Introduction: This research analyzes the behavioral and biological concepts of depression, aggression, and resilience. It also analyzes the Quran recitation as a noise-inducer for aggression but also encouraging intervention for depression.

Method: Experimental research with a post-test-only control group design created an agitated depression model in mice as a basis for understanding the biological concepts of aggression. Healthy mice (Mus musculus balb/c) aged 10-12 weeks, weighing 20-25 grams, were random-allocated into 9 (nine) groups, namely the control group (K_ negative, depression, and aggression), depression group (DP_1, 2, 3), and aggression group (AP_1, 2, 3). The tail suspension approach triggered helplessness to form a depression model. Quran recitation was performed above 60 decibels as noise exposure triggers agitation and forms an aggression model. QRP performed under 60 decibels was assumed to create a resilience model. Depression, aggression, and resilience were measured using an eight-arm radial maze (TM) and immobile time when hung (TG). After the intervention, mice were sacrified and the brains harvested. Normal cells were counted in the average of ten microscopic fields using 40x objective lens magnification and HE staining.

Results: The QRP alleviated the psychomotor retardation in the depression group, while the aggression group experienced a goal-directed behavioral activation as the cognition increased with psychomotor calm. Neuron cells were significantly different among groups; the optimum QRP dose was an hour once a day.

Conclusions: The QRP intervention can improve depression and aggression, but also a source of noise-induced stress at a higher frequency. These results should be carefully generalized and need further research.

Background: The emergence of a new variant of Omicron in 132 countries at the beginning of 2022 leaves concerns for nurses. The experience of nurses handling the COVID-19 pandemic makes a question mark on how prepared the profession is to deal with the spreading of the virus. This article attempts to analyze the perceptions of nurses' readiness to use information technology (IT) when facing the new Omicron variant.

Methods: The study used a quantitative approach with a descriptive cross-sectional design supported by the Technology Acceptance Model. This study used a questionnaire to assess respondents' perceptions. A total of 180 eligible respondents were involved in the study. Technology Acceptance Model (TAM) was used to measure the respondents' perception, and SPSS version 26 was used for analytical data.

Results: The results showed that 96% of nurses were vaccinated, 45% never attended COVID-19 training (External Variables), 45.6% ready with information technology facilities (Perceived Ease to Use), 47.2% were mentally/psychologically prepared, 47.2% supported by family, and 37.8% they had public support (Perceived Usefulness). Those 3 components shaped different perceptions (Attitudes) towards using the IT in which 44.4% were ready, 27.2% were in the process, 25.3% were not prepared and 3.1% had no idea (3.1%). As a result (Behavior), out of 180 population, 63.6% of participants were categorized as not ready.

Conclusion: The findings recommend that nurses using IT in dealing with Omicron 100% must be vaccinated and participate in COVID-19 training.

Introduction:  Ovarian cancer is one of the leading causes of cancer death in women globally. The objective of this study was to determine the correlation and the association between age, stage, histopathology, grade, ascites, tumor residual, CA-125 level, and type of surgery on recurrence, disease-free survival, overall survival and mortality of epithelial ovarian cancer patients.

Methods: An analytical retrospective study using medical records and interviews of epithelial ovarian cancer patients was conducted in Dr. Soetomo Hospital. The study included the data from January 2016-December 2020. Kaplan-Meier and log-rank test were used to assess the factors associated with disease-free survival (DFS) and overall survival (OS).

Results: A total of 358 patients with epithelial ovarian cancer from 2016 to 2020 were included in the study of which 153 of recurrence cases. Clinicopathological factors that correlated with disease-free survival were stage, histopathology, grade, ascites, tumor residual, CA-125, and type of surgery (p<0.05). The factors that correlated with overall survival were stage, histopathology, grade, ascites, residual tumor, and CA-125 value (p<0.05). The most significant factors associated with recurrence and mortality were stage, grade, and ascites. Stage II and III had an HR (hazard ratio) of 1.9 and 2.1 for recurrence compared to stage I, respectively. Grade II and III patients had HRs of 2.1, and 3.4 for recurrence compared to stage I, respectively. The presence of ascites had an HR of 1.5 compared to those had no ascites. Stage III had an HR of 1.9 for mortality compared to stage I, respectively. Grade II and III patients had HRs of 3.6, and 5.0 for death compared to stage I, respectively. The presence of ascites had an HR of 1.6 compared to patients with no ascites. Compared to serous type, those patients with mucinous and clear cell had HR of 1.8 and 3.1 for mortality, respectively

Conclusion: Stage, grade, and ascites were the most significant factors in the incidence of recurrence and mortality of epithelial ovarian cancer.

Introduction: Meningitis is the most severe and dangerous complication of tuberculosis, and can be fatal if not treated adequately. Acute hydrocephalus is often accompanied by tuberculous meningitis. This study aims to assess the prognostic factors in adult patients with tuberculous meningitis accompanied by hydrocephalus.

Methods: The study was conducted retrospectively by collecting data from the medical records of patients with TB meningitis. Patient data were collected and analyzed using multiple logistic regression to obtain significant prognostic factors.

Result: Fifty-four patients had Grade II TB meningitis and 42 patients had Grade III TB meningitis. In this study, it was found that patients with Grade III had higher mortality than patients with Grade II, especially within 30 days of treatment (HR = 3.73 (2.02-6.89), p<0.0001). In patients with Grade II, low sodium levels increased the risk of mortality compared to near-normal sodium levels (HR = 4.22 (1.44-12.43), p = 0.0088). In patients with Grade III, VP-shunt action reduced the risk of mortality (HR = 0.23 (0.09-0.55), p = 0.0011). Meanwhile, the ratio of glucose levels and neurological deficits was not significant as a prognostic factor (p>0.05).

Conclusions: Patients with grade III TB meningitis generally have a high risk of mortality and require VP-Shunt intervention to increase life expectancy. In patients with grade II tuberculous meningitis, sodium level plays a role in determining the prognosis.

Introduction: An instrument that is frequently used to gauge academic procrastination is the Procrastination Assessment Scale for Students (PASS). During covid-19 pandemic the chance to get more into procrastination mode is higher because while students is studying at home they have something distracted their mind such as watching movie, using social media and the others things. The objective of this study was to evaluate the constructs of validity and reliability of the procrastination assessment scale for nursing students during the pandemic COVID-19 are examined.

Method: It is a cross sectional study where distributed to 416 nursing students and the data taken by stratified sampling. The scale consists of two part, part one is area of procrastination had 18 items and second part is reason for procrastination had 26 items. The data was analyzed with Stata.

Results: The reliability of first part was 0.6615 and the second part was 0.9136. The model was acceptable where root mean squared error of approximation (RMSEA) = 0.108, standardized root mean square residual (SMRS) = 0.063, comparative fit index 0.957, CI 90%.

Conclusion: Based on the investigation, the dimensions and indicators that make up the academic procrastination construct are credible and valid ways to assess it among Indonesian nursing students.

Background: Endometrial cancer is the second most common type of gynecologic malignancy. Studies on factors of lymphatic metastases are few. This study aimed to determine the clinical and pathological characteristics that can predict lymph node metastases.

Purpose: To determine the correlation of clinicopathological characteristics with LNM (Lymph Node Metastases) in Endometrial Cancer (EC).

Methods: This study used observational analysis and a cross-sectional methodology to examine medical records of endometrial cancer patients who underwent lymphadenectomy sampling surgery in 2018-2020. The risk factors are determined using multivariate analysis.

Results: The stage IB and IIIC1 patients accounted for the most (17.27%) of the 63 research participants. Only one patient (1.1%) is in stage IIIB. The rests are stage IA and IIIA, each including eight patients (8.13%), and stage II, which has twelve people (12.19% ). There were 17 patients with endometrial cancer who had lymph node metastases (27% ). The incidence of LNM is 23.2% in endometrioid types, while the incidence of metastases is 57.1% in non-endometrioid kinds. The incidence of LNM in EC was not linked with the patient's age (p=0.628), BMI (p=0.190), parity (p=0.194), or menopausal status (p=0.970). The study found no correlation between LNM and histological kinds (p=0.078), histopathological degrees (p=0.514), or myometrium invasion (p=0.134) in EC. The risk factors most linked with LNM in EC are LVSI (+) (OR = 0.10; IK 95% 0.19–0.56; p = 0.009) and cervical invasion (OR = 0.07; IK95 percent 0.008–0.64; p = 0.019) according to the results of multivariate analysis.

Conclusion: Cervical invasion and LVSI (+) are the risk factors most associated with the incidence of LNM.

Background: A wound is a discontinuity of any bodily tissue due to various causes. Every wound of any severity could result in problems related to its healing process, such as scar tissue formation. According to the duration of its healing process, wound is divided into 2 categories: acute wound that takes approximately 3-4 weeks to heal and chronic wound that needs 4-6 weeks and resulted from inappropriate healing of the acute wound. Tretinoin's use in wound healing has been controversial for more than 40 years. Topical Tretinoin has keratolytic effect that stimulates fibroplasia and epithelization on full-thickness wounds. On the other hand, single administration along with long-contact topical Tretinoin has an irritative effect that could delay healing due to continuous inflammation. This study aims to explore the effectiveness of single administration compared to repeated administration of topical Tretinoin in full-thickness acute wound healing on rats at Faculty of Veterinary Medicine, Airlangga University, Surabaya.

Methods: This experimental study involved 27 male rats which were randomly divided into 3 groups: control (A), single-administration (B), and repeated-administration (C). Full-thickness wound size 20 mm in diameter was made on the skin of each rat. On group A, wounds were covered with Tulle and transparent dressing. On group B, wounds were treated with lidocaine 2% and tretinoin solution 0,05% in single administration, while the same treatment was given repeatedly on group C for 4 days straight. Evaluation was done microscopically on day 5 according to epithelization phase on wound healing with hematoxylin and eosin (H&E) staining.

Results: The result from the calculation showed that group C obtained a significantly higher average number of fibroblast cells count compared to the treatment group A and B. The average number of fibroblast cells in treatment group B was three times higher than the number of fibroblast cells in treatment group A, while the average number of fibroblast cells in treatment group C was three times the number of fibroblast cells in treatment group B. From the statistic, it was proven that the regular application of 0.05% topical tretinoin solution in a full-thickness wound (Group C) has shown a significant increase in the number of fibroblasts during the proliferative phase.

Conclusion: A frequent administration of 0.05% topical tretinoin solution resulted in a higher number of fibroplasia improvements compared to once administered in full thickness acute wound healing, however it did not result in epithelialization on day 5.

Introduction: Stress in nursing students has been documented in many studies and this will lead to various health problems. However, there is scanty research assessing the level of stress among nursing students during Covid-19 in Malaysia.  Hence, this study aimed to assess the level of stress and its association with social and environmental factors amongst nursing students in Universiti Malaysia Sabah, Malaysia.

Methods: A cross-sectional study was conducted by random sampling among nursing students in Universiti Malaysia Sabah between March and May 2021. The primary outcome was stress symptoms, derived from the validated Perceived Stress Scale-10 (PSS) questionnaire. Socio-demographic, social, and environmental factors were also assessed. T-test was used to assess the associations between level of stress and social and environmental factors.

Results: A total of 115 responses were received with the mean (SD) age of the students being 20.5 (1.3) years old. Of all the students, 84.9% were female, 54.6% received financial support from National Higher Education Fund Corporation and 46.2% were in nursing Year 2 followed by the nursing year 1 (28.6%) and nursing year 3 (25.2%). The students in this study reported a higher level of stress. The students who reported most or all the time being trapped in a hostel (p<0.01), challenges of online classes (p=0.03), and catching up with class projects (p=0.03) had a higher level of stress compared to those who reported none or little or some of the factors.

Conclusion: This study showed that social and environmental factors may play a role in determining the stress level among nursing students. Hence, authorities should foster supporting strategies to lower student stress and tackles the unwanted consequences.

Introduction: Obesity is a cause of metabolic syndrome. Intermittent fasting is a method that is quite popular today, and this is an alternative method to lose weight compared to the traditional method of undergoing calorie restriction (20-40% reduction in daily calorie intake) and/or physical activity. However, the effect of intermittent fasting and physical exercise on changes in the muscle remains unclear. This study aimed to determine the changes in muscle histology in intermittent fasting and physical exercise in obese mice.

Methods: 8-weeks old mice were given a high-fat diet for two weeks and then grouped into four groups (a control group, group two as a group with a high-fat diet, group three with a high-fat diet which was given physical exercise, and group four was a high-fat diet which was given fasting for 8 hours 5 days a week, for two weeks). Histological analysis was performed to see the changes in the muscles with hematoxylin staining at 40 times magnification.

Results: The fasting and physical exercise group were significantly less weight gain. The histological results found that the muscle diameter widened in the physical exercise group compared to the high-fat diet group (p<0.05). In comparison, the fasting group was found to have almost the same muscle diameter as the control group without the high-fat diet (p<0.05).

Conclusion: Both intermittent fasting and exercise were effective in reducing body weight, whereas intermittent fasting is more effective than exercise in maintaining muscle mass by maintaining muscle diameter to prevent obesity.

Background: The main factor causing failure of root canal treatment is re-infection of the bacterium Enterococcus faecalis, so it is necessary to give the right intracanal medicament. Calcium hydroxide (Ca(OH)2) is an intracanal medicament often used in endodontic treatment. To increase the effectiveness of calcium hydroxide, a mixing agent is needed. Mixing agents such as Chlorhexidine digluconate (CHX) 2% (aqueous) and Clindamycin hydrochloride 5% (viscous). The viscous mixing agent can penetrate well into the dentinal tubules, and the antibiotic can fight various root canal endodontic pathogens and dentinal tubules without causing discoloration. This study aims to determine the differential effectiveness of calcium hydroxide combination of chlorhexidine digluconate 2% and Clindamycin hydrochloride 5% as an intracanal medicament against Enterococcus faecalis (in vitro).

Methods: The design was in vitro experimental laboratories that tested the value of turbidity (Optical Density) using a spectrophotometer before and after being treated. Data were analyzed by the Kruskal-Wallis test and then Mann-Whitney U Test.

Results: The positive control group had the largest negative Optical Density (OD) difference, followed by a calcium hydroxide combination of Chlorhexidine digluconate 2%, and the third sequence was a calcium hydroxide combination of Clindamycin hydrochloride 5%. A negative OD difference indicates a decrease in the number of bacterial cells.

Conclusion: There are differences in the effectiveness of the antibacterial of intracanal medicament calcium hydroxide combination of Chlorhexidine digluconate 2% and calcium hydroxide combination of Clindamycin hydrochloride 5%.

Introduction: Glaucoma is one of the most common complications in uveitis. The surgical intervention has been known for a lower success rate in Uveitis Glaucoma (UG). However, it is still a treatment of choice when medical therapy no longer could control the intraocular pressure (IOP). This study aims to describe UG's demographic and clinical characteristics that received glaucoma surgery and the outcome.

Methods: Medical records of UG patients that received glaucoma surgery in 2018-2019 were reviewed. Age, gender, type and etiology of uveitis, duration of uveitis, intraocular pressure (IOP), visual acuity, gonioscopy, ocular characteristic, previous surgery and laser, current surgery, and complication were studied. Success was defined as IOP ≤21 mmHg or reduction >20% from baseline and >6mmHg with or without medication. Failure is defined in the presence of surgery complication that leads to a change of IOP, uncontrolled IOP that needs additional surgery, and visual acuity becomes no light perception (NLP).

Results: 48 patients (57 eyes) with UG underwent glaucoma surgery. The mean age was 47,23±14,62. Anterior uveitis was the most common type of UG, with a mean uveitis duration before surgery was 13,75±17,65 months. The mean initial IOP was 35,81±13,30 mmHg, at the final visit 15,09±3,36. The mean follow-up duration was 6,41±4,02 months. The overall partial success was 75,44% in one month, 67,74% in 6 months

Conclusion: A decrease in IOP was found in all surgery interventions, including Glaucoma Drainage Device (GDD) implant, trabeculectomy with 5-Fluorouracil (5FU), and combined trabeculectomy cataract surgery with or without 5FU, and cyclodestructive laser surgery. There was a high percentage of successful surgery but many losses to follow-up eyes in a short follow-up period.

Background: Acute lymphoblastic leukemia (ALL) is a bone marrow malignancy that is the most common cause of death in children. This study aims to determine the characteristics of ALL patients in 2016-2020 at Sanglah Hospital Denpasar, Bali.

Methods: This study used a retrospective descriptive study with secondary data from 166 patients. Variables assessed in this study included: demographic characteristics (age, gender, place of origin), complete blood count results include of hemoglobin levels, leukocyte (white blood cell) count, absolute neutrophil count, absolute lymphocyte count, thrombocyte count, and morphology subtype of ALL based on FAB classification from bone marrow aspiration (BMA).

Results: From demographic characteristics: most patients' age was in school-age children (>6 - <18 years) about 59.7%, dominated by male (60.2%), place of origin from Bali (71.7%) which is from Denpasar city (23.5%). From the laboratory results, complete blood count found that the most results are moderate anemia in children (54.7%), in adult female (70%), and in adult male (52.9%); leukocytosis in children (41%), in adult (77.8%); neutropenia in children (61.2%), in adult (59.3%); lymphocytosis in children (43.2%), in adult (81.5%); thrombocytopenia in children (97.1%), in adult (100%). From the results of the BMA examination, based on the FAB (French, American, and British) classification, the most common morphology of ALL was L2 subtype (78.9%).

Conclusion: Characteristics of patients with ALL at Sanglah General Hospital are dominated by children, male, from Denpasar, Bali, with laboratory results showing moderate anemia, leukocytosis, neutropenia, lymphocytosis, thrombocytopenia, and the most common morphological variants are ALL-L2 subtype.

Introduction: The condition that appears in patients who have had a stroke is cognitive impairment. Cognitive impairment can worsen the condition of stroke patients so that it can slow down the recovery process and have a high risk of disability. This study aims to analyze the correlation between cognitive impairment and the level of disability in post-stroke patients.

Methods: This study uses a correlational analytical design with a cross sectional technique design with a population of 70 participants and a sampling technique using consecutive sampling obtained a sample of 64 participants. The independent variable in this study is cognitive impairment of post-stroke patients while the dependent variable is the level of disability of post-stroke patients. The instrument for collecting data on cognitive impairment was using the MoCA-Ina questionnaire and the level of disability using the WHODAS questionnaire. The data were analyzed using the Spearman Rank test with significance < 0.05.

Results: The results of this study showed that most of the 52 (81.2%) participants had cognitive impairment and most of the 42 (65.6%) participants had moderate disabilities and a small portion of 10 (15.6%) participants had severe disabilities. The results of statistical tests on the relationship between cognitive impairment and the level of disability in post-stroke patients through the Spearman Rank test showed p = 0.000 with coefficient correlation 0.665.

Conclusions: The analysis test showed a strong correlation between cognitive impairment and the level of disability in post-stroke patients. Post-stroke patients with cognitive impairment must be treated properly so that it does not result in disability in patients that has a direct impact on the psychosocial and quality of life of the patient.

Introduction: Based on the low interest in inpatient visits by company insurance, only 11.4% of employees utilize inpatient facilities at CMH. This study aimed to find the relationship between demographics and infographics of company insurance patients on the use of inpatient services.

Methods: This study was conducted on 95 respondents from a customer's company. Ninety-five customers are divided into actual customers who have used inpatient services (58 people) and potential customers who have not utilized (37 people). The data is processed by grouping some between actual and potential customers and processed descriptively using a chi-square of several variables, including demographics and infographics.

Results: This study informs that the distance from home and the length of time known to the hospital did not affect inpatient care. At the same time, knowledge of cooperation and socialization of HRD influences the utilization of inpatient services. Repeated socialization and the hospital's proximity to HRD can cause more patients to visit and take advantage of inpatient services

Conclusion: In carrying out inpatient services, the company's role as a guarantor is very decisive in directing customers to CMH. Utilization of inpatient services is not influenced by distance from home and length of time with CMH but by customer knowledge regarding collaboration with CMH and socialization by HRD.

Background: Occupational exposure to aluminum can potentially cause health problems for workers in the aluminum foundry industry, which might associate with cognitive impairment. However, studies in the informal aluminum foundry industry are still very limited. This study aimed to determine the relationship between aluminum exposure and cognitive impairment in informal aluminum foundry workers.

Methods: This study used a cross sectional design with logistic regression analysis. Seventy-nine workers in the informal aluminum foundry industry participated in this study. Aluminum in urine was measured using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Cognitive function was measured using the Montreal Cognitive Assessment-Indonesian version (MoCA-Ina) instrument.

Results: A total of 69.6% of the subjects experienced cognitive impairment. There was a statistically significant relationship between urinary aluminum levels and cognitive impairment. Multivariate logistic regression analysis showed that urinary aluminum levels (adjusted odds ratio (aOR) = 6.550; 95% confidence interval (CI) = 1.281-33.499) and length of education (aOR = 16.885; 95% CI = 2.042 – 139.604) were associated with cognitive impairment, with cut-off value set at 45.985 µg/L. Other results showed that workers with less than 7 years of formal education have a 16.885 times higher risk of experiencing cognitive impairment.

Conclusion: Workers with urinary aluminum levels ≥45.985µg/L and formal education fewer than 7 years have a higher risk of having cognitive impairment. Regular bio-monitoring of workers' urinary aluminum levels and adequate aluminum exposure control efforts are needed to prevent cognitive impairment in informal aluminum foundry workers.

Introduction: The concept of feedback and supervision is at the core of efforts to reduce hospital patient safety incidents. This study aimed to analyze the effect of feedback and supervision on the occurrence of patient safety incidents in hospitals.

Methods: The population included 18 work units that provide services to patients with samples of the unit head or room head, the person in charge of work shifts and the person in charge of patient safety quality. Data in the form of respondents' perceptions were collected through a questionnaire using Google form and analyzed using cross-tabulation and the Pareto approach with a note that it is influential if a difference of >20% is found between the independent and the dependent variable.

Results: The results showed that most of the feedback in the work unit was lacking (50.0%), and supervision in the work unit was good (55.6%). The number of patient safety incidents at the Surabaya Islamic Hospital was dominated by near-injury incidents (NII) with a green rating. The outpatient unit is the unit with the highest incidence. Feedback and supervision affect the number of patient safety incidents because they have a difference of 22.2% and 52.5%, respectively. This study has shown that hospital patient safety incidents are influenced by feedback and supervision.

Conclusion: This study showed that feedback and supervision influence the incidence of patient safety incidents in hospitals. Therefore, there is a need for training on supervision at the head of the room, providing socialization and education about the importance of patient safety, and increasing the commitment of decision-makers and related stakeholders.

Introduction: Urinary disorders in Asian women about 25-45% occur in premenopausal age, and it keeps increasing to 40% at the age of 70. This study aims to determine the sensitivity, specificity, and non-invasive laser therapy in the intervention of problematic stress urinary incontinence and urge incontinence.

Method: This study was a quasi-experimental study using Pre and Post-test design methods with inclusion criteria in the form of Stress Urinary Incontinence (SUI) and urge incontinence. The fractionated CO2 laser non-invasive therapy was applied using the brand Femilift©. Univariate and bivariate data analyses were conducted by using STATA version 19.

Results: There was a significant improvement after three times of Femilift© CO2 laser fractionated intravaginal therapy one month after the procedure, but the same malaise was completely recovered three months after having the therapy. By using the QUID questionnaire, it was found that the mean value of SUI after 1 and 3 after treatment was significantly lower (p-value < 0.05).

Conclusion: A Femilift© CO₂ fractionated laser is a minimally invasive therapy with relatively immediate results so that patients can immediately return to normal activities (no downtime). Femilift© CO₂ fractionated laser makes a very effective, efficient therapy and improves the patient's quality of life.

Introduction: Research on the efforts made to prevent the transmission of COVID-19 in pregnant women with online antenatal care and the telehealth method as well as visits to obstetric polyclinics with improved service strategies have been carried out. However, the strategy of midwifery care by paying attention to the anxiety experienced by pregnant women in carrying out self-care during pregnancy during a pandemic and combined with policies from health workers has not been studied. The strategy applied in a pandemic situation must take into account the socio-demographic conditions of the community. Therefore, the purpose of this study was to explore the factors that influence maternity care and find interventions and strategies to develop prenatal care guidelines. This research has the potential to be applied to the socio-demographic conditions of the middle class.

Methods: The data used in this study were psychological and self-care data for pregnant women during the COVID-19 pandemic, involving 65 respondents at the Endang Widayat Maternity Hospital Sidoarjo from April to June 2021. This study is a mixed method study so the data collection process includes quantitative data. and qualitative data. Quantitative data were collected through questionnaires given to pregnant women, while qualitative data was conducted by conducting in-depth interviews with health workers who carried out pregnancy check-ups.

Results: This study showed that more than half (61.5%) of respondents had moderate self-efficacy and low psychological factors or anxiety. In addition, the bivariate analysis showed that age, education, occupation, parity status, and psychological factors have a significant association with self-efficacy with p-value respectively 0.01, 0.00, 0.03, 0.01, and 0.00. 

Conclusion: The study was conducted to explore the factors that influence pregnancy care and that self-efficacy is related to age, education, occupation, and parity. Self-efficacy also affects the psychological factors of mothers during the Covid 19 pandemic. Pregnancy care during the Covid 19 pandemic is focused on increasing the mother's ability in daily self-care to minimize the spread of Covid 19 to pregnant women.

Introduction: There is a growing number of studies on coronavirus disease 2019 (COVID-19) but data analysis focusing on clinical characteristics in the tropics has not been widely carried out. This study aimed to analyze demographic characteristics, symptoms, length of stay, laboratory results at hospital admission, and the final outcome of infected patients in the tropics in confirmed COVID-19 patients.

Methods: This retrospective study analyzed medical records including socio-demography, clinical manifestations, length of stay, comorbidities, laboratory data, and disease outcomes of 128 COVID-19 patients hospitalized, with confirmed COVID-19 infection results. Existing data were compared using Fisher's Exact Test or Chi Square (X2), determining the difference in the median value which was then assessed using Mann-Whitney.

Results: The mean age of the patients was 50 years, the most common comorbidity was diabetes mellitus 18.8%, the most common symptom was dyspnea 36.7%.

Conclusion: In general, studies conducted to analyze the clinical characteristics of confirmed COVID-19 patients show that the clinical picture of COVID-19 patients in the tropics is generally similar to previous studies. Older age, comorbid patients and patients with dyspnea may help identify a higher risk of death.

Introduction: COVID-19 is a disease that causes severe respiratory infections and has spread to various countries around the world, including Indonesia. The Indonesian government has made efforts to curb the spread of COVID-19 through vaccination. However, public acceptance of the vaccine varies among Indonesians related to COVID-19 vaccination beliefs. The purpose of this study was to assess the relationship between beliefs and acceptance levels of Covid-19 vaccination among nursing students.

Methods: This research used correlation analysis with a cross-sectional study involving 145 nursing students which selected by simple random sampling. This study used self-administered questionnaire to measure beliefs and acceptance of COVID-19 vaccination. Data were analyzed by Pearson’s Product Moment.

Results: The result showed that there is a high correlation between beliefs and acceptance of COVID-19 vaccination among nursing students with p value=0,000 and r=0,876.

Conclusion: Beliefs is one of the factors that influenced the acceptance of vaccination COVID-19 among nursing students, which can be used as a basis for providing future health education.

Background: Risky sexual behavior in adolescents occurs in several cities in Indonesia, including in students in Islamic boarding schools. The phenomenon of risky sexual behavior is found in adolescents in Islamic boarding schools. This study aimed to analyze the factors that influence risky sexual behavior on a biopsychosocial basis.

Method: This study used a cross-sectional observational analytical design, explaining the relationship between variables through hypothesis testing. The samples of this study were adolescents from Islamic Boarding Schools in Probolinggo. A total of 346 adolescents were selected by multistage random sampling. Data were analyzed by Structural Equation Modeling-Partial Least Square (SEM-PLS) test.

Results: The results showed that the independent variables contributed 43.8% to risky sexual behavior, and the model had a good fit. There is a significant relationship between biological maturation, self-perceptions, perception of social and spiritual, and perceptions of sexual on risky sexual behavior.

Conclusion: The results of this study revealed that the model of risky sexual behavior viewed from risk-taking behavior and biopsychosocial theory could be used as a theoretical basis for carrying out activities related to health-promotive and preventive actions for adolescents, which focus on individual, family and peer group factors.

Introduction: Tuberculosis is still a public health problem. Indonesia is the third rank of highest TB in the world. Community empowerment is one of the strategies for finding TB suspects. Community empowerment in Probolinggo Regency is carried out by forming the local TB Association. Evaluation of the role of this TB community has never been done. There is no available measure of community empowerment in this TB community. A measuring tool for community empowerment models is needed for the TB community to increase empowerment. This study aimed to develop a measuring tool for community empowerment through the TB community in finding TB suspects.

Methods: This type of research is quantitative with a cross-sectional design. The population and sample are all local TB communities in Probolinggo Regency are about 325 people. Determination of the sample using simple random sampling according to the inclusion criteria of 128 respondents. Instruments using questionnaires and data analysis with exploratory factor analysis.

Results: The results showed that the measuring instrument for community empowerment was personal factors, knowledge, communication, motivation, self-efficacy, motivational incentives, group factors, and community empowerment factors in finding TB suspects, participation, leadership, and organizational structure having a Bartlett test of sphericity value P < 0.001, Reliability of Life Satisfaction Questionnaire with Cronbach Alpha > 0.800.

Conclusion: This instrument is valid and reliable to be applied to measure local TB community empowerment in finding TB suspects.

Introduction: The Corona Virus-19 (COVID-19) pandemic is the biggest health crisis for generations and has a devastating impact on lives around the world. Several studies found an increase in negative emotions such as anxiety, depression, irritability, and decreased positive emotions (Oxford happiness) and life satisfaction. One form of psychosocial disorder in adolescents is depression and it can be fatal

Objective: To know the risk factors associated with depressive symptoms in adolescents during the COVID-19 pandemic

Methods: A cross-sectional design study was conducted in junior high school and senior high school students in Denpasar Bali, Indonesia for the period December 2020-January 2021. Symptoms of depression were assessed using the Children's depression inventory (CDI). Bivariate analysis using chi-square test and followed by multivariate analysis using logistic regression.

Results: Total subjects were 636, female 70.3%, mean age 14.1 years. 89.6% of the subject's parents work, and 43.4% with low-middle income. 90.9% of the subjects lived with their father and mother, 31.6% experienced bullying, and 2% experienced sexual abuse. Total of 29.4% of the subjects experienced depressive symptoms. Depressive symptoms were associated with female gender (PR 1.580; 95%CI 1.046-2.387; p=0.03), age ≥15 years (PR 1.644; 95%CI 1.133-2.384; p=0.009), bullying (PR 2.232; 95%CI 1.537-3.241; p=0.001), sexual abuse (PR 4.982; 95%CI 1.279-18.710; p=0.002) and history of contact with or have suffered from COVID-19 (PR 2.823; 95%CI 1.501-5.310; p =0.001).

Conclusion: Depressive symptoms were associated with female gender, age ≥15 years, bullying, sexual abuse, and a history of contact with or having suffered from COVID-19.

Background: Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia and associated with several risk factors, such as an unhealthy and unbalanced diet. Porang tubers, known as healthy diet resources, contain glucomannan, a substance that has many positive effects, such as ameliorating blood glucose. Porang tubers are processed as many food products, one of which is porang-processed rice (PR). This study investigated the immediate effects of PR on the blood glucose levels compared to white rice (WR) in patients with diabetes mellitus (DM).

Methods: This was a pilot study of a non-randomized clinical study with a pre-and post-test design held from July to August 2021 in Diponegoro National Hospital, Semarang, Indonesia, among 40 DM patients. Subjects who met the inclusion criteria were divided into two groups: subjects that consumed Porang-processed rice (PR group, n=20) for two days and those that consumed white rice (WR group, n=20). They were measured for fasting blood glucose (FBG) and 2 hours post-prandial glucose (2hPPG) at baseline (T0) and at day-3 after observation (T1). Data were analyzed using SPSS version 20 for Windows.

Results: There were no significant differences in FBG and 2hPPG between the PR group and WR group at T0 and T1 (p>0.05). However, there were slightly larger decreases in FBG and 2hPPG in the PR group compared to the WR group, although they were insignificant (p>0.05).

Conclusion: The immediate consumption of PR for only two days in patients with DM could not reduce FPG and 2hPPG. It is needed to be confirmed by further studies whether PR may have the role as adjunctive in inhibiting the dramatic rise of FBG or 2hPPG or stabilizing blood glucose in patients with DM in a more extended time of consumption.

Background: Tinnitus is the perception of sound heard by a person in the absence of an external stimulus. About 10-14.5% of the world's population experience tinnitus, with the most common age group being 40-60 years. As many as 10-12 million people in the United States suffer from severe tinnitus and feel disturbed enough to seek treatment. The management of tinnitus is still a challenge for researchers. Existing therapies include counseling, cognitive therapy, hearing aids, and tinnitus retraining, but until now, there has been no significant therapy. The last therapy that is available is to make artificial sounds that imitate the sound of tinnitus so that it can mask the actual tinnitus sound. In addition, therapy using music is expected to reduce the stress level of tinnitus patients.

Methods: This research is action research, a follow-up study from previous research, with consecutive sampling and in accordance with the inclusion and exclusion criteria. After getting the frequency and amplitude of tinnitus, a sound stimulus is made in the form of combining tone variations and sound generators obtained from audiometric masking. Tone variations are made using a basic tone that matches the patient's tinnitus frequency. After that, the patient will assess the results of the merger.

Results: The results showed the frequency and amplitude of tinnitus, suitability with masking, type of tinnitus, degree of deafness, and all participants were comfortable when listening to sound therapy from a sound generator.

Discussion: The patient will use a tinnitus sound generator for 2 hours for 2 days, so the amplitude is safely limited to less than 91 dB. In this study, we set the tinnitus sound as closely as possible with the frequency, amplitude, tinnitus pulsating or not, appropriate music and paying attention to the hearing threshold.

Introduction: Tooth discoloration is a change in color that occurs on the enamel and dentin surfaces of a tooth due to the habit of drinking tea. Some fruits are used as natural teeth whitening ingredients, such as Manalagi Apple (Malus sylvestris), which contains malic acid.

Method: This study was an experimental study with a pre-and post-test control group design involving 27 samples divided into three groups, Control (K), P1, and P2. We immersed tooth samples from three groups in tea solution for two weeks. After that, the P1 group was immersed with 50% Manalagi Apple extract three times a day for one week and the P2 group three times a day for two weeks, while the Control group (K) did not get any treatment. We analyzed the tooth discoloration before and after immersing 50% of Manalagi Apple extracts utilizing a Colorimeter, with hunter L, a, and b color scales. The color difference value was obtained using the formula of ⧍E(Lab) = [(L)²+(a)²+(b)²]^1/2].

Results: The ANOVA test results showed significant differences between the three sample groups (p = 0.00). Besides, the Post-hoc test revealed a significant difference between the K group and the P1 group with a p-value of 0.00 (p <0.05). It also indicated a significant difference between the K group and the P2 group with a p-value of 0.00 (p <0.05).

Conclusions: Color changes occurred after immersing the teeth in Manalagi Apple extract for one and two weeks. Immersing the teeth for two weeks caused whiter teeth compared to immersing the teeth for one week.

Introduction: Although several studies on the influence of knowledge and education of family planning (KB) acceptors on the selection of intrauterine contraceptive devices (IUDs) have been carried out previously, research on knowledge and attitudes of family planning acceptors towards the selection of IUDs during the COVID-19 pandemic is still limited. The purpose of this study was to assess the effect of knowledge and attitudes of family planning acceptors on the selection of an intrauterine device (IUD) during the Covid-19 pandemic.

Methods: The data used in this study were obtained from filling out questionnaires involving 162 respondents. This study was analyzed descriptively analytically with the parameters of knowledge and attitudes towards the selection of intrauterine devices (IUD) using a bivariate table.

Results: This study showed that 38.4% had sufficient knowledge, only 1.2% chose to use the IUD with a p-value of 0.348 > 0.05 and of the 66% who had a positive attitude only 2.5% chose to use the IUD with a p-value 0.146 > 0.05.

Conclusion: Although family planning acceptors have sufficient knowledge and a positive attitude, it does not affect the selection of the IUD as an effective long-term contraceptive, so the use of other contraceptives is still recommended as an effort to control fertility according to the needs of the acceptor during the Covid pandemic.

Background: Hamstring autograft (HA) is the most common graft used in ACL reconstruction procedures. However, harvesting HA could weaken the secondary stabilizer of the knee joint. Peroneus longus grafts (PL) is a novel option secondary to hamstring graft with less morbidity at the knee joint. We intended to determine whether peroneus longus autograft (PL) is a comparable alternative to hamstring autograft for ACL Reconstruction.

Methods: 84 patients were grouped into "hamstring" (n = 51) and "peroneus longus" (n = 33) groups, with a mean age of 26.2 ± 5.9 in the Hamstring group and a mean age of 26.4 ± 6.6 in peroneus group. We obtain secondary data from the medical records of several hospitals in Makassar.

Results: There was a significant difference in Lysholm score (p<0.05) in the hamstring group with peroneus at 6 months and 12 months postoperatively for IKDC score, anterior translation, Power Grading Flexi-Extension, ROM on flexion, and extension. In addition, in muscle atrophy, the Hamstring group compared to the peroneus group also showed a significant difference (p=0.001).

Conclusion: The study's results did not show significant differences between the hamstring and peroneus groups other than atrophy of thigh muscles in the hamstring group. Based on the results of this study, we conclude peroneus longus graft is one of the graft options in ACL reconstruction surgery.

Background: Melasma is an acquired hyperpigmentation disorder characterized by pigmented macules and patches scattered on the forehead, cheeks, and chin area exposed to sunlight. Dermoscopy is a non-invasive technique that allows fast and clear observation of melasma in vivo with morphological visualization that is not visible to the naked eye. The color bar tool is an economical and simple tool that can be used to determine skin color. This study aims to determine the dermoscopic appearance of melasma on various skin colors.

Methods: This study is a descriptive observational study with a cross-sectional method of all patients with melasma who came to the outpatient department of the cosmetic dermatology division, Department of Dermatology and Venereology, Universitas Sumatera Utara Hospital, Medan, Indonesia, from September 2020-October 2021. The assessment was carried out by dermoscopy and color bar tools.

Results: This study included 50 melasma patients in total. Most participants (n=23, or 46 %) were between the ages of 36 and 45. Based on clinical features, 42 subjects (84%) presented with centrofacial pattern. In epidermal type melasma, 21 subjects (42%) were associated with color bar 3. In dermal type melasma, color bar 3 is found in 2 subjects (4%); in mixed type melasma, three subjects (6%) were found in color bar 3.

Conclusion: The dermoscopy of melasma in various skin colors has a similar distribution of skin color. Color bar 3 is the most dominant skin color. There were no color bars 5 and color bars 6 in this study.

Background: Grafts and flaps are commonly used for wound closure which can be caused by trauma, chronic disease, post excision tumors, burns, and infections. Reconstructive can fail because of the poor wound bed, radiation, vascular insufficiency and reperfusion injury (IR). EPA and DHA (omega-3) are new compounds that have a strong effect on controlling inflammation in the resolution phase. Some studies say that EPA and DHA (omega-3) are described not only to lower plasma triglyceride levels but also have anti-inflammatory effects and improve endothelial function, all of which mediate anti-atherogenic effects. This study aimed to prove whether preoperative omega-3 administration could increase the viability of extended random skin flaps

Method: This is an experimental post-test-only control group design. 24 rats were divided into 4 groups. The control group (I and II) only had an extended random skin flap, and the sample was taken on the 3rd day (Group I) and 7th day (Group II) and the treatment group (II and IV). Omega was administered according to the animal dose for 21 days. The extended random skin flap was performed, and the sample was taken 3rd day (Group III) and 7th day (Group IV) and the viability of the extended random skin flap in the study was assessed from the expression of VEGF, the number of capillaries and clinical examination assessed from survival area.

Results: Independent T test for each pair in groups I and III showed a significant difference between the mean number of blood vessels in group I and the average number of blood vessels in group III, P=0.000, p<0.005, a significant difference between the mean number of blood vessels in group II and the mean number of blood vessels in group II. group IV blood vessels obtained P = 0.000, p <0.005. Mann-Whitney test found a significant difference between the intensity of VEGF in groups I and III with a value of p=0.031 (p<0.05) and a significant difference in VEGF expression in groups II and IV with p=0.038 (p<0.05). The results of the statistical test of survival area independent T-test for pairs in groups I and III obtained p: 0.353 (p>0.05), and the Mann-Whitney test for groups II and IV obtained p: 0.749 (p>0.05).

Conclusion: Consumption of omega 3 oral before surgery increased the viability of the extended random skin flap by histopathologically increasing VEGF expression and capillary count, and omega 3 oral administration before surgery did not increase the viability of the extended random skin flap assessed from the survival area on the first week.

Introduction: Suicide as a complication of depression is often caused by two main feelings, helplessness and hopelessness. Patients with borderline personality disorder (BPD) experience these two emotional conditions for a long time in their lifetime, which makes them self-harm quite often. They need another person as a “holding environment”, including their caregiver or doctor. This case study aims to assess how influential the role of medical personnel and pharmacotherapy is on the management of suicide in patients with BPD with a history of major depression.

Case Description: Depression has multifaceted symptoms, including feeling sad, confused thoughts, hopelessness, reduced concentration, loss of interest in doing things, reduced self-esteem and self-confidence, decreased appetite, difficulty breathing, sleeping, contemplating suicide, and eventually attempting suicide. This patient's dynamics illustrate that suicide is often the last peak of her depressive state, however impulsive she may be with her BPD. The patient experiences a preoccupation with helplessness, that she no longer deserves to live and is no longer able to face the problems she faces. Her meeting with her doctor made her feel recognized that her feelings were valid, and not try to deny what she was feeling. The patient received treatment with fluoxetine 20mg tab and felt that the medicine she was taking was not a "punishment" for her illness, but a way of healing. The patient felt that from the beginning of treatment until now, she admitted that she had never thought about committing suicide again.

Conclusion: The combination of pharmacotherapy with psychotherapy is more effective in anticipating this risk of suicide, and preventing relapse or recurrence of depression, compared to pharmacotherapy or psychotherapy alone.

Background: COVID-19 can provide symptoms outside the respiratory tract and musculoskeletal symptoms. Some viruses can indeed cause arthritis, and the genetic material of these viruses can be found in a joint fluid using PCR assays. With this study, we will conduct an examination using PCR on the joint fluid of COVID-19 patients who have musculoskeletal symptoms, especially arthralgia, during the infection.

Methods: This cross-sectional study with a descriptive explanation of synovial fluid in COVID-19 patients was performed from April 1^st to July 30^th, 2021, with patient data collection conducted centrally at Wahidin Sudirohusodo Hospital Makassar Synovial fluid was taken from the knee using the sterile procedure in a patient that met the inclusion criteria, such as hospitalized patients who had positive PCR swab results in the nasopharynx for less than 2 weeks and had arthralgia symptoms on April – July 2021. Other musculoskeletal symptoms (e.g., myalgia and fatigue) were noted. About 2 ml sample of synovial fluid was tested using a PCR kit (M BioCov) in the laboratory. The sample shows a positive result when there is an amplification of RDNP with a CT value below 40.

Results: 189 patients with 21 participated, 14 subjects were male, and 7 subjects were female. Age range 18 - 72 years with arthralgia, myalgia, and fatigue symptoms. Only 2 patients had arthralgia, 13 patients had myalgia and arthralgia, 1 patient had fatigue and arthralgia, and 5 patients had all of the symptoms (arthralgia, myalgia, and fatigue). Only 1 patient had direct contact with the COVID-19 patient. PCR test for synovial fluid in all patients showed negative for COVID-19.

Conclusion: COVID-19 infection can be manifest in the musculoskeletal system. Detection of COVID-19 virus using a specimen from knee synovial fluid in a patient with musculoskeletal symptoms (arthralgia, myalgia, fatigue) was negative.

Introduction: Zephyranthes candida plants or known as chocolate flowers are usually only used as ornamental plants, many people in Indonesia do not know that this plant has medicinal properties. The purpose of this study was to determine total phenol levels, and total flavonoids and determine the antioxidant activity of chocolate flower plants.

Methods: This study was an experimental study using cacao flower leaves, ethanol, aqua dest, ABTS, gallic acid, quercetin, AlCl3, Folin-Ciocalteu reagent, Na2CO3, FeCl3, sodium acetate, and Vitamin C. Samples of cacao flower leaves (Zephyranthes candida) were collected from Leles, Garut Regency, West Java. The material taken is collected and then sorted wet to separate the plant parts that are not needed, then washed with running water until clean. Then dried in a drying cabinet at a temperature of 40-50°C to dry. Furthermore, dry sorting is carried out to separate foreign objects that enter during drying. The dried samples were mashed using a blender. Then the simplicia powder is stored in a tightly closed container at room temperature and is ready to be extracted. Then the extract will be analyzed to determine the total phenol content, flavonoid content, antioxidant activity, and thin layer chromatography.

Results: The results of the determination of total phenol and total flavonoid levels and the antioxidant activity of brown flower leaves showed that the total phenol content of the brown flower ethanol extract was 20.5803 ± 0.15 mgGAE/gram. And the total flavonoid content of the brown flower ethanol extract was 1.8411 ± 0.0641 mgQE / g. The test results of the antioxidant activity of brown flower leaves showed that these plants had a very strong antioxidant activity with IC50 of 18.2106.

Conclusions: The results of the research to determine the total phenol and total flavonoid content and antioxidant activity of cacao flower leaves showed that the total phenol content of the ethanol extract of cacao flower was 20.5803 ± 0.15 mgGAE/gram. Moreover, the total flavonoid content of the cacao flower ethanol extract showed a very strong antioxidant activity.

Background: African leaf is a traditional plant from southern Africa known as the Bitter leaf. African leaves (Vernonia sp.) belong to the family Asteraceae. African leaves (Vernonia sp.) are widely used as medicine, with bioactive compounds that are useful for curing various diseases. This study was conducted to find out the content of secondary metabolic compounds.

Method: About 120 grams of simplicia powder were extracted using 3:1 ethanol solvent. We conducted the identification screening test to reveal the phytochemical compounds of African leaves, such as alkaloid, triterpenoid, steroid, tannin, flavonoid, saponin, and phenolic. The phytochemical screening methods looked at changes in color and sediment.

Result: Based on the color reaction and deposition results in African leaves (Vernonia sp.), they contained compounds of the group alkaloids, phenols, flavonoids, tannins, saponins, steroids, and triterpenoids.

Conclusion: African leaf (Vernonia sp.) contained various compounds such as alkaloids, flavonoids, tannins, saponins, steroids, triterpenoids, and phenolics.

Introduction: The Covid-19 pandemic has brought changes to the education system, one of which is the implementation of online learning. This condition makes students like students have to use digital devices, even with a more intense frequency. Therefore, this study aims to determine the level of nomophobia in students as participants in online learning. 

Methods: This research is descriptive research with a quantitative approach. The study was conducted with a one-time survey (cross-sectional survey). The research was conducted through 3 stages: preparation of the nomophobia measurement instrument, data collection, and measurement of the level of nomophobia.

Results: 287 respondents were obtained, then the demographics of the respondents can be grouped by gender, age, internet fund source, and online learning media used. Most of the respondents were female (71%) and teenagers (12-25 years) (99%). In addition, the results show that nomophobia has become a new disease epidemic among students, especially in online learning, that requires an increase in the frequency of smartphone access. There are no respondents who are not nomophobia. The respondents have mild nomophobia (6%), moderate nomophobia (40%), and severe nomophobia (54%).  

Conclusions: Most of the respondents had a severe level of nomophobia. In addition, the students feel uncomfortable when communicating and accessing information via smartphones or other gadgets, lose connectivity, and cannot use smartphones as desired. Their lives are very dependent on smartphones or other devices. One of the triggers is online learning, where all processes are carried out through digital media. At least students who are not nomophobia also show that nomophobia has proven to be one of the negative impacts that students have to face as participants in online learning.

Background: Febrile neutropenia is defined as a fever with a temperature more than or equal to 38.3°C in two measurements within 24 hours and accompanied by severe neutropenia (≤500/μL). Gram-positive bacteria have been the most common cause of febrile neutropenia in children for the previous two decades. However, the contradiction in some studies reported that gram-negative bacteria were the main pathogens causing infection. Because there are differences and shifts in the bacterial spectrum, information on the bacterial pattern and antibiotic susceptibility is critical to reaching the optimal management of febrile neutropenia patients.

Methods: This observational, descriptive study was conducted in Sanglah Hospital, Bali, Indonesia, involving pediatric patients (<18 years old) with febrile neutropenia. Data on antibiotic susceptibility and microbial patterns were collected retrospectively from the blood culture registry taken from febrile neutropenia patients from October 2017 to August 2020. Collected data were analyzed using the SPSS program for Windows, version 21.0. Univariate analysis was conducted, and data with a categorical scale were reported in frequency distribution and percentage, then displayed in a table and graph.

Result: A total of 180 episodes of febrile neutropenia were collected from 89 patients. Among 180 blood cultures, there were found 44 (24.44%) blood cultures with positive results. A higher proportion of gram-negative organisms (33; 75%) is found compared to gram-positive organisms (11; 25%). The susceptibility rates were 100% for Azithromycin, Amoxicillin Clavulanate, Cefoperazone Sulbactam, Meropenem, Linezolid, and Doxycycline, while Cefepime, the previous empirical antibiotic, was susceptible at 79.31% isolates.

Conclusion: Gram-negative bacteria were the most frequent cause of infection among febrile neutropenic patients. Although the research evidence is still weak due to the small sample size, Cefoperazone Sulbactam could be a better option to replace Cefepime as an empirical antibiotic due to its significantly higher susceptibility.

Introduction: The opening-stages of the cervix during baby-delivery-process is a physiological condition. In any case, if the interaction is excessively long, whenever left unchecked, it can influence the mother's condition as weariness, dread, stress, and stress that can expand agony and influence the conveyance cycle. The reason for this investigation was to break down the impact of murottal or reading Al-Qur'an treatment on the advancement of the main phase of work in the dynamic period of primigravida mothers.

Methods: The research is utilized pre-experimental with a pre-posttest design. The participants in this study was 102 primigravida mothers who emanated to the VK Maternity who met the inclusion conditions with the sampling technique utilizing the accidental sampling method. Data collection comprises coding, editing, and tabulating, then the data is scrutinized by computer using the paired t-test with P-Value = 0.05.

Results: The results exposed that the average cervical dilatation before murottal therapy was 5.46, the average after murottal therapy was 8.95. Paired t-test showed that there was an effect after murottal therapy. There is an increment in the amassing of cervical dilatation after murottal Al-Qur'an treatment. The examination presumes that there is an impact of murottal Al-Qur'an treatment on the advancement of the main phase of work in the dynamic period of primigravida mothers.

Conclusion: The use of murottal Al-Qur'an treatment to primigravida mothers is extremely huge in aiding smooth the advancement of baby-delivery as far as the cervical opening. With the goal that the baby-delivery-process is simpler for the mother to live.

Introduction: Typhoid fever is a disease caused by Salmonella typhi, Salmonella paratyphi A, B, C. An estimated 200,000 people die each year from about 21.6 million people infected with typhoid fever. This study aims to determine the hematological profile in typhoid fever cases in children under five at Idaman Banjarbaru Hospital.

Methods: The research was carried out with a retrospective descriptive approach with a consecutive sampling technique. The research subjects were children under five diagnosed with typhoid fever recorded in the Idaman Banjarbaru Hospital's medical records for July 2018 to January 2019.

Results: The sample consisted of 58 patients, 32 boys, and 26 girls. Most patients were found in 12 - <36 months, namely 28 (48.28%) children. Thirty-eight (65.52%) children have a normal weight. The hematological profile showed that 46.55% of the patients had iron deficiency anemia (IDA). Hematocrit levels decreased in 51.72% of patients. Erythrocyte levels in 86.21% of patients were normal. Low MCV, low MCH, IDA were found in 46.55%, 36.21%, 46.55% of patients. Leukopenia was present in 17.24% of children. All patients had normal basophil values. Eosinopenia, band neutropenia, segmented neutropenia,  lymphocytosis, monocytosis  were found in 69.09%, 90.90%, 56.37%, 58.18%, 58.18% of children, respectively. Thrombocytopenia and thrombocytosis were found in the same percentage, 13.80%.

Conclusion: The haematological profile of typhoid fever patients in children under five can have different results depending on each child's body's response to S. typhi and S. paratyphi that enter the body.

Background: Nasal polyps are benign chronic inflammatory masses with epithelial tissues of the nasal mucosa and paranasal sinuses. The clinical diagnosis is made based on sinonasal symptoms for more than three months and the presence of polyps in the nasal cavity. The classification of nasal polyps based on the histopathological structure is divided into three types, i.e., oedematous, eosinophilic polyps, inflammatory polyps, and chronic seromucous inflammatory polyps. This study aims to describe the profile of patients with nasal polyps at Dr. Soetomo Public Hospital Surabaya.

Methods: This study applied a descriptive method with a retrospective approach by obtaining data from the medical records of the outpatient unit in the Ear, Nose, Throat, and Head-Neck (ENT-HN) Department of Dr. Soetomo Public Hospital Surabaya for the period January 2017-December 2018 based on age, gender, clinical symptoms, symptoms duration, polyp types, location of nasal polyp, and comorbidities.

Results: The number of patients with nasal polyps was slightly more in women, as many as 13 patients or 52%, mostly aged 51-60 years old, amounting to 11 patients or 44%. The most common clinical symptom experienced by patients was nasal obstruction, as many as 24 patients or 96%. Patients who experienced symptom duration for one to three years before treatment amounted to 13 patients or 52%. Patients with histopathology of inflammatory nasal polyps were 19 patients or 76%, while patients of nasal eosinophil polyps were six patients or 24%. Additionally, patients with comorbidity in nasal polyps of allergic rhinitis medical history were 11 patients or 44%. Also, bilateral nasal polyps were mostly experienced by patients, reaching 14 patients or 56%.

Conclusion: This study reveals nasal polyps in women aged 51-60 years with clinical symptoms of nasal obstruction with the results of a histopathological examination of the inflammation type at bilateral polyps.

Introduction: Maternal and child health problems (MCH) are still a health problem in Indonesia. The high rate of maternal and child mortality requires intensive intervention and monitoring by the health department through health facilities available in the community. The recording and reporting of the MCH program at the Jagir and Wonokromo Health Centers has not been well documented because most of the MCH program recording and reporting is done manually. The purpose of this research is to produce a model of recording and reporting information system that is useful in handling the recording and reporting process of the integrated MCH program from the Independent Midwife Practice to the Puskesmas.

Method: The method used in the development of this software is the Scrum Management Framework. The result of this research is the SISKIA (Maternal and Child Health Information and Surveillance System) software application which is integrated from the Independent Midwife Practice to the Puskesmas which can be used to manage maternal and child health data.

Results: The SISKIA software application makes it easier to map Maternal and Child Health data, including in high-risk cases, in order to get health services according to the schedule determined by the midwife. SISKIA can directly assess the condition of mothers and children reported by the midwife and can be accurately displayed on the map included in SISKIA installed at the Jagir and Wonokromo Health Centers. Mobilization of the entire community in reducing MMR and IMR in the Jagir and Wonokromo Health Centers can be carried out by monitoring maternal health conditions in the surrounding environment by using this software application.

Conclusion: The Maternal and Child Health Information and Surveillance System (SISKIA) has proven useful for obtaining regular and up-to-date maternal and child health data.

Background: Cervical cancer is the leading cause of cancer in the world, especially in developing countries. Kefir is a goat's milk product that contains a lot of nutrients and bioactive complex which are involved in the synthesis of the anticancer, and have anticarcinogenic and antimutagenic effect. Integrins are involved in various biological processes associated with cancer development, such as migration, invasion, differentiation and proliferation. MMP-9 can also degrade ECM through proteolytic action, affecting cell-cell interactions in ECM. This research aimed to see the effect of kefir on MMP-9 and integrins activation. Thus, it is expected that kefir can be used as an additional supplement in patients with cervical cancer.

Methods: This research study was conducted in an experimental laboratory in vitro using HeLa cells as the object of research. Data were analyzed using the SPSS program to determine the most effective dose of kefir and a regression test to determine the effect between integrins and MMP-9.

Results: The mean value of MMP-9 and integrin at a dose of 180 µg/ml was 165.1 ± 5.8 and 378.5 ± 12.6 respectively. This result had a significant value of p = 0.0000 for both MMP-9 and integrin-b. In the regression test, the value of p = 0.05 was obtained while the coefficient value was positive (0.565).

Conclusion: The higher the expression of MMP-9, the activation of the integrin-b would increase. Kefir extract dosage of 180 µg/ml significantly reduced MMP-9 and Integrin-b expression. MMP-9 affects improving Integrin-b

Introduction: Ginger is one of the herbal plants that has been known for a long time. However, most people did not know further about the benefits of ginger for pregnant women. Therefore, this study aimed to analyze the ginger effect to compress the lower back in third-trimester pregnant women.

Methods: The data were used in this study obtained from the intensity of pain felt by pregnant women in the third trimester. This study involved 10 respondents who were collected by purposive sampling technique. The analysis used in this study was to determine the difference in the level of the back before the ginger compress and after the ginger compress in the third trimester of pregnant women using the Wilcoxon test.

Results: This study shows that the significant value of ρ=0.005<0.05, from these results, it was shown that there is an effect of ginger compresses on reducing back pain in third-trimester pregnant women.

Conclusion: This study was conducted to analyze the effect of ginger compress on the lower back in third-trimester pregnant women. Furthermore, this study proves that ginger compress can significantly reduce back pain in the third-trimester pregnant women

Introduction: People who live in red zone communities are at high risk of COVID-19 transmission. This condition can elicit various societal reactions, both physically and psychologically. This psychological response will urge them to search for alternative solutions. The fundamental purpose of this study was to determine the psychological state and coping mechanism, especially for people living in the rural red zone.

Methods: A cross-sectional study was conducted on 12.423 persons living in a rural area of East Java province. According to Krejcie and Morgan's table, the sample size was 372 participants. The questionnaires were circulated through social media applications and a Google form. Two experts examined the validity of the content. In early June 2021, data collection began. The data were analyzed using descriptive statistics, Pearson correlation, and Kruskal-Wallis tests.

Results: The population suffers from three categories of ailments, the most common of which are anxiety and stress. The community employs both emotion-focused and problem-focused coping mechanisms. Seeking emotional and instrumental social support, turning to religion, acceptance, mental and behavioral divergence, active coping activities, focusing and releasing emotions, denial, and bodily symptoms are examples of coping mechanisms. The findings also show a significant relationship between several demographic variables, precisely age and coping strategies. People who live in the rural red zone have varied psychological reactions, such as anxiety and stress. The community's coping mechanisms tend to revolve around releasing emotions and denial.

Conclusions: The increasing prevalence of COVID-19 contributes to the onset of psychological health problems in some people living in the red zone. When psychological health difficulties occur, they urge an individual to develop coping mechanisms for coping with the current condition.

Introduction: Color blindness can be congenital or acquired due to certain diseases. One of the causes of acquired color blindness is due to toxic optical neuropathy. Tobacco consumption, assumed to be one of the risk factors, has been proposed to be associated with toxic optical neuropathy. Active smokers are subjects who are susceptible to the toxic effects of tobacco. This study aimed to analyze the correlation between blood cotinine levels in active smokers with color blindness.

Methods: This study was an observational analysis of 33 smokers and 35 non-smokers samples. Cotinine levels were examined from blood samples, which were then examined by Calbiotech reagent. Farnsworth Munsell 15 Hue was used to examine color vision. Statistical analysis was done using Shapiro-Wilk for normality distribution data, Mann Whitney and Independent T-test comparing data between two groups, and Spearman correlation test.

Result: There was a significant difference between the mean color blind error score in the smoker group (4.83 ± 6.27) and the non-smoker group (0.24 ± 0.65). Similarly, a significant difference was found between the blood cotinine level of the smoker group (64.59 µg/ml) and the non-smoker group (0.44 µg/ml). There was a significant correlation between the color blind error score and blood cotinine levels in the total sample.

Conclusion: There was a correlation in the total sample between blood cotinine levels and a color-blind error score. The higher the blood cotinine level, the higher the color blind error score.

Introduction: Charcot neuroarthropathy (CN), also known as Charcot's foot, is consequently causing a reduction in quality of life, high disability, and an increased risk of mortality that poses many clinical challenges in its diagnosis and management. Common surgical interventions typically include ulcer debridement, exostectomy, deformity correction, and minor and major amputations.

Methods: This systematic review was conducted using the PRISMA guideline. Literature research incorporating PubMed/ MEDLINE database for English language studies published in the last 5 years with the key terms defined using the PICO framework, which includes: Charcot, neuroarthropathy/arthropathy, neurogenic, and surgery, which were used interchangeably. A further set of keywords within the topic were then identified, including ankle, hindfoot, foot, fore-foot, and mid-foot.

Result: 221 feet undergone surgical reconstruction. Bony fusion occurred in 154 of 221 feet (71%), 79 of 128 feet (62%) in internal fixation, 47 of 58 feet (81%) in external fixation, and 29 of 34 feet (85%) in the utilization of both internal and external fixation.

Conclusion: Charcot neuroarthropathy poses many clinical challenges in its diagnosis and management. Many experts have proposed the implementation of different strategies to manage this complex condition depending on the acute and chronic phases of its nature. Delayed diagnosis can result in a severe deformity that can act as a gateway to ulceration, and infection and, in the worst case, can lead to limb loss. Further studies aimed at determining selection criteria and treatment algorithms are required for greater standardization of outcomes.

Introduction: Imperata cylindrica or cogon grass can be found throughout the world. This wild plant, which is considered a weed, has several properties including antidiabetic, antihypertensive, antidiuretic, anti-inflammatory, and antioxidant properties. This review article aimed to discuss the antidiabetic effects of I. cylindrica.

Methods: There were 12 full text articles published from 2005 to 2021 which were relevant for review. Through in vitro and in vivo studies which show that the active compounds of I. cylindrica have the potential to be antidiabetic agents.

Results: Several studies have shown that I. cylindrica has phenolic compounds, flavonoids and tannin which have antioxidant effects. Flavonoids as antioxidative properties prevent cell damage caused by free radicals reactive. By donating their hydrogen atoms or the ability to adhere metals, in the form of glucosides or a form called aglycones so that they can reduce blood glucose levels. I. cylindrica was processed as extracts or decoction.

Conclusion: It was concluded that I. cylindrica is the potential to have an anti-diabetic effect.

Background: Aging process commonly associated with multiple comorbidities such as metabolic disorders, vascular, visual, gait, balance and psycho-social problems. Atherosclerosis is one of comorbidities that could occur as a pre-existing condition in elderly with peripheral artery disease (PAD). Elderly patients associated with complex and multi-factorial medical conditions need to be addressed in a comprehensive approach. Here we report the complexity of perioperative management of an elderly with acute limb ischemia in elderly with multiple comorbidities and underlying diseases.

Case Presentation: An elderly woman, 77-year-old, was referred to emergency room due to decreased level of consciousness. There were complaints of loss appetite, inactivity, bedridden, pain, paresthesia and muscle weakness in the right lower limb. There was history of chronic hypertension and dyspepsia. Since there was a sign of right lower limb acute limb ischemia, the patient was discussed with the multi-discipline team, planned for primary amputation, and received systemic anticoagulant treatment. Due to multiple comorbidities and underlying diseases, the patient died prior to amputation surgery.

Conclusion: Surgery is not contraindication to elderly; however, from this case it shed light the needs of multi-discipline approach to decide the best treatment options for patient’s needs. Utilizing a Comprehensive Geriatric Assessment (CGA) could be an alternative to non-invasive, simple, and effective approach available in any healthcare setting.

Background: Mucopolysaccharidoses type I is a lysosomal storage disorder characterized by a deficiency of the lysosomal enzyme α l-iduronidase. It is an autosomal recessive condition with incidence of 1 case per 100 000 live births. MPS type I disorders characteristically present with dysmorphic features, growth failure, umbilical and/or inguinal hernia, a protruding abdomen, musculoskeletal disorder and cognitive impairment from an early age. The time period between the onset of symptoms and diagnosis remains prolonged and patients are still predominately diagnosed by enzyme activity tests.

Case: We reported a 7-year-old girl patient presented with stiffness and soreness in both hand. Since birth, the patient had corneal clouding and progressive vision impairment. She was unable to communicate effectively, developmental milestones delay and lost physical skills. There was no consanguineous in her parents. Radiologic finding with epiphyseal skeletal dysplasia. Confirmation of the diagnosis of MPS type I was accomplished by measuring blood spots with the MPS enzyme (MS/Ms Assay), which revealed a deficit of L-Iduronidase (0:08 uM/hr) (normal level >1.32 uM/hr) and Urinary glycosaminoglycan (GAG) concentration by DMB test showed elevated Heparan Sulfate and Dermatan Sulfate excretion in urine (7.56 mmol creatinine/L urine), 737.50 mg GAGs/L urine, 97.55mg GAGs/mmol creatinine (normal level 4.04) (1.22~8.758).

Conclusion: The combination of symptom and lack of disease awareness usually resulting in diagnostic delays. The early recognition of MPS type I is important for monitoring the chronic and progressive course of the disease and effective treatment with enzyme replacement which can decrease morbidity.

Background: CD4+ T cells deficiency generally occurs in human immunodeficiency virus (HIV) patients, leading to some infections such as pulmonary and extrapulmonary tuberculosis. A rare case of decreased CD4⁺ T cells is idiopathic CD4+ T cell lymphocytopenia, a rare and unexplained immunodeficiency syndrome with no evidence of HIV infection. In this case report, we are reporting a patient with CD4+ T cells deficiency, pulmonary tuberculosis, pleuritis tuberculosis, and meningitis with HIV test negative.

Case Presentation: A 58-year-old male was referred to the Emergency Department of Dr. Soetomo General Hospital with a gradual decrease of consciousness following six days of hospitalization at a private hospital. During hospitalization, one liter of fluid was evacuated from the right lung and analyzed, revealing tuberculosis infection. History of diabetes, hypertension, stroke, hepatitis, and cardiovascular disease was denied. The patient also never had chemotherapy or radiation treatment. Based on history taking, physical examination, and laboratory results, this patient has been diagnosed new case of pulmonary tuberculosis with deficiency CD4+ T cells and altered consciousness et causes meningitis tuberculosis with pleurisy tuberculosis. After 32 days of hospitalization with anti-mycobacterium therapy, the patient was improved and was discharged.

Conclusion: This case highlights the challenges of having the definitive cause of CD4+ T cells deficiency either active tuberculosis infection or idiopathic CD4+ lymphocytopenia. Therefore, serial analyses of CD4+ T cells are advised on the patient during the treatment with anti-tuberculosis drug.

Introduction: Lipomyelomeningocele is one of closed spinal dysraphism, inherently associated with tethered cord. Its prevalence ranges between 0.3 and 0.6 per 10.000 live births. Deterioration of bladder and bowel function often manifests before the motor and sensory function. Intraoperative neurophysiological monitoring (IONM) is often used in lipomyelomeningocele surgery to facilitate safe resection of lipomatous components and detethering of the spinal cord due to the absence of a clear boundary between the lipoma and neural placode.This case highlights the critical role of adequate IONM to reduce the complications of lipomyelomeningocele resection surgery.

Case Presentation: Here we present a 10-year-old boy with a lump over the back since birth, progressively increased in size, and with a history of urinary and faecal incontinence since one year before admission. There was also hypoesthesia on lumbar 2 spinal cord level. Physical examination of the lumbosacral region revealed a single lump measured about 4.5 x 1.9 x 3.2 cm in size, soft consistency, and immobile. Magnetic resonance imaging of the lumbosacral region revealed a lipomyelomeningocele with tethered cord protruded into the anatomical defect from sacral vertebrae S1-S4. Surgery was indicated because of the neurological symptoms and it was safely performed with the assistance of IONM. There were no postoperative complications after surgery and there was an improvement in the patients' neurological symptoms.

Conclusion: IONM in spinal surgery has been proven useful to reduce the postoperative neurological complication by providing identification of neural structures topographically and functionally, therefore, giving a warning alarm during surgery, which can be immediately responded by the surgeons.

Background: Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease that potentially attacks all parts of the human body. Despite the use of disease-modifying anti-rheumatic drugs (DMARDs), the rate of total knee arthroplasty (TKA) remains high. Critical complications such as infection, dislocation, and readmission following TKA are also reportedly high and therefore, appropriate management during perioperative period is critical. We reported the perioperative management of a patient with late RA and genu contracture underwent tenotomy.

Case Presentation: A 22-year-old male was referred to Dr. Soetomo General Hospital with a chief complaint of pain in the right and left groin. He also complained of immobilization and stiffness in both knees. He had been diagnosed with bone tuberculosis in 2014 and underwent a total knee replacement of both knees in 2015 due to stiffness and inability to walk. Radiography examination indicated erosion and loss of joint spaces in the joints of the hip, fingers, and toes. Laboratory investigation showed positive anti-mutated citrullinated vimentin (anti-MCV), confirming RA. The patient underwent tenotomy surgery and was treated with methylprednisolone 4 mg peroral daily, chloroquine 250 mg peroral daily, and natrium diclofenac peroral to reduce pain. Tenotomy was performed. Considering the disease activity, conventional DMARDs (chloroquine 250 mg peroral and low dose steroid, methylprednisolone 1x4mg peroral) were prescribed.

Conclusion: The case highlights the complexity of perioperative management of late RA and genu contracture underwent tenotomy that required multiple disciplines. Therefore, interdisciplinary collaborative team is critical to be able to achieve optimal results of the patient.

Background: Alopecia universalis is an autoimmune condition on hair follicles with the characteristics of ovoid or round-shaped hair loss (focal) that develops into multiple hair losses and is the most severe form of alopecia. The pathogenesis of alopecia universalis is unclear. However, the most accepted hypothesis is based on the immunologic factor, especially T-cell mediated autoimmune process.

Case: A 19-year-old male Indonesian complained of hair loss all over his body. Efflorescence of the whole body showed an alopecia patch. The Severity of Alopecia Tool (SALT) score showed 100%. Skin dermoscopy indicated yellow dots. The patient was given 8 mg of intraoral methylprednisolone every 8 hours and 100 mg of intraoral cyclosporine every 12 hours for four weeks and slowly tapering off. The patient experienced acneiform eruption and was topically treated with 2% sulfur lotion every 12 hours. After 51 days of observation, an improvement was found in terminal hair growth on the head, eyelashes, and eyebrows, visible growth of vellus hair on the body, and a SALT score of 40%.

Conclusion: Alopecia universalis is rare and can cause significant damage and psychological pressure to the affected individuals. Treatment with corticosteroid and cyclosporine resulted in good therapy response.

Introduction: Psoriatic arthritis is a spondyloarthropathy subtype with a broad clinical spectrum and diverse symptoms. The use of biological disease-modifying antirheumatic medications (DMARDs), such as TNF inhibitors is recommended as pharmacological therapy for PSA in cases of axial involvement and high disease activity level. Since Indonesia has the second-highest tuberculosis (TB) cases globally, and patients receiving TNF inhibitors have an elevated risk of latent TB reactivation, evaluation of latent TB before starting TNFi is necessary and challenging.

Case Presentation: A 63-year-old male psoriatic arthritis patient with bilateral hip joint osteoarthritis, bilateral knee effusions and bilateral frozen shoulder. The patient also had coronary heart disease with a history of underwent coronary artery bypass graft (CABG), diabetes mellites type 2 and confirmed latent TB. Psoriatic arthritis had high activity based on the Bath Ankylosing Spondylitis Disease Activity (BASDAI) score and Ankylosing Spondylitis Disease Activity Score (ASDAS). TNF inhibitor treatment started a month after latent TB treatment. The patient responded satisfactorily to the TNFi treatment, as demonstrated by clinical evaluation and decreased disease activity. Latent TB treatment was continued for up to six months, followed by latent TB activity monitoring during TNFi administration to prevent latent TB reactivation.

Conclusion: This case highlights the challenges in management of axial psoriatic arthritis patients with high disease activity, concomitant latent TB infection, and early extra-articular symptoms of cardiovascular disease.

Background: Cholangiocarcinoma, a malignancy of the biliary duct system, has been recognized as the second most common cause of biliary tract and primary liver malignancies. The incidence has increased in the last three decades worldwide. Percutaneous transhepatic biliary drainage (PTBD) has been considered a highly important palliative therapy for bile duct obstruction due to its high success rate and low incidence of cholangitis. However, bleeding and catheter dislodgment are still found during the procedure. This case discusses the complications of repeated PTBD stent placement as palliative therapy in a patient with obstructive jaundice due to cholangiocarcinoma.

Case Presentation: A 58-year-old female presented with a chief complaint of weakness and pain on the right side of the abdomen, particularly at the site of PTBD stent installation three days before being admitted to Dr. Soetomo General Hospital. In 2017, the patient was diagnosed with cholangiocarcinoma­ with obstructive jaundice and had undergone PTBD procedure five times during the period of July 2017 to March 2018 due to biliary leakages. Laboratory investigation indicated elevated bilirubin, decreased potassium, increased random blood sugar, increased blood urea nitrogen, high levels of the 2-hour postprandial blood glucose, and elevated HbA1c, suggesting the conditions of cholangiocarcinoma with obstructive jaundice complicated with hypokalemia, acute kidney injury and type-2 diabetes. The blood smear also indicated normochromic normocytic anisopoikilocytosis anemia and leukocytosis. The patient improved after PTBD replacement, antibiotics treatment, packed red cells transfusion, and rehydration therapy.

Conclusion: This case highlights that the complication of PTBD could occur relatively frequently and to prevent the complications in patients with post-PTBD regular medical check-up is therefore recommended. In addition, it is also critical to improve the patient knowledge on how to prevent the bleeding and to avoid the conditions that are potentially increase the chance of catheter dislodgment.