The potential effect of intradermal Botulinum Toxin Type-A (BTA) injection to increase extended random skin flap survival

Background: Extended random skin flap failure often occurs due to insufficient vascularization. Several attempts have been tried to increase the viability of the flap, but none of these attempts have achieved maximal success. Previous research has shown that Botulinum toxin type A (BTA) increases the viability of cutaneous flaps by inhibiting muscle contraction along with increasing vasodilation and angiogenesis. This study examines the effect of intradermal BTA injection on extended random skin flaps viability.

Methods: In thirty-six Wistar rats, a rectangular random cutaneous flap (6 cm × 1.5 cm) was made on each dorsal rat area and then elevated the flap. The treatment group was intradermally injected evenly with BTA 8 IU and saline solution for the control group. Each rat flap viability was observed after five days. Primary outcome measures are survival flap area using Visitrak, microscopic assessment of the number and diameter of capillaries and Vascular Endothelial Growth Factor (VEGF) expression was analyzed using immunohistochemistry semi-quantitative scoring system. Data were analyzed using SPSS version 21 for Windows.

Results: The treatment group has better results in all observed parameters than the control group. However, Only the VEGF expression of proximal edge showed a statistically significant increase in the group treated with BTA injection (p=0.004).

Conclusion: This study showed that the BTA treatment has a positive effect on random skin flap survival and the reduction of distal necrosis in rats, so it has been proven that BTA has the potential to increase flap survival rates in small animal models. Further studies are needed to determine whether BTA treatment can produce similar findings in humans.

The effect of ACTH4-10Pro8-Gly9-Pro10 on neurotrophin-3 expression in Sprague Dawley rat on acute spinal cord injury

Background: Neurotrophic factors such as NT-3 play an important role in spinal cord regeneration, contributing to spinal cord regeneration assisting functional improvement in SCI. ACTH4-10Pro⁸-Gly⁹-Pro¹⁰, an analog of the N-terminal fragment (4-10) adrenocorticotropic hormone, is one of the neuroprotective compounds that can increase NT-3 levels in brain ischemia. Therefore, we conducted a study with experimental animals to determine the effect of NT-3 expression on ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ administration in acute compression SCI.

Method: We used Sprague Dawley rats with acute compression SCI model using 20 gr and 35 gr aneurysm clips. ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ was administered intranasally to the treatment group, and 0.9% NaCl was administered intranasally to the positive control group. Both of the groups then terminated at 3 and 6 hours.

Results: In rats with mild SCI that were given ACTH4-10Pro⁸-Gly⁹-Pro¹⁰, the NT -3 expression after 3 hours and 6 hours was 14 (12-17) and 10 (7-13). In rats with severe SCI given ACTH4-10Pro⁸-Gly⁹-Pro¹⁰, the NT-3 expression after 3 hours and 6 hours was 9 (6-11) and 8 (7-10). Intranasal administration of ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ showed higher NT-3 expression than the group with 0.9% NaCl in mild and severe SCI.

Conclusion: Intranasal administration of ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ can increase NT-3 expression in mild and severe acute SCI at 3 and 6 hours. Expression of NT-3 in the group with ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ mild acute SCI was higher than in the group with severe acute SCI. Further research needs to be done to determine the neuroregeneration effect of ACTH4-10Pro⁸-Gly⁹-Pro¹⁰ on SCI.

Retrospective Study on Very Early Relapse of Childhood Acute Lymphoblastic Leukemia at a Reference Centre in Indonesia

Introduction: The cure rate of Acute Lymphoblastic Leukemia (ALL) in low and middle-income countries is still low. Many factors contribute to relapses event, thus leading to failure of the treatment outcome. However, there are limited studies regarding the relapse of childhood cancer in Indonesia. This study determined demography, clinical, and characteristic laboratory differentiation between relapse and non-relapse in the bone marrow childhood ALL group.

Methods: This was a retrospective descriptive study in children newly diagnosed with ALL ages 0-18 who completed the induction phase using the 2013 treatment protocol during the 2018 period in Pediatrics Hematology-Oncology Unit at a reference center hospital in Indonesia. Of 78 data collected from the Indonesian Pediatric Cancer Registry (IP-CAR) and Hospital Information System after excluding abandoned treatment or death during treatment, only 35 patients completed the overall therapy. We evaluated bone marrow relapse and classified it into 'very early' relapse that occurs at least 18 months from diagnosis, 'early' relapse between 18 and 36 months, and more than 36 months is called 'late' relapse. Chi-square test was used to elaborate association between relapse and sex, leukocyte count, morphological classification, risk stratification, nutritional status. Kruskal Wallis tests were used to elaborate on the association between relapse, age, and induction duration. P value<0.05 was considered statistically significant.

Results: Among 35 patients in this study, seven patients experienced bone marrow relapse. Relapses were dominant in four male patients, four patients aged from 1-10 years old, six patients with leukocytes count below 50.000/mm³, six normal nutritional status patients, and six patients classified as L2 patients. All relapse events occurred in a very early stage. Four patients are classified as standard risk, and three patients are high risk. There were no significant differences among characteristics of the relapse and non-relapse groups.

Conclusions: The observed relapse onset is less than 18 months from diagnosis (very early relapse) during maintenance treatment. However, we found no significant demography, clinical, and laboratory differentiation between relapse and non-relapse groups.

Identification of PST 10 bacterial isolate with ?-hemolysis characteristic isolated from pig's tonsil

Background: Pig's tonsil is one of the entry points and habitat of commensal microbes and pathogenic bacteria, both Gram-positive and Gram-negative bacteria. Recently, a human meningitis outbreak has reported at Sibang Kaja, Badung-Bali. The cause of this outbreak has been suspected due to the consumption of pig-derived foods. The outbreak was known to be caused by Gram-positive ?-hemolytic bacteria. Based on this fact, PST 10 bacterial isolate with similar characteristics to the outbreak caused interesting identification.

Method: PST 10 isolate was cultivated in a specific medium 5% defibrinated sheep blood agar plate. Subsequently, Gram staining, catalase, oxidase, salt tolerance (6% NaCl), and hemolysis test. This presumptive isolation was then conventionally identified by KIT API 20 STREP and molecularly using the 16S rRNA gene.

Results: PST 10 isolate was identified as Enterococcus faecium using KIT API 20 STREP. Furthermore, the 16S rRNA gene sequencing analysis shows that the isolate has 99.6% similarities with Enterococcus faecalis (MG543832). The isolate shares the same clade in the phylogenetic tree analysis with a 100% bootstrap value.

The variability of temperature, rainfall, humidity and prevalance of dengue fever in Manado City

Background: Dengue hemorrhagic fever (DHF) was one of infectious diseases that is still a concern in Indonesia, especially the Manado city. This study aimed to analyze the variability of temperature, rainfall, humidity, and the incidence of DHF in Manado city 2011-2020.

Method: This ecological research used secondary data obtained from the Health Office and the Central Bureau of Statistics of the Manado City. The variables studied were air temperature, humidity, rainfall and the incidence of DHF in Manado city 2011-2020.

Result: in 2016 there were 567 cases of dengue fever and the highest was in the Malalayang sub-district and the lowest was in the Ranomut sub-district. In 2017 there was a significant decrease to 139 cases, the highest in Malalayang sub-district with 32 cases, and the lowest in Bunaken sub-district with 1 case. In 2018, there was an increase in cases by 294 cases, the highest was in the Malalayang sub-district. The air temperature continues to fluctuate where based on the trendline it is found that the air temperature tends to increase. Whereas, the humidity tends to decrease. The rainfall in the city of Manado continues to fluctuate, where based on the trendline it is found that rainfall tends to decrease. Mosquitoes are cold-blooded animals and their metabolic processes or life cycles depend on the environment's temperature. The DHF cases continue to fluctuate (up and down) where based on the trendline it is found that DHF cases tend to decrease

Conclusion: In the period 2011-2020 in Manado City, air temperature tends to increase but rainfall, humidity, and cases of DHF tend to decrease.

Characteristic of testicular torsion and predictors of testicular salvage: A retrospective study

Background: Testicular torsion is one of the urological emergencies that require immediate scrotum exploration. Characteristics of testicular torsion patients, variated time exploration, and the findings of the degree of testicular torsion at the time of exploration can affect the outcome of the testicles. The study aimed to determine the characteristics of testicular torsion diagnosed patients and identify the predictors of testicular salvage.

Method: The method used in the study was cohort retrospective with inclusion and exclusion criteria. Receiver operator characteristics analysis is performed to determine the probability of orchidectomy based on time to exploration and degrees of twist. Multivariate logistic regression tests are performed to identify the factors that cause the testicles to be retained. P<0.05 was significant.

Results: There are 45 patients mostly diagnosed with testicular torsion aged between 12 to 16 years (64.40%). Left testicular torsion was more frequent than the right torsion (82.20%). The etiology of torsion was mostly idiopathic (77.80%). Orchidopexy procedure was performed on 12 testicular torsion patients (26.70%); on follow-up, one patient was found to have testicular atrophy. The time to explore cut-off value 8.5 hours and the 450 degrees of twisting will cause the testis to not survive with the specificity of 83% and 92% and sensitivity of 81% and 82%, respectively. Multivariate analysis shows time to explore and degree of twisting associated with orchidectomy of the affected testis (p<0.05).

Conclusion: Patients are relatively young. Not all patients with testicular torsion will manifest typical symptoms of acute, atypical symptoms such as lower abdominal pain, which can be identified as testicular torsion. Mostly affected left testicle. Orchidectomy is the most commonly performed operation on patients. The outcome of testicular torsion can be predicted by observing the time to exploration factor and the degree of testicular torsion in the patient.

Aqueous Humour Malondialdehyde Level as Oxidative Stress Marker In Types Of Glaucoma

Background: Angle-closure glaucoma is the most common type of glaucoma in Asia, leading worse damage due to its oxidative stress. Another type is  open angle glaucoma in second line. The oxidative stress level can be known by malondialdehyde level examination. The study about MDA levels in aqueous humour in primary angle-closure and open angel glaucoma has not been done before.

Objective: To determine the difference of malondialdehyde levels in aqueous humour between primary open-angle glaucoma and primary angle-closure glaucoma.

Methods: This study was an analytical observational study. Nine subjects were primary open-angle glaucoma patients and ten subjects were primary angle-closure glaucoma patients. The aqueous humour was aspirated from the anterior chamber during trabeculectomy and measured the MDA levels using a spectrophotometer. Data were analyzed by Mann Whitney test.

Results: There was no significant difference (p=0.095) of MDA levels in aqueous humour between primary open-angle glaucoma (62.913±17.259 ?mol/L) and primary angle-closure glaucoma (53.485±9.670 ?mol/L).

Conclusion: The oxidative stress level in primary open-angle glaucoma and primary angle-closure glaucoma are the same, indicate that inflammation status of both condition have been similar.

TNF-a serum Level between SARS-CoV-2 Infected Pregnant women with normal pregnant women in RSUD Dr. Soetomo Surabaya

Introduction: Pregnant women infected with SARS-CoV-2 experienced increased pro-inflammatory cytokines, including TNF-a, resulting in a cytokine storm condition. This study compares TNF-a levels between pregnant women infected and not infected with Covid-19 in the 3rd trimester.

Methods: This observational research was conducted with cross sectional design. Our study included pregnant women who came to delivery room/inpatient at RSUD Dr. Soetomo Surabaya before or during the labor period between May and June in 2021. The inclusion criteria were 3rd trimester gestational age or > 28 weeks with SARS-RT-PCR nasopharyngeal swab result. The exclusion criteria were all significant pregnancy complications. The pregnant woman coming to the delivery room will be screened for COVID-19, and blood samples will be examined using the flow cytometry method for the cytokine Th1: TNF-?.

Results: There were no significant differences in TNF-a levels in pregnant women who were infected and not infected with COVID-19 (median 3.42 (7.24) pg/ml vs. 2.70 (3.06) pg/ml. p=0.138). There were also no significant differences in TNF-a levels in pregnant women with symptomatic vs. asymptomatic COVID infection (3.21(3.97) vs. 2.41(2.71) pg/ml; p=0.314).

Conclusion: This study revealed no significant difference in TNF-a serum level between SARS-CoV-2 infected pregnant women with normal pregnant women. 

Application of Moringa Oleifera leaves extract cream inhibits paw edema in white male Wistar rat (Rattus norvegicus) induced by carrageenan 1%

Introduction: Inflammation is the body's response to body tissue injury characterized by swelling or edema. Moringa oleifera is known to have many benefits as herbal medicine. Moringa oleifera leaves have been shown to have anti-inflammatory activity. The polyphenol content in Moringa leaves, such as flavonoids and tannins, has been observed as a potential anti-inflammatory.

Methods: Thirty white male Wistar rats were randomly divided into five groups. Group 0 (negative control group) was given base cream, group 1 (positive control) was given 2.5% hydrocortisone cream, group 2 was given 10% moringa leaves extract cream, group 3 was given 12% moringa leaves extract cream, and group 4 was given 14% moringa leaves extract cream. One hour after treatment was applied in the plantar area, all mice were induced with 0.1 ml of 1% carrageenan. The thickness of the rat paw edema was measured every 1 hour for 6 hours using a caliper.

Results: This study showed a significant difference in rat paw edema between the base cream and the entire treatment groups (p<0.05). There was no significant difference between the 2.5% hydrocortisone cream group and the 10%, 12%, and 14% moringa leaves extract cream group (p>0.05). The 14% cream extract had the largest paw edema inhibition among other moringa leaves extract creams which were 27.4%.

Factors predicting clinical outcome during hospitalization after pericardiocentesis in Sanglah General Hospital, Bali, Indonesia

Background: Even though pericardiocentesis is a routine life-saving procedure for massive pericardial effusion, there is scarce data regarding risk factors predicting the outcome in patients undergoing pericardiocentesis. This study aimed to investigate the role of various clinical, demographic, and laboratory risk factors as a predictor of in-hospital mortality and Major Adverse Cardiac Events (MACE) in patients undergoing pericardiocentesis at Sanglah General Hospital, Bali, Indonesia.

Methods: Prospective cohort study with consecutive sampling was conducted in patients undergoing pericardiocentesis in Sanglah General Hospital, Bali, Indonesia, from May 2017 until September 2021. Risk factors and blood samples were observed and measured at the first admission. MACE and in-hospital mortality were observed during hospitalization. Data were analyzed using SPSS version 23 for Windows.

Results: Twenty-seven patients were involved in this study. Malignant etiology was associated with increased risk of in-hospital mortality with HR 13.459 (95%CI: 1.378-131.49). Respiratory Failure during admission was associated with increased risk of mortality with HR 5.99 (95% CI: 1.355-26.55) and increased risk of persistent pericardial effusion HR 5.72 (95% CI: 1.570-20.800).

Exploring the role of the combination of propolis and vitamin D3 on VCAM-1 and Caspase-3 expression in preventing atherosclerosis in chronic kidney disease rats

Background: Increased blood pressure that occurs in chronic kidney disease (CKD) is influenced by the occurrence of thickening of blood vessels. This study evaluates the utilization of propolis which acts as an anti-inflammatory and vitamin D3 which plays a role in calcium-phosphate metabolism, that when combined are expected to prevent atherosclerosis.

Methods: This experimental research used a post-test only group design with a total of 24 male rats divided into 3 groups. Subjects were induced to develop CKD with unilateral ureteral obstruction. A combination of 50mg/kgBW of propolis and 0.126mcg/kgBW of vitamin D3 was given orally every morning in the intervention group. Hemodynamics and atherosclerosis status were observed using sonography until week 4. Inflammatory markers with vascular cell adhesion molecule 1 (VCAM-1) and Caspase-3 were evaluated weekly via plasma and target organ samples were immunohistochemically examined at the study’s end.

Results: Propolis and vitamin D3 significantly reduced blood pressure from 156 mmHg at the beginning of the study to 117mmHg at week 4 (p=0.000). Thickening of the aorta occurred in the control and intervention groups but the thickening in the control group (0.90mm) was statistically significantly (p=0.000) higher than the intervention group (0.30mm). There were decreased VCAM-1 and Caspase-3 levels in the intervention group compared to the control group, both in plasma and target organ levels

Conclusion: Utilization of propolis and vitamin D3 combined has a good effect on lowering inflammation, improving hemodynamics and preventing atherosclerosis in chronic kidney disease rat models.

Risk factors for disability in leprosy patients: a cross-sectional study

Background: The disability in leprosy is caused by M. leprae invasion and infiltration into the skin and the mucous membrane that results in nerve damage and deformities, loss of sensation, paralysis, and ocular manifestation. The risk of disability can be influenced by several factors, including the type of leprosy, disease duration, the number of nerves affected, leprosy reactions, gender, age, type of treatment, socioeconomic factors, and leprosy case detection methods. This study aimed to evaluate the risk factor of disability in leprosy patients.

Methods: It was a cross-sectional retrospective analytical study to discover the correlation between risk factors with the grade of disability in leprosy patients who were treated in Dermatovenerology Outpatient Clinic Dr. Soetomo General Hospital Surabaya from 2017 to 2019.

Result: This study found a total of 275 leprosy patients with disabilities, consisting of 76 patients (27,6%) with grade-1 disability and 199 patients (72,4%) with grade 2 disability. There was a statistically significant correlation between age (p=0,025), duration of disease (p=0,001), and multidrug therapy (MDT) history (p=0,001) with the incidence of disability. Gender, bacterial index, type of leprosy, and leprosy reaction were not significantly related to disability.

Conclusion: This study showed that age, duration of disease, and the history of MDT treatment were related to the incidence of disability. The longer the disease's duration despite the patient having received MDT, the more risk of the patient having a disability.

Analysis of Isocitrate Dehydrogenase (IDH) expression in astrocytoma patients: cases of South Sulawesi, Indonesia

Background: Astrocytoma is the most common primary intracerebral tumor in adults and causes high morbidity and mortality. Most patients with astrocytomas, especially diffuse gliomas, have a poor prognosis. Recent genetic and epigenetic studies have shown that mutations in the Isocitrate Dehydrogenase (IDH) gene play an important role in the pathogenesis and prognosis of gliomas, thus facilitating IDH1 mutations in the population to become an important marker, not only to assist in the diagnosis and prognostic factors of these gliomas but also to develop therapeutic targets as currently available. This study aims to see differences in the expression of the IDH in each astrocytoma classification.

Methods: A cross-sectional analytic study was conducted at the Anatomical Pathology Laboratory, Faculty of Medicine, Universitas Hasanuddin, from October 2020 to August 2021. The research sample came from 65 paraffin block preparations for primary brain tumors with the diagnosis of Diffuse Astrocytoma (DA), Anaplastic Astrocytoma (AA) and Glioblastoma (GB). The immunohistochemical staining was performed using the monoclonal antibody IDH1-R132H. The microscopic assessment was carried out using a light microscope. Data were analyzed using SPSS version 20 for Windows.

Results: There was a significant relationship between the expression of IDH1-R132H in each astrocytoma classification (p=0.008). The prevalence of astrocytoma with negative IDH1-R132H expression (IDH-wildtype) is lower by 21 samples (32.3%) compared to astrocytoma with positive IDH1-R132H expression (IDH-mutant), which is 44 samples (67.7%).

Conclusion: There are significant differences in the expression of IDH1-R132H in Diffuse Astrocytoma, Anaplastic Astrocytoma and Glioblastoma, where the proportion of IDH-mutant status is higher than IDH-wildtype and IDH1 mutation status has a significant relationship with tumor grade.

Comparison of prognostic models for severe burn patients in an Indonesian tertiary hospital: retrospective study

Background: Despite the high burn-related mortality rate, few studies investigate the discriminating power of various mortality prognostic models for burn patients in the Indonesian setting. Thus, the objective of our study is to describe and compare the discriminating power of several prognostic models for burn patients, including the Prognostic Burn Index (PBI), Belgian Outcome of Burn In-jury (BOBI), Revised Baux Score (rBaux), and Abbreviated Burn Severity Index (ABSI).

Patients and methods: We conducted a retrospective study using medical records data with analysis including patients with severe burn (>20% Total Body Surface Area (TBSA), >10% for children and elderly), excluding those with known chronic conditions. Statistical analyses were performed on IBM SPSS 23.0 and included ROC curve and diagnostic values calculation, including sensitivity, specificity, positive, and negative predictive values with 95%CI.

Results: Final analysis included 117 subjects with a 38.9% mortality rate. All prognostic models were statistically significant discriminating power with Area Under the Curve (AUC) values of 0.817, 0.849, 0.929, and 0.859, respectively. Comparing diagnostic values identified rBaux to have the strongest discriminating power with the highest specificity, PPV, and NPV. PBI score was identified with the highest sensitivity score.

Conclusion: Discrepancy of results between our study and another Indonesian study with a similar design pointed to the need for a multi-centered study with a larger sample size to improve generalizability and statistical power of analysis.

The effect of Epigallocatechin-3-Gallate (EGCG) combined with low dose sorafenib in apoptosis and Platelet-Derived Growth Factor Receptor (PDGFR) expression in hepatocellular carcinoma rats

Background:  Sorafenib is a targeting therapy in Hepatocellular carcinoma (HCC) that targets Vascular Endothelial Growth Factor Receptors 1 (VEGFR-1), VEGFR-2, and VEGFR-3; Platelet-Derived Growth Factor Receptors ? (PDGFR-?); c-Kit proto-oncogenes; FLT-3 genes; RET proto-oncogenes; and Raf-1 genes that have the same function in suppressing tumor cell proliferation, angiogenesis, and promotes tumor cell apoptosis;  but its high cost makes necessary to reduce the dosage by combining with other agents. Epigallocatechin-3-Gallate (EGCG) has great potential in cancer treatment because of its anti-angiogenesis, induced apoptosis, and low cost. This study aimed to examine the effects of combination EGCG with low dose sorafenib compared to standard dose sorafenib in apoptosis and PDGFR expression in HCC rats

Methods: Twenty-five male Wistar rats were randomly assigned into 4 groups: sham, control, EGCG+low dose sorafenib, and standard-dose sorafenib. Diethylnitrosamine (DEN) injection to induce HCC was carried out to all Wistar rats except for the sham group. After HCC was developed, the EGCG+low dose sorafenib group and standard-dose sorafenib group received the administration of the drugs for two weeks. PDGFR expression and apoptotic index were assessed in the last 3 groups. Data were analyzed using SPSS version 20 for Windows.

Results: There was a non-significant difference of mean PDGFR expression level between the EGCG+low dose sorafenib group and standard-dose sorafenib group (p>0.05); however, there was a lower significant difference of both groups compared to the control group (p<0.05). There was a non-significant difference of apoptotic index between low dose sorafenib+EGCG group and standard-dose sorafenib group (p>0.05); in addition, there were a higher not significantly different of both groups compared to the control group (p>0.05).

Conclusion: Combining low dose sorafenib with EGCG has a comparable effect with standard-dose sorafenib in reducing PDGFR of HCC, but not for apoptosis.

Clinical and radiological profiles of metastatic brain tumor in Indonesia: A study at Dr. Soetomo Hospital, Surabaya

Background: Brain metastases have increased over time, and imaging has been considered an important diagnostic tool. In Indonesia, the record of metastatic brain tumors is limited. Therefore, understanding the epidemiology and the imaging characteristics of brain metastases will provide insights into a better diagnosis, management, and therapy towards the disease. This study aimed to evaluate the characteristics of patients with metastatic brain tumors.

Methods: A cross-sectional study was conducted in Neurology Unit at Dr. Soetomo Hospital in Surabaya, Indonesia from August 2018 - July 2019. Patients with metastatic brain tumors were enrolled in the study. Data demographics, clinical, and brain imaging characteristics were collected from the patients’ Brain Tumor Registry. Computerized tomography (CT) scan and magnetic resonance imaging (MRI) was used to assess the images of the brain metastases. Mini-Mental State Exam (MMSE) was used to assess the patient's cognitive function.

Results: Of the total 22 subjects, 14 (63.6%) were male, 13 (59.1%) aged ?50 years. Headache was the most common clinical symptom, reported by 78.2% of patients. Most of the patients (63.3%) had MMSE score of ? 23. CT-scan and MRI imaging suggested that multiple lesions were the most common, 57.8% and 71.4%, respectively. The brain tumor's most frequent was in the parietal and temporal lobes (CT-scan imaging) and temporal and cerebellar lobes based on MRI. Lung tumors were the most common source of brain metastases (50%), followed by breast and nasopharynx cancers (13.6% each); 9% had unknown sources.

Conclusions: Our study suggests that the frequency of metastatic brain tumors is gender and age-specific. Headache with early stage of dementia is common among patients with metastatic brain tumor. Multiple lesions in parietal and temporal lobes with lung cancer as the source are common. 

The relationship between catheter placement and the incidence of urinary tract infections in Condong Catur Hospital, Yogyakarta

Introduction: Catheter-related urinary tract infections for one-third of all health-care related infections in the United States, and have also been shown to increase morbidity, mortality, and length of stay. Various problems are associated with urinary catheter insertion, namely trauma, complications, and patient discomfort. The purpose of this study was to analyze the relationship between catheter placement and the incidence of urinary tract infections in hospitalized patients in Condong Catur Hospital Yogyakarta.

Methods: The design of this study was an analytic observational study using a cross sectional design. The sample was patients diagnosed with UTI for 12 months from August 2019 to July 2020 and inclusion and exclusion criteria. The sample selection was done by consecutive sampling. There were 98 samples of inpatients at the Condong Catur Hospital. The data were taken from the medical records of patients who had UTIs or those with a catheter installed.

Results: There are 98 patients in the Condong Catur Hospital, 18 of them have had UTIs, ten of which were caused by catheter insertion. In this study, bivariate analysis was used to compare the two groups with partners and found a significant association between catheter use and urethral infection, with a p-value of 0.001.

Analysis of RGB range value on fingernail image for detecting diabetes mellitus risk

Introduction: Fingernail has various colors related to the organ’s body condition, such as the pancreas, indicated by diabetes mellitus. The study aims to determine and compare the RGB range value on the fingernail image to detect diabetes mellitus risk in fasting and non-fasting conditions.

Methods: The study was a true experimental study using fasting and non-fasting respondents. Data were obtained by blood glucose level testing and fingernail image capturing. The result of blood glucose levels was classified into normal, prediabetes, or diabetes, and fingernail images were followed according to their categories. The histogram determined the RGB values of fingernail images, and calculated the maximum value of color intensity based on the height peak appeared. The distribution frequency of each group was used to get a range of RGB fingernail images in each category.

Results: Based on the results, it showed a comparison of RGB range value between fasting and non-fasting condition, including range value differences in red and blue, but any slightly overlapped in green range value. In a future study, we will use ordinal logistic regression to determine the prediction program of diabetes mellitus risk. Furthermore, we will develop a program by adding some features to improve the analysis system of the fingernail image for diabetes mellitus risk detection.

Conclusion: There was a comparison of RGB range value on fingernail image between fasting and non-fasting condition. 

Combination of diabetic Foot Spa and Sauna Bathing Therapy Decreases the Level of Blood Glucose

Introduction: There was evidence that diabatic foot spa has a crucial role in regulating blood glucose levels, but the combination of diabetic foot spa and sauna bathing have never been carried out to decrease blood glucose. The aim of this study was to analyze the combination of diabetic foot spa and sauna bathing therapy and its impact on blood glucose levels.

Methods: The data studied were blood glucose levels. This data can be obtained after administering a combination of diabetic foot spa and sauna bathing and afterward. Then this data was analyzed using an independent t test with p value of 0.000 (p <0.005).

Results: : This study showed that 60 respondents, mostly 58.3% were aged 45- 60 years, almost half of the respondents (48.3%) had suffered from DM for <1- 5 years, (70%) women, from the independent t test obtained blood glucose p value= 0.000 (p <0.05).

Conclusion: There was a decrease level of blood glucose after the patients receive the diabetic foot spa and sauna bathing therapy. 

Patient preferences for surgery or non-surgery for the treatment of clavus and callus at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

BACKGROUND: Clavus and callus are common hyperkeratotic lesions that can be very painful and affect the quality of life. The clinicians are faced with various factors affecting the resolution of the lesion, and no treatment has been considered ideal. Surgical has been preferable to conservative treatment but is still more likely to increase patients' desirability due to great discomfort. This study aims to evaluate the factors contributing to the resolution of callus and clavus.

METHODS: Retrospective analysis was done on 25 medical records of patients who met the inclusion criteria. Factors contributing to the lesion resolution were identified and analyzed using the SPSS version 17 program.

RESULT: Among 25 (33.7%) patients recruited for the study, 13 were (52%) male and 12 (48%) female. The most common types of lesions were clavus (20 [80%]). In both cases, the distribution of lesion locations was mostly found in the lower extremities (20 [80%]). Excision was performed in 21 cases (84%), and 20 patients (80%) achieved resolution. Treatment modalities were found to be a factor that had a significant relation to the resolution of the lesion after receiving treatment (p = 0.003; Spearman test).

CONCLUSION: Treatment of callus and clavus has shown satisfactory results in our center. Excision was found to be the most preferred method, with 80% resolution observed during 1 month. The treatment choice was found to be significantly related to the resolution of the lesion after receiving therapy.

The effectiveness of mindfulness based stress reduction and sama vritti pranayama on reducing blood pressure, improving sleep quality and reducing stress levels in the elderly with hypertension

Introduction: Increasing age has the potential to cause hardening of the arteries. Hypertension is also related to sleep quality and stress levels. Hypertension can be controlled with non-pharmacological therapy using Mindfulness Based Stress Reduction (MBSR) and samavriti pranayama. Samavriti pranayama increases the oxygen supply to the brain, lungs and lowers the heart rate. The purpose of this study was to determine the effectiveness of MBSR and samavriti pranayama for lowering blood pressure, improving sleep quality, and reducing stress levels.

Methods: This study utilized a cross-sectional model. Elders analyzed with hypertension were surveyed for qualification. A add up to of 40 seniors were randomized into the mediation and control bunches. Both bunches gotten schedule care. Eight sessions of MBSR and samavritti pranayama were conducted within the intercession bunch, whereas the control gather gotten no mental intercession. Elders were surveyed with respect to diminished hypertension, uneasiness, and rest quality at two unmistakable stages: some time recently and after the mediation.

Results: There were no significant differences in sociodemographic and clinical parameters between the intercession and control bunches at standard. The mediation program essentially lightened mental and physiological complications in elderly with hypertension. Particularly, the consider uncovered that 8 weeks of the combined MBSR and samavritti pranayama mediation viably decreased lower hypertension and uneasiness scores and made strides the quality of rest in elderly.

The effect of workload and length of work on the occurrence of fatigue in workers in the informal industry

Introduction: Work fatigue is a condition that can lead to a decrease in vitality and work efficiency. Workers with heavy workloads are at risk of work fatigue, and working too long in a day will also increase the risk of fatigue. Therefore, it is necessary to know the influence that causes fatigue in workers, especially the workload factor and the length of time working. So that this study can provide a work evaluation to prevent fatigue.

Methods: This research method uses quantitative methods with the type of observational research with a cross-sectional design. The population in this study were informal workers in the furniture industry on Semarang Street, Surabaya City, with a sample taking using a total population of 35 people.

Results: The results of this study indicate that most workers often experience fatigue when working with high classification. Based on the results of the analysis, it is influenced by the workload and length of work, it is known from the results of the significance value <0.05. Fatigue occurs because it is influenced by the length of work in a day that exceeds 7 hours a day (work is done 6 days a week) and the heavy workload factor received by workers.

Conclusion: Can be concluded that giving workers rest time, regulating working hours in a day need to be done, reducing the burden received by workers by dividing the work evenly and so on.

Early detection of elevated liver function test in drug-resistant tuberculosis with short term therapy and individual therapy

Introduction: Tuberculosis (TB) treatment consists of more than one drug to achieve goal treatment. Hepatotoxicity is a form of side effect that causes the termination of TB treatment or regimen changes due to treatment failure, relapse, and drug resistance. Hepatotoxicity may increase the problem, covering more than 7% of all side effects. DILI is also one of the concerns in the treatment of TB. The objective of this study to assess the role of risk factor in the hepatotoxicity during drug-resistant TB treatment and investigate the time of onset hepatotoxicity during drug-resistant TB treatment.

Methods: The research method was retrospective study. Comprehensive demographic and clinical data, management, and outcome were recorded. Patients who were treated with drug-resistant treatment in Dr. Soetomo General Hospital between January 2018 and January 2020 were enrolled. The statistical method used SPSS ver 16.0. A total sample of 129 patients met the inclusion and exclusion criteria.

Results: Prevalence of hepatotoxic side effects was 54 cases. A total of 2 patients occurred hepatotoxicity in the first 2 weeks, and 52 patients developed hepatotoxicity in the late 2 weeks. There was one risk factor influencing the hepatotoxic side effects of drug-resistant Tuberculosis treatment. The history of alcohol consumption the only one risk factor (OR=3,182; 95% Cl=0,120-9,927.

Conclusion: Hepatotoxicity is a common problem among patients during Antituberculosis Treatment, especially on drug-resistant Tuberculosis in our population. Early detection not only reduces the risk of developing hepatic injury but also prevents mortality.

Clinical improvement of patients with moderate-to-severe psoriasis treated with methotrexate at Dr. Soetomo General Hospital, Surabaya, Indonesia

Background: Psoriasis is a complex, chronic disease with increasing global incidence. Studies on the effectiveness of psoriasis therapy in Indonesia are limited. This study aimed to evaluate the patient's clinical improvement with moderate-to-severe psoriasis vulgaris using the Psoriasis Area and Severity Index with ?75% score reduction (PASI75).

Methods: This is a retrospective study involving patients diagnosed with psoriasis vulgaris who visited the Dermatology and Venereology Outpatient Clinic in Dr. Soetomo General Hospital between January 2016 and December 2018. The electronic medical record obtained data on demographic characteristics, the number of visits, psoriasis at initial (PASI) score before and after treatment, type and dose of treatment, and comorbidities. Data were analyzed using SPSS version 23 for Windows.

Results: Overall, 54 patients with psoriasis vulgaris were included. Almost all subjects were adults (?18 years old) and presented with severe PASI (PASI score > 10) (96.3%). The majority of the subjects (64.8%) successfully achieved PASI75. Most subjects received methotrexate (72.2%); the most frequent dosage was 15 mg/week (61.5%). A significant association was found between methotrexate treatment and a larger improvement in PASI scores (p=0.001).

Conclusion: moderate-to-severe psoriasis therapy in terms of PASI75 achieved a satisfactory success rate of 64.8%, and the improvement of PASI score was significantly better in patients who received methotrexate. Further studies in Indonesia are needed to explore the effectiveness of psoriasis therapy and its factors.

The outcome of hypospadias surgery and it’s advanced treatment in Arifin Achmad General Hospital in January 2019 – December 2020

Introduction: Hypospadias, the most common congenital genital anomaly, is defined as the abnormal ventral opening of the urethral meatus extent from the proximal tip of the glans penis, penis rod, scrotum until perineum. The incidence of Hypospadias continued to increase from time to time. Urethroplasty and orthoplasty is the only possible treatment for Hypospadias until this time. Surgical reconstruction cannot always be done in one step, many cases need more than one reconstruction even though an experienced surgeon did it. This study aims to describe patients’ characteristics in Arifin Achmad General Hospital.

Methods: This is a descriptive retrospective study using a total sampling method and carried out 28 hypospadias patients at Pediatric Surgery of Arifin Achmad General Hospital from January 2019 until December 2020. Data were analyzed descriptively to describe the patient’s characteristics including age, hypospadias type, frequency of surgery based on Hypospadias type, day of hospitalization based on surgical procedure, complication after surgery based on Hypospadias type, and advanced treatment for the complication.

Results: From 28 patients with hypospadias, it could be concluded that the highest number of hypospadias patients found in the 0-5 years age group (50%) with the most common type was penoscrotal as many as 12 cases (43%). One stage procedure was predominant and attributed to 75% more than multistage procedure (25%). Chordectomy procedure got hospitalized for 3 days and multi procedure (cordectomy + urethroplasty + scrotoplasty) got hospitalized for 7 days. Fistula urethrocutaneous majority found in shaft penile type as a complication after surgery (78%) and had cutaneous fistula closure as an advanced treatment for the complication. From the 28 cases, 23 cases were successful without complication (82%) and 5 cases had fistula as a complication after surgery (18%).

Conclusion: Hypospadias treatment in Pediatric Surgery division at Arifin Achmad General Hospital such as Characteristics of hypospadias patient and surgical outcome majority had satisfied outcome and advanced treatment for complication after surgery is fistula urethrocutaneous closure.

The effect of metformin on autophagy by LC3 expression in Type 2 Diabetes Mellitus (T2DM) human skeletal muscle cell culture

Background: Skeletal muscle is an essential tissue in glucose metabolism. Reduced autophagic capacity to remove damaged contractile proteins in skeletal muscle cells will contribute to the loss of muscle mass. Metformin is the first-line agent for treating type 2 diabetes mellitus (T2DM) patients. This study aims to investigate the effects of metformin on autophagy through LC3 expression in human skeletal muscle cell culture (SkMC).

Methods: The T2DM human SkMC was obtained from T2DM treatment naïve patients, purchased from AcceGen Biotech®. Fully differentiated myotubes were randomized into the control and treatment groups. The treatment group was given Metformin in three doses (1 mM, 2 mM, and 3 mM). An immunoblotting assay of AMPK? and LC3 was performed using electrochemiluminescence (ECL). The quantitative expression of AMPK? and LC3 were measured at baseline, after 24-hour, 48-hour, and 72-hour. Data were analyzed using SPSS version 22 for Windows.
Results: AMPK? and LC3 expression were higher in the treatment group compared to the control group. The levels of AMPK? and LC3 expression in the treatment group increased dose-dependent. Linear regression analysis demonstrated a significant correlation between metformin administration and LC3 expression levels (p<0.0001).

Conclusion: Metformin administration on T2DM human SkMC resulted in increased autophagic activity, marked by increased LC3 expression.

The prevalence and characteristics of perineal rupture during vaginal delivery at Sanglah General Hospital and Regional Hospitals in Bali from January 2018 until December 2019 period

Background: One of the causes contributing to the high maternal mortality rate in Indonesia is postpartum hemorrhage, which can be the consequence of perineal rupture. Perineal rupture can happen spontaneously in normal vaginal delivery or worsen after episiotomy, induction of labor, vacuum and forceps delivery. This study aims to know the prevalence and characteristics of perineal rupture so that it can be used as data to make policy guidelines for preventing and reducing the incidence of perineal rupture.

Methods: This is a retrospective descriptive study analyzing secondary data collected from Sanglah General Hospital and nine other Regional Hospitals from January 2018 until December 2019. The data analysis technique used is a univariable analysis by calculating the frequency distribution and proportion to determine the prevalence and characteristics of the research subjects. Data were analyzed using SPSS version 20 for Windows.

Results: There are 8,178 cases of vaginal delivery, 6,191 cases (75.70%) with perineal rupture and 1,987 cases (24.30%) without perineal rupture. Perineal rupture is most often found in women < 20 years old (82.66%), primigravida (81.76%), preterm gestational age (78.23%), the baby with birth weight > 4,000 grams (94.26%), underweight mother (87.50%), and women with assisted delivery by vacuum or forceps (100.00%). 

Conclusion: The Prevalence of perineal rupture in this study is 75.70%, with the most characteristics being women < 20 years old, primigravida, preterm gestational age, macrosomia baby, normal IMT, assisted vaginal delivery.

Antiproliferation and Apoptosis Effect of Cisplatin and Nanocurcumin on Ovarian Cancer SKOV3 Cell

Background: Ovarian cancer is one of the leading cancers in women. Seventy percent were founded in the advanced stage, with a 5-year survival rate of only 46%. The current treatment modality is cytoreduction with platinum-based adjuvant chemotherapy as the first line. The effectiveness of chemotherapy is only 60% in the advanced stage, later developing into recurrent. Therefore, additional types of therapy are required based on agents that work specifically in cancer cells and synergize with current standard treatments. This study aimed to know the anti-proliferation effect and apoptosis effect of combination cisplatin with nanocurcumin on SKOV3 cells.

Methods: This experimental study was conducted in vitro using the biological cell line SKOV3 to determine the anti-proliferation effect (expression Ki67) and the apoptosis effect (caspase 3 and 8) of combination cisplatin with combination with cisplatin nanocurcumin on the cell. The data were analyzed with unpaired T when regular distribution / Mann Whitney test when the distribution is abnormal and using Graph Pad Prism.

Results: Based on this result, 50cc of nanocurcumin is 67 μm, and 50cc of cisplatin is 54 μm, using the MTT Assay method. The viability of the cells in this study decreased according to the dose-dependent, whereas the combined dose of 134 μm nanocurcumin with 108 μm cisplatin found the lowest life cell, 24.3% (p <0.001). Ki67 expression was low in the SKOV3 cells post-exposure to cisplatin, but increased post-exposure to nanocurcumin, suspected nanocurcumin at certain doses of pro-oxidant properties that triggered proliferation. Caspase 3 and 8 cannot be detected in this cell by the ELISA method.

Conclusions: Nanocurcumin has a potential effect on chemosensitive cells. However, our study shows no healing effect in chemoresistance cells, particularly SKOV3.

Factors that influence on Islamic caring behavior

Introduction: There are not many studies that investigate Islamic caring behavior and the factors that influence it. The purpose of this study was to analyze the factors that influence Islamic caring behavior.

Methods: This study was an observational analytic research design that used nurses' perceptions of Islamic caring behavior and the factors that influence it, including organizational characteristics, job characteristics, and individual characteristics. This survey involved 100 respondents that filled out a questionnaire via a google form. Data analysis using Chi-Square and multiple logistic regression test, with a significance level of <0.05.

Results: This study shows that 51% respondents have good Islamic caring behavior. The factors that influence Islamic caring behavior from organizational characteristics are; 1) vision and mission (p = 0.001), 2) reward system (p = 0.001), 3) selection (p = 0.002), 4) organizational structure and culture (p = 0.003), from job characteristics are 1) performance objective (p = 0.000), 2) work schedule (p = 0.001), 3) job design (p = 0.041), 4) correction (p = 0.002), and 5) feedback (p = 0.002), from the individual characteristics of nurses is attitude (p = 0.028. There are three multivariate test results that have an effect, namely objective performance (p = 0.002; B = 3.19), understanding of vision and mission (p = 0.005; B = 1.401), selection (p = 0.017; B = 1.521), and all three show that there is an interaction.

Conclusion: The most dominant factor influencing Islamic caring behavior is Objective performance.

Effect of proteasome inhibitor on serum 8-OHdG and aortic SOD2 in a rat model of atherosclerosis

Background: Numerous studies have been performed to analyze the effect of proteasome inhibitors on atherosclerosis. However, there is still controversy and the mechanism of action of proteasome inhibitors is still not clearly understood. This study aimed to analyze the effect of proteasome inhibitor on 8-hydroxy-2′-deoxyguanosine (8-OHdG) level in the serum of atherosclerotic rats and the antioxidant expression of Superoxide Dismutase 2 (SOD2) in the aorta.

Methods: The sample was 18 rats with the strain Wistar rats aged 2-3 months. The sample was grouped into normal (N) group got a standard feed, A1 induced by atherosclerosis, and A2 induced by atherosclerosis and given proteasome inhibitor. The proteasome inhibitor was a bortezomib dose of 50 µg/kg BW/day given on days one and three. After four days of treatment, rats were sacrificed, and the aorta removal was done for analyzing the tunica intima-media thickness (IMT) and SOD2 expression assessment using immunohistochemistry, and serum 8-OHdG measurement was done using the ELISA method. SOD2 expression assessment was carried out quantitatively using Adobe Photoshop.

Results: We established a decrease in IMT in the A2 group compared to the A1 group and an enhancement of SOD2 expression and a decrease in 8-OHdG levels in the A2 group compared to the A1 group, although not statistically significant.

Conclusion: In our findings showed bortezomib can prevent thickening tunica intima-media in the aorta, although does not reduce serum 8-OHdG levels and did not significantly increase SOD2 expression in the aorta.

Relationship between plasma adiponectin levels and cellulite

Background: Decreased adiponectin levels as a humoral vasodilator in subcutaneous adipose tissue in the cellulite area are thought to cause microcirculation disorders and tissue hypoxia, ultimately a local fibrotic response and collagen strands (septa) resulting in the appearance of cellulite. Adiponectin accumulates in the extracellular matrix. It is suspected that an increase in adiponectin levels can suppress the process of sclerotic fibrosis, thereby inhibiting the formation of cellulite. This study aimed to determine the relationship between plasma adiponectin levels and cellulite.

Methods: This study is an analytic observational study with a cross-sectional design involving 40 cellulite patients and 40 controls. Each patient underwent a history and dermatological examination. Then proceeded to assess plasma adiponectin levels from blood samples by ELISA test. These data were analyzed statistically using the Chi-square test.

Results: In this study, both cellulite and control patients were 20-30 years with the average plasma adiponectin level in cellulite was 8.07±3.94 µg/ml. The highest cellulite location in the femoral and gluteus areas was 62.5%. The results of this study showed that there was a statistically significant relationship between plasma adiponectin levels and cellulite (p = 0.025 < 0,05).

Conclusion: There is a significant relationship between low plasma adiponectin levels and the risk of cellulite.

COMPARISON OF SERUM AND VITREOUS TGF-?1 LEVELS IN PROLIFERATIVE DIABETIC RETINOPATHY WITH AND WITHOUT PANRETINAL PHOTOCOAGULATION LASER THERAPY

Abstract

Background: A long-term diabetic retinopathy will cause an increase of several growth factors expression like Transforming Growth Factor ? (TGF-?), a multipotent cytokine that involved in the process of endothelial cell proliferation. 

Purpose: This study aims to observe the relationship between TGF-?1 levels in serum and vitreous fluid of Proliferative Diabetic Retinopathy (PDR) patients given Pan Retinal Photocoagulation (PRP) laser therapy.

Method: This was a cross-sectional study involving 14 patients with PDR. TGF-?1 levels of vitreous and peripheral blood were measured using Enzyme linked Immunosorbent Assay (ELISA) method.

Results: Our subjects consisted of 57.1% males with a mean age of 51.8 years, where dyslipidemia was the most common comorbid disease. Mean serum TGF-?1 level was 12,821.43 ± 5,253.16 pg/ml, while the mean value in vitreous was 3,692.86 ± 333.89 pg/ml. Meanwhile, there was no significant difference in serum and vitreous TGF-?1 levels between subjects with and without PRP laser therapy (p>0.05).

Conclusion: There were no significant correlation between TGF-?1 levels in proliferative diabetic retinopathy patients with and without pan retinal photocoagulation laser therapy. However, there was a decreasing trend in TGF-?1 levels in the vitreous fluid which indicates that PRP laser therapy has a positive effect on preventing the formation of neovascularization in the eye.

Keywords: TGF-?1 levels, proliferative diabetic retinopathy, panretinal photocoagulation laser

The role of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in determining the prognosis of patients with testicular cancer

Background:  Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as systemic inflammatory response markers, have been shown to play a role in prognostic factors for patients with malignancies in recent years. However, their application as the prognostic factors of testicular cancer remains unknown. This study aims to evaluate the prognostic role of testicular malignancies using preoperative hematological parameters, NLR and PLR, and their pre-diagnostic role in the staging of testicular cancer.

Methods: This was a cross-sectional retrospective study of thirty-nine patients who underwent radical orchiectomy due to testicular cancer at the Department of Urology Haji Adam Malik General Hospital between January 2014 and December 2018. For each patient, clinical features including age, sex, clinical stage, chemotherapy, radiology report, pre-treatment neutrophil count, lymphocyte count, platelet count, NLR, PLR, and postoperative histopathological report were collected. Then we analyzed the association between NLR, PLR and the testicular cancer metastasis incidence.

Result: The mean age of the patients was 27.56 ± 17.47 years. Seventeen patients had seminoma (42.5%), 16 others were yolk sac type of cancer (40.0%), and the rest six patients were teratoma (3 patients), lymphoma (2 patients), and embryonal carcinoma (1 patient). More than half (66.48%) of the patients received chemotherapy after radical orchiectomy, with 48.70% in clinical stage III. PLR was associated with testicular cancer metastases (p=0.024), while NLR was not (p=0.729).

Conclusion: High pre-treatment PLR levels are associated with the occurrence of metastasis in testicular cancer patients. Hematological parameters will become critical in the preoperative evaluation of such testicular cancer cases. The potential prognostic significance of NLR and PLR in testicular cancer should be tested with further studies.

The difference of platelet-white blood cell ratio in severe preeclampsia and normotensive pregnancy

Background: Inflammation is believed to play a role in preeclampsia. Leukocytes increase due to inflammatory response. Endothelial damage in preeclampsia induces platelet aggregation, triggers platelet consumption, and decreases platelet. Therefore, preeclampsia could alter the platelet-white blood cell ratio, which can be used as a marker for preeclampsia. This study examines the difference of platelet-white blood cell ratio in severe preeclampsia and normotensive pregnancy.

Methods: This study used the medical records of pregnant women in Dr. Kariadi General Hospital Semarang from 2019 to 2020. Samples were collected using a consecutive sampling method. Data were analyzed using an independent t-test and Mann-Whitney.

Results: There was a significant difference in platelet count (p=0.011) and leukocyte count (p=0.018) between severe preeclampsia and normotensive pregnancy. Therefore, a difference (p<0.01) in platelet-white blood cell ratio between severe preeclampsia and normotensive pregnancy was observed.

Medical Management of Kidney Stones: a review

The incidence of kidney stone disease has been rising in past decades. The prevalence has doubled in both genders, and the prevalence ratio is shrinking from 3.4 to 1.3 between males and females. This condition greatly impacts individuals, the health care system, and socioeconomic levels. Kidney stone diseases are related to various risk factors and medical conditions. A detailed diagnosis through history taking, urinalysis, metabolic evaluation, and stone analysis is important to direct the therapy approach. The therapy in managing kidney stone diseases comprises dietary and pharmacological treatment. In addition to general advice on sufficient fluid intake, citrate intake, maintaining ideal body weight, and restricting sodium and animal protein, the therapy should be adjusted based on the specific type of stones. 

Management of complications of RV branch ellis type V artery perforation with handmade covered stent

Introduction: Coronary artery perforation is a rare and frightening complication of percutaneous coronary intervention. One of the rarest is Ellis type V coronary perforation that involves a perforation of the distal coronary artery generally caused by a rigid guide and hydrophilic.

Case Presentation: We presented a case of type V Ellis coronary artery perforation during percutaneous intervention. Patient came with persistent chest pain starting from the proximal radiating to her left side and also penetrated to her back. An echocardiography examination showed mild dilatation of the right atrium and ventricle, with the decrease of global left ventricular systolic function with an ejection fraction of 45%. There was also left ventricular diastolic dysfunction with impaired relaxation with increased LVEDP. A calcified aortic valve appeared with good function. A mild regurgitation of the mitral valve and mild-moderate tricuspid regurgitation was found with a low probability of pulmonary hypertension. Patient was diagnosed with temporary working diagnosis of Recent Inferoposterior STEMI RV TIMI 4/14 Killip I, AVB grade 1, PAC bigemini, controlled hypertension, and reactive leukocytosis. Patient underwent percutaneous coronary intervention in RCA on the 6th day of admission, in which an anomaly of the RV branch was found and perforation in the coronary artery occurred, thus a hand made cover stent was made to overcome the incidence. The procedure was finished with a total of 130 cc of contrast used and 100 cc of total bleeding. Patient was then admitted to the ICCU with stable vital signs and was evaluated for signs of tamponade using a Vscan every 3 hours. On the 8th day of hospital admission, patient had no complaints with stable vital signs. The final diagnosis at the time of outpatient was CAD 2VD post PTCA with 2 stents on RCA, RV Ellis type V branch perforation, STEMI Inferoposterior RV TIMI 4/14 Killip I, post AVB grade 1, post PAC bigemini, hypertension and reactive leukocytosis. Outpatient’s therapy included anticoagullants, statins, beta blockers, ACE-I, PPI, and sucralfate.

Conclusion: We reported a rare case of RV branch artery perforation complication, specifically Ellis type V perforation during percutaneous coronary intervention that was then treated with a handmade covered stent. This perforation occured due to a total occlusion at the proximal RCA. An anomaly of the RV branch caused the guidewire to perforate the distal part of RV branch artery. As there was no improvement achieved with ballon inflation, a handmade covered stent was then made to close the RV branch, which was placed on the RCA covering the ostium of the RV branch.

A severe COVID-19 patient with diabetes mellitus getting dexamethasone with depression disorders: a case report

Background: Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 coronavirus requires host cells to replicate, leading to rapid and uncontrollable viral replication and could end in increased production of pro-inflammatory cytokines. This case study aims to evaluate a severe COVID-19 patient with diabetes mellitus getting dexamethasone with depression disorders.

Case Presentation: A-56 years old Javanese female who lives in Sidoarjo was admitted to the emergency room of Dr. Soetomo Public Regional Hospital, Surabaya due to shortness of breath from the patient’s anamnesis. The shortness of breath was getting worse in the last 3 days before being admitted to the hospital. The patient had a fever in the previous 3 days before being admitted to the hospital. She also had a cough with phlegm for 1 week before being admitted to the hospital. The patient’s condition is oxygen saturation at 93% with a simple mask 6-8 lpm (oxygen saturation at 72% in free air. Her medical history revealed that she had suffered from diabetes since approximately 8 years ago and routinely took 5 mg of glibenclamide once a day. She also had high blood pressure from 5 years ago and routinely took 10 mg of amlodipine once a day. Treatment for this patient in severe condition requires comprehensive management such as symptomatic therapy, oxygenation, and adequate nutritional therapy. In addition, the patient received dexamethasone and antidepressant drugs such as fluoxetine 10 mg.

Conclusion: The oxygenation therapy, symptomatic, antiviral, supportive, and adequate nutritional treatment can improve the clinical outcome regarding a severe COVID-19 patient with diabetes mellitus getting dexamethasone with depression disorders. 

Advanced MRI prediction of meningioma histopathological classification: a literature review and case presentations

Meningioma is not uncommon case; however, the differentiation of high-grade from low-grade meningioma is important. The rate of recurrence of grade I meningioma is 7-20%, but in grade II meningioma is 30-40% and in grade III 50-80%. Non-invasive MRI techniques that can differentiate high-grade from low-grade meningiomas before surgery are useful for surgical planning and subsequent treatment. We present a review article and some case studies of low-grade (WHO grade I) and high-grade (WHO grade II and grade III) meningioma with conventional MRI and continue with advanced MRI; we performed diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) value, dynamic susceptibility contrast (DSC), dynamic contrast-enhanced (DCE) magnetic resonance (MR) perfusion and 3D ASL. From these three cases show that advanced magnetic resonance imaging with ADC value, DSC, DCE, and 3D arterial spin-labelling (ASL) is an essential sequence to differentiate high-grade from low-grade meningioma.

Uncommon presentation of COVID-19 in ophthalmology: a case report

Introduction: The COVID-19 pandemic is well known for its clinical respiratory symptoms. Currently, the medical literature describing the neuro-ophthalmologic manifestations of COVID-19 is gradually emerging. We hereby report a case with an uncommon presentation of COVID-19 in a patient.

Case Report: A 19-year-old man presented with ptosis and limited left eye movement in his left eye followed by other neurological manifestations, without classical respiratory manifestations. Brain imaging and nasopharyngeal PCR suggest COVID-19 encephalitis.

Conclusion: This experience confirms that COVID-19 infections can be present despite the absence of significant respiratory symptoms mimicry to other symptoms. Therefore, physicians should consider the possibility of COVID-19 infections, and time management may lead to a better outcome.

Profuse haematochezia related to Crohn’s disease: a rare case report

Background: Lower gastrointestinal bleeding (LGIB) can be caused by irritable bowel disease. Haematochezia is one of the LGIB symptoms. Profuse haematochezia is a rare complication in Crohn’s disease.

Case Presentation: We reported a 24-year-old patient with profuse haematochezia with severe anaemia and hypovolemic shock. Anamnesis, physical examination and colonoscopy showed that haematochezia was caused by Crohn’s disease. Colonoscopy was done after the patient was hemodynamically stable with findings of external haemorrhoid and multiple ulcers with varying size (0.5–2 cm) on ascending colon, caecum and terminal ileum. The tissue histopathology of ileocecal junction indicated intestinal epithelia with partially eroded, crypts infiltrated by inflammatory cells, swollen lamina propria with proliferation and dilation of blood vessels indicting the Crohn’s disease.  The patient then treated with Crohn’s disease medical therapy including low dose oral steroid, sulfasalazine and antibiotics. Clinical improvement was found on one week follow-up after discharge from hospital.

Conclusion: Profuse haematochezia could be associated with Crohn’s disease and the comprehensive approaches should be taken to manage the Crohn’s disease with such presentation. 

Diagnostic problems and management of pituitary gigantism leading to ischemic stroke and atrial myxoma in young adult patient: a case report

Background: Gigantism is the excessive secretion of growth hormones (GH) during childhood and is mostly caused by benign pituitary adenomas. The signs and symptoms are not specific in early childhood due to growth spurt. An ischemic stroke is rarely present in pituitary adenoma, and here we present a case of ischemic stroke and atrial myxoma associated with pituitary gigantism.

Case Presentation: The patient was an 18-year-old male who complained of continuous growth. In June 2016, the patient suffered from an embolic stroke, and in January 2017 he complained of fatigue and shortness of breath. The echocardiography showed a mass in the left atrium that was removed in March 2017 through open-heart surgery; the pathological histology confirmed a myxoma. The brain magnetic resonance imaging (MRI) showed a pituitary macroadenoma, and the growth hormone (GH) level was 20.6 ng/mL. In October 2019, the patient was referred to Dr. Soetomo Hospital. The height increased from 185 cm in 2017 to 205 cm in 2019. The height was 205cm, weight 85kg, body mass index 20.2 kg/m², GH level >40 ng/mL, cortisol 11.24 ug/dL, prolactin 1.21 ng/mL, testosterone 425.6 ng/dL, free thyroxine (FT4) 1.03 ng/dL, and insulin-like growth factor 1 (IGF-1) 688 ng/mL. The patient was administered oral cabergoline 0.25 mg twice a week and had endoscopic endonasal transsphenoidal hypophysectomy (EETH). The patient developed postoperative polyuria after surgery which indicated diabetes insipidus, and the patient was administered desmopressin 0.05mg/12 h with fluid restriction. One week later, the morning cortisol level was low, and hydrocortisone therapy was administered and was tap-off. One month-post surgery, the level of morning serum cortisol was 0.86 µg/dL.

Conclusion: This case is extremely rare and we demonstrated that the EETH surgery the stability of GH could be achieved.

Diagnosing and treating Patent Foramen Ovale (PFO) from various manifestations in adults: case series

Background. Patent foramen ovale (PFO) is a part of atrial septal defects (ASD) entities. While mostly asymptomatic, some adults with PFO will develop symptoms, from mild complaints such as migraine or palpitation to more debilitating complications such as syncope or cryptogenic stroke. Therefore, it is highly crucial that PFO be diagnosed and treated promptly. Echocardiography, trans-thoracal and or trans-esophageal, is the main diagnosis modality. For treatment, antiplatelet with or without anticoagulation, trans-catheter closure, and surgery are utilized in accordance with their indications.

Case Presentation. We present four adult patients referred with various symptoms: vertigo, migraine, palpitation, and cryptogenic stroke. Three of them had no explicit risk factors for the cerebrovascular event, with one patient having a co-existing hypercoagulable state. Echocardiography revealed a positive bubble test, which meant that PFO was the primary etiology of those cases. We then treated each of them with transcatheter device closure, which improved their symptoms, before adding antiplatelet for six months.

Conclusion. Proper diagnosis and prompt treatment of PFO are imperative in reducing complications. Echocardiography, mainly TEE, is the main diagnostic tool for PFO. Antithrombotic (with or without anticoagulant), minimally invasive procedure and surgery in some cases are the modalities available.

Fatality in a pregnant woman with COVID-19 after a cesarean section: A case report

Background: SARS-CoV-2 can infect anyone, including pregnant women. Pregnant women with COVID-19 experienced fetal hypoxia and reduced amniotic fluid; therefore, a cesarean section was performed. This study aimed to report a case of fatality in pregnant women's G3P1A1 status with COVID-19 after a cesarean section.

Case Report: The patient was a 33-year-old female 36-37 weeks pregnant with G3P1A1 status and infected with SARS-CoV-2. A cesarean section is performed to save the mother and fetus in cases of pregnancy complications. Due to fetal hypoxia and reduced amniotic fluid, a cesarean section was performed, thereby changing the patient status from G3P1A1 to P2A1. The baby survived, healthy and normal after the cesarean section, while the mother underwent COVID-19 treatment. However, the patient still experienced shortness of breath and acute respiratory distress syndrome. Unfortunately, she experienced more symptoms, including hematuria, respiratory failure, acute respiratory distress syndrome, and cardiac arrest on cardiopulmonary resuscitation, before her eventual death.

Conclusion: The pregnant mother G3P1A1, successfully underwent a cesarean section, and the baby is healthy and normal. The pregnant woman's condition worsened during treatment for COVID-19, and she died.