Introduction: Nosocomial infection is one of the infections that occurs in the hospital environment and can cause several diseases, but nosocomial infection can also cause the sufferer to experience sepsis and even die if they do not get treatment. This study aims to determine the active compound of black turmeric extract (Curcuma caesia Roxb) and measure the inhibitory ability of several bacteria that cause nosocomial infections.

Methods: The diameter of the inhibitory zone was evaluated using the Kirby-Bauer disk diffusion method in this investigation

Results: The results showed that black turmeric extract has the potential to act as an antibacterial against both gram-positive and gram-negative bacteria. The highest results were obtained at the highest concentration (80%) against Staphylococcus aureus bacteria with a 15.10 ± 6.95 mm inhibition zone.

Conclusion: Based on the results of this study, it can be stated that black turmeric extract (Curcuma caesia Roxb) has the potential to be an antibacterial control for nosocomial infections.

Background: Mitochondria have crucial roles in human cardiomyocyte metabolism. The isolation of mitochondria from various cells and tissues has been described in previous studies. However, the isolation of human heart muscle is rarely performed because of the ethical problems inherent in obtaining fresh human heart muscle samples. Resected infundibular hypertrophy muscle in tetralogy of Fallot surgery provides a fresh sample source without causing ethical issues. This study aimed to isolate mitochondria from patients with tetralogy of Fallot.

Methods: The optimization of mitochondria isolation protocol in this in vitro study was performed to facilitate our study of ischemia and reperfusion injury. The samples of human heart tissue used in this study were resected infundibulum muscle collected during surgery to correct tetralogy of Fallot. Subjects were recruited from Cipto Mangunkusumo Hospital and Jakarta Heart Center Hospital between July 2021 and November 2022. Tissue was collected before aortic cross-clamp applied, after aortic cross-clamping applied and after aortic cross-clamping off. After collected tissue was trimmed and cleaned, mechanical disruption followed by enzymatic disruption using trypsin was performed. Homogenization was then performed with a sonicator. Mitochondria pellet was further obtained by differential fractionation of homogenate.

Results: Mean infundibular tissue weight obtained from the three periods mentioned was 64.92-109.7 mg. Our protein yield was 7.65-8.38 mg/ml. Mean JC-1 was 9945-12430 FLU/mgP. The median value of SDH activity shown by our mitochondria pellet was 17.45-18.12 nmol/min/L).

Conclusion: The fractionation method allowed us to successfully isolate mitochondria from human heart tissue with intact membrane integrity.

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.

Introduction: Pancasila is the ideology of the state and is a collection or set of values that are believed to be true by the government and the people of Indonesia.  Perception is a person's ability to organize an observation. One of students perception is regarding nurses communication. The research aims are to describe students perception regarding nurses communication between nurses and patients according values of Pancasila.

Method: A design of descriptive study was used with mixed methods approach that combines or associates qualitative and quantitative. Descriptive research was to describe the data obtained from students' perceptions of learning communication between nurses and patients according to the values of Pancasila.

Results: There were 52 nursing students involved in this study. We showed that almost all of the students' perceptions strongly agreed with the application of Pancasila values in nurse-patient communication

Conclusion: Nurse-patient communication has implemented Pancasila values in serving patients in hospitals with evidence that stands out the value of strongly agree and agree answers.

Background: Exclusive Breastfeeding supports optimal growth and development and prevents kids from getting sick. Knowledge about Exclusive Breastfeeding is one of the most important factors affecting its practice. This study aims to know about knowledge level based on mothers’ characteristics.

Methods: This descriptive study, which involved 39 respondents, was conducted in the Pediatric Wards and Outpatient Clinics of Dr. Ramelan Central Naval Hospital Surabaya in October 2019 using a questionnaire. The focus of this study is knowledge about Exclusive Breastfeeding based on the mother’s age, educational level, employment, counseling, and birth orders. The inclusion criterion is mothers with 0-6 month-old babies. The exclusion criterion is a mother who is unable to speak Bahasa. We classify knowledge levels as good, average, and insufficient based on the questionnaire.

Result: This study includes 39 respondents. There are 21 out of 26 (80.8%) mothers in the group of 20-35 years old who have better knowledge. Fifteen out of 16 (93.8%) mothers who graduated from high school have better knowledge. There 26 out of 31 employed mothers (83/8%) have better knowledge. We also found that 22 out of 25 (88%) who’ve got counseling have better knowledge. Of 21 mothers with firstborns, there are 20 mothers (95.2%) who have better knowledge.

Conclusion: Younger age, higher educational level, employed mothers, mothers who’ve got counseling, and those with first-born tend to have better knowledge on Exclusive Breastfeeding.

Introduction: Fit-to-work assessment is one of the health examination efforts to assess the physical function and occupational health of workers before starting work. This fit-to-work assessment is very important during the current pandemic because the workplace is a place that is at risk of transmitting the COVID-19 virus, especially a workplace that continues to operate during the pandemic. Thus, this study aims to analyze the influence of fit-to-work assessment on the work performance of Heavy Equipment Operators at a port service terminal in Indonesia during the COVID-19 pandemic.

Methods: The type of research used descriptive analytics with the cross-sectional study. The sample was collected with a simple random sampling technique. The population in this study is heavy equipment operators in one of the sub-holding of PT. Pelindo Terminal Petikemas Surabaya- Indonesia with a sample of 54 operators who can represent each work shift. Each participant was given a questionnaire and needed to fulfill it. The data will be analyzed using SPSS 25. The data analyzed was descriptive only.

Results: According to the study of the characteristics, mostly the ages were 31-40 (46.30%), with a high prevalence of high school (76%). The work shift schedule was classified into three parts. Shift two from 3.30 pm until 11.40. The length of work was also more than five years or greater than others (59.25%), with the work performance from 54 respondents, we found that they had a high work performance (72%), and all of the respondents were mostly in a reasonable condition (94.04%).

Conclusion:  Fit-to-work assessment is carried out before work to determine whether the worker is fit or unfit to work according to the level of health required. The work performance we found that mostly they have a high work performance. It was also in line with the fit-to-work assessment results that most respondents were in a reasonable condition.

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.

Background: Peripheral arterial disease (PAD) is an important consequence of atherosclerosis commonly determined based on the results of ankle-brachial index (ABI) measurements. Due to its limitations, the search for potential predictors of PAD severity is ongoing. Serum soluble Lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) levels and LOX-1 polymorphism rs1050283 are candidates for predictors of PAD severity. This study aimed to investigate the association between the LOX-1 rs1050283 TT genotype and the severity of PAD.

Methods: This cross-sectional study involved PAD patients recruited consecutively. The patients were genotyped for rs1050283 (3’ UTR C>T) LOX-1 single nucleotide polymorphism using the sequencing method. Serum sLOX-1 levels were measured using ELISA. Data on ABI were collected, and the patients were categorized into mild and moderate to severe PAD groups.

Results: A total of 66 PAD patients with a mean age of 58.9 years participated in this study, which consisted of 45 patients with mild PAD and 21 patients with moderate to severe PAD. Multivariate logistic regression analysis showed that the TT genotype was associated with PAD severity compared to those with the CC genotype (odds ratio (OR): 15.0, 95% confidence intervals (CI): 1.1 – 209.0), while higher serum sLOX-1 levels were not. PAD severity was also associated with increasing age (OR: 5.7, 95% CI: 1.3 – 25.7) and male gender (OR: 6.0, 95% CI: 1.1 – 32.2).

Conclusion: TT genotype of LOX-1 rs1050283 polymorphism was associated with PAD severity, whereas higher serum sLOX-1 levels were not. In addition, increasing age and male gender were also associated with PAD severity.

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: Triamcinolone acetonide (TA) and bevacizumab have anti-inflammation and anti-proliferation in the wound-healing process caused by ocular injury. There was no medicament to treat ocular injury besides corticosteroids and anti-VEGF, but their comparison is not yet elucidated. This study aimed to compare the effects of injection of intravitreal triamcinolone acetonide and bevacizumab in an expression of TGF-β and PAI-1 in an experimental rabbit model of open-globe injury (OGI). TGF beta and PAI-1 have an important role in the hemostasis of the wound healing process, wherein the eye, the wound healing process should not occur excessively because it can cause PVR (unlike wound healing in the skin or other organs in the body).

Methods: This study was an experimental study of 30 eye rabbits with an OGI model. Six eyes as control and 24 eyes received treatment for 21 days. Thirty Male New Zealand rabbits and we make OGI in the superotemporal quadrant of the right eyes by making a 5 mm circumferential incision, 6 mm behind the limbus. TA and bevacizumab were treated in different groups. The subjects were divided into several groups: A) OGI group (PC), (B) OGI with intravitreal TA group 3 days after (T3), (C) OGI with intravitreal TA group 7 days after (T7), (D) OGI with intravitreal bevacizumab group 3 days after (B3), and (E) OGI with intravitreal bevacizumab group 7 days after (B7). A negative control group (NC) was randomly selected, including five left eyes from the treatment group (n = 6 each). All eyes were examined and evaluated by measuring the expression level of TGF-β and PAI-1. Normality test was done using Shapiro-Wilk, and the expression was compared using One-way ANOVA and Tukey post-hoc test.

Results: The expression of PAI-1 was significantly lower in the treatment group than in the control group (PC) (PC = 10,08 ± 1,23 %, p-value 0,0444). However, the expression of TGF-β was higher in the treatment group compared to the control group (PC) (PC = 6,60 ± 3,30 %, p-value 0,0228).  

Conclusion: Triamcinolone acetonide and bevacizumab treatments after OGI significantly weakened the upregulation of PAI-1 but could not reduce TGF-β expression in the retina and wound site tissue. It reduces the risk of developing posttraumatic complications of proliferative vitreoretinopathy (PVR).

Introduction: Preeclampsia is one of the most common medical problems during pregnancy and is the leading cause of maternal death worldwide. Through professional antenatal care services, increasing knowledge and behavior in pregnancy care is expected to be able to prevent the occurrence of preeclampsia. The interaction of the client nurse with the self-hypnosis approach will increase the mother's abilities. This study aimed to analyze pregnant women's characteristics influencing nurses' interaction with a self-hypnosis approach in the prevention of preeclampsia.

Methods: This is a cross-sectional study with 260 pregnant women who were taken using purposive sampling as the sample. The data analysis uses using chi-square test, and the result is considered significant if p < 0.05.

Results: At the induction stage, there were significant results on the characteristics of pregnant women with hypertension (p = 0.036) and the characteristics of pregnant women based on education (p = 0.019). At the suggestion stage, significant results were obtained on the characteristics of pregnant women with a hereditary history of preeclampsia (p = 0.023) and maternal characteristics based on knowledge (p<0.001). At the termination stage, significant results were obtained on the characteristics of the mother with a hereditary history of preeclampsia (p = 0.037) and the characteristics of the mother based on knowledge (p<0.001).

Conclusions: The mother's characteristics that affect the nurse's interaction with the self-hypnosis approach are hypertension history, hereditary history of hypertension, and the mother's knowledge about the prevention of preeclampsia.

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.

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.

Introduction: Communication between parents and health professionals in children about assessing and managing their children's pain with both oral and written instructions still needs to be improved. Children with a relationship with a parent or caregiver may be easier to assess and benefit from non-pharmacological treatment. This study aimed to evaluate the development of non-pharmacological pain management (behavioral intervention) model based on family-centered empowerment in toddlers with invasive procedures.

Methods: This study design is an explanation survey with cross sectional approach. The sample consisted of 115 mothers with toddler-age children subjected to invasive prosedures in Rumah Sakit Islam Surabaya using purposive sampling. The data was analyzed using SmartPLS.

Results: Non-pharmacological pain management model based on family-centered empowerment was formed from the mother factor, nurse factor, filial values, and appraisal. The greatest effect was on the filial values factor, with the T statistic value = 2.777.

Conclusions: Nonpharmacological pain management (behavioral intervention) is formed by the mother factor, nurse factor, filial values, and appraisal, where filial values are the most influential. Therefore, in conducting pain nursing care in the nurse's room, paying attention to the four factors above is necessary to improve the quality of care services, especially in comfort for toddler children who undergo invasive actions.

Link of Video Abstract: https://youtu.be/9qgtSz73eyE

Introduction: Pringle maneuver is the choice of hepatic inflow occlusion, when blood circulation is reopened, reperfusion will occur which causes ischemia/reperfusion injury (IRI) which will result in liver tissue damage. Methylprednisolone injection plays a role in deactivating kupffer thereby preventing inflammatory reactions that will reduce hepatic IRI. This study aims to determine intravenous methylprednisolone's effect on the degree of hepatic ischemia/reperfusion injury in class III hypovolemic shock where continuous clamping was performed.

Methods: Fifteen white rats (Rattus novergicus) underwent laparotomy, aspiration of blood up to 30% of the estimated blood volume (EBV) was carried out to prevent class III hypovolemic shock. The treatment group was given a single dose of 30 mg/kgBW methylprednisolone, while the control group received 30 mg/KgBW 0.9% sodium chloride. Then the Pringle maneuver continuous clamping is performed for up to 30 minutes and resuscitation of the aspirated blood back to the vena cava. On the 5th postoperative day, hepatic biopsy and total bilirubin were examined.

Results: Histopathological examination of the liver parenchyma as assessed by Suzuki's score showed a mean ± SD of the control group (K) 1.40 ± 0.91 while the treatment group (MP) 5.93 ± 1.03 with a p-value of 0.001 < 0.05. Total bilirubin results showed a mean ± SD of the control group (K) 0.21 ±  0.13 while the treatment group (MP) 0.22 ±  0.11 with a p-value of 0.477 > 0.05.

Conclusion: Intravenous methylprednisolone in rats that experienced ischemic/reperfusion injury after continuous clamping in class III hypovolemic shock did not reduce the degree of hepatic parenchymal damage assessed by Suzuki's histopathology score. However, it reduces the total bilirubin value. 

Introduction: The COVID-19 pandemic has not only had an impact on health problems, but also brought many changes in other aspects of human life, including the education sector. Difficulty in adapting with the learning process can affect the mental health, especially medical students who are quite susceptible to depression and anxiety. We aimed to aims to provide an overview of mental health problems in medical students during the COVID-19 pandemic.

Method: The method used was an online cross-sectional survey using student characteristics instruments, the GAD-7 and PHQ-2 questionnaires. Respondents were 7949 medical students from 49 medical faculties in Indonesia from February to May 2021. All data were analyzed by univariate and bivariate statistics to see the relationship between several variables using SPSS version 22.0.

Results: The majority of respondents were women (69.4%) with an average age of 20.9±2.1 years and domiciled in Java (63.4%). The survey was joined by students from all years of education and the most followed by students in the second year (20.3%). Based on the GAD-7 questionnaire, 3471 respondents (43.7%) experienced symptoms of anxiety (mild, moderate, severe) and the most experienced mild anxiety (29.8%), while from the PHQ-2 questionnaire it was found that 1332 respondents (16.8%) experienced symptoms of depression. Analysis of the mean GAD-7 and PHQ-2 on several factors (gender, year of education, education phase, and place of domicile showed a significant relationship (p<0.05), except for the PHQ-2 score which was not significant for place of domicile (p=0.06).

Conclusion: The results of this survey describe the mental health conditions of medical students in Indonesia during the pandemic. This study emphasizes the importance of early detection, support, and mental health services to improve the ability and resilience of medical students in dealing with various changes during the COVID-19 pandemic.

Link of Video Abstract: https://youtu.be/BXu-DkOsh0k

Introduction: Acute appendicitis is the most common acute abdomen in pediatrics. The diagnosis is challenging because of the various symptoms and characteristics of children with difficulty expressing pain. This condition makes perforated appendicitis high in pediatrics. This study aimed to investigate the potential role of hyponatremia as a biochemical predictor of complicated appendicitis.

Methods: An analytical-observational study in Soetomo General Hospital was performed from 2017-2021. The natrium level of patients, particularly those under 18 years of age diagnosed with appendicitis, was examined.

Results: There were 102 pediatric patients with appendicitis. In this study, 32 subjects (31%) were diagnosed with acute appendicitis, and 70 (69%) had perforated appendicitis. It was found that there was a correlation between hyponatremia and appendicitis perforation, indicated by a sensitivity of 58.5% and specificity of 65.6%. The mean serum of natrium level in patients with perforated appendicitis, 131.1 ± 3.8 mEq/L, is lower than in patients with acute appendicitis, 136.6 ± 3.9 mEq/L. The prevalence risk value of patients diagnosed with perforated appendicitis and hyponatremia was approximately 2,69. The area under the ROC curve was 0.721, with a 95% confidence interval of 62.3% to 80.5%. With the cut-off natrium value set to ≤ 133 mEq/L, the sensitivity and specificity values were estimated at 50% and 81.25%, respectively.

Conclusions: There was a correlation between hyponatremia and appendix perforation. Hyponatremia can be potentially used as a biomarker predictor in pediatric perforated appendicitis.

Introduction: The lifestyle of patients with hypertension is an important factor in treating hypertension, but in fact, the lifestyle of patients with hypertension is still quite bad. A bad lifestyle triggers complications and increases the prevalence of hypertension. The purpose of the study was to analyze the relationship between spiritual coping and the lifestyle of hypertension sufferers.

Methods: The research method uses observational analytics, the independent variable is spiritual coping, the dependent variable is the lifestyle of people with hypertension, and the sampling technique uses simple random sampling. The sampled population is all hypertension sufferers in Ploso Kuning village who are between 26 to 65 years old, can read and are willing to be respondents. The sampling technique used is simple random sampling with a sample size of 108 respondents. Data analysis using Spearman rank correlation test.

Results: The results showed that spiritual coping had a significant effect on the lifestyle of hypertension sufferers with a p-value of 0.000.

Conclusion: The lifestyle of patients with hypertension can be improved by increasing the spiritual coping of the sufferer.

Link of Video Abstract: https://youtu.be/QSRsiXuo-EU

Background: Fractures are a common cause in the present, where the main cause is trauma/injury. The ideal current fracture treatment is orthopedic surgery in the hospital, sometimes with bones that are not completely fused (non-union) or delayed union. This study aimed to determine the risk factor associated with the incidence of the non-union and delayed union in patients operated at Siloam General Hospital, Kupang, Indonesia.

Method: An observational retrospective study with a case-control design was conducted from January 2020 to June 2021 in Siloam Kupang Hospital, East Nusa Tenggara. The case involved patients experiencing non-union or delayed union complications, while the control involved fractured patients without both complications. Data were extracted from Electronic Medical Records (EMR) and then were analyzed by χ² Cramer's V. The p<0.05 was significant.

Result: The study results found a relationship between smoking (p=0.000), open fracture (p=0.001), infections (p=0.000), time intervals between events and surgeries (p=0.000), high energy injury mechanisms (p=0.021), and crush injury (p=0.000) with non-union or delayed union events in fracture patients at Siloam Hospital Kupang.

Conclusion: The non-union and delayed union complications in fractured patients were related to smoking habits, open fracture, local infections, time intervals between events and surgeries, high energy injury mechanism, and crush injury.

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: 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.

Backgound: Dengue vector control using chemical insecticides for a long time on the same target encourages the rapid development of a resistant dengue vector population of Aedes aegypti. Therefore, an alternative method is needed in the form of the use of plant-based insecticides, Lansium domesticum or duku has been proven to contain secondary metabolites that have the potential as insecticides. This study was conducted to measure the activity of enzyme esterase and glutathione S-transferase, as well as to observe the concentration of inorganic substances such as Fe, Mg, Na, and K in Ae. aegypti larvae exposed to L. domesticum extract using methanol as the solvent and fractionation using hexane, butanol, and ethyl acetate as the solvents.

Methods: This study used Ae. aegypti larvae and L. domesticum leaves extract and fraction. Esterase activity was measured using a spectrophotometer at λ = 490 nm and obtained as light absorption per minute per mg protein. GST activity was measured using a spectrophotometer at λ = 340 nm and expressed as light absorption per minute per mg protein. Inorganic substance level was evaluated by the absorbance of the atoms using an atomic absorption spectrophotometer which was analyzed at certain wavelengths of each atom according to Beer's law equation

Results: The results showed LD50 and LD90 of the crude extract of L. domesticum were 2200ppm and 3200ppm after 24 hours of observation. Crude extract and the fraction of L. domesticum leaf influenced the development of Ae. Aegypti. It reduced the activity of the esterase enzyme. Meanwhile, it increased the GST enzyme activity of Ae. aegypti larvae as well as affects the levels of inorganic substances in Ae. aegypti larvae.

Conclusion: Thus, L. domesticum as a plant-based insecticide is an alternative to control the vector whose target is more selective and safe.

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.

Introduction: Excessive physical activity can pose risks to various organs due to induced stress. This study aims to investigate the impact of the supplementation of wild bee honey on the expression of SOD2 and HIF-1α in rats undergoing the forced swimming test (FST) as a model of physical stress.

Methods: As many as 24 adult female rats were categorized into four groups: control (C) with FST only; (T1) FST and honey supplementation of 2 g/day; (T2) FST and honey supplementation of 4 g/day; and (T3) FST and honey supplementation of 6 g/day. The FST was conducted for 5 minutes daily over a period of 14 days. The collected ovaries were histopathologically prepared and subjected to immunohistochemical staining for SOD and HIF-1α proteins.

Results: The findings of this study revealed an increase in SOD2 expression in the group supplemented with honey. Similarly, HIF-1α expression exhibited a similar trend, with a decrease observed in the group receiving 6 g/day of honey. However, these three parameters did not demonstrate significant differences among them.

Conclusion: In conclusion, honey supplementation does not significantly influence the expression of SOD2 and HIF-1α in the ovarian follicles of rat models subjected to physical stress.

Link of Video Abstract: https://youtu.be/u6GkzKfCplE

Background: Psychological changes such as body image are important factors that need to be considered to boost the positive sense of self-acceptance in stroke patients with hemiparesis. One measure that can be taken to minimize the incidence of disability, both physically or psychologically, in stroke patients is mirror therapy (mirror therapy combined with flashcards). This study aims to determine whether mirror therapy combined with flashcards can improve the upper limb muscle strength function and the stages of self-acceptance of stroke patients with hemiparesis.

Methods: This study was quantitative, with an experimental research design. The design used was a quasi-experiment with a pre-test-posttest control group design involving 60 respondents with consecutive sampling techniques for 5 months in the Nusa Indah Ward of the Dr. Doris Sylvanus Palangkaraya General Hospital. Upper extremity/arm muscle strength was measured using the muscle strength scale from the Medical Research Council, while self-acceptance stages were measured using a stage questionnaire adapted from Kubler Ross. Data were analyzed using SPSS version 20.0 for Windows.

Results: Our results showed there was a significant increase in the mean value of muscle strength and self-acceptance stages of the treatment group from the control group (p<0.05). The results of the Mancova test showed that gender affects the intervention given (p<0.05).

Conclusion: Our study provided information for nurses in nursing care to stroke patients with hemiparesis on the upper arm and motivation to improve the patient's self-acceptance stages.

Link of Video Abstract: https://youtu.be/nI_6kXZ0cSw

Introduction: The coronavirus disease (COVID-19) pandemic severely affected healthcare services, including causing negative impacts on healthcare workers’ mental health. An observational study was conducted at Dr. Soetomo General Hospital aimed to measure the prevalence of anxiety, resilience, burnout and their correlations to stress biomarkers amongst healthcare workers in Surabaya, Indonesia, during the COVID-19 pandemic.

Methods: Participants were residents who managed COVID-19 patients, chosen using random sampling. All participants had a 1-week shift working with COVID-19 patients in an isolation ward. The study used online questionnaires and laboratory data at the shift’s beginning and end. Along with collecting sociodemographic characteristics, State-Trait Anxiety Inventory (STAI), Brief Resiliency Scale (BRS), and Maslach Burnout Inventory (MBI) scales were administered online. At the same time, laboratory markers such as Neutrophil to lymphocyte ratio (NLR), Interleukin-6 (IL-6), cortisol, and CD4 values were studied.

Results: 61 participants were included in the study. At the beginning of the shift, 59% of participants had moderate to severe anxiety, and 83.62% had normal to high resilience. The early proportion of the participants having burnout from combined MBI measures was 88.52%. MBI-EE median scores were lower in the married group (6.50 vs. 9.50, p-value=0.030). NLR value was significantly related to STAI-S and BRS (p-value=0.007 and 0.049, respectively).

Conclusions: Most healthcare workers had anxiety and burnout, with normal levels of resilience. Our study found that NLR might be useful as a marker for anxiety and resilience.

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.

Background: With 1 in 10 women receiving a new cancer diagnosis each year, breast cancer is the most frequent cancer among women. Luminal B breast cancer incidence rates are rising in non-Hispanic white women aged 55 to 69 in Asia/Pacific and Indonesia subtype across all age groups. In Bali, Luminal B is the most prevalent subtype with the greatest fatality rate. This study aims to prove the survival analysis of Luminal B subtype breast cancer patients based on lymphovascular invasion (LVI), tumor-infiltrating lymphocyte (TIL), and mammaglobin A expression.

Methods: This study is a survival analysis using nested and prospective cohort methods. Retrospective data were taken from the Cancer Registry and Medical Records (MR) of patients in Sanglah General Hospital, mammaglobin results (Paraffin block test) on anatomical pathology analysis. Statistical Kaplan Meier and Cox Proportional hazard calculations performed with the SPSS program were significant (p<0.05).

Results: The number of research subjects was 60, with 32 subjects dying and 28 still alive until the data collection was completed. There was no difference in age between the two groups. The mean of all ages is 50.12 ± 9.93 years. Positive LVI has 9 months median survival (95% CI 8-10) with p= 0.013 risk 2,797 times. TIL high (positive 2- positive 3) median survival 8 months (95% CI 6.3-9.7) with p=0.003 and risk 3,151 times. Strong expression of mammaglobin A (3-4) had a median survival of 12 months (95% CI 4.4-19.5 months; p=0.015) and risk 3.34 times.

Conclusion: LVI, TIL, and mammaglobin A expression significantly affected poor survival in the breast cancer Luminal B subtype.

Link of Video Abstract: https://youtu.be/j5NtdcbvTE4

Background: Concern for behavior change in compliance with health protocols during this pandemic continues to increase, especially when the coronavirus disease (COVID-19) vaccination is carried out. During the initial pandemic, the public perceived it as risky to be infected with COVID-19. However, this situation manifests itself in the emergence of a phase where public awareness of wearing masks, maintaining distance, and washing hands is decreasing. This study aimed to understand the impact of implementing the vaccine on the compliance behavior of wearing masks, washing hands, and keeping a distance, as well as attitudes towards behavior complying with health protocols during the COVID-19 vaccination period and the implementation of level 1 restriction on community activities (PPKM).

Method: We used a cross-sectional design, recruiting 110 respondents at the Menteng Primary Health Care Center, Palangka Raya City. Recruited patients were those over 18 years of age. This research instrument is an adaptation of several research questionnaires carried out in Indonesia, and we asked respondents using Indonesian.

Results: Of the 110 respondents, 59.1% were dominated by women, and 61.8% were in the 17-25 age group. A total of 106 respondents (96.4%) revealed that they had received information regarding health protocols. More than 70% obtained information from television (77.3%). Only half of the respondents received the 3rd dose or booster I. Knowledge was not the dominant factor influencing adherence to health protocols, but people's attitudes towards the Covid-19 health protocol. No relationship was found between knowledge and people's behavior toward health protocols.

Conclusion: Most of the respondents (80%) still adhere to health protocols as recommended by the government even though 74.5% of the people have received the 2nd and booster doses of the vaccine.

Link of Video Abstract: https://youtu.be/Qw5E3Le-WJk

Background: Alkaline trauma of cornea often causes irreversible vision loss, even though it is quickly treated. The effectiveness of anti-inflammatory therapy as a main treatment is still limited clinically, as well as has dangerous side effects. Platelet-rich fibrin (PRF) is quite safe and effective in the treatment of descemetocele and also important in wound healing process. PRF membrane also provides a mechanical function as a framework for cell proliferation, differentiation and migration which is important for tissue regeneration. This study aimed to analyse the effectiveness of PRF grafts on expression of interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) in cornea post NaOH exposure.

Methods: An experimental study was conducted on Oryctolagus cuniculus which was exposed to 1 N NAOH for 30 seconds. The study subjects were 14 rabbits consisting of 7 PRF graft rabbits and 7 control rabbits. The rabbit's right eye was then irrigated, dripped with 1% levofloxacin 1 drop and a PRF graft was placed.

The effectiveness of PRF graft was analysed by percentage of expression of IL-1 and TNF-α in cornea post NaOH exposure

Results: No significant differences were found in expression of IL-1 (p>0.05) and expression of TNF-α (p>0.05) in cornea post NaOH exposure. There was a decrease in the expression of IL-1 between control and PRF graft groups. The combination of the mechanical and chemotactic functions of PRF membranes makes them suitable as an autologous biomaterial for reconstruction, repair, and maintenance of ocular surfaces.

Conclusion: PRF plays a significant role in wound healing and preventing excessive fibrosis, therefore it has the enormous potential to reduce the expression of IL-1 in corneal alkaline damage.

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.

Introduction: Screening in pregnant women by performing a triple elimination test to prevent transmission of HIV/AIDS, syphilis and hepatitis B, as well as a Roll Over Test (ROT) and Mean Arterial Pressure (MAP) to detect pre-eclampsia became really hard during the COVID-19 pandemic due to many restrictions on almost all routine health services. Adaptation is needed in responding to changes that can overcome physical and mental health problems in the community, one way to overcome this is through self-hypnosis. For this reason, there is a need for research on the effectiveness of triple elimination, ROT and MAP examinations as well as self-hypnosis in high-risk pregnant women in an effort to manage emergency pregnancy.

Method: A cross sectional design was used. All samples were selected by simple random sampling at PMB Ika Mardiyanti. Data were collected for completion of triple elimination, ROT, MAP, as well as the outcome of the emergency treatmentin the high-risk pregnant women.

Results: There were 30 pregnant women involved, in which 17 of them were at low risk and 13 of them at high risk. Most respondents with complete data of triple elimination, ROT and MAP had good emergency management (73.3%). Those who received self hypnosis seemed to have better emergency management compared to controls (p=0.001).

Conclusion: Doing the triple elimination examination, ROT, MAP and self hypnosis could be the strategies for handling emergencies and lead to better outcome in high-risk pregnant women.

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: Anxiety can occur in pregnant women that can endanger the health of the mother and fetus if not treated. Non-pharmacological therapy to reduce anxiety includes acupressure and dhikr. This study aimed to evaluate the effectiveness of acupressure and dhikr in reducing anxiety in third-trimester pregnant women at PMB Maulina Hasnida, M. Mkes.

Methods: This study used a quasi-experimental design involving 30 third-trimester pregnant women who visited PMB Maulina Hasnida, M. Mkes in April - July 2022. In the intervention group, 15 pregnant women were given therapy acupressure and dhikr, while the control group 15 pregnant women were given standard care. Anxiety level was evaluated using the HARS questionnaire. Data were analyzed using SPSS ver.20.

Results: In the intervention group, the mean anxiety before the intervention was 3.53 and after the intervention was 2.73 (p= 0.277), while in the control group, it was 3.33 before and 3.40 after the intervention (p= 0.014). There was a significant difference in the anxiety levels before and after the intervention in the intervention group (p=0.001). There was no significant difference in the frequency of anxiety levels before and after the intervention in the control group (p= 0.655).

Conclusion: There was a significant difference in anxiety levels in pregnant women in the third trimester, given a combination of acupressure with dhikr compared to standard care.

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://www.youtube.com/watch?v=Ryf_-hvseVc

Introduction: In Indonesia, cervical cancer is the second most prevalent type of cancer among the general population. Cervical cancer has the second-highest mortality rate of all cancers. Infection with the Human Papilloma Virus (HPV) is one of the causes that starts the growing phase of cervical cancer. The purpose of this study, therefore, is to determine the prevalence of HPV infection in patients with cervical cancer who were examined at Dr. Moewardi Hospital and lived in the ex-Surakarta Residency.

Methods: Cervical tissue biopsy at the Anatomical Pathology Installation of Dr. Moewardi General Hospital Surakarta which had been diagnosed as cervical cancer was examined by the detection of E6 protein from HPV 16 and HPV 18 using immunohistochemical staining techniques. The data obtained would be analyzed based on the characteristics of the patient's age and the degree of histopathological malignancy with a p-value < 0.05 deemed significant.

Results: Overall, the prevalence of high-risk HPV infection was 77.8% (35/45), with women aged between 41-55 years having the highest prevalence of HPV infection (45.7, 16/35), followed by women aged 56-70 (42.9%), women over 70 (8.6%) and women under 40 (2.9%). The results of statistical tests showed that no significant relationship was found between HPV infection and age (p = 0.428). High-risk HPV infection was most prevalent in the poorly differentiated group (54.3%), followed by the well-differentiated group (34.3%) and the moderately differentiated group (11.4%). The results of statistical tests revealed a significant association between HPV infection and tumor grade (p = 0.027).

Conclusion: To lower patient morbidity and mortality, it is crucial to receive a prophylactic HPV vaccine due to the incidence of HPV 16 and 18 infections in patients with cervical cancer at the Regional Hospital Dr. Moewardi Surakarta, with a prevalence of 77.8%.

Introduction: Stress can happen anywhere and to anyone. Stress that cannot be controlled causes difficulty in concentration, difficulty remembering lessons, difficulty understanding lessons, frequent dizziness, feeling sluggish, weak and insomnia. Thus, this study aimed to determine the relationship between stress levels and insomnia with student achievement at Pondok Pesantren Tebuireng Jombang.

Method: The research design was correlational analytic using a retrospective research approach—the population of all students in class X-XII at Pondok Tebu Ireng Jombang in February 2022. From 620 children, 243 students were taken by stratified simple random sampling. The independent variables were the level of stress and insomnia, and the dependent variable was the learning achievement. Data collection in this study used a questionnaire (DASS), an insomnia rating scale questionnaire, and learning achievement with a learning report book. The data were analyzed by the Spearman Rho test in SPSS 25.

Results: Based on a characteristic sample from 243 respondents, it was found that most of them were male (59.26%), by the age were 17 years old (34.16%). Several students experienced stress. Luckily the highest stress level they experienced was moderate (31.3%), and the highest grade of insomnia they experienced was moderate. The correlation analysis of stress level and learning achievement obtained r=-0.425 and p=0.001. It indicated a significant correlation between stress level and learning achievement, with a moderate correlation.  A similar finding was also found in the correlation of insomnia with learning achievement (p=0.001; r=-0.482)

Conclusion:  In this study, almost all respondents have a mild stress level and sufficient achievement. Meanwhile, nearly all respondents who experienced mild insomnia had acceptable learning achievement. Both variables correlated with the level of achievement of students. Thus, maintaining stress levels and sleep time among students at a normal level is needed.

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

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

Background: Locally advanced breast cancer (LABC) is a term that refers to advanced non metastatic stage breast cancer. Neoadjuvant chemotherapy is one of the therapies given to patients with LABC. Many factors can affect the chemotherapy response, platelets produce growth factors, and cytokines promote angiogenesis and tumor growth. Inflammatory biomarkers such as platelet lymphocyte ratio (PLR) may indicate tumor progressiveness. The Ki67 proliferation index is a marker of the aggressiveness or growth of tumor cells. This study aimed to determine the correlation of platelet count, platelet lymphocyte ratio and Ki67 proliferation index before chemotherapy with neoadjuvant chemotherapy response.

Method: This research used the cohort retrospective design method. A sample of 155 patients was selected using a simple random sampling technique. The inclusion criteria of this research are having complete data about pre-treatment platelet, lymphocyte platelet ratio, Ki67 and the neoadjuvant chemotherapy response result assessed by the oncologist that is written in the medical record. Patient data from other types of cancer, chronic, systemic or autoimmune diseases are excluded from this research. The data of each variable was analyzed with the Spearman correlation test.

Result: There was no correlation between platelet count and neoadjuvant chemotherapy response (p=0.301). There was a negative correlation between the platelet lymphocyte ratio (p=0.026) and the Ki67 index (p=0.040) with neoadjuvant chemotherapy response.

Conclusion: Based on this study, it can be concluded that platelet count is not significant in relation to chemotherapy responses. The higher the platelet lymphocyte ratio and the proliferation index of Ki67, the lower the response to neoadjuvant chemotherapy.

Background: Human Immunodeficiency Virus (HIV) is an RNA virus from the Retroviridae family, Lentiviri subfamily, which attacks the immune system, especially T lymphocytes, namely Cluster of Differentiation 4+ (CD4+) cells. Human Immunodeficiency Virus destroys T lymphocyte CD4+ cells, decreasing immunity against opportunistic infections. For monitoring of HIV, an examination of T lymphocyte CD4+ cells and complete blood counts were conducted.

Methods: A cross-sectional quantitative analytic study was conducted from October 2021 to January 2022 at Prof. Dr. IGNG Ngoerah Hospital. Measurements were made on the total number of lymphocytes, hemoglobin levels, neutrophil-to-lymphocyte ratio (NLR), CD4+ levels and CD4+/CD8+ ratios. We analyze normality data using Kolmogorov-Smirnov and correlation using Pearson and Spearman tests. The p-value < 0.05 was considered significant.

Results: 56 patients met the inclusion and exclusion criteria, with 46 males (82.1%) and 10 females (17.9%). Mean age 38.98±11.58 years, mean total lymphocyte 0.64 x 10³ μL, median T lymphocyte CD4+ 133.50 sel/mm³, mean hemoglobin 10.11±1.49 g/dL, median NLR 6.51, median CD4+/CD8+ ratio 0.06. The hemoglobin variable was normally distributed, while the other variables were abnormal. The Pearson Correlation test showed a significant relationship between T lymphocytes CD4+ and hemoglobin with r=0.329 (p=0.013). Spearman's Correlation test showed a significant relationship between T lymphocytes CD4+ and NLR, total lymphocytes, CD4+/CD8+ ratio with r-0.334 (p=0.012), r=0.777 (p=0.000), r=0.729 (p=0.000) respectively.

Conclusion: There is a strong and significant correlation between the level of T lymphocytes CD4+ and total lymphocyte count and the ratio of CD4+/CD8+, a weak and significant correlation between the level of T lymphocytes CD4+ with hemoglobin and NLR in HIV patients at Prof. Dr. IGNG Ngoerah Hospital.

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.

Link of Video Abstract: https://youtu.be/9chL7pTn3bA

Backgrounds: Liver injury induced by antituberculosis drugs showed high proportions in many countries and might result in serious effects. Previous studies had proved the increase of reactive oxygen species formation and induction of apoptosis related to antituberculosis treatment. There has been no standard therapy for protecting the liver from damage related to antituberculosis. Purple sweet potato extract is one of natural sources that possess hepatoprotector action regarding its antioxidant activity. This research aimed to prove the action of purple sweet potato ethanol extract on apoptosis related to liver injury caused by antituberculosis.

Method: This research was an experimental study with randomized post-test only control group design. The samples were male rats (Rattus norvegicus) strain Wistar, age 8-12 weeks, weight 150-200 grams (divided into two groups: control and experimental group). Purple sweet potato ethanol extract was prepared with maceration technique. The measurement of bcl-2 and caspase-3 expression was conducted with ELISA method. Data analysis was performed using independent t-test.

Results: Our study result revealed that the liver expression of bcl-2 in treatment group was significantly higher than control group (15.83 ± 3.14 vs. 12.11 ± 1.53), whereas the liver expression of caspase-3 in treatment group was significantly lower than control group (1.96 ± 0.38 vs. 2.41 ± 0.30; p < 0.05).

Conclusion: Purple sweet potato extract potentially protects the liver from apoptosis induced by antituberculosis.

Link Video Abstract: https://youtu.be/5cvWJq-8s0w

Background: Nocturia is the need or the number of waking up at night to urinate, with each void preceded and followed by sleep. It is included in lower urinary tract symptoms and reported as the most bothersome and common. Nocturia causes long term sleep deprivation and lowers someone's quality of life. Thus, they need to know how to diagnose and treat nocturia, including time to refer to a specialist. This study aims to review the management and diagnosis of nocturia among Indonesian general practitioners.

Methods: This study used cross sectional design. The data was collected by distributing a self-made online survey with Google Forms about the overview of nocturia among general practitioners in Indonesia, taken from October 2021 to March 2022. Data were analyzed using SPSS version 20.0 for Windows.

Results: There were 252 participants in this study that filled in the questionnaire from October 2021 to March 2022. Most patients (57.8%) were between 50 and 65 years old. Different approaches for nocturia were made, with mainly chose education and lifestyle change (88.1%) and medication such as alpha blocker (19.8%) compared to desmopressin (13.5%). Only 65.5% of respondents referred their patients to urologists for further therapy.

Conclusion: General practitioners in Indonesia face difficulty in dealing with nocturia. It is better to refer these patients to a urologist or other related specialist after they perform the diagnostic examinations and standard therapy.

link of Video Abstract: https://youtu.be/-6sruWeh-_Q

Introduction: Coronavirus-2 (SARS-COV2) is the agent that causes Coronavirus Disease (COVID-19), an acute respiratory tract illness. Early in December 2019, COVID-19 was created in Wuhan, China. On March 11th, 2020, COVID-19 was classified as a pandemic by WHO. As a result, the Indonesian government enacted extensive social restrictions on March 31, 2021. This rule prohibits unnecessary public actions. This study aimed to ascertain how COVID-19 affected This study sought to ascertain how COVID-19 affected orthopedic treatments provided in the spine area at the Orthopaedic Center Hospital in Indonesia.

Methods: This research is cross-sectional and comparative. The population in Indonesia during the COVID-19 epidemic was compared to the same population one year earlier in the research. This report covers every patient who visited Prof. Dr. R. Soeharso Orthopaedic Hospital with a spine-related diagnosis from the emergency room, an outpatient clinic, or an inpatient setting. Patients with other orthopedic subspecialty diagnoses and those registered at orthopedic service support facilities like radiography, laboratories, or physiotherapy were excluded. SPSS version 26 was used to analyze the data.

Results: The overall number of spine patients decreased significantly (30%) from 2440 (pre-covid) to 1695 (during covid). Additionally, there was a significant decline in outpatient visits and surgical procedures (p≤0.05). Patients with trauma reported a crucial decrease during outpatient visits and during surgery (p≤0.05).

Conclusions: During the COVID-19 pandemic, the overall number of spine patients from outpatient visits and patient surgery decreased significantly. Additionally, orthopedic care provided during outpatient visits and surgeries decreased.

Introduction: The demand for health treatment in hospitals has arisen since the Indonesian government launched the National Health Insurance. Admission delay to medical wards (MWs), which makes patients board in the emergency department (ED), disrupts patient flow. This study aims to explore the barriers to boarding patients at the ED by identifying waiting time, waste, and resource adequacy.

Methods: A case study was conducted in the ED of RSUD by Dr. Moewardi. The subject was 45 patients with internal diseases. Collecting data by direct observation using a real-time method is described in value stream mapping. Problem-finding was sharpened by in-depth interviews with health workers and non-health workers in the ED and internal MWs.

Results: Prominent causes of patient flow disruptions depended on service in the ED and inpatient room. Disruptions of patient flow indicated by waiting time amounted to 3 hours, 3 minutes, and 52 seconds. Patients who transferred to the transition room were considered to have gone into MWs, although patients can be treated for more than 3 days due to waiting for bed availability in the inpatient room. Waiting and motion were the most frequent. Inadequate resources both in the ED and inpatient rooms made a wide impact on patient flow, which was worsened by problems with tool layout, fragmented work, and poor utilization of the hospital information management system.

Conclusion: The bottleneck in ED’s and MW's processes contributes to the degeneration of the stacked bed of boarding patients in ED. The improvements must be integrated to address the issues of waiting time, waste, and capacity. Improvements in the flow of boarding patients focus on fixing the documentation of laboratory result problems, arranging patient discharges, and optimizing the use of the hospital information system.

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.

Introduction: Hypercholesterolemia is an indicator of atherosclerosis in blood vessels and is currently a top priority in overcoming health problems, especially non-communicable diseases in developed and developing countries. Thyroid hormones regulate various metabolic processes in the body including synthesis, mobilization, and lipid degradation. A lack of thyroid hormone in the body or called hypothyroidism will decrease the number of LDL receptors in the liver. This causes an increase in plasma LDL levels which also increases total cholesterol levels. Despite the lack of study, Fermented Honey-Garlic (FHG) is now widely developed for its high antioxidant activity. This study aims to determine the content of bioactive compounds in FHG by qualitative secondary metabolite testing and GC-MS analysis and to evaluate the activity of the enzyme glucose-6-phosphate dehydrogenase (G6PD) in rats with hypothyroidism.

Method: Rats were grouped into 6 groups: positive control group induced by propylthiouracil (PTU) with a dose of 20 mg/day, negative control treated with distilled water, treatment group with a dose of FHG 0.2 g/kg BW (P1), treatment group with a dose of FHG 0.5 g/kg BW (P2), treatment group with a dose of FHG 1 g/kg BW (P3) and standard drug Simvastatin group with the dose 0,18 mg/day/200 g BW.

Results: Results showed that FHG contained flavonoid compounds, alkaloids, tannins, and saponins, and statistical results showed that the significance value for G6PD activity was 0.014 (P<0.05).

Conclusion: Therefore, it can be concluded that FHG administration yields a significant effect on G6PD levels.

Introduction: The high cases of hypertension are increasing due to the lack of public knowledge in the management of eating patterns. This revolves around cultural, environmental, and educational factors that can affect knowledge and attitudes in people with hypertension. The aim of this study is to determine the effect of health education on knowledge and attitudes of hypertension patients.

Method: This study used a one group pre-post test design. The study was conducted in one village in Java region of Indonesia, which involved 56 respondents, selected by purposive sampling. The research instruments used were knowledge and attitude questionnaire sheets. Statistic analysis by utilizing Wilcoxon sign rank test to determine the difference between pre and post test with a significance value of p < 0.05.

Results: The results of the knowledge variable before and after being given health education with a p-value = 0.000, and for the attitude variable with a p-value = 0.000. This shows that there is a difference in average between the results of knowledge and attitudes of hypertensive patients before and after being given health.

Conclusion: Health education about the DASH diet affects knowledge and attitudes in patients with hypertension. 

Link of Video Abstract: https://youtu.be/r399GEt3guo

Introduction: Tubularized Incised Plate Urethroplasty (TIPU) is a technique that is widely used in distal hypospadias repair. The advantages possessed by this technique are better cosmetics, the meatus is at the tip of the penis, and the phallus is straight. Some researchers believe that a urethral plate with a size of less than 8 mm is unsuitable for the TIPU technique so augmentation with a graft using the dorsal inlay graft urethroplasty (DIGU) technique is needed. To date, there have been no systematic reviews and meta-analyses that have directly compared the efficacy and complications of DIGU and TIPU. Therefore, this study aimed to compare the effectiveness and complications of these two modalities for repair in primary distal hypospadias patients.

Methods: This study is a systematic review study and meta-analysis. The protocol for conducting and compiling this study was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was performed on six databases: PubMed, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. The risk of bias in the study will be analyzed using the Cochrane Risk of Bias Tools for Randomized Trials version 2 (RoB 2).

Results: Six studies that met the inclusion criteria were included in the meta-analysis with a total of 381 samples. The success rates (OR 1.46, 95% CI 0.74-2.87, p = 0.28) and urine output (OR 2.54, 95% CI 0.63-10.20, p = 0.19) were not significantly different, while the mean operating time (MOT) (SMD 1.96, 95% CI 1.10-2.82, p < 0.0001) was significantly shorter in TIPU (P < 0.05). The incidence of meatal stenosis was significantly more in TIPU than DIGU significantly (OR 5.11, 95% CI 1.46-17.92, p = 0.01), while fistula (OR 2.93, 95% CI 0.92-9.35, p = 0.07) and dehiscence (OR 3.05, 95% CI 0.81-11.45, p = 0.10) was not significantly different between the two techniques.

Conclusion: TIPU has the advantage of shorter operating time but a higher incidence of meatal stenosis than DIGU.

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: https://youtu.be/KtNkkeJmbh4

Background: Chronic kidney disease (CKD) is a progressive disease whose prevalence increases annually. Studies in recent years report that statins (hydroxy-3-nethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors) affect preventing the progression of kidney damage, in addition to their ability to prevent cardiovascular risk in patients with CKD. This study aims to determine the effect of statins on kidney function and renal fibrosis in chronic kidney disease.

Methods: This research is pure experimental (randomized post-test only control group design). The research sample consisted of 20 white mice (Mus musculus L.), Swiss line, aged 3-4 months, and weight 30-40 grams. Samples were randomly grouped into four treatment groups: control (K, n = 5), treatment with simvastatin at a dose of 5.2 mg/kgBW (P1), treatment with simvastatin at a dose of 10.4 mg/kgBW (P2), and treatment with simvastatin at a dose of 20.8 mg/kgBW (P3). Interstitial fibrosis was assessed using Picrosirus Red staining. Data analysis used One-Way ANOVA and Tukey's post hoc tests with a significance value of p<0.05 in SPSS version 25.0 for Windows.

Results: The results showed that the control group (K) was the group with the highest serum creatinine level (1.07 ± 0.43) compared to the other treatment groups (p <0.05). Administration of simvastatin at doses of 5.2 mg/kgBW, 10.4 mg/kgBW, and 20.8 mg/kg BW in CKD mice resulted in lower interstitial fibrosis than controls. There was a significant difference between renal tissue fibrosis in the simvastatin group at a dose of 5.2 mg/kgBW (P1) with a dose of 10.4 mg/kgBW (P2) and a dose of 20.8 mg/kgBW (P3).

Conclusion: Simvastatin can improve kidney function and reduce the degree of renal fibrosis in animal models of CKD. Thus, it can be a therapeutic strategy for CKD.

Introduction: Lifting equipment operators risk having work accidents when loading/unloading containers. One of the risks can be minimized by doing a fit-to-work/ health check before work. This study aimed to analyze the relationship between the level of participation in implementing fit to work on the unsafe behavior of lifting equipment operators at PT. BJTI.

Methods: The research design was cross-sectional from March to May 2022. Monthly data fit to work, questionnaire sheets were used to collect data, and data were analyzed by chi-square. The respondents were as many as 77 randomly selected through cluster sampling. Data analysis was tested using chi-square test (α = 0.05).

Results: As many as 69 (89.6%) showed that operators tended to behave unsafely in the high category, with details of 28 operators participating fit to work medium and 41 operators in the low sort. The chi-square results showed a significant relationship between participation fit to work and unsafe behavior with a significance p<0.05.

Conclusion: There was a significant relationship between the level of participation fit to work on the unsafe action operator lifting equipment PT. BJTI. Therefore, it is recommended that companies provide programs to increase involvement in implementing fit-to-work by giving awards to every worker who actively participates in fit-to-work.

Introduction: Seborrheic keratosis (SK) is a benign tumor of the epidermis, its development is associated with various hypotheses, but none came out as the main culprit. A few study results regarding the oxidative stress strongly associated with skin tumors have been reported. Superoxide dismutase (SOD) is a potent protective enzymatic antioxidant. Malondialdehyde (MDA) is the end product of lipid peroxidation produced by free radicals in the body. Increased levels of MDA usually accompany low levels of antioxidants.

Methods: This study was an observational analytic study with a cross-sectional method involving 42 seborrheic keratosis subjects based on inclusion and exclusion criteria. We recorded the gender, age, family history, and occupation of the subjects. Diagnosis of seborrheic keratosis was made based on history taking and clinical examination—measurement of SOD level by ELISA method and MDA levels by TBARS method. The Spearman correlation test was measured and was considered significant if the p-value was <0.05.

Results: Seborrheic keratosis was more common in females (92.9%), with the most common age group being 40 ̶ 50 years old (57.1%), had a family history of SK (26.2%), and worked in agriculture, forestry, and fisheries (26.2%). The average blood plasma SOD level was 1.68 mmol/L, and the blood plasma MDA level was 181.19 U/L. The correlation coefficient between blood plasma SOD levels and blood plasma MDA levels was -0.393, with a significant value of p=0.01. This study showed that the lower the SOD level, the higher the MDA level in the blood plasma of seborrheic keratosis.

Conclusion: There is a significant correlation between SOD and MDA levels in the blood plasma of seborrheic keratosis subjects.

Introduction: Preeclampsia is an important problem in obstetrics because it is a pregnancy complication often found and results in high morbidity and mortality in both mother and baby. Preeclampsia is one of the complications of pregnancy that needs to be detected or monitored for symptoms, because in addition to being risky for the mother, it will also have an impact on the occurrence of preterm birth and even further impact, namely fetal death in the womb. This study aimed to determine the effectiveness of CRP and leukocyte examination to detect preeclampsia.

Method: This research was conducted at the Jagir Health Center Surabaya in March-July 2022. The research used case control with 30 pregnant women as samples divided into 15 as a control group of normal pregnant women and 15 pregnant women with preeclampsia.

Result: The results showed that of the 15 respondents who had preeclampsia more than half (60%) had high leukocyte and CRP levels, the remaining less than half (40%) had normal CRP and leukocyte levels. While in the control group more than half (67%) had normal CRP and leukocyte levels and less than half (33%) had normal CRP and leukocyte levels. The results of data analysis showed p value 0.001 (<0.005), which means there is a relationship between the CRP and leukocytes on the incidence of preeclampsia.

Conclusion: Examination of CRP levels and leukocyte count proved effective for detecting the incidence of preeclampsia in pregnant women. It is expected that pregnant women carry out routine pregnancy checks and health workers are expected to routinely carry out early detection to prevent pregnancy complications such as preeclampsia

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/kSlkMRdPkO8

Introduction: Intestinal anastomosis leakage is a significant concern following intestinal suturing due to its potential to cause morbidity and mortality. Curcuma longa, commonly known as turmeric, has been observed to have wound-healing properties by promoting collagen deposition and increasing the number of fibroblasts. However, the effect of Curcuma longa on left colon anastomosis with acute intra operative loss of 15% circulating blood volume is unknown. This study aimed to determine the impact of oral administration of Curcuma longa extract on the number of fibroblasts and collagen density in the left colon anastomosis with acute intraoperative loss of 15% circulating blood volume.

Methods: This is an experimental study; the researchers investigated the effect of Curcuma longa extract on the healing process of colon anastomosis in white rats - Rattus norvegicus.

Results: A total of 30 white rats - Rattus norvegicus underwent laparotomy for left colon anastomosis resection, and they were randomly divided into two groups. One group was given Curcuma longa extract orally after surgery, and the other group did not received it. After five days of treatment, the group that received Curcuma longa extract orally had a significantly higher mean number of fibroblasts (1168.13) compared to the control group (749.60) (p-value: 0.006). Moreover, the collagen density in the treated group was also higher, with a density range of 50-72% (60% of rats) and 75-100% (33.30% of rats), compared to the control group's density range of 25-50% (66.70% of rats) and 10-25% (13.30% of rats) (p-value: 0.000).

Conclusion: Oral administration of Curcuma longa extract can increase the number of fibroblasts and collagen density in the left colon anastomosis with acute intra operative loss of 15% circulating blood volume.

Introduction: Food consumption has a substantial impact on the physical condition of work for unskilled individuals like construction workers because their activity demands a lot of energy. Consumption of bananas can increase energy, so it is hoped that the results of this study can be used as a consideration to maintain the health of construction workers so that they are kept in good condition. The aim of the study was to determine the effectiveness of bananas on blood pressure, liver function, and lipid function.

Methods: This is an experimental study with samples taken from the total population of 15 employees. The blood pressure, liver function, and lipid function measurements in construction workers were made before and after consuming bananas. The analysis of the data in this study was conducted by a paired t test.

Results: Based on the data analysis, the result showed that there was no significant difference in blood pressure and liver function measurements between the workers before and after consuming bananas (p>​​0.05). Meanwhile, the results showed that there was a significant difference in lipid function measurements between the workers before and after consuming bananas (p<​​0.05).

Conclusion: The effectiveness of banana consumption can be seen in the examination of lipid function. However, there is no effect on the blood pressure or liver function of the workers.

Introduction: Classical music has beneficial effects on heart rate variability and also reduces one's stress levels due to parasympathetic dominance. Mozart's classical music was shown to provide subsequent short-term enhancement of spatial-temporal reasoning ability. This research aimed to study the effect of Mozart's classical music on blood pressure.

Methods: The design of this study is true experimental with a post-test-only design with a control group.

Thirty Wistar white rats were randomized by simple random sampling method into the control group and experimental group receiving Mozart’s classical music for 90 minutes, twice daily for 1, 3, and 4 weeks. SBP, DBP, and MAP were measured and analyzed using descriptive analysis, Shapiro Wilk, Mann-Whitney U, and Wilcoxon Sign Rank test.

Results: DBP and MAP of the experimental group week 1 and 3 were significantly different from the control group. There were significant differences between SBP, DBP, and MAP of experimental group week 1 from week 3 (p=0.00, p=0.00, p=0.00 respectively) and week 1 from week 4 (p=0.00, p=0.00, p=0.00).

Conclusion: Listening to Mozart's classical music has a direct effect on blood pressure.

Introduction: Vitamins have a main role in controlling metabolism in the body and the immune system. Vitamins A, C, and E are known as antioxidant nutrients and vitamin D is essential for innate and adaptive immune function. This study is aimed to analyze the effect of vitamin intake regularly on malondialdehyde (MDA) levels, white blood cell (WBCs) and platelet counts, and differences count of leukocyte

Method: The study used 6 groups including the control group without intervention and the intervention group intake of one tablet of vitamin a day for 7 days which were divided into groups of vitamin A 2000 IU, vitamin C 1000 mg, vitamin D 400 IU, vitamin E 100 IU and multivitamins C 1000 mg and D 400 IU

Results: Based on the study was explained that vitamins C, D, and E and multivitamins C and D were able to reduce MDA levels and leukocyte counts descriptively but not significantly. The differential leukocyte count has various levels depending on the type of vitamin.

Conclusion: Therefore, the consumption of vitamins A, C, D, and E and multivitamins C and D had no significant effect on MDA levels, WBCs count, platelets count, and differential count of leukocyte.

Introduction: Hemodialysis is one of the treatments for kidney failure patients, although it is not always effective and has a tendency to make the patient's health worse. One such effect is a rise in interdialytic weight. In this study, patients with chronic kidney failure receiving hemodialysis at the Islamic Hospital A. yani Surabaya were examined to establish the association between family support and weight growth.

Method: a cross-sectional research strategy for analysis. 70 respondents made up the population of all hemodialysis patients with chronic renal failure, and 60 respondents made up the purposive sampling sample size. The unrestricted factor is family support. The weight gain between dialysis sessions was the dependent variable. A questionnaire and an observation sheet were used as instruments. The Spearman Rank test was utilized in data analysis.

Results: According to the findings, out of the 60 respondents, the majority's (70%) family support was excellent, and the majority (76.7%) of those who had dialysis saw modest weight gain. According to statistical analysis, the p value was 0.001, which indicates that among hemodialysis patients with chronic renal failure who receive family support, there is a relationship between weight gain.

Conclusion: In patients with chronic renal failure receiving hemodialysis, the more well-controlled the interdialytic weight increase, the better the family support. The requirement for support and assistance for dialysis patients so they can follow the recommended course of treatment.

Introduction: The Objective Structured Clinical Examination (OSCE) is an acceptable measure to assess nursing students' skill competencies. To date, rapid changes in the education system, technology information, and pandemic enforced the need to develop and implement an online OSCE scoring management system, an online system to score the student during the OSCE. Although the satisfaction of the online OSCE scoring management system has been studied, the study to assess readiness to implement the online OSCE scoring management system is still lacking. This study aimed to identify the nursing education institution readiness level in implementing an online OSCE scoring management system named ON-OSCE.

Methods: The online survey involved 144 nursing lecturers across Indonesia. The survey consisted of 30 questions with a 5-point Likert scale that entails technology, innovation, people, and self-development dimensions. Each dimension was constructed by the questions related to resources, skills, and attitudes. The readiness levels were categorized into not ready (average score of 1-3.39) and ready (average score of 3.40-5.00).

Results: Mostly, the participants worked at a private institution (93%) with an accreditation level of B level (75.5%) and implemented an e-Learning system (85.4%). However, the common OSCE scoring management system was paper-based/hardcopy (73.2%). About two third of participants (67.4%) were ready to implement an online OSCE scoring management system (Mean = 3.57, SD = 0.57).

Conclusion: Most participants perceived that their institution was ready to implement an online OSCE scoring management system. Further study is needed to pilot an online OSCE scoring management system in a nursing education institution and explore the student and examiner's satisfaction before implementing an online OSCE scoring management system.

Link of Video Abstract: https://youtu.be/5LTsY60dY0s

Background: Myopia is one of the numerous visual problems that continue to increase in incidence throughout the world. Various genetic and environmental factors are thought to influence the onset of myopia. Myopia is known to have a significant impact on the economy, vision problems, and a decrease in quality of life so that it needs serious attention. This study aims to explore the relationship between parental risk factors with degree severity of myopia.

Methods: This study is an analytic observational study research design. The population of this study are patients diagnosed with myopia in the Ophthalmology Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Patients who met the inclusion and exclusion criteria were included as samples. Data are gathered through medical records and by questionnaire, this includes age and spherical equivalent (SE) in right eye or left eye. Degree of severity was classified based on SE. Myopia’s degree of severity and parental history are then analyzed to determine the relationship.

Results: A total 72 patients were included in this study. The majority of participants have a familial history of parental myopia. The degree of severity with the highest frequency is low myopia. The results of statistical tests showed that there was no relationship between history of parental myopia and the severity of myopia in the right eye (RE) (p-value = 0.712) and the severity of myopia in the left eye (LE) (p-value = 0.565).

Conclusion: There was no relationship between the history of parental myopia and the severity of myopia.

Background. One of the fundamental pathogenesis of endometriosis to grow and develop is to carry out a cellular invasion of the surrounding tissue where it attaches. The invasion process of endometriotic focus is linked with the activity of matrix metalloproteinases-2 (MMP-2) and tissue inhibitors of metalloproteinases-2 (TIMP-2). In this study, we used endometrioma tissue to be implanted in chick chorioallantoic membrane (CAM) as a medium culture model to reconstruct and evaluate the invasion process of endometriosis. Then the MMP-2, TIMP-2 and invasion pattern can be invitro observed.

Methods. Endometrioma tissue fragments were taken from ovarian endometrioma patients, reproductive age, no medication and no malignancy who underwent laparoscopic surgery. Sample research was taken in consecutive and non-probability sampling. The tissue fragments were divided into 4-8 strips, each dimension of 2 x 2 mm². Two strips were assessed for the activity of MMP-2. Two remaining strips were transplanted onto the CAM. After incubation for five days, the transplanted tissues were harvested for assessment of MMP-2 by gelatin zymography, TIMP-2 by western blot and histological assessment by hematoxylin-eosin staining. The assessment was carried out by two qualified biologists as an observer.

Result. Twenty-four fragments of endometrioma have been collected from 24 endometrioma patients who underwent laparoscopy surgery. The average age was 31±5 years, the BMI was 22±3 kg/m², the duration of infertility was 58 ± 3 months, and r-ASRM was 67±35. In CAM of transplanted endometriomas tissue, MMP-2 activity was positively correlated with TIMP-2 in a moderate relationship (r_ô = 0.56, p-value < 0.05), very weak positive correlation with invasion level (r_ô = 0.08, p-value >0.05). TIMP-2 expression was negatively correlated with invasion level in a strong relationship (r_ô = -0.35, p-value <0.05). The ratio between MMP-2/TIMP-2 was positively correlated with invasion level in a very strong relationship (r_ô = 0.72, p-value < 0.05). ICC (intraclass correlation coefficient) value was 0.96, and p-value= 0.01, CI 95%. It shows that there was high reliability between observers.

Conclusion. The invasion level of endometrioma transplanted onto CAM was determined by the balance between MMP-2 and TIMP-2.

Background: The making of batik in Malon Village utilized natural dyes. The process of making batik was done through 7 stages: designing pattern, tracing, outlining, coloring, fixating, masking and rinsing. Those processes were conducted with poor ergonomic working positions and were highly potential to cause injury for the batik workers. This study aimed at finding out the potential health risks that exist for the natural batik workers and the occupational health profiles of batik workers in Malon Village which is an icon for naturally dyed batik.

Method: This study was descriptive quantitative research by using observational design. The data were collected from subjective complaint questionnaires, workplace observation and measurement of Vital Lung Capacity (VLC) of the batik workers.

Results: The results showed that 45.5% of the working tools used poor ergonomic designs. Batik in Malon Village used four chemical irritants: wax, alum, soda ash and lime. All of them could potentially lead to health problems. The result also showed that around 61% of batik workers complained about stinging/ burning eyes, 28% watery eyes and 11% red eyes. In addition, 22% of them complained about itchy skin, 6% redness in the skin and 6% pain in the skin. The VLC showed that 50% of respondents had normal VLC, 47% mild restriction and 3% severe restriction.

Conclusion: The area where the batik workers worked had high health and safety risks, but only 22% of respondents used Personal Protective Equipment (PPE) and all of the worn PPE did not meet the standards.

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

Background: Bipolar Transurethral Vaporization of the Prostate (B-TUVP) is a surgical technique for Benign Prostatic Hyperplasia (BPH) patients that known for its technical reliability, short operating time, and low risk of intraoperative bleeding. However, despite these advantages, it appears to be an unpopular choice among urologists. Previous studies have produced conflicting results when comparing B-TUVP to Transurethral Resection of the Prostate (TURP), particularly bipolar TURP (B-TURP). To date, no studies have directly compared the efficacy and complications of B-TUVP and B-TURP, which using the same energy type. Therefore, the objective of this study is to compare the efficacy and potential complications of these two modalities for the treatment of BPH.

Methods: The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) were followed to perform a systematic search in six databases. The risk of bias in RCT was evaluated using the Cochrane Risk of Bias (RoB) tool version 2. The Review Manager® 5.4 software was used for analyzing all the data.

Results: Six eligible RCTs were included with a total of 940 samples. International Prostate Symptom Score (IPSS), fastest flow rate (Qmax), and post void residual (PVR) were not significantly different, while the quality of life (QoL) score (SMD = -0.64; 95%CI = -1.09 – -0.18; I² = 86%) were significantly lower in B-TUVP (p < 0.05).  Hemoglobin drop (SMD = -2.05; 95%CI = -2.78 – -1.31; I² = 95%), catheterization period (SMD = -1.14; 95%CI = -1.45 – -0.84; I² = 60%), and hospital stay (SMD = -0.68; 95%CI = -1.04 – -0.31; I² = 61%) were significantly lower in B-TUVP (p < 0.05). The analysis of complications did not differ significantly between the B-TUVP and B-TURP groups.

Conclusion: B-TUVP had similar short- to medium-term efficacy and complications as B-TURP, with advantages in terms of significantly better QoL score, lower hemoglobin drop, shorter catheterization period and hospital stay.

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/-i3vr4qpQUU

Background: Chronic kidney disease (CKD) patients on hemodialysis are more susceptible to COVID-19 infections. Mortality and morbidity rate are higher in this population. Thus, it is critical to understand which parameters are associated with mortality in this population. C-reactive protein (CRP), albumin, and d-dimer were shown in several studies to be associated with mortality in COVID-19-infected hemodialysis patients.

Methods: This study was a comparative observational, retrospective study from the medical records of Dr. Soetomo General Hospital in Surabaya, Indonesia. Chronic kidney disease patients on maintenance hemodialysis who tested positive for COVID-19 from June 2020 to January 2021 and underwent treatment in the isolation ward were included in this study. Data were analyzed using SPSS version 21.0 for Windows.

Results: The non-survivor groups have statistically significant lower albumin (2.78 (2.21-3.40) g/dL vs. 3.20 (2.45-3.80) g/dL; p=0.040) and higher CRP (10.40 (4.10-28.6) mg/L vs. 3.20 (0.10-80.0) mg/L; p=0.020) compared to the survivor group (Table 2). D-dimer value has no significant difference between the non-survivor and survivor groups (4,290 (190-18,310) ng/mL vs. 2,630 (190-19,430) ng/mL; p=0.140)

Conclusion: Non-survivor CKD patients with COVID-19 infections have significantly lower serum albumin and higher CRP concentrations. There is no significant difference in D-dimer concentrations in the survivor and non-survivor groups.

Purpose: The National Health Insurance (JKN) implemented by the Indonesian government since 2014 has brought Indonesia to a new phase in realizing the right to health for its people. The social insurance system managed by Social Health Insurance Administration Body (BPJS) is felt to bring many benefits to the community despite many obstacles in its implementation. This study seeks to find the ethical dilemmas experienced by surgical and non-surgical specialists in implementing the JKN program in hospitals.

Methods: The study was conducted using the qualitative method with the phenomenological approach by conducting in-depth interviews with five surgical specialists (an obstetric and gynecology, an otolaryngologist specialist, a surgeon, an eye specialist, and an anaesthesiologist) and six non-surgical specialists (children, mental health, internal medicine, medical rehabilitation, nerves, and skin specialists) in Semarang, Indonesia. In each specialization, there are two respondents interviewed. The data were analyzed using a qualitative approach.

Results: Some problems still exist when specialist doctors treat BPJS patients in hospitals, which include: 1) lack of socialization, making doctors as implementers find it difficult to implement the rules; 2) different implementations in various hospitals, making doctors find it difficult to adjust when they practice at type C hospitals because the number of claims is often insufficient to provide services to patients; 3) the JKN program that has increased the number of patients, resulting in doctors' concerns about lawsuits if they make mistakes; moreover, doctors also have to adjust to existing cost claims; and 4) doctors still trying to uphold the doctor's oath and The Indonesian Medical Ethics Code (KODEKI) and always do the best for patients whatever the problem. Conclusion: The implementation of JKN must always be evaluated continuously, and the government still has to pay attention to the obstacles faced by doctors in the field. In carrying out their practice full of dilemmas, doctors must always receive adequate legal and ethical protection.

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: 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.

Introduction: The use of a tourniquet in lower extremity surgery can help surgeons optimize the surgical field. However, tourniquet inflation may create ischemic conditions in the extremity, and tourniquet deflation may pose a risk of ischemic reperfusion injury (IRI). Ischemic conditions can increase the production of reactive oxidative stress (ROS), which, if it occurs simultaneously with IRI, will produce malondialdehyde (MDA), a toxic metabolite. The prolonged use of tourniquets can cause damage to the local skin tissue at the tourniquet inflation and poses a risk of IRI to other organs. This study aims to observe the effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets.

Methods: This study is an observational study with a prospective cohort design to measure malondialdehyde levels in lower extremity surgery using tourniquets. When the data were normally distributed, a statistical test was performed using an independent sample t-test to compare the demographic data of the two groups. To compare the results of the observation after the induction, 15 and 120 minutes after the release of the tourniquets, a repeated measures ANOVA was performed when the data were normally distributed. Then, to examine the correlation between variables, Spearman's correlation test was applied when the data were not normally distributed.

Results: In this study, almost all the subjects in the isoflurane and dex-iso groups had no significantly different characteristics, and also showed no effect of tourniquet pressure on malondialdehyde levels.

Conclusion: Based on statistical analysis and discussion of the effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets, it can be concluded that there was no statistically significant effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets.

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.

Link of Video Abstract: https://youtu.be/d3xTL9HvM2U

Background: Systemic lupus erythematosus (SLE), an autoimmune inflammatory disease that affects various organ systems, has a severe form called lupus nephritis (LN). The management of LN has changed over the past few decades due to the discovery of new immunosuppressive drugs and advances in our understanding of the disease process. This study evaluates lupus nephritis and kidney transplantation in the past, present, and future challenges.

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 challenges of lupus nephritis and kidney transplantation management according to past, present, and future data.

Results: Treatment strategies for LN typically involve a combination of immunosuppressive medications, such as corticosteroids, cyclophosphamide, and mycophenolate mofetil, to induce and maintain remission. Many LN patients progress to ESRD, necessitating renal replacement therapy (RRT) through dialysis or kidney transplantation. The results of kidney transplantation in LN patients have been progressively improving. Developing novel immunosuppressive agents may improve graft survival and reduce complications in LN patients undergoing kidney transplantation.

Conclusion: The future of kidney transplantation for LN patients appears promising, with emerging research focused on novel immunosuppressive agents, personalized medicine, biomarkers for predicting recurrence and graft rejection, preventive strategies for recurrent LN, and cell-based therapies

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/8w4jBvx0pJc

Background: Plasma-rich fibrine (PRF) membrane is a new biomembrane useful in ocular surface reconstruction technique. Since its development, PRF membrane has been used successfully in many studies; however, some controversies maintained. This literature study aims to evaluate the role of Platelet Rich Fibrin (PRF) membrane and conjunctival autograft on TGF-β and collagen type 1 expression in conjunctival wound healing.

Methods: This literature review compiles and elaborates on previous studies from many authors to support future experimental studies, which will be conducted to compare the effect of PRF membrane and conjunctival autograft on TGF-β and type 1 collagen expression.

Results: PRF has many advantages, such as the ability to reduce inflammation, rich in growth factors, and can be a temporary scaffold for fibroblast migration. However, despite its advantages, PRF is not widely used, unlike its counterpart techniques, such as conjunctival autograft. Conjunctival autograft has long been used as an option for ocular surface reconstruction techniques, but it has some limitations. The conjunctival autograft technique cannot be performed in large or bilateral conjunctival damage. Thus, the PRF membrane technique can become a perfect solution for such a case. This literature review will provide more information on how PRF can regulate inflammation and support the conjunctival wound healing process.

Conclusion: Some impacts of PRF membrane and conjunctival autograft are still unclear, especially their effect on TGF-β and type 1 collagen expression. This literature review is expected to encourage and support future experimental studies about the impact of PRF and conjunctival autograft on TGF-β and type 1 collagen expression.

Link of Video Abstract: https://youtu.be/Rg5QfPqxtqA

Background. Breast emptying causes more milk to be released, which stimulates the production of breast milk. One of the crucial hormones that will rise with breastfeeding is oxytocin. This literature study aims to evaluate the mothers' attitudes toward giving breastfeeding and how it relates to the mother's oxytocin levels is reviewed in this study.

Methods. We used the phrases "mother's attitude," "breastfeeding," and "oxytocin level" in several databases, including PubMed (NIH), Scopus, EMBASE, and Google Scholar, as keywords for literature searching. Also manually searched were pertinent reference databases. This review article integrated any previously recognized relevant publications from the database, explained the findings in a narrative format, and offered a thorough evaluation and analysis of the literature findings.

Results. According to this study, oxytocin levels are linked to many mothers' attitudes toward nursing, most favorable. Several studies indicate that the oxytocin levels increase high empathy, reduce stress, reduce cortisol hormone, typical of bonding, and mother will feel confident.

Conclusion. The mother's mindset and the increase in oxytocin are related to breastfeeding.

Strabismus surgery aims to improve visual function, binocular vision, and cosmetics by fixing the position of the eyeball. However, inflammation after surgery can lead to fibrous tissue formation. Dexamethasone is routinely used as an anti-inflammatory but has unwanted side effects. On the other hand, Asiatic acid, the most important saponin constituent of Centella asiatica, has anti-inflammatory and anti-fibrous properties. It has been widely used as a traditional medicine plant in China, India, and Indonesia. The findings show that Asiatic acid has been shown to affect wound healing after strabismus surgery positively. Asiatic acid inhibits inflammation, increases cell proliferation, and inhibits fibrosis. It promotes wound healing by increasing the strength of the incision wound, epithelialization, keratinization, and angiogenesis. Overall, using natural compounds like Asiatic acid in wound healing is promising and should be explored further. It can be a safer and more effective alternative to dexamethasone, which has known side effects. However, further studies are required to determine the optimal dosage and administration method of Asiatic acid for post-operative strabismus wound healing. The results of this study are expected to be the basis for selecting alternative therapies to reduce inflammation and fibrosis after strabismus surgery.

Bacterial keratitis is an ocular emergency and is one of the leading causes of blindness worldwide. Pseudomonas aeruginosa is the most frequent causative agent of keratitis. The infectious process of P. aeruginosa is highly invasive and can rapidly lead to corneal ulcers, ocular infections (endophthalmitis), and corneal perforation. Delayed or inadequate treatment may result in complications such as corneal fibrosis and neovascularization. Platelet-rich fibrin (PRF), which contains high levels of platelets, can aid in hemostasis, cell migration, and proliferation to accelerate the wound healing process. PRF contains several growth factors, such as Platelet-derived growth factor (PDGF), Vascular endothelial growth factor (VEGF), and Transforming growth factor (TGF- β), which are released in a time-dependent manner during the wound healing process, ranging from 7 to 28 days. TGF- β regulates the expression and activity of matrix metalloproteinases (MMP-1, MMP-2, MMP-3, MMP-9) involved in wound remodeling and healing, where MMPs are regulated or balanced with tissue inhibitors of metalloproteinases (TIMP-1, TIMP-2). In previous studies, PRF was found to be effective in managing bacterial keratitis in cats. In this discussion, we explore the molecular effects of PRF as an adjuvant therapy for bacterial keratitis

Link of Video Abstract: https://youtu.be/fn9kA601YVo

ACL rupture is a common injury often resulting from previously healthy individuals' non-contact knee injuries. ACL rupture in young adults and teenagers are becoming more common, contrary to earlier theories that suggested ACL damage was uncommon in skeletally immature people. This risk is significantly raised by concomitant meniscal injury whether or not an ACL reconstruction is undertaken. Although surgical management with allograft or autograft reconstruction can be achieved successfully, there are some serious complications following ACL reconstruction. The supply of autografts is limited, especially in situations with numerous ligament injuries or re-ruptures, which might result in morbidity at the donor site. Allografts can increase the spread of illness and trigger an inflammatory response, which is a drawback. There has been much interest in a tissue-engineered ACL graft because of these issues and current developments in bioengineering and regenerative medicine. According to recent research, following an ACL repair, the bone marrow density surrounding the knee area diminishes. Platelet Rich Plasma (PRP) and Bisphosphonate are the substrates that could ameliorate this phenomenon.  Therefore, this review aims to compile evidence of PRP and bisphosphonate and its effect on the tendon-bone interface in ACL reconstruction.

Link of Video Abstract: https://www.youtube.com/watch?v=1zdsWuZBGgc

Introduction: Stroke has been reported in symptomatic and asymptomatic COVID-19 patients with undetermined characteristics and outcomes. Stroke is one of the non-respiratory pathology reported amongst COVID-19 patients with various manifestations. We elucidated the characteristics and outcomes in symptomatic and asymptomatic COVID-19 patients.

Methods: A systematic review was performed from 01/01/2020 to 16/03/2022 in EBSCOhost, Google Scholar, Pubmed, Scopus, and Web of Science with search terms, i.e., COVID-19, Coronavirus, SARS-CoV-2, Coronavirus Disease-19, stroke, CVA (cerebrovascular accident), brain MRI, head MRI, magnetic resonance imaging, antithrombotic agent, thrombectomy, using the PRISMA guidelines. Inclusion criteria include case reports or series of adult stroke patients with confirmed COVID-19 written in English; other articles were excluded.

Results: From 239 articles screened initially, 23 articles were included. Twenty-five patients are classified as symptomatic (n=17) and asymptomatic (n=8). In symptomatic patients, motor and sensory abnormalities with loss of consciousness and alteration of memory were detected. Eight symptomatic patients had elevated D-dimer, and 2 had elevated fibrinogen levels. Complete resolution was found 6 times higher in symptomatic vs. asymptomatic cases, while the mortality rate was lower in symptomatic compared to asymptomatic patients.

Conclusions: Stroke in symptomatic patients occurred more frequently than the asymptomatic and was observed pre- or post-diagnosis of COVID-19; thus could be the comorbidity and/ or complication.

Link of Video Abstract: https://youtu.be/Ja9klXNlw5A

Background: Keratitis Pseudomonas aeruginosa is the most frequently occurring eye infection. It is a rapidly developing condition that can lead to ocular infections (endophthalmitis) and corneal perforation resulting in vision loss. Although prompt administration of antibiotics can effectively kill the bacteria, the corneal damage caused by toxins persists. The following inflammatory process results in corneal thinning, fibrosis, and eventual perforation.

Methods: This study is a literature review to support future experimental studies which will be conducted to examine the expression of IL-1b and MMP-9 on pseudomonas keratitis after administration of EGCG.  

Results: Interleukin-1ß is a proinflammatory cytokine secreted by various immune cells in response to acute and chronic inflammation. At the same time, matrix metalloproteinase (MMP) is a group of proteolytic enzymes involved in the pathophysiology of various ocular surface diseases. Epigallocatechin gallate (EGCG) is the major polyphenol compound in green tea, produced from the Camellia sinensis plant. Recent studies suggest that EGCG has anti-inflammatory and antioxidant effects on various cell types, including the cornea. EGCG inhibits IL-1β, which induces the activation of the NF-kB signaling pathway, which may explain the decrease in uPA expression and the reduction of collagen degradation by corneal fibroblasts. EGCG inhibits the activation of pro-MMP 9 produced by corneal fibroblasts in response to IL-1β stimulation, and this effect is mediated by the inhibition of uPA upregulation without a significant impact on pro-MMP 9 expressions.

Conclusion: Epigallocatechin gallate (EGCG) in Camellia sinensis extract has the potential as an alternative adjuvant therapy for bacterial keratitis because it has antibacterial, anti-inflammatory and antioxidant effects.

Link of Video Abstract: https://youtu.be/KigXgHWz0JU

Background: The common neuroaesthetics used for neurosurgery was inhalation of Sevoflurane and the newest, by continuous infusion of propofol called Total Intravenous Anesthetic (TIVA). Anesthesia procedures are one of the biggest healthcare expenditures in hospitals. Thus, finding the most effective and efficient anesthetic technique but in the same time can maintain patient safety is important. This literature review compares a cost-effective Sevoflurane and propofol TIVA analysis in craniotomy surgery.

Methods: This literature review was carried out by searching studies in three online databases consisted of PubMed, the Cochrane Library, and Google Scholar using the keywords "sevoflurane inhalation anesthetic", "propofol total intravenous anesthesia", "TIVA”, “craniotomy’, "cost-effective analysis", and “pharmacoeconomic”. Appropriate studies were then carried out through a narrative synthesis analysis.

Results: The assessment of cost-effective analysis in anesthesia is broadly divided into fixed commodities and various commodities. The analysis found the highest use of costs in the TIVA group and the lowest in the isoflurane inhalation group. The high cost in the TIVA group was caused by propofol being the most expensive compared to other inhalation agents such as isoflurane and Sevoflurane. Based on the average intraoperative anesthetic cost, it was also found that the anesthetic cost per patient was Rp. 957,870,- for the TIVA propofol group and Rp. 1,318,130,- for the sevoflurane group. Sevoflurane use for induction and maintenance of anesthesia resulted in a further modest decrease in costs (especially if fresh gas flow was reduced early), primarily through less drug waste.

Conclusion: The cost-effective analysis showed that Sevoflurane was less expensive than propofol. Yet, in terms of pharmacoeconomics, using TIVA propofol results in much fewer PONV episodes, unplanned hospital admissions, and patient lengths of stay, all of which improve pharmacoeconomic benefits.

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/lODjSgZ6vm0

Background: Glaucoma is a progressive neurodegenerative disease characterized by glaucomatous optic neuropathy, including loss of retinal ganglion cells and axons. Optic neuropathy causes progressive vision loss and is managed by reducing intraocular pressure. However, even when the intraocular pressure has dropped to normal, the damage to the retinal ganglion cells may linger in certain situations. Thus, commence investigations on natural sources such as neuroprotection to prevent the loss of retinal ganglion cells.

Methods:  This literature review compiles and elaborates on previous studies to support future experimental studies that will be conducted to comprehend the effect of intravitreal Resveratrol as a glaucoma treatment to prevent the loss of retinal ganglion cells.

Results: Resveratrol is a naturally occurring phenol and phytoalexin detected in the skins of grapes and berries like raspberries, blueberries, and mulberries. Resveratrol inhibits the production of reactive oxygen species (ROS) and apoptosis as well as lengthens the life span of nerve cells via multiple mechanisms. Resveratrol treatment can reverse the progression of apoptosis, preserve mitochondrial membrane potential by reducing caspase-3, and inhibit cytochrome-C release, enhancing cell survival, as shown in many previous studies. Before the systemic administration of resveratrol in eye disease, it is necessary to consider the presence of the blood-ocular barrier—about 10 out of 35 eyes detected resveratrol in the conjunctiva after oral trans-resveratrol supplementation. Several studies have administered intravitreal injections of resveratrol to increase intraocular resveratrol concentrations.

Conclusion: Resveratrol may be utilized as an alternative adjuvant treatment for glaucoma due to its antioxidant and antiapoptosis properties.

Introduction: MDR-TB is an infectious disease that can cause death and stigma for those infected. MDR-TB patients with depression are at risk for LTFU, which will worsen their condition and strengthen the stigma they receive.

Case report: A 52-year-old female psychiatric interview and assessment using the Beck Depression Inventory (BDI) found that BDI score of 4 (no depression), and the patient adhered to TB treatment. She was found to be laid off, and an assessment using the BDI to detect depression in the patient found potential stigma in the patient, such as being laid off from work, prohibited from teaching face-to-face, and shunned by colleagues. Interventions given were prescribing Fluoxetine 20 mg per day and Clobazam 10 mg per day, a brief intervention using the FRAMES technique, psychoeducation about disease and drug effects and the duration of treatment, and an office visit. A worksite intervention was performed by the patient's husband. Antituberculosis drugs were monitored by both a pulmonologist and a psychiatrist. Her work-related problems were resolved through interventions at the school with psychoeducation about drug-resistant tuberculosis, the transmission method, the duration of treatment, and the side effects of the treatment. The results of the last sputum examination after one month of treatment showed drug resistance, and the patient was advised to undergo 18 months of treatment. The patient could finally work offline with fewer responsibilities after getting negative laboratory test results twice in a row.

Conclusion Work-related psychosocial interventions are required to address rejection at work, which results in depression and nonadherence to treatment. Liaison services with social interventions at work in drug-resistant tuberculosis-infected patients are necessary to improve their quality of life and maintain their treatment adherence.

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

Background: Subaortic stenosis (SAS) is the second most common form of left ventricular outflow obstruction, accounting for 14% of LVOT obstruction in the general population. This obstruction is in the area of the heart under the aortic valve. While only a few cases have been reported in pediatrics, SAS is a gradually progressive disorder rarely seen at birth and infancy. This case study aims to evaluate the successful treatment of severe SAS with left ventricular dysfunction in children

Case Presentation: We present the case of an 8-year-old boy who presented with shortness of breath on exertion and diaphoresis 3 months ago. Transthoracic echocardiography revealed severe aortic stenosis (PG 69.86 mmHg) with discrete tissue in the anterior LVOT and left ventricular systolic function decreased (EF Teich 29.44%), with global hypokinetic. Transesophageal echocardiography (TEE) results in severe subvalvular AS with a fixed subaortic membrane (PG 51.16 mmHg; Stenotic area 0.1 cm2), anterior to the aortic valve 1 cm long. There was mild mitral regurgitation and moderate tricuspid regurgitation. The patient then undergoes successful medical treatment and surgical subaortic membrane resection with tricuspid repair. After one year's operation, the patient remained stable, in good condition and free of symptoms.

Conclusion: Subaortic stenosis is a gradually progressive disorder and could develop into heart failure with significant left ventricular dysfunction. Monitoring is an important aspect, given the nature of disease progression. Successful management of a patient with subaortic stenosis involves a multidisciplinary approach, including an early diagnosis, a comprehensive understanding of cardiac pathophysiology, risk factors of recurrence, optimal medical management and surgical strategy.

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.

Introduction: Lupus enteritis is a rare first manifestation of active systemic lupus erythematosus (SLE). diagnosis of this condition is hard, specially without other signs and symptoms associated with active SLE. this article will report a woman with SLE and lupus enteritis as the first manifestation of active systemic lupus erythematosus

Case presentation: A 25-year-old woman presented to the Emergency department complaining of abdominal pain and vomiting. From her medical history, four years in the past, she reported the same signs and symptoms as now and turned into identified with appendicitis. Her abdomen examination found out mild abdominal distention without a abdominal tenderness. Wall thickening and irregularity of small and big bowel loops were observed on the CT abdomen. She turned into given a excessive dose glucocorticoid as initial treatment and turned into maintained with low dose glucocorticoid and cyclosporin. After 6 months of follow-up, the patient did not have a recurrence of signs and symptoms.

Conclusion: A high index of suspicions is essential to differentiate lupus enteritis from other differential diagnoses. For lupus enteritis, excessive-dose steroids were an efficient initial treatment.

Link of Video Abstract: https://youtu.be/ep7OSDbigho

Background: Intracranial subdural empyema, although rare, represents an extreme medical and neurosurgical emergency. Multiple burr holes or a craniotomy for drainage and antibiotics are the treatment of choice. This case study aims to evaluate the complete recovery of interhemispheric subdural empyema extending to cerebellar tentorium treated with antibiotics as unimodal therapy.

Case Presentation: We present a case of a 40-year-old male with severe headache, a decrease of consciousness GCS E3V1M5, generalized onset tonic-clonic seizure, right abducens palsy, and right hemiparesis. Interhemispheric subdural empyema extending to cerebellar tentorium with associated intracranial abscess was seen from brain magnetic resonance imaging (MRI). Antibiotics were administered without surgical intervention due to the patient's family rejection. The patient regained full consciousness within 1 week and complete neurological function after 4 weeks of continuous use of antibiotics. The patient was discharged, and his recovery was uneventful on subsequent follow-up.

Conclusion: The use of antibiotics as monotherapy in subdural empyema is controversial, as it is widely accepted that surgery must be initiated as soon as possible in this pathology. It is indicated in small portions of cases without major neurological deficits or in particular conditions where surgery could not be performed. Still, more recent studies found it justifiable in patients with documented initial good responses. This case report highlights the complete recovery and the clinical outcome of antibiotics as monotherapy for subdural empyema.

Introduction: Ovarian Sertoli – Leydig Cell Tumor (SLCT) are one of sex cord tumor that has incidence rate less than 0,2% of all ovarian tumors. It occurs predominantly in second and third decades of lifetime. It has characteristics mostly low–grade malignant although poorly differentiated type may behave more aggressively. Clinical characterstic of ovarian SLCT usually hormonal changes, nevertheless in patients without hormonal changes, the manifestation of the disease consists of abdominal pain and abdominal enlargement, and palpable adnexal mass on physical diagnostic.

Case: a 52 years woman that has been undergo right salpingooforectomy 5 months prior with PA result shows poorly differentiated sertoli – leydig cell tumor, and refusing to chemotherapy. She came with chief complaint of abdominal enlargement since 3 months accompanied with lower abdominal pain 2 weeks prior. Ultrasound examination shows cystic ovarian neoplasm with solid part size 9 x 9 x 9 cm from left adnexa. Tumor markers that arise are Alpha–Fetoprotein (AFP)  52 ng/mL and Lactate Dehydrogenase (LDH) = 432 U/mL which correspond to sex cord tumor. She has undergone Laparotomy Total Abdominal Hysterectomy Left Salpingooforectomy and chemotherapy afterward.

Conclusion: Ovarian Sertoli – Leydig Cell Tumors (SLCT) are a rare sex cord ovarian tumor that may behave more aggressively as it poorly differentiated. It has manifestations of hormonal changes and also abdominal enlargement.

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.

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.

Introduction: Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non-pharmacological therapies can be viable alternatives to conventional therapies. Recently, laser therapy has been widely used in the treatment of acne vulgaris due to its effectiveness and safety as it provides a more rapid response with less rate of recurrence, specifically 1064nm Nd: YAG laser. Few studies have investigated laser combinations. Combination 1064nm Nd: YAG and 2940nm fractional erbium laser for severe acne with acne scar has not been reported.

Case report: We report a case of severe acne with acne scars in a 21-year-old female, skin type IV, treated using 1064nm Nd: YAG laser in five sessions and 2940nm fractional erbium laser two sessions. Reduction of acne lesions counts and acne scars improvement prominent after Nd:YAG laser at least four sessions. Our patient's acne scars improved not significantly after 2940nm fractional erbium laser. Acne remission was sustained through the follow-up period. There were no post-inflammatory hyperpigmentation and no exacerbation of acne lesions after the procedures.

Conclusion: 1064nm Nd: YAG laser is very effective for mild to severe acne and improves new acne scars. While 2940nm fractional erbium laser is more effective for mature scars.

Introduction: Transverse vaginal septum or known as partial vaginal agenesis, is a rare case. The most frequent causes are defects or fusion disorders of the Mullerian Ductus and defect formation of the urogenital ducts of the urogenital sinuses. The septum may obstruct the entire vaginal opening and cause hematocolpos. The diagnosis is based on a detailed physical and gynecological examination supported by ultrasound and magnetic resonance imaging (MRI). The management option is surgery which is performed as soon as possible.

Case Report: An 11-year-old girl came with lower abdominal pain and amenorrhea, diagnosed with a transverse vaginal septum complicated with hematocolpos based on anamnesis, physical and gynecological examination, and imaging study by ultrasound and MRI. The management includes excision and cross-incision of the septum followed by diagnostic laparoscopy. Endometriosis was found at the broad ligament during laparoscopy and continued with endometriosis resection.

Conclusion: The transverse vaginal septum is still one of the rare anomalies of the Mullerian Duct. The diagnosis was made from a history of low abdominal pain, primary amenorrhea, and a pelvic examination that revealed the vaginal septum. MRI is a gold standard examination procedure of anomalies or abnormalities involving the vagina. The management of the transverse vaginal septum is a surgical approach involving drainage of hematocolpos.

Introduction: Ovarian cyst torsion is a rare gynecological emergency characterized by acute abdominal pain due to torsion of the ovarian vascular pedicle. Most cases are associated with several risk factors including pregnancy, ovarian cyst size, and pelvic organ anatomy. Despite the incidence of detected ovarian cysts during pregnancy increasing along with better antenatal care, the clinician needs to consider appropriate management for the safety of the mother and fetus.

Case description: A 25-years old woman who was pregnant with a gestational age of 10 weeks was referred to the Emergency Department of Zainoel Abidin General Hospital. The patient complained of sudden abdominal pain at the lower right abdominal quadrant within the last 5 hours before hospital admission. The patient stated the history of the ovarian cyst based on previous ultrasonography assessment on previous antenatal care. Abdominal tenderness on the relevant quadrant was positive during the physical examination. A vaginal examination revealed a regular non-tender cystic mass with a diameter of 5 cm on the right adnexa. The ultrasonographic finding showed the presence of a cystic mass on the right ovary with a size of 6.52 cm x 5.6 cm x 4.06 cm and a positive whirlpool sign. The patient was diagnosed with ovarian cyst torsion in the first trimester of pregnancy. Due to the patient refractoriness to conservative management, the patient was treated surgically by cystectomy laparotomy in an emergency setting. Histopathology examination of the intraoperative specimen revealed a luteoma. The pregnancy was successfully maintained until full-term pregnancy and the baby was delivered by caesarian section due to malposition.

Conclusion: Appropriate supportive management was required to maintain pregnancy and prevent fetal loss.

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

Introduction: Apert syndrome (AS) is a rare type 1 acrocephalosyndactyly syndrome, characterized by craniosynostosis, severe syndactyly of the hands and feet, and dysmorphic facial features. It exhibits autosomal dominant inheritance assigned to mutations in the fibroblast growth factor receptor gene.

Case Illustration: We presently describe the case of a 14 years old male patient with acrocephaly, prominent forehead, ocular hypertelorism, proptosis, short and broad nose, pseudoprognathism, crowding of teeth and ectopia, maxillary hypoplasia, low hairline, webbed neck, pectus excavatum, and severe bilateral syndactyly of hands and feet. The examination revealed apical cranium, occipital flattening, enlargement and hypoplasia of the premaxillary opening, crowding, ectopic teeth, tapering of the mandibular apex, and pseudognathia.

Conclusion: We reported a 14 years old male patient with AS with craniosynostosis and acrocephalosyndactyly. The characteristics of clinical manifestation of AS should be aware by physicians to be able to diagnose the disease.

Link of Video Abstract: https://youtu.be/d196XKGsPek

Background: Parathyroidectomy is a method of treating secondary hyperparathyroidism associated with Chronic Kidney Disease (CKD), which has been largely abandoned in developed countries due to the existence of calcimimetic drugs which are reported to be effective in treating secondary hyperparathyroidism in this population. However, in developing countries like Indonesia, the availability of Calcimimetic drugs is still rare and expensive, so that parathyroidectomy can be an option. The study aimed to present four case reports of chronic HD patients with SHPT accompanied by clinical symptoms. As far as our knowledge goes, this is the first case series reported from Indonesia.

Case Presentation: This research is a multicenter case series study. All patients had undergone dialysis for five years and complained of body aches. All calcium levels were within the normal range, while three patients had hyperphosphatemia and one patient had normal phosphate levels. All patients had iPTH levels >1000 pg/ml in the last six months. Before the surgery, all patients had received long-term phosphate-binding drugs, including calcium-based and non-calcium-based drugs and vitamin D3 agonists. All patients underwent total parathyroidectomy with autotransplantation of parathyroid tissue in the right antebrachial regions, except for the second patient who received the transplant in the left antebrachial region due to an AV fistula in the right arm.

Conclusion: In dialysis patients, especially in developing countries, approximately 10.7% of them experience SHPT with PTH levels >1,000 pg/mL, and one study in Indonesia showed that around 35% of patients undergoing chronic hemodialysis had PTH levels >200 pg/ml, making parathyroidectomy a highly possible option considering that medications such as cinacalcet are more expensive and not widely available.

Link of Video Abstract: https://youtu.be/FZsJ7mtGsW8

Introduction: Superior vena cava syndrome (SVCS) associated with jugular internal vein thrombosis can be dangerous. Diagnosing SVCS and venous thromboembolism (VTE) must be done precisely and accurately to minimize the risk of pulmonary embolism.

Case Presentation: Male, 55 years old, complaining of shortness of breath, the feeling of choking in the neck, and a lump in the neck for one month. The patient has a history of type 2 diabetes mellitus and does not routinely take medication. The patient experienced tachypnea and tachycardia, and there was an enlargement in the submental to the submandibular region; the boundaries were not firm, supple, or fixed, approximately ten centimeters in diameter, and the collateral veins were enlarged and felt pain. Chest examination revealed telangiectasia, crackles, and bronchovesicular breath sounds over both lungs at the base and medial side. The patient had mild anemia and leukocytosis, increased HbA1c levels, total cholesterol levels, and increased D-dimer and Lactate dehydrogenase (LDH). Antero-posterior (AP) lateral cervical radiograph shows a widening of the soft tissue in the retro tracheal space at the level of the second cervix. The patient given warfarin, enoxaparin, methylprednisolone, and heparin. Improvement of the condition was shown.

Conclusion: Superior vena cava syndrome due to internal jugular vein thrombosis is a challenging case. Careful diagnostic measurement based on history and physical examination, in addition of additional investigation may lead to the diagnosis. Management with warfarin, enoxaparin, methylprednisolone, and heparin show clinical benefit.

Link of Video Abstract: https://youtu.be/f6IaLnu3sz8

Introduction: Spinal cord injury (SCI) rehabilitation is a resource-intensive and time-consuming process and this is problem in particular for patients from a rural, remote areas, or low socioeconomic backgrounds. This problem is further exacerbated by social restriction policies in place due to coronavirus disease 2019 (COVID-19). This case report aimed to describe how telerehabilitation could overcome these challenges

Case presentation: A 20-year-old female involved in a motor vehicle accident. Preoperative magnetic resonance imaging (MRI) indicated  a complete burst fracture of the L1 vertebral body. The patient experiences paraplegia and loss of autonomic control. Long spine fusion was performed. After being discharged, the patient could only visit the hospital once one-month post-surgery due to personal financial reasons and COVID-19-related social distancing policy. Telerehabilitation was used for the remaining follow-ups and rehabilitation programs were monitored through instant messaging platform between the patient, the operating surgeon, and the rehabilitation specialist. Telerehabilitation using instant messaging was an affordable and practical platform of communication for patient self-reporting and monitoring of progress. With intensive telerehabilitation program, the patient’s functional abilities recovered from Frankel B to D after 6 months of following the domiciliary telerehabilitation plan.

Conclusion: We report a case of satisfactory functional outcome of SCI rehabilitation following the use of instant messaging to assist the rehabilitation. This highlights that instant messaging may be utilized to guide the rehabilitation process with the consideration of other factors such as the patient's engagement and the healthcare provider’s commitment. We recommend for further refinements in the adoption and use of telerehabilitation for  orthopaedic and traumatology cases that need long-term rehabilitation.

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

Background: Prostate cancer frequently presents with a non-specific clinical appearance, similar to benign prostatic hyperplasia (BPH). In many countries, early detection and treatment of prostate cancer are associated with lower mortality rates. Several prostate cancer biomarkers have been studied, one of which is programmed death ligand-1 (PD-L1), currently used as a therapeutic method. This study aimed to examine the expression of PD-L1 in prostate cancer and BPH.

Methods: This was a cross-sectional retrospective study involving subjects diagnosed with prostate cancer by histopathological examination. The expression of PD-L1 from 30 prostate tissues was analyzed using qRT-PCR. Data were then analyzed using the ANOVA test and continued with the Post Hoc test. P < 0.05 was considered significant.

Results: From a total of 30 prostate tissues that were examined histopathologically, ten samples were BPH (33.3%), ten samples were non-metastatic prostate cancer (non-MPCa) (33.3%), ten samples were metastatic prostate cancer (MPCa) (33.3%). The data analysis showed significant differences in PD-L1 expression between groups (p=0.000). The Post Hoc test showed significant differences between the non-MPCa group and BPH (p=0.003; 95% CI 36.1-142.8) and the MPCa group with BPH (p=0.000; 95% CI 50.9-127.3).

Conclusion: PD-L1 was overexpressed in the prostate cancer group, both in non-metastatic Pca and metastatic Pca. As a result, using PD-L1 inhibitors in the early stages of the disease may improve survival and prognosis.