Introduction: Traumatic brain injuries (TBIs) could have short and long-term sequelae, including cognitive and behavioral changes and physical impairments. This study aimed to determine the correlation between post-traumatic amnesia and neurobehavioral disorders in mild and moderate TBI patients.

Methods: A cross-sectional study was conducted on 75 patients with mild or moderate TBI who had or didn't have a period of post-traumatic amnesia during their hospital stay in the Department of Neurosurgery Dr. Hasan Sadikin Hospital (RSHS), Bandung, from January to August 2019. The Galveston Orientation Amnesia Test (GOAT) was performed, and neurobehavioral functions were examined in post-TBI patients (mild or moderate) using the neurobehavioral rating scale (NRS), which was performed at the time of hospital discharge.

Results: The subjects were predominated with male patients (76%) with a mean age of 25 years old (15 – 35 years old). The analysis showed that the patients with post-traumatic amnesia had a higher median total NRS score (10.4 [5.0-18.0]) compared to those who didn't have any neurobehavioral disorders (2.6 [1.0-12.0]). The statistical analysis showed that the difference was statistically significant (p-value: 001; r: -0.776).

Conclusion: According to the result, it can be concluded that post-traumatic amnesia was significantly associated with neurobehavioral disorders. However, further study is needed to confirm this finding and assess the other potential factors that may affect both variables.

Background: Depression is the most common comorbid in people with epilepsy (PWE). Detection of depression in PWE is not a routine examination at a neurology clinic because it takes a long time. The education of Acehnese people regarding epilepsy is still limited, leading to discrimination and stigma in society. It is not easy to carry out examinations, and the diagnosis is often overlooked. The objective of this study was to screen and to describe the characteristics of depression in PWE in Aceh.

Method: This study was a descriptive observational study with the total respondents involved 41 PWEs. Detection of depression in PWE was conducted using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), a valid, reliable, shorter and more straightforward instrument test. The sample was determinate using the probability sampling method with a simple random sampling technique.

Results: Our results found that 39% of respondents experienced depression, with the most NDDI-E scores ranged between 11-15, with a percentage of 41.5%. Out of total, 57.1% of the depression occurred in women and those who aged between 18-25 years old were more frequent to experience depression. Depression was more frequent among those who had no formal education (66.7%).

Conclusion: Depression in PWE in Aceh tends to occur in women, those with no education and those who worked as labor or farmer.

Introduction : Extended-spectrum ?-lactamase (ESBL) is a mutated ?-lactamase enzyme that can hydrolyze beta-lactam antibiotics. The aim of this study was to determine the incidence rate, characteristics of patients, antibiotic use and outcome of urinary tract infections (UTIs) due to ESBL-producing Escherichia coli and Klebsiella pneumoniae at Dr Zainoel Abidin General Hospital Aceh.

Method : The samples of this study were all Escherichia coli and Klebsiella pneumoniae isolated from urine culture of UTI cases. Patient characteristics and antibiotic use data were extracted from medical records. UTIs outcome was assessed as clinical improvement or death within a maximum of 30 days of treatment.

Result : The results of this study obtained 63 patients with UTIs caused by E. coli and K. pneumonia of which 52.4% of them were ESBL producers. The incidence of UTIs due to E. coli was higher than that of K. pneumoniae, 63.5% and 36.5% respectively. E. coli ESBL producers were more in number than non-ESBL, conversely K. pneumoniae were mostly non-ESBL. The characteristics of patients with UTIs caused by E. coli and K. pneumoniae were predominant women 52.4%,  and most cases were at 56-64 years old. Antibiotic therapy that given before and after culture results to UTI patients were generally ceftriaxone. UTIs outcome due to ESBL producing Escherichia coli and Klebsiella pneumoniae showed that 26/33 (78.8%) patients experienced improvement, however, 7/33 (21.2%) patients died.

Conclusion : The irrational use of ceftriaxone in patients with UTI caused by ESBL producing E. coli and K. pneumoniae has led to a poor outcome for the patient.

Introduction: Oncom is a processed soybean that contains isoflavone compounds. The types of isoflavones found in soybeans and their dairy products are daidzein and genistein which have an estrogenic effect on animals' reproductive performance. This study aimed to determine the effect of oncom extract on productive age white rats (Rattus norvegicus) estrogen levels.

Methods: This research is an experimental study with a randomized posttest control group design. We used 21 samples divided into three groups. First group was control without being given oncom extract. The second group was given a black oncom extract dose of 0.005 g/g BB. The third group was given red oncom extract of dose 0.005 g/g body weight. Serum collection for estrogen hormone level measurement was collected on day 14 after administration of oncom extract. Data then analyzed to determine the normality and homogeneity. ANOVA test was used to compare the means between groups. P<0.05 was significant.

Result: We found in the control group with the lowest estrogen level mean (16.70±0.581) than the experimental groups. The ANOVA analysis results showed that oncom extract significantly increase estrogen levels of productive age white rats (p<0.05).

Conclusion: Oncom extract can increase the estrogen level in productive age white rats. However, the estrogen levels between red oncom and black oncom showed an insignificant difference.

Background: Non-united fracture shaft of the femur after plate fixation is a common problem. Management of this problem is still controversial. There are many methods for treating femoral shaft aseptic nonunions with a broken implant which conversion to reaming solid intramedullary nail is one of the procedures. However, the reported success rate varies. This study aimed to evaluate bone healing, especially callus formation, radiologically after nonunion reconstruction using intramedullary nailing reaming

Method: This study is a cross-sectional retrospective case analysis presenting 22 patients with the patient's age was 15 to 50 years old who underwent operation procedures managed by removing the hardware and converting to reaming solid intramedullary locking nail with or without autogenous iliac bone graft for at least six months. The bone healing process was assessed by serial plain radiography every six weeks using the Callus Index method.

Results: Conversion to reaming solid intramedullary nailing after nonunion with broken implant gives union rate 95%. Among 22 patients, one patient persisted in nonunion, and two patients experience delayed union. The Callus index of Fracture location (P=0,043)      significantly affected index callus formation (P<0.05); The fracture location, whereas fracture classification (P=0,365), nonunion type (P=0,398), and bone graft (P=0,510) did not significantly affect index callus formation (P>0.05). There was no significant difference in time to the solid union between patients with or without iliac autogenous bone graft. Proximal third nonunion affects the time to solid union. No significant complications were noted.

Conclusion: Nonunion reconstruction using solid reaming nail at both types nonunion gives a solid union. Solid union achieves with or without bone graft.

Background: Metabolic dysfunction-Associated Fatty Liver Disease (MAFLD) is a prevalent liver disease affecting 1 million people and projected to be the leading cause of liver transplantation in 2030 due to its progression of liver fibrosis. Several non-invasive scoring systems have been established to predict advanced fibrosis among MAFLD patients, namely NAFLD Fibrosis Score (NFS). Whether its performance remains useful in determining mortality risk in the MAFLD population is less clear. This study was aimed to assess the usefulness of NFS to predict mortality risk among MAFLD patients.

Method: A systematic search was conducted on Pubmed, ProQuest, and ScienceDirect from inception to February 28, 2021. All studies that met the inclusion criteria investigating MAFLD patients diagnosed with biopsy or non-biopsy were included. Bias risk was assessed using The Newcastle-Ottawa Scale. The outcome was mortality risk. We used a random-effects model, and data were pooled to determine the risk ratio (RR) and its 95% CI. Meta-analysis was conducted using Review Manager 5.3.

Result: 9 cohort studies comprising 21,041 MAFLD patients were included. The risk of bias was found to be low. Pooled analysis showed that high NFS (>0.676) was significantly associated with increased mortality (RR=3.14; 95%CI=2.35-4.19; p<0.0; I²=89%). The finding was more prominent in the biopsy-proven MAFLD subgroup (RR=3.75; 95%CI=2.20-6.38; p<0.00).

Conclusion: High NFS is associated with an increased risk of death in MAFLD patients. 

Background: Patients with thalassemia major who require regular blood transfusions, have experienced a decline in the level of 25-Hydroxyvitamin D and an increase in oxidative stress biomarkers, one of which is Malondialdehyde (MDA). Both mechanisms are thought to be associated with iron overload seen in transfusion-dependent thalassemia patients. It is necessary to research the differences in 25-hydroxyvitamin D and malondialdehyde levels among thalassemia major and non-thalassemia patients along with the increasing prevalence of thalassemia. The study aims to prove the differences in 25-hydroxyvitamin D and malondialdehyde levels among thalassemia major and non-thalassemia patients.

Methods: The study was an observational analytic study with cross sectional approach. Research subjects were 42 children consisting of 21 thalassemia major patients hospitalized at the Dr. R. Soedjati Grobogan Public Hospital and Dr. R. Soetrasno Rembang Public Hospital and 21 healthy children were matched for age. This study was conducted from March to September 2020. 25-Hydroxyvitamin D and malondialdehyde levels were examined using the enzyme-linked immunosorbent assay (ELISA) method and Thiobarbituric acid reactive substances (TBARS) method. Statistical analysis was done using Independent Sample T test and Mann-Whitney test, which p<0.05 was considered significant.

Results: There was no significant difference in the level of 25-hydroxyvitamin D (p = 0.45) in thalassemia major and non-thalassemia patients (25.96 ± 6.36 ng/mL and 27.54 ± 7.09 ng/mL respectively). There was a significant difference in the malondialdehyde level (p = 0.00) in thalassemia major and non-thalassemia patients (0.43 µmol/L and 0.14 µmol/L respectively).

Conclusion: Iron overload in patients with thalassemia major causes a decrease in 25-hydroxyvitamin D level. An insignificant difference in 25-hydroxyvitamin D level among thalassemia major and non-thalasemia indicates that other factors such as nutritional status, nutrient intake, and sun exposure also play an important role in 25-hydroxyvitamin D level. The formation of ROS triggered by iron overload also results in a significant increase of malondialdehyde level in thalassemia major.

Introduction: Deaths due to the novel coronavirus (COVID-19) infection in Indonesia continue to increase each day. Limiting patient contact with family and health workers directly in the inpatient room can raise suspicion and complaints from the patient's family being treated. The risk of medical disputes can also arise due to the limited fulfillment of obtaining information from the patient or family. This study aims to highlight the role of hospital-assisted Tele-education in conveying information to family members regarding the death of their loved ones.

Methods: This study is a descriptive quantitative study by taking secondary data from medical records and quality committee data in hospitals to compare patient complaints that arise before and after hospital tele-education policy in COVID-19 cases at Prof.dr.R.D Kandou hospital. 

Results: Tele-education implementation appears to increase. From 14.43% in the first month of implementation to 80.46%, after the policy was set at the end of the 6th month. The number of complaints related to patients hospitalized due to COVID-19 before the use of virtual education in the patient's family was 18.26%, and in cases where patients died, family complaints before the use of virtual education had a mean of 39.1%. After implementing the policy, the complaint rate for patients being treated fell to an average of 5.06%, and in deceased cases, the complaint rate decreased to an average of 8.95%. 

Conclusion: The number of cases that using virtual education increased each month, and the peak was in December 2020; meanwhile the lowest percentage was in July 2020. The use of virtual media in delivering family information and education reduces the barriers that are formed due to hospitalization in isolation rooms.

Background: Burn injuries remain the third cause of death in the world. The treatment, management of deep dermal burns is by applying topical medications like nanosilver collagen cream. Collagen is widely used for wound healing, cell development, angiogenesis, and platelets' activation. This study observed the effectiveness of the drug administration of nanosilver collagen cream compared to the silver sulfadiazine cream against the healing of deep dermal burns reviewed based on neutrophils counts and angiogenesis.

Methods: This study represents an experimental study of a laboratory with a randomized post-test with a control group design. The study used the Sprague Dawley mice to be divided equally into four randomly generated groups. Data were analyzed using SPSS version 20 for Windows.

Results: The Post-Hoc Mann Whitney test shows there is a significant difference in the angiogenesis between the 3^rd and 6th-day groups such as group I (p = 0.034), II (P = 0.009), III (P = 0.009), and IV (P = 0.009). Kruskal-Wallis test also obtained that neutrophil counts decrease but not significant (p=0.159) on day 3^rd and (p = 0.315) dan day 6^th administration of nanosilver collagen.

Conclusion: The administration of nanosilver collagen creams cannot decrease neutrophils counts significantly and administration of nanosilver collagen 2% increase angiogenesis compared to the silver sulfadiazine cream against the healing of deep dermal burns reviewed from the Sprague Dawley mice.

Background: Acne vulgaris is a chronic and self-limiting inflammation disorder of the pilosebaceous unit, generally manifested in adolescents with polymorphic lesions, such as comedones, papules, nodules, and cyst. Brain-derived neurotrophic factor (BDNF) is a member of neurotrophins that can be downregulated because of stress. It is suspected that a lower BDNF level is induced inflammatory process, although its relationship with acne vulgaris has not been widely studied. This study compared BDNF serum levels in the inflammatory and non-inflammatory type of acne vulgaris.

Methods: This is analytical observational research with a cross-sectional design that involved 31 acne vulgaris patients with inflammatory lesions and 31 acne vulgaris patients with non-inflammatory lesions. Each subject was interviewed and going through dermatology examinations, followed by blood sampling to assessed their BDNF serum levels through the ELISA test. The collected data were analyzed statistically using an independent T-test. P<0.05 was significant.

Result: The mean BDNF serum levels in acne vulgaris patients were 32,53±6,32 ng/ml. In subjects with inflammatory-type lesions, the mean BDNF level is 27,55±3,31 ng/ml. While, in the non-inflammatory type lesions group, the mean BDNF is 37,51±4,37 ng/ml. The BDNF serum level is significantly lower in inflammatory-type subjects than in non-inflammatory type (p < 0,001).

Conclusion: There was a significant difference in serum BDNF levels between the inflammatory and non-inflammatory type acne groups.

Background: Prostate cancer is one the most common malignancy in men worldwide, and acinar adenocarcinoma is the most prevalent one. Gleason score and grade group is recently used to predict the therapy and prognosis based on Gleason pattern. Her-2 and Ki-67 are markers that are widely studied in breast cancer, but their role in prostate cancer is still unclear. Her-2 is a transmembrane protein involved in oncogenesis. We hope by using the basic determinant Gleason pattern to analyze the expression of these two markers, it will contribute to understand its carcinogenesis and prognosis. The aim of the study is to determine the expression of Her-2 and Ki-67 in Gleason grade of prostate acinar adenocarcinoma.

Methods: An analytic observational study with cross-sectional design was done using 31 paraffin-embedded tissues of prostate acinar adenocarcinoma from the Anatomic Pathology Laboratory of Dr. Kariadi General Hospital, focusing on 48 areas classified into pattern 3, 4, and 5. Immunohistochemical staining was performed using Her-2 and Ki-67 antibodies to all tissues and the datas were analyzed using the Kruskal Wallis test and the Spearman test.

Results: There are significant differences and correlations between the expression of Ki-67 and Gleason grade, but there are neither significant differences nor correlation between Her-2 expression and Gleason grade.

Conclusion: Her-2 expression is almost the same among Gleason grade as basic determinant of prostate acinar adenocarcinoma

Introduction: Diarrhea is still a considerable health problem today, especially in developing countries, including Indonesia. One common etiology of diarrhea is Vibrio cholerae, which still causes many problems, such as inappropriate use of antibiotics causes antibiotic resistance. The golden sea cucumber (Stichopus hermanii) has antibacterial potential against Vibrio cholera. This study aims to determine the effect and lethal concentration of golden sea cucumber extract on the growth of Vibrio cholerae bacteria.

Methods: This research is an experimental laboratory using the post-test-only control group design method. Dilution is conducted, where six groups are consisting of 4 treatment groups and two control groups. The concentration of the treatment group is 100%, 50%, 25%, and 12.5%, while for positive control using tetracycline and distilled water as a negative control.

Results: The results of this study indicate that the extract of golden sea cucumbers can inhibit the growth of Vibrio cholerae bacteria, as evidenced by a dilution test, where the higher the concentration of the golden sea cucumber extract, the more Vibrio cholerae bacteria are inhibited its growth. With a value of p = 0.001. The lethal concentration of golden sea cucumber extract obtained from this study through a dilution test starting from a concentration of 25%.

Conclusion: Golden sea cucumber extract (Stichopus hermanii) can inhibit the growth of Vibrio cholerae bacteria through dilution test, regardless of concentration.

Background: Resistance of Neoadjuvant Chemotherapy (NAC) in Locally Advanced Rectal Cancer (LARC) makes patients lose their therapeutic window for tumor resection oncologically. As one of the inflammatory biomarkers, Neutrophil Lymphocyte Ratio (NLR) has a significant role in tumor progression. This study aims to evaluate the NLR values as a predictive factor radiological response of NAC in LARC.

Methods: This study used a cross-sectional study to assess the relationship of pre-chemotherapy NLR with NAC response. All subjects were LARC patients who underwent the NAC FOLFOX regiment at the Dr. Soetomo General Hospital from January 2016 to December 2020. Variables assessed in this study included tumor size (T), staging, pathology, metastasis status, Complete Blood Count (CBC) and abdominopelvic CT-scan examination before and after (3^rd cycle) NAC FOLFOX regiment, after 3^rd cycle NAC FOLFOX regiment, gender, and albumin level. Data were analyzed using SPSS version 23 for Windows.

Result: A total of 102 LARC patients underwent NAC. There were 62 patients (60.8%) with low pre-chemotherapy NLR (<2.15) and 40 patients (39.2%) with high pre-chemotherapy NLR (> 2.15). There were 57 patients with a positive response to NAC (Complete Response (CR)/Partial Response (PR)), with 48 patients have low NLR (84.2%) and 9 patients (15.8%) with high NLR. There was a significant relationship between pre-chemotherapy NLR and type of histopathology (OR 11.810; 95% CI: 4.561-30.579; p<0.001) to the radiological response of NAC in the Chi-Square test. However, a logistic regression test found that the OR value of pre-chemotherapy NLR increased to 13.649 (95% CI: 4.266-43.671; p<0.001) to the radiological response of NAC.

Conclusion: Pre-chemotherapy NLR can be used as one of the predictive factors of radiological response after the NAC FOLFOX regiment in LARC patients.

Introduction: Vital signs are important physiological signs of the body. Autonomous Sensory Meridian Response (ASMR) is an experience of calm and tingles, a tingling sensation like electricity radiating from the head and neck, which affects the autonomic nervous system. This study aims to determine heart rate changes, blood pressure, and respiratory rate before and after watching the ASMR video.

Methods: Double-blind pre-experimental study with a one-group pretest-posttest design. The sample consisted of 30 students who met the inclusion and exclusion criteria. All samples were asked to rest for 30 minutes before treatment and then watch the ASMR video for 3 minutes. Heart rate, blood pressure, and respiratory rate data were calculated before and after treatment. The data analysis was carried out using the Wilcoxon test.

Results: Vital sign data of all samples before treatment were obtained within normal limits. After watching the ASMR video, the results of data analysis using the Wilcoxon test showed that there were significant differences in heart rate (p = 0.013), systolic blood pressure (p = 0.026), and diastolic blood pressure (p = 0.00) after watching the ASMR video. While the p-value on the respiratory rate data is 0.349 which means there is no significant difference in the respiratory rate after watching the ASMR video.

Conclusion: In this study, evidence has been obtained that watching ASMR videos can reduce heart rate and blood pressure. However, the respiratory rate did not give significant results because several factors. More research is needed to determine the exact effects of watching ASMR videos.

Background: Leprosy or Morbus Hansen is a contagious, chronic, and infectious disease mainly caused by Mycobacterium leprae (M. leprae), affecting the skin and peripheral nerves. Vitamin A is an essential non-enzymatic antioxidant for the body, which regulates various immune response components. A decline in the levels of vitamin A was discovered in leprosy. This study determined the levels of vitamin A and its comparison in multibacillary (MB) and paucibacillary (PB) type leprosy patients, also the relationship between vitamin A levels with bacterial index.

Method: This cross-sectional study included thirty-four leprosy patients, conducted at the Leprosy Division in Dermatology and Venereology Department of Haji Adam Malik General Hospital Medan, Pirngadi General Hospital Medan, Lau Simomo Leprosy Hospital, Sicanang Leprosy Hospital, and Belidahan Leprosy Hospital with consecutive sampling techniques from March to October 2018. We determined the levels of vitamin A and its comparison in multibacillary (MB) and paucibacillary (PB) type leprosy patients, also the relationship between vitamin A levels with bacterial index. A T test was then performed to compare vitamin A levels between PB and MB types of leprosy. The relationship between vitamin A levels and the bacterial index was tested using Pearson correlation.

Results: Most of these subjects were MB, male sex predominance, in 16-35 years with 21 subjects. The bacterial index of 0 can be found in 16 subjects (47.1%), +1 in 8 subjects (23.6%), +2 in as many as 5 subjects (14.7%), and +3 in 5 subjects (14.7%). The vitamin A level in MB type leprosy was lower than PB type leprosy (p = 0.001). We also found a negative correlation between vitamin A levels and the bacterial index in leprosy patients (r = -0.632, p = 0.000).

Conclusion: The higher the bacterial index value is, the lower the vitamin A level will be.

Introduction: Balinese piglets, separated from the mother and given traditional feeding, can cause prolonged growth. So, it is necessary to provide feed with a complete formula to support the growth process. Previous studies reported that Balinese piglets fed with a mixture of yellow corn, pollard, Aminovite, table salt, and minerals with several formulations and a metabolized energy (ME)/crude protein (CP) ratio 2800 kcal/kg/12% significantly increased body weight. However, his health status has not been reported, both the hematological profile and antibody titer. The purpose of this study was to determine the effect of the amino acid methionine, lysine, and choline (Aminovite) on health, hematological profile, and antibody titer as immunomodulatory effects.

Methods: This study used 72 Balinese piglets after being separated from the mother, divided into four groups of 18 piglets each. The first group (P0) was given basic feed mixtures of corn and pollard as a control. The second group (P1) was fed P0 + 0.5% Aminovite. The third group (P2) was fed P0 + 1.00% Aminovite. The fourth group (P3) was fed P0 + 1.50% Aminovite. Bali piglets are vaccinated with the Hog Cholera vaccine. Furthermore, on the 12th day of the week after treatment (aged 80-90 days), a hematological profile examination will be carried out, and the antibody titer of Hog Cholera will be examined. The data were analyzed using the One Way Anova test and Duncan's Multiple Range Test. The p-value <0.05 is significant.

Result: There was no mortality of piglets in all groups, but the control group had a high morbidity rate (22.2%) than the other groups. Aminovite mixed in the feed significantly increased WBC, total RBC, Hb levels, and PCV values compared to control (p<0.05). Aminovite can also increase neutrophils and monocytes and significantly reduce lymphocytes compared to control (p<0.05).

Conclusion: The addition of Aminovite as a feed supplement in Balinese piglet feed improved the health of Bali piglets seen from the blood profile and increased Antibody titers resulting from Hog Cholera vaccination. 

Introduction: Urolithiasis is the formation of biomineral stones in the urinary tract, kidneys, and bladder. The formation of stones (uroliths) is still a multifactorial and complex phenomenon that has not been clearly understood; this cannot be attributed to a multifactorial leading to increased excretion of stone-forming components. Renal stones' etiology is still not well understood. Some studies stated that demographics in the population have a strong correlation as a risk factor for urolithiasis. This study was aimed to know the correlation between demographic factors in society and urolithiasis composition in the Aceh population between the year 2018 to 2020.

Methods: This study included 52 patients diagnosed clinically and radiographically with their first episode of urolithiasis at Dr. Zainoel Abidin General Hospital, Aceh, Indonesia, from 2018 to 2020. All samples were first characterized using Fourier Transform Infrared spectroscopy (FTIR) to obtain the mineralogical compositions.

Results: Obtained 52 patients diagnosed with urolithiasis were aged 3-67 years, with most patients (27 patients; 51,92%) were aged 45-64 years old. The mean age of the subjects of this study is 45,52 + 13,90. Of the 52 patients included in this study, 37 patients (71,15%) were male, and 15 patients (28,85%) were female. Of 52 patients, 22 (42,31%) presented with one stone only. Of 52 patients, most of the uroliths consisted of Calcium oxalate monohydrate (Whewellite), which is presented in 27 (51,92%) patients, followed by uric acid (Uricite) in 19 (36,54%) patients.

Conclusion: most of the urolithiasis patients were aged 45-64 years. The ratio of male to female patients was found to be 2:1. Most of the patients presented with one stone only. Most of the uroliths consisted of Calcium oxalate monohydrate (Whewellite) as the main composition, followed by uric acid (Uricite).

Background: Inflammation is related to insulin resistance. Neutrophil to Lymphocyte Ratio (NLR) and Lymphocyte to Monocyte Ratio (LMR) are used as inflammation markers and predictors of complications associated with diabetes. This study aims to determine the differences of NLR and LMR values in controlled and uncontrolled type 2 diabetes mellitus (DM) patients.

Methods: A cross-sectional was conducted in this study at Sanglah General Hospital. Research data were taken from the Laboratory Information System (LIS) and medical records. NLR is obtained from the absolute neutrophils divided by absolute lymphocytes, LMR is obtained from absolute lymphocytes divided by absolute monocytes. Data were analyzed using SPSS version 25 for Windows.

Results: Type 2 diabetes mellitus mainly was male (58.3%) with the highest proportion at the age of 46-55 years (50.0%). The mean leukocyte count was significantly higher in the uncontrolled group (8.45±1.58 cells/µL) (p<0.05). NLR showed a significant difference in the two groups (p<0.05). However, there was no significant difference in LMR between groups (p>0.05)

Conclusion: NLR in uncontrolled type 2 DM was significantly higher than in controlled type 2 DM. Meanwhile, the LMR did not show a significant difference between the two groups.

Background: Extensive wound closure due to trauma, infection and post tumor excision often requires a skin graft procedure. One of the successful factors of skin graft is the good quality of recipient tissue vascularization. Reactive oxygen species (ROS) is a factor that plays a role in vascularization, an excessive accumulation of ROS can interfere with the process of vascularization. Administration of the antioxidant can keep the ROS levels from being excessive thus producing the recipient vascularization for a successful skin graft. Propolis has an effect of antioxidant, inflammation and immunomodulator, anti-ROS and anti-inflammatory effects due to the large polyphenol content. This study aims to examine the antioxidant effect of propolis ethanol extract Lawu mountain (EEP) in a rats skin graft model by examining its effect on oxidative stress levels (Malondialdehyde blood levels/MDA), effect on inflammation (IL-6 blood levels and NF-kB expression), effect on angiogenesis (VEGF blood levels and Caspase 3 expression) and skin graft vascularization (Micro Vessels Density /MVD).

Methods: The study used 24 white male rats (Rattus norvegicus) aged 3-4 months, body weight 150-300 grams, and divided into a control group with skin graft without treatment and three groups of skin graft treated with a dosage, 200 mg/kg-BW EEP, a dosage, 400 mg/kg-BW EEP, dan a dosage, 800 mg/kgBW EEP) for 7 days. Wound tissue granulation is made according to previous research. Skin graft procedure uses allograft donors for 7 days. Blood draw from retro orbita veins and skin graft with a small amount of recipient tissue done after the seventh day. The propolis ethanol extract of mount Lawu (EEP) is made by maceration technique 3,75 liters of ethanol 70% as a solvent. Using the SPSS 22 for windows program, blood MDA levels, blood IL-6 levels, and blood VEGF levels were analyzed by One Way ANOVA and post hoc. Examination of Nuclear Factor-Kappa Beta (NF-kB) expression, Caspase-3 expression, and MVD was carried out by using Immunohistochemistry (IHC) tested with non-parametric Mann-Whitney test.

Results: There was a significant decrease in MDA blood levels (p<0.05), with an effective dosage, 400 mg/kgBW EEP and a dosage, 800 mg/kg-BW EEP. There was a significant decrease of IL-6 blood levels (p<0.05) at administration dosage, 200 mg/kg-BW EEP and a dosage, 400 mg/kg-BW EEP, and statistically significant (p<0.05). Vascular Endothelial Growth Factor (VEGF) blood levels increased with a dosage from 200 mg/kg-BW EEP until a dosage, 800 mg/kgBW EEP and significant (p<0.05), the post hoc test showed significant results in all group comparisons. There was no significant increase of skin graft vascularization (MVD) (p=0.254). Caspase-3 and NF-kB expressions decreased at certain dosages, although the decrease of Caspase-3 (p=0.557) and NF-kB (p=0.916) were not significant in statistic analysis test.

Conclusion: Propolis ethanol extract of mount Lawu (EEP) has anti-ROS, anti-inflammatory, and angiogenic effect through decreased MDA blood levels, decreased IL-6 blood levels and increased VEGF blood levels, no significant reduction in NF-kB and caspase-3 expression and there was no increase in skin graft vascularization (MVD). 

Background: The factor affecting the liver's healing process after resection in liver malignancy is liver fibrosis. Bovine Colostrum (BC), as one of the anti-fibrosis products of the liver, improves hepatic fibrosis and reduces hepatocyte damage caused by carbon tetrachloride (CCl4). Meanwhile, Mesenchymal Stem Cell (MSC) is a new therapeutic source after resection. MSC is able to differentiate into specific cells in the healing process. This study aims to determine the effects of BC, MSC, and a combination of both in terms of increasing Alkaline Phosphatase (ALP) and Takeda G-Protein Coupled Receptor-5 (TGR5) levels in Wistar rats post hepatectomy 50% with liver fibrosis.

Methods: This study is an experimental study with a randomized control trial design. Subjects were 25 Wistar rats (Rattus norvegicus) which were divided into 5 groups: Sham (surgery only), K (Control), K1 (CCL4 +BC), K2 (CCL4 + MSC), and K3 (CCL4 + MSC +BC). Blood was also taken to assess ALP and TGR5 at Day-3, Day-7, and Day-10 of treatment. Data were analyzed using SPSS version 25 for Windows.

Results: A significant differences are found in ALP in the Sham group with K2 (p = 0.014) and the K2 group with K1 (p=0.026) on day 10. Significant differences in TGR5 are found in the Sham and K2 groups (p=0.009), control with K2 (p=0.014), K2 with K1 (p=0.007) on day 3. On day 7 in the control group with the combination (p=0.013). The test results showed that TGR5 on day 3 had a moderate significant strong correlation on ALP levels on day 10 (r=0.596; p=0.014).

Conclusion: The combination of BC and MSC was not better than the administration of BC or MSC only in increasing ALP and TGR5 levels in rats with liver fibrosis after hepatectomy 50%.

Based on this study, the administration of MSC is recommended. 

Introduction: Keloid is a fibroproliferative tumor with excessive growth caused by an abnormality in the wound healing process. Several factors are contributing to the development of keloid, such as genetics, local and systemic factors. Keloid can happen in any skin color, but more common in darker skin colors related to melanocytes, melanin, or ?-MSH. Color bar tool is an objective and economical tool used to determine each skin color. This study aimed to evaluate the relationship between skin color and keloid.

Methods: This is an analytic observational study with a cross-sectional method that includes 44 keloid subjects and 44 controls according to inclusion and exclusion criteria. Sex, age, education, job, family history were documented. Diagnosis of keloid was made by history taking and clinical examination. The skin color is measured with the color bar tool. Kruskal Wallis test was used to determine the relationship between skin color and keloid. The result was significant, with a p-value <0.05.

Results: Keloids were found primarily in females (58.8%), 18-25 years old age group (40.9%), and unemployed (40.9%). The majority of the subjects have high education (47.7%) and no family history of keloid (63.6%). The most common location was the sternum (18.9%), followed by the abdominal (15.0%). This study found that the most documented skin color was color bar 2 (54.5%), followed by color bar 3 (29.5%). We found that there was a significant relationship between skin color and keloid (p=0.026).

Conclusion: There was a relationship between skin color and keloid.

Introduction: The COVID-19 pandemic has spread throughout the world, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that affects the respiratory system. The emergence and spread of the COVID-19 pandemic have caused confusion, anxiety and fear among the community, including university students. Anxiety to the COVID-19 pandemic causes various psychological manifestations, including fear of disease transmission, loss of loved ones, and decline in future socio-economic aspects. Anxiety can also lead to physical responses like gastrointestinal symptoms. This study aimed to determine the relationship between anxiety to COVID-19 pandemic and gastrointestinal symptoms complained by university students.

Methods: This observational analytic study using cross-sectional approaches involved 311 university students of Universitas Syiah Kuala, Banda Aceh, Indonesia. Anxiety to COVID-19 pandemic was measured using the Depression, Anxiety, and Stress Scale questionnaire, while gastrointestinal symptoms were measured using the Gastrointestinal Symptom Rating Scale questionnaire.

Result: Of the 311 respondents, 157 (50.5%) of them felt anxiety about the COVID-19 pandemic, with 28 (9%) and 13 (4.2%) students experienced severe and very severe anxiety, respectively. Besides, 264 (84.9%) university students complained of gastrointestinal symptoms, both upper and lower gastrointestinal tracts. There was a significant relationship between the level of anxiety to COVID-19 pandemic and gastrointestinal symptoms.

Conclusion: In conclusion, anxiety about the COVID-19 pandemic can cause gastrointestinal symptoms amongst university students. Therefore psychological assistance is needed to reduce psychological and physical disorders during the pandemic. 

Introduction: Decreased renal function is associated with a poor prognosis in acute heart failure (AHF). The current standard for assessing the decline in kidney function, creatinine, has several limitations. Serum Neutrophil gelatinase-associated lipocalin (NGAL) is one of the predictive biomarkers that was shown better at indicating an early AKI. Although several studies have examining the role of NGAL as a predictor for poor prognosis in various medical conditions, the result in AHF condition is still inconsistent. This study aimed to determine the role of serum NGAL and decreased renal function (estimated using serum creatinine) in predicting the mortality and major adverse cardiovascular (MACE) events during hospitalization in acute heart failure patients

Methods: Prospective cohort study with consecutive sampling was conducted in AHF patients who were treated at Sanglah General Hospital from July to September 2017. Serum NGAL and creatinine levels were measured at the onset of hospital admission and observed for mortality and MACE during hospitalization.

Results: Seventy-seven patients were involved in this study. We found hazard ratio (HR) serum NGAL to mortality was 7.8 (p = 0.009) and increased to 18,9 in multivariate analysis with cox proportional hazards regression model (p = 0.002). There were significant differences in survival (p = 0.002) between patients with high serum NGAL (424 hours survival rate, 95% CI 296-552) than low serum NGAL (baseline survival 680 hours; 95% CI 584-775) after log rank test. Meanwhile, the effect of serum NGAL on MACE and decreased of kidney function on mortality or MACE did not yield significant result.

Introduction: Ovarian cancer is one of the top three deadliest cancer in women and diagnosing this disease still leaves some challenges to overcome. Therefore, this study aimed to compare the diagnostic accuracy of the Risk of Malignancy Index (RMI) to International Ovarian Tumor Analysis (IOTA) simple rules in adnexal masses.   

Methods: A retrospective study was conducted involving 29 patients diagnosed with ovarian tumors. RMI and IOTA Simple Rules were determined preoperatively and compared with histopathology examination as the gold standard. The accuracy of both methods was analyzed using SPSS.

Results: The mean age of the patients in this study was 45 years old. The sensitivity and specificity of RMI were 65% and 55,5%, respectively. The sensitivity and specificity of the IOTA SR were 90% and 55,5%, respectively. The values for the AUC for RMI and IOTA SR are 0.342 and 0.728, respectively. The AUC of the IOTA SR was significantly higher than the RMI (P < 0.005).

Conclusions: IOTA SR is a relatively useful diagnostic model in characterizing adnexal masses, while the RMI only performs fairly. 

Background: Coronary artery disease (CAD) that can cause high mortality may be diagnosed by cutaneous markers such as earlobe crease. Aside from the earlobe crease, other cutaneous markers are suspected of helping detect the existence of CAD. Therefore, it is necessary to investigate the prevalence of cutaneous markers in patients with CAD submitted to coronary angiography.

Case Report: A study was conducted involving 115 patients who had undergone coronary angiography to confirm the existence of CAD. These patients were examined for the presence of seven cutaneous markers. As a result, a preauricular crease was found in 77% of cases, 67.8% corneal arcus, 47% achocordon, and 45.2% cases of earlobe crease.

Conclusion: Preauricular crease was numerous in CAD cases and may be investigated in relationship with CAD.

Background: Aging is an inevitable process, and skin is the body organ that most demonstrates this process. Skin aging occurs due to two continuous processes, which are intrinsic and extrinsic. Dermoscopy is a non-invasive technique that allows physicians to rapidly observe skin aging in vivo and visualize the morphological structures that are invisible to the naked eyes. Dermoscopic features of facial aging might differ in various ethnic groups. Medan is a multi-ethnic city; thus might show facial skin aging differently. This study investigated the dermoscopic features of facial aging among various ethnic groups in Medan, Indonesia.

Methods: This descriptive study was a cross-sectional study design with 164 subjects from 10 ethnicities in Medan. Subjects were sampled based on ethnic group by quota sampling technique with inclusion and exclusion criteria. Each subject was evaluated for dermatological history and physical examination. The assessment of facial aging is based on the Dermoscopy Photoaging Scale (DPAS) using 11 criteria. The data then processed in the SPSS program ver 23 then presented in descriptive with percentages.

Results: Most of the subjects were Javanese ethnic (30.5%). The age group 30 - 39 years old has the highest frequency (59.1%). Most of them were in married status (87.2%). DPAS criteria showed yellowish discoloration (97.0%), ephelids/lentigo (96.3%), and superficial wrinkle (96.3%0 were the three most dermoscopic features. Each ethnic has its dominant dermoscopic features and various with the others ethnic.

Conclusion: Yellowish discoloration, ephelid/lentigo, telangiectasis and superficial wrinkles were the dominant dermoscopy features. Meanwhile, yellow papules, actinic keratoses and criss-cross wrinkles were rarely observed, and senile comedones were not found in this study. 

Introduction: Radiography interpretation of osteosarcoma is almost similar with the benign and other malignant bone tumors. The radiologists’ ability to accurately diagnose osteosarcoma will determine the therapy and diagnostic consistency. Currently, there is lack of evidence on radiography interpretation reliability of osteosarcoma performed by radiologists. This study aimed to evaluate the interobserver and intraobserver radiologists’ compatibility to confirm the diagnosis of osteosarcoma and explore the interpretation variability of radiological description.

Methods: This was an interobserver and intraobserver reliability study for osteosarcoma radiograph interpretation. The osteosarcoma radiographs, which have been histopathologically diagnosed, were evaluated retrospectively by two observers and twice by one observer in a different timeline. The components of osteosarcoma identified through the radiographs are bone destruction and its pattern, zone of transition, type of periosteal reaction, type of matrix calcification, skip metastasis, and soft tissue mass. The data analyzed with reliability testing through agreement analysis and Kappa value.

Results: After evaluation of 30 radiographs of osteosarcoma, substantial reliability score for periosteal reaction (Kappa 0.79) to almost perfect for bone destruction, types of bone destruction, transitional zone, types of periosteal reaction, calcification matrix, and presence of soft tissue mass (Kappa 0.84-1) were found. There is a strong level of agreement (96.7%) found for skip metastasis. Intraobserver reliability also showed substantial value for the presence of soft tissue mass (Kappa 0.78) and almost perfect for other characteristics of osteosarcoma (0.84-0.93).

Conclusion: Intraobserver and interobserver reliability of osteosarcoma radiograph interpretation was substantial and almost perfect. 

Background: Stretch marks are harmless skin disorders but can cause cosmetic and psychological problems. The mechanism in the pathogenesis of stretch marks is still not well known yet. However, it is most related to changes in the extracellular matrix components, including fibrillin, elastin and collagen. Skin hydration can affect the primary mechanism of its pathogenesis. This study determined the relationship between skin hydration and stretch marks.

Methods: This was a cross sectional study with a total sampling method, involving 84 female residents from the Faculty of Medicine, Universitas Sumatera Utara batch 2020. The diagnosis of stretch marks is made through history taking and physical examination. The skin hydration checking was conducted on the right and left femur by using Corneometer CM 825 device. The data collected were analyzed by using the Kruskal Wallis test. The Ethical Committee of Universitas Sumatera Utara has approved this study.

Result: The majority of ages ranged from 26-35 years (86,1%). Subjects who had a pregnant history with stretch marks were 44,6%. The majority of stretch marks located in the subjects were femur 45,5%. Skin hydration 65,5% of subjects was classified as dry. Skin hydration in subjects with stretch marks was lower than those without stretch marks with a p-value <0,001. There is a relationship between skin hydration and stretch marks with a p-value <0,001.

Conclusion: There is a significant relationship between skin hydration and stretch marks.

Acne vulgaris (AV) is the most common and multifactorial skin disease in adolescents affecting the pilosebaceous unit that involves hormonal imbalance, increased sebum production, and bacterial colonization, which causes both physical and psychological disorders. Cutibacterium acnes is considered one of the key contributing factors even though many Cutibacterium acnes colonies are on healthy skin. Cutibacterium acnes induces lipogenesis and production of sebum. Through its production of porphyrins, it may act as a catalytic agent in squalene oxidation that is comedogenic, thus aggravating comedogenesis. We review the dual role of Cutibacterium acnes to provide an understanding of the pathophysiology of acne vulgaris.

Due to the COVID-19 pandemic, the general public must comply with health protocols and adopt new habits as this disease spreads through droplets and enters the respiratory tract through the nose and mouth. Meanwhile, water penetration into the nasal cavity (istinsyaq) and out (istintsar) during ablution corresponds to the nasal rinse and gargling methods, which prevents the mechanical and chemical attachment of viruses. This article discusses the role of Islamic-based nasal rinse and gargling in the prevention of COVID-19 infection.

Various solutions such as plain water, saline, povidone-iodine, and antiseptics have chemical effects. Gargling and nasal rinse mechanically and chemically wash the mucosal surface in the mouth and nose to prevent the attachment of virus and other pathogens. Mechanically, the difference in concentration causes water to move outside the cell by osmosis, reducing mucus secretion and releasing the virus. Meanwhile, a chemical mechanism occurs when the free iodine in povidone-iodine oxidizes fatty acids and damages the virus cell walls and the respiratory chain of cytosolic enzymes, hence preventing inflammation of the host cell. However, the choice of liquid type, concentration, duration, and frequency of use still need to be considered to prevent side effects.

During the current Coronavirus Disease 19 (COVID-19) pandemic, regular handwashing and other hand hygiene practices as the primary infection prevention program are highly encouraged. Notwithstanding the noticeable benefits in combating viral infection, hand hygiene practice potentially promotes dysbiosis of the skin microbiome. This review aimed to summarize the possible impacts of hand hygiene practices using soap products and alcohol-based hand rubs (ABHR) on the homeostasis of human skin microbiota. We discuss recent findings to provide evidence of the effectiveness of hand hygiene practices in viral infection control, the role of the skin microbiome in human health and the effects of hand hygiene practice on the homeostasis of the skin microbiome. Finally, this review also suggests improving research and practice of hand hygiene in response to the ongoing COVID-19 pandemic.

Fractures of the talus are uncommon. The relative infrequency of these injuries relates to limited guidelines to treat talus fracture. Talus fracture is always associated with high energy injury critical to the normal function of the ankle, subtalar, and transverse tarsal joints.  Outcomes vary widely and are related to the degree of initial fracture displacement. Nondisplaced fractures have a favorable outcome in most cases. Failure to recognize fracture displacement (even when minimal) can lead to undertreatment and poor outcomes. Current detailed diagnoses through Multidetector CT (MDCT) are preferred to avoid miss diagnosed in talar fracture. Although early treatment and delayed treatment did not significantly differ, multiple-choice to treat talus fracture should be known. Conservative and operative treatment can be done in accordance with clinical findings and fracture patterns. With a high risk of complication, appropriate therapy should be done. Many research and articles have been done to develop the treatment and reduce complications over talar fracture from an invasive procedure to a non-invasive procedure like arthroscopy. Therefore, we compile current treatment to give another perspective for surgeons to treat talar fracture patients

The lung is a distant metastatic site of gynecologic cancers. These metastases have clinical characteristics which can be solitary, multiple, solid, or manifest by pleural effusion. Diagnosing and managing lung metastasis is challenging because each type of gynecological cancer has different clinical characteristics. Some gynecologic cancers have tumor markers that can help diagnose lung metastasis; however, others do not have them. The options for managing lung metastasis in gynecologic cancer include; chemotherapy, surgery, or combination therapy. The clinical aspects of lung metastasis from cervical, endometrial, ovarian, vaginal, and vulvar cancers and gestational trophoblastic neoplasia were discussed in this article.

Preterm birth still causes significant mortality and morbidity in newborns, despite modern advancements in preterm care. The gut microbiota is the most significant microbial colonization in the human body and plays a significant role in supporting a healthy body. Preterm infants are susceptible to gut dysbiosis, which is thought to contribute to the many adverse outcomes of prematurity, such as necrotizing enterocolitis (NEC), late-onset sepsis (LOS), and developmental delays. Human breast milk is considered the ideal nutrition source for newborns and can help create ideal microbiota in preterm infants. Breast milk contains human milk oligosaccharides (HMO), prebiotics that promote beneficial bacteria growth, absent in cow's milk. Supplementation of non-milk oligosaccharides such as long-chain fructo-oligosaccharides (lcFOS) and small-chain galacto-oligosaccharides (scGOS) in formula milk for preterm infants is found to be beneficial with a favourable safety profile. This review discusses gut microbiota in preterm neonates, its role in developing immune systems, growth and development, and the benefits of prebiotic supplementation.

Vaginal laxity is a condition that often occurs in women, especially after vaginal delivery, and its prevalence increases with age. This review aimed to explain the role of fractional Erbium laser as a new modality for vaginal laxity management. The typical symptom reported by patients was reduced vaginal sensation. One therapeutic option for vaginal laxity is fractional Erbium laser: yttrium aluminum garnet (Er: YAG) at 2,940 nm frequencies. The laser's thermal stimulation of the dermis appears to stimulate the formation of new collagen, resulting in the thickening of the vaginal mucosa. Previous studies on Er: YAG fractional lasers have shown satisfactory results with minimal side effects.

Background: The coronavirus disease (COVID-19) pandemic has several clinical manifestations from asymptomatic to critical condition. Shortness of breath is one of the hallmark symptoms of COVID-19 infection. The main medical management for shortness of breath in COVID-19 infection is oxygen therapy. Physiotherapy and medical rehabilitation such as breathing exercise and chest physiotherapy can be adjuvant therapy that effectively improves breathing effort in COVID-19 patients. This case report will describe breathing exercises and chest therapy done in a patient with a COVID-19 infection.

Case: In this study, we presented the case of a 53-year-old female patient with complaints of fever, cough, fatigue, anosmia, shortness of breath, and diagnosis with confirmed COVID-19 infection based on swab PCR result. On admission in the isolation ward, the patient was on non-invasive ventilation (NIV), medical medication, and physical therapy. The physical therapy done in this patient was breathing exercise and chest therapy once daily. After four series of chest therapy and breathing exercise, the shortness of breath and her breathing effort was improved. The patient was discharged after 15 days of hospitalization.

Conclusion: This case shows the utility of chest therapy and breathing exercise as a physical rehabilitation treatment for the COVID-19 patient. This physical therapy helps to maximize lung expansion and improve the patient's breathing effort.

Background: Duplication of the gastrointestinal tract is a rare congenital disorder in pediatric patients.  Complete resection in case of a total tubular duplication that requires total or subtotal colectomy is undesirable in children.

Case Presentation: This case presented a simple surgical technique for treating complete colonic duplication without colonic resection. A 2 months old female baby with abdominal distention and stool complaint came out from her vaginal vestibular and normal anus. A digital rectal exam showed a palpable mass in the posterior region. Abdominal CT Scan showed a rounded mass with size 2x2 cm in the left posterolateral of rectum region. The initial diagnosis was suspected sacrococcygeal tumor type 4 with rectovestibular fistula. Intraoperative findings showed duplication of the caecum, appendix, total colon (ascending to sigmoid) and rectum (one directed to the vagina and the other to anus). The ileostomy was done 20 cm from the ileocaecal junction as a temporary treatment to relieving distention with definitive repair planned in the following months. The second stage repair was performed after 1-year-old with posterosagital anorectoplasty followed by distal separation of the duplicated colon using a 12 cm linear stapler. For this case, the third stage repair was done one year after the previous surgery to close the remaining ileostomy. The patient’s outcome showed good results with normal defecating function and no complication.

Conclusion: Complete tubular duplication is a rare case without specific clinical symptoms, but the assessment of the diagnosis can be assisted by radiology such as abdominal CT and barium enema. We hope this article could illustrate management for complete tubular duplication of colon presenting as rectovestibular fistula, thus reflect how important clinical judgment and initial diagnostic in our health care system.

Background: Amenorrhea is a condition where women do not experience menstruation or the cessation of menstrual cycles at reproductive age. Amenorrhea is divided into primary and secondary. Turner syndrome is one example of gonadal dysgensis that cause the most common primary amenorrhea. It is represented by the absence of all or part of the normal second sex chromosome and physical features including short stature, webbed neck, cubitus valgus, pterygium colli, low hairline, edema of the hands and feet, and shield chest. Clinical pictures and karyotype of Acehnesse patients with Turner syndrome are presented in this study. The patients involved in the study were those who came to an endocrinology clinic in a tertiary care center.

Case Presentation: We reported four cases of Turner syndrome which were confirmed from anamnesis, physical examination and chromosomal analysis at the Department of Obstetrics and Gynecology in the Fertility, Endocrine and Reproductive Division of RSUD Dr. Zainoel Abidin Banda Aceh.

Conclusion: All patients with Turner syndrome had amenorrhea,  short stature, bone deformity and underdeveloped primary dan secondary sexual characteristic. Only one case has monosomy X (45, XO), a mosaic chromosomal component was present in the rest of them (45, X with mosaicism). 

Background: Blunt abdominal trauma is one of the leading causes of morbidity and mortality among populations worldwide. However, renal artery injury due to blunt abdominal trauma is a rare occurrence. In this case, a patient who suffered multiple trauma was found in the emergency department, including blunt abdominal trauma, after a motor vehicle accident.

Case report: A 13-year-old boy with multiple trauma was referred to our emergency department, with the primary consideration being to lose consciousness 3 hours before admission due to a traffic accident. After receiving examination, there was no evidence of abdominal bruising, whereas the results of the head CT scan show epidural hemorrhage. After four days of treatment, the urea and creatinine serum levels increased, abdominal CT scan shows right renal infarction suggestive of right renal arterial rupture. The patient was diagnosed with a moderate head injury and right renal trauma AAST grade IV. The patient was referred to the interventional radiology unit. The endovascular revascularization techniques were performed with renal artery stent placement and vasodilator (nitroglycerin) flush into the renal artery before stent placement. Renal artery stenting placement performed on main right renal artery demonstrates the absence of intraluminal defects and substantially blood flow was established, abdomen CT Scan shows an enhancement on right renal parenchyma which mean right kidney vascularization appears to be improved with the return of glomerular filtration rate to normal value at the time the patient was discharged.

Conclusion: Traumatic renal artery thrombosis is a rare occurrence with devastating consequences if any imaging is missed. Endovascular therapy plays a significant role in the treatment of renal artery thrombosis with a better prognosis.

Introduction: Chronic limb-threatening ischemia (CLTI), a manifestation of peripheral arterial disease (PAD) that is characterized by chronic ischemic pain in the foot, inadequate tissue perfusion at rest more than 2 weeks, non-healing wounds, or gangrene that is attributable to objectively proven arterial occlusive disease. Endovascular surgery has played an important rules for revascularization in limb saving.

Case description: 57-years-old man came to the Zainoel Abidin General Hospital emergency room, with a chief complaint of ischemic pain at the right foot since 3 months ago, and being extremely progressive for 10 days. He has no history of smoking and 10-year history of controlled type 2 diabetes mellitus. On the physical examination revealed a stable hemodynamic, an unhealed wound in the right lower limb as well as an open wound size 10cm x 6cm x 4cm. He has palpable femoral pulses but not distal pulses. Peripheral CT angiography obtained a total occlusion at the right anterior tibialis artery (ATA), and no flows at the right dorsalis pedis artery (DPA). Performed a revascularization procedure with endovascular therapy using 3 mm balloon angioplasty with good results along the ATA and DPA. The patient was discharged on the 4^th day after surgery. Clinical Evaluation after 2 months showed improvement on pain, good ulcer healing and ready for skin grafting.

Conclusion: The goal of treatment for CLTI is to relieve pain, heal wounds, and preserve a functional limb, with a cornerstone of treatment is timely arterial revascularization Endovascular surgery in one of the best revascularization techniques for CLTI.

Introduction: Colorectal cancer or known as CRC, is rare among adolescents younger than 20 years old. CRC diagnosis in children is commonly delayed until it reaches the advanced stage due to the nonspecific symptoms mimicking other gastrointestinal disorders. Most CRC in children is poorly differentiated mucinous adenocarcinoma, in contrast to CRC in adults, mostly moderately or well-differentiated adenocarcinoma. The delay in diagnosing CRC in children leads to an extremely poor prognosis rather than adults. Thus, this article aimed to report a rare case related to the CRC in pediatric.

Case presentation: A rare case of a 14-year-old male present with abdominal distention since a month before presented to the emergency department. He also complained of bilious vomiting and not passing stool for three days, there was decreased body mass of about 15 kilograms since a year ago, and a family history of malignancy was refused. There was a distended abdomen, arm contour and metallic sound. The full blood count showed no significant results. We found a dilated prominent bowel filled with air in the entire abdomen from plain abdominal radiography that led us to suspect total bowel obstruction. We decided to do an emergency exploratory laparotomy. Intraoperatively, we found multiple masses look like polyposis in the intraluminal of a descending colon ranging about 10 centimeters long. The histopathological finding showed adenocarcinoma well-differentiated colon T3N0. Postoperatively, there were no complications from the surgery until a month after surgery, and we suggested our patient continue his treatment with adjuvant chemotherapy.

Conclusion: The treatment of colorectal cancer in pediatric is complete surgical resection of the tumor and chemotherapy. Early detection of colorectal cancer is required to prevent further morbidity and mortality. 

Introduction: Lymphedema of lower limb or elephantiasis is debilitating condition causes quality of life impairment, physical, mental, and social burdens. Surgical techniques of lymphedema are physiologic therapy and excisional procedure, one of them is Charles procedure. Currently, surgical approach controversies remain. This case report aims to present Staged Modified Charles Procedure on stage III lymphedema of lower limb, other excisional procedure techniques.

Case description: A Male, 43 years old, complain enlargement of left leg since 18 years ago, his leg was bigger and heavier gradually with intermittent pain until he got difficult to walk. History of trauma, or previous surgery was denied. There were lymphostatic elephantiasis, non-pitting edema with skin changes (acanthosis, increase in thickness, fat deposition, and fibrosis) on physical examination. The patient was diagnosed as lymphedema stage III. Modified Charles's procedure consisted of two-stage tissue excision, negative pressure wound therapy, and delayed skin graft. There were no fluid or blood loss, and infection, obtained 95% of skin graft take, good wound healing, and maximum soft tissue reduction. Histomorphologically supports the  diagnosis of elephantiasis.

Conclusion: Staged modified Charles procedure on stage III lymphedema of lower limb are safe and effective treatment, provide maximum tissue reduction, with excellent skin graft and wound healing, without fluid and blood loss, or infection.

Background: Benign neonatal sleep myoclonus (BNSM) is a condition commonly mistaken for seizures. It is characterized by self-limiting "lightning-like" myoclonic limb jerks that occur primarily during sleep in the newborn phase but are not associated with epilepsy that suddenly stops when the infant is agitated. This condition is potentially resolved between the ages of 2 and 6 months.  The incidence of BNSM per 1,000 births is 0.8 to 3 cases. This case report aims to explain the findings of a neonate with multiple episodes of abnormal jerks affecting the entire limb, only during sleep.

Case Report: We reported a 40-day-old baby boy with multiple episodes of abnormal jerks affecting the entire limb since 10-day-old only during sleep. The jerky body movements appeared six until nine times a day with approximately an hour interval between movements. The patient did not have any neurologic deficits, pathologic reflexes and vital signs abnormalities. Electroencephalogram (EEG) revealed the normal result. We diagnosed the patient with BNSM.

Conclusion: The BNSM is a self-limiting disorder. For neonatal seizures or even neonatal status epilepticus, BNSM can be misinterpreted, recognizing childhood benign sleep myoclonus is important to prevent unnecessary diagnostic studies and treatments. The prognosis was good and the patient didn't need any medication and long-term follow-up.

Background: Hypertrophic cardiomyopathy (HCM) is a left ventricle hypertrophic condition related to genetic disorders involving the gene encoding protein from the cardiac sarcomere apparatus. The prevalence of this disease is relatively low, but various clinical presentations make underrecognized and underdiagnosed. We reported obstructive hypertrophy cardiomyopathy patients with an episode of unexplained syncope and malignant arrhythmia.

Case Report: A 44 years old man came with the chief complaint of shortness of breathing. The patient felt the chief complaint since two years ago with getting worse during mild physical activity. The symptom got better during rest or slept with one pillow without complaining of dyspnea. One year ago, the patient started to feel palpitation disappear and arise with shortness of breathing. The patient got syncope two weeks ago during mild activities after a short period of breathlessness. For the vital sign, blood pressure was at 90/60 mmHg, blood pulse was 67 bpm irregular, breath frequency was 17x/min, and oxygen saturation was 99% room air. The electrocardiogram (ECG) showed atrial fibrillation with regular ventricular rate and left bundle branch block morphology of the QRS complex with Q wave at anterior precordial. The patient also checked for electrocardiography and ambulatory ECG monitoring using Holter. The patient was diagnosed with obstructive hypertrophy cardiomyopathy (OHCM), atrial fibrillation with regular ventricular rate and given Dabigatran 110 mg twice daily, metoprolol XL 12,5 mg once daily, and furosemide 10mg once daily for his medication.

Conclusion: Theoretically, myectomy is the best option for this case; however, due to limited high-volume hospitals in Indonesia doing myectomy for hypertrophic obstructive cardiomyopathy, alcohol septal ablation may be an alternative option if the medication was no longer adequate to improve symptoms.

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