fiber density.

Conclusion:  Jatropha multifida L Stem Sap gel has the same potential as Aloe vera gel in accelerating wound healing after gingivectomy in Wistar rats.

Background: Biochemical recurrence (BCR) occurs in more than one-third of prostate cancer (PCa) patients 10 years after radical prostatectomy. The percentage of positive biopsy cores (PPBC) obtained from prostate needle biopsy is suggested as one of the predictors of BCR. We aim to investigate the role of PPBC in predicting BCR and adverse pathology in PCa patients after RP.

Methods: A systematic search was conducted based on PRISMA guidelines from Pubmed, Scopus, and Cochrane Library databases up to July 2022. We screened studies that met our inclusion criteria and NOS (Newcastle-Ottawa Scale) was utilized as the quality assessment tool. The primary outcome was BCR measured as Hazard Ratios (HRs). The secondary outcome was adverse pathology, including positive surgical margin (PSM), Extra-prostatic disease (EPD), and seminal vesicle invasion (SVI). Review Manager®5.4 was used as the statistical analysis tool.

Results: A total of 5971 patients were included from eleven eligible studies with overall good quality scores. Eleven studies were included in the qualitative synthesis and five of them were analyzed in the meta-analysis. The pooled analysis demonstrated that higher PPBC has a 2.77 times risk of BCR (OR 2.77 (95% CI: 1.97, 3.9; p<0.00001) after RP. Similarly, it has significant results in SVI (OR 2.61 (95% CI: 1.19, 5.73; p=0.02). However, there were insignificant results in terms of EPD (p=0.17) and PSM (p=0.33).

Conclusion: This systematic review and meta-analysis (SRMA) indicate that a high PPBC is strongly correlated with a greater risk of BCR and SVI, but not EPD and PSM in patients following RP.

Background: End-stage renal disease (ESRD) patients undergoing maintenance HD typically adopt a sedentary lifestyle which increases cardiometabolic risk and takes many years to be clinically detectable. Heart rate variability (HRV) is a non-invasive method to assess cardiac autonomic modulation. Interventions to increase HRV, such as exercise therapy, have been examined, given the theoretical plausibility that improvements in HRV may lead to improved outcomes. This study aimed at assessing the effects of aerobic exercise during hemodialysis sessions on the HRV of patients with ESRD.

Methods: This research is a quasi-experimental study with pre and post-test randomized control group design. From the total of 20 ESRD patients undergoing maintenance HD randomly assigned to either exercise or control group, 2 subjects dropped out, leaving 18 ESRD patients. The patients in the exercise group were submitted to a low intradialytic aerobic exercise, performed during the first two hours of HD, twice weekly, for 12 weeks. At baseline and after 12 weeks, all participants underwent short-(for 5 min) term measurements of HRV. The data were analyzed in the SPSS package program.

Results: There is a significant difference in post-pre changes (Δ) SDNN between the exercise and control group, but there were no significant differences in ΔRMSSD (p = 0.157) and ΔLF/HF ratio (p = 0.859), with the large effect size for ΔSDNN (Cohen’s D 1.01), medium effect size for ΔRMSSD (Cohen’s D 0.70), and very small effect size for ΔLF/HF ratio (Cohen’s D 0.09).

Conclusion: Twelve weeks of supervised low-intensity intradialytic aerobic exercise has modified heart rate variability in maintenance hemodialysis patients.

Background: Retinoblastoma is an intraocular malignant neoplasm of retinal neurosensory origin and often occurs in childhood. The average global survival rate is less than 50%. An increase in the pT stage is associated with worse survival. Through its distinct protein-binding and phosphorylation activities, Polo Like Kinase 1 (PLK1) is essential in mitotic activity. PLK1 protein expression has been proposed as a novel prognostic marker for many cancers. This study aims to analyze the correlation between PLK1 with pT stages of retinoblastoma.

Methods: An observational analytic study with a cross-sectional approach was conducted on 56 formalin-fixed paraffin-embedded tissue of patients diagnosed with retinoblastoma from January 2016 - December 2020 in Dr. Soetomo General Academic Hospital, Surabaya. The samples were divided into four groups based on pT-stage retinoblastoma. Immunohistochemistry for PLK1 was applied to all models and evaluated semi-quantitatively using an immunoreactivity score.

Results: There were significant differences in PLK1 expression in each pT stage of retinoblastoma (p=0.000014). There was a significant correlation between PLK1 and the pT stage of retinoblastoma (p=0.0001).

Conclusion: The increase of PLK1 expression in retinoblastoma is associated with an increased pT stage. PLK1 plays a role in the proliferation of retinoblastoma tumor cells, hence increasing the pT stage.

Introduction: The incidence of ovarian cancer is high and continues to increase yearly, especially in Padang. About 90% of them are the type of epithelial ovarian cancer. One of the predisposing factors of this cancer is endometriosis. Endometriosis has the same characteristics as malignant tumors, including the ability to invade other organs. It is known that endometriosis occurs in 7% -15% of women of childbearing age and has a variety of symptoms, making diagnosis difficult. This study aims to determine the relationship between the incidence of endometriosis and epithelial ovarian cancer in type 1 in Dr.M.Djamil Hospital Padang from 2017 to 2018.

Methods: This study is a cross-sectional analytic study. Subjects were obtained using a total sampling of ovarian cancer patients who went to the Obstetrics and Gynecology Dr. M.Djamil Hospital Padang from January 2017 - December 2018.

Results: The retrospective study used the data of epithelial ovarian cancer patients diagnosed at the Obstetrics and Gynecology Dr. M.Djamil Hospital Padang. The incidence of endometriosis was obtained at 8.3%, and the highest type of epithelial ovarian cancer is epithelial ovarian cancer type 1 (70.7%). The incidence of endometriosis had significantly increased in patients with ovarian cancer in type 1 with a significance value of 0,010.

Conclusion: The incidence of endometriosis was significantly associated with epithelial ovarian cancer type 1 because of p<0.05. Health agencies need extraordinary attention to prevent epithelial ovarian cancer endometriosis changes into type 1.

Introduction: Pseudomonas aeruginosa is a pathogen that frequently causes healthcare-associated infections (HAI), which has also been associated with high mortality and morbidity rates. Carbapenems have been widely utilized as empiric therapy for P. aeruginosa infections since these organisms have intrinsic resistance to various antibiotics. Therefore, the high rate of CRPA infection became the reason for conducting this study to determine the prevalence and susceptibility pattern of CRPA in Dr. Soetomo Public Hospital, Surabaya, from January to December 2021.

Method: The researcher employed descriptive observational study from secondary data with the first isolate sample of P. aeruginosa per specimen per patient that has been identified by the BD Phoenix™ automated identification and susceptibility testing system from specimens of urine, blood, sterile fluid, pus, tissue, and sputum that are phenotypically resistant to meropenem or imipenem antibiotics, examined at the Clinical Microbiology Unit of Dr. Soetomo Public Hospital, Surabaya, from January to December 2021.

Result: Of the total P. aeruginosa isolates, 149 CRPA isolates were obtained. The researcher conveyed that the majority of the samples were male (59.1%); the most comorbid cases were diabetes mellitus with complications (22.4%) found in the intensive care unit (40.3%); the majority of specimens were from the respiratory tract (43%); the highest antibiotic susceptibility was amikacin (62.4%); the prevalence of CRPA in Dr. Soetomo Public Hospital, Surabaya, from January to December 2021 reached 21.25%.

Conclusion: In this study, CRPA isolates showed the highest sensitivity to amikacin, and the highest distribution of CRPA events was found in the intensive care unit.

Background: The degree of inflammation dramatically affects the morbidity of ulcerative colitis. Local and systemic inflammation features are modalities to determine disease severity and evaluation. Furthermore, local inflammation can be seen from endoscopic and histological examinations. This study aimed to examine the relationship of histological inflammatory profile with endoscopic scoring in ulcerative colitis patients.

Method: A retrospective study was conducted using colonoscopic and histologic data from 68 ulcerative colitis patients. The endoscopic grade was assessed based on the Mayo Endoscopic Score (MES). The histological grade was analyzed using a microscope by assessing acute and chronic inflammatory cells and the presence of ulceration and crypt changes based on the Nancy Score Index and Geboes Score Index. Furthermore, the analysis test used Spearman and Mann-Whitney.

Results: There is a significant positive relationship between endoscopic and histology scoring. The Nancy Score Index and MES combination yields 95% CI: 0.000-0.043, p=0.000, Correlation coefficient (r)=0.810, and odds ratio (OR)=3.272. Meanwhile, the combination of the Geboes Score Index with MES yields 95% CI: 0.000-0.043; p=0.000; r=0.727; and OR=1.347. In each histological scoring, there was a significant difference between the Nancy Score Index and Geboes Score Index tα (r = 0.018; p<0.05).

Conclusion: There is a significant relationship between histological and endoscopic scoring. Therefore, an endoscopic examination can be a reference for histologically active disease.

Introduction: Caring is a basic professional character that nurses must have in providing nursing care, including patients exposed to COVID-19, where nurses play an important position in maintaining their quality of life. This study aimed to find out the spiritual caring of nurses in this case is altruistic caring and humanistic caring on the quality of life of patients exposed to COVID-19 in the physical, psychological, social, and environmental dimensions.

Methods: This research was correlational using a cross-sectional approach to 118 respondents, namely patients exposed to COVID-19, both those being treated in isolation at the hospital, as well as independent isolation using the purposive sampling method. The instrument used in this study is the quality of life questionnaire which consists of 4 dimensions and a spiritual care questionnaire given by nurses.

Results: The research showed the characteristics of the sample were mostly women 83 (70.33%), the age of the respondents was at least 23 years and a maximum of 65 years, the most with undergraduate education as many as 53.38%; employment status 80.51% private employees, marital status 83.89% married; treatment status 82.20% hospitalized; length of hospitalization between 2 to 40 days with an average of 12.26 days; Most of the respondents are Muslim 95.76%. The value of altruistic caring is good (63.56%), humanistic caring is good (68.64%). The quality of life of respondents who were exposed to COVID-19 was mostly good, 66.94%.

Conclusion: There was a relationship between spiritual caring, both altruistic caring and humanistic caring, on the quality of life of patient respondents exposed to COVID-19, where the better the perception of spiritual caring the better the quality of life. This research can be used as evaluation material for nursing care providers to cultivate caring character to improve the quality of life of patients.

Introduction: Many experts have tried to invent appropriate measures for deciding children’s school readiness, one of which is the Nijmeegse Schoolbekwaamheids Test (NST). Unfortunately, it conveys several troubles such as being time-consuming, expensive, and uncomfortable for children. Meanwhile, the majority of parents have been accustomed to the pre-screening developmental questionnaire (PDQ) and mother and child health (MCH) handbook to monitor their children's development. The present study aimed to examine the PDQ and MCH handbook’s validity for determining children’s readiness to enter elementary school based on sensitivity, specificity, positive predictive value, and negative predictive value.

Methods: The study used a descriptive-observational research approach with a cross-sectional research design conducted from March to May 2022. Data were obtained from the completed PDQ, MCH handbook, and NST forms. The data were analyzed using the Chi-squared test to contrast the results of sensitivity, specificity, positive predictive value, and negative predictive value between variables to reveal whether the PDQ and MCH handbook were valid to be used besides the NST.

Results: There was a relationship between children’s readiness to enter elementary school based on PDQ and NST (p < .05) and the MCH handbook and NST (p < .05). The sensitivity of children’s readiness to enter elementary school based on PDQ was 96.2% with the specificity of 50%, the positive predictive value of 96.2%, and the negative predictive value of 50%. Moreover, the sensitivity of children’s readiness to enter elementary school based on the MCH handbook was 80% with a specificity of 75%, a positive predictive value of 97.7%, and a negative predictive value of 23.1%.

Conclusion: The PDQ and MCH handbook can help Indonesian parents define their children’s readiness to enter elementary school as it is more reachable and applicable.

Introduction:  Unmet need for Family Planning (FP) was conducted to measure the achievement of the FP program. Since decentralization, each region has the flexibility to implement certain policies according to regional needs, including family planning program policies. This study aimed to describe the unmet need for FP in 7 regions in Indonesia in 2018-2021.

Methods: This research is an ecological study using data derived from the National Population and Family Planning Agency Field Control Report in 2018-2021 and descriptively analyzed based on 7 development areas of the 2020-2024 National Medium-Term Development Plan. Unmet need for FP is the percentage of married couples whose wife is between the ages of 15 to 49 years and aren’t using contraception, those who still wanted children but have postponed it for up to 2 years and those who decided that they didn’t want any more children.

Result: The results showed that the unmet need for FP in the Nusa Tenggara, Kalimantan, Sulawesi, Maluku, and Papua regions continued to decline in 2018-2021. The largest decrease in unmet need for FP occurred in Papua (7.6%) while the smallest decrease occurred in Sumatra (0.9%).  

Conclusion: The magnitude of the decrease in the unmet need for FP varies by region. Region-specific FP program interventions are needed to increase the need for contraception in couples of childbearing age (EFA).

Introduction: In managing ventral hernia, using mesh for the anterior abdominal wall defect closure has become a standard. Different types of materials have been used as a mesh, each with its own benefits and drawbacks. This study aimed to investigate the potential of a triple-layered composite mesh made from amniotic membrane-coated polypropylene mesh (AMPM)  with an adhesion barrier as an alternative for anterior abdominal wall defect closure.

Methods: An experimental study was conducted using Sprague-Dawley mice, imposed with a mechanical ventral hernia and divided into four groups with different treatments: sham surgery, mesh polypropylene, AMPM composite, and AMPM with adhesion barrier (triple-layered composite mesh). After 7 and 30 days of the procedure, the mice were evaluated for the recurrence of anterior abdominal wall defects, the histological profile of polymorphonuclear (PMN) cells, foreign body giant cells (FBGC), fibroblast cells, neovascularization, and adhesion of mesh to surrounding tissue in each group.

Results: No anterior abdominal wall defect recurrence was observed in all groups at  7- and 30-days post-procedure. We found no significant difference in histological profiles of PMN, FBGC, and fibroblast cells from each group. There was a statistically significant difference in the neovascularization (p=0.025) and adhesion (p=0.034) between the polypropylene mesh group and the triple-layered composite mesh group.

Conclusion: Triple-layered composite mesh has the potential to be an alternative to cover anterior abdominal wall defects, with triple-layered composite mesh and AMPM mesh groups showing a significantly higher rate of neovascularization and a lower rate of adhesion than the polypropylene mesh group.

Background: The Enhanced Recovery After Surgery (ERAS) strategy has been proven to be successful in lowering hospital perioperative problem rates and postoperative length of stay (LOS) in colorectal surgery. The inability of dr. Cipto Mangunkusumo General Hospital's to implement all of the components of the ERAS protocol was attributed to three major factors: patient-related (compliance), physician-related (silo mentality), and hospital-related (long waiting lists and inability to provide required facilities). This study aims to determine how well the ERAS procedure can be partially implemented to achieve the ERAS objective.

Methods: This study is a cross-sectional study involving sixty-three colorectal patients who underwent surgical procedures between 2015 and 2017 were evaluated retrospectively for complete ERAS protocol implementation. The complete implementation is the ability to accomplish all 15 ERAS components. Demographic, clinical, and total LOS data were also collected from medical records. These samples were analyzed using univariate analysis and Pearson correlation tests to determine the relationship between the number of ERAS components that accomplish per subject and the LOS of the patient.

Results: Eleven out of 15 ERAS components were implemented on 63 patients. The majority of the cohort were female (male-to-female ratio of 1:1.2) with an average age of 53 years, 0% mortality, 7.9% morbidity (1.6%, 1.6%, and 4.8% due to surgical site infection, pneumonia, and urinary retention, respectively), and underwent conventional rather than laparoscopic surgery (84.1% vs. 15.9%). The most common location of tumors and procedures were sigmoid (47.6%) and colostomy closure (25.4%). None of the patients was able to comply with all components of the ERAS protocol; however, the results from 6 patients who implemented ten or more components of the ERAS protocol showed a higher reduction rate of the total LOS from 8−12 days to only five days (a reduction rate of 62.5%) compared to patients who completed less than 10 components (p<0.01, r=−0.568).

Conclusion: Implementing at least 10 ERAS components may have a similar impact to fully implementing the ERAS protocol regarding how patients who have colorectal surgery are managed. These ten components are subsequently called the adjusted ERAS protocol for colorectal surgery.

Link of Video Abstract: https://youtu.be/yS431sCL3VQ

Background: Several studies have reported that modern wound dressings offer better results. Allogeneic PRP products in the form of injections and gels are available in the market, which helps accelerate wound healing without triggering an immunological reaction. Meanwhile, this study was carried out to investigate the Allogeneic Freeze-Dried PRP form, which is more practical, efficient, and safer. This study aims to determine the effect of Allogeneic Freeze-Dried PRP on human split-thickness skin graft donor wounds on clinical manifestations of allergic reactions and levels of Immunoglobulin E (IgE).

Methods: A randomized Pre- and Post-test Control-Trial Group Design was conducted on patients with split-thickness skin graft donor wounds using Allogeneic Freeze-Dried PRP dressings at Dr. Soetomo General Hospital, Surabaya. Allergic manifestations were reviewed during the observation period of up to 4 days, and IgE levels were measured pre-test and 60 minutes post-application. A statistical comparison of results was carried out between the trial and control groups that used paraffin dressings.

Results: A total of 36 patients were used as subjects, with 19 (52.78%) in the trial group and 17 (47.22%) in the control group, and their parameters were generally homogeneous. There were no clinical manifestations of allergic, changes in vital signs, and significant differences in IgE levels before and after application statistically in all study subjects (p>0.05).

Conclusion: Application of Allogeneic Freeze-Dried PRP to human split-thickness skin graft donor wounds did not generate clinical manifestations of allergic reactions and an increase in IgE.

Background: Gastric mucosal protective factor plays an important roles in gastric homeostasis between mucosal injury and mucosal repair. Previous study implicated probiotics in the repair of the intestinal mucosa, while probiotic role in gastric mucosa remains poorly understood.  This study aims to determine the role of probiotic L. plantarum IS-10506 in gastric protective mucosal factors by examining the expression of cyclooxygenase-1 (COX-1), COX-2, prostaglandin E2 (PGE2), and gastric mucus production (Mucin 5AC/ MUC5AC) by surface mucous cells as gastric mucosal protective factors.

Methods: Twenty-seven male Wistar rats (Rattus norwegicus) were divided into 3 groups, ie. control, curative and preventive group. Ibuprofen 300mg/kgBW were given to all groups to induce gastric injury, while Lactobacillus plantarum IS-10506 1x10⁹ CFU/day were given into the curative (5 days) and preventive (12 days) groups. Antrum tissue with primary monoclonal antibodies againts COX-1, COX-2, PGE2, and MUC5AC were examined in the day -1, -3, and -5 after necropsy.

Results: Number of cells expressed COX-1, COX-2, PGE2 and MUC5AC in curative and preventive groups were significantly higher than control group. L. plantarum IS-10506 showed its efficacy in gastric mucosal repair on third day in the curative group and on first day in the preventive group. L. plantarum IS-10506 probiotic plays a role in gastric protective mucosal factors by promoting cell expression of COX-1, PGE2, and MUC5AC. In addition, it has been determined that L. plantarum IS-10506 inhibits COX-2 expression, that may lead to minimalize the inflammatory conditions and a deterioration of the gastric mucosal environment.

Conclusion: Lactobacillus plantarum IS-10506 can prevent ibuprofen-induced antral mucosal damage through gastric protective mucosal factors.

Background: Hirschsprung is a congenital disorder of the distal bowel caused by the absence of a ganglion in the Aurbach and Meissner plexuses. Definitive treatment of the disorder is operative, namely by resection of the aganglionic segment of the intestine and performing a pull-through on the ganglionic segment. It cannot be denied that there are still disturbances in the pattern of defecation after definitive surgery, even though the pull-through segment has enough ganglion cells. Interstitial cells of Cajal (ICC) are the pacemaker in smooth muscle contraction in the intestine. In several studies, the number of these cells decreased in Hirschsprung's disease (HD), and it is not known with certainty the effect on the occurrence of defecation pattern disturbances.

Methods: Data were collected retrospectively from all patients with Hirschsprung’s Disease (HD) who underwent Duhamel Procedure in Dr. Soetomo General Hospital, starting January 2016 – December 2021. Correlation analytic research with a cross sectional design was performed to analyze the correlation between the number of ICC and the defecation pattern of patients at Dr. Soetomo after Duhamel surgery.

Results: From this study, it was found a decrease in the number of ICC in the ganglionic segments of the resected specimens from pull-through surgery. From the results of the correlation test, it was found that the p-value was 0.49 for the defecation pattern of postoperative Duhamel patients at Dr. Soetomo for the period January 2016 – December 2021.

Conclusion: In this study, a significant correlation was found between the number of ICC and definitive pull-through postoperative defecation pattern.

Background: Tuberculosis (TB) is an infectious disease that is the leading cause of death from a single infectious agent worldwide. Culture is still the gold standard for the diagnosis of pulmonary TB. As an important specimen, sputum is often contaminated by normal flora at the time of collection, making the decontamination process an essential step of Mycobacterium tuberculosis culture. Decontamination with chlorhexidine 0.7% is expected to improve the detection of Mycobacterium tuberculosis in the culture method better than Modified Petroff's method.

Methods: This research is an experimental study. Sputum was collected from pulmonary TB patients. Each sputum was decontaminated with chlorhexidine 0,7% and others with Modified Petroff's. Decontaminated sputum inoculated on Lowenstein-Jensen media. Samples were incubated, and evaluated the recovery rate of Mycobacterium tuberculosis. Data were analyzed using SPSS version 25.0 for Windows.

Results: In total, we collected 16 sputum with 11 (68.75%) direct smear positive, 14 (87.5%) smear positive by chlorhexidine 0.7% method, and 13 (81.25%) by Modified Petroff's method. The number of cultures positive for Mycobacterium tuberculosis by chlorhexidine 0.7% method was 14 (87.5%), of which 11 (68.75%) have specific colony characteristics of Mycobacterium tuberculosis, 3 (18.75%) non-tuberculous mycobacteria, and 1 (6.24%) mixed. In Modified Petroff's, 6 (37.5%) were positive cultures and showed only growth of Mycobacterium tuberculosis. The contamination rate was 1 (6.25%) using chlorhexidine 0.7% and 8 (50%) using Modified Petroff’s method.

Conclusion: Chlorhexidine 0.7% has a higher recovery rate in the culture of Mycobacterium tuberculosis compared with Modified Petroff's, showing recovery of non-tuberculous mycobacteria and a lower contamination rate.

Introduction: Fall risk is generally increased in older adults. The aging process is linked to several balance issues and gait abnormalities in the elderly. A multicomponent exercise program for older persons that combines locomotor training and cardiovascular exercise may help the aged population's balance and strength. This study aims to investigate the effects of aerobic exercise and locomotor training on the elderly's capacity to balance.

Methods: This study is a randomized clinical trial with a pre-test and post-test group design. 24 older adults were divided into an intervention group (locomotor training combined with aerobic exercise) and a control group (aerobic exercise only). They underwent locomotor training 3 times a week for 8 weeks under supervision and aerobic exercise 7 times a week 40-70% HR maximal. The pairwise comparisons within-group evaluations, and between-group evaluations used independent- and paired-sample t-tests.

Results: One Leg Stance (OLS) and Timed Up and Go (TUG) test intra-group and inter-group differences were significantly higher (p< 0.05).

Conclusion: The combination of locomotor exercise and aerobic exercise improves static and dynamic balance in older adults with locomotive syndrome stage 1.

Background: A hospital must maintain and increase patient visits by presenting and providing quality services. This study examines factors determining inpatient satisfaction concerning nursing care at Siti Hajar General Hospital, Medan, Indonesia.

Methods: A cross-sectional descriptive study was conducted on 67 patients hospitalized at Siti Hajar General Hospital using the accidental sampling method from January to October 2018. Data were collected using a standardized questionnaire, while univariate and bivariate tests were used for data analysis. Furthermore, the SPSS version 20.0 for Windows was used for the Spearman Correlation test with a p-value <0.05 considered significant.

Results: The study showed that there were a significant correlation between nursing care in the form of attention (p=0.002), acceptance (p=0.016), communication (p=0.010), cooperation (p=0.004), and responsibilities (p=0.011) with inpatient satisfaction at Siti Hajar General Hospital.

Conclusion: Nurses must actively respond to every patient complaint and show a caring attitude. They also have to communicate with patients and families about their disease and explain all activities related to nursing care actions for adequate understanding and compliance.

Background: Microscopy imaging-based detection is the main component of the malaria diagnostic test. The healthcare technician’s skill and experience will influence the results of the malaria microscopy examination. The polymerase chain reaction (PCR) is another sensitive detection technique that can be used as a diagnostic tool. PCR methods can be based on the conventional method or Real-time PCR. Real-time PCR is said to be more sensitive than the conventional one.  This study aimed to compare the performance of Malaria microscopic imaging, Conventional PCR, and Real-time PCR (abTESTMMalaria qPCRII) for detecting Plasmodium in human blood.

Methods: This research was a cross-sectional analytical study that successfully generated 150 specimens from November 2018 to June 2019. Blood samples were examined using microscopy imaging detection, RT-PCR, and conventional PCR.  Mann-Whitney test was used to analyze the performance of each test, which was significant if p < 0.05.

Results: A total of 150 participants were recruited. Ninety-eight subjects were detected positive by microscopic method and then compared to RT-PCR and conventional PCR. Plasmodium vivax dominated the features of the subject in all three tests. The tests show several multiple infections, like double and triple infections, especially when done by RT-PCR (28.6%). Mann-Whitney analysis revealed the significant difference between microscopic detection and  Real-Time PCR AbTes in detecting P falciparum (Pf), P vivax, and P malariae (Pm) (p<0.05). PCR Conventional and Real-time AbTes also differed significantly while evaluating  Pm.

Conclusion: Real-time PCR (abTEST Malaria qPCRII) positivity was beyond microscopic imaging and conventional PCR. It also shows significant differences with another test detecting P falciparum, Plasmodium vivax, and P malariae.

Introduction: Slow transit constipation ended up causing persistent symptoms that do not respond to medical treatment. Children have common soiling, irregular bowel movements, and colicky abdominal pain. Treatment-resistant slow-transit constipation in children has improved with transcutaneous electrical nerve stimulation (TENS). Several studies reported that TENS therapy was successful in prolonging colonic transit time in children with chronic constipation and reported no side effects. Thus in this study, we would like to investigate the effectiveness of TENS in conjunction with standard therapies for constipated children with cerebral palsy (CP).

Method: This was a cross-section study with a consecutive random sampling technique. This study was conducted from April 2022 – October 2022, in the faculty of medicine, Universitas Airlangga, Surabaya, Indonesia. Patients from 2 until 18 years with cerebral palsy suffering from constipation with slow transit time were recognized according to Rome-IV criteria of constipation and colonic transit colon (CTT) based on radio-opaque markers, Sitzmarks^®. In two treatment groups, the intervention group was given laxatives with TENS, and the control group was given laxatives without TENS. Patient records the history of defecation frequency/week, type of stool, and colonic transit colon (CTT) based on radio-opaque markers. Analyses based on statistical parametric comparisons were performed before and after therapy (paired t-test).

Result: Defecation frequency was increased significantly in the intervention group (pre 1.33 ± 0.5 vs post 3.56 +2.0 defecation/week p=0.019) compared with the control group (pre 1.9 ± 01.9 vs post 3 ± 1.8 defecation/week p=0.117). Stools got wetter after stimulation significantly in the intervention group (p = 0.02). Colonic transit was a shorter duration in the children intervention group compared to their based line (p = 0.039).  

Conclusion: Transcutaneous electrical nerve stimulation can speed up colonic transit time to be considered for constipation in CP children.

Background: Low back pain can significantly reduce a patient's quality of life if it is not treated properly. The SF-36 questionnaire assesses the patient's quality of life with chronic low back pain. Transcutaneous vagus nerve stimulation (tVNS) is one of the treatment options for chronic pain. This study aims to determine how adding tVNS to exercise treatment affects the quality of life of individuals with chronic low back pain.

Method: 22 subjects in total joined the study consecutively. They were randomly assigned to the intervention group or the control group. Eleven patients receiving exercise therapy without the addition of tVNS made up the control group, and 11 patients receiving exercise therapy and tVNS made up the intervention group. The SF-36 questionnaire was utilized to assess participants' quality of life before and after two weeks of therapy. Throughout the study, safety and adverse events were monitored.

Results: Both the control and intervention groups showed a positive effect on improving the SF-36 score. The improvement of the SF-36 score on the pain aspect differed significantly in the intervention group (p = 0.011). Adding tVNS to exercise therapy produces a better clinical response in improving the quality of life, especially in pain.

Conclusion: tVNS should be considered as an additional therapy to increase patients' quality of life with chronic low back pain.

Introduction: Polycystic Ovary Syndrome (PCOS) is the most prevalent metabolic disease affecting reproductive-age women and is often present with insulin resistance. Angiopoietin-like-protein-2 (ANGPTL2) is an angiogenic factor influencing insulin resistance in PCOS, manifesting in the anti-mullerian hormone (AMH). There are no previous studies regarding the relationship between ANGPTL2 levels and AMH in PCOS. The study aims to analyse the relationship between ANGPTL2 and AMH levels in PCOS and to compare ANGPTL2 and AMH levels between PCOS phenotypes.

Methods: This cross-sectional study on 43 women aged 18-40 diagnosed with PCOS according to the Rotterdam criteria. Subjects were recruited consecutively and categorized into four PCOS phenotypes. Serum levels of ANGPTL2 and AMH were measured and analysed by correlation and comparison test using SPSS 26.

Results: A total of 43 PCOS samples were included in the study within 4 months. Based on the severity, phenotype A (anovulation, hyperandrogenic and polycystic ovaries) showed the highest levels of ANGPTL2 and AMH. There was no significant difference in ANGPTL2 levels between the PCOS phenotypes. There was a significant difference in AMH levels between phenotypes, where the highest value was between phenotypes A and B. There was a positive correlation between ANGPTL2 and AMH levels.

Conclusion: There is a positive relationship between ANGPTL2 and AMH serum levels. The ANGPTL2 serum levels were not significantly different. In contrast, the AMH serum levels significantly differed across the four PCOS phenotypes, with the highest level found in phenotype A.

Introduction: Adolescence is also called the transition period because, at this time, adolescence has not entered childhood but has not yet entered adulthood. During this period, there will be several changes in adolescence. Adolescents who have been victims of bullying will have a long-term impact that will affect their psychological condition and feel depressed and insecure. Adolescence who are victims of bullying will certainly affect their self-concept. Adolescence will feel that he is helpless, unattractive, weak and unwelcome.

Aims: The purpose of this study was to determine the relationship on the impact of bullying on adolescent self-concept.

Methods: This study used a correlational quantitative method with a cross-sectional approach. The variables examined were the impact of bullying and adolescent self-concept. The sample in this study was 62 respondents who were taken by accidental sampling technique. Prior to data collection, the researcher gave informed consent to prospective respondents and had conducted an ethical test.

Results: The results of this study indicate that the level of impact of bullying on respondents in the medium category is 35 respondents (56.5%), a negative self-concept 43 respondents (69.4%). In addition, there is no relationship between the impact of bullying and adolescent self-concept with the p-value of 0.958 (p> 0.05) and r of 0.007 with a very weak interpretation.

Conclusion: The impact of bullying only slightly affects the self-concept of adolescents, besides that self-concept is influenced by other factors such as parenting patterns of parents, peers, physical appearance and self-esteem.

Background: Borderline ovarian tumors (BOT) are a subset of epithelial neoplasms histologically defined as atypical epithelial proliferation without stromal invasion. BOTs account for 10-20% of ovarian cancer cases. This study aims to know the clinical and pathological characteristics and determine the differences in these characteristics based on age classification.

Methods: A 5-year retrospective study was conducted in a single center. Information was obtained from the pathological reports of 53 patients with BOTs between 2016-2021. Statistical analysis was performed using the Student’s t-test with SPSS version 20.0 (SPSS Inc). Continuous data were analyzed using t-tests, and categorical data were tested with Chi-square or Fisher's exact test to assess differences in clinical and pathological features between the <40 years and the >40 years age groups

Results: Most of the tumor diameters were >10 cm (92.45%) and <10 cm (7.55%). For histopathological description, respectively are MBOT (69.81%), SBOT (24.53%), EBOT (3.77%), and SMBOT (1.89%). There were 29 (45.28%) cases with elevated CA125 levels, and normal levels were 24 (45.283%). Unilateral tumors were 36 (67.92%), and bilateral tumors were 17 cases (32.08%). Serous borderline Ovarian tumor histology was higher in the >40 years group than in the < 40 years group (p<0.05). There was no relationship between cancer antigen (CA) 125 levels and bilaterality, tumor size, or stage (p > 0.05). The mean CA 125 level was higher in the >40 years group (257.92± 64.35) than in the <40 years group (74.42±63.02) (p < 0.05).

Conclusion: The median age of BOT was 40 years old and the majority had a large unilateral tumor with mucinous, the most common histologic type. There was a correlation between age, SBOT histologic type, and elevated CA-125.

Background: Stunting is the most common form of child malnutrition in millions of children in Indonesia, around 37% and one of the highest proportions of stunting is found in West Nusa Tenggara. Breastfeeding counseling during antenatal care (ANC) can encourage early breastfeeding. Still, counseling is not generally done even though the stage I and stage IV of normal labor, coverage exceeds the target and only one-fifth of the midwives provide complete and correct ANC services for the ten-step component service. The study aims to evaluate model of integrated antenatal care services with breastfeeding counseling practices to increase pregnant women's knowledge, skills and readiness to breastfeed

Methods: Pregnant women from Kuripan Primary health care were selected randomly. This study compared two study groups, namely the intervention and control group of third-trimester pregnant women who were given integrated ANC and breastfeeding counseling compared to conventional ANC. Both groups were assessed for the knowledge, skills, and readiness of exclusive breastfeeding mothers before and after counseling. Chi-square test were used to compare readiness, knowledge, and breastfeeding practice before and after intervention in the study group.

Results: The provision of integrated ANC and breastfeeding counseling in this study show a difference between knowledge before and after treatment with a p-value = 0.002 (p<0.05). There was a difference between the practice of breastfeeding before and after the treatment with p-value = 0.003 (p<0.05) and in the integrated antenatal care breastfeeding counseling treatment group it showed that there was a difference in readiness for exclusive breastfeeding before (p = 0.005) (p<0.05) and after being given treatment with p-value = 0.001 (p<0.05).

Conclusions: Integrated antenatal care and breastfeeding counseling have shown differences in increased knowledge, exclusive breastfeeding practices and readiness for breastfeeding.

Background: An e-cigarette is a cigarette that does not contain tobacco. The most toxic compounds in conventional cigarette smoke and e-cigarette vapors are carbonyls, such as formaldehyde which induce lung tissue damage. This study aims to compare the effect of exposure and the difference in duration of exposure to conventional cigarettes and electronic cigarettes on blood formaldehyde levels and alveoli histopathological features in Sprague dawley rats.

Method: This research is an experimental study with 30 white Sprague dawley rats, male, aged 10-12 weeks, and with body weights of 150-250 grams. Rats will be necropsied after intervention for two weeks and four weeks. Blood samples will be examined for formaldehyde levels, and lung tissue will be assessed for alveolar damage. The results were analyzed by one-way ANOVA statistical for blood formaldehyde levels and Mann Whitney for the degree of histopathological damage to the alveoli.

Result: There was no significant difference in blood formaldehyde levels between groups (p>0.05). There was an increasing trend in the intervention group compared to the control and in the fourth-week group compared to the second-week group. There was a significant difference in the degree of alveolar damage in the intervention group compared to the control (p<0.05). There was no significant difference between exposure for 2 and 4 weeks (p>0.05). Between rats given conventional cigarettes and e-cigarettes, there was no significant difference in the degree of alveolar damage at weeks 2 and 4 (p>0.05)

Conclusion: Exposure to conventional cigarette smoke or electronic cigarette vapor has a significant effect on alveoli histopathological features

Background: Foot morphology is an essential intrinsic factor in athlete performance. Therefore, abnormality of the foot morphology, such as flatfoot, can affect the foot biomechanics, reduce motor performance, and increase the risk of injury. Assessment of flatfoot in the competitive athlete is essential to decide on the appropriate management; however, the imaging evaluation method needs special equipment and experience. Footprint analysis using Clarke's angle (CA), Chippaux Smirak Index (CSI), and Staheli Index (SI) offers a cheaper, faster, more effective, and easier method for flatfoot diagnosis. This study aims to determine the validity and reliability of various footprint analysis with calcaneal inclination angle (CIA) from the radiographic image as the standard examination.

Method: This is an analytic observational study with a retrospective cohort design. The data of CIA, CA, CSI, and SI were collected from 70 athletes' medical records from 6 different sports that met inclusion criteria. The validity, reliability, diagnostic performance, and determination of the cut-off point were performed.

Results: The correlation test and intraclass correlation coefficient showed that CSI and SI were valid and reliable in diagnosing flatfoot, while CA was invalid but reliable in diagnosing flatfoot. Area under the curve of the ROC curve and the cut–off point of CA were 0.427 (p=0.403) and 39.32^o; CSI was 0.446 (p=0.537) and 33.58; and SI was 0.418 (p=0.347) and 73.59, respectively. The sensitivity and specificity of CA were 26.78% and 100%; CSI was 10.71% and 100%; and SI was 78.57% and 78.57%, respectively.

Conclusion: Footprint analysis using CA is not valid but reliable in diagnosing flatfoot, while CSI and SI are valid and reliable in diagnosing flatfoot. The Staheli Index has the best diagnostic performance compared to others.

Background: The World Health Organization (WHO) stated that treatment adherence is one determinant of the successful management of pulmonary tuberculosis therapy. Non-adherence can result in recurrence or treatment failure. Knowledge of tuberculosis is crucial for a patient's adherence to treatment, and the level is proportional to the information obtained. This study aimed to determine the relationship between the knowledge level of pulmonary tuberculosis and adherence to anti-tuberculosis drugs (ATD).

Methods: This study is a non-experimental quantitative study with analytic correlation and a cross-sectional approach. Sampling was done at the Umbulharjo 1 Public Health Center, Yogyakarta, Indonesia, in November-December 2021, using purposive sampling with 43 respondents. The knowledge level and adherence were measured using a questionnaire and the Morisky Medication Adherence Scale (MMAS-8). Meanwhile, the relationship between the variables was analyzed using the Pearson Product Moment correlation test with a significance level of 95%.

Results: The results showed that respondents with high, moderate, and low knowledge levels were 88.37%, 11.63%, and 0%, respectively. Respondents with high, moderate, and low adherence to ATD were 95.34%, 4.7%, and 0%, respectively. Furthermore, analysis of the relationship to taking ATD obtained a p-value of 0.001 (<0.05) and a correlation value (r) of 0.609.

Conclusion: Most patients had high knowledge and adherence to medication, and the correlation showed a strong relationship between the variables and taking ATD.

Background: Schizophrenia, which affects about 0.85% of people worldwide, is the most common illness among psychotic disorders. Antipsychotic drugs have been a mainstay of schizophrenia treatment. Antipsychotics are now the most typical factor causing increased prolactin levels (hyperprolactinemia). This research aimed to determine the overview of prolactin levels in patients with schizophrenia that receive antipsychotic therapy at HB. Saanin Mental Hospital Padang.

Methods: This descriptive research included 50 patients with schizophrenia at HB. Saanin Mental Hospital Padang in July-December 2020. It was conducted using the ELISA test method to analyze prolactin levels. Data were analyzed using SPSS version 20.0 for Windows.

Results: From a total sample of 50 patients, the research subject characteristics were as follows, the mean age of the research subjects was 39.48±12.53 years old, most were male (68.0%), and the most used antipsychotics given were second-generation antipsychotics (Atypical) (64%). The prolactin level among the research subjects was 30.20 ng/mL (CI 95% 25.18-36.31). It indicates that the average prolactin level in the research subjects is higher than the normal prolactin level, which is 5-25 ng/mL. The research results showed that females have a significant higher average prolactin level than males (p<0.05). However, the use of typical, atypical, and combination antipsychotics do not show significant differences between groups (p>0.05).

Conclusion: Patients with schizophrenia at HB. Saanin Mental Hospital Padang, who became the research respondents and consumed antipsychotics, has higher prolactin levels than average.

Introduction: COVID-19 cases in Indonesia continue to grow, including in Padang, 48% of the largest contributors to cases in West Sumatra. The distribution cluster occurs in the economic center of Pasar Raya market Padang. Traders are very at risk of contracting COVID-19 because of the dense market activity and interaction between sellers and buyers. The first survey by the COVID-19 Task Force showed that 40% were reprimanded for not implementing health protocols. This study aims to determine the factors related to the compliance of Pasar Raya Padang traders in implementing health protocols.

Methods: The type of research conducted is analytical with a quantitative approach to prove the existence of a statistical correlation between the variables studied. The total sample in this study amounted to 103 respondents. The sampling techniques used in this study are a proportional random sampling.

Results: 103 respondents showed that most respondents were female 52.4%. Respondents were dominated by the elderly age group aged 45 years 39.8%, 26-45 years were 31.1% and the young group 29.1 %. Variable dependent obedience 53.4% or 55 people. Independent variables, knowledge, attitude, and environment. Respondents have high knowledge 60.2%, positive attitude 51.8% and a supportive social environment 53.4%. Bivariate analysis showed a significant relationship between knowledge, attitude, and environment with compliance with health protocols. Based on qualitative results, the inconvenience of wearing a mask is the main priority of the obstacles found.

Conclusion: There is a significant relationship between knowledge, attitude, and environment with compliance with health protocols. Education about implementing health protocols and the vulnerability of traders to COVID-19 infection, as well as strict monitoring of effectiveness to improve merchant compliance with health protocols.

Introduction: Interprofessional education is a learning method that involves two or more professions learning from each other to create effective collaboration. Meanwhile, the education program at the medical faculty still adheres to each study program's curriculum, which creates obstacles in implementing IPE courses. This study aimed to assess the readiness and perceptions of students and teaching staff at the Faculty of Medicine, Universitas Udayana, regarding implementing IPE.

Methods: This study used a cross sectional design. Research subjects were collected using the total sampling method, and data were collected using IEPS and RIPLS questionnaires and distributed online. Data were analyzed using the SPSS ver.25.0 programs using the chi-square test, with a p <0.05, considered statistically significant.

Results: Based on the research results, the total number of research respondents was 37 supervisors and 416 students with an average age of 40.6±6.15 years and 19.05±1.04 years, respectively. Based on the results of research on supervisor respondents, it was found that the average IEPS and RIPLS scores were 85.41±9.15 and 76.86±5.35, respectively, with a distribution of readiness levels dominated by good IPE readiness (>75) of 22 people (59.5%). While the student respondents found an average score of IEPS and RIPLS, respectively 86.42±10.64 and 75.58±5.94, with a distribution of readiness levels dominated by good IPE readiness (>75) of 229 people (55.0%).

Conclusion: Based on the study results, it can be concluded that supervisors and students of the Faculty of Medicine, Universitas Udayana, have a good level of perception and readiness for IPE.

Link of Video Abstract: https://youtu.be/XrtI29YbnTs

Background: Osteoarthritis (OA) is the most common form of arthritis, which cause pain and disability that can affect the quality of life. The inflammation in OA is chronic and characterized by the infiltration of immune cells and the secretion of cytokines. Previous OA treatment used hyaluronic acid intraarticular injection, but several studies show no satisfactory clinical outcome. This study aims to determine and compare the anti-inflammatory and anti-catabolism effects of stem cell-derived secretomes versus hyaluronic acid as the gold standard for the treatment of OA.

Methods: This research was conducted using an experimental randomized post-test-only control group design. According to veterinarians, the population in this study were local rabbits, aged 6-8 months, weighing > 1,500 grams, and healthy. Data were analyzed using SPSS version 22.0 for Windows.

Results: Twenty-two subjects were included in each treatment and control group. From the descriptive analysis, it was found that MMP-13 levels were 7.55 ± 0.23 (Treatment) (ng/mL) and 8.36 ± 1.04 (Control) (ng/mL), ADAMTS-5 levels were 0.83 ± 0.08 (Treatment) (ng/mL) and 1.14 ± 0.33 (Control) (ng/mL), and levels of IL-1β 23.0 5± 2.48 (Treatment) (ng/mL) and 26.81 ± 5.57 (Control) (ng/mL). From the inferential test, it was found that all research results were statistically significant (MMP-13= 0.81; p = 0.021; 95%CI = -1.48 – (-0.13)) (Agrekanase 2 = 0.32; p = 0.006; 95% CI = -0.53 – (-0.09)) (IL-1β = 3.76; p = 0.023; 95% CI = -7.59 – (-0.08)).

Conclusion: Administration of mesenchymal stem cell-derived secretomes resulted in significantly lower levels of MMP-13, Agrekanase 2, and IL-1β compared to administration of hyaluronic acid in rabbit knee osteoarthritis

Background: Late-onset neonatal sepsis (LONS) is a leading cause of death and morbidity among preterm neonates. Early diagnosis is crucial for appropriate and prompt management. A rapid, simple, and readily accessible diagnostic tool is important to diagnose LONS early. This study aims to assess the diagnostic value of the neutrophil-lymphocyte ratio (NLR) and NLR combined with the immature-to-total (I/T) ratio for diagnosing LONS.

Methods: This retrospective cross-sectional study collected data from Cipto Mangunkusumo Hospital Neonatology Division medical records from January 2018 to December 2019. Preterm neonates with 31-36 weeks of gestational age, 7-28 days of postnatal age, and clinical sepsis were eligible for this study. Enrolled neonates were classified into two groups, proven sepsis, and unproven sepsis. The NLR and I/T were taken from the medical records.

Results: From 126 subjects, 70 were proven sepsis, and 56 were unproven. Receiver operating curve analysis for NLR was calculated, and the area under the curve of NLR corresponded to 0.953. The NLR cut-off point with the highest specificity and positive predictive value (PPV) was 1.785 (78.57% sensitivity, 92.86% specificity, 93.22% PPV, and 77.61% negative predictive value). Using a cut-off point of > 0.2, the I/T ratio has 55.70% sensitivity,  83.70% specificity, 81.25% PPV, and 60.26% NPV. The NLR and I/T ratio increased the sensitivity and PPV of the I/T ratio to 90% and 84.44%, respectively.

Conclusion: The NLR with cut-off point 1.785 has good diagnostic value for LONS in 31-36 weeks preterm neonates. A combination of NLR and the I/T ratio can increase the diagnostic value of the I/T ratio.

Introduction: Bloodstream infections can lead to a high rate of life-threatening sepsis, morbidity and mortality, requiring early and accurate detection. The gold standard for diagnosing bacteremia is blood culture. The recommended incubation time of blood cultures is five days minimum, but studies have shown that five-day incubation is unnecessary. This study aims to determine the optimal blood incubation time on the BACTEC^TM FX machine.

Methods: This is an analytic observational study with a cross-sectional retrospective approach. The samples resulted from tests in the Clinical Microbiology Laboratory and medical record data of patients at Dr. Soetomo Regional Public Hospital, Surabaya, with suspected bacteremia and fungemia-positive blood cultures based on tests with the BACTEC^TM FX machine who met the inclusion criteria. Samples were analyzed for Time to Detection (TTD) and identification results. TTD of 96–120 hours was analyzed to assess the occurrence of Laboratory-Confirmed Bloodstream Infection (LCBI).

Results: From a total of 2,221 samples, 875 (39.4%) pathogenic microorganisms and 1,346 (60.6%) nonpathogenic microorganisms were identified. At TTD < 24 hours, the number of pathogenic microorganisms was higher, reaching 86.6%, than that of nonpathogenic microorganisms, reaching 68.8%. Whereas at TTD of 24–< 48 hours, nonpathogenic microorganisms had a higher count, reaching 23.1%, than pathogenic microorganisms, reaching 10.1%. A total of 2,203 (99.2%) microorganisms were identified at TTD < 96 hours, and as many as 18 (0.8%) microorganisms with TTD > 96 hours.

Conclusion: There is no difference in the distribution of pathogenic and nonpathogenic microorganisms at TTD < 96 hours and TTD 96–120 hours. Based on tests using the BACTEC^TM FX machine, five LCBI-group microorganisms based on NHSN criteria were found with TTD of 96–120 hours, namely Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Trichosporon asahi, and coagulase-negative Staphylococcus, and thirteen non-LCBI-group microorganisms were identified.

Purpose: To determine the effectiveness of calamansi orange peel aromatherapy in reducing pain and anxiety in the active first stage of labor.

Patients and methods: This research is a quasi-experimental pre-posttest control group design. The number of samples was 60 people, 30 mothers for each intervention and control group. Samples were obtained by accidental sampling from 10 independent Privat Midwifery Clinics in Bengkulu and divided into 2 groups randomly. Pain level was assessed by VAS, and anxiety level was measured by HARS. Data were collected before the intervention (pre-test and after the intervention (post-test) 1 (dilatation 4), post-test 2 (dilatation 7-8 cm), and post-test 3 (dilatation 9-10). Meanwhile, the level of anxiety was only measured 2 times during the pre-test and post-test (dilatation 4). The results were analyzed using the Wilcoxon signed rank test and the Mann-Whitney U test.

Results: The results showed that in the intervention group, it was known that there was an effect of giving calamansi orange peel aromatherapy on pain (0.001) and anxiety (0.001) in mothers in the active phase of the first stage of labor. In the control group given orange aromatherapy, the results also showed an effect on pain (0.005) and anxiety (0.046). The results of the Mann-Whitney U test showed that there was a significant difference between the intervention and control groups in post-test 1 (0.000) and post-test 2 (0.004), but there was no significant difference in post-test 3 (0.121). Meanwhile, for the level of anxiety, it is known that there is a difference between the intervention and control groups (0.042).

Conclusion: Using aromatherapy of calamansi orange peel essential oil as a complementary therapy effectively reduces the level of pain and anxiety in mothers during the active phase of the first stage of labor.

Background: The transmissibility and severity of coronavirus disease 2019 (COVID-19) are higher in the delta variant (B.1.617.2) infection responsible for Indonesia's second epidemic wave. This study aimed to establish an epidemiological profile of COVID-19 in patients with diabetes mellitus, a comorbid that has been widely suggested for its association with increased severity and mortality.

Methods: This study employed a retrospective observation on medical records from May to December 2021. Patients (n=115) aged >18 presented with COVID-19 and diabetes mellitus were enrolled. The SARS-CoV-2 infection was confirmed by a pharyngeal swab sample's reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The diabetic condition was determined by previous medical records and persistent level of random blood sugar (RBS) of >200 mg/dL. Demographic, clinical characteristics, COVID-19 symptoms, radiological findings, and hematological and coagulopathy markers were collected from the medical records. The data were presented as frequency (%) assigned based on severity levels: mild, moderate, severe, and critical COVID-19.

Results: A group of patients aged 50—59 years had higher prevalence of severe COVID-19 (n=14; 28.6%) than the other groups. Severe cases were relatively more common in a group with body mass index (BMI) ranged from 30—<35 kg/m² (n=13; 27.1%). Notably higher number of severe cases was recorded in patients having <3.5 mg/dL albumin (n=11 out of 50), >200 mg/dL RBS (n=22 out of 93), and ≥1 μg/mL D-dimer (n=18 out of 73). Critical COVID-19 cases were found in those with C-reactive protein levels of <5 mg/L (n=6; 6.8%) and procalcitonin levels of ≥0.05 ng/mL (n=6; 7.1%). Patients who had stage 1 and 3 chronic kidney disease (CKD) were found to develop critical COVID-19 with a frequency of 5.9% (n=2) and 10.5% (n=4), respectively.

Conclusion: The severity of COVID-19 in diabetic patients is indicatively associated with the age, BMI, hematological and coagulopathy markers, and CKD. Active monitoring of these parameters in diabetic COVID-19 patients is encouraged.

Introduction: Since Islam is the dominant religion in the country, it is evident that Muslims make up most of the patients at Islamic hospitals. By incorporating Islamic values, Islamic hospitals should get Islamic nursing care. How patients perceive a hospital can be used to gauge its effectiveness. One of the reasons Islamic nursing should be practised is due to patient requests. This study aimed to understand how patients perceive Islamic nursing care.

Methods: Descriptive quantitative study was used with adult inpatient ward patients. Eighty-four subjects in this study met specific requirements and used accidental sampling. A valid and reliable Likert scale and a questionnaire with 26 questions made up the study instrument. Frequency distribution-based data analysis.

Results: Patients perceived good in three components, including doing care only with same-sex patients (88.1%), assisting prayer (66.7%) and doing Islamic communication (66.7%). At the same time, the poor perceived is to assess the spiritual aspect and help with prayer.

Conclusion: Based on the findings of this study, nurses can better attend to patients' spiritual needs to ensure that they receive Islamic nursing care.

Introduction: Blood transfusion has been widely used in various medical services due to its benefits. Blood transfusion units (UTD) in Indonesia remain to experience a shortage of 972,552 blood units, or amounted to 18.8%. The percentage of female donors in Indonesia is 27.5%, while that of male donors is 72.5%. This large difference in proportion is caused by various erroneous assumptions, including that women are considered to have donated blood naturally every month through the menstrual process. This study aims to prove the low proportion of female donors and discovering the profile of female donors in the Blood Transfusion Unit (hereinafter referred to as UTD) of Dr. Sardjito General Hospital (hereinafter referred to as RSUP Dr. Sardjito) Yogyakarta.

Methods: This descriptive study utilized data from 62,221 blood donors in 2017–2019 taken from the donor database of the UTD of RSUP Dr. Sardjito Yogyakarta.

Results: Female donors at RSUP Dr. Sardjito in 2017-2019 reached 13,873 (22.3%) donors, 71.6% of them having an age range of 17-30 and 38.31% of them having blood type O. Rhesus positive was found in 99.58% of donors, while rhesus negative was found in 0.42% of donors. Female donors with a Hb range of 12.5-14 g/dL reached 69.16%, while those with a Hb range of 14.1-15.5 g/dL reached 26.97%. Whole blood component was found in 99.97% of donors, and voluntary donor status was found in 94.25% of donors.

Conclusion: The proportion of female donors is much smaller than that of males, with the majority being whole-blood donors. The most common blood type found in female donors is O, and the highest age range is 17 to 30. The highest Hb range is 12.5-14 g/dL. Most of them are voluntary donors. 

Background: Nesfatin-1 and leptin are hormones that control appetite and affect glycemic control. Nesfatin-1 and leptin levels are affected by body mass index (BMI). Hemoglobin A1c (HbA1c) is an objective parameter to assess long-term glycemic control. This present research aims to know the relationship between levels of nesfatin-1 and leptin with HbA1c values ​​as an indicator of long-term objective glycemic control in patients with T2DM with obesity.

Methods: Cross-sectional study on 54 obese T2DM subjects. Measurement of nesfatin-1 and leptin levels using the enzyme linked immunosorbent assay (ELISA) method. The value of HbA1c was measured by the fluorescent immunoassay (FIA) method. The correlation between nesfatin-1 and leptin with Hb1c was tested using the Spearman correlation analysis test (p <0.05 was considered significant).

Results: The median value of nesfatin-1 levels was 1,824.0 (134.0-5,255.0) pg/mL, the median value of leptin levels was 14.0 (0.4 - 66.4) ng/mL, and the median value of HbA1c was 7.70 (4.9-15.0)%. There is no correlation between nesfatin-1 levels and HbA1c values (p = 0.282 and r = 0.149). There is no correlation between leptin levels and HbA1c values (p value = 0.895 and r = 0.018).

Conclusion: HbA1c levels are not associated with an increased appetite, as evidenced by no association between appetite biomarkers and glycemic control.

Background: Staphylococcus aureus is the main pathogen infect chronic rhinosinusitis (CRS) and the biofilms play an essential role in the pathophysiology of infection and treatment of patients. However, research on clinical conditions is still limited. This study aimed to evaluate the relationship between S. aureus biofilms with severity and infection degree in CRS patients.

Methods: A post-test-only study was conducted at Dr Zaionel Abidin Hospital in Banda Aceh, Indonesia from January to April 2022. Thirty-five CRS patients, classified according to the disease severity and infection degree, were included and followed in the study. A mucosal swab on each patient was collected and biofilm formation analyzed quantitatively and qualitatively using a spectrophotometer and scanning electron microscope (SEM), respectively. The relationships between the bacterial growth, biofilm formation and mass of biofilms with the disease severity and degree of infection were assessed statistically.

Results: More than half of the patients (54.3%) were aged younger than 40 years, and 51.4% were male. Nasal congestion and rhinorrhoea were the most common reported obligate symptoms (78.2%) and 82.9% patients have additional symptom on facial pain. There was the relationship between bacterial growth and disease severity (p=0.046) and infection degree of CSR cases (p=0.031). Our data showed a significant association between biofilm formation and the disease severity (p=0.022) and infection degree of CSR patients (p=0.020). The mass of the biofilm was also associated significantly with disease severity (p=0.029) and degree of infection (p=0.018).

Conclusions: Our study shows that the formation and mass of biofilm associated with the disease severity and degree of infection in CSR. Biofilms may contribute to the clinical condition and also be considered during management of CRS patients.

Link of Video Abstract: https://youtu.be/BQ3uiW1O8GQ

Background: The quadriceps angle (Q-angle) affect the biomechanics of the lower extremities and is important in assessing the knee joint function. Increasing Q-angle can increase the risk of knee injury and also the chance of an athlete withdrawing from training or competition. Ligament laxity, gender, and high body mass index are proposed as risk factors for increasing Q-angle. Only a few research have investigated the correlation between these risk factors and Q-angle in competitive athletes, especially in Indonesia. This study aims to determine the correlation between Beighton score, genders, body mass index and Q-angle in competitive athletes in Indonesia.

Method: This study was a non-reactive study that used medical records from 94 competitive athletes collected to determine the subjects’ characteristics and research variables. The sampling technique was proportional random sampling. Ordinal regression tests were performed to assess the correlation between Q-angle and Beighton Score, Genders, and Body Mass Index in competitive athletes.

Result: There is a significant correlation between Beighton score and Q-angle in the supine position (p=0.000, R=2.829) and standing position (p=0.000, R=2.839), as well as body mass index and Q-angle in the supine position (p=0.003, R=0.23) and standing position (p=0.002, R=0.259), but there is no significant correlation between genders and Q-angle in the supine position (p=0.262, R=0.517) and standing position (p=0.235, R=0.550).

Conclusion: In competitive athletes, there is a strong correlation between Beighton score and Q-angle in both positions, as well as body mass index in both positions; nevertheless, there is no correlation between genders and Q-angle.

Background: Children with cerebral palsy (CP) often experience many comorbidities, such as constipation. Pain and discomfort that often accompany constipation have an impact on behavior and decrease quality of life. Abdominal muscle weakness can cause a low increase in intra-abdominal pressure so that the expulsive force during defecation is not adequate. The aim of this study was to evaluate the addition of interferential current (IFC) therapy on standard therapy (lactulose) on abdominal muscle activity in children with cerebral palsy (CP) with constipation.

Methods: This research is a true experimental study with pre and post-test randomized control group design. Subjects were 18 children with CP who were constipated according to the ROMA IV criteria, which were divided into two groups, namely the control group who received standard therapy (lactulose) and the intervention group who received lactulose plus IFC therapy with a frequency of 4000-4100 Hz, duration 20 minutes, 3 times a week for 1 month. The parameters evaluated in this study were the value of abdominal muscle activity at rest and during contraction. Measurements were carried out twice, before and one week after the completion of the IFC therapy series. Data were analyzed computerized with SPSS v20.0.

Results: There was a significant decrease in abdominal muscle activity at rest (P= .024) in the treatment group, while there was an insignificant increase in the control group (P= 0,266).

The abdominal muscle activity during contraction in the treatment group showed a greater increase (P= 0.730) than in the control group (P= 0.831). The effect size in the treatment group is 0.2, which means it has a small effect, while in the control group is 0.1, which means it has no effect.

Conclusion: The addition of IFC to standard therapy (lactulose) can improve abdominal muscle activity so that IFC can be an alternative supporting therapy in cerebral palsy with constipation to provide a good clinical response.

Introduction: Foodborne illness is a significant global public health issue. Improper food handling and personal cleanliness can result in a few ailments. Over 400 food-related infections have been found by the CDC, of which food handlers cause 20%. Escherichia coli is often found in hospital food handler hand and nasal swabs. This study aimed to ascertain the prevalence of  E. coli and the antibiotic susceptibility profile of food handlers working in hospitals in Jember City, Indonesia.

Method: A cross-sectional investigation uses a total sampling method held between October and November 2022. Inclusion criteria are asymptomatic food handlers that have not taken antibiotics for the last three months and have already given informed consent. Exclusion criteria are food handlers who’s sick or with incomplete questionnaires. We performed hand and nasal swabs and continued with bacteria identification, culture, and antibiotic sensitivity tests.

Result: Ten food workers (14.71%) and fourteen (20.59%) of the 68 who underwent hand and nasal swab culture screenings for E. coli were positive. All E. coli hand swab isolates were susceptible to levofloxacin and azithromycin antibiotics. Still, of the 10 E. coli hand swab isolates, 90% were resistant to the antibiotics; penicillin, Cefotaxime, and ceftriaxone, while 70% were resistant to erythromycin. For E. coli isolates originating from nasal swabs, 85.71% were resistant to Cefotaxime, 71.43% to Penicillin and Cefepime, and 57.14% were resistant to Ceftriaxone and Erythromycin. E. coli  Multiple Antibiotic Resistance (MAR) index for hand and nasal swab specimens is 0.18 – 0.82. Most of the hand swab specimens (90%) are Multidrug Resistant (MDR), while nasal swab specimen shows 78.57% Multidrug Resistant (MDR).

Conclusion: The predominance of multidrug-resistant E. coli among hospital food handlers makes it imperative to implement infection control measures, including better biosecurity, to ensure that they do not enter the food supply and limit alternatives to inpatient therapy.

Link of Video Abstract: https://youtu.be/E3KoLryYLng

Background: Helicobacter pylori is a bacterium often found in the stomach and can cause several diseases, including gastritis, gastric ulcers, MALT-lymphoma, and gastric carcinoma. An invasive and direct gastric biopsy is a more appropriate way to see the presence of these bacteria. Microscopy of Helicobacter pylori on gastric biopsy specimens can be seen using several tissue stains. This study aimed to analyze the concordance of immunohistochemistry and toluidine blue tissue stain results on gastric biopsies in detecting Helicobacter pylori at Dr. Soetomo Hospital.

Methods: This study was a retrospective study with a cross-sectional design to detect Helicobacter pylori in paraffin-block of gastric biopsy specimens at Dr. Soetomo Hospital, Surabaya. Each sample would be stained by immunohistochemistry and toluidine blue. Data were analyzed using SPSS version 25 for Windows.

Results: Helicobacter pylori have been found in all 45 samples by immunocytochemical staining and in 66.67% of them by toluidine blue staining. The Kappa test indicated a significant difference between immunohistochemical staining and toluidine blue (p=0.000; p<0.05).

Conclusion: There are significant differences between the two methods for detecting Helicobacter pylori in gastric biopsy. Their concordance is at 66,67%. Some factors should be considered for the future routine process.

Background: The fundamental priority program for controlling Tuberculosis (TB) is accurate and rapid diagnosis. Variable Mycobacterium tuberculosis (MTB) phenotypes were discovered in sputum samples from pulmonary TB (PTB) patients. Active replicating bacteria and differentially culturable tubercle bacteria (DCTB) are present in the sputum. Differentially culturable tubercle bacilli did not grow on the standard medium. Culture filtrate (CF) H37Rv supplementation containing resuscitation-promoting factors (Rpfs) has the potential to increase sensitivity and reduce time to detection (TTD) on culture-based diagnostics.

Methods: This study was a true experimental laboratory. A clinical sample was taken from the sputum of 15 PTB patients, which was "MTB detected" by Xpert MTB/RIF assay. Sputum samples were divided into two groups and inoculated on MGIT 960 in one group with CF-H37Rv supplementation and without in the other as standard MGIT medium.

Results: On both standard MGIT medium and MGIT+CF H37Rv, the recovery rate was 100%. Seven samples (47%) show a growth promotion effect with CF H37Rv supplementation (ΔTTD > 10 hours), while eight samples (53%) show no change in TTD (ΔTTD < 10 hours). There is no evidence that CF H37Rv supplementation inhibits growth. Six of the seven samples with ΔTTD > 10 jam (85,7%) were dominated by samples with acid-fast bacilli (AFB) grading 1+, which could be an assumption related to re-treatment PTB cases, chronic cases, treatment stages, TB-HIV, or follow up of treatments.

Conclusion: There was no difference in recovery rate or TTD between standard MGIT medium and MGIT+CF H37Rv. The supplementation of culture filtrate H37Rv has a greater advantage on samples with low bacterial load (AFB 1+).

Introduction: Knowing the risk of surgery before performing one is essential for informed consent and decisions making for the doctors, patients, and their families. Complexities of surgery and pancreatic cancer aggressiveness are two factors that contribute to high mortality rate in pancreaticoduodenectomy. There has been a few scoring systems developed to predict mortality after pancreaticoduodenectomy. However, external validation of these scoring systems failed to achieve good predictive value consistently. This could happen due to differences in patient demographics, variables and their cut-off, patient samples, and hospital or health care standard where these scoring systems were constructed. This study aims to develop a novel scoring system to predict postoperative mortality and to compare its performance with the existing scoring systems.

Methods: Data were collected retrospectively from all patients who underwent pancreaticoduodenectomy in Dr. Soetomo General Hospital, starting from January 2012 to October 2022. 75 patients were included based on the inclusion criteria. Multivariate logistic regression analysis was performed to select multiple risk factors correlated with in-house mortality. A novel scoring system was formed using these risk factors. We also assessed and compared the predictive value of the existing scores (Parikh, Nugroho, and WHipple-ABACUS) using the ROC curve. Chi square test with odds ratio calculation and logistic regression were used in this study.

 Results: Post pancreaticoduodenectomy mortality rate was 28% (21 out of 75 patients) with 4 statistically significant risk factors. Those factors are age > 52 years. (OR 7.435; 95% CI 1.113-49.677, p = 0.038), comorbidities (OR 5.793; 95% CI 1.116-30.067, p = 0.037), American Society of Anaesthesiology (ASA) 3 (OR 8.932; 95% CI 1.329-60.022, p = 0.024), and total bilirubin > 16.6 mg/dL (OR 8.329; 95% CI 1.577-43.983, p = 0,013). These factors were used to form a novel scoring system. The predictive performance of the newly created scoring system was 0.911 (95% CI 0.823-0.965). While external validation of the existing scoring systems was as follows: Parikh 0.684 (95% CI 0.567-9.787), Nugroho 0.829 (95% CI 0.724-0.906), and WHipple-ABACUS 0.736 (95% CI 0.62-0.832).

Conclusion: The newly created scoring system uses 4 relatively easy and accessible preoperative variables to predict post-pancreaticoduodenectomy mortality. However, it still requires external validation in multicenter hospitals with large numbers of patients.

Introduction: Purnajiwa (Kopsia arborea Blume.) fruit has been traditionally used to improve male sexuality. This study aims to evaluate the potential of K.arborea ethanolic extract to stimulate rats' sexual behavior and testosterone.

Methods: This study used 25 healthy male and 25 female albino rats (Rattus novegicus), aged 15 weeks, and weighed 220-230g. Rats were divided into five groups, with five replications for each group. The phytoconstituent was quantified and analyzed using Gas Chromatography-Mass Spectrometry (GCMS). The sexual behaviors (mount and intromission frequency) and testosterone levels were evaluated in adult male Wistar rats. Three doses of extract (300, 200, and 100 mg/kg BW orally) were compared to sildenafil citrate as standard. Data were statistically analyzed using one-way analysis of variance (ANOVA) and Post Hoc Tukey Honestly Significant Difference (HSD) Test, using IBM SPSS Statistics version 25

Results: Vincadifformine alkaloid was detected as the dominant compound. Treatment of the extract increased all parameters suggestive of dose dependence. Twenty-six days of administration of 300 mg/kg BW of extract produced the highest increase of mount and intromission frequency, higher and similar to sildenafil citrate. Treatment of K.arborea also showed increased testosterone, suggestive of dose dependence.

Conclusion: K.arborea fruit stimulates sexual behavior and plasma testosterone. Nevertheless, further investigation, safety analysis, and mechanism study are required.

Background: Despite the immunoscore benefit function as a prognostic tool in colorectal cancer, no study reports its reason. This study tried to identify the relationship between the immunoscore and the incidence of lymphovascular invasion and clinical stage in colorectal cancer patients as a mechanism for immunoscore to predict the outcome of colorectal cancer.

Methods: This is correlational with a cross-sectional study that analyzed medical record data and laboratory results. Immunoscore was collected from an independent private laboratory, and other data (gender, age, diagnosis, tumor location, lymphovascular invasion) were from medical records from the Private Hospital colorectal cancers registry. Data collection was carried out from October to December 2022. We performed data analysis with the Chi-Square statistical test with a significant p-value<0.05.

Results: The results showed that the majority of subjects had tumor locations in the rectosigmoid (25%) and advanced stages (65%) with lymphovascular invasion findings (80%). Chi-Square statistical test shows the result of p = 0.025 and p = 0.64, respectively, lymphovascular invasion and clinical staging.

Conclusion: This study shows that the immunoscore has a dependent relationship with the incidence of lymphovascular invasion and an independent relationship with the clinical stage of TNM in colorectal cancer patients. The application and use of immunoscore are beneficial for clinicians to give suggestions and understanding to patients about their choice of therapy also outcome for the patient.

Partograph is a simple tool that World Health Organization (WHO) has recommended utilizing during labor monitoring. The ability of health workers in the obstetric unit to interpret clinical data from partograph to detect abnormal labor monitoring is influenced by their knowledge, attitude, and skills. We undertook a systematic review to determine the knowledge, attitude, and skill of partograph among health workers in the obstetric unit. We use the standard of PRISMA guidelines. Different online databases were used for this review: PubMed, ScienceDirect, Scopus, and Google Scholar. We found 16 of 1.957 articles from the selection process which meet the eligibility criteria. Overall, the partograph utilization was low due to a lack of knowledge, poor attitude, and poor skills of health workers. This influences how health workers interpret clinical data from partograph to detect abnormal labor progress. Therefore, on-the-job training and supportive supervision are needed to improve the knowledge, attitude, and skills of health workers in the obstetric unit.

Massage stimulation has been suggested to be used to promote the growth and development of preterm and low birth weight (LBW) infants. Some experts believe that infant massage can help develop the central nervous system, which increases vagal activity, improves hormone secretion, triggers the release of melatonin, and increases its production. Rhythmic endogenous melatonin secretion appears in term infants around 2-3 months of age, whereas preterm infants have delayed melatonin secretion, which persists after correction for 8 to 9 months of gestation. Massage stimulation increases vagal activity, which causes an increase in melatonin. Vagal activity then modulates pineal and extrapineal activity, resulting in melatonin production. Based on scientific evidence, current reviews suggest that massage stimulation can provide health benefits to newborns, particularly preterm infants. This article aims to review that massage stimulation can increase melatonin levels by activating vagal mechanisms.

A chronic inflammatory skin condition called psoriasis affects 1-3% of people worldwide. It will lead to other psychological, endocrine, and cardiovascular issues. It mainly affects the elbows, knees, scalp, back, umbilicus, and lumbar regions and is distinguished by well-defined crimson plaques and thick silvery white scales. Topical corticosteroid cream has been the main therapy in treating inflammatory skin in psoriasis vulgaris until now. Nowadays, andrographolide is an active compound of Andrographis paniculate, or the name in Indonesia is Sambiloto, which has been reported as a potential anti-inflammatory. Therefore, this study aimed to systematically review the published efficacy of andrographolide as an anti-inflammatory in an in vivo study and synthesize the available data. This study was a literature review searched using PubMed/ Medline, Science Direct, and Cochrane up to September 2022. The following search terms were used: (andrographolide or Andrographis paniculate) AND (anti-inflammatory) AND (animal study or in vivo). The bias in the research using the Newcastle-Ottawa quality assessment score was rated as low risk, of some concern, or high risk. A total of six in vivo studies were included in our analysis. Methotrexate and biologic agents are used for the systemic treatment of psoriasis. Topical corticosteroid therapy remains the first line of topical therapy but has some side effects. Specific reporting of andrographolide as a potential anti-inflammatory in other inflammatory diseases is necessary to support the possible treatment for psoriasis. There still needs to be further studies regarding the use of andrographolide as a topical psoriasis treatment.

Medical educators always want the best method for conducting formative and summative student evaluations. The Objective Structured Clinical Examination (OSCE) is an assessment that evaluates aspects of clinical competence in a comprehensive, consistent and structured manner with due observance of objectivity. Clinical skills assessment in OSCE includes history taking, physical examination, communication skills, professionalism, technical skills, problem-solving, decision-making, and time management. However, OSCE is currently one of the exams that students are afraid of, causing sleep disturbances and anxiety. In addition, OSCE involves many personnel in its implementation, so good coordination is needed to create a conducive exam situation. Therefore, evaluation is very important to measure student competency or capability, determine goals that have been and have not been achieved, and get feedback to improve OSCE implementation in the future.

Introduction: Ascariasis is the most common soil-transmitted helminths (STH) infection in children, with prevalence ranging from 6 to 60%, especially in an endemic region in Indonesia such as East Nusa Tenggara, Sumatera, and other remote areas. Ascariasis effects toward undernutrition were still unclear because there were differences between studies. This study aimed to investigate the association between Ascariasis and undernutrition in children.

Methods: Six authors reviewed and analyzed eligible studies from PubMed and MEDLINE, Google Scholar, ProQuest, EBSCO-Host, and Springer Link, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) guidelines with Reference manager was used, and the data analyzed using Revman 5.4. Newcastle-Ottawa Scale adapted for cross-sectional studies was used to examine the publication bias.

Results: This review included 15 studies and 12 studies used for meta-analyses. Pooled data indicates that Ascariasis is significantly associated with stunting (OR = 2.22, 95% CI = 1.31;3.77, p = 0.003) and underweight (OR = 1.27, 95% CI = 1.01;1.60, p = 0.04), meanwhile not significantly associated with wasted (OR = 1.11, 95% CI = 0.87;1.40, p = 0.40) of children aged 0-19 years.

Conclusion: Ascariasis increases the risk of stunting and underweight among other parameters of undernutrition. Therefore, early screening, diagnosis, and intervention must be taken to prevent stunting and underweight in children.

Decision-to-delivery interval of emergency Caesarean Section (CS) Category 1 is a medical intervention that consists of many factors that influence it and should achieve within 30 minutes. In adaptation to the Covid-19 pandemic, health services in hospitals had changed. Thus, this literature review aims to identify factors affecting DDI in emergency CS category 1 during the Covid-19 pandemic. This study was conducted using a scoping review method that referred to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) protocol. The literature search uses electronic databases such as PubMed, ScienceDirect, and Google Scholar with keywords such as “The Covid-19 Pandemic”, “Emergency Caesarean Section”, and “Decision-to-delivery Interval”. Literature included were health reports, clinical practice guidelines or recommendations, and peer-reviewed journal articles without limiting published years. From 451 articles retrieved, 17 articles meet the eligible criteria. Eleven articles discussed factors that influenced DDI of CS emergencies before and during the Covid-19 pandemic and six articles discussed emergency surgery practices recommendations. New factors that had been affecting DDI during the Covid-19 Pandemic were the shortage of health workers number, limited medical supplies, installation of PPE, and infection protocol system due to virus transmission. Postponing elective surgery and new patient triage systems could help the hospitals to achieve decision-to-delivery intervals within the recommended time when medical supplies and shortage of health workers during the Covid-19 Pandemic.

Endometriosis is one of the most frequent abnormalities in women with infertility. Endocrine disruptors, such as dioxin, are considered to affect the development of endometriosis. Various studies have been done to find an association between dioxin and endometriosis, but the results are conflicting. Hence, this study aims to systematically review existing epidemiological studies on exposure to dioxin and the development of endometriosis.

The challenges in the health sector are getting tougher with the opening of the ASEAN Economic Community. Health workers do compete not only domestically but also abroad. To create Indonesian health workers who have good knowledge and skills, think critically, and can make good use of technology, the education process since undergraduate must be continuously improved. Various innovations have been made to form graduates who can compete in the future, including implementing SGD. This review aims to assess the effectiveness of SGD in improving student learning outcomes and critical thinking. The method in this study was a literature review, with 16 articles that met the inclusion criteria. A review of several studies found that SGD can improve medical students' learning outcomes and critical thinking if the process is carried out effectively.

Introduction: Numerous types of inflammatory markers are used by health workers to predict the patients infected with COVID-19 condition. However, fewer studies have identified the specific inflammatory markers to predict the severity, mortality, and need for intensive care treatments among patients infected with COVID-19. Thus, this scoping review aimed to evaluate and grouping the inflammatory markers related to severity, mortality, and need for intensive care treatments.

Methods: Electronic databases were discovered for studies by elaborating specific proposed keywords related to types of inflammatory markers for predicting the severity, mortality, and need for intensive care treatments of patients infected with COVID-19. Authors independently comprised the literature search, evidence evaluation, and article extraction until the types of inflammatory markers for predicting the severity, mortality, and need for intensive care treatments of patients infected with COVID-19 are discovered.

Results: 8 of 133 identified articles were included. These articles summarized that the mean of thrombocyte volume-to-platelet count ratio (MPV/PLT), the C-reactive protein/albumin ratio (CAR), prognostic nutritional index (PNI) and lymphocyte to C-reactive protein ratio (LCRP) were significant in predicting mortality. Lymphocyte-to-monocyte ratio (LMR) and Lymphocyte-to-CRP ratio (LCR) were inversely correlated with disease severity. The systemic-immune-inflammation index (SII) and platelet-to-lymphocyte ratio (PLR) findings were statistically significant in predicting disease severity and the need for intensive care treatments. Moreover, Elevated C-reactive protein (CRP), lymphocyte-to-CRP ratio (LCR), and neutrophil-to-lymphocyte ratio (NLR) were statistically significant in predicting the disease severity, need for intensive care treatment, and mortality.

Conclusion: Each of the inflammatory markers has specificity in predicting the severity, mortality, and need for intensive care treatments among patients infected with COVID-19. These predictors can be used by health professionals, particularly nurses in providing the best clinical decisions and nursing care to COVID-19 patients.

It is natural for women to be pregnant but full of risks.  Food and diet greatly influence the gestation, it can worthful supporting the pregnancy or in the opposite it can also be harmful to and destroy the mother and/or the foetus growing inside her.  Healthy diet at the time of pregnancy is very important. The amount shall meet the requirement, the composition shall be balanced and it has to be safe from anything harmful for the mother or the foetus. Some suggestions such as cooking all food consumed, consuming more fresh food rather than processed and/or canned, avoiding alcohol and cigarette smoke and also limiting salt, simple sugar and seafood are very important to be followed.

Background: Artemisinin-based combination therapy (ACT) consists of a potent artemisinin component. Since the dihydroartemisinin performance effectiveness depends on piperaquine interaction still challenging, further research needs to establish the current status of artemisinin resistance relative to its geography and recognize any drug resistance interaction between dihydroartemisinin and piperaquine. 

Aim: This systematic review was aimed to find out the effect of dihydroartemisinin and piperaquine interaction concerning resistance, recurrence, parasitological failure, clinical failure, parasite clearance time, parasite reduction ratio, cure rate, which may affect treatment failure of patients with uncomplicated P. falciparum.

Method: The article was not limited to year and country. This study analyzed any effect of interaction. Pubmed and Scopus were used as electronic databases, and MeSH terms and keywords were used to find specific studies. A total of 2131 studies were initially identified; however, 20 were eligible for qualitative synthesis.

Result: The dihydroartemisinin piperaquine cure rate reported in Asia and Africa was above 98%. Eight RCTs, eleven prospective cohort studies, and one retrospective and prospective cohort study were included in this review. Design studies did not compare the same anti-malarial drug pattern, so it was difficult to do a pooled analysis. Even though this drug combination did not show a clear description of piperaquine resistance can affect artemisinin resistance, the adequate clinical and parasitological failure (ACPR) from this research reached above 93%, and for early treatment failure (ETF), late clinical failure (LCF), and late parasitological failure (LPF), were almost 0 %.

Conclusion: The dihydroartemisinin-piperaquine combination still has highly efficacious therapy to fight malaria in some areas based on these multiple factors and reviews.

Link of Video Abstract: https://www.youtube.com/watch?v=AC472eZBXII

Background: Most acute leukemias can be classified into myeloid or lymphoid strains based on the expression of several specific phenotypes. However, some cases of acute leukemia express both phenotypes (myeloid and lymphoid phenotypes). To establish the diagnosis of acute leukemia with co-expression of myeloid markers or mixed phenotype acute leukemia (MPAL), we need a system that can differentiate between the two, namely by using the scoring system from The European Group for the Immunological Characterization of Leukemias (EGIL) and The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues 2016.

Case Presentation: A 10-year-old boy was admitted to the hospital because of repeated nosebleeds for 3 weeks before entering the hospital. Patients also complain of decreased appetite, nausea, vomiting, and joint pain. On physical examination, anemic conjunctiva was found, and no abnormalities were found on other physical examinations. Hemoglobin examination: 8.2 g/dl, leukocytes 112.10×10³/µl, platelets 10×10³/µl. Examination of peripheral blood smear: acute lymphoblastic leukemia. Examination results of bone marrow aspiration acute lymphoblastic leukemia (ALL L1). Immunophenotype analysis found blast cells with positive expression for CD34, CD79a, CD10, HLA-DR, CD33 and CD13.

Conclusion: The diagnosis in this patient was B-ALL with myeloid marker co-expression based on the EGIL and WHO scoring systems.

Background: Keratoconus has been reported in as many as 8% to 36% of people with Down syndrome. Corneal hydrops, a complication of advanced keratoconus, is characterized by the sudden onset of severe stromal and epithelial edema resulting from descemet membrane rupture. According to previous studies, acute corneal hydrops occurs in between 0.2% and 2.8% of keratoconus patients, while the incidence of corneal hydrops in Down syndrome patients with keratoconus is unclear. This study aims to evaluate the bilateral keratoconus hydrops in a patient with Down Syndrome.

Case Presentation: We reported a case of bilateral corneal hydrops in a Down syndrome patient aged 28. Upon arrival, his bilateral visual acuity was fixed to follow the object. Slit-lamp examination revealed bilateral corneal edema and apical corneal scarring, and grade 4 plus keratoconus were seen on the Scheimpflug camera system. The patient receives medical treatment to lessen the patient's symptoms while they wait for a cornea donor to do a transplant.

Conclusion: Patients with Down syndrome could experience bilateral corneal hydrops. Strong symptom communication, quick referral, and good cooperation during eye examinations are needed for early detection of this eye condition.

Background: Pancreatic cancer is associated with a poor prognosis and high cancer-related deaths in developed and developing countries because most of the patients are symptomatic until the advanced stage. A small percentage of pancreatic cancer could develop gastric outlet obstruction (GOO) when the tumor causes intestinal obstruction. This case report aimed to highlight the palliative management of GOO due to caput pancreatic cancer.

Case presentation: A 48 years-old male was admitted to Dr Soetomo General Academic Hospital in Surabaya during coronavirus disease 2019 (COVID-19) pandemic with complaint of severe heartburn and pain for the last two months with lump around the upper right abdomen. The pain was not related to diet and only slightly relieved by pain relievers and ulcer medication. The patient also complained of nausea and vomiting after eating and drinking with significant weight loss. Unclear borders mass was palpable. The magnetic resonance imaging (MRI) of upper abdomen yielded the mass of head pancreatic that invaded the duodenum, the involvement of the superior mesenteric artery and multiple lymphadenopathies in the paraaortic. Pathology examination confirming the malignant, ductal adenocarcinoma. With other examinations, the patient was diagnosed as GOO due to T4N1M0 head pancreatic cancer. The tumor was unresectable. The patient underwent urgent double bypass biliodigestive laparotomy as part of palliative management. loop gastrojejunostomy, cholecystectomy and choledocujejunostomy Roux en Y was performed. Celiac plexus block was performed to reduce the cancer pain in the patient.

Conclusion: This case highlights that the GOO case's selected management depends on the stage disease and evaluation of multidisciplinary involvement even in the COVID-19 pandemic. Therefore, collaboration between surgeons, medical oncologists, gastroentero-hepatologist, radiologists, and supportive and palliative care specialists is required to reduce mortality. 

Background: Primary breast angiosarcomas are very rare type malignant breast tumor. It may have an insidious clinical onset, presenting as a painless, often discrete palpable mass that grows rapidly. The ranged age of disease is 20-50 years.

Case description: We report a case of a young woman with palpable and painless mass of her left breast.  Based on radiological findings with mammography and MRI examination reported as malignant mass of the left breast suspected angiosarcoma. Pathological confirmation post-surgery reported a well-differentiated angiosarcoma that arose primarily in the left breast. Patient treated with simple mastectomy followed by whole breast radiotherapy. External beam radiotherapy delivered using 3DCRT with FIF technique, prescribed dose 60Gy in 30 fractions within 6 weeks.

Conclusion: There is no established standard treatment for primary angiosarcoma of the breast. Mastectomy remains the mainstay of treatment. Adjuvant radiotherapy appears to improve local control.

Introduction: Bacterial meningitis remains a serious global health problem. Streptococcus pneumoniae as the causative organism, is fastidious. Microbiology diagnostic approach is needed to identify S.pneumoniae and antimicrobial susceptibility tests (AST). This study aims to report S. pneumoniae meningitis has been successfully cured strongly related to diagnostic stewardship.

Case: A 1 year old child who fell, suffering from vomiting, fever and seizures was brought to the Emergency Department. Multi-slice Computerized Tomography shows cerebral edema and intracerebral hemorrhage. Laboratory blood tests and cerebrospinal fluid analysis strongly indicate bacterial meningitis. Presumptive Gram microscopy of Cerebrospinal Fluid (CSF) and initial identification of CSF cultures on lysed blood agar under microaerophilic conditions, consistently showed lancet-shaped and encapsulated Gram-positive diplococci. Our Clinical Microbiology Laboratory finally identified the growth of S.pneumoniae from blood and CSF cultures. Patients were treated with cefepime 50 mg/kg body weight/8 hours in the first 10 days as empirical and switched later definitively to ciprofloxacin 10 mg/kg body weight/12 hours according to the AST result on day 11 to day 26. On the 31ˢᵗ day, the patient recovered and was discharged.

Conclusion: The case of a 1 year-old child with S. pneumoniae meningitis has been successfully cured strongly related to diagnostic stewardship by the Clinical Microbiology Laboratory. Supplementation media with sodium bicarbonate can improve S. pneumoniae recovery as a basis for identification and AST. Proper inoculation and AST need to be accelerated because S.pneumoniae easily undergoes autolysis.

Background: The survival of children with congenital heart disease (CHD) has increased drastically in the last few decades. However, in children with the acyanotic type of CHD, it is often accompanied by symptoms of failure to thrive. This study aims to assess the correlation between age at repair surgery and the growth and development of children with acyanotic CHD.

Method: A cross-sectional study was conducted on eligible patients with acyanotic CHD who had undergone heart repair procedures. Age was taken when the patient was preoperatively repaired and categorized based on the age range of 3 months to 5 years. According to the WHO curve (weight/height), growth is assessed from nutritional status. Development was assessed from the category of height (cm) after surgery. Differences in growth and development before and after repair surgery were tested using the Wilcoxon method.

Results: Of the 40 samples analyzed, there were 20 males and 20 females, the majority aged 3-4 years (25%) followed by ages 2-3 years (10%). There was an effect of repair surgery on growth when surgery was performed at 2 to 3 years with a p-value of 0.016 (<0.05). In the development category, there was no effect of surgery on development in all age categories, with a p-value of 0.424 (>0.05).

Conclusion: Surgery at an early age has better growth outcomes, especially at 2-3 years, but is unrelated to developmental aspects.

Background: Major omphalocele is defined as an abdominal defect greater than 5 cm with the presence of the liver and most parts of the bowel in the sac. The management remains challenging for pediatricians and surgeons with remarkably high mortality. Reports about topical agents/dressing used as escharotic therapy, such as silver sulfadiazine, povidone-iodine, topical antibiotics, or honey, have been published with different results. Continued application of a thick layer of silver sulfadiazine on the omphalocele surface is needed to promote eschar formation and neo-epithelialization.

Case description: A term, 2700-gram newborn male infant presented with abdominal defect and herniated abdominal contents covered by a membranous sac containing liver that is widely known as omphalocele. A thick layer of silver sulfadiazine was applied repeatedly onto the omphalocele sac to promote epithelialization and successfully reduce the sac diameter. The patient showed a positive outcome as it reduced the omphalocele size after nine days. The patient family has been educated about the continued application of silver sulfadiazine. Although non-operative delayed treatment has lower mortality rates and better clinical outcomes, the patients should wait for the reconstruction surgery for a long time.

Conclusion: Conservative treatment with silver sulfadiazine is safe and shows satisfying results to the giant omphalocele.

Background: The incidence of penile cancer in the general population is rare. Epidemiologically, penile cancer occurs less than 1% compared to other types of cancer. Penile Intraepithelial Neoplasia (PeIN) is a precancerous lesion of invasive squamous cell carcinoma characterized by dysplastic changes of squamous epithelium with the intact basement membrane. This case report aims to increase understanding of Penile Intraepithelial Neoplasia (PeIN), especially with the clinical appearance of the Buschke Lowenstein Tumor, diagnosis, examination, and appropriate management.

Case Presentation: A 21-year-old Balinese man presented with a lump on his genitalia without itching, pain, and a lesion that bleeds easily, which has appeared since January 2022. He complained that the lump was getting bigger and bigger. Physical examination showed multiple hyperpigmented papules and plaques with well-defined oval and corn shapes that vary in size with a dense consistency and a verrucous surface. Laboratory tests showed negative on Hep-B and HIV tests. The patient also had a biopsy of the lump where the results showed Penile Intraepithelial Neoplasia. The patient was treated with 6 cycles of TCA 80% once a week, but it did not improve, so circumcision and surgical excision were carried out on June 2022. Fourteen days after surgery, multiple lumps appeared, recurred, and increased in number and size. On 1-month observation after the second surgery, the patient denied complaints of the genitals. Venerological status was within normal limits.

Conclusion: HPV-related Penile Intraepithelial Neoplasia (Warty subtype) with the clinical appearance of Buschke Lowenstein Tumor was reported in a 21-year-old Balinese man treated with Glans Resurfacing surgical excision with satisfactory results characterized by no functional abnormalities both during urination or erection.

Background: Malignancy during pregnancy can cause medical complications and quandaries therefore it necessitates careful consideration of the risks and benefits of therapy for the mother's and fetus's safety, as well as the impact on the fetus's health and development. In this case report, we highlight important aspects of a pregnant woman with second trimester who had non-Hodgkin's lymphoma (NHL) receiving chemotherapy.

Case presentation: A 20-years old pregnant woman was referred to One-Stop Oncology Outpatient clinics (POSA) at Dr. Soetomo General Academic Hospital. The patient complained that during the first semester, the patient felt a lump in the right neck with the size of a marble (±1.5 cm), dense, supple, sticky, firm boundaries, and growing over time. The patient reported tired and nauseous almost every day, had lost 5 kg in one month, and also had night sweats. The patient slept in a sitting position to reduce complaints of shortness of breath and a feeling of chest tightening. Based on CT scan, cytology of fine needle aspiration biopsy (FNAB) and immunohistochemistry (IHC) examination the patient was diagnosed with NHL of right neck and mediastinum, stage IIB+ superior vena cava syndrome (SVCS) and microcytic hypochromic anemia. The patient was treated using the CHOP chemotherapy regimen, with doses based on body surface area: C (cyclophosphamide): 1.065 mg/iv, H (doxorubicin): 71 mg/iv, O (vincristine): 1.98 mg/iv and P (prednisone): 100 mg/day and discharged on the 13^th day of the admission. However, four months after hospital admission, the patient had an obstetric ultrasound and the fetal had reduced heart rate. Pregnancy was terminated with a cesarean section resulting in a live baby with 2300 g body weight.

Conclusion: Chemotherapy on pregnant women should be considered after evaluating the benefits and negative effects for both mother and fetus. The consideration should be based on the evaluations from multidisciplinary aspects.

Introduction: The viral pneumonia disease covid-19 is currently becoming a pandemic throughout the world due to SARS-CoV-2. With a lack of therapy choices for covid-19, convalescent plasma therapy was considered an emergency intervention in some countries. Convalescent plasma was, by unit cost, the most expensive service at the laboratory of Dolopo Hospital, thus easy, practical, and efficient calculation of unit cost was needed. This research aims to analyze the unit cost of convalescent plasma as calculated using the Time-Driven Activity-Based Costing (TDABC) method and to examine the difference between the unit cost of convalescent plasma calculated using the TDABC with the real cost at Dolopo Hospital.

Methods: This qualitative research used a case study approach. The primary data were obtained through observation of convalescent plasma activity, and the secondary data were obtained through interviews related to the data of convalescent plasma cost.

Results: The convalescent plasma unit cost calculated based on the TDABC method was IDR2,287,675 and on real cost was IDR2,250,000. The result of the calculation using the TDABC method was higher than the real cost calculation by IDR36.765.

Conclusion: The research results showed that cost analysis using the TDABC method resulted in a more detailed and accurate calculation that the calculation was activity and time-based.

Background: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide, including in Indonesia. ROP screening and intervention are essential to establish the diagnosis, stop disease progression, and prevent retinal detachment that causes blindness. ROP treatments such as vitrectomy and laser are beneficial. This case aims to report the anatomical and functional outcomes after surgery for ROP.

Case description: A very preterm baby with 29 weeks of gestational age and birthweight of 1300 grams was referred to the pediatric ophthalmology clinic at Cipto Mangunkusumo Hospital for ROP screening. Retinal camera (RetCam®) examination revealed stage 3 ROP in the right eye (RE) and stage 4A ROP in the left eye (LE). The LE underwent a vitrectomy, while the RE underwent laser photocoagulation under general anesthesia. Upon examination under sedation (EUS) after surgery, the retina was examined using RetCam® and was found attached to the LE and regressed on the RE. The baby is able to fixate on and follow objects. However, the refraction examination showed myopia in both eyes. Glasses were prescribed due to the myopia outcome in this case. 

Conclusion: Vitrectomy for stage 4A ROP and laser photocoagulation for stage 3 ROP are effective in anatomical and functional outcomes in a very preterm baby.

Background: The appearance of noticeable strands of developed fibrous tissue bridging the fatty lobules is a characteristic of fibrolipoma. Despite being general, clinicians should be aware of the different fibrolipoma imaging findings to identify the patients. This case study aims to evaluate the rare case of multiple fibrolipoma of the face.

Case Presentation: We presented a 69-years-old female with multiple fibrolipoma in the facial area. The presence of a fibrolipoma has been confirmed through laboratory and physical examination. Fibrolipomas that develop in the nasal area and obstruct the patient's airway is initially treated with cautery therapy.

Conclusion: The occurrence of multiple fibrolipomas in the facial area is a very rarely reported case. Treatment using cauterization is recommended in such cases. Results were satisfactory, without any post-operative issues or fibro lipoma recurrence.

Introduction: Ascites is an accumulation of free fluid with an abnormal amount in the peritoneal cavity. The causes of ascites are hepatic cirrhosis, malignant ascites, and mixed ascites, which can be caused by tuberculosis infection. Malignant ascites is a pathological condition caused by primary abdominal and extra-abdominal malignancies. This study aims to report malignant ascites that was misdiagnosed with abdominal tuberculosis.

Case Presentation: Forty-one years old man came with an enlarged stomach, pain in the abdomen, fever, and decreased appetite accompanied by >20 kg weight loss with a change in bowel habits in the last 3 months. At first, the patient was diagnosed with abdominal tuberculosis and took a tuberculosis drug regimen for almost 2 months. However, the patient did not feel any improvement in the symptoms he was experiencing. The patient then went to Soetomo General Hospital and underwent several examinations. In colonoscopy examination, we found a mass in the transverse colon that almost covered the lumen with hard consistency and was not easy to bleed. Pushing outside the recto-sigmoid lumen causes narrowing of the lumen, and from CT scan showed a solid mass in the pelvic cavity; visible lesions penetrate the serosa to form a picture of "fat stranding," attached to the rectum posteriorly and bluntly to the anterior; multiple nodules in the left mesentery with peritumoral lymphadenopathy can be a feature of malignant soft tissue mass. Ascites accompanied by multiple nodular peritoneal thickening and thickening of the omentum that forms an omental cake can represent peritoneal carcinomatosis. The results of the open biopsy obtained histopathological results in the adverse colon suggesting adenocarcinoma, signet ring cell carcinoma. All the examination results led to the diagnosis of colorectal cancer.

Conclusion: A 41 years old man, who was misdiagnosed with abdominal tuberculosis and had been taking the drug for tuberculosis for 2 months, has no improvement in his symptoms. Then he went to Soetomo General Hospital and underwent several examinations, which led to the diagnosis of colorectal cancer. This instance demonstrates that some doctors still struggle to diagnose colorectal cancer, even if patient outcomes improve with earlier treatment.

Background: Pseudoarthrosis is a false joint that occurs in cases of non-union and is commonly associated with neurofibromatosis. Treatment of refracture and non-union remains a challenge, and many methods have been attempted with varying results.

Case Presentation: A 7-year-old, left-handed male sought consult at the Philippine Orthopedic Center (POC) last February 2016 with a complaint of left forearm deformity. This patient was diagnosed with neurofibromatosis type 1 with pseudoarthrosis of the radius and ulna. The pseudoarthrosis was treated with an application of an intramedullary rod and synthetic bone graft. Union and a full range of motion of the forearm were achieved at 1.5 years post-op.

Conclusion: Pseudoarthrosis is a rare case of non-union that occurs spontaneously or after a minor trauma, most commonly associated with Neurofibromatosis Type 1. Since the condition is so rare, many methods have been attempted with varying results. Successful treatment of most atrophic non-union is achieved by optimizing the mechanical and biological environment of the pseudoarthrosis site.

Background: Trigger finger is associated with limited flexion and extension of the finger due to inflammation in the flexor tendon pulley and leads to a loss of functional capacity in the hands. There is a need for safe, fast management and a low risk of recurrence in managing this disease. This study aims to evaluate the clinical effectiveness of the USG-guided corticosteroid injection with needle release of the A1 pulley in treating the trigger finger, particularly in pain degree, joint function, and adverse effects. The parameters were evaluated, including the NRS, Quinnell grading system, and inflammation or infection signs from the physical examination.

Case Presentation: There were seven trigger fingers in five patients with various Quinnell grades ranging from 2 to 3. They received a single treatment of USG-guided corticosteroid injection with needle release of the A1 pulley. Follow-up was carried out immediately after the procedure (day 0), 1 day, and 30 days after. Improvement was seen in all fingers immediately and one day after the procedure. After 30 days, all patients no longer experienced pain, snapping, or locking sensations. No adverse events were observed during the follow-up period.

Conclusion: USG-guided corticosteroid injection with needle release of the A1 pulley in treating trigger fingers is safe and has a good effect on reducing pain and improving joint finger function.

Introduction: Hungry Bone Syndrome (HBS) refers to a condition in the form of prolonged and severe hypocalcemia accompanied by hypophosphatemia and hypomagnesemia that occurs after parathyroidectomy. The sudden cessation of PTH production leads to increased bone re-mineralization and a rapid shift of calcium from circulation to bone. This case report aims to present our management of hypocalcemia in a person with HBS after he underwent parathyroidectomy surgery due to parathyroid carcinoma.

Case Presentation: Mr. S, 46 years old, had a total thyroidectomy and a total parathyroidectomy on April 30^th, 2019, due to parathyroid carcinoma, which the patient previously had. The patient was planned for surgery because of pathological fractures in the patient's hands and feet, which were complications of parathyroid carcinoma. The laboratory examination on the first postoperative day, May 1st, 2019, obtained a total calcium of 8.2 mg/dL. On May 5^th, 2019 (day 5), total calcium decreased to 6.1 mg/dL. On May 10^th, 2019 (day 10), hypophosphatemia was also found with a value of 2.1 mg/dL and hypomagnesemia of 1.2 mg/dL. When experiencing complaints, the patient's calcium was monitored regularly, low calcium was found, and symptoms of hypocalcemia were also found, so this patient was given drip calcium gluconate 1000 mg every 8 hours in 100 ml normal saline. Calcium checks are carried out every 24 hours; calcium is still low for over 3 days. In addition, he was given calcitriol 2x0.25 mcg titrated up to 2x0.5 mcg, drip 40% MgSO4 in 500 salines in 24 hours, and 4x200 oral phosphate. During the treatment, the patient's calcium reached 8.2 mg/dL with albumin 3.3 g/dL with a calcium ion count of 8.4 mg/dL after 17 days of treatment.

Conclusion: HBS was found due to total parathyroidectomy as the main therapy for parathyroid carcinoma. Close calcium monitoring and early administration of postoperative calcium are needed to avoid complications from hypocalcemia. Avoiding HBS can reduce the number of days in the hospital, thereby saving costs and improving the patient's quality of life.

Background: Urticarial vasculitis (UV) is a rare clinicopathologic, especially among children and infants. Most urticarial vasculitis is caused by unknown etiology. Rarely has it been linked to post-streptococcal disease as a non-suppurative complication of a streptococcus infection. Treatment of urticarial vasculitis can be challenging. It is based on the clinical phenotype, systemic symptoms, and/or underlying diseases.

Case Presentation: This study reports a case of a child with an itchy but more painful and burning sensations urticarial lesion which persisted for more than 24 hours, left a residual ecchymotic hyperpigmentation lesion when resolved, and was accompanied by systemic symptoms such as joint pain, fatigue, and gastrointestinal symptoms. The symptoms were preceded by signs of pharyngitis one week before the symptoms and supported by an increase in ASO titer that raised the suspicion of a previous recent streptococcal infection. Skin biopsy revealed a leukocytoclastic vasculitis, a specific finding supporting the diagnosis of urticarial vasculitis. The combination of antibiotics, antihistamines, and corticosteroids gave our case a good clinical response and outcome.

Conclusion: A high awareness of urticarial vasculitis linked to post-streptococcal diseases is needed to establish prompt treatment and prevent further complications.

Background: Numerous studies present evidence of the association between nasal-septal deviation and impaired breathing that led to a multisystem disorder, nasal-midface growth alteration, and gets worse with facial growth. However, the extent of the traumatic septal injury is often neglected. Here, we summarized the clinical experience in treating a pediatric patient with those problems.

Case Presentation: A case of a 10-year-old girl with type C-IIB nasal deviation and type IVb septal deviation with left obstructive nasal breathing and snoring is presented. A nasal injury history at the age of four was reported. She had divergent dorsal lines, hump irregularity, lower lateral cartilage (LLC), columella/septum deviation, drooping-indented-boarded tip, asymmetrical nostrils, and internal valve incompetence. We conducted corrections on nasal bones by bilateral osteotomies, c-shaped anteroposterior caudal septum by scorings, mattress suture techniques and batten grafts, upper lateral cartilage by dorsal septal manipulation, tip/columella by LLC manipulation, dorsal long spreader graft, columellar strut grafts, and septum repositions. A crushed cartilage was placed on the hump. Improvements, complications, and patient satisfaction were documented. No complications were reported after the surgery. The patient was satisfied with the final result. Snoring and left nostril breathing obstructions no longer existed. Corrections on dorsal, columella and septal deviation, hump, nasal tip shape and projection, and asymmetrical nostril were observed.

Conclusion: Septorhinoplasty's philosophy on pediatric patients highlighted the importance of weighing its risks. Findings suggest studies of the pediatric anatomy and surgical technique to minimize the risks. Thorough observation is also advised until the cessation of facial growth.

Background: Perforated peptic ulcer is the most dangerous complication of peptic ulcer.  Neutrophils and lymphocytes are crucial in the inflammatory process. A simple and effective biomarker to assess systemic inflammation is the neutrophil-lymphocyte ratio (NLR). This study aims to ascertain the connection between NLR and mortality in peptic ulcer patients.

Methods: This study was a cross-sectional observational analytic study. Data were obtained from medical records in Dr. Soetomo General Hospital from January 2018 to December 2022. The dependent variable was patient mortality, while NLR value served as the independent variable. NLR cutoff value calculated using the Receiver Operating Characteristic (ROC) curve. The collected data was tested using the Chi-square test and the Spearman rank correlation test integrated in the SPSS software.

Results: There were 109 patients, consisting of 74 male and 35 female patients. There were 29 patients with the Boey Score category 1, 54 patients with the Boey score category 2, and 25 patients with the Boey score 3. Using a cutoff of 15.60, the NLR values were separated into low and high NLR groups. There were 56 patients with high scores and 53 patients with low scores. A significant relationship was found between NLR values and mortality (p <0.0001). The results of Spearman's analysis revealed a strong correlation between the incidence of mortality and an increase in the NLR value (p<0.0001; r = 0.500).

Conclusion: There is a significant relationship between NLR and mortality in patients with perforated peptic ulcers.