Introduction: Hypertension is a chronic disease that is the main concern especially in the middle of the Covid-19 pandemic, where hypertension is a dangerous comorbid disease for people infected with the Covid-19 virus. Self-regulation is an important thing that hypertension sufferers must have to help control their blood pressure. Patients with hypertension who can regulate themselves will affect their acceptance of chronic diseases suffered. The purpose of this study was to analyze the relationship of self- regulation to self-acceptance of hypertension sufferers during the Covid-19 pandemic in Indonesia.

Method: The type of research is correlational with a cross-sectional research design. The sampling technique is probability sampling with a random sample size of 100 patients with hypertension in Indonesia. The research instrument was in the form of Self-Regulation and Self Acceptance Scale-Early Blindness (SAS-EB) questionnaires. Data analysis was performed with the Spearman Rank statistical test with a significant p <0.05.

Results: The results showed that almost half of respondents had high self- regulation (40%) and half of the respondents had a high level of self-acceptance (47%). Spearman Rank statistical test shows the result of p = 0,000 and the level of strength is very strong 0.795 and its value is positive.

Conclusion: There is a very strong relationship between self-regulation and self-acceptance of hypertension sufferers during the co-19 pandemic in Indonesia. It is expected that health workers play a role in providing health education about the treatment of hypertension especially during the co-19 pandemic, as well as increasing social support that can help hypertension sufferers in treating their diseases.

Background: Nurses are responsible for ensuring the safety of their patients. It has long been known that weariness and sleepiness can lead to mistakes that jeopardize patient safety. The researchers wanted to see if there was a link between exhaustion and excessive daytime sleepiness among nurses.

Methods: The study used a cross-sectional correlational design with 36 nurses from a Tertiary Eye Care Hospital as participants. Convenience sampling was used to collect data. The Epworth Sleepiness Scale (ESS) and the Three-Dimensional Work Fatigue Inventory (3D-WFI) were used to collect data. Pearson's correlation coefficient was used to calculate the correlation between WFI and ESS.

Results: The statistical analysis with ratio data between exhaustion and Excessive Daytime Sleepiness, we obtained that p 0.000 with Pearson correlation and suggests that there is a strong link between fatigue and excessive daytime sleepiness (EDS) among hospital nurses.

Conclusions: Fatigue and daytime sleepiness are significant occupational health concerns for hospital nurses. According to this study, nurses should optimize their work hours to avoid daytime sleepiness and maintain circumstances to avoid excessive sleepiness, which can lead to adverse outcomes.

Background: Chemotherapy-induced neutropenia (CIN) is chemotherapy's most frequent myelosuppression effect. Previous studies have examined static prognostic factors to assess dynamic neutrophil changes in each cycle. This study focuses on post-chemotherapy monocytopenia as a more dynamic predictor of CIN. This research aimed to know whether post-chemotherapy monocytopenia can be used as a predictor of CIN in breast cancer patients undergoing the chemotherapy cycle.

Methods: This research used a prospective and a retrospective longitudinal cohort of breast cancer patients undergo a CAF regimen at Sanglah Hospital Denpasar. The research was conducted on 30 samples for three cycles (90 total cycles). Monocyte data is taken in the first week (days 4 to 9), and neutrophil data is taken in the second week (days 10 to 16).

Results: From statistical analysis with interval data scale, we obtained that p 0.001 with Pearson correlation 0.613 for cycle 1, p 0.001 with Pearson correlation 0.611 for cycle 2, and p 0.003 with Pearson correlation 0.522 for cycle 3.

Conclusions: In conclusion, post-chemotherapy monocytopenia can be used to predict the occurrence of chemotherapy-induced neutropenia (CIN) with the strongest positive correlation in the first cycle.

Introduction: Arteriovenous fistula (AVF) is the gold standard for vascular access for hemodialysis in end-stage renal disease (ESRD) patients. There is a high rate of AVF maturation failure, especially in DM patients, and it takes longer for maturation in diabetes mellitus (DM) patients. This study aimed to obtain the recommendations for the minimum diameter of the brachial artery and cephalic vein as a predictor of brachiocephalic AVF maturation in ESRD patients with type 2 diabetes mellitus after six weeks to eight weeks of AVF creation.

Methods: This study is a retrospective cohort study using secondary data from patients with brachiocephalic arteriovenous fistula. The examined variables were brachial artery diameter, cephalic vein diameter, and brachiocephalic arteriovenous fistula maturation. Comparative analysis and ROC curve analysis were performed.

Results: A total of 72 patients met the inclusion and exclusion criteria. Forty-four (61,11%) patients were mature at six weeks, while 47 (65,28%) were mature at eight weeks postoperatively. At week six, the mature group had a significantly larger cephalic vein diameter (3,20±0,94 vs. 2,65±1,02, p=0,002). At week eight there was a significantly larger brachial artery (4,22±0,70 vs 3,78±0,60, p=0,012), and cephalic vein diameter (3,28±0,98 vs 2,43±0,82, p=0,000) in the mature group.

Conclusion: The best threshold value for preoperative brachial artery diameter predicting AVF maturation eighth week was 3.85 mm. The best threshold value for preoperative cephalic vein diameter predicting AVF maturation at the sixth week was 2.45 mm, and at the eighth week, it was 2.45 mm.

Background: Knee osteoarthritis (KOA) is a degenerative joint disease with relatively high prevalence globally and is one of the leading causes of disability in the elderly population. Dextrose prolotherapy (DPT) has been proven effective in improving functional outcomes in knee osteoarthritis. The effect of hypertonic dextrose on cartilage biomarkers has not been evaluated.

Purpose: To evaluate the association between a cartilage biomarker and changes in clinical outcomes among patients with KOA who received dextrose prolotherapy (DPT).

Patients and methods: This study was conducted with a cross-sectional design. Twenty-six participants received DPT at weeks 1, 5, and 9. Our primary measures were urinary c-terminal telopeptides of type II collagen (uCTX-II), measured by an enzyme-linked immunosorbent assay (ELISA), and the WOMAC score, measured at baseline and week 12.

Results: There were significant improvements in all WOMAC subscales and uCTX-II levels after DPT. There is no significant correlation between biomarker levels with the WOMAC score as a functional outcome indicator in KOA after DPT (p > 0.05), but there are positive correlations between pain, functional, total WOMAC score, and uCTX-II.

Conclusion: DPT may reduce cartilage degradation and improve functional outcomes in osteoarthritic knees. Significant drops in uCTX-II levels can affect functional outcomes, especially pain, functional and total WOMAC scores.

Introduction: Skin prick test (SPT) is a method for diagnosing IgE-mediated allergen sensitization. Although the sensitivity and specificity are quite good, false positive and false negative results are possible. The diameter of the wheal and flare of each allergen can affect the skin prick test measurement, especially if the results of the examination overlap. Because of the usage of the SPT and the emphasis on quality control of health services recently, several variables that can affect the results of SPT must be considered. This study aims to analyze the effect of age, gender, family history of allergy, clinical symptoms, and illness duration on SPT's flare diameter.

Method: This is a cross-sectional study conducted from 2015 to 2020 in Surabaya, Indonesia. Children with possible allergies were tested with a skin prick test at the allergy immunology outpatient clinic of the Dr. Soetomo General Academic Hospital. Inclusion criteria were ≤ 18 years old children, possibly diagnosed with allergies, who had skin prick test. Children with incomplete medical record data were excluded.  The Chi-square test or Fisher exact test to determine the relationship between the independent and dependent variables for nominal data. The p-value was declared significant if P<0.05 to determine the effect between variables on flare diameter on skin prick test. We use SmartPLS to analyse the relationships simultaneously to compare relationships with the regression analysis.

Result: Age, gender, clinical symptoms, and duration of illness did not show a significant effect. In contrast, the flare diameter determined by SPT and the presence of an allergic family had a significant correlation (p = 0.017). Therefore, the appropriate distance between allergens must be specified to prevent overlap of SPT flare diameters.

Conclusion: Member of family allergy affects the diameter of the flare on skin prick test.   

Introduction: Although research to analyze the sanitation situation in Indonesia has been intensively carried out, the results of this research are not sufficient to show aspects of community behavior comprehensively based on the components in total community-based sanitation (STBM). A recent study based solely on the availability of sanitation facilities and community affordability found that weak financial support allocated to address sanitation problems was a key factor. Therefore, this study aimed to analyze the sanitation situation comprehensively based on the components in STBM.

Methods: This research was conducted in 34 provinces in Indonesia. All areas were selected so that a complete and comprehensive analysis could be carried out. The data used in this study is secondary data obtained from the Basic Health Research and the Indonesian Demographic and Health Survey (IDHS). Cluster analysis using Fuzzy C-Means (FCM) was performed to cluster sanitation conditions based on the parameters of healthy latrine use; handwashing behavior and facilities; safe drinking water and food management; management of household waste and its facilities; and safe household liquid waste management.

Results: It is found that the value for cluster 1 does not have priority problems in terms of environmental health. There is only one indicator, namely littering, which is above the national average. While in cluster 2, the complexity of the problem is more complex where almost all indicators are above the national average, only the indicators of carelessly throwing garbage and disposing of feces are below the national average. Cluster 3 has complex problems in no defecation, no defecation, no sewerage, and littering. These areas are included in the priority sanitation intervention program; Bangka Belitung, North Sulawesi, Southeast Sulawesi, Gorontalo, West Kalimantan, Central Kalimantan, West Nusa Tenggara, South Kalimantan, Maluku, Central Sulawesi and East Nusa Tenggara.

Conclusions: This study determines the classification of sanitation conditions to provide comprehensive information on which areas are included in the priority sanitation intervention program. The novelty and contribution of this research is a comprehensive analysis based on the components of STBM, which has never been done before.

Introduction: The COVID-19 pandemic has dramatically impacted people's lives. Families are affected in many ways, including daily life, the economy, social life, and health. Families who have resilience can face the COVID-19 pandemic situation. This study aims to determine the factors related to family resilience during the Covid-19 pandemic, including Family income, education, family type, family relations, and social support.

Methods: This study is a cross-sectional study conducted on 403 respondents using purposive sampling. Inclusion criteria include Husband or wife (with or without children) who live together, ages 18-65 years, in Jakarta and Tangerang. Data collection using an online questionnaire consisted of demographic data, the Family Resilience Assessment Scale (FRAS), and the Multidimensional Scale of Perceived Social Support (MSPSS). The questionnaire has passed the validity and reliability test. The Ethics Board of the Mochtar Riady Institute of Nanotechnology (MRIN) provided ethical approval.

Results: Multivariate analysis using a logistic regression test showed that factors related to family resilience were income (p-value: 0.028, OR: 3.08) and social support (p-value: 0.001, OR: 7.16). Social support is the dominant variable related to family resilience. An increase in social support increases the likelihood of family resilience by 7.16 times. Furthermore, an increase in family income has a 3.08 times greater chance of increasing family resilience.

Conclusion: Families and the government can collaborate to improve family resilience during the Covid-19 pandemic by optimizing social support and family income.

Introduction: According to WHO, the COVID-19 epidemic a public health emergency came to international attention in March 2020, and the pandemic quickly spread around the world. This disease is caused by the novel coronavirus SARS-CoV-2, which may enter human target cells via angiotensin-converting enzyme 2 (ACE2). This study aimed to assess the risk factors associated with poor prognosis among COVID-19 patients in the Islamic Hospital of Jemursari, Surabaya, Indonesia.

Methods: This study was a retrospective cohort study that used patients hospitalized with COVID-19 at the Islamic Hospital of Jemursari, Surabaya as a study subject. Patients of all ages who enter the hospital and were confirmed with a positive real-time polymerase chain reaction (RT-PCR) result for SARS-CoV-2 were inclusion criteria of this study.

Results: We included 554 COVID-19-positive patients with the highest age at 26-35 years old as much as 26.72%, followed by the second highest at 36-45 years old at 20.86%. In addition, from all the patients in this study, it was found that the most patients were 281 male and 273 female. Characteristics of comorbidities in COVID-19 patients, where type 2 diabetes mellitus is the most comorbid factor 88.89% in recovered COVID-19 patients and 11.11% in patients who have died. In addition, hypertension is also the second most comorbid 96.55% of Covid-19 patients.

Conclusion: Based on this study, the independent risk factors related to critical outcomes among COVID-19 cases include old age, males, diabetes mellitus, cardiac-related disease history, and the presence of two or more comorbidities. In future research, we suggest designing a unique multi-item scale system to prognosticate COVID-19 patients.

Background: Intraocular hypothermic perfusion can be used as an alternative to reduce corneal endothelial cell damage in phacoemulsification procedures. This study aimed to analyze the effect of hypothermic intraocular perfusion on cell density and expression of the Na⁺/K⁺-ATPase on corneal endothelial cells after exposure to ultrasonic phacoemulsification energy.

Methods: Sixteen New Zealand white rabbits (n=16 eyes) were randomly divided into two groups and exposed to phacoemulsification ultrasonic energy. The control group received room-temperature Intraocular Balanced Salt Solution (BSS) hyperthermic perfusion (24^oC) and the treatment group received low-temperature intraocular BSS hypothermic perfusion (4^oC). Corneal endothelial cell density (ECD) was measured before and 1 day after surgery using a specular microscope. On the first postoperative day, the expression of Na⁺/K⁺ATPase was examined using immunohistochemical antibody staining. Data were analyzed using SPSS version 26 for Windows.

Results: There was no statistically significant difference in the expression of corneal endothelial Na⁺/K⁺-ATPase between the control and treatment groups (p=0.053). There was no significant difference in corneal endothelial cell density changes between the control and treatment groups (p=0.115). There was no correlation between changes in cell density and corneal endothelial Na⁺/K⁺ATPase expression in the control and treatment groups (p=0.216).

Conclusion: The effect of intraocular hypothermic perfusion on phacoemulsification procedures remains controversial. Endothelial cell density decreased in hypothermic perfusion after phacoemulsification and Na⁺/K⁺ATPase expression was not significantly affected by hypothermic perfusion.

Background: Obesity is an inflammatory condition that results in an increase in high sensitive C-Reactive Protein (hs-CRP), a risk for insulin resistance (IR). Vaspin has the effect of increasing insulin receptor sensitivity and on the other hand is a compensatory response to insulin resistance, one of which is measured by homeostasis models assessment-insulin resistance (HOMA-IR). This study was an analytical cross-sectional observational design, to determine the association between insulin, glucagon, CRP, and HOMA-IR levels with serum vaspin in obesity.

Method: This study is an analytical study with a cross-sectional design.  Criteria of inclusion were subjects in the range 18-60 years Denpasar citizen with BMI above 25 kg/m² and willing to be involved in this study, while exclusion criteria were with either chronic conditions or acute inflammation such as infection, cancer, tumor, or chronic disease which is altered and threatening life. Correlation tests using spearman analysis.

Results: From 131 obese subjects in this study, there were 72 (55%) men and 59 (45%) women. Median age: 33 (22-57) years, fasting insulin: 8.90 (2.20-74.50) ìIU/mL, glucagon: 48.10 (7.58-293.90) pq/mL, hs-CRP: 1.90 (0.20-9.50) mg/L, HOMA-IR: 2 (0.50-23.15), and vaspin levels: 0.16 (0.04-1.46) ng/mL. There was a significant positive correlation between HOMA-IR, insulin and glucagon with vaspin (r = 0.20, p = 0.020; r = 0.20, p = 0.022; and r = 0.28, p = 0.001), and a significant negative correlation between hs-CRP and vaspin (r = -0.24, p = 0.005) in obesity. In the path analysis, there was a direct and total negative effect of hs-CRP on vaspin (coefficient = -0.19; p = 0.027 and coefficient = -0.02; p = 0.038).

Conclusion: This study shows a positive association between insulin, glucagon, and HOMA-IR with serum vaspin, while CRP is negatively associated with serum vaspin in obesity.

Introduction: The prevalence of anemia among adolescent girls is still quite high. Whereas anemia will have a negative impact on health and productivity. The government implements a program of providing blood-added tablets, one of which is through school institutions. However, during the Covid-19 pandemic, this condition becomes an obstacle for the implementation of the iron injection distribution through schools. This study aims to analyze the distribution of TTD in adolescent girls during the Covid-19 pandemic.

Methods: Descriptive study with a case study approach and is located in 6 districts/cities in East Java Province from September-November 2021. This study used purposive sampling by taking 6 respondents, namely 1 person from each district/city health office. Data collection was carried out using a questionnaire instrument.

Results: The results of the study show that 4 of the 6 regencies/cities in this study have special policies in the form of appeals and circulars so that the TTD program for adolescent girls can continue during the pandemic. However, 2 districts that did not issue specific policies continued to run the TTD program. The distribution of TTD is still carried out through schools and also directly to homes. The control of TTD consumption is not only carried out by teachers but is also assisted by parents and cadres. Adolescent girls who received TTD in the 1st and 2nd quarters have not yet reached their target. Data for adolescent girls who consume TTD is also difficult to obtain.

Conclusion: Four of the 6 districts/cities have nutrition education programs that are implemented with a special time allocation or combined with other lessons at school. So adolescent girls have a high awareness to obediently consume iron tablets even without the supervision of other parties.

Background: Purnajiwa is one of the medicinal plants in Bali. Species information regarding this plant is still unconfirmed. Currently, this plant is considered rare and endangered. Molecular identification supports authentication at the species level, which will also support conservation efforts.

Method: Molecular identification using DNA Barcoding was carried out on purnajiwa from three sampling locations in Bali (Jimbaran, Mambal, and Bedugul) using rbcL primers (rbcLaF and rbcLaR). Data analysis was performed using BLAST with species on GenBank. Pairwise and similarity values ​​were used to measure the three samples' proximity to the Gen Bank species.

Result: The phylogenetic tree was constructed with the Maximum Likelihood and Tamura-3-parameter model. The analysis results show a close relationship between the purnajiwa from Jimbaran and Mambal with the species Kopsia arborea (KP095079). Meanwhile, the Purnajiwa from Bedugul showed a difference from the other two purnajiwa and was closely related to Euchresta horsfieldii (U74225).

Conclusion: It can be concluded that the Purnajiwa from Jimbaran and Mambal is a species of Kopsia arborea while the Purnajiwa from Bedugul is a species of Euchresta horsfieldii.

Introduction: Exercise has been believed to prevent metabolic syndrome (Mets) from occurring.  Accumulation of inflammation factors such as monocytes chemoattractant protein-1 (MCP1) in adipose tissue is a factor in the development of MetS. However, the inflammatory mediators that play a role in the accumulation of macrophages are still unclear, so this study aims to determine the expression of MCP-1 in perivascular adipose tissue (PVAT).

Methods: Eight-week-old male wild-type mice, were divided into five groups. One control group was given a standard diet and four groups were given a high-fat diet (HFD) for 2 weeks. Exercise treatment was given to the HFD group by dividing HFD with exercise once a week, HFD with exercise three times a week, and HFD with exercise five times a week. As for the exercise, speed is given 10-18m/minute for 30 minutes. and this exercise is carried out for two weeks. Gene expression of MCP-1 in PVAT tissues was analyzed using quantitative chain reaction (PCR).

Results: The HFD group experienced an increase in body weight (P <0.01) and adipose tissue mass (P <0.01) compared to the control group. Furthermore, exercise decreased body weight (P <0.05) and adipose tissue in the HFD-Exc1 group (P <0.01). Furthermore, exercise tends to decrease the inflammatory mediator in macrophages MCP-1 in PVAT compared to the HFD group.

Conclusion: These results suggested that exercise partially reduces adiposity, tended to decreases MCP-1 in HFD-induced obesity.

Introduction: Lavender essential oils (LEO) have been known to have relaxing effects, improve mood, and treat anxiety, but the effect on multiple organ stress concurrently is unknown. This multiorgan stress is related to depression can be caused by chronic psychological stress due to excessive cortisol levels and can lead to organ damage. This study analyzed LEO in preventing depression and multiorgan failure using intraperitoneal injection of corticosteroids in animal-model.

Methods: Rats (Rattus norvegicus) Wistar strain, male, aged 7-8 weeks were involved in this study. Depression in animal-model is defined by immobilization using tail suspension test and anhedonia using sucrose preference test. LEO 5% was diluted in virgin coconut oils as vehicle. Serum cortisol was analyzed using enzyme-linked immunosorbent assay (ELISA). Organs were extracted and processed using hematoxylin eosin staining.

Results: The results of this study indicate that LEO was able to prevent damage to the glial cells, myocardiac cells, and gastrointestinal mast cells infiltration, but not to the hepatocytes and renal cells damage. LEO also induced behavioral activation as improvement of depression, but anhedonia was still remained.

Conclusion: The effect of LEO is to prevent the increase in blood cortisol levels, thus reduce the reactivity of depressed individuals to stress, although the individual still has anhedonia as a residual symptoms

Introduction: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, may result in musculoskeletal tissue injury and is assumingly regulated through central and peripheral pathways. Muscle-specific creatinine kinase (CK-MM) is a specific biomarker used to indicate the presence of musculoskeletal tissue damage. This study aimed to investigate the correlation between the levels of CK-MM and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.

Methods: A cross-sectional study was conducted among COVID-19 survivors at the Faculty of Medicine and Clinical Pathology Laboratory, Universitas Airlangga, Surabaya from June - August 2022. The degree of pain of the myalgia was assessed using a visual analog scale (VAS), while CK-MM level was measured using a sandwich enzyme-linked immunosorbent assay (ELISA). Pearson correlation test at α=0.05 was used to identify the correlation between the levels of CK-MM and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.

Results: A total of 84 participants were enrolled in the study and half (50%) of them reported persistent myalgia post-COVID-19 recovery. Fatigue was the patients' most common persistent symptom (63%). Of the total 42 patients with persistent myalgia, more than half (56%) had mild pain intensity (VAS score: 1–3), and almost all of them (41 patients) experienced myalgia during the COVID-19 diagnosis. All the patients with post-COVID-19 myalgia had normal levels of CK-MM (mean: 32.7 ng/mL; range: 12–93 ng/mL), suggesting no musculoskeletal tissue damage. Anova test suggested no significant different of CK-MM levels between those with and without myalgia in patients with post-COVID-19 syndromes p=0.054).

Conclusion: There was no significant association between CK-MM levels and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.

Background: Many factors were involved performing circumcision such as knowledge, religion, or culture. Circumcision was the most common surgical procedure, but considered low in Bali. This study aims to determine the general knowledge and attitudes of parents towards the decision to make circumcision in children in the city of Denpasar.

Methods: A study in Denpasar area involving 1655 questionnaires was filled out by one parent who had at least one son in the Denpasar elementary school.

Results: The response rate was 86.5% (1655); Most respondents were fathers (55.3%), Hinduism (66,8%), and educational level was high school (45%). 70,5% respondents didn’t circumcise their sons. 51% respondents believe that circumcision was necessary. Most reason to circumcision was better hygiene (52.3%). The best age for circumcision was Elementary School (76.4%). Most reason for not being circumcision was didn’t know medical benefits (30.6%). It was found that most respondents had good knowledge (71.9%). Parents with a high level of education were more positive in responding to circumcision in their sons (P <0.05). Mothers were more positive in responding to circumcision (P <0.05). no significant differences were found in the respondents of father and mother to level of knowledge about circumcision.

Conclusion: This study concluded that most respondents had well knowledge about circumcision but majority didn’t circumcise their son. More future research is needed to describe the condition of circumcision in some regions in Indonesia and it’s important to both children and parents know about advantage and disadvantage of circumcision.

Aim: The goal of this study was to compare maternal and neonatal results in diabetic pregnant ladies who were treated either insulin and metformin or insulin only.

Methods: 220 pregnant diabetic women with type 1, 2 or gestational diabetes were randomisely assigned into two groups .each group is 110 pregnant diabetic women. One group takes insulin and metformin treatment to achieve glycemic targets and other take insulin only treatment. Pregnancy results in 110 ladies who stayed solely on insulin have been compared to pregnancy results in 110 pregnant diabetic ladies treated with insulin and metformin who were matching for age, weight, as well as ethnicity.

Results: No significant variations in maternal risk factors existed at the start of the study. Group II from enrolling to term, they gained significantly more weight (5.90 vs. 4.39   kg;   P < 0.000). When it came to gestational hypertension, there was no significant difference between groups I and II (14.5 against 19.1%, P = 0.367), pre-eclampsia (7.27 vs. 9.09%, P = 0.622),insulin dosage was decreased in group I statistically significant (mean 39.5±16.5 vs. 55.4±17.5 units, P= 0.000), vaginal delivery (41.8 vs. 47.3%, P = 0.416) or rate of elective Caesarean section (39.1 vs. 32.7%, P = 0.325), rate of emergency caesarean section (19.1 vs. 20%, P=0.865), perinatal loss  (4 cases in group II vs. 3 cases in group I;P=0.701). Group I had a lower rate of neonatal morbidity; prematurity (16.63 vs. 24.55%, P = 0.417), neonatal hypoglycemia (7.3 vs. 24.5 %, P= 0.000), respiratory distress (13.64 vs. 30 %, P= 0.003), neonatal jaundice (13.6 vs. 33.6%, P < 0.000) and admittance to the newborn intensive care unit (24.55 vs. 35.45%, P = 0.077). Macrosomia occurrence (There was a significant difference in birth weight centiles > 90 [group I (16.4%) vs. group II (29.1%); P = 0.024]. The incidence of polyhydramnios was significantly different [group I (13.6%) vs. group II (32.7%); P = 0.001].Shoulder dystocia [group ? (2.7%) vs. group II (4.5%); P=0.721].

Conclusions: Diabetic pregnant women who were treated with insulin plus metformin who had equal baseline risk factors for unfavourable pregnancy outcomes gained less weight and needed less insulin to maintain glycemic control. Furthermore improved neonatal outcomes as macrosomia, neonatal hypoglycemia, respiratory distress and special care baby admission compared with those treated with insulin alone.

Introduction: In both poor and developed countries, chronic suppurative otitis media affects 1-46 percent of the population. The incidence of chronic suppurative otitis media is much higher in Indonesia due to various of factors, including poor sanitation, low socio-economic and nutritional status, and high population density. To reduce the occurrence of chronic suppurative otitis media, an adequate treatment is required.

Purpose: the study was to identify the bacteria that cause chronic suppurative otitis media and ciprofloxacin and amoxicillin antibiotic sensitivity pattern in Asri Medical Centre and PKU Muhammadiyah Gamping hospital, Yogyakarta.

Patients and methods: This is a prospective descriptive study with 27 patients with chronic suppurative otitis media whom met the inclusion criteria. Bacteria were isolated from ear secretions and cultured on TSA and McConkey agar medium. The antibiotics ciprofloxacin and amoxicillin were tested for susceptibility, and Gram staining, catalase test, and biochemical test were used to identify bacteria.  

Results: 63 bacteria were isolated from 27 chronic suppurative otitis media patients, among of them positive-gram bacteria (52%) and negative-gram bacteria (48%). The sensitivity of positive-gram bacteria and negative-gram bacteria causing chronic suppurative otitis media to ciprofloxacin was 84% and 79%, respectively. The resistance of positive-gram bacteria and negative-gram bacteria to amoxicillin by 100%.

Conclusion: Staphylococcus sp and Pseudomonas aeruginosa were the most caused chronic suppurative otitis media at the Asri Medical Centre and PKU Muhammadiyah Gamping hospital in Yogyakarta. The antibiotic ciprofloxacin is the most effective treatment for bacteria that cause chronic suppurative otitis media.

Introduction: Bromage score is used in assessing patients post-spinal anesthesia while the patient is in the recovery room. Patients can be transferred to the treatment room from the recovery room if they have achieved a Bromage score of <2. Post-anesthesia recovery is significant to pay attention to because if there are obstacles in post-anesthesia recovery, it will cause some complications that the patient needs a long time in the treatment room. Several factors may be related to Bromage score, American Society of Anesthesiology (ASA) physical status, age, gender, the dose of local anesthetic drugs, and other factors. 

Methods: This type of research Observational Analytics used secondary data with a cross-sectional study design with 327 participants. Data analysis using coefficient contingency correlation test. 

Results: The majority of 315 (96.6%) patients achieved a Bromage score of 1, with the highest number of patients aged (12-45 years). Patients with ASA physical status 1, a male and spinal anesthetic with a dose of Bupivacaine 10 mg – 15.5 mg achieved the most Bromage score 1. There was a significant relationship between gender and Bromage score in patients after spinal anesthesia, p-value = 0.048 (p-value < 0.05).

Conclusion: There is a significant relationship between sex and the Bromage score, and there is no significant relationship between ASA physical status, age, and local anesthetic dose with the Bromage score.

Background: Breast cancer is a malignancy originating from breast tissue, where chemotherapy is one of the choice therapy. Doxorubicin, 5-fluorouracil, and cyclophosphamide (FAC) are the most commonly used combination of chemotherapy. One of the side effects of chemotherapy is cardiotoxicity. Multiflora honey prevents cardiotoxic effects through its flavonoids and polyphenols compounds. The aim of this research is to analyze the effectiveness of adding honey in preventing cardiotoxic effects in breast cancer patients receiving FAC chemotherapy.

Methods: An experimental study with double-blind randomized pre and post-test with control group design. Ductal invasive breast cancer patients were divided into 2 groups, the control group, who received FAC chemotherapy (n=18) and the treatment group, who received chemotherapy and 90 ml/day honey consumption for 14 days (n=18). The patient's Troponin I and NT-proBNP enzyme levels before and after 14 days of the study were assessed.

Results: Post-treatment, there was an increase in Troponin I levels from the treatment group (0.22 ± 0.07 vs. 0.24 ± 0.07) vs. control (0.25 ± 0.11 vs. 0.34 ± 0.20) with a significant difference. (p = 0.031). There was a decrease in NT-proBNP levels in the treatment group (461.0 ± 610.4 vs. 215.6 ± 260.3) and an increase in NT-proBNP levels (275.9 ± 392.4 vs. 315.4 ± 293.9) with a significant difference (p = 0.006).

Conclusion: Multiflora honey can prevent cardiotoxic effects in breast cancer patients receiving FAC chemotherapy.

Background: In intraperitoneal infection or peritonitis, intestinal resection and anastomosis might result in severe morbidity and intestinal anastomosis leakage have been documented to be fatal. We aim to examined the effect of free peritoneal patch on fibroblast count and density of collagen on primary colon anastomosis in intraperitoneal infection.

Methods: This is an experimental study with randomized control trial design using New Zealand White Rabbit. We collected sample’s characteristic data (e.g., age, weight before and after intervention), fibroblast and collagen levels.

Results: The mean of fibroblast level in treatment group was higher than the mean of fibroblast level in control group but there was no significant difference between both group (P value=0.202). The medial collagen level in treatment group was 2, higher than the medial collagen level in control group that was 1 and there was significant difference between both group (P value = 0.010)

Conclusion: The free peritoneal patch on colon anastomosis in intraperitoneal infection can increase fibroblasts and collagen levels compared to those without free peritoneal patch.

Introduction: The COVID-19 pandemic creates parenting stress for parents. When parents experience parenting stress, the solution that can be done is to give the gadgets to make children calm at home so they don't interfere with their parents' daily activities. This study aims to analyze the effect of parenting stress on symptoms of gadget addiction in elementary school-aged children.

Methods: The research design used the quantitative correlation method. The research was carried out in July - August 2021. The subjects of this study were parents whose children were in elementary school in Surabaya involving 130 respondents who were taken by random sampling technique. Determination of the parenting stress scale and gadget addiction symptoms using the Parental Stress Scale (PSS) and Internet Addiction Test (IAT) questionnaires. Data analysis used a simple linear regression test with a significance value of p <0.05.

Result: The results of the analysis show that parental stress has an effect on symptoms of gadget addiction in elementary school-aged children (F=6,821, sig.=0,000, R2= 0,554) with the regression equation Y=-17,198 + 1,360 X.

Conclusion: The higher the stress level of parenting, the higher the symptoms of gadget addiction in elementary school-age children. The need to overcome the stress of parenting to prevent early symptoms of gadget addiction in children. Family and professional support is needed to overcome the stress of parenting and how to prevent gadget addiction in elementary school-aged children.

Background: The contracted socket is caused by fibrosis leading to the shortening of the orbital tissue. Vascular endothelial growth factor (VEGF) is a profibrotic factor in postoperative wound healing. The novel option to prevent fibrosis is the use of fibrin glue. This study aims to evaluate the role of fibrin glue in reducing the VEGF expression in cells that cause post-socket surgery scar.

Methods: An in vivo experimental study using an animal model was conducted. We used twenty eyes of white rabbit species as the study sample. The evisceration was carried out and distributed to the animals in four experimental groups consisting of the control group, the MMC group (0.1 ml of mitomycin-C (MMC) 0.4 mg/ml), the triamcinolone acetonide (TCA) group (0.1 ml of TCA 40 mg/ml), and the fibrin glue group (0,1 ml of fibrin glue). The treatment was performed through injection of the subconjunctival. After 14 days, rabbits were euthanized, and conjunctiva samples were cut. Immunoreactivity scores (IRS) were used to analyze the expression of VEGF in epithelia conjunctiva with a significant level of p <0.05. Data were analyzed using SPSS version 26 for Windows.

Results: All groups showed a statistically significant difference in VEGF expression with a p-value 0,000 (p<0,05). The VEGF level was significantly lower in the three treatment groups compared with the control group. The VEGF expression was highest for the control group, followed by fibrin glue, TCA and MMC group. We found significant differences between the control group and the three treatment groups; the MMC group (p=0.001), the TCA group (p=0.002), and the fibrin glue group (p=0.005). While differences in VEGF expression between the three treatment groups could not be proven statistically.

Conclusion: Fibrin glue is proven to reduce VEGF expression as a marker of fibrosis; thus, fibrin glue can be an alternative anti-fibrotic agent.

Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic inflammation that causes a variety of pulmonary and systemic disorders. Pursed-lip breathing and diaphragmatic breathing exercises are useful techniques for improving ventilation, reducing the degree of breathlessness, enhancing performance, and improving quality of life. The aim of this study was to determine the effect of pursed-lip breathing and diaphragmatic breathing exercise on the value of the 6-min walk test and to improve quality of life by SGRQ in stable COPD patients.

Methods: This study was an experimental study using group control before and after examining 60 stable COPD patients at Dr. RSUD Lung Center. Zainoel Abidin from November 2019 to February 2020. Samples were extracted by systematic random sampling and divided into two groups. The intervention group received indacaterol bronchodilator therapy in addition to four weeks of apron and diaphragmatic breathing exercises. The control group received only indacaterol therapy. A 6-minute walk test was administered and a quality of life questionnaire was completed using the SGRQ. A t-test and Wilcoxon test were performed to assess differences between groups, level of significance p < 0.05).

Results: There was a significant effect on the 6-minute walk test in the intervention group compared with the control group (p = 0.001). There was a significant effect in improving quality of life using the SGRQ questionnaire in the intervention group compared with the control group (p = 0.001).

Conclusion: There was a significant effect on the six-minute walking test in the intervention group compared to the control group. There was a significant effect on improving the quality of life using the SGRQ questionnaire in the intervention group compared to the control group.

Introduction: Coronary artery disease (CAD) is the accumulation of atherosclerotic plaques in the coronary arteries. CAD is the most common cause of death worldwide, and its prevalence continues to increase, especially in the elderly population. Atherosclerosis is a chronic inflammatory condition that involves various inflammatory markers, including tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). In the inflammatory process, vitamin D plays an essential role in developing atherosclerotic plaques affecting the severity of CAD. The elderly are susceptible to vitamin D deficiency and an increase in the inflammatory process related to the severity of CAD. Therefore, this study aims to prove the relationship between inflammatory markers and vitamin D levels with the severity of CAD in elderly patients.

Methods: This study used a cross-sectional design in stable CAD patients aged 60 - 75 years who had passed through coronary arteriography. The severity was assessed from the angiography results using the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, which 3 cardiovascular consultants evaluated and the average outcome was calculated. TNF-α, IL-6, and vitamin D were taken during angiography and examined using high sensitivity enzyme-linked immunoabsorbent assay (ELISA). The correlation test was analyzed using Spearman's Rank correlation test.

Results: A total of 38 subjects were included in this study, where 30 (78.9%) patients were male. The mean age of the patients was 64.79 years, and the prevalence of vitamin D deficiency was 57.9%. There was a moderately significant positive correlation between markers of inflammation TNF-α (r=0.499, p=0.001) and IL-6 (r=0.518, p=0.001) and the SYNTAX score. A weak negative correlation was also discovered between vitamin D and the SYNTAX score (r=-0.335, p=0.040).

Conclusion: The levels of inflammatory markers (TNF-α and IL-6) and vitamin D correlated with the severity of CAD in elderly patients.

Background: Atopic dermatitis (AD) is the most common skin disease in infants and children, influenced by hereditary and environmental factors and characterized by an inflammatory reaction in the skin. The increase in AD has been explained by two hypotheses: the "hygiene hypothesis" and the "diet–microbiome hypothesis." AD is driven by a familial or personal predisposition to induce immunoglobulin E (IgE) antibodies and sensitize in response to stimuli. Microorganisms on the skin have been shown to play an important role in the pathogenesis of AD, and changes in the composition of the skin microbiome have been investigated in disease progression in pediatric AD patients.

Method: This descriptive observational study with a cross-sectional approach aims to determine the bacteria found in AD. The samples were taken from both the lesion and non-lesion areas in children with AD, which grown anaerobically and aerobically in blood and Brucella agar at 37C. The bacteri then indentified by Vitek® 2 and the data presented in percentage.

Result: Thirty-five pediatric patients (18 males and 17 females) with a mean age of 7.58 (0,17 – 16) years were diagnosed with AD and were examined for bacterial culture on lesions and non-lesions. A total of 4 types of bacteria were found on the neck, 20 on the forearm, 2 on hand folds, 2 on fingers, 1 on the knee, and 5 on the lower limbs.

Conclusion: The most common bacteria were Gram-negative bacilli, namely, Acinetobacter baumannii (15%) and Burkholderia cepacian (14.3%), followed by the Gram-positive coccus Staphylococcus hominis (11.4%).

Background: Coronavirus disease 2019 (COVID-19) has emerged as a global health catastrophe since its first reported cases in late December 2019. Critically ill COVID-19 patients have been related to cytokine storms leading to acute respiratory distress syndrome and high mortality rates. Therapeutic plasma exchange (TPE) and convalescent plasma (CP) therapy improve clinically by removing inflammatory cytokines excess and using passive antibody-containing blood, respectively. This study aimed to evaluate TPE and CP treatment for moderate-to-severe COVID-19 infection.

Method: The patients were randomly divided into TPE group (n = 10), CP group (n = 11), and control group (n = 10). This 1-week quasi-experimental study with a pretest–post-test control group design was conducted in the Intensive Care Unit (ICU) of Dr. Moewardi General Hospital and Universitas Sebelas Maret (UNS) Hospital. The study comparison between groups included blood gas analysis profile (pH, base excess, PaCO₂, PaO₂, hematocrit, HCO₃, total CO₂, SaO₂), FiO₂, P/F ratio, COVID-19 severity, and D-dimer. The paired t-test was used to analyze every group's pretest–post-test mean difference. One-way ANOVA was performed to analyze the mean difference across the three groups. SPSS version 22.0 for Windows was used to perform statistical analyses.

Result: TPE and CP groups showed significant clinical-laboratory improvement than control (p > 0.05). Furthermore, high clinical-laboratory improvement tendency was observed in CP therapy than TPE.

Conclusion: The use of TPE and CP in moderate-to-severe COVID-19 patients has been related to improving clinical-laboratory outcomes.

Introduction: Aloe vera has anti-bacterial ability against Gram-positive and Gram-negative bacteria; however, anti-bacterial study, especially in multidrug resistant strain of Mycobacterium tuberculosis, has not been evaluated yet. This study aims to determine the potential of Aloe vera as an antituberculosis against drug-resistant strains of tuberculosis.

Method: Stages of research include the production of ethanol extract of Aloe vera, then testing the phytochemicals (identification of alkaloids, steroids/triterpenoids, anthraquinone, flavonoids, saponins, tannins) and chemical content testing by thin layer chromatography (TLC). The anti-bacterial test for Mycobacterium tuberculosis was performed on the Lowenstein Jensen media.

Results: Test results showed the qualitative identification, and TLC contains alkaloids, steroids/triterpenoids, anthraquinone, flavonoids, saponins, and tannins. Antioxidant activity against DPPH radical shows an IC₅₀ value of 6927.133 ppm. Test of anti-bacterial activity to Mycobacterium Tuberculosis H37Rv and MDR TB strains HE (resistant to INH and Ethambutol), and SR (resistant to streptomycin and Rifampicin) showed inhibition ranging concentration of 50 mg/mL in all extracts as well as to test the sensitivity, a sensitive start to a concentration of 50 mg/mL in all extracts.

Conclusions: Aloe vera contains alkaloids, steroids/triterpenoids, anthraquinone, flavonoids, saponins, and tannins that act as antioxidants and antituberculosis against strains of Mycobacterium tuberculosis that are not resistant and resistant to anti-tuberculosis drugs.

Background: Alveolar bone remodeling is very helpful in orthodontic treatment to prevent relapse after treatment is completed with new bone formation. Using natural materials that have a mechanism of action on the periodontal ligament and alveolar bone as a relapse prevention triggers osteogenesis with the formation of new bone in the tension area so that orthodontic treatment can be achieved maximally. This study aims to determine the formation of woven bone in the area attraction of orthodontic tooth movement after administration of Mangostin

Methods: A total of 30 male Wistar rats were divided into 3 groups, namely a negative control group (K1) without treatment, K2 and K3 a positive control group K(+), K2 a positive control group K(+), which was given a mechanical stressor without Mangostin administration and observed for 7 days, K3 positive control group K(+) which was given a mechanical stressor without Mangostin administration and observed for 14 days, K4 and K5 treatment group (P), K4 treatment group (P) where the group was given a mechanical stressor and Mangostin which was observed for 7 days, K5 the treatment group (P) where the group was given a mechanical stressor and Mangostin which was observed for 14 days. Dara was analyzed using SPSS version 23 for Windows.

Results: It was seen that the administration of Mangostin was very effective in increasing the expression of Runx-2, IL-10 and the formation of woven bone in the area of ​​higher tension than without the administration of Mangostin significantly (p<0.05). There was a significant increase (p<0.05) of Runx-2 and IL-10 in the treated group compared to the control group on day 7 and day 14, respectively.

Conclusion: The administration of Mangostin effectively prevented orthodontic relapse by increasing the expression of Runx-2 and Il-10 and accelerating the formation of woven bone in the tension area of ​​orthodontic movement.

Introduction: Covid-19 Pandemic event in Indonesia is still spreading, with one of the worst outbreaks occurring in Probolinggo, East Java. Pregnant mother is at a high risk of getting covid-19 pandemic, thus prenatal checkups at Public Health Center or independent practice midwives are limited during the pandemic. The purpose of this study is to investigate the correlation between the usage of the kami pekarasa card (cards of pregnant mother for posyandu's members and villages authority holders) and the coverage of the visit of k4 pregnant mother during the covid-19 pandemic event.

Methods: Correlational analytic research design was adopted in this study. This study used a 32-person sample. Data was collected by cadres using health protocols and analyzed using the chi-square test.

Results: The data revealed a p-value=0.018 and r=0.05, indicating that there is a correlation between the usage of kami pekarasa card and visit coverage of k4 pregnant mother during covid-19 pandemic.

Conclusion: Based on the result there was a significant between the usage of kami pekarasa card and the visit coverage of k4 pregnant mother during covid-19 pandemic event.

Introduction: Pediatric acupuncture is an interesting subject to study along with strengthening the current development of acupuncture therapy. Not only for adults, but acupuncture is also safe for children. There have been many studies on acupuncture, but publications related to acupuncture for children are still very few compared to adults. The purpose of this study is to visually map and guide future research on Pediatric acupuncture based on bibliometric analysis.

Method: We conducted this study from September 16 to 19, 2022. Publications regarding pediatric acupuncture were extracted from the Scopus database. The search strategy included two keywords: (ACUPUNCTURE)*(PEDIATRIC). The final result was acquired by searching those keywords without limitation because the number of articles was less than 1000. We used VOSviewer and bibliometric indicators to generate a maps-based data network from all keywords-related studies showing association among journals, countries, publication frequency, authors, and citations. Keywords were used to infer pediatric acupuncture. A total of 669 documents related to pediatric acupuncture were retrieved. This includes 432 articles, 176 reviews, and 16 conference papers.

Results: A total of 10,918 citations have been recorded for all publications with an h-index count of 52. The first relevant study is dated on 1966. Since then, there has been a steady increase in total publications each year whereas 2021 as the most productive year with 53 publications. The Medical Acupuncture Journal (25) was the most prolific journal. The United States of America (298) and China (54) are the most productive country and institutions. The article entitled Clinical Practice Guideline: Allergic rhinitis by Seidman et al. (386) is the most cited reference.  

Conclusion: The benefit and potential of acupuncture for several diseases in pediatric patients are promising and no adverse side effects have been reported.

Background: COVID-19 affects the multiorgan system, mostly the respiratory system. Symptoms might vary from upper respiratory manifestation to acute respiratory distress syndrome, with the main feature being impairment of gas exchange. This pulmonary impairment might lead to a decrease in functional capacity, which cause activity limitation. Thus, COVID-19 patient requires the right pulmonary rehabilitation strategy to improve pulmonary function and prevent further pulmonary complications. This study aimed to compare the effectiveness of incentive spirometry and diaphragm breathing exercise on cardiorespiratory functional capacity in COVID-19 patients.

Methods: Subjects were divided into two groups of breathing exercises, the incentive spirometry group and the diaphragm breathing exercise group. They performed breathing exercises for 5 days, and the functional capacity was measured by a test named 4-meter gait time test (4MGT) and 30 sit-to-stand test (30STS). The test was taken before and after performing breathing exercises.

Results: These two respiratory exercises significantly affected the functional capacity in a good manner (p < 0.05). The incentive spirometry had improved 30STS (P = 0.763) and 4MGT results (P = 0.674), as well as diaphragm breathing exercise did to 30STS (P = 0.456) and 4MGS (P = 0.441).

Conclusion: In conclusion, diaphragm breathing exercises and incentive spirometry improved the functional capacity of COVID-19 patients. However, incentive spirometry showed a larger effect on 30STS and 4MGT compared to diaphragm breathing exercises.

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. Histopathological diagnosis has been the gold standard for diagnosing and determining the severity of non-alcoholic steatohepatitis (NASH). However, this method is invasive, especially for diagnosing NASH in children. This research aimed to study the effect of probiotics on the De Ritis ratio, TGF-β levels, and histopathological changes in rats given High Fat, High Fructose (HFHFr) diet to look at the correlation between the De Ritis ratio and liver histopathology in diagnosing NAFLD.

Method: Twenty-one male Sprague Dawley rats were included and divided into three groups. In the first group, as control only received a normal chow diet for eight weeks. The second group received an HFHFr diet for eight weeks, and the last group received HFHFr for eight weeks and a combination of HFHFr and probiotics for another eight weeks. After decapitation, we took 3 ml of serum from each rat to measure AST, ALT, and TGF-β. A 4 μm thick liver tissue slide was taken and stained with Hematoxylin – Eosin Stain for histopathological analysis. We used the Non-Alcoholic Steatohepatitis (NAS) Score for measuring liver damage progression.

Results: De Ritis ratio and TGF-β level did not significantly differ between probiotic and non-probiotic groups (p = 0.064 and 0.383), but there was a significant NAS score difference (p = 0.001) in probiotic and non-probiotic groups. This was followed by a significant correlation between the De Ritis ratio and the NAS score (r = 0.613, p = 0.003).

Conclusion: Probiotic supplementation alleviated liver damage caused by the HFHFr diet but did not successfully reduce the De Ritis ratio or improve TGF-β.

Introduction: The prevalence of diabetes mellitus (DM) is still high and is expected to continue to increase. An increase follows this increase in the number of side events, so innovation is needed in DM therapy. DM induces oxidative stress so antioxidants can be an alternative therapy for DM. One source of antioxidants whose use is still limited is the banana plant, especially the banana stem. This study aimed to determine the effectiveness of kepok banana stem extract (Musa paradisiaca Var. Balbisiana colla) on MDA levels in diabetic rats.

Methodology/Approach: The study used a post-test-only control group design on 24 male rats (Rattus novergicus) Sprague Dawley strain with a bodyweight of 150-250 grams and ± eight weeks old. Rats were divided into four groups, namely the metformin treatment for positive control, distilled water for the negative control, and stem banana extract dose of 200 mg/kg BW and 250 mg/kg BW as treatment group of mice induced diabetes using STZ-NA and given treatment according to the group for 14 days. MDA level measurement using the TBARS method on rat liver. Data were analyzed using the One Way ANOVA comparison test.

Results: MDA levels in the positive control group, negative control, treatment 1 (200 mg), and treatment 2 (250 mg) were 0.9790 + 0.52 mg/dl, 0.7533 + 0.58 mg/dl, 1.2510 + 0.52 mg/dl, 1.5175 + 0.53 mg /dl. There was no statistically significant difference in MDA levels between groups (p=0.182), but there was a decrease in blood glucose levels in the group treatment. The highest decrease in blood glucose levels was in the dose treatment group, 250 mg/kg BW.

Conclusion:The treatment of kepok banana stem extract (Musa paradisiaca Var. Balbisinia colla) for 14 days at 200mg/kg BW and 250mg/kg BW increased malondialdehyde (MDA) levels, although not statistically significant.

Introduction: The largest public health issue in the globe, particularly for women who are close to childbearing age, is anemia. Anemia during pregnancy is said to be “dangerous to mother and child”. In 2015, Indonesia's maternal mortality rate (MMR) was 305 per 100,000 KH. Pregnancy who experienced anemia in the world are still very high. The prevalence of anemia in pregnancy is 41.8%. In Indonesia, the increasing in the incidence of anemia in pregnancy from 37.1% in 2013 to 48.9% in 2018. One of the causes of anemia in pregnant women is the knowledge and parity. This study aimed to analyze the knowledge and parity of the incidence of anemia in pregnant women.

Methods: The research design is cross-sectional with the independent variables which are knowledge and parity. The dependent variable is the incidence of anemia in pregnant women. The population used by all pregnant women is 48. The sampling technique uses total sampling and collecting data using questionnaires and interviews. Data analysis used univariate and bivariate.

Results: The results of research informed that most pregnant women had anemia, around 56.2%. The results of the statistical analyses revealed a p value of 0.007, indicating a relation between parity and the prevalence of anemia. Besides that, there was a relation between knowledge and the prevalence of anemia.

Conclusion: There is an influence between knowledge and parity on the incidence of anemia in pregnant women. Countermeasures that can be done by providing information communication and education on pre-wedding preparation.

Background: The golden standard of Hirschsprung's disease diagnosis is through a histopathological examination of the aganglionic site. The significance of serum acetylcholinesterase (AChE) immunohistochemistry for diagnosing Hirschsprung's disease has been widely accepted. However, the study of serum AChE levels in Hirschsprung's disease patients is still scarce. We aimed to examine the serum levels of AChE in individuals with Hirschsprung's disease.

Methods: An analytical observational study with a cross sectional design was conducted on 29 patients with Hirschsprung's disease. We divided the patients into two groups: 14 in Hirschsprung's disease group and 15 in the control group. Serum AChE level was measured using the enzyme-linked immunosorbent assay (ELISA) method. The optimal cut-off value for detecting Hirschsprung’s disease was determined using the ROC analysis.

Results: The prevalence of Hirschsprung was higher in males than in females. The average AChE level in the Hirschsprung group was 95.89 ± 51.11 Units/mL, while the average level of AChE in the control group was 44.45 ± 33.40 Units/mL. The optimal cut-off value was 46.615 Units/mL. We found that this study's sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values ​​were 83.3%, 70.6%, 66.7%, 85.7%, and 75.9%, respectively. There was a significant relationship between serum AChE levels and Hirschsprung's disease (p=0.004).

Conclusion: The AChE levels in blood serum can be used as an alternative diagnostic parameter for Hirschsprung's disease. Patients with Hirschsprung's disease had higher serum AChE levels than patients without Hirschsprung's disease.

Introduction: The decrease in muscle mass in the elderly is due to a decrease in nerve function and muscle weakness due to the aging process, lack of physical activity, and malnutrition. This study aimed to determine the effect of chair-based exercise and vitamin D levels on the strength of the hand grip on elderly women.

Patients and methods: Cross-sectional study involving 50 female respondents (aged 64.94±5.42 years) The study sample was elderly individuals who met the inclusion criteria at the Semarang Elderly Posyandu. Respondents were divided into 2 groups, namely the chair-based sports group and the chair-based no-sport group for 8 weeks. Checking the strength of the hand grip using a grip dynamometer.

Results: No significant differences was found in hand grip score between chair-based and non chair-based exercise (p>0.05). Meanwhile significant difference was found in hand grip score between person with .

Conclusion: There is an influence of vitamin D levels on the strength of the hand grip in elderly women

Introduction: Tartrazine is still one of the most widely used coloring agents in the pharmaceutical, cosmetic, and food industries; various hazardous consequences have been identified in rodents and humans, including impaired kidney function. This current study aimed to evaluate the effect of tartrazine on the biochemical parameters and structures of the kidney.

Methods: Twenty-four adult male Wistar rats were divided into four groups of 6 each. The experimental animals received tartrazine orally at a dose of 3.75, 7.5, and 15 mg/kg body weight along with a normal diet. The control group received only food and drinking water. The study was carried out for 21 days. At the end of the experiment, biochemical (blood urea nitrogen and serum creatinine) and histopathological examinations were performed on animal kidney tissues.

Results: Our findings revealed a significant increase in urea and creatinine levels in the serum of tartrazine-treated rats compared to controls (p < 0.05). The kidney section of rats treated with tartrazine showed lumen compression of tubular cells and loss of integrity of the renal tubule membrane. Tartrazine was associated with increases in the percentage of renal tubular necrosis in a dose-dependent manner compared to the control group (p < 0.05).

Conclusions: The current study concluded that oral administration of tartrazine affected the kidney by increasing urea nitrogen, creatinine levels, and the percentage of renal tubular necrosis in male Wistar rats. The results showed that tartrazine intake could cause adverse kidney health effects.

Background: Excessive physical exercise can cause injury and disrupt the body's homeostasis. Excessive physical exercise also causes increasing oxygen demand and reactive oxygen species production (ROS) that induce damage in various cells and body tissue, including HSC and CD4⁺ cells. This study aims to prove that excessive physical exercise decreases the CD4⁺ and HSC levels in Wistar rats and evaluates the correlation between HSC and CD4⁺ cell levels.

Methods: An experimental study with a randomized post-test-only control group design was conducted among 44 male Wistar rats in Clinical Pathology Laboratory, Mangusada General Hospital, Bali, from June to September 2022. The samples were divided into two groups; 22 rats received excessive physical exercise (treatment group) and 22 rats as the control group. The CD4⁺ cells and HSC were examined after 14 days of intervention. Data regarding the means of CD4⁺ and HSC levels between the two groups were assessed, and the correlation between HSC and CD4⁺ cell levels was analyzed using SPSS version 21 for Windows.   

Results: We used 22 rats for each treatment and control group. The mean level of CD4⁺ and HSC were significantly lower in the treatment group compared to the control group (356.41 vs. 661.41x10⁶ cell/µl; p<0.001) and (359.14 vs. 551.09 x10⁶ cell/µl). We found a statistically significant difference in CD4⁺ and HSC levels between the two groups, p<0.001). We also found a positive correlation between HSC and CD4⁺ level with r=0.636; p<0.001. Excessive physical exercise affected the immune function by decreasing CD4+ ad HSC levels in Wistar rats.

Conclusions: The impact of excessive physical exercise on immune function showed by decreasing the level of CD4⁺ and HSC level in Wistar rats. The HSC number also has a positive correlation with CD4⁺ cell level.

Background: Arteriovenous fistula (AVF) failure rate in chronic kidney disease patients is relatively high due to inadequate feeding arteries and draining veins. The primary balloon angioplasty (PBA) dilatation technique is a way to mitigate AVF failure. There have not been many studies to determine the patency rate with and without PBA. This study analyzed the patency rate and the number of patency failures in Indonesia AVF patients with and without PBA.

Methods: A retrospective cohort study was conducted in AVF surgery patients from 2019 to 2021 with or without PBA with a total sample technique. The patient was choosen without AVF surgery in the same arm with had follow-up every three months for three years. We excluded incomplete medical record data and unfollowed patients six weeks after surgery. The Kaplan–Meier method used the log-rank test to estimate each group's patency rate. The p-value<0.05 was considered significant.

Results: There were 60 subjects, of which 29 were with PBA and 31 were without PBA. There was a significant difference between the two groups regarding venous diameter and postoperative venous flow volume (p<0.01). The log-rank test showed a significant difference in patency failure in the group without PBA (35.5%, mean patency rate 56.3 weeks) compared to the group with PBA (10.3%, mean patency rate 104.4 weeks) with p=0.028. The median duration showed that 50% of the group without PBA experienced patency failure at week 59.3. In contrast, until the observation's end, the PBA group experienced patency failure of less than 50%.

Conclusion: Using the PBA technique can reduce the incidence of patency failure and maintain longer patency in patients with AVF.

Purpose: A ruptured intracranial aneurysm has a high mortality rate. Moreover, many of its surviving patients have to live with severe disabilities. Therefore, surgical or endovascular treatment is recommended in some patients with a known aneurysm and a high risk of rupture. However, many patients are reluctant to undergo treatment, fearing its complications. This study aimed to evaluate the treatment outcomes and safety in patients with a ruptured and unruptured intracranial aneurysm.

Methods: We retrospectively reviewed the records of patients treated for intracranial aneurysms in our hospital between 2017 to 2021. Our primary outcome was discharge functional outcome. We also evaluated cerebral infarction, stay duration, and mortality. We used bivariate and multivariate analysis.

Results: 85 patients were included in this study. 69 (77.5%) patients were treated after rupture. Most patients were treated with clipping (78.8%). Patients with a ruptured aneurysm significantly had a higher risk of poor discharge functional outcome (OR 5.708 [1.061 – 30.712]; p 0.042). Six patients with a ruptured aneurysm died. Patients with a ruptured aneurysm also spent more time at the hospital. There was no mortality or complication in patients with an unruptured aneurysm.

Conclusion: Patients treated before their aneurysms ruptured had better outcomes with no complications. Therefore, treatment should be considered for high-risk patients.

Background: Infections of the dental pulp and periapical tissues involve bacteria which can induce and enhance the immune response of the dental pulp but are not effective in eliminating root canal bacteria. A study was conducted to determine the effect of giving ethanol extract of green meniran leaves (Phyllanthus niruri Linn) in a mixture of calcium hydroxide and 2% chlorhexidine digluconate on the chronic inflammatory response in periapical tissue by measuring MMP-9, TGF-β₁ levels, osteoclast, and osteoblast cells count.

Methods: An experimental design with a post-test-only control group design involving 24 right molars of male Wistar rats divided into 4 groups. Each group consisted of 6 rats (K-) bacteria, (K+) bacteria, calcium hydroxide and 2% chlorhexidine digluconate, (P₁) bacteria, calcium hydroxide and 10% meniran extract, (P₂) bacteria, calcium hydroxide, 2% chlorhexidine digluconate and 10% meniran extract}. Examination of MMP-9, TGF-β₁ levels, and the number of osteoclasts and osteoblasts were evaluated until day 14.

Results: The administration of ethanol extract of green meniran leaves (Phyllanthus niruri Linn) in a mixture of calcium hydroxide as an intracanal medicament (P1) which was evaluated for 14 days overall showed a significant difference between groups (p<0.005). This condition can be seen in the group (P1), which has a lower MMP-9 level of 2465.88 pg/mL compared to the group (P2), (K+), and (K-). The levels of TGF-β₁ in the group (P1) were 181.57pg/mL, lower than the group (P2), (K+), and (K-). The number of osteoclast cells in the group (P1) was 1.67, which was lower than the group (P2), (K+), and (K-) was 5.00. The number of osteoblast cells in the (P1) group was 52.67, higher than the 32.17 group (P2), (K+), and (K-).

Conclusion: Green meniran extract (Phyllanthus niruri Linn) and its role as an intracanal medicament in teeth with chronic apical periodontitis.

Introduction: Currently, the coronavirus (Covid-19) is still a global problem that is felt by various countries in the world, including Indonesia. The occurrence of this epidemic greatly affected all sectors of human life, one of which was in the education sector where there was a changing the learning process from face-to-face to an online learning system. The implementation of online learning turned out to have a considerable impact on students, especially nursing students, one of which was the emergence of academic stress that was felt during the learning process. This study aimed to determine the correlation between academic stress due to online learning and the motivation, satisfaction and learning achievement of nursing students during the Covid-19 pandemic.

Methods: This study uses a descriptive correlative method with a cross-sectional approach. Researchers distributed online questionnaires to 259 respondents, namely active nursing students who carried out online learning. Then the data obtained were analyzed by researchers univariately to determine the distribution and frequency distribution and bivariate test using somersd and lambda to determine the correlation of each variable with academic stress.

Results: The results showed that there was a significant correlation between age (ρ=0.001), gender (ρ=0.005), grade education (ρ=0.048), learning understanding (ρ=0.000), and academic stress while the variable of media use did not correlate with academic stress (ρ=. In addition, academic stress is also correlated with variable satisfaction (ρ=0.041), and motivation (ρ=0.002) and is not correlated with learning achievement (ρ=0.388).

Conclusions: The current Covid-19 pandemic situation has greatly impacted the teaching and learning process, especially the emergence of academic stress, and decreased motivation and learning satisfaction of nursing students. This condition will become serious if each variable that is correlated with academic stress is not handled properly.

Introduction: Injuries are a major medical problem in military populations. The physical fitness assessment is a series of tests that measure and monitor physical fitness levels. The existing physical fitness assessment and formula used by the Indonesian Military requires a running test that only applies to healthy soldiers. This study attempted to construct a formula for assessing physical fitness using tests that soldiers may perform with lower limb injury/disability.

Method: The design of the study was an internal cross-sectional comparison. This study included 104 healthy, well-trained male normal soldiers (NS) and 50 injured or disabled soldiers (DS) who matched the inclusion criteria. The NS was required to perform a 12-minute running and wheeling test, a ball-throwing test, push-ups, and lunges. The DS was also required to perform the same tests except for the 12-minute running test and lunges. The analysis of the data consisted of four steps: constructing a conceptual framework, describing the characteristics of each group, identifying significant indicators using Partial Least Square-Structural Equation Modeling (PLS-SEM) to develop a physical fitness formula, and determining whether the formula is appropriate for assessing physical fitness in running and wheeling tests.

Result: There is no significant difference in the characteristics of NS and DS (p>0.05); thus, the subjects in both groups are comparable. Physical fitness test has several major contributing factors: distance, test method, muscle strength, and age. There is no significant difference in the number of NS in each category between the running and wheeling tests (p>0.05).

Conclusion: Physical fitness formula= {1.1 × (0.98 × distance^*) + (0.97 × method value^**)} – (0.093 × age) – (0.17 × muscle strength^***) Note: *) Distance traveled during running or wheeling test (meter). **) The running test method value is entered as 1, and the wheeling test method value is entered as 2. ***) The value of wheeling muscle strength is obtained from the ball-throwing test. In contrast, the value of running muscle strength can be determined by multiplying the result of the ball-throwing test by 2. These findings may be used for assessing the physical fitness of normal soldiers or those with lower limb injury/disability.

Background:  Breast milk plays a role in cognitive, sensory, and motor development and protects against infections and chronic diseases. The process of breastfeeding will protect the baby from illness, and increase cognitive intelligence and social-emotional development between mother and baby. Duration of breastfeeding was associated with acute illnesses, diarrhea, constipation, and a lower likelihood of being overweight/obese. Thus, this study aimed to the investigated correlation between pregnancy status and delivery type with successful breastfeeding in postpartum mothers at Roemani Muhammadiyah Hospital Semarang

Methods: This type of research was analytical descriptive, conducted in December 2021 with purposive sampling and a sample size of 120 respondents. The inclusion criteria of postpartum mothers who breastfeed their babies, mothers who are in good health, and baby who has no congenital abnormalities. Respondents who refused and who have babies with congenital abnormalities are excluded from the study. The data was extracted from the questionnaire and also coded into the SPSS 25 ver. Data were analyzed descriptively and analytically by using chi-square analysis.

Results: The participant with a planned pregnancy was 107 mothers (89.2%), unplanned 13 mothers (10,8%), section Caesarea type of delivery was 70 mothers (52%) and vaginal type of delivery was 50 mothers (48%). Based on LATCH score analysis planned pregnancy showed good category 38 mothers (31,7%), medium category 69 mothers (57,5%), and planned pregnancy showed good category 4 mothers (3,4%), medium category 8 mothers (6,7%), bad category 1 mother (0,8%). Based on the type of delivery, the vaginal type score was good for 25 mothers (50%), medium for 25 mothers (25%), and the section Caesarea type score was good for 17 mothers (24%), medium for 52 mothers (75%) and bad 1 mothers (1%). Either pregnancy status and type of delivery have P value scores of 0,016 and 0,012, respectively.

Conclusion: A mother that delivers a vaginal has a better level of breastfeeding than SC, and pregnancy status such as planned pregnancy also shows a better level than they are not.

Background: Nickel (Ni²⁺) allergy on the mucosa and gingiva is frequently found in patients with fixed metal orthodontic treatment as the manifestation of type-IV hypersensitivity reactions.

Method: This study aims to observe the effect of Brazilian propolis wax on salivary Ni²⁺ ion levels and blood serum IFN-γ and IL-10 levels during fixed metal bracket orthodontic treatment. A total of 34 New Zealand rabbits were divided into three groups. Before the treatment, Ni²⁺sensitization was done using a 125 μL NiCl₂ injection. Metal brackets were placed on the four anterior teeth for 28 days. Saliva was carried out for Ni²⁺ ion level analysis by inductively coupled plasma-optical emission spectrometry (ICP-OES), and ELISA measured peripheral blood serum for IFN-γ and IL-10 level analysis.

Result: Ni²⁺ ion release in the control group showed a higher expression than in the wax and propolis-wax groups. IFN-γ expression level is reduced in the wax and propolis-wax group than in the control group. Moreover, a significantly different IL-10 expression was also observed in the wax and propolis-wax groups.

Conclusion: The combination of propolis into wax orthodontic inhibits Ni²⁺ ion release by promoting anti-inflammatory IL-10 expression.

Introduction: Coronavirus Disease 2019 (COVID-19) has spread throughout the world, including Indonesia, so it is designated as a pandemic. To prevent the wider spread of COVID-19 transmission, the Indonesian government has implemented a COVID-19 vaccination program. The community knowledge, attitudes, and behavior towards COVID-19 vaccination are needed to support the success of this program. Therefore, this research aims to determine the Indonesian community knowledge, attitudes, and behavior towards COVID-19 vaccination.

Methods: This research was conducted by non-experimental observation with a cross sectional approach. Sampling using accidental sampling technique with the duration of the distribution of the e-questionnaire for 30 days. The sample of this research is the Indonesian community. The data were processed using descriptive statistical tests.

Results: The results of the univariate analysis with a total of 662 respondents showed that the majority of respondents were female, aged 18 to 25 years, educated in Senior High School/Equivalent, Muslim, domiciled in Riau, student, and received information from social media and other online media. The majority of respondents have a good level of knowledge with a score of 80.1%, have a positive attitude and behavior with a score of 53.5% and 51.8%.

Conclusion: The Indonesian community have a good level of knowledge, as well as positive attitudes and behaviors towards COVID-19 vaccination.

Background: The initial presentation of hospitalized End-Stage Kidney Disease (ESKD) patients with and without coronavirus disease 2019 (COVID-19) is similar and can overlap. We aimed to compare clinical dan laboratory characteristics of the COVID-19 positive and negative patients to help clinicians screen and differentiate hospitalized ESKD patients.

Methods: We reviewed data from the medical record of ESKD patients hospitalized between May 1, 2020, and April 30, 2021. The study comprised all suspected COVID-19 patients. The COVID-19 positive was based on results from RT-PCR for SARS-CoV-2. The bivariate analysis was used to compare the positive and negative groups. The association of all characteristics and diagnosis of COVID-19 were then evaluated by multivariable analysis.

Results: There was twenty-nine percent of confirmed COVID-19 in 176 ESKD patients. The proportion of dyspnea, pulmonary edema, pleural effusion, and cardiomegaly were lower in the COVID-19 positive group. Diastolic blood pressure, pulse rate, white blood cell differential counts, and potassium were lower in the COVID-19 positive group. Using a multivariate analysis, eosinophil count <0.04 x10³µl (P<0.001, OR 3.50, 95%CI:0.123-0.665), monocyte count <0.69 x10³µl (P=0.004, OR 2.54, 95%CI:0.166-0.931), and neutrophil-to-lymphocyte ratio (NLR) <3.13 (P=0.044, OR 3.18, 95%CI:0.102-0.968) were associated with the presence of COVID-19.

Conclusions: Leukocyte differential count and chest x-ray should be evaluated as an initial screening of COVID-19 in hospitalized ESKD. Low levels of monocyte and eosinophil count and mild elevation of NLR were associated with COVID-19 in ESKD patients.

Introduction: Javanese Handwriting Calligraphy (JHC) is taught at the elementary & junior high school level on Java island in Indonesia. Calligraphy is part of Javanese culture and language. The number of Javanese speakers worldwide is 85 million (speakers of the 11th language worldwide). The study was conducted using elements of art and visuospatial aspects in Javanese calligraphy, not far from Chinese calligraphy, which has been proven to affect neuropsychiatric therapy. This research is a preliminary study aimed at proving JHC calming effect.

Method: Thirty elementary school students who are already proficient in writing JHC and willing to participate in the study voluntarily in placed in a quiet room, then the pulse rate was measured before and after writing calligraphy Latin letters. Next, rest for 15 minutes and measure the pulse before and after writing JHC.

Results: There is no difference in heart rate before the intervention in writing Latin and Javanese letters (p = 0.382). There is a difference in heart rate after the intervention of Latin and Javanese letters (p = 0.006). There is no difference in the value before and after the Latin letter intervention (p = 0.651). There is a difference between before and after the intervention of writing Javanese letters (p = 0.018).

Conclusion: JHC can be considered as a way of calming down. More research on different age groups and more robust designs is needed (cross-over).

Introduction: Low hemoglobin levels in pregnant women are global health problem that adversely affect the mother’s and newborn’s health. There is no study proving the effect of anemia during adolescence in pregnancy, especially in Indonesian population. This study aimed to investigate the effect of anemia in adolescence on the hemoglobin level during pregnancy, using Indonesian Family Life Survey (IFLS) data.

Methods: This retrospective cohort study used the 1997, 2007 and 2014 IFLS data. The hemoglobin levels in adolescents aged 10-18 years were obtained from the IFLS-II data in 1997. Then, the hemoglobin levels during pregnancy from the same individuals were tracked from the IFLS-IV in 2007 and IFLS-V in 2014. Data from 210 subjects were included in the analysis as these subjects had the complete data on hemoglobin levels during adolescence and pregnancy and all other considered confounding variables, such as maternal age, iron protein, vitamin C consumption, education, working status, residence, socioeconomic status, gestational age at data collection, parity, antenatal care, iron supplement consumption. Data was analyzed by T tests, Pearson’s correlation tests and General Linear Model.

Results: The mean hemoglobin levels of pregnant women was 11.23 g/dL with standard deviation 1.271 and the prevalence of anemia during adolescence was 34.3%. There was a significant difference of 0.447 g/dL in the average hemoglobin levels in pregnant women with and without history of anemia during adolescence (p=0.023). The hemoglobin levels in pregnant women also differed among trimesters of gestational age (p=0.001). After being controlled for vitamin C and protein consumption, anemia status during adolescence still has a significant effect on lowering hemoglobin level during pregnancy.

Conclusion: Anemia during adolescence negatively impacts pregnant women's hemoglobin levels. Prevention programs for anemia in pregnant women should be started from adolescence period.

Introduction: Tinospora crispa (T. crispa) is an herbaceous plant that commonly grows wild in tropical regions of South East Asian countries such as Indonesia, Malaysia, and Thailand. In Indonesia, this plant is well known to be used as a traditional medicine to treat gout, diabetes, hypertension, rheumatic, fever, and appetite stimulant. Researches worldwide indicate that T. crispa poses several pharmacological properties. One of those is the antioxidant activity, acting as a free radical scavenger. The objective of this study was to determine the antioxidative properties of T. crispa and to compare the different ethanol solvents used for extraction.

Methods: The amount of 300 g T. crispa powder was extracted using 70%, 80%, and 96% ethanol. The spectrophotometry method is used to assess the total flavonoid and polyphenol contents as well athe s DPPH assay.

Results: The 80% ethanol had the highest flavonoid content 0.090% ± [0.453%], while 96% ethanol indicated the lowest 0.038% ± [3.090%]. In the case of phenolic content, 96% ethanol showed the highest result 0.521 ± [11.341%]. However, this value was relatively comparable with the other solvents. The highest DPPH activity was shown by 80% ethanol 6.46 mg ± [3.04 mg].

Conclusion: Despite low in the concentration, flavonoid and polyphenol content was successfully determined from T. crispa by using different ethanol solvents. Based on the result of antioxidants concentration and activity, 80% ethanol is the most ideal solvent to be used for extraction of T. crispa.

Abstract: The decision that declared COVID-19 as a pandemic in March 2020 had become a medical emergency that also effects kidney transplantation program and care. Kidney transplantation has been a definitive treatment for end-stage renal disease (ESRD) patients since it improves patient’s quality of life. However great the beneficence is, kidney transplant procedure still carries high risk of COVID-19 infection especially for recipients who are obliged to take immunosuppression agents after transplantation.

Purpose: This study aimed to evaluate kidney transplant procedure in Dr. Sardjito General Hospital within before and during pandemic based on recipients’ and donors’ characteristics and laboratory findings such as creatinine and urine time.

Patients and methods: This study is designed as a cross-sectional analytic research to evaluate 30 patients that underwent kidney transplant in Dr. Sardjito General Hospital within before (April 2019-2020) and during (April 2020-2021) COVID-19 era. Data analyses were carried out using SPSS version 25.0 and were served with simple charts and tables.

Results: There is a decrement of kidney transplant procedure within before (n=16) and during (n=14) COVID-19. Age group of recipients that underwent the most of transplantation before pandemic are 20-29 years old while during pandemic are 40-49 years old. There is no significant difference in length-of-stay within before (12.0±4.17 days) and during (9.29±3.73 days) COVID-19 (p=0,077). Laboratory findings such as creatinine of pre-transplantation (9.47±4.05; 7.81±6.00) and 3 months’ post-transplantation (1,55±0,78; 1,15±0,67) also did not show significant changes (p=0,153) as well as urine time (245.60±225.55; 428.38±657.70; p=0.321).

Conclusion: There is a decrement of kidney transplant procedure in Dr. Sardjito General Hospital within before and during COVID-19 era. There are no significant differences found within length-of-stay, creatinine pre and 3 months’ post-transplantation and urine time. On the whole, transplant outcomes have remained similar within pre and during COVID-19 era.

Introduction: Various surgical procedures have been found to effectively treat intractable temporal lobe epilepsy (TLE), including transcortical selective amygdalohippocampectomy (SAH), which is intended to protect the temporal lobe and to prevent interference with vascular structure. This research analyzed the outcome of post-operative seizure-free with transcortical selective amygdalohippocampectomy for intractable mesial temporal lobe epilepsy patients in a minimum two-year follow-up after surgery.

Methods: Data of one hundred ninety-two patients who had undergone transcortical selective amygdalohippocampectomy for non-lesional, medically intractable, temporal lobe epilepsy were analyzed.

Result: The statistical analysis indicated that Focal to Bilateral Tonic-Clonic Seizure had a more significant outcome (p=0.019) than other seizures. In all research subjects, after three, six, and twelve years of follow-up, the chance for a seizure-free after surgery was respectively 93.2 percent, 67.9 percent, and 36.7 percent with a median average survival period for all subjects of 11.00 years (95 % CI: 8.55 – 13.44)

Conclusions: Transcortical selective amygdalohippocampectomy is an effective therapy for intractable mesial temporal lobe epilepsy and provides a satisfactory outcome. The transcortical approach allows an appropriate operative field by careful dissection with limited retraction to eliminate the epileptogenic target while preventing damage to the underlying vascular and cortical structures.

Introduction: The elderly will experience a decrease in health status caused by either disease or nature, so they are at risk of suffering from hypertension. Hypertension can be controlled by medication adherence. Self-efficacy is a factor that plays an important role in medication adherence. The important role of self-efficacy lies in a person's self-knowledge, which refers to self-confidence in achieving hypertension treatment goals. To identify the relationship between self-efficacy and the level of medication adherence in the elderly with hypertension.

Methods: This study used a cross-sectional method with a random sampling technique. The sample of this study was 60 older people in Mejing Wetan. The measuring instrument used was MASES-R to measure self-efficacy and MMAS-8 to measure medication adherence. Univariate analysis used descriptive statistical analysis, while Bivariate analysis with SPSS used the Chi-Square analysis method. There will be a significant relationship if p is < 0.05.

Results: The results showed that the respondents' self-efficacy is dominated by the moderate category (41.7%), (73.3%) respondents were disobedient in taking medication, and the significance value was p=0.000. It indicated a significant relationship between self-efficacy and medication adherence as p<0.05. In addition, the correlation results were very strong (r=0.781).

Conclusion: There was a strong relationship and a positive direction between self-efficacy and the level of medication adherence in the elderly with hypertension

Introduction: Health professionals as key players in the health effort, who must prepare to face the 'triple burden' of challenges such as the current pandemic COVID-19. Closely related to interprofessional education is the realization of a workforce that is prepared through independent learning to face change, social order, culture, labor needs and technological advances. The purpose of this study was to assess acceptance of interprofessional education among health-based undergraduate educators.

Methods: Cross-sectional study design. Respondents are 45 educators from 141 educators from the Public Health, Nutrition, Nursing, Medicine, Midwifery, Occupational Health and Safety, and Medical Laboratory Technology Study Program. The instrument is a questionnaire that refers to the Interdisciplinary Education Perception Scale (IEPS) in the form of multiple-choice questions and the results are analyzed descriptively.

Results: The result of the study is respondents agree that educators need to work with other professions through interprofessional education is 62,2%. Respondents that said about individuals in their profession are very positive about their contributions and achievements are 71,1%. 68.9% of respondents trust each other's professional judgment. There are 40% of respondents who do not agree with the assumption that their status profession is looked higher than other professions. 64,4% of respondents understand that they need to make every effort to understand the capabilities and contributions of other professions.

Conclusion: The results of this study indicate that educators' perceptions of IPE can provide an understanding of the need for collaboration and a better attitude in teamwork through interdisciplinary education. Further research is needed to explore other factors that may influence specific perceptions among educators.

Background: Conjunctiva, when injured, can heal spontaneously. However, in extensive wounds, wound healing is often accompanied by scarring and wound contraction. Currently, for cases of disease and trauma to the surface of the eyeball, it can be reconstructed using the amniotic membrane, but there are still weaknesses in the use of amnion. Platelet-rich fibrin (PRF) is currently being developed for the reconstruction of ocular surface wounds.

Methods: A total of 20 male New Zealand rabbits (20 eyes) were divided into two groups. In the first group, conjunctival excision and PRF membrane graft suturing were performed on the right eye conjunctival defect, while the second group had an amniotic membrane sutured on the right eye conjunctival defect. On the 14^th day, enucleation was carried out and continued with histopathological examination using immunohistochemistry using TGF antibodies and type 1 collagen to evaluate the levels of TGF and type 1 collagen in the conjunctiva.

Results: The results after 14 days of treatment showed that there was a very significant difference in TGF Beta expression between the AMT group and the PRF group (p = 0.007*; <0.05). However, in the expression of type 1 collagen, there was no significant difference in the expression of type 1 collagen between the AMT group and the PRF group (p = 0.791; >0.05).

Conclusion: There were differences in the expression of TGF-β and type 1 collagen in the administration of the PRF membrane compared to the administration of the amniotic membrane after conjunctival excision of experimental male New Zealand rabbits on day 14.

Introduction: Unachieved exclusive breastfeeding is still a problem in Indonesia. During pandemic covid-19 situation, the condition required to keep the distance from other people resulting the limited access between breastfeeding mothers and midwives. The role of the closest person that is husband is needed to constantly provide support. The objective of this research is to determine the relationship between husband's support during the covid-19 pandemic with exclusive breastfeeding

Methods: The type of research used is an analytic survey with a cross sectional method. The total population are 51 people and the sample of 45 people is taken using purposive sampling technique. Collecting data using questionnaire sheets given to respondents. Data analysis using Chi Square test (X2).

Results: Based on analysis, we found that husband’s support has a significant association with the quality of exclusive breastfeeding with p=0.000.

Conclusion: The result of the research informed husbands who want to provide support in the form of effective communication between husband and wife during the breastfeeding process, able to help breastfeeding mothers to keep the spirit of breastfeeding, and will help provide breast milk as the best food for their babies. There is a significant relationship between husband's support in the success of exclusive breastfeeding during the covid-19 pandemic.

Introduction: Epilepsy is an unprovoked seizure caused by an abnormal paroxysmal neuronal release in the brain. One of epilepsy treatments is anti-epileptic drug divalproex sodium. It is often prescribed to control seizures but it increases body weight. Weight gain may decrease the effectiveness of epilepsy treatment and cause endocrine disorders. CYP2C19 polymorphism may help physicians map patients vulnerable to weight gain due to divalproex sodium. This study aimed to determine the relationship between CYP2C19 polymorphisms and the incidence of weight gain based on gender in epilepsy patients treated with divalproex sodium.  

Methods: This cross-sectional study consisted of 17 male and 23 female patients. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to identify CYP2C19 polymorphism which was grouped into: extensive metabolizer, intermediate metabolizer and poor metabolizer. The results were analyzed using Chi-squared test to determine the relationship between CYP2C19 and each variable (gender, age, epilepsy types, valproic acid types, family history of obesity and presence of weight gain) based on of gender.

Results: The results showed that there was no statistically significant association between CYP2C19 polymorphisms and gender-based epilepsy patients groups (p>0.05). We found that most of the subjects in this study were women with an increase in body weight by 57.5%. There was no association of CYP2C19 polymorphism with type of divalproex sodium, dose of divalproex sodium, length of treatment, type of epilepsy and family history of obesity.

Conclusion: There is no significant association between CYP2C19 polymorphism and weight gain between genders in epilepsy patients.  

Background: A widespread intra-abdominal organ infection or complicated intra-abdominal infection (cIAI) causes localized peritonitis, intra-abdominal abscess, and diffuse peritonitis. Patients suffer from morbidity and mortality as a result of this condition. Sepsis indicators such as SOFA, WSESSSS, and CPIRO scores were predictors of mortality in cIAI patients. We aimed to examine the performance of WSESSSS, CPIRO, and SOFA scoring systems to predict mortality in patients with cIAI.

Methods: A retrospective cohort, analytic observational study was conducted to assess differences in SOFA, WSESSSS, and CPIRO scoring systems' sensitivity, specificity, and accuracy as predictors of death during treatment in cIAI patients in Dr. Soetomo General Hospital, Surabaya.

Results: A total of 265 patients were evaluated. The optimal cutoff for SOFA was score 5 with sensitivity, specificity, PPV, NPV, and accuracy of 77.2%, 87.9%, 77.2%, 87.9%, and 84.2%, respectively. The optimal cutoff for WSESSSS was score 8 with sensitivity, specificity, PPV, NPV, and accuracy of 83.7%, 82.7%, 72.0%, 90.5%, and 83.0%, respectively.  The optimal cutoff for CPIRO was 4 with sensitivity, specificity, PPV, NPV, and accuracy values of 62.0%, 90.2%, 77.0%, 81.7%, and 80.4%, respectively. Patients with high scores had a higher percentage of being hospitalized longer and cost higher than patients with a low score.

Conclusion: The SOFA, WSESSSS, and CPIRO scoring systems had comparable performance in predicting mortality in patients with cIAI. Considering the performance of WSESSSS, the use of WSESSSS alone may be sufficient enough to predict the outcome of patients with cIAI in Indonesia.

Introduction: Recognition of conus medullaris position, contains lumbosacral plexuses which supply motor and sensory innervation to the whole lower limb, pelvic and perineal areas, is critical to avoid injury due to lumbar procedures, such as spinal anesthesia and lumbar punctures. This study aimed to investigate the position of conus medullaris among Indonesians through magnetic resonance imaging (MRI) of the lumbar spine at Dr. Soetomo General Academic Hospital in order to minimize the risk of conus medullaris trauma.

Methods: A retrospective study was conducted to investigate the conus medullaris level and its correlation to gender and age Indonesian patients. The data were collected from lumbar MRI at Dr Soetomo General Academic Hospital during January 2020 and December 2021. The level variations of conus medullaris were recorded and determined as the highest, lowest and most common location descriptively.

Results: A total of 257 patients (126 male and 131 female) were included. The highest level of conus medullaris was in T11-T12 vertebrae (five patients). There were 12 patients in T12 vertebrae, T12–L1 in 86 patients, L1 in 62 patients, L1–L2 in 76 patients, and L2 in 12 patients. The lowest level was in between L2 and L3 vertebrae in 4 patients. Gender and age had no association with conus medullaris level.

Conclusion: The lowest level of conus medullaris was in between L2 and L3 vertebrae. The lumbar procedure such as punctures should be done below the L3 to avoid conus medullaris puncture trauma.

Introduction: There are still many people in Indonesia who are not aware of the importance of information related to the early symptoms that must be experienced when they become patients. Not infrequently, this lack of information disclosure results in misdiagnosis and even leads to unexpected death. Anamnesis is a process where the doctor or medical record nurse gives several questions about the clinical pathway in the form of a narrative to facilitate early identification of the disease, and the results of this history-taking process are stored in the Electronic Medical Record (EMR). EMR narratives often cannot be processed by computers if language literacy is not standardized or ambiguous, so the need to overcome this problem requires the use of technology to minimize misdiagnosis and facilitate the identification process by developing digitization in the form of mobile applications that are integrated with Natural Language Processing technology and ICD-11 in the symptom identification process. This study aims to identify ICD-11 symptoms based on clinical NLP mobile application to diagnose the disease (ICD-11).

Methods: The applications of Natural language processing includes literature study, Voice Recognition, Tokenization, Stemming, The process of Stopwords Removal, Named Entity Recognition, Data Translation, Access ICD Data, and Mobile User Interfaces.

Results: Named Entity Recognition (NER) is used to identify symptoms of digestive system diseases, with an accuracy rate of 74.3%. In stemming and stopwords processing, the NLP accuracy rates are 95.9% and 97.2%, respectively.

Conclusions: This research focuses on the application mobile and development of the Named Entity Recognition (NER) model. The importance of the NLP process in the development of information, especially for word processing, aims as a device that simplifies speech recognition systems to be more helpful.

Introduction: Several studies showed 324 severe cases of COVID-19 and 1234 mild cases with the highest comorbidities of Hypertension, Diabetes Mellitus, Chronic Obstruvtives Pulmonary Disease (COPD), and Cardiovascular disease. These comorbid factors lead to a poor prognosis in COVID-19. Chest radiography is an important modality as one of the parameters that can indicate the severity of COVID-19. This study aims to determine the relationship between Covid-19, comorbid Hypertension, and Diabetes Mellitus with chest radiography.

Method: This research is analitic observational with cross-sectional, relationship between Covid-19 patients with comorbid Hypertension and Diabetes Mellitus with chest radiography (type, location, and extent of lesions) that Modified Chest X-Ray Scoring System in Evaluating Severity of COVID-19 Patient in Dr. Soetomo General Hospital Surabaya, Indonesia in 2021, COVID-19 radiology category.  The data from PKU Muhammadiyah Gamping Hospital, Yogyakarta retrospectively from the medical records of Covid-19 patients who met the inclusion and exclusion criteria. Chi-Square analyzed the results variables with unpaired categorization.

Result: Most of the respondents who had comorbid diseases had moderate chest radiological features (65.4%) and those who did not have comorbid diseases had mild chest radiological features (71.9%), the results of chi-square data analysis between variables were p: 0.000.

Conclusion: The results of data analysis showed that comorbid diseases had a significant relationship with chest radiography in patients with confirmed COVID-19. The novelty of this study is the importance of radiological modalities as one of the parameters that can indicate the severity of Covid-19 patients with comorbidities.

Introduction: Many studies have provided non-pharmacological therapies to overcome health problems, including maternal and child health. One is how to overcome sleep disorders often complained about in pregnant women's third trimester. Some previous studies have analyzed aromatherapy using floral fragrances by inhaling aromatherapy oil directly or applied to cotton and using one type of aroma only, while inhalation using a diffuser and combining two or more similar scents have not been studied. The combination of both compositionally and beneficial aromas can complement each other, for example, lemongrass and lemon. This study aimed to examine the impact of essential oils diffuser and mix aromatherapy lemon grass on sleep quality and anxiety levels in pregnant women in their third trimester.

Methods: This study used quasi-experimental studies with one group pre-test and post-test. The research sample is 48 pregnant women in the third trimester of Wonokromo were selected with simple random sampling. The Independent variable is aromatherapy interventions (blended lemongrass and lemon) inhalation using diffuser, while the dependent variables are sleep quality. Data collection instrument using Pittsburg Sleep Quality Index (PSQI). Data analysis using Wilcoxon test with α=0.05.

Results: After being given aromatherapy intervention, almost all respondents have good sleep quality, 8-point increase in average sleep quality score. The results of the Wilcoxon test obtained a value of ρ = 0.01.

Conclusion: Essential oils diffuser blend aromatherapy of lemongrass and lemon effectively improves the sleep quality of third-trimester pregnant women. Aromatherapy makes participants feel relaxed, comfortable, and feel sleepy better. For health workers, this technique can be one of the practical options for non-pharmacological therapy to decrease discomfort during pregnancy.

Abstract

Background: Breast cancer is the most common cancer in women. The occurrence of metastasis in breast cancer should be detected early. Tumor necrosis factor-α (TNF-α) is involved in every step of the carcinogenesis process. A rise in TNF-α level is linked to the advancement of breast cancer. We aimed to determine the association between TNF-α levels and breast cancer metastases.

Methods: An analytic cross-sectional study was conducted on women with breast cancer treated at the Oncology Surgery Center between November 2021 and April 2022. The patient's data were collected from the medical record, including age, menopausal status, tumor size and lymph node involvement, and tumor subtype. The serum TNF-α level was measured using ELISA. The optimal cut-off value was determined using the receiver operating characteristics analysis. The association between serum TNF-α and the incidence of breast cancer metastases was analyzed using SPSS version 26 for Windows.

Results: We analyzed a total of 50 patients. The mean age was 48.8 ± 8.3 years. The serum TNF-α level was divided into high-TNF-α and low-TNF-α using a cut-off value of 22.755 pg/mL. There were 27 patients (27/50; 54.0%) with high serum TNF-α levels and 23 patients (23/50; 46.0%) with low TNF-α levels. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 73.9%, 63.0%, 63,0%, 73,9%, and 68%, respectively. There was a statistically significant association between serum TNF-α levels and metastatic breast cancer (p=0.009).

Conclusion: There was a significant association between TNF-α levels and metastatic breast cancer. Serum TNF-α may be a potential biomarker to detect metastasis in breast cancer patients.

Background: Based on the onset of events, the most common neonatal sepsis is early-onset neonatal sepsis (EONS), which occurs within the first 72 hours of life. Blood culture is the gold standard for EONS, but this examination takes a long time to provide the results. However, the latest method is obtained to determine the shift to the left granulocytic image by counting Immature Granulocyte (IG). This study aims to evaluate the accuracy of the IG Ratio for diagnosing EONS in neonates suspected of having sepsis.

Methods: A cross-sectional observational study was conducted among 60 EONS patients consecutively, who met the inclusion criteria from January to June 2022 at Prof. dr. I.G.N.G Ngoerah Hospital, Bali. Variables assessed in this study included age, gender, delivery methods, birth status, birthweight, blood culture, complete blood count (CBC), I/T ratio, and IG ratio. Data were analyzed using SPSS version 23 for Windows.

Results: The cut-off point of the IG Ratio was 2.21 (AUC=0.670 (0,490-0,851); p=0.041; OR: 8.021 (2.283-28.185); p=0.001), which had a sensitivity of 64.7% and a specificity of 81.4% for diagnosing EONS in neonates suspected of having sepsis. The results also obtained a Negative Predictive Value (NPV) of 85.35 and a Positive Predictive Value (PPV) of 57.89.

Conclusion: The cut-off point of the IG Ratio of 2.21 has a risk factor of 8.021 times higher for diagnosing EONS in neonates with sepsis.

Introduction: Breast cancer is the leading cause of death in women. Many studies of adjuvant therapy have used the Quran recitation (later will be mentioned as the murotal approach). The murotal approach has been shown to induce feelings of well-being, enhance therapeutic response, and aid in patient healing. This study aimed to analyze the effect of the murotal approach on lymphocytic cell activity in inducing programmed cancer cell necrosis in a breast cancer mouse model.

Methods: After testing in a fully randomized design using 24 female mice (Mus musculus) BALB/c strain, a real-world experimental study with a control group design method. The mice were divided into four groups: negative control (K-), positive control (K+), treatment group (P1) which receiving the murotal approach for 2 hours and 30 minutes per day for a week, and the (P2) which receiving the murotal approach for 30 minutes in five times a day for a week. Mice were subcutaneously injected with DMBA 0.56 mg/20 g every 2 days for 3 weeks. The murotal approach was using specifically in Surah al-Faatihah and Al-Baaqarah from Qori' Al-Mathrud. Cancer tissue was harvested 5 weeks after her. The data were analyzed using the Kruskal-Wallis hypothesis test.

Results: There was a significant difference (P<0.05) in the effect between the P2 treatment group that received murotal therapy for 30 minutes at each prayer time and the other groups. The efficacy of treatment murotal for 2 hours and 30 minutes per day does not affect the extent of lymphocytic infiltration.

Conclusion: From the research, the dosage of murotal therapy to increase the degree of lymphocyte infiltration is for 30 minutes five times a day, or during prayer time.

Background: Combine Oral Contraceptives (COCs) pills is one of the many popular contraceptives worldwide, with 100 million women who use contraceptive pills. To increase the choice of oral contraceptives, COCs Novadiol® (Pill A) domestic production, which has the same dosage as Microgynon® (Pill B), are still imported drugs. This study aims to determine Pill A's efficacy, safety and acceptance level compared to Pill B for 3 months.

Methods: The study was a randomized control clinical trial, an open-label trial in 200 women of childbearing age who met the inclusion and exclusion criteria from July to November 2015. Data were analyzed using SPSS version 20 for Windows.

Results: About 300 participants were selected and 200 met the inclusion and exclusion criteria who participated study from the beginning to the end of the study period. In the first month of observation, 1 complaint of dizziness in pill A and 2 from pill B. One nausea complaint was found in the participant from Pill A. These differences were not statistically significant (p>0.05). In the second month of observation, 1 complained of dizziness from pill B and 1 nausea from Pill A. In the third month, observation found no complaints about using Pill A and pill B. There were changes in menstrual patterns in both pills and bleeding outside the cycle during the use of 3 months, but they were not statistically significant (p>0.05).

Conclusion: Pills A has the same efficacy, safety and acceptance when compared to the use of birth control pills B for 3 months.

Background: Skin is considered a reflection of a person's appearance, so it is normal if many people try to take care of their skin, especially facial skin, and retard the aging process. Dermoscopy is a quick, non-invasive technique that allows physicians to observe the skin. Different ethnic groups may show different signs of aging on the face. Medan is a multiethnic city and thus might show facial skin aging differently. This study aimed to evaluate facial skin aging through the Dermoscopic Photoaging Scale (DPAS) and assess the relationship between DPAS, Glogau and Fitzpatrick scales among various ethnic groups in Medan, Indonesia.

Subjects and Methods: This cross-sectional study enrolled 155 subjects from 10 ethnicities in Medan. The examination of facial aging is based on DPAS using 11 criteria, the Glogau scale, and the Fitzpatrick skin type.

Results: Malay and Karonese got the highest DPAS score. There was a significant difference between DPAS, Glogau, and Fitzpatrick in age (p = <0.001,<0.001 and 0.032), and Fitzpatrick scores in ethnicity (p <0.001). There was a strong and significant correlation between DPAS and Glogau scores (p < 0.001, r = 0.748), while DPAS and Fitzpatrick's scores showed a moderate and significant correlation (p < 0.001, r = 0.288).

Conclusion: The highest DPAS scores were found in the Malay and Karonese ethnic groups. There were significant differences between DPAS, Glogau, and Fitzpatrick in age and Fitzpatrick scores in ethnicity. There was a strong and significant correlation between DPAS scores and the Glogau scale and a moderate and significant correlation between DPAS and Fitzpatrick scores in various ethnic groups.

Introduction: The current burden of malnutrition in Indonesia is trifold. The nutrition programme component aims to reduce the triple burden of malnutrition throughout the life cycle, through support to maternal nutrition, prevention of stunting and wasting in children under 5 years of age, nutrition for school-age children and adolescents, and overweight prevention. The purpose of this study was to determine the factors to accelerate the reducing stunting cases in Jombang regency, with optimal convergence actions and cross sectoral effort.

Methods: This study is a qualitative study with a case study approach. The study is located in 11 village in Jombang regency. This study was conducted in September-November 2021. Data collection was carried out in in 11 village in Jombang district East Java Province, Curah Malang Village, Murukan Village, Diwek Village, Rejoslamet Village, Dukuh Klopo, Pakel, Kali Kejambon, Jombatan, Sumber Mulyo, Gadingmangu, Darurejo.  

Results: The percentage of stunting in 2018 to 2021 has decreased significantly. According to data from the Bappeda of Jombang Regency on November 29, 2021, the stunting performance review activity showed that, in 2018 the number of cases in Jombang Regency was 20.1% with the number of stunting toddlers being 15,056 children, experiencing a decrease of 9.8% in 2021. The percentage of case data in 2021 is 10.3% with a total of 7,518 stunting children under five

Conclusion: The percentage of stunting in 2018 to 2021 has decreased significantly which is influenced by various factors that need to be controlled to reduce the incidence of stunting in Jombang regency.

Background: Coronavirus disease 2019 (COVID-19) patients with obesity are more susceptible to liver injury. There is currently no published overview regarding COVID-19 patients with liver injury in Indonesia. Our study reported 7 cases of obese COVID-19 patients with an increase of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT), followed by 5 of them developing severe symptoms of COVID-19 in isolation room of Dr. Soetomo Hospital Surabaya within June-December 2020.

Case Presentation: A total of 7 COVID-19 patients, by the average age 46.2±15.5 years, were obese. The mean body mass index (BMI) was 36,3±3,4 kg/m2. Five of them experienced serious symptoms. There were 3 patients (patient no. 2, 4, 7) who had normal SGOT level, while the rest had an increased SGOT level for <2x upper limit of normal (ULN) at admission. During treatment, SGOT level increased in 5 patients for 1-<3x ULN and normal in the rest of them (patient no. 2, 4). Meanwhile, the normal SGPT levels were shown in 3 patients (patient no. 2, 4, 7) and increased in 4 others at admission for 1-<4x ULN. All of them tended to have an increased SGPT level during treatment for 1-<5x ULN. However, since the increase of SGOT and/or SGPT for >3x ULN is defined as liver injury, it happened in 2 patients that occur since admission (patient no. 3) and during treatment (patient no. 5).

Conclusion: Obesity may impede the recovery of COVID-19 and manifest in the deterioration of liver function.

Background: Striae distensae (SD) is a common skin disorder in the form of linear atrophy, which arises due to stretching and is one of the most common cosmetic problems. There is no scoring system to assess the severity of striae distensae that is easy to use, non-invasive, and consistent and can be used to evaluate SD treatment. This study formulated and validated a scoring system to assess the severity of striae distensae.

Methods: This study was a descriptive observational study with a cross sectional approach involving 30 female health workers at the Universitas Sumatra Utara Hospital. Assessment of SD severity in six regions using four parameters.

Results: A scoring system for the severity of striae distensae has been formulated, named the INA score, to assess the severity of SD in six regions; mammae, axilla, abdomen, femur, gluteus and poplitea using four parameters; the number of lines, the size of the longest striae distensae line, color, and itchy. The results of the validation test are statistically valid (r-value>0.361), and the reliability test is found to be reliable (Cronbach's Alpha>0.361).

Conclusion: The formulation of a valid and reliable scoring system, named the INA score, has been obtained to assess the severity of striae distensae measured at six locations and four parameters.

Introduction: Children should not only be managed in high pain conditions; pain management in children should also involve moderate procedures, particularly invasive. Behavioral intervention is pain management for children since it is invasive action. The study's objective was to examine how behavioral therapies were used to treat children's discomfort without the use of drugs.

Method: We used PRISMA principles and conducted a systematic review. The original keywords utilized were "child," "behavioral treatment," and "pain management," which were further developed using "medical subject headings." Scopus, PubMed, and Research Gate were the three databases that were searched for prospective papers published between 2000 and 2020.

Results: Children can experience less pain by engaging in behavioral interventions like joyful pingu pain relief, cognitive behavioral therapy, positive reinforcement, graphic books about intravenous placement for training the desired behavior, and watching their favorite music videos.

Conclusion: Children can experience less pain with the help of behavioral therapies like happy pingu, cognitive behavioral therapy, picture books about intravenous placement, and watching their favorite music videos. These interventions train the desired behavior and can also be used to stop discomfort.

Background: We conducted a systematic review and meta-analysis to determine the efficacy and safety of mini-Percutaneous Nephrolithotomy (PCNL) compared to standard PCNL in children with nephrolithiasis. Clinical trials and observational studies comparing standard PCNL and mini-PCNL in pediatric patients were identified from electronic databases in November 2021.

Method: Studies were extracted for author, year, location, design, subjects’ age, sample size, objective, primary endpoint, level of evidence, and results (stone-free rates and complications). Results were subjected to qualitative analysis using the synthesis method. Adequate results were extracted and analyzed quantitatively using the fixed-effect model on homogenous data or the random-effect model on heterogeneous data for meta-analysis. Outcome variables are shown as odds ratios (ORs) with 95% confidence intervals (CIs). All statistical analyses were performed with Review Manager version 5.4.

Result: We reported that stone-free rate and residual stone vary between two studies with contrary results. However, our quantitative analysis showed an insignificant difference between both groups of stone-free rate (OR 0.75; 95% CI 0.22-2.54) and residual stone (OR 1.27; 95% CI 0.55-2.91). Complications rates were insignificantly different between mini-PCNL group and PCNL group in two studies in Clavien 1 (OR 0.65; 95% CI 0.27-1.54) and Clavien 2 grade (OR 0.48; 95% CI 0.19-1.22). In addition, pooled analysis of both complication grades was also insignificant in the difference between groups (OR 0.56; 95% CI 0.30-1.06).

Conclusion: The efficacy and safety of mini PCNL were neither superior nor inferior compared to standard PCNL in managing nephrolithiasis in pediatric patients. Moreover, mini PCNL was considered better regarding post-operative pain and tract infection; thus, mini PCNL could be considered a treatment option for pediatric patients with nephrolithiasis.

Clostridium difficile is an anaerobic gram-positive bacillus, capable of forming spores and toxins, transmitted to humans by the faecal-oral route C. difficile infection (CDI) is recognized as a typical cause of healthcare-associated infections (HAIs) and contributes to a significant proportion of morbidity and mortality of hospitalized patients. C. difficile culture and toxin examinations are still minimal in many hospitals in various Asian countries. As a result, reports of C. difficile in Asia are still rare, while reports of cases of CDI in Indonesia are still rare. Several risk factors including advanced age, antibiotic exposure, and hospitalization are strongly associated with CDI. C. difficile has the ability to colonize the large intestine, then release exotoxin proteins (TcdA, TcdB) causing colitis in people with risk factors. A diagnosis of suspected C. difficile infection in a patient with diarrhea without a clear alternative explanation, with relevant risk factors (including long antibiotic consumption, hospitalization events, and elderly age), was then performed microbiological examination to carry out proper management and control of infection. This study aims to review C. difficile virulence factors as the cause of antibiotic-associated diarrhea.

Patients with end-stage chronic kidney disease require hemodialysis treatment to maintain kidney function. The patients should be prepared to manage symptoms that may arise and cope with physical, psychological and financial changes. In addition, the patients are expected to be able to make their own decisions on how to manage the disease and adhere to treatment. This situation requires good health literacy skills. Little is known about the synthesis of health literacy among patients with chronic kidney disease.

Goal: To summarize the available evidence on benefits and factors that affect health literacy in patients undergoing hemodialysis from the available literature.

Method: The study reviewed health literacy among patients undergoing hemodialysis.   A literature search using a database was conducted in  Ebsco, PubMed, Science Direct, Scopus, and Emerald in December 2021 using the terms health literacy, hemodialysis, dialysis, CKD, and ESRD. We included studies from 2010-2021 that involved adult patients. Screening title, abstract, and full text were conducted to check each study's eligibility.

Results: A total number of eight of 1223 articles were included, with 2,036 respondents. Most included studies found that patients had a low level or inadequate health literacy (n = 5). In contrast, one study shows moderate health literacy (n = 2), and one article found a good level of health literacy. Higher health literacy was shown can improve patients' quality of life. The review summarizes several factors influencing health literacy, such as education, health care providers, life experiences, happiness and anxiety.

Conclusion: The review shows that most studies found lower health literacy levels. It is expected that nurses and healthcare professionals can improve health literacy which could positively impact patients' quality of life.

Pregnant women are a population group at high risk of contracting SARS-CoV-2. Several cases have been reported, including diabetic ketoacidosis and hypertension, diabetes mellitus and hypertension, and heart disease associated with COVID-19. In addition, it is also reported that pregnant women are also exposed to SARS-CoV-2. Most pregnant women with COVID-19 show mild symptoms. The placenta is usually an effective barrier to prevent the spread of infection from mother to fetus (vertical transmission). Certain pathogens can overcome this barrier, with effects that are sometimes detrimental to the development of pregnancy. Vertical infection of SARS-CoV-2 from mother to fetus is possible, although there is no adequate evidence. It has been reported that in pregnant women with COVID-19, the vertical transmission of SARS-CoV-2 from mother to fetus is low. The transmission of SARS-CoV-2 from mother to fetus occurs in the third trimester of pregnancy. Although there is vertical transmission of SARS-CoV-2 from mother to fetus, there are no reports of adverse effects in neonates.

The results of another study explained that in the case of pregnant women who were confirmed positive for COVID-19, there was an gene expression of the ACE2 receptor, N and S proteins from SARS-CoV-2 in the placenta. This study's results contradict the opinion that ACE2 and TMPRSS2 in the placenta that mediates viral entry can be ignored. Vertical transmission of SARS-C0V-2 during delivery can occur through close contact with infected cervical secretions or perineal tissue. It is more important to note that the angiotensin-converting enzyme (ACE)-2, the SARS-CoV-2 receptor, is significantly elevated during pregnancy, which may contribute to susceptibility to SARS-CoV-2. The selection of drugs that demonstrate superior maternal and fetal safety should be considered for pregnant women with COVID-19.

The coronavirus Disease-19 (COVID-19) pandemic was announced in March 2020 by World Health Organization (WHO). Studies showed that the elderly had higher morbidity and mortality rates. Acute sarcopenia in the elderly with COVID-19 is an overlooked problem. Inflammation, malnutrition, immobilization, a side effect of COVID-19 treatment, depression, and hormonal dysregulation contributed to acute sarcopenia in COVID-19, especially in the elderly. Muscle quantity can be assessed with different techniques such as imaging or anthropometric measurements in diagnosing sarcopenia. Imaging such as CT scan was widely used in multiple studies. Still, anthropometric measurements are more fit in developing countries because they are widely available, safe, do not require special skills, and fit in low-resources facilities. Muscle strength can be assessed with grip strength. Acute sarcopenia was associated with immune dysregulation and cytokine storm, length of stay and readmission, and ICU admission and mechanical ventilation. These will contribute to high mortality in sarcopenic elderly with COVID-19.

Background: Cranial base fractures are primary brain injuries with high importance in neurotrauma. They occur in 3.5 - 24% of head injuries and are often related to brain injury. Based on location, cranial base fractures occur 70% in the anterior fossa, 20% in the middle central cranial base and 5% in the middle and posterior fossa. The dura mater at the cranial base is significantly thinner than the dome area and easier to cause meningitis when torn due to CSF (Cerebrospinal Fluid) leak. Post-traumatic meningitis refers to the meningeal infection caused by craniocerebral trauma. Therefore, we decided to analyze meningitis as a complication of CSF leakage in cranial base fracture.

Methods: This systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A thorough literature search was conducted on PubMed, Cochrane and Google scholar. Articles were systematically selected based on the PRISMA protocol and reviewed completely. The articles that met the criteria were summarized and analyzed. The primary outcome measured was CSF, leakage event and Cranial Base Fractures, while the secondary outcome was a meningitis event. This study hasn't been registered to PROSPERO.

Result: There were 15 literatures included in this research. From quantitative analysis, we found that the Risk Ratio (RR) for meningitis incidence in the CSF leakage group was 16.18 (95% CI 1.31 to 199.85). RR for meningitis incidence in the anterior cranial base fracture group was 2.59 (95% CI 1.64 to 4.09). In the antibiotic prophylaxis group, the RR for meningitis incidence was 0.67 (95% CI 0.49 to 0.90). CSF leakage incidence had an RR of 1.39 (95% CI 0.90 to 2.16) in the anterior cranial base fracture group. While RR for meningitis incidence in the surgical management of the CSF leakage group was 1.77 (95% CI 0.87 to 3.61)

Conclusion: There was a significant risk of post-traumatic meningitis in patients with cranial base fractures with CSF leakage compared to those without CSF leakage. Patients with anterior fossa cranial base fractures had a significantly higher risk of post-traumatic meningitis than the posterior fossa. There is a significant risk reduction of developing post-traumatic meningitis in patients with cranial base fractures who were given prophylactic antibiotics compared to those without prophylactic antibiotics. In contrast, CSF leak risk was higher in patients with anterior fossa cranial base fractures compared to the posterior fossa, but not statistically significant. The risk of post-traumatic meningitis in patients with cranial base fractures who underwent surgical treatment was higher than in the conservative group.

Spine vascular lesions like brain vascular lesions include spinal cord stroke, vascular malformation such as venous malformation or venous angioma, cavernous malformation, arteriovenous malformation or arteriovenous fistula. Embryogenesis of spinal vascular is the basic principle to understand the vascular malformation of the spine. This study aims to report serial cases with review of spinal vascular lesions. MR angiography techniques with contrast injection may reflect the direction of flow epidural veins to describe the site of arterial feeders. Serpiginous veins are commonly visible through the dorsal cord surface in MR myelography. The gold standard for diagnosing vascular malformation is Digital Subtraction Angiography (DSA). MRA helps to guide the location for DSA. Several cases are reported using MRA modalities and show the special location site of the spinal disorder.

Introduction: The curriculum for health profession education uses a variety of teaching techniques. A strategy is needed to create a creative learning environment during the implementation of the academic learning process so that students can achieve the expected competencies. Peer learning is one of the learning methods to facilitate student learning experience. Peer learning (PL) uses peers as tutors in the learning process and the process of students learning with and from each other. The application of the peer learning method in the health student learning curriculum is considered to have several advantages and challenges.

Purpose: To identify the benefits and challenges of implementing peer learning methods on health professional students.

Methodology: This study is a literature review with databases form ScienceDirect, PubMed, Scopus and Emerald. The articles search results obtained 10 articles that were screened using the PRISMA guide. This study is looking for articles about peer learning methods in health students who are included in the inclusion criteria.

Findings: There are total 1273 articles obtained from 4 databases, with details ScienceDirect 499 articles, PubMed 366 articles, Scopus 255 articles and Emerald 153 articles. The results of a review of 10 articles show that the peer learning method can be implemented in academic learning settings as well as clinical learning. The application of peer learning methods in the learning process has several benefits including; improve social skills, increase knowledge and better understanding of learning materials, increase self-confidence, improve clinical skills. Apart from the benefits, there are some challenges in implementing the PL method.

Implication: PL can be applied in health student learning because it has many benefits for health students.

Background: Nasal myiasis, a type of cavitary myiasis, is an infestation of parasitic insect larvae or eggs in the nasal cavity of the human body. The risk of nasal myiasis increases in individuals with immunocompromised such as diabetes mellitus (DM). The aim of this study was to report a rare case of nasal myiasis in a patient with DM.

Case Presentation: A 54-year-old female patient was referred to Dr. Soetomo General Hospital Surabaya with a chief complaint of spontaneous anterior epistaxis from the left nostril for three days. Anterior rhinoscopy revealed a narrowed left nasal cavity covered with excessive bloody discharge and>50 larvae coming out of the nasal passage. Nasoendoscopy showed ulcerated lesions on the left nasal cavity floor and nasal lateral wall, destructions of the osteomeatal complex and lateral wall, thick bloody discharge with excessive crust, as well as a larva around the osteomeatal complex entering the maxillary sinus. Paranasal sinus CT scan showed no further infection to surrounding organs. The patient had a history of type 2 DM for the past 2.5 years. The patient was diagnosed with nasal myiasis, unregulated type 2 DM, and diabetic neuropathy. Therapies included larval removal by endoscopy, wound irrigation using antiseptic solutions, maxillary sinus irrigation, administration of the topical antiparasitic ivermectin, and insulin therapy. After seven days of the treatment, the patient was discharged from the hospital with a resolved infection and controlled blood sugar levels.

Conclusion: Awareness of risk factors for myiasis along with proper therapy is prominent. Nasal endoscopy, together with nasal irrigation and antiparasitic drug administration was effective in the management of nasal myiasis.

Background: Syphilis increases the risk of HIV transmission. Coinfection of both infectious diseases potentially changes the presentation of mucocutaneous lesions and accelerates disease progression, complicating the diagnosis and treatment with standard regimens. In the case study, we present a case of secondary syphilis in an HIV-positive patient with clinical manifestations resembling mid-borderline leprosy.

Case presentation: A 23-year-old male patient was referred to the emergency care unit of Dr. Soetomo General Hospital with red spots on the palms of the hands and soles of the feet for the past four months. The skin manifestation first appeared as a single spot, grew over time with itch and pain. The patient had lost 15 kg of body weight in the last three months which was confirmed as HIV-positive. He was also treated for leprosy based on the skin manifestations ever since. There was no history of direct contact with leprosy patients. The patient admitted that he had sex with men in the last 3-4 years. The laboratory examination showed negative results for Mycobacterium leprae through skin biopsy and negative for IgM and IgG of anti-phenolic glycolipid-1 (PGL-1). The patient however was positive for syphilis due to high titers of venereal disease research laboratory/rapid plasma regain (VDRL/RPR) and treponema pallidum hemagglutination (TPHA), supported by histological findings. The patient’s condition improved after receiving penicillin benzathine G, the definitive treatment for syphilis.

Conclusion: Secondary syphilis is a great imitator to mid-borderline leprosy, especially in HIV patients. To avoid misdiagnosis and mistreatment, a careful physical and laboratory examination, including serology and histopathology, should be carried out.

Background: Congenital diaphragmatic hernia (CDH) is a rare, complex and severe abnormality in an infant. Globally, neonatal mortality as a consequence of congenital anomalies is increasing and is therefore outlined as an emerging priority to be addressed by the UN Sustainable Development Goals (SDGs) in the post-2015 child health agenda. Although numerous cases are discovered prenatally or in the early postnatal period, 5-25% of CDH are detected in delayed onset after birth. The aim of this article was to discuss the case of CDH with moderate persistent pulmonary hypertension, moderate muscular ventricular septal defect, and small patent ductus arteriosus.

Case Presentation: A-8 days old, 3,060 g, a full-term male infant was referred to our tertiary hospital with transient tachypnea of the newborn and a suspected case of congenital heart disease. The defect was repaired after stabilization of the cardiac output and gas exchange. During recovery after surgery, the patient was placed on high-frequency oscillation after surgery and was given potent inotropic support. The patient made an uneventful postoperative recovery.

Conclusion: The management of CDH patients should be multidisciplinary. More clinical studies were required to elaborate on a suitable management protocol for the CDH

Background: Pregnant women with congenital heart disease tetralogy of fallot who undergo cesarean section have their own challenges for the anesthesiologist, not to mention if they have pregnancy complications such as placenta previa. The choice of the safest anesthetic technique is still debated today. The anesthetic technique must be able to maintain systemic vascular resistance, avoid increasing pulmonary vascular resistance, and be aware of the threat of blood loss due to placenta previa.

Case Report: 29 years old pregnant woman, weighing 46 kg and height 155 cm, G1P0A0, Gravida 27-28 weeks, single alive fetus, fetal distress, comes with complaints of shortness of breath, vaginal bleeding due to placenta previa with tetralogy of fallot planned emergency cesarean section. The patient presented with functional class NYHA II-III. We used low-dose spinal anesthesia with 5 mg bupivacaine 0.5% and 25 ug fentanyl as an adjuvant. Colloading was done with gelofusin colloid fluid to replace the amount of bleeding. Hemodynamics prior to anesthesia were BP 120/80, Heart Rate 80 x/minure, SpO2 72% with a non-rebreathing mask 10 litre/minute. There was no severe hypotension during surgery, and was hemodynamically stable with limited use of vasopressors. After the cesarean section was completed, the patient was transferred to the ICU and treated for 2 days, and was only discharged after 5 days of treatment without additional complications.

Conclusion: The use of low-dose spinal anesthesia in combination with adjuvant fentanyl results in a relatively safe anesthetic technique with minimal hemodynamic changes and adequate analgesia for cesarean delivery.

Background: Subdural empyema is an intracranial focal collection of purulent material between the dura and arachnoid mater. The most common causes are purulent meningitis in infants and sinusitis and otitis media in older children through a direct extension of the infection. Although it is very rare, parotitis may also cause subdural empyema. This report presents our case of subdural empyema due to infectious parotitis in a pediatric patient.

Case report: A 1-year-old boy was referred from other hospitals for multiple seizure episodes. He also had a complaint of vomit and fever 3 weeks ago. On the neurological examination, we found that he had a GCS of 8, no meningeal sign was found, and with dilated pupil on the right side. A contrast-enhanced head computed tomography (CT) scan revealed multiple hypodense masses with ring enhancement over the right hemisphere, and a severe midline shift suggested as subdural empyema. We then performed a craniotomy to evacuate the empyema. Two weeks after surgery, he was fully alert without any surgical morbidity.

Conclusion: Although parotitis is the less likely disease that can cause subdural empyema, we should also include the disease as the possible cause before we examine the patient more thoroughly and exclude them as the disease that can cause subdural empyema.

Background: Spinal cord injury is not only caused by trauma but also by non-trauma, such as spinal epidural abscess (SEA). Tuberculous SEA is a rare infectious disorder, a delayed diagnosis associated with morbidity and mortality. The problems of tuberculous SEA is not only infection but also neurological deficit, axial back pain, pathological fracture, deformity, and socioeconomic and psychogenic problem. There are a few cases of SEA caused by Mycobacterium tuberculosis, mostly caused by Staphylococcus aureus with decreasing body’s defense mechanism caused by a deficiency of vitamin D. This study aimed to evaluate the neurological recovery of non-traumatic spinal cord injury caused by spinal tuberculosis with spinal epidural abscess and vitamin D deficiency that treated with vitamin D as an adjuvant.

Case Report: A 31-year-old female came to the orthopedic clinic with paraparesis ASIA grade C, axial back pain, and spinal deformity for three months, with vitamin D levels of 15.5 ng/ml. MRI showed epidural abscess at the level of the 10th-11th thoracic vertebrae, spondylodiscitis of the 10th-11th thoracic vertebrae accompanied by paraspinal abscess of the 8th thoracic vertebrae to the 1st lumbar vertebra. The diagnosis was confirmed by cultured and histopathological examination. The treatment was surgery, followed by anti-TB drugs and daily vitamin D 5000 IU for one year. After one year of follow-up, the patient returned to work without a neurological deficit and axial back pain.

Conclusion: This report describes the importance of early diagnosis and proper treatment of spinal cord injury in tuberculous SEA with a deficiency of vitamin D.

Background: Peritoneal tuberculosis (PTB) could mimic advanced ovarian cancer cases, making its diagnosis challenging. Comprehensive and conscientious examinations for diagnosis are needed to differentiate such cases to avoid inappropriate treatment. We report a problematic diagnosis of PTB that mimic ovarian malignancy.

Case Presentation: A 20-year-old female patient with history of multiple rehospitalizations, presented with complaints of abdominal pain, nausea/vomiting, low-grade fever, and weight loss in the last five months. In the first admission, patient was suspected with malignant ovarian cyst due to clinical features of malignancy with normal chest X-ray, abdominal USG suggested ovarian cyst in both ovaries, high levels of Ca125. However abdominal CT-scan showed thickening in peritoneum which suggested PTB. The patient was planned for urgent laparotomy while waiting for GenExpert result. On the second admission, patient presented with recurrent abdominal pain, GenExpert sputum and stool showed negative result, and planned for surgery but the patient refused. On the last admission, patient diagnosed with impending bowel obstruction and underwent abdominal CT-scan with contrast showed diffuse multiloculated cystic lesion in cavum pelvic and multiple prominent mesenteric lymph nodes that suggested abdominal TB with abscess in cavum pelvic. Exploratory laparotomy revealed conglomeration, pus and tubercles in the peritoneum. A TB was confirmed based on pathology and microbiology examination from tissue biopsy and pus.

Conclusion: We reported patients with PTB with unspecific clinical symptoms which suspected as ovarian malignancy. This study highlights the challenges in diagnosing PTB and therefore PTB could be considered a differential diagnosis in patients suspected of ovarian malignancy in the TB endemic countries.

Background: Hypocalcemia, a condition where the serum calcium concentration or total serum calcium is below normal, could be associated with various manifestations including severe symptoms requiring immediate hospitalization. The condition can cause by several causes including iatrogenic thyroidectomy. Here, we report a patient of hypocalcemia associated with hypoparathyroidism due to post-thyroidectomy.

Case presentation: A 32-year-old woman admitted to the hospital complained of stiffness and tingling in the extremities accompanied by recurrent seizures. The serum calcium level was low and this hypocalcemia condition was associated with low parathyroid hormone levels after subtotal thyroidectomy surgery. Laboratory examination indicated calcium 4.8 mg/dL and parathyroid hormone 2.21 pg/ml. The patient had bradycardia with prolonged QT on electrocardiography (ECG) and developed cataracts in both eyes which could be associated with chronic hypocalcemia. The patient's condition improved after correction of hypocalcemia. After discharge, the patient was given calcium and levothyroxine supplementation due to hypothyroid conditions.

Conclusion: The hypocalcemia condition in the patient was associated with low parathyroid hormone level post-subtotal thyroidectomy surgery. This case highlights the impotence of detailed analyses of hormonal, radiological and histological investigations of patients with thyroid gland diseases to diagnose such conditions early and to ensure timely management.

Introduction: Sezary syndrome defined as a set of symptoms consist of erythroderma, generalized lymphadenopathy, and Sezary cells were detected in peripheral blood, skin and lymph nodes.

Case: Patients with chief complaints red and scaly patches cover almost part of the body accompanied by itching since 1 week ago. The patient had history of taking herbal medicines 2 weeks earlier. There is an erosion and crusting at inferior lips. There is also fissure at left side ventral hand region. There is no generalized lymphadenopathy. The patient has fever, hypertension and hyperglycemia. The laboratory result showed leukocytosis with Sezary cells > 1000 cells/mm³, and bacteremia (coccus). Differential diagnosis of patients was Sezary syndrome, drug-induced erythroderma and mycosis fungoides. The diagnosis was Sezary syndrome because erythroderma and Sezary cells > 1000 cells/ mm³ were found. The patient was treated with injection of corticosteroid, antibiotic, barrier repair moisturizer and potent topical corticosteroid.

Conclusion: Sezary syndrome is often accompanied by bacteremia due to impaired skin barrier function and decreased cellular immunity. Examination of biopsy, bacterial culture and flow cytometer is required for diagnosis.

Background: Acute Erythroleukemia (AML-M6) is a rare case with approximately 3-4% of all Acute Myeloid Leukemia (AML) cases. AML-M6 is less common in the pediatric population, with an incidence of <1% of all pediatric leukemia cases. This case study aims to evaluate Acute Erythroleukemia (AML-M6) in a one-year-old boy at Prof. dr. IGNG Ngoerah Denpasar.

Case Presentation: A one-year-old boy with clinical manifestations of fluctuating fever for a month, paleness, bleeding gums, bruising all over his body, swelling of both eyelids and splenomegaly. Peripheral Blood Smear (PBS) examination revealed bicytopenia with moderate normochromic normocytic anemia, severe thrombocytopenia and leukocytosis. A hypercellular picture was obtained from the examination of Bone Marrow Aspiration (BMA) with an increase in erythroblast activity of 74%, proerythroblast at 50% and normal myeloblasts activity at 10%. The patient was diagnosed with Acute Erythroleukemia (AML-M6). The patient died on day 16 of treatment.

Conclusion: Based on the examination results, it was concluded that the patient was diagnosed with AML-M6 according to the PBS and BMA evaluation.

Background: Iatrogenic short-nose and saddle-nose deformities due to previous alloplastic implants remain the most challenging secondary rhinoplasty, particularly among Asian patients. Cartilage framework reinforcement, dorsal augmentation, sufficient nasal tip projection, and proportional nasal length are considered essential for Asian features. This study aimed to elaborate on full rib and ear cartilage revision rhinoplasty in a patient with those problems.

Case Presentation: A difficult case of a 31-year-old female with short-saddle-nose deformity due to infected silicone implant rhinoplasty is presented. A history of nose filler and thread lift was also reported. We noted a short and under-projected nose, indented scarring, dorsal irregularities, retracted columella, severe septal losses, and high trans-columellar incision scars. We conducted two stages of revision: (1) Secondary septorhinoplasty with the seventh costal graft and right concha cartilage, then alar-plasty and (2) Tip-plasty and columellar shield graft with left concha cartilage. Anatomic improvements, complications, and patient satisfaction responses were documented. The improvement of nasal length (39-46-48 mm), nasal tip projection index (0.5-0.59-0.63), nasofrontal angle (150-137-137°), nasolabial angle (117-85-93°), columella-lobular angle (60-45-42°), columellar show (0-0.5-2 mm), and alar flare (4.5-2.6-2.3 mm) on the pre-operative, first, and second stage were noted. No sign of significant absorption and wrapping was observed in both stage.

Conclusions: Short and saddle-nose deformity is considered one of the most challenging issues in rhinoplasty surgery. This finding is expected to create grounded perspectives among the young surgeons, also well-balanced and sensible beliefs on the final results among the patients.

Background: Diabetic ketoacidosis (DKA) has been well-known as the main complication that is a potentially fatal emergency in some teenagers with type 1 diabetes mellitus (DM). Although children with diabetes are not at high risk for severe COVID-19 infection, it can hypothetically lead to type 1 DM and severe DKA. The aim of this article is to briefly discuss a case of a teenager with DKA and COVID-19.

Case: A 13 years old girl came in with abdominal pain, nausea, vomiting and dyspnea. She was alert but weak. Her blood pressure was 100/70 mmHg with 120 pulses and 35 breaths per minute. Oxygen saturation was at 99%. History of previous illness was denied. She was treated using a dyspepsia algorithm while waiting for the laboratory result. Later on, the test showed conditions of hyperglycemia, severe acidosis, ketonuria and a positive rapid COVID–19 antibody test. Hence, a diagnosis of DKA with probable COVID–19 was made and PCR for confirmation of COVID-19 diagnosis was scheduled. Oxygen support, rehydration, and insulin therapy were also given with a precautionary condition of possible COVID–19. In minutes, she developed respiratory distress that led her to be intubated and put on a ventilator. Due to a lack of facilities, a referral to a higher-level hospital was needed. However, since the referral process for probable COVID-19 patients required a long preparation, the patient died during the process.

Conclusion: Besides early diagnosis and prompt treatment, a well-coordinated referral system is crucial in managing DKA patients with possible COVID–19.

Airlangga International Endodontic Symposium is aimed as a platform for scientific communication for Endodontists as well as those who work this topic. The symposium upheld “The Roles of Endodontist to Achieve Sustainable Development Goals (SDGs)” as the theme to highlight the importance of Endodontists and Endodontist science in achieving SDGs in national level. This symposium hosted several notable experts in endodontists who have acknowledge as legend in endodontist and restorative expertise. Nevertheless, this symposium was hoped to enhance scientific interaction, scientific and expert networks, as well as to update the practical and scientific knowledge in endodontic area.