Introduction: Many social media platforms are available today that can facilitate social interaction and potentially affect health behavior. Social media can potentially serve as a source of information about how to treat acne. They can also be a tool to compare and raise dissatisfaction with their body image. Acne is a skin condition that primarily affects the face and can lead to significant psychosocial effects.

Methods: This study was a descriptive observational study with a cross-sectional design that included 50 subjects with acne vulgaris according to inclusion and exclusion criteria. Basic data were recorded, including age, gender, education and job. Social media usage data were recorded, including actively used social media platforms and duration of use. Acne vulgaris treatment used by the subject based on information obtained from social media was recorded. Psychosocial was assessed using Acne-QoL-INA and Rosenberg Self-Esteem Scale questionnaire.

Result: In this study, acne vulgaris was more common in women and the 18-25 age group, where most subjects had higher education and student group. Instagram was the social media used daily by most acne vulgaris patients. Instagram was also the most used social media to access regarding therapy for acne vulgaris and was mostly used 1 hour per day. The subject used skin care to treat their acne, followed by topical agents and practicing instruction to heal acne. The influence of social media on the quality of life showed the lowest score range (0-10) on self-perception, role-social and role-emotional domain, on the acne symptoms domain was in the middle score range (11-20). Social media's influence on self-esteem shows 6% on low self-esteem, followed by 94% in the normal score range.

Conclusion: Using social media could encourage patients with acne to seek self-medication, mostly use skincare and have a psychosocial impact on patient's quality of life.

Introduction: Obesity is a nutritional disorder that can affect all ages, including teenagers. Obesity can affect gut microbiota and cause increased intestinal permeability. This process leads to interleukin-6 and TNF-α production which can increase leptin levels. The soluble leptin receptor (sLR) is a leptin receptor in the plasma that transports leptin to the hypothalamus. Low sLR numbers are associated with high leptin levels in obesity. Obesity in hyperleptinemia conditions indicates leptin resistance (defects in leptin receptors) which causes hyperphagia and reduces energy expenditure. This study was conducted to prove high TG and IL-6 serum levels and low sLR levels in obese adolescents who have a higher risk of developing leptin resistance than normal adolescents.

Methods: This research is a case-control study. The subjects underwent an assessment including food recall, anthropometric status, and lipid profile. The food recall assessment was obtained by means of a questionnaire given to parents. Blood sampling and laboratory examination are carried out by the Prodia® Clinical Laboratory. Data analysis was performed by computer, using the Independent t-test, Mann-Whitney test. Chi-Square test, and analysis of the ROC curve.

Results: ROC curve analysis obtained the optimal cut points for TG and IL-6 levels, respectively 101.5 mg/dL (sensitivity 82.1%, specificity 89.7%) and 11.95 pg/mL (sensitivity 84.6%, specificity of 80%), with area under the curve (AUC) values of 0.96 and 0.89, respectively. ROC curve analysis obtained the optimal cut point for sLR levels of 19.3 ng/mL (sensitivity 64.1%, specificity 71.8%) with an AUC value of 0.77. Multivariate analysis using logistic regression found a significant relationship between TG and IL-6 levels on the incidence of hyperleptinemia.

Conclusion: This study reinforces the theory of chronic low-grade inflammation and proved that inflammation and high TG levels play a role in hyperleptinemia in obese adolescents.

Background: Sepsis has become the most common postoperative complication caused by major surgery. Early diagnosis of sepsis is very important to know the patient's prognosis and survival. Changes in mean platelet volume (MPV) and platelet distribution width (PDW) were assessed to have a relationship with the incidence of sepsis. The use of MPV and PDW platelet preoperative indicators is expected to help predict sepsis so that appropriate interventions can be given immediately.

Methods: A total of 50 patients who met the inclusion criteria became the subjects of this study to determine the potential of MPV and PDW preoperative biomarkers for predicting sepsis in laparotomy patients. All blood tests for the diagnosis of sepsis were examined. Spearman's test and ROC curve were performed for statistical calculations to determine the cut-off point for MPV and PDW.

Results: Analysis of the relationship between PDW and MPV values ​​as an indicator of sepsis using the Spearman test found a significant relationship between MPV and PDW ​​on the incidence of sepsis (p<0.05). Furthermore, statistical tests using the ROC area under the curve (AUC) curve, MPV levels were 0.968, which indicates that if MPV were examined in 100 patients, it would predict sepsis in 96 patients. Meanwhile, the AUC of PDW is 0.770, which shows that if MPV examination is performed in 100 patients, it will predict sepsis in 77 patients. . The best cut-off point ​​that the researchers got in this study was MPV levels 9.8 fL (sensitivity 93.3% and specificity 85%) and PDW levels 9.45 fL (70% sensitivity and 70% specificity).

Conclusion: Preoperative MPV and PDW can be predictive indicators of sepsis in laparotomy surgery, with MPV sensitivity and specificity of 93.3% and 85% and sensitivity and specificity of PDW of 70% and 70%, respectively.

Link of Video Abstract: https://youtu.be/YEQ3ICJPmxA

Background: Ventilator-associated pneumonia (VAP) occurs after endotracheal intubation and ventilator for more than 48 hours therefore it is an emerging threat to patient safety. The aim of this study is to determine the incidence and compare the risk factors of ventilator patients diagnosed with ventilator-associated pneumonia and patients with ventilators who are not diagnosed with ventilator-associated pneumonia.

Methods: This study used a retrospective observational with a case-control approach. Data was collected from January 2019 to December 2021. The risk factors to be analysed were comorbidities, antibiotic therapy, length of stay in the intensive care unit, duration of ventilator use, and history of surgery.

Results: There were 18 patients in the VAP and the control groups met the inclusion and exclusion criteria. The incidence of incidents in 2019 was 3.2 per 1000 ventilator days; in 2020, it was 1.2 per 1000 ventilator days; and in 2021, it was 1.2 per 1000 ventilator days. Comparison test results using Mann-Whitney showed a difference with a p<0.05. Patients with prolonged use of ventilators (p<0.05) and prolonged hospitalization (p<0.05) have a higher risk of developing ventilator-associated pneumonia. The average VAP occurs on the fourth day on a ventilator. Gram-negative bacteria, Pseudomonas aeruginosa, Acinetobacter baumanii, and Klebsiella pneumoniae cause most bacterial infections

Conclusion: There is a high risk of developing VAP in patients with prolonged use of ventilators and extended stays in the intensive care unit of the Tertiary Referral Hospital.

Introduction: Gender-based violence (GBV) is an important issue, especially violence experienced by women in the household. Social norms and beliefs (SNB) held by a person in society also affect the occurrence of violence. The purpose of this study was to examine the construct validity and reliability of SNB on the GBV scale in Indonesia.

Methods: Cross-sectional research was used in this study. A questionnaire on gender-based SNB was used to gather data. It had two domains—injunctive social norms and personal beliefs—each with three subscales: the husband's right to use violence, preserving family honor, and responding to sexual violence. By using a random sampling technique, data were obtained from 234 people consisting of 197 women and 37 men aged over 18 years. Data were analyzed using SmartPLS.

Results: The item which was strong on social norms with Cronbach's alpha 0.844 was protecting family honor. All items were above 0.5 so it can be stated that the gender-based SNB scale was valid and reliable to be used in measuring gender-based violence in Indonesia.

Conclusions: Psychometrics of SNB about GBV scale in the Indonesian version is valid and reliable.

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

Introduction: The pandemic of COVID-19 has put healthcare workers under high pressure with possible psychological problems and its most common effects are insomnia, depression, distress, anxiety, and somatization symptoms. Previous studies in several centers have shown different results between frontline and non-frontline healthcare workers. This study aims to evaluate the levels of anxiety and perceived needs for mental healthcare among non-frontline healthcare workers during the COVID-19 pandemic in a referral hospital in Surabaya.

Patients and methods: This cross-sectional study involved forty respondents, but one was discontinued due to technical problems. Questionnaire of The Hospital Anxiety and Depression Scale (HADS) was adopted that has 14 scales with two subscales. The subscales include HADS-A for Anxiety and HADS-D for depression

Results: The results show that both HADS-A and HADS-D have significant differences between the indirect and direct groups of contact healthcare workers, except in gender and depression, as shown in Table 3, with an average score of 8.000 (SD 5.02169) and 8.7333 (SD 4.71270), respectively.

Conclusion: Anxiety and depression remain a problem for all healthcare workers, whether frontline or non-frontline. Therefore, issues must be used to mitigate both the frontline and non-frontline healthcare workers.

Background: The COVID-19 pandemic mandated people to use masks to control the disease spreading. However, mask usage can cause skin-related problems such as acne, which is called maskne. This study aimed to find out whether there is a relationship between the use of masks and the event of maskne in Universitas Sumatera Utara (USU) Hospital healthcare workers during the COVID-19 pandemic.

Subjects dan Methods: This study was an observational analytic study with a cross sectional approach with consecutive sampling methods involving 100 healthcare workers at USU Hospital. Diagnosis of maskne was established through history taking and dermatological examination. The data collected was analyzed using Chi-square, Kruskal Wallis and Fisher Exact tests. This research has received approval from the Research Ethics Commission of the Faculty of Medicine Universitas Sumatera Utara and Universitas Sumatera Utara Hospital.

Results: Maskne was more common in women (84.9%) in the age group 26-35 years old (69.9%). Doctors and nurses (31.5%) had more maskne, polyclinic (23.3%) was the work location that often has maskne. The use of medical masks (74.0%) had a significant relationship with the event of maskne (p=0.002), while the duration of wearing masks was 36 hours/day (80.8%), frequency of masks replacement 2 times/day (52.1%) and using 1 layer of masks (74.0%) was more often found in subjects who has maskne but did not have a significant relationship with the event of maskne.

Conclusion: There is a relationship between the use of masks and the event of maskne based on the type of masks in healthcare workers Universitas Sumatera Utara Hospital during the COVID-19 pandemic.

Background: Soft tissue engineering has widely explored freeze-dried human amniotic membrane (FdHAM) and human adipose-derived stromal cells (hADSC) as separate components. In this study, the composite of FdHAM and hADSC combination was investigated regarding cell morphology and density, constituent components, and cytotoxicity evaluation.

Methods: In vitro experimental laboratory research was conducted to analysis of the FdHAM and hADSC composites. Evaluation of cell viability and CD105 for hADSC, evaluation of pore diameter for amniotic membrane and assessment of composite cell morphology, constituent components, evaluation of cytotoxicity, and cell density was conducted.

Results: Our morphology data indicated that clusters of hADSC with homogenous distribution on FdHAM. The viability test showed that the hADSCs were still dominantly alive with an average percentage of 69.3% with the mean cell concentration being 1.53 x 10⁶/mL. The average FdHAM pore diameter was 1.90±0.30 µM. Our data suggested that FdHAM was nontoxic with good cell survivability after exposure to FdHAM.

Conclusions: The structure of FdHAM and hADSC has excellent basic properties and therefore suitable for use as carriers of hADSC or in soft tissue engineering. Compared to the available literature, the characteristic of the FdHAM and hADSC composite is ideal and may be used as an end-product for use in humans.

Link of Video Abstract: https://youtu.be/K2R3dfdvi20

Background: Simple, cost-effective, and practical laboratory indicators are required to diagnose and evaluate COVID-19 disease severity. This study assessed the diagnostic value and predictor of severity and outcome parameters of NLR, d-NLR, MLR, PLR, and ALC in COVID-19 patients.

Methods: A retrospective study used medical record data from 100 COVID-19 patients from November 2020 to March 2021. SPSS version 22 was used to analyze the data. The severity of COVID-19 was predicted using a ROC curve. Kaplan-Meier analysis was employed to evaluate the ability of various inflammatory markers to predict COVID-19 prognosis. A multivariate analysis with logistic regression was conducted to assess the ability of an independent predictor of COVID-19 severity. A p-value of <0.05 was considered significant.

Results: ALC values were lower in the severe-critical COVID-19 group, whereas NLR, d-NLR, MLR, and PLR values were higher. The NLR, d-NLR, and ALC parameters had sufficient accuracy, whereas the MLR and PLR parameters had low accuracy. NLR, d-NLR, MLR, PLR, and ALC had optimal cut-off values of 7.865, 4.82, 0.455, 235.000, and 0.895, respectively. The multivariate odds ratio for ALC was 7.348 (95% CI = 1.914-28.214; p = 0.004). Kaplan-Meier analysis revealed differences in survival time based on the optimal NLR, MLR, d-NLR, and ALC cut-offs obtained.

Conclusion: NLR, d-NLR, MLR, PLR, and ALC are all potential predictors of COVID-19 severity and prognosis. ALC is a reliable predictor of COVID-19 severity.

Link of Video Abstract: https://youtu.be/fvbkSDEVY3Q

Background: A child's ability to speak must be supported by a good hearing function. With early detection of hearing loss, it is hoped that intervention can be made promptly, thus improving the quality of life (QOL) of children with hearing loss at birth. The purpose of this study was to compare the otoacoustic emissions (OAE) examination results in infants with and without risk.

Method: The OAE examination was conducted on 60 newborns with and without risk factors in the nursery room and ORL-HNS outpatient unit. For all the newborns aged > 24 hours and before being discharged from the hospital with inclusion criteria, the OAE examinations were performed and repeated when they were 1 and 2 months old. Furthermore, the comparison of OAE results on newborns with and without risk factors aged > 24 hours, 1 month, and 2 months were statistically analyzed.  

Results: A Friedman statistical analysis test was then conducted to examine the correlation between the results of the first, second, and third OAE examinations. The first, second, and third OAE examination results of newborns with and without risk factors were compared, significant differences were found with a p-value of 0.0111 (p < 0.05).

Conclusion: The newborn hearing screening using OAE should be performed for all newborns (Universal Newborn Hearing Screening) and serially to minimize the number of higher referrals to health facilities to improve an individual's quality of life in the future.

Background. Breast cancer has the highest incidence of cancer in women. The first-line chemotherapy, Adriamycin-cyclophosphamide (AC) has good results, but its efficacy is not optimal. The fruit lectin substance Abelmoschus esculentus has an anti-cancer effect, so it is widely used as a chemotherapy supplement. The aim of the study is to prove Abelmoschus esculentus extract can increase the apoptotic index against chemotherapy

Method. In vivo laboratory trial study, we are using Sprague Dawley female rats aged 28 days with mammary adenocarcinoma induced by DMBA. There are 4 groups, namely; control (K): placebo, treatment1 (P1): AC chemotherapy (Adriamycin 1.5 mg and cyclophosphamide 15 mg), treatment2 (P2): Abelmoschus esculentus extract 150 mg/kgBB/day, and treatment3 (P3): a combination of AC and Abelmoschus esculentus extract.

Results. The P3 group had the highest levels of Endonuclease_G (EndoG) and apoptosis at (38.66 ± 0.73) and (21.03 ± 0.69), respectively. Combination of Abelmoschus esculentus extract with chemotherapeutic agents can improve the anticancer outcome by significantly increasing EndoG expression and apoptosis index (p<0.05) in comparison to other groups.

Conclusion. Extract from Abelmoschus esculentus fruit shows high apoptotic index and EndoG expression which means that this extract can increase the apoptotic response to in vivo in-cyclophosphamide adriamis chemotherapy.

Link of Video Abstract: https://www.youtube.com/watch?v=RG95aJkUndg

Background: Thalassemia and hemoglobinopathies are caused by mutations in the globin genes that reduce haemoglobin synthesis. In many Asian countries, including Indonesia, thalassemia is a common inherited disorder. Thalassemia has specific characteristics due to the wide variability of the mutations from various populations. Therefore, screening protocol should be designed on specific populations’ regional gene mutation patterns. This study aims to investigate the mutational diversity of the globin genes in thalassemia major patients in Rembang Regency, Central Java, Indonesia.

Methods: Genetic mutations were carried out in all major thalassemia patients who were recorded and underwent routine blood transfusions at the Rembang District Hospital from 2018 – 2020. Mutation identification was carried out using a PCR- RFLP  (Polymerase Chain Reaction-Restriction Fragment Length Polymorphism) based method, the ACRS (Amplified Created Restriction Site) method, and genome sequencing.

Results: The most common genotypes are double heterozygous HbE and Cd 35 mutation (-C) (42.87%), HbE and IVS1-nt.5 mutations (G> C) (28.57%), HbE and IVS1- nt.2 mutations (T> C), HbE and codon 8/9 (insertion + G), codon 8/9 (insertion + G) and Hb Malay, as well as Hb Adana and Hb Constant Spring (1.74%).

Conclusion: The β-thalassemia and α-thalassemia mutations most commonly found in Rembang Regency are Cd 35 (-C) and non-deletional mutations.

Link of Video Abstract: https://youtu.be/wBzC28ImZ7Q

Background: Surgery remains the best choice curative treatment for pancreatic cancer. Therefore, it is crucial to establish accurate diagnosis from the beginning. BACAP score and CA 19-9 have been identified as good predictors of pancreatic cancer resectability, and their accuracy is expected to increase when combined. This study aimed to determine the outcomes produced by the combination of the BACAP score and CA 19-9 tumor marker.

Methods: This was retrospective cross-sectional study involved pancreatic cancer patients who underwent surgery between January 2017 and April 2023. Logistic regression analysis was performed on all variables of the BACAP score and CA 19-9. The primary outcomes were demographic characteristics, predictive value of BACAP score, Modified BACAP score, and CA 19-9

Results: A total 87 patients were included. BACAP score yields a sensitivity of 50.0%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 73.8%, and accuracy of 75.9% (AUC 94.6%). While modified BACAP score yielded a sensitivity of 83.1%, specificity of 85.7%, PPV of 70.5%, NPV of 92.5%, and accuracy of 83.9% (AUC 89.4%).

Conclusion: The combination of CA 19-9 and the BACAP score yields a modified score with better outcomes compared to the BACAP score alone in predicting the resectability of pancreatic carcinoma.

Link of Video Abstract: https://youtu.be/2L4njgfd3SE

Background: The dissemination of coronavirus disease (COVID-19) has led to delayed infertility treatment and fear of contracting the virus which can affect the mental status of women with infertility. This research aimed to investigate whether fear, depression, perceptions, and knowledge related to COVID-19 affected infertility patients in seeking treatment and analyzed factors associated with depression during COVID-19 pandemic.

Method: This is a cross-sectional study utilizing an electronic survey distributed to infertility patients attending fertility services between May and July 2021. The primary outcomes were demographic characteristics, clinical parameters of infertility, depressive symptoms based on the Patient Health Questionnaire-9 (PHQ-9) score, and fear of COVID-19 scale (FCV-1 and FCV-2).

Results: A total of 533 patients were included. The fear of infertility treatment suspension due to COVID-19 was perceived by 34.1% of patients. The mean Patient Health Questionnaire-9 (PHQ-9) score was 4.55 ± 4.248, with mild depression occurring in 33.4% of patients. Low income, delayed treatment, and fear of COVID-19 scale (FCV-1) score together could significantly predict depression status. Despite the pandemic, 94.7% of patients decided to continue the treatment.

Conclusion: The COVID-19 pandemic has given rise to stressors that may aggravate the psychological condition of women with infertility. However, the enthusiasm to continue the treatment remains undisturbed. It is imperative to offer emotional support and address the consequences of COVID-19 infection in women with infertility during the pandemic era.

Link of Video Abstract: https://youtu.be/KymCxU8ATU0

Background: Colorectal cancer is now the third most common cancer both globally and in Indonesia. An important component of the adaptive immune system, tumor-infiltrating lymphocytes (TILs) cluster of differentiation 8 (CD8+) are key in the immune response to malignancies, which were previously believed to be the primary initiators of anti-tumor immunity. A higher TIL CD8+ levels in the tumor microenvironment and a better prognosis have been associated with anticancer benefits in a number of cancers. This study aimed to describe the characteristics of colorectal cancer patients with increased tumor-infiltrating lymphocyte CD8+ expression and their relationship with clinicopathological features.

Methods: A cross-sectional investigation was conducted. Patients in the digestive surgery division with colorectal cancer served as the study's research subjects. There were 36 study subjects that were randomly selected from the available specimens. Examination of tumor-infiltrating lymphocytes CD8+ expression was carried out by the immunohistochemistry method.

Result: Expression of tumor-infiltrating lymphocytes CD8+, was positive in nine (25%) patients, and normal expression was shown in 27 (75%) patients. Most of the patients had adenocarcinomas histologically (91.7%), and 66.7% of patients were older than 50, with 77.8% of the tumors located at the rectum. Univariate analysis of the clinicopathological characteristics related to the tumor-infiltrating lymphocytes CD8+, showed a non-significant relationship statistically (p > 0.05).

Conclusion: There was no relationship between clinicopathological characteristics and tumor-infiltrating lymphocyte CD8+ expression in colorectal cancers.

Link of Video Abstract: https://youtu.be/15Du23GFCWc

Introduction: A niche (also called an isthmocele) is a defect or uterine scar that can be detected by ultrasound a few weeks or months after delivery by cesarean section. A niche is often associated with obstetric complications in subsequent pregnancies, including uterine dehiscence and/or rupture, placenta previa, and placenta accreta. Placenta accreta is characterized by abnormal attachment of the placenta to the uterine wall and is one of the leading causes of maternal morbidity and mortality in developing countries. Therefore, this study aims to evaluate the healing of surgical wounds with the figure of eight suturing techniques.

Methods: This study included 32 primigravida patients who underwent cesarean section at RSIA (Mother & Child Hospital) Rosiva from March 2006 to July 2006. On day 6 of the puerperium, the uterine sutures were examined with transvaginal ultrasound. Patients were subsequently allowed to return to their homes to receive outpatient treatment. On day 40, the patients were requested to return to the hospital for a follow-up ultrasound examination.

Results: On day 6, incomplete wound healing was found in 31 patients (96.9%) and complete wound healing in 1 patient (3.1%). On day 40, 31 patients (96.9%) experienced perfect or complete healing. Statistical analysis showed a significant difference in wound healing between day 6 and day 40 (p = 0.0001).

Conclusion: On day 40 after cesarean section, as many as 96.9% of patients showed perfect/complete wound healing (type I) without a niche. Therefore, these patients had a low risk of obstetric complications associated with uterine scarring in subsequent pregnancies.

Introduction: Endometriosis is a benign gynecological disease whose pathogenesis mechanism is not fully understood with treatment modality with hormonal and surgical methods aiming to relieve symptoms, suppress progression, and increase fertility. This study aims to observe the differences in the administration of Chromolaena odorata leaf extract on the area of endometriosis implants in the mice model of endometriosis

Materials and Methods: This study was an experimental study with a Randomized Separated Pre and Post Test Design research conducted with the control group. Thirty mice (Mus musculus) were injected with 0.2 ml/mice of cyclosporine A. Then endometrial tissue was injected into the peritoneal cavity, followed by 0.1 ml Ethinyl estradiol/mice injections on the 1st and 5th days. Mice were reared for 14 days until the endometriosis model was formed. Mice models of endometriosis were randomly divided into five groups: endometriosis mice that were terminated on day 14 (pretest), then the other groups are endometriosis mice given Aquadest as placebo (P0), endometriosis mice treated with Chromolaena odorata leaf extract at a dose of 400 mg per kilograms of body weigh (mg/kgBW) (P1), 800 mg/kgBW (P2) and 1200 mg/kgBW (P3) for 14 days. On the twenty-eighth day, mice were dissected to examine and assess the extent of endometriosis implantation macroscopically in hyperemic areas by taking samples in the most hyperemic areas of the peritoneal wall. Research data were analyzed using SPSS Version 22.

Results: From this study, the average value of endometriosis implant area in the group given Chromolaena odorata leaf extract was 400 mg/kgBW (P1 = 15.60 mm²), 800 mg/kgBW (P2=14.23 mm²) and 1200 mg/kgBW (P3=0.00 mm²) was lower than the pretest group (P=104.72 mm²) and the placebo group (P0 = 153.89 mm²), showing a significant difference (p<0.001). There was a tendency that the area of endometriosis implants was also lower in the group receiving a higher dose of Chromolaena odorata leaf extract 1200 mg/kgBW (P3=0.00 mm²) than the group receiving a dose of 400 mg/kgBW (P1=15.60 mm²) and 800 mg/kgBW (P2=14.23 mm²).

Conclusions: It can be concluded that the administration of Chromolaena odorata leaf extract can reduce the area of endometriosis implants in mice models of endometriosis. Higher doses result in the lower endometrial implant area.

Link or Video Abstract: https://youtu.be/oy1cDLwM0M8

Introduction: Periodontal packs have frequently received extra anti-inflammatory and antibiotic medications, but they might trigger allergic reactions. As a result, alternative materials are required, such as herbal plants like lime peel, which can hasten wound healing without producing negative side effects. Citrus aurantifolia Swingle's peel extract, which has active ingredients with anti-inflammatory, antioxidant, antimicrobial, and antibacterial actions, can hasten the healing of wounds when added to periodontal packs. One marker in the healing process is reducing the production of lymphocytes. This study aims to determine the effect of lime (Citrus aurantifolia Swingle) peel extract on periodontal packs and the number of lymphocytes in rabbit gingival preparations.

Methods: Thirty-two New Zealand white rabbits were employed as the sample; they were harmed on the mandibular gingiva using a punch biopsy with a diameter of 2 mm. The animals were split into eight groups on the third and fifth days, with the treatment group receiving a periodontal pack containing lime (Citrus aurantifolia Swingle) peel extract and the control group receiving a periodontal pack without it. In order to count the lymphocytes, histological preparations were examined using HE staining.

Results: Statistical test results showed a significant difference in the number of lymphocytes between the control group and the treatment group on days 3 and 5 (ANOVA, p < 0.05).

Conclusion: Lime (Citrus aurantifolia Swingle) peel extract can decrease the number of gingival lymphocytes in rabbit's periodontal tissue.

Link of Video Abstract: https://youtu.be/8kcI8mX5A6Y

Background: Hemodialysis vascular access dysfunction is a significant cause of morbidity and mortality in hemodialysis patients. Over the past decades, numerous animal models have been developed. However, there needs to be more animal model protocol with rabbits to investigate neointimal hyperplasia in the arteriovenous fistula. This study aimed to explore an alternative rabbit model using a wild-type local model for investigating neointimal hyperplasia in the arteriovenous fistula.

Methods: One local-type male rabbit performed arteriovenous fistula, in which the right carotid communis artery was anastomosed end-to-side to the right internal jugular vein. When examining vascular tissue, measurements were taken of the thicknesses of the tunica intima and tunica media, as well as the areas of the tunica intima and tunica media, vascular diameters, and vascular lumen areas.

Result: We successfully induced neointimal hyperplasia in local-type rabbits, indicated by increased tunica intima thickness after 28 days of the arteriovenous fistula procedure.

Conclusion: Optimation of the Rabbit model using a wild-type local model for investigating neointimal hyperplasia in arteriovenous fistula may be susceptible and considered as it is accessible and cost-effective besides producing the same outcome as a laboratory rabbit

Background: Antenatal depression in pregnant women becomes less of a concern, leading to the worse condition of developing postpartum blues, ranging from moderate to severe degrees. In this study, antenatal depression was detected as a psychosocial impact on pregnant women, and their perspective on accepting pregnancy may alter due to the COVID-19 pandemic.

Methods: This study used a cross-sectional study design. A total of 257 pregnant women were enrolled in this study with a purposive sampling technique. Inclusion criteria: healthy pregnant women (over 18 years) from trimester I until trimester III. Antenatal depression was measured using a PHQ-9 scale questionnaire. Data were analyzed using SPSS version 20.0 for Windows.

Results: The prevalence of antenatal depression of 257 pregnant women was: 80.95% had mild depression, 14.12% had moderate depression, 4.69% had moderate or severe depression, and 0.79% had severe depression. The factor analysis results indicated that refusal of pregnancy had the highest correlation coefficient (coef. 0.586; p=0.000) on the incidence of antenatal depression compared to the history of abortion, parity, financial deficits, and conflicts with partners. During the assessment, pregnant women who reported refusal of their pregnancy felt that their pregnancy was a burden because it occurred at a challenging time.

Conclusion: Changes in psychosocial status through determinants of antenatal depression in pregnant women in East Kalimantan during the COVID-19 pandemic are expected to be the initiation of policy and antenatal depression screening formulation for each pregnant woman and mental health improvement during pregnancy.

Introduction: The active substance of pyrethroids, especially dimefluthrin, in insect repellent not only plays a role in killing mosquitoes but is also toxic to human health. This study aims to analyze the effect of insect repellent exposure on the histopathological findings in the liver and kidneys of the Wistar rat.

Methods: This experimental study used 24 male wistar rats, which were divided into four groups, namely control, type of insect repellent, which included mat electric (dimefluthrin 0.566%), liquid electric (dimefluthrin 0.014%), and coil (dimefluthrin 0.031%), with a duration of exposure a day for 8 hours in 20 days.

Results: There was a significant effect of the type of insect repellent exposure on the histopathological findings of the liver and kidneys (p<0.05). This study also showed the highest rate of cell degeneration and necrosis in the liver and kidneys belonged to Mat electric repellent exposure in the liver and kidney. Higher concentrations of dimefluthrin in insect repellent have a significant effect on the histopathology of the liver and kidney.

Conclusions: The use of mosquito coils, electric mats, and liquid electricity for 8 hours over 20 days affects the histopathological evaluation of the liver and kidneys. The higher the concentration of dimetfluthrin in insect repellent, the higher the level of damage.

Background: Striae distensae (SD) is a harmless skin disorder that can cause cosmetic and psychological problems. Until now, no easy-to-use, useful and non-invasive method can be used to determine the severity of SD. The scoring system can be used as a guide for selecting and administering effective therapy for striae distensae. This study aimed to assess the severity of striae distensae using INA score.

Methods: This research was a descriptive observational study with a cross-sectional approach involving 72 female health workers at the Universitas Sumatera Utara Hospital. The diagnosis of stretch marks is made through history and physical examination. We did the whole body examination for scoring of striae distensae. This research has been approved by the Research Ethics Commission of the Universitas Sumatera Utara.

Results: A new scoring system, namely the INA score, to assess the severity of striae distensae at the mammae, axilla, abdomen, femoral, gluteus, and popliteal locations. The assessment of the INA score based on the entire region of the study subjects was obtained at a mild degree (54.2%). The characteristics of majority of the subjects were in the age range of 18-25 years (93.1%) and had a family history of striae distensae (54.2%). The distribution of the majority of striae distensae locations is in the femoral and gluteus region (47.2%). Based on each region, the majority of the subjects had striae distensae with severe degree in the mammae (20.8%), abdomen (8.3%), femoral (90.3%), gluteus (94.4%), and popliteal (22.2%);. In comparison, the axilla was dominant with a moderate degree (5.5%).

Conclusion: The new scoring system named INA score assesses the severity of striae distensae at the mammary, axillary, abdominal, femur, gluteus and popliteal locations.

Link of Video Abstract: https://youtu.be/AfvCd6OEtcY

Introduction: Microsurgical varicocelectomy is the gold standard for varicocele therapy because it has a higher success rate and minimal complication rate than other surgical modalities. This review aims to directly compare the efficacy and safety of inguinal and subinguinal varicocelectomy microsurgery.

Method: This study conducted based on Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Articles examining the comparison of inguinal micro-varicolectomy compared to subinguinal in patients with varicoceles undergoing varicocele surgical procedures were systematically reviewed from the PubMed, ScienceDirect, and Scopus databases. Randomized Controlled Trials (RCT) studies’ quality was determined using the RoB Tool v2: for randomized trials. Risk Ratio with a 95% confidence interval is applied to the measurement of research outcomes. The analysis is performed with RevMan 5.4 software. This research protocol is listed in the PROSPERO register.

Result: A total of 293 study subjects were included from three articles in the study. Inguinal micro-varicocelectomy has a faster operating time outcome than the subinguinal approach (MD: -3.81 95% CI -6.41-1.21; p = 0.004) but has a higher postoperative visual analog pain scale (VAS) outcome (MD: -0.44 95% CI 0.85-0.03; p = 0.03).

Conclusion: There were no significant differences in the outcome of hydrocele incidence, the degree of recurrence, or the number of veins that were ligated after surgery. Micro-varicocelectomy with the inguinal approach has the advantage of faster operating time than the subingunal approach but has a higher pain rate than the subinguinal approach. We suggest the sub-inguinal rather than inguinal approach because of the higher number of benefits.

Link of Video Abstract : https://youtu.be/umLlj1K4l2w

Background: Depression is one of the most common causes of disability in the world, and one third of patients do not respond to currently available antidepressants, so a strategy is needed in its management. There have been many studies looking for a relationship between the role of the gut and mental health. Probiotics are the focus of much research in the field of psychiatry today due to their alleged role in improving mental health through gut health.

Methods: This research was a true experimental study with a posttest-only design with a control group design. Brain-derived neurotrophic factor (BDNF) plasma levels, serum serotonin (ST) serum levels, and sucrose preference test (SPT) values were analysed in 39 male Wistar rats with anhedonic behavior.

Results: Average BDNF plasma level in treatment group was 1.63 ng/mL with a standard deviation of 0.56 ng/mL, while the mean BDNF plasma level in control group was 0.89 ng/mL with a standard deviation of 0.46 ng/mL. There was a significant difference in that the BDNF plasma levels in the control group were lower than in the treatment group, with a p<0.001 (CI = 95%). The median ST serum level in the treatment group was 25.78 with an IQR of 9.61 ng/mL, while the median ST serum level in the control group was 7.5 with an IQR of 0.38 ng/mL. Statistically, the difference is significant from the p value <0.001. The median SPT score in the treatment group was 84.5 with an interquartile range (IQR) of 12%, while the median SPT value in the control group was 67 with an IQR of 8%.

Conclusion: There was an effect of probiotics as an adjuvant antidepressant therapy in male Wistar rats with anhedonic behavior.

Background: Androgenetic alopecia is the main concern hair problem in the male which is characterized by progressive miniaturization of hair follicles. One factor which contributed in androgenetic alopecia progression is sebum level. This study determined the correlation between sebum level and the severity of AGA in men.

Patients and methods: This study was an observational analytic study with a cross sectional method involving 50 male androgenetic alopecia (AGA) patients based on inclusion and exclusion criteria. Recorded age, education, occupation, family history and duration of illness. AGA severity was determined by the Hamilton- Norwood classification I–VII. Sebum levels were measured using Sebumeter® SM 815. The correlation between sebum level and severity of AGA was analyzed using the Gamma correlation test and significant if p-value<0.05.

Results: Most AGA patients were found in the 36–45 age group, had a diploma/bachelor education level, worked in business services and salespeople, had a family history of their father suffering from AGA, and had suffered from AGA for >20 years. Most AGA patients were found in Hamilton-Norwood III (50%) with the most sebum levels were found to be normal (60%). The results of this study showed a positive correlation (p<0.01) with a very strong strength between sebum level and severity of AGA (r=0.94).

Conclusion: There is a very strong correlation between sebum level and severity of AGA.

In recent years, the national usage of Plasma Derived Medicinal Products (PDMPs), particularly albumin and immunoglobulin, has expanded due to a rise in disease prevalence, as well as enhanced patient management practices and broader assurance coverage. Now, Indonesia is a country that imports all of its PDMPs, resulting in high pricing and market reliance; nevertheless, barely a third of recovered plasma gets transfused to patients. The plasma that has not been used should be discarded, at a cost. The government intended to begin meeting the needs of the PDMP by implementing the plasma fractionation program. The decision was taken to use contract fractionation for three years, after which a national fractionation manufacturer was anticipated. The potential utility of recovered plasma and the prospective requirement for plasmapheresis collection have been assessed. The Minister of Health has enacted legislation concerning plasma fractionation, including the potential of establishing plasmapheresis centers to facilitate plasma collections. The Food and Drug Administration of Indonesia has also initiated a certification scheme for blood establishments (BEs), and only certified BEs can provide plasma for fractionation. After the epidemic, the government restarted the fractionation program by modifying existing laws to allow private manufacturers to participate. The difficulty was obtaining plasma from uncompensated donors, recruiting plasma donors, increasing the number of qualified biological examiners, of which only 19 out of 469 have been certified, and increasing technology and personnel capacities. Other significant obstacles were the harmonization or consolidation of existing biological entities (BEs) and the expense of paying for recovered and source plasma. The government and other parties involved had to make substantial efforts and collaborate to overcome these problems.

Background: Kidney stones are the most common case in the field of urology, particularly in Indonesia. Extracorporeal shock wave lithotripsy (ESWL) is one of the therapeutic modalities with the aid of fluoroscopy and/or ultrasonography to visualize the location of the stone. To date, there is no research in Indonesia on the efficacy, safety and cost compatibility between ESWL and their implementation in various hospitals. This study aimed to compare the efficacy, safety and cost of fluoroscopy-ultrasonography-guided ESWL (FU-ESWL) and ultrasonography-guided ESWL (U-ESWL) as target devices in type-C hospitals in Denpasar.

Methods: This research is a quantitative study with a prospective cohort approach that involved two group pre-post-test designs. The intervention was performed using the target device of FU-ESWL at Surya Husadha Hospital and U-ESWL at Balimed Hospital. The population of this study was patients with kidney stones less than 1.5 cm who underwent ESWL. The post-treatment assessment was the efficacy (stone size, stone-free rate (SFR), frequency, re-treatment, auxiliary procedure), safety (complication) and cost (unit cost, perceived cost, actual cost, Average Cost Effectiveness Ratio (ACER), Efficiency Quotient (EQ)).

Results: After treatment, the FU-ESWL group showed a smaller remaining stone size than the U-ESWL group. The ESWL frequency and re-treatment in FU-ESWL showed significantly better results than in U-ESWL. No significant differences in complication and SFR between the two groups. The unit cost of FU-ESWL was significantly higher than U-ESWL. However, the perceived cost and actual cost were not significantly different between the two groups. Moreover, the cost aspect of the average cost-effectiveness ratio (ACER) and efficiency Quotient (EQ) of FU-ESWL is better than U-ESWL.

Conclusion: The combination targeting of FU-ESWL has better efficacy, ACER and EQ than U-ESWL.  However, no significant differences were found in complication and SFR between the two groups. Important findings in this research are expected to contribute to monitoring and evaluating the national health insurance implementation in the field of Urology.

Link of Video Abstract: https://youtu.be/FcVVr3DoiOs

Background: Obesity is an issue with public health that affects people worldwide and raises morbidity and mortality rates. In addition to dietary factors, non-nutritional factors like meal frequency and duration also contribute to the increased risk of obesity. This study aims to evaluate the duration of meals that will be compared between obese subjects who receive a mini low carbohydrate diet and those who do not.

Methods: Used a cross-sectional, quasi-experimental design in this study. Seven days of testing on 70 obese subjects who met the inclusion criteria for this study were conducted in November at the Palangka Raya city health center. Using a stopwatch to time the length of each meal in seconds and fasting blood glucose tests. Paired T-test and Independent Sample T-test are used in statistical analysis, while Wilcoxon and Mann-Whitney tests are used in the non-parametric analysis. Data were analyzed using SPSS version 20.0 for Windows.

Results: Blood glucose levels and eating speed did not correlate significantly in the mini low carbohydrate diet (M-LCD) group (p>0.05), but they correlated significantly in the control group (CG) (p<0.05). There was a significant difference in fasting blood glucose of the M-LCD and CG groups (p<0.05).

Conclusion: There was no correlation between meal speed and fasting glucose levels in the M-LCD group, but there was a significant difference between the M-LCD and CG groups' fasting blood glucose levels.

Link of Video Abstract: https://youtu.be/9kem7M9SNWI

Background: Ovarian cancer remains as major problem worldwide. BRCA1 and BRCA2 play a unique role in deoxyribonucleic acid (DNA) damage repair, especially in homologous recombination repair. There are no data on the prevalence of BRCA1 and BRCA2 somatic mutations in the Indonesian population. This study aimed to determine the incidence of BRCA1 and BRCA2 somatic mutations among a cohort of patients with high-grade serous epithelial ovarian cancer, and assess its correlation with clinical characteristics of the cohort.

Methods: This was an analytical observational study of 26 patients admitted to our hospital from 2019 to 2021. Pathological specimens were obtained from the patients and examined for BRCA1 and BRCA2 somatic mutations. Data on clinical characteristics were collected from medical records. Statistical analysis was performed to determine the relationship between BRCA mutation status and clinical characteristics, including age, stage, menopausal status, parity, family history of malignancy, and patient outcomes.

Results: Twenty-six patients with high-grade serous epithelial ovarian cancer were included in the study. Six patients (27% of 22 patients) had BRCA1 and BRCA2 somatic mutations, four did not pass the quality control test, and the remaining tested negative for these mutations. Most patients were over 50 years of age (73%). Additionally, 84% of patients were diagnosed at stage III, and only one patient had a family history of malignancy. At the end of the study, most patients (65%) had died. Statistical analysis showed no significant differences between the clinical characteristics of the groups.

Conclusion: The incidence of BRCA1 and BRCA2 somatic mutations among patients with high-grade serous epithelial ovarian cancer at our hospital during 2019–2021 was 27%. There were no significant differences in the clinical characteristics of those with and without mutations, hence NGS screening following diagnosis establishment may be beneficial in further management plans.

Background: Special needs students come from many diverse and different family backgrounds. It may become a factor in special needs student learning performance. The purposes of this study are to find out how family background can affect special needs students in Pronunciation mastery and the process of special needs students in pronunciation mastery.

Methods: This study is a descriptive qualitative study using the case study method with three data collections. There are interviews, observations, and documentation. It becomes a unique single case study because the object of the study is an autism spectrum disorder student who continues his study until college and has good English pronunciation.

Results: The result of the study found that the most influential factor that can affect an autism spectrum disorder child’s pronunciation mastery is family motivation. The term motivation here is the desire from the parents who want to develop their skills and also motivation to develop their special needs child, in the hope that the special needs child can be Independent with their skills.

Conclusion: This autism spectrum disorder student has certain unique repetitive behavior: checking an English word through google translate. He often listens to how to pronounce words correctly. Although the parents come from a low social class, they can still improve their special needs child's Pronunciation by giving a supportive educational environment.

Background: Burns is one of society's most common types of trauma. It is estimated that around 1.2 million people experience burns each year and 100,000 of them require hospitalization. The giwang fern cactus leaf (Euphorbia milii) extract contains many antimicrobial compounds in almost all plant parts. This study determined the effect of giwang fern cactus leaf extract (Euphorbia milii) on the number of fibroblasts in burnt white rats infected with Pseudomonas aeruginosa.

Methods: This experimental study uses a randomized post-test research design with a control group using three groups of rats. The data results were analyzed statistically using a parametric test with Anova (One Way Anova). Data were analyzed using SPSS version 20.0 for Windows.

Results: This study showed that the 50% giwang fern cactus leaf (Euphorbia milli) extract had the highest average number of fibroblasts (38.3±8.77), compared with the control (23.3±1.86) and P1 group (25%) (27.6±6.65). Based on the analysis test, it is known that there is a significant comparison between groups (p<0.05).

Conclusion: There is a significant difference in the number of fibroblast cells among groups after providing giwang fern cactus leaf (Euphorbia milii) extract.

Background: Pain medication with meditation has been practiced for a long time. Multiple meta-analyses have shown whether meditation is ineffective for treating pain, but there does not appear to be enough information for researchers to draw firm conclusions. At the same time, the trend of just using meditation as a pain therapy is still apparent in the search results for documents related to this subject.

Method: We collected the Scopus database of meditation as a pain therapy and then performed a quantitative analysis using Biblioshiny and VOSviewer software.

Results: The quantitative analysis's findings show the use of meditation as a pain therapy technique. Researchers continue to trust in the clinical benefits of mindfulness meditation in pain management, despite several studies showing the limited effect of meditation as a pain therapy. Many methods have been utilized to modify mindfulness meditation in recent studies.

Conclusion: Due to mounting clinical evidence supporting its efficacy, researchers are increasingly turning to mindfulness meditation as a kind of pain management.

Background: Emesis gravidarum is an inconvenience that often occurs in the first trimester of pregnancy. Continuous emission of gravidarum can be bad for the health of pregnant women and the fetus is conceived, so it must be overcome as early as possible, one of which can use non-pharmacological therapy, namely applying self-hypnosis and prenatal gentle yoga to reduce emissions of gravidarum can make pregnant women relax. This study aimed to analyze the application of self-hypnosis with Prenatal Gentle Yoga on emissions of gravidarum in first-trimester pregnant women.

Methods: The design of this study used a Quasi experimental design with a Two group pretest-posttest design without control using purposive sampling. This research was conducted on first-trimester pregnant women who experienced the emission of gravidarum in the PMB Nanik Sidoarjo of ​​32 pregnant women in the first trimester. The self-hypnosis was carried out every day for approximately 15-30 minutes for 1 week, while prenatal yoga was carried out 3 times a week for 30 minutes. Data collection on the intensity of nausea and vomiting used the Pregnancy Unique Quantification of Emesis and Nausea (PUQE)-24 scoring system questionnaire. Data analysis used an independent T-Test test.

Results: The results of the analysis of this study indicate that the mean difference in the Self Hypnosis treatment group is greater (1.77) than in the Prenatal Gentle Yoga group (1.25), which means that Self Hypnosis is more effective in reducing the intensity of nausea and vomiting in emesis gravidarum versus Prenatal Gentle Yoga.

Conclusion: Therapy Self Hypnosis and Prenatal Gentle Yoga can reduce the emission level of gravidarum in first-trimester pregnant women so that it can be used as an alternative therapy that is easy to apply and has minimal side effects by pregnant women who experience gravidarum emissions.

Background: Diabetes mellitus (DM) could hamper the immune responses, including that induced by the vaccine. The aim of this study was to evaluate the immunogenicity of coronavirus disease 2019 (COVID-19-19) inactivated vaccines in patients with DM either controlled or uncontrolled through a systematic review approach.

Methods: Without regard to time constraints, searches were conducted in ProQuest, Embase, and PubMed  to assess the available data on the impact of DM regulation on the immunogenicity of post-vaccinated DM patients. The PRISMA guideline and the PICO criteria were used. The quality of studies was assessed using the National Institutes of Health (NIH) quality assessment tool. There is not enough Available data comparing the immunogenicity of the vaccine in controlled and uncontrolled DM patients is limited.

Results: Out of 20,657 articles, five studies were included, of which three had good quality and two had fair quality. Our data suggested that DM patients vaccinated with CoronaVac/SinoVac had lower seroconversion rates significantly lower compared to non-DM patients. The immunogenicity of BBV-152 vaccine in DM patients was also significantly lower than in patients without DM. Studies comparing the immunogenicity of the vaccine between controlled and uncontrolled DM patients are limited.

Conclusion: Patients with DM have lower antibody levels than non-DM patients who received inactivated COVID-19 patients. Glycemic management has emerged as critical to maximizing the immunogenicity induced by inactivated vaccines in a small number of patients; however, to support this conclusion, studies with adequate number of patients are critical.

Link of Video Abstract: https://youtu.be/-B5Z8H6e4o0

Background: During pandemic, the amount of screen time in individuals is tremendously expanding. Excessive screen time may result in eye blinks reduction, tears evaporation, and eventually dry eye syndrome (DES). This study aims to show the descriptions of the duration of screen time and dry eye symptoms in medical students during the pandemic.

Methods: This study uses a descriptive and cross-sectional methods.  The subjects were students of The School of Medicine at UIN Alauddin Makassar, who were undergoing online learning. The data were collected through a questionnaire containing subjects' activities using gadgets per day and the Ocular Surface Disease Index (OSDI) to assess dry eye symptoms. Ophthalmological examinations for DES (blink rate, tear meniscus height, tear break-up time, Schirmer test) were also performed on the study subjects.

Results: Most of the subjects are female and 22 years old. The average screen time of the subjects was 17.7 hours per day. Two subjects (4.55%) had mild dry eye symptoms, 14 subjects (31.82%) had moderate dry eye symptoms, and 28 subjects (63.64%), had severe dry eye symptoms. This study also found that the average blink rate of the subjects was 11.36±7.45 times per minute, and the average TBUT value was 10.58±2.69 seconds. Schirmer 1 examination showed a value with a mean of 23.67±12.76 mm, and Schirmer 2 examination showed a value of 20.21±11.64 mm.

Conclusion: The average screen time of the subjects was 17.7 hours. Most subjects had severe dry eye symptoms (63.64%) and low blink rate (59.09%).

Background: Riskesdas in 2018 showed that the Caesarean birth rate in Indonesia was 17.6%. In addition to the many benefits of Caesarean section, postoperative patients face various problems ranging from healing after surgery, lactation process constraints and other discomforts. Various studies have been carried out to prove the superiority of the Enhanced Recovery after Caesarean Surgery (ERACS) method. This investigation seeks to evaluate the impact of ERACS on postoperative discomfort and the beginning of colostrum excretion.

Methods: In this study, a control group was used in a quasi-experimental study to assess the degree of postoperative discomfort and the beginning of colostrum excretion between the control group (non-ERACS) and the treatment group (Sectio Caesarean with ERACS method). For this study's simple random sample, there are 30 respondents in each group. The Chi-Square and multivariate logistic regression tests were used to evaluate the data and discover the variables' relationship.

Results: Based on the data analysis, it was found that ERACS was effective in reducing post-operative pain (p<0.001), and the coefficient of determination is 0.645, which means that the ERACS can influence 64.5% of the variation in the postoperative pain score variable. ERACS method is ineffective for accelerating the onset of colostrum excretion p=0.267 (p>0.05).

Conclusion: The type of mother's birth, the mother's psychological changes, pain, and the administration of medicines to the mother are all factors that can impact the mother's ability to excrete colostrum right away after delivery.

Background: Diabetes mellitus is becoming a public health problem and can be found in every population, including a pregnant women. Hyperglycemia conditions in pregnancy can lead to gestational diabetes mellitus involving proinflammatory cytokines such as Tumor Necrosis Factor-Alpha (TNF-α) and Transforming Growth Factor- β (TGF-β). Isothiocyanate is a bioactive compound found in Moringa leaf extract with anti-glycemic activity and anti-inflammatory effects. This study aims to evaluate the impact of isothiocyanate therapy on trophoblast cell culture-hyperglycemia atmosphere toward the levels of tumor necrosis factor- α (TNF-α) and transforming growth factor- β (TGF-β).

Methods: An experimental study with a post-test-only control group design was conducted using trophoblast cell culture from placental tissue. To create a gestational diabetes event, glucose was administered into the trophoblast cell culture. The sample was divided into six groups: negative control without treatment, positive control by glucose administration, and treatment groups P1, P2, P3 and P4 with the treatment of isothiocyanate with doses of 0.1; 0.2; 0.4 and 0.8 mg/ml, respectively. The TNF-α and TGF-β levels in each group are quantified using immunoassay by ELISA method.

Results: The mean TNF-α in the negative control, positive control, P1, P2, P3, and P4 groups were 20.59, 43.54, 32.76, 30.15, 27.32, and 24.05, respectively. While the mean of TGF-β levels in the negative control, positive control, P1, P2, P3, and P4 groups were 15.76, 10.44, 11.05, 11.70, 12.46, and 14.32, respectively. The lowest TNF-α and the highest TGF-β levels were found in the treatment group (P4) that received isothiocyanate with a dose of 0.8 mg/ml.

Conclusion: The administration of isothiocyanates from Moringa leaf extract significantly lowered the level of TNF-α and increased the level of TGF-β in hyperglycemic trophoblast cell culture compared with the positive control group.

Link of Video Abstract: https://youtu.be/Pp9SqvVDzlw

Backgrounds: The COVID-19 outbreaks began at 2020 and spreading fast throughout the world. Infection in pregnancy is associated with increasing number of mortality and morbidity reports as well as increasing reports of preeclampsia (PE) cases complicating the cases. This study aimed to analyze the impact of preeclampsia  on the outcome of COVID-19 patients during pregnancy and determine the effect of these variables on maternal and neonatal morbidity and mortality.

Methods: A retrospective study was performed on 711 COVID-19 patients admitted at Dr. Soetomo Hospital during 2020 - 2021. Demographic, clinical, laboratory, complication, and patient outcomes data were collected. Patients were then classified as COVID-19 with preeclampsia and COVID-19 without preeclampsia. Data were collected from hospital medical records, and statistical analysis was carried out to analyze these variables.

Results: We reported 711 pregnant patients with COVID-19, of which 510 patients (72%) had no preeclampsia and 201 patients (28%) had preeclampsia. There were statistically significant differences in maternal age, referral status, gestational age at admission, comorbidities, complications, and symptoms of COVID-19. COVID-19 with PE had higher comorbidities and severe performance than COVID-19 without PE : > 50% were preterm pregnancy, oxygen saturation < 90% on admission reported on 5.9% cases, 35.8% had symptoms, 20.4 % cases suffered severity/ critical condition, 24.4% need ventilation support. However, there was no significant difference in maternal death cases between COVID-19 with and without PE. Risk analysis shows an increased risk of morbidity in pregnant patients with COVID-19 infection: pulmonary edema, critical condition, ICU admission, and Ventilation needed with OR 18.9, 12.5, 5.1, and 2.7, respectively. 

Conclusion: Preeclampsia increases the risk of morbidity in COVID-19 pregnant patients.

Introduction: Readiness for the discharge process to caring for low birth weight (LBW) is a top priority in providing quality nursing services in the perinatology room. The process of readiness for discharge is considered successful if the LBW is safe and comfortable during discharge. This study aimed to identify interventions relevant to readiness for discharge to improve transitional care for LBW and to assess the quality of available evidence using a systematic scientific approach.

Methods: Following the PRISMA checklist, a systematic review of randomized controlled trials and quasi-experimental studies was identified in eight electronic databases published from 2015 to 2022. All articles were discovered using the PICO framework and assessed using the Critical Appraisal Skills Program (CASP) tool. All articles were analyzed and synthesized narratively.

Results: A total of 201 titles were identified, and 25 studies met the inclusion criteria involving 3158 parents. Ten studies were RCT studies, and fifteen were quasi-experimental studies. The results of the narrative synthesis carried out on twenty-five articles showed that interventions relevant to readiness for discharge were effective in improving the transition care for LBW, including the transition to parenthood and the transition from hospital to home related to the ability to care for LBW.

Conclusion: This study provides evidence that nurses can modify and effectively carry out interventions relevant to discharge readiness to improve the transition care for LBW. Perinatology nurses must actively involve families in supporting mothers in optimal readiness for discharge.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Background: Cryptococcal meningitis is an inflammation of the meninges due to Cryptococcus fungal infection which commonly invades people living with immunodeficiency virus (PLHIV) with impaired immunity. The disease has a high mortality rate and is frequently misdiagnosed in the early stages due to vague symptoms. This case report aimed to provide information regarding diagnosing and managing cryptococcal meningoencephalitis in patients with acquired immunodeficiency syndrome (AIDS) and tuberculosis.

Case presentation: We reported a case of 34-year-old woman that complained of headache and fever from one month ago. There were also oral white patches in the last two weeks. The patient was diagnosed with lung TB and human immunodeficiency virus (HIV) in February 2021, but the TB was just being treated in the past two months and HIV in last two weeks. Head CT-scan with contrast showed meningoencephalitis, brain edema, left frontal, left ethmoidal, left and right maxillary and left sphenoid sinusitis. On the 9^th day of hospitalization, the patient had seizures. Analysis of the cerebrospinal fluid culture revealed Cryptococcus neoformans. The patient’s comorbidities were leucopenia, hypoalbuminemia, pneumonia, brain edema which led to poor prognosis. On the 10^th day, the seizures relapsed, followed by the drastically reduced SpO₂ and death. Septic shock and multiorgan failure were considered the cause of the case's death.

Conclusion: This case highlights the importance of early diagnosis and management to avoid unfavorable outcome.

Introduction: The most common neoplasm of the uterus, uterine leiomyomas, or fibroids, are benign growths that affect 20–30% of women between the ages of 30 and 50. The smooth muscle of the uterus gives rise to leiomyomas. In this case report, we sought to highlight the case of a 39-year-old nulligravida lady with a fast expanding abdominal mass and abdominal pain.

Case Presentation: The gynecologist department at Dr. Kariadi General Hospital Semarang received a visit from a 39-year-old nulligravida lady complaining of a fast-expanding lump in her belly and extreme weight loss over the past year. During the abdominal exam, an immovable mass that could have been an 8-month pregnancy was felt in the midline of the abdominal area, extending from the lower abdomen to the epigastric area. Ascites were also discovered. The multislice computerized tomography (MSCT) results showed a solid lobulated inhomogeneous mass with internal calcification which extended from the abdominal cavity to the pelvic cavity and visualized the size of (anteroposterior 21.7 cm x laterolateral 24.1 cm x craniocaudal 36.8 cm), compressing the surrounding bowel structures, liver, spleen, and bladder. Several lymphadenopathies were also discovered. A frozen section, a bilateral salpingo-oophorectomy, and a total abdominal hysterectomy were performed. The results of the histology suggested a benign leiomyoma. Her vital signs were steady after surgery, and she fully recovered. The patient was called for a follow-up one week after being released for surgical suture removal and evaluation. The patient was discharged on the sixth postoperative day in good condition.

Conclusion: In determining if uterine smooth muscle tumors are benign or malignant, clinical characteristics, physical examination, imaging, and pathological findings are still considered very useful. The histopathology examination is still the most reliable diagnostic tool. The decision to perform a hysterectomy on this patient was determined accordingly to the tumor's size, probability of malignancy, and increasing morbidity.

Link of Video Abstract: https://youtu.be/9-ynkRS_wo8

Introduction: Brunner’s glands are acinotubular glands which are located mostly  in the deep mucosal or submocosal layers of the proximal duodenum. Hyperplasia of these glands is reported in almost 1 in 50 upper gastrointestinal endoscopies and accounts for approximately 5 to 10 percent of all benign duodenal tumors. Brunner’s gland hyperplasia is usually asymptomatic. It  can take form of polypoid or mass lesions and precipitate pyloric obstruction, gastrointestinal hemorrhage, and intussusception in children. Due to its rarity in pediatric population, it tends to be misdiagnosed.

Case Description: This case report presents a case of seven year old boy with Brunner’s gland hyperplasia presented with recurrent vomiting. A seven year-old boy was admitted to the hospital due to of worsening of intractable vomiting since five months prior to admission. He also felt abdominal discomfort, bloating, and early satiety since he was 3 years old. The patient had been treated with several medications without significant improvement. Epigastric pain was observed on abdominal palpation. Gastroscopy showed partial gastric outlet obstruction (pyloric obstruction), erosive gastritis, multiple ulcers, and erosive esophagitis. Histopatologic results from biopsy revealed chronic gastritis and positive for  Helicobacter pylori. Abdominal CT scan showed protrusion solid lesion intraluminal with diameter 1.18 x 1 x 1.25 cm in part II duodenum. Patient was consulted to pediatric surgeon for laparotomy exploration and duodeno-duodenostomy. Excision of Brunner’s gland dan biopsy were performed. Surgical report showed gastric dilatation with duodenal wall hypertrophy on part I-II of duodenum. Histopathological from biopsy revealed Brunner’s gland hyperplasia with lymphoid tissue.  Post surgery patient recovered well and eventually discharged without any complains. The prognosis was good.

Conclusion: Generally, Brunner’s gland hypertrophy is benign and has a good prognosis. However, with the growth of benign proliferative lesions of Brunner’s glands, mucosal ulcers may develop, thereby leading to the repair of gastric foveolar metaplasia with papillary architecture and then malignant transformation.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and potentially fatal hypersensitivity reactions that can be drug-induced, especially in patients with AIDS. This report aims to highlight the diagnosis and management of a patient with acquired immunodeficiency syndrome (AIDS) that consumed multiple drugs including anti-tuberculosis drugs that develop SJS.

Case presentation: A 30-year-old male patient with AIDS administered with chief complaints of burning sensation all over the bodies and erythematous macules scattered across the stomach and back, followed by blisters distributed across the chest, back, face, lips, hands and feet, as well as genitals for 3 days. Patient was diagnosed with AIDS and under ARV medication since about 5 years ago and dan cotrimoxazole for 9 months. Couple months before admission, patient was diagnosed with tuberculosis and under anti-tuberculosis treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE)) but stopped due to drug-induced hepatitis (DIH) which then changed to another regiment (streptomycin, levofloxacin, and ethambutol (SLE)) followed by another regiment (rifampicin, isoniazid and ethambutol (RHE)). The patient diagnosed with drug-induced SJS, however, in order to find out the SJS drugs inducer, an algorithm for assessment of drug causality in Stevens-Johnson Syndrome and toxic epidermal necrolysis (ALDEN) score as causality assessments tool was applied and rifampicin decided to be the precursor. The patient was managed for 13 days prior to discharge with improved condition.

Conclusion: Diagnosing process for drug-induced in patient with AIDS, in addition to multiple drugs consumption, is a challenge. A multidisciplinary approach and appropriate causality assessments tool should be considered before administering further management and medications.

Introduction:  In 10% of head injury cases, nonmotor seizures were detected by electroencephalography (EEG) performed in the acute phase.  Nonmotor seizures are often not diagnosed at the start of treatment because the symptoms are often not recognized by the patient's family or doctor. The incidence of seizures in patients with minor head injuries is very low. From the literature, it was found that the type and severity of the head injury is a significant factors in the incidence of post-traumatic seizure. Thus, in this article, we report a case of nonmotor seizures in a patient after a minor head injury.

Case description: An Indonesian female, 53 years old, complained of sudden silence when speaking after 4 days earlier, she fell and hit her head on the right side. There was no loss of consciousness, headache, vomiting or limb weakness. Complaints of motor seizures and a history of previous seizures were denied. There were no cranium defects, hematomas, or open wounds on examination. The results of laboratory tests and non-contrast head CT scans were expected. On electroencephalography (EEG) examination, epileptiform waves were found in the left temporal region. The patient was given anti-seizure drugs, and complaints improved within 2 days of therapy. It is crucial to carry out an EEG examination in the acute phase of a head injury to exclude the possibility of nonmotor seizures and brain dysfunction, which will be at risk of causing seizures later in life after trauma.        
Conclusion: EEG examination in the acute phase of head injury is used to exclude the possibility of nonmotor seizures and brain dysfunction, which will be at risk of causing seizures later in life after trauma.

Title:
“The First Mulawarman International Conference on Tropical Public Health”

Theme:
“Digital Health for Public Health on Post-Pandemic Covid-19”

This conference will be held on:
Day, date : Saturday , November 12, 2022