Introduction: Low mood condition is related to a low level of brain serotonin. An early sign of depression with low mood symptoms is generally treated with psychotropic drugs that work as selective serotonin reuptake and monoamine oxidase (MAO) inhibitors (one of which is sertraline), to increase serotonin levels in the brain. There are some concerns regarding side effects available medication like serotonin syndrome, suicidality and aggressive behavior. Thus, development of alternative herbal products made from a combination of pineapple and banana extract with less side effect and its potential affinity with serotonin regulation is important.

Aim of the study: To determine potential herbal rich (banana and pineapple) of L-tryptophan and potential active compounds interaction with the human serotonin transporter.

Method: In the present study, using in silico molecular docking techniques, the active compound of banana and pineapple and its potential interaction with human serotonin transporter were assed. Docking study explored the bioactive compounds interactions with specific target like catechin, dopamine, epigallocatechin, gallic acid, L-tryptophan, malvidin, norepinephrine, pelargonidin, peonidin, and serotonin. Molecular docking simulations were performed using AutoDock 4.2 software. The docking method was validated first by re-docking sertraline (nature ligand) in a complex with PDB ID: 6AWO against the target receptor (SERT).

Result: The molecular docking results had showed that L-tryptophan, peonidin, and catechin could bind to esential amino acid residues in the binding pocket, with binding affinity -5.69,  -8.63, -8.24 kcal/mol respectively.

Conclusion: L-tryptophan, peonidin, and catechin are the most promising compounds that have good potency as anti-depressant agents through SERT inhibitory activity. This compounds in bananas and pineapples have the potential to affect serotonin transporter receptors that play a role in mood and behavior.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction: School-age children are a critical age group because they are vulnerable to health problems that usually arise related to clean and healthy living behavior. The purpose of this study was to determine the relationship between parental support and clean and healthy living behavior as an effort to prevent covid-19 in students of SDN 1 Panglungan Wonosalam Jombang.

Methods: Analytical research design with "cross sectional" approach. The population was 40 students from class V and VI. A sample of 37 students was taken using the Cluster Sampling technique. The instrument used a parental support questionnaire and clean and healthy living behavior. Data analysis used Spearmen Rank correlation statistical test with a significant level of = 0.05.

Results: The results of the study were obtained from 37 respondents, almost entirely (81.1%) had a good level of support and most (62.2%) had a clean and healthy lifestyle as a good covid 19 prevention effort. Spearman rank correlation test analysis obtained p value of 0.01 <0.05, then h0 is rejected and h1 is accepted.

Conclusion: There is a significant relationship between parental support and clean and healthy living behavior as an effort to prevent covid-19 in students of SDN Panglungan 1 Wonosalam Jombang. The role of nurses can provide nursing care in the form of education for children and parents, so that children are able to carry out clean and healthy living behaviors as an effort to prevent Covid-19.

Introduction: The intangible nature of soft skills makes it difficult for nursing academics to evaluate nursing students' attainment of these skills. Most of the time, academics focus more on assessing nursing students' knowledge and performance (hard skills) in clinical skill assessments. In focusing primarily on assessing nursing students' hard skill competencies, the nursing profession has given inadequate attention to developing their soft skill competencies. Thus, this study aimed to explore the nursing academic's view on soft skills elements in structured clinical skill assessment for the undergraduate nursing program.

Method: This study was conducted using a qualitative approach. A total of 10 nursing academics were involved, and they were recruited through a purposive sampling method. Data was collected through in-depth interviews using open-ended questions to gain insight into nursing academics' perception of soft skills elements in structured clinical skill assessment for the undergraduate nursing program. Data analysis was conducted by using an inductive content analysis method.

Results: Four themes emerge from this study. These are 1) awareness and involvement, 2) Factors influencing on implementation of soft skills in the structured clinical skills assessment, 3) academic responsibility, and 4) suggestions to overcome barriers.

Conclusion: Findings from this study provide new insights into the nursing academic perception of soft skills elements in structured clinical skill assessments of undergraduate nursing program needs improvement and proper structure on how/what are the soft skills elements that want to measure for nursing students. These findings would assist in developing a more strategic framework for soft skills elements in structured clinical skill assessments to produce quality nursing graduates.

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

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

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

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

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

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

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

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

Introduction: The disease progression of coronavirus disease 2019 (COVID-19) in individuals with comorbidities, such as type 2 diabetes mellitus (T2DM) in particular, has been associated with the occurrence of the cytokine storm. Ferritin, an acute-phase protein indicating inflammation, has been linked to T2DM and the severity of COVID-19. Our study aimed to investigate the association between the level of ferritin and the severity of COVID-19 in T2DM patients.

Methods: A cross-sectional study was conducted among COVID-19 patients admitted at Dr. Soetomo General Hospital, Surabaya, from April to September 2020. The patients who met the inclusion criteria were enrolled in the study. The data used in this study was secondary data obtained from the medical records at Dr. Soetomo General Hospital, which consisted of serum ferritin levels, the severity of COVID-19, the results of blood analysis, and other demographic and clinical characteristics (age, gender, hypertension, the number of complaints, and vital signs). Data analysis was performed using SPSS software and presented in percentage (%), mean ± standard deviation (SD), or median (min-max). A chi-square test was carried out to identify the association between serum ferritin level and the severity of COVID-19 in T2DM patients at α=0.05.

Results: Of the total 159 patients were included and 80.8% of them had moderate severity of COVID-19, whereas the rest (19.5%) had severe COVID-19. Out of total patients, 78.6% had ferritin levels of ≥400 mg/dL, suggesting hyperferritinemia syndrome (mean ± SD: 1177.21 ± 1275.90 mg/dL). The Chi-squared analysis revealed a significant association between serum ferritin levels with the severity of COVID-19 in T2DM patients (p=0.024).

Conclusion: There was a significant relationship between serum ferritin levels and the severity of COVID-19 in T2DM patients and further study with a bigger sample size is needed to confirm this finding.

Introduction: Colorectal cancer (CRC) occurs, accounting for 11.5% of all patients with cancer in Indonesia. The less the spread of cancer, the higher the life expectancy of patients with cancer. Glutamine is involved in tumor cell proliferation and growth. This study aims to verify the correlation of serum glutamine levels with the one-year survival rate of patients with stadium III colorectal cancer at Dr. Moewardi Hospital, Surakarta, Indonesia.

Method: A quantitative analytic-observational longitudinal study (Cohort) was conducted from May 1^st, 2020, to September 30^th, 2021. Inclusion criteria were the CRC patients with stage III and could be followed up for one year. Exclusion criteria were the CRC patients who had other systemic problems. The patient’s blood glutamine levels were taken three months postoperatively measured by Glutamine Assay kit (Colorimetric) ab197011 and evaluated clinically for one year. Glutamine levels in the blood are low if they are less than 52 ng/µL. The parameters assessed were glutamine serum level and survival rate of colorectal cancer patients. Statistical analysis using the Chi-square test and the Kaplan Meier method was employed to obtain the survival curve. Analysis to compare survival rate with glutamine levels used the Cox regression model.

Results: A one-year survival rate in patients with stadium III colorectal cancer was 95.5% at post-operative glutamine levels of ≥ 52 ng/µL and 65.4% at post-operative glutamine levels of < 52 ng/µL. The mean progressive free survival rate was 11.818 months (95%CI=11.470-12.166) at post-operative glutamine levels of ≥ 52 ng/µL and 10.038 months (95%CI=8.913-11.164) at post-operative glutamine levels of < 52 ng/µL. The overall free survival rate was 11.955 months (95%CI=11.868-12.042) at post-operative glutamine levels of ≥ 52 ng/µL and 10.885 months (95% CI=10.128-11.641) at post-operative glutamine levels of < 52 ng/µL. Patients with glutamine levels of <52 ng/µL were 8.959 times more probable to die than patients with post-operative glutamine levels of ≥ 52 ng/µL.

Conclusion: This study shows a significant relationship between serum glutamine levels and the one-year survival rate of patients with stadium III colorectal cancer at Dr. Moewardi Hospital, Surakarta, Indonesia.

Introduction: Infectious mouth diseases are caused by microorganisms such as      Staphylococcus aureus and Streptococcus mutans. Sentul fruit peel extract contains several phytochemical compounds, flavonoid compounds, saponins and tannins are aromatic hydroxyl groups that act as antibacterial so that they can be used as a treatment for infections of the mouth. This study aimed to determine the inhibitory ability of Sentul fruit peel extract (Sandoricum koetjape) against Streptococcus mutans and Staphylococcus Aureus bacteria which can cause oral infections.

Method: Sentul fruit peel simplicia was extracted by maceration method with ethanol for 24 hours. The maceration method was chosen in this study because it is a method that is easy to do and uses simple tools, which is enough to soak the sample in a solvent. A filtering process followed this and the filtrate was then evaporated with a vacuum rotary evaporator at a temperature of 45oC, so that a thick extract was produced. The maceration process was repeated 2 times. After the extraction process, then proceed with liquid-liquid fractionation using distilled water. The thick extract was put into a separating funnel and distilled water was added. Then it was shaken and the aquadest fraction was taken, followed by evaporation with a vacuum rotary evaporator at 45^oC, so that the aqua fraction of the ethanol extract was produced.

Result: The results showed that the Sentul fruit peel extract was able to inhibit the growth of      S. mutans and S. aureus bacteria as seen from the formation of a clear zone. Based on the ANOVA test, the extract concentration treatment had a significant effect (p<0.005) on the diameter of the clear zone on S. mutans and S. aureus bacteria. Positive control (streptomycin) showed significant differences in Duncan's test, because it produced the greatest antibacterial activity against test bacteria compared to negative control and various extract concentrations. The diameter of the clear zone in the positive control against S. mutans and S. aureus bacteria were 17.63±0.28 mm and 17.62±1.04 mm, respectively. Sentul peel ethanol extract of aqua fraction at a concentration of 100% gave the highest inhibition zone compared to concentrations of 75%, 50%, and 25%, although it was still smaller than the diameter of the clear zone in the positive control. In bacteria S. mutans, the ethanol extract of Sentul peel aqua fraction at a concentration of 100% gave a clear zone diameter of 14.31±1.06 mm and in S. aureus bacteria it gave a clear zone diameter of 15.34±1.81 mm.

Conclusion: Sentul fruit peel extract (Sandoricum koetjape) has the ability to inhibit Streptococcus mutans bacteria and Staphylococcus Aureus bacteria.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction: Phenytoin is reported to heal the enterocutaneous fistula. Meanwhile, vitamin C is known to improve wound healing. The comparison of phenytoin and vitamin C in the treatment of enterocutaneous fistula is never reported.

Methods: A randomized controlled trial with a post-test-only group design using artificial enterocutaneous fistula Ratus Norvegicus male Wistar rats were reported. Rats were divided into four groups randomly, namely, Control (K), Treatment 1: combined phenytoin and vitamin C (P1), Treatment 2: phenytoin (P2), and Treatment 3: vitamin C (P3). Variables under study were a number of fibroblast and angiogenesis. One Way Anova test, followed by the Post-Hoc Test, was used to test the difference among and between groups.

Results: The mean value of fibroblasts in groups K (501.86 ± 107.10), P1 (861.53 ± 25.99), P2 (719.93 ± 24.61), P3 (781.46 ± 28.23). The mean value of angiogenesis in groups K (18.63 ± 4.24), P1 (48.86 ± 10.23), P2 (26.26 ± 1.64), P3 (31.96 ± 2.97). The Post-Hoc test showed that were significant differences in the number of fibroblasts and angiogenesis from the group given a combination of oral phenytoin and vitamin C therapy compared to the group given oral phenytoin, vitamin C, and control (p <0.05).

Conclusion: A combination of oral phenytoin and vitamin C therapy increased the number of fibroblasts and angiogenesis of enterocutaneous fistula in Wistar rats, better than single.

Introduction: The coronavirus disease 19 (COVID-19) and autoimmune disease has been associated bidirectionally, several reports has shown COVID-19 precipitate an exacerbation of an autoimmune disease that has already stable. Recognize and treatment of flare in SLE condition with COVID-19 is challenging in this pandemic era. This review aims to report a case SLE patient who experienced severe flares after being infected with COVID-19 and review of the literature.

Case report: We presented a 27-year-old female with a history of Systemic Lupus Erythematosus (SLE) who experienced severe flares after being infected with COVID-19 and a review.

Methods and Results: A total of 72 potentially relevant citations were identified. After removing the duplicate citations, the title, and abstracts of 61 articles were evaluated and 11 relevant articles were reviewed in detail. A total of 72 potentially relevant citations were identified. After removing the duplicate citations, the title, and abstracts of 61 articles were evaluated and 11 relevant articles were included.

Conclusion: The COVID-19 pandemic is a devastating situation all over the world. SLE patient has already been in a susceptible condition as the disease progressed and continued having immunosuppressant therapy also one of the risk factors. A Flare condition can be happened during the COVID-19 Infection or after the infection is resolved. In SLE patient having COVI-19, close monitoring, high adherence to the therapy, and the health protocol are needed.

Introduction: Acute ischemic stroke is one of the three main causes of death in developed countries. RISKESDAS data of 2013 depicted the fact that the prevalence rate of stroke was 12.1 per 1,000 population. CT protocol and magnetic resonance imaging (MRI) are excellent evaluations of acute ischemic stroke. Magnetic resonance angiography (MRA) is an MRI technique to delineate arteries and evaluate stenosis and occlusion. Arterial Spin Labeling (ASL) MRI is quantitative and non-invasive, does not require Gadolinium contrast, measures cerebral blood flow, is useful for performing perfusion-based functional MRI (fMRI), and is able to be reevaluated. The study aimed to analyze the correlation between MRA and the relative Cerebral Blood Flow on ASL in patients with acute ischemic stroke.

Methods: The study aimed to analyze the correlation between MRA and the relative Cerebral Blood Flow on ASL in patients with acute ischemic stroke.

Results: The patients with acute ischemic stroke were in the age category of 40 years or more (92.3%) with the average age of the patients was 56.96 years  14.05. The youngest patient was 8 years old and the oldest one was 79 years old. Most of them were women (56.5%) with the most comorbid hypertension (45.7%) and diabetes mellitus (34.8%). The results of the evaluation after agreeing the consent portrayed that MRA was normal in 10 patients (21.7%) and there was stenosis or occlusion in 36 patients (78.3%). ASL examination showed that 20 patients (43.5%) were normal, whereas 26 patients (56.5%) were decreased.

Conclusion: Phi value was 0.601 (p < 0.05), meaning that there was a strong relationship between the results of MRA examination and ASL.

Introduction: Coronary Heart Disease (CHD) is a degenerative disease caused by fat accumulation and chronic inflammation. The elderly have a significant CHD risk due to the prevalence of vitamin D insufficiency and decreased platelet function, influencing the inflammatory response in this population. Therefore, this study aims to assess the relationship between vitamin D levels and platelet function measured by the mean platelet volume (MPV) and P-Selectin serum levels of CHD patients.

Method: The cross-sectional design was carried out on stable CHD patients aged 60-75. Meanwhile, vitamin D, MPV, and P-Selectin were taken through venous blood, and an ELISA examination was performed to determine their levels in serum. A correlation test using the Pearson product-moment was also conducted between vitamin D and platelet function.

Result: The subjects involved were 45 male and 16 female at 73.8% and 23.2%, respectively. The highest risk factor was dyslipidemia found in 45 (73.8%) and all subjects (100%) received statins. This study showed no correlation between vitamin D levels and MPV levels (p= 0.094) and P-Selectin (p=0.362).

Conclusion: Vitamin D levels are not associated with platelet function levels (MPV and P-Selectin) in elderly patients with CHD.

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

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

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

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

Background: Several studies link urinary tract infection (UTI) and bladder cancer. However, the association between bladder cancer muscle invasiveness and the incidence of UTI is not known

Objective: This study aimed to study the association between the occurrence of UTI in bladder cancer and the severity of the bladder cancer, specifically in a patient admitted to Karawang regional hospital, Indonesia.

Material and Methods: This is a single-center retrospective case control. Data were obtained through medical records of the patient admitted with bladder cancer in Karawang Regional Hospital from 2019-2021. Diagnosis of Non-muscle invasive Bladder cancer (NMIBC)/Muscle-invasive Bladder Cancer (MIBC) and UTI were all obtained through medical records. Binary logistic regression analysis was used to determine the odds ratio between these variables and the incidence of UTI

Result: A total of 59 samples were obtained. 57.7% were males, and 42.3% were females, with a mean age of 59 years and distributed into two groups, NMIBC/MIBC. There are also no significant gender and age difference between groups. Our data showed no significant association between bladder cancer muscle invasiveness and the incidence of UTI (OR=1.67; 95%CI 0.218-12.7; p=0.622). Subgroup analysis with different gender also yields no significant result.

Conclusion: UTI incidence increased in MIBC patients compared to NMIBC, but it is not statistically significant.

Introduction: Titanium mesh is commonly used to reconstruct the cranium in cranioplasty procedure. Although it is generally well-tolerated, erosion of the overlying soft tissue due to the implant exposure remained as a major risk that could impair patients' outcome. This study aimed to investigate the potential risk factors of titanium mesh exposure.

Methods: Medical records from patients who underwent titanium mesh cranioplasty within the period of July 2016 to July 2020 were retrieved. Patients' demographic and characteristics were reviewed to investigate the potential risk factors in titanium mesh exposure.

Results: Twenty-three patients were included in this study with the mean age of 44.6 (+10.9) years. Fourteen patients (60.9%) acquired titanium mesh exposure in less than 6 months after cranioplasty surgery. In majority, the duration of surgery were more than 3 hours (65.2%). Intraoperative blood loss volume was less than 500 cc in 8 patients (34.8%), 500-1000 cc in 8 patients (34.8%), and more than 1000 cc in 7 patients (30.4%). Nineteen patients had bone defect of >10 cm and the indications for craniectomy were tumor resection in 56.5% patients, followed by infection in 17.4%. The sign of infection was present in 12 patients (52.2%). Only 2 patients (8.7%) had radiotherapy after cranioplasty. One patient was diagnosed with polycythemia vera.

Conclusion: Titanium mesh exposure following cranioplasty surgery is a complication that might affect the patients' overall outcome. Female predominance, long surgery duration, excessive intraoperative blood loss might be correlated with higher risk of titanium mesh exposure.

Aortic stenosis is a valvular heart disease commonly found in developed and developing countries. The frequency of aortic valve sclerosis is about 25% in people over 65 years of age. In contrast to developing countries, infectious diseases, such as endocarditis or rheumatic fever, contribute greatly to aortic stenosis. Severe aortic stenosis without valve replacement has a poor prognosis and some patients are at high risk for surgery. Transcatheter aortic valve implantation (TAVI) is emerging as an alternative in patients with aortic stenosis who cannot or are at high risk for surgery. TAVI has revolutionized the management of aortic stenosis. This procedure continues to improve yearly and exceeds surgical aortic valve replacement in 2019. Initially, TAVI generated skepticism and criticism, but with many clinical trials and evidence-based investigations, TAVI is now widely accepted. Until now, the development of TAVI continues, starting with better technology, approaches, and new implantation strategies; TAVI is becoming safer for patients. This literature review will discuss more deeply about TAVI and its development.

Introduction: Controlled hypotension is one of the techniques applied to several microscopic ear, nose, and throat (ENT) surgeries. However, this technique has risks and complications, which result in impaired perfusion and oxygenation of organs including the brain that could trigger the postoperative cognitive dysfunction (POCD). Damage that occurs in brain cells can trigger the secretion of biomarker proteins in the blood, one of which is S100B which can indicate nerve damage in the intra and postoperative period. This study aimed to analyze the correlation between S100B protein level and the incidence of POCD in patients who received ENT surgeries with controlled hypotension.

Methods: A cross-sectional study was conducted among patients that underwent elective ENT surgeries at Dr. Soetomo General Academic Hospital, Surabaya, from July to August 2022. Cognitive function was assessed using Mini-mental State Examination (MMSE) at 12 hours before and 2 and 24 hours after surgery. The level of S100B was measured using enzyme-linked immunosorbent assay (ELISA) 12 hours prior surgery and 30 minutes post-surgery.

Results: A total of 31 patients were recruited in the study, including a mean age of 31.7 years. The mean S100B levels in POCD patients pre- and postoperative were 311.97 ng/L, and 415.34 ng/L, respectively. In non-POCD patients, the mean levels of S100B pre and postoperative were 436.90 ng/L, and 444.29 ng/L, respectively. There were 3 (9.7%) patients experienced POCD. Our data suggested there was a significant difference between preoperative and postoperative S100B levels in the groups of patients with POCD (103.37ng/L) and non-POCD (7.38 ng/L) (p<0.001). Patients that experienced POCD had significantly increased S100B compared to those who did not.

Conclusion: There is a correlation between changes of S100B levels and the incidence of POCD in patients undergoing ENT surgeries with controlled hypotension.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction: Chemotherapy is one of the management applied to cervical cancer patients. Chemotherapy is beneficial to kill cancer cells, but it affects normal body cells, such as hair roots, skin, and changes in physical appearance. These physical changes result in poor self-assessment and stress. This study was conducted to describe the correlation between body image and stress level of cervical cancer patients undergoing chemotherapy at the Gynecology Polyclinic, Dr. Kariadi General Hospital Medical Center Semarang.

Methods: This type of research is quantitative using a correlational research design. The research process was carried out in 2020 at Dr. Kariadi General Hospital Medical Center Semarang with the number of samples obtained was 87 respondents.

Results: It showed that there was a relationship between body image and stress levels in cervical cancer patients receiving chemotherapy (r = -0.313 and p-value = 0.003). With a change in physical appearance, patients would feel something different which affects psychological situations and further causes stress.

Conclusions: The level of stress has a significant correlation with the body image score of cervical cancer.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Background. Severe acute malnutrition (SAM) is one of major cause of morbidity and mortality in children, especially under 5 years old. Successful management of SAM can be determined by many factors. Therefore, the purpose of this study was to identify the factors associated with outcome of inpatient SAM management.

Methods. The present study performed a cohort study on children with SAM admitted to dr. Mohammad Hosein Hospital Palembang (RSMH) from January to July 2021. Outcome was weight gain during 14 days of observation period and rehabilitation phase, defined in g/kg body weight (BW)/day, and was categorized as follows: poor (<5 g/kg BW/day) and moderate-good (≥5 g/kg BW/day).

Results. There were 87 children, 62% were female, and median age was 14 (1-60) months old. Moderate-good outcome was found in 31 subjects (36%) with weight gain during rehabilitation phase was 2.10 (0–71.4) g/kg BW/day. The highest mean weight gain was in subjects aged 6-<12 months which was 7.68.2 g/kg BW/day. Most subjects had good acceptability with median 100% (44.4-100%) (p=0.696), while 36% showed diet intolerance such as vomiting (24%) and diarrhea (17%) (p=0.656). Most common associated symptom was shortness of breath (32%) (p=0.066). Non-infectious was more common than infectious disease (47% vs 44%) with p=0.470 and p=0,110, respectively. All of subjects with tuberculosis showed poor outcome (RR 1.70; 95% CI 1.41-2.06; p=0.004).

Conclusion. In this study, SAM treatment outcome was not influenced by associated symptoms, accompanying disease, diet intolerance, and acceptability. However, tuberculosis in SAM patients significantly raised the poor outcome.

Background: Human amnion contains several growth factors, inflammatory inhibitors, collagen and hyaluronic acid, which are proven to accelerate wound healing. The collection, processing, and storage of data have several limitations, especially in remote areas. Nile Tilapia fish (Oreochromis niloticus) skin contains amino acids, collagen, and tilapia piscidin, which allows it to be used as a xenograft. This study analyzes the effectiveness of tilapia fish skin compared to the fresh human amnion.

Method: Twenty-four rats were divided into three groups. Group, I was a full-thickness wound treated with tilapia skin, group II was treated with fresh human amnion, and group III was a control. On the third day, a punch biopsy was performed. The granulation tissue thickness and collagen density were examined. A wound area measurement and histopathological examination of the entire wound were performed on the seventh day.

Results: The speed of epithelialization in the tilapia group compared to the amnion was not significantly different (p = 0.065). On the third day, histopathologically, the tilapia group formed the same amount of granulation tissue as the amnion group. In the middle section between tilapia, amnion and control with the Kruskal-Wallis test showed no significant difference (p = 0.573). There was no significant difference in collagen density on the third day between the three groups at the edges and in the middle of the wound (p = 0.097 and 0.253). The Mann-Whitney test on the seventh day found that the density of collagen between tilapia and amnion groups was not much different (p = 0.126).

Conclusion: The speed of epithelialization, growth of granulation tissue, and collagen density of wound healing in full-thickness rats were not significantly different between Nile tilapia skin and fresh human amnion. The skin of Nile Tilapia fish can be used for wound care or as a temporary biological dressing until the wound can be permanently closed.

Background: Ultrasound (US) is a reliable, non-invasive, and inexpensive modality for evaluating femoral cartilage (FC) thickness. Several studies evaluated the US accuracy in assessing FC thickness by comparing it to MRI and macroscopic measurements, reporting that the US exhibit highly accurate FC thickness measurement. This study evaluated the FC thickness among healthy Indonesian adults using ultrasound US assessment.

Methods: An analytical observational study with a cross-sectional design was conducted in Surabaya Hajj General Hospital, Indonesia, from April to August 2022. A total of 127 participants with no symptoms or pathologies on both knees were involved in the study. In this study, a certified examiner performed the ultrasound scanning in three sites: medial condyle (MC), intercondylar (IC), and lateral condyle (LC) of both knees.

Results: A total of 254 knees from 127 healthy Indonesian adults were examined. The participants’ mean age was 32.83 years. Most of them were female (69%). Participants’ average weight, height, and BMI were 62.25 kg, 161.17 cm, and 23.93, respectively. The mean FC thickness of the right MC, IC, and LC was 1.76 mm, 1.92 mm, and 1.71 mm, respectively. Meanwhile, the mean FC thickness of left MC, IC, and LC was 1.76 mm, 1.89 mm, and 1.69 mm, respectively. This study found that FC thickness was associated with gender (<0.05) but not age and BMI.

Conclusion: Mean FC thickness among healthy Indonesian adults of MC, IC, and LC were 1.76 mm, 1.89 –1.92 mm, and 1.69 – 1.71 mm, respectively. The IC mean was higher than the MC and LC means. Mean FC thickness on both sides was associated with gender but not age and BMI.

Background: Tooth extraction is a procedure with the highest prevalence of causing alveolar bone damage. After extraction, the dimension will change. This procedure needs a balance of bone formation and resorption. Osteocytes are the most common cells in bone and have an essential role in bone formation. This study explores the effect of bovine tooth grafts on the number of osteocytes in the socket preservation process post-dental extraction.

Methods: A total of 28 Wistar rats, 14 control and 14 treatment groups, were extracted on the lower left incisor. Control group with PEG without induction and treatment group with bovine tooth graft and PEG induction. On the 14th and 28th days, the rats were euthanized. Then perform histological examination with HE staining and cell counting using a light microscope

Results:  We found the treatment group had higher the average number of the osteocyte, which was 146.43±11.41 on 14th day and 288.14±161.91 on 28th day. There was a significant increase in osteocytes among the treatment group compared to the control (p=0.000).

Conclusion: Bovine tooth graft application as dental socket preservation was proven to increase the number of osteocyte cells in the alveolar bone of Wistar rats after extraction. Bovine tooth grafts as dental socket preservation materials increased the number of osteocytes at a peak at 28 days.

Background: A diabetic foot ulcer is a complication that often occurs in patients with diabetes mellitus. The healing process of a chronic wound is more complicated and requires more complex treatment. There is an increase in IL-1, IL6, and TNF-α pro-inflammatory cytokines in a chronic wound. Hyaluronic acid (HA) is a component that has been used for a long time and is known to help the wound healing process. This study was at a time to determine the effectiveness of hyaluronic acid on the reduction of interleukin-6 in accelerating the healing of Wagner II-III diabetic foot ulcers.

Methods: This study is an experimental, randomized study of pre and post-test design on diabetic foot ulcer patients with the Wagner II-III classification who were controlled at the thoracic, cardiac, and vascular surgery polyclinic at Dr. Soetomo Hospital Surabaya. Data were analyzed using SPSS version 20 for Windows.

Result: About 39 samples are willing to participate in the study, divided into 20 samples in the treatment group and 19 in the control group. The mean concentrations of IL-6 in the treatment group before and after the intervention were 280.70±155.50 ng/ml and 126.60±145.60 ng/ml. There was a significant decrease in IL-6 levels (p<0.05) before and after the intervention. The mean concentrations of IL-6 in the control group pre and post were 315.20±127.40 ng/ml and 136.30±134.60 (p<0.05). The decrease in the control and treatment groups was no statistically significant difference (p>0.05). There was no significant difference in the PUSH Score (p>0.05) in the two groups before intervention/treatment. The decrease of wound area in the control and treatment groups were -4.80 ((-0.40)-(-24.50)) and -4.8 ((-0.70)-(-30.90)) (p>0.05).

Conclusion: Topical hyaluronic acid and wound care using 0.9% NaCl reduced interleukin-6 levels, PUSH scores, and wound area in Wagner II-III diabetic foot ulcers.

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

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

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

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

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

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

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

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

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

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

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

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

Abstract

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

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

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

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

Introduction: Hypertension in adolescents’ risk factors include foods that contain high sodium, lack of physical activity, stress, obesity, alcohol consumption, and smoking. Order to prevent hypertension incidence in adolescents by increasing self-awareness through the provision of health education. This study aimed to determine the health education effect regarding the risk factors of hypertension (stress and sodium diet) on the self-awareness of undergraduate students in Yogyakarta.

Methods: This study was a quantitative study with a quasi-experiment pretest & posttest with a control group design. The hypertension self-awareness questionnaire was used in this study and the results will be classified into two groups (the control and the intervention group). The sample obtained in this study was 54 respondents. The Mann-Whitney U and Wilcoxon Signed Rank test was done in this study.

Results: It showed that there were significant differences in the intervention group and control group. There were significant differences in results found before and after health education (significance value 0.000), while the result for the control group is 0.06, which indicates that there were no significant differences before and after the leaflet.

Conclusions: It can be concluded that health education regarding risk factors for hypertension (stress and a high sodium diet) can increase self-awareness for undergraduate students in Yogyakarta.

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

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

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

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

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

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

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

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

Introduction: Oxidative damage can be brought on by inhaling free radicals from cigarette smoke. Malondialdehyde (MDA), a byproduct of lipid peroxidation, is a biomarker for oxidative stress. Beta vulgaris L., sometimes known as beetroot, is a root vegetable with phenolic and betalain chemicals that have antioxidant qualities and can reduce oxidative stress in the body.

Determine how beetroot juice affects male Wistar rats exposed to cigarette smoke regarding their MDA levels.

Methods: 24 samples of male Wistar rats, separated into 4 groups, were utilized in this genuine experimental investigation using a posttest-only control group design. Traditional food and beverages were served to Group N. Two cigarettes were smoked each day by the cigarette smoking group, BV1, and BV2. Beta vulgaris L. juice was also administered to group BV1 at a dose of 8 ml/kg BW per day and to group BV2 at 16 ml/kg BW per day. MDA serum levels were measured using the TBARS technique after 28 days of therapy. The one-way ANOVA and the Games-Howell test were used to evaluate the data.

Result: The group control's mean MDA level was 1,539 ppm; the cigarette smoking group was 3,167 ppm; BV1's was 2,452 ppm, and BV2's was 2,0527 ppm. Between-group control and cigarette smoking group BV1 and BV2, as well as between BV1 and BV2, there were significant differences in MDA levels (p 0,05).

Conclusion: The MDA levels of the groups exposed to cigarette smoke and given beetroot juice were lower than those of the groups exposed to cigarette smoke alone, with the MDA levels of the group given a dosage of 8 ml/kg BW being lower than the group given a dose of 16 ml/kg BW.

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

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

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

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

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

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

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

Background: Skin graft is one of the best options for wound closure. This method is the gold standard for skin burns and large open wounds. Coffee, or Robusta coffes (BP-2) is believed to reduce the level of hyperpigmentation due to chlorogenic acid, a major polyphenolic found in coffee with anti-tyrosinase activity. However, the anti-tyrosinase activity of BP-42 coffee extract is unknown. This study aims to measure the chlorogenic acid content of BP-42 coffee bean extract and its anti-tyrosinase activity.

Methods: BP-42 coffee beans were extracted using ethanol by maceration technique. Then, the thin-layer chromatography (TLC) profile of the BP-42 coffee bean extract was made to determine the chlorogenic acid content. At the same time, its anti-tyrosinase activity was performed using the spectrophotometric method. The chlorogenic acid's content was determined using the TLC-densitometric method. Data were analyzed using SPSS version 20.0 for Windows.

Results: BP-42 coffee bean extract had chlorogenic acid concentrations at 12.452 mg/g extract. As expected, the extract exhibited anti-tyrosinase activity with IC₅₀ at 312.213 ppm, while kojic acid showed higher bioactivity (IC₅₀ = 30.696 ppm).

Conclusion: BP-42 coffee bean extract showed a notable anti-tyrosinase activity, promising to be used as the natural anti-pigmentation candidate.

Introduction: Corona Virus Infection 2019 (Covid-19) is still a problem faced by all countries in the world, including Indonesia. Islamic boarding schools are a vulnerable place to be cluster spread of COVID-19 because there is much interactivity in a limited environment. This study aims to study the impact of Covid-19 on the personal hygiene behavior of female students in Islamic Boarding School.

Methods: The research design is cross-sectional. The sample in this study was 117.  Data collection using questionnaires and interviews by applying strict health protocols. Data analysis used univariate and bivariate.

Results: The results of the study informed that before covid-19 there were many female students who did not practice personal hygiene properly. Meanwhile, during the COVID-19 pandemic, most of the female students had practiced personal hygiene with sufficient category. Conclusion: There was a significant change in the personal hygiene behavior of female students in Islamic boarding schools before and during the COVID-19 pandemic.

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

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

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

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

Background: Thyroid cancer continues to be a problem all over the world, with the number of cases increasing year after year. We aimed to examine the association between various laboratory parameters and follicular-type thyroid nodules. We also examined the performance of several parameters to differentiate malignant and benign follicular thyroid lesions.

Methods: This is a retrospective cohort study to determine the association between various laboratory parameters and follicular-type thyroid nodules in Dr. Soetomo General Hospital, Surabaya.

Results: A total of 62 patients were examined. The NLR in the follicular carcinoma group was 2.26 ± 1.35, whereas the NLR in the adenoma group was 2.72 ± 0.74. The average lymphocyte in the follicular carcinoma group was significantly higher than the adenoma group, 2.20 ± 0.78 vs. 1.76 ± 0.82. With a cut-off value of 2.405, NLR had a 69.40% accuracy rate for diagnosing a follicular adenoma (sensitivity: 70%; specificity: 69.2%, PPV: 30.4%, NPV: 92.3%). Lymphocyte had an accuracy of 80.6% in detecting follicular carcinoma (cut-off: 1.625; sensitivity: 80.8%; specificity: 80.0%, PPV: 95.5%, NPV: 44.4%). With an accuracy of 72.6% (cut-off: 270.500; sensitivity: 71.2%; specificity: 80.0%, PPV: 94.9%, NPV: 34.8%), platelet value is a promising parameter for differentiating follicular cancer and adenoma. There was a significant relationship between NLR, lymphocyte, and platelet with follicular-type thyroid nodules (P < 0.05 for all).

Conclusion: NLR, lymphocytes, and platelets are potential biomarkers that can be used to differentiate follicular thyroid carcinoma and follicular thyroid adenoma.

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

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

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

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

Background: Hydrocephalus is a brain disease that requires prompt treatment. The outcome of hydrocephalus is dependent on early detection and treatment. This study was conducted to analyze the medico-socio-economic perspective on the delayed treatment of hydrocephalus patients, which aimed to advance the practice of neurosurgery in the socio-neurosurgery field, including both preventive and therapeutic aspects.

Method: This was an observational analysis study. The study subjects were all patients with congenital hydrocephalus treated in dr. Soetomo Academic General Hospital between January 2017 and December 2019. The study was carried out on January 2017 to December 2019 at the Inpatient Surgery ward, dr Soetomo Academic General Hospital, neurosurgery outpatient unit, and home visits. Research data consists of both primary and medical record data. Data on patient characteristics were obtained through direct interviews with the sample using prepared questionnaires, medical record data, and radiological data of both patients examined at dr. Soetomo Academic General Hospital and other health services. Bivariate correlation analysis was performed to assess the effect of each risk factor on the incidence of delay in treatment, and multivariate logistic regression analysis was performed to assess the magnitude of the effect of risk factors.

Result: The number of cases was 101 subjects. A total of 101 patients included as research samples were congenital hydrocephalus patients who received the first treatment at dr. Soetomo Academic General Hospital from January 2017 to December 2019. Up to 50 individuals (49.5%) were delayed in treatment. The data analysis with Chi-square did not reveal a statistically significant correlation between delay in treatment and level of parent's education (p=0.0951), delay in treatment and economic status ((p=0.4955). Delays in the treatment of congenital hydrocephalus were statistically significant and correlated with Posyandu's role (p=0.0012), health insurance ownership (p=0.0001), family support (p=0.0130), and professional medical decisions (p=0.0001). Health insurance ownership has the smallest p-value (0.000) and largest wald (16.545) in the multivariate logistic regression analysis calculation using the enter method. The insurance ownership variable has the most significant and largest partial influence on the delay in treating congenital hydrocephalus.

Conclusion: There were 101 patients included, and up to 50 individuals (49.5%) were delayed in treatment. Parents' education level and socioeconomic status were not associated with delayed treatment of congenital hydrocephalus. Delays in managing congenital hydrocephalus were influenced by Posyandu's role, health insurance ownership, family support, and professional medical decisions.           

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction: Patients with thalassemia experience a synthesis of one of the beta chains of the globin gene, resulting in reduced hemoglobin formation. Patients with beta-thalassemia major require routine transfusions and iron chelation. Both of these cause impaired kidney function. This study aims to determine the relationship between the amount of blood transfusion and the amount of iron chelation with blood urea and saliva levels in children with beta-thalassemia major.

Methods: An observational cross-sectional study was conducted at Moewardi Hospital, Solo using patients with beta-thalassemia major as subjects, taken by consecutive sampling from September to November 2018. The data on blood transfusion, iron chelation, and blood urea levels were obtained from medical records. Unstimulated saliva was taken in the morning. The urease method was used to assess the salivary urea levels and all data was analyzed using Pearson correlation analysis.

Result: The results showed the mean amount of transfusion was 71.9 ± 34.3, the amount of iron chelation 61.0 ± 32.1, blood urea levels 4.41 ± 1.1 mg / dL, and salivary urea levels 35.6 ± 12.5 mg / dL. Correlation analysis showed a positive correlation between the amount of blood transfusion and the amount of iron chelation with blood and saliva urea levels. There was also a positive correlation between blood urea and saliva levels.

Conclusion: It can be concluded that the amount of blood transfusion and iron chelation affects urea levels in blood and saliva in children with beta-thalassemia major. The close correlation between blood and saliva urea indicates that salivary urea can be used as an alternative assessment of blood urea.

Background: Tumor-infiltrating lymphocytes (TIL) serves as the host adaptive immune response in breast cancer. TIL has the potential to be an independent prognostic factor in breast cancer patients. In this study, we aimed to examine the association between stromal TIL and recurrence in locally advanced breast cancer patients.

Methods: A cohort retrospective study was conducted using medical records of female breast cancer patients with locally advanced breast cancer. We collected patients' data, including demographic data from the medical record. Stromal TIL was examined following the recommendations of the International TIL Working Group 2014.

Results: 75 samples were included with an average age of 49.5±8.4. Ductal carcinoma was the most common type histologically (88.0%). Luminal B Her2-negative was the predominant breast cancer subtype (32.0%). There was a significant association between the breast cancer subtype and disease-free survival (P – 0.014). The optimal cut-off to determine the recurrence of breast cancer was 15%. The sensitivity, specificity, PPV, NPV, and accuracy of TIL to predict the 24-month disease-free survival (DFS) were 80.5%, 82.4%, 84.6%, 77.8%, and 81.3%, respectively. Every 10% increase in TIL percentage could raise the DFS by 5.45 months (p=0.001). Patients with high TIL values had higher survival than those with low TIL values.

Conclusion: There was a significant correlation between the stromal TIL and the recurrence rate. The pre-therapy stromal TIL percentage can be employed as a potential biomarker to predict breast cancer recurrence, particularly in the first two years.

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

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

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

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

Background: Coronavirus Disease 2019 (COVID-19) is an easily contagious disease, and not much is known about the characteristics of COVID-19, both in terms of susceptibility, severity, and spreadability of various SARS-CoV-2 strains. Patient genomic factors, especially related to genomic polymorphisms that affect the body's immune system, can influence the course of infectious diseases. The aim of this study is to get an adequate picture regarding gene polymorphisms, both susceptibility and related to the clinical degree in COVID-19 patients.

Methods: The PCR preparations were carried out in the Biomedical laboratory of the Faculty of Medicine, Universitas Sebelas Maret. The qualitative PCR (qPCR) examination was sent to the Genetica Science laboratory, Tangerang, West Java. The research subjects were divided into 3 groups, namely COVID-19 patients with no symptoms, COVID-19 patients with mild-moderate symptoms, COVID-19 patients with severe-critical symptoms. The research subjects were taken 6 cc of venous blood (3 cc for examination of serum IL-6 and TNFα levels and 3 cc for DNA examination).

Results: Serum levels of IL-6 and TNF-α in the clinical grade group were almost all above normal values. The frequency of TNF- α polymorphisms (-376G/A) all showed homozygote GG. TNF-α (-308G/A) also showed homozygote GG was dominant for SARS CoV2. IL-6 (-572G/C) polymorphism for cases requiring medium and severe clinical degree hospitalization was found to have more C allele than G allele. IL-6 polymorphism (intron A/G) the G allele is less common in cases requiring hospitalization.

Conclusion: TNF-α(−308A) allele has an influence on the development of clinical symptoms of SARS CoV2 infection. The rs1800796GG genotype in the IL-6 promoter contributes to milder symptoms in SARS CoV2 infection. Allelic variants of the gene under study may show different effects in other races depending on their interactions with other risk factors.

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

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

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

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

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

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

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

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

Introduction: Coriandrum sativum L (ketumbar seeds) nano extract was prepared using chitosan as a nano extract framework and tripolyphosphate as a stabilizer by ionic gelatin method. This study aimed to reduce free radicals in streptozotocin-induced hyperglycaemic rats by administering Coriandrum sativum L nano extract as nano herbal

Methods: The surface topography of nano extract and characterization of zeta potential particle size was carried out using PSA (Particle Size Analyser). The ability of nano extract as anti-hyperglycaemic on streptozotocin-induced rats was tested using the randomized post-test only control group design.

Results: The result of the antihyperglycemic test on streptozotocin-induced rats showed that oral administration of the nano extract at a dose of 50 mg/Kg BW/day gave the best result for decreasing glucose blood, and MDA and increasing SOD levels in hyperglycaemic rats. The characterization of nano extract using PSA showed change here had been an encapsulation of bioactive substances from Coriandrum sativum L extract on the chitosan-tripolyphosphate absorption of NH, PO groups, and change histopathology pancreas of hyperglycaemic wistar rats. Characterization with PSA strongly supports nano extract as a delivery system for bioactive substances with a zeta potential of -25.80 mV and a particle size of 455.20 nm.

Conclusion: Coriandrum sativum L (ketumbar seeds) nano extract was prepared using chitosan had potential to reduce free radicals in streptozotocin-induced hyperglycaemic rats.

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.

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.

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.

Background: Spinal congenital malformations are closely associated with other congenital anomalies, are usually asymptomatic and be found incidentally. Moreover, spine abnormalities such as hemivertebra may cause further complications if left untreated. Among patients with VACTERL anomalies, spine anomalies account for 60-95% of them. This report aimed to describe rare and interesting cases of spinal malformation in children to provide further information on the importance of a proper approach in such cases.

Case Presentation: We present three pediatric cases of vertebral anomalies associated with anorectal malformations incidentally found in contrast studies. All patients have a history of anorectal abnormalities at birth and are referred to the hospital for contrast studies. The first case found semi-segmented hemivertebra at T8-9 levels, cleft at T10 level and high-type anorectal malformations (ARMs). The second case showed unsegmented hemivertebra at the level of L1 and butterfly vertebra at T10, approximately at the same level as the skin lesion, with the possibility of occult spina bifida and high-type ARMs. The third case revealed bilateral vesicoureteral reflux (VUR), grade 1 right hydroureteronephrosis and left hydroureter, with semi-segmented hemivertebra at the level of L3, unsegmented hemivertebra at L4-5 and an extra lumbar vertebra, possibly a lumbosacral transitional vertebra (LSTV).

Conclusion: Thorough screening and other examinations such as contrast studies could reduce their morbidity as more sophisticated imaging may be done to better visualize the anatomical malformation.

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

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

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

Introduction: Acute Disseminated Encephalomyelitis (ADEM) is an immunity-mediated central nervous system demyelinating disorder. Myelin Oligodendrocyte Glycoprotein (MOG) examination provides information about a patient's ADEM development status. A positive MOG antibody can signify a first episode or incomplete recovery. This review aims to report a case of a pediatric patient with acute disseminated encephalomyelitis with positive MOG antibody.

Case Presentation: We present a 5-year-old girl with symptoms of low-grade fever, encephalopathy, blurred vision, numb and tingling sensations on hands and feet, weakness, unable to walk. Head MRI (Magnetic Resonance Imaging) examination reveals lesions in the bilateral thalamus and white matter of the left parietal lobe. There was also a bilateral thickening of the optic nerves. Blood laboratory examination was relatively normal, and the MOG antibody test was positive. The patient was then treated with corticosteroids for 1 year and had 2 recurrent episodes of attacks. MOG test evaluation was still also positive 6 months after the first attack. After Intravenous immunoglobulin (IVIG) treatment was given, resulting in excellent clinical response and no recurrent attack since then.

Conclusions: ADEM cases have a good prognosis and good recovery. IVIG administration, with the help of other supportive therapy, improves recovery in treating pediatric ADEM.

Background: Acute limb ischemia is a sudden decrease in limb blood perfusion with an onset of less than 14 days, most commonly occurs in lower extremities. Diabetes mellitus, one of diseases underlying peripheral artery disease, complicates the pathophysiology of acute limb ischemia. In this case report we present a patient with type 2 diabetes mellitus and acute limb ischemia in the left upper extremity that had successful thrombectomy treatment.

Case presentation: A 58-year-old female patient came to the Emergency Care Unit of Dr. Soetomo General Hospital with the continuous pain in the five fingers to the palm of the left hand for the past two days. The numbness spread from the elbow to the left fingers, making them weak and difficult to grip. Those five fingers were pale and cold as well. The left hand had no pulsated radialis and ulnar artery, weak brachial pulse and undetected pulse oximetry result. The patient was diagnosed with type 2 diabetes mellitus since 2005 and has a controlled treatment. On the first day of hospitalization, the patient was scheduled for emergency thrombectomy at Dr. Soetomo General Hospital. Follow-up on the seventh-day post-surgery, the patient had no complaints of pain and pale in the left hand and the brachial, ulnar and radial arteries were palpable.

Conclusion: Acute limb ischemia is uncommon in the upper extremities but we found that it has an excellent prognosis with early revascularization, even in a patient with diabetes mellitus. The treatment must be in conjunction with aggressive diabetes mellitus treatment to avoid acute limb ischemia worsening

Introduction: Postoperative cognitive dysfunction (POCD) following general anesthesia is frequent among geriatric patients worldwide. Neuroinflammation and neuronal injury have been associated with the incidence of POCD. Some biomarkers of brain damage including neuron-specific enolase (NSE) and S100B protein have been widely studied; however, their association with the incidence of POCD is still controversial. This study aimed to assess the correlation of serum NSE and S100B levels with the incidence of POCD among geriatric patients receiving general anesthesia.

Methods: A prospective cohort study was conducted among geriatric patients receiving general anesthesia at Dr. Soetomo Hospital, Surabaya from July to October 2022. The Montreal Cognitive Assessment (MoCA) INA instrument was used to assess POCD, and enzyme-linked immunosorbent assay (ELISA) was used to quantify the levels of serum NSE and S100B. Spearman’s rank correlation was implemented to identify the correlation of MoCA INA scores with the levels of NSE and S100B. Mann-Whitney analysis was used to determine the association between NSE and S100B levels with the incidence of POCD. A p-value of ≤0.05 was considered statistically significant.

Results: A total of 48 patients were enrolled in the study and 16.7% of them had POCD. Spearman’s correlation test suggested no significant correlation between MoCA INA score with serum NSE level (r_s:-0.095; p=0.522) and S100B level (r_s:-0.213; p=0.146). Mann-Whitney analysis indicated no significant difference in the NSE and S100B levels of patients with and without POCD (p=0.3470 and p=0.097, respectively).

Conclusion: There was no significant association between NSE and S100B levels with the incidence of POCD among geriatric patients receiving general anesthesia during elective surgeries at Dr. Soetomo Hospital, Surabaya.