Background: Cervical cancer is the second most cancer in women after breast cancer. Emotional stress is the most common comorbid attacking women with advanced-stage cervical cancer, where 13- 40% are depressed which can increase mortality by 39%. Management of cervical cancer has so far focused on standard chemoradiation treatment, but has paid less attention to other aspects such as cognitive, psychological, spiritual and physical. The study aims to determine cortisol levels, Depression Anxiety Stress (DAS) score and quality of life for patients with advanced-stage cervical cancer after two years of psychocurative intervention

Methods: The pretest-posttest group design experimental study, continued previous studies, 30 subjects with advanced-stage cervical cancer patients, divided into 15 subjects received standard and psychocurative treatments, the other 15 as controls only received standard therapy. Psychocurative is done independently three times a week for two years based on psychocurative smart books. Home visits are conducted once per week to monitor, motivate the subject to do the psychocurative independently properly and discipline. Cortisol levels, DAS scores and quality of life were measured before and after treatment, the data were analysed by paired t-tests in the SPSS 25 program.

Results: One control group subject died before the study was completed. Before and after psychocurative, cortisol levels in the treatment group were 12.29 ± 4.36 and 6.71 ± 3.88 with p<0.05. The Depressive scores were 14.13 ± 3.02 and 8.46 ± 3.07 with p<0.05. The Anxiety scores 12.13 ± 1.64 and 6.73 ± 2.40 with p<0.05. The Stress scores were 14.40 ± 2.64 and 7.27 ± 2.81 with p<0.05. The quality of life score of the physical domain were 55.00 ± 6.54 and 62.67 ± 8.63 with p <0.05. The Psychical domain was 57.00 ± 9.41 and 65.66 ± 8.42 with p <0.05. The Social domain was 33.67 ± 9.15 and 41.67 ± 10.29 with p <0.05. The Environmental domain was 63.00 ± 1.93 and 69.33 ± 7.76 with p <0.05

Conclusions: Psychocurative decreases serum cortisol levels, decreases depression, anxiety, and stress scores and improves the quality of life of the physical, psychological, social and environmental domains.

Abstract

Introduction: Atopic dermatitis occurs due to multifactorial interactions such as genetic, environmental, impaired skin barrier function, immunological factors, infection and post-psychological stress. Th1 cells and some proinflammatory cytokines such as IL-6, IL-10 and others play a role in the pathogenesis of atopic dermatitis, also IL-31. IL-31, including cytokines of the IL-6 family expressed mainly on CD4 T cells. Many researchers also associate stress with the occurrence of atopic dermatitis, stress will trigger the release of these cytokines from immune cells (e.g. IL-6, TNF α). The aim of the study is determine correlation  between stress and increase in IL-31 level in person with atopic dermatitis

Method: We designed a case-control study including  58 patient, range from 14-65 years old. Diagnosis of atopic dermatitis is established based on Hanifin and Rajka criteria, and the severity based on SCORAD. Venous blood was collected for IL-31 examination, stress index was measured by interview according to the Holmes-Rahe stress scale test method.

Result: In this study, the stress index in atopic dermatitis was 102.26 + 11.71, and in control 61.35 + 19.87 there was a significant difference with p <0.005. IL-31 levels in atopic dermatitis were 274.44 + 95.35, higher than controls 129.44 + 85.45, significantly with p<0.005. The results of linear regression between stress index and severity of dermatitis (SCORAD), appeared to have a moderate positive correlation with r = 0.04. OR 4.56 (95% CI 2.78-11.56).

Conclusions: From this study it can be concluded that stress increases IL-31 levels and positively correlates with the severity of atopic dermatitis.

Aim: This study aims to prove the effect of infant massage stimulation on the improvement of vagal activity and neurological effects (HPA axis) in infants with 6-12 months of nutrition including increased nutritional status, insulin-like growth factor 1 (IGF-1) and decreased cortisol.

Method: The design method used for this study was a quasi-experimental with randomized pre-test and post-test control group design. Samples in this study were infants aged 6-12 with undernutrition status as many as 24 person as an intervention group (infant massage interventions and complementary feeding) and 24 people in the control group (provision of supplementary feeding). Infant massage interventions carried out for 3 months. Data collected included body weight, IGF-1 level, and Cortisol.

Results: Effective infant massage improves nutritional status (p = 0.035) / (p≤0.05), increases IGF-1 levels (p = 0.002) or (p <0.05), and decreases cortisol levels (p = 0.022) / (p <0.05).

Conclusion: Infant massage stimulation increases body weight, IGF-1 level, and reduces cortisol in undernourished infants aged 6-24 months. It is recommended for every mother to apply baby massage stimulation for alternative treatments to improve the nutritional status of infants who are undernourished.

Background: There are several approaches to solve the problems of many pathological processes’ correction, such as clinical pathology and experiment in modern science. At the same time, genetically-conditioned diseases usually demand researchers’ attention and generalization of earlier information for making the correction foundation of their manifestations in the future. Down’s syndrome is considered to be one. Our objective was to review existing literature regarding physiological and morphological peculiarities of children with Down’s syndrome.

Methods: A total of 30 relevant literature were reviewed regarding physiological and morphological peculiarities of children with Down’s syndrome. The data collection for eligible articles were conducted from 1989-2017. Different database and manual search methods were used to find the topic-related articles.

Results: Abnormalities of heart, gastrointestinal tract and the system of urinary excretion are considered as the underlying congenital abnormalities for children with Down’s syndrome influencing their lifespan. People with Down’s syndrome have difficulties in their cognitive activity, such as lag in development, speaking, and reading. Limitation existence of ideas and scarcity of conclusions make studying different school subjects impossible for children with Down’s syndrome. They need more time to master new skills and remembering new material. On the other hand, children with Down’s syndrome possess positive personal qualities: they are tender, friendly and even-tempered. Conclusion: Down’s syndrome is considered as one of the most common genetic diseases occurred newborns. Children with Down’s syndrome have several physical abnormalities. It is important to understand children with Down’s syndrome as a whole, as they can be put into a well-adjusted system of rehabilitation.

Background: Women in the postmenopausal period will experience a hormonal shift that makes them facing difficulties ranging from symptoms to complication. Vaginal dryness, hot flashes, decreased thinned vaginal mucosa may cause painful intercourse. This problem may adversely affect sexual activity among postmenopausal women such as a decrease in libido or sexual desire, inability to reach orgasm, pain during sexual intercourse, and fatigue. This study aims to explore the sexual experience among postmenopausal women in a rural area in Yogyakarta.

Methods: This was a descriptive qualitative study. Twelve participants aged 50-60 years old who met the criteria, were purposively enrolled in this study. Individual face to face, semi-structured and in-depth interviews were performed for data collection. All conversations were audio-recorded and transcribed. We employed a conventional content analysis to derive coding categories from raw data.

Results: Three main themes emerged from data analysis: (1)“negative changes in sexual function” (decreased in frequency of sex, low libido, vaginal dryness, anorgasmia, and fatigue), (2)” intimacy with the couple” (couple communication and romance, lack of physical intimacy),  (3)” coping with the symptoms in postmenopausal period” (acceptance of negative changes in sexual function, improve healthy diet and physical activity).

Background: Acute limb ischemia (ALI) is a sudden decrease in limb perfusion that threatens limb viability and requires urgent evaluation and management. Assessment determines whether the limb is viable or irreversibly damaged. Neutrophil-lymphocyte ratio (NLR) is a useful marker for cardiovascular disease to delineate the prognosis. Endothelial dysfunctions related to atherosclerotic plaques are usually associated with states of neutrophilia together with lymphopenia processes.

Methods: This study was a post-test only control group performed on Wistar strain white rats. Thirty rats were divided into 5 groups, Control group (K), treatment group one (P1) examined NLR and femoral muscle tissue after 3 hours of ALI, P2 after 4 hours of ALI, P3 after 5 hours of ALI and P4 after 6 hours of ALI. Muscle tissue was histologically examined.

 Results: The duration of ALI increases the NLR value in Wistar strain white rats, the NLR value examined 6 hours after the rats experienced ALI increased significantly compared with the NLR values examined in the control group, the group examined 3 hours, 4 hours and 5 hours after the rats had ALI (p = 0.004). Necrotic muscle tissue very strongly correlated with the duration of ALI (r = 0.860, p<0.001). NLR value is strongly correlated with muscle tissue damage (r = 0.634, p<0.001).

 

Conclusion: The duration of ALI increases the NLR value in wistar strain white rats, NLR values increased significantly after 6 hours of ALI. Necrotic muscle tissue occurs after six hours of ALI. NLR value is strongly correlated with muscle tissue damage. Revascularization must be done within 6 hours to prevent permanent damage.

 

 

Background: People with Alzheimer's dementia can experience a disruption in their daily activities, which can increase the burden of treatment costs. Puzzle therapy can encourage the release of the expression of the person living with Alzheimer's through artistic expression and creative processes. This study aims to determine the effectiveness of puzzle therapy on cognitive function of elderly dementia.

Methods: A quasi-experimental approach using pre-post with control group design was used in this study.  The number of respondents in the intervention group was 44 and in the control group was 27. The cognitive function on the elderly was assessed by the questionnaire of the Hopkins Verbal Learning Test (HVLT). Data were analyzed using SPSS version 17 for Windows. Bivariate paired T-test and Independent T-test were used in this study.

Results: There was a significant increase in the mean value of cognitive function among the intervention group (2.16±2.67; P=0.013) after puzzle therapy. The intervention group without dementia was also found significantly increase (2.10±2.19; 0.000). While in the control group who had dementia obtained a non-significant decrease in cognitive functions (0.29±0.75; 0.356). However, the control group without dementia was found to be significantly increased (0.5±0.7; 0.008) in the cognitive function.

Conclusion: Puzzle therapy intervention can improve cognitive scores significantly in all elderly people.

Background: Rapid wound healing is needed after tooth extraction treatment so that prosthodontics treatment can be done immediately. However, systemic diseases, such as diabetes mellitus, can inhibit the wound healing process. The state of hyperglycemia in people with diabetes mellitus can interfere with the function of macrophages and neutrophils. This condition can cause an imbalance in the cytokines IL-1β, TNF-α and IL-10 that are produced by macrophages and thus will affect the wound healing process. Spirulina and chitosan are two natural substances that have been proven to have anti-inflammatory properties. This study was aimed to determine whether the combination of 12% spirulina and 20% chitosan can accelerate wound healing through its intervention in cytokines IL-1β, TNF-α and IL-10.

Method: The samples used were 36 Wistar rats suffering from diabetes mellitus and divided into control groups induced by CMC Na base gel and treatment groups induced by the combination of 12% spirulina and 20% chitosan in the socket. These 2 groups were further divided into groups terminated on one day, three days and seven days post-extraction.

Results: The amount of IL-1β and TNF-α in the treatment groups is lower than that of the control group. Meanwhile, the treatment group of IL-10 showed an increase in IL-10 levels. 

Conclusion: The combination of 12% spirulina and 20% chitosan can accelerate wound healing. They are decreasing the amount of pro-inflammatory cytokines IL-1β and TNF-α as well as increasing the number of anti-inflammatory cytokines IL-10.

Backgrounds: Mechanical bowel preparation (MBP) was almost considered dogmatic in colorectal surgery. There are several methods known to perform MBP. Anastomotic leakage is considered higher in patients who had MBP, and it is thought due to alteration colonic morphologic, electrolyte and fluid imbalance.

Methods: This is an experimental study divided into two groups.  This study aims to determine the difference in collagen density, amount of fibroblast and histopathologic features in the anastomotic site between Wistar rats that had MBP and without MBP to the colonic anastomosis. The first group consists of 6 Wistar rats who had colonic anastomosis without MBP, and the second group consists of 6 Wistar rats who had colonic anastomosis with BMP. On the 10^th day after surgery, histopathology examination is performed with regards to collagen density, the number of fibroblasts, infiltration of inflammatory cells and the degree of bowel wall damage at the anastomotic site. Independent t-test is used to analyze the data if it is normally distributed and Mann-Whitney test is used if the data is not normally distributed.

Results: The amount of fibroblast was significant difference between two groups (p=0.02), which is amount of fibroblast in the second group (3.83 ± 0.408) is higher than the first group (2.33 ± 0.816). Meanwhile, there is no significant difference regarding collagen density, infiltration of inflammatory cells and the degree of bowel wall damage (p=0.59, p=0.082 dan p=1.00).

Conclusion: The conclusion of this research is by performing MBP prior to colonic anastomosis will exert the effect of more abundant fibroblast.

Background: Delirium often occurs to the elderly, which is associated with inflammation, malnutrition and low activities of daily living (ADL). The reduced ADL is associated with poor outcomes and death. ADL is affected by malnutrition and inflammation. Albumin is a marker for malnutrition and inflammation, while the neutrophil-lymphocyte ratio (NLR) is a marker for inflammation. This study aims to determine the relationship between albumin serum levels and NLR to ADL in elderly delirium patients in Sanglah Hospital Denpasar.

Methods: A cross-sectional correlative study among elderly delirium patients were conducted at Sanglah Hospital Denpasar from January to July 2018. The variables studied were albumin levels, NLR and ADL scores. Data analysis using SPSS version 23 with Pearson or Spearman correlation tests to determine the relationship between the variables examined.

Results: Total of 73 patients were sampled. The average albumin levels were 3.35 gram/dL, the median NLR was 8.17 and the median ADL scores were 3. There was no significant relationship between albumin and ADL in elderly delirium patients (p=0.35, r=0.10), but a significant correlation was obtained between NLR and ADL scores (p=0.04, r=-0.24).

Conclusion: Albumin did not significantly affect ADL. NLR was negatively correlated with ADL. The higher the NLR, the lower the ADL of elderly delirium patients.

 

Background: Cancer is caused by uncontrolled cell growth and angiogenesis as a vital component in tumor growth and metastasis. Angiogenesis provides nutrients needed by cancer cells in order to grow. Angiogenesis is triggered by pro-angiogenic mediators and overexpression of these mediators have been associated with malignant phenotype of ovarian cancer. It is thought that the more advanced tumors have higher tumor cell survival, proliferation, invasion, and angiogenesis, so that it will show higher expression of pro-angiogenesis mediators.

Objective: To examine the differences in nerve growth factor (NGF), tyrosin kinase receptor A (TrkA), and vascular endothelial growth factor (VEGF) expression level in different stages of epithelial ovarian cancer.

Patients and methods: This is a retrospective cross-sectional study conducted from June to August 2019 in the Department of Obstetrics and Gynecology in association with the Department of Anatomic Pathology of Dr. Moewardi General Hospital, Surakarta, Indonesia. The staging of the epithelial ovarian cancer was determined using the FIGO 2014 staging system. NGF, TrkA, and VEGF expression level were determined using immunohistochemical examination.

Results:The samples were 53 formalin-fixed, paraffin-embedded ovary, its adnexa, uterus, and lymph nodes tissue blocks of epithelial ovarian cancer patients. There are statistically significant differences in the proportion of NGF, TrkA, and VEGF level of expression in different stages of epithelial ovarian cancer (p<0.05).

Conclusion: There are statistically significant differences in NGF, TrkA, and VEGF level of expression in different stages of epithelial ovarian cancer.

Background: Caco-2 cells monolayer is one of invitro models to evaluate the translocation capacity of Lactobacillus spp probioticstrains. The translocation is influenced by mucosa permeability of enterocytes as shown by increasing transepithelial resistance (TER) and formation of tight junction proteins. The pore size of the supported permeable membrane used in in vitro assay was one of the crucial factors in performing bacterial translocation assay. Almost no study has been conducted using Caco-2 cells monolayer grown on 8-μm pore size polycarbonate membrane for evaluating probiotics translocation. Therefore this study aimed to determine whether the Caco-2 cells monolayer model was suitable as an in vitro translocation model.

Methods: Caco-2 cells monolayer was seeded onto 8-μm collagen-coated polycarbonate membrane insert Transwell^®. Differentiation of Caco-2 cells was detected by measuring the TER, while the ZO-1 protein (the tight junction proteins) was detected by immunofluorescence. H₂O₂ was used as a tight junction disruptive agent. Data were analyzed using SPSS version 23 software to compare the mean of TER measurement between untreated and H₂O₂-treated Caco-2 cells monolayer.

Results: The result showed that the TER of Caco-2 cells monolayer was gradually increasing until day 14, reaching more than 800 ohm.cm². Furthermore, the ZO-1 protein was successfully detected, indicated the tight junction formation.  TER value of H₂O₂-treated cells showed significantly lower than that of untreated cells (P<0.05), indicating a disturbance of cells monolayer integrity. Lactobacillus rhamnosus FBB81 was used for validating the translocation. There was no translocation observed; however, translocation was observed in H₂O₂-treated cells.

Introduction. Albumin is widely used to evaluate nutritional status. However, its usage on patients with chronic kidney disease (CKD) remains controversial. This study was conducted to determine whether serum albumin levels can be used indicator of nutritional status in end-stage CKD patients undergoing routine hemodialysis.

Methods. This cross-sectional study included 535 subjects who underwent hemodialysis twice per week in 2017 from three hospitals in Jakarta, Indonesia. Data were collected from the medical records of the subjects and analysed using descriptive statistics and mean comparisons of independent samples.

Results. Based on body mass index as a marker of nutritional status, the majority (85.9%) of subjects were not underweight. Almost an equal proportion of underweight subjects had normal serum albumin (15.1%) compared with hypoalbuminemia (14.4%). Hypoalbuminemia was found in 29.7% and 28.6% of non-underweight and underweight subjects, respectively. Moreover, there was no significant difference in serum albumin levels between underweight and non-underweight patients (p = 0.886, Mann-Whitney test).

Conclusions. Our data do not support a role for serum albumin level as a marker for nutritional status in CKD patients.

Introduction: Calciphylaxis (or calcific uremic arteriolopathy) is a life-threatening condition that affects 1–4% of patients with end-stage renal disease (ESRD). Penile necrosis is one of the complications of calciphylaxis that occur in ESRD patients undergone haemodialysis. Although rarely happen, this condition is potentially life-threatening and usually has a poor prognosis. It is associated with diabetes mellitus (DM), cholesterol embolism. The treatment varies, from surgical to conservative, and is usually depends on patient’s general condition.

Case presentation: A 41-years-old male, known to have ESRD and underwent hemodialysis for 1 year in 2014, but has been switched to peritoneal dialysis ever since, presented with complaints of severe pain, purulent and progressive necrosis of glans penis within the last two months, and history of long-term DM and hypertension. Physical examination showed that the patient was alert, with blood pressure of 141/80 mmHg, pulse rate of 88 bpm, respiration rate of 20 times per minute, and temperature of 36.8ºC. A yellow purulent tissue was noticed over the glans penis, foul-smelling discharge was observed from urethra and undersurface of penile lesion. Laboratory examination showed elevated calcium level of 7.3 mg/dL. Ultrasound revealed multiple calcifications at the base of penis, hypoechoic lesion, nearly circular, irregular border, likely sac with thin wall, attached to the gland penis, and filled with exudate. Doppler confirmation showed avascular area. The patient was treated with partial penectomy, debridement, and antibiotic.

Background: Chronic kidney disease (CKD) has a high global prevalence with an estimated prevalence of 10.6%. While the global prevalence of erectile dysfunction (ED) is 18.4% in men aged> 20 years and 33% aged> 50 years. ED is found in 70% of CKD patients. The aim of the study is to determine the relationship between duration of chronic kidney disease with ED in patients undergoing routine hemodialysis.

Method: A cross-sectional study conducted from 1 October 2018 to 18 June 2019 of 60 CKD patients undergoing hemodialysis. History and examination were carried out using the International Erectile Function Index (IIEF-5) questionnaire.

Result: Out of 60 samples, 42 patients (70%) had ED. The average duration of chronic kidney disease resulting in mild, moderate-moderate and moderate ED was 10.94 ± 10.79, 24.20 ± 17.84 and 38.40 ± 16.78 months, respectively. Univariate analysis using Spearman rank correlation showed a direct relationship between the duration of CKD and DE (P = 0.00, R squared 0.814).

Introduction: Fracture is one of the most common health problem cases in the community. The goal of treatment for fractures is to restore the condition of the bone to pre-injury condition. This research aims to obtain a novel treatment for fracture healing. Bitter melon is a plant that is easily found and widely consumed in Indonesia. According to previous research, Bitter melon extract (Momordica charantia L.) can accelerate bone growth and repair after a fracture.

Method:  In this study, parameters used to assed fracture healing were histological, radiological, and alkaline phosphatase levels. This study used Bitter melon extract with 70% ethanol. Research groups consist of 3 groups with different doses and 1 control group where each group consisted of 6 subjects. The dosage used is 200 mg/Kg BW (P1), 300 mg/Kg BW (P2), and 400 mg/Kg BW (P3). Before being treated the subjects underwent factorization procedure and then treated used using bandages and wooden sticks for immobilization of fracture segments. Furthermore, the subjects were given Bitter melon extract twice a day for 84 days. Then checked according to the parameters seen. The data obtained are quantitative data which will be tested for normality and homogeneity first, then ANOVA test.

Result: Callus formation findings shows the P1 groups showed the highest mean of callus formation among treatment groups after induced by Bitter melon ethanol extract of 200 mg/kg BW The results of LSD test in alkali phosphatase parameter between groups showed significant differences between the P1 group with controls (p = 0.000), P2 with controls (p = 0.000), P3 with controls (p = 0.000), P3 with P1 (p = 0.000) and P3 with P2 (p = 0.021)

Conclusion: There was a significant effect of the administration of bitter melon fruit extract on the formation of callus formation in animal model after osteotomy.

Background: The aging process can increase the incidence of neurodegenerative diseases such as dementia. Dementia is characterized by a gradual loss of cognitive performance for locomotor activity in exploring new environments. Research on dementia in mice was carried out by administering d-galactose to induce mitochondrial dysfunction, oxidative stress, inflammation and apoptosis of neurons.

Objective: The purpose of this study was to determine differences in locomotor activity in rats induced by oral d-galactose and intraperitoneal injection.

Methods: An experimental study with a posttest control group design. The subjects were male Wistar rats aged 12-14 weeks with weighing 200-300gram obtained from the Animal Laboratory of the Pharmacology Unit of the Faculty of Medicine, Udayana University. The study was conducted for 8 weeks, from June to August 2019. A total of 20 rats induced d-galactose dose of 100 mg/kg/day orally and intraperitoneal injection. The use of animals was carried out after obtaining ethical clearance from the ethical committee of the Faculty of Medicine, Udayana University. Y maze test is conducted for 5 minutes at the end of week 8.

Results: There was a decrease in locomotor activity in both groups. The average locomotor activity in the oral group was 6.5+0.268, and the injection group was 5.5+0.341. Bivariate analysis with unpaired t-test showed significant differences in locomotor activity between groups given oral d-galactose compared to the intraperitoneal injection group with p=0.034 (<0.05).

Background: Macrophage migration inhibitory factor (MIF) is known had pleiotropic properties particularly participating in inflammatory and immune responses. MIF has initially involved phagocytosis, spreading, and tumoricidal activity in macrophage. Recently, MIF was determined as a proinflammatory cytokine that has a pivotal role in viral infection such as dengue. This study aims to evaluate the role of MIF levels in patients with dengue infection at Sanglah General Hospital, Bali, Indonesia

Methods: A cross-sectional study was conducted among 48 children aged 1 to 12 years who hospitalized in the Children's Ward of Sanglah General Hospital, Bali, Indonesia, from August 2016 to July 2017. The respondents were divided into two groups: 24 children with a diagnosis of Dengue Shock Syndrome (DSS) (Group 1) and 24 non-DSS children. Data regarding age group, gender, obesity status, history of secondary infection, grading for dengue infection, and levels of MIF were assessed in this study. The MIF levels between both groups were evaluated and analyzed using SPSS version 23 for Mac. 

Results: Most of the patients were age > 5 years old in Non-DSS (87.5%) and DSS (54.2%) groups. However, females were predominant in the Non-DSS group (66.7%), but males in the DSS group (58.3%). The non-obesity history was more frequent in both Non-DSS (87.5%) and DSS (87.5%) groups. But, the history of secondary infection was more common in the DSS (70.8%) compared with a non-DSS group (37.5%). A significant difference in mean MIF levels was found between patients with DSS (102 (42.91-141.12) ng/ml) and non-DSS (24.85 (12.61-50.80) ng/ml) (p <0.001). MIF levels were significantly different between several degrees of dengue infection (P<0.05).

Conclusions: Serum MIF levels in non-DSS patients significantly differ from MIF levels in DSS patients. MIF serum levels increase in accordance with the increasing degree of severity of dengue infection. This data shows that MIF has a role in the occurrence of severe dengue infection.

Introduction: Brain tumor is a neoplasm originating from various type of intracranial tissue. Histopathology is the gold standard to diagnose brain tumor. However, due to its invasive nature, the biopsy procedure poses a substantial risk. Therefore, advanced imaging, such as conventional Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS), has been widely developed to determine brain tumor type. Conventional MRI has been a routine examination for a suspected brain tumor in Indonesia, and with the utilization of MRS, could theoretically improve the diagnostic yield. This study aims to find diagnostic properties of conventional MRI, Choline/Creatine and Choline/NAA ratio extracted from MRS, and as a combined parameter to differentiate brain tumor type.

Methods: This cross-sectional study involved 52 patients who underwent conventional MRI, MRS, and histopathology examination for a suspected brain tumor. The cut-off from Dean Criteria of conventional MRI, Choline/Creatine and Choline/NAA ratio to classify tumor type was determined from the ROC curve and then the diagnostic parameters were calculated from cross-tabulation. Also, a novel approach was made with logical-mathematical equation (disjunction/ ˅ / “or” and conjunction/ ˄ / “and”) to combined parameter obtained from MRI and MRS to predict histopathological brain tumor type.

Results: Conventional MRI combined with MRS improve diagnostic yield compared to a single parameter with a sensitivity of 87.5%, a specificity of 88.6%, accuracy of 88.5%, PPV of 58.3%, NPV of 97.5%, LR+ of 7.68, dan LR- of 0.1.

Conclusion: Combination of conventional MRI and MRS parameter could improve the diagnostic yield in differentiating the type of brain tumor.

Purpose:  Ventilator-associated pneumonia is a significant disease with high mortality rates. Acinetobacter baumannii is one of the most critical pathogens leading to ventilator-associated pneumonia. This study aims to evaluate the underlying risk factors in patients diagnosed with ventilator-associated pneumonia caused by Acinetobacter baumannii, who were followed in intensive care units of our hospital.

Patients and Methods:  The data of 112 patients diagnosed with ventilator-associated pneumonia caused by Acinetobacter baumannii, who were followed in Intensive Care Units other than Pediatric Intensive Care Unit of our hospital from 2013 to 2017, were evaluated retrospectively.

Results: Of the cases included in our study, 70.5% were male, and 29.5% were female patients. Of the cases, 87.5% were followed in Anaesthesiology and Reanimation Intensive Care Unit. The most common modifiable risk factors are mechanical ventilation, antacid use, and the most common non-modifiable risk factors were the presence of trauma and a history of cardiovascular disease.

Conclusion: Ventilator-associated pneumonia is a clinical condition with high mortality and morbidity in intensive care units. Incidence and mortality of ventilator-associated pneumonia can be reduced through the implementation of some necessary policies for the prevention of ventilator-associated pneumonia and the practices for the reduction or elimination of modifiable risk factors.

Background. The increasing number of elderly people in Indonesia reflects the success in various aspects of service, but on the other hand, these conditions have brought about the consequences of various social problems among the elderly such as physical, spiritual, social, and economic deterioration.

Method. The qualitative study was conducted in April 2019.

Result. Wana Seraya Nursing Home was founded in 1975 with the aim of developing the nursing home as a service center, guidance and information on social welfare for the elderly. The activities of the elderly include mental/spiritual guidance, exercise, recreation, and routine health services. Received the elderly who were escorted by their family and who were found neglected.

Conclusion. Various social and cultural aspects are the reasons for living in a nursing home, and with integrated services, the elderly feel comfortable and meaningful.

Background: Obesity is a state of Body Mass Index (BMI) above or equal to 25 kg/m2. In obesity, dyslipidaemia can occur alone or together with other comorbid. This situation could affect pro-inflammatory and anti-inflammatory cytokines that lead to health problems. Several parameters assessed in dyslipidaemia conditions include High-Density Lipoprotein (HDL) and adiponectin. This study aims to evaluate the correlation between HDL and adiponectin levels in obese adolescents. 

Methods: A cross-sectional observational study was conducted among 33 obese adolescence (0-18 years) who met the inclusion criteria at Junior and Senior High School in Denpasar during August 2018-January 2019 period. Variables evaluated in this study were age, sex, weight, height, BMI, HDL, and adiponectin. The correlation assessment of HDL and adiponectin levels was conducted by Partial Correlation test after controlling age and sex using SPSS version 23 for Windows. 

Results: Males (66.70%) were predominant than females (33.30%) with a ratio of 2:1. The average age of respondents was 15.51±0.70 years old. The mean body weight was 91.04±15.40 kilograms, followed by height (163.09±7.40 cm), BMI (34.08±3.90 kg/m2), HDL (43.40±8.00 mg/dl), and adiponectin (4.55±2.1 µg/ml). There was a very weak and not significant correlation by Partial correlation test (r=0.143; p=0.444) between HDL and adiponectin levels.

Conclusion: Our study found There was a very weak and not significant correlation between HDL and adiponectin levels among obese adolescent in Denpasar, Bali, Indonesia

Objectives: This study aimed to determine the association between Lecithin-cholesterol acyltransferase (LCAT) and Platelet-activating factor (PAF) with atherogenic potential in the ABO blood system.

Background: The current study is the first study that focuses on healthy blood donors and investigating a relationship between ABO blood groups and LCAT enzyme and PAF, which plays a notable role in atherogenesis.

Methods: ABO blood types characterize the role of the individualistic phenotype. Hence, it is generally assumed that ABO blood phenotypes are involved with many diseases. This cross-sectional study involved 176 healthy subjects with different ABO blood phenotypes. Measurements of routine lipids, LCAT, PAF and atherogenic plasma index (AIP) were performed in these subjects.

Results: Our most important finding was that individuals with blood group AB have statistically significant lower LCAT levels in serum. Additionally, there was a moderately negative correlation between LCAT and triglycerides in the AB blood phenotype (r=-0.452, P=0.02). Nevertheless, there were statistically significant correlations between LCAT levels and PAF levels of subjects with only non –O blood phenotypes (A, B and AB). Serum AIP values were statistically significantly higher in the AB blood group.

Conclusion: The present study suggests that blood group AB can be associated with decreased LCAT   levels when compared to the non- AB phenotypes. We suggest that LACT and AIP may be helpful biomarkers to illustrate atherogenic risk in AB blood phenotype, although this requires further investigation.

Abstract: Giardiasis is a gastrointestinal disease caused by the protozoan Giardia sp. Recent data showed that constant contact with livestock could pose greater risk of contracting this disease, especially without any protective gears. Unfortunately, this condition is still prevalent in several areas in Indonesia. Therefore, this study was aimed to evaluate the prevalence of giardiasis and its risk factors in the community around livestock areas and rivers in Mlati, Sleman, DIY, Indonesia.

Methods: A cross-sectional study was conducted from January-August 2019 around the livestock area and rivers in Mlati, Sleman, DIY. Stool samples were obtained from subjects who have livestock and live along the rivers or its tributaries. The status of Giardiasis were determined from microscopic examination and PCR using beta-giardin as the reference conducted in Parasitology and Biomedical Laboratory, Faculty of Medicine, UNS.

Results: A total of 179 subjects were were enrolled in this study. The prevalence of giardiasis among study population was found to be at 5.02% (n=9), 19 (10.6%) of them were cattleman, and 122 (68.1%) had a history of contact with cattle. Subjects who did not own any cattle seemed to have a significantly lower risk of contracting giardiasis (AOR: 0.041, 95%CI: 0.009-0.185; p=0.000) since contact with cattle also proved to be the risk factor of giardiasis (AOR: 1.080, 95%CI: 1.027-1.135; p<0.002).

Conclusion: This study revealed that constant contact with cattle lead to significantly higher risk of giardiasis for those who live among livestock and along the rivers in Mlati, Sleman DIY.

Background: Relapse in acute lymphoblastic leukemia (ALL) patients are still widely found even though most patients experience remission at the end of the induction phase. Inaccurate determination of remission status due to the remaining leukemic cells that cannot be detected by bone marrow morphology examination is thought to play a considerable role in the occurrence of relapse.

Objective: To measure the accuracy of the bone marrow morphology in determining remission at the end of the induction phase of ALL.

Methods: Diagnostic tests were carried out in pediatric ward and laboratory of Sanglah Hospital and Dharmais Cancer Hospital Jakarta in January 2017 to March 2019. Bone marrow morphology and minimal residual disease (MRD) test was performed on ALL children at the end of the induction phase. Minimal residual disease is the gold standard.

Results: Forty subjects with a median age of 5 years were included in this study. The median duration of induction phase was 75 days. Thirty-eight subjects (95%) had complete remission by bone marrow morphology, while only 16 (40%) subjects had complete remission by MRD. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of bone marrow morphology in this study were 100%, 8.3%, 42.1% and 100% respectively. Area under the curve (AUC) value of bone marrow morphology was 0.521 (95% CI 0.338 - 0.704). 

Conclusion: Bone marrow morphology has high sensitivity but low specificity and PPV in determining remission at the end of the induction phase of children with ALL. 

Background: Pneumonia is a respiratory disease that can cause a lot of morbidity and mortality. Factors that associated with severe pneumonia in children include toddler age, malnutrition, male sex, exclusive breastfeeding, incomplete immunization. This study aims to evaluate the probiotic effectiveness as adjuvant therapy in childhood pneumonia compared to placebo.

Methods: This is a randomized, double-blind controlled trial among 54 children with severe pneumonia aged 2 months-5 years who received standard therapy and probiotics compared to standard therapy and placebo from August 2017 to July 2019. Both groups were evaluated for treatment outcomes after receiving 5 days of adjuvant therapy at Sanglah General Hospital, Bali, Indonesia which divided into Group I (n=27) (standard therapy and probiotics) and Group II (n=27) (standard therapy and placebo). Variables assessed in this study include the characteristic of subjects, length of stay, duration of fever, shortness of breath, retractions, rales, C-reactive protein (CRP), probiotics, and history of breastfeeding. Data were analyzed by SPSS version 20 for Windows. 

Results: Both groups were shown predominantly in male gender (66.67% and 59.26%), exclusive breastfeeding (88.89% and 77.78%), no malnutrition status (81.48% and 77.78%), and having complete immunization history (81.48% and 88.89%) in Group I and II, respectively. There was no statistically significant difference on the length of stay, length of fever, duration of the breath, length of subcostal retraction and decrease in CRP levels on both groups (p>0.05). Meanwhile, there was a statistical difference in rales duration (p=0.037). Multivariate analysis using Ancova found probiotics were able to reduce the duration of rales significantly by 5.87 hours (p=0.022; 95% CI: -10.89 – (-0.86)).

Background: Striae are harmless skin disorders, but can cause cosmetic and psychological concerns. The role of estrogen in reducing adhesion between collagen fibers can cause striae in stretch area. Menarche that occurs during puberty play a role in the increment of estrogen levels. Adolescents who had experienced menarche tend to have higher estrogen levels.

Methods:  This was a cross-sectional study with total sampling method. 151 female students in Faculty of Medicine, Universitas Sumatera Utara were included and physical examination on the site of striae was done to confirm diagnosis. Age of menarche is classified as early (≤11 y.o), normal (12-13 y.o) and late (≥14 y.o). Study was conducted after approval from the Ethics Committee Faculty of Medicine, Universitas Sumatera Utara.

Results: Subjects in early menarche group were 84 (55.6%) subjects, normal were 56 (37.1%) subjects and late were 11 (7.3%) subjects. Median (11.0 y.o) and minimum-maximum age of menarche (9-16 y.o). Sites of striae were found mostly in thighs (66.9%), followed by buttocks (11.8%), calves (7.4%), hips (6.6%), chest (3.7%), upper arms (2.2%) and breasts (1.4%). Subjects with early menarche were 84 subjects in which 78 with striae and 6 without striae. Subjects with normal and late menarche was 67 subjects with 35 having striae and 32 without striae. In this study, we found a significant correlation between age of menarche with striae (p <0.05).

Conclusion: Early menarche can induce risk of striae in adolescents

Introduction: Hypospadias is one of the most frequent urological congenital anomalies. Due to the high difficulty of the procedures, a surgeon must face a steep learning curve at the start of the practice and experiencing the procedure to achieve maximum results. This study would like to evaluate the effect of experiences from a single surgeon doing hypospadias urethroplasty with the clinical outcome in Harapan Kita Mother and Children Hospital.

Method: Retrospective cohort study was done from the period of 2016 until 2018 in Harapan Kita Mother and Children Hospital by reviewing the medical records of all patients that underwent hypospadias surgical treatment by a single pediatric urologist. All forms of hypospadias, age, and procedures were included. The operative techniques were done by the operational standard within the literatures. All data were presented as tables and learning curve line graph. Statistical Analysis was done using SPSS v.23(IBM Statistics, New York).

Results: Total of 125 patients have undertaken urethroplasty by the surgeon. Most of the cases were new cases (96%) and dominant with 2-6 years group (57.6%). Proximal hypospadias (75%) followed by distal hypospadias (25%). Complications of fistula urethrocutan and stenosis neourethra were found to occur in 23% of the patients. Among the two most frequently done techniques, Onlay preputial island flap showed 10% occurrence of fistula urethrocutan and 1% occurrence of stenosis neourethra, as opposed to TPIF Duckett showing 13% and 20% respectively. There were trends of decrease in occurrences of fistula urethrocutan  and stenosis neourethra following more experience in operating the surgery. All occurrences achieved 0% of occurring complication at the recent experiences of hypospadias urethroplasty.

Conclusion: More experience in performing hypospadias urethroplasty seemed to affect clinical outcome, as occurrences of fistula urethrocutan and stenosis mid urethra be decreasing with more experience in a single pediatric urology surgeon.

Background: Diabetes mellitus (DM) is a condition which could lead to induce testicular damage due to oxidative stress by hyperglycemic stress. Several therapies have been elucidated to reduce the testicular damage; one of them is Platelet-Rich Plasma (PRP). PRP has known growth factor properties which may serve potential effects in the tissue regeneration. This study aims to determine the role of PRP on testes in streptozotocin-induced diabetic rats by evaluating its impact on testosterone serum level.

Methods: A randomized clinical trial with control group design has been conducted among 20 rats in this study. The sample of rats was divided into four groups such as control, DM (streptozotocin-induced), DM-Ins (treated with insulin daily), and DM-Ins-PRP (treated with insulin daily and PRP thrice in 2 weeks). Six weeks later, the testosterone level was measured by ELISA, and the right testis was collected for histopathology findings. Data were analyzed using SPSS version 25 for Windows. 

Results: The testes weight in the control group was 1.61±0.37 grams, followed by DM group (0.86±0.22 grams), DM-Ins group (1.15±0.25 grams), and DM-Ins-PRP group (1.09±0.36 grams). DM reduced testicular weight, seminiferous tubules diameter, the thickness of the epithelium and testosterone serum level significantly (p<0.05) compared with control. PRP administration increases the thickness of seminiferous epithelium (p<0.05) significantly. Besides, it also increased the testicular weight, tubules diameter, lumen diameter, and testosterone serum level, but not significant (p>0.05).

Conclusion: The administration of PRP showed a significant role in repairing testicular damage among diabetic rats.

Background: In the field of geriatrics, ethical issues (including the law) are very important, even among various branches of medicine, possibly in this branch that ethics and law have the most crucial role. Those several issues need special attention in Indonesia, in which geriatrics is a field of science which was just starting to develop. Therefore, some of the following ethical principles which will be put forward have often not yet present/executed in Indonesia. Meaning and knowledge regarding this matter will give a picture concerning how ethical and legal issues on the elderly patient should be enforced.

Objective: This review aims to explore further about the law and medical ethics in geriatric patient.

Method: A review of relevant literature was performed to elaborate the law and medical ethics in geriatric patient. A total of 12 qualified published literature of all years until 2019 were collected from several electronic database and manual search and included in this review.

Result: According to the law and medical ethics in geriatric patient, there were several considerations that need to carried out in the service of the elderly patient, those are ethical principles, directives of patient’s wish, administration of life sustaining device, condition of geriatric in unconscious/deep coma, approach to the patient, and religious and ethical aspects.

Conclusion: In the practice of geriatric services in our country, several aspects should be a considerations by following the law and medical ethics.

Background: Non-Obstructive Azoospermia (NOA) had dominating 60% of all azoospermia cases. Sperm Retrieval Techniques (SRT) continued with Intra-Cytoplasmic Sperm Injection (ICSI) are therapy modalities helping infertile azoospermia to be fertile. There are some options of SRT such as PESA, MESA, TESE, TESA and microdissection-TESE (mTESE) to collect sperm from azoospermia cases. This study aims to evaluate some factors influencing sperm retrieval rate by mTESE in non-obstructive azoospermia cases.

Method: The data collection for eligible articles were conducted from 2011 to 2019. Different database and manual search methods were used to find the topic-related articles, particularly in some factors influencing the sperm retrieval rate of mTESE in NOA cases. A total of 21 relevant kinds of literature were studied regarding some factors that might be increasing or decreasing of sperm retrieval rate by mTESE procedure. However, four literature were elaborated further due to a similar approach to get the results.

Results: A previous study from Saudi Arabia with 264 patients samples found significant different on testosterone level who had successful Sperm Retrieval Rate (SRR) 57.25%. SRR was related by several factors of testosterone, FSH, bilateral testis retrieval and seminiferous tubules diameter taken as the earliest study from India. Besides, taking bilateral testis sperm retrieval also had low SRR 14.4%, but serum FSH level was not influenced by increasing SRR. The previous study found a very weak correlation between FSH and SRR. A different study was conducted in Italy found that all NOA patient who undergone mTESE procedure found the Maturation Arrest (MA) has the significant higher success SRR until 67% after Sertoli Cell Only (SCO) syndrome and sclera-hyalinosis histology.

Conclusion: SRR depends on some factors those influencing by hormonal baseline preoperative such as testosterone level and FSH serum level, technique and how mTESE done by the operator in mTESE procedure.

Background: Bochdalek hernia is the most common type of congenital diaphragmatic hernia and is commonly diagnosed prenatally or in the immediate postnatal period. Adult cases are extremely rare and mostly asymptomatic. Symptomatic cases are even more exceptional with a wide variety of gastrointestinal or respiratory symptoms, which makes it difficult to diagnose.

Case: A 58-year-old female had experienced nausea, vomiting, atypical chest pain, and productive cough for two weeks before admission. She was diagnosed and treated for pneumonia and dyspepsia before being referred to our hospital. Further investigation using computerized tomography (CT) scan of the thorax showed a defect at the posterior aspect of left hemidiaphragm with a protrusion of the stomach and its omentum to the left hemithorax.

Conclusion: Symptomatic adult case of Bochdalek hernia is rare and difficult to diagnose. The CT scan can be used to confirm the diagnosis.

Background: Reincarnation (reborn after death), is a Hindu belief in Bali where it is proven by 'ngaluwang' ritual. In this ritual, every person who has a newborn baby will ask the help of  'orang pintar' to find out whose atman (spirit) has manifested in the baby. By returning to the world, there is no more sadness or feeling of loss in the elderly who suffers from the death of a spouse or other family member. This case study aims to know the reincarnation as supportive therapy for the elderly with depression.

Case Description: A qualitative case study with in-depth interviews has been conducted by 2 (two) elderly people with a history of depressive disorders from the community. The first case came from a retired woman 72 years old and other case was derived from a female-farmer 80 years old. Face-to-face interview assessment has been evaluated to the cases and narrative synthesis about the findings has been written by qualitative approach.  From the case study, the elderly experienced improvement in depressive symptoms, where feelings of loss, sadness, loneliness, guilt and hopelessness disappeared after the return of dead family members’ spirits into the world. The reincarnation of a loved one makes sadness and loss cease to exist, so symptoms of depression are healed.

Background: Hodgkin's lymphoma is a hematologic malignancy of lymphocyte cells. Intrahepatic or extrahepatic disorders can cause jaundice associated with lymphoma. An extrahepatic obstructive jaundice due to lymphoma is still rarely reported, the incidence is only 1.3% out of 370 patients.

Case Description: A male patient, 44 years old, admitted to the hospital because his eyes and all over his body became yellowish. He also felt itchy on his skin, and his stool color was pale. The patient was diagnosed with a post-chemotherapy relapse of Hodgkin's lymphoma twice with different regimens. The first chemotherapy was with the CHOP regimen. We evaluated the patient nine months after the chemotherapy with abdominal CT-scan, and we found paraaortic lymphadenopathy with infiltration to the spleen and gaster. Then, the patient was re-chemotherapy using Mesna's ICE regimen. Seven months after the second chemotherapy, the patient was re-admitted to the hospital with jaundice throughout his body. His laboratory results were 25.3 mg/dl for total bilirubin, 21.5 for direct bilirubin, 199 U/L for AST, 213 U/L for ALT, 469 mg/dl for ALP, and 6,400/mm3 for leukocytes. We found gall bladder hydrops and Intra-Hepatic Bile Duct Dilatation (IHBD) during an abdominal ultrasound examination. The results of the PET-scan showed multiple metastases to the peritoneal/omentum and diffuse lymphomatous infiltration in the gastric. After that, the patient was given the third chemotherapy with gemcitabine and vinorelbine regimens. His laboratory results in three weeks post-chemotherapy were, 6.4 mg/dl for total bilirubin, 5.87 mg/dl for direct bilirubin, 82 U/L for AST, and 36 U/L for ALT. We also found significant clinical improvement after the third chemotherapy.

Conclusion: The diagnosis is difficult to establish because many other things can also cause obstructive jaundice. Chemotherapy is one therapeutic choice in the management of obstructive jaundice related to Hodgkin's lymphoma.

Background: A postnatally acquired ileal atresia is very rare. Only few cases are described in literature and the etiology is still unclear.

Case Description: A Girl 15 years old was referred to Zainoel Abidin hospital with abdominal distention and can’t pass motion for 10 days ago. She also had intermittent colicky pain and billious vomiting. Previously, she had surgical correction for anorectal malformation with rectovestibular fistulae. Physical examination revealed tachycardia and tachypnea with abdominal distention as well as metallic sound even though there was no sign of peritonitis. Anal position index was normal and rectal vault collapse. Potassium level was low. Abdominal x-ray revealed multiple air-fluid level and gas only in the ileum level with dilatation all small bowel. Exploratory laparotomy was prompted and there was acquired atresia (type II) in the ileum 70 cm from ileocaecal valve due to adhesive band that twisted the bowel to the umbilical area. Proximal tappering and anastomosis end to end ileoileal were performed. She was discharged on operative day 7 with uneventful recovery.

Conclusion: Intestinal atresia typically presents in neonatal period with the classical symptoms of abdominal distension and vomiting.

Background: Hemisection is an endodontic surgery performed by removing one or more roots and existing crown structures to increase retention of the remaining teeth and to correct defected dental roots that are not possible to maintain. This study aims to evaluate the treatment of hemisection in the lower left first molar in the mesial tooth root with the restoration of the splint crown end with tooth 35 as retention at Sanglah General Hospital, Bali, Indonesia. 

Case Description: Male patient aged 21 years, in tooth 36 there is a cavity with a temporary restoration accompanied by a periodontal abscess. Teeth are sensitive to percussion tests and palpation, mobility is normal. Radiographic features appear to be perforated in the furcation section, and furcation involvement. Diagnosis of teeth 36 pulp necrosis is accompanied by abscess periodontal. During the first visit periodontal abscess drainage was performed, followed by functional crown lengthening in the periodontia. After one week of observation, there were no complaints, continued treatment of the distal root canal until the root canal filling. The next visit was carried out hemisection surgery in the form of separation of root bifurcation and extraction of mesial roots to the existing crown structure. Two months after the surgical procedure was evaluated, there was a good increase in bone density and no complaints. Then, the tapered serrated post was accompanied by the manufacture of composite core and final restoration using PFM crown splint with tooth 35 as retention. 

Conclusion: Surgical treatment of hemisection is a reliable alternative solution and has a good prognosis because it can maintain dental and periodontal tissue as long as possible without tooth extraction.

Background: Pemphigus Vulgaris (PV) is an autoimmune bullous disorder that usually affected the middle-aged and elderly. PV management in elderly patients is still a challenge for clinicians because of an increased risk of developing diabetes in the elderly. Corticosteroid is the first-line treatment for PV; however, careful consideration should be taken for diabetes patients due to the risk of disrupting glucose control leading to acute decompensation.

Case: A seventy-year-old female with type II diabetes reported to Sanglah General Hospital with multiple painful blisters on the chest, back, and oral mucous. She has been treated with insulin since last year, but the treatment was non-compliant. Dermatological examination showed multiple flaccid bullae containing serous fluid with a positive Nikolsky sign, and multiple skin erosions. Histopathology finding is appropriate with PV. The Tzank smear examination revealed acantholytic cells. She was diagnosed with PV and typed II diabetes; therefore, we treated her with azathioprine, insulin and Lantus injection; sodium chloride 0.9% compress and fusidic acid cream 2% twice daily for topical treatment.

Conclusion: Azathioprine is the treatment of choice because it works by blocking DNA replication without increasing blood glucose levels. The selection of appropriate medications can improve patient prognosis.

Background: In Toxic Epidermal Necrolysis (TEN), age has been reported to be not only a risk factor but also associated with increased mortality. The presence of underlying illness and comorbidities also increased the burden of TEN in elderly patients.

Case: A-70-years old male patient was consulted with a history of pulmonary tuberculosis and skin detachment. Symptoms started since four weeks before admitted to the hospital with redness in the face and extremities that spread to the chest and back accompanied by fever and malaise. The patient also complained of a wound in the lips and genitalia. Physical examination found multiple erosion, geographical shape, varied in size with positive nickolsky sign. The detachment covered 40% of the body surface area. From the laboratory, a result found a decrease in hemoglobin, blood glucose, albumin, and potassium. The patient was diagnosed with TEN, treated in the burn care unit, given supportive care and intravenous dexamethasone 10 mg every 8 hours, and then tapered off. The mortality rate from SCORTEN count was 12,1%.

Discussion: The incidence and mortality of TEN were higher in the elderly than among younger adults. Supportive care was the key feature of management with various adjunctive therapy, including systemic corticosteroids, intravenous immunoglobulin, and other immunosuppressant agents. Giving more comorbidities, more observation, and a multidisciplinary approach for TEN in elderly patients might be needed.

Conclusion: In the elderly, the risk and mortality of TEN were even higher, and the presence of comorbidities require more observation and supportive care.

Introduction: Acute angle closure glaucoma is an emergency ophthalmic condition that occurs due to a sudden closure of the angle in the anterior chamber of the eye, causing an abrupt intraocular pressure (IOP) increase. The purpose of writing this case is to present clinical findings in acute glaucoma and the initial managements taken in reducing IOP.

Case: A 45-year-old gentleman presented with 24-hour history of sudden severe left-sided headache associated with reduced vision on his left eye. Examination on the left eye revealed mixed conjunctival and ciliary injection, with visual acuity of 4/60 and raised intraocular pressure with the value of 40.2 on Schiotz tonometry. The anterior chamber was shallow, cornea was edematous, pupil was mid-dilated with diameter of 4 mm and unresponsive to light, iris crypt unclear, and hazed lens. The contralateral eye had a deep anterior chamber with normal pressure and a clear lens. He was treated initially by oral acetazolamide 250 mg two times a day, oral analgesic, a topical beta blocker 0,5% two times a day, and a topical steroid six times a day.

Conclusion: A prompt and appropriate management in cases of acute glaucoma can prevent further complications and permanent blindness.

Dear Colleagues,

It was a true honor that we accept colleagues at the 3rd Biennial Meeting of Pendidikan Intensif Fertilitas dan Embriologi (PIFE) from the Ikatan Alumni Andrologi Fakultas Kedokteran Universitas Airlangga (IAA FKUA) was held on Aula Fakultas Kedokteran Universitas Airlangga in Surabaya, November 22-24th 2019.

The theme of this conference was “Excellent Infertility Services; Competent and Accredited” and divided in the main form of workshops and symposiums, which are expected to update and improve the knowledge, especially about infertility and embryology. Also, this conference can be used as the right venue for reunion and brainstorming sessions with peers in arms. 

 This conference was participated by a total of almost 500 participants both on symposiums and workshops, also 37 abstracts to be presented. And these proceeding paper contains articles that were accepted for publication to Bali Medical Journal (BMJ) through the single-blind review process.

Finally, we would like to thank the committee, reviewer, and another scientific team who dedicating to finalized this proceeding book. We hope to be able to meet with all of you soon on the next PIFE in 2021.

dr. I Gusti Ngurah Pramesemara, S.Ked., M.Biomed, Sp.And

Coordinator of Organizing Committee