Background: Osteonecrosis is the death of bone cells that can be associated with alcohol abuse. Alcohol abuse has been projected to increase by 0.6% every year. The high morbidity and cost of therapy of osteonecrosis necessitate the effort to prevent osteonecrosis before it manifested. Astaxanthin is an antioxidant that is expected to increase the number of osteocyte and osteoblast cells, decrease the number of adipocyte cells, and reduce the incidence of osteonecrosis.

Methods: This is an experimental randomized post-test control only group design. A total of 24 Wistar rats who met the inclusion criteria were randomly assigned to the control group with the administration of alcohol and the treatment group with the administration of alcohol and astaxanthin. The number of osteocytes, osteoblasts, adipocytes, and osteonecrosis occurrence was examined in the first, second, and third week.

Results: Statistical analysis showed a lower average number of osteoblast cells in the control group (38+1.43) than in the treatment group (55.63±2.17) with astaxanthin administration. The same results can also be seen in the number of osteocyte cells in the control group (16.69±0.94) as compared with the treatment group (28.06±1.26). Meanwhile, the average number of adipocyte cells in the control group showed a higher yield (58.69±1.18) when compared with the treatment group (27.50±1,24). The occurrence of osteonecrosis, as depicted by the presence of empty lacunae and necrotic osteocyte cells, showed the highest increase in osteonecrosis occurrence at week 3 (34.56±0.31) of the control group. While in the treatment group, the decrease in the incidence of osteonecrosis showed the lowest number in week 3 (4.75±0.79). The statistical analysis test using one-way ANOVA showed that the mean difference between treatment and control groups was statistically significant (p <0.05).

Conclusions: The above calculation showed that administration of astaxanthin could decrease the incidence of osteonecrosis in the femoral head of rats exposed to alcohol. 

Purpose : To compare the Ganglion Cell Complex (GCC) thickness with Retinal Nerve Fiber Layer
(RNFL) thickness in correlation with visual field (VF) in varying degrees of myopia. Design: a Cross-
Sectional study. Participants: Ninety-six eyes of 49 patients with myopia. Methods: Patients with
myopia examined with streak retinoscope to obtained the best corrected visual acuity based on
spherical equivalent. Patients then divided into low (50 eyes=50.1%), moderate (31 eyes=32.3%), and
high (15=15.6%) myopia. Axial length measured with A-Scan ultrasound divided into short (4=4.2%),
moderate (74=77.1%), and long (18=18.7%). SD-OCT was used to measured GCC thickness in 9 areas
including fovea (R1), parafovea (R2-R5), and perifovea (R6-R9) according to early treatment diabetic
retinopathy study (ETDRS), and RNFL thickness in five areas (G, TS, TI, NS, N, NI). VF analysis
with humphrey field analyzer with SITA 24-2 pattern. Main outcome measures: GCC thickness has
higher correlation with degree of myopia particularly in perifovea area and means deviation than
RNFL thickness. Results: GCC thickness decreased significantly along with the elevation of myopia
degree in almost entire area except R1 and R5 . Parafovea (R2-R4) and perifovea (R6-R9) were
significantly correlated with p= 0.001, 0.005, 0.006 and p= 0.000, 0.000, 0.000, and 0.003
respectively. In contrast, RNFL thickness obtained lower correlation with myopia degree whereas the
only significant result was found in Nasal area (p= 0.045). VF found to be strongly correlated with the
degree of myopia in which p-value for Mean Deviation = 0.000. Conclusions: GCC thickness may
compare the predictive value of RNFL in predicting early retinal microstructural changes even in low
degree myopia. Financial Disclosure: Author has no financial disclosure.

Background: Nowadays, there are many researchers interested in the role of oxidative stress in the pathophysiological mechanism against erectile dysfunction. Oxidative stress occurs when there is an imbalance between pro-oxidant and the ability of the antioxidants to scavenge excess reactive oxygen species. The important role of oxidative stress in the pathophysiological mechanism of male and female infertility has been known.  However, its role in maintaining the integrity structure of penile erectile tissue especially corpus cavernous smooth muscle cell has not been investigated comprehensively yet. In another side, testosterone has a critical role in maintaining the integrity of the penile erectile tissue. Aim: This study aims to investigate the effect of oxidative stress condition on the administration of testosterone for increasing corpus cavernous smooth muscle cells. Methods: The experiment uses pretest-posttest control group design. Data were collected from 40 rodent’s strain SD (Sprague-Dawley). Ten penile organs were removed before stress, and 30 rodents given psychosocial stress for 6 weeks. After the third-week of stress, 10 penile organs were removed. At the beginning of the fourth week, 20 rodents were randomly divided into 2 groups: the control group (untreated mouse), were treated with an intramuscular aquabides injection and the case group were treated with intramuscular testosterone injection (case group). Five penile organs from each group were removed to observe the corpus cavernous smooth muscle cells number at the sixth weeks of the stress. During the six week stress, blood samples were collected for MDA and SOD measurement at the beginning, at the third week, and at the sixth week. Results: This study found that oxidative stress decreases the corpus cavernous smooth muscle cell (CCSM) number significantly. The number of CCSM before stress 20,20 ± 1,23, and after the third-week of stress is 14,20 ± 1,03 (P < 0,05). In addition, the administration of testosterone at the beginning of fourth-week of stress raises CCSM number significantly. The number of CCSM before treatment is 13,80 ± 0,84, and after treatment is 18,40 ± 1,14. Conclusion: There was a significant elevation of CCSM number without being affected by oxidative stress in this study.

 

Background:Hospitals that are part of the organization because of the sensitivity and importance of the treatment must have in today's dynamic agile structure to be able to adapt to environmental changes. Therefore this study was to provide a structural model of agility in hospitals.Methods:This descriptive study was conducted in the year 2015. A total of 260 people were selected as sample from mentioned the statistical population. Validityof the questionnaire through examination exploratory and confirmatory factor analysis and reliability tests with Cronbach's alpha was approved 0.97. Data software 18 SPSS and 8.5 Lisrel a factor analysis using mathematical models the final model was developed based on confirmatory factor analysis confirmed the pattern was evaluated.Results:Question related to four agility (responsiveness, competence, flexibility, speed) are measured at the agility hospital And supply chain (independent variables) to correctly cover the variable and valid. Agile supply chain variable between maximum sensitivity and responsiveness(1.98±0.66) To develop the skills of employees received the lowest average (1.34±0.46) As well as structural equation modeling and all relationships were verified  (P-value < 0.001).Conclusions:Therefore, it is suggested to apply that to be successful and better adapted to the environment and achieve enhanced service quality, employee satisfaction and patients, competitiveness, reduce costs, reduce time to service delivery and organizational agility.

 

Background: Cranial nerve disorders among nasopharyngeal carcinoma (NPC) patients were around 15-30%. Complaints that encourage patients to come for treatment are due to symptoms of the spread of tumor cells to the lymph nodes in the neck and symptoms of cranial nerve disorders. There was no previous data regarding cranial nerve involvement on NPC cases at Dr. Kariadi General Hospital Semarang. This study aimed to determine the proportion of neurologic abnormalities in NPC patients. Methods: This was a descriptive retrospective study conducted in Dr. Kariadi General Hospital Semarang. Data were collected retrospectively from medical records on January 2014 to December 2016. The diagnosis of NPC was based on several examinations such as medical history, physical examination, nasopharyngoscopy, histopathology, chest radiography, ultrasound and nasopharyngeal MSCT Scan. Results: Within 3 years (2014-2016), 141 new NPC cases were obtained, which were found commonly in third, fourth and fifthdecades of life with 3:1 male to female ratio. Neurological disorders were found in 27.7% of NPC, in the form of impaired eyeball movement (most affected to cranial nerve VI followed by cranial nerves III and IV), swallowing disorders (cranial nerves IX, X) and facial sensibility disorder (cranial nerve V). Conclusion: The proportion of cranial nerve involvement in NPC was 27.7%. The most affected cranial nerves were a group cranial nerves innervating eye movement muscles followed by the nerves controlling swallowing activities and facial sensibility.

 

Background: Productivity is a universal concept that applies to all systems because every activity requires productivity in its implementation. Individual productivity can be assessed from what the individual does in his work. Based on this fact, the purpose of this study is to know the relationship between quality of work life (employee involvement, career development, pride of institution, balanced compensation, job security, available facilities, work environment safety, problem solving and communication) with Work Productivity on Nurse profession at Inpatient Room Bhayangkara TK III Manado Hospital.

Methods: Study design using cross-sectional analytic approach which was conducted in July - December 2017 at Bhayangkara TK III Manado Hospital. Total sampling technique was used by considering inclusion criteria nurses who work> 3 months, and exclusion criteria are nurses who are taking furlough time. The analysis used chi-square test and started from univariate, bivariate and multivariate.

Results: The results showed that the p-value of employee involvement (0.089), career development (0.006), pride of institutions (0.060), balanced compensation (0.005), available facilities (0.014), occupational security (0.388) work safety (0.003), problem-solving (0.006), communication (0.009) with work productivity of inpatient nurses at Bhayangkara Tk III Manado Hospital.

Conclusions: There is a relationship between career development, balanced compensation, available facilities, work environment safety, communication and problem solving are the variables most related to work productivity of inpatient nurses at Bhayangkara TK III Manado Hospital.

 

Background; High incidence of congenital hydrocephalus will become a big problem for the family, and even the nation. The standard management is liquoral shunnting with implantation of various V-p Shunt devices. The complication relatively high beside high cost. Endoscopic third ventriculostomy(ETV) is considered to be superior to V-P Shunt.

Method: All of the Obtructive hydrocephalus admitted to Sanglah Hospital between 2005 until 2016 who treated by ETV were analyzed the method of how we do it.

Result: The most important is patient selection, than  trajectory with rigid endoscope, identify the foramen of Monroe by following choroidal flexus, identify infundibular recess, mammillary body, locate the fenestration of base of the third ventricle safely by monopolar cauther, dilated the fenestration by Fogarty catheter F3/F4, fenestration of Liliquist membrane, and last is closing and suturing the dura and skin water tightly.

Conclusion: ETV is the simple procedure for hydrocephalus lower cost compares to V-p Shunt and high successful rate, and low risk of complication, V-p shunt just for those patients who does not response to ETV.

Introduction and Aims: Patients with heart failure experience many physical and psychological symptoms such as anxiety, which reduces their life expectancy. The use of alternative methods of therapy, including slow-stroke back massage (SSBM), can be effective in reducing the symptoms of heart failure. This study aims to investigate the effect of slow-stroke back massage on anxiety in women with heart failure.

Methods: In this quasi-experimental study conducted in the Department of Cardiology of Ghaem Hospital (affiliated with the Hamedan University of Medical Sciences) in 2015, 60 patients with heart failure were randomly assigned to the control and intervention groups. Slow-stroke back massage was performed in 7 sessions for 7 consecutive days (one session per day) for 10 minutes in the intervention group. Demographic characteristics and standard anxiety questionnaires Depression, Anxiety and Stress Scales (DASS-42). were used to collect the patient data. The data were analyzed using descriptive and inferential statistics.

Findings: The mean of anxiety before intervention in intervention group 28.2 ±6.04 and in control group was 27.47±5.22 and after the intervention in the intervention group was 21.37±6.24 and in control group 26.1±6.27, that showed a significant difference compared with before the intervention (p<0.001).

he mean anxiety scores of all participants in the intervention group before and after the intervention was very severe, but after the intervention, its mean anxiety scores decreased. Using Paired t-test, the mean anxiety scores of the control group before and after the intervention was not significantly different (P <0.05).

Conclusion: Slow-stroke back massage significantly decreased anxiety in female patients with heart failure.

Introduction: Extrapulmonary TB in pediatric patient affects the quality of life and must be considered seriously. Early surgical treatment is needed to eradicate infection, preserve the physis, and simultaneously correct the deformity. The aim of this study is to assess the efficacy of conservative treatment compared to early surgical treatment regarding neurological improvement, kyphotic correction, and pain relieve.

Method: This is a retrospective case series. We reviewed 28 pediatric spine tuberculosis in Dr. Soetomo General Hospital Surabaya, Indonesia during year 2010-2012. All patients have received TB drugs and indicated for surgical treatment, yet the 15 patients did not provide parental consent. These were selected as non-surgical group. Thirteen patients obtained surgical treatment including bone graft, w/o instrumentation (surgical group). All clinical data were collected at the time of diagnosis and a year after treatment. The improvement of kyphotic (thoracic segments) was defined as narrowing of post-treatment Cobb’s angle. Conversely, lordotic improvement (cervical or lumbar segments) was defined as widening Cobb’s angle. Improvement of neurological status (Frankel classification) was analyzed using chi-square test. The deformity correction and pain relieved were analyzed using independent-samples t-test. All statistical analyses were conducted by SPSS-23.

Result: VAS improvement was not significant. Frankle classification in the surgical group was significantly better. The kyphotic deformity correction was 0% (n=8) in the non-surgical group and, 57.1% (n=4) in the surgical group. There lordotic deformity correction was 74.1% (n=4) in non-surgical group and 83.3% (n=5) in surgical group. There is a significant difference of the kyphotic deformity correction between both groups. but no significant difference in lordotic correction.

Conclusion: Surgical management showed better outcomes in the degree of correction (stopped and corrected the kyphosis progression), and also in the neurological improvement.

Introduction Premature canities is a terminology to describe a premature condition graying of hair before the age of 20 in Caucasians, 25 in Asians, and 30 in Africans, involving complex processes such as genetic, hormonal and environmental factors. Quality of life is generally measured using a validated questionnaire. Body Image Questionnaires (BIQ) is a questionnaire that specifically assesses the impact of self-appearance, especially in the hair appearance, on the individual self-esteem and the influences in life. In clinical practice, measuring the association of premature canities to the quality of life and understanding how a patient's life is affected by premature canities can be helpful in determining the most appropriate and better management for the patients.

Aim: To evaluate the association between premature canities and quality of life

Methods: This is a cross-sectional analytic method, with BIQ to assess the quality of life. Diagnosis of premature canities was made based on clinical examination. This study involving 63 subjects with premature canities and 114 normal subjects. Statistical analysis was done using descriptive method and chi-square test to assess the association between premature canities and quality of life.

Results: There is a significant association between premature canities and quality of life (P<0.05). There is no significant association between age, sex, and severity degree of premature canities with quality of life (P>0.05).

Conclusion: There is a significant association between premature canities and quality of life, but there is no association between age, sex and severity degree of premature canities with quality of life.

The authorpresents areviewofadult idiopathic scoliosis (AIS), etiology, epidemiology, clinical and radiology assesment, conservative managementandsurgery,includingthe pitfallsthat are oftenencountered. Although the author's experience in handling AIS is quite new,butgiven thedesiretosharethe difficultiesandobstaclesencourageauthortopublish the review.The authordoes notintendto teachbutto shareandstart doingscoliosissurgeryandshould be studiedproperly.

The success ofsurgeryin these patients,the resultswere encouragingfor bothpatientand doctor. Calculation ofappropriate corrections,outsmartwedgevertebraandhemivertebra, mountingscrewwithanatomybased onlandmarksandstraightenthe curveof the spineisthe mostinterestingpart. Ifallcan bedonewitheitherthepatientcanhave anear normalcurveandis free fromthe difficulty of expandinglungorneurological deficits.

Scoliosiscorrectionshouldalsobe doneby us, theneurosurgeonspine, shouldbe started immediatelyin Indonesia, because the casesarethere,verychallengingandencouraging resultssoworth doing.Thorough knowledgeof the anatomy ofthe spinelandmarksandstrictselection of casesas indicated,wouldmaximize the results ofpatientoutcomes.

Introduction: Conferences and scientific meetings are valuable opportunities to transfer and exchange research findings. In Iran, National Conference on Medical Education is held annually, with more than 1500 participants from different disciplines. Participants’ competency in utilizing research findings, research finding readiness for utilization, and perceived organizational support are three domains that contribute to the enhancement of research utilization in medical education. This study was conducted to assess the conference participants’ own competency on research utilization, viewpoints about research readiness and perceived organizational support for research utilization in medical education.

Method: This is a survey study on a convenient sample of participants in the conference; researcher-designed, self-administered questionnaire was applied. It consisted of 19 items in four domains (baseline characteristics, scientific activities, Competency for research report utilization, Research findings readiness for utilization and, organizational support for research utilization).The face and content validity of the questionnaire was approved by experts in the field, and its reliability was 0.94.Data were analyzed by descriptive analysis, Pearson correlation, one way ANOVA and stepwise linear regression tests.

Results: 130 questionnaires were filled (response rate was 52%). 36% had a medical education degree. Faculty members rated their competency in the utilization of research report, viewpoint toward readiness of research report for utilization, and organizational support above the average. There was a statistically significant positive correlation between research utilization competency and the number scientific articles they had written, journal clubs participated and their work experience. The stepwise linear regression test revealed that journal club participation is the main factor of competency in research report utilization predictive model.

Conclusion: Participants’ competency and viewpoint about research utilization were not desirable. The medical education must invest in training researchers and utilizers to earn essential competencies and change their mind about the important role of research findings in decision making. A limited study in this field implies the need to do more studies on research utilization in medical education.

Background: This study aimed to determine the effect of a training program based on Health Belief Model for the promotion of teachers' social capital in the city of Baft.

 Methodology: The present research is an experimental and interventional study. The sample size was 100 school teachers in the city of Baft who were selected randomly from among 500 teachers using Cochran sample size formula and assigned to two groups of 50 experiment and control. The instruction was conducted in 9 two- hour sessions in the form of pamphlets, lectures, and group discussions and the post-test was performed after 3 months. Data collection tools included the author-made 36-item HBM questionnaires and 36-item Bohlen social capital questionnaire. Data analysis methods included correlation coefficients of the regression slope (b), beta values or standardized regression coefficient, T values for each variable, determining their significant levels, and covariance analysis carried out.

 Results: Comparison of the pre-test and post-test means among components of the health belief model and social capital of in both experiment and control groups showed that there was no significant difference between the two groups in the pre-test; however, comparison of results in post-test the showed significant difference. Levene test calculation, T, and covariance confirmed these differences and reflected the impact of intervention and implementation of a training program on the experiment group.

Conclusion: According to the results, the impact of training programs implementation to increase levels of social capital was approved. 

Introduction : Nasopharyngeal carcinoma is one of the most common head and neck malignancy in Indonesia. Due to the evaluation of clinical stage is not enough to predict its prognosis, therefore other markers are needed to help to assess its progressivity. One of the markers is known as survivin, an apoptosis inhibitor, which usually shows increase expression in carcinoma. Roles of survivin in nasopharyngeal carcinoma carcinogenesis has not been studied well yet. The aim of this study was to analyze the association between high survivin expression and the late clinical stage of nasopharyngeal non-keratinizing squamous cell carcinoma.

Methods : This study was a cross-sectional observational analytic study, involved 30 histopathological samples of nasopharyngeal non-keratinizing squamous cell carcinoma, which have been examined at Pathology Anatomy Laboratory Sanglah Hospital by using stratified random sampling from January 2^nd, 2014 to May 31^st, 2017. The paraffin slides were stained with survivin immunohistochemical at Pathology Anatomy Laboratory Dr. Sardjito Hospital Yogyakarta. The cut-off point of survivin expression was analyzed by Receiver Operator Curve (ROC) analysis. The association between survivin expression and the clinical stage was analyzed with Fisher’s Exact test.

Results : The cut-off point of survivin expression based on ROC analysis was 4.5. High survivin expression was significantly associated with late clinical stage cases (p=0.026; p<0.05).

Conclusion : High survivin expression has a significant association with the late clinical  stage of nasopharyngeal non-keratinizing squamous cell carcinoma. Survivin can be used as a prognostic marker, which is useful for nasopharyngeal carcinoma therapy.

Background: Young women have a tenfold anemia risk compared with young men, anemia that occurs in adolescent girls because it has hemoglobin levels less than the normal rate of 12 g / dL. Factors that cause anemia in adolescent girls are the iron deficiency (Fe) due to menstruation, lack of nutrient intakes such as Fe, fat, protein, carbohydrate and energy. In order for adolescents are not lack iron that the body needs, it is a necessary intake of Fe supplementation and also the provision of dates fruit.

Aim: The purpose of this study was to determine the effect of the addition of dates on supplementation of Fe to hemoglobin levels in adolescent girls.

Method: Type of experimental research with the design of Pre Test and Post Test Control Group Design. The sample in this research is adolescent girls with anemia in two Senior High School amounted to 68 people who are divided into two groups that is intervention group counted 32 people and control group counted 36 people. Data collection techniques on Hb measurements with cyanmethemoglobin. The data analysis tools used are paired simple t-test and independent t-test.

Result: There was a significant difference in hemoglobin levels before and after the addition of dates in iron supplementation in adolescent girls with anemia with mean before intervention (9.94 g / dL) and mean after intervention (11.22 g / dL). There were significant differences in hemoglobin levels before and after iron supplementation in adolescent girls with anemia with mean before treatment (10.09 g / dL) and mean after treatment (10.93 g / dL). There was no significant difference in hemoglobin levels after treatment between the intervention groups (addition of dates on Fe supplementation) and control group (Fe supplementation) in adolescent girls with anemia (p = 0.855).

Conclusion: There is a difference of Hb levels between adolescent girls with anemia who were given additional dates in Fe supplementation with only Fe supplementation.

Introduction: Spontaneous intracerebral hemorrhage accounts for 10-15% of strokes and the most fatal type. Management of spontaneous intracerebral hematoma (SICH) is divided into two groups - medical and surgical interventions. Although surgical management is controversial, it can be lifesaving when patient is deteriorating. Objective: The aim of this study are to describe clinical, radiological features, surgical management, and patient’s outcome. Method: This is a descriptive case series study, carried out retrospectively over a period of 2 years at department of surgery, neurosurgery division, Prof. DR. WZ Johannes General Hospital, Kupang. Total of 14 patients were included in the study. Clinical, radiological features, period between onset and operation, surgical management and outcome were identified. Results: Hemiparesis or hemiplegia and language dysfunction (92.86%) was the commonest presenting clinical feature followed by headache (71.43%). Most of the hematomas were in basal ganglia region (57.14%), (50.00%) involving cortex cerebral, (35.71%) involving thalamus, and (28.57%) had intraventricular extension. Craniotomy clot evacuation was the major surgical intervention used to manage. Conclusion: Hemiparesis and language dysfunction were the most frequent presenting clinical features. Deeper region of the brain as basal ganglia more involved than other area of the brain. Surgical intervention used to manage is based on clinical condition and anatomical complication of the patients.

 

Background: Difficulties of the earliest stages' detection of erythrocytes' microrheological abnormalities' development at obesity are connected with falling out of clinicians' field of view of persons with first signs of this pathology. It dictates the necessity of experimental investigations' fulfillment on laboratory animals with just developed obesity in them.

Methods: 91 of healthy male-rats of Vistar line at the age of 2.5-3 months were taken into an investigation. 29 animals of them had experienced no impacts and composed the control group. In 62 rats after their putting into small cages (one specimen - in a cage) during 30 days there was developed OB as the result of giving them of high-caloric diet from combined feed (47%), sweet condensed milk (44%), vegetable oil (8%) and vegetable starch (1%). There were used biochemical, hematological and statistical methods of investigation. During obesity development lipids' peroxidation activated in rats' erythrocytes because of activity weakening of their antioxidant protection.

Results: At obesity development in rats, there was found reliable decrease of erythrocytes-discocytes quantity in blood. It was accompanied by the increase of reversibly and irreversibly changed erythrocytes' quantity in examined animals' blood. At obesity development in rats, there was found the quick rise of erythrocytes' sum in aggregate and these aggregates' quantity at lowering of free erythrocytes' number.

Conclusion: During experimental obesity modeling we noticed very early in rats' blood decrease of erythrocytes-discocytes' quantity, the level rise of their reversibly and irreversibly varieties with the strengthening of their aggregative ability. It takes place in the background of a weakening of erythrocytes' antioxidant protection and activation of lipids' peroxidation in them. 

Introduction: Radiodermatitis or radiation dermatitis is a side effect that is produced in the skin and skin adnexal as a consequence of exposure to radiotherapy. There are several factors that influence the occurrence of radiodermatitis: factors related to the patient (intrinsic), such as: age, race, comorbid conditions, nutritional status and factors associated with treatment (extrinsic), such as: dose radiotherapy, fractionation and radiotherapy techniques.

Methods and results : This study is a descriptive observational study with prospective approach in 50 patients who received radiotherapy in Haji Adam Malik Hospital in Medan. History taking by anamneses and dermatological examinations were conducted to all subjects on the first day, 3 weeks and 8 weeks during radiotherapy. From this study, the majority of the patients are women, age 40-60 years old. The most clinical features is erythema macular rash (100%) and the most location is in the coli region. The majority of total dose is 5000-5900 cGy, and the most fractionation used 31-40 fraction.

Conclusion: The results of this study indicate that elderly, high total dose and fractionation leads to an increased risk of radiodermatitis.

Background: Osteoarthritis is a common musculoskeletal degenerative disease of the cartilage of joints and rheumatoid arthritis is a destructive autoimmune joint disease. The aim of our study was comparing of ultrasound findings in knee osteoarthritis and rheumatoid arthritis with MRI as the gold standard.

Methods: One hundred subjects with chronic knee pain referred for knee MRI were evaluated by ultrasound and MRI on the same day. Two radiologists assessed knee osteoarthritis and rheumatoid arthritis parameters on ultrasound and MRI separately and independently. Agreement between the ultrasound and MRI evaluations was determined using weighted kappa statistics. Intra-class correlation coefficients were used to evaluate agreement using the absolute values of knee osteoarthritis and rheumatoid arthritis parameters.

Results: The overall agreements between the two expert’s radiologists were 85% for the knee joint. Taking an agreement in US examination of 2 expert’s radiologist the overall k for was 0.69 when comparing assessment of knee osteoarthritis and rheumatoid arthritis parameters between ultrasound and MRI. For the knee joint the overall agreement of US findings with MRI was 89%. The overall sensitivity for US of the knee joint was 95.59%, the overall specificity 81.88% in the detection of knee osteoarthritis and rheumatoid arthritis parameters.

Conclusions: Ultrasound assessment of knee osteoarthritis and rheumatoid arthritis parameters is reliable and, showing good diagnostic performance for the detection of knee osteoarthritis and rheumatoid arthritis parameters compared with MRI.

Background: Surgical complications are often inevitable despite advances and improvement in surgical skills and science. Objective: We performed a study to investigate the clinical features of urological injury following obstetric and gynecologic procedures. Methods: We identified the urological complications which arose during or following obstetric-gynecologic procedures at Sanglah General Hospital, Bali from January 2014 to July 2017. The retrospective data retrieved included details of the procedures, the sites of injury, the treatments, and the outcomes. Results: We had 41 patients with urologic complications following obstetric and gynecologic procedures. According to the medical records, 14 had a bladder injury, 6 had a ureteral injury, 3 had both bladder and ureteral injuries, 16 had a vesicovaginal fistula, and 2 had a ureterovaginal fistula. A total abdominal hysterectomy was the most common procedure underlying complications. The second most common was radical abdominal hysterectomy. All cases of bladder injury underwent a primary suturing during surgery without complications. Where the ureter was injured, 2 patients underwent primary suturing, 5 underwent Boari flap technique, 2 underwent end-to-end anastomosis, and 2 underwent laparoscopic ureteroneocystostomy. Vesicovaginal fistula (VVF) was mostly managed using the transvaginal approach with a tissue flap. The overall success rate of VVF repair was 75% after a primary repair. Conclusion: Bladder injuries were the most common urological injury during obstetric and gynecologic procedures. VVF management with various surgery techniques yields a good result.

Stroke is a world leading cause of death and disability in the field of neurology. Ischemic stroke occurs from the obstruction of blood flow to the brain and accounts for 85% of all strokes. Currently, the initial management of stroke to reduce the mortality rate is well known, resulted in increasing number of stroke survivor over the years.  However, lack of appropriate treatment for post-stroke recovery lead to prolonged disability that will produce a negative impact, in particular for the productive-aged survivor. Researchers found that miRNA-124 has a lot of beneficial effect to the ischemic brain. miRNA-124 will upregulate the growth factor substances and down-regulate the TNF-α and other cytotoxic substances and increase the number of M2 microglia which is important to promote angiogenesis and matrix remodeling. Expression of miRNA-124 will also lead to differentiation and migration of neuro-progenitor cells to the lesion site while reducing the formation of the glial scar. Furthermore, chitosan derived from the extraction of shells, shrimp, and crabs, have been reported for its various advantages such as anti-infection, anti-tumor and also as carrier-mediated transported across blood–brain barrier. Administration of miRNA-124 loaded chitosan by intranasal route will improve the drug delivery into neuron by provides moiety for cell penetration and as affinity agent towards neuronal tissues. Based on those points, the combination of chitosan and miRNA-124 may be a potential therapy to improve revitalization and reduce disability after stroke ischemic.

Background: Segmental bone defects resulting from traumatic injuries are complicated problems with significant long-term morbidity. Vascularized bone grafts, by definition, are placed with their vascularity intact, and thus are immediately viable.

Case: A 46 years old man referred to Sanglah Hospital after roadway accident and subsequently fell to the valley. Open wound  Ø 5x2 cm (already stitched), bone loss 13 cm length, tenderness over the arm and elbow, radial  artery and ulnar artery palpable, O₂ saturation 98%, no paresthesia,  no active ROM elbow flexion and extension, active ROM wrist  80/70 , active ROM MCP-IP 90/45, and patient can do a thumb extension. Already done the free vascularized fibular graft, and stabilized with 3.5 mm reconstruction plate and screwing for intercondylar fracture. Then checked with angiography for vascular viability.

Discussion: Management of bone defects after severe open fractures of the distal humerus encompasses many technical difficulties. In these cases, appropriate osteosynthesis may not always feasible, and bone grafting should be considered for the restoration of normal elbow anatomy. Vascularized bone transfers are more efficient than conventional corticocancellous interposition grafting for the management of massive bone loss (>6 cm). The free osteocutaneous fibula flap is a composite tissue transfer suitable to address combined defects. Clinical monitoring and early detection of anastomoses failure can be done within hours after the surgery by evaluating the skin paddle viability.

Conclusion: The surgeon should decide elbow reconstruction in severe injuries that compromise several structures and create tissue defects by careful evaluation. The kind of lesion and mechanism of trauma are not necessarily the most important factors for planning treatment. The free osteocutaneous fibular graft should be further considered as a reconstructive option for the treatment of metaphyseal or juxta-articular complex defects of the elbow joint.

Background: To enhance the publication of all researcher in the indexed international scientific journal (in term of quantity and quality), The Doctoral Program of Medicine Science, Faculty of Medicine, Udayana University will hold The 3rd Iswirap with theme “How to Publish a Good International Scientific Article”. This workshop aims to assist in the development of the skill needed to write and submit scientific article with the ultimate goal of improving the dissemination of research and enhancing the knowledge sharing. Technical training articleclinic will be provided to succesfully published a scientific article.