Introduction: Gynecological malignancies are one of the most common causes of death from cancer in women. Hydronephrosis or obstructive uropathy is the most common finding in patients with gynecological malignancy. This study aimed to describe the profile of obstructive uropathy patients causes of gynecology malignancies treated in our center from 2019 to 2021.

Method: From January 2019 to January 2021, obstructive uropathy patients with gynecological malignancies who underwent DJ stent or nephrostomy insertion procedures at Cipto Mangunkusumo Hospital were included in this prospective study. Patients with a history of urinary diversion or other diseases that may cause urinary tract obstruction were excluded.

Result: One hundred and twenty-one patients with gynecological malignancies with obstructive uropathy were included. Cervical carcinoma was the most common cause, followed by ovarian carcinoma and endometrial carcinoma. The percentages of bilateral, right-, and left-sided stenting were 72%, 18%, and 10%, respectively. Most of them were grade 3 or grade 4 hydronephrosis. Percutaneous nephrostomy was mainly used for 69,4%, and only 17% of patients experienced a polyuria episode.

Conclusion: Most cases of obstructive uropathy were caused by cervical malignancies, with bilateral obstruction due to cervical cancer occurring in most cases. Nephrostomy is the method of choice for urinary drainage in our center.

Introduction: The historical treatment of convalescent plasma was successful against RNA viruses. However, the significance of COVID-19 convalescent plasma therapy has not been clinically proven consistently in most studies and the available data showed contradictory results so far. Our study aims to evaluate the role of convalescent plasma therapy as an adjunctive treatment for severe and critically ill COVID-19 patients.

Methods: This study was an open-label, non-randomized comparative clinical trial that was conducted at Dr. Kariadi Hospital, Semarang, Indonesia. This study sample are hospitalized severe and critically ill COVID-19 patients were assigned with a 2:1 ratio to receive convalescent plasma and local standard of care. The primary outcome was the clinical status 30 days after the intervention

Results: A total of 73 patients received convalescent plasma and 38 patients received local standards of care. Both of the groups had similar clinical ordinal scales (median was 5, p=0.65), while patients in the study groups had significantly higher SOFA scores and P/F ratio. The control group had a worse overall mortality rate (61.1% vs 18.4%) with a hazard ratio of 3.5 (95%CI, 2.1-5.9) compared to the study group. From the subgroup analysis, we found that patients in the study group without mechanical ventilation support had the best survival rate compared to other groups HR: 0.0047 (95%CI, 0.01-0.19). The clinical outcome 7 days after convalescent plasma infusion was also significantly improved in the study group (median baseline & day-7, 5 & 3, p<0.001). From the multivariate analysis of therapeutic variables, convalescent plasma was the most significant variable for survival outcome (OR=0.089, 95%CI, 0.029-0.27; p<0.001). There was one case of anaphylactic shock and was excluded.

Conclusions: The convalescent plasma administration significantly improved clinical outcomes and overall survival rates compared to those who received local standards of care.

Introduction: Maternal mortality in Indonesia especially in dr. Soetomo General Hospital is still very high, and the biggest problem is obstetric complications. It is possible that the mother who has obstetric complications is safe and recovered or died. This study aimed to identify the root cause of maternal death at Dr. Soetomo General Academic Hospital in 2019.

Methods: This is a descriptive retrospective study with the Root Cause Analysis method to analyze total of 87 maternal deaths at Dr. Soetomo General Academic Hospital in 2019.

Results: There were 87 cases of maternal death at Dr. Soetomo General Academic Hospital in 2019. Direct maternal death was the leading cause of maternal death, contributing 59 cases (67.8%). From 59 cases, 31 cases (35.6%) direct maternal deaths were caused by preeclampsia/eclampsia. Contributing factors that influence maternal mortality are including organizational management, medical personnel, equipment, materials, & ward, environmental, and family barriers factors. Organizational management factors, the most common factor that causes maternal death is a poor information sharing system at the referring hospital, as many as 17 cases (27.4%). Medical personnel factors, maternal death was mostly caused by lack of knowledge and skills during antenatal care, as many as 42 cases (44.2%). Equipment, materials,  and ward factors, the most common cause was the unavailability of the ward, contributing 5 cases (55.6%). Family barrier factors, most maternal deaths were caused by the families that did not understand about the emergency condition of the patient, as many as 52 cases (67.5%).

Conclusion: The maternal deaths at Dr. Soetomo General Academic Hospital in 2019 were mostly caused by the family barrier factor which did not understand about patient’s emergency condition, followed by the medical personnel factor which was lack of knowledge and skills during antenatal care.

Background: Lower extremity injuries are the most common injuries in young athletes due to running, jumping, sudden change of movement, and contact with the other player in most of the sport’s activities. Preventive efforts are the most effective ways to decrease the risk of lower extremity injuries. Functional Movement Screen (FMS) can be considered effective ways in helping to identify risk factors in the young athlete. This study aims to evaluate the FMS as a determinant factor to assess the risk of injuries in young athletes in Jakarta Province, Indonesia

Methods: Participants were young athletes who train in Provincial Student Sports Training Center (PSSTC), South Jakarta. Athlete age less than 18 years old, agree to participate in this research and has normal physical health will be included in this research and proceed to be asked time exposure of training and history of injuries; body posture and FMS examination. Analysis bivariate dan multivariate were done to see if there is the association of seven components of FMS, sex, time exposure of training, history of injuries, body posture and lower extremity injuries. Data were analyzed using SPSS version 20 for Windows.

Results: There was 87 participant that participated in this research. The data showed that ankle (36.7%), thigh (36.7%) and knee (16.0%) were the three most common lower extremity injuries. Bivariate analysis showed a significant association between hurdle step, time exposure of training, and histories of injuries with the incidence of injuries (p<0.25). Logistic regression multivariate analysis showed that history of injuries (OR=4.276; 95%CI=1.599-11.437) and time exposure of training (OR=3.470; 95%CI=1.274-9.448) had a significant association with incidence of injuries (p<0.05)

Conclusions: There was no association of seven components of FMS with lower extremities injuries. However, there was a significant association of injury histories and training exposure with the incidence of injuries.

Introduction: Doping is an invisible cheating act in a match; therefore, it is necessary to provide an anti-doping understanding to overcome doping behavior in a competition. The research purpose was to produce a product in the Rumi Doping application as a medium for anti-doping understanding in Indonesian NPC athletes.

Methods: This research used R&D with the Agile Sprint planning model, which consists of (1) planning (planning for the preparation of software components); (2) developing (start software development); (3) testing (software testing); (4) delivering (present the software product); and (5) assessing (assess and provide feedback on the products that have been made). Data were collected by observation, interviews, and questionnaires. The testing stage used experts' product validation, and the assessment stage used product users (Indonesian National Paralympic Committee athletes). Aiken V Coefficient for validity testing and descriptive percentages to measure user ratings in the form of practicality and effectiveness of the Rumi Doping application.

Results: The results showed that the average Aiken V value was 0.89 > 0.77, so it could be stated that the application developed was valid. The practicality assessment of the Rumi Doping application showed an average percentage of 80% (24/30) of athletes stated that it was practical to use. The effectiveness assessment of the Rumi Doping application showed that 90% (27/30) athletes disagreed about doping in sports, which means athletes have understood that doping is prohibited in sports. Conclusion: The research concluded that the Rumi Doping application is valid, practical, and effective in providing information about doping. 

Objective: To determine and compare either change in length, anterior angle, and consistency of cervix can be used as the predictors of preterm labor or not.

Methods: This case-control study involved 54 pregnant women with gestational age 20 - 37 weeks, which the case group is women in preterm labor and the control group were not in labor at Sanglah General Hospital, Bali, Indonesia from November 2018 to October 2019. The samples were examined using Transvaginal Sonography (TVS) to collect Cervical Length (CL), Anterior Cervical Angle (ACA), and Cervical Consistency Index (CCI) data.

Results: Short CL could increase the risk of preterm labor by 9 times (OR = 8.80, 95% CI = 2.50-30.97, p-value 0.001). Wide ACA could increase the risk by 10 times (OR = 10.45, CI 95% = 2.92-37.39, p = 0.001). Low CCI could increase the risk by 7 times (OR = 7.43, 95% CI = 1.80-30.67, p = 0.003). Anterior cervical angle has the greatest role in the occurrence of preterm labor, followed by CL and CCI, although statistically insignificant (p=0.138; p=0.212= p:0.203).

Conclusion: Performing cervical examination using TVS as the antenatal care routine can help predict and prevent preterm delivery.

Introduction: Diabetes mellitus is a metabolic disease characterized by hyperglycemic and disorders of carbohydrate, protein and fat metabolism due to abnormalities in insulin secretion, insulin sensitivity or both. Based on previous research, Wharton's Jelly's mesenchymal stem cells have anti-inflammatory, immunoregulatory properties that can improve metabolic control and have the ability to differentiate into pancreatic lineage cells that function as insulin-producing cells in vitro culture. The purpose of this study was to prove that administration of mesenchymal stem cells Wharton's Jelly can increase the number of pancreatic beta cells and reduce fasting blood glucose levels in male rats (Rattus norvegicus) Wistar strain of diabetes mellitus.

Methods: The research design used was pure experimental with post-test only control group design using 36 white male rats. All samples were induced with Streptozotocin and Nicotinamide. The selected samples were divided into two groups: the control group given glibenclamide + 0.9% NaCl, and the treatment group was given glibenclamide + mesenchymal stem cells from Wharton's Jelly. Calculation of the number of pancreatic beta cells and measurement of blood glucose levels were carried out after 14 days of treatment.

Result: The results showed that the treatment group had a higher number of pancreatic beta cells than the control group (105.17 ± 16.379 cells/field of view vs. 54.00 ± 11.366 cells/field of view) (p <0.001). In addition, the treatment group had lower fasting blood glucose levels than the control group (109.06 ± 16.71 mg/dl vs 122.78 ± 10.14 mg / dl) (p <0.05).

Conclusion: It was concluded that intravenous administration of Wharton's Jelly mesenchymal stem cells increased the number of pancreatic beta cells and decreased fasting blood glucose levels in male rats (Rattus norvegicus) Wistar strain of diabetes mellitus.

Background: While the effects of sodium bicarbonate on buffering capacity have been repeatedly examined on short-term and high-intensity exercise performance, studies on prolonged endurance performances such as running are scarce. Thus, the purpose of this study was to investigate the effect of NaHCO? (0.3 g/kgBW) ingestion 60-minutes prior to the prolonged running testing and recovery in trained runners.

Methods: A total of 10 trained male runners (age: 20.70±1.10 years; weight: 61.30±6.20 kg; height: 166.10±3.70 cm; VO_2max 58.43±5.62 mL/kg/min) were recruited in this study. Subjects undertook 1 preliminary testing and 2 experimental trials: Sodium Bicarbonate (SB) and Placebo (PLA) trials, which consisted of: (i) a 60-minutes Prolonged Exercise Testing (PET) (30-minutes of constant speed run at 65 % of VO_2max followed by a self-selected speed of 30-minutes maximum distance run) and (ii) 30-minutes of the recovery period in randomized order. Data were analyzed using SPSS version 23 for Windows.

Results: Subjects ran further during the SB trial than the PLA trial (5,233.60±524.70 m vs. 5,021.40±440.10 m; p=0.012) associated with a greater blood lactate level (5.66±1.09 mmol/L vs. 3.68±0.71 mmol/L). Ingestion of SB drinks significantly increased urine pH during PET and recovery period (p<0.01). During post-recovery, a greater decrease in blood lactate level was found in the SB trial (2.53±0.91 mmol/L; 55%) as compared to the PLA trial (2.17±0.50 mmol/L; 41%) (p<0.01).

Conclusion: The ingestion of NaHCO?(0.30 g/kgBW) 60-minutes prior to the PET improved prolonged running performance associated with a faster lactate removal rate during the 30-minutes recovery period.  

Background: Reduced Left Ventricular Ejection Fraction (LVEF) is considered to worsen prognosis after an acute myocardial infarction (AMI), including Non-ST-elevation myocardial infarction (NSTEMI). This study aims to find a correlation between LVEF with mortality risk after hospital discharge following myocardial infarction using GRACE score among NSTEMI patients.

Methods: Data was collected from the iSTEMI Registry database in Prof. Dr. R. D. Kandou General Hospital from October 3^rd 2018, to July 28^th 2019. About 122 NSTEMI patients were collected to measure their LVEF by transthoracic echocardiography and routine clinical workup for GRACE score calculation at admission. A descriptive analysis, normality test, and bivariate correlation were applied. A p-value less than 0.05 was considered statistically significant using SPSS version 23 for Windows.

Results: The mean age of the patients was 62.07±11.11 years old and most of the study subjects were male (73%). The mean GRACE score was 118.92±33.52, whereas the mean ejection fraction was 48.76±16.32%. LVEF was negatively significant correlated with the GRACE score (p=0.017; r=-0.230).

Conclusion: Lower LVEF is correlated with increased six-month mortality risk after hospital discharge using GRACE score following myocardial infarction in a patient with Non-ST-elevation myocardial Infarction.

Background: Indonesia is located in the global thalassemia belt region, with major thalassemia prevalence that increase every year. Ineffective erythropoiesis (IE) is a condition that is commonly found in major thalassemia. An increase in lactate dehydrogenase (LDH) level and Activin A level was found in major thalassemia patient, that is caused by ineffective erythropoiesis (IE) and other factors. However until now, there is still no known studies that compare LDH level and Activin A level in major thalassemia and non-thalassemia. The aim of the study is to evaluate difference between LDH level and Activin A level in major thalassemia and non-thalassemia.

Methods: An observational analytical study with cross sectional design was conducted in March – September 2020, which consist of 25 major thalassemia patients in Dr. R. Soedjati Grobogan Public Hospital and Dr. R. Soetrasno Rembang Public Hospital, and 25 healthy population with equivalent age. LDH levels were measured using photometry and Activin A levels were measured using ELISA. Differences between LDH levels and Activin A levels in major thalassemia and non-thalassemia were analyzed using Independent Sample T test, which p < 0.05 was considered significant.

Results: There is a significant difference (p=0.00) between LDH levels in major thalassemia (524.48 ± 167.44 U/L) and non-thalassemia (294.48 ± 131.24 U/L). There is a significant difference (p = 0.04) between Activin A levels in major thalassemia (118.75 ± 45.47 pg/ml) and non-thalassemia (95.66 ± 26.26 pg/ml).

Conclusion: Hypoxia due to IE and the formation of ROS due to repeated transfusions causes an increase in LDH levels and Activin A levels in thalassemia major patients, indicated by a significant difference between LDH levels and Activin A levels in thalassemia major and non-thalassemia.

Background: Asthma causes changes in the airway structure called airway remodeling due to chronic inflammatory reactions. Transforming Growth Factor-? (TGF-?) is one of the inflammatory mediators which has a significant role in the remodeling and inflammatory process. One of the medicinal plants known to have anti-inflammatory potential is Kaempferia galanga L. This study aims to analyze the effect of ethyl p-methoxycinnamate isolated from Kaempferia galanga L. rhizome on the expression of TGF-? and fibrosis in the bronchial mucosa of asthmatic rat models.

Methods: We conducted an experimental laboratory study using the posttest only control group design. Thirty-six Wistar male white rats were allocated into six groups, NC (negative control), PC (positive control), T1 (treatment group), T2 (treatment group), T3 (treatment group), and T4 (treatment group) receiving 1% ovalbumin in alum (OVA); 1% OVA as well as 1 mg/kg steroid; 1% OVA, 1 mg/kg steroid, and 200 mg/kg ethyl p-methoxycinnamate isolated from Kaempferia galanga L. rhizome (KG-EPMC); 1% OVA, 1 mg/kg steroid, and 400 mg/kg KG-EPMC; 1% OVA and 200 mg/kg KG-EPMC; and 1% OVA as well as 400 mg/kg KG-EPMC, respectively. Data were analyzed with SPSS version 22.0 for Windows.

Results: The expressions of TGF-? and fibrosis were significantly lower in positive control as well as treatment groups than those of the negative control group (only receiving OVA) (p<0.05). There were no significant differences between positive control and treatment groups regarding TGF-? level and fibrosis (p>0.005).

Background: Hirschsprung's disease is a congenital gastrointestinal disorder that is the most common cause of intestinal obstruction in children. One of the factors that influence gastrointestinal disorders is the sacrum bone. The sacral index can review the evaluation of the sacral bone, an instrument that can evaluate the development of the sacral bone in different clinical conditions. This study assessed the value of the sacral ratio in children with Hirschsprung's disease and non-Hirschsprung's disease at Dr. Hospital. Hasan Sadikin Bandung.

Methods: This study was a descriptive-analytic study with a case-control design. Sampling was done retrospectively by collecting medical record data and the enema barium readings from October 2019 to July 2020. The study was conducted at the Department of Radiology Hospital Dr. Hasan Sadikin Bandung from September to October 2020. Data processing uses an unpaired T-test.

Results: The total sample was 58 objects, consisting of 29 with Hirschsprung’s disease and 29 non-Hirschsprung, with an average age of Hirschsprung’s disease was 3.14±3.905 years. In the Hirschsprung’s disease group, the mean sacral ratio value was 0,62 and, and the mean sacral ratio in the non-Hirschsprung group was 0,74. Statistical test results with unpaired T-test showed significant mean differences in the case and control groups (p=0.0001).

Conclusion: The sacral ratio value in children with Hirschsprung’s disease compared to non-Hirschsprung were different significantly. 

Introduction: Pityriasis Versicolor (PV) is an infection caused by Malassezia, especially Malassezia furfur, most commonly seen in adolescents and young adults. In the skin, sebum lipid is an essential ingredient in supporting the growth of Malassezia because of its lipophilic properties. Higher sebum levels are detected in some body regions, such as the face, scalp, chest, and back. Therefore, in these areas, a higher amount of Malassezia is found. Thus, sebum levels may affect the occurrence of PV. This study aims to determine the correlation between sebum levels and PV.

Methods: This research studies the correlation between sebum levels and PV with a cross-sectional design on 31 subjects with PV and 31 non-PV subjects. They were treated at the Dermatology and Venereology Polyclinic, Haji Adam Malik General Hospital, Medan. The assessment was based on examining sebum levels on the chest and back of the PV and non-PV groups. Research subjects who met the inclusion and exclusion criteria underwent anamnesis, physical examination, and dermatological examination and examination with 10% KOH solution on subjects with PV. Then, all PV and non-PV subjects recorded primary data, including age, gender, education level, and sebum levels. The data collected were tabulated and presented in a frequency distribution table and analyzed statistically.

Results: The age with the most suffering from PV was <20-40 years, as many as 24 people (77.4%). The most affected sex was male as much as 87.1%, and the highest level of education affected was high school as many as 25 people (80, 6%). The mean level of sebum in the chest of the PV group was 20.97 mg/cm2, while in the non-PV group, it was 16.29 mg/cm2. The average sebum level in the back of the PV group was 24.13 mg/cm2, while in the non-PV group, it was 21.71 mg/cm2. There was no significant difference in the sebum levels on the chest and back between PV and non-PV groups.

Conclusion: There was no significant difference in sebum levels between PV and non-PV. Indicating other factors are influencing the onset of the disease.

Background: Acne vulgaris is a common skin disorder in the pilosebaceous unit that is self-limited, especially in adolescents. Adam Malik Hospital in Medan reported the incidence of acne vulgaris to be 1.10%. Telemedicine has become popular in recent years, especially during the COVID-19 pandemic. SAF teledermatology using digital cameras has also increased patient service satisfaction, promising diagnostic reliability and clinical outcomes similar to face-to-face visits. This study aimed to compare teledermatology's diagnostic test parameters and accuracy and face-to-face consultations in diagnosing acne vulgaris.

Methods: This study was an observational analytic study with a cross-sectional design involving 110 suspected acne vulgaris. The characteristics of sex and age were recorded. The resident established the diagnosis of acne vulgaris directly and teledermatologically by the consultant based on photo documentation of 5 facial lesion areas, namely the forehead, chin, right cheek, left cheek, and the entire face, along with the photo with photos from the history submitted by the resident. Diagnostic tests were carried out, including sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and an agreement test.

Results: Acne vulgaris was more common in women (76 patients, 69.1%) and patients aged 18-22 years (55 patients, 50%). Of 110 patients, 105 were diagnosed with acne vulgaris by face-to-face consultations and teledermatology. Teledermatology showed 100% sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. The agreement test between teledermatology and face-to-face consultations was 1, indicating favorable agreement.

Conclusion: There was no significant difference in the diagnosis of acne vulgaris through teledermatology and face-to-face consultations.

Introduction: Dysmenorrhea (menstrual pain) usually occurs at the beginning of menstruation, can be sharp, blunt, cyclic or persistent until the end of the menstrual phase and can last for several hours to one day.

Objective: This study aims to determine the difference in the effectiveness of warm compresses and active stretching exercises in reducing pain in dysmenorrhoea patients.

Method: The design of this study is an experimental method. Pre-test and post-test control group designs were the designs in this study. This study used 20 subjects, divided into two groups, in which the control group (n = 10) received a warm compress while the treatment group (n = 10) received an active stretching exercise. Interventions were given three times a week for four weeks. The sampling technique is simple random sampling. Pain biomarkers were measured by prostaglandin levels, while the pain was measured through a menstrual distress questionnaire (MDQ).

Results: The data analysis showed no difference in prostaglandin level in the control or treatment groups. In contrast, the MDQ value shows a significant value for both the control and treatment groups, with a mean value that is more significant in the treatment group.

Conclusion: Therefore, it can be concluded that active stretching exercise is more effective at reducing pain than warm compresses in dysmenorrhea.

 Background: The purpose of this study was to investigate the suitability of the widths of some commercially available preformed NiTi arch wires to the dental arch widths of a sample of the Egyptian population.

Methods: This cross-sectional study included 420 maxillary and mandibular pairs of casts for subjects with an age range of 10-16 years as part of project by the National Research Centre. The casts were traced using TracerNet; intercanine and intermolar widths were measured on the casts. Anterior and posterior arch lengths were measured to facilitates the measurements on the wires. The intercanine and intermolar widths of eight commercially available archwires were measured on a graph paper.

Results: Regression analysis was performed to create a regression model for the predicted means of the intercanine and intermolar widths in different age groups. The mean square error (MSE) was calculated for all the available arch wires in relation to the dental arch. Ormco (Broad arch/small) had the lowest MSE; 1.55 for the upper intercanine width and 1.72 for the upper intermolar width. For the lower intercanine width its MSE was 0.30 for the Ormco and 0.31 for Ortho Technology, while for the lower intermolar width it was 0.78 for Ormco.

Conclusions: The commercially available archwires were all considerably larger than the mean dental arch size of the majority of the population, except for the Ormco; thus, inviting potential relapse of treatment. It is necessary to produce a wider range of customized archwires that better suit the dental arch sizes of the Egyptian population.

Background: Post-ERCP pancreatitis (PEP) has been the most frequent complication of Endoscopic Retrograde Cholangiopancreatography (ERCP). It has been documented to happen after 5–30% of ERCP procedures. PEP is new or exacerbated abdominal pain associated with a serum lipase or amylase concentration which is more than three times the upper limit of normal at 24 hours post-ERCP, requiring at least two days of prolongation of the planned admission. Following pancreatic sphincterotomy, pancreatic stenting is commonly used with the objective of decreasing both early restenosis and post-ERCP pancreatitis. Aim of the work: Evaluation of the pancreatic stenting technique as a preventive measure against post ERCP pancreatitis in calcular obstructive jaundice patients with difficult cannulation.

Patients and methods: Forty Egyptian patients with calcular biliary obstruction with a difficult biliary cannulation who are at risk of developing PEP enrolled in a prospective randomized controlled comparative study. Group A: 20 patients with manipulation of pancreatic duct by guidewire without pancreatic stent insertion; Group B: 20 patients with manipulation of pancreatic duct by guidewire with pancreatic stent insertion.

Results: The pancreatic duct stenting technique had reduced the risk of PEP significantly in calcular biliary obstruction patients with difficult CBD cannulation to 20?% (in group B) compared with 60?% in (group A).

Conclusion: Prophylactic pancreatic stenting technique is a simple and easy procedure that showed to be efficient in decreasing cases of post ERCP pancreatitis in difficult cannulation patients. The endoscopists should be trained to practice the procedure safely.

Background: Researches towards Glioblastoma multiforme therapy (GBM) has been performed, especially in finding the tumor’s genetic cellular expression. The overexpression of EGFR, frequently found in human malignancies, is known to significantly impact cancer cells hallmark traits, such as increased cell survival, proliferation and invasion. This research is performed to figure out the synergistic effect of temozolomide, the main chemotherapy regimen used, and the monoclonal antibody anti-EGFR nimotuzumab in inhibiting the growth of GBM cells in vitro.

Methods: We performed cell cultures using GBM U87MG cells and administered nimotuzumab 1000µg/ml and temozolomide 20 µg/ml in different sequences and timings. Inhibition of GBM cell growth is evaluated by measuring Ki-67 and ?H2AX levels using flowcytometry and tested with one-way ANOVA. Data were analyzed using SPSS version 21 for Windows.

Results: Levels of Ki-67 were in the control group (23.17±1.72), nimotuzumab monotherapy (15.43±1.70), temozolomide monotherapy (14.80±1.37), simultaneous therapy (10.73±1.19), nimotuzumab 24 hours before temozolomide (10.57±1.05), and nimotuzumab 48 hours before temozolomide (14.47±1.37). The level of ?H2AX is measured in the control group (11.90±1.25), nimotuzumab monotherapy (29.33±1.91), temozolomide monotherapy (28.13±1.58), simultaneous therapy (41.53±3.51), nimotuzumab 24 hours before temozolomide (39.56±2.06), and nimotuzumab 48 hours before temozolomide (35.93±3.56).

Conclusion: This research shows that administration of nimotuzumab simultaneously with temozolomide and nimotuzumab 24 hours before temozolomide effectively inhibits the growth of U87MG GBM cells. Inhibition of EGFR expression before temozolomide administration is able to increase DNA damage and inhibit the proliferation of glioma cells.

Backgrounds: Acne vulgaris is a chronic sebaceous gland inflammatory disorder that predominantly affects adolescents and young adults. Increased sebum, alterations in follicular keratinization, Cutibacterium acnes colonization, and inflammation are the critical pathways in the pathogenesis of acne vulgaris. Facial skin hydration can affect the primary pathogenesis mechanism of acne vulgaris. This study aimed to examine the correlation between the level of facial skin hydration and the severity of acne vulgaris.

Methods: This study was an observational analytical study of 40 subjects with acne vulgaris and 40 subjects without acne vulgaris, using a cross-sectional design. The subjects' facial skin hydration was analyzed using a CM 825 corneometer, and the severity of acne vulgaris was assessed based on Lehmann's criteria. Data were analyzed using the Spearman correlation test. Health Research Ethics Committee of the Faculty of Medicine at the University of North Sumatra has approved this study.

Results: Of the 40 subjects with acne vulgaris, women dominated (65 %) with a mean age of 19.6 ± 1.86 years old. Most subjects had moderate (50 %) degrees of acne vulgaris, followed by mild (42.5 %) and severe (7.5 %) degrees. In acne vulgaris subjects, the considered normal level of facial skin hydration was 92.5 %. The facial skin hydration found in acne vulgaris subjects was lower than non-acne vulgaris subjects with a p-value of 0.002. The degree of facial skin hydration is associated with the severity of acne vulgaris with moderate strength correlation values (p=<0.001, r= -0.453).

Conclusions: A significant correlation exists between the level of hydration of the facial skin and the severity of acne vulgaris. The lower facial skin hydration level could promote the more severe form of acne vulgaris.

Background: Osteosarcoma is a connective tissue malignancy producing osteoid and some cartilaginous and fibrous matrix. It provides a challenging diagnostic approach since it is considered as a great mimicker in radiography and histopathology appearance. Triple diagnostic approach is mandatory, involving the clinical, radiologic and histopathologic aspect of all cases suspected. This study aimed to discover the correlation between radiographic and histopathological findings of fibroblastic, chondroblastic and osteoblastic subtypes of conventional osteosarcoma.

Methods: This study implemented a cross-sectional study design. Components of radiographic findings of conventional osteosarcoma were bone destruction, transitional zone, periosteal reaction, matrix of calcification, skip lesion and soft tissue mass which were analyzed and correlated with its histopathological subtype. Statistical analysis was performed using the Spearman correlation test with p-value < 0.05.

Results: Significant negative correlation was obtained between chondroid matrix calcification and histopathology description of conventional osteosarcoma with osteoblastic subtype (r = -0.383; p < 0.05) and negative correlation between osteoid matrix and histopathologic analysis of fibroblastic subtype (r = -0.435; p < 0.05). All of the radiographic components of the chondroblastic subtype did not show significant correlation with their histopathological findings.

Conclusion: Chondroid matrix finding in radiography showed negative correlation with histopathologic evaluation of osteoblastic subtype while osteoid matrix description in radiography had negative correlation with histopathologic analysis of fibroblastic subtype.

Background: Hyperbilirubinemia is a condition defined by an increased total serum bilirubin level exceeding 5 mg/dL and clinically characterized by the presence of jaundice. Jaundice can be observed on the skin and sclera if the bilirubin level increases more than 5 mg/dL. Several risk factors, including birth weight, asphyxia, gestational age, mode of delivery, and breastfeeding practices, have been studied regarding their relationship to the incidence of hyperbilirubinemia, with varying results. Therefore, the purpose of this study was to determine the relationship between these risk factors and the incidence of hyperbilirubinemia.

Methods: An analytical observational cross-sectional study was conducted by collecting secondary data from the Perinatology Ward registry and the medical records department. The subjects were neonates treated in the Perinatology Ward of Wangaya Hospital, Denpasar. The data that met the inclusion and exclusion criteria were then analyzed with the SPSS 25.

Results: There were 59 neonates with hyperbilirubinemia and 135 neonates without hyperbilirubinemia among the 194 research subjects. The results of the chi-square test were the following: p-value for birth weight = 0.002, p-value for asphyxia = 0.002, p value for breastfeeding practice = 0.003, p value for gestational age = 0.000, and p value for delivery mode = 0.110.

Conclusion: There was a significant relationship between birth weight, asphyxia, gestational age, breastfeeding practices, and the incidence of neonatal hyperbilirubinemia in the Perinatology Ward, Wangaya Hospital, Denpasar City. Meanwhile, no relationship was observed between the mode of delivery and newborn hyperbilirubinemia.

Coronavirus disease (COVID-19) was declared a pandemic in March 2020 and has the potential to overload health system, compromise hospital staffs and use up essential hospital supplies. Patients with Spinal Cord Injuries (SCI) are classified as patient with disability and has increased morbidity from COVID-19 due to physiological changes from the nature of pathology, subsequently their clinical and social characteristics puts them in high risk of contracting COVID-19. Patients with SCI might present different symptoms of COVID-19 than others. Weakness in thoraco-abdominal and diaphragm muscles might impair cough, reduce lung volumes, and reduce flow rates. Interrupted pathway between hypothalamus and efferent nerves (sympathetic and motoric) might results in temperature dysregulation (poikilothermia) and dysfunction of febrile response. Patients with injuries at higher levels would present with more severe symptoms. The pandemic of COVID-19 further complex the situation of delivering adequate and dignified treatment. Therefore, the main goal is for complete avoidance of infection in this specific population and should be considered with high index of suspicion when mild symptoms of COVID-19 are present. This vulnerable group of patients deserves more attention when presented with extraordinary situations such as pandemics or earthquakes. This overview summarizes the symptom and pathophysiology of SCI in COVID-19 pandemic. 

Introduction: A point mutation of codon 59 (GGC ➞ GAC) of the α2-globin gene, known as haemoglobin (Hb) Adana, contributes to various kinds of α-thalassemia syndrome. This case report described a patient who had heterozygous alpha-thalassemia 3.7 kb deletion and hemoglobin adana.

Case report: We report a case of a 17-year-old boy who was referred for the investigation of persistent anemia. His peripheral blood film was consistent with mild hemolytic anemia, without HbH inclusions. Normal HbA₂ levels without HbH and HbBart peaks. Both his parents had normal Hb levels, but his mother presented with mild microcytosis. DNA analysis revealed a compound heterozygote for one gene deletion (α^-3.7) thalassemia and CD59 (GGC→GAC) mutation in the α2-globin gene. The mother was heterozygous for Hb Adana, and the father was heterozygous for α^-3.7.

Conclusion: This case report emphasizes the need to consider Hb Adana detection in the absence of HbH inclusions and normal Hb analysis. Therefore, DNA analysis is strongly suggested to confirm the diagnosis and improve the management of thalassemia patients.

Background: Spindle cell/Sclerosing rhabdomyosarcoma is the rarest variant of rhabdomyosarcoma, accounting for 5-10% of all rhabdomyosarcoma cases. Pathologically, these tumors can provide a variety of features and can resemble other tumors, thus often difficult to diagnose. We report a case of sclerosing rhabdomyosarcoma of the gingiva with histomorphology mimicking a malignant peripheral nerve sheath tumor.

Case Presentation: The patient was a 39-years old Balinese male who noticed a lump on the left gum since 9 months ago. Head CT scan revealed a solid mass with soft tissue density at the left lower gingiva that extend superiorly and laterally, involving the left parapharyngeal and masticator spaces, infiltrated into the left mylohyoid muscle and left medial and lateral pterygoid muscles, and caused destruction of the left mandibular ramus and alveolar process of the left maxilla. The initial biopsy showed the proliferation of atypical spindle cells with a pattern resembling peripheral nerve sheath tumor and concluded as a low-grade malignant peripheral nerve sheath tumor. Wide excision specimen consists of proliferation of low-grade atypical spindle cells arranged in a fascicular pattern with foci of strap cells embedded in glassy eosinophilic sclerosis matrix. Some parts of the tumor showed palisading nuclei. The tumor cells were diffusely positive for desmin and negative for S100. This case was finally diagnosed as sclerosing rhabdomyosarcoma.

Conclusion: Sclerosing rhabdomyosarcoma should be considered when atypical spindle lesions occur between the hyalinized stromal matrix of the head and neck in adults. Because of wide differential diagnosis, an adequate sampling, careful microscopic examination, and immunohistochemistry staining can avoid misdiagnosis.

Background: Intractable singultus is a rare disorder, and there are no guidelines for its management. More than 100 etiologies are described in the literature, but the etiology cannot be defined in as much as 20% of patients. Acute singultus needs no further treatment, but intractable singultus warrants thorough evaluation and treatment because it has high morbidity and mortality.

Case Presentation: We present a 29-year-old male with intractable singultus accompanied by a sliding hiatal hernia, refractory to chlorpromazine and baclofen treatment, and hiatal hernia repair. The patient underwent hiatal hernia repair and Nissen fundoplication, which provided 3 days free of singultus. On the fourth postoperative day, the singultus begins 3 times a day, with episodes lasting up to 5 minutes, with a rate of 10-25 singultus per minute. The patient was discharged on postoperative day-5, hemodynamic was stable and no signs of infection were reported.

Introduction:While initially suggested as a primary respiratory infection, there has been increasing proof that the novel coronavirus disease (COVID-19) also leads to severe neurological manifestation particularly ischemic stroke. The hypercoagulable state observed in COVID-19 patients is thought to contribute to this phenomenon although the exact pathophysiology is still unclear.

Case: We are reporting two cases of hemorrhagic transformation after ischemic stroke in COVID-19 patients. Both patients were women presenting with ischemic stroke and bronchopneumonia due to COVID-19. They both experienced prolonged coagulation studies before sudden neurological deterioration. Evaluation CT scan demonstrated the hemorrhagic transformation of infarction.  It is still unknown whether the coagulation disruption is primarily caused due to viral activity or secondary due to the inflammatory response. Hemorrhagic transformation is a complication of ischemic stroke, particularly in post-thrombolysis patients. However COVID-19 coagulopathy was thought to induce such event in COVID-19 patients presented with ischemic stroke.

Conclusion: Although ischemic stroke has been widely reported in COVID-19 patients, there have been a few reports of hemorrhagic transformation events. This may lead to an increased understanding regarding COVID-19 pathophysiology and cerebrovascular disease.