Background: The success of development is the ideals of a nation that can be seen from the improvement in living standards and life expectancy. This also results in a shift in the composition of the population, which will increase the composition of the elderly population. Increased life expectancy must also be accompanied by a good quality of life. During this time the elderly are related with helplessness, dependence, with various health problems such as various cardiovascular diseases, osteoporosis, cognitive impairments such as dementia. This needs to be the concern of all parties. This study aims to determine: 1) the prevalence of elderly women who experience cognitive dysfunction in Buleleng Regency; 2) the relationship between cognitive impairment and the onset of menopause; and 3) and the relationship between cognitive impairment and the level of exercise activities of elderly women in Buleleng Regency.

Methods: This research is a descriptive correlational quantitative observational study with a cross sectional study approach. The study sites were in 5 sub-districts in Buleleng Regency with a total sample of 73 people. To find out the relationship between cognitive impairment and the onset of menopause and the pattern of exercise activities in older women, data were analyzed by contingency coefficient correlation test.

Results: The results showed that 18.4% of elderly women experience definite cognitive impairment, 23% probale cognitive impairment, and 58.6% normal cognitive function. The relationship between cognitive impairment and the onset of menopause was obtained p value 0.296 which indicates that the correlation between the onset of menopause and cognitive function was not statistically significant. The relationship between cognitive impairment in elderly and level of exercise activity obtained a p value of 0,000 which indicates that the correlation between exercise activity and cognitive function is statistically significant.

Background: Every year, there is an increase in malignancy cases in the world. In women, malignancy is the second most cause of death. Gynecologic malignancy can be found in all women reproductive tract, including cervix, ovary, uterus, vagina and vulva. Most women death from gynecologic malignancy occurred in developing countries, and this is due to lack of access for early detection and treatment. The study aims to report characteristic of patients referred from Obstetrics and Gynaecology Outpatient Clinic Mangusada Hospital, Badung from January 2016 – December 2018.

Results: Total referred case were 451 gynaecology-oncology patients in obstetrics and gynaecology outpatient clinic Mangusada Hospital, Badung-Indonesia. Top three most referred case were cervical cancer, ovarian cyst with malignancy suspected and ovarian cancer. For Cervical cancer, most of the patients are in group age 41-50 years old (40,3%), in-stadium III (59,2%) and squamous cell type (71,7%). For ovarian cancer, most of the patients are in group age 41-50 years old (45,1%), in-stadium III (59,2%), and epithelial type cell (87,3%). For endometrial cancer, most of the patients are in group age 51-60 years old (53,9%), in-stadium III (46,1%) and adenocarcinoma cell type (100%).

Conclusion: The most common gynaecological referral cases are cervical cancer, suspicious malignant ovarian cysts, and ovarian cancer. All gynaecological cases referred to are suspected or diagnosed as gynaecological malignancies and require the handling of a gynaecology-oncology division and integrated oncology services.

Background: The microrheological disorders of red blood cells in obesity is often missed by the researchers. This study aimed to report an experimental investigation on laboratory animals with developed obesity and to find out the effect of meldonium on the erythrocytes.

Methods: A total of 95 healthy male-rats of Vistar line were taken into the investigation, 29 animals had experienced no impacts and allocated as the control group, while 64 rats which had developed obesity induced by a cardioangionefopathogenic semisynthetic diet into the obesity group. These rats were casually divided into an experimental (34 rats) group and the control group (30 rats). The rats of the experimental group in the next ten days were intragastrically injected with meldonium for 80 mg/kg. The biochemical, hematological and statistical methods of investigation were used in this study.

Results: During the formation of obesity and the use of meldonium, the body weight of the rats were gradually decreased to the normal level. On the obese rat's group receiving meldonium, the content of the lipids peroxidation products in erythrocytes progressively decreased.  and reached the level of the healthy control rats group. Moreover, there was a decrease in the number of erythrocytes-discocytes accompanied by an increase in the reversible and irreversible changes. These values were returned to the level of the healthy control rats group at the end of the observation. This pattern was observed in the total number of erythrocytes aggregate and free erythrocytes.

Conclusion: The application of meldonium eliminates the existing erythrocytes abnormal microrheological features in the rats with recently developed obesity.

Background: Patients with second-degree lumbar osteochondrosis are observed to pay more attention to their health, have higher levels of anxiety, and a lower degree of life satisfaction. Daily wearing of therapeutic-prophylactic clothes by the subjects was applied for correction of osteochondrosis signs. Levels of life-satisfaction, anxiety levels, personal self-estimation, and attention paid to their health were observed in subjects with osteochondrosis who wore the garments daily for 6 months.

Methods: The study was conducted in Central Russia (Moscow City and Moscow region). Data were obtained from 37 healthy subjects as a control group and 43 subjects of second-degree lumbar spine osteochondrosis as a case group in both sexes of the second mature age (mean age – 43.5±2.5 years, 44.7±1.9 years, respectively). The doctor in the institutions diagnosed second-degree lumbar spine osteochondrosis.

Results: Our results revealed subjects with osteochondrosis who daily wore the author’s version of therapeutic-prophylactic clothes for six months, had persistent remission of osteochondrosis with reduction of painful and unpleasant sensations in the lumbar spine. Furthermore, the subjects also showed a significant decrease of anxiety level, an increase of personal self-estimation and satisfaction with life at the rise of motivation to wearing of therapeutic-prophylactic clothes.

Conclusion: Daily wearing of therapeutic-prophylacticclothes’ applied version for six months can ensure the correction of clinical osteochondrosis manifestations in people of mature age and the formation of psychological comfort what secures the achieved remission.

Introduction: Intracranial and extracranial factors causing secondary Traumatic Brain Injury (TBI) are the primary targets for medical intervention and preventing brain damage. One of the extracranial factors that worsen the prognosis of TBI is Cerebral Salt Wasting (CSW) syndrome. There are only a few articles that report CSW in TBI patients, and no studies are describing the relationship between CSW and clinical outcome of head injury. This study aimed to determine the relationship between CSW and clinical outcome of TBI patients.

Methods: This was a prospective cohort study conducted from October 2018 to May 2019. Data collection was carried out in a surgical emergency and inpatient ward at Sanglah Hospital. The outcome was assessed using the Glasgow Outcome Scale (GOS) 3 months after head injury. The relationship between variables was analyzed and using Chi-square analysis. Data were analyzed using SPSS version 23 for Windows.

Results: Most of respondents are male (83.3%), severe head injury (73.3%), mild hyponatremia (90.0%), and negative fluid balance (100.0%) in CSW (+) group (Table 1). However, in CSW (-) group, most of respondents are male (70.0%), moderate head injury (85.0%), normal serum natrium (80.0%), and positive fluid balance (60.0%). CSW increased the risk of unfavorable outcomes, 5.7 times in moderate and severe head injuries (95% CI=1.8 – 18.4; p=< 0.001).

Conclusion: CSW syndrome increased the risk of unfavorable outcomes in moderate and severe traumatic brain injury patients.

Background: Keloid is a fibroproliferative disease in which its etiology remains unknown. Various therapy modalities have been improved, but none of them gives a satisfying outcome. Pirfenidone (PFD) is a commonly used drug in pulmonary fibrotic diseases, which has an anti-fibrotic effect. 5-fluorouracil (5-FU) is one of the keloid therapy choices that has long been used. This study aimed to investigate PFD's effect and its combination with 5-FU on fibroblast proliferation and collagen deposition.

Methods: This experimental study using post only control group design was conducted by comparing PFD in various doses (0.5, 1.0, 1.5, 2.0, 3.0 mg/ml) and its combination with 5-FU on keloid fibroblast proliferation and collagen deposition. We used MTT (3-[4,5-dimethylthiazol-2-yl}-2,5diphenyl tetrazolium bromide) and Sirius Red assays to measure the fibroblast proliferation and collagen deposition, respectively. The statistical analysis used one-way ANOVA with p-value p<0.05 was considered significant.

Results: The combination of PFD 3.0 mg/ml + 5-FU 1.0 mg/ml had more significant effect on inhibiting fibroblast proliferation as well as decreasing collagen deposition compared to 5-FU only (p<0.043). PFD 1.0 mg/ml + 5-FU 1 mg/ml as well as PFD 1.5 mg/ml+ 5-FU 1 mg/ml are more effective in inhibiting fibroblast proliferation and lowering collagen deposition than PFD only with p values of <0.001 and <0.000, respectively.

Background: Pseudomonas aeruginosa is one of the bacteria that cause otitis media, leading to progressive structural damage of the middle ear mucosa due to virulence factor, toxin, and enzyme produced. The excessive inflammatory process can cause oxidative stress, which will aggravate tissue damage, thus difficult to cure. This study aimed to assess the effect of ethanol extract of propolis (EEP) in decreasing IL-8 expression and blood MDA level in the otitis media rat model induced by Pseudomonas aeruginosa.

Methods: A randomized controlled trial was conducted among 42 SDF Sprague-Dawley rats. They were divided into 6 groups: normal control, negative control: Otitis Media (OM), positive control: OM + Ciprofloxacin 20 mg/kg body weight/day, OM + EEP 200 mg/kg body weight/day, OM + Ciprofloxacin 20 mg/kg body weight/day + EEP 100 mg/kg body weight, OM + Ciprofloxacin 20 mg/kg body weight/day + EEP 200 mg/kg body weight/day. Induction of Pseudomonas aeruginosa to obtain the OM model was administered on the first day of the study and waited for 28 days before treatments were given. Data were analyzed with SPSS version 23 for Windows.

Results: After 14 days of treatment, the expression of IL-8 and MDA level in each treatment group (OM + Ciprofloxacin, OM + EEP 200, OM + Ciprofloxacin + EEP 100, OM + Ciprofloxacin + EEP 200) revealed significant decrease compared to OM (negative control group) (p<0.05). The reduction of IL-8 expression between the Ciprofloxacin group and EEP 200 was not significantly different (p>0.05). There was a significant difference between the Ciprofloxacin group and Ciprofloxacin + EEP 100, and between Ciprofloxacin and Ciprofloxacin + EEP 200 (p<0.05).

Conclusion: Ethanol extract of propolis decreased IL-8 expression and MDA level in the OM rat model induced by Pseudomonas aeruginosa.

Background: Lupus Nephritis (LN) is one of the serious manifestations of SLE. Because of its role in the pathogenesis of LN, IL-6 is likely to be a potential marker, whereas for diagnosing kidney involvement at the subclinical stage, microalbuminuria can be examined. Therefore, early detection of kidney damage in SLE is needed to prevent the progression of NL to permanent kidney failure. This study aims to evaluate the relationship between IL-6 levels and microalbuminuria in SLE patients at Sanglah General Hospital Bali.

Methods: This study used a cross-sectional analytic design, carried out in Sanglah General Hospital on SLE patients, conducted in May until July 2019. Blood and urine samples were taken to obtain the data needed to measure the Mex-SLEDAI score. Cytokine evaluation is done by quantitative examination using enzyme-linked immunosorbent assay (ELISA). Chi-square analysis was done using SPSS version 24 for Windows.

Results: The results of the study were 85 subjects with SLE (94.1% women). The median age is 35 years (18-61 years), and the median duration of illness is three years (0.4-18 years). Most of the patients were in inactive clinical condition, 54 patients (63.53%) and laboratory results were still in the normal range. Steroids (94.1%) are the most widely used therapeutic options. Urine IL-6 levels were obtained with a mean of 0.41±0.21 pg/ml, while microalbuminuria levels were obtained with a median of 20 (0-100) mg/L. The results of data analysis stated that there was no significant relationship between urine IL-6 levels and microalbuminuria in SLE (p = 0.972).

Conclusion: In this study, there was no significant relationship between urine IL-6 levels and microalbuminuria.

Introduction: HIV infection and AIDS have a potential impact on future generations, especially in Indonesia, as a significant contributor to HIV transmission. HIV-infected and AIDS patients are easily contracting possible infections, mainly in the oral cavity, which are decreasing patient’s quality of life due to pain, discomfort, and appetite loss. They also subjected to oral health problems, such as dental caries and gingivitis. However, patients with HIV/AIDS tend to neglect their oral health, as they are more concerned with their systemic conditions. This study reports oral manifestations of HIV/AIDS patients and their dental-related problems to assess the need for holistic management.

Methods: Observational studies performed on stadium 4 AIDS patients admitted in the outpatient facility of the Intermediate Care Unit for Infectious Diseases in Soetomo Hospital Surabaya from 2011-2012. Eighty-seven patients participated in this study. Subjects were interviewed regarding previous dental check-ups and examined for oral diseases. Diagnosis of oral lesions and dental problems were made based on clinical appearance.

Results: Many cases of strongly-related lesions were observed, such as oral pseudomembranous candidiasis, atrophic glossitis, chronic hyperplastic candidiasis, oral hairy leukoplakia, linear gingival erythema, and also other less strongly-related lesions such as aphthous stomatitis, exfoliative cheilitis, and angular cheilitis. Dental problems were observed, including dental caries, chronic marginal gingivitis due to calculi deposit, residual roots, and impacted wisdom teeth. During the survey on previous dental check-ups, subjects revealed that most of the patients had never visited a dentist since they diagnosed with HIV (+), and other patients admitted that they choose to conceal their HIV status to the dentist.

Conclusion: Dentists must be well-equipped with comprehensive knowledge of HIV-related manifestations and dental treatment considerations to provide adequate dental and oral health management as a part of the holistic management of HIV/AIDS.

Background: Deep vein thrombosis (DVT) is a blood clot that occurs in the inner veins caused by heart disease, infection, cancer, and prolonged immobilization of the limbs. Neutrophil-Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) have been known as a marker of the primary hemostasis process related to the inflammatory pathway. This study aims to evaluate the correlation of Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio compared to D-dimer as a diagnostic test in Deep Vein Thrombosis (DVT)

Methods: A cross-sectional approach has been conducted in this diagnostic study at the Sanglah General Hospital by using secondary data from medical records during July 2018-2019. The study sample consisted of 49 patients with suspected DVT originating from a population who met the inclusion and exclusion criteria. The variables assessed in this study were NLR, PLR, and D-Dimer. Data collection and data analysis were performed by SPSS version 17 for Windows.

Results: The average age of respondents was 53.10±13.40 years old. Most of the respondents were male (59.20%), having edema in the lower extremity (61.20%), left unilateral laterality (53.10%), and D-Dimer levels ≥ 0,5 µg/ml (76.1%). There was a statistically significant relationship between the average value of NLR (9,07±4,2) and PLR (183,55±66,52) with the occurrence of DVT (P<0.05). The Area Under Curve (AUC) of ROC Analysis was 94.40% (Cut-off: 8.20; p<0.050) in NLR and 92.10% (Cut-off: 159.66) in PLR to the D-Dimer on the incidence of DVT. There was a significant moderate positive correlation between NLR and PLR combination on DVT incidences (r=0.532; p=0.001).

Conclusion:  NLR and PLR can be used as an alternative to DVT diagnostic tools due to high sensitivity and specificity, easy to use, inexpensive, simple, and widely available in Indonesia.

Introduction: Serous type ovarian carcinoma occurs in about 59% of all ovary’s malignant tumors. The high incidence of advanced ovarian carcinoma at the time of diagnosis causes 5-year survival rate of only about 20%. Thus deep science in predictive biomarkers of prognosis is needed, which later could use in therapeutic considerations. Human epidermal growth factor receptor-2 (HER2/neu) is a proto-oncogene that is involved in cell proliferation, differentiation, and apoptosis. Ki-67 is a marker of proliferative activity that plays an essential role in tumor aggressiveness. This study aimed to prove that HER2/neu and Ki-67 have a role as a prognostic factor in serous type ovarian carcinoma.

Methods: The study design was an analytic cross-sectional study, with total sample were 36 samples from the patient’s surgery specimen of serous type ovarian carcinoma, examined at Anatomical Pathology Laboratory Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Denpasar. Histopathological diagnosis for the type of malignancy, grade, and pathological stage according to tumor size was determined on H & E stain. The expression of HER2/neu and Ki-67 was examined with immunohistochemical stain. The correlation between HER2/neu and Ki-67 expression with the degree of differentiation and tumor size was analyzed by the chi-square test, with p<0.05 was significant.

Result: The mean of the age was 49.6 ± 11.28, with range was between 26-64 years.  The most were in the age group 51-60 years (38.9%). No significant correlation was found between HER2/neu expression with the degree of differentiation (α =0.178) and tumor size (α =0.264). A significant correlation was found between Ki-67 expression with the degree of differentiation (α =0.019) and tumor size (α =0.039).

Conclusion: In this study, Ki-67 can be considered for its role as a prognostic factor, whereas HER2/neu requires further research, with a larger sample and followed by an examination of gene amplification.

Background: Hypertension is an increase in persistent blood pressure with systolic 140 mmHg and diastolic ≥ 90 mmHg. In Indonesia, hypertension ranks the 6^th largest non-infectious disease, with a prevalence of 25.8%. Uncontrolled hypertension results in target organ damage, causing strokes, heart attacks, retinopathy, or kidney disorders. The presence of protein in urine can be a marker of kidney abnormality. This study evaluates the relationship between blood pressure and urine protein examination in fishermen of Batu Karas Village, Cijulang, Pangandaran, West Java.

Methods: The descriptive-analytic cross-sectional study was conducted using a total sampling of 97 Batu Karas fishermen. Samples were examined their blood pressure and urine dipstick at the social service event of Faculty of Medicine and Health, University of Muhammadiyah Jakarta, in August 2016. Univariate analysis and gamma relationship tests were done using SPSS version 21 for Windows.

Results: In the fishermen with normal blood pressure, we found 29 samples with 1+ protein urine, two samples were 2+, and 11 were negative. In the pre-hypertensive group, 27 were 1+, and 15 were negative. In the stage I hypertension group, three were 1+, and four were negative. In the stage II hypertension group, three were 1+, and three were negative. We also found a significant correlation between blood pressure and urine protein examination results (p=0.048).

Conclusion: There was a significant relationship between blood pressure and urine protein examination results in fishermen in Batukaras, Cijulang, Pangandaran, West Java.

An acute spinal cord injury (SCI) early management is one of the most challenging tasks in trauma cases. The outcome of its cases depends upon the accuracy, adequacy, and speed of first aid management, diagnosis, and treatment within the “Golden Hours Periods.” Rapid and safe transport of the spinal injury patient allows for early medical stabilization designed to preserve and potentially improve the neurological outcome. The complications that arise from spinal instability or neurological must be prevented immediately and involves all members of the multidisciplinary team. Specialized assessment of people with new spinal cord injuries must take place immediately after an injury. The diagnosis of SCI should include the level and severity of the damage of the spinal cord, type of fracture or/and dislocation of the injured vertebrae, and the stability of the spinal column. Imaging begins from plain radiograph and should include a multi-slice CT protocol of the entire spine to delineate the known injury and to exclude non-contiguous damages. The outcome SCI treatment depends on the number of axons that survived – the higher the number of surviving axons, the restoration of neurological functions might be higher. The management of SCI begins before the patient admitted to the hospital. The principles of treatments include early reduction and fixation, combined extramedullary and intramedullary decompression, cell transplantation, early rehabilitation treatment, and complication prevention. The surgical treatment sometimes needed to evaluate, stabilize the spine, decompress the area that injured, and managed any other injuries that may have been associated with the accident. Once a patient was stabilized, care, and treatment focus on supportive care and rehabilitation.

A newly emerging pandemic of coronavirus disease 2019 caused by severe acute respiratory coronavirus 2 is responsible for significant morbidity and mortality worldwide. The ongoing substantial research endeavor to comprehend its associated coagulopathy requires proportional progress on guidance establishment. Current review of evidence and statements on management of coagulopathy and thrombotic complications related to this novel disease is expected to be a precursory formulation for prospective guideline development.

Cemented total hip arthroplasty is believed to offer adequate pain relief, satisfactory walking ability, and activities of daily living as one of the most widely used techniques for treating hip fragility fractures. However, some complications may occur perioperatively, not to mention the catastrophic bone cement implantation syndrome. Thorough assessment, perioperative monitoring, early detection, and treatment plays an essential role to maximalize the result of this procedure, as well as minimalizing morbidity and mortality. Some anesthetic measures that can be done in order to keep the stability of intraoperative conditions are avoiding volatile anesthetic agents in high-risk patients, administering 100% inspired oxygen throughout the procedure, invasive hemodynamic monitoring, and maintenance of normovolemia.

A central line placement also provides a rapid route of drug administration if resuscitation becomes necessary. Orthopaedic surgeons should also consider thorough lavage of the femoral medullary canal, especially pulsatile jet lavage, removal of tissues before cementation to minimize the formation of microemboli during the procedure, and using cement restrictor to compartmentalize the bone marrow tissue and blood separately from the cement. Therefore, it can be concluded that understanding hemodynamic changes during this procedure is essential, not only for the operator but also for the anaesthesiologists.

Aortic enlargement is not an uncommon incidental finding with potential omission of clinical implications. During routine dissection in the middle of the thorax, there was an incidental finding of a disproportionately enlarged aorta in comparison to normal-sized heart at gross observation despite normal anatomy in local and adjacent structures. Incidental finding of aortic enlargement should not be disregarded as it might contribute to pathological processes. The use of indices could give a more comprehensive appraisal of cardiovascular system dimensions.

Congenital anomalies of the kidney and urinary tract (CAKUT) is an uncommon finding with challenging diagnosis establishment and potentially devastating long-term renal outcome. We describe a case of unilateral duplex collecting system with upper pole vesicoureteral reflux and lower pole ureterocele. This 4-year-old female with prior antenatal assessment of kidney abnormality presented with recurrent urinary tract infection. A multidisciplinary approach was employed to encourage comprehensive diagnostic workup and management strategy. The complexity of such a rare case warrants higher index of suspicion and coordinated collaboration of a multispecialistic team.