
A network meta-analysis on comparative efficacy and tolerability of on-demand therapy for premature ejaculation
Niwanda Yogiswara, Yusuf Azmi, Yufi Aulia Azmi Online First: December 01, 2020A network meta-analysis on comparative efficacy and tolerability of on-demand therapy for premature ejaculation
Niwanda Yogiswara, Yusuf Azmi, Yufi Aulia AzmiIntroduction: The use of pharmacotherapy as a first-line treatment for premature ejaculation (PE) is recommended by EAU guidelines. However, no study had analyzed multiple treatment comparisons among available on-demand therapy. Therefore, we aimed to perform a network meta-analysis (NMA) to characterize the comparative efficacy and tolerability of on-demand therapy for PE.
Methods: We systematically searched randomized controlled trials (RCTs) in several databases at any period up to November 2019. NMA was performed to estimate efficacy and tolerability outcomes using intravaginal ejaculation latency time (IELT) and overall adverse effects (AEs), respectively. We ranked each outcome using the surface under the cumulative ranking curve (SUCRA) and presented the two outcomes as a clustered ranking plot.
Results: A total of 19 RCTs comprising 5950 patients were included in this NMA. All active treatments showed significant improvement compared to placebo. Among the available on-demand treatment, the combination of SSRI plus PDE5i showed the highest efficacy (MD: 3.06; 95%CI 1.84-4.29) followed by tramadol 100 mg and vardenafil 10 mg (MD 2.9, 95%CI 1.63-4.16; MD 2.36, 95%CI 1.2-3.52; respectively). Based on the SUCRA, the combination of SSRI plus PDE5i had the highest score (91.7%) in efficacy, while dapoxetine 30 mg had the highest score (73.3%) in terms of tolerability.
Conclusion: The combination of SSRI plus PDE5i was the treatment of choice for individuals who prioritize efficacy. For those who prioritize tolerability, dapoxetine 30 mg and vardenafil 10 mg became alternative treatments. Various on-demand therapy options require careful discussion with patient expectations of treatment effects.
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Risk scoring in predicting preterm birth of women receiving cervical cerclage
Chro Najmaddin Fattah Online First: December 01, 2020Risk scoring in predicting preterm birth of women receiving cervical cerclage
Chro Najmaddin FattahBackground: Cervical incompetence is primarily a clinical diagnosis, which is characterized by recurrent painless dilation of cervix and spontaneous second trimester loss and preterm delivery. Despite recent advances, the indications and efficacy of cervical cerclage have been remained controversial. This study was performed with the aim of evaluating the risk factors of preterm birth among women who underwent cervical cerclage and establishing a scoring system to predict preterm labor in this group of women.
Material and Methods: This retrospective cohort study was performed on 95 women who had undergone cervical cerclage from January 2016 to January 2018 in Maternity Teaching Hospital of Sulaimaniyah, Iraq. A total of 66 women who delivered after 34 weeks were used as control group, compared to 29 cases who delivered before 34 weeks.
Results: According to the findings of the present study, there was a significant association between the preterm birth before the 34 weeks of pregnancy and the risk factors of pathological vaginal discharge, cervical length less than 25 mm prior to cerclage placement, and passive smoking. The positive predictive value was calculated using the prediction model was %99 with a risk score of 3, 47.6% with risk score 2 and 28.2 % with risk score 1.
Conclusion: The prediction model can be used as a tool to identify patients at a higher risk for PTD <34 weeks and to recognize those that could benefit from cerclage and deliver after 34 weeks. It could also be a useful tool for identifying those high risk women with cerclage who require increased surveillance.
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Quickert procedure for involutional lower eyelid entropion: a multi-centre study
Rodiah Rahmawaty Lubis, Novie Diana Sari, Herna Hutasoit Online First: September 27, 2020Quickert procedure for involutional lower eyelid entropion: a multi-centre study
Rodiah Rahmawaty Lubis, Novie Diana Sari, Herna HutasoitBackground: Involutional entropion is the inward turning of the eyelid margin and commonly happens in the inferior eyelids in elderly people. The prevalence is as high as 2.1% in people ≥ 60 years old and more common in women than men. This condition may cause ocular surface irritation and discomfort secondary to contact between cilia and the ocular surface. Several etiological factors are suspected to be important causes of involutional entropion. One of them was horizontal eyelid laxity. Quickert Procedure is one of the surgical interventions recommended to correct involutional lower eyelid entropion in the elderly Asian population with 0% of recurrent entropion in a recent study by Miyamoto et al.
Methods: This is a descriptive retrospective study of 16 involutional lower eyelid entropion patients (18 eyelids) that needed surgical correction. About ten males and six females were undergone Quickert procedure to correct the involutional entropion. Patients were assessed postoperatively for 24 months to evaluate the recurrence entropion, cosmetic, and functional improvement. Data were analyzed by SPSS version 20 for Windows.
Results: This study included 16 patients, with mean age was 69.8 years old which range from 62-85 years old. They consisted of 9 (56.0%) patients were male, and the rest was female (44.0%). Eleven (61.0%) patients were with left eye laterality, and 10 (63.0%) patients found without anticoagulant consumption. All patients (100.0%) had positive snapback test and achieved >6 mm in distraction test. After surgical intervention, no patients (0.0%) were found to experience recurrence of involutional entropion nor ocular discomfort due to prior surgery.
Conclusion: A detailed assessment of the etiology, accurate preoperative evaluation, and precision in addressing patients underlying eyelid anatomic abnormalities are needed in the selection of appropriate surgical procedures to correct entropion.
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The functional and physical state of the anal sphincter complex in the patients with rectal prolapse in the post-surgery period
Solmaz Soltan Imanova Online First: October 21, 2020The functional and physical state of the anal sphincter complex in the patients with rectal prolapse in the post-surgery period
Solmaz Soltan ImanovaPurpose: The work was aimed at comparative studying of the functional and physical state of the patients with rectal prolapse after surgical treatment with various surgical techniques and at identifying the most optimal procedure technique.
Patients and methods: The authors observed 49 patients (32 women, or 65.3 %) aged 22 — 83 years (the median age of women was 46.1 ± 1.3 years old, of men — 48.7 ± 1.4 years old) with the rectal prolapse of varying severity. The Delorme’s procedure was indicated for 28 patients (57.1 %). Perianal proctosigmoidectomy (the Altemeier’s surgery) was performed in 12 patients (24.5 %). In the young patients, preference was given to the Ripstein’s abdominal surgery (nine patients; 18.4 %). To objectively assess the physical state of the anal sphincter apparatus, traditional sphincterometry was performed using S4402 sphincterometer with a nonperfusing sensor (Pro Medika GmbH, Germany), and the functional state of the sphincter complex was subjectively assessed using the Wexner’s score scale.
Results: The best results were obtained after the Delorme’s procedure (p<0.05), while the worse results were obtained in the young patients after the Ripstein’s surgery (p<0.05).
Conclusion: The obtained results may be used for assessing the functional and physical state of the anal sphincter complex in the surgical treatment of the patients with the rectal prolapse syndrome, especially in those with ASFs of varying severity.
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Scoring predictor for successful of arteriovenous fistulas as vascular access in hemodialysis patients: PAVAS score
Maulidya Ayudika Dandanah, Budiono Budiono, Ito Puruhito Online First: December 01, 2020Scoring predictor for successful of arteriovenous fistulas as vascular access in hemodialysis patients: PAVAS score
Maulidya Ayudika Dandanah, Budiono Budiono, Ito PuruhitoIntroduction: The use of vascular access (AV-fistula) for long-term hemodialysis is still served as the primary choice. The fact that there is still a high rate of failure of arteriovenous fistulas procedure is one of the obstacles in the treatment of chronic kidney disease problems. This study aims to assess the risk factors for AV-fistula or AV-shunt failure and develop a risk scoring system for the failure of the AV-fistula procedure in patients with chronic kidney disease.
Methods: This study is a prospective study conducted at Dr. Soetomo Hospital, Surabaya, Indonesia. The analysis focuses on the risk factors for AV-fistula failure and performs a scoring order using multiple logistic regression methods.
Results: Based on this study, three variables were found to have significant values in determining the risk of AV-fistula failure scoring, namely local arterial condition (p<0.1), local venous condition (p<0.1), and arterial diameter (p<0.1). The scoring system for normal arteries, normal veins, and artery diameter >1.8 mm was scored 1. Scoring for veins and arteries with a history of puncture was 1. Arteries with stiff sensation with weak pulses and veins with a history of intravenous catheters scored 2.
Conclusion: The use of scoring based on parameters of arterial diameter, local venous condition, and local arterial condition becomes a scoring system for predictors of the risk of failure of the AV-shunt procedure, with three scoring categories, namely low risk (score 0-1), medium risk (score 2 -3), and high risk (score 4-5). This study is only a preliminary study for arteriovenous fistula scoring (PAVAS Score) due to the limited sample size so that a large-scale follow-up study is needed to assess the validity of the proposed PAVAS score.
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IDH1 mutation in Balinese glioma patients and its relationship with clinicopatological parameters
Ni Putu Sriwidyani, Ida Ayu Ika Wahyuniari, Herman Saputra, I Gusti Kamasan Nyoman Arijana Online First: December 01, 2020IDH1 mutation in Balinese glioma patients and its relationship with clinicopatological parameters
Ni Putu Sriwidyani, Ida Ayu Ika Wahyuniari, Herman Saputra, I Gusti Kamasan Nyoman ArijanaPurpose: Isocitrate dehydrogenase 1 (IDH1) mutation plays an important role in the carcinogenesis of gliomas. The most recent WHO classification of central nervous system tumors has added molecular genetic in addition to the histological features of the tumor, including status of IDH mutation in glial tumors. The purpose of this study was to determine the prevalence of IDH1 mutations in Balinese glioma patients and its association with clinicopathological features.
Patients and methods: This study was conducted from 30 glioma patients at Sanglah General Hospital during January 2018 until June 2019. DNA extractions were carried out from the FFPE of tumor tissue, followed by amplification of codon 132 in exon 4 of the IDH1 gene by allele specific PCR. Relationship between IDH1 mutation status and clinicopathological features was tested with X2 with 0.05 significance.
Results: The age range of patients is 14-81 years with an average age of 43.4 years (SD±17.9 years). Most patients with astrocytic tumors (25/30; 83.3%), others were oligodendroglial tumor (2/30; 6.7%) and oligoastrocytic tumor (3/30; 10%). Most patients were found with grade IV glioblastoma (18/30; 60%). Genotyping analysis showed IDH1 mutations in the majority of glioma patients (90%). Most cases (92.6%) of mutant IDH1 showed heterozygous mutations (GA genotype) while the rest showed homozygous mutations (AA genotype). There were no significant relationship between IDH1 status and age (p=0.09), sex (p=0.63) and histologic type (0.14), but there was significant relationship between IDH1 mutation status and tumor grade (p=0.01). All of IDH1 mutation were found in diffuse glioma (grade II and III gliomas and grade IV glioblastoma).
Conclusion: Most of diffuse glioma (grade II-IV glioma) patients in Bali had IDH1 mutation and IDH1 mutation status has significant relationship with tumor grade. Further research about genetic abnormalities in order to improve therapeutic efficacy against IDH-mutated gliomas is needed.
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Seizure free status as a good predictor for quality of life of temporal lobe epilepsy patients after amygdalohippocampectomy
Muhamad Thohar Arifin, Ashari Ashari, Surya Pratama Brilliantika, Jacob Bunyamin, Hardian Hardian, Happy Kurnia Brotoarianto, Alifiati Fitrikasari, Zainal Muttaqin Online First: December 01, 2020Seizure free status as a good predictor for quality of life of temporal lobe epilepsy patients after amygdalohippocampectomy
Muhamad Thohar Arifin, Ashari Ashari, Surya Pratama Brilliantika, Jacob Bunyamin, Hardian Hardian, Happy Kurnia Brotoarianto, Alifiati Fitrikasari, Zainal MuttaqinBackground: The aim of epilepsy surgery is to improve the quality of life of people with epilepsy. Temporal lobe epilepsy (TLE) is the most common form of intractable epilepsy with a risk of low quality of life due to uncontrolled seizures. In this study, we evaluated the quality of life among TLE patients who underwent amygdalohippocampectomy between those who were free from seizure and those who were not.
Methods: This was a cross-sectional observational study. The postoperative quality of life was measured by QOLIE-31 questionnaire followed-up at least 12 months since the surgery.
Results: Among 31 patients, 21 patients (67.7%) were free from seizures after 12 months of follow-up. We observed significantly higher quality of life of those seizure-free patients either as overall quality of life (p=0.001) or among domains such as seizure anxiety (p=0.003), emotional well-being (p<0.001), fatigue (p<0.001), cognition (p=0.002), medication effects (p=0.01) and social function (p<0.001).
Conclusion: TLE patients who were seizure-free had better quality of life compared to those who were not after amygdalohippocampectomy.
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Relationship between body mass index, handgrip, and cognitive status on frailty status in elderly women
Dwi Ngestiningsih, Hermina Sukmaningtyas, Timothy G Susanto, Enny Probosari Online First: December 01, 2020Relationship between body mass index, handgrip, and cognitive status on frailty status in elderly women
Dwi Ngestiningsih, Hermina Sukmaningtyas, Timothy G Susanto, Enny ProbosariBackground: Decreased health due to the aging process is characterized by a decrease in the function and work of the body's organs which triggers the risk of disability and frailty, especially in postmenopausal women prone to sarcopenia which can worsen the condition of the elderly. The aim of the study is to determine the relationship between body mass index, handgrip, and cognitive status on frailty status in elderly women at some elderly integrated health services (posyandu lansia), Semarang City, Indonesia.
Methods: This study used a cross sectional design with a consecutive sampling method of 70 subjects. Subjects measured vital signs, weight and height. Subjects were then assessed for handgrip strength, cognitive status and frailty status. Univariate and bivariate data analysis used SPSS 25.0 with the Spearman correlation test.
Results: A total of 70 elderly women followed this study with an average age of 65.96 years. As many as 67.1% of elderly women have hypertension. There are 70% of all elderly women with pre-frail status and 4.3% with frail status. There is no significant relationship between body mass index and frailty status (p=0.328). There is no significant relationship between handgrip and frailty status (p=0.476). There is no significant relationship between cognitive status and frailty status (p=0.664).
Conclusion: The elderly women at the some elderly integrated health services, Semarang City mostly have pre-frail status. There is no significant relationship between body mass index, handgrip, and cognitive status on frailty status in elderly women.More ... | PDF
Differences of maternal leukocyte count in premature rupture of membranes and preterm premature rupture of membranes
Besari Adi Pramono, Putri Sekar Wiyati, Julian Dewantiningrum Online First: December 01, 2020Differences of maternal leukocyte count in premature rupture of membranes and preterm premature rupture of membranes
Besari Adi Pramono, Putri Sekar Wiyati, Julian DewantiningrumBackground: Premature rupture of membranes (PROM) is rupture of membranes amniotic membrane prior to the labor. PROM is associated with an increased incidence of preterm labor and infection.
Aim: To compare maternal leukocyte count in premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM)
Methods: This cross-sectional design was conducted at Dr. Kariadi General Hospital Medical Center and Kartini General Hospital Jepara from September 2019 to January 2020. The study sample was pregnant women with premature rupture of membranes that came to Emergency Department. Samples were divided into two groups, PROM and PPROM. All samples were subjected to leukocyte count examination.
Results: This study has a total of 40 samples, with 20 samples each. In PROM, 8 (40%) leukocytosis and 12 (60%) were normal, while in PPROM 7 (35%) leukocytosis and 13 (65%) were normal. There were no significant differences in maternal leukocyte levels in PROM and PPROM (p=0.229).
Conclusion: There were no significant differences in maternal leukocyte levels in PROM and PPROM.
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The correlation between serum fibroblast growth factor-23 with urinary fractional excretion of phosphate in predialysis chronic kidney disease
Yenny Kandarini, Vika Wirdhani, Anak Agung Wira Dewi Lestari Online First: December 01, 2020The correlation between serum fibroblast growth factor-23 with urinary fractional excretion of phosphate in predialysis chronic kidney disease
Yenny Kandarini, Vika Wirdhani, Anak Agung Wira Dewi LestariPurpose: To investigate the correlation of serum fibroblast growth factor-23 (FGF-23) with urinary fractional excretion of phosphate (FEPi) in predialysis chronic kidney disease (CKD).
Methods: This cross-sectional study involved 75 patients with CKD stage 2-4. Blood and 24-hour urine samples were taken from eligible participants to measure key variables using standard commercial assays. FGF-23 concentration was measured using enzyme-linked immunosorbent assay (ELISA). The correlation between FGF-23 serum level and urinary FEPi was analyzed using the Spearman correlation test.
Results: Of 75 eligible subjects, the majority had the characteristics of male gender, CKD stage 3, with mean age and body mass index of 50±10.8 and 23.51±3.3, respectively. The median FGF-23 level was 108.7 (13.6-1226.2) RU/ml, while the median urinary FEPi was 24.3% (4.04%-65.9%). There was a moderate positive correlation between FGF-23 and FEPi (r = 0.44, p<0.001).
Conclusion: The result confirmed the correlation between serum FGF-23 level with urinary FEPi in predialysis CKD.
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Correlation between perceived stigma and quality of life of Leprosy patients
Duma Wenty Irene Sinambela, Syahril Rahmat Lubis, Dina Arwina Dalimunthe Online First: December 01, 2020Correlation between perceived stigma and quality of life of Leprosy patients
Duma Wenty Irene Sinambela, Syahril Rahmat Lubis, Dina Arwina DalimuntheBackground: Stigma is one of many problems that hinders leprosy prevention efforts. Perceived stigma refers to the perceptions and subjective awareness of leprosy patients what the community thinks or do to themselves which can reduce quality of life (QOL). This study aimed to analyze the correlation between perceived stigma and QOL of leprosy patients
Methods: This study involved 30 leprosy patients and the baseline data were collected through interview. We assessed perceived stigma and QOL respectively by using Explanatory Model Interview Catalogue (EMIC) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire. Pearson correlation test is used to analyze the collected data.
Results: There was a significant correlation between perceived stigma and QOL (p=0,011; r= -0,459). The majority of research subjects were aged between 19-40 years old with male sex predominance, senior high school education, income below the city minimum wage and married status. Most of them had negative perceived stigma. Covering illness from others and discussing their illness closest people were the dominant factors affecting perceived stigma. They had ordinary QOL subjectively, not satisfied to health condition, physical domain was the most affected by Leprosy and had a good QOL.
Conclusion: There was a significant correlation between perceived stigma and QOL.
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The effect of purple sweet potato (Ipomea batatas L) ethanol extract on Estrogen Receptor Alpha (ERα) and SOD mRNA expression in the menopause-liver animal model
I Wayan Sugiritama, Ida Ayu Ika Wahyuniari, I Gusti Ayu Dewi Ratnayanti, Ni Made Linawati, I Gusti Nyoman Sri Wiryawan, Ni Luh Gede Yoni Komalasari, I Gusti Kamasan Nyoman Arijana Online First: October 13, 2020The effect of purple sweet potato (Ipomea batatas L) ethanol extract on Estrogen Receptor Alpha (ERα) and SOD mRNA expression in the menopause-liver animal model
I Wayan Sugiritama, Ida Ayu Ika Wahyuniari, I Gusti Ayu Dewi Ratnayanti, Ni Made Linawati, I Gusti Nyoman Sri Wiryawan, Ni Luh Gede Yoni Komalasari, I Gusti Kamasan Nyoman ArijanaBackground: Aging and estrogen deficiency in menopause women increase susceptibility to liver diseases. In postmenopausal women, the change of ERα expressions and oxidative stress is related to liver diseases' pathogenesis. Phytoestrogens have been shown to protect and repair the liver organ due to estrogen deficiency. Purple Sweet Potatoes contain anthocyanins, a subgroup of flavonoids that have been shown to have antioxidant and phytoestrogen activity. This study aims to evaluate the phytoestrogen and antioxidant activities of purple sweet potato in a liver animal model of menopause through Superoxide Dismutase (SOD) and ERα expressions.
Method: A true experimental study by randomized post-test-only control group design was conducted among 28 female Wistar rats-aged 10-12 weeks with a bodyweight of 180-220 gram, which underwent bilateral ovariectomies. These animals were divided into 4 groups, with 7 rats in each group. On day 7, Group T0, as control was given aquadest, ethanol extract of purple sweet potato was assigned to Group T1, T2, and T3 with doses 1, 2, and 4 mL/day, respectively, during 30 days. The SOD and ERα mRNA expressions were evaluated by qRT-PCR with specific primers. Data were analyzed using SPSS version 20 for Windows.
Results: The mRNA expressions of ERα were not significantly different among groups (p>0.05), while SOD expressions were significantly different among groups (p<0.05). The expression of SOD in Group T1 (504.39±231.4 pg/μL), T2 (2,147.92±417.1 pg/μL), and T3 (405.30±224.1 pg/μL) showed a significantly higher than Group T0 (15.34±15.27) (p<0.05)
Conclusion: Oxidative stress could be prevented by purple sweet potato in the liver through the SOD mRNA expression but not ERα.
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The effect of Balinese Purple Sweet Potato (Ipomoea batatas L.) tuber ethanolic extract on renal Nox4 level in mice with a high purine diet
Agung Nova Mahendra, Ni Wayan Sucindra Dewi Online First: October 13, 2020The effect of Balinese Purple Sweet Potato (Ipomoea batatas L.) tuber ethanolic extract on renal Nox4 level in mice with a high purine diet
Agung Nova Mahendra, Ni Wayan Sucindra DewiBackground: TLR4-NADPH Oxidase-4 or TLR4-Nox4 signaling pathway uric acid (UA)-induced oxidative stress is involved in urate nephropathy pathogenesis, which can culminate into renal fibrosis, a common feature of chronic kidney disease (CKD). Based on the hyperuricemic and antioxidant effect of anthocyanin on the kidney, we assumed that Balinese purple sweet potato (Ipomoea batatas L.) tuber in its ethanolic extract form (PSPEE) could suppress the activation of renal TLR4-Nox4 signaling. This study was aimed to investigate the renoprotective effect of PSPEE via renal Nox4 downregulation, using a murine model induced with a high-purine diet.
Methods: This study was an experimental laboratory study using a post-test only with a control group design among 38 male Swiss mice. The Male Swiss mice (20-30 g) were randomly allocated into 2 groups, namely, the control group (treated with a high-purine diet for 7 days) and the PSPEE group (treated with a high-purine diet for 7 days and PSPEE for 14 days). The serum uric acid (sUA) level was quantified using the UA phosphatase method. Meanwhile, the renal Nox4 level was quantified using ELISA. Data were analyzed using SPSS version 20 for Windows.
Results: Our study found that the renal Nox4 levels were 18.65±1.67 ng/mL and 15.14±1.66 ng/mL for the control and PSPEE groups. Based on the statistical analysis, there was no statistically significant difference between control and PSPEE groups (p>0.05).
Conclusion: Balinese PSPEE tends to decrease renal Nox4 level in high-purine diet-treated mice, but fails to show a significant effect.
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The in-vivo anti-inflammatory effect of red earthworm (Lumbricus rubellus) ethanolic extract from organic farmland in Bali, Indonesia
Ni Wayan Sucindra Dewi, Agung Nova Mahendra Online First: October 13, 2020The in-vivo anti-inflammatory effect of red earthworm (Lumbricus rubellus) ethanolic extract from organic farmland in Bali, Indonesia
Ni Wayan Sucindra Dewi, Agung Nova MahendraBackground: One of the typical responses to the protection of the body is inflammation. Extensive and severe inflammation can result in tissue damage. Earthworms have been used empirically for years to treat diseases that are based on inflammatory events. This study evaluates the anti-inflammatory properties of red earthworm (Lumbricus rubellus) ethanolic extract from organic farmland in Bali, Indonesia.
Methods: An experimental study by post-test only control group design was conducted among 30 adult male Wistar rats, divided into 6 groups. Each group was given 0.5% NaCMC (negative control), Diclofenac sodium 9 mg/kgBW (positive control), Red earthworm ethanolic extracts of 50 mg/kgBW (P1) and 100 mg/kgBW (P2) at 1 hour before carrageenan injection. In addition, the ethanolic extracts of Red earthworms, respectively 50 mg/kgBW (P3) and 100 mg/kgBW (P4), which had been given once a day, during 1 week before and at the eighth day 1 hour before carrageenan injection. The measurements of edema were performed 4 hours after the administration of the test material. Data were analyzed using SPSS version 20 for Windows.
Results: The median score of Rats Hind Paw Edema was 0.3 (0.2-0.4) ml in negative control, 0.1 (0.0-0.2) ml in positive control, 0.2 (0.1-0.2) ml in P1, 0.2 (0.1-0.3) ml in P2, 0.2 (0.1-0.2) ml in P3, and 0.1 (0.1-0.2) ml in P4 groups. There was a significant differences between the NaCMC group (negative control) with the Diclofenac sodium group (positive control), P1, P3, and P4 groups (p<0.05), but not with P2 group (p>0.05).
Conclusion: We conclude that red earthworm (Lumbricus rubellus) ethanolic extract from Bali's organic farmland exhibits an anti-inflammatory effect.
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The hepatoprotective effect of cacao beans whole extracts (Theobroma cacao L.) in oxidative stress mice
Ida Ayu Dewi Wiryanthini, I Wayan Gede Sutadarma, Ni Wayan Sucindra Dewi, I Wayan Surudarma Online First: October 13, 2020The hepatoprotective effect of cacao beans whole extracts (Theobroma cacao L.) in oxidative stress mice
Ida Ayu Dewi Wiryanthini, I Wayan Gede Sutadarma, Ni Wayan Sucindra Dewi, I Wayan SurudarmaBackground: Increased production of reactive oxygen species (ROS), causing accumulation of oxidative damage. Carbontetraclorida (CCl4) is known as a toxic material and causing hepatocellular damage initiated by oxidative stress, which increased blood serum glutamic pyruvic transaminase (SGPT) concentration. Cacao beans (Theobroma cacao L.) extracts have antioxidant properties from flavonols, consisting of catechin, epicatechin, and procyanidin. This study aims to investigate the effect of hepatoprotective of cacao beans (Theobroma cacao L.) extracts in oxidative stress mice induced by CCL4.
Methods: The study was conducted at the Department of Biochemistry and Department of Pharmacology and Therapy, Faculty of Medicine Udayana University using the Pretest-Postest Control Group Design. About 20 male mice were divided into 4 groups, as control or placebo group (P0), intervention group by 15 mg extracts of cacao beans (P1), 30 mg (P2), and 60 mg (P3) for 7 days. On the eight-day induced by 0,55 mg/gram mice bodyweight of CCl4. All groups were examined for blood SGPT concentration before and after the intervention. Data were analyzed using SPSS version 20 for Windows.
Results: The SGPT level prior to the administration of cacao bean extract and CCl4 was 18.56±0.19 µ/L in P0 group, followed by 18.41±0.28 µ/L (P1), 18.36±0.21 µ/L (P2), and 18.16±0.47 µ/L (P3), but statistically not significant (p=0.260). However, after CCl4 administration, the SGPT levels were 38.63±0.37 µ/L in P0 but significant decrease in the P1 (28.14±0.34 µ/L), P2 (20.72±0.35 µ/L), and P3 (18.68±0.25 µ/L) following cacao beans whole extracts administration (p=0.000).
Conclusion: This study concluded that cacao beans extracts administration could inhibit the oxidative stress and protect hepatocellular damage induced by CCl4 by decreasing the blood SGPT concentration.
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Correlation of plasma vitamin d receptors with the severity of psoriasis vulgaris
Made Swastika Adiguna, Luh Made Mas Rusyati, Prima Sanjiwani Saraswati Sudarsa Online First: October 20, 2020Correlation of plasma vitamin d receptors with the severity of psoriasis vulgaris
Made Swastika Adiguna, Luh Made Mas Rusyati, Prima Sanjiwani Saraswati SudarsaIntroduction: Psoriasis vulgaris is still a major problem in the field of dermatology. Until recently, the exact cause of psoriasis is still being debated. In recent years research has been carried out on vitamin D and its role in the immune system, especially in psoriasis. Vitamin D cannot be separated from the role of VDR. The study aims to evaluate correlation between VDR plasma levels and the severity of psoriasis vulgaris.
Method: Study design using a cross-sectional design to determine the correlation of vitamin D levels in plasma with the severity of psoriasis vulgaris calculated using the Psoriasis Area and Severity Index (PASI) score.
Result: This study included 47 study participants who had psoriasis vulgaris, consisting of 30 (63.8%) men and 17 (36.2%) women with a mean age of 44.66 years. The mean PASI score was 6.904, while the mean plasma VDR level was 30.328 ng/ml. Spearman correlation shows a strong negative correlation (r = - 0.979; p <0.001) between plasma VDR levels and PASI scores in psoriasis vulgaris patients.
Conclusion: Vitamin D plays a role in regulating the growth and differentiation of keratinocytes and influences dendritic cells and T lymphocytes' immune function so that low vitamin D levels have essential implications in the pathogenesis of psoriasis vulgaris. In performing its function, vitamin D must bind to VDR and form a complex. In this study, it was found that there was a strong negative correlation between plasma VDR levels and PASI scores, so it can be concluded that low plasma VDR levels correlate with high degrees of psoriasis vulgaris severity and vice versa.
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High serum interleukin-2 levels are associated with pruritus in chronic kidney disease undergoing regular hemodialysis
Luh Made Mas Rusyati, Yenny Kandarin, Ni Nyoman Tri Priliawati Online First: October 20, 2020High serum interleukin-2 levels are associated with pruritus in chronic kidney disease undergoing regular hemodialysis
Luh Made Mas Rusyati, Yenny Kandarin, Ni Nyoman Tri PriliawatiBackground: Uremic pruritus or more accurately termed ‘chronic kidney disease-associated pruritus’ (CKD-aP) is chronic itch in patients with advanced or end-stage renal disease without evidence of any other active disease that could explain the pruritus. The pathogenesis of CKD-aP is complex and not fully clarified. Some preliminary studies indicate that CKD-aP is a systemic inflammatory disease with a deranged balance of T helper (TH) cell differentiation toward TH1 predominance especially IL-2. This study aimed to elucidate further the association of interleukin-2 serum levels with CKD-aP in patients undergoing regular hemodialysis (HD).
Methods: This was an analytical cross-sectional study. Sampling was taken with consecutive sampling technique. This study was carried out on 72 patients on regular HD consist of 36 patients with CKD-aP and 36 patients without CKD-aP after meeting the inclusion and exclusion criteria. Blood samples were obtained at Hemodialysis Unit Sanglah General Hospital and IL-2 serum levels were measured at Clinical Pathology Laboratory Sanglah General Hospital Denpasar between July 2019 and August 2019. Mann-Whitney U Test was used to compare IL-2 serum between CKD-aP and non-CKD-aP group.
Results: Results in this study we found higher median IL-2 level (17.1 ng/l) on pruritus group versus those without pruritus (13 ng/mL) (p<0.05).
Conclusion: IL-2 serum levels on CKD-aP patients are higher than those without CKD-aP in patients who undergo regular hemodialysis.
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Correlation between malondialdehyde levels and disease activity in vitiligo
Prima Sanjiwani Saraswati Sudarsa, I Gusti Ayu Agung Praharsini, Ratih Vibriyanti Karna Online First: October 20, 2020Correlation between malondialdehyde levels and disease activity in vitiligo
Prima Sanjiwani Saraswati Sudarsa, I Gusti Ayu Agung Praharsini, Ratih Vibriyanti KarnaBackground: Vitiligo is an acquired depigmented skin disease that occurs due to the death of melanocytes. There are various presumed theories about the cause of melanocyte death in vitiligo; one of them is oxidative stress theory. Lipid peroxidation is the primary manifestation of oxidative stress, producing malondialdehyde (MDA) as its end product. Malondialdehyde is a stable marker to assess the occurrence of oxidative stress. This study aims to prove the differences in serum MDA levels in the active vitiligo, stable vitiligo, and normal control groups.
Method: This research is an analytical cross-sectional study involving 64 vitiligo patients with active and stable lesions and 20 normal controls. The study was conducted at Sanglah General Hospital Denpasar in February - November 2019. Serum MDA levels were measured to assess oxidative stress. The measurement of MDA levels was carried out by a spectrophotometer instrument using Competitive-ELISA method.
Results: In this study, there were significant differences in MDA levels between active, stable vitiligo patients, and control group (p=0.000) with active vitiligo type have the highest MDA mean, followed by stable type and control group respectively.
Conclusion: Increased serum MDA levels are an indicator of oxidative stress in vitiligo, which leads to melanocyte death and manifests as increased vitiligo disease activity. The results of this study support the role of oxidative stress in vitiligo pathogenesis and the use of oxidative stress indicators like serum MDA levels as biomarker in evaluating vitiligo disease activity.
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Overexpression of nuclear factor kappa B (NF-кB) protein as a risk factor for anthracyclin chemoresistance in luminal a subtype locally advanced breast cancer (LABC) at Sanglah General Hospital, Bali - Indonesia
Prabudi Prabudi, Ida Bagus Tjakra Wibawa Manuaba, I Wayan Sudarsa Online First: October 23, 2020Overexpression of nuclear factor kappa B (NF-кB) protein as a risk factor for anthracyclin chemoresistance in luminal a subtype locally advanced breast cancer (LABC) at Sanglah General Hospital, Bali - Indonesia
Prabudi Prabudi, Ida Bagus Tjakra Wibawa Manuaba, I Wayan SudarsaBackground: Around 68.6% of women who have breast cancer seek medical treatment at a locally advanced stage (LABC), where the neoadjuvant chemotherapy (NAC) modality is the initial choice therapy. Luminal A was recorded as the subtype with the chemotherapy response being the most resistant among others. The cause of chemoresistance is multi-factorial, and several studies correlate this condition with several anti-apoptotic agents expressed in the nucleus of cancer cells, especially nuclear factor-kappa B (NF-кB). The NF-κB transcription factor as an anti-apoptotic agent in some cancers blocks the apoptotic pathway through the extrinsic and intrinsic pathways. NF-κB plays a vital role in the development of chemoresistance. Understanding the NF-κB pathway and perceiving more about the cellular characteristics of LABC is very important to develop NF-κB inhibitors as therapy. NF-κB as a transcription factor can be considered a promising research target because it can affect oncogenes' transcription and play an essential role in prognostic and predictive biomarkers. This study was conducted to determine whether NF-κB overexpression is a risk factor for anthracycline-based neoadjuvant chemoresistance in Luminal A subtype LABC patients at Sanglah General Hospital.
Methods: An unpaired case-control study was conducted at Sanglah General Hospital. The research subjects were 40 people, divided into case groups (chemoresistance) and control groups (chemosensitive). Hereafter the NF-κB H-Score was carried out by IHC examination. Data are presented in table form and analyzed by Chi-square test or Fischer exact.
Results: Samples of cases with NF-κB overexpression were obtained 13 (65%), compared with the control group 7 (35%) (p<0.05). Multivariate analysis has shown that NF-κB overexpression is an independent factor against anthracycline-based chemotherapy resistance in advanced LABC patients with local luminal subtypes with p=0.013; OR 3.45 (95% CI=2.94-12.65).
Conclusion: NF-κB expression in Luminal A subtype LABC can be used as a predictor for anthracycline-based neoadjuvant chemoresistance. NF-κB overexpression is a predictor factor for NAC chemoresistance in luminal A subtype LABC.
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High c-reactive protein level as risk factors of complications in upper gastrointestinal bleeding
I Ketut Mariadi, Karismayusa Sudjana, I Dewa Nyoman Wibawa Online First: October 30, 2020High c-reactive protein level as risk factors of complications in upper gastrointestinal bleeding
I Ketut Mariadi, Karismayusa Sudjana, I Dewa Nyoman WibawaPurpose: Upper gastrointestinal bleeding is the major medical emergency case in the field of gastroenterology. The complications of UGI bleeding are recurrent bleeding and death. Identifying risk factors for the complications is expected to prevent or reduce recurrent bleeding complications and deaths from UGI bleeding. This study aims to know the risk of UGI bleeding complications in patients with a high level of C reactive protein (CRP).
Patients and methods: A prospective observational analytic study was performed, including all UGI bleeding patients (variceal and nonvariceal). CRP level was used to determine the high-risk cohort. High-risk cohort if the CRP level 5 mg/L and above, and low risk if CRP level less than 5 mg/L. The outcome of the study was the incidence of complication, both rebleeding and death during follow up for six weeks.
Results: Based on the characteristic data of the sample, the high-risk group appears to have a slightly older age, higher leucocyte count, lower hemoglobin levels, and higher serum creatinine than the low-risk group. The incidence rate of complication in the high-risk group was 85.3% while in the low-risk group was 37.5%, and the relative risk (RR) was 2.27 (95% CI: 1.43-3.67). There were significant differences in the incidence of complications between the group, X2: 16; p <0.001. The RR for rebleeding in the high-risk to low-risk cohort was 2.68 (95% CI: 1.31-5.47); this difference is statistically significant (X2:9.3; p=0.02). The RR for death complication was 1.70 (95% CI: 0.63-4.53), and the difference is not statistically significant (X2: 1.2; p=0.28).
Conclusion: In this study, we found the CRP level ≥ 5 mg/L as a significant risk factor for rebleeding complications but not mortality in a patient with UGI bleeding.
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Patient characteristics of non-operative anterior cruciate ligament injury associated with poor knee functions on activities of daily living: a cross-sectional study
I Putu Gde Surya Adhitya, Ida Bagus Amertha Putra Manuaba, Lalu Suprawesta, Yosika Septi Mauludina, Siti Ainun Marufa Online First: November 03, 2020Patient characteristics of non-operative anterior cruciate ligament injury associated with poor knee functions on activities of daily living: a cross-sectional study
I Putu Gde Surya Adhitya, Ida Bagus Amertha Putra Manuaba, Lalu Suprawesta, Yosika Septi Mauludina, Siti Ainun MarufaIntroduction: The ACL injury has commonly occurred in a greater number of athletes, less publication is about poor knee function and ACL injury in the patient with non-operative treatment. This study aimed to describe the characteristics of patients with ACL injury non-operative, which are associated with poor knee function on daily living activities.
Methods: We included patients with ACL injury that has been diagnosed for ACL injury by an orthopedic surgeon or physiotherapist in a hospital or private clinic. All participants were recruited from February 2019 to April 2019. The inclusion criteria were patients who at least 18 years old. We used the KOOS ADL function cut-off score ≤80 to dichotomous the patient with knee problems, and score >80 have no statistical analysis problem. We calculated using binary logistic regression on the KOOS ADL function for each variable.
Results: The mean score of KOOS daily living was 72.8 points, of which 66 participants had poor scores, and 37 were acceptable. Women were 9.2 times more likely to had poor KOOS daily living scores than men in non-operative ACL injury patients (p=0.044), and non-elite athletes had a higher possibility by 8.5 times higher than those who were participated in sports only for leisure or recreation (p=0.002).
Conclusion: This study confirmed that patients who did not undergo the ACL reconstruction had a poor knee function in daily living. It was associated with women and non-elite athlete participants, yet the concomitant injuries were possibly confounder for the association.
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In vitro study comparison of purple leaf extract as denture cleanser at different concentration towards S. mutans growth on flexible denture
Tri Purnami Dewi Online First: November 05, 2020In vitro study comparison of purple leaf extract as denture cleanser at different concentration towards S. mutans growth on flexible denture
Tri Purnami DewiBackground: The denture usage should be accompanied by good denture cleansing to prevent denture damage and oral disease due to bacterial on the denture. Research on purple leaves (Graptophyllum pictum) showed that purple leaves have anti-bacterial and antimicrobial activity. So it is essential to study the effectiveness of purple leaves as denture cleanser towards the growth of S. mutans on flexible denture plates.
Objective: The objective of the study was to compare the effectiveness of purple leaf extract at different concentrations: 1.25%; 2.5%; 10% and 40%, fittidentÒ and aquadest towards S. mutans growth on flexible denture plates.
Methods: This study was in vitro study that used S. mutans from local isolates of the microbiological laboratory faculty of medicine, Universitas Udayana. The isolates were incubated for 24 hours with temperature 37oC on 18 plates (10x10x2mm). The concentration of purple leaf extract was 1.25%; 2.5%; 10% and 40%. The effectiveness of purple leaf extract, fittidentÒ and aquadest towards the growth of S. mutans can be evaluated from the number of S. mutans colonies on flexible denture base plate (CFU/ml). Data were analyzed using the One Way Anova test with 95% confidence level (α = 0,05%). LSD (Least Significant Different) was tested to determine the significance of differences in the treatment group.
Result: The lowest mean of colonies' growth was found in 10% concentration (21.0000). There was significant difference in colony count between the extract concentration groups (p=0.000). LSD-multi comparisons test on the Post Hoc analysis showed a significant difference between the extract concentrations of 1.25% to 10% (p=0.037), and the 2.5% extract to 10% (p=0.012) and 40% (p=0.027). Graptophylum pictum extract showed with highest flavonoid content (4340,30 mg/100 QE wb).
Conclusion: All extract concentrations are effective in suppressing bacterial growth. The optimum concentration to the growth of S. mutans was the extract with 10% concentration but did not differ significantly with the 40% concentration extract.
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The effect of ethyl acetate fraction of Moringa oleifera leaves on neutrophil and MDA levels in the improvement of liver dysfunction in male rats with sepsis model
Riswanto Riswanto, Tatar Sumandjar, Dhani Redhono, Robby Kurniawan, Arief Rahman Online First: December 01, 2020The effect of ethyl acetate fraction of Moringa oleifera leaves on neutrophil and MDA levels in the improvement of liver dysfunction in male rats with sepsis model
Riswanto Riswanto, Tatar Sumandjar, Dhani Redhono, Robby Kurniawan, Arief RahmanPurpose: Sepsis is life-threatening organ dysfunction caused by the dysregulation of the host response due to infection. Sepsis is caused by an imbalance between pro-inflammatory and anti-inflammatory cytokines. Moringa oleifera (Mo) leaves naturally contains antiinflammation and antioxidant. We aim to investigate Mo leaves in sepsis.
Patients and methods: This is an experimental laboratory study with Post Test Only Control Group Design. 30 Winstar males rats were divided into four treatment groups; each consist of 6 rats. The negative group, the positive control group received an injection of LPS dose of 0.25 mg/kg BW, and the interventional group with Mo-EA dose of 10, 20, 40 mg/kg BW. The Annova and Kruskal-Wallis test was used in this study. The significant p-value<0.05. The measured outcome were neutrophil levels, malondialdehyde (MDA) levels, and Serum Glutamic Pyruvate Transaminase (SGPT) / Serum Glutamic Oxaloacetic Transaminase (SGOT).
Results: The neutrophil, MDA, SGOT, and SGPT levels were decreased significantly within the treated group. MO Fraction can decrease the serum of MDA, Neutrophil, and SGOT/SGPT levels in days 3 and 7 (p<0.05).
Conclusion: There was a decrease in the level of Neutrophil, MDA, SGOT, and SGPT improvement of Hepar organ dysfunction after administration of MO Extract, so it is useful to inhibit the progression of sepsis.More ... | PDF
Investigating the relationship between accountability and job satisfaction: A case study in hospitals affiliated to Yazd University of Medical Sciences 2017
Askari Roohollah, Hatami Hanza Maryam Online First: December 01, 2020Investigating the relationship between accountability and job satisfaction: A case study in hospitals affiliated to Yazd University of Medical Sciences 2017
Askari Roohollah, Hatami Hanza MaryamIntroduction: high accountability of employees, the organization can be helped to achieve the goals. In general, this research is to investigate the relationship between accountability and job satisfaction in nurses in an educational hospital affiliated to Yazd University of Medical Sciences
Method: This study was a descriptive study of correlation type that has been conducted a cross-sectional study in 2017. We involved 190 nurses from selected educational hospitals affiliated to the Yazd University of Medical Sciences in the city of Yazd that have been chosen by stratified random sampling method. The data collection tool was Costa and M Care Accountability Questionnaire concerning 12 items, and Kendall and Smith Job Satisfaction Questionnaire were 37 items. Likert's 5 scales were used to determine the score of accountability and job satisfaction. The data was analyzed by descriptive-analytical statistical tests and Pearson correlation coefficient, a significance level of 0.05, and in the SPSS software version 20.
Results: there was no significant relationship between accountability and job satisfaction except one of job satisfaction (nature of work) (p=0.009). Also, a significant association was observed between three demographic variables of the age group (31-35) years (p=0.047) and work experience between (11-15) years (p=0.03) and the gender of women (p = 0.005) and two variables of accountability and satisfaction.
Conclusion: According to the results, it is better to pay more attention to work nature to implement responsibilities more efficiently and increase job satisfaction.
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Effect of heparin administration on heparin-induced thrombocytopenia (HIT) in atherosclerotic New Zealand Rabbit (Oryctolagus cuniculus)
Victor Jesron Nababan, Agung Prasmono, Endang Retnowati, Djoko Legowo, Sofna Banjarnahor Online First: December 01, 2020Effect of heparin administration on heparin-induced thrombocytopenia (HIT) in atherosclerotic New Zealand Rabbit (Oryctolagus cuniculus)
Victor Jesron Nababan, Agung Prasmono, Endang Retnowati, Djoko Legowo, Sofna BanjarnahorBackground: Platelets have been associated with the pathogenesis of atherosclerosis by excreting various chemokines (i.e. PF4), which systematically interact with multiple molecules. The formation of circulating heparin-platelet factor-4 (PF4) complexes have been observed in heparin-induced thrombocytopenia (HIT) cases, raising questions about the role of PF4-derived atherosclerosis in the predisposition of HIT.
Methods: An in vivo model of atherosclerosis was generated by feeding rabbits with a high-cholesterol diet for six weeks and a normal rabbit as a control group. HIT was induced by injecting heparin subcutaneously for ten days twice daily. Platelets count before and after heparinization was performed by hemocytometer, PF4 measurement was determined by ELISA assay. Histopathology examinations for artery thickness, foam cell, and endothelial denudation were conducted by Hematoxylin and Eosin (H&E) staining.
Results: There was no significant difference in the IgG PF4/heparin complex between the atherosclerotic and the normal groups (43.84±2.07 ng/mL vs. 41.87±3.44 ng/mL), platelet count was significantly reduced only in the atherosclerotic group (p=0.01; mean differences 7162.00±57311.02/mm3), endothelial denudation and foam cell formation were observed in the atherosclerotic group. Also, a significant difference observed in endothelial thickness between the atherosclerotic group compared to the normal group (470.32 ± 131.15 µm vs. 332.05±50.82 µm; p=0.032).
Conclusion: Our results suggest that atherosclerosis was significantly associated with the development of heparin-induced thrombocytopenia. However, atherosclerosis is not a risk factor for the formation of PF4-heparin complex in HIT.
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Growth parameters in children with atopic dermatitis in Erbil City, Kurdistan Region-Iraq
Ahang Mohammed Hamid, Dindar Sharif Qurtas Online First: December 01, 2020Growth parameters in children with atopic dermatitis in Erbil City, Kurdistan Region-Iraq
Ahang Mohammed Hamid, Dindar Sharif QurtasBackground: Atopic dermatitis is a chronic inflammatory skin condition that significantly impacts patients' quality of life. A disturbed sleep pattern, frequent potent topical and sometimes systemic corticosteroid use, and diet restriction, all of which could affect child's growth.
Objective: This study determined height and weight impairment in children with atopic dermatitis.
Patients and Methods: A cross-sectional study took children with atopic dermatitis ≤18 years, which was conducted in the "Erbil Dermatology Teaching Center." The patients' data included sociodemographic information, family history, drug history, and present complaints. The severity of the disease evaluated using SCORAD score. The weight was recorded using a medical electronic weighing machine, and standing height was recorded using a stadiometer.
Results: Among 100 children with atopic dermatitis, their mean of age was 6.84±1.8 years. Males and Females frequencies were 54 and 46, respectively. The family history of atopic dermatitis was positive in 73%. Generally disturbed sleep pattern was dominant, and almost all severe AD patients had disturbed sleep (87.5%). The severity of AD was classified by SCORAD score to mild (23%), moderate (69%), and severe (8%). Patients having their growth percentile for weight and height for age below 3rd percentile were 10% and 3%, respectively. Patients' weight and height for age below 25th percentile were 15% and 9%, respectively.
Conclusions: Atopic dermatitis can affect the height and weight of the children inversely. The study sample's most dominant character was sleep pattern disturbances, which can affect both weight and height.
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Correlation between postherpetic neuralgia (PHN) patients’ stress level and the quality of life of their families in Universitas Sumatera Utara Hospital
Finisia Angkasa, Imam Budi Putra, Ariyati Yosi Online First: November 07, 2020Correlation between postherpetic neuralgia (PHN) patients’ stress level and the quality of life of their families in Universitas Sumatera Utara Hospital
Finisia Angkasa, Imam Budi Putra, Ariyati YosiBackground: Postherpetic neuralgia (PHN) is the most common complication seen in herpes zoster patients. Its clinical manifestations consist of persisting sharp pain even when the initial exanthema has disappeared. These patients experienced stress from the conditions and from the treatment process, which in turn affect their families’ quality of life.
Patients and Methods: This study was an observational analytic study with a cross-sectional design involving 30 PHN patients and their families. Patients were required to fill out the Perceived Stress Scale (PSS-10) questionnaire to assess their stress levels. Their respective families were required to fill out the Family Dermatology Life Quality Index (FDLQI) questionnaire to assess their quality of life. Statistical analysis was performed on both data with the Spearman correlation test (data were not normally distributed). ANOVA test was performed to assess the average difference between the stress levels experienced by PHN patients and the quality of life of their families.
Results: The families of PHN patients who experienced severe stress levels had worse or lower quality of life compared to the families of patients with moderate or mild stress levels. The lowest average score of quality of life is 27.20 (severe stress level) and the highest average score of quality of life is 14.33 (mild stress level).
Conclusions: The stress level of PHN patients was significantly related to the quality of life of their respective families in the aspects covered in the FDLQI questionnaire (p <0.005). There was a significant difference in the family's quality of life score based on the patient's stress level (p<0.001)
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Bacterial identification of acne vulgaris
Lovena Sari, Nelva Karmila Jusuf, Imam Budi Putra Online First: November 07, 2020Bacterial identification of acne vulgaris
Lovena Sari, Nelva Karmila Jusuf, Imam Budi PutraBackground: Acne vulgaris (AV) is a chronic inflammation of the pilosebaceous unit with clinical polymorphic lesion consist of non-inflammatory (open and closed comedones) and inflammatory lesions (papules, pustules, and nodules) with varying degree of inflammation and depth. Earlier studies showed that other bacteria might also found and played a role in acne pathogenesis besides Cutibacterium acnes (C. acnes).
Patients and Methods: This descriptive observational study used cross-sectional method. Samples were collected from 40 subjects with AV. We took the samples from non-inflammatory (closed comedones) and inflammatory lesions (pustule) in each subject, followed by Gram staining, aerobic and anaerobic bacterial culture, and bacterial identification. This research has been approved by the Ethical Committee, Faculty of Medicine, University of Sumatera Utara.
Results: There were 12 bacterial species that were identified from 80 samples. We identified Cutibacterium acnes (21,2%) in anaerobic culture. While in aerobic culture, we identified Staphylococcus epidermidis (47,5%), Staphylococcus hominis (17,5%), Staphylococcus aureus (8,7%), Staphylococcus haemolyticus (8,7%), Leuconostoc mesentroides (6,2%), Micrococcus luteus (3,7%), Kocuria varians (2,5%), Staphylococcus vitulinus (1,2%), Staphylococcus cohnii (1,2%), Staphylococcus arlettae (1,2%) and Dermacoccus nishinomyaensis (1,2%).
Conclusion: The two most common bacteria in acne vulgaris are Staphylococcus epidermidis and Cutibacterium acnesMore ... | PDF
The quality of life in the treatment of maxillofacial fractures using open reduction: A prospective study
Nyoman Ayu Anggayanti, Endang Sjamsudin, Tantry Maulina, Aulia Iskandarsyah Online First: November 17, 2020The quality of life in the treatment of maxillofacial fractures using open reduction: A prospective study
Nyoman Ayu Anggayanti, Endang Sjamsudin, Tantry Maulina, Aulia IskandarsyahPurpose: To assess the impact of open reduction on quality of life in patients with maxillofacial fractures.
Methods: A prospective study of 15 patients admitted to a general hospital in Bandung for maxillofacial trauma from October 2017 through February 2018 was conducted. Trauma severity was assessed using facial injury severity scale (FISS) score, while the quality of life was assessed using Oral Health Impact Profile (OHIP) -14 questionnaires at one day before surgery (T0) and 14 (T1) and 60 days (T2) after surgery.
Results: Male (3.92±1.89) and younger patients (3.89±1.69) had a greater mean FISS score than their respective counterparts. The most common areas involved in maxillofacial fractures were mandible body (80%) and dentoalveolar (46.67%). The overall quality of life was worse in younger patients as indicated with a higher mean OHIP-14 score. There was a disparity in the domain of interest where younger patients (17-30 years) had more concern over psychological discomfort, whereas older patients (31-50 years) were more concerned about physical disability. Both qualitative and quantitative improvement in quality of life was observed in the follow-up period. Consistent and statistically significant improvement in mean OHIP-14 score before intervention (20.80±5.94), 14 days post-intervention (17.93±4.68), and 60 days post-intervention (14.67±3.42) was observed.
Conclusion: Open surgery approach yielded a good outcome in quality of life improvement. Further study on demographic factors, timing, and quality of life domain affected in maxillofacial fractures is recommended.
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Correlation between body mass index with striae in female adolescent
Imam Budi Putra, Nelva K. Jusuf, Chyntia Giska Aryunisari Online First: November 19, 2020Correlation between body mass index with striae in female adolescent
Imam Budi Putra, Nelva K. Jusuf, Chyntia Giska AryunisariBackground: Striae has been reported as a skin problem often experienced by a woman and becomes an aesthetic problem. This skin problem can occur at any age, including adolescents, even though it is more common in younger women. Some conditions increase the risk of striae, such as weight, pregnancy, puberty, and hormonal drugs. Women with higher body mass index (BMI) tend to have more striae. With a limited study on striae, it is quite interesting to evaluate the high incidence of striae in the population.
Patients and Methods: This was a cross-sectional study using a total sampling method. The study was conducted after approval from the Ethics Committee Faculty of Medicine, Universitas Sumatera Utara. Samples are 155 female students aged 18-25 years old from the Medical Faculty of Universitas Sumatera Utara. All samples were physically examined to diagnose the striae, and the BMI was calculated. All the collected data were analyzed statistically with ETA statistical tests to see the relationship between BMI and striae. P-value <0.05 considered statistically significant.
Results: The dominant age of the subject is 19 years old (62.5%), followed by 20 years old (30.3%), 21 years old (3.8%), and 18 and 23 years old (0.6%). Out of 155 subjects, there are 117 have striae (75.5%). None of the striae subjects is underweight, normal weight was 113, 3 obese and one overweight. The 38 subjects without striae are in normal BMI. An analysis using ETA proved that BMI is not significantly associated with striae (p>0.05).
Conclusion: There is no significant relationship between BMI and striae.
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Prevalence of and risk factors associated with anal HPV infection among men who have sex with men in Bali, Indonesia
I Ketut Agus Somia, Tuti Parwati Merati, Dewi Dian Sukmawati, I Gusti Ayu Agung Elis Indira, Ida Bagus Nyoman Putra Dwija, Made Yogi Oktavian Prasetia, Nittaya Phanuphak, Siriporn Nonenoy Online First: November 23, 2020Prevalence of and risk factors associated with anal HPV infection among men who have sex with men in Bali, Indonesia
I Ketut Agus Somia, Tuti Parwati Merati, Dewi Dian Sukmawati, I Gusti Ayu Agung Elis Indira, Ida Bagus Nyoman Putra Dwija, Made Yogi Oktavian Prasetia, Nittaya Phanuphak, Siriporn NonenoyBackground: Anal human papillomavirus (HPV) is one of the most common sexually transmitted infection. Men who have sex with men (MSM) are commonly affected by anal HPV infection. Until now, there is no data available on the prevalence of HPV genotype in the MSM in Indonesia
Purpose: This study aimed to determine the prevalence and risk factors of anal HPV infection among MSM in Bali, Indonesia.
Patients and methods: A cross-sectional study was conducted among MSM in Sanglah Hospital, Bali, Indonesia. Blood samples were collected for HIV serological testing and syphilis serological screening, and anal swabs were collected for HPV genotyping. Risk factors associated with anal HPV infection were assessed by univariate and multivariate logistic regression. Anal HPV infections were also being categorized into any anal HPV types, HR HPV types, LR HPV types, and multiple HPV types.
Results: Mean age of participants was 31.4 years. The prevalence of HPV infection was 89.3% and 61.3% for coinfection between LR and HR types. Almost half of our participants had at least two HR anal HPV and they were co-infected with HPV 16, 39, and 51. Participants with HIV infection were associated with anal HPV, LR HPV, and multiple HPV types of infections.
Conclusion: HIV status were associated with anal HPV infection among MSM in Bali, Indonesia. Since all of the participants with at least two anal HPV genotypes were co-infected with HPV 16, 39, and 51, it is to be hoped that HPV vaccination can be introduced into MSM communities in Bali, Indonesia.
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Clinical presentation and outcome of COVID-19 infection in Type 2 Diabetes Mellitus: a preliminary data from a tertiary hospital in Jakarta during the early days of the pandemic
Ida Ayu Kshanti, Giri Aji, Marina Epriliawati, Md Ikhsan Mokoagow, Jerry Nasarudin, Nadya Magfira, Anggraini Permata Sari, Annela Manurung, Aryan Yohanes Djojo, Elizabeth Yasmine Wardoyo, Martha Iskandar, Nikko Darnindro, Radhiyatam Mardiyah Online First: December 01, 2020Clinical presentation and outcome of COVID-19 infection in Type 2 Diabetes Mellitus: a preliminary data from a tertiary hospital in Jakarta during the early days of the pandemic
Ida Ayu Kshanti, Giri Aji, Marina Epriliawati, Md Ikhsan Mokoagow, Jerry Nasarudin, Nadya Magfira, Anggraini Permata Sari, Annela Manurung, Aryan Yohanes Djojo, Elizabeth Yasmine Wardoyo, Martha Iskandar, Nikko Darnindro, Radhiyatam MardiyahIntroduction. This study aimed to review the clinical characteristics and outcomes of COVID-19 patients presented with in-hospital hyperglycemia or pre-existing type 2 diabetes (T2DM).
Methods. This is a retrospective study conducted in Fatmawati General Hospital, Indonesia, from March 18th-Apr 30th, 2020. We reviewed medical records of 27 COVID-19 patients presented with either in-hospital hyperglycemia (11, 12.2%) or pre-existing T2DM (16, 17.8%) from a total of 90 confirmed COVID-19 cases admitted in our hospital.
Results. Critical conditions occurred in 50% of T2DM and 54.55% of the in-hospital hyperglycemia group. Mortality was documented in 68.75% of T2DM and 81.82% of in-hospital hyperglycemia group. Hypoglycemia, diabetic ketoacidosis, lactic acidosis and ketosis were found in 12.5%, 25%, 18.75%, and 25% of individuals with T2DM, respectively, resulting in a high mortality rate. Meanwhile, diabetes-related complications were rare among the in-hospital hyperglycemia group. However, respiratory failure (45.45% vs. 6.25%) and septic shock (27.27% vs. 6.25%) were more frequent than in the T2DM group.
Conclusion. In this preliminary study, a high mortality rate was documented among COVID-19 patients with preexisting T2DM and in-hospital hyperglycemia. In T2DM subjects, diabetes related-complications contributed to a higher mortality rate, while in-hospital hyperglycemia group, respiratory failure and septic shock were more frequent.
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High expression of early secretory antigenic target 6 mRNA as a potential predictor of tuberculous lymphadenitis
Rita Cempaka, Titik Nuryastuti, Vincent Laiman, Fara Silvia Yuliani, Ahmad Musthafa, Hadis Pratiwi, Marcellus Marcellus, Didik Setyo Heriyanto Online First: December 01, 2020High expression of early secretory antigenic target 6 mRNA as a potential predictor of tuberculous lymphadenitis
Rita Cempaka, Titik Nuryastuti, Vincent Laiman, Fara Silvia Yuliani, Ahmad Musthafa, Hadis Pratiwi, Marcellus Marcellus, Didik Setyo HeriyantoPurpose: Tuberculous lymphadenitis is one of the most common presentations of extrapulmonary tuberculosis. The diagnosis can be challenging due to its varying clinical manifestations and the low sensitivity of conventional bacteriological methods for confirming the causative agent, Mycobacterium tuberculosis. Early secretory antigenic target 6 (ESAT-6), which is released early during M. tuberculosis infection and plays a role in granuloma formation, determines the pathogen’s invasion, its severity, and virulence factors related to the immune response. This study aimed to analyze the potential diagnostic value of ESAT-6 using real-time polymerase chain reaction (RT-PCR) and compare it with histopathologic diagnostics.
Materials and methods: This retrospective observational study with the cross-sectional design was conducted using consecutive sampling. A total of 50 formalin-fixed, paraffin-embedded lymph node tissue samples from lymphadenectomy consisted of 25 tuberculous lymphadenitis and 25 granulomatous lymphadenitis were collected. The specimens were diagnosed with tuberculous and granulomatous lymphadenitis based on histopathologic features. Analyses using conventional PCR from commercial kit to detect TB and RT-PCR to determine the expression of ESAT-6 were performed. Statistical analysis of the categorical data was performed using the Mann-Whitney test. Statistical significance was set at p < 0.05.
Results: The mean age of the patients was 35.66 years old (range: 6–85 years). The age group between 16 and 30 years was the most common (40%). Almost two-thirds (62%) of the patients were female. Sixteen (64%) tuberculous lymphadenitis and 13 (52%) granulomatous lymphadenitis samples were positive by PCR TB. ESAT-6 expression was significantly higher in tuberculous lymphadenitis (p = 0.004).
Conclusion: ESAT-6 as a potential predictor of tuberculous lymphadenitis can be used in patients for whom histopathologic diagnostics fail to confirm the presence of M. tuberculosis.
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Lipid and cardiac profile assessment following the co-administration of Cisplatin and methanolic extract of Portulaca oleracea in adult Wistar rats: an experimental study
Izuchukwu Azuka Okafor, Uchenna Somtochukwu Nnamah, Jude Nnaka Online First: December 01, 2020Lipid and cardiac profile assessment following the co-administration of Cisplatin and methanolic extract of Portulaca oleracea in adult Wistar rats: an experimental study
Izuchukwu Azuka Okafor, Uchenna Somtochukwu Nnamah, Jude NnakaIntroduction. There is a need for continual evaluation of the effective use of plant-based medicine as combination therapies as more therapeutic potentials are being associated with phytomedicine. The changes in the lipid and cardiac profile of adult Wistar rats following the co-administration of Cisplatin and methanolic extract of Portulaca oleracea (MEPO) were investigated.
Methods. Twenty-four (24) rats with an average weight of 154 kg were randomly divided into six (6) groups (A-F). Group A was given no treatment and served as the normal control group. Group B received only a cisplatin injection and served as the cisplatin control group. Group C and D were given 400mg/kg and 800 mg/kg MEPO six hours after cisplatin injection. Group E and F were administered 400mg/kg and 800 mg/kg MEPO 6 hours before cisplatin injection. All cisplatin injections were single-dose intraperitoneal injection (2 ml/kg) and MEPO administration lasted for 7 days. Animals were euthanized under diethyl ether anesthesia at the end of the experiment and blood collected for serum lipid profile investigations. Some cardiac and lipid parameters were estimated from standard formulae.
Results. There was a significant increase in the serum levels of TG and TC (p=0.01 and p < 0.001) and some estimated parameters – LDL, VLDL, CRR, HDL-LDL and TG-HDL (p<0.001, p=0.049, p<0.001, p<0.001 and p=0.001 respectively) while HTR was significantly decreased (p<0.001) due to cisplatin treatment. HDL and AI levels were unchanged by cisplatin treatment. MEPO significantly reversed (p<0.05) the cisplatin-induced changes in the serum lipid parameters (TG and TC) and estimated parameters (VLDL, CRR and TG-HDL) across all MEPO-treated groups.
Conclusion. MEPO shows evidence of attenuating cisplatin-induced hyperlipidemia and cardiac risk.More ... | PDF
The problem of prevention and correction of posture disorders with the help of orderly muscle activity: a literature review
Raspopova E.A., Shmeleva Svetlana Vasilyevna, Irina Vitalevna Mikhaylova, Rysakova O.G. Online First: December 01, 2020The problem of prevention and correction of posture disorders with the help of orderly muscle activity: a literature review
Raspopova E.A., Shmeleva Svetlana Vasilyevna, Irina Vitalevna Mikhaylova, Rysakova O.G.Background: One of the frequent manifestations of decreased motor activity and a decrease in the strength of skeletal muscles is a violation of posture. Under these conditions, the deformation of the posture is the result of a violation of the vertical position of the spine and the weakening of its adaptive reactions aimed at maintaining the vertical posture. The redistribution of the load in the spine is accompanied by a change in its configuration. In this regard, the only way to combat the violation of posture can be considered increased muscle activity.
Objective: This article provides a review of the literature regarding the problem of prevention and correction of posture disorders with the help of orderly muscle activity.
Method: The writing methodology used was the literature review. The source of study consists of relevant journals from the search engines www.pubmed.com, scholar.google.com, and proquest.com.
Conclusion: In this regard, exercise is a powerful biological stimulant for most of the physiological functions of the body. This allows them to purposefully increase the volume of various muscle structures, change the functional state of the body and solve the problems of short-term and long-term recovery.
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The potential role of exosome on cytokine storm and treatment of severe COVID-19 infection
Hamsu Kadriyan, Eka Sunarwidhi Prasedya, Nova Audrey L Pieter, Masyita Gaffar, Abdul Qadar Punagi, Agussalim Bukhari Online First: September 26, 2020The potential role of exosome on cytokine storm and treatment of severe COVID-19 infection
Hamsu Kadriyan, Eka Sunarwidhi Prasedya, Nova Audrey L Pieter, Masyita Gaffar, Abdul Qadar Punagi, Agussalim BukhariThe symptoms of COVID-19 varies from mild to severe. The risk of severe infection occurs about 10% of cases, while the risk of death occurs about 0-14.6% of cases. One of the suspected pathophysiology in cases of severe infection and death of COVID-19 is due to cytokine storms. Exosome plays a vital role in the pathogenesis of several diseases, including severe disease such as sepsis due to cytokine storm. Exosome has been proven as a nanomaterial carrier that can tackle cytokine storm in the treatment of severe COVID-19 infection. Several studies have been conducted for this purpose, and its clinical application continually increases. This review will explore the role of exosomes in cytokine storms that occur in patients with COVID-19 and seek the opportunity to use exosomes in their management
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Hypertensive emergency: an overview of heart as target organ damage
Starry Homenta Rampengan, H J Sunarto Online First: December 01, 2020Hypertensive emergency: an overview of heart as target organ damage
Starry Homenta Rampengan, H J SunartoHypertension is currently still a global problem in the cardiology and vascular fields with an increasing trend. One of the emergency conditions related to an increase in blood pressure is emergency hypertension. Emergency hypertension is a condition where blood pressure rises rapidly and severely, resulting in new or progressive organ damage. Symptoms can range from chest pain, shortness of breath to delirium. The heart is one of the organs that can be damaged by hypertensive emergencies. The availability and demand for oxygen from the coronary blood vessels to the heart muscle cells will experience an imbalance due to a sudden increase in blood pressure. Lack of oxygen that occurs can cause heart muscle cells' death affected heart structure and its function. The symptoms that appear can be in the form of acute coronary syndrome or acute heart failure. Some modalities can detect heart structure changes, like electrocardiography for general and echocardiography for specific examination. Hypertensive emergencies can be treated by several rapid-acting antihypertensive agents, which can be selected based on the clinical manifestations. As the symptoms related to heart damage are acute coronary syndrome and acute heart failure, so the treatment will be specific, respectively. Good knowledge related to emergency hypertension management and early treatment will reduce patient morbidity.
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Virtual patient simulation method for learning and assessment in cardiology field
Ida Bagus Amertha Putra Manuaba, Ni Gusti Ayu Putu Lestari Santika Dewi, I Putu Yuda Prabawa, Agha Bhargah, Chien-Chih Wu Online First: October 17, 2020Virtual patient simulation method for learning and assessment in cardiology field
Ida Bagus Amertha Putra Manuaba, Ni Gusti Ayu Putu Lestari Santika Dewi, I Putu Yuda Prabawa, Agha Bhargah, Chien-Chih WuVirtual patient simulation (VPS) is an online computer simulation system that contains patients' clinical situation to train and realistically assess clinical abilities with supplemental animation, demonstration of anatomy, ECG tracing, etc. It can be used for teaching, learning, and assessment supports learning. Until now, it is difficult to ascertain how many VPS systems have been used today in the world, both for learning and assessment, especially in cardiology medicine field. We searched for all research using the term "virtual patient in medical education, virtual patient in cardiology & virtual patient simulation in cardiology" in the title or research abstract from 2014 until 2019. In this current review, we will describe the use of VPS for learning and assessment purposes in cardiology medicine field.
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Potential development of turmeric extract nanoparticles as a topical anti-inflammatory agent
Nyoman Suryawati, I Made Jawi Online First: October 21, 2020Potential development of turmeric extract nanoparticles as a topical anti-inflammatory agent
Nyoman Suryawati, I Made JawiTurmeric is the most commonly studied herbal ingredient because it has antioxidant, anti-inflammatory, antimicrobial, and anticancer activity. Considering that most inflammatory skin diseases are localized, it is considered that the topical application of turmeric extract can be beneficial because it has a local effect on the skin. The topical application of turmeric extract has limitations because the active ingredient content of curcumin (CUR) has poor solubility in water, low absorption, and rapid elimination of metabolites, which results in low bioavailability of the drug. Recent studies have focused more on nanoparticle formulations that can improve the stability and bioavailability of CUR.
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Role of PRP (platelet-rich plasma) in alopecia areata: A literature review
Ni Wayan Eka Ciptasari Online First: November 26, 2020Role of PRP (platelet-rich plasma) in alopecia areata: A literature review
Ni Wayan Eka CiptasariAlopecia areata (AA) is an autoimmune disease that causes hair loss, and its specific cause is not fully determined. This disease affects the patients physically, psychologically, and cosmetically. Treatment of AA is not curative, but controls or limits the disease course. Most treatment modalities are an immunosuppressive or immunomodulatory agent, which are associated with increased side effects. PRP has been used in aesthetics and dermatology, especially for wound repair. Improvement characterized by hair growth has been reported in several studies. Hair growth improvement with PRP is an effective procedure for AA without any allergic reaction. Epidermal proliferation, induction of angiogenesis, and stimulation of the growth of follicular bulge cells were also reported. Despite showing the efficacy of PRP in AA, it is necessary to carry out randomized clinical trials and long-term evaluations to support the efficacy of therapy.
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Uterine cervix mixed adenoneuroendocrine carcinoma: case report of a rare, high grade and aggressive tumor
I Gusti Ayu Sri Mahendra Dewi Online First: December 01, 2020Uterine cervix mixed adenoneuroendocrine carcinoma: case report of a rare, high grade and aggressive tumor
I Gusti Ayu Sri Mahendra DewiIntroduction: Neuroendocrine carcinoma of the uterine cervix is a rare type of cancer in the female reproductive system, accounting for only about 1% of all malignancies in the uterine cervix. Mixed Adenoneuroendocrine Carcinoma (MANEC) is a combination of neuroendocrine components and non-neuroendocrine components, with each component contribute >30% of the tumor cells. This rare type of tumor is aggressive, high recurrence rates, and early distant metastases.
Case description: A 37-year-old female patient referred for evaluation after a previous finding of a cervix mass and a clinical diagnosis of cervical carcinoma IB2. Ultrasonography examination concluded a cervical mass, suspicious of malignancy. On macroscopic examination, it was found white-grey colored, huddle, and brittle mass filled the entire cervix with a size of 5x4 and 5x1 cm. Routine histopathological examination shows neoplastic cells forming a trabecular pattern, organoid, part with rosette formation, infiltrative between the connective tissue and a large area of necrosis. These cells conform to a uniform morphology, small oval to round nucleus, partially composed of molding, narrow cytoplasm, salt and pepper chromatin, and mitotic figure > 25/10 HPF. At some other focus, neoplastic cells appear cribriform, solid, and tubular, with a round to oval hyperchromatic nuclei, increased N/C ratio, severe nuclear pleomorphism, eosinophilic cytoplasm, mitotic figure 5/10 HPF. The metastatic cell was found in four right pelvic lymph nodes, and five left pelvic lymph nodes. Immunohistochemistry examination of chromogranin-A and CEA shows positive, focal distribution on tumor cells cytoplasms. Synaptophysin shows positive, diffuse distribution on tumors cell cytoplasm. Ki-67 was positive in 90% malignant cell nuclei.
Conclusion: The result of clinical, radiological, routine histopathology, and immunohistochemical examinations support the pathological diagnosis of MANEC.More ... | PDF
Pregnancy with seropositive toxoplasmosis: a case report
Natassa Zefanya Darsana, Anak Agung Ngurah Jaya Kusuma Online First: December 01, 2020Pregnancy with seropositive toxoplasmosis: a case report
Natassa Zefanya Darsana, Anak Agung Ngurah Jaya KusumaIntroduction: Toxoplasmosis is present in every country and seropositive rates vary between regions from less than 10% to more than 90%. Toxoplasmosis in pregnancy can result in severe sequelae to the fetus. Primary infection in pregnancy may cause spontaneous abortion or fetal death in utero. Congenital ocular and neurological abnormalities may also occur. We present a case involving toxoplasmosis infection in early pregnancy and an overview of the management and the clinical outcomes for both mother and fetus.
Case report: A 26-year-old pregnant woman (G1P0A0) showed a high concentration of IgG anti-toxoplasmosis in early pregnancy with a concentration of 1200. Throughout the pregnancy, an increase in the concentration of IgG anti-toxoplasma was found. At 14 weeks gestation, concentration increased four-fold to 9068. During the ultrasound observation no hydrocephalus, ocular, and neurological abnormalities were found. Amniocentesis was performed for PCR examination and the result turned out negative. The patient was given spiramycin 1 gram daily for the remaining of her pregnancy. At 40 weeks gestation, the patient gave birth vaginally to a healthy term 3700 grams baby boy. There were no signs of major anomalies found in the baby.
Conclusions: Diagnosis and screening of toxoplasmosis require proper understanding of serological examination, as well as the specificity and sensitivity of the diagnostic tools. Ultrasound monitoring for the detection of congenital toxoplasmosis can also help with diagnosis.
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Coronavirus disease 2019 (COVID-19): A case report in a patient with diabetic ketoacidosis and hypertension
Mauritus Lambertus Edy Parwanto, Reza Aditya Digambiro, Dwi Utomo Nusantara, Twindy Rarasati Online First: September 26, 2020Coronavirus disease 2019 (COVID-19): A case report in a patient with diabetic ketoacidosis and hypertension
Mauritus Lambertus Edy Parwanto, Reza Aditya Digambiro, Dwi Utomo Nusantara, Twindy RarasatiBackground: Until May 2020, Indonesia is still on COVID-19 emergency status. South Jakarta is part of the Special Capital Region of Jakarta that has applied large-scale social restrictions. The Indonesian government has extended Jakarta's large-scale social restrictions to Friday, May 22nd, 2020 to curb the spread of the corona-virus that causes COVID-19.
Case report: Patients with diabetic ketoacidosis and hypertension were infected with SARS-CoV-2. He had traveled from Saudi Arabia a week before and already has a fever. Arriving in Indonesia, the patient showed symptoms of worsening disease, experienced coughing, shortness of breath, and sore throat. The patient does not inject insulin due to loss of appetite. On March 30th, 2020, a laboratory examination showed high blood sugar levels (369 mg/dL) followed by positive ketones bodies. On April 2nd, 2020, the patient was designated as a confirmed case of COVID-19 after a positive polymerase chain reaction test. The rapid diagnostic test also showed a positive IgM. Management of patient includes giving O2 through the non-rebreathing oxygen mask, infusion of sodium chloride, 20 IU Apidra®, 12 IU Lantus® injection, Oseltamivir orally, Levofloxacin, Paracetamol, Vitamin C, Candesartan, Concor. This therapy was continued until April 5th, 2020. On April 5th, the patient complained about a cold sensation all over his body. The patient died on the afternoon of April 6th, (8 days of hospitalization) due to sudden cardiac arrest and acute respiratory distress syndrome. Cardiopulmonary resuscitation was done with standardized protocol with no avail.
Conclusion: Diabetic ketoacidosis and hypertension worsen the condition of COVID-19 patients. There are many unknown disease progression outcomes in these patients.
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Recombinant tissue plasminogen activator (rTPA) in young adult patient with acute ischemic stroke: a case report
Dodik Tugasworo, Aditya Kurnianto, Retnaningsih Retnaningsih, Yovita Andhitara, Rahmi Ardhini, Runy Dyaksani, Jethro Budiman Online First: December 01, 2020Recombinant tissue plasminogen activator (rTPA) in young adult patient with acute ischemic stroke: a case report
Dodik Tugasworo, Aditya Kurnianto, Retnaningsih Retnaningsih, Yovita Andhitara, Rahmi Ardhini, Runy Dyaksani, Jethro BudimanBackground: Stroke is one of the highest causes of morbidity and mortality in the world. The incidence rate of ischemic stroke is about 80% of all stroke incidents. The use of recombinant tissue plasminogen activator (rtPA) is recommended under 4.5 hours of stroke onset. Stroke in young adults are reported as being uncommon, compromising 10% -15% of all stroke patients. Many studies were reported the most common risk factor in young adults were obesity and dyslipidemia. This case report will discuss a 33-year-old men with ischemic stroke with obesity and dyslipidemia treated at dr. Kariadi Hospital Semarang.
Case presentation: A 33-year old obese man with left-sided hemiparesis and central facial nerve palsy with an onset of 1 hour. On laboratory examination, it was obtained total cholesterol 179mg/dL, LDL level 123mg/dL, and HDL level 39mg/dL. The protocol code stroke was performed in emergency room with alteplase (r-TPA) 0.6 mg/kgBW, after his head MSCT shows there was no sign of blood in the brain parenchym.
Conclusion: The increased risk of ischemic stroke in young patients is due to dyslipidemia, hypertension, obesity, physical inactivity, and smoking. Treatment of the hyperacute phase of ischemic stroke with thrombolysis can reduce the outcome of stroke due to the disability.
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Spontaneous conversion to sinus rhythm in atrial fibrillation after dual antiplatelet and anticoagulant therapy in patients with unstable angina
Agha Bhargah, I Gusti Agung Bagus Krisna Jayantika, I Putu Yuda Prabawa, Ida Bagus Putra Manuaba Online First: October 17, 2020Spontaneous conversion to sinus rhythm in atrial fibrillation after dual antiplatelet and anticoagulant therapy in patients with unstable angina
Agha Bhargah, I Gusti Agung Bagus Krisna Jayantika, I Putu Yuda Prabawa, Ida Bagus Putra ManuabaIntroduction: Atrial fibrillation (AF) is a common arrhythmia and often becomes persistent with a high risk of thromboembolism event. Spontaneous conversion to sinus rhythm can occur in 50% of cases with new-onset AF. In this case report we report the spontaneous conversion of AF to sinus rhythm in patients with Unstable Angina without any thromboembolic complications.
Case description: A 65-year-old man with unstable angina pectoris (UA) with new-onset atrial fibrillation normal ventricular rate (AF-NVR) came to the Emergency Department Bali Mandara General Hospital. Patients have a history of uncontrolled hypertension and active smokers. Standard management of UA using dual antiplatelet, nitrates, and anticoagulants was given to this patient. There were no anti-arrhythmia drugs given to seek for AF cardioversion. Within 6 hours after initial therapy, spontaneous conversion of AF to sinus rhythm occurs. The patient was treated for five days in a stable condition without thromboembolic complications. Long-term anticoagulants were not given to patients because the CHA2DS2-Vasc score is less than two indicating a low risk of thromboembolism.
Conclusion: New-onset AF has the chance of spontaneous conversion to sinus rhythm within 48 hours, proper management of the trigger factors of AF and optimal rate control are determinants of prognosis. Provision of long-term anticoagulants must be based on the CHA2DS2-Vasc score.
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Delayed reconstruction of soft tissue defects in mangled lower extremities: A report of three cases
Agus Roy Rusly Hariantana Hamid, I Gusti Putu Hendra Sanjaya, I Made Suka Adnyana, I Gusti Ayu Putri Purwanthi, Grace Inriani Ronge, Gede Wara Samsarga Online First: October 27, 2020Delayed reconstruction of soft tissue defects in mangled lower extremities: A report of three cases
Agus Roy Rusly Hariantana Hamid, I Gusti Putu Hendra Sanjaya, I Made Suka Adnyana, I Gusti Ayu Putri Purwanthi, Grace Inriani Ronge, Gede Wara SamsargaBackground: The best timing for the soft tissue reconstruction procedure in the mangled lower extremity is still controversial. Despite the advantages of acute treatment, delayed soft tissue reconstruction are often inevitable for various reasons. This case report aims to present three cases of delayed reconstruction to treat lower extremities soft-tissue defects in mangled lower extremity following high-energy trauma.
Case Series: This study included three cases that underwent delayed reconstruction for the mangled lower extremity. The definitive reconstructions were done in 15, 30, and 60 days after injury and all cases underwent serial debridement before the definitive procedure. The reconstruction methods used were skin graft and free flap. There was no graft/flap loss observed in this study.
Conclusion: We believe that soft tissue reconstruction of mangled lower extremities following high-energy trauma may also be safely done in a delayed setting if the wound debridement is adequately done, and the basic reconstructive principles are fulfilled.
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Management of von willebrand disease in pregnancy in resource-limited settings: a case report
I Wayan Losen Adnyana Online First: October 30, 2020Management of von willebrand disease in pregnancy in resource-limited settings: a case report
I Wayan Losen AdnyanaBackground: Von Willebrand's disease (VWD) is the most common autosomal dominant bleeding disorder. Pregnancy and delivery in patient with VWD possess significant clinical challenges.
Case description: a 24-year-old woman who will undergo labor with a history of VWD. The patient was planned for induction of vaginal delivery and has been given intranasal desmopressin, cryoprecipitate, and factor VIII from before delivery to 5 days after delivery. Labor occurs without excess bleeding. The patient was monitored for 6 days after delivery, and there is no complication of excessive bleeding.
Conclusion: This case emphasizes how to manage Von Willebrand's disease in pregnancy with limitation in the examination and therapeutic option, also the importance of joint management from the hematologist, obstetrician, starting from the antepartum, delivery, and postpartum phases.
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Unilateral pedicle screw fixation as a less invasive surgical procedure: a case series and literature review
Tjokorda Gde Bagus Mahadewa Online First: October 30, 2020Unilateral pedicle screw fixation as a less invasive surgical procedure: a case series and literature review
Tjokorda Gde Bagus MahadewaIntroduction: The principle of treatment for degenerative spinal diseases when conservative modality failed is surgery. Unilateral pedicle screw fixation is a less invasive methods with clinical outcomes that were similar to a bilateral fixation, especially for lumbar degenerative disease. Improvement of symptoms, neurological outcome and spinal stability is the utmost priority. This was a case series study with five patients with degenerative spine disease from January 2019 - January 2020. The aims are to evaluate unilateral pedicle screw surgery outcomes and elucidate the effectiveness of this method clinically.
Case Description: Five patients aged 40-64 years old involved in this series. Four patients presented with lumbar radiculopathy and one patient with cervical radiculopathy. All experienced weakness (MMT score 2-4) and pain along the affected extremities. Three patients diagnosed with concomitant Herniated Nucleus Pulposus (HNP) and Foraminal Stenosis (FS) based on clinical examination and Magnetic Resonance Imaging result. The rest of two patients each diagnosed with FS and HNP. Surgery initiated with a midline incision. Muscle ipsilateral to the symptomatic side was dissected and retracted to expose the facet joint and the vertebral lamina. Screws were inserted into the vertebral body and the rod used to connect the screws was bent following the vertebral curvature. Facetectomy or Hemilaminectomy was done to expose and decompress the ipsilateral side's nerve root and intervertebral space. The incision site is then irrigated and closed. All operation was done by the same surgeon. Postoperative clinical outcomes were evaluated for six months after surgery. All patients showed a complete motor improvement and fully relieved from pain.
Conclusion: Unilateral pedicle screw fixation is considered as a less invasive instrumentation system with clinical outcome comparable to bilateral screw fixation.
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Myasthenic crisis in pregnancy: a case report
I Nyoman Hariyasa Sanjaya, Anton Supono, I Made Oka Adnyana, Ryan Saktika Mulyana, Evert Solomon Pangkahila, I Made Ariyana Online First: November 17, 2020Myasthenic crisis in pregnancy: a case report
I Nyoman Hariyasa Sanjaya, Anton Supono, I Made Oka Adnyana, Ryan Saktika Mulyana, Evert Solomon Pangkahila, I Made AriyanaIntroduction: This case report aims to describe the diagnostic strategy and optimal management of pregnancy with Myasthenia Gravis and Myasthenic Crisis.
Case Description: A 27-years-old pregnant female with Myasthenia Gravis complicated by Myasthenic Crisis was hospitalized six times during her pregnancy. Two initial hospitalizations due to acute exacerbation treated with plasmapheresis, and two other hospitalizations complicated with myasthenic crisis treated with massive Therapeutic Plasma Exchange in the Intensive Care Unit. Managing myasthenia gravis in pregnancy, from early pregnancy until delivery, is challenging. Furthermore, the myasthenic crisis in pregnancy is a rare case that requires airway and ventilation support and treatment with plasmapheresis.
Conclusion: Myasthenic crisis in pregnancy is a rare condition. Therefore, a guideline about the prenatal, antenatal, delivery plan, exacerbation, and myasthenic crisis management in pregnancy and pregnancy planning women are urgently needed.
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Ruptured ectopic pregnancy management in the COVID-19 pandemic era: a case report
I Gde Sastra Winata, Anton Supono Online First: November 18, 2020Ruptured ectopic pregnancy management in the COVID-19 pandemic era: a case report
I Gde Sastra Winata, Anton SuponoIntroduction. COVID-19 protocol and the unavailability of proper instruments in the isolation room had complicated the usual protocol to diagnose and manage the medical and surgical conditions. This article is about the first ruptured ectopic pregnancy cases encountered during the COVID-19 pandemic in Sanglah General Hospital. Considering the unique circumstances and the difficulty during establishing the diagnosis and conducting the management, we ought to present our experience through this article.
Case Description. This case report reviews a 24-years-old female, an asymptomatic COVID-19 case, who was diagnosed with ruptured ectopic pregnancy during appendectomy surgery in Sanglah General Hospital, Denpasar, Bali-Indonesia. The patient complained about mild lower right abdominal pain, with a clinical picture that supports acute appendicitis. However, the history taking revealed a history of post-curettage 15 days prior to admission due to vaginal bleeding suspected for incomplete abortion. Except for a positive pregnancy test, the clinical picture did not support a pregnancy nor a ruptured ectopic pregnancy. We still consider an ectopic pregnancy as no histopathological examination result was available to supports the previous vaginal bleeding was an intrauterine pregnancy. Further to complicate the problem, the patient was reactive for the COVID-19 screening test, thus requiring a COVID-19 protocol. As an ultrasound device was unavailable at the time in the isolation room, we could not assess for extrauterine pregnancy. Only during the surgical procedure for appendectomy, our surgical college notified us of the accompanying presence of sign of ruptured right ampullary pregnancy.
Conclusion. The COVID-19 isolation protocol and the unavailability of essential equipment and diagnostic tools in the isolation room could hinder the usual protocol used to diagnose and manage various medical and surgical problems. We hope this article could illustrate how COVID-19 had complicated unusual cases, thus reflect how important clinical judgment and infrastructure in our health care system.
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Ventral meatotomy as management of female urethral stricture: a case report
Anak Agung Gde Oka Online First: December 02, 2020Ventral meatotomy as management of female urethral stricture: a case report
Anak Agung Gde OkaIntroduction: Female urethral stricture is considered a rare condition. This condition may lead to recurrent lower urinary tract symptoms and urinary retention. Several techniques have been reported to overcome this disease with some advantages and disadvantages. This case report shows the author's experience in treating female urethral stricture using the ventral meatotomy technique.
Case description. A 63-year-old female suffered from poor urinary flow, recurrent urinary tract infection and lower urinary tract symptoms. Physical examination and urethrocystoscopy showed narrow urethral opening and severe trabeculation, respectively, which indicated bladder outlet obstruction due to urethral stricture. A ventral meatotomy was performed, followed by an indwelling catheter for a week. The patient showed improvement of the symptoms postoperatively.
Conclusion. Urethral reconstruction in female urethral stricture should be decided as definitive therapy, and an individualized approach must be applied based on patient factors and surgeon experience.
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Tracheostomy in upper airway obstruction on a COVID-19 patient
Rohaizam bin Japar Jaafar, Zakinah Binti Yahaya, Mohd Razif Bin Mohamad Yunus, Marina Binti Mat Baki Online First: December 01, 2020Tracheostomy in upper airway obstruction on a COVID-19 patient
Rohaizam bin Japar Jaafar, Zakinah Binti Yahaya, Mohd Razif Bin Mohamad Yunus, Marina Binti Mat BakiBackground: Stridor due to upper airway obstruction in a COVID-19 positive patient is a big challenge to the medical team especially to anaesthetists and otolaryngologists. In this condition, performing aerosol generating procedures (AGP) are time-sensitive and this increased the risk of virus transmission.
Case Report: A 66-year-old male, chronic smoker, completed 6 days in-patient treatment for community acquired pneumonia when the RT-PCR for COVID-19 was found to be negative. He was seen in the otorhinolaryngology (ORL) clinic 2 weeks later due to hoarseness for two months that was associated with worsening shortness of breath and cough. He had soft stridor at rest and was mildly tachypnoeic. Flexible endoscopy revealed mass on the right immobile vocal cord with small glottic airway. Repeat nasopharyngeal swab for COVID-19 on the same day was positive. A meticulous discussion involving multidisciplinary team lead to the decision to secure the patient’s airway by first intubating him with a small endotracheal tube and followed by tracheostomy in the same setting. Here, the experience in managing upper airway obstruction due to laryngeal carcinoma (at least T3) in a patient with stage 4 COVID-19 is presented and discussed. The challenges emerged due to inevitable series of AGPs that need to be performed. Multidisciplinary team involvement comprises ORL surgeon, anaesthetist, infectious disease and respiratory physician is pertinent.
Conclusion: This is the first case in the literature on a stridorous COVID-19 positive patient with laryngeal carcinoma that requires emergency tracheostomy. The case highlights the challenges and decision making in managing such case that supposed to be straightforward before the COVID-19 pandemic era. This shall be the new normal for otorhinolaryngologists, anaesthetists and may be any other specialities that deal with AGPs.
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P2B2 PABI XVII Semarang 2020 Continuing Professional Development in Surgery: Increasing the Competence of General Surgeons to Improve The Health Services
Benedictus Kartika Widjajanto Online First: October 28, 2020P2B2 PABI XVII Semarang 2020 Continuing Professional Development in Surgery: Increasing the Competence of General Surgeons to Improve The Health Services
Benedictus Kartika WidjajantoAssalamu’alaikum Wr. Wb. Shalom
Greetings, Praise Our gratitude to God Almighty because we are all in good health for His blessings and grace. We will hold P2B2 PABI XVII in 2020, and to coincide with that, we PABI Semarang Branch are entrusted with being the executor of this activity.
PABI Semarang branch invited fellow surgeons to attend and participate in the P2B2 activities of PABI XVII, which we have prepared on 26-30 October 2020. The warmth of gathering with family also enlivened the event with the Family Program to explore the city of Semarang, which is famous for its Culinary Tour, Religious Tourism, Nature Tourism, Shopping Tour, and Cultural Heritage Tour.
We will try to organize and provide the best. Let us welcome our fellow surgeons and their families.
Wassalamu alaikum Wr. Wb
Benedictus Kartika Widjajanto, MD chairman of the committee P2B2 PABI XVII Semarang 2020
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The 4th International Conference on Translational Medicine and Health Sciences
Muhamad Thohar Arifin Online First: November 12, 2020The 4th International Conference on Translational Medicine and Health Sciences
Muhamad Thohar ArifinAll praises to Allah, the most merciful, beneficent and compassionate, for His blessing that this conference could be organized today. I would like to express my greatest gratitude to Prof. Dr. Yos Johan Utama, S.H., M.Hum; Rector of Universitas Diponegoro, Dr. dr. Dwi Pudjonarko, M.Kes, Sp.S (K); Dean of Faculty of Medicine Universitas Diponegoro, Prof. Dr. Jamari, S.T., M.T.; Director of LPPM, Dr. dr. Hermina Sukmaningtyas, M.Kes., Sp.Rad and Dr. dr. Udadi Sadhana, M.Kes, Sp.PA, Vice Deans of Faculty of Medicine for all of their kind supervision during the preparation of this event. I would like to express my sincere gratitude to all of the committee members for all of your hard work, kind help, and best effort as a solid team work, by which this event can be held successfully even during the COVID-19 pandemics. I would like to thank all of the honorable speakers for your willingness to give lectures and all of participants from various institutions in the world. Welcome to the 4th International Conference on Translational Medicine and Health Sciences (ICTMHS) 2020. It is a great pleasure to announce that this is the first virtual ICTMHS, which is traditionally held in Semarang, Indonesia. ICTMHS is an annual routine program that began in 2017 initiated by the faculty to support the university's vision of becoming a world class university. The theme of this conference is "Unraveling the New Normal Guideline Treatment of Diseases in COVID-19 Pandemic". This difficult time has pushed us to strengthen our collaborative practices in the health sectors including Interprofessional Education and Research, Collaborative Practice, Translational Medicine, and Nutrition, Dietetic and Food. This is an interesting theme that invites all health workers to unite to increase collaboration in various aspects to tackle the pandemics affecting our country and beyong. Through this conference, we hope to contribute in introducing and educating the scientific community on the recent advances in the medical, dentistry, nursing, pharmaceutical, and nutrition sciences field. As a major goal of this event, we hope that it can be an excellent chance to discuss interesting ideas and develop fruitful project in the future, network opportunities with old and new colleagues, coordination new partnerships which advance collaboration either about the research field or not, as well as the careers of all participants. Please enjoy your participation in ICTMHS 2020.
dr. Muhamad Thohar Arifin, PhD, Sp.BS(K), PA
Chief of Organizing Committee
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Strategy within limitations during COVID-19 pandemic in Indonesia: Shortage of PPE, prevention, and neurosurgery practice
Christopher Lauren, Angel Iskandar, Donny Argie, Elric Brahm Malelak, Samuel Edhi Surata Sebayang, Reza Mawardy, Vito Masagus Junaidy, Yohanes Firmansyah Online First: December 01, 2020Strategy within limitations during COVID-19 pandemic in Indonesia: Shortage of PPE, prevention, and neurosurgery practice
Christopher Lauren, Angel Iskandar, Donny Argie, Elric Brahm Malelak, Samuel Edhi Surata Sebayang, Reza Mawardy, Vito Masagus Junaidy, Yohanes FirmansyahN/A
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