Introduction: Dental and oral diseases are experienced by many children, especially kindergarten or elementary school children. Health promotion with a demonstration method with props is one of the first steps in conveying dental health knowledge and a mouth that is easy to understand by children, using a humorous approach, the demonstration method is one of the most effective methods. The purpose of the study was to determine the effect of counseling demonstration method on increasing knowledge about dental health and mouth in Children at TPQ Al Jakfar Tiris Probolinggo

Methods: Methods: this study used a pre-experimental design that used a one-group pretest-post-test approach with a design of 20 students.  The type of research is used quasi-experimental with pretest-posttest design with control group design. The research subjects were divided into the treatment group (20 people) and the control group (17 people). The research sample is based on purposive sampling. Questionnaire to measure knowledge and check list to measure skills. Data analysis used paired t-test.

Results: The research shows that there is an effect of demonstration method counseling on increasing knowledge about dental and oral health in children at TPQ Al Jakfar Tiris Probolinggo. From the analysis results showed that the significant data equal to <0.001, p <α = 0,05 the result is H1 is accepted.

Conclusion: Health promotion methods with demonstration models have an effect on increasing knowledge about dental and oral health in children at TPQ Al Jakfar Tiris Probolinggo.

Introduction: Bacteriuria in pregnancy is quite common, with the prevalence of asymptomatic bacteriuria occurring in about 2-5% of pregnancies, acute cystitis occurring in 1.3% of pregnancies and acute pyelonephritis occurring in about 3%. If not treated properly, asymptomatic bacteriuria can increase the risk of pyelonephritis and the incidence of low birth weight (LBW). This study aims to describe the characteristics of patients with bacteriuria in pregnant women at Sanglah Hospital. Acknowledging the characteristics of patients with bacteriuria may help the screening process establish an early diagnosis and management.

Methods: This study is a retrospective descriptive study carried out at Sanglah Hospital Denpasar from January 2018 to January 2020. Pregnant women diagnosed with bacteriuria in pregnancy from January 2018 to January 2020 at Sanglah Hospital Denpasar who had met the inclusion criteria and did not meet the exclusion criteria were included in the study. Data regarding the patient’s age, gestational age when bacteriuria was diagnosed, UTI complaints, bacterial urine levels, and culture results were collected for each subject.

Results: Based on the results of this study, it was found that the prevalence of positive bacteriuria from January 2018 to 2020 was 0.89%. Most of the pregnant women diagnosed with bacteriuria were aged 20-35 years (77.1%), had gestational age of 0 - 28 weeks (64.9%), were multigravida (52.7%), and had high school education level (50.8%). The majority of pregnant women who experience bacteriuria were included in the group of asymptomatic bacteriuria (64.9%). The urinalysis results on pregnant women with bacteriuria showed that most of the pregnant women (45.6%) had +1 bacteria levels, followed by +2 and +3 bacteria levels, namely 28% and 26.4%, respectively.

Conclusion: Bacteriuria in pregnancy is still a problem that is often encountered in daily practice

Background: Cancer and chemotherapy are venous thromboembolism (VTE) risk factors. The immune system and inflammation are essential in cancer-associated thrombosis's pathogenesis. Chemotherapy can induce inflammatory conditions that trigger the nuclear factor kappa B (NF-κB) signaling pathway to produce proinflammatory cytokines. Interleukin 6 (IL-6) improves procoagulant status primarily by inducing tissue factor (TF) expression. Tissue factor expression triggers the coagulation system, characterized by increased levels of D-dimer. This study assessed the change in plasma levels of IL-6 and D-dimer changed in high-risk thrombosis cancer patients undergoing chemotherapy.

Methods:  This study was a prospective cohort study of 54 newly diagnosed high-risk thrombosis cancer patients undergoing chemotherapy in Dr. Kariadi General Hospital from January 2021 to September 2021 based on inclusion and exclusion criteria. IL-6 and D-dimer concentrations were collected a day before and after chemotherapy. IL-6 measured by ELISA method and D-dimer measured by the turbidimetry chromogenic immunoassay method. We did correlation test, compared mean, and subgroup analysis. The p-value<0.05 was significant.

Results: There was a positive correlation between plasma levels of IL-6 and D-dimer both pre- and post-chemotherapy (r=0.36; 95% CI (0.1-0.6); p=0.006 and r=0.45; 95% CI (0.2-0.6); p=<0.001, respectively). Post-chemotherapy plasma IL-6 (61.0±84.9 pg/mL) was significantly lower (p=0.022) than pre-chemotherapy (102.4±141.6 pg/mL). Subgroup analysis based on risks of thrombosis showed a significant decrease in plasma levels of IL-6 in the higher risk cancer group of thrombosis post-chemotherapy compared with the low risk cancer group (77.7±144.1 pg/mL vs -0.9±127.8 pg/mL; p=0.037). There was an increase in D-dimer plasma levels post-chemotherapy, but it was not statistically significant (2598.1±2487.8 µg/ml vs 3098.6±3547.4 µg/ml; p=0.512). The subgroup analysis based on blood type, tumor stage, chemotherapy regimen, and risk of thrombosis showed no significant differences in delta plasma IL-6 and D-Dimer levels pre- and post-chemotherapy.

Conclusion: In high-risk thrombosis cancer patients who underwent chemotherapy, there was a statistically significant decrease in plasma levels of IL-6 post-chemotherapy. There was an increase in D-dimer plasma levels post-chemotherapy, but it was not statistically significant.

Background: Astrocytoma is the most common primary intracerebral tumor in adults and causes high morbidity and mortality. Most patients with astrocytomas, especially diffuse gliomas, have a poor prognosis. Recent genetic and epigenetic studies have shown that mutations in the Isocitrate Dehydrogenase (IDH) gene play an important role in the pathogenesis and prognosis of gliomas, thus facilitating IDH1 mutations in the population to become an important marker, not only to assist in the diagnosis and prognostic factors of these gliomas but also to develop therapeutic targets as currently available. This study aims to see differences in the expression of the IDH in each astrocytoma classification.

Methods: A cross-sectional analytic study was conducted at the Anatomical Pathology Laboratory, Faculty of Medicine, Universitas Hasanuddin, from October 2020 to August 2021. The research sample came from 65 paraffin block preparations for primary brain tumors with the diagnosis of Diffuse Astrocytoma (DA), Anaplastic Astrocytoma (AA) and Glioblastoma (GB). The immunohistochemical staining was performed using the monoclonal antibody IDH1-R132H. The microscopic assessment was carried out using a light microscope. Data were analyzed using SPSS version 20 for Windows.

Results: There was a significant relationship between the expression of IDH1-R132H in each astrocytoma classification (p=0.008). The prevalence of astrocytoma with negative IDH1-R132H expression (IDH-wildtype) is lower by 21 samples (32.3%) compared to astrocytoma with positive IDH1-R132H expression (IDH-mutant), which is 44 samples (67.7%).

Conclusion: There are significant differences in the expression of IDH1-R132H in Diffuse Astrocytoma, Anaplastic Astrocytoma and Glioblastoma, where the proportion of IDH-mutant status is higher than IDH-wildtype and IDH1 mutation status has a significant relationship with tumor grade.

Background: CD4 can assess the immune status of a patient with HIV, and this is considered the standard way of assessing and characterizing the severity of HIV-related immunodeficiency. CD4 cell counts are associated with increased mucocutaneous manifestations. This study aims to explain the relationship between CD4 and mucocutaneous manifestations in HIV-AIDS   patients.

Methods: This study is analytical with a retrospective cross-sectional design. The data of the present study was obtained from a number of 614 HIV-AIDS patients with mucocutaneous manifestations, but only 149 patients met the inclusion criteria, including the CD4 level data.

Results: The majority of the patients in this study were male (74.5%), which includes patients under the age group of 25-49 years (70.5%). The most common risk factor was heterosexuality (48.3%). Most CD4 levels were in the CD4 group < 200 (64.4%). Based on the distribution of mucocutaneous manifestations, the various cases were reported as infections (55.8%). Pyoderma and syphilis were significantly associated with CD4 counts ≥ 200 cells/mm³ with a risk of 3.7 and 7.8 times than CD4 cells < 200 cells / mm³. On the other hand, candidiasis was higher in CD4 count < 200 cells/mm³ with a significant difference and a risk of 0.3 times compared to CD4 count ≥ 200 cells/mm³.

Conclusion: Several mucocutaneous manifestations can be considered predictors of advanced immunosuppression (low CD4 level), which were pyoderma, syphilis, and candidiasis in this study.

Background: Skeletal muscle is an essential tissue in glucose metabolism. Reduced autophagic capacity to remove damaged contractile proteins in skeletal muscle cells will contribute to the loss of muscle mass. Metformin is the first-line agent for treating type 2 diabetes mellitus (T2DM) patients. This study aims to investigate the effects of metformin on autophagy through LC3 expression in human skeletal muscle cell culture (SkMC).

Methods: The T2DM human SkMC was obtained from T2DM treatment naïve patients, purchased from AcceGen Biotech®. Fully differentiated myotubes were randomized into the control and treatment groups. The treatment group was given Metformin in three doses (1 mM, 2 mM, and 3 mM). An immunoblotting assay of AMPKα and LC3 was performed using electrochemiluminescence (ECL). The quantitative expression of AMPKα and LC3 were measured at baseline, after 24-hour, 48-hour, and 72-hour. Data were analyzed using SPSS version 22 for Windows.
Results: AMPKα and LC3 expression were higher in the treatment group compared to the control group. The levels of AMPKα and LC3 expression in the treatment group increased dose-dependent. Linear regression analysis demonstrated a significant correlation between metformin administration and LC3 expression levels (p<0.0001).

Conclusion: Metformin administration on T2DM human SkMC resulted in increased autophagic activity, marked by increased LC3 expression.

Introduction: There are not many studies that investigate Islamic caring behavior and the factors that influence it. The purpose of this study was to analyze the factors that influence Islamic caring behavior.

Methods: This study was an observational analytic research design that used nurses' perceptions of Islamic caring behavior and the factors that influence it, including organizational characteristics, job characteristics, and individual characteristics. This survey involved 100 respondents that filled out a questionnaire via a google form. Data analysis using Chi-Square and multiple logistic regression test, with a significance level of <0.05.

Results: This study shows that 51% respondents have good Islamic caring behavior. The factors that influence Islamic caring behavior from organizational characteristics are; 1) vision and mission (p = 0.001), 2) reward system (p = 0.001), 3) selection (p = 0.002), 4) organizational structure and culture (p = 0.003), from job characteristics are 1) performance objective (p = 0.000), 2) work schedule (p = 0.001), 3) job design (p = 0.041), 4) correction (p = 0.002), and 5) feedback (p = 0.002), from the individual characteristics of nurses is attitude (p = 0.028. There are three multivariate test results that have an effect, namely objective performance (p = 0.002; B = 3.19), understanding of vision and mission (p = 0.005; B = 1.401), selection (p = 0.017; B = 1.521), and all three show that there is an interaction.

Conclusion: The most dominant factor influencing Islamic caring behavior is Objective performance.

Introduction: Tantrums are a normal condition that occurs in children aged 1-3 years. If not handled properly, Tantrum behavior will affect the formation of the next child's personality. In Indonesia, 23-83% of children aged 2 to 4 years have experienced temper tantrums. One way to overcome tantrums in toddlers is to provide sound to children. However, not all mothers can do sounding to their children; another alternative is to provide sounding using media. The alternative media is audio-visual affirmation. This study aimed to analyze the effect of audio-visual affirmation on tantrum behavior in toddlers.

Methods: This study uses a quasi-experimental study with one group pre-test-post-test. The population is toddlers who attend Raudlatul Jannah Preschool, namely 98 children, then sampling is done with simple random sampling, a sample of 78 respondents is obtained. The data used in this study is data on the temper tantrums of children aged 1-5 years before and after being given an audio-visual affirmation. This data was analyzed by comparing the temper tantrums in toddlers before and after being given audio-visual affirmation therapy.

Results: The results of data analysis using the Paired T-test showed a significant effect between before and after being given the audio-visual affirmation treatment with p = 0.000 (p < 0.05). This study shows that audio-visual affirmation affects tantrum behavior in toddlers.

Conclusion: Audio-visual affirmation affects tantrum behavior in toddlers.

Introduction: Hypospadias, the most common congenital genital anomaly, is defined as the abnormal ventral opening of the urethral meatus extent from the proximal tip of the glans penis, penis rod, scrotum until perineum. The incidence of Hypospadias continued to increase from time to time. Urethroplasty and orthoplasty is the only possible treatment for Hypospadias until this time. Surgical reconstruction cannot always be done in one step, many cases need more than one reconstruction even though an experienced surgeon did it. This study aims to describe patients’ characteristics in Arifin Achmad General Hospital.

Methods: This is a descriptive retrospective study using a total sampling method and carried out 28 hypospadias patients at Pediatric Surgery of Arifin Achmad General Hospital from January 2019 until December 2020. Data were analyzed descriptively to describe the patient’s characteristics including age, hypospadias type, frequency of surgery based on Hypospadias type, day of hospitalization based on surgical procedure, complication after surgery based on Hypospadias type, and advanced treatment for the complication.

Results: From 28 patients with hypospadias, it could be concluded that the highest number of hypospadias patients found in the 0-5 years age group (50%) with the most common type was penoscrotal as many as 12 cases (43%). One stage procedure was predominant and attributed to 75% more than multistage procedure (25%). Chordectomy procedure got hospitalized for 3 days and multi procedure (cordectomy + urethroplasty + scrotoplasty) got hospitalized for 7 days. Fistula urethrocutaneous majority found in shaft penile type as a complication after surgery (78%) and had cutaneous fistula closure as an advanced treatment for the complication. From the 28 cases, 23 cases were successful without complication (82%) and 5 cases had fistula as a complication after surgery (18%).

Conclusion: Hypospadias treatment in Pediatric Surgery division at Arifin Achmad General Hospital such as Characteristics of hypospadias patient and surgical outcome majority had satisfied outcome and advanced treatment for complication after surgery is fistula urethrocutaneous closure.

Background: One of the causes contributing to the high maternal mortality rate in Indonesia is postpartum hemorrhage, which can be the consequence of perineal rupture. Perineal rupture can happen spontaneously in normal vaginal delivery or worsen after episiotomy, induction of labor, vacuum and forceps delivery. This study aims to know the prevalence and characteristics of perineal rupture so that it can be used as data to make policy guidelines for preventing and reducing the incidence of perineal rupture.

Methods: This is a retrospective descriptive study analyzing secondary data collected from Sanglah General Hospital and nine other Regional Hospitals from January 2018 until December 2019. The data analysis technique used is a univariable analysis by calculating the frequency distribution and proportion to determine the prevalence and characteristics of the research subjects. Data were analyzed using SPSS version 20 for Windows.

Results: There are 8,178 cases of vaginal delivery, 6,191 cases (75.70%) with perineal rupture and 1,987 cases (24.30%) without perineal rupture. Perineal rupture is most often found in women < 20 years old (82.66%), primigravida (81.76%), preterm gestational age (78.23%), the baby with birth weight > 4,000 grams (94.26%), underweight mother (87.50%), and women with assisted delivery by vacuum or forceps (100.00%). 

Conclusion: The Prevalence of perineal rupture in this study is 75.70%, with the most characteristics being women < 20 years old, primigravida, preterm gestational age, macrosomia baby, normal IMT, assisted vaginal delivery.

Background: Increased blood pressure that occurs in chronic kidney disease (CKD) is influenced by the occurrence of thickening of blood vessels. This study evaluates the utilization of propolis which acts as an anti-inflammatory and vitamin D3 which plays a role in calcium-phosphate metabolism, that when combined are expected to prevent atherosclerosis.

Methods: This experimental research used a post-test only group design with a total of 24 male rats divided into 3 groups. Subjects were induced to develop CKD with unilateral ureteral obstruction. A combination of 50mg/kgBW of propolis and 0.126mcg/kgBW of vitamin D3 was given orally every morning in the intervention group. Hemodynamics and atherosclerosis status were observed using sonography until week 4. Inflammatory markers with vascular cell adhesion molecule 1 (VCAM-1) and Caspase-3 were evaluated weekly via plasma and target organ samples were immunohistochemically examined at the study’s end.

Results: Propolis and vitamin D3 significantly reduced blood pressure from 156 mmHg at the beginning of the study to 117mmHg at week 4 (p=0.000). Thickening of the aorta occurred in the control and intervention groups but the thickening in the control group (0.90mm) was statistically significantly (p=0.000) higher than the intervention group (0.30mm). There were decreased VCAM-1 and Caspase-3 levels in the intervention group compared to the control group, both in plasma and target organ levels

Conclusion: Utilization of propolis and vitamin D3 combined has a good effect on lowering inflammation, improving hemodynamics and preventing atherosclerosis in chronic kidney disease rat models.

Introduction: There was evidence that diabatic foot spa has a crucial role in regulating blood glucose levels, but the combination of diabetic foot spa and sauna bathing have never been carried out to decrease blood glucose. The aim of this study was to analyze the combination of diabetic foot spa and sauna bathing therapy and its impact on blood glucose levels.

Methods: The data studied were blood glucose levels. This data can be obtained after administering a combination of diabetic foot spa and sauna bathing and afterward. Then this data was analyzed using an independent t test with p value of 0.000 (p <0.005).

Results: : This study showed that 60 respondents, mostly 58.3% were aged 45- 60 years, almost half of the respondents (48.3%) had suffered from DM for <1- 5 years, (70%) women, from the independent t test obtained blood glucose p value= 0.000 (p <0.05).

Conclusion: There was a decrease level of blood glucose after the patients receive the diabetic foot spa and sauna bathing therapy.

Introduction: Work fatigue is a condition that can lead to a decrease in vitality and work efficiency. Workers with heavy workloads are at risk of work fatigue, and working too long in a day will also increase the risk of fatigue. Therefore, it is necessary to know the influence that causes fatigue in workers, especially the workload factor and the length of time working. So that this study can provide a work evaluation to prevent fatigue.

Methods: This research method uses quantitative methods with the type of observational research with a cross-sectional design. The population in this study were informal workers in the furniture industry on Semarang Street, Surabaya City, with a sample taking using a total population of 35 people.

Results: The results of this study indicate that most workers often experience fatigue when working with high classification. Based on the results of the analysis, it is influenced by the workload and length of work, it is known from the results of the significance value <0.05. Fatigue occurs because it is influenced by the length of work in a day that exceeds 7 hours a day (work is done 6 days a week) and the heavy workload factor received by workers.

Conclusion: Can be concluded that giving workers rest time, regulating working hours in a day need to be done, reducing the burden received by workers by dividing the work evenly and so on.

Background:  Sorafenib is a targeting therapy in Hepatocellular carcinoma (HCC) that targets Vascular Endothelial Growth Factor Receptors 1 (VEGFR-1), VEGFR-2, and VEGFR-3; Platelet-Derived Growth Factor Receptors β (PDGFR-β); c-Kit proto-oncogenes; FLT-3 genes; RET proto-oncogenes; and Raf-1 genes that have the same function in suppressing tumor cell proliferation, angiogenesis, and promotes tumor cell apoptosis;  but its high cost makes necessary to reduce the dosage by combining with other agents. Epigallocatechin-3-Gallate (EGCG) has great potential in cancer treatment because of its anti-angiogenesis, induced apoptosis, and low cost. This study aimed to examine the effects of combination EGCG with low dose sorafenib compared to standard dose sorafenib in apoptosis and PDGFR expression in HCC rats

Methods: Twenty-five male Wistar rats were randomly assigned into 4 groups: sham, control, EGCG+low dose sorafenib, and standard-dose sorafenib. Diethylnitrosamine (DEN) injection to induce HCC was carried out to all Wistar rats except for the sham group. After HCC was developed, the EGCG+low dose sorafenib group and standard-dose sorafenib group received the administration of the drugs for two weeks. PDGFR expression and apoptotic index were assessed in the last 3 groups. Data were analyzed using SPSS version 20 for Windows.

Results: There was a non-significant difference of mean PDGFR expression level between the EGCG+low dose sorafenib group and standard-dose sorafenib group (p>0.05); however, there was a lower significant difference of both groups compared to the control group (p<0.05). There was a non-significant difference of apoptotic index between low dose sorafenib+EGCG group and standard-dose sorafenib group (p>0.05); in addition, there were a higher not significantly different of both groups compared to the control group (p>0.05).

Conclusion: Combining low dose sorafenib with EGCG has a comparable effect with standard-dose sorafenib in reducing PDGFR of HCC, but not for apoptosis.

Introduction: High recurrence of a fibrotic disease, pterygium, following the surgical procedure is perceived as the primary challenge of its management. As the standard procedure, adjuvant therapy of using mitomycin C could dramatically reduce the recurrence of pterygium but could cause multiple serious complications. Our study aimed to investigate curcumin and fibrin glue as alternative candidates for adjuvant therapy in pterygium surgery.

Methods: Human pterygium fibroblast (HPF) was isolated from the patient and cultured in-vitro. The HPF culture was then exposed with mitomycin C (0.4 mg/mL), curcumin (200 μmol/L), and fibrin glue, respectively, for 48 hours. The outcomes were determined by the proliferation of HPF and the expression of transforming growth factor-beta (TGF-β) which were obtained from 2,5-diphenyl-2H-tetrazolium bromide assay and immunofluorescence staining analysis with TGF-β antibody.

Results: The experiment revealed that mitomycin C, curcumin, and fibrin glue could significantly inhibit the proliferation of HPF (p<0.05) suggesting their antifibrotic effect. Further analysis with immunofluorescence staining showed that mitomycin C, curcumin, and fibrin glue could significantly reduce the level of TGF-β as compared with control group (p<0.05).

Conclusion: Mitomycin C was the most potent adjuvant agent to reduce the recurrence of pterygium, followed by curcumin and fibrin glue. Taken altogether, curcumin and fibrin glue have role as adjuvant therapy to prevent recurrence in pterygium surgery.

Background: Obesity is defined as a medical condition characterized by excessive accumulation of body fat and is associated with an increased prevalence of dyslipidemia. Probiotics are living microorganisms, which upon consumption in sufficient numbers, exert health benefits. One of the benefits that has been studied is improving blood lipid profile. The aim of this study was to determine the efficacy of probiotics supplementation on obese adolescents’ lipid profiles.

Methods: A randomized, double-blind, controlled clinical trial involving 58 obese adolescents aged 12-15 years in Denpasar City was performed. After the physical activity, nutritional intake, and lipid profile were assessed, subjects were randomized with random block into two groups: the treatment group who received sachet containing probiotics with five strains bacteria (Streptococcus thermophilus, Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium longum, Bifidobacterium bifidum) and the control group who received placebo for eight weeks. During the study, there were six drop out subjects, and the final analysis was performed on 52 subjects. The data was analyzed using MANCOVA test, with p value of <0,05 considered significant.

Results: In the supplementation group, total cholesterol was decreased by 22,6 mg/dL (95% CI: -33.3 to -12.1, p = 0.0001), LDL was decreased by 16.9 mg/dL (95%CI: - 26.7 to -7.1, p = 0.001), and TG was decreased by 30.8 mg/dL (95%CI: -55.3 to -6.4, p = 0.014). Probiotic supplementation was not proven to increase HDL levels and HDL: LDL ratio with p values of 0.370 and 0.374, respectively.

Conclusion: Probiotics supplementation in obese adolescent could reduce total cholesterol, LDL, TG, but had no effect on improving HDL levels and HDL: LDL ratio.

Background: Malnutrition, systemic inflammation, and atherosclerosis known as MIA syndrome occurs in patients who have undergone regular hemodialysis (HD) and can lower their quality of life (QoL). Current study aimed to determine the interrelation of malnutrition and inflammation to QoL.

Methods: A cross-sectional analytic study was conducted in our hemodialysis installation. We performed Malnutrition Inflammation Score (MIS) and measure serum IL-6 to determine malnutrition and inflammation conditions in regular HD patients and utilized ‘Kidney Disease Quality of Life-Short Form (KDQOL-SF) to assess QoL MIS. IL-6 cut-off point were determined by the Receiver Operating Curves (ROC) then we performed linear regression to analyze the relationship level of MIS and IL-6 with level of QoL. We also used path analysis to prove the mechanism model of MIS and IL-6 to QoL on regular HD patients.

Results: This study consisted of 60 regular HD patients, 40 (66.7%) of men with mean age of 51.8 years and 78 months average of dialysis vintage. Good QoL was obtained ≥60 overall health (above the median value) and high level of MIS was obtained ≥5 with 75% sensitivity and 21.8% specificity, while high IL-6 level were ≥47.21 pg/mL, with 62.2% sensitivity and specificity of 78.3%. This study found the prevalence of protein-energy wasting (PEW) in regular HD patients was 81.7% by using high level of MIS. MIS were significantly correlated to IL-6 (r = 0.376, p = 0.003) however high level of MIS were uncorrelated to poor QoL. The mechanism of the interrelation of MIS, IL-6, and QoL showed on path analysis that MIS was 15% directly correlated to QoL, however, IL-6 indirectly correlated to QoL on regular hemodialysis patients.

Conclusion: MIS and IL-6 were correlated to QoL and MIS also correlated to IL-6. Malnutrition inflammatory score directly affected QoL but IL-6 indirectly affected QoL in regular HD patients.

Background: Coronavirus disease of 2019 (COVID-19) is a new disease that causes clinical symptoms that vary from mild to severe. As a new disease, there is no standard treatment for the disease. Several drugs are used to treat COVID-19, most of which were previously used for other diseases, and the efficacy in COVID-19 is not yet known. This study aimed to evaluate COVID-19 therapy in the early phase of the pandemic.

Methods: In this study, we evaluate data on the characteristics of hospitalized COVID-19 patients in several hospitals in Indonesia from March until December 2020. We also evaluate the therapy given and the results of the therapy.

Results: Most hospitalized patients in this study were mild to moderate COVID-19 patients. The most common combination therapy was chloroquine/ hydroxychloroquine + Azithromycin (79.4%). A small number of patients received chloroquine/ hydroxychloroquine without Azithromycin (9.3%), and only a few did not get chloroquine/ hydroxychloroquine therapy (10.8%). The clinical outcome appeared to be better in the chloroquine/ hydroxychloroquine + azithromycin group than in the other groups. The mortality rate was lower in the chloroquine/ hydroxychloroquine + azithromycin group (2.6%) compared to those in the chloroquine/ hydroxychloroquine group (52%) and the group without chloroquine/ hydroxychloroquine (38%). However, the chloroquine/ hydroxychloroquine + azithromycin group had better baseline characteristics and received more additional medications, such as oseltamivir, corticosteroid, and levofloxacin, rather than levofloxacin, the other groups.

Conclusion: Hospitalized COVID-19 patients in Indonesia from March until December 2020 mostly had mild to moderate COVID-19. Most of them received treatment combinations consisting of chloroquine/ hydroxychloroquine and Azithromycin. The most common combination therapy for hospitalized COVID-19 patients was chloroquine/ hydroxychloroquine + Azithromycin. The clinical symptom improvement was seen mainly in this group.

Introduction: Increasing age has the potential to cause hardening of the arteries. Hypertension is also related to sleep quality and stress levels. Hypertension can be controlled with non-pharmacological therapy using Mindfulness Based Stress Reduction (MBSR) and samavriti pranayama. Samavriti pranayama increases the oxygen supply to the brain, lungs and lowers the heart rate. The purpose of this study was to determine the effectiveness of MBSR and samavriti pranayama for lowering blood pressure, improving sleep quality, and reducing stress levels.

Methods: This study utilized a cross-sectional model. Elders analyzed with hypertension were surveyed for qualification. A add up to of 40 seniors were randomized into the mediation and control bunches. Both bunches gotten schedule care. Eight sessions of MBSR and samavritti pranayama were conducted within the intercession bunch, whereas the control gather gotten no mental intercession. Elders were surveyed with respect to diminished hypertension, uneasiness, and rest quality at two unmistakable stages: some time recently and after the mediation.

Results: There were no significant differences in sociodemographic and clinical parameters between the intercession and control bunches at standard. The mediation program essentially lightened mental and physiological complications in elderly with hypertension. Particularly, the consider uncovered that 8 weeks of the combined MBSR and samavritti pranayama mediation viably decreased lower hypertension and uneasiness scores and made strides the quality of rest in elderly.

Conclusion: The conclusion MBSR combined with samavritti pranayama significantly alleviated clinical symptoms, and could be considered a new, effective psychotherapeutic intervention for Elderly with Hypertension.

Introduction: Tuberculosis (TB) treatment consists of more than one drug to achieve goal treatment. Hepatotoxicity is a form of side effect that causes the termination of TB treatment or regimen changes due to treatment failure, relapse, and drug resistance. Hepatotoxicity may increase the problem, covering more than 7% of all side effects. DILI is also one of the concerns in the treatment of TB. The objective of this study to assess the role of risk factor in the hepatotoxicity during drug-resistant TB treatment and investigate the time of onset hepatotoxicity during drug-resistant TB treatment.

Methods: The research method was retrospective study. Comprehensive demographic and clinical data, management, and outcome were recorded. Patients who were treated with drug-resistant treatment in Dr. Soetomo General Hospital between January 2018 and January 2020 were enrolled. The statistical method used SPSS ver 16.0. A total sample of 129 patients met the inclusion and exclusion criteria.

Results: Prevalence of hepatotoxic side effects was 54 cases. A total of 2 patients occurred hepatotoxicity in the first 2 weeks, and 52 patients developed hepatotoxicity in the late 2 weeks. There was one risk factor influencing the hepatotoxic side effects of drug-resistant Tuberculosis treatment. The history of alcohol consumption the only one risk factor (OR=3,182; 95% Cl=0,120-9,927.

Conclusion: Hepatotoxicity is a common problem among patients during Antituberculosis Treatment, especially on drug-resistant Tuberculosis in our population. Early detection not only reduces the risk of developing hepatic injury but also prevents mortality.

Background: Even though pericardiocentesis is a routine life-saving procedure for massive pericardial effusion, there is scarce data regarding risk factors predicting the outcome in patients undergoing pericardiocentesis. This study aimed to investigate the role of various clinical, demographic, and laboratory risk factors as a predictor of in-hospital mortality and Major Adverse Cardiac Events (MACE) in patients undergoing pericardiocentesis at Sanglah General Hospital, Bali, Indonesia.

Methods: Prospective cohort study with consecutive sampling was conducted in patients undergoing pericardiocentesis in Sanglah General Hospital, Bali, Indonesia, from May 2017 until September 2021. Risk factors and blood samples were observed and measured at the first admission. MACE and in-hospital mortality were observed during hospitalization. Data were analyzed using SPSS version 23 for Windows.

Results: Twenty-seven patients were involved in this study. Malignant etiology was associated with increased risk of in-hospital mortality with HR 13.459 (95%CI: 1.378-131.49). Respiratory Failure during admission was associated with increased risk of mortality with HR 5.99 (95% CI: 1.355-26.55) and increased risk of persistent pericardial effusion HR 5.72 (95% CI: 1.570-20.800).

Conclusion: Malignant etiology and respiratory Failure are independent predictors of in-hospital mortality in patients undergoing pericardiocentesis in Sanglah General Hospital. Respiratory Failure was associated with an increased risk of persistent pericardial effusion.

Background: An executive dysfunction is a form of cognitive impairment commonly found in ischemic stroke patients with a significant impact on the patients' quality of life. The methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and homocysteine ​​are considered important risk factors for stroke and various forms of cognitive dysfunction. This study aimed to investigate the association between the MTHFR C677T polymorphism and serum homocysteine levels and the risk of ischemic stroke-associated executive dysfunction.

Method: 87 ischemic stroke patients within the first three months of stroke onset in West Nusa Tenggara General Hospital, Siti Hajar Hospital, and Mataram General Hospital were recruited. Serum homocysteine levels were assessed using ELISA. The MTHFR C677T polymorphism was analyzed using the PCR-RFLP procedure. The executive function of the patients was evaluated using Trail Making Test Part-B, verbal fluency, and backward digit span tests.

Results: The mean age of the subjects was 54.1 years. CT scan data revealed that 78.2% of subjects had a small infarct size. The MTHFR C677T polymorphism frequency was 25.3%, consisting of 2.3% homozygous and 23.0% heterozygous mutants. Multivariate logistic regression analysis showed that patients with MTHFR C677T polymorphism were more likely to have executive dysfunction than those with the wild-type genotype of the MTHFR gene (OR 4.53, 95% CI 1.06–19.27, p = 0.041). However, patients with hyperhomocysteinemia (≥13 μmol/l) were not associated with an increased risk of executive dysfunction.

Conclusion: The MTHFR C677T polymorphism was the risk factor for ischemic stroke executive dysfunction.

Background: Administration of antenatal magnesium sulfate (MgSO₄) to pregnant women is thought to increase the synthesis of Brain-Derived Neurotrophic Factor (BDNF), which functions as a nerve-growth factor for the process of neurogenesis and also strengthen neuronal resilience in the hypoxic condition that occurs during preterm delivery. Protocols for administering antenatal MgSO4 differ between countries and institutions. One of the concerns is whether the dose is given and the time interval to delivery has a big contribution towards a better fetal outcome. These relationships have not been studied before. This study aimed to analyze the correlation of the total dose of MgSO4 and time interval to delivery with BDNF levels in cord blood.

Methods: This study enrolled 72 pregnant women who will deliver the baby prematurely, with gestational age 28-34 weeks. Subjects were divided into three protocols groups: (1) 4 g iv. only, (2) 4 g iv. initial continued with 1 g/hours until maximum 24 hours, and (3) 6 g iv. initial continued with 2 g/hours until a maximum of 24 hours. At the time of delivery, cord blood of preterm babies was collected. The antenatal MgSO4 total dose and time interval to delivery were collected, and BDNF serum levels were then measured with enzyme-linked immunosorbent assay (ELISA). The correlation between antenatal MgSO4 total dose and time interval to delivery with BDNF levels was analyzed using Spearman’s correlation test.

Result: There was a weak significant correlation of antenatal MgSO4 total dose and BDNF cord blood levels (p<0.001; r=0.381). There was no significant correlation between delivery time interval and BDNF cord blood levels (p=0.44; r=0.092).

Conclusion: Regarding the weak correlation of total dose and time interval to delivery with BDNF, we suggest that all protocols provide comparable outcomes if seen only from the BDNF increase perspective. 

Introduction: Patients undergoing hemodialysis tend to have low self-acceptance; this will impact the willingness to undergo treatment and adherence to hemodialysis therapy to recover. This study aimed to determine the relationship between self-acceptance and compliance in undergoing hemodialysis at A. Yani Islamic Hospital in Surabaya.

Methods: The research design is correlational analytic with a cross sectional approach. The population in this study were all patients who underwent hemodialysis at the A. Yani Islamic Hospital, Surabaya, with 80 patients and a sample size of 36 respondents using a simple random sampling technique. The independent variable in this study was self-acceptance, and the dependent variable was adherence to hemodialysis. The research instrument used a questionnaire. Data analysis used the chi-square test with a significant level of α = 0.05.

Results: The results showed that most respondents who underwent hemodialysis (52.8%) had low self-acceptance, and most (58.3%) had low adherence. The chi-square test results showed p-value = 0.008, which means p < α, then H0 is rejected, indicating a relationship between self-acceptance and compliance with patients undergoing hemodialysis at the A. Yani Islamic Hospital Surabaya. Self-acceptance is directly proportional to the patient's compliance is undergoing hemodialysis. The higher the patient's self-acceptance caused the higher the patient's compliance in undergoing hemodialysis. Families can provide social support to increase the self-acceptance of patients undergoing hemodialysis.

Conclusion: There is a significant relationship between self-acceptance and compliance of patients undergoing hemodialysis at A. Yani Islamic Hospital Surabaya.

Introduction: Indonesia has the fourth-largest child population globally, estimated at 80 million children by the Central Statistics Agency (BPS). The application of Clean and Healthy Living Behavior (PHBS) in early childhood can reduce the number of early childhood health complaints in Indonesia. In addition, the role of positive parenting is also needed to keep the child's environment clean and healthy. This study aimed to determine the attractiveness, clarity, efficiency, accuracy, and novelty of the Be-Health application as a target for parents to help implement PHPBS for early childhood.

Methods: The data was taken from the Statistics Agency in 2018. The Be-Health application's implementation stage used the application development method Extreme Programming (XP). XP was chosen because it is a simple, effective, and efficient application development method. There are five stages in developing the Be-Health application, including five stages, including planning, design, coding, testing, software increment.

Results: Be-Health app is an Android-based application that provides a means to help parents apply PHBS to early childhood. Children can play and learn using the Be-Health application that applies the concept of gamification. It allows children to play and learn to complete learning missions about the application of PHBS through the Be-Health application. 

Conclusion: Based on the results of the prototype design of The Be-Health application using the User Experience Questionnaire (UEQ), it can be concluded that the Be-Health application prototype has above average value for the attributes of attractiveness, clarity, efficiency, stimulation and novelty.

Introduction: The success of therapy did not follow the increasing number of type 2 diabetes mellitus patients. This systematic review aimed to evaluate the relationship between diabetes distress and HbA1c in type 2 diabetes mellitus patients during therapy.

Methods: The authors systematically searched databases (PubMed, Cochrane library, and ScienceDirect) up to January 2021. Articles were screened according to PRISMA 2020 statements. The selection criteria of this study were patients’ characteristics, type of therapy, and outcomes.

Results: The search started from 1.303 articles to 17 eligible articles. Furthermore, seventeen studies included 11,976 patients. The mean HbA1c level was around 6.4% to 9.9%. The result of diabetes distress scores were five studies with low scores, eight moderate scores, and two high scores. Emotional burden and regimen-related distress were the highest domain score. Age, health facilities, and type of therapy affected diabetes distress. The correlation between diabetes distress and HbA1c was dominant in the range of 0.15 to 0.26.

Conclusion: Diabetes distress had a low-moderate correlation with HbA1c. The dominant domains were emotional burden and regiment-related distress. There were two mechanisms of effect, direct by hormones and indirect through medication adherence, self-management, and 12 months of quality of life.

Background: Clavus and callus are common hyperkeratotic lesions that can be very painful and affect the quality of life. The clinicians are faced with various factors affecting the resolution of the lesion, and no treatment has been considered ideal. Surgical has been preferable to conservative treatment but is still more likely to increase patients' desirability due to great discomfort. This study aims to evaluate the factors contributing to the resolution of callus and clavus.

Methods: Retrospective analysis was done on 25 medical records of patients who met the inclusion criteria. Factors contributing to the lesion resolution were identified and analyzed using the SPSS version 17 program.

Result: Among 25 (33.7%) patients recruited for the study, 13 were (52%) male and 12 (48%) female. The most common types of lesions were clavus (20 [80%]). In both cases, the distribution of lesion locations was mostly found in the lower extremities (20 [80%]). Excision was performed in 21 cases (84%), and 20 patients (80%) achieved resolution. Treatment modalities were found to be a factor that had a significant relation to the resolution of the lesion after receiving treatment (p = 0.003; Spearman test).

Conclusion: Treatment of callus and clavus has shown satisfactory results in our center. Excision was found to be the most preferred method, with 80% resolution observed during 1 month. The treatment choice was found to be significantly related to the resolution of the lesion after receiving therapy.

Background: Stroke is a syndrome characterized by loss of focal and function of the rapidly developing CNS. Furthermore, hypertension is a known risk factor that occurs approximately 70% of the time, and lowering systolic BP from 1 to 3 mmHg effectively reduces the risk of stroke by 20 to 30%.

Methods: An observational analytic design, using a retrospective medical record data collection in Malang City Hospital. A total of 113 patients met the inclusion criteria. In addition, the inclusion criteria include hospitalized patients with a primary diagnosis of stroke, ischemia or bleeding as evidenced by a head CT scan, having comorbid hypertension, and having received antihypertensive therapy. Meanwhile, the exclusion criteria were the BP data of the patient measured only once.

Results: The results showed the ability of antihypertensive monotherapy and combinations to lower systolic BP by 33.62 ± 30.15 mmHg and 30.50 ± 29.47 mmHg (p = 0.744) in ischemic patients. In comparison, diastolic BP decreased by 6.86 ± 13.18 mmHg and 11.50 ± 16.26 mmHg (0.291), respectively. Moreover, the administration in bleeding stroke patients resulted in a decrease to 16.95 ± 17.89 mmHg and 22.82 ± 23.91 mmHg, (p = 0.029) for systolic, and 8.63 ± 14.63 mmHg and 8.71 ± 17.17 mmHg (p = 0.647) for diastolic BP, respectively. Furthermore, a combination of 4 antihypertensives drugs showed a better decrease in systolic BP in both patients (44.50 ± 21.63) compared to monotherapy, and a mixture of 2 as well as three drugs, by 27.02±27.05, 25.65 ± 29.97, and 25.37 ± 25.08 (p = 0.027), respectively.

Conclusions: Combination therapy is recommended in stroke patients because BP can be better controlled.     

Introduction: Catheter-related urinary tract infections for one-third of all health-care related infections in the United States, and have also been shown to increase morbidity, mortality, and length of stay. Various problems are associated with urinary catheter insertion, namely trauma, complications, and patient discomfort. The purpose of this study was to analyze the relationship between catheter placement and the incidence of urinary tract infections in hospitalized patients in Condong Catur Hospital Yogyakarta.

Methods: The design of this study was an analytic observational study using a cross sectional design. The sample was patients diagnosed with UTI for 12 months from August 2019 to July 2020 and inclusion and exclusion criteria. The sample selection was done by consecutive sampling. There were 98 samples of inpatients at the Condong Catur Hospital. The data were taken from the medical records of patients who had UTIs or those with a catheter installed.

Results: There are 98 patients in the Condong Catur Hospital, 18 of them have had UTIs, ten of which were caused by catheter insertion. In this study, bivariate analysis was used to compare the two groups with partners and found a significant association between catheter use and urethral infection, with a p-value of 0.001.

Conclusion: There is a significant relationship between catheter placement and the incidence of urinary tract infections in hospitalized patients in Condong Catur Hospital.

Background: Until now the existing male contraceptive methods are periodic abstinence, interrupted intercourse (coitus interruptus), the use of condoms, and vasectomy. Another alternative method of contraception for men is the use of the hormone depot medroxyprogesterone acetate (DMPA) as has been done in female contraceptives. Research with DMPA at a dose of 1.25 mg was effective in reducing the concentration and viability of spermatozoa and testosterone secretion in male rats.

Aim: to discover if DMPA as a gonadotropin hormon could effectively inhibit the process of spermatogenesis in male mice.

Methods: This research is an experimental research with post-test control group design. A total of 36 samples were grouped by simple random sampling into two groups. Control group (P0): consisted of 18 male mice given 0.3 ml of intramuscular aquabides. Treatment group (P1): 18 male mice were given DMPA intramuscularly (IM) with a dose of 3 mg as much as 0.3 ml. Data obtained from examination of the mean of 60 tubules (30 tubules from the right testis and 30 tubules from the left testis) for each treatment with HE staining at 400x magnification.

Results: The results showed a significant difference in the decrease in the number of spermatogonia cells in the treatment group compared to the control group (9.83±2.33 vs 12.78±1.67 cells/tubule), with p value = 0.000 (p<0.01) and Spermatid cells (76.50±7.66 vs 86.44±6.06 cells/tubule), with p value = 0.000 (p<0.01). The administration of DMPA could significantly reduce the number of spermatogonia and spermatid cells in the seminal tubules of male mice.

Conclusion: The results of the study have implications for further research on the use of DMPA as a male contraceptive in higher experimental animals such as rabbits, then clinical trials in humans.

Introduction: Fractures of the hip are common injuries; approximately 50% of fractures occur in the intertrochanteric region. The treatment is to restore patients to their pre-injury level of mobility. Secure fixation is required to allow immediate return to unrestricted weight-bearing. The common fixation methods are dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA). This study compared postoperative walking ability in femoral intertrochanter fractures treated with DHS and PFNA and evaluated the confounding factors.

Methods: We conducted a retrospective cross-sectional conducted at Wahidin Sudirohusodo General Hospital and Universitas Hasanuddin Hospital for patients from 2018 to 2021. The sample was patients with intertrochanteric femoral fracture based on x-ray treated with DHS and PFNA using the purposive sampling method. A total of 107 patients with complete medical record data were included in this research, consisting of 81 DHS cases and 26 PFNA cases. Obtained data from these patients were then statistically analyzed by Chi-square and Fischer exact test. The p-value <0.05 was significant.

Results: In bivariate analysis, the percentage of weight-bearing subjects was higher in DHS (61.7%) than in PFNA (46.2%), although not statistically significant (p>0.05). By controlling for confounding factors such as age, gender, type of fracture, and length of stay, it turns out that there is no significant difference in the results of the postoperative walking ability comparison.

Conclusion: It was concluded that there was no difference in weight-bearing walking ability (full and partial) at discharge between PFNA and DHS.

Introduction: Early menarche and long menstrual cycle were several factors that influence the occurrence of dysmenorrhea. Girls who have early menarche got a higher risk of experiencing dysmenorrhea as well as girl who experience long menstrual cycle. These both problems resulted excessive uterine contractions and secreted more prostaglandins so that causing dysmenorrhea. This study aims to analyze whether there is a relationship between early menarche, menstrual duration and dysmenorrhea in class VIII students in 2019-2020 school year at SMPN 20 Surabaya.

Methods: The design of this study used a cross-sectional approach. The population was all students of class VIII 2019-2020 school year at SMPN 20 Surabaya. Sample were 140 students which were taken based on proportional stratified simple random sampling technique. Retrieval of data by taken through filling out online forms. The independent variable were early menarche and menstrual duration, and the dependent variable was dysmenorrhea. The data analysis used the Spearman rank test with the significance level α = 0,05.

Results: Research result of first independent variable, it was obtained p value = 0.022 which means there is a relationship between early menarche and dysmenorrhea in class VIII students of SMPN 20 Surabaya, and research for the second independent variable, it was obtained p value = 0.04 which means there is a relationship between menstrual duration and dysmenorrhea in class VIII students of SMPN 20 Surabaya.

Conclusion: Students who experience early menarche and have a long menstrual duration are more at risk of experiencing dysmenorrhea with severe pain levels. Students who experience early menarche and long menstrual periods are able to minimize the incidence of dysmenorrhea by such as maintaining a regular diet, consuming nutritious food intake, and taking pain relievers if dysmenorrhea occurs.

Background: Extended random skin flap failure often occurs due to insufficient vascularization. Several attempts have been tried to increase the viability of the flap, but none of these attempts have achieved maximal success. Previous research has shown that Botulinum toxin type A (BTA) increases the viability of cutaneous flaps by inhibiting muscle contraction along with increasing vasodilation and angiogenesis. This study examines the effect of intradermal BTA injection on extended random skin flaps viability.

Methods: In thirty-six Wistar rats, a rectangular random cutaneous flap (6 cm × 1.5 cm) was made on each dorsal rat area and then elevated the flap. The treatment group was intradermally injected evenly with BTA 8 IU and saline solution for the control group. Each rat flap viability was observed after five days. Primary outcome measures are survival flap area using Visitrak, microscopic assessment of the number and diameter of capillaries and Vascular Endothelial Growth Factor (VEGF) expression was analyzed using immunohistochemistry semi-quantitative scoring system. Data were analyzed using SPSS version 21 for Windows.

Results: The treatment group has better results in all observed parameters than the control group. However, Only the VEGF expression of proximal edge showed a statistically significant increase in the group treated with BTA injection (p=0.004).

Conclusion: This study showed that the BTA treatment has a positive effect on random skin flap survival and the reduction of distal necrosis in rats, so it has been proven that BTA has the potential to increase flap survival rates in small animal models. Further studies are needed to determine whether BTA treatment can produce similar findings in humans.

Background: Neurotrophic factors such as NT-3 play an important role in spinal cord regeneration, contributing to spinal cord regeneration assisting functional improvement in SCI. ACTH4-10Pro⁸-Gly⁹-Pro¹⁰, an analog of the N-terminal fragment (4-10) adrenocorticotropic hormone, is one of the neuroprotective compounds that can increase NT-3 levels in brain ischemia. Therefore, we conducted a study with experimental animals to determine the effect of NT-3 expression on ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ administration in acute compression SCI.

Method: We used Sprague Dawley rats with acute compression SCI model using 20 gr and 35 gr aneurysm clips. ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ was administered intranasally to the treatment group, and 0.9% NaCl was administered intranasally to the positive control group. Both of the groups then terminated at 3 and 6 hours.

Results: In rats with mild SCI that were given ACTH4-10Pro⁸-Gly⁹-Pro¹⁰, the NT -3 expression after 3 hours and 6 hours was 14 (12-17) and 10 (7-13). In rats with severe SCI given ACTH4-10Pro⁸-Gly⁹-Pro¹⁰, the NT-3 expression after 3 hours and 6 hours was 9 (6-11) and 8 (7-10). Intranasal administration of ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ showed higher NT-3 expression than the group with 0.9% NaCl in mild and severe SCI.

Conclusion: Intranasal administration of ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ can increase NT-3 expression in mild and severe acute SCI at 3 and 6 hours. Expression of NT-3 in the group with ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ mild acute SCI was higher than in the group with severe acute SCI. Further research needs to be done to determine the neuroregeneration effect of ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ on SCI.

Introduction: The cure rate of Acute Lymphoblastic Leukemia (ALL) in low and middle-income countries is still low. Many factors contribute to relapses event, thus leading to failure of the treatment outcome. However, there are limited studies regarding the relapse of childhood cancer in Indonesia. This study determined demography, clinical, and characteristic laboratory differentiation between relapse and non-relapse in the bone marrow childhood ALL group.

Methods: This was a retrospective descriptive study in children newly diagnosed with ALL ages 0-18 who completed the induction phase using the 2013 treatment protocol during the 2018 period in Pediatrics Hematology-Oncology Unit at a reference center hospital in Indonesia. Of 78 data collected from the Indonesian Pediatric Cancer Registry (IP-CAR) and Hospital Information System after excluding abandoned treatment or death during treatment, only 35 patients completed the overall therapy. We evaluated bone marrow relapse and classified it into 'very early' relapse that occurs at least 18 months from diagnosis, 'early' relapse between 18 and 36 months, and more than 36 months is called 'late' relapse. Chi-square test was used to elaborate association between relapse and sex, leukocyte count, morphological classification, risk stratification, nutritional status. Kruskal Wallis tests were used to elaborate on the association between relapse, age, and induction duration. P value<0.05 was considered statistically significant.

Results: Among 35 patients in this study, seven patients experienced bone marrow relapse. Relapses were dominant in four male patients, four patients aged from 1-10 years old, six patients with leukocytes count below 50.000/mm³, six normal nutritional status patients, and six patients classified as L2 patients. All relapse events occurred in a very early stage. Four patients are classified as standard risk, and three patients are high risk. There were no significant differences among characteristics of the relapse and non-relapse groups.

Conclusions: The observed relapse onset is less than 18 months from diagnosis (very early relapse) during maintenance treatment. However, we found no significant demography, clinical, and laboratory differentiation between relapse and non-relapse groups.

Background: Pig's tonsil is one of the entry points and habitat of commensal microbes and pathogenic bacteria, both Gram-positive and Gram-negative bacteria. Recently, a human meningitis outbreak has reported at Sibang Kaja, Badung-Bali. The cause of this outbreak has been suspected due to the consumption of pig-derived foods. The outbreak was known to be caused by Gram-positive ?-hemolytic bacteria. Based on this fact, PST 10 bacterial isolate with similar characteristics to the outbreak caused interesting identification.

Method: PST 10 isolate was cultivated in a specific medium 5% defibrinated sheep blood agar plate. Subsequently, Gram staining, catalase, oxidase, salt tolerance (6% NaCl), and hemolysis test. This presumptive isolation was then conventionally identified by KIT API 20 STREP and molecularly using the 16S rRNA gene.

Results: PST 10 isolate was identified as Enterococcus faecium using KIT API 20 STREP. Furthermore, the 16S rRNA gene sequencing analysis shows that the isolate has 99.6% similarities with Enterococcus faecalis (MG543832). The isolate shares the same clade in the phylogenetic tree analysis with a 100% bootstrap value.

Background: Dengue hemorrhagic fever (DHF) was one of infectious diseases that is still a concern in Indonesia, especially the Manado city. This study aimed to analyze the variability of temperature, rainfall, humidity, and the incidence of DHF in Manado city 2011-2020.

Method: This ecological research used secondary data obtained from the Health Office and the Central Bureau of Statistics of the Manado City. The variables studied were air temperature, humidity, rainfall and the incidence of DHF in Manado city 2011-2020.

Result: in 2016 there were 567 cases of dengue fever and the highest was in the Malalayang sub-district and the lowest was in the Ranomut sub-district. In 2017 there was a significant decrease to 139 cases, the highest in Malalayang sub-district with 32 cases, and the lowest in Bunaken sub-district with 1 case. In 2018, there was an increase in cases by 294 cases, the highest was in the Malalayang sub-district. The air temperature continues to fluctuate where based on the trendline it is found that the air temperature tends to increase. Whereas, the humidity tends to decrease. The rainfall in the city of Manado continues to fluctuate, where based on the trendline it is found that rainfall tends to decrease. Mosquitoes are cold-blooded animals and their metabolic processes or life cycles depend on the environment's temperature. The DHF cases continue to fluctuate (up and down) where based on the trendline it is found that DHF cases tend to decrease

Conclusion: In the period 2011-2020 in Manado City, air temperature tends to increase but rainfall, humidity, and cases of DHF tend to decrease.

Background: Testicular torsion is one of the urological emergencies that require immediate scrotum exploration. Characteristics of testicular torsion patients, variated time exploration, and the findings of the degree of testicular torsion at the time of exploration can affect the outcome of the testicles. The study aimed to determine the characteristics of testicular torsion diagnosed patients and identify the predictors of testicular salvage.

Method: The method used in the study was cohort retrospective with inclusion and exclusion criteria. Receiver operator characteristics analysis is performed to determine the probability of orchidectomy based on time to exploration and degrees of twist. Multivariate logistic regression tests are performed to identify the factors that cause the testicles to be retained. P<0.05 was significant.

Results: There are 45 patients mostly diagnosed with testicular torsion aged between 12 to 16 years (64.40%). Left testicular torsion was more frequent than the right torsion (82.20%). The etiology of torsion was mostly idiopathic (77.80%). Orchidopexy procedure was performed on 12 testicular torsion patients (26.70%); on follow-up, one patient was found to have testicular atrophy. The time to explore cut-off value 8.5 hours and the 450 degrees of twisting will cause the testis to not survive with the specificity of 83% and 92% and sensitivity of 81% and 82%, respectively. Multivariate analysis shows time to explore and degree of twisting associated with orchidectomy of the affected testis (p<0.05).

Conclusion: Patients are relatively young. Not all patients with testicular torsion will manifest typical symptoms of acute, atypical symptoms such as lower abdominal pain, which can be identified as testicular torsion. Mostly affected left testicle. Orchidectomy is the most commonly performed operation on patients. The outcome of testicular torsion can be predicted by observing the time to exploration factor and the degree of testicular torsion in the patient.

Background: Angle-closure glaucoma is the most common type of glaucoma in Asia, leading worse damage due to its oxidative stress. Another type is  open angle glaucoma in second line. The oxidative stress level can be known by malondialdehyde level examination. The study about MDA levels in aqueous humour in primary angle-closure and open angel glaucoma has not been done before.

Objective: To determine the difference of malondialdehyde levels in aqueous humour between primary open-angle glaucoma and primary angle-closure glaucoma.

Methods: This study was an analytical observational study. Nine subjects were primary open-angle glaucoma patients and ten subjects were primary angle-closure glaucoma patients. The aqueous humour was aspirated from the anterior chamber during trabeculectomy and measured the MDA levels using a spectrophotometer. Data were analyzed by Mann Whitney test.

Results: There was no significant difference (p=0.095) of MDA levels in aqueous humour between primary open-angle glaucoma (62.913±17.259 ?mol/L) and primary angle-closure glaucoma (53.485±9.670 ?mol/L).

Conclusion: The oxidative stress level in primary open-angle glaucoma and primary angle-closure glaucoma are the same, indicate that inflammation status of both condition have been similar.

Introduction: Pregnant women infected with SARS-CoV-2 experienced increased pro-inflammatory cytokines, including TNF-a, resulting in a cytokine storm condition. This study compares TNF-a levels between pregnant women infected and not infected with Covid-19 in the 3rd trimester.

Methods: This observational research was conducted with cross sectional design. Our study included pregnant women who came to delivery room/inpatient at RSUD Dr. Soetomo Surabaya before or during the labor period between May and June in 2021. The inclusion criteria were 3rd trimester gestational age or > 28 weeks with SARS-RT-PCR nasopharyngeal swab result. The exclusion criteria were all significant pregnancy complications. The pregnant woman coming to the delivery room will be screened for COVID-19, and blood samples will be examined using the flow cytometry method for the cytokine Th1: TNF-?.

Results: There were no significant differences in TNF-a levels in pregnant women who were infected and not infected with COVID-19 (median 3.42 (7.24) pg/ml vs. 2.70 (3.06) pg/ml. p=0.138). There were also no significant differences in TNF-a levels in pregnant women with symptomatic vs. asymptomatic COVID infection (3.21(3.97) vs. 2.41(2.71) pg/ml; p=0.314).

Conclusion: This study revealed no significant difference in TNF-a serum level between SARS-CoV-2 infected pregnant women with normal pregnant women. 

Introduction: Inflammation is the body's response to body tissue injury characterized by swelling or edema. Moringa oleifera is known to have many benefits as herbal medicine. Moringa oleifera leaves have been shown to have anti-inflammatory activity. The polyphenol content in Moringa leaves, such as flavonoids and tannins, has been observed as a potential anti-inflammatory.

Methods: Thirty white male Wistar rats were randomly divided into five groups. Group 0 (negative control group) was given base cream, group 1 (positive control) was given 2.5% hydrocortisone cream, group 2 was given 10% moringa leaves extract cream, group 3 was given 12% moringa leaves extract cream, and group 4 was given 14% moringa leaves extract cream. One hour after treatment was applied in the plantar area, all mice were induced with 0.1 ml of 1% carrageenan. The thickness of the rat paw edema was measured every 1 hour for 6 hours using a caliper.

Results: This study showed a significant difference in rat paw edema between the base cream and the entire treatment groups (p<0.05). There was no significant difference between the 2.5% hydrocortisone cream group and the 10%, 12%, and 14% moringa leaves extract cream group (p>0.05). The 14% cream extract had the largest paw edema inhibition among other moringa leaves extract creams which were 27.4%.

The incidence of kidney stone disease has been rising in past decades. The prevalence has doubled in both genders, and
the prevalence ratio is shrinking from 3.4 to 1.3 between males and females. This condition greatly impacts individuals, the
health care system, and socioeconomic levels. Kidney stone diseases are related to various risk factors and medical conditions.
A detailed diagnosis through history taking, urinalysis, metabolic evaluation, and stone analysis is important to direct the
therapy approach. The therapy in managing kidney stone diseases comprises dietary and pharmacological treatment. In
addition to general advice on sufficient fluid intake, citrate intake, maintaining ideal body weight, and restricting sodium and
animal protein, the therapy should be adjusted based on the specific type of stones.

Introduction: Circumcision in children can be done with local anesthesia. Indifferent from other surgeries, circumcision certainly has its own risks dan complications.

Case description: A 5-month-old baby who underwent circumcision with local anesthesia was reportedly losing consciousness intraoperatively, followed by a generalized seizure. No previous medical abnormalities were known. It was thought that a breath-holding spell (BHS) was a possible etiology of this event. The patient regains consciousness after a few hours. Electroencephalogram showed normal results. BHS is a harmless condition, where it is believed that crying may cause children to be hypoxic due to prolonged breath-holding and may lead to loss of consciousness or even seizure. Patients with BHS usually recover and regain consciousness after several minutes and should not have any long-term effects after the episode.

Conclusion: Although considered a benign condition, BHS is still a frightening situation for parents and even the surgeon; thus, good communication with the patient's parents is necessary.

Background: Turner syndrome is a rare condition with high morbidity and mortality rates, it leads to multiple organ damage when left untreated. Meanwhile, liver involvement in this condition ranges from asymptomatic to severe such as cirrhosis with massive gastrointestinal bleeding. This study presents a case of gastrointestinal bleeding due to cirrhosis in Turner syndrome where the patient showed third-grade esophageal varices as a sign of portal hypertension.

Case Presentation: A 26-years old female came to the Emergency Department of Dr. Soetomo General Hospital in Surabaya with massive gastrointestinal bleeding. The patient was a Turner syndrome, diagnosed ten years ago. The patient was negative for hepatitis B surface antigen (HbsAg) and anti-hepatitis C virus (anti-HCV). The gastric lavage was performed to reduce active bleeding with blood transfusion. The upper gastrointestinal endoscopy indicated portal hypertension with third-grade esophageal varices, fibro scan indicated cirrhosis hepatic and abdominal CT-scan showed early cirrhosis and splenomegaly supporting the presence of portal hypertension. Since the patient refused to endoscopic varices ligation, hematemesis repeated three times after the first visit resulting death of the patient.

Conclusion: This is a Turner syndrome patient who experienced life-threatening gastrointestinal bleeding as complication of liver abnormality. This case highlights that liver cirrhosis should be evaluated in individuals with Turner syndrome to prevent such complications.

Background: Lower gastrointestinal bleeding (LGIB) can be caused by irritable bowel disease. Haematochezia is one of the LGIB symptoms. Profuse haematochezia is a rare complication in Crohn’s disease.

Case Presentation: We reported a 24-year-old patient with profuse haematochezia with severe anaemia and hypovolemic shock. Anamnesis, physical examination and colonoscopy showed that haematochezia was caused by Crohn’s disease. Colonoscopy was done after the patient was hemodynamically stable with findings of external haemorrhoid and multiple ulcers with varying size (0.5–2 cm) on ascending colon, caecum and terminal ileum. The tissue histopathology of ileocecal junction indicated intestinal epithelia with partially eroded, crypts infiltrated by inflammatory cells, swollen lamina propria with proliferation and dilation of blood vessels indicting the Crohn’s disease. The patient then treated with Crohn’s disease medical therapy including low dose oral steroid, sulfasalazine and antibiotics. Clinical improvement was found on one week follow-up after discharge from hospital.

Conclusion: Profuse haematochezia could be associated with Crohn’s disease and the comprehensive approaches should be taken to manage the Crohn’s disease with such presentation.

Background: SARS-CoV-2 can infect anyone, including pregnant women. Pregnant women with COVID-19 experienced fetal hypoxia and reduced amniotic fluid; therefore, a cesarean section was performed. This study aimed to report a case of fatality in pregnant women's G3P1A1 status with COVID-19 after a cesarean section.

Case Report: The patient was a 33-year-old female 36-37 weeks pregnant with G3P1A1 status and infected with SARS-CoV-2. A cesarean section is performed to save the mother and fetus in cases of pregnancy complications. Due to fetal hypoxia and reduced amniotic fluid, a cesarean section was performed, thereby changing the patient status from G3P1A1 to P2A1. The baby survived, healthy and normal after the cesarean section, while the mother underwent COVID-19 treatment. However, the patient still experienced shortness of breath and acute respiratory distress syndrome. Unfortunately, she experienced more symptoms, including hematuria, respiratory failure, acute respiratory distress syndrome, and cardiac arrest on cardiopulmonary resuscitation, before her eventual death.

Conclusion: The pregnant mother G3P1A1, successfully underwent a cesarean section, and the baby is healthy and normal. The pregnant woman's condition worsened during treatment for COVID-19, and she died.

Introduction: Tuberculous colitis and Crohn’s disease (CD) are two disorders that possess similarities in clinical features and colonoscopy findings.

Case presentation: The patient had previously undergone colonoscopy and mucosal biopsy in this case report, indicating chronic diarrhea and hematochezia. Based on the results from the colonoscopy, the patient was suspected for Crohn's disease. Meanwhile, the collected mucosal biopsy stained with Hematoxylin-Eosin suggested the early diagnosis of CD. Hence, patient was prescribed with sulfasalazine 2x500 mg for 6 weeks, where no clinical improvement was found afterward. Patients still complained nausea, vomiting, frequent diarrhea and bloody stools. The patient was later suspected of intestinal tuberculous and prepped for interferon-gamma release assay (IGRA) and stool Xpert MTB/RIF test. Both of the additional tests suggested that the patient was positive tuberculous. According to the collective facts and findings, the patient was diagnosed with intestinal tuberculous and prescribed with category 1 anti-tuberculosis.

Conclusion: The patient was followed-up after nine months treated with anti-tuberculosis, where the negative result was obtained from the stool Xpert MTB/RIF test. In the following year after the therapy, the patient felt no complaints.

Introduction: Scrotal lymphedema is a rare condition characterized by the swelling of the scrotal skin due to deterioration in lymphatic drainage. Although not life-threatening, chronic lymphedema is disabling with significant physical and psychological morbidity and complications, including impaired hygiene, urinary incontinence and immobility. This report aimed to describe the diagnosis and treatment of giant scrotal lymphedema.

Case Presentation: A 23-year-old man presented with a gradually enlarging scrotum. Physical examination of the genitalia shows that the patient’s penis was difficult to identify, and testes were completely impalpable due to the thickness of the scrotal skin. There were neither inguinal lymph node enlargement nor other skin lesions on the scrotum. The scrotum was homogenous, with a measured dimension of 35 cm x 28 cm x 20 cm anterior to posterior. Laboratory evaluation, including complete blood count, complete metabolic panel, human immunodeficiency virus, sedimentation rate, and antibodies to strongyloides, schistosomes, and filaria, were within normal limits. The penis and testes were normal-sized and clearly demarcated from computed tomography scan, buried within the hardened scrotal soft tissues, with no signs of testicular tumor or any pelvic lymph node enlargement.

Conclusion: Scrotal lymphedema is a rare condition characterized by the swelling of the scrotal skin due to deterioration in lymphatic drainage.

Background: Gigantism is the excessive secretion of growth hormones (GH) during childhood and is mostly caused by benign pituitary adenomas. The signs and symptoms are not specific in early childhood due to growth spurt. An ischemic stroke is rarely present in pituitary adenoma, and here we present a case of ischemic stroke and atrial myxoma associated with pituitary gigantism.

Case Presentation: The patient was an 18-year-old male who complained of continuous growth. In June 2016, the patient suffered from an embolic stroke, and in January 2017 he complained of fatigue and shortness of breath. The echocardiography showed a mass in the left atrium that was removed in March 2017 through open-heart surgery; the pathological histology confirmed a myxoma. The brain magnetic resonance imaging (MRI) showed a pituitary macroadenoma, and the growth hormone (GH) level was 20.6 ng/mL. In October 2019, the patient was referred to Dr. Soetomo Hospital. The height increased from 185 cm in 2017 to 205 cm in 2019. The height was 205cm, weight 85kg, body mass index 20.2 kg/m², GH level >40 ng/mL, cortisol 11.24 ug/dL, prolactin 1.21 ng/mL, testosterone 425.6 ng/dL, free thyroxine (FT4) 1.03 ng/dL, and insulin-like growth factor 1 (IGF-1) 688 ng/mL. The patient was administered oral cabergoline 0.25 mg twice a week and had endoscopic endonasal transsphenoidal hypophysectomy (EETH). The patient developed postoperative polyuria after surgery which indicated diabetes insipidus, and the patient was administered desmopressin 0.05mg/12 h with fluid restriction. One week later, the morning cortisol level was low, and hydrocortisone therapy was administered and was tap-off. One month-post surgery, the level of morning serum cortisol was 0.86 µg/dL.

Conclusion: This case is extremely rare and we demonstrated that the EETH surgery the stability of GH could be achieved.

Background: Fournier gangrene is necrotizing fasciitis of the genitalia and perineum that can extend to the abdominal wall, gluteus or lower extremities. Predisposing factors for Fournier gangrene include obesity, diabetes mellitus (DM), alcoholism, smoking, hypertension, chronic kidney disease, perianal trauma and immunosuppressive conditions. This case report aims to evaluate the management of Fournier gangrene on metabolic and surgical treatment

Case Presentation: A-53 years old-female with Type 2 Diabetes Mellitus (T2DM) came to the Emergency Ward of Dr. Sutomo General Hospital, Surabaya, with the chief complaint of sores on the buttocks for 1 week. The patient was diagnosed with Fournier gangrene. On physical examination in the room, erythematous macular lesions were found in the folds of the breast and armpit on chest examination. Obtained scratch marks were found because the patient is often scratched. The wound from the buttock and keep enlarged due to the Fournier gangrene ( necrotizing infection). In this case, the patient was given the antibiotics ceftriaxone and metronidazole. The patient died during the 8^th day of treatment due to a suspected septic shock.

Conclusion: Surgical management in this patient is debridement. Multi-disciplinary management of obstetrics, urology, digestive surgery, and plastic surgery is required for the management of Fournier gangrene in T2DM patients

Introduction: Desmoid tumors are rare cases that arise from aponeurotic tissue. Parasitic leiomyoma is a rare type of leiomyoma that grows in reproductive age, but differential diagnostics have something in common.

Case report: A case of a 34-year-old Asian woman, secundigravida, outpatient clinic, referred from surgery division with chief complaint of a lump in the stomach that has become bigger in the past 4 years. There was no menstrual complaint, and the patient had a history of one previous cesarean section. Computed Tomography (CT) revealed a mass on the abdominal wall that extends to the abdominal cavity, and the patient underwent a mass biopsy and the histopathology results were obtained in the form of uterine leiomyoma or fibroid. During the operation, the mass was obtained from the abdominal wall and had no connection to internal reproductive organs, and due to the large mass, we consulted to digestive surgery division for mass resection, and a mesh graft was placed. Based on the results of tissue examination, the desmoid fibromatosis tumor was obtained from histological findings.