Background:  Estrogen deficiency in menopausal women induces bone loss and makes them prone to pathological fractures. Age, body mass index (BMI), parental history of osteoporosis, and smoking tobacco also increase bone loss and pathological fractures. This study aims to determine whether age, BMI, parental history of osteoporosis, and smoking tobacco can predict pathological fractures in menopausal women. Moreover, the relationship between the early detection of osteoporosis with pathological fracture incidence will also be determined.

Methods: This is an analytic observational epidemiological research with a cross-sectional retrospective design that involved 40 menopausal women. The data were collected from the patients' medical records 2020 in Obstetrics and Gynecology Clinic, Asri Medical Center (AMC) Muhammadiyah Hospital, Yogyakarta. The predictive factors for pathological fracture (age, BMI, parental history, smoking tobacco) were analyzed by using Fisher's exact test and the relationship between osteoporosis early detection, including bone mineral density (BMD) value, parathyroid hormone (PTH) levels, osteocalcin levels, and osteoporosis self-assessment tool for Asians (OSTA) score, with pathological fractures were investigated by using the chi-square test.

Result: Age has a significant relationship with the occurrence of pathological fractures in menopausal women (OR = 6.6, 95% CI: 1.128-8.604, p = 0.042), while BMI, parental history of osteoporosis, and smoking tobacco did not have a significant relationship with pathological fractures (p > 0.05). Early detection of BMD and PTH was also found to have a significant relationship to fracture incidence. Additionally, menopausal women with high PTH levels and osteoporosis BMD values are eight times and four times greater risk of acquiring fractures than menopausal women with normal BMD values and PTH levels.

Conclusion: Age can be a predictive factor for pathological fractures, and the early detection of PTH and BMD is related to the occurrence of pathological fractures in menopausal women.

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: 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: A long-term diabetic retinopathy will cause an increase in several growth factors expression like Transforming Growth Factor β (TGF-β). This multipotent cytokine is involved in the process of endothelial cell proliferation. Therefore, this study aims to observe the relationship between TGF-β1 levels in serum and vitreous fluid of Proliferative Diabetic Retinopathy (PDR) patients given Pan Retinal Photocoagulation (PRP) laser therapy.

Method: This was a cross-sectional study involving 14 patients with PDR. TGF-β1 levels of vitreous and peripheral blood were measured using Enzyme-linked Immunosorbent Assay (ELISA) method. The data were statistically analyzed using SPSS software for Windows ver. 23.0 for Mann-Whitney and the Spearman correlation test.

Results: Our subjects consisted of 57.1% males with a mean age of 51.8 years, where dyslipidemia was the most common comorbid disease. Mean serum TGF-β1 level was 12,821.43 ± 5,253.16 pg/ml, while the mean value in vitreous was 3,692.86 ± 333.89 pg/ml. Meanwhile, there was no significant difference in serum and vitreous TGF-β1 levels between subjects with and without PRP laser therapy (p>0.05).

Conclusion: There was no significant correlation between TGF-β1 levels in proliferative diabetic retinopathy patients with and without panretinal photocoagulation laser therapy. However, there was a decreasing trend in TGF-β1 levels in the vitreous fluid, indicating that PRP laser therapy has a positive effect on preventing the formation of neovascularization in the eye.

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.

Background: Effective risk stratification is an integral part of acute myocardial infarction (AMI) management. Meanwhile, the stratification system should be performed by using easy instruments or methods, where appropriate management, intervention timing, and prognosis can be determined. A previous study established acute ischemia implicate the diastolic function of the left ventricle. In this situation, echocardiography is an easy-to-use and effective diagnostic tool. Therefore, this study evaluates left ventricular diastolic function using the tissue Doppler imaging (TDI) method to analyze the reduction of early diastolic velocity (e’) as a predictor for numerous cardiovascular events in patients with AMI.

Method: The study design was an observational study with a prospective cohort design. The data for the septal and lateral Early Diastolic Velocities (e’) was acquired using the transthoracic echocardiography procedure on AMI patients. The Hazard Ratio (HR) and survival curve from prognostic factors of major adverse cardiovascular events were also produced.

Results: There were 66 patients diagnosed with AMI. The median was 6.625cm/s, and the cut-off point was to determine the decreasing or abnormal mean e’. Subsequently, this value at RR 2.8 was shown by the multivariate analysis via Cox regression as an independent factor of major adverse cardiovascular events.

Conclusion: Decreased means e’ has been proven as an independent predictor of major adverse cardiovascular events in hospitalized patients with AMI.

Background: Decreased adiponectin levels as a humoral vasodilator in subcutaneous adipose tissue in the cellulite area are thought to cause microcirculation disorders and tissue hypoxia, ultimately a local fibrotic response and collagen strands (septa) resulting in the appearance of cellulite. Adiponectin accumulates in the extracellular matrix. It is suspected that an increase in adiponectin levels can suppress the process of sclerotic fibrosis, thereby inhibiting the formation of cellulite. This study aimed to determine the relationship between plasma adiponectin levels and cellulite.

Methods: This study is an analytic observational study with a cross-sectional design involving 40 cellulite patients and 40 controls. Each patient underwent a history and dermatological examination. Then proceeded to assess plasma adiponectin levels from blood samples by ELISA test. These data were analyzed statistically using the Chi-square test.

Results: In this study, both cellulite and control patients were 20-30 years with the average plasma adiponectin level in cellulite was 8.07±3.94 µg/ml. The highest cellulite location in the femoral and gluteus areas was 62.5%. The results of this study showed that there was a statistically significant relationship between plasma adiponectin levels and cellulite (p = 0.025 < 0,05).

Conclusion: There is a significant relationship between low plasma adiponectin levels and the risk of cellulite.

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: Hypertension is one of the leading health concerns that can be intervened, especially in rural areas. Thus, this study determined the prevalence and risk factors associated with hypertension among rural dwellers in Kudat's village, Malaysia.

Methods: This study used a cross-sectional design carried out from 5^th October 2019 until 17th October 2019. Universal sampling was used for sample size calculation. There are 111 respondents who are above 18 years old involved in this research. Association between hypertension and risk factors outcomes were analyzed by using logistic regression. The relationship between continuous variables was analyzed using correlation analysis.

Results: The prevalence of hypertension among Kudat's villagers was 30% (n=33). There is a significant association between age and BMI with Hypertension. Also, there is a significant correlation between age, BMI, physical activity, with blood pressure. While other risk factors, including sociodemographic and lifestyles, do not significantly correlate with hypertension.

Conclusion: Hypertension is highly prevalent in the village and is significantly associated with BMI and age group. Physical activity also correlates with blood pressure. Hence, an effective intervention that includes lifestyle and dietary behavior changes, health promotion, and health screening should be implemented to tackle this problem.

Background: COVID–19 cases in children are not as prevalent as in adults and tend to be milder. However, clinical profiles in pediatric COVID–19 cases in Indonesia have not been extensively studied. This study aims to know clinical profiles of pediatric COVID–19 cases in dr. R. Soedarsono General Hospital Pasuruan City from April–July 2020.

Methods: This descriptive study used medical records of pediatric patients who were diagnosed with suspected, probable, confirmed, and close contact with COVID – 19. Total populations with complete data in medical records were included in the study.

Results: Of 78 respondents, 41 (53%) were male, 42 (54%) were hospitalized, 18 (23%) were 1 until under 12 months and 12 until under 18 years old consecutively, 32 (41%) had moderate symptoms, and 31 (39%) had close contact with positive cases at home. The most common symptoms were cough (59%) and fever (54%). Most cases showed normal laboratory and radiologic findings. There were eight children with comorbidities, and most patients showed satisfying outcomes.

Conclusions: Most pediatric patients with COVID–19 at dr. R. Soedarsono General Hospital from April to July 2020 showed moderate symptoms with good outcomes.

Background: Psoriasis is a complex, chronic disease with increasing global incidence. Studies on the effectiveness of psoriasis therapy in Indonesia are limited. This study aimed to evaluate the patient’s clinical improvement with moderate-to-severe psoriasis vulgaris using the Psoriasis Area and Severity Index with ≥75% score reduction (PASI75).

Methods: This is a retrospective study involving patients diagnosed with psoriasis vulgaris who visited the Dermatology and Venereology Outpatient Clinic in Dr. Soetomo General Hospital between January 2016 and December 2018. The electronic medical record obtained data on demographic characteristics, the number of visits, psoriasis at initial (PASI) score before and after treatment, type and dose of treatment, and comorbidities. Data were analyzed using SPSS version 23 for Windows.

Results: Overall, 54 patients with psoriasis vulgaris were included. Almost all subjects were adults (≥18 years old) and presented with severe PASI (PASI score > 10) (96.3%). The majority of the subjects (64.8%) successfully achieved PASI75. Most subjects received methotrexate (72.2%); the most frequent dosage was 15 mg/week (61.5%). A significant association was found between methotrexate treatment and a larger improvement in PASI scores (p=0.001).

Conclusion: moderate-to-severe psoriasis therapy in terms of PASI75 achieved a satisfactory success rate of 64.8%, and the improvement of PASI score was significantly better in patients who received methotrexate. Further studies in Indonesia are needed to explore the effectiveness of psoriasis therapy and its factors.

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: Cigarettes contained addictive substances that may have adverse effects on health, such as memory impairment. The hippocampus is a part of the brain that plays a role in regulating memory. This study aimed to compare the effects of conventional cigarette smoke and e-cigarette vapor on hippocampal pyramidal cells in animal models.

Method: Experimental study used 30 male Sprague Dawley white rats aged 10-12 weeks. Rats were divided into 5 groups consisting of 1 control group and 4 treatment groups and exposed to conventional cigarette smoke and electronic cigarette vapor for 2 weeks and 4 weeks. The amount of exposure given was 12 times each day. After two weeks and four weeks of exposure, rats were necropsied, the Hippocampus was processed and stained using Hematoxylin and eosin. Pyramidal cell nuclei were viewed with a biological microscope CX-33 microcamera DP2 with 400x magnification in 3 fields of view. The average number of pyknotic nucleus pyramidal cells collected was statistically analyzed using the Mann-Whitney test.

Result: The hippocampal pyknotic pyramidal cells number in each treatment group was higher compared to the control group. A correlation was found between 2 weeks groups and 4 weeks groups of treatment. Conventional cigarette smoke groups showed higher means of pyknotic pyramidal cells than electronic cigarette vapor and were statistically significant in both 2 weeks groups and 4 weeks groups of treatment (p<0.05).

Conclusion: The type of cigarette and the duration of cigarettes exposure affects the number of pyknotic pyramidal cells. Conventional cigarette causes more significant changes than electronic cigarettes, and the exposure duration of conventional cigarettes affects pyramidal cells in the hippocampus.

Background: Sharp force injuries are the second most common cause of trauma after blunt force injury. TNF- α is a cytokine that triggers the expression of adhesion molecules, other cytokines and chemokines by endothelial cells, stopped and migrated to damaged tissues or infections that trigger inflammation. Furthermore, the initial population of leukocytes leading to the wound comprises mostly neutrophils. This study aimed to assess the correlation between TNF-α levels in the blood and skin tissues and neutrophils number with the wound age of wounds caused by sharp trauma.

Methods: This study is an experimental study using animal models.  The samples were divided into the control group and the group in which the blood and the skin tissue samples were taken 1-, 3-, 12-, 24-, 48- and 72 hours after being sharp traumatized.  The Elisa method examined the samples from the blood, and the skin of the right back of the mice was examined for TNF-α levels.  Others from the left-back skin of the mice were microscopically examined to assess the number of neutrophils.

Results: The TNF- α level from the skin samples were detected in wound tissue as the peak levels were in the 24 hours post-traumatic group. The TNF-α levels from blood samples indicated a significant difference in TNF-α levels in each group (p < 0.05). However, TNF-α levels from skin samples showed no significant difference between each group. From the microscopic examination, there was a significant difference in the infiltration of neutrophil cells in all groups (p<0,05). The neutrophils peak at 24 hours post-traumatic.

Conclusion: There was no significant correlation between the TNF-α levels and the number of neutrophils with the wound age in wounds caused by sharp traumas.  

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: Revascularization in patients with stable coronary artery disease (SCAD) can reduce myocardial ischemia and improves the autonomic nervous system, which can be measured by heart rate variability (HRV) and signal-averaged electrocardiogram (SAECG). This study aimed to investigate the effect of revascularization on HRV and SAECG in patients with SCAD.

Methods: This is a single-center prospective cohort study. Revascularization refers to percutaneous coronary intervention (PCI). The primary outcome of this study is the change in short-term HRV and SAECG from before revascularization to after revascularization. HRV and SAECG measurement was performed for 10 minutes before PCI and one-month post-PCI. Data were analyzed using SPSS version 23 for Windows.

Results: There are 30 patients included in this study, and 46.7% underwent incomplete PCI. There was no significant difference in HRV parameters in the time domain method. In the frequency domain, only the LF/HF ratio changed significantly from 3.5±2.6 before PCI to 2.16±1.9 after PCI, with a 1.33 decrease in LF/HF (p=0.007). Subgroup analysis was performed for patients receiving complete and incomplete revascularization. In patients who received complete revascularization, there was a significant difference in LF/HF ratio change of 1.6±2.28 (p=0.013). In patients that receive incomplete revascularization, there is a significant increase in HF 37.8±57.3 (p=0,028). In terms of SAECG parameters, there is no significant difference between before and after PCI in both primary and subgroup analysis.

Conclusion: Revascularization resulted in a significant reduction in LF/HF ratio assessed by short-term HRV. There was no benefit of revascularization in terms of SAECG parameters.

Background: Melasma is characterized by symmetrical brownish macules with well-defined borders. The etiology of melasma is still unknown, but factors that are thought to influence include genetic predisposition, ultraviolet radiation, hormonal factors, thyroid disorders, use of cosmetics, and drugs. This study aimed to determine the epidemiological data, evaluate risk factors, management, and follow-up in new melasma patients.

Methods: The medical records of patients with melasma attending Dermatology and Venereology Outpatient Clinic over a 4-year period from 2015 to 2018 were analyzed retrospectively for this descriptive, observational study. Data were analyzed using SPSS version 23 for Windows.

Results: This study found 739 new melasma patients from January 2015 to December 2018, with the proportion of women 734 patients (99.3%) more than men only 5 patients (0,7%). The age of most patients who were treated was 46-55 years in 320 patients (43.3%), with the highest age of onset being 37-45 years in 308 patients (41.7%). About 561 patients (75.9%) had a melasma duration of more than 1 year. The most common job of melasma patients was housewives in 366 patients (49.5%). The most frequent risk factor for melasma was ultraviolet radiation in 258 patients (34.9%). The most common melasma was malar type in 482 patients (65.2%) and mixed melasma in 617 patients (83.4%). The most widely administered therapy was sunscreen in 735 patients (99.5%) and Tretinoin 0.05% in 235 patients (31.8%). Most patients did not make repeat visits as many as 448 patients (60.6%).

Conclusion: The most common disease in women of childbearing age with ultraviolet radiation is the most precipitating risk factor. The low number of patient repeat visits can be caused by a lack of doctor education or a lack of patient adherence to treatment due to chronic and recurrent diseases.

Introduction: Fingernail has various colors related to the organ’s body condition, such as the pancreas, indicated by diabetes mellitus. The study aims to determine and compare the RGB range value on the fingernail image to detect diabetes mellitus risk in fasting and non-fasting conditions.

Methods: The study was a true experimental study using fasting and non-fasting respondents. Data were obtained by blood glucose level testing and fingernail image capturing. The result of blood glucose levels was classified into normal, prediabetes, or diabetes, and fingernail images were followed according to their categories. The histogram determined the RGB values of fingernail images, and calculated the maximum value of color intensity based on the height peak appeared. The distribution frequency of each group was used to get a range of RGB fingernail images in each category.

Results: Based on the results, it showed a comparison of RGB range value between fasting and non-fasting condition, including range value differences in red and blue, but any slightly overlapped in green range value. In a future study, we will use ordinal logistic regression to determine the prediction program of diabetes mellitus risk. Furthermore, we will develop a program by adding some features to improve the analysis system of the fingernail image for diabetes mellitus risk detection.

Conclusion: There was a comparison of RGB range value on fingernail image between fasting and non-fasting condition.

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: Lipoteichoic Acid (LTA) of Lactic Acid Bacteria (LAB) is a cell wall component of LAB with immunomodulatory properties towards inflammatory skin diseases due to immune dysregulation, such as atopic dermatitis. Topical glucocorticoids are given as the mainstay therapy in some inflammatory skin diseases. However, the adverse effects of topical glucocorticoids are commonly found, such as skin atrophy, reduced pigmentation, and masking-effect of skin infections. Therefore, safer therapy for inflammatory skin diseases is necessary to be developed. This study aimed to analyze the potential of LTA of LAB against glucocorticoid receptors (GR) as a topical therapy for inflammatory skin diseases.

Methods: This study used the bioinformatics method with molecular docking to predict the binding site and the binding affinity of LTA of LAB to GR and analyze the toxicity of LTA of LAB. According to the previous studies, this research was also conducted within silico/ molecular docking. Data were analyzed using Toxtree v 2. 6.13 application to evaluate the skin irritation.

Results: LAB’s lipoteichoic acid (LTA) has the same binding site with glucocorticoid control compounds to the GR. Toxicity analysis shows that LTA of LAB is not irritative to the skin.

Conclusion: LAB’s lipoteichoic acid (LTA) is potential as alternative topical therapy for inflammatory skin diseases.

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.

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.

Background: Differentiation of typical from atypical meningiomas would greatly improve surgical planning and further treatment options. Appparent diffusion coefficient (ADC) has the potential to characterize meningioma subtypes. This study aimed to assess the value of ADC in differentiating typical and atypical meningiomas.

Method: A retrospective study was conducted using medical records at RSUD Dr. Soetomo Surabaya in January 2019 – September 2021. ADC values were obtained by placing three ROIs on tumors. We used receiver operating curve (ROC) analysis to determine the optimal cut-off ADC value to differentiate meningioma grading and Mann-Whitney U test to evaluate the difference in ADC values between the two groups. In addition, Chi-square was used to assess the correlation between ADC values and the type of meningioma.

Results: The ADC values in typical meningiomas ranged from 1.12 - 2.47 × 10-3 mm2/s with an average of 1.45 ± 0.38 × 10-3 mm2/s, while in atypical meningiomas ranged from 0.64 – 1.12 × 10-3 mm2/s with an average of 0.81 ± 0.20 × 10-3 mm2/s. Based on ROC analysis to distinguish typical and atypical meningiomas, the cut-off mean ADC value is 1.12 × 10-3 mm2/s with a sensitivity of 100%, specificity of 96.87%, and area under the curve (AUC) of 0.996. The cut-off difference in the ADC value and the relationship between the ADC value and meningioma type based on histopathology were significant.

Conclusion: Typical meningiomas have higher ADC values than atypical cases. ADC value can help differentiate typical from atypical meningiomas.

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: Diagnosing typhoid fever definitively, using bone-marrow, blood or feces culture is either invasive, time-consuming, expensive, or complicated. Hence, clinicians often use clinical presentations and/or rapid diagnostic methods to examine the indirect evidence of Salmonella typhi infections. This study describes the proportion of typhoid fever, challenges of diagnosing typhoid fever, and the kinetics of anti-Salmonella O9 IgM.

Methods: During a prospective dengue study in Bandung, Indonesia, 1,431 febrile occurrences were observed among 2,978 adult volunteers over a four-year period. As typhoid fever is endemic and represents a major cause of febrile illness in this study area, acute- and convalescent-phase sera from 964 subjects that had been excluded for dengue and chikungunya infections, were tested with Tubex^® TF. To observe the kinetics of anti-Salmonella O9 IgM, we tested sequential sera up to 260 days post-illness from 3 subjects.  

Results: Based on Tubex^® TF, 71 of 964 (7.4%) subjects had anti-Salmonella O9 IgM (score≥4) in their convalescent sera. Anti-Salmonella O9 IgM scores in convalescent sera increased compared to the acute sera in 36 subjects, indicating probable acute typhoid fever. The convalescent scores decreased/remained the same as acute sera in the other 35 subjects, which more likely indicating previous S. typhi infections. Using serially collected sera, it was determined that anti-Salmonella O9 IgM could be detected for a long period after illness.

Conclusion: Tubex^® TF test should be conducted using paired acute- and convalescent-phase sera to reduce the chance of false positive result that may due to long-lasting anti-Salmonella O9 IgM.

Introduction: Preterm labor is still a global problem because it affects perinatal morbidity and mortality, especially in developing countries. An increase in hs-CRP in pregnant women is associated with the incidence of preterm labor. This study was conducted to prove that high serum hs-CRP levels are a risk factor for preterm labor.

Method: The method used in this study is an observational case-control study, in which pregnant women with preterm labor are in cases group, whereas preterm pregnant women that are not in labor, included in control group. Cases and controls were not matched in the gestational age variable. In both groups blood samples were taken. Blood sampling was taken in the cubital vein to examine the serum levels of hs-CRP. From the data collected, data analysis was performed using SPSS version 23.0. In this study, after the data normality test was performed using the Shapiro-Wilk test, the result p values <0.05 or abnormal distribution data, the Mann Whitney test was chosen. A Chi-square test was performed to determine the increase in serum hs-CRP levels as a risk of preterm labor.

Result: hs-CRP levels as a risk of preterm labor. Calculation of the OR is 19.46 times with 95% CI: 2.25–168.27.

Conclusion: it can be concluded that high levels of hs-CRP as a risk factor for preterm labor.

Background: Several serum inflammatory markers have been investigated as prognostic biomarkers for rectal cancer patients, including C-Reactive Protein (CRP)/Albumin Ratio (CAR). We aimed to examine the association between the CAR pre-therapy value and radiological response after neoadjuvant chemotherapy

Methods: We recruited locally advanced rectal cancer patients who underwent FOLFOX first-line neoadjuvant chemotherapy (NAC) at Dr. Soetomo General Hospital (Surabaya, Indonesia) from January 2015 to December 2020. Before neoadjuvant chemotherapy treatment, the C-reactive protein (CRP) and albumin were measured. The chemotherapy response was performed by evaluating the CT scan result before and after the NAC was given. We used RESIST criteria to assess the radiological response after NAC treatment. Data were analyzed using SPSS version 23 for Windows.

Results: We included a total of 102 patients, with the female being the predominant gender with LARC (52%.0). The well-differentiated adenocarcinoma was the most common adenocarcinoma type found in this study (59.8%). We found 57 patients with positive responses and 45 patients with negative responses. Patients with well-differentiated status who had adenocarcinoma had a higher chance to have a positive response to NAC. Patients with low CAR values had a 2.13 times higher chance of having a positive chemotherapy response than patients with high CAR values (95% CI = 1.30-3.30).

Conclusion: There was a significant relationship between high CAR values and poor radiological response after neoadjuvant chemotherapy in locally advanced rectal cancer patients. The CAR value may be a potential biomarker to predict the radiologic response after NAC treatment.

Background: SARS-CoV-2, as the leading cause of COVID-19 disease, can cause kidney disorders characterized by the presence of hematuria, increased creatinine, and other kidney pathological conditions. Since a 24-hour urine examination as the gold standard for urea examination has several weaknesses, it is necessary to carry out an alternative examination method especially, the Urea Creatinine Ratio (UCR). This study evaluates the correlation between UCR and lipid profile in COVID-19 patients.

Methods: A descriptive-analytical design with a cross-sectional approach is applied. COVID-19 patients with positive PCR were examined for UCR, Total Cholesterol, Triglycerides, HDL, and LDL. The assessment was based on clinical chemistry analysis using an automatic analyzer. We perform a normality test using Shapiro-Wilk. The Pearson correlation test is used to see a correlation between variables. The study was conducted at Siloam Hospital in April-August 2021. Data were analyzed using SPSS version 20 for Windows.

Results: There was no significant difference between UCR and the other variables based on the statistical analysis test (p>0.05). There was no significant correlation between UCR and cholesterol total (p= 0.230), UCR and Triglyceride (p= 0.680, UCR and HDL (p=0.970) and UCR and LDL (p= 0.190).  

Conclusion: There is no significant correlation between UCR and lipid profile in COVID-19 patients

Background: Maternal with to COVID-19 is a new maternal emergency issue leading to maternal morbidity and mortality. In Indonesia, the number of cases of maternal mortality with COVID-19 began to increase. This study aims to determine the characteristic of maternal deaths due to COVID-19 in a tertiary care center in Indonesia.

Method: This observational-retrospective study descriptively analyzed 15 maternal deaths due to COVID-19 admitted to the Department of Obstetrics and Gynaecology at the tertiary care teaching hospital from March to December 2020. We included suspect, probable, and confirmed COVID-19 in the samples. Therefore, the total sampling was recorded and analyzed descriptively by Microsoft Excel.

Results: There are fifteen maternal deaths from 429 maternal cases with COVID-19 in our hospital. The majority ages were in the age group 19-35 years (73.33%); body mass index (BMI) 25-29.9 (33.33%); five days average length of stay; one comorbidity (53.33%); and multiple comorbidities (20.00%). The case fatality rate (CFR) of maternal death due to COVID-19 is 3.49% were profiled out this study. The most cause of death was acute respiratory distress syndrome (ARDS) (53.33%).

Conclusions: Most common characteristics of the object of this study were the age between 19-35 years, comorbidity, obesity, upper respiratory tract symptoms, elevated D-dimer, and the complication of ARDS, which are the risk factors of the deaths.

Background: Many scoring systems have been developed to predict outcomes after surgery, but it has limitations due to differences in population, comorbidity, type of surgery, or hospital effects. External validation from these scoring systems sometimes failed to achieve good discriminatory power consistently. This study aims to develop a novel scoring system for predicting postoperative mortality and comparing its performance with the AFC, CR-POSSUM, IRCS, and ACS-NSQIP SRC model.

Methods: Data were collected retrospectively from all consecutive patients (n=1,294) undergoing colorectal cancer surgery in Dr. Soetomo Hospital between 2011 and 2020. After excluding missing data and 215 patients who did not satisfy the inclusion criteria, multivariate logistic regression analysis was performed in 1,079 patients to estimate odds ratios (ORs) and 95% confidence intervals (CIs) linking the explanatory variable postoperative mortality, and a Surabaya scoring system was constructed. Data were analyzed using SPSS version 23 for Windows.

Results: Variables identified as the strongest predictors based on Odds Ratio (OR) postoperative mortaliy were albumin < 3.4 g/dL (6.93; 95%CI: 4.37-10.99; p< 0.001), pulse > 120 times per-minute (5.49; 95%CI: 2.11-14.29; p< 0.001), totally dependent functional status (4.43; 95%CI 2.06-9.49; p<0.001) or partially dependent (2.34: 95%CI: 1.28-4.28; p< 0.001), ascites (3.58; 95%CI: 1.84-6.94; p=0.001), major procedure (2.48; 95%CI: 1.38-4.33; p=0.009), dyspnea (2.40; 95%CI: 1.19-4.84; p=0.014), and haemoglobin < 10 g/dL (1.85; 95%CI: 1.12-3.04; p=0.016). The Surabaya model predicted postoperative mortality with a predictive performance (0.831; 95%CI: 0.790-0.871) in the validation population. In this population the predictive performance of the AFC score was 0.630 (95%CI: 0.498-0.762), CR-POSSUM 0.698 (95%CI: 0.563-0.833), IRCS 0.564 (95%CI: 0.426-0.702), and ACS-NSQIP SRC 0.674 (95%CI: 0.541-0.806).

Conclusion: The Surabaya score has been shown as a good predictor of postoperative mortality after colorectal cancer surgery despite the relatively low number of risk factors. 

Background: Cluster of differentiation 44 (CD44) is one of the markers of cancer stem cells belonging to the cell adhesion molecule family, which may play a role in tumorigenesis of mucoepidermoid carcinoma (MEC) of the salivary gland. The histological grade is one of the most important factors for prognosis. This study was aimed to investigate the association between CD44 expressions with histological grade in MEC of the salivary gland.

Methods: In A cross-sectional study, 34 cases diagnosed with MEC in the Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia from 2012 to 2017 were included. Histological grade was classified into low-, moderate-, and high-grade. CD44 expression was done by immunohistochemistry staining and classified into weak and strong expressions.

Results: Eighteen cases (52.9%) were high-grade, 3 cases (8.8%) were moderate, and 13 cases (38.2%) were low-grade. Perineural invasion was found in 7 cases (20.6%) and mostly in high-grade tumors. CD44 expression was significantly associated with histological grade (p = 0.002, OR=0.09, 95%CI=0.02–0.48). Strong CD44 expression was found more in low-grade MEC.

Conclusions: This study suggests that strong CD44 expression may act as a potential favorable predictive factor for prognosis in the MEC of the salivary gland.

Background: Psoriasis is a chronic, recurrent, inflammatory skin disease that alters the quality of life. Systemic therapy and biologic agents are prescribed for severe and widespread psoriasis, but these drugs may have systemic side effects and immune suppression. Narrowband Ultraviolet B (NB-UVB) phototherapy remains one of the most effective and safe treatments for psoriasis.

Methods: This study was an observational retrospective cohort with one group pretest and post-test design. A retrospective analysis was done on 16 medical records of patients who met the inclusion criteria. The efficacy of the therapy was identified and analyzed using the SPSS version 17 for Windows.

Results: This study found that 16 psoriasis patients received NB-UVB phototherapy, 11 (68.75%) in men and 5 (31.25%) in women. The mean age was 47.31 years. There was a statistically significant difference in the reduction in PASI score before and after receiving combination methotrexate with 24 sessions of NB-UVB phototherapy (p=0.000); the delta PASI score was 45,02%. A statistical analysis based on the number of phototherapy sessions per week showed enhanced results when patients attended 3 phototherapy sessions per week (p = 0.001).

Conclusion: There was a statistically significant reduction in PASI score in psoriasis vulgaris patients before and after receiving combination methotrexate with 24 sessions of NB-UVB phototherapy.

Stem cell therapy is an emerging therapy in the medical field. Recent studies show that stem cell therapy gives promising results. One of the stem cell sources is the human umbilical cord that has many potential, not only for therapy alone but also for banking. Human umbilical cord mesenchymal stem cells (HUCMSCs) have greater advantages than bone marrow and adipose tissue-derived stem cells in isolating the cells and the shortest culture period. Studies on animal models showed improvement of kidney disease in the various mechanism. Human studies regarding human umbilical cord mesenchymal stem cells as therapy for kidney disease have not been conducted on a large scale, but MSC therapy appears safe.

The magnitude of coronavirus disease 2019 (COVID-19) pandemic leads to the significane difference in daily living. Less direct interaction between people is emphasized to prevent the spread of the virus. Consequently, the medical education had been affected considerably. The concept of medical education compromised of pre-clinical curriculum and clinical curriculum (clinical clerkship). Indeed, the implementation of self-distance makes the essence of clinical clerkship disappeared. In order to overcome this issue, several methods have been employed. The use of virtual or online learning method had been developed with the use of online platform. Regardless of the various approach, pros and contras still existed. The common challenge in the use of online learning method including technical issue and less interaction between patient and student. The hybrid combination of online learning with traditional method could be beneficial for the current medical education in this era.

Background. Patent foramen ovale (PFO) is a part of atrial septal defects (ASD) entities. While mostly asymptomatic, some adults with PFO will develop symptoms, from mild complaints such as migraine or palpitation to more debilitating complications such as syncope or cryptogenic stroke. Therefore, it is highly crucial that PFO be diagnosed and treated promptly. Echocardiography, trans-thoracal and or trans-esophageal, is the main diagnosis modality. For treatment, antiplatelet with or without anticoagulation, trans-catheter closure, and surgery are utilized in accordance with their indications.

Case Presentation. We present four adult patients referred with various symptoms: vertigo, migraine, palpitation, and cryptogenic stroke. Three of them had no explicit risk factors for the cerebrovascular event, with one patient having a co-existing hypercoagulable state. Echocardiography revealed a positive bubble test, which meant that PFO was the primary etiology of those cases. We then treated each of them with transcatheter device closure, which improved their symptoms, before adding antiplatelet for six months.

Conclusion. Proper diagnosis and prompt treatment of PFO are imperative in reducing complications. Echocardiography, mainly TEE, is the main diagnostic tool for PFO. Antithrombotic (with or without anticoagulant), minimally invasive procedure and surgery in some cases are the modalities available.

Introduction: The COVID-19 pandemic is well known for its clinical respiratory symptoms. Currently, the medical literature describing the neuro-ophthalmologic manifestations of COVID-19 is gradually emerging. We hereby report a case with an uncommon presentation of COVID-19 in a patient.

Case Report: A 19-year-old man presented with ptosis and limited left eye movement in his left eye followed by other neurological manifestations, without classical respiratory manifestations. Brain imaging and nasopharyngeal PCR suggest COVID-19 encephalitis.

Conclusion: This experience confirms that COVID-19 infections can be present despite the absence of significant respiratory symptoms mimicry to other symptoms. Therefore, physicians should consider the possibility of COVID-19 infections, and time management may lead to a better outcome.

Background: Turner syndrome is characterized by abnormality of one X chromosome. Those with Turner syndrome are at risk of developing tuberculosis infection due to decreased immune function.

Case: A 17-year-old girl came with complaints of short stature, amenorrhea, and no signs of secondary sexual growth. She also felt weak. On physical examinations, she weighed 24 kg, and her height was 119 cm. Her conjunctiva looked pale. She had a low set hairline, small mandible, short 4^th metacarpal, and wide-spaced nipple. Her breast and genitalia did not grow (1^st stage of Tanner classification). There was a lesion between her breasts. Laboratory results showed Hemoglobin 7 g/dL, MCV 62,6 fL, MCH 18,2 pg, MCHC 29 g/L, FSH >170 IU/L, LH 95,3 IU/L, Estradiol 11 pg/mL, Iron Ferrozine 7 mg/dL, TIBC 186 μg/dL, and Ferritin 50 ng/mL. Her Mantoux test showed induration with a diameter of 20-23 mm, and the Xpert MTB-RIF test showed low detection of MTB. Her bone age was appropriate for a 13-year-old girl. Histopathology test of her lesion showed chronic granulomatous inflammation. Her chromosome analysis showed Mos 45,X(56)/46,XX(44). She was diagnosed with Turner syndrome and tuberculosis. She received Progynova® 2 mg every 24 hours for 21 days, stopped for 10 days, and continued again for 21 days. She also got anti-tuberculosis drugs (pediatric regime).

Conclusion: The clinical spectrums of Turner syndrome vary widely. Decreased immune function in Turner syndrome can lead to infections such as tuberculosis. Early diagnosis and treatment can prevent further morbidity.

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.

Background: On average, one-third of patients seeking treatment for skin problems have associated psychological stress or psychiatric disease. Most psychodermatologic patients visit a dermatologist instead of a psychiatrist. It is important to recognize the signs and symptoms immediately, make a prompt diagnosis and do a comprehensive treatment that involves multi-disciplinary approach, including dermatology, psychiatry and other discipline if necessary.

Case Presentation: A 40-year-old female, visited the Dermatology and Venereology (DV) outpatient clinic of Dr. Cipto Mangunkusumo Hospital with a chief complaints of wound on her right ear since 2 weeks ago. The patient was also diagnosed with Chiari malformation type 1 and had undergone surgery twice. The patient confessed of having a habit of intentionally skin picking until they were chafed and bled when she was stressed. The patient was diagnosed as neurotic excoriations, treated with potent topical corticostreroid and consulted to the psychiatric department.

Discussion: Neurotic excoriations is classified as primary psychiatric skin disorders. Symptoms usually occurred when the patient was in the depression state. At first the patient only followed the dermatologist treatment and had a poor compliance with psychiatric management. Therefore the patients keep manipulating the lesions and the outcome was not satisfactory because the underlying disease has not been well treated. After the dermatologist convinced her to see the psychiatrist regularly, accompanied by a good compliance in applying the corticosteroid cream, the result was satisfactory.

Conclusion: The psychocutaneous disease need a comprehensive and multi-disciplinary approach. Dermato-venereologists should work together with the psychiatrist.

Introduction: Varicella-zoster virus (VZV) infection in pregnant women in the last three weeks of pregnancy or the days before delivery causes neonatal varicella. It is rare in newborns and infants due to passive immunity received from the mother. Thus we report a rare case of neonatal varicella for an educational purpose.

Case report: A 14-day-old girl was referred to the Department of Pediatrics with a red rash all over her body. The red rash begins on the face and subsequently spreads across the body fever for four days before the appearance of the rash. During the third trimester of pregnancy, the patient's mother had varicella. The patient was delivered vaginally by the midwife at full term, weighing 3,400 g. Macules, papules, pustules, and vesicles, multiple in number, distinct, miliary to guttate in size, and universal distribution, were identified on physical examination in the facial, thoracic, and upper extremities region et inferior bilaterally. The Tzank test found multinucleated giant cells. Skin biopsy found stratum spinosum edema with powdered lymphocyte inflammatory cells (typical for varicella). Treatment with intravenous acyclovir showed improvement after 5 days.

Conclusion: VZV generates a wide spectrum of clinical symptoms in the fetus and newborn and can be a life-threatening condition. Early recognition of pregnant women and newborns who are at risk for VZV infection is very necessary so that prophylaxis and treatment can be started immediately

Meningioma is not uncommon case; however, the differentiation of high-grade from low-grade meningioma is important. The rate of recurrence of grade I meningioma is 7-20%, but in grade II meningioma is 30-40% and in grade III 50-80%. Non-invasive MRI techniques that can differentiate high-grade from low-grade meningiomas before surgery are useful for surgical planning and subsequent treatment. We present a review article and some case studies of low-grade (WHO grade I) and high-grade (WHO grade II and grade III) meningioma with conventional MRI and continue with advanced MRI; we performed diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) value, dynamic susceptibility contrast (DSC), dynamic contrast-enhanced (DCE) magnetic resonance (MR) perfusion and 3D ASL. From these three cases show that advanced magnetic resonance imaging with ADC value, DSC, DCE, and 3D arterial spin-labelling (ASL) is an essential sequence to differentiate high-grade from low-grade meningioma.

Background: Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 coronavirus requires host cells to replicate, leading to rapid and uncontrollable viral replication and could end in increased production of pro-inflammatory cytokines. This case study aims to evaluate a severe COVID-19 patient with diabetes mellitus getting dexamethasone with depression disorders.

Case Presentation: A-56 years old Javanese female who lives in Sidoarjo was admitted to the emergency room of Dr. Soetomo Public Regional Hospital, Surabaya due to shortness of breath from the patient’s anamnesis. The shortness of breath was getting worse in the last 3 days before being admitted to the hospital. The patient had a fever in the previous 3 days before being admitted to the hospital. She also had a cough with phlegm for 1 week before being admitted to the hospital. The patient’s condition is oxygen saturation at 93% with a simple mask 6-8 lpm (oxygen saturation at 72% in free air. Her medical history revealed that she had suffered from diabetes since approximately 8 years ago and routinely took 5 mg of glibenclamide once a day. She also had high blood pressure from 5 years ago and routinely took 10 mg of amlodipine once a day. Treatment for this patient in severe condition requires comprehensive management such as symptomatic therapy, oxygenation, and adequate nutritional therapy. In addition, the patient received dexamethasone and antidepressant drugs such as fluoxetine 10 mg.

Conclusion: The oxygenation therapy, symptomatic, antiviral, supportive, and adequate nutritional treatment can improve the clinical outcome regarding a severe COVID-19 patient with diabetes mellitus getting dexamethasone with depression disorders. 

Background: Inflammation plays an important role in colorectal cancer formation, where colitis inflammatory cells can trigger the production of free radicals that interact with genes in carcinogenesis. Meanwhile, the colonic mucosal epithelium contains goblet cells that function to prevent inflammation. This study aims to examine the correlation between the number of goblet and inflammatory cells in the colon of patients with colorectal cancer, colitis, and healthy colon and their relationship with the incidence of colorectal cancer and colitis.

Methods: Histopathological samples consisting of 30 healthy colons, 30 colons with colitis, and 31 colons with colorectal cancer were examined to obtain the average cell number in 10 or the entire field of view using a light microscope with 400 magnification. Using the Pearson correlation test and Multivariate Multinomial Logistic Regression, these samples were analyzed with SPSS version 26 for Windows.

Results: Consequently, the results showed a weak but insignificant negative correlation between the number of goblet and inflammatory cells in the colon with colorectal cancer (r²=0.055; p=0.200), colitis (r² = 0.002, p = 0.833), and healthy colon (r² = 0.110, p = 0.073). The number of inflammatory cells is significantly associated with the incidence of colorectal cancer (OR=1.326; 95%CI=1.155-1.521; p=0.000) and colitis (OR=1.374; 95%CI=1.192-1.583; p=0.000) compared to normal colon.

Conclusion: An increase in inflammatory cells is significantly associated with the incidence of colorectal cancer and colitis.