Introduction: The prevalence of type 2 diabetes mellitus (T2DM) is increasing steadily, assuming an epidemic proportion throughout the world. Most of this increased burden will come from developing countries. Studies show an increasing role of inflammation in the pathophysiology of diabetes. Estimation of neutrophil-lymphocyte ratio (NLR) could be a simple, inexpensive marker to stratify at-risk diabetes patients. This study aimed to estimate the NLR and CRP levels as a measure of systemic inflammation in diabetics compared to healthy controls. We also investigated if NLR was lower in diabetics with good glycemic control. 

Methods: A cross-sectional comparative study, conducted in a tertiary hospital on 60 patients with T2DM and 69 healthy controls after voluntary informed consent. Anthropometric parameters, fasting plasma glucose, Lipid profile, CBC, CRP, and HbA1c were measured for all participants. 

Results: The diabetic group showed significantly higher waist circumference(p=0.007) mean TG (p=0.003), VLDL-c (p=0.001), LDL-c (p=0.010), TG/HDL-c (p=0.001), HbA1c (p=0.00001), MPV (p=0.002), NLR (p=0.006), and CRP (p=0.004) values and lower HDL-c values (p=0.039) as compared to the control group. No significant difference was seen in BMI, Waist -Hip ratio, total cholesterol, and total cholesterol/HDL-c values between the two groups. Among the diabetics, only HDL-c (p=0.018) and TG/HDL-c ratio (p=0.049) differed significantly with glycemic control.

Conclusion: Diabetics had higher inflammatory markers (NLR, CRP) as compared to controls. Dyslipidemia (high TG, low HDL-c with high TG/HDL-c) and a higher waist circumference were seen in diabetics. Diabetics with fair control of glycemia (HbA1c < 7%) did not demonstrate lower NLR levels indicating that meticulous glycemic control may not ameliorate the chronic inflammation seen in diabetics until dyslipidemia is corrected. 

Background: Breast cancer is the most common cancer diagnosed in women. It basically caused by a progressive accumulation of genetic disorders. Vitamin D and its receptor (VDR) have been shown to have an effect on the carcinogenesis of breast cancer. Several studies have shown VDR Apa1 polymorphisms became the most prevalent polymorphism of other polymorphism variants of breast cancer. There are still lack of studies that review the relationship of VDR gene polymorphisms, especially Apa1 on breast cancer risk among Balinese woman.

Method: This study was a case-control design- analytic study to see the relationship between Vitamin D receptor Apa1 gene polymorphism and breast cancer risk in Balinese women. There were 42 venous blood samples from breast cancer women and healthy women in Bali. This study was carried out at the Faculty of Medicine Integrated Biomedical Laboratory. DNA isolation was done for sequencing to determine the sequence of gene bases. Then the data were analyzed using SPSS 16.

Results: Univariate analysis showed the characteristics of the subject and research variables. Bivariate analysis showed that the presence of VDR Apa1 polymorphism in Balinese women increased the risk of breast cancer by 5,846-fold higher compared to women without polymorphism (CI95%:1.065- 32.082; P = 0.03). Multivariate analysis confirmed that the VDR Apa1 polymorphism independently influence and increase the risk of breast cancer without being influenced by other variables (95% CI: 1.065-32.082; P = 0.042).

Conclusion: In this study has shown VDR Apa1 polymorphism significantly associated and increased the risk of breast cancer in women in Bali.

Background: The role of liver surgery is increasing for primary and secondary liver tumors. One of the most feared complications of liver surgery is Post-Hepatectomy Liver Failure (PHLF). The authors would like to present their experience in a year for liver surgery with morbidity and mortality, including PHLF as evaluation parameters.

Methods: This is a prospective study from July 2019-2020 in a single-center, in which patients with pre-existing liver pathology were assigned to receive liver resection. Types and duration of liver resection, duration of Pringle maneuver, and blood loss were measured. PHLF was evaluated using the ISGLS classification, and morbidity was evaluated using Clavien-Dindo and FABIB classification. The energy device used varies from the harmonic scalpel, ligature, and Thulium-doped fiber laser (TDFL). Data were processed descriptively with IBM SPSS 25 (SPSS Inc., Chicago, USA). Data are presented in descriptive frequency tables as medians and means.

Results: A total of 17 procedures were performed, including minor hepatectomies (58.82 %) and major hepatectomies (41.18%). The mean duration of operation 5.3 hours, the duration of parenchymal transection 91.5 minutes, and the estimated blood loss 1638.2 cc. Vascular occlusion method using Pringle maneuver with mean duration of 31.67 minutes. PHLF incidence found were grade B (5.88 %) and grade C (11.7%), while morbidities by Clavien-Dindo mostly are grade 2 (38.2%) and FABIB classification mostly are Bleeding (45%). The mean postoperative ICU is 3.06days, and the mortality rate is as high as 23.52%.

Conclusion: Liver resection in our center is quite fair judging from the low incidence of PHLF, although the mortality rate is at 23.52%. Due to that, surgical technique and teamwork between units involved need to be improved even further.

Background: Acne scar is the most common complication in acne that occurs in about 49% of acne individuals. Fractional resurfacing lasers such as CO₂ laser and erbium-doped yttrium aluminum garnet (Er: YAG) have been widely used for acne scar treatment and give satisfying results have complications such as pain, hyperpigmentation, infection, prolonged erythema, and scarring. Fractional erbium: yttrium scandium gallium garnet (Er: YSGG) laser solves previous laser techniques' disadvantages. It has an ideal wavelength of 2790 nm, which balances the epidermis layer's vaporization and thermal damage in the dermis's superficial layer. Platelet Rich Plasma (PRP) is an autologous concentration of human platelets in a small plasma volume that secreted various growth factors that can speed up the scar healing process.

Case report: A-24 years old male student came with a chief complaint of acne scars on his face four years before the examination. The patient's condition is classified as moderate-severe acne scarring based on Goodman and Baron's criteria (qualitative global acne scarring system). Acne scars treatment plan was single fractional erbium: YSGG laser for the left side of the face and combined fractional Er: YSGG laser with topical autologous PRP on the right side. This procedure was performed in 2 sessions with an interval of 4 weeks, the final evaluation at 12 weeks after the first procedure. Clinical improvement of acne scars was assessed using qualitative and quantitative scales based on Goodman and Baron's, patient and observer scar assessment scale (POSAS), quartile grading scale, and patient satisfaction level.

Conclusion: In the final evaluation, there was an improvement on the entire grading scale on the right side of the face (Er: YSGG laser + PRP) and the face's left side (Er: YSGG laser only). Post-treatment erythema was found on both sides of the patient's face but disappeared within three days on the face's right side and five days on the face's left side.

Background: Non-genital warts are a very common and benign skin disease caused by low-risk Human Papilloma Virus (HPV) infection. Common warts, flat warts, and plantar warts are common clinical manifestations of non-genital warts and are caused by many different types of HPV. Data on the prevalence or incidence of non-genital warts in Bali is still very limited. Therefore, it is important to identify the incidence and prevalence as a reference for conducting further studies on non-genital warts cases. This research studied the incidence, distribution, and characteristics of non-genital warts at Mangusada Badung General Hospital.

Methods: Descriptive cross-sectional retrospective study, using secondary data from outpatient clinic's patient register book and medical records in a period of 1 year, from January 1 - December 31 2019. Variables that included are types of non-genital warts, age and sex. Data were analyzed with SPSS 18 for Windows.

Results: The number of patients in this research was 3086. The incidence of non-genital warts was 88 cases (2.85%). Common wart was the most frequent findings, with 82 cases (93.2%) and flat wart with 6 cases (6.8%). Non-genital warts frequency was highest among age 11-20, with 31 cases (35.2%). Based on sex, non-genital warts are more frequent in males than females (56.8% vs. 43.2%). The most frequent non-genital warts cases in the male population occur at age 11-20 (20 cases), while in female populations, 11-20 and 21-30 share the same incidence of non-genital warts (11 cases).

Conclusion: Non-genital warts most likely to affect a male compare to the female population. It tends to occur more frequently in children and young adults. The common wart is the most frequent findings in non-genital warts.

Background: Bulung sangu (Gracilaria sp). is wildly widespread Rhodophyta in Bali and usually consumed as vegetable. Bulung sangu is reported for its bioactive compound scientifically proven as antioxidant, anti-inflammatory, and anti-hypercholesterolemia. Likewise, Bulung sangu as Rhodophyta is a potential source for food, fertilizer, cosmetic and pharmaceutical industry. Bulung sangu production is highly fluctuating and unable to meet its demands. Proper and correct cultivation methods based on molecular information are expected to increase the availability of Bulung sangu in Bali. Complete taxonomy is required to design the proper cultivation method. Meanwhile, Bulung sangu taxonomy is limited to the genus level. More information on Bulung sangu strain is needed, either does its relatedness.

Methods: Fresh Bulung sangu was collected from Serangan coastal area, Bali. DNA extraction was applied followed by PCR amplification using six combinations of COI primer sequence. DNA sequences obtained was evaluated to determine pairwise distance, percent of similarity and phylogenetic relationship compared to Gracilaria species registered in GenBank.

Results: PCR amplification produced 730 base pairs amplicons. Genetic distance and percentage of similarity obtained exhibit relatedness to Gracilaria gracilis with 0.487 of pairwise distance and 49.04% of similarity. The phylogenetic tree produced seven clades in which Bulung sangu and Gracilaria gracilis were in the same clade.

Conclusion: Bulung sangu showed closest relatedness to Gracilaria gracilis.

Background: Modified Blalock-Taussig shunt (MBTS) is a common palliative procedure for congenital heart defect to connect the systemic to the pulmonary circulation via a synthetic shunt from a subclavian artery to a pulmonary artery. However, certain postoperative complications do exist, such as blockage. Early identification of modifiable risk factors is important to prompt early intervention for better outcomes.

Material: This article is a descriptive narrative retrospective study. We gather data from the Cipto Mangunkusumo Hospital Cardiovascular Center medical report of 8 patients having undergone reoperation post-MBTS surgery as their first operation between January 2018 and October 2020. Data were analyzed using SPSS version 20 for Windows.

Results: The patient’s age ranged from 3 months to 30 years old. Seven of them suffered from shunt occlusion complications, while the other suffered from the bleeding problem. The laboratory results showed that preoperative hemoglobin (18.9±4.1 g/dL vs. 16.90 (10.80-19.20) g/dL), hematocrit (58.8±12.40% vs. 42.9±14.30%), platelet counts (284.487±147.003 vs. 210.625±104.688) 10³/uL, and oxygen saturation (86.00 (75.00-89.00) vs. 70.00±17.00) levels were higher than the pre-reoperative. The coagulation markers showed that PT value has increasing trend (1.10 (0.90-2.30) vs. 1.30±0.20) while aPTT (5.90 (2.90-6.30) vs. 2.30 (1.60-5.30)) seconds and activated clotting time (ACT) (205.00±86.00 vs. 165.00 (114.00-255.00)) showed the opposite.

Conclusion: MBTS remains the first-choice bridging palliation surgery to increase the pulmonary blood flow in congenital heart defects. The cause of shunt failure remains inconclusive in this study. Other studies suggest that graft material choice, S/PA ratio, S/W ratio, operative approach, thrombus formation, and aPTT value contribute to shunt failure, thus needing a reoperation.

Background: Psoriasis vulgaris is a recurrent chronic skin disorder signed by hyperproliferation and epidermal inflammation. One of the etiology of psoriasis is genetic factors related to genetic polymorphism as disease susceptibility markers. This study was aimed to analyze the correlation of TNF-α gene promoter region polymorphism with psoriasis vulgaris.

 Methods: An analytical observational study with cross-sectional design to identify correlation TNF-region promoter polymorphisms with psoriasis vulgaris. This study included 45 psoriasis vulgaris patients and 45 non-psoriasis vulgaris patients from April to October 2016 at Immuno-dermatology Polyclinic of Dermatology and Venereology/Haji Adam Malik Hospital, Medan. We isolated DNA from the blood sample then ran into the PCR process with specific primers. PCR results were examined by electrophoresis with 2% agarose. Chi-Square test was used to test the hypothesis of a relationship between the TNF-α promoter region and psoriasis vulgaris at a significance of P <0.05.

 

Result: Analysis by Chi-Square test found a significant correlation of polymorphism in TNF-α gene promoter region with psoriasis vulgaris in -308G (p=0,001) and 1031 (p=0,002) loci.

Conclusion: TNF-α gene promoter region polymorphism TNF-α gene -1031 was more frequent in the case group, -308G was commonly found in the control group. Both of them were significantly correlated with psoriasis vulgaris.

Background: Humans' role in small industries as a source of labor is still dominant, mostly manual work. The research was conducted on manual workers in small agel fiber industries in Yogyakarta. Manual work is related to human strength and endurance. Ergonomic problems often arise in manual labor, including neck pain, back pain, and leg pain called musculoskeletal disorders. Non-ergonomic working conditions also increase the electrical activity of muscles. This study aims to reduce electrical muscle activity and musculoskeletal complaints by repairing an ergonomic workstation in the agel fiber twisting process.

Methods: This research is an experimental study with 15 female subjects. The electrical activity of muscles is measured when working under conventional conditions (Period 1) and repairing an ergonomic work station (Period 2). The electrical activity of the muscles was measured using surface electromyography. Musculoskeletal complaints were measured before and after intervention with conventional conditions (Period 1) and ergonomic work station repair (Period 2). Musculoskeletal complaints were measured using the Nordic Body Map Questionnaire. The measurement data between the two periods were analyzed by using the paired samples t-test and the Wilcoxon signed-rank test.

Results: The results showed a decrease in the upper trapezius muscles' electrical activity by 35.46% and the erector spinae muscles' electrical activity by 22.43%. The average of musculoskeletal complaints decreased by 23.77%, measured after working in period 1 and period 2.

Conclusion: Ergonomic work station can reduce the electrical activity of the upper trapezius muscles, electrical activity of the erector spinae muscles, and musculoskeletal complaints in workers twisting the agel fiber rope.

Introduction: Indonesia is a country with a large agricultural and industry, known to utilize various types of pesticides, as well as several other industries with uncontrolled pollution levels distributed across the nation. Besides, numerous studies have stated the adverse effects of chemicals substances used in daily life and industrial waste on the health of living things, including humans. This study aimed to determine the infertility characteristic in the agricultural and industrial areas in Karawang Regency, West Java Province, Indonesia.

Methods: The study was conducted retrospectively on medical records. Therefore, this study determined the infertility characteristics based on sperm analysis, the etiology of the causes of infertility in female, and the diagnosis of infertility. Data collection was obtained from patients' medical records in the Infertile Poly of Mitra Bunda Amanda Hospital Karawang, Karawang Regency, West Java Province, Indonesia. 

Result: The results showed infertility was most prevalent in males aged 30-40 years (55.79%) and females below 30 years (61.05%). Furthermore, the male and female's most prevalent educational qualification (33.68% and 36.84%, respectively) was discovered to be high school diploma. In terms of occupation, most male (56.84%) were laborers, while the female was mostly housewives (36.84%). Meanwhile, oligoasthenoteratozoospermia was the most analyzed sperm type (33.68%), and polycystic ovary syndrome was the most common etiology of infertility in females (26.32%). The most prevalent diagnosis was primary infertility factors, male and female (45.26%).

Conclusion: Primary infertility of male and female factors, polycystic ovary syndrome and oligoasthenoteratozoospermia dominate the infertile population in agricultural and industrial areas in Karawang Regency, West Java Province, Indonesia.

Introduction: Free non-vascularized fibular head graft (FNVFHG) is a method in handling bone defect after wide resection of the tumor.

Methods: This study used descriptive research with the sample of three cases of proximal humeral giant cell tumor that underwent bone resection and reconstructed with a free non-vascularized fibular head graft. The outcomes were measured by the Musculoskeletal Tumor Society (MSTS) score, range of motion of the shoulder, and activity of daily living.

Results:  The overall MSTS score of 3 patients was 73%. Two patients were able to perform all the shoulder motions, including flexion, extension, abduction, external rotation, internal rotation with limited range of motion, while the other patient could only perform restricted internal rotation. Two patients performed all of their daily activities with the affected extremity, including personal hygiene (tooth brushing), writing, eating, holding a glass, dressing, and riding a motorcycle. In contrast, the other patient encountered difficulty performing tooth brushing and self-feeding with the affected extremity, using the contralateral upper extremity.

Conclusions: Free non-vascularized fibular head graft may serve as an option in handling bone defect after wide resection of musculoskeletal tumor at the proximal humerus. This method can be safely performed with an acceptable functional outcome.

Background: The utilization of technology in diabetes management, especially self-monitoring blood glucose (SMBG), is growing rapidly. However, the effectiveness of SMBG applications on the smartphone is not yet known. This study aims to assess the effectiveness of using a smartphone-based SMBG application in type 2 diabetes mellitus (T2DM) patients in the Indonesian population.

Methods: This is a quasi-experimental (before and after) study conducted at three tertiary hospitals in Jakarta and Malang, Indonesia. Inclusion criteria were T2DM patients aged 18 years and above who have been familiar with performing SMBG  and manually record the results. All subjects were asked to use a smartphone-based SMBG application named Teman Diabetes application for six months, and patients' SMBG performance was assessed at the end of the study Bivariate analysis using T-test or with the Mann Whitney U test performed. Chi-square test is used to analyze the categorical with Risk Ratio (RR) and 95% Confidence Interval (CI). The p-value <0.05 (two-tailed) is considered statically meaningful.

Results: From 100 patients enrolled in the study, 78 patients completed the follow-up. We found that the use of the SMBG application helped the subject overcome the difficulty in remembering to perform SMBG (p=0.004), helped change the subject's perception of the benefits of SMBG (p=0.049), improved the subject's diet pattern (p=0.006), and decreased the number of subjects who stopped performing SMBG due to self-perception of lack of benefit SMBG activity (p=0.049).

Conclusions: The study found that using the SMBG application helps manage diabetes in T2DM patients.

Background: The differences of Hemodialysis and Hemoperfusion’s  combination can increase of Uremic Toxin clearance, average creatinine clearance, and Angiotensin elimination optimally. The hemodialysis and hemoperfusion’s  combination also can decrease blood pressure and reduce the use of Anti Hypertension drugs so that the number of cardiac events in CKD patients may decrease. The use of ABPM is chosen because this is the best method of automatic blood pressure which has the most accurate blood pressure measuring periodically.

Objective: This study aims to determine the difference of regular Hemodialysis and Hemodialysis with Hemoperfusion on blood pressure measured by using ABPM in Medan, North of Sumatra.

Methods: This study was a pre-experimental study which conducted since December 2013-March 2014 to the 20 regular hemodialysis patients. The measurement included anamnesis, height, weight, systolic and diastolic blood pressure among patients with regular hemodialysis and hemodialysis with hemoperfusion.
Results: The study found that about 3 of 20 subjects were out of the study. There was no significant difference found in systolic and diastolic blood pressure between regular hemodialysis and hemoperfusion group (P = 0.807 and 0.906, respectively) based on the T-paired test and Wilcoxon test.
Conclusion: There was no significant difference between blood pressure measured using ABPM on the combination of hemodialysis and hemoperfusion compared with regular hemodialysis

Introduction: Endothelial progenitor cell (EPC) numbers are reduced in stable coronary artery disease (CAD), partly due to oxidative stress. This study aimed to evaluate the effect of different antioxidants, purple sweet potato (PSP) extract and vitamin C, on EPC proliferation in stable CAD patients.

Methods: Peripheral blood mononuclear cells were isolated and cultivated on fibronectin-coated plates with the colony-forming unit (CFU)-Hill medium for three days. Non-adherent cells were divided into control, PSP extract (1, 5, 25 μg/ml), and vitamin C (10, 50, 250 μg/ml) groups; then cultured for two days. EPC proliferation was assessed with MTT Cell Proliferation Assay Kit. EPCs were identified by detecting the expression of CD34. Resulted CFU-Hill colonies were counted under an inverted light microscope.

Results: EPC proliferation was increased in low, moderate, and high doses of PSP extract and vitamin C compared to control (all groups vs. control, p<0.001). The high dose of PSP extract increased EPC proliferation non significantly compared to the moderate dose (p=0.289). Vitamin C increased EPC proliferation better than PSP extract in moderate and high dose groups (p=0.042 and p<0.01, respectively). Meanwhile, the low dose of both treatments increased the EPC proliferation equally (p=0.353). CFU numbers, representing EPC differentiation capability, were highest in the groups given PSP extract compared to control and vitamin C groups.

Conclusions: PSP extract and vitamin C increased EPC proliferation dose-dependently. Vitamin C induced EPC proliferation better than PSP extract. Furthermore, PSP extract was presumably a better EPC differentiation inducer.

Background: Psoriasis is a recurring chronic inflammatory disease, which can involve the skin, nails and joints. Nail psoriasis occurred in 50% of psoriasis patients. Nail psoriasis can interfere with the quality of life (QoL) due to its physical, mental, and social impacts. To determine the correlation between Nail Psoriasis Severity Index (NAPSI) score and QoL in nail psoriasis patients.

Methods: This was a correlative analytical study with a cross-sectional approach that involved nail psoriasis subjects aged ≥18 years. Data accessed from the recording of basic data. The examination of subjects included an assessment of NAPSI scores and the Nail Psoriasis Quality of Life (NPQ10) questionnaire. Statistical analyses were performed using Pearson’s correlation coefficients, with P<0.05 was considered statistically significant.

Results: A total of 26 subjects with nail psoriasis, with the highest proportion, were female (57.7%), age group of 48–57 years (34.6%), duration of psoriasis >5 years (76.9%), NAPSI score 81-100 (30.8%), the mean NAPSI score was 89.42±32.01, and the mean NPQ10 score was 6.96±3.30. There was a significant moderate positive correlation between the NAPSI score and QoL (r=0.632, p=0.001).

Conclusion: The higher the NAPSI scores, the worse the quality of life for nail psoriasis patients.

Background: The international guideline suggests that the ideal DDI is 30 minutes for grade 1 and grade 2 CS, but they are still hardly achieved. Therefore, the main purpose of this study was to determine the DDI for grade 1 and 2 CS, and its determinants in two academic hospitals.

Methods: A prospective cohort study was conducted using pregnant women who underwent grade 1 and 2 emergency CS. Data regarding demographic characteristics of the subjects were extracted from the medical record, while DDI and its components were measured by direct observation. Odds ratio was used to determine the association between DDI and its determinants.

Results: The median DDI for grade 1 and 2 CS in the main academic hospital were 112.5 minutes and 181 minutes respectively, longer than their duration in the affiliated hospital with 80 minutes for grade 1 CS and 104 minutes for grade 2 CS. The significant determinants for a 75-minute DDI in the main academic hospital were grade of CS (OR: 0.12; 95%CI: 0.01-1.05; p: 0.047), indication of CS (OR: 0.77; 95%CI: 0.6-0.89; p: 0.014), and anesthesiologist response time (OR: 9.18; 95%CI: 2.21-38.13; p: 0.001), while in the affiliated academic hospital, operating room waiting time was the only significant determinants (OR: 6.18; 95%CI: 2.07-18.48; p: 0.001).

Conclusions: DDI for emergency CS still exceeded the standard in academic hospitals with different determinants causing the delay. Strengthening interprofessional collaboration should be implemented systematically.  

Introduction: Cancer patients experience significant physical symptoms and psychosocial problems during cancer treatment that negatively impact on quality of life which can be intervened by palliative care. However, the referral of cancer patients to palliative care is still low. Therefore, this study aimed to explore the need of palliative care among doctors working in oncology in order to develop an instrument of criteria for palliative care referral in oncology practice.

Methods: A mixed method research with a sequential variant exploratory, quantitative dominant design was used. Using phenomenology orientation, the qualitative study exploring the needs of palliative care referral was conducted and data were obtained through in-depth interviews with 32 oncologic care doctors. Identified dimensions, criteria, sub-criteria and indicators were then used to develop the instrument. In the quantitative study, validity of the instrument was tested through expert judgement and Aiken’s V content-validity coefficient was calculated.

Results: The study found that palliative referral criteria consisted of 20 indicators, i.e., 15 medical indicators of the aspects related to disease stage, patient’s condition, treatment status, and status of care; and 5 non-medical indicators, included the aspects associated with psychological, social, spiritual, communication and decision making. The validity of the instrument was confirmed through the expert panel, in which the Aiken’s V coefficient of all indicators ranged high from 0.825 to 0.975.

Conclusion: The instrument of palliative care referral criteria was developed which consist of 20 indicators and had good validity.

 

Background: Skin tags (known as acrochordon) are the most common benign skin tumors, usually skin-colored or hyperpigmented, found in the natural folds of the skin. They have been associated with various clinical conditions. A few studies results have been reported regarding the oxidative stress are strongly associated with skin tumor. Malondialdehyde (MDA) is an end product of lipid peroxidation by free radicals in the body. MDA assay is widely used as a biomarker to evaluate systemic oxidative stress in biomedical fields. This study evaluated the difference in serum MDA level in skin tags patients and control

Methods: This study is an analytic observational study with a cross-sectional design, including 40 patients with skin tags and 40 healthy volunteer controls, based on inclusion and exclusion criteria. Age, sex, and family history of skin tags were estimated on the patients. Diagnosis of skin tags was made based on history and clinical examination. Measurement of MDA level by enzyme-linked immunosorbent assay (ELISA) to the patients and controls. Mann- Whitney test is used to determine the differences in serum MDA levels. The results were significant, with a p-value <0.05.

Results: Mean MDA level of skin tags patients was highest at age 50– 59 years (27,01 ± 10,87 nmol/ml). The mean MDA level of male skin tag patients (15,99 ± 8,23 nmol/ml) was higher than females (15,23 ± 8,17 nmol/ml). The mean MDA level of skin tag patients with a family history (19,77± 7,92 nmol/ml) was higher compared to patients without a family history (11,82 ± 8,48 nmol/ml). The mean of MDA level was significantly higher in the skin tags group (15,81 ± 8,23 nmol/ml) than the control group (8,86± 7,02ng/ml) with p = 0.032.

Conclusion: There were higher significant differences in serum MDA levels in the skin tags patients than in control.

Background Hypertension is the second most common cause of maternal death in the world. Predicting the occurrence of preeclampsia (PE) complications is needed to optimize management. Brain natriuretic peptide (BNP) is a polypeptide, secreted by cardiac ventricular myocytes. Research linking N-Terminal Pro B-Type Natriuretic Peptide (NT-proBNP) levels with maternal complications has never been conducted in Indonesia. The aim of the study is to evaluate plasma NT-proBNP levels in pregnant women with pre-eclampsia and normotension and to find a relationship between NT-proBNP levels and maternal complications incidence.

Methods This cross sectional study was conducted on thirty women with severe preeclampsia with gestational age >20 weeks who attended and underwent labor at Dr. Kariadi Hospital Semarang during study period. Patients with a history of chronic disease, underweight or obese, history of heart disease and consumption of heart drugs were excluded. Serum NT-proBNP was taken prior labor. Correlation between NT-proBNP serum levels and physical characteristics as well as complications was performed using the Mann-Whitney and Spearman correlation test.

Results NT-proBNP serum levels were significantly higher in the severe preeclampsia group, especially early-onset compared to the normotensive group (p<0.05). Increased serum NT-proBNP levels are associated with several maternal complications, especially HELLP syndrome, pulmonary edema, retinopathy and renal impairment.

Conclusions Increased serum NT-proBNP levels are associated with severe preeclampsia and several maternal complications.

Introduction: Anxiety is one of prevalent mental disorders in pregnant women and causes alteration in autonomic nervous system (ANS) function and cardiovascular system adaptation. It could potentially lead to increased risk of maternal complications and morbidity. SEFT had been known to lower anxiety level and autonomic nervous system activity but its application in pregnant women is still debated. Therefore, this study aimed to assess the effectiveness of SEFT in primipara women.

Method: a quasi-experimental, non-equivalent control group study was conducted in Bantul District, Yogyakarta, Indonesia involving primipara who fulfilled the research criteria. SEFT was performed at the 9^th month of pregnancy and 1 week before the estimated date of delivery. LF/HF ratio was assessed and compared in the two groups as representation of HRV and autonomic nervous activity.

Results: 62 primiparous women were enrolled in this study and divided equally to the intervention and control group. This study showed that the LF/HF ratio was already different between the two groups at the beginning of the study. However, while the mean of LF/HF ratio was decreasing in the intervention group, an increasing trend was observed in the control group. Finally, the comparison of the mean difference between the two groups revealed that SEFT significantly lowered the ratio of LF/HF in primipara, thus improving the HRV.

Conclusion: SEFT effectively lowered LF/HF ratio in primipara women which might indicate a better balance between sympathetic and parasympathetic nerve responses. However, further study should be conducted to validate the application of SEFT in pregnant women with anxiety.

Background: Burns are the most common and devastating form of trauma yet constitute a common cause of morbidity worldwide. Complications of burns such as sepsis and tissue hypoperfusion may increase serum lactate and reduce hemoglobin. Measuring lactate levels has been proven to be a useful predictive marker of hypoperfusion and sepsis in patients with burns. Melatonin which acts as an anti-inflammatory and antioxidant, has been proposed to be used as pharmacological adjuvant in patients with burns, reducing oxidative damage. The study aims to investigate the effects of melatonin supplementation on serum lactate and hemoglobin levels in burn-induced male Wistar rats.

Method: This was an experimental animal study with randomized control group design. All samples (n=12 male Wistar rats) were randomized and divided into two groups. Each rat was exposed to a hot metal rod for 10 seconds to induce 30% burns injury. Rats in the control group were administered with placebo (aquadest), while rats in the experimental group were administered with melatonin intraperitoneally at 0, 8, and 16 hours after burns injury. Blood samples were collected from the retro-orbital sinuses at 0, 3, and 24 hours after treatment. Data were statistically analyzed using Paired t-Test, Independent t-Test Mann-Whitney Rank Test and Wilcoxon test.

Results: There were no significant differences in lactate and hemoglobin levels between melatonin group and control group 0 hours after treatment (T0), 3 hours after treatment (T3), and 24 hours after treatment (T24) (p>0.05). There were increased lactate levels and decreased hemoglobin levels in both melatonin and control groups, however the increment of lactate and the decrement of hemoglobin were steeper in control group compared to melatonin group. There were higher serum lactate increments and higher hemoglobin decrement at 24 hours (∆T0–T24) in control compared to melatonin group (p<0.05).

Conclusion: Melatonin might prevent dramatic rise of serum lactate levels and decrease of hemoglobin levels until 24 hours after treatment in burns injury. If confirmed by further studies, melatonin might have a role as adjuvant therapy in burns.

Background: The prevalence of cognitive impairment increased by 10% that is doubling every 20 years. Brain gym is one of the non-pharmacological cognitive stimulation therapies that effectively increases brain neuroplasticity and is easy to do. The interleukin 6 biomarker is a pro-inflammatory blood marker that is sensitive to cognitive impairment. This research aims to analyze the relationship between the brain gym and the changes in interleukin 6 levels and the cognitive function in the elderly.

Methods: This research is a quasi-experimental observational study with a pretest and post-test approach without controls. The subjects are the elderly from the Tresna Werdha Social Home, Semarang. For comparative hypothesis test between categorical and numerical scale variables, normal data distribution was conducted by Independent T-test.

Results: In this research, 33 subjects had the average age of 70.06 ± 6.43 years and the dominant sex was male. There was a significant difference between interleukin 6 levels in pre and post brain gym (p<0.001). There was also a significant difference between the MoCA-Ina values in pre and post brain gym (p<0.001).

Conclusion: Interleukin 6 levels decreased after doing brain gym compared to before while the MoCA-Ina value increased after doing brain gym compared to before. Brain gym is safe, easy to do, and effective as a non-pharmacological therapy of neuroplasticity in cognitive impairment.

Introduction: Surgeries are potential procedures for Coronavirus Disease 2019 (COVID-19) transmission due to the presence of a multidisciplinary team and high-risk activities such as airway assessment and intubation. This study was carried out to assess risk of surgeries conducted at the main referral hospital in Aceh province, Indonesia during COVID-19 pandemic.

Method: A Medical necessary, Time-Sensitive (MeNTS) score was used to assess risk of emergency and elective surgeries conducted at Aceh main referral hospital, Dr. Zainoel Abidin, from July to August 2020. In total, 463 surgeries were screened, consisted of 126 emergency surgeries and 337 elective procedures.

Result: Orthopaedic department contributed the most with 129 patients (27.9%), while ear, nose, throat (ENT) departments contributed the least with only 16 patients (3.4%). Orthopedic surgeries had the lowest MeNTS score (36.23), while neurosurgeries had the highest MeNTS score (46.91). Most of the surgeries were elective (72.8%), and the MeNTS score for elective surgeries was higher than emergency procedures (41.0 to 39.6).

Conclusion: Neurosurgeries were the highest risk procedures conducted in Aceh main referral hospital, Indonesia, followed by ENT, thoracic-vascular, and digestive surgeries. MeNTS scoring can be used as an additional screening tool in the Department of Surgery, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia to minimize the risk of COVID-19 transmission during surgical procedures.

Background: In the last few decades, several hypotheses have been proposed to explain the pathogenesis of type 2 diabetes mellitus (T2DM) that links this disease with a systemic chronic inflammatory state. New predictors of lipoprotein-associated phospholipase A2 (Lp-PLA2) and monocyte HDL-c ratio (MHR) has been observed to predict atherosclerosis severity, progression of atherosclerosis and cardiovascular events. The study aims to evaluate correlation between HbA1c with Lp-PLA2 and MHR in patients with T2DM.

Methods: Analytic observational research with cross sectional design. HbA1c levels were measured by high-pressure liquid chromatography, Lp-PLA2 values using the ELISA method, and MHR values based on the ratio of absolute monocytes to HDL counted manually.

Results: The study was conducted on 42 DMT2 patients aged 34-74 years, mean value HbA1c, Lp-PLA2, and MHR were 8.16±2.10, 217.20±42.49, 10.55±6 11 respectively. Statistical analysis showed a positive correlation between HbA1c  and Lp-PLA2 levels (p=0.046 and r=0.310), and there was a correlation between HbA1c levels and MHR values  (p=0.038 and r=0.321).

Conclusion: A weak positive correlation between glycemic control (HbA1c) and atherosclerotic markers (Lp-PLA2 and MHR) in DMT2 patients.

Introduction: Experiences of trance in Sintren dancer with a history of psychosocial problems, it is possible that comorbidity of mental disorders will appear. One of the Primary Health Care programs is dealing with mental disorders. By providing counseling training to Primary Health Care Staffs, it is hoped that there will be guidance and assistance from the Primary Health Care for the Sintren dancer community.

Methods: Screening is carried out to recruit synthetic dancers who have psychological problems and are given counseling. This service involves Primary Health Care Staffs. This service includes networking and treatment and providing counseling to Sintren dancers to deal with the problems they are experiencing.

Result: Sintren dancers met the category of mental disorders (dysthymia and PTSD). Primary Health Care Staff had bad experiences in helping people with mental disorders, they are afraid of helping people with mental problems. With counseling training, primary health care staff more confident to help people with mental problems.

Conclusion: Sintren dancers have a psychosocial and mental disorder background. Counseling training in Primary Health Care Staff provides understanding of stress management and early detection of mental disorders that often occur in society.

Introduction: Despite having abundant sunshine all year long, hypovitaminosis D in Indonesia is still surprisingly prevalent. However, hypovitaminosis D in Indonesia has still been severely underdiagnosed and there were even fewer studies on its treatment. Thus, we aim to assess the effectiveness of daily vitamin D supplementation for subjects with hypovitaminosis D.

Method: A randomized double-blind, placebo-controlled trial conducted was conducted with a total of 76 healthy, non-obese, working-age participants with hypovitaminosis D. The intervention was daily 1,000 IU of vitamin D3 supplementation for 12 weeks, while the placebo group received a placebo pill. The serum 25(OH)D level was measured pre-intervention, after 4 weeks, and after 12 weeks of intervention. The data were analyzed using an unpaired t-test in SPSS version 24.0. Out of the 81 participants, a total of 76 participants (93.8%) have hypovitaminosis D.

Result: The serum 25(OH)D level in the treatment group was significantly higher than in the placebo group after 12 weeks of supplementation. The delta of serum 25(OH)D level after 12 weeks of supplementation was also significantly higher in the treatment group. Furthermore, the serum 25(OH)D level in the placebo group was found to be significantly reduced at the 12^th week compared to the baseline. Participants who received daily supplementation of 1000 IU vitamin D3 for 12 consecutive weeks have significantly higher serum 25(OH)D levels than the participants in the placebo group. Same result was also observed when the changes of serum 25(OH)D after 12 weeks were analyzed.

Conclusion: Hypovitaminosis D was surprisingly very prevalent among the working-age group in Indonesia. Participants who received daily supplementation of 1000 IU vitamin D3 for 12 consecutive weeks have significantly higher serum 25(OH)D levels than the participants in the placebo group.

Background: Cardiovascular disease (CVD) has caused at least 1.1 million deaths per year globally. Heart and blood vessel disease are silent killer which can cause disability or death if left untreated. Stress on the walls of the blood vessels leads to hypertrophy and hyperplasia of the vascular smooth muscle causing endothelial damage and facilitating atherosclerosis. Endothelial dysfunction indirectly affects platelet (thrombocyte) function which has an important role in the formation of primary blockage. The formation of the primary blockage is influenced by the number and function of the thrombocyte and can be checked by biomarkers of thrombocyte, erythrocytes, and the ratio of thrombocyte -to-leukocytes. The purpose of this study was to analyze the relationship between erythrocytes, thrombocyte, and the ratio of thrombocyte-to- leukocyte (RTL).

Materials & Methods: Descriptive analytic design with a cross sectional approach was applied. Sixty CVD patients were examined for thrombocyte, erythrocytes, and ratio thrombocyte-to-leukocyte (RTL) based on routine hematological examinations. Data were tested for normality and checked with Pearson Correlation test. The research was conducted at the Dr. Kariadi Hospital for the period January-April 2020.

Results: Based on the statistical analysis test, the Pearson correlation test showed a moderate positive correlation between thrombocyte and RTL (p=<0.001; r=0.569), while the correlation between thrombocyte and erythrocytes were not significantly correlated (p=0.687; r=-0.046) in CVD patients.

Conclusion: There is a relationship between thrombocyte, and RTL values in CVD disease, so that thrombocyte biomarkers and RTL are suggested to be biomarkers in the management of CVD.

Background: AISI 316L stainless steel material is one of the widely used hip joint implant material. Even with excellent properties for the hip joint implant, this material is likely to fail after 12-15 years of implantation because of excessive wear and stresses. The computational analysis using the finite element method can be used to analyze the stress in the hip joint implant. The study aims to evaluate the stresses and safety factors analysis on the hip joint implant using four different types of AISI 316L materials from several manufacturers are highlighted as the objective of this study.

Method: There are four different types of AISI 316L materials used in this study, which are manufactured with different methods. These materials are simulated into Diponegoro University's artificial hip joint design. The ASTM F2996-13 and ISO 7206-4 are considered standard references in the simulation for loading and boundary condition application.

Results: Based on the static structural analysis, the total deformation, equivalent elastic strain, equivalent von-Mises stress, and the safety factor are obtained from Undip hip joint implant design.

Conclusion: The analysis concludes that the four types of stainless steel materials are safe for UNDIP hip joint implants, which have >1 safety factor. The highest safety factor is obtained from the forging material but has a high manufacturing cost that needs to be optimized.

Background: Diabetes mellitus is one of the health problems that is growing rapidly today. In Asia, majority of the population are non-obese with Type 2 Diabetes Mellitus (T2DM). Two main defects of T2DM, insulin resistance and impaired insulin secretion due to reduced pancreatic β cells. Persistent metabolic stress due to hyperglycemic conditions, causes inflammation of the islets of Langerhans. Interleukin-1β (IL-1β) signaling is the most frequent pathway inducing β cell dysfunction. The bariatric Sleeve Gastrectomy (SG) procedure increases particular hormone which stimulates β cell growth and pancreatic insulin production. Aside from the role as a blood glucose regulator, insulin also plays a role in anti-inflammatory modulation. Omentoplasty can be used to wrap organ or tissue structures. The Omentum has unique biological functions, including promote tissue regeneration and anti-inflammatory effect. The study evaluates the effect of Sleeve Gastrectomy and pancreas Omentoplasty procedures on β cell insulin expression and Interleukin-1β (IL-1β) serum levels in non-obese diabetes mellitus subjects.

Methods: Experimental study with "post-test control group design" on 27 rats with Diabetes Mellitus was divided into 3 groups: K (control), P1 (Sleeve Gastrectomy), P2 (Sleeve Gastrectomy + Omentoplasty). 10 days after procedure, we evaluated the insulin expression of β cells using monoclonal antibody anti-insulin stain and IL-1β serum levels using rat IL-1β Enzyme-Linked Immunosorbent Assay (ELISA) kit. Statistical analysis with Kruskal Wallis and Mann Whitney test. Correlation test with Spearman.

Results: β cell insulin expression increased in P2 (p=0.020), compared to control. While the IL-1β serum levels reduced significantly in all groups (p<0.001) compared to control. Moderate negative correlation (r = -0.476) between β cell insulin expression and IL-1β serum levels.

Conclusion: Sleeve gastrectomy and omentoplasty increased β cell insulin expression and decreased IL-1 β serum levels in non-obese rats with diabetes mellitus.

Background: Stroke is a cerebrovascular disease caused by atherosclerosis. Oral health and atherosclerosis may be associated with cerebrovascular disease. Some studies proved the association between chronic infectious diseases, including periodontal tissue disease with stroke risk factors. Diabetes Mellitus has a risk of microvascular complications that are pathologically related to periodontal disease. This study compares the degree of periodontitis between ischemic stroke with diabetes mellitus and ischemic stroke with prediabetes mellitus.

Methods: This study is an observational analytic study with a cross-sectional design. The subjects of this study were infarct stroke patients with diabetes mellitus and prediabetes mellitus in the inpatient ward of Kariadi Hospital Semarang, who met the inclusion and exclusion criteria. The study was conducted from January to March 2020. Infarct stroke was assessed by using head CT scan, while diabetes mellitus using blood glucose with 2 hours postprandial blood glucose and HbA1c, and periodontal disease using MMI (Miller’s Mobility Index). The data were analyzed with chi-square correlation test and logistic regression test. The results were significant if the p-value <0.05.

Results: This study was conducted to 42 ischemic stroke patients with diabetes mellitus and prediabetes mellitus. All of the cases also had hypertension. The prevalence of severe periodontitis in DM-hypertension was (OR=0.66; 95% CI=0.12-0.354) compared to prediabetes-hypertension. The chances of severe periodontitis in the age of 61-70 years (OR=2.626; 95% CI=0.473-14.587) compared to the age 51-60 years, dyslipidemia (OR=0.392; 95% CI=0.076-2.016) compared to non dyslipidemia, obesity (OR=2.346; 95% CI=0.382-14.428) compared to non-obesity, smoking (OR=1.768; 95% CI=0.371-8.425) compared to non-smokers.

Conclusion: in this study, all cases of diabetes mellitus and prediabetes mellitus were suffered along with hypertension. The prevalence of severe periodontitis in prediabetes-hypertension patients increased compared to hypertensive-DM patients. There was an increased possibility of severe periodontitis in the risk factors groups of age 61-70 years, obesity, and smoking.

Introduction: Voluntary Counseling and Testing (VCT) is one of HIV screening programs to detect HIV infection earlier by counseling before and after doing blood test. During implementation of this program, there were various factors influenced prisoners to do VCT. The purpose of this research to determine factors influenced the participation of prisoners to do VCT.

Method: This research was an analytical research with cross sectional design. A total of 145 respondents have filled questionnaire distributed by researcher The result showed that 73 respondents (50.3%) have followed VCT and 72 respondents (49.7%) did not VCT yet. Factors related prisoner’s participation (WBP) towards VCT program were education level, perception of needs about VCT service, prison support, health workers support, support by family and people around them.

Result: The result showed that there are two types of support related with prisoner’s participation: prison’s support which is among 104 respondents (71.7%) who have high support, 62 respondents (42.8%) have followed VCT with p-value = 0.000. According to health workers support, 114 respondents (78.6%) who have high support, there are 64 respondents (44.1%) have followed VCT with p-value = 0.007.

Conclusion: The counselor’s ability must be improved to perform good VCT and the prison was expected to give more information about HIV/AIDS and VCT program to increase prisoner’s knowledge to follow VCT.

Introduction: Since its operation in 2016, the Universitas Sumatera Utara Hospital (USU Hospital) has implemented Medical Services for patients with cardiac arrest conditions by forming a Code Blue team. Based on data in 2018, the number of patients who received the Code Blue emergency was 240 patients. There are still many cardiac arrest events at USU Hospital, it is necessary to evaluate the implementation of the Code Blue services and create an early warning system (EWS) for patients who are potentially in cardiac arrest to prevent high cardiac arrest cases that will economically harm USU Hospital.

Method: We analyze the secondary data from the Medical Record, an interview with the code blue team, and an analysis of the resuscitation form that has been completed.

Result: The results of the study (n=30) which experienced the most stop breathing and cardiac arrest before the implementation of EWS were chronic diseases with 63.3% (n=19) and after the implementation of EWS there were still chronic diseases with 56.7% (n=17). A paired t-test was conducted with the result that code blue services on the numeric response time parameter was different in response time of 0.266 minutes after the implementation of EWS services (p=0.354). Meanwhile related to the length of time for cardiopulmonary resuscitation(CPR) there is a time difference of 10,767 minutes after the implementation of EWS services, (p=0.000).

Conclusion: Interpretation of EWS implementation can affect the time of the CPR performed because the worsening condition of the patient has been monitored before respiratory and cardiac arrest occurred. The conclusion of making an early warning system (EWS) at USU Hospital can be immediately implemented as stated in the guidelines as a form of service in medical and nursing services.

Over the last few years, the development of three-dimensional (3D) skin bioprinting has increased rapidly. The concept of bioprinting involves a computer in designing using conventional 3D printing. 3D bioprinting can produce tissue structures such as skin and have the opportunity to substitute autografts, which are still the gold standard today. Network construction in bioprinting requires stages in the network structure design, selection of cell and biomaterial raw materials, and the molding process. The use of keratinocytes and fibroblasts is used as the main raw material in the manufacture of the dermis and epidermis layers. The biomimetic technique will combine these raw materials with other biomaterials (hydrogel, collagen, fibrin, gelatin, alginate, chitosan, and chitin) and growth factors (hydrocortisone, thrombin, and FGF-2) so that the physiological condition of the skin can be created. Currently, 3D bioprinting research continues to develop in response to the various shortcomings and challenges faced. The purpose of this review is to discuss the current use of 3D bioprinting technology, the principles of this technology and the prospects for 3D skin bioprinting in the future.

Introduction: Healthcare leaders must have management skills, administrative competency, and leadership roles to fulfill the market demands, patient satisfaction, health policy, and complexity of the healthcare environment. Healthcare leader is expected to improve the competency through educational and professional program attainment to maximize measurable performance outcome for the hospital. The study aimed to systematically review the existing literature and carefully examine the findings to investigate the relationship between higher education and the performance of healthcare leaders.

Methods: Three independent reviewers conducted a literature search in electronic databases for publications that met the inclusion and exclusion criteria. Each of the included studies' risk of bias was independently evaluated by the lead author, who then discussed their findings with the other two authors to reach a consensus. Five papers out of 529 found by database searching met the requirements for this study.

Results: The Majority of the study designs were cross-sectional (4 of 5). Most of the studies discussed the outcome of the higher degree of education in healthcare leaders.

Conclusion: Higher and advanced degrees of education affect the better leadership role, administrative competence, and patient experience. Top healthcare leaders mostly have higher degrees of education focused on healthcare.

Overactive bladder (OAB) is a common multifactorial disease that can cause a burden to the patient. Despite being a symptomatic diagnosis, several urological examinations need to be done to rule out other possible causes. The management of OAB is specific to each individual, from the very first line of behavioral therapy to surgical for an extremely rare case of OAB. This overview will look out for OAB thoroughly from the epidemiological burden, pathophysiology, clinical presentation and diagnosis, and the current treatment of OAB.

Background :The incidence of sarcomas occurs in less than 1% of all malignant tumors but sarcoma is the cause of 2% of total cancer deaths. Based on the National Registry the incidence of neonatal sarcomas is 2.6 per million live births.

Case Description : A baby girl aged 3 days, complaining of a mass on the patient's left thigh since birth. the mass was large from birth and there was only one on the left thigh. In the prenatal history, the mother and baby with routine ANC history to the midwife, and never having a control with an obstetrician, the mother was not sick during pregnancy and took medication during pregnancy outside of a doctor's prescription. In the perinatal history, the baby was born to mother G1P1A0, gestational age at term, was born by cesarean section, with birth weight 2800 grams, was born crying, active movement, reddish color, vomiting (-) genitalia (+) anus (+)

Conclusion : Soft tissue sarcomas (STS) require proper diagnosis and management. The results of rhomboid flap in the tumor resection area are better than skin grafts of similar shape and location and provide cosmetic advantages with very few complications.

Background: Single umbilical artery (SUA) is a rare presentation in obstetrics practice, yet it comprises most of the umbilical anomaly. Despite its rare occurrence, a proper prenatal diagnosis needs to be established timely in order to prevent morbidity and mortality from commonly coexisting abnormalities. This case report presents a delayed diagnosis of SUA by prenatal sonography diagnosis and vascular imaging features postnatal cord at the third trimester of pregnancy and discusses the proper diagnosis and management of such cases.

Case Presentation: We reported a case of a 37 year old pregnant woman who found to have one artery one vein in her umbilical cord on ultrasound. This is very rare case and precise concern for us. Unfortunately we found this case in the third trimester of pregnancy (37w5d), therefore we have slightly to evaluate. Female baby was born by elective C-section. The baby cried immediately, with an Apgar score of 8-9. We didn’t find major abnormalities in the baby. Birth weight 3700 grams. There were not sign of heart diseases and kidney’s abnormality. Baby was monitoring for one weeks and the baby has good growth and development.

Conclusion: This report is expected to increase the awareness of this disease entity as a fundamental basis for developing its screening and management protocols.      

Background: The incidence of gastric perforation in neonates is rare but has a high mortality rate of 15-70%. Spontaneous gastric perforation in neonates is estimated to occur in one of 2,900 live births and accounts for approximately 7% of all gastrointestinal perforations in neonates and children.

Case: We present a case of gastric perforation complicated by sepsis, anemia, thrombocytopenia, and hypoalbuminemia in a 3-day-old girl. The patient was brought to the emergency room of Dr. Soetomo Hospital Surabaya with blood vomiting complaints from 1 day. On physical examination, it was found that the general condition was weak, with an axillary temperature of 38.2° C. The abdomen looked distended from inspection of the abdominal region, with the dilated vein and periumbilical hyperemia. Its percussion revealed the loss of liver dullness. The results of laboratory examinations: Hb 10.7 g/dl, Platelet 14,000/mm³, Albumin 2,6 g/dl. Plain thoracoabdominal X-Ray study showed a pneumoperitoneum. Needle decompression was performed because there were signs of Abdominal Compartment Syndrome (ACS). After five days of optimization in the Intensive Care Unit, a laparotomy exploration and primary repair of gastric perforation were conducted.

Conclusion: Gastric perforation in neonates is a rare condition. The management principle for each patient is different depending on the patient's condition. Needle decompression is indicated when ACS is present or the patient's condition is not optimal for surgery. Definitive laparotomy can be done after the patient's condition has been stabilized. Proper selection of treatment can improve the patient's outcome and reduce the risk of morbidity and mortality.

Background: Empyema is a condition that can be treated depending on the etiology of the empyema and the phase of empyema development. Open thoracotomy surgery is a conventional technique commonly used in empyema that has greater risk and more extended postoperative hospital stay. This case series aims to evaluate Video-Assisted Thoracoscopic Surgery (VATS) to shorten postoperative hospital stay and lower the risk during the surgery.

Case Presentation: We describe a case series of empyema in five patients, each with a different presentation, clinical course, and outcome. All of our patients were performed VATS procedures under General Anesthesia and evaluated for postoperative hospital stays and complications that occur after the surgery. Most of the patients experienced tolerable pain on the site of surgery and only need 3 – 4 days post-operation hospital stays after VATS before being discharged. Only one patient with a poor prognosis after VATS in this case series caused the patient to be admitted to the Intensive Care Unit and using a mechanical ventilator.

Conclusion: In this case series, VATS has a promising result for the patient and can become a choice of treatment for empyema.

Background: Priapism is defined as a prolonged erection of the penis lasting over 6 hours in the absence of sexual stimulation. Priapism is divided into two types, Low-Flow (ischemic priapism) and High-Flow (trauma). This case study aims to evaluate penile gangrene as a priapism sequele due to Chronic Myeloid Leukemia (CML) as the first report in Indonesia.

Case Presentation: A 45-years old male patient admitted at Muara Teweh hospital before referred to Ulin Hospital presented with Fournier gangrene with unconfirmed leukemia as comorbidities used in this case report. In his medical history, “Snake Maneuver Shunting” has been carried out in this patient as an indication for priapism lasting more than 24 hours.

Conclusion: Hyperleukocytosis is thought to be the cause of priapism in patients with leukemia. Leukostasis is the most common medical emergency seen on CML patients in blast crisis.

Introduction: Cancer surgery in the head and neck area generally causes a wide defect and usually cannot be closed primarily or by using the surrounding tissue, thus a flap is needed. There are several types of flaps, namely local flaps, pedicle flaps, and free flaps. Although the free flap is currently the gold standard for reconstruction of the head and neck in developing countries, the resources for a free flap in most healthcare center are still lacking, as well as the large number of patients with poor economic and nutritional status. Thus, the pectoralis major myocutaneous flap (PMMF) remains popularly used.

Case Description: A 46-year-old male patient with squamous cell carcinoma in the neck area, underwent wide excision procedure and the surgical defect was reconstructed with a pectoralis major myocutaneous flap.  The results of reconstruction with pectoralis major myocutaneous flap were viable, and were functionally and aesthetically acceptable. There are no postoperative complications such as hematoma or abscess observed.

Conclusion: Pectoralis major myocutaneous flap was one of the main and easy to learn modalities for head and neck reconstruction surgery and it was acceptable functionally and aesthetically in situations where free flap could not be performed for one or many reasons.

Background: Ameloblastomas are rare odontogenic neoplasms of the mandible and maxilla. They have high recurrence rates if improperly treated. Due to their aggressive nature and high recurrence rate, treatment remains a matter of debate. Complete excision of the lesion with the least morbidity would be the therapeutic challenge.

Case Report: A 67 years old woman complained of swelling on her left jaw four years ago, the jaw was small swelling initially, and then it has grown to the size of a tennis ball. She had a history of similar swelling on the same site 12 years back for which she was operated on (enucleation). On physical examination, there is a mass in the left mandibular bone above the surgical wound, hard, painless and motionless, with a size of 18 cm x 11 cm x 11 cm. Plain x-ray examination showed multiple cystic lesions in the left mandible. In this case, segmental mandibular resection was performed, followed by reconstruction using a K-wire.

Discussion: Many treatment options range from conservative treatment of curettage, enucleation to radical surgical approaches of wide margin excision. Radical treatment approaches have the advantage of lowering the recurrence rates but at the same time pose extremely difficult challenges of reconstruction of the surgical defects.

Conclusion: Ameloblastoma has high recurrence rate if it is not treated properly. At least 1 cm of healthy bone should be removed during surgical procedure beyond panoramic radiograph visible margins. In our patient, though radical surgery eliminated a large possibility of recurrence.

Background: Laryngeal amyloidosis is a rare pathology of the airway in which the diagnosis can only be made via tissue biopsy. We reported a case of laryngeal amyloidosis presenting with symptoms of hoarseness and voice fatigue.

Case report: This is a case report of laryngeal amyloidosis in a middle-aged female patient who presented with hoarseness of voice. Upon obtaining a further history and performing a clinical examination, it was noted that the patient had a laryngeal mass. She underwent surgery, and the mass was histopathologically confirmed as laryngeal amyloidosis. She was successfully treated with a combination of surgical and medical treatment. This case presentation describes these rare pathological findings, their clinical manifestations, the histopathological and surgical diagnostic problems, treatment and patient’s progress that we followed up till presence.

Conclusion: Isolated laryngeal amyloidosis is a rare benign laryngeal tumor that is often presented with various symptoms depending on the tumor location and can even cause upper airway obstruction. It is a histological diagnosis confirmed by histopathological specimens that are stained with Congo red. Treatment of laryngeal amyloidosis includes symptomatic relief, surgical or even conservative treatment. 

Background: Myasthenia Gravis (MG) is an autoimmune disorder, which autoantibodies against postsynaptic (muscle) nicotinic acetylcholine receptors (nAChR). MG patients have a higher prevalence of cardiac manifestations in the presence of thymoma. It is not known whether Coronavirus disease 2019 (COVID-19) can cause more severe illness in patients with chronic neuromuscular disorders such as MG, which can cause respiratory muscle weakness, or in those who are immunosuppressed. This case report will discuss patient with MG, thymoma, atrial fibrillation, and COVID-19.

Case presentation:  A 60-year old man came to the hospital with difficulty of swallowing. He had nasal voice and dropping of eyelids. These complaints were happened repeatedly, worsened at night and got better in the next morning. From the neurological examination, it was also obtained Wartenberg test (+), counting test (+), and prostigmine test (+). Atrial fibrillation was found with normal ventricular response and decreased systolic left ventricular function on the electrocardiogram and echocardiography. On the chest MSCT, a lobulated homogeneous solid mass was found in anterior mediastinum which supported the image of thymoma, and there was the imaging of typical viral pneumonia. The patient also had the positive result of COVID-19 PCR test.

Conclusion: MG patients have been shown with abnormal manifestations of heart rhythm. This may reflect as a complication of myocarditis or autonomic nervous system dysfunction. COVID-19 infection in MG can be challenging for many reasons. Current guidelines recommend continuing the current standard care treatment of MG during hospitalization.

Introduction: Spinal tumors are rare lesions. The incidence of spinal tumors is about 0.5-2.5 cases per 100,000 population per year.¹ Thirty percent of spinal tumors are located intradural. Twenty to thirty percent of intradural tumors are schwannoma and spinal neurofibroma.² Surgery is the leading choice for schwannomas and neurofibromas that grow progressively or cause neurological deficits.^2,3,4 Currently, minimally invasive surgery is developing rapidly, including minimally invasive surgery on spine surgery.Better outcomes are expected in endoscopic spine surgery compared to conventional spine surgery techniques.This paper aims to provide an overview of endoscopic procedures for the surgical removal of spinal tumors.

Case description: A 59-year-old man presented paraplegia of both lower limbs. The patient complained difficulty walking for nine months before admitted to the hospital. The patient also complained of difficulty moving both of his legs, burning pain sensation, pain and numbness sensation that radiates from chest region to both of his toes, he felt that his chest was tied, and he complained hard to breathe when he feels pain. Complaints are getting worse until the patient was unable to walk. We found intra-dural extramedullary lesion from the MRI that was suspicious of a nerve cell sheath tumor. The patient underwent surgical treatment for tumor removal with an endoscopic technique, the cancer was complete. From the histopathology, the tumor was a neurofibroma tumor.

Conclusion: Neurofibroma is one of the most frequently intradural extramedullary spinal tumors. Good imaging can guide the diagnosis and a good plan for manage patients with spinal tumors. Complete tumor resection provides a better prognosis in patients with neurofibromas. With endoscopic techniques, total spinal tumor removal surgery can be performed. The surgical procedure for spinal tumors using an endoscopic approach may be an option for spinal neurofibromas patients.

Background: Immune reconstitution inflammatory syndrome (IRIS) is a paradoxical condition in which the administration of ART (antiretroviral therapy) to human immune virus (HIV) patients causes a deterioration in clinical situations. This article describes IRIS in an HIV patient who discontinued the drugs and was accompanied by opportunistic infection with tuberculous meningoencephalitis.

Case Presentation: A 40-year-old male complained of high fever and severe headache for 1 week, then the patient had general tonic-clonic seizures twice and less than 5 minutes. After seizure, patient experiences a loss of consciousness with the only response to pain stimuli. He was diagnosed with HIV since 3 years ago and only taking ART 2 months after being diagnosed. The physical examination revealed neck stiffness with a positive Brudzinski I and Kernig Sign, as well as lateralization to the right side. Oral candidiasis was found. HIV screening tests were reactive with CD4 65 cells/mm³. Cerebrospinal fluid (CSF) examination showed 172.8 mg/dL protein, 23 mg/dL glucose, MN 13/mm³ dominant cells, clear CSF fluid and colorless, supporting tuberculous meningoencephalitis (METB). Multi sliced CT-Scan (MSCT) head contrast shows enhancement of the basal cistern. The patient received the ART tenofovir-lamivudine-efavirenz. Then he has experienced a deterioration in clinical condition. He had ARDS, respiratory failure and was intubated, but failed resuscitation attempts.

Conclusion: The patient was diagnosed with HIV 3 years ago but discontinued the treatment. HIV causes diffuse inflammation throughout the body including the cardiac, where myocarditis cannot be ruled out as a cause of death. IRIS may occur when the patient has risk factors for not getting previous ART (withdrawal of drugs) and has a low CD4 count. According to the criteria proposed by Robertson, there were worsening clinical symptoms, associated with initiation of ART administration, not explained by the presence of previously acquired infection, we suggest IRIS as causes of death in this patient. 

Background: Meningiomas represent about 20% of intracranial tumors. Due to these tumors' proximity to the optic nerve, typically progressive unilateral vision loss, over several months to years, is the classic clinical presentation.

Case Presentation: A 23 y.o. male presented with a progressive monocular visual loss of the right eye since 4 months. Visual acuity on the right eye was 1/300 and 6/6 on the left eye. Color vision and contrast sensitivity of the left eye was excellent. Fundus examination showed papilledema on right eye and left eye was within normal limit. MRI reveals a strong enhancing mass along the right and left sphenoid wing, measuring approximately 3.9 x 5.5 x 3.3 cm, extending into the parasellar region, compressing optic chiasm and encasing right and left N.III, N.IV and N.V. Patient were diagnosed with compressive optic neuropathy on the right eye due to meningioma. Following the decompression surgery, visual acuity on the right eye improved to 6/24, color vision 25/38 and contrast sensitivity was 5%. The patient was discharged 4 days after surgery and scheduled for routine follow-up at the polyclinic.

Conclusion: Vision loss due to the compressive effect of meningioma may be reversible. The severity and the duration of vision loss due to compression may affect the final visual recovery. Early detection and prompt multidisciplinary approach are necessary to obtain a better outcome.

Introduction: Covid 19 is a respiratory system disease caused by SARS-COV2. Geriatric patients with Covid-19 equipped with multiple comorbidities and a high vulnerability have high morbidity and mortality rates.

Case illustrations: A 75-year-old woman presents with confusion and fever. She was treated in the previous hospital for 7 days, experienced a deterioration of consciousness and had respiratory failure, thus was referred to Kariadi Hospital.She had comorbid hypertension, type 2 diabetes mellitus and grade 2 osteoarthritis genu bilateral. Bodyweight 45kg, height 150cm, BMI 20kg/m2,blood pressure 100/58 mmHg,pulse 110x/minute, Respiratory rate 28x/minute, Temperature 38.5?, 93% oxygen saturation, Frailty Index 0.7, Katz Index G, Norton score 11/20. Leucocytes 9100,Lymphocytes 10%, Neutrophil Lymphocyte Ratio 2.2, Blood Glucose 247mg/dL, CRP 4.41mg/dL, Ferritin 5472.28,D-Dimer >20,000ug/dL, Fibrinogen498 mg/dL, Procalcitonin 0.39, Chest X-ray showed pneumonia infiltrates with cardiomegaly. The RT-PCR swab examination showed positive SARS-Cov-2. Brain CT showed lacunar infarct and aging atrophy cerebral. the patient was admitted to intensive isolation room because of acute respiratory distress syndrome and covid coagulopathy. After clinical improvement, the next problems that must be addressed in isolation rooms are frail, confusion, cerebral syndrome, immobility and grade 1 decubitus.

Conclusion: Management of frail geriatric patients with Covid-19 has its challenges because of the high mortality rate. It requires a comprehensive and multidisciplinary approach.

Background: Green meniran plant (Phyllanthus niruri Linn) is traditionally believed to treat many diseases, such as reducing fever, diarrhea, cough with phlegm, inflammation, malaria, and acne. This research aims to determine the class of compounds and active compounds in the ethanol extract of green meniran leaf.

Methods: An experimental study was conducted using phytochemical testing includes qualitative and quantitative tests to identify the active compounds in green meniran leaf (Phyllanthus niruri Linn) by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). Crude powder packaging of green meniran leaf was conducted at Materia Medika Herbal Laboratory, Malang, Indonesia. The ethanol extraction from green meniran leaf was conducted at Pharmacology Laboratory, Faculty of Mathematics and Natural Sciences, Udayana University.

Results: Based on the results of the phytochemical qualitative test, the green meniran leaf extract was positive for flavonoids, saponins, steroids, terpenoids, alkaloids, phenols, tannins, and glycosides. From quantitative phytochemical tests, we found the levels of phenolic, flavonoid, tannin 5.13%, 3.30%, 5.01%, respectively and 28.212.67 mg/kg chlorophyll. Identification using LC-MS/MS showed the suspected compounds Apigenin-8-C-glucoside from the glycoside group and 5,6,7-trimethoxyflavone from the flavonoid group.

Conclusion: Green meniran leaf contains flavonoids, saponins, steroids, terpenoids, alkaloids, phenols, tannins, and glycosides with the active compounds Apigenin-8-C-glucoside and 5,6,7-trimethoxyflavone.