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.

Introduction: PT. X is a chemical industry with high hazards, especially those related to hazardous and toxic materials; the company also uses equipment and machines with fire or explosion hazards. Component's failure to operate is a major problem in PT. X. The specific objective of this study was to evaluate hazards and control the risks to prevent accidents and protect company assets, especially for employee safety.

Methods: The data collected is Process Flow Diagram (PFD), Material Safety Data Sheet (MSDS), and component failure data. The risk assessment for the components of Sodium Silicate Production is carried out by multiplying the occurrence measurement scale and severity measurement scale. The risk value for the unacceptable risk category is between 12 and 25, where the risk must be controlled first.

Results: This study found that the highest risk value is dissolver tank leaks, the production pump not working, and the ball valve stuck. An example of structural mitigation in the dissolver tank is to carry out routine maintenance once a month to know the material's condition and to immediately make repairs if there are signs of tank damage to prevent leakage in the tank.

Conclusions: This research proves that some hazards have not been evaluated and controlled, so there are still some failures in the production process of Sodium Silicate.

Background: The novel coronavirus disease (COVID-19) emerged in Wuhan, China, in December 2019. Since then, it has spread to 215 countries, and 42 million people around the globe are affected. The knowledge, attitudes, and practices (KAP) toward COVID-19 play a role in determining the acceptance of behavioral change measures from health authorities to suppress this pandemic status. The KAP on COVID-19 is also important among university students during the COVID-19 pandemic to mitigate the outbreak of COVID-19. Hence, this study aimed to determine the level of knowledge, attitudes and practices towards COVID-19 and its association with sociodemographic factors among nursing students of Universiti Malaysia Sabah.

Methods: A cross-sectional, questionnaire-based study was conducted among the Year 1, Year 2 and Year 3 nursing students. The questionnaire consists of four parts: 1) demographics, which surveys participants' sociodemographic information; 2) knowledge about COVID-19; 3) attitude towards COVID-19; and 4) practices relevant to COVID-19. Statistical Package for Social Science (SPSS) version 26.0 was used for data entry and analysis

Result: A total of 113 Nursing Students participated in the study. More than half of the respondents have good general knowledge and practices of COVID-19. However, only one in three respondents have positive attitudes towards COVID-19. Older age was associated with good knowledge about COVID-19 (p=0.02). Female (P=0.02) and high household income (P=0.02) has a better attitude towards COVID-19. However, no significant association between sociodemographic and practices towards COVID-19.

Conclusion: Most of the respondents demonstrate a good level of knowledge and practices towards COVID-19 but not for attitudes. Sociodemographic characteristics such as younger, male respondents and those with lower-income families have inadequate knowledge and practices towards COVID-19. Hence, health education programs such as campaigns need to be conducted to increase the knowledge and encourage adequate preventive practice towards COVID-19 should be targeted towards this group.

Background: Acute appendicitis is the most common cause of abdominal surgery. The delay of diagnosis and surgery increases the risk of perforated appendicitis, which is associated with increased morbidity and mortality. The COVID-19 pandemic has an impact on the delays in the diagnosis (time-to-diagnosis) and therapy (time-to-intervention). In this study, we aimed to analyze the profiles and characteristics of acute appendicitis patients in COVID-19 pandemic and non-pandemic periods in Indonesia.

Methods: We collected samples from all patients with acute appendicitis who visited the emergency department from November 10, 2018 – February 10, 2020 (non-COVID-19 pandemic) and March 11, 2020 – August 11, 2021 (COVID-19 pandemic). The data are secondary data taken from medical records. We collected the patient’s demographic data (e.g., age and sex), operation description, length of stay, and duration of the operation.

Results: We recruited a total of 121 patients, consisting of 56 patients during the non-pandemic period and 65 patients during the pandemic. Based on the severity, patients with grade 1 were the most common during the non-pandemic period, while patients with grade 4 were the most common during the pandemic. There was a significant difference between the severity of acute appendicitis during the non-pandemic and the pandemic (P < 0.0001). During non-pandemic periods, the majority of patients were hospitalized for 3-4 days, while during the pandemic, the majority of patients required hospitalization of up to 5-6 days.

Conclusion: There was a substantial difference in the severity of acute appendicitis patients during the COVID-19 pandemic and non-pandemic periods.

Background: The quality of a blood product is determined by collecting, processing, storing, and transporting it. When blood is stored, there will be mechanical and biochemical changes. Mechanical changes consist of morphological changes and hemolysis, while one of the biochemical changes is increased plasma potassium levels. This study aimed to determine the correlation between the hemolysis index and the storage period to potassium levels of the packed red cell (PRC).

Methods: This study was a cross-sectional study at Sanglah Hospital. The sample was taken from the tube in the PRC blood bag and then a complete blood count and potassium analysis were performed. Data were analyzed using SPSS version 25 for Windows.

Results: From 70 subjects, the median hemolysis index was 0.15% (0-1.69%), the mean storage period was 12.06±4.95 days, and the mean potassium level was 12.06±3.92 mmol/L. The Spearman test results showed a positive weak significant correlation between the hemolysis index and potassium levels (r=0.360; p=0.002). The Pearson test results also showed a positive weak significant correlation between the parameter of the storage period and potassium levels (r=0.357; p=0.002).

Conclusion: There was a positive weak significant correlation between the hemolysis index and the storage period to potassium levels of the PRC.

Introduction: One serious effect of knee osteoarthritis (OA) is falling. Some predictors caused its vulnerability, one of which was fear of falling. However, few studies investigated how fear of falling leads to falling among the elderly. This study analyzed the fear of falling towards falls incidence among knee OA patients in Malang, and the results of this study might have a significant recommendation for the geriatric fall prevention system policy in Indonesia

Methods: This is a cross-sectional study with 53 participants recruited using the purposive sampling technique from Puskesmas Rampal Celaket and Posyandu Lansia Samaan Malang from March-April 2021. Measurements were the Falls International Efficacy Scale (FES-I) to assess fear of falling, the John Hopkins Grading Scale to measure fall incidence, and the self-reported sociodemographic questionnaire. Data analysis used were the Chi-Square test, Independent T-test, and multivariate logistic regression to analyze significant predictors of falling.

Results: From the bivariate analysis, it was found that the falling group tends to have a higher fear of falling than the non-falling group (34% and 1.9%, respectively). For BMI, the falling group tends to have a higher BMI than the non-falling group (27.2±2.8 and 25.7±3.9, respectively). While multivariate analysis showed that only fear of falling has a significant effect on falling incidence among the elderly (p<0.05), with participants having the risk 2.32 times (OR=2.32; 95%CI= 0.96-4.87) of falling compared to others.

Conclusion: As there was a significant positive correlation between fear of falling and falling incidence among knee OA patients, thus it gives a significant recommendation for the Health Department to design a fall prevention program for the elderly, focusing on managing its predictor.

Introduction: Hospitals must provide the best service to patients. The best services include speed in service, being on time, and being safe from medical errors. The best service to patients is to provide electronic medical records. Electronic medical records contain social data and patient medical data. The advantages of medical records are data stored in structured files, timely filling, data can be recalled at any time, patient confidentiality, and patient safety. This study aims to design electronic medical records with Clinical Decision Support System (CDSS) to prevent the interaction of drug content in the outpatient department.

Methods: General background of the research is the design of electronic medical records with a clinical decision support system to prevent interaction of drug content for outpatient Departement. The design included: Business Process, Data Flow Diagram (DFD), and Entity Relationship Diagram. Five doctors, two nurses, and a pharmacist assistant were respondents. Qualitative data from FGD were analyzed by transcripts looking for similarities or differences, finding themes, and developing categories. The Design of Electronic Medical Record with Clinical Decision Support System (CDSS) was designed based on paper forms and the Result of FGD.

Results: Electronic medical records were designed according to the users' needs in the outpatient department. User requirements had been taken by Focus Group Discussion (FGD). User requirements about Electronic Medical records included: Infrastructure Availability, Software (open source and web application because it was easy to develop according to users' needs, and training on electronic medical records. There are steps to designing electronic medical records: Business Process, DFD, ERD, and Data Dictionary.

Conclusion: The design of electronic medical records with CDSS in the form of drug content interactions is a novelty that has the potential to be applied. Implementation of electronic medical records can prevent medical errors and support patient safety.

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.

Introduction: Customer relationship management (CRM) is a strategy hospitals can use to realize patient-centered care. The study was based on the low interest in inpatient visits by company guarantees, where only 11.4% of employees used inpatient facilities at Ciputra Mitra Hospital (CMH). This study aimed to develop an effort to increase inpatient visits by company guarantees at CMH Banjarmasin.

Methods: This study was conducted on 95 respondents from company customers. Of the 95 customers, they are divided into actual customers, namely those who have used inpatient services, as many as 58 people and potential customers who have not utilized as many as 37 people. The data is processed by classifying some between actual and potential customers and processed descriptively from several variables, including Satisfaction, Interact and Loyalty.

Results: This study informs that the low interest in visiting is strongly influenced by customer knowledge regarding the company's cooperation with hospitals and services following customer needs. The actual customer differentiation is mostly just first-timers and repeat customers, while the rest are prospects who have not taken advantage of the services at CMH. The interaction of the hospital with partner company customers at CMH influences satisfaction with a significance of <0.001, while the resulting patient satisfaction influences loyalty with a significance of <0.001, thereby increasing customer loyalty.

Conclusion: Based on this study, most customers were prospective customers who had never used inpatient services. The service experience felt by customers is the same as other customers, while customer loyalty to CMH is higher than customer loyalty to other hospitals.

Introduction: There is no much information on how admission rates of non-coronavirus disease 2019 (COVID-19) diseases altered after two years of COVID-19 pandemic. The aim of this study was to determine the pattern of ischemic stroke admission rates within the two years of the COVID-19 pandemic in Indonesia.

Method: A cross-sectional retrospective study investigated the admissions data of ischemic stroke was conducted at a tertiary hospital in Indonesia between January 2019 and December 2021. Ischemic stroke patients aged over 18 years old were identified using the ICD-10 I63 code. The data was accumulated every month and analyzed descriptively. We also analyzed the admissions data of ischemic stroke patients with COVID-19 and in-hospital mortality was calculated.

Results: There were 2,710 ischemic stroke patients treated between 2019 and 2021 of which the number decreased from 1535 patients in 2019 to 730 in 2020 and only 445 cases in 2021. During 2019-2021, a total of 777 patients (28.67%) died during hospitalization; the most was in 2021 (33.3%). There is a consistent downward trend in ischemic stroke admissions during the COVID-19 pandemic with the monthly average admissions decreased 52.4% in 2020 compared to 2019 and 38.9% in 2021. Despite that, the mortality rate of ischemic stroke patients in the hospital increased from 26.5% in 2019 to 30.4% in 2020, and 33.3% in 2021. The number of ischemic stroke patients coinfected with COVID-19 was 3.5% (26/730) in 2020 and 8.1% (36/445) in 2021. Of all 62 ischemic stroke cases with COVID-19 in 2020-2021, 36 died yielded 58.1% in-hospital mortality rate.

Conclusion: The decreased admissions and the increased mortality rate of ischemic stroke patients in particular those coinfected with COVID-19 during the first two years of pandemic should draw government attention to the necessity of improving stroke managements in Indonesia.

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: 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: 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.

Purpose: The implementation of online learning during Covid-19 presents challenges especially for nursing education. Nurse students during online learning did not receive enough opportunities to learn clinical skill.  Blended learning becomes an alternative in nursing education during Covid-19 pandemic because it offers both face-to-face and online learning.

Participants and methods: The participants of the current study were nurse students in nursing education university in Bali. 105 nurse students were invited to join blended learning program. After blended learning program, they were asked to fill an online questionnaire. 10 students were also invited to join interview.

Results: The results confirmed that students are satisfied with the interaction (M=3.77, SD=.783), instruction (M=4.04, SD=.794), instructor (M=3.88, SD=.685), and course management (M=4.06, SD=.657) of blended learning implementation. However, in terms of technology the students are neither satisfied nor dissatisfied (M=3.41, SD=.800) with blended learning program.

Conclusion: This study concluded that blended learning could be used as an alternative teaching and learning approach for nursing education especially in Covid-19 pandemic era.

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.

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.

Introduction: The global injury death rate is 1.2 million in the world. Airway, breathing, circulation, disability, and exposure can be used for all emergencies with a systematic approach for critical and injured patients. However, not many people understand and are not skilled in doing initial aid handling injured patients. This study aims to analyze the factors that influence the ability in the initial treatment of injured patients with the airway, breathing, circulation, disability, and exposure approach to the community.

Methods: This study used an observational analytic design with a cross-sectional approach. The population is all ordinary people, with a sample size of 110 people taken by simple random sampling. The independent variables are the factors that affect the ability, namely age, education, and experience factors. The dependent variable is ability. Data analysis used linear regression p-value = 0.001.

Results: Research shows that age, gender, and knowledge affect the ability to handle injured patients, so all factors have a significant effect on ability. In general, research was conducted to analyze the factors that affect the skill level in handling injured patients with the airway, breathing, circulation, disability, and exposure approach to the community. The airway, breathing, circulation, disability, and exposure approach proves an ability in the initial treatment of injured patients.

Conclusion: The factors of age, gender, and knowledge affect the ability to handle injured patients. Following that, the BLS guideline 2020 effectively improves the ability for daily emergency management. For health workers, this method is very helpful in reducing morbidity and mortality.

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: 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.

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: Many pregnant women and their families are lack to carry out the examination to detect earlier about high-risk pregnancies. Family empowerment models can improve the ability of families to early detection of pregnancy during the COVID-19 pandemic. This study aims to analyze the effectiveness of the family empowerment model on the ability to detect early pregnancy at risk during the COVID-19 pandemic.

Methods: This study used an explanatory survey with a cross-sectional study approach and interventions of the family empowerment model on early detection ability of risk pregnancy. Sampling using the Probability sampling method with simple random sampling, a sample size of 100. Independent variables are interventions of the family empowerment model, while dependent variables of early detection ability of risk pregnancy during the covid-19 pandemic. Data collection instrument using questionnaires. The research data were analyzed using Structural Equation Modeling (SEM) based on variance or SEM-based components, known as Partial Least Squares (PLS).

Results: The influence of personal factors, resource factors, cognitive behavioral factors, interpersonal factors, filial values, and commitments showed t-statistics > 1.96 and p-values <0.05. This means that there is a significant effect on all of these variables on family empowerment. The resulting coefficient is positive 0.080 so it can be said that better family empowerment tends to increase the ability of families in early detect high-risk pregnancies. That means there is a family empowerment model that makes participants feel more responsive, and alert, pay attention to self-care, and immediately check with health workers if there are danger signs.

Conclusion: After being given the family empowerment model intervention almost all respondents were good in the ability to detect early pregnancy at risk during the COVID-19 pandemic contributed to increasing family involvement in intensive care for pregnant women to prevent pregnancy complications.

Background: The lack of physical activity and high sedentary behavior is among the main causes of non-communicable diseases at a young age. Moreover, exergaming (EXG) is a type of exercise that integrates different modes of digital games into physical activities. Since several young men spend a significant amount of time on sedentary games, it is believed that replacement with exergames will improve physical activity levels. Therefore, this study was carried out to evaluate the effectiveness of exercise by measuring blood lactate (BLa) and VO_2max in non-athlete healthy young men. This study aims to analyze the effect of exercise using Nintendo^TM switch "Fitness Boxing 2" on BLa and VO_2max in non-athlete healthy young men.

Methods: Experimental series with repeated measures on healthy young men of 20-40 years by the health worker at Dr. Soetomo Hospital Surabaya. This research was based on the exercise using Nintendo Switch^TM "Fitness Boxing 2" with the hard or high-intensity mode at a duration of 38 minutes consisting of warm-up, core training which included variations of Straight, Hook, and Uppercut strokes, and cooling down three times a week for one month. The BLa examination was carried out 3 times before and after exercises I, VI, and XII during the exercise. VO_2max was examined using the 6-minutes walking test based on the Nusdwinuringtyas formula one day before and after exercises I and XII, respectively.

Results: This study included 13 healthy young men, with an average age of 30.77± 3.632. The mean BLa before and after exercise was 2.03 and 3.02, respectively, with an increase of 0.99. The three p-values ​​were carried out by the Wilcoxon Signed Rank Test, where a p-value = 0.001 was obtained, indicating a significant increase in post-exercise BLa levels. The VO_2max before and after treatment obtained an average of 23.39± 2.82 (mL/kg/minute) and 30.69 ± 4.95 (mL/kg/minute), respectively. Furthermore, the comparison of VO_2max examination before and after treatment with an average of 7.30±4.04 (mL/kg/min) obtained a significant difference with a p-value = 0.000.

Conclusion: The effect of high-intensity exercise using Nintendo Switch^TM "Fitness Boxing 2" increases the BLa levels and VO_2max in non-athlete healthy young men.

Introduction: Preterm birth is delivery that occurs prematurely, and is still a global problem because it is the largest contributor to perinatal mortality and neonatal morbidity, both in the short and long term. This study aims to investigate the role of psychosocial status, in the form of degrees of depression, anxiety, and stress in pregnant women as evidenced by the expression of the enzyme 11β Hydroxysteroid Dehydrogenase-1 (11β HSD-1) in amnion in relation to premature activation of maternal-fetal hypothalamic-pituitary-adrenal (HPA) axis as a risk factor of preterm labor.

Method: Case-control study, comparing preterm and term groups (n=54) who underwent labor in Obstetrics Emergency Room, Sanglah Central General Hospital Denpasar, Bali. The degree of depression, anxiety, and stress was assessed using the Depression, Anxiety, and Stress Score (DASS 42) questionnaire. Amnion expression of 11β HSD-1 was examined semi-quantitatively using immunohistochemistry methods. An independent T-test and Mann-Whitney test were performed. Cut off of 11β HSD-1 expression was determined using Receiver Operating Characteristic (ROC) curve. Bivariate analysis between labor status and degrees of depression, anxiety, and stress, as well as the expression of 11β HSD-1 with simple logistic regression test and multivariate analysis of all variables with multiple logistic regression test was used to estimate odds ratio (OR) and 95% confidence interval (95% CI).

Results: Depression (OR = 5.045; 95% CI = 1.302 – 19,559; p = 0.019) and stress (OR = 14.943; 95% CI = 1.860 – 120.064, p = 0,011) is a risk factor for preterm delivery. Whereas for the anxiety variable, there was no significant difference between the case and control groups in bivariate analysis (p = 0.125) with OR = 1.647; 95% CI = 0.870 – 3.117. Analysis of 11β-HSD-1 expression and preterm delivery showed a statistically significant difference between the case and control groups, with p = 0.013 (OR = 4.156; 95% CI = 1.312 – 13.169). Furthermore, in multivariate analysis showed that stress was statistically significant (p = 0.034) with OR = 11.354; 95% CI = 1.209 – 106.651 as a risk factor for preterm delivery.

Conclusion: The abnormal degree of depression and stress based on the DASS criteria and high expression of 11β-HSD-1 is a risk factor for preterm delivery.

Introduction: The COVID-19 pandemic has fundamentally altered how society functions, including the conditions under which health professionals work. Nurses, who are at the forefront of providing care to COVID-19 patients, spend extended periods in close contact with infected patients. These stressful conditions may increase nurses' risk of developing depression and other mental health problems. This study aimed to explore the experiences of Indonesian nurses working in two COVID-19-designated hospitals that provide direct patient care.

Methods: The qualitative phenomenological design was used in this study. Between June and December 2020, 15 nurses at two COVID-19-designated hospitals participated in in-depth telephone interviews, and four nurses were selected to participate in a focus group discussion for data triangulation. Following that, data were analyzed according to Colizzi's phenomenological method.

Results: The data were categorized into four themes: 1) Responsibility to maintain nursing professionalism; 2) Challenges in caring for COVID-19 patients; 3) Support in caring for COVID-19 patients; 4) Increase insights while caring for COVID-19 patients. These themes indicate that, while nurses felt supported by hospital administration and close family members, they were also affected by the high workload, which resulted in behavioral changes associated with mental illness.

Conclusion: These findings shed light on the benefits and drawbacks of nurses caring for COVID-19 patients. These findings can serve as a starting point for hospital administration in developing policies and systems that promote nursing staff well-being.

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: Coronavirus 2 (SARS-CoV-2) is a syndrome of acute respiration that is serious like corona acid ribonucleic detected, made separation and identification in pneumonia sick patients in Wuhan, China in December 2019 (WHO, 2020). Timor-Leste on May 1, 2020, 24 cumulative cases was confirmed, 16 cases recovered, 12 cases are still being treated, and 12 patients experienced psychological pressure from patients and health professional. This study aimed to determine the knowledge of nurses; nursing service and the psychological influence of nurses after providing care for Covid-19 patients.

Method: Qualitative research with a phenomenological approach has been used in this study, ten nurses who have worked serving Covid-19 patients participated in this study, and data was collected using interview guidelines, voice recorder, deep-interview, data analysis techniques by organizing data, grouping, categorical data, topic and answer formulation, data assessment and writing the results.

Result: The majority of nurses understand and apply Covid-19 prevention, but some are confused the cause. Have not carried out nursing care according to the standards of the International Counsel of Nursing (ICN) and the Timor-Leste Nursing Association, as (assessment, diagnosis, intervention, implementation, and nursing evaluation), reasoned: new job, no format, less manpower, no orientation from senior, emergency time. The majority experienced psychological effects after providing care to the Covid-19 patient.   

Conclusion: This study concluded that nurses understand Covid-19, the nursing care implementation is not yet based on ICN and ETNA standards and after returning home the nurses experienced psychological effects. 

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: Analysis of health workers' anxiety in providing patient services towards the COVID-19 variant has never been done well. Therefore, this study analyzes factors that affect anxiety among health workers because it has the potential to interfere with health services. The purpose of the study is to analyze the factors that affect the prevalence of anxiety among health workers in providing patient services variant of COVID-19.

Methods: Participants involves health workers who handle patient variant of COVID-19. The data collection was approved by the research ethics committee of Surabaya Islamic Hospital A.Yani. Data source taken in Surabaya and surrounding areas in June 2021 namely N= 300-400 data breeding techniques is purposive sampling, research instrument is in the form of questionnaires by sharing to social media using a google form, data in the univariate analysis is done descriptively to see the respondents' characteristics and bivariate analysis is used to analyze factors affecting anxiety in statistical tests used is regression ordinal.

Results: The results of statistical analysis obtained factors that affect anxiety, namely: female sex obtained = 0.02), age 30 years obtained results= 0.00, working in public health center = 0.08, nursing profession= 0.25, unmarried= 0.00, works outside Surabaya= 0.00, has a child and 2-3 children= 0.00.

Conclusions: The study was conducted to analyze the prevalence factors of health care workers' anxiety in providing care for patients with COVID-19 variants and how the anxiety management strategies that resulted in this greatly contributed to the condition of health workers with psychological problems, namely anxiety.

Introduction: High heels are still the top choice of women's footwear and have an aesthetic function. A previous study showed that high heels were the potential to give musculoskeletal disorders. This study aimed to find the presence of musculoskeletal disorders and the factors influencing the routine and long-term use of high heels amongst bank employees.

Methods: This is an observational study with a cross-sectional design. The research study participant collection was carried out in November - December 2020 in several Bank branches; 233 participants were obtained. Each participant was given a questionnaire about musculoskeletal disorders and the factors influencing high heels used.

Results: It was found that there is a relationship between body mass index (BMI), shoe height, and the length of time used per week for the pain Visual Analogue Scale (VAS) in the use of high heels. However, it was found that there is no relationship between the type of shoes and the pain VAS using high heels.

Conclusion: The higher BMI, shoe height, and the longer time using high heels per week contribute to the increasing pain VAS amongst high heel users.

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: 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:  Betel leaf is very popular in Asia and known to have a function as traditional medicine. And is often referred to as the "Golden Heart of Nature". This is because the betel leaf has an effect such as antimicrobial, antiviral, radioprotective, antioxidant, antiseptic, bactericidal, anti-inflammatory, antiallergic, wound healing, antiplatelet, antibacterial, antifungal, and immunomodulatory activity. Nutraceutical nano-betel leaf extract contains rich in minerals, vitamins, antioxidants, phenolic compounds, and essential oils. Effectively protects the mouth from pathogens. This research aims to review the nutraceuticals of nano-betel leaf extract to prevent COVID-19 and oral cavity disease.

Methods:  This systematic review study was conducted through six steps: (1) framing the questions (based on theory); (2) Run a search (on Scopus, Google Scholar, EBSCO, ProQuest, and Science Direct publishing articles from 2020 to 2022); (3) Determine the relevant research; (4)  Determine the articles come from diverse backgrounds; (5) Extraction of data from individual studies; (6) Synthesis of results using the narrative method.

Results:  Betel leaf contains nutrients for oral health, immunomodulators, and COVID-19, namely protein, amino acids, vitamins A, B, C, and K, as well as minerals such as Mg, K, Ca, Fe, I, P, Zn, essential oil (eugenol, hydroxylchavicol, allylpyrocatechol, quercetin, etc). Betel leaf nano extract has a significant role as antioxidants, anti-inflammatory, antimicrobial, and antivirus, which act as anti-oral cavity disease and anti-COVID-19. Betel leaf nano extract has a significant role in curing various oral cavity diseases related to COVID-19, including fungal infections, toothache, conjunctivitis, re-current HSV, oral ulcerations, xerostomia or decreased salivary flow, and gingivitis.

Conclusion:  Betel leaf nano extract has a significant role in curing oral cavity disease and COVID-19. It is recommended that research into the oral disease and COVID-19 drugs combined with viable ingredients substances from betel leaf.

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.

Introduction: The allocation of village funds to the health sector focused on reducing nutritional problems and involving the village in controlling non-natural disasters caused by COVID-19. The study aimed to analyze the implication of the village fund toward public health performance in the pandemic era.

Methods: Ecological analysis was conducted using secondary data from the East Java Health Profile 2020. The sample was 29 districts of East Java, where all the villages receive village funds. Apart from village fund utilization as the dependent variable, the independent variable consists of nutritional status, active Posyandu, case of COVID-19 and recovery rate of COVID-19. Data were analyzed by univariate and bivariate. The bivariate analysis was performed using the chi-squared test.

Results: Undernourished and wasting were silent health burdens in the pandemic. The pandemic also made the active Posyandu is lower. High attention to Kediri dan Jombang was grouped to vulnerable health areas. Statistically, no correlation between the village fund utilization with public health improvement in the pandemic era

Conclusion: Although there is no statistical correlation, nutrition issues and the impact of using village funds on health must be a concern. An in-depth evaluation needs to be carried out on the use of village funds to get clear implications for public health

Introduction: The new daily activities undertaken by students at the Islamic boarding school are a time of change, in terms of individual religiosity and social interaction. This is because not all new students have the experience of living in boarding schools. The purpose of this study was to analyze the relationship between religiosity and social support with student adaptation in Islamic boarding schools.

Method: The design of this study was cross-sectional. The sample was 102 new students who were living in a boarding school for less than a year which were taken by simple random sampling. The independent variables were religiosity and social support, the dependent variable was student adaptation. The research instrument used a questionnaire. Data were analyzed using the Chi-Square test and Binary Logistic Regression test

Results: The results of the Chi-Square test analysis showed that p-value = 0.042 and p-value = 0.021, which means that there is a significant relationship between the two variables. Meanwhile, the results of the binary logistic regression analysis showed that p-value = 0.220, which means that 22% of the student adaptation variable can be explained by the variable of religiosity and social support.

Conclusions: The higher the level of religiosity and social support, the higher and easier the students will adapt. It is hoped that the Islamic boarding school caretakers will be able to carry out mentoring activities for new students so that it can make it easier for students to adapt.

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.

Introduction: Healthcare is a complex system that requires collaboration across health professions. However, a plethora of reports has identified poor communication and collaboration within healthcare teams which could lead to patient safety issues. Interprofessional education (IPE) is an educational strategy to promote communication and collaboration between healthcare professionals. Despite knowing the readiness among students, opinions among faculty members regarding the need for IPE at UPH (Universitas Pelita Harapan) have yet to be examined despite the important roles of both students and faculties in developing an IPE curriculum. This study aimed to investigate the readiness among medical and nursing faculty members in establishing an IPE curriculum at UPH.

Methods: This study applied a quantitative study design using the Readiness for Interprofessional Learning Scale (RIPLS) by Parsell and Bligh (1999) which was translated to Indonesian and tested for its validity and reliability. The translated RIPLS questionnaire was administered to a total of 60 participants which consisted of 30 nursing and 30 medical faculty members. Subsequently, both descriptive and Mann-Whitney statistical analyses were conducted.

Results: Findings revealed a statistically significant difference between the IPE scores (RIPLS) of nursing faculties and medical faculties  (U = 652, z = 3.028; p = 0.012, r = 0.390). This demonstrates that the nursing faculty members (Median 4.30) indicated a higher level of readiness or more positive attitude towards IPE compared to the medical faculty members (Median 4.07).

Conclusions: This study highlights that faculty members have a positive attitude or readiness toward IPE, with nursing faculties indicating higher levels of readiness than their counterparts in the medical faculty. Further exploration using a qualitative method is also important to understand the faculty members’ readiness for IPE as well as the commitments of faculty members and leadership on delivering IPE.

Introduction: Noni, which has the scientific name Morinda citrifolia L., is a plant often found in Indonesia and has many properties used for generations. However, this noni fruit has potential toxicity that needs to be studied further. This study aimed to determine the phytochemical compounds and determine the toxicity of the ethanol extract of noni fruit using the Brine Shrimp Lethality Test (BSLT) method.

Methods: The research was conducted at the Chemistry Laboratory, Universitas Nahdlatul Ulama Surabaya. This research includes experimental research. Artemia salina L. larvae aged 48 hours were put into a test tube containing a solution of noni fruit extract with concentrations of 10, 50, 100, 250, 500, 750, and 1000 ppm, then observed after 24 hours.

Results: In the phytochemical screening results, noni fruit ethanol extract contains tannins, saponins, flavonoids, and terpenoids. The test results obtained an LC50 value of 17.78 ppm, which indicates that the ethanol extract of the noni fruit is toxic.

Conclusion: The ethanol extract of the noni fruit contains tannins, saponins, flavonoids, and terpenoids and has toxicity to Artemia salina L. larvae. It can be concluded that the ethanolic extract of noni fruit has the potential as an anticancer.

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.

Background: As part of the surgery, sternotomy is a common technique to expose the underlying organs, allowing surgeons to explore the targeted organ. Despite the benefits offered, it has several considerable complications; one of them is wound healing defect. The impairment of sternal wound healing after sternotomy could be superficial and/or deep. This condition is influenced by many factors, including diabetes mellitus, obesity, and other comorbidities. These anomalies will affect the normal healing process of the bone and other connective tissue, particularly after a major invasive event, such as in sternotomy. This study aimed to review the outcome of sternum healing among diabetics that underwent heart surgery with a sternotomy approach.

Methods: Works of literature reviewed in this study were obtained from Pubmed and Google Scholar databases starting from 1992 until April 2022. The keywords used were ‘sternal wound healing’, ‘cardiac surgery’, and ‘diabetes mellitus’. An advanced search based on the exact phrases was conducted on Google Scholar. Gathered kinds of literature were then selected based on relevancy.

Results: The majority of articles reviewed were observational, and most of them had CABG as a part of open heart surgery, followed by valvular and aortic surgeries and others. The incidence of impaired sternal healing and other complications (superficial and/or deep) was more commonly seen among patients with diabetes. Most studies also reported a significant correlation between DM and the incidence of impaired sternal healing, suggesting that DM was a significant predictor of it.

Conclusion: Diabetes mellitus is a medical condition that must be taken into account among the candidates for open heart surgery, particularly if it is poorly controlled. The Hyperglycaemic state experienced by the patients will lead to multiorgan damage and immunological dysfunction that could affect the healing process of the sternum.

Background: Targeting PCSK9 by maintaining hemodynamic shear stress stability has been shown in several studies to reduce LDL-C, arterial plaque formation, and PCSK9 expression in atherosclerotic cardiovascular disease. Genome editing with CRISPR-associated regularly interspersed short palindromic repeats (CRISPR/Cas9) have therapeutic potential for atherosclerotic cardiovascular disease. This study aims to evaluate the role of CRISPR/Cas9 in targeting PCSK9 as an effective therapeutic and long-term effect on atherosclerotic vascular disease.

Methods: The method used in this study summarizes the article by looking for keywords that have been determined in the title and abstract. The authors used official guidelines from Science Direct, PubMed, the American College of Cardiology, Google Scholar, and PERKI to select full-text articles published within the last decade, prioritizing searches within the last five years.

Results: CRISPR/Cas9 deletion of PCSK9 in mouse models reduces LDL-C, Plaque accumulation in the arteries, and PCSK9 expression. Furthermore, CRISPR/Cas9 deletion in PCSK9 saves the stability of Hemodyanimc shear stress to control the PCSK9 expression that causes Atherosclerotic cardiovascular disease.

Conclusion: PCSK9 targeting by CRISPR/Cas9 deletion effectively reduces LDL-C, plaque buildup in the arteries, and PCSK9 expression. However, more research is needed to determine its side effects and safety.

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.

Introduction: Recent studies have shown that in HIV patients, the incidence of acute myocardial infarction is up to two times higher than in people who are not infected with HIV. HIV patients presenting with the first episode of the acute coronary syndrome are, on average, a decade younger than the general population, more frequently in men and current smokers.

Case Report: We report a case report of a 33-year-old man with a diagnosis of anteroseptal STEMI and recent HIV on first-line ART, a combination of zidovudine 300 mg and lamivudine 150 mg, plus efavirenz 600 mg. The patient had typical angina complaints and had risk factors, namely smoking and a history of dyslipidemia. Patients were treated according to acute coronary syndrome guidelines, given DAPT, heparinization for five days, statins, anti-ischemia, ACE-I, and DCA-PCI. The DCA-PCI result in this patient was CAD 1 VD with 1 DES installed in the proximal LAD (complete revascularization). The patient was discharged from the hospital after seven days of treatment. Prognosis in these patients is still quite good, but preventing recurrent myocardial infarction needs risk factors and control for successful myocardial infarction therapy and ART.

Conclusion: Special attention should be given to the risk of myocardial in HIV patients. Early diagnosis and prompt treatment could significantly lower mortality and improve patients' quality of life.

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.

Introduction: Guillain-Barre syndrome is the most common and most severe acute paralytic neuropathy with any clinical features. Some patients present with the neurogenic bladder in which bladder dysfunction happens, resulting in urinary retention. The delayed diagnosis often leads to some complications, including bladder perforation. Vesico-peritoneal is lined by epithelial cells that communicate between the peritoneal cavity and the urinary bladder. In this location, can occur a fistula called vesico-peritoneal fistula. This type of fistula leads to peritonitis with high morbidity and mortality.

Case description: A 22- year- old female was admitted to a neurologist with lower extremities paralysis. The surgery department then consulted the patient for suspicion of generalized peritonitis. The patient had a history of taking medication for Guillain-Barre syndrome and complaint of abdominal pain, bloating, nausea, hematemesis, and hematuria. The abdominal radiograph showed pneumoperitoneum. The patient received antibiotics and underwent exploratory laparotomy. Exploratory laparotomy revealed vesico-peritoneal fistula. In this case, the defect was achieved by dissection of the fistulous tract and the primary closure of the bladder. Postoperative follow-up indicated no sign of complication.

Conclusion: Fistulation between the bladder and peritoneal in GBS could cost high morbidity and mortality. Dissection of the fistulous tract and primary closure of the bladder could overcome this condition without any concerning complications.

Background: Diabetes mellitus (DM) is characterized by hyperglycemia due to a defect in insulin secretion, action, or both. Immunocompromised individuals such as those with DM tend to suffer from skin disorders, including crusted scabies (Norwegian scabies). However, studies regarding the incidence of Norwegian scabies are still limited. This article reports a case of an elderly diabetic patient suffering from crusted scabies.

Case Presentation: A 67-year-old male patient was referred to Dr. Soetomo Hospital with sepsis caused by suspected skin infection, hypertension, and type 2 DM. The patient presented with a chief complaint of recurrent skin diseases throughout the body and itching for the past three years. The itching became severe in the last three weeks prior to the hospital admission. The patient had a medical history of diabetes, tuberculosis, hypertension, and arrhythmia. Based on our assessments the patient was diagnosed with crusted scabies, septic shock, sepsis, pneumonia, pulmonary tuberculosis, hypoalbuminemia, type 2 DM, and erythroderma. The patient received oxygen, antibiotics, norepinephrine, albumin, ranitidine, metoclopramide, NovoRapid, ventolin nebules, rehydration, topical keratolytic cream, and scabicidal cream as therapies. However, on the 3^rd day of the treatment, the patient suffered from type 1 respiratory failure and passed away the next day due to septic shock.

Conclusion: We reported a diabetic male patient suffering from crusted scabies, accompanied by pneumonia, pulmonary tuberculosis, hypoalbuminemia, and type 1 respiratory failure. Secondary infections had been developed at the time of presentation. Therefore, establishing an early diagnosis of Norwegian scabies will help prevent the disease's progression.

Background: Toxic Epidermal Necrolysis (TEN) are rare but potentially life-threatening disorder. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the cause of COVID-19 disease with various clinical manifestations. Two cases of TEN were reported in pediatric patients. The causal relationship between COVID-19 infection and vaccination against TEN has not been fully understood.

Case presentation: This study reports a case of a child with COVID-19 who was admitted to a pediatric hospital ward with TEN which occupies > 30% of total body surface area, and one case that suffered from TEN due to COVID-19 vaccination. All patients received IVIG 0.5 g / kg / day for 3 consecutive days.

Conclusion: The child was treated with intravenous immunoglobulin with a good outcome and clinical improvement.

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: 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.

Background: Deep Aggressive Angiomyxoma (DAA) is a rare benign tumor with about 250 cases reported worldwide. It was first reported in 1983. This tumor is commonly found in women of reproductive age, with the highest incidence in the 3rd and 4th decades of life. DAA is most often found in the pelvic, genital, inguinal region, or perineum.

Case Report: Nulligravida woman 52 years old, with enlargement of the vulva that had felt since ± 20 years ago. A mass was found on local examination of the right vulva with a size of ±50x40x10cm, which was supple, mobile, and with no pain. Enlarged inguinal lymphadenopathy was also observed. MRI showed a well-defined lesion at the right vulvar region (which visualized the size of ± AP 14.95 x LL 31.80 x CC 15. 3 cm) with the signal intensity hypointense on T1WI, hyperintense on T2WI and FatSat, restricted on DWI, with no enhancement was seen. A wide excision was conducted, and post-excision measurements showed a right vulvar mass size was 50x42x10cm, with 14.8kg in weight.

Conclusion: DAA is a rare benign tumor that can disturb patients. The nature of the tumor should be evaluated carefully using radiological and pathological approaches. A wide excision can remove the tumor completely, but control and follow-up are mandatory to evaluate the completeness of the procedure and monitor for any relapse.