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.

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: 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: 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: Coronavirus disease-19 is a disease caused by the SARS-CoV-2 virus. This virus is the newest type of coronavirus identified in humans. A recent study in 2022 in several different age groups found that older age, men, comorbidities such as hypertension, diabetes, and malignancy, were independent risk factors for mortality in COVID-19 inpatients. This study aimed to determine the risk factors for age and gender in the COVID-19 mortality rate.

Method: The design study was a retrospective case control. The research subjects were 6,697 patients from the secondary data medical record from March 2020 to September 2021 at Pasar Minggu Regional General Hospital.

Results: Results obtained 3313 men (49.5%) and 3384 women (50.5%). Men patients have a 1.5 times greater risk of mortality rate [OR 1.5 (1.3-1. 7)] compared to women. Elderly patients have a 3 times greater mortality risk than non-elderly people [OR 3.1 (2.6-3.7)]. There was a correlation between the after-treatment condition and age (p = 0.05).

Conclusion: This study concludes that the elderly and men are the risk factors for the mortality rate in COVID-19 patients at Pasar Minggu Regional General Hospital.

Background: This study determined the effect of adding grape skin extract (Vitis vinifera L.) to the diet of Wistar rats fed with high cholesterol on levels of SGPT and SGOT and the structure of liver tissue.

Methods: This study used 5 groups, namely control (standard diet), P1 (high cholesterol diet), P2 (high cholesterol diet and extract of grape skin as much as 100 mg/200 gBW/day), P3 (high cholesterol diet and extract of grape skin as much as 250 mg/200 gBW/day) and P4 (high cholesterol diet and extract of grape skin 500 mg/200 gBW/day). The study began with the production of extracts, the extracts dosage determination, high cholesterol diet preparation, sample (animals) preparation, extract addition to animals, SGPT and SGOT levels measurement, rat liver histopathology preparation and histopathological features observation, then ended with data analysis.

Results: The results showed that administration of grape skin extract in Wistar rats fed a high-cholesterol diet affected the levels of SGPT and SGOT, as well as parenchymatous degeneration of hepatocytes. Administration of grape skin extract as much as 500 mg/200 g BW/day had the lowest mean levels of SGPT and SGOT and the lowest parenchymatous degeneration of hepatocytes.

Conclusion: Thus, the extract of grape skin (Vitis vinifera L.) has the potential of hepatoprotector because it contains anthocyanin, which functions as an antioxidant and protects against liver damage.

Background: Transmission of pathogenic and non-pathogenic microorganisms from animals to humans can affect the composition of gut bacteria (gut microbiome) in humans and can also be a potential source of transmission of zoonotic diseases. Therefore, this study aimed to analyze the gut microbiome interactions between the human and the livestock.

Method: This study was a cross-sectional study conducted in Mlati District, Slemanm Yogyakarta. The fecal sample was used to identify parasites by using trichrome staining. Then NGS selected samples were used to analyze the gut microbiome using Illumina high throughput 16S rRNA region V3-V4 sequencing.

Result: The analysis showed that Bacteroidetes was prevalent in the HCA group (57%), while Firmicutes (70%) were commonly found in HNC. Regarding the potential parasitic infection, direct microscopic examination and trichrome staining showed that Blastocystis sp and Entamoeba coli cyst was found in several subjects in HCA groups, with prevalence rate at 7.69% and 2.5%. Meanwhile, no parasite was found in HNC feces.

Conclusion: There was a significant difference in the gut microbiome and parasitic infections between the HCA and HNC groups, with Blastocystis sp and Entamoeba coli as the most prevalent parasites.

Background: The ongoing COVID-19 impacts the world of health, including IRC BDU. There is a need for a rapid response and countermeasures to meet the enormous challenge of balancing blood supply and demand. IRC BDU Banda Aceh in collaboration with the Aceh Government has carried out the civil servant (CS) movement for blood donation. This movement has been carried out since June 2020 until now. The CS donation movement is one of the IRC BDU strategies for the City of Banda Aceh in preserving donors during the COVID-19 pandemic. The study aims to see the impact of the COVID-19 pandemic and the implementation of strategies at IRC BDU Banda Aceh City on the number of blood donors at IRC BDU Banda Aceh City.

Methods: This type of research is a descriptive study with a cross sectional survey design. The first quarter of the analysis was carried out to compare the initial period of the 2020 pandemic with the non-pandemic year 2019 to see the impact of the pandemic on the number of blood donors. The second quarter analyzed the impact of the 2020 pandemic with the implementation of the strategy carried out in 2021 on the number of blood donors at IRC BDU Banda Aceh.

Results: There was a 12.8% decrease in the number of blood donors in the 2020 period compared to the 2019 period (Mann Whitney test, p-value = 0.038). This shows the impact of the COVID-19 pandemic on the decline in the number of blood donors at IRC BDU Banda Aceh in 2020. In the second quarter, the government's strategy to deal with the shortage of blood supply with the CS donor movement succeeded in increasing the number of blood donors by 12.7% (Mann Whitney test, p-value = 0.242) in 2021 (compared to 2020). This shows that the implementation of the COVID-19 handling strategy from the local government plays an important role in increasing the number of blood donors at IRC BDU Banda Aceh. but there was no significant difference in the average number of donors each month.

Conclusion: Management and government participation in mobilizing blood donors and proper utilization are the keys to blood availability during the covid-19 pandemic era.

Introduction: Carotid intima-media thickness (CIMT) is a predictor marker of subclinical atherosclerosis that can be measured by ultrasound technique. The clinical symptoms of atherosclerosis usually begin with the thickening of the carotid artery walls. Polymorphism in Apolipoprotein E4 (APO-E4) is considered to be an important genetic determinant of atherosclerosis and Coronary Artery Disease (CAD). The genetic role of APO-E4 on plasma lipid has shown that the APO-E4 allele is associated with increased plasma LDL and total lipid concentration. The main objectives of this study were to identify genotype polymorphisms of the APO-E gene and measure the thickness of the carotid intima in subjects with APO-E4 polymorphisms in the first descendant of coronary heart patients.

Patients and methods: A cross-sectional study design was used to determine the polymorphism of the APO-E4 genotype in the first descendant of CAD and non-CAD groups. There were 21 samples in each group. Gene polymorphism examination was carried out by PCR and the CIMT was measured with doppler ultrasound.

Results: The result showed that 21.4% of subjects had polymorphism of the APO-E4 genotype with a significant difference between CHD and non-CHD group. This data shows that the APO-E4 genotype is more dominant in the first descendant of patients with CHD when compared to non-CHD parents. The mean values of CIMT ini right and left-sided carotid arteries among APO-E4 genotype and non-APO-E4 genotype were 0.4743 mm vs. 0.4195 mm and bivariate analysis showed a significant difference with a P-value of 0.017. This shows that there is a significant difference in the thickness of the carotid intima in the first descendant of subjects who have the APO-E4 genotype and those who do not.

Conclusion: The APO-E4 gene polymorphism was more dominant in the first descendant of CAD patients with a higher CIMT mean value.    

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: 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%).

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

Background: Granulation tissue is formed during the proliferative phase of wound healing. In the presence of granulation tissue, the process of epithelialization can take place. Disturbance in the formation of granulation tissue, especially hyper-granulation, will result in an abnormal wound healing process. Antihistamines have been shown to have an effect on abnormal wound tissue fibroblasts and reduce collagen synthesis both by topical administration in vivo and in vitro culture. This study aimed to investigate the effect of oral antihistamines on granulation tissue formation, collagen deposition, and angiogenesis involved.

Method: The study design used was an experimental randomized post-test only. Thirty-two rats were divided into 2 groups, wherein group 1 was treated as a control while those in the second group were given oral diphenhydramine with a dose according to body weight. Full-thickness wounds were made on the back of all rats. The treatment was carried out every day for 7 days. On the 7^th day, granulation tissue specimens were taken with an excisional biopsy from the wound. From each granulation tissue sample, data taken were the granulation tissue thickness, collagen density, and the number of capillaries formed.

Results: Using an independent T-test, the mean thickness of granulation tissue in the treatment group was significantly smaller than the control group (215.82 ± 44.73 μm vs. 304.43 ± 58.61 μm, p<0.005). Mann-Whitney test revealed that the mean number of capillaries in the treatment group was significantly less than the control group (38.11 ± 5.31 vs. 69.66 ± 11.81, p<0.005). Kruskal-Wallis test revealed that the collagen density of the treatment group was significantly smaller than the control group (p<0.0001).

Conclusion: Administration of oral antihistamines can inhibit the formation of granulation tissue in full-thickness wounds and also reduce collagen density and angiogenesis. This can serve as a reference for the effect of oral antihistamines on wound healing, especially in the process of granulation tissue formation.

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.  

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.

Background: The use of certain opioids associated differently with the incidence of postoperative delirium (POD). Remifentanil and fentanyl are short-acting opioids widely used in surgery; however, studies assessing their relationship with POD incidence are still limited. This study aimed to determine the association of remifentanil and fentanyl uses with the incidence of POD in elective orthopedic surgery patients.

Methods: A cross-sectional study was conducted in Surgical Unit at Dr Soetomo General Academic Hospital in Surabaya, Indonesia from August to September 2022. Patients who underwent elective orthopedic surgery and used remifentanil (n=16) and fentanyl (n=14) as postoperative analgesia were enrolled in the study. Delirium was assessed using Confusion Assessment Method-ICU tool (CAM-ICU). The associations of remifentanil and fentanyl use as well as patients’ characteristics with POD incidence were assessed statistically.

Results: Our data found that there was no significant difference between the incidence of POD with the use of remifentanil (p=0.125) in orthopedic surgery patients. The total doses of fentanyl and morphine equivalent (of remifentanil or fentanyl) were associated significantly with the POD incidence (p=0.010 and p=0.002, respectively). Other factors associated with POD incidence were the use of bone cement during the surgery (p=0.034), duration of surgery (p<0.001), and bleeding volume during the surgery (p=0.024).

Conclusions: Our study showed high dose of fentanyl, use of bone cement, longer duration of surgery, and high bleeding volume have greater risk of developing POD in orthopedic surgery patients.

Introduction: Noni fruit is one of the plants that is often used in traditional medicine as a medicine for high blood pressure, beriberi, smooth urination, inflammation of the gallbladder, colitis, dysentery, constipation, spleen pain, liver disease, diabetes and back pain. This study aimed to analyze the content of bioactive compounds, antioxidant properties and cytotoxic activity of fermented noni juice and noni juice.

Method: Identification of the content of bioactive compounds was carried out using Gas Chromatography (GC), antioxidant activity testing using the DPPH method (2,2-Diphenyl-1 picrylhydrazine) and cytotoxic testing using the Brine Shrimp Lethality Test (BSLT) method.

Results: The results showed that the content of phenolic compounds contained in noni juice and fermented noni juice had strong antioxidant properties with the IC50 value for noni juice of 22.23 ppm and for fermented noni juice of 13.95 ppm. Meanwhile, the results of the cytotoxic test of noni juice and fermented noni showed that the LC50 values of 33.26 ppm and 2.25 ppm respectively.

Conclusion: It can be concluded that both of these materials have high antioxidant activity and potential as anticancer.

Background: Malondialdehyde (MDA) is a marker that can assess the level of oxidative stress. Studies support that this marker can reflect the severity of heart failure. Carvedilol is a third-generation beta-blocker with antioxidant effects. Slow titration may contribute to the suboptimal dose use and therapeutic effect due to improved left ventricular systolic function and reduced dose-dependent mortality.

Aim: To determine the effect of rapid titration of carvedilol compared with standard titration according to standard guidelines on MDA levels in HFrEF (heart failure reduced ejection fraction) patients.

Methods: This study is a single-centre experimental study with a randomized, double-blind control trial conducted from October to December 2021. A total of 26 HFrEF patients undergoing treatment at UNS Hospital Sukoharjo were sequentially included in the study and then randomly divided into the rapid titration group carvedilol given an initial dose of 2 x 3.125 mg and increased every day with a target dose of 2 x 25 mg (or the maximum tolerated dose). The control group was given carvedilol dose titration according to standard guidelines. Blood plasma was taken on the first day before treatment and on the day the patient was discharged. MDA levels were checked by the ELISA method.

Results: The decrease in mean MDA levels was greater in the carvedilol rapid titration group than in the control group (2.84 ± 1.00 vs. 3.59 ± 2.55). However, these results were not statistically significant (p = 0.590). In the rapid titration group, carvedilol also showed a change in post-pre-MDA with a larger mean decrease (-0.55 ± 1.01) although not statistically significant (p = 0.157).

Conclusion: Rapid up-titration of carvedilol in patients with HFrEF during hospitalization can reduce MDA levels better than titration according to standard guidelines but is not statistically significant.

Introduction: The inflammatory process underlies either osteoarthritis (OA) or metabolic syndrome. Systemic inflammation that occurs in the metabolic syndrome will result in the production of inflammatory cytokines and activation of macrophages and chondrocytes. This can affect the entire body including joints and the surrounding tissues, causing OA. Type 2 Diabetes Mellitus (DMT2) and hypertension are the first and second most common metabolic syndrome components found in OA patients. This study aimed to determine the relationship between metabolic syndrome and knee OA in DMT2 patients with hypertension.

Methods: By using an analytic observational method and cross-sectional design, this study involved the medical records of patients with DMT2. The sample consisted of 50 medical records selected by using the purposive sampling technique and fulfilling the inclusion and exclusion criteria.

Results: This study involved 25 medical records of patients with and without knee (genu) OA. The characteristics of the sample were as follows: 1 medical record of patient aged 36-45 years, 18 medical records of patients aged 46-55 years, 16 medical records of patients aged 56-65 years, 15 medical records of patients aged > 65 years, 21 medical records of male patients, 29 medical records of female patients, 27 medical records with metabolic syndrome, and 23 medical records without metabolic syndrome. The association between metabolic syndrome and knee (genu) OA was analyzed by using the Chi-Square Test using the SPSS application, where the results showed a significance value of p < 0.05 (p = 0.001).

Conclusion: This study shows that there is a significant association between metabolic syndrome and knee (genu) OA.

Background: Ludwig's angina is an infection of the submandibular cavity in the form of cellulitis that is rapidly progressive and potentially life-threatening. Neutrophils and lymphocytes play an important role in this infection process. Neutrophil-lymphocyte Ratio (NLR) is a simple biomarker to evaluate systemic inflammation. We aimed to determine the association between NLR and various prognostic parameters in patients with Ludwig's Angina.

Methods: A retrospective cohort study was conducted using medical records of Ludwig's Angina patients treated at Dr. Soetomo General Hospital, Surabaya, Indonesia, between January 2018 – December 2021. The NLR cut-off value was calculated using the receiver operating characteristics (ROC) curve. The association between NLR with severity, length of stay (LoS), and mortality were analyzed using SPSS version 23 for Windows.

Results: We recruited a total of 96 patients. NLR values are divided categorically into low NLR and high NLR using a cut-off value of 16.86. There were 49 patients (51%) with low NLR and 47 (49%) with high NLR. There was a significant relationship between NLR with severity, LoS, and mortality in Ludwig’s angina patients (p=0.032, p=0.002, and p=0.026, respectively). According to a survival study, the high NLR group's survival rate was significantly lower than the low NLR group's (p=0.009).

Conclusion: There was a significant relationship between NLR severity grading, survival, and the length of stay in patients with Ludwig's Angina.

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: 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: 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.

Introduction: Cases of coronavirus that causes Covid-19 disease in the world have reached 1.8 million people. Cases of coronavirus that causes Covid-19 disease in the world have reached 1.8 million people. The purpose of the study analyzed predictions of covid-19 vaccine acceptance based on sufferers and health belief models in Indonesia and Timor Leste. 

Method: Analytical research method with cross-sectional survey approach, the population is taken from community living at Surabaya Indonesia and Timor Leste as many as 250 respondents. Sampling was conducted in a consequent sampling in two regions at Surabaya Indonesia and Timor Leste.  Data collection using google form, share through were respondents. Statistical analysis with rank spearmen.

Result: the relationship of vulnerability perception with acceptance vaccine covid-19 and correlation coefficient showing a figure of 0.29. It refers to the value of 0.20- 0.40 is considered weak. Similarly, the relationship of severity perception with acceptance vaccine covid-19 obtained coefficient correlation 0.41 expressed strong. on the perception of cues doing actions with acceptance vaccine covid-19, there is a strong relationship, because value correlation coefficient 0.41. For the relationship of benefit perception with acceptance vaccine covid-19 get a weak result because the correlation coefficient of 0.23 in the category below 0.40 is considered weak.

Conclusion: there are four components of Health Belief Model associated with Acceptance vaccine covid-19

Purpose: This study aimed to examine the ameliorative effect of 50% ethanol extract of Moringa leaves on lead-induced oxidative stress in the liver of male Wistar rat model.

Experimental Animal and methods: In this study, adult male Wistar rats were divided into 4 groups, consists of one control group (Kn) and three experimental groups (P1, P2 and P3). All group received Pb-acetate 750 mg/kgBW/day for 7 days. After that, control groups received 1 ml aqua for 14 days, and 3 experimental groups received 1 ml volume of 250, 500 and 1.000 mg/kgBW/day of 50% ethanol extract of moringa leaves orally for 14 days, respectively. Methods measured liver level of GSH, GPx, SOD, CAT and MDA describes by Hernayanti and Simanjuntak (2018) and Ratnaningtyas et al (2022). GSH was measured by a method described by El Shater et al (2016). Data were analyzed with ANOVA and Tukey HSD post hoc test.

Results: Study results demonstrated that there was significant elevation of liver level of GSH, GPx, SOD, and CAT (p<0,05), and significant decreased of MDA levels (p<0,05) in all experimental groups. Significant amelioration of oxidative stress (p<0,05) were found in groups received 250, 500 and 1.000 mg/kgBW/day orally for 14 days.

Conclusion: In conclusion, 50% ethanol extract of moringa leaves doses 250, 500 and 1.000 mg/kgBW/day orally for 14 days ameliorates lead-induced oxidative stress in rat liver. The most effective dose was 1.000 mg/kgBB/day orally for 14 days.

Background: Hand injury often causes acute morbidity and long-term disability. In the case of hand surgery, thirty percent of cases are from tendon injuries. The biomechanical strength of the tendon plays an important role in preventing post-repair rupture, where this strength is believed to be influenced by the number of strands of thread or the suturing technique used. In addition, biological materials such as amnion can reduce the risk of tendon adhesions and increase the biomechanical strength of the tendon itself.

Method: This study used an experimental randomized post-test-only control group research design. 18 male New Zealand rabbits had their right Achilles tendon severed, then divided into 2 groups, where group A was treated as a control while group B was treated with freeze-dried human amnion after tendon repair using braided suture (silk) material. On day 21, all rabbits were terminated and subjected to the macroscopic examination of tensile strength and microscopic examination of the number of fibroblasts and collagen density with hematoxylin-eosin staining. The test that will be carried out on each variable is the Mann-Whitney Test and T-test methods.

Result: The results showed that the average tensile strength in the treatment group was significantly greater than the control group (3.02±1.05 N/mm2 vs. 0.78±0.28 N/mm2, p<0.05). The mean number of fibroblasts in the treatment group was significantly greater than the control group (189.67±23.34 vs. 85.44±9.17, p<0.05). For the variable collagen density, 77.80% of the treatment group had collagen density with a score of 3 (p<0.05).

Conclusion: The application of freeze-dried human amnion after tendon grafting using braided suture material could increase tensile strength, number of fibroblasts, and collagen density in tendon healing.

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.

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: Pregnancy is a uniquely critical and sensitive period in a woman's life. The pregnancy conditions are determinants in the successful growth of the fetus and baby. Zinc is important in fetal bone growth (ossification) because zinc deficiency in pregnancy can interfere with fetal bone formation. Being short (stunted) at birth is associated with a high risk of shortness in childhood and adulthood. Several ultrasound parameters can assess the intrauterine growth and development of the fetus, one of which is the length of the femur: the measurement of the length of the femur can detect intrauterine stunting early. The objective of this study was to investigate the average length of fetal femurs in pregnant women given zinc tablets and assess differences in the percentile changes in fetal femoral length between pregnant women given zinc tablets and those not given zinc tablets.

Methods: This prospective design observational analytic study was conducted at Universitas Sumatera Utara Hospital and other hospitals from June to November 2019. Eligible subjects were pregnant women who met the inclusion criteria and were collected with consecutive sampling techniques.

Results: Fetal femur length was examined using ultrasonography on 31 subjects given zinc tablets and 31 who were not. The average fetal femur length prior to treatment was 61.97 mm (SD=8.13 mm) and 58.84 mm (SD=9.37 mm), respectively. There was no significant difference in the mean length of fetal femurs (p=0,110) prior to treatment. Fetal femur length increase in subjects given zinc tablets was 27.74 mm (SD=5.32 mm), whereas in subjects not given zinc tablets was 23.08 mm (SD=2.81 mm).

Conclusion: There were significant fetal femoral length percentile changes in pregnant women given zinc tablets.

Introduction: The COVID-19 pandemic has impacted the community's disruption of nutrition and health services, including the closure of an integrated healthcare center (posyandu) in many areas in Indonesia. Posyandu plays an important role in nutrition services, particularly in detecting and managing growth and development disorders, such as stunting. This study aims to identify the improvement of knowledge in health cadres and community leaders in areas with high cases of severe acute malnutrition (SAM), namely, Temon, Kalibawang, and Dekso subdistricts in Kulon Progo, DIY, which followed a capacity-building program about strengthening the role of the community in the delivery of nutrition programs.

Methods: The program was conducted through interactive online seminars to ensure the continuity of essential nutrition care services during this pandemic. This study used a one-group pre-test and post-test design. Knowledge measurement was conducted in three consecutive online seminars with 180 participants: health cadres/volunteers, village heads, community leaders, nursery/early years teachers, and academicians. The pre-test and post-test questionnaires were spread through Google Forms before and after online seminars and assessed using the Wilcoxon Signed Ranks Test.

Results: The results showed that the participants improved their knowledge in webinars I and III (p-value 0.001). However, there was no significant improvement in the participants’ knowledge in webinar II (p-value 0.251).

Conclusions: Multi-sectoral collaboration among the government, community leaders, health cadres, health professionals, non-government organizations, institutions, and nursery/early years teachers are needed to reduce stunting, particularly in pandemic situations.

Introduction: Early age is the golden age period of growth and development of children. Therefore, it is necessary to monitor the fulfillment of children's nutritional needs based on the quantity and quality of good nutrition. This study aims to examine the relationship between the level of parental knowledge and the teacher's feeding pattern on the nutritional status of early childhood at the Jungle School Nature Kindergarten, Sekaran, Gunungpati District, Semarang City.

Methods: The total sampling technique conducted this analytic observational study with a cross-sectional design by 24 parents of kindergarten students and 11 teachers or caregivers. The parents' knowledge and teachers' feeding parenting styles were obtained from the interviews. The assessment of the nutritional status of kindergarten students was using indicators of WAZ, HAZ, and BAZ. All research subjects had normal nutritional status based on indicators of WAZ and HAZ.

Results: Based on BAZ indicators, as many as 12.5% of students have underweight nutritional status, and 87.5% have normal nutritional status. The results of the association test showed that the level of parental knowledge (p=0.533; 0.845; and 0.372) and eating patterns by teachers in schools (p=0.770; 0.896; and 0.597) were not significantly related to the nutritional status of early childhood (WAZ, HAZ, and BAZ).

Conclusions: Parents with a good level of knowledge do not necessarily have nutritional problems.

Introduction: Acute kidney injury (AKI) is a sudden decrease in kidney function due to damage within seven days or less, thus inducing an early stress response that can be promptly detected by biomarkers, such as Neutrophil Gelatinase-Associated Lipocalin (NGAL). The aim of this study was to analyse the role of NGAL level as a biomarker of postoperative prerenal AKI in patients who underwent otorhinolaryngology surgery with controlled hypotension.

Methods: A prospective study was conducted among patients that underwent otorhinolaryngology surgery with controlled hypotension. Patients were selected with purposive sampling. NGAL level was measured using enzyme-linked immunosorbent assay (ELISA) from venous blood collected 1-hour pre- and 2-hour post-surgery. NGAL levels were compared between preoperative and postoperative states. Wilcoxon and Spearman test were used to determine the correlation between NGAL levels and parameters of AKI.

Results: A total of 30 patients underwent a varies of otorhinolaryngology surgeries were recruited in this study. Our data suggested no significant different between the level of NGAL during preoperative and postoperative (184.73±120.09 ng/mL vs 175.80±129.97 ng/mL). Pre-operative laboratory parameters of AKI such as blood urea nitrogen (BUN), serum creatine (SCr), BUN/SCr ratio, and GFR had no correlation with postoperative NGAL level. In addition, systolic blood pressure, diastolic blood pressure, MAP, heart rate, EtCO₂, duration of surgery and the duration of controlled hypotension had no correlation with postoperative NGAL.

Conclusion: NGAL levels have nonsignificant role as biomarker of incidence of postoperative prerenal AKI in patients who receiving otorhinolaryngology surgery with controlled hypotension. However, further study with the bigger sample size is warrant to confirm the findings of this study.

Introduction: Diabetes mellitus (DM) is a serious threat to human health in the 21st century, Indonesia as a developing country has a high number of sufferers. This study aims to analyze the effect of discharge planning on the stability of blood sugar levels in type 2 patients.

Methods: The design of this study was a Quasi-Experimental Pre and Post-test with a Control Group. The population in this study were all patients with type 2 DM, a large sample of 54 respondents, taken by purposive sampling technique. The instruments used are a glucometer, questionnaire, and discharge planning form. Data analysis used Wilcoxon statistical test for pre-treatment and control groups and the Mann-Whitney test for post-treatment and post-control.

Results: The results of the Wilcoxon statistical test pre-post-treatment obtained = 0.000 and pre-post-control obtained = 0.093. The results of post-treatment and control group obtained = 0.009 and value = 0.05. It means that there is an effect of discharge planning on the stability of blood sugar levels in type 2 DM patients at A. Yani Islamic Hospital, Surabaya.

Conclusion: The conclusion of this study is discharge planning can affect the stability of blood sugar levels in patients with diabetes mellitus type 2.

Introduction: Public awareness of halal lifestyles is increasing. This understanding concerns food and beverage and other halal aspects such as halal tourism, household needs and halal cosmetics. Indonesia is the country with the largest Muslim population in the world. However, the general public, especially teenagers, does not understand the concept of halal cosmetics, which currently prefers other cosmetic products whose halal identity is not yet clear. The willingness and intention to use halal cosmetics remain low. This research aims to determine the factors affecting the use of halal cosmetics in Indonesian students.

Methods: The study design was a descriptive study with a cross-sectional approach. This study combined the Theory of Planned Behavior and the Theory of Consumption Value (TCV) to identify factors affecting halal cosmetics in Indonesian students. This research employed a structured online survey, and 934 Muslim students aged 17 to 30 years old. The analysis process used Partial Least Square-Structural Equation Modelling (PLS-SEM).

Results: The results showed that three of the 11 hypotheses were not proved. There was a significant relationship between intention, conditional value, epistemic value, emotional value, and halal cosmetics, with an R square value of 0.762.

Conclusion: Four factors affect the use of halal cosmetics, 76.2%, while other factors outside the model cause the additional 23.8%.

Background: Dynamic contrast-enhanced MRI (DCE-MRI) is a functional imaging technique using gadolinium contrast to enhance the tumor site. Several reported the diagnostic performance of DCE-MRI with various parameters used qualitatively, semi-quantitatively or quantitatively to differentiate benign and malignant soft tissue tumors. However, those evaluations were done separately. We investigated three DCE-MRI parameters simultaneously in determining musculoskeletal tumor malignancy: qualitative, semiquantitative and quantitative.

Method: This was a retrospective diagnostic study conducted in the Radiology Department of Prof. dr. IGNG Ngoerah Hospital Denpasar, Bali, in January – September 2022. We evaluated patients' qualitative, semiquantitative and quantitative DCE-MRI results of musculoskeletal tumors, also the histopathological result as the gold standard. We analyzed the ROC curve to predict the best cut-off value. The p-value <0.05 was significant.

Result: We found the qualitative DCE-MRI analysis showing AUC was 0.847. The qualitative parameters showed the best cut-off value with 68.4% sensitivity, 90.9% specificity, 92.9% PPV and 62.5% NPV. On the other hand, semiquantitative AUC was around 0.368 – 0.593, and quantitative parameters AUC was estimated at 0.380 – 0.612. Both semiquantitative and quantitative parameters did not produce the cut-off value.

Conclusion: Qualitative DCE-MRI parameters are a potential predictor for musculoskeletal malignancy.

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: 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.

Introduction: Channa striata collagen-chitosan wound dressing (3:1 v/v) was founded contaminate by bacterial and fungal. Therefore, to suppress bacterial and fungal contamination in Channa striata collagen-chitosan composite dressing, it needs several efforts such as sterilization under Ultra-Violet Light Exposure. The study aimed to determine UV-light exposure duration to supress bacterial and fungal growth on C. striata collagen-chitosan composite dressing.

Methods: C. striata collagen was extracted from skin and scales using 2% HCl for 48 hours, then neutralized using NaOH 1 M until collagen fibers appeared. Chitosan powder dissolved in 2% acetic acid. Afterward C. striata collagen and chitosan liquid (1:3 v/v) were mixed and formed until wound dressing was reached. Wound dressing was sterilized under UV exposure for 0, 5, 10, 15, and 30 minutes. Chitosan dressing was used as a negative control.

Results: The results of the study showed that the total number of bacteria and fungi decreased significantly with increasing time of exposure of UV light on composites dressing with a value of p=0.001 for bacterial growth and a value of p= 0.005 for fungus growth. The UV exposure on collagen-chitosan dressing to reduce bacterial and fungal growth proved effective in 10 minutes.

Conclusions: The UV light exposure treatment can reduce bacterial and fungal contamination on collagen-chitosan composites on each addition duration exposure descriptively.

Background: Hypothermic perfusion can be used as adjunctive therapy to reduce corneal endothelial cell damage during phacoemulsification procedures. This study aims to evaluate the effect of hypothermic perfusion on the expression of Superoxide Dismutase-1 (SOD1) and morphological changes in the corneal endothelium after ultrasound energy of phacoemulsification exposure.

Methods: Sixteen New Zealand white rabbits (n=16 eyes) were randomly divided into two groups and exposed to ultrasound energy of phacoemulsification. The control group was administered room temperature (RT) (24°C) Balanced Salt Solution (BSS) intraocular perfusion, and the treatment group was administered hypothermic (4°C) BSS intraocular perfusion. Coefficient of Variation (CV) and hexagonality were measured before and one day after surgery with specular microscopy. The expression of SOD1 was examined by immunohistochemistry staining. Data were analyzed using SPSS version 26 for Windows.

Results: The result showed that the SOD1 expression was significantly lower in the hypothermic perfusion group compared with the control group (p=0.024, p<0.05). There were no significant differences between the two groups in CV changes (p=0.494, p>0.05) and hexagonality changes (p=0.916, p>0.05). There was no correlation between the expression of SOD1 and change in CV (p=0.188, p>0.05) or the expression of SOD1 and change in hexagonality (p=0.763, p>0.05).

Conclusion: Hypothermic perfusion suppresses all metabolic processes, including the expression of SOD1 and ROS production. The coefficient of variation and hexagonality as a representative of corneal endothelial morphology changes also decrease with hypothermic perfusion after ultrasound exposure but are not statistically significant. There is no correlation between the expression of SOD1 and changes in CV and hexagonality.

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: 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.

Introduction: Colorectal cancer still causes high morbidity and death rates worldwide. This study aims to determine the histopathology of colorectal cancer at Cut Meutia Hospital, North Aceh Regency in 2017-2020.

Methods: This research is descriptive with a cross-sectional approach. The total sample of 64 CRC patients was taken by total sampling that met the inclusion and exclusion criteria.

Results: Univariate data analysis showed that the most histopathological type of research was found in Adenocarcinoma, amounting to 55 people (88.7%). The anatomical location of cancer was found mostly in the rectum, amounting to 26 people (41.9%). Description of the characteristics according to age and gender was mostly at the age of 45-54 years, amounting to 21 people (33.9%) and male gender which amounted to 36 people (58.1%).

Conclusion: The study showed the distribution of age in CRC patients at Cut Meutia Hospital, North Aceh Regency in 2017-2020, the most were at the age of 45-54 years. The description of characteristics according to gender in CRC patients, most of them were male. This study showed the anatomical location of cancer in CRC patients was more commonly found in the rectum. The histopathology type of CRC was mostly found in Adenocarcinoma.

Background: Decompensated cirrhosis (DC) in children is the main indication of liver transplantation (LT). The lack of access to liver transplantation and impending clinical complications while awaiting transplantation affect the morbidity and mortality in pretransplant patients. Granulocyte colony-stimulating factor (G-CSF) therapy has shown promising results in adult decompensated cirrhosis as a potential bridging treatment. Our study aimed to identify the effect of G-CSF on pediatric end-stage liver disease (PELD) score, liver function,  CD34+ cell mobilization, nutritional status, survival, and short-term side effects in children awaiting LT.

Methods: This study was an open-label, randomized controlled trial that included patients with decompensated liver cirrhosis between 3 months and 12 years of age. The intervention group received 12 courses of G-CSF subcutaneous injection (5 μg/kg/day) plus standard medical treatment (SMT) for liver cirrhosis. Results were obtained regarding PELD scores, liver function, CD34+ cell mobilization, changes in leukocyte and neutrophil counts, nutritional status, survival, and side effects within three months.

Results: Thirty-five pediatric patients were randomized into the intervention (17 patients) and control (18 patients) groups. During the trial, 14 (82%) in the intervention group completed the treatment. The median ages of the patients in the intervention and control groups were 18 and 14.5 months, respectively. The study's primary outcome identified no statistically significant difference in PELD scores between the intervention and control groups after G-CSF treatment. Liver function tests that showed significant changes in the intervention group compared to the control group were from improvements in alanine aminotransferase (ALT) levels. Other liver function tests, nutritional status, and survival did not. CD34+ cell mobilization was increased in the intervention group compared with the control group, but there was no significant difference. Minor side effects of G-CSF were observed in the intervention group.

Conclusion: Multiple doses of G-CSF did not improve the PELD score, nutritional status, and survival after three months but significantly showed temporary improvement in ALT level.

Background: Contracted socket is still a major problem for patients with anophthalmia. The main factor for this condition is inflammation and fibrosis, which result in conjunctival shortening. Myofibroblasts that express α-SMA are the primary mediators of anophthalmic socket contraction.

Methods: One healthy eye of a New Zealand white rabbit were randomly selected for evisceration and divided into four treatment groups, each with five rabbits. Each rabbit in the group received a single subconjunctival injection of a different agent. Group, I was the control group that received no injection, Group II received MMC 0.4 mg/ml, Group III received TCA 40 mg/ml, and Group 4 received fibrin glue. After 14 days, the animals were euthanized, and conjunctival samples were submitted for histopathological analysis. A monoclonal α-SMA antibody was applied, and pathologists provided the IRS score for each sample. The differences in α-SMA expression were statistically analyzed with a significant level of p <0.05

Result: All groups displayed a statistically significant decrease in α-SMA expression compared to the control group (p<0.05) as sorting as MMC group with p=0.007, TCA group with p=0.007, and fibrin glue with p= 0.009. MMC was the most effective at reducing α-SMA (p=0.004). Surprisingly, there were no statistically significant differences between MMC, TCA, and fibrin glue when they were evaluated independently.

Conclusion: A single subconjunctival injection of fibrin glue may be used as a novel treatment to prevent socket contracture in actively healing sockets.

Background: Psoriasis is a skin disease belonging to the group of erythrosquamous dermatoses, chronic recurrent. Most psoriasis patients will experience psychological problems related to physical appearance and causing the patient's withdrawal from the social environment and also has a negative impact on work and career problems of patients, which will eventually cause stress in patients. The design of this study was a cross sectional study with the independent variable being psychosocial problems and the dependent variable being the severity of psoriasis.

Methods: The design of this study was a cross sectional study with the independent variable being psychosocial problems and the dependent variable being the severity of psoriasis. The design of this study was a cross sectional study with the independent variable being psychosocial problems and the dependent variable being the severity of psoriasis. We took the sample with consecutive sampling who appropriate with inclusion and exclusion criteria. Data were analyzed by ANOVA test with the p-value <0.001 was declared significant.

Results: The distribution of psoriasis vulgaris is more in males (16/30 patients, 53.3%). Psoriasis vulgaris mainly occurs in the age group of 41-50 (8/30 patients, 26.7%). The highest occupation distribution is not working (11/30 patients, 37%). The distribution of psoriasis vulgaris who did not experience anxiety and depression was 73.3%. The distribution of family history is 24 people 80% there is no family history. The most distribution of the severity of psoriasis vulgaris was mild, 73.3%.

Conclusion: There was no relationship between psychosocial factors and the severity of psoriasis (p=0.551).

Introduction: Mitragyna speciosa is known to have beneficial effects, such as antinociceptive and anti-inflammatory effects. There are some components that involve in inflammatory, such as Inducible nitric oxide synthase (iNOS), cyclooxygenase 2 (COX-2) enzymes, and also cytokines. This study aimed to investigate the anti-inflammatory effect and its mechanism of Mitragyna speciosa leaf.

Methods: Carrageenan-induced rat paw edema model was used for inflammation induction. Rats were given Mitragyna speciosa leaf methanol extract at a dose of 75, 150, and 200 mg/kg.

Results: Intraplantar injection of carrageenan led to the development of time-dependent peripheral inflammation, which, in turn, was a significant increase in the swelling process as measured by a plethysmometer. However, administration of EMS (75,150 and 200mg/kg) can reduce edema in a dose-dependent manner. We also demonstrated that skin histology on EMS administration significantly preserved skin thickness at 4 h after carrageenan injection.

Conclusion: In conclusion, we reveal the role of Mytragyna speciosa methanol extract as anti-inflammatory and maintain skin thickness in the inflammatory process.

Background: Preterm labor is a serious perinatology problem with the consequences of increasing morbidity and mortality in neonates. Increased levels of homocysteine (Hcy) in serum have been reported to play a role in the pathogenesis of various pregnancy complications, including preterm labor. This study aimed to determine whether serum. Hcy levels are a risk factor for preterm labor.

Methods: This case-control study was conducted from January to June 2021. The case and control group included a consecutive woman with preterm and term labor. Homocysteine level was measured from maternal blood samples during labor. Maternal age, parity, and body mass index (BMI) data were also collected and compared between those two groups.

Results: A total of 30 preterm deliveries and 30 term deliveries were included in the study. The mean Hcy level in the preterm group was 17.26±6.814 mmol/L and in the term group was 9.788±4.532 mmol/L. Serum Hcy levels were classified as high (≥12.85 mmol/L) and low (<12.85 mmol/L) level. High serum Hcy level increased the risk of preterm labor by 9.118 times compared to low Hcy (p=0.001; 95% CI=2.581 – 32.211). There was no significant association between age, parity, and BMI with preterm labor (p>0.05).

Conclusion: High maternal serum Hcy level is a risk factor for preterm labor. Prospective studies with larger samples are required to confirm these results.

Background: The bone healing of the alveolar socket post-dental extraction is critical in dental services. Delayed healing is a common problem in diabetes mellitus (DM) patients. It is due to the impaired angiogenic response and microvascular complications. Okra fruit extract can control diabetes mellitus (DM) in several ways, delaying glucose absorption and regenerating pancreatic cells. It can impact an increase in insulin secretion and glycogenesis to control hyperglycemia in DM. This study analyzed the regenerative alveolar bone through the expression of TGF-β2 in the tooth socket of Wistar rats with diabetes mellitus post-extraction after administration of okra fruit extract.

Patients and methods: Extraction of the rat mandibular left incisor was performed using a pair of modified forceps. The tooth sockets were then rinsed using a saline solution. Two groups (control & treatment) of four rats were sacrificed on days 3, 5, and 7. The socket tissues from the rats were then immunohistochemically analyzed

Results: The average level of TGF‐β1 expression in the treatment (T) groups was higher compared to the control (C) group: day 3 (10.50±2.67 versus 4.83±1.17), day 5 (12.33±1.63 versus 5.17±2.32), and day 7 (13.00±2.83 versus 4.50±1.05), with P = 0.000

Conclusion: The administration of okra fruit extract can increase regenerative alveolar bone healing through increased expression of TGF-β2 in the dental socket after tooth extraction of diabetic Wistar rats.

Introduction: A lot of hospital management systems, especially open-source ones, still lack interoperability which is holding back the effectiveness of administration. This happens due to different regulations from hospital organizations. Therefore, there must be a system that facilitates interoperability. Blockchain is a decentralized ledger system, to insert the data from the blockchain all parties must agree that the data is valid thus the data can be inserted so, all the data are immutable thus every change can be audited.

Methods: We integrate the Hyperledger fabric network, an open-source modular blockchain platform, into an open-source hospital management system, openEMR. We take the changed data using debezium connect and Kafka and inserted it into the blockchain.

Results: Based on our test, we managed to get average read latency at 27ms, average read throughput at 36 Read per Second, average transaction latency at 45ms, average transaction throughput at 22 Transaction per Second, and average integrated system data transfer at 111.36ms.

Conclusions: All services deployed successfully at the Kubernetes without any error. All services work as they should be. One service can integrate through the internal network of the Kubernetes and from the outside cluster using ingress. OpenEMR can be used normally as indicated in the official documentation and the data change is stored in the blockchain.

Background: Post-evisceration fibrosis remains the leading cause of contracted socket. The application of fibrin glue is considered an alternative adjuvant therapy in suppressing profibrotic factor (TGF-β) expression following evisceration surgery to prevent contracted socket. This study aimed to know the role of fibrin glue in suppressing the TGF-β expression following evisceration surgery.

Methods: An in vivo experimental study with a randomized post-test-only control group using twenty New Zealand rabbits were conducted. The sample was divided into four groups, each consisting of five rabbits, and one healthy eye was selected randomly for evisceration. Each rabbit in the study group was given a subconjunctival injection of agents corresponding to each study group, namely: Group I (control [no injection]), Group II (0.1 ml MMC 0.4 mg/ml), Group III (0.1 ml TCA 40 mg/ml), and Group 4 (0.1 ml fibrin glue) at the inferior fornix. Following a 14-day observation period, the animals were euthanized, and tenon conjunctiva in inferior fornix samples was collected for immunohistochemistry (IHC) staining examination. The pathologist calculates the immunoreactive scores (IRS) for each specimen. The differences in TGF-β expression were statistically analyzed with a significant p<0.05. Data were analyzed using SPSS version 26 for Windows.

Result: The highest TGF-β expression was found in the control group (I), and the lowest was in the mitomycin-C group (III), followed by the triamcinolone group (IV) and fibrin glue group (II). There were significant differences in TGF-β expression among the four groups (p=0.004). The difference between fibrin glue, MMC, and triamcinolone acetonide groups was insignificant (p>0.05).

Conclusion: As an alternative to mitomycin-C and triamcinolone acetonide, fibrin glue can be used as adjuvant therapy to prevent constricted sockets after evisceration.

Introduction: High-dose Methotrexate (HD-MTX), a chemotherapy agent for acute lymphoblastic leukemia, is a cytotoxic agent for some organs, including kidneys. One of the most important toxicities due to HD-MTX is acute kidney injury due to Methotrexate crystallization in renal tubules. The prevalence of Acute kidney injury due to HD-MTX administration in pediatric ALL in dr. Soetomo General Hospital was unknown. The study aims to analyze renal function features in pediatric ALL during HD-MTX chemotherapy.

Methods: An analytical observational study with a prospective approach was conducted at Dr. Soetomo General Hospital Surabaya from December 2021 - July 2022. The subjects were ALL children aged 1-18 years who met inclusion and exclusion criteria. High-dose Methotrexate chemotherapy was given 3 times every 2 weeks during the consolidation phase. Laboratory examinations were performed before and after HD-MTX chemotherapy. Laboratory results were recorded to determine the GFR value. The difference test was performed using Wilcoxon signed rank test and the Friedman test with a significance value of p<0.05.

Results: A total of 20 subjects, the median age was 78 months old, and boys and girls were equal. Standard Risk of ALL was in 55% of subjects, and 45% were at high risk. There was no significant difference in laboratory parameters between before and after HD-MTX chemotherapy in all cycles with a p-value >0.05. The median value of GFR in each cycle is 257.5; 243.5; 228.5. Minimal GFR was 119 ml/min/1.73 m^2, and maximum GFR was 638 ml/min/1.73 m². It showed a median value of GFR in all cycles was >175 ml/min/m² (hyperfiltration).

Conclusions: We concluded there was no AKI due to HD-MTX chemotherapy in pediatric ALL. It may be caused by providing adequate hydration, urine alkalinization, and leucovorin rescue.

Introduction: Diabetes mellitus, or hyperglycemia, is one of the risk factors for atherosclerosis, causing disruption of blood flow through arterial plaque formation and atherosclerosis. Diabetic kidney disease (DKD) is the most common cause of chronic and end-stage renal disease (CKD and ESRD) worldwide and is a stronger predictor of mortality in people with diabetes. Although the concept that the kidney plays a key role in glucose balance is not new, it is only recently that this organ has been viewed as a potential therapeutic target. This study aimed to assess the potential effect of Syzygium polyanthum extract in DKD mice model.

Methods: We administrated Syzygium polyanthum extract for 2-weeks to alloxan-induced diabetic mice.

Results: Treatment with Syzygium polyanthum extract reduced blood glucose levels in dose dependency (2,62mg/20g/day, 5,24mg/20g/day, and 7,86mg/20g/day). Histological analysis showed that Syzygium polyanthum extract significantly (p<0,05) improved the kidney lesions in low dose, but did not show a significant effect on inflammatory cell at glomerulus.

Conclusion: Syzygium polyanthum extract has potential to improve the kidney lesion in low dose and showed therapeutic potential in DKD treatment.

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.

Background: Turmeric (Curcuma longa) contains curcumin as an active ingredient that has ability as a potent antioxidant and antiinflammation. Turmeric extract can improve glucose level and surpress micro and microangiopathy complication in Diabetes Mellitus Type 2. The aim of this study was to investigate the role of turmeric extract administration on fasting glucose level, MMP-9, and IFN-γ.

Methods: Experimental PostTest Only Control Group Design study was conducted. Twenty four Wistar rats aged 2 months weighing 180-200 grams were adapted for 2 days, divided into 4 groups randomly: negative control group induced by STZ-NA only (P1),  positive control group induced by STZ-NA and received metformin 45mg/kgBW/day (P2), treatment group induced by STZ-NA and received  turmeric extract 200mg/kgBW/day (K1), and  ), treatment group induced by STZ-NA and received   combination of metformin 22,5mg/kgBW/day and turmeric extract 100mg/kgBW/day.  The levels of fasting glucose serum were measured by spectrophotometric method, while ELISA measured the levels of MMP-9 and IFN-γ.

Results: Mean + SD Fasting blood glucose level was decreased respectively from K1, K2, P1 and P2 (277.00 + 4.00, 100.00 + 2.00, 98.04 + 3.00, 92.00 + 3.00 mg/dl). MMP-9 level was decreased respectively from K1, K2, P1 and P2 (653.09 + 18.00, 328.00 + 14.00, 156.00 + 4.00, 131.00 + 4.00 ng/ml). IFN–γ level was decreased respectively from K1, K2, P1 and P2 (300 + 16.00, 85.00 + 3.00, 61.05 + 2.04, 49.00 + 1.09 ng/ml.) Kruskal Wallis test for Fasting blood glucose, MMP-9, dan IFN–γ shows significant differences among groups. (p=0.004, p=0.004, dan p=0.004). Using post hoc test, all groups significantly differ with p=0.000.

Conclusion: The administration of turmeric extract improves fasting glucose level, MMP-9, and IFN-γ in type 2 DM Wistar rats

Introduction: Extrauterine metastases often occur in patients with advanced stages of endometrial carcinoma. Retroperitoneal lymph nodes and pelvic lymph nodes are the most common metastatic sites for endometrial carcinoma, while distant metastases, including those to the lung, liver, and brain, are uncommon. This study compares the characteristics of endometrial carcinoma with or without extrauterine metastases and evaluates risk factors associated with extrauterine metastases.

Methods: A retrospective analytical study of 155 women with a history of endometrial cancer

following complete surgical staging treatment from January 2017 to December 2021 at Dr. Kariadi General Hospital Semarang. All data were obtained using medical records. The clinical and pathological characteristics were compared using the Unpaired T-test and Chi-Square test. Multivariate logistic models were performed to estimate the odds ratio (OR) and 95% CI to analyze independent risk factors for extrauterine metastases.

Results A total of 155 endometrial cancer patients were included in this study. Of these, 77 patients have extrauterine metastases (49.67%). The most common site for extrauterine metastases is ovarian metastases (26.5%). Using univariable and bivariate analysis, tumor differentiation grading (OR=3.69, p=0.027) and myometrial invasion (OR=2.84, p=0.027) were the two risk factors associated with extrauterine metastases. 

Conclusion: There were significant differences in clinicopathological characteristics between the two groups with and without extrauterine metastases. Tumor differentiation grading and myometrial invasion were two independent risk factors.

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: 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: 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: The ability of pregnant women to detect early-risk pregnancies is still low, which is one of the causes of complications that can endanger the welfare of the mother and fetus. This research analyzed the effectiveness of the Self Care Model in Midwifery Care through an Android Application on the Ability of Pregnant Women to Early Detection of Risky Pregnancy During the Covid-19 pandemic.

Methods: The data of this study of pregnant women who conducted examinations at PMB Ika Mardiyanti in Maret-May 2021 involved a sample of 100 obtained by simple random sampling. This study uses an analytic design with a cross-sectional design. Data analysis using the Wilcoxon Signed Rank Test.

Results: The results show that Asym. Sig. (2-tailed) obtained < (0.0001 < 0.05), this means that the Self Care Model in Midwifery Care through the Android Application is effective for increasing the ability of pregnant women in early detect risky pregnancies during the COVID-19 pandemic.

Conclusion: The research conducted to analyze the self-care model in midwifery care through the android application contributes to increasing the efforts of pregnant women to care for their care during pregnancy to prevent the dangers of pregnancy.

Background: Cancer cells increase iron absorption, interfere with iron storage, and reduce iron excretion. Acute lymphoblastic leukemia (ALL) condition may interfere with the iron synthesis, and the patients usually receive a blood transfusion which leads to iron buildup. Excess iron is linked to a poor prognosis and significantly becomes morbidity and mortality factors. Serum ferritin levels that can be assessed from complete blood count may become a low-cost and sensitive biomarker and prognostic marker for ALL. The aim of this research is to assess serum ferritin levels in pediatric patients with ALL in the diagnosis and remission phases.

Methods: An analytical observational cross-sectional study was conducted on pediatric patients with ALL in the pediatric ward Haji Adam Malik hospital Medan from July – October 2021. Physical examination and blood sampling for complete blood count and serum ferritin level assessment were carried out. Bivariate analysis using the Chi-square test was used to compare serum ferritin levels during early diagnosis and remission phases in ALL pediatric patients.

Results: Ferritin levels were higher in the newly diagnosed patient group with a median value of 951 µg/L (28.07-6632 µg/L) than the group in remission phase with a median value of 374.5 µg/L (29-2426 µg/L). There were no significant relationships between ferritin levels and BMI, SGOT, and SGPT in the newly diagnosed group. In contrast, the ferritin levels of the patients in the remission group were significantly correlated with SGOT and SGPT.

Introduction: Endoscopic endonasal is one of the technological advances used as a supporting examination for diagnosis and therapy. This procedure is often used to evaluate medical problems of the nose and sinuses, such as functional endoscopic sinus surgery or FESS (functional endoscopic sinus surgery), turbinoplasty, and septoplasty. Surgery can be difficult to manage because there is often bleeding due to the large supply of blood vessels in the sinus area. This study aimed to investigate differences in qNOX scores and fentanyl requirement in patients undergoing endoscopic endonasal surgery with sphenopalatine ganglion block.

Methods: The total sample was 18 patients, with each treatment 9 patients. Patients were divided into two groups: group 1 patients who received sphenopalatine ganglion block with 0.75% ropivacaine and group 2 patients who did not receive a block. The selection of patients in groups 1 or 2 was done randomly (simple random) using lottery numbers and with a single blind.

Result: Statistical analysis showed significant differences in intraoperatively in qNOX scores at the 5th, 10th, 15th and 20th minute and the mean qNOX score in the first 1 hour between the control group and the sphenopalatine ganglion block group. Significant differences were also found in fentanyl requirement between the control group and intraoperative sphenopalatine ganglion block, where fentanyl requirement was lower in the treatment group.

Conclusion: The sphenopalatine ganglion block is a useful adjunct in patients undergoing endoscopic surgery and may reduce the need for fentanyl. In addition, it can provide a more stable qNOX score

Introduction: The demands of academic life and obstacles during online learning in the Covid-19 pandemic make female students physically and mentally exhausted which can trigger stress. Stress involves the neuroendocrinological system that can affect the menstrual cycle. This study aims to analyze the correlation between stress due to online learning during the Covid-19 pandemic with students' menstrual cycles.

Method: The data measured are the stress due to online learning during the pandemic and the student’s menstrual cycles through the DASS 42 questionnaire (Depression Anxiety Stress Scale 42) to measure stress levels and a questionnaire containing categories to measure students' menstrual cycles.

Results: This study found that stress levels are correlated with the menstrual cycle. Stress levels affect the condition of the menstrual cycle

Conclusion: This study proves that stress due to online learning during the Covid-19 pandemic is related to the menstrual cycle of students.

Introduction: Several countries, including Indonesia, have made tracing efforts to control the spread of infectious diseases such as COVID-19. In carrying out this tracing, it is not only about tracing close contacts but also about digging up some information related to the epidemiological characteristics of COVID-19. So this information can be useful in analyzing the future incidence of disease or health problems. This paper aims to analyze the management of tracing and epidemiological characteristics of close contacts with COVID-19 in Primary Health Care (Puskesmas). Especially Primary Health Care in Pengasih I, Pengasih II, Sentolo I, and Sentolo II.

Methods: The design of this study is a type of descriptive epidemiological research with retrospective data. Retrospective data were analyzed descriptively regarding the epidemiological characteristics of close contact with COVID-19. They then tested the formulation of the hypothesis with univariate, bivariate, and multivariate data analysis. Total sampling was utilized for the study from February 1^st to March 3^rd, 2022.

Results: Contact tracing was carried out by following the guidelines for tracing implementation issued by the government. Close contact data is 1,450 and dominated by women aged 16-54. The frequency of asymptomatic is more than that of symptomatic. There are 535 close contacts whose status changed to confirmed cases.

Conclusion: Close contacts have the risk of undetected infection, so early control of close contact can control the spread of the COVID-19 outbreak. Therefore, tracing efforts by health workers aimed at early detection of close contacts and quarantine measures for close household contacts are appropriate to break the chain of transmission of COVID-19 so that this tracing can be achieved.

Introduction: Bitter (Andrographis paniculata or Burm.f.), red ginger (Zingiber officinale var Rubrum Rhizoma), and turmeric (Curcuma domestica) are medicinal herbs of Asian countries used in many traditional medicinal. This study aimed to evaluate the potential antioxidant effect combination of bitter, red ginger, and turmeric extract with the DPPH (1,1-diphenyl-2-picrylhydrazyl) method.

Methods: This is an observational analytic study using the DPPH method to evaluate the potential antioxidant effect of four extracts, including bitter, red ginger, turmeric, and a combination of those three extracts called “SIJAKUN,” which stands for SambIloto, JAhe merah, and KUNyit in Indonesian. The antioxidant effect was evaluated by IC50 value. The comparable standard of antioxidants was Vitamin C.

Result: The IC50 value showed from the lowest to highest was 2.34, 3.75, 10.15, and 13.5 μg/mL occur in red ginger extract, “SIJAKUN” combination extract, turmeric extract, and bitter extract, respectively. The IC50 value of Vitamin C as a comparable compound was 13.2 μg/mL. The “SIJAKUN” combination extract was better than the single turmeric, bitter, and vitamin C extract, but not with red ginger extract.

Conclusion: The highest potential antioxidant effect with the DPPH method occurred in red ginger extract, even better than other extracts, such as combining the “SIJAKUN” extract based on the lowest IC50 value.

Introduction: UV light is the principal cause of photoaging, a kind of aging. The problem arises because it is less enjoyable. Utilizing the secretome of adipose stem cells (ASC), which is rich in growth factors, could be a novel anti-photoaging therapy. The secretome of ASCs has been extensively examined for their role in wound healing, but their function in photoaging has just lately been investigated. This study looked at changes in epidermal and dermal thickness, expression of MMP-1 and TIMP-1, as well as dermal collagen density to assess the influence of the secretome of ASC in photoaging treatment.

Methods: 28 male Wistar rats, 10-12 weeks old, were randomly assigned to one week of acclimation in each of four groups: UV-irradiated group with topical secretome of ASC (Group P1); UV-irradiated group with topical vehicle only (Group P2); only topical secretome of ASC, non-UV-irradiated (Group P3); and non-UV-irradiated and no topical treatment (Group P4) (Group P0). Prior to treating the rats, the UV exposure was administered for six weeks. Then, for a period of four weeks, the secretome ASC was administered as a treatment.

Results: The epidermal and dermal thickness were significantly improved after four weeks treatment compared to UV irradiated with topical vehicle only group (p<0.05). The expression of TIMP-1 and dermal collagen density were significantly increased (p<0.05).

Conclusion: Secretome of ASC may be a solution for photoaging skin.

Introduction: As the next generation of professional nurses, nursing students must adapt to the learning system implemented in Indonesia during the COVID-19 pandemic. This study aimed to explore information on the transformation that occurred from the application of the learning system.

Method: Using a qualitative descriptive research design with the guidance of the Meleis Transition Theory, which was used to gather information from nursing students about the application of learning systems, both theory and laboratory practice at the Nursing department, Universitas Muhammadiyah Surakarta during the pandemic, interviews were conducted on 13 participants. Data was collected by interviewing one by one using a semi-structured format and then transcribed. Data were analyzed using Colaizzi phenomenological reduction. The interview results obtained three themes: technological challenges, academic challenges, and resilience.

Result: The study's results obtained a theme that revealed a number of challenges experienced by students during this transition period, such as technological challenges, academic challenges, and resilience.

Conclusion: The COVID-19 pandemic requires the world of nursing education to adapt to maintain the skills and knowledge of its students to become the successors of professional nurses.

Introduction: Intestinal fatty acid binding protein (I-FABP) is expected could be used as predictor of tissue hypoperfusion. This study sought to compare the level of I-FABP between pre- and post-surgery and its associated determinants in patients with otorhinolaryngology surgeries using general anesthesia with controlled hypotension (CH) technique.

Methods: We did a cross-sectional study was conducted among patients that underwent elective surgeries at Dr. Soetomo in Surabaya, Indonesia. Those who underwent surgeries using general anesthesia with CH technique were recruited in the study. I-FABP levels were measured using ELISA 1 hour before the surgery and 30 minutes after general anesthesia ended. Fisher's exact test and Mann-Whitney test were used to determine the determinants associated with changes of I-FABP level between pre- and post-surgery.

Results: A total of 31 patients who underwent the surgeries with general anesthesia and CH technique were included in this study. The median of I-FABP level pre- and post-surgery was 0.639 ng/mL to 0.779 ng/mL, respectively suggesting there was a significant increase of I-FABP level after the CH technique (p<0.001). Gender and ASA score did not associate with I-FABP level changes pre- and post-surgery with p=0.333 and 0.060, respectively. Age, BMI did not associate with changes of I-FABP level between pre- and post-surgery (p=0.747 and p=0.051, respectively). Surgery duration, anesthesia duration, systolic, diastolic and MAP all also had no association with changes of the I-FABP level with p>0.05.

Conclusion: The levels of I-FABP increased significantly in post-surgery in patients with otorhinolaryngology surgeries using general anesthesia with CH. Further studies are warranted to confirm this result with bigger sample size.

Background: Postpartum contraception is a way to prevent recurrent pregnancies to ensure the health of both mother and baby. Many postpartum mothers think that there will be no pregnancy during amenorrhea in the postpartum period and will use the contraceptive method after the first menstruation. There are still some who do not use contraception. Contraceptive success will be achieved if the counseling and media are effective. Palangka Raya's city has a Bapalas Bidan culture, a ritual in which a newborn baby is declared a midwife's child until the midwife's blessing ceremony is carried out for the baby and the mother.

Methods: This research type is a quasi-experimental study with two group comparison pretest-posttest design with counseling intervention and booklets. The research subjects were postpartum mothers who gave birth or were treated at the Midwives Individual Service in Palangka Raya City, amounting to 30 each per treatment and control group.

Results: There was a difference in the mean and an increase in the group's knowledge score after receiving counseling through the Bapalas Bidan (p = 0.000). The increase in knowledge was higher in the group that received counseling than in those who did not get counseling. Postpartum mothers who have high knowledge of contraception use contraception more than mothers with low knowledge. The proportion of postpartum mothers who used contraception was more in the group who received counseling (p = 0.018), aged 20-35 years (p = 0.015), had parity ≥3 (p = 0.024), and higher education (p = 0.006).

Conclusion: Postpartum mothers who have high knowledge of contraception use contraception more than mothers with low knowledge.

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.

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: 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.

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.

Treatment of Alzheimer's Disease is currently limited only to slowing the progression of the symptoms, not curing the disease. Current FDA-approved therapies such as Donepezil, Tacrine, Galantamine, Rivastigmine, and Memantine have quite disturbing side effects, as well as the mechanism of action of these drugs, which is dominated by working as AChE inhibitors. On the other hand, the hypothesis for Alzheimer's causes is varied. Another study also states that Non-Steroid Anti-Inflammatory Drugs (NSAIDs) can be given to people with Alzheimer's. However, the reports were conflicting as one study stated that NSAIDs can help reduce the risk of Alzheimer's; on the contrary, other studies have argued that giving NSAIDs to people with Alzheimer's is not necessary. Despite administering Alzheimer's drugs and NSAIDs, which have adverse side effects on long-term use and high doses, the administration of traditional medicines and medicinal plants can be a good solution due to lower side effects than common drugs, less risk, easy access and affordable. These medicinal plants have several mechanisms to counter the hypothesis that causes Alzheimer's disease.

Introduction: Telemedicine is a form of healthcare that uses technology to provide various health services. This method has been widely used during the COVID-19 pandemic when physical distancing is called. This systematic review aimed to review various uses of telemedicine on 11 databases using the PRISMA flowchart from January 1^st, 2020, to December 31^st, 2021.

Methods: This review has been registered in PROSPERO (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269809). The search terms are: "COVID-19," "Coronavirus," "SARS-CoV-2," "2019-nCoV," "Telemedicine," "Telehealth," "Teleconsultation," "Telemonitoring," "Telemanagement," "Teleconferencing," "Video conferencing," "Video consultation," "Virtual care," "Virtual service," "Virtual treatment," "Remote treatment," "Remote service," "Remote consultation," "Digital care," "Digital treatment," "Mobile health," and "E-health." The quality assessment used indexed databases for the SCOPUS, Web of Science (ESCI), and PubMed (PMC and Medline).

Results: On initial scrutiny, 2.031.242 articles were obtained; after screening with inclusion and exclusion criteria, 17 articles were included. Only 4 articles reported the use of telemedicine for respiratory-related diseases patients; 3 of these were COVID-19-related cases. Other 13 articles reported the use of telemedicine for admission, anamnesis, diagnosis, treatment, follow-up, and monitoring purposes for non-respiratory-related diseases. Methods applied include voice calls, video conferences, and specific software on computers and smartphones. There were no significant differences between telemedicine and the face-to-face method, although the lack of health providers' presence has been complained about in the prior method.

Conclusion: From this review, telemedicine is a beneficial tool for delivering health services during the COVID-19 pandemic.

Due to their capacity to reduce acute inflammation by increasing the immune response, honey and its constituents are gaining attention as an efficient natural therapeutic. Studies have suggested that it may be able to treat a variety of chronic illnesses and conditions, including as bacterial and fungal infections, cardiac issues, diabetes, hypertension, and abnormalities of the lungs and heart. More significantly, honey has proven to have virucidal effects on a number of enveloped viruses, including the varicella-zoster virus, herpes simplex, influenza virus, and HIV.

Honey may help patients with COVID-19, a disorder brought on by the SARS-CoV-2 enveloped virus, by boosting the host's immune system, treating comorbid conditions, and engaging in antiviral activities. Additionally, patients with COVID-19 are presently participating in a clinical trial of honey. We've attempted to condense the possible advantages of honey and its components in this review in terms of antibacterial properties, some chronic illnesses, and the host's immune system. Therefore, we have made an effort to develop a relationship with honey in order to treat COVID-19. In light of the COVID-19 epidemic, this review will be useful in reevaluating our understanding of the potential therapeutic benefits of honey. However, more in vitro and in vivo research is required to determine the effects of honey on SARS-CoV-2 replication and/or the host's immune system.

Indonesia has implemented a National Competency Examination for medical graduates since 2014 called the Indonesian Doctors National Competency Examination (IMDNCE). The first component of the exam is multiple choice-based questions that use a computer-based testing method (MCQs-CBT) to assess the candidate's knowledge. The second component is Objective Structured Clinical Examinations (OSCE) to assess the performance of the candidate's clinical skills. The IMDNCE pass rate has never reached 100% because, in each exam period, 16-32% of examinees fail. CBT passes are also always lower than OSCE passes, and IMDNCE retakers mostly repeat CBT. The literature explaining the determinants of learning behavior and passing national exams is still limited. This study aims to identify the determinants of medical students' learning behavior in the national medical competency exam and their relationship to graduation outcomes. Learning behavior consists of two categories: the quality of learning and learning regulation. The conclusion is the determinant factors consist of internal and external factors. Internal factors include learning motivation and academic achievement, anxiety, and health conditions facing exams. External factors include environmental factors such as tutoring, family and peer support. These factors determine the learning behavior of medical students in the national medical competency exam in Indonesia, both in terms of quality and learning regulations.

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.

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.

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: Non-cirrhotic portal hypertension refers to elevated portal vein pressure in the absence of liver cirrhosis. Surgery could be an effective procedure for patients with recurrent variceal bleeding who fail to respond to pharmacotherapy or endoscopic therapy. We report a success story of modified Sugiura technique in managing a patient with non-cirrhotic portal hypertension.

Case presentation: A male, 24-year-old, complained of recurrent vomiting of dark red blood color for six months. Anemic conjunctiva and splenomegaly were discovered during a physical examination. Pancytopenia and normal hepatobiliary function were revealed in the laboratory examination. Ultrasonography of the abdomen demonstrates nonspecific splenomegaly. An abdominal computerized tomography scan revealed hepatosplenomegaly and pelvic fluid accumulations. Grade IV esophageal varices and mild portal hypertensive gastropathy were observed during endoscopic examination. Active bleeding still presented despite initiation of medical treatment and endoscopic ligation. Finally, a surgical procedure using the Sugiura technique was performed. The patient was recovered, no recurrent symptom of hematemesis was reported after one year of follow-up.

Conclusion: Modified Sugiura technique is a useful treatment of choice in non-cirrhotic portal hypertension patients who failed to respond other medical treatments. However, comprehensive assessment is critical prior to choose this procedure.

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

Introduction:  Subscapular abscess is an extremely rare condition. To our knowledge there were nine reports on subscapular abscess in the literature, four of them happened paediatric patients. The signs and symptoms could be very subtle making the diagnosis is difficult and often delayed.

Case description: We share a rare case of isolated subscapularis abscess with no glenohumeral involvement of a healthy 9-year-old boy following blunt trauma to the shoulder treated with antibiotics and percutaneous drainage with good outcome.

Conclusion: Subscapular abscess should be suspected in a child present with fever and shoulder pain. Magnetic resonance imaging is the best modality for diagnosis as plain radiograph would not give any diagnostic help. Surgical drainage combined with antibiotics are the mainstay of treatment. However, percutaneous drainage is one of treatment options especially in paediatric patient as demonstrated in our report.

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: Micropenis is a condition where the penis size is smaller than 2.5 standard deviation on average without any anatomical malformations. Hypogonadotropic hypogonadism is one of the causes of micropenis and one of the structural disorders that could lead to hypogonadotropic hypogonadism is a pituitary microadenoma that alters the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone. In this case-report we present a patient with micropenis caused by pituitary adenoma.

Case presentation: A 40-year-old male patient, presented to Dr Soetomo Hospital with a chief complaint of having a small penis that did not match the proportions of the body but could still erect and ejaculate. The patient experienced fatigue for about two months before the admission and struggled to concentrate while walking for the last six months. The laboratory results were hyperprolactinemia, hypo albumin, and dyslipidemia. From the MRI examination with contrast, a mass was found in the left pituitary. The patient was diagnosed with pituitary microadenoma, hypogonadotropic hypogonadism, micropenis, hypotestosterone, hypocortisolism, and hypothyroidism. The patient was assigned for monthly monitoring. Consultation with a neurosurgeon suggested there were no indications for surgery. The patient was treated with testosterone intramuscular injection 250 mg every month, methylprednisolone 4 mg every 8 h, simvastatin 20 mg every 24 h, and levothyroxine sodium 50 mg every 24 h. One month follow up, fatigue was disappeared and nine months follow up found improvements in hormone levels and balance during walking.

Conclusion: Pituitary microadenoma can manifest as micropenis, hypocortisolism, and shift hormone levels. The main therapy for pituitary microadenoma is hormone therapy as presented this present case report.

Background: Complex distal radius fracture (CDRF) associated with median nerve injury is rarely reported due to low incidence or low recognition rate. Thus, we reported the outcome of using distraction bridge plate fixation (DBPF) in managing CDRF associated with median nerve injury without volar nerve exploration.

Case description: We reported a 67-years old male who sustained pain in the right wrist with dorsal angulated deformation following a fall on an outstretched hand two hours before being admitted to the emergency department. The patient also complained of numbness in all of the fingers except the little finger of the right hand. Posteroanterior (PA)/right lateral X-rays showed grossly dorsal displaced of the comminuted distal radius fracture associated with ulnar styloid avulsion. The diagnosis was a CDRF associated with median nerve injury. He underwent surgery in an emergency setting with DBPF on the dorsal side without opening the fracture site guided by an image intensifier. Early mobilization was started as the patient could tolerate the pain, and neuromuscular electrical stimulation was given twice a week after surgery. Plate removal was done six months after surgery and continued with a range of motion exercise of the right wrist.

Conclusion: It is important to consider the anatomical reduction without additional soft tissue trauma by opening the fracture site and the early emergency surgery decision based on physical examination in CDRF management. The stable fixation allows axonal regeneration after median nerve injury, proved by good nerve functional outcomes. DBPF is suitable for post-operative wound care and decreases costs compared to staged fixation surgery and volar nerve exploration. However, we still need to further investigate this procedure through higher comparison studies.

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: Filum terminal is a fibrous tissue to stabilize the position of the spinal cord, located in both intradural and extradural sections anchored caudally to the coccyx. Tumors located at the filum terminal are a rare case. Filum terminal does not have any spinal cord component, but tumours in that area can directly cause a significant neurological disorder. 

Case Presentation: Presenting 43 years old man with chief complaints of drop left foot and tethered cord syndromes. MR Image revealed 9,4x10mm intradural extramedullary mass at L1 with L1-L5 disc desiccation. The patient was untethered by laminectomy and underwent total mass excision. The sample was analyzed pathologically, and the results matched myxopapillary ependymoma. Pain sensation and sensory disturbance immediately improved after surgery. The urinary disorder also gradually improved. The patient was discharged without any urinary problems. After six months of follow-up, painless, mild left lower drop foot and mild gait disturbance was found without residual urinary and other neurological disorder.

Conclusion: Filum terminal ependymomas need to be considered for differential diagnoses in patients with drop foot and adult-onset tethered cord syndromes. 

Background: Spinal cystic intradural Schwannoma is a type of tumor that is rarely found, with an incidence of 0.3–0.5/100,000 person per year. The operative procedure for this tumor was simple. However, some patients showed other comorbidities, such as heart failure with low ejection fraction (EF) and atrial fibrillation. Such cases are a challenge to the anaesthesiologist as they are most commonly complicated by progressive cardiac failure.

Case Presentation: A 68-year-old woman was consulted by the Anaesthesiology Department in dr. Kariadi General Hospital Semarang in April 2019. She had been experiencing right lower extremity and lower back pain since April 2018, and they have been getting worse since two weeks ago. She also complained of shortness of breath two weeks before, accompanied by typical symptoms and signs of heart failure. Her electrocardiogram showed atrial fibrillation, and her echocardiogram showed an LVEF of 33.7%. Magnetic resonance imaging (MRI) showed two lobulated intradural-extramedular cystic lesions at thoracal vertebrae 12 until lumbar vertebrae 1 (VTh12–L1) that were a high suspicious of Schwannoma on the anterior aspect and the lateral aspect accompanied by spinal cord compression at that level. The drugs used for premedication were metoclopramide 10 mg and ranitidine 50 mg, for induction was fentanyl 100 μg, and for maintenance were dobutamine 10 μg/kgBW/minute, rocuronium bromide 30 mg/hour via syringe pump, opioid fentanyl 100 μg and muscle relaxant using rocuronium bromide 40 mg. The patient was hemodynamically stable throughout the surgery, and blood loss was minimal.

Conclusion: In patients with heart problems, a moderate reduction in contractility and heart rate often occurs and may induce mild to severe bradyarrhythmia or tachyarrhythmia related to induction agents. It is important to maintain adequate cardiac output that requires inotropic agents to augment contractility and improve circulation. As an inotropic choice, a β-agonist (e.g., dobutamine) causes less vasodilation, increased contractility, and adjuncts to augment contractility in the setting of significant hypotension.

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.