Background: Thalassemia is an autosomal recessive disease. It occurs due to abnormalities in hemoglobin synthesis, causes the imbalance of globin production. Identification of thalassemia’s carrier plays a role to prevent disease’s inheritance. Diagnostic approaches regarding anemia, especially in families are important because they are prone to inherit the disease. This study was aimed to know the compatibility of Mentzer, England & Fraser, Shine & Lal, and Srivastava indices with hemoglobin electrophoresis in transfusion-dependent thalassemia patient’s family.

Methods: This was a cross sectional study by obtaining routine hematology and hemoglobin electrophoresis from thalassemia major patient’s family screening. The data then analyzed with Kappa and chi-square to get the compatibility and significance between variables. Data were analyzed using Microsoft Excel and SPSS version 17 for Windows

Results: From 99 subjects, most of them are women aged 18-55 years. Beta thalassemia trait based on Mentzer, England & Fraser, Srivastava, and Shine & Lal was in 46,5%, 55,6%, 55,6%, and 54,5% research subjects respectively. Hemoglobin electrophoresis results showed that beta thalassemia trait was in 47.5% subjects. Kappa test showed good and significant compatibility result of hemoglobin electrophoresis with Mentzer (k=0,663,p= 0,0001) and England & Fraser (k=0,636,p=0,002)  indices, also moderate and significant compatibility for Srivastava (k=0,558,p=0,018) and Shine & Lal indices(r=0,527,p= 0,015) with hemoglobin electrophoresis

Introduction: Improper use of antibiotics is a risk factor for C. difficile infection. The increasing incidence of C. difficile infection is one of the indications of failure in infection prevention and control in hospitals. The aim of this study was to analyze the incidence of C. difficile infection in diarrhea patients after receiving antibiotics in the ICU and internal medicine ward of Dr. Soetomo Hospital Surabaya.

Methods: Stool samples were taken from 31 diarrhea patients with at least 2 x 24-hours of antibiotic use who were admitted to the ICU and hospitalized at Dr. Soetomo Hospital Surabaya from August 2017 to May 2018. Each sample was examined for glutamate dehydrogenase (GDH) and A and B toxins of C. difficile. The results of this study were analyzed descriptively.

Results: The average age of respondents was 48.94 (21 – 86) years old. In addition, based on demographic data, it was predominant by females (65%), diabetes mellitus and fever (16%), and ceftriazone usage (22%).  The results showed one sample (3%) with positive results and 30 samples (97%) with negative results for both A/B toxins and GDH enzyme.

Background: Earthworm (L. rubellus) contains many compounds such as Lumbricin I, G-90 glycoprotein, and polyphenols as antimicrobial, antioxidant, and hepatoprotective toward bacterial infections. Tumor necrosis factor (TNF-α) has been identified as a mediator for necrosis tumor inside animal serum treated by lipopolysaccharide (LPS). High concentrated LPS can cause tissue damage and death. The increasing number of Nuclear Factor Kappa Beta (NFkB) activation has been responded by macrophage to produce cytokines pro-inflammation TNF-α as an indicator of inflammation.

Methods: The research was conducted in the Animal Laboratory Pharmacology Unit, Biomolecular Laboratorium, Faculty of Medicine Udayana University and the Pathology Clinic Sanglah General Hospital with a post-test only control group design. Thirty-two experimental rats were made as samples and divided into four groups, which are negative control, positive control, treatment 1, and treatment 2. Treatment was performed for 14 days. The containment of NFkB and TNF-α was measured on the 16_th day using quantitative technique sandwich enzyme immunoassay (ELISA).

Results: The results of the Shapiro-Wilk test and Levene’s test showed that the data were normally distributed and homogeneous, with p > 0.05. As the data were normally distributed, the one way ANOVA was used to analyze the data, followed by the Least Significant Difference (LSD) test. There was a significant difference between the average amount of TNFα found in each treatment group p = 0.001 (< 0.05). There were also significant differences between the average amount of NFkB found in each treatment group p = 0.001 (< 0.05). Advanced test using LSD shows more significant differences by p < 0.05.

Conclusion: It can be concluded that earthworm extract (L.rubellus) raises the amount of NFkB and TNF-α in male experimental rats injected with LPS.

Background: Coronary artery bypass surgery (CABG) is a surgical procedure for coronary arterial disease (CAD). It has a risk of postoperative complication, extending from a long length of stay in the intensive care unit (ICU) to death. CABG needs a long duration of perioperative time, which decreases tissue oxygenation. It causes increased lactic acid production and initiates the secretion of inflammatory factors. Neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) become inflammatory signs that are caused by the failure of heart microcirculation during the operative procedure. This study aimed to determine the relationship of lactic acid, NLR and MLR with the outcomes of CAD patients following CABG surgery.

Methods: This was a prospective study including 42 CAD patients who had undergone CABG procedure at Dr. Kariadi Hospital Semarang between December 2017 and July 2018. Lactic acid data were taken using the spectrophotometer method.  NLR and MLR were taken by the calculation index. The outcomes data were ICU length of stay (LoS), complications, and death, which were obtained from the medical record. The data were analyzed using bivariate analysis.

Results: There was a significant correlation between lactic acid with ICU LoS (p = 0.001), complication (p = 0.01), and mortality (p = 0.044). There was a significant correlation between NLR with ICU LoS (p = 0.003), complication (p = 0.009), and mortality (p = 0.014). There was a significant correlation between MLR with ICU LoS (p = 0.02), complication (p = 0.027), and mortality (p = 0.017).

Conclusion: There was a significant correlation between lactic acid, NLR dan MLR with the outcomes of CAD patients (ICU LoS, complication and mortality) that have undergone CABG procedure.

Introduction: Intense prolonged physical exercises such as athletic need more energy. It causes fatigue and sweat excretion which is possibly related to decreasing of electrolyte and recovery delay. This research aimed to prove that administration of mix juice of banana, honey, and tomato (pismatom) increasing of potassium serum levels and faster of recovery in middle run athletes.

Method: This research was an experimental design using randomized pre-test-post-test control group design using 28 middle run athletes. Selected samples divided into two groups using random allocation technique. Treatment group was given pismatom juice before and after physical activity with 240 of volume and control group was given mineral water before and after physical activity with 240 ccs of volume during 14 days. Blood-vein measurement was used to evaluate potassium serum levels and measure of pulse recovery rate. The statistical analysis using SPSS version 20.0 for windows, comparison of electrolyte level and recovery time using t-independent test and General Linear Model (GLM).

Result: The results showed that potassium serum levels increasing significantly (p<0.05) in the Treatment Group (4.90 + 0.17 mmol/L vs 3.69 + 0.15 mmol/L). Pulse rate indicate the recovery more faster in the Treatment Group to 3^rd minute recovery pulse (RPR3) (124.21+6.61 x/mnt vs 131.57+12.49 x/mnt), to 4^th minute recovery pulse (RPR4) (120.14+8.29 x/mnt vs 126.50+12.13 x/mnt) and to 5^th minute recovery pulse  (RPR5) (111.29+6.69 x/mnt vs 123.14+12.06 x/mnt) that was significantly different (p<0.05).

 

Background: The erythrocyte sedimentation rate (ESR) test is one of the most widely performed laboratory test to assess acute phase of inflammation, infection, autoimmune or malignancy. The reference method for ESR measurement was introduced by Westergren. This method is generally easy, un-expensive, yet, time consuming. Automatic instrument has been introduced to decrease the measurement time. Caretium XC-A30 is automatic instrument to measure ESR; it is used in Sanglah General Hospital Denpasar without previous research. Aim of this study was to assess comparison, correlation and agreement of Caretium XC- A30 to the reference method.

Methods: A total of 35 samples in consecutive sampling were taken during August 2018 at Sanglah General Hospital, Denpasar. The samples were examined for ESR with Caretium XC-A30 and manual Westergren. Comparison, correlation and agreement were tested for both methods used.

Results: The Westergren method was the reference method and Caretium XC-A30 was the tested method. Wilcoxon signed rank test showed no difference between two methods (p= 0.439). There was a very strong correlation and excellent agreement showed by Spearman coefficient correlation r= 0.989 and kappa coefficient 0.942.

Conclusion: This study showed no difference between Caretium XC-A30 and Westergren as the reference method for ESR measurement, with very strong correlation and excellent agreement. Thus, Caretium XC-A30 has a potential use in performing ESR measurement with high throughput and lesser time than manual Westergren method.

Introduction: Serum albumin level may predict the mortality risk in burn patients. This study aimed to determine the mortality risk in burn patients based on serum albumin level within the first 24 hours of hospitalization.

Method: A cross sectional study was conducted reprostecively to the patient’s medical records. The subjects were burned patients who were hospitalized in Dr. Hasan Sadikin General Hospital Bandung during January-December 2017. The subjects were divided into two groups, which were dead and survived at the end of hospitalization. The mortality risk based on serum albumin level within the first 24 hours of admission was assessed using the odds ratio (OR) of two groups. Data were analyzed using SPSS version 17 for windows.

Result: The subjects were 47 patients, consisted of 9 dead subjects and 38 survived subjects. Males were predominant in both groups such as 12.8% in dead subjects and 70.2% in survived subjects. The OR value based on serum albumin level <2 g/dL within the first 24 hours of hospitalization was 14.40 (p=0.009; CI:2.1–100).

Conclusion: The subjects with serum albumin level <2 g/dL within 24 hours of hospitalization has 14 times higher mortality risk compared to the subjects with serum albumin level >2 g/dL. Therefore, burn patients need to be examined for serum albumin level within the first 24 hours of hospitalization.

Background: Psychosocial stress in pregnant women is one of the factors that cause the disorder of metabolism for pregnant women. Maintaining physical and mental health on a pregnant woman can be conducted by ANC, pregnant gymnastics, and IEC pregnancy to optimize health degrees while pregnant and expedited the process of childbirth.

Aim: This study aimed to analyze the relationship of the gymnastics, ANC, and the IEC pregnancy with stress rate on pregnant women.

Methods: This was an observational analytical with a case-control approach. The subject of this study was the mother of a toddler as many as 390, ages 2 to 2.5 years that live settled in Klaten Regency, Karanganyar and Sragen.

Results: Stress while pregnant is significantly associated with the gymnastics pregnant (p = 0.023; CI 0.38-0.93; OR 0.69), ANC (p = 0.001; CI 0.01-0.57; OR 0.75) and IEC of pregnancy (p = 0.049; CI 0.45-1.00; OR 0.69).

Conclusion: Stress during pregnancy can be reduced by doing pregnant gymnastics and the ANC. Granting education can also be used as an alternative to reduce stress during pregnancy.

Background: Medication using herbal medicine is one of the alternatives chosen to reduce the adverse effects caused by synthetic drugs. Betel nut (Areca catechu L) usually used as an alternative drug such as anthelmintic and others.

Aim: The study aims to determine the chronic toxicity effect of betel nut.

Method: Five hundred grams of simplicial powder was macerated using 95% ethanol in a container, then sealed and let them for three days. They were protected from light while repeatedly stirred. Rat was given Betel nut extract for three weeks. The histopathological examination was observed under the microscope.

Result: The mean GOT serum, GPT serum, BUN, and creatinine serum levels between control (no extract given) and each dose, i.e., 0.2 ccs, 0.4 ccs, and 0.8 ccs, showed insignificant results (p > 0.05). According to the histopathological observation, there was no difference between control and treatment.

Conclusion: Various orally doses of betel nut extract did not cause toxicity in white rats (rattus novergicus). 

Background: Malaria still becomes a major health problem in Indonesia, especially in the eastern part of Indonesia. The occurrence of Plasmodium resistance against antimalarial medications increases the difficulty of malaria wipe-out effort. As regard with such a great potential Sargassum production that Indonesia possesses, it is very likely to develop Sargassum as adjuvant therapy to prevent and even to stop the resistance.

Aim: This research aims to develop adjuvant therapy of Sargassum extract to avoid the resistance of malaria therapy on the SGPT level.

Method: There were 24 white rats (Rattus norvegicus) that had been infected by Plasmodium berghei and were given dihydroartemisinin-piperaquin (DHA-PPQ) therapy as antimalarial therapy at the dose of 3mg/KgBW for three consecutive days. The rats were later divided into three groups. Group 1 received only (DHA-PPQ), group 2 received Sargassum duplicatum extract as adjuvant therapy at  the dose of 100 mg/KgBW for ten consecutive days. Group 3 also received Sargassum duplicatum extract as adjuvant therapy but the dose was at 300 mg/KgBW for ten consecutive days.

Result: SGPT level decreased more significantly in groups in which the rats received dihydroartemisinin-piperaquine and 100 mg/kgBW Sargassum extract as adjuvant therapy and on the other hand only received Sargassum extract at the dose of 300 mg/kgBW. After ten days of therapy the blood SGPT level was examined from all rats. The data were analyzed using one-way ANOVA test.

Conclusion: Sargassum duplicatum (100 mg/kgBW) showed a more significant decrease of SGPT level in Rattus norvegicus (Wistar strain) inoculated by Plasmodium berghei as against those in the dose 300 mg/kgBW. 

Background: Polymerase chain reaction (PCR) has become a fundamental technique in molecular biology. Nonetheless, PCR amplifications are frequently impaired by high GC content of the target sequence, leading to low yield and specificity of products, with no product at all in the worst cases. Locally high-temperature melting regions within the template can act as permanent termination sites.

Method: Here we designed and tested an effective and low-cost PCR enhancer, a combination of dimethyl sulfoxide (DMSO) 10% (v/v) and magnesium chloride (MgCl2) 1,5 mM that broadly enhanced the qualitative output of PCRs. We used Mycobacterium tuberculosis strain H37vR as a PCR template.

Result: It was found that PCR enhancer containing 10% (v/v) of DMSO and 1,5 mM of MgCl2 improved the amplification of GC-rich template of M. tuberculosis gene other than without the PCR enhancer.

Conclusion: Therefore, this PCR enhancer could be widely useful to improve the amplification of GC rich construct from another genome.

Background: Even with optimized anti-epileptic medications, 30% of epilepsy patients will be refractory and this condition leads to cognitive and psychosocial decline, resulting in worse quality of life and higher mortality. With 0,75% prevalence, there are more than 2.0 million epileptic in Indonesia, about 360.000 will be refractory, and half of them are potential candidates for epilepsy surgery (ES). After 17 years since the first ES on July 1999, number of ES increases every year reaching around 50 cases per year. By the end of 2017,  the total number reached 615 and most was temporal lobe epilepsy (TLE) cases. Pre-surgical investigations were compared in relation to the seizure free results between the first five-year and the recent twelve-year. Despite the excellent result shown, all of these ES were still performed in Semarang (Diponegoro University), and demographic analysis showed that 80% patients came from Java-Bali area. So that new basic centers capable of performing ES for simple TLE cases are desperately needed to improve treatment for refractory epilepsy cases elsewhere.

Material and methods: Until the end of 2017, there were 615 ES cases, including 514 Temporal Lobe Epilepsies (TLEs). Pre-surgical investigations were grouped as Simple (MRI with specific protocol and routine EEG), Difficult (needs long-term ictal EEG, and /or PET CT), and Complex (needs invasive or intracranial/ subdural grid EEG, and or Electrocorticography/ ECoG during the surgery). For the first five year-period, besides seizure semiology, decision to operate were based on MRI and routine EEG (Simple) in 54 out of 56  (96,4%) TLE cases. One patient had long-term ictal EEG and another had subdural grid EEG implanted, both patients showed visually normal MRI. But for the recent twelve-year, Simple TLEs occupy only 234 out of 458 (51%) TLE cases. Long-term ictal EEG were performed in 161 patients (35,2%), PET study in 39 patients (8,5%), subdural grid EEG in 30 patients (6,5%), and ECoG in 61 patients  (13,3%).

Results: As a new ES center performing only simple TLE cases, our surgical results were Class I: 82%, Class II: 11%, and Class III: 7% (9). As a semi advance ES center (after more than 5 years, and only half were simple ES cases), the Class I or seizure free results were 78,7% for simple TLEs, 73,4% for Difficult TLEs, and 65,2% for Complex TLEs.            

Demographic distribution showed that almost 80% of ES patients came from Java-Bali area, and half of them were from Central Java Province with Semarang as its capital. Patients from other parts of the country were scarce, especially from remotely located islands of East Indonesia.

Background: Thalassemia is the most common hereditary blood disorder in the world and Indonesia. Major β-thalassemia is classified as Transfusion-Dependent Thalassemia (TDT). Specific changes in the composition of red cell membrane lipids and hemosiderosis may lead to hypercoagulation. This study aimed to determine the difference in Protein C, Protein S, Antithrombin III (AT-III), and D-dimer between major β-thalassemia patients and normal people.

Methods: This was an observational analytical study with a cross-sectional design, including 18 major β-thalassemia patients in H. Adam Malik Hospital Medan who met the study criteria and 18 normal controls. Subjects were examined for Protein C, Protein S, AT-III and D-dimer. The assessment was also carried out among patients based on their transfusion frequency and serum ferritin.

Results: There were significant differences in Protein C, Protein S, and D-dimer levels between major β-thalassemia patients and normal controls (p < 0.05). AT-III level in major β-thalassemia patients was lower than healthy controls, however the difference was not significant. The level of Protein C in patients who infrequently and frequently underwent blood transfusions were 34.88 ± 8.6 and 45.19 ± 7.8 respectively, which was significantly different (p < 0.05). A significant differences in Protein C, Protein S and D-dimer were also found between patients with serum ferritin level < 2,500 ng/ml and  ≥ 2500 ng/ml.

Conclusion: Significant changes were found in anticoagulation proteins of major β-thalassemia patients. Frequent blood transfusions and chelation therapy should be emphasized for major thalassemia patients because they affect anticoagulation protein levels.

Introduction: Sepsis is a major health problem, and the incidence is still increasing. Generally, sepsis occurs in about 2% of all inpatients in developed countries. The immunologic response that causes sepsis is a systemic inflammatory response that causes activation of the inflammatory and coagulation pathways. If sepsis untreated, it can lead to organ failure then death. Organ dysfunction is expressed as an acute change of Sequential Organ Failure Assesment (SOFA) score >2 points as a consequence of infection.

Methods: This is a cohort prospective’s study. Prothrombin time (PT), activated partial thromboplastin time (aPTT), Thrombin time (TT), Fibrinogen, D-dimer were examined 3 times (first, second, third day), and then assessed to see its relation with the corresponding SOFA score. Twenty-four subjects of the study were ICU patients in H. Adam Malik Hospital who matched the inclusion and exclusion criteria.

Results: There were significant differences of PT on the first, second and third day (p =0.03). There were no significant differences in aPTT, TT, Fibrinogen, D-dimer on the first, second, third day. There were no significant correlations of PT, aPTT, TT, Fibrinogen with the corresponding SOFA score on the first, second, third day. There was a moderate positive correlation between D-dimer and SOFA score in the first, second and third day of examinations (p <0.05).

Conclusion: PT changes occurred significantly on the first, second, third day of sepsis and D-dimers can be used to asses the risk of organ failure in septic patients.

Background: Thalassemia is a genetic disorder which until now has become a global health problem. Regular blood transfusions in managemen of BTM result in iron overload. Free iron in the form of intracellular ferrous (Fe²⁺), in the presence of oxygen, will initiate the formation of reactive oxygen species (ROS), produce another free radical superoxide that will oxidize the lipid and protein compounds of the cell membrane. F₂-IsoPs is the best, most stable and more accurate marker of lipid peroxidation in vivo, found urine. This study aimed to determine the association between hyperferritinemia and lipid peroxidation in kidney reflected as elevated u-F₂IsoPs as controlling several factors affecting oxidative stress in the kidney.

Methods: This cross sectional study was conducted between May and June 2016. Thirty subjects of BTM admitted to pediatrics unit of Dr. Moewardi Hospital Surakarta who met the inclusion and exclusion criteria were enrolled. The data were analyzed to calculate prevalence ratio and 95%CI for each variable, followed by multivariate analysis with logistic regression.

Results: The prevalence of lipid peroxidation in kidney, characterized with elevated u-F₂IsoPs of > 2 ng/mg urine creatinine, was 67%. Age, hyperferritinemia status and duration of illness did not associate with lipid peroxidation in the kidney. Transfusion volume of ≥25 unit/year showed statistically significant association with lipid peroxidation (PR 24.10; 95%CI 2.16-268.42; p=0.010).

Conclusion: Transfusion volume, rather than hyperferritinemia, independently associated to oxidative stress and lipid peroxidation of the kidney in BTM.

Introduction: Sepsis mortality rate in Indonesia reaches over 50 %, hence, acknowledgement of its pathophysiology need to be elucidated, including the pathway of apoptotic. The objective of this study was to describe the lipopolysaccharide (LPS)-induced sepsis in which triggers intrinsic apoptotic pathways in terms of the expression of caspase-9 (Cas9) and caspase-3 (Cas3).

Method: By experimental with time series randomized post test-only control group design, 48 Balb/C mice divided into 2 groups (control and treatment). Each group was injected intra-peritoneally with saline 250 µL/mice and saline 250 µL + 0.1 mg E. coli LPS/mice. Each group divided into 4 termination time (12^th, 24^th, 36^th and 48^th hours), examined by immunohistochemistry (IHC) for Cas9 and Cas3 expression, and analyzed by mean difference test (Mann-Whitney and t test) and correlation test (Spearman’s test).

Results: The LPS-induced sepsis in the treatment group revealed increasing number of caspase-9 compared to control group (2.34+0.24 vs 0.82+0.08; p<0.001. There were increasing trends in the treatment group compared to control group includes for: all groups Cas3 (1.54+0.10 vs 0.48+0.05; p<0.001), t12 Cas3 (3.25+0.22 vs 0.50+0.06; p<0.001), t24 Cas3 (1.37+0.27 vs 0.45+0.05; p=0,002), and t36 Cas3 (1.03+0.20 vs 0.52+0.22; p=0,002). Instead, there were no difference between treatment group and control group for t48 Cas3 (0.50+0.14 vs 0.43+0.10; p=0,485). There was decreasing pattern on serial time 12, 24, 36 and 48 hours for Cas9 (p<0,001) and Cas3 (p=0,002). There was a correlation between Cas9-Cas3 (r_s=0.835;p=0.001).

Conclusion: The LPS-induced sepsis caused an increase of caspase-9 and caspase-3, strongly correlated with decreasing pattern on time serial.

Background: Psoriasis is a complex chronic inflammatory skin disease with multifactorial mechanism affected by immunological, genetic, environmental and nervous system factors which its mechanism is still unknown. The involvement of nervous system in psoriasis is ruled by nerve growth factor (NGF). Increased levels of NGF serum are expected occurring in psoriasis vulgaris.

Aim: To determine the differences between NGF serum levels in psoriasis vulgaris patients and controls

Methods: This study is an analytic study with cross sectional design involving 30 psoriasis vulgaris patients and 30 healthy controls. Diagnosis of psoriasis vulgaris was made based on history and clinical examination; we conducted blood sampling and measurement of NGF serum level to the patients and controls. The differences between NGF serum levels in psoriasis vulgaris patients and controlled is analyzed by independent-t test. This research approved by the health research ethics committee of the Faculty of Medicine of Sumatra Utara University/ H. Adam Malik  Medan General Hospital.

Results: In this study, we found the mean NGF serum level of female psoriasis vulgaris patients (810.30 ± 299.97 pg/ml)  was higher compared to male (806.70 ± 256.04 pg/ml).  The mean NGF serum of psoriasis vulgaris patients were highest on ages group 15 – 23 years (930.14 ± 69.03 pg/ml). The mean NGF serum level of psoriasis vulgaris without family history (875.38 ± 203.91 pg/ml) was higher compared to patient with a maternal history (600.87 ± 387.45 pg/ml) and paternal history (477.88 ± 406.97 pg/ml). The mean NGF serum level in the psoriasis vulgaris group (808.38 ± 272.48 pg/ml) was higher compared to the control group (524.92 ± 281.22 pg/ml) dengan with p=0.0001.

Background: The prevalence of  Hb S/β Thalassemia has not been widely reported, and until now, there is a lack of statistical data on the prevalence of the disease in Indonesia. In 1974, cases of β thalassemia with Hb S were found in one family in Jakarta. The aim of this study was to describe the cytogenetic mutation in a family with Hb S/β thalassemia in North Sumatera.

Methods: This was a descriptive study with a cross-sectional design conducted in one family of HbS patients with thalassemia trait, with a total of five samples. Complete blood count, hemoglobin electrophoresis examination, peripheral blood smear, PCR, and amplicon were performed to describe the hematology and cytogenetic profile of samples. Data were analyzed descriptively.

Results : The father (64 years old) suffered from HbS (HbA = 58.3%, HbS = 38.3%, HbA2 = 2.8%) with heterozygote HbS mutation type. The mother (36 years old) suffered from β-thalassemia trait (HbA = 93.8, HbF = 1.2%, HbA2 = 5%) with β-thalassemia heterozygote IVS1-nt5 mutation type. The first child (male, 18 years old) suffered from HbS/β thalassemia (HbA = 25.9%, HbF = 22.4%, HbS = 48.2%, HbF = HbA2 = 3.5%), the second child was normal (HbA = 97.4%, HbA2 = 2.6%) and the third child (female, 10 years old ) suffered from HbS β-thalassemia (HbA = 3.3%, HbF = 25.5%, HbS = 67.6%, HbA2 = 3.6%). The first and third child had β-thalassemia with double heterozygote HbS and IVS1-nt5 mutation type.

Conclusion: Population migration between nations followed by marriage could lead to cytogenetic mutations and cause sickle-cell beta-thalassemia. The finding of double heterozygous HbS mutation and beta thalassemia need to be explored further about the patient’s fathers family.

Welcome remark The Chairman of GHI Conference

Dear all participants and invited speakers,

It is my privilege and pleasure, on behalf of Dean of Faculty of Medicine and Rector University of Mataram, to welcome you all to the 1st International Conference on Global Health and Innovation. This conference is held by the Faculty of Medicine Universitas Mataram with the support of Chungnam National University, Indonesian Doctor Association of West Nusa Tenggara, and Indonesia Pharmacist Association. This conference is in conjunction with the 57th Dies Natalis of Universitas Mataram and 16th Dies Natalis of the Faculty of Medicine Universitas Mataram.

The theme of the conference this year, “Multiple Burden of Diseases in the Developing Countries” reflects the current health situation faced by Indonesia and other developing countries, where due to the demographic and socio-economic transition and the increasing trend of non-communicable diseases, more constraints are imposed to our health systems in dealing with the pre-existing burden of communicable diseases. This is a challenge that calls out further action and innovation.

This conference is presenting you with internationally recognized, multidisciplinary expert speakers from Indonesia and abroad to share their knowledge in regards to the current global health concerns of the multiple burdens of diseases in developing countries. We have 100 participants with 53 abstract.

To further disseminate the scientific endeavors of researchers who have submitted their study to be presented in this conference, we are partnering with Bali Medical Journal, an experienced and internationally-indexed journal in Indonesia.

Conferences such as this provide a valuable opportunity for health professionals, researchers and students to share knowledge, ideas, and experiences. It is also a forum for young and senior researcher to connect and explore potential future collaboration.

We would like to thank the provincial government of West Nusa Tenggara, Indonesian Doctor Association, Indonesia Pharmacist Association and all sponsors for the supports.

I am sure you will have fruitful and rewarding exchanges during this conference. I wish you every success with this important conference and I look forward to learning about the outcome. We once again welcome you to Lombok and we hope that you are enjoying this conference.

Thank you.

Background : Rabies occurred in Bali since 2008, and in 2017 rabies cases were still found in Bali, including in Buleleng Regency. Prevention of rabies in Bali must involve the participation of the community especially family, which is in direct contact with dogs. This study aims to develop family-based health promotion media, which is later called as the rabies eradication package, to overcome rabies in Buleleng, Bali.

Methods:  This study uses the research and development (R&D) method. which consists of 5 phases, namely analysis, design, development, implementation and evaluation. at the implementation and evaluation stage researchers used a quasi-experimental approach. The total number of samples used was 100 families taken from 2 villages. The variables measured were the level of knowledge and attitudes towards prevention of rabies. data analysis using the Mann-Whitney U test.

Result :   This study develop rabies eradication package as a family-based health promotion media. This package consists of a rabies eradication book, a dog vaccination card, a medical history cards and bite wound treatment tools. Of the 100 respondents in the study sample, 50 respondents who were included in the treatment group, which received a rabies eradication package for 1 month, experienced a significant increase in knowledge (p <0.001) and attitudes (p <0.001) in prevention of rabies compared to the control group.

Conclusion : Rabies eradication package can be used as a family-based health promotion media to increase rabies prevention efforts because it can increase knowledge and attitudes in preventing rabies

Introduction: People with diabetes mellitus (DM) have an increased risk for thrombosis compared with non-diabetic patients. Several studies showed contradicting in data on levels of antithrombin III (AT-III) in people with type 2 DM and diabetic ulcers.

Methods: This is a descriptive and analytical cross-sectional study on AT-III concentration of patients with type 2 DM with and without foot ulcers. A total of 40 subjects are divided equally into the control group, which consist of type 2 DM patients without foot ulcers, and the case group of type 2 DM patients with a diabetic foot ulcer based on the Wagner criteria. Blood samples are then taken after 8 to 10 hours of fasting to check for AT-III concentration and hemostasis examination including platelet count, prothrombin time (PT),  activated partial thromboplastin time (aPTT), thrombin time (TT), fibrinogen levels, and D-dimers.

Results: The mean AT-III level of diabetic foot ulcers group was 216.02 ± 71.23 pg/mL, which was lower than the mean AT-III level of the group without diabetic foot ulcers, i.e. 243.05 ± 48.05 pg/mL. The mean AT-III concentration in the diabetic foot ulcers group with hypercoagulation state was 221.52 ± 64.25 pg/mL, which was slightly higher than the mean AT-III concentration of the diabetic foot ulcers group with hypocoagulation state of 203.18 ± 90.92 pg/mL.

Conclusion: No statistically significant difference was found in the levels of AT-III between the diabetic foot ulcers group and the non-diabetic foot ulcers group (p> 0.05). There was no statistically significant difference in AT-III levels of diabetic foot ulcers with hypercoagulation compared with no diabetic foot ulcers with hypocoagulation and no statistically significant relationship between grade diabetic foot ulcers and AT-III concentration.

Background: The SLC39A14 zinc transporter showed a role in the growth of the mouse model. There was no report regarding SLC39A14 protein expression in human chondrocyte, which might prevent further identification of SLC39A14’s function in human growth. This study aims to describe the SLC39A14 protein expression in chondrocyte using human umbilical cord (UC)-derived mesenchymal stromal cell (MSC) isolation and differentiation.

Methods: A cross sectional study was conducted at the Faculty of Medicine, Universitas Padjajaran Bandung, Indonesia, in 2019. The UC was derived after the respondents signed informed consents were documented. Specimens transferred, UC tissue digestion, cell isolation, cultures, and passages were done under the laboratory standard protocols. The immuno-phenotyping and differentiation toward chondrocyte procedure were done after third passage. The SLC39A14 expression of the chondrocytes was observed under immunofluorescence microscopy after staining using polyclonal anti SLC39A14 antibody. The collagen 2A and 10A production was measured using the medium supernatant and analyzed using GraphPad Prism 8 edition.

Results: The adherent fibroblast-like cells appeared on day 5^th, which continued to proliferate and showed MSC characteristic with positive markers for CD 73, CD90 and CD105, but absent for negative lineage markers. Upon differentiation, cells positive for Alcian blue staining denoted the chondrocyte which shown capacity for further proliferation on Methyl Tetra Toluene assay. Zinc transporter SLC39A14 was expressed on cell membrane. The Collagen 2A produced at a mean level 0.097 ng/ml (SE 0.011;95%CI 0.073-0.12) and Collagen 10A at mean level 31.078 ng/ml (SE 3.792;95%CI 22.870-39.287).

Conclusion: Zinc transporter SLC39A14 was expressed in monolayer human chondrocyte from UC-derived MSC. The chondrocyte shown capacity for proliferation and collagen-producing enables future utility to identify the role of SLC39A14 in chondrocyte pathology.

Background: Sepsis is a critical emergency that causes morbidity and mortality worldwide. The latest sepsis diagnosis is made by using quick Sepsis-Related Organ Failure Assessment (qSOFA). Cluster of Differentiation 64 (CD64) is a surface antigen leukocyte that is deregulated during infection and sepsis. The percentage of immature granulocyte (IG) could rise in patients with infection and sepsis, mainly in severe circumstances. Procalcitonin (PCT) is a calcitonin prohormone that increases in sepsis and is already known as a bacterial infection marker. Presepsin (CD14) is a glycoprotein that is known to increase in bacterial infection. This study aimed to determine the correlation of leucocyte CD64, IG, and presepsin with PCT in bacterial sepsis patients.

Method: This cross-sectional study was performed from June to September 2018 at Dr. Soetomo General Academic Hospital. Twenty-five patients who met the qSOFA criteria with positive bacterial blood cultures were included. All samples underwent examinations of leucocyte CD64, IG, presepsin, and PCT. The correlation of leucocyte CD64, IG and presepsin with PCT was analyzed using Spearman correlation.

Results: The samples comprised 17 males (68.0%) and 8 females (32.0%). The mean age was 51.24 ± 14.85 years. The mean ± SD of leucocyte CD64 was 6.95 ± 2.13%, the median (min-max) of IG, presepsin and PCT was 3.67 (0.33–17.33)%, 2,641(487-20,000) pg/mL and 5.96 (0.39–181.5) ng/mL respectively. There was no correlation between leucocyte CD64 with PCT (p = 0.281). There was a significant correlation between IG and presepsin with PCT (p < 0.0001).

Conclusions: Presepsin and IG can be used as alternative bacterial sepsis markers that are supported by other examinations. leucocyte CD64 still needs to be studied further before it can be used as a bacterial sepsis marker.

Background: The geriatric population has continued to grow globally. The incidence of geriatric fractures increases along with the population. The geriatric assessment could be useful to build a warning sign for the fall risk.

Aim: The authors aimed to describe the geriatric fractures; the factors affecting; to further give recommendation regarding its prevention and management.

Methods: This is a cross-sectional study involving 741 patients with geriatric fractures admitted to Surabaya Orthopedics and Traumatology Hospital from 2012-2017. All data acquired from medical records.

Results: The number of female patients in our study are three times the male patients. The distribution of the cases across ethnicity, gender, and different age group were quite similar. The case of vertebral and hip fracture was significantly higher. Domestic accident was the mechanism of injury in 80% of all cases, and this MOI is significant across all fracture types. Only 32% patients do not have confounding disease. However 25% has diabetes mellitus, and 42% has hypertension.  Although patients with diabetes mellitus, hypertension, moderate to severe anemia, and hyponatremia were more frequent but not significant to be the risk factor for certain fracture type.

Background: The use of the term "Autism Spectrum Disorder" has led to confusion over this substance. Prior to DSM-V criteria, symptoms of Autism Spectrum Disorder (ASD) refers to the problems in brain vasculature and brain chemistry most likely affect the children behavior, whereas the authors' findings suggest such problems depicting a similar anomaly in cerebral vein thrombosis case (CVT). Recently, the evoked potentials, that demonstrated in CVT, have a possible prognostic value on patients suffering from ASD. This study purposes to measure the motor evoked potentials (MEPs) on patients following the intervention of intraarterial heparin flushing (IAHF).

Methods: A descriptive study was conducted on 17 patients admitted in Cerebrovascular Center of RSPAD Gatot Soebroto, Jakarta, diagnosed with ASD presenting CVT. The MEPs value was measured by conforming the IAHF procedure.

Results: The MEPs value (amplitude, latency, CMCT) pre and post-IAHF showed an increasing value. Meanwhile, there was a lowering value of latency and CMCT in left cortical participants after IAHF.

Conclusion: The group tends to perform more expected positive MEPs changes after IAHF.

Objective: The current study aims to provide valid information about the causes and types of hospital deduction records via a systematic review.

Method: This systematic review was performed by searching the databases including PubMed, Scopus, Science Direct, Ovid, Medline, Cochrane, ProQuest, and IranMedex, Magiran, Sid, and Medlib databases for studies without time limitation. Updates were added to the searches during the study. Search strategies included the combination of keywords including “Billing error” OR “Deductive” OR “Error payment” OR “Insurance claim” OR “Medical claim” OR “Improper payment” OR “Insurance reimbursement” OR “Medical payment” OR “payment error” with “Hospital” and “medical records”. The reference lists of each article were manually searched to find additional relevant articles. All records without time limitation, those written in Persian and English, and the ones investigating the types and causes of deductions in hospital inpatient bills records were included. To determine the eligible records, two authors extracted the data independently; and discrepancies were resolved through discussion or, if required, through consultation with a third author. The quality of the articles was analyzed using STROBE checklist.

Results: The search strategy yielded 1,264 records from electronic databases, and 15 records were identified by the manual search. After removing the duplicates and screening the database by titles and abstracts, 39 of these records remained. The full text of these 39 records was checked and, finally, 22 of them met inclusion criteria. The major causes of deductions in the documentation included human errors, incomplete document registration, documentation errors, added prices, added request, and calculation errors.

Conclusions: Education and cooperation of staff and collaboration of all stakeholders such as hospitals, insurance organizations, and related staff in this field are necessary for conducting a substantial action to reduce hospital deduction.

Nerve growth factor (NGF) was uncovered in near beginning the 1950s which had a growth effect on sympathetic and sensory neurons. In the dorsal root neuron ganglion, the second member of a group of neurotrophic factors widely known as the brain-derived neurotrophic factor (BDNF) appeared. Like other members of the neurotrophin group, such as neurotrophin 3 (NT-3) and NT-4/5, it is explained to have trophic effects on peripheral and central neurons. Since BDNF purification in 1982 evidence of its involvement in development, physiology, and brain pathology demonstrated. BNDF is significant within the molecular mechanism of synapse plasticity regarding neuronal growth and cell survival. The initial step associated with the central nervous system depends on its adaption of synapse transmission, especially in the hippocampus and neocortex. Pathological intensities of the BDNF relationship and synapse plasticity affect sort of situations such as epilepsy and chronic pain sensitization, where BDNF applications can affect therapy in neurodegenerative diseases and neuropsychiatric diseases. BDNF plays a pivotal role in cognitive processes, affecting the advancement and brain structures’ motion. Predominantly in the hippocampus and prefrontal cortex, by modulating synaptic neurotransmission, it changes the plasticity and proliferation of neurons through regulation of neuronal migration processes such as differentiation, perseveration, neuronal modification and replacement of synaptic structures. BDNF also affects the development of dopaminergic, serotonergic, cholinergic and GABAergic. BDNF further causes rapid postsynaptic reactions in ion channels and N-Methyl D-Aspartate (NMDA) receptors. BDNF as a vital component in the normal functioning of the brain is one of the neurotrophins that contributes to the development, maintenance of function and healthy neuron cells and cynical plasticity.

Introduction: Anterior skull base meningiomas are frequently associated with changes in personality and behavior. Olfactory groove meningiomas take their origin from the cribriform plate and frontoethmoidal suture in the floor of the anterior cranial base. The cardinal clinical features usually observed are mental changes, visual deterioration, and headaches as a result of olfactory or optic nerve and frontal lobe compression. However, several authors have reported minimal changes in cognition or behavior following surgical resection, and many patients do not return to their premorbid level of function.

Case presentation: A 42-year-old male with four months history of changes in behavior, apathy, and lack of motivation. Over the course of two months, his vision progressively worsened in both eyes, and he developed a diffuse, mild headache. On examination, he was fully alert and cooperative. He only had light perception and could see faint silhouettes of people. All other neurological examinations were normal. Head Computed Tomography (CT) demonstrated a large, extra-axial mass consistent with an anterior skull base mass extending to the sellar and suprasellar region, which suggests an olfactory groove meningioma. The patient underwent a bifrontal approach craniotomy tumor resection and subsequently recovered from medial prefrontal syndrome following tumor resection. Surgical tissue pathology confirmed the diagnosis as an olfactory groove meningioma.

Discussion: The anatomical location of the olfactory groove meningioma may cause prolonged psychiatric symptoms before the onset of more overt neurological deficits. Personality changes that occur may be subtle, so patients may avoid seeking treatment for their headaches and delay ophthalmic care until their complaints become severe. Anterior skull base meningiomas often involve the ventromedial prefrontal cortex (vmPFC) that is associated with elevated levels of apathy.

Conclusion: Olfactory groove meningiomas are treatable. Reversal of cognitive impairments and changes in behavior can be expected after surgical resection.

Background: Hemoglobin H (HbH) disease is alpha thalassemia characterized by inactivation of three of four α-globin genes due to deletions with or without non-deletional α-thalassemia. Hb Quong Sze (Hb QS) is a very rare non-deletional α-thalassemia in Indonesia caused by a CTG^Leu>CCG^Pronucleotide substitution at codon 125 of α₂ globin gene generating highly unstable hemoglobin. Compound heterozygosity for Hb QS and Southeast Asian double α-globin gene deletion (--^SEA) result in accumulation of b-globin tetramers, causing hemolytic anemia.

Case Report: A 49 years old Chinese Indonesian female was assessed for thalassemia screening. The phenotype of the proband was normal and only mild anemia was noticeable. She experienced blood transfusion five years ago due to a sudden fall of hemoglobin level after malarial infection. Complete blood count found hemoglobin 8.3 g/dL, Mean Corpuscular Volume (MCV) 65.7 fl and Mean Corpuscular Hemoglobin (MCH) 17.1 pg. HbH disease suggested by abundant Hb H inclusion bodies in the red blood cells. Microcapillary hemoglobin electrophoresis result showed HbH 31.8 %, Hb Bart 0.4%, HbA 67.3% and HbA₂ 0.5%. Molecular studies were carried out using multiplex polymerase chain reaction (PCR) method, and the common a⁰-thalassemia(--^SEA) was detected in one allele. Direct sequencing analysis of the α₁ and α₂ globin genes revealed Hb QS in the other allele.

Conclusion: Non-deletional Hb H disease due to compound heterozygous of  Hb QS with Southeast Asian double α-globin gene deletion (--^SEA) has a very low incidence in Indonesia. An advanced molecular analysis should be performed to determine this rare mutation.

Background: Testicular cancer is now the most common malignancy in young males. Markers available in the management of patients with testicular cancer are alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH). Female patients with androgen insensitivity syndrome (AIS) and pure gonadal dysgenesis have a pure XY karyotype and an increased risk of developing a gonadal malignancy.

Case Description: A 26-year-old female presented with a hardened stomach and primary amenorrhoea. Physical examination revealed Tanner Stage I for both the right and left breast and no pubic or axillary hair. On local examination, there was a large firm non-tender mass extending across the abdominopelvic region. Gynecological examinations revealed normal labia; however there was clitoromegaly, the vagina was blind (5 cm) with the absent cervix. Laboratory tests with increased abnormal results were as follows: LDH 3,448 U/L, AFP 1,842.6 ng/mL, Cortisol 22.41 ug/dL and Testosterone 128.7 ng/dL. An MSCT of the abdomen showed a solid mass with no signs of a vagina or uterus. Blood karyotyping results were 46 XY with the presence of the SRY gene. Due to an increase in LDH, AFP, Cortisol and Testosterone, with 46 XY karyotyping, Tanner stage 1 breasts, pubic and axillary hair, female genitalia phenotype and abdominal MSCT showing a solid mass with no signs of vagina and uterus, this patient was diagnosed with non seminoma testicular cancer with widespread disease and 46, XY karyotype (male).

Background: Cardiac myxoma is a primary tumor that grows intracardiac. Primary heart tumors are rare, and incidents range from 0.0017 to 0.03%. Around 75% of primary heart tumors are benign, and 50-80% are cardiac myxoma. Echocardiography is the gold standard in detecting tumor mass in the heart. With the development of diagnostic modalities and cardiac surgery techniques, cardiac myxoma can be detected and treated correctly and leading to a better prognosis.

Objective: To report a series of cases of cardiac myxoma resection carried out by the Cardiac Surgery team of Sanglah General Hospital Denpasar.

Cases: Data collected from 2016 to March 2019 cased based on Sanglah General Hospital Denpasar. Six cases were diagnosed based on the clinical, electrocardiographic, radiological, and histopathological basis.

Conclusion: This series of cases reported six intracardiac tumor patients who were found through echocardiographic examination and five patients had open heart surgery for tumor resection; also all histopathological examination results were following cardiac myxoma. There were no reported post-treatment complications and the patients were discharged hemodynamically stable after hospitalized for approximately one week. Until now, there have been no reports of recurrence in patients who have taken resection and patients have normal daily life activities.