Introduction: Preeclampsia is an important problem in obstetrics because it is a pregnancy complication often found and results in high morbidity and mortality in both mother and baby. Preeclampsia is one of the complications of pregnancy that needs to be detected or monitored for symptoms, because in addition to being risky for the mother, it will also have an impact on the occurrence of preterm birth and even further impact, namely fetal death in the womb. This study aimed to determine the effectiveness of CRP and leukocyte examination to detect preeclampsia.

Method: This research was conducted at the Jagir Health Center Surabaya in March-July 2022. The research used case control with 30 pregnant women as samples divided into 15 as a control group of normal pregnant women and 15 pregnant women with preeclampsia.

Result: The results showed that of the 15 respondents who had preeclampsia more than half (60%) had high leukocyte and CRP levels, the remaining less than half (40%) had normal CRP and leukocyte levels. While in the control group more than half (67%) had normal CRP and leukocyte levels and less than half (33%) had normal CRP and leukocyte levels. The results of data analysis showed p value 0.001 (<0.005), which means there is a relationship between the CRP and leukocytes on the incidence of preeclampsia.

Conclusion: Examination of CRP levels and leukocyte count proved effective for detecting the incidence of preeclampsia in pregnant women. It is expected that pregnant women carry out routine pregnancy checks and health workers are expected to routinely carry out early detection to prevent pregnancy complications such as preeclampsia

Introduction: Communication between parents and health professionals in children about assessing and managing their children's pain with both oral and written instructions still needs to be improved. Children with a relationship with a parent or caregiver may be easier to assess and benefit from non-pharmacological treatment. This study aimed to evaluate the development of non-pharmacological pain management (behavioral intervention) model based on family-centered empowerment in toddlers with invasive procedures.

Methods: This study design is an explanation survey with cross sectional approach. The sample consisted of 115 mothers with toddler-age children subjected to invasive prosedures in Rumah Sakit Islam Surabaya using purposive sampling. The data was analyzed using SmartPLS.

Results: Non-pharmacological pain management model based on family-centered empowerment was formed from the mother factor, nurse factor, filial values, and appraisal. The greatest effect was on the filial values factor, with the T statistic value = 2.777.

Conclusions: Nonpharmacological pain management (behavioral intervention) is formed by the mother factor, nurse factor, filial values, and appraisal, where filial values are the most influential. Therefore, in conducting pain nursing care in the nurse's room, paying attention to the four factors above is necessary to improve the quality of care services, especially in comfort for toddler children who undergo invasive actions.

Backgound: Dengue vector control using chemical insecticides for a long time on the same target encourages the rapid development of a resistant dengue vector population of Aedes aegypti. Therefore, an alternative method is needed in the form of the use of plant-based insecticides, Lansium domesticum or duku has been proven to contain secondary metabolites that have the potential as insecticides. This study was conducted to measure the activity of enzyme esterase and glutathione S-transferase, as well as to observe the concentration of inorganic substances such as Fe, Mg, Na, and K in Ae. aegypti larvae exposed to L. domesticum extract using methanol as the solvent and fractionation using hexane, butanol, and ethyl acetate as the solvents.

Methods: This study used Ae. aegypti larvae and L. domesticum leaves extract and fraction. Esterase activity was measured using a spectrophotometer at λ = 490 nm and obtained as light absorption per minute per mg protein. GST activity was measured using a spectrophotometer at λ = 340 nm and expressed as light absorption per minute per mg protein. Inorganic substance level was evaluated by the absorbance of the atoms using an atomic absorption spectrophotometer which was analyzed at certain wavelengths of each atom according to Beer's law equation

Results: The results showed LD50 and LD90 of the crude extract of L. domesticum were 2200ppm and 3200ppm after 24 hours of observation. Crude extract and the fraction of L. domesticum leaf influenced the development of Ae. Aegypti. It reduced the activity of the esterase enzyme. Meanwhile, it increased the GST enzyme activity of Ae. aegypti larvae as well as affects the levels of inorganic substances in Ae. aegypti larvae.

Conclusion: Thus, L. domesticum as a plant-based insecticide is an alternative to control the vector whose target is more selective and safe.

Background: The loss of the uterus means the loss of one of the functions of a woman's life, namely the reproductive function. The impact of a hysterectomy will have a major influence on the quality of life; this can be seen in how to carry out life, such as activities, social relations and interactions with the environment. All of these things can lead to changes in daily behavior, namely changes in self-image that will lead to insecurity, withdrawn behavior, distrust of God and ultimately, self-injury behavior. This study analyzes the self-acceptance model's effect on maintaining the quality of life after a hysterectomy.

Methods: This type of research is an experiment to compare 2 design groups. This research was conducted for 4 weeks in May-June 2022, with a total sample of 12 respondents, with details of 6 respondents in the control group and 6 in the treatment group. The type of sampling used is non-probability sampling with a purposive sampling method. Data analysis used the Wilcoxon, and Mann Whitney marked rank test with a significance value of p < 0.05. The questionnaire used in this study was designed using a reference and behavioral theory approach with a reliability of 0.89 and a validity test that obtained a Cronbach alpha value of 0.86.

Results: The value of behavior of caring for sexual function after hysterectomy before intervention in the control group was 29.00±1.789, and after being given the intervention, the value changed to 29.33±0.816 (p=0.564). In the treatment group, the value of behavior of caring for sexual function after hysterectomy before the intervention was 28.50±1.225 and after the intervention was 33.83±2.639 (p=0.027). Behavioral analysis of caring for sexual function after hysterectomy before intervention in the control and treatment groups showed no difference (p=0.591). The self-acceptance model affects the behavior of maintaining the quality of life after hysterectomy in the control and treatment groups (p=0.006).

Conclusion: This study proves that the self-acceptance model affects the behavior of maintaining the quality of life after a hysterectomy.

Introduction: Seborrheic keratosis (SK) is a benign tumor of the epidermis, its development is associated with various hypotheses, but none came out as the main culprit. A few study results regarding the oxidative stress strongly associated with skin tumors have been reported. Superoxide dismutase (SOD) is a potent protective enzymatic antioxidant. Malondialdehyde (MDA) is the end product of lipid peroxidation produced by free radicals in the body. Increased levels of MDA usually accompany low levels of antioxidants.

Methods: This study was an observational analytic study with a cross-sectional method involving 42 seborrheic keratosis subjects based on inclusion and exclusion criteria. We recorded the gender, age, family history, and occupation of the subjects. Diagnosis of seborrheic keratosis was made based on history taking and clinical examination—measurement of SOD level by ELISA method and MDA levels by TBARS method. The Spearman correlation test was measured and was considered significant if the p-value was <0.05.

Results: Seborrheic keratosis was more common in females (92.9%), with the most common age group being 40 ̶ 50 years old (57.1%), had a family history of SK (26.2%), and worked in agriculture, forestry, and fisheries (26.2%). The average blood plasma SOD level was 1.68 mmol/L, and the blood plasma MDA level was 181.19 U/L. The correlation coefficient between blood plasma SOD levels and blood plasma MDA levels was -0.393, with a significant value of p=0.01. This study showed that the lower the SOD level, the higher the MDA level in the blood plasma of seborrheic keratosis.

Conclusion: There is a significant correlation between SOD and MDA levels in the blood plasma of seborrheic keratosis subjects.

Background: With 1 in 10 women receiving a new cancer diagnosis each year, breast cancer is the most frequent cancer among women. Luminal B breast cancer incidence rates are rising in non-Hispanic white women aged 55 to 69 in Asia/Pacific and Indonesia subtype across all age groups. In Bali, Luminal B is the most prevalent subtype with the greatest fatality rate. This study aims to prove the survival analysis of Luminal B subtype breast cancer patients based on lymphovascular invasion (LVI), tumor-infiltrating lymphocyte (TIL), and mammaglobin A expression.

Methods: This study is a survival analysis using nested and prospective cohort methods. Retrospective data were taken from the Cancer Registry and Medical Records (MR) of patients in Sanglah General Hospital, mammaglobin results (Paraffin block test) on anatomical pathology analysis. Statistical Kaplan Meier and Cox Proportional hazard calculations performed with the SPSS program were significant (p<0.05).

Results: The number of research subjects was 60, with 32 subjects dying and 28 still alive until the data collection was completed. There was no difference in age between the two groups. The mean of all ages is 50.12 ± 9.93 years. Positive LVI has 9 months median survival (95% CI 8-10) with p= 0.013 risk 2,797 times. TIL high (positive 2- positive 3) median survival 8 months (95% CI 6.3-9.7) with p=0.003 and risk 3,151 times. Strong expression of mammaglobin A (3-4) had a median survival of 12 months (95% CI 4.4-19.5 months; p=0.015) and risk 3.34 times.

Conclusion: LVI, TIL, and mammaglobin A expression significantly affected poor survival in the breast cancer Luminal B subtype.

Link of Video Abstract: https://youtu.be/Qw5E3Le-WJk

Background: Alkaline trauma of cornea often causes irreversible vision loss, even though it is quickly treated. The effectiveness of anti-inflammatory therapy as a main treatment is still limited clinically, as well as has dangerous side effects. Platelet-rich fibrin (PRF) is quite safe and effective in the treatment of descemetocele and also important in wound healing process. PRF membrane also provides a mechanical function as a framework for cell proliferation, differentiation and migration which is important for tissue regeneration. This study aimed to analyse the effectiveness of PRF grafts on expression of interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) in cornea post NaOH exposure.

Methods: An experimental study was conducted on Oryctolagus cuniculus which was exposed to 1 N NAOH for 30 seconds. The study subjects were 14 rabbits consisting of 7 PRF graft rabbits and 7 control rabbits. The rabbit's right eye was then irrigated, dripped with 1% levofloxacin 1 drop and a PRF graft was placed.

The effectiveness of PRF graft was analysed by percentage of expression of IL-1 and TNF-α in cornea post NaOH exposure

Results: No significant differences were found in expression of IL-1 (p>0.05) and expression of TNF-α (p>0.05) in cornea post NaOH exposure. There was a decrease in the expression of IL-1 between control and PRF graft groups. The combination of the mechanical and chemotactic functions of PRF membranes makes them suitable as an autologous biomaterial for reconstruction, repair, and maintenance of ocular surfaces.

Conclusion: PRF plays a significant role in wound healing and preventing excessive fibrosis, therefore it has the enormous potential to reduce the expression of IL-1 in corneal alkaline damage.

Introduction: The large number of TB cases was  caused by the boredom of treatment for too long, the lack of knowledge of patients about pulmonary TB, the distance between the patient's home and public health services. The purpose was to analyze effect interventions of self-management education based on the health belief model on adherence medications and visiting compliance in pulmonary tuberculosis patients at Community health center Pamekasan Regency.

Method: This research is conducted using a quantitative approach, type of intervention research. Participants in this study were the >20 year old age group. This study has certain characteristics on the selection of subjects; therefore use purposive sampling techniques. Intervention Researchers gave treatment self-management education based on a health belief model. The collected data is then analyzed using a statistical test independent T-test with the level of significance α = 0,05.

Result: The average difference in drug administration adherence in the intervention group was 17.89 with a standard deviation of 9,650. The control group showed a difference in drug adherence value of 5.23 and a standard deviation of 3,456. The average difference in visiting compliance in the intervention group was 15.37 with a standard deviation of 6,130. In the control group it showed a visiting compliance difference value of 5.76 and a standard deviation of 4,162.

Conclusion: There was an influence of self-management education based on health belief model on increasing adherence to taking medications and increasing visiting compliance in tuberculosis patients at community health centers in Pamekasan Regency, East Java, Indonesia

Link of Video Abstract: https://youtu.be/mYpKu0PcJrM

Background: Colorectal cancer remains as the major problem worldwide. Numerous studies have investigated factors associated with mortality and recurrence rates in colorectal cancer. To facilitate the everyday use of mortality predictors, they should be incorporated into a prognostic scoring system. This study aimed to identify factors affecting mortality in resectable colorectal cancer patients after surgery and to develop a prognostic scoring system capable of predicting mortality in these patients.

Methods: This retrospective cohort study involved colorectal cancer patients at Cipto Mangunkusumo Hospital, Indonesia, from January 2016 – April 2020 diagnosed with resectable colorectal cancer. Data were collected from medical records, operation reports, histopathology reports, and laboratory test results. Mortality was assessed three years after curative surgery.

Result: A total of 214 resectable colorectal cancer patients were included in the study. Tumor size ≥ 5 cm, T3/T4 staging, absence of adjuvant chemotherapy, unachieved free circumferential margin, and CEA levels > 11.4 ng/mL were significantly associated with increased three-year mortality. The constructed three-year mortality prognostic scoring system was able to predict outcomes with a sensitivity of 91.3% and a specificity of 67.6%.

Conclusion: The prognostic scoring system, consisting of five variables, is significantly capable of predicting three-year mortality rates with high sensitivity

Link of Video Abstract: https://youtu.be/Nr9MKgu2v2E

Background: Chronic suppurative otitis media (CSOM) causes partial or complete damage to the tympanic membrane and ossicles, causing hearing loss in the form of conductive and mixed hearing loss with a decrease of up to 60 dB. This study aimed to evaluate the hearing threshold before and after tympanoplasty surgery in CSOM patients.

Methods: This type of research was carried out in a retrospective descriptive manner. The materials in this study were the medical records of CSOM patients who underwent canal wall up (CWU) tympanoplasty and canal wall down (CWD) tympanoplasty at the outpatients of ear, nose, and throat – head and neck surgery (ENT-HNS) Otology Division Dr. Soetomo Hospital Surabaya for the period January 1, 2018 to December 31, 2018 with a total of 51 patients. This study analyzed with the Wilcoxon test.

Results: The mean age was 30.96 years (51% female and 49% male). Postoperatively 40 (78.5%) patients experienced an increase in hearing threshold, 10 (19.6%) patients experienced a decrease and 1 (1.9%) patient remained. The average increase in air-bone gap (ABG) pre and post tympanoplasty surgery was 9.78 dB, from 38.92 dB to 29.14 dB.

Conclusion: There was an increase in hearing threshold after tympanoplasty.

Link of Video Abstract: https://youtu.be/ZNusQRjFEH0

Introduction: Several methods have been explored to increase the effectiveness of prostate-specific antigen (PSA) for prostate cancer screening. A lower prostate-specific antigen-age volume (PSA-AV) score is associated with higher cancer risk. This study aimed to evaluate the value of PSA-AV scores in the detection of prostate cancer among the Indonesian population.

Methods: A retrospective study was conducted on 844 prostate biopsies performed at our center between January 2015 and December 2019. The score of PSA-AV was derived by multiplication of the patient's age and prostate volume and then division with PSA level. A ROC curve analysis was conducted to determine the cutoff for the PSA-AV score. The sensitivities and specificities of the PSA-AV score were contrasted with total PSA, PSA density, and age-adjusted PSA.

Results: The mean age of the patient was 63.63±8.6 years, with a mean PSA of 16.3±13.9 ng/mL and a mean volume of 42.7±16.0 cm³. Among 844 biopsies, 25.5% tested positive for prostate cancer. Prostate cancer patients had significantly higher mean age, PSA levels, and positive digital rectal examinations (P<0.05). In predicting prostate cancer, the PSA-AV score demonstrated a higher AUC of 0.772, surpassing the AUC of 0.762 achieved by the total PSA. The analysis identified a cutoff of 700 for the PSA-AV score, which showed significant sensitivity (94%) and sufficient specificity (8.4%). These values outperformed the total PSA cutoff of 4 ng/mL (sensitivity 91.6%; specificity 5.4%), PSA density cutoff of 0.15 (sensitivity 85.1%; specificity 30.0%), and age-adjusted PSA cutoff (sensitivity 88.4%; specificity 11.8%). The superiority of the PSA-AV score of <700 was more prominent in the subgroup analysis of patients below 70 years of age and those with a low-moderate prostate volume (<60 cm³).

Conclusions: The PSA-AV score demonstrated superior sensitivities and specificities compared to total PSA, PSA density, and age-adjusted PSA. Therefore, it is recommended to utilize a PSA-AV score of <700, particularly for men below 70 years of age with low-moderate prostate volumes (< 60 cm³).

Link of Video Abstract: https://youtu.be/u6GkzKfCplE

Background: Psychological changes such as body image are important factors that need to be considered to boost the positive sense of self-acceptance in stroke patients with hemiparesis. One measure that can be taken to minimize the incidence of disability, both physically or psychologically, in stroke patients is mirror therapy (mirror therapy combined with flashcards). This study aims to determine whether mirror therapy combined with flashcards can improve the upper limb muscle strength function and the stages of self-acceptance of stroke patients with hemiparesis.

Methods: This study was quantitative, with an experimental research design. The design used was a quasi-experiment with a pre-test-posttest control group design involving 60 respondents with consecutive sampling techniques for 5 months in the Nusa Indah Ward of the Dr. Doris Sylvanus Palangkaraya General Hospital. Upper extremity/arm muscle strength was measured using the muscle strength scale from the Medical Research Council, while self-acceptance stages were measured using a stage questionnaire adapted from Kubler Ross. Data were analyzed using SPSS version 20.0 for Windows.

Results: Our results showed there was a significant increase in the mean value of muscle strength and self-acceptance stages of the treatment group from the control group (p<0.05). The results of the Mancova test showed that gender affects the intervention given (p<0.05).

Conclusion: Our study provided information for nurses in nursing care to stroke patients with hemiparesis on the upper arm and motivation to improve the patient's self-acceptance stages.

Purpose: The National Health Insurance (JKN) implemented by the Indonesian government since 2014 has brought Indonesia to a new phase in realizing the right to health for its people. The social insurance system managed by Social Health Insurance Administration Body (BPJS) is felt to bring many benefits to the community despite many obstacles in its implementation. This study seeks to find the ethical dilemmas experienced by surgical and non-surgical specialists in implementing the JKN program in hospitals.

Methods: The study was conducted using the qualitative method with the phenomenological approach by conducting in-depth interviews with five surgical specialists (an obstetric and gynecology, an otolaryngologist specialist, a surgeon, an eye specialist, and an anaesthesiologist) and six non-surgical specialists (children, mental health, internal medicine, medical rehabilitation, nerves, and skin specialists) in Semarang, Indonesia. In each specialization, there are two respondents interviewed. The data were analyzed using a qualitative approach.

Results: Some problems still exist when specialist doctors treat BPJS patients in hospitals, which include: 1) lack of socialization, making doctors as implementers find it difficult to implement the rules; 2) different implementations in various hospitals, making doctors find it difficult to adjust when they practice at type C hospitals because the number of claims is often insufficient to provide services to patients; 3) the JKN program that has increased the number of patients, resulting in doctors' concerns about lawsuits if they make mistakes; moreover, doctors also have to adjust to existing cost claims; and 4) doctors still trying to uphold the doctor's oath and The Indonesian Medical Ethics Code (KODEKI) and always do the best for patients whatever the problem. Conclusion: The implementation of JKN must always be evaluated continuously, and the government still has to pay attention to the obstacles faced by doctors in the field. In carrying out their practice full of dilemmas, doctors must always receive adequate legal and ethical protection.

Link of Video Abstract: https://youtu.be/9chL7pTn3bA

Backgrounds: Liver injury induced by antituberculosis drugs showed high proportions in many countries and might result in serious effects. Previous studies had proved the increase of reactive oxygen species formation and induction of apoptosis related to antituberculosis treatment. There has been no standard therapy for protecting the liver from damage related to antituberculosis. Purple sweet potato extract is one of natural sources that possess hepatoprotector action regarding its antioxidant activity. This research aimed to prove the action of purple sweet potato ethanol extract on apoptosis related to liver injury caused by antituberculosis.

Method: This research was an experimental study with randomized post-test only control group design. The samples were male rats (Rattus norvegicus) strain Wistar, age 8-12 weeks, weight 150-200 grams (divided into two groups: control and experimental group). Purple sweet potato ethanol extract was prepared with maceration technique. The measurement of bcl-2 and caspase-3 expression was conducted with ELISA method. Data analysis was performed using independent t-test.

Results: Our study result revealed that the liver expression of bcl-2 in treatment group was significantly higher than control group (15.83 ± 3.14 vs. 12.11 ± 1.53), whereas the liver expression of caspase-3 in treatment group was significantly lower than control group (1.96 ± 0.38 vs. 2.41 ± 0.30; p < 0.05).

Conclusion: Purple sweet potato extract potentially protects the liver from apoptosis induced by antituberculosis.

Background: Traumatic brain injury (TBI) is damage to the head caused by an external physical attack/impact. Deaths that occur from brain injury are 14-30 out of 100,000 population each year. TBI is diagnosed using Computed Tomography (CT) as the gold standard. Different densities of the pathological feature on CT can be measured by Hounsfield Unit (HU) to define its pathology. We try to asses if the HU can predict the hematoma expansion in TBI.

Methods: This research is an observational study. The data is taken from the radiology installation data of the emergency care installation at the Dr. Soetomo Regional General Hospital regarding factors that play a role in hematoma expansion with related factors in patients with subdural and epidural bleeding. Data were taken from January 2021 to December 2021. The factors analyzed were Hounsfield Unit, age, and hemostasis factors.

Results: In this study, there were 30 patients. This study was dominated by men (73.00%) and the age group of 16-20 years (26.6%). The mean PTT value in this study's subjects was 13.3±3.27. The mean value of APTT is 29.8±2.82. The average Hounsfield Unit is 43.60±5.82. No significant relationship was found between Houndsfield Unit, Age, APTT level, and age with hematoma expansion. A significant relationship was found between PTT and hematoma expansion. Simultaneously Hounsfield Unit, PTT, APTT, and age had a significant relationship with hematoma expansion.

Conclusion: There was no statistically significant relationship between Hounsfield Unit and hematoma expansion. There is a statistically significant relationship between PTT and hematoma expansion. Simultaneously found a significant relationship between Hounsfield Unit, PTT, APTT, age, and bleeding activity.

Link of Video Abstract: https://youtu.be/QSRsiXuo-EU

Background: Fractures are a common cause in the present, where the main cause is trauma/injury. The ideal current fracture treatment is orthopedic surgery in the hospital, sometimes with bones that are not completely fused (non-union) or delayed union. This study aimed to determine the risk factor associated with the incidence of the non-union and delayed union in patients operated at Siloam General Hospital, Kupang, Indonesia.

Method: An observational retrospective study with a case-control design was conducted from January 2020 to June 2021 in Siloam Kupang Hospital, East Nusa Tenggara. The case involved patients experiencing non-union or delayed union complications, while the control involved fractured patients without both complications. Data were extracted from Electronic Medical Records (EMR) and then were analyzed by χ² Cramer's V. The p<0.05 was significant.

Result: The study results found a relationship between smoking (p=0.000), open fracture (p=0.001), infections (p=0.000), time intervals between events and surgeries (p=0.000), high energy injury mechanisms (p=0.021), and crush injury (p=0.000) with non-union or delayed union events in fracture patients at Siloam Hospital Kupang.

Conclusion: The non-union and delayed union complications in fractured patients were related to smoking habits, open fracture, local infections, time intervals between events and surgeries, high energy injury mechanism, and crush injury.

Introduction: Preeclampsia is one of the most common medical problems during pregnancy and is the leading cause of maternal death worldwide. Through professional antenatal care services, increasing knowledge and behavior in pregnancy care is expected to be able to prevent the occurrence of preeclampsia. The interaction of the client nurse with the self-hypnosis approach will increase the mother's abilities. This study aimed to analyze pregnant women's characteristics influencing nurses' interaction with a self-hypnosis approach in the prevention of preeclampsia.

Methods: This is a cross-sectional study with 260 pregnant women who were taken using purposive sampling as the sample. The data analysis uses using chi-square test, and the result is considered significant if p < 0.05.

Results: At the induction stage, there were significant results on the characteristics of pregnant women with hypertension (p = 0.036) and the characteristics of pregnant women based on education (p = 0.019). At the suggestion stage, significant results were obtained on the characteristics of pregnant women with a hereditary history of preeclampsia (p = 0.023) and maternal characteristics based on knowledge (p<0.001). At the termination stage, significant results were obtained on the characteristics of the mother with a hereditary history of preeclampsia (p = 0.037) and the characteristics of the mother based on knowledge (p<0.001).

Conclusions: The mother's characteristics that affect the nurse's interaction with the self-hypnosis approach are hypertension history, hereditary history of hypertension, and the mother's knowledge about the prevention of preeclampsia.

Introduction: Sexual needs are very important for domestic harmony. The incidence of pain during sexual intercourse often occurs in postpartum mothers, which causes concern and fear of mothers doing these activities. One of the efforts to reduce the pain is lavender aromatherapy. This study aimed to analyze the effect of lavender aromatherapy on the incidence of dyspareunia in postpartum mothers.

Methods: The research design, which takes the form of a nonequivalent control group design, is quasi-experimental. Aromatherapy with lavender is the independent variable, and dyspareunia is the dependent variable. In Wonokromo Village, Surabaya, 102 respondents with accidental sampling for 3 months made up the population of postpartum mothers in 2022. The survey served as the research tool. The Spearman's test was used to assess the data.

Results: The majority of mothers who did not use lavender aromatherapy (55.9%) experienced severe dyspareunia, almost half of the mothers who used lavender aromatherapy (41.2%) experienced moderate dyspareunia, and mothers who always used lavender aromatherapy almost half (44.1%) had mild dyspareunia. There is a significant effect of lavender aromatherapy on the incidence of dyspareunia in postpartum mothers (p = 0.001).

Conclusions: The more mothers do not use lavender aromatherapy before having sex, the more severe the incidence of dyspareunia or pain during sexual intercourse.

Background: Peripheral arterial disease (PAD) is an important consequence of atherosclerosis commonly determined based on the results of ankle-brachial index (ABI) measurements. Due to its limitations, the search for potential predictors of PAD severity is ongoing. Serum soluble Lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) levels and LOX-1 polymorphism rs1050283 are candidates for predictors of PAD severity. This study aimed to investigate the association between the LOX-1 rs1050283 TT genotype and the severity of PAD.

Methods: This cross-sectional study involved PAD patients recruited consecutively. The patients were genotyped for rs1050283 (3’ UTR C>T) LOX-1 single nucleotide polymorphism using the sequencing method. Serum sLOX-1 levels were measured using ELISA. Data on ABI were collected, and the patients were categorized into mild and moderate to severe PAD groups.

Results: A total of 66 PAD patients with a mean age of 58.9 years participated in this study, which consisted of 45 patients with mild PAD and 21 patients with moderate to severe PAD. Multivariate logistic regression analysis showed that the TT genotype was associated with PAD severity compared to those with the CC genotype (odds ratio (OR): 15.0, 95% confidence intervals (CI): 1.1 – 209.0), while higher serum sLOX-1 levels were not. PAD severity was also associated with increasing age (OR: 5.7, 95% CI: 1.3 – 25.7) and male gender (OR: 6.0, 95% CI: 1.1 – 32.2).

Conclusion: TT genotype of LOX-1 rs1050283 polymorphism was associated with PAD severity, whereas higher serum sLOX-1 levels were not. In addition, increasing age and male gender were also associated with PAD severity.

Link of Video Abstract: https://youtu.be/5LTsY60dY0s

Background: Myopia is one of the numerous visual problems that continue to increase in incidence throughout the world. Various genetic and environmental factors are thought to influence the onset of myopia. Myopia is known to have a significant impact on the economy, vision problems, and a decrease in quality of life so that it needs serious attention. This study aims to explore the relationship between parental risk factors with degree severity of myopia.

Methods: This study is an analytic observational study research design. The population of this study are patients diagnosed with myopia in the Ophthalmology Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Patients who met the inclusion and exclusion criteria were included as samples. Data are gathered through medical records and by questionnaire, this includes age and spherical equivalent (SE) in right eye or left eye. Degree of severity was classified based on SE. Myopia’s degree of severity and parental history are then analyzed to determine the relationship.

Results: A total 72 patients were included in this study. The majority of participants have a familial history of parental myopia. The degree of severity with the highest frequency is low myopia. The results of statistical tests showed that there was no relationship between history of parental myopia and the severity of myopia in the right eye (RE) (p-value = 0.712) and the severity of myopia in the left eye (LE) (p-value = 0.565).

Conclusion: There was no relationship between the history of parental myopia and the severity of myopia.

Introduction: Many virulence factors of Pseudomonas aeruginosa PAO1 are regulated by temperature and host conditions upon infection. Based on microarray data, the PA3235 gene is one of the upregulated genes during cell growth at 37 °C. Until now, no information about its role in PAO1 pathogenicity.

Methods: The PAO1∆PA3235 strain was constructed by overlapping polymerase chain reaction (PCR) method and through biparental mating. The deletion was confirmed by PCR and restriction analyses. The virulence factors of both P. aeruginosa PAO1 wild type and ∆PA3235 mutant strains were examined, which consisted of the amount of pyocyanin and pyoverdine, swarming, swimming, and twitching motility, biofilm formation, 3-oxo-dodecanoyl-homoserine lactone concentration, and growth curve profile. Data were analyzed using Student’s t-tests to determine differences between treatments. P-value < 0.05 were considered significant.

Results: The ∆PA3235 strain was successfully constructed. At 37 ºC, the mutant produced less pyocyanin (p-value 0.0004), pyoverdine (p-value 0.0009), and swarm area than the wild-type. The dendrites pattern of both strains was similar. The mutant and parental strains showed no differences in swimming and twitching motility when incubated at 22 ºC and 37 ºC. The mutant produced more biofilm compared to the wild-type strain (p-value 0.0013). The AHL was higher in the mutant than in wild type strain (p-value 0.0095) after 24 h incubation. Both the wild type and mutant strains exhibited similar growth patterns in LB broth. The mutant colonies also showed the same morphology as the wild type on the LB plate (not shown here).

Conclusion: The deletion of the PA3235 gene from the Pseudomonas aeruginosa genome caused some changes in virulence factors production, as the bacterium grew at body temperature 37°C. We predicted that the PA3235 gene might function to transport molecules involved in the early infection of this bacterium to humans.

Introduction: The COVID-19 pandemic has not only had an impact on health problems, but also brought many changes in other aspects of human life, including the education sector. Difficulty in adapting with the learning process can affect the mental health, especially medical students who are quite susceptible to depression and anxiety. We aimed to aims to provide an overview of mental health problems in medical students during the COVID-19 pandemic.

Method: The method used was an online cross-sectional survey using student characteristics instruments, the GAD-7 and PHQ-2 questionnaires. Respondents were 7949 medical students from 49 medical faculties in Indonesia from February to May 2021. All data were analyzed by univariate and bivariate statistics to see the relationship between several variables using SPSS version 22.0.

Results: The majority of respondents were women (69.4%) with an average age of 20.9±2.1 years and domiciled in Java (63.4%). The survey was joined by students from all years of education and the most followed by students in the second year (20.3%). Based on the GAD-7 questionnaire, 3471 respondents (43.7%) experienced symptoms of anxiety (mild, moderate, severe) and the most experienced mild anxiety (29.8%), while from the PHQ-2 questionnaire it was found that 1332 respondents (16.8%) experienced symptoms of depression. Analysis of the mean GAD-7 and PHQ-2 on several factors (gender, year of education, education phase, and place of domicile showed a significant relationship (p<0.05), except for the PHQ-2 score which was not significant for place of domicile (p=0.06).

Conclusion: The results of this survey describe the mental health conditions of medical students in Indonesia during the pandemic. This study emphasizes the importance of early detection, support, and mental health services to improve the ability and resilience of medical students in dealing with various changes during the COVID-19 pandemic.

Introduction: Adolescents suffer from various forms of psychosocial, behavioral, mental and emotional problems. The relationship between salivary cortisol levels and the risk of behavioral-psychosocial-emotional disorders in adolescents is still controversial. To analyze the relationship between salivary cortisol levels and the risk of behavioral-psychosocial-emotional disorders in adolescents aged 12-16 years using PSC-17.

Methods:  An observational analysis with a cross-sectional research design and simple random sampling was conducted from November 2022 - March 2023. Adolescents aged 12-16 years filled out biodata, characteristics and PSC-17 questionnaires. Salivary cortisol levels were measured by the Enzyme-linked immunosorbent assay method. Data analysis with univariate and multivariate tests.

Results: Of 170 adolescents, 53 (31.2%) were at risk of behavioral-psychosocial-emotional disorders with PSC-17 total score ≥15, consisting of risk of internalizing disorders at 73 (42.9%) adolescents, risk of externalizing disorders at 14 ( 8.2%), risk of attention disorder at 23 (13.5%) adolescents. The majority of adolescents who have normal salivary cortisol levels are 117 (68.8%) adolescents, and salivary cortisol levels are abnormal (high) in 53 (31.2%) adolescents. Salivary cortisol levels were associated with adolescents' risk of behavioral-psychosocial-emotional disorders (p<0.001).

Conclusion: Salivary cortisol levels are associated with the risk of behavioral-psychosocial-emotional disorders in adolescents. Likewise, salivary cortisol levels are related to the risk of internalizing disorders, the risk of externalizing disorders, and the risk of attention disorders in adolescents.

Introduction: Increased levels of benzene in the air in the work environment can increase the case of leukemia cancer in workers. In their every activity, printing workers unwittingly breathe benzene vapor from the solvent used in ink. This study aimed to estimate safe concentrations and exposure times when working with benzene exposure in the workplace.

Methods: The type of this study is observational and cross-sectional. The research sample consisted of 25 people who worked in the printing industry.

Results: Benzene measurements in the work environment in the production section range from 1.57-4.88 mg / m3 with an average level of 2.54 mg/m3. The average intake was 0.0243 mg/ kg/day, while the average Risk Quotient (RQ) value was >1 (88%), which means there is a risk of adverse effects due to exposure to benzene vapor. Based on the calculation results, the current conditions with the concentration and characteristics of workers obtained an average safe duration of 3.2 years. For safe concentration, assuming a working life of 25 years and with the characteristics of the workers, the average safe concentration value is 0.2 mg/m3.

Conclusions: The level of risk of benzene exposure will continue to increase as the working period increases. It can be prevented by taking technical and administrative control measures and using personal protective equipment.

Link of Video Abstract: https://youtu.be/_dm9Vyddxvg

Background: Hyperthyroidism is an excessive concentration of thyroid hormone in tissues caused by increased thyroid hormone synthesis, excessive thyroid hormone release, or an endogenous or exogenous extrathyroid source. There are 3 types of hyperthyroid therapy: antithyroid drugs (PTU, thiamazole, and carbimazole), radioactive ablation, and surgery. However, PTU is one of the drugs included in the list of medications that cause Drug-induced Liver Injury (DILI).

Case Presentation: A-36-years old male came to the IRD Dr. Sutomo General Hospital with a chief complaint of weakness for 1 month. The patient also complained of yellowing of the skin on the body, especially in the eyes, for 1 month, and the stomach was getting bigger and bloated before admission to the hospital. The patient has had a history of hyperthyroidism since 6 months ago and has taken PTU for 5 months. Exophthalmos eyes, icteric eyes, ascites, and splenomegaly were found on physical examination. The laboratory results showed hyperbilirubinemia, an increase in transaminase enzymes, and hypoalbumin. In the hospital, the patient was given an infusion of albumin, tyrosol, UDCA, spironolactone, and propranolol.

Conclusion: It has been reported that a man, 36 years old, has an underlying disease of liver cirrhosis. The patient has habitual risk factors for consuming alcohol. The patient had received PTU therapy for 1 month and came to the hospital suspected of DILI. Based on these cases, it is necessary to be vigilant about administering medications to patients with underlying diseases.

Link of Video Abstract: https://youtu.be/9Gip7ztxLJk

Background: Colorectal cancer is reaching the third highest incidence globally, including in Indonesia. Members of the RAS family are frequently discovered in colorectal cancers and may be a contributing factor for the successfulness of anti-epidermal growth factor receptor monoclonal antibodies therapy. Microtubule-associated protein 1 light chain 3 (LC3) is one of the autophagy markers in colorectal cancer cells routinely tested. The relevance of RAS mutation and expression of LC3 as a prognostic factor in CRC has so far only been discussed in several reports. This study aimed to describe the different clinicopathological characteristics of colorectal patients with mutations of the RAS family and LC3 overexpression.

Methods: This study was a cross-sectional study, and the subjects for this study were patient from the Digestive Surgery division at the Tertiary Hospital in West Java, Indonesia with colorectal cancer. A total of 40 study subjects were included in this study. Examination of RAS mutations was carried out by polymerase chain reaction. Meanwhile, the LC3 examination was performed with immunohistochemistry.

Results: The RAS family mutation, which is a mutation of either KRAS, NRAS, or both, was shown in 22 (55%) colorectal cancer patients, and a positive LC3 test was shown in 24 (60%) patients. A univariate analysis of the mutations of the RAS family and expression of the LC3 showed non-significant relationships.

Conclusion: No association observed between RAS family mutations and LC3 expression in colorectal cancer patients.

Link of Video Abstract: https://youtu.be/vwaMtqzZyI0

Background: Nasopharyngeal carcinoma (NPC) is a malignant tumor in the nasopharynx with a high incidence of metastasis. NPC is one of the most common cancers in Indonesia, and from the age distribution, it often affects the productive age population. This study aims to describe the characteristics of NPC patients in Dr.Soetomo General Academic Hospital from January 2017 – December 2018.

Methods: This study is a retrospective descriptive by taking medical records of patients with NPC at Dr. Soetomo Hospital, Surabaya, from January 2017-December 2018, that meet the inclusion and exclusion criteria. The basic data taken are gender, age, education, and occupation. Complaints assessed are the main complaints of patients who make patients come for treatment listed in the medical record data.

Results: Data from 262 patients showed that the five-year life expectancy for NPC sufferers in women is 84%, while in men, it is 78%. The main complaints of patients in this study were lumps in the neck in 130 patients (49.61%), with the highest distribution of patients based on stage IV a with 78 patients (29.77%), and the majority were non-keratinizing carcinoma undifferentiated type, with a total of 245 patients (93.51%).

Conclusion: Male sufferers are more than females; the largest age group is 41-50. Most jobs are private employees, and most sufferers' last education is high school. The main complaint of most patients was a lump in the neck, and the patient came with an advanced stage where the most found was stage IV. The histopathological type of most patients is non-keratinizing carcinoma undifferentiated type.

Link of Video Abstract: https://youtu.be/8WQpmpndIfA

Background: Bipolar Transurethral Vaporization of the Prostate (B-TUVP) is a surgical technique for Benign Prostatic Hyperplasia (BPH) patients that known for its technical reliability, short operating time, and low risk of intraoperative bleeding. However, despite these advantages, it appears to be an unpopular choice among urologists. Previous studies have produced conflicting results when comparing B-TUVP to Transurethral Resection of the Prostate (TURP), particularly bipolar TURP (B-TURP). To date, no studies have directly compared the efficacy and complications of B-TUVP and B-TURP, which using the same energy type. Therefore, the objective of this study is to compare the efficacy and potential complications of these two modalities for the treatment of BPH.

Methods: The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) were followed to perform a systematic search in six databases. The risk of bias in RCT was evaluated using the Cochrane Risk of Bias (RoB) tool version 2. The Review Manager® 5.4 software was used for analyzing all the data.

Results: Six eligible RCTs were included with a total of 940 samples. International Prostate Symptom Score (IPSS), fastest flow rate (Qmax), and post void residual (PVR) were not significantly different, while the quality of life (QoL) score (SMD = -0.64; 95%CI = -1.09 – -0.18; I² = 86%) were significantly lower in B-TUVP (p < 0.05).  Hemoglobin drop (SMD = -2.05; 95%CI = -2.78 – -1.31; I² = 95%), catheterization period (SMD = -1.14; 95%CI = -1.45 – -0.84; I² = 60%), and hospital stay (SMD = -0.68; 95%CI = -1.04 – -0.31; I² = 61%) were significantly lower in B-TUVP (p < 0.05). The analysis of complications did not differ significantly between the B-TUVP and B-TURP groups.

Conclusion: B-TUVP had similar short- to medium-term efficacy and complications as B-TURP, with advantages in terms of significantly better QoL score, lower hemoglobin drop, shorter catheterization period and hospital stay.

Link of Video Abstract: https://youtu.be/j5NtdcbvTE4

Background: Concern for behavior change in compliance with health protocols during this pandemic continues to increase, especially when the coronavirus disease (COVID-19) vaccination is carried out. During the initial pandemic, the public perceived it as risky to be infected with COVID-19. However, this situation manifests itself in the emergence of a phase where public awareness of wearing masks, maintaining distance, and washing hands is decreasing. This study aimed to understand the impact of implementing the vaccine on the compliance behavior of wearing masks, washing hands, and keeping a distance, as well as attitudes towards behavior complying with health protocols during the COVID-19 vaccination period and the implementation of level 1 restriction on community activities (PPKM).

Method: We used a cross-sectional design, recruiting 110 respondents at the Menteng Primary Health Care Center, Palangka Raya City. Recruited patients were those over 18 years of age. This research instrument is an adaptation of several research questionnaires carried out in Indonesia, and we asked respondents using Indonesian.

Results: Of the 110 respondents, 59.1% were dominated by women, and 61.8% were in the 17-25 age group. A total of 106 respondents (96.4%) revealed that they had received information regarding health protocols. More than 70% obtained information from television (77.3%). Only half of the respondents received the 3rd dose or booster I. Knowledge was not the dominant factor influencing adherence to health protocols, but people's attitudes towards the Covid-19 health protocol. No relationship was found between knowledge and people's behavior toward health protocols.

Conclusion: Most of the respondents (80%) still adhere to health protocols as recommended by the government even though 74.5% of the people have received the 2nd and booster doses of the vaccine.

Introduction: The use of a tourniquet in lower extremity surgery can help surgeons optimize the surgical field. However, tourniquet inflation may create ischemic conditions in the extremity, and tourniquet deflation may pose a risk of ischemic reperfusion injury (IRI). Ischemic conditions can increase the production of reactive oxidative stress (ROS), which, if it occurs simultaneously with IRI, will produce malondialdehyde (MDA), a toxic metabolite. The prolonged use of tourniquets can cause damage to the local skin tissue at the tourniquet inflation and poses a risk of IRI to other organs. This study aims to observe the effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets.

Methods: This study is an observational study with a prospective cohort design to measure malondialdehyde levels in lower extremity surgery using tourniquets. When the data were normally distributed, a statistical test was performed using an independent sample t-test to compare the demographic data of the two groups. To compare the results of the observation after the induction, 15 and 120 minutes after the release of the tourniquets, a repeated measures ANOVA was performed when the data were normally distributed. Then, to examine the correlation between variables, Spearman's correlation test was applied when the data were not normally distributed.

Results: In this study, almost all the subjects in the isoflurane and dex-iso groups had no significantly different characteristics, and also showed no effect of tourniquet pressure on malondialdehyde levels.

Conclusion: Based on statistical analysis and discussion of the effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets, it can be concluded that there was no statistically significant effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets.

Link of Video Abstract: https://youtu.be/FvU45HL3HyE

Introduction: Human amniotic membrane and platelet rich fibrin (PRF) are biological materials that can accelerate wound healing through their content of growth factors and cytokines. This study aimed to determine the effectiveness of the combination of these two biological agents for wound healing.

Methods: This study used an experimental method with a randomized post-test only control group design, to compare the use of human amniotic membrane alone with a combination of human amniotic membrane and PRF in acute full thickness wounds of the skin of Wistar rats. The research subjects were 32 rats which were divided into four groups. Groups 1 and 2 used human amniotic membrane, while groups 3 and 4 used a combination of human amniotic membrane and PRF, then the epithelialization process was observed on the 3rd and 6th day.

Result: There was no statistically significant difference in the speed of epithelialization of excision wounds on the backs of rats on the third day (Significance 0.498) and Sixth (Significance 0.9) between the Amnion group and the combination of amnion and PRF because it was greater than α = 0.05.

Conclusion: The use of a combination of freeze dried human amniotic membrane and platelet rich fibrin was not significantly more effective than freeze dried human amniotic membrane in accelerating the epithelialization of acute full thickness excision wounds in rats (Rattus novergicus).

Introduction: Iron deficiency anemia (IDA) is still a problem of pregnant women's health related to its high prevalence and its negative effects on health. Prevention efforts have been carried out through administration of oral iron tablets to women during their pregnancy; however, the expected results have not been satisfied yet. This failure is probably due to the assumption that, especially in developing countries, the iron store in pre-pregnant women is very low or may be empty, so that iron supplementation during pregnancy is not enough to prevent IDA. The aim of study is to know the difference of effect of iron supplementation in treated and control groups in terms of hemoglobin concentration, serum ferritin level and prevalence of IDA.

Method: A quasi-experimental study was conducted on 99 non-pregnant new couple women. Iron tablets were administered to the treated group from the beginning of pre-pregnant period, continuing until the first 3 months of pregnancy, while in the control group iron tablets were only given during the first 3 months of pregnancy.  IDA was measured by serum ferritin and hemoglobin concentration using WHO’s criteria, the benefit of iron tablet was measured by BCR technique.

Result: The administration of an oral iron tablet from the prepregnant period (treated group) could decrease prevalence of IDA higher than the administration of oral iron tablet during pregnancy only (control group) (0% vs 38.46%, p<0.05). A significant difference was also observed on mean serum ferritin concentration at the end of observation (the third month of pregnancy) 33.45±14.12 µg/dL in the treated group, and 19.65±8.99 µg/dL in the control group. This difference was statistically significant (p<0.05). Meanwhile, the hemoglobin concentration was 12.25±1.20 g/dL in the treated group and 10.91±0.67 g/dL in the control group. This difference was also statistically significant (p<0.05). Benefit analysis showed that administration of an oral iron tablet starting from pre-pregnancy is more advantageous (BCR >1) compared to oral administration of iron tablet during the pregnancy period only. There were no significant differences in side effects and compliance of the patient to consume iron pills in both treated and control groups.

Conclusion: The administration of oral iron tablets (iron supplementation) to pregnant women starting from pre-pregnant period results in a better effect compared to oral iron supplementation during pregnancy only. This program is feasible to be implemented in a community setting because its compliance is good.

Background: Postoperative Cognitive Dysfunction or POCD is a reversible decline in the cognitive function of patients after surgery. The risk factors for POCD are age, comorbidities, duration of CPB, intraoperative hypoperfusion, duration of ventilator use, and postoperative sedation are risk factors of POCD. This study aims to determine the prevalence and characteristics of postoperative cognitive dysfunction (POCD) in patients who undergo on-pump cardiac surgery at Dr. Kariadi General Hospital.

Methods: This study's population was all patients undergoing on-pump cardiac surgery at Dr. RSUP. Kariadi in July 2021-December 2021. The study subject was 97 patients, obtained by total sampling technique. The study subjects were examined for cognitive function with MoCA-INA one day before surgery and the third day after surgery. Data were analyzed using SPSS version 23 for Windows.

Results: There were 68 (70.1%) patients who experienced POCD and 29 (29.9%) patients who did not experience POCD. The median age of patients with POCD is 50 (18-68) years and 36 (18-63) years for patients without POCD. Based on MAP during CPB, patients with POCD had a median of 64 (51-80) minutes. In patients with POCD, the median length of CPB was 53 (22-92) minutes, and the median length of the aortic cross-clamp clamp was 35 (11-69) minutes.

Conclusion: We found a high prevalence of POCD patients after on-pump cardiac surgery, as many as 70.1% at Dr. Kariadi General Hospital.

Link of Video Abstract: https://youtu.be/J6ZC8xzJB8M


Background: Nasopharyngeal carcinoma (NPC) is distinct from other head and neck cancers in terms of epidemiology, clinical presentation, biological markers, carcinogenic risk factors, and prognostic factors. However, there is only a small amount of information available on NPC in Indonesia, where the recorded mean prevalence is 6.2/100,000 and there are 13,000 new cases reported annually. Numerous treatments are used, and it's important to pinpoint the risk factor that contributes to a poor prognosis. The aim of this study is to look at the outcomes of nasopharyngeal cancer patients who were hospitalized at a referral hospital based on their characteristics and laboratory results.

Methods: Data from medical records were analyzed to conduct a retrospective study. Up to 785 patients who were hospitalized at a single referral hospital from 2018 to 2022 and received a nasopharyngeal cancer diagnosis were included. Data were statistically and descriptively analyzed.

Results: Chronic kidney disease, education level, and tumor, node, metastasis (TNM) classification was associated with patient outcomes (p < 0.05). The results of the multivariate analysis showed that there were significant differences in the variables of chronic kidney disease and pre-treatment albumin levels. Therefore, people with nasopharyngeal cancer who have chronic kidney disease have a 12,151 chance of mortality.

Conclusion: In Indonesia, there is a critical need for efforts to identify NPC as early as possible. These should include public education to increase awareness of the comorbidity status, especially chronic kidney disease to prevent poor outcomes.

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

Background: Locally advanced breast cancer (LABC) is a term that refers to advanced non metastatic stage breast cancer. Neoadjuvant chemotherapy is one of the therapies given to patients with LABC. Many factors can affect the chemotherapy response, platelets produce growth factors, and cytokines promote angiogenesis and tumor growth. Inflammatory biomarkers such as platelet lymphocyte ratio (PLR) may indicate tumor progressiveness. The Ki67 proliferation index is a marker of the aggressiveness or growth of tumor cells. This study aimed to determine the correlation of platelet count, platelet lymphocyte ratio and Ki67 proliferation index before chemotherapy with neoadjuvant chemotherapy response.

Method: This research used the cohort retrospective design method. A sample of 155 patients was selected using a simple random sampling technique. The inclusion criteria of this research are having complete data about pre-treatment platelet, lymphocyte platelet ratio, Ki67 and the neoadjuvant chemotherapy response result assessed by the oncologist that is written in the medical record. Patient data from other types of cancer, chronic, systemic or autoimmune diseases are excluded from this research. The data of each variable was analyzed with the Spearman correlation test.

Result: There was no correlation between platelet count and neoadjuvant chemotherapy response (p=0.301). There was a negative correlation between the platelet lymphocyte ratio (p=0.026) and the Ki67 index (p=0.040) with neoadjuvant chemotherapy response.

Conclusion: Based on this study, it can be concluded that platelet count is not significant in relation to chemotherapy responses. The higher the platelet lymphocyte ratio and the proliferation index of Ki67, the lower the response to neoadjuvant chemotherapy.

Introduction: Inverted papilloma is a benign tumor that generally arises from the lateral wall of the nasal cavity and mostly grows on the middle meatus.The incidence is rarely found in the ear, throat, nose, throat, head and neck, which is around 0.5% -4% of all nasal and paranasal sinus tumors.The etiology of inverted papilloma remains unknown.Clinical features of inverted papilloma are unilateral nasal obstruction, rhinorrhea, epistaxis, anosmia, tinnitus and some other symptoms.The diagnostic examination are histopathological examinations, CT scans and magnetic resonance imaging (MRI). Histopathology is the gold standard in diagnosing of inverted papilloma.Management of inverted papilloma is carried out with surgical approach including lateral rhinotomy, maxillectomy, degloving, and non-invasive surgery via endoscopy depending to the krouse classification.

Case description: A 44-year-old female patient diagnosed with inverted papilloma was reported.The patient complained of progressive right nasal obstruction appeared two years ago which turned into total obstruction and rhinorrhea in the last 6 months.A biopsy was done with the result of inverted papilloma. CT scan of the paranasal sinuses showed a mass filling the right nasal cavity, right maxillary sinus and right ethmoid sinus. Patientwas diagnosed with sinonasal inverted papilloma with Krouse 2 classification based on clinical examination, radiological findings and preoperative endoscopy. The patient was treated with sinonasal inverted papilloma extirpation via endoscopic approach.

Conclusion: Inverted papilloma is a benign tumor of the nasal and paranasal sinuses in which biopsy is the gold standard for diagnostic test while the main treatment is done by surgical approach depending on the krouse classification.

Ocular chemical trauma is a true emergency in ophthalmology. Chemical trauma on the ocular area may disturb vision, reduce the quality of life, and functional state. Prompt and adequate treatment is needed to prevent further complications, such as a decrease in vision due to corneal neovascularization. Treatment started with immediate eradication of the chemical agent by continuous rinsing and followed by inflammation and epithelial defect control. Medroxyprogesterone and doxycycline are two common treatments used in ocular chemical trauma. We speculate that both medications may influence VEGF expression and corneal neovascularization in corneal alkali trauma. It was demonstrated that medroxyprogesterone and doxycycline reduce the expression of VEGF, hence, reducing corneal neovascularization.

Introduction: School closures and online learning during the Coronavirus Disease-19 (Covid-19) pandemic have raised concerns about school-aged children's learning loss during the epidemic. This study aims to evaluate the effects of school closures and online learning during the Covid-19 pandemic on the academic performance of elementary school-aged children in East Java.

Methods: The data taken were basic characteristic data as well as academic performance statistics in Mathematics, Indonesian Language, and Science from six elementary schools in two major cities (Surabaya and Sidoarjo) during the 2018–2019 and 2021–2022 academic years. Inclusion criteria were the academic reports of fourth- through sixth-grade elementary school-aged children. Chi-Square, ANOVA, and independent sample T-test were used for statistical analysis.

Results: Overall, academic performance decreased near the end of online learning as compared to the beginning of online learning (87 ± 5.8 vs. 84.7 ± 6.2; p-value = 0.043). Lower academic performances were also shown by children from private schools during online learning compared to before online learning (89.9 ± 4.7 vs. 87.8 ± 4.9; p-value = 0.003), and at the end of online learning compared to the beginning of online learning (89.8 ± 4.5 vs. 86.9 ± 3.3; p-value = 0.013). Lower academic performance was also shown by children in Sidoarjo during online learning compared to before online learning (90.4 ± 4 vs. 89 .1 ± 2.9; p-value = 0.009), and at the end of online learning compared to the beginning of online learning (90.3 ± 3.5 vs. 88 ± 2.1; p-value = 0.004).

Conclusion: We found differences in children's academic performance at the beginning and end periods of online learning, as well as differences between private and public school students. Considering online learning has impacted children's academic performance, offline learning should be undertaken to optimize comprehension effectively.

Background: The treatment of spinal cord injuries (SCIs) is a controversial topic and is not yet effective. Stem cell secretome is an emerging alternative treatment that uses the paracrine effect of stem cells. Although there have been many studies on this subject, there are still differences regarding the origin, dose, route of secretome administration, type of experimental animal, phase of the SCI, and outputs evaluated. The topic needs a systematic review and meta-analysis.

Methods: This systematic review and meta-analysis were reported based on criteria from Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The authors searched PubMed, ScienceDirect, Cochrane Library, and Google Scholar with multiple electronic databases until October 2021.

Results: Twenty-eight studies that met the inclusion criteria were included in this research. The stem cell secretome was very beneficial as the axonal regeneration agent (n=12); it increases the locomotor recovery (n=28) and growth factors (n=2) and reduces the size of the cystic cavity (n=1) and lesion extension (n=14). We recognized 28 studies that met our inclusion criteria. Stem cell secretome therapies showed improvement in the locomotor score (standard mean difference [SMD]: 0.94; 95% confidence interval [CI]: 0.75–1.13, p<0.000001, I²=90%) and reduction in the lesion size (SMD: 5.06; 95% CI: 3.44–6.67, p<0.00001, I²=94%).

Conclusion: The stem cell secretome greatly affects treating SCI rodent models. Future studies should focus on chronic SCIs in the primary research, translational research, and neurological research stage of stem cell secretome.

Introduction: The goal of surgeons to avoid Pseudophakic Cystoid Macular Edema (PCMO) has led to the widespread use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) after cataract surgery, although current research into the best anti-inflammatory drugs to avoid PCMO is still underway. This review aimed to determine the efficacy of topical NSAIDs in preventing PCMO following phacoemulsification.

Methods: This systematic review was built on the recommended reporting items for systematic reviews and meta-analyses (PRISMA) and PICO criteria for papers during the previous 10 years. The keywords was searched by Boolean operator: “NSAIDs” AND “Prevention” AND “Cystoid Macular Edema” AND “Optical Coherence Tomography” AND “Phacoemulsification”. According to  STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist, the quality of each chosen article was evaluated.

Results: We have selected five articles of prospective cohort studies, which involved 756 patients whom received topical NSAIDs (Nepafenac 0.3%, Ketorolac Tromethamine 0.4%Nepafenac 0.1%, , and Diclofenac 0.1%) in treatment group and 700 patients received Placebo (Artificial tears) in control group. There was significant difference of central macular thickness based on OCT results between NSAIDs and control (placebo) group after uneventful phacoemulsification. Additionally, NSAIDs used as a preventative before phacoemulsification procedure exhibited a significantly reduced rise in central foveal thickness compared to placebo. There were changes of central macular thicknes postoperatively, and were significantly different from preoperative.

Conclusion: It has been demonstrated that topical NSAIDs successfully lower the incidence of Pseudophakic Cystoid Macular Edema following phacoemulsification.

Link of Video Abstract: https://youtu.be/rXb-E8We3vU

Background: COVID-19 vaccines involve a humoral response to produce a neutralizing antibody that could protect subjects from severe COVID-19 infection. However, obesity tends to lower the immune response to the COVID-19 vaccine. Therefore, we conducted a systematic review to determine the immune response of various types of COVID-19 vaccines in a population with obesity.

Methods: We conducted a systematic review based on The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Using keywords, we search studies from Taylor & Francis, PubMed, ScienceDirect, Cochrane, and EBSCOHost.

Results: We included eight cohort studies with 21,280 subjects after thorough selection and appraisal. Four studies stated that obesity was related to lower antibody titer post-SARS-CoV-2 vaccination, even though one study stated that obesity was not associated with long-term immune response. Another prospective cohort study involving approximately nine million populations stated that SARS-CoV-2 vaccination provided similar protection against COVID-19 compared to normoweight when underweight was a risk factor for lower protection. One study found that antibody titer wanes faster in obesity compared to normoweight. In addition, another study found lower antibody titer in obese men, whereas no significant findings were found in obese women.

Conclusion: Therefore, it should be noted that COVID-19 vaccination in an obese population tends to provide a lower immune response regardless of vaccine type and doses are given. This should inform clinicians who want to administer the COVID-19 vaccine to obese populations.

Link of Video Abstract: https://youtu.be/VVibnyUdBx4

Background: Proliferative vitreoretinopathy (PVR) is common following an open globe injury (OGI) due to aberrant wound healing that can result in retinal detachment or vitreous hemorrhage. Despite the anatomical success, visual acuity improvement remains unsatisfactory. Triamcinolone acetonide (TCA) and Bevacizumab are among these therapies. This study aims to explore the effect of TCA and Bevacizumab intravitreal injection as potential preventive therapies for PVR in OGI.

Methods: This literature review compiles and elaborates on previous studies from many authors to support future experimental studies, which will be conducted to evaluate the intravitreal triamcinolone acetonide and bevacizumab injection as prevention of proliferative vitreoretinopathy in open globe injury through several relevant articles.

Results: The healing process requires inflammation that stimulates inflammatory cells and mediators, such as transforming growth factor-β (TGF-β), tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), interleukin-1 (IL-1), IL-2, IL-3, IL-6, IL-8, and IL-10. Plasminogen activator inhibitor-1 (PAI) is upregulated during inflammation, resulting in continued collagen deposition due to fibrosis. The injection of corticosteroids as immunosuppressants and anti-VEGFs as antiangiogenesis is thought to have a positive impact by reducing inflammation and the development of new blood vessels, thus suppressing fibrosis.

Conclusion: TCA injection was associated with improved anatomical and visual acuity in humans, pre-operatively or during pars plana vitrectomy. Anti-VEGFs, such as Bevacizumab, ranibizumab, conbercept, and aflibercept, demonstrated protective effects on the eyes of animal models and showed their ability to reduce VEGF, TGF-β, and PAI-1, thereby inhibiting wound fibrosis.

Link of Video Abstract: https://youtu.be/rypOUr0MPxA

Corneal alkali burn is a typical ophthalmology emergency which requires immediate management and treatment. Alongside conventional treatment, medroxyprogesterone and doxycycline are considered potent add-on treatments. This literature review was conducted to determine their impact towards corneal wound healing after an alkali burn. It was proven from studies extracted from literature searching among various databases that medroxyprogesterone and doxycycline proven to reduce the inflammatory condition of corneal wounds after alkali trauma. In addition, they are subjected to reduce matrix metalloproteinase (MMP-9) and transforming growth factor (TGF-β1), which are abundant and over-expressed in a corneal wound and could cause excessive inflammation and neovascularization of cornea, which results in hazy and disintegrated corneal tissue after recovery. Therefore, the usage of topical medroxyprogesterone acetate 1% and doxycycline is proven beneficial for patients with corneal wounds after being exposed to alkali burns.

Background: Central nervous system (CNS) tumors have been recognized as a type of tumor with high progressivity and a five-year survival rate of just 36%. SRY-related high mobility group box-2 (SOX2) is a gene encoding the Sox2 protein which is found to be overexpressed in various CNS tumors and contribute to its progressiveness. This gene contributes to CNS tumors through several signaling pathways, including Shh, Wnt, FGFR, and TGF-β signaling pathways. This meta-analysis aims to evaluate the clinicopathological and prognostic significance of SOX2 overexpression in CNS tumor.

Patients and methods: The literature searches on Cochrane Library, PubMed, and ScienceDirect were conducted systematically up to December 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method to find relevant references. The effect of SOX2 overexpression on clinicopathological characteristics and prognostic value were analyzed using Review Manager 5.4 (Cochrane Collaboration, Oxford, UK).

Results: Ten suitable studies with a total of 466 patients with CNS tumors including gliomas (glioblastoma, astrocytoma, oligoastrocytoma, and oligodendrogliomas) and meningiomas, were included. Our analysis shows a significant association between the overexpression of SOX2 with the grade of CNS tumor (OR 7.05; 95%CI: 2.83 to 17.53; I² = 53%; p< 0.0001) both in gliomas and meningiomas, with gender (OR 2.08; 95%CI: 1.30 to 3.34; I² = 13%; p = 0.002) especially in non-Asian population, and higher in primary tumor than recurrent tumor (OR 4.31; 95%CI: 1.41 to 13.14; I² = 13%; p = 0.01). On the prognostic value, SOX2 overexpression insignificantly associates with poor overall survival (HR 1.73; 95%CI: 0.49 to 6.18; I² = 83%; p = 0.40)

Conclusion: SOX2 overexpression suggests a role as a biomarker in predicting the poorer grade of CNS tumors.

Introduction: Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non-pharmacological therapies can be viable alternatives to conventional therapies. Recently, laser therapy has been widely used in the treatment of acne vulgaris due to its effectiveness and safety as it provides a more rapid response with less rate of recurrence, specifically 1064nm Nd: YAG laser. Few studies have investigated laser combinations. Combination 1064nm Nd: YAG and 2940nm fractional erbium laser for severe acne with acne scar has not been reported.

Case report: We report a case of severe acne with acne scars in a 21-year-old female, skin type IV, treated using 1064nm Nd: YAG laser in five sessions and 2940nm fractional erbium laser two sessions. Reduction of acne lesions counts and acne scars improvement prominent after Nd:YAG laser at least four sessions. Our patient's acne scars improved not significantly after 2940nm fractional erbium laser. Acne remission was sustained through the follow-up period. There were no post-inflammatory hyperpigmentation and no exacerbation of acne lesions after the procedures.

Conclusion: 1064nm Nd: YAG laser is very effective for mild to severe acne and improves new acne scars. While 2940nm fractional erbium laser is more effective for mature scars.

Link of Video Abstract: https://youtu.be/FZsJ7mtGsW8

Introduction: Superior vena cava syndrome (SVCS) associated with jugular internal vein thrombosis can be dangerous. Diagnosing SVCS and venous thromboembolism (VTE) must be done precisely and accurately to minimize the risk of pulmonary embolism.

Case Presentation: Male, 55 years old, complaining of shortness of breath, the feeling of choking in the neck, and a lump in the neck for one month. The patient has a history of type 2 diabetes mellitus and does not routinely take medication. The patient experienced tachypnea and tachycardia, and there was an enlargement in the submental to the submandibular region; the boundaries were not firm, supple, or fixed, approximately ten centimeters in diameter, and the collateral veins were enlarged and felt pain. Chest examination revealed telangiectasia, crackles, and bronchovesicular breath sounds over both lungs at the base and medial side. The patient had mild anemia and leukocytosis, increased HbA1c levels, total cholesterol levels, and increased D-dimer and Lactate dehydrogenase (LDH). Antero-posterior (AP) lateral cervical radiograph shows a widening of the soft tissue in the retro tracheal space at the level of the second cervix. The patient given warfarin, enoxaparin, methylprednisolone, and heparin. Improvement of the condition was shown.

Conclusion: Superior vena cava syndrome due to internal jugular vein thrombosis is a challenging case. Careful diagnostic measurement based on history and physical examination, in addition of additional investigation may lead to the diagnosis. Management with warfarin, enoxaparin, methylprednisolone, and heparin show clinical benefit.

Introduction: MDR-TB is an infectious disease that can cause death and stigma for those infected. MDR-TB patients with depression are at risk for LTFU, which will worsen their condition and strengthen the stigma they receive.

Case report: A 52-year-old female psychiatric interview and assessment using the Beck Depression Inventory (BDI) found that BDI score of 4 (no depression), and the patient adhered to TB treatment. She was found to be laid off, and an assessment using the BDI to detect depression in the patient found potential stigma in the patient, such as being laid off from work, prohibited from teaching face-to-face, and shunned by colleagues. Interventions given were prescribing Fluoxetine 20 mg per day and Clobazam 10 mg per day, a brief intervention using the FRAMES technique, psychoeducation about disease and drug effects and the duration of treatment, and an office visit. A worksite intervention was performed by the patient's husband. Antituberculosis drugs were monitored by both a pulmonologist and a psychiatrist. Her work-related problems were resolved through interventions at the school with psychoeducation about drug-resistant tuberculosis, the transmission method, the duration of treatment, and the side effects of the treatment. The results of the last sputum examination after one month of treatment showed drug resistance, and the patient was advised to undergo 18 months of treatment. The patient could finally work offline with fewer responsibilities after getting negative laboratory test results twice in a row.

Conclusion Work-related psychosocial interventions are required to address rejection at work, which results in depression and nonadherence to treatment. Liaison services with social interventions at work in drug-resistant tuberculosis-infected patients are necessary to improve their quality of life and maintain their treatment adherence.

Introduction: Chronic limb-threatening ischemia (CLTI) is a remarkably morbid condition that causes significant mortality, limb loss, pain, as well as reduce health-related quality of life in those who are affected. The cornerstone of CLTI therapy is revascularization, which can lower the amputation rate.

Case description:  A diabetic type II 68-year-old female patient presented with complaints of pain, swelling, and itching in the left leg that was felt for approximately 1 month ago. The wound persists although the ankle was already amputated. CT-angiography showed total occlusion in 1/3 distal of left femoral artery and no visualization of left popliteal artery. She was diagnosed as left CLTI femoral popliteal Rutherford VI TASC II type D with ischemic rest pain. The patient planned for an endovascular revascularization procedure. Victory 14 wire 0.014” was inserted but recanalization did not penetrate, continued with Victory 18 wire the lesion could penetrate. Digital Subtract Angiography (DSA) evaluation found significant residual stenosis, thus continued using Abbott Supera peripheral stent system. The patient was successfully treated showed left femoral artery was seen well visualized with TIMI flow 3, left popliteal artery was still seen 50% no significant residual stenosis with TIMI flow 2. Followed up after 3 months, she did not complain any ischemic pain at left leg.

Discussion: The Supera peripheral stent system was developed to withstand the femoropopliteal artery's unique stressors. There have been few studies on the use of supera stenting in complex CLTI, and the primary patency at 1 year was 77% in lesions measuring 92-236 mm. In this case report, the procedure was successfully applied in complex CLTI (mean length >200mm) with no restenosis and repeat target limb revascularization after one year of procedure.

Conclusion: We successfully performed revascularization using supera stenting, and the femoropopliteal artery showed good TIMI flow results. In CLTI patients, stenting may be an option to lower the risk of major lower limb amputation.

Introduction: Lupus enteritis is a rare first manifestation of active systemic lupus erythematosus (SLE). diagnosis of this condition is hard, specially without other signs and symptoms associated with active SLE. this article will report a woman with SLE and lupus enteritis as the first manifestation of active systemic lupus erythematosus

Case presentation: A 25-year-old woman presented to the Emergency department complaining of abdominal pain and vomiting. From her medical history, four years in the past, she reported the same signs and symptoms as now and turned into identified with appendicitis. Her abdomen examination found out mild abdominal distention without a abdominal tenderness. Wall thickening and irregularity of small and big bowel loops were observed on the CT abdomen. She turned into given a excessive dose glucocorticoid as initial treatment and turned into maintained with low dose glucocorticoid and cyclosporin. After 6 months of follow-up, the patient did not have a recurrence of signs and symptoms.

Conclusion: A high index of suspicions is essential to differentiate lupus enteritis from other differential diagnoses. For lupus enteritis, excessive-dose steroids were an efficient initial treatment.

Background: Criminal profiles are also often referred to as psychological profiles or engagement profiles. Profile means a description the term profile to be discussed when discussing techniques and determining the possible characteristics of the debate about the results of research on crime itself. The following paper aims to present the case in predicting criminal profiles in Banda Aceh Indonesia based on forensic medical investigations.

Case presentation: The victim is a male 16-year-old which is conducted a forensic medical examination. The result of forensic medical autopsy findings is the destruction of face-forming bones and skull fractures in the victim. According to the autopsy finding, the doctor concluded that the violence was carried out by someone who is powerful. The doctor states that the alleged criminal's profile consists of someone close to the victim, someone likely to be male, and someone who engaged in violence by using blunt objects. The police investigator is an Indonesian National Police in Banda Aceh district who has done the interview. The discussion with police investigators was conducted to predict the alleged perpetrator's profile. Based on the doctor's statement, the police conducted an investigation looking for the suspect, and the doctor's prediction was correct about the criminal profile of the perpetrator. During the trial, the panel of judges stated that the perpetrators used blunt objects to attack the victim.

Conclusion: There is an association between the results of forensic medical examination, police investigations and facts at the trial in predicting the profiles of criminals.

Background: Liver disease in pregnancy can be related to the process of pregnancy (liver disease of pregnancy) or not associated with pregnancy (liver disease in pregnancy). Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening cause of jaundice in the third trimester of pregnancy and early postpartum period which in most cases no definitive risk factors are found. In this case report, we report a patient with AFLP with acute pancreatitis manifestations.

Case presentation: A 33-year-old woman referred to the Dr Soetomo General Academic Hospital, Surabaya, Indonesia with diagnosis of day-4 post-section caesarian (SC) accompanied by ileus paralytic, obstructive jaundice hypoalbuminemia hyperbilirubinemia, acalculi cholecystitis, acute kidney injury (AKI) with dd acute on chronic kidney disease (ACKD), suspect pneumonia, and sepsis. Indications for SC were premature rupture of membrane (PROM). The patient initially complained of yellow body and eyes 10 days before delivery with additional complaints including tea-colored urine and brown feces. Chest x-ray results showed infiltrates on the right paracardial suggesting pulmonary inflammation. Abdominal x-rays showed normal result. Abdominal ultrasound results suggested acalculi cholecystitis, however, liver, lien, pancreas, kidney right and left, urinary bladder, uterus, adnexa right and left showed no abnormality. The patient was treated with intravenous fluids, nasogastric insertion for nutrition, analgesics and antibiotics and other symptomatic therapy. The patient was discharged after 20 days of treatment.

Conclusion: This case highlights a potentially fatal complication of AFLP case with acute pancreatitis manifestations and the need of rapid diagnosis and comprehensive management to avoid the complicaton and death.

Introduction: Asthma bronchial is a disease characterized by increased sensitivity of the tracheobronchial tree to various stimuli. During an asthma attack, there will be bronchospasm, mucosal swelling, and increased secretions in the airway. The incidence of asthma in pregnancy in Indonesia is around 3.7- 4%, most commonly occurring at 24 to 36 weeks of gestation. The effect of asthma on the mother and fetus depends on the frequency and severity of asthma attacks because it can cause effects in the form of hypoxia. The state of hypoxia affects the fetus in the form of abortion, premature delivery, and fetal weight that is not in accordance with gestational age. Symptoms that can be felt are shortness of breath, cough, wheezing and can be accompanied by chest pain.

Case description: A 35-year-old woman came with complaints of heartburn for 2 hours before admission to the hospital, the patient denied amniotic fluid flow, blood was found to come out. Fetal movements felt active. The patient claimed to be 9 months pregnant with LMP on 27 December 2021, and EDD on 27 September 2022, with a gestational age of 39-40 weeks. ANC to the obstetrician was 3 times and the midwife was 5 times. No complaints of vaginal discharge, bowel and bladder within normal limits. The patient also had a history of asthma when she was 8 months pregnant, with complaints of shortness of breath, easily fatigued and coughing, the patient denied chest pain. Wheezing was also claimed sometimes. The patient had been treated by a pulmonologist, given 3 drugs to take if shortness of breath occurred. The patient complained of painless lesions on the hands, trunk and feet. This complaint has been felt since 3 months ago. There is no thickening of the nerves or numbness in the joints. The patient was diagnosed at the regional hospital with Morbus Hansen and is currently on treatment.

Conclusion: Asthma in pregnancy will cause hypoxia to the fetus which affects the development of the fetus, therefore prompt and appropriate management will reduce the risk to the mother and fetus. Outcome infants showed no sign of Morbus Hansen infection.