Background: The nasal cavity of a pig serves as an entry point and a habitat for the colonization of commensal microbes and pathogenic bacteria such as bacterial zoonosis. This study aimed to identify the phenotypic and genotypic of Gram-positive β-hemolytic organisms collected from nasal and tonsil swabs of pigs that were collected from the abattoir surrounding outbreak area, complete with testing sensitivity test of the bacterial isolates to Penicillin G and Tetracycline antibiotics.

Material and Methods:  Totaling 18 isolates consisting of 9 isolates from nasal and 9 isolates from tonsil of coccus β-Hemolysis bacteria originating from 60 samples were used. These isolates were then conventionally identified, then molecularly using 16S rRNA gene analysis. The sensitivity test was carried out by the Kirby Bauer method following the standards of the Clinical and Laboratory Standards Institute (CLSI).

Results: The results of the phenotypic identification (biochemical test) revealed that 9 out of 18 isolates were identified as Enterococcus spp. Furthermore, the confirmation of isolates by molecular analysis i.e. the 16S rRNA gene showed consistency with the biochemical test,  and there was confirmed as Enterococcus faecium and Enterococcus faecalis. The sensitivity test showed as many as 9 isolates resistant to Penicillin G and Tetracycline,  5 isolates were resistant, 1 isolate was sensitive and 3 were intermediates. Moreover, the results of the sensitivity test to Penicillin G and Tetracycline, 5 out of 9 isolates showed resistance to more than one antibiotic.

Conclusion: The phenotypic and genotypic of Gram-Positive Coccus β-Hemolysis bacteria isolates from the tonsil and nasal of pigs showed as Enterococcus faecium and Enterococcus faecalis. The use of antibiotics such as Penicillin G and Tetracycline is not recommended for the treatment of this agent resulting in most of the agents being resistant.

Link of Video Abstract: https://youtu.be/DjGx56j9LiU

Introduction: Women of reproductive age with anemia are recommended to take iron supplements and increase their intake of iron-rich food. Moringa (Moringa oleifera) leaf is a potential plant containing high iron, which is simple to find in Indonesia.

Aims: to determine the effectiveness of Moringa leaves supplementation in women of pro age.

Methods: This type of research is an experiment with experimental research with pre-post test control group design. The sample was 119 subjects collected using purposive sampling according to the inclusion criteria. The study subjects were divided into 3 treatment groups: supplementation of Ferrous sulfate tablets 30 mg per day (Group P0); 3000 mg Moringa leaf capsules three times a day (3 x 1000 mg) (Group P1); and Moringa leaf capsules at a dose of 3000 mg three times a day (3 x 1000 mg) plus 30 mg ferrous sulfate tablets once daily (Group P2) for 60 days, then hemoglobin (Hb) levels were re-evaluated.

Result: The Friedman test showed a mean Hb difference between the three measurement groups, which was statistically significant with p <0.05. The treatment group with P2 had the highest value of 4.74, followed by P1 and P0 of 4.71 and 4.65.

Conclusion: Supplementation of Moringa leaf capsules at a dose of 3000 mg for 60 days may increase Hb levels in women of reproductive age with iron deficiency anemia.

Link Of Video Abstract: https://youtu.be/zIVTZc6xl_8

Introduction: Emergency obstetric referrals are crucial for preventing pregnancy complications that may escalate into severe, life-threatening conditions, ultimately resulting in fatalities. The pandemic influenced the obstetric referral system of healthcare services. Specifically, Dr. Soetomo Regional Public Hospital recorded 107 cross-referral cases in 2020 and 58 in 2021 with obstetric risk factors. In this study, we analyze these obstetric emergency cross-referral cases during the pandemic at the hospital. This study aims to provide an epidemiological description of cross-referral cases with risk factors for obstetric emergencies at Dr. Soetomo Regional Public Hospital during the COVID-19 pandemic from 2020 to 2021.

Methods: An analytical descriptive research design, employing a case study approach, was used to analyze cross-referral cases with risk factors for obstetric emergencies over the pandemic period. The research subjects encompassed all obstetric emergency cross-referral cases at Dr. Soetomo Regional Public Hospital during the pandemic, with a total sampling technique applied to select cases that met specific inclusion and exclusion criteria.

Results: The analysis of emergency obstetric referrals revealed a significant relationship between the patient’s age and their risk factor categories for obstetric emergencies (p < 0.001). Furthermore, a significant correlation was found between the delayed referral phases and the risk factors for obstetric emergencies (p < 0.001). A significant correlation was observed concerning the need for Intensive Care Unit (ICU) care. The analysis also demonstrated a significant relationship between obstetric emergencies and birth weight as well as APGAR score (p < 0.05).

Conclusion: This study reveals a compelling relationship between the risk factors for obstetric emergencies and the variables such as age, methods of vaginal delivery, delayed referral phases, birth weights, and APGAR scores during the COVID-19 pandemic.

Introduction: The common cold is an emergency that often occurs in children due to shortness of breath and even death, so attempts are needed to massage the baby so that respiratory failure does not happen. Not only massage but a combination with percussion (clapping) as a physical chest therapy (CPT) helps effectively against breathing difficulties and respiratory infections in toddlers. Thus, this research is aimed to evaluate the effectiveness of clapping and common cold massage combination therapy on breathing frequency and the number of staphylococcus bacteria in toddlers with upper respiratory tract infections (ARI)

Methods: This quantitative research used a quasi-easy experiment with a pre-test and a post-test with a control group. The population in this study was PKM Sidoarjo, Indonesia. The sample size was 42 people. Sampling was done by consecutive selection. This study was divided into the intervention group, which received massage and clapping therapy, and the control group only received massage therapy. Data analysis was performed using the Wilcoxon Sign Rank statistical test in the SPSS 25.

Results: According to the age category, most respondents in both groups were one (K1: 45.5%; K2: 54.0%). We reported a respiratory rate decrease in the sample after the massage therapy. The reduction in the respiratory rate was 2.50 times, and decrease in Staphylococcus bacteria in the sample after getting the massage therapy. The amount of decrease in Staphylococcus bacteria rate was 3.50 times. A significant difference in the increase in the respiratory rate was established in the group that had a massage and clapping therapy (p=0.000), and the amount of Staphylococcus bacteria was found in the group that had a massage and clapping treatment (p=0.000).  The amount of decrease in Staphylococcus bacteria was 10.50 times.

Conclusion: The combination of clapping therapy and cold massage therapy will affect the respiratory frequency and the number of Staphylococcus bacteria. So, it is necessary to motivate parents, especially mothers, to do one of the usual cold massage therapy movements.

Link of Video Abstract: https://youtu.be/iUu03npEjEo

Background: Trauma cases, especially head injuries, are cases that are often found in hospital emergency departments. Coagulopathy can occur in head injuries and intracranial bleeding, where a low Glasgow Coma Scale (GCS) is associated with coagulopathy. This study aims to evaluate the correlation between the degree of severity and type of intracranial hemorrhage and the incidence of coagulopathy in head injuries at the Ulin Regional General Hospital, Banjarmasin, Indonesia.

Methods: An observational analytic study with 74 sample populations was conducted among patients with a head injury treated at Ulin Regional General Hospital, Banjarmasin, in the 2019-2022 period taken by total sampling, which met the inclusion and exclusion criteria. The data of each variable was analyzed with the Kruskal-Wallis test. Data were analyzed using SPSS version 25.0 for Windows.

Results: There was a significant relationship between the two variables towards the occurrence of coagulopathy; namely, the degree of severity was 0.000 (p <0.05), and the type of bleeding was 0.003 (p<0.05).

Conclusion: There is a significant relationship between the degree of severity of the incidence of coagulopathy and the bleeding with the incidence of coagulopathy, so knowing the degree of severity by clinical examination of GCS and the type of intracranial bleeding by CT scan of the head, as well as blood tests to determine the incidence of coagulopathy are important so that management can be carried out and assessing outcomes.

Link of Video Abstract: https://youtu.be/VC3Gcd7oS5Y

Introduction: Tetanus is a disease that can be diagnosed clinically. However, there is a lack of research data on tetanus patients and their clinical outcomes, especially in adult tetanus patients in Indonesia. This study aims to determine the factors that influence the outcome of tetanus patients.

Method: A cross-sectional study was performed from May to June 2021 at Dr. Soedono Madiun General Hospital. Subjects were recruited by total sampling. The data that will be taken in this study are gender, age, immunization history, incubation period, onset, port of entry, Philips score, and clinical outcomes of patients.

Result: Were 112 patients diagnosed with tetanus at Dr. Soedono General Hospital from January 2019 to December 2020. The male subjects outnumbered female subjects by 81.3%. The youngest subject was 19 years old, and the oldest was 81 years old. The tetanus immunization status showed that 2 patients were known to be fully immunized, 21 were not fully immunized, and 89 (79.5%) had unknown immunization status. This study showed that the port of entry of the wound is most often the entry point for tetanus in the inferior extremity of 72 patients (64.3%). Most onset occurred in 1-7 days, with a mean onset for generalized tetanus was 2.3 ± 1.8 days. The mean incubation period for the appearance of tetanus symptoms in this study was 9.4 ± 5.6 days. The most common comorbid disease in this study was diabetes mellitus (11.6%). This study's clinical outcome of tetanus showed that 74 patients (66.1%) had improved, while 38 patients (33.9%) died during treatment.

Discussion: This study's most common port of entry was on the inferior extremities. This lower limb predominance as the port of entry could be explained by the fact that C. tetani exists in soil; hence, any lower limb injury would be open to contamination and infection by this organism. Based on the Dakar and Phillips score system, tetanus has a worse prognosis when there is a faster incubation period, faster onset, more proximal port of entry location, immunization status, comorbidities and signs of muscle spasm, fever, and tachycardia are obtained.

Conclusion: In this study, tetanus still has a high mortality rate. Male gender, age over 45, a moderate to severe disease degree (considering a relatively short incubation time, short onset period, and unknown immunization status) are a few factors that may affect this high mortality rate.

Introduction: In general, wastewater produced by Public health centers contains many microorganisms, pathogenic compounds, and hazardous and toxic chemicals that can cause environmental pollution and transmit various diseases.¹ The danger posed by the liquid waste produced is quite large, so it is necessary to have a wastewater treatment process before it is disposed of. Wastewater treatment is carried out using a wastewater treatment plant (WWTP). Thus, this study aims to evaluate the performance, environment and economy of WWTPs in Public health centers.

Methods: This research uses descriptive quantitative research methods. The inclusion criteria were the laboratory data results in 2018 and 2019. The exclusion criteria were the data needed to be completed. The research variable was the performance of the WWTP on wastewater quality. The data analysis of the laboratory test results is analyzed and compared with the East Java Governor Regulation Number 72 of 2013 concerning Wastewater Quality Standards for Business and Hospital Activities.

Results: The results of laboratory tests in 2018 showed the parameters by the requirements according to regulations, such as temperature, pH, BOD5, COD and TSS. At the same time, the parameters were not following requirements according to rules such as free NH3-N, PO4 and MPN-coliform bacteria. Data from laboratory test results in 2019 showed requirements according to regulations: temperature, pH, BOD5, and TSS. The effects on the COD parameter were seen only in July that they did not follow the requirements, while most of the results for the NH3-N, PO4 and MPN-free coli groups did not meet the criteria.

Conclusion: Based on the research done in this study, the following conclusions can be drawn: The results of the performance evaluation of the WWTP at the Taman Public health center are included in the category that meets the stipulated regulatory requirements.

Background: Sepsis and vasodilatory shock are serious medical conditions and cause high mortality rates worldwide. It is known that IL-6 and angiopoietin-2 levels have a role in the etiology of shock in ICU patients. Consequently, this research aims to examine the involvement of angiopoietin-2 and IL-6 in the severity of coagulation problems in patients with vasodilatory shock.

Methods: The study's design is observational analytic with a cross-sectional study design, and the data came from those treated in the ICU room and the Emergency Room at RSUD Dr. Soetomo Surabaya from February 2020 to March 2022. Data collected included age, respiratory rate, DIC score, APACHE II score, mortality, IL-6 levels, and angiopoietin-2 levels. The data was then analyzed using Easy R (EZR).

Result: 27 of the 44 patients (61.4% of the total) belonged to the DIC group. A correlation between IL-6 levels and DIC incidence and mortality at first ICU admission and after 24 hours in the ICU was shown to be significant (p<0.05). There was also a significant correlation between Angiopoietin-2 and both DIC incidence and mortality upon admission to the ICU and after 24 hours in the ICU (p<0.05). It was found that the test specificity and sensitivity of Angiopoetin-2 and IL-6 levels on the severity of coagulation disorders and mortality in patients with vasodilatation shock were 85.9% for Angiopoetin-2 and 71.6% for IL-6.

Conclusion: There is a correlation between the severity of coagulation disorders in vasodilated shock and increased IL-6 and angiopoietin-2. IL-6 and angiopoietin-2 were to be correlated with mortality and Angiopoietin-2 has higher specificity and sensitivity than IL-6. Multicenter prospective studies are needed to confirm study results.

Introduction: Burns are injuries caused by heat and cause damage to the skin. Burns are characterized by red, peeling skin. Burns must be treated properly so that wound healing can close completely. In Indonesia, seaweed is a promising commodity. From 5.2 million wet tons in 2011 to 9.2 million tons in 2013, seaweed output increased by 76.4 percent in Indonesia. This study aimed to study the histopathological picture of burn tissue given Sargassum sp.

Methods: An experimental study design with a randomized post-test-only control group design was used for this study. White mice (Mus musculus), the study's population, made up this group. The study was divided into 4 treatment groups. The results of the calculation of the number of fibroblast cells were then evaluated using statistical tests to determine differences between groups. Data analysis was carried out using SPSS ver. 25 with a One-Way ANOVA test.

Results: The mean result of fibroblast cell count in group 1 (plain gel) was 36.14 PLP, group 2 (Sargassum sp. 5%) was 51.28 PLP, group 3 (Sargassum sp. 10%) was 53.36 PLP and group 4 (Sargassum sp. bioplacenton) 20.05 PLP. The results of the statistical test showed that there was a significant difference between groups with a p-value of 0.03 (<0.05).

Conclusion: The results of the histology show that there is a potential content of Sargassum sp. to affect wound healing.

Link of Video Abstract: https://youtu.be/nINFPi4uVow

Background: Abnormalities in the neurosurgical field concerning cranial structure are almost always followed by increased intracranial pressure (ICP), which causes cerebral hypoxia and disrupts the whole cellular system. This study analyzes the correlation between ICP changes and oxidative stress markers, in subjects with various anatomical pathology abnormalities who underwent surgery.

Methods: This was a cross sectional study of 24 subjects with ICP conducted in the Department of Neurosurgery, Cipto Mangunkusumo Hospital, Jakarta, from November to December 2009. In this study, ANOVA analysis has been done to measure the mean difference oxidative stress (MnSOD, NADPH, MDA, and catalase) in subjects with various changes in ICP who have undergone surgery and Spearman analysis to measure the correlation between each oxidative stress markers. Oxidative stress markers were measured from normal brain tissue taken intra-operatively, cerebrospinal fluid (CSF) taken while doing ventriculostomy, and peripheral blood taken from a central vein catheter (CVC).

Results: The results showed that MDA concentrations in blood were significantly correlated with MDA in brain tissue (P = 0.029) in all of the ICP groups, CSF MnSOD concentration and CSF NADPH concentrations correlated with brain tissue NAPDH (p= 0.000) in congenital group and CSF catalase concentration correlated with brain tissue catalase (p = 0.00) in congenital group.

Conclusion: Increased ICP caused by various pathological conditions causes changes in oxidative stress markers in brain cells, CSF and blood. Oxidative stress markers in blood and CSF are correlated strongly with the brain. It is suggested that it could be used to predict intracranial high pressure in all cases with intracranial abnormalities.

Background: The prevalence of malnutrition in East Java still tends to be high, one of which is in Banyuwangi City, namely 16.78%. One of the causes of under-five nutrition problems is the lack of knowledge of nutrition and health, attitudes and behavior of mother's feeding. This study aims to analyze differences in mothers' knowledge and dietary diversity of toddlers before and after being given health food education with video media and leaflets 2 times for 14 days.

Method: This is a quasi-experimental design with pre-post test control group design. The research subjects were 44 divided into 2 groups. The statistical test results showed p value < 0.05 on the variables of mother's knowledge and dietary diversity of toddlers before and after healthy food education from 2 groups.

Result: The knowledge of mothers  of toddlers  in  The  Intervention  Group,  before education was partially in the sufficient category as many as 12 people (59,1%), and almost all of them were in the good knowledge category as many as 19 people (86,4%) after education with a mean±SD value of 76,5 ± 23,2 before education, increased to 90,1 ± 10,8 after education. The Intervention Group's average dietary diversity score of toddlers was 4,27 ± 0,9. After education, most of the toddlers' dietary diversity was in the high category, namely 13 (59.1%), the moderate category was 9 (40,9%), and none were in the low category with an average score of 5,91 ± 1,27.

Conclusion: This study has identified a significant difference in knowledge of mothers and toddlers' dietary diversity before and after education with video media and leaflets. Education with video media and leaflets effectively increases mother's knowledge and toddler's dietary diversity.

Background: Vitamin D deficiency is still common in various community groups, including women of childbearing age. Not only because of a lifestyle that avoids the sun, but recent research has shown that circadian behavior, which includes eating and sleeping patterns, is associated with vitamin D deficiency. This study aims to provide information about female students' vitamin D status and circadian behavior to prevent further health problems.

Methods: This research was quantitative, analytic, and observational, with a cross sectional study approach. The population was students of the academic year 2019 in the Faculty of Health, Universitas Nahdlatul Ulama Surabaya, in 2022. The sample size was 50 people. Data collection includes circadian behavior with parameters of sleep patterns, eating patterns, and plasma vitamin D levels. Sleep pattern data was collected using The Pittsburg Sleep Quality Index (PSQI) questionnaire. Circadian eating pattern data was taken with 24-hour recall instruments. Plasma vitamin D levels were obtained by taking blood samples analyzed using the Fluorescence Immunoassay Rapid Quantitative Test method. Data analysis was performed using the Mantel-Haenszel statistical test on the SPSS program.

Results: The results showed that 80.0% of samples had a predominantly daytime (pDT) eating pattern, 64.0% had poor sleep quality, and 68.0% had vitamin D deficiency. Bivariate analysis for eating patterns and vitamin D status showed OR = 0.890 (0.197-4.012). Bivariate analysis for sleep pattern and vitamin D status showed OR value = 1.362 (0.385-4.817). However, the p-value indicates an insignificant correlation (p=0.880 and p=0.631)

Conclusion: The study shows poor sleep quality and predominantly daytime eating patterns are not risk factors for vitamin D deficiency.

Link of Video Abstract: https://youtu.be/Jb1SATaI8oQ

Introduction: The difference in the Neutrophil-to-Lymphocyte Ratio (NLR) before and after chemotherapy, which is commonly called the delta NLR, is thought to be a better predictive factor than pre-chemotherapy NLR or post-chemotherapy NLR in breast cancer patients.

Methods: We analyzed 130 locally advanced breast cancer (LABC) patients who received anthracycline-based neoadjuvant chemotherapy (NACT) at Dr. Soetomo General Hospital Surabaya from January 2017 – December 2021.

Results: Out of 130 patients, 91 (70.0%) responded to chemotherapy. Bivariate analysis showed a significant relationship between delta NLR and chemotherapy response (p = 0.002). Patients with delta NLR < 0 achieved a significantly higher rate of clinical response to NACT compared to those with delta NLR ≥ 0 (OR: 4.67, 95% CI: 1.69 – 12.85, p: 0.003)

Conclusion: LABC patients with delta NLR < 0 have better clinical response to anthracycline-based NACT than those with delta NLR ≥ 0.

Background: Photoaging is a type of aging primarily caused by exposure to radiation, such as Ultraviolet B (UVB). This radiation penetrates the upper epidermis and papillary dermis leading to sunburn, tanning, photoaging, and photocarcinogenesis. Its light is a significant cause of direct deoxyribonucleic acid (DNA) damage. Furthermore, it induces transcription factors, such as NF- and other pro-inflammatory cytokines, the expression of matrix metalloproteinase (MMP), and generates reactive oxygen species (ROS). Therefore, this study aimed to determine the differences in the histologic features of the photoaged animal models.

Methods: There were three groups, including P1, P2, and P3. Group P1 consists of male Wistar rats (Rattus norvegicus), aged 10-12 weeks, with average body weight between 100-150 grams. Group P2 consists of C57BL aged 5-6 weeks with an average weight of 50-75 grams. P3 comprises BABL/c mice aged 5-6 weeks with an average weight of 50-75 grams. They were photoaged for 6 weeks using UV lamps (Ultraviolet B Broadband TL lamps. Phillips TL 20W/01 RS) with a 290-315 nm wavelength.

Results: The results showed a significant difference in epidermal thickness, dermal thickness, and sunburn cell (SBC) between groups after exposure to UVB radiation (p<0.05). Meanwhile, there was no significant difference in their blood vessels (p>0.05).

Conclusion: The exposure to UVB for six weeks affects epidermal and dermal thickness, amount of SBC, and blood vessels in the photoaged animal model.

Link of Video Abstract: https://youtu.be/h1rynQ_AAaY

Background: Aquaporin-4 (AQP4), a water channel protein, is important in regulating brain water distribution. We hypothesized that increased expression of AQP4 in the kaolin-induced hydrocephalic mice brain is associated with the severity of hydrocephalus. This study aims to evaluate the AQP4 expression related to hydrocephalus severity in hydrocephalus mice model

Methods: Hydrocephalus was induced in 8-10 weeks Sprague-Dawley mice by kaolin injection into cisterna magna. The mice were randomly divided into normal control and hydrocephalus groups and were sacrificed on days 7, 14, and 21 after kaolin induction. The brains were analyzed for AQP4 expression by histological and immunohistochemistry analysis. Data were analyzed using SPSS version 25.0 for Windows.

Results: Histopathological analysis showed an increase in AQP4 expression in periventricular zone astrocytes with the duration of hydrocephalus (p < 0.001). A significant difference in AQP4 expression in this study was found in the hydrocephalus group between the 7^th and 14^th days (p = 0.023), 7^th and 21^st days (p < 0.001), and 14^th and 21^st days (p = 0.044) after kaolin induction. The highest expression of AQP4 was found in the hydrocephalus induction group on day 21.

Conclusion: The results showed that the expression of AQP4 increased with the severity of hydrocephalus. Expression of AQP4 in the kaolin-induced hydrocephalic mice brain was significantly altered depending on the length of time after kaolin induction. Changes in AQP4 expression in periventricular zone astrocytes may be a compensatory mechanism resulting in drainage of CSF accumulation.

Introduction: The elderly are a range group, the older they get, the more problems they will have, such as Diabetes Mellitus. Diabetes Mellitus and distress are two things that affect each other, either directly or indirectly. Management of Diabetes Mellitus in daily life can be a burden for people with DM, so it can cause feelings of frustration, anger, being overwhelmed, and hopelessness. This study aimed to analyze the effect of Ergonomic Exercise Based on Spiritual Care on Distress Levels in the Elderly with Diabetes Mellitus.

Method: This study used a Quasy Experimental design with a pre-test and post-test with a control group. The population in this study were all elderly people with Diabetes Mellitus who attended the Mahatma Elderly Posyandu. Instrument The measurement of the level of distress using the Diabetes Distress Scale (DDS) questionnaire. Data analysis using paired t-test and independent t-test.

Results: The results of this study showed that the average level of distress before being given ergonomic exercise based on spiritual care in the intervention group was 2.65 (moderate distress) and 2.66 (moderate distress) in the control group with p-value = 0.843. The level of distress after being given an ergonomic exercise based on spiritual care found the average level of distress in the intervention group was 1.52 (mild distress) and in the control group 2.80 (moderate distress) with a p-value = 0.000.

Conclusion: This study shows that the effectiveness of ergonomic exercise and spiritual care- can reduce distress levels. So that this research is highly recommended for nurses in carrying out their duties independently in providing non-pharmacological therapy to reduce distress levels, especially in the elderly with diabetes mellitus.

Link of Video Abstract: https://youtu.be/N3kTT9WiLNw

Background: Cardiovascular disease (CVD) is Indonesia's primary cause of morbidity and mortality. Rapid detection and appropriate treatment of CVD cases are needed to reduce mortality. Electrocardiography (ECG) is a simple examination modality that can detect many cardiac abnormalities. General practitioners are expected to master the interpretation of basic ECG. Massive open online course (MOOC) is a breakthrough that can facilitate profound learning without temporal and physical barriers and support continuing medical education. This pilot study aimed to evaluate the implementation of MOOC in ECG learning among a limited number of general practitioners.

Methods: Consecutive sampling was used to recruit the subjects. Subjects were given ten weeks to finish all modules and quizzes. Pre-test and post-test were taken. User satisfaction was evaluated using a questionnaire. A focused group discussion (FGD) was conducted to explore subjects' learning experiences and perspectives toward the learning system using MOOC.

Results: 17 general practitioners participated in the study, but only seven could finish all the modules and quizzes. All subjects were aged under 30 years old. Those who could complete the course took 10-39 days. Post-test scores were significantly higher than pre-test scores (p=0.038). Although subjects agreed that MOOC was convenient, attractive, and suitable for general practitioners in clinical practice, they demanded an explanation of the quiz answers. They suggested that some modules should be optional.

Conclusion: MOOC learning was suitable for general practitioners to improve their ECG interpretation skills. Some features should be added to increase user satisfaction. A study with extensive subjects is needed to analyze the effectiveness of this ECG course.

Link of Video Abstract: https://youtu.be/DVqGIPOyWR0

Background: Tuberculosis (TB) continues to be a significant health issue and causes various complications, especially in developing countries. Bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis that needs to be treated by surgical procedure. This research aimed to compare the outcome of post-operative BPF repair caused by Tuberculosis and non-Tuberculosis cases.

Methods: In this retrospective review, we include patients from post-operative repair of BPF with Tuberculosis and non-Tuberculosis cases from January 2020 to December 2022 who were admitted to our primary center. Preoperative, operative and postoperative data were collected from medical records. We identified 36 patients and analyzed the differences between TB and non-TB groups.

Results: There were 36 patients with BPF who underwent surgery. The mean age of the subjects was 47.940±15.288 years. Out of these, 25 subjects (69.4%) had TB, while 11 (30.6%) subjects did not. Among the subjects, 14 TB patients (38.9%) and 2 non-TB patients (56%) experienced recurrent pneumothorax before surgery. Statistical analysis showed a significant association between comorbid TB and the occurrence of secondary attack BPF before surgery (p = 0.035). Regarding the duration of post-operative drain placement, 22 TB patients (61.1%) had the drain placed for less than 7 days, while 3 subjects (8.3%) had it for more than 7 days. Among the non-TB patients, 10 subjects (27.8%) had the drain placed for less than 7 days, and only 1 subject (2.8%) had it for more than 7 days. The statistical analysis showed no association between the TB group and the duration of post-operative drain placement (p=0.798).

Conclusion: There are numerous post-operative complications and morbidities following BPF repair surgery. Patients with TB who undergo BPF repair surgery are significantly associated with secondary attack BPF before surgery.

Introduction: Honey and Garlic is recognized to offer several health advantages due to its numerous constituents, one of which being flavonoids. Flavonoids’ pharmacological activity includes antibacterial, antioxidant, antifungal, antiviral, and immunomodulatory properties. Honey's immunomodulatory action plays a vital role in immune system boosting. The purpose of this study is to determine the immunomodulatory effect of fermented garlic honey, which is considered to have a synergistic effect, using two alternative techniques.

Methods: Macrophage phagocytic activity is the first approach, while the delayed type hypersensitivity is the second. Each method used 30 male rats (Rattus norvegicus) divided into 5 groups, where each group consisted of 6 rats. Group I negative (Placebo 0,005 g/kg BW), group II positive (Stimuno 0,005 g/kg BW), group III FGH dose I (1,5 g/kg BW), group IV FGH dose II (3 g/kg BW), group V FGH dose III (4,5 g/kg BW). The dosage form was orally given for 21 days. The Macrophage phagocytic activity method measured %activity of macrophage phagocytosis using a microscope. The rats were injected with an antigen which is Staphylococcus aureus by intraperitoneal route.

Results: The Delayed Type Hypersensitivity was measured volume change of the rat’s feet at the 4, 24, and 48 hours using a plethysmometer.  Based on the results, fermented garlic honey had an immunomodulatory effect. The dose 2 (3 g/kg BW) has the highest effectiveness as an immunomodulator. Fermented Garlic Honey may be concluded to be efficient as an immunomodulator by enhancing the macrophage phagocytic activity indicator and lowering the edema volume of the rat.

Conclusion: Fermented garlic honey can increase the immune system and can be used as an immunostimulant. The most effective dose of fermented garlic honey as immunomodulator is dose 2 was 3 g/kg BW.

Background: Sedentary behavior is a common risk factor for mechanical chronic low back pain. Functional capacity and serum vitamin D levels are associated with low back pain intensity. The aim to analyze the effect of aerobic exercise walking on maximal oxygen consumption and serum vitamin D levels in patients with mechanical chronic low back pain.

Method: true experimental with pre and post-test randomized control group design. Each group consisted of 16 respondents. The treatment group received additional aerobic exercise walking 3x/week, intensity 40-50% HRR (weeks 1-3), 50-60% HRR (weeks 4-6) and 60-80% HRR (weeks 7-8), 30 minutes per session for 8 weeks. The control group only received conventional training 3x/week for 8 weeks. The parameters evaluated were VO₂ max and 25(OH)D. Measurements were taken before and after 8 weeks of intervention.

Results: The VO₂ max values of both groups increased with a significant difference after the intervention (p < 0.001) and there was a difference in the difference (p < 0.001). 25(OH)D levels in both groups increased with no significant difference after the intervention (p = 0.720) and no significant difference in the difference after the intervention (p = 0.662)

Conclusion: There is a difference in the addition of walking aerobic exercise to conventional exercise compared to conventional exercise alone on maximal oxygen consumption, but there is no difference on serum vitamin D levels in mechanical chronic low back pain patients.

Link of Video Abstract: https://youtu.be/6NXSL59eReA

Background: Hemangiomas are benign tumors that originate from blood vessels. Sclerotherapy effectively treats benign vascular lesions, especially small lesions located at sites with aesthetic impact. Polidocanol is the solution most commonly known to work by causing a local inflammatory reaction, thrombosis obliteration of the hemangiomatous space, and fibrosis of the endothelial space, leading to the lesion's regression. This study evaluated the effectiveness of polidocanol sclerotherapy injection therapy (Aethoxysklerol 3%) in patients with cavernous haemangioma at Dr. Soetomo general hospital.

Method: This study is a cross-sectional correlative analysis study, with research samples derived from medical records of patients with cavernous type haemangioma who were indicated to undergo sclerotherapy injection therapy (Aethoxysklerol 3%) at Dr. Soetomo general hospital in the period 2017-2023 who met the inclusion and exclusion criteria. The data obtained will be processed using SPSS software version 25.0 for Windows. Statistical tests were significant if the p-value was <0.05.

Results: There were 26 samples in this study, with the gender of patients mostly female (65.4%) and aged >20 years (38.5%). The most common location was buccal region hemangioma (34.2%). The results of the therapeutic response showed that 50% of the majority of patients not well responded, 34,2% showed no response, and only 15.4% responded well with a p-value = 0.000.

Conclusion: Injection sclerotherapy using polidocanol (Aethoxysklerol) in 3x administration sessions is a treatment method that has not been effective in treating hemangioma.

Introduction: Self-management, which rests on self-efficacy and self-care, is the cornerstone of diabetes mellitus treatment in managing blood sugar levels. Healthy behavior affects how a disease develops, therefore it's crucial to develop strategies for sustaining self-management. This study looked at the impact of spiritual diabetes self-management health coaching on patients with type 2 diabetes mellitus' levels of self-efficacy, self-care, and blood sugar.

Methods: This study was designed as a quasi-experiment with a pre-post control group. There were 210 patients with diabetes mellitus overall in the Surabaya A-Yani Islamic Hospital. 120 respondents were included in the research sample, including 60 in the intervention group and 60 in the control group. For one month, Spiritual Diabetes Self-Management Health Coaching was provided to the intervention group once daily for 60 minutes. The control group, meanwhile, received a program in accordance with hospital protocols. a parametric test is used in data analysis.

Results: The intervention group's self-efficacy, self-care, and blood sugar levels differed between the pretest and post-test results. According to the findings, the intervention group's pretest and posttest scores for the variables of self-efficacy, self-care, and blood sugar levels varied.

Conclusion: Spiritual Diabetes Self-Management Health Coaching can improve the self-efficacy and self-care of the type 2 diabetic patients; also reduce their blood sugar levels.

Link of Video Abstract: https://youtu.be/TRnFAXBESHc

Background: Coronavirus disease 2019 (COVID-19) has become a significant disease causing a pandemic worldwide. Many variants were detected within the globe and may have an important role in transmission capability or reinfection conditions. The ‘unknown’ level of immunity’s protection from previous infection and the more virulent virus could lead to reinfection. Using the whole genome sequence, we can analyze the genomic insight within the first and second infections to help understand the reinfection pattern of COVID-19.

Methods: In this study, we investigated three COVID-19 cases with reinfection for primary and secondary infection each. The SARS-CoV-2 confirmation was conducted using qPCR with multiplex gene targets Orf1ab and E. Confirmation of reinfection was done by genomic analysis. Library preparation and sequencing were done using ARTIC protocol using nanopore technology.

Results: There was a wide variety of mutations between two episodes of infection and different clinical manifestations in each episode.

Conclusions: The result concluded that reinfection happened in worsened clinical symptoms and distinct genomic variation in each episode of infection

Link of Video Abstract: https://youtu.be/G8AKREK9E9Q

Introduction: Synthetic drugs can cause toxicity. Finding new natural sources of medicinal materials with low toxicity is one of the efforts to reduce it. This was done by using biotechnology from endophytic fungi growing on dahlia tubers (Dahlia variabilis). This study aimed to find the optimum temperature and aeration in the fermentation of endophytic fungi Fusarium sp LBKURCC 41 in producing secondary metabolites.

Methods: The method of this research was temperature optimization with temperature variations of 10˚C, 27˚C, 37˚C and 40˚C. For aeration, the variation of oxygen provided was 50 ppb and 100 ppb. Both fermentation environment factors were incubated for 5, 10, 15, 20, and 25 days. The activity test was conducted against pathogenic microbes E. Coli, S. aureus, and C. albicans using the agar diffusion method. Positive controls used ketoconazole for Candida albicans and ciprofloxacin for E. coli and Streptococcus aureus bacteria.

Result: The results showed the optimum temperature of the fermentation of endophytic fungi Fusarium sp LBKURCC 41 based on statistical analysis of T-Test for (p < 0.05) is to have the highest inhibition zone diameter value of 10.5 ± 0.62 mm on day 20 against Candida albicans with a positive control of 6.0 ± 0.23 mm. For aeration, the highest inhibition zone value was 12.3 ± 0.12 mm with a positive control of 19.5 ± 0.12 mm.

Conclusion: The optimum temperature of the fermentation is to have the highest inhibition zone diameter value of 10.5 ± 0.62 mm. The ability of endophytic fungi to produce secondary metabolite compounds is determined by the temperature and aeration used.

Introduction: Complementary foods (complementary foods) are additional nutrition for babies after the age of 6 months because breastfeeding alone cannot meet the daily needs of calories and nutrients. But it is not uncommon to find children unable to eat because of oral motor skills. This study aimed to determine the effect of oral massage stimulation and tummy time on oral motor skills which were seen from the baby's response to the first food.

Methods: The design of this research was using True Experimental analysis with a post-test-control group design, the population of babies aged 4-5 months was 210 respondents with probability sampling technique with purposive random sampling for 3 months in the independent practice of Gresik East Java Indonesia midwives. The research instrument was a checklist from The Schedule for Oral Motor Assessment (SOMA). Data analysis with Kruskal-Wallis test, and Mann-Whitney test.

Results: The results showed that in the group of babies who received oral massage treatment almost all (77.1%) had good oral motor skills, and in the group of babies who got tummy time stimulation most (65.7%) had good oral motor skills and in the control group almost half (34%) had good oral motor skills. The value of p = 0,0001 <=0,05 means that differences in infant oral motor skills in the tummy time stimulation group, oral massage group, and control group. Oral massage has a good impact on the baby's oral motor skills.

Conclusion: There are other stimulations that have a good impact on the child's motor development.

Link of Video Abstract: https://youtu.be/0zW7g_T0heE

Introduction: Applying research activity in hospitals in Indonesia is a kind of challenge. This study aimed to assess the research’s capacity in Prof. I.G.N.G Ngoerah General Hospital. It is related to the indicators and cultural analysis at the team, organization, and individual levels in Prof. I.G.N.G Ngoerah General Hospital.

Methods: A cross-sectional study and qualitative analysis using Focus Group Discussion (FGD) were conducted in July-August 2022 at Prof. I.G.N.G Ngoerah General Hospital. The Research Capacity and Culture (RCC) validated survey measured self-reported research capacity at leadership, individual, team, and organization levels. Additionally, this study explored barriers and motivators. The rate of research capacity decisions and the domains in this study use the ROC curve. This statistical analysis used chi-square with a significance of p-value < 0.05.

Results: One hundred and thirty respondents were analyzed. The individual characteristics were 45-54 years old, male, medical specialist, clinician without structural position, with a master’s degree or specialist, internal medicine department and pediatric department, 0–10 years of work history, 1–10 journal publications, and having a research history. In leadership and team capacity, most have low scores, and in individual capacity, organization and research capacity have high scores. There is a statistically strong relationship between each domain and research capacity.

Conclusions: High research capacity in a hospital is very important. Evidence-based research can be used to support the services and progress of the hospital itself, especially as a teaching hospital.

Introduction: Cavernous malformations of the brainstem are groups of dilated sinusoidal tracts. The surgical excision of cavernous abnormalities of the brainstem is high-risk and challenging. Clinical manifestations due to mass effect or hemorrhage, as well as MRI studies, have become valuable factors in determining the most appropriate procedure for brainstem cavernoma to achieve the safe entry zone of the brainstem.

Case: A case report on a brainstem cavernoma is reported here. A 10-year-old male with a pontomesencephalic cavernoma is presented. The cavernoma was surgically removed using a lateral supracerebellar infratentorial approach. The safe brainstem entry point was obtained with an intraoperative neuromonitoring (IOM) in spite of a neuronavigation devices. Post-op MRI images revealed a small residual mass. The patient had a favorable surgical outcome and was discharged on day 5.

Conclusion: Recognizing a microsurgical anatomical landmark and an intraoperative neuromonitoring instrument will be critical in preventing neurologic function injury.

Introduction: Preeclampsia is one of the most typical perinatal illnesses and the main factor in maternal deaths globally, particularly in underdeveloped nations like Indonesia. Preeclampsia consequences can be avoided by obtaining an early diagnosis by being aware of the condition's warning signs and symptoms. Based on the Surabaya human interaction model, this study sought to examine the variables influencing nurse-patient contact.

Methods: This cross-sectional study employed a quantitative methodology with observational research. With 108 responders, pregnant women made up the study's sample. Age, gravidity, education, knowledge, disease history, access to medical services, and husband support were the independent factors considered in this study. The interaction between the nurse and the patient served as the dependent variable. Through the use of a questionnaire, the study's findings were gathered. To determine the influences of the independent variables on the dependent variable in this study, a logistic regression test was performed. The analysis was done with SPSS version 25.

Results: The findings indicated that education (p-value=0.015, B=3.482), knowledge (p-value0.001, B=4.255), and health facilities (p-value=0.049, B=2.802) were the factors influencing nurse-patient contact. Health facilities and the support of the husband are external determinants, but age, gravidity, education, knowledge, and medical history (anamnesis) are internal elements that originate from the pregnant woman herself.

Conclusion: The connection between nurses and patients is crucial to the delivery of nursing care to patients. Therefore, for nurse-patient interactions to be as effective as possible, pregnant women need to have access to education, knowledge, and good healthcare facilities.

Link of Video Abstract: https://youtu.be/5Q9QmV4Qmyg

Background: Regarding prevalence among females worldwide, cervical cancer ranks fourth and has a high fatality rate. Cervical cancer growth is correlated with high-risk human papillomavirus (HPV) infection. Retinoblastoma protein (pRb) is a protein that interacts with E6/E7 oncoproteins to regulate cell proliferation, differentiation, and death. Mutations on the E6/E7 protein oncogenes of high-risk HPV can disrupt this relationship. This investigation aims to establish the association between pRb expression and the HPV genotype.

Methods: This observational cross-sectional study examined 43 patients diagnosed with cervical cancer at Wahidin Sudirohusodo Hospital and its network. Samples were taken using consecutive random sampling based on established criteria. HPV genotype was examined using the polymerase chain reaction (PCR) method, while pRB expression was assessed by immunohistochemical examination. The relationship between the two variables was assessed using the Chi-Square test.

Results:  There were 5 (11.6%) patients with HPV type 16, 14 (32.6%) with HPV type 18, 12 (27.9%) with other types of HPV and 12 (27.9%) were negative for HPV. Examination of pRb expression showed that 33 (76.7%) samples had +2 expression, 7 (16.3%) had +1 expression, and 3 (7.0%) samples had no pRb expression. The pRb expression and HPV type were not significantly correlated in this study (p = 0.410). However, pRb expression and cervical cancer clinical stage were shown to be significantly correlated (p = 0.007).

Conclusion: pRb expression is more prevalent when a malignancy is more advanced. In this investigation, no association between HPV genotype and pRb expression was discovered, despite oncogene mutations being involved in the regulation mechanism of cell proliferation, differentiation, and apoptosis.

Introduction: OHS culture can contribute to achieving productivity and zero accidents. Without a safety culture in workers, no matter how well the system or structure is designed and how sophisticated the safety devices are, there is no functioning due to the things underlying human behavior. This study aims to evaluate the description of the level of OHS cultural maturity using SCMM (Safety Culture Maturity Model).

Method: This study uses a descriptive quantitative design with a cross sectional approach. The population used is all permanent workers of the Commercial Ship Division in the Shipping Industry, numbered 173. The total sample of all workers is 34 people using a non-probability sampling method. The variables of this study were 10 components of SCMM. The instrument used is a questionnaire sheet based on the SCMM (Safety Culture Maturity Model).

Result: The results showed that the components of management, commitment and visibility showed a value of 2.82, communication a value of 3.12, productivity versus safety a value of 3.94, learning organization a value of 4.44, safety resources a value of 3.26, participation value of 4.12, shared perceptions about safety score 4.88, trust value 3.88, industrial relations and job satisfaction score 4.38, and training value 3.70.

Conclusion: The conclusion in this study shows the level of maturity of OHS culture at the Shipping Industry has a final average score of 3.85 at the level involving. The advice is to increase the level of OHS culture by evaluating the fulfillment of the target of management visits to the field, evaluating OHS media, evaluating the fulfillment of safety patrols or visiting the OHS team to indoor places.

Background: Food is an essential thing in human activities. Therefore, it is said that agricultural sectors have a crucial role in human life. The purpose of this study is to analyze the role of the agricultural sector in the national economy of Indonesia.

Method: The data used in this study are Indonesian input-output (IO) tables in 1990, 1995, and 2005. The analytical instrument of this research is IO analysis. This study uses more specific parts of the IO analysis such as simple household income multiplication, simple output multiplication, sensitivity distribution index, and power distribution index as analysis tools. The analysis of this research has a period of 1990-2005. In this study, the analyzed sectors are (1) paddy, (2) maize, (3) cassava, (4) other rootlcrops, including sweet potatoes, (5) groundnut, (6) soybeans, (7) other beans, (8) vegetables, (9) fruits, (10) cereals and other food crops, (11) rubber, (12) sugarcane, (13) coconut, (14) oil palm, (15) fibrelcrops, (16) tobacco, (17) coffee, (18) tea, (19) clove, (20) otherlestatelcrops, and (21) otherlagriculture. The first step of the methodology of this study is to describe the data, while the final step is to explain the study's conclusions and suggested further research.

Results: The results show that, by using a simple output multiplier, the analyzed sectors did not include the top five Indonesian industries from 1990 through 2005. Conversely, one of the analyzed sectors, rubber, was admitted in the top five Indonesian industries in the period of the analysis from the point of view of another multiplier. Using both indices, almost all analyzed industries were consistent in the quadrant from 1990 through 2005.

Conclusion: Indonesian government shall prioritize the rubber sector for the next economic development plans.

Link of Video Abstract: https://youtu.be/VpTspeX7fe0

Background: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Symptoms include irregular menstrual cycles, hirsutism, obesity, acne vulgaris, and infertility. PCOS is a stigmatized condition that affects women's identity and mental health, especially anxiety. In addition, increased cortisol is associated with increased anxiety. This study aims to determine the effect of phenotype and cortisol on anxiety status in polycystic ovary syndrome (PCOS) patients.

Methods: 40 patients diagnosed with polycystic ovary syndrome (PCOS) aged 18-40 years in Makassar. The Indonesian version of the Hamilton Anxiety Rating Scale (HAM-A) assesses anxiety. A blood sample is taken to check for cortisol (drip blood test). Cortisol levels were measured using the CMIA (Chemiluminescent microparticle Immunoassay) method. Data were analyzed using SPSS version 25.0 for Windows.

Results: The prevalence of phenotypes A, B, C, and D were 27.5%, 0%, 45%, and 45%, respectively. Phenotype C had a higher body mass index than the other phenotypes but was not significantly different. (p > 0.05). About 26.1% of patients with phenotype A were found to suffer from mild anxiety and 29.5% experienced moderate anxiety. Compared to phenotype C, 52.2% experienced mild anxiety and 35.5% experienced moderate anxiety; however, these results were not statistically significant. Higher cortisol levels were found in phenotype A compared to other phenotypes (phenotype C; 7.01±3.12 and phenotype D; 6.37±3.02) but not significantly different (p>0.05).

Conclusion: The PCOS phenotype has no relationship with the anxiety status of PCOS patients and there is no relationship between the phenotype and serum cortisol levels in PCOS patients.

Introduction: The number of Covid-19 cases in Indonesia continues to increase in several places. Management support in producing realistic policies for business continuity during the pandemic is very much needed. This research is needed to provide an overview of the business community or business managers and or industry related to the implementation of Covid-19 control management at PT. Pelindo 3.

Method: This is descriptive research. The sample is PT. Pelindo 3 head office, Surabaya. Data was taken using company secondary data related to the management of Covid-19 control. Data was collected using related document literature studies, observations, interviews, and documentation. Presentation of data carried out descriptively. To provide a clear picture of Pelindo 3's efforts in controlling Covid 19.

Results: To prevent and control Covid 19 at PT. Pelindo 3, the company carries out all government directives, as well as human resource, financial, facilities, and infrastructure support. The company's ability can be proven by receiving an award from the Ministry of Manpower as a recipient of the Platinum Award in implementing the Covid 19 control and prevention program at the company in 2021.

Conclusion: Management support in carrying out efforts to control Covid-19 is very good, starting from policy support and support for the realization of the Covid-19 control program, namely carrying out all government directives

Background:  This study aims to investigate the effects of adding transcutaneous auricular vagus nerve stimulation (tVNS) to exercise therapy on back extensor muscle endurance of patients with mechanical chronic low back pain (CLBP).

Methods: A randomized controlled group study was conducted on 22 patients with mechanical CLBP aged 16-55. Participants were randomized into an exercise group (control) and an exercise with a tVNS group (experimental). The outcome was back extensor muscle endurance measured by the Biering Sorensen Test (BST), evaluated before and after 2 weeks of intervention

Results: There was a significant improvement in pre-post evaluation in the intervention group (before: 40.30± 31.20 and after: 66.49±45.87, p<0.05), with a large effect size (Cohen’s d=0.918). No difference in pre-post evaluation in the control group (before: 58.18±50.75; after: 66.82±38.56; p>0.05) with a small effect size (Cohen’s d=0.414). There was no significant difference between the delta BST of the two groups (p=0.418).

Conclusion: Our results suggest that no difference was found between the two groups. However, tVNS addition to exercise therapy showed beneficial effects potency on back muscle endurance of the experimental group in CLBP patients during a relatively short period in two weeks of intervention. Further research is needed to confirm the potential of tVNS therapy in CLBP.

Introduction: Worker productivity measures quantity and quality in specific units to produce outputs efficiently. Low labor productivity is one of Indonesia's biggest issues. In these times of constant change, rising economic conditions, and increased dominance of the market economy system, there is an increase in fierce competition between businesses operating in similar industries. The rise and fall in labor productivity are influenced by various variables, including those at work, the environment, and personal issues. This research aims to identify the variables that influence employee productivity.    

Method: This research's methodology employs cross-sectional observational research with quantitative approaches. The participants in this study were employees of PT. Z in Samarinda, with a sample size of 45 participants.

Result: The study's findings point to several variables impacting employee productivity. PT. Z. According to the analysis, productivity is determined by workload, working time, and nutritional status. It is evident from the significance value's findings, which have a value of 0.05.

Conclusion: Workloads that are above the employee's capabilities, working hours, and irregular nutritional state can impact the degree of productivity. Implementing fit-to-work policies, a healthy diet, regulating the workload, and obtaining enough rest are some examples of the modifications that must be made to increase workers' productivity.

Introduction: It is estimated that the long-term consequences of Coronavirus Disease 2019 (COVID-19) can be significant problems since they cause prolonged clinical manifestations after COVID-19. The aim of this study was to investigate patients with long-term effects of COVID-19 in Aceh Province, Indonesia.

Methods: A cross-sectional study was conducted on COVID-19 patients in Aceh, Indonesia using an online survey software tool. The COVID-19 survivors were contacted after a diagnosis of COVID-19 at least 14 days after a negative real time polymerase chain reaction (RT-PCR) result.

Results: A total of 303 respondents were contacted after a diagnosis of COVID-19 at least 14 days after a negative RT-PCR result. The results showed that 31% experienced long COVID until the 14^th to 15^th day of the month, while 69% did not offer long COVID symptoms. The most common symptoms experienced by the patients were fatigue (9.9%), headache (8.7%), and joint and muscle pain (8.1%). Other symptoms reported by COVID-19 survivors were polypnea and shortness of breath, sleep disturbances, coughing, hair loss, palpitations, runny nose, stuffy nose, mental health problems such as anxiety, impaired concentration and depression. The long COVID symptoms were more experienced by female respondents (64.9%) than male respondents (35.1%).

Conclusion: Our data suggested that the symptoms of long COVID or long-term consequences of COVID-19 were relatively high. Therefore, measures should be taken to prevent long-term effects among COVID-19 survivors.

Introduction: The possibility of system failure is something that can happen and can cause harmful effects on workers and the community around the factory. This is shown from the component failure data for the last five years. Components of the sodium silicate production system often fail especially the production pump component. Thus, this study is aimed to analyze the forms of failure, conduct a risk assessment, and determine the basic cause (cut set) of component failure for risk mitigation.

Methods: This was a cross-sectional study. This study was conducted in a company that has sodium silicate production (the company name is withheld). The data or sample that was collected was primary and secondary. FMEA was the next step after mapping the functional block diagram (FBD). Then from the results of the risk assessment on the FMEA, hazard identification was carried out using the FTA method to determine the basic cause (cut set) of component failure for mitigation. After that, the data was analyzed.

Results: This study found that the highest risk values ​​were solvent tank leaks (with a risk value of 15) and production pumps that were not functioning (with a risk value of 20). The results of identification by using FTA to the peak incident of solvent tank leaks obtained 12 cut sets and a minimum of 2 cut sets, caused by the factor of poor maintenance and service life, in the pump production section received 7 cut sets and a minimum of 5 cut sets, caused by there was no supply factor of sodium silicate, bearing life, corrosion, irregular lubrication and short circuit.

Conclusions: Regarding this study, the hazard identification was sodium silica from X company, mainly caused by the dissolver tank leakage and production pump.

Link of Video Abstract: https://youtu.be/XmIf_eavZto

Background: Endometriosis is a disease that causes recurrent chronic pain related to menstruation in around 10% of women of reproductive age. However, current non-invasive diagnostic tools are not sufficiently good at detecting endometriosis. Anogenital Distance (AGD) is a new measurement parameter that is non-invasive and proven to be used to help detect endometriosis. This study aims to assess the ability of AGD in detecting endometriosis.

Methods: This study is a diagnostic test study involving 35 endometriosis patients and 35 controls by comparing the clinical characteristics of the patients and the length of AGD-AF and AGD-AC for both groups. Data were analyzed using SPSS version 22.0 for Windows.

Results: The median AGD-AF length in endometriosis patients and controls were 22.65 + 6.54 and 29.53 + 3.52 (p<0.001) respectively, with AGD-AC lengths being 68.04 + 5.8 and 66.81 + 5.49 (p=0.369). In the multivariate logistic regression test, AGD-AF length was a single significant predictor (p <0.001). Based on the ROC curve, the length of AGD-AF with a cut-off of 23.35 mm has a sensitivity and specificity value of 97.1% and 65.7%.

Conclusion: This study states that there is a correlation between AGD and endometriosis, especially AGD-AF, so it can be used as one of the predictors to help detect endometriosis.

Introduction: Employment issues are still important in the development plan and the Indonesian economy. Indonesia's human resources quality is relatively low, and the unemployment rate is high. The high number of unemployed in Indonesia must continue to be studied, otherwise, the problem of poverty will increase. This study aimed to see what factors can influence entrepreneurial interest, researchers focus on bonding cognitive, and social capital, bridging cognitive social capital, entrepreneurial knowledge, subjective norms, self-efficacy, perceived desirability, and perceived feasibility of entrepreneurial intention.

Methods: This quantitative research used purposive random sampling and collects data using a questionnaire distributed to 150 students in Surabaya. The research data obtained were then analyzed using Smart PLS.

Results: The study results explained a positive and significant relationship between bonding cognitive social capital, bridging cognitive social capital, entrepreneurial knowledge, subjective norms, self-efficacy, perceived desirability, and feasibility of entrepreneurial intention. The outer loading of convergent validity was found >0.6 in all variables. The average variance extracted results were found >0.5 with significant hypothesis testing results (p-value≤0.05) in all variables.

Conclusion: Cognitive bonding and bridging have a significant influence on subjective norms. The same influence was found in entrepreneurial knowledge on subjective norms, subjective norms on perceived desirability and feasibility, and self-efficacy on perceived feasibility.

Link of Video Abstract: https://youtu.be/-l5AY96hUI8

Background: Light emitting diodes (LED) lamps are used widely in daily because of their many benefits, including their low cost, extended lifespan, low energy consumption, and low environmental impact. The use of LEDs, especially ultraviolet B LED (UVB LEDs) is quite extensive and has been developed for the treatment of skin diseases, irradiating pet reptiles, and conducting research on experimental animals. The use of light for therapy must be done carefully so that unwanted side effects do not occur because light also harms tissue. The purpose of this characterization is to determine the stability of temperature and irradiation of the device we make and to determine the duration of light exposure based on the characterization.

Methods: The irradiation device use UVB LEDs with a wavelength of 305-310 nm. The characterization carried out included temperature stability and irradiation stability, with observations every 30 minutes for 10 hours and no replication. Statistical analysis using the Kolmogorov-Smirnov (Asymptotic Approximation) testing technique. The test criteria state that if the probability value > level of significance (alpha (α) = 5%).

Results: The characterization results from 10 hours of observation with sampling data taken every 30 minutes showed stable LED temperature and room temperature while unstable cage temperature and irradiance.

Conclusion: This device can be considered to use in Wistar rat’ experimental studies using UVB and perhaps developed further. The duration of exposure can be adjusted according to the distance of the object and the dose required.

Link of Video Abstract: https://youtu.be/bmHkb4pnp9I

Background: Herpes zoster is an infectious disease caused by the reactivation of the latent varicella zoster virus. One of the complications that has the potential to cause long-term problems is post-herpetic neuralgia. This study aims to evaluate the Herpes zoster and postherpetic neuralgia progression rate: an epidemiological study at Tertiary Hospital in Bali, Indonesia

Methods: This is a retrospective descriptive cross-sectional study. The data was obtained from the patient's medical records in Dermatovenereology Clinic at Sanglah General Hospital Denpasar from January 2020 to December 2021. The samples were all new patients diagnosed with herpes zoster and post-herpetic neuralgia. The variable is sex, age, occupation, comorbid, and location. Data were analyzed using SPSS version 25.0 for Windows.

Results: A total of 23 new patients were diagnosed with herpes zoster and the total visit was 132. Most patients were male 12 (52.3% vs 47.7%). The highest age group was more than 65 years old with 12 (51.5%) patients, followed by 45-64 years with 8 (35.6%) patients. The lesion location in most patients was thoracic in 9 patients (38.1%), followed by cervical in 7 patients (29.5%), lumbar in 6 patients (25.8%), and ophthalmic in 1 patient (6.6%). Six patients (26.0%) had comorbid diseases. Ten patients experienced PHN.

Conclusion: Most herpes zoster patients in Dermatovenereology Clinic, Sanglah Hospital from January 2020 to December 2021 were more than 65 years old, predominantly male sex, with the most common location of herpes zoster in the thoracic region 9 patients (38.1%), and 10 patients (43.5%) had PHN.

Introduction: The development of technology today is moving very rapidly. Various kinds of activities are associated with technology. In response to this, it is necessary to adopt technology by everyone so that adults and children are not left behind. It is important to introduce technology adaptation to students in order to face the increasingly rapid technological developments in the future. Therefore, one of the efforts to apply technology in the field of art is through the introduction of coding learning. The purpose of this research is to implement learning coding to train the artistic creativity of Elementary School Teacher Education Students at FKIP UNUSA.  

Methods: This research method uses a qualitative research method. The subjects of this study were PGSD 4th semester students as many as 90 people. The research was carried out using the code.org website with dance party material.  

Results: The results showed that the implementation of coding learning can train students' creativity in making simple dance moves that are unique and interesting. In addition, students can also be creative with the background of the stage setting and the floor pattern of the dancers. As many as 80 students are able to make dance choreography by using the code.org website for dance party materials.  

Conclusion: It can be concluded that the artistic creativity of students increases through learning coding.

Link of Video Abstract: https://youtu.be/lrnQiVZyH8Q

Background: Perineal lacerations damage the tissues around the vagina and rectum and can cause disruption of the anatomy and function of the pelvic floor. The incidence of perineal lacerations after vaginal delivery ranges from 53-89%. This anatomical damage and muscle dysfunction can cause urinary incontinence, anal incontinence, and uterovaginal prolapse. This study aims to evaluate the effects of postpartum perineal lacerations on the anatomy and strength of the pelvic floor muscles.

Methods: The sample of this study is primiparous women who experienced perineal lacerations. Sampling was carried out prospectively using the consecutive sampling method. Pelvic floor anatomy and strength were measured using a POP-Q system and a perineometer. The 1^st and 2^nd degree laceration group measurements will be compared using the chi-square, and Mann-Whitney tests will be carried out.

Results: Of the 123 research samples that met the criteria, a significant difference was found in the strength of the pelvic floor muscles in the first-degree perineal laceration and second-degree perineal laceration groups at 1st day and 12 weeks postpartum (p = 0.000 and p = 0.042). The only significant difference found for pelvic floor muscle anatomy is in perineal body length at 12 weeks postpartum.

Conclusion: The degree of perineal laceration is related to the strength of the pelvic floor muscles after delivery and the length of the perineal body 12 weeks postpartum.

Introduction: Clinical learning is an experiential learning process in which students apply the theory obtained from academics to be applied to real cases in the clinic. Clinical facilitator support of learning, satisfaction, and stress with clinical placement aspects of support are crucial because they impact the knowledge acquired during classes and the development of practical skills to become fully competent health care professionals. This study aimed to determine the factors of clinical facilitators, satisfaction, and stress levels of nursing students in clinical learning.

Method: The design of study was cross-sectional design. The study was conducted on 141 nursing students for the 2021/2022 period who were taking clinical learning in hospitals, social institutions, and communities from the Diploma Nursing, Bachelor Nursing and Ners study programs at Universitas Nahdlatul Ulama Surabaya.

Result: The results of the partial T-test showed that the clinical facilitator variable has no significant effect on clinical learning (p=0,938); the student satisfaction variable has no significant effect on clinical learning (p=0,199); the stress variable has a significant effect on clinical learning (p=0,000).

Conclusion: The stress level of students is the most significant factor for students during their clinical practice.

Background: Gentle birth is one way to prepare mothers to give birth naturally by utilizing all the natural elements (body, mind, and soul), which is expected to minimize both physical and psychological trauma and provide a positive experience from the labor process, a mother must have self-efficacy or belief in herself that the mother can do it. The purpose of this research is to analyze the factors that influence self-efficacy in readiness for Gentle birth.

Method: This research is an explanatory analytical study that analyzes the factors that affect the self-efficacy of Gentle Birth labor. The sample size is 64 pregnant women in the third trimester. Sampling using a simple random sampling technique. The dependent variable is the mother's self-efficacy, and the independent variables are physical condition, experience, social modeling, verbal persuasion, family support and health workers. The instrument used a questionnaire about self-efficacy factors and General Self Efficacy (GSE). Analysis with multivariate logistic regression test with a significance value <0.05.

Result: Based on the statistical test, the results obtained that verbal persuasion affects self-efficacy with p = 0.005, social modeling affects Self Efficacy with p = 0.012, experience affects self-efficacy with p = 0.02, and physical and emotional conditions affect Self Efficacy with p = 0.036 while the characteristics mother has an effect on self-efficacy with p = 0.042.

Conclusion: Verbal persuasion is the most influential role in the mother's self-efficacy in preparing for a gentle birth. Therefore it is important to give verbal persuasion, positive affirmations and suggestions to the mother to increase self-efficacy.

Link of Video Abstract: https://www.youtube.com/watch?v=KF58IGGdWmc

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma. It is classified into homogeneous subtypes, namely Germinal Center B-Cell Like (GCB) and Non-Germinal Center B-Cell Like (GCB), with the latter associated with worse survival outcomes. Increased expression of Hypoxia-Inducible Factor-2α (HIF-2α) is often observed in DLBCL and has been correlated with enhanced angiogenesis, suggesting its potential as a prognostic factor in managing DLBCL. The study evaluates the association between HIF-2α overexpression and the GCB and non-GCB subtypes of DLBCL.

Methods: This cross-sectional study utilized samples from DLBCL patients at Dr. Kariadi Semarang Hospital between January and December 2021. Immunohistochemistry was performed on the samples to determine the DLBCL subtypes and assess the presence of HIF-2α. HIF-2α was evaluated by immunohistochemistry based on its distribution and intensity. The Kruskal-Wallis test was used to find the association between HIF-2α expression and the GCB and non-GCB subtypes of DLBCL. Furthermore, Spearman's rank correlation test explored the correlation between all numeric variables.

Results: A total of 30 subjects were included in this study, with 7 samples of GCB subtype (23.3%) and 23 samples of non-GCB subtype (76.6%). Kruskal-Wallis test showed no association between HIF-2α expression and the subtypes of DLBCL (p=0.812). Spearman's rho correlation test indicated no correlation between HIF-2α overexpression score with NCCN IPI score in GCB (r=0.219; p=0.637) and non-GCB (r=-0.194; p=0.386).

Conclusion: There was no association between HIF-2α expression and GCB and non-GCB subtypes of DLBCL. Additionally, no correlation was found between HIF-2α overexpression and NCCN IPI score.

Link of Video Abstract: https://youtu.be/4zHCrIC1IGE

Background:  The development of innovative and technology-aligned learning media is a necessary solution for nursing students. Students require access to interactive, practical, and easily accessible learning resources. An application that can facilitate students' learning in nursing diagnosis for surgical nursing, such as Virtual Nursing Diagnosis (VND), is needed. This study focuses on the development of the VND application specifically designed for the Surgical Nursing Care course.

Patients and methods: The research is a Research and Development (R&D) study involving 253 nursing students from Aceh Health Polytechnic. A needs analysis was conducted to identify the difficulties faced by students in applying nursing diagnoses to topics related to surgical nursing, particularly the cardiovascular system. Based on the findings of the needs analysis, it was discovered that students face difficulties in determining nursing problems. Therefore, the VND application was developed with features such as assessment forms, assessment tools, disease pathology, and nursing diagnoses. Additionally, the application is equipped with competency tests on interesting nursing cases that are user-friendly for students.

Results: The research results indicate that the VND application has received positive feedback from 253 students who have used it in real classroom environments. The application is user-friendly, efficient in performing nursing diagnoses, and provides available nursing case questions. VND application provides an interactive, innovative, and effective learning tool for understanding nursing diagnoses while enhancing accessibility and flexibility through mobile-based learning. The application equips students with the necessary skills to apply nursing diagnoses in real-world surgical medical practice.

Conclusion: the VND application significantly contributes to the development of nursing education. It not only improves understanding of nursing diagnoses but also provides an engaging and interactive learning experience. It is hoped that the use of the VND application in surgical nursing education can be an effective and innovative solution to enhance competency in applying nursing diagnoses in clinical practice.

Introduction: Pneumonia, also known as pneumonia, is caused by inflammation of the air sacs (alveoli) in one or both lungs. In severe pneumonia, intravascular and intra-alveolar coagulation occurs, which is a response to local and systemic inflammatory processes. The clinical consequence of these changes in coagulation is an increase in the level of D-Dimer which causes death. The purpose of this study was to evaluate D-Dimer in 29 pneumonia patients and 37 COVID-19 patients at Jemursari Hospital.

Methods: This research is quantitative with a cross-sectional analytic observational method. The research sample was obtained from the Jemursari Islamic Hospital in Surabaya for pneumonia and Covid-19 patients in 2021

Results: The results of the study, a number of women more than men. In women 63,6% and in men 36,4%, while the age is 46-54 years in pneumonia patients 28% and in Covid-19 patients 30%. D-Dimer levels in pneumonia patients 1001-2000 ng/mL were 35% higher compared to COVID-19 patients 501-1000 ng/mL were 30%. Mann Whitney's non-parametric test results obtained p=0.041 (p<0.05), meaning that there was a difference in D-Dimer levels between pneumonia patients and COVID-19.

Conclusion: D-Dimer levels were more elevated in pneumonia patients than in Covid-19, so Covid-19 infection did not exacerbate coagulation and fibrinolysis activities.

Link of Video Abstract: https://youtu.be/zg5vubHMcDY

Introduction: Chronic pain requires a thorough assessment if it persists in patients with cancer. Depressive disorder is one of the psychosocial problems that can occur in cancer patients. Depressive disorders affect up to 34.4% of patients with cancer in Indonesia, causing increased morbidity and complicating the management of patients. Quinolinic acid (QUIN) and serotonin (5-HT) are chemicals that can affect pain perception and depressive disorders. This study aims to analyze the relationship between quinolinic acid and serotonin levels with depression and pain degree in cancer pain patients.

Methods: A cross-sectional study design was conducted at the Palliative Polyclinic of Dr. Soetomo Surabaya General Hospital, Indonesia. Patients were collected with purposive sampling. The patient's quinolinic acid and serotonin plasma were collected through blood samples and assessed using enzyme-linked immunosorbent assay (ELISA) method. Spearman's comparison test determined the correlation between quinolinic acid and serotonin levels with depression and pain degree.

Results: A total of 76 cancer patients were included in this study. The cancer types reported were pelvic cancer (23 patients, 30.3%), head and neck cancer (21 patients, 27.6%), abdominal cancer (ten patients 13.2%), breast cancer (seven patients, 9.2%), lung cancer (five patients, 6.6%), skin cancer (three patients, 3.9%), and other types of cancers (seven patients, 9.2%). As many as 24 patients (31.6%) had mild depression and only three patients (3.9%) experienced major depression. Mild pain was reported by 47 patients (61.8%) and 11 patients (14.5%) suffered from severe pain. Spearman's comparison test was conducted on quinolinic acid and serotonin levels against depression degree and pain degree, resulting in a weak correlation.

Conclusion: Quinolinic acid and serotonin levels are related to depression and pain degree in cancer pain patients (p<0.05), though with a weak correlation. However, further study is needed to confirm the findings of this study.

Link of Video Abstract: https://youtu.be/_nqEUazGnE0

Background: Ameloblastoma is a rare odontogenic epithelial tumor affecting the jawbone (maxilla or mandible). According to the WHO in 2005, there are four different classifications of ameloblastoma: solid or multicystic, unicystic, peripheral, and desmoplastic. Despite being benign, ameloblastoma can seriously damage bones, resulting in deformity and even death. This research aims to know the profile of ameloblastoma due to limited data in Indonesia.

Methods: This study is an observational descriptive study. Cross-sectional data collection was used. Information was gathered from the medical records of patients with ameloblastoma treated at Dr. Soetomo general hospital, Surabaya between January 2018 and December 2022. A descriptive analysis was conducted to determine the frequency and proportion of each research variable.

Results: Forty-two ameloblastoma patients participated in the study. Patients with ameloblastoma ranged in age from 14 to 75, with a mean age of 39.6 (15.7) years. The majority of patients (57.1%) were female. The majority of the cases were mandibular ameloblastoma. Only 4.8% of ameloblastoma cases occurred in the maxilla, while 76.2% of ameloblastoma locations were found in the left mandible. Up to 97.61% of the surgeries conducted include extensive resection. Most patients (95.2%) with ameloblastoma had successful outcomes.

Conclusion: Although rare, the profile of ameloblastoma patients reveals that there are still incidences of fatality, necessitating further discussion of patient mortality risk factors.

Introduction: Indonesia was ranked as the second largest country in the world as a person with pulmonary Tuberculosis (TB) after India. This shows that there needs to be action to reduce the transmission of pulmonary TB, especially in family members who are in the same house. The purpose of this study was to identify factors related to preventive measures for the transmission of pulmonary tb in the city of Surabaya.

Methods: Quantitative research design with a cross-sectional approach, respondents were pulmonary TB sufferers aged > 15 years old for treatment at the East Perak Health Center and Jagir Health Center was totaling 262 respondents. Research variables include gender, age, education, patient category, drug ingestion supervisor, regularity of drug ingestion, search for treatment, knowledge, attitudes, and behaviors towards TB disease are obtained through the dissemination of questionnaires. Furthermore, data processing and statistical tests through (X²) chi square and linear regression.

Results: The results showed that gender, age, education, patient category, drug ingestion supervisor, regularity of drug ingestion, search for treatment, knowledge, attitudes, and behaviors towards TB disease significantly affect the prevention of pulmonary Tb transmission.

Conclusion: Pulmonary TB patients and family members need to remind each other to behave clean and healthy to prevent the transmission of pulmonary TB. It is very necessary to visit regularly from health services or health workers, to provide education about clean and healthy living behaviors.

Link of Video Abstract: https://youtu.be/tduoO-xy3ZE

Introduction: Cartilage destruction in knee osteoarthritis (KOA) caused the inflammation process. It makes the patient complain of knee pain, tends to immobilize, and induced neural inhibition (Arthrogenic muscle inhibition) on the quadriceps muscle as a knee stabilator and shock absorbent. These caused quadriceps weakness. The combination of blood flow restriction (BFR) and low-intensity resistance training (LIRT) showed an improvement in isotonic peak torque significantly, but the prescription is varied and limited in Indonesia.

Patient and Methods: This was a clinical experimental study with randomized control trial with pre and post-test design. The subjects were 28 KOA patients (50-70 years old). The intervention group (n=14) received a combination of low-load resistance training (30% 1-RM; 75 repetitions) and BFR (50 mmHg). The control group (n=14) received low load resistance training only (30% 1-RM; 75 repetitions). Both groups received training 2 times per week with a Q-bench machine for 6 weeks. Isokinetic peak torque was assessed before and after the training program.

Results: There was a significant improvement in isokinetic peak torque before and after the training program in both groups (intervention group p=0.001; control group p=0.000). There was a significant improvement of delta isokinetic peak torque between both groups (p=0.018) and post-test between both groups (p=0.044). The effect size value of the intervention group was 1.22 (very large) and the control group was 0.89 (large).

Conclusions: The addition of BFR on LIRT for 6 weeks can improve isokinetic quadriceps strength in patients with knee osteoarthritis

Introduction: Handling the COVID-19 pandemic has consumed the time and energy of every health worker. Empowering the role of peer counselors through the deployment of distance lactation counseling is the key to maintaining the services. Furthermore, counseling is implemented frequently and for a long duration. Therefore, the cost of accessing the media and internet connection plays an important role in implementing distance counseling. This study aimed to reduce the duration and frequency of distance lactation counseling using a combination of WhatsApp and linktr.ee media.

Methods: The method used was a quasi-experimental post-test group design with a case study approach. The population consists of 40 peer counselors in Kampung ASI, Wonokromo Village. Additionally, the sample size used is the total population. The difference in duration and frequency of lactation counseling is tested using the independent sample t-test.

Results: There was a significant difference between the duration and frequency of counseling in the two groups, with a p-value = 0.000 <0.05. Longer duration and high frequency were observed in the implementation of individual counseling using WhatsApp media, with a mean difference (95% CI) for the duration and frequency at 46.4 and 1.7, respectively.

Conclusion: Counseling media equipped with video recordings of materials can reduce the duration and frequency, hence, counselees can learn independently according to their needs and only discuss things they do not understand with counselors. It also reduces media access costs for peer counselors recruited with minimal salaries.

Link of Video Abstract: https://youtu.be/JRX2wJWFCKs

Introduction: COVID-19 has had profound implications on global healthcare systems, and this pandemic management has led to a significant change in orthopedic surgical activity. We aimed to evaluate the types and incidence of fractures treated during the pandemic to provide insight into the situations for which orthopedic trauma surgeons should be prepared in unusual circumstances that may arise in the future.

Methods: Descriptive observational cross-sectional study from Dr. Hasan Sadikin General Hospital and Ulin General Hospital was conducted from electronic medical records between January 2018 and December 2022. Analysis was performed using SPSS version 26 on descriptive analysis using mean, frequency, percentage, and standard deviation.

Results: 2890 patients were enrolled for the current cohort, from 2018 until 2022, with predominantly male (n = 2117). Even though, an increase in overall admission from 2018 (n = 631) to 2019 (n = 784), a decrease after that occurred during the COVID-19 pandemic, which is from 2020, 2021, and 2022 (n = 652, 500, and 323, respectively)

Conclusion: Knowing the number of fractures can be a tool to evaluate the types and incidence of fractures treated during the pandemic to provide insight into the situations for which orthopedic trauma surgeons should be prepared in unusual circumstances that may arise in the future.

Link of Video Abstract: https://youtu.be/Cw5keIvNHoQ

Introduction:  This study aims to analyze the effect of chronic periodontitis (CP) on  Troponin I levels in coronary artery disease (CAD) patients.

Patients and methods: This study was a cross-sectional study. A total of 90 CAD patients at Dr. Doris Sylvanus Hospital, Palangka Raya, Central Kalimantan, Indonesia, who underwent coronary angiography and had CP, was involved in the study. CAD was examined based on significant stenosis on coronary angiography. CP was measured based on mean physical diagnostic (PD) and panoramic X-rays. The blood sample was collected to determine Troponin I level by sandwich immunodetection method with fluorescence immunoassay (FIA). Bivariate analysis of factors affecting Troponin I (with threshold ROC results) was conducted using the Chi-square test, followed by multivariate analysis. A logistic regression test was also evaluated to determine the most influential independent variable on Troponin I.

Results: Based on bivariate analysis, CP and dyslipidemia significantly differed in both troponin groups. There was 53.3% mild CP at Troponin I level <0.015 ng/mL, while 80% moderate-severe CP at Troponin I level >0.015 ng/mL with p value=0.018. Based on multivariate analysis showed that CP had a significant effect on Troponin I. Additionally, patients with moderate-severe CP tended to have more Troponin I > 0.015 ng/mL with an odds ratio (OR) of 5.528 (95% CI 1.373-22.247; p value=0.016).

Conclusion: There was an effect of CP on increasing Troponin I levels in CAD patients.

Introduction: The skin is the largest organ of the human body. Sepsis is a serious disease and causes multi-organ damage, with a high cause of death. however, the mechanism by which sepsis can damage the skin structure is not clear. This study aimed to investigate skin damage in a lipopolysaccharide-induced endotoxemia (LPS) model widely used in mice.

Methods: This study used an experimental design with a control group that was randomized solely for the post-test. White mice (Mus musculus), the study's population, made up this group. LPS injection for 4 hours (LPS+4h, n=4), LPS injection for 8 hours (LPS+8h, n=4), and control group (Ctrl group, n=4) were randomly assigned to mice. The SPSS ver. 25 statistical analysis program was used. One-Way ANOVA was used to compare more than three sets of data, and Tukey's multiple comparison test was used to assess the results. The p-value of 0.05 was used to determine if the difference was significant.

Results: Based on this study, LPS injection increased the leukocyte concentration significantly (p-value<0.05) in the 4 h and 8 h vs control group. LPS-induced sepsis decreased body weight significantly (p-value<0.05). The morphology of skin thickness in the control group was normal, according to the results of the histopathologic study of the area stained with hematoxylin and eosin. However, the thickness was decreased in mice after 4 hours and 8 injections of LPS significantly (p-value<0.05).

Conclusion: LPS-induced septic mice cause damage to the skin, and changes in skin thickness due to the inflammatory process due to sepsis.

Background: The average incidence of falls in elderly women exceeds that of elderly men in all age groups. Exercise had a consistent effect on reducing the risk of falls when prescribed correctly and was successful in reducing fall rates in the community, with an even greater effect seen in a balance-challenging exercise program. The exercise in question is a series of combined activities that maintain or increase flexibility, endurance, strength and balance. Compared to traditional sports, sports games are more interesting and challenging, are not affected by the weather, and being able to practice at home increases safety and comfort. Exergame boxing is considered a fun and competitive fighting video game, so it has an effect on psychological and social interactions in the elderly. The aim of this study was to evaluate the effect of adding exergame boxing on the balance function of elderly women.

Methods: This study is a true experimental research with pre and post-test randomized control group design. The research participants were 32 elderly women, with each group consisting of 16 elderly women. Participants in the treatment group received exergame boxing, which was carried out 3 times per week for 8 weeks. Participants in both groups are required to take part in conventional exercises programmed by Nursing Home 5x/week for ±15 minutes. The outputs were assessed at the beginning (initial value) and after 8 weeks of intervention (final value).

Results: There were significantly significant differences in the One Leg Stance (OLS) and Timed Up and Go (TUG) values in the control and treatment group (p<0.005), but the effect size was higher in the treatment group.

Conclusions: The addition of exercise boxing for 8 weeks can improve the static and dynamic balance function of elderly women as measured by OLS and TUG.

Introduction: The two biggest issues for post-ischemic stroke patients are disability and mortality. Patients with post-ischemic stroke have a decline in quality of life due to alterations in neurological function. Additionally, post-stroke patients require ongoing education to improve their independence in completing daily tasks. His research thus sought to examine the impact of stroke self-management on post-ischemic stroke patients' neurological function and quality of life using the framework of health behavior theory.

Methods: The sampling method utilized in the study design was successive sampling with a quasi-experimental design to choose the sample following the inclusion and exclusion criteria. 58 intervention and control groups were created from a total sample of 116 respondents. This research used the National Institute of Health Stroke Scale (NIHSS) and Stroke Specific Quality of Life Scale (SS-QoL). Statistical analysis using t-test with p<0.5.

Results: According to the findings, the mean neurological function in the intervention group before and after the intervention was 8.259, whereas the mean quality of life before and after the intervention was -20.93. In the control group, the mean neurological function was -0.179 before and after the intervention, whereas the mean quality of life was 0.069. Data analysis revealed a significant difference between health behavior therapy-based stroke self-management programs and neurological function and quality of life in post-ischemic stroke patients with p = 0.00.

Conclusion: Stroke self-management based on health behavior theory can be applied over the long term to help patients’ neurological function and quality of life.

Link of Video Abstract: https://youtu.be/6j-cheXQzQE

Background: Hyperglycemia plays a significant role in developing insulin resistance, leading to a continuous decline in metabolism. Uncontrolled long-term hyperglycemia has deleterious effects on muscles, leading to a decline in muscle mass, impaired capillarization, and muscle atrophy. We identified the effect of hyperglycemia on reducing myoblast cell viability through observation using the MTT assay.

Methods: Primary culture of myoblast cells was performed using rat's muscle tissue which was further induced by hyperglycemia by adding D-glucose with concentrations of 10 mM, 25 mM, and 50 mM in the plating media. Cell viability was observed using the MTT assay by identifying the absorbance using an ELISA reader with λ=550-600 nm (595 nm)

Results: There was a significant decrease in cell viability (p=0.000) due to administering various glucose concentrations in the plating media. There is a negative correlation between glucose concentration and myoblast cell viability (P-value = 0.000; t = -8.284; r = -0.926)

Conclusion: Elevated blood sugar levels result in a significant reduction in the viability of myoblast cells, as indicated by the MTT assay. The MTT assay proved invaluable for precisely evaluating myoblast cell viability in the context of hyperglycemia.

Link of Video Abstract: https://youtu.be/OG7qXwNHzHQ

Background: Meningioma, a prevalent intracranial neoplasm, ranks among the most frequently encountered tumors within the cranial cavity. The utilization of Magnetic Resonance Imaging (MRI) in the diagnostic process of meningioma has proven to be highly valuable. This study aims to evaluate the Conventional-MRI and histopathology agreement for the diagnosis of intracranial meningioma at Dr. Soetomo General Hospital, Surabaya.

Methods: This study presents a diagnostic test and retrospective case-control analysis to evaluate the precision of head MRI in diagnosing intracranial meningioma, as confirmed by histopathological examination. The research was conducted at Dr. Soetomo Surabaya General Hospital from January 2016 to December 2021. Sample size calculations were performed on a cohort of patients diagnosed with intracranial meningioma who underwent head magnetic resonance imaging (MRI) scans and histopathological examinations at the Radiology and Anatomical Pathology Installation of Dr. Soetomo General Hospital. Only patients who satisfied the predetermined inclusion and exclusion criteria were included in the study. Data were analyzed using SPSS version 25.0 for Windows.

Results: At the time of diagnosis, it was observed that the average diameter of grade II/III meningioma was 6.6 ± 1.5 cm, which was found to be greater than the average diameter of grade I meningioma, measuring 4 ± 1.92 cm. The prevalence of grade I meningioma was higher in the skull base region higher in the skull base region, accounting for approximately 36% of cases. Conversely, grade II/III meningioma was found more frequently in the non-skull base area, constituting approximately 76% of cases. In our investigation, it was observed that there exists a higher occurrence of irregular border shape in grade II/III meningioma, accounting for approximately 75% of cases, as compared to grade I meningioma, which only accounts for 14.2% of cases. The presence of contrast enhancement in meningiomas can provide valuable insights into their histological grade. Grade II/III meningiomas exhibit a higher degree of contrast enhancement, which is observed to be heterogeneously distributed in approximately 75% of cases.

Conclusion: This study highlights the potential of MRI as a valuable tool in assessing the grade of meningioma while emphasizing the importance of considering other diagnostic modalities and clinical factors to ensure accurate diagnosis and treatment decisions.

Background: Educational science is a reciprocal adjustment process between humans and humans and nature as a regular development and improvement of all moral, intellectual, and physical potentials. In the learning process in the clinical laboratory, lecturers only use textbooks or observation sheets and do not get videos and modules as media in the learning process in the clinical laboratory about nursing skills. Students can choose learning styles through video media and modules to understand nursing materials and skills. This study aims to identify the effectiveness of implementing the clinical skills learning process in the laboratory for nursing students during the COVID-19 pandemic with video media and modules at Universitas Nahdlatul Ulama Surabaya (UNUSA).

Methods: This research is a descriptive quantitative study. The selected population is laboratory practicum educators of UNUSA diploma nursing students during the year 2021. The sample was randomly selected, and 60 diploma Nursing students who had used learning media with videos and skill modules made by teaching lecturers during the COVID-19 pandemic were selected. The instrument is designed as a questionnaire regarding various student opinions on online learning with video media and clinical skills modules during the COVID-19 pandemic. Data were collected using a questionnaire and analyzed by t-test and multiple linear regression.

Results: The results showed that there was an effect of video learning media on the learning outcomes of skills in the laboratory for diploma nursing students (b=6.64; p=0.023), and there was no effect of learning styles on the learning outcomes of infusion skills (b=6.38; p= 0.111) from the results of multiple linear regression analysis, there is an effect of using video learning media and student learning styles on nursing skills learning outcomes in the laboratory, the effect is statistically significant (b=6.64; p=0.041).

Conclusion: This research concludes that using video learning media and modules is very effective in the learning process in clinical laboratories' nursing skills. Therefore, it is recommended that all lecturers make video media and modules about nursing skills per the Standard Operating Procedures from Persatuan Perawat Nasional Indonesia (PPNI) to facilitate the learning process in the laboratory and clinic.

Link of Video Abstract: https://youtu.be/cKF7Miu4D9I

Background: Thyroidectomy is the surgical removal of part or all of the thyroid glands. Thyroidectomy is performed to treat thyroid disease which can be in the form of enlargement of the thyroid glands and thyroid cancer. Thyroidectomy is performed to help cure the patient's disease, but after thyroidectomy, there is still the possibility of post-operative complications. One of the common complications that can occur is hypothyroidism. The type of thyroidectomy surgery that generally results in hypothyroidism is near-total or total thyroidectomy.

Methods: An analytic observational study with a cross-sectional design was carried out at PKU Muhammadiyah Gamping Hospital. A total of 50 people who had thyroid problems or diseases and had undergone thyroidectomy surgery were included in the samples. The inclusion criteria for this study were patients aged 20–80 years, with hyperthyroidism or euthyroidism, both outpatients or inpatients. Patients with hypothyroidism and those with thyroid disease are excluded from this study. The research data were analyzed with the Fisher exact test.

Results: Majority of the sex of subjects in this study were female. Most of the subject age groups in this study were in the 20-50 year age group. Hypothyroid complications occur in 8% of subjects. The results of bivariate analysis obtained a significant value

Link of Video Abstract: https://youtu.be/_B_bL8gi7hU

Background: Colorectal carcinoma is one of the most common malignancies and is one of the leading causes of cancer-related death worldwide. The incidence of colorectal carcinoma in Indonesia is reported to be 12.8 per 100,000 adult population, accounting for 9.5% of all cancer-related deaths. Assessment of Human Epidermal Growth Factor Receptor 2 (HER2) expression is used to help predict tumor behavior and the effect of anti-HER2 receptor therapy. This study aims to analyze the relationship between HER2 immunohistochemical expression with age, gender, tumor location, and tumor budding in this malignancy.

Methods: This study is a cross sectional analytic study of 45 samples diagnosed with colorectal carcinoma at H. Adam Malik General Hospital Medan. Tumor budding was assessed for tumor invasiveness based on the International Tumor Budding Consensus Conference (ITBCC) 2016 in a field area of ​​0.785 mm2 with a 20x objective lens using a three-level scoring system, which was categorized into low budding (0-4 buds), intermediate budding (5-9 buds), and high budding (≥10 buds). Staining was performed using immunohistochemistry of the monoclonal anti-human HER2 anti-human DBS manufacturer, which would appear positive on the tumor cell membrane at a dilution of 1:100. HER2 expression was assessed using the HERACLES criteria. The results are presented as a score of 0, 1+, 2+, 3+, then categorized into negative (score 0-2+) and positive (score 3+). Data were analyzed using SPSS version 25.0 for Windows.

Results: There was no significant relationship between HER2 and clinicopathological parameters such as age (p=0.755), gender (p>0.05) and tumor location (p>0.05). However, there was a significant relationship between HER2 and tumor budding histopathological parameters with a value of p=0.011 in a positive direction (the greater the number of budding, the more positive HER2 expression, and vice versa).

Conclusion: HER2 is not significantly related to age, gender and tumor location. However, it is significantly associated with tumor budding. HER2 plays a role in the proliferation and differentiation of colorectal carcinoma tumor cells.

Introduction: Character education for children today is very important to improve. One of the efforts to improve children's character education is through folklore. The purpose of this study is to describe the inculcation of educational values in Folklore from Surabaya as a supporter of character learning in elementary schools.

Methods: Research on planting educational values in folklore from Surabaya to Support Character Learning is a qualitative descriptive study. The research approach used in this study is pragmatic. In the pragmatic approach, it is related to benefits or utility as stated by Horatius. A pragmatic approach is an approach that sees literary works as a medium to convey certain goals to the reader. These goals can be in the form of goals that have to do with education, morals, politics, religion, or other goals.

Results: The approach in this study refers to the educational value in Folklore from Surabaya which consists of nine stories. Sawunggaling Folklore contains several character values, namely, persistence, love for the homeland, and responsibility. The Kalimas legend contains the character values of mutual cooperation, the spirit of nationalism (nationalism), and love for the homeland. The Story of the Origin of Ketintang Village contains the character of caring, responsibility, mutual cooperation, persistence, and perseverance, tolerance, hard work, creativity, and independence. The fairy tale of Jaka Dolog is a fairy tale with the theme of the need for honesty. Ki Ageng Jangrana who rebelled against the Dutch was a form of nationalism, responsibility, and self-sacrifice character values. In Folklore from Surabaya, religious values are found in the stories of Ki Ageng Brondong and Sunan Ampel.

Conclusion: Folklore originating from Surabaya contains educational values ​​that can be adopted by teachers to support student character education.

Introduction: Banana peels are often discarded without further use. Whereas each banana peel contains nutrients that are quite high depending on the ripeness of the banana fruit. This has the potential to use banana peels as a medium for fungal growth. The purpose of this study was to determine the potential of banana peel as a growth medium for the test fungi, namely Aspergillus fumigatus, Aspergillus flavus, and Candida albicans.

Method: The type of research is experimental with variations in the mass of banana peels. The potency of banana peel media was evaluated by the growth of the test fungus which was expressed quantitatively by growth diameter and number of colonies. While the qualitative evaluation was carried out by observing the morphology of the test fungus colonies on banana peel media. The gold standard media used in this study were Sabouraud dextrose agar (SDA) for Aspergillus, and Potato dextrose agar (PDA) for Candida. Incubation for Candida albicans growth was carried out at 48 hours, while Aspergillus growth was incubated for up to 10 days. The data obtained were analyzed using Mann-Whitney.

Result: The results showed that the banana peel media could be overgrown with the test fungus. Candida albicans showed the best results in the 3% (w/v) variant, while Aspergillus fumigatus grew optimally at the 2% (w/v) variant. Aspergillus flavus was best at the 1% (w/v) variant.

Conclusion: Based on the results obtained, banana peels media can be used for the growth media of the tested fungi, and it is recommended to use the 2% (w/v) variant so that it can be used to grow all the tested fungi in this research. 

Link of Video Abstract: https://youtu.be/nk1qtXzfl7I

Background: Transnasal esophagoscopy (TNE) is a small-caliber flexible esophagoscopy technique with the same diagnostic accuracy as conventional esophagoscopy. In addition, this technique is safer than any other technique and has patient tolerance. This study aims to analyze and evaluate the TNE procedure in patients.

Methods: a retrospective approach was used in this study by taking data from the activity register of the broncho-eschatology division of the outpatient unit of ORL-HNS Dr. Soetomo General Academic Hospital. TNE report book and patient medical records were collected to have the data. The observation period was from 2013 to 2017. Data were analyzed using SPSS version 25.0 for Windows.

Results: patients met the inclusion and exclusion criteria were 99 patients, with a male-to-female ratio of 2.3: 1. Most endoscopic findings were normal esophagus (56.57%). Existing abnormal findings included esophageal stenosis (18.18%), esophageal mucosal lesions (14.14%), and esophageal tumors (11.11%). TNE examination complications were found to be 1%.

Conclusion: TNE is widely used in patients aged 51-60, with dysphagia, reflux or Globus as the most common indications. TNE is quite safe to do in an outpatient hospital setting.

Introduction: CYP17 gene polymorphism causes susceptibility, can interfere with the enzyme biosynthesis mechanism in steroidogenesis, and becomes a possible genetic factor for hyper-androgen in PCOS. The study aimed to analyze the relationship between CYP17 gene polymorphism and increased androstenedione levels in PCOS women with obesity.

Methods: This study is an observational case-control analytic. The sample is 23 obese PCOS women and 23 obese non-PCOS women, using a purposive sampling technique. CYP17 gene polymorphism examination with PCR and RFLP. Examination of androstenedione hormone by ELISA. The examination results were tested using a logistic regression statistical test with α = 0.05, the hypothesis being accepted if p-value <0.005.

Results: The study subjects were 20-30 years old, 50-60 kg body weight, with BMI more than 25%. The distribution of CYP17 gene genotypes in the case group was TC, 47.8%, while in the control group, it was TT, 100%, Chi-Square test on CYP17 gene polymorphism in PCOS and control groups showed significant differences (P 0.000). Wilcoxon-Mann Whitney test of androstenedione levels in cases compared to controls P = 0.000, eta CYP17 correlation test with androstenedione levels P = 0.061.

Conclusion: There is a difference in CYP 17 gene polymorphism in obese PCOS women compared to obese non-PCOS women. Androstenedione levels are higher in PCOS women than in obese non-PCOS women and there is no association of CYP17 with Androstenedione levels in PCOS women with obesity.

Introduction: Mental health is a problem that can occur to everyone, especially to postpartum mothers, because of the process of physical and psychological changes, namely as parents. This exploratory study aims to identify strategies for successfully implementing postpartum depression screening in health services that provide midwifery care during the postpartum period.

Method: This qualitative study included four focus group discussions and two in-depth individual interviews with participants using a semi-structured interview guide. Topics examined included acceptance of, and readiness for, screening programs for postpartum depression. Participants included perinatal women and their families, policymakers, and health service providers. Interviews were transcribed verbatim, coded, and analyzed for emerging themes.

Result: The results of the analysis show that postpartum psychological screening needs to be carried out by health workers on postpartum mothers. The process of implementing the screening can be done when the postpartum mother visits a health worker. Screening can be done at the beginning of the puerperium as early detection of postpartum blues and postpartum depression. The potential challenge that must be done to implement this postpartum screening is the preparation/introduction of detection tools to health workers, including a referral system and treatment if a postpartum mother is found with problems. In addition, there is a need for synergy between stakeholders, health workers and health service facilities to implement postpartum psychological screening.

Conclusion: Conclusions from our analysis suggest several factors to support the successful implementation of the postpartum depression screening program, guidelines for screening implementation for successful implementation, and an evidence-based approach to encourage the implementation of postpartum psychological screening.

Link of Video Abstract: https://youtu.be/uGfZNQrEQqY

Background: Coronavirus disease 2019 (COVID-19) has caused serious public health problems since the end of 2019. Viral load is known in COVID-19 infection, which indicates the number of causative agents and is indirectly assessed by the Cycle threshold value (Ct value). Ct value assessment has not been declared an essential parameter in COVID-19 infection. Due to the high number of COVID-19 cases, an additional strategy is needed to help identify patients at high risk of experiencing severe clinical conditions by knowing the relationship between the Ct value of SARS CoV-2 and neutrophil lymphocyte ratio (NLR), absolute lymphocyte count (ALC), severity, length of stay, and outcomes.

Methods: This was an analytic observational study with cross-sectional approach in confirmed COVID-19 patients to investigate the relationship between the Ct value of SARS CoV-2 and NLR, ALC, severity, length of stay, and outcome of COVID-19 patients. There were 337 patients analyzed with chi square test.

Results: The results of this study indicate that the majority of subjects were male (51%), aged <60 years (27%), Ct value ≤29 (70%), had a critical severity (36.5%), length of stay >10 days (64.1%) and survived (74.7%). Inflammatory markers examination shows NLR<3,13 (57.9%) and ALC<1500 (66.2%). The chi-square test shows a significant relationship between Ct value and ALC, degree of severity, and outcome in COVID-19 patients (p <0.05). No association was found between Ct value, NLR, and length of stay (p>0.05).

Conclusion: There is a relationship between Ct value and ALC, degree of severity, and outcome in COVID-19 patients.

Background: The maternal referral system is still a health problem, especially in Indonesia’s remote areas. That system is related to the maternal referral system regarding referral decision-making. At the same time, in deciding to refer anyone other than the husband, it must involve parents, shaman/confidant, then the hamlet head. If the patient still does not want to be referred, it must involve the village head, even the sub-district head. Besides, the referral facility's distance also takes a very long time, around 2 hours to travel; therefore, many mothers/babies die while traveling to the referral place. Health professionals, especially midwives, are responsible for explaining to patients and families because average midwives do not give detailed explanations, starting from the anamnesis, examination results, and actions done before and in the referral process.

Method: The research design utilized the Participatory Action Research (PAR) approach, consisting of four stages: problem identification, planning, action, and evaluation. Qualitative data is obtained through in-depth interviews and FGD (Focus Group Discussion) to determine existing problems and programs that are not yet running. Contradictary, quantitative data were obtained from the intervention and control groups. Qualitative data analysis used content analysis, while quantitative data used Wilcoxon sign-rank and rank-sum.

Result: This study aimed to determine the quality of midwives towards maternal referrals, to design a module for midwife empowerment programs, to implement a model design, and to evaluate the results of implementing a midwife empowerment model for maternal referrals so that midwives have guidelines and improve midwife skills so that pregnant women are given explanations by midwives, in order to facilitate the referral process.

Conclusion: The PAR approach is one of the potential ways to determine the midwife’s quality, improving the maternal referral system, especially for the remote area in Indonesia.

Introduction: Farmers generally provide NPK chemical fertilizers (Nitrogen, Phosphorus, Potassium) to provide nutrients for green spinach plants. However, the use of NPK chemical fertilizers harms the environment. Nowadays, chicken feathers are known as beneficial for fertilizing plants, similar to NPK chemical fertilizers. Fermentation of chicken feathers by Bacillus sp. can improve the quality of protein in chicken feather fertilizers which can be used as a supplement in renewing soil conditions.  Thus, this study is aimed to evaluate the nutrient component of fermented chicken feather fertilizer waste using Bacillus subtilis on the growth of green spinach (Amaranthus tricolor)

Methods: This was a cross-sectional study. In this study, we used a total sampling technique. In this study, three groups got different chicken father fertilizers, and two groups of standard and did not get the chicken father fertilizer. Data from the research will be statistically analyzed descriptively. The descriptive data will provide in the table.

Results:  In the first treatment group, the value of nitrogen (N) was 2.439, phosphorus (P) was 2.225%, and potassium (K) was 2.408%. In the second treatment group, the nitrogen (N) value obtained 2.866%, the phosphorus (P) value was 2.174%, and the potassium (K) value was 2.477%. In the third treatment group, the nitrogen (N) value was 3.291%, the phosphorus value was 3.082 %, and the Potassium (K) value was 3.135%.

Conclusion: According to the results, the higher the chicken feather fermented fertilizer dose, the higher the NPK content. This is certainly good for the growth of spinach.

Introduction: Anxiety is a common thing experienced by women who will undergo cesarean section surgery. The level of anxiety and the ability to manage anxiety are not the same for everyone, so efforts are needed to manage anxiety so that there is no delay in surgery. The purpose of this study was to explain the relationship between spiritual experiences and the level of anxiety in patients with preoperative cesarean section.

Methods: The design of this research was correlational analytic with cross sectional approach. The population of this study were mothers who underwent preoperative cesarean section as many as 32 people and with the purposive sampling technique obtained a sample of 30 respondents. The variables measured were spiritual experience and level of anxiety. Data were collected using DSES and HARS instruments. Data analysis using chi square test.

Result: The results showed that 90% of respondents with negative spiritual experiences were in moderate anxiety. The results of the chi square test obtained p = 0.002 which means that spiritual experience is significantly related to the level of anxiety of preoperative cesarean section patients.

Conclusion: Nurses have a role in managing the anxiety of preoperative cesarean section patients. Efforts that can be made are with a spiritual approach so as to create calm for preoperative section patients.

Introduction: Someone who is overweight has the potential to experience complications from various diseases which become a heavy economic burden for the community. Dietary modification is considered as one of the strategies to prevent and handling obesity. It can be done by adjust the type, amount, frequency, processing methods, and schedule. Maintenance of intestinal microflora can be done by regulating food intake by consuming foods or drinks that have physiological functions for health. Synbiotics can control the number of good micro-flora in the digestive tract, thus providing health and therapeutic benefits. The aim of this study was to see the effectiveness of milk kefir plus sorghum flour on maintain the cholesterol and blood glucose levels of mice that have been fed a high-fat diet or induced obesity.

Methods: This type of research design is true experimental in vivo using a randomized controlled pre-test-post-test control group design. Based on the test results using one way ANOVA statistical test which can be seen, it can be concluded that there are differences in blood glucose levels in the treatment group using the COD-PAP method with a p-value of 0,031.

Results: According to ANOVA test, there are differences in total cholesterol levels in the treatment group using the CHOD-PAP method with a p-value of 0,000.

Conclusion: There are differences in blood glucose and total cholesterol levels in mice fed kefir milk with the addition of sorghum flour.

Link of Video Abstract: https://youtu.be/hCLGE3-eNjw

Background: Computed tomography (CT) as a chest radiographic examination has emerged as a crucial procedure for screening, diagnosing, and monitoring COVID-19 patients. This study aims to determine the radiographic appearance of thoracic imaging in pediatric cases of COVID-19 at Dr. Wahidin Sudirohusodo Hospital in Makassar, Indonesia.

Methods: This study is an observational study design that uses secondary data from medical records to examine the radiographic appearance of thoracic imaging in pediatric patients with COVID-19 infection. The study was conducted at the Radiology Department of Wahidin Sudirohusodo General Hospital in Makassar, Indonesia, from January 1^st 2020, to December 31^st 2021. The population included all pediatric patients with positive SARS-CoV-2 RT-PCR results and a chest X-ray examination sent for thoracic imaging examination. The study sample was taken from all accessible populations that met the study criteria until the end of the study period.

Results: A total of 147 samples (51.05%) showed abnormalities or pathological lesions on thoracic radiography, with consolidation being the most common finding (27.77%) distributed diffusely in both unilateral and bilateral regions. The rarest pathological finding was pleural effusion in 22 samples (7.63%). Conversely, 141 samples (48.95%) showed normal results on thoracic radiography examination. In the age group of 0-<1 month, 46 samples (55.43%) showed abnormalities on thoracic radiography, with consolidation being the most common finding in this age group, found in 30 samples (36.14%).

Conclusion: This study showed that most children with COVID-19 symptoms exhibit abnormalities on thoracic radiography. However, these findings are not specific, and therefore, thoracic radiography cannot be used for screening or as a first-line diagnostic examination.

Background: Most people with hypertension feel healthy and energetic; this situation is dangerous and can cause death in the community. Non-compliance is a complex phenomenon often occurring in health care, especially in hypertensive patients. Medication adherence is very important so that complications do not occur, but many hypertensive patients still do not comply with medication. This study aimed to analyze the correlation between health literacy and adherence to medication for hypertension patients in the COVID-19 pandemic era at Private Hospital Surabaya.

Methods: This research design was correlative analytic with a cross-sectional approach. This study's population was hypertensive patients treated at Hospital D with a simple random sampling of 74 people. The instruments used in this study were Health Literacy Scale (HLS-EU-Q16) to measure health literacy and adherence to medication by using Morisky Medication Adherence Scale (MMAS-8). The Rank Spearman test used data analysis to measure health literacy with medication adherence.

Results: The results showed a relationship between health literacy and adherence to medication for hypertension patients at Private Hospital Surabaya with a level (p=0.000).

Conclusion: Findings from the study suggest that improving health literacy important for support to be more responsible in hypertension medication.

Link of Video Abstract: https://youtu.be/VsAy9X8XIAk

Background: Preeclampsia is a pregnancy-related disease involving multi-organs, characterized by increased blood pressure in the second trimester of pregnancy. Preeclampsia can have short-term and long-term consequences for the mother and the fetus, including intra-uterine growth restriction (IUGR). One of the markers of DNA damage due to oxidative stress due to endothelial dysfunction in preeclampsia is the increase in 8-OHdG levels in cord blood. This study aims to see an increase in 8-OHdG levels in preeclampsia.

Methods: This study was a cross-sectional study with a total of 41 patients with preeclampsia and 41 patients with healthy pregnant women at Wahidin Sudirohusodo Hospital and its network. Samples were taken using the purposive sampling method according to the inclusion criteria. This 8-OHdG level was examined using the ELISA kit at the HUMRC laboratory of Hasanuddin University Hospital. The data is then processed statistically using SPSS.

Results: This study found 6 patients with PE + IUGR, 31 with PE, and 41 without PE. The examination results of 8-OHdG levels found significant differences between the 3 groups PE + IUGR, PE, and normal pregnancies, which showed a significant relationship between elevated 8-OHdG levels and the incidence of PE accompanied by IUGR (p = 0.006)

Conclusion: Elevated 8-OHdG levels are found in preeclampsia, especially in preeclampsia accompanied by IUGR.

Introduction: Addiction to online games is one of the impacts caused by technological developments. One of the effects of online game addiction is a change in sleep quality. This study aims to analyze the relationship between the habit of playing online games with adolescent sleep quality.

Method: This study is a correlation analytic research design with a cross-sectional approach, the research sample was 109 respondents from 150 populations using simple random sampling. The independent variable of this study was the habit of playing online games and the dependent variable was sleep quality. The instrument used in this study is gaming disorder using the 7-item Game Addiction Scale (GAS) and sleep quality using the 10-item Adolescent Sleep-Wake Scale (ASWS). Data analysis using chi-square test.

Results: The result of this study, most of them (55.6%) had fairly bad sleep quality and almost half (44.4%) had very bad sleep quality. Spearman rank test results p = 0.000, which means that game addiction has a relationship with adolescent sleep quality.

Conclusion: Game addiction is one of the factors for adolescents' bad sleep quality. It is hoped that adolescents can reduce playing online games because bad sleep quality can interfere with health.

Introduction: The gold standard of intracranial pressure (ICP) measurement is an invasive procedure of inserting ICP monitor and one of the limitations of its surrogate, ultrasonography-based (US) optic nerve sheath diameter (ONSD) measurement is operator-dependent. Quantitative pupillary light reflex (PLR) measurement provides objective data promisingly able to predict ICP elevation. The aim of this study was to evaluate diagnostic accuracy of PLR as an indicator of ICP elevation in traumatic brain injury (TBI) patients compared to US-ONSD measurement.

Methods: This was a cross-sectional study involving moderate and severe TBI patients aged 18-65 years without any eye lesion, nor medication and illness that may influence PLR. Healthy volunteers were recruited as control group. ONSD and quantitative PLR measurements (baseline diameter, maximum constriction, constriction velocity, latency and amplitude) were assessed to both groups. The Student t-test or Mann-Whitney U-test was used to compare the ONSD and PLR between case and control group. Further analyses were done to determine the sensitivity, specificity and cut-off value of PLR compared to ONSD in case group.

Result: ONSD measurements or parameters were significantly different between case and control group (p<0.001), while all PLR parameters  were significantly different (p<0.005) except for right eye constriction latency. The baseline diameter of the right eye had the highest accuracy with cut-off value of >3.9 mm (specificity of 100%, sensitivity of 50%). Other PLR components had variable in accuracy.

Conclusion: The baseline diameter of the right eye was the most accurate PLR component as an indicator of ICP elevation, represented by ONSD.

Background: Perforated peptic ulcer often occurs in peptic ulcer disease. Identifying the clinical presentation before any operation is important to predict mortality and decision-making about management perforated peptic ulcers. Until to date, there is no report data of perforated peptic ulcer

characteristics at Dr Soetomo Hospital Surabaya.

Methods: This is a non-experimental study with descriptive retrospective design. Data were collected retrospectively from medical records all consecutive patients with diagnosis of perforated peptic ulcer at Dr. Soetomo Hospital 2020 - 2022.

Results: For three years, 97 patients were treated with perforated peptic ulcers with a high mortality of 48.5%. Patients were 67% male and 33% female with an average age of 61.4 ± 12.1 years old. There are two options for source control management: external drainage in patients with a Boey score of 3 with a mortality rate of 78.9% and definitive laparotomy repair perforation with a mortality rate of 28.8%. Patients with hemodynamic instability and sepsis have a high mortality rate. The most comorbid patients with perforated peptic ulcer are peripheral vascular disease, endocrine disorders,and lung disease.

Conclusion: Patients with perforated peptic ulcers at Dr. Soetomo Hospital have a high mortality rate. Treatment can be in the form of definitive surgery and external drainage. However, external drainage has a high mortality rate.

Link of Video Abstract: https://youtu.be/2uoN5ciMk14

Umbilical cord mesenchymal stem cells have been shown to reduce neointimal hyperplasia in animal models. However, current studies about therapeutic use to reduce neointimal hyperplasia mainly utilized bone-marrow and adipose tissue-derived mesenchymal stem cells and lack of in vivo testing from umbilical cord mesenchymal stem cells. Herein, we explore the potential of the therapeutic use of umbilical cord-derived mesenchymal stem cells to reduce neointimal hyperplasia in patients with arteriovenous fistula. Studies were identified from Scopus, Pubmed, and Google Scholar published between 2000 and 2022. The inclusion criteria for the articles were: (1) written in English, (2) focused on the use of mesenchymal stem cells (MSCs) for the treatment of neointimal hyperplasia, and (3) animal-controlled studies. Exosome-derived from mesenchymal stem cell studies were excluded. A total of 9 articles were included. Overall, the available evidence suggests that UC-MSCs may be a promising therapeutic option for reducing neointimal hyperplasia in arteriovenous fistula (AVF) patients. However, more research is needed to confirm these findings and to determine the optimal dosing and administration for their use in clinical practice. Additionally, further studies are required to fully understand the standardization in isolating and characterizing UC-MSCs and their effects on neointimal hyperplasia.

Link of Video Abstract: https://youtu.be/mPotwhRZbsY

Cataracts and glaucoma are two leading causes of global blindness that are often found together, creating complex clinical challenges. Cataracts, which cause visual impairment by covering the eye's lens, and glaucoma, characterized by increased intraocular pressure and damage to the optic nerve, are mainly related to age and lens size. Mixed case management is becoming increasingly important in ophthalmic practice.

Choosing the right surgical technique is the key to overcoming both. This decision requires consideration of long-term effectiveness, benefits, and risk of complications. One technique that has emerged is phacotrabeculectomy, but the decision to choose this surgical technique is not easy because it requires considering various factors.

Further research and a better understanding of the management of this eye disease will be crucial in improving patients' quality of life and well-being. With the prevalence of cataracts and glaucoma continuing to increase as the population ages, an emphasis on effective and sustainable management strategies will significantly impact society's overall eye health. This review will compare phacoemulsification and phacotrabeculectomy for managing primary angle-closure glaucoma with cataracts.

Link of Video Abstract: https://youtu.be/tl9Q8g6DUdc

Background: Coronary artery bypass grafting (CABG) is still one of the optimal treatment options for revascularization in coronary heart disease. Despite Atrial Fibrillation being the most common arrhythmia after CABG, there’s still no agreement on which risk assessment to predict the incidence of Post Operative Atrial Fibrillation (POAF).  Some studies have shown that the findings of Atrial fibrillation after CABG are associated with increased hemodynamic disturbances, thromboembolic manifestations, readmission to the Intensive Care Unit (ICU), increased length of stay, organ failure, and death. This study aims to analyze the scoring system used for predicting the incidence of POAF in cardiac surgery.

Methods:  This study used “POAF” AND “Scoring system," AND "CABG” AND “Atrial Fibrillation” as keywords to explore the literature from PubMed, Google Scholar, ProQuest, and Clinical Key. Search engines were searched for relevant papers from the last 15 years.

Result: CHA2DS2-VASc score has a sensitivity of 74.2%, a specificity of 44.7% and can identify patients who are predicted to have a high risk of experiencing POAF by 49.4%. The CHA2DS2-VASc score can be used as an independent predictor for predicting POAF. HATCH score cut-off point exceeding 1 was linked to AF prediction, yielding a sensitivity of 42% and specificity of 70%. POAF Score, the scoring system anticipates an increased likelihood of POAF development (58.5%). A score of 1 corresponds to a 30.1% probability of POAF occurrence and is a practical point for commencing preventive therapy.

Conclusion: Despite the various scoring systems used to predict postoperative atrial fibrillation, including the CHA2DS2-VASc score, HATCH score and Mariscalco. POAF Score demonstrated a validated ability to predict POAF.

Link of Video Abstract: https://www.youtube.com/watch?v=M4wrqsa21hw

An essential component of the ocular surface is the conjunctiva. The most common non-pigmented malignancy that can affect the conjunctiva is ocular surface squamous neoplasia (OSSN). Despite the vast investigations on this deadly organism, certain elements related to demographics, clinical traits, and recurrence remain unclear. The objective of this review was to explore OSSN in depth. OSSN is classified into several types based on its clinical morphology, such as nodular, plaque, and diffuse OSSN. Plaque types can be classified into gelatinous, leucoplakia, and papilliform. Histopathological classification of OSSN consists of benign, pre-invasive, and invasive types. The OSSN tumor stadium can be classified using the TNM criteria by the American Joint Committee on Cancer (AJCC). OSSN management can be divided into medical and surgical management based on classification and tumor stadium. Despite the advances in the treatment of OSSN, there are still variances and conflicting results in the recurrence after surgery, which certain demographic and clinical types of OSSN might cause. Further study is needed to confirm the significance of the recurrence of each demographic and clinical characteristic of each OSSN tumor.

Background: Menopause affects all parts of the women's body system, especially in the genitourinary area. The impact on the genitourinary system causes post-menopausal women to complain of menopause-related genitourinary syndrome due to vaginal atrophy, sexual dysfunction, and pelvic organ prolapse in the long term. Various research has been conducted to find alternative therapy, especially flavonoid quercetin, due to its phytoestrogen characteristic.

Methods: This review article assembles much literature to highlight the menopause effect on the vagina and the phytoestrogen effect of flavonoid quercetin as a potential alternative therapy. This study aims to develop future experimental studies of quercetin's effect on the vagina.

Results: Hypoestrogenic condition affects all vaginal layers. This is due to estrogen receptors distributed in the epithelial lining, lamina propria, and muscular layer of the vagina. In vitro studies showed quercetin induces cell proliferation by activating signal pathway b-catenin/c-Myc/cyclin A2, mediated by estrogen receptor. The signal pathway increases the cell cycle transition to the G1 phase. It also increases keratinocyte proliferation and migration, proliferating cell nuclear antigen, and positive a6 and b1 integrin cells in the basal layer of the epidermis, which causes thickening of the epidermis.

Conclusion: Flavonoid quercetin is a promising alternative for menopause therapy in the vagina. Further, in vivo studies are needed to confirm the result of in vitro study and as basic data for comparison with other potent phytoestrogen.

Link of Video Abstract: https://youtu.be/Zv9b2Zj96yk

Menopause is a physiological process as women get older. Urogenital syndrome, sexual difficulties, and pelvic organ prolapse (POP) are all common complaints among postmenopausal women, and these conditions can negatively impact their quality of life. There are still many unknowns regarding the pathophysiology and mechanisms of POP. Pelvic organ prolapse has been linked to the equilibrium of the extracellular matrix (ECM), which is controlled by matrix metalloproteinases and tissue inhibitors of metalloproteinases. Menopausal women experience a variety of symptoms due to hormonal changes, from urinary tract disturbance, vaginal atrophy, vaginal shortening, up to genital prolapse. Due to the collagen's diminished contractility, POP happens. Matrix metalloproteinase is responsible for breaking down collagen, but TIMP prevents MMP from doing its job. In women with POP caused by the breakdown of the collagen network, MMP-9 exhibits the greatest rise. In order to preserve the health of fibroblasts and collagen in postmenopausal women, increased expression of MMP-9 and decreased expression of TIMP-1 are necessary, which results in a decreased incidence of POP. The expression of MMP-9 in prolapse patients was significantly higher than control patients. In addition, TIMP-1 expression levels were significantly decreased in prolapse patients. Damage to the ECM's equilibrium is caused by increased MMP-9 expression and decreased expression of timp-1, which leads to clinical signs of pelvic organ prolapse.

Background: Spina bifida leads to unfavourable outcomes for the fetus, particularly in developing countries. This study aims to investigate the characteristics and risk factors associated with spina bifida in Surabaya, Indonesia. The findings could inform improved management strategies.

Methods: This study is a descriptive retrospective study that utilized medical records data of pregnant women with fetuses diagnosed with congenital spina bifida, who were treated in the delivery room at Dr. Soetomo General Hospital, Surabaya, from 2016 to 2021. Data on maternal characteristics, risk factors, pregnancy management, and prenatal outcomes were collected. Data was processed descriptively to calculate and display the percentage of each case.

Results: Over a span of five years, ten cases of spina bifida were identified. More than 50% of these cases occurred in multigravida pregnancies, with mothers aged 20-29 years. Seventy percent of the cases were referrals. Recorded maternal risk factors included obesity (30%) and low socio-economic status (60%). Only 30% of pregnant women received antenatal check-ups in the first trimester, and most cases were detected after 28 weeks of gestation. Only 10% of cases were associated with other syndromes. Eighty percent of the cases were born after 37 weeks of gestation. The neonates' outcomes were recorded, revealing that the majority of them were male, with 60% having open spina bifida. Ninety percent of cases were non-isolated, and 40% of them were accompanied by hydrocephalus. Only 60% of neonates underwent surgery to close the defect. Perinatal mortality was observed in 50% of cases.

Conclusion: Maternal risk factors for spina bifida included obesity and low socio-economic status. The majority of cases involved male neonates, and most were non-isolated spina bifida cases, resulting in a perinatal survival rate of 50%. Most of the cases were detected in the third trimester.

Link of Video Abstract: https://youtu.be/UfCbUNzPIRE

Background: Anterior capsular contraction syndrome (ACCS) is a disorder in which the anterior capsulectomy opening shrinks excessively. One of the many factors that have been discovered to aggravate the problem is a lack of zonular support for the lens capsule. The prognosis for non-progression of contractions after Nd:YAG anterior capsulotomy is quite excellent. This study aims to present a complete resolution of the hyperopic shift in an anterior capsular contraction syndrome (ACCS), a rare complication of cataract surgery.

Case Illustration: This case report presented a 63-year-old female who developed ACCS in the right eye two years after uncomplicated cataract surgery and intraocular lens implantation. A moderate hyperopic shift of +3.00 D was noted in the affected eye at the initial presentation. Slit-lamp examination revealed an anterior capsule opacification and anterior capsular contraction with fibrosis surrounding the capsulorhexis opening. Ocular and systemic past medical history was unremarkable, and no known risk factors associated with contraction syndrome were found. Nd:YAG laser capsulotomy with six relaxing incisions was performed to release the anterior capsular contraction. Two weeks following capsulotomy, the patient’s visual acuity remarkably improved to LogMAR 0.00 without correction. The hyperopia was completely resolved, and a decrease in anterior chamber depth compared to pre-capsulotomy measurement was noted. ACCS is a possible complication following capsulorrhexis performed in uneventful cataract surgery, which may occur in patients with no known ocular or systemic risk factors. ACCS is commonly asymptomatic, and hyperopic shift is a rare manifestation of ACCS. The backward shift of the intraocular lens (IOL) induces hyperopia due to the anterior capsule contraction. The preferred treatment for ACCS is relaxing incisions using Nd:YAG laser capsulotomy.

Conclusion: Hyperopic shift in ACCS is a rare complication of cataract surgery. However, prompt treatment of contraction release with Nd:YAG laser capsulotomy effectively restored visual function.

Background: Lipodystrophy (LD) syndromes are a diverse group of ultra-rare diseases characterized by adipose tissue deficiency, resulting in potentially severe metabolic disturbances. Due to their scarcity, diagnosis and management are often challenging for clinicians. This study aimed to report a rare case of LD syndromes, as well their diagnosis and possible management.

Case Presentation: A 27-year-old female presented to Dr. Soetomo General Academic Hospital, Surabaya, Indonesia with a chief complaint of abdominal (epigastric) pain, accompanied by diarrhea, nausea, and vomiting. The patient had a history of uncontrolled type-2 diabetes mellitus (T2DM), dyslipidemia, severe hypertriglyceridemia (HTG), diabetic retinopathy, and glaucoma. Physical examination indicated subcutaneous fat loss, especially from the extremities, and excessive fat accumulation in the face. Hepatosplenomegaly and ascites were detected, further confirmed through abdominal ultrasonography (USG). Laboratory investigations revealed hyperglycemia, dyslipidemia, severe HTG, and renal dysfunction. All of the assessment findings led to the diagnosis of LD syndrome with familial partial lipodystrophy 2 (FPLD2) (Dunnigan syndromes). Therapies included insulin injections and pioglitazone for the treatment of hyperglycemia, simvastatin and fenofibrate to reduce HTG, and some symptomatic drugs to reduce symptoms of the disease. Lifestyle modification (diet and exercise) was recommended to ameliorate metabolic derangements.

Conclusion: There is currently no cure for LD syndrome. Treatment modalities are limited to preventing or reducing severe comorbidities of these syndromes. Increasing knowledge and awareness of the symptoms indicative of LD at an early onset is important.

Background: Chiari Malformations (CM) is a collection of hindbrain abnormalities ranging from simple to complete agenesis of the cerebellum. Type III CM (CM III) is the rarest CM, with herniation of the cerebellum and brainstem into a posterior encephalocele and other intracranial anomalies. Reduction of the viable herniated brain, along with providing intracranial space and inadequate closure, often presents as the main problem. This case study aims to evaluate the Chiari malformation type III surgical management in infants.

Case Presentation: A 16-day-old male infant with an intact congenital mass in the occipital, with no neurological deficit. Radiological examination shows a defect in the occipital skull consisting of cystic non-contrast enhancing lesion and parenchymal tissue herniated through the defect.  The cele excision and defect closure were performed, and viable neural tissue was found inside the sac. Blossom flower-like trim expanded the fossa posterior space and put the viable neural tissue inside the intracranial room. The defect was then closed with a dura, periosteal patch, and tension-free two-layered scalp closure. Post-operative follow-up presented a good outcome, and 1-year follow-up showed good recovery, with developmental delay, following developmental rehabilitation.

Conclusion: CM III is rare and has poor outcomes because neurological deficits and respiratory problems usually follow it. Operative management patient with CM III was presented with occipital encephalocele with no post-operative complication. Occipital bone reconstruction using a blossomed-flower-like technique could be considered to create adequate room for viable neural tissue.

Background: Ophthalmic manifestations, like uveitis, might be one of the complications of spondyloarthritis. Many individuals experiencing acute uveitis are unaware that spondyloarthritis has already been present. The late diagnosis and treatment of uveitis can result in permanent vision impairment. This case report presents the diagnosis and management by a rheumatologist and ophthalmologist of a spondyloarthritis patient with complicated uveitis.

Case: On October 27, 2021, a 42-year-old male patient came to the rheumatology outpatient clinic of Dr. Soetomo General Hospital, Surabaya, Indonesia with intermittent low back pain for the past fourteen years, which worsened in the last eight months. The pain was accompanied by morning stiffness for about an hour after getting-up every day, gradually relieved by stretching. The lumbosacral x-ray revealed bilateral sacroiliitis. The patient also came to the ophthalmology outpatient clinic with sudden left eye pain and gradually blurred vision for the past two years. He was diagnosed with spondyloarthritis with bilateral uveitis, secondary glaucoma, and secondary cataract on both eyes. He was given methotrexate, sulfasalazine, sodium diclofenac, topical timolol 0.5%, topical atropine, acetazolamide, and methylprednisolone. The low back pain and impaired vision were improved after three months of treatment.

Conclusion: Uveitis should be suspected as a relatively common complication of spondyloarthritis. Early diagnosis and treatment of this uveitis might prevent permanent damage.

Link of Video Abstract: https://youtu.be/LZnyDExOr9w

Background: Ventricular septal defect (VSD) is the most common congenital cardiac anomaly in children and the second most common in adults. It often coexists with other cardiovascular conditions, including hypertension, coronary artery disease (CAD), and heart failure. This presents unique challenges in diagnosis and treatment.

Case Presentation: We present the case of a 46-year-old woman with a previously undiagnosed VSD complicated by a ventricular septal rupture and prior myocardial infarction. Coronary artery bypass grafting (CABG) and VSD repair were performed. Unexpectedly, the VSD turned out to be an atrial septal defect (ASD) of the muscular type. The repair was successful using mattress sutures and a 0.6mm PTFE patch. Two-coronary-artery bypass was also performed. The patient's recovery was uneventful, with no residual VSD.

Conclusions: Discovering a large, asymptomatic VSD in an elderly patient is uncommon. Simultaneous repair of VSD and CAD yields favorable surgical outcomes, highlighting the importance of thorough preoperative evaluation in such cases.

Link of Video Abstract: https://youtu.be/DWVi34rPNOg

Background: Moyamoya disease (MMD) is a non-atherosclerotic cerebrovascular disorder characterized by progressive stenosis of the distal part of the internal carotid artery (ICA), thus forming an abnormal vascular network in the base of the brain. MMD is often found in women. The common symptoms of MMD are migraine, epilepsy, recurrent transient ischemic attack (TIA), ischemic stroke, and intracerebral hemorrhage. Stroke at young onset has challenges in looking for risk factors and etiology. A detailed examination is needed to prevent recurrent strokes.

Case Presentation: Male 17-year-old complained of a throbbing headache on the right side for 5 months, with a numeric rating scale (NRS) 4. The headache duration was 24-72 hours, with a frequency of 1-2 times a month. Complaints are exacerbated by activity and improve when taking over medication. 2 months after the first onset, he felt severe headache with NRS 7, accompanied by weakness and tingling on the left side. All his laboratory results were within normal limits. Cerebral Digital Subtraction Angiography (DSA) results showed severe stenosis at the base of the right ICA bifurcation segment accompanied by slow flow at the right middle cerebral artery (MCA) and severe stenosis at the base of the left ICA accompanied by cross-filling to the contralateral anterior cerebral artery (ACA). Cortico-cortical collaterals were obtained from the posterior cerebral artery (PCA) branch covering the MCA area. The patient was diagnosed with MMD.

Conclusion: MMD is a rare cerebrovascular disease that can be a risk factor for stroke at a young age. Diagnosis and evaluation of the collateral system need to be carried out through cerebral angiography so that the selection and consideration of appropriate management of recurrent stroke attacks can be carried out.

Link of Video Abstract: https://youtu.be/WQnJQwwYcHc

Introduction: After liver resection, pancreatitis is a well-known yet uncommon consequence. The actual cause is unclear, and the postoperative condition may mask the clinical symptoms. When a patient unexpectedly worsens after surgery, postoperative pancreatitis should always be taken into consideration due to its high fatality risk. After liver resection, we present our patient with acute pancreatitis. The paper was written using certain hypotheses. First, the surgeon should be aware of the possibility of pancreatitis following liver surgery, which is not included in the literature as a side effect of liver surgery. The second step is to increase our knowledge and develop measures to reduce the risk of acute pancreatitis following liver surgery.

Case Description: We present here a case of acute pancreatitis following liver resection surgery from our institution, and we strongly suspect that the results of our postoperative white bile leak test contributed to this. According to the literature analysis, this test is risk-free and won't have a materially detrimental impact on the patient. Keep in mind the white test rule, which suggested things like focus and spooling following the test.

Conclusion: The white test is effective for identifying bile leakage following liver resection, however, we do not advise frequent use of this test since there is a chance that it can trigger acute pancreatitis, which can have a substantial negative impact on the patient's morbidity or death. The precise process is still a mystery and will require further experimental research.

Link of Video Abstract: https://youtu.be/XIJo_o_yeV0

Background: Obesity is defined as being 20% ​​or more above ideal body weight (IBW). Obesity is a major problem in children and adolescents, affecting 30% or more. It led to many changes and limited their ability to be physically active. Obese children often suffer from musculoskeletal pain, decreased physical function, and a sense of well-being. This might cause poor motor competency and also developmental alteration.

Case Presentation: A 14-year-old boy was referred to the Pediatric Department following complaints of excruciating pain in his lower leg. Under anthropometry examination, the patient was diagnosed with obesity with 115 kg at presentation. The patient was then treated and managed by changing their inactive lifestyle and increasing daily activities; also referred to a psychologist to help with psychological well-being and behavior change. Family and friends are involved during treatment. After four months of treatment, his body weight dropped from 115 kg to 98 kg to 73 kg in the next 2 years.

Conclusion: Success obesity management needs multidisciplinary involvement, which includes a pediatrician, nutritionist, psychologist, and also the patient's family

Link of Video Abstract: https://youtu.be/qD-dDYr0m2U

Introduction: Coronary artery fistula (CAF) transcatheter coil embolization is very effective in treating symptomatic coronary fistula and has many advantages compared to the surgical approach. Although this procedure is considerably safe, some life-threatening complications, including vessel rupture, coil migration and death, could still happen. We reported an example case of coil migration into the left anterior descending (LAD) artery during transcatheter CAF embolization.

Case Description: A 61-year-old man reported recurrent episodes of typical chest pain and a history of inconclusive exercise tests. Computed tomography (CT) angiography revealed a considerable medium size complex coronary fistula from proximal LAD to main pulmonary artery (MPA), which could cause coronary steal syndrome. The patient then underwent CAF transcatheter coil embolization with 3 pushable coils. Upon delivery of the last coil, the coil suddenly migrated into proximal LAD and made the patient feel chest pain with slight ST depression on electrocardiogram (ECG) monitor lead. This coil migration was treated with a coronary stent to pin the coil into the ostial CAF and coronary vessel wall. After the procedure, the chest pain disappeared, and the ST segment on ECG resolved back to baseline.

Conclusion: Coil migration is one of the potentially life-threatening complications during transcatheter CAF coil embolization. Careful preparation in choosing the closure technique, selecting coil size, determining the landing zone and using a detachable coil in high-risk CAF anatomy is mandatory to prevent this event.

Background: Epilepsy is a recurrent seizure without a trigger. Epilepsy is a chronic disease that is often found in children. Valproic acid is an Anti-Epileptic Drug (AED) often given to children. The effect of valproic acid administration on speech delay has rarely been reported. This case study aims to evaluate the effect of administering valproic acid on epilepsy and speech delay in children

Case Description: A 3-year-old girl was referred to Dr. Soetomo Hospital with epilepsy and speech delay. The patient had recurrent unprovoked seizures since the age of 2 years. She had received valproic acid therapy at the previous hospital and was seizure-free for 5 months before being referred to DSH. The girl can speak in one word but lacks two-word meaningful phrases. There was no perinatal history or previous serious illness. Physical examination was within normal limits. The Denver II examination result was suspect because she failed in speech and language. Her hearing test was normal. Valproic acid was then replaced with phenytoin. In follow-up 7 months after the AED was changed to phenytoin, the patient could string words and speak in sentences. A repeat Denver exam reveals normal speech and language aspects.

Conclusion: Giving valproic acid to patients with epilepsy may trigger speech delay in children.

Dear Colleagues,

It was a true honor that we accept colleagues at the Annual Scientific Meeting of PAMKI in Conjunction with The 3rd Global health and Innovation Conference 2023 that was held on West Lombok, Indonesia on July 7-8th 2023.

The theme of this conference was "Combating Antimicrobial Resistance: Strengthening Collaboration and Nurturing Innovation". The event is expected to update and improve the knowledge in microbiology, particularly about antimicrobial resistance. This conference also contributed for the venue of reunion and brainstorming sessions with peers in arms. 

The proceeding article contains articles that were accepted for publication to Bali Medical Journal (BMJ).

Finally, we would like to thank the committee, reviewer, and another scientific team who dedicating to finalized this proceeding article. We hope to be able to meet with all of you soon on the next event.

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