Introduction: Banana peels are often discarded without further use. Whereas each banana peel contains nutrients that are quite high depending on the ripeness of the banana fruit. This has the potential to use banana peels as a medium for fungal growth. The purpose of this study was to determine the potential of banana peel as a growth medium for the test fungi, namely Aspergillus fumigatus, Aspergillus flavus, and Candida albicans.

Method: The type of research is experimental with variations in the mass of banana peels. The potency of banana peel media was evaluated by the growth of the test fungus which was expressed quantitatively by growth diameter and number of colonies. While the qualitative evaluation was carried out by observing the morphology of the test fungus colonies on banana peel media. The gold standard media used in this study were Sabouraud dextrose agar (SDA) for Aspergillus, and Potato dextrose agar (PDA) for Candida. Incubation for Candida albicans growth was carried out at 48 hours, while Aspergillus growth was incubated for up to 10 days. The data obtained were analyzed using Mann-Whitney.

Result: The results showed that the banana peel media could be overgrown with the test fungus. Candida albicans showed the best results in the 3% (w/v) variant, while Aspergillus fumigatus grew optimally at the 2% (w/v) variant. Aspergillus flavus was best at the 1% (w/v) variant.

Conclusion: Based on the results obtained, banana peels media can be used for the growth media of the tested fungi, and it is recommended to use the 2% (w/v) variant so that it can be used to grow all the tested fungi in this research. 

Background: Sepsis and vasodilatory shock are serious medical conditions and cause high mortality rates worldwide. It is known that IL-6 and angiopoietin-2 levels have a role in the etiology of shock in ICU patients. Consequently, this research aims to examine the involvement of angiopoietin-2 and IL-6 in the severity of coagulation problems in patients with vasodilatory shock.

Methods: The study's design is observational analytic with a cross-sectional study design, and the data came from those treated in the ICU room and the Emergency Room at RSUD Dr. Soetomo Surabaya from February 2020 to March 2022. Data collected included age, respiratory rate, DIC score, APACHE II score, mortality, IL-6 levels, and angiopoietin-2 levels. The data was then analyzed using Easy R (EZR).

Result: 27 of the 44 patients (61.4% of the total) belonged to the DIC group. A correlation between IL-6 levels and DIC incidence and mortality at first ICU admission and after 24 hours in the ICU was shown to be significant (p<0.05). There was also a significant correlation between Angiopoietin-2 and both DIC incidence and mortality upon admission to the ICU and after 24 hours in the ICU (p<0.05). It was found that the test specificity and sensitivity of Angiopoetin-2 and IL-6 levels on the severity of coagulation disorders and mortality in patients with vasodilatation shock were 85.9% for Angiopoetin-2 and 71.6% for IL-6.

Conclusion: There is a correlation between the severity of coagulation disorders in vasodilated shock and increased IL-6 and angiopoietin-2. IL-6 and angiopoietin-2 were to be correlated with mortality and Angiopoietin-2 has higher specificity and sensitivity than IL-6. Multicenter prospective studies are needed to confirm study results.

Link of Video Abstract: https://youtu.be/JRX2wJWFCKs

Introduction: COVID-19 has had profound implications on global healthcare systems, and this pandemic management has led to a significant change in orthopedic surgical activity. We aimed to evaluate the types and incidence of fractures treated during the pandemic to provide insight into the situations for which orthopedic trauma surgeons should be prepared in unusual circumstances that may arise in the future.

Methods: Descriptive observational cross-sectional study from Dr. Hasan Sadikin General Hospital and Ulin General Hospital was conducted from electronic medical records between January 2018 and December 2022. Analysis was performed using SPSS version 26 on descriptive analysis using mean, frequency, percentage, and standard deviation.

Results: 2890 patients were enrolled for the current cohort, from 2018 until 2022, with predominantly male (n = 2117). Even though, an increase in overall admission from 2018 (n = 631) to 2019 (n = 784), a decrease after that occurred during the COVID-19 pandemic, which is from 2020, 2021, and 2022 (n = 652, 500, and 323, respectively)

Conclusion: Knowing the number of fractures can be a tool to evaluate the types and incidence of fractures treated during the pandemic to provide insight into the situations for which orthopedic trauma surgeons should be prepared in unusual circumstances that may arise in the future.

Background: Most people with hypertension feel healthy and energetic; this situation is dangerous and can cause death in the community. Non-compliance is a complex phenomenon often occurring in health care, especially in hypertensive patients. Medication adherence is very important so that complications do not occur, but many hypertensive patients still do not comply with medication. This study aimed to analyze the correlation between health literacy and adherence to medication for hypertension patients in the COVID-19 pandemic era at Private Hospital Surabaya.

Methods: This research design was correlative analytic with a cross-sectional approach. This study's population was hypertensive patients treated at Hospital D with a simple random sampling of 74 people. The instruments used in this study were Health Literacy Scale (HLS-EU-Q16) to measure health literacy and adherence to medication by using Morisky Medication Adherence Scale (MMAS-8). The Rank Spearman test used data analysis to measure health literacy with medication adherence.

Results: The results showed a relationship between health literacy and adherence to medication for hypertension patients at Private Hospital Surabaya with a level (p=0.000).

Conclusion: Findings from the study suggest that improving health literacy important for support to be more responsible in hypertension medication.

Introduction: Air pollution is increasing due to industrial and transportation activities in the community. This has an impact on health problems, one of which is respiratory problems. Carbon monoxide (CO) is one of the air pollutants resulting from incomplete combustion of transportation and can be harmful to the human body. The purpose of this study was to analyze the levels of carboxyhemoglobin (CoHb) and the effect of the habit of wearing a mask and not using a mask on COHb levels in public transportation workers in the Bangkalan district.

Method: We used analytic observational with cross-sectional design. Respondents used in this study were public transportation workers who had the habit of wearing masks and not wearing masks in the Bangkalan district. COHb levels were checked using the Hinsberg Lang method by reading a UV-Vis spectrophotometer at a wavelength of 414.2 nm with normal values for COHb levels < 3.5%.

Results: There were 13% respondents who had the habit of using masks and smoking, 37% respondents were non-smokers and use masks. While respondents who did not have the habit of using masks and smoking were 27% and non-smokers were 23%. Respondents who smoked and used masks had an average COHb level of 8.56%, whereas those who did not smoke and used masks had an average COHb level of 6.50%. Respondents who smoked and did not use masks had an average COHb level of 9.36%, while those who did not smoke and did not use masks had average COHb levels of 8.08%. Bivariate analysis showed that COHb levels were higher in public transportation workers who did not use masks than those who used masks while working (p < 0.05).

Conclusion: We discovered a correlation between the habit of wearing a mask and the levels of COHb in those who work in public transport in the Bangkalan District. The analysis of respondents' COHb levels based on the type of mask used and consideration of underlying disease should be done in future studies.

Link Video Abstract: https://youtu.be/NAnsqP7dPd0

Background: Current keloid treatment involves intralesional injection of triamcinolone acetonide (TA), which, despite its usage, is associated with high recurrence rates and adverse effects. Mesenchymal stem cells (MSCs) exhibit potent proliferative abilities and can curb fibroblast activity and proliferation within keloids. It is now known that umbilical cord mesenchymal stem cells (UC-MSCs) have been shown to have greater proliferative potential than bone marrow-derived MSCs (BM-MSCs), and other advantages of UC-MSCs include being easily accessible and less immunogenic. To assess the viability of administering umbilical cord MSC (UC-MSC) and its conditioned medium (UC-CM) via intralesional injection compared to TA in reducing macroscopic keloid volume and type 1:3 collagen ratio.

Methods: This randomized controlled trial enrolled twenty-four keloid patients by consecutive sampling. Eligible patients were required to have keloids on the chest, back, abdomen, or extremities. Patients with hypertrophic scars, a history of kidney failure, hypertension, blood disorders, malignancy, pregnancy, breastfeeding, or keloid treatment were excluded. Sociodemographic data, keloid size, and tissue biopsies were collected during scheduled visits. Bivariate analyses applied were considered significant at a p-value of <0.05.

Results: The study revealed that the most significant decrease in macroscopic volume occurred within the UC-MSC group, followed by the UC-CM group, and then the TA group (UC-MSC: 50.24% ± 3.58%; UC-CM: 43.97% ± 3.04%; TA: 33.53% ± 2.64; p = 0.004. The UC-CM group exhibited the most substantial decrease in the type 1:3 collagen ratios (4.80±0.26), with UC-MSC (4.60(4.15-8.05)) and TA (3.96(1.63-4.14)) following in sequence (p=0.002).

Conclusion: The findings of this study indicate that the use of UC-MSC and UC-CM exhibits promising superiority over TA in terms of reducing macroscopic keloid volume and type 1:3 collagen ratio.

Introduction: Farmers generally provide NPK chemical fertilizers (Nitrogen, Phosphorus, Potassium) to provide nutrients for green spinach plants. However, the use of NPK chemical fertilizers harms the environment. Nowadays, chicken feathers are known as beneficial for fertilizing plants, similar to NPK chemical fertilizers. Fermentation of chicken feathers by Bacillus sp. can improve the quality of protein in chicken feather fertilizers which can be used as a supplement in renewing soil conditions.  Thus, this study is aimed to evaluate the nutrient component of fermented chicken feather fertilizer waste using Bacillus subtilis on the growth of green spinach (Amaranthus tricolor)

Methods: This was a cross-sectional study. In this study, we used a total sampling technique. In this study, three groups got different chicken father fertilizers, and two groups of standard and did not get the chicken father fertilizer. Data from the research will be statistically analyzed descriptively. The descriptive data will provide in the table.

Results:  In the first treatment group, the value of nitrogen (N) was 2.439, phosphorus (P) was 2.225%, and potassium (K) was 2.408%. In the second treatment group, the nitrogen (N) value obtained 2.866%, the phosphorus (P) value was 2.174%, and the potassium (K) value was 2.477%. In the third treatment group, the nitrogen (N) value was 3.291%, the phosphorus value was 3.082 %, and the Potassium (K) value was 3.135%.

Conclusion: According to the results, the higher the chicken feather fermented fertilizer dose, the higher the NPK content. This is certainly good for the growth of spinach.

Introduction: Addiction to online games is one of the impacts caused by technological developments. One of the effects of online game addiction is a change in sleep quality. This study aims to analyze the relationship between the habit of playing online games with adolescent sleep quality.

Method: This study is a correlation analytic research design with a cross-sectional approach, the research sample was 109 respondents from 150 populations using simple random sampling. The independent variable of this study was the habit of playing online games and the dependent variable was sleep quality. The instrument used in this study is gaming disorder using the 7-item Game Addiction Scale (GAS) and sleep quality using the 10-item Adolescent Sleep-Wake Scale (ASWS). Data analysis using chi-square test.

Results: The result of this study, most of them (55.6%) had fairly bad sleep quality and almost half (44.4%) had very bad sleep quality. Spearman rank test results p = 0.000, which means that game addiction has a relationship with adolescent sleep quality.

Conclusion: Game addiction is one of the factors for adolescents' bad sleep quality. It is hoped that adolescents can reduce playing online games because bad sleep quality can interfere with health.

Introduction: Solutions that can be done to overcome reproductive health problems in adolescents include increasing access to health services, especially reproductive health education. By increasing the participation of youth/students (especially health students) who play a role in peer educators, It is hoped that it can help adolescents in discussing and dealing with problems faced, especially reproductive health. For this reason, it is necessary to prepare students as peer educators by developing students' self-awareness of their effectiveness as counselors. This study aimed to evaluate health communication skills through the Self-awareness approach of students as prospective health workers.

Methods: This research design is cross-sectional with a questionnaire instrument and a Chi-Square analysis test.

Results: The results show that most of the respondents feel nervous when speaking in front of the group, most still feel shy, pay less attention, are very worried about other people's thoughts, and do not give a good impression, respondents find it difficult to work when being watched by others, and almost all respondents need time to adapt to new situations and are still looking for an identity.

Conclusion: It is necessary to develop a self-awareness approach with the hope that students are called to know, acquire, use, and adapt basic health communication skills as counselors so that they can effectively overcome problems that arise regarding reproductive health in adolescents.

Link of Video Abstract: https://youtu.be/0zW7g_T0heE

Introduction: Applying research activity in hospitals in Indonesia is a kind of challenge. This study aimed to assess the research’s capacity in Prof. I.G.N.G Ngoerah General Hospital. It is related to the indicators and cultural analysis at the team, organization, and individual levels in Prof. I.G.N.G Ngoerah General Hospital.

Methods: A cross-sectional study and qualitative analysis using Focus Group Discussion (FGD) were conducted in July-August 2022 at Prof. I.G.N.G Ngoerah General Hospital. The Research Capacity and Culture (RCC) validated survey measured self-reported research capacity at leadership, individual, team, and organization levels. Additionally, this study explored barriers and motivators. The rate of research capacity decisions and the domains in this study use the ROC curve. This statistical analysis used chi-square with a significance of p-value < 0.05.

Results: One hundred and thirty respondents were analyzed. The individual characteristics were 45-54 years old, male, medical specialist, clinician without structural position, with a master’s degree or specialist, internal medicine department and pediatric department, 0–10 years of work history, 1–10 journal publications, and having a research history. In leadership and team capacity, most have low scores, and in individual capacity, organization and research capacity have high scores. There is a statistically strong relationship between each domain and research capacity.

Conclusions: High research capacity in a hospital is very important. Evidence-based research can be used to support the services and progress of the hospital itself, especially as a teaching hospital.

Introduction: According to empirical evidence, Curcuma xanthorrhiza (CX) and black cumin (BC) have been utilized extensively in Indonesia. The primary components of Curcuma xanthorrhiza and black cumin (CXBC) formulations are BC oil and CX extract. This study aimed to assess the influence of CXBC active compounds (polyphenols, flavonoids, and thymoquinone) on IFN-g expression in HTB-183 cells. This study aimed to determine the levels of vitamins and minerals in CXBC preparation and the potential for immunomodulatory activities.

Methods: We engaged in experimental laboratory research. Observing the expression of interferon-gamma (IFN-γ) was used to evaluate the immunomodulatory activities of the HTB-183 human large lung cancer cell line.

Results: The results demonstrated that the CXBC supplement included vitamins (A, C, and E) and minerals (potassium, calcium). CXBC preparations boosted HTB-183 cell IFN-γ expression.

Conclusion: The study's findings indicate that the CXBC formulation contains a high concentration of vitamins and minerals. CXBC formulations augment IFN-γ expression.

Introduction: Nowadays, new cases of COVID-19 have been found with severe cases and deaths. The upper respiratory microbiota has been associated with susceptibility to viral infection and disease severities. However, the association of respiratory tract microbiota with the modulation of COVID-19 outcomes still raises a question. Therefore, we examined the association between the diversity of upper respiratory microbiota and clinical manifestations of COVID-19.

Methods: This research is an observational cross-sectional study. We characterized the microbiota in the upper airway using the 16S ribosomal RNA sequencing method in 74 COVID-19 patients aged 18-64 years. We also examined the association between COVID-19 severities with alpha and beta diversity of upper respiratory microbiota. The alpha and beta diversity was analyzed by QIIME and shown by R software, AMOVA and MRPP testing was done with R software. The t test and diagrams were performed using R software. Bivariate analysis was carried out by t-test and Chi-square test. 

Results: The top five phyla in the upper respiratory tract of Indonesian COVID-19 patients with age 18-64 years old were Firmicutes (32,3%), Bacteroidota (27,1%), Fusobacteriota (15,2%), Proteobacteria (15,1%) and Actinobacteria (7,1%). Shannon and ACE index analysis showed no decline of microbiota diversity in the upper airway with increased disease severity. However, there were significant beta diversity differences in the upper airway microbiota between mild and severe COVID-19. The Firmicutes phylum and Oribacterium genus abundance were significantly higher in severe COVID-19 than in mild. The quantity of the Fusobacteriota phylum, Neisseria, and Fusobacterium genera was significantly higher in mild COVID-19 than in severe.

Conclusion: Our research supports the relationship between the severity of COVID-19 and the diversity of the microbiota in the upper airway in adults. Further studies are needed to examine how microbiota prevents COVID-19 severities.

Background: The prevalence of malnutrition in East Java still tends to be high, one of which is in Banyuwangi City, namely 16.78%. One of the causes of under-five nutrition problems is the lack of knowledge of nutrition and health, attitudes and behavior of mother's feeding. This study aims to analyze differences in mothers' knowledge and dietary diversity of toddlers before and after being given health food education with video media and leaflets 2 times for 14 days.

Method: This is a quasi-experimental design with pre-post test control group design. The research subjects were 44 divided into 2 groups. The statistical test results showed p value < 0.05 on the variables of mother's knowledge and dietary diversity of toddlers before and after healthy food education from 2 groups.

Result: The knowledge of mothers  of toddlers  in  The  Intervention  Group,  before education was partially in the sufficient category as many as 12 people (59,1%), and almost all of them were in the good knowledge category as many as 19 people (86,4%) after education with a mean±SD value of 76,5 ± 23,2 before education, increased to 90,1 ± 10,8 after education. The Intervention Group's average dietary diversity score of toddlers was 4,27 ± 0,9. After education, most of the toddlers' dietary diversity was in the high category, namely 13 (59.1%), the moderate category was 9 (40,9%), and none were in the low category with an average score of 5,91 ± 1,27.

Conclusion: This study has identified a significant difference in knowledge of mothers and toddlers' dietary diversity before and after education with video media and leaflets. Education with video media and leaflets effectively increases mother's knowledge and toddler's dietary diversity.

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

Background: Pseudomonas aeruginosa keratitis is a prevalent ocular illness that carries the potential risk of endophthalmitis and corneal perforation. The use of antibiotics effectively eradicates the bacteria; nevertheless, the corneal damage caused by toxins remains unresolved, resulting in the thinning of the cornea, which can ultimately lead to corneal perforation or the development of corneal fibrosis. This study aims to analyze the quantification of neutrophils and the expression levels of interleukin-6 in the Pseudomonas aeruginosa keratitis model.

Methods: The study used an experimental research design. The research utilized a Rattus norvegicus corneal preparation to establish a keratitis model. Each test group consisted of six samples, including a negative control (solvent), moxifloxacin 0.5%, and a combination of moxifloxacin 0.5% and EGCG at a concentration of 50 µg/mL.

Results: The combined group of 0.5% moxifloxacin and epigallocatechin gallate (EGCG) 50 µg/mL exhibited a reduced count of neutrophils compared to the group treated with 0.5% moxifloxacin alone. The findings indicated a statistically significant disparity in the neutrophil count across the various treatment groups (p<0.05). No significant distinction was observed in the neutrophil count between the moxifloxacin 0.5% group and the combination group (p>0.05). The average percentage of IL-6 expression level in the group treated with a combination of 0.5% moxifloxacin and 50 µg/mL EGCG was found to be lower compared to the group treated with only 0.5% moxifloxacin. There was statistically significant variation in the expression of IL-6 across the three treatment groups (p<0.05). There was no statistically significant difference in the level of IL-6 expression between the moxifloxacin 0.5% group and the combination group (p>0.05).

Conclusion: The results of this investigation demonstrated that EGCG possesses the capability to serve as an adjunct treatment for the suppression of inflammation in cases of Pseudomonas aeruginosa keratitis.

Link of Video Abstract: https://www.youtube.com/watch?v=KF58IGGdWmc

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma. It is classified into homogeneous subtypes, namely Germinal Center B-Cell Like (GCB) and Non-Germinal Center B-Cell Like (GCB), with the latter associated with worse survival outcomes. Increased expression of Hypoxia-Inducible Factor-2α (HIF-2α) is often observed in DLBCL and has been correlated with enhanced angiogenesis, suggesting its potential as a prognostic factor in managing DLBCL. The study evaluates the association between HIF-2α overexpression and the GCB and non-GCB subtypes of DLBCL.

Methods: This cross-sectional study utilized samples from DLBCL patients at Dr. Kariadi Semarang Hospital between January and December 2021. Immunohistochemistry was performed on the samples to determine the DLBCL subtypes and assess the presence of HIF-2α. HIF-2α was evaluated by immunohistochemistry based on its distribution and intensity. The Kruskal-Wallis test was used to find the association between HIF-2α expression and the GCB and non-GCB subtypes of DLBCL. Furthermore, Spearman's rank correlation test explored the correlation between all numeric variables.

Results: A total of 30 subjects were included in this study, with 7 samples of GCB subtype (23.3%) and 23 samples of non-GCB subtype (76.6%). Kruskal-Wallis test showed no association between HIF-2α expression and the subtypes of DLBCL (p=0.812). Spearman's rho correlation test indicated no correlation between HIF-2α overexpression score with NCCN IPI score in GCB (r=0.219; p=0.637) and non-GCB (r=-0.194; p=0.386).

Conclusion: There was no association between HIF-2α expression and GCB and non-GCB subtypes of DLBCL. Additionally, no correlation was found between HIF-2α overexpression and NCCN IPI score.

Link of Video Abstract: https://youtu.be/tduoO-xy3ZE

Introduction: Cartilage destruction in knee osteoarthritis (KOA) caused the inflammation process. It makes the patient complain of knee pain, tends to immobilize, and induced neural inhibition (Arthrogenic muscle inhibition) on the quadriceps muscle as a knee stabilator and shock absorbent. These caused quadriceps weakness. The combination of blood flow restriction (BFR) and low-intensity resistance training (LIRT) showed an improvement in isotonic peak torque significantly, but the prescription is varied and limited in Indonesia.

Patient and Methods: This was a clinical experimental study with randomized control trial with pre and post-test design. The subjects were 28 KOA patients (50-70 years old). The intervention group (n=14) received a combination of low-load resistance training (30% 1-RM; 75 repetitions) and BFR (50 mmHg). The control group (n=14) received low load resistance training only (30% 1-RM; 75 repetitions). Both groups received training 2 times per week with a Q-bench machine for 6 weeks. Isokinetic peak torque was assessed before and after the training program.

Results: There was a significant improvement in isokinetic peak torque before and after the training program in both groups (intervention group p=0.001; control group p=0.000). There was a significant improvement of delta isokinetic peak torque between both groups (p=0.018) and post-test between both groups (p=0.044). The effect size value of the intervention group was 1.22 (very large) and the control group was 0.89 (large).

Conclusions: The addition of BFR on LIRT for 6 weeks can improve isokinetic quadriceps strength in patients with knee osteoarthritis

Link of Video Abstract: https://youtu.be/Ethmg0srBhU

Background: Traditional Postnatal Care (TPC) is derived from traditional medicines as health practices. The approaches of knowledge and beliefs incorporating plant and manual techniques are applied singularly or in combination to prevent illnesses and maintain well-being. TPC is used widely among the postnatal mother as a self-care for the healing process, both physically and mentally. As part of the nursing management in a community health setting, understanding the different health and wellness approaches and their benefits is part of the early knowledge and skills when delivering care to postnatal mothers. This study aimed to assess the relationship between TPC and sociodemographic data of postnatal mothers in selected study settings to understand more about the types of common TPC practiced within the study setting.

Methods: Participants were among the postnatal mothers within one week after delivery and selected purposely based on inclusion criteria. A cross-sectional survey from November 2021 to February 2022 with 178 postnatal mothers completed the distributed questionnaires. The researcher used SPSS version 28.0 to analyse the data.

Results: The result showed that the educational background (p=0.001, p<0.05) and household income per month (p=0.001, p<0.05) demonstrated a significant effect concerning postnatal mothers practising and non-practising TPC.

Conclusion: This study identified the significant variables of sociodemographic, namely household income and education level. This study’s result is the starting point for the researcher to begin a broader analysis of this title.

Link of Video Abstract: https://youtu.be/WzYiDQR2RvA

Introduction: The coronavirus disease 19 (COVID-19) vaccination scheme is still being implemented worldwide, but problems with stock availability and other factors are still impeding this endeavor, especially in developing nations like Indonesia. Ethnopharmacology is known to provide a good source of a cheap candidate for anti-inflammation drugs. This study was conducted to determine the effectiveness of affordable adjuvant therapy, Eucalyptus oil, which has been used as a household remedy for respiratory tract infections in Indonesia.

Methods: 52 mild-moderate COVID-19 patients were randomly assigned for a prospective clinical trial. A group of 26 patients was given standard COVID-19 treatment as a control group, while another 26 patients as the treated group were given standard therapy and use Eucalyptus oil as an adjuvant. The clinical sign and symptoms, cytokines interleukin (IL) 6, IL-10, and transforming growth factor-beta (TGF-β) profiles were recorded during the study period.

Result: There was a trend of better improvement of clinical symptoms among patients who received adjuvant treatment than the control group. Altered smell (p = 0.003) and cough (p = 0.641) recovered faster in the treated group. While there was no marked difference in IL-10 and TGF-β levels among both groups, IL-6 level in the treated group was significantly lower and the neutrophil-to-lymphocyte ratio (NLR) was significantly decreased (p < .05) than the control.

Conclusion: Using Eucalyptus oil as an adjuvant of COVID-19 treatment promotes faster recovery of mild-moderate COVID-19 patients, probably via inhibition of the IL-6-mediated inflammation process.

Abstract: The association between progesterone serum levels on the day of hCG administration and IVF pregnancy outcomes has been the subject of numerous studies and clinical investigations. We aim to conduct a systematic review and meta-analysis to explore the influence of progesterone serum levels on hCG trigger day on pregnancy outcomes in vitro fertilization (IVF) cycles. Through a comprehensive search of the PubMed and Embase databases, eight studies were identified for inclusion. The analysis revealed a risk ratio for live birth rate of 0.91 (95% CI 0.79-1.06), clinical pregnancy rate of 1.01 (95% CI 0.89-1.15), miscarriage rate: 0.98 (95% CI 0.80-1.21), implantation rate 0.81 (95% CI 0.49-1.35), and mean difference for endometrial thickness -0.01 (95% CI -0.16, 0.14). This study showed insignificant progesterone serum levels on the day of hCG administration and IVF pregnancy outcomes. However, the heterogeneity across studies emphasizes the need for larger, standardized investigations to elucidate the nuanced associations between progesterone levels and IVF success. This study contributes to our understanding of the role of progesterone in IVF outcomes and provides a basis for future research to optimize fertility treatment protocols.

Link of Video Abstract: https://youtu.be/nINFPi4uVow

Background: Abnormalities in the neurosurgical field concerning cranial structure are almost always followed by increased intracranial pressure (ICP), which causes cerebral hypoxia and disrupts the whole cellular system. This study analyzes the correlation between ICP changes and oxidative stress markers, in subjects with various anatomical pathology abnormalities who underwent surgery.

Methods: This was a cross sectional study of 24 subjects with ICP conducted in the Department of Neurosurgery, Cipto Mangunkusumo Hospital, Jakarta, from November to December 2009. In this study, ANOVA analysis has been done to measure the mean difference oxidative stress (MnSOD, NADPH, MDA, and catalase) in subjects with various changes in ICP who have undergone surgery and Spearman analysis to measure the correlation between each oxidative stress markers. Oxidative stress markers were measured from normal brain tissue taken intra-operatively, cerebrospinal fluid (CSF) taken while doing ventriculostomy, and peripheral blood taken from a central vein catheter (CVC).

Results: The results showed that MDA concentrations in blood were significantly correlated with MDA in brain tissue (P = 0.029) in all of the ICP groups, CSF MnSOD concentration and CSF NADPH concentrations correlated with brain tissue NAPDH (p= 0.000) in congenital group and CSF catalase concentration correlated with brain tissue catalase (p = 0.00) in congenital group.

Conclusion: Increased ICP caused by various pathological conditions causes changes in oxidative stress markers in brain cells, CSF and blood. Oxidative stress markers in blood and CSF are correlated strongly with the brain. It is suggested that it could be used to predict intracranial high pressure in all cases with intracranial abnormalities.

Introduction: Self-management, which rests on self-efficacy and self-care, is the cornerstone of diabetes mellitus treatment in managing blood sugar levels. Healthy behavior affects how a disease develops, therefore it's crucial to develop strategies for sustaining self-management. This study looked at the impact of spiritual diabetes self-management health coaching on patients with type 2 diabetes mellitus' levels of self-efficacy, self-care, and blood sugar.

Methods: This study was designed as a quasi-experiment with a pre-post control group. There were 210 patients with diabetes mellitus overall in the Surabaya A-Yani Islamic Hospital. 120 respondents were included in the research sample, including 60 in the intervention group and 60 in the control group. For one month, Spiritual Diabetes Self-Management Health Coaching was provided to the intervention group once daily for 60 minutes. The control group, meanwhile, received a program in accordance with hospital protocols. a parametric test is used in data analysis.

Results: The intervention group's self-efficacy, self-care, and blood sugar levels differed between the pretest and post-test results. According to the findings, the intervention group's pretest and posttest scores for the variables of self-efficacy, self-care, and blood sugar levels varied.

Conclusion: Spiritual Diabetes Self-Management Health Coaching can improve the self-efficacy and self-care of the type 2 diabetic patients; also reduce their blood sugar levels.

Introduction: OHS culture can contribute to achieving productivity and zero accidents. Without a safety culture in workers, no matter how well the system or structure is designed and how sophisticated the safety devices are, there is no functioning due to the things underlying human behavior. This study aims to evaluate the description of the level of OHS cultural maturity using SCMM (Safety Culture Maturity Model).

Method: This study uses a descriptive quantitative design with a cross sectional approach. The population used is all permanent workers of the Commercial Ship Division in the Shipping Industry, numbered 173. The total sample of all workers is 34 people using a non-probability sampling method. The variables of this study were 10 components of SCMM. The instrument used is a questionnaire sheet based on the SCMM (Safety Culture Maturity Model).

Result: The results showed that the components of management, commitment and visibility showed a value of 2.82, communication a value of 3.12, productivity versus safety a value of 3.94, learning organization a value of 4.44, safety resources a value of 3.26, participation value of 4.12, shared perceptions about safety score 4.88, trust value 3.88, industrial relations and job satisfaction score 4.38, and training value 3.70.

Conclusion: The conclusion in this study shows the level of maturity of OHS culture at the Shipping Industry has a final average score of 3.85 at the level involving. The advice is to increase the level of OHS culture by evaluating the fulfillment of the target of management visits to the field, evaluating OHS media, evaluating the fulfillment of safety patrols or visiting the OHS team to indoor places.

Introduction: Meningitis is a major contributor to global mortality and morbidity rates. The rapid diagnosis of its etiology is crucial. Cerebrospinal fluid (CSF) analysis plays a key role in this process. This study aims to compare CSF analysis results with the Biofire Filmarray ME panel to expedite and simplify the diagnosis of meningitis etiology.

Method: Using an observational analytical cross-sectional design, the study was conducted over 4 months. CSF samples were collected from multiple hospitals. The CSF analysis involved flow cytometry using Sysmex XN 1000 and Dimension EXL platforms. The Biofire Filmarray ME panel employed multiplex PCR technology.

Result: Of the 30 samples, 83.3% exhibited clear appearance, 93.3% lacked clots, and 83.3% were clear in color. Increased cell counts were noted in 56.7% of samples, elevated protein levels in 43.3%, and normal glucose levels in 56.7%. CSF analysis interpretations indicated 70% normal, 3.3% viral infection, and 26.7% bacterial infection. The Biofire Filmarray ME panel results showed 96.7% negatives and 3.3% positive for Cytomegalovirus. Comparing CSF analysis with Biofire Filmarray ME panel results using McNemar's test indicated significant differences. The study highlighted the quality assurance of CSF analysis, challenges of antibiotic use, low prevalence of pathogens detected by the Biofire Filmarray, and the potential for false negatives due to untargeted pathogens.

Conclusion: In conclusion, this study provides insights into CSF analysis and its comparison with the Biofire Filmarray ME panel. However, limitations include the Biofire Filmarray's inability to detect all pathogens and absence of certain data during CSF sampling. Further improvements are needed to enhance accuracy in meningitis diagnosis..

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

Introduction: Radical cystectomy is one of the most invasive urological procedures, with high difficulty and various complications. The Enhanced Recovery After Surgery (ERAS) protocol was created to improve patient outcomes after such surgery, including radical cystectomy. This study aims to evaluate the application of ERAS on radical cystectomy in Indonesia.

Methods: This was a multicenter study (Jakarta, Yogyakarta, Bandung, and Medan) from July 2016 to April 2021. This study compared the postoperative length of stay, diet intake, bowel movement, and mobilization pattern of the subject receiving ERAS protocol with the non-ERAS subject. Curtailed, fast preoperative carbohydrate loading was administered to patients. There was no mechanical bowel preparation except one day before in selected cases. Postoperative patterns after surgery and the length of stay were analyzed.

Results: We collected 128 subjects in this study, with 74 (60 %) subjects enrolled with ERAS protocol and 54 (40 %) with non-ERAS. There were statistically significant differences in length of stay with a median of 11 days vs. 16 (p: 0.001), intensive care unit admission duration with a median of 2 days vs. 3 (p: 0.004) and time to sit after radical cystectomy with a mean of 2.14 days vs 2.89 (p-: 0.004) in subject with ERAS protocol compared to non-ERAS protocol.

Conclusion: This multicenter study found that ERAS was demonstrated to be efficacious in decreasing the duration of hospital stay, the duration of intensive care unit admission, and the time for the subject to sit after the radical cystectomy.

Link of Video Abstract: https://youtu.be/nk1qtXzfl7I

Background: Transnasal esophagoscopy (TNE) is a small-caliber flexible esophagoscopy technique with the same diagnostic accuracy as conventional esophagoscopy. In addition, this technique is safer than any other technique and has patient tolerance. This study aims to analyze and evaluate the TNE procedure in patients.

Methods: a retrospective approach was used in this study by taking data from the activity register of the broncho-eschatology division of the outpatient unit of ORL-HNS Dr. Soetomo General Academic Hospital. TNE report book and patient medical records were collected to have the data. The observation period was from 2013 to 2017. Data were analyzed using SPSS version 25.0 for Windows.

Results: patients met the inclusion and exclusion criteria were 99 patients, with a male-to-female ratio of 2.3: 1. Most endoscopic findings were normal esophagus (56.57%). Existing abnormal findings included esophageal stenosis (18.18%), esophageal mucosal lesions (14.14%), and esophageal tumors (11.11%). TNE examination complications were found to be 1%.

Conclusion: TNE is widely used in patients aged 51-60, with dysphagia, reflux or Globus as the most common indications. TNE is quite safe to do in an outpatient hospital setting.

Introduction: Adaption is required in responding to changes that can overcome the community's physical and mental health concerns, particularly adaption of pregnant women in preparation for childbirth during COVID-19 to minimize maternal mortality in Indonesia. Pregnancy during a pandemic like this may increase the risk of anxiety disorders in pregnant women. As a result, every individual must have a positive affirmation.

Method: The purpose of this study is to learn more about the impact of self-affirmation and self-positive imagery on anxiety disorders in pregnant women during the COVID-19 pandemic. A quasi-experimental design was adopted in this investigation, comprising pre- and post-test groups. There are 52 people in the population. Sampling employs the Probability sampling approach in conjunction with simple random sampling. The intervention was performed four times. The respondent's degree of anxiety was assessed using the perinatal anxiety screening scale (PASS) questionnaire.

Result: According to the findings, the average anxiety level prior to the intervention was 35.59, and the average anxiety level after the session was 18.72. Implementing self-affirmation and positive visualization has a significant (p = 0.000) effect on anxiety.

Conclusion: During the pandemic, self-affirmation and positive imagery should be supplemented by a commitment to increasing positive thinking before to childbirth.

Background: The average incidence of falls in elderly women exceeds that of elderly men in all age groups. Exercise had a consistent effect on reducing the risk of falls when prescribed correctly and was successful in reducing fall rates in the community, with an even greater effect seen in a balance-challenging exercise program. The exercise in question is a series of combined activities that maintain or increase flexibility, endurance, strength and balance. Compared to traditional sports, sports games are more interesting and challenging, are not affected by the weather, and being able to practice at home increases safety and comfort. Exergame boxing is considered a fun and competitive fighting video game, so it has an effect on psychological and social interactions in the elderly. The aim of this study was to evaluate the effect of adding exergame boxing on the balance function of elderly women.

Methods: This study is a true experimental research with pre and post-test randomized control group design. The research participants were 32 elderly women, with each group consisting of 16 elderly women. Participants in the treatment group received exergame boxing, which was carried out 3 times per week for 8 weeks. Participants in both groups are required to take part in conventional exercises programmed by Nursing Home 5x/week for ±15 minutes. The outputs were assessed at the beginning (initial value) and after 8 weeks of intervention (final value).

Results: There were significantly significant differences in the One Leg Stance (OLS) and Timed Up and Go (TUG) values in the control and treatment group (p<0.005), but the effect size was higher in the treatment group.

Conclusions: The addition of exercise boxing for 8 weeks can improve the static and dynamic balance function of elderly women as measured by OLS and TUG.

Link of Video Abstract: https://youtu.be/5DFCQHg86rU

Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. Although the survival rate of pediatric patients with ALL is currently improving, cases of relapse still occur. Minimal residual disease (MRD) status is a prognostic factor that plays an important role in recurrence of ALL patients who have been through induction therapy. Aim: To determine the survival rate in pediatric patients with ALL based on negative MRD examination is better than positive MRD at the end of therapy.

Method: A retrospective cohort study with inclusion criteria including pediatric patients aged 1 to 18 years who were diagnosed with ALL in the period of 2017-2019 at Sanglah General Hospital, Denpasar. Subject’s recruitment was initiated when the minimum number of subjects was fulfilled.

Result: From 32 research subjects, the mean age was 5.1 years, the majority obtained MRD+ results, the dominant sex was male, the average leukocyte was 28.33 thousand, most of the subjects had no mediastinal masses, and generally experienced remissions. MRD levels were found to be significantly lower in remitting patients than patients who did not achieve remission (p value <0.05). The Kaplan-Meier estimates for event-free survival on MRD status (negative versus positive) were 84.6% and 42.1% (P = 0.030).

Conclusion: There was a significant relation between MRD levels and the survival rate to achieve remission and MRD levels are significantly lower in remitting patients than patients who do not achieve remission.

Link of Video Abstract: https://youtu.be/5Q9QmV4Qmyg

Background: Regarding prevalence among females worldwide, cervical cancer ranks fourth and has a high fatality rate. Cervical cancer growth is correlated with high-risk human papillomavirus (HPV) infection. Retinoblastoma protein (pRb) is a protein that interacts with E6/E7 oncoproteins to regulate cell proliferation, differentiation, and death. Mutations on the E6/E7 protein oncogenes of high-risk HPV can disrupt this relationship. This investigation aims to establish the association between pRb expression and the HPV genotype.

Methods: This observational cross-sectional study examined 43 patients diagnosed with cervical cancer at Wahidin Sudirohusodo Hospital and its network. Samples were taken using consecutive random sampling based on established criteria. HPV genotype was examined using the polymerase chain reaction (PCR) method, while pRB expression was assessed by immunohistochemical examination. The relationship between the two variables was assessed using the Chi-Square test.

Results:  There were 5 (11.6%) patients with HPV type 16, 14 (32.6%) with HPV type 18, 12 (27.9%) with other types of HPV and 12 (27.9%) were negative for HPV. Examination of pRb expression showed that 33 (76.7%) samples had +2 expression, 7 (16.3%) had +1 expression, and 3 (7.0%) samples had no pRb expression. The pRb expression and HPV type were not significantly correlated in this study (p = 0.410). However, pRb expression and cervical cancer clinical stage were shown to be significantly correlated (p = 0.007).

Conclusion: pRb expression is more prevalent when a malignancy is more advanced. In this investigation, no association between HPV genotype and pRb expression was discovered, despite oncogene mutations being involved in the regulation mechanism of cell proliferation, differentiation, and apoptosis.

Introduction: Clinical learning is an experiential learning process in which students apply the theory obtained from academics to be applied to real cases in the clinic. Clinical facilitator support of learning, satisfaction, and stress with clinical placement aspects of support are crucial because they impact the knowledge acquired during classes and the development of practical skills to become fully competent health care professionals. This study aimed to determine the factors of clinical facilitators, satisfaction, and stress levels of nursing students in clinical learning.

Method: The design of study was cross-sectional design. The study was conducted on 141 nursing students for the 2021/2022 period who were taking clinical learning in hospitals, social institutions, and communities from the Diploma Nursing, Bachelor Nursing and Ners study programs at Universitas Nahdlatul Ulama Surabaya.

Result: The results of the partial T-test showed that the clinical facilitator variable has no significant effect on clinical learning (p=0,938); the student satisfaction variable has no significant effect on clinical learning (p=0,199); the stress variable has a significant effect on clinical learning (p=0,000).

Conclusion: The stress level of students is the most significant factor for students during their clinical practice.

Link of Video Abstract:https://youtu.be/fff-Unnud2w

Background: Human Papilloma Virus (HPV) infection is the main cause of cervical cancer, a primary malignant tumor developing from squamous epithelial cells. HPV expresses oncoproteins E6 and E7, known to inactivate tumor suppressor proteins, one of which is protein 53 (p53). A promising biomarker for diagnosing and prognosis malignancies brought on by the HPV genotype is the identification of p53. This study investigates the association between p53 expression and HPV genotype in cervical cancer patients.

Method: This observational cross-sectional study involved patients diagnosed with cervical cancer on histopathological examination who met the requirements. The polymerase chain reaction (PCR) method was used to determine the HPV genotype, and an immunohistochemistry analysis was used to assess the level of p53 expression. A Chi-Square test is utilized to evaluate the association between the two variables.

Results: Of the 49 patients, there were 7 (14.3%) patients with HPV type 16, 13 (26.5%) with HPV type 18, 14 (26.5%) other types of HPV and 15 (30.6%) negatives for HPV. Examination of p53 expression showed that 17 (34.6%) samples had <10% expression, 17 (34.6%) had 10-50% expression, and 15 (30.8%) samples had >50% expression. There was no correlation between p53 expression and HPV genotype (p = 0.071). However, an association between p53 expression and cervical cancer's clinical stage was identified (p = 0.028).

Conclusion: Increased cervical cancer stage can be associated with increased p53 expression. Thus, p53 can be used as a predictor of cervical cancer stage. However, in cervical cancer, p53 expression cannot be associated with the HPV genotype.

Introduction: Non-compliance is the cause of therapy failure, which has an impact on the worsening of the patient's condition because of complications and damage to organs. Family support plays an important role for the elderly because the family is a support system, which requires the presence of the family to assist in daily activities, for example in terms of reminding you to take medication regularly and so on. The purpose of this study was to analyze the relationship between the role of the family and the use of control cards with the level of adherence to medication in elderly patients.

Methods: This research is an analytic correlation with a cross-section approach. The population in this study was all elderly in the UPTD Puskesmas Wonokromo, with a total of 993 elderly. The number of samples studied amounted to 285 respondents. The data collection technique used non-probability sampling purposive sampling, the instrument used was a family role questionnaire, a Morisky Medication Adherence Scale (MMAS) medication adherence quasi-satire, and a drug control card sheet. Data analysis using a rank- spearman statistic test with a significant value of p < = 0.05.

Results: The results showed that of the 285 respondents, almost half (49.1%) had good family roles, most (55.4%) had routine control cards and most (55.4%) medication adherence was obedient. Based on the Spearman rank test found that the significance level < = 0.05, so there is a relationship between family roles and the use of control cards with the level of adherence to taking medication for elderly patients.

Conclusion: There is a relationship between the role of the family and the use of control cards with the level of adherence to taking medication in elderly patients.

Link of Video Abstract: https://youtu.be/zg5vubHMcDY

Introduction: Chronic pain requires a thorough assessment if it persists in patients with cancer. Depressive disorder is one of the psychosocial problems that can occur in cancer patients. Depressive disorders affect up to 34.4% of patients with cancer in Indonesia, causing increased morbidity and complicating the management of patients. Quinolinic acid (QUIN) and serotonin (5-HT) are chemicals that can affect pain perception and depressive disorders. This study aims to analyze the relationship between quinolinic acid and serotonin levels with depression and pain degree in cancer pain patients.

Methods: A cross-sectional study design was conducted at the Palliative Polyclinic of Dr. Soetomo Surabaya General Hospital, Indonesia. Patients were collected with purposive sampling. The patient's quinolinic acid and serotonin plasma were collected through blood samples and assessed using enzyme-linked immunosorbent assay (ELISA) method. Spearman's comparison test determined the correlation between quinolinic acid and serotonin levels with depression and pain degree.

Results: A total of 76 cancer patients were included in this study. The cancer types reported were pelvic cancer (23 patients, 30.3%), head and neck cancer (21 patients, 27.6%), abdominal cancer (ten patients 13.2%), breast cancer (seven patients, 9.2%), lung cancer (five patients, 6.6%), skin cancer (three patients, 3.9%), and other types of cancers (seven patients, 9.2%). As many as 24 patients (31.6%) had mild depression and only three patients (3.9%) experienced major depression. Mild pain was reported by 47 patients (61.8%) and 11 patients (14.5%) suffered from severe pain. Spearman's comparison test was conducted on quinolinic acid and serotonin levels against depression degree and pain degree, resulting in a weak correlation.

Conclusion: Quinolinic acid and serotonin levels are related to depression and pain degree in cancer pain patients (p<0.05), though with a weak correlation. However, further study is needed to confirm the findings of this study.

Link of Video Abstract: https://youtu.be/DjGx56j9LiU

Introduction: Women of reproductive age with anemia are recommended to take iron supplements and increase their intake of iron-rich food. Moringa (Moringa oleifera) leaf is a potential plant containing high iron, which is simple to find in Indonesia.

Aims: to determine the effectiveness of Moringa leaves supplementation in women of pro age.

Methods: This type of research is an experiment with experimental research with pre-post test control group design. The sample was 119 subjects collected using purposive sampling according to the inclusion criteria. The study subjects were divided into 3 treatment groups: supplementation of Ferrous sulfate tablets 30 mg per day (Group P0); 3000 mg Moringa leaf capsules three times a day (3 x 1000 mg) (Group P1); and Moringa leaf capsules at a dose of 3000 mg three times a day (3 x 1000 mg) plus 30 mg ferrous sulfate tablets once daily (Group P2) for 60 days, then hemoglobin (Hb) levels were re-evaluated.

Result: The Friedman test showed a mean Hb difference between the three measurement groups, which was statistically significant with p <0.05. The treatment group with P2 had the highest value of 4.74, followed by P1 and P0 of 4.71 and 4.65.

Conclusion: Supplementation of Moringa leaf capsules at a dose of 3000 mg for 60 days may increase Hb levels in women of reproductive age with iron deficiency anemia.

Introduction: Pulmonary Tuberculosis is an infectious disease that can cause negative stigma in the community, causing stress because of the length of the treatment period and the side effects of drugs. Therefore, alternative therapies are needed, one of which is aromatherapy relaxation. The purpose of this study was to analyze the effect of relaxing aromatherapy Lavender (Lavandula Angustifolia) and Peppermint (Mentha piperita) on Stress Reduction in Pulmonary Tuberculosis Patients

Method: The design of this study used the One group pre-post test design with a population of 31 people. Sampling technique with simple random sampling to obtain a sample of 29 people. The independent variable is lavender and peppermint aromatherapy relaxation. The dependent variable is stress reduction. The data collection technique was using the DASS questionnaire. This analysis uses the Wilcoxon Sign Rank test.

Result: Based on the Wilcoxon sign rank test, the results of sig (2-tailed) 0.000 <0.05 mean that there is a relaxing effect of Lavender (Lavandula Angustifolia) and Peppermint (Mentha piperita) aromatherapy on stress reduction.

Conclusion: Relaxation aromatherapy Lavender (Lavandula Angustifolia) and Peppermint (Mentha piperita) can be used as non-pharmacological therapy to reduce stress in patients with pulmonary TB. Nurses can use aromatherapy relaxation with a diffuser to reduce patient stress during treatment.

Introduction: The two biggest issues for post-ischemic stroke patients are disability and mortality. Patients with post-ischemic stroke have a decline in quality of life due to alterations in neurological function. Additionally, post-stroke patients require ongoing education to improve their independence in completing daily tasks. His research thus sought to examine the impact of stroke self-management on post-ischemic stroke patients' neurological function and quality of life using the framework of health behavior theory.

Methods: The sampling method utilized in the study design was successive sampling with a quasi-experimental design to choose the sample following the inclusion and exclusion criteria. 58 intervention and control groups were created from a total sample of 116 respondents. This research used the National Institute of Health Stroke Scale (NIHSS) and Stroke Specific Quality of Life Scale (SS-QoL). Statistical analysis using t-test with p<0.5.

Results: According to the findings, the mean neurological function in the intervention group before and after the intervention was 8.259, whereas the mean quality of life before and after the intervention was -20.93. In the control group, the mean neurological function was -0.179 before and after the intervention, whereas the mean quality of life was 0.069. Data analysis revealed a significant difference between health behavior therapy-based stroke self-management programs and neurological function and quality of life in post-ischemic stroke patients with p = 0.00.

Conclusion: Stroke self-management based on health behavior theory can be applied over the long term to help patients’ neurological function and quality of life.

Background: Endothelial keratoplasty (EK) is a selective lamellar corneal transplantation technique that replaces damaged endothelium while preserving the patient's corneal stroma. Donor graft preparation can be done using Descemet stripping endothelial keratoplasty (DSEK) or Descemet stripping automated endothelial keratoplasty (DSAEK). Research on EK in Indonesia is currently underreported, but it is crucial for developing strategies to treat corneal blindness in the future. This study aimed to present visual acuity, graft survival, and complications after DSEK or DSAEK at Undaan Eye Hospital Surabaya.

Methods: This study involved 17 eyes, treated with DSEK or DSAEK surgery between 2017 and 2022. Patients with other ocular diseases and incomplete medical records were excluded. Best corrected visual acuity (BCVA) was documented before the surgery, and at 1 day, 1, 3, 6 months, and 1 year after. Data in this study were analyzed using multiple techniques, including Wilcoxon, Kaplan-Meier survival, and bivariate logistic regression analysis.

Results: The postoperative mean BCVA significantly increased to 1.36 ± 0.57 logMAR (p=0.012) at 1 day, 1.02 ± 0.62 logMAR (p=0.002) at 1 month, 0.94 ± 0.66 logMAR (p=0.002) at 3 months, 0.72 ± 0.66 logMAR at 6 months (p=0.000), and 0.74 ± 0.74 logMAR (p=0.001) at 1-year compared to preoperative BCVA of 1.84 ± 0.39 logMAR. The graft could survive 100% within 1 day to 6 months and 76% within 1 year after surgery. Bivariate logistic regression showed donor origin had a statistically significant effect with p-value = 0.031 and odds ratio = 1.8, 95% confidence interval (CI) = 1.003 - 3.229. Corneal edema was the most common complication in the early and late postoperative periods.

Conclusion: DSEK or DSAEK surgery is safe, effective, and viable. It shows good visual outcomes and becomes the most used EK treatment for corneal endothelial dysfunction.

Background: Educational science is a reciprocal adjustment process between humans and humans and nature as a regular development and improvement of all moral, intellectual, and physical potentials. In the learning process in the clinical laboratory, lecturers only use textbooks or observation sheets and do not get videos and modules as media in the learning process in the clinical laboratory about nursing skills. Students can choose learning styles through video media and modules to understand nursing materials and skills. This study aims to identify the effectiveness of implementing the clinical skills learning process in the laboratory for nursing students during the COVID-19 pandemic with video media and modules at Universitas Nahdlatul Ulama Surabaya (UNUSA).

Methods: This research is a descriptive quantitative study. The selected population is laboratory practicum educators of UNUSA diploma nursing students during the year 2021. The sample was randomly selected, and 60 diploma Nursing students who had used learning media with videos and skill modules made by teaching lecturers during the COVID-19 pandemic were selected. The instrument is designed as a questionnaire regarding various student opinions on online learning with video media and clinical skills modules during the COVID-19 pandemic. Data were collected using a questionnaire and analyzed by t-test and multiple linear regression.

Results: The results showed that there was an effect of video learning media on the learning outcomes of skills in the laboratory for diploma nursing students (b=6.64; p=0.023), and there was no effect of learning styles on the learning outcomes of infusion skills (b=6.38; p= 0.111) from the results of multiple linear regression analysis, there is an effect of using video learning media and student learning styles on nursing skills learning outcomes in the laboratory, the effect is statistically significant (b=6.64; p=0.041).

Conclusion: This research concludes that using video learning media and modules is very effective in the learning process in clinical laboratories' nursing skills. Therefore, it is recommended that all lecturers make video media and modules about nursing skills per the Standard Operating Procedures from Persatuan Perawat Nasional Indonesia (PPNI) to facilitate the learning process in the laboratory and clinic.

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

Introduction: Sentul fruit peel extract (Sandoricum koetjape) has the ability to bacterium Streptococcus mutans and Staphylococcus aureus after administration of Sentul fruit peel extract gel on gingivitis model white Wistar rats. Utilization of extracts from the skin of sentul fruit (Sandoricum koetjape) as well as the proper use of natural sources will have an impact on the prevention and healing of gingivitis. The study aimed to determine the decrease in the number of Streptococcus mutans and Staphylococcus aureus bacteria colonies after administration of nano gel of sentul fruit peel extract in the gingivitis model of white Wistar rats.

Method: study design with experimental animal models. The data obtained by the One-Way ANOVA test and if the effect is significant continue with Duncan's test at the 5% level.

Result: There was a decrease in the number of Streptococcus mutans and Staphylococcus Aureus bacteria colonies after administration of Sentul fruit peel extract gel in the gingivitis model of white Wistar Rats. The best gel concentration was Sentul peel extract gel 2.4% with the smallest number of bacterial colonies, Staphylococcus aureus colonies of 2.2 x 10² ± 1.9 x 10¹ colony forming unit (cfu) and the number of Streptococcus mutans colonies of 2.6 x 10² ± 1.2 x 10¹ CFU.

Conclusion: Sentul fruit peel extract 2.4% effectively inhibits the growth of Streptococcus mutans and Staphylococcus Aureus in white Wistar rat models with gingivitis.

Introduction: Healthcare monitoring is a part of medical treatment. This research aims to increase the interoperability of the healthcare monitoring process. So that user does not need to go to the hospital and check their condition with the doctor directly.

Methods: This was a qualitative study. The sample was doctors, inpatients, and outpatients. We proposed a concept of Internet of Things platform architecture that could monitor and record patient health. The features we provided are monitoring, immutable data recording using NoSQL database and blockchain by implementing Change Data Capture, and data analytics.

Result: In this research, we proposed the Matter protocol for data communication. Matter protocol opens the possibility of increasing Internet of Things interoperability. On the other hand, implementation of blockchain could increase the security in the data at rest step, we also increase traceability by implementing Change Data Capture in the NoSQL database and store all data to the blockchain.

Conclusion: Our proposed conceptual system could be used for building healthcare monitoring using an Internet of Things system that needs high interoperability and low energy consumption. The outpatient activity could be monitored in their own house or anywhere, and the patient does not need to go to the hospital to check their health.

Introduction - The family as the smallest unit of society is a social institution that has and functions at every stage of development. During the pandemic, all needs are shifted to online from offline activities, so our interaction with smartphones or laptop screens is increasing. This study aims to arrange the invention of a new method of family nursing care standards with a Supportive Educative System based on integrating Family Centered Care and family tasks towards family support in adolescents with Smartphone addiction.

Method - The study used quantitative design with Quasy Experiments. The sample taken was 24 respondents who were divided into two groups. Data analysis using the Paired t-test it shows that in the treatment group the results of the p value (0.002) < (0.05), meaning that there is a difference between family support before and after being given treatment, namely an increase in the average value of 95 to 97.08. While in the control group the statistical.

Result - The results of the p value (0.028) < (0.05), meaning that there is a difference between family support before and after being given treatment, namely an increase in the average value of 94, 75 becomes 96.

Conclusion - There is change to the treatment of inventions new methods of standardized family nursing care with a Supportive Educative System based on the integration of Family Centered Care and family duties towards family support in adolescents with Smartphone education to families is expected to be the basis for members to support each other in Addiction.

Introduction: Hyperbaric oxygen therapy causes ear pain as a side effect, causing anxiety in patients which results in the length of recovery. The purpose of this study was to analyze the factors that influence the level of anxiety of patients undergoing hyperbaric oxygen therapy.

Method: This study used a cross-sectional design. The sampling technique used was consecutive sampling with a total sample of 26 respondents. The independent variables in this study were age, gender, education, information, income/income, and experience, and the dependent variable measured anxiety levels. The research instrument used a questionnaire. The data were tested using the Logistics Regression Test.

Results: The results of the Logistics Regression Test showed that the factors of gender (p-value = 0.001), information (p-value = 0.005), and experience (p-value = 0.000) affected the anxiety of patients undergoing hyperbaric oxygen therapy, while the age factor (p-value = 0.924) and education (p-value) =0.201), did not affect the anxiety of patients undergoing hyperbaric oxygen therapy.anxiety

Conclusion: Economic factors cannot be analyzed in this study because all respondents have incomes above or equal to the regional-standard wage. The dominant factor influencing anxiety is experience. Officers are expected to always apply therapeutic communication by providing explanations about hyperbaric oxygen therapy that will be given to reduce patient anxiety.

Background: Sedentary behavior is a common risk factor for mechanical chronic low back pain. Functional capacity and serum vitamin D levels are associated with low back pain intensity. The aim to analyze the effect of aerobic exercise walking on maximal oxygen consumption and serum vitamin D levels in patients with mechanical chronic low back pain.

Method: true experimental with pre and post-test randomized control group design. Each group consisted of 16 respondents. The treatment group received additional aerobic exercise walking 3x/week, intensity 40-50% HRR (weeks 1-3), 50-60% HRR (weeks 4-6) and 60-80% HRR (weeks 7-8), 30 minutes per session for 8 weeks. The control group only received conventional training 3x/week for 8 weeks. The parameters evaluated were VO₂ max and 25(OH)D. Measurements were taken before and after 8 weeks of intervention.

Results: The VO₂ max values of both groups increased with a significant difference after the intervention (p < 0.001) and there was a difference in the difference (p < 0.001). 25(OH)D levels in both groups increased with no significant difference after the intervention (p = 0.720) and no significant difference in the difference after the intervention (p = 0.662)

Conclusion: There is a difference in the addition of walking aerobic exercise to conventional exercise compared to conventional exercise alone on maximal oxygen consumption, but there is no difference on serum vitamin D levels in mechanical chronic low back pain patients.

Link of Video Abstract: https://youtu.be/Cgi15seZAw4

A growing evidence links periodontitis, a chronic inflammatory disease of the oral cavity, to the development of systemic inflammation. One of the most commonly reported is pneumonia, arising from aspiration of the periodontal pathogens into the lung tissue. In high-risk individuals, the morbidity and mortality rate is high, raising the concern for prevention measures. Secondary systemic effects are proposed to arise from both direct periodontal pathogens spread and through leakage of bacterial byproducts and local inflammatory cytokines to the bloodstream. The association of periodontitis and systemic diseases is bi-directional, as systemic diseases may, in turn, increase the incidence and severity of periodontal diseases. Here, the conflicting roles of the immune system in both limiting pathogen growth and its potential catastrophic inflammatory activation is further discussed. In addition, possible approaches to prevent periodontitis from spreading into the respiratory organs are also proposed. Given the large number of the population affected by periodontitis, a comprehensive understanding of the pathomechanisms of the development of systemic diseases, notably pneumonia, as well as the discovery of prevention and therapeutic approaches, is urgently needed.

Link of Video Abstract: https://youtu.be/bL0NSpeda_k

The platelet-rich fibrin (PRF) membrane represents a new reconstructive material employed in ocular surface procedures. Platelet-rich fibrin (PRF) offers several notable benefits, including its potential to mitigate inflammation, its abundance of growth factors, and its capacity to serve as a transient framework for fibroblast migration. Nevertheless, despite the numerous benefits it offers, PRF is not extensively utilized in comparison to alternative methods like conjunctival autograft. The utilization of conjunctival autograft has been a longstanding approach in ocular surface reconstruction methodologies; however, it is not without its inherent limitations. Therefore, the utilization of the PRF membrane technique presents a viable solution for addressing this particular scenario. This literature review aims to present a comprehensive analysis of the role of PRF in the regulation of inflammation and its potential to facilitate the healing of conjunctival wounds. This review is expected to stimulate further experimental investigations into the influence of α-SMA and collagen type III expression on the efficacy of PRF membranes in promoting conjunctival wound healing.

Oxygen supplementation is potentially harmful in patients with acute coronary syndrome as it may lead to hyperoxia-induced coronary vasoconstriction. This phenomenon may deteriorate the already poor coronary perfusion. The exact physiology mechanisms of how hyperoxia causes vasoconstriction are still not fully elucidated. Some hypotheses were proposed, among others: 1) reduced nitric oxide (NO) bioavailability due to increased reactive oxygen species (ROS) generation; 2) hyperoxia-induced ATP-sensitive potassium channel closure; 3) activation of smooth muscles’ oxygen-sensitive calcium channel; 4) increased endothelin-1 release; and 5) increased production of 20-hydroxyeicosatetraenoic acid (20-HETE). A decent understanding of this phenomenon will aid in more awareness and better clinical management.

Link of Video Abstract: https://youtu.be/XIJo_o_yeV0

Background: Obesity is defined as being 20% ​​or more above ideal body weight (IBW). Obesity is a major problem in children and adolescents, affecting 30% or more. It led to many changes and limited their ability to be physically active. Obese children often suffer from musculoskeletal pain, decreased physical function, and a sense of well-being. This might cause poor motor competency and also developmental alteration.

Case Presentation: A 14-year-old boy was referred to the Pediatric Department following complaints of excruciating pain in his lower leg. Under anthropometry examination, the patient was diagnosed with obesity with 115 kg at presentation. The patient was then treated and managed by changing their inactive lifestyle and increasing daily activities; also referred to a psychologist to help with psychological well-being and behavior change. Family and friends are involved during treatment. After four months of treatment, his body weight dropped from 115 kg to 98 kg to 73 kg in the next 2 years.

Conclusion: Success obesity management needs multidisciplinary involvement, which includes a pediatrician, nutritionist, psychologist, and also the patient's family

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

Background: Anterior capsular contraction syndrome (ACCS) is a disorder in which the anterior capsulectomy opening shrinks excessively. One of the many factors that have been discovered to aggravate the problem is a lack of zonular support for the lens capsule. The prognosis for non-progression of contractions after Nd:YAG anterior capsulotomy is quite excellent. This study aims to present a complete resolution of the hyperopic shift in an anterior capsular contraction syndrome (ACCS), a rare complication of cataract surgery.

Case Illustration: This case report presented a 63-year-old female who developed ACCS in the right eye two years after uncomplicated cataract surgery and intraocular lens implantation. A moderate hyperopic shift of +3.00 D was noted in the affected eye at the initial presentation. Slit-lamp examination revealed an anterior capsule opacification and anterior capsular contraction with fibrosis surrounding the capsulorhexis opening. Ocular and systemic past medical history was unremarkable, and no known risk factors associated with contraction syndrome were found. Nd:YAG laser capsulotomy with six relaxing incisions was performed to release the anterior capsular contraction. Two weeks following capsulotomy, the patient’s visual acuity remarkably improved to LogMAR 0.00 without correction. The hyperopia was completely resolved, and a decrease in anterior chamber depth compared to pre-capsulotomy measurement was noted. ACCS is a possible complication following capsulorrhexis performed in uneventful cataract surgery, which may occur in patients with no known ocular or systemic risk factors. ACCS is commonly asymptomatic, and hyperopic shift is a rare manifestation of ACCS. The backward shift of the intraocular lens (IOL) induces hyperopia due to the anterior capsule contraction. The preferred treatment for ACCS is relaxing incisions using Nd:YAG laser capsulotomy.

Conclusion: Hyperopic shift in ACCS is a rare complication of cataract surgery. However, prompt treatment of contraction release with Nd:YAG laser capsulotomy effectively restored visual function.

Introduction: Patients with multiple brain abscesses and a secondary diagnosis of tetralogy of fallot (TOF) rarely occur fatal complications. Brain abscess is a very uncommon but potentially fatal infection of the brain parenchyma that can affect 5%-18.7% of the CHD population. The degree of right-to-left shunt is responsible for brain tissue hypoxia, which can lead to cerebral infarction, which is a precursor to cerebral abscess. Therefore, this study aimed to report on a patient with several brain abscesses and TOF.

Case description: A 30-year-old cyanotic male with a chief complaint of gradually decreased consciousness since 2 weeks ago without a history of vomiting. The patient has a clubbing finger. The patient has a TOF history without a prior infection, such as toothache, ear discharge, paranasal infection, cough, or flu. Physical examination revealed the Glasgow Coma Scale of E4VxM6 (global aphasia), right hemiparesis, increased physiological reflexes and positive pathological reflexes in the right of the body. Laboratory results showed slight leucocytosis and hyponatremia and elevated CRP. Head MRI spectroscopy was performed 3 days later, revealing multiple brain abscesses. The patient was given therapy antibiotics, namely ceftriaxone injection and metronidazole injection intravenously.

Conclusion: A brain abscess should be suspected in patients with TOF who arrive with a fever and an acute neurological condition. Besides antibiotics, patients should be encouraged to have corrective surgery as soon as possible to avoid future deadly consequences.

Background: The majority of dementia patients exhibit behavior and psychological symptoms of dementia (BPSD). It is extremely painful for both patients and caregivers. Following the COVID-19 epidemic, it is necessary to strike a balance between social distance and isolation, because the loneliness created by quarantine can have harmful psychological implications, particularly for the elderly. BPSD patients and carers require greater health services in the setting of a pandemic. Telemedicine has the potential to lessen the likelihood of unfavorable outcomes in mental health treatment. We hope to highlight how BPSD does not worsen in patients during the pandemic and how telemedicine can be a significant option in the current scenario in this post.

Case illustration: The older woman aged 76 years, came to the psychiatric polyclinic at RSUD Dr. Soetomo with complaints that he often forgets for 2 years, counting money over and over again, and is angry if not given money, but if given money the patient will distribute it to neighbors, and some will be spent. Patients often talk slurred, talk to themselves, talk dirty, and do violence, such as hitting and throwing things. During the COVID-19 pandemic, the family did not bring patients for control to the hospital. The family came to Poly to collect medicine. When the family arrived, the doctor communicated with the patient via video call.

Conclusion: The use of telemedicine allows patients and caregivers to get access to mental health services easily.

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

Background: Leprosy is a chronic disease caused by Mycobacterium leprae. This disease can be diagnosed if one of the four criteria is met. Histopathological examination can vary depending on the spectrum of the disease. The following describes two cases of borderline-type leprosy that aimed to increase understanding of the diagnosis and management of leprosy, especially the borderline type.

Cases: Both cases had complaints of numb spots on the body. The first case had more lesions than the second one with borderline-borderline histopathological examination results, while the second one had borderline lepromatous histopathological examination results. Both patients received the same therapy (multidrug therapy for multibacillary leprosy). During observation, there were no drug side effects that the patient could not tolerate. The prognosis in both cases is dubia, depending on the patient's adherence to treatment. 

Conclusion: The diversity of clinical and histopathological features can occur, including cases of leprosy. Early diagnosis and prompt treatment should be started as possible to prevent disabilities. 

Background: Ophthalmic manifestations, like uveitis, might be one of the complications of spondyloarthritis. Many individuals experiencing acute uveitis are unaware that spondyloarthritis has already been present. The late diagnosis and treatment of uveitis can result in permanent vision impairment. This case report presents the diagnosis and management by a rheumatologist and ophthalmologist of a spondyloarthritis patient with complicated uveitis.

Case: On October 27, 2021, a 42-year-old male patient came to the rheumatology outpatient clinic of Dr. Soetomo General Hospital, Surabaya, Indonesia with intermittent low back pain for the past fourteen years, which worsened in the last eight months. The pain was accompanied by morning stiffness for about an hour after getting-up every day, gradually relieved by stretching. The lumbosacral x-ray revealed bilateral sacroiliitis. The patient also came to the ophthalmology outpatient clinic with sudden left eye pain and gradually blurred vision for the past two years. He was diagnosed with spondyloarthritis with bilateral uveitis, secondary glaucoma, and secondary cataract on both eyes. He was given methotrexate, sulfasalazine, sodium diclofenac, topical timolol 0.5%, topical atropine, acetazolamide, and methylprednisolone. The low back pain and impaired vision were improved after three months of treatment.

Conclusion: Uveitis should be suspected as a relatively common complication of spondyloarthritis. Early diagnosis and treatment of this uveitis might prevent permanent damage.

Link of Video Abstract: https://youtu.be/bx7KdiTKiOQ

Introduction: Gestational trophoblastic neoplasia (GTN) comprises a series of malignancies characterized by abnormal proliferation of fetal trophoblastic tissue. GTN lesions refer to a class of malignant lesions that have distinct histopathologic features, including invasive hydatidiform moles, choriocarcinomas, placental site trophoblastic tumors (PSTT), and epithelioid trophoblastic tumor (ETT). Most often, they occur coexist separately, but there are also cases of mixed GTN with a combination of histologic PSTT, ETT, or choriocarcinoma. PSTT is a rare form of gestational trophoblastic disease (GTD). The percent incidence of this disease is 0.23% of total GTD and 1-2% of total GTN. The incidence rate of choriocarcinoma is also limited. Data collection on the incidence of mixed GTN has been more challenging due to the rarity of this disease.

Case Description: We report a case of a 26-year-old female patient with choriocarcinoma and PSTT. The patient’s beta-human chorionic gonadotropin (β-hCG) levels remained elevated despite treatment with single-agent chemotherapeutic regimen. She underwent a series of chemotherapy treatments and two surgeries were required. The histological examination of the uterine tumor revealed a choriocarcinoma whilst the hysterectomy thereafter showed a PSTT. After the hysterectomy the β-hCG level continued to rise. Due to chemotherapy resistance, EMACO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) was changed to EP-EMA (Etoposide, cisplatin, etoposide, methotrexate, actinomycin-D). After two administrations of EP-EMA, β-hCG levels normalized.

Conclusion:  This is a rare case of mixed GTN of choriocarcinoma and PSTT. Mixed GTN should be considered when chemotherapy is not effective in the treatment of GTN. These cases need to be reported to improve the diagnosis and management of patients.

Background: Lipodystrophy (LD) syndromes are a diverse group of ultra-rare diseases characterized by adipose tissue deficiency, resulting in potentially severe metabolic disturbances. Due to their scarcity, diagnosis and management are often challenging for clinicians. This study aimed to report a rare case of LD syndromes, as well their diagnosis and possible management.

Case Presentation: A 27-year-old female presented to Dr. Soetomo General Academic Hospital, Surabaya, Indonesia with a chief complaint of abdominal (epigastric) pain, accompanied by diarrhea, nausea, and vomiting. The patient had a history of uncontrolled type-2 diabetes mellitus (T2DM), dyslipidemia, severe hypertriglyceridemia (HTG), diabetic retinopathy, and glaucoma. Physical examination indicated subcutaneous fat loss, especially from the extremities, and excessive fat accumulation in the face. Hepatosplenomegaly and ascites were detected, further confirmed through abdominal ultrasonography (USG). Laboratory investigations revealed hyperglycemia, dyslipidemia, severe HTG, and renal dysfunction. All of the assessment findings led to the diagnosis of LD syndrome with familial partial lipodystrophy 2 (FPLD2) (Dunnigan syndromes). Therapies included insulin injections and pioglitazone for the treatment of hyperglycemia, simvastatin and fenofibrate to reduce HTG, and some symptomatic drugs to reduce symptoms of the disease. Lifestyle modification (diet and exercise) was recommended to ameliorate metabolic derangements.

Conclusion: There is currently no cure for LD syndrome. Treatment modalities are limited to preventing or reducing severe comorbidities of these syndromes. Increasing knowledge and awareness of the symptoms indicative of LD at an early onset is important.