INTRODUCTION. There are no recent estimates of the complication rate associated with Intra Arterial Heparin Flushing (IAHF). The purpose of this study was to estimate the rate of complication occurring during and after Intra Arterial Heparin Flushing.

METHOD. This report is a descriptive study based on analysis of interventional radiology database. The study involved patients who underwent IAHF procedure started from January 2018 until December 2018 in Rumah Sakit Pusat Angkatan Darat Gatot Soebroto (Indonesian Army Central Hospital). Subjects were assessed for their age, sex, medical history, diagnosis, intra-procedural complication, and post-procedural complication.

RESULT. All IAHF procedures were performed via transfemoral catheterisation and using a vascular closure device to help achieve homeostasis. Our population included 1223 (70,57%) male and 510 (29,43%) Female, with age ranging from 21 to 80 years old. The majority of the subject was in 51-60 years old age group (35,31%). All IAHF were technically successful. No intraprocedural complication was noted, there was no occurrence of iatrogenic vessel injury (dissection) and no neurological deficit secondary to IAHF procedures. There was some local complication after IAHF procedure such as hematoma 44 persons (2,54%), oedema around the puncture site six patients (0,35%), and bleeding at the puncture site three patients (0,17%). Beside local complication, there were several systemic complications such as allergy in 10 persons (0,58%). No neurological complication was reported after IAHF.

CONCLUSION. We concluded that IAHF has a relatively low rate of acute complication. Most complications were related to local hemostasis control, and no severe sequelae were found.

Purpose: This study aims to identify the relationship between sociodemographic and obstetric factors with the use of the internet by women as a source of information about pregnancy, childbirth, and baby care.

Method: This cross-sectional study involved 185 women who had babies aged 0-3 months. Data were collected in August and September 2018. Data were collected by interviews using questionnaires. Data analysis was conducted by chi-square and logistic regression

Results: The age factor (p = 0.255), education (p = 0.071), occupation (p = 0.100), income (p = 0.077) and parity (p = 0.380) were not related to the use of the internet. The factor of service provider is significantly related to internet usage (p = 0.031).

Conclusion: The use of the internet by women in Bali to search information about pregnancy, childbirth, and baby care is not related to most sociodemographic and obstetric characteristics. The results of this study could be taken into consideration by health practitioners to create innovative programs in the field of maternal and child health services.

Background: Hepatocellular carcinoma (HCC) is a primary liver malignancy with high prevalence rate, associated primarily with the Hepatitis B Virus. HCC is the third leading cause of death worldwide. The prevalence in Indonesia is estimated at 100 per100,000 inhabitants. Treatment is generally ineffective as patients are already at advanced stages when diagnosed. Trans-arterial Chemoembolization (TACE) is a promising treatment, and β-Glucan combined therapy is expected to treat HCC more efficiently. This study evaluated the treatment response of TACE in HCC combined with β-Glucan orally.

Methods: A randomized clinical trial was conducted on 63 patients with HCC. The subjects of the study were randomly assigned into two groups: 32 administered TACE plus β-Glucan, and 31 with TACE plus placebo.

Results: In the β-Glucan group, there were four patients (12.50%) with complete response, 16 (50%) partial response, 3 (9.38%) no response, and 9 (28.12%) in deteriorated response. In the placebo group, there were 0 complete response, 11(35.48%) partial, 2(6.45%) no response, and 18 (58.07%) deteriorated response. The survival rate of the β-Glucan group was longer (median 39 weeks) than the placebo group (median 26 weeks). CD4, CD8 and IL-2 post-TACE increased significantly (p<0.05). The placebo group had 4.143 times, significantly higher hazard risk (p<0.05).

Conclusion: HCC therapy with a combination of TACE and β-Glucan is beneficial to increase the therapeutic response, immunity and survival rate.

Background: E-selectin plays a pivotal role in the inflammatory response of acne. Astaxanthin (AST), an supplement claimed having anti-inflammatory and antioxidant properties, has potential in inflammatory skin therapy. This study aims to determine the effect of oral AST as an anti-inflammatory agent on the serum level of e-selectin in acne vulgaris. 

Methods: This is a double-blind, randomized controlled trial study with a pretest and posttest control group design. The participants were 34 acne vulgaris patients with inflammatory lesions (papulopustular acne). The participants are randomly assigned to the treatment or control group to receive oral tablet of 4 mg of AST or placebo in addition to standard acne therapy of tretinoin cream 0.025% and clindamycin cream 1.2%. Each group was measured for the serum level of E-selectin before therapy (pretest) and after one month of therapy (posttest). 

Results: The pretest and posttest level of the mean serum e-selectin in the treatment  group were 50.21 ± 21.12 ng/ml and 50.04 ± 22.99 ng/ml, respectively. There is no significant difference between the pretest and posttest of the mean e-selectin level in the treatment group (p=0.943). While, the pretest and posttest of mean serum e-selectin level in control group were 57.84 ± 20.71 ng/ml and 55.87 ± 15.98 ng/ml, respectively. There is no significant difference between the pretest and posttest of the mean e-selectin level in the control group (p=0.453). There was a decrease in the mean serum e-selectin level of the treatment and control groups one month after therapy. However, the decrease of the mean e-selectin level between treatment and control group is not significantly different (p=0.547).

Conclusion: The addition of oral AST to standard acne therapy shows no significant difference in reducing the serum e-selectin level compared to placebo.

Introduction: Ureteropelvic Junction Obstruction (UPJO) is the obstruction of upper urinary tract, present in fetal life until adulthood. Congenital UPJO mostly results from an intrinsic process with dilatation of renal collecting system. Acquired UPJO in adulthood may present without dilatation of renal collecting system, correlated with urolithiasis, infection, postoperative peripyelo-inflammatory fibrotic complication, and urothelial malignancy. In the past, Pyeloplasty, classic dismembered (Anderson-Hynes) or laparoscopic, is the gold standard treatment. In this study we would like to report and discuss comprehensive etiologies, diagnostic, and its treatment based from real case.

Case Presentation: We report case: a 33-year-old Indonesian man with left flank colic pain (VAS:8/10), nausea, and hematuria that did not disappear with medication. He had stone history in right proximal ureter with hydronephrosis and hydroureter, Ureterorenoscopy had been performed two years ago. Other vital signs and hemodynamics were stable. Abdominal USG demonstrated bilateral hydronephrosis and hydroureter. Abdominal X-Ray showed right ureter stone. Right-Left Ureterorenoscopy + Double-J-Stent were performed. The diagnosis was Bilateral Nephrolithiasis, Stenosis, and Proximal Ureter Obstruction leading to Recurrent UPJO. Three months later there was still pain, the patient was undergone Cystoscopy + URS + Laser Endopyelotomy + DJ-Stent Replacement (from 6 to 7 Fr). One month later, DJ-stents were removed but the stenotic ureter remained so Laparoscopic End-to-End Proximal Ureter Anastomosis Resection and DJ-stent Insertion were finally performed. Patient’s complaints were slightly reduced.

Conclusion: The Recurrent UPJO cause inadequate urinary flow leading to renal impairment. Clinical signs, symptoms, etiologies, and diagnostic imaging have significant role in determining the diagnosis. Early surgical intervention is the definitive treatment to reduce renal damage and its complications. Further researches to establish the causes, clinical manifestations, diagnostic imagings, and alternative treatments of UPJO are highly expected.

Background: Foreign bodies in upper digestive tract, as well as respiratory tract, are common cases in daily life. This incident can occur in all age groups, ranging from children to elderly. Endoscopy and bronchoscopy are the first treatment option, nevertheless, case with complications which endoscopy or bronchoscopy cannot be done, it requires another extraction procedure specifically surgery.

Method: We conducted a retrospective review of patients who came to consult to Thoracic Cardiovascular Surgery Department by ENT Department. The data obtained are from 2009-2019.

Result: Out of 290 patients recorded, experiencing foreign body impaction in both digestive and respiratory tract for the last 10 years, the highest number was digestive tract with 243 cases (83.8%) and 47 respiratory tract cases (16.2%). From 17 patients who underwent surgery, 70.6% men and 29.4% women. The age group of children and adults had the same number as seven patients (41.2%) and elderly with three patients (17.6%). The highest number of surgical procedure was thoracotomy with 10 patients (58.8%) while cervical esophagotomy with seven patients (41.2%).

Conclusion: The failure of the extraction procedure using endoscopy or bronchoscopy in the case of a foreign body leads to surgery as a definitive therapy for patients. The age group of children and adults have same number. Cases of impaction in the esophagus are the most common. The most common surgical procedure performed is thoracotomy. In this study the success rate of extraction by surgery reached 100% without additional morbidity and mortality.

Background: Regular physical exercises can improve physical and mental health and especially important for individuals with extensive disorders, such as Down’s syndrome. For the success of rehabilitation, it is necessary to involve the parents of children with Down’s syndrome in the process. By understanding the parents' motivation, a successful training program will be possible.

Aim: This study is aimed to determine the importance degree of various parents’ motivations in sports participation of their children with Down’s syndrome.

Method: A survey was conducted in 137 families from 22 regions of Russia in November 2016. The survey included 23 motivational statements and parents were asked to rate the importance of each statement on a scale of 1 to 10. The results were divided into 5 groups based on the importance of the motivational statements: “absolutely important”, “important”, “difficult to say”, “not important”, and “absolutely not important”. Statistical analysis was done using average values method.

Result: Parents considered the following reasons to let their children participate in sports as “absolutely important”: to implement healthy and active lifestyle; to develop interaction skills in a group, independence, and dexterity; to improve the skills of large-scale body movements and coordination of movements; and to encourage socialization. None of the motivational statements were considered as “absolutely not important”.

Conclusion: This study found that parents considered the majority of the motivational statements as important. Considering the parents’ motives will encourage the sports participation of children with Down’s syndrome.

Background: Urethral strictures cause malfunction of the urethra. Urethroplasty is a cost-effective treatment option. Its success rate is greater than 90% where excision and primary anastomosis(EPA)is performed and 80-85% following substitution urethroplasty. Definitive treatment for recurrent urethral strictures after urethroplasty is not defined. Repeat urethroplasty is a viable option with unknown efficacy.

Method: Retrospective analysis of patients who underwent revision urethroplasty for unsuccessful urethroplasty at KNH from 2015 to 2018 was performed. Patients’ age, demographic data, stricture length, location, aetiology, comorbidities and type of urethroplasty was evaluated from records with complete data. Male patients aged 13 to 80years were evaluated. Comparison of urethroplasty outcome between two patient cohorts was made: Fresh urethroplasty patients versus failed urethroplasty who underwent revision so as to determine efficacy of the later. Principal outcome measure was urethral patency, while Subsidiary outcome measures were associated complications. Outcomes were compared using statistical package SPSS version 23.0.

Result: 235 patients who met inclusion criteria underwent urethroplasty, 71.5% (n=168) had a successful outcome, while28.5% (n=67) failed and were subjected to revision urethroplasty. Another 58% were successful upon revision but experienced significant morbidity. Majority of urethral strictures were bulbomembranous. Trauma was the leading cause of urethral strictures followed by idiopathic strictures. EPA was the commonest surgery while Tissue transfer featured prominently in revision urethroplasty. A significant correlation was evident between stricture length, prior surgery, and procedure choice and urethroplasty outcome.

Conclusion: Revision urethroplasty is feasible after failed urethroplasty but less efficacious. Stricture length, number of prior surgeries and procedure choice affected outcome.EPA and Tissue Transfer techniques are essential surgical armamentarium in revision setting.

Background: High Body Mass Index (BMI) is known associated with mortality and morbidity among the elderly. However, other studies also show the opposite result in high BMI as protective against Activity Daily Living (ADL). Accurate quantification of the role of BMI in the incidence of disability in ADL is desirable in the face of the increasing prevalence of individuals with overweight and obesity and prolonged life span in the population. This study aims to investigate the association between Body Mass Index and Activity of Daily Living in population-based elderly.

Method: A cross-sectional analytic study was conducted in the urban and rural area of Bali Province, particularly in Buleleng and Tabanan regencies. BMI and Barthel Index score were recorded among respondents. Data were analyzed using SPSS version 17 for Windows and aP-value less than 0.05 was considered statistically significant.

Results: A total of 167 respondents, 100 and 67 from the urban and rural area of Bali Province respectively, was predominant by 93 (55.7%) females and followed by 74 (44.3%) males. Spearman test found a significant weak positive correlation between weight and Activity of Daily Living (r= 0.168; p<0.05). In addition, a significant weak positive correlation was also found between BMI and ADL (r= 0.158; p<0.05).

Conclusion: Our study showed increased values of BMI is a protective effect on ADL.

Background: Psoriasis is debilitating, albeit remained underdiagnosed and undertreated, disease typically known for its cutaneous manifestations. Recent evidence pointed towards multisystemic comorbidities that we aim to elucidate further in this study.

Methods: A cross-sectional descriptive study was conducted in Dermatology Teaching Center in Slemani city from April to September 2019. One hundred dermatologist-confirmed psoriasis patients aged 18 years old and above were subjected to structured interview, physical examination and blood investigations to determine the presence of psoriasis extracutaneous manifestations.

Results: There were a total of 100 patients with a mean age of 47.2 ± 15. Majority of the patients comprised of middle age group (42.0%), female (67.0%), with 10-20 years disease duration (36.0%). Only a few of them are currently smoking (16.0%) and consume alcohol (6.0%). Patients with extracutaneous involvement primarily had multiple (37.0%) as opposed to singular (24.0%). Metabolic syndrome was the most prevalent (30.0%) extracutaneous manifestation in this study.

Conclusions: Extracutaneous manifestations of psoriasis were ubiquitous and often coexisted. Emerging progressive comorbidities prompted greater recognition and integrated multidisciplinary approach.

Background: Traumatic brain injury (TBI) is responsible for more than one million hospital visits and causes disability and death in all age groups and genders. Every day, 153 people die from injuries including traumatic brain injury.

Methods: We use a retrospective, cross-sectional study design. We collect data from patients admitted to our hospital on November 2018 that was diagnosed and treated for traumatic brain injury. The clinical information at follow-up was also analyzed.

 

Results: We collected 60 cases of TBI, that consist of 35 male (58%) and 25 females (42%) with an average age of  18-39 years. 42% of patients had post-traumatic amnesia. The leading cause of TBI was from motor vehicles accident, which constitutes to 90%, followed by falls (8%) and others (i.e. self-harm and assaults 2%). Glasgow Coma Scale (GCS) were examined, and we found 85% of patients presented with GCS scores ≥ 9 and 25% with score ≤ 8. Brain Ct scanning findings showed cerebral oedema (25%), epidural hemorrhage (18%), intracranial hemorrhage (15%), and subarachnoid haemorrhage (12%). Laboratory findings showed an increase of leukocyte count (80%), high segmented neutrophils count (72%), hyperglycemia after TBI (7%), hyponatremia (2%), hypernatremia (11%), hypokalemia (22%), hyperkalemia (17%) and hyperchloremia (30%).

Conclusion: We reported 60 cases of TBI and collected demographic data upon patients arrival in the hospital, such as; GCS score, brain imaging and laboratory findings. This information can help prevention strategies, identify research and education priorities, and support service needs among those living with TBI.

 

Introduction. Stroke is the leading cause of disability and has a high mortality rate with most death occur in developing countries. Unfortunately, only a few informations available about strokes in developing countries, including Indonesia. Thus, this research aimed to provide a general overview of stroke patients from stroke unit in Bali, Indonesia.

Methods. A cross-sectional study was carried out in Sanglah General Hospital, Denpasar Bali between August 2017 – January 2018 evaluating newly admitted stroke patients. There was no age limit, both male and female were enrolled. Data related to socio-demographic, risk factors, clinical features, and imaging result were extracted from medical records.

Results. A total of 82 subjects were enrolled. Strokes were more common in males (61%) with most affected age group was 50-59 years (29.3%) and young stroke (age ≤45 years) accounted for 19.5% of the cases. Ischemic stroke (53.7%) was more common type encountered, and hypertension (76.8.3%) was leading risk factor. First-time stroke accounts for 80.5% while recurrent stroke accounts for 19.5% with 3.6% admitted for the ≥3 episodes. Overall, territories of middle cerebral artery including basal ganglia (25%) and internal capsule (20.5%) were frequently affected in ischemic stroke while lenticular-capsular (44.7) and lobar structure (18.4%) in hemorrhagic stroke. Typical chief clinical presentation was hemiparesis (42.7%) and altered consciousness (26.8%).

Conclusions. Stroke tends to affect late adult with male predominance and hypertension as leading risk factor. Ischemic stroke was the most common type. There were differences in clinical presentations and anatomic site preferences between hemorrhagic and ischemic stroke.

Introduction: This study aims to prove the model of family planning classes based on predisposing, enabling and reinforcing factors to increase knowledge, attitudes, family support, and the use of long-term contraception methods in high risk fertile age pairs.

Method: The design used for this study is the Community Trial with the Randomized Pretest-Posttest Control Group Design approach. The sample in this study were couples of childbearing age who had one or more high risk criteria (age <20 years, age> 35 years, number of children> 3 and birth distance <2 years) as many as 150 respondents as an intervention group (family planning class model based on predisposing, enabling and reinforcing factor) and 150 respondents as a Control group (Conventional Family Planning Class Model). This intervention was carried out for 6 months. Data collected includes data on knowledge, attitudes, family support, and use of contraception methods. Data were analyzed using Chi-Square test.

Result: The family planning class model based on predisposing, enabling and reinforcing factors effectively increases knowledge (p=0.000), attitudes (p=0.000), family support (p=0.037), and long-term contraception method use (p=0.000).

Conclusion: The family planning class model based on predisposing, enabling and reinforcing factors effectively increases knowledge, attitudes, family support, and the use of long-term contraception methods in high risk fertile age couples

Background: Kidney stone still a health problem in the world. Today, the choice of therapeutic modality is also increasingly varied, percutaneous nephrolitotomy (PCNL) is still the first line for stone therapy with varying success rates, some high or low. Sometimes need additional measures such as extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) for the rest stone and good preventive behaviour are needed. This can be influenced by several risk factors, a risk factor predictor is required to get a high stone free rate in patients after PCNL.

Methods: This research is a cross sectional retrospective study, we recorded 50 patients at the Medical Records Installation at Sanglah Education General Hospital in Denpasar since January 2018-November 2019 with kidney stones performed by PCNL, each patient will be calculated S.T.O.N.E Nephrolithometry score can be seen on CT Stonography and the presence or absence of stone after PCNL. The parameters of S.T.O.N.E Nephrolithometry are size, tract obstruction, number of calyces, essence. And calculated the best cut off, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of the S.T.O.N.E Nephrolithometry score to predict stone free status after PCNL.

Results: The best cut off value in this study is <9, where patients with S.T.O.N.E Nephrolithometry score  < 9 have a risk stone free after PCNL 25 (50%) patients, while the S.T.O.N.E Nephrolithometry score >9, has a risk of not being free and there are stones left  25 (50%) patients. S.T.O.N.E Nephrolithometry had % sensitivity 60.6%, specificity 70.6%, and 64 % accuracy in this study. Positive predictive value and negative predictive values were 80% and 48%.

Conclusion: from this study the S.T.O.N.E Nephrolithometry score sensitively predicts stone free status in kidney stone patients after PCNL and can be used as a tool to education the patient before PCNL and therapy.

Background: Post-operative non-articular tibia fracture some problems that often occur include pain, muscles atrophy, muscles weakness, and joint stiffness that makes patients limited in their daily activities. Several factors that play a role in muscles atrophy and weakness prolonged immobilisation and lack of exercise. Plantar flexor isometric exercise might effectively prevent the problem. Not yet known the effect isometric exercise of plantar flexor on calf circumference in patients post open reduction internal fixation of tibia fractures, due to the lack of studies in this field. The aim of investigating the effect of isometric exercise plantar flexor on calf circumference in patients post open reduction internal fixation non-articular tibia fracture.

Methods: Study design using an experimental model with pre-test and post-test control group design divided into two groups, group A obtained treatment of isometric exercises of the plantar flexor muscles, range of motion knee and ankle joint while group B obtained a range of motion knee and ankle joint.

Results: Descriptive analysis in group A there were 13 (81.3%) samples which increased calf circumference and 3 (18.7%) samples did not change while group B there were 4 (25%) samples increased calf circumference, 1 (6%) sample did not change and 11 (69%) samples were reduced calf circumference. The study was found increase mean calf circumference in group A was 0.76 cm and reduction mean calf circumference group B was 0.44 cm. Independent samples differences with α of 0.05 and confidence interval 95% was obtained p-value = 0.003, which has shown there is a significant difference in increased calf circumference group A obtained isometric exercises plantar flexor compared to group B without isometric exercises plantar flexor in patients  post open reduction internal fixation of a non-articular tibia fracture. 

Conclusion: The study found plantar flexor isometric exercise in patients post open reduction internal fixation non- articular tibia fracture enhances calf circumference that will prevent muscle calf atrophy and weakness.

Background: Epilepsy patients in developing countries is quite high. A person can have epilepsy within a certain time limit, but also not a few people who survive with this condition for life. This situation will affect cognitive function. Cognitive function impairment in epilepsy patients can be triggered by various factors related to aetiology, clinical, and others. Therefore, we tried to find the factors that influence the cognitive function in epilepsy patients.

Methods: This study was an observational analytic study with a cross-sectional design. The study was conducted using primary data obtained from direct interviews and MMSE examination and secondary data obtained from medical records to confirm the diagnosis of epilepsy. Samples were collected based on the diagnosis of neurologist in the patient's medical record at the Regional General Hospital Dr. Zainoel Abidin Banda Aceh from October to December 2019. This study involved thirty-four epilepsy patients.

Result: There were cognitive function decreased in recalling 47,1% and 26,5% in Attention and calculation. The relationship between the frequency of seizure (p = 0.028) and therapy (p = 0.012) on the  MMSE .

Conclusion: Politherapy was the dominant factor affecting the MMSE score of epilepsy patients.

Background: The elderly will experience several physical and psychological changes. Such problems will inevitably lead to stress in the elderly. The prevalence of stress events in the elderly in Indonesia is 8.34% and at Yogyakarta Social Service Center of Tresna Werdha, Abiyoso Pakem Unit, Sleman is 38.4%. If left unchecked, stress can result in a prolonged depression. This study aims to identify the effectiveness of music and music video on stress in the elderly at Yogyakarta Social Service Center of Tresna Werdha, Abiyoso Pakem Unit, Sleman.

Methods: A quasi-experimental study with Pre-and Post-test without control design were conducted. The number of respondents was 24, whereas taken by Simple Random Sampling approach. The music intervention was given to the 12 respondents and music video intervention to the 12 respondents. Stress was measured using DASS. Data were analyzed using paired T-test to determine the effectiveness of therapy and Independent T-test to evaluate the differences in therapy using SPSS version 17 for Windows.

Results: Based on age, the respondents with 60-74 years were predominant (83.3%). Most of the respondents were female (79.2%). The analysis using Paired T-test indicated that there was a significant relationship of music therapy on the elderly (P<0.05). In addition, a significant result in reducing stress was also found in the music-video group on the elderly (P<0.05).

Conclusion: Music and music video therapies are effective to reduce stress in the elderly.

Background: Isoniazid Preventive Therapy (IPT) can reduce the Active Pulmonary Tuberculosis (APT) in People living with HIV/AIDS (PLWHA).  IPT is recommended by the World Health Organization (WHO). It has not been implemented routinely in all countries.

Aim: To evaluate whether IPT in PLWHA reduces the APT at Wangaya Hospital, in Denpasar, Bali, Indonesia.

Methods: A prospective cohort study was conducted during October 2014 until November 2016. A total of 244 PLWHA were included in this study. The first group were 122 participants received antiretroviral therapy (ART) and IPT and 122 participants received only ART (second group). Cox regression analysis was employed to calculate effects in both groups and to identify predictor factors for active tuberculosis. The statistical analysis performed with cox proportional hazard model.

Results: There were 137 (56.1%) males and 107 (43.9%) females. Incidence of APT in the IPT group was 1.09 per 100 person years and non IPT groups was 12.57 per 100 person years. Incidence of APT in the non IPT groups was significantly higher than in the IPT groups with crude hazard ratio (cHR) of 12.59 (95% CI: 2.70-53.43). After variables adjustment for age, sex and CD4 count, the incidence of APT in the non IPT group were found with adjustment hazard ratio (aHR) of 10.26 (95% CI: 2.15-48.99).

Conclusion:  The incidence of APT was significantly higher in the non IPT group than in the IPT group.

Background: Halal Assurance System (HAS) training is mandatory for industries that will apply for halal certification at LPPOM MUI of Banten Province. In some trainings, the participants felt uncomfortable which can be seen from the level of fatigue and complaints caused by an uncomfortable sitting position due to poor design of tables and chairs. This condition is very detrimental to participants.

Methods: This treatment by subject design study did from April to November 2019. The participants were who attended the HAS Training-23000 that fulfilled the inclusion and exclusion criteria. Samples then grouped into three group with different condition in each. We took indoor environment data and each sample about sample characteristics and business characteristics. Muscle complaints took by subjective questionnaires before and after training. The data analyzed by SPSS and p<0.05 was significant.

Results: Total 120 participants were included consisting of 40 participants in each condition.  The indoor environment conditions in the three conditions are the same (p>0.05). There were significant reduce of score of musculoskeletal complaints and fatigue before and after trainings in each condition (p<0.0001). Seats with multilevel arrangement (condition III) have the lowest value of musculoskeletal complaints and fatigue.

Conclusions: The smooth communication among participants influences the speed in implementing participatory ergonomics. The use of tables and chairs with a seating capacity of 6 people/table is the most effective when compared to others. The application of participatory ergonomics can reduce musculoskeletal complaints and fatigue of participants of the Halal Assurance System.

Background: The ageing process (photoaging) can be caused by sun exposure, especially ultraviolet light. Organic and inorganic sunscreen products are commercially available. Two calixarene organic compounds, namely C-phenylcalix[4]resorcinaryl octacinnamate and C-methylcalix[4]resorcinaryl octabenzoate, have been successfully synthesized. Besides, the antioxidant quercetin can be potentially combined with these two compounds since ultraviolet rays also cause reactive oxygen species. This study aimed to evaluate the acute toxicity profile in vitro by cell line Vero and to develop the optimal activity of the product in New Zealand rabbit skin.

Methods: Optimal formulation of three formulas nanoemulgel of sunscreen was using  D Optimal Mixture Design. Acute cytotoxicity test in vitro by culture cell line Vero was using randomized post-test only control group design. The activity of the product was measured by the value of Sun Protection Factor (SPF) in vivo using randomized post-test only control group design. Data of acute toxicity in vitro test (IC50 value) was analyzed using probit analysis and activity sun protection factor was analyzed using one-way ANOVA on SPSS version 20 for Windows. 

Results: The in-vitro toxicity test of formula 1, 2, 3 nanoemulgel were 2,940.569 µg/mL, 13,489.728 µg/mL, and 6,289.248 µg/mL respectively. The formula 1 nanoemulgel sunscreen products were produced with the three highest SPF values. SPF in vivo test showed that the nanoemulgel protection capability of the formula 1 with three different doses were 34; 36; dan 43 respectively. 

Backgrounds: Life-threatening organ dysfunction such as sepsis often happens in developing and developed countries. Ethyl acetate fraction of Moringa oleifera leaf (MO-EA fraction) is claimed by several studies to be able to control inflammation and oxidative stress.

Objective: This study aims explore the effect of MO-EA fraction in improving the liver and kidney function in sepsis rat model.

Materials and Methods: This study is an experimental research using sepsis rat model. The research was conducted on a total of 66 white Wistar rats aged 3-4 months, weighing 200-300 grams, randomly allocated into nine treatment groups, negative, and normal control groups. The treatment and the negative control group received LPS induction to reproduce the inflammation stress during a sepsis. The treatment groups receive various daily dose of MO-EA fraction starting of 10, 20, and 40 mg/kgBW. The measured outcome were serum creatinine, ureum, serum glutamic oxaloacetic transaminase (SGOT), and serum glutamic pyruvic transaminase (SPGT).

Results:  There are statistically significant differences of the level of ureum, creatinine, SGOT, and SPGT between various treatment group receiving various dose of MO-EA fraction and negative and normal control group within seven days after LPS induction. α=0.05.

Conclusion: The serum level of ureum, creatinine, SGOT and SGPT in the sepsis rats administered with MO-EA were lower than the control group. The best MO-EA fraction is A2 which was 20 mg/kgBW/day given from 5 days before the LPS induction continuing to the seventh day after the LPS induction. MO-EA fraction supplementation may have a potential as a preventive therapy for endothelial stress in sepsis rat model.

Background: The increasing number of elderly populations also increases the number of chronic degenerative diseases, including diabetes mellitus (DM). Therefore, diabetes control is needed to prevent various complications and improve the health quality of the elderly patient. This study aims to obtain preliminary information about diabetes control in elderly patients in the geriatric clinic of Karangasem District Hospital to provide appropriate management to improve diabetes control.

Method: This research is a cross-sectional study and consecutive sampling of 46 DM patients who seek treatment at the geriatric clinic of Karangasem District Hospital in the period May-July 2019. Inclusion criteria were DM patients aged ≥60 years. We exclude diabetes person with acute infection and end-stage renal disease. The criteria for DM control used in this study is body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), postprandial glucose (PPG), and HbA1c levels. Data were analyzed using SPSS version 25 for Windows and depicted descriptively. 

Results: Among 46 samples, there were 23 (50.0%) male and 23 (50.0%) female enrolled in this study. We find median of each, BMI was 23.2856 kg/m

 

Background: Vulnerability among older women than older men create a different challenge to achieve their quality of life. A different place to stay and the aging process can affect a high risk of malnutrition among older people. Based on Indonesia regulation, no. 11/2009, the government builds one program to ensure older people get social welfare. But negative stigma toward panti wreda from community provokes panti wreda’s challenge in their services. Moreover, the different aging process creates a different challenge. Sometimes, older people find it difficult to communicate in recent places, different physical activity, and nutrition status. 

Objective: To explore quality life from older women in panti wreda from the social and nutrition aspect. 

Methods: This study uses descriptive quantitative methods. Recall, Index Bartel, and Mini Nutrition Assessment (MNA) are used to collect data in Panti Wreda Sosial Salib Putih. Data can be obtained from 13 older women among 16 total older women in Panti Wreda. Three older women cannot be collected regarding their condition, i.e., bed rest and mental health problems.

Result: Panti Wreda Sosial Salib Putih has the challenge of providing diet requirements among older women. The tight budget causes Panti Wreda Sosial Salib Putih only to provide indifferent food every day. Limited diet requirements among older people lead to a high risk of malnutrition. Recall data show that older people in Panti Wreda Sosial Salib Putih have excess in protein and fats. And based on MNA, 7 older women from 13 older women in total have malnutrition, while data from index bartel show that all older women have independent status. 

Conclusion: older women in Panti Wreda Salib Putih still have the challenge to meet their diet requirements while independent status can create a new challenge to have malnutrition.

Background: Maternal mortality rate is not only an indicator of the quality level of maternal care but also represents the socio-economic status of any country. Maternal mortality had a decreasing trend in Iran during the last 24 years. Since preventable maternal mortality rate should be decreased to zero by 2030, effective planning and management in this regard are more needed.

Aim: This study aims to review the maternal mortality status in Iran systematically.

Method: This systematic review was designed and conducted in 2016. The information was gathered from searching databases including PubMed, Cochrane, Elsevier, Scopus, and also national databases including SID, Medlib, MagIran, IranMedex, and IranDoc. The selected time interval for searching was the studies published between 1985 and 2016. Meta-analysis statistical methods were used to calculate the maternal mortality rate.

Result: There were 26 studies related to the study objectives were included and analyzed. The mean and standard deviation of the age of maternal mortality was estimated to be 30.8±5.6 years. Of the 15 studies mentioning types of termination of pregnancy, they showed the maternal mortality rates of 44% in natural childbirth, 52% in cesarean section, and 4% during pregnancy.

Conclusion: This study emphasizes the importance of leading and guiding studies and knowledge management to complete the knowledge cycle for maternal mortality. Considering the disparities in regions, the interventions should take into account the socioeconomic factors as well as improving roads and transportation system and women literacy level.

Background: Infertility is one of the clinical problems that affect medical and psychological conditions. An estimated 15% of couples in the world experience infertility and almost half occur on men. Excessive stress oxidation has been known responsible to the DNA damage and induces shortening of sperm telomere length. This study aims to determine the role of vitamin C and ubiquinone as antioxidants to maintain sperm telomers length among infertile men. 

Methods: An experimental clinical trial with a pre and post-test control group design has been conducted among 30 infertile men respondents at Doctor Soetomo Regional General Hospital, Surabaya. The respondents were divided into three groups: the combination of Vitamin C and Ubiquinone (P1), Vitamin C and Placebo (P2), and Ubiquinone and Placebo (P3) administration. All three groups were examined for pre- and post-test of sperm telomere length. Data were analyzed using SPSS version 21 for Windows.

Results: Most of the respondents were origin from Surabaya (66.7%), never been treated (66.7%), normal BMI (46.7%), non-smoking history (66.7%), non-alcohol consumption (90.0%), having 22-25 of IIEF-5 Score (60.0%), no heat exposure (90.0%), no chemical exposure (73.3%), and diagnosis with primary male infertility (90.0%). No significant difference of sperm telomere length was found among three treatment groups (p>0.05) using Post-Hoc Test. 

Conclusion: There was no significant difference in sperm telomere length of infertile men among groups. All antioxidants used in this study have a similar ability to maintain or influence sperm telomere length in infertile men.

Background: The massive development of Assisted Reproductive Technology (ART) offers new hope for the infertile couple. However, the advanced storage methods to preserve the quality of sperm has been raising by cryopreservation technique. This study aims to analyze the motility rate, recovery rate, and viability in subgroups of cryopreserved spermatozoa from the oligozoospermic patient as the quality parameter.

Method: A true-experimental study by pre-test and post-test group design was conducted among 13 oligozoospermic patients with a very low sperm counts at Medical Biology Laboratory Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. Parameters assessed in this study include motility, viability, and concentration of spermatozoa according to Laboratory Manual for the Examination and Processing of Human Sperm 5th edition. The samples were divided into 4 groups such as Group 1 (71-100 sperm), Group 2 (31-70 sperm), Group 3 (11-30 sperm), and Group 4 (1-10 sperm) based on sperm counts which underwent 30 repetitions of cryopreservation. Data were analyzed using SPSS version 17 for Windows. 

Results: There was a significant difference in the recovery rate among Group 1 (34.88±1.87), Group 2 (44.77±1.89), Group 3 (61.83±2.09), and Group 4 (70.90±2.71) of cryopreservation technique (P<0.001). However, there was no significantly different in the motility rate of sperm-cryopreservation technique among Group 1 (65.60±14.63), Group 2 (52.50±26.28), Group 3 (39.90±9.95), and Group 4 (44.70±41.77) (p=0.070). Based on the sperm-viability parameter assessed in this study, there was no significant difference among Group 1 (56.40±3.89), Group 2 (58.60±5.99), Group 3 (59.60±9.96), and Group 4 (56.70±11.30) (p=0.504).

Conclusions: The sperm-cryopreservation technique significantly affected the recovery rate of very low sperm number count among groups. However, there was no significantly different in the motility rate and viability parameter in this study. 

Background: Polyalkylimide is a permanent dermal filler that has been used for skin augmentation to ameliorate skin ageing. The massive volume injection has a higher risk of complication. This study aims to find collagen capsule formation by small volume polyalkylimide implantation.  

Methods: We used an experimental post-test only control group design. The control group received subcutaneous NaCl injection, and the treatment group received subcutaneous polyalkylimide injection 0.018 mL (equal 1 mL in the humans). After five weeks, all rats (Rattus norvegicus) strain Wistar were sacrificed. The skin samples were collected and proceed for histologic staining. Capsule thickness was performed as mean ± SD.     

Results: The treatment group showed polyalkylimide mass in subcutaneous tissue, collagen fibres surrounding the polyalkylimide, and no inflammatory cells. The collagen capsule thickness was 7.45 ± 0.78 µm.

Conclusion: The small volume polyalkylimide subcutaneous injection-induced collagen capsule formation. The small volume implantation shows promising effects for skin augmentation.

Background: The management of advanced epithelial ovarian cancer (EOC) has evolved to become a combination of initial cytoreductive surgery (CRS) followed by chemotherapy. Chemotherapy has been regarded as standard therapy for the majority of women with advanced EOC for several decades. A thorough understanding of drug resistance mechanisms is needed, as this remains the largest obstacle in treating patients with recurrent disease. The aim of characterized by age of women, type, stage, grade and clinical staging of the tumor.

Methods: Data from regimens containing platinum (cisplatin or carboplatin) used in treating ovarian carcinoma in Sarjito General Hospital were analyzed prospectively. Relative dose intensity was calculated as a fraction of the dosage of a drug in the standard regimen of cyclophosphamide, doxorubicin, and platinum.

Results:   The higher age of women will have lower response to chemotherapy. Women aged below 50 years old are much higher responsive to chemotherapy.

Conclusion: Cisplatin based chemotherapy has a better response to ovarian carcinoma in earlier stage. In higher stage, it will give a complete removal of all macroscopic tumor tissue.

Background: Acne vulgaris (AV) is a chronic inflammatory disease of pilosebaceous follicles with polymorphic lesions, consist of blackheads, papules, pustules and nodules with varying degree of severity. Stress is one of the triggers for acne vulgaris.

Aim: This study aimed to determine the correlation between stress scale with the severity of acne vulgaris.  

Methods: This study was an observational analytic study with a cross-sectional design involving 100 patients with acne vulgaris. The dermatological examination was performed in each patient to determine the severity of acne vulgaris with Acne Grading Indonesian Acne Expert Meeting 2015 based on Lehmann Criteria, followed by Holmes-Rahe stress scale questionnaire to evaluate stress scale. The collected data were analysed using the Spearman correlation test.

Results: Of the total 100 samples examined, the majority of patients with acne vulgaris were 17-25 years old (71%) and most of them were female (68%). The majority of research subjects were classified with moderate acne vulgaris (45%), followed by mild (43%) and severe (12%). Low-stress scale (44%) is mostly found in this study, followed by a medium stress scale (29%) and high (27%). There is a positive correlation between stress scale and the severity of acne vulgaris with moderate strength (r = 0.456; p = 0.001).

Conclusion: It can be concluded in this study that there is an association between stress scale and the severity of acne vulgaris.

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