The main purpose of the present research is studying the effectiveness of art therapy with sand play method on behavioral disorders, emotional problems, and communication skills of children. This research had done with semi-experimental method by pretest-posttest plan with control group. The sample of this study was all elementary school boys in first urban area of Tehran city, which were 12500 students. Multi-stage random cluster sampling method used between 24 areas of Tehran
to achieve the purpose. The information gathering tools were Rutter Questionnaire (Teacher Form) for measuring behavioral disorders, Ashbanah (teacher form) for measuring emotional problems, and SDQ (Teacher Form) for measuring children's communication skills which was given to teachers for data collection. Thirty students randomly divided into two experimental and control groups (15 students for experimental group and 15 for control group). The presence of symptoms of behavioral disorder, emotional problems, and communication skills, and the age range of 6-12 years were requirements for experimental group. The experimental group subjected to sand play therapy in 10 sessions of 30 minutes. No training provided for the control group. The findings analyzed using covariance analysis. The results showed that the mean score of behavioral disorder in the experimental group was lower than the control group after the sand play therapy. The emotional problems in the experimental group were lower than the control group after the sand play therapy. The mean of communication skills in the experimental group was more than the control group after the art therapy with sand play method. 

Background: Pain resulting from the stone passage is one of the most severe and intractable pain experiences. The aim of our study is evaluating the effect of intra-muscular ketorolac on pain reduction; reduce the length of stay and cost of patients with renal colic.

Methods: This was a randomized clinical trial study which held in an academic emergency department (ED). Based on defined criteria, 222 patients with renal colic were randomized in two groups: half of them received a single intramuscular injection of 30 mg ketorolac, and other 111 patients got conventional treatment (hydration, morphine sulfate). Demographic characteristics, pain score after 30 minutes, the length of stay in ED, complications as well as hospital costs were recorded for both groups.

Result: The baseline characteristics and pain score were similar in the two groups (p>0.05). Ketorolac was significantly (p<0.001) more effective than conventional treatment in reducing pain score. Those treated with ketorolac left the ED significantly earlier than those treated with conventional treatment (65.54; 95%CI, 59.7-71.5 vs. 193.1; 95%CI, 172.8-215.2 minutes, p<0.001). Drug adverse effects (nausea, dizziness, and drowsiness) and cost of ketorolac group were significantly lower than the control group (43310 Tomans (110$) (95% CI, 42590-44030) vs. 150410 Tomans (350$) (95% CI, 240100-70940). (p<0.001).

Conclusion: This study showed that intramuscular ketorolac as a single agent for renal colic is cost-effective and promotes earlier discharge of renal colic patients from the ED.

Objective: to investigate productivity and efficiency linked to the hospitals affiliated Boshehr province before and after the implementation of the HSTP.

Material and Method: this study is a descriptive-analytical kind conducted by applying a panel data for a 5- Year time horizon. The study was carried out on 8 teaching and non-teaching hospitals of Boshehr Province. An input- oriented DEA technique combined with SFA and Malmquist indices were used to estimate the efficiency and productivity changes. Data were analyzed using Excel.22 and DEA-solver learning version 8 Software.

Result:  Our results illustrated that efficiency and technological changes over the study span were -3% and +17%, respectively. As a corollary, Malmquist index has experienced an ongoing trend equaling +14%. In spite of being a progressive trend in technical efficiency based on SFA model,  the technical efficiency of the hospitals examined was not favorable.  

Conclusion: Estimates on the basis of Malmquist index revealed that a 5-year average productivity change was +14%. However, the implementation of health system transformation plan (HSTP) has no statistically significant effect on that. So, there is considerable room for improving technical efficiency or cost containment by way of employing unused capacity or expanding outputs.  

Keyboards: Malmquist index, productivity, DEA and SFA

Purpose: This study aimed to assess the relationship between S100β protein with neurological
deficit and mortality within 1 week in patients with Intracerebral hemorrhage (ICH) stroke. And
also, to determine the relationship between hematoma volume with S100β protein.
Patients and Methods: a prospective observational cohort study. Patients with sampling from
consecutive admission from August 2016 to December 2017 were performed head CT Scan, met
inclusion and exclusion criteria. Neurological deficits as ascertained with National Institute of
Health Stroke Scale (NIHSS). Blood samples were taken at the admission to the hospital and on the
7th day of onset.
Results: There were 46 patients with 25 men (54.3%) and 42 controls with a median age of 56 (31-
76) and 34.5 (21-67) years. The most risk factor was hypertension (78,3%). Median onset of acute
ICH stroke was 8.5 (0.5-48) hours. Median level of consciousness according to Glasgow Coma
Scale (GCS) at the admission to the hospital was 14 (3-15) and the NIHSS was 11.50 (0-37). Serum
S100β protein levels correlated significantly with NIHSS (r=0.418;p=0.004). Area Under Curve
(AUC) of S100β was 0.839±0.103 (95% CI, 0.638-1.000), cutoff level was 28,505 pg/mL with 80%
sensitivity and 87.8% specificity (p=0.014). Serum S100β protein levels associated significantly
with mortality within 1 week (p=0.032). The hematoma volume correlated with S100β protein
levels (r=0.678;p&lt;0.001).
Conclusion: S100β protein was significant correlation with neurological deficits. S100β protein
was associated significantly with mortality within 1 week. The hematoma volume was significant
correlation with S100β protein.

Background:Female Sexual Function Index (FSFI) is a multidimensional questionnaire that can show female sexual function. This questionnaire consists of 6 domains in which sexual desire, sexual arousal, lubrication, orgasm, sexual satisfaction and pain (19 questions in total). The questionnaire is useful for early detection of female sexual dysfunction complaints. The validated questionnaires are useful to support the overall validity of research data.

Purpose:To obtain an Indonesian FSFI questionnaire that is in accordance with the original questionnaire as well as valid and reliable for the usage in the Indonesian population.

Methods:Series ofvalidation testare conducted through several stages: forward translation, expert panel, backward-translation, pre-testing and cognitive interviewing, final version and documentation. The study was conducted by collecting data from 107 patients in reproductive health age (18-35 years old) in Daerah Istimewa Yogyakarta province, from January to March 2018.

Results:Indonesian version of Female Sexual Function Index (FSFI-I) iseasy also excellent to understand and assess the sexual function of women). The test value more than 0.300 (0.326-0.623)was considered as valid. One question (number 19) is 0.282, less than 0.300 but still valid because the value is more than r-table. Reliabilitytestof questionnaire was performed using Cronbach's Alpha with a high significant result of 0.844. Reliabilityretest testwas evaluated using V Aiken with a result of 0.833 showingFSFI having good content validity for all groups.

Conclusions:Indonesian version Female Sexual Function Index (FSFI-I) is valid and reliable in this study; however, it requires further study with larger samples widely used in Indonesia.

Keywords:Female Sexual Function Index, Indonesia, validation test

Background: In the treatment of patients with hypertension and dyslipidemia, great attention has been devoted to hypolipidemic diet, graduated exercise and statins. Accordingly, a complex application of non-medication and statins to those patients is concerned in weakening of regular blood elements' aggregative ability. This study aims to establish the complex impact of rosuvastatin and nonmedicinal therapy on aggregative features of regular blood elements in patients with arterial hypertension and dyslipidemia.

Materials and Methods: There were 61 patients with grade I-II of hypertension, risk 3 with dyslipidemia of IIb type. All the patients were prescribed rosuvastatin, hypolipidemic diet, and graduated exercise. Enalapril 10 mg twice a day was given for hypotension. Registration of clinical and laboratory indices was made in 6, 12, 18, 52 and 104 weeks of therapy. Biochemical, hematological, and statistical methods of investigation were applied. There were 26 healthy volunteers as a control group.

Results: This study show a surplus aggregation of erythrocytes (aggregates' quantity rose to 44,4%), platelets (with ADP on 74,5%; with collagen - on 48,2%) and neutrophils (with lectin on 55,8%; with phytohemagglutinin - on 38,2%). During 104 weeks of therapy, it suggested a positively influenced lipid composition and level of lipid peroxidation in plasma as well as regular blood elements taking the given indices on the control level for 6 weeks. Fulfilled therapy show a normalized erythrocytes' aggregative abilities (aggregates' quantity decreased on 44,4%), platelets' aggregation (inhibited with ADP on 74,8%, with collagen - on 47,8%), and neutrophils (aggregation weakened with lectin on 55,8%, with phytohemagglutinin - on 38,2%) during 6 weeks. Reached results were kept in patients until the end of the investigation.

Conclusion: Rosuvastatin intervention give normalizes lipid composition and level of lipid peroxidation in plasma as well as regular blood elements for 6 weeks of study. In addition, it is also lowering erythrocytes' aggregative abilities as well as platelets and neutrophils during for 6 weeks of therapy.

Salmonellosis (also called “a disease of civilization”) is widespread across the globe, including the Russian Federation. Hence, measures to lower the morbidity of human beings, animals, and to limit propagation of infectious causative agents are needed. We studied colonization resistance and Salmonella typhimurium №5715 dissemination into chickens’ tissues and organs. The duration of the experiment was 30 days. We identified microorganisms to study colonization resistance of bowels and salmonella dissemination into chickens’ tissues and organs. We used the microscope “H604T Trinocular Unico” for morphological studies. We noticed acute and subacute course of salmonellosis, extensive vessel hemorrhages, cyanosis, hyperemia, numerous dotted and spotted hemorrhages in chickens’ tissues and organs. Pathological signs developed were accidental transformation of thymus, bursa of Fabricius’ atrophy, hyperplasia of the spleen, catarrhal-hemorrhagic pericarditis, air sacculusis, enteritis, perihepatitis, stagnant hemorrhagic infarct of kidneys. Common symptoms of infection were observed, such as exudation and infiltration, increase of plasma clumps, macrophage reactions, perivascular edema, and disseminated thrombosis. The study confirms that salmonellosis is a dangerous disease that can affect many organs and requires etiologic and pathogenetic treatment.

Introduction: As the most critical medicinal establishment, hospitals ought to be prepared for responsibility and appropriate administration of catastrophes before the accidents.

There must be readied operational plans available to cope with the critical conditions, and awareness of the significance of the persuasive influential is fundamental.

The aim of this study was to identify and prioritize the factors effective in disaster preparedness in hospitals of Hormozgan in 2016.

Method: In terms of purpose, the study is applied conducted using descriptive-survey method. The study was conducted in three steps. In the first step, library studies method was utilized for identifying the main components of preparedness for disasters in hospitals; in the second stage, Delphi method was used to identify the factors effective in disasters; and in the third step, Analytical Hierarchy Process (AHP) was used to prioritize the effective factors. Data collection tool was a researcher-made questionnaire scored based on a 5-point Likert scale. The validity of the questionnaire was assessed through the experts’ judgment, and the reliability was measured by Pearson correlation method (0.89). SPSS 22 was used to analyze the data.

Findings: Based on the various factors of disaster management in the hospitals, the most important factors in the preparation stage considering the priority are given below. These include formulation of Emergency Operations Plan (EOP) in treatment in the province (weight 0.02895), creation, reinforcing, and advancement of Emergency Operation Center (EOC) at the province level (weight 0.02745), and providing logical strategies for dealing with crises and environmental incidents (weight 0.02716). Moreover, we have developing a comprehensive annual exercise program for exercising and maneuvering from health home level to the reference hospital (weight of 0.02496), and the center of disaster management training and practice program at the province (weight 0.02185).

Conclusion: for more preparedness against disasters, it is necessary that Hormozgan hospitals put establishing, strengthening and developing a disaster management center on the agenda of managers. Besides, the viable elements recognized in this investigation can be utilized as a suitable guidance for better disaster preparedness.

Purpose: The purpose of this study is to explore Balinese traditional healers perception related to knowledge, belief, and health practice of epilepsy and their influence to the epilepsy patients.

Material and Methods: A cross sectional study was carried out between 1st and 20th February 2018. Balinese traditional healers, who were Hindu, and had treated epilepsy patients were recruited and had an interview. Demographic characteristics of respondents were noted.

Results: A total of sixteen respondents consisted of eight Balinese traditional healers and eight epilepsy patients were enrolled. It was found 87.5% of respondents said epilepsy was combination of medical and spiritual illness. The abnormality of body temperature (n=5, 62.5%), hereditary disease (n=2, 25%), and blood disorders (n=1, 12.5%) were their knowledge about etiology of epilepsy. The traditional opinion about epilepsy was about ancestor’s sin (n=4, 50%) and black magic (n=4, 50%). The patients were also given vary herbal medication contained plants, oil, roots, fruits, holy water and showed both positive and negative effect to the patients. According to the patients, issues of religious belief, accessibility, affordability, and economy were the reason of coming to the Balinese traditional healers at first.

Conclusion: Traditional belief were assumed to have a great impact in health system among Balinese communities along with medical therapy. This traditional belief should be one of health practices consideration while taking care of epilepsy patient.

Introduction: The thyroid hormone itself carries out a variety of metabolic functions including the regulation of lipids, carbohydrates, proteins and electrolytes, and mineral metabolism, which will affect electrolyte balance. The objective of this study was to look at the relationship between sodium and potassium, and hypothyroidism.

Methods: A cross-sectional study on subject data were taken retrospectively by looking at medical records of patients treated at Dr. Kariadi Hospital Semarang from 1 June 2017 to 1 June 2018 to see the relationship between serum sodium and potassium, and hypothyroidism.

Results: Sodium did not show significant correlation with thyroid-stimulating hormone (TSH) and thyroxine (T4) (p = .985 and p = .705).Correlation test between potassium and urea showed a significant relationship (p = .005 and r = .441). Likewise, regarding the relationship with creatinine, sodium did not show a significant correlation (p = .890 and r = .023), while potassium showed significant correlation (p = .003 and r = .466).

Conclusions: There was no significant relationship between serum sodium and potassium and thyroid hormone (TSH and T4). There is a significant positive correlation between ureum creatinine and potassium.

Background: This study aimed to assess the comparison between two HbA1c analyzers, Alere Afinion AS100, a boronate affinity based point of care testing (POCT), and High-Performance Liquid Chromatography (HPLC) based analyzer Bio-Rad Variant II Turbo HbA1c kit-2.0 as reference method.

Methods: This study involved 120 samples of peripheral K₃EDTA whole blood sent to Clinical Pathology Laboratory of Cipto Mangunkusumo National Hospital for HbA_1c measurement. Based on reference method, 40 samples with HbA_1c ≤ 6.4%, 40 samples with HbA_1c > 6.4%, and 40 samples with variant hemoglobin or hemoglobinopathy were included. Precision and accuracy of both analyzers were assessed using control materials. The goodness of fit between these methods were assessed by Bland-Altman plot and Passing-Bablok regression test. Results were compared to National Glycohemoglobin Standardization Program (NGSP) recommendations.

Results: Reference method had total error (TE) ranging from 3.15% to 4.9%, while Afinion ranged from 2.16% to 3.24%. Both methods correlated well with Passing-Bablok regression showing no proportional or systematic differences. Linearity between tests was proven by Cusum test value of p > 0.05. Bland-Altman plot yielded 91.74% goodness of fit. No significant differences were observed in hemoglobinopathy and variant hemoglobin analysis of HbA_1c.

Conclusion: Afinion was precise, accurate, and linear to HPLC reference method. Both methods exhibited no systematic or proportional differences. Despite Bland-Altman plot of less than 95% goodness of fit, no clinically significant result was found based on NGSP criteria.

Background: Diabetes mellitus (DM) case continues to rise as WHO reported that the number of adults suffering from DM had almost quadrupled since 1980 to 422 million cases. Laser acupuncture for DM therapy is performed by perpendicularly attaching laser probes to the body, and the laser light was directed to the acupuncture point until reaching the appropriate.

Aim: We aimed to investigate the laser acupuncture at BL20 point in type 1 diabetes mellitus in stimulating pancreatic beta cell.

Methods: Twenty-Two Rattus norvegicus were randomly divided into two groups. Rats in the L1 group were not radiated, while rats in the L2 group were radiated every two days for 12 days. Laser was radiated at BL20 acupuncture point. Fasting blood glucose (FBG) levels were measured in the 13th day by cutting tail. Pancreas tissue ware took to be further microscopically evaluated.

Results: The FBG level and immunohistochemistry of pancreatic beta cell between the two groups were compared using independent t-test and Spearman’s correlation test (p <0.05). Rats in L2 showed a significant decrease in FBG level, a significant increase pancreatic beta cell and Langerhans area.41 patients undergo hysteroscopy procedure dan endometrial biopsy.

Conclusion: This finding indicated that laser acupuncture at BL20 point could reduce FBG level, increase pancreatic beta cell and wider Langerhans area in type 1 diabetes mellitus.

Background: In recent decades, various techniques include flaps and grafts have been deployed to heal deep burn wounds. All efforts tend to use a method which will cause faster epithelization and fewer scars. Amniotic membrane and stem-cells are shown to have unique properties in epithelization and wound healing for depth wounds.

Objective: There are many studies in which the prevalence of using fresh amniotic membrane has been discussed as a biological dressing. In this study, we used frozen amniotic membrane enriched with stem-cells to evaluate the outcomes of this biological combination on epithelization rate, wound healing and scar formation in third-degree burn wounds.

Method: In this study, we evaluated outcomes of using amniotic membrane enriched with stem-cells in the repair process of third-degree burn for 180 days after the reconstructive surgery. We divided the burn area into two sections of control (skin mesh graft only) and case (skin mesh graft with the dressing of amniotic membrane enriched with stem-cells). All patients were followed-up for 180-days to analyze the risk of infection, scar formation, and pain score during this period.

Results: Our findings showed that there is a significant difference between pain score in case and control group only during the first 7-days of follow-up. The mean Vancouver scar scale score in case group is less than it in the control group and has a statistically significant relationship with it. Prevalence of infection in case and control group showed no statistically significant difference and yet, there was a significant difference between satisfaction in both groups.

Conclusion: Using frozen amnion, in addition, to maintain the properties of fresh amnion, may reduce the risk of infection transfer. Also because of the unique properties of stem cells in reepithelization and wound healing, using amniotic membrane enriched with stem-cells may be an ideal dressing to treat depth wounds.

Introduction: Self-efficacy is one of the determinants of effective communication between the nurse and the patient and promotion of communication skills can increase it. This systematic and meta-analysis study was conducted to investigate the effectiveness of communication skills training on self-efficacy of nurses.

Methods: PubMed, Science Direct, CINAHL and Web of science were searched up to 2017, for relevant studies. Studies that assessed the effect of communication skills training on the self-efficacy of nursing personnel were included in the study. Finally, 10 studies were selected. In this study, novice and nursing students were not considered.

The standard deviation (SD) mean of changes in communication self-efficacy were used to assess Hedges’ g to be used as an effect size for meta-analysis. DerSimonian and Liard random effects model was included in the study in order to summarize the effects.

Results: Meta-analysis findings showed that communication skills training can improve nurses' self-efficacy (Hedge’s g = 0.51, 95% CI: 0.311-0.699, p<0.001). Education was also affected by increasing the self-efficacy based on the random effects model. Furthermore, after analyzing the subgroup this effect retained significant in single group trials. The effectiveness of communication skills training was higher in studies with the intervention group compared with control groups. The quality of studies was investigated based on cochran. Most studies were qualitatively low.

Conclusion: Educational programs for nurses' communication improve their feelings towards communication self-efficacy. Due to the importance of self-efficacy in communication skills development, trainings related communication skills should be considered as a permanent program in hospitals.

Background: Emergency department (ED) is a useful place in terms of clinical education opportunities for medical students, residents, and even other hospital staffs. Overcrowding in ED except for the effects on the patients' fate and ED condition, it's may be effective in resident clinical education.

Aims: This study aims to investigate the effect of emergency crowding on the education of residents.

Methods: This cross-sectional study was carried out on the emergency medicine residents for 21 weeks in ED of Imam Khomeini Hospital in Tehran. This hospital is a level-1 trauma center and a training center. The crowding indexes included Occupancy Rate (OR), Residences Work-Load (RWL). The educational indexes included the amount of Trauma Team Participation (TTP), Assistance's Physical Examinations (APE), Assistance's Taken Histories (ATH), Assistance's written orders (AWO), the participation in the clinical scientific discussion, Assistance's Independently Procedures (AIP), and the number of Assistant Ultrasounds (AUS). Educational Indices, Clinical Education Satisfaction, and Residents' Viewpoints were evaluated by using a questionnaire on the amount of crowding in shift works.

Results: A total of 126 Resident Shifts were reviewed. There was a significant relationship between the useful education (UE) with OR (P = 0.006). RWL was a significant statistical relationship with all parameters except for the TTP and AUS. No relevance was found for age and sex with educational indicators. Postgraduate Year (PGY), was strongly associated with educational indicators except for TTP and AUS.

Conclusion: Emergency crowding did not adversely affect the education in term of total OR and RWL. Moreover, it has been useful and effective in educational indicators such as storytelling, conducting procedures, placing orders and physical examination.

Background: Susceptibility to acne vulgaris had seen by modulating devolution of encoding cytochrome P450 1A1 (CYP1A1) gene polymorphism which is involved in bioactivation and detoxification of drugs, chemical agents, and pollutants from the environment. Acne incidence is known different based on ethnic, so that, we did this study in Indonesian acne vulgaris patients.

Aim: To characterize cytochrome P450 1A1 (CYP1A1) polymorphism in Indonesian acne vulgaris patients.

Method: Multiplex polymerase chain reaction (PCR) dan PCR based restriction fragment length polymorphism (PCR-RFLP) were used to detect polymorphism changes of CYP1A1 by doing a case-control study of 35 acne patients dan 35 controls. All the examination samples were obtained from Pekanbaru, Riau Province, Indonesia.

Result: The frequency of CYP1A1 heterozygous variant alleles was higher in case (odds ratio 2.21; 95% Confidence Interval 0.71-6.87).

Conclusion: Polymorphism of CYP1A1 allele m1 gene increases susceptibility to acne vulgaris.

Background: Vitiligo is a chronic systemic acquired disease that has an unpredictable clinical course, characterized by the appearance of macules and achromic or hypochromic patches on the skin and mucous membranes due to the disappearance of melanocytes in the affected area. Until now, the underlying pathogenesis of vitiligo is still unclear. The role of superoxide dismutase (SOD) in vitiligo is mentioned that it can be a biomarker to determine vitiligo activity and progressivity.

Aim: To determine correlation between SOD and vitiligo disease activity score (VIDA)

Materials and methods: This study was a cross-sectional analytic study which involved 39 vitiligo patients that were diagnosed by clinical and Wood’s lamp examinations. VIDA score was determined to assess lesion activity, which is categorized in the six-point scale. We conducted blood sampling and measurement of SOD level to the patients by ELISA.

Results: We found mean SOD in +4 group was 37.55 ng/ml, +3 group was 25.32 ng/ml, +2 group was 4.67 ng/ml, +1 group was 5.60 ng/ml, and 0 group was 3.88 ng/ml.  There was is no difference of SOD level based on VIDA score  (p=0.775 r=-0.047). In this study, we found the highest mean SOD level in subjects with vitiligo activity lasting from 6 weeks to 3 months and the lowest level in group with lesion activity stable for 1 year.

Conclusion: There was no significant correlation between SOD and VIDA score in vitiligo patients.

Background: Keloid and hypertrophic scars are the results of abnormal skin cells proliferation that usually cause major physical, psychological and cosmetic problems. However, there is no effective method for eliminating this scars yet. Recent reports suggested that BTX-A improves wound healing. However, there is no comprehensive study to assess the efficacy of BTX-A injection for treatment of keloid and hypertrophic scars.

Aim: This study aims to investigate whether BTX-A injection improves the keloid and hypertrophic scars treatment or not.

Methods: Ten patients with keloid or hypertrophic scar lesions were enrolled in this study and randomized into two groups (injected by BTX-A or placebo). Injections were applied at one-month intervals for a total of three months. All the patients were followed up for at least six months. Scars were assessed by mVSS (modified Vancouver Scar Scale) and an independently blinded evaluator with standardized photographs.

Results: The study was completed with ten patients at the six months follow up visits in the treatment group. BTX-A reduced (not significantly, p>0.09) mVSS including pliability, vascularity, pigmentation, and height, but did not affect the pruritis and pain.

Conclusion: It can be concluded in this study that BTX-A can reduce some parameters of mVSS and may be a suitable compound for the treatment of keloid and scar tissue.

Introduction: Hospitalized malnutrition in children is a nutritional imbalance that occurs during hospital treatment, regardless the nutritional status at admission. Hospitalized malnutrition can be prevented, with periodic evaluation of nutrition status and early detection of hospital malnutrition. Pediatric Yorkhill Malnutrition Score (PYMS) can be one of the instruments used at Sanglah Hospital to prevent hospital malnutrition. This study aims to know the validity of PYMS to detect hospitalized malnutrition in pediatric patient at Sanglah Hospital.

Method: This Study was a prospective cohort study, performed at Sanglah Hospital Denpasar between August and December 2017. The subjects were collected using consecutive sampling method. PYMS was measured when admitted. Hospitalized malnutrition was defined if there is any weight loss during hospitalization. Between August and December 2017, 240 subjects were retained for analysis.

Result: The incidence of hospitalized malnutrition was 14.1%. The combined high risk and medium risk of PYMS had 97.1% sensitivity, and 47.1% specificity, positive predictive value (PPV) 23.2% and negative predictive value (NPV) 98.9% for detecting children who are at risk for hospitalized malnutrition.

Conclusion: Pediatric Yorkhill Malnutrition Score is acceptable for a screening tool, however it also important to ensure to the staff low score does not negate referral for dietetic assessment.

Background: Ovarian cancer was the seventh most frequent cancer worldwide, with 238.700 new cases in 2012, and eight ranked leading cause of cancer mortality, with 151.900 deaths. Most ovarian cancer patients are diagnosed at an advanced stage (67%) and prospects for significant improvement in survival reside in early diagnosis. Therefore, the development of a novel biological marker for the diagnosis and prognosis prediction of epithelial ovarian cancer remains urgent. Current literature shows that microRNA-21 (miRNA-21/miR-21), as an oncogenic miRNA, is involved in the growth, metastasis and apoptosis of cancer cells through its control of various target molecules and signaling pathways

Objective: To determine the differences expression of miR-21 in blood plasma epithelial ovarian cancer patient (EOC) between early stage epithelial ovarian cancer and advanced stage.

Methods: This study is a cross sectional study in 40 epithelial ovarian cancer patients that underwent primary surgery for suspected ovarian cancer. Blood sample taken prior to surgery and when pathological anatomy result confirmed it is an epithelial ovarian cancer, then the RNA was isolated. Based on the RNA, the cDNA was synthesized and run through qPCR. All the data will be analyses with GenEx analyzing software.

Results: The expression of miR-21 in advanced stage EOC is 1,36 fold compare to early stage (p=0,52), expression of miR-21 in type II EOC is 1,33 fold compare to type I EOC (p=0,56), and expression of miR-21 in residual tumor >1cm after surgery is 1,30 fold compare to residual tumor after surgery < 1cm (p=0,59)

Conclusion:. Despite a trend, there was no significant increase in the expression of circulating miR‐21 in severity of stages, histopathology type and residual tumor in this study. In conclusion, the circulating miR-21 may be promising candidate biomarkers for EOC that require validation in a larger study.

Background: The fibrotic process in liver fibrosis is faster when there is coinfection with HIV than in Hepatitis B or Hepatitis C mono-infection. Objectives: We sought to compare the presence of liver fibrosis based on Aspartate Aminotransferase to Platelet Ratio Index (APRI) in HIV clinical stage I-II and III-IV. We also sought to identify factors associated with liver fibrosis in HIV-infected children. Methods: The population was HIV-infected children who were registered in 2006-2014 Sanglah hospital’s TApHOd (Treat Asia Pediatric HIV Observational Database) cohort. The cutoff point for fibrosis was APRI > 0.5. The sample was grouped into two outcomes: liver fibrosis and without fibrosis. The associations of liver fibrosis to the severity of HIV clinical stage and other variables were analyzed using Fisher-Exact test. Results: From 81 HIV-infected subjects, 46 were in stage III-IV and 35 in stage I-II. The range of APRI was 0.11 to 12.01. There were 27 subjects with liver fibrosis. There were 21 subjects with liver fibrosis in stage III-IV HIV infection and 6 in stage I-II. The analysis showed in a group of liver fibrosis patients; there are more patients with the severe clinical stage of HIV (p-value = 0.009). Conclusion. Liver fibrosis is more common in the more severe clinical stage of HIV infection in children than in the milder clinical stage. Advanced clinical stage significantly increases the risk for liver fibrosis.

Background: Inflammation and anxiety have reciprocal relationships because low grade chronic inflammation characterized by elevated hs-CRP in central obesity has been proved to induce anxiety. Likewise, anxiety could also induce central obesity and inflammation of peripheral tissue. Brisk walking and relaxation have been proved to have anti-inflammatory effects. However, the effects of their application in central obesity population have not been observed.

Objective: The aim of the study is to determine the combination effect of brick walking and relaxation on hs-CRP and anxiety level.

Method: This research is an experimental research with randomized controlled trial design. According to sample size formula, this study required 80 with central obesity which would be selected using purposive sampling. The sample was divided into 4 groups by randomization procedure intocontrol group, brisk walking group, relaxation group and combination of brisk walking and relaxation group. Each group was given thrice a week treatment for six weeks. Data were analyzed by using SPSS 22.

Results: A total of 80 samples with central obesity were enrolled with mean age 47.66 ± 7.47 years old and WHtR 0.57 ± 0.04. There is no significant effect of brisk walking, relaxation, and their combination to hs-CRP level (p = 0.696). On the other hand, all of the interventions were significantly reduce the anxiety level. However, the combination of brisk walking and relaxation had the most significant effect in decreasing anxiety level even when compared to either brisk walking or relaxation group (p <0.05).

Conclusion: Both brisk walking and relaxation significantly reduce the level of anxiety but their combination had the most significant effect. However, no intervention had proved to alter the level of hs-CRP.

Introduction: Tinea corporis and tinea cruris are skin infections caused by dermatophyte fungus and may be characterized by the serpiginous plaque with scales along the edges of an active erythematous lesion accompanied by central healing in the center of the lesion. Blood type is thought to play a role in the incidence of tinea corporis and tinea cruris disease and can affect the disease becomes chronic. This study aims to determine the relationship between ABO blood group typing with tinea corporis and or tinea cruris.

Methods: Study design using cross-sectional analytic study which involved 68 patients who suspected tinea corporis and or tinea cruris. We did 10% potassium hydroxide examination of skin scrapping, cultured of dermatophyte, collected blood sampling and checked for ABO blood group typing to all subjects. Chi-square analysis is used to evaluate the relationship between tinea corporis and cruris with ABO blood type.

Results: In this research, most of the sexes were male (45,6%), most of the ages were 26-35 years old (38,2%), the highest level of education were junior high school and college (25% and 25%), the highest duration of disease was chronic (72,1%), the highest result of 10% potassium hydroxide examination was negative (52.9%), most of fungal culture result was no dermatophyte fungus growth (73.5%), and the highest incindence of tinea corporis and or tinea cruris belonged to blood group A (27.9%). Statistically, there was significant relationship between blood group with tinea corporis and or tinea cruris (p= 0.000), there was significant relationship between blood group with tinea corporis and or tinea cruris based on 10% potassium hydroxide examination (p = 0.000), and cultured of dermatophyte (p = 0.000), but there was no significant relationship between blood type with duration of disease (p = 0.634).

Conclusion: There was significant relationship between blood group with tinea corporis and or tinea cruris.

Background: Keloid is solid fibrous tissue tumors that occur due to an imbalance between deposition and degradation of extracellular matrix components, especially collagen. Vitamin D is known to have a beneficial role in slowing the progression of tissue fibrosis and proven to play an important role in the synthesis and degradation of collagen and acts as an anti-inflammatory mediator.

Aim: To determine the difference between serum 25-hydroxyvitamin D level in keloid patients and controls.

Method: This is a cross-sectional analytic study involving 60 subjects consist of 30 keloid patients and 30 controls. Keloid patients were diagnosed by history and clinical examinations, and we conducted blood sampling and measurement of serum 25-hydroxyvitamin D level to the patients and controls.

Results: The mean of serum 25-hydroxyvitamin D level in keloid patients (16.92 ± 5.96 ng/mL) was significantly lower than controls (23.57 ± 6.72 ng/mL), p=0.0001

Introduction: Potentially toxigenic Corynebacteria (Corynebacterium diphtheriae, Corynebacterium ulcerans, and Corynebacterium pseudotuberculosis) can produce diphtheria toxin and stated as diphtheria causative agent. The bacteria causing diphtheria could be identified by Cystinase test on the Tinsdale medium, while its toxigenicity determined by Elek test on the Elek medium. This study aims to develop a new modified medium for both Cystinase and Elek tests simultaneously.

Methods: There were ten reference strains of bacteria used for the modified medium optimization. Moreover, 15 clinical isolates were used as samples in the modified medium testing. The result of Cystinase and Elek tests on the modified medium was compared with the standardized tests on the Tinsdale and Elek mediums.

Results: Twelve of 25 isolates tested on the modified medium were identified as toxigenic strain, corresponding with the result from standardized Elek test on the Elek medium. Moreover, 16 of 25 isolates tested on the modified medium were identified as positive for Cystinase test. The similar result was obtained using the standardized Cystinase test on the Tinsdale medium. This result was visible 24 hours after incubation. The modified medium was in excellent condition with the consistent result after stored in half-finished condition for 32 days at 2-8 ^oC.

Conclusion: The modified medium developed in this study was a new good medium that could be used for Cystinase and toxigenicity tests simultaneously.

Background: Subcutaneous immunotherapy (SCIT) is an established recommended treatment for allergic asthma. SCIT provides symptomatic relief, and it is potentially curative. Its build-up phase represents vital information to improve patient compliance and treatment outcomes.

Aim: This study aims to assess the build-up phase outcomes of subcutaneous immunotherapy (SCIT) for pediatric allergic asthma.

Methods: The retrospective cohort study comprised 65 children with allergic asthma due to house dust mites at the end of initial build-up phase of SCIT (3 months) from 2009 until 2012 at one hospital in Surabaya, Indonesia. Pre-SCIT clinical evaluation included skin prick tests for Der p 1 and Der f 1, eosinophil counts test, and the reversibility of forced expiratory volume in a second. The serum level of IFN-γ (TH₁), IL-4 (TH₂), TGF-β (T_regs), and IL-17 (TH₁₇) were measured via enzyme-linked immunosorbent assays (ELISA) at the end of the initial build-up phase of SCIT.

Results: Of the 65 samples, 48 (73.8%) exhibited significant improvement after three months, including 37 (56.9%) partially controlled asthma as against 11 (16.9%) controlled one, respectively. Eosinophil counts, IL-4, and IL-17 levels were higher among subjects who did not have an improvement, whereas they showed lower IFN-γ levels and smaller wheal diameters for either Der p 1 or Der f 1. Total IgE and TGF-β levels were not significantly different according to the asthma refinement.

Conclusion: At the end of the build-up phase, SCIT facilitated improvement in most subjects with allergic asthma, and the outcome was associated with eosinophil counts, wheal diameters for Der p 1 and Der f 1, as well as IFN-γ, IL-4, and IL-17 levels.

Background: Diabetes mellitus is a major public health problem with an increasing prevalence each year. Chronic hyperglycemia causes impaired function and organ damage. Centella asiatica is a plant that contains antioxidants with the main component of pentacyclic triterpenes that has been proven to have antioxidant, anti-inflammatory, and antimicrobial activity. This study aimed to analyze the changes in blood glucose level, the weight of liver, kidney, heart, and brain of streptozotocin-nicotinamide-induced male Wistar rats.

Methods: The research consists of four treatments: negative control (P1), positive control (P2), ethanol extract of Centella asiatica with a dose of 300 mg/kg of body weight (P3), and ethanol extract of Centella asiatica with a dose of 600 mg/kg of body weight (P4). The treatments were conducted within four weeks at the laboratory of PSPG UGM Yogyakarta. The statistical tests used were the analysis of variance (ANOVA) and the Duncan Multiple Range Test (DMRT) to determine differences between control groups and the treatment groups.

Results: The induction of nicotinamide and streptozotocin led to type 2 diabetes mellitus (p = 0.001). The administration of ethanol extract of Centella asiatica reduced blood glucose level significantly (p = 0.001). The administration of ethanol extract of Centella asiatica increased the weight of the liver significantly (p = 0.030). There were significant differences between the intervention group of Centella asiatica dose of 300 mg/kg of body weight and 600 mg/kg of body weight compared to positive control.

Conclusion: Ethanol extract of Centella asiatica with a dose of 600 mg/kg of body weight can potentially improve hyperglycemia and increase the weight of the liver organ, which is an indicator of liver cell regeneration in the animal model of diabetes mellitus type 2.

Background: Human error in the health industry that deals with the lives of people can lead to irreparable losses and massive costs.

Aim: The current study aimed at identifying and evaluating human errors using the SPAR-H technique in one of the hospitals in Qazvin Province.

Method: This study was a cross-sectional study that was conducted in one of the training hospitals of Qazvin in 2016-2017. The target community was 49 of the most senior personnel in four groups of nursing, laboratory, radiology, and services. At first, task analysis was conducted to target group using Hierarchical Task Analysis (HTA) technique by Focus Group method. In the next step, the Human Error Probability (HEP) was determined to utilize SPAR-H method and of performance-shaping factors (PSFs) and action and diagnosis activities were identified. Finally, after determining the dependency level, the final diagnosis HEP was calculated.

Result: Of the total tasks and errors identified, 9 tasks and 17 errors were related to the activities of the nursing staff, 5 assignments and 17 errors related to the activities of the laboratory experts, 3 tasks and 5 errors related to the activities of radiology experts and 3 tasks and 6 errors related to the activities of the service.

Conclusion: The analysis of errors identified in this study showed that the major causes of errors due to the high volume of work and insufficient time in all target groups could be attributed to shortage of available time, stress and high work pressure of personnel.

Background : Lipoprotein (a) is a lipid component with proatherogenic and prothrombogenic component. Levels of Lp(a) are influenced by genetic factors. Lp(a) has a role in the pathogenesis of stroke, but research on its association with the severity of stroke shows vary on results. This study aims to determine correlation of Lp(a) the severity of ischemic stroke measured by the NIHSS score.

Method : This study was a prospective observational research conducted at Dr. Soedono Madiun in December 2016 - May 2017. The inclusion criteria were patients with first acute ischemic stroke. Exclusion criteria included patients with liver disease, kidney disease, pregnancy, sepsis. Lp (a) was examined by the immunoturbidimetry method. The NIHSS score was examined when the patient arrived (NIHSS 1) and on day 7 or the day patient left the Stroke unit (NIHSS 2). Statistical analysis was performed by computerization.

Result : There were 40 subjects, 27 men and 13 women. Higher median level of Lp(a) was found in more severe type of stroke. The group with Lp (a) level more than 30 mg/dL had a higher median NIHSS score than the group with Lp (a) level lower than 30 mg/dL. HDL dan LDL had no correlation with stroke severity (p>0,05). Triglycerida only had signifficant correlation with NIHSS 2 (r = 0.364; p 0.021). Lp (a) had a significant correlation with NIHSS 1 score (r = 0.394; p 0.012) and NIHSS 2 (r = 0.366; 0.020).

Conclusion : Lp (a) has a correlation with the severity of stroke. Lp (a) can be one of the biomarkers that needs to be monitored in subjects who have a risk of cerebrovascular disease.