Background: The concept of "stress” has been growing for a long time and has attracted a lot of attention, behaviour, and philosophy of many people in the world. Nowadays, stress has become a popular topic among health care professionals. Nurses are assumed to have heavy and various workloads. The nursing workload is influenced by stressors that can cause stress. At some level, psychological, physiological and sociological symptoms might appear. Job stress related to work stress factors include role ambiguity, role conflict, quantitative work overload, career development, and responsibility toward others, which have an impact on psychological distress and social dysfunction.

Objective: This study aims to determine the psychological distress and social dysfunction in nurses related to job stressors in Haji Hospital Medan.

Method: This research was an analytic research with a cross-sectional method using total sampling of 186 nurses who are still working in Haji Medan Hospital. The instruments used were the Stress Diagnostic Survey to measure work stress and GHQ12 to measure psychological distress and social dysfunction. The statistical tests used were Pearson correlation test (for a normal distribution) and Spearman (for non-normal distribution).

Results: There was a significant relationship between total work stressors and psychological distress (p = 0.0001), also, a weak positive correlation (r = 0.364) showed that total work stressors and psychological distress would increase together. The relation between total work stressors and social dysfunction was statistically significant (p = 0.018) and a very weak negative correlation (r = -0.173) was found, meaning that an increase in total job stress score would lower the social dysfunction score.

Background: RAAB 2013 reported the prevalence of bilateral blindness in South Sulawesi is 2,6%, with the main causes of blindness is cataract (64.3%). This report describes the crash program for cataract blindness control in South Sulawesi within the last 3 years (2014 - 2016). Material and Methods: Collecting the data of cataract infrastructures, human resources, and cataract surgical rate (CSR) from each district in South Sulawesi. From these data, we conduct statistical analysis and crash program planning, establish special and regional teams, and perform advocacy to stake holders of each district to describe the condition of the eye health services and action plans for cataract blindness prevention in each district. Results: The number of cataract surgery in South Sulawesi was 13.988 with CSR 1.753 in 2014. The number of cataract surgery in 2015 and 2016  was increased to 16.295 with CSR 1.954 and 19.147 with CSR 2.383 respectively. In August 2016, an advocacy workshop was held resulting the agreement of all stakeholders from each district in South Sulawesi in the development of the cataract blidness control  program. Conclusions: By implementing a serious and sustained crash program for cataract blindness control involving stakeholders from each district, the number of cataract blindness in South Sulawesi reduced and the CSR target of 3.000 in 2018 can be reached.

Background: Malaria is still considered as a major health problem in the world including in Indonesia, which is regarded as one of the malaria-endemic countries. Since 2006, WHO has recommended the use of artemisinin-based combination therapy (ACT) to treat uncomplicated falciparum malaria. In Indonesia, DHP tablet (combination of dihydroartemisinin and piperaquine) is the first line therapy used in malaria control program, which currently used imported DHP tablet. To produce generic DHP tablet, comparative bioequivalence test between DHP tablet and the drug previously used is needed. Methods: A single dosed, randomized, double-blinded, one-period, and parallel study design was conducted in the present research. Every twenty-four subjects were assigned into two groups, which are test group and comparison group. Results: The results showed that even though in vitro comparison of dissolution test has fulfilled the requirements, in vivo test results has not fulfilled the bioequivalence standards. Obtained geometric mean ratios (90% confidence intervals) of the test drug to comparator drug for dihydroartemisinin were 83.30% (67.06%–103.48%) for AUC_0-t, 83.24% (67.10%–103.26%) for AUC_0-inf, and 75.67% (61.83%–92.61%) for C_max. The geometric mean ratios (90% confidence intervals) of the test drug to comparator drug for piperaquine were 97.31% (76.50%–123.80%) for AUC_0-t, 94.18% (74.18%–119.59%) for AUC_0-inf, and 96.47% (71.80%–129.62%) for C_max. Conclusions: Therefore, the pharmacokinetic profile of the test drug is concluded to be bio-inequivalent with the comparator drug.

Background: MicroRNAs are a class of negative regulators of gene expression. Evidence indicates that miRNAs involved in the pathogenesis of New type 2 diabetes(NT2D)  through decrease the expression of the genes secreting insulin and increase expression of insulin secretion suppressing ones, as well as exocytosis, incorporate in New type 2 diabetes. In this study, we evaluated the expression level of miR-135 in plasma sample of those prone to susceptible diabetes and New type 2 diabetes patients compared to the control group.

Methods:  Subsequently to evaluation of biochemical parameters such as (TG, TC, HDL, and LDL) in susceptible diabetes, New type 2 diabetes and control group, miR-135a level was measured by qRT-PCR in the plasma samples and results were analyzed by  Stata and REST software.

Results: We identified a significant increase in miR-135a expression in New type 2 diabetes and susceptible diabetes samples compared to the control group. AUC in ROC curve analysis was 1.1 respectively (confidence interval of 1.0-1.0) for NT2D and susceptible diabetes group, the best cut-off points for diagnostics in diabetics and susceptible diabetes were 2.00 and 1.02. The optimum sensitivity and specificity for both groups were 100 and 100. Results confirmed the test for 100% confidence in healthy, susceptible diabetes and New type 2 diabetes subjects.

Conclusion: It seems that plasma level of miR-135a can be a desirable biomarker to differentiate T2DM diabetics from the control group.

Background: Kidney stones is one of the many causes of chronic kidney disease (CKD) in clinical and kidney fibrosis in histopathology presentation. Its occurs characterized by the presence of glomerulosclerosis (GS), tubulointerstitial fibrosis (TIF) and tubular atrophy (TA). This research aims to find out that the effect of glomerulosclerosis index (GSI), tubular index (TI), and matrix metalloprotein (MMP-9) against serum creatinine (SC) and estimated glomerular filtration rate (eGFR)  in kidney stone disease.  Methode: A total of 62 samples of kidney biopsy patients during kidney stone surgery in Sanglah General Hospital Denpasar-Bali, from February until December 2013. Kidney tissue biopsy stained with Masson's Trichrome.  Determination of GSI was counted GS in 30 glomerular in power field 400, and TI was counted normal tubular in 30 glomerular in power field 400, and MMP-9 was carried out using Kit Methode. Structural Equation Modelling (SEM) program Analysis of Moment Structure (AMOS) was used to analyze the effect of GSI, TI, and MMP-9 against SC and eGFR in kidney stone patients.  Results: Descriptive analysis were male 43 (69.35%), and female 19 (30.65%). Age (years) 50.0 ± 10.56; SC (mg/dl) 1.71 (0.47 to 6.76); GSI (glomerosclerosis/30 glomerular) 11 (0-30); TI (normal tubulars/30 glomerular) 850.24 (118 to1523); eGFR (ml/min) 65.41 ± 20.47; Leukocytes (cells/mm3) 7.82 ± 1.89; and MMP-9 (ng/ml) 6.13 (0.05 to 28.37). Direct and total effect (direct and indirect effect) were GS to eGFR = -0.16 and 0.33; TI to eLFG = 0.28 and 0.36, GS to SC = 0.31; TI to SC = -0.14; MMP-9 to SC = -0.16; SC to eGFR = -0.55. Conclusion:  Direct and total effect of GSI to eGFR were negative (-) 16% and (-) 33%; TI to eGFR were positive (+) 28% and (+) 36%. Direct effect (without indirect effect; direct effect as same as a total effect) of GSI, MMP-9, and TI to SC were positive (+) 31%, negative (-) 16%; and negative (-) 14% consecutively. Direct effect or total effect of SC to eGFR were negative (-) 55%. The results concluded that the effect measurements of urinary MMP-9, and GSI, and TI score to SC were negative (-) 16 %, positive (+) 31 % and negative (-) 14 % consecutively. The effect measurements of urinary MMP-9, and GSI, and TI score to eGFR were negative (-) 0.09 %, negative (-) 16 %, and positive (+) 28 %.

Background: The implantation rate of IVF remains low due to the adverse effect of ovarian stimulation on endometrial receptivity. Integrin β3, E-cadherin and Leukemia Inhibitory Factor (LIF) are the best markers known for endometrial receptivity evaluation. In this study, the effect of adding Letrozole to antagonist protocol based on the expression of integrin β3, E-cadherin and LIF level during implantation window was investigated. Letrozole is an inhibitor of aromatase that can prevent the supraphysiological estrogen level. The goal of the study was to prove that adding Letrozole to IVF antagonist protocol can increase the expression of Integrin β3, E-cadherin, and LIF concentration of mice uterine. 

Methods: This is an experimental study with a post-test only group design using Balb/c mice mimicked ovarian stimulated IVF. Antagonist protocol was applied to one group as ovarian stimulation, while the other group received the combination of Letrozole and antagonist protocol.  Uterus samples were collected 48 hours after ovarian stimulation. Integrin β3 and E-cadherin expression were detected by immunohistochemistry technique and LIF level assay by ELISA. Normality test was carried out using Shapiro-Wilk, and homogeneity test by Levene’s T. Comparison between integrin β3 and E-cadherin expression were tested by Mann-Whitney and Fisher's exact, while comparison of LIF was tested by Mann- Whitney, with p<0.05 considered as significant. Path analysis was done to measure each variable contribution.

Results: The Letrozole + GnRH antagonist treated mice showed significantly higher integrin β3 (2.71 + 0.61 vs 1.04 + 0.08, p<0.05) and E-cadherin (3.73 + 0.28 vs 1.16 + 0.29, p<0.05) expression in endometrium. It also showed significantly higher level of uterine LIF (1.78 + 0.13 vs 1.66 + 0.17 ng/ml, p<0.05) during implantation window than GnRH antagonist treated mice alone. Expression of integrin β3 (c2= 22.91, p<0.05) and E-cadherin (c2=36.00, p<0.05) were significantly higher in Letrozole group compared to control.

Conclusion: Letrozole caused higher expression of Integrin β3, e-cadherin, and, LIF concentration in Mice uterine stimulated by antagonist protocol. Letrozole had the highest contribution to the increase of E-cadherin.  Integrin β3 together with E-cadherin and Letrozole had 31.4% contribution to the increase of LIF.

The present study investigated the relationship between spiritual intelligence and life expectancy and self-regulation among students. The study was a descriptive and correlational research. The population included all high school female students in Tehran province. Using Cochran formula, 384 students were selected as the sample through multi-step cluster random sampling. The instruments included King Spiritual Intelligence Questionnaire (2008), Hope Scale Schneider (1991), and Boufard self-regulation questionnaire (1995). The data was analyzed through descriptive and inferential statistics (multivariate regression and canonical correlation).  The results showed that there is a positive relationship between the spiritual intelligence and life expectancy and self-regulation. Also, through Canonical analysis, it was showed that spiritual intelligence explained 26% and 2.5% of variance in life expectancy and self-regulation, respectively. Regression analysis of spiritual intelligence components showed that transcendental consciousness, personal meaning generation, and expanded state of consciousness all together explained 17.4 % of variance in life expectancy. Similarly, 18% of the variance in self-regulation was explained by personal meaning generation and expanded state of consciousness. Due to the important role of spiritual intelligence in life expectancy and self-regulation, it is suggested that spiritual intelligence training for students be taken into account.

Background: Geriatric patients are elderly patients who have memory impairment problems, which may have an impact on medication adherence. The aim of this study was to evaluate the effect of medicine reminder on the smartphone to increase the adherence of geriatric patients with type 2 diabetes mellitus. Method: This study used the Randomized Control Trial (RCT) method, where the subjects were divided into 2 groups: geriatric patients who were performing diabetic neuropathic pain therapy with the help of the Medicine Reminder (Group of Intervention) and without the aid of Medicine Reminder (Usual Care) Which are randomized using odd-even techniques. Patient therapy compliance is assessed by pill count. Results: Subjects who received medicine reminder intervention had significantly greater adherence than the control group (p <0.05). The RR value obtained is 2.38 with CI95% at intervals of 1.58-3.61. Conclusions: The medicine reminder application can improve geriatric patient therapy adherence with significant diabetic neuropathic pain.

Background: The most effective way to manage problems in research, especially plagiarism, is to prevent them from initially occurring. Therefore, comprehensive planning to prevent and reduce plagiarism, or actions to internalize honesty in speech, behavior, and actions, will not only make researches worthwhile but also reduce plagiarism.

Methods: In this qualitative research, eighteen faculty members of Tabriz University of Medical Sciences participated from 2015-2016. Data were collected through a semi-structured interview and analyzed by qualitative content analysis (Mayring method).

Results: Effective factors in the prevention of plagiarism were extracted and presented in 23 subclasses and four themes including policy-making, legislation, an institutionalization of ethics in research, and the application of technology capabilities.

Conclusion: Providing strategic and operational plans to internalize ethics in research and gradual changes in policy making and updating laws and regulations are factors affecting preventive measures. Also, with an increase in information literacy and applying information technology capabilities, it is possible to prevent informed and uninformed plagiarism.

Purpose: This study aims to understand the impact of the type of endometrioma and two different laparoscopic cystectomy excision techniques (“stripping” or complete excision vs partial excision) on the ovarian reserve by measuring the anti-mullerian hormone (AMH) levels in patients with endometrioma.

Method: This is an experimental study in the form of “pre test – post test group design”. The subjects were patients with >3 cm endometrioma detected via transvaginal USG which were classified into two different groups, i.e. the “stripping” laparoscopic cystectomy group as control and partial excision laparoscopic cystectomy as a intervention group. Cystectomy techniques were chosen based on “formuted block sampling”. The AMH levels measurements were performed before the operation (pre-test) and post-operation levels were measured at one and three months after the procedures on both groups. The study was conducted in Bali Royal Hospital (BROS), Denpasar,  Indonesia, between January 2012 and January 2018. T-independent test was used to analyse the collected data.

Results: No significant difference in the age and length of marriage between the two groups (p>0.05). Unilateral endometrioma had higher concentration of AMH compared to bilateral endometrioma before the laparoscopy (2.09±1.33 vs 1.99±1.25 ng/ml; p=0.768), 1 month after the laparoscopy (1.20±0.59 vs 1.12±0.72 ng/ml; p=0.647), as well as 3 months after the laparoscopy (1.79±0.97 vs 1.44±0.87 ng/ml; p=0.148), but they were not statistically significant (p>0.05). Based on the laparoscopy techniques, AMH concentration in partial excision laparoscopic cystectomy was significantly greater (p<0.05) than in the stripping laparoscopic cystectomy, whether before laparoscopy (1.87±1.23 vs 2.36±1.13; p= 0.119), 1 month after (1.33±0.62 vs 0.98±0.67 ng/ml; p=0.038), as well as 3 months (1.88±0.97 vs 1.29±0.77; p=0.011) after the surgery.

Conclusion: Unilateral and bilateral endometriomas have no significant difference in AMH levels. The partial excision laparoscopic cystectomy had significantly less effect on the AMH level compared with stripping laparoscopic cystectomy.

Introduction: Professional self-concept is defined as an individual’s perception of self as a professional person, which affects different aspects of professional performance. This study was aimed to investigate the professional self-concept and its relation to work stress in a sample of Iranian nurses. 

Methods: This research is a cross-sectional study using Cowin's 36-item questionnaire of professional self-concept and the Expanded Nursing Stress Scale (ENSS) in three educational hospitals of Yazd, Iran. A total of 150 nurses were included. We used descriptive statistics and Pearson’s correlation coefficient for data analysis in SPSS ₂₂.

Results: The analysis of gathered data was done separately for included hospitals due to the nature of the study. Only in one hospital, a statistical relationship was found between professional self-concept and nursing stress while in the other two hospitals, the same relationship was not statistically significant. This finding may be due to different working conditions in different types of hospitals.

Conclusion: Although the definitive confirmation of the relationship between professional self-concept and working stress requires further studies, the approved effect of professional self-concept on some aspects of nursing stress in the studied hospitals can have important policy implications.

Introduction: Since the World Health Organization (WHO) has emphasized the importance of estimating the economic costs and traffic-related injuries the society as well as their roles in the analysis of cost efficiency; traffic-related accidents toll estimation has risen as one of the main concerns of the WHO.

Materials and methods: This analytical, descriptive study is an applied research conducted in 2015 in Isfahan province. Among the 35 educational health centers and hospitals in Isfahan, 19 hospitals were selected randomly according to the type of the centers. Information was gathered using traffic accidents system and imported into the Microsoft Excel software. In a country standard, the cost for each patient in traffic accident by NO. 400/11607, dated 9/7/2016 has announced from the Ministry of Health and Medical Education to the Isfahan University of Medical Sciences.

Results: The highest average spending per injured patient is in the Imam Musa Kazim hospital, and lowest average spending per patient can be seen in the hospital Behnia Tiran. (Please elaborate more information in this section)

Introduction: The role of the hospital in maintenance and promotion of public health is more important in times of crisis because the hospitals also act as public shelters and a ray of hope for the affected population in the crisis. Therefore, preparation and continuous improvement of the hospital's safety against probable disasters is one of managerial key tasks. The aim of this research was to evaluate hospital safety index in Susa public hospital before and after interventions. Method: This is an action research study which was conducted from July 2015 to July 2016 in Susa public hospital, Khuzestan, Iran. The study was performed using Hospital Safety Index (HSI) checklist of the Iranian National Institute of Health Research (INIHR). The checklist has three main modules and 145 measures. The hospital was categorized based on A, B, and C level of safety. Result: The results showed that hospital safety index in the first year was at level C which after planned managerial interventions was promoted to the level B in the second year. Despite the partial improvement in the overall hospital safety index level in the second year, the safety level of three main modules including functional, structural, and non-structural safety was still at level C in both years. Despite the improvement of the overall hospital safety score in the second year, the safety score in three main modules remained at a level C. Conclusion: Therefore, the hospital's managers should address the hospital safety weaknesses using safety improvement techniques and quality improvement tools.

Latar Belakang: Asam urat adalah produk akhir metabolisme purin pada manusia. Peningkatan produksi asam urat atau penurunan ekskresi asam urat di ginjal dapat mempengaruhi kenaikan kadar kreatinin darah. Jambu biji merah (Psidium Guajava Linn.) merupakan buah tinggi kandungan vitamin C, polifenol, flavonoid yang berfungsi sebagai antioksidan. Secara empiris jambu biji merah digunakan sebagai obat berbagai penyakit salah satunya hiperurisemia.

Tujuan: Penelitian ini bertujuan untuk mengetahui pengaruh pemberian jus jambu biji merah (psidium guajava linn.) terhadap kadar asam urat dan kreatinin darah mencit putih (mus musculus) model hiperurisemia.

Metode: Penelitian ini berjenis true experimental dengan rancangan pre test dan post test control group design. Sampel penelitian sebanyak 48 ekor mencit putih jantan galur Balb/c usia 2 bulan. Pengelompokan di bagi menjadi 6 kelompok, yaitu kelompok KN hanya diberi pakan standar, kelompok KP diinduksi potasium oxonate dan diberi pakan standar, kelompok P1 diinduksi potasium oxonate, diberi pakan standar dan obat allopurinol 0,26 mg/Kg BB mencit/hari, kelompok perlakuan (P2,P3,P4) diinduksi potasium oxonate, diberi pakan standar dan jus jambu biji merah dosis 5 mg/Kg BB mencit/hari, 10 mg/Kg BB mencit/hari, 20 mg/Kg BB mencit/hari. Kadar asam urat darah mencit diukur dengan metode enzimatik dengan menggunakan reagen uric acid FS TBHBA dan Kadar kreatinin darah mencit diukur dengan metode jaffe dengan menggunakan reagen Creatinine FS. Data dianalisis menggunakan uji One Way Anova dan perbedaan bermakna bila nilai p < 0,05.

Hasil: Berdasarkan analisis statistik jus jambu biji merah dosis 5 ml/Kg BB mencit/hari, dosis 10 ml/Kg BB mencit/hari dan dosis 20 ml/Kg BB mencit/hari dapat menurunkan kadar asam urat dan kadar kreatinin secara bermakna (p < 0,05). Penurunan kadar asam urat dan kreatinin terbaik dengan jus jambu biji merah dosis 20 ml/Kg BB mencit/hari dengan hasil penurunan signifikansi kadar asam urat (6,71±0,47) dan penurunan signifikansi kadar kreatinin (2,12±0,14).

Kesimpulan: Pemberian jus jambu biji merah dapat menurunkan kadar asam urat dan kreatinin darah mencit. Dosis jus jambu biji merah 20 ml/Kg BB mencit/hari paling efektif dalam menurunkan kadar asam urat dan kreatinin darah mencit putih (mus musculus) model hiperurisemia.

Introduction: Post episiotomy mother often experience variable sexual function disturbance, and the outcomes are potentially disadvantaged. Sexual function disturbance can be measured by using female sexual function index (FSFI) questionnaire. To determine the sexual function of post-episiotomy mother measured by using FSFI. Methods: Post episiotomy mother fill the FSFI questionnaire. The study had been done at H. Adam Malik Hospital and networking hospital in October 2014. This is a cross-sectional study, using descriptive method. Chi-square test and Fisher exact were used to analyze the data. Results: From 100 cases, the majority are 19-25 years old (43%), 26-30 years old (25%), 31-35 years old (23%), and 36-40 years old (9%). Based on the period of episiotomy, the study objects >9 months ago (65%), 6-9 months ago (14%), and 3-5 months ago (11%). Average scoring of the FFSI domain is lubrication (FSFI score=10.24±3.83), arousal (FSFI score=9.61±3.54), pain (FSFI score=8.91±4.39), satisfaction (FSFI score=8.74±3.66), orgasm (FSFI score=8.63±3.66), and desire (FSFI score=4.72±1.86). The above of cut off point was 26,55 (68%) and below it was (32%). Conclusion: The average score of FSFI based on domain respectively started from the highest to the lowest score are lubrication, arousal, pain, satisfaction, orgasm, and desire. It is important for a woman to understand that sexual dysfunction they experienced after episiotomy is temporary.

Background: The portable chest X-ray in infants hospitalized in neonatal intensive care units is one of the most common diagnostic procedures. Every child during hospitalization period may be incurred over a number of portable chest radiography examinations. Optimization of the infant position for radiography results in the improved diagnostic quality of radiographs.

Objective: To evaluate rotation factor during pediatric portable chest radiography; the present study examined the effect of two different methods to stabilize infant position during radiography on the incidence of rotation.

Materials and methods: This is an interventional study with nonequivalent groups in which rotation factor was evaluated on 250 portable chest radiography on fields of newborns admitted to NICUs (in two intervention and control groups), by comparing the length of posterior ribs on both sides of the chest. In this study, 176 radiographs were related to infants from three university hospitals so that sandbags or patients accompany had been used to stabilize the position of the patient, and 74 radiographs were for infants referred to an academic center whose positions had been stabilized during X-ray using body immobilizer.

Results: The mean difference between the length of right and left posterior ribs in infants stabilized with the usual method (sandbags or patients accompanies) was obtained 6.51±5.05 mm. This statistical index for the second group of infants whose positions had been stabilized through body immobilizer was 2.87±2.15mm. Independent t-test showed a significant difference between the two groups in terms of the difference in the quantity of rotation. In this study, the difference in the length of posterior ribs over 5 mm was found as detectable rotation in the images.

Conclusion: The infant position during radiography can be improved considerably by using proper body immobilizer, and repeating the tests can be avoided due to the inappropriate position. By means of such an instrument, there is no need for the help of accompanies or personnel to stabilize infant position, and their exposure will be prevented.

Introduction

Efficient correction methods should be applied early at the detection of scoliosis. One of them is medioprophylactic clothes. However, the effect of medioprophylactic clothes towards the dynamics of erythrocyte microrheological features in children with scoliosis has not been fully studied.

Methods

In this study, we tracked indices changes of erythrocyte cytoarchitecture and aggregation in thirty-nine 5-6-year-old children with grade I-II scoliosis who wore medioprophylactic clothes (designed by one of the authors) daily for 6 months. Thirty-four healthy subjects were enrolled for the control group. The measurement was conducted at the beginning of the research and after 3 and 6 months of intervention.

Result

At their initial state of the observation, the experimental group had worse erythrocyte microrheological features because of physical development inhibition. Daily usage of medioprophylactic clothes for six months reduced the evidence of spinal curvature, increased force, and tolerance of body muscles, lowered reversible and irreversible modified erythrocyte, and weakened spontaneous erythrocyte aggregation.

Introduction: Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae ,which is an obligate intracellular bacteria. The therapy of leprosy involves a combination of drugs called multi-drug therapy and one of the drugs included in this therapy is dapsone. Dapsone has a hematotoxic effect because of its toxic metabolite called hydroxilamine. The most common side effect of this drug is hemolytic anemia. Hemolytic anemia occurs when the production of erythrocytes is not balanced with their destruction, causing the lifespan of erythrocyte to become shorter and the bone marrow fails to compensate for this.

Methods: This research is a pre experimental study with a pre-post design, involving 15 leprosy patients that were diagnosed by clinical and laboratory examination. We conducted measurements of hemoglobin, MCV, MCHC, and reticulocyte count before and after the MDT therapy for 3 months.

Results: In this study, the incidence of hemolytic anemia after 3 months receiving MDT was 66.7%. There was decreased hemoglobin level (mean 11.320 g/dl), increased reticulocyte count (mean 2.341%), normal level of MCV (mean 88.807 fL), and decreased level of MCHC (mean 31.920 g%). There were significant differences in hemoglobin level, MCHC level, and reticulocyte count before and after 3 moths of MDT.

Conclusion: There was a significant difference in the number of hemolytic anemia before and after MDT with a p-value < 0.05.

Background: Tinea pedis is a dermatophyte infection of the feet, especially the toes and soles of the feet. The clinical features of tinea pedis consists of four forms. They are interdigitalis, chronic hyperkeratotic, vesicobullous, acute ulcerative or combination. Tinea pedis mainly interdigitalis form often involved bacterial superinfection, initially Gram-positive bacteria, but Gram-negative bacteria may also be involved. In a state of severe infection, the fungus is getting hard to find, otherwise the bacteria were easier to find, so it is necessary to do  fungal and bacterial culture with antibiotic sensitivity tests.

Objective: To determine dermatophyte species and bacterial superinfection in tinea pedis at H.Adam Malik General Hospital Medan.

Methods: This study is a descriptive observational with cross sectional design. The results of the study are presented in the form of frequency distribution table. These research involved 45 subjects with tinea pedis who met the inclusion and exclusion criteria. We conducted anamnesis, dermatologic examination and collection of samples that were skin scrapings and smears on the lesion. The samples then examined on microscopic directly by using KOH. When KOH result was positive, it followed by fungal and bacterial culture.

Results: The number of subjects who suffer from tinea pedis is not much different between men (48.9%) and women (51.1%).The highest prevalence was in age group 37-46 years (28,9%), mostly graduated from elementary school (40%) and mostly housekeepers (22.5%),  with the most prevalence type was interdigitale by 40 cases (88.9%). Dermatophytes T. mentagrophytes were most found by 44.4%, followed by T. rubrum, E. floccosum and T. violaceum. Bacterial superinfection were mostly involved S.aureus by 30,8%, but B. subtilis, S.epidermidis, K.oxytoca, K.pneumoniae, E. coli, P. vulgaris were also found.

Conclusion: Dermatophytes T. mentagrophytes were most found followed by T. rubrum. Bacterial superinfection S.aureus were mostly involved.

Background: Overweight is a disproportionate nutritional status between intake and energy expenditure that leading such health problems. Its features that arise in adolescence tend to continue in adults and the elderly. Nutritional status in adolescents can indicate the level of dietary issues occur – namely daily intake problems in adolescents in which one of them can be described from breakfast consumption. Fulfillment of intake in those students can affect weight, but other things that need to be considered is about their physical activities such as jogging. Jogging itself is included in cardio exercises (cardiovascular) or often called aerobic exercise. The great benefit of cardio in addition to improving fitness is to increase fat burning in the process of weight loss. Aim: The study aims to evaluate the effects of jogging and breakfast consumption on the alternation of weight in overweight students. Methods: This research is a kind of analytical quasi-experimental design with pre-test and post-test control group design. This study was conducted by grouping it into the treatment group and the control group for 12 weeks. The statistical test uses independent samples t-test to compare the average of either jogging and breakfast consumption influenced the weight changes. Results: The research shows that the body weight changes on the students before and after treatment were differed significantly (p= 0,023). Conclusion: There is a difference in the effect of breakfast consumption compared to the setting of breakfast consumption by jogging against weight changes in overweight adolescents.

Background. Sepsis is a life-threatening organ dysfunction, caused by the dysregulation of the body's response to infection. Sepsis remains one of the major causes of hospitalization and mortality in hospitals with large medical expenses. Sequential (sepsis-related) organ failure assessment/SOFA is a score that describes the presence of organ dysfunctions. Lactate is a metabolite formed  anaerobic respiration due to hypoperfusion. This study was conducted to determine the role of SOFA score as a predictor of sepsis mortality and its association with capillary lactate levels.

Method. This was an observational study with a cohort design. A sample of 68 subjects with sepsis was taken using consecutive sampling. Calculation of the SOFA score was performed at the beginning of sepsis diagnosis whilst capillary lactate examination was performed in the first 3 hours after diagnosis.

 Result. The most frequent cases of organ dysfunction based on SOFA score was respiration system (83.8%), kidney (58.8%), central nervous system (55.9%), cardiovascular (41.2%), coagulation (36.8%), hepatobiliary (23.5%). The mean score of SOFA and the initial capillary lactate level of the living group compared with the deceased group was 4.89±2.06 vs. 7.64±2.67 (p <0.05); 3.28±1.39 vs 3.60±1.43 (p 0.116). The best cut-off values of the SOFA score for mortality were ≥ 5.5 (area under curve/AUC 0.788, sensitivity 74.2% and specificity 62.2%, positive predictive value/PPV 62.2%, and negative predictive value/NPV 74.2%). The log-rank test of the Kaplan-Meier curve was statistically significant (p <0.05). Multivariate Cox regression analysis showed that the SOFA score with cut-off ≥5.5 could be used as a predictor of mortality in sepsis patients with a hazard ratio of 2.475 (p <0.05). Spearman correlation test between SOFA score with initial capillary lactate level was statistically significant (p <0.05) with correlation coefficient 0.319 (weak correlation)

Conclusion. The SOFA score with cut-off ≥5.5 can be used as a predictor of mortality in sepsis. The SOFA score correlated weakly with capillary lactate levels.